Maintaining an operating microscope

o Principles of operation
 function
 use
 scientific
principles
o construction
o preventive maintenance
 components
 replacing
 system diagram
 inputs/outputs components
 calibrating
o troubleshooting
o safety considerations
 identifying
 user and patient
common faults
 replacing safety
 electrical safety 13.6.5 Maintaining an operating microscope
components
o performance monitoring Unit B 13.6 Maintaining theatre and surgery equipment
 rectifying faults
 calibration
Module 279 18 B Medical Instrumentation I
 quality assurance and
control
dr. Chris R. Mol, BME, NORTEC, 2015
Scientific Principles: Lenses and Magnification
Optical magnification is the process to enlarge something in appearance. The
degree of magnification is given by the magnification factor.
Optical magnification is the ratio between the apparent size of an object (or
its size in an image) and its true size, and thus it is a dimensionless number.

The magnification M of a (thin) lens: M = f / (f – d 0)

where f = the focal distance of the lens
d 0 = the distance of the object in front of the lens

That is:
the magnification is dependent on the ‘strength’ of the lens (focal distance) and on the distance of the object to the lens.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

 Scientific Principles: Image Formation
The optical microscope magnifies an object in two
steps. In both steps converging lenses are used.
1. The objective lens (in reality an optical system
consisting of several lenses) produces a magnified,
real image of the object.
2. The eye piece is positioned so that this image is in
its focal point. As a result we generate a beam of
parallel rays, but not a real image.
The human eye is able to handle this parallel beam
and generates an image onto its retina.
In a microscope, all distances between object, lenses
and eye are fixed. Therefore the magnification is
determined by the strength of eye piece and objective An eye-piece lens often has magnification X10.
lens, usually written on it. Objective lenses are usually: X4 (low power), X10 (medium
For a microscope, M is calculated as power) and X40 (high power).
If you have a X10 eye-piece and you are using a X4 objective
lens (low power) the total magnification will be: 10x4 = X40
M microscope = M objective x M eyepiece
dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope
Construction
The optical components of a basic stereo microscope consist of:
• the binocular head
• a magnification changer
• the objective lens
• an illuminator which beams light through the objective lens and
onto the operating field
The binocular head consists of two telescopes with adjustable eyepieces for
users with refractive error (glasses!). The magnification can be changed by
turning a knob (which selects different magnification lenses) or by using a
motorised zoom controlled by a foot pedal.

The working distance is the distance from the microscope objective lens to the
point of focus of the optical system. This value is fixed and is dependent on the
chosen focal length of the objective lens. The choice of working distance depends
on the type of surgery. For modern ophthalmic surgery objective focal lengths of
150 mm, 175 mm and 200 mm are commonly used.
ophthalmologic surgery

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

 Operating microscope: Construction
Operating microscopes are similar in design to standard laboratory
optical binocular microscopes but are equipped with features that
enable use in the surgical environment
• special illumination,
• relatively large field sizes,
• long working distances
The microscope body is typically held by an adjustable arm
attached to a mobile floor stand or wall/ceiling mount.
Enclosed in the body tube of the microscope is a magnification
changer—a drum with pairs of lenses arranged so that rotating the
drum provides different magnifications without altering the focus or
the working distance.

The lens system consists of magnification drum lenses, eyepiece

lenses, and objective lenses.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

Operating microscope: Construction

most knobs are to

select and to
change distances
between various
lenses in order to
focus the image on
the object under
investigation.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

Operating microscope: Selection of lenses
Eye Pieces Objective lenses
When a procedure requires a different range of Objective lenses are classified by working distance, which
magnifications, the operator replaces the objective is determined by the focal length (the distance from the
and/or eyepiece lenses with lenses of greater or focused objective lens to the object being viewed).
lesser power.
The typical focal length of objective lenses used with a
The magnification, or power, of operating microscope 12.5× eyepiece is
eyepieces is typically 8× to 20×. • 175 to 200 mm for ophthalmology;
• 200 to 250 mm for plastic surgery and oral surgery,
There are two types of eyepiece tubes: straight and
• 250 to 375 mm for ear, nose, and throat (ENT) or
inclined. Straight tubes are coaxial to the body tube
gynecologic, neurologic, and vascular surgeries.
and the axis of observation, while inclined tubes are
attached at an angle. In some models, this angle can
be adjusted.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

Operating microscope: Operation
To focus the microscope, the surgeon
• engages the appropriate optical filters
• switches on the illumination
• sets the magnification changer to the
lowest magnification
• adjusts the distance between the
binocular eyepieces to get a clear
three-dimensional view
• adjusts the eyepieces to compensate
for personal eyesight limitations
• moves the microscope arm until the
field of illumination coincides with the
operating field and the view is clearly
focused.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

Preventive maintenance
Weekly maintenance
• Keep the microscope in a dry, cool and well-ventilated place to prevent fungus growth on the lenses.
• Clean the optics according to the optical cleaning instructions
• To protect it from dust when not in use, drape a cover over the microscope.
• Wipe down the external surfaces with a damp cloth soaked in hot, soapy water.
• Cover the foot pedal with a clear plastic bag to prevent fluids from entering and damaging the electronics.
• Lift the foot pedal off the floor when washing the floor.
• Use a voltage stabiliser with the microscope. This will prevent sudden increases in voltage from destroying
the bulbs and will ensure that the illumination provided remains constant.
• Before using, test the controls of the foot pedal (the x,y movement, zoom, focus, light on and off).
• Before using, check that the suspension arm can be fixed into position to ensure that it does not fall on the
patient.
• Avoid kinking or bending the fibre optic cables.
• When replacing the bulbs, avoid touching them with your fingers. The oil left as fingerprints on the bulb can
shorten its life.
• Do not move the microscope while the bulb is still hot because strong vibrations may damage the filament.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

Preventive maintenance
The entire microscope should be checked by a biomedical equipment technician at least once every six
months.
• Clean and oil the wheels and the brakes. Remove any surplus oil when done.
• Check that:
• All mechanical connections which are relevant to safety are properly connected and screw
connections tightened.
• All cables and plugs are in good working condition.
• The voltage setting on the instrument conforms to the rated voltage of the line supply on site.
• The instrument is plugged into a power outlet which has a properly connected protective earth
contact.
• The power cord being used is the one designed for use with this instrument.

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

Safety considerations

• Stability of stand must be ensured

• The system must be connected to a special emergency
backup line supply (in case of power failure)

When used in ophthalmology:

• Avoid looking directly into the light source, e.g. into the microscope objective lens or a light guide. Any
kind of radiation has a detrimental effect on biological tissue. This also applies to the light illuminating the
surgical field.
• Reduce the brightness and duration of illumination on the surgical field to the absolute minimum required.
• When operating on the eye, always use a protection filter to ensure that the patient's retina is not exposed
to unnecessary (blue) radiation (retinal injury).

dr. Chris R. Mol, BME, NORTEC, 2015 Operating microscope

 END
The creation of this presentation was supported by a grant from THET:
see [Link]