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ImportanceAirline pilots and cabin crew are occupationally exposed to higher levels of cosmic and UV radiation than the general population, but their risk of developing melanoma is not yet established.ObjectiveTo assess the risk of melanoma in pilots and airline crew.Data sourcesPubMed (1966 to October 30, 2013), Web of Science (1898 to January 27, 2014), and Scopus (1823 to January 27, 2014).Study selectionAll studies were included that reported a standardized incidence ratio (SIR), standardized mortality ratio (SMR), or data on expected and observed cases of melanoma or death caused by melanoma that could be used to calculate an SIR or SMR in any flight-based occupation.Data extraction and synthesisPrimary random-effect meta-analyses were used to summarize SIR and SMR for melanoma in any flight-based occupation. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test.Main outcomes and measuresSummary SIR and SMR of melanoma in pilots and cabin crew.ResultsOf the 3527 citations retrieved, 19 studies were included, with more than 266 431 participants. The overall summary SIR of participants in any flight-based occupation was 2.21 (95% CI, 1.76-2.77; P

This paper presents a magnetic-field system and the method developed for testing the immunity of the active implantable medical devices to continuous-wave magnetic fields in the frequency range up to 1 MHz. The system is able to produce magnetic fields of 150 A/m for frequencies up to 100 kHz and strengths decreasing as 1/f between 100 kHz and 1 MHz, with uniformity of the field within [+ or -] 2.5% in the volume for tests. To simulate human tissue, the medical device, together with its leads, is placed on a plastic grid in a saline tank that is introduced in the magnetic field of the induction coil. This paper offers an alternative for the injection voltage methods provided in the actual standards for assessing the protection of the implantable medical devices from the effects of the magnetic fields up to 1 MHz. This paper presents the equipment and signals used, the test procedure, and results from the preliminary tests performed at the Food and Drug Administration-Center for Devices and Radiological Health on implantable pacemakers and neurostimulators. The new system and test method are useful for the EMC research on the implantable medical devices. Index Terms--Electromagnetic compatibility (EMC), electromagnetic interference (EMI), implantable biomedical devices, magnetic fields, pacemakers.

This paper presents a detailed numerical study of specific absorption rate (SAR) and temperature increase calculations within pregnant female models exposed to magnetic resonance imaging (MRI). Nine pregnant female models, representing different pregnant stages, were used for this study. SAR and temperature increase within and around fetuses at different pregnancy stages were calculated for two MRI operating modes (normal mode and first-level controlled mode) at 64 and 128 MHz. Local fetus energy deposition exceeds the International Electrotechnical Commission limit of 10 W/kg in the first-level controlled mode at 64 MHz. Fetus temperature exceeds or approaches 38 [degrees]C for both frequencies in the first-level controlled mode at later stages of pregnancy. The core temperature limits for both modes and both frequencies are not exceeded. The results show higher maximum SAR and higher temperature at 64 MHz and during later pregnancy stages with a significant increase starting with the fifth month of pregnancy. Based on the results of this study, radiologists can minimize local fetus heating, especially late in pregnancy, by using normal mode sequences, which minimize the whole body SAR in the mother. Index Terms--Electromagnetic heating, finite-difference method, magnetic resonance imaging (MRI), pregnant woman, safety standards.

The specific absorption rates (SAR) determined computationally in the specific anthropomorphic mannequin (SAM) and anatomically correct models of the human head when exposed to a mobile phone model are compared as part of a study organized by IEEE Standards Coordinating Committee 34, SubCommittee 2, and Working Group 2, and carried out by an international task force comprising 14 government, academic, and industrial research institutions. The detailed study protocol defined the computational head and mobile phone models. The participants used different finite-difference time-domain software and independently positioned the mobile phone and head models in accordance with the protocol. The results show that when the pinna SAR is calculated separately from the head SAR, SAM produced a higher SAR in the head than the anatomically correct head models. Also the larger (adult) head produced a statistically significant higher peak SAR for both the 1- and 10-g averages than did the smaller (child) head for all conditions of frequency and position. Index Terms--FDTD methods, IEEE standards, phantom, simulation, software standards, specific absorption rate (SAR), specific anthropomorphic mannequin (SAM).

We propose an efficient algorithm for the simulation of densely sampled biological objects. This technique is based on an algebraic multi-grid (AMG) accelerated Crank-Nicholson (CN) finite-difference time-domain (FDTD) method. Using this scheme, simulation time step sizes are no longer limited by the Courant-Friedrich-Levy (CFL) number. A practical guideline on how to choose appropriate time-step sizes for accurate bioelectromagnetic applications is also presented. Numerical examples are used to demonstrate the effectiveness of this technique. Index Terms--Algebraic multi-grid method, bio-electromagnetics, FDTD method, unconditionally stable algorithm.

This paper describes a novel simulator to perform electromagnetic compatibility (EMC) tests for active implantable medical devices (AIMDs) with electromagnetic fields emitted by security systems. The security system simulator was developed in response to over 100 incident reports over 17 years related to the interference of AIMD's with security systems and the lack of a standardized test method. The simulator was evaluated regarding field homogeneity, signal distortion, and maximum magnetic field strength levels. Small three-axis probes and a three-axis scanning system were designed to determine the spatial and temporal characteristics of the fields emitted by 12 different types of walk through metal detectors (WTMDs). Tests were performed on four implanted pacemakers with a saline phantom and correlated to a newly developed test method performed 'in air' (without the phantom). Comparison of the simulator thresholds with tests performed in real WTMDs showed that the simulator is able to mimic the pacemaker interference. The interference thresholds found in the simulator indicate that pulsed magnetic fields are more likely to cause interference in pacemakers than sinusoidal fields. The security system simulator will help biomedical engineers, manufacturers of medical devices, and manufacturers of security systems to identify incompatible combinations of WTMDs and AIMDs early in the development stage. Index Terms--EMC, EMI, metal detector, pacemaker, simulator.

Abstract Background Typically, electrodes for Deep Brain Stimulation (DBS) are used for chronic stimulation. However, there are conditions where this therapy has to be discontinued. In such cases using the DBS electrodes as a tool for thermo-lesioning (coagulation) could be used for an alternative treatment. The aim of this study was to determine if it is possible to generate coagula with a predictable geometry and to define their dimensions as a function of power and time in an in vitro model (egg white at room temperature). Furthermore, we tested if repetitive (cumulative) coagulation has an impact on the overall form and size of the clot. Findings Coagulation-growth was achieved as a function of power and duration of coagulation; reproducible well-formed thermocoagulations could be achieved. When using two adjacent electrodes a power range between 1.25 Watt and 2.00 Watt resulted in homogenous ovoid coagula. After two minutes of coagulation the clots reached a maximum in size and further growth could not be achieved. It was also possible to increase the size of a preformed clot by repetitive coagulation either by increasing the power level or the duration of the coagulation process. Conclusions We could show that it is possible to obtain predictable coagula in-vitro when using DBS electrodes for thermocoagulation even though they have not been developed for that specific purpose. However, until in-vivo safety and efficacy of DBS electrodes for ablation purposes is properly assessed, only approved electrodes should be used for brain ablation.

Abstract Background MRI induced heating on PM leads is a very complex issue. The widely varying results described in literature suggest that there are many factors that influence the degree of heating and that not always are adequately addressed by existing testing methods. Methods We present a wide database of experimental measurements of the heating of metallic wires and PM leads in a 1.5 T RF coil. The aim of these measurements is to systematically quantify the contribution of some potential factors involved in the MRI induced heating: the length and the geometric structure of the lead; the implant location within the body and the lead path; the shape of the phantom used to simulate the human trunk and its relative position inside the RF coil. Results We found that the several factors are the primary influence on heating at the tip. Closer locations of the leads to the edge of the phantom and to the edge of the coil produce maximum heating. The lead length is the other crucial factor, whereas the implant area does not seem to have a major role in the induced temperature increase. Also the lead structure and the geometry of the phantom revealed to be elements that can significantly modify the amount of heating. Conclusion Our findings highlight the factors that have significant effects on MRI induced heating of implanted wires and leads. These factors must be taken into account by those who plan to study or model MRI heating of implants. Also our data should help those who wish to develop guidelines for defining safe medical implants for MRI patients. In addition, our database of the entire set of measurements can help those who wish to validate their numerical models of implants that may be exposed to MRI systems.

Abstract We reviewed articles using computational RF dosimetry to compare the Specific Anthropomorphic Mannequin (SAM) to anatomically correct models of the human head. Published conclusions based on such comparisons have varied widely. We looked for reasons that might cause apparently similar comparisons to produce dissimilar results. We also looked at the information needed to adequately compare the results of computational RF dosimetry studies. We concluded studies were not comparable because of differences in definitions, models, and methodology. Therefore we propose a protocol, developed by an IEEE standards group, as an initial step in alleviating this problem. The protocol calls for a benchmark validation study comparing the SAM phantom to two anatomically correct models of the human head. It also establishes common definitions and reporting requirements that will increase the comparability of all computational RF dosimetry studies of the human head.

Abstract Background The purpose was to investigate mobile phone interference with implantable deep brain stimulators by means of 10 different 900 Mega Hertz (MHz) and 10 different 1800 MHz GSM (Global System for Mobile Communications) mobile phones. Methods All tests were performed in vitro using a phantom especially developed for testing with deep brain stimulators. The phantom was filled with liquid phantom materials simulating brain and muscle tissue. All examinations were carried out inside an anechoic chamber on two implants of the same type of deep brain stimulator: ITREL-III from Medtronic Inc., USA. Results Despite a maximum transmitted peak power of mobile phones of 1 Watt (W) at 1800 MHz and 2 W at 900 MHz respectively, no influence on the ITREL-III was found. Neither the shape of the pulse form changed nor did single pulses fail. Tests with increased transmitted power using CW signals and broadband dipoles have shown that inhibition of the ITREL-III occurs at frequency dependent power levels which are below the emissions of GSM mobile phones. The ITREL-III is essentially more sensitive at 1800 MHz than at 900 MHz. Particularly the frequency range around 1500 MHz shows a very low interference threshold. Conclusion These investigations do not indicate a direct risk for ITREL-III patients using the tested GSM phones. Based on the interference levels found with CW signals, which are below the mobile phone emissions, we recommend similar precautions as for patients with cardiac pacemakers: 1. The phone should be used at the ear at the opposite side of the implant and 2. The patient should avoid carrying the phone close to the implant.

Abstract According to manufacturers of both magnetic resonance imaging (MRI) machines, and implantable neurological pulse generators (IPGs), MRI is contraindicated for patients with IPGs. A major argument for this restriction is the risk to induce heat in the leads due to the electromagnetic field, which could be dangerous for the surrounding brain parenchyma. The temperature change on the surface of the case of an ITREL-III (Medtronic Inc., Minneapolis, MN) and the lead tip during MRI was determined. An anatomical realistic and a cubic phantom, filled with phantom material mimicking human tissue, and a typical lead configuration were used to imitate a patient who carries an IPG for deep brain stimulation. The measurements were performed in a 1.5 T and a 3.0 T MRI. 2.1°C temperature increases at the lead tip uncovered the lead tip as the most critical part concerning heating problems in IPGs. Temperature increases in other locations were low compared to the one at the lead tip. The measured temperature increase of 2.1°C can not be considered as harmful to the patient. Comparison with the results of other studies revealed the avoidance of loops as a practical method to reduce heating during MRI procedures.