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INTRODUCTION TO OBJECTIVE

INTRODUCTION The objective of my project training was to study marketing and augmenting the sales of X-ray machines in Medford Medical Systems Pvt. Ltd. which I undertook successfully leading to the completion of project with grace. In the organization, Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions. These devices are usually designed with rigorous safety standards. There are several basic types:
1.

Diagnostic equipment includes medical imaging machines,

used to aid in diagnosis. Examples are ultrasound and MRI machines, PET and CT scanners, and x-ray machines.
2.

Therapeutic equipment includes infusion pumps, medical

lasers and LASIK surgical machines.


3.

Life support equipment is used maintain a patient's bodily

function. These include medical ventilators, heart-lung machines, ECMO, and dialysis machines.
4.

Medical monitors allow medical staff to measure a patient's

medical state. Monitors may measure patient vital signs and other parameters including ECG, EEG, blood pressure, and dissolved gases in the blood.

5.

Medical laboratory equipment automates or help analyze

blood, urine and genes. Diagnostic Medical Equipment may also be used in the home for certain purposes, e.g. for the control of diabetes mellitus A Biomedical equipment technician or BMET is a vital component of the healthcare delivery system. Employed primarily by hospitals, BMETs are the people responsible for maintaining a facility's medical equipment.

CORPORATE PROFILE

COMPANY PROFILE: ESTABLISHMENT: Medford Medical Systems Pvt. Ltd. was incorporated on 15th December 1994 under the Companies Act, 1956 with the Registrar of Companies as a Limited Company. MANAGEMENT: Company is being managed by a team of qualified and experienced professionals. Managing Director has got vast experience in X ray field with multi national companies and other leading manufacturers of X ray equipments. Our people are sincerely committed to customer service. We know that when all is said and done the service you received will have an impact on your future purchase decisions. We encourage our customers to visit us to see our operations as well as the product to enhance their faith. PROUCT RANGE: Presently the company is manufacturing and marketing

Diagnostic X ray machines ranging from 30 mA Real Portable/Mobile to 500 mA X-ray machines in various models and capacities, Dental X-ray machines and Dental Chairs / Dental Compressors.

GOVERNMENT APPROVALS/CERTIFICATIONS: Our X-ray products are having approval from Bureau of Indian Standards (BIS) for quality assurance and Atomic Energy Regulatory Board (AERB) Government of India for radiation safety. MEDFORD is also an ISO 9001: 2000 certified company. CORPORATE OFFICE: 301, Adarsh Plaza, Khasa Kothi Circle, Bani Park, Jaipur 302016 MANUFACUTURING UNIT: G1 50, RIICO Industrial Area, Road No. 2C, Bindayaka Jaipur -12 We are also registered as SSI unit with National Small Industries Corporation Limited, New Delhi. MARKETING ACTIVITIES: We have our Corporate Office at Jaipur and Branch Offices in various states and dealer network in other states. We have a team of qualified and experienced Engineers to look after sales and service of our X-ray equipments all over India. We have already simplified/installed more than 5000 X-ray machines of various capacities and models in Government Hospitals, Private Hospitals, Nursing Homes and Diagnostic Centres in the states of

Rajasthan, Gujarat, Madhya Pradesh, Delhi, Haryana, Mumbai, Uttar Pradesh, TamilNadu and other southern and eastern states. We have also been awarded with one prestigious order by Tamilnadu Medical Services Corporation Limited, Chennai for supply of 14 Nos. 100 mA X-ray machines to the various Taluka Headquarter Hospitals in the state of TamiNadu and the same has already been executed by us to the entire satisfaction of the corporation. We have also received order from Rajasthan Government for installation of 6 Nos. 300 mA and 18Nos. 100 mA machines in various Government District Hospitals / Community Health centres and Primary Health centres. We have also been awarded the rate contract from the State Government of Gujarat Central Medical Stores Organization, Gandhinagar for supply of 100 mA X-ray machines for the period of one year. We are already in correspondence with some foreign buyers also for export of our X-ray / Dental equipments and hope to get few more orders from abroad. AFTER SALES SERVIES FACILITIES: We have got a team of qualified and experienced Engineers to look after service and maintenance of our X-ray equipments based at Jaipur, Jodhpur and Kota. We have also facilitated services and maintenance of X-ray machines for companies like Wipro, GE, Escorts, Allenger etc.

MANUFACTURING SET UP: We have got our manufacturing unit in RIICO industrial Area, Road No. 2C, Bindayaka, Jaipur with more modern

manufacturing facilities built on an Industrial Plot measuring 2000 sq. metres. TESTING FACILITIES: We have got most modern testing laboratory fully equipped with indigenous and imported testing equipments for conducting quality assurance and radiation safety tests as per Bureau of Indian Standards and Atomic Energy Regulatory Board standards, WE are taking all necessary steps to ensure best quality built-in through a series of tests ranging from checking of incoming materials to packing. Starting with mechanical and stability tests for raw materials, tests for surface strength and smoothness and high voltage tests for insulating materials, online tests are carried out at every stage of production till the finished product. That is what gives Medford medical equipment its precision, quality and functional values. MANUFACTURING CAPACITY: With our existing infrastructure, we have got manufacturing capacity of around 50 X-ray equipments per month. We have got

sufficient stocks of electronic / electrical and mechanical raw material.

A FEW WORDS FOR HEALTHCARE

HEALTHCARE Healthcare has emerged as one of the largest service sectors in India. In 2004, the market size of the healthcare industry was Rs.910 billion which is expected to grow at a CAGR of 13% and reach Rs.1900 billion by 2010. In India, there are presently more than half a million doctors employed in 15,097 hospitals. Additionally there are 0.75 million nurses, who look after more than 870,161 hospital beds, 162 medical colleges, 143 pharmacy colleges and 350,000 chemists. In the last decade, the number of doctors has increased by 36.6 percent. An estimated 30 percent of medical practitioners hold specialist qualifications. Much of Indias healthcare expenditure comes from private patients, primarily the higher-income households. Tertiary-care treatment tends to be expensive. The top 33 percent income earners in India accounted for 75 percent of total private expenditure on healthcare in 2004. Rich households (the top 8 percent) paid US$ 578 per treatment and hospitalization in 2004, three times the overall average of US$ 191.

The proportion of households in the low-income group has declined significantly. Rising incomes are expanding the rich and middle-income groups, and they are expected to form 49 percent of the total households in financial year 2010, as compared to 33 percent in financial year 2004. Households that have higher education levels tend to spend more per illness than households with lower education levels. Rising literacy in India is improving health awareness, especially about lifestyle-related diseases - which tend to be more costly to treat than infections. While rising incomes and growing literacy are likely to drive higher per-capita expenditures on healthcare, the shift in disease profiles from infectious to lifestyle-related diseases are expected to raise expenditures per treatment. Lifestyle related diseases are typically more expensive to treat than infectious ones. In 2001, the average inpatient cost for lifestyle-related diseases (cardiac problems, digestive issues etc.) was US$ 658 compared to US$ 91 for infectious diseases. Indias disease profile is expected to follow the same pattern as in developed economies.

Based on demographic trends and disease profiles, lifestyle diseases - cardiovascular, asthma and cancer have become the most important segments, and inpatient spending is expected to represent nearly 50 percent of total healthcare expenditure. In the inpatient market, the share of infectious diseases is expected to decline from 19 percent in 2004 to 16 percent in 2008. The number of cardiac-disease-related treatments in India is expected to grow from 1.5 million to 1.9 million per year over 2004-08, which would constitute 5.1 percent of all treatments, The spend share of inpatient cardiac treatment is estimated to grow to 19 percent of the total in 2008 from 16 percent in 2004. This would drive a 13.4 percent CAGR in the inpatient cardiac care market from US$ 1.2 billion in 2004 to US$ 2.04 billion in 2008. The average realisation per inpatient for cardiac related treatment is much higher than for other disease segments. Increased life expectancy and an ageing population is expected to play a role as well. In the domestic market, health spending will be sustained by two demographic trends: increased life expectancy and an ageing population. Life expectancy, which averaged 63.3 years in 200004, is expected to increase to 65.1 years in 2005-09 and to 66 years in 2006-10.

The proportion of the population aged 65 years and over is also on the rise, and will increase from 4.7 percent in 2000 to 5.3 percent in 2005 and 5.8 percent in 2010. Although the rate of ageing in India is slower than the developed world, the large population makes any increase significant in terms of absolute numbers, and therefore also in terms of market potential. The majority of healthcare services in India are provided by the private sector. In 2002 fee-charging private companies accounted for around 82 percent of overall healthcare expenditure, with various levels of Government covering the remaining 18 percent. The contribution of the private healthcare sector is on the rise, with investments from the corporate sector steadily growing since the mid- 1990s. In the last few years, a number of new players have entered the healthcare delivery sector, and set up specialty and superspecialty centres. In the Government sector, the States provide the bulk of healthcare. Presently, the public spending is at a level of 1.3 percent of the GDP.

Public spending on healthcare will continue to rise, but the prospect of large and sustained increases is low. It is expected to increase to 3 percent over the next few years. Although Indias public spending is low, overall health spending has improved due to higher private spending. Studies by the Central Bureau of Health Intelligence has shown that a majority of Indians trust private healthcare despite the average cost being higher at US$ 4.3 than the US$ 2.7 it costs at Government-owned healthcare agencies. It has further been estimated that while 59 percent of healthcare expenditure comes from the self-paid category, less than 30 percent is contributed by the States. Significant investment opportunities for private sector Limited Government investment provides significant

opportunities for private healthcare service providers, as large investments are required to scale up the countrys healthcare infrastructure. By certain estimates, to reach even half of Chinas current beds per 1,000 population over the next 10 years, India would need an additional 920,000 beds entailing an investment of between US$ 32 billion and US$ 49.1 billion, assuming that 20 percent of those beds would be in the tertiary-care segment. The Government is likely to meet only 15-20 percent of investment in hospital beds, assuming it increases expenditures by

6-7 percent from the current base. Assuming 10-15 percent commitment from international donors, there would be a shortfall of 70 percent, which could be funded by private companies. Similarly, to match Chinas level of physician availability (1.1 per 1,000 population) over the next 10 years, it is estimated that an additional 818,000 physicians would be needed - which translates into a need for more medical schools. Investment is also needed in medical equipment and training facilities for professionals such as nurses and pharmacists. Indias unmet demand for healthcare facilities, rapidly changing demographics, increasing private spending on healthcare, and a readily available intellectual pool are fuelling the growth of the healthcare industry and making it highly attractive for international investors.

Key Opportunities Medical Tourism India is seeing a surge of patients from developed countries as well as from countries in Africa and South and West Asia. Medical tourism has gained momentum in India over the past few years, a trend underpinned by Indias low-cost advantage and the emergence of new high-quality healthcare service providers. In India, approximately 1,80,000 patients arrived in 2004 from across the globe for medical treatment. The medical tourism market in India is estimated at US$ 333 million in 2004. It is expected to become a US$ 2 billion-a-year business opportunity by 2012. The emergence of low-cost, high value specialist medical care territories in India has been noteworthy. For instance, New Delhi has emerged as a prime destination for cardiac care, as has Gujarat. Similarly, Chennai has established a niche for quality eye care, while Kerala and Karnataka have emerged as hubs for state-ofthe-art Ayurvedic healing. These medical hotspots are beginning to witness an influx of health tourists from nontraditional geographies. Among others, foreign health travellers to India comprise a large number of Non Resident Indians (NRIs).

Value proposition : Low cost, good quality and reduced waiting period. Foreign patients currently account for only 5% of the total foreign tourists. For most Corporates, foreign clients account for less than 7% of total clientele Clients are mainly from the Middle East and South East Asia Players gearing up Accreditation (such as JCI), tie-ups with hotels etc. Overburdened health infrastructure and high costs in the West is a key driver for looking at India. The healthcare systems in Europe and the United States are under severe pressure; particularly the National Health Service (NHS) in the UK, which has a long list of patients waiting for over a year for surgery. In the US, the healthcare crisis has a different dimension. Around 50 million citizens are uninsured, with even the insured having to pay dearly for treatment. Further, the shortage of paramedical professionals such as nurses has aggravated the situation. Patients from the US are now regularly beating a path to India, as many of their insurance companies have entered into tieups with private Indian hospital chains.

X-RAY & SURGICAL INSTRUMENTS

X-RAY MACHINE An X-ray machine utilizes electromagnetic radiation to produce an image of an object, usually with the purpose of visualizing something located below the object's surface. The machine is made up of an X-ray source or X-ray tube, an X-ray detection system, and positioning hardware to align these two components with the object to be imaged. History Shay M. Anderson and Ryan W. Preuninger formulated mathematical equations for X-rays. Physicist Johann Hittorf observed tubes with energy rays extending from a negative electrode. William Crookes investigated the effects of energy discharges on rare gases. Heinrich Hertz began experimenting and demonstrated that cathode rays could penetrate very thin metal foil (such as aluminium). In 1887, Nikola Tesla began to investigate X-rays and produced the bremsstrahlung process. In 1895, Wilhelm Rntgen began observing and further

documenting X-rays while experimenting with vacuum tubes. X-rays are produced by bombarding a surface with high speed electrons (in a vacuum). One of the first X-ray photographs was made of the hand of Rntgen's wife. The image displayed both her wedding ring and bones.

On January 18, 1896 an X-ray machine was formally displayed by H.L. Smith. Upon discovery in 1895, X-Rays were advertised as the new scientific wonder and seized upon by entertainers. Circus patrons viewed their own skeletons and were given pictures of their own bony hands wearing silhouetted jewelry. While many people were fascinated by this discovery, others feared that it would allow strangers to look through walls, doors, and invade people's privacy. In the 1940s and 50s, (real time) X-ray machines were used in stores to help sell footwear. These were known as fluoroscopes. However, as the harmful effects of X-ray radiation were properly considered, they finally fell out of use. These devices probably caused many untold radiation injuries and infertilities.[citation needed] Shoe-fitting use of the device was first banned by the state of Pennsylvania in 1957. (They were more a clever marketing tool to attract customers, rather than a fitting aid. There was an obvious novelty attraction to children. How They Work An X-ray imaging system consists of a X-ray source or generator, and an image detection system which can either be comprised of film (analog technology) or a digital capture system (such as a Picture archiving and communication system).

X-ray Sources

In the typical X-ray source of less than 450 kV, X-ray photons are produced by an electron beam striking a target. The electrons that make up the beam are emitted from a heated cathode filament. The electrons are then focused and accelerated towards an angled anode target. The point where the electron beam strikes the target is called the focal spot. Most of the kinetic energy contained in the electron beam is converted to heat, but around 10% of the energy is converted into X-ray photons, the excess heat is dissipated via a heat sink. At the focal spot, X-ray photons are emitted at 180deg from the target surface,the highest intensity being around 60deg to 90deg there is a small round window in the X-ray tube directly above the angled target. This window allows the X-ray to exit the tube with little attenuation while maintaining a vacuum seal required for the Xray tube operation. X-ray machines work by applying controlled voltage, current, and time to the X-ray tube, which results in a beam of X-rays. The beam is projected on matter. Some of the Xray beam will pass through the object, while some are reflected. The resulting pattern of the radiation is then ultimately detected by a detection medium including rare earth screens (which surround photographic film), semiconductor detectors, or X-ray image intensifiers. X-Ray Detection

In healthcare applications in particular, the x-ray detection system rarely consists of the detection medium. For example, a typical stationary radiographic x-ray machine also includes an ion chamber and grid. The ion chamber is basically a hollow plate located between the detection medium and the object being imaged. It determines the level of exposure by measuring the amount of x-rays that have passed through the electrically charged, gas-filled gap inside the plate. This allows for minimization of patient radiation exposure by both ensuring that an image is not underdeveloped to the point the exam needs to be repeated and ensuring that more radiation than needed is not applied. The grid is usually located between the ion chamber and object and consists of several lead slats stacked next to each other (resembling open window blinds). In this manner, the grid allows straight x-rays to pass through to the detection medium but absorbs reflected x-rays. This improves image quality by preventing reflected (nondiagnostic) x-rays from reaching the detection medium allowing for lower exam doses overall. Images taken with such devices are known as X-ray photographs or radiographs. The older term Rentgenogram continues to be used by radiologists. Uses X-ray technology is used in health care for bones, security and material analysis.

Health care There are two basic areas in which Health Care uses X-radiation; Radiography, and Dental Hygiene. Radiography is used for fast, highly penetrating images. Usually it's used on areas with a high bone content. Some forms of radiography uses are Panoramic X-rays, Radiography, Mammography, Tomography, and Radiotherapy. Fluoroscopy is used in cases where real-time visualization is necessary. You may have seen a type of fluorography at the airport. Some of the uses of Fluorography are Angiography, barium enemas, barium swallows, biopsies, and hip replacement. X-rays are highly penetrating, ionizing radiation, and X-ray machines are used in radiology to take pictures of bones and teeth. This is because bones absorb the radiation more than the less-dense soft tissue. X-rays from a source pass through the body and onto a photographic cassette. Areas where radiation is absorbed show up as lighter shades of gray (closer to white). This can be used to diagnose broken or fractured bones. Imaging of the digestive tract is done with the help of a radiocontrast agent such as barium sulfate, which is opaque to X-rays. Security

X-ray machine at an airport X-ray machines are used to screen objects non-invasively. Luggage at airports is examined for possible bombs and weapons. These machines are very low dose and safe to be around. The largest manufacturer of X-Ray inspection systems is Smiths Heimann GmbH located in Wiesbaden, Germany. X-ray image of a backpack: Advances in X-ray technology A film of carbon nanotubes (as a cathode) that emits electrons at room temperature when exposed to an electrical field has been fashioned into an X-ray device. An array of these emitters can be placed around a target item to be scanned and the images from each emitter can be assembled by computer software to provide a 3-dimensional image of the target in a fraction of the time it takes using a conventional X-ray device.The carbon nanotube emitters also use less energy than conventional X-ray tubes leading to lower operational costs.

SURGICAL INSTRUMENT: A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access or viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps), or a compound scientific name related to the kind of surgery (for example, a tracheotome is a tool used to perform a tracheotomy). The expression surgical instrumentation is somewhat

interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a nurse.

Classification 1. There are several classes of surgical instruments: 2. Graspers, especially tweezers and forceps 3. Clamps and occluders for blood vessels and other organs 4. Retractors, used to spread open skin, ribs and other tissue 5. Distractors, positioners and stereotactic devices 6. Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, etc.) 7. Dilators and specula, for access to narrow passages or incisions 8. Suction tips and tubes, for removal of bodily fluids
9. Irrigation and injection needles, tips and tubes, for introducing

fluid Tyndallers, to help "wedge" open damaged tissues in the brain. 10.Powered devices, such as drills, dermatomes 11.Scopes and probes, including fiber optic endoscopes and tactile probes 12.Carriers and appliers for optical, electronic and mechanical devices 13.Ultrasound tissue disruptors, cryotomes and cutting laser guides 14.Measurement devices, such as rulers and calipers

An important relative distinction, regarding surgical instruments, is the amount of bodily disruption or tissue trauma that their use might cause the patient. Terms relating to this issue are 'atraumatic' and minimally invasive. Minimally invasive systems are an important recent development in surgery. In the future, these devices will include many microscopic autonomous and directed devices.

CT SCANNING Computed tomography (CT), was originally known as "EMI scan" as it was developed at a research branch of EMI, a company best known today for its music and recording business. It was later known as computed axial tomography (CAT or CT scan) and body section roentgenography. Computed tomography is a medical imaging method employing tomography where digital geometry processing is used to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. The word "tomography" is derived from the Greek tomos (slice) and graphein (to write).

CT produces a volume of data which can be manipulated, through a process known as windowing, in order to demonstrate various structures based on their ability to block the X-ray beam. Although historically the images generated were in the axial or transverse plane (orthogonal to the long axis of the body), modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. Although most common in healthcare, CT is also used in other fields, for example nondestructive materials testing. Another example is the DigiMorph project at the University of Texas at Austin which uses a CT scanner to study biological and paleontological specimens.

Advantages and hazards Advantages over projection radiography


1.

First, CT completely eliminates the superimposition of

images of structures outside the area of interest.


2.

Second, because of the inherent high-contrast resolution of

CT, differences between tissues that differ in physical density by less than 1% can be distinguished.
3.

Third, data from a single CT imaging procedure consisting

of either multiple contiguous or one helical scan can be viewed as

images in the axial, coronal, or sagittal planes, depending on the diagnostic task. This is referred to as multiplanar reformatted imaging.

Radiation exposure CT is regarded as a moderate to high radiation diagnostic technique. While technical advances have improved radiation efficiency, there has been simultaneous pressure to obtain higherresolution imaging and use more complex scan techniques, both of which require higher doses of radiation. The improved resolution of CT has permitted the development of new investigations, which may have advantages; e.g. Compared to conventional angiography, CT angiography avoids the invasive insertion of an arterial catheter and guidewire; CT colonography may be as useful as a barium enema for detection of tumors, but may use a lower radiation dose. The greatly increased availability of CT, together with its value for an increasing number of conditions, has been responsible for a large rise in popularity.

So large has been this rise that, in the most recent comprehensive survey in the UK, CT scans constituted 7% of all radiologic examinations, but contributed 47% of the total collective dose from medical X-ray examinations in 2000/2001. Increased CT usage has led to an overall rise in the total amount of medical radiation used, despite reductions in other areas. The radiation dose for a particular study depends on multiple factors: volume scanned, patient build, number and type of scan sequences, and desired resolution and image quality.

Additionally, two helical CT scanning parameters that can be adjusted easily and that have a profound effect on radiation dose are tube current and pitch. CT scans of children have been estimated to produce non-negligible increases in the probability of lifetime cancer mortality leading to calls for the use of reduced current settings for CT scans of children. A 2007 report in the New England Journal of Medicine suggested that the radiation from current CT-scan use may cause as many as 1 in 50 future cases of cancer. According to the USAToday, and members of the American Heart Association, an average CT scan can expose a patient to between 1,000 to 10,000 millirems of radiation, depending on the exact machine and the examination being performed.

However, Japanese people who were 1 mile from ground zero received only 3,ooo millirems of radiation, on average. Typical scan doses 1. 2. 3. 4. 5. 6. 7. 8. Examination Typical effective dose (mSv) (milli rem) Chest X-ray 0.1 10 Head CT 1.5[13] 150 Abdomen CT 5.3[13] 530 Chest CT 5.8[13] 580 Chest, Abdomen and Pelvis CT 9.9[13] 990 Cardiac CT angiogram 6.7-13[14] 670 - 1300 CT colonography (virtual colonoscopy) 3.6 - 8.8 360 - 880

Adverse reactions to contrast agents Because CT scans rely on intravenously administered contrast agents in order to provide superior image quality, there is a low but non-negligible level of risk associated with the contrast agents themselves. Certain patients may experience severe and potentially life-threatening allergic reactions to the contrast dye.

The contrast agent may also induce kidney damage. The risk of this is increased with patients who have preexisting renal insufficiency, preexisting diabetes, or reduced intravascular volume. In general, if a patient has normal kidney function, then the risks of contrast nephropathy are negligible. Patients with mild kidney impairment are usually advised to ensure full hydration for several hours before and after the injection. For moderate kidney failure, the use of iodinated contrast should be avoided; this may mean using an alternative technique instead of CT e.g. MRI. Perhaps paradoxically, patients with severe renal failure requiring dialysis do not require special precautions, as their kidneys have so little function remaining that any further damage would not be noticeable and the dialysis will remove the contrast agent.

Process CT scan illustrationX-ray slice data is generated using an X-ray source that rotates around the object; X-ray sensors are positioned on the opposite side of the circle from the X-ray source. The earliest sensors were scintillation detectors, with photomultiplier tubes excited by (typically) sodium iodide crystals.

Modern detectors use the ionization principle and are filled with low-pressure Xenon gas. Many data scans are progressively taken as the object is gradually passed through the gantry. They are combined together by the mathematical procedures known as tomographic reconstruction. The data are arranged in a matrix in memory, and each data point is convolved with its neighbours according with a seed algorithm using Fast Fourier Transform techniques. This dramatically increases the resolution of each Voxel (volume element). Then a process known as Back Projection essentially reverses the acquisition geometry and stores the result in another memory array. This data can then be displayed, photographed, or used as input for further processing, such as multi-planar reconstruction. Newer machines with faster computer systems and newer software strategies can process not only individual cross sections but continuously changing cross sections as the gantry, with the object to be imaged, is slowly and smoothly slid through the Xray circle. These are called helical or spiral CT machines. Their computer systems integrate the data of the moving individual slices to generate three dimensional volumetric information (3DCT scan), in turn viewable from multiple different perspectives on attached CT workstation monitors.

This type of data acquisition requires enormous processing power, as the data are arriving in a continuous stream and must be processed in real-time. In conventional CT machines, an X-ray tube and detector are physically rotated behind a circular shroud (see the image above right); in the electron beam tomography (EBT) the tube is far larger and higher power to support the high temporal resolution. The electron beam is deflected in a hollow funnel shaped vacuum chamber. X-rays are generated when the beam hits the stationary target. The detector is also stationary. This arrangement can result in very fast scans, but is extremely expensive. The data stream representing the varying radiographic intensity sensed at the detectors on the opposite side of the circle during each sweep is then computer processed to calculate crosssectional estimations of the radiographic density, expressed in Hounsfield units. Sweeps cover 360 or just over 180 degrees in conventional machines, 220 degrees in EBT. CT scanner with cover removed to show the principle of operationCT is used in medicine as a diagnostic tool and as a guide for interventional procedures. Sometimes contrast materials such as intravenous iodinated contrast are used.

This is useful to highlight structures such as blood vessels that otherwise would be difficult to delineate from their surroundings. Using contrast material can also help to obtain functional information about tissues. Pixels in an image obtained by CT scanning are displayed in terms of relative radiodensity. The pixel itself is displayed according to the mean attenuation of the tissue(s) that it corresponds to on a scale from -1024 to +3071 on the Hounsfield scale. Pixel is a two dimensional unit based on the matrix size and the field of view. When the CT slice thickness is also factored in, the unit is known as a Voxel, which is a three dimensional unit. The phenomenon that one part of the detector cannot differ between different tissues is called the "Partial Volume Effect". That means that a big amount of cartilage and a thin layer of compact bone can cause the same attenuation in a voxel as hyperdense cartilage alone. Water has an attenuation of 0 Hounsfield units (HU) while air is -1000 HU, cancellous bone is typically +400 HU, cranial bone can reach 2000 HU or more (os temporale) and can cause artifacts. The attenuation of metallic implants depends on atomic number of the element used: Titanium usually has an amount of +1000 HU, iron steel can completely extinguish the X-ray and is therefore responsible for well-known line-artifacts in computed tomograms. Artifacts are

caused by abrupt transitions between low- and high-density materials, which results in data values that exceed the dynamic range of the processing electronics. Windowing Windowing is the process of using the calculated Hounsfield units to make an image. The display device, as well as the human eye, can only resolve 256 shades of gray. These shades of gray can be distributed over a wide range of HU values to get an overview of structures that attenuate the beam to widely varying degrees. Alternatively, these shades of gray can be distributed over a narrow range of HU values (called a "narrow window") centered over the average HU value of a particular structure to be evaluated. In this way, subtle variations in the internal makeup of the structure can be discerned. This is a commonly used image processing technique known as contrast compression. For example, to evaluate the abdomen in order to find subtle masses in the liver, one might use liver windows. Choosing 70 HU as an average HU value for liver, the shades of gray can be distributed over a narrow window or range. One could use 170 HU as the narrow window, with 85 HU above the 70 HU average value; 85 HU below it. Therefore the liver window would extend from -15 HU to +155 HU. All the shades of gray for the image would be distributed in this range of Hounsfield values.

Any HU value below -15 would be pure black, and any HU value above 155 HU would be pure white in this example. Using this same logic, bone windows would use a "wide window" (to evaluate everything from fat-containing medullary bone that contains the marrow, to the dense cortical bone), and the center or level would be a value in the hundreds of Hounsfield units. To an untrained person, these window controls would correspond to the more familiar "Brightness" (Window Level) and "Contrast" (Window Width). Artifacts Although CT is a relatively accurate test, it is liable to produce artifacts, such as the following. Example of Beam Hardening Aliasing Artifact or Streaks These appear as dark lines which radiate away from sharp corners. It occurs because it is impossible for the scanner to 'sample' or take enough projections of the object, which is usually metallic. It can also occur when an insufficient X-ray tube current is selected, and insufficient penetration of the x-ray occurs. These artifacts are also closely tied to motion during a scan. This type of artifact commonly occurs in head images around the pituitary fossa area.

Partial Volume Effect This appears as 'blurring' over sharp edges. It is due to the scanner being unable to differentiate between a small amount of high-

density material (e.g. bone) and a larger amount of lower density (e.g. cartilage). The processor tries to average out the two densities or structures, and information is lost. This can be partially overcome by scanning using thinner slices. Ring Artifact: Probably the most common mechanical artifact, the image of one or many 'rings' appears within an image. This is usually due to a detector fault. Noise Artifact: This appears as graining on the image and is caused by a low signal to noise ratio. This occurs more commonly when a thin slice thickness is used. It can also occur when the kV or mA of the X-ray tube is insufficient to penetrate the anatomy. Motion Artifact: This is seen as blurring and/or streaking which is caused by movement of the object being imaged. Windmill: Streaking appearances can occur when the detectors intersect the reconstruction plane. This can be reduced with filters or a reduction in pitch. Beam Hardening: This can give a 'cupped appearance'. It occurs when there is more attenuation in the center of the object than around the edge. This is easily corrected by filtration and software.

RESEARCH METHODOLOGY

RESEARCH METHODOLOGY A research methodology defines what the activity of research is, how to proceed, how to measure progress, and what constitutes success. AI methodology is a jumbled mess. THE RESEARCH Research has to be undertaken in a systematic manner, to ensure that problems are dealt with properly and that nothing overlooked. The systematic way in which research was undertaken and referred to as the research process to which there are a number of stages. Each stage is explained in brief in context with the project undertaken as written as under: NATURE OF MARKET RESEARCH: Information plays an important role in helping firm to make decisions. A firm undertakes marketing research to uncover facts about both buyer and non-buyer of its products. This involves ascertaining the nature of wants and assessing the current and potential demand for products and services. Information can help to reduce the element of uncertainty and guess work in making marketing decision.

Main divisions of marketing research are: 1.

Customer Research: Covering such matters as buyer behavior

in relationship to social, economic and cultural factors.


2.

Product Research: Concerned with the design, development

and testing of new products, the improvement of existing products and prediction if trends in consumer preferences related to styling product performance and quality of materials.
3.

Sales Research: Examining the selling activities of a company,

usually by sales outlets, territories, agencies and so on.


4.

Promotion Research: Concerned with testing and evaluation of

the effectiveness of the various methods used in promoting companys product or services. This include things such as exhibition public relation campaigns, merchandising, consumer and trade advertising etc. Research Design: - The Research was Descriptive in nature as is dealt with describing the market and the buying behavior of consumers. The research was designed for marketing and augmentation of the sales of X-Ray machines and is related surgical instruments.

The survey of the customers to know about their perception, the psychological factors associated with the product, the benefits they are looking forth from the product and how do they rank the company in the competition of the its rivals. Sample Design: - The first step in order to accomplish the task was to draw a sample. To serve this purpose, the sample technique adapted was Random Sampling. Also by adopting this procedure it was ensured that the sample drawn would have the same composition and characteristics of the population. Types of universe: - The respondents were basically the hospitals including private as well as public, medical dispensaries and local clinics for the purpose of the survey carried out in order generate interpretations and formation of analysis. Size of the sample: - Since the population was homogeneous in nature to large extent, hence a sample size of 60 respondents was taken into account to achieve the objective of the study. Other prominent factors, kept in view while determining the size of the sample were size of the population, the number of questions in the schedule, the sampling procedure adopted and the time constraint.

Thus a sample consisting of 60 respondents were chosen which fulfilled the requirements of efficiency, reliability and flexibility. Method of data collection: - A questionnaire was designed containing a Performa of set of questions was developed to conduct the survey. The researcher put the respondents the questions from the performer and recorded the replies. The schedule was available alternatives for data collection. The other option was that of interview and questions. The schedule has many features which added value to its use as a tool for accumulation of the required information. Interview as a tool is quite economical but it is difficult to record and retain the information and especially if the queries include open ended question. Moreover, schedule surveys the purpose of a structure form the interview. Though schedule has limitations like error on behalf of researchers while recording the response or putting the query. It solved the purpose of data collection for the project.

Contents of the schedule: - The schedule mainly comprised closed end questions. A structure schedule was preferred for the study. Also the language was kept as simple as possible and the questions were made an unambiguous as possible. The questions have been arranged in a form to provide all the needed information in maximum possible standardized form. The schedule consisted of questions which probed for the preference and the reasons for certain buying pattern of the respondents. In order to evaluate the efficiency of the schedule, a pilot survey was carried out. On the basis of the finding of the pilot survey, necessary alternations were made in he schedule to make it more effective.

INTERPRETATIONS & ANALYSIS

INTERPRETATIONS & ANALYSIS Q.1 Is your Hospital/ Dispensary Clinic is in expansion mode?

45 40 35 30 25 20 15 10 5 0 i) Yes ii) No 18 42

Interpretation: - From the survey of 60 hospitals 42 Hospitals said No for the expansion mode where as 18 Hospitals confirmed Yes. Q.2 Are you equipped with any of the following: 18% 32%

i) X Ray machine ii) CT Scan Machine iii) Surgical Instruments iv) Dental accessories or equipments

27%

23%

Interpretation: - The hospitals are equipped with the instruments as follows:- i) X Ray machine 19, ii) CT Scan Machine 14, iii) Surgical Instruments 16 iv) Dental accessories or equipments 11 Q.3 Are you planning to buy any of the instruments:

40 35 30 25 20 15 10 5 0 i) Yes ii) No 36 24

Interpretation: - i) 24 Hospital respondents said Yes whereas 36 said No for instruments they are planning to buy. Q.4 Have you been heard the name of MEDFORD MEDICAL SYSTEM PVT. LTD.?

40 35 30 25 20 15 10 5 0 i) Yes ii) No 22 38

Interpretation: - 38 of the total respondents replied positively about heard the name of Medford Medical System Pvt. Ltd.. Rest 22 said No as they were not aware with the name of the company. Q.5 If No, would you to know comprehensively about the company and its products information?

10 9 8 7 6 5 4 3 2 1 0 i) Now ii) Later iii) Not Interested 5 10 7

Interpretation: - The responses to know comprehensively about the company and its products information were received as follows: i) Now 5, ii) Later 10, iii) Not Interested 7 Q.6 If yes, would you like us to serve you for your requirements of X-Ray machines/CTscans machines or other surgical instruments?
25 20 15 10 5 0 6 i) Yes ii) No iii) Later 23 9

Interpretation: - The responses to serve you for your requirements of X-Ray machines/CTscans machines or other surgical instruments were received as follows: - i) Yes: 6, ii) No: 23, iii) Later: 9

Q.7 What are your expectations from the company in respect of product or quality improvement?

17% 28%

23% 32%

i) Durability ii) Latest technology equipped iii) Reasonable Price quotation iv) Applications should be easy and accurate results are desired

Interpretation: - It is been depicted that expectations from respondents with companys products were as follows: - Durability: 14, Latest technology equipped: 19, Reasonable Price quotation: 17, and Applications should be easy and accurate results are desired: 10 Q.8 Do you agree that X-ray, CT Scan machines have become a prerequisite for any Hospital/dispensary/clinic to deal with patient?
60 40 20 0 51 9

i) Yes

ii) No

Interpretation: - i) Yes by 51, ii) No by 9

Q.9 Would you like to opt and consider us for your future need and services?
25 20 15 10 5 0 13 24 23

i) Yes

ii) No

iii) Depends on circumstances

Interpretation: - For your future need and services, the respondents confirmed Yes by 13, No by 24 and Depends on circumstances by 29 Q.10. Do you think our organization is worth safe for recommendation since we handle proper quality, team and successful years of performance?

45 40 35 30 25 20 15 10 5 0

44

16 i) Yes ii) No

Interpretation: - i) Yes by 44 and ii) No by 16 respondents.

SWOT ANALYSIS

SWOT ANALYSIS STRENGTHS 1. Company is being managed by a team of qualified and

experienced professionals. 2. Our X-ray products are having approval from Bureau of Indian

Standards (BIS) for quality assurance and Atomic Energy Regulatory Board (AERB) Government of India for radiation safety. 3. We have got most modern testing laboratory fully equipped

with indigenous and imported testing equipments for conducting quality assurance and radiation safety tests WEAKNESSES 1. 2. Limited Publicity and channels of distribution. Lack of marketing professionals OPPORTUNITIES 1. A wide open market and growing development of medicines and medical appliances in Jaipur, Rajasthan. THREATS 1. Since the setup cost of X-ray machines, CT Scan is considerably dear, it is indeed a major issue to implement such medical appliance.

SUGGESTIONS

SUGGESTIONS

CONCLUSION

CONCLUSION At the end of the conclusion I would end up with these words that the training was a fruitful experience for me in undergoing the study of corporate atmosphere and understanding of working which I undertook in Medford Medical systems Pvt. Ltd. which a part of my curriculum of BBA programme and is essential for getting corporate exposure and experience which is vital for every fresher management graduate like me. My task and objective was marketing and augmenting the sales of X-ray machines and related surgical instruments which according to my best efforts I fulfilled diligently while being implemented in dispensaries, hospitals private or public or in medical clinics through a patterned of survey and asked questions pertaining to the title of my training which was a beneficial source in forming the relevant conclusion for my project report. The data collected by me through the visit of such medical institutions led me to interpret efficiently the information which was a base for fulfillment of my project motive. Therefore at the conclusion, I would finally declare my views that Medford Medical systems Pvt. Ltd. is a leading organization in manufacturing of X-rays, CT scans, Dental chairs equipments and which has a base in Jaipur.

QUESTIONNAIRE

QUESTIONNAIRE Name of Hospital/Dispensary: Location: Contact No.:-

Q.1 Is your Hospital/ Dispensary Clinic is in expansion mode? i) Yes ii) No Q.2 Are you equipped with any of the following: i) X Ray machine ii) CT Scan Machine iii) Surgical Instruments iv) Dental accessories or equipments Q.3 Are you planning to buy any of the aforesaid mentioned instruments: i) Yes ii) No Q.4 Have you been heard the name of MEDFORD MEDICAL SYSTEM PVT. LTD.? i) Yes

ii) No Q.5 If No, would you to know comprehensively about the company and its products information? i) Now ii) Later iii) Not Interested Q.6 If yes, would you like us to serve you for your requirements of X-Ray machines/ CTscans machines or other surgical instruments? i) Yes ii) No iii) Later Q.7 What are your expectations from the company in respect of product or quality improvement? i) Durability ii) Latest technology equipped iii) Reasonable Price quotation iv) Applications should be easy and accurate results are desired Q.8 Do you agree that X-ray, CT Scan machines have become a prerequisite for any Hospital/dispensary/clinic to deal with patient? i) Yes

ii) No Q.9 Would you like to opt and consider us for your future need and services? i) Yes ii) No iii) Depends on circumstances Q.10. Do you think our organization is worth safe for recommendation since we handle proper quality, team and successful years of performance? i) Yes ii) No Suggestions: i. .. ii. .. iii. .. iv. ..

BIBLIOGRAPHY

BIBLIOGRAPHY BOOKS: Kothari C.R., Research Methodology, New Age International Private Ltd. Second Edition.

NEWSPAPER: The Financial express The Hindu The Times of India

MAGAZINES: India Today Business World Health

WEBSITES: www.who.com www.companyinformation.com