 
Medical Equipment Buying Guide

MedWOW Ltd.

Smashwords edition, copyright 2012

_License notes:_ ALL RIGHTS RESERVED. This book contains material protected under International and Federal Copyright Laws and Treaties. Any unauthorized reprint or use of this material is prohibited. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without express written permission from the author / publisher.

# Preface

As with purchasing any other pre-owned product, there are certain factors that you must take into account prior to purchasing used medical equipment. However, the responsibility that accompanies used medical equipment purchases is far greater than with purchasing products in other industries, since the equipment that you buy will eventually be used to monitor, diagnose, and treat patients, and in many cases, even save lives.

It is therefore essential to be aware of the particular elements, specifications, and common malfunctions of each medical device prior to making your purchase.

After receiving many requests from buyers like you, and realizing the tremendous information void in the used medical equipment market; we at MedWOW decided to take advantage of our extensive knowledgebase and produce the ultimate, accessible tool to close this knowledge gap. The Medical Equipment Buying Guide is a first-of-its-kind, comprehensive database, the result of extensive research by MedWOW's affiliated team of medical equipment experts, doctors, technicians, and engineers from around the world.

Written as a guideline for device buyers involved in the purchasing of medical equipment, the guide provides: buying tips, recommended questions to ask the seller, and **Inspections Forms** for over 300 of the most common medical devices used in clinics, hospitals, labs, and other medical facilities. The tips emphasize the important features, specifications, and capabilities to consider for each device, so you will know exactly what to look for.

On each page you will find:

The Medical Equipment Buying Guide is updated frequently, and your input is important to us. Please send your comments, questions and feedback to: feedback@medwow.com

Sincerely, the MedWOW Team

# Table of Contents

A

Air Cleaner

Air-Purifying Respirator

Alternating Pressure Bed

Alternating Pressure Mattress

Ambulatory Infusion Pump

Amino Acid Analyzer

Anaerobic Chamber

Analytical Scale

Anesthesia Cart

Anesthesia Machine

Apheresis Machine

Apnea Alarm

Apnea Monitor

Argon Coagulator

Arthroscope

Arthroscopic Pump

Artificial Heart Valve

Aspiration Pump

Aspirator, Emergency

Aspirator, Surgical

Aspirator, Ultrasonic

Atomic Absorption

Audiometer

Audiometric Booth

Auditory Function Screening

Automated Coagulation Analyzer

Autopsy Table

B

Bed Alert System

Bed Head System

Bed, Pediatric

Beta / Gamma Counter

Bilirubinometer

Biochemistry Analyzer, Automated

Birthing Bed

Blood Bank Information System

Blood Centrifuge

Blood Gas Analyzer

Blood Gas Analyzer, POC

Blood Grouping System

Blood POC Analyzer

Blood Pressure Holter

Blood Pressure Monitor

Blood Warmer

Blood-Bank Refrigerator

Bone Densitometer, Dual Energy

Bone Densitometer, Single Energy

Bone Densitometer, Ultrasound

Brachytherapy System

Breast Biopsy System

Breathing Monitor

Bronchoscope

C

C-Arm

CAD Mammography

Cardiac Ablation System

Cardiac Catheterization Monitor

Cardiac Echo

Cardiac Electrophysiologic Monitor

Cardiac Output Computer

Cardiac Stress Test

Cardiac Video System

Cardiology Information System

Cataract Surgical Unit

Cath Lab

Cautery Unit

Cell Saver

Cell Washing Centrifuge

Centrifugal Laboratory Analyzer

Centrifuge

Centrifuge, Table Top

Chemistry Analyzer, Manual

Chest X-ray

Choledochoscope

Cine Camera

Cine Projector

CO2 Monitor

Cobalt Linear Accelerator

Colonoscope

Computer Assisted Surgery

Contrast Injector

Corneal Topography System

CPAP

CR System

Cryostat

Cryosurgical Unit

CT Phantom

CT Scanner

Cytological Centrifuge

Cytometer

D

Data Management System, Anesthesia

Daylight Film Processor

Densitometer, Laboratory, Scanning

Dental X-ray

Dental X-ray Scanner

Diathermy Unit, Physical Therapy

Digital Angiography

Digital Mammography Unit

Digital Radiography Upgrade Adapter

Duodenoscope

E

Ear Thermometer

ECG

ECG Holter

ECG Scanner

EEG Monitor

EEG Unit

Electroconvulsive Therapy Unit

Electrohydraulic Lithotripter

Electrolyte Analyzer

Electromagnetic Blood Flow Detector

Electron Microscope

Electrophoresis System

Electrosurgical Unit

ELISA Analyzer

Emergency Cart

EMG & Evoked Potential Response Unit

Endoscope Cleaner

Endoscope Light Source

ENG Unit

Ergometer

Esophageal Motility Analyzer

Ethylene Oxide Sterilizer

External Automated Defibrillator

External Defibrillator

External Pacemaker

Extracorporeal Lithotripter

F

Feeding Pump

Fetal Monitor

Film Duplicator

Film Processor

Film Processor, Cine

Film Scanner

G

Gamma Camera

Gamma Camera, Mobile

Gamma Knife

Gas Liquid Chromatograph

Gas Monitor, Atmospheric

Gastroscope

Glucose Monitor

Glycohemoglobin Analyzer

H

Halogenated Anesthetics Analyzer

Harmonic Scalpel

Heart-Lung Machine

Hematocrit Centrifuge

Hematology Analyzer

Hemodialysis Machine

Hospital Bed

Hospital Information System

HPLC

Hyperbaric Chamber

Hypothermia Unit

I

Immunoassay Analyzer, Enzyme

Implantable Defibrillator

Infant Incubator

Infant Scale

Infant Warmer

Information System, Radiology

Infusion Pump

Instrument Cart

Insufflator

Insulin Pump

Intermittent Compression Unit

Intra-Aortic Balloon Pump

Intracorporeal Lithotripter

Intraoral Video Camera

Intravascular Ultrasound (IVUS)

L

Laboratory Glucose Analyzer

Laboratory Hood

Laboratory Hood, Ductless

Laboratory Incubator

Laboratory Incubator, Thermocycling

Laboratory Information System

Laboratory Oven

Laboratory Safety Cabinet

Laboratory Scale

Laboratory Washer

Laboratory X-ray

Laparoscope

Laser - CO2

Laser - Diode

Laser - Excimer

Laser - Nd:YAG

Laser - YAG

Laser Blood Flow Detector

Laser Imager

Laser Lithotripter

Linear Accelerator

Lung Function Analyzer

M

Mammographic Phantom

Mammography Unit

Manual Wheelchair

Mass Spectrometer

Material Management Information System

Medical Gas Monitor

Medication Management System

Medicine Cart

Microbiological Culture Analyzer

Microcentrifuge

Microplate Washer

Microscope

Microscope, Operating

Microtome

Microtome Knife Sharpener

Mist Tent

Mobile X-ray

Motorized Wheelchair

Motorized X-ray View-box

MRI

MRI Phantom

Multi Image Camera

N

Nebulizer

Nephelometer

Nerve Locator

Nerve Stimulator

Neuromuscular Electrical Stimulator

Nuclear Computer

Nuclear Medicine Phantom

Nurse Call System

O

Obstetric Data Analyzer

Obstetrical Data Management System

Oculoplethysmograph

Operating Room Monitor

Operating Table

Ophthalmic Laser

Ophthalmic Retinal Laser

Optical Digitizer

Orthopedic Table

Osmometer

Oximeter

Oxygen Concentrator

Oxygen Monitor

Oxygenator

P

Pacemaker

PACS

Passive Motion Exerciser, Limbs

Pathology Information System

Patient Hoist

Patient Monitor

Patient Scale

Patient Warmer

Peritoneal Dialysis Unit

PET/CT

Phototherapy Unit

Physician Order Entry System

Plasma Sterilizer

Platelet Aggregation Analyzer

POC Coagulation Analyzer

Polysomnography

Portable ECG

Portal Imaging System

Powered Wheelchair

Practice Management System

Printer, Thermal

Prosthesis, Joint, Hip

Prosthesis, Joint, Knee

Pulmonary Stress Test

Pulse Oximeter

Pump IV

R

Rad Room, Analog

Rad Room, Digital

Rad/Fluoro Room, Flat Panel

Rad/Fluoro Room, Image Intensifier

Radiation Counter

Radiation Detector

Radioaerosol Delivery Kit

Radiographic Phantom

Radiographic Photospot Camera

Radioisotope Calibrator

Radiotherapy CT Simulator

Radiotherapy Phantom

Radiotherapy Planning System

Radiotherapy Simulator

Radiotherapy Verification System

Refractometer, Laboratory

S

Safety Eyewear

Scale, Chair

Sigmoidoscope

Silver Recovery Cartridge

Silver Recovery Unit

Single Channel ECG

Slide Stainers, Hematology

Slide Stainers, Histology

Slit Lamp

Spectrophotometer

Spirometer

Spot Film Device

Steam Sterilizer

Stereotactic Head Frame

Stereotactic Radiotherapy System

Sterilization Box

Stretcher

Suction Regulator

Supplies Boom

Surgical Helmet

Surgical Light

Surgical Power Tool

Surgical Smoke Evacuation System

Sweat Tester

Syringe Pump

T

Table Top Steam Sterilizer

Telemedicine System

Telemetry Monitor

Temperature Monitor

Thermometer

Thyroid Uptake System

Tissue Processor

Tomographic X-ray

Tourniquet

Training Manikin

Transport Ventilator

U

Ultracentrifuge

Ultrasonic Blood Flow Detector

Ultrasonic Cleaning System

Ultrasonic Fetal Monitor

Ultrasonic Lithotripter

Ultrasound and Electrical Stimulation Unit

Ultrasound Phantom

Ultrasound Therapy System

Ultrasound, Cardiac

Ultrasound, Diagnostic

Ultrasound, Portable

Ultraviolet Lamp

Urine Analyzer

Urine Analyzer, Automated

Urodynamic Measurement System

Urological X-ray

Uterine Aspirator

V

Ventilator, Intensive Care

Ventilator, Pediatric

Ventilator, Portable

Ventricular Assist Device

Video Conferencing Equipment

Video Endoscopy

Voice Recorder

W

Warming Cabinet

Washer / Disinfector

Water Purification System

Whirlpool / Bath

X

X-ray Generator

X-ray Subsystem

X-Ray Tube

Xenon System

# Portable particulate air filter devices

Portable particulate air filters designed for convenient relocation within a medical institution. May also be used to protect from toxic elements (biological, industrial, or radioactive) in emergency shelters.

Tips for Buying an Air Cleaner

1. Basic personnel should be able to operate and maintain high-efficiency mobile air filter cleaners, and therefore all air cleaners should be easy to set up and require minimal training.

2. For ease-of-use, it is recommended that all air cleaner dials and gauges be easily readable and understandable, and that the portable air filtration systems be easily cleaned and moved.

3. A filter change indicator should be available on the air cleaner unit.

4. Some air cleaners have light emitting diode indicators, while others may rely on a pressure gauge.

5. Monitoring air cleaner system performance in general can benefit from pressure gauges. Measuring changes in pressure can help discover a dirty filter or leaks in the seal of the high-efficiency particulate portable air filtration system.

6. An ultraviolet germicidal irradiation lamp is usually offered, though it is not recommended by ECRI. It is an unneeded added expense, which may pose a potential health hazard due to harmful effects on exposed skin and eyes and the creation of ozone

7. Users must periodically change high-efficiency particulate air cleaners and pre-filters. High-efficiency particulate air filtration systems should be changed every 1-2 years, and pre-filters - every 60-90 days, depending on conditions. To check for adequate airflow and possible leaks around the filters or in the housing, routine inspections must be performed.

8. Frequently changing the mobile air filters increases the ongoing costs and raises the risk to personnel performing such maintenance. However, when filters are not changed often enough, capture and filtration efficiency decreases, and the risk of tuberculosis transmission is increased.

9. Air cleaner filter removal, replacement methods and other required maintenance should all be easily performed.

10. The instructions for air cleaner routine maintenance and service should be clear and simple. Ongoing air cleaner maintenance is required to ensure safe and effective operation.

Questions for the Seller

Before you purchase your Air Cleaner, we recommend you ask the seller the following questions:

Configurations

Does it include recirculating?

Does it include an exhaust?

Is it mobile?

Is the filter disposable?

Is the filter reusable?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Mobile High-Efficiency-Filter Air Cleaners

# Tips and Guidelines for Buying an Air-Purifying Respirator

### Air-supplying and/or filtering respirators worn to protect from airborne particle/gas inhalation

Devices that filter environmental air for the protection of the wearer. Airborne particles and/or various gases are filtered to prevent wearer from contamination. Self-contained devices include air source, or devices that can be connected to an external source of compressed air.

Tips for Buying an Air-Purifying Respirator

1. Medical facilities should select a respirator that is comfortable and provides adequate protection for the duration of its use. The selected type must be compatible with any eye and face protection, corrective lenses, hearing protection, and protective head cover.

2. Medical facilities should consider the following factors when selecting respirators: the types of contaminants and their concentrations and relative toxicity, as well as compliance with applicable regulations; the physical circumstances of the user; the environmental conditions; the length of time protection is required, and the kinds of activity that need to be carried out while the device is being worn. Other important factors to be considered include: product availability, ease-of-use, reliability, and the service and technical assistance history of the manufacturer. When using the respirator, users should have a wide field of vision and the ability to communicate freely with others without having to remove the device.

3. Medical facilities are encouraged to select respirators that allow the use of cartridges, canisters, and filters from more than one manufacturer. These accessories have a significant replacement cost over the lifetime of a respirator.

4. Some face pieces can be used in both air purifying and air supplying devices. This is beneficial for facilities that require the use of both types of respirator.

5. Medical facilities should use the HR to determine the minimum APF needed. APF must be greater than or equal to the calculated HR.

6. A full-face elastomeric negative-pressure or chemical-resistant is recommended if a chemical can be absorbed through the skin and eyes.

7. Facilities should select a lightweight respirator with little or no breathing resistance, such as a PAPR, for conditions including strenuous work, long periods of use, or high heat and humidity. When a PAPR is required, it is recommended to test the flow rate of the unit using the protocol supplied by the manufacturer. A tight-fitting unit should provide a flow rate of 4 cfm, while a loose-fitting face piece, helmet, or hood should have airflow of at least 6 cfm.

8. In oxygen-deficient and/or IDLH atmospheres, or when the contaminant and/or concentration are unknown, it is recommended to use an atmosphere-supplying respirator. Facilities purchasing such a respirator should verify an airflow rate of 4-15 cfm for a tight fitting facepiece, while a loose-fitting facepiece, helmet, or hood should maintain an airflow rate of6-15 cfm. During use of an atmosphere-supplying respirator, users should ensure that the length and position of the air-line do not affect mobility or pose a tripping hazard.

9. Buying a replacement part - such as a gas cylinder, a battery, a facepiece, or a visor - may be significantly cheaper than replacing the entire respirator. Facilities should look for manufacturers who provide fit testing or any other support with the purchase of a respirator.

Questions for the Seller

Before you purchase your Air-Purifying Respirator, we recommend you ask the seller the following questions:

Air-Purifying APF

Half-face?

Full-face?

Atmosphere Supplying

Air line?

Pressure demand?

Does it include an air source?

Escape bottle?

Does it include a compressor?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Mobile High-Efficiency-Filter Air Cleaners

Pulmonary Resuscitators, Gas-Powered

# Tips and Guidelines for Buying an Alternating Pressure Bed

**Bed with electrically controlled inflatable air cushions**

Electrically controlled beds with inflatable fabric cushions using automated air compressor. Inflation and deflation intervals are controlled. Used for patients with problems that specifically concern skin such as burns, and for patients suffering circulatory problems to prevent ulcers and skin breakdown.

Tips for Buying an Alternating Pressure Bed

1. Alternating pressure beds should support a maximum weight of 159 kg, which should accommodate most patients. However, for bariatric patients, they should support 272 kg or more, depending on the individual patient.

2. Alternating pressure beds should have casters of at least 12 cm in diameter. To ensure that the air bed remains stationary when necessary, brakes are required.

3. For safety purposes, the air-fluidized beds should include CPR controls that, when triggered, provide a hard surface on which CPR can be performed.

4. Noise levels of operating these alternating pressure beds should not exceed 35 dBA, which is the typical sound level in a quiet hospital.

5. When the air bed or air-pressure mattress is not functioning within specified ranges, the system should alarm.

6. To allow constant functioning of the alternating pressure bed during transport and power outages, a battery backup or other feature should be available.

7. Specialty care beds are expensive and have limited application. Buyers should compare the cost of buying vs. leasing them when needed. Facilities should ask suppliers for training programs for clinical personnel who will be using these alternating pressure beds.

8. Specialty air-fluidized bed frames should have side rails that can be locked in the upright position. To prevent slippage, mattress overlays should have straps.

9. There is no compelling evidence that one support surface performed better than others, under all circumstances.

10. The alternating pressure bed's surface should match the patient, so when selecting a support surface for the alternating pressure bed, caregivers should consider the clinical condition of the patient, characteristics of the care setting, and characteristics of the support surface.

11. Low-air-loss and air-pressure mattress replacements and overlays are often cheaper than low-air-loss beds because they use a standard bed as the platform. However, facilities should know that mattress overlays and replacements may have a shorter life span than low-air-loss beds.

12. Mattresses and overlays eliminate the need to store two large bed frames because an existing bed frame is used. However, mattress overlays and mattress replacements may not be compatible with all hospital beds.

13. Buyers need to determine whether air-fluidized bed or low-air-loss therapies are necessary in the hospital. Home use of these therapies may be a better option.

14. Facilities should keep in mind that surfaces that can be laundered require cleaning and disinfecting, especially in the case of overlays and air-pressure mattress replacements. Specially treated surfaces may require chemical disinfection or other special handling.

Questions for the Seller

Before you purchase your Alternating Pressure Bed, we recommend you ask the seller the following questions:

Accessories

Does it include a compressor?

Does it include an input air filter?

Does it include a pressure gauge?

General Information

Are there any signs of rust?

Does the mattress of the bed keep the pressure?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Beds \- Air-Fluidized and Low Pressure

# Tips and Guidelines for Buying an Alternating Pressure Mattress

**Inflatable mattresses designed for pressure relief**

Controlled air loss inflatable mattresses designed for pressure relief, and to avoid skin maceration. Inflation and deflation are alternated in a controlled manner in order to both support patient and relieve pressure. May be used for both patients at risk, and for those who have already developed skin conditions which need management.

Tips for Buying an Alternating Pressure Mattress

1. These beds should support a maximum weight of 159 kg, which should accommodate most patients. However, for bariatric patients, they should support 272 kg or more, depending on the individual patient.

2. Beds should have casters of at least 12 cm in diameter. To ensure that the bed remains stationary when necessary, brakes are required.

3. For safety purposes, the beds should include CPR controls that, when triggered, provide a hard surface on which CPR can be performed.

4. Noise levels of operating these beds should not exceed 35 dBA, which is the typical sound level in a quiet hospital.

5. When the bed or mattress is not functioning within specified ranges, the system should alarm.

6. To allow constant functioning of the bed during transport and power outages, a battery backup or other feature should be available.

7. Specialty care beds are expensive and have limited application. Buyers should compare the cost of buying vs. leasing them when needed. Facilities should ask suppliers for training programs for clinical personnel who will be using these beds.

8. Specialty bed frames should have side rails that can be locked in the upright position. To prevent slippage, mattress overlays should have straps.

9. There is no compelling evidence that one support surface performed better than others, under all circumstances.

10. The surface should match the patient, so when selecting a support surface, caregivers should consider the clinical condition of the patient, characteristics of the care setting, and characteristics of the support surface.

11. Low-air-loss and alternating-pressure mattress replacements and overlays are often cheaper than low-air-loss beds because they use a standard bed as the platform. However, facilities should know that mattress overlays and replacements may have a shorter life span than low-air-loss beds.

12. Mattresses and overlays eliminate the need to store two large bed frames, because an existing bed frame is used. However, mattress overlays and mattress replacements may not be compatible with all hospital beds.

13. Buyers need to determine whether air-fluidized or low-air-loss therapies are necessary in the hospital. Home use of these therapies may be a better option.

14. Facilities should keep in mind that surfaces that can be laundered require cleaning and disinfecting, especially in the case of overlays and mattress replacements. Specially treated surfaces may require chemical disinfection or other special handling.

Questions for the Seller

Before you purchase your Alternating Pressure Mattress, we recommend you ask the seller the following questions:

Accessories

Does it include a compressor?

Does it include an input air filter?

Does it include a pressure gauge?

General Information

Is there any loss of pressure?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Beds \- Air-Fluidized and Low Pressure

# Tips and Guidelines for Buying an Ambulatory Infusion Pump

**Liquids infusion pumps for ambulatory use**

Infusion pumps with disposable syringe or bag reservoir, small enough to be worn by ambulatory patients. These pumps are used to deliver therapeutic drugs. They can deliver liquids intravenously, epidurally, or subcutaneously. The pumps have a battery powered mechanism (which includes peristaltic, syringe-driven, elastomeric, and osmotic mechanisms) for propelling the infusate, with a flow control mechanism, and a display for user prompts and alarm.

Tips for Buying an Ambulatory Infusion Pump

1. Ambulatory Infusion Pumps are used to deliver parenteral agents from syringes or collapsible bags. Their size should be small enough so that patients can comfortably wear or carry them. During sleep they should not disturb the patient, and during daily use they should not be conspicuous.

2. Medical facilities should carefully select patients to ensure successful insulin infusion therapy. The patients should be motivated and mature with a history of good compliance with insulin therapy.

3. All pumps should be able to run for at least 72 hours without draining the reservoir or depleting the batteries. Pumps should have a flow range of <=0.5 to >=100 mL/hr and maintain a flow accuracy of 5%. Ambulatory infusion pumps should be capable of operating in a continuous infusion mode, though it is desirable for pumps to offer additional modes. In a Peristaltic pump, a set of rollers pinches down on a length of flexible tubing, pushing fluid forward.

4. Luer-lock fittings or integral tubing, distal air filters, and air-in-line detectors may be used as protection methods against air embolism in ambulatory infusion, ambulatory insulin pumps and peristaltic infusion pumps that can deliver from an external reservoir.

5. Volumetric Infusion Pumps should detect an upstream occlusion and suspend infusion when downstream pressure is >=10 psi. The bolus volume released after an occlusion is cleared should be 0.5 mL.

6. Volumetric Infusion Pumps can be utilized for continuous or intermittent delivery through clinically acceptable routes of administration such as: intravenous (IV), intra-arterial (IA), subcutaneous, epidural, or irrigation of fluid spaces applications

7. Free flow protection should be part of any ambulatory and ambulatory infusion pump. Audible alarms should sound for all conditions that might interrupt infusion, including: high pressure/occlusion, low or depleted battery, reservoir-side obstruction, pump malfunction, air-in-line, and empty or near empty reservoir.

8. Ambulatory Infusion Pump alarm volumes should be adjustable with settings loud enough for critical alarms and soft enough for social situations. The pumps should have data logs that can store up to 200 events including: volume delivered, program settings, error codes, alarms, and rate.

9. Display screens in ambulatory insulin infusion pumps, volumetric infusion pumps and peristaltic infusion pumps should be clear and easy-to-read and should indicate: time, basal rate, bolus dose, and accumulated dose.

10. All ambulatory insulin infusion pumps offered should be able to deliver basal flows of 5 to 100 U/day with a resolution of 2 U/day. The recommended ones are those with a bolus dose range of <=0.5 to >=25 U/bolus with a resolution of <=0.5 units.

Questions for the Seller

Before you purchase your Ambulatory Infusion Pump, we recommend you ask the seller the following questions:

Controls

Is it programmable?

Alarms

Reservoir unlocked?

Temp alarm silence?

Air-in-line?

Infusion near end?

Reservoir empty?

System malfunction?

Low battery?

Transtelephonic

Status check?

Programming?

Data Log

Display?

Printout?

Time/date stamp?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying an Amino Acid Analyzer

**Analyzer of primary and secondary amino acid levels in physiologic fluids**

Primary and secondary amino acids in physiologic fluids are detected and measured by this automated analyzer, utilizing ion-exchange or reversed-phase high pressure liquid chromatography techniques. In clinical use it is also possible to monitor treatment of genetically produced disorders in protein metabolism.

Tips for Buying an Amino Acid Analyzer

1. Automated features should be a factor for facilities considering the purchase of amino acid analyzers. Some automatic features can best facilitate sample analysis, and automatic sample injection is preferred to manual injection.

2. It is best if the clinical laboratory HPLC amino acid analyzers can interface with a laboratory information system for easier collection and reporting diagnostic test results. Displaying results and other data should be available both on a monitor and as a printout.

3. Rustproof material should make up the sample amino acid analyzer's column, to ensure greater life expectancy. The column should generally be 10-150 cm long and 2-5 mm wide.

4. When using an amino acid analyzer, to ensure sufficient separation of the sample, the particle size should be as uniform as possible. The following pumps are generally acceptable: dual piston, single-piston, and syringe eluent pumps. Pumps should have a pressure limit of at least 2,000 psi.

5. Facilities need to assess the HPLC amino acid analyzers in their own clinical environment for a few weeks before making a purchase. On-site evaluation allows laboratories to test the qualities of the amino acid analyzer instrument, as reported by the manufacturer with the workload and sample types they normally handle.

6. Facilities should prefer amino acid analyzer devices that diminish the risk of infection involved with handling any body-fluid specimen, by minimizing operator contact with specimens.

7. Procedures may become more complex and sophisticated in certain situations when purchasing or upgrading an amino acid analyzer device. Implications may include additional staff training and certification, as well as changes in quality control, proficiency testing, quality assurance programs, and other laboratory procedures.

8. Computer interface capability is another significant factor to keep in mind. The effectiveness of the HPLC amino acid analyzer interface with the existing laboratory information system or the facility's central computer system, is extremely important for inputting test data and verifying testing accuracy.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical laboratory device

# Tips and Guidelines for Buying an Anaerobic Chamber

**Airtight chambers providing anaerobic environment for laboratory testing needs**

An anaerobic laboratory environment, for growth of specimen cultures, testing, and/or incubation in a strictly oxygen-free environment. These large airtight containers are of rigid stainless steel, flexible acrylic, or vinyl. Chamber is accessible using gloves sealed into the wall, in order to sustain anaerobic conditions. Isolation and culturing of anaerobes is facilitated by use of specialized equipment, which includes integral or modular antechamber airlock entry port with fittings for vacuum pump and gas connection, catalyst box, and oxygen monitor.

Tips for Buying an Anaerobic Chamber

1. In the system specification chart, users can find recommendations for minimum requirements for safe and effective anaerobic chambers or anaerobic glove boxes.

2. These devices are designed to provide a stable, oxygen-free environment for the growth and study of anaerobic microorganisms.

3. It is recommended that these anaerobic chamber devices contain an oxygen monitor, as well as a method for circulating anoxic gases through the chamber.

4. A preferred feature, though not a required one, is an integral vacuum pump.

5. For a safe and reliable anaerobic chamber system, vacuum gauges and pressure regulators are required features. Humidity removal is also necessary to prevent the growth of contaminants.

6. Facilities needing rapid culturing and identification of large volumes of microbial agents should consider purchasing anaerobic chambers or glove boxes.

7. The chamber and the antechamber must be large enough to allow for a reasonable-sized working space.

8. Some anaerobic box suppliers offer add-on work chambers, trays, and plate racks.

9. Automated antechambers are frequently used with manual antechambers to assist with the initial evacuation of the chamber. The automated antechambers lessen the time of entry into the chamber.

10. Anaerobic box models containing internal incubators or heating blocks diminish contamination, because they eliminate the need to move the specimens to external anaerobic environments.

# Tips and Guidelines for Buying an Analytical Scale

**Highly accurate analytical balances and scales, designed for laboratory and other accurate weighing use**

High precision analytic mechanical balances and scales, electronic or mechanical, with an accurate weighing range of up to 200g, and a readability of 0.01-1 mg. Used for clinical, pharmaceutical and toxicological laboratories. This balances produce data with superior reproducibility and stability.

Tips for Buying an Analytical Scale

1. Before making an analytical scale purchase, buyers need to consider the minimum load, the maximum weight needed for the scale to weigh, and the scale's reproducibility and linearity. A full list of applications and features contained in an analytical scale can be found in the model's user manual.

2. Typically, analytical electronic balance scales using AC power adapters are more accurate than battery-operated models.

3. Facilities should inquire whether the analytical scale weighs only in grams or whether it has multiple weighing units, such as the option for % weighing, piece counting, target weighing (weighing of packed products for fill weight), or supports density (underhook) weighing . Moisture balances can be used to determine loss on drying of samples.

4. Certain analytical scale models can transfer data to a computer or printer. Facilities should look into whether interface cables for PCs or printers, or communications software are included with the microanalytical balance.

5. The method of calibration that the microanalytical balance has is an important factor to consider. Internal calibration balances use an internal weight to automatically calibrate the instrument at a preset time, or due to changes in temperature, or upon request; while external analytical electronic calibration balances are manually calibrated by placing a calibration test weight on the balance pan.

# Tips and Guidelines for Buying an Anesthesia Cart

**Carts for use during anesthesia procedures with appropriate storage space**

Anesthetist carts equipped with all storage features necessary for organizing equipment, including instruments and drugs for use during anesthesia procedures. An easily cleaned work surface provides space to prepare all items that may be needed during anesthesia procedures.

Tips for Buying an Anesthesia Cart

1. Before making the purchase, buyers should examine the cart's stability, durability, maintenance requirements, and maneuverability.

2. If drugs are to be stored in the cart, then security features are an important factor for buyers.

3. These units should include several drawers and shelves for storage of drugs, disposables, and other instruments.

4. To help separate contents in a logical fashion, dividers should be available as an option.

5. To help control access to the cart, locks or seals should be standard.

6. To provide stability during transport, casters should be large enough and include at least 2 locks to prevent unwanted movement.

7. To help users tailor the carts to meet specific needs, manufacturers should offer a wide range of accessories.

8. Manufactures offer a wide range of features, including varying numbers and sizes of drawers, shelves, and compartments.

9. Facilities are encouraged to seek a group purchase discount because acquisition usually involves several carts.

10. Customized carts can be made according to the specific needs of an individual facility.

Questions for the Seller

Before you purchase your Anesthesia Cart, we recommend you ask the seller the following questions:

Drawers

Does it include Dividers?

Does it include Lock or seal?

Casters

Does it include Conductive casters?

Does it have brakes?

Accessories

Does it include an equipment hanger?

Does it include a tape dispenser?

Does it include an IV pole?

Does it include a waste container?

Does it include a sharps disposal?

Does it include a lockbox?

Does it include a drawer tray?

Does it include a record holder?

Does it include a supply basket?

Does it include a portable light?

Does it include an electrical outlet strip?

Does it include a long catheter container?

Does it have divided organizers?

Does it include a bag/bottle holder?

Does it include a drug transfer tray?

Does it include a spare gas tank carrier?

General Information

Does it include a top guardrail?

Does it include push handles?

Does it include shelves?

Does it include accessory clips/rail?

Is it all Stainless steel?

Are there any Plastic/composed materials parts?

# Tips and Guidelines for Buying an Anesthesia Machine

Ventilator device transferring specified gas mixtures to patient during anesthesia

An anesthesia unit including integral or optional ventilator. The ventilator uses positive pressure to transfer specified gas mixtures to the lungs. The gas mixture is produced by the anesthesia unit according to anesthetist's requirements.

Tips for Buying an Anesthesia Machine

1. Buyers can purchase customized modular systems assembled from standard components or they can put together their own modular systems.

2. Standardization of anesthesia equipment should be seriously considered. Facilities should choose systems that are compatible with the equipment already in their possession, reduce parts inventory, minimize the number of suppliers and service personnel, and diminish confusion.

3. A preferred unit is one that accepts compressed-air input, to allow delivery of air and N2O.

4. It shouldn't be possible to deliver air and N2O simultaneously. Anesthetic vapor concentration delivered to the common gas outlet should be accurate within 0.2% vapor concentration of agent, or 10% of the set value at any gas flow.

5. It is preferable that ventilation rate and PEEP values will be monitored.

6. The anesthesia unit should include a gas supply and control circuit, breathing and ventilation circuit, and a scavenging system.

7. The units must be able to measure O2 concentration, airway pressure, and either the volume of expired gas or the concentration of expired CO2.

8. Medium performance units can be upgraded to high performance units by adding stand-alone physiologic and/or gas monitors.

9. Pre-configured monitoring offers advantages such as convenience, electronically integrated displays and prioritized alarms.

10. If the facility already owns the monitors, it can use modular systems, which can be cheaper than preconfigured systems.

11. Pulse oximeters provide a spectrophotometer assessment of hemoglobin oxygenation by measuring light transmitted through a capillary bed, synchronized with the pulse.

12. Line-powered units should be equipped with a power loss alarm, while battery-powered units should have an automatic low-battery alarm. If line power is interrupted, the anesthesia unit should automatically switch to the internal battery.

Questions for the Seller

Before you purchase your Anesthesia Machine, we recommend you ask the seller the following questions:

General

What is the date of the last periodic maintenance?

Software installed? (Name + Version)

System Features

Is an airway pressure monitor included?

Is a high-pressure alarm included?

Is an expiratory vol/flow monitor included?

Is an O2 failsafe device included?

Is a hypoxic mixture failsafe device included?

Is an O2 concentration monitor included?

Is a disconnection/leak/obstruction alarm included?

Is an automatic ventilator included?

Does it have pediatric capability?

Does it have neonatal capability?

Is a suction system included?

General Information

Is a scavenging system included?

Is it FDA certified?

Is it CE certified?

Is a back-up battery included?

Is it a trolley mount unit?

Is it a wall mount unit?

Is it a rail mount unit?

Is it a ceiling suspended pendant mount unit?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following:

Anesthesia Unit Ventilators

Anesthesia Units

# Tips and Guidelines for Buying an Apheresis Machine

**Automated units for blood component collection, separation, and reinfusion**

Aphereses units separate blood components using centrifugation and/or filtration, depending on the specific blood product to be separated. These automated devices, complete with centrifugation chamber, filters, and safety detectors, can be used in blood donations and for therapeutic purposes. These units can be used to collect blood products (donors), separate substances for removal or exchange, or a combination of these procedures.

Tips for Buying an Apheresis Machine

1. These units must allow users to manually set the anticoagulant ratio and the replacement fluid balance.

2. Some of the preferred features include: auto calculation of the anticoagulant, replacement volume, and extra corporeal volume. These units should have monitors or alarms, and a battery backup.

3. Standardization of equipment is important for reducing costs for training, inspection and preventive maintenance.

4. Providing users with training for these units is extremely important.

Questions for the Seller

Before you purchase your Apheresis Machine, we recommend you ask the seller the following questions:

General Software installed? (Name + Version)

# Tips and Guidelines for Buying an Apnea Alarm

**Airway pressure alarms signaling ventilation failure**

Alarms used in critical and non-critical ventilators, breathing circuit connections, and anesthesia circuits. They warn of high or low pressure changes in airway circuits of mechanically ventilated patients, indicating ventilation failure.

Tips for Buying an Apnea Alarm

1. A remote alarm feature should be available.

2. The airway pressure alarm should have a continuous elevated pressure alarm. If operated on line power, it should also have a power failure alarm.

3. Battery-operated apnea alarm systems should have a low-battery indicator.

4. Both visual and audible alarms should be part of the breathing circuit monitor unit: there should be an apnea alarm delay of 5 to 100 seconds, a low-pressure alarm of 2 to 30 cm H2O, and a high-pressure alarm of 5 to 100 cm H2O.

5. Audible and visual airway pressure alarms should be clear and noticeable.

6. Apnea alarm systems offering volume adjustments should not allow users to turn the volume down, so it is not likely to be heard. When silencing an alarm, there must be a clear visual display. Turning off visual alarms should be impossible. Alarms should remain until the condition is corrected.

7. Users should protect the breathing circuit monitors in the appropriate way against loss of power.

Questions for the Seller

Before you purchase your Apnea Alarm, we recommend you ask the seller the following questions:

Pressure Alarm Parameters

Does it include PEEP, cm H2O?

Does it include I/E ratio?

Does it include CPAP, cm H2O?

Does it include continued elevated pressure, sec?

Does it include subatmosphere pressure?

Does it include respiratory rate?

Does it include MAP, cm H2O?

Pressure Alarm

Low Battery?

Low-Battery Test Function?

Line-Power Failure?

System Alarm Parameters

Low battery?

Low-battery test function?

Line-power failure?

Other (free text)

Alarm Types

Does it include an audible alarm?

Does it include a visual alarm?

# Tips and Guidelines for Buying an Apnea Monitor

Devices which detect breathing stops (apnea)

Apnea monitors measure respiration parameters in order to detect instances where breathing stops. Audio- visual alarms note changes in respiratory rate or air volume. Alarm activation parameters can be set by user. Respiration can be sensed mechanically or directly, using thermistors and carbon dioxide sensors.

Tips for Buying an Apnea Monitor

1. These devices are designed to detect the cessation of breathing in infants and adults who are at risk of respiratory failure and alert the parent or attendant in such a condition.

2. The apnea monitors should interpret clinical waveforms, accurately detect respiration, avoid misinterpreting inappropriate signals as breaths, and incorporate an adjustable bradycardia alarm setting.

3. Breath rates up to 90 bpm should be detected; the minimum bradycardia alarm limit should be 30 bpm. If a respiration rate meter is included, it should be accurate to within 10%.

4. Each detected breath should activate a light to indicate respiration. The visual indicator should be bright enough to be seen from across the room, in a well-lit room at varying angles.

5. Clear visible and/or audible alarms should be available. Users will not be able to turn the volume down on an audible alarm so it could not be heard. An audible alarm silence is acceptable, but the alarm must recur automatically if the condition is present, and a visual display should clearly indicate which alarm is silenced.

6. For safe and effective monitoring, several features are crucial. These include a built-in heart rate detector, a remote alarm, a power-loss alarm, and a battery-charge or AC-power indicator.

7. Other important features include: documentation capabilities, output jacks for additional devices, such as recorders and pulse oximeters. The maximum respiratory sensitivity should be 0.2 to 0.3 ohms. The sensitivity control should be automatic to prevent user error. When a manual control is provided, it should be graduated to facilitate adjusting and troubleshooting.

8. Home monitors include some important features to ensure that alarms are always seen and heard. Among these are visual alarms that can be seen from a variety of angles, loud and distinct audible alarms, and remote alarms.

9. To prevent tampering, some of these home units feature hidden alarm controls.

10. Manufacturers and facilities often offer home care services for setting up and maintaining the monitor. These should include educational support, 24-hour telephone hotlines, and replacement equipment in the event of a failure.

11. Suppliers must provide parents or caregivers with training in the use of a home monitor. To ensure that the monitor performs effectively, safety practices should be followed.

Questions for the Seller

Before you purchase your Apnea Monitor, we recommend you ask the seller the following questions:

Breath Detector

Does it include a visual alarm memory?

Does it include a ratemeter?

Does it have a disable indicator?

Does it have a malfunction alarm?

ECG Functions

Does it include a ratemeter?

Does it have a heart rate alarm?

Does it have memory?

Does it have a lead-fault alarm?

Does it have a malfunction alarm?

Memory

Is a computer required?

Is a computer included?

Is a battery backup included?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Apnea Monitors

# Tips and Guidelines for Buying an Argon Coagulator

**Electrosurgical units capable of delivering argon gas for coagulation purposes**

Argon gas delivery systems on mobile carts. These units can be connected to electrosurgical units that perform both monopolar and bipolar (without use of argon) functions. Gas and electric current can be delivered simultaneously. Argon enhanced electrosurgical units are used for coagulation of large surfaces, in a rapid and uniform manner.

Tips for Buying an Argon Coagulator

1. These units should come with a solid-state generator, with a typical frequency range of 0.3 to 1 MHz. They should have an isolated monopolar output, a hand switch, a footswitch, and bipolar output.

2. The output power for monopolar cutting should not exceed 300 W, and the open circuit voltage should not exceed 2,000 peak-to-peak volts. These values apply for general-purpose use.

3. For coagulation, the output and open circuit voltage should not exceed 120 W and 6,000 peak-to-peak volts, respectively. Bipolar mode should use no more than 50 W and 300 peak-to-peak volts.

4. Units should include the following: a return electrode contact quality monitor, independent output, visual and audible activation indicators, alarm capable of volumes higher than 45 dB at one meter, power-setting display, and convection or fan cooling system.

5. Argon-enhanced units should have a flow range of 0 to 10 L/min, a tank capacity of more than 1,200 L (42 ft3), and a low-pressure alarm. The device should include an alarm capable of volumes higher than 45 dB at one meter.

6. There are numerous designs of electrosurgical units, and facilities should base their comparisons among devices according to characteristics, usefulness of features, safety, and reliability - all of these affect clinical performance.

7. Users who are considering which argon-enhanced coagulation system to purchase, should determine whether they wish to expand their current electrosurgical system with a compatible argon module or get a new one with an integral argon unit.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Argon-Enhanced Coagulation Units

# Tips and Guidelines for Buying an Arthroscope

**Internal visual evaluation of joints, especially during surgery**

Arthroscopes have a rigid external casing, a working channel for catheters and other working devices, and a lighting system. They are inserted into a joint to allow visual evaluation, as well as biopsy and treatment of lesions if necessary. A television camera electronically transmits images for display and video recording.

Tips for Buying an Arthroscope

1. Standard arthroscope and articular cavity endsoscope units should permit connection to all common models of camera heads.

2. Video arthroscopes should be compatible not only with the facility's current video processors, but also with more recent processor models offered by the same manufacturer.

3. To ensure compatibility, facilities are encouraged to buy arthroscopes and accessories from the same manufacturer. Anthroscope accessories may include video monitors, specially designed leg or arm holders, scissors, and knives.

4. To permit connection to all common light source designs, manufacturers should offer a wide variety of light guides.

5. Facilities need to consider the reprocessing methods approved by the rigid endoscope manufacture. The more options, the better the facility may effectively manage its inventory.

6. Facilities should prefer scopes that are also compatible with autoclaving and other fast sterilization methods.

7. Facilities are strongly encouraged to use the arthroscopes that they wish to purchase on a trial basis; this will allow surgeons to directly compare perceived performance. While performing these trials, facilities should standardize all other equipment, including monitors, video processors, light sources and guides, and signal format, to ensure that the articular cavity endsoscope's performance is the only variable.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Endoscopes

# Tips and Guidelines for Buying an Arthroscopic Pump

**Irrigation/distention systems for use in endoscopic orthopedic procedures**

A system used during endoscopic orthopedic procedures to expand the joint, improving visibility and enlarging the surgical field. The irrigation/distention system pumps solution into the joint, keeping it filled with pressurized distention solution. The solution may be held in place by a manual stopcock, or an automated pinch valve.

Tips for Buying an Arthroscopic Pump

1. When choosing an arthroscopic pump, the main selection factor should be the ability of the device to adequately keep pressures at appropriate levels.

2. The surgeon should be the one to choose the arthroscopic pump type. Surgeons need to decide between the greater control provided by volumetric pumps, which provide greater control, and gravity-assisted units, which provide effective air-infusion protection.

3. Facilities should also consider the cost and the efficiency issues involved. They should avoid arthroscopic irrigation distention systems that offer more sophistication than is required by the types of procedures being performed.

4. An arthroscopic pump that can cause or allow a joint to become over-pressured, can put patients at a higher risk for extravasations, which are the most common significant complications linked to use of these devices.

5. The arthroscopic pump should monitor actual joint pressures and maintain these within 10 mm Hg or within 20% of the set pressure (whichever is greater).

6. The arthroscopic pump will not be able to generate sustained pressures that are greater than 180 mm Hg and relieve pressures greater than 250 mm Hg.

7. For safety purposes, arthroscopic pumps should include gauges that clearly and accurately display joint pressure, as well as a means of preventing the infusion of air.

8. Clear audible and visual alarms should inform the user of an over pressurization.

9. There are some benefits to arthroscopic irrigation systems that can control solution outflow from the joint. They allow the surgeon to adjust pressure and they flow more precisely than those that control only inflow.

10. Some arthroscopic irrigation distention systems allow continuous flow through the joint. This usually consumes more distention solution during the procedure and requires changing solution bags more frequently. Also the added tubing can complicate the setup, use, and maintenance of such a system.

11. Some arthroscopic irrigation systems can pump the air trapped in irrigation solution bags into the joint, causing bubbles large enough to interfere with visibility.

12. Peristaltic-driven systems are better at pressure maintenance and are preferable to impellers.

Questions for the Seller

Before you purchase your Arthroscopic Pump, we recommend you ask the seller the following questions:

General Information

Does it display joint pressure?

Does it have a joint pressure gauge?

Is it IV pole mountable?

Does it have remote control?

Does it have a footswitch?

Overpressure Protection

What is the alarm type?

Does it include electronic venting?

# Tips and Guidelines for Buying an Artificial Heart Valve

**Artificial replacement for cardiac valve**

These prostheses are available in different materials and configurations (caged ball, tilting disk, and leaflet), depending on type of valve to be replaced, and patient characteristics.

Tips for Buying an Artificial Heart Valve

1. Artificial heart valves replace aortic and mitral valves. They are designed to provide smooth, even blood flow through the heart chambers. The artificial cardiac valve prostheses should be able to diminish restriction or disturbances.

2. Each component should be supplied in the right number of sizes, depending on the prosthesis.

3. A guide to surgery and prostheses implantation should accompany all artificial heart valve devices, along with their own instrumentation for all cardiac prosthetic surgical applications.

4. It is known that there is no design that fits every surgical procedure. There is a large selection of cardiac prostheses for that reason.

5. Selecting the right artificial heart valve (which is done by the surgeon) is usually done based on the surgical procedure and the patient's condition. The surgeon needs to determine which valve is to be used - mechanical or bioprosthetic one.

6. Mechanical valves often have larger orifice areas than bioprosthetic valves with the same prosthetic annulus size. Therefore, they are usually selected for patients with small valve annulus sizes.

7. Another important factor is the cavity size of the chamber. Usually, a small downstream cavity in either the aortic or mitral position needs a low-profile mechanical valve.

8. Tilting disk cardiac valves have a single circular occluder controlled by a metal strut. Leaflet cardiac valves have the advantage of having a greater effective opening area (2.4-3.2 square cm c.f. 1.5-2.1 for the single-leaflet valves). Also, they are the least thrombogenic of the artificial valves.

9. Current mechanical heart valves are very reliable and allow the patient to live a normal life. Most artificial heart valves last for at least 20 to 30 years.

10. Before implantation of these devices, precautionary measures should be taken to ensure their sterility. Resterilization guidelines should be provided by the manufacturers, in case prostheses encounter non-sterile conditions.

Questions for the Seller

Before you purchase your Artificial Heart Valve, we recommend you ask the seller the following questions:

Applications

Aortic?

Mitral?

Adult?

Pediatric?

Is it MRI compatible?

# Tips and Guidelines for Buying an Aspiration Pump

**Suction of liquid or gas build-up from pleural space**

Portable device for suction removal of gas and liquid build-up from pleural space. These self-contained units include high/low volume pump, multiple container and water seal collection system, and pressure gauge. Two separate chest tubes inserted surgically, remove liquids and gases into drainage tubes after thoracic surgery, pneumothoracic wounds, chest trauma, etc.

Tips for Buying an Aspiration Pump

1. The preferred aspiration pump models are those that limit vacuum to a predetermined rate and have an appropriate safety cutoff pressure, to avoid hazardous excessive vacuum.

2. Adjustable suction should be provided on pleural drainage pumps with a maximum setting of 50 cm H2O, and a maximum flow rate of >20 L/min measured at open flow. This should prevail over high negative intrapleural pressures in some patients.

3. Aspiration pumps with no control system that limits suction to 200 cm H2O must be used with a disposable chest drainage unit, which provides this safety feature.

4. When using reusable canisters for collection with a pleural drainage pump, facilities should consider their price and availability, as well as the cost of sterilization.

5. Aspiration pump units with a collection system must have overflow protection or some other method to prevent contamination.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Aspirators

# Tips and Guidelines for Buying an Aspirator, Emergency

**Secretion removal from patient's air passages to allow ventilation**

Portable, battery operated or manual units providing oropharyngeal or tracheal suctioning for secretion removal from patient air passages. This ensures effective spontaneous or mechanical ventilation where a central system isn't available, or in emergency situations.

Tips for Buying an Aspirator, Emergency

1. Emergency aspirator units are commonly used outside clinic or hospital settings, and must be easy-to-use and transport.

2. The vacuum level of the emergency aspirator should reach 300 mm Hg in 4 sec or less. Emergency aspiration could require moderate to high vacuum and flow rates. It should be able to provide suction of at least 400 mm Hg at maximum settings to remove tenacious secretions, while allowing lower vacuum levels as well, to prevent tissue damage.

3. The vacuum gauges and vacuum limiting devices help to ensure appropriate and safe suction levels, and they should be read easily and accurately.

4. All the collection canisters, disposable or reusable, should hold at least 1 L of liquid to prevent overflow of aspirated material that is infectious and might clog the battery-powered emergency aspirator.

5. Emergency Aspirators should weigh less than 6 kg. Units that are used for crash carts only, can be heavier.

6. The emergency aspirator unit should perform at maximum vacuum for at least 30 minutes when batteries are fully charged. It should provide audible and visual warnings when depletion is close.

7. To prevent loss of the charger, integral battery chargers are preferred to separate battery-powered emergency aspirator units.

8. All the controls and connections must be clearly marked.

9. For emergency aspirator units used for pharyngeal suctioning only, vacuum regulators or gauges are optional. A model without these options is cheaper and simpler to operate. However, if a vacuum gauge is indeed included, it should be installed properly to prevent falsely low readings that will cause higher than intended vacuum levels.

10. When measuring vacuum levels, the end of the tubing must be occluded. This should be kept in the mind of all users using relatively high vacuum levels for tracheal suctioning, because excessive vacuum levels can cause trauma.

11. Using the emergency aspirator should be easy and intuitive, including: turning it on, adjusting and operating it, setting it to maximum vacuum for pharyngeal suctioning, emptying, exchanging or disposing canisters and continuing to operate the pump without significant risk of contaminating the instrument or the operator.

12. Installed filters supplied with the canisters will differ with different emergency aspirator models; some may severely limit airflow rates.

Questions for the Seller

Before you purchase your Aspirator, Emergency, we recommend you ask the seller the following questions:

General

What is the date of the last periodic maintenance?

Oropharyngeal use

Does it have prehospital (EMS) capabilities?

Does it have intrahospital (crash carts) capabilities?

Does it include a battery?

Tracheal use

Does it have prehospital (EMS) capabilities ?

Does it have intrahospital (crash carts) capabilities ?

Does it include a battery?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Aspirators

# Tips and Guidelines for Buying an Aspirator, Surgical

Suction of blood, fluid, and other material during surgery

Deep vacuum suction for removal of large quantities of blood, fluid, and other material during surgery.

Tips for Buying an Aspirator, Surgical

1. Surgical aspirator units should provide a moderate to high vacuum and flow rates and suction of at least 500 mm Hg at maximum settings to remove tenacious materials.

2. Some surgical aspirator units have vacuum limits of more than 500 mm Hg and free airflow capabilities of 25 to 40 L/min.

3. Lower vacuum levels should also be allowed to prevent tissue damage.

4. All the line-powered surgical aspirator controls and connections should be clearly marked.

5. In order to prevent the risk of contaminating the surgical aspirator instrument or the operator, it must be simple and easy to empty or exchange reusable canisters.

6. Discarding disposable canisters and their contents should be easy as well, with no risk of spills or contamination.

7. Buyers should consider the price of disposables vs. the cost, time, and infection risks associated with disposing infectious waste and disinfecting reusables.

8. There are surgical aspirator units with disposable containers that can use containers from different manufacturers. This may be easier to order and will provide a wider suppliers' choice.

9. To allow for better communication among clinicians, the surgical aspirator unit should not be noisy.

10. The overflow of aspirated material might clog the line-powered surgical aspirator and should be avoided.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Aspirators

# Tips and Guidelines for Buying an Aspirator, Ultrasonic

**Ultrasonic irrigation/suction system for soft tissue removal from body**

Suction devices for surgical procedures involving tumors, cysts, or lesions that require cutting, coagulating, and removal of soft tissue or high water content growths from the body. These high-frequency, mechanical ultrasonic vibration with irrigation/suction systems are also used for surgical procedures where use of blades may cause damage to surrounding tissue.

Tips for Buying an Aspirator, Ultrasonic

1. These units should be capable of operating at a maximum vacuum of 700 mm Hg.

2. The unit should have irrigation, aspiration, and ultrasound controls. It should display power, vacuum, irrigation level, application time and error code messages. The footswitch control should possess both present and linear modes.

3. Some systems incorporate a standard suction canister for holding aspirated tissue, and are self-contained for that matter. Others may require hospital vacuum and suction systems.

4. Manual tuning is needed in some systems before the tip is used. Once the tip encounters a change in mass, the unit may no longer be tuned to resonance.

5. Other systems have a continuous auto-tuning function and may or may not have a pre-use tuning button.

6. An ultrasonic generator can constantly change its output to match the changing resonance of the hand piece with auto tuning. This eliminates the need for manual tuning and increases the efficiency of the ultrasound circuit and tip.

7. Buyers should make sure that service support is readily available, replacement of parts is easily identified, and that parts can be quickly obtained from the supplier.

8. Facilities should perform clinical evaluations before a purchase decision is made, to ensure that the surgeon is comfortable with the system. The effectiveness of each system depends on the surgeon's comfort level and familiarity with the system.

Questions for the Seller

Before you purchase your Aspirator, Ultrasonic, we recommend you ask the seller the following questions:

General

Is it mobile?

Is it suitable for OR use?

Fluidic System

Does it include an irrigation system?

Handpiece Configurations

Straight handpiece?

Angled handpiece?

Straight extended handpiece?

Angled extended handpiece?

Footswitch Control

Does it have a Preset mode?

Does it have a Linear mode?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Aspirators, Ultrasonic

# Tips and Guidelines for Buying an Atomic Absorption

**Atomic absorption spectrophotometers**

Atomic absorption spectrophotometers are used to identify and quantify electrolytes, trace elements, and metals used in therapy. They are also used to monitor exposure to various pollutants. The analysis of body fluids and tissues is based on the absorption of radiation by free atoms. This is achieved by exposing the sample to thermal energy, which separates chemical components into free atoms.

Tips for Buying an Atomic Absorption

1. In order to minimize background noise, atomic absorption equipment should be dual channel. They should have at least two lamps: one for use and the other on the warm-up setting, to minimize down time for lamp replacement.

2. These atomic absorption analyzers should have at least a flame photometer device for sample ionization. A graphite furnace is generally more sensitive and eliminates the need for a flame.

3. Purchasing atomic absorption equipment with both capabilities is recommended for facilities needing extra flexibility.

4. Atomic absorption equipment using a flame photometer should have gas controls and at least a flashback arrestor onboard to protect against explosion. Automatic ignition is recommended over manual ignition because it is more user friendly and also adds safety by starting the flame automatically when necessary.

5. A background correct feature is needed to reduce the occurrence of erroneous results due to interference from contaminants in the sample, variations in the flame, or other sources of background noise.

6. All atomic absorption equipment should store results in memory and have a computer interface to transmit results to the laboratory information system.

7. Atomic absorption equipment should produce hard copies of results using a printer. Readout with graphic capabilities can display results in tables and graphs. It is recommended for some advanced atomic absorption analyzer applications.

8. Auto sampling and auto dilution functions are also desirable because they free up technician time and ensure consistent sampling techniques.

9. When facilities are considering whether to use this technology and which atomic absorption analyzer system to buy, they should look into: the relative accuracy of different AAS methodologies, the demand for a particular test, the number of tests ordered, and the cost of the atomic absorption equipment system.

10. Facilities should determine the complexity of the atomic absorption equipment system and the accessories needed based on: the number and types of elements to be determined, the number of samples to be tested, the experience of the operators, and the estimated amount of equipment use.

11. Before purchasing the atomic absorption analyzer, facilities should evaluate physical requirements, such as: the size of the working area and the types and number of exhaust vents, gas tanks, and connections offered by the manufacturer.

12. Tests needing little or no training do not require elaborate QC, and are less likely to produce inaccurate results - for example: the non-automated dipstick urinalysis.

13. Most clinical laboratory tests, including automated urine, blood, and chemistry analyses, belong to the moderate complexity category. In this group the tests and atomic absorption analyzers require a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process.

14. This highly complex category encompasses procedures requiring a high degree of operator preparation, calibration, intervention, and analysis, such as: clinical cytogenics and histopathology applications.

15. Computer interface capabilities in an atomic absorption analyzer are very important. An effective interface with the existing LIS or the central computing system can be useful for inputting test data, verifying testing accuracy, and maintaining QC, calibration, proficiency testing, and patient files.

16. The suppliers offer facilities service contracts or service on a time-and-materials basis. A third-party organization may also offer such services. Facilities should carefully consider the decision to purchase an atomic absorption analyzer service contract, which can be justified for several reasons.

17. Usually, service contract customers get routine software updates, which enhance the atomic absorption equipment system's performance, at no charge. Software updates are often cumulative, so previous software revisions may be required in order to install and operate a new performance feature.

18. Facilities buying a service contract also ensure that preventive maintenance is performed at regular intervals to eliminate the possibility of unexpected maintenance costs. Many suppliers do not extend system performance and uptime guarantees beyond the length of the warranty, unless the atomic absorption analyzer system is covered by a service contract.

19. Before deciding on a specific configuration, facilities should consider the number and types of tests performed to avoid paying for unnecessary analysis packages and assaying features.

20. Facilities are strongly encouraged to standardize their atomic absorption equipment as there are numerous benefits to doing so including: it simplifies staff training and servicing and parts acquisition, and provides greater bargaining leverage when negotiating new atomic absorption analyzer equipment purchases and service contract costs.

Questions for the Seller

Before you purchase your Atomic Absorption, we recommend you ask the seller the following questions:

General

Please specify types of the included lamps

General Information

What is the Beam Type?

When was the optical system last calibrated?

Are there any signs of rust?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Audiometer

**Testing device measuring hearing impairment by evaluating hearing threshold**

A testing device with tone generators, amplifiers and sound-level monitors, to assess and diagnose hearing and other otological disorders. Hearing impairment is measured using pure test tones and/or signals.

Tips for Buying an Audiometer

1. Facilities that purchase units with greater capability may end up with more difficult operation and/or higher costs. Therefore, buyers should prefer units that are easy to operate, particularly in screening programs where operators may have less training and experience.

2. Speech eudiometry is not a recommended feature in audiometers used for screening purposes. For this purpose, pure-tone audiometers, at minimum, should be capable of testing at frequencies of 500 to 6,000 Hz.

3. Standard clinical eudiometry testing is performed over a range of 250 to 8,000 Hz. OSHA does not require bone-conduction testing for annual or baseline audiograms. However, it can be useful in determining diagnosis in a clinical setting.

4. The frequency accuracy should be within 3% for most testing; for some clinical applications, accuracy within 1% is recommended.

5. For clinical testing and diagnosis the audiometers should be at least type 3 as specified by ANSI S2.6-1996. Type 1 may be required under certain conditions and are recommended for clinical environments where a full range of testing applications must be met.

6. Speech-testing capabilities may also be needed for clinical audiometers. For this purpose, the audiometer should be designated at least type C. Standardized specially prepared speech material from tape or CD input is preferred to microphone input, to ensure consistent testing and results among subjects.

7. For both clinical and screening applications, it is recommended that half-octave or octave steps are available. Testing at half-octave frequencies is often used to verify that the subject's hearing level does not change significantly within an octave.

8. Facilities should consider the earphones for any type of audiometric testing. Those used to deliver the signal to the subject should include one earphone for each ear.

9. Insert earphones are preferred because they are generally lighter and provide a better fit than supra-aural earphones. They offer greater protection against the signal being heard by the opposite ear.

10. Free-field testing is not normally recommended for screening purposes. It may be a good alternative to earphones when testing small children who may not tolerate earphones. It is also used in certain hearing-aid assessments.

11. To ensure that one ear is not compensating for the other during the test, masking noise should be available for clinical testing.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Audiometers

# Tips and Guidelines for Buying an Audiometric Booth

**Acoustically controlled testing booth for clinical use**

An insulated testing booth with outer solid panels, and inner perforated panels. This acoustically controlled ,enclosed test area is suitable for clinical audiometry and research. Double wall booths provide additional reduction of noise interference in the testing environment. Single wall booths are designed for sound absorbing mostly in pure-tone testing.

Tips for Buying an Audiometric Booth

1. Facilities should consider industry standards for noise levels to determine whether a booth is needed.

2. The booth is required if the test area is too noisy. In some cases, testing may be performed without a booth.

3. To determine the required amount of sound reduction, users need to evaluate the noise level in the area, including the noisiest periods. Other individual circumstances may be considered as well.

4. The booth's size depends on the available space. However, it should comfortably accommodate the subject, the examiner, and all the necessary equipment.

5. Booths with two rooms need a window between the rooms.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Audiometric Booths

# Tips and Guidelines for Buying an Auditory Function Screening

**Device for detection of hearing impairment in newborns**

A computerized testing device to assess hearing responses in newborns, using an audio frequency generator, earphones, sensors, and cables, with display and printer. Otoacoustic emissions from the ear to the brainstem and auditory brainstem response can be detected.

Tips for Buying an Auditory Function Screening

1. Facilities should mainly consider these three factors before making a purchase: configuration, referral rate, and whether the system is automated. Other considerations may include the following: patient load, relative costs of the different methods, type of acquisition, duration of contract, patient volume, service coverage, price increases during contract, and the availability of backup equipment and consumable parts. Facilities implementing a newborn hearing screening program should use either ABR testing or a combination of the OAE and ABR methods. ABR testing alone is effective for all applications.

2. An alternative strategy, to minimize the cost of testing a large number of infants, may be to use OAE/ABR. The cost of disposables for OAE testing is less expensive, but the referral rate is significantly higher. This method may be beneficial for hospitals with a high birth rate. The initial screening with OAE followed by ABR for infants failing the initial screen may reduce costs while still providing a low false-referral rate.

3. This approach has the shortcoming of additional time delay. While ABR can be performed earlier, OAE should be conducted at least six hours after birth, so if a second test is required, it must be conducted afterward.

4. There may not be time to complete the process with infants leaving hospitals earlier. Failure to complete the protocol is a concern for facilities and for personnel who are responsible for ensuring follow-up.

5. Immediately after a failed OAE test, it is recommended to perform the ABR test. ABR testing alone may be preferred in situations where infants may not complete an OAE/OAE or OAE/ABR protocol before discharge.

6. A facility that is screening within the first six hours of birth should prefer ABR alone. This is also the preferred method in neonatal intensive care units because of its higher sensitivity to neurological hearing losses. OAE screening may give higher false referral rates associated with ear infections, which are common in the NICU and will eventually clear up.

7. Facilities with only a well-baby nursery should base their decision on cost analysis using actual costs. In most cases, the difference in the cost of disposables will dominate the analysis. Capital equipment costs and cost of personnel time should be considered, because they may influence which choice is least expensive if the costs of disposables are similar.

8. Facilities are encouraged to use automated newborn hearing screeners over manual units. Automated technology eliminates the need for a trained audiologist to perform the testing. Nurses or volunteers can perform it to save money on personnel costs.

9. Buyers should select the type of technology based on the birth census for a facility, screening provider, training of screening personnel, end point being measured, and the availability of an audiologist.

10. ABR may be more expensive and involve longer test times than OAE, depending on patient load. OAE, which can be less expensive and may have a shorter test time, is increasingly becoming the initial screening method, though it can often result in a higher referral rate due to debris in the ear canal. OAE/ABR combination screening devices are available.

11. Some audiologists prefer either the ABR or OAE method exclusively and do not wish to use dual or combination testing devices, although they have been found to decrease false positives and referral rates, which can lower hospital costs.

Questions for the Seller

Before you purchase your Auditory Function Screening, we recommend you ask the seller the following questions:

Alarms

Visual?

Audible?

Screening Method

Right only?

Left only?

Alternating?

Simultaneous?

Power

Line Power, VAC?

Is it battery operational?

Is the battery rechargeable?

Does it have a low-battery alarm?

# Tips and Guidelines for Buying an Automated Coagulation Analyzer

**Semi or fully automated plasma sample analyzers**

Coagulation testing of plasma samples detect s abnormalities of blood clotting components. Analyzers perform tests for compilation of coagulation profiles, to monitor and follow coagulation disease states. Coagulation testing monitors drug effects, and effects of blood component therapy. Semi or fully automated instruments vary in the number of reagents, specimens, batch tests, and printed results they provide.

Tips for Buying an Automated Coagulation Analyzer

1. When selecting an automated coagulation analyzer or any analytic clinical instrument, facilities should rely mainly on the assays available on the instrument, the throughput capacity of the system, and the availability of models to meet different volume and testing needs within the facility.

2. Facilities should select the type of automated coagulation analyzer based on the types of tests to be performed, the number of tests, and the laboratory facilities available.

3. Stat capability, computer interfacing, and bar coding must be available for automated coagulation analyzers. Preferred features include primary and closed tube sampling, and printers are optional.

4. Semi-automated coagulation analyzers should have a printer - bar coding is a preferred feature.

5. Required specifications indicate the minimum necessary for the automated coagulation analyzer to perform its indicated function, while preferred specifications enhance either test operations or ease-of-use, and therefore its effectiveness.

6. Optional specifications do not affect the thrombo analyzer's performance but may provide wider applications of use by offering greater testing options or minimizing user interaction, allowing the automated coagulation analyzer to be operated under a wide variety of circumstances.

7. Both automated and semi-automated coagulation analyzers have only a few reagent preparation and sample handling steps.

8. Larger, more automated coagulation analyzer instruments with a comprehensive test menu and high throughputs are used in central laboratories. Though these can also provide stat testing, they are most frequently used for determining diagnosis, follow-up care, and the effectiveness of treatment.

9. Smaller whole blood coagulometer systems that are less automated, with lower throughput and a more limited test menu can be used in midsize or small laboratories or those with specialized testing requirements. However, when used in specialized areas, they should be capable of testing for certain key analytes - the presence or absence of which, indicates a life-threatening situation and calls for immediate action.

10. Small automated coagulation analyzers for specialty tests and/or stats may be beneficial in laboratories with high volumes of routine testing.

11. Laboratories performing urgent or specialty testing might consider thrombo analyzer instruments that can assay whole blood.

12. Buyers should carefully examine automated coagulation analyzer test menus to ensure that the tests clinically meet their needs.

13. Automated coagulation analyzers are suitable for laboratories with heavy workloads, because they can perform tests simultaneously, which may increase throughput. They have a wide range of data management programs, including quality control, data analysis, and patient test storage.

14. Laboratories whose workloads allow specimens to be individually tested can use semi-automated coagulation analyzers, although some of these devices can test two or four specimens at a time.

Questions for the Seller

Before you purchase your Automated Coagulation Analyzer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Service & Maintenance

When was it last calibrated?

Was it calibrated by a certified lab?

Does it calculate INR values?

Does it include a printer ?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Autopsy Table

**Tables designed for autopsy or dissection (pathology tables)**

Smooth, stainless steel tables with a specially designed working surface and drainage system. They are used for autopsies and dissections.

Tips for Buying an Autopsy Table

1. To prevent bacterial growth, these units should have smooth surfaces and edges and finished welds to prevent bacterial growth.

2. In tables with no plumbing, the water supply should be drawn from a separate tank, or the tubing connection to the water supply should have a vacuum breaker. This is important for preventing contamination of the facility's water supply.

3. Ground-fault circuit interrupters are recommended for all electrical outlets in the working area in order to minimize the risk of electric shock presented by the large grounded surfaces and the quantity of fluids. These will shut the power off when a fault current flowing to ground exceeds the preset limits.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Tables, Autopsy-Dissecting

# Tips and Guidelines for Buying a Bed Alert System

**Audio/visual warning system tracking movements of unattended patients**

A device based on sensor-activated alarms to track movements of unattended patients. A control unit monitors patient's location, in some cases directly connected to nurse stations with a remote alarm. This device is used to avoid falls by patients with impaired mobility or who need support assistance, and to keep mentally disabled patients from wandering.

Tips for Buying a Bed Alert System

1. Sensor configuration is the main difference between bed alert system alarms. Facilities should consider which sensor configuration is best for their patients based on: how mobile patients are, as well as their mental status and level of cooperation.

2. Facilities should also consider differences in remote occupancy alarm capability. For example, a small, 15-bed rehabilitation unit would probably only need a bed alert system with audible alarms that sound in the patient rooms. On the other hand, a 60-bed long-term care unit may require additional wandering prevention system alarms that can be connected to the nurse call system or linked to wireless consoles in the hallways to ensure alarms are heard.

3. Some bed alert system alarms have alarm delay, which enables staff to more effectively use anti-wandering system alarms on highly restless patients by reducing the number of nuisance alarms.

4. Facilities are encouraged not to get bed alarm systems without hold or mute mode, because caregivers may forget to turn the occupancy alarm back on after attending to the patient.

5. Facilities may find remote bed alert system alarms useful if caregivers can disable audible alarms at the bedside to avoid disturbing other patients in the room.

6. Bed alert systems in general can be interchanged between beds, chairs, and wheelchairs.

7. Some wandering prevention systems can interface with nurse call, paging, and fire systems. However, this increases the price of the bed alert system.

8. Risk management procedures should be established in facilities for determining alarm parameters, identifying at-risk patients, and dealing with fall victims.

9. Facilities that need to monitor multiple patients with one wandering prevention system control unit or restless patients who require additional sensors, should favor the use of multiple pressure-sensitive sensors or weight transducers used simultaneously with a Y-connector attached to a single control bed alert system unit.

10. The pressure-sensitive, anti-wandering system sensors can either be reusable or disposable. Facilities requiring frequent patient occupancy monitoring will find reusable pads ideal.

11. Reusable bed alert system pads are sealed to resist damage from liquids and have an expected lifetime of 6-12 months. Disposable pads are sealed to resist damage from fluids and to control infections, and have a typical expected lifetime of 30, 60, or 90 days.

12. Disposable or rechargeable batteries are most appropriate for portable bed alert system units. Facilities should consider the type, operating time, and recharging time of the batteries, and then compare these to the patient occupancy tracking requirements.

13. Facilities that use occupancy alarms infrequently will find battery-operated wandering prevention system models ideal. Facilities requiring frequent occupancy tracking will find line-powered wandering prevention system models to be beneficial, to reduce the costs of replacing, recharging, or disposing of batteries. Battery backup should be used in case of power loss.

14. Anti-wandering system users should be able to record personalized alarm messages for patients in their native languages. This bed alert system feature would remind patients not to exit until a staff member has arrived and may help relax patients. Messages can encourage patients to wait for assistance or remind them to use a walker or cane.

Questions for the Seller

Before you purchase your Bed Alert System, we recommend you ask the seller the following questions:

Alarms

Is it visual?

Is it audible?

Does it auto-reset?

Does it include hold button (staff)?

Does it include an alarm record?

Does it have an interface capability with the HIS?

Bed Mat

Is it reusable?

Is it disposable?

Chair/Wheelchair Mat

Is it reusable?

Is it disposable?

# Tips and Guidelines for Buying a Bed Head System

**Bedside organization units for utility services and devices**

Prefabricated organization units that can be either wall recessed or in self-standing columns. They are used for bedside organization of utilities (electrical, gases, vacuum) and devices. They are factory manufactured, pre-wired and pre-piped, with standard parts.

Tips for Buying a Bed Head System

1. Several configurations are offered for these units to meet the needs of acute care, OR, and PACU areas. Facilities should carefully determine the needed configuration for each patient care area.

2. These systems should allow access to the patient during an emergency and diminish interference with the patient bed. It should also allow easy access to services, devices, internal wiring, and piping that need routine repair and maintenance.

3. The minimum recommended features include:

4. 6 hospital-grade duplex receptacles

5. 1-3 oxygen outlets, depending on patient care area

6. 1-3 vacuum outlets, depending on patient care area

7. Up to three medical compressed air outlets, depending on patient care area

8. Vacuum collection bottle/canister mounts

9. A physiologic monitor bracket with provision for a monitor connector

10. Provisions for a nurse call system, code button, examination light, and telephone jack

11. If the system includes circuit-breaker panels, they should be easily accessible and clearly labeled. The main circuit breaker should be distinguished from branch circuit breakers; doors to the panels should not be lockable.

12. Cleaning solvents and other fluids are commonly found in the hospital and near patients, and the exposed surfaces of headwall systems and service columns should resist staining and degradation by these materials.

13. Back of bed bumpers are helpful features that minimize the scratching of headwall fascia panels caused by the side-to-side movement of patient beds.

14. To provide proper flow to the outlets, copper medical gas and vacuum piping is preferred. However, flexible hoses of the appropriate size may be used.

15. The nurse call system is usually supplied by the hospital and installed separately.

16. Medical gas outlets are usually specified to match the hospital's general system and equipment connections.

17. Sometimes it is possible to order customized large, uniquely dimensioned full wall units. Some suppliers do not even sell a fixed product line of distinct models, but rather produce custom-made units. To fit the buyer's needs, most companies will also customize catalog units.

18. When determining the location and mounting of all external devices, facilities should consider minimizing the potential for patient or staff injury as well as the possibility of physical damage to the devices and fixtures.

19. Facilities need to ensure that the fixtures can support the intended loads.

20. A mounting bracket should first be affixed to a load-bearing portion of the wall during the installation of a typical prefabricated headwall.

Questions for the Seller

Before you purchase your Bed Head System, we recommend you ask the seller the following questions:

Accessories

Monitor bracket?

Bed bumper?

Sphygmomanometer?

IV supports?

Catheter basket?

Electrical Features

Circuit breaker?

Electrical power receptacles?

Equipotential ground bus?

Grounding jacks?

Telephone jack?

Isolated power system?

Code alarm button?

Nurse call system?

Elapsed timer/clock?

Computer communication line/jack?

Medical Gas Services

Oxygen outlets?

Vacuum inlets?

Nitrous oxide?

Vacuum bottle slides?

Vacuum bottle storage?

Outlet type? (please specify)

Lighting Options

Chart light?

Reading light?

Night-light?

Overbed light?

Exam light?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Headwall Systems and Service Columns

# Tips and Guidelines for Buying a Bed, Pediatric

Pediatric beds for intensive care or transport within medical facility

Pediatric beds that can be used both for transport within medical facility and in intensive care. Safety features prevent climbing, falling, and other injury-causing situations for pediatric patients. Convenient access for treatment by caregiver.

Tips for Buying a Bed, Pediatric

1. When purchasing pediatric beds, safety is the most important consideration. Facilities should consider the following: No sharp edges.

2. The pediatric bed should be made of non-toxic and non-peeling finishes.

3. No openings through which a child could fall or become entrapped, including: openings between the mattress and side rails or openings created when the mattress is adjusted into other positions.

4. To prevent a child from slipping through the rails, the side rail slats on the pediatric bed should be no more than 2 2/8 inches apart.

5. To eliminate the possibility of a child becoming trapped under the mattress or between the mattress and the crib, the mattress should fit snugly inside the neonatal bed.

6. Safety tops should be available on infant cradles, although they are not necessary for non-crawling infants.

7. Electrically powered pediatric beds should come with lockout controls. The crib must meet the requirements of applicable electrical safety standards.

8. The pediatric bed should offer a comfortable sleep surface that is adjustable to positions appropriate for children.

9. Manufacturers offer the neonatal beds in a variety of sizes and features. Facilities should carefully consider which features would meet the clinical needs of the area in which the bed is to be used.

10. Weight capacity varies among suppliers and their product lines. Therefore, facilities should consider patient size when purchasing a pediatric bed or crib.

11. Facilities are encouraged to purchase standard pediatric beds that come with all the needed features, and not to request customized features. They should ask for a demonstration neonatal bed to evaluate it within the department where it will be used.

12. Facilities can sometimes modify their existing pediatric beds to make them safer, and to eliminate the need to purchase new ones. But if the spacing between slats is significantly more than 6 cm, beds should be replaced.

13. Facilities are strongly encouraged to negotiate for a significant discount. There are infant cradle suppliers who may offer discounts from 5% to over 20%, depending on the facility's negotiating skills, the models and quantities to be purchased, and the extent of concessions granted by the supplier.

Questions for the Seller

Before you purchase your Bed, Pediatric, we recommend you ask the seller the following questions:

General Information

Are the endrails movable?

Are the endrails stationary?

Does it have High/Low function?

Is it electrical?

Are there any signs of rust?

Mattress Support Type

Is it flat?

Is it reversible?

Does it support Trendelenburg?

Does it support Fowler?

Does it support Gatch?

Siderails

Are the slats semidetachable?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Beds, Electric

# Tips and Guidelines for Buying a Beta / Gamma Counter

A system for performing various assays, utilizing radioactivity in gamma or/and beta range

A system for performing various assays, utilizing radioactivity in gamma or/and beta range. The principal of operation is: Labeling one of the outcomes of a specific chemical reaction with a radioactive element, and counting the radioactivity in gamma or/and beta range, to obtain a quantitative measure of the reaction.

Tips for Buying a Beta / Gamma Counter

1. Facilities that are considering the purchase of gamma counter systems should make sure that the data reduction process permits manual or online data entry, the choice of mathematical curve fits, positive and negative-slope curves and editing data for recalculation.

2. The gamma counter systems should have rapid running and printout capabilities, including printouts of curves and user programmability for special tests.

3. Facilities should also look into the following gamma counter features: amount of statistical data analysis needed, number of data bytes needed for a complete analysis and number of programs the data storage system can handle.

4. The ease of information retrieval, automatic or stepwise program call-up, automatic running of multiple assays, and QC tracking (that may include user-selected limits for flagging outliers and QC monitoring and storage ) should all be evaluated as well, before facilities make a gamma counter purchase.

5. Gamma counter buyers should look at the waste disposal costs for the unit and determine whether special sinks and trash receptacles are needed.

Questions for the Seller

Before you purchase your Beta / Gamma Counter, we recommend you ask the seller the following questions:

Energy Windows

Dual-label assay?

Protocols

Are they preprogrammed?

Are they user programmable/defined?

Data Reduction

Calibration curve display?

Calibration curve edit?

Internal calibration?

Reagent Supply

Substitution?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Bilirubinometer

# A device which measures bilirubin concentration in blood samples, or non-invasively

Whole blood, serum, or plasma samples are analyzed using spectrophotometric techniques, as well as skin reflective techniques in a non-invasive, cutaneous manner. Cutaneous bilirubin meters measure bilirubin levels in newborns through the skin. A light beam is directed to newborn's forehead or sternum. Optical detectors measure 2 beams of reflected light, from which the blood bilirubin concentration is determined.

Tips for Buying a Bilirubinometer

1. Facilities should answer the following before selecting a bilirubin meter:

2. Who will be using and maintaining the bilirubin meter

3. Which analyzers are already being used in the hospital

4. What jaundice meter features are needed

5. When the bilirubin meter is interfacing with other laboratory testing devices or information systems, it can improve the accuracy of data transmission and record keeping, as well as save operator time in data recording.

6. If non-laboratory personnel are using the bilirubin meter, facilities should consider features that minimize user interactions.

7. Some of the recommended cutaneous bilirubin meter features include: automatic calibration, easy-to-read display for reporting results, and printer or an interface for a printer to obtain hardcopies of test results.

8. Facilities should consider standardization of equipment. Therefore, if they already own a particular cutaneous bilirubin meter, they should consider retaining this manufacturer.

# Tips and Guidelines for Buying a Biochemistry Analyzer, Automated

Automated chemical analyzers for clinical laboratory use

Single channel or multi-channel automated laboratory analyzers using photometric methods for analyte evaluation and ion-selective electrodes for electrolyte concentration measurements. Specimens are separated in reaction vessels throughout analysis procedures, as reagents are added and reaction is measured.

Tips for Buying a Biochemistry Analyzer, Automated

1. Facilities considering the purchase of these automated biochemistry analyzer instruments should base their decision on the available assays and the throughput capacity of the system.

2. Clinical chemistry analyzers should be able to perform a set of certain tests that are commonly used in patient diagnosis and treatment.

3. Facilities purchasing automated biochemistry analyzers should carefully examine test menus to ensure that the tests meet their clinical needs.

4. Smaller biochemistry analyzer systems may be suitable for facilities that require specialty testing. These clinical chemistry analyzer discrete systems carry out the required tests faster, using a smaller amount of patient sample.

5. Automated biochemistry analyzer instruments that can assay whole blood or samples that do not need centrifugation may be considered by urgent or specialty testing laboratories.

6. A laboratory that routinely runs a few thousand tests per hour requires an automated biochemistry analyzer capable of performing more than 10,000 tests per day. Facilities running only several hundred tests per day do not require such a clinical chemistry analyzer, as it will be underutilized.

7. The following features minimize user interaction with the automated biochemistry analyzers, which results in less operator errors and more time for other laboratory procedures: automatic calibration, verification, and dilution.

8. The automated biochemistry analyzers should have a computer interface to connect with the LIS in order to report results directly into the system.

9. The cholesterol screening device should have flags for abnormal values, which should be prominently displayed to alert for any unusual results that may require the biochemistry analyzer test to be rerun.

10. Accurate and timely test data should be provided consistently by the automated biochemistry analyzers, to make them cost-effective.

11. A relatively expensive biochemistry analyzer, that is easy-to-operate, durable, analyzes samples accurately and reliably, may cost less over time than an inexpensive automated biochemistry analyzer with low cost reagents that breaks down frequently, requires a high percentage of repeat tests, and is labor intensive.

12. When selecting an automated biochemistry analyzer, facilities need to decide whether the qualities of the cholesterol screening device fit their chemistry needs and requirements.

13. Any clinical chemistry analyzer discrete system failure that could produce false results should produce an alarm to alert the user.

14. It is important for facilities to know that an automated biochemistry analyzer's throughput depends on the amount and type of tests performed by the instrument during a particular time.

15. Claims made by clinical chemistry analyzer manufacturers regarding very high throughput may be based on tests that react rapidly to the addition of chromomeric reagent and quickly show measurable results.

16. Most clinical laboratory tests, including automated urine, blood, and chemistry analyses, can be included in the moderate-complexity category. Tests of this group need only a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process.

17. More specific testing belongs to the high-complexity classification and involves extensive education and training.

18. This highly complex category includes procedures that require: a high degree of clinical chemistry analyzer discrete operator preparation, calibration, intervention, and analysis. These may include clinical cytogenics and histopathology applications.

19. When upgrading or buying a new automated biochemistry analyzer system, facilities need to be aware of the needed additional staff training and certification, as well as changes in quality control, proficiency testing, quality assurance programs, and other laboratory procedures.

20. The clinical chemistry analyzer system's computer interface capabilities are a very important factor when selecting clinical chemistry analyzers.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Birthing Bed

An adjustable bed allowing more natural delivery positions at birthing

An adjustable bed offering women in labor the option of more natural positions. The entire process of childbirth can be conducted in the same bed from labor to delivery and through postpartum period, minimizing risks and discomfort of transferring beds

Tips for Buying a Birthing Bed

1. For the proper operation of these devices, they should have certain features, such as a removable headboard to allow easy access to the patient's head. Desired features include leg supports, and a removable foot section for the birthing process.

2. At minimum, the bed height should be adjustable over a range of 22-40 inches. In some situations a larger range may be preferred.

3. To allow easy movement over small obstacles during transport, the casters should be at least five inches in diameter. At least two of them should have breaks located diagonally from each other.

4. To collect fluids, a removable drain pan is recommended.

5. Facilities should look into several factors before making the purchase. These include the range of bed positions, the quality of construction and mechanical reliability, the service history of the unit, and the ease-of-use.

6. The cost of maintenance and the availability of manufacturer support and replacement parts are to be considered as well by facilities considering the purchase of these beds.

Questions for the Seller

Before you purchase your Birthing Bed, we recommend you ask the seller the following questions:

General Information

Are there any signs of rust?

Patient Controls

What type of control?

Patient Controls: What are the control functions?

Maximum Angle (Degrees)

Backrest?

Seat?

Additional Options

Does it include a drain pan?

Does it include leg supports?

Does it have a removable headboard?

Does it include a mattress?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Beds, Electric

# Tips and Guidelines for Buying a Blood Bank Information System

Blood bank information management systems

Computerized systems used in blood banks, providing clinical and administrative information. These data management information systems process blood bank information, including blood donor status, cross-match results, blood logistic management system, etc., using specialized software.

Tips for Buying a Blood Bank Information System

1. Many software features can be used with blood bank information systems; each facility should select the combination of features based on the intended use of the system in the facility.

2. These systems should offer some basic features, including transfusion and donor functions, autologous unit tracking, cross match results, and other features to facilitate the running of a blood bank. Additional features should be considered based on specific needs.

3. Information systems should offer methods for system security, such as password protection. They should be HL7 compliant. If the facility has an existing information system, interfaces to it are necessary. This feature is needed even if the facility is purchasing a stand-alone BBIS and considering an LIS or HIS in the future.

4. Facilities should also look into the backup features and storage media provided by the systems. At minimum, storage onto a hard disk with RAID and/or an optical disk should be available.

5. To increase database integrity and help prevent data loss, automatic backups and transaction logging are recommended.

6. Before buying a system, facilities should first carefully evaluate their current operating process. Automation will not necessarily resolve inefficiencies if there are any. They should then define the objectives and functional requirements for the system and submit a request for proposal to suppliers.

7. Buyers need to carefully examine current costs against the estimated reduction.

8. Only systems that meet the needs of all the users in the facility should be considered.

Questions for the Seller

Before you purchase your Blood Bank Information System, we recommend you ask the seller the

following questions:

General

Software installed? (Name + Version)

Software

Does it include clinical features?

Does it include transfusion?

Does it include donor?

Does it include autologous/direct unit tracking?

Does it include crossmatch results?

Does it include donor history?

Does it include mobile scheduling?

Does it have blood group device interface?

Does it include ad hoc reporting?

Does it include crossmatch/transfusion ratio?

Does it include management features?

Does it include inventory control?

Does it include bar coding?

Does it include RFID?

Does it include billing?

Does it include remote ordering?

Does it include remote results reporting?

Does it include a direct printer?

Does it include a fax?

Does it include a modem?

Does it include HIS interfaces?

Does it include order entry?

Does it include results reporting?

Does it include electronic signature?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Blood Centrifuge

Floor or tabletop nonrefrigerated low speed centrifuges for blood banks

Floor or tabletop nonrefrigerated centrifuges used to centrifuge suspended red blood cell solutions, to intensify agglutination and to promote formation of packed cells. For use in blood bank centrifugion processes. Most have a timer mechanism.

Tips for Buying a Blood Centrifuge

1. The specific needs of facilities should determine most blood centrifuge specifications such as: rotational speed, display type, and capacity.

2. These are some preferred blood bank centrifuge features that help ensure safety and ease of use: biohazard-containment capabilities, programmability, and lid interlock.

3. The recommended motors are the brushless motors. They do not require as much maintenance, because they do not experience the wear and tear that traditional blood centrifuge motors undergo.

4. Audible blood centrifuge alarms are preferred over visual indicators. Alerts should sound at the end of a run or cycle and for imbalance, current leakage, and open lid.

5. Laboratory personnel are strongly encouraged not to operate blood bank centrifuges with lids open, because of the hazards posed by a flying rotor or the dispersal of biologically hazardous material.

6. Workers may be exposed to the risk of infection and injury from blood products and glass sprayed from beneath the lid onto the chest.

7. Rotor misalignment, old or defective tubes, or incorrect use may cause tube breakage in blood centrifuges.

8. When purchasing a blood centrifuge, facilities should consider safety features as a main factor. Blood bank centrifuges with safety lid latches and/or interlocks that shut off the motor when the lid is opened or that keep the lid latched until the rotor has stopped are preferred. The blood centrifuge unit should have an inner lid that can be securely fastened

9. For blood bank centrifuges that process many different types of samples, it is recommended that the centrifuge have room temperature and cold-temperature operation capabilities.

10. Some more safety features include an inner protective cover over the rotor assembly, as well as a clear label warning not to open the blood bank centrifuge while the rotor is spinning.

11. The visual indicators on the blood centrifuge should be clear and easily read.

12. Facilities should look into the issue of cost of a warranty and of applicable disposables that are used regularly, such as brushes, when purchasing blood centrifuges.

13. To deal with various needs of discrete workstations, facilities may wish to install two or more units. This may also help with handling a staggered workflow and large and small specimen batches.

Questions for the Seller

Before you purchase your Blood Centrifuge, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Blood Gas Analyzer

Blood gas/pH analyzers for laboratories

Laboratory blood gas analyzers using 3 different sets of electrodes to directly measure pH and partial pressure of carbon dioxide(PC02) and oxygen(PO2) from arterial whole blood specimens. Some blood gas/pH analyzers measure other parameters (oxygen total content, bicarbonate HC03) as well as electrolyte and hematological determinations. Laboratory analyzers are used for diagnosis and therapy regulation, by determining patient's acid-base balance and oxygen/carbon dioxide exchange. Partial pressure of blood gases and pH values in the arteries can also be measured by bedside blood gas monitors. A sensor cassette is inserted with the arterial catheter tubing system near the wrist.

Tips for Buying a Blood Gas Analyzer

1. When choosing a blood gas analyzer instrument, facilities should rely mainly upon available assays on an instrument, the throughput capacity, and the availability of blood gas/pH analyzer models to meet different volume and testing needs within the same facility.

2. Larger, more automated blood gas analyzers with a wide-scale test menu and high throughput will probably be used in medical centers. These blood gas analyzers can also provide stat testing. These blood gas analyzers are often used for determining diagnosis, follow-up care, and the effectiveness of treatment.

3. Facilities with specialized testing requirements or midsize or small facilities can use smaller blood gas analyzer systems that may be less automated, with lower throughput, and a smaller test menu. Smaller blood gas/pH analyzer systems that offer the required test in the shortest time using the smallest amount of patient specimen may be sufficient for specialty testing.

4. Facilities that handle urgent or specialty testing may consider blood gas analyzer devices that can assay whole blood or samples that do not need centrifugation.

5. A broad test menu is not necessarily needed in blood gas analyzers used in specialty areas. However, it is required in central blood gas analyzers, which should be capable of testing for certain key analytes; the presence or absence of which may indicate a life-threatening situation and calls for immediate action.

6. Facilities are encouraged to perform an on-site evaluation of the blood gas/pH devices to be purchased. This enables facilities to test performance qualities with the workload and sample types that are normally handled.

7. An important factor to be considered by facilities is an effective quality control system. An inappropriate blood gas analyzer system can result in unnecessary test runs, delayed patient results, and failure of proficiency tests; all of which waste time and money.

8. Facilities should prefer blood gas analyzer devices that minimize operator contact with specimens because of the risk of infection involved with handling any body-fluid specimen.

Questions for the Seller

Before you purchase your Blood Gas Analyzer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Blood Gas Analyzer, POC

Blood testing devices for use at Point-Of-Care

Point-of-Care analyzers for clinical testing. These analyzers take less time than laboratory testing. Time elapsed from test order to physician review of results is less than 5 minutes as opposed to central laboratory testing which can take from 20 minutes to over one hour.

Tips for Buying a Blood Gas Analyzer, POC

1. When selecting the right blood gas analyzer unit, facilities should look into the level of device automation. Since non-laboratory trained personnel often use these blood gas monitor devices, it is better to have more automated features and greater data-management capabilities.

2. All point-of-care blood gas analyzer devices should have basic data management features, including a way of recording patient identification, test results, and date and time. If trained personnel are not available when the test is performed, then intermediate data management capabilities are more desirable.

3. Carbon dioxide analyzer systems should be able to capture quality control results, reagent lot numbers, and operator ID. Some facilities should consider more advanced data management functions, such as the ability to collect data from one or more blood gas monitor devices into a central data repository, which can be a stand-alone PC or an information system.

4. Advanced data management capabilities will usually include the ability to generate reports based on the collected oxygen analyzer data.

5. These oxygen analyzer devices should be able to provide test results in a hard copy, including a built-in printer or communication with an existing printer.

6. It is recommended to have a computer interface to enable automatic results reporting and communication with a facility's data management system.

7. Facilities should perform a thorough cost-benefit evaluation of their current blood gas monitor testing, versus the point-of-care testing before they decide to begin a point-of-care blood gas analyzer testing program.

8. The ongoing costs of operating point-of-care pH analyzer instruments are often higher than those of central laboratory equipment, and this is on top of the initial capital investment. The maintenance of point-of-care testing devices is often more expensive than that of the central laboratory analyzers. However, since patient care is often improved, cost savings can be realized in other areas of the quality control, and some benefits of this testing may reduce overall costs in the long run.

9. Facilities with high-test volume are more likely to realize savings than those with a low-test volume. The potential impact on savings grows with the test volume. The point-of-care testing can lessen the need for duplicate test runs due to error during sample transport and unneeded tests performed because of delayed results.

10. Some tests are usually less expensive to run than others, and the blood gas monitor instruments they need may be cheaper than other analyzers, so the cost of equipment and reagents varies based on the test types.

11. It is recommended that facilities look into other options available to them before they decide on starting carbon dioxide analyzer point-of-care testing. The specific situation in each facility determines whether blood gas analyzer point-of-care testing will be cost effective or not.

Questions for the Seller

Before you purchase your Blood Gas Analyzer, POC, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Configuration

Is it battery operated?

Does it have a handle?

Does it have a carrying case?

Does it have a cart?

Is it line operated?

Is it both line and battery operated?

Data Management

Does it have a printer?

Does it include a bar code reader?

Does it include reagents?

Does it include samples?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Blood Grouping System

Blood grouping analyzers with data processing capabilities for testing, used in hematology, blood banks, and laboratories

Automated and semi-automated laboratory analyzers for blood-grouping tests, and test results interpretation. Automated analyzers maximize speed and accuracy of testing, as well as minimize use of reagents. Some analyzers require previous centrifugation to separate red blood cells from plasma. Most of them perform forward and reverse grouping for routine blood tests, and use micro-plate and/or cassette-based methods. Fully automated systems are used in large transfusion centers, and modular semi-automated units are used in smaller centers.

Tips for Buying a Blood Grouping System

1. The blood grouping systems should perform ABO forward and/or reverse grouping and Rh detection. The following additional donor tests should be considered based on specific needs of the site: syphilis, hepatitis B surface antigen, anti-hepatitis B core antigen, anti-hepatitis C virus, anti HIV types 1 and 2, and anti-human T-cell lymph tropic virus types I and II.

2. The following functions should be carried out by these blood grouping systems: dilution, agitation, and centrifugation.

3. Preferred automated blood type analyzer systems are those that are robotics-compatible. In general, automated blood grouping systems should provide data processing with minimal human intervention.

4. It is worthwhile to get a fully automated blood type analyzer system only for larger transfusion centers, where the labor savings and the lower cost per test will justify the expense.

5. Smaller transfusion laboratories with limited budgets find semi-automated blood grouping systems, which have components that can be purchased separately, to be an affordable alternative. These blood grouping systems provide rapid sample processing and computer-managed data handling and interpretation.

6. Facilities that are using a subsystem for detecting and analyzing agglutination patterns can affect the cost of a blood grouping analyzer.

7. Storage space is an important issue for donor centers, which accumulate a large number of paper records and must store blood donor histories indefinitely. These facilities should aim at saving space and allowing rapid retrieval of records using a storage system, such as microfilm or optical disc.

8. Blood grouping analyzer results can be downloaded to a computer storage system if the computer interfaces with blood grouping systems.

9. For inputting blood grouping analyzer test data, verifying testing accuracy, and maintaining quality control, calibration, proficiency testing, and patient files, it is essential to have an effective interface to the existing laboratory information system or the hospital's central computer system.

10. Facilities should ensure blood type analyzer results confidentiality by taking the following precautions: adjusting monitor positions so only authorized personnel can view the screen, using passwords and identifiers, having repair technicians sign a confidentiality waiver, refraining from using email to transfer patient data, performing random audits, putting up firewalls, and using access restriction and encryption.

11. There are standards for handling the security of health information, for giving patients control over the disclosure of their health records, and for establishing specific identifiers for healthcare providers, health plans, employers, and other individuals. Compliance is required only for electronic health information; for paper-record it is voluntary.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Blood POC Analyzer

Point-Of-Care analyzers for hemotological tests

Analyzers using volumetric impedance, or light-scatter techniques, to measure red and white blood cells and platelets in whole blood. These point-of-care analyzers can also calculate other parameters (e.g. hematocrit and mean corpuscular values).

Tips for Buying a Blood POC Analyzer

1. When facilities are considering the purchase of blood POC analyzer (point of contact) units, they should look into the degree of automation of the device. Non-laboratory trained personnel often use these hematology analyzer units, and so more automated features and greater data-management capabilities may be desirable.

2. All blood POC analyzer devices should provide basic data management features, including: a means of patient identification, record of the test result, date and time.

3. When trained personnel are not available while the hematology analysis test is performed, intermediate data management capabilities will be desirable on top of the basic ones, including: captures of QC results, reagent lot numbers, and operator ID.

4. There are more advanced data management functions that may be suitable for certain facilities. These advanced features may include the ability to collect data from one or more clinical blood analyzer devices into a central data repository; which may be a stand-alone PCor an information system, or the ability to generate clinical blood analysis reports based on the data collected.

5. All hematology POC analyzer devices are expected to produce a hardcopy of test results using a built-in printer or an interface to an existing printer. A computer interface is also preferred to allow automatic results reporting and communication with a facility's data-management system.

6. During cardiac surgery, activated clotting time testing is usually required and not PT or APTT testing capabilities. The most frequently ordered tests in a hematology point-of-care setting would be hemoglobin and/or hematocrit. A blood donor setting may only require hematology analyzer testing, while an intensive care setting may require both, and a clinic may prefer one or the other.

7. Facilities should carry out a detailed cost-benefit evaluation of the current blood POC analyzer testing system compared with point-of-care testing before deciding to begin a clinical blood analyzer point-of-care testing program. They should keep in mind that in addition to the initial capital investment required, ongoing costs of operating point-of-care instruments are often higher than the operating costs of central laboratory equipment. However, some benefits provided by clinical blood analyzer point-of-care testing can reduce overall costs in the long run and improve patient care.

8. Hematology POC analyzer devices can allow physicians to give faster, more appropriate diagnoses, by providing immediate results. This can diminish unnecessary treatments and tests, prolonged hospital stays and unnecessary stays. As a result of a better triage in EDs and pre-hospital settings, time spent in ICU can be minimized, thus reducing treatment costs.

9. Different factors must be considered by different facilities when evaluating the cost effectiveness of blood POC analyzer testing. The facility's average TAT, reagent and disposables costs, and test volume are some of the factors. Others include the types of tests most often ordered, the areas in which point-of-care testing may be needed, and the personnel involved in performing the tests.

10. The use of blood POC analyzer point-of-care testing will probably reduce the average TAT for laboratory tests. Having a point-of-care hematology POC analyzer eliminates the intermediate steps involved with specimen transport. If TAT can be reduced enough, the increase in reagent and disposables costs may be offset by reduced lengths of stay and improved quality of care.

11. Duplicate test runs due to error during sample transport and unnecessary tests performed as a result of delayed results can all be reduced by hematology POC analyzer point-of-care testing. The cost of equipment and reagents can vary according to the test types; some tests are usually less expensive to run than others, and the instruments needed for them may be less expensive.

12. Point-of-care blood POC analyzer applications usually have more potential for savings and improved care when used in the ED, the OR, and critical care areas. The effect of point-of-care testing on costs is different for each facility depending on the areas where it is used.

13. The use of point-of-care blood POC analyzer testing will shift staffing expenses, as fewer nurses and clinicians will perform tests. Many employee expenses may be difficult to quantify. They should, nonetheless, be carefully examined by facilities considering the purchase of a blood POC analyzer. Time spent in transit by transport personnel will probably decrease with the reduction in specimen transport.

14. Before deciding to begin point-of-care blood POC analyzer testing, facilities should look into other available options, such as pneumatic tube transport systems and satellite STAT laboratories.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Blood Pressure Holter

Data recorders/storage systems for blood pressure monitoring in ambulatory patients

Non-invasive data recorders/storage systems. A sphygmomanometer records blood pressure variations during activity. Also suitable for outpatient use.

Tips for Buying a Blood Pressure Holter

1. A Holter blood pressure monitor is a small, wearable device that records the patient's heart rhythm.

2. Before making a purchase of a Holter blood pressure monitor, facilities should examine the unit's capacity for data storage, retrieval, and computer interfacing. These abilities are crucial for gathering large quantities of information.

3. Facilities can purchase software that takes stored Holter blood pressure monitor readings and correlates them into a graph, at an additional cost.

4. Holter blood pressure monitor buyers should also consider the cost of disposable/reusable batteries and the charging and operating time.

5. These Holter blood pressure monitor units should measure systolic pressures between 60 and 250 mm Hg and diastolic pressures between 30 and 180 mm Hg.

6. To minimize patient reactions, cuff inflation should be no greater than 80 mm Hg/sec. Cuff deflation should be 2-3 mm Hg/sec, depending on the pulse rate.

7. The cuffs should be offered in several sizes: neonatal, pediatric, adult, large adult, and thigh. 8. Holter blood pressure monitor users should be able to select the timing between cycles of automatic blood pressure measurements.

9. These measurements are used to monitor patients in normal living conditions, and therefore visual and audible alarms are optional.

10. In case of an abnormal reading, a note should be taken on the event log for clinician review, and the measurement should have a patient-event marker.

11. These Holter blood pressure units are battery-powered. Using rechargeable batteries reduces the costs of replacing and disposing batteries and is therefore recommended.

12. Battery power should last at least 24 to 48 hours; a low-battery indicator should be available.

13. Systolic, diastolic, and pulse rate should be displayed on a LED or LCD.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Sphygmomanometers

# Tips and Guidelines for Buying a Blood Pressure Monitor

Automatic electronic non-invasive blood-pressure meters and monitors, also other non-invasive parameters

Automatic electronic non-invasive blood-pressure meters and monitors, also other non-invasive parameters. The other parameters may be: pulsed oximetry, temperature, surface temperature, etc. the combinations of selected parameters may differ from one manufacturer to another.

Tips for Buying a Blood Pressure Monitor

1. The complexity of the blood pressure monitor depends on where it will be used and the types of blood pressure monitors presently used in that location.

2. The measurements are taken using either the oscillometric or auscultatory method.

3. The inflation pressure should be adjustable or automatically set based on a previous or current pressure reading.

4. Typical ranges for individual patient requirements are 150-260 mm Hg for an adult and for a neonate - 85-140 mm Hg.

5. The automatic blood pressure meter system should be able to measure systolic pressures as high as 250 mm Hg. Cuff inflation must be less than 80 mm Hg/sec in order to reduce patient reactions. Cuff deflation should be 2-3 mm Hg/sec, depending on pulse rate.

6. The non-invasive blood pressure monitor will allow choosing from at least 5 values over a range of 1-60 minutes, when selecting the timing between automatic blood pressure meter measurement cycles.

7. When the cuff pressure reaches 300 mm Hg for an adult and 150 mm Hg for a neonate, the sphygmomanometer must automatically deflate.

8. Systolic and diastolic pressures and pulse rate should be displayed by the blood pressure monitor system. Other optional parameters may be available, such as MAP and other physiologic parameters. These will be selected in accordance with clinician and patient demographic requirements.

9. When the sphygmomanometer is unable to take an accurate measurement, it should alert the operator visually or audibly, and provide the reason for the error.

10. Silencing the alarm's volume should be impossible, and so should be setting its limits outside the specified measurement range of the unit.

11. One or more of the following cuff sizes should be available on non-invasive blood pressure monitors: neonatal, pediatric, adult, large adult, and thigh.

12. These blood pressure monitors can be line-powered or battery-powered. Battery-powered non-invasive blood pressure monitors accept any commonly available battery.

13. Rechargeable batteries are recommended, since they reduce replacing and disposing costs.

14. Additional monitoring capabilities, such as oxygen saturation and temperature, are offered by some expensive models.

15. Often, blood pressure monitor suppliers will offer adjunctive equipment, such as monitor stands or pressure cuffs of various sizes.

Questions for the Seller

Before you purchase your Blood Pressure Monitor, we recommend you ask the seller the following questions:

General Information

Does it have automatic zero adjustment?

Is it MRI compatible?

Does it include a printer?

Does it have battery operation capability?

Display Parameters

Does it display systolic?

Does it display diastolic?

Does it display MAP?

Does it display pulse?

Does it display graphic trends?

Does it display tabular trends?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Sphygmomanometers

Blood Pressure Monitors, Electronic Indirect

# Units designed for warming blood products and IV solutions

Units for warming blood products and IV solutions before infusion, using a heat exchanger. Usually they are attached to the IV pole. Some are used for irrigation solutions used in endoscopies.

Tips for Buying a Blood Warmer

1. Blood warmer units are used mainly in operating rooms or intensive care areas.

2. The following factors should be considered before making a solution warmer purchase: flow range specification, size, mobility, and ease-of-use.

3. Facilities should also look into disposable, battery-operated blood warmer units or those integrated in a high flow pump.

4. When selecting the right solution warmer, facilities should also examine the applications for which that blood warmer will be used. They should select a unit that can warm refrigerated blood and solution to body temperature at an appropriate flow rate.

Questions for the Seller

Before you purchase your Blood Warmer, we recommend you ask the seller the following questions:

High-Temperature Alarm

Does it include an audible alarm?

Does it include a visual alarm?

Does it include an alarm test?

Does it include manual temperature setting?

Air Vent or Trap

Is it freestanding?

Does it have an IV-pole attachment?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Blood and Solution Warmers

# Tips and Guidelines for Buying a Blood-Bank Refrigerator

Blood bank refrigerators

Blood bank refrigerators with temperature control and safety features for accurate temperature maintenance, for storage of whole blood, blood components, and reagents.

Tips for Buying a Blood-Bank Refrigerator

1. The most important factors to consider when looking at these blood-bank refrigerator systems are temperature and temperature-alarm systems.

2. Doors of these laboratory refrigerator units should be made of thermal or multi-pane glass with heated wires to reduce condensation.

3. A temperature monitoring system should come with the blood-bank refrigerator, and it should consist of at least one temperature sensor and an integral recorder. A more desirable configuration is two sensors and a combination of remote and integral recorders.

4. An audible, on-unit alarm for temperature, low battery, and power failure should be provided by the laboratory refrigerator unit. Audible remote alarms are desirable as well as power and refrigeration back-up systems.

5. Storage space is another issue to consider when buying these systems. Facilities should determine how much storage space is needed and whether the temperature-alarm system is included with the laboratory refrigerator or sold separately. A remote alarm system may be desirable.

6. Regarding configuration, facilities must choose between blood-bank refrigerator units with refrigeration systems incorporated into their base or separate refrigeration systems that can be installed on top of the unit or placed remotely.

7. Base-mounted laboratory refrigerator units require more frequent cleaning because of floor dust and dirt. Some laboratory refrigerators have key locks on the doors to restrict access to certain types of blood products. Some units have both a refrigerator and a freezer.

Questions for the Seller

Before you purchase your Blood-Bank Refrigerator, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

General Condition

What is the isolation condition?

Is the temperature stable?

Are there any defects in the door seal?

Are there any signs of rust?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Refrigerators and Freezers

# Tips and Guidelines for Buying a Bone Densitometer, Dual Energy

Bone densitometers, dual energy, isotope or X-ray tube. (DEXA)

The bone densitometers are systems which utilize an X-ray source and a detector to scan a limb and to determine the degree of the bone decalcification. The simpler systems are of the single energy X-ray source type. More accurate data can be obtained by applying the dual energy source technique. The source in each case can be either an isotope or an X-ray tube.

Tips for Buying a Bone Densitometer, Dual Energy

1. When selecting Bone Densitometers (Absorptiometer) units, speed should be the main factor.

2. X-ray Densitometer Systems should perform scans in less than one minute and perform automatic data analysis and corrections.

3. Report management is an important issue since X-ray Densitometry (DXA) is used for long-term monitoring and creating reference databases.

4. There is a broad range of bone densitometer models designed for specific clinical applications. Buyers should consider the following features: data mining, analysis options, and the ability to share old data with a new system.

5. Beam shape should be considered when choosing among bone densitometers.

6. As a result, shorter scan times and higher patient throughput are achieved with X-ray Densitometer systems using fan-beam technology, which performs a single sweep across the patient. However, pencil-beam systems offer lower exposure to radiation and usually cost less than fan-beam systems.

7. Facilities considering whole-body bone densitometer DXA systems should keep in mind that the installation of such a system usually requires an examination room that can accommodate the scanner table and the operator console. A room measuring at least 244 × 244 cm may be necessary, depending on the size of the table and operator console; small tables are becoming more available.

8. Bone densitometers may require certified technicians for proper operation since they use radiation.

9. There are some alternatives to whole-body DXA systems, including peripheral x-ray densitometer and ultrasound systems. These are smaller and cheaper, and they typically assess the peripheral rather than the axial skeleton. The radiation exposure is lower than typical bone densitometers.

10. Ultrasonic bone densitometers or Absorptiometers do not use ionizing radiation or need special facilities, certification, or operation by registered technicians. Therefore, it is ideal for physician offices, mobile clinics, and other sites.

11. DXA is limited to hospital-based osteoporosis clinics.

12. Some suppliers offer financing arrangements under a fee-sharing program to qualifying facilities to assist with the purchase of a X-ray Densitometer system. This program requires the payment of a specific fee per tested patient, and allows the facility to back down from the program at any time and return the equipment without penalty.

Questions for the Seller

Before you purchase your Bone Densitometer, Dual Energy, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Densitometers, Bone System

When was the x-ray tube last exchanged ?

Smooth up-down motion?

Smooth left -right motion?

System Table - Where Available

Smooth stretcher motion?

Smooth table motion?

Any signs of rust?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Bone Densitometer, X-Ray - Operational

# Tips and Guidelines for Buying a Bone Densitometer, Single Energy

Bone densitometer using isotope of X-ray radiation

X-ray bone densitometers use single energy spectrum from an x-ray source. Computerized isotope bone densitometers use a single-photon source. These densitometers are used to determine bone mineral content in appendicular skeleton by measuring forearm radius or heel.

Tips for Buying a Bone Densitometer, Single Energy

1. The availability of drugs for treating osteoporosis, as well as the extent of Medicare coverage enhances the market for Single Energy Bone Densitometer systems or Osteoporosis Densitometers.

2. The drug is the first non-hormonal medicine shown to restore lost bone mass in women with osteoporosis.

3. Physicians will order more tests for osteoporosis screening with this promising new therapy option, leading to an increased demand for Osteoporosis Densitometer and Single Energy Bone Densitometer equipment.

4. More pharmaceuticals for treating osteoporosis are available in Europe, and therefore the sales are greater there.

Questions for the Seller

Before you purchase your Bone Densitometer, Single Energy, we recommend you ask the seller the following questions:

General

Was the equipment upgraded?

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Bone Densitometer, X-Ray - Operational

# Tips and Guidelines for Buying a Bone Densitometer, Ultrasound

Bone densitometers using ultrasonic measurements to assess bone density, usually at the calcaneus or patella. Patients are not exposed to radioactive X-rays

Bone densitometers using ultrasonic measurements are used to assess bone density, usually at the calcaneus or patella. Ultrasound reports calculate a T-score (standard deviations above or below the mean) based on an impedance and ultrasound attenuation.

Tips for Buying a Bone Densitometer, Ultrasound

1. When selecting an ultrasound bone densitometer, speed should be the main factor.

2. Ultrasound Bone Densitometer systems should perform scans in less than one minute and perform automatic data analysis and corrections.

3. Report management is an important issue since DXA is used for long-term monitoring and creating reference databases.

4. There is a broad range of ultrasound bone densitometer models designed for specific clinical applications, such as Ultrasonometers and Absorptiometers. Buyers should consider the following features: data mining, analysis options, and the ability to share old data with a new system.

5. Beam shape should be considered when choosing among DXA ultrasound bone densitometer systems.

6. Shorter scan times and higher patient throughput as a result are achieved with s ultrasound bone densitometer systems using fan-beam technology, which performs a single sweep across the patient. However, pencil-beam ultrasound bone densitometers offer lower exposure to radiation and usually cost less than fan-beam systems.

7. Facilities considering whole-body DXA ultrasound bone densitometers should keep in mind that the installation of such a system usually requires an examination room that can accommodate the scanner table and the operator console. A room measuring at least 244 × 244 cm may be necessary, depending on the size of the table and operator console; small tables are becoming more available.

8. DXA ultrasound bone densitometer systems may require certified technicians for proper operation since they use radiation.

9. There are some alternatives to whole-body ultrasound bone densitometers, including peripheral DXA and ultrasound systems. These are smaller and cheaper, and they typically assess the peripheral rather than the axial skeleton. The radiation exposure is lower than typical DXA systems.

10. Ultrasonic bone densitometers do not use ionizing radiation or need special facilities, certification, or operation by registered technicians. Therefore, they are ideal for physician offices, mobile clinics, and other sites.

11. DXA is limited to hospital-based osteoporosis clinics.

12. Some suppliers offer financing arrangements under a fee-sharing program to qualifying facilities to assist with the purchase of a DXA system. This program requires the payment of a specific fee per tested patient, and allows the facility to back down from the program at any time and return the equipment without penalty.

Questions for the Seller

Before you purchase your Bone Densitometer, Ultrasound, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Densitometers, Bone System

When was the x-ray tube last exchanged?

Smooth up-down motion?

Smooth left-right motion?

System Table - Where Available

Smooth stretcher motion?

Smooth table motion?

Any signs of rust?

DICOM 3.0

Is it DICOM 3.0 compatible?

# Tips and Guidelines for Buying a Brachytherapy System

An automated system for radioisotope delivery directly into cancerous tissue

Automated delivery of radioisotopes directly to cancerous tissue. These Brachytherapy systems consist of radioisotope delivery unit, with source-drive mechanism and a shielded safe, applicators, a control console and computerized planning unit. Special applicators, or disposable needles, tubes, or catheters are used for interstitial radioisotope delivery. After treatment, radioactive sources retract into shielded unit. Brachytherapy treatments may be low dose, with radioactive source implanted into tumor for several days, or high dose implantations of several minutes.

Tips for Buying a Brachytherapy System

1. Brachytherapy radiation systems deliver the radioactive source accurately and safely.

2. With a high dose-rate brachytherapy system, safety is especially important; there must be some form of emergency source retraction.

3. Beneficial features of brachytherapy systems are those enhancing accuracy.

4. Small radioactive seeds that can be reliably delivered to the desired location with a minimal chance for error enhances accuracy.

5. The remote afterloading brachytherapy systems are better than external beam radiotherapy units, because 3-7-day treatment delivery does not allow the significant proliferation of tumor cells that often occurs with the longer treatment required for external beam therapy.

6. Remote afterloader brachytherapy systems apply the highest concentration of radiation directly within the tumor, and therefore normal tissue is not exposed to as much radiation.

7. When using these brachytherapy systems, the dose distribution and source dwell times can be programmed to fit the tumor's geometry.

8. Buyers debating between an HDR and an LDR system should consider the fewer side effects and greater cure rates associated with HDR units, as well as the benefits of low staff radiation exposure risks, early investment returns, and reduced hospital costs that these outpatient therapy units offer.

9. These brachytherapy radiation systems usually require walls consisting of 4 cm of lead or 35 cm of concrete shielding. They can also be placed in an existing shielded room designed for a cobalt radiotherapy unit or a linear accelerator.

10. Buyers should remember to change their NRC license to cover the radioactive sources used in brachytherapy.

11. Facilities need to ensure that the brachytherapy system treatment suite includes rooms for endoscopic, telemetry, oximeters, patient recovery, and computerized treatment planning.

Questions for the Seller

Before you purchase your Brachytherapy System, we recommend you ask the seller the following questions:

Applicators

Can it be used for gynecologic treatments?

Can it be used for bronchial treatments?

Can it be used for esophageal treatments?

Can it be used for nasopharynx treatments?

Can it be used for rectal treatments?

Does it include implant catheters?

Can it be used for intraluminal?

Can it be used for treatments of brain?

Can it be used for interstitial?

Is there a source draw back history?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Brachytherapy Systems, Remote Afterloading

# Tips and Guidelines for Buying a Breast Biopsy System

Biopsy units, some mammographic, used to take samples from breast tissue for testing

These systems can either stand alone, or be mounted onto mammographic radiography unit. Some include a computerized system to communicate lesion coordinates for guiding the needle.

Tips for Buying a Breast Biopsy System

1. Stereotactic Mammography Biopsy screening equipment must meet the minimum MQSA requirements for tube outputs, compression performance, position controls, and reproducibility.

2. Facilities should base their mammographic biopsy stereotactic system purchase decision on life-cycle cost, local service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment.

3. The complexity of the automatic exposure control is the main difference between systems. Some systems control only the exposure time, while more advanced ones control the x-ray spectrum, including the kVp, anode, and filtration. Such stereotactic mammography biopsy systems improve the image quality, especially in larger and denser breasts.

4. Some manufacturers have developed advanced grids, which are expensive to manufacture but improve the image quality.

5. When purchasing a mammography unit, performance and reliability are important factors.

6. A high-frequency x-ray generator will help ensure higher efficiency of operation with a minimum of output ripple. It will also need less space than a conventional generator.

7. Mammography involves a narrow range of tissue thickness, and therefore 1 kV increments and a range of approximately 22 to 35 kV are necessary in a mammography unit.

8. The stereotactic mammography biopsy system should offer at least 500 mAs and an exposure time of 0.1 second or shorter to avoid unnecessary long exposures.

9. A rotating anode, which has a higher heat capacity than a stationary anode, should be available in the stereotactic breast biopsy system to promote longer x-ray tube life and provide a more consistent x-ray output.

10. AEC provides the appropriate image optical density and x-ray exposure for breast composition and thickness.

11. Focal spot sizes should be approximately 0.1-0.3 mm to ensure that micro calcifications as small as 200 μm can be detected.

12. To clearly image the smallest micro calcifications, SID of at least 66 cm is needed.

13. Facilities considering the purchase of a stereotactic breast biopsy system should consider the number of procedures to be performed and the compatibility with existing equipment.

14. Film-based units are not recommended because they do not allow real-time guidance. Instead, both dedicated and add-on mammographic biopsy stereotactic systems are equipped with small digital detectors.

15. Add-on stereotactic mammography biopsy systems may be harder to use, because they have more limited motions compared to dedicated stereotactic breast biopsy systems. Consequently, most of the differences are a matter of user preference, rather than clinical efficacy.

16. In digital detector performance, detective quantum efficiency is an important factor. DQE is directly related to the signal-to-noise ratio that results between detector input and output. The noise generated by the detector and the spatial resolution contributes to the DQE of the system. To reduce DQE, SNR must be reduced; a recommended DQE is less than 20% at 5 lp/mm.

17. Another important factor is modulation transfer function. MTF refers to the loss of contrast relative to an x-rayed object. As spatial frequencies in a given image increase, MTF decreases, creating loss of visualization. a 50% MTF at 5 line pairs per millimeter is recommended.

18. If facilities need multiple stereotactic mammography biopsy systems or stereotactic breast biopsy systems to handle the patient volume, they should consider buying all units from one supplier for cost savings. The standardization of equipment within a facility simplifies staff training, servicing and parts acquisition, and provides greater bargaining leverage when negotiating costs.

19. Suppliers offer service contracts or service on a time-and-materials basis. This may also be available from a third-party organization. Facilities should carefully consider whether to purchase such a service, which will ensure the performance of preventive maintenance at regular intervals, minimizing unexpected maintenance costs.

20. Only stereotactic mammography biopsy systems that are covered by a service contract will get extended system performance and uptime guarantees beyond the length of the warranty from some suppliers.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

MAM System

Suprevision Forms

MAM System - Dismantling

# Tips and Guidelines for Buying a Breathing Monitor

Bedside monitors for continuous measurement of carbon dioxide and/or oxygen

Continuous measurement of partial pressure of carbon dioxide and/or oxygen at skin surface. These bedside monitors may use two separate electrodes or one combined sensor. This combined sensor includes a modified pH electrode, an O2 cathode and heated reference electrode, a membrane and an electrolyte in a shielded container. Some monitors have a third electrode to measure blood pH.

Tips for Buying a Breathing Monitor

1. Before making a breathing monitor purchase, facilities should carefully consider their needs and the intended application of the monitors.

2. Both CO2 and O2 oxygen monitors are offered in bench top and floor configurations. Line-powered models and battery-powered models are available.

3. Facilities should obtain performance data in the form of tcpO2 versus paO2 correlations at recommended electrode temperatures. This should be examined for each breathing monitor model being considered for purchase.

4. Facilities should also ask manufacturers to provide references from clinical studies performed with their transcutaneous blood gas monitors.

5. Some additional factors to consider include the following: length and coverage of the warranty, quantity discounts given by the oxygen monitor suppliers, and cost of accessories.

Questions for the Seller

Before you purchase your Breathing Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Capnometers and Multiple Medical Gas Monitors

Oxygen Analyzers

Transcutaneous Oxygen and Carbon Dioxide Monitors

# Tips and Guidelines for Buying a Bronchoscope

Flexible bronchoscopes for insertion through respiratory tract

Flexible bronchoscope with plastic sheath, capable of insertion and manipulation through respiratory tract. A television camera on distal tip electronically transmits image through the endoscope for display and recording.

Tips for Buying a Bronchoscope

1. Image quality and ease-of-use are the two most important selection factors for bronchoscopes.

2. The best way to judge the bronchoscope's optical quality is through on-site equipment trials. Facilities are encouraged to use each system on a trial basis before purchasing, to allow physicians to offer their input.

3. Bronchoscopes vary in their image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view. Different types include fiber optic bronchoscopes and flexible bronchoscopes.

4. All controls should be clearly marked and easy to operate.

5. All bronchoscopes should be clearly marked with depth-of-insertion markers. Their dimensions may vary, especially between adult and pediatric models.

6. To aid the physician in estimating the location of the structures under view, markers should be no more than 10 cm apart, and their marked position should be accurate to within 1.0 cm.

7. Bronchial endoscopes should also be compatible with as wide a range of reprocessing agents and devices as possible.

8. The cleaning requirements of these bronchoscopes should be evaluated by facilities. They should also review their scope reprocessing protocol to ensure that it coincides with the scope manufacturer's reprocessing recommendations.

9. Some bronchial endoscopes have channels that can be cleaned with a brush.

10. The purchase of additional bronchoscopes may be needed to fulfill daily caseload requirements if EtO gas sterilization is the preferred reprocessing procedure.

11. Some facilities automate part of their reprocessing with liquid disinfecting or sterilizing units. Users should turn to the operator's manual when reviewing high-level disinfection or sterilization. They should also look at the hospital's infection control and risk management departments.

12. Before making a purchase, facilities should consider the sensitivity of the bronchoscope to heat, the required rinse time and temperature, the reuse life of the cleaning solution, and whether manual or automatic processing will be used.

13. Other factors to consider include: the shelf life of the cleaning solution, the minimum effective concentration, and associated disposal restrictions.

14. Buyers should also consider safety issues and cost-per-cycle, as well as the educational options provided by the manufacturer. Facilities should keep in mind that preventive maintenance training can help in avoiding costly repairs to delicate components.

15. Additional video hardware may be offered. This may include camera adapters, image processors, monitors, and image archiving equipment.

16. Buyers should confirm compatibility between the bronchoscope and an automatic bronchoscope reprocessor.

# Tips and Guidelines for Buying a C-Arm

Mobile R/F units are used in various surgical, critical and emergency care procedures. Radiotransparent beds or tables are used to image patients that cannot be transported to radiology department. Fluoroscopic imaging is real-time , which facilitates quick diagnosis and minimal anesthesia time.

Tips for Buying a C-Arm

1. There are four basic groups of C-arms, including: mini, low-power, medium-power, and high-power.

2. When buying mobile C-arms, these three main features should be considered: x-ray power, geometry, and image processing.

3. Before making a purchase, companies should verify that digital storage and/or transmission devices related to the use of mobile C-arms conform to certain standards.

4. Mini C-arms should be considered for extremity imaging. These smaller Mobile Fluoroscopic-Radiographic units are designed for use in office and surgical environments. Mini C-arms are most useful when instantaneous imaging of the feet, hands, wrists, elbows, or ankles is needed.

5. Hand or foot surgeons are likely to be the main users of these C-arm devices. Bone alignment can be visualized in a non-invasive manner, in real time - which makes these units especially useful during external reduction and fixation of fractures.

6. The other three types of C-arms are usually used in surgical procedures. These systems have been providing more and more imaging tools and increased x-ray power, resulting in more useful imaging and therefore use in cardiac imaging.

7. There are several benefits for increased x-ray power: it allows greater flexibility for imaging and it shortens exposure times and reduces the risk for error. These benefits may be very important for pediatric and obese patients who may find longer exposure times difficult.

8. These Mobile Fluoroscopic-Radiographic units should be maneuverable around hospitals and provide positioning flexibility. The geometry of the units is important for achieving its purpose. A great C-arm depth may be preferable, but it can also make the maneuverability a bit more difficult.

9. For effective and easy usage, the C-arm gantry must have the proper dimensions. For example, it must be deep enough to accommodate obese patients. The mobile C-arm's lower portion must be low enough to fit underneath the hospital's beds and operating room tables.

10. Isocentric rotation, where the center of rotation is the same as the midpoint between the x-ray tube focal spot and the image intensifier, is beneficial.

11. Mobile C-arm images should be quickly manipulated with digital image processing. It is recommended to be able to send data and image to PACS.

12. During fluoroscopic procedures, the C-arm television chain system displays the output of an image intensifier on one or more TV monitors.

13. High-resolution systems, which are offered by some suppliers, are rarely used and require more radiation. When such a system is needed in a mobile C-arm, it should be able to switch between standard and high-resolution modes.

14. The C-arm TV chain should have some additional features such as high SNR, a large digital storage capacity, and the ability to add alphanumeric characters for patient identification to a recorded image.

Questions for the Seller

Before you purchase your C-Arm, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Please specify the included application packages

Is a Radiological Examination Table included ?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Mobile C-Arms

Radiographic and Fluoroscopic Units, General-Purpose

Mini C-Arms

# Tips and Guidelines for Buying CAD Mammography

A computerized image analyzing system of mammographic images. The input to the system is digital mammography images. The system is sometimes designed to digitize films. The software packages are used for the recognition of the pathologies of the breast.

Tips for Buying CAD Mammography

1. Before purchasing a Mammography Image Station or Mammography Unit, buyers should assess the available configurations and their potential impact on workflow. The operating and staffing costs can be affected by the design of the CAD Mammography system and how it fits into the departmental workflow.

2. Facilities should also look at the compatibility of the CAD Mammography system with full-field digital mammography systems.

3. Potential buyers who are currently practicing double reading, or those considering implementing double reading should investigate the cost of CAD Mammography.

4. CAD Mammography systems may provide a cost-effective means of implementing double reading without the need to add more staff radiologists to smaller facilities with few radiologists.

5. A CAD Mammography Image Station system required to process images usually does not require human interaction. Therefore, a low-volume center's existing staff should be able to cover the staffing needs of a CAD system; if the center is very busy, an additional clerical-level staff member may be needed to administer CAD Mammography.

6. The processing rate for different units and the effect on workflow in the facility will determine whether full-time or part-time positions are needed.

7. Facilities that are waiting for prices to drop down might achieve cost savings, but will not be able to enjoy the benefits of using a CAD Mammography Unit to assist the radiologist in mammogram review.

8. The overall sensitivity of the system is a major consideration for buyers; a CAD Mammographic Image Digital Analyzer system with high sensitivity will detect a high percentage of cancers.

9. The term "specificity" refers to the percentage of cancer-free images not marked. In most detection tasks, as the sensitivity is increased, the specificity decreases. Decreased specificity increases radiologist review time. The costs associated with increased sensitivity and those associated with decreased specificity should be balanced.

10. An additional issue to consider is the film throughput of such CAD Mammography devices.

11. Standard mammography film should be used, with a bit depth of 14-μm and pixel size of 50 μm.

Questions for the Seller

Before you purchase your CAD Mammography, we recommend you ask the seller the following questions:

General

Does the system include a printer?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

Mammography Unit

MAM System

Suprevision Forms

MAM System - Dismantling

# Tips and Guidelines for Buying a Cardiac Ablation System

Lesion generators using low-end radio frequency currents (below 500 kHz)

Lesion generators use a low end radio frequency current that is used for selectively removing tissues. This technique removes pain-carrying nerve fibers, and is used for treating trigeminal neuralgia, and severe lower back and leg pain. They can also be used in certain brain operations (for pain management in cancer patients), and in RF catheter ablation for certain cardiac arrhythmias triggered by bioelectric signals.

Tips for Buying a Cardiac Ablation System

1. Ablation technologies are combined methods of multiple modalities that are individually used to excise, destroy or otherwise effectively treat tissue therapeutically for the various purposes of removing dead tissue or other biological matter.

2. To ensure safe and efficient operation of cardiac ablation systems and interstitial thermotherapy systems, facilities need to look into several considerations including: RF generator output, which should be between 0 to 50 W; the waveform should be approximately 500 sinusoidal; stimulator output should range from 0 to 10 V and 0 to 10 mA.

3. Pulse duration of a cardiac ablation system should be between 0 to 3 msec, with a frequency of 2 to 200 Hz.

4. To ensure suitable functioning during its operation, the cardiac ablation system should display the current and voltage range, impedance range, and temperature range.

5. It is recommended to have both visual and audio indicators to show activation. The cardiac ablation system should have a self-test mode and include protective circuits such as patient isolation, fault conditions, and impedance and temperature monitors.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Lesion Generators

# Tips and Guidelines for Buying a Cardiac Catheterization Monitor

Cath lab monitoring/recording system

A system for monitoring and recording during cardiac catheterization procedures. It is used to determine pressures in the heart chambers and great vessels, by amplifying and recording invasive and non-invasive signals including intracardiac electrodes, and blood pressure transducers.. This data enables calculation of many cardiac parameters, to identify pathological conditions, including heart and vascular functions, aorta, vena cava, and shunts flow and pressure, as well as size and severity of lesions.

Tips for Buying a Cardiac Catheterization Monitor

1. The monitoring and recording systems of a cardiac catheterization monitoring system should have: console with high-resolution color monitors, fitted-to-display waveforms and data, an integrated computer with data-processing software and recording media, a chart recorder with printing capabilities, and plug-in modules with vital signs and procedure monitoring functions.

2. Monitoring capabilities of these cardiac catheterization monitors should include 12 surface ECG channels, 4 invasive blood pressure monitors, 1 non-invasive blood pressure monitor, integral SpO2, and cardiac output monitoring. Other available parameters should be specified.

3. The modularity of the multichannel cardiac monitor enables users to add capabilities as needs change.

4. The cardiac catheterization monitoring system should be able to interpret printouts using reference lines or grids and event markers. The multitasking software should allow users to configure parameters and analyze real-time signal.

5. It is recommended that the cath lab system have either integrated or stand-alone electrophysiology capabilities. Many cardiac catheterization monitors offer capabilities for electrophysiology procedures, on top of the cardiac catheterization monitor procedures.

6. If a facility performs a significant number of procedures, it may require a dedicated electrophysiology room with its own system. In some facilities a cardiac catheterization monitor system with dual capabilities for both electrophysiology and cardiac catheterization may be used in the same room.

7. Electrocardiographic monitors with an x-ray image display should also have ventriculography, angiography, frame grabbing, and zoom functions.

8. The number of channels and paper speeds provided by the recording system should be compatible with the facility's applications. The type of recorder used may vary. However, the most important factor on a cardiac catheterization monitor system is a high degree of clarity and accuracy. Hard copies are not necessarily produced.

9. Cardiac catheterization monitoring systems now allow the recording of overlapping waveforms. Facilities should be aware of the differences in the type and cost of paper used by each recorder. A significant amount of paper is needed for each procedure if paper records are kept, and this may have a huge impact on the long-term cost of the system

10. Multichannel cardiac monitor systems can be linked to: each other, central workstations, operating room monitors, personal computers, or hospital data management systems.

11. Storage capabilities may include various hard-disk capacities, and streaming tape or compact discs. Recordable CD technology, known as CD-R, can store a patient's cardiac catheterization study on a single, low-cost disk.

12. Many electrocardiographic monitor systems offer digitization hardware and software for ventriculography or coronary arteriography, based on the system. These tasks may be performed at a central workstation, on the cath lab computer, or on a PC.

Questions for the Seller

Before you purchase your Cardiac Catheterization Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following **Inspections Forms** :

Patient Monitors

ECG Monitors

Blood Pressure Monitors, Invasive

# Tips and Guidelines for Buying a Cardiac Echo

Data analysis systems for cardiac ultrasound images

Computerized systems for analyzing cardiac ultrasound images obtained from cardiac echocardiography. They are capable of calculating various heart function parameters. Cardiac images can be displayed directly during scanning, but are usually used off-line. These systems may be used on desktop, or as a mobile unit.

Tips for Buying a Cardiac Echo

1. When purchasing a cardiac echo, medical facilities should consider the ECG patient load and the analytical software offered by the echocardiography data analysis system.

2. The flexibility and versatility of the echocardiography data analysis system's analytics relies heavily on IBM compatibility. This is an important consideration, because many cardiac echo analyzer programs and other software are designed for the IBM PC.

3. These cardiac echo systems offer many functions that are now directly incorporated into cardiac scanning systems. Therefore, when facilities are planning to purchase a new cardiac ultrasonic scanning system, the necessity for a separate data analysis system should be carefully evaluated.

4. There are some ultrasound scanners that are DICOM compatible; a few of the echo analyzer systems listed in the chart are DICOM compatible.

5. Some additional important cardiac echo system features include: Doppler color-flow software, a color monitor, and a high-resolution VCR; these may be offered either as standard features or options.

Questions for the Seller

Before you purchase your Cardiac Echo, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Cardiac Electrophysiologic Monitor

Cardiac electrophysiology monitoring/recording system

Cardiac electrophysiology monitoring systems are used to perform EPS procedures, to perform diagnostic tests and therapeutic procedures, which include analysis of the atrioventricular conduction system under certain stressors, determination of intervention site, and assessment of sinus node function. They are used during cardiac catheterization.

Tips for Buying a Cardiac Electrophysiologic Monitor

1. In terms of their positioning, cardiac electrophysiology monitoring systems may be mobile, tabletop, or wall-mounted. Physicians should select the maximum channels depending on procedural requirements. The cardiac electrophysiologic monitor should have at least 12 surface electrocardiogram channels and 24 intracardiac electrocardiogram channels, as well as programmed lead switching.

2. The cardiac electrophysiologic monitor system should have a console with high-resolution color monitors fitted to display waveforms and data on an integrated computer with data processing software and recording media. The system should also have a chart recorder with printing capabilities, plug in modules with vital signs and procedure monitoring functions and a remote amplifier unit to process and condition cardiac electrode signals.

3. The cardiac electrophysiologic monitor system should be able to interpret chart printouts using various reference lines. It should also be able to interface with radio frequency generating devices and cardiac CAT lab imaging systems, and use multitasking software with user-configurable parameters that allows real-time signal analysis.

4. The CAT lab system should be capable of networking and communicating with a hospital information system. This type of networking should be bi-directional and Health Level 7 compliant. The cardiac electrophysiology monitoring system should also have the ability to interface with the National Cardiology Database and cardiology data management system.

5. A basic cardiac electrophysiologic monitor system is configured with amplifiers and filters for signal acquisition and processing, a display screen, and a recorder. Preexisting amplifiers can be used and be interfaced with a corresponding display screen and recorder.

6. The number of available electrocardiogram channels is different among different cardiac electrophysiology monitoring systems. The maximum number of channels desired should be determined by clinicians.

7. The number of displayed waveforms varies among display screens, and also the recorders vary in the number of traces recorded.

8. Recorders may not be offered as standard equipment by some cardiac electrophysiologic monitor systems, because all the waveforms can be retrieved from storage and viewed onscreen for manipulation.

9. When a recorder is needed, it should interface with these cardiac electrophysiologic monitor systems. Semi-automated or automated input switching systems enable the selection of different electrode combinations.

10. Most cardiac electrophysiologic monitor systems provide some flexibility in changing some configurations to better fit the needs of the facility.

11. The amount of channels provided by the recording system should fit the facility's applications.

12. Cardiac electrophysiologic monitor systems with communication capabilities enable links to other electrophysiology labs, central workstations, personal computers, CAT labs, or medical centers' data management systems.

13. Cardiac electrophysiologic monitor systems with storage capabilities offer various hard disk capacities and can also have different digital media for archival purposes and easy retrieval of data.

14. Before purchasing a system, facilities should look into their communications and storage needs. These systems are also offered with a variety of analysis and data management software packages, which enable generating user-programmable or customized reports.

15. Most cardiac electrophysiologic monitor system manufacturers do not offer stimulators as standard components. Therefore, these should be purchased from a stimulator supplier.

16. Medical centers need to determine whether separate rooms are needed for the cardiac electrophysiology monitoring system. They should also look at the time required for each test, the type and number of tests, and patient volume.

Questions for the Seller

Before you purchase your Cardiac Electrophysiologic Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

How many inputs there are for Elect. Potentials?

How many inputs are there for invasive pressure?

How many inputs are there for temperature / card. output?

How many inputs are there? Please specify

Recorder

Laser type?

Does it record annotations?

General Information

Can it network between labs?

Programmed lead switching?

Does it include stimulators?

Integral Computer

Does it include data management?

Does it include a report generator?

Does it include statistical analysis?

Interfaces HIS

Does it include HIS interfaces ?

Does it have a cardiology data management system?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Patient Monitors

ECG Monitors

Blood Pressure Monitors, Invasive

# Tips and Guidelines for Buying a Cardiac Output Computer

Device using indicator dilution technique to measure blood flow from heart

A device using indicator dilution technique ( thermodilution) to measure blood flow from the heart. Cardiac output units use a balloon tipped, flow directed catheter with a thermistor placed in the right side of the heart. Output flow is measured. The thermistor signal is processed, and a thermal dilution curve is displayed from which various hemodynamic parameters can be determined.

Tips for Buying a Cardiac Output Computer

1. Cardiac output computer units display the thermal dilution curves to ensure acceptable injection and dilution.

2. The cardiac output monitors should have the capability of removing bad curves to exclude them from the final average.

3. These cardiac output computers should provide a digital display of injectate and blood temperatures, and CO consumption constant with injectate volume/temperature controls and hemodynamic calculations.

4. The cardiac output computers' range should cover 0 to 12 L/min; the injection volume should be delivered at 3, 5, or 10 mL with a temperature range of 0° to 25°C.

5. The cardiac output monitors should provide accurate values with a mean error of 5% or 0.25 L/min, whichever is greater.

6. Cardiac output computers should be precise, regardless of the patient's stroke volume or heart rate, and whether room temperature or ice-cold injectate is used (with a large or small volume over any reasonable range of patient temperatures) in either a weak or firm injection rate.

7. If the cardiac output monitor unit cannot provide a correct calculation, it should display a message describing and explaining the problem.

8. The visual alarm should be easily noticeable and specific to the problem. It should remain on until the problem is corrected; turning off the alarm should be impossible.

9. All cardiac output computer controls should be visible and clearly identified with simple and clear functions. They should be protected against accidental setting changes.

10. Facilities need to determine whether a stand-alone or a modular cardiac output computer is a better fit for their needs. Depending on a facility's physiologic monitoring equipment, a modular cardiac output monitor may allow existing equipment to monitor cardiac output units.

11. It is important to know that some cardiac output monitors can provide trending for curves, while others trend cardiac output units' values. The number of values that can be stored is different among units.

Questions for the Seller

Before you purchase your Cardiac Output Computer, we recommend you ask the seller the following questions:

General Information

Does it have a curve self-test?

Does it have a circuits self-test?

Does it include output computation?

Does it have a thermistor circuit fault indicator?

Does it include a printer/recorder?

# Tips and Guidelines for Buying a Cardiac Stress Test

Systems for cardiac stress tests

Systems used for performing and monitoring stress exercise tests. These systems evaluate cardiac and/or pulmonary function, using treadmills or ergometers. Cardiac stress testing monitors are used as a tool for diagnosis and an overall assessment of cardiac or pulmonary disease. They can be used to predict physiological reaction to stress.

Tips for Buying a Cardiac Stress Test

1. These stress test monitors can administer accurate incremental workloads in a progressive manner.

2. Cardiac stress tests should use a microprocessor-controlled, 12-lead electrocardiograph to record and store electrocardiogram signals.

3. Stress test monitors should display the following: electrocardiogram, heart rate, patient data, blood pressure, treadmill speed and grade/ergometer load, and the protocol being used.

4. The available protocols should be commonly used exercise protocols and user programmable. 5. A printer should be included with the cardiac stress test system to provide hard copy reports.

6. All reports should be: available in standard templates, user-customizable, and user-selectable.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Patient Monitors

# Tips and Guidelines for Buying a Cardiac Video System

Video camera and recording device used for fluoroscopic systems

Video system used to display fluoroscopic images on monitors inside the examination room as well as in remote locations. They are used for CCD cameras, for fast motion studies, or for viewing a series of images. This video system also has recording capability.

Tips for Buying a Cardiac Video System

1. Users can configure fluoroscopic television chains with different combinations of television camera pickup devices and television display monitors.

2. Television camera pickup devices range from tube types to CCDs. Some types hold special qualities, such as: sensitivity, lag, contrast, resolution, noise, and cost. All these features range from poor to excellent, based on the specific fluoroscopic application.

3. Only two characteristics of the different pickup device types are measurable: bandwidth and SNR. Camera tubes and CCDs, which operate at high line rates, need wider bandwidths. However, a wide bandwidth can have a poor SNR.

4. These units are usually purchased as parts of standard radiographic or fluoroscopic or digital angiographic imaging systems.

5. Dual-mode television systems can function in both fluoroscopy and digital angiographies. In some specific procedures, dual systems that provide high-resolution images in conventional fluoroscopy, and 525 line images in digital angiographies may be especially useful.

6. Facilities considering the purchase of this type of unit should look into the intended application of the imaging system and the television chain's compatibility with other parts of the system.

Questions for the Seller

Before you purchase your Cardiac Video System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiographic and Fluoroscopic System - Operational

# Tips and Guidelines for Buying a Cardiology Information System

Cardiology information and image management systems

Cardiac patient information including image management systems, and cardiovascular data providing clinician access for analysis, diagnosis, follow-up, and archiving. Stored data can be transferred throughout the medical facility and to other locations such as physicians' offices.

Tips for Buying a Cardiology Information System

1. When purchasing a cardiology information system, to assist the supplier with providing the requested device, the facility should present a full description of in-house operating systems. In addition, they should specify the maximum number of simultaneous users, required terminals, and sites.

2. The ECG data management system should automatically perform the following tasks: archive entire patient records; backup the data storage; maintain a directory of all archived patients; retrieve data by patient name, ID, archive date, or by other user-defined parameters.

3. User ID and password are the minimum-security features for entering the cardiology information system. It should also have individualized access functions, several levels of system security, and confidential password codes.

4. These cardiology information systems should be able to communicate with a remote workstation, to enable monitoring from a remote site or data download from a physician's office. They should also be able to communicate with other information ECG data management systems.

Questions for the Seller

Before you purchase your Cardiology Information System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Clinical Features, Data

Does it include echocardiology?

Does it include cardiac cat?

Does it include stress testing?

Does it include electrophysiology?

Does it include Holter?

Clinical Features, Waveform

Does it include echocardiology?

Does it include cardiac cat?

Does it include stress testing?

Does it include electrophysiology?

Does it include Holter?

Clinical Features, Image ECG

Does it include echocardiology?

Does it include cardiac cat?

Does it include stress testing?

Does it include electrophysiology?

Does it include Holter?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Cataract Surgical Unit

Units for cataract extraction using probe with ultrasonic waves

A device for cataract extraction, using a probe that cuts and emulsifies the lens using ultrasonic waves. These devices include a hollow probe with irrigation sleeve, an oscillating tip to convert electric energy to US waves, and a channel for aspiration of lens fragments. Also included is a mode of operation unit .

Tips for Buying a Cataract Surgical Unit

1. The most important considerations are safety and effectiveness.

2. Another important factor is how comfortable the surgeon is using the system.

3. Users should be able to operate the units remotely.

4. The units should possess irrigation, irrigation/aspiration, ultrasound, diathermy, and vitrectomy operational modes.

5. All hand pieces should weigh less than 5 oz.

6. The following features are required for the US system hand piece: a piezoelectric transducer that causes the hand-piece tip to vibrate at a frequency of 25 to 80 kHz, a pulse mode, and made from autoclavable titanium.

7. It is also recommended that the US hand piece feel light and comfortable enough in the surgeon's hand. Additionally, the response of the foot pedal control should be suitable, the system should deliver the objectives and the US output that the surgeon requires.

8. The I/A hand piece should be autoclavable with 0.2-0.5 mm port diameters. It should have a peristaltic pump capable of 500 mmHg maximum vacuum, atmospheric vents, and gravity or pump reversal reflux.

9. The anterior vitrectomy mode should utilize a guillotine type hand piece with variable speed.

10. The following may come standard with the unit or as options purchased separately: ultrasonic capsulotomy, automated reflux, anterior or posterior vitrectomy, and diathermy capabilities.

11. Buyers should examine the differences in cost between disposable and reusable I/A tubing, collection devices, and other equipment.

12. Facilities performing many phacoemulsification procedures must remember that they need to sterilize most of the reusable equipment after every operation.

13. Before making a purchase facilities should make sure that service support is readily available, and replacement or repair parts are easily identified and quickly obtainable.

14. Free operation and maintenance training should be offered by the supplier, along with a clear, concise, and comprehensive instruction manual.

Questions for the Seller

Before you purchase your Cataract Surgical Unit, we recommend you ask the seller the following questions:

Ultrasound System

Is it autoclavable?

Does it include pulse mode?

I/A System

Is it an atmospheric type?

Is a bottle included?

Is tubing included?

Is it reusable?

Is it disposable?

Is it autoclavable?

Operational Modes

Does it include irrigation?

Does it include anterior capsulotomy?

Does it include vitrectomy?

# Tips and Guidelines for Buying a Cath Lab

Angiographic and special-procedure R/F imaging systems (fluoroscopy), including cardiovascular and cardiac catheterization

X-ray fluoroscopic angiography (both diagnostic and interventional) is the most widely used vascular imaging system. Integrated R/F units utilizing video/movie camera equipment, digital recording devices, as well as the patient table. This equipment is suitable for performing the evaluation and treatment of cardiac catheterization (Cath Lab) and for other cardiovascular diseases. It provides real-time images of blood flow and vascular activity for diagnosis or during surgical procedures.

Tips for Buying a Cath Lab

1. Devices in the cardiac catheterization field are concerned with the study and treatment of the heart chambers, coronary arteries, and other proximal vasculature. Categories in this field may include: Cath Labs, Radiographic Fluoroscopic units, Digital Vascular Imaging Systems, Angiography Units, Cardiac Catheterization Equipment and Cardiac Cath Lab Imaging Systems The preferences and recommendations regarding angiography are for systems intended mainly for peripheral and abdominal vasculature cases.

2. All three types of systems - cardiac catheterization equipment, general angiography units, and multipurpose systems - have different requirements regarding the C-arm assembly, image-acquisition detector, image processor, and patient-table characteristics.

3. The requirements of general angiography systems include: a larger field of view, expended tabletop movement, a lower frame rate, and C-arm gantry angulation range that is less than that of dedicated cardiac catheterization equipment.

4. In some hospitals, the demand for any one procedural category may not justify a dedicated Cardiac Cath Lab Imaging System. The multipurpose special procedure systems are designed to meet such needs. However, both cardiologists and radiologists should be concerned with detector size.

5. Rotational angiography capabilities, which are offered by some Cath Lab systems, allow users to select start and end points for arm rotation. These systems can be used in bolus chasing and certain cardiac imaging procedures. Although rotational angiography is slower than biplane systems, it is useful in studies traditionally performed with biplane systems.

6. Facilities that are considering the purchase of a Cath Lab capable of rotational angiography, should determine how it applies to the types of procedures performed in the facility and the rotational speed offered by the Digital Vascular Imaging System.

7. One of the most important factors to consider before purchasing an angiography unit is detector size. For imaging peripheral vessels, larger sizes may be necessary, while smaller sizes are suitable for more detailed images of cardiac anatomy.

8. When selecting an x-ray generator, facilities must also consider the needs of the department in mind. The following Digital Vascular Imaging System generators are currently available and commonly used for vascular imaging: three-phase, 12-pulse, high frequency, and constant-potential generators.

9. While constant potential generators have the lowest amount of ripple but can be larger and more expensive, high frequency generators are smaller and easier to install in space-constrained areas, with an amount of waveform ripple that is not clinically significant.

10. Some additional critical factors when choosing a Cath Lab are the heat dissipation rate and heat capacity of the x-ray tube anode. Only 0.2% of the electrical energy delivered to any given tube is converted to x-rays; the rest is converted to heat, which will harm the anode if not quickly dissipated.

11. The following may help dissipating the heat: rotating and larger diameter anodes, circulated liquid cooling systems, and ceramic tube envelopes, also crucial when considering a Cath Lab purchase..

12. When using a Radiographic Fluoroscopic Unit, using higher anode heat capacity provides longer fluoroscopy runs, higher overall output, and an extended x-ray tube life.

13. For some advanced interventional procedures that require longer imaging times, the high heat capacity and faster heat dissipation tubes are especially important in a Cath Lab.

14. Cath Lab anode heat capacity should be at least 1,000,000 HU.

15. Facilities should also consider the Angiography Unit's focal spot size and target angle of the anode. Anodes with a smaller focal spot provide better quality images but do not dissipate heat as well as larger ones, which are ideal for investigating ischemic heart disease. Cath Lab magnification angiography requires a focal spot size of 0.3 mm or less.

16. Cath Lab Manufacturers often offer multi focus tubes with two or three focal spot sizes, to accommodate this wide range of imaging techniques and procedures.

17. The focal spot size and the heat dissipation characteristics of the tube are both determined by the target angle, another important feature to consider when purchasing a Cath Lab.

18. Pulsed fluoroscopy can be carried out by some of the Cath Lab systems. In this technique an x-ray output of 32 pulses per second is possible.

19. The monitor holds the image acquired during each pulse until it is updated by another pulse and a continuous image is seen as a result; although the pulsed-mode display may become jittery a very fast motion is observed.

20. Exposure rates can be significantly reduced by pulsed fluoroscopy by as much as 70% without a significant loss of image information. Some Cath Lab systems can perform multiple-rate pulsed fluoroscopy with two or more rates ranging from 7.5 to 30 fps.

21. The last-image holding feature, which retains the fluoroscopic image on the screen even after the x-rays are turned off, is offered by some Cardiac Catheterization Equipment systems. This feature enables the radiologist to examine the area in question with decreased x-ray exposure to the patient.

22. DSA is the most common application in Cath Labs. A mask image is digitally stored before injection of the contrast medium and then subtracted from the image acquired after injection.

23. Another common application is the road mapping, which allows Cath Lab users to retain a contrast-enhanced image on the monitor for use as a guide during certain procedures. Using this feature can facilitate the placement of devices such as stents and balloons and the navigation of guide wires and catheters through severe stenoses, as well as reduce the total contrast medium dose.

24. Cath Lab Systems offering three-dimensional angiography should be considered by facilities planning to purchase new R/F angiographic systems.

25. Multiple views can be recorded from a single injection of contrast medium by using rotational angiography, which is an acquisition mode designed to allow this capability in Cath Labs.

Questions for the Seller

Before you purchase your Cath Lab, we recommend you ask the seller the following questions:

General

Did this equipment pass the American College of Radiology (ACR) accreditation?

What is the size of the detector (Length + Width)?

DICOM 3.0

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Angiographic Systems

# Tips and Guidelines for Buying a Cautery Unit

The Electrocautery units are used to stop bleeding by means of heat

The Line-Powered Electrocautery Units are used for the electro cauterization (or electrocautery) in surgery to burn and seal blood vessels to stop bleeding, and to remove unwanted or harmful tissue. The electro cauterization is achieved by using a small probe with a heated tip, or a tip that uses an electric current running through it, to burn or destroy the tissue.

Tips for Buying a Cautery Unit

1. The intended use of these units, as well as the users, should determine most of the unit's specifications.

2. The unit has a cable attached to its handle. To allow free maneuverability, the length of this cable should be at least 1.5 m (5 ft).

3. These units are typically cheaper than ESUs and surgical lasers. However, thermal cautery units offer more limited uses.

4. The units can be purchased with various special features, which add greatly to the cost. These extras may include probes with integral water jets for clearing blood from endoscopic surgical sites, computer-controlled units, units that have power-supply controllers with digital displays of temperature setting and other information, and smoke evacuation systems.

Questions for the Seller

Before you purchase your Cautery Unit, we recommend you ask the seller the following questions:

Activation Control

Does it include a handle switch?

Does it include a footswitch?

Does it have thermal control?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrosurgical Units

# Tips and Guidelines for Buying a Cell Saver

Autotransfusion units for blood processing

1. Strict quality assurance programs should be developed by facilities performing auto-transfusion. A physician dedicated to the program should direct these; a full-time intra operative blood salvage staff should be in place.

2. Blood recovery is the main purpose for which this system should be designed. Other applications such as plasma sequestration, as an example, are optional.

3. These units should be equipped to display the following: cycle mode, pump, wash speed, wash volume, and alarms.

4. Units containing an integral regulated aspirator are preferred, though this feature is not required.

5. The instruments should display operator messages and individual and cumulative bowl tallies.

Questions for the Seller

Before you purchase your Cell Saver, we recommend you ask the seller the following questions:

General Information

Does it have an automatic mode?

Does it have a manual mode?

Does it include an integral aspirator?

Does it include a reinfusion-line air detector?

Does it have an occlusion alarm?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Autotransfusion Units

# Tips and Guidelines for Buying a Cell Washing Centrifuge

Cell washing, low speed, non-refrigerated table top centrifuge

Automatic washing, decanting, mixing, and rewashing of red blood cells. Little or no sample preparation is necessary before Coombs testing. This standard blood bank test detects most antibodies associated with transfusion problems.

Tips for Buying a Cell Washing Centrifuge

1. The specific needs of facilities should determine most cell washing centrifuge specifications, such as: rotational speed, display type, and capacity.

2. These are some preferred cell washing centrifuge features that help ensure safety and ease of use: biohazard-containment capabilities, programmability, and lid interlock.

3. The recommended cell-washing centrifuge motors are the brushless motors. They do not require as much maintenance, because they do not experience the wear and tear that traditional cell-washing centrifuge motors undergo.

4. Audible alarms are preferred over visual indicators. Alerts should sound at the end of a run or cycle and for imbalance, current leakage, and open lid.

5. Laboratory personnel is strongly encouraged not to operate cell-washing centrifuges with lids open because of the hazards posed by a flying rotor or the dispersal of biologically hazardous material.

6. Workers may be exposed to the risk of infection and injury from blood products and glass sprayed from beneath the lid onto the chest.

7. Rotor misalignment, old or defective tubes, or incorrect use may cause tube breakage in cell-washing centrifuges.

8. When purchasing a cell-washing centrifuge, facilities should consider safety features as a main factor. Cell-washing centrifuges with safety lid latches and/or interlocks that shut off the motor when the lid is opened or that keep the lid latched until the rotor has stopped are preferred. The unit should have an inner lid that can be securely fastened.

9. Some more safety features include an inner protective cover over the rotor assembly, as well as a clear label warning not to open the cell-washing centrifuge while the rotor is spinning.

10. The visual indicators on the cell-washing centrifuge should be clear and easily read.

11. To avoid spending on unnecessary capabilities or purchasing a cheaper model that cannot handle the workload or that is inadequate for certain procedures, facilities should try to correlate cell-washing centrifuge features with their current and future laboratory needs.

12. In large facilities, where many cell-suspension samples are centrifuged daily, a cell-washing centrifuge with programmable functions may be required. These units are not needed in smaller laboratories that process a low or moderate number of daily samples.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Centrifugal Laboratory Analyzer

Laboratory analyzers which perform discrete chemical analysis

Automatic analyzers for discrete chemical analysis, using a rotating rotor disk. Reagents are transferred to sample wells as the disk rotates. Reagents are then transferred to an outer disk, to be read by a photometer.

Tips for Buying a Centrifugal Laboratory Analyzer

1. A clinical chemistry analyzer, like any other analytical instrument, must provide consistently accurate and timely test data to be cost-effective. An inexpensive centrifugal laboratory analyzer with low-cost reagents that breaks down frequently, requires a high percentage of repeat tests. The device is labor-intensive to use and may cost more over time than a more expensive clinical chemistry analyzer that is durable, analyzes samples accurately and reliably, and is relatively easy to operate. However, before considering instrument quality, a laboratory must determine if its own chemistry needs to correspond with the capabilities of the clinical chemistry analyzer. Purchasers should consider a centrifugal laboratory analyzer that can fulfill laboratory requirements such as the following: Performing the kinds of tests and test profiles (i.e., combinations of tests) requested by the physicians in the facility. Clinical chemistry analyzers that have random access testing can perform a variety of tests simultaneously and can reduce turnaround time for the results of certain test profiles

2. Processing the specimen workload (stat test counts should be considered separately from nonemergency tests in calculating the needed throughput).

3. Handling the work flow (i.e., the varying numbers of specimens submitted to the laboratory throughout the day).

4. Fitting in the available laboratory space.

5. Requiring relatively little time and training to learn to operate based on the degree of sophistication of the centrifugal chemistry analyzer equipment and the level of experience, competence, and training of the laboratory personnel who will operate it. In addition to these basic requirements, other clinical chemistry analyzer features that should be considered are walk-away capability, preferred report format, bar coding, the ability to run different types of samples, automated sample dilution, onboard reagent stability, and closed-tube sampling. ECRI recommends that all centrifugal chemistry analyzers have alarms that alert users to any system failure (e.g., insufficient reagents, out-of-range errors) that can produce false results.

6. Centrifugal laboratory analyzer buyers should be aware that a clinical chemistry analyzer's throughput depends on the number and type of tests performed by the instrument during a particular time. Very high throughput claims by a manufacturer may be based on tests that react rapidly to the addition of chromogenic reagent (i.e., have short incubation times) and quickly show measurable results. Centrifugal laboratory analyzer manufacturers should reveal the test profile, and the number and kinds of tests used to determine analyzer throughput claims.

7. Final regulations of the Clinical Laboratory Improvement Amendment of 1988 (CLIA 88) were published in February 1992 by the Department of Health and Human Services (HHS). Under the CLIA 88 regulations, all clinical laboratories are required to obtain federally issued certificates. To acquire a certificate, a lab must meet all relevant standards, which are determined by the complexity of the tests being performed.

8. The standards set forth by CLIA ˜88 apply to areas such as patient test management, quality control (QC), proficiency testing, personnel qualifications, and quality assurance programs. Certification fees vary according to complexity level and test volume. There are three different levels of complexity outlined in the CLIA regulations waived, moderate complexity, and high complexity. Waived tests require little or no training or experience to perform, do not require elaborate quality control, and therefore, are less likely to produce inaccurate results. Non-automated dipstick urinalysis is one of several waived tests. The moderate-complexity category encompasses most clinical laboratory tests, including automated urine, blood, and chemistry analyses. Tests and centrifugal laboratory analyzers in this group require a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process. The high-complexity classification covers more specific testing, which requires extensive education and training in the specialty. Procedures that necessitate a high degree of operator preparation, calibration, intervention, and analysis, such as clinical cytogenics and histopathology applications, are placed in the highly complex category.

9. Before purchasing new clinical chemistry analyzer equipment or upgrading existing clinical chemistry analyzer equipment, laboratories should thoroughly investigate the CLIA regulations that apply to their facility and to the centrifugal laboratory analyzer devices being considered. In certain situations, purchasing or upgrading a centrifugal laboratory analyzer device may change the complexity category of the procedures. This could require additional staff training and certification, as well as changes in QC, proficiency testing, quality assurance programs, and other laboratory procedures. With clinical chemistry analyzers, an important consideration is the system's computer interface capabilities. The effectiveness of the interface with the laboratory information system (LIS) or the hospital's central computer system is crucial for inputting test data, verifying testing accuracy, and maintaining QC, calibration, proficiency testing, and patient files according to CLIA. Although CLIA does not mandate computerized reporting systems in hospital laboratories, it does require labs to have a system in place to ensure compliance with CLIA performance standards for QC and quality assurance of patient testing instruments and procedures. An LIS is a fast and efficient way to manage the large volume of test data that a laboratory generates each day, as well as a convenient method to organize and store data needed to comply with CLIA and other inspection agencies' requirements. Hospitals should perform a cost assessment of the centrifugal laboratory analyzer's operating features, such as its testing reliability and accuracy, cost per reportable result, stat time, average downtime, QC and calibration methods and frequency, start-up procedures and time, and the cost of labor, consumables, maintenance, and service.

10. Also included in this assessment should be nonoperational but essential expenses such as: clinical chemistry analyzer installation (e.g., some clinical chemistry analyzers require special plumbing and/or water filters), the disposal costs for solid and liquid waste generated by the unit, and reagent preparation and storage.

11. In addition to reagents and other disposables, the cost of consumables should also include an estimate of the amount of water used over a specified time by centrifugal laboratory analyzers that require a water reagent supply. Centrifugal laboratory analyzer water costs can range from relatively small amounts to a significant proportion of an instrument's overall operational costs. Using deionized water may be much more expensive than using local water.

12. The centrifugal laboratory analyzer purchaser should carefully evaluate the manufacturer's service, which should include 24-hour hotline access. The buyer should also inquire about the terms of the warranty (e.g., some may not include preventive maintenance visits), as well as which service contracts are available, what they include, and what discounts are available if the contracts are purchased at the same time as the centrifugal laboratory analyzer. The buyer should also inquire about service coverage if other manufacturers' reagents are used on the clinical chemistry analyzer. Hospitals can purchase service contracts or service on a time-and-materials basis from the vendor. Service may also be available from a third-party organization.

13. State-of-the-art computer-driven centrifugal laboratory analyzers can become obsolete in a very short time, if they cannot be adapted for future advances in hardware development or accept software upgrades. Clinical chemistry analyzers that have the flexibility to accept these kinds of improvements have a long-term advantage over those that do not. By the same token, clinical chemistry analyzers that have open channels can be programmed to perform new analytical tests as they are developed by the instrument manufacturer. Most clinical chemistry vendors provide routine software updates, which enhance the system's performance, at no charge to service contract customers. Furthermore, software updates are often cumulative; that is, previous software revisions may be required in order to install and operate a new performance feature. Many clinical chemistry vendors do not extend system performance and uptime guarantees beyond the length of the warranty unless the system is covered by a service contract. ECRI recommends that hospitals negotiate pricing for service contracts before the system is purchased, to maximize bargaining leverage. Additional service contract discounts may be negotiable for multiple-year agreements, or service contracts that are bundled with contracts on other centrifugal laboratory analyzers in the department or hospital.

14. Buyers should also negotiate for a non-obsolescence clause stating that the clinical chemistry analyzer vendor agrees not to introduce a replacement system within the next one or two years, and if a replacement system is introduced during this time period, 100% of the purchase price can be applied to the purchase of the new centrifugal laboratory analyzer.

15. In addition, given the current highly competitive market for clinical chemistry analyzer equipment, hospitals should negotiate for a significant discount — some vendors may discount up to 20% or 30%. The actual discount received will depend on the hospital's negotiating skills, the system configuration and model to be purchased, the number of units being purchased, previous experience with the vendor, and the extent of concessions granted by the vendor, such as extended warranties, fixed prices for annual service contracts, and guaranteed on-site service response.

16. Buyers should make sure that application training is included in the purchase price of the clinical chemistry analyzer. Some vendors do offer more extensive on-site or off-site training programs for an additional cost. ECRI recommends that buyers consider the number and types of tests performed before deciding on a specific system configuration. Also, if multiple centrifugal laboratory analyzers are being purchased, hospitals should consider the types of systems and capabilities that need to be purchased to avoid paying for unnecessary analysis packages.

17. For instance, a hospital may want to purchase two centrifugal laboratory analyzers, one dedicated to routine general chemistry profiles, and one for stat testing. In this case, purchasing both clinical chemistry analyzers from one vendor could result in a significant discount. Standardization of equipment can make staff training easier, simplify servicing and parts acquisition, and provide greater bargaining leverage when negotiating new equipment purchases and/or service contract costs. Current clinical chemistry analyzer users are valuable sources of information on the quality, reliability, and overall efficiency of the instruments. Buyers should ask centrifugal laboratory analyzer manufacturers to supply an unedited list of their customers when considering an instrument.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Centrifuge

Floor centrifuges, refrigerated/non refrigerated, high/low speed

Centrifuges for collection of microorganisms, cells and cellular debris, and precipitates. These high speed floor units operate at max. speeds of 10,000-25,000 rpm, and are also capable of sedimenting viruses and cellular organelles. Low-speed refrigerated units or nonrefrigerated ones which operate at room temperature are also available.

Tips for Buying a Centrifuge

1. The specific laboratory centrifuge needs of facilities should determine most centrifuge specifications such as rotational speed, display type, and capacity.

2. These are some preferred features that help ensure safety and ease-of-use: biohazard-containment capabilities, programmability, and lid interlock.

3. The recommended motors are the brushless motors. They do not require as much maintenance because they do not experience the wear and tear that traditional centrifuge motors undergo.

4. Audible alarms are preferred over visual indicators. Alerts should sound at the end of a run or cycle and for imbalance, current leakage, and open lid.

5. Laboratory personnel is strongly encouraged not to operate laboratory centrifuges with lids open because of the hazards posed by a flying rotor or the dispersal of biologically hazardous material.

6. Centrifuge workers may be exposed to the risk of infection and injury from blood products and glass sprayed from beneath the lid onto the chest.

7. Rotor misalignment, old or defective tubes, or incorrect use may cause tube breakage in centrifuges.

8. When purchasing a refrigerated centrifuge, facilities should consider safety features as a main factor. Laboratory centrifuges with safety lid latches, and/or interlocks that shut off the motor when the lid is opened, or keep the lid latched until the rotor has stopped are preferred. The centrifuge unit should have an inner lid that can be securely fastened.

9. For laboratory centrifuges that process many different types of samples, it is recommended that the centrifuge have room temperature and cold-temperature operation capabilities.

10. Some more safety features include an inner protective cover over the rotor assembly, as well as a clear label warning not to open the laboratory centrifuge while the rotor is spinning.

11. The visual indicators on the refrigerated centrifuge should be clear and easily read.

12. Facilities should look into the issue of cost of a warranty and of applicable disposables that are used regularly, such as brushes, when purchasing laboratory centrifuges.

13. To deal with various needs of discrete workstations, facilities may wish to install two or more refrigerated centrifuge units. This may also help with handling a staggered workflow and large and small specimen batches.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Centrifuge, Table Top

Refrigerated and non-refrigerated centrifuges for clinical laboratory testing

Centrifuges for use in the clinical laboratory. The simplest model is a metal rotor with holes that can hold vessels of samples. The samples are spun using high-gravity centrifugal force to expedite separation of suspended particles from liquids (body fluids, commercial reagents, etc.) or to separate liquids of different densities.

Tips for Buying a Centrifuge, Table Top

1. One of the main factors to consider when buying a tabletop centrifuge is safety.

2. A preferred laboratory tabletop centrifuge is one with a securely interlocking lid that either shuts off the unit's motor when the lid is opened or keeps the lid latched until the rotor has stopped. In addition, an inner protective cover over the rotor assembly is recommended, as well as a displayed alert not to open the tabletop centrifuge while the rotor is spinning.

3. The visual indicators on the laboratory tabletop centrifuge should be clear and easily read.

4. It is recommended to have audible alarms for conditions such as: device malfunction, rotor imbalance, open lid, and end-of-run or cycle.

5. The preferred motors are the brushless motors, which require less maintenance than the traditional tabletop centrifuge motors.

6. To avoid overspending on a tabletop centrifuge and paying for unnecessary features, facilities should try and correlate laboratory tabletop centrifuge features with their current and anticipated laboratory needs. On the other hand they should not be purchasing a cheaper model that cannot handle the laboratory workload or that is inadequate for certain procedures.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Chemistry Analyzer, Manual

Manual chemical analyzers for clinical laboratory use

Manual chemical analyzers are used for testing a limited amount of samples, or as back-up. Reagents and samples are introduced manually for each test. Chemical analyzers of this kind are mainly used to measure analyte concentrations, hematology values, and to analyze composition of therapeutic drugs.

Tips for Buying a Chemistry Analyzer, Manual

1. When selecting a manual clinical chemistry analyzer, facilities should look into its test-menu options, the overall physical conditions in which it will be used, such as quality and availability of water supplies, electrical supplies, and space allocation.

2. Bigger facilities can use clinical chemistry analyzer units that offer a broad range of tests as backup systems. Physician offices or outpatient clinics can use such units as the primary instrument.

3. These are some of the factors which determine the manual clinical chemistry analyzer's price: test-menu options, degree of operator input, price of reagents, disposables, and other supplies needed to operate the cholesterol analyzer.

4. Users need to decide whether the clinical chemistry analyzer can perform the needed test mix prior to purchasing any analytic system.

5. The clinical chemistry analyzers with the widest testing capabilities are those that use spectrophotometer. Filter photometers can only perform tests that are measurable at wavelengths for which the instrument has filters.

6. When selecting a manual clinical chemistry analyzer, facilities should look into the following considerations:

7. A qualified user should be able to operate the cholesterol screening device with minimal error with the help of proper labeling, and instructions and a display that is easy to read and interpret.

8. A clearly written and comprehensive operator's manual should accompany the clinical chemistry analyzer, describing test methodology, all operating controls functions, error messages, diagnostics, and troubleshooting instructions for minor problems.

9. Manual clinical chemistry analyzer operating instructions should also identify all consumables and frequently replaced parts, and the manual should also provide guidance on the routine use of control material to ensure proper system operation.

10. Preventive maintenance should be minimal and easy to perform, and the clinical chemistry analyzer should be easy to clean, disassemble, and reassemble.

11. The cholesterol screening device user should never be exposed to any biohazards by the unit or any of its accessories.

12. These are some of the features to be considered by facilities buying an clinical chemistry analyzer:

13. The concentration range over which a manual clinical chemistry analyzer can measure a particular analyte. This value should be checked carefully, because the actual range may vary significantly from that stated by the manufacturer.

14. The ability to determine the true or actual value of an analyte and standards or controls used to verify this is typically instrument-specific and is supplied by the cholesterol screening device's manufacturer.

15. The linearity of a cholesterol analyzer determines how accurately the unit can measure analyte concentration over a certain concentration range as determined by a given control or standard.

16. Clinical chemistry analyzers with large linear ranges can analyze samples with a wide range of analyte concentrations without diluting or manipulating them in any way; this feature provides faster turnaround of results and may save operator time if dilutions must be manually performed.

17. A high degree of precision (which is a measure of how closely a test result can be reproduced) not only provides a more sensitive determination of changes in the patient's condition, but also may reduce the need for duplicate testing to verify the accuracy of initial test results.

18. Cholesterol screening devices that give readings with a high degree of precision for extended periods of use have very stable calibration curves.

19. These units may be less costly to operate than manual clinical chemistry analyzers with more labile curves, because they do not require recalibration as often. Therefore, the unit uses fewer calibration standards and runs fewer patient analytical tests.

20. A clinical chemistry analyzer with low specificity for a particular analyte cannot discriminate between it and similar, but different substances and may include them all in the analyte measurement.

21. Clinical chemistry analyzers that measure a substance nonspecifically may provide results that can potentially lead to a false diagnosis and require testing verification on other instruments, increasing the cost of testing.

22. Medical Centers should consider whether the manual clinical chemistry analyzer can accept future hardware upgrades and can interface with medical center computer systems. The cost of upgrading the software annually should be included in an estimate of recurring expenses.

23. Long-term storage of results for physician review or for entry into a data management system requires a large memory.

24. Medical centers can simplify record keeping and quality control using built-in data management systems that store and print quality control or patient test values or transfer it to a computer. However, these are not essential features but they facilitate data organization for inspections by various agencies.

25. For medical facilities, the storage of the date, time, and patient/operator identification is essential.

26. Tests in the waived tests category involve very little or no training or experience to perform. These do not require elaborate quality control, and therefore are less likely to produce inaccurate results.

27. Most clinical laboratory tests, including automated urine, blood, and chemistry analyses, belong to the moderate complexity category. Tests and analyses in this group need a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process.

28. The highly complex category includes procedures that require a high degree of operator preparation, extensive education and training, calibration, intervention, and analysis, such as clinical cytogenetic and histopathology applications.

29. Facilities should be aware of the fact that purchasing or upgrading a device can change the complexity category of the procedures.

Questions for the Seller

Before you purchase your Chemistry Analyzer, Manual, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

General Information

Maintenance time requested daily

Maintenance time requested weekly

Maintenance time requested monthly

Is it an open system?

Does it include a computer ?

Does it include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Chest X-ray

Chest radiographic units, conventional and digital

Units for radiographic imaging, both conventional and digital, regular or automatic, of the thorax. These images are used for both routine pulmonary surveys and for clinical diagnostic use. They are used for diagnosing lung disorders (infections, malignancies), and for imaging inhaled objects.

Tips for Buying a Chest X-ray

1. Buyers in the market for Chest Radiographic Units should consider an x-ray generator with 3-phase, 12-pulse output or the equivalent with an appropriate power rating; an x-ray tube with a dual focal spot; and an anode with a high-speed rotor.

2. For chest x-ray procedures, a 5 kW generator is acceptable. If other projections - such as lumbar spine - are necessary, users should consider an 80 kW generator.

3. An external cassette holder is one of the available options, which allows the use of either portrait or landscape alignment of 35 × 43 cm film.

4. Another option on some Multibeam Equalization Radiographic Units is film-size interchangeability.

5. There are several advantages to digital chest x-ray systems over conventional chest radiographic units. The main one is that the dynamic range of digital imaging receptors is much larger than that of x-ray film. While x-ray film can record exposure differences of approximately 100:1, digital imaging receptors record differences of approximately 10,000:1. This large dynamic range allows a wider range of exposures, diminishing the need for additional exposures.

6. Other benefits of direct digital chest x-ray imaging include: post processing features, electronic storage, and networking capability.

7. Chest Radiographic Unit image quality is defined by pixel size and the signal-to-noise characteristics of the detector. Digital chest x-ray systems must produce high-quality radiographs fast and effectively.

8. Some systems can read out and process an image in less than 10 seconds, while nontraditional techniques take over a minute. This time is not the same as the cycle time. Some systems with longer image-readout time can re-expose the patient before the final image is ready. Therefore, even the busiest system only needs to process up to 60 images per hour.

9. To deliver images to radiologists without further manipulation, advanced chest x-ray image processing must be available after the image is produced.

10. Advanced applications, such as dual energy subtraction, temporal subtraction, and computer-aided detection, can be done with digital image capture. This allows collecting more information from simple chest x-rays.

11. To facilitate future network additions, all newly purchased equipment should be compliant with the DX class of the DICOM 3.0 standard.

12. Suppliers need to provide DICOM-conformance statements. These should explain in detail which information objects, service classes, and data encoding are supported by the chest x-ray system. The statements should be inspected by a competent specialist, and should share the same format and vocabulary to facilitate comparisons between suppliers.

13. Facilities should verify compatibility among components if they plan to integrate the chest radiographic unit with other x-ray components.

14. Facilities should consider overhead patient-support bars in departments examining extremely ill or debilitated patients.

15. Some chest x-ray units require keypunch cards or file cards for patient identification. Others accept both.

16. A stereo-shift option for depth-perception studies or support belts for securing the patient against the unit are not offered by all chest x-ray manufacturers.

Questions for the Seller

Before you purchase your Chest X-ray, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Radiographic Units, Chest System

When was the x-ray tube last exchanged?

Is the rotating motion smooth?

Is the up-down motion smooth?

Work Station

LCD monitor?

Work station transportation wills roll smoothly?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

X-Ray System - Stored

X-Ray Conventional Radiographic System - Operational

Suprevision Forms

X-Ray System - Dismantling

# Tips and Guidelines for Buying a Choledochoscope

Upper GI endoscopes with various light sources and video processors

Gastroscopes are used for diagnosing and treating upper GI disorders.

Tips for Buying a Choledochoscope

1. The most important quality of the choledochoscope's image is the optical quality.

2. The following factors determine this quality: the ability of the fiber optic cables and the light source to adequately illuminate the area under view; the ability of the lens system to transmit a clear and bright image with minimal distortion to the eyepiece.

3. When making a purchase of a gastrointestinal choledochoscope, facilities should consider the device's sensitivity to heat, the time and temperature of rinsing required, the reuse life of the cleaning solution, and the use of manual or automatic processing.

4. Other issues to consider when purchasing a fiber optic choledochoscope include: shelf life, disposal restrictions, and minimum effective concentration of the cleaning solution.

5. Choledochoscope buyers should also examine the safety and cost per cycle, as well as the educational options provided by the manufacturer. They should keep in mind that preventive maintenance training can eliminate costly repairs to delicate components.

6. The differences between these fiber optic choledochoscope units include differences in image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view.

7. Videoscopes depend on the number of pixels on the CCD to illuminate the area under view, while Fiberscopes and videoscopes both depend on the light guide.

8. Videoscopes and fiberscopes with cameras depend on the ability of image processors to transmit clear images to the viewing screen.

9. All flexible endoscopes should be compatible with multiple processors. Choledochoscopes should also be compatible with multiple light sources.

10. Gastrointestinal choledochoscope users can clean the lens without removing the scope using lens washing.

11. Choledochoscope buyers should look into the cleaning process of the scope. They should carefully review their flexible endoscope reprocessing protocol to make sure it coincides with the recommendations from the manufacturer.

12. In places where EtO gas sterilization is the preferred reprocessing procedure, there might be an increased need for more choledochoscopes in order to meet daily caseload requirements.

13. There are users who want to automate part of their reprocessing with liquid disinfecting or sterilizing units.

14. When reviewing high-level disinfection or sterilization, facilities should look into the operator manual as well as the facility's infection control and risk management.

Questions for the Seller

Before you purchase your Choledochoscope, we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

Optics

Does it have ocular focusing?

Does it have compatible cameras?

Does it perform lens washing?

Does it include a light source?

Does it include a video system?

Does it come in the original box/case?

Does it have any optical defects?

Umbilical Cord

Does it have an aspiration option?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Endoscopes

# Tips and Guidelines for Buying a Cine Camera

Special cameras adapted for fast recording of fluoroscopic images on roll film

Special cameras adapted for fast recording of fluoroscopic images in cardiac procedures, and other radiographic examinations. These cameras were designed to record 16 or 35mm roll film that can be played back on projectors.

Tips for Buying a Cine Camera

1. Digital storage systems are gradually replacing these devices.

2. The average archiving costs of cine film is $100 per patient, while digital storage of cardiac catheterization data costs a few dollars per patient study.

3. There is a standard for storage media, file formatting, and digital image retrieval/processing; in early 1995, network image transfer of x-ray angiographic and radiographic/ fluoroscopic images was added to the standard.

4. Facilities should use these standards to eliminate problems with acquiring, storing, and transferring digital angiographic images and information from different manufacturers and imaging modalities.

# Tips and Guidelines for Buying a Cine Projector

Movie projectors for viewing 35mm film

Movie projectors used for viewing 35mm roll films, with rear hood viewing option.

Tips for Buying a Cine Projector

1. Digital storage systems are gradually replacing cine projectors and cardiac film projectors.

2. The average archiving costs of film from a cine projector is $100 per patient, while digital storage of cardiac catheterization data only costs a few dollars per patient study.

3. There is a standard for cine projector storage media, file formatting, and digital image retrieval/processing. In early 1995, network image transfer of x-ray angiographic and radiographic/ fluoroscopic images was added to the standard.

4. Facilities should use these standards to eliminate problems with acquiring, storing, and transferring digital angiographic images and information from different manufacturers and imaging modalities.

# Tips and Guidelines for Buying a CO2 Monitor

Bedside carbon dioxide respiratory monitors

Mainstream or sidestream measuring of carbon dioxide partial pressure in exhaled breath. Respiratory bedside carbon dioxide monitors are used during anesthesia, for detection of ventilator dysfunction, to verify placement of endotracheal tubes, and for use during cardiopulmonary resuscitation. The device's sensor includes an infrared light source, optical filter, reference and sample chambers, and detector. Most monitors measure end-tidal carbon dioxide concentration, some are computerized.

Tips for Buying a CO2 Monitor

1. The measurement range of these CO2 monitor units should be at least 0 to 76 mm Hg. Carbon dioxide room monitors should be accurate to within 10% of the actual concentration.

2. To ensure that the CO2 monitor remains within the optimal accuracy, interference with CO2 measurements by other gases should be eliminated or automatically compensated for by the CO2 monitor.

3. Water vapor, aspirated fluid, or pressure in the breathing circuit can all cause interference. The presence of CO2 should be detected by the carbon dioxide monitor within 30 sec of being turned on.

4. Exhaust gas from the operating room monitors must be returned to the patient's breathing circuit or scavenged. When gas is to be scavenged, an easy-to-access port - to which the sampling tube can be connected, should be provided with the CO2 monitor.

5. To connect the exhaust port to the expiratory breathing circuit or a scavenger, tubing with the appropriate fittings should be provided by the operating room monitor manufacturer.

6. CO2 monitors should have adjustable alarm limits for high and low ETCO2, high inspired CO2, and high and low respiration rates for continuous monitoring. When alarm limits are not active, "alarms off" indicator should be available.

7. Alarm limits should initialize to useful default values once the CO2 monitor is turned on. Visual alarms could not be disabled. If the alarm condition is not corrected, the alarm must recur automatically after a short period of time. However, an audible-alarm silence is acceptable.

Questions for the Seller

Before you purchase your CO2 Monitor, we recommend you ask the seller the following questions:

Alarms

Default?

High/low expired?

High inspired CO2?

Low inspired O2?

High/low insp N2O?

Respiration rate?

Apnea?

Occlusion?

Temporary silence?

Reset?

General Information

Does it have a purging mode?

Does it have a liquid trap/filter?

CO2 Measurement

Are interference compensation measurements available?

Are measurements of other gases available?

Are atmospheric pressure measurements available?

Display

N2O concentration?

O2 concentration?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Capnometers and Multiple Medical Gas Monitors

# Tips and Guidelines for Buying a Cobalt Linear Accelerator

A machine which allows teleradiotherapy with a Cobalt 60 source

The cobalt machine consists of a heavy gantry with an arm ended by a heavy shielded container. Inside the container there is a high intensity cobalt source. The shutter at the front of the head can be either opened or closed to allow the radiation treatment. The system is very accurate and stable which allows precise for radiotherapy

Tips for Buying a Cobalt Linear Accelerator

1. Facilities should select the radiotherapy unit based on the range of energies required and ease of patient setup.

2. Due to the high price of radiotherapy equipment, facilities need to carefully assess their needs and choose a versatile radiotherapy unit that can meet their needs.

3. Many different cobalt linear accelerator designs are available from various manufacturers who offer a slightly different approach to device design. There is no sufficient data to show the clinical superiority of a particular design.

4. Different cobalt linear accelerator models offer various numbers and sizes of collimator leaves.

5. The main differences between low, mid, and high-energy cobalt linear accelerators are the photon and electron energy ranges. Buyers should choose the appropriate type based on the main uses of the radiographic unit.

6. The cobalt linear accelerator units, much like the low energy LINACs, are mainly used for treating bone cancer and head, neck, and breast tumors.

7. For treating deep-seated neoplasms and tumors of the pelvis and thorax, higher energy cobalt linear accelerators are used. These can also produce low-energy beams, and therefore are capable of more applications than lower-energy LINACs. However, they are significantly more expensive.

8. The cobalt linear accelerator can be either a travel or standing wave accelerator for all types of LINACs. The microwave power source can be either magnetron or klystron, and the gantry rotation range should be 360

9. LINACs should have multileaf collimators with at least 40 leaves.

10. For x-rays, the collimators should define fields of 40 × 40 cm. For electrons, they should be 25 × 25 cm.

11. Radiation treatment requires a wide range of photon and electron energy and treatment field sizes due to the fact that cancerous tumors occur at different depths and locations within the body.

12. Approximately 60% of patients require low-energy therapy, 25% of patients require medium to high-energy therapy, and 15% require a high-energy electron beam.

13. Before installation of a radiotherapy unit, the shielding requirements should be determined by a medical physicist. Due to the higher doses, IMRT may require additional shielding.

14. For calibrating equipment and identifying operating irregularities, buyers should establish a comprehensive quality assurance program.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Cobalt Radiotherapy Unit

# Tips and Guidelines for Buying a Colonoscope

Flexible fiberoptic or video endoscopes intended for viewing and treating disorders of the entire large intestine

Fiberoptic or opto-electronic flexible devices for viewing and treating disorders of the large intestine. A long tube is inserted through the rectum, allowing for examination while being guided through the colonic pathway. Colonoscopies are used to examine the entire large intestine up to and including the cecum. For both adult and pediatric use.

Tips for Buying a Colonoscope

1. When purchasing a colonoscope, facilities should consider the following two main factors (which are highly subjective): image quality and ease-of-use. Buyers are encouraged to use each flexible endoscope system on a trial basis to allow physicians' input before purchase.

2. All colonoscope controls should be clear and easy-to-operate.

3. All colonoscopes should be clearly marked with depth-of-insertion markers no more than 10 cm apart. Marked position should be accurate to within 1.0 cm to help the physician in evaluating the location of the structures under view. The dimensions of the flexible endoscopes may vary, especially between adult and pediatric models.

4. Facilities are encouraged to acquire colonoscopes that are compatible with a variety of video processors and light sources. This can help in reducing expenses when replacing a component in the endoscope/processor/light source chain.

5. It is recommended that colonoscopes be compatible with as many reprocessing agents and devices as possible. Before purchasing an colonoscope, facilities should check compatibility between the endoscope and an automatic endoscope reprocessor.

Questions for the Seller

Before you purchase your Colonoscope, we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Endoscopes

# Tips and Guidelines for Buying Computer Assisted Surgery

Image-guided systems used for stereotactic surgical procedures and preoperative information

A system used for image-guided surgery, for stereotactic surgical procedures such as frameless cranial and spinal neurosurgery, endoscopic sinus surgery, and orthopedic surgery. The image-guided surgery system uses diagnostic imaging modalities (CT, MRI) together with localization/digitization techniques. Surgeons view displayed images of the system's probe in relation to patient anatomy, for preoperative surgery planning, and for interactive guidance during surgery.

Tips for Buying Computer Assisted Surgery

1. Facilities should make sure that the system they are about to purchase is compatible with their existing CT and MRI equipment to facilitate image-data transfer.

2. Buyers should also consider compatibility with surgical microscopes.

3. Image-guided surgery systems should be capable of automatic and manual registration.

4. Localization systems should use an electromagnetic position-sensing localization method, or a passive method for the MRI suite.

5. The digitizer must be able to import any DICOM 3.0 image from CT and MRI.

6. These systems should come with software offering features such as 3-D imaging tools, multiple planes and quantitative calculations for surgical planning.

7. Another important consideration for buyers is the host computer system; memory should be larger than 512 MB, and archival storage should be larger than 20 GB.

8. Clarity and ease-of-use are crucial during surgical procedures. Therefore, monitors should be at least 43 cm (17") in size with a pixel resolution greater than 1024 x 768. User interaction should be available via keyboard, mouse, or touch-screen.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Image-Guided Surgery Systems

# Tips and Guidelines for Buying a Contrast Injector

Contrast media injectors for CT, MRI and angiography

Contrast media injectors insert viscous fluids into an artery or vein through a small catheter. They are used for CT's. MRI's and angiography procedures, so that the vessels being studied are contrasted.

Tips for Buying a Contrast Injector

1. When medical facilities are considering whether a contrast injector is suitable for the types and numbers of procedures performed, they should consider the catheterization injector unit's capabilities, including: programmability and ECG and x-ray generator synchronization and also available configurations.

2. Facilities should make sure that the injector for cardiology or infusion system they are about to purchase is MRI-compatible.

3. These are some requirements for all new and used contrast injectors: disposable syringes, selectable pressure in increments of 10 psi, and an adjustable volume stop in 1 mL increments.

4. These are some requirements for contrast injectors used for angiography: a syringe capacity of 100 mL, a flow range of 0.8-7 mL/sec, a delivery pressure range of 14-82 bar, and an x-ray generator.

5. These are some requirements for catheterization injector units used for CT scanning: a syringe capacity of 125 mL, a flow range of 0.1-7 mL/sec, a delivery pressure range of 0-20 bar, and an x-ray generator.

6. These are the requirements for MRI injectors: a syringe capacity of 60 mL, a flow range of 0.1-7 mL/sec, and a delivery pressure range of 0.7-13.8 bar.

7. Hand-driven syringes may be preferable by some physicians for delicate procedures, since they provide a better feel for resistance than an automatic injector. However, automatic injectors deliver more consistent flow.

8. Some contrast injector systems have contrast media conservation features that could result in significant cost savings.

9. Before making a purchase of either a new or used contrast injector, buyers should negotiate the pricing and supply of disposable syringes and administration sets with the supplier. Suppliers of injectors for cardiology may offer unit doses with prefilled syringes.

Questions for the Seller

Before you purchase your Contrast Injector, we recommend you ask the seller the following questions:

General Information

Does it have selectable pressure?

Does it have adjustable rise time?

Does it include the OptiBolus feature?

Is it a specially designed for MRI injector?

Syringes

Are they disposable?

Are they reusable?

Specifications

Designed for both small and large injections?

Injection parameters selectable from sterile field?

Can the syringe be used for up to 5 separate patients?

What is the prefill volume [cc] of the Injector?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Injector for Cardiology, Angiography, CT, MRI

# Tips and Guidelines for Buying a Corneal Topography System

System for measuring corneal topography

System incorporating computer image-processing and videokeratoscope, for measuring corneal topography. Software for patient data-management may also be incorporated.

Tips for Buying a Corneal Topography System

1. Facilities should consider several parameters prior to making the purchase, including: system accuracy and number of projected rings. The preferred accuracy of the system is 0.1 diopter, and it should have at least 20 projected rings.

2. The keratometer cannot provide information on the shape of irregular corneas, though it can adequately measure normal corneas or those with regular astigmatism. When dealing with corneal abnormalities, such as keratoconus or irregular astigmatism, specialists should decide whether a corneal topography system is more valuable than a keratometer.

3. For patients with an atypical corneal shape, VK is a helpful process, particularly for refractive surgery and contact lens candidates.

4. Auto-focus or auto-correction features are recommended because user errors could affect the performance of the device.

Questions for the Seller

Before you purchase your Corneal Topography System, we recommend you ask the seller the following questions:

Clinical Applications

Does it have refractive surgery planning option?

Does it have cataract surgery planning option?

Does it have a keratoconus detection option?

Does it have a contact lens fitting option?

Does it have a printer?

# Tips and Guidelines for Buying a CPAP

CPAP unit (Continuous Positive Airway Pressure) for delivering positive pressure

CPAP units for delivering continuous pressure of air and oxygen, by preventing closure and narrowing of patient's airway. The unit consists of a mask or nasal tubing connected to an airflow generator.

Tips for Buying a CPAP

1. Before making a CPAP (Continuous Positive Airway Pressure) unit purchase, buyers should consider the ease with which the unit can be carried or transported.

2. All the CPAP unit's controls should be clear and visible, and located on one face of the unit. Controls should be protected against accidental changes in setting. This is especially important in homes with young children.

3. Audible tones and visual indicators should serve as alarms. Continuous Positive Airway Pressure Unit users will not be able to disable visual indicators.

4. Power surge protectors are recommended, especially for units used in an area that has frequent power surges or thunderstorms

5. Some more CPAP unit options include air/O2 blender, flow meter, humidifier, and oxygen analyzer.

6. The CPAP unit's operation should not be affected by electromagnetic interference and electrostatic discharge. It should be able to operate in different environments.

Questions for the Seller

Before you purchase your CPAP, we recommend you ask the seller the following questions:

General Information

Is a power failure alarm included?

Is a fault alarm included?

Is a humidifier included?

Is an air filter included?

Is it PC compatible?

# Tips and Guidelines for Buying a CR System

A system for digitizing X-ray images from fluorescence plates (cassette)

A system which digitizes the X-ray images from fluorescence plates. The special cassette with the plate records the image. After the exposure the cassette is manually, or in some cases automatically transferred to the digital reader. The digital images are PACS compatible.

Tips for Buying a CR System

1. When purchasing new or used CR Systems, medical facilities should consider the following key factors: image plate throughput, cassette buffer size, and number of technologist terminals.

2. The image quality of X-ray CR Imaging Systems is not as high as other more expensive Digital Radiography technologies, but the versatility a new or used CR system offers is desirable.

3. Operating these systems is much like other Digital Radiography technologies, where versatility is traded off for increased speed.

4. Radiology departments wanting a digital modality to replace film can often find that Computer Radiography CR has become a popular choice.

5. Four categories of X-ray CR Imaging Systems readers are available: multi-plate readers, single-plate readers, desktop plate readers, and cassetteless readers:

6. Busy areas, in which the CR cassettes can be simply dropped into the Computed Radiography CR reader and left there, require multi-plate readers.

7. In single-plate readers, the reader must be empty before the next cassette is loaded because there is no buffer facility.

8. Very-low-throughput facilities can use desktop units, which are the smallest readers with only the essential components.

9. Cassetteless readers use a CR reader built into either a chest stand or a bucky table.

10. Sometimes it is possible to get higher image quality at the price of slower image plate throughput.

11. Cassette buffer size is extremely important for the multi-cassette loaders. It should be possible to place multiple technologist terminals next to each image reader.

12. All multiple readers should be networked, so a technologist can use any reader with any terminal.

13. To facilitate future additions to any network, buyers should ensure compatibility with existing x-ray components and conformance with the Digital Imaging and Communications in Medicine 3.0 Standard.

14. Suppliers should provide CR system buyers with DICOM conformance statements that explain what information objects, service classes, and data encoding are supported by their system. These are highly technical, and should be reviewed by specialists. All statements from all suppliers should use the same format and the same vocabulary to facilitate comparisons.

Questions for the Seller

Before you purchase your CR System, we recommend you ask the seller the following questions:

General

Does the system include a printer?

Does it include a multiformat printer?

Does the scanner include an Auto Loader?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Applications

Does it support general radiology?

Does it support orthopedics?

Does it support bone densitometry?

Is it useful for the simulation of radiation therapy?

Does it support mammographic imaging?

Performance

What is the system resolution in line pairs per mm?

What is the pixel size?

Does it accept cassette size 35 x 43 cm?

What is the throughput of the system?

Are the cassettes fed one by one or in series/batches?

Does the system support DICOM 3.0 in all respects?

Does the system include a technician workstation?

Does the system include a process monitor for the technician?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Digital Imaging Systems, Computed Radiography

# Tips and Guidelines for Buying a Cryostat

Cryostat microtomes, some with knife sharpeners

Cryostat microtomes, with temperature controlled cabinets, for cutting frozen tissue samples. May be automated or manual. Some include knife sharpeners.

Tips for Buying a Cryostat

1. To protect the operator during use, cryostat devices should have a knife guard. To ensure that the specimen is being processed under the right conditions, the chamber temperature should be displayed.

2. Some additional important features should be considered as well, including an antiroll device to prevent the specimen from curling while it is being cut, and an automatic defrost function to simplify maintenance of the product.

3. More than one compressor for the refrigerated cryostat system is desirable, to ensure that appropriate temperatures are maintained and to provide a backup if one compressor fails.

4. Based on the complexity of the refrigerated cryostat system and the selected features, prices of cryostat freezing microtomes vary considerably. Before making a decision, facilities should make careful considerations.

5. The cleaning and decontaminating of the freezing microtome holds a risk of injury, and is therefore an important safety issue. Self-cleaning/decontaminating features, such as a biocidal solution flush, could eliminate exposure to potentially infectious tissue and are recommended investments, even though they may add costs.

6. Before purchasing a freezing microtome knife sharpener, facilities need to consider staff time, disposable costs, and the cost of maintenance. Some cryostat suppliers offer sharpening services via mail, which can be useful in busy laboratories where technologist time is at a premium. Laboratories should have enough reserve blades to prevent the waiting time while the blade is being sharpened.

7. A sharpener that can sharpen blades of various materials and shapes is beneficial for histology laboratories that use several blade types for sectioning samples for different procedures or applications.

8. Using disposable freezing microtome blades, for which long-term replacement costs can be high, is less cost-effective than using a versatile, low maintenance sharpener.

9. Automated sharpeners have significantly reduced the amount of operator involvement in knife sharpening. One drawback is the length of time it takes the device to sharpen a refrigerated cryostat blade.

# Tips and Guidelines for Buying a Cryosurgical Unit

Cryosurgical units for general and ophthalmic use, which cause target tissue freezing

Units for cryosurgery procedures. Tissue is targeted for freezing using a gas or liquid coolant (carbon dioxide, liquid nitrogen, or nitric oxide). Freezing condition for tissue destruction is induced either by direct application or using a probe. Intended for general purpose and ophthalmic use, with handheld and console configurations. Ophthalmic units for intracapsular cataract extraction are also included.

Tips for Buying a Cryosurgical Unit

1. Facilities are strongly encouraged to carry out a cost-benefit analysis to decide whether they need a specialized unit.

2. Different probe and tip types should be supported by all units. N2O units should have scavenging ability because of the adverse effects of chronic exposure to waste anesthetic gases.

3. Applications in areas where cost constraints are great should consider inexpensive, disposable handheld units. Other areas may consider a general-purpose console unit with ophthalmic attachments. This can be more practical because of the greater number of surgical procedures for which it can be used.

4. Units with multiple probe tips allow physicians to perform several specialized procedures 5. When the facility signs a long-term probe/catheter agreement with a manufacturer, it may be offered the main console free of charge.

Questions for the Seller

Before you purchase your Cryosurgical Unit, we recommend you ask the seller the following questions:

Probes

Is shaft insulation included?

Is probe-tip cryometer included?

Does it include illumination?

Does it have temperature gauge?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Cryosurgical Units

# Tips and Guidelines for Buying a CT Phantom

Phantoms for CT simulation and testing

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of radiation absorption and dose distribution, also for research, QA/QC, equipment calibration, and teaching purposes.

Tips for Buying a CT Phantom

1. Medical Facilities should consider buying CT Phantoms to test system performance on a regular basis i.e. daily, weekly, and monthly.

2. CT Phantoms should especially be used in radiography, fluoroscopy, and radiotherapy, where patient radiation exposure is a concern.

3. U.S. mammography departments and facilities should purchase only new or used CT Phantom units that meet the requirements of an accreditation program or MQSA.

4. To save on costs, some facilities create their own biopsy training phantoms from inexpensive materials, or purchase used CT Phantoms.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms

# Tips and Guidelines for Buying a CT Scanner

Radiographic computed tomography systems (CT) for total body scanning

CT scanners produce thin cross-sectional views of the human body, using non-invasive radiographic techniques. They are capable of using a number of imaged slices to reconstruct the tomographic plane of the patient. These images are used for diagnostic purposes, and can be used for any anatomic region.

Tips for Buying a CT Scanner

1. Make sure you know exactly what type of CT scanner you require: a mid-range 16-slice system can adequately perform most routine clinical exams.

2. Wide-bore CT scanners, which are similar systems with larger gantry apertures, are appropriate for oncology exams, and are also useful for scanning bariatric patients.

3. CT scanning systems with more and thinner slices in one rotation, can handle more complex exams and more varied patient populations. The incremental benefit actually decreases as the number of slices that can be acquired increases. The smallest slice width on a 4-slice CT scanner, for example, is the same as that on a 16-slice scanner.

4. Most exams do not require the smallest slice width. For slices wider than 5 mm, there is no difference between 4-slice and 16-slice systems.

5. Computer Tomography Systems may also be different in the speed of image reconstruction. Acquiring more slices is not advantageous if patient throughput is held up by slow image reconstruction. There is no point in buying a very high specification computer that will rarely be utilized.

6. Before buying a CT scanning system, facilities must evaluate patient population, clinical needs, and desired throughput. Low-volume facilities, for example, will not benefit much from the more efficient use of the x-ray tube on a 16-slice scanner to justify its replacement cost.

7. Buyers should consider several design features before purchasing a CT scanner. The basic clinical applications are quite similar for units from various manufacturers. The differences between top-of-the-line CAT scanner units and less sophisticated ones generally involve cycle time, spatial resolution, data-storage features, and helical scanning protocols.

8. Buyers are encouraged to examine any CT scanner model they are considering, while it is operating.

9. Specially air-conditioned computer rooms are still required in some cases, although distributed processing in the construction of CT scanners has eliminated the need for them.

10. The reliability of the CT scanning system can be harmed if adequate air-conditioning for the computer equipment is not provided. This ultimately shortens its useful life. The existing hospital air-conditioning system cannot be used in most cases since its operation is connected to outdoor weather and since many times it is already operating close to capacity.

11. The ability of the CT scanner to make artifact-free images often depends strongly on the electrical power energizing the instrument. Buyers should install surge suppressors and means for automatic disconnection if the power fails.

12. Installation time varies among suppliers and may range from one week to two months. The most common installation period is two weeks.

13. Adequate training is a must due to the complexity of CT scanners. The training usually consists of one or more visits to the site by an instructor provided by the supplier. These visits can last 3-4 days, but longer visits are often desirable, depending on the expertise and experience within the facility. Users should arrange for follow-up visits 3-6 months after installation.

Questions for the Seller

Before you purchase your CT Scanner, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Is the detector a multislice array?

Is there a 3D reconstruction option?

What is the minimum 2D slice width [mm]?

What is the maximum 2D slice width [mm]?

Work Station

Known failure history?

Are there additional work stations?

Are there additional software packages?

X-ray Tube

Tube size (M.H.U)?

Tube slice count / MAS?

Slices count on gantry?

Date of manufacture?

What was the initial number of slices under the tube warranty?

Miliseconds count?

Additional components

Are there any kind of imagers available with the system?

Does it include injector, contrast?

Does it have calibration phantoms?

Does it include UPS?

Are any spare parts available with the system ?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

CT System - Stored

CT System - Operational

Supervision Forms

CT System - Dismantling

CT System - Packaging

# Tips and Guidelines for Buying a Cytological Centrifuge

Low speed, nonrefrigerated tabletop centrifuge to concentrate biological fluids for slides

Centrifuges used for biological fluid specimens with high fluid to cell ratio. These materials are concentrated from a fluid matrix, so that they can be put onto a glass microscope slide. Acceleration rate can be chosen according to specimen.

Tips for Buying a Cytological Centrifuge

1. Buyer needs determine most cytological centrifuge specifications, such as: rotational speed, display type, and capacity.

2. These are some of the preferred parameters that help ensure safety and ease of use: biohazard containment capabilities, programmability, and lid interlock.

3. The recommended motors are brushless motors since they require less maintenance as they do not experience the wear and tear that traditional cytological centrifuge motors undergo.

4. Audible CytoCentrifuge alarms are preferred over visual ones. Alerts should sound at the end of a run or cycle and in events such as: imbalance, leakage current, and open lid. All indicators and displays on the cytological centrifuge should be clear and easily read

5. Laboratory personnel are strongly encouraged not to operate CytoCentrifuges with lids open because of the hazards posed by a flying rotor or the dispersal of biologically hazardous material. Blood products and glass sprayed from beneath the lid onto the chest exposes the worker to the risk of infection and injury.

6. Rotor misalignment, old or defective tubes, or incorrect use can cause tube breakage in CytoCentrifuges.

7. Facilities can select between dedicated cytological centrifuges, which may cost several thousand dollars apiece, and cytological assembly devices, which can fit many kinds of centrifuges and are much cheaper than buying a cytological centrifuge.

8. Trunnion carriers and other types of optional equipment in non-dedicated units usually require more operator intervention; moreover, cytological adapter devices may not perform as many processing functions as assemblies designed for dedicated cytological centrifuges.

9. Reusable chambers require cleaning and disinfections between sample runs, and are therefore more time and labor consuming than disposable ones - which also reduce the risk of sample contamination.

10. As for safety features, each cytological centrifuge should have a securely interlocking lid that either shuts off the unit's motor when the lid is opened, or keeps the lid latched until the rotor has stopped. An additional safety feature includes an inner protective cover over the rotor assembly, as well as a display warning that the CytoCentrifuge should not be opened while the rotor is spinning.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Cytometer

Devices intended to measure the number of cells (particles) in a flow of suspension. Detection is done either by electrical methods, or by an optical system (e.g. laser system)

Blood cell counting is achieved by applying a fixed rate stream of the suspension, which passes at one point a very small orifice. At this point there are electrodes which detect variations in the resistance, or other electrical parameter, while a single particle is passing, or a laser beam is focused on the orifice and the resulting light is modulated by the passage of the particle.

Tips for Buying a Cytometer

1. Facilities should evaluate their requirements and chose a impedance tester based on them. Coulter cytometers provide various applications - some optional and should be considered according to the needs of a specific facility.

2. Flow cytometers should come equipped to perform immunophenotyping.

3. The number of colors used in the analysis determines the wavelength requirements for flow cytometers. When working with 2 or 3 colors, a wavelength of 488 nm is required. A wavelength near 560 or 640 nm is preferred when working with 4 or 6 colors.

4. The preferred Coulter cytometers are those that can detect 4 colors. Analysis of 6 colors should be considered optional.

5. Another impedance tester feature which should be considered optional is cell sorting. Facilities need to determine if this is a required capability for them, either immediately or in the future.

6. Manufacturers should provide free instruction for these devices. The flow cytometer operation requires special training. To become proficient, users require additional training and frequent operation of the instrument.

7. In some medical facilities, there are dedicated technologists for flow cytometry measurement.

8. When purchasing flow cytometers or Coulter cytometers, facilities must communicate with physicians to determine how the results will be used and what tests should be performed, and should also look into personnel requirements.

9. Cost of these impedance tester units depends on computer hardware and software, available applications on the unit, and the inclusion of automatic sample preparation units and other

10. Facilities can buy reagents from many suppliers, and it is generally not necessary to standardize the manufacturer of the flow cytometer and reagents since flow cytometers are open-platform instruments.

11. Other factors to consider before purchasing a Coulter cytometer unit include: computer and printer options, DNA software options, immuno-fluorescence, and features such as biohazard containment and refrigeration.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Data Management System, Anesthesia

Systems for collecting and processing data from devices used in anesthesia

A computerized system for anesthesia data management, in real-time and off-line applications. Both clinical and administrative information is provided. Data from devices used in anesthesia is collected, enabling physicians to manage prognosis and treatment, while establishing patient's physiological status, and parameters of anesthesia machines.

Tips for Buying a Data Management System, Anesthesia

1. The following processing capabilities are offered by these anesthesia data management systems: scheduling by OR, patient case and personnel; predefined or customized anesthesia patient record generation; artifact filtering to identify and process suspected artifacts and quality assurance.

2. The system's database should provide automatic backup capabilities, long-term storage for archived reports, anesthesia archiving record keeper, and maintenance of database integrity.

3. For higher efficiency, the anesthesia information management system must interface with the appropriate monitors.

4. The following tasks should be performed by the anesthesia data management system: quality assurance checks, tracking patient outcomes, drug use analyses, narcotic controls, and equipment use analyses.

5. Additional equipment may be required when connecting distant computers. This can include modems, fiber optic cables, and special conduits.

6. It is extremely important to plan the anesthesia patient record unit installation carefully. Special attention should be given to airflow, the use of floor space, and cable management.

Questions for the Seller

Before you purchase your Data Management System, Anesthesia, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

System Features

Does it include a central display?

Does it include patient/case record?

Does it include charge capture?

Can it perform cost accounting by procedure?

Does it include billing software?

Does it include an anesthesia record?

Does it have stand-alone capability?

Does it have Intranet capability?

Does it include QA posting?

Does it have tracking patient outcomes capabilities?

Can it perform drug utilization analysis?

Does it include narcotics control?

Can it perform equipment utilization analysis?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Daylight Film Processor

X-ray film processor for use in normal light conditions

X-ray film processing units that automatically load and unload film from the cassette ,using specialized equipment for daylight film handling. This equipment allows for processing close to working area without need for a darkroom, and significantly increases throughput.

Tips for Buying a Daylight Film Processor

1. Medical facilities should look into the compatibility of the new Daylight Film Processor they are about to purchase with existing equipment, such as film cassettes.

2. The location of the system and the type of x-ray film daylight processor to be attached are also important considerations when selecting the appropriate system.

3. Daylight x-ray film handling equipment is still used widely because it eliminates the need for a darkroom.

4. Daylight film processors shorten x-ray processing time since they automatically load empty cassettes with fresh film.

5. Buyers should make sure their x-ray film handling equipment can store at least 20 cassettes in each storage rack and have built-in identification systems.

6. The processing time for mammography films should be slightly longer. These x-ray film processor units should also have a low-film indicator.

7. All cassette and film handling functions are performed at one location in centralized systems. Therefore, the area in which they are located can become congested, unless there are enough units to meet the department's needs. Centralized daylight film processor systems must be located immediately next to the x-ray room to get the full benefits of the systems.

8. Facilities that are trying to cut costs by compromising installation (for example: placing the x-ray film daylight processor equipment in corridors so that several x-ray rooms can share a single installation) are actually diminishing the potential benefits of the system.

9. The unexposed fresh-film supply magazines used in centralized units must be loaded under darkroom conditions, which takes more darkroom floor space.

10. Centralized daylight film processor systems can reduce total processing and staff training time. The best location for them is the darkroom. To minimize renovation, users can place them inside an existing darkroom, or next to an outside wall of such room, and use the power supply and plumbing fixtures already in place.

11. This x-ray film processor installation makes more productive use of darkroom space and personnel and allows for convenient quality control practices.

12. Usually, modular daylight film processor systems use less floor space and are more easily serviced than centralized systems. Some x-ray film daylight processors do not require a darkroom, greatly reducing new construction or renovation costs.

13. The department may have to purchase several x-ray film processor to maximize the benefits of a modular system.

14. Modular daylight film processor systems can be located inside the x-ray examination room, and can be easily integrated into existing departments. They are well suited for dispersed processing applications generally considered to be one x-ray film processor for every two rooms.

# Tips and Guidelines for Buying a Densitometer, Laboratory, Scanning

Scanning and video densitometers for use in clinical laboratory

Scanning and video densitometers for clinical laboratory use. These densitometers quantify the separated fractions of various serum components, and detect very low fraction concentrations. This is done by automated measuring of transmitted and/or reflected light from patterns in a support medium resulting from electrophoreses, thin-layer chromatography, or immunoassay blot separation samples. This measurement can produce graphic band dispersion of the components of a fraction, providing precise data for accurate diagnosis.

Tips for Buying a Densitometer, Laboratory, Scanning

1. Densitometers can be part of an electrophoresis system. All densitometers should have some minimum components, such as: a light source, a monochromatic, and a photo detector.

2. The densitometer should be able to handle agarose gel and cellulose acetate at a minimum.

3. Densitometer devices should be capable of taking absorbance readings and will need a light source that can produce wavelengths in the visible range between 390 and 770 nm.

4. Fluorescence capabilities may be preferable for many applications and/or greater precision. However, not all laboratories need this function.

5. For densitometer units with fluorescence capability, it is required to have a light source with the ability to produce wavelengths in the ultraviolet range between 200 and 600 nm.

6. To enable data management and results reporting, a computer interface is desirable.

7. Facilities with an existing information system should have the densitometer interface with this system, to reduce the need to manually record results and reduce errors in transferring results.

8. The densitometer should provide a graphic display and a way of producing a hardcopy of results through either an interface to an external printer or a built-in printer.

9. Facilities can purchase scanning densitometers with or without electrophoresis units.

10. Combined densitometer systems carry out all operations automatically, from dispensing samples to printing analyzed results; except for application of the gel to the electrophoresis unit, which must be done manually.

# Tips and Guidelines for Buying a Dental X-ray

Film based radiographic system for conventional dental radiography

Film based radiographic system intended for dental use. The outcome is a hard copy conventional image.

Tips for Buying a Dental X-ray

1. Facilities should examine the number and type of procedures to be performed annually, as well as the types of patients to be treated before buying a dental radiographic unit or digital dental imaging system.

2. A panoramic unit with cephalometric imaging capabilities should be considered where skull view radiography is performed frequently. Facilities treating a wide range of patients should consider a unit that accommodates both seated and standing patients, and has motorized vertical height adjustment.

3. An intraoral unit should be considered in facilities performing mainly routine dental radiography; digital systems may be useful if immediate image analyses for endodontics and implantation planning are performed frequently.

4. An intraoral system with a half-wave, rectified x-ray generator is recommended for facilities that desire a system for routine dental radiography; the SID should be about 200 mm standard.

5. There is no need for special system capabilities, such as TMJ or cephalometry, in the intraoral systems, because they are used only for routine imaging. These systems should accommodate all patient types needing routine exams.

6. Two types of digital systems are available: CCD and image plates. Image plates are very similar to conventional intraoral films and are compatible with existing equipment. Digital systems in general have become more popular for dental x-rays due to the fact that chemical-based film processing can be discarded. Images from the CCD detector are displayed very quickly. Retakes can be initiated faster, minimizing total time and exposure. A CCD must be integrated with the x-ray generator.

7. Facilities should keep in mind that the additional ongoing costs associated with film based dental radiography, including film and film processing, processing chemicals and equipment, film storage, and record keeping can be considerable, depending on the number of patients treated. Using a digital radiography system can eliminate all of these costs.

8. There are costs that cannot be avoided in both film based and digital radiography. These include plastic covers for equipment that contacts the patient, as well as radiation protection/monitoring equipment for patients and staff.

Questions for the Seller

Before you purchase your Dental X-ray, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

What is the size of the detector (Length + Width)?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

X-Ray System - Stored

X-Ray Conventional Radiographic System - Operational

Suprevision Forms

X-Ray System - Dismantling

# Tips and Guidelines for Buying a Dental X-ray Scanner

Digital X-ray scanner with a 360 degree rotation

The system is a rotational X-ray cone beam scanner, specially designed for maxillofacial imaging. The acquisition may be done by an image intensifier. 2D and 3D images are digitally reconstructed.

Tips for Buying a Dental X-ray Scanner

1. Facilities should examine the number and type of procedures to be performed annually, as well as the types of patients to be treated before buying a dental radiographic unit or digital dental imaging system.

2. A panoramic unit with cephalometric imaging capabilities should be considered where skull view radiography is performed frequently. Facilities treating a wide range of patients should consider a unit that accommodates both seated and standing patients and has motorized vertical height adjustment.

3. An intraoral unit should be considered in facilities performing mainly routine dental radiography; digital systems may be useful if immediate image analyses for endodontics and implantation planning are performed frequently.

4. An intraoral system with a half-wave, rectified x-ray generator is recommended for facilities that desire a system for routine dental radiography; the SID should be about 200 mm standard.

5. There is no need for special system capabilities, such as TMJ or cephalometry, in the intraoral systems, because they are used only for routine imaging. These systems should accommodate all patient types needing routine exams.

6. Two types of digital systems are available: CCD and image plates. Image plates are very similar to conventional intraoral films and are compatible with existing equipment. Digital systems in general have become more popular for dental x-rays due to the fact that chemical-based film processing can be discarded. Images from the CCD detector are displayed very quickly. Retakes can be initiated faster, minimizing total time and exposure. A CCD must be integrated with the x-ray generator.

7. Facilities should keep in mind that the additional ongoing costs associated with film-based dental radiography, including film and film processing, processing chemicals and equipment, film storage, and record keeping can be considerable, depending on the number of patients treated. Using a digital radiography system can eliminate all of these costs.

8. There are costs that cannot be avoided in both film based and digital radiography. These include plastic covers for equipment that contacts the patient, as well as radiation protection/monitoring equipment for patients and staff.

Questions for the Seller

Before you purchase your Dental X-ray Scanner, we recommend you ask the seller the following questions:

General

What is the size of the detector (Length + Width)?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Dental X-Ray Imaging System

# Tips and Guidelines for Buying a Diathermy Unit, Physical Therapy

Radio frequency high power generator for tissue heating

A high power and high frequency generator used for tissue heating. The output is coupled to the patient by capacitance or by inductance. The high frequency radio fields inside the tissue produce heat which has a curative effect.

Tips for Buying a Diathermy Unit, Physical Therapy

1. Facilities can select a tabletop, wall mounted, or cart mounted therapeutic ultrasound unit.

2. To permit user exchange, these systems should have transducers with connectors. The unit should be capable of frequencies at 1 and 3 MHz. It should run in both continuous and pulsed modes.

3. Each transducer should have a beam with a non-uniformity ratio of less than 8 and should have a variable pulse rate that falls between 80 and 150 pps.

4. Systems equipped with several transducers of various diameters facilitate treatment of different areas of the body. However, there are systems with only one transducer.

5. An automatic shutoff function is a preferred feature.

6. Configuration, ERA, and maximum power should be based on patient and clinician preference as well as on treatment location.

7. If the unit is to be used for offsite therapy, some portable devices are available in a carrying case or tote bag.

8. Systems with dual frequencies provide a wider range of treatment capabilities.

9. To reduce costs, facilities can obtain a combination ultrasound neuromuscular stimulator unit instead of buying separate units. Using these units, facilities can choose therapeutic ultrasound only, neuromuscular stimulation only, or a combination of both. 10. Facilities should consider the costs associated with the following: additional transducers, coupling gel, service and a therapist.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Diathermia Radio Frequency Units for Physical Medicine

# Tips and Guidelines for Buying Digital Angiography

Digital imaging systems that convert input signal to visual display

A digital system used to convert input signals from TV cameras or couple-charged devices, into digital signals, for visual display on computerized imaging systems or TV monitors.. A multi storage camera or laser imager can make x-ray films of final images. Angiographic digitization systems can be added to angiographic/cardiovascular radiographic/fluoroscopic systems for the purpose of digital subtraction angiography. These systems include an analog to digital and digital to analog converter, high speed digital memory, digital storage device, and a controlling computer.

Tips for Buying Digital Angiography

1. When looking into purchasing an angiography imaging system, buyers should select a system that best meets their needs in the areas of resolution, performance characteristics, and clinical applications.

2. To limit contrast resolution that may affect image quality, an SNR of 60 dB is recommended. SNR is the most important requirement for digital angiography systems.

3. It is recommended to use a host camera with a scan mode >1,024 lines and progressive readouts to form the analog image. This will maximize the resolution and image quality of your chosen digital vascular imaging system .

4. When purchasing digital angiography systems, facilities should consider image memory.

5. To increase small details within a processed image, such as tissue densities, the memory depth should range about 10 bits.

6. Some digital angiography systems have optional capabilities, such as edge enhancement, filtering, image zoom, road marking, and land marking.

7. To ensure the transfer from image memory to image storage, a 10-second loop memory is recommended with a bit depth of 10. Digital angiography images should be displayed on a matrix of 1024 × 1024 with 256 accompanying gray levels.

8. DSA affects the contrast resolution and image enhancement.

9. Remote diagnostics is a service feature offered by some manufacturers. A supplier could download a software patch, order replacement parts, or alert a repair technician to fix the problem.

10. The continuous (fluoroscopic) mode obtains images of organs in the midst of rapid movement, while the serial (radiographic) mode obtains images with minimal organ motion; both modes are recommended for use in a cardiovascular digital imaging system.

11. Specialized angiographic and vascular software is offered separately by some manufacturers for expanding the digital subtraction angiography system's analysis capabilities.

12. These angiography imaging systems are often purchased with R/F imaging equipment for use in special procedures or cardiac catheterization suites.

13. Facilities can purchase digital vascular imaging systems as options with their R/F equipment from most major suppliers. There are a few suppliers that market only digital recording and digital angiography systems that are compatible with R/F equipment marketed by other suppliers.

14. Before purchasing a cardiovascular digital imaging system, facilities are encouraged to obtain a list of users from the manufacturer and speak with the experienced ones.

15. Buyers who are planning to connect the digital angiography system with other computer systems in the hospital should also consider networking capabilities and conformance with industry standards.

16. The Open System Interconnect is an international standard for network architectures, which was developed under the guidance of the International Organization for Standardization.

17. An additional feature to consider when purchasing digital angiography is the system's capability to email images and/or results for remote consultation. This can speed up the review process by specialists or personnel. Medical facilities should consider security of transmission before making a digital subtraction angiography system purchasing decision.

Questions for the Seller

Before you purchase your Digital Angiography, we recommend you ask the seller the following questions:

General

Does the system include a printer?

What is the size of the detector (Length + Width)?

Image Processing

Does it include edge enhancement?

Does it include filtering?

Does it include image zoom?

Does it include roadmapping?

Does it include landmarking?

Does it include remasking?

Does it include replay?

Does it include reregistration?

Does it include window and level?

Does it have frame rate options?

What are the matrix resolution options?

What is the maximal frame rate?

DSA Modes

Serial?

Continuous?

TID?

Image Display

Does it have color display?

Does it have split screen display?

General Information

Does it include frame averaging?

Is it ACR/NEMA DICOM 3.0 compatible?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Angiographic Systems

# Tips and Guidelines for Buying a Digital Mammography Unit

Digital radiographic mammography units

Digital mammographic systems used for screening and/or evaluation of breast lesions. These digital imaging systems use a high-frequency, constant potential x-ray generator, automatic exposure control device, collimator, and compression devices. Image acquisition can be done be DR (direct digital radiology) or by phosphor plates (CR). that are used for imaging, then scanned by laser and digitized.

Tips for Buying a Digital Mammography Unit

1. Digital mammographic radiographic unit screening equipment must meet the minimum MQSA requirements for tube outputs, compression performance, position controls, and reproducibility.

2. Medical facilities should base their digital mammography unit purchase decision on life-cycle cost, local service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment.

3. Suppliers offer digital mammography unit service contracts or service on a time-and-materials basis. This may also be available from a third-party organization. Facilities should carefully consider whether to purchase such a service.

4. When purchasing a digital mammography unit, performance and reliability are important factors.

5. A high-frequency x-ray mammography generator will help ensure higher efficiency of operation with a minimum of output ripple. It will also need less space than a conventional generator.

6. Mammography involves a narrow range of tissue thickness, and therefore 1 kV increments and a range of approximately 22 to 35 kV are necessary.

7. The digital mammograph system should offer at least 500 mAs and an exposure time of 0.1 second or shorter to avoid unnecessary long exposures.

8. A rotating anode, which has a higher heat capacity than a stationary anode, should be available to promote longer x-ray tube life and provide a more consistent x-ray output.

9. AEC provides the appropriate image optical density and x-ray exposure for breast composition and thickness.

10. Focal spot sizes should be approximately 0.1-0.3 mm to ensure that microcalcifications as small as 200 ìm can be detected using x-ray mammography.

11. To clearly image the smallest micro calcifications, an SID of at least 66 cm is needed.

12. The complexity of the automatic exposure control is the main difference between digital mammography unit systems. Some x-ray mammography systems control only the exposure time, while more advanced ones control the x-ray spectrum, including the kVp, anode, and filtration. Such digital mammograph systems improve the image quality, especially in larger and denser breasts.

13. Some manufacturers have developed advanced grids, which are expensive to manufacture but improve the image quality in digital mammographic radiographic units.

14. Facilities considering the purchase of a stereotactic biopsy system should consider the number of procedures to be performed and the compatibility with existing equipment.

15. Film-based digital mammograph units are not recommended because they do not allow real-time guidance. Instead, both dedicated and add-on digital mammography unit systems are equipped with small digital detectors.

16. Add-on systems may be harder to use because they have more limited motions compared to dedicated digital mammographic radiographic units. Consequently, most of the differences are a matter of user preference rather than clinical efficacy.

17. In digital detector performance, detective quantum efficiency is an important factor when comparing digital mammographic radiographic units. DQE is directly related to the signal-to-noise ratio that results between detector input and output. The noise generated by the detector and the spatial resolution contributes to the DQE of the system. To reduce DQE, SNR must be reduced; a recommended DQE is less than 20% at 5 lp/mm.

18. Another important factor when choosing a digital mammography unit is modulation transfer function. MTF refers to the loss of contrast relative to an x-rayed object. As the spatial frequencies in a given image increases, MTF decreases, creating loss of visualization; a 50% MTF at 5 line pairs per millimeter is recommended.

Questions for the Seller

Before you purchase your Digital Mammography Unit, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Work Station

Does the system include the option of Computer Aided Detection?

Does the system include an Acquisition Work Station?

Does the system include a Radiologist Work Station?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

What is the number of exposures?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

Mammography Unit

MAM System

Digital Mammography Unit - Stored

Supervision Forms

MAM System - Dismantling

# Tips and Guidelines for Buying a Digital Radiography Upgrade Adapter

Digital radiography upgrade system

DR flat panel can replace the film cassette in an existing radiographic table or chest stand. The digital data is transported into a digital radiographic image format. Images can be exported, stored, or processed later.

Tips for Buying a Digital Radiography Upgrade Adapter

1. Storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of digital radiography over film-based radiography.

2. The tilting tables on a digital radiography upgrade adapter allow a wide range of tilting movements from -15° to +90° and have an average speed of 6°/sec. Horizontal-to-vertical tilt should average 15 sec.

3. The non-tilting tables on a digital radiography upgrade adapter specify a wide range of tabletop motions but do not allow tilting angles.

4. Digital Radiography Upgrade Adapter systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed in the table system in table-based units, preventing certain examinations due to patient positioning constraints. Some upright digital radiography upgrade adapter systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed before deciding which type of digital radiography upgrade adapter will better suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables on because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky digital radiography upgrade adapter systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Buyers should look into the digital radiography upgrade adapter system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Buyers of digital radiography upgrade adapters should consider generator options as well; high-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any network, compatibility with DICOM 3.0 is a requirement for all newly purchased equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail which information objects, service classes, and data encodings are supported by the digital radiography upgrade adapter system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate comparisons between suppliers.

Questions for the Seller

Before you purchase your Digital Radiography Upgrade Adapter, we recommend you ask the seller the following questions:

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

# Tips and Guidelines for Buying a Duodenoscope

GI endoscopes with various light sources and video processors, used to view and treat diseases of the first segment of the small intestine

GI endoscopes with various light sources and video processors, used to view and treat diseases of the first segment of the small intestine.

Tips for Buying a Duodenoscope

1. The most important quality of the duodenoscope's image is the optical quality.

2. The following factors determine this quality: the ability of the fiber optic cables and the light source to adequately illuminate the area under view; the ability of the lens system to transmit a clear and bright image with minimal distortion to the eyepiece.

3. When making a fiber optic duodenoscope purchase, facilities should consider the device's sensitivity to heat, the time and temperature of rinsing required, the reuse life of the cleaning solution, and the use of manual or automatic processing.

4. Other issues to consider include shelf life, disposal restrictions, and minimum effective concentration of the cleaning solution.

5. Gastrointestinal endoscope buyers should also examine the safety and cost per cycle, as well as the educational options provided by the manufacturer. They should keep in mind that preventive maintenance training can eliminate costly repairs to delicate duodenoscope components

6. The differences between these flexible endoscope units include differences in image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view.

7. Videoscopes depend on the number of pixels on the CCD to illuminate the area under view, while Fiberscopes and videoscopes both depend on the light guide.

8. Videoscopes and fiberscopes with cameras depend on the ability of image processors to transmit clear images to the viewing screen.

9. All flexible endoscopes should be compatible with multiple processors. They should also be compatible with multiple light sources.

10. Users can clean the lens without removing the Duodenoscope, using lens washing.

11. Fiber optic duodenoscope buyers should look into the cleaning process of the scope. They should carefully review their duodenoscope reprocessing protocol to make sure it coincides with the recommendations from the manufacturer.

12. In places where EtO gas sterilization is the preferred reprocessing procedure, there might be an increased need for more duodenoscopes in order to meet daily caseload requirements.

13. There are users who want to automate part of their reprocessing with liquid disinfecting or sterilizing units.

14. When reviewing high-level disinfection or sterilization, facilities should look into the operator manual as well as the facility's infection control and risk management.

Questions for the Seller

Before you purchase your Duodenoscope, we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

# Tips and Guidelines for Buying an Ear Thermometer

Electronic infrared thermometers

Electronic infrared ear and skin thermometers, for estimation of core temperature. Infrared thermometers that estimate shell temperature by localized infrared emissions.

Tips for Buying an Ear Thermometer

1. Ear thermometer devices should allow users to measure body temperature quickly and non-invasively; the possibility of cross-contamination is minimal because the units do not contact mucous membranes.

2. A one-piece tympanic thermometer with a disposable probe cover makes up the unit. An ear thermometer should have a measurement range of at least 80-108°F with readings accurate to ≤0.5°F (≤0.3°C). A message should be displayed if a temperature reading is outside the range.

3. The ear thermometer should have a display screen that is either an LCD or LED indicating °F or °C, low-battery alarm, and high/low patient temperature.

4. The ear thermometer units should be light, easy to carry, and comfortable to hold. They should provide a way of carrying a sufficient supply of probe covers, to minimize the possibility of probe spilling and contamination.

5. It should be easy to apply and remove probe covers with minimal user contact to avoid contamination. Tympanic thermometer covers should be smooth with no sharp edges that may cause discomfort.

6. To ensure long battery life, automatic shut-off is preferred. The battery should allow for at least 5,000 measurements.

7. Common batteries should be used for the tympanic thermometer; replacement should be simple. The display should indicate the need for recharging in case of rechargeable batteries.

8. Facilities should know the limitations of ear thermometers and understand the difference between temperatures taken in the ear canal or on the skin and those obtained from traditional sites before making a purchase decision.

9. Tympanic thermometers have several advantages, including the ease of temperature-taking process for both patients and nurses, particularly when patients are unconscious, unwilling, or unpredictable. These ear thermometer devices reduce the incidence of infection caused by cross contamination.

10. Facilities should look into the cost of the disposable tympanic thermometer probe covers and calibration-checking devices, as well as the price of the ear thermometer and service agreements, before they determine the true life-cycle cost of the instrument.

11. It is important for hospitals to be able to verify calibration and perform in-house service on ear thermometers. The service manual should provide a procedure for that purpose.

# Tips and Guidelines for Buying an ECG

Multichannel and interpretive electrocardiographs for on-site analysis

Electrocardiographs detect cardiac activity signals and produce a graphic record of the signal vs. time. Electrocardiographs record the ECG (EKG) from two or more leads at the same time, and can perform on-site data analysis and transmit ECG signals through a telephone modem. Used for diagnosis, to assist in treatment for some types of heart diseases and arrhythmias, and to warn of potentially critical situations.

Tips for Buying an ECG

1. A multichannel ECG should record the standard 12 leads. It should have at least 3 channels of simultaneous ECG data, and be capable of simultaneous acquisition of all 12 leads. It should measure all basic axes and durations including: RR, PQ, QT, ATC, P, QRS, T, and HR.

2. Battery status markers should be available on the electrocardiograph, as well as indicators for loose electrode contact, systems status, and artifacts.

3. The device should be able to store ECG waveforms for later retrieval, printing, and transmission.

4. The ECG should enable the user to enter patient data, which should include the patient's name or ID number, age, sex, weight, and height. The data will also contain the recording date and time, sensitivity setting, chart speed, and leads being recorded.

5. The ECG device should have an RS232 port or other appropriate digital interface to allow its communications with other devices such as electrocardiographs, computers, or a data management system.

6. The ECG may come with a complete interpretation software package and should store at least 20 ECGs. It can also include an expandable storage capability.

7. The unit should be able to print at least 3 leads of the ECG waveform continuously with manual switching between leads. It should provide sensitivity settings of at least 2.5, 5, 10, and 20 mm/mV and recorders with a typical chart speed of 5, 10, 25, and 50 mm/sec.

8. ECG devices designed for adult defibrillation should have energy settings of 50-360 J.

9. ECG devices capable of internal or pediatric defibrillation or synchronized cardio version should have energy settings of 5-50 J.

10. ECG devices for neonatal applications should have additional low-energy settings of 1-20 J.

11. Units should be able to charge to maximum energy in less than 15 seconds over the full range of battery-charge indicator levels.

12. The unit should automatically disarm within two minutes if not intentionally discharged.

13. Interpretative electrocardiograph units should have the option of running on battery power. Line-powered ECG units will not disarm when the line cord is unplugged or when line power is otherwise interrupted.

14. The monitor should display a clear and distinct marker to indicate the synchronization point on the ECG waveform.

15. The defibrillator's ECG input amplifiers should be protected against damage from discharge energy.

16. The display should recover a readable ECG trace within five seconds of an input overload from a maximum-energy defibrillator pulse.

17. The interpretative electrocardiograph unit should include a recorder, and the recorded strip should include periodic annotations.

Questions for the Seller

Before you purchase your ECG, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Recorder

Does it include an integral printer?

Does it include a lead marker?

Does it include a timing marker?

Does it include an event marker?

Does it include a keyboard?

Does it include a display?

Does it include patient name and ID input?

Leads

Switching?

Leads-off indicator?

Measurements

Does it include arrhythmia ID?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrocardiographs

# Tips and Guidelines for Buying an ECG Holter

Electrocardiography scanners for analysis and display of recorded data

Electrocardiographic scanners that receive recorded cardiac data for analysis, display, storage, and for generating reports. The information transferred from the Holter recorder is used to determine ECG abnormalities, pacemaker function, and for assessment of therapeutic effects.

Tips for Buying an ECG Holter

1. Ambulatory monitor scanners should provide a time and heart-rate display, full disclosure, and pacemaker analysis.

2. ECG Holter units should be reading recordings at 60-240 times the recording speed.

3. Facilities should select the data archiving methods.

4. To receive transferred data from the recorder, a real-time scanner should have an electronic interface.

5. For all types of beats - normal, ventricular, and supraventricular - the reports should indicate total beats and a beat per hour.

6. The following are required ECG Holter features: an arrhythmia detection indicator, ST segment analysis capability, trend graphs for the R.R interval, ST segment deviation, and ventricular beats.

7. When using an ECG Holter, the following data should appear on the patient's strip: the time, patient identification, heart rate, and arrhythmias; full disclosure must be expanded on the strip.

Questions for the Seller

Before you purchase your ECG Holter, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Long-Term ECG Recorders and Scanners

# Tips and Guidelines for Buying an ECG Scanner

Scanners that analyze and display recorded data from ECG holters/recorders

A device used for analyzing and displaying data transferred from ECG holters/ recorders. It receives input from prolonged recording time. Data can be stored, edited and analyzed for reporting. These devices are generally used to determine ECG pathologies.

Tips for Buying an ECG Scanner

1. The time spent by cardiologists interpreting ECG results can be decreased significantly using computerized electrocardiography.

2. Some cardiologists find this beneficial, while others feel it eliminates the necessary additional diagnostic accuracy that can be provided by the physician.

3. The purchase price, as well as the life cycle costs of portable systems, varies depending on the recording medium, number of input leads, storage capabilities, and degree of technician involvement.

Questions for the Seller

Before you purchase your ECG Scanner, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Long-Term ECG Recorders and Scanners

# Tips and Guidelines for Buying an EEG Monitor

Electroencephalogram bedside monitors

Bedside monitors used for continuous monitoring and processing of brain signal information. Electrodes are placed on scalp or forehead, sometimes using intracranial and nasopharyngeal sites. Electroencephalogram (EEG) bedside monitors measure and display numeric values and trends, in a variety of display techniques which depend on the specific application(i.e. ICU patients, anesthetized patients), with appropriate audio/visual alarms.

Tips for Buying an EEG Monitor

1. The electroencephalographic monitor should be capable of acquiring at least 16 channels of EEG. It should be able to check electrode impedance for each channel and the common mode rejection ratio should be at least 100 dB at 60 Hz.

2. Many electroencephalographic monitor configurations are available, and EEG monitors should be selected by facilities based on testing procedures and user requirements.

3. Users must be able to store the results on the hard drive or onto removable media.

4. Facilities should specify if whether the EEG monitor is based on a standard PC or it is a customized digital recording device.

5. EEG monitors should have a low-frequency filter setting of no higher than 0.3 Hz at its lowest setting, and the high-frequency filter setting should be no lower than 70 Hz at its highest setting.

6. The sampling rate to acquire the EEG signal should be at least 200 Hz; sampling rates of 256 to 400 Hz are preferred.

7. EEG monitor data should be acquired with a resolution of at least 12 bits. The sensitivity settings should be adjustable over the range of 1 to 100 mV/mm.

8. The EEG monitor should allow users to review an earlier section of the EEG recording, while real-time monitoring carries on.

9. The electroencephalographic monitor display modes should be offered as follows: compressed spectral array, density spectral array, and dot density array on EEG data trend graphs.

Questions for the Seller

Before you purchase your EEG Monitor, we recommend you ask the seller the following questions:

General Information

Does it include Graphic Recorder/Printer?

Are all electrode cables included?

Sensitivity Control

Does it include a master switch?

Does it have individual channel override?

Low-Frequency Filters

Does it have individual channel override?

Master Notch Filter

Does it include a master notch filter?

Does it have individual channel override?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Patient Monitors

# Tips and Guidelines for Buying an EEG Unit

Graphic recording of brain electrical activity

A device which transmits electric signals from brain onto a recorder which reproduces their characteristics on an electroencephalogram. Can be used for localizing tumors or lesions on or near brain surface, also for studying various neurological conditions, and to assist in evaluating psychiatric disorders.

Tips for Buying an EEG Unit

1. These units are offered with a wide range of analytical software programs. Users may upgrade in many cases to answer a specific user's needs.

2. The available features include brain mapping and sleep studies, video EEG capabilities, and optical disk storage.

3. Results should be printed with the following data: the montage, filter and gain settings, horizontal and vertical scale, events, date, time, and patient identification.

4. It is the responsibility of the manufacturer to specify the following: the number of patient records that can be stored on either the local hard drive and on removable media; whether the device could compress data files; the battery type and maximum operation time; availability and pricing of any additional capabilities offered as options, such as: spike and seizure; detection algorithms; EP and electromyography; sleep diagnostics; digital video; photo-stimulation; other physiologic monitoring parameters.

5. A low-battery indicator should be available. For rechargeable batteries, after complete depletion it should take no more than 16 hours to reach full charge.

6. Units that are used for ambulatory recording should use removable data storage media.

Questions for the Seller

Before you purchase your EEG Unit, we recommend you ask the seller the following questions:

Software

Does it include billing?

General Information

Hi-Frequency Filters, Hz: Does it have individual channel override?

Does it include all electrode cables?

General: What is the sampling rate?

General: Does it have integral diagnosis processor?

General: What is the number of channels?

General: Does it have input/output for auxilary device?

Sensitivity Control

Does it include a master switch?

Does it have individual channel override?

Master Notch Filter

Does it include a master notch filter?

Does it have individual channel override?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrophysiology Recorders - EEG

# Tips and Guidelines for Buying an Electroconvulsive Therapy Unit

Apparatus for electroconvulsive therapy (ECT) for use in psychiatric treatment

ECT units are used to apply an electric current to the brain through electrodes connected to the scalp. ECT's cause grand mal seizures, as part of the treatment of specific psychiatric disorders.

Tips for Buying an Electroconvulsive Therapy Unit

1. ECT devices should be capable of administering a charge of up to 1,200 mill coulombs.

2. Lower charge doses are usually sufficient for most severely depressed patients.

3. Some studies show that a few extremely ill patients, for whom no other alternative exists, need doses of this magnitude for effective treatment.

4. Designs that use a footswitch to trigger the convulsive stimulus are not recommended because of the risk of accidental activation. However, at least one model has a footswitch that requires deliberate action by the operator, preventing inadvertent triggering of the device.

5. Buyers should check the compliance of any existing information systems with a new system.

6. Some units have hinged protective hands to prevent inadvertent activation.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electroconvulsive Therapy Units

# Tips and Guidelines for Buying an Electrohydraulic Lithotripter

Intracorporeal lithotripters using plasma-induced shockwaves for fragmentation

Intracorporeal lithotripters that use a generator-powered probe which is irrigated by saline while it fires energy pulses at the stone. The resulting plasma bubble causes a hydraulic wave. This fragments the stones, which can then be removed.

Tips for Buying an Electrohydraulic Lithotripter

1. These units are used for locating, viewing, fragmenting, and removing urinary tract or renal calculi. They may also be used to disintegrate salivary stones or bile duct stones. Units with a footswitch are recommended, because they keep the operator's hands free to position the unit.

2. Different pulse energy and pulse rate characterize electro-hydraulic lithotripters. Pulse duration and voltage determine the amount of energy delivered per pulse. Available pulse rates vary and are often a function of the pulse duration selected. Acceptable electrode size varies from 1.7 Fr/77 cm to 9 Fr/40 cm; the longer lengths are usually used for biliary applications.

3. Laser devices should have a wavelength of about 2,100 nm and a visible aiming beam to ensure accurate placement. Pulse duration and power determine the amount of energy delivered per pulse; available pulse rates also vary among manufacturers and are often a function of the selected pulse duration.

4. General lithotripsy and soft tissue surgical procedures can use low-watt lasers. High-watt lasers can be used for bladder stone lithotripsy, and pulse duration may be up to 500 usec.

5. A laser lithotripter should have a fiber diameter between 200 and 1,000 um and at least 3 ft long.

6. For lithotripsy in the lower pole of the kidney, usually small fiber diameters are used with flexible scopes. Lithotripsy in the bladder and ureter will generally use large fiber diameters with rigid scopes. Operators can use any standard endoscope to visualize placement of the lithotripter.

7. With nephroscopes, operators usually use a shorter lithotripter probe than the one used with ureteroscopes, with an outer diameter that is larger than the one used with ureteroscopes. Also the sheath diameter of the nephroscope is larger and the length is shorter than that of the ureteroscope.

8. Any rigid or flexible endoscope is acceptable for electromechanical lithotripters. The available sizes for probes should be between 0.8-9.6 Fr and 26.7-90 cm long, at minimum.

9. Manufacturers offer a wide range of IL devices. However, there is no one device that covers the entire range of clinical situations. The factors that affect the choice should include: location and size of the stone burden, endoscope configuration working channel caliber, and offset or end on port.

10. Video and photographic accessories such as cameras, videocassette recorders, and light sources, are also offered by suppliers at an additional cost. This can enhance imaging and educational uses of the instrument.

11. To compare high-cost alternatives and to determine the economic value of a single alternative, facilities can use a life cycle cost analysis. They can use low cycle cost analysis techniques to examine the cost-effectiveness of leasing or renting equipment versus purchasing it outright.

12. Low cycle cost analysis is most useful for comparing alternatives with different cash-flows and for revealing the total costs of equipment ownership because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time.

13. Suppliers offer facilities service contracts or service on a time-and-materials basis. Some third-party organizations may also provide this service. Facilities should carefully consider this issue.

14. Service contract customers can get routine software updates, which enhance the system's performance, free of charge from most suppliers. Facilities should keep in mind that software updates are often cumulative, which means that previous software revisions may be required in order to install and operate a new performance feature.

15. Facilities with a full-service contracts ensure preventive maintenance at regular intervals, thereby avoiding any unexpected maintenance costs. Many suppliers extend system performance and uptime guarantees beyond the length of the warranty, only for systems covered by a service contract.

# Tips and Guidelines for Buying an Electrolyte Analyzer

General purpose electrolyte analyzers

Electrolyte analyzers using ion-selective electrodes, coulometric titration, thermal conductivity detection, or flame photometry techniques. Some analyzers are capable of testing other non-electrolytic parameters. Some are portable, bedside models.

Tips for Buying an Electrolyte Analyzer

1. A facility should select the right electrolyte analyzer unit based on the assays available on the instrument, the throughput capacity of the system, and the availability of models to meet different volume and testing needs within that specific facility.

2. Larger and more automated electrolytemeter units may be suitable more for reference or central laboratories. These systems will provide them with comprehensive test menu and a high throughput, as well as stat testing. They are most frequently used for determining diagnosis, follow-up care, and the effectiveness of treatment.

3. Smaller electrolyte analyzer systems - which are less automated, have a lower throughput capacity, and offer smaller test menus, can be used by midsize or small laboratories, or those with specialized testing requirements. Facilities with specialty testing should keep in mind that smaller electrolyte analyzers may offer the required test in the shortest period of time, using the smallest amount of patient specimen.

4. Electrolytemeter instruments that can assay whole blood or samples that do not require centrifugation might be considered by urgent or specialty-testing laboratories.

5. Central electrolyte analyzers need broader test menus than electrolyte analyzers used in specialty areas. However, even calcium analyzers used in specialty areas should be capable of testing for certain key analytes whose presence or absence indicates a life-threatening situation and calls for immediate action.

6. Facilities should look carefully into the electrolyte analyzer test menus to ensure that the tests offered meet their clinical needs.

7. Facilities that are considering a portable calcium analyzer, should consider issues related to the cost of calibration materials, a portable printer, unit and reagent storage, paper, reagent controls, and interfacing capability.

Questions for the Seller

Before you purchase your Electrolyte Analyzer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Electromagnetic Blood Flow Detector

Electromagnetic blood flowmeters measuring blood flow in vessels after various surgical procedures

Electromagnetic blood flowmeters used in vascular reconstructive surgery to confirm and measure velocity of blood flow in vessels. This invasive technique involves use of a catheter inserted into vessel, or use of probe surrounding a surgically exposed vessel, so as not to penetrate the vessel wall.

Tips for Buying an Electromagnetic Blood Flow Detector

1. Laser blood flow meters and blood-flow detectors can be handheld, portable, or tabletop units. Facilities should select the right configuration based on clinician monitoring needs and preference.

2. Blood-flow detectors and meters should include an on/off indicator, and transducers with different user-selectable transmitting frequencies. The detectors and flow meters should have a range of 2 to 8 MHz.

3. External speakers with volume control for Doppler analysis should be included with the flow meters. They should also have bi-directional flow indicators, and a transducer mounted on a catheter or probe or integral to a clamp.

4. Flow meters should have probes with different lumen diameters. Frequency response should be user-selectable and within a range of 0.5 to 100 Hz.

5. A flow meter should remain zeroed and calibrated for at least one day after it was zeroed and calibrated according to the manufacturer's instructions.

6. In order to provide the required accuracy for the evaluation of blood perfusion, the units should include a fiber optic probe designed for that purpose.

7. The following data should be specified by the manufacturer: the unit's measurement depth, response time, laser class, wavelength, and power output at probe tip, Doppler-shift frequency range, cable length, and probe-head diameter.

8. When facilities consider buying probes to be used with blood flow meters, they should look into various factors, such as: the length of the vessel that can be exposed, the available space around the vessel, the location of adjacent organs, and the depth of the vessel's location.

9. Facilities must use probes of the right size and type to obtain accurate results. Most manufacturers will try to meet specific needs for probe sizes and accessories, although they don't necessarily include it in their usual product lines.

10. Various output options are offered with these units. These may include headphones, chart recorder, extra output jacks, a printer, and meters.

11. Other options are available as well, including pneumoplethysmography, strain-gauge plethysmography, photoplethysmography, a carrying case, a remote control, a footswitch, and interfacing capabilities.

12. The units can be line-powered or battery-powered. Battery-powered units should have their battery operating the device for at least two hours. A visible and audible alarm should warn when a battery level falls to the point that may fail to perform satisfactorily.

13. Rechargeable batteries should require less than 16 hours of recharging after depletion When there's a need to recharge the battery, a clear indicator should appear.

Questions for the Seller

Before you purchase your Electromagnetic Blood Flow Detector, we recommend you ask the seller the following questions:

General Information

Is it bidirectional?

Does it have computer interface?

Does it have volume control?

Does it have an on/off indicator?

Can it be battery operated?

Outputs

Does it include a speaker?

Does it include a headphone?

Does it include a chart recorder?

Does it include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying an Electron Microscope

Electron microscopes with transmission and scanning capabilities

Transmission electron microscopes, which provide an image of the area being studied. The electron beam passes through the specimen, allowing highly magnified (500,000x) visual images of tissues, cells, and cell structures.. These microscopes are most often used for identifying cancer cells, and for diagnosis and differentiation of renal diseases.

Tips for Buying an Electron Microscope

1. Electron microscopes should be able to use sheet film, although a digital photographic system is preferred. The minimum resolution required for lattice image and point-to-point measurements is 0.2 nm.

2. An objective, intermediate, and projector lens system should be part of electron microscope device. The preferred systems are of the auto-focusing type.

3. Water interruption, diffusion pump heater failure, and vacuum failure are the required safety indicators. Facilities should also consider scanning capability as an option when purchasing an electron microscope, depending on their needs.

4. Facilities must place electron microscope devices in a room large enough to accommodate all necessary components, such as: vacuum systems and power-supply units. The designated electron microscope room should be temperature-controlled with lights that can be dimmed or turned off.

5. Facilities must consider additional costs for sample preparation equipment and physical facilities, as well as electron microscope mounts, filaments, and grids. They should also know that TEM have limited clinical use, require auxiliary equipment for operation, and need complex specimen preparation.

Questions for the Seller

Before you purchase your Electron Microscope, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Microscopes, Electron, Transmission

# Tips and Guidelines for Buying an Electrophoresis System

A system for separation of ionic solute mixtures using electrophoresis

Electrophoresis systems are used to separate and assess mixtures of ionic solutes. They are capable of performing one or more procedures such as zone, gel, and isoelectric focusing electrophoresis. The system includes an electrophoresis chamber with support media, temperature control unit, densitometer, and power supply. The procedure of separating ionic solute mixtures by the differences in rate of migration in an applied electric field, requires use of reagents. Some systems are automatic, using a computerized data processing system. Less expensive manual systems are available.

Tips for Buying an Electrophoresis System

1. Electrophoresis systems are offered in various configurations. Facilities should keep in mind that the cost may vary significantly based on the specific modules purchased. For example, an electrophoresis system unit with an integral densitometer will cost more than one without it.

2. Other units offered include automated electrophoresis systems, some with densitometers and data-analysis capabilities. These can automatically apply sample to the gels, perform electrophoresis, scan the gels, and print the results.

3. When gel analyzer units become less integrated, resolution decreases and results become less reproducible.

4. When using modular components, each component should be physically and functionally compatible so that the performance is not compromised, and sample separation is not affected.

5. Required specifications indicate the minimum necessary for the gel analyzer system to perform its indicated function, while preferred specifications enhance either test operations or ease of use and, therefore, the effectiveness.

6. Optional specifications do not affect the performance, but provide wider applications of use by offering greater testing options or minimizing user interaction, allowing the gel analyzer system to be operated under a wide variety of circumstances. 7. The typical gel analyzer testing requirements of individual labs determine the available testing.

8. Protein and hemoglobin are the test kits offered. These should be available from the manufacturer.

9. To ensure that the sample can be tested under ideal temperature conditions, an incubator or oven is desirable.

# Tips and Guidelines for Buying an Electrosurgical Unit

Monopolar and bipolar electrosurgical devices

Monopolar and bipolar units for electrosurgery. In monopolar units an active cable and electrode is used to deliver a high-frequency current to the patient, which returns to the unit using a dispersive electrode. In bipolar units the two tips of forceps or scissors are used as the active and dispersive leads. Bipolar electrosurgery is mainly used for coagulation of fine tissue .

Tips for Buying an Electrosurgical Unit

1. These units should come with a solid-state generator, with a typical frequency range of 0.3 to 1 MHz. They should have an isolated monopolar output, a hand switch, a footswitch, and bipolar output.

2. The output power for monopolar cutting should not exceed 300 W, and the open circuit voltage should not exceed 2,000 peak-to-peak volts; these values apply in general-purpose use.

3. For coagulation, the output and open circuit voltage should not exceed 120 W and 6,000 peak-to-peak volts, respectively. Bipolar mode should use no more than 50 W and 300 peak-to-peak volts.

4. Units should include the following: a return electrode contact quality monitor, independent output, visual and audible activation indicators, alarm capable of volumes higher than 45 dB at one meter, power-setting display and convection or fan cooling system.

5. Argon-enhanced units should have a flow range of 0 to 10 L/min, a tank capacity of more than 1,200 L (42 ft3), and a low-pressure alarm; the device should include an alarm capable of volumes higher than 45 dB at one meter.

6. There are numerous designs of electrosurgical units, and facilities should base their comparisons among devices according to characteristics, usefulness of features, safety, and reliability - all of these affect clinical performance.

7. Users who are considering which argon-enhanced coagulation system to purchase, should determine whether they wish to expand their current electrosurgical system with a compatible argon module or they get a new one with an integral argon unit.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrosurgical Units

# Tips and Guidelines for Buying an ELISA Analyzer

Analyzers for photometric immunoassays

Immunoassay analyzers using photometric radiation restriction methods. Many of these analyzers use a visible or UV light source. Immunoassays are optically read from within the microplate sample tray. Results are presented and printed.

Tips for Buying an ELISA Analyzer

1. ELISA analyzer buyers should carefully evaluate their clinical needs before making a purchase.

2. Facilities should consider the following: resolution characteristics, wavelength range, accuracy, flexibility of operation, and availability of auxiliary equipment.

3. Dual-wavelength application and balanced-circuit data display are features to be considered in an ELISA analyzer.

4. Double-beam ELISA analyzer units measure at a faster rate and offer continuous automatic correction for optical errors or deficiencies. They are more expensive than single-beam units.

5. The preferred ELISA analyzer units are ones that can be programmed, and their reader is required to have a display of some kind.

6. Photometric microplate readers should have a computer interface. Printers are considered optional.

Questions for the Seller

Before you purchase your ELISA Analyzer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Emergency Cart

Carts with appropriate features for emergency cardiopulmonary resuscitation procedures

Carts with appropriate features for storage and transportation, used for emergency cardiopulmonary resuscitation procedures. These carts are usually pre-stocked and ready for use, located strategically throughout the hospital for use by emergency medical team. They include defibrillator, ECG monitor, pulmonary resuscitator, oxygen reservoir, backboard for external cardiac compression, as well as surgical supplies and drugs.

Tips for Buying an Emergency Cart

1. An important factor to examine is the ergonomics of the emergency cart in relation to its supplies, the staff that uses it, and the patient.

2. These nursing trolley units should include several drawers or shelves for storing vital pharmaceuticals and resuscitation equipment. Locks or seals should help control access to the emergency cart. Seals are preferred, because they allow access more quickly during an emergency.

3. To help separate contents, dividers should be available as an option.

4. To accommodate defibrillators and still leave space for other necessary tasks, the working surface should be large enough.

5. To provide stability during transport, nursing trolley casters should be large enough. At least 2 locks should be available to prevent unwanted movement. The two leading wheels should be non-swiveling. Emergency carts with four swiveling wheels in a diamond configuration may tend to drift and can be difficult to steer.

6. The best tracking and maneuverability can be found in five-wheeled or six-wheeled emergency carts or resuscitation trolleys, with two center-fixed wheels and corner-swiveling wheels.

7. To help users tailor the emergency carts for their specific needs, a wide selection or accessories should be offered.

8. It may be useful to add preprinted labels or label holders on the drawers, as well as record or inventory checklist holders.

9. A crash emergency cart would usually include the following: defibrillator/monitor; intubations tray with instruments; tracheotomy tray with instruments; surgical bandages and sponges; central venous pressure catheters and manometers; manual resuscitator; resuscitator-inhalator; suction equipment and catheters, irrigating set; laryngoscope, blades, airways, endotracheal tubes in various sizes; IV fluid bags and tubing; backboard; electrode gel; ECG recording paper; sphygmomanometer; antibiotic ointment, disinfectant, alcohol wipes, sterile gloves; needles and syringes; and drugs for controlling heart rate and rhythm, blood pressure, cardiac output, pain, and anxiety.

10. In some facilities, a special CPR committee or code committee determines the type and quantity of supplies and equipment for crash carts.

11. Emergency cart buyers need to decide whether they want a line cord for charging battery-powered defibrillators.

Questions for the Seller

Before you purchase your Emergency Cart, we recommend you ask the seller the following questions:

Drawers

Does it include dividers?

Does it include locks or seals?

Casters

Does it have brakes?

Are they conductive?

Accessories

Does it include an IV pole?

Does it include an oxygen tank holder?

Does it include a heart board?

Does it include a waste container?

Does it include an equipment hanger?

Does it include a line cord?

Does it include a medication tray?

General Information

Are there any signs of rust?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Carts

# Tips and Guidelines for Buying an EMG & Evoked Potential Response Unit

Classic EMG units, and equipment for testing the evoked potential response

EMG equipment is used to assess muscular function, nerve conduction and reflexes. EP equipment measures and records electrical signals from brain in response to audio, visual, or somatosensory stimuli. This information is used together with other clinical information to assess brain sensory functions. Modern equipment is usually designed for both tasks.

Tips for Buying an EMG & Evoked Potential Response Unit

1. Facilities should consider the following factors before making the purchase: reliability, safety, supplier service support, the initial cost of the unit and its accessories, and the cost of electrode replacement. Some additional factors to consider include computer software and combined usage as an EP unit. Systems that can be upgraded have an advantage.

2. To narrow down the list of devices to consider, facilities should decide on the intended applications. If the device will be used only for auditory EPs, devices without this capability can be eliminated, as can those that provide a comprehensive set of capabilities, including auditory, visual, and somatosensory EPs - since they would be more costly. However, if the device is to be used for a wide range of applications, only a comprehensive set of capabilities should be considered.

3. When purchasing any type of EP graphic recorder, buyers should consider some data management capabilities. A computer interface is highly recommended to transfer collected data to an information system. The unit should also be able to store data, preferably on a hard drive and removable media, and must have a waveform display capable of showing at least eight waveforms simultaneously. A printer to provide hard copies of collected information is desirable as well as an artifact-rejection option.

4. It is possible to expand EP unit capabilities to include electromyography and electro-oculography. This can be cost-effective because it often eliminates the need to purchase a dedicated system for those procedures.

5. EP users should be trained in using the systems and interpreting the results. Certification as a clinical neuro-physiologist is required, and the technician administering the tests should also receive training in patient preparation.

6. Depending on facility preference, the electric stimulator can be either sub dermal or surface. The auditory stimulator should be capable of producing broadband clicks and noise masking at the minimum. Insert earphones are also recommended, and the minimum signal produced should be 5 to 50 pulses per second at an intensity of 0 to 100 dB SPL. The visual stimulator should include a checkerboard capable of at least 1 to 50 reversals per second.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrophysiology Recorders - EPT

# Tips and Guidelines for Buying an Endoscope Cleaner

Disinfecting system for flexible endoscopes, and other medical devices

A system which uses liquid germicides to kill or inactivate microorganisms from flexible endoscopes, taking less time than sterilization. Some units provide near sterile disinfection. A liquid chemical germicide is circulated throughout the endoscope. Some units can be used for other medical devices such as microsurgical instruments and forceps.

Tips for Buying an Endoscope Cleaner

1. Endoscope Cleaners should have an auto-disinfection cycle to optimize efficiency. They should also have documentation of cycle times and results. Audible alarms should alert operators of any problem or endoscope cleaner failure.

2. Facilities should carefully examine their existing endoscope reprocessing protocol prior to purchasing a flexible endoscope reprocessor.

3. Automatic flexible endoscope reprocessors may be considered in facilities with the following problems: glutaraldehyde exposure complaints, reprocessing inconsistency, inability to handle the volume of endoscopes that need reprocessing.

4. When comparing high cost alternatives or determining the positive or negative economic value of a single alternative, medical facilities may use the life cycle cost analysis. These techniques can be used to examine the cost effectiveness of leasing or renting endoscope cleaning equipment versus purchasing endoscope washers outright.

5. Life cycle cost analysis is most useful for comparing alternatives with different cash-flows and for revealing the total costs of endoscope cleaner equipment ownership because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time.

6. The present value analysis is extremely useful because it accounts for inflation and for the time value of money. It often demonstrates that the cost of endoscope cleaner ownership is much more than just the initial acquisition cost, and that even a tiny increase in initial acquisition cost may produce significant savings in endoscope washers operating costs.

Questions for the Seller

Before you purchase your Endoscope Cleaner, we recommend you ask the seller the following questions:

General Information

Does it have a 'wash cycle' capability?

Can it reprocess also rigid endoscopes?

Can it also reprocess small surgical instruments?

Does it produce documentation on the reprocessing cycle?

Is a printer included?

Does it have a memory for the reprocessing data?

Does it have an autodisinfection cycle capability?

Is there reprocessing fail/malfunction alarm?

Are there any signs of leaks?

Are there any signs of rust?

# Tips and Guidelines for Buying an Endoscope Light Source

Fiberoptic light sources for endoscopes

Fiberoptic light sources for endoscopes (flexible or rigid) in diagnostic, observation, and surgical procedures. High and low intensity fiberoptic light is used for viewing surgical fields and body cavities, while minimizing tissue heating. These lighting sources are smaller and more cost-effective as opposed to incorporating a light source in each fiberoptic instrument.

Tips for Buying an Endoscope Light Source

1. When purchasing an endoscope light source, compatibility with a variety of light guides is a must.

2. The recommended endoscope light source units are those with a universal clamp or turret ports.

3. When selecting the right endoscope light source device, facilities should look into light source gastroscopic devices offering manual and automatic methods of adjusting light output. Endoscope light source units with a backup bulb are also preferable, since they provide illumination when the main bulb burns out or malfunctions.

4. All the endoscope light source device's controls should be simple to operate and clearly marked. They should be easily accessible and easy to read even under low-light conditions.

5. The displays should be clear and easy to read. They should include a mode indicator, light output meter, and lamp life meter.

6. A standby feature should accompany the light source gastroscopic device sources to suspend light output, which is active at start-up.

7. At startup, endoscope light source devices should default to a low to medium light setting. This will eliminate excessive light when the standby feature is deactivated.

8. When the light guide is disconnected from the port, the light sources should not allow the output of light. Therefore, preferred devices are those preventing light output when the light guide is disconnected from the instrument.

9. Light source gastroscopic applications are offered in a wide range of options and prices. Therefore, facilities should make a very careful assessment of the available selection.

10. The ability to connect to other endoscopes is an important factor, and so is the portability of some of the light sources.

Questions for the Seller

Before you purchase your Endoscope Light Source, we recommend you ask the seller the following questions:

Lamp

What is the type of the lamp?

How many hours was the lamp in use?

# Tips and Guidelines for Buying an ENG Unit

Electronystamographs are used as a testing device to detect and record nystagmus

Electronystagmographs are used to induce and test nystagmus to support diagnoses based on clinical examinations. These devices detect, amplify, and record nystagmus, which are an indication of brain stem or vestibular dysfunctions, Multiple Sclerosis, or drug/alcohol presence. Various types of nystagmus can also be induced to test for specific disorders.

Tips for Buying an ENG Unit

1. Facilities should consider the following factors before making the purchase: reliability, safety, supplier service support, the initial cost of the unit and its accessories and the cost of electrode replacement. Some additional factors to consider include computer software and combined usage as an EP unit. Systems that can be upgraded have an advantage.

2. To narrow down the list of devices to consider, facilities should decide on the intended applications. If the device will be used only for auditory EPs, devices without this capability can be eliminated, as can those that provide a comprehensive set of capabilities, including auditory, visual, and somatosensory EPs - since they would be more costly. However, if the device is to be used for a wide range of applications, only a comprehensive set of capabilities should be considered.

3. When purchasing any type of EP graphic recorder, buyers should consider some data management capabilities. A computer interface is highly recommended to transfer collected data to an information system. The unit should also be able to store data, preferably on a hard drive and removable media, and must have a waveform display capable of showing at least eight waveforms simultaneously. A printer to provide hard copies of collected information is desirable as well as an artifact-rejection option.

4. It is possible to expand EP unit capabilities to include electromyography and electro-oculography. This can be cost-effective because it often eliminates the need to purchase a dedicated system for those procedures.

5. EP users should be trained in using the systems and interpreting the results. Certification as a clinical neuro-physiologist is required, and the technician administering the tests should also receive training in patient preparation.

6. Depending on facility preference, the electric stimulator can be either sub dermal or surface. The auditory stimulator should be capable of producing broadband clicks and noise masking at the minimum. Insert earphones are also recommended, and the minimum signal produced should be 5 to 50 pulses per second at an intensity of 0 to 100 dB SPL. The visual stimulator should include a checkerboard capable of at least 1 to 50 reversals per second.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrophysiology Recorders - ENG

# Tips and Guidelines for Buying an Ergometer

Bicycle ergometers

Bicycle ergometers are used in standardized exercise testing for certain suspected disease diagnoses. Rate of effort can be measured by calculating effort expended. They have the same features as stationary exercise bicycles.

Tips for Buying an Ergometer

1. When purchasing ergometers, these factors should be considered: stability, ease of maintenance, adjustable seat and handlebar height, and ease of mounting.

2. To facilitate stress exercise, facilities may wish to add programmable protocols, but these add to the cost of the bicycle ergometer.

3. To ensure the accuracy of workload measurements, the bicycle ergometer requires periodic calibration and adjustment. The reason is that the resistive element in a mechanical ergometer is subject to wear.

4. Calibration and adjustments may often be a complex process, depending on the type of braking system used.

5. Facilities can buy this equipment for use by in-house service personnel.

# Tips and Guidelines for Buying an Esophageal Motility Analyzer

Peristaltic analyzers for esophagus, gastric and /or small intestine motility

Analyzers using a swallowed catheter in order to measure esophageal pressure directly, and extracorporeal transducers to measure indirect pressure. They are used to evaluate patients with acid reflux, dysphagia, and/or non-cardiac chest pain. Esophageal motility analyzers also use sensors to measure pH, respiration, and swallowing. Gastric and/or small intestine motility is determined by using peristaltic analyzers that measure pressure at several points on an intragastric probe. They also measure acidity of stomach contents using a pH electrode.

Tips for Buying an Esophageal Motility Analyzer

1. All systems should include sufficient storage space on both permanent drives and writable media to permit the archiving and transfer of test results. They should also allow networking with other computers and information systems.

2. Multiple pressure channels allow more complete analysis of the swallowing reflex without the need to reposition the catheter.

3. Usually, ambulatory devices require fewer monitoring channels than systems intended for hospital use. Systems are considered more flexible and can better aid in the diagnosis of conditions such as GERD when they have the ability to monitor other variables, such as pH.

4. Manufacturers offer many types of esophageal motility analyzers - each with its own level of sophistication.

5. Optional features offered by some manufacturers include ambulatory units for 24-hour studies, direct link to computers to calculate and graphically display peak and average pressures, wave velocities, sphincter volumes, and other information, and software packages to perform these functions in real time.

Questions for the Seller

Before you purchase your Esophageal Motility Analyzer, we recommend you ask the seller the following questions:

Channels

Pressure?

Respiration?

Swallowing?

pH?

Electromyograph?

Electrogastrograph?

Electrocardiograph?

Catheters/Probes

Infusion?

Noninfusion?

pH?

# Tips and Guidelines for Buying an Ethylene Oxide Sterilizer

Ethylene Oxide sterilizing units

Ethylene oxide sterilizing units, with strict controls defining gas concentration, temperature, and relative humidity.

Tips for Buying an Ethylene Oxide Sterilizer

1. Before purchasing a sterilizer, facilities need to examine their existing protocols for sterilization/reprocessing, as well as their current and future needs. EtO is one of four sterilization methods that are available for medical devices. The other three are: pressurized steam, gas plasma, and liquid germicides. Each method has its own limitations. The recommendations for EtO sterilization mainly relate to safety issues, since this type of sterilization is a well-established technology.

2. All doors of sterilizing units should have a locking system to prevent the door from being opened before the cycle is completed and posing a risk of EtO exposure. Dedicated exhaust and ventilation systems should be carefully designed to avoid personnel exposure. Sterilizers should be placed in isolated, well-ventilated areas with controlled access. Exposures should be well below the permissible exposure limit of 1ppm, with sufficient engineering controls and proper work techniques.

3. Users should be notified by audible alarms of cycle completion and any system faults. To ensure proper sterilization, a recorder should document the pressure and temperature during the cycle as it proceeds through each phase.

4. Exhaust lines should be local and lead directly from the sterilizer door to an exhaust drain and/or outside. The ventilation system should discharge air from the space to the outdoors.

5. These units have larger chambers than gas plasma sterilizers and can therefore process more items at once, but they require a longer cycle time and 10 to 16 hours of aeration after processing to eliminate toxic residues from sterilized items. This can result in the removal of sterilized items from use for up to 24 hours, and may necessitate the purchase of additional inventory to meet the demands of the facility.

6. Some regions have enacted regulations to restrict emissions from EtO sterilizers because of the potentially damaging effects of EtO on the environment. Facilities that are affected by these regulations, may find the use of an EtO-emission abatement system most desirable. In some of these systems a process called catalytic oxidation break down EtO into CO2 and water. Other emission-abatement systems use a scrubbing method.

7. Some systems can effectively reduce emissions by up to 99.9% -allowing those who wish to continue using EtO sterilizers to comply even with the strictest regulations.

Questions for the Seller

Before you purchase your Ethylene Oxide Sterilizer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

General Information

Is it CO2 adaptable?

Is it HCFC adaptable?

Single-use 100% EtO?

What is the Recorder type?

Does it have audible alarms?

Are there any signs of rust?

Doors

Configuration?

Operation?

Hinge 1 door?

Hinge 2 door?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Ethylene Oxide Sterilizing Units

# Tips and Guidelines for Buying an External Automated Defibrillator

External automated defibrillators which can be operated by non-medical personnel

External defibrillators, compact and easy to operate by trained individuals. The fully automated external defibrillators determine the need for the electric shock, and consequently charge and discharge for the delivery of the shock. The semi-automated defibrillators are very similar, but the discharge is activated by an operator.

Tips for Buying an External Automated Defibrillator

1. Both automated external defibrillators and semi-automated defibrillators will usually be situated in areas within the medical centers where starting defibrillation would take less than three minutes and be used by first responding nurses or carried by police officers and firefighters who respond to medical emergencies.

2. The PAD units are designed for use by individuals who may arrive on the scene before first responders, such as security guards and flight attendants, who have no medical training but are trained to use these devices.

3. The difference between the two types of external defibrillators is mostly the level of voice prompting, with PAD offering more detailed instructions.

4. The ECG must be obtained through disposable defibrillation electrodes, and the analysis program must analyze ECG data and reach a fast decision in less than 14 seconds.

5. The external defibrillators must deliver defibrillation energy at preset levels and sequences, and users must be able to program the energy sequences without help from service personnel. The automated external defibrillators should charge to maximum energy in less than 15 seconds.

6. When the automated external defibrillators are turned on, analysis should start automatically, or the operator should be prompted to press an analyze button to eliminate delays in starting analysis.

7. When not in analyzing mode, the automated external defibrillator should indicate in an audible and visual manner the presence of a potentially shockable rhythm, or a change to such a rhythm.

8. External defibrillators should be able to deliver a series of 3 shocks within 90 seconds. An automated device should not automatically deliver more than 3 successive detection-shock episodes.

9. Semi-automated defibrillators, which are equipped with a discharge control, should automatically disarm when fully charged, if not intentionally discharged within 10 to 30 seconds after charging. The device should provide a simple and fast way of disarming the unit manually, if the charge is held for over 30 seconds. It should not lose more than 15% of the initial deliverable energy before automatic disarm in either automated external defibrillators or manual mode.

10. Fully automated defibrillators should not hold their charge more than 10 seconds before disarming.

11. Manual override can let the more experienced user continue a resuscitation attempt upon arrival without the need to remove the current defibrillator. This feature would be more commonly found on standard automated external defibrillators.

12. The automated external defibrillators, which are simple and easy-to-use, require less user training than the semi-automated defibrillators in rhythm recognition and device operation, as well as less constant education time, compared with conventional defibrillators. When the incidence of cardiac arrest is low, skill maintenance is important for users of both conventional defibrillators and automated external defibrillators.

13. An ECG display also allows the rescue to continue without having to disconnect or unravel the paddles or electrodes to switch the plug-in cord from the automated external defibrillators to a compatible defibrillator/monitor.

14. The automated external defibrillators have different documentation features such as dual-channel ECG - voice recorders or solid-state memory with a device that stores information summarizing the resuscitation attempt.

15. Several software packages are offered by some of the manufacturers of these devices to help with information storage and trending. However, many large emergency medical systems choose to develop their own databases.

16. Based on the external defibrillator's amount of use, the disposable electrodes can be a serious expense.

17. Battery life is reduced when the battery is installed, and if the unit performs periodic self-tests, a non-rechargeable battery can be exhausted within a few days of training.

18. Automated external defibrillators, which are used by first responders in the pre-hospital environment, should be light and portable.

19. In order to minimize intricacy, some advanced features of manual, semi-automated defibrillators or monitors have been stripped to create an easy-to-use device capable of offering an effective initial response to cardiac arrest.

Questions for the Seller

Before you purchase your External Automated Defibrillator, we recommend you ask the seller the following questions:

General

What is the date of the last periodic maintenance?

Software installed? (Name + Version)

Defibrillators, External, Automated

Does it have manual override?

Does it have voice prompting?

Monitor

Does it include an ECG display?

Monitor Type?

Does it include a message display?

Does it include heart rate display?

Does it include Gain, mm/mV?

Data Storage

Does it include event record database storage?

Does it include solid-state memory?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Automated External Defibrillators

External Defibrillators

# Tips and Guidelines for Buying an External Defibrillator

Manually and battery-operated external defibrillators which include an ECG monitor

Manually configured external defibrillators that are battery powered, and include an ECG monitor. They may also include an external non-invasive pacemaker. The ECG monitor may be either integral or modular. It is used to verify a shockable cardiac rhythm, and monitor effectiveness of treatment. Electric impulse is delivered to patient after confirmation of ventricular fibrillation, using ECG. These units are usually battery operated, and may also be line powered.

Tips for Buying an External Defibrillator

1. The recommendations for this device have been divided into two categories: basic and advanced. These two groups vary in the features they offer and the situations in which they will be used.

2. A basic defibrillator is used mainly as a crash-cart unit to provide defibrillation therapy. It does not need an extensive monitoring capability; advisory/automated external defibrillator capability can allow use by personnel trained in basic life support.

3. An advanced defibrillator will be operated especially by personnel trained in advanced cardiac life support.

4. When adding external pacing and advanced monitoring capabilities, these devices become suitable for intra and inter-hospital transport applications and emergency medical services paramedic use on top of their crash cart applications.

5. To meet specific needs of a facility, some combinations of features can be configured in many units. Many defibrillator/monitors on the market provide comparable capabilities and functionality.

6. When selecting the right unit, facilities should consider user preference and standardization issues. When standardizing on a model or a manufacturer, users simplify the purchasing process and clinician training, and gain the ability to negotiate for a discount.

7. Most units on the market employ a biphasic waveform, which are strongly recommended over the monophasic ones. Clinical evidence supports the superiority of the biphasic waveform.

8. Devices designed for adult defibrillation should have energy settings of 50-360 J.

9. Devices capable of internal or pediatric defibrillation or synchronized cardio version should have energy settings of 5-50 J.

10. Devices for neonatal applications should have additional low-energy settings of 1-20 J.

11. Units should be able to charge to maximum energy in less than 15 seconds over the full range of battery-charge indicator levels.

12. The unit should automatically disarm within two minutes if not intentionally discharged.

13. Units should have the option of running on battery power. Line powered units will not disarm when the line cord is unplugged or when line power is otherwise interrupted.

14. The monitor should display a clear and distinct marker to indicate the synchronization point on the ECG waveform.

15. The defibrillator's ECG input amplifiers should be protected against damage from discharge energy.

16. The display should recover a readable ECG trace within five seconds of an input overload from a maximum-energy defibrillator pulse.

17. The unit should include a recorder, and the recorded strip should include periodic annotations.

18. All units should include low-battery alarms to provide an adequate warning that the battery is low.

19. While the batteries are charged, the unit should provide an indication, as well as when they have reached full charge. The charge time should not exceed 24 hours. Batteries should be easily available and should not need frequent replacement.

20. The pacemaker should have a pulse duration within 10% of the specified value.

21. The output current should be selectable by constant, calibrated control or at small incremental levels to assist in delivering the minimum output current that achieves capture.

22. A clear indicator should appear on the ECG waveform showing the occurrence of each delivered pacing pulse.

23. The pacing pulse must be suppressed on the ECG waveform display to enable patient monitoring during the pacing procedure.

Questions for the Seller

Before you purchase your External Defibrillator, we recommend you ask the seller the following questions:

General

What is the date of the last periodic maintenance?

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

External Defibrillators

# Tips and Guidelines for Buying an External Pacemaker

External transvenous cardiac pacemakers

Transvenous pacemakers are generally used in emergencies, when temporary pacing is needed, or until a pacemaker can be surgically implanted, for control of heart rate and during cardiac electrophysiologic studies. Impulses are delivered through an electrode catheter that is inserted through the vein into the heart.

Tips for Buying an External Pacemaker

1. Two types of external pacemakers are available: single and dual chamber pacemakers. Both are recommended for cardiac pacing.

2. All external pacemakers should have adjustable rate, output amplitude, and sensitivity settings.

3. Single chamber pacemakers can pace only a single chamber of the heart, while dual chamber pacemakers can pace both chambers.

4. The single chamber external invasive electrode pacemakers are used in VVI mode, while dual chamber external invasive electrode pacemakers are used in DDD mode.

5. Patients undergoing open-heart surgery, whom prophylactic placement of both atrial and ventricular epicardial leads is common use dual chamber pacemakers.

6. External, invasive electrode pacemakers are available as either constant-current or constant voltage devices, while implant pacemakers only offer constant voltage output.

7. Temporary pacemaker systems use an external pulse generator with leads placed via transvenous cardiac pacemaker approaches. Transcutaneous leads are the easiest to use but transvenous cardiac pacemaker leads are the most reliable options for temporary pacemakers.

8. It is not recommended to use dual chamber pacemakers for single chamber pacing, though it is possible. The dual type is more complex, and therefore requires more training and experience to achieve and maintain proficiency.

Questions for the Seller

Before you purchase your External Pacemaker, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Is the patient cable included?

General Information

Does it have a pace indicator?

Does it have a sense indicator?

Does it have protected off control?

Is it defibrillation protected?

Does it have a strap holder?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

External Pacemaker

# Tips and Guidelines for Buying an Extracorporeal Lithotripter

Extracorporeal lithotripters for kidney stones

Third generation extracorporeal lithotripters use focused shock waves generated using a pressurized water-filled cylinder. This noninvasive treatment causes disintegration of kidney stones into small bits that are passed out of the body in the urine.

Tips for Buying an Extracorporeal Lithotripter

1. The individual requirements of the facility should determine the options of these devices. Systems vary widely in price, based on the type of shock-wave generator, the imaging system, and the table design.

2. Buying a motorized table depends on a facility's budget requirements, the anticipated frequency at which this option will be used, or whether the table will be used for additional applications.

3. Triggering the shock-wave generator can be carried out by the unit in several methods, including ECG, respiratory, manual, and fixed triggering, at minimum, the system should permit ECG triggering.

4. Generator pulse frequencies may vary from 30 to 480 pulses per minute. The system should allow a pulse frequency of at least 96 pulses per minute, and pulse durations may range from less than 1 nanosecond to greater than 500 milliseconds. Durations of less than 500 milliseconds should be available.

5. A penetration depth of at least 120 mm is recommended, and some systems provide depths of up to 170 mm. For stone localization, fluoroscopic, radiographic, and ultrasonic imaging can be used.

6. Fluoroscopic and ultrasonic imaging are recommended. Ultrasound transducer frequencies may range from 3 to 7 MHz, while recommended values are 3 to 5 MHz. In addition, the system can have several patient monitoring features, including: ECG, respiratory, arrhythmia, and anesthesia capabilities.

7. Facilities should determine whether a fixed site is necessary before purchasing a unit. Hospitals and clinics may be able to share mobile services, and therefore the lithotripter's space, shielding, power, and water requirements also need to be considered.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Extracorporeal Lithotripters

# Tips and Guidelines for Buying a Feeding Pump

Enteral feeding pumps

Pumps designed to deliver feeding solutions through temporary or surgically implanted feeding tubes. They control flow of liquid feeding solutions using a rotary peristaltic pump or linear peristaltic pump. They have a memory function for different settings, as well as audio/visual alarms to warn of flow changes or malfunctions.

Tips for Buying a Feeding Pump

1. Feeding pumps are included at no charge from most suppliers, with the purchase of administration sets. It is usually recommended to use the dedicated food pump sets supplied by the manufacturer.

2. When facilities are using alternate-source feeding pump sets, they should test them for proper performance. Facilities should only purchase food pumps that use administration sets with connectors that are incompatible with those for intravenous infusion.

3. The battery in ambulatory feeding pumps should run for 12 to 24 hours at a time. Pole-mounted or tabletop pumps should run for at least 2 to 4 hours; batteries should recharge in less than 8 hours.

4. Facilities should look at the following factors before making an enteral feeding pump purchase: life cycle cost, discount rates and non-price related benefits offered by the supplier, and standardization with existing equipment. These are important because the feeding pumps use disposable accessories.

5. To compare high-cost alternatives to enteral feeding pumps and to determine the economic value of a single alternative, facilities can use a life cycle cost analysis. They can use life cycle cost analysis techniques to examine the cost-effectiveness of leasing or renting feeding pump equipment versus purchasing it outright.

6. Life cycle cost analysis examines the cash flow impact of initial acquisition costs and operating costs over a period of time, and therefore it is most useful for comparing alternatives with different cash flows and for revealing the total costs of feeding pump equipment ownership.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying a Fetal Monitor

**Electronic fetal monitors with antepartum and intrapartum applications**

Electronic fetal monitors that provide information necessary for assessment of fetal well-being, Fetal heartbeat can be detected, displayed, and printed. Examination of these patterns, and other parameters during labor contractions can indicate the need to perform operative delivery , or use of drugs to alter the course of labor. In the event of litigation, documented monitoring of fetal condition could prove to be useful.

Tips for Buying a Fetal Monitor

1. These devices detect, display, and print a record of FHR and UA. Numeric values and graphical trends should be provided.

2. Facilities should consider the unit's ability to interface with other patient monitors and/or hospital information systems/OB data management systems. They should also look into the capability to connect the unit with other patient monitors.

3. A digital display and recorder should indicate FHR over a minimum of 50 to 210 bpm. Alarm limits and status for each monitored parameter should also be displayed.

4. The ultrasound probe can be continuous wave/Doppler or pulsed with a frequency of 1-2.5 MHz.

5. Users should be able to adjust alarm limits for high and low FHR, and for any other monitored parameter. Audible and visual indicators should be present for all alarm conditions.

6. Some units have these capabilities as an integral part: monitoring maternal ECG, pulse oximetry, and NIBP. This may save costs if the facility does not already have the stand-alone maternal monitoring, often used with epidural administration.

7. Telemetric monitoring is optional and should be selected based on a clinician's needs. Some units have internal or external telemetry systems in which the FHR and UA signals are transmitted by radio waves to a receiver at the fetal monitor.

8. With telemetric systems, the supplier should specify the operating frequency band.

9. These units can usually be networked with central stations and/or archiving systems. If the fetal monitor is to be interfaced with a different manufacturer's system, buyers should ensure that all the capabilities of both devices will be accessible.

10. Some archival systems automatically record all patient data on optical disks; others will have the staff periodically download the patient data onto the disk.

11. Data collected from the cardiotocograph can be used with some units for research, remote display, or further processing using an RS232 connector; the fetal monitor acts as a slave monitor and operates by commands from the host computer.

12. For entering nursing notes, some units offer data-entry keyboards or bar coding.

13. Full-service contracts usually cost about 8% of the unit's purchase price. Facilities are encouraged to negotiate for additional service contract discounts for multiple-year agreements or for contracts bundled with contracts on other fetal monitors in the facility.

Questions for the Seller

Before you purchase your Fetal Monitor, we recommend you ask the seller the following questions:

Antepartum/Intrapartum

Does it include uterine activity?

Does it include internal?

Does it include external?

Does it include external?

Does it include twins or MHR?

Does it include twins or FHR?

Does it include maternal SpO2?

Does it include maternal ECG?

Does it include maternal NIB?

Output Signals

Does it include calibration, FHR/UA?

Does it include integral signal simulation?

Can it be interfaced to the EPR (CMR, HER)?

Does it have an alarm?

Display Features

Does it include digital UA?

Does it include alarms?

Does it include high/low FHR?

Does it include digital FHR?

Recorder

Is a recorder included?

Is a printer included?

Does it include events marker?

Does it have remote recording capability?

Is record storage included?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Fetal Monitors

# Tips and Guidelines for Buying a Film Duplicator

X-ray film duplicators, for making quality copies of imaging films

A device for duplicating imaging films. The original x-ray is copied on duplicating film using a light source for transferring image, then put through an x-ray processor, producing a diagnostic quality image on the duplicate.

Tips for Buying a Film Duplicator

1. The quality of duplicated films is good only for reference purposes.

2. When using a film duplicator for archiving, it should be capable of processing 100 films per hour; the maximum size of the duplicates should be 35 × 43 cm.

3. Facilities planning to buy a new film duplicator should consider the number and types of applications for which it will be used. When there is no immediate need for the device, users should continue using their current systems until they buy a digital system. Digital imaging systems are causing film duplicators to become obsolete.

4. Digital systems are expensive, but they can produce as many copies of an image as required. They may reduce record management costs, and archive images more efficiently.

Questions for the Seller

Before you purchase your Film Duplicator, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

X-Ray Film Duplicators

# Tips and Guidelines for Buying a Film Processor

Automatic film developing units for X-rays

These film developing units produce high-quality final images in a short period of time. Tabletop and floor models are available, as well as dental x-ray and sheet film processors.

Tips for Buying a Film Processor

1. When purchasing an automatic x-ray film processor, facilities should primarily consider the number of films processed per hour.

2. Automatic film processors work best with constant and regular throughput. Therefore, facilities are encouraged to match the film processing time and the workload to optimize chemical usage and output quality.

3. Film processor units that handle low to medium volumes should process 150-200 films per hour.

4. The capacity depends on film size and the processing time - both should be clearly indicated in the manufacturer specifications.

5. General radiography processing times should range from 60 to 120 seconds, while dental radiography may take longer - up to 240 seconds.

6. X-ray film processors should have as many automatic controls as possible to optimize results. Automatic temperature and replenish controls will help eliminate human error and ensure clear film results.

7. To help avoid jamming, slipping, or wrapping in the film processor's transport mechanisms, rapid processing film has a constant, precise base and a certain emulsion thickness.

8. Buyers should use only film and processing chemicals that are specially designed for automatic film processors.

9. Before making a purchase, facilities should evaluate the cost of chemicals for a particular film processor and the frequency of replacing it.

10. Some special chemicals were designed to control swelling and shrinking of the film emulsion and to process the film at specific temperatures while it moves through the rapid transport system.

11. Buyers should also address the costs involved with disposal and silver-recovery. Facilities should look for x-ray film processors that do not require a silver-recovery system because their wastewater contamination is less than one part per million.

Questions for the Seller

Before you purchase your Film Processor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Film Types

Different sheet sizes?

Different sheet thickness?

Indicators

Temperature fix?

Temperature dev?

Replenish fixer?

Replenish developer?

Adjustable Dryer temp?

Stand-by mode?

# Tips and Guidelines for Buying a Film Processor, Cine

Cine film processors used mainly for cinefluorography films

A film processing unit used to develop rolls of film (16 or 35 mm.) with cinefluorography images taken by motion picture camera.

Tips for Buying a Film Processor, Cine

1. These units process rolls of 16 or 35 mm film used to record fluoroscopic images. Depending on the quality of the image being processed, the cine film travels from 0 to 6.1 m/min.

2. Quality images' processing time may range from one to five minutes.

3. In order to minimize processing time and variations in film density, systems should be able to perform chemical agitation and re-circulation.

4. Another recommended capability is the performance of automatic replenishment, to maximize solution usage.

5. General radiography processing times should range from 60 to 120 seconds, while dental radiography may take longer, up to 240 seconds.

6. Processors should have as many automatic controls as possible to optimize results. Automatic temperature and replenish controls will help eliminate human error and ensure clear film results.

7. To help avoid jamming, slipping, or wrapping in the processor's transport mechanisms, rapid processing film has a constant, precise base and a certain emulsion thickness.

8. Buyers should only use film and processing chemicals that are specially designed for automatic film processors.

9. Before making a purchase, facilities should evaluate the cost of chemicals for a particular processor and the frequency of replacing it.

10. Some special chemicals were designed to control swelling and shrinking of the film emulsion and to process the film at specific temperatures while it moves through the rapid transport system.

11. Buyers should also address the costs involved with disposal and silver-recovery. Facilities should look for processors that do not require a silver-recovery system because their wastewater contamination is less than one part per million.

Questions for the Seller

Before you purchase your Film Processor, Cine, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Film Types

Roll?

Sheet?

Dry or Wet?

Stand-by mode?

Film detection?

Indicators

Temperature fix?

Temperature dev?

Replenish fixer?

Replenish developer?

Dryer temp indicator?

Adjustable dryer temp?

Input Water

°C, cold?

°C, hot?

# Tips and Guidelines for Buying a Film Scanner

X-ray film digitizers

A film digitizer used to transfer x-ray images to a digital format that can be mapped into a two dimensional digital matrix , then processed and passed through hospital information systems. The images can be printed using laser printers, and saved on magnetic media. These devices include a light source (some have laser light source), light transmission system, light sensor, analog to digital converter, mechanical film transporting system, electronic processor, and computer interface.

Tips for Buying a Film Scanner

1. When choosing a Radiographic Image Digitizer (film scanner), facilities should consider image quality and the film throughput to meet a facility's specific needs. Scanning speed and auto-loading capacity should also be considered.

2. Before purchasing an x-ray film scanner, facilities should consider the following: number of images digitized daily in the department; level of image quality needed; user acceptance of image-processing features; availability of interfaces for connecting with the hospital PACS, radiology information system, and hospital information system; integration with a local area network or wide area network; space requirements for storage devices; service contracts for hardware, software and other maintenance costs.

3. Importing film-based images into PACS or other systems, which is done by x-ray film scanners, can never produce a digitized image as precise as the original one.

4. The best images are produced by modern radiographic image digitizers with good resolution, large field of view, and large grayscale ranges. These film scanner units are expensive and require long scan times that may not be suitable for be clinical applications. These are high quality x-ray film scanners, whether they use laser or CCD technology.

5. A higher resolution and a greater bit depth will result in better image quality.

6. All new film scanner equipment should be compatible with DICOM 3.0. 7. Facilities need to establish policies for handling digitization of film, non-digitized film storage, and generation of new films. They should also develop procedures and guidelines for digitizing current films and archived films if they decide to convert to an all-digital facility.

Questions for the Seller

Before you purchase your Film Scanner, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the scanner include an Auto Loader?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Film Digitizers

# Tips and Guidelines for Buying a Gamma Camera

Stationary gamma cameras with scanning capabilities

Gamma camera scanning system, for determining distribution of administered radiopharmaceuticals in patient's body . Gamma camera scanners produce planar images in cross-sectional slices.

Tips for Buying a Gamma Camera

1. Before deciding on a specific gamma camera (also known as scintillation camera) system configuration, facilities need to consider the number of nuclear medicine studies that will be performed and the clinical applications for which the new system will be used. At this point, the dimensions and weight of the system, humidity and temperature requirements should also be taken into consideration.

2. Whole-body gamma cameras are commonly used for large and small organ studies. They are general-purpose imagers that usually use detectors with a relatively large field of view. Some have SPECT, FDG-SPECT, and coincidence imaging capabilities.

3. Dedicated gamma cameras are designed for particular studies including PET/SPECT brain, small parts cardiac, and neurological applications, the detectors are generally smaller with a small field of view.

4. Mobile gamma cameras usually use smaller detectors than stationary gamma cameras with a reduced field of view, and are mainly used for small organ studies including the thyroid and heart.

5. Facilities planning to buy a mobile gamma camera system or stationary gamma camera should carefully select optional features. The type and number of these will greatly affect the final price.

6. The cost of a dual-head or triple-head system is extremely higher than a single-head system, but multi-head systems allow faster acquisition times and better image resolution. This does not necessarily result in a significantly greater throughput because other factors, such as patient preparation time for example, remain unchanged.

7. A dual-head gamma camera is ideal for single-pass whole-body bone scanning and general SPECT. However, for cardiac SPECT, a dual-head gamma camera with opposing detectors offers little advantage over a single-head scintillation camera, since SPECT data is acquired in a 180

8. Facilities planning to perform a wide range of studies will find a more efficient configuration in the variable-angle dual-head gamma camera because it allows the detectors to be positioned at 90

9. Cardiac scans and certain other procedures can be performed with the detectors positioned at 90

10. For brain and cardiac SPECT, triple-head gamma cameras are more commonly used; they can collect all image data for a heart scan in about one-third the time of a single-head camera and are well suited for nuclear medicine departments conducting many stress thallium or cardiac studies.

11. Most gamma cameras have a 51 × 38 cm (20 × 15 in) rectangular large field of view (LFOV), and some provide an ultra large 61 × 38 cm (24 × 15 in) field of view. LFOV cameras cover larger areas of the body and acquire a complete study in less time, thereby increasing patient throughput.

12. Facilities that are buying more than one gamma camera or adding on to existing gamma cameras should carefully consider interface between old and new systems. Buyers should consider purchasing multiple systems from one supplier. This will ensure easier training, simpler servicing and parts acquisition, and greater bargaining leverage when negotiating the purchase of new equipment or service-contract costs.

13. Facilities should make sure that a scintillation camera is capable of sharing data with existing computer systems.

Questions for the Seller

Before you purchase your Gamma Camera, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does it include a multiformat printer?

General Information

SPECT?

Is the rotation of the gantry smooth?

Operator Console

Zoom control?

Anatomic marker?

Scaler?

Time readout?

Energy selection?

Auto peaking?

Image rotation control?

PHA window capacity?

Window selection?

Auto uniformity correction?

Nonuniform attenuation correction?

Computer

Is it DICOM 3.0 compliant?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Gamma Camera System - Packaging

Gamma Camera System - Operational

Gamma Camera System - Stored

# Tips and Guidelines for Buying a Gamma Camera, Mobile

Mobile gamma cameras for irradiation scanning

Mobile gamma camera scanning systems for bedside assessment of critically ill patients. These systems can obtain only planar images, however some are capable of single-photon emissions. Wheeled units include a detector, stand, and data-processing console which might be on a separate wheeled base. This system is often used for diagnosis of cardiac patients.

Tips for Buying a Gamma Camera, Mobile

1. Before deciding on a specific system configuration, facilities need to consider the number of nuclear medicine studies that will be performed and the clinical applications for which the new mobile gamma camera system will be used. At this point, the dimensions and weight of the system, humidity and temperature requirements should also be taken into consideration.

2. Whole-body mobile gamma cameras are commonly used for large and small organ studies.

They are general-purpose imagers that usually use detectors with a relatively large field of view. Some have SPECT, FDG-SPECT, and coincidence imaging capabilities.

3. Dedicated mobile gamma cameras are designed for particular studies including PET/SPECT brain, small parts cardiac, and neurological applications, the detectors are generally smaller with a small field of view.

4. Mobile gamma cameras usually use smaller detectors with a reduced field of view, and are mainly used for small organ studies including the thyroid and heart.

5. Facilities planning to buy a mobile gamma camera system should carefully select optional features. The type and number of these will greatly affect the final price.

6. The cost of a dual-head or triple-head mobile gamma camera system is extremely higher than a single-head system but multi-head systems allow faster acquisition times and better image resolution. This does not necessarily result in a significantly greater throughput because other factors, such as patient preparation time for example, remain unchanged.

7. A dual-head mobile gamma camera is ideal for single-pass whole-body bone scanning and general SPECT. However, for cardiac SPECT, a dual-head camera with opposing detectors offers little advantage over a single-head camera, since SPECT data is acquired in a 180

8. Facilities planning to perform a wide range of studies will find a more efficient configuration in the variable-angle dual-head mobile gamma camera because it allows the detectors to be positioned at 90

9. Cardiac scans and certain other procedures can be performed with the detectors positioned at 90

10. For brain and cardiac SPECT, triple-head mobile gamma cameras are more commonly used; they can collect all image data for a heart scan in about one-third the time of a single-head camera and are well suited for nuclear medicine departments conducting many stress thallium or cardiac studies.

11. Most mobile gamma cameras have a 51 × 38 cm (20 × 15 in) rectangular large field of view (LFOV), and some provide an ultra large 61 × 38 cm (24 × 15 in) field of view. LFOV mobile gamma cameras cover larger areas of the body and acquire a complete study in less time, thereby increasing patient throughput.

12. Facilities that are buying more than one mobile gamma camera or adding on to existing mobile gamma cameras should carefully consider interface between old and new systems. Buyers should consider purchasing multiple systems from one supplier. This will ensure easier training, simpler servicing and parts acquisition, and greater bargaining leverage when negotiating the purchase of new equipment or service-contract costs.

13. Facilities should make sure that a mobile gamma camera is capable of sharing data with existing computer systems.

Questions for the Seller

Before you purchase your Gamma Camera, Mobile, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does it include a multiformat printer?

General Information

SPECT?

Is the rotation of the gantry smooth?

Operator Console

Zoom control?

Anatomic marker?

Scaler?

Time readout?

Energy selection?

Auto peaking?

Image rotation control?

PHA window capacity?

Window selection?

Auto uniformity correction?

Nonuniform attenuation correction?

Computer

Is it DICOM 3.0 compliant?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Gamma Camera System - Packaging

Gamma Camera System - Operational

Gamma Camera System - Stored

# Tips and Guidelines for Buying a Gamma Knife

Stereotactic systems for radiosurgery using gamma radiation sources

Stereotactic systems for setting exact coordinates in radiosurgery using gamma radiation sources.

Tips for Buying a Gamma Knife

1. Several clinical procedures, such as radio surgery, neurosurgery, microsurgery, and biopsies, should be able to a use stereotactic radiosurgical system, featuring a gamma knife.

2. The following features should be available in treatment planning systems: removable media archival storage or connection to central storage, a film scanner, a color monitor, a keyboard and mouse, and 3-D planning software with graphics, digital imaging and communications in medicine compatibility, as well as dose computation and analysis features.

3. The gamma navigation system's headframes should be constructed of non-ferromagnetic materials for use with magnetic resonance and should be compatible with all cross-sectional imaging modalities, such as: CT, DSA, MRI, PET, and X-ray. Headframes should be lightweight, around 1 kg.

4. In most gamma knife headframes, fixation uses 2 to 4 carbon fiber or titanium pins or screws but some headframes use alternative fixation methods.

5. Several target approaches should be allowed by the center-of-arc or target-centered arc system. These include lateral, parallel, posterior fossa, and hypophyseal.

6. Method of approach confirmation should be available and target access should have a vertical range of >=150 mm, a lateral range of >=160 mm, and an anterior-posterior range of >=170 mm.

7. In dedicated gamma radiosurgical systems, radiation sources should use more than 200 encapsulated 60Co sources.

8. The gamma knife system should have tungsten collimators ranging from 4 to 18 mm in diameter.

9. Systems that allow attachments can have up to 20 MV, but dedicated LINAC radio surgery systems should have 6 MV photon energies.

10. Treatment delivery assemblies should be floor-mounted or wall-mounted with an isocentric accuracy of 0.5 mm for dedicated LINACs. Those mounted onto the LINAC should have an isocentric accuracy of 1 mm.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Manual Medical Device

# Tips and Guidelines for Buying a Gas Liquid Chromatograph

Gas Chromatography systems for use with liquid or solid as stationary phase

Gas chromatography systems using solids in a packed column (glass, metal, or plastic tube) as the stationary phase, and systems using non-volatile liquid coatings on the chromatographic column for the stationary phase.

Tips for Buying a Gas Liquid Chromatograph

1. The needs of a particular facility will determine the features of a gas chromatography system. For most uses, however, certain minimum requirements are common.

2. All systems must include capillary columns. Based on the intended use, other columns may be required.

3. Units must come with at least one detector, but multiple detectors certain applications are preferred. If there's a risk of destruction to the sample, multiple detectors should be avoided.

4. The chromatography system should include some data management features. To produce hard copy of test results, a printer or an interface to a printer is necessary.

5. To present obtained results in a more useful format without requiring manual interpretation, data interpretation software is required.

6. The range of prices for these units is wide, depending on configuration, options, and data management features. Integrators have a wide range of capabilities and price ranges; they are often compatible with different manufacturers' GCs.

7. Buyers should consider the costs for supplies and column replacement before purchasing the equipment.

8. Some suppliers sell reagents that are not their own. Buyers must know which reagent types are compatible with their units and where to purchase them.

9. For purchasing reagents in bulk, some suppliers may give significant discounts.

10. Tests that need little or no training are categorized as waived tests. They do not need elaborate QC, and are less likely to produce inaccurate results. An example would be the non-automated dipstick urinalysis.

11. Tests in the moderate complexity category include most clinical laboratory tests, including automated urine, blood, and chemistry analyses. In this group, tests and analyzers require a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process.

12. More specific testing belongs to the high complexity classification. Tests in this group require extensive training. This category holds procedures with a high degree of operator preparation, calibration, intervention, and analysis, such as clinical cytogenics and histopathology applications.

Questions for the Seller

Before you purchase your Gas Liquid Chromatograph, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Columns

Are mfr columns included?

Are other mfrs' columns included?

Does it include an exhaust vent?

Integrator

Is an integrator included?

Is it built in?

Is it a separate module?

Are other mfr integrators compatible?

Is another mfr integrator included?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Gas Monitor, Atmospheric

Monitors for measuring concentration of ethylene oxide

Monitors used mainly in hospital sterilizing rooms to measure and display ethylene oxide levels. The monitors include sensor, control unit, and display. In addition they may also include alarms triggered to activate at preset concentrations, remote transmitting to a central monitor, and recording options.

Tips for Buying a Gas Monitor, Atmospheric

1. Systems in the high specificity category are usually better at detecting low levels of EtO. Sequential air sampling from different locations is required if multiple points must be monitored.

2. Depending on the number of sensing points and the system response time, sensing locations may go unmonitored for extended periods of time. No sensing point should go unmonitored for over 5 minutes to ensure that the monitor will alarm before dangerous exposure levels. The monitor should take less than 5 minutes to respond.

3. Systems in the low specificity category are usually set to alarm at higher EtO levels. In this case a shorter response time is necessary to prevent extended exposure to the higher EtO levels.

4. The monitor should display measured levels in ppm because this is how EtO regulations specify limits. Audible and visible alarms should alert users when limits exceed a specified concentration. The monitors should be designed for continuous monitoring in a fixed area.

5. These devices are offered in a wide range of sizes, configurations, and capabilities, and their prices vary accordingly.

6. There is no specific OSHA standard about the type of continuous monitor a hospital needs. There are few other concrete guidelines, either from local agencies or in the published literature.

7. Facilities should consider the following factors: backup capabilities in the event of a power failure, the availability of accessory equipment, calibration requirements, and the price of a service contract. Some models offer additional features, such as generating printed reports, performing internal diagnostics, and storing summaries of previous alarm conditions.

8. Monitors with both visual and audible alarms should be preferred.

9. There are systems with optional service-relay contacts inside the monitor that activate concurrently with the alarm and can be used to control ventilation equipment or auxiliary alarms.

10. Facilities are encouraged to buy monitors that can also detect and measure other sterilization gases, such as hydrogen peroxide and ozone, because of the rapid development in alternative forms of sterilization.

11. In the future, lower availability and higher costs of EtO may force facilities to purchase sterilizers that use toxic non-EtO sterility, which may also require monitoring.

# Tips and Guidelines for Buying a Gastroscope

Upper GI endoscopes used for diagnostics and treatment of the esophagus and stomach

Upper GI endoscopes with various light sources and video processors. Gastroscopes are used for diagnosing and treating upper GI disorders.

Tips for Buying a Gastroscope

1. The most important quality of the gastroscope's image is the optical quality.

2. The following factors determine the quality of the fiberoptic gastroscope: the ability of the fiber optic cables and the light source to adequately illuminate the area under view; the ability of the lens system to transmit a clear and bright image with minimal distortion to the eyepiece.

3. When making a purchase, medical facilities should consider the gastroscope device's sensitivity to heat, the time and temperature of rinsing required, the reuse life of the cleaning solution, and the use of manual or automatic processing.

4. Other issues to consider when purchasing a gastrointestinal endoscope include: shelf life, disposal restrictions, and minimum effective concentration of the cleaning solution.

5. Buyers of gastroscopes should also examine the safety and cost per cycle, as well as the educational options provided by the manufacturer. They should keep in mind that preventive maintenance training can eliminate costly repairs to delicate fiberoptic gastroscope components.

6. The differences between these gastroscope units include: differences in image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view.

7. Videoscopes depend on the number of pixels on the CCD to illuminate the area under view, while Fiberscopes and videoscopes both depend on the light guide.

8. Videoscopes and fiberscopes with cameras depend on the ability of image processors to transmit clear images to the viewing screen.

9. All flexible endoscopes should be compatible with multiple processors. They should also be compatible with multiple light sources.

10. Gastroscope users can clean the lens without removing the scope using lens washing. 11. Buyers should look into the cleaning process of the flexible endoscope. They should carefully review their gastroscope reprocessing protocol to make sure it coincides with the recommendations from the manufacturer.

12. In places where EtO gas sterilization is the preferred reprocessing procedure, there might be an increased need for more scopes in order to meet daily caseload requirements.

13. There are users who want to automate part of their reprocessing with liquid disinfecting or sterilizing units.

14. When reviewing high-level disinfection or sterilization, facilities should look into the operator manual, as well as the facility's infection control and risk management.

Questions for the Seller

Before you purchase your Gastroscope, we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

# Tips and Guidelines for Buying a Glucose Monitor

Point-of-Care whole blood analyzers measuring glucose concentration in blood

Glucose analyzers for use by health professionals or diabetic patients, to test glucose levels in capillary blood. Some units can use venous and/or arterial blood. Mostly reflectance photometry, or electrochemical methods, are used. Some analyzers can also determine cholesterol levels. These glucose analyzers may be used at point -of-care, in surgery, and in sports medicine.

Tips for Buying a Glucose Monitor

1. When choosing a glucose monitor (also known as glucometer), buyers should verify its reliability. The range of glucose readings should be checked with check strips or control solutions to make sure the results fall in the target range specified by the manufacturer.

2. Another important consideration is the simple use of the glucose monitor with minimal training to obtain reliable results. The displays should be large and easy to read; the control buttons should not have multiple functions or other confusing qualities; codes should be easy to enter if applicable.

3. Each glucose monitor should accept strips designed only for those units. Some glucose analyzer units may also reject outdated, used, or blank test strips or control solutions. For extremely high or low blood glucose levels, the glucose monitor should provide error messages to avoid misleading data interpretations.

4. The glucometer devices should offer low battery indicators, warning the user before the performance is affected. The monitors should use commonly available batteries.

5. Typical use and abuse should be tolerated by the monitors. This may include rough handling - normally encountered in medical centers and emergency vehicles. When users disassemble the device for cleaning or replacing a battery, no damage or loss of function should occur.

6. The manufacturer should provide facilities with information regarding glucose monitor maintenance, such as the ease and frequency of cleaning, materials needed for cleaning, and whether the monitor can be disinfected.

7. In facilities with multi-patient applications, there are some glucose analyzer monitors that require disinfection or replacement of components after use on each patient. Some glucose monitor devices are not designed to protect against cross-contamination, so they should not be used in medical centers or physician offices.

8. The blood glucose monitor should be easily and properly operated also by people with vision and/or hearing impairment. They should be able to correctly interpret its data. Visually impaired users should look for tactile landmarks that are easy to locate and use, as well as audible signals, such as those for reaction time and out-of-range glucose values. Some hypoglycemia detection units offer electronic voice readouts.

9. For hearing-impaired users, one manufacturer is offering optional tele-communicative devices and teletypewriters to enable users to contact the company's customer service department for troubleshooting tips or maintenance advice.

10. To minimize user errors in general, buyers are encouraged to undergo intensive training in blood glucose monitor (glucometer) use.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Glycohemoglobin Analyzer

Laboratory and point-of-care analyzers that measure levels of glycohemoglobin in blood

Laboratory analyzers using a separation technique based on charge differences, chemical analysis, or structural differences, to measure glycohemoglobin in whole blood. Point-of-care analyzers are mostly used for assessing glucose control in physician's office. Blood levels of GHB are the integrated value of the past three month period. GHB concentration can be measured using several methods, including photometry and immunoassay.

Tips for Buying a Glycohemoglobin Analyzer

1. Before purchasing a dedicated glycohemoglobin analyzer, facilities should determine the volume of specimens to be tested and the desirability of fractionating HbA1, since chemistry analyzers can also perform glycohemoglobin tests.

2. Some of the less expensive options for measuring HbA1 or HbA1c may be manual column, electrophoretic, or general-purpose, high-performance liquid chromatography systems. These should be considered when the test volume does not warrant the purchase of a large automated hemoglobinometer.

3. Facilities should also consider the time needed to develop a test procedure and prepare reagents when using an alternative hemoglobin A1c analyzer.

4. Purchasing a dedicated glycohemoglobin analyzer may be justified in facilities with high-test volumes due to the loss of precision and the cost and time involved in setting up an alternative analyzer for frequent glycohemoglobin analysis.

5. Hemoglobinometers with test methods based on a specific monoclonal antibody typically allow for the use of smaller test-sample volumes.

6. Facilities should consider the amount of memory in some hemoglobin A1c analyzers that store results.

7. The glycohemoglobin analyzers provide results within minutes, allowing physicians to discuss the results and treatment plans with patients immediately. They are easy to use and do not require highly trained staff.

8. To prevent the expiration of large volumes of reagents that might not be needed in small-volume facilities, the reagents come in cartridges that are used on a per-patient basis

9. Before deciding to buy glycohemoglobin analyzers, facilities should also look into the availability of service contracts.

10. Facilities should know that some glycohemoglobin analyzer suppliers provide services such as maintenance and calibration, standard solutions, extended warranties, hotline services, and/or consolidated services.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Halogenated Anesthetics Analyzer

Portable gas system analyzers for halogenated compounds

Portable analyzers used to measure and display concentrations of halogenated compounds, in some cases also for nitrous oxide compounds. They are used to check anesthesia unit vaporizer accuracy at the gas outlet, and for gas leaks that could potentially affect personnel. These analyzers are based either on optical interferometer or on an infrared spectrophotometer.

Tips for Buying a Halogenated Anesthetics Analyzer

1. These units are spot-checking the accuracy of anesthesia vaporizers and WAG levels in the operating room, and continuously monitoring WAG levels.

2. The type of the counted agent determines the range covered by the analyzer. Typical ranges are 0%-6% for halothane and 0%-20% for desflurane.

3. Units checking vaporizers should directly measure at least one of the agents most commonly used in the facility.

4. Some agent levels can be measured directly or calculated by multiplying the actual reading by a conversion factor.

5. Units that are periodically checking WAG levels should measure levels of N2O and other common anesthetic agents.

6. An automatic gas sampling should be available for analyzers used for continuous monitoring. These units must include an alarm set by the user indicating when a reasonable WAG level is exceeded.

7. Units that are able to save readings can allow the review of WAG levels without the user's presence during a procedure.

8. The measurements must be direct, and the readings in ppm.

Questions for the Seller

Before you purchase your Halogenated Anesthetics Analyzer, we recommend you ask the seller the following questions:

Application

Does it include a vaporizer check?

Does it include an ambient-air monitor?

Does it display level/ppm?

Does it have a history record capability?

Does it include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Capnometers and Multiple Medical Gas Monitors

# Tips and Guidelines for Buying a Harmonic Scalpel

A system which includes a high-frequency generator driving a hand-piece with a vibrating knife, for tissue cutting and coagulation in surgery

A system which includes a high-frequency generator driving a hand-piece with a vibrating knife, for tissue cutting and coagulation in surgery. This surgical unit uses ultrasound energy with its heating effect to cut and coagulate targeted tissue allowing for proper hemostasis with no significant damage to vessels up to 3 millimeters in diameter. This definition relates to complete systems or separate generators and separate knife hand-pieces.

Tips for Buying a Harmonic Scalpel

1. Clinical evaluations should be performed before a purchase decision is made. This is a complex technology, and buyers should make sure that the surgeon is comfortable with the system they are about to purchase. Buyers should remember that the effectiveness of each system depends on the surgeon's comfort level and familiarity with the system.

2. The transducer assemblies of these units should be housed permanently in the headpieces.

3. Displays should include power level (setting), mode, and system status indicators. The unit should have audible indicators and error code messages.

4. Facilities should make sure that service support is readily available, and replacement or repair parts are identified and quickly obtainable.

5. The size and weight of the headpiece and tip, the consistency of the tumor or tissue to be removed, and the importance of minimizing damage to surrounding tissues and structures - all determine the hand-pieces to be chosen for a particular clinical procedure.

Questions for the Seller

Before you purchase your Harmonic Scalpel, we recommend you ask the seller the following questions:

General

Is it mobile?

Software installed? (Name + Version)

Fluidic System

Does it include an irrigation system?

Handpiece Configurations

Straight handpiece?

Straight extended handpiece?

Angled extended handpiece?

Handpiece Configurations: Is it suitable for general surgery?

Handpiece Configurations: Is it suitable for plastic/aesthetic surgery?

Handpiece Configurations: What is the weight of the handpiece (gr)?

Footswitch Control

Does it have a Preset mode?

General Information

General: What is the ultrasonic mode frequency (kHz)?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

US System

Suprevision Forms

US System - Dismantling

# Tips and Guidelines for Buying a Heart-Lung Machine

Bypass units for temporary circulation, oxygenation and blood filtration

Heart-lung bypass units used during open heart surgery (cardiac valve replacement, coronary artery bypass grafting). They oxegenate the body's venous blood supply, pumping it back into the arterial system, providing temporary external circulatory support to cardiopulmonary functions. The bypass unit console includes arterial pump , a backup arterial pump, one or two suction pumps, an arterial vent pump, a cardioplegia pump, and backup unit. Disposable parts include oxygenator/heat exchanger, cardiotomy reservoir, blood tubing, and filters.

Tips for Buying a Heart-Lung Machine

1. These units act as a temporary substitute for circulatory and pulmonary function. As such, they should circulate, oxygenate, and filter blood.

2. Facilities are strongly encouraged to standardize their equipment. This can simplify and ease upgrading or adding new components.

3. An in-line arterial filter should be included with the disposable tubing for the heart-lung bypass unit. This can help trap particulate matter and gaseous emboli.

4. Today, most units consist of modular components that fit into a portable console base; facilities can now buy a basic unit and later upgrade or replace it as needed.

5. Customized units are also offered. Before making the purchase, buyers should consider the level of modularity of each system.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Heart-Lung Machine

# Tips and Guidelines for Buying a Hematocrit Centrifuge

High-speed microhematocrit centrifuges

Microhematocrit centrifuges for hematological testing, used to determine red blood cell to whole blood volume ratio. These tabletop centrifuges are high-speed (10,000-25,000 rpm. with minimum relative centrifugal force of 10,000 gravities) and can pack cells within 3-5 minutes. Smaller sample sizes can be used than in conventional centrifuges.

Tips for Buying a Hematocrit Centrifuge

1. Hematocrit centrifuge buyers need to determine the product's specifications, such as rotational speed and capacity.

2. One of the main factors to consider when buying a hematocrit centrifuge is safety. A preferable microhematocrit centrifuge is one with a securely interlocking lid that either shuts off the unit's motor when the lid is opened, or keeps the lid latched until the rotor has stopped. In addition, an inner protective cover over the rotor assembly is recommended, as well as a displayed alert not to open the hematocrit centrifuge while the rotor is spinning.

3. Audible alert indicators should alert for hematocrit centrifuge motor imbalance, leakage current, lid open, and cycle complete.

4. The preferred microhematocrit centrifuge motors are the brushless motors, which require less maintenance than the traditional motors.

5. To avoid overspending on a unit and paying for unnecessary features, facilities should try and correlate cell washing hematocrit centrifuge features with their current and anticipated laboratory needs. On the other hand, they should not be purchasing a cheaper model that cannot handle the laboratory workload or that is inadequate for certain procedures.

6. A hematocrit centrifuge with programmable functions may be suitable for larger facilities in which many cell-suspension samples are centrifuged daily. Smaller laboratories with a low or moderate number of daily samples may not need such a microhematocrit centrifuge unit.

7. Facilities considering the purchase of microhematocrit centrifuges should examine the cost of a warranty and of disposables, such as sample tubes, which are used regularly.

8. It is recommended that microhematocrit centrifuges attain a relative centrifugal force or field between 10,000 to 15,000 g.

9. Other recommended hematocrit centrifuge qualities are an 8 cm rotor radius, a 50-μL sample, and a 75 mm capillary tube.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Hematology Analyzer

Semi-automated and fully automated hematology analyzers

Automated hematology analyzers based on fluorescence quantification and cytometry techniques, or on electrical impedance techniques. Most provide a five-part white blood cell differential count, some perform a three- part count. Some analyzers may include reticulocyte analysis capabilities. They are intended for use in larger medical facilities or laboratories. The Semi-automated hematology analyzers, are used in small laboratories or as back-up for automated analyzers. Sampling and dilution, cell-counting, and red blood cell indices determination are automated. Most of these analyzers perform a three part white blood cell differential count.

Tips for Buying a Hematology Analyzer

1. When purchasing an analytic clinical instrument such as a blood analyzer, facilities must first consider the available models that can meet different volume and testing needs within that facility. Considerations include the size of the facility, immediate and future throughput and test capability needs, budget constraints, and staffing.

2. Main laboratories use hematology analyzers that can also provide stat testing. Blood analyzers are most frequently used for determining diagnosis, follow-up care, and the effectiveness of treatment.

3. Smaller hematology analyzer systems that are less automated, have a lower throughput, and offer smaller test menus, are used in midsize or small laboratories or those with specialized testing requirements.

4. Having a small blood analyzer for specialty and/or stat tests may be an advantage for laboratories with high volumes of routine testing.

5. Larger high volume hematology analyzer systems are marketed to large or medium sized facilities that require high throughput, and therefore may want white blood cell count differentials, along with the basic measurements offered by smaller blood analyzer units.

6. The compliance with regulations for waste disposal should also be a factor for facilities to evaluate before the hematology analyzer purchase.

7. Medium and large sized laboratories constantly use hematology analyzers. These units should therefore be durable and reliable enough to handle a large sample workload without frequent breakdowns or maintenance shutdowns.

8. When the hematology analyzer needs repairs or adjustments, fast and efficient service by the manufacturer is critical because the blood samples deteriorate quickly.

9. It is recommended to get an unedited list of users from the blood analyzer manufacturer to help evaluate the reliability and the service record of the company.

10. A critical factor for any type of hematology analyzer instrument that analyzes potentially infectious body fluids is automation that eliminates or minimizes contact between the user and the patient specimen, such as auto sampling or closed tube sampling.

11. Most clinical laboratory tests belong to the moderate complexity category, including automated urine, blood, and chemistry analyses. These tests require a limited amount of sample and reagent preparation, as well as limited operator intervention during the hematology analytical process.

12. The more specific blood analysis testing is covered by the high complexity classification. These tests require extensive training. This classification also encompasses procedures requiring a high degree of operator preparation, calibration, intervention, and analysis, such as clinical cytogenics and histopathology applications.

13. Another important factor to consider when purchasing a hematology analyzer is the system's computer interface capabilities.

Questions for the Seller

Before you purchase your Hematology Analyzer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Hemodialysis Machine

Devices for hemodialysis

Hemodialysis units that direct blood through a hemodialyzer (coil) that uses diffusion and convection to transfer substances. This is done for the purpose of decreasing biochemical abnormalities, and fluid, electrolyte and acid-base imbalances.

Tips for Buying a Hemodialysis Machine

1. When considering the right Hemodialysis machine for a facility, patient safety and effectiveness should be considered primarily. The Hemodialysis unit should include certain alarms and monitors; the dialysis delivery system should monitor the temperature, and if it's above 41°C, an alarm should sound.

2. TMP should also be monitored, because blood exposed to higher temperatures can be damaged. If the TMP falls below 0, reverse ultra filtration can occur, allowing fluids and toxins to filter back into the blood, and therefore an alarm should sound in that event.

3. Hemodialysis machines should monitor ultra filtration removal rates with an accuracy of ±10% of set volume. They should have air/foam and conductivity detectors to reduce patient risk in the extracorporeal blood circuit.

4. A disinfection method, either heat or chemical, should be available to reduce the possibility of infection.

5. Facilities that are buying only one or two Hemodialysis machines to add to an existing stock, should consider staff familiarity and experience with a particular manufacturer's machines. Clinicians will usually be more comfortable with Hemodialysis machine models from a manufacturer they already know and will require less training. The clinical engineers would also benefit from the experience gained in servicing earlier Hemodialysis machine models from the same manufacturer.

6. Using the same brand could also reduce the need to store additional parts and thereby simplify inventory because the new components may be identical to those of earlier Hemodialysis units.

7. To reduce costs, earlier Hemodialysis machine models may be sufficient for facilities that need units for limited chronic or acute care applications not requiring recent innovations, as well those considering units for home use.

8. Hemodialysis machines for home use should be as user-friendly as possible.

9. Power, water pressure, and temperature may not be regulated as well at home as in medical facilities. Buyers should consider issues like limited acceptable ranges of supply voltage and water temperature when selecting a Hemodialysis machine unit.

10. At home there is usually no backup Hemodialysis unit or repair technician available. Therefore, reliability is a major concern. There are serious consequences when a Hemodialysis machine ceases to function in the middle of treatment.

11. Different brands of disposable accessories can be used with most Hemodialysis units; some Hemodialysis units require the use of proprietary disposables, which can increase the operational costs per procedure.

12. If many Hemodialysis machines are used in a facility, it is important to make sure that all of them accept the same brands of disposables; bulk quantities can cost less.

Questions for the Seller

Before you purchase your Hemodialysis Machine, we recommend you ask the seller the following questions:

General Information

Was it used for virus infected patients (Hepatitis, HIV, etc.)?

Are there any signs of rust?

Display Parameters

Dialysate pressure?

Transmembrane pressure?

Conductivity?

Flow rate?

Elapsed time?

Remaining time?

Prescribed time?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Hemodialysis Units

# Tips and Guidelines for Buying a Hospital Bed

Adjustable electrically controlled bed

Electrically controlled adjustable beds with moveable siderails. Patient and staff can control mattress positions and elevations, in three different sections independently for varied patient positions including Trendelburg.

Tips for Buying a Hospital Bed

1. In the event of a power failure, all electric beds should allow adjusting the position of the bed manually or hydraulically.

2. For easy access to the patient, the height should be adjustable to at least 83 cm from the ground. In certain situations, side rails and bumpers are desirable.

3. To allow smooth transport through doorways and over obstacles, the casters' diameter should be at least 5 inches. They should swivel, and at least two should lock to prevent unwanted movement.

4. Critical care beds should have a Trendelenburg gauge. It is recommended that they have additional features, such as a radiolucent window and an in-bed scale to minimize the need of moving patients to another bed during treatment, clamps and poles for infusion devices, oxygen tank holders, and patient and caregiver controls.

5. They may also include bed scales, removable headboards and footboards, which can be used during CPR or converted into defibrillator trays, isolation transformers, fracture fittings, lifting poles and handles, and double insulation.

6. Before making a purchase, facilities are encouraged to carefully evaluate the benefits and costs of buying a critical care bed versus a general-purpose bed.

7. A general-purpose bed may be adequate in some cases; the isolation transformer or double-insulation options may add extra safety to beds used in critical care areas. There may be no need to add these options to hundreds of beds, but just to ensure that a few critical care beds have them.

8. Some factors to be considered by facilities include the range of bed positions, quality of construction, ease-of-use, mechanical reliability, service history and availability of manufacturer support and replacement parts.

9. There are some beds that are instantly configurable to manual, semi-electric, or fully electric status with the use of interchangeable cranks and motors.

Questions for the Seller

Before you purchase your Hospital Bed, we recommend you ask the seller the following questions:

Patient Controls

Type of controls?

Additional Options

Automatic contour?

Retractable?

Hyperextension?

Trendelenburg gauge?

Are there any signs of rust?

Nurse Control

Pt control lockouts?

Walk-away down?

Full-low indicator?

CPR control?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Beds, Electric

# Tips and Guidelines for Buying a Hospital Information System

Bedside information and data management systems

Bedside computerized information systems used for acquiring, displaying, and reporting patient data and information. Clinical information is provided in real-time tracking of vital signs, as well as administrative information.

Tips for Buying a Hospital Information System

1. These systems should provide the following features: a user defined screen, nursing care plans, flow sheets order entry, results reporting, ADT, QA, audit trails, and printed reports. Decision support may be offered as a clinical function. For system security, multilevel user ID and password are minimum requirements.

2. To provide an effective use, these systems should be interfaced with the appropriate existing information systems. They should also be expandable and able to incorporate new technologies easily without affecting performance.

3. Facilities need to give special consideration to installation planning, airflow and utilization of floor space and cabling because an entire room may be dedicated to hardware.

4. Sprinklers should be replaced by inert-gas systems to prevent hardware damage from fire.

5. Additional equipment, including modems, fiber optic cable, and special conduit may be required for connections between distant computers. Facilities should keep in mind that adding special equipment may cause design problems and increase cost.

6. Facilities should seriously consider the issue of servicing the computer hardware and software and should discuss it in detail with prospective suppliers. They should touch on issues like: who provides service and software maintenance, where the service representatives are located, and when they are available. Some suppliers offer support via telephone and modem. Facilities should evaluate their current system before making a purchase. Automation will not necessarily solve inefficiencies if there are any.

7. The objectives and functional requirements of the system should be determined by facilities considering a purchase of a bedside information system. They should then submit requests for proposals to several suppliers.

8. A desirable system is one that meets the needs of all the users in the facility.

9. Facilities are encouraged to hire a health information security officer to maintain the privacy and confidentiality of patients.

Questions for the Seller

Before you purchase your Hospital Information System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Clinical Functions

Does it have a user-defined screen?

Does it have a user-defined reports?

Does it include a nursing care plan?

Does it include flow sheets?

Does it include nursing?

Does it include medical/surgical?

Does it include ICU?

Does it include order entry?

Does it include results reporting?

Does it include decision support?

Does it include Quality Assurance?

Does it include an audit trail?

Does it include printed reports?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a HPLC

High pressure liquid/gas chromatography system (High Pressure Liquid Chromatography)

A system used for high-pressure packed column gas chromatography. The packing of the column can be of porous solid material, with the interactive solid on permanently bonded ionic sites, and separation occurs by electrostatic interaction. The packing of the column can also be of microparticulate silica gel. The functional groups of the stationary stage are usually non-polar (reverse bonded-phase chromatography), or polar relative to those of normal phase (normal bonded-phase chromatography).

Tips for Buying a HPLC

1. Based on HPLC user preference, the sample injector can be either fixed or variable loop.

2. To meet the needs of most HPLC chromatograph analytical testing requirements, an injector capable of injecting a sample volume of 0.5 to 50 uL is needed.

3. An automatic HPLC sample injector is preferable because it is generally more precise and provides continuous injection without user intervention for batch processing of samples. 4. A manual sample chromatography system injector may be suitable for small testing volumes

5. Stainless steel or any other material that can withstand pressures of up to 10,000 psi should be constructing the HPLC chromatograph column. The column should be at least 10-150 cm long with an internal diameter from 2-5 mm.

6. To maximize efficiency of the HPLC, the particle size should be uniform and either spherical or irregularly shaped.

7. A chemical resistant material, such as stainless steel or Teflon, should be constructing the high-performance liquid chromatography system pump.

8. HPLC chromatograph pumps should be able to deliver solvents at pressures ranging from 500 to 5,000 psi.

9. The waived tests category requires little or no training or experience to perform. These tests do not require elaborate quality control, and they are less likely to produce inaccurate results.

10. Most clinical laboratory tests are included in the moderate complexity category, including automated urine, blood, and chemistry analyses. Tests and HPLC analyzers in this group require a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process.

11. More specific testing is covered by the high complexity category, and requires extensive education and training.

Questions for the Seller

Before you purchase your HPLC, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Hyperbaric Chamber

Hyperbaric treatment chambers

Hyperbaric chambers used to treat formation of gas bubbles in the blood, including pulmonary and cerebral air embolism. Also used for gas gangrene and other anaerobic infections. Air pressure is raised to levels above atmospheric pressure in chambers designed for patient treatment. Patient breathes pure oxygen delivered by mask or hood, or oxygen pressurization of the chamber. Multiplace chambers can hold more than one patient, including medical personnel.

Tips for Buying a Hyperbaric Chamber

1. One patient in a sitting or reclining position can be accommodated by monoplace hyperbaric chambers. These hyperbaric chambers do not allow space for personnel, and therefore require a two-way communication system. Acrylic dome or viewing ports must allow medical personnel to directly view the patient's progress.

2. Monoplace hyperbaric chambers should operate in maximum pressures from about 30 psi. Multiplace chambers operate from 75 psi.

3. For monoplace hyperbaric chambers, the main pressure gauges should range from 1-3 ATA (atmospheres absolute), and from 1-6 ATA for multiplace hyperbaric chambers. The majority of treatments for decompression sickness and embolisms are performed at 2-3 ATA.

4. Examining discharge data and estimating the number of patients with the appropriate indications for this therapy will help facilities in evaluating the potential demand for HBOT.

5. There is a study that suggests that a reasonable daily treatment volume for the first year of operation can be reached by applying a factor of 1 for every 100,000 people in the facility's service area.

6. A multiplace hyperbaric oxygen chamber may be more cost effective when a facility's throughput gets to 12 patients a day

7. Facilities should consider the following factors before making a hyperbaric chamber purchase: chamber capacity, duration of treatments, and daily hours of operation.

8. To allow for emergencies and flexible scheduling of patients, the hyperbaric chamber operation at 80% of facility capacity is considered appropriate.

9. Facilities should check with their insurance carriers to find out if there are any specific insurance requirements for hyperbaric chamber systems.

10. Specially trained technical and medical staff is needed for a fully developed HBOT program. Such a program also requires an investment in hyperbaric oxygen chamber equipment and training in proper hyper pressure chamber installation and operation.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Hyperbaric Chambers

# Tips and Guidelines for Buying a Hypothermia Unit

Units for heating or cooling of the body or of a localized area

A machine which circulates warm or cold fluid (e.g. water) through a special mattress, blanket or pads. The temperature and the flow of the fluid is electronically monitored and controlled, to keep the body temperature in a preset range. Safety foolproof measures are embedded in the system.

Tips for Buying a Hypothermia Unit

1. The main concern when purchasing a hypothermia (warming) unit or hyperthermia (cooling) unit should be safety.

2. The water temperature at the machine outlet should always be between 0°C and 43°C under normal operating conditions or control settings.

3. Hypothermia and hyperthermia units should include an automatic shutdown and audible alarm. When the temperature limits are exceeded, the alarm should be activated. Silencing it should be impossible, and the safety temperature limits should be preset and not operator tuned.

4. It is preferred that both Celsius and Fahrenheit degrees be displayed in hypothermia and hyperthermia units. A flow indicator should also be included.

5. These hypothermia units and hyperthermia units should also include patient temperature probe alarm, to warn about a disconnected or defective probe.

6. Hypothermia units and hyperthermia units which are specific for joints or limbs need smaller pads, usually designed for certain anatomic features.

7. Reusable and disposable pads come in several sizes to meet a facility's specific needs. Some sites reuse the single-use pads in order to minimize costs. Cleaning these pads with soap and water should not affect their wholeness. However, this is an important issue to address. Users of hypothermia units and hyperthermia units should check carefully for laws and regulations on the reuse of single use devices.

8. Full body warming or cooling units for adults need a full-body pad; pediatric sizes are available as well.

Questions for the Seller

Before you purchase your Hypothermia Unit, we recommend you ask the seller the following questions:

General

Does the set include a Mattress, a Blanket or a Pad?

Alarm Functions

Hi-Temp Fluid Limit?

Lo-Temp Fluid Limit?

Patient Temp Set?

Low Fluid?

H2O Temp Sensor?

Patient Temperature Probe?

Alarm Silence?

Pad Sizes

Joint/limb?

Full body, adult?

Full body, child?

Full body, infant?

Modes of Operation

Does it have manual mode?

Does it have automatic mode?

Is it monitor only?

Connectors

Number of connections?

Is it an integral connector?

Is it a Strain relief?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

HypoHyperthermia Unit

Circulating-Fluid Pumps

# Tips and Guidelines for Buying an Immunoassay Analyzer, Enzyme

Analyzers for enzymes using fluorescence and chemiluminescence immunoassay techniques

FIA, EIA, and CIA analyzers are instruments that use reagents to analyze drugs and endogenous substances in biological fluids. May be used to determine drug concentrations ( such as antiarrhythmics, antibiotics, anticonvulsants, or cardiac glycosides) as well as testing for endocrines, proteins, and bacterial toxins.

Tips for Buying an Immunoassay Analyzer, Enzyme

1. A medical facility should select the right analytic immunoassay analyzer based on the assays available on the instrument, the throughput capacity of the system, and the availability of models to meet different volume and testing needs within that specific facility.

2. Larger and more automated enzyme immunoassay analyzer instruments with a comprehensive test menu and high throughput are needed by reference or central laboratories.

3. Smaller immunoassay analyzer systems, which are less automated, have a lower throughput, and offer a smaller test menu may be suitable for midsize or small laboratories or those with specialized testing requirements.

4. Some general analytic requirements are shared by automated immunoassay analyzers. These include bar coding, bidirectional computer interfacing, small sample volume, insufficient-sample detection, and speed.

5. Among the specific technical requirements are: selective multitesting, full automation, complete panels, and a high throughput rate.

6. Some of the analytic requirements for automated enzyme immunoassay analyzer systems are: a defined precision limit for each test, an accurate assay calibration, specific antibodies, and acceptability criteria for inaccuracy.

7. Facilities considering any type of chemiluminescence immunoassay analyzer instrument that analyzes potentially infectious body fluids are mainly concerned with the instrument's automation that eliminates or reduces contact between the user and the patient specimen, such as auto sampling or closed tube sampling.

8. Patient results can be matched to the printed copy, regardless of the specimen sequence, using immunoassay analyzers with barcode labeling systems.

9. One of the important factors with immunoassay analyzers is the system's computer interface.

Questions for the Seller

Before you purchase your Immunoassay Analyzer, Enzyme, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Implantable Defibrillator

Battery operated defibrillators for continuous monitoring and prompt corrective cardioversion

Defibrillators for continuous monitoring of cardiac rhythm, and identification of ventricular tachycardia or fibrillation. These battery operated and implantable ICD's are designed to deliver corrective cardioversion or defibrillatory charges as necessary. Antitachycardia and/or bradycardia pacing is possible with some devices.

Tips for Buying an Implantable Defibrillator

1. The implantable defibrillator/pacemaker should have cardio version, defibrillation, and bradycardia pacing therapies; antitachycardia pacing is an option depending on user requirements.

2. The unit should be able to provide at least 30 joules the minimum of five separate shocks. A biphasic waveform is preferred. For bradycardia pacing, the rate should be 30-100 pulses per minute, and the sensitivity should be 0.5 to 5 mV \- atrial and 0.5 to 7.5 mV ventricular.

3. The unit should be able to store and transmit at least 15 events via telemetry, including: intracardiac electrogram and last shock impedance. The minimum life expectancy of the battery should be five years. Many types and levels of ICD are available for implementation by facilities. The physician based on the patient's illness should make the selection through a process in which cardiologists, cardiovascular surgeons, and electro physiologists will all be included for better assessment of the specific needs of the facility.

4. The lead system needs to be approved for use with the pulse generator.

Questions for the Seller

Before you purchase your Implantable Defibrillator, we recommend you ask the seller the following questions:

Therapies

Does it include Bradycardia pacing?

Does it include Antitachycardia pacing?

Does it include Telemetria?

Leads

Epicardial?

Transvenous?

Compatibility?

VT/VF Detection Algorithms

Programmable rate threshold?

Tiered therapy?

Abdominal?

Pectoral?

# Tips and Guidelines for Buying an Infant Incubator

Infant and newborn incubators

Infant incubators provide a heated, temperature controlled environment. Warm air is circulated over the skin surface, and absorbed into the body by tissue conduction and blood convection. Infant incubators are used in intensive, intermediate, and neonatal care.

Tips for Buying an Infant Incubator

1. These units circulate heated air over the skin to provide a closed, controlled environment that warms an infant.

2. The temperature range of the incubator in the manual mode should be at least 23

3. The temperature range should be 35

4. Alarms should sound in the following events: high air temperature, low air temperature, high skin temperature, low skin temperature, fan failure, sensor failure, and power failure. A backup thermostat should be available, and shielding if a light bulb breaks or bursts. Units that are battery-powered should have clear indicators for battery power level and for the need to recharge or replace the battery. Recharging a battery after depletion should not require more than 16 hours.

5. Each incubator must have 2 hand ports, 6 tubing ports, and 1 oxygen inlet port. Internal noise should be less than 60 dB. The casters on the incubators should be conductive and swivel and at least 12.7 cm in diameter; at least two of them must have locks.

6. Units that are designed for transport should provide thermal support for infants during transport within and between hospitals even during adverse weather conditions. When operating on internal batteries, units should maintain air temperature for at least 2 hours.

7. Once the unit is removed from line power, it should automatically switch to battery power; Facilities should make sure there is space for storing the oxygen cylinder and an adequate mechanism for securing the cylinder.

8. Preventive maintenance at regular intervals is provided within a service contract, which facilities can purchase to eliminate the possibility of unexpected maintenance costs. Many suppliers extend system performance and uptime guarantees beyond the length of the warranty only for systems covered by a service contract. Facilities should carefully consider this issue and keep in mind that some third-party organization can offer service as well.

Questions for the Seller

Before you purchase your Infant Incubator, we recommend you ask the seller the following questions:

Alarms

High air temp alarm?

Low air temp alarm?

High skin temp alarm?

Low skin temp alarm?

Fan failure alarm?

Sensor failure alarm?

Power failure alarm?

General Information

Does it have a double wall?

Does it have supplemental humidity?

Does it have a backup thermostat?

Is it a mobile unit?

Is it a transport unit?

Are there any signs of rust?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infant Incubators

Phototherapy Units

Radiant Warmers

# Tips and Guidelines for Buying an Infant Scale

Mechanical or electronic infant scales

Scales that have a weighing platform with a tray, designed for infants. They use either a beam lever system, a spring system, or electronic display for weighing. Some scales are capable of taking into account diaper weight.

Tips for Buying an Infant Scale

1. When purchasing infant scales, institutions should consider both performance and ease-of-use.

2. Pediatric scales performance features to consider include accuracy and resolution.

3. Features such as calibration adjustment controls and the display are important to examine because sensitive pediatric scales that are difficult to use may increase the opportunity for error.

4. In addition to performance and ease-of-use, infant scale purchasers should consider the weighing capacity that will be needed, the battery life if applicable, and the configuration.

5. Ease of service must be examined as well; the units should be easy for a hospital's biomedical engineering staff to service and should be well supported by the supplier to keep ongoing costs to a minimum.

# Tips and Guidelines for Buying an Infant Warmer

Radiant heat warming units for infants and newborns

Infant warming units using radiant heat, generally used for newborns. They may be permanently mounted, modular, or single freestanding unit.

Tips for Buying an Infant Warmer

1. The task of infant warmers is providing thermal support for newborns in the delivery room, for ill infants who need continuous nursing intervention, or those undergoing treatment with extended exposure to a cool environment.

2. In normal use conditions, the radiant warmer heat capacity should keep optimum thermo neutral temperature.

3. The infant warmer will have the capability of safely warming a cold infant in a rate of skin heating that is safely controlled with a skin temperature sensor.

4. Infant incubators should display the following data: skin temperature, power status (on/off), the timing of warming cycle and whether the heater is energized.

5. Infant warmer controls may be manual or automatic, at least for the following degrees: 34

6. A warning unit in a manual mode should have an automatic timer set by the user, allowing the heater to function at a fixed temperature for a certain amount of time. The infant warmer should also provide an alarm.

7. An infant warmer unit in an automatic mode should turn the heating element on and off in response to temperature changes in the infant's skin.

8. Broad and quick changes of the patient's core or skin temperatures should not be allowed by the control unit, and so should excessively low and high skin or core temperatures.

9. All the equipment and instruments assembled or positioned above the infant should be protected to prevent it from falling onto the infant and causing injury.

10. Infant warmer units should provide shelf space and storage areas to eliminate the placing of objects on the units. The high heat exhaust from vents may cause a fire when items are placed on top of the hypothermia units.

11. The radiant warmer units should offer a way of channeling patient leads, chest drainage tubes, and other lines. This is important for preventing cables/leads/tubes from being ensnared and gagged in bassinet sidewalls or subjected to a tug that might displace them.

12. Some infant warmer units offer more options such as: phototherapy lights, resuscitation equipment packages, x-ray cassette holders, and fine cabinetry for use in homelike birthing suites.

13. The platform for infant warmers with bassinets should be able to support the weight that a physician and assistants might apply during a procedure.

Questions for the Seller

Before you purchase your Infant Warmer, we recommend you ask the seller the following questions:

Accessories

Does it include a resuscitation module?

Does it include Phototherapy lights?

Does it include light?

Does it include an X-ray tray?

Does it include an Apgar timer?

Does it include drawers/shelves?

Alarms

Does it have a temperature alarm?

Does it have a manual mode alarm?

Does it have a sensor disconnect alarm?

Does it have a malfunction alarm?

Does it have a power failure alarm?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiant Warmers

# Tips and Guidelines for Buying an Information System, Radiology

Data management information systems for radiology (RIS)

Systems used by Radiology departments and imaging centers for management of clinical and administrative information. These data management information systems can be used to organize and store result reports, patient registration, tracking, billing, scheduling, and other tasks.

Tips for Buying an Information System, Radiology

1. The ability to interface with other hospital networks and systems is one of the most important aspects of a RIS. It must be able to interface with PACS and HIS, and preferably with billing, digital dictation systems, and other networks and systems. The RIS should also be HL7 compliant.

2. Any new equipment purchased should be DICOM compatible in order to facilitate networking. Users should be able to enlarge the system and easily incorporate new technologies to it, without affecting performance.

3. The system's software should provide a variety of features including scheduling, patient tracking, results reporting, teaching files, QC, inventory control, and productivity reporting. The database should enable transaction logging and a UPS, as well as a backup system.

4. Radiology departments or imaging centers are enhanced and supported by RIS. Hospital wide integration allows high-speed image and report transmission, as well as linking images to patient registration information, which facilitates hospital-wide information exchange.

5. Interdepartmental communication and patient tracking are improved by the integration of the RIS with an HIS and PACS. As a result, there is increased efficiency and quality of patient care in the facility.

6. Facilities should also consider multiple site networking capabilities for outreach services and integration with a MAN or WAN.

7. Before purchasing, facilities need to consider installation planning, because an entire room may be dedicated to hardware. Other factors to consider in this area include airflow and utilization of floor space and cabling.

8. Some RIS products can create a paperless workflow by incorporating electronic requisitions, consent forms, and other information that in the past was maintained on paper. To further enhance this capability, some systems will store scanned documents.

9. To facilitate system integration and expansion, open system architecture is preferred because it allows interfacing with other operating systems for information and application sharing. Many suppliers are now offer open system architecture, which also provides flexibility for future system integration and expansion.

10. Some suppliers offer single integrated products because of the need to integrate/interface many systems within radiology. These products reduce the need for expensive, time consuming, and often difficult to maintain interfaces by incorporating RIS, PACS, and other features into a single product. However, the replacement of many systems must be made at once, which is difficult, costly, and may require discarding a system in which some parts still function adequately.

11. Some facilities may find the ASP model more desirable because the initial capital investment in hardware and software for an RIS operated through an ASP organization is dramatically lower than that for a LAN configuration. However, it places the responsibility for maintenance, upgrades, and level of application customization in the hands of the ASP.

12. Additional equipment, such as telephone modems or fiber optic wiring, may be required to accommodate longer-distance signal connections. Facilities should keep in mind that these additions can pose design problems and increase costs.

Questions for the Seller

Before you purchase your Information System, Radiology, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

General Information

Is it PACS compatible?

Is it DICOM 3.0 compliant?

Is it HL7 compliant?

Other interfaces available?

Does it include a bar-code reader?

Does it support teleradiology?

Does it include electronic signature?

Database Integrity

Does it have transaction logging?

Does it have a backup system?

Software Functions

Does it include scheduling?

Does it include patient tracking?

Does it include results reporting?

Does it include film library management?

Does it include case retrieval?

Does it include word processing?

Does it include teaching files?

Does it include E-mail?

Does it include order entry/stats?

Does it include quality control?

Does it include inventory control?

Does it include productivity reporting?

Does it include digital dictation/voice recognition?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying an Infusion Pump

Infusion pumps for general-purpose liquid delivery

General purpose infusion pumps are used in hospitals, health-care facilities, and in some instances in emergency medical service vehicles. They are used to deliver liquids for therapeutic and/or diagnostic purposes, through IV or epidurally. Some pumps are multi-channel with two or more channels.

Tips for Buying an Infusion Pump

1. Infusion pumps should include a time and date stamped log, capable of storing at least 200 events of error codes, alarms, flow rates, and key presses. This is an important safety and performance-enhancing feature since it helps in determining the cause of a pump-associated adverse incident.

2. All infusion pumps should be fluid proof. If fluid penetrates the electronic circuitry, an alarm should be emitted and an automatic shutdown should occur.

3. Infusion pumps should provide a flow of 0.1 to at least 999 ml/hr, and maintain an accurate flow rate to within 5% of flow settings.

4. There should be no more than a 10-second interruption in pumping when performing flow-setting changes.

5. Once the programmed volume is delivered, the infusion pumps should be designed to revert to a KVO rate between 1 and 5 ml/hr.

6. Once it has delivered the secondary volume, the volumetric infusion pumps should have an automated secondary infusion that switches from a programmed secondary flow rate to the primary flow rate.

7. It should take less than 10 hours for the infusion pump's batteries to fully recharge. Batteries should be charged independently of the main power switch. In case of a line-power failure, the peristaltic pumps should automatically switch over to battery power.

8. To determine the number of pumping channels needed, buyers should investigate whether it is advantageous for them to purchase single channel infusion pumps, multichannel pumps, or both types of infusion pumps.

Questions for the Seller

Before you purchase your Infusion Pump, we recommend you ask the seller the following questions:

Alarms & Indicator Functions

Occlusion upstream?

Occlusion downstream?

Detection mechanism?

Real-Time display?

Infusion complete?

Empty fluid container?

Flow error?

Drop sensor?

Set disengaged?

Door open?

User prompts?

Circuit malfunction?

Low battery?

Depleted battery?

General Information

Is a nurse call jack included?

Is it MRI compatible?

Does it include a data port?

Is it a volumetric pump?

Does it include syringe delivery?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying an Instrument Cart

Surgical supply carts for sterile/contaminated material

Open or closed surgical supply carts, to transport sterile supplies to operating room, and to transport out contaminated supplies. These carts are designed for easy cleaning, loading, and unloading.

Tips for Buying an Instrument Cart

1. Case carts are available in a wide range of sizes and configurations.

2. These units should include several drawers or shelves for storage of surgical instruments and supplies.

3. To help separate contents in a logical fashion, dividers should be available as an option.

4. Large enough casters should provide stability during transport. At least 2 locks should be available to prevent unwanted movement.

5. Facilities should prefer carts with drawers and shelves that are made of a durable, sterilizable material - ideally stainless steel, as it resists corrosion and damage from chemicals. Other materials should be able to withstand impacts and shocks, as well as tolerate water temperature of 88

6. There should be a cardholder to identify the cart.

7. To help users tailor the carts to meet their specific needs, manufacturers should offer a wide variety of accessories as options. Facilities can create the cart that best suits their needs by choosing the right accessories.

8. Stain and corrosion resistance are desirable features, as well as resistance to abrasion. Carts with chrome-plated steel are cheaper and may meet the buyer's requirements, but only if the cart is to be manually washed .

9. To help facilities with customizing units, some manufacturers provide design engineering and consulting services. Some also offer services for training central supply and OR personnel to use these units.

10. Buyers should keep in mind that manufacturers usually offer discounts for bulk purchases.

Questions for the Seller

Before you purchase your Instrument Cart , we recommend you ask the seller the following questions:

Shelves

Does it have shelf dividers?

Are they adjustable?

Is it all Stainless Steel?

Does it have a plastic/composed materials parts?

Caster

Does it have brakes?

Does it include conductive casters?

Does it include a complete zippered cover?

Does it include a card holder?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Carts

# Tips and Guidelines for Buying an Insufflator

Laparoscopic insufflators

Laparoscopic insufflators are used during laparoscopy procedures such as infertility diagnosis and treatment, female tubal ligation, and other surgical procedures. They are used to produce and maintain a gas-filled space within the peritoneal cavity. During laparoscopic procedures this is necessary for increasing visibility of organs, and to provide space for insertion of instruments.

Tips for Buying an Insufflator

1. The pressure settings offered by insufflators should be less than 30 mm Hg, with maximum settings ranging from 12-15 mm Hg to prevent over pressurization.

2. To allow for initial insertion of instrumentation, the low-flow settings on the insufflator should range from 0-30 L/min with minimum settings at 1-2 L/min.

3. The pneumatic laparoscopic insufflators/ electronic laparoscopic insufflators should provide some type of flow display, such as a qualitative/non-numeric display.

4. A visual and audible alarm should be part of the insufflator to protect against over pressurization. If activation pressure exceeds 30 mm Hg, the alarm should sound within 5 seconds.

5. Abdominal pressure should be displayed within 3 mm Hg during flows of 0-4 L/min. The remaining gas should also be displayed. The electronic laparoscopic insufflators must allow the use of hydrophobic bacterial filters.

6. Facilities should carefully examine their needs before they make a purchase because some insufflators may be suited only for a limited number of laparoscopic procedures. They should verify that the selected unit meets the needs of any surgeon for whom inadequate flow has been a problem.

7. Physical dimensions may become an important consideration for facilities, if they plan on placing the insufflators on a video cart or with suction/irrigation equipment on a separate cart.

8. If the CO2 insufflator device is placed on a surgical boom, both weight and dimensions may be an issue to consider.

Questions for the Seller

Before you purchase your Insufflator, we recommend you ask the seller the following questions:

General Information

What is the alarm type?

Does it have electronic venting?

Peritoneal pressure indicator?

Insufflation volume indicator?

External gas cylinder ?

Does it have gas warming?

Does it have a humidifier?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Laparoscopic Insufflators

# Tips and Guidelines for Buying an Insulin Pump

Insulin infusion pumps for ambulatory use

These pumps are designed to deliver insulin subcutaneously at a slow and continuous basal rate, and, if necessary, in quick large amounts. They deliver insulin similar to a normally functioning pancreas, so the metabolic control is better than with insulin injections. They are generally used for type-1 diabetes patients, but in some cases they can be used for intermittent delivery in type 2 diabetes and in pregnancy induced diabetes.

Tips for Buying an Insulin Pump

1. These units are used to deliver parenteral agents from syringes or collapsible bags. Their size should be small enough so that patients would comfortably wear or carry them. During sleep they should not disturb the patient, and during daily use they should not be conspicuous.

2. Facilities should carefully select patients to ensure successful insulin infusion therapy. The patients should be motivated and mature with a history of good compliance with insulin therapy.

3. All pumps should be able to run for at least 72 hours without draining the reservoir or depleting the batteries. Pumps should have a flow range of <=0.5 to >=100 mL/hr and maintain a flow accuracy of 5%. Ambulatory pumps should be capable of operating in a continuous infusion mode, though it is desirable for pumps to offer additional modes.

4. Luer-lock fittings or integral tubing, distal air filters, and air in line detectors may be used as protection methods against air embolism in ambulatory infusion and ambulatory insulin pumps that can deliver from an external reservoir.

5. Pumps should detect an upstream occlusion and suspend infusion when downstream pressure is >=10 psi. The bolus volume released after an occlusion is cleared should be 0.5 mL.

6. Free flow protection should be part of any ambulatory and ambulatory insulin infusion pumps. Audible alarms should sound for all conditions that might interrupt infusion, including high pressure/occlusion, low or depleted battery, reservoir-side obstruction, pump malfunction, air in line, and empty or near empty reservoir.

7. Alarm volume should be adjustable with settings loud enough for critical alarms and soft enough for social situations. The pumps should have data logs that can store up to 200 events including volume delivered, program settings, error codes, alarms, and rate.

8. Display screens in ambulatory insulin infusion pumps should be clear and easy to read and should indicate time, basal rate, bolus dose, and accumulated dose.

9. All ambulatory insulin infusion pumps offered should be able to deliver basal flows of 5 to 100 U/day with a resolution of 2 U/day. The recommended ones are those with a bolus dose range of <=0.5 to >=25 U/bolus with a resolution of <=0.5 units.

Questions for the Seller

Before you purchase your Insulin Pump, we recommend you ask the seller the following questions:

Controls

Are they programmable?

Alarms

Reservoir unlocked?

Temp alarm silence?

Alarms: Air-in-line?

Alarms: Infusion near end?

Reservoir empty?

System malfunction?

Alarms: Low battery?

Transtelephonic

Status check?

Programming?

Data Log

Display?

Printout?

Time/date stamp?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying an Intermittent Compression Unit

Compression devices, intermittent or sequential, for treatment of poor circulation

For clinical or home use, devices using intermittent or sequential compression for prevention of DVT and/or treatment of lymphedema. Accessories to IC and SC devices include pneumatic and antiembolic stockings, and pneumatic compression boots.

Tips for Buying an Intermittent Compression Unit

1. The operation and technologies of both IC and SC types of compression are similar; therefore the recommendations apply to both.

2. Clinicians disagree about the comparative effectiveness of both IC and SC therapy. They also do not agree on the effectiveness of treating only the calf versus treating both the calf and thigh or the foot only, with a DVT prevention device.

3. Facilities should consider the following before making an intermittent compression unit purchase: cost-effectiveness, ease-of-use, reliability, service support, and pump operation noise levels.

4. The intermittent pneumatic compression system devices should assist in the circulation of blood by pumping the venous system. Pressures that stop arterial blood flow are counterproductive to optimal refilling of the veins, and so a high pressure of 100 mm Hg that is greater than systolic blood pressure, acts as a tourniquet and stops arterial blood flow.

5. The applied pressures should be as low as possible between 30 and 60 mm Hg for the calf, and not over 220 mm Hg as a rule.

6. To allow for venous refilling, 45 seconds of deflation is optimal. To measure and communicate pressure and duration, some type of display is needed on the intermittent compression unit.

7. DVT prevention device audible and visual overpressure alarms should alert the user if cuffs are inflated to a pressure that is 10% greater than the specified setting. Audible and visual duration alarms on all intermittent compression units should alert if cuffs have been inflated longer than intended.

8. Intermittent compression unit users should manually check proper connection and alignment of pressure tubes. To provide an easy method of stopping operation in an emergency, a power switch is recommended.

# Tips and Guidelines for Buying an Intra Aortic Balloon Pump

Units producing mechanical counterpulsation to assist cardiovascular functioning during heart failure

Devices used to improve cardiovascular functioning during life-threatening situations involving cardiac failure. They increase coronary and cerebral blood flow by producing mechanical counterpulsation. An inflatable balloon catheter is placed in the aorta. Automated inflation and deflation of the balloon is synchronized with cardiac cycle, regulated by an external pneumatic system. Physiological parameters of the patient are monitored, as well as balloon pressure and volume. Blood is forced towards the heart during diastolic phase.

Tips for Buying an Intra Aortic Balloon Pump

1. To allow for timing adjustments, the intra-aortic balloon pump monitor should display inflation and deflation intervals on the pressure waveform.

2. Data to be displayed on the diastolic augmentation pump includes the following: ECG, heart rate, arterial pressure, and alarm conditions. Other optional data to be displayed may include: balloon pressure, volume, and setup instructions.

3. Automatic and manual timing adjustments should be offered by the intra-aortic balloon pump unit. ECG and pressure triggering modes should be available. The necessary controls and displays, as well as a chart recorder, should all be part of the pump console.

4. Moving the pumps should not present any physical challenges to the clinical staff. The intra-aortic balloon pump needs to protect against disconnection and catheter displacement during transport. It should be strong enough to handle mechanical shocks it may encounter during transport.

5. Audible and visual alarms should be part of the intra-aortic balloon pump, and they should alert users in the following conditions: trigger loss, vacuum/pressure loss, trigger change, balloon disconnect, balloon over inflate, balloon leak, power loss, inflation during asystole, and significant heart rate change.

6. Alarms should be clear and noticeable since the intra-aortic balloon pump is a life-support system. Audible and visual alarms for critical parameters should be activated and deflate the balloon. When the alarm is silenced, a visual display should clearly show the disabled alarm.

7. Before purchasing such a diastolic augmentation pump, facilities need to look at its ability to use and support this technology in an effective manner. Not every facility finds the intra-aortic balloon pump to be appropriate for its needs.

Questions for the Seller

Before you purchase your Intra Aortic Balloon Pump, we recommend you ask the seller the following questions:

Display

Does it display heart rate alarm?

Does it display pressure alarm?

Alarms

Trigger Change?

Vac/Pressure Loss?

Balloon Overinflate?

Systolic Inflate?

Loading Failure?

High Pressure?

Power Loss?

General/other malfunctions alarm?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Intra-Aortic Balloon Pumps

# Tips and Guidelines for Buying an Intracorporeal Lithotripter

Intracorporeal lithotripters with a mechanical, pneumatic, or hydraulic- powered probe

Intracorporeal lithotripters for kidney stone fragmentation. A probe with a vibrating metal end cap is powered by an electrohydraulic or pneumatic generator. The probe is placed directly on the stone. The metal end cap strikes the stone, and its vibrations cause the stone to fragment.

Tips for Buying an Intracorporeal Lithotripter

1. These units are used for locating, viewing, fragmenting, and removing urinary tract or renal calculi. They may also be used to disintegrate salivary stones or bile duct stones. Units with a footswitch are recommended, because they keep the operator's hands free to position the unit.

2. Different pulse energies and pulse rates portray electro-hydraulic lithotripters. Pulse duration and voltage determine the amount of energy delivered per pulse. Available pulse rates vary and are often a function of the pulse duration selected. Acceptable electrode size varies from 1.7 Fr/77 cm to 9 Fr/40 cm; the longer lengths are usually used for biliary applications.

3. Laser devices should have a wavelength of about 2,100 nm and a visible aiming beam to ensure accurate placement. Pulse duration and power determine the amount of energy delivered per pulse; available pulse rates also vary among manufacturers and are often a function of the selected pulse duration.

4. General lithotripsy and soft tissue surgical procedures can use low-watt lasers. High-watt lasers can be used for bladder stone lithotripsy, and pulse duration may be up to 500 usec.

5. A laser lithotripter should have a fiber diameter between 200 and 1,000 um and at least 3 ft long.

6. For lithotripsy in the lower pole of the kidney, usually small fiber diameters are used with flexible scopes. Lithotripsy in the bladder and ureter will generally use large fiber diameters with rigid scopes. Operators can use any standard endoscope to visualize placement of the lithotripter.

7. With nephroscopes, operators usually use a shorter lithotripter probe than the one used with ureteroscopes, with an outer diameter that is larger than the one used with ureteroscopes. Also the sheath diameter of the nephroscope is larger and the length is shorter than that of the ureteroscope.

8. Any rigid or flexible endoscope is acceptable for electromechanical lithotripters. The available sizes for probes should be between 0.8-9.6 Fr and 26.7-90 cm long, at minimum.

9. Manufacturers offer a wide range of IL devices. However, there is no one device that covers the entire range of clinical situations. The factors that affect the choice should include: location and size of the stone burden, endoscope configuration working channel caliber, and offset or end on port.

10. Video and photographic accessories, such as cameras, videocassette recorders, and light sources, are also offered by suppliers at an additional cost. This can enhance imaging and educational uses of the instrument.

11. To compare high cost alternatives and to determine the economic value of a single alternative, facilities can use a life cycle cost analysis. They can use low cycle cost analysis techniques to examine the cost-effectiveness of leasing or renting equipment versus purchasing it outright.

12. Low cycle cost analysis is most useful for comparing alternatives with different cash-flows and for revealing the total costs of equipment ownership because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time.

13. Suppliers offer facilities service contracts or service on a time-and-materials basis. Some third-party organizations may also provide this service. Facilities should carefully consider this issue.

14. Service contract customers can get routine software updates, which enhance the system's performance, free of charge from most suppliers. Facilities should keep in mind that software updates are often cumulative, which means that previous software revisions may be required in order to install and operate a new performance feature.

15. Facilities with a full-service contract ensure preventive maintenance at regular intervals, thereby avoiding the unexpected maintenance costs. Many suppliers extend system performance and uptime guarantees beyond the length of the warranty only for systems covered by a service contract.

# Tips and Guidelines for Buying an Intraoral Video Camera

Video camera for intraoral inspection

A pencil hand piece with a small tip camera which can be easily manipulated is used to obtain a clear Intraoral video image on a standard monitor. A special high power illumination is responsible for a clear Intraoral .vision

Tips for Buying an Intraoral Video Camera

1. Facilities should examine the number and type of procedures to be performed annually, as well as the types of patients to be treated before buying a dental radiographic unit or digital dental imaging system.

2. A panoramic unit with cephalometric imaging capabilities should be considered where skull view radiography is performed frequently. Facilities treating a wide range of patients should consider a unit that accommodates both seated and standing patients and has motorized vertical height adjustment.

3. An intraoral unit should be considered in facilities performing mainly routine dental radiography; digital systems may be useful if immediate image analyses for endodontics and implantation planning are performed frequently.

4. An intraoral system with a half-wave, rectified x-ray generator is recommended for facilities that desire a system for routine dental radiography; the SID should be about 200 mm standard.

5. There is no need for special system capabilities, such as TMJ or cephalometry, in the intraoral systems, because they are used only for routine imaging. These systems should accommodate all patient types needing routine exams.

6. Two types of digital systems are available: CCD and image plates. Image plates are very similar to conventional intraoral films and are compatible with existing equipment. Digital systems in general have become more popular for dental x-rays due to the fact that chemical-based film processing can be discarded. Images from the CCD detector are displayed very quickly. Retakes can be initiated faster, minimizing total time and exposure. A CCD must be integrated with the x-ray generator.

7. Facilities should keep in mind that the additional ongoing costs associated with film based dental radiography, including film and film processing, processing chemicals and equipment, film storage, and record keeping can be considerable, depending on the number of patients treated. Using a digital radiography system can eliminate it.

8. There are costs that cannot be avoided in both film based and digital radiography. These include plastic covers for equipment that contacts the patient, as well as radiation protection/monitoring equipment for patients and staff.

# Tips and Guidelines for Buying an Intravascular Ultrasound (IVUS)

Ultrasonic scanning systems for intravascular analysis (IntraVascular Ultrasound)

Ultrasonic scanning systems using high frequency miniature transducers mounted on a catheter, for intravascular use. The system produces cross-sectional vessel imaging as well as Doppler flow measurements. Main applications in cardiology and vascular surgery.

Tips for Buying an Intravascular Ultrasound (IVUS)

1. To help diagnose arterial and venous abnormalities and their causes, intravascular ultrasonic scanning systems (diagnostic IVUS) provide the clinician with flow profiles of vessels throughout the body.

2. Buyers of intravascular ultrasounds should consider the following issues: intravascular ultrasonic scanner functions and features, cost, ease-of-use, upgrading, image storage, and customer support.

3. The use of Doppler further extends vascular techniques by providing flow detection in vessels.

4. Spectral Doppler analysis packages can make calculations automatically.

5. A full-featured intravascular ultrasound system that is used in a radiology department, cardiology department, vascular lab, or a vascular surgeon's office is needed for a comprehensive vascular study.

6. Most comprehensive vascular studies are performed within the lab of the responsible facility, but the department's personnel also perform many routine studies at the patient's bedside, ICU, or emergency department.

7. Most vascular studies use linear array probes that operate at frequencies of 5-10 MHz.

8. The same ultrasound imaging technology described for cardiac and vascular ultrasound is used by intravascular ultrasound.

9. The intravascular ultrasound catheter that is introduced into an artery has a transducer mounted at its end.

10. These catheters, in addition to imaging, can measure the velocity of blood flow within an artery, which is useful for determining the severity of a blockage.

11. Catheters also show the underlying atherosclerotic plaque, which is useful for determining which of the many types of angioplasty procedures is best to treat the blockage under study.

12. The following are part of a typical configuration for an intravascular ultrasonic scanning systems (diagnostic IVUS): an intravascular ultrasonic scanner and software, several single or multi-frequency transducers, color Doppler, M-mode, CFM, cardiac analysis software, a VCR, and a black-and-white or color printer.

13. Compatibility with DICOM 3.0 is an important factor. Networking ultrasonic scanning systems and computer workstations can make image storage and retrieval as well as ultrasound department management more efficient.

14. The following options may be added to some intravascular ultrasound systems: optional vascular, abdominal or intra-operative scanning capabilities, additional probe analysis packages, image archiving and obstetrics/gynecology devices.

Questions for the Seller

Before you purchase your Intravascular Ultrasound (IVUS), we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

US System

Suprevision Forms

US System - Dismantling

# Tips and Guidelines for Buying a Laboratory Glucose Analyzer

Laboratory glucose analyzers

Glucose analyzers that use amperometric or chemical methods to test body fluids. These analyzers can measure larger concentration ranges than in bedside units, and deal with larger volumes of samples.

Tips for Buying a Laboratory Glucose Analyzer

1. Facilities considering the purchase of a laboratory glucose analyzer, should closely review the following factors: initial costs, operating costs, the availability and cost-effectiveness of renting the blood glucose analyzer, reliability of both the specific model and the manufacturer, and the manufacturer's reputation.

2. When examining the initial cost of purchasing a glucometer, buyers should consider the complexity, capability, and reliability of the unit. They should also look into the capital costs and the expected lifetime of the laboratory glucose analyzer, and the cost and expected lifetime of non-disposable glucometer accessories.

3. Buyers of laboratory glucose analyzers should carefully evaluate the operating costs, including: service contracts, employee salary and expenses, disposables, accessories, and utilities, as well as other contributions to overhead.

4. If there are laboratory information systems already in the facility, buyers should consider purchasing blood glucose analyzers that could directly interface with such existing systems.

5. All ancillary test sites within the same facility can be included in a single certificate with the central clinical lab if the central and satellite labs are under common direction.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Laboratory Hood

Hoods which are used to remove or filter harmful materials from clinical laboratories

Hoods used in clinical laboratories to remove or filter harmful materials. Contaminated air can be removed or filtered and recirculated.

Tips for Buying a Laboratory Hood

1. Because laboratory hoods and biological safety cabinets are used under a wide variety of conditions, they should be constructed of materials that provide a safer and longer-lasting use. Laboratory hoods should be rigid, nonflammable, and non-corrosive with a chemical-resistant and acid-resistant work surface.

2. The chemical hoods should come with an airflow monitor with an alarm to measure the face velocity and to alert employees when operation is out-of-range. The exhaust blower/fan should also have an alarm to indicate below-normal operation.

3. To provide access to the inside of the laboratory hood without requiring that its sash would be completely open, an adjustable sash is recommended

4. Facilities must look into other factors when considering a fume hood. These may include electrical receptacles, light fixtures, and utility controls offering conveniences that may be desirable.

5. The mentioned above features might eliminate the need to put wires or other objects in the path of the sash, as this will prevent it from closing properly and may diminish the effectiveness of the laboratory hood.

6. In any laboratory, the most common equipment is the chemical fume hood. However, before a laboratory hood or biological safety cabinet is installed, many important factors specific to each individual laboratory must be examined to ensure safety and user satisfaction. These factors include the type of hood to best fit the lab's needs, the specific space, energy, and ventilation requirements of the hood, duct installation, and the cost of maintenance.

7. Each chemical hood should have its inner portion lined with a material that is chemically resistant to the reagents that will be used in the work area, as well as to their reaction products.

8. Ductwork and exhaust-fan materials must also be inert to any chemicals or substances used in the biological safety cabinet.

9. Facilities installing new air handling or local ventilation equipment, such as chemical hoods, should evaluate laboratory ventilation quality and quantity to ensure that the airflow remains uniform and non-turbulent.

10. Facilities should carry out routine monitoring at least quarterly. This should include airflow patterns and face velocity, as well as maintenance of fans, ducts, and grilles.

11. Facilities intending to buy auxiliary-air laboratory hoods should carry out an energy audit to determine if the cost of installing untreated air-supply systems justifies the savings from running less conditioned air through the biological safety cabinets.

12. If facilities anticipate frequent handling of hazardous chemicals, they should seriously look into a ducted system.

# Tips and Guidelines for Buying a Laboratory Hood, Ductless

Hoods which are used for the protection of the personnel while using hazard materials

These hoods are used in laboratories and pharmacies for protecting the personnel and the environment from hazard materials that are used in these locations. The hoods are a closed and protected area, where the necessary work can safely be performed. In these types of hoods, the inner air is sucked in, filtered by special filters, and returned to the hood after filtration.

Tips for Buying a Laboratory Hood, Ductless

1. Ductless laboratory hoods do not exhaust conditioned air to the outside, and therefore they are more energy efficient than exhaust hoods. However, the issue of safety of using ductless hoods with hazardous chemicals is still questionable.

2. A laboratory that uses hazardous materials on a regular basis, may find the ductless hood to be of limited use.

3. Because ductless laboratory hoods are used under a wide variety of conditions, they should be constructed of materials that provide safer and longer-lasting use. Ductless hoods should be rigid, nonflammable, and non-corrosive with a chemical-resistant and acid-resistant work surface. Ductwork and exhaust-fan materials must also be inert to any chemicals or substances used in the hood.

4. The ductless laboratory hoods should come with an airflow monitor with an alarm to measure the face velocity and to alert employees when operation is out of range.

5. An alarm should be provided by the exhaust blower/fan to indicate below-normal operation.

6. An adjustable sash is recommended to provide access to the inside of the ductless laboratory hood without the need to completely open the sash. This may allow harmful fumes to escape the ductless hood. The sash should be made of shatterproof material to protect against small explosions that may occur during handling of dangerous substances inside the ductless hood.

7. Among the most common pieces of equipment in any laboratory are chemical fume hoods. Facilities should look into various important factors specific to each individual laboratory.

8. When installing new air handling or local ventilation equipment, such as fume hoods, facilities should assess ventilation quality and quantity to ensure that the airflow remains uniform and non-turbulent.

9. Facilities should carry out routine ductless laboratory hood monitoring at least quarterly and should include airflow patterns and face velocity, as well as maintenance of fans, ducts, and grilles.

10. Before the purchase of auxiliary-air fume hoods, facilities should carry out an energy audit to determine if the cost of installing untreated air-supply systems justifies the savings from running less conditioned air through the hoods.

# Tips and Guidelines for Buying a Laboratory Incubator

Aerobic incubators for microorganism and cell cultures

Aerobic incubators used for growing microorganisms and cells in an oxygenated environment. The incubators are heated by electrical currents which pass through a heating element. These incubators are usually required for in vitro fertilization, serology and crystallization studies, tissue culture work, and paraffin embedding.

Tips for Buying a Laboratory Incubator

1. Aerobic laboratory incubators enable the growth of microorganisms and cells that can grow in the presence of oxygen, by providing a controlled environment.

2. Facilities should consider the following factors before purchasing an aerobic laboratory incubator: its ability to maintain the required temperature within a specific range and to maintain a constant level of CO2 ,as required by the specimens placed in it.

3. To maintain the hydration of growth medium, humidity control is important.

4. Visual and/or audible alarms should warn operators of any system fault that may cause unsafe or erroneous results.

5. A safety thermostat and temperature alarm are minimum recommendations for bacteriology incubators.

6. For better environmental control, it is preferable that aerobic laboratory incubators have an inner door. Some other optional features include water reservoirs.

7. Rounded edges and surfaces of the Aerobic/Carbon Dioxide (CO2) incubators should be easy to clean and able to withstand bacteriostatic and fungi static cleaning agents. For greater sterility, even more extensive cleaning options are offered by laboratory incubator units with removable auto-cleavable shelves.

8. Features such as size, method of heat conduction, type of temperature monitoring and control device, and environmental controls determine the price of general-purpose laboratory incubators.

9. Some features, such as double door designs with a heat resistant, safety glass inner door and an outer steel door, add to the cost of the virology incubator, but increase its insulation properties. Heating elements of low watt density have an open-coil design that allows them to effectively heat the chamber while operating at low power, extending the useful life of the elements and increasing the energy efficiency of the Aerobic/Carbon Dioxide (CO2) incubator unit.

10. Some laboratory incubators have brackets and removable shelves to accommodate containers of different sizes.

11. Several metals used in wall construction also diminish the spread of contaminants. Seamless stainless steel wall construction allows for easy cleaning and inhibits corrosion of the bacteriology incubator

12. Some laboratory incubators have a vertical design, which provides sufficient chamber volume without occupying much space. In equipment-crowded facilities, this may be an important factor.

13. Users can stack smaller laboratory incubator models to save floor space. Smaller bacteriology incubator models also enable laboratories to use separate incubators.

14. Multiple laboratory incubator units can be combined into one virology incubator in multi-chamber models. Chambers are sealed and completely separated from each other and have independent controls.

15. Different cultures and temperatures are provided by separate Aerobic/Carbon Dioxide (CO2) incubator units.

16. Before purchasing a virology incubator, facilities should consider which sensor best suits the laboratory workflow, as well as the source of gas and monitoring capabilities in the laboratory. Thermo conductivity sensors measure temperature changes while remaining sensitive to changes in humidity. Infrared sensors are more expensive but are also more effective for maintaining internal conditions with frequent door openings.

17. Some additional considerations include: the temperature ranges, relative humidity, and concentration of CO2 desired. To eliminate bacteria and spore growth, some Aerobic/Carbon Dioxide (CO2) incubator models provide superheating self-decontamination procedures.

Questions for the Seller

Before you purchase your Laboratory Incubator, we recommend you ask the seller the following questions:

General Information

Are any parts rusted?

Are the legs in good condition?

# Tips and Guidelines for Buying a Laboratory Incubator, Thermocycling

Laboratory incubators for heating and cooling test samples, cell culture, DNA and gene manipulation studies

Self-contained units for temperature cycling in test samples, using water, metal blocks, and/or conductive fluids. These incubators are used for heating/cooling cycles in cell culture studies, DNA sequencing, and gene manipulation.

Tips for Buying a Laboratory Incubator, Thermocycling

1. The thermocycling laboratory incubator instrument's throughput and reaction success are affected by some thermal cycled features, which ultimately affect time and cost savings.

2. When determining the laboratory hybridization incubator's throughput, the reaction time is important.

3. The overall cycling time depends largely on the temperature uniformity of the sample block or chamber. If a sample requires one minute at 95

4. Before the samples reach the same temperature as the block or chamber, there will be some lag time, and therefore, temperature uniformity should be measured by sample temperature, not block or chamber temperature.

5. Another important feature of the thermocycling laboratory incubator may be dwell time. If reactions are performed overnight, the length of time a device can store samples at a specific temperature becomes important.

6. Facilities should carefully examine various cycling methods before purchasing a laboratory hybridization incubator, with respect to their effect on reaction time and outcome.

7. The capillary air thermal cycles were introduced for the purpose of reducing the total cycling time of a reaction, by increasing the ramp rate uniformity and decreasing the hold times necessary at each step of the polymerase chain reaction cycle.

8. A reaction is performed by thermocycling laboratory incubators in 10 to 30 minutes, while it requires three to five hours to complete a reaction for conventional heat-block cycles. One study, however, indicates that it is possible to achieve similar reaction times in a heat-block cycled by significantly reducing the hold times at each of the three cycle steps and still obtain acceptable results.

9. To prevent evaporation, samples may require oil overlay, which can add extra time to the sample-preparation process and is often messy.

10. Heated lids are now offered by most thermocycling laboratory incubators. These prevent evaporation and eliminate the need to add oil to the samples.

11. Facilities may consider the adaptability of thermal cycled-to-robotics systems with the increasing degree of laboratory automation. Some laboratory hybridization incubators can be adapted fairly easily for robotics applications, which can save time and, in some cases, reduce the number of false-positive results caused by human contamination.

# Tips and Guidelines for Buying a Laboratory Information System

A clinical and administrative information system for hospital laboratories

A system for managing administrative information and clinical tasks in hospital laboratories. Procedures such as test ordering, results reporting, and quality control can be automated, as well as maintenance scheduling, billing, and other administrative transactions. These systems are generally connected to the hospital administration system.

Tips for Buying a Laboratory Information System

1. Various software features are available for laboratory information systems. The intended use of the clinical laboratory workstation system determines the combination of features necessary for each facility.

2. An laboratory information system should offer some basic features, including general laboratory functions, phlebotomy functions and other features beneficial to the basic operation of a clinical laboratory.

3. File backup capabilities as well as system security, such as password protection, should be offered by all laboratory data management information systems. They also need to be health level 7 compliant.

4. When the laboratory has an existing system or is purchasing stand-alone laboratory information systems and may be considering implementing a hospital data management information system in the future, it should have the capability to interface with a medical center information system.

5. To obtain hard copies of stored data, a printer should be available. Laboratories using bar coding should ensure that the symbologies are compatible with the laboratory management systems they are considering.

6. Facilities considering the purchase of an ancillary information system, should carefully evaluate their current laboratory information system. Any inefficiency they might have will not necessarily be solved by automation.

7. Facilities need to come up with a list of objectives and functional requirements for the laboratory information system and submit it for proposals to several suppliers.

8. Facilities need to select the laboratory information system that best meets the needs of all the users. These are some of the factors to consider:

9. Hardware and software requirements for integrating with other laboratory information systems in the same facility or interfacing with another facility's microbiology information system.

10. The number and types of laboratory instrument interfaces available. Bi-directional interfaces can save time on high-volume instruments.

11. Multiple-site networking capabilities for outreach services and integration with a wide-area network.

12. Ease of upgrading and frequency with which the supplier upgrades.

13. Process regulation capability for use with an automated laboratory management system.

14. Availability of electronic commerce features, such as internet access and direct billing.

15. An effective laboratory management information system is one that can interface with all existing information systems. It should be easily enlarged and upgraded and able to incorporate new technologies easily without affecting performance.

16. Facilities should carefully design floor space and cabling. Installation planning is critical, because an entire room may be dedicated to hardware.

17. To prevent hardware damage due to fire, sprinklers should be replaced by inert gas systems. Accommodating longer-distance signal connections may require additional equipment, such as telephone modems or fiber optic wiring. Facilities should keep in mind that adding special equipment might pose design problems and increase costs.

18. Another factor to be considered by facilities to best defend against attack from computer viruses or worms is the microbiology information systems manufacturer's policy on handling security threats.

19. An ancillary information management system to address security threats should be in place to minimize confusion, save time for system users, and reduce the risk of catastrophic failures from installation of an inappropriate update or from infection by a virus or worm.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Laboratory Oven

This definition relates to various types of ovens and heaters used for drying and other purposes applicable in medical laboratory

Heated cabinets or systems which are used to dry vessels instruments and biological material or other materials used in medical laboratory. It can sometimes be used for other laboratory required purposes.

Tips for Buying a Laboratory Oven

1. When comparing laboratory ovens/heaters, facilities should consider whether the unit is bench or floor standing and its external dimensions relative to the space that is available and ease of its accessibility.

2. Facilities should also check the number of shelves provided in the laboratory oven and number of possible shelf positions; the option for additional shelves should also be available if they are required.

3. The interior of the contrast media warmer unit should be stainless steel or aluminum clad.

4. The control and display type that is required (analogue or digital) should be determined. Analogue: control is normally achieved by a numbered dial; a thermometer displays the actual temperature. Control is usually hydrostatic and may need time before stabilizing on the set temperature. Digital: temperature is set and displayed via a digital LCD controller. It is more accurate as it adjusts the rate of heating down gradually, and avoids temperature overshoot.

5. Facilities should inquire whether the laboratory oven is programmable or has a timer.

6. When temperature uniformity is important, fan forced circulation gives better temperature uniformity in the contrast media warmer cabinet than gravity - this can be especially important in larger laboratory ovens.

7. The laboratory oven should at least have an independent, manually adjustable high temperature cut-out dial, so that if the cabinet overheats it will cut out at the cut-out temperature, rather than hitting the maximum temperature. Some laboratory ovens have high/low temperature alarms; other can be connected to an external alarm system.

8. Facilities should verify the lowest temperature that the laboratory oven may be used at.

9. It is better to check the contrast media warmer's internal dimensions (W x D x H) rather than relying on the manufacturer's listed capacity of the laboratory oven's internal volume, as different manufacturers describe the internal liter capacity differently, which can be misleading; some specify the total internal volume, while others state the theoretical available volume, which may not include distance from the sides (space for air convection).

10. Vents enable any fumes to be emitted outside the chamber and room.

# Tips and Guidelines for Buying a Laboratory Safety Cabinet

Safety cabinets designed to isolate and protect from various biological pathogens

Cabinets with different safety classifications. They are designed to protect operator, samples, and environment from various low and moderate risk biological agents using HEPA filter for laminar flow.

Tips for Buying a Laboratory Safety Cabinet

1. Some specifications that involve safety and quality assurance are required of all laminar air flow units. Other requirements depend on the laboratory safety cabinet's configuration and use.

2. An airflow monitor, which verifies that the airflow is at the appropriate rate to ensure adequate protection for employees or specimens, is a preferable feature when purchasing a laboratory safety cabinet.

3. Another preferred feature is self-test, an adjustable sash to be placed in a variety of positions while working on the laboratory safety hood.

4. The laboratory safety cabinet work area should be easy to clean and durable, therefore, a stainless steel work area is recommended.

5. The laboratory safety cabinet units should provide alarms to warn users of potential risks due to user error or problems with the hood itself, such as an open sash or inadequate airflow.

6. All laboratory safety hoods require a cabinet light, and for certain applications, a UV light may be desirable.

7. When buying laminar air flow units, the main expenses include the cabinet and for ducted hoods, the remote blower as well as the ductwork and other hardware.

8. Other expenses include the installation costs, which involve installation of the cabinet, the exhaust system, and the remote blower.

9. Laboratory safety cabinet manufacturers advise on-site certification after installation, even though hoods are tested before shipment. This is also necessary when filters are changed, maintenance repairs are performed, or when hoods are used for hazardous or critical applications or workloads.

10. When a technician certifies the laboratory safety cabinet, the high efficiency particulate air filters should also be checked. The frequency of filter change depends on the use and location of the laminar air flow unit and the quality of the room air.

# Tips and Guidelines for Buying a Laboratory Scale

General purpose balance for quick weighing of relatively large quantities of substance

General purpose balance for quick weighing of relatively large quantities of substance. This type of balance usually has an accuracy rate of no more than ±10μg.

Tips for Buying a Laboratory Scale

1. Before making a laboratory scale purchase, medical facilities need to consider the minimum load, the maximum weight needed for the scale to weigh, and the scale's reproducibility and linearity. A full list of applications and features contained in a laboratory scale can be found in the model's user manual.

2. For laboratory scales, some of the features to consider and examine include: the maximum temperature, sample weight, readability, switch of criteria, and accuracy of the result needed.

3. The laboratory scale's readability should be taken into account in terms of the decimal places or units displayed, and how many accurate decimals/units are needed to weigh down to (1g., 0.1g., 0.001g., 0.1mg. etc.)

4. Typically, laboratory balances using AC power adapters are more accurate than battery-operated models.

5. Facilities should inquire whether the laboratory scale weighs only in grams or whether it has multiple weighing units such as: the option for % weighing, piece counting, target weighing (weighing of packed products for fill weight), or supports density (underhook) weighing. Moisture laboratory scales can be used to determine loss on drying of samples.

6. Certain laboratory balance models can transfer data to a computer or printer. Facilities should look into whether interface cables for PCs or printers, or communications software are included with the laboratory scale.

7. The method of calibration that the laboratory scale has is an important factor to consider. Internal calibration scales use an internal weight to automatically calibrate the instrument at a preset time, due to changes in temperature, or upon request, while external calibration scales are manually calibrated by placing a calibration test weight on the laboratory balance pan.

# Tips and Guidelines for Buying a Laboratory Washer

Automatic washers specifically designed for laboratory and surgical equipment

Automatic washers for laboratory instruments/ surgical equipment. A stainless steel compartment is designed for use with high water temperatures and detergents, and has special spraying features that wash the insides of test tubes and beakers. Different storage options are available (undercounter, recessed, or pass-through (tunnel) washers).

Tips for Buying a Laboratory Washer

1. Facilities should keep in mind that the initial acquisition cost does not accurately reflect the total cost of ownership, because laboratory washers require ongoing maintenance and operational costs. Facilities should look into life cycle cost, local service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment.

2. To compare high cost alternatives and to determine the economic value of a single alternative, facilities can use a life cycle cost analysis. Life cycle cost analysis techniques can be used to examine the cost effectiveness of leasing or renting laboratory washer equipment versus purchasing it outright. It is most useful for comparing alternatives with different cash flows and for revealing the total costs of labware washer equipment ownership, because it examines the cash flow impact of initial acquisition costs and operating costs over a period of time.

3. Life cycle cost analysis often demonstrates that the cost of ownership includes more than just the initial acquisition cost. A small increase in initial acquisition cost may produce significant savings in long-term laboratory washer operating costs.

4. The annual cash outflow, the dollar discount factor, and the lifetime of the labware washer equipment are used in a mathematical equation to calculate the present value. The usage cycle and the cost depreciation present a value analysis that is especially useful, because it accounts for inflation and for the value of usage/capital invested.

5. Electrical consumption is the major operating cost of a laboratory washer. Buyers may be able to reduce long-term expenses by purchasing a low-power labware washer unit, in which the largest consumables outlay is for detergents.

6. Using liquid detergent is recommended over powder, although powder costs less. Users tend to dispense more powder than necessary for a wash cycle. Many laboratory washers have automatic dispensers, which inject precise amounts of liquid detergent to help minimize detergent consumption. Liquid detergent can also eliminate problems caused by powder detergent residue.

# Tips and Guidelines for Buying a Laboratory X-ray

X-ray source for scientific purposes

X-ray source which is not used in clinical use. Usually intended for irradiation of in vivo lab animals or in vitro biological materials.

Tips for Buying a Laboratory X-ray

1. When considering which laboratory x-ray to purchase, storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of digital radiography over film-based radiography.

2. The laboratory x-ray tilting tables allow a wide range of tilting movements from -15

3. The non-tilting tables specify a wide range of tabletop motions but do not allow tilting angles.

4. Digital radiographic laboratory x-ray systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed in the table system in table-based laboratory X-ray units, preventing certain examinations due to patient positioning constraints. Some upright laboratory x-ray systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed before deciding which type of laboratory x-ray will best suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the laboratory x-ray system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables, because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Laboratory x-ray buyers should look into the system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Laboratory x-ray buyers should consider generator options as well. High-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any network, compatibility with DICOM 3.0 is a requirement for all newly purchased equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail which information objects, service classes, and data encodings are supported by the laboratory x-ray system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate laboratory x-ray comparisons between suppliers.

Questions for the Seller

Before you purchase your Laboratory X-ray, we recommend you ask the seller the following questions:

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Scientific and Laboratory X-Ray

# Tips and Guidelines for Buying a Laparoscope

Endoscopes for observation and treatment ( e.g. percutaneous insertion through abdominal wall)

Two different types of laparoscopes are available, one for viewing (diagnostic), and another for surgery. The endoscopes are inserted into the body, with imaging systems for examination or performing surgical procedures. They use a relayed lens, optics, or fiberoptic light system for illumination and imaging. Most have camera heads for external display, documentation, and image processing. These endoscopes use fiberoptic light systems or relayed lens optics for illumination and imaging during procedures, usually within the abdominal cavities.

Tips for Buying a Laparoscope

1. Laparoscopes can meet a wide range of fixed specifications, including viewing angle and diameter. Facilities should carefully evaluate their needs to choose models accordingly.

2. Laparoscopes - standard and video - should be compatible with many sterilization methods. Autoclave compatibility is preferred. For sterilization purposes, video laparoscopes and peritoneoscopes should be completely submersible.

3. Another required compatibility is with all common types of light sources and video processors.

4. Video laparoscopes should be compatible with different video processors; the capability for remote control of video processor or documentation functions is preferred.

5. Facilities should carefully examine the needs of their clinical setting, determining the frequency with which laparoscopic procedures are performed, and the types of surgical instruments and accessories required, including pelviscopes and peritoneal cavity endoscopes.

6. Facilities should evaluate the compatibility of the laparoscope with other surgical equipment. Many manufacturers offer sets of laparoscopes of various sizes and viewing angles.

7. One of the most important peritoneoscope purchase considerations is the optical quality of the image, which is determined by the ability of the fiber optic cables and light source to adequately illuminate the area under view, and the ability of the lens system to transmit a clear, bright image to the eyepiece with minimum distortion.

8. Pelviscope devices are different from one another in their image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view.

9. Facilities should consider the sensitivity of the peritoneal cavity endoscope device to heat, the time and temperature required for rinsing, the reuse life of the cleaning solution, and manual versus automatic processing before making the purchase.

10. Some additional factors to consider include: shelf life, disposal restrictions, minimum effective concentration, safety, and cost per cycle.

Questions for the Seller

Before you purchase your Laparoscope, we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

General Information

Is it a Laparoscopic type?

Is it a Videoscopic type?

Does it have an internal chip/CCD?

Does it have an external chip/CCD?

Does it include a light source?

Does it include a full video system?

Sleeve

Does it include a valve?

Does it include a stopcock?

Does it include an accessory sleeve?

# Tips and Guidelines for Buying a Laser - CO2

Carbon dioxide lasers for use in general surgery and dermatology

Surgical carbon dioxide lasers are used in microscopic surgery, macroscopic surgery, endoscopic and laparoscopic procedures, as well as in general surgery and dermatology. They are used to make surgical incisions, to cut and vaporize deeper tissues, and for coagulation of small vessels.

Tips for Buying a Laser - CO2

1. Facilities cannot use one type of laser for all their surgical applications; so they should identify the types of lasers that will meet the specific needs of their surgical departments.

2. Facilities should make sure that the power output at tissue is at least 1 to 30 W and the exposure time is at least 0.01 sec. Lasers should also include a gas-filled sealed tube and an internal air-cooling system.

3. Facilities should examine the modes of operation that a laser provides. Some lasers offer both modes for different levels of surgical control.

4. Some purchase options are available for buyers. These may include micromanipulators, handpieces, focusing lenses to adjust spot sizes, and wave-guides.

5. The power distribution system of the facility is another important factor to consider. Some CO2 lasers may need up to 240 VAC, particularly those for high power applications. Lower power output units, which usually require 120 VAC, are suitable for dermatological uses, but high-powered lasers are necessary for other surgeries.

Questions for the Seller

Before you purchase your Laser - CO2, we recommend you ask the seller the following questions:

Delivery System

Does it include a Handpiece?

Does it include a Micromanipulator?

Does it include an Aiming laser?

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Please indicate the number of shots performed

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Surgical Lasers

Carbon Dioxide Surgical Lasers

# Tips and Guidelines for Buying a Laser – Diode

Diode lasers for photodynamic therapy, cutting, vaporizing and coagulating tissues

Diode lasers used for photodynamic therapy. Tissue ablation is performed by a combination of light, sensitizers, and tissue oxygen destruction that create a non-thermal phototoxic effect. For use in open, laparoscopic, and endoscopic surgery. The laser energy penetrates deep tissue and causes photocoagulation of blood vessels at low power densities, and vaporization of tumors at high power densities.

Tips for Buying a Laser - Diode

1. Facilities need to identify their specific needs before making a purchase because there is no one single laser that is appropriate for all surgical applications.

2. The main two factors to consider are the power output and exposure time. Recommended values are maximum power of >=25 W and the ability to produce a 0.1 to 9.9 sec single and repeat pulse.

3. These devices are considered very reliable and have been reported to last for 10,000 to 25,000 hours of use.

4. The lasers have no mirrors or other internal components to adjust and are air-cooled, so they are almost maintenance-free and contribute to significant cost savings over time.

5. The price of the surgical diode lasers is lower than that of other comparable surgical lasers. As laser semiconductor diodes become less expensive, the cost of these devices is expected to decrease even further.

6. Because of all these benefits, diode lasers are attractive for use in physician offices and other outpatient settings and as replacements for functionally equivalent lasers that have reached the end of their useful life.

7. Usually manufacturers provide training in laser operation. However they may be charging for it in some cases.

Questions for the Seller

Before you purchase your Laser - Diode , we recommend you ask the seller the following questions:

Surgical Application

Is it applicable for dermatology?

Is it ENT applicable?

Is it applicable for gastroenterology?

Is it applicable for general surgery?

Is it applicable for gynecology?

Is it applicable for head and neck?

Is it applicable for neurosurgery?

Is it applicable for occuplasty?

Is it applicable for ophthalmology?

Is it applicable for orthopedics?

Is it applicable for plastic surgery?

Is it applicable for pulmonary/thoracic?

Is it applicable for urology?

Treatment Models

Continuous ?

Countdown?

Exponential decay?

Linear decay?

Fiberoptic System

Is it disposable?

Is it reusable?

Contact?

Noncontact?

Previous Usage

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Please indicate the number of shots performed

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Surgical Lasers

# Tips and Guidelines for Buying a Laser – Excimer

Q-Switched Excimer lasers for opthalmic procedures

Q-switched Excimer laser system, equipped with patient table, physician's chair, and computer system. Some include built-in slit-lamps. These lasers are used for corneal ablation and other opthalmic procedures.

Tips for Buying a Laser - Excimer

1. This is the delivered power for the different beams: 3 W for an argon blue-green beam, 1 W for an argon green beam, 1 W for a dye beam, 1.5 W for a krypton green beam, 1.5 W for a krypton yellow beam, 1 W for a krypton red beam, and 1 W for a Nd:YAG beam. The following lasers should have principal wavelengths of 530-540 nm: argon, dye, krypton, and frequency doubled Nd:YAG lasers. The requirements of the unit include: single and repeat delivery modes, exposure duration of 0.01 to 2 seconds, repeat time of 0.1 to 2 seconds, a spot diameter of 50 to 1,000 mm, a slit lamp, an intraocular probe, a hand piece, and an indirect ophthalmoscope. An Nd:YAG laser should use a Q-switched operating mode and a fundamental mode structure; it should have a single pulse of 0.3 to 10 mJ, pulse duration of 4 n/sec, and 1 to 3 pulses per burst. The spot size should be 10 1

2. Selected energy, shot selection, power output, and shot counter should all be displayed and controlled by the unit.

3. The laser should have a joystick beam actuator.

4. A compatible slit lamp should be used with magnification up to 25× and a working distance of 1,000 mm.

5. Each unit should have an automatic calibration system and the following accessories: contact lens, co-observation, a television with 35 mm adapter, a head restraint system, and a tonometer. An excimer laser should have a wavelength of 193 nm, 0-3 W of power output at tissue, 10 mJ per pulse, and an energy density of 150- 200 mJ/cm2; it should have both continuous and pulsed delivery modes, a beam diameter of 1 to 5 mm, a pulse repetition rate of 10 to 200 Hz, and a pulse duration of 10 to 15nsec.

6. Buyers should expect a unit with a high precision spot delivery system, a computer system, halogen gas cylinders, and 24 months of halogen source useful life.

7. A diode laser should have a power output on tissue of 1 W, both continuous and pulsed delivery modes, a pulse repetition rate 10 Hz, and pulse duration of 50 msec to continuous.

8. There are units requiring higher voltages and greater current capacity than those available from a standard outlet. If a unit needs an external water source, facilities should locate it above the first floor of an older building, and they may need a booster pump to provide adequate water pressure for cooling.

9. Facilities are encouraged to submit requests for proposal to several suppliers; they should discuss the important issue of prospective servicing.

10. Buyers should evaluate whether the laser is adaptable for other types of therapy for which they have a need.

Questions for the Seller

Before you purchase your Laser - Excimer , we recommend you ask the seller the following questions:

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Please indicate the number of shots performed

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Excimer Laser

# Tips and Guidelines for Buying a Laser - Nd:YAG

Surgical Nd:YAG lasers for laparoscopic and endoscopic procedures

Lasers that are mainly used for cutting, excising, vaporizing, and coagulation of deep tissue. The laser energy of the Nd:YAG penetrates and is absorbed into a large body of deep tissue. This leads to photocoagulation of blood vessels at low power densities, and vaporization of tumors at high power.

Tips for Buying a Laser - Nd:YAG

1. Facilities should look into the following factors before purchasing: clinical need, existing technology of the facility or alternate devices, type and number of procedures to be performed, versatility of the instrument, experience and preferences of the surgical staff, effect the device will have on reimbursement, voltage and electrical current requirements, safety, reliability, and service.

2. Facilities should carefully identify the types of lasers that will meet the specific needs of the different surgical departments. One laser is not appropriate for all surgical applications.

3. The most important factor to be considered is power output. Many free-beam procedures require 60 to 100 W.

4. Facilities planning to use the Nd-YAG laser for contact procedures do not need a high-power laser but rather one that delivers up to 40 W.

5. At tissue surfaces the power output should be more than 1 W, and both the exposure time and repetition rate should be at least 0.1 sec.

6. A power output display and an internal air-cooling system should be included with the device, and it should allow manual fiber calibration. The laser should be able to operate at 120 VAC in the USA.

Questions for the Seller

Before you purchase your Laser - Nd:YAG, we recommend you ask the seller the following questions:

Fibers

Are they reusable?

Are they disposable?

Is an aiming laser included?

Fiber Cooling

Does it use tap water?

Does it use liquid cooling system?

Does it use air?

Does it need any external cooling assistance/apparatus?

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Please indicate the number of shots performed

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Surgical Lasers

Frequency-Doubled Nd:YAG Surgical Lasers

Nd:YAG Surgical Lasers

# Tips and Guidelines for Buying a Laser – YAG

Solid-state Ho:YAG lasers with the doping element HO

HO:YAG lasers emit energy near the absorption peak of water, so they can cut or ablate tissue with moderate hemostasis, minimal charring, and a thin zone of necrosis. These lasers belong to a group of solid-state lasers containing the doping element HO. They are used in hospitals and outpatient facilities for various surgical applications.

Tips for Buying a Laser - YAG

1. The most important factor when choosing surgical Ho-YAG lasers is the power output. The cost increases with the power. The amount of power needed depends on the types of planned procedures.

2. High-power YAG laser units can be widely applied, while low-power surgical laser units are well appropriate for procedures in niche specialties, such as ophthalmologic, dental, and sinus surgery.

3. The following requirements should be met by the YAG laser: an output of at least 5 W, a wavelength of 2,100 nm, at least 0.2 J per pulse, an aiming beam and an internal cooling system. The surgical Ho-YAG laser should also be capable of external fiber calibration.

4. When the facility is considering buying only one surgical laser, the one to consider should be the Ho-YAG or Nd-YAG combination laser, which can be used for various types of specialty procedures. Facilities can also check the CO2 laser, which has the same cutting ability at a relatively low cost.

5. Facilities should carefully identify the types of lasers that will meet the specific needs of the different surgical departments. One YAG laser is not appropriate for all surgical applications.

6. Laser technology committees were formed in some medical facilities in order to evaluate policies, procedures, safety factors, and purchasing issues related to surgical Ho-YAG lasers.

7. Facilities should look into the following factors before selecting a YAG laser: clinical need, existing technology, number and types of procedures to be performed, versatility of the instrument, experience and preferences of the surgical staff, effect on reimbursement, and some safety and reliability issues.

Questions for the Seller

Before you purchase your Laser - YAG, we recommend you ask the seller the following questions:

Fibers

Are they reusable?

Are they disposable?

Are they user calibrated?

Can it be user repaired?

Does it include special tips?

Cooling System Type

Does it use internal liquid?

Does it use forced air?

Does it need any external cooling assistance/apparatus?

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Please indicate the number of shots performed

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Surgical Lasers

Ho:YAG Surgical Lasers

# Tips and Guidelines for Buying a Laser Blood Flow Detector

Laser blood flowmeters using Doppler principle from laser source

Flowmeters which transmit light through fiberoptic lighting probe, illuminating the tissue being tested. The frequency shift of the light that reflects back from the tissue is a measure of the blood flow (Doppler effect). Laser flowmeters are often used during surgery and endoscopic procedures to accurately measure perfusion in the superficial tissue.

Tips for Buying a Laser Blood Flow Detector

1. Laser blood flow meters and blood-flow detectors can be handheld, portable, or tabletop units. Facilities should select the right configuration based on clinician monitoring needs and preference.

2. Blood-flow detectors and meters should include an on/off indicator, and transducers with different user-selectable transmitting frequencies. The detectors and flow meters should have a range of 2 to 8 MHz.

3. External speakers with volume control for Doppler analysis should be included with the flow meters. They should also have bi-directional flow indicators, and a transducer mounted on a catheter or probe or integral to a clamp.

4. Flow meters should have probes with different lumen diameters; frequency response should be user selectable and within a range of 0.5 to 100 Hz and should be user selectable.

5. A flow meter should remain zeroed and calibrated for at least one day after it was zeroed and calibrated according to the manufacturer's instructions.

6. In order to provide the required accuracy for the evaluation of blood perfusion, the units should include a fiber optic probe designed for that purpose.

7. The following data should be specified by the manufacturer: the unit's measurement depth, response time, laser class, wavelength, and power output at probe tip, Doppler-shift frequency range, cable length, and probe-head diameter.

8. When facilities consider buying probes to be used with blood flow meters, they should look into various factors, such as the length of the vessel that can be exposed, the available space around the vessel, the location of adjacent organs, and the depth of the vessel's location.

9. Facilities must use probes of the right size and type to obtain accurate results; most manufacturers will try to meet specific needs for probe sizes and accessories although they don't necessarily include it in their usual product lines.

10. Various output options are offered with these units. These may include headphones, chart recorder, extra output jacks, a printer, and meters.

11. Other options are available as well, including pneumoplethysmography, strain-gauge plethysmography, photoplethysmography, a carrying case, a remote control, a footswitch, and interfacing capabilities.

12. The units can be line-powered or battery-powered. Battery-powered units should have their battery operating the device for at least two hours. A visible and audible alarm should warn when a battery level falls to the point that may fail the unit to perform satisfactorily.

13. Rechargeable batteries should require less than 16 hours of recharging after depletion; when there's a need to recharge the battery, a clear indicator should appear.

Questions for the Seller

Before you purchase your Laser Blood Flow Detector, we recommend you ask the seller the following questions:

General Information

Is it bidirectional?

Does it have computer interface?

Does it have volume control?

Does it have an on/off indicator?

Can it be battery operated?

Outputs

Does it include a speaker?

Does it include a headphone?

Does it include a chart recorder?

Does it include a printer?

Previous Usage

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

# Tips and Guidelines for Buying a Laser Imager

Laser imaging system that produces high-resolution multi format films

Laser imaging systems which produces high-resolution multi-format films directly from diagnostic radiology procedures image data. The hard copy that these imagers produce is for diagnostic purposes, instead of using an onscreen electronic image. Most laser imagers use standard wet film processing for developing laser-sensitive film, some use special dry-processing methods. These devices include a laser source, controlling computer, optional film processor, and interface to imaging system or host computer.

Tips for Buying a Laser Imager

1. Laser Imagers can be divided into wet and dry processing categories, and then further divided into system throughput, depending on a facility's demand.

2. The dry processing laser printer units eliminate the facility's pollution concerns and the need to process chemicals, and therefore are advantageous over wet-processing systems. Some other benefits include: less maintenance costs - such as darkroom ventilation, chemical storage, and additional plumbing, electricity, and drainage. Also, dry processing laser printing systems can be strategically placed almost anywhere in a facility because of their compact nature.

3. A dry processing laser imaging system may be a cost-effective solution for a facility that is upgrading or purchasing new equipment. Facilities that are already using wet processing equipment usually stick with it; the film is well produced, the conversion from one system to another can be too costly, and the radiologists are comfortable with the stability of developing by wet processing systems.

4. Laser imagers of all categories should have eight input ports, pixel matrix size should be 4000 × 5000 for high and low throughput imagers and 2000 × 2500 for small format imagers.

5. All laser printers should be able to record about 4,000 shades of gray.

6. In nuclear medicine departments, the dry small format laser imager is most commonly used.

7. Facilities must first determine the necessary throughput of the system based on the current patient load. They should also make sure that the laser printer's system's memory and throughput can handle the number of imaging devices that will be connected to it.

8. Low-throughput laser imagers should average 60 films/hour, while high throughput imagers should average 120 films/hour, while low-throughput laser printers should average 60 films/hour.

9. For high-throughput laser imagers, the average print time should be about 20 seconds/film, and about 60 seconds/film for low-throughput imagers.

10. Dry small format laser imagers, used specifically for NM and ultrasound, average the same throughput as low throughput imagers. They need a smaller film size than high and low throughput imagers, using 20 × 25 cm films.

11. For all laser imagers, local hard-drive storage is recommended. In order to accommodate various images, imagers should have multiple formats.

12. Users need to follow calibration procedures recommended by the manufacturer for acceptable long-term performance.

13. All units should offer remote diagnostics. To increase system compatibility, DICOM interface options are recommended.

14. ACR/NEMA DICOM 3.0 is a standard that ensures data exchange among laser imaging devices, regardless of the brand or image format used. The purpose of this standard is that several devices meeting the standard could be organized into a system that communicates without customized interfaces.

15. Facilities may find a DICOM compliant system more compatible with existing laser printing equipment, especially DICOM gray scale conformance.

Questions for the Seller

Before you purchase your Laser Imager, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Laser Imagers

# Tips and Guidelines for Buying a Laser Lithotripter

Intracorporeal lithotripters using laser energy

Intracorporeal lithotripters using laser energy delivered through an optical fiber placed in contact with the stones. Stone fragmentation can be caused in two ways : The energy released by laser activation produces a plasma bubble that fragments the stone. The laser energy released can also be absorbed by the stone, causing it to vaporize and fragment. The stone fragments usually pass through the urinary tract. The laser medium used is either a crystalline solid or an organic dye solution.

Tips for Buying a Laser Lithotripter

1. These units are used for locating, viewing, fragmenting, and removing urinary tract or renal calculi. They may also be used to disintegrate salivary stones or bile duct stones. Units with a footswitch are recommended because they keep the operator's hands free to position the unit.

2. Different pulse energy and pulse rate portray electro-hydraulic lithotripters; pulse duration and voltage determine the amount of energy delivered per pulse. Available pulse rates vary and are often a function of the pulse duration selected. Acceptable electrode size varies from 1.7 Fr/77 cm to 9 Fr/40 cm, the longer lengths are usually used for biliary applications.

3. Laser devices should have a wavelength of about 2,100 nm and a visible aiming beam to ensure accurate placement. Pulse duration and power determine the amount of energy delivered per pulse. Available pulse rates also vary among manufacturers and are often a function of the selected pulse duration.

4. General lithotripsy and soft tissue surgical procedures can use low-watt lasers. High-watt lasers can be used for bladder stone lithotripsy, and pulse duration may be up to 500 usec.

5. A laser lithotripter should have a fiber diameter between 200 and 1,000 um and at least 3 ft long.

6. For lithotripsy in the lower pole of the kidney, usually small fiber diameters are used with flexible scopes. Lithotripsy in the bladder and ureter will generally use large fiber diameters with rigid scopes. Operators can use any standard endoscope to visualize placement of the lithotripter.

7. With nephroscopes, operators usually use a shorter lithotripter probe than the one used with ureteroscopes, with an outer diameter that is larger than the one used with ureteroscopes. Also the sheath diameter of the nephroscope is larger and the length is shorter than that of the ureteroscope.

8. Any rigid or flexible endoscope is acceptable for electromechanical lithotripters. The available sizes for probes should be between 0.8-9.6 Fr and 26.7-90 cm long, at minimum.

9. Manufacturers offer a wide range of IL devices. However, there is no one device that covers the entire range of clinical situations. The factors that affect the choice should include: location and size of the stone burden, endoscope configuration working channel caliber, and offset or end on port.

10. Video and photographic accessories, such as cameras, videocassette recorders, and light sources, are also offered by suppliers at an additional cost. This can enhance imaging and educational uses of the instrument.

11. To compare high cost alternatives and to determine the economic value of a single alternative, facilities can use a life cycle cost analysis. They can use low cycle cost analysis techniques to examine the cost-effectiveness of leasing or renting equipment versus purchasing it outright.

12. Low cycle cost analysis is most useful for comparing alternatives with different cash-flows and for revealing the total costs of equipment ownership because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time.

13. Suppliers offer facilities service contracts or service on a time-and-materials basis. Some third-party organizations may also provide this service. Facilities should carefully consider this issue.

14. Service contract customers can get routine software updates, which enhance the system's performance, free of charge from most suppliers. Facilities should keep in mind that software updates are often cumulative, which means that previous software revisions may be required in order to install and operate a new performance feature.

15. Facilities with a full-service contract ensure preventive maintenance at regular intervals, thereby avoiding the unexpected maintenance costs. Many suppliers extend system performance and uptime guarantees beyond the length of the warranty only for systems covered by a service contract.

Questions for the Seller

Before you purchase your Laser Lithotripter, we recommend you ask the seller the following questions:

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

# Tips and Guidelines for Buying a Linear Accelerator

Linear accelerator units for X-ray and electron radiotherapy.

Linear accelerator is an electronic device which converts microwave energy into high energy electrons and photons. Range of energies will be generally between 4-22 MeV. The geometrical structure is very stable and precise to allow high precision treatment. The two main parts are the gantry with the radiation source and the special coach for patient placement.

Tips for Buying a Linear Accelerator

1. Facilities should select the radiotherapy unit based on the range of energies required and ease of patient setup.

2. Due to the high price of radiotherapy units, facilities need to carefully assess their needs and choose a versatile linear accelerator unit (LINAC) that can meet their needs.

3. Many different linear accelerator designs are available from various manufacturers, who offer a slightly different approach to device design. There is no sufficient data to show the clinical superiority of a particular radiotherapy unit's design.

4. Different models offer various numbers and sizes of collimator leaves.

5. The main differences between low, mid, and high-energy LINACs are the photon and electron energy ranges. Buyers should choose the appropriate linear accelerator type based on the main uses of the unit.

6. The cobalt units, much like the low energy linear accelerators, are mainly used for treating bone cancer and head, neck, and breast tumors.

7. For treating deep-seated neoplasms and tumors of the pelvis and thorax, higher energy LINACs are used. These can also produce low-energy beams, and therefore are capable of more applications than lower-energy linear accelerators. However, they are significantly more expensive.

8. The accelerator can be either a travel or standing wave accelerator for all types of LINACs. The microwave power source can be either magnetron or klystron, and the gantry rotation range should be 360

9. Linear accelerators should have multileaf collimators with at least 40 leaves. 10. For x-rays, the collimators should define fields of 40 × 40 cm. For electrons, they should be 25 × 25 cm.

11. Radiation treatment requires a wide range of photon and electron energy and treatment field sizes due to the fact that cancerous tumors occur at different depths and locations within the body.

12. Approximately 60% of patients require low-energy therapy, 25% of patients require medium to high-energy therapy, and 15% require a high-energy electron beam.

13. Before installation of a radiotherapy unit, the shielding requirements should be determined by a medical physicist. Due to the higher doses, IMRT may require additional shielding.

14. For calibrating radiotherapy units and identifying operating irregularities, buyers should establish a comprehensive quality assurance program.

Questions for the Seller

Before you purchase your Linear Accelerator, we recommend you ask the seller the following questions:

Tube

Is the acceleration tube of a sealed type?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Linear Accelerators

# Tips and Guidelines for Buying a Lung Function Analyzer

Pulmonary function analyzers of volume, flow, resistance etc.

Computerized pulmonary function analyzers with data processing and recording capabilities. They are used for outpatient and presurgical screening, also for evaluation of common diseases in older children and adolescents. These analyzers consist of a spirometer with volume and flow-sensing devices, gas analyzer for gas diffusing capacity of lungs, and evaluation of absolute lung volumes. Some can measure both lung volumes and airway resistance using a total body plethysmograph.

Tips for Buying a Lung Function Analyzer

1. Before making a purchase, facilities need to determine their present and future needs to ensure they get a system that meets those needs.

2. The analyzers offer different complexity and test capabilities. They can be cart-mounted, stand-alone, or a console.

3. The analyzer should allow measurement of ventilation, diffusion, and distribution of gases in the lung.

4. All units usually include a spirometry instrument, various gas analyzers, a plethysmograph, and other test equipment.

5. Computerized pulmonary function analyzers are becoming more user-friendly, providing customized reports, and increasing software options.

6. Users should be able to define and select the predictive equations as needed.

7. The analyzer should measure CO and O2. These devices can complete certain procedures and measure various parameters.

8. Manufacturers should provide the following information: A list of the procedures and measurements of the specific unit.

9. Whether the analyzer has computer-interfacing capabilities. If so, a list of those capabilities.

10. Whether software is required. Any necessary software should be included in the purchase price.

11. Whether the analyzer could be upgraded through future software improvements and/or add-on components that increase versatility.

12. Costs for these enhancements.

13. The analyzer, as a diagnostic tool, must accept patient data, measure patient ventilatory efforts, and present the diagnostic information to the clinician. A hard-copy must be produced as well.

14. All controls should be clear, easy to operate, protected against accidental setting changes, and sealed against fluid penetration.

15. All control functions should be simple; the design should prevent misinterpretation of displays and control settings.

16. Fluid spills should not affect patient and operator safety, or system performance. If the device is indeed affected, it should fail safely.

17. To prevent cross-contamination, the operator's manual should describe the appropriate reprocessing or sterilization methods for reusable, patient-contacted parts.

Questions for the Seller

Before you purchase your Lung Function Analyzer, we recommend you ask the seller the following questions:

General Information

Does it meet ATS standard?

Does it include real-time graphics?

Does it include an integrated computer?

Does it include an interpretation program?

Does it include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Pulmonary Analyzers

# Tips and Guidelines for Buying a Mammographic Phantom

Phantoms for mammography

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of radiation absorption and dose distribution, also for research, QA/QC, equipment calibration, and testing purposes.

Tips for Buying a Mammographic Phantom

1. With the increasing emphasis on QA/QC programs, hospitals should consider purchasing mammographic phantoms to test system performance on a regular basis (e.g., daily, weekly, monthly), particularly for modalities such as radiography, fluoroscopy, and radiotherapy, in which patient radiation exposure is a concern. For United States-based mammography departments and facilities, mammographic phantoms that meet the requirements of an accreditation program or MQSA should be purchased. Some facilities create their own biopsy training phantom mammography units from inexpensive materials, to save on costs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms

# Tips and Guidelines for Buying a Mammography Unit

**Mammographic X-ray imaging units (mammograph)**

Mammographic x-ray imaging units are used to detect and diagnose breast cancer, and for evaluation of other breast lesions. These units use a high-frequency or constant potential x-ray generator, automatic exposure control, filters, collimator, and compression devices. They also include an image recording system.

Tips for Buying a Mammography Unit

1. Mammography screening equipment must meet the minimum MQSA requirements for tube outputs, compression performance, position controls, and reproducibility.

2. Facilities should base their Mammography unit screening purchase decision on life-cycle cost, local service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment.

3. Suppliers offer service contracts or service on a time-and-materials basis. This may also be available from a third-party organization. Facilities should carefully consider whether to purchase such a service.

4. When purchasing a Mammography screening equipment unit, performance and reliability are important factors.

5. A Mammographic unit high-frequency x-ray generator will help ensure higher efficiency of operation with a minimum of output ripple. It will also need less space than a conventional generator.

6. Mammography involves a narrow range of tissue thickness, and therefore 1 kV increments and a range of approximately 22 to 35 kV are necessary.

7. The system should offer at least 500 mAs and an exposure time of 0.1 second or shorter to avoid unnecessary long exposures.

8. A rotating anode, which has a higher heat capacity than a stationary anode, should be available on the Mammography unit to promote longer x-ray tube life and provide a more consistent x-ray output.

9. AEC provides the appropriate image optical density and x-ray exposure for breast composition and thickness.

10. Focal spot sizes should be approximately 0.1-0.3 mm to ensure that micro calcifications as small as 200 μm can be detected.

11. To clearly image the smallest micro calcifications, an SID of at least 66 cm is needed.

12. The complexity of the automatic exposure control is the main difference between systems. Some systems control only the exposure time, while more advanced ones control the x-ray spectrum, including the kVp, anode, and filtration. Such systems improve the image quality, especially in larger and denser breasts.

13. Some manufacturers of Mammography units have developed advanced grids, which are expensive to manufacture, but improve the image quality.

14. Facilities considering the purchase of a stereotactic biopsy system should consider the number of procedures to be performed and the compatibility with existing mammographic equipment.

15. Film-based Mammographic units are not recommended because they do not allow real-time guidance. Instead, both dedicated and add-on systems are equipped with small digital detectors.

16. Add-on systems may be harder to use because they have more limited motions compared to dedicated mammographic systems. Consequently, most of the differences are a matter of user preference rather than clinical efficacy.

17. In digital detector performance, detective quantum efficiency is an important factor. DQE is directly related to the signal-to-noise ratio that results between detector input and output. The noise generated by the detector and the spatial resolution contributes to the DQE of the system. To reduce DQE, SNR must be reduced; a recommended DQE is less than 20% at 5 lp/mm.

18. Another important factor when considering a purchase of a Mammography unit is modulation transfer function. MTF refers to the loss of contrast relative to an x-rayed object. As spatial frequencies in a given image increase, MTF decreases, creating loss of visualization. A 50% MTF at 5 line pairs per millimeter is recommended.

Questions for the Seller

Before you purchase your Mammography Unit, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

What is the number of exposures?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

Mammography Unit

MAM System

Mammography Unit - Stored

Suprevision Forms

MAM System - Dismantling

# Tips and Guidelines for Buying a Manual Wheelchair

User and/or attendant operated manually propelled wheelchairs

Manually operated wheelchairs that can be propelled either by user or attendant. Usually designed for heavy use with strong steel construction and large rear wheels. Heavy-duty models are available for special weight or size needs, as well as lighter versions which are more portable but not as durable for extended use. Other specialty mobility chairs include those designed for children, teens, or sports activities.

Tips for Buying a Manual Wheelchair

1. Safe, manual wheelchair use requires proper maintenance.

2. Several levels of mechanical wheelchair product support after purchase are offered. Buyers of manual wheelchairs should consider how easy it would be to obtain replacement parts from the vendor or manufacturer, and how easily the operator can install replacement parts.

3. Buyers of manual wheelchairs should also look at the availability of national or worldwide service facilities offered by the manufacturer or vendor, the length of time that the manufacturer/vendor has been in business, the availability of service policies and loaner if extended repairs are necessary, and whether the coverage policies for prescription mechanical wheelchairs set by third-party payers.

4. Facilities are encouraged to look at the ranges of models the dealers have in stock, and available discounts for multiple purchases.

5. Buyers should also consider their need to schedule manual wheelchair maintenance or repairs in advance and the time it would take to order and receive replacement.

6. Facilities should inquire about the general condition of the home wheelchair, including: wheels, seat, tire, foot rests, armrests, etc. Photos of the tires and chairs from all angles can reveal signs of wear and tear.

7. The specified capacities of the manual wheelchair being considered should fit the patient's weight and size.

8. Prior to purchasing, facilities should complete the following: search for reviews of the chair to learn about the mechanical wheelchair's features and reliability, and review manuals and related paperwork which were supplied when the chair was originally purchased.

9. Additional factors to consider include: the home wheelchair's size, ease of steering, seating comfort and transport capability.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Manual Medical Device

# Tips and Guidelines for Buying a Mass Spectrometer

Mass spectrometers for clinical laboratory use

Clinical laboratory mass spectrometers consist of a magnetic sector, ion trap, or quadruple mass analyzers. These devices are often used together with gas or liquid chromatographs, or with an additional mass spectrometer. In laboratories, a combined system is used to identify pathological indications in body fluids, and for identification of foreign substances (i.e. toxins, lipids, drugs, metals) The masses of the compounds identified and measured are usually between one and 4,000 atomic mass units.

Tips for Buying a Mass Spectrometer

1. When buying mass spectrometers, computer interface capabilities are a major factor to consider. An effective interface with the facility's existing information system is useful for inputting test data, verifying testing accuracy, and maintaining quality control, calibration, proficiency testing, and patient files.

2. Facilities should examine the number and types of tests performed, before deciding on a specific mass spectrometer system. If the test volume justifies multiple units, facilities should consider the types of systems and capabilities that need to be purchased to avoid paying for analysis packages and assaying features they don't need.

3. Relying on price alone when determining the real cost of mass spectrometer equipment is often misleading. Facilities should consider the cost of replacement parts, as well as maintenance and repair services.

4. Before purchasing quadruple mass analyzer or LC mass spectrometer units, facilities should examine safety features and environmental requirements provided by the manufacturer.

5. Mass spectrometer and quadruple mass analyzer suppliers may sell service contracts or service on a time-and-materials basis. This service may also be available from a third-party organization. Purchase of such service contract should be carefully considered by the facilities.

6. Service-contract customers may get routine software updates provided by most LC mass spectrometer suppliers. These will enhance the system's performance at no charge. It is important to know that software updates are often cumulative, which means that previous software revisions may be required in order to install and operate a new one.

7. Mass spectrometer tests needing little or no training or experience to perform belong to the waived tests category. These tests do not require elaborate QC, and are less likely to produce inaccurate results. An example would be the no-automated dipstick urinalysis.

8. Most clinical laboratory tests, including: automated urine, blood, and chemistry analyses, are part of the moderate complexity category. These require a limited amount of sample and reagent preparation, as well as limited operator intervention during the analytical process.

9. More specific testing, which needs extensive training, falls under the high complexity classification. This category also includes procedures that require a high degree of operator preparation, calibration, intervention, and analysis; such as clinical cytogenics and histopathology applications.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Material Management Information System

Computerized materials management system for hospitals

An automated information system used for inventory and management of central supply, including ordering and tracking of hospital supplies and equipment , invoicing, budgeting, and accounting. This system has modules for par stock, case cart and other specialized routines.

Tips for Buying a Material Management Information System

1. To perform duties of material management, facilities have formed unique and specific policies and procedures. Material management information systems offer different collections and levels of features and functionality.

2. In order to determine the features and equipment necessary for a system, facilities need to possess a good understanding of their practices for inventory management, purchasing, and material management administration.

3. Facilities look at installing a new system as a way of improving materials management practices and making the hospital's supply chain more efficient. However, purchasing a new system alone will not solve problems in the current process. Facilities should first improve efficiency and fix other shortcomings, and only then evaluate the cost-effectiveness of implementing a material management information system to accompany their new and improved process.

4. A simple automation of the purchasing process should be provided by the system, and it should also offer requisition and purchase order tools.

5. The system should provide the administrators with the ability to analyze stored information through report writing such as capital equipment management records. Since facilities have different specific needs, some features are more or less important in regard to these needs.

6. Large facilities, which handle larger volumes of materials, may need systems that offer additional inventory and management features compared to a smaller facility. These systems should support communication standards and protocols compatible with any ancillary hospital applications that share information with the materials management information system. They should also support non-ancillary communications with suppliers and financial institutions that may connect with the material management information system through an electronic data interchange.

7. Preferred manufacturers are those who have interfaced with the ancillary systems owned by the facility. The system should support the necessary non-ancillary electronic data interchange communication protocols that the facility's most common suppliers and financial institutions need to communicate with the materials management information system.

8. All systems use some kind of a software package. Facilities should try to get the best warranty and maintenance contracts possible for cost and service, since at some point users will have problems with the system's software.

9. Some facilities may have sophisticated information requirements in their material management department. Therefore, they are encouraged to purchase a system through a supplier with a clear understanding of material management needs.

10. Facilities should also look into hardware compatibility. For example, if a system requires the latest computer systems, but the computers on-site are outdated, the expense of upgrading could be an important issue.

11. Future goals are also to be considered by facilities. If, for example, there's a plan to upgrade computer systems in the near future, facilities should coordinate it with the consideration and purchase of a material management information system.

12. When the same supplier provides both the material management information system and the hardware, facilities should make sure that a warranty and maintenance contract is included.

13. If purchasers routinely analyze supplier bids for contracts, the purchasing department may find the feature of bid analysis important. Facilities that use just-in-time inventory management features will benefit from certain automation features in the system.

14. Portable devices are useful for facilities that routinely capture patient charges. The decision of purchasing portable data entry devices depends on a facility's practices for patient billing, maintaining accurate inventory levels, and receiving items.

15. Facilities with portable entry devices already in use are encouraged to select the same suppliers if they have previously supported the same type of device.

16. Facilities should also consider the financial software they currently use. If the accounts payable department already has software for invoice matching, a new system will not need an invoice-matching feature.

17. Before purchasing, facilities may wish to look into some more specifications, such as access to online marketplaces or applications accessible through the internet.

18. Some other important features, which were mentioned by material managers, include contract management features, receiving features that have a system in place for managing returns and back orders, and additional supply chain management features for material management administrators.

19. Facilities are encouraged to contact hospitals and other facilities that use the system under consideration, and obtain information regarding the installation process, technical service quality, and overall satisfaction.

Questions for the Seller

Before you purchase your Material Management Information System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

System Features EDI

Does it include requisitioning?

Does it include purchase order?

Does it include inventory control?

Does it include online inventory and reordering?

Does it include JIT inventory?

Does it include reordering methods?

Does it include control of nonstock supply?

Does it include automatic purchase/receive?

Does it include invoice matching?

Does it include exchange cart/par stock supply?

Does it include a case cart system?

Does it include capital assets?

Does it include an automated financial system interface?

Does it include report writing?

Is it customizable?

Does it include supplier bid analysis?

Does it include cost accounting?

Does it include patient charges?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Medical Gas Monitor

Respiration monitors for bedside use that measure concentration of different gases

Bedside monitors with a set of analyzers that can simultaneously and continuously measure concentrations of different gases, such as oxygen and CO2, as well as anesthetic gases. These respiration monitors sample, measure, and display data on inspired and expired concentrations of the gases. They are computerized, including alarms, and display of values, waveforms, and trends.

Tips for Buying a Medical Gas Monitor

1. Medical gas monitors sample and measure inspired and expired concentrations of respiratory and anesthetic gases during and immediately following anesthetic administration.

2. Medical gases monitors display inspired and expired gas concentrations of CO2 and homogenate agent, inspired concentrations of O2 and N2O, and respiration rate.

3. Water vapor, aspirated fluid, or pressure in the breathing circuit may interfere with the measurements and therefore should be eliminated or automatically compensated for by the medical gas monitors.

4. These medical gases units must remain zeroed and calibrated for at least six months. The medical gas monitor measurements should remain accurate over commonly used ventilation rates. The rise time for O2 measurements should be less than 20 seconds.

5. The actual alarm-limit setting should not be altered if the displayed CO2 concentration is changed between mm Hg and percent CO2. Preferably, the alarm limit will be converted into the new anesthetic gas module units. The medical gas monitor should not be allowed to silence the apnea alarm indefinitely.

6. When the medical gas monitor unit is turned on, agent monitoring should activate automatically. However, a medical gas monitor unit can require that agent be selected before monitoring begins, as long as it warns the user when agent is detected but has not been selected.

7. Units with pulse oximetry should have a probe failure/disconnect alarm and audible alarms for low and high SpO2 and low and high pulse rates. The medical gas monitor should indicate when SpO2 and pulse rate readings are likely to be inaccurate due to a weak pulse.

8. Multiple Medical Gas Monitors should display the CO2 waveform. A preferred unit is one that allows users to select at least two additional graphical displays.

9. The exhaust gas from the multiple medical gas monitors must be returned to the patient's breathing circuit or scavenged. The attachment to a scavenger must not affect the performance. An easy-to-access port to which the sampling tube cannot be connected should be provided with the medical gas monitor.

10. A multiple medical gas monitor is produced as either a configured unit or a modular part of a physiologic monitoring system. Therefore, medical centers and clinics should consider the status of their present physiologic monitoring system before purchasing a medical gases monitor.

11. A modular medical gas monitor may allow all information and alarms to be integrated into one display. It can also be integrated into anesthesia delivery units.

12. It is possible to add modules, in order to expand the capabilities of the monitoring equipment of these monitors, because of the variety of its configurations.

13. Facilities that already have pulse oximeters can purchase anesthetic gas module units without this option.

14. When planning to replace the current anesthetic delivery equipment, facilities may wish to consider an anesthetic gas module system with optional modules for combined CO2, N2O, and agent monitoring or for pulse oximetry.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Capnometers and Multiple Medical Gas Monitors

# Tips and Guidelines for Buying a Medication Management System

Automated system for dispensing, counting, packaging and medication management

Automated computerized system for management and confirmation of physician's orders, patient ID, and medications distributed within healthcare facilities. The system can be interfaced with the pharmacy and hospital information systems, for efficient confirmation, and inventory management. The computerized system is comprised of medication-dispensing cabinets , some have a bar-code scanner to read patient identification wristband, and medication packages, for order confirmation.

Tips for Buying a Medication Management System

1. The amount and type of information storage and transfer are the main factors to consider before purchasing a medication management system.

2. Facilities should also determine how the medication management system will be used. Systems may be implemented in many ways, such as: providing narcotics control, dispensing floor stock medications only, or replacing unit-dose exchange carts entirely.

3. For some users, this medication management system serves as drug inventory control cabinets.

4. Buyers often use these medication management systems as a component of a larger hospital information network, electronic charting or medication administration record systems, bar-code-enabled point-of-care systems, and other systems for billing, patient census, or inventory management.

Questions for the Seller

Before you purchase your Medication Management System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Types of Dispensing

Does it have multidrug/multidose function?

Does it have single-drug/multidose function?

Does it have single unit-dose function?

Does it include supply?

Does it have physician orders (PO) function?

Types Dispensed as a Single Unit-Dose

Does it include oral solids?

Does it include liquids?

Does it include ampoules?

Does it include syringes?

Does it include vials?

Does it include large-volume IVs?

Does it include small-volume IVs?

# Tips and Guidelines for Buying a Medicine Cart

Carts designed to transport medication and supplies to patient's bed

Carts with appropriate storage and organization features designed to transport medication and other supplies to patient's bed. A removable section is used for individual dispensing of daily medication to patient directly from pharmacy.

Tips for Buying a Medicine Cart

1. Facilities should evaluate their specific needs before purchasing medicine carts. Acquiring nursing trolleys is a major expense, and buyers should determine if the standard features are sufficient.

2. Some of the main factors to consider when purchasing medicine carts include: security features, stability, maintenance requirements, durability, ease of maneuvering, and clarity of organization.

3. These medicine carts should include several drawers for storage of pharmaceuticals. To prevent theft, all nursing trolley drawers should have locks.

4. All medicine trolleys should have a work surface to accommodate the distribution of medications quickly and efficiently.

5. To provide stability during transport, medicine cart casters should be large enough. They should include at least 2 locks to prevent unwanted movement.

6. To help users tailor the medicine trolleys to meet their specific needs, a wide variety of optional accessories should be offered.

Questions for the Seller

Before you purchase your Medicine Cart, we recommend you ask the seller the following questions:

Casters

Does it have brakes?

Are they conductive?

Accessories

Does it include a waste container?

Does it include a cup dispenser?

Does it include a lamp?

Does it include an extension leaf?

Does it include a wall lock?

General Information

Are there any signs of rust?

Work Surface

Does it have storage wells?

Does it have fenced sides?

Doors

Does it include door locks?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Carts

# Tips and Guidelines for Buying a Microbiological Culture Analyzer

Automated microbiological systems for laboratory use

Automated culture analyzers for processing and interpretation in microbiology. Some systems perform microbiological susceptibility analysis. The systems are intended for blood and other body fluids culture analysis.

Tips for Buying a Microbiological Culture Analyzer

1. The specifications for the microbiological culture analyzers come in three categories: required, preferred, and optional. Required specifications present the minimum necessary specification for the blood culture analyzer to perform the desired function. A preferred specification enhances either test operations or ease-of-use, while an optional one does not affect the microbiological culture analyzer's performance, but may provide wider applications of use by offering greater testing options or minimizing user interaction.

2. Automated bacteriology analyzers have many qualities that make them a better fit than manual analyzers, for laboratories that perform large amounts of tests. Among these are: saving time, increasing productivity, providing more accurate test results, and improving job satisfaction by reducing the number of tedious manual procedures.

3. Facilities may need to purchase additional mandatory quality control strains, usually from a third party, in order to provide consistent performance of automated microbial detection systems.

4. Facilities should examine whether the detector could accept future hardware upgrades, and whether the microbiological culture analyzer unit will be able to interface with other laboratory instruments to allow for more parameters.

5. Preferred microbiological culture analyzer systems are those that can store large numbers of test results.

6. It is recommended to purchase an automated blood culture analyzer with a data management system. Large memories are required for long-term storage of results and for physician review or entry into a data management system.

7. Bar code labeling used by some microbiological culture analyzers allows matching patient results to printed results or a laboratory information system interface regardless of the specimen sequence.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Microcentrifuge

Microcentrifuges for small volume samples

Microcentrifuges used to separate cells and microorganisms, and to sediment viruses and cellular organelles. Some models are refrigerated. They are used to separate small volume samples, such as from pediatric patients. Nonrefrigerated low speed models are mainly used to centrifuge blood or precipitates, also for small volume samples. Centrifuges for slides (cytology) are also included in this category.

Tips for Buying a Microcentrifuge

1. Before purchasing an ultracentrifuge, facilities need to carefully examine their current and future laboratory needs to avoid purchasing an expensive microcentrifuge unit with unnecessary capabilities, or a cheaper microcentrifuge that cannot handle the laboratory workload.

2. Larger facilities with many samples daily centrifuged may need programmable functions, while smaller laboratories with a low or moderate number of samples may not need a programmable microcentrifuge unit.

3. When purchasing a ultracentrifuge, safety features should be a prime factor. Each microcentrifuge should have a securely interlocking lid that shuts off the unit's motor when the lid is opened, or keeps the lid latched until the rotor has stopped.

4. An inner protective cover over the rotor assembly is an additional safety feature, as well as a clear display warning not to open the laboratory micro centrifuge while the rotor is spinning.

5. The visual indicators and displays on the laboratory microcentrifuge should be clear and easily read. It is recommended to have audible alarms for device malfunction, rotor imbalance, or open lid.

6. Alert indicators and safety features help protect microcentrifuge components and rotor contents from breakage, and also protect operators from flying debris. Buying laboratory microcentrifuges with such features is recommended.

Questions for the Seller

Before you purchase your Microcentrifuge, we recommend you ask the seller the following questions:

General Information

Was this system used for testing biologically hazardous chemicals?

Is it brushless?

Does it include a hematocrit rotor?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying a Microplate Washer

Automatic microplate washers

Automatic washers with programmable control unit for cleaning microplates that have been used in laboratory procedures such as fluorescence, enzyme and DNA probes immunoassays . Removal of dirt and/or biological debris is performed using several customized cycles of operation.

Tips for Buying a Microplate Washer

1. Facilities should consider the following factors before making a microplate washer purchase: accuracy and precision of the instrument, the type and number of plates accepted by it, wash head design, ease-of-use and programming, and liquid-level sensing.

2. There are some microplate washer units designed specifically to reduce cross-contamination.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Microscope

Light microscopes using various contrast methods for use in clinical laboratories

Light microscopes using various contrast methods (fluorescence. phase contrast, darkfield, brightfield, polarized light, and/or interference). These microscopes are used to examine specimens of body tissues, fluids, and feces, in every clinical laboratory department. Magnification and resolution of specimens is provided by focusing visible light through a lens system.

Tips for Buying a Microscope

1. In order to minimize costs, facilities are strongly encouraged to consider used laboratory microscopes, reconditioned equipment, or demonstration models before purchasing laboratory light microscopes.

2. Newer specular microscopes can adapt and reuse components, such as old objectives, especially if they are purchased from the same manufacturer.

3. Users should properly care for the equipment to prolong the practical life of the microscope. 4. Manufacturers offer some optional equipment for monocular and trinocular microscopes, which includes: cameras, video systems, photomicrography equipment, special filters, fluorescence microscopy equipment, and special illumination systems.

5. There are systems that accommodate multiple heads, permitting the viewing of a single specimen by several people. These trinocular microscope systems are mainly used for teaching and consultation in pathology and histology.

6. Facilities considering the purchase of a laboratory microscope should examine the camera options before the purchase. Adapters are used to attach photomicrography equipment to the eyepiece of the specular microscope, so buyers should ask each supplier if its microscope requires a particular adapter.

7. Facilities are encouraged to look into other features that can be added, including a heated stage, electronic controls, drop-in diaphragms, counting reticules, and graticule eyepieces. The specific requirements of each facility determine laboratory microscope slides to be purchased.

8. Facilities considering the purchase of specular microscopes should also consider ergonomics. A tilting body tube allows operators to adjust the eyepiece to accommodate their changing needs throughout the day.

9. Users can bring the images closer to their eyes with some eyepieces that telescope. For users needing a taller instrument, riser tubes can be inserted between the main body and eyepiece tube. The stage handles and focus control knobs should be equidistant from the operator and positioned so that the hands rest comfortably on the table.

Questions for the Seller

Before you purchase your Microscope, we recommend you ask the seller the following questions:

General Information

Does it have any mechanicals defects/damages?

Does it have any optical defects/damages?

Are the microscope lens scratched?

Are the microscope sprockets damaged?

Does it include an integral/internal light source?

Is the power supply included?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Laboratory Microscopes

# Tips and Guidelines for Buying a Microscope, Operating

Operating microscopes for high magnification in surgery

Operating microscopes used for magnifying miniscule structures during surgical procedures, when high magnification and adjustable focusing is required, when a loupe isn't sufficient. Surgeons can use a loupe, with a single lens for each eye and is attached to glasses or a headband, but focal length of the loupe cannot be adjusted.

Tips for Buying a Microscope, Operating

1. Operation Microscopes are expensive devices, but they are designed to last many years. They are more expensive than portable examining microscopes, which are less versatile and stable. General examinations, office surgery, surgical assistant use - all of these can be handled using examining microscopes.

2. The main factor when deciding which microscope to purchase is the quality of the optics.

3. The recommended microscopes are those allowing surgeons to concentrate on the surgery with a minimal amount of distraction. This mainly applies to operating microscopes.

4. Facilities need to determine whether a microscope can accommodate accessories. If it can, they should consider the types of accessories needed.

5. Microscopes, which are to be used in the operating room, need to have an emergency backup illumination of the same level as the primary one. This is also important for examining microscopes.

6. Based on the procedure, there may be a need to use illumination filters - a desirable capability.

7. Surgical microscopes should be ergonomically designed as well.

8. Floor stands should use at least two lockable casters to ensure stability. Mounted systems should provide balanced support for the operation microscope and all other accessories.

9. According to the manufacturer's instructions, operation microscopes should be kept clean, dust free, and sterile. When not in use, surgical microscopes should remain covered with a special sterile drape to avoid contaminating the surgical field.

Questions for the Seller

Before you purchase your Microscope, Operating, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Accessories

Does it include coaxial scopes?

Does it include a twin scopes option?

Does it include an X/Y-coordinate arm?

Does it include a photo/video adapter?

Does it include an emergency backup?

Is it a sealing mount unite?

Is it cart-mounted?

Does it have a standalone stand?

Is it a surgical boom mounted microscope?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Microscopes, Operating

# Tips and Guidelines for Buying a Microtome

Microtomes used in histopathology laboratories, for cutting tissue specimens

Specially designed microtomes for use in histopathology laboratory, using a steel, tungsten-carbide, or glass knife. They are especially accurate for cutting tissue specimens that have been embedded in a medium, into thin sections required for microscopic analysis.

Tips for Buying a Microtome

1. Facilities should consider certain factors to ensure safe and effective operation of a rotary histotome or microtome, such as knife guards and a drive-wheel lock, which are required to prevent injury from the microtome knife.

2. The microtome/rotary histotome should be able to handle paraffin or plastic at a minimum, since most common specimens will be embedded in these materials. Specialized applications may require a microtome to handle other embedding materials.

3. To facilitate handling of the specimen, facilities may also consider a motorized microtome. This type is useful in a high throughput environment where the microtome is used continuously.

4. Some types of microtomes, such as the microprocessor controlled or motor driven microtomes, can cost several thousand dollars more than manually operated units. In a high volume, short-staffed facility, automated cutting functions save a great deal of operator time and offer invaluable benefits.

5. In some rotary histotomes the microprocessors automatically correct the feed movement or the knife cutting motion when needed, while microprocessor control of the specimen cylinder gives it a steadier motion during the feed movement, providing the microtome with a greater cutting precision.

6. Some devices have a wide variety of cutting thickness, and they can actually do the work of two or more rotary histotomes with more limited cutting ranges. A wide range of section thickness is required in laboratories that perform both light and electron microscopy. In addition, laboratories that use both paraffin and plastic as embedding materials can benefit from microtomes that can section both materials over units that section only one or the other.

7. Interchangeable parts and standard accessories are additional factors that facilities need to consider regarding the rotary histotomes. For example, some accessories are standard items with certain models, but are only optional at added cost with other models.

8. To ensure the effectiveness of the microtome knife guards, they should fit properly and snugly around the knife and should not be easily detached. The flywheel can be locked in place on some rotary histotomes to prevent accidental movement of the specimen block or an operator's fingers adjusting the block into the knife.

9. A device that can sharpen blades of various materials and shapes is beneficial for histology laboratories that use several rotary histotome blade types for sectioning samples for different procedures or applications.

10. The operator involvement in microtome knife sharpening was significantly reduced by the use of automated sharpeners. A drawback to sharpener use is the long time it takes the device to sharpen a blade, several hours in time (depending on the blade's composition).

# Tips and Guidelines for Buying a Microtome Knife Sharpener

Mechanical microtome knife sharpeners

Mechanical microtome knife sharpeners. Different methods are used to renew cutting angle of the knives, which are used for cutting microscope- thin tissue segments. A mechanical arm lowers the microtome knife onto a sharpening plate. Another method uses a sliding mechanism with honing and stropping wheels. Other sharpeners hold the blade against a disk containing an abrasive compound. Duration of process is set by automatic controls. Knife angle is adjustable.

Tips for Buying a Microtome Knife Sharpener

1. Busy laboratories, in which technologist time is at a premium, can take advantage of sharpening services through the mail, which is offered by some suppliers.

2. A microtome knife sharpener device that can sharpen blades of various materials and shapes is extremely beneficial in histology laboratories that use several blade types for sectioning samples for different procedures or applications.

3. Automated microtome knife sharpeners have significantly decreased the amount of operator involvement in knife sharpening. However, it takes a long time for the device to sharpen a blade. Sharpening may even take several hours, depending on the blade's composition.

4. Using a microtome knife sharpener requires the facility to keep a reserve of knives in stock and monitor their sharpness, as well as to maintain and service the microtome knife sharpener.

5. The long-term replacement costs of disposable microtome blades can be high. Therefore, a versatile, low-maintenance microtome knife sharpener may be more cost-effective.

# Tips and Guidelines for Buying a Mist Tent

Aerosol treatment tents

Aerosol treatment tents are used for treatment of breathing disorders when the use of direct facial attachments or tubing is not indicated. Plastic sheeting is held over the bed like a canopy over the patient's head and upper body.

Tips for Buying a Mist Tent

1. Mist tents use thermoelectric cooling or refrigeration, which allows for thermostat control, and eliminates the use of ice-cooled units, which involve inconvenient maintenance and can vary in temperature depending on the amount of ice surrounding the tube.

# Tips and Guidelines for Buying a Mobile X-ray

Mobile radiographic units

Three different types of mobile radiographic units are available, (line powered , capacitor-discharge, and battery-powered generators) . A wheeled cart transports the x-ray generator, X-ray tube, and tube stand, collimators, and film cassette storage drawer. It may be either manually or battery-powered motor driven.

Tips for Buying a Mobile X-ray

1. Ruggedness and durability are the two main factors to consider when purchasing a mobile x-ray unit (also known as a portable x-ray).

2. Mobile radiographic units should be designed to keep an important balance between maneuverability, ease-of-use and performance; combined with high quality of x-ray output.

3. All portable x-ray units should be lightweight and easy to assemble, carry, and transport. X-ray mobile units should be able to produce sufficient x-ray output for simple exams.

4. Three categories of portable x-ray units are available: self-propelled, manual propulsion, and units for use outside hospitals - where mobility is necessary.

5. Large batteries are the main power source of the self-propelled x-ray mobile units. Maneuverability is a key factor, without compromising x-ray output. These portable x-ray units, when fully charged, should be able to produce all necessary x-ray exposures without an outside power source.

6. It is heavier to maneuver the manually propelled x-ray mobile units. These are line-powered and do not rely on batteries as a main power source. They are designed with a focus on a specific patient group.

7. Manufacturers offer many different features for different models. Some of the options include automatic exposure control, anatomic programming, and input voltage.

8. Mobile x-ray units that are motor-driven need battery power. For safety, they should have collision brakes, as well as a manual override for driving the unit through swinging doors.

9. The x-ray exposure on some units is powered directly from the line voltage. On other portable x-ray units, the input line voltage charges a battery or capacitor to power the x-ray exposure.

Questions for the Seller

Before you purchase your Mobile X-ray, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

General Information

Are there any signs of rust?

What is the condition of the system mechanics?

When was the battery last exchanged?

X-ray Tube

When was the x-ray tube last exchanged?

Is the arm left - right motion smooth?

Is the arm up - down motion smooth?

Is the horizontal x- ray tube rotating motion smooth?

Is the vertical x-ray tube rotating motion smooth?

Is the axis x-ray tube rotating motion smooth?

Is the z axis x-ray tube rotating motion smooth?

Is the rotation x-ray tube rotating motion smooth?

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Mobile X-Ray Units

Mini C-Arms

X-Ray System - Stored

X-Ray Conventional Radiographic System - Operational

Suprevision Forms

X-Ray System - Dismantling

# Tips and Guidelines for Buying a Motorized Wheelchair

Battery-powered wheelchairs for outdoor use, which enable crossing rougher terrain and traveling longer distances. Models have either three or four wheels

Battery-powered wheelchairs for outdoor use, which enable crossing rougher terrain and traveling longer distances. Models have either three or four wheels, and typically feature front and rear lights, padded seating and other accessories.

Tips for Buying a Motorized Wheelchair

1. Safe motorized wheelchair use requires proper maintenance.

2. Several levels of motorized wheelchair product support after purchase are offered. Buyers should consider how easy it is be to obtain replacement parts from the vendor or manufacturer, and how easily the operator can install replacement parts.

3. Motorized wheelchair buyers should also look at the availability of national or worldwide service facilities offered by the manufacturer or vendor, the length of time that the manufacturer/vendor has been in business, the availability of service policies and motorized wheelchair loaner if extended repairs are necessary, and whether the coverage policies for prescription chairs set by third-party payers.

4. Facilities are encouraged to look at the ranges of motorized wheelchair models that dealers have in stock, and available discounts for multiple purchases.

5. Buyers should also consider their need to schedule motorized wheelchair maintenance or repairs in advance and the time it would take to order and receive a replacement.

6. Facilities should inquire about the general condition of the motorized wheelchair, including wheels, seat, tire, foot rests, armrests, etc. Photos of the tires, controls, battery box and wiring, and of the motorized wheelchair from all angles, can reveal signs of wear and tear.

7. The specified capacities of the motorized wheelchair being considered should fit the patient's weight and size.

8. Prior to purchasing, facilities should complete the following: search for reviews of the motorized wheelchair to learn about its features and reliability, review manuals and related paperwork that were supplied when the motorized wheelchair was originally purchased, inquire about the condition of the joystick and other controls, the motor housing, and the drive shaft - where it exits the motor, as well as the condition of the battery box, possible corrosion and the state of all wires and connectors.

9. Additional factors to consider include: the motorized wheelchair's size, ease of steering, seating comfort, transport capability, power, speed capacity, and battery life.

# Tips and Guidelines for Buying a Motorized X-ray View-box

Motorized viewboxes for loading X-ray sequence

View boxes that electronically load X-rays in a predetermined sequence. Generally used to minimize examination time, also for presentations and consultations.

Tips for Buying a Motorized X-ray View-box

1. The capacity requirements and future reading practices of the facility are the most important factors when selecting a Motorized Radiographic Film Viewer (motorized x-ray view box). Another important consideration with x-ray viewer units is reliability, because radiologists cannot afford any delay in the reporting process.

2. Facilities that are interested in a motorized x-ray film viewer should first determine whether it is actually needed, based on an assessment of throughput. If only two or three films are reviewed for each patient, a motorized x-ray view-box will probably not improve efficiency and productivity. When medical facilities expect a large number of films to be reviewed, a motorized radiographic film viewer may be indicated.

3. Motorized x-ray view- boxes for mammography should have a higher film capacity than general-purpose motorized x-ray film viewers. They should accommodate an average of 600 films, while general-purpose motorized x-ray view-boxes are required to accommodate only about 200 films. Mammography viewers should hold more images and be able to view about 8 images simultaneously, while general-purpose view boxes should be able to view only 4 images simultaneously.

4. These devices (also known as Motorized Negatoscopes) are offered with several different options, ranging from security codes to automatic shutoff features. Facilities should consider the necessity of these options based on their needs.

5. Brighter hot lights and masking devices should be provided by mammography x-ray viewers for the reviewer's use.

6. Facilities considering both general radiographic and mammography films may want to end up only with mammography x-ray viewer boxes, which incorporate the bright spot and masking features. This will reduce redundant expenses.

7. There is growing use of filmless review of clinical images on computer displays, due to the proliferation of digital imaging.

8. When looking at all the motorized Negatoscope options, buyers should look into future reading practices of their radiologists before purchasing new film viewing equipment.

Questions for the Seller

Before you purchase your Motorized X-ray View-box, we recommend you ask the seller the following questions:

Options

Does it include masking?

Does it have full random access?

Does it include automating indexing?

# Tips and Guidelines for Buying an MRI

Magnetic Resonance Imaging scanning units (stationary)

MRI units make computer generated images of anatomic structures by measuring radio frequency interference in a strong electromagnetic field. These images have exceptional contrast, allowing a clear picture of tissue structure details. Clinicians can distinguish normal from diseased tissue, for diagnostic and therapeutic purposes. Some models have magnetic resonance angiography, echo planar imaging, and spectroscopy capabilities.

Tips for Buying an MRI

1. When purchasing an MRI system, facilities should consider these important factors: the magnet, gradient system, computer.

2. As for the MRI magnet, it should produce a highly homogeneous magnetic field covering as wide a field of view as possible and provide as much patient space as possible.

3. The MRI system image resolution is higher when the gradient system is faster, but then the field of view is smaller.

4. Keeping up with the magnet, so that images are instantly available while the scan progresses, is the computer system's task in a Magnetic Resonance Imaging system.

5. Facilities should also consider the site requirements, which are specific to each institution. In this area, three issues should be examined: the extent of the magnetic field, the area occupied by the magnet, and the weight of the magnet.

6. When selecting the MRI site, the two most important planning considerations are the fringe field and the need for a site free from ambient RF electrical noise. A permanent magnet has a minimal fringe field, but needs careful preconstruction planning because of its tremendous weight.

7. To contain the magnetic fringe field of resistive and superconducting electromagnet systems, shielding can be used. The fringe field could cause problems at some sites without shielding.

8. To contain the fringe field, two approaches are used for MRI units: active and passive shielding. Active shielding is a design feature of the magnet, while the passive shielding involves the use of steel around the magnet.

9. Generally, the size of the MRI unit's controlled-access area increases as the operational field strength increases, for the fringe fields created by superconducting and resistive magnets. The recommended general-public access limit is 5 G. The distance to the 5 G line ranges from approximately 9 meters for a 0.5 T magnet to 13 meters for a 1.5 T magnet. For a 3.0 T magnet, the 5 G line is about one meter further from the isocenter than it is for a 1.5 T magnet, and therefore larger safety boundaries are required.

10. With MRI active magnet shielding, the distance to the 5 G line can be drastically reduced to less than 4 meters for a shielded 1.5 T magnet and less than 3 meters for a shielded 0.5 T magnet.

11. Fringe fields are 3-D, so for higher field strengths, areas on the floors above and below the imaging facility may also need controlled access and/or shielding.

12. Careful site selection is required for MRI units. The operation of gamma cameras, CRT displays, electroencephalogram and electrocardiogram monitors, and image intensifiers - are all affected by the magnetic field; ferromagnetic material in the surrounding area affects the homogeneity of the static magnetic field.

13. MRI system technicians can partially compensate for the effects of large stationary masses on field uniformity by placing corresponding masses of ferromagnetic material in a symmetric position in the magnet area. A careful site selection for your MRI system can eliminate moving ferromagnetic objects such as elevators, automobiles, or forklifts.

14. To address the problems associated with the fringe field, active shielding can be used, as well as close-fitting steel shields integral to the magnet, or steel shielding in the walls around the magnet. If MRI system users wish to install large steel sheets of magnetic shielding, they should keep in mind that these are expensive, and require innovative construction techniques because of the weight involved.

15. Facilities should be sure to include all these extra precautions in early design considerations before the purchase of MRI systems, because they raise the cost of construction. Implementation after installation may be even more costly. Actively shielded magnets have significantly reduced fringe fields and generally do not require steel shielding.

16. External ambient RF signals can degrade MRI image quality below diagnostically acceptable levels; so even in the most complex MRI system, the magnet assembly must have some type of RF shielding. These shield assemblies usually consist of a complete room of copper or aluminum sheets bonded to a composite plywood support. Physical and visual access to the room is provided by special door assemblies and window coverings shielded with copper screening.

17. MRI specialists should install, fine-tune, and maintain the equipment since MRI technology is especially complex and sensitive. Experts should train physicians and technologists and answer their questions.

18. Facilities should choose a supplier whose local MRI service and training resources are extensive and reliable. The availability of such resources should be guaranteed in writing within any contract between the supplier and the buyer.

19. To facilitate future additions to the network, all newly purchased MRI equipment must be compatible with DICOM 3.0. DICOM conformance statements should be provided by the suppliers and should explain in detail what information objects, service classes, and data encoding are supported by their systems. All statements should share the same format and vocabulary to facilitate Magnetic Resonance Imaging system comparisons among suppliers.

Questions for the Seller

Before you purchase your MRI, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Are you willing to sell the Faraday cage?

Does the system include a printer?

Does the system include an easily removable Faraday Cage?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Is it possible to perform cardiac studies?

Is there a cardiac software package?

Table

Is the in-out motion smooth?

Is the up-down motion smooth?

Accessories (Mattress, foam supports & cushions)?

Magnet

When was the last time the displacer was exchanged?

Is there any known quench history?

CCTV existence & operational?

Magnet: What is the magnetic field strength of MRI?

Magnet: Does the system include acoustic noise reduction means?

Magnet: Does the system include patient communication and music system?

Magnet: Does the system include a removable Faraday Cage?

Magnet: Helium yearly liters evaporation?

Crayocooler Compressor

When was the last time that the compressors filters were exchanged?

Coils

Does it have an operational head coil?

Knee Coil exists & operational?

Spine Coil exists & operational?

Body Coil exists & operational?

Breast Coil exists & operational?

Shoulder Coil exists & operational?

TMJ Coil exists & operational?

Extremity Coil exists & operational?

Other Coils?

Coils: Is it possible to perform spectroscopic diagnosis?

Coils: Is it possible to perform diffusion imaging?

Coils: Is it possible to perform perfusion imaging?

Coils: Is it possible to perform functional MRI?

RF section

RF section: Have the RF amplifier ever been repaired?

RF section: Was there any arcing event in the transmitting chain?

RF section: Has the performance of the receivers been checked in the last year of operation?

Gradient Coils

Gradient Coils: Has the gradient coils been ever in fault?

Gradient Coils: Have the gradient amplifiers ever been repaired?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

MRI System - Operational

MRI System - Stored

Suprevision Forms

MRI System - Dismantling

MRI System - Packaging

# Tips and Guidelines for Buying an MRI Phantom

Phantoms for MRI simulation and testing

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of radiation absorption and dose distribution, also for research, QA/QC, equipment calibration, and testing purposes.

Tips for Buying an MRI Phantom

1. With the increasing emphasis on QA/QC programs, hospitals should consider purchasing phantoms to test system performance on a regular basis (e.g., daily, weekly, monthly), particularly for modalities such as radiography, fluoroscopy, and radiotherapy, in which patient radiation exposure is a concern. For U.S. mammography departments and facilities, phantoms that meet the requirements of an accreditation program or MQSA should be purchased. Some facilities create their own biopsy training phantoms from inexpensive materials to save on costs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms

# Tips and Guidelines for Buying a Multi Image Camera

Motion picture cameras for photographing and reproducing digital images from diagnostic imaging systems

Multi-image cameras for digital photographing and reproduction of images that can be played back from imaging systems (CT, MRI, PET, US, and gamma cameras). Operator can adjust method used for image recording, and for determining number of images on each film sheet.

Tips for Buying a Multi Image Camera

1. When purchasing a multi-image camera, medical facilities should consider the specific capabilities of the unit, availability and cost of proprietary or generic cassettes, cost of service, and integration with other equipment within the facility.

2. The initial purchase cost of the medical imaging camera does not reflect the total cost of ownership because these multi-image cameras entail ongoing maintenance and operational expenses.

3. Typically, these medical imaging cameras are sold as optional components of a larger imaging system, such as an ultrasound system.

Questions for the Seller

Before you purchase your Multi Image Camera, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Cameras, Multi-Image

# Tips and Guidelines for Buying a Nebulizer

Humidifiers for humidity and temperature control of respiratory gas flow to lungs

Humidifiers that introduce moisture to respiratory gas using bubble-through or pass-over heating units. Heated water vapor increases temperature and humidity of gas flow from source to patient. Another approach is to nebulize water by ultrasonic means.

Tips for Buying a Nebulizer

1. The type and use determine the costs of heated humidifiers. Long-term costs are also affected by whether nebulizer parts are disposable or reusable: disposables usually cost twice as much per year as reusables. Conversely, reprocessing costs should be considered for reusable nebulizer items.

2. In cost estimations, buyers should consider the depreciation of the nebulizer unit.

3. Facilities should also consider the remote water reservoir reprocessing costs and water usage.

4. Price reductions on disposables are offered for large volume purchases. Also, some manufacturers offer contracts for disposables in which the heated humidifier is supplied free of charge.

5. The expenses on nebulizer accessories also vary based on the size of the breathing circuit and chamber, the need for an exhalation valve and for dual or single heated wires.

6. Facilities are strongly encouraged to evaluate the nebulizer procedures and techniques of the clinical staff.

7. A circuit hose insulated with disposable orthopedic cast padding may be less expensive to use than non-disposable servo-control-led heated wires, with no loss of effectiveness.

8. Usually, nebulizer units with heated-wire capability cost more and lead to greater expenses for cleaning and disinfecting the wires.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Heated Humidifiers

# Tips and Guidelines for Buying a Nephelometer

Analyzers for immunoassays using nephelometric system

Analyzers for monitoring immunoassays using a nephelometer as the detection system. Used for antigen-antibody immunoassays that can scatter monochromatic light at a specific wavelength.

Tips for Buying a Nephelometer

1. Nephelometer units should display results and other information both on a monitor and in hard-copy format.

2. When planning to purchase a nephelometric immunoassay analyzer, the automated features, which may facilitate sample analysis, should be considered.

3. Automatic nephelometer sample handling is more efficient than manual handling, because it eliminates operator errors and ensures the same treatment for all samples.

4. Facilities purchasing an nephelometric immunoassay analyzer instrument should look into assays available on the instrument, the system's throughput, and the availability of models to meet different volume and testing needs within the facility.

5. Bigger facilities will need larger, more automated nephelometer instruments with a comprehensive test menu and high throughput, while small laboratories, or those with specialized testing requirements, can use smaller nephelometer systems with lower level of automation or throughput and a smaller test menu.

6. Computer interface capabilities are an important consideration with these nephelometric immunoassay analyzer units. The effectiveness of the interface with the existing LIS or the medical center's central computer system is essential to inputting test data, verifying testing accuracy and maintenance, calibration, and patient files.

7. To ensure that test menus meet clinical needs, buyers should carefully assess them.

Questions for the Seller

Before you purchase your Nephelometer, we recommend you ask the seller the following questions:

Tests Available Protein Assays

Alpha 1-acid glyco?

Alpha 1-antitryp?

Alpha 2-macroglob?

Prealbumin?

Albumin?

Antistreptolysin O?

Antithrombin III?

Apolipoprotein A1?

Apolipoprotein B?

C3 complement?

C4 complement?

Ceruloplasmin?

C-reactive protein?

Haptoglobin?

IgA?

IgM?

Properdin factor B?

Rheumatoid factor?

Transferrin?

Therapeutic drugs?

Carbamazepine?

Gentamicin?

Phenobarbital?

Phenytoin?

Valproic acid?

Theophylline?

Data Input

Keyboard?

Bar code?

Patient data?

Reagent data?

Automated Features

Sample handling?

Ag excess check?

Out-of-range repeat?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Nerve Locator

Facial nerve locators used for diagnosis of nerve damage

Facial stimulators are used to diagnose and evaluate functioning of facial nerves. These nerve locators are used for clinical assessment in conditions of facial paralysis or facial nerve damage.

Tips for Buying a Nerve Locator

1. There is a wide range of configurations for these devices, from simple battery-operated units to line-powered console units with several monitoring features.

2. Other applications may be offered, such as iontophoresis, which could make the units more cost-effective.

3. Buyers should consider the cost of disposables, such as needles, electrodes and gels, as well as any reasonable gains from the use of single-use disposable units.

# Tips and Guidelines for Buying a Nerve Stimulator

Analgesic stimulators using electrodes for transcutaneous stimulus

Portable analgesic stimulators, using electrodes to provide transcutaneous electrical stimulus to peripheral nerve. These are battery-operated units with several preset options, such as pulse frequency and duration. They are used for pain relief in physical therapy, trauma, surgery, dental problems, and others.

Tips for Buying a Nerve Stimulator

1. An electronic stimulus generator and two or four electrodes are recommended to be included in the TENS unit.

2. If the unit is battery-powered, a low-battery alarm should indicate visibly and audibly on low voltage. The unit should use common batteries that are easy to replace.

3. The unit's pulse should be adjustable to a width from 10-to 1,000 μsec and pulse rate from 0.5 to 150 mA, based on clinician orders and patient preferences. These are recommended according to commonly used settings in clinical applications; individual responses to treatment may require a unit that can perform outside the range of these specifications.

4. Patients may respond differently to various models of units because pain is subjective.

5. Battery-powered units may be considered. These could use rechargeable or disposable batteries.

6. Facilities may wish to purchase more than one type of unit. Suppliers often offer quantity discounts.

# Tips and Guidelines for Buying a Neuromuscular Electrical Stimulator

Electrical pulse generator for physical therapy and diagnosis

Preprogrammed electrical pulse generator, sometimes used for diagnostic purposes. The output is applied to the treated area by means of surface electrodes. Various frequencies, sequences, pulse forms and amplitudes can be selected according to the medical prescription

Tips for Buying a Neuromuscular Electrical Stimulator

1. Facilities can select a tabletop, wall mounted, or cart mounted therapeutic ultrasound unit.

2. To permit user exchange, these systems should have transducers with connectors. The unit should be capable of frequencies at 1 and 3 MHz. It should run in both continuous and pulsed modes.

3. Each transducer should have a beam with a non-uniformity ratio of less than 8 and should have a variable pulse rate that falls between 80 and 150 pps.

4. Systems equipped with several transducers of various diameters facilitate treatment of different areas of the body. However, there are systems with only one transducer.

5. An automatic shutoff function is a preferred feature.

6. Configuration, ERA, and maximum power should be based on patient and clinician preference as well as on treatment location.

7. If the unit is to be used for offsite therapy, some portable devices are available in a carrying case or tote bag.

8. Systems with dual frequencies provide a wider range of treatment capabilities.

9. To reduce costs, facilities can obtain a combination ultrasound neuromuscular stimulator unit instead of buying separate units. Using these units, facilities can choose therapeutic ultrasound only, neuromuscular stimulation only, or a combination of both.

10. Facilities should consider the costs associated with the following: additional transducers, coupling gel, service and a therapist.

# Tips and Guidelines for Buying a Nuclear Computer

Computer systems specifically designed for nuclear medicine

Nuclear medicine computers analyze, display, and/or archive data from one or more nuclear medicine gamma cameras.

Tips for Buying a Nuclear Computer

1. Technologists and physicians routinely use nuclear computers for managing and processing the range of exams carried out in a nuclear medicine department.

2. Facilities are encouraged to form a nuclear computer purchasing committee to assess the technologies, create a budget, select suppliers, conduct negotiations, and oversee network installation and implementation.

3. Some of the users' tasks include making sure that the correct patient details are associated with each set of images, seeing that the appropriate method of image processing is applied, and that physicians use the nuclear computer's advanced image analysis tools to interpret the findings.

4. To review images adequately, the monitor should be large enough with high enough resolution.

5. A nuclear computer is usually placed between the information system and the camera. Facilities must pay special attention to DICOM conformity.

6. It is wrong to assume that a nuclear computer from a specific manufacturer will interface with all the gamma cameras sold by that same manufacturer. Buyers should make sure that the nuclear computer and its peripherals can interface with the gamma camera work station.

7. When facilities purchase the nuclear computer and gamma camera work station from two different suppliers, they should know which supplier is responsible for which part of the system to ensure fast and efficient service.

8. When dealing with DICOM compliance, facilities should consider areas such as nuclear medicine, secondary capture, service class user/service class provider, query and retrieve, modality work list, and performed procedure step.

9. Sufficient memory is an important consideration. It enables the nuclear computer to store and retrieve data obtained from nuclear medicine studies. The storage space is available on hard disk, floppy disk, optical disk, and other forms of storage media.

10. Many applications are covered by analytic software, including cardiac, pulmonary, renal, whole-body, tomography, isotope scanning, ECT scanning, elliptical orbit/body contouring, and planar and SPECT Thallium-201 analysis.

11. The camera is often located far away from the nuclear computer. Therefore, a special line driver circuit is usually required to drive the low power camera signals over the long lines to the computer. This will ensure that the distances do not distort the signals, and it will protect the camera circuits from being damaged by the long lines.

12. Clinical software is included with most systems. The exact form and norms vary among manufacturers. It is extremely important that buyers understand the operation of the software and the basic assumptions underlying its design.

13. Buyers should look into the software's ease-of-use and versatility, the reliability of its clinical results, the execution speed of its programs, and the manufacturer's upgrade policy.

Questions for the Seller

Before you purchase your Nuclear Computer, we recommend you ask the seller the following questions:

Application Software

Does it include a cardiac module?

Does it include a pulmonary module?

Does it include a renal module?

Does it include whole body module?

Does it include tomography?

Does it include elliptical orbit/body contouring?

Does it include elliptical orbit/body contouring?

Does it include Tl-201 analysis?

Does it include planar?

Does it include SPECT?

Is it Dicom 3.0 compliant?

Does it include a processing system?

Does it include a printer?

Does it include a plotter?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Computers, Nuclear Medicine

# Tips and Guidelines for Buying a Nuclear Medicine Phantom

Phantoms for nuclear medicine

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of radiation absorption and dose distribution, also for research, QA/QC, equipment calibration, and testing purposes.

Tips for Buying a Nuclear Medicine Phantom

1. With the increasing emphasis on QA/QC programs, hospitals should consider purchasing phantoms to test system performance on a regular basis (e.g., daily, weekly, monthly), particularly for modalities such as radiography, fluoroscopy, and radiotherapy, in which patient radiation exposure is a concern. For U.S. mammography departments and facilities, phantoms that meet the requirements of an accreditation program or MQSA should be purchased. Some facilities create their own biopsy training phantoms from inexpensive materials to save on costs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms for Nuclear Medicine

# Tips and Guidelines for Buying a Nurse Call System

Nurse call communication systems for patient or staff use

Nurse call systems with audio/visual signals are used for routine or emergency communication between patients and hospital staff. An integrated system enables location of staff members, and for the emergency resuscitation teams. Some systems are computerized and enable follow-up of patient calls and staff responses.

Tips for Buying a Nurse Call System

1. The basic system should come equipped with two different audible tones, a flashing light display, call reminder capabilities, two priority levels, and a patient disconnect signal. The system should also include corridor lights in at least two different colors.

2. The enhanced system should be able to perform self-diagnostics on top of all the functions of the basic system. It should have at least three distinct audible tones and three priority levels, and should come equipped with speakers and microphones.

3. Enhanced systems use the microprocessor technology, which allows for the sequencing of calls in order of their priority.

4. Enhanced nurse call systems should be able to interface with other systems in the facility. The patient bed station should provide communication with the nurse call stations via speakers and microphones. Corridor lights should be installed in at least three colors to allow caregivers to determine the priority.

5. Facilities should evaluate their needs in order to determine whether they need all the additional capabilities of an enhanced system. To ensure the selection of the most appropriate system, facilities need to decide on the mode of operation and the preferred method for locating and contacting caregivers, as well as specific additional features such as management reports or ADT interfaces.

6. Certain systems with only visual/audible signal displays can be modified under some circumstances for voice communication, if the conduits are large enough for additional wiring. Many suppliers can custom design systems to interface with other communications systems.

Questions for the Seller

Before you purchase your Nurse Call System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Nurse Call Station

Self-diagnostics?

Handset?

Speaker/microphone?

Hold/recall button?

Call reminder?

Priority sequencing?

Patient disconnect signal?

Staff register?

Staff follower?

Staff locator?

Management reports?

Patient Bed Station

Speaker/microphone?

Controls?

Pendant for O2 use?

Music/Radio capability?

# Tips and Guidelines for Buying an Obstetric Data Analyzer

Obstetric data analysis systems for fetal ultrasound images

Data analysis systems for obstetrical ultrasound data. Assessment of fetal growth can be reported, entered ,and archived. These systems are used in the hospital OB/GYN department, or in the physician's office. An alternative to the desk-top system is a small hand-held computer with manual data entry options.

Tips for Buying an Obstetric Data Analyzer

1. Most desktop data analysis systems currently use an IBM or compatible PC. Potential data analysis system purchasers may already own one of these computers and need only buy software. However, in some cases, data analysis software may not be compatible with existing units, and hardware modifications might be necessary. For example, programs using joystick controllers may require additional circuit boards. Buyers should consider the costs associated with any necessary software and hardware modifications and upgrades. They should also consider the costs related to software capabilities; a handheld system costs significantly less than a PC-based system with software. The applications for which the system will be used and whether the system will be connected in a local area network should be considered before a purchase decision is made.

# Tips and Guidelines for Buying an Obstetrical Data Management System

Obstetrical data management system for determining maternal and fetal status

A computerized system designed to assist physicians in assessing maternal and fetal status during pregnancy , labor, and follow-up. These obstetrical data management systems are capable of collecting data from different monitors such as maternal and fetal ECG's, and uterine activity. Prognosis and treatment of both mother and fetus is facilitated by this information collecting system.

Tips for Buying an Obstetrical Data Management System

1. These systems should have long-term storage capabilities, as well as the ability to analyze information and produce different reports, because their task is to collect information from fetal and maternal monitoring devices and perform electronic charting functions.

2. Other required capabilities include automatic backup database integrity maintenance. The manufacturer should provide information for the LAN and wide-area network protocols used with the system.

3. Viewing multiple fetal traces with real-time data and reviewing the entire fetal monitoring trace - both from central and bedside workstations - are enabled using these systems. Alarms must activate when a user-adjustable alarm limit for FHR has been violated.

4. The entire patient records should automatically be archived by the system. It should also perform backup data storage of patient records, maintain a directory of all archived patients, retrieve data by patient name, ID, or archival date, and allow user-defined parameters for data retrieval.

5. Users should be able to enter free text or set phrases to customize prenatal/ante partum data.

6. Other features should intrapartum and postpartum forms, automatic data acquisition of interfaced monitors, and ad hoc reporting functions. The system should be able to access a drug calculator, eliminate redundant data entry, and store care plans and department critical path procedures.

7. The system should be able to interface with a remote workstation to allow fetal monitoring trace review from a remote site and allow physician offices to download ante partum test data.

8. As for security, the system should (at least) include a user ID and password. The security levels should include individualized access functions, multiple levels of system security, and confidential password codes.

9. Facilities should carefully evaluate their current data management practices before they make a purchase. If there are inefficiencies in their system, automation will not necessarily solve them.

10. Before making the purchase, facilities should form a committee to inspect the purchasing budget, hire a consultant or consulting group, and negotiate with suppliers because buying this kind of a system can be a large capital expense.

11. Facilities are strongly encouraged to send requests for information to specific suppliers after they have identified needs and established goals and a budget. This will allow them to learn more about the systems offered and to determine which is best for their needs.

12. When facilities review the RFI responses, they can reduce the list of potential suppliers. They should then send each potential supplier a request for proposal containing the functional specifications that the system should meet.

13. The following data should be requested in the RFP: detailed descriptions of the system, installation plans, interfaces, training, maintenance, upgrade policies, acceptance criteria, and payment policies. The RFP should also provide a full description of the facility's needs, including the number of rooms to be wired, the number of fetal and maternal monitor interfaces needed, the number of surveillance workstations, the number of data-entry and mobile workstations, and archiving needs.

14. Facilities need to evaluate the required capabilities for their healthcare network and plan for interfacing and wiring needs. They should consider the number of workstations and monitors, including: remote and bedside workstations and maternal and fetal monitors, and decide about printers, bar coding, and input devices.

Questions for the Seller

Before you purchase your Obstetrical Data Management System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying an Oculoplethysmograph

Devices used for determining changes in opthalmic blood volume

Oculoplethysmographs that record data on blood flow in the eyes. These devices are used to obtain data used for calculating opthalmic artery pressure, for detection and assessment of diseases related to carotid arteries.

Tips for Buying an Oculoplethysmograph

1. Three types of these devices are available: vacuum OPG, air OPG, and air-filled cuff systems. Each type has certain benefits and drawbacks.

2. Facilities eventually choose the right type for them based on the end user's choice of technique.

3. When purchasing a vacuum or air OPG, buyers should also consider the cost of eyecups.

# Tips and Guidelines for Buying an Operating Room Monitor

Mass spectrometers for gas mixture concentration monitoring

Mass spectrometers used to monitor concentrations of gases such as nitrous oxide, carbon dioxide, nitrogen, and oxygen, during surgery or in intensive care.

Tips for Buying an Operating Room Monitor

1. Facilities are required to perform careful site planning before purchasing operating room monitors. Special anesthetic gas-respiration monitor installation should be considered as well.

2. Buyers should be aware of the fact that multiplexed operating room monitor systems require conduits for long tubing and electrical wiring from the central location to each patient in the OR, recovery room, or ICU.

3. Facilities should make sure that they involve one or more staff physicians, beside the facility's engineer, to ensure that all aspects of planning and use - including design and installation - are covered. This will help to guarantee that reliable data is produced and that the full capabilities of the operating room monitor system are realized.

4. Facilities should make sure they provide proper training for users of the operating room monitor system.

5. The operating room monitors should be properly maintained.

Questions for the Seller

Before you purchase your Operating Room Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

# Tips and Guidelines for Buying an Operating Table

General purpose operating tables with adjustable segments

Tables used during surgical procedures. Patient's body has full support with minimum manipulation. Divided segments for head, body, and legs, as well as table height, can be adjusted manually or using hydraulic systems.

Tips for Buying an Operating Table

1. The main factor to consider when selecting an operating or orthopedic table is that it meets the positioning needs of the procedures for which it is intended.

2. Facilities may wish to consider some additional factors: reliability of the table, replacement pad availability, durability of caster locking mechanisms, low maintenance, ease of cleaning and disinfecting the table and its accessories, protection of mechanisms from corrosive fluids, sufficient power cord length, and service record of the manufacturer.

3. Minimal positioning for operating tables and orthopedic tables: from the horizontal plane 25

4. These tables should be consisted of at least three sections:

5. A table back section, which at minimum should position- +55

6. A table foot/leg section, which should position +20

7. A table head section, which should position +45

8. Other requirements for tables include: a side rail, a load limit of at least 159 kg, a hand or foot operated remote control, arm boards, shoulder braces, stirrups, leg holders, counter supports, and a radiolucent tabletop.

9. The operating beds should be C-arm accessible, and accept 35 × 43 cm x-ray cassettes.

10. There are several accessories used to position and stabilize the patient, such as arm boards, shoulder braces, stirrups, leg holders, and counter supports. These can usually be obtained from operating table manufacturers.

11. For both remanufactured and new tables, cleaning the hydraulics is important. Users should follow manufacturers' guidelines in this matter. To remove debris, oil, and water, manufacturers suggest periodically replacing the filters.

12. Lately, operating tables that are compatible with accessories from several manufacturers have been developed.

Questions for the Seller

Before you purchase your Operating Table, we recommend you ask the seller the following questions:

Accessories

Does it include a sacral rest?

Does it include lateral IM nailing support?

Does it include retractable abductor bars?

Does it include a radiolucent tabletop?

Does it include radiologic accessories?

Controls

Does it have remote control?

Does it have manual override?

Base Attachment

Does it include conductive casters?

Does it include a caster lock?

Is it all Stainless Steel?

Are there Plastic/Composed materials parts?

Are there any signs of rust?

Is a mattress included?

Is it electrical?

Is it pneumatic?

Is it manual?

Does it have a manual override?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Operating Tables

# Tips and Guidelines for Buying an Ophthalmic Laser

Lasers used in ophthalmology for treatment and surgery

Pulsed lasers usually incorporated into a slit lamp. Used for photocoagulation and as a photodestructive tool in surgical procedures.

Tips for Buying an Ophthalmic Laser

1. This is the delivered power for the different beams: 3 W for an argon blue-green beam, 1 W for an argon green beam, 1 W for a dye beam, 1.5 W for a krypton green beam, 1.5 W for a krypton yellow beam, 1 W for a krypton red beam, and 1 W for a Nd:YAG beam. The following lasers should have principal wavelengths of 530-540 nm: argon, dye, krypton, and frequency doubled Nd:YAG lasers. The requirements of the unit include: single and repeat delivery modes, exposure duration of 0.01 to 2 seconds, repeat time of 0.1 to 2 seconds, a spot diameter of 50 to 1,000 mm, a slit lamp, an intraocular probe, a hand piece, and an indirect ophthalmoscope. An Nd:YAG laser should use a Q-switched operating mode and a fundamental mode structure; it should have a single pulse of 0.3 to 10 mJ, pulse duration of 4 n/sec, and 1 to 3 pulses per burst.

2. The spot size should be 101¼m, and the cone angle 16°. A single pulse should be at 1-2 Hz, and a burst should be at 1 Hz.

3. Selected energy, shot selection, power output, and shot counter - should all be displayed and controlled by the unit.

4. The laser should have a joystick beam actuator.

5. A compatible slit lamp should be used with magnification up to 25× and a working distance of 1,000 mm.

6. Each unit should have an automatic calibration system and the following accessories: contact lens, co-observation, a television with 35 mm adapter, a head restraint system, and a tonometer. An excimer laser should have a wavelength of 193 nm, 0-3 W of power output at tissue, 10 mJ per pulse, and an energy density of 150- 200 mJ/cm2, it should have both continuous and pulsed delivery modes, a beam diameter of 1 to 5 mm, a pulse repetition rate of 10 to 200 Hz, and a pulse duration of 10 to 15nsec.

7. Buyers should expect a unit with a high precision spot delivery system, a computer system, halogen gas cylinders, and 24 months of halogen source useful life.

8. A diode laser should have a power output at tissue of 1 W, both continuous and pulsed delivery modes, a pulse repetition rate 10 Hz, and pulse duration of 50 msec to continuous.

9. There are units requiring higher voltages and greater current capacity than those available from a standard outlet. If a unit needs an external water source, facilities should locate it above the first floor of an older building, and they may need a booster pump to provide adequate water pressure for cooling.

10. Facilities are encouraged to submit requests for proposal to several suppliers; they should discuss the important issue of prospective servicing.

11. Buyers should evaluate whether the laser is adaptable for other types of therapy for which they have a need.

Questions for the Seller

Before you purchase your Ophthalmic Laser, we recommend you ask the seller the following questions:

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Surgical Lasers

Argon Surgical Lasers

# Tips and Guidelines for Buying an Ophthalmic Retinal Laser

Opthalmic diode lasers

Low-power (810 nm wavelength) Diode lasers, with gallium arsenide as the active medium. The lasers can be incorporated into a slit-lamp or indirect opthalmoscope by a flexible fiber-optic cable. They are used for coagulation of abnormal vascular tissue in the retina, and other photocoagulation procedures.

Tips for Buying an Ophthalmic Retinal Laser

1. This is the delivered power for the different beams: 3 W for an argon blue-green beam, 1 W for an argon green beam, 1 W for a dye beam, 1.5 W for a krypton green beam, 1.5 W for a krypton yellow beam, 1 W for a krypton red beam, and 1 W for a Nd:YAG beam. The following lasers should have principal wavelengths of 530-540 nm: argon, dye, krypton, and frequency doubled Nd:YAG lasers. The requirements of the unit include: single and repeat delivery modes, exposure duration of 0.01 to 2 seconds, repeat time of 0.1 to 2 seconds, a spot diameter of 50 to 1,000 mm, a slit lamp, an intraocular probe, a hand piece, and an indirect ophthalmoscope. An Nd:YAG laser should use a Q-switched operating mode and a fundamental mode structure; it should have a single pulse of 0.3 to 10 mJ, pulse duration of 4 n/sec, and 1 to 3 pulses per burst. The spot size should be 10 μm, and the cone angle – 16°. A single pulse should be at 1-2 Hz, and a burst should be at 1 Hz.

2. Selected energy, shot selection, power output, and shot counter - should all be displayed and controlled by the unit.

3. The laser should have a joystick beam actuator.

4. A compatible slit lamp should be used with magnification up to 25× and a working distance of 1,000 mm.

5. Each unit should have an automatic calibration system and the following accessories: contact lens, co-observation, a television with 35 mm adapter, a head restraint system, and a tonometer. An excimer laser should have a wavelength of 193 nm, 0-3 W of power output at tissue, 10 mJ per pulse, and an energy density of 150- 200 mJ/cm2, it should have both continuous and pulsed delivery modes, a beam diameter of 1 to 5 mm, a pulse repetition rate of 10 to 200 Hz, and a pulse duration of 10 to 15nsec.

6. Buyers should expect a unit with a high precision spot delivery system, a computer system, halogen gas cylinders, and 24 months of halogen source useful life.

7. A diode laser should have a power output on tissue of 1 W, both continuous and pulsed delivery modes, a pulse repetition rate 10 Hz, and pulse duration of 50 msec to continuous.

8. There are units requiring higher voltages and greater current capacity than those available from a standard outlet. If a unit needs an external water source, facilities should locate it above the first floor of an older building, and they may need a booster pump to provide adequate water pressure for cooling.

9. Facilities are encouraged to submit requests for proposal to several suppliers. They should discuss the important issue of prospective servicing.

10. Buyers should evaluate whether the laser is adaptable for other types of therapy for which they have a need.

Questions for the Seller

Before you purchase your Ophthalmic Retinal Laser, we recommend you ask the seller the following questions:

Previous Usage

What was the first operation date of the equipment?

Is there a log book for the equipment?

How much was the last laser element in use (number of pulses)?

Does the beam shutter function properly?

Is the optical path aligned and clean (mirrors, end fiber optics etc.)?

Is the laser output (Energy/Power) according to the manufacturer specification?

Is the laser beam aligned with the visual pointing beam?

Is the timing device which controls the exposure accurate?

Does the cooling system function properly?

Is the system labeling (including the laser class) clear?

What is the general condition (external) of the system?

Was the equipment ever repaired?

Was the original laser element ever replaced?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Surgical Lasers

Argon Surgical Lasers

# Tips and Guidelines for Buying an Optical Digitizer

An optical image digitizer for scanning dental films

A special high resolution scanner used for scanning intraoral filmspanoramic films etc. The scanned image is transferred to a standard digital image format. The digital images can be stored, retrieved, imported, exported and printed for further processing and .examination

Tips for Buying an Optical Digitizer

1. Facilities should examine the number and type of procedures to be performed annually, as well as the types of patients to be treated before buying a dental radiographic unit or digital dental imaging system.

2. A panoramic unit with cephalometric imaging capabilities should be considered where skull view radiography is performed frequently. Facilities treating a wide range of patients should consider a unit that accommodates both seated and standing patients and has motorized vertical height adjustment.

3. An intraoral unit should be considered in facilities performing mainly routine dental radiography. Digital systems may be useful if immediate image analyses for endodontics and implantation planning are performed frequently.

4. An intraoral system with a half-wave, rectified x-ray generator is recommended for facilities that desire a system for routine dental radiography. The SID should be about 200 mm standard.

5. There is no need for special system capabilities, such as TMJ or cephalometry, in the intraoral systems, because they are used only for routine imaging. These systems should accommodate all patient types needing routine exams.

6. Two types of digital systems are available: CCD and image plates. Image plates are very similar to conventional intraoral films and are compatible with existing equipment. Digital systems in general have become more popular for dental x-rays due to the fact that chemical-based film processing can be discarded. Images from the CCD detector are displayed very quickly. Retakes can be initiated faster, minimizing total time and exposure. A CCD must be integrated with the x-ray generator.

7. Facilities should keep in mind that the additional ongoing costs associated with film based dental radiography, including film and film processing, processing chemicals and equipment, film storage, and record keeping can be considerable, depending on the number of patients treated. Using a digital radiography system can eliminate it.

8. There are costs that cannot be avoided in both film based and digital radiography. These include plastic covers for equipment that contacts the patient, as well as radiation protection/monitoring equipment for patients and staff.

# Tips and Guidelines for Buying an Orthopedic Table

Examination and/or treatment tables with adjustable orthopedic accessories

Orthopedic tables with individual adjustable parts for examination and treatment. Various support and traction accessories may be included.

Tips for Buying an Orthopedic Table

1. The main factor to consider when selecting an operating or orthopedic table is that it meets the positioning needs of the procedures for which it is intended.

2. Facilities may wish to consider some additional factors: reliability of the table, replacement pad availability, durability of caster locking mechanisms, low maintenance, ease of cleaning and disinfecting the table and its accessories, protection of mechanisms from corrosive fluids, sufficient power cord length, and service record of the manufacturer.

3. Minimal positioning for operating tables and orthopedic tables: from the horizontal plane 25

4. These tables should consist of at least three sections:

5. A table back section, which at minimum should position- +55

6. A table foot/leg section, which should position +20

7. A table head section, which should position +45

8. Other requirements for tables include: a side rail, a load limit of at least 159 kg, a hand or foot operated remote control, arm boards, shoulder braces, stirrups, leg holders, counter supports, and a radiolucent tabletop.

9. The operating beds should be C-arm accessible, and accept 35 × 43 cm x-ray cassettes.

10. There are several accessories used to position and stabilize the patient, such as arm boards, shoulder braces, stirrups, leg holders, and counter supports. These can usually be obtained from operating table manufacturers.

11. For both remanufactured and new tables, cleaning the hydraulics is important. Users should follow manufacturers' guidelines in this matter. To remove debris, oil, and water, manufacturers suggest periodically replacing the filters.

12. Lately, operating tables that are compatible with accessories from several manufacturers have been developed.

Questions for the Seller

Before you purchase your Orthopedic Table, we recommend you ask the seller the following questions:

Accessories

Does it include sacral rest?

Does it include lateral IM nailing support?

Does it include retractable abductor bars?

Does it have a radiolucent tabletop?

Does it include radiologic accessories?

Are there other accessories included (Please specify by free text)?

Controls

Does it have remote control?

Does it have manual override?

Base Attachment

Does it include conductive casters?

Does it include a caster lock?

Is it all Stainless Steel?

Are there Plastic/Composed-materials parts?

Are there any signs of rust?

Is a mattress included?

Is it electrical?

Is it pneumatic?

Is it manual?

Does it have a manual override?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Operating Tables

# Tips and Guidelines for Buying an Osmometer

Osmometers for laboratory use

Osmometers used in the laboratory to measure and display osmotic pressure and/or osmolality through a semipermeable membrane. Several techniques are used, such as cryoscopy, vapor-pressure, and/or colloid technology. In the clinical laboratory, these instruments are used to gather information used in the treatment of body fluid disorders and electrolyte imbalances such as those caused by diabetes and renal diseases, for cases of acute poisoning and shock trauma, and for postoperative monitoring of pulmonary edema and intravenous fluid delivery.

Tips for Buying an Osmometer

1. Results and alarm events should be displayed by the osmometer.

2. To facilitate results reporting to physicians, printouts should be offered by the osmometer. An interface option is desirable to allow the transfer of results to the facility's information system.

3. Facilities need to carefully examine their osmometer needs when evaluating the different osmometer methodologies.

4. Membranes are custom made for a specific vapor-pressure osmometer model, so when purchasing vapor-pressure osmometers, facilities must use the specific size and type of membrane designed for their devices. It could be difficult to use other types, and they may be forced to use only membranes made by the cryoscope manufacturer.

5. Facilities are encouraged to ask the osmometer manufacturer to provide a list of users in other laboratories and then check whether an instrument in one location gives the same readings as the same model in another laboratory. In case the results don't match, the facility should acquire conversion standards that can be used to compare dissimilar readings.

6. Facilities should examine the number of samples a cryoscope can process at one time and the processing time per sample. Larger facilities should consider osmometer devices with high sample throughput.

7. Facilities should carefully evaluate safety features with any osmometer instrument that processes potentially contaminated body fluids, such as blood. Buyers should look for designs that reduce contact between the operator and the sample, and whether the cryoscope device can use only custom-made reusable cuvettes or has sample chambers that must be manually decontaminated before reuse.

8. When performing osmometry or any other procedures that may cause exposure to body fluids, users should always apply universal precautions, including wearing disposable gloves, facial protection, gowns, and laboratory coats.

9. Disposing processed samples is an issue to be carefully considered due to the soaring cost of infectious-waste disposal. It is important to remember that osmometer instruments using larger sample sizes generally create larger amounts of infectious waste.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Oximeter

A laboratory instrument used to simultaneously determine oxygenation of hemoglobin forms

Oximeters measure the light intensity that passes through a blood sample at four or more wavelengths. Photometric or spectrophotometric techniques are used to select the wavelengths. These measurements are used to calculate oxygenation derivatives. Laboratory oximeters are used to simultaneously determine hemoglobin forms and the sum of all hemoglobin derivatives.

Tips for Buying an Oximeter

1. When considering the purchase of a laboratory oximeter or hemoximeter, facilities should mainly consider its interface capability with the lab's existing blood gas system, because oximeters are often used in conjunction with a blood gas system, and both should be compatible.

2. The interface capability will not affect the oximeter's performance, but it will expand the usefulness of each instrument by providing a broader analysis of the patient's condition.

3. Facilities should also consider the compatibility of the oximeters with the laboratory's data management system, as well as an interface with a printer, to allow information to be recorded electronically and obtained as a hard copy. This will also facilitate with reporting of results to physicians and ensure recording for future reference

4. The hemoximeter unit is more user-friendly with self-diagnostic and alarm features, which alert the operator about potential problems without requiring active monitoring.

5. It is easier to use oximeters that automatically correct for common sample interferences, such as bilirubin and lipemia, because they require less user interpretation.

6. The following should be considered by facilities when selecting oximeters: who will use and maintain the instrument, analyzers already being used in the hospital, and features required.

7. Too many measured parameters are not necessarily an advantage if most of the values will never be used. Clinicians must know that the parameter was derived and not actually measured because inaccuracies may be present.

8. Oximeters (hemoximeters) that hemolyze blood have higher service and preventive maintenance costs than units that do not hemolyze samples and do not require hemolyzing reagents and the associated hardware.

9. Before purchasing the oximeter unit, facilities are encouraged to evaluate oximeters for a few weeks in their own clinical environment. This will ensure that performance of the instrument as reported by the manufacturer fits the workload and sample types that the facility normally handles.

10. Analytical range, accuracy, precision, reliability, timesaving options and available interfaces are some of the performance features facilities need to consider when evaluating an oximeter unit's overall usefulness and long-term operating costs.

11. Tests requiring little or no training belong to the waived tests category. These do not require elaborate QC, and are less likely to produce inaccurate results.

12. The moderate-complexity category includes most clinical laboratory tests, including automated urine, blood, and chemistry.

13. The high-complexity category covers more specific testing, which requires extensive training, or procedures that necessitate a high degree of operator preparation, calibration, intervention, and analysis.

Questions for the Seller

Before you purchase your Oximeter, we recommend you ask the seller the following questions:

General Information

When were the houses last exchanged?

When was preventive maintenance last done?

Does it include a spare cuvette?

Does it include printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying an Oxygen Concentrator

Oxygen concentrators which produce an oxygen-rich gas mixture

Oxygen concentrators are used for patients with respiratory difficulties who benefit from high oxygen concentrations. These concentrators pull in room air and extract nitrogen, producing an oxygen rich gas mixture. Mainly used for chronically ill patients in home care.

Tips for Buying an Oxygen Concentrator

1. A detailed service manual should accompany each unit. The supplier should also provide routine inspection and preventive maintenance.

2. These devices should deliver an oxygen concentration of at least 90% over the full range of flow settings.

3. The flow setting of the oxygen concentrator should be at least 3 L/min.

4. The device must have an OCSI, either a built-in component or an add-on accessory, to alert the user with both an audible alarm and a visual indicator, if the unit's product gas has an oxygen concentration below 85%.

5. The device should initiate alarms for high and low pressures, battery or line power failures, low oxygen purity, and occlusions.

6. Facilities should choose options as cabinetry, mobility, and accessories.

7. These units offer an unlimited supply compared to oxygen cylinders and liquid oxygen systems, which rely on dealer deliveries of oxygen. Oxygen concentrators are best suited for long term low flow use.

8. The unit should be light enough to allow the patient to move it if necessary. The tubing length should allow for freedom of movement.

9. Devices for home use should meet electrical safety standards.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Oxygen Concentrators

# Tips and Guidelines for Buying an Oxygen Monitor

Oxygen monitors with electrochemical sensors

Oxygen monitors that continuously measure and display oxygen concentration in hospital supply lines, compressed gas cylinders, and in gas mixtures supplied to the patient. Most units have alarms signaling dangerous levels of oxygen concentration. These monitors are also used to check accuracy of ventilator settings. For use mainly in ICU's, operation theaters and in critical care units.

Tips for Buying an Oxygen Monitor

1. Oxygen monitors should have 3% accuracy when exposed to the following potentially interfering components: carbon dioxide, halothane, condensing water vapor and water droplets.

2. The intended use of the oxygen monitor determines the need for an alarm feature.

3. Alarms may not be essential for oxygen analyzer units intended to perform only routine oxygen spot checks or equipment maintenance, while they are definitely required in operating room monitor units intended for patient monitoring.

4. Whenever the audible alarm has been disabled, an alarm silence indicator should be provided. If the audible alarm can be disabled, it should be automatically reactivated within two minutes and should sound if the alarm condition persists.

5. The oxygen monitor should indicate the oxygen level to within 3% oxygen. An oxygen monitor unit for continuous monitoring should have a low alarm that cannot be set below 18% oxygen.

6. Audible alarms should be loud and noticeable especially since the units are often used in noisy areas. Intermittent or alternating tone alarms are preferred over steady tone alarms.

7. Changes in oxygen concentration should be indicated very fast. The response time, including alarm delay, should be less than 20 seconds.

8. Temperature and pressure effects should be minimal over normal breathing circuit conditions.

9. A change in breathing circuit temperature or pressure will not require oxygen monitor recalibration. The changes should be predictable from the manufacturer's specifications.

10. Operating room nits intended for spot checks or maintenance should operate for at least 12 hours on fully charged batteries. Those using rechargeable batteries may not need the same endurance.

11. An automatic low-battery indicator should be included with battery-powered oxygen monitors, or the unit may include a manually activated battery test to allow assessment of battery condition.

12. Low-battery indicator or battery test should not affect the medical oxygen monitor's operation and alarms. After the first indication of a low battery, the oxygen monitor should function normally for at least one hour.

13. When a medical oxygen monitor with rechargeable batteries is operating from its charger, open-circuited batteries or short-circuited batteries should not affect it. Recharging the battery will take less than 16 hours.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Capnometers and Multiple Medical Gas Monitors

Oxygen Analyzers

Transcutaneous Oxygen and Carbon Dioxide Monitors

# Tips and Guidelines for Buying an Oxygenator

Oxygenators for gas exchange in blood

Bubble oxygenators are used in short term procedures for gas exchange. They bubble oxygen from tanks or central hospital supply through a column of blood. They include a defoamer to break up bubbles formed during oxygenation process, and an arterial reservoir to collect defoamed blood, a gas flowmeter, and a filtering system. Membrane oxygenators diffuse oxygen across a gas permeable membrane. They may be used in long term procedures as they cause less blood damage than bubble oxygenators.

Tips for Buying an Oxygenator

1. The following functions should be performed by a disposable unit: oxygenating the blood from the arterial pump, removing carbon dioxide, regulating temperature, and exchanging anesthetic gases.

2. An in-line arterial filter should be included with the disposable tubing for the heart-lung bypass unit. This can help trap particulate matter and gaseous emboli.

3. The membrane oxygenator should have a gas-permeable membrane. Membranes come in three types: flat sheet/plate, coil, and hollow fiber.

# Tips and Guidelines for Buying a Pacemaker

Implantable cardiac pacemakers

Cardiac pacemakers are surgically implanted beneath the skin, and electrodes are positioned in or on the heart. Reprogramming of parameters can be done noninvasively and some are rate-responsive. These pacemakers are used as a permanent treatment for bradycardia, and certain cardiac arrhythmias . They include a battery, electronic circuits for producing electrical pulses and sensing cardiac activity electrodes, and leads for conducting electrical signals.

Tips for Buying a Pacemaker

1. Physicians are in the best position to decide on the pacemaker specifications, based on patient illness and specific requirements. Different patients need pacemakers with different operating modes, levels of adjustability, and other capabilities. In the selection process, facilities should include cardiologists, cardiovascular surgeons, and electro physiologists.

2. A hermetically sealed pulse generator and either one or two insulated conductive leads should be in each implantable pacemaker, as well as a programmable mode, rate, sensitivity, pulse width, and amplitude.

3. Pulse generators should be compatible with IS-1/VS-1 leads or encountered lead connectors.

4. These implantable pacemakers display four available categories. The pacing modes common to each are listed in brackets. Many manufacturers offer at least one model of each of these four types of cardiac pacemakers:

5. · Multiprogrammable, single chamber (VVI, AAI, VOO)

6. · Multiprogrammable, single chamber with rate modulation (VVIR)

7. · Multiprogrammable, dual chamber (DDD)

8. · Multiprogrammable, dual chamber with rate modulation (DDDR)

9. Suppliers should offer each type of pacemaker with either a unipolar or bipolar lead configuration. All units should be capable of transmitting patient information and the pacemaker's operating parameters to the programmer. These transmittable parameters may include: programmed settings, battery status, lead impedance, identification number, model number, serial number, and measurements of pacing rate, pulse amplitude, and pulse width.

10. Each cardiac pacemaker unit should operate for at least five years at 100% pacing, and should include a low battery indicator.

11. All leads should be pre-sterilized and double packaged in hermetically sealed individual containers. These packages should be clearly labeled with the following information: manufacturer, model, serial number, expiration date, connector type and size, and tip electrode type.

12. The expiration date on the leads should not be less than one year from the delivery date.

13. These are the main factors to consider when selecting a pacemaker: technology, service issues, and reliability.

# Tips and Guidelines for Buying a PACS

PACS (Picture Archiving and Communication System) for collecting, storing and retrieving patient images and data

Computer-based systems (PACS) that can collect, store, archive and retrieve images and data in digital format from single or multiple modalities (CT, MRI, US, CR, DR, nuclear medicine, etc.). These systems are used in medical centers in conjunction with the HIS and RIS and serves as a major tool for clinical routine work. These systems enable telemedicine consultations.

Tips for Buying a PACS

1. Buyers of Picture Archiving and Communication Systems (PACS) may need to provide assistance to physicians in adapting to soft-copy images and reports. Some physicians may resist reading reports and reviewing images on monitors, preferring tangible recording of data.

2. The following requirements apply for PACS: unlimited concurrent user support, potentially unlimited long-term and on-demand storage capacity, a proven encryption system, preferably 128-bit SSL.

3. Suppliers of PACS are responsible for supporting users in the following methods: 24/7 telephone support, on-site support within one day, training upon installation, remote system monitoring, and remote system updates.

4. PACS Suppliers offer many software features that add functionality to the systems. In general, a Picture Archiving and Communication System will better serve the facility when it has more functionality.

5. Some of the important PACS software features include workstation-independent user log-ins, administrator-controlled work lists, and automatic notification of prior exams.

6. A web-based image access is another requirement for PACS, with a variety of image manipulation tools and patient search tools.

7. Both lossless and lossy compression of images should be offered. It should have GUI-based tools for patient and hardware management, automatic fail-over of critical components, and a UPS standard power backup.

8. If the PACS system fails, there should be an automatic alert.

9. The database should automatically be backed up at least once an hour .

10. These systems should be able to interface with other hospital systems. A system should feature broker less and bi-directional RIS interfacing, year 4 IHE, and report dictation interfacing, and the supplier should guarantee uptime of at least 99%.

11. To facilitate future additions to the network, all newly purchased equipment must be compatible with the current version of the DICOM standard.

12. Facilities are encouraged to ask DICOM conformance statements from suppliers. These should explain in detail which information objects, service classes, and data encodings are supported by their Image Analysis and Archives systems.

13. The fact that a system meets the requirements of DICOM, does not guarantee that the data is indeed stored in DICOM format. It is important to remember that when migrating data to a new Image Analysis and Archives system.

14. Before purchasing a PACS system, facilities should ask suppliers about the issues surrounding data migration in the future.

15. Buyers should carefully plan the installation of these Image Analysis and Archives systems. Sometimes an entire room may be dedicated to hardware. They should consider airflow and use of floor space and cabling.

16. To prevent hardware damage, sprinklers for fire protection should be replaced by inert gas systems.

17. Additional equipment may be needed to accommodate longer-distance signal connections for PACS. Adding telephone modems or fiber optic lines, as well as any other special equipment, may increase costs and pose design problems.

Questions for the Seller

Before you purchase your PACS, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does it include a multiformat printer?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Import? Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

PACS \- Picture Archiving and Communication Systems

Medical Data & Information Systems

# Tips and Guidelines for Buying a Passive Motion Exerciser, Limbs

Exercisers for continuous passive motion of patient's limbs

Devices using continuous passive motion, allowing for movement without muscular exertion. These devices are used for hand flexing, upper and lower limb passive flexing, and extensions.

Tips for Buying a Passive Motion Exerciser, Limbs

1. Facilities should consider the following before purchasing a passive motion exerciser: mechanical and electrical safety features, stability and compatibility with the facility's beds, ability of the motor to withstand worst-case application, quietness of operation, portability and ease of storage.

2. There are various mechanisms for adjusting the passive motion exerciser device for patient fit and for changing ROM.

3. There are some continuous passive motion exercisers that are used at the hospital, as well as in the patient's home.

4. Buyers of passive motion exercisers should try the products to make sure all adjustments are easily made over an adequate range and will hold their position constantly.

Questions for the Seller

Before you purchase your Passive Motion Exerciser, Limbs, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

# Tips and Guidelines for Buying a Pathology Information System

Computerized anatomic pathology information management system

A system for the anatomic pathology laboratory, providing clinical and administrative information and management features. These include automation of laboratory activities, tracking capabilities, such as automatic image processing and analysis, tumor registry, trend reports, and billing. Most systems offer surgical pathology, autopsy, and cytology clinical packages.

Tips for Buying a Pathology Information System

1. Before purchasing a system, facilities should carefully evaluate their current operating process.

2. Anatomic pathology information systems come with many software features. The necessary combination for each facility will depend on the intended use of the system.

3. APIS should offer some basic features, including surgical pathology, autopsy, cytology, specimen tracking, and other features beneficial to the basic operation of an anatomic pathology lab.

4. Facilities should consider additional features based on the needs of the particular lab.

5. The systems should be HL7 compliant and offer file backup capabilities and system security, such as password protection.

6. If the laboratory has an existing system or is purchasing a stand-alone APIS and may be considering an LIS or HIS in the future, an interface to HISs or LISs will be a necessary feature.

7. Buyers can expect an effective APIS to provide the following: specimen control and tracking, accurate diagnoses records and coding, timely and clear records of communications, and relation to external agencies, such as licensing and accreditation bodies. Buyers should consider several parameters to determine whether they need two separate systems. Stand-alone systems that interface with an LIS or HIS typically need two software fees and two hardware maintenance fees.

8. Laboratories in which an LIS anatomic pathology module would not meet the pathology requirements or those with special needs, such as teaching facilities, will find a stand-alone system to be a more sensible choice.

9. An APIS operated through an ASP organization dramatically reduces the initial capital investment in hardware and software compared to a LAN configuration. Using the ASP model, facilities do not need to provide maintenance and upgrades; however, they lose control over these, as well as the level of application customization, and they incur a continuous expense.

10. Facilities are strongly encouraged to maximize bargaining leverage; they should negotiate maintenance fees before making the purchase.

Questions for the Seller

Before you purchase your Pathology Information System, we recommend you ask the seller the following questions:

Software

Does it include clinical features?

Does it include surgical pathology?

Does it include autopsy?

Does it include cytology?

Does it include specimen tracking?

Does it include Histology labels?

Does it include Pathology image capture?

Does it include ad hoc reporting?

Does it include management features?

Does it include bar coding?

Does it include billing?

Does it have ad hoc reporting capability?

Does it include a Histology worksheet?

Does it include word processing?

Does it include SNOMED coding?

Is SNOMED coding automatic?

Does it include patient demography?

Does it include primary, second, and tertiary codes?

Does it include Bethesda coding?

Does it include autopsy measurements?

Does it include tumor registry?

Does it include Cytology report?

Does it include transcription?

Does it include outreach services?

Does it include billing mode?

Does it include remote ordering?

Does it include remote results reporting?

System Configuration

Does it include bar-code reader?

Does it include a Fax?

Does it include a printer?

Does it include a remote printer?

Does it include a direct printer?

Does it include a modem?

Does it include UPS?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Patient Hoist

Transfer lifts and track-mounted patient lifts

Manual, electric, or battery operated lifts with hydraulic or screw jack lifting mechanisms. Some lifts are wheel base mounted, so patients can be moved or transferred between rooms. These lifts are used to safely and easily transfer patients as needed with minimum risk to the assistant and to the patient. They consist of a support base, swivel bar, a sling or rigid seat, and the lifting mechanism. Some are track-mounted, usually on the ceiling, with a suspension system for the seat, motor and pulleys, in addition to a control box regulating the lift's movements.

Tips for Buying a Patient Hoist

1. The patient hoists should be capable of handling a capacity of at least 350 lb. Heavier patients are usually in specialty wards, where specialized equipment should be considered.

2. In general, patient transfer lifts should be easy to use. Placing a patient in the sling or seat should be an uncomplicated process, and the pump or lifting mechanism must be reliable and easy to operate.

3. During the normal course of use, the support material on the patient hoists often becomes soiled. To control infection, it should be able to withstand heavy use and frequent disinfection, which means it has to be washable and sanitizable.

4. The patient transfer lifts must have a range sufficient to move a patient from the floor to his bed, at minimum. Patients with limited mobility sometimes fall out of bed, and manually lifting them from the floor is a common cause of caregiver injury.

5. In order to make sure that patients are moved smoothly from room to room with mobile patient hoists, facilities should consider the base width of the lift in the closed position.

6. For easy movement, the casters should be at least 4" in diameter. A greater diameter provides an easier maneuver over obstructions. The patient transfer lift should roll well even on dense carpeting and be able to maneuver through tight or awkward spaces. To prevent movement while the patient is being positioned, at least one brake should be available on the lift.

7. Facilities should select a safe patient hoist model, which is strong and stable, securely supports the patient, and operates smoothly.

8. The patient hoist sling or seat should be selected based on the patient's needs. Patients with leg amputations may fall out of two-piece slings, because their center of gravity is higher; they have more of their weight in the upper body. Patients with weak head or neck conditions may require slings with head support.

9. Users are strongly encouraged to first try the patient hoist without a patient, to become familiar with the procedure and to assess ease of use. Only then they should try it with a patient aboard to assess the patient hoist's appropriateness for a specific patient or group of patients.

10. Facilities should examine the physical layout of the location where the bath patient lift will be used and evaluate the needs of the patient to be lifted. A particular living area or storage space may be too small for some mobile patient hoist bases. In some places, bathtub and toilet design may interfere.

11. Regardless of the area of use, the minimum and maximum bath patient lift height must match the patient's lifting needs. Transferring a patient from a high bed to a standard bathtub requires a more extensive patient hoist range than transferring the same patient from a standard-height wheelchair to a bed.

12. Track mounted patient transfer lifts are limited to use in the area where the track has been mounted.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Manual Medical Device

# Tips and Guidelines for Buying a Patient Monitor

Physiologic monitoring systems that detect and display ECG's, respiratory rate, non-invasive and invasive blood pressure, body temperature, airway gas concentrations, and others

Physiologic continuous monitoring systems for evaluation of patient's cardiac activity. These monitors can detect and display ECG's. Other parameters that can be configured using appropriate sensors, are respiratory rate, non-invasive and invasive blood pressure, body temperature, airway gas concentrations, and others.

Tips for Buying a Patient Monitor

1. Patient Monitor Systems can be divided into three groups based on acuity: low, medium, and high. These three categories represent the care settings and the types of patients to be monitored.

2. Low acuity physiologic monitors perform basic vital signs monitoring, and may be used for outpatient surgical applications with a low level of monitoring.

3. Medium acuity patient monitors are found in a variety of settings, including the emergency department, intermediate care unit, and general medical/surgical floors. These may be modular or configured with other add-on modules.

4. High acuity physiologic monitoring system monitors are used in CCU and OR environments, or in post anesthesia care units. They may be modular or configured with other add-on modules.

5. Using a LAN-based system, central-monitoring stations should display and control data from bedside monitors, in a way that a failure of any bedside ecg monitor or central station display will not affect the performance of the entire system.

6. A patient monitor should be able to display data from another bedside physiologic monitor, including automatic display of alarm information.

7. The central stations should display waveforms, numeric and graphic displays, tabular displays, and calculations.

8. Users should select electrodes from a big selection available to them. They should test electrodes from multiple suppliers to ensure the best results for their particular patient monitor.

9. The facility's resources, expected and desired patient population, and current technology base - all of these should be considered when making a decision regarding purchasing of a physiologic monitoring system. This decision should be part of a long-range strategic monitor acquisition and management plan. The purchasing process should start at least six to eight months ahead and consider the care area size and its architectural layout, staffing levels, and geographic proximity of patient assignments.

10. Patient monitors in critical care areas require these parameters: ECG, IBP, NIBP, SpO2, temperature, cardiac output, and ETCO2. All patient data should be available at a central station monitor.

11. Buyers of patient monitors should evaluate the alarms on a monitoring system before purchasing. Patient outcome can be affected if a monitoring system fails to alarm for a critical event.

12. A modular or a configured ecg monitoring system may be used for routine OR procedures, which are shorter and less complex and usually require fewer monitored parameters than intensive procedures.

13. The capability of integration with the anesthesia monitoring equipment is necessary for monitors used in both intensive and routine OR procedures. This provides centralized alarm information.

Questions for the Seller

Before you purchase your Patient Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Networking

Is it hardwired?

Is it wireless?

Max no. of beds?

Does it have peripheral device interfaces?

ECG

Does it include failure alarms?

Does it have arrhythmia detection capabilities?

Does it have ST analysis capability?

Does it include an auto lead switch?

Does it include a recorder

Respiration

Is respiratory waveform displayed ?

Is there threshold control ?

IBP

Does it have multiple channels ?

Does it have a scales range, mm Hg ?

Does it have labels capability?

Does it have alarms ?

Auxiliary Output

Does it have synchronization for Defib?

Does it have BP output signal?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Patient Monitors

ECG Monitors

Blood Pressure Monitors, Invasive

# Tips and Guidelines for Buying a Patient Scale

Underbed patient lifting scales, and bedside scales with lifting mechanism

Underbed scales with transducers that are placed under the hospital bed wheels, and are connected to a control and display console. Bedside scales utilize a mechanism for lifting the patient, much like a sling, and include a weighing unit with display.

Tips for Buying a Patient Scale

1. Patient scales are designed to measure and display the body weight of patients who cannot stand on a scale or sit in a chair scale.

2. Some patient scales are designed to weigh prone or supine patients mainly for routine weight checks, while others continuously monitor a patient's weight during procedures in which small changes in body weight are critical, such as hemodialysis, or during fluid maintenance to prevent dehydration or fluid overload.

3. These hammock scales eliminate the risk of pain or injury that could be incurred by moving these patients.

4. Drug dosage must be based on body weight, so these hammock scales are used for close monitoring of weight in patients who are comatose, paralyzed, debilitated, or severely burned.

# Tips and Guidelines for Buying a Patient Warmer

A device for warming patients by a warmed airflow or electric pads

The warmed air is forced to flow by a fan through a blanket. The system is electronically controlled to maintain the patient's body temperature.

Tips for Buying a Patient Warmer

1. Patient warmers should have audible and visual alarms to alert the caregiver of any over-temperature events with a limit setting of 44

2. Dual safety thermostats should be included on hypothermia warmers as well, to provide redundant over-temperature protection.

3. To help prevent cross contamination during surgery, single-use disposable blankets are recommended. These are offered in several sizes. In the past, some sites were reusing them to diminish costs.

4. If air temperature exceeds the convective air-warming unit's settings, the whole patient warmer should automatically shut off or shut off the heater.

5. The different options, the blanket size and quantity are factors that affect the purchasing cost of these hypothermia warmer units.

6. In the OR, where space is limited, small size and ease of transport of the convective air-warming unit are important, as well as storage options and readability of the control panel.

7. To regulate temperatures, facilities can use a hypo/hyperthermia warmer unit, which circulates fluid - hot or cold - through a pad. This can be used instead of the forced air hyperthermia unit.

8. The risks of airborne dust, bacteria, and mold blowing onto the patient or into wounds is reduced with HEPA filters.

Questions for the Seller

Before you purchase your Patient Warmer, we recommend you ask the seller the following questions:

General

Does the set include a Mattress, a Blanket or a Pad?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Hyperthermia Units, Forced-Air

# Tips and Guidelines for Buying a Peritoneal Dialysis Unit

A device for automated peritoneal dialysis

Automated peritoneal dialysis is performed mainly while a patient is asleep, using a permanently implanted abdominal catheter which provides access to the peritoneal cavity. The device removes metabolic wastes through selective diffusion across peritoneum. These dialysis units infuse and remove a specially designed dialysate by means of the catheter and a sterile disposable tubing system.

Tips for Buying a Peritoneal Dialysis Unit

1. Safeguards such as a low-drain alarm and a fluid-retention alarm should be in place to prevent overfilling a patient's peritoneum with dialysate. When less than a set percent of the infused dialysate volume is drained from the patient after each drain cycle, the low drain alarm should be set.

2. It is important to prevent overfilling because besides discomfort from the intra-abdominal pressure, it can cause serious complications, such as decreased pulmonary function, and decreased cardiac performance, periatherter leakage, and hernia.

3. The low drain alarm should be set to a point between 60% and 85%. A fluid retention alarm is generated by the ultra-filtration monitor and activates in case of a significant discrepancy between the dialysate-fill volume and the drain volume.

4. If the patient cumulatively retains over one half of the fill volume setting, it is recommended that the fluid retention alarm go off.

5. Facilities should carefully consider the dialysate temperature. It must be warm enough so that the patient is comfortable, and cool enough not to damage the peritoneum. Warm dialysate increases patient comfort by avoiding body cooling and is also thought to increase the effectiveness of dialysis by causing vasodilatation and increased diffusion.

6. The patient should be protected from receiving cold dialysate fluid by disallowing dialysate infusion until it is warmed. If the dialysate enters the patient when it's too warm, it can cause peritoneal sclerosis. If the unit starts to deliver dialysate over 43

7. Other alarms are recommended to alert users to the disruption of dialysis to the patient. The unit should also alarm upon power failure or an insufficient volume of dialysate delivered to the patient.

8. In units used at home, reliability is a special concern. No backup unit or repair technician is usually available at home, and if the unit ceases to function in the middle of a treatment, the consequences can be serious.

9. In homes, power, water pressure, and temperature may not be regulated as well as in medical facilities. Therefore, limited acceptable ranges of supply voltage and water temperature become important issues in selecting a unit.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Peritoneal Dialysis Units

# Tips and Guidelines for Buying a PET/CT

Computed Tomography Positron Emission Tomography (PET/CT) scanning systems generate PET and CT images of a patient in a single study

Computed Tomography Positron Emission Tomography (PET-CT) scanning systems incorporate a CT scanner and PET scanner in the same System. Two images data set are registered and shows both, the anatomical location and the PET metabolic activity sites. Some models are fusing the finding into one fused image that shows both the anatomical location from CT along with the metabolic activity of PET on a single image.

Tips for Buying a PET/CT

1. Before deciding on a specific system configuration when buying a PET scanner, buyers should consider the number and types of PET studies to be performed.

2. All CT PET scanners should provide adequate image quality.

3. Patient throughput varies among PET scanners. It is impossible to specify patient throughput, which depends on the types of exams being performed and the size of the patient.

4. The sensitivity of a CT PET scanner is used as a guide to the patient throughput; the higher the sensitivity, the shorter the exam time is.

5. Scatter fraction must also be considered. A higher scatter fraction indicates reduced image quality.

6. High detector performance is crucial for facilities wishing to conduct PET scans using isotopes with very short half-lives.

7. Facilities adding a Positron Emission Tomography (PET) facility should expect extensive planning and construction, special permits, and serious training for technical staff.

Questions for the Seller

Before you purchase your PET/CT, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Is the detector a multislice array?

Work Station

Known failure history?

Are there additional work stations?

Are there additional software packages?

X-ray Tube

Tube size (M.H.U)?

Tube slice count / MAS?

Slices count on gantry?

Date of manufacture?

What was the initial number of slices under the tube warranty?

Miliseconds count?

Additional components

Are there any kind of imagers available with the system?

Does it include injector, contrast?

Does it have calibration phantoms?

Does it include UPS?

Are any spare parts available with the system ?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

PET/CT

# Tips and Guidelines for Buying a Phototherapy Unit

Hyperbilirubinemia phytotherapy units for newborns

Phototherapy units for treatment of hyperbilirubinemia in newborns. Visible light with a high intensity in the blue range, converts water insoluble bilirubin to water-soluble photoproducts that are excreted into bile. These units may apply overhead radiation directly from lamp to newborn, or separate light sources using fiberoptic cable and transparent pad.

Tips for Buying a Phototherapy Unit

1. Buyers of phototherapy units need to decide which technology they wish to use. Two options are available for them: overhead lamps or fiber optic systems.

2. Facilities should keep in mind that the irradiance levels provided by phototherapy unit manufacturers depend on the type and combination of light sources, the radiometer used, and the method of measurement. Without knowing these variables, the irradiance levels listed in the chart specifications cannot be compared. Radiometer readings depend on the unique characteristics of the specific models of phototherapy unit lamps and radiometer.

3. The phototherapy unit should have multidirectional angle-adjustment capabilities of at least 30

4. To change the light intensity, the phototherapy unit should be able to either adjust the light or the phototherapy unit's proximity to the neonate.

5. Phototherapy pads should provide average spectral irradiance levels in the suggested therapeutic range of 4-40 μW/cm2/nm in the bandwidth of 420-480 nm. Ultraviolet levels radiated by phototherapy systems should not exceed a maximum irradiance of 1,000 μW/cm2 for UVA radiation or a maximum effective radiance of 0.1 μW/cm2 for UVB radiation.

6. The irradiance should produce minimal increases in an infant's body temperature. The hyperbilirubinonemia phototherapy unit should include shielding for the infant in the event that the light bulb breaks or bursts.

7. To avoid the risk of burning an operator, the phototherapy unit's light source housing should not become excessively hot. Thermal protection should prevent damage to components in the event of excessive heating and should remain thermally safe if the cooling vents become blocked.

8. For years, facilities have been using conventional overhead lamps for phototherapy treatment. These devices are most useful when intensive phototherapy is needed, because they irradiate a large skin surface area and can be positioned close to the infant, providing high average spectral power levels.

9. When patient access and space are critical, fiberoptic phototherapy blanket systems are most useful, even though they cannot provide power levels high enough for intensive therapy. They are also useful when double phototherapy is needed. The use of a fiber optic pad together with an overhead lamp is more practical than using two overhead lamps because a fiberoptic phototherapy blanket under an infant allows better access to the infant than a second bilirubin lamp does.

10. Both methods are comparable in the intermediate care nursery, because space and access to the infant are not critical there, and intense irradiance levels are not usually needed.

11. Fiberoptic systems diminish the need for eye patching and thermoregulation of the infant and provide the psychological advantage of not interfering with parent-infant contact.

12. Fiberoptic systems are easy to set up, move, and use. They eliminate the exposure of

caregivers to blue light, which can cause discomfort. Parents may accept the use of fiberoptic phototherapy blankets more easily than they would overhead bilirubin lamps.

13. Some lamp manufacturers offer a radiometer intended for use with their bilirubin lamp model.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phototherapy Units

# Tips and Guidelines for Buying a Physician Order Entry System

System for computerized ordering of medications, tests, etc. (CPOE)

A computerized network using desktop, mobile, or hand held computers designed for health-care provider use. This data management information system enables ordering of medications, diagnostic tests, and other patient needs on a computerized network, which can track, check status, and retrieve patient records. Eliminating the need for handwritten or oral orders reduces margin for error. This is part of a hospital-wide system to accurately manage, record, and administer medications, with on-line safety alerts and clinical decision support.

Tips for Buying a Physician Order Entry System

1. Typically, it takes at least 2 years for the planning, selection, and implementation of a CPOE system.

2. Interconnectivity with other information systems in the hospital is an essential requirement for CPOE.

3. This system should be used for all orders, not just medication orders. Essential patient information that may be critical to the medication ordering decision should be readily available at the time of ordering.

4. Facilities should investigate whether the system that they are considering can be integrated or interfaced with the existing HIS and ancillary information systems.

5. The system must provide real time alerts in the following cases: allergies, serious drug interactions, common test interactions, dose limits, duplicate therapy, the danger of exceeding a cumulative dose of a particular drug, and abnormal lab results.

6. The system should provide an easy-to-use protocol that allows users to customize the severity levels for different alerts.

7. Route, dosage, duration, and frequency options should be provided in accordance with facility guidelines. The system should also provide safety features specific to the categories of high-risk patients or those with special needs.

8. The system should provide direct online access to reference information without the user having to leave the ongoing user session. Authorized personnel should be able to easily customize the database rules used for clinical decision support.

9. This type of system can cost from several hundred thousand dollars to several million dollars, depending on the size of the facility, the existing information systems, and the number of users.

10. When first implemented, the system may require more order-entry time than a traditional paper system. As users become more familiar with the system, the average time necessary to complete an order is likely to decrease.

11. Eventually, using the system will allow the facility to take full advantage of its benefits and eliminate the use of a costly and confusing dual paper and electronic system.

12. Confidentiality of patient data is crucial, especially when the system handles a stream of data

from multiple sources that is intended to be available only to specific users. 13. Facilities need to plan the number, location, and type of workstations dedicated to order entry.

14. To maximize flexibility, suppliers should offer laptop computers on roller stands and thin client handheld units that can be used over wireless networks, in addition to fixed workstations.

Questions for the Seller

Before you purchase your Physician Order Entry System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Orders/Tests

Does it include medication?

Does it include diagnostic lab?

Does it include radiology?

Does it include IV fluids?

Does it include ADT and bed types?

Does it include consultation?

Does it include diet?

Does it include enteral/parenteral nutrition?

Does it include activity/restraints?

Does it include respiratory therapy?

Does it include physical therapy?

Does it include occupational therapy?

Does it include treatments?

Does it include monitoring?

Does it include nonformulary?

Networking

Does it include extranet?

Does it include security?

Software

Does it include demographics?

Does it include profiles?

Does it include allergies?

Does it include diagnoses?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Plasma Sterilizer

Plasma sterilizers

Sterilization units using plasma for the sterilization process. An electromagnetic field is directed to a vapor (hydrogen peroxide or peracetic acid), or gas (argon) substrate, to generate the plasma.

Tips for Buying a Plasma Sterilizer

1. Most facilities were choosing EtO as the preferred low-temperature sterilant; however, they are now looking for alternatives because of its toxicity, long aeration time, and emissions restrictions.

2. EtO is highly flammable and explosive. To reduce its flammability, chlorofluorocarbons have been mixed with EtO, but it has been found to deplete the earth's ozone layer, and many nations stopped the production or banned the use of it.

3. EtO units have larger chambers than gas plasma sterilizers and can process more items at once, but need a longer cycle time.

4. To eliminate toxic residues from the sterilized items, they require 10-16 hours of aeration time after processing. This may cause sterilized items to be removed from use for up to 24 hours, which may require the facility to purchase additional inventory to meet the demands.

5. Maintaining this type of inventory is costly and is in addition to the costs associated with meeting federal regulations for emissions and personnel safety.

6. For low-temperature sterilization, plasma sterilization may be a cost-effective and environmentally sound choice. Its installation is straightforward, with no risk of emission-related errors, and its end products are not toxic, reducing regulatory and safety concerns.

7. Plasma sterilization needs fewer instruments in stock, since used instruments can be made ready for reuse faster than when EtO sterilization is used; however, if a large number of medical items are processed, many sterilization cycles may be needed each day.

8. The STERRAD 50 has a sterilization chamber of 50 liters, while the size of the sterilization chamber of the STERRAD 100S is 100 liters. The chamber of the 100S is circular in cross section, while that of the 50 is rectangular. Since most loads are rectangular, they can potentially be packed more efficiently into the STERRAD 50 chamber than into the STERRAD 100S chamber.

9. When considering plasma sterilizers, facilities should examine the two important issues of capacity and throughput.

Questions for the Seller

Before you purchase your Plasma Sterilizer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

# Tips and Guidelines for Buying a Platelet Aggregation Analyzer

Blood coagulation (platelet aggregation) analyzers for laboratory use

Platelet aggregation analyzers that are used to determine platelet dysfunctions. An aggregating agent is used to activate aggregation process, and platelet adhesion is evaluated using optical density, electrical impedance, or bioluminescence methods. Samples preparation (centrifugation) is usually necessary, but in impedance analysis whole blood can be used.

Tips for Buying a Platelet Aggregation Analyzer

1. Facilities should carefully consider their needs before purchasing a platelet aggregation analyzer, to better select the type that would meet those needs including: previous supplier contact/presence, service concerns, staff familiarity, and delivery time are among the factors that influence the purchase of platelet aggregation analyzers.

2. Platelet aggregation analyzers should have optical methodology, depending on the facility's needs. Platelet aggregation meter devices should also accept PRP specimens and multiple sample types as an option.

3. Some of the required features are temperature control, as well as a temperature indicator. Some of the preferred features are an adjustable temperature range, an adjustable speed and a tachometer for the stirrer, automatic calibration, and a chart recorder. The platelet aggregation analyzers should have a printer. Display and computer interface are optional.

4. Facilities are encouraged to evaluate the platelet aggregation analyzers for a few weeks in their own clinical environment before purchase. This enables them to verify that instrument performance as reported by the manufacturer fits the workload and sample types that the facility normally handles.

5. One of the important selection criteria is sensitivity, which is the smallest change in either sample turbidity or impedance. This is important for platelet aggregation meter instruments that must identify platelet adherence disorders.

6. Another crucial criterion is high degree of precision, which measures how closely a test result can be reproduced. This is important, because it reduces the need for duplicate testing to verify the accuracy of initial test results

7. Other applications can use some platelet aggregation analyzers. These may include leukocyte aggregation studies and ATP release. Platelet aggregation meter instruments with such flexibility are extremely valuable to the laboratory, because they can be used as alternative testing devices for more costly and time-consuming analytical methods.

8. Facilities should prefer platelet aggregation meter devices that minimize operator contact with specimens, and automate steps such as reagent addition and dilution or eliminate certain sample preparation steps, to reduce the risk of operator contamination from these hazards. Generally, there's a risk of infection involved with handling any body fluid specimen.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a POC Coagulation Analyzer

Analyzers for point-of-care analysis of coagulation process

Blood analyzers that perform various coagulation tests (coagulometers) on whole blood, at point-of care. They use photometric, mechanical impedance, or electromagnetic techniques to detect clotting deficiencies and to monitor drug effects, and for blood component therapy. These analyzers are capable of performing the following tests: activated clotting time (ACT), activated partial thromboplastin time (WBAPTT), prothrombin time (WBPT), recalcification time (WBRT), heparin dose response, heparin/protamine titration, and high-dose thrombin time (HiTT).

Tips for Buying a POC Coagulation Analyzer

1. Facilities should consider the POC coagulation analyzer's degree of automation when selecting the right analyzer. Facilities should keep in mind that point-of-care POC coagulation analyzer devices are often used by non-laboratory trained personnel. However, more automated features and greater data-management capabilities may be preferred.

2. All point-of-care POC coagulation analyzer devices should provide basic data management features, including a means of patient identification, record of the test result, date, and time. In cases where trained personnel are not available while the test is performed, intermediate data management capabilities will be desirable on top of the basic ones, including captures of QC results, reagent lot numbers, and operator ID.

3. Some medical facilities should look into more advanced data management functions, which may include, on top of all of the options previously mentioned, the ability to collect data from one or more POC coagulation analyzer devices into a central data repository, which may be a stand-alone PC or an information system. Another advanced data management option may be the ability to generate reports based on the data collected from the PTT analyzer.

4. These POC coagulation analyzer devices should have the capability of producing a hardcopy of test results, using a built-in printer or an interface to an existing one. A computer interface is also preferred to allow automatic results reporting and communication with a facility's data-management system.

5. The individual needs of facilities determine the test menu preferences. For example, POC coagulation analyzers for use in monitoring heparin therapy, such as in a home setting, need only perform prothrombin time and activated partial thromboplastin time testing.

6. PTT analyzers used during cardiac surgery generally require activated clotting time testing and usually not PT or APTT testing capabilities. The most frequently ordered tests in a hematology point-of-care setting would be hemoglobin and/or hematocrit. A blood donor setting may only require hemoglobin testing, while an intensive care setting may require both, and a clinic may prefer one or the other.

7. Facilities considering a point-of-care testing program should perform a careful, detailed cost-benefit assessment of the current testing system compared with point-of-care testing. The ongoing costs of operating point-of-care instruments are often higher than the operating costs of central laboratory equipment, and this is on top of the initial capital investment. However, point-of-care testing may offer some benefits that reduce overall costs in the long run and improve patient care.

8. POC coagulation analyzers and coagulometers provide physicians with immediate results, and allow them to give faster, more appropriate diagnoses, which can eliminate unnecessary treatments and tests. Also prolonged hospital stays may be reduced, and unnecessary stays may be eliminated, as a result of more appropriate triage from EDs and pre-hospital settings. The time spent in ICU can be minimized, thus reducing treatment costs.

9. Different facilities must consider different factors when investigating the cost effectiveness of POC coagulation analyzer testing. These factors include the facility's average TAT, reagent and disposables costs, and test volume; the types of tests most often ordered, the areas in which point-of-care testing may be needed and the personnel performing the tests.

10. PTT analyzer use will decrease the average TAT for laboratory tests. With these devices, the intermediate steps involved with specimen transport are eliminated, and TAT is reduced to a little more than a period of analysis. If TAT can be reduced enough, the increase in reagent and disposables costs may be offset by reduced lengths of stay and improved quality of care.

11. This type of INR meter testing can also reduce the need for duplicate test runs due to error during sample transport and unnecessary tests performed as a result of delayed results. The cost of equipment and reagents can vary according to the test types. Certain tests are usually less expensive to run than others, and the instruments needed to perform such tests may be less expensive than other analyzers.

12. POC coagulation analyzer testing affects costs in several ways, depending on the areas of the facility in which it will be used. PTT analyzer and coagulation timer applications usually have more potential for savings and improved care when used in the ED, OR, and critical care areas.

13. The use of POC coagulation analyzer testing will affect staffing expenses as well. Time spent in transit by transport personnel is also likely to decrease with the reduction in specimen transport. It may be difficult to quantify many employee expenses but they should be carefully examined.

14. Before deciding to begin POC coagulation analyzer testing, facilities should explore other available options, such as pneumatic tube transport systems and satellite STAT laboratories.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying Polysomnography

Computerized analyzers for measuring, recording, and interpreting sleep related physiological functions, used in the diagnostic evaluation of insomnia, hypersomnia, apnea, and other sleep disorders

Somnography analyzers that are used for diagnostic evaluation of sleep related disorders. They use electrodes and other transducers to measure and record physiological functions of patients while they sleep. Additional audio/visual information is recorded for behavioral analysis . Software for processing and recording is included.

Tips for Buying Polysomnography

1. Before purchasing computerized polysomnography analyzers, facilities should carefully evaluate their clinical needs to ensure acquisition of proper equipment.

2. Buyers should consider operating and installation costs, including electrodes and adhesive gel, installation of network cables and interface devices, hardware and software maintenance, storage devices, and media.

3. These devices enable the study of a variety of physiologic activities simultaneously and are therefore useful diagnostic tools.

4. The standard polysomnography protocol should include: electroencephalography, electrooculography, electrocardiography, submental and limb electromyography, measurements of airflow, respiration, and blood oxygenation, and a collection of audiovisual information on patient behavior during sleep. The standard for each room should be one polysomnograph with at least 10 channels capable of continuous monitoring.

5. Montages should be user programmable or selectable, and the unit should have trending and full disclosure.

6. There are different operating systems, database management, networking, input and output, and data storage options. Data retrieval and storage options should be decided by clinicians.

7. Some models can only be used within the sleep clinic or laboratory, while others allow monitoring within the patient's home.

8. A quiet, appropriately furnished room free of interference from light and noise is necessary, in addition to the purchase of equipment. For the patient's comfort, an adjoining bathroom with a shower may be helpful in preparations for sleep.

9. Computerized polysomnography analyzers hold some advantages regarding costs, including a reduction in the amount of time needed to manually score polysomnograph readings, a decrease in storage requirements and the need for storage space, and eliminating the need for supplies such as paper, ink, and pens.

10. Some alternative means of monitoring sleep disorders exist, such as apnea monitors.

Questions for the Seller

Before you purchase your Polysomnography, we recommend you ask the seller the following questions:

Paremeters EEG

Does it include EOG?

Does it include EMG?

Does it include ECG?

Does it include respiration?

Does it include SpO2?

Does it include expired CO2?

Does it include body/limb movement?

Does it include audio/video monitoring?

Storage

Does it include a hard disk?

Does it include a floppy disk?

Does it include an optical disk?

Does it have a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrophysiology Recorders - Polysomnography

# Tips and Guidelines for Buying a Portable ECG

Data tape recorders used to record ECG in ambulatory patients

Portable recorders used to tape data using external chest electrodes and electrocardiograph. They are used for ambulatory patients that require real-time or retrospective analysis for detection of arrythmias and various heart diseases during a prolonged period of time.

Tips for Buying a Portable ECG

1. The time spent by cardiologists using a portable ECG interpreting ECG results can be decreased significantly using computerized electrocardiography.

2. Some cardiologists find this beneficial, while others feel it eliminates the necessary additional diagnostic accuracy that can be provided by the physician.

3. The purchase price of a portable ECG, as well as the life cycle costs of portable systems, varies depending on the recording medium, number of input leads, storage capabilities, and degree of technician involvement.

Questions for the Seller

Before you purchase your Portable ECG, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Long-Term ECG Recorders and Scanners

# Tips and Guidelines for Buying a Portal Imaging System

Image digitization systems for real-time verification of radiation treatment

Real-time verification of radiation treatment using fluoroscopic detection and image processing techniques, instead of traditional processing method. Image digitization systems include detector assembly (usually mounted on a linear accelerator gantry), computerized image processing system, hard copy printing and/or image storage.

Tips for Buying a Portal Imaging System

1. The performance of radiotherapy computer systems should be evaluated based on ease of use, accuracy and speed.

2. These systems are highly customized, and configured on a case-by-case basis.

3. Some of the basic requirements include: a linear accelerator, a simulator, radiotherapy planning system interfaces, treatment recording and verification, and certain administrative functions. Field size and the detector type are the most important variables to consider when buying a digital portal imager.

4. Facilities should consider the interfacing capability to other computer systems (e.g., hospital information systems), water phantom dissymmetry systems, computed tomography (CT) and magnetic resonance imaging (MRI) systems, and block cutting/milling machines.

5. Facilities need to make sure that the system they are about to buy is compatible with existing linacs and simulators. They should contact the linac and simulator manufacturers and check whether additional computer hardware, software, and interfaces are required. Usually, the manufacturers specify compatible linacs and simulators, as well as any additional hardware and software requirements.

6. By providing online monitoring and verification of treatment parameters, the real-time digital portal imaging systems and record-and-verify systems facilitate QC in the radiation therapy department. Departments that use a real-time digital system for portal imaging can reduce the time and cost of exposing and processing portal films.

7. Facilities need to evaluate the image quality obtained with a digital portal imaging system compared to that of radiographic portal films; surrounding anatomy present in a radiographic portal film may not be seen in an online portal image.

8. Some of the advantages of flat panel amorphous silicon-based EPIDs include: superior image quality for treatment setup verification and faster acquisition speeds. These units have been rapidly replacing camera and liquid-ion chamber-based EPIDs.

# Tips and Guidelines for Buying a Powered Wheelchair

Battery-powered wheelchairs for indoor and outdoor use. These electric models are heavier than manual chairs, and are suitable for users with limited upper body strength, or those who can't use self-propelled chairs

Battery-powered wheelchairs for indoor and outdoor use. While being heavier than manual chairs, electric models are suitable for users with limited upper body strength, or those who can't use self-propelled chairs. Models come in front, mid and rear wheel drive.

Tips for Buying a Powered Wheelchair

1. Safe electric wheelchair use requires proper maintenance.

2. Several levels of product support after purchase are offered. Buyers should consider the how easy it will be to obtain electric wheelchair replacement parts from the vendor or manufacturer, and how easily the operator could install replacement parts.

3. Buyers should also look at the availability of national or worldwide service facilities offered by the battery-powered wheelchair manufacturer or vendor, the length of time that the manufacturer/vendor has been in business, the availability of service policies and loaner if extended repairs are necessary, and whether the coverage policies for prescription electric wheelchairs set by third-party payers.

4. Facilities are encouraged to look at the ranges of electric wheelchair models that dealers have in stock, and available discounts for multiple purchases.

5. Buyers should also consider their need to schedule battery-powered wheelchair maintenance or repairs in advance, and the time it would take to order and receive a replacement.

6. Facilities should inquire about the general condition of the battery-powered wheelchair, including wheels, seat, tire, foot rests, armrests, etc. Photos of the tires, controls, battery box and wiring, and of the chair from all angles, can reveal signs of wear and tear.

7. The specified capacities of the electric wheelchair being considered should fit the patient's weight and size.

8. Prior to purchasing, facilities should complete the following: search for reviews of the electric wheelchair to learn about its features and reliability, review manuals and related paperwork that were supplied when the battery-powered wheelchair was originally purchased, inquire about the condition of the joystick and other controls, the motor housing, and the drive shaft - where it exits the motor, as well as the condition of the battery box, possible corrosion and the state of all wires and connectors.

9. Additional factors to consider include: the battery-powered wheelchair's size, ease of steering, seating comfort, transport capability, power, speed capacity, and battery life.

# Tips and Guidelines for Buying a Practice Management System

Data management information systems for physician's office and clinics

A system used by healthcare providers in private or group medical clinics or organizations. These systems have the appropriate hardware and software for patient record keeping and diagnosis, and for administrative tasks such as inventory, billing, and scheduling.

Tips for Buying a Practice Management System

1. Information practice management systems can provide different features to different buyers, based on intended use and special needs.

2. Practice management systems should be HL7 compliant and offer capabilities such as file back-up and system security (password protection).

3. There are many different practice management systems software packages for physician practice. Some are to be used within one office and don't track financial and clinical data from multiple sources.

4. If a practice is communicating regularly with a hospital or laboratory facility with existing information systems, an interface to their information practice management systems is a preferred feature.

Questions for the Seller

Before you purchase your Practice Management System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Clinical Features

Does it include patient profile?

Does it display diagnoses?

Does it print prescriptions?

Does it include ad hoc reporting?

Does it include clinical summaries?

Does it have print referrals?

Does it include nurse/physician assessment?

Does it include drug profiles?

Can it view multiple encounters?

Management Features

Does it have appointment scheduling capability?

Does it have physician orders (PO) capability?

Does it have scheduling pool capability?

Does it include hospital rounds scheduling?

Does it include insurance claims?

Does it include insurance authorization?

Does it include benefit coordination?

Does it include automatic billing?

Does it include family/individual record?

Does it include cycle billing?

Does it include installment?

Does it include flexible fee schedules?

Does it include daily physician activity summary?

Does it include patient/account histories?

Does it include inventory control?

Does it include patient chart log?

Does it include CPT code payments?

Does it include ICD9/ICD10 classification?

Does it include custom reports?

Does it include ad hoc reports?

Installation

Does it include hospital schedule system?

Does it include hospital registration?

Does it include hospital LIS?

Does it include hospital radiology info system?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Printer, Thermal

Thermal printers that produce hard copy from diagnostic imaging data

Printers that use heat to produce hard copy (paper or film) from diagnostic imaging procedures (CT, MRI, US, digital radiography, and others) They can be linked to hospital's computer network, and interfaced with most imaging modalities.

Tips for Buying a Printer, Thermal

1. Thermal printers can be grouped in four categories: small color ultrasound and multimedia units, large color ultrasound and multimedia units, grayscale ultrasound and multimedia units, and radiography units.

2. Color and grayscale are the two basic types of thermal printers that are available. These can be further broken down into a range of sizes, including small and large.

3. Radiography printers benefit from higher bit depths, ranging from 10 to 12, for increased image quality.

4. Facilities should make sure that the memory and throughput of the thermal printer they are about to purchase can handle the number of imaging devices that will be connected to it. They should also ensure that the thermal printer is able to accommodate their patient loads.

5. Departments that handle a heavy volume of images may consider purchasing a laser imager, which often has higher throughput than video thermal printers.

6. For all printer categories, ECRI recommends a throughput capability of 100 films/hour and 99 multiple originals.

7. Automatic calibration is also recommended for all units, to ensure higher image quality and to reduce human error.

8. Small color and grayscale ultrasound and multimedia thermal printers require an average of 2 gigabytes (GB) of hard-drive storage.

9. To accommodate increased throughput, large ultrasound, large multimedia, and radiography printers require an average of 4 GB.

10. Spatial resolution (the number of pixels) should be at least 300 dots per inch or 12.2 pixels/mm.

11. A thermal printer's contrast resolution, the number of gray or color levels, should generally display 8 bits, corresponding to 256 gray levels or 16 million colors.

12. To ensure higher image quality and to reduce human error, automatic calibration for all thermal printer categories is recommended.

13. Thermal printers have several advantages over wet-processing systems. First, they eliminate concerns about pollution and the need for processing chemicals. They also reduce some maintenance costs, such as: darkroom ventilation, chemical storage; and additional plumbing, electricity, and drainage. Thermal printers can be strategically placed almost anywhere in a facility.

14. Facilities should look into the thermal printer's interface options to ensure compatibility among the printer, the scanning devices, and the hospital computer network.

Questions for the Seller

Before you purchase your Printer, Thermal, we recommend you ask the seller the following questions:

General

What is the type of the Hard Copy - Film?

What is the type of the Hard Copy - Paper?

What is the size of the Hard Copy? (Length + Width). Please specify [cm] or [in].

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

# Tips and Guidelines for Buying a Prosthesis, Joint, Hip

Total hip joint replacement prostheses

Prostheses for total hip joint replacement in total hip arthroplasty procedures (THA), which is sometimes called total hip replacement (THR).

Tips for Buying a Prosthesis, Joint, Hip

1. It is essential to match a patient's activity level with the type of prosthesis implanted.

2. Before purchasing, facilities should consider cemented versus cementless fixation techniques and the design of associated components.

3. Buyers also need to consider the discounts given by the various suppliers, and the Medicare payments as they relate to the increasing costs of implant.

4. Facilities are strongly encouraged to standardize types of implants for cost effectiveness, and

to study the effectiveness of certain designs, patient types, and other parameters.

5. Facilities have shifted their use of expensive, all-porous coated hip implants to lower-priced hybrid devices over time. This was caused by cost-cutting efforts and managed-care pressures to use lower-cost devices whenever possible.

6. Facilities should carefully consider the cost of the prosthesis and related components. They should look into the costs of cement, instrumentation, and other supplies, as well as operating room time, length of the patient's hospital stay, nursing and rehabilitation, and other hospitalization costs.

7. Recycling opened, unused metal, or plastic implants may result in cost savings, as well as in reducing the amount of discarded, unused surgical supplies, and monitoring the amount of cement used during each procedure.

8. Other ways to help reduce costs associated with THA include establishing an implant and related supplies inventory tracking program, and increasing cost awareness among surgical staff.

# Tips and Guidelines for Buying a Prosthesis, Joint, Knee

Knee joint replacement prostheses (Total knee)

Knee joint prostheses for replacement in total knee arthroplasty(TKA) , or total knee replacement.

Tips for Buying a Prosthesis, Joint, Knee

1. Facilities should study the effectiveness of certain designs, patient types, and other parameters.

2. It is essential to match a patient's activity level with the type of prosthesis implanted.

3. Facilities are encouraged to standardize their equipment and choose one vendor when purchasing prostheses. This vendor should have the most complete product lines in all or most of the prostheses that will be needed.

4. Before purchasing implants, facilities should consider cemented versus cementless fixation techniques and the design of associated components.

5. Another important consideration should be the discounts given by suppliers.

# Tips and Guidelines for Buying a Pulmonary Stress Test

Whole systems intended to measure the pulmonary (and sometimes the associated cardiac) functions under stress conditions

Stress testing monitoring systems for evaluation of cardiac and/or pulmonary function. These systems can help determine various functional capacities of the individual being tested. They are also used in diagnosis of cardiac and/or pulmonary disease, by evaluating physiological response to physical stress ( use of treadmills and bicycle ergometers).

Tips for Buying a Pulmonary Stress Test

1. Pulmonary stress testing systems should perform, besides the required O2 and CO2 analysis, other procedures, such as: cardiac output evaluation, bronchial provocation, nutrition analysis, spirometry, plethysmography and metabolic equivalents.

2. Manufacturers of cardiopulmonary stress test units should specify whether a mask or mouthpiece is used to collect gases for analysis, as well as a list of all of the parameters analyzed by the pulmonary stress test system.

3. Facilities should carefully examine the present setting and future requirements regarding the projected volume of stress testing, patient diagnoses, and method of record keeping.

4. Many features are offered with these cardiopulmonary stress test units. Therefore, buyers should carefully evaluate each model to make sure all of the costs are identified before the actual purchase.

5. To ensure stability, the width of the base of the ergometer bicycle must be equal to 1/3 of the height; the feet should be adjustable in order to level the ergometer. It should mechanically or electrically brake, and its front wheel should be solid for safety reasons. The handlebars, seat, and pedals should be adjustable.

6. The treadmill for most cardiovascular stress testing should operate at 0-7 miles per hour, and elevate to grades from 0% to 20%.

7. The following are important factors when selecting a pulmonary stress test treadmill: durability, evenness of treads motion, physical design of the handrails, and type of displays available. Also the treadmill must include an emergency stop to stop the treadmill within 5 seconds, and the walking platform should be no less than 16 inches in width and 50 inches in length.

# Tips and Guidelines for Buying a Pulse Oximeter

Pulse oximeters that measure oxygenated and deoxygenated hemoglobin in arterial blood

Non-invasive pulse oximeters that continuously measure light absorbance changes that result from arterial blood flow pulsations, and determine relative amount of oxygenated and deoxygenated hemoglobin. Pulse oximeters include red and infrared light sources, photodetectors, and probes for light transmission through a pulsing artery. Some also measure and display heart rate.

Tips for Buying a Pulse Oximeter

1. Pulse Oximeter units can either be stand-alone or a module in a larger patient monitor.

2. Most pulse oximeters can interface with printers, recorders, computers, or multiparameter monitoring systems. It is important to make sure that the purchased unit is compatible with existing equipment.

3. The multiwavelength oximeter should display at least 70% to 100% SpO2 values with an accuracy of

4. The pulse oximeter probes should provide accurate measurements, while tolerating probe movement caused by the patients or clinicians.

5. In addition to SpO2 and pulse rate, the pulse oximeter should also display pulse strength and low battery.

6. Audible and visual alarms should alert for high and low SpO2/pulse rate, sensor off, and low battery.

7. Finger oximeter units usually operate on AC power, and many have battery backup as well. The unit should switch automatically to battery power if line power fails.

8. Multiwavelength oximeters intended for transport within the facility should operate at least four hours without charging.

9. Multiwavelength oximeters intended for transport outside the facility should operate at least eight hours without charging.

10. In case of a pulse oximeter that is unable to obtain accurate readings, there should be a clear indication, preferably with the reason.

Questions for the Seller

Before you purchase your Pulse Oximeter, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

General Information

Does it include a Printer/Recorder?

Does it have an external output?

Is it MRI compatible?

Does it include a self-test mode?

Does it include an alarm-volume control?

Does it include a battery?

Probe Types

Does it use a "finger type" probe?

Does it use disposable probes?

Does it use a reusable probe?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Pulse Oximeters

# Tips and Guidelines for Buying a Pump IV

Patient-controlled analgesic infusion pumps

Patient-controlled analgesic pumps are programmed to deliver analgesic drugs on demand, with safeguards that restrict the amount of drug that can be delivered over a predetermined period of time. They have several modes of delivery - continuous infusion, single demand dose, or demand dose plus continuous infusion. The pumps include software that stores accumulated data on total amount of drug delivered, including number of requests, date, and time.

Tips for Buying a Pump IV

1. The dose button on the IV pumps should be easily accessible and located on the bolus cord or pump. The patient should easily activate the dose button, and a recessed button or a double-activation requirement should prevent accidental activation. The PCA pump should acknowledge the request with an audible tone, a tactile response, or a visual display.

2. IV Pumps (Pain Control Syringe Pumps) should be able to log up to 200 events including: error codes, alarms, programmed settings, and dose delivery. The data should be retained for at least 1 year. The pain control syringe pump should be able to display dose, concentration, lockout interval, rate, patient requests, and alarm conditions.

3. Pain control syringe pumps should be designed to allow clinicians to limit access to the reservoir and controls with a lockbox, combination box, or digital code. Patient-controlled analgesic pumps should allow control of continuous (basal) rate, bolus volume, and time between boluses; the IV pump should be capable of delivery continuously from 0.1 to 99.9 ml/hr.

4. At least a 12-hour therapy should be supported by the dose delivery system, reservoir, and syringe. For home epidural analgesia unit use, longer operating times are preferable.

5. PCA pump systems that run entirely off of battery power should have batteries that can last for several days at nominal dose rates.

6. Line-powered PCA pumps should be able to charge independent of the main power switch. Epidural analgesia units should automatically switch to battery operation if line power fails, and run for at least 4 hours at the maximum dose rate.

7. Antisiphon valves should accompany intravenous analgesia unit pumps using glass syringes to prevent free-flow in case the syringe breaks.

8. Audible alarms or indicators should alert patients and staff to conditions such as low or depleted battery, occlusion, near end of infusion.

9. Occlusion alarm should be sound at >=6 psi. If complete occlusion occurs, the patient-controlled analgesic pump should alarm within three dose activations at every dose-volume setting.

10. Facilities should consider the ease of transport before purchasing. To facilitate transportation of epidural analgesia units, many suppliers offer specialized bags or pouches.

11. For most patient-controlled analgesic pump models, free flow protection depends on the use of tubing with an integral pressure activated valve, to connect the pump reservoir to the patient catheter. This valve should allow fluid to flow to the patient only when enough positive pressure is generated by the pump to open the valve.

12. The key issue of assessment for free-flow protection should be to determine if a tubing set is protected rather than whether a particular patient-controlled analgesic pump model is acceptable.

13. Facilities need to make sure they do not stock extension sets without a pressure-activated valve in clinical locations where PCA pumps are used.

14. Some pain control syringe pumps allow the use of larger reservoirs, which may require less frequent reservoir changes.

15. Some manufacturers of intravenous analgesia units offer prefilled reservoirs, which are usually more expensive than reservoirs filled by the pharmacy, but can be useful in small pharmacies with limited staff, and may also help avoid human errors and accidents associated with filling and labeling reservoirs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying a Rad Room, Analog

A complete general purpose film based radiographic system

General purpose conventional film based system. The basic components are: The generator, X-ray tube, control console, the table, cassette holder bucky, and AE unit. A chest stand may be included.

Tips for Buying a Rad Room, Analog

1. When choosing an Analog Rad room, storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of CR Radiographic Systems over film-based radiography.

2. The tilting tables allow a wide range of tilting movements from -15

3. The non-tilting tables specify a wide range of tabletop motions but do not allow tilting angles.

4. Digital or CR radiographic systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed in the radiographic table system in table-based units, preventing certain examinations due to patient positioning constraints. Some upright systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed before deciding which type of Analog Rad Room will better suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the radiographic table system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables, because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Buyers should take into consideration the Analog Rad Room system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Buyers of Analog Rad Rooms should consider generator options as well. High-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any network, compatibility with DICOM 3.0 is a requirement for all newly purchased equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail what information objects, service classes, and data encoding are supported by the Analog Rad Room system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate comparisons between suppliers.

Questions for the Seller

Before you purchase your Rad Room, Analog, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

What is the size of the detector (Length + Width)?

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

# Tips and Guidelines for Buying a Rad Room, Digital

A complete general purpose digital radiographic system

Direct digital (flat panel) system or CR system with an embedded CR reader. The basic system includes a generator X-ray tube, control console and digital image display, a table and a bucky. Chest stand may be included.

Tips for Buying a Rad Room, Digital

1. Storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of digital rad rooms over film-based radiography.

2. The tilting tables allow a wide range of tilting movements from -15

3. The non-tilting tables specify a wide range of tabletop motions, but do not allow tilting angles.

4. Digital radiographic table systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed on the digital radiographic table system in table-based units, preventing certain examinations due to patient positioning constraints. Some upright digital radiography systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed, before deciding which type of digital rad rooms will better suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the digital rad room system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables, because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Buyers of digital radiography should take into consideration the digital rad room system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Buyers of digital rad rooms should consider generator options as well. High-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any digital radiography network, compatibility with DICOM 3.0 is a requirement for all newly purchased digital radiography equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail which information objects, service classes, and data encodings are supported by the system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate comparisons between suppliers.

Questions for the Seller

Before you purchase your Rad Room, Digital, we recommend you ask the seller the following questions:

General

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

What is the size of the detector (Length + Width)?

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

X-Ray Digital Radiographic System - Operational

# Tips and Guidelines for Buying a Rad/Fluoro Room, Flat Panel

Digital radiographic (DR) and fluoroscopic system

DR detector (flat panel) replaces the role of the film and the image intensifier. Both radiographs and fluoroscopic images are acquired by the detector. The digital images can be exported, stored or processed later.

Tips for Buying a Rad/Fluoro Room, Flat Panel

1. Storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of digital radiography (flat panel fluoro rooms/flat panel rad rooms) over film-based radiography.

2. The tilting tables allow a wide range of tilting movements from -15

3. The non-tilting tables specify a wide range of tabletop motions but do not allow tilting angles.

4. Digital radiographic systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed in the table system in table-based units, preventing certain examinations due to patient positioning constraints. Some upright systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed before deciding which type will best suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Buyers of flat panel fluoro rooms/flat panel rad rooms should look into the fluoroscopic table system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Buyers of digital RF equipment should consider generator options as well. High-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any flat panel fluoro room/flat panel rad room network, compatibility with DICOM 3.0 is a requirement for all newly purchased equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail which information objects, service classes, and data encodings are supported by the system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate comparisons between suppliers.

Questions for the Seller

Before you purchase your Rad/Fluoro Room, Flat Panel, we recommend you ask the seller the following questions:

General

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

What is the size of the detector (Length + Width)?

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

X-Ray Digital Radiographic System - Operational

# Tips and Guidelines for Buying a Rad/Fluoro Room, Image Intensifier

Conventional radiographic and fluoroscopic equipment

Radiographic and fluoroscopic system, based on film radiography and image intensifier derived fluoroscopy (fluoroscopic image may be converted into a digital format such as DICOM 3.0). Chest stand may be included.

Tips for Buying a Rad/Fluoro Room, Image Intensifier

1. Storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of digital radiography over film-based radiography. Image intensifiers increase the intensity of available light in an optical system to allow use under low light conditions such as at night, to facilitate visual imaging of low-light processes such as fluorescence of materials to x-rays or gamma rays, or for conversion of non-visible light sources such as near-infrared or short wave infrared to visible.

2. The tilting tables allow a wide range of tilting movements from -15

3. The non-tilting tables specify a wide range of tabletop motions but do not allow tilting angles.

4. Digital radiographic systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed in the table system in table-based units, preventing certain examinations due to patient positioning constraints. Some upright systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed before deciding which type of image intensifier will better suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the image intensifier system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Buyers should take into consideration the image intensifier system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Buyers should consider generator options as well. High-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any network, compatibility with DICOM 3.0 is a requirement for all newly purchased equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail which information objects, service classes, and data encodings are supported by the system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate comparisons between suppliers.

Questions for the Seller

Before you purchase your Rad/Fluoro Room, Image Intensifier, we recommend you ask the seller the following questions:

General

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

What is the size of the detector (Length + Width)?

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiographic and Fluoroscopic System - Operational

# Tips and Guidelines for Buying a Radiation Counter

Geiger-Muller radiation meter

Geiger-Muller radiation meters for detection of low level radiation. These meters are sensitive enough to detect a single ionization event. A pressurized cylinder contains a mixture of helium, neon, or argon, and a quenching gas. A metal rod running through the center acts as the anode, the cathode is the cylinder wall. An ionization chain-reaction is produced as ionization radiation enters through a window on the front of the cylinder. A pulse counter registers each reaction and quenching as a pulse displayed on a meter.

Tips for Buying a Radiation Counter

1. For detailed calibration requirements of specific survey meters, facilities should contact the appropriate regulatory agencies.

2. All radiation counters should have an audio speaker.

3. These radiation counter units should detect, at minimum, gamma and x-ray radiation, with a shorter response time than 20 seconds.

4. Radiation counters that are battery-powered should provide a low-battery alarm - visible and audible - to alert when battery voltage falls below the level needed for an adequate operation.

# Tips and Guidelines for Buying a Radiation Detector

**Radiation meters using ionization chamber (dosimetry)**

Radiation measuring meters using an ionization chamber to measure exposure rates and quantity for a wide- range of radiation emissions (dosimetry). A gas filled chamber contains anode and cathode conducting plates, which create an electric current when gas molecules are ionized. This current is then measured by an electrometer, and displays exposure rates in R/hr and or dose equivalents in Sv/hr.

Tips for Buying a Radiation Detector

1. Radiation detectors should detect gamma and x-ray radiation, at minimum, with a response time that is no more than 20 seconds.

2. For detailed calibration requirements of specific survey radiation detector meters, facilities should contact appropriate regulatory agencies.

3. If battery voltage falls below the level to perform adequately, a low-battery alarm - visible or audible - should alert the user. Radiation monitors should also have easily rechargeable batteries.

4. There are new radiation detector designs with large-volume ionization chambers for exposure and dose equivalent measurement.

5. There is a potential for error in exposure measurements whenever the volume of the ionization chamber increases. This is due to recombination losses and polarity effects.

6. An accredited or national radiation detector laboratory should calibrate for proper polarity and minimal recombination loss before any ionization chamber is used for exposure measurements. Failing to do so could lead to a significant error in radiation monitor exposure measurements.

# Tips and Guidelines for Buying a Radioaerosol Delivery Kit

Disposable kits for radioaerosol administration

A disposable kit for administering radioactive aerosols. These sets include nebulizer, several one-way valves for flow direction, tubing for transport of aerosol from nebulizer to patient, mouthpiece, and bacteria filter.

Tips for Buying a Radioaerosol Delivery Kit

1. When purchasing this type of equipment, the most important factor to consider is the mass mean aerodynamic diameter of the aerosol droplets produced by the nebulizer - a measure of the average particle size. This should be 0.4 μm or smaller.

2. Facilities need to evaluate the cost of the radio aerosols used in lung scanning. 99mTc DTPA imaging provides mainly the same information and with the same quality as 81mKr imaging. Hhowever, it is much more cost-effective than 81mKr, especially for smaller facilities, where the cost of using 81mKr for a few patients is excessive. 99mTc is also applicable in many nuclear medicine studies.

3. The filter and the radiation shielding protect against radioactive contamination. For safety, both should have efficiency percentages in the region of 99.9%.

4. The disposable components of this set are usually inexpensive and come packaged in one kit.

5. Manufacturers offer different designs and costs for reusable lead shields. Some offer free or discounted shields with volume purchases of disposables.

Questions for the Seller

Before you purchase your Radioaerosol Delivery Kit, we recommend you ask the seller the following questions:

General Information

Is a scavenging device necessary?

Disposable Components

Does it include a filter?

Does it include tubing?

Does it include one-way valves?

Does it include a nebulizer?

Does it include a mouthpiece?

Optional Accessories

Does it include oxygen tubing and adapter?

Does it include reusable face mask/mouthpiece?

Does it include a respirator unit?

Does it include a head harness?

# Tips and Guidelines for Buying a Radiographic Phantom

Phantoms for radiography

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of radiation absorption and dose distribution, for research and testing purposes.

Tips for Buying a Radiographic Phantom

1. With the increasing emphasis on QA/QC programs, hospitals should consider purchasing radiographic phantoms to test system performance on a regular basis (e.g., daily, weekly, monthly), particularly for modalities such as radiography, fluoroscopy, and radiotherapy, in which patient radiation exposure is a concern. For U.S. mammography departments and facilities, x-ray phantoms that meet the requirements of an accreditation program or MQSA should be purchased. Some facilities create their own biopsy training radiographic phantoms from inexpensive materials, to save on costs.

Questions for the Seller

Before you purchase your Radiographic Phantom, we recommend you ask the seller the following questions:

DICOM 3.0

Import?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms

# Tips and Guidelines for Buying a Radiographic Photospot Camera

Radiographic photospot fast image recording cameras used for direct radiography

Fast Image recording cameras used for direct radiography. Specially designed cameras which can expose film in a higher format.

Tips for Buying a Radiographic Photospot Camera

1. Before purchasing a radiographic photospot camera, medical facilities should consider the types of procedures to be performed and determine the table tilt, travel, image intensifier size, and image processing methods that will best suit their needs.

2. X-ray photospot unit purchasers should also look into the following issues: heat dissipation rate, and heat capacity of the x-ray tube anode.

3. In any given tube, only 0.2% of the electrical energy delivered to the anode is converted to x-rays; the rest is converted to heat, which if not quickly dissipated, will destroy the anode.

4. Photofluoroscope digital cameras are used to capture both fluoroscopic and fluorographic images taken during fluoroscopic exams.

5. In order to meet the needs of both photofluoroscopic and photospot images, specifications for x-ray photospot unit cameras must be as high as possible.

6. For some advanced interventional procedures that require longer imaging times, high heat capacity tubes are especially important. The anode heat capacity should be at least 350,000 heat units.

7. Buyers of radiographic photospot cameras need to consider the focal spot size of the anode. A smaller focal spot provides better quality images but does not dissipate heat as well as a larger one. It also requires a larger anode heat capacity than a larger focal spot does.

8. Magnification angiographies require a focal spot size of 0.3 mm or less, while larger sizes are ideal for investigating chemic heart disease.

9. To accommodate the many different procedures performed, facilities may need additional equipment such as patient monitors, defibrillators, contrast injectors, software for specific imaging such as cardiac or vascular, and emergency resuscitation devices.

Questions for the Seller

Before you purchase your Radiographic Photospot Camera, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Did this equipment pass the American College of Radiology (ACR) accreditation?

X-ray Tube

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiographic and Fluoroscopic System - Operational

# Tips and Guidelines for Buying a Radioisotope Calibrator

Calibrators for measuring radiopharmaceutical ionization production

Radioisotope calibrators are used to measure activity in prepared concentrations of radiopharmaceuticals before administration, and to measure the activity of radionuclide impurities. Total amount of radiopharmaceutical ionization production from syringes, vials, or capsules is detected and measured using Curie or Becquerel scale. These calibrators include power supply, ionization chamber, sample holders, amplifiers, electrometer, and display. Controls adjust for different isotopes. Some calibrators are capable of measuring both high-energy gamma and beta nuclides, high-dose brachytherapy and/or PET isotopes.

Tips for Buying a Radioisotope Calibrator

1. Radioisotope calibrators are used to assay vials and syringes containing radioactive isotopes before administration to patients.

2. High accuracy and repeatability are two essential characteristics of PET radioisotope calibrators.

3. Facilities should choose a radionuclide dose calibrator based on the range and type of isotopes that will be assayed and the level of automation required.

4. The more advanced radioisotope calibrator units offer buyers more calibration factors built-in and more automated documentation features.

5. Facilities should also consider the amount of built-in lead shielding when purchasing a radioisotope calibrators. Higher energy and higher activity isotopes may require more lead shielding than is built in. Additional shielding with specially designed lead blocks can be added.

6. The operating environment immensely affects the radionuclide dose calibrator performance. Therefore, buyers are encouraged to evaluate radioisotope calibrator performance on-site for linearity, geometric variation, accuracy, and constancy, and compare the findings with the manufacturer's specifications. These tests should be performed prior to putting a new unit in service, after repair, and at regular intervals.

7. Sample container, sample position within the well, and sample volume are all responsible for the radionuclide dose calibrator response to differences in sample geometry.

8. Depending on whether the sample is in a vial or a syringe, the readouts of equal activities can differ. Readings of 125I and 133Xe are known to vary widely, depending on the container used, and usually require a correction factor to compensate for the differences.

9. Plastic sample holders and deep-well detectors have eliminated the adverse effects of varying sample positions within the well. Deep wells best approximate 4 geometry, the best situation in which the sample is completely surrounded by the sensitive volume of the ionization chamber.

10. A standard with a long half-life, such as 137Cs, is the best for measuring radioisotope calibrator constancy. Sample readings of the same source taken at 24-hour intervals should agree within 5%.

11. To determine the PET radioisotope calibrator accuracy, the certified activity of a traceable standard is measured. The average of three consecutive readings should match the certified activity within 5%. Users should repeat the test for standards of various energies.

12. The overall accuracy depends on the combined accuracy of the detector, the electrometer, the digital readout, and the traceable standard.

Questions for the Seller

Before you purchase your Radioisotope Calibrator, we recommend you ask the seller the following questions:

General

What is the energy range?

System Features

Does it include a well liner?

Does it include a syringe holder?

Does it include a vial holder?

Does it include a 99Mo shield?

Does it include a printer?

System Operation

Does it have a microprocessor control?

Does it have automatic ranging?

Does it have dose computation?

Does it have a permanent record printout?

Certification

Was it certified?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Calibrators, Radiopharmaceutical

# Tips and Guidelines for Buying a Radiotherapy CT Simulator

Simulation systems for radiotherapy treatment planning using CT scanner

Simulation systems for radiotherapy treatment planning. A CT scanner, usually with a wide bore, is used together with a treatment planning computer to delineate treatment field and mark patient for radiotherapy. These systems are also used for 3-D image analysis, to verify tumor margins, and to track tumor regression.

Tips for Buying a Radiotherapy CT Simulator

1. Buyers of radiotherapy CT simulators must make sure that the patient can be positioned with respect to the beam in such a way that radiotherapy is simulated as close as possible to the patient.

2. The radiation treatment simulation system should, therefore, have a SAD ranging from 80 to 150 cm and a source-to-image distance (SID) ranging from 80 to 200 cm.

3. The gantry should be able to rotate

4. To allow for proper patient positioning, the patient table should be capable of a wide range of translations and rotations.

5. The radiotherapy CT simulator should be capable of

6. To enhance details and minimize the image width of the treatment area, smaller focal spot sizes of 0.6 mm or 1 mm are preferred.

7. To meet minimum recommendations, the radiotherapy simulator should have an image x-ray field of 45 cm2 at 100 cm SAD, a 12

8. Radiotherapy CT simulator systems should include the following standard system components: CT gantry, laser alignment, control console, and workstation. If the CT scanner is not included, the CT simulation system should be able to interface with any DICOM-compatible CT scanner.

9. The scanner should have a large bore diameter of 70-80 cm, a 60 cm maximum field of view, and multislice capability with 0.5, 1, 2, 4, 5, and 10 mm slice widths.

10. The radiotherapy CT simulator system should be able to reconstruct 20 images per second, digitally reconstruct radiographs in less than 1 second, and instantaneously reconstruct with beam's-eye-view.

11. Networking and system interfacing are also important considerations when purchasing a radiotherapy CT simulator.

12. The radiation treatment simulation system should include a shielded room for the radiotherapy CT simulator and x-ray generator, as well as separate control and treatment planning rooms. The control room should be separated from the simulator room by a large lead glass or plate-glass window.

13. Some radiotherapy CT simulation systems may require the use of a pit for installation. This provides both an anchor for the base of the radiotherapy simulator system and a conduit for cables and wiring.

Questions for the Seller

Before you purchase your Radiotherapy CT Simulator, we recommend you ask the seller the following questions:

General

Does the system include a printer?

X-Ray Field Size

Independent X & Y axes?

Motorized?

Treatment Field Delineation

Independent X & Y axes?

Motorized?

Image Intensifier

Auto brightness?

Safety Devices

Anticollision?

Does it have an emergency off switch?

Does it have warning lights?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

CT System - Stored

CT System - Operational

Suprevision Forms

CT System - Dismantling

CT System – Packaging

# Tips and Guidelines for Buying a Radiotherapy Phantom

**Phantoms for radiotherapy**

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of radiation absorption and dose distribution, for research and testing purposes. Also assists in treatment planning.

Tips for Buying a Radiotherapy Phantom

1. With the increasing emphasis on QA/QC programs, hospitals should consider purchasing phantoms to test system performance on a regular basis (e.g., daily, weekly, monthly), particularly for modalities such as radiography, fluoroscopy, and radiotherapy, in which patient radiation exposure is a concern. For U.S. mammography departments and facilities, phantoms that meet the requirements of an accreditation program or MQSA should be purchased. Some facilities create their own biopsy training phantoms from inexpensive materials to save on costs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms

# Tips and Guidelines for Buying a Radiotherapy Planning System

Computer system for radiotherapy planning

A computerized system for radiotherapy planning, in treatment of cancer and related diseases. Radiation doses are calculated and areas for stereotactic radiosurgery procedures are targeted, for optimal effect and minimizing dose.

Tips for Buying a Radiotherapy Planning System

1. The performance of these radiotherapy planning systems is evaluated based on three main factors: ease-of-use, accuracy and speed of treatment calculations.

2. Facilities should consider the radiotherapy project system's capability to interface with other computer systems, water phantom dosimeter systems, CT and MRI systems, and block cutting or block-milling machines. In addition, buyers should evaluate the costs of support, upgrade, installation, and networking.

3. Facilities with multiple mega-voltage treatment units and electron beam capabilities must examine the number of treatment planners available, the number of patients treated per day, the legal requirements for patient data archiving, the scope of data needed for storage, and the accuracy of calculations provided. They need to know the relative frequency and importance of electron-beam calculations in their practice.

4. Most of the available radiotherapy planning systems conform to the National Electrical Manufacturers Association DICOM Standard guidelines for radiotherapy equipment.

5. Facilities are encouraged to perform acceptance testing to ensure that results obtained from the new radiotherapy project system can be compared with those from previously used methods.

6. Radiotherapy project system buyers should obtain service contracts from the supplier, including support for both hardware and software.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Radiotherapy Simulator

**Simulation systems for radiotherapy that perform radiographic or fluoroscopic imaging**

Radiographic and/or fluoroscopic imaging is used in radiotherapy treatment planning to determine, document, and mark area to be treated. Both therapeutic and radiology techniques are used for simulation purposes.

Tips for Buying a Radiotherapy Simulator

1. Radiotherapy simulator buyers must make sure that the patient can be positioned with respect to the beam in such a way that radiotherapy is simulated as close as possible to the patient.

2. The radiation treatment simulation system should, therefore, have a SAD ranging from 80 to 150 cm and a source-to-image distance (SID) ranging from 80 to 200 cm.

3. The gantry should be able to rotate

4. To allow for proper patient positioning, the patient table should be capable of a wide range of translations and rotations.

5. The radiotherapy simulator should be capable of

6. To enhance details and minimize the image width of the treatment area, smaller focal spot sizes of 0.6 mm or 1 mm are preferred.

7. To meet minimum recommendations, the radiotherapy simulator should have an image x-ray field of 45 cm2 at 100 cm SAD, a 12

8. CT-based RF radiotherapy simulation systems should include the following standard system components: CT gantry, laser alignment, control console, and workstation. If the CT scanner is not included, the radiotherapy simulator system should be able to interface with any DICOM-compatible CT scanner.

9. The scanner should have a large bore diameter of 70-80 cm, a 60 cm maximum field of view, and multislice capability with 0.5, 1, 2, 4, 5, and 10 mm slice widths.

10. The radiation treatment simulation system should be able to reconstruct 20 images per second, digitally reconstruct radiographs in less than 1 second, and instantaneously reconstruct with beam's-eye-view.

11. Networking and system interfacing are important considerations.

12. The radiotherapy simulator suite should include a shielded room for the simulator and x-ray generator, as well as separate control and treatment planning rooms. The control room should be separated from the simulator room by a large lead glass or plate-glass window.

13. Some radiotherapy simulator systems may require the use of a pit for installation. This provides both an anchor for the base of the simulator and a conduit for cables and wiring.

Questions for the Seller

Before you purchase your Radiotherapy Simulator, we recommend you ask the seller the following questions:

X-Ray Field Size

Independent X & Y axes?

Motorized?

Treatment Field Delineation

Independent X & Y axes?

Motorized?

Image Intensifier

Auto brightness?

Safety Devices

Anticollision?

Does it have an emergency off switch?

Does it have warning lights?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

RF Radiotherapy Simulation Systems

# Tips and Guidelines for Buying a Radiotherapy Verification System

Radiotherapy computer system for verification of treatment parameters during therapy

Computers for use during radiotherapy to verify treatment parameters, tracking patients, and radiation doses. If errors are detected, can override radiation beam. Can be used for various information management and administrative functions, e.g. entering data and reports, schedules, and billing.

Tips for Buying a Radiotherapy Verification System

1. The performance of radiotherapy computer systems should be evaluated based on ease-of-use, accuracy, and speed.

2. These systems are highly customized, and configured on a case-by-case basis.

3. Some of the basic requirements include: a linear accelerator, a simulator, radiotherapy planning system interfaces, treatment recording and verification, and certain administrative functions. Field size and the detector type are the most important variables to consider when buying a digital portal imager.

4. Facilities should consider the interfacing capability to other computer systems (e.g., hospital information systems), water phantom dissymmetry systems, computed tomography (CT) and magnetic resonance imaging (MRI) systems, and block cutting/milling machines.

5. Facilities need to make sure that the system they are looking into purchasing is compatible with existing linacs and simulators. They should contact the linac and simulator manufacturers and check whether additional computer hardware, software, and interfaces are required. Usually, the manufacturers specify compatible linacs and simulators, as well as any additional hardware and software requirements.

6. By providing online monitoring and verification of treatment parameters, the real-time digital portal imaging systems and record-and-verify systems facilitate QC in the radiation therapy department. Departments that use a real-time digital system for portal imaging can reduce the time and cost of exposing and processing portal films.

7. Facilities need to evaluate the image quality obtained with a digital portal imaging system compared to that of radiographic portal films; surrounding anatomy present in a radiographic portal film may not be seen in an online portal image.

8. Some of the advantages of flat panel amorphous silicon based EPIDs include superior image quality for treatment setup verification and faster acquisition speeds. These units have been rapidly replacing camera and liquid-ion chamber based EPIDs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Refractometer, Laboratory

Refractometers for laboratory use

Refractometers used for testing urine samples. They indicate refractive index, serum/plasma protein presence in the urine, and specific gravity of urine.

Tips for Buying a Refractometer, Laboratory

1. Three categories cover all the specifications for urine screening instrument devices: required, preferred, and optional.

2. Specifications covered by the required category are the minimum specifications necessary for the bacteriuria detection analyzer to perform its indicated function.

3. Specifications enhancing the urine screening instrument's effectiveness by improving test operations or ease-of-use fall under the preferred category.

4. Specifications that enable a wider range of applications by offering greater testing options or minimizing user interaction, or allowing the bacteriuria detection analyzer to be operated effectively under a wide variety of circumstances fall under the optional category.

5. Several factors may determine which bacteriuria detection analyzer to purchase, including the location of the instrument in the facility, cost, purpose, ease-of-use, and number of urine specimens analyzed per day or work shift.

6. Devices that should be best considered for emergency departments or ICUs are ones that provide specific gravity results quickly, are simple to operate, and are easily transportable, such as a handheld refractometer or a simple reagent strip analyzer.

7. Reflectance analyzers and portable refractometers provide readings that are suitable for urine specific gravity screenings, though they are not as accurate as laboratory refractometers. 8. Only laboratory refractometers should be considered for laboratory use, which requires highly accurate data for medical diagnoses.

# Tips and Guidelines for Buying Safety Eyewear

Eyeware used for protection during laser procedures

Eyeware with filter glass used during laser procedures. Laser wavelength can be specified to offer adequate protection.

Tips for Buying Safety Eyewear

1. For every laser used in the facility, the laser safety officer should select the right eye protection and determine the NHZ for each.

2. Wearing vision-correcting eyeglasses alone does not protect against most laser wavelengths.

3. Comfortable, size-adjustable eyewear can reduce fatigue.

4. Side and brow coverage is another preferred feature.

5. There are several types of laser safety eyewear. Before purchasing, facilities should consider the following: the amount of peripheral protection desired, the field of vision, the user's face and head shape, and whether the user is wearing vision-correcting spectacles.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Audiometers

# Tips and Guidelines for Buying a Scale, Chair

Scales designed to weigh patients directly from a chair or wheelchair

Weighing mechanisms designed for patients who cannot stand on conventional scales. Some have a ramp and platform suitable for wheelchair access, with the weighing mechanism on a separate column with control and display console. Other models don't have a platform, and place the weighing mechanism under the chair.

Tips for Buying a Scale, Chair

1. Regardless of patient position, chair scales are designed to provide accurate weight readings.

2. These chair scales are used for routine weighing of patients who are disabled, elderly, or weak, and therefore cannot stand on a conventional scale.

3. To measure body fluid gain and loss during dialysis, specialized chair scales should monitor patient weight continuously and accurately over several hours with negligible drift.

4. Weighing chairs may use two basic types of weighing mechanisms: mechanical and electronic.

5. In the weighing chair's mechanical scales there's a beam-balance configuration in which a lever arrangement transmits forces from the floor platform to the beam.

6. Weight is sensed directly in the electronic scales by means of transducers in the weighing chair platform.

7. There are also electromechanical units, in which the patient's weight causes a mechanical deflection, which is transmitted by a beam to a linear variable differential transformer, which then produces a voltage in proportion to the deflection of the beam.

# Tips and Guidelines for Buying a Sigmoidoscope

Sigmoidoscopes intended for insertion through rectum into lower GI tract

Flexible endoscopes with illumination system. They are intended for insertion into lower GI tract through the rectum. Sigmoidoscopes are used for treatment of lesions in the lower part of the colon, as well as for observation and biopsy procedures.

Tips for Buying a Sigmoidoscope

1. The most important quality of the sigmoidoscope's image is the optical quality.

2. The following factors determine this quality: the ability of the fiberoptic cables and the light source to adequately illuminate the area under view; and the ability of the lens system to transmit a clear and bright image with minimal distortion to the eyepiece.

3. When making a sigmoidoscope purchase, facilities should consider the device's sensitivity to heat, the time and temperature of rinsing required, the reuse life of the cleaning solution, and the use of manual or automatic processing.

4. Other issues to consider include: shelf life, disposal restrictions, and minimum effective concentration of the cleaning solution.

5. Sigmoid colon endoscope buyers should also examine the safety and cost per cycle, as well as the educational options provided by the manufacturer. They should keep in mind that preventive maintenance training can eliminate costly repairs to delicate sigmoidoscope components.

6. The differences between these sigmoidoscope units include differences in image brightness and resolution, depth of focus, magnification, color differentiation, angle of vision, and field of view.

7. Videoscopes depend on the number of pixels on the CCD to illuminate the area under view, while fiberoptic sigmoidoscopes depend on the light guide.

8. Videoscopes and fiberoptic sigmoidoscopes with cameras depend on the ability of image processors to transmit clear images to the viewing screen.

9. All sigmoidoscopes should be compatible with multiple processors. They should also be compatible with multiple light sources.

10. Users can clean the lens without removing the sigmoidoscope using lens washing.

11. Buyers should look into the cleaning process of the sigmoidoscope. They should carefully review their endoscope reprocessing protocol to make sure it coincides with the recommendations from the manufacturer.

12. In places where EtO gas sterilization is the preferred reprocessing procedure, there might be an increased need for more sigmoid colon endoscopes in order to meet daily caseload requirements.

13. There are users who want to automate part of their reprocessing with liquid disinfecting or sterilizing units.

14. When reviewing high-level disinfection or sterilization, facilities should look into the operator manual as well as the facility's infection control and risk management.

Questions for the Seller

Before you purchase your Sigmoidoscope, we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Endoscopes

# Tips and Guidelines for Buying a Silver Recovery Cartridge

Silver recovery system using the principle of metallic replacement

Silver recovery systems are used to restore silver soluble from the x-ray fixer solution. This is done using the principle of metallic replacement by using special cartridges.

Tips for Buying a Silver Recovery Cartridge

1. Radiology departments can select silver recovery plans in a wide variety of options. The department can purchase, operate, and maintain its own equipment and then sell the silver, or it can hire an outside firm to perform these functions.

2. Before choosing a silver recovery system, facilities should compare the costs for maintaining their own program with the proposals of several outside firms.

3. Facilities should consider the following before making a purchase: ease of operation, recovery efficiency, environmental regulations, film processing volume, initial and maintenance costs, local dealer support, and revenues from recovered silver.

# Tips and Guidelines for Buying a Silver Recovery Unit

Silver recovery systems using electrolytic plating cells

Silver recovery systems are used to restore silver soluble from the x-ray fixer solution, and other silver-soluble solutions. This is done using electrolytic plating cells.

Tips for Buying a Silver Recovery Unit

1. Radiology departments can select silver recovery plans in a wide variety of options. The department can purchase, operate, and maintain its own equipment and then sell the silver, or it can hire an outside firm to perform these functions.

2. Before choosing a silver recovery system, facilities should compare the costs for maintaining their own program with the proposals of several outside firms.

3. Facilities should consider the following before making a purchase: ease of operation, recovery efficiency, environmental regulations, film processing volume, initial and maintenance costs, local dealer support, and revenues from recovered silver.

# Tips and Guidelines for Buying a Single Channel ECG

Single channel electrocardiographs

Single channel electrocardiographs that can receive electric signals from up to 12 leads. Signals are recorded in sequence, either operator selected or automatically regulated.

Tips for Buying a Single Channel ECG

1. The Single Channel ECG (single channel EKG) device should measure all basic axes and durations including, RR, PQ, QT, ATC, P, QRS, T, and HR. It should have indicators for battery status, loose electrode contact, system status, and artifacts.

2. The Single-Channel Electrocardiograph should be able to store ECG waveforms for later retrieval, printing, and transmission to enable entering patient data by the operator. Each record should include the patient's name or ID number, age, sex, weight, and height as well as the recording date and time, sensitivity setting, chart speed, and leads being recorded.

3. The Single Channel ECG device should have an RS232 port or another appropriate digital interface to allow communications with other electrocardiographs, computers, or data management systems. It should store at least 20 ECGs and have expandable storage capability.

4. The Single Channel ECG device should provide sensitivity settings of at least 2.5, 5, 10, and 20 mm/mV; the recorders will have a chart speed of 5, 10, 25, and 50 mm/sec.

5. The batteries in a battery-operated Single Channel EKG unit should be rechargeable. This type of unit should operate on a battery for at least 8 hours and should be able to be charged while connected to line power.

6. Battery-powered Single Channel ECG units should have a clear low-battery indicator on the outside of the unit, to make sure the batteries are being recharged. Plugging the charger into an AC outlet is not sufficient.

7. Single channel electrocardiographs are cheaper than other electrocardiography recorders. They are also light, simple, and compact, and therefore convenient for use in special situations of rapid testing - often outside the usual clinical setting.

8. Spare parts for single-channel ECG unit devices are often available and inexpensive and the maintenance of these instruments is fairly simple.

9. Some electrocardiographs can store rhythm strips for later retrieval. Some systems allow transmission of ECG data, and many others can communicate with a data management system, allowing the report to be stored.

10. Optional carts may be used to turn the larger Single Channel ECG devices into more transportable units, to provide a working surface for the user, and to store spare lead wires, electrodes, and recording paper.

Questions for the Seller

Before you purchase your Single Channel ECG, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Recorder

Is a lead marker included?

Is a timing marker included?

Leads

What are the lead switching options?

What is the calibration signal option?

Usage

Is it for neonatal use?

Is it for pediatric use?

Is it for adult use?

General Information

Does it include ECG Transmission?

Does it include interpretation?

Does it include auxiliary output?

Does it include auxiliary input?

Does it include defibrillator overload protection?

Is it battery operated?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Electrocardiographs

# Tips and Guidelines for Buying Slide Stainers, Hematology

Automated slide stainers for hematology and microbiology laboratory

Slide stainers using different staining methods in an automated procedure that can be pre-programmed according to different specifications. A transport arm moves slides through parallel reagent vessels.

Tips for Buying Slide Stainers, Hematology

1. Slide stainers should come equipped with audible alarms. It is preferred that they have visual alarms as well. Facilities should determine waste disposal and water requirements on a case-by-case basis.

2. To remove excess reagents, some units offer circulating water washes. These models require separate water and waste lines or containers to prevent contamination of subsequent staining vessels.

3. Stainers that drain into sinks or a wastewater line must operate according to local wastewater treatment regulations; in some areas, these regulations may forbid the dumping of biohazard material into the main sewage system. State and local laws may require facilities to dispose of reagent runoff and specimen slides as chemical and/or medical waste.

4. There are systems with self-enclosed waste tanks for containing reagent waste.

5. Before making the purchase, facilities need to consider the operating costs of hematology or microbiological slide stainers. Buyers should keep in mind the ongoing expense for reagents.

6. Some models are designed to accept only reagents packaged in specific containers, so facilities need to keep in mind that there are manufacturers who do not permit reagent substitution on their units. However, many devices do accept stains, solvents, and other materials from various suppliers, and this offers significant cost savings. It is not recommended for a laboratory to depend on one supplier's prices for reagent supplies, and it is always better to select from many brands and not be limited to just one.

# Tips and Guidelines for Buying Slide Stainers, Histology

Automated slide stainers suitable for different staining techniques

Automated slide stainers using rotating or linear transport processing systems. Tissues are prepared for dye diffusion using different techniques (direct, indirect, or mordant staining, or surface absorption). Slides are moved either using a circular turntable or linear conveyer belt. Some have integrated fume hoods to protect laboratory personnel from exposure.

Tips for Buying Slide Stainers, Histology

1. When purchasing a histology slide stainer, facilities should primarily look at safety and waste management aspects.

2. Hematology slide stainers should come equipped with audible alarms. It is recommended that they have visual alarms as well, and manual interrupt or cycle override options.

3. To determine if they require an automatic slides stainer device with a slide dryer or incubator, facilities should carefully evaluate their own needs.

4. Hematology slide stainers with programmable cycle control are much more desirable and so are hematology slide stainers with agitation capabilities to allow for stain-optimization.

5. During the slide staining process, fume extraction is necessary, and therefore hematology slide stainers with fume extraction mechanisms are recommended.

6. Water washes are used in the rotating and linear transport configurations to remove excess stain from the slides and to prevent contamination of subsequent staining vessels with other stains. This requires the use of water and waste lines or containers. Some automatic slides stainer systems contain their own waste storage tanks, while others need a drain system.

7. Hematology slide stainers that drain into sinks or a wastewater line must follow local wastewater treatment regulations. In some areas, the dumping of biohazardous material into the main sewage system is forbidden. Other hematology slide stainers have self-enclosed waste tanks for containing reagent waste.

# Tips and Guidelines for Buying a Slit Lamp

**Opthalmic slit lamps used for diagnostic purposes in office, clinic, or hospital**

Slit lamps used by eye-care professionals for routine eye examinations and in acute situations. Some are capable of taking ocular photographs.

Tips for Buying a Slit Lamp

1. Facilities should look into the following factors when buying a slit lamp: resolution, image quality, and the quality of life illumination system. In addition, they should consider ease-of-use, solid construction, adjustable range of movement, and the ability to accommodate large size patients. The lamps should produce a uniform white slit beam with no divergence and should allow for various sizes and shapes of beam. They should use binocular microscopes that are capable of magnification levels of up to 10x or more.

2. The recommended units are those that adjust from 0 to 10 mm or greater.

3. The units should include heat absorption filters, and some come with other dedicated easy to attach illumination filters.

4. A typical use and cleaning should not affect the unit's performance.

5. Users need to make sure that all external components are securely mounted, and serviceable parts are easily accessible for maintenance.

6. Photographic and video equipment can also be purchased for teaching and research applications

7. To conduct eye examinations on rounds, at the patient's bedside, or outside the medical facility, manufacturers offer portable slit lamps that are either battery or line-powered, very compact, and cost less than most stationary models.

8. Prices include the basic unit and usually a few standard accessories, such as spare bulbs, a dust cover, chinrest tissue, and maintenance equipment. Specialized attachments and equipment, such as applanation tonometers, Hruby lenses, additional eyepieces, halogen lamps, and instrument tables are all extras and not included in the price.

Questions for the Seller

Before you purchase your Slit Lamp, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Slit Lamp

# Tips and Guidelines for Buying a Spectrophotometer

Laboratory spectrophotometers for visible and UV light

Spectrophotometers measure light absorption in the UV or visible spectrum. They use tungsten lamps, and usually hold rectangular silica or quartz cuvettes, unless wavelength is over 300 nm. Other UV and visible spectrum spectrophotometers can produce a graph with absorbance vs. wavelength functions, by automatically scanning the entire spectrum using a double beam.

Tips for Buying a Spectrophotometer

1. The configuration of spectrophotometers can be either a single-beam or double-beam. A double-beam spectrophotometer configuration offers better accuracy, especially when used for spectral scans, because it allows continuous automatic correction for anomalies in the light beam. The single-beam spectrophotometer configuration is also suitable for many applications.

2. When choosing spectrophotometers lamp types, facilities should consider ones that offer the spectral range required for the types of tests to be run.

3. For the visible spectrum, the most common choices are tungsten and halogen lamps - both produce light in a relatively wide wavelength range. Labs that will heavily use the spectrophotometer should consider halogen lamps, which tend to have almost double the life of tungsten lamps. Both deuterium and hydrogen lamps emit radiation in the ultraviolet range, but deuterium lamps have a longer life and tend to be more stable.

4. The following are recommended features for any analytical instrument, including spectrophotometers: an available display to report results, an interface to a laboratory information system to facilitate data management and reporting of results to physicians, and an interface to a printer for producing hard copies of spectrophotometer results.

5. Facilities need to evaluate their clinical needs before purchasing spectrophotometers. The spectrophotometers range from recording double beam devices to spectrophotometers with less spectral purity.

6. Facilities should be aware of the fact that the initial acquisition cost of spectrophotometers does not accurately reflect the total cost of ownership, since these devices require ongoing maintenance and operational costs. Facilities should consider life-cycle cost, local service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment.

7. To compare high-cost alternatives and to determine the economic value of a single alternative, facilities can use an LCC analysis. They can use LCC analysis techniques to examine the cost-effectiveness of leasing or renting spectrophotometer equipment, versus purchasing it outright.

8. When facilities debate the use of disposable over reusable spectrophotometer accessories, they should consider the long-term costs of these items. The analyses for plastic and glass curettes show that the cost of replacing all the used curettes every two years can be significantly less than the cost of using disposable curettes over this period.

9. The spectrophotometer suppliers offer facilities service contracts or service on a time-and-materials basis. A third-party organization may also offer such services. Facilities should carefully consider the decision to purchase a spectrophotometer service contract, which can be justified for several reasons.

10. Usually, spectrophotometer service contract customers get routine software updates, which enhance the system's performance, at no charge. Software updates are often cumulative, so previous software revisions may be required in order to install and operate a new performance feature.

11. Facilities are strongly encouraged to standardize their equipment. There are numerous benefits to doing so: it makes staff training easier, simplifies servicing and parts acquisition, and provides greater bargaining leverage when negotiating new equipment purchases and service contract costs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Spirometer

Diagnostic spirometers for evaluation of pulmonary function

A device for evaluating pulmonary function by measuring air flow rate and volume. Diagnosis is made by comparing patient values with normal standard values.

Tips for Buying a Spirometer

1. This stand-alone spirometer unit is designed to measure the rate and volume of airflow to and from the lungs during various phases of the respiratory cycle.

2. Spirometer units should accept patient data, measure patient ventilatory efforts, and present diagnostic information. A hard copy must also be provided.

3. Manufacturers of angiospirometers should clearly specify what parameters are evaluated by the system, and whether it is volume or flow sensing. They should also indicate the computer interfacing capabilities, if there are any, and the required software.

4. The spirometer purchase price should include all necessary software.

5. The sampling frequency, the number of parameters calculated, the reference values, and the format for reported results determine the hardware and software to be used.

6. Diagnostic spirometer manufacturers should also inform buyers on future software improvements and/or add-on components that increase versatility, as well as the associated cost.

7. A user manual should describe the appropriate reprocessing or sterilization methods for reusable spirometer parts that come in contact with patients. This will help in preventing cross-contamination.

8. All angiospirometer controls should be easy to identify with clear functions and a design that prevents misinterpretation of displays and control settings. They should be protected against accidental setting changes, and sealed against penetration of fluids.

9. Fluid spills should not affect patient and operator safety and system performance. If the diagnostic spirometer is affected, it should fail safely.

10. There is an additional cost for training in outreach programs. These programs allow transmission of spirometer data to regional overread centers where pulmonary specialists offer second-opinion consultations.

11. Software improvements or add-on components that increase versatility can upgrade some diagnostic spirometer units.

12. Angiospirometer users may wish to purchase a calibration syringe. A three-liter syringe will usually suffice.

13. Users are encouraged to check the spirometer's ability to accurately measure volume of up to and including three liters, at least daily.

Questions for the Seller

Before you purchase your Spirometer, we recommend you ask the seller the following questions:

Measurement Device

Is it bidirectional?

Plots

Does it have timed spirogram?

Does it have flow-volume loop?

Data Analysis

Does it include actual, normal, % normal reports?

Does it include respiratory status?

Does it include respiratory diagnosis?

Hard-Copy Report

Is it formatted?

Does it include a printer?

Does it include a strip chart?

Computer Interface

Does it include a modem?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Pulmonary Analyzers

# Tips and Guidelines for Buying a Spot Film Device

Serial imaging systems for dynamic radiography

Serial imaging systems for dynamic radiography, to capture the images from the phosphor screen or directly from the image intensifier.

Tips for Buying a Spot Film Device

1. Facilities should consider the types of procedures to be performed and determine the table tilt, travel, image intensifier size, and image processing methods to best suit those procedures.

2. The main consideration for buyers should be the table tilt.

3. Tables usually offer a 90

4. Certain procedures, such as cervical myelography, can benefit from a 90

5. Manufacturers offer various longitudinal and lateral table travels. When deciding on table travel parameters, positioning the patient for various procedures is a major consideration.

6. When using larger image intensifiers, more anatomy can be viewed in one image.

7. Facilities need to carefully consider their needs when selecting the x-ray generator. The available generators that are commonly used for cardiac imaging include: three phase, 12 pulse, high frequency, and constant-potential generators. All can provide the high power, direct current, or very low ripple waveform required for cinefluorography. Space-constrained areas would benefit from high frequency generators, which are smaller and easier to install.

8. Facilities should also consider the heat dissipation rate and the heat capacity of the x-ray tube anode. Only 0.2% of the electrical energy delivered to the tube is converted to x-rays, and the rest is radiated as heat - which will destroy the anode if not quickly dissipated.

9. To help dissipate the heat, rotating and larger diameter anodes may be used, as well as circulated liquid cooling systems and ceramic tube envelopes.

10. Using a higher anode heat capacity allows for longer fluoroscopy runs. It also provides a higher overall output, and extends x-ray tube life.

11. The minimum anode heat capacity should be 1,000,000 heat units.

12. Advanced interventional procedures requiring longer imaging times would benefit the most from high heat capacity tubes.

13. Suppliers now offer x-ray tubes with anode heat capacities over 2,000,000 HU and heat dissipation rates of 900,000 HU/min.

14. Buyers need to look at the focal spot size of the anode; a smaller focal spot provides better quality images, but the larger one dissipates heat better. Therefore, smaller ones need a larger anode heat capacity than larger focal spots do.

15. Some suppliers offer two or three focal spot sizes to accommodate the variety of imaging techniques and procedures.

Questions for the Seller

Before you purchase your Spot Film Device, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiographic and Fluoroscopic System - Operational

# Tips and Guidelines for Buying a Steam Sterilizer

Steam sterilizing units for large quantities

Large steam sterilizers that are used to eliminate microorganisms from heat-resistant medical and surgical devices, and surgical equipment. Infection control concerns itself both with prevention (hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance) and with investigation and management of demonstrated or suspected spread of infection.

Tips for Buying a Steam Sterilizer

1. Facilities should consider the following factors before making a steam sterilizer purchase: life-cycle cost, local service support, discount rates, non-price-related benefits offered by the washer-sterilizing unit supplier, and standardization with existing equipment in the facility.

2. Steam sterilization should be performed in at least 121

3. Steam sterilizers should have microprocessor controllers, which provide a more precise control and monitoring of sterilization cycles.

4. To ensure that sterility is achieved, the flash sterilizing units should record time and temperature.

5. The prices of these washer-sterilizing units vary. The following features significantly contribute to the price: method of air removal, chamber size, doors - manual or power, controller options, auxiliary loading equipment, service contracts, trade-in equipment, delivery area, and freight charges.

6. Some of these steam sterilizer features affect the cost of autoclaves, including: method of air removal, controller options, and service contracts.

7. Steam sterilizer suppliers offer service contracts or service on a time-and-materials basis, and so do some third-party organizations. Facilities should carefully consider all the options.

8. To compare high cost alternatives and/or determine the economic value of a single alternative, facilities can use an LCC analysis. Buyers can use analysis techniques to examine the cost-effectiveness of leasing or renting steam sterilizer equipment versus purchasing it outright.

Questions for the Seller

Before you purchase your Steam Sterilizer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Installation

Is it cabinet enclosed?

Is it recessed in wall?

Is it pit mounted?

Does it include a loading cart?

Does it include a cycle recorder?

Is it all stainless steel?

Does it include any alarm systems?

Are there any signs of rust?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Sterilizing Units, Steam, Bulk

# Tips and Guidelines for Buying a Stereotactic Head Frame

A headframe attached to skull for stereotactic use during surgery

A unit used for neurosurgical or radiosurgical procedures, with adaptors for various imaging systems (CT, MRI and others). A head ring with fixating pins is attached to the skull. The precise area of the brain that is targeted can be localized. Target coordiantes can be set using information from CT, MRI. etc.

Tips for Buying a Stereotactic Head Frame

1. Several clinical procedures, such as radio surgery, neurosurgery, microsurgery, and biopsies, should be able to use stereotactic headframes.

2. The following features should be available in treatment planning systems: removable media archival storage or connection to central storage, a film scanner, a color monitor, a keyboard, and mouse, 3-D planning software with graphics, digital imaging and communications in medicine compatibility, as well as dose computation and analysis features. The headframes should be constructed of non-ferromagnetic materials for use with magnetic resonance and should be compatible with all cross-sectional imaging modalities, such as CT, DSA, MRI, PET, and X-ray. Headframes should be lightweight, around 1 kg.

3. In most headframes, fixation uses 2 to 4 carbon fiber or titanium pins or screws but some headframes use alternative fixation methods.

4. Several target approaches should be allowed by the center-of-arc or target-centered arc system. These include lateral, parallel, posterior fossa, and hypophyseal.

5. Method of approach confirmation should be available and target access should have a vertical range of >=150 mm, a lateral range of >=160 mm, and an anterior-posterior range of >=170 mm.

6. In dedicated gamma stereotactic systems, radiation sources should use more than 200 encapsulated 60Co sources.

7. The system should have tungsten collimators ranging from 4 to 18 mm in diameter.

8. Systems that allow attachments can have up to 20 MV, but dedicated linac radio surgery systems should have 6 MV photon energies.

9. Treatment delivery assemblies should be floor-mounted or wall-mounted with an isocentric accuracy of 0.5 mm for dedicated linacs. Those mounted onto the linac should have an isocentric accuracy of 1 mm.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Manual Medical Device

# Tips and Guidelines for Buying a Stereotactic Radiotherapy System

Linear accelerator based stereotactic systems for radiosurgery

Stereotactic system for radiosurgery, used to accurately direct the electromagnetic ray produced by a radiation source, like a linear accelerator.

Tips for Buying a Stereotactic Radiotherapy System

1. Several clinical procedures, such as radio surgery, neurosurgery, microsurgery, and biopsies, should be able to use stereotactic radiotherapy headframes.

2. The following features should be available in treatment planning stereotactic radiosurgical systems: removable media archival storage or connection to central storage, film scanner, color monitor, keyboard, mouse, 3-D planning software with graphics, digital imaging and communications in medicine compatibility, as well as, dose computation and analysis features.

3. The stereotactic radiotherapy headframes should be constructed of non-ferromagnetic materials for use with magnetic resonance and should be compatible with all cross-sectional imaging modalities, such as CT, DSA, MRI, PET, and X-ray. Headframes should be lightweight, around 1 kg.

4. In most stereotactic radiotherapy headframes, fixation uses 2 to 4 carbon fiber or titanium pins or screws but some headframes use alternative fixation methods.

5. Several target approaches should be allowed by the center-of-arc or target-centered arc system. These include lateral, parallel, posterior fossa, and hypophyseal.

6. Method of approach confirmation should be available and target access should have a vertical range of >=150 mm, a lateral range of >=160 mm, and an anterior-posterior range of >=170 mm.

7. In dedicated gamma stereotactic radiotherapy systems, radiation sources should use more than 200 encapsulated 60Co sources.

8. The stereotactic radiosurgical system should have tungsten collimators ranging from 4 to 18 mm in diameter.

9. Linear accelerator radiosurgical systems that allow attachments can have up to 20 MV, but dedicated LINAC radio surgery systems should have 6 MV photon energies.

10. Treatment delivery assemblies should be floor-mounted or wall-mounted with an isocentric accuracy of 0.5 mm for dedicated LINACs. Those mounted onto the linear accelerator radiosurgical system should have an isocentric accuracy of 1 mm.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Manual Medical Device

# Tips and Guidelines for Buying a Sterilization Box

Containers used to pack, sterilize and store surgical instruments for re-use

Containers used during the sterilization process. Sealed perforated boxes allow sterilizing agent to flow through, and filters for bacteria control sterility of contents. These containers are also used for poststerilization and pre-use storage.

Tips for Buying a Sterilization Box

1. Sterilization box buyers are strongly encouraged to review all of the manufacturers' documentation and test data.

2. The sterile integrity of a disinfection container depends on several factors, and users should therefore test performance in the area where the sterilization boxes will be used.

3. An independent laboratory hired by the manufacturer has tested each sterilization box to determine shelf life or sterile storage capability. The shelf life listed in the chart reflects only the duration of testing for which the manufacturer can provide data.

4. Sterilization boxes can require additional counter space and a longer decontamination time than wraps. On the other hand, they can be faster and easier to prepare for sterilization.

5. Sterilization boxes buyers should carefully examine all the options and requirements for instrument trays and baskets.

6. Mesh-bottomed baskets with textile wraps might be appropriate for use with disinfection container systems. However, their handles may need modification to allow removal from the sterilization container.

7. To simplify assembly and removal of instrument sets, particularly in an emergency, a combination of stackable trays within a disinfection container may be preferred.

8. Suppliers offer trays with dividers, clips, pegs, and silicone racks to organize instrument sets and to provide protection for delicate instruments. These trays may be offered with their containers, and some suppliers provide all necessary accessories as well.

# Tips and Guidelines for Buying a Stretcher

Hospital stretchers for patient transportation within a healthcare facility, usually in a supine or prone position

Mobile stretchers used for patient transportation within a healthcare facility. They can be fixed height, mechanically adjustable, or hydraulically adjustable. Equipment needed for patient treatment during transfer can be accommodated on stretcher.

Tips for Buying a Stretcher

1. In order to enhance staff familiarity, facilities are encouraged to use only one type of hospital stretcher. This is important because during emergencies, it is necessary to manipulate stretchers in a quick and easy manner.

2. Hospital stretcher specifications are divided into three groups, based on areas of use in the facility: ER/OR, ICU critical care unit post anesthesia care unit and radiology. Each group is offered a different set of stretcher features according to its special needs.

3. Most hospital stretchers should have a utility shelf, restraint straps and side rails, perimeter bumpers and an oxygen tank holder. Hospital stretchers should also be equipped with at least one mountable IV pole at each corner.

4. Stretchers should include >=8-inch casters. One of the casters should be equipped with a swivel lock to aid in steering and maneuvering during transport. At least two brakes should be mounted at diagonal corners of the Stretcher.

5. The hospital stretchers should be able to carry patients weighing up to 300 lb. To fit through doorways, the stretcher should be less than 32 x 84 inches. Stretcher mattresses should be no smaller than 26 x 73 inches.

6. Patients with serious conditions can benefit from special positioning features such as Trendelenburg, reverse Trendelenburg and Fowler position. The Fowler position, for example, helps patients with pulmonary congestion (due to congestive heart failure) breathe more easily.

7. The various stretcher height positions are suitable for different needs. A higher position is convenient for suturing or examination, while a lower position is better for cardiopulmonary resuscitation.

8. If a stretcher is used as a treatment platform, it should have height adjustment capabilities. However, if it is used mainly for transport, a fixed height stretcher, which is cheaper, may be sufficient.

Questions for the Seller

Before you purchase your Stretcher, we recommend you ask the seller the following questions:

Position Control

Does it include leg lift?

Does it include knee flex?

Features

Does it include a radiolucent top?

Does it include a grid?

Does it include a film cassette tray?

Does it include an oxygen tank holder?

Does it include a utility shelf?

Does it include restraining straps?

What is the wheels (casters) diameter in inches?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Stretchers, Mobile, Hospital

# Tips and Guidelines for Buying a Suction Regulator

A device which regulates the negative pressure of the suction line

A mechanical device which is installed on the low pressure line to keep the suction power within a predetermined limit.

Tips for Buying a Suction Regulator

1. Suction regulators should provide adequate vacuum and flow capabilities, while preventing patient injury.

2. When considering the purchase of suction regulator units, buyers should look into the manufacturer recommendations to ensure compatibility with the facility's existing equipment and procedures.

3. Clear instructions for cleaning, disassembly and reassembly, as well as recommended cleansers and sterilization procedures should be provided by the supplier; easy cleaning is an important feature of suction regulators.

4. A gauge covering the range of vacuum levels to be delivered should be part of the unit or attached to it.

Questions for the Seller

Before you purchase your Suction Regulator, we recommend you ask the seller the following questions:

General Information

Does it have an adjustable cycle?

Does it have a vacuum adjust lock?

Does it have a vacuum gauge-pin stop?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Suction Regulators

# Tips and Guidelines for Buying a Supplies Boom

Ceiling-mounted devices (booms) for utility and medical device organization

Prefabricated ceiling fixtures (booms) designed with a steel support structure and movable arms. An equipment carrier is customized to support medical devices, such as monitors, electrosurgical units, and anesthetic devices. Electricity, gases, vacuum, and other utilities are organized on a specially designed module. This device is used mainly in OR and emergency rooms.

Tips for Buying a Supplies Boom

1. The selected unit should address the needs of the surgical team and the types of procedures performed, as well as improve operational efficiency. The equipment selection and installation process should both involve clinical users to ensure proper placement of booms and equipment and facilitate with the transition from the current OR design to the new one.

2. Facilities should pay attention to the following factors when purchasing this type of unit: finished ceiling height; room layout; required structural support; overhead and surgical lights, heating, ventilating, and air conditioning diffusers and grills; wiring, piping, and ductwork proximate to the ceiling, as well as door location. Buyers should determine the load carrying ability of the ceiling structure. The load carrying capacity of the boom should be noted and not exceeded.

3. Another consideration is the movement of boom arms with regard to other ceiling mounted devices, such as surgical lights and other booms. Facilities need to ensure that they do not interfere with each other when moved.

4. Cleaning solvents and other fluids commonly used in medical facilities might stain and degrade exposed surfaces of ceiling booms and should be resistant to these materials.

5. Circuit breaker panels, when included, should be easily accessible and clearly labeled; the main circuit breaker should be different from branch circuit breakers, and it should be impossible to lock the doors to the panels.

6. All external devices should be located and mounted to minimize the possibility of injury for patients or staff, or physical damage to devices and fixtures. All fixtures must be able to support the loads for which they are intended.

7. The surgical boom system should not affect the access to the patient during an emergency, or other booms, or ceiling mounted devices, and should minimize interference with the operating table. The unit should allow easy access to services, devices, internal wiring, and piping that need routine repair and maintenance.

8. To provide proper flow to the outlets, copper medical gas and vacuum piping is preferred; however, flexible hoses of the appropriate size may be used.

9. To meet user needs, many features can be customized; configurations for anesthesia and laparoscopic, endoscopic, or general surgery are available. Some suppliers do not sell a fixed product line of distinct models; instead they produce only custom made units. Companies offering catalog units will customize their products to fit the facility's needs. It is essential that OR staff work closely with the manufacturer to determine the best configuration.

10. All conditions should be appropriate for a communication system, which is usually supplied by the facility and installed separately Medical gas station outlets are usually specified to match the facility's current system.

Questions for the Seller

Before you purchase your Supplies Boom, we recommend you ask the seller the following questions:

Accessories

Monitor bracket?

IV supports?

Catheter basket?

Others? (please specify)

Electrical Features

Circuit breaker?

Equipotential ground bus?

Grounding jacks?

Telephone jack?

Isolated power system?

Code alarm button?

Nurse call system?

Elapsed timer/clock?

Medical Gas Services

Nitrous oxide?

WAG evacuation?

Vacuum bottle slides?

Vacuum bottle storage?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Ceiling-Mounted Surgical and Supply Booms

# Tips and Guidelines for Buying a Surgical Helmet

Helmets worn during surgery to protect from cross-infection

Surgical helmets with face shield and disposable hood , battery-pack, and filters. Used during surgery to guard against cross-infection, also for patients.

Tips for Buying a Surgical Helmet

1. Buyers should consider protection and cost, as well as user preferences.

2. Facilities should closely examine the costs of deep wound infections and the most cost effective ways to provide appropriate infection control measures. They should determine whether the infection rates they experience during orthopedic procedures justify the purchase of these systems and whether their existing infection control programs are sufficient.

3. These systems include reusable parts, which should be durable during normal use. It should be easy and simple to repair or replace damaged components.

4. To prevent possible cross contamination between wearers, all areas of the helmet should be accessible for cleaning. The hood or toga should be constructed of fabric that is splash and fluid resistant.

5. The filtration system should have an efficiency of 85% or better for particles 0.3 μm and larger.

6. Users should be notified of battery failures and other system errors.

7. Batteries for these systems should operate at least five hours. There should be a recharge indicator for each battery, such as a light illuminating when the battery is fully charged.

8. It is not clear yet whether these systems are needed for patient protection in the operating room.

# Tips and Guidelines for Buying a Surgical Light

Surgical lamps for use in the OR (operating lights)

Operating room lights, to illuminate the surgical site with minimal color distortion, and to reduce shadow effect. They optimize visualization of small objects at different depths, or through small incisions.

Tips for Buying a Surgical Light

1. The diameter of the field size should be at least 16 cm, and the focal length should be 65 cm at least.

2. Surgical lights are required to provide a minimum illumination level of 2,500-foot candles. They should rotate 360

3. A sterilizable handle should accompany the device. Life expectancy of the bulb should be at least 1,000 hours.

4. A surgical light does not have a standard set of optimal lighting characteristics.

5. It is recommended to carry out a shadow reduction test, which applies best to a single large light head that simulates the incision with a tube and the surgeon's head with an opaque disk. Facilities concerned with shadow reduction should consider several design features, such as light head position, reflector size, optical design, and number of lamps aimed.

6. A failure of a single bulb in a multiple-bulb light head will have a lesser impact on surgery than a failure of the bulb in a single bulb light head with no automated backup bulb replacement feature, which can delay or interrupt surgery.

7. Facilities should examine the type of the bulb, its life expectancy, and the replacement costs of individual bulbs, when they consider the purchase of bulbs.

8. Among the many factors to consider when selecting surgical bulbs are ambient lighting, surgeon's preferences, and the requirements of different surgical procedures.

9. When designing or heating, ventilating, and air-conditioning systems, facilities should consider the heat generated by surgical lights.

10. It is recommended to ask for a demonstration of prospective lights in the hospital's ORs. Selecting these lights is still considered to be subjective, although many attempts have been made to standardize lighting performance.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Lights, Surgical

# Tips and Guidelines for Buying a Surgical Power Tool

Pneumatic and electrically powered surgical handpieces, and other tools

A wide variety of surgical handpieces and accessories that are used in operative procedures involving bone and cartilage dissection. These pneumatic or electrically powered handpieces are used for dissecting, drilling, curetting, abrading, sculpting, and sawing. They are also used on materials used in implanted prostheses. Bone mills produce the material used for bone regeneration in bone grafting and joint reconstruction.

Tips for Buying a Surgical Power Tool

1. The safety and effective use of these instruments depend on the user's familiarity and comfort with the device.

2. These devices can be hand or foot operated with different operating speeds. They should all accept a variety of bone saws, drills, and tools.

3. Tools can be used with any unit that has the appropriate rotational speed and compatible chuck.

4. Facilities using units and tools from different manufacturers should keep in mind that some manufacturers will be responsible for any mishaps involving their units, only if the used tools are those under their control.

5. Before combining drill bits from one manufacturer with power units from another, buyers should contact the manufacturers.

6. Buyers should be aware that some manufacturers offer training and certification programs for their equipment.

7. Drill bits are available as both disposable and reusable units. After comparing the cost of stocking disposables to that of sterilizing reusables, facilities need to consider which type is best for them.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following **Inspections Forms** :

Handpiece for Surgical Tools

# Tips and Guidelines for Buying a Surgical Smoke Evacuation System

Smoke evacuation systems for use during various surgical procedures

Smoke evacuation systems are suitable for use during various surgical procedures, to capture smoke which may contain potentially hazardous materials. The smoke plume that is not evacuated can release airborne particles which can be inhaled by the surgical team causing unwanted side effects.

Tips for Buying a Surgical Smoke Evacuation System

1. The system should have a high-efficiency particulate air or ultra-low penetration air filter to ensure that particles of the right size are captured.

2. Laser procedures may generate smoke containing hazardous gases. The evacuator should have a carbon filter to adsorb gaseous hydrocarbons.

3. It is recommended that smoke evacuators have a minimum flow of 25 cfm to provide effective smoke capture.

4. To avoid interruptions in communication during surgery, the system's noise levels should not exceed 60 dBA.

5. The system should provide some mechanism, a footswitch for example, to synchronize evacuation with the laser procedure. Visual or audible alarms should warn operators of any system malfunction that may cause results to be unsafe or wrong.

6. In order to prevent damage to the tissue, the device should not exceed 150 mm Hg of pressure. The device should have a clear indication when filters need replacement.

7. Facilities need to determine whether the system will be used for open procedures or closed procedures; some units listed in the chart are designed for laparoscopic procedures in particular.

8. Another factor to be considered by facilities is whether the systems will be used during all laser and electro surgical procedures or only select ones. This information will help determine the number of units to be purchased.

9. It is important that facilities know the planned usage before finalizing a purchase, to help them select an evacuator that is the most suitable for their needs.

10. Regulatory agencies do not bind the use of smoke evacuation systems. The medical facility is the one to decide in this matter.

11. During the last few years, the concept of centralizing smoke evacuation has become increasingly accepted.

12. Facilities need to carefully decide between a portable and a stationary system. A stationary system represents a major commitment on the part of the facility for its size, power, and cost.

Questions for the Seller

Before you purchase your Surgical Smoke Evacuation System, we recommend you ask the seller the following questions:

Configuration

Is it portable?

Is it tabletop?

Is it cart-mounted?

Is it surgical boom mounted?

Filtration

Is prefiltering required?

Does it have a filter life indicator?

Maximum Flow

Does it have a variable flow control?

Evacuation Wand

ESU?

Laser?

Add-on?

Integrated?

Extendable?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Smoke Evacuators

# Tips and Guidelines for Buying a Sweat Tester

Sweat-testing devices for the diagnosis of cystic fibrosis

Sweat testing devices are used as a method of diagnosing cystic fibrosis. CF affects different exocrine glands, which creates typical abnormalities in sweat electrolyte concentration. These devices stimulate, collect, and/or analyze sweat for testing purposes.

Tips for Buying a Sweat Tester

1. These are a few required parameters: this unit should need no more than 50 μL of sample and should have an open circuit sensor; the stimulation time should be 5 minutes or less, with a collection time of no longer than 30 minutes; the meter's precision should be at least 2%.

2. CF diagnosis is done by sweat testing because of the following benefits: it is noninvasive, it has acceptable accuracy limits, and it is a low-cost procedure performed with relatively inexpensive equipment.

3. Collecting an adequate amount of sweat for analysis is sometimes difficult. Positive or marginal results from sweat testing require further testing for confirmation.

4. Facilities performing routine CF neonatal screening should consider faster testing techniques that are as accurate and reliable as sweat testing for screening purposes. These methods may be more invasive and therefore less desirable. Developing technology has enabled these tests to become less traumatic, allowing them to be reconsidered for certain facilities.

5. Damaged testing devices might cause electric shocks or burns. To reduce the risk of injury, facilities should prefer devices with electrical safety features, such as automatic power shutoff and sensors and alarms. It can be worth the extra cost.

6. Facilities are encouraged to carry-out cost comparisons on disposable and replaceable items, such as: collection containers, electrodes, drugs, and analytical reagents.

7. Facilities need to be aware of the fact that some devices labeled as sweat testers are merely collecting the sweat sample, while separate instruments actually perform the analysis.

# Tips and Guidelines for Buying a Syringe Pump

Intravenous, controlled low-dose infusion pumps

These pumps are used for intravenous, controlled low-flow administrations of infusates. They are especially appropriate for use in situations which necessitate delivery of small quantities of concentrated drugs over an extended period. They may be calibrated according to drug-specific units. A motor-driven mechanism advances the plunger at a predetermined rate, with electronic controls and alarms. The syringe containing the solution must be manually replaced when emptied.

Tips for Buying a Syringe Pump

1. The need for infusion sets should be determined based on the annual number of syringe pump infusions and the average infusion duration in a facility.

2. These syringe infusion pumps should generally have adjustable flow rates with increments of 0.1 mL/hr.

3. The syringe pumps should be designed to accommodate syringe sizes of up to 60 mL.

4. The preferred syringe pumps are those with prime/purge control, and the ones that perform accurately to within 5% of the displayed flow rate and volume.

5. The alarms included with the syringe infusion pumps should indicate at least the following: empty reservoir, infusion near end, infusion end, high pressure/occlusion, system malfunction, syringe unlocked, and low/depleted battery.

6. A syringe pump should be able to store at least 200 events of error codes, alarm conditions, quantity infused, and programmable settings.

7. An alarm-silencing mechanism for syringe pumps may be available, as long as it's temporary.

8. These syringe infusion pumps should come with luer-lock connectors. They should provide a needleless connection for the brand of primary infusion sets used by the facility.

Questions for the Seller

Before you purchase your Syringe Pump, we recommend you ask the seller the following questions:

Alarm Functions

Infusion Near-End?

Infusion End?

Hi Press/Occlusion?

System Malfunction?

Syringe Unlocked?

Plunger Disengaged?

Low Battery?

Compatibility

Is it compatible with all standard "3 parts" syringes?

Is it compatible with BD Plastipak?

Is it compatible with Monoject?

Is it compatible with Terumo?

What is the largest syringe that can be used? (please mark one volume)

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Infusion Devices

# Tips and Guidelines for Buying a Table Top Steam Sterilizer

Tabletop steam sterilizers

Tabletop steam sterilizers with compact sized chambers for hospital and physicians' office use. These sterilizing units eliminate microorganisms from heat resistant medical devices and other surgical equipment.

Tips for Buying a Table Top Steam Sterilizer

1. Facilities need to follow certain procedures to ensure successful sterilization. These include: pre-washing instruments, correctly loading instruments, and using the appropriate time and temperature setting on the steam sterilizer. Steam sterilizing unit users are strongly encouraged to follow the suppliers' instructions.

2. These steam sterilizer units should have a method to continually monitor key parameters, such as: temperature, pressure, and time, and to provide a record that can be signed and dated for quality assurance purposes. Audible and visible alarms should alert users in case a fault is detected that might cause unsafe or erroneous results.

3. A steam sterilizer's price is affected by the following: method of air removal, chamber size, controller options, service contracts, trade-in equipment, delivery area and freight charges. However, the main operating expense for these steam sterilizer units is energy cost, which is linked to the steam production method used by the steam sterilizing unit, and depends on the price of electricity or flammable gas.

4. Some third-party organizations may also provide steam sterilizer service. Facilities should carefully consider buying a service contract, which can be justified for several reasons. With a service contract, facilities receive preventive maintenance at regular intervals, and reducing the possibility of unexpected maintenance costs. Many steam sterilizing unit suppliers extend performance guarantees beyond the length of the warranty only to steam sterilizer systems covered by a service contract.

Questions for the Seller

Before you purchase your Table Top Steam Sterilizer, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Installation

Does it require special wiring?

Does it require special plumbing?

General Information

Does it have an automatic cycle shutoff?

Does it have pressure purge?

Are there any signs of rust?

Controller Type

Is it programmable?

Temperature Range

Does it have an overheat shutoff?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Sterilizing Units, Steam, Bulk

# Tips and Guidelines for Buying a Telemedicine System

Teleradiology information systems for transmission of radiology images

Information systems using telecommunications for transmitting and receiving digital images such as MRI, DR, and CT. Images and text can be transmitted to and from remote sites and in emergency situations when on-site radiologist consultation is not available.

Tips for Buying a Telemedicine System

1. Buyers should choose a telemedicine system that provides the resolution and performance that best suit their needs.

2. Facilities considering the purchase of such a telemammography system should look into the applications of the teleradiology system.

3. Facilities that need real-time telemedicine system reviews by consulting physicians at different sites are looking for high-resolution images and rapid transmission by either ISDN or satellite for point-to-point transmission or by dedicated coaxial cable, DSL, or cable modems for LAN transmission.

4. On-call radiologists at home can get telemammography system image transmission over telephone lines. Each radiologist should have a high-resolution computer monitor at home, and the department should have a portable modem, CPU, and hard disk that the radiologist can carry home.

5. Facilities should invest in a laser imager if they wish to have a hardcopy review.

6. When users plan to integrate the teleradiology system with a PACS, they should consider the compatibility with communications standards, such as the Open System Interconnect, which was developed under the guidance of the International Organization for Standardization.

7. The ACR/NEMA Digital Imaging and Communications standard ensures data exchange among imaging devices, regardless of the brand or image format used. It sets minimum requirements for hardware, data-link service, networking, message presentation, and applications.

8. Open architectures that comply with ACR/NEMA and ISO/OSI standards are now replacing supplier-specific network architectures.

9. When facilities adopt an industry-wide standard, they can install multi-supplier telemedicine systems and reduce the expenses of implementing a whole digital department.

10. Buyers are encouraged to get a list of users from the manufacturer and consult with experienced telemedicine system experts before purchasing a system.

11. Any new equipment purchased should be DICOM compatible to facilitate networking.

Questions for the Seller

Before you purchase your Telemedicine System, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Data & Information Systems

# Tips and Guidelines for Buying a Telemetry Monitor

Telemetric monitors used for in the hospital setting

Telemetric monitors are used to monitor ECG's and other physiologic parameters using single/multi channel, analog/digital systems . Analysis of these parameters can reveal changes in hospitalized patients. Signals can be transmitted to a central station to be observed by the staff. An alarm system can be incorporated.

Tips for Buying a Telemetry Monitor

1. When considering the need for additional telemetry monitors, facilities should look closely at the current usage need of the technology, the changes caused to the patient care by adding more transmitters and receivers, and the necessary additional staff and training.

2. Facilities can choose from many options for telemetric patient monitoring. They should determine whether telemetry monitoring is the best choice for each individual patient.

3. Display should accommodate at least 8 patients per display. For each one, it should show alarm and rhythm status, heart rate, alarm limits, and graphic trending of arrhythmia data. It should also indicate unit status.

4. Facilities are encouraged to integrate the ambulatory monitoring system completely with the central station.

5. Depending on the monitoring capabilities of the transmitter and user requirements, the central station should display ECG waveforms and other physiologic parameters. ECGs should be trended.

6. The antenna system access points should provide uniform coverage over the monitored area. The telemetry monitor system should include all the necessary antennae access points, amplifiers, and couplers. Elementary systems should operate in the WMTS or ISM frequency bands.

7. The ambulatory monitor's transmitter should transmit at least 2 leads; 12-lead diagnostic ECG is optional.

8. The central station should include a visible and audible low-battery alarm. A rechargeable battery should require minimal recharging after depletion.

9. The telemetry monitor controls should be easy to operate, visible and clearly identified. Their design should prevent misinterpretation of displays and settings. The controls should be protected against accidental setting changes, and sealed to prevent fluid penetration.

10. In no case should fluid spills adversely affect the patient and operator's safety or system performance. An affected telemetric patient monitor transmitter should fail safely.

Questions for the Seller

Before you purchase your Telemetry Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Central Station

Does it include a Receiver?

Is it Tunable?

Does it have Telemetry & hardwired patients on same display?

Does it include Prioritized alarms capability?

Does it have a recorder?

What is the largest number of patients that can be connected?

What is the largest number of patients that can be presented on the display?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Patient Monitors

ECG Monitors

Blood Pressure Monitors, Invasive

# Tips and Guidelines for Buying a Temperature Monitor

Temperature monitors for bedside use

Monitors for continuous temperature measurements and display at patient's bedside. Monitoring probes may be disposable or reusable, for core or shell temperature measurements.

Tips for Buying a Temperature Monitor

1. Temperature monitors (also known as Telethermometers) should be light and easy to hold and carry.

2. There are quite a few features and operational costs associated with electronic temperature monitors, which cause the initial capital costs to vary immensely.

3. Temperature monitors measure a patient's body temperature in cases needing constant temperature monitoring. These may include surgeries, postoperative recovery, critical care, sepsis and infections, shock, fertility and ovulation, treatment of hypothermia and hyperthermia.

4. The temperature range of the Telethermometers should be at least 26.6-42.2°C with readings accurate to 0.3°C. A message should be displayed when the reading is outside the range.

5. The electronic temperature monitor measurement screen should indicate the following:

6. Temperature monitors should provide a way of carrying a sufficient supply of probe covers, which lessen probe spilling and contamination. The covers should be smooth with no sharp edges that might cause discomfort. To avoid contamination, a probe cover should be easily applied or removed with minimal user contact.

7. Common batteries should be used with the battery-powered temperature monitors, in order to ensure the simplest replacement. For rechargeable batteries, the need for recharging should be indicated clearly.

8. To calculate the cost effectiveness of these Telethermometer devices, facilities should perform LLC analyses.

Questions for the Seller

Before you purchase your Temperature Monitor, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Probe

Connector type (free text)?

Is it reusable?

Is it single use?

Is it gas sterilizable?

Alarms/Indicators

Measurement finished?

High Temperature?

Low Temperature?

Low Battery?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Temperature Monitors

# Tips and Guidelines for Buying a Thermometer

Electronic thermometers with digital or analog display

Electronic thermometers with analog or digital display, to measure body temperature. May be used for oral, axillary, and rectal sites, using disposable probe covers.

Tips for Buying a Thermometer

1. Intermittent electronic thermometers should measure a patient's temperature at oral, rectal, and axillary sites. The measurement range should be 90-108

2. These thermometers are used for periodic temperature measurements and return final temperatures in under 90 seconds.

3. Thermometers have a disposable probe cover or are a one-piece probe thermometer. They should carry an adequate supply of probe covers that minimizes the likelihood of probe spilling and contamination. The probe cover should be smooth with no sharp edges. It should be easy to apply and remove them with minimal user contact to avoid contamination. Separate probes for oral and rectal use should be prominently labeled so that they cannot be mistaken, even with the probe cover in place.

4. All electronic thermometer measurements should be easily read.

5. The following data should be displayed: the final temperature in

6. Fluids that are normally present in a hospital setting should not block or obscure the temperature readout after cleaning. Fluid spills should not affect the electronic thermometers' performance.

7. The electronic thermometers should be lightweight, easy to carry and comfortable to hold; some may be cart-mounted or wall-mounted.

8. To extend battery life, an automatic shut-off is recommended. Commonly available batteries should be used.

9. For rechargeable batteries, a clear indicator should alert for need to recharge.

10. One-piece electronic thermometers are cheaper and may be used in hospitals, clinics, and physician offices for single-patient use and in the home for family use.

11. Two-piece electronic thermometers, which consist of a handheld meter and attached probe, are mainly used in the hospital during temperature rounds for readings on any number of patients. The major long-term cost with these electronic thermometers is replacing probe covers and batteries.

12. Personal choice, standardization, and price should be the factors when selecting an electronic thermometer.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Temperature Monitors

# Tips and Guidelines for Buying a Thyroid Uptake System

Thyroid uptake systems, to assess thyroid activity by measuring radioactive iodine

Computerized systems for assessing thyroid gland activity. Radioactive iodine is ingested, and thyroid uptake is measured by using scintillation crystal detectors and photomultiplier tube.

Tips for Buying a Thyroid Uptake System

1. Thyroid Uptake System devices should have peripheral output ports for interfacing with other systems. They should be CRT or LCD, with the capability of spectrum and alphanumeric display of at least 256 channels.

2. Thyroid uptake system units with personal computers for system management and analysis can process more data at a faster speed than integrated microprocessor systems. Thyroid scanners can also use a greater variety of software programs for formatting and image enhancement. Of course, this type of thyroid scanner is more expensive, and cost several thousand dollars more than thyroid scanning system units with dedicated microprocessors.

3. Facilities need to determine whether the labor saved by the decreased operating and processing time and the thyroid scanning system's flexibility justifies the initial costs of these systems. They are encouraged to perform a serious cost-effectiveness study on several types of thyroid uptake systems.

4. Collimator-crystal-PMT detector assemblies should be mounted on a wheeled, floor stand-configured yoke. The yoke should rotate at least 340

5. All the assemblies mentioned above should all be attached to an articulated arm composed of two or more sections that can travel vertically at least 22 inches, and extend horizontally at least 26 inches.

6. The flat-field collimator should be constructed of lead, and the NaI crystals should be 2 inches in diameter and 2 inches thick (5.1

7. The number of radioactive isotopes should be assessed by a thyroid izotope analyzer, most commonly 123I, 125I, and 131I, as well as 57Co, 51Cr, 137Cs, 99mTc, and others.

8. In addition to the automatic control of the amplifier gain, it should be also controlled by user selection.

9. The pulse-height analyzers should have either 256 or 1,024 channels, a high-voltage range of 0 to 1,250 V, and both LLD and ULD energy-level discriminators.

10. For energy level and/or window selection, thyroid izotope analyzers should use a keyboard. As data entry method, a keyboard and/or mouse can be used.

11. Menu prompting and auto calculation of thyroid uptake should also be available on thyroid uptake systems.

12. The preset time range should be 0 to 9,999 sec. The preset count range should be 0 to 9,999,999.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Thyroid Uptake Systems

# Tips and Guidelines for Buying a Tissue Processor

Automated devices for processing tissue specimens

Devices used to prepare tissue specimens before microscopy. The process of fixation, dehydration, clearing, and treatment of tissues is automated by these devices.

Tips for Buying a Tissue Processor

1. Users' preferences and space requirements should determine the configuration of the tissue processor or infiltrator unit. Options include floor standing, bench top, and freestanding. The tissue processor should be configured as a multi-station system.

2. The unit should operate using at least paraffin bath processing for light microscopy, and should include a chamber/beaker with a capacity of at least 1 L.

3. Because tissue processors use potentially dangerous chemicals, the infiltrator unit should have the appropriate vacuum and fume handling systems. Facilities should also consider other safety features, such as automatic shutdown and spill prevention.

4. Preferred tissue processor units are those that can interface with a printer or data management system for data processing and storage. However, this is not a required feature. It is also preferred that tissue processors have protection during a power loss for memory and specimen protection.

5. Paraffin baths are usually used by facilities to embed most tissue specimens. It is easily formed into a ribbon of serial sections that can be quickly mounted. However, paraffin sections show more specimen shrinkage.

6. For delicate specimens, such as gastrointestinal mucosa and pulmonary parenchyma, the plastic embedding technique is often used. It is also used for cases in which cellular detail is significant, as in lymph node pathology and bladder, prostate, and breast neoplasm grading.

7. This technique shows similar long-term costs in comparison to paraffin bath processing, as well as greater visual definition, because thinner tissue sections down to single cell layers, can be obtained and the plastic does not form serial sections. Facilities should be aware of the fact that the initial acquisition cost does not accurately reflect the total cost of ownership, since these devices require ongoing maintenance and operational costs.

8. Facilities should consider life-cycle cost, local service support, discount rates and non-price-related benefits offered by the tissue processor supplier, and standardization with existing equipment.

9. The tissue processor, infiltrator or paraffin bath suppliers offer facilities service contracts or service on a time-and-materials basis. A third-party organization may also offer such services.

Facilities should carefully consider the decision to purchase a service contract, which can be justified for several reasons.

10. Tissue processor tests needing little or no training belong to the waived tests category. These do not require elaborate QC, and are less likely to produce inaccurate results. One example is the no automated dipstick urinalysis.

11. Most clinical laboratory tests, including automated urine, blood, and chemistry analyses, belong to the moderate complexity category. In this group the tests and analyzers require a limited amount of sample and reagent preparation, as well as limited operator intervention during the tissue processor analytical process.

12. The highly complex category encompasses procedures requiring a high degree of operator preparation, calibration, intervention, and analysis, such as clinical cytogenics and histopathology applications.

# Tips and Guidelines for Buying a Tomographic X-ray

Linear radiographic/ tomographic system

Linear radiographic/tomographic systems . Film and x-ray tube move in opposite directions, in parallel, straight lines.

Tips for Buying a Tomographic X-ray

1. The preferred tomographic x-ray systems are the ones that allow flexible imaging and easy patient transfer.

2. Facilities should consider the radiographic-tomographic table system manufacturer's reputation

for long-term availability of replacement parts and service support before making a purchase.

3. To avoid movement during procedures, the patient table movement must allow for easy patient positioning.

4. To prevent vibration interference and to ensure accuracy of tomograms, electronic clutching is recommended for all linear tomographic units.

5. For a direct interface of the collimator on the tomographic x-ray tube with the Bucky tray, linear x-ray unit devices should have positive beam-limiting equipment.

6. Positive beam limitation is designed mainly for patient safety and is expensive to implement. The maximum field size depends on the size of the cassette in the Bucky tray.

7. Users of tomographic x-ray systems should be able to easily reach the controls at tableside.

8. Facilities need to assess their need for a dedicated system, since computed tomography procedures have largely replaced many tomographic procedures.

9. Many options are available from different manufacturers. These may include the type of x-ray generator and output kV and mA; floor, table, or wall-mounted cassette holders; ceiling-mounted x-ray tube supports; and anatomic programming options.

10. Only qualified personnel should perform calibration of linear x-ray units and they should comply with manufacturer specifications.

Questions for the Seller

Before you purchase your Tomographic X-ray, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

System

When was the x-ray tube last exchanged?

Are the tomographic motions smooth?

Are the up-down motions smooth?

Smooth left-right motion?

Does it have an additional work station?

System Table

Is the left-right and in-out stretcher motion smooth?

Is the up-down table motion smooth?

Does it include a Coronal Head Holder?

Does it include an Axial Head Holder?

Does it include a Stretcher Extender?

Does it include a Mattress?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

# Tips and Guidelines for Buying a Tourniquet

Pneumatic tourniquets for use in limb surgery

Pneumatic tourniquets for use in limb surgery. They are used to maintain a bloodless field during lower limb surgery. They also assist in IVRA, for intravenous local anesthesia, which is an alternative to general anesthesia.

Tips for Buying a Tourniquet

1. A pneumatic tourniquet in surgical applications maintains the minimum pressure necessary to stop blood flow in the limb. This minimum pressure setting is affected by factors like repositioning the limb during the procedure, changes in systolic pressure, and the ratio of cuff width to limb circumference.

2. These tourniquets are mainly used to occlude blood flow and to obtain a bloodless field during lower limb surgery. Tourniquets also facilitate intravenous regional anesthesia, an alternative to general anesthesia for surgery of the upper or lower limbs.

3. Three basic components in most tourniquets are: a cuff, a means of inflating the cuff bladder, and a controller. Some controllers also have a timer or an elapsed time meter.

4. To inflate tourniquet cuffs, several methods are offered.

5. In the majority of tourniquets, air or nitrogen is delivered from a wall outlet or a tank with a regulator.

6. Some models use an electric pump to compress ambient air for cuff inflation; these are mainly line powered with backup batteries.

7. There is a model that uses liquefied tetrafluoroethane from a canister that is discharged into a glass reservoir in the controller. When released, the tetrafluoroethane vaporizes and inflates the cuff. Here, the tourniquet prevents infused local anesthetic from flowing out of the limb, as well as provides a bloodless operating field.

8. Typically, a variety of single and dual bladder tourniquet cuffs will be needed.

9. Both reusable and disposable tourniquet cuffs are available, but a reusable cuff is more cost-effective because of its long life.

10. Facilities should consider whether a control valve is included with the controller or whether they must purchase it separately, and also the cost of accessories such as tubing and connectors for rotating tourniquets and DVT tourniquets.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Pneumatic Tourniquets

# Tips and Guidelines for Buying a Training Manikin

Various training manikins, for CPR training, trauma rescue, defibrillation and other patient treatment skills, tasks and techniques

These manikins are used for teaching various treatment techniques. Adult, child, and infant models are available.

Tips for Buying a Training Manikin

1. Buyers should consider the initial cost of training manikins well as ongoing costs, such as: replacement parts, disposable airbags and face shields.

2. The level and objectives of the training program determine the features needed in a CPR training manikin.

3. Suppliers offer the following features and training manikin options: torso or full body model: can be weighted to simulate the average weight of an adult, child, or infant; a foldout design that allows for easy transport and storage; can be used in water for water rescue training; adult manikin can be converted to a child simulator; upgraded capabilities to provide defibrillation and arrhythmia in cognition training.

4. It should be easy to assemble and disassemble these training manikin units, as well as to clean and disinfect them according to the manufacturer's recommendations. 5. Replacement parts should be easy to obtain and reposition.

# Tips and Guidelines for Buying a Transport Ventilator

**Mobile ventilators for use during transportation, in or out of the hospital**

Ventilators for use during transportation of patients within the healthcare facility, or in emergency situations outside of the hospital. These ventilatory support devices are designed to work in a controlled mode, with preset breathing intervals, and not for spontaneous breathing. Most of them include monitors and alarms for indicating high and low pressure and respiratory failures.

Tips for Buying a Transport Ventilator

1. Transport ventilators are normally used in emergency situations. They should offer the control mode of ventilation, which provides mandatory breaths at preset intervals and does not allow the patient to breathe spontaneously. For continuous care units, other modes are available, such as assist/control and SIMV.

2. Transport ventilator audible and visual alarms should be available at least in the following events: high and low pressures, low battery power level, loss of power, and loss of supply gases. Based on its level of sophistication, an emergency ventilator may have several alarms. They should all be clear. If users can adjust the alarm's volume, they should not be able to turn it down to an inaudible level.

3. If the alarm condition is not fixed, the alarm silence feature must reactivate automatically. When an alarm is silenced, a clear visual display should indicate which alarm is disabled. 4. An oxygen analyzer should monitor the delivered O2 or O2/air mixture. The analyzer can either be included with the emergency ventilator or purchased separately and should be placed in line with the breathing circuit and include an alarm for concentrations outside acceptable ranges.

5. All continuous ventilator controls should be clear with easy-to-understand functions. Misinterpretation of displays and control settings should not occur. Transport ventilator controls should be protected against accidental setting and sealed against fluid penetration. Fluid spills should not affect patient and operator safety and system performance.

6. Facilities should consider the ease with which the transport ventilator can be carried or transported before making the purchase. Users may need to maneuver the continuous ventilator to gain access to the controls or to accommodate space constraints. Transport ventilators need to be small and lightweight, resistant to tipping over, and easily mounted in different orientations

7. Another important factor for facilities to consider is how long can the transport ventilator operate on internal battery power.

8. The preferable emergency ventilator devices are the easy to operate ones. This is especially important in emergencies. Primary controls should be located on one side and should be protected against accidental setting changes.

9. All displays and labels should be clear and visible even in pale lighting and from different angles. They should be resistant to damage from liquid disinfectants and normal wear. Transport ventilators with additional modes, such as SIMV, should have visual indicators to identify when the continuous ventilator senses a breathing effort and what type of breath the patient receives.

10. Disabling visual indicators on a transport ventilator should not be possible. The alarms should allow quick evaluation and correction of the condition. The priority of the alarm should be indicated by different audible tones and visual indicators.

11. To expand the integral airway-pressure monitor, some additional monitors can be used. The preferable supplemental monitors include: exhaled-volume monitors, O2 monitors, and pulse oximeters.

12. Electromagnetic interference and electrostatic discharge should not affect transport ventilators' operation. These emergency ventilator devices should be able to operate in many adverse conditions.

13. Facilities with transport ventilators are strongly encouraged to use power-surge protectors, especially in an area with frequent power surges or thunderstorms.

14. The emergency ventilator operator manual should provide sufficient information for clinicians, users, and caregivers. Servicing a transport ventilator unit by a skilled technician should be easy.

15. MRI compatibility is a necessary feature for continuous ventilators used to transport patients to the MRI suite. Some suppliers offer transport ventilators constructed of materials compatible with magnetic resonance imaging (MRI) scanners.

Questions for the Seller

Before you purchase your Transport Ventilator, we recommend you ask the seller the following questions:

Operating Modes

Assist/control?

Is it a Volume ventilator?

Is it a Pressure ventilator?

SIMV?

Pressure support?

Spontaneous/CPAP?

Apnea-backup vent?

Equipment Alarms

Gas-supply failure?

Power failure?

Vent inoperative?

Low battery?

Self-diagnostic?

Cylinder oxygen and pressure regulator?

Patient Alarms O2

Low insp pressure?

High pressure?

Loss of PEEP?

Apnea?

Inverse I/E?

High continuous pressure/occlusion?

High resp rate?

Monitored Parameters PEEP

PIP?

MAP?

Exhaled tidal volume?

Exhaled minute volume?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Critical Care Ventilators

Oxygen-Air Proportioners

Portable Ventilators

# Tips and Guidelines for Buying an Ultracentrifuge

Ultracentrifuges for floor or tabletop

Ultra high -speed floor or tabletop centrifuges are used for lipoprotein separation, isolation of viruses, enzymes, blood fractions for analysis, and cell structure and function studies. They include a refrigerating system so that samples do not decompose from the heat generated by ultrahigh speed.

Tips for Buying an Ultracentrifuge

1. Before purchasing an ultracentrifuge, facilities need to carefully examine their current and future laboratory needs to avoid purchasing an expensive high-speed centrifuge unit with unnecessary capabilities, or a cheaper one that cannot handle the laboratory workload.

2. Larger facilities with many samples centrifuged daily may need programmable functions, while smaller laboratories with a low or moderate number of samples may not need a programmable unit.

3. When purchasing a high-speed centrifuge, safety features should be a prime factor. Each ultracentrifuge should have a securely interlocking lid that shuts off the unit's motor when the lid is opened, or keeps the lid latched until the rotor has stopped.

4. An inner protective cover over the rotor assembly is an additional safety feature, as well as a clear display warning not to open the ultracentrifuge while the rotor is spinning.

5. The visual indicators and displays on the high-speed centrifuge should be clear and easily read. It is recommended to have audible alarms in case of device malfunction, rotor imbalance, or open lid.

6. Alert indicators and safety features help protect ultracentrifuge components and rotor contents from breakage, and also protect operators from flying debris. Buying ultracentrifuges with these features is recommended.

Questions for the Seller

Before you purchase your Ultracentrifuge, we recommend you ask the seller the following questions:

General Information

Was this system used for testing biologically hazardous chemicals?

Is it brushless?

Does it include a hematocrit rotor?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Centrifuges

# Tips and Guidelines for Buying an Ultrasonic Blood Flow Detector

**Ultrasonic blood flowmeters, also assisting in assessment of flow restrictions**

Ultrasonic blood flowmeters used to locate and assess flow restrictions. The flowmeters use a radio frequency unit with ultrasonic transducer probe, and audio/visual indicator. Blood velocity can be measured invasively or non-invasively, using either continuous-wave or pulse-Doppler techniques.

Tips for Buying an Ultrasonic Blood Flow Detector

1. Laser blood flow meters and ultrasonic blood-flow detectors can be handheld, portable, or tabletop units. Facilities should select the right configuration based on clinician monitoring needs and preference.

2. Ultrasonic blood-flow detectors and meters should include an on/off indicator, and transducers with different user-selectable transmitting frequencies. The Ultrasonic blood-flow detectors and flow meters should have a range of 2 to 8 MHz.

3. External speakers with volume control for Doppler analysis should be included with the flow meters. They should also have bi-directional flow indicators, and a transducer mounted on a catheter or probe or integral to a clamp.

4. Ultrasonic blood-flow detectors should have probes with different lumen diameters. Frequency response should be user selectable and within a range of 0.5 to 100 Hz.

5. An ultrasonic blood-flow detector should remain zeroed and calibrated for at least one day after it was zeroed and calibrated according to the manufacturer's instructions.

6. In order to provide the required accuracy for the evaluation of blood perfusion, the ultrasonic blood-flow detectors should include a fiberoptic probe designed for that purpose.

7. The following data should be specified by the manufacturer: the ultrasonic blood flow detector unit's measurement depth, response time, laser class, wavelength, and power output at probe tip, Doppler-shift frequency range, cable length, and probe-head diameter.

8. When facilities consider buying probes to be used with ultrasonic blood flow meters, they should look into various factors, such as: the length of the vessel that can be exposed, the available space around the vessel, the location of adjacent organs, and the depth of the vessel's location.

9. Facilities must use ultrasonic blood-flow detector probes of the right size and type to obtain accurate results. Most manufacturers will try to meet specific needs for probe sizes and accessories although they don't necessarily include it in their usual product lines.

10. Various output options are offered with these TachoMeter units. These may include headphones, chart recorder, extra output jacks, a printer, and meters.

11. Other options are available as well, including: pneumoplethysmography, strain-gauge plethysmography, photoplethysmography, a carrying case, a remote control, a footswitch, and interfacing capabilities.

12. The ultrasonic blood flow detectors can be line-powered or battery-powered. Battery-powered HemotachoMeter units should have their battery operating the device for at least two hours. A visible and audible alarm should warn when a battery level falls to the point that may fail the ultrasonic blood flow unit to perform satisfactorily.

13. Rechargeable batteries should require less than 16 hours of recharging after depletion. When there's a need to recharge the battery on the Tachometer or Hemotachometer, a clear indicator should appear.

Questions for the Seller

Before you purchase your Ultrasonic Blood Flow Detector, we recommend you ask the seller the following questions:

General

Was the equipment upgraded?

Software installed? (Name + Version)

General Information

Is it bidirectional?

Does it have computer interface?

Does it have volume control?

Does it have an on/off indicator?

Can it be battery operated?

Outputs

Does it include a speaker?

Does it include a headphone?

Does it include a chart recorder?

Does it include a printer?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Ultrasonic Blood Flowmeters

# Tips and Guidelines for Buying an Ultrasonic Cleaning System

Ultrasonic cleaning systems for surgical and laboratory instruments

Ultrasonic cleaning systems with washing, rinsing, and drying cycles, used for surgical and laboratory instruments. Ultrasonic waves are directed to a tank filled with specially formulated detergents. Ultrasonic vibration performs a scrubbing action. Thermal or chemical disinfection is generally needed after cleaning cycle.

Tips for Buying an Ultrasonic Cleaning System

1. Before deciding on a specific ultrasonic cleaning system unit, facilities should check on local service. It is preferred to have a modular system, which provides easy removal of parts to be serviced or replaced.

2. Facilities should also consider the type, quantity, and cost of cleaning solutions that can be used with particular ultrasonic bath cleaners before deciding on a model. The cost of ultrasonic cleaning system accessories should also be examined.

3. Ultrasonic cleaning system suppliers offer facilities service contracts or service on a time-and-materials basis. A third-party organization may also offer such services. Facilities should carefully consider the decision to purchase a service contract, which can be justified for several reasons.

4. Facilities buying ultrasonic cleaning system service contracts ensure that preventive maintenance is performed at regular intervals, and eliminate the possibility of unexpected maintenance costs. Many ultrasonic bath cleaner suppliers extend system performance and uptime guarantees beyond the length of the warranty, only for systems covered by a service contract.

5. Facilities should be aware of the fact the initial acquisition cost does not accurately reflect the total cost of ultrasonic bath cleaner ownership, since these devices require ongoing maintenance and operational costs. Facilities should consider life-cycle cost, local ultrasonic cleaning system service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment.

# Tips and Guidelines for Buying an Ultrasonic Fetal Monitor

Ultrasonic fetal heart detectors

A device used to detect fetal heartbeat from ten weeks after conception, using ultrasonic waves. A probe placed on the maternal abdomen amplifies Doppler effect of the returning ultrasonic waves, providing audible output to speakers or headphones. Heartbeat can most accurately be measured using automated autocorrelation procedures, or by measuring timing of peaks in the Doppler signal.

Tips for Buying an Ultrasonic Fetal Monitor

1. Ultrasonic Fetal Monitor devices should monitor FHR ranges of at least 50 to 210 bpm. Outputs are generated using a speaker or headphones for private or shared listening.

2. The controls on these Ultrasonic Fetal Monitor devices should include power (on/off) and volume.

3. Batteries on battery-operated devices should be rechargeable. They should allow at least eight hours of operation, and be able to be charged while connected to line power.

4. Battery-powered Doppler device units should have a clear low-battery indicator on the outside of the unit to make sure the batteries are being recharged. Plugging the charger into an AC outlet is not sufficient.

5. Some Ultrasonic Fetal Monitor models will include one obstetric probe, coupling gel, a carrying case, and a user guide.

6. Facilities planning to use the Doppler device for non-obstetric applications should look into devices with multiple-probe capacity. Those who plan to use the device on a regular basis may select one with rechargeable batteries.

Questions for the Seller

Before you purchase your Ultrasonic Fetal Monitor, we recommend you ask the seller the following questions:

Accessories

Does it include a battery charger kit?

Does it include a charger?

Does it include a low-batt indicator/alarm?

Outputs

Does it include headphones?

Does it include a stethoscope?

Does it include a chart recorder?

Does it include an extra output jack?

# Tips and Guidelines for Buying an Ultrasonic Lithotripter

Intracorporeal lithotripters using US transducer and a hollow steel probe

Intracorporeal lithotripters fragment kidney stones by putting them in direct contact with a vibrating probe. An external generator produces high-frequency soundwaves which are converted into vibrations by a transducer . These vibrations are carried through the hollow probe. In some of the units, stone fragments are aspirated through the probe using a suction pump.

Tips for Buying an Ultrasonic Lithotripter

1. These units are used for locating, viewing, fragmenting, and removing urinary tract or renal calculi. They may also be used to disintegrate salivary stones or bile duct stones. Units with footswitch are recommended because they keep the operator's hands free to position the unit.

2. Different pulse energy and pulse rate portray Electro-hydraulic lithotripters; pulse duration and voltage determine the amount of energy delivered per pulse. Available pulse rates vary and are often a function of the pulse duration selected. Acceptable electrode size varies from 1.7 Fr/77 cm to 9 Fr/40 cm; the longer lengths are usually used for biliary applications.

3. Laser devices should have a wavelength of about 2,100 nm and a visible aiming beam to ensure accurate placement. Pulse duration and power determine the amount of energy delivered per pulse. Available pulse rates also vary among manufacturers and are often a function of the selected pulse duration.

4. General lithotripsy and soft tissue surgical procedures can use low-watt lasers. High-watt lasers can be used for bladder stone lithotripsy, and pulse duration may be up to 500 usec.

5. A laser lithotripter should have a fiber diameter between 200 and 1,000 um and at least 3 ft long.

6. For lithotripsy in the lower pole of the kidney, usually small fiber diameters are used with flexible scopes. Lithotripsy in the bladder and ureter will generally use large fiber diameters with rigid scopes. Operators can use any standard endoscope to visualize placement of the lithotripter.

7. With nephroscopes, operators usually use a shorter lithotripter probe than the one used with ureteroscopes, with an outer diameter that is larger than the one used with ureteroscopes. Also the sheath diameter of the nephroscope is larger and the length is shorter than that of the ureteroscope.

8. Any rigid or flexible endoscope is acceptable for electromechanical lithotripters. The available sizes for probes should be between 0.8-9.6 Fr and 26.7-90 cm long at minimum.

9. Manufacturers offer a wide range of IL devices. However, there is no one device that covers the entire range of clinical situations. The factors that affect the choice should include: location and size of the stone burden, endoscope configuration working channel caliber, and offset or end on port.

10. Video and photographic accessories, such as cameras, videocassette recorders, and light sources, are also offered by suppliers at an additional cost. This can enhance imaging and educational uses of the instrument.

11. To compare high-cost alternatives and to determine the economic value of a single alternative, facilities can use a life cycle cost analysis. They can use low-cycle -ost analysis techniques to examine the cost-effectiveness of leasing or renting equipment versus purchasing it outright.

12. Low-cycle-cost analysis is most useful for comparing alternatives with different cash-flows and for revealing the total costs of equipment ownership because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time.

13. Suppliers offer facilities service contracts or service on a time-and-materials basis. Some third-party organizations may also provide this service. Facilities should carefully consider this issue.

14. Service contract customers can get routine software updates, which enhance the system's performance, free of charge from most suppliers. Facilities should keep in mind that software updates are often cumulative, which means that previous software revisions may be required in order to install and operate a new performance feature.

15. Facilities with a full-service contract ensure preventive maintenance at regular intervals, thereby avoiding the unexpected maintenance costs. Many suppliers extend system performance and uptime guarantees beyond the length of the warranty only for systems covered by a service contract.

# Tips and Guidelines for Buying an Ultrasound and Electrical Stimulation Unit

An electrical stimulator / ultrasound generator for physical therapy

The unit may contain two functions in one enclosure: An electrically programmed pulse generator, and an ultrasound system. It is claimed that applying both outputs has synergetic healing and pain relief effects.

Tips for Buying an Ultrasound and Electrical Stimulation Unit

1. Facilities can select a tabletop, wall mounted, or cart mounted therapeutic ultrasound unit.

2. To permit user exchange, these systems should have transducers with connectors. The unit should be capable of frequencies at 1 and 3 MHz. It should run in both continuous and pulsed modes.

3. Each transducer should have a beam with a non-uniformity ratio of less than 8 and should have a variable pulse rate that falls between 80 and 150 pps.

4. Systems equipped with several transducers of various diameters facilitate treatment of different areas of the body. However, there are systems with only one transducer.

5. An automatic shutoff function is a preferred feature.

6. Configuration, ERA, and maximum power should be based on patient and clinician preference as well as on treatment location.

7. If the unit is to be used for offsite therapy, some portable devices are available in a carrying case or tote bag.

8. Systems with dual frequencies provide a wider range of treatment capabilities.

9. To reduce costs, facilities can obtain a combination ultrasound neuromuscular stimulator unit, instead of buying separate units. Using these units, facilities can choose therapeutic ultrasound only, neuromuscular stimulation only, or a combination of both.

10. Facilities should consider the costs associated with the following: additional transducers, coupling gel, service and a therapist.

# Tips and Guidelines for Buying an Ultrasound Phantom

Phantoms for ultrasound

Phantoms that are used for simulation. They utilize characteristics of human tissue for testing situations of U.S wave absorption and returning wave, also for research, QA/QC, equipment calibration, and testing purposes.

Tips for Buying an Ultrasound Phantom

1. With the increasing emphasis on QA/QC programs, hospitals should consider purchasing ultrasound phantoms to test system performance on a regular basis (e.g., daily, weekly, monthly), particularly for modalities such as radiography, fluoroscopy, and radiotherapy, in which patient radiation exposure is a concern. For U.S. mammography departments and facilities, imaging phantom units that meet the requirements of an accreditation program or MQSA should be purchased. Some facilities create their own biopsy training ultrasound phantoms from inexpensive materials to save on costs.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Phantoms

# Tips and Guidelines for Buying an Ultrasound Therapy System

Ultrasound systems for physical therapy

Physical therapy ultrasound systems are used for pain relief and soft tissue healing ( e.g. muscle or tendon injury, bursitis). Ultrasound waves are applied through the skin, producing thermal and nonthermal effects on tissues.

Tips for Buying an Ultrasound Therapy System

1. Facilities can select a tabletop, wall-mounted, or cart-mounted therapeutic ultrasound unit.

2. To permit user exchange, these systems should have transducers with connectors. The unit should be capable of frequencies at 1 and 3 MHz. It should run in both continuous and pulsed modes.

3. Each transducer should have a beam with a non-uniformity ratio of less than 8 and should have a variable pulse rate that falls between 80 and 150 pps.

4. Systems equipped with several transducers of various diameters facilitate treatment of different areas of the body. However, there are systems with only one transducer.

5. An automatic shutoff function is a preferred feature.

6. Configuration, ERA, and maximum power should be based on patient and clinician preference as well as on treatment location.

7. If the unit is to be used for offsite therapy, some portable devices are available in a carrying case or tote bag.

8. Systems with dual frequencies provide a wider range of treatment capabilities.

9. To reduce costs, facilities can obtain a combination ultrasound neuromuscular stimulator unit instead of buying separate units. Using these units, facilities can choose therapeutic ultrasound only, neuromuscular stimulation only, or a combination of both.

10. Facilities should consider the costs associated with the following: additional transducers, coupling gel, service, and a therapist.

Questions for the Seller

Before you purchase your Ultrasound Therapy System, we recommend you ask the seller the following questions:

Handpiece Configurations

Handpiece Configurations: Is it suitable for gynecology?

Handpiece Configurations: Is it suitable for lipoaspiration?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Physical Therapy Ultrasound Units

# Tips and Guidelines for Buying an Ultrasound, Cardiac

Cardiac ultrasonic scanning systems

Cardiac ultrasonic scanners including different transducers needed for the evaluation of cardiac functions including blood flow and heart structures. They include software, image recorder, and printer. These systems operate in real-time, for non-invasive imaging of heart structures.

Tips for Buying an Ultrasound, Cardiac

1. A cardiac ultrasound unit can call on the full range of a scanner's Doppler capabilities. Using echocardiography, flow and turbulence can be examined throughout the heart and great vessels.

2. For timing reference, electrocardiography is incorporated and some cardiac ultrasound scanners are able to perform stress echocardiography studies.

3. This area of study involves examining the structure and function of the heart and great vessels, including imaging the cardiac valves, heart chambers, wall motion, and thickness.

4. Cardiac ultrasound packages calculate quantitative 2-D and Doppler values to aid diagnosis.

5. If there is a need to transport a system from the Cardiology Department to the bedside, Intensive Care Unit, coronary care unit, catheterization lab, or even to an offsite clinic, then a portable cardiac ultrasound scanner system could be used.

6. A full-featured cardiac ultrasound system, typically used in cardiology departments or private cardiology clinics, is needed for a comprehensive cardiac study.

Questions for the Seller

Before you purchase your Ultrasound, Cardiac, we recommend you ask the seller the following questions:

General

Was the equipment upgraded?

Software installed? (Name + Version)

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Probes - Type

Linear array?

Phased array?

Multifrequency?

Doppler Type

Frequency display?

Velocity display?

Duplex mode?

Triplex mode?

Analysis Packages

Vascular scanning?

OB/GYN scanning?

Harmonic Imaging?

Other Analysis Packages? (please specify)

Pan/Zoom

Real-time image?

Frozen image?

Monitors

Monitors quantity?

Monitors Size (Please specify)?

Probes - Repairing

Has the Linear array probe (including the cable and the plug) been repaired?

Has the Phased array probe (including the cable and the plug) been repaired?

Has the Multifrequency probe (including the cable and the plug) been repaired?

Probes - Refurbishment

Was the Linear array probe refurbished?

Was the Phased array probe refurbished?

Was the Multifrequency probe refurbished?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

Diagnostic Ultrasound (Cardiac)

US System

Suprevision Forms

US System – Dismantling

# Tips and Guidelines for Buying an Ultrasound, Diagnostic

Ultrasonic imaging and measurement systems

Ultrasound systems are used to manually scan and produce echo images of anatomic structures (soft tissue). Each system is designed to the specific needs of the discipline. Lower frequency US is used for deep structures images. High frequency US can produce high resolution images, but may only be used for a limited range of depth. There are general purpose US systems as well as specific equipment, e.g. OB/GYN, urology, vascular, cardiology.

Tips for Buying an Ultrasound, Diagnostic

1. Facilities need to consider the following basic issues before purchasing an ultrasound scanning system: functions and features, cost, ease-of-use, upgradeability, image storage, and customer support.

2. The uses of ultrasound scanning systems with OB/GYN capabilities include: investigating a variety of gynecologic abnormalities, including infertility; detecting the presence and condition of a fetus; examining the blood supply to the fetus; and monitoring fetal growth throughout pregnancy.

3. This technology is also useful in guiding amniocentesis and other invasive procedures.

4. Obstetric analysis packages provide valuable information, including gestational age, fetal weight, and fetal growth calculation, and some are also capable of report generation.

5. Endocavity transducers are available for use with gynecologic imaging and on some general-purpose ultrasound scanners for prostate screening.

6. Comprehensive OB/GYN studies and general-purpose abdomen and small-parts studies require a full-featured diagnostic ultrasound system, which is used in a hospital's radiology department or imaging center, OB/GYN department, or OB/GYN offices, in which comprehensive obstetric ultrasound examinations are performed.

7. Another field requiring a full-featured diagnostic ultrasound system is comprehensive vascular study. Such a ultrasound scanning system is usually used in a hospital's radiology department, cardiology department, or vascular lab or in a vascular surgeon's office. Examinations include comprehensive extra cranial and peripheral vascular studies.

8. Specialized high-frequency small-parts probes are available with some general-purpose diagnostic ultrasound scanners for use in thyroid, breast, scrotum, neonatal brain, and musculoskeletal evaluation.

9. For diagnosing arterial and venous abnormalities and their causes, general-purpose diagnostic ultrasound scanners with vascular capabilities provide flow profiles of vessels throughout the body.

10. Doppler provides flow detection in vessels, such as those found in organs and tumors and in extremities. Spectral Doppler analysis packages can perform calculations automatically.

11. Remote diagnostic ultrasounds are offered by some suppliers. This enables scanning functions remotely through a modem.

Questions for the Seller

Before you purchase your Ultrasound, Diagnostic, we recommend you ask the seller the following questions:

General

Was the equipment upgraded?

Software installed? (Name + Version)

Does the system include a printer?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Probes - Type

Linear array?

Phased array?

Multifrequency?

Endovaginal?

Endorectal?

Probe Transiver Esofaplial- T.E.?

Doppler type

Frequency display?

Velocity display?

Power Doppler?

Duplex mode?

Triplex mode?

Analysis Packages

Cardiac scanning?

Vascular scanning?

OB/GYN scanning?

Harmonic Imaging?

Other Analysis Packages? (please specify)

Pan/Zoom

Real-time image?

Frozen image?

Monitors

Monitors quantity?

Monitors Size (Please specify)?

Probes - Repairing

Has the Linear array probe (including the cable and the plug) been repaired?

Has the Phased array probe (including the cable and the plug) been repaired?

Has the Multifrequency probe (including the cable and the plug) been repaired?

Has the Endovaginal probe (including the cable and the plug) been repaired?

Has the Endorectal probe (including the cable and the plug) been repaired?

Probes - Refurbishment

Was the Linear array probe refurbished?

Was the Phased array probe refurbished?

Was the Multifrequency probe refurbished?

Was the Endovaginal probe refurbished?

Was the Endorectal probe refurbished?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

Diagnostic Ultrasound (Cardiac)

US System

US System - Dismantling

# Tips and Guidelines for Buying an Ultrasound, Portable

Portable, small, and lightweight ultrasonic scanning systems of small superficial organs

US scanners for superficial examinations of small organs, with appropriate software, recorder, and printer. These scanning systems produce high resolution images, and have Doppler capabilities. Suitable mainly for basic diagnostic functions. They can be used in physicians' offices, outpatient facilities, and for hospital bedside scanning.

Tips for Buying an Ultrasound, Portable

1. The anatomic data provided by ultrasound scans make diagnoses of diseases, cysts, and tumors (size, texture, and location). General-purpose use for imaging the abdomen and small parts is one of the oldest and most common ultrasound procedures.

2. To evaluate abdominal organs and allow further diagnosis by providing information on blood flow, basic Doppler capabilities are used.

3. Specialized high frequency, small parts probes are used in some general-purpose portable ultrasound scanners for evaluating thyroid, breast, scrotum, neonatal brain, and musculoskeletal. Some general-purpose portable ultrasound scanners are equipped with endocavity transducers for prostate screening.

4. A hospital's radiology department or imaging center will usually use a full-featured portable ultrasonic scanner system, which is required by general-purpose abdomen and small parts studies.

5. A portable ultrasound scanner system containing only basic features can perform limited abdominal studies, which may permit detection of abdominal trauma, fluid collections, gallstones, and aortic aneurysms.

6. Assessment of the structure and function of the heart and great vessels is done by comprehensive cardiac ultrasonography, or echocardiography. The cardiac ultrasound can call on the full range of a portable ultrasound scanner's Doppler capabilities.

7. To help with diagnosis, cardiac analysis packages calculate quantitative 2-D and Doppler values. Electrocardiography is normally incorporated for timing reference. There are portable ultrasonic scanner units that perform stress echocardiography studies.

8. Portable ultrasound scanners can be transported from the hospital's cardiology department to the bedside, intensive-care-unit critical care unit, catheterization lab, or an offsite clinic.

9. The clinician can get flow profiles of vessels throughout the body to diagnose arterial and venous abnormalities and their causes using a comprehensive vascular study. Doppler further extends vascular techniques by providing flow detection in vessels, such as those found in organs and tumors in extremities.

10. Calculations can be made automatically by some spectral Doppler analysis packages. A full-featured portable ultrasound system is required by a comprehensive vascular study, which is usually conducted in a hospital's radiology department, cardiology department, vascular lab, or vascular surgeon's office.

11. Most of the vascular studies are performed within the lab of the responsible hospital department. However, many routine studies are performed at the patient's bedside, using a portable ultrasound, or in the ICU or emergency department.

12. There are many frequently performed vascular studies included in the limited vascular studies in which the used imaging and Doppler modes, number of measurements made, and required documentation are substantially limited.

13. One of the applications is vascular access guidance, which includes ultrasonic guidance for vascular surgical procedures, catheter insertions, peripherally inserted central catheter line placements, and biopsies.

14. Comprehensive OB/GYN studies use ultrasonography to investigate many gynecologic abnormalities, including infertility, and detection of various conditions of the fetus throughout pregnancy.

15. Some invasive procedures, including guiding amniocentesis, use ultrasonography as well. OB analysis packages provide a variety of commonly used gestational age, fetal weight, and fetal growth calculation methods, and some can also generate reports.

16. To carry out comprehensive OB/GYN studies, facilities need a full-featured portable ultrasound system. This is typically the situation in a hospital's radiology department, OB/GYN department, imaging center, or even in an OB/GYN office that performs comprehensive obstetrical ultrasound examinations.

17. Some functions can be carried out by limited OB/GYN studies. They may determine the presence, position, and viability of a fetus along with gestational-age verification. It is also possible to determine amniotic fluid levels, pelvic morphology, and detect ectopic pregnancy.

18. Limited OB/GYN studies are usually performed by personnel in a hospital's labor and delivery or emergency departments.

Questions for the Seller

Before you purchase your Ultrasound, Portable, we recommend you ask the seller the following questions:

General

Was the equipment upgraded?

Software installed? (Name + Version)

Does the system include a printer?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Probes - Type

Linear array?

Phased array?

Multifrequency?

Endovaginal?

Endorectal?

Probe Transiver Esofaplial- T.E.?

Doppler Type

Frequency display?

Velocity display?

Duplex mode?

Triplex mode?

Analysis Packages

Cardiac scanning?

Vascular scanning?

OB/GYN scanning?

Harmonic Imaging?

Other Analysis Packages? (please specify)

Pan/Zoom

Real-time image?

Frozen image?

Monitors

Monitors Size (Please specify)?

Probes - Repairing

Has the Linear array probe (including the cable and the plug) been repaired?

Has the Phased array probe (including the cable and the plug) been repaired?

Has the Multifrequency probe (including the cable and the plug) been repaired?

Has the Endovaginal probe (including the cable and the plug) been repaired?

Has the Endorectal probe (including the cable and the plug) been repaired?

Probes - Refurbishment

Was the Linear array probe refurbished?

Was the Phased array probe refurbished?

Was the Multifrequency probe refurbished?

Was the Endovaginal probe refurbished?

Was the Endorectal probe refurbished?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

Diagnostic Ultrasound (Cardiac)

US System

Suprevision Forms

US System - Dismantling

# Tips and Guidelines for Buying an Ultraviolet Lamp

Ultraviolet lights with germicidal function

UV lights with one or more low-pressure mercury vapor tubes. They are used to prevent the spread of pathogens, by reducing the concentration of airborne microorganisms.

Tips for Buying an Ultraviolet Lamp

1. The operating time of the ultraviolet lights should be at least 9,000 hours or 1 year. This may vary based on how often the ultraviolet lamp is on and the conditions under which it operates.

2. Bulbs may appear to be lit after they have stopped radiating UV light, and should therefore be tracked.

3. It should be easy to remove the light tube from the ultraviolet light fixture, to clean, and reinsert it.

4. Clear and comprehensive operator's manual should be provided by the manufacturer. The guide will specify the light's electrical ratings and requirements, effective tube life, and lockout switch operation as well as installation and maintenance recommendations and troubleshooting instructions for minor problems. All consumables and frequently replaced parts should be defined as well, and safety measures that can prevent UV exposure to workers and patients should be discussed.

5. In places where other engineering controls are less likely to be completely effective in decontaminating room air, such as lobbies, waiting areas, corridors, and certain treatment areas, ultraviolet lamps can be most effective.

6. Facilities need to examine other supplemental engineering and infection control methods that can work in conjunction with ultraviolet lamps.

7. These methods may include HEPA filtered duct systems, which are highly effective in disinfecting air from patient-room-size areas. CDC states that there is no current evidence demonstrating that ultraviolet sterilizing units used together with a properly maintained HEPA filter decontaminate air more efficiently than using a HEPA filter alone. HEPA filters in exhaust ducts are less effective for decontaminating air in larger areas because of unpredictable airflow patterns that can prevent effective air changing. These systems can be used to filter air in a patient isolation room or public area.

8. Another method is the portable air purifiers, which are typically more costly than an ultraviolet lamp system designed for the same size room; in addition, CDC notes that as with ultraviolet sterilizing units, the air-decontaminating effectiveness of these devices in a clinical setting has not been conclusively demonstrated. These devices are the most effective types of PPE for preventing TB exposure.

# Tips and Guidelines for Buying a Urine Analyzer

A device for urine analysis at the point-of-care (bedside urine analysis)

These devices are aimed to perform the urine analysis at the point of care, they are mostly small and easy for use. A typical POC analyzer tests: Bilirubin, Blood, Glucose, ketone body, Leukocytes, Nitrite, pH, Protein, Specific gravity and Urobilinogen.

Tips for Buying a Urine Analyzer

1. Facilities should consider the urine analyzer's degree of automation when selecting the right type of urine tester. Facilities should keep in mind that non-laboratory trained personnel often use point-of-care devices. However, more automated features and greater data-management capabilities may be preferred.

2. All point-of-care urine analyzer devices should provide basic data management features, including a means of patient identification, record of the test result, date, and time. In cases where trained personnel are not available while the test is performed, intermediate data management capabilities will be desirable on top of the basic ones, including captures of QC results, reagent lot numbers, and operator ID.

3. Some medical facilities should look into more advanced urine laboratory tester data management functions, which may include - on top of all of the options previously mentioned - the ability to collect data from one or more urine testers into a central data repository, which may be a stand-alone PC or an information system. Another advanced data management option may be the ability to generate reports based on the data collected.

4. Urine analyzer devices should have the capability of producing a hard copy of test results using a built in printer or an interface to an existing one. A computer interface is also preferred to allow automatic results reporting and communication with a facility's data-management system.

5. Urine analyzers used during cardiac surgery generally require activated clotting time testing and usually not PT or APTT testing capabilities. The most frequently ordered tests in a hematology point-of-care (POC) setting would be hemoglobin and/or hematocrit. A blood donor setting may only require hemoglobin testing, while an intensive care setting may require both, and a clinic may prefer one or the other.

6. Facilities considering a POC urine analyzer testing program should perform a careful, detailed cost-benefit assessment of the current urine testing system compared with point-of-care testing. The ongoing costs of operating point-of-care instruments are often higher than the operating costs of central laboratory equipment, and this is on top of the initial capital investment. However, point-of-care urine testing may offer some benefits that reduce overall costs in the long run and improve patient care.

7. POC urine analyzer devices provide physicians with immediate results, and allow them to give faster, more appropriate diagnoses, which can eliminate unnecessary treatments and tests. Also prolonged hospital stays may be reduced, and unnecessary stays may be eliminated as a result of more appropriate triage from EDs and pre-hospital settings. The time spent in ICU can be minimized, thus reducing treatment costs.

8. Different facilities must consider different factors when investigating the cost effectiveness of point-of-care urine analysis. These factors include the facility's average TAT, reagent and disposables costs, and test volume; the types of urine analyzer tests most often ordered; the areas in which point-of-care testing may be needed; and the personnel performing the tests. 9. Point-of-care use will decrease the average TAT for laboratory tests. With these POC urine analyzer devices, the intermediate steps involved with specimen transport are eliminated, and TAT is reduced to little more than analysis time, if TAT can be reduced enough, the increase in reagent and disposables costs may be offset by reduced lengths of stay and improved quality of care.

10. Testing using a POC urine analyzer can also reduce the need for duplicate test runs due to error during sample transport and unnecessary tests performed as a result of delayed results. The cost of urine analyzer equipment and reagents can vary according to the test types; certain tests are usually less expensive to run than others, and the instruments needed to perform urine analyzer tests may be less expensive than other analyzers.

11. Point-of-care urine analyzer testing affects costs in several ways, depending on the areas of the facility in which it will be used. Point-of-care urine analyzer applications usually have more potential for savings and improved care when used in the ED, OR, and critical care areas.

12. The use of point-of-care urine laboratory testing will affect staffing expenses as well. Time spent in transit by transport personnel is also likely to decrease with the reduction in specimen transport. It may be difficult to quantify many employee expenses, but they should be carefully examined.

13. Before deciding to begin point-of-care urine analysis, facilities should explore other available options, such as pneumatic tube transport systems and satellite STAT laboratories.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Urine Analyzer, Automated

Semi automated or fully automated urine analyzers for laboratory use

Semi automated or fully automated laboratory urine analyzers for determining urine parameters.

Tips for Buying a Urine Analyzer, Automated

1. Three categories cover all the specifications for automated urine analyzers: required, preferred, and optional.

2. Specifications covered by the required category are the minimum specifications necessary for the automated urine analyzer to perform its indicated function.

3. Specifications enhancing the automated urine analyzer model's effectiveness by improving test operations or ease of use fall under the preferred category.

4. Specifications that enable a wider range of automated urine analyzer applications by offering greater testing options, minimizing user interaction, or allowing the analyzer to be operated effectively under a wide variety of circumstances fall under the optional category.

5. Several factors may determine which automated urine analyzer to purchase, including the location of the instrument in the facility, cost, purpose, ease of use, and number of urine specimens analyzed per day or work shift.

6. Automated urine analyzers that should be best considered for emergency departments or ICUs are ones that provide specific gravity results quickly, are simple to operate, and are easily transportable - such as a handheld refractometer or a simple reagent strip analyzer.

7. Reflectance automated urine analyzers and portable refractometers provide readings that are suitable for urine-specific gravity screenings, though they are not as accurate as laboratory refractometers.

8. Only laboratory refractometers should be considered for laboratory use, which requires highly accurate data for medical diagnoses.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Medical Laboratory Device

# Tips and Guidelines for Buying a Urodynamic Measurement System

Measurement systems for various urodynamic evaluation functions

Urodynamic measuring systems using different functions to measure and evaluate urethral function and urine parameters, including external urine flow measurements, bladder capacity, muscle activity, and pressure profile. Some have video and recording capabilities. Some models are capable of performing cystometrogram and LLP tests, as well as performing H2O and CO2 cystometry, UPP, LPP, EMG, Uroflowmetry and Pressure flow studies.

Tips for Buying a Urodynamic Measurement System

1. Facilities should select the unit's configuration based on user preference; some available options include trolley, cart, pole, and wall mounted, portable, or standalone.

2. The uroflowmeter transducers can be a spinning disk, weight sensor, or turbine configuration.

3. The unit should monitor a flow range of 0-50 ml/sec, a peak flow of 50 or 100 ml/sec, and a volume range of 0-2,000 ml.

4. The uroflowmeter should have an auto record and auto zero. The output should be displayed on a monitor or printed out.

5. The cystometer, measuring the pressure within the bladder, is either integral to the unit or a stand-alone monitor. It should monitor H2O; CO2 is optional. The unit should monitor a flow of 0-200 ml/min for H2O and 0-300 ml/min for CO2.

6. The transducer can be calibrated by hardware, software, or by an automatic process. Output should be displayed on a monitor or printed out.

7. The profilometer, measuring urethral pressure, should have withdrawal rates of 0.25-5 mm/sec with a range of 0-300 mm. Outputs should be displayed on a monitor or printed out.

8. An electronic manometer, measuring intravesical and intra-abdominal pressures, should monitor abdominal pressure with a rectal balloon and vesicle pressure monitored by a urethral or suprapubic catheter.

9. It should have an auto zero with an H2O pressure range of 0-300 cm. Calibration for the transducer should be completed automatically, and the output should be displayed on a monitor or printed out.

10. Before and during urination, the EMG amplifier should be capable of monitoring and amplifying sphincter and other muscle activity. It should have a sensitivity of 5 mV or 50 mV. The upper frequency limit should be at least 10 kHz with a lower limit of 10 Hz.

11. Data processing and storage through data management system are not required but are preferred. Fluoro interface and video recorder are also optional.

12. Some facilities may find that a simple system with an uroflowmeter and cystometer is sufficient; others will need additional channels for measuring collateral pressures and subtracted pressures.

# Tips and Guidelines for Buying a Urological X-ray

R/F systems for various examinations and surgical procedures

Urological tables for radiographic procedures. These R/F systems have a wide range of tilting and movement capabilities. They are used for endoscopic procedures in the urinary tract, and various other diagnostic and surgical procedures. A wide range of height/tilt positions can be achieved, including tilt needed for urological radiographic procedures.

Tips for Buying a Urological X-ray

1. The ability to carry out the full range of necessary urological examinations is the most important aspect of these urological x-ray devices. They should also provide sufficient x-ray output and fluoroscopic screen size to capture the images required.

2. These urological imaging systems should have a range of accessories to accommodate different procedures. Recommended features include foot and hand controls, tissue screen, crutches, leg holders, padded arm boards, and a surgeon's elbow rest. The accessories should not interfere with urological x-ray procedures and should be movable, removable, or collapsible when not needed.

3. Urological x-ray room tables require a full range of movement. To improve flexibility in positioning the patient for various procedures, table tilts should range from 0

4. A recommended feature when purchasing a urological imaging system is the Fowler positioning, in which the table raises the upper torso of the patient to various sitting positions.

5. To ensure procedure efficiency and patient comfort, the availability of appropriate leg supports, shoulder supports, armrests, drainpans, and other accessories is important in a urological x-ray system.

6. The area of urology is not very demanding from an imaging perspective. Nevertheless, the pelvis and abdomen do require a high-power tube due to increased x-ray attenuation.

7. High-frequency generators tend to be more efficient and produce less kilovolt ripple than standard rectified systems. They are generally smaller and require much less space than conventional single or three-phase, full-wave rectified generators.

8. When purchasing this type of urological x-ray systems, the ability to store images on picture archiving and communication systems is an important factor.

9. The drainage system should prevent fluids from entering the table mechanism or spilling onto the floor. The urological x-ray system, with all its components, should resist damage from fluids and cleaning solutions.

10. The electrical controls that are near medical procedures and cleaning operations should be sealed or protected in some other method from fluids seeping into the urological x-ray circuitry.

11. For ease of operation and minimizing operator errors in a cystoscopic fluoroscopic system or cystoscopic radiographic system, all controls should be clear and unambiguous.

12. Both the patient and operator of urological x-ray systems should not be in contact with mechanical parts with sharp edges, or those that are not strongly constructed.

Questions for the Seller

Before you purchase your Urological X-ray, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Does the system include an mAS indicator?

Does it include a multiformat printer?

Did this equipment pass the American College of Radiology (ACR) accreditation?

Accessories

Does it include foot controls?

Does it include hand controls?

Does it include a drain pan?

Does it have a drain hose connect?

Does it include flushing?

Does it include a tissue screen?

Does it include a disposable drain bag?

Does it include crutches?

Does it include knee/leg/foot supports?

Does it include leg holders?

Does it include Alcock boots?

Does it include pediatric stirrups?

Does it have a padded arm board?

Does it include shoulder braces?

Does it have a surgeon's elbow rest?

Does it include a cysto seat/stool?

Imaging Features

Does it have digital storage?

Does it include frame averaging?

Does it include edge enhancement?

What are the number of exposures on this x-ray tube?

What is the image intensifier size (in)?

How old is the image intensifier?

Does it include zoom and roam?

Table

Does it include a Fowler positioner?

Does it include a mattress pad?

X-ray Tube

What is the manufacturing date of the X-ray tube?

What is the installation date of the X-ray tube?

What is the last date the X-ray tube was operated?

What was the work load of the X-ray tube?

Additional Options

Does it have anatomic position memory?

Is it DICOM compatible?

Does it have a moving image intensifier?

Does it include dual monitors with articulating arm?

Does it have CD/DVD burning capabilities?

DICOM 3.0

Is it DICOM 3.0 compatible?

Printer?

Export?

Import?

Work List?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiographic and Fluoroscopic Units, General-Purpose

Radiographic and Fluoroscopic System - Operational

# Tips and Guidelines for Buying a Uterine Aspirator

Uterine suction device, also used for terminating early pregnancies

High vacuum linepowered suction devices with a fine curet, used to remove gases, fluids, and tissue from the uterus. May be used for diagnostic purposes, dilation, and evacuation therapy.

Tips for Buying a Uterine Aspirator

1. Uterine aspirators are required to have an adjustable vacuum with at least a 400 mm Hg maximum vacuum level and a flow rate higher than 30 L/min at maximum vacuum, as well as some type of vacuum-level regulator.

2. The unit should have collection canisters that hold at least 1.5 L of liquid with overflow protection or any other anti-contamination method.

3. It is essential that units be resistant to fluid spills, because they are used in potentially wet environments.

4. Turning the aspirator on should be simple and intuitive, as well as adjusting and operating it. It should also be easy to empty and exchange reusable canisters without significant risk of instrument or operator contamination.

5. Disposable canisters should be able to be discarded simply and easily, with minimal risk of spills or contamination.

6. Most units with disposable containers can accept alternative manufacturers' containers. These standard containers may be more convenient to order and offer the user a choice of suppliers.

7. Some of the installed filters supplied with the canisters may severely limit airflow rates. 8. Higher suction rates are available in some units, so that they may be used to perform general-purpose suction; some are being used for liposuction procedures.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Aspirators

# Tips and Guidelines for Buying a Ventilator, Intensive Care

Intensive care ventilators providing respiratory gases to lungs

Ventilators used for administering respiratory gases to patient's lungs through an endotracheal tube or tracheostomy. These ventilators are generally used in intensive care. They deliver respiratory gases to the lungs at predetermined breathing rates, using positive pressure. Pressure, volume, and time are the modes used to determine the ventilation process.

Tips for Buying a Ventilator, Intensive Care

1. All intensive care ventilators should offer assist/control and SIMV modes, and for volume and pressure breaths, should provide CPAP/PEEP and pressure support.

2. The following measures should be monitored by the intensive care ventilators: airway pressure, respiratory rate, I: E ratio, and minute volume. Controls should be available for pressure level, tidal volume, breath rate, inspiratory time, FiO2, PEEP/CPAP, I: E ratio, pressure support, and sensitivity.

3. Visual and audible alarms should be available for inspiratory pressure low, CPAP/PEEP, minute volume, respiratory rate, gas supply loss, and power failure.

4. The intensive care ventilator should provide clear alarms. If users can adjust the alarm volume, they should not be able to turn it down so the alarm is inaudible.

5. If the alarm condition is not corrected, the alarm silence feature must reactivate automatically

within two minutes. If an alarm is silenced, a visual display should clearly indicate which alarm is disabled.

6. An O2 analyzer should be included with the intensive care ventilator to monitor the delivered O2 or O2/air mixture. The analyzer should include an alarm for concentrations outside acceptable ranges.

7. All respirator controls should be clear, with easy-to-understand functions. Misinterpretation of displays and control settings should not occur. Controls should be protected against accidental setting and sealed against fluid penetration.

8. Fluid spills should not affect patient and operator safety and system performance.

9. Intensive care ventilators with good human factors design are desirable in an environment where staff shortages and frequent employee turnover make formal training difficult. It is also recommended to standardize Continuous Positive Airway Pressure (CPAP) Ventilator equipment to minimize retraining and confusion, and to get discounts for large quantities of intermittent positive-pressure breathing units.

10. Different intensive care ventilators offer many features such as modes, variables monitored and controlled, and alarms. Facilities should evaluate these features to determine whether they are needed for a particular patient population and clinical setting.

Questions for the Seller

Before you purchase your Ventilator, Intensive Care, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Operating Modes

Assist/control?

Volume breaths?

Pressure breaths?

SIMV?

Pressure breaths?

Pressure support?

Apnea-backup vent?

Is nebulizer included?

Equipment Alarms

Gas supply failure?

Power failure?

Vent inoperative?

Low battery?

Self-diagnostics?

Patient Alarms O2

Low minute volume?

Low inspiration pressure?

High pressure?

Loss of PEEP?

Apnea?

High continuous pressure/occlusion?

Inverse I/E?

High respiration rate?

High minute vol?

High PEEP?

Monitored Parameters

Pressure?

PEEP?

MAP?

PEEP?

Volume?

Tidal?

Minute?

Spontaneous minute?

FiO2?

Respiratory rate?

Inspiratory time?

Expiratory time?

Interfacing

Remote alarm/display?

Analog output?

Report generation?

Display?

Hard copy?

Archival disk?

Network?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Critical Care Ventilators

Oxygen-Air Proportioners

Portable Ventilators

# Tips and Guidelines for Buying a Ventilator, Pediatric

Neonatal and pediatric ventilators for use in intensive care

Breathing systems used in pediatric and/or neonatal intensive care, for infants in need of respiratory support. These ventilators have CPAP and PEEP controls .These devices are mainly pressure controlled and time-cycled.

Tips for Buying a Ventilator, Pediatric

1. Pediatric ventilators should have time-cycled, pressure-limited operation and should offer assist/control and SIMV ventilation modes. Neonatal ventilators should also have the supplemental functions of pressure support or leak compensation and provide inverse I:E ratio, PEEP, and CPAP support.

2. The following measures should be monitored by the pediatric ventilator: airway pressure, respiratory rate, I:E ratio, and minute volume; controls should be available for FiO2, PEEP/CPAP, flow, pressure, pressure level, tidal volume, inspiratory time, I:E ratio, pressure support, sensitivity, and pressure limit.

3. Pediatric ventilators and neonatal ventilators should have audible and visual alarms available for the following events: peak inspiratory pressure (high and low), minute volume respiratory rate, gas supply loss, and power failure, all alarms should be distinct and easily identified.

4. If users can adjust the alarm volume, they should not be able to turn it down so that the alarm is inaudible. When the alarm-silencing feature is acceptable, the alarm must reactivate automatically if the condition is not corrected. Whenever the alarm is silenced, a clear visual display should indicate which pediatric ventilator alarm is disabled.

5. An oxygen analyzer should monitor the delivered oxygen or oxygen/air mixture. This should either be included with the pediatric ventilator or purchased separately and placed in line with the breathing circuit. Neonatal ventilator and pediatric ventilator alarms should be displayed or sound for concentrations outside the acceptable ranges.

6. All controls should be clear with easy-to-understand functions. Misinterpretation of displays and control settings should not occur. Controls should be protected against accidental setting and sealed against fluid penetration. Fluid spills should not affect patient and operator safety and system performance.

Questions for the Seller

Before you purchase your Ventilator, Pediatric, we recommend you ask the seller the following questions:

Operating Modes

Volume ventilator?

Pressure ventilator?

SIMV?

Pressure support?

Spontaneous/CPAP?

Pressure support?

Apnea-backup vent?

Equipment Alarms

Gas supply loss?

Power failure?

Vent inoperative?

Low battery?

Self-diagnostic?

Does it include a compressor?

Patient Alarms O2

High/low minute volume?

Low inspiratory pressure?

High PIP?

High PEEP?

Loss of PEEP?

FiO2?

Apnea?

High continuous pressure/occlusion?

Inverse I/E?

High respiration rate?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Critical Care Ventilators

Oxygen-Air Proportioners

Portable Ventilators

# Tips and Guidelines for Buying a Ventilator, Portable

Portable/home-care ventilators for respiratory support

Simple lightweight ventilators, which can also be used at home. These ventilators can be line-powered or battery operated, and include an alarm system. Positive pressure is used to deliver respiratory gases at predetermined breathing rates. Some have heating and humidifying functions. Some ventilators can be operated in different ventilation and cycling modes.

Tips for Buying a Ventilator, Portable

1. Portable ventilators should monitor the following: airway pressure, respiratory rate, I:E ratio, and minute volume.

2. The portable ventilator units should provide controls for the following: FiO2, PEEP/CPAP, tidal volume, pressure level, respiratory rate, I:E ratio, pressure support, sensitivity, and pressure limit.

3. Portable ventilators (also known as intermittent positive-pressure breathing units) should be able to operate in a variety of conditions. They also should not be affected by electromagnetic interference and electrostatic discharge. The ventilator and breathing circuit should not be excessively noisy or distracting.

4. All controls on the home care ventilator should be visible and clearly identified, with simple functions. The design should prevent misinterpretation of displays and control settings. Controls should be protected against accidental setting changes and sealed against fluid penetration. Fluid spills should not affect patient and operator safety, as well as system performance.

5. Portable respirator visual and audible alarms, which are distinct and easily identified, should alert for peak inspiratory pressure, low CPAP/PEEP, respiratory rate, gas supply loss, low battery, and power failure.

6. Even in cases where the alarm volume is adjustable, users should not be able to turn the volume down so low that the alarm is not heard. If the alarm condition is not corrected, the alarm-silencing feature must reactivate automatically. If an alarm is silenced, a visual display should clearly indicate which portable respirator alarm is disabled.

7. Visual indicators are recommended for home care respirator units offering additional modes, such as SIMV. These indicators should identify when the portable ventilator senses a breathing effort and what type of breath the patient receives.

8. When the portable ventilator is switched from line to battery power and from an external to an internal battery, audible and visual alarms should activate. The home care ventilator unit should also have a low internal battery alarm.

9. Portable ventilator alarms should use different audible tones and visual indicators to identify the priority of the alarm. It should not be allowed to disable visual indicators.

10. A major factor for facilities to consider is the ease of use and transportation of the portable ventilator. Home care respirators should be easy to operate, especially in emergencies. Portable ventilators should be small and lightweight, resist tipping over, and easy to mount in different orientations.

11. Mounting is an important issue, especially when the portable ventilator unit goes on the back of a wheelchair, because users may need to position the home care ventilator in different orientations to gain access to the controls, to prevent it from aspirating battery fumes, or to accommodate space constraints.

12. Several wheelchair trays are available from wheelchair manufacturers; they can also be custom built.

13. Manufacturers offer a cable to operate the portable respirator from a car's cigarette lighter jack or another accessory power jack, to prevent the batteries from being depleted while the patient is traveling long distances by car.

14. All the controls of the portable ventilator device should be on one face. The labels and displays should be clear and visible, even in dim lighting and from different angles and should resist damage from liquid disinfectants and normal wear. The intermittent positive-pressure breathing unit controls should be protected against accidental settings, which is vital around young children. Some of these protection methods include: locating the controls behind a door, having the controls locked unless an UNLOCK membrane switch is pressed, or using a clear plastic cover that can be placed over the controls.

15. The line cord, which is needed to recharge the portable ventilator's battery or to operate it if the battery becomes depleted, should be secured to the portable respirator, but easily removed for replacement.

16. Users can augment the integral airway-pressure monitor by using additional monitors. At home, though, they are used sparingly because their cost is not always reimbursable.

17. It is recommended to have power surge protectors, especially if the portable ventilator is used in an area that experiences frequent power surges or thunderstorms.

18. A detailed user's manual should accompany the intermittent positive-pressure breathing units, providing sufficient information for clinicians, users, and caregivers. Skilled technicians should be able to easily servicing the system.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Critical Care Ventilators

Oxygen-Air Proportioners

Portable Ventilators

# Tips and Guidelines for Buying a Ventricular Assist Device

Devices for temporarily improving blood circulation by external pump

A pump mechanism designed to improve blood circulation in patients with heart failure, as a temporary measure. Left or right ventricles are assisted using a cannula for drawing venous blood, and a pump for delivery to aorta or pulmonary artery.

Tips for Buying a Ventricular Assist Device

1. Ventricular assist devices provide aggressive mechanical support to patients with failing hearts. They can support one ventricle or both ventricles (Biventricular Assist Device).

2. Several types of ventricular assist devices and biventricular assist devices are available to meet different needs.

3. Since these ventricular assist devices are used as long-term support for patients awaiting transplantation, or after open-heart surgery or acute myocardial infarction, it motivates these devices to be used as destination therapy for the rest of the patient's life.

4. Several pump modes are available: fixed, automatic, or user selectable by the clinician. The flow volume should be 10 L/min or less.

5. The cardiac assist pump must be made of blood-compatible materials to minimize clot formation and thromboembolism. Different manufacturers use diverse ventricular implanted pump materials.

6. The variety of ventricular assist device models on the market, and the differences in patient requirements and demographics call for clinicians to select the right device for their facility based on the appropriate therapy and patient type.

7. Implementation of the ventricular assist device as destination therapy is reasonable and required only when the procedure is performed in an approved heart transplant facility with experience of at least 15, that left ventricular assist devices as a bridge to transplantation or destination therapy. A facility may request an exception based on its geographic location, the number of destination procedures performed, and patient outcomes.

8. A facility performing ventricular assist device implantation as destination therapy must be an active, permanent member of a national audited registry that requires submission of health data on all cardiac assist pump destination therapy patients from the date of implantation throughout the rest of their lives.

9. Facilities should set up procedures and assign staff to provide prospective recipients with all information needed to help obtain an informed consent for the procedure.

Questions for the Seller

Before you purchase your Ventricular Assist Device, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

External Driver

Is it portable?

Is it implantable?

Does it include a battery?

Is it rechargeable?

Does it have a low-battery indicator?

Is it for intra-hospital use?

Is it suitable for home-care use?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Ventricular Assist Device

# Tips and Guidelines for Buying Video Conferencing Equipment

Telemedicine systems using remote telecommunications for videoconferences

Computerized information systems using telecommunications devices such as video cameras, displays, and microphones. These systems are used for telemedicine videoconferencing, making communication possible between physicians in remote locations, for real-time consultation and diagnoses. These systems can also be connected to other telemedicine systems and devices.

Tips for Buying Video Conferencing Equipment

1. When looking for video conferencing equipment, make sure that the display matrix consists of 256 colors for a proper view of the transmitted video.

2. Other features to be included in the ideal video conferencing equipment are: a full common intermediate format resolution of at least 352 x 288, and a quarter common intermediate format resolution of at least 170 x 144 with a frame capture rate of at least 30 fps.

3. The video teleconferencing system's supported compression algorithms should include H.261 and H.263 for video and G.711, G.722, and G.723 for audio at minimum.

4. The video conferencing equipment camera should be a color charge coupled device with a horizontal resolution of at least 300 lines.

5. Based on the type of consultation required using the video teleconferencing system, some additional input devices may be needed.

6. The facility should include technical specifications in their request for proposal to suppliers. These should be based on the applications planned for the telemedicine videoconferencing system.

7. Facilities should clearly specify their telecommunications and networking requirements before purchase of a teleconsultation system. They need to ensure that the telecommunications technology needed to transmit diagnostic quality information is available at the primary and remote sites.

8. When choosing a carrier, facilities should look into the following factors: monthly and annual fees, certification costs per site, billing procedures, and experience with videoconferencing and telemedicine applications.

9. Before purchasing scopes from a telemedicine supplier, facilities should decide whether they could use existing scopes with the telemedicine system.

10. Facilities should also consider the installation requirements of video conferencing equipment or a telemedicine videoconferencing system, and whether it needs roll-about, group, or desktop configurations. They should keep in mind that group configurations require a dedicated room for videoconferences.

Questions for the Seller

Before you purchase your Video Conferencing Equipment, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Does the system include a printer?

Far-End Control

Video source?

Audio source?

Codec

Is it an integrated type?

Is it a stand-alone type?

Does it include AGC?

Input Devices VCR

Does it include a film scanner?

Does it include a document scanner?

Does it include a document camera?

Does it include a stethoscope?

Does it include a microscope?

Does it include a dermascope?

Does it include an otoscope?

Does it include an ophthalmoscope?

# Tips and Guidelines for Buying a Video Endoscopy

A video system used during endoscopic procedures

A video system used during endoscopic procedures for viewing, storing, and retrieving images. These systems are generally used in procedures using rigid and flexible endoscopes, for both diagnostic and therapeutic purposes.

Tips for Buying a Video Endoscopy

1. Endoscopic Video Systems should provide a vast range of video signal formats as its output.

2. Image quality is the most eminent factor when choosing surgical video endoscopy systems.

3. Image quality of three CCD systems is usually better than one CCD systems. However, it is recommended that medical centers use each system on a trial basis and get the surgeons' input before purchasing.

4. Another important factor in video endoscopy units is the system operation. For surgeons who prefer direct control to surgical video system functions, the more suitable video endoscopy systems are those allowing control of multiple functions from the camera head or other components, such as the front panel and keyboard.

5. To fully use their benefit of higher picture resolutions, the three CCD systems should include RGB format.

6. Video Endoscopy Systems with digital output are also available for purchase. These allow recording images or video onto recording media or an information system, or to display digital images on a surgical monitor.

7. The types of surgical procedures performed and the surgical caseload should be taken into consideration when deciding on the quantity and type of endoscopic video systems needed in a facility.

8. All the controls on all endoscopic video system components should be easily identified and activated. The system should verify the activation and provide the level setting. The video endoscopy system should be easily operated, so capturing, storing, retrieving, and printing images are all clear and simple.

9. It is recommended to maintain equipment standardization practices within a single medical facility. This may present as discounts in multiple systems or volume purchase. It may also be possible to negotiate for equipment trade-in allowances.

10. Facilities should look into the utility of integrating imaging and text features. Some video endoscopy systems allow the simultaneous display of a live image combined with images taken previously in the examination.

11. Some additional hardware may be needed for more image enhancement options. An example of this is the enhancement unit. Though it can be integrated with a camera controller, it does not typically increase the actual amount of detail in an image, but rather makes visualizing it less stressful to the eye.

Questions for the Seller

Before you purchase your Video Endoscopy , we recommend you ask the seller the following questions:

General

Are there any black dots on the visual field?

Video Processor

Hue adjustment?

Illumination?

White balance?

Transillumination?

Video gain?

Sharpness?

Does it include RGB?

Does it include NTSC?

Does it include PAL system?

Peripherals Available

Does it include a monitor?

Does it include a VCR?

Does it include a video printer?

Does it include a video disk record?

Does it include digital capture?

Does it include a cart?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Video Endoscopy Systems

# Tips and Guidelines for Buying a Voice Recorder

**Digital system for dictating and transcribing medical reports and records**

A language-linked system used for digital dictation. Physicians and medical personnel use this system to dictate, transcribe and review medical reports. For added efficiency, speech recognition software can directly transmit recorded data into a written format, for immediate editing. Most systems enable remote access, and management functions such as quality assurance and workflow tracking. Some can be used for voice-mail messages.

Tips for Buying a Voice Recorder

1. To allow easier expansion and addition of workstations, digital voice recording systems must be HL7 compatible, have client/server architecture with an unlimited number of ports, and be able to accommodate an unlimited number of dictation and transcription.

2. The digital voice recorder should have some form of security to ensure confidentiality. Log-on names and multilevel passwords should limit the access necessary personnel only.

3. The standard digital voice recorders are configured to meet the needs of each facility. However, some special functions may require additional equipment. Facilities are therefore encouraged to examine their necessary functions before purchasing a digital voice recording system.

4. The growth rate of each department within the facility, as well as the scalability and upgradability of the digital dictation system, should be considered before purchase..

5. Buyers may wish to consider digital voice recorder systems that can accommodate speech recognition software. Facilities will be able to choose a wider range of transcription options if they use digital voice recorder systems that support speech recognition. The speech recognition applications should include, at a minimum, a general medical-terminology dictionary.

6. Before making a digital dictation system purchase, facilities should consider the following features, which are quite beneficial for users: continuous speech, voice-enabled processing, batch processing, macros and/or templates, and text-to-speech.

7. When buyers wish to add on to an existing digital voice recording system, they should verify with the supplier that the new equipment is fully compatible.

8. Over time, speech recognition systems offer significant cost savings because of shortened turnaround time for reports and features that allow integration of speech recognition into PACS.

9. One significant shortcoming of the digital voice recorder system is accuracy, meaning that users may need to spend more time producing a report than they would in traditional transcription. As a result, some tend to resist using the system.

10. A different reason for not using these digital voice recorder systems may be that they require a change in the users' current dictation procedures.

11. As a result of these, the cost-benefits of speech recognition may not be fully realized, since a facility may not be able to use it for all reports. In that case, there would still be a need for some form of traditional transcription, which is probably the in-house transcription service with a reduced workforce. Facilities can also renegotiate the contract with the third-party transcription service to reduce the number of reports.

Questions for the Seller

Before you purchase your Voice Recorder, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

Applications

Does it include dictation?

Does it include transcription?

Does it include voice mail?

Does it have remote access?

Does it have a security system?

Does it include optional languages?

Speech Recognition

Does it include speech-to-text?

Does it include text-to-speech?

Does it include continuous speech?

Does it include voice-enabled processing?

Does it include batch processing?

Does it include macros/templates?

Report Types

Are they customizable?

# Tips and Guidelines for Buying a Warming Cabinet

Warming devices for blankets and other items

Cabinets for warming blankets, using hot air or steam circulation for heating. These units have a heating system with temperature controls and alarms that indicate overheating. Some units have other heating functions ( various solutions, bedpans) and can be used for different heating purposes within the hospital units.

Tips for Buying a Warming Cabinet

1. For efficient use of space, mobile warming cabinets (also called circulating fluid pumps) are recommended for laboratory and operating room settings.

2. The temperature of the warming cabinet unit should be verified on an annual basis. Blanket warmers should be set from 49

3. Warming cabinets should have audible or visual alarms to indicate over temperature due to the greater conductivity of solutions.

4. Facilities considering the purchase of a warming cabinet should determine whether they need to heat blankets, solutions, or both.

5. Facilities should compare the available space for a cabinet with the dimensions of warming cabinet/ circulating fluid pump models under consideration.

6. If facilities do not purchase the multifunction cabinet, they may need to use multiple units for warming blankets and/or solutions. These warming cabinet units may take up more floor space, although some manufacturers offer stackable models.

7. Compact size and ease-of-transport are important factors in the operating room, where space is often very limited.

8. Facilities should not consider disposables as a factor when purchasing circulating fluid pumps. However, one manufacturer offers a reusable filter for linen fibers that may need to be replaced.

9. There are very few manual models, and they are usually less expensive than automatic ones.

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Blood and Solution Warmers

# Tips and Guidelines for Buying a Washer / Disinfector

Automatic or semi-automatic washing apparatus for medical instruments and devices

Devices that wash medical instruments, to remove dirt or various physical contaminants using programmed cleaning cycles. This process is mechanically done using water jets, or by ultrasound energy and special detergents. Some units are specifically designed for surgical instruments and provide a higher level of disinfection. Other units are used for the simpler utensils (i.e.. various containers).

Tips for Buying a Washer / Disinfector

1. Decontamination washers/disinfectors should perform at least the following 6 cycles for the preparation and decontamination of instruments before sterilization: cold pre-wash, detergent wash, rinse, distilled water rinse, rinse/lubricate (applicable for metal instruments), and dry.

2. Before making a purchase, facilities should consider the decontamination washer/disinfector's dimensions, ease-of-use, required preloading preparation, automatic or manual loading/unloading capabilities, and the size and number of chambers and baskets/trays.

3. It is recommended that each decontamination washer/disinfector's cycle status be indicated clearly to allow users to monitor progress of wash cycles and to prevent burns if the washer is opened during a cycle in which the water is at a high temperature.

4. Buyers of decontamination washers and disinfectors should consider energy use costs, and in some areas, the availability and quality of the water supply, as well as the costs of modifying the central service area and the existing electrical wiring and plumbing to accommodate a unit's needs.

5. When replacing the central service instrument/utensil-washing equipment, facilities need to perform careful planning in order to do so with minimal disruption of vital services.

6. Leakage current should be less than 300 μA.

7. Audible or visible alarms should be available with these units, indicating events such as: component failure, door unlocked, and temperature below set point.

8. During each cycle, audible or visible indicators for water in chamber, cycle select, cycle status, and temperature should alert users in order to avoid improper decontamination of instruments.

9. Buyers of decontamination washers/disinfectors should decide whether they wish to have ongoing maintenance performed by their engineering staff or through a service contract with the supplier. When purchasing a service contract, facilities ensure that preventive maintenance is performed at regular intervals -hopefully eliminating unexpected maintenance costs. Buyers of decontamination washers/disinfectors should keep in mind that many suppliers extend guarantees beyond the length of the warranty only for systems that are covered by such a contract.

# Tips and Guidelines for Buying a Water Purification System

Devices that perform water purification for pure or ultra-pure water that are used in the Clinical Laboratory and in other hospital units

Devices that produce pure and ultra-pure water by mean of filtration, exchange columns, reverse osmosis or distillation. Some models produce water for hemodialysis units, others for Clinical Laboratory use, for Pharmacy use, for parenteral feeding preparations etc.

Tips for Buying a Water Purification System

1. Before purchasing a water purification system, facilities should not only take the unit's purchasing price into account, but also consider the long term investment in running costs for maintenance, replacement parts, and service contracts over the water purification system's service life.

2. The quality of the water needed should be determined - ultrapure water is required for critical analysis uses, while purified water is sufficient for equipment such as sterilizers, glassware washers, etc. The daily volumes required for each water quality is also something to be considered when purchasing a water purification system. .

3. The quantity of feedwater required, or possible pre-treatment of tap water as feedwater is a factor that should be taken into account when purchasing a water purification system.

4. Facilities should inquire whether the water purification system allows for obtaining ultrapure water from tap water (pre-treatment of tap water, reverse osmosis, deionization with UV/UF), or will add on to their current supply of treated water to produce ultrapure water.

# Tips and Guidelines for Buying a Whirlpool / Bath

Baths for therapeutic purposes

Baths used for therapeutic purposes, including massage and hydrotherapy, using water jets, underwater exercise etc.

Tips for Buying a Whirlpool / Bath

1. Hubbard tank hydrotherapy is the preferred treatment in certain applications; although it is more expensive to use and maintain than smaller baths since it requires more water and heat and takes longer to disinfect.

2. Facilities are encouraged to use smaller baths whenever possible.

3. In-house hospital-based clinical engineering departments can usually maintain whirlpool baths, though a third-party service organization may also provide the service.

4. Buyers can negotiate service contract discounts with suppliers.

# Tips and Guidelines for Buying an X-ray Generator

Power supply generators for X-ray tubes

Power supply generators for x-ray tubes, which deliver the necessary voltage and amperes for producing x-ray beams of varying characteristics. The power supply is controlled by the user, and settings are determined by a technician. The x-ray tube may be an integral part of the generator unit in some models.

Tips for Buying an X-ray Generator

1. Facilities should select power rating and timing capabilities based on the types of examinations to be performed and the operating technique factors required with the type of x-ray generator selected.

2. Power setting is the main factor when dealing with these x-ray generator units.

3. Low power x-ray generators are capable of the full range of x-ray exposures.

4. Shorter exposure times can be used with higher power. With shorter exposure times, there is less chance of movement artifacts.

5. A 50 kW-generator is sufficient if the generator is used predominantly for extremity and chest imaging.

6. When large patients are expected, particularly in Radiographic/Fluoroscopic system applications, higher power generators are needed.

7. If a heavy workload of abdominal imaging is expected, then an 80 kW generator should be considered.

8. When choosing a Radiographic-Tomographic system unit, facilities should consider the secondary waveform type, timing capabilities, and compatibility with other system components.

9. The secondary waveform type determines the efficiency of x-ray production, including the magnitude of ripple and the ratio of average to peak x-ray tube voltage.

10. Secondary waveforms that are single-phase, full-wave rectified provide the least efficient production of x-rays, which results in longer radiographic exposure times and higher patient radiation exposure.

11. Single-phase x-ray generators cause increased x-ray tube anode heating, and therefore restrict small focal spot examinations and reduce tube life.

12. Three-phase x-ray generators allow higher mA exposures at shorter exposure times, reduce motion un-sharpness, and produce higher-quality radiographs for many examinations.

13. Facilities should add power installation costs to the project budget if three-phase power service is not available at the planned location.

14. A procedure using a three-phase or high frequency x-ray generator needs lower kVp and/or mAs than the same one using a single-phase x-ray generator.

15. Routine radiographic, angiographic, fluoroscopic, and tomographic procedures vary in their kVp and mAs requirements, so all features of Radiographic-Tomographic Systems and Radiographic/Fluoroscopic Systems must be taken into consideration.

16. Putting the x-ray generator too far away from the x-ray tube may cause distortions in voltage waveforms and timing responses caused by capacitance in excessively long high-voltage cables.

17. Facilities must select x-ray generator components for compatibility as an integrated system. It is specifically critical to choose compatible x-ray tubes and generators to fully utilize all features of both components.

Questions for the Seller

Before you purchase your X-ray Generator, we recommend you ask the seller the following questions:

General

Software installed? (Name + Version)

How many High Tension outputs are in the generator?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Standard Forms

X-Ray System - Stored

X-Ray Conventional Radiographic System - Operational

X-Ray Digital Radiographic System - Operational

Suprevision Forms

X-Ray System – Dismantling

# Tips and Guidelines for Buying an X-ray Subsystem

Subsystems which can be added to existing X-ray equipment

Subsystems which replace, upgrade or improve existing X-ray equipment, e.g. generator, chest stand, X-ray table, RF table.

Tips for Buying an X-ray Subsystem

1. Storage space reduction, enhanced image processing, and off-site diagnostic capabilities are some of the advantages of digital radiography over film-based radiography.

2. The tilting tables allow a wide range of tilting movements from -15

3. The non-tilting tables specify a wide range of tabletop motions but do not allow tilting angles.

4. Digital radiographic systems generally perform upright examinations or table-based examinations, for which detector mounting is crucial.

5. The detector is fixed in the table system in table-based units, preventing certain examinations due to patient positioning constraints. Some upright systems can be tilted to allow table based exams.

6. Facilities should evaluate all types of examinations being performed before deciding which type will better suit their needs. The number and types of procedures will influence the features selected for the system.

7. Smaller focal-spot sizes can provide better spatial resolution on film for certain studies, and options such as tomography and table tilt can increase the system's overall procedural capabilities.

8. Departments handling trauma and emergency cases may prefer elevating tables because the table height can be adjusted to facilitate patient transfer from a mobile stretcher or a wheelchair.

9. Bucky systems for both tilting and non-tilting tables should be motorized.

10. To ensure acceptable film darkening, a three-field AEC device is recommended. Grid ratios should be 10:1 or higher. Grids with higher ratios provide higher image quality.

11. Buyers should look into the system's integration into picture archiving and communication systems (PACS) already in use in the facility.

12. Buyers should consider generator options as well; high-frequency generators need less space and often eliminate the need for high-voltage cables.

13. To facilitate future additions to any network, compatibility with DICOM 3.0 is a requirement for all newly purchased equipment (including storage devices).

14. Suppliers must provide DICOM conformance statements that explain in detail which information objects, service classes, and data encodings are supported by the system. The statements should be inspected by specialists, and should share the same format and vocabulary to facilitate comparisons between suppliers.

Questions for the Seller

Before you purchase your X-ray Subsystem, we recommend you ask the seller the following questions:

Accessories

Does it include compression bands?

Does it include handgrips?

Does it include head clamps?

Does it include a footrest?

System

Film?

Digital?

Tomography?

Radiographic Capabilities

Bucky?

Cross table?

Horizontal?

Off table?

Upgradable for digital?

Inspections Forms

When you order an inspection prior to purchase, we highly recommend that you use the following inspections forms:

Radiographic Subsystem

# Tips and Guidelines for Buying an X-Ray Tube

X-ray tube designed for X-ray patient imaging, enclosed in its special housing

X-ray tube is a source of high energy X-ray photons, which are used to expose patient or limb for medical imaging and diagnosis. X-ray tubes are produced with focuses of different sizes, sometimes with two or three different focuses in one enclosure. X-ray tubes are characterized by maximum energy (kVp), power capabilities with each focus and heat capacity for the anode.

Tips for Buying an X-Ray Tube

1. Inside the X-ray tube, as with any electronic vacuum tube, there is a cathode, which emits electrons into the vacuum and an anode to collect the electrons, establishing a flow of electrical current (knows as the beam) through the x-ray tube.

2. A high voltage power source, 30 to 150 kilovolts (kV), is connected across the cathode and anode to accelerate the electrons. The X-ray spectrum depends on the anode material and the accelerating voltage.

3. The energy generated by the electron beam is a result of excitation of atoms, which free their electrons from orbit. These electrons are now free to become part of the electron beam.

4. This beam is then accelerated through a high voltage field, gaining speed and energy until the electrons strike the target, where this energy is converted into heat and given off as an x-ray.

5. This energy is approximately 0.1% - 2% of the total amount of energy produced by the electron beam. This x-ray is energy in the form of an electromagnetic wave.

6. The main difference between an x-ray photon and that of a visible light photon lies is the energy of each photon. An x-ray photon has much higher energy than the energy of an ordinary light photon. This allows the x-ray photon to pass more readily through materials than would a regular light photon.

7. By exciting the electrons and increasing their energy, x-ray passes more freely through flesh and other materials than would an ordinary light photon. This free passage through flesh and other materials is what allows x-ray to be such a useful diagnostic tool in medical and other imaging disciplines.

8. The x-ray tube envelope components are sealed into a glass or other material envelope. This allows for gases and other impurities to be pumped out of the tube, creating the vacuum necessary for proper performance. The x-ray creation process must occur in a vacuum, so as not to disrupt the electron beam, and also to allow for proper "filament" performance and durability.

9. The x-ray tube cathode acts to excite electrons to the point where they become free from their parent atom and are then able to become part of the electron beam. The cathode acts as a negative electrode and propels the free elections, in the form of an electron beam, towards the positive electrode.

10. The shape and the size of the focal spot of the x-ray tube depend on the "filament" (the active part of the cathode).Focal spot size is a measurement of the resolution that will be afforded by a particular x-ray tube. In general, the smaller the focal spot size, the better the resolution. This often leads to requests for the smallest focal spot size possible.

11. The size of the focal spot is contingent upon the mA level for the application, the kV for the application, duty cycle, necessary beam coverage and target angle of the tube.

12. It is often assumed that the smaller the focal spot size, the "better" the tube. While it is true that improved resolution is afforded by small focal spot sizes, we must keep in mind that by reducing focal spot size, it will be necessary to run at lower mA and/or kV levels relative to focal spot size.

13. The x-ray tube anode acts as a positive electrode, attracting the free electrons and accelerating the electrons through the electromagnetic field that exists between the anode and cathode.

14. This acts to increase the velocity of the electrons, building potential energy. The higher the kV rating, the greater the speed at which the electrons are propelled through the gap between the cathode and anode.

15. The electrons then impact a target (most commonly made of tungsten, but this target can also be molybdenum, palladium, silver or other material), causing the release of the potential energy built up by the acceleration of the electrons comprising the electron beam.

16. Most of this energy is converted to heat and is radiated by the copper portions of the anode. The remainder is refracted off of the target in the form of high energy photons, or x-rays, forming the x-ray beam.

17. The x-ray tube kVp (kilovolts peak) is a measurement of the energy applied to the electrons, which accelerates them through the high voltage field that exists between the cathode and the anode.

18. By accelerating an electron through a 1000V potential field, the electron has one kilo electron Volts (1 KeV of energy). Increasing the kV levels may cause an excessive amount of heat to be given off as the electron beam strikes the target, causing x-ray tube malfunction and component degradation.

19. This is also why modern x-ray tubes used in most CT machines have an anode which rotates during operation, as these applications require much higher levels of kV and mA to accomplish their required imaging operations. By rotating the anode, the heat generated by the electron beam is distributed, rather than focused on a stationary point on the anode.

20. Rotation of the anode allows for operation at higher peak voltage (kVp) and milliamp (mA) ratings.

21. The x-ray tube mAs (Milliampseconds) is a function of Amps applied (mA) and the amount of time the Amps are applied in seconds. This gives an idea of the amount of x-rays generated by a given x-ray tube over a given exposure time.

22. For tube selection, you should determine the minimum level of mA that will satisfy your requirements. The concern here is that at too high an mA with a small focal spot, the electron beam is focused on too small of an area to properly handle the amount of heat generated by the energy conversion process that occurs as the electrons strike the target. This will cause the target material to melt and/or crack, causing tube malfunction.

23. At higher mA levels, focal spot size will necessarily be increased, sacrificing resolution, making this relationship a direct tradeoff between these two factors.

24. The x-ray duty cycle is how long each exposure will be and how long will be given in between exposures for cooling. If a unit will be operated continuously, with no cooling intervals, this is termed continuous duty.

25. Also of importance is at what mA level and kV level the x-ray tube will be run at for a given exposure time. This critical information allows computation of the energy being exerted on a given x-ray tube under a given set of operating characteristics.

26. Existing heat storage and dissipation rates for a given x-ray tube can determine whether or not an x-ray tube will function properly in a given application at the required mA level, kV level and exposure time necessary for proper performance.

27. The x-ray beam coverage area is a central issue in determining what x-ray tube will satisfy your requirements in determining the amount of coverage required.

28. Coverage is contingent upon the angle of the anode of the x-ray tube and the distance between the anode and the intended target of the beam.

29. It is always preferable to use the original type of the x-ray tube, or a tube type recommended by the manufacturer of the equipment.

30. The shelf life of the x-ray tube can be limited to one year or so. Always check production date of the x-ray tube.

# Tips and Guidelines for Buying an Xenon System

Units for safe Xenon delivery and/or disposal

Xenon delivery systems used mostly in pulmonary function testing. A gamma camera displays images of the lungs and air distribution while inhaling xenon. They are also used in CT and SPECT scans.

Tips for Buying an Xenon System

1. Xenon systems that use isotope 127Xe have a longer half-life and a higher energy rate, permitting more flexibility in ventilation scanning.

2. Xenon evacuation systems that use isotope 133Xe are less expensive and require less shielding to compensate for higher energies. 3. The thickness of shielding material for delivery systems and gas traps should be 1/8 inch.

4. Xenon systems should include an exhaust-port monitor and a monitor alarm for all gas traps.

5. Monitors are available in some Xenon evacuation systems for room-air xenon concentration, in case of leaks or patient rebreathing problems.

6. Facilities that perform many pulmonary ventilation studies are advised to purchase separate delivery systems and Xenon gas trap systems to allow for gas delivery while the xenon is being stored for safe disposal.

Questions for the Seller

Before you purchase your Xenon System, we recommend you ask the seller the following questions:

Delivery System

Does it include blower-controlled air & O2 delivery?

Is it mobile?

Does it include an automatic timer?

Does it include bag view windows to patient?

Does it include bag view windows from patient?

Gas Trap

Does it include an exhaust-port monitor?

Does it include a monitor alarm?
