Life Scope G9 (CSM-1901) Patient Monitor and the Measurement Network from NIHON KOHDEN

Category: Product Review, NIHON KOHDEN (日本光電) Life Scope J (Jupiter) to Genesis series Life Scope monitors (CSM-1000 series); the missing digital modular platform in Life Scope G9 (CSM-1901), Life Scope G7 (CSM-1700 series) and Life Scope G5 (CSM-1500 series) bedside monitors.
 

 

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In this knowledge-sharing record we reviewed the new NIHON KOHDEN Life Scope G9, G7, G5 Bedside Monitor (监护仪) and explained why there is no digital modular support platform for them. The continued use of the puzzling Smart Cables and MULTI sockets are also not what the market needs from Japan.

Life Scope G9 (CSM-1901) bedside monitor inherits the last Life Scope J bedside monitor configuration

 

The first of NIHON KOHDEN Genesis series bedside monitors started with a high-end model, Life Scope G9 (CSM-1901) Bedside Monitor. The basic configuration offered comprises of the Core unit, a 19-inch display monitor (three display monitors can be supported), and a BSM-1700 (Life Scope PT) transport monitor placed on a JA-694PA Data Acquisition Unit (DAU) connected to the main unit using point-to-point serial communication.

 

 

There are two types of Data Acquisition Units that the BSM-1700 transport monitor can make use of; the JA-694 DAU has four yellow expansion MULTI-parameter sockets while the JA-690 DAU has none. Note the JA-690 DAU or JA-694 DAU both do not have an IP address for networking need, the connection to the main  unit is only by direct serial digital communication.

The Life Scope PT acts as an input unit when placed on the Data Acquisition Unit (DAU) linked to the Core Unit of Life Scope G9, and when mechanically released from the DAU will operate as an independent transport monitor. If the Life Scope G9 is connected to a Central Monitor, beware Life Scope PT when released to be an independent transport monitor cannot be linked to the central monitor wirelessly; data continuity at the central monitor is assured only after the transport monitor is re-attached back to any host monitor as input unit, and stored data is then updated via host monitor to the central monitor. 

When a transport monitor is not required, the cheaper AY-663P Input Unit is being used instead and expanded with a AA-674P four-socket expansion box. In such a case, the JA-690 DAU without any expansion socket is the one utilized for use.

There are four models of Life Scope PT (BSM-1700) transport monitor to select from. The alternative AY-663P Input Unit can be substituted with AY-653P Input Unit using Nellcor OxiMax algorithm or AY-633P Input Unit using Masimo SET algorithm as a choice fo users.  

 

The Core Unit is the new name for the usual main unit, the name update is because this time a PC sub-unit is included. The PC sub-unit makes it possible for Life Scope G9 bedside monitor to have web browsing capability, and this is the first ever a Nihon Kohden Life Scope bedside monitor has such a capability!

 

Other than the Core Unit being new, the rest of the items mentioned above are all existing hardware initially designed for Life Scope TR (BSM-6000 series) bedside monitors. A sense of history is necessary to understand the shallowness of Life Scope G9 bedside monitor design.

It is embarassing Life Scope G9 Bedside Monitor is the first NIHON KOHDEN patient monitor ever to be equipped with a web browser

 

Before Life Scope G9 (CSM-1901), None of the Life Scope patient monitors (including Central Monitors) had ever been able to access external servers for images of Ultrasound, CT, MRI, Laboratory test results, clinical decision support etc. These servers usually utilize portal technology for access and a patient monitor needs a web browser as well as an additional non-realtime network path to access them for services.

NIHON KOHDEN was finally able to introduce the first monitor with built-in web browsing capability after learning from the Singapore subsidiary how Philips made use of UPS in a Central Monitor. NIHON KOHDEN is using a PC for the first time in a bedside monitor, so system stability is a top concern. To have peace of mind, the PC unit is not integrated into the monitoring block in G9; the trick is to use the monitoring block to keep an eye on the PC Unit and reset it when it hangs or freezes. The independent PC sub-unit is the reason for the Core Unit's large physical size.

 

Why does NIHON KOHDEN take so long to release a patient monitor with a web browser?

An old slide of Philips introducing the (long-discontinued) IntelliVue MP20/ MP30 patient monitors should make clear our point.

 

"Portal technology compatible" bedside monitors from a leading competitor

The Philips slide showed the middle to high end products (namely IntelliVue MP40, MP50, MP60, MP70, MP90) all have web browsers already incorporated at that point of time. In the year 2013, the IntelliVue MP20, MP30 patient monitors were already replaced by newer IntelliVue MX400/ MX450 patient monitors. The events just described had taken place long before the launch of Life Scope G9 bedside monitor, making clear this can only be tolerated in the domestic market in Japan, which is protectively insulated from international high-tech competitions.

Portal Technology application illustration

What we are seeing is a demonstration to the world how extreme is NIHON KOHDEN in falling behind the international competitors in digital technology.

What are essential but missing in Life Scope Genesis G9 bedside monitor?

Do you understand what does this mean? Such sentences had nothing to say.

 

First, it is being promoted as a modular monitor; a modular monitor needs a network infrastructure for exchange of measurement-data but this is blatantly missing.

Next, there are plenty of missing connector sockets on the AY-663P input unit or in its place, the Life Scope PT transport monitor. The users will soon learn they need enough connector sockets, not a few flexible sockets. Why should the users tolerate such illogical design?

Similarly configured input units with different SpO2 algorithms

The prominent feature of the AY-663P Input Unit (or Life Scope PT transport monitor) is the utilization of yellow MULTI-parameter sockets. These MULTI sockets do not accept ordinary measurement cables but only measurement cables that have NIHON KOHDEN parameter codes embedded in their yellow plugs. The end result of using flexible connector sockets means less connector sockets on the monitor; although the advantage of the Multi-parameter sockets is claimed to be flexible, but in reality, the shortage of connector sockets makes for inflexible monitoring!

Concept of the Multi-parameter Unit (MPU)

NIHON KOHDEN had identified five types of analog hardware that can be linked to the MULTI-parameter sockets (from the inside) and to make use of these hardware, a cable with the correct code on its plug must be inserted into one of the MULTI-parameter sockets. These cables with coded plugs are collectively cited as Smart Cables by the manufacturer and the codes are also known as parameter codes. Each MULTI-parameter socket selects only one channel of the hardware, except for Temperature allowing two channels of hardware to be selected.

 

A measurement cable with a correct code in its plug can make use of any of the internally configured hardware shown here

The configured hardware using the Smart Cables are grouped into a block known as MULTI-parameter Unit (MPU), complete with a small number of yellow MULTI-parameter sockets.

It is the hardware rule that all MULTI-parameter sockets must be able to do IBP monitoring, each socket comes together with its own exclusive IBP hardware to adhere to this rule. This means said IBP hardware is not intended for shared-use.

A MULTI-parameter socket makes use of its own exclusive IBP hardware when a measurement cable with an IBP code is plugged into it. For non-IBP monitoring, the socket can access a common pool of Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware in the MULTI-Parameter Unit, which are designed for sharing.

Many are puzzled by the contents of the MULTI-parameter Unit, whose design has many hardware sharing only two MULTI-parameter sockets, this is because it was originally devised to solve the problem of limited panel space. When panel space is enough to accomodate all the neccessary connector sockets, it is effectively throwing away money to adopt this design.

Principle of operation

To reiterate,

A  functional MULTI-parameter socket always come with its own exclusive one-channel IBP hardware, and the number of IBP monitoring channels always correspond to the total number of yellow MULTI-parameter sockets on the monitor or input unit.

This being a hardware rule, and the key word is "functional" because a non-functional MULTI-parameter socket may not need to care about the capability to do IBP monitoring, such a socket can be found on the CardioLife TEC-5600 series defibrillators and this socket cannot do IBP monitoring, it is a fake MULTI-parameter socket and can only be used as a serial port for mainstream CO2 kit sets.

Given the large amount of hardware in the MULTI-parameter Unit block, more MULTI-parameter sockets should be added whenever possible, to make good use of the hardware that would otherwise be idling; this is actually done by using an external expansion box filled with MULTI-parameter sockets (plus associated IBP amplifier hardware).

The additional sockets are added using analog interface, and limited to a maximum four MULTI-parameter sockets, to avoid signal deterioration caused by voltage drop and noise.

Variations to the basic theme

There are variations to the basic theme, such as doing without use of external expansion box, or increasing the number of MULTI-parameter sockets in the MULTI-parameter Unit, or reducing the hardware configured in the Multi-parameter Unit.

In the AY-663P, AY-653P, AY-633P Input Units (or Life Scope PT transport monitors), 3 channels of IBP amplifiers, 2 channels of Temperature, one channel each of Thermistor Respiration, FiO2 and Cardiac Output are configured for use by Smart Cables.

As the hardware in the input units are extensive, they were designed to work with external expansion boxes which can add two or four MULTI-parameter sockets to make use of the idle hardware in the input units.

NIBP, SpO2, ECG and two channels of Temperature are configured using dedicated measurement cables. They are not part of the MULTI-parameter Unit.

The digital hexadecimal code is stored in an EEPROM chip mounted on a small flexible PC board electrically wired to the pins of the cable plug. It is not difficult to make the Smart Cables but they are being priced highly by the manufacturer; only the common IBP cable can be sourced from China suppliers at a reasonable price.

A parameter code is stored in the plug of the measurement cable

One MULTI-parameter socket can select two Temperature hardware channels.

Each MULTI-parameter socket can take two channels of Temperature measurements

The MULTI-parameter sockets are additionally diverted to serve as digital serial ports

As explained earlier, the design concept of MULTI-parameter Unit was to solve the problem of limited panel space, further reduction of sockets could be achieved by using the MULTI-parameter sockets as serial ports. This being an easy task since there is no need for additional internal analog hardware and the digital serial signals from the serial kit sets just go straight to the monitor main unit.

Currently, mainstream CO2, 2nd SpO2, BIS and NMT hardware are self-contained digital serial kits using the MULTI-parameter sockets only as a link to the monitor, to save on connector sockets. We must be clear when use of MULTI-parameter sockets as serial ports is not to solve the problem of limited panel space, the cost cannot be justified.

Shown below is the original label for the yellow MULTI socket, indicating the five specific hardware and also serving as serial port for mainstream CO2 serial kits; the purpose of this arrangement was to minimize the number of sockets being used on a limited panel space.

 

The original label for the yellow MULTI-parameter sockets when they were first used

 

The use of Smart Cables does not upgrade a configured monitor to be modular

A yellow MULTI-parameter socket by itself does not automatically mean all the five types of mentioned parameters are available for measurements; it still depends on whether what hardware are actually being placed inside for selection.

Additional parameter capability can be added using serial kit sets or via interfaces to external equipment.

When a model is not equipped with FiO2 hardware internally, no amount of yellow MULTI sockets is going to provide this measurement capability. The amount of configured hardware linked to each multi-parameter socket varies, so is the system support for serial kits and external interfaces.

Examples of configured hardware and serial kits using Smart Cables

It is the built-in hardware that determine the parameter capability; and in the case of serial kit sets, the system software. This of course, is the same description as a configured patient monitor

Actual internal hardware and system support for serial kits varies for each multi-parameter unit

It is clear a monitor like Life Scope G9 with input units making use of Smart Cables is still a configured monitor. The only advantage of using the Smart Cables is to allow sharing of connector sockets, which are of negligible hardware cost; the cost needed to make use of Smart Cables is however, far higher. It does not make logical sense, and we should look out for the ulterior motivation behind its use.

Notice the captured value from using Smart Cables is negative for users

Take a closer look at the AY-663P Input Unit shown below, it needs at least ten sockets for carefree use but the manufacturer can only provide three yellow MULTI-parameter sockets for time-sharing use. This means only three of the ten connectable cables can plug into the input unit at any one time. The input unit is so short of connector sockets, why would anyone need such a skewed input unit?

The reason AY-663P Input Unit cannot come with more MULTI-parameter sockets is because only three IBP amplifier hardware are specified for said input unit. Since each MULTI-parameter socket comes with its own one-channel IBP hardware, the manufacturer cannot provide more than three MULTI-parameter sockets. Notice the two channels of Temperature hardware in the shown input unit are not making use of the yellow MULTI-parameter sockets for connections, this is to provide relief to the three yellow MULTI-parameter sockets which are not enough for use.

A skewed input unit delivering pain of not having enough connector sockets

The BIS, Second SpO2, ETCO2 and NMT parameters are using self-contained kit sets with processed digital serial data using the input unit only as a link to the monitor, they have no reason to queue for the scarce yellow MULTI-parameter sockets.

What value can the users capture from using input units that come with deficiency of connector sockets? The first vehement complaint from users is always, and always the yellow MULTI-parameter sockets are not enough for use!

Next comes the unconvincing offer to add more yellow MULTI-parameter sockets to supplement the inadequate three on the AY-663P Input Unit, using an external box (AA-674P) which comes with four MULTI-parameter sockets.

The link from AA-674P expansion box to AY-663P is an analog interface, not digital; as such, only a maximum of four MULTI-parameter sockets can be added, limited by signal deterioration caused by voltage drop and noise pickup.

AA-674P box compensates for four missing sockets on the AY-663P Input Unit but at the same time adds four channels of IBP hardware

It is obvious the manufacturer should have designed an input unit with enough connector sockets in the first place, but there is a reason for wanting to do it. The purpose is to imitate the scalability process of patient-monitoring parameters when MULTI-parameter sockets are shown visually being added to the input unit; the manufacturer is however, adding sockets, and not monitoring parameters. A bedside monitor using AY-663P Input Unit and AA-674P expansion box is not modular in design.

Users must distinguish the difference between scalability of the MULTI-parameter connector sockets and scalability of patient-monitoring parameters

We should be clear, the scalability of patient-monitoring parameters is the one being sought after by the market, not scalability of usable connector sockets. The act of adding four MULTI-parameter sockets using the AA-674P expansion box also means adding four channels of IBP hardware to what are already configured in the AY-663P Input Unit. Do you need seven channels of IBP hardware? This is how Life Scope TR bedside monitor got its maximum ability to do seven channels of IBP monitoring; it is either three channels of IBP monitoring using AY-663P alone or seven channels of IBP monitoring using both AY-663P and AA-674P, but the AY-663P Input Unit can never be sold alone because of the massive deficit of connector sockets.

The above translates to users are being made to accept 7 channels of built-in IBP hardware in one go, without proper explanation. This is not scalability of patient-monitoring parameters!

The limitation of only four additional MULTI-parameter sockets also means it is not possible for the AY-663P Input Unit to make use of two AA-674P expansion boxes; be sure to ask for a field demonstration to verify the truth if any salesman insists on this possibility!

For the Life Scope PT transport monitor, the four additional MULTI sockets are available on the JA-694PA Data Acquisition Unit (DAU).

Multi-parameter sockets on JA-694PA Data Acquisition Unit

The four additional sockets on the JA-694PA Data Acquisition Unit can also be connected to the AY-663P Input Unit but the limit of four additional sockets applies. It should be clear it is not possible for AY-663P Input Unit to make use the four MULTI sockets on JA-694A DAU and those on the AA-674P box at the same time.

Elaborate time-sharing are applied to things that are expensive (high in demand, an asset), and not worth the efforts for things that are cheap (high in supply, a commodity) like a connector socket or a switch! It only makes sense to see productive efforts being made to time-share a CPU, a car, a hotel room, a yacht, an airplane but not a calculator, a pencil or a pair of scissors.

The next picture shows Philips time-sharing one channel bio-amplifier hardware between IBP and Temperature measurements, and there was no sharing of connector socket; this is exactly the opposite of what Nihon Kohden is doing. The said manufacturer merely ensures physically it is not possible to make use of both the  PRESS and the TEMP socket at the same time.

PRESS and TEMP socket cannot be engaged simultaneously

 

Philips modular monitors

 

The AY-663P Input Unit together with AA-674P expansion box corresponds to a Philips MMS module with an extension. These are operating at the configured level, not modular.

 

The Philips MMS modules (initiated by Hewlett Packard) are however additionally capable of being linked to a measurement data network using Ethernet

   

HP Agilent M3/M4 portable monitor

While the Philips MMS modules can be upgraded using extensions, it also has an IP address on the Measurement Ethernet network, and can be expanded by linking to a module rack with individual modules. This way, those expensive individual modules can be easily shared.

On the contrary, NIHON KOHDEN Life Scope TR Input Units do not have IP addresses for networking because the manufacturer failed to achieve this capability, there is no way to use module rack for sharing individual modules.

The Philips MMS module (and extension) serves as the basic module and can be expanded using a measurement LAN

If you are still harboring the misconception there are monitoring hardware embedded in the NIHON KOHDEN Smart Cables, we show here, beyond any doubt, there is no active electronics in the Smart Cables.

The marketing messages "New Modular Technology" and "The Module is in the cable!" are mere imaginations of people without the necessary electronics knowledge.

What do the manufacturer mean by this statement? 

It started with the Life Scope TR (BSM-6000) series monitors in the USA market and gradually adopted officially for International markets. These are precise statements.

Keep in mind,  continued repetitions of an assertion without offering any proof does not make it the truth.

This is just assertion without showing any proof

Chip makers need huge demand to justify each of their products, so which chip manufacturer is supplying NIHON KOHDEN the variety of analog chips given the extremely low volume in demand? If we were to open up the plug of a Smart Cable, what do we see? A small PC board is seen attached to some pins of the yellow plug.

A small PC Board is soldered to some pins of the yellow connection plug

The PC board confirms a cheap digital EEPROM chip is being used to code the Smart Cable.

 

A cheap digital EEPROM chip was what we found inside the yellow Smart Cable plug

If we were to open up the plug of a compatible IBP cable from China suppliers, what do we see? It is the same thing, a plug with a digital code defined by NIHON KOHDEN.

Under US FDA rule, a cable is only a cable if it does not change the signal that passes through it. A Smart Cable with a hexadecimal code is just a cable and does not change a signal passing through it, but if it has an amplifier it becomes a medical device and requires FDA registration. Can you find any stand-alone Smart Cables registered with US FDA as a medical device?

When the Smart Cables are used with serial kit sets, such as mainstream CO2 kit sets or the NMT AF-101P kit set, the registration is for the active serial kit set and not the passive Smart Cable.

Irrefutable Proof the IBP amplifier hardware is configured internally, an important fact withdrawn from later monitor manuals

 

The Life Scope BSM-2301 bedside monitor was launched before the Life Scope TR bedside monitors, and the Service Manual is clear on the design; manuals for later models stop providing such information. The major move to curb details in manuals started from Life Scope J (BSM-9101) Bedside Monitor, launched before the Life Scope TR bedside monitors.

In BSM-2301 service manual, you can see the IBP and thermistor respiration are internal hardware inside the Life Scope BSM-2301 monitor. These hardware are shown clearly linked internally to the MULTI-parameter socket, and to make use of either hardware, a Smart Cable with the correct code must be plugged into the MULTI socket.

 

Can you see the IBP amplifier and thermistor respiration hardware are internal components of the Life Scope BSM-2301 monitor?

The MULTI-parameter socket doubles as a serial port without any need for internal monitoring hardware, only as a link to the monitor. In the block diagram below, the processed digital serial data from a CO2 kit set goes straight to the digital microcontroller APU (Analog-block Processing Unit) and is forwarded to the DPU.  For a parameter using the internal analog hardware, the analog signal needs to pass through an Analog-Digital converter before going to the APU for digital processing. 

Relevant page in the combined Service Manual for BSM-2301A, BSM-2301K, BSM-2303K, BSM-2304A

You should know by now the three IBP amplifier hardware inside the AY-663P Input Unit or Life Scope PT transport monitor is the reason they can each perform three channels of IBP monitoring.

Knowing there are three built-in IBP amplifier hardware inside the AY-663P Input Unit easily allows us to conclude the rest of the configured hardware after confirming all parameters that can be measured by the input unit.

There are huge amount of hardware inside the AY-663P Input Unit

 

First we filter out the parameters using self-contained serial kit sets, and they are mainstream CO2, 2nd SpO2, BIS and NMT hardware for the AY-663P Input Unit.

We can conclude the patient monitoring hardware in the AY-663P Input Unit to be:

NORMAL BLOCK

(The hardware using dedicated sockets and ordinary measurement cables)

- 2 channels of Temperature

- ECG

- SpO2

- NIBP

MULTI-PARAMETER UNIT BLOCK with three MULTI-parameter sockets

(The hardware only use Smart Cables for connections)

- 3 channels of IBP (3 MULTI sockets = 3-ch IBP)

- 2 channels of Temperature (1 MULTI socket = 2-ch TEMP)

- Cardiac Output

- FiO2

- Thermistor Respiration

< Self-contained kit sets using Multi-parameter sockets as serial ports>

- BIS, 2nd SpO2, mainstream CO2 and NMT

These configured hardware in the Multi-parameter Unit of AY-663P is the reason for its size

In the AA-674P expansion box, each of the four MULTI sockets makes use of its own IBP hardware when a IBP Smart Cable is plugged in; for the other four parameters, the sockets can access and make use of the Temperature, Cardiac Output, FiO2 and Thermistor Respiration hardware already configured in the Multi-parameter Unit of AY-663P Input Unit.

The hardware in the AA-674P expansion box

There is no proper viability assessment and is only leading customers into having an unrealistic expectation of what the Smart Cables can actually deliver. The apparent flexibility of the MULTI sockets is in reality an adaptation with negative captured value for the users.

Origin of the MULTI-parameter Unit (MPU) design

 

In the 1990s, when developing the first digital modular monitor, the development team encountered a problem of insufficient front panel space for connector sockets on the first digital multi-parameter module being made. Five types of internal analog hardware were found suitable for time-sharing two modified connector sockets, to differentiate them, they were colored yellow and known as MULTI sockets.

 

At the time NIHON KOHDEN was responding to an important emerging trend of using a high-density digital multi-parameter module as basic building block for modular monitors

 

 

In analog modular monitors, only single parameter modules were produced by NIHON KOHDEN. When designing the first digital modular monitor, the company discovered the critical care market had already moved to using a digital multi-parameter module with higher density of electronic components as a basic building block for modular monitors.

 

Apart from the higher electronic density, the difference between a single parameter module and a multi-parameter module is the presence of a CPU processor in the latter; the output of a multi-parameter module is thus processed digital data. This new development of distributed processing made it possible for patient data to be stored and moved with the module. Digital modules can also be connected directly to a (proprietary) digital data-exchange network as a node.

 

NIHON KOHDEN wanted to follow the trend by offering the first digital multi-parameter module, and the first digital multi-parameter module made by the company was named the Saturn module. However, putting in a lot of hardware into the Saturn module also means more panel space needed for connector sockets.

Responding to new trend in the 1990s using a multi-parameter module with higher electronic density as a basic building block for modular monitor

Nihon Kohden intended a module rack integrated physically with the main unit to form a limited footprint just big enough to stack the display monitor on top of it (see below illustration). The physical size of the Saturn module was therefore constrained; in addition, the multi-parameter module must work in combination with other parameter modules like recorder, sidestream CO2, BIS, EEG, Flow/ PAW, SvO2 in the module rack.

The Saturn module was intended to be physically small in size

The solution from NIHON KOHDEN for panel space limitation of Saturn module was to introduce a MULTI-parameter Unit with many hardware sharing two yellow sockets for common use.

 

The Saturn module turned to sharing two modified connector sockets as solution to the constraint of space for more sockets

In the Saturn module, the hardware are divided into two blocks, a normal block and a MULTI-parameter Unit.

ORDINARY BLOCK

(These hardware make use of dedicated sockets and ordinary measurement cables)

- ECG

- SpO2

- NIBP

MULTI-PARAMETER UNIT with two yellow sockets

(These hardware only use Smart Cables for connections)

- 2 channels of IBP (2 MULTI sockets = 2-ch IBP)

- 4 channels of Temperature (2 MULTI sockets = 4-ch TEMP)

- Cardiac Output

- FiO2

- Thermistor Respiration

< Self-contained kit sets using Multi-parameter sockets as serial ports>

- mainstream CO2

Huge amount of configured hardware in the Saturn module

The MULTI-parameter Unit design has many hardware sharing only two MULTI-parameter sockets, this is to solve the problem of limited panel space.

More MULTI-parameter sockets are of course needed to make good use of the hardware that would otherwise be idling. This is done by using an external expansion box filled with MULTI-parameter sockets, each with its own IBP amplifier hardware.

Analog solution of adding more sockets, not monitoring parameters

The additional sockets are added using analog interface, and limited to a maximum four MULTI-parameter sockets, to avoid signal deterioration caused by voltage drop and noise.

The image gives an impression of scalability but this is scalability of connector sockets, and not the scalability of monitoring parameters that is being sought after by the market. All necessary hardware are already configured in the Saturn module except for additional IBP amplifier which must always come with each MULTI-parameter sockets.

 

A MULTI-parameter socket makes use of its own IBP hardware when a Smart Cable with an IBP code is plugged into it; for the other four parameters, the sockets are linked to the common pool of Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware already embedded in the the MULTI-parameter Unit of Saturn module.

It is the hardware rule that all MULTI-parameter socket must be able to do IBP monitoring, each socket has its own IBP hardware that is not shared

The extension Smart module is therefore a 2-channel IBP box adding two MULTI-parameter sockets for use by the Saturn module. Remember, the analog interface limits the number of Smart modules that can be added to the Saturn module to two, making a total of four additional Multi-parameter sockets.

The MULTI-parameter sockets were additionally allowed to be diverted to act as a costly digital serial ports so that mainstream CO2 digital serial kit sets can also use it; we must remember this is for purpose of minimizing connector sockets on the Saturn multi-parameter module, as it does not make sense outside this context.

The mainstream CO2 comes in the form of a self-contained serial kit set, and has no need for the MULTI-parameter Unit.

Keep in mind, a yellow MULTI-parameter socket is a high-cost serial port when it does not select any internal hardware

MULTI-parameter socket poorly utilized as a costly serial port

The initial arrangement was only for mainstream CO2 serial kit sets, but later extended enthusiastically to BIS kit set, 2nd-SpO2 kit set, APCO kit set, NMT kit set etc., whose motivation is highly questionable given this greatly increases the interface cost compared to a plain serial port.

The use of Smart Cables for serial communication does give a false illusion of mighty MULTI-parameter sockets but the capabilities are in reality coming from the system software.

 

Make no mistake, the serial kit sets are self-contained and whether a particular kit set is supported depends on the system software, not on the type of connector sockets being used.

To reiterate, there is no difference if you connect digital serial data to the monitor using Smart Cables or ordinary serial cables

This is how you connect the BIS processor kit to a yellow MULTI socket

Using Smart Cables for serial interface means an unnecessary jump in demand for more yellow MULTI-parameter sockets and there is no technical need for the serial kit sets to use the yellow MULTI-parameter sockets. Putting things into perspective, most patient monitoring parameters cannot be made into self-contained serial kits; for example, the AE-918P Neuro Unit or a strip chart recorder cannot be linked to a yellow MULTI-parameter socket as serial kit as shown. They are connected as external devices to a monitor.

 

The MULTI PARAMETER UNIT is an official term found in the service manual

 

The Saturn module, together with two satellite boxes adding 4 channels of IBP to the Saturn module is shown below. The four MULTI-parameter sockets on the satellite boxes can also access the MPU of the Saturn module. Together, six IBP channels and six shared-use MULTI-parameter sockets are available to the users.

The sockets on the satellite boxes compensate for the missing connector sockets on the Saturn module

The two Modular Monitors that made use of the Saturn multi-parameter module were failures

The two modular monitors that could make use of the first Multi-parameter Module (Saturn module) made by NIHON KOHDEN were Life Scope S (BSS-9800) bedside station and Life Scope M (BSM-9510) bedside monitor; the software supporting the network infrastructure exchanging digital measurement data between the Saturn module and main units was unfortunately, not reliable and both modular monitors ended up as failures.

Life Scope S (BSS-9800) bedside station was a digital modular monitor

 

 

Lower-end Life Scope M bedside monitor was using a (6-slot) built-in module rack. The Life Scope M (BSM-9510) bedside monitor has lower processing power compared to the Life Scope S bedside station.

 

 

From the US FDA records, you could tell that Life Scope S and Life Scope M monitors were not launched in the US market

 

The two monitors were found lacking before they could be marketed in the USA market.

The cause of the failure for Life Scope S and Life Scope M modular monitors was the problematic network infrastructure needed by modular monitors for data exchange between modules and main unit. This resulted in Life Scope S bedside station functioning only as a limited monitor while the Life Scope M bedside monitor had to be withdrawn from the market due to insufficient processing power.

There were two digital real-time data network infrastructures used by BSS-9800 Life Scope S bedside station. The software supporting the Ethernet network linking patient monitors to the Central Nurse Station proved stable but the software supporting the network linking the modules to the main units of BSS-9800 bedside station/ BSM-9510 bedside monitor was unreliable and further development work on the network infrastructure was stopped to avoid incurring unbearable losses.

The exchange of measurement-data between main unit and modules was problematic

The product failures were huge financial losses incurred at a time when the company was already suffering badly from poor sales due to the lack of digital technology know-how.

NIHON KOHDEN could not solve the communication problem between main unit and modules

 

Failure to succeed in the measurement data-exchange network infrastructure meant NIHON KOHDEN was downgraded to be a manufacturer only capable of making configured patient monitors.

To avoid being seen as a failure, the company tried to hide the truth from the market. In order not to reveal NIHON KOHDEN had given up development to make modular monitors, the modular Life Scope S and Life Scope M were still being actively promoted on brochures. Since it could not be for sales improvement, its real purpose was to lie that the company is still capable of making modular monitors.

 

The failed modular monitors that still appeared in this brochure was to hide the truth from the market

About 9 years after the launch of modular Life Scope S Bedside Station, a new Life Scope J (BSM-9101) purporting to be a modular bedside monitor was released for export. The monitor was a bizarre attempt to hide the missing technology platform essential for modular monitors.

 

Below picture shows how Life Scope G9 bedside monitor is derived from Life Scope J bedside monitor, with a new Core Unit replacing both MU-910R main unit and QI-930P Interface Unit. To evaluate Life Scope G9 bedside monitor professionally, it is first necessary to study the Life Scope J (BSM-9101) bedside monitor in details.

 

New Life Scope G9 bedside monitor is re-configuration of Life Scope J bedside monitor

 

Life Scope J Bedside monitor replaced failed high-end Life Scope S (BSS-9800) modular bedside station

 

Life Scope J (BSM-9101) Bedside Monitor was released in June 2007 using MU-910R as main unit, and an AY-920PA with four yellow MULTI sockets as the input unit.

AY-920PA Input Unit with expansion box

The four yellow MULTI-parameter sockets tells us this input unit has to be equipped with four channels of configured IBP amplifiers. We conclude the rest of hardware after knowing all parameters that can be measured.

We first filter out the serial kit sets; mainstream CO2, 2nd SpO2, BIS and NMT hardware are supplied as self-contained serial kit sets with digital serial processed data.

The patient monitoring hardware in the AY-920PA Input Unit are concluded as:

(NORMAL BLOCK) The hardware using dedicated sockets and ordinary measurement cables:

- 2 channels of Temperature

- ECG

- SpO2

- NIBP hardware using dedicated sockets.

(MULTI-PARAMETER UNIT BLOCK with four MULTI-parameter sockets) The hardware only use Smart Cables for connections:

- 4 channels of IBP (4 MULTI sockets = 4-ch IBP)

- 6 channels of Temperature (3 MULTI sockets = 6-ch TEMP)

- Cardiac Output

- Thermistor Respiration

- FiO2

Note:

Not using the MULTI-parameter sockets are Sidestream CO2, Multi-gas, EEG etc., which are connected using external device interface.

The configured Life Scope J bedside monitor was dressed up to be a modular monitor

 

The market communication was meticulously executed to portray Life Scope J (BSM-9101) bedside monitor as a modular monitor when the manufacturer is fully aware it is a true-blue configured monitor.

 

Life Scope J bedside monitor appears to be a modular monitor in this brochure image

In above brochure image, Life Scope J (on the right) is shown using 12 yellow MULTI-parameter sockets, which is an impossible configuration. There is obvious intention to hide the fact only four MULTI-parameter sockets can be added using an external box, because this will expose the solution is analog, not digital.

This is a fake configuration, since AY-920PA Input Unit can only make use of one AA-910P expansion unit

In the next picture, you can see the AY-920PA Input Unit was designed in a shape that when combined with the recorder make Life Scope J (BSM-9101) bedside monitor (left) closely resemble the Life Scope S (BSS-9800) bedside station with a 8-slot module rack filled with modules (right).

 

Life Scope J bedside monitor was configured while Life Scope S bedside station was modular

In other words, Life Scope J bedside monitor was specially designed in appearance to look like an updated version of the Life Scope S bedside station.

The components making up a Life Scope J (BSM-9101) bedside monitor system is shown in next picture. The connection from MU-910R Main Unit to AY-920PA Input Unit is using the same connector type utilized by BSS-9800 bedside station; the old modular racks can therefore theoretically be daisy-chained to the AY-920A Input Unit.

Why offer the same old stuff that had caused the failure of both Life Scope S bedside station and Life Scope M bedside monitor? The problematic module racks and old modules could not be merchantable since there was no longer any new module under development!

 

Life Scope J Bedside Monitor is not a bona fide modular monitor

 

The purpose of the questionable module racks and old modules were there for the powerful association of Life Scope J with modular monitors in the minds of the intended audience (including foreign employees). It was a powerful way to get the audience to nod their heads when making claim that the Life Scope J is a modular monitor.

Without offering a new network infrastructure for measurement data, connecting to the old module racks (from BSS-9800 modular monitor) is meaningless. This pretense can no longer be feigned after discontinuity of old module racks and associated modules without replacement.

There was no replacements for the discontinued module rack and modules

The Input Unit and expansion box of Life Scope J bedside monitor is only the equivalence of Life Scope S modular monitor's Saturn module and extension. The rest of the other modules are being solved by using external device interface, a truly configured monitor.

Life Scope J bedside monitor has to depend on external device interface for expansion

The Life Scope J (BSM-9101) Bedside Monitor is relying on using external device interface on the AY-920PA Input Unit or MU-910R Main Unit to third party devices.

 

Life Scope TR bedside monitors offer varieties of input units

 

After Life Scope J monitor, NIHON KOHDEN went on develop the Life Scope TR (BSM-6000 series) monitors. The latter has a main unit to hold one input unit plus a satellite socket box, there is choice of input units and socket boxes for user selection. Life Scope TR bedside monitors are discussed here because Life Scope G9 inherits the input units from the Life Scope TR series.

Compared to Life Scope J, Life Scope TR bedside monitors have more than one type of Input Unit to choose from

The challenge of monitoring a patient during transportation

 

The idea of turning the Input Unit on a host monitor into a Transport Monitor was not yet conceived when Life Scope TR (BSM-6000 series) monitors were first designed, the initial design was to follow GE Marquette way, transferring the input unit from Life Scope TR bedside monitor (BSM-6501 or BSM-6701) to a compact 10.4-inch Life Scope TR (BSM-6301) to fulfill the transport role.

 

The original way was to use Life Scope TR 10.4 inch model as transport monitor

Change of mind from following GE Marquette to follow Philips IntelliVue MMS X2

 

Due to market pressure, a transport monitor was realized by the addition of touch-screen, storage memory and rechargeable battery to the multi-parameter input unit, doing away the need to attach it to a monitor during patient transfer; the design is an adaptation to imitate the Philips IntelliVue MMS X2.

 

Before the introduction of transport monitor Life Scope PT, Nihon Kohden first released the JA-690PA and JA-694PA Data Acquisition Units for the BSM-6000 series bedside monitor in April 2009,

The JA-690PA and JA-694PA data acquisition units were designed so that an Input Unit can be placed next to the patient while allowing the main unit with the screen to be mounted at a suitable height (away from the patient) for purpose of convenient viewing.

 

The main purpose of JA-690PA and JA-694PA Data Acquisition Units is to bring the Input Unit nearer to the patient

The Life Scope PT acts as an input unit when placed on the Data Acquisition Unit (DAU), and becomes an independent transport monitor when it is released from the DAU.

Life Scope J discarded original AY-920PA Input Unit to make use of Life Scope PT as transport monitor

Since it was not possible for Life Scope J bedside monitor MU-910R main unit to link directly to JA-690PA or JA-694PA data acquisition unit, a new costly QI-930P Interface Unit had to be introduced (as shown). This meant AY-920PA Input Unit was no longer needed.

 

By discarding the original AY-920PA Input Unit, Life Scope J could make use of Life Scope PT as a transport monitor

The extra QI-930P Interface Unit could be dispensed with when a new core unit replaced the older MU-910R main unit, and has direct interface to the JA-690PA or JA-694PA data acquisition unit. A new Genesis model known as Life Scope G9 bedside monitor was thus born.

 

Life Scope TR updated to Life Scope Genesis G5 bedside monitor

The updated model of Life Scope TR is Life Scope G5 bedside monitors; the main unit of Life Scope G5 bedside monitor is Life Scope TR main unit updated with an integrated panel PC replacing previous LCD display. The main unit is now known as Core Unit like Life Scope G9.

There is an alternative model to Life Scope G5 bedside monitors, known as Life Scope G7 bedside monitors. The latter model makes use of a Panel PC as main unit and rely on the data acquisition unit to interface with input units or Life Scope PT transport monitor.

As shown below, the main unit is the panel PC with touchscreen sizes of 15.6-inch and 19-inch. Notice the Input Units (originally designed for Life Scope TR) cannot be placed on the main unit, and a data acquisition unit is mandatory for use. Life Scope G7 monitor configuration makes it redundant to have Life Scope G5 bedside monitor using a data acquisition unit. The external socket box for Life Scope G7 bedside monitor is the same one (AA-174P) as Life Scope G5, with MULTI sockets arranged horizontally and must be linked to a new type Data Acquisition Unit (JA-170PA).

The system weakness discussed in BSM-1700 From Input Unit to Transport Monitor applies to Life Scope G9, G7, G5 bedside monitors as host monitor since it is regardless of the type of Host Monitor being deployed. Essentially, Life Scope PT (BSM-1700 series) has no wireless mechanism to continue linking with the central nurse station the moment it is detached from Life Scope G9 Host Monitor to operate as an independent transport monitor. The Central Nurse Station simply has no idea what is happening to the patient during the period of transport and can only be updated after the transport monitor is attached back to another Host Monitor (i.e. completion of patient transfer). This effectively means using the BSM-1700 as a transport monitor for Life scope G9 and others should be re-examined.

Users should be aware of the mandatory need for network isolation units when connecting Life Scope G9 bedside monitor to a Central Nurse Station

 

For networking, the LIFE SCOPE G9 equipped with a non-isolated Ethernet LAN interface when connecting to a real-time LAN network is a danger to the patient. It is mandatory to observe patient electrical safety by using a network isolation unit to protect the patient.

NIHON KOHDEN network isolation transformer

When an isolated monitor with an non-isolated Ethernet port is connected to a hardwired network, it is no longer a medical device unless the above-shown network isolation transformer is introduced between the monitor and network. Dangerous electric shocks can be delivered to the monitored patient through the wired Ethernet network if such a network isolation is not installed. The dangerous electric shocks are potentially lethal and should not be ignored.

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