Risk assessment of electromagnetic fields exposure with metallic orthopedic implants: a cadaveric study

Numerical assessment of induced electric fields in a worker's hand with commonly used metallic implants under exposure to low frequency magnetic fields

The European Union's Workers' Directive 2013/35/EU on the minimum health and safety requirements regarding the exposure of workers to electromagnetic fields specifies action levels (ALs) for external electric and magnetic fields, which should protect against induced tissue-internal electric field strengthEiabove the exposure limit values, the latter being defined in order to prevent tissue stimulation at low frequencies. However, although 2013/35/EU explicitly calls for the protection of 'workers at particular risk' (including workers with metallic implants), the AL specified in the Directive have been derived under the assumption that there are no metallic parts present inside the body. Therefore, in the present work, we analysed the situation of a worker's hand and forearm bearing metallic implants (Herbert screw and volar radius plate) used for osteosynthesis after the most common bone fractures of the hand/forearm, exposed to low frequency magnetic fields. The uniform exposure of the whole hand and forearm as well as the exposure to a specific and widely used device, a deactivator for single-use labels of acousto-magnetic electronic article surveillance systems, were considered based on numerical computations using a high-resolution anatomical hand and forearm model. The results obtained indicated that the maximum induced electric field strength averaged in a volume of 2 mm × 2 mm × 2 mm cube was higher in the presence of the metallic implants by a factor of up to 4.2 for bone tissue and 2.3 for soft tissue compared with the case without an implant. Hence, it is obvious that the local induced electric field strengths may be substantially increased by the implants. The extent of this increase, however, is highly dependent on the implant's position inside the body, the implant's geometry, and the field distribution and orientation with respect to the anatomical structure and the implant.

Enhancement of bone consolidation using high-frequency pulsed electromagnetic short-waves and titanium implants coated with biomimetic composite embedded into PLA matrix: in vivo evaluation

Purpose

Bone consolidation after severe trauma is the most challenging task in orthopedic surgery. This study aimed to develop biomimetic composite for coating Ti implants. Afterwards, these implants were tested in vivo to assess bone consolidation in the absence or the presence of high-frequency pulsed electromagnetic short-waves (HF-PESW).

Materials

Biomimetic coating was successfully developed using multi-substituted hydroxyapatite (ms-HAP) functionalized with collagen (ms-HAP/COL), embedded into poly-lactic acid (PLA) matrix (ms-HAP/COL@PLA), and subsequently covered with self-assembled COL layer (ms-HAP/COL@PLA/COL, named HAPc).

Methods

For in vivo evaluation, 32 Wistar albino rats were used in four groups: control group (CG) with Ti implant; PESW group with Ti implant+HF-PESW; HAPc group with Ti implant coated with HAPc; HAPc+PESW group with Ti implant coated with HAPc+HF-PESW. Left femoral diaphysis was fractured and fixed intramedullary. From the first post-operative day, PESW and HAPc+PESW groups underwent HF-PESW stimulation for 14 consecutive days. Biomimetic coating was characterized by XRD, HR-TEM, SEM, EDX and AFM.

Results

Osteogenic markers (ALP and osteocalcin) and micro-computed tomography (CT) analysis (especially bone volume/tissue volume ratio results) indicated at 2 weeks the following group order: HAPc+PESW>HAPc≈PESW (P>0.05) and HAPc+PESW>control (P<0.05), indicating the higher values in HAPc+PESW group compared to CG. The fracture-site bone strength showed, at 2 weeks, the highest average value in HAPc+PESW group. Moreover, histological analysis revealed the most abundant COL fibers assembled in dense bundles in HAPc-PESW group. At 8 weeks, micro-CT indicated higher values only in HAPc+PESW group vs CG (P<0.05), and histological results showed a complete-healed fracture in groups: HAPc+PESW, HAPc and PESW, but with more advanced bone remodeling in HAPc+PESW group.

Conclusion

Using Ti implants coated by HAPc jointly with HF-PESW stimulation positively influenced the bone consolidation process, especially in its early phase, thus potentially providing a superior strategy for clinical applications.

Navigated Transcranial Magnetic Stimulation in Patient with Cranioplasty in Situ: Safe and Accurate Procedure

BACKGROUND

Navigated transcranial magnetic stimulation (nTMS) is a nonsurgical mapping technique used in mapping of motor and language eloquent areas within and/or surrounding brain tumors. Previous reports support this as a safe technique with minor side effects associated with minor headaches and discomfort around the stimulation area. Currently there are no published reports concerning the accuracy and safety of this procedure in patients with a titanium cranioplasty in situ.

CASE PRESENTATION

A 59-year-old lady was diagnosed with a recurrent glioma in the context of increasing seizure frequency, left-sided numbness, and weakness. She was diagnosed with a World Health Organization grade 2 oligodendroglioma 10 years before her presentation, which was initially treated with radiotherapy and then surgical resection of this lesion 5 years later. The procedure was complicated with a wound infection, treated with a craniectomy and wound washout, followed by a titanium cranioplasty. Before proceeding with surgery for recurrence, nTMS was performed for motor mapping. No complications were identified. She underwent a craniotomy for tumor resection with aminolevulinic acid HCl (Gliolan), and the tumor was completely removed. Intraoperatively, the direct cortical stimulation correlated with the preoperative nTMS. The pathologic diagnosis on recurrence was an anaplastic oligodendroglioma grade III, and the patient is currently undergoing adjuvant chemotherapy.

CONCLUSION

This report confirms that nTMS is a safe and accurate procedure in patients who have a titanium cranioplasty in situ.

Determination of Soft Tissue Breakpoint Based on Its Temperature Enhancement Pattern: In Vivo and In Vitro Experiments

The breakpoint of fresh commercial meats and in vivo mice has been assessed using tissue temperature enhancement pattern. A 1 cm length and 0.1 cm diameter gold rod was implanted in fresh chicken breast, beef, fish, and in vivo Mus musculus white mice and was insonated with ultrasound. The temperature enhancement of gold rods was measured with a needle type thermistor over a temperature range from 35 to 50 °C. From these results the breakpoints were determined by plotting the gold rod temperature versus ultrasound exposure duration using the interception point of two curves fitted by a linear regression equations of thermal response above and below 43 °C. The linear correlation coefficients for all fitted curves lie within 0.985 and 0.997. The breakpoints were found to be 42.1 ± 1.1, 42.3 ± 0.9, 42.6 ± 0.8 and 43.5 ± 0.6 for fish, chicken breast, beef and in vivo Mus musculus white mice, respectively. The interception of the thermal response curves above and below 43 °C. Soft tissue temperature enhancement pattern has demonstrated to be a fast method to determine breakpoint. It denotes the temperature where cells may start to be destroyed and may be used to spot the startup point in dosimetry of hyperthermia cancer therapy.

Significant RF-EMF and thermal levels observed in a computational model of a person with a tibial plate for grounded 40 MHz exposure

Using numerical modeling, a worst-case scenario is considered when a person with a metallic implant is exposed to a radiofrequency (RF) electromagnetic field (EMF). An adult male standing on a conductive ground plane was exposed to a 40 MHz vertically polarized plane wave field, close to whole-body resonance where maximal induced current flows are expected in the legs. A metal plate (50-300 mm long) was attached to the tibia in the left leg. The findings from this study re-emphasize the need to ensure compliance with limb current reference levels for exposures near whole-body resonance, and not just rely on compliance with ambient electric (E) and magnetic (H) field reference levels. Moreover, we emphasize this recommendation for someone with a tibial plate, as failure to comply may result in significant tissue damage (increases in the localized temperature of 5-10 °C were suggested by the modeling for an incident E-field of 61.4 V/m root mean square (rms)). It was determined that the occupational reference level for limb current (100 mA rms), as stipulated in the 1998 guidelines of the International Commission on Non-Ionizing Radiation Protection (ICNIRP), is satisfied if the plane wave incident E-field levels are no more than 29.8 V/m rms without an implant and 23.4 V/m rms for the model with a 300 mm implant.