Thursday, April 22, 2021

All You Need About Dialysis Machine Preventive Maintenance

How Kidney Failure Occurs? 


There are many reasons for a kidney to stop functioning. Once the kidneys are unable to filter wastes and fluids a fast action needs to take place, as body wastes can quickly accumulate to dangerous levels. There are many reasons for kidney failure the most common are blockages in the urethra, direct damage to the kidney, or due to slow blood flow to the kidney. 

Patients with kidney failure need to alter their diets dramatically, as foods rich in phosphorous are totally prohibited to them as it will accumulate in their bloodstream and then affect their bones as it binds to calcium in the bones. There has been a growing market for foods that are custom made for people on dialysis as it improves their quality of life by keeping renal failure patients away from harmful nutrients to them.  

Why the Dialysis machine is needed?


A dialysis machine is a vital machine that is used for patients with renal failure. Patients with total kidney failure mostly considered end-stage patients or even partial kidney failure might need to apply for several dialysis sessions. Typically 3 sessions per week are needed for renal failure patients to dispose of extra water and other wastes.


Dialysis Patients


Usually, end-stage kidney patients are eligible to get a kidney transplant. However, the numbers of patients that are in need of a kidney transplant are far more than the donors available thus leading to a prolonged need to have dialysis sessions. A patient with end-stage kidney failure is deemed to have 3 dialysis sessions per week for the rest of his life.

In 2017 there were 500,000 people who needed dialysis and more than 200,000 who were living with a kidney transplant, wherein 2019 alone there are 100,000 Americans were waiting for a kidney transplant (1).  

Dialysis in Children

There are many factors that can lead to kidney failure in children when the kidney is not functioning properly then the child will need to have his blood filtered. Usually, the same techniques are used for blood filtration in children. 

Although more care and caution needs to be taken as children are not cooperative to treatment like adults. Many facilities do not provide care for children dialysis as they are not equipped with the needed care for children. 

Searching for hospitals and centers that can treat children in need of dialysis is an important step to have the child accepted to be treated with dialysis. 


Dialysis Machine


Once a patient reaches end-stage dialysis, he will need to have a dialysis machine. Where the dialysis machine takes blood and is filtered through the dialyzer filter and then is returned back to the patient's body. A patient usually needs 2-3 sessions per week and one session will last for around 4 hours.

Can Dialysis Machines replace ALL Kidney Functions? 


Unfortunately, a dialysis machine cannot replace all kidney functions, and will only work on filtering wastes and excessive water. There are various other functions that are currently irreplaceable by having dialysis and this why the lifespan of renal patients is usually lower than usual.  

How a Dialysis Machine Works? 

Dialysis Machine
Diagram Showing Main parts of the Dialysis Machine 

One of the primary jobs of the kidney is to filter wastes or toxins and remove excess water from the blood. So mainly a dialysis machine will try to do just that by having blood taken outside the body and filtered through a filter then returned back to the body. 

Blood passes through a filter or rather a porous membrane that is called the dialyzer or more easily the "Artificial Kidney" where there is a dialysate solution that will help remove unwanted wastes from the blood. There are many alarms and sensors that monitor various things while the dialysis machine is working. Most of the time new dialysis patients will be afraid of the alarms that are beeping. But these alarms are there for their safety as they indicate various things to the operators. 

Saturday, April 4, 2020

How ABBOTT'S Five Minute COVID-19 Test Device Works?

We have seen it all over the news! President Trump has showcased it in one of his press conferences. And we expect that it will be a game-changer in the fight over COVID-19 pandemic. As one of the best strategies to fight COVID-19 is massive testing of the public. A lesson we learned from various countries like South Korea, Germany, and Singapore.

ID NOW ABBOTT
Abbott ID NOW Testing Device

Why it is important?


With the spread of the COVID-19 pandemic, there is a great need for testing millions of people. As testing people will enable health providers to actively act based on the results. With around 80% of COVID-19 patients showing no or mild symptoms. Thus testing plays a major role in having COVID-19 positive patients to be quarantined until they are no longer carriers of the virus.

How ID NOW Works? 


First things first, the device name is ID NOW™  Formerly Alere™. That is a fast molecular testing device produced by Abbot Laboratories. It will give positive results in as little as 5 minutes. however, negative results will need as much as 13 minutes to show up.

The Test Kit has a chemical that rips open the virus allowing the genetic material of the COVID-19 to be read by the ID NOW device. Even f there is a small quantity of the virus ID NOW will replicate the virus's genetic material to be detected. So mainly the ID NOW will read the RNA of the virus, not the antibodies produced by the patient's immune system. So it is similar to PCR tests in this manner.

Now here is the good part, the ID NOW device is not only used to test for COVID-19. Actually, it was produced before the pandemic to test patients for Influenza A & B, Strep A, and respiratory syncytial virus (RSV) testing.

For those who already have the device already they will need to buy an additional 40$ additional cartridge. This cartridge is specifically designed to test patients for the SARS-COV-2 virus. It also means that the ID NOW device will not become obsolete after the pandemic is over as test centers can make use of it's testing capabilities for Flu, strep, and RSV in addition to COVID-19 testing. Also, this means that the already existing 18,000 devices that are spread around the USA health center, hospitals and clinics.

Before we start with the known compromise between quality and quantity let us go a little deeper into how does the ID NOW works in comparison with conventional testing devices. Conventional devices will replicate the virus's RNA by repeatedly cycling temperature from normal to medium then to high and back down to normal. Where the ID NOW is able to replicate COVID-19 RNA in normal temperature conditions. Thus allowing it to provide the results in a 5-15 minutes span.



Where is it best to use? 


The ID NOW cutting advantage is its small size that is just a few pounds. Allowing the ID NOW to be fitted in small clinics and even in doctors' offices.  That, in turn, will allow healthcare personnel to better deal with patients as they are able to get the results in a few moments.

Since the ID NOW is a lightweight small device it is considered a portable device, where it can be used seemingly anywhere it is needed. For large hospitals with the ability to accommodate large testing machines, Abbott’s m2000 RealTime system got U.S. Food and Drug Administration approval for use in hospitals and molecular laboratories to diagnose the infection. That system can churn through more tests on a daily basis, up to 1 million a week, but it takes longer to get the results.

5 - 15 Minutes what does that mean?


Well, put simply, if a patient has high COVID-19 concentration in the samples taken from the nose or the back of the throat. Then the device can detect that the patient is COVID-19 positive in 5 minutes. However, if the concentration of the virus is less, then the results can take up to 15 minutes to verify.

Test Accuracy VS Speed


What makes it able to do the test so fast compared to conventional testing equipment?


It is one thing to have a fast testing device, but it is another thing to have accurate results. Usually the faster the test the lower the accuracy is. We will need to know how accurate this device is in comparison to its speed. As at the end of the day, we need reliable data that can have health care providers know coronavirus infected people to be separated from the non-infected ones. 

Are we Sacrificing Quality for the sake of Speed? 


There are no specific numbers stating the accuracy of the ID NOW testing device. Although, we are inclined to observe for the few coming days to get feedback from users of the ID NOW with regards to test accuracy and margins of error. However, we have the below image, provided on the Abbott website, comparing the speed of ID NOW with normal PCR tests. So we feel that it is only fair that the ID NOW is as accurate as normal PCR tests.


Competitors have Faster Devices!


Well, we heard and saw devices that can give test results in as low as 2 minutes. So isn't it more logical to have these devices to be used for testing? 

It is a fact that there are some devices that claim to give faster test results. However, those devices are not looking for COVID-19 RNA, but it looks for antigens that are produced by the immune system of the infected patient. Usually, such tests are not accurate as many early-stage patients may not have antigens in their bodies fighting the virus to be detected by the testing device. Besides, these devices need blood samples to be withdrawn from the patient, meaning a greater chance of cross-contamination. 

Test Accuracy


So far there have been no numbers on the accuracy that are concise enough for us to be able to Juge. "Highly accurate" and more than 90% accurate is not enough. Having false positive or false negatives with a 10% margin of error is not acceptable. But it seems that many tests performed have the same margin of error problem.

That is usually attributed to how early is the patient tested. In other words, a patient that is infected today is likely to test negative if she was tested for the virus. But after a few days, the same patient will test positive. 

Production Quantities 


It is not clear how many of these devices there will be and when are they going to be available. Many reports vary from as little as 5500 devices to as much as 500,000 devices. We will need an official report to be released from Abbot laboratories related to production capacity.

Though Abbott laboratories announce that they will be producing around 5 million tests in April. But these tests are combines for normal testing and fast testing.

What was already announced from Abbot Laboratories' official website is that they are pledging to provide 50,000 tests/day. But without mention of the number of devices. Also according to Abbots's official website:

"This comes on the heels of our announcement last week of the availability of the Abbott RealTime SARS-CoV-2 EUA test under FDA EUA, which runs on m2000 RealTime molecular system for centralized lab environments. Combined with ID NOW, Abbott expects to produce about 5 million tests in April."

Consumables


Each Assay kit contains all necessary components for testing to include: 24 tests, swabs for sample collection, pipettes, positive and negative controls.

Price Tag


There are no clear pricing criteria for the ID NOW testing device. We are looking forward to having some of the devices to be distributed for free to some of the most affected areas, Just like Tesla motors did when producing the Medtronic Ventilators PB980.

Our expectations are that the ID NOW price might range between 10,000-20,000 USD. But we don't have any confirmed price of these small devices.

Technical Specs


  • Color Touch Screen 3.5”
  • Communications 10/100 Mbps Ethernet Port for Data Transfer
  • 3 x USB Ports for data export,
  • barcode reader and printer 
  • Data storage 999 patient test results 
  • 99 QC test results 
  • Memory allows search and retrieval Archive or export via USB
  • Power Supply 12V DC from external AC/DC 
  • supplied plug pack DC Voltage fluctuation: ±10% DC Current consumption: 12V DC, 3.0 Amps
  • Dimensions 8.15” W x 5.71” H x 7.64” D 207 mm W x 145 mm H x 194 mm D 
  • Weight 3.0 kg (6.7 pounds)
  • Operating Environment Indoor Use 15ºC to 30ºC (50ºF to 86ºF) 
  • Humidity 10% to 80% RH (non-condensing) 0m (1.01 bar) to 2000m (0.763 bar) IP20
  • Storage 15ºC to 30ºC (50ºF to 86ºF) 10% to 80% RH (non-condensing) 0m (1.01 bar) to 2000m (0.763 bar)
  • ID NOW Instrument User Manual 1.3.2 
  • 12V Power Supply 
  • Rated input voltage: 100-240VAC 
  • Rated input frequency: 50/60Hz 
  • Rated input current: 1.2 Amps 
  •  As per instrument Output voltage: 12V Output current: 3.5 Amps


ID NOW Training


It is very useful not only to have the ID NOW device to be available widely across the USA and even across the Globe. Training healthcare personnel on how to use the ID NOW plays a crucial part in fighting the COVID-19 pandemic. 

Thanks to Abbott they have provided video material of various aspects to dealing with device usage. Divided into eight training modules. Where each module explains a specific part of using the ID NOW. We have the videos, most of them are from 3-10 minutes and have valuable information on best user practices. The longest of all modules is the first one as it is almost 15 minutes long and teaches the user how to unpack and prepare the ID NOW.  

The first 4 modules are the most important ones in addition to the 8th module. As they contain the core material needed to effectively operate and use the ID NOW testing device.  

  

Thursday, April 2, 2020

Medtronic Opensource PB560 Files Download

We have been following Medtronic activities very closely. First, they published a series of training videos for the PB980 From the moment their CEO, Omar Ishrak announced the partnering with Tesla. Then announcing that they will be open-sourcing PB560.

At first, the published material for the PB560 did not include the software programming of the ventilator. To us, that was a red flag, as the hardware alone is not important. Finally, now Medtronic published the software as programming as well!

PB560
Puritan Bennett 560 Ventilator

We can't thank Medtronic enough for their active contributions in saving many lives in the midst of the COVID-19 pandemic. The good thing about the PB560 is that it is a simple ventilator that is lightweight and portable. In addition, the PB560 manufacturing price is expected to be considerably low.

Since it is lightweight and has a simple design we expect that many manufacturers will be able to produce the PB560. In addition, we are also expecting that the PB560 manufacturing process can be fast. Thus enabling manufacturers to produce the PB560 in high volumes.

Monday, March 30, 2020

Medtronic Open Sourcing Ventilator Design Fighting COVID-19 Pandemic

Medtronic Tesla Partnership
Tesla Medtronic partnership  

Ramping up Production 

In response to COVID-19 Pandemic ventilator producing medical companies have been ramping up production to be able to adjust to the spike in ventilator demand. Medtronic has already announced that it will be increasing production by working 24/7 producing ventilators.

Medtronic Partnering With Tesla


In addition, Medtronic has partnered with Tesla motors to producing its top of the line Puritan-Bennett 980 ventilator. Also, they have published a series of training videos on using the ventilator and adjusting its settings.


Medtronic CEO Omar Ishrak has announced that they are open to other partnerships with other manufacturers to produce ventilators. Another announcement was that they will be open-sourcing one of their lower end ventilators to anyone who is able to produce them.


At the time we were little skeptical of the move. As usually, medical companies are very preservative about their intellectual properties. However, we didn't know which ventilator that is going to be open-source. We speculated that it will be the Puritan-Bennett 760 version, however today we had it all cleared out for us!

Medtronic Open-Sourcing PB 560


Medtronic has announced that the ventilator is the Puritan-Bennett 560. As mentioned many times earlier, medical companies are protective of their intellectual properties. Medtronic is asking the would-to-be manufacturer to label produced devices with a warning. That warning sign would be that the produced devices were manufactured in response to the COVID-19 pandemic. Also, the regulatory approvals of the makeshift designs are not Medtronics responsibility.


According to the Medtronic website: "PB 560 product and service manuals, design requirement documents, manufacturing documents, and schematics are now available at Medtronic.com/openventilator. The PB 560 design specifications are available today, software code and other information will follow shortly."


We will be looking forward to the entire open-sourcing to be done. The service and operator manuals are now available. We get Medtronic's point of view of still wanting to protect their intellectual properties. And we respect Medtronic for stepping up and taking such an initiative. And we are looking forward to having other leading medical companies to open-source one of their low-end ventilators.


Puritan-Bennett 560
PB560 Light and Small Sized Ventilator

Snap information about the Puritan-Bennett 560



It was on the market for 10 years now and was distributed over 35 countries. Most importantly it is fitting for both Adults and Children. It is possible to use it at home in addition to having it in hospitals. We would like Medtronic to issue a series of training videos for the Puritan-Bennett 560 just like they did for the Puritan-Bennett 980.
The Puritan-Bennett 560 is a low-end ventilator, as you might have noticed from the picture, is for patients who do not need critical care. The PB 560 is a small device with limited ventilation and patient breathing assistance capabilities. On the other hand, a high volume of COVID-19 patients needs just that. Only those who develop severe symptoms need critical care and require a much more advanced ventilator like the PB 980.

What do you think of the Medtronic move to open source one of their ventilators? Have you ever worked on such a device? please comment on your thought below! 

Saturday, March 28, 2020

Medtronic Tesla Partnership Producing Ventilators



Photo by Andreas Dress on
Last week there was a tweet from Elon Musk, in that week he stated that: "Tesla makes cars with sophisticated HVAC systems. SpaceX makes spacecraft with life support systems. Ventilators are not difficult but can't be produced instantly."

The Real-Life Iron Man


When I read that tweet from Elon Musk I was shocked by it! As much as I respect Elon Musk, but I felt that he was stretching his abilities. Yes, the man is visionary and has disrupted the car industry forever.

At that time my thoughts were: "Man you gotta know your limits, we need ventilators a week ago! Please don't make me lose faith in you". As for someone working in the medical industry I know, it would take ages to build a ventilator from scratch then getting it FDA approved.

Walk The Talk!


I really appreciated the reply on Elon's Musk tweet from the Mayor of New York City: "We need ventilators ASAP- we will need thousands". It felt to me like the mayor was saying walk the talk and deliver what you promised.

Friday, March 27, 2020

Great News Medtronic Europe Releases Videos about Puritan Bennett 980 Ventilator Series

Corona Virus magnified look
CDC Corona Virus Depiction
In light of the COVID-19 pandemic and its widespread across the world, a few hours before publishing this article, Medtronic Europe has decided to publish a series of videos related to training staff and nurses on operating the Puritan Bennett 980 Ventilators. This is a great step forward in helping hospitals to fight COVID-19 pandemic.
Usually, the Biomedical Department handles providing training on various medical devices available in the hospital. Either by one of the Biomed technicians or by holding training sessions provided by the supplier or distributor of that device.
Yet, since there is a huge load on the medical sector in general and the sharp ventilators demand surge has to lead us to wonder,


Who will be operating all these ventilators and will they be properly trained on operating them?

Thanking Medtronic Europe for publishing this series of videos, explaining the various operational aspects of the Puritan Bennett 980 Ventilator is not enough! We will be writing about the videos published in this article.

Puritan Bennett 980 Ventilator
What we like about the Medtronic Puritan Bennett 980 Ventilator Series is that all the videos are a few minutes of length. And are specific to a certain goal stated at the beginning of the video making it easier for the trainee to learn fast.

What we don't like about the Medtronic Puritan Bennett 980 Ventilator Series is that there are actually other ventilators produced by Medtronic. It will be useful as well to publish these videos on YouTube so that older models are also included in this training series.

Thursday, March 26, 2020

Ventilator a Biomedical Point Of View

Lungs Model
Photo by Robina Weermeijer
Ventilators are crucial machines that are one of the most important medical devices in a hospital not because of its complexity. But because it is one of the machines that are considered life-saving for patients who have trouble breathing normally.


In this article, we are not going to mention how the ventilator's preventive maintenance is done as we already covered that in a different article. But we will be shedding light on the various modes of operation in addition to explaining the various parts of a ventilator in a simplified way.


Ventilators or respirators are devices used to assist patients in ventilating their lungs and they are divided into two categories:


  •         Controller ventilator
  •         Assisted ventilator

For controlled ventilation, the respiratory ventilation of the patient is determined by the machine, and it sets the ventilator cycle. If the patient tried to ventilate, this will affect the machine, and it can oppose it too.

As for the "assister" mode ventilator, the respiratory ventilation is determined or controlled by the patient himself. So it assists rather than controls the patient in ventilation.

Another classification of ventilation is:

-        Negative pressure ventilation.
-        Positive pressure ventilation.

For negative pressure ventilators, which are more physiological than positive ones. A pressure, varying between atmospheric pressure and negative pressure is applied to the thorax of the patient to force him to ventilate.


For positive pressure ventilators, pressure, varying between atmospheric pressure and positive pressure, is applied and the air is blown into the lungs. Thus an exchange of gases is done in the patient's lungs.


Machine Components

  •     Breathing circuit (inspiration – expiration)
  •     A controlling system that defines the characteristics of the cycle used 
  •     A gas supply 
  •     Monitor
  •     Valves, pressure sensors, and alarm systems. 

In this article, we are going to give an example of the Puritan-Bennett ventilator that is 760, Puritan Bennett is now part of Medtronic and is a specialized line for producing ventilators

Mode/breath type availability on 760 Ventilators:


  •     VCV (volume control ventilation) breathe type.
  •     PCV (pressure control ventilation) breathe type.
  •     PSV ( pressure support ventilation) breath type (support pressure setting)
  •     PSV (rise time factor and exhalation sensitivity setting)
  •     SIMV (Synchronous Intermittent Mandatory Ventilation) mode
  •     Apnea ventilation (choice of VCV or PCV breath type)

Functional description


By pressing keys and turning the knob on the ventilator keyboard, the operator gives initial instructions and data to the ventilator. The user interface micro-controller processes this information and stores it in the ventilator’s memory. The breath delivery micro-controller uses this stored information to control and monitor the flow of gas to and from the patient.

Saturday, March 21, 2020

Biomedical Say About COVID-19 Ventilators Shortages

With the emergence of COVID-19 and its widespread around the globe, we find it as an important time for Biomedical engineers and biomedical technicians to have an impact on fighting such a pandemic.

Many hospitals around the globe have shortages in ventilators many other medical supplies that are vital in fighting this virus.
Ventilator Shortages forces Medtronic to go 24/7


Increasing Ventilators Production 


Many medical equipment companies have ramped up their production to vital medical devices to cope with the rising needs for such supplies, for example, Getinge has announced that it will increase its ventilators production by 60%. Also, we are sure that many manufacturers will follow this trend.

On the other hand, there will be logistical problems preventing or at least delaying the reach of these newly manufactured devices to where they are needed especially in countries that are far away from the production point. This is mainly because almost all types of transportation have been stopped or reduced significantly. Where the fastest way to ship such equipment via airplanes it seems that most cargo planes are no longer flying.

So will ramping up production really solve the shortage of medical supplies?

In the short term it will not, and that is related to logistical problems mainly, so what can we do and are there any alternatives?

Biomedical Department Role


The fastest alternative is to be able to optimize the performance of the ventilators that are already there in the hospital. And here where the role of a biomedical department kicks in.

Doing the needed preventive maintenance procedure on time and making sure that the end-user is using the medical equipment properly is key to optimize the performance of any medical device. Also making sure that the device's software is updated to the newest software version will many times enhance the performance of a ventilator due to bug fixes or new features that were not available in the previous software versions.

In addition to this, the biomedical department can go one step further and see if there are any older ventilators lying around in the hospital warehouse and trey to get these to a working condition, although sometimes it might be time-consuming to do so in many cases some hospitals put aside there old medical devices to make room for the newer better equipped medical device that is packed with better features and abilities, but in situations of crises, such luxury is not an option as there are patients who might lose their lives if not put on life support.

What else can a biomedical engineer do?


Monday, June 18, 2018

Baby Incubator Preventive Maintenance All You Need To Know

What is Neonatal Incubator 


Neonatal incubators or baby incubators are medical devices that were created to provide a controlled environment for newborns that require special care. An environment is generated where different variables important for the development of newborns are controlled, such as temperature, humidity, and oxygen.

Infant Baby Incubator
Baby Incubator

The incubators consist of a transparent cover that allows isolating the patient without losing visual contact with the baby. In addition, NICU team has access to the newborn through gates that allow you to assist the baby with limiting the introduction of cold air in the incubator. 


The baby incubator's main components are a patient compartment, the cover, the mattress, the platform, the rolling base, and the control module, in which are all the parameters like temperature, humidity, and oxygen are controlled.

Commercially, the types of neonatal incubators differ in shape and form in which they are constructed or in their control and heating systems. However, all of them generally include the following basic components:

- Hood or cover made of transparent material, inside which the newborn is placed and where a controlled microclimate is generated.

- Mattress; Here the patient is placed; the mattress cover must be made of a low porosity material to facilitate cleaning and sterilization.

- Trolly; which is the structure that serves as a base and support for the Hood and its control systems. In general, this structure is incorporated with all the components that make up the incubator and allows its mobilization.

- The temperature control module, where you can select the operating mode of the incubator, and temperature set limits that the incubator is going to operate on.

- Humidifier. that usually includes water tanks to control the relative humidity of the environment.

- Port or entrance for oxygen supply.

- Block or control of alarms. Alarms pre-set at the factory or adjustable by the operator. These are audible and visible and are intended to increase patient safety during treatment. 

The alarms commonly found in the incubator models are:

- Air temperature Alarm: In relation to the temperature established by the health personnel; the alarm can be activated when the 'high/low' temperature limits sets are reached.

- Skin temperature alarm: In relation to the temperature set by the operator, the high or low-temperature alarm of the skin for the newborn can be activated.

- Sensor Alar:. It is activated in case of failure of the patient's temperature sensor.

- Air intake filters. This alarm is activated when there is resistance at the entrance to the outside airflow to the incubator.

- The concentration of O2. Detects the variation of oxygen concentration inside the incubator.

PREVENTIVE MAINTENANCE


Routinely inspect the patient compartment for signs of rupture and replace the assemblies before operating the incubator. In addition, you must ensure that all connections to the incubator are disconnected, especially with the oxygen supply when performing cleaning and maintenance procedures; there is a risk of fire when performing maintenance procedures in spaces containing supplemental oxygen.

Monday, June 11, 2018

What Everyone Must Know About Robotics Uses In Medical Field

What is Robotics?


Robotics or robots form an integral part of our life as most high production factories rely on machines and robots to an extent that the need for a human manpower is limited in many aspects, why not as when a robot is capable of lifting heavy objects, welding microchips and it can do the job precisely and robustly. I will not get into the debate of being pro or against such acts and its effect on the future of working forces and unemployment. But I’d like to dwell on this subject from the biomedical engineer's point of view or at least point of interest.    


Robotic Arm Aiding Human Life
Next Generation Prosthetics


What is a medical Robot? 


               The definition of a medical robot is that it’s a robot used to perform medical surgery or take part in the healing process of a patient while the definition of medical robotics is sometimes limited to robots that aid in making precise medical surgeries the definition can be a broad as including the CT scanner and C-arm. We are here interested in the effect of these robots on a biomedical engineer that is supposed to maintain fully functional medical machines by using the most effective ways to do so.