Wednesday, December 30, 2020

Anatomy of the Brain

Hi Friends!!!


In our previous anatomy and physiology session we have discussed about Lung Anatomy, Function and Disease, Anatomy of Kidney, Functions of Kidney, Anatomy of Liver, Functions of Liver.  Please check out for the link below.


Functions of Kidney


Lung Anatomy, Function and Disease


Anatomy of  Kidney


Anatomy of Liver


Functions of Liver


Being a healthcare professional, it is very important to have knowledge about human body.


Human body’s Central Nervous System consists of Brain and the Spinal Cord. In today’s topic we are going to discuss about anatomy of the brain.


Let's get into the topic.


ANATOMY OF THE BRAIN


The brain is made up of more than 100 billion nerves which communicate between trillions of connections called synapses. The brain is surrounded by the layer of tissue called meninges. The skull protects the brain from external injury.


The brain is divided into three main parts structurally, cerebrum, cerebellum, brainstem.


Let’s discuss in detail about each of the above-mentioned parts.


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CEREBRUM


The cerebrum is the largest part of the brain. The cerebrum is composed of right and left hemispheres. The fissure that separates the two hemispheres is called as great longitudinal fissure. The corpus callosum connects the two sides of the brain at the bottom which is used to deliver messages from one side of the brain to the other side.


The cerebral hemispheres have several distinct fissures. Based on these fissures, it can divided into pair of lobes. Each hemisphere have separate lobes called frontal lobe, temporal lobe, parietal lobe, occipital lobe.


The functions of cerebrum include interpretation of touch, vision, hearing as well as speech, reasoning, learning, emotions, fine control of movements and learning.

 

LOBES OF THE BRAIN

 

The Brain is divided into several lobes which are as follows.

 

FRONTAL LOBE: The frontal lobes are located in the front part of the brain. The frontal lobes are largest lobes in the brain.

 

PARIETAL LOBE: The parietal lobes are located behind the frontal lobes.

 

TEMPORAL LOBE: The temporal lobes are located on both sides of the head as the same level of the ears.

 

OCCIPITAL LOBE: The occipital lobes are located on the backside of the brain.


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CEREBELLUM

 

It is located at the back of the brain beneath occipital lobe. The cerebellum is separated from cerebrum by the tentorium. Similar to cerebrum, the cerebellum has right and left hemispheres. The both hemispheres are connected by middle region called vermis.

 

The Arbor Vitae is a central white stem within the interior tissue. The Arbor Vitae spreads branches and sub branches through the right and left hemispheres.

 

The cerebellum’s main function is to coordinate muscle movements, maintain balance and posture. The cerebellum is responsible for rapid and repetitive actions.

 

BRAINSTEM

 

The brainstem is present at the base of the brain. It extends from upper cervical spinal cord to diencephalon of cerebrum. The brainstem connects cerebrum and cerebellum to the spinal cord. The brainstem is further divided into medulla, pons and midbrain. The 12 Cranial Nerves originate from the brain stem.


The 12 Cranial nerves are as follows.


1. Olfactory

2. Optic

3. Oculomotor

4. Trochlear

5. Trigeminal

6. Abducens

7. Facial

8. Auditory

9. Glossopharyngeal

10. Vagus

11. Accessory

12. Hypoglossal

 

The medulla oblongata which extends as a spinal cord, connects to the pons at the upper side. Both medulla oblongata and pons are considered as the parts of hindbrain. The midbrain connects pons to the diencephalon and the forebrain.

 

The midbrain plays a important role in ocular motion. The pons is involved in eye coordination and facial movements, hearing and balance. The functions of medulla oblongata include breathing, maintaining body temperature, heart rate, sleep cycle, sneezing, coughing, vomiting, swallowing and digestion.

 

DEEP BRAIN STRUCTURES


The following are the deep structures of the brain.


HYPOTHALAMUS

The hypothalamus is located at the floor of the third ventricle. Hypothalamus is a part of diencephalon which is also a part of forebrain which connects  to the midbrain and cerebrum. The hypothalamus is the master control of the autonomic system. The hypothalamus plays a important role in sensory functions like taste, vision and smell.


BASAL GANGLIA

The basal ganglia is present at the center of the brain. The basal ganglia are cluster in structure which plays a important role in coordinating messages between multiple other brain areas.


PITUTARY GLAND

The pituitary gland lies in a small pocket of a bone at the skull base called as sella turcia. The pituitary stalk connects the pituitary gland to the hypothalamus. The pituitary gland is also know as the master gland which controls the other endocrine glands.


PINEAL GLAND

The pineal gland is located behind the third ventricle. The pineal gland secrets melatonin which helps to regulate body’s internal clock and cardiac rhythms.


THALAMUS

The thalamus is a relay station for all the information that comes and goes to the cortex.


LIMBIC SYSTEM

The limbic system is considered as emotional brain. The limbic system is located on the top of brain stem and under the cerebral cortex.

 

CEREBROSPINAL FLUID


The cerebrospinal fluid is a clear watery substance which cushions and  surrounds the brain and the spinal cord to prevent them from injury. The cerebrospinal fluid is also found inside the brain. This CSF fluid constantly circulates around the channels of the brain, which is constantly absorbed and replenished. The choroid plexus is a specialized structure within each ventricle responsible for CSF production.

 

Now I hope you have acquired some knowledge about Anatomy of the Brain.  We will discuss in detail about a topic related to biomedical engineering in our future blogs.


NOTE: Dear friends!!!... Please do comment a topic related to Biomedical, so that we can discuss it in future blogs.


Check out for this blog about Computed Tomography,  X ray, MRI scan, ECG.


Generations of CT Scanners


COMPUTED TOMOGRAPHY|TECHNOLOGY|ARTIFACTS


x ray machine working principle


components of x ray tube


MRI scan 


MRI With Contrast


Brain MRI


Types of MRI scanners


ELECTROCARDIOGRAM


12 Lead ECG Placement


HOW TO READ AN ECG


Holter Monitor


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Monday, December 21, 2020

MDSAP Measurement, Analysis and Improvement - Part 7

Hi friends!!!


In our previous blog we had a introduction about Medical Device Single Audit Program, MDSAP Audit Cycle, Management process Audit, Device marketing authorization and facility registration, MDSAP Measurement, Analysis and Improvement Process Task 1 - Task 6. Please check out for the link below.


Medical Device Single Audit Program - Part 1


MDSAP Audit Cycle - Part 2


MDSAP Management Process Audit - Part 3


MDSAP Management Process Audit - Part 4


MDSAP Device Marketing Authorization and Facility Registration - Part 5


MDSAP Measurement, Analysis and Improvement - Part 6


In today's blog we will discuss in detail about Medical Device Single Audit Program (MDSAP) CHAPTER 3 -  Measurement, Analysis and Improvement Task 7 - Task 16.


MDSAP is a common Medical Device auditing program followed by countries like Australia, USA, Brazil, Canada and Japan. Therefore it is important for every healthcare professionals who wish to market their product in the above mentioned countries to know in detail about MDSAP.


Let's get into the topic.


CHAPTER 3: MEASUREMENT,

ANALYSIS AND IMPROVEMENT


 Let's discuss in detail about Task 7 - Task 16.



TASK 7 – Assessment of

Process Change Resulting

from Corrective or

Preventive Action


Ensure that medical device organization has assessed the risks in process change due to the implemented corrective and preventive action. If necessary, the revalidation of the process should be performed.


Ensure that medical device organization is informing about the changes in the critical process (eg: Sterilization process) to the respective regulatory bodies and auditing organizations before implementing the change.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.1.2, 4.1.4, 4.1.6, 4.2.1, 7.1, 7.5.2, 7.5.6, 7.5.7

FDA: 21 CFR 820.100(a)(4), 820.100(a)(5), 820.70(b), 820.75(c)

TGA: TG(MD)R Sch1 P1 2; Sch3 P1 1.5(4)

ANVISA: RDC ANVISA 16/2013: 2.4, 5.6, 7.1.1.4

MHLW/PMDA: MO169: 5, 6, 26, 45, 46


TASK 8 – Identification and Control of Non-conforming Product


Ensure that the medical device organization has special procedure in place to identify and control the unintended use of products which does not conform to the product requirements. Verify whether the medical device organization is notifying all the external parties responsible for non-conformity of the product.


Ensure that the medical device organization has implemented the procedure for disposition of non-conforming product.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 8.3.1, 8.3.2

FDA: 21CFR 820.90(a)

TGA: TG(MD)R Sch3 P1 1.4(5)(b)(iii)

ANVISA: RDC ANVISA 16/2013: 6.5, 7.1.1.6

MHLW/PMDA: MO169: 60


TASK 9 – Actions regarding

Non-conforming product

detected after delivery


Ensure that the medical device organization has determined the procedure to control the nonconforming products detected after delivery or use, based on the risk associated with a product failure.


Decision regarding the recall of non-conforming product should be based on the justification of adequate risk.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 8.3.3, 8.5.2

FDA: 21 CFR 820.100(a)

TGA: TG(MD)R Sch1 P1 2, TG(MD)R Sch3 P1 1.4(3)(a),(b), (5)(b)(iii), (f)

ANVISA: RDC ANVISA 16/2013: 2.4, 7.1.1.8

MHLW/PMDA: MO169: 60, 63


TASK 10 – Internal Audit


Ensure that the medical device organization is conducting a periodic internal audit to established the compliance of quality management system and applicable regulatory requirements.


The training efficiencies of auditors performing the internal audits should be verified by the auditing organization. The audit team should ensure that the output of internal audits is an input to management review.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 6.2, 8.2.4

FDA: 21 CFR 820.22, 820.100

TGA: TG(MD)R Sch3 P1 1.4(5)(b)(iii)

ANVISA: RDC ANVISA 16/2013: 7.3

MHLW/PMDA: MO169: 22, 23, 56


TASK 11 – Information Supplied for Management Review


Ensure that the medical device organization has supplied relevant information regarding the product non-conformities, QMS non-conformities, Corrections, Corrective actions and preventive actions to the management review.


During the audit of measurement, analysis and improvement process, determine whether the management is aware of high risk quality problems, corrective and preventive actions implemented.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 5.6.2

FDA: 21 CFR 820.100 (a)(7)

TGA: TG(MD)R Sch3 P1 1.4(5)(b)(iii)

ANVISA: RDC ANVISA 16/2013: 2.2.6, 7.1.1.7

MHLW/PMDA: MO169: 19


Task 12 – Evaluation of

Information from Post-

Production Phase, Including

Complaints


Ensure that the medical device organization has implemented procedures for post market surveillance, complaint handling, service & repair information, literature reviews, device tracking  and investigating the cause of nonconformities related to advisory notices.


The risk management file shall be updated based on the Information from complaints, customer feedback, and post market surveillance. 


The following details should be recorded during the investigation of non-conformity that arises in post production phase,


1. Name of the device

2. Date the complaint was received, Nature and details of the complaint.

3. Unique identifier (UDI), or Universal Product Code (UPC) or any other device identification(s) and control number(s) used

4. Name, address, and telephone number of the complainant

5. Dates and results of investigation, Any corrective action taken


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.2.1, 7.2.3, 7.5.4 (a), 8.2.1, 8.2.2, 8.5.1

FDA: 21 CFR 820.198

TGA: TG(MD)R Sch1 P1 2, Sch3 P1 1.4(3), 1.4(5)(b)(iii) &1.4(5)(f)

ANVISA: RDC ANVISA 16/2013: 7.2

MHLW/PMDA: MO169: 6, 29, 43, 55, 62.6


Task 13 – Communications

with External Parties

Involved on Complaints


Ensure that the medical device organization has shared and exchanged relevant information to the external parties outside the medical device organization which contributed to the complaints.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.1.5, 7.4.1, 8.3.1

FDA: 21 CFR 820.100(a)(6)

ANVISA: RDC ANVISA 16/2013: 7.1.1.6

MHLW/PMDA: MO169: 5, 37, 60


Task 14 – Evaluation of Complaints for Adverse Event Reporting


Ensure that the medical device organization has defined, documented and implemented procedures to evaluate the complaints for adverse event reporting.


Verify that the medical device organization is making a decision of not reporting a complaint to regulatory authorities with proper and valid justification.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.2.1, 7.2.3, 8.2.3

FDA: 21 CFR 803

TGA: TG(MD)R Sch3 P1 1.4(3)(c)

ANVISA: RDC ANVISA 16/2013: 7.1.1.8, RDC ANVISA 67/2009

HC: CMDR 59-61.1

MHLW/PMDA: MO169: 6, 29, 62


Task 15 – Evaluation of Quality Problems for Advisory Notices


Ensure that the medical device organization has implemented procedures for evaluation of non-conformities related to the distributed product and for potential issuance and implementation of advisory notices.


Verify whether the medical device organization has taken a decision to issue or not to issue advisory notices based on the risk associated and valid justification.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.2.1, 7.2.3, 8.3.3

FDA: 21 CFR 806, 820.100(a)

TGA: TG(MD)R Sch3 P1 1.4(3)(c)

ANVISA: RDC ANVISA 16/2013: 7.1.1.8, RDC ANVISA 23/2012

HC: CMDR 63-65.1

MHLW/PMDA: MO169: 6, 29, 60


Task 16 – Top Management

Commitment to

Measurement, Analysis, and

Improvement Process


Ensure that the medical device organizations top management provides the necessary commitment to detect and address product and quality management system related nonconformities


Verify that the top management is ensuring the continued suitability and effectiveness of the quality management system.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.1.3, 5.2, 8.1, 8.5.1

ANVISA: RDC ANVISA 16/2013: 2.2.1

MHLW/PMDA: MO169: 5, 11, 54, 62


Now I hope you have acquired some knowledge about MDSAP Chapter 3 - Measurement, analysis and improvement Task 7 - Task 16. We will discuss in detail about remaining chapters of Medical Device Single Audit Program in our future blogs.


NOTE: Dear friends!!!... Please do comment a topic related to Biomedical, so that we can discuss it in future blogs.


Check out for this blog about Computed Tomography,  X ray, MRI scan, ECG.


Generations of CT Scanners


COMPUTED TOMOGRAPHY|TECHNOLOGY|ARTIFACTS


x ray machine working principle


components of x ray tube


MRI scan 


MRI With Contrast


Brain MRI


Types of MRI scanners


ELECTROCARDIOGRAM


12 Lead ECG Placement


HOW TO READ AN ECG


Holter Monitor


DON’T FORGET TO FOLLOW THIS BLOG PAGE


DROP YOUR MAIL ID TO GET IMMEDIATE UPDATES


If you find this blog post knowledgeable, 

comment & share it with a friend!   



Saturday, December 12, 2020

MDSAP Measurement, Analysis and Improvement - Part 6

Hi friends!!!


In our previous blog we had a introduction about Medical Device Single Audit Program, MDSAP Audit Cycle, Management process Audit, Device marketing authorization and facility registration. Please check out for the link below.


Medical Device Single Audit Program - Part 1


MDSAP Audit Cycle - Part 2


MDSAP Management Process Audit - Part 3


MDSAP Management Process Audit - Part 4


MDSAP Device Marketing Authorization and Facility Registration - Part 5


In today's blog we will discuss in detail about Medical Device Single Audit Program (MDSAP) CHAPTER 3 -  Measurement, Analysis and Improvement.


MDSAP is a common Medical Device auditing program followed by countries like Australia, USA, Brazil, Canada and Japan. Therefore it is important for every healthcare professionals who wish to market their product in the above mentioned countries to know in detail about MDSAP.


Let's get into the topic.


CHAPTER 3: MEASUREMENT,

ANALYSIS AND IMPROVEMENT


The following are the tasks involved in the audit of Measurement, Analysis and Improvement process.



TASK 1 – PROCEDURES FOR 
MEASUREMENT, ANALYSIS, AND 
IMPROVEMENT OF QMS EFFECTIVENESS AND PRODUCT CONFORMITY


TASK 2 – SOURCES OF QUALITY DATA

 
TASK 3 – INVESTIGATION OF

NONCONFORMITY 


TASK 4 – INVESTIGATION OF POTENTIAL

NONCONFORMITY 


TASK 5 – CORRECTION, CORRECTIVE

ACTION, AND PREVENTIVE ACTION


TASK 6 – ASSESSMENT OF DESIGN CHANGE

RESULTING FROM CORRECTIVE OR

PREVENTIVE ACTION 


TASK 7 – ASSESSMENT OF PROCESS

CHANGE RESULTING FROM CORRECTIVE

OR PREVENTIVE ACTION

 
TASK 8 – IDENTIFICATION AND CONTROL

OF NONCONFORMING PRODUCT


TASK 9 – ACTION REGARDING

NONCONFORMING PRODUCT DETECTED

AFTER DELIVERY 


TASK 10 – INTERNAL AUDIT

 
TASK 11 – INFORMATION SUPPLIED FOR

MANAGEMENT REVIEW 


TASK 12 – EVALUATION OF INFORMATION

FROM POST-PRODUCTION PHASE,

INCLUDING COMPLAINTS

 
TASK 13 – COMMUNICATIONS WITH

EXTERNAL PARTIES INVOLVED ON

COMPLAINTS 


TASK 14 – EVALUATION OF COMPLAINTS

FOR ADVERSE EVENT REPORTING


TASK 15 – EVALUATION OF QUALITY

PROBLEMS FOR ADVISORY NOTICES 


TASK 16 – TOP MANAGEMENT

COMMITMENT TO MEASUREMENT,

ANALYSIS, AND IMPROVEMENT PROCESS


Let's discuss in detail about each task.

 


Task 1 – Procedures for

Measurement, Analysis, and

Improvement of QMS Effectiveness

and Product Conformity


Ensure that medical device organizations has established and documented the procedures for measurement, analysis and improvement addressing the requirements of the QMS standard and other applicable regulatory authorities. Ensure that the medical device organization maintains and implements the necessary procedures to monitor and measure product conformity throughout the product realization.


The following are some of the requirements of procedures to analyze the data and to implement corrective action and preventive action.


1. The nonconformities shall be reviewed, including customer complaints

2. There should be a provision to record the results of any investigations and of actions taken

3. Ensure that the corrective action and preventive action taken is effective and does not adversely affect the finished device

4. Required changes in methods and procedures needed to correct and prevent the identified quality problems should be Implemented and recorded


Verify the medical device organizations procedures which provide mechanisms for feedback. The feedback is required to provide early warnings of quality problems and the implementation of corrective action and preventive action.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 4.2.1, 8.1, 8.2.1, 8.2.6, 8.5

FDA: 21 CFR 820.100(a)

TGA: TG(MD)R Sch3 P1 1.4(3)(a),(b), (5)(b)(iii), (f)

ANVISA: RDC ANVISA 16/2013: 5.3.1, 7.1, 7.2

MHLW/PMDA: MO169: 6, 54, 55, 58, 62, 63, 64


Task 2 – Sources of quality data


Ensure that medical device organization has identified and analyzed the appropriate sources of quality data according to a documented procedure for use of valid statistical methods (where appropriate) as a input into the measurement, analysis and improvement process.


The source of quality data may come from following ways but are not limited to customer complaints, returned product, internal and external audit findings, suppliers, feedback, nonconformities from regulatory audits and inspections, service records and data from the monitoring of products, processes, nonconforming products.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 7.5.4, 8.1, 8.2.1, 8.2.6, 8.4

FDA: 21 CFR 820.100(a)

TGA: TG(MD)R Sch3 P1 1.4(3)(a),(b), (5)(b)(iii), (f)

ANVISA: RDC ANVISA 16/2013: 7.1.1.1, 9.1

MHLW/PMDA: MO169: 43, 54, 55, 58, 61


Ensure that the medical device organization has used appropriate statistical methodology to detect recurring quality problems. And also ensure that medical device organization has not misused statistics in an effort to minimize the problem or avoid addressing the problem.


Task 3 – Investigation of 

Nonconformity


Verify whether medical device organization has made necessary investigations to identify the underlying causes of detected nonconformities wherever possible.


The organization should define and implement a risk-based approach for investigating complaints and non-conformities.  The roles and responsibilities, timelines should be well defined.


The auditing person shall select the records of investigations where the nonconformity of product has a higher risk.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 8.5.2

FDA: 21 CFR 820.100 (a)(2)

TGA: TG(MD)R Sch3 P1 1.4(3)(a),(b), (5)(b)(iii),(f), TG(MD)R Sch1 P1 2

ANVISA: RDC ANVISA 16/2013: 2.4, 6.5.1, 7.1.1.2

MHLW/PMDA: MO169: 63


Task 4 – Investigation of Potential

Nonconformity


The core content of Task 4 is similar to Task 3.

Verify the depth and extent of investigations conducted to identify the underlying causes) of potential nonconformities, wherever possible.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 8.5.3

FDA: 21 CFR 820.100(a)(2)

TGA: TG(MD)R Sch3 P1 1.4(3)(a),(b), (5)(b)(iii),(f),TG(MD)R Sch1 P1 2

ANVISA: RDC ANVISA 16/2013: 2.4, 7.1.1.1

MHLW/PMDA: MO169: 64


Task 5 – Correction, Corrective

Action, and Preventive Action


Ensure that the medical device organization has determined, implemented, documented all the corrections, corrective actions, preventive actions and made it effective. Verify that the medical device organizations corrections, corrective actions, and preventive actions did not adversely affect the finished devices.


Ensure that the medical device organizations corrective action and preventive action is appropriate to the risk of potential nonconformities encountered.


The medical device organization shall perform corrections regarding the affected products, whether it is distributed or not.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO 13485:2016: 8.2.1, 8.2.5, 8.3.1,8.5.2, 8.5.3

FDA: 21 CFR 820.100(a)(3), 820.100 (a)(4),820.100(a)(6), 820.100(b)

TGA: TG(MD)R Sch1 P1 2, TG(MD)R Sch3 P1 1.4(3)(a),(b), (5)(b)(iii), (f)

ANVISA: RDC ANVISA 16/2013: 2.4, 6.5, 7.1.1.3, 7.1.1.4, 7.1.1.5

MHLW/PMDA: MO169: 55, 57, 60, 63, 64


Task 6 – Assessment of Design

Change resulting from Corrective

or Preventive Action


Ensure that the medical device organization has evaluated new hazards and any new risks under the risk management process when their corrective or preventive action results in a design change.


Ensure that the medical device organization has performed verification and validation activities to make sure that their corrective and preventive actions does not introduce any new hazards.


APPLICABLE REGULATORY STANDARDS AND CLAUSE


ISO: ISO 13485:2016: 7.1, 7.3.9

FDA: 21 CFR 820.30(i), 820.30(g)

TGA: TG(MD)R Sch1 P1 2

ANVISA: RDC ANVISA 16/2013: 2.4, 4.1.10

MHLW/PMDA: MO169: 26, 36


Now I hope you have acquired some knowledge about MDSAP Chapter 3 - Measurement, analysis and improvement. We will discuss in detail about remaining tasks of Medical Device Single Audit Program Chapter 3  in our future blogs.


NOTE: Dear friends!!!... Please do comment a topic related to Biomedical, so that we can discuss it in future blogs.


Check out for this blog about Computed Tomography,  X ray, MRI scan, ECG.


Generations of CT Scanners


COMPUTED TOMOGRAPHY|TECHNOLOGY|ARTIFACTS


x ray machine working principle


components of x ray tube


MRI scan 


MRI With Contrast


Brain MRI


Types of MRI scanners


ELECTROCARDIOGRAM


12 Lead ECG Placement


HOW TO READ AN ECG


Holter Monitor


DON’T FORGET TO FOLLOW THIS BLOG PAGE


DROP YOUR MAIL ID TO GET IMMEDIATE UPDATES


If you find this blog post knowledgeable, 

comment & share it with a friend!