Evaluation of stray radiofrequency radiation emitted by electrosurgical devices

Electrosurgery refers to the passage of a high-frequency, high-voltage electrical current through the body to achieve the desired surgical effects. At the same time, these procedures are accompanied by a general increase of the electromagnetic field in an operating room that may expose both patients and personnel to relatively high levels of radiofrequency radiation. In the first part of this study, we have taken into account the radiation emitted by different monopolar electrosurgical devices, evaluating the electromagnetic field strength delivered by an electrosurgical handle and straying from units and other electrosurgical accessories. As a summary, in the worst case a surgeon's hands are exposed to a continuous and pulsed RF wave whose magnetic field strength is 0.75 A m(-1) (E-field 400 V m(-1)). Occasionally stray radiation may exceed ICNIRP's occupational exposure guidelines, especially close to the patient return plate. In the second part of this paper, we have analysed areas of particular concern to prevent electromagnetic interference with some life-support devices (ventilators and electrocardiographic devices), which have failed to operate correctly. Most clinically relevant interference occurred when an electrosurgery device was used within 0.3 m of medical equipment. In the appendix, we suggest some practical recommendations intended to minimize the potential for electromagnetic hazards due to therapeutic application of RF energy.     

Dose in the buildup region outside the primary beam

The dose received in the buildup region outside the primary beam has been measured for 60Co gamma rays and 6- and 18-MV X rays. The variation of this dose with field size and depth was evaluated. The effect of blocking trays and the importance of their design was determined.     

Calculation of the dose delivered to organs outside the radiation beams

An organ dose calculation based on measurements is described which models the total dose delivered outside a beam from 10 to 50 cm from the field edge. The dose distribution is parametrized for each beam energy as a function of depth, distance from the edge, and field size and shape. The algorithm also takes into account the organ location relative to the beam. Comparisons with measurements in an Alderson phantom using thermoluminescent dosimetry are given for various typical treatments.     

Cone beam computed tomography of plastinated hearts for instruction of radiological anatomy

Radiological anatomy education is an important aspect of the medical curriculum. The purpose of this study was to establish and demonstrate the use of plastinated anatomical specimens, specifically human hearts, for use in radiological anatomy education. Four human hearts were processed with routine plastination procedures at room temperature. Specimens were subjected to cone beam computed tomography and a graphics program (ER3D) was applied to generate 3D cardiac models. A comparison was conducted between plastinated hearts and their corresponding computer models based on a list of morphological cardiac features commonly studied in the gross anatomy laboratory. Results showed significant correspondence between plastinations and CBCT-generated 3D models (98 %; p < .01) for external structures and 100 % for internal cardiac features, while 85 % correspondence was achieved between plastinations and 2D CBCT slices. Complete correspondence (100 %) was achieved between key observations on the plastinations and internal radiological findings typically required of medical student. All pathologic features seen on the plastinated hearts were also visualized internally with the CBCT-generated models and 2D slices. These results suggest that CBCT-derived slices and models can be successfully generated from plastinated material and provide accurate representations for radiological anatomy education.     

Kinetics of the main sections of the hematopoietic system in radiation chimeras

During the first 3 days after irradiation of mice and transplantation of syngeneic bone marrow into them the number of hematopoietic stem cells (CFUs) does not increase (about 0.5% of the number of injected cells) although induction of proliferation in these cells starts as early as 24 h after transplantation. It was shown by the thymidine suicide method that after 24 h all CFU were in a mitotic cycle. Conversely, the buffer section of the hematopoietic system—the section of committed cells or precursors of granulopoiesis (CFUc) immediately went into the logarithmic phase of growth. An exponential increase in the number of CFUs was observed after the 4th day, at the same times as increased proliferation of CFUc and the beginning of restoration of the total number of bone marrow cells. In late radiation chimeras (1 month after irradiation and transplantation) the number of stem cells was 50–70% of its initial value. The remaining hematopoietic parameters were within normal limits.Laboratory of Culture and Transplantation of Bone Marrow, Central Institute of Hematology and Blood Transfusion, Ministry of Health of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR N. A. Fedorov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 84, No. 8, pp. 227–229, August, 1977.     

Optimization of photon beam flatness for radiation therapy

In this work, we investigate the relation between lateral fluence/dose distributions and photon beam uniformity, possibly identifying ways to improve these characteristics. The calculations included treatment head scatter properties associated with three common types of linear accelerators in order to study their impact on the results. For 6 and 18 MV photon beams the lateral fluence distributions were optimized with respect to the resulting calculated flatness, as defined by the International Electrotechnical Commission (IEC), at 10 cm depth in six different field sizes. The limits proposed by IEC for maximum dose ratios ('horns') at the depth of dose maximum have also been accounted for in the optimization procedure. The conclusion was that typical head scatter variations among different types of linear accelerators have a very limited effect on the optimized results, which implies that the existing differences in measured off-axis dose distributions are related to non-equivalent optimization objectives. Finally, a comparison between the theoretically optimized lateral dose distributions and corresponding dose measurements for the three investigated accelerator types was performed. Although the measured data generally fall within the IEC requirements the optimized distributions show better results overall for the evaluated uniformity parameters, indicating that there is room for improved flatness performance in clinical photon beams.     

An evaluation of safety guidelines to restrict exposure to stray radiofrequency radiation from short-wave diathermy units

Short-wave diathermy (SWD), a form of radiofrequency radiation used therapeutically by physiotherapists, may be applied in continuous (CSWD) or pulsed (PSWD) mode using either capacitive or inductive methods. Stray radiation emitted by these units may exceed exposure guidelines close to the equipment. Discrepant guidelines exist on a safe distance from an operating unit for operators and other personnel. Stray electric (E-field) and magnetic (H-field) field strengths from 10 SWD units in six departments were examined using a PMM 8053 meter and two isotropic probes (EP-330, HP-032). A 5 l saline phantom completed the patient circuit. Measurements were recorded in eight directions between 0.5 m and 2 m at hip and eye levels while the units operated at maximum output and data compared to current guidelines. Results found stray fields from capacitive CSWD fell below operator limits at 2 m (E-field 4.8-39.8 V/m; H-field 0.015-0.072 A/m) and at 1 m for inductive CSWD (E-field 0-36 V/m; H-field 0.01-0.065 A/m). Capacitive PSWD fields fell below the limits at 1.5 m (E-field 1.2-19.9 V/m; H-field 0.002-0.045 A/m) and at 1m for inductive PSWD (E-field 0.74.0 V/m; H-field 0.009-0.03 A/m). An extra 0.5 m was required before fields fell below the guidelines for other personnel. These results demonstrate, under a worst case scenario, emissions from SWD exceed the guidelines for operators at distances currently recommended as safe. Future guidelines should include recommendations for personnel other than physiotherapists.     

Modelling of the oxygen enhancement ratio for ion beam radiation therapy

The poor treatment prognosis for tumours with oxygen-deficient areas is usually attributed to the increased radioresistance of hypoxic cells. It can be expressed by the oxygen enhancement ratio (OER), which decreases with increasing linear energy transfer (LET) suggesting a potential clinical advantage of high-LET radiotherapy with heavy ion beams compared to low-LET photon or proton irradiation. The aim of this work is to review the experimental cell survival data from the literature and, based on them, to develop a simple OER model to estimate the clinical impact of OER variations. For this purpose, the standard linear-quadratic model and the Alper-Howard-Flanders model are used. According to our calculations for a carbon ion spread-out Bragg peak at clinically relevant intermediate oxygen levels (0.5-20 mmHg), the advantage of carbon ions might be relatively moderate, with OER values about 1%-15% smaller than for protons. Furthermore, the variations of OER with LET are much smaller in vivo than in vitro due to different oxygen partial pressures used in cell experiments or measured inside tumours. The proposed OER model is a simple tool to quantify the oxygen effect in a practical way and provides the possibility to do hypoxia-based biological optimization in treatment planning.     

Recent data from the literature on the biological and pathologic effects of electromagnetic radiation, radio waves and stray currents

Electromagnetic radiation is present in increasing amounts in our environment, and its potential effects on human (and animal) health has been investigated. It remains unclear whether the risk of acute childhood leukemia is associated with cumulative exposure to magnetic fields. An association with brain cancer and colon cancer has been suggested in electrical company workers. The radars used by police departments may increase the incidence of cancer. Electromagnetic radiation may play a role in a number of disorders such as depression and memory loss. It has been established that cell phones interfere with pacemakers only if direct contact occurs and have no effect if held in their normal position. Interferences have been reported between pacemakers and shop-lifting detectors.     

Deleterious effects of electron beam radiation on allergen extracts

BACKGROUND: The recent threat to the public posed by the dissemination of Bacillus anthracis through the US postal system has resulted in increased security measures, including electron beam irradiation for the sterilization of some mail. The deleterious effects of electron beam radiation on biological products are not fully understood. OBJECTIVE: The purpose of this investigation was to assess the effect of electron beam radiation, as currently used to sterilize packages and mail in the United States, on several standardized or characterized allergen extracts. METHODS: Selected irradiated extracts were analyzed for allergen content and potency by SDS-PAGE, immunoblot, and ELISA (including inhibition) and compared with untreated extracts. RESULTS: The compositions and immunochemical potencies of these products were altered significantly by irradiation treatment. Physical changes to native protein structures observed after electrophoretic separations coincided with near-complete loss of allergenic and antigenic epitopes present on major and minor allergens, according to ELISA and immunoblot comparisons with untreated extracts. CONCLUSIONS: These results indicate that extracts subjected to electron beam sterilization conditions are likely to contain modified component structures and properties that might compromise the clinical effectiveness of these products.     

Improving intensity-modulated radiation therapy using the anatomic beam orientation optimization algorithm

A novel, anatomic beam orientation optimization (A-BOO) algorithm is proposed to significantly improve conventional intensity-modulated radiation therapy (IMRT). The A-BOO algorithm vectorially analyses polygonal surface mesh data of contoured patient anatomy. Five optimal (5-opt) deliverable beam orientations are selected based on (1) tangential orientation bisecting the target and adjacent organ's-at-risk (OARs) to produce precipitous dose gradients between them and (2) parallel incidence with polygon features of the target volume to facilitate conformal coverage. The 5-opt plans were compared to standard five, seven, and nine equiangular-spaced beam plans (5-equi, 7-equi, 9-equi) for: (1) gastric, (2) Radiation Therapy Oncology Group (RTOG) P-0126 prostate, and (3) RTOG H-0022 oropharyngeal (stage-III, IV) cancer patients. In the gastric case, the noncoplanar 5-opt plan reduced the right kidney V 20 Gy by 32.2%, 23.2%, and 20.6% compared to plans with five, seven, and nine equiangular-spaced beams. In the prostate case, the coplanar 5-opt plan produced similar rectal sparing as the 7-equi and 9-equi plans with a reduction of the V 75, V 70, V 65, and V 60 Gy of 2.4%, 5.3%, 7.0%, and 9.5% compared to the 5-equi plan. In the stage-III and IV oropharyngeal cases, the noncoplanar 5-opt plan substantially reduced the V 30 Gy and mean dose to the contralateral parotid compared to plans with five, seven, and nine equiangular-spaced beams: (stage-III) 7.1%, 5.2%, 6.8%, and 5.1, 3.5, 3.7 Gy and (stage-IV) 10.2%, 10.2%, 9.8% and 7.0, 7.1, 7.2 Gy. The geometry-based A-BOO algorithm has been demonstrated to be robust for application to a variety of IMRT treatment sites. Beam orientations producing significant improvements in OAR sparing over conventional IMRT can be automatically produced in minutes compared to hours with existing dose-based beam orientation optimization methods.     

Computer-assisted selection of coplanar beam orientations in intensity-modulated radiation therapy

In intensity-modulated radiation therapy (IMRT), the incident beam orientations are often determined by a trial and error search. The conventional beam's-eye view (BEV) tool becomes less helpful in IMRT because it is frequently required that beams go through organs at risk (OARs) in order to achieve a compromise between the dosimetric objectives of the planning target volume (PTV) and the OARs. In this paper, we report a beam's-eye view dosimetrics (BEVD) technique to assist in the selection of beam orientations in IMRT. In our method, each beam portal is divided into a grid of beamlets. A score function is introduced to measure the 'goodness' of each beamlet at a given gantry angle. The score is determined by the maximum PTV dose deliverable by the beamlet without exceeding the tolerance doses of the OARs and normal tissue located in the path of the beamlet. The overall score of the gantry angle is given by a sum of the scores of all beamlets. For a given patient. the score function is evaluated for each possible beam orientation. The directions with the highest scores are then selected as the candidates for beam placement. This procedure is similar to the BEV approach used in conventional radiation therapy, except that the evaluation by a human is replaced by a score function to take into account the intensity modulation. This technique allows one to select beam orientations without the excessive computing overhead of computer optimization of beam orientation. It also provides useful insight into the problem of selection of beam orientation and is especially valuable for complicated cases where the PTV is surrounded by several sensitive structures and where it is difficult to select a set of 'good' beam orientations. Several two-dimensional (2D) model cases were used to test the proposed technique. The plans obtained using the BEVD-selected beam orientations were compared with the plans obtained using equiangular spaced beams. For all the model cases investigated, the use of BEVD-selected beam orientations improved the dose distributions significantly. These examples indicate that the technique has considerable potential for simplifying the IMRT treatment planning process and allows for better utilization of the technical capacity of IMRT.     

Measurement of the restricted linear energy transfer of stray radiation close to the treatment volume of 12 and 18 MeV clinical photon beams

The restricted dose mean linear energy transfer (LET) (L500,D) of the stray radiation field a few centimeters outside the treatment volume has been measured for 12 and 18 MV photons produced by a clinical Therac-20 (AECL) accelerator. The measurements were performed as a function of field size and distance from the edge of the treatment volume, using the method of the high-pressure ionization chamber. Contrary to what was found in a previous investigation for a clinical Co-60 unit and despite the presence of photoneutrons (in the case of 18 MV photons), the L500,D outside the beam does not increase significantly relative to the L500,D of the primary beam.     

Radiation-induced cardiomyopathy as a function of radiation beam gating to the cardiac cycle

Portions of the heart are often unavoidably included in the primary treatment volume during thoracic radiotherapy, and radiation-induced heart disease has been observed as a treatment-related complication. Such complications have been observed in humans following radiation therapy for Hodgkin's disease and treatment of the left breast for carcinoma. Recent attempts have been made to prevent re-stenosis following angioplasty procedures using external beam irradiation. These attempts were not successful, however, due to the large volume of heart included in the treatment field and subsequent cardiac morbidity. We suggest a mechanism for sparing the heart from radiation damage by synchronizing the radiation beam with the cardiac cycle and delivering radiation only when the heart is in a relatively hypoxic state. We present data from a rat model testing this hypothesis and show that radiation damage to the heart can be altered by synchronizing the radiation beam with the cardiac cycle. This technique may be useful in reducing radiation damage to the heart secondary to treatment for diseases such as Hodgkin's disease and breast cancer.     

Effect of low-dose radiation on the main organs of erythro-and lymphocytopoiesis in the human fetus

The liver, thymus, and blood of 31 human fetuses of 6–32 weeks of gestation obtained from parents who are permanent residents in radionuclide-contaminated regions are studied by histological methods. The pathological effect of environmental factors on fetal liver and thymus development are shown. Both the liver hemopoiesis and thymic lymphocytopoiesis are inhibited. In the thymus and increased secretion in the stromal epithelium is associated with the formation of specific microtubules. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 119, No. 5, pp. 548–551, May, 1995 Presented by N. K. Permyakov, Member of the Russian Academy of Medical Sciences     

Assessment of the biocompatibility of photosensitive polyimide for implantable medical device use

Polyimides have been widely used for biosensor encapsulation and more recently as substrates for neural implants. They have excellent thermal stability, high chemical resistance, and can be prepared as thin, flexible films. Photosensitive polyimides present similar physical properties to polyimides, and have the advantage that they can be photo-lithographically patterned. However, to date little data on their biocompatibility has been reported. Two commercially available polyimides (PI) and one photo-sensitive polyimide (PSPI) were evaluated in vitro using the ISO 10993 standard on biocompatibility. The materials were Dupont Kapton foil HN, HD Microsystem PI2611, and Fujifilm Durimide 7020 (PSPI). PI2611 and Durimide 7020 were spin-coated on silicon wafers, cured at temperatures ranging from 150 to 450 degrees C, and sterilized by autoclave. All materials were evaluated using a scanning electron microscope pre- and postcell culture. Cell viability was determined by an MTS assay. Their mechanical properties and stability during cell culture as a function of time and environment were investigated by nanoindentation. The MTS results show that PSPI is noncytotoxic compared with the negative control of polyethylene and the conventional PIs tested. Fibroblast adhesion, morphology, and spreading were good and better on the PSPI substrate than on the PI2611. Schwann cell appearance was similar on each of the PIs and the PSPI tested. The results suggest that PSPIs may have potential use for biological microsystem and neuroprosthetic applications.