BY LISA HITCHEN
There are many reasons why patients choose one
particular medical facility rather than another. The skills of medical
staff, the sophistication of the facility, its international reputation
and its standards all play their part. But for well-informed patients,
it is increasingly high-tech equipment that is a major draw. They
believe that the best equipment can make significant differences to
patient outcomes. It is also seen as evidence of a facility being up to
date and with impressive financial resources. Here we look at 12 pieces
of medical equipment that, increasingly, are being used in Google
searches by patients.
1. Intuitive Surgical da Vinci Robot
Minimally
invasive surgery took a huge leap forward in the late 1990s when
robotics were introduced. US-based firm, Intuitive Surgical, developed
the da Vinci Surgical System. The da Vinci has four robotic arms for
instruments and the laparoscope. The surgeon co-ordinates their
movements from a control panel, allowing his skill to be exercised with
pin-point accuracy, the surgeon’s hand and wrist movements translated
into corresponding, scaled movements by the instruments while the
operation is viewed on a monitor. Used for surgery of the heart, spine,
prostate and bladder and for kidney transplants, benefits of the da
Vinci are said to be less pain, less scarring, less blood loss and
faster recovery times.
High Definition was added to the refined
da Vinci, the da Vinci S Surgical System, earlier this year, making it
the world’s first robotic surgical system with 3D HD vision, according
to its manufacturers. By the end of March 2007, there were 602 unit
shipments worldwide.
Prof Roger Kirby, a urologist at the London
Clinic in England, says use of the robot has transformed his practice.
Previously he used open surgery to perform around 1,200 open
prostatectomies. With the da Vinci, he and his seven-strong team have
performed over 240 procedures using the robot.
“There is a real
improvement in outcomes,” he says. “Patients are out of hospital in
three days compared to six with open surgery and there is less blood
loss.”
He is also clear of other benefits of using the machine.
“It is a useful marketing tool, I think,” he admits. “It promotes the
high-tech stuff – 66 percent of all prostatetectomies in the US are
done using this robot. Compared with open surgery, there is no question
that this is better.”
Intuitive Surgical markets to surgeons and
hospital administrators interested in developing their minimally
invasive surgical programmes. But recently, it has recognised the
growing consumer interest in such technologies and set up a website for
patients: www.intuitivesurgical.com and www.thelondonclinic.co.uk
2. Varian Medical Systems’ Trilogy System
Trilogy is a precision radiotherapy medical linear accelerator used for treating tumours.
Radiotherapy
has always been a rigorous and taxing treatment for patients with
significant short- and long-term side effects. The 1990s saw the
development of new, more targeted radiation therapies (Intensity
Modulated Radiation Therapy or IMRT), whilst Image-Guided Radiation
Therapy pinpointed moving tumours. Stereotactic radiotherapy and
surgery allow radiation of a clearly defined tumour, leaving most
surrounding tissue intact. With early diagnosis of smaller tumours,
this method is becoming more useful.
The Trilogy has the ability
to deliver these and all other external beam therapies, meaning it can
be used to treat a large number of different cancers anywhere in the
body. The machine has a couch controlled by remote control so the
patient can be re-angled or moved quickly into another position, which
maximises the number of beam angles that can be used. Short or long
courses of radiation can be delivered in a single dose or over a number
of weeks.
Malaysia’s NCI Cancer Hospital in Negeri Sembilan is
the first hospital in Southeast Asia to purchase a Trilogy with Smart
Beam, the hospital claims. Operational since March 2006, the Trilogy
massively extends the sort of radiation oncology that can be performed
at the hospital, allowing over 43 different cancers to be treated.
NCI
medical director, Dr Selvaratnam Govindaraju says: “We decided to
purchase this system after a thorough investigation of the various
linear accelerators available. We thought that this was the most
optimal in terms of cost effectiveness, quality, accuracy of treatment,
reputation of our centre and the supplier. From the patient’s point of
view, the treatment has resulted in less toxicity, greater response,
better acceptability and fewer side effects. It gives the treating
physician flexibility to choose the optimal treatment option. It gives
the confidence to treat difficult tumours.”
Initial results
comparing use of Trilogy for IMRT with conventional methods have shown
the system is more effective, he adds, with reduced toxicity and
increased response for breast and prostate cancer patients.
Since
the NCI’s first IMRT treatment 18 months ago, the hospital has seen
increased interest in its services from across Malaysia and
neighbouring countries.
The hospital’s international patient
centre provides information and support for referring doctors and
overseas patients’ families, helping with travel, appointments and
accommodation arrangements, including its new residential wing for
family and friends of patients.
www.varian.com and www.nci.com.my
3. Accuray CyberKnife Robotic Radiosurgery System
The
CyberKnife offers stereotactic radiosurgery to cancer patients in what
its manufacturer claims is the “world’s first and only robotic
radiosurgery system designed to treat tumours anywhere in the body with
sub-millimeter accuracy”.
Its X-band linear accelerator is small
and light so it can be placed on a robotic arm to send the precise dose
of radiation needed in any direction, avoiding healthy cells. The
system is able to track moving tumours and any movement made by the
patient.
Its development has meant patients previously thought
inoperable or surgically complex can now be treated. This usually
happens over one to five visits to the clinic where patients don’t need
anaesthetic and can then go home after the procedure.
At
Anadolu Medical Center, Gebze in Turkey, the CyberKnife was just one of
a range of state-of-the-art equipment purchased for the opening of the
new centre in 2005. With three years’ experience using the CyberKnife,
the number of patients treated with it has risen from approximately 140
in 2005 to over 300 in 2007.
“We can use CyberKnife by itself
as a curative modality or in combination with other radiotherapy
modalities or with chemotherapy or surgery or we can use it
palliatively to decrease pain or bleeding,” says Prof Kayiham Engin,
director of radiation oncology at the hospital.
Lung cancer is
the number one cancer type in Turkey so this is one patient group that
is often seen at the Center. With conventional radiotherapy, such
patients often require up to seven weeks of treatment whilst with
CyberKnife, three fractions of radiation in a week can be sufficient,
he says.
The hospital is also having increasing success using
the machine with pancreatic, liver and prostate cancer with faster,
more defined treatment and increasing opportunities to re-irradiate
patients previously treated with radiotherapy. People with brain
lesions still account for around 60 percent of the clientle where both
primary and benign tumours are treated with CyberKnife as a safer
alternative to conventional surgery.
“CyberKnife helped a lot
with our international reputation,” notes Prof Engin. “It really
attracted new patients to the hospital and with its help, Anadolu has
become known as the best oncological centre in Turkey.” This includes
patients from Europe, the Middle East, Central Asia as well as domestic
patients.
www.accuray.com and www.anadolusaglik.org
4. Hippocratech Surgical’s SurgiCube Operation Unit
Minor
surgery is increasingly being carried out in health settings beyond
hospitals by primary care physicians and nurses where an operating room
is not available.
This challenge inspired Dr Gerrit Melles to
come up with a portable and accessible operating room that can offer a
sterile environment for performing small types of surgery anywhere. Dr
Melles, a corneal surgeon at the Netherlands Institute for Innovative
Ocular Surgery in Rotterdam, the Netherlands, designed the SurgiCube to
help solve many of the efficiency problems he saw in operating rooms
globally.
“It can be used for every type of minor incision
surgery and most of this is quick and not very complicated,” he says.
“If you could get the bulk of it done in the SurgiCube, you could get a
lot done and save space for other surgeries.”
The SurgiCube is a
box-like metallic structure that can be housed in any dust and
germ-free room. Unlike normal operating rooms, the airflow works
differently: the clean air flow is restricted to the operating surface
and instrument table.
The cube is set up around the part of the
patient’s body that is to operated upon. So for head surgery, only the
patient’s head will be inside the SurgiCube. This can mean that
patients don’t have to get changed for surgery and staff that don’t
need to be inside the SurgiCube don’t have to wear surgical scrubs
either.
Because microsurgery can be done in this “microclimate”
it reduces the restrictions on where surgery can be performed – so it
can take place in an office, home or primary care clinic rather than in
a hospital.
Nicoline Schalij-Delfos is an opthalmologist at
Leiden University Medical Center, the Netherlands. There the SurgiCube
is used for surgery under local anaesthesia for the majority of
surgical day-care patients. This is usually for cataracts, glaucoma
surgery, oculoplastic surgery and removal of radioactive plaques.
“Patients
are in hospital for about half the time they needed before,” she says.
“That means we can do larger numbers in the same time. Turnover time is
much quicker. I think the service to the patients has improved.”
“As
we work more efficiently, more surgeons can do surgery compared to the
previous system,” says Schalij-Delfos. “Surgeons have to be flexible to
make the step from a large operating theatre to a small cube, but you
get used to it very quickly and the unit is much less expensive than
building a new day-care operating theatre.”
www.hippocratechsurgical.com and www.lumc.nl
5. Philips Panorama 1.0 Tesla Open MRI scanner
Scanners
have been regarded as frightening and claustrophobic by some patients,
and having a scan can increase patients’ anxiety and trauma during
their time in hospital.
So the design of an open scanner has
obvious benefits. Philips claims to offer the world’s only high-field
open (HFO) MR system. Open on three sides instead of being a long,
narrow tunnel, this means patients can see out at all times and staff
can always see the patient.
The patient is placed on an MRI
table which is moved in and out of the scanner. An MRI coil is put over
the area being scanned and each scan takes 30 minutes. The scanner has
the disadvantage of being noisy so patients wear earplugs or headphones
to reduce the problem.
The HFO is also effective at examining
joints in any position – which means injuries are more likely to be
picked up. Obese patients might find the open design less constraining
and therefore less stressful. Images are of a very high quality and the
incorporation of SmartExam technology makes it easier for staff to
obtain meaningful results quickly and easily. All this means patients
spend less time inside the scanner.
Paul Mezacapa is a
radiographer and founder of Desert Medical Imaging, California, US,
which bought an HFO earlier this year. California is an open MR market,
he admits, and that meant the company had to choose a product that
could compete successfully.
“We wanted to buy a piece of
equipment that was going to thwart the competition,” he says. Having
installed the third HFO in the US, the next challenge was to convince
the doctors.
“It is very difficult to get doctors in the States
to think that open MRI is good for all things. We had to prove to
doctors that this was as robust as other systems such as 1.5 Tesla. It
is a very strong statement saying that there were radiologists that
could not detect the difference in imaging quality.”
Patient
endorsement has been high as well, he says, with the open layout
providing immense reassurance to those who are claustrophobic.
Clinically,
the HFO scanner is particularly useful for the high proportion of
patients with musculo-skeletal problems, he says. Individual joints in
motion can also be seen, which was not possible with the previous
scanner. This saves money and medicine, Mezacapa explains, as
treatments can be more specifically targeted. With less need for
sedation and its greater flexibility, the machine has meant faster
throughput of patients.
The initial expensive investment has paid
off, he says. Turnover in one quarter after acquiring the HFO was the
revenue equivalent for the whole year with the previous scanner,
according to Mezacapa.
www.medical.philips.com/uk and www.desertmedicalimaging.com
6. Philips Ambient Experience
Philips
Ambient Experience allows patients to make choices about visual,
lighting and atmospheric effects to accompany them during a medical or
diagnostic procedure such as CT scans, PET/CT, MRI and heart
catheterisation. The idea is to engage their senses so that any worry
they might have of this medical process is forgotten.
Able to
be integrated into any hospital room, the various suites have lights
and electronics that can be operated by the patient so they can create
their own setting. This is especially good for children who might
otherwise need to be anaesthetised for a procedure and reduces the need
for repeat examinations when patient movement leads to an ineffective
first result.
Desert Medical Imaging bought the Ambient
Experience to facilitate its scanning procedures and other tests.
Mezacapa admits to having reservations at first. “At first I thought it
was fluff. We are gamblers and we said: ‘Let’s just do it’.”
His
instincts that it would help grab market share paid off with a positive
response from patients. “When they come and look at the Ambient
Experience, their minds are distracted from the test,” he says.
“Patients like to have control of some part of their test. We ask them
where would they like to be? In the sands of Africa? We give them a
choice and people love it.”
Is it making a difference? It seems
so. Eight hours for sedation of claustrophobic patients per week is now
down to one hour, he says.
California is well known for
offering a comfortable winter retreat for older North Americans and
others. The clinic has taken advantage of a doubling of the population
during the winter to offer scans within the Ambient Experience suite to
a range of clients beyond its local market without the need to
advertise elsewhere, he says.
“We have gained 16 percent more
market share by having the Ambient Experience. It is a big expense in
the first place, but the amount of market share we have gained is worth
the investment.”
The Subang Jaya Medical Centre (SJMC) in
Malaysia purchased the country’s first 3.0 Tesla MRI and Ambient
Experience suite in August 2007.
www.sjmc.com.my
7. Dutch Opthalmic Research Center’s (DORC) One Step 23 Gauge Vitrectomy System and Xenon BrightStar
Huge,
high-tech machines might steal all the glory in promotions by hospitals
vying for overseas business, but possession of small and precise
instruments to do a specific job can be just as important.
On
the market since January 2007, the 23 gauge vitrectomy system has some
distinct advantages over older systems. Vitrectomy is eye surgery that
involves removing some or all of the vitreous humour. The new one-step
cannula set that is part of the system contains special closure valves
that sit on the eye and can be removed with forceps at the end of the
operation. This means surgeons don’t have to sucture??? incisions,
resulting in less trauma and quicker recovery times for patients. There
is also less risk of post-operative low intraocular pressure or
inflammation of the inner linings of the eye.
The company has
specialised in developing 23 gauge instruments for 15 years. These
allow the whole operation to take place inside a tiny (0.6mm or 23
gauge) incision. This equipment actually looks and feels the same as 25
gauge instruments because only the end of the instrument is smaller.
Retinal specialists across the globe have praised the Vitrectomy System
for the advantages it provides for their surgery in comparison to 20
gauge and 25 gauge instruments.
Prof Peter Stalmans, an
opthalmologist at University Hospitals Leuven, Belgium says: “At
present I perform up to 80 percent of my vitrectomies using the 23
gauge transconjunctival approach. Average surgery time has decreased
compared to 20 gauge surgery. In our centre, we recently conducted a
retrospective study of almost 900 patients, which confirmed a
statistically significant better and faster postoperative recovery
compared to a 20 gauge approach.”
DORC’s Xenon BrightStar is a
lighting system for eye surgery that was developed in response to
clinical concerns over photo-toxicity. Eye surgery can often take
longer than expected and the surgeon will keep going without having a
full idea of how longer exposure to a light source might be damaging
the retina.
This machine takes such dangers into account. It has
four UV safety filters that can be cut off, so the surgeon has control
over the spectrum of light that gets to the retina. The machine can
calculate exactly how long the surgeon can stay in the eye. With a
particular filter for a particular procedure selected, they can work
for longer close to the retina. Its increased illumination helps the
surgeon to see better during the operation even when using tiny light
fibres.
www.dorc.nl
8. IntraLase Femtosecond Laser
The
IntraLase is used for creating a corneal flap in Laser-assisted in Situ
Keratomileusis (LASIK) surgery without the need for a surgeon’s knife.
This refractive laser eye surgery is widely used to correct short- and
long-sightedness and astigmatism. Faster and less painful than
photorefractive keratectomy, it is a procedure highly conducive to
medical travellers and ends the need for wearing of glasses or contact
lenses.
The IntraLase is also used for making shaped incisions for corneal transplantation or keratoplasty procedures.
A
femtosecond is less than one quadrillionth of a second. This tiny burst
of laser activity, known as IntraLASIK, creates a series of cavitation
bubbles within the cornea. These bubbles, made of water and carbon
dioxide when arranged next to each other lead to the separation of the
corneal stroma to create the flap. Once the flap is made, a hinge is
left at one side and it is then folded back to give access to the
stroma. A glass plate placed in the corneal surface and attached to the
eye by a low pressure suction ring is then ready for the LASIK
treatment.
Earlier this year, the Grewal Eye Institute in
Chandigarh, India, bought an IntraLase as well as the Advanced Medical
Optics’s STAR S4 IR Excimer Laser System (see 9). There it is used for
all three of its clinical applications – LASIK, corneal rings for
keratoconus and in corneal transplants.
“It offers the best
visual results after LASIK surgery,” says Dr Satinder Pal Singh Grewal,
the chief operating officer at Grewal. “The flaps created are of
uniform thickness throughout and the thickness is also highly accurate,
with a standard deviation of 12 micrometres. This level of accuracy and
predictability is reassuring for the surgeon and helps to improve the
visual outcome and reduce the incidence of complications like glare and
post-LASIK ectasia.”
www.intralase.com and www.gei.co.in
9. Advanced Medical Optics’s VISX STAR S4 IR Excimer Laser System with the WaveScan WaveFront System
This
system enables individualised LASIK treatment for each eye through
fourier-based wavefront technology called CustomVue. STAR S4 also has
iris registration, an automatic, non-contact method of aligning the
correct treatment to the corneal site. It also offers variable spot
scanning where beam sizes from 0.65mm to 6.5mm can be scanned over the
treatment area, preserving tissue and reducing treatment times. Its
ActiveTrak 3-D system tracks all intra-operative eye movements while
automatic centering finds and sets the treatment centre to the middle
of the eye’s pupil.
Working with this is the WaveScan WaveFront
System that makes a detailed wavefront map of the cornea. This map is
like a fingerprint of the eye, providing data on all individual
imperfections and curvatures of that particular cornea. This
information is relayed back to the STAR S4 that then customises LASIK
treatment for that cornea.
Both systems are in use at the Grewal
Eye Institute. “Custom laser vision correction results in significantly
improved visual results with better contrast sensitivity and reduced
glare at night,” says Dr Grewal.
“All this equipment serves to
differentiate us from other eyecare organisations,” he explains. “They
also give the surgeon greater confidence in operating and enhance the
visual results for the patient.”
www.amo-inc.com
10. Bristol Maid Hospital Metalcraft’s Resus:Station
As well as efficiency, safety is crucial to confidence in new machines and new methods of working.
That
was the thinking behind the design of a new emergency trolley currently
being trialled by a team in the UK. Once launched, the Resus:Station
crash trolley will ensure that heart attack emergencies in hospitals
are dealt with more efficiently and safely, says one of its designers,
Jonathan West, a senior research associate at the Helen Hamlyn Research
Centre (HHRC), London, UK.
The impetus for a better trolley
came through research from the country’s National Patient Safety
Agency, which found that poorly stocked crash trolleys led to error and
poorer outcomes for patients.
The brief was to design a trolley
which would facilitate resuscitation and restocking afterwards. “Crash
trolleys were put on wards in the 1940s before cardio pulmonary
resuscitation was defined in the 1960s,” explains West. “Products got
left behind in a system that is constantly being updated and one of
those was the resuscitation trolley. Staff were just left with a tool
chest on wheels.”
Researchers from the Helen Hamlyn worked with
staff from Imperial College and St Mary’s hospital to come up with
something that could cope with the demands of today’s resuscitation
process. The team involved industrial designers, clinicians, clinical
psychologists and patient safety academics.
Interviews and
workshops led to a prototype with all the equipment laid out openly for
ease of access. The design also allowed the trolley to be divided into
three sub-trolleys so parts of the team can work separately from one
another. It has a touch screen so one person can take a lead role in
coordinating and logging what the team is doing. Radio Frequency
Identification technology tracks all equipment on the trolley and
flashes if stock is not complete, when the item was removed and when
drugs have reached their expiry date.
A first prototype has
already been tested with great success in simulated cardiac arrest
scenarios. “With a conventional trolley it took eight separate searches
and 25 seconds to find a cannula whereas with our system, people found
it straight away,” says James Kinross, clinical research fellow at
Imperial College.
Similar testing at the Chelsea and Westminster
hospital gave a clearer idea of which features on the prototype needed
to be changed and a second prototype is now being developed with
manufacturer Bristol Maid Hospital Metalcraft.
After that the
team hope to see it marketed across the world. “We are hoping it is
going to shape high-tech solutions for emergency healthcare,” says
Kinross.
www.bristolmaid.com and www.hhrc.rca
11. Siemens Biograph Truepoint High Definition Positron Emission Tomography Computed Tomography scanner (HD PET-CT)
Adding
high definition to Siemens’ PET-CT systems is the latest innovation
from the company. This will improve the quality of molecular imaging
over and above what high resolution PET-CT scanners already offer.
The
technology is a step up on old scanners because it eliminates the
problem of image quality decreasing with increasing distance from the
centre of the scanner. The HD PET uses a proprietary reconstruction
technique to get around this. This allows a 2mm resolution (other
scanners only go to 4mm) so clinicians can see the tiniest of lesions
anywhere they appear on the scan.
“HD PET eliminates this effect
providing increased diagnostic confidence to more accurately resolve
peripheral lesions,” says Dr David Townsend, director of the molecular
imaging and translational research programme at Tennessee University
School of Medicine.
Contrast is better, too, with an
improvement in signal to noise that makes images sharper. This can help
doctors to work out which tissue is malignant and which is healthy.
Clinically
it is hoped the increased clarity will allow doctors to spot small
lesions more easily including those in the lymph nodes, abdomen, head,
neck and brain. This will help them to get earlier and more accurately
targeted treatments to patients so improving outcomes.
PET
scanning is becoming more popular as a means of measuring therapeutic
response to oncological treatments and HD PET can help make this
process even better, says Dr Joe Busch, a diagnostic oncological
radiologist for Diagnostic Radiology Consultants in Tennessee.
The
company has two Siemens Biograph High Resolution 16 PET-CT scanners.
Busch says the combined PET-CT scanner has made a significant
difference to both staff and patients’ experience in diagnostics and
therapeutic scanning.
“With a combined scanner the patient lays
down on the table, and in less than 20 minutes we have completed the
diagnostic CT and the PET scan. That saves them a lot of hassle as they
don’t have to go somewhere else to get the CT,” he says.
Clinical
benefits include the ability to spot reactivation of lymph nodes
following therapy. “With lymphoma tumours, most people just do CT scans
to follow the lymph nodes and see if they get smaller but if a lymph
node reactivates, we will see the activity on PET.”
And the
addition of PET means other cancers are also more likely to be picked
up when radiologists are looking at scans. For example, a colon tumour
was spotted in the abdomen of a lung cancer patient through PET.
In
the last year, the company has also used the scanners for checking up
on cancer patients who have undergone radiofrequency ablation. Usually
used for liver, lung and kidney cancer patients, the scanners can pick
up a failure in treatment or a recurrence of cancer in 90 days, says
Busch, so the tumour can be re-treated quickly. Previously a six month
or one year wait was the norm before the old scanning system was able
to pick up changes.
The company has 10 staff working across
four clinics and one 150-bed hospital. Patients are referred by doctors
for diagnostic or follow-up scans. With the two scanners, they carry
out 15 to 17 scans daily and can get results back to patients’
physicians very speedily using a combined Siemens Radiological
Information System and Picture Archiving and Communications System
(RIS-PACS).
Both technologies have meant faster turnaround time
for the patient and fewer staff overheads for the business. Three years
ago prior to purchase of the two scanners, they saw around two to four
patients a day; now 15 is the norm.
“It is difficult to have a
good cancer programme unless you have a PET-CT scanner,” says Busch.
“This stages the patient and then restages them after therapy. It can
actually measure the therapeutic response.”
www.siemens.co.uk
12. GE Healthcare Mobile Prodigy Dual-Energy X-ray Absorbtiometry (DEXA) scanner
Access
to bone density scans, even in rich, Western countries has always been
difficult. GE Healthcare has put its X-ray bone densitometer technology
into a van so that DEXA scanning can go to the patients instead of the
other way around.
DEXA scans calculate bone mass. In doing so,
they can pick up the bone thinning disease, osteoporosis and other
skeletal diseases and perform vertebral imaging.
As the
population lives longer, more and more women, as well as some men,
could develop osteoporosis. The National Osteoporosis Foundation says
it affects over half of all women aged over 50 in the US. In the UK,
the figures are much the same: one in two women and one in five men
over 50 will break a bone usually due to osteoporosis, says the
National Osteoporosis Society.
The Mobile Prodigy has the same
technology at the company’s Lunar Prodigy, but allows patients’
fracture risk to be measured without them having to drive somewhere for
diagnosis.
“Rather than the patient driving farther for bone
mineral density and body composition testing, we can bring it closer to
their homes,” says Laura Stoltenberg, general manager of GE
Healthcare’s Lunar business, “delivering the benefits to smaller, rural
hospitals and clinics that don’t have a dedicated system.”
Purchase
of such a van could be shared by hospitals and clinics in one region –
adding another valuable marketing tool to promote themselves to
domestic or overseas patients.
With obesity on the rise world wide, the GE Lunar Body Composition software allows measurements of fat distribution in adults.
This can help doctors to work with patients on weight reduction through exercise and diet.
The
software can also provide knowledge of patients’ relative amounts of
lean or fat tissues, where a condition or its treatment can affect
this. As well as obesity this might include anorexia nervosa, chronic
renal failure, AIDS and HIV and cystic fibrosis.
www.gehealthcare.com
