"Tool-in-lesion" Accuracy of Galaxy System-A Robotic Electromagnetic Navigation BroncHoscopy With Integrated Tool-in-lesion-Tomosynthesis Technology: The MATCH Study

BACKGROUND

The Galaxy System (Noah Medical) is a novel robotic endoluminal platform using electromagnetic navigation combined with integrated tomosynthesis technology and augmented fluoroscopy. It provides intraprocedural imaging to correct computerized tomography (CT) to body divergence and novel confirmation of tool-in-lesion (TIL). The primary aim of this study was to assess the TIL accuracy of the robotic bronchoscope with integrated digital tomosynthesis and augmented fluoroscopy.

METHODS

Four operators conducted the experiment using 4 pigs. Each physician performed between 4 and 6 nodule biopsies for 20 simulated lung nodules with purple dye and a radio pacifier. Using Galaxy's "Tool-in-Lesion Tomography (TOMO+)" with augmented fluoroscopy, the physician navigated to the lung nodules, and a tool (needle) was placed into the lesion. TIL was defined by the needle in the lesion determined by cone-beam CT.

RESULTS

The lung nodule's average size was 16.3 ± 0.97 mm and was predominantly in the lower lobes (65%). All 4 operators successfully navigated to all (100%) of the lesions in an average of 3 minutes and 39 seconds. The median number of tomosynthesis sweeps was 3 and augmented fluoroscopy was utilized in most cases (17/20 or 85%). TIL after the final TOMO sweep was 95% (19/20) and tool-touch-lesion was 5% (1/20). Biopsy yielding purple pigmentation was also 100% (20/20).

CONCLUSION

The Galaxy System demonstrated successful digital TOMO confirmed TIL success in 95% (19/20) of lesions and tool-touch-lesion in 5% (1/20) as confirmed by cone-beam CT. Successful diagnostic yield was achieved in 100% (20/20) of lesions as confirmed by intralesional pigment acquisition.

Advances in navigating to the nodule and targeting

PURPOSE OF REVIEW

The multitude of available platforms and imaging modalities for navigational bronchoscopy, in combination with the various sampling tools that can be used intra-procedurally, is complex. This review seeks to describe the recent developments in peripheral bronchoscopy in regards to navigation, imaging, and sampling target lesions in the pulmonary parenchyma.

RECENT FINDINGS

Robotic assisted bronchoscopy has improved navigation to the peripheral airways for sampling of peripheral parenchymal lesions. These navigational platforms use innovative technology utilizing electromagnetic navigation and shape-sensing technology for guidance. The greatest improvement has been the stabilization of the robotic scope in the periphery to allow for accurate sampling. Despite improvements in these platforms, limitations of CT to body divergence continue to impact navigation to the lesion and therefore diagnostic yield of the procedure. Advanced intraprocedural imaging with cone beam CT or augmented fluoroscopy has been a recent focus to improve this area. Further, the adoption of newer sampling tools, such as cryobiopsy, offers the possibility of increased diagnostic yield.

SUMMARY

The developments in advanced bronchoscopy will impact the role of biopsy in the diagnosis of peripheral pulmonary parenchymal lesions.

The non-ionizing electromagnetic stimulation enhanced antibody production (NESEAP) effect - Discovery and technological applications

The rise of biological therapeutics in the global pharmaceuticals market has escalated the demand for quality monoclonal antibodies for healthcare and scientific applications. Reducing costs while enhancing production yields without compromising quality are the main challenges to the growth of this industry today. Over the last two decades non-ionizing radiation has been demonstrated to elicit targeted biological responses in a frequency and dose dependent manner. We hypothesize and design a millimeter wave radiation procedure to enhance the yields of antibody-producing hybridoma cell lines. We demonstrate this method enhances the production of IgA and IgG antibodies from MOPC315.BM and U13.6 cells by a factor of 24.05 ± 3.32 and 1.41 ± 0.03 respectively relative to untreated cells. No treatment associated cytotoxicity was observed in either cell line corroborating physiological viability of irradiated cells. Our results demonstrate proof-of-concept of a novel technique to significantly enhance antibody yields from hybridoma cells which could lead to a reduction in antibody production costs. Further studies will focus on scaling up of this technology and employment of non-contact, tuned electromagnetic stimulation of biological systems for targeted responses.

Peripheral Nerve Stimulation With a High-Frequency Electromagnetic Coupled Powered Implanted Receiver at the Posterior Tibial Nerve for the Treatment of Chronic Pain in the Foot

INTRODUCTION

Peripheral neuropathy has several causes, with diabetes being the most common. Conservative management may fail to control pain. Our study aimed at evaluating the use of peripheral nerve stimulation of the posterior tibial nerve for treating peripheral neuropathy.

MATERIALS AND METHODS

This was an observational study of 15 patients who received peripheral nerve stimulation at the posterior tibial nerve to treat peripheral neuropathy. Outcomes measured were improvement of pain scores and Patient Global Impression of Change (PGIC) at 12 months compared with before the implant.

RESULTS

Mean pain scores with the verbal rating scale were 3 ± 1.8 at >12 months compared with 8.6 ± 1.2 at baseline, a reduction of 65% (p < 0.001). Median satisfaction with the PGIC at >12 months was 7 of 7, with most subjects reporting a 6 (better) or a 7 (a great deal better).

CONCLUSION

Peripheral nerve stimulation of the posterior tibial nerve can be a safe and effective modality for treating chronic pain symptoms related to peripheral neuropathy of the foot.

Synthesis and characterisation of Zn-doped cerium oxide nanoparticles for electromagnetic radiation shielding

CeO2-NPs (nanoparticles) exhibit a variety of properties, which have prompted researchers to explore various applications, such as gas sensing, biomedical, Electromagnetic Interference (EMI) shielding, etc. Zn-doped CeO2-NPs with concentrations ranging from 7 to 11 mol were synthesised using Aloe vera extract as a reducing agent by the solution combustion method. As obtained, NPs were characterised by standard techniques. Braggs reflections confirm the formation of a single-phase cubic structure of CeO2Zn NPs. Crystalline size is calculated using both the W-H plot and the Scherrer equation, which were found to be 12 and 9 nm, respectively. The Energy-dispersive X-ray analysis (EDAX) pattern confirmed the presence of Ce, O and Zn. The direct energy band values are found to be decreasing from 3 to 2.87 eV with an increase in the doping concentration of Zn from 7 to 11 mol. Total shielding efficiency (SET) will give the best representation of shielding properties. The SEt values of CeO2Zn NPs are compared to those of other conventional materials and NP materials, finding significant applications in EMI shielding.

Synthesis and characterization of calcium-iron-chromium nanocomposites for electromagnetic radiation shielding application

Over a century, shielding harmful electromagnetic radiations (EMR) and finding a suitable material, which can replace lead has become the major interest of researchers in this field. Herein, calcium-iron-chromium oxide nanocomposites with the different atomic ratios are synthesized using the solution combustion method. The as-obtained nanoparticles (NPs) are subjected to several structural and surface characteristics such as powder X-ray diffraction, scanning electron microscopy, elemental diffraction X-ray analysis, Fourier Transform Infrared Spectroscopy and UV-visible spectroscopy analysis were performed to confirm the successful synthesis. Furthermore, the EMR shielding of as-procured NPs is investigated and observed that the obtained NPs show good shielding properties.

Training Universal Deep-Learning Networks for Electromagnetic Medical Imaging Using a Large Database of Randomized Objects

Deep learning has become a powerful tool for solving inverse problems in electromagnetic medical imaging. However, contemporary deep-learning-based approaches are susceptible to inaccuracies stemming from inadequate training datasets, primarily consisting of signals generated from simplified and homogeneous imaging scenarios. This paper introduces a novel methodology to construct an expansive and diverse database encompassing domains featuring randomly shaped structures with electrical properties representative of healthy and abnormal tissues. The core objective of this database is to enable the training of universal deep-learning techniques for permittivity profile reconstruction in complex electromagnetic medical imaging domains. The constructed database contains 25,000 unique objects created by superimposing from 6 to 24 randomly sized ellipses and polygons with varying electrical attributes. Introducing randomness in the database enhances training, allowing the neural network to achieve universality while reducing the risk of overfitting. The representative signals in the database are generated using an array of antennas that irradiate the imaging domain and capture scattered signals. A custom-designed U-net is trained by using those signals to generate the permittivity profile of the defined imaging domain. To assess the database and confirm the universality of the trained network, three distinct testing datasets with diverse objects are imaged using the designed U-net. Quantitative assessments of the generated images show promising results, with structural similarity scores consistently exceeding 0.84, normalized root mean square errors remaining below 14%, and peak signal-to-noise ratios exceeding 33 dB. These results demonstrate the practicality of the constructed database for training deep learning networks that have generalization capabilities in solving inverse problems in medical imaging without the need for additional physical assistant algorithms.

Standard low-resolution electromagnetic tomography imaging of brain for the analysis of mental fatigue during a simulated air traffic control task

BACKGROUND

Standard low-resolution electromagnetic tomography (sLORETA) was used to accurately detect EEG changes in mental fatigue of air traffic controllers (ATCo) under a simulated air traffic control (ATC) task. We explored the changes in standard current density, activated cortical intensity, and brain source location.

METHODS

The participants were instructed to use the tower flight command simulation training system for three hours of uninterrupted ATC task. The 3-hour EEG signal was divided into four stages: task start, 1st hour, 2nd hour, and task end. Each stage was preprocessed for 3 minutes to explore the EEG changes and then processed by sLORETA in a statistical non-parametric mapping analysis.

RESULTS

The current density distribution of δ and α oscillations differed significantly during the four tasks, while θ, β and γ oscillations did not. Changes in δ oscillations of the brain during mental fatigue were detected mainly in the postcentral gyrus (BA2 and BA3), precentral gyrus (BA4 and BA6), inferior temporal gyrus (BA20), and superior temporal gyrus (BA38). The α oscillations were found mainly decreased in the postcentral gyrus (BA2) and inferior parietal lobule (BA40) when the task was in progress compared with the end of the task.

CONCLUSION

The superior temporal gyrus and somatosensory cortex were the main activated cortical regions during the simulated ATC task. The α and δ oscillations showed contrasting activity during simulated ATC task, which might reflect the release of task-relevant brain's areas from inhibition and enhance the neural activity.

Novel electromagnetic navigation bronchoscopy system for the diagnosis of peripheral pulmonary nodules: a prospective, multicentre study

BACKGROUND

Traditional electromagnetic navigation bronchoscopy (ENB) is a real-time image-guided system and used with thick bronchoscopes for the diagnosis of peripheral pulmonary nodules (PPNs). A novel ENB that could be used with thin bronchoscopes was developed. This study aimed to evaluate the diagnostic yield and the experience of using this ENB system in a real clinical scenario.

METHODS

This multicentre study enrolled consecutive patients with PPNs adopting ENB from March 2019 to August 2021. ENB was performed with different bronchoscopes, ancillary techniques and sampling instruments according to the characteristics of the nodule and the judgement of the operator. The primary endpoint was the diagnostic yield. The secondary endpoints included the diagnostic yield of subgroups, procedural details and complication rate.

RESULTS

In total, 479 patients with 479 nodules were enrolled in this study. The median lesion size was 20.9 (IQR, 15.9-25.9) mm. The overall diagnostic yield was 74.9% (359/479). A thin bronchoscope was used in 96.2% (461/479) nodules. ENB in combination with radial endobronchial ultrasound (rEBUS), a guide sheath (GS) and a thin bronchoscope was the most widely used guided method, producing a diagnostic yield of 74.1% (254/343). The median total procedural time was 1325.0 (IQR, 1014.0-1676.0) s. No severe complications occurred.

CONCLUSION

This novel ENB system can be used in combination with different bronchoscopes, ancillary techniques and sampling instruments with a high diagnostic yield and safety profile for the diagnosis of PPNs, of which the combination of thin bronchoscope, rEBUS and GS was the most common method in clinical practice.

TRIAL REGISTRATION NUMBER

NCT03716284.

A scintillation dosimeter with real-time positional tracking information for in vivo dosimetry error detection in HDR brachytherapy

PURPOSE

To evaluate the performance of an electromagnetic (EM)-tracked scintillation dosimeter in detecting source positional errors of IVD in HDR brachytherapy treatment.

MATERIALS AND METHODS

Two different scintillator dosimeter prototypes were coupled to 5 degrees-of-freedom (DOF) EM sensors read by an Aurora V3 system. The scintillators used were a 0.3 × 0.4 × 0.4 mm3 ZnSe:O and a BCF-60 plastic scintillator of 0.5 mm diameter and 2.0 mm in length (Saint-Gobain Crystals). The sensors were placed at the dosimeter's tip at 20.0 mm from the scintillator. The EM sampling rate was 40/s while the scintillator signal was sampled at 100 000/s using two photomultiplier tubes from Hamamatsu (series H10722) connected to a data acquisition board. A high-pass filter and a low-pass filter were used to separate the light signal into two different channels. All measurements were performed with an afterloader unit (Flexitron-Elekta AB, Sweden) in full-scattered (TG43) conditions. EM tracking was further used to provide distance/angle-dependent energy correction for the ZnSe:O inorganic scintillator. For the error detection part, lateral shifts of 0.5 to 3 mm were induced by moving the source away from its planned position. Indexer length (longitudinal) errors between 0.5 to 10 mm were also introduced. The measured dose rate difference was converted to a shift distance, with and without using the positional information from the EM sensor.

RESULTS

The inorganic scintillator had both a signal-to-noise-ratio (SNR) and signal-to-background-ratio (SBR) close to 70 times higher than those of the plastic scintillator. The mean absolute difference from the dose measurement to the dose calculated with TG-43U1 was 1.5% ±0.7%. The mean absolute error for BCF-60 detector was 1.7%± 1.2 % $\pm 1.2\%$ when compared to TG-43 calculations formalism. With the inorganic scintillator and EM tracking, a maximum area under the curve (AUC) gain of 24.0% was obtained for a 0.5-mm lateral shift when using the EMT data with the ZnSe:O. Lower AUC gains were obtained for a 3-mm lateral shifts with both scintillators. For the plastic scintillator, the highest gain from using EM tracking information occurred for a 0.5-mm lateral shift at 20 mm from the source. The maximal gain (17.4%) for longitudinal errors was found at the smallest shifts (0.5 mm).

CONCLUSIONS

This work demonstrates that integrating EM tracking to in vivo scintillation dosimeters enables the detection of smaller shifts, by decreasing the dosimeter positioning uncertainty. It also serves to perform position-dependent energy correction for the inorganic scintillator,providing better SNR and SBR, allowing detection of errors at greater distances from the source.

Small-bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition

BACKGROUND

The Cortrak Enteral Access System (CEAS) was previously approved by the United States Food and Drug Administration (FDA) to be used in lieu of radiographic confirmation imaging for feeding tubes placed by trained clinicians. Following an institutional protocol change in 2016, our registered dietitians had the option to forgo radiographic confirmation imaging for tubes placed using the CEAS. Our research aimed to determine the difference in the number of radiographic confirmation images for feeding tubes placed using the CEAS between preprotocol and postprotocol environments and the associated cost avoidance after the institutional policy change.

METHODS

We retrospectively reviewed data from 506 tube placements (n = 253 per protocol environment) in adult patients with diverse diagnoses admitted to various in-patient care units.

RESULTS

There was a significant reduction in the mean number of radiographic images per tube placement (preprotocol = 1.10 [95% CI, 1.05-1.15]; postprotocol = 0.36 [95% CI, 0.30-0.41]; P < 0.001), leading to a cost avoidance of $67,282.80 for the 253 tube placements and a potential cost avoidance of $279,236 over the 5-year postprotocol environment. Additionally, the mean time to initiation of enteral nutrition was significantly reduced by 2.65 h in the postprotocol environment (P < 0.001).

CONCLUSION

Our findings suggest that using the CEAS can reduce the number of radiographic images, provide cost avoidance, and improve nutrition outcomes. However, updated 2022 FDA regulatory changes to the use of the CEAS for tube confirmation lead to an uncertain future for this practice because of safety concerns.

Employing direct electromagnetic coupling to assess acute fracture healing: An ovine model assessment

OBJECTIVES

This study explored the efficacy of collecting temporal fracture site compliance data via an advanced direct electromagnetic coupling (DEC) system equipped with a Vivaldi-type antenna, novel calibration technique, and multi-antenna setup (termed maDEC) as an approach to monitor acute fracture healing progress in a translational large animal model. The overarching goal of this approach was to provide insights into the acute healing dynamics, offering a promising avenue for optimizing fracture management strategies.

METHODS

A sample of twelve sheep, subjected to ostectomies and intramedullary nail fixations, was divided into two groups, simulating normal and impaired healing scenarios. Sequential maDEC compliance or stiffness measurements and radiographs were taken from the surgery until euthanasia at four or eight weeks and were subsequently compared with post-sacrifice biomechanical, micro-CT, and histological findings.

RESULTS

The results showed that the maDEC system offered straightforward quantification of fracture site compliance via a multiantenna array. Notably, the rate of change in the maDEC-measured bending stiffness significantly varied between normal and impaired healing groups during both the 4-week (p = 0.04) and 8-week (p = 0.02) periods. In contrast, radiographically derived mRUST healing measurements displayed no significant differences between the groups (p = 0.46). Moreover, the cumulative normalized stiffness maDEC data significantly correlated with post-sacrifice mechanical strength (r2 = 0.80, p < 0.001), micro-CT measurements of bone volume fraction (r2 = 0.60, p = 0.003), and density (r2 = 0.60, p = 0.003), and histomorphometric measurements of new bone area fraction (r2 = 0.61, p = 0.003) and new bone area (r2 = 0.60, p < 0.001).

CONCLUSIONS

These data indicate that the enhanced maDEC system provides a non-invasive, accurate method to monitor fracture healing during the acute healing phase, showing distinct stiffness profiles between normal and impaired healing groups and offering critical insights into the healing process's progress and efficiency.

Regulation of myogenesis and adipogenesis by the electromagnetic perceptive gene

Obesity has been increasing in many regions of the world, including Europe, USA, and Korea. To manage obesity, we should consider it as a disease and apply therapeutic methods for its treatment. Molecular and therapeutic approaches for obesity management involve regulating biomolecules such as DNA, RNA, and protein in adipose-derived stem cells to prevent to be fat cells. Multiple factors are believed to play a role in fat differentiation, with one of the most effective factor is Ca2+. We recently reported that the electromagnetic perceptive gene (EPG) regulated intracellular Ca2+ levels under various electromagnetic fields. This study aimed to investigate whether EPG could serve as a therapeutic method against obesity. We confirmed that EPG serves as a modulator of Ca2+ levels in primary adipose cells, thereby regulating several genes such as CasR, PPARγ, GLU4, GAPDH during the adipogenesis. In addition, this study also identified EPG-mediated regulation of myogenesis that myocyte transcription factors (CasR, MyoG, MyoD, Myomaker) were changed in C2C12 cells and satellite cells. In vivo experiments carried out in this study confirmed that total weight/ fat/fat accumulation were decreased and lean mass was increased by EPG with magnetic field depending on age of mice. The EPG could serve as a potent therapeutic agent against obesity.

Detailed high quality surface-based mouse CAD model suitable for electromagnetic simulations

Transcranial magnetic stimulation (TMS) studies with small animals can provide useful knowledge of activating regions and mechanisms. Along with this, functional magnetic resonance imaging (fMRI) in mice and rats is increasingly often used to draw important conclusions about brain connectivity and functionality. For cases of both low- and high-frequency TMS studies, a high-quality computational surface-based rodent model may be useful as a tool for performing supporting modeling and optimization tasks. This work presents the development and usage of an accurate CAD model of a mouse that has been optimized for use in computational electromagnetic modeling in any frequency range. It is based on the labeled atlas data of the Digimouse archive. The model includes a relatively accurate four-compartment brain representation (the 'whole brain' according to the original terminology, external cerebrum, cerebellum, and striatum [9]) and contains 21 distinct compartments in total. Four examples of low- and high frequency modeling have been considered to demonstrate the utility and applicability of the model.

The effect of combining different sampling tools on the performance of electromagnetic navigational bronchoscopy for the evaluation of peripheral lung lesions and factors associated with its diagnostic yield

BACKGROUND

We assessed the performance of Electromagnetic navigational bronchoscopy (ENB) as a standalone diagnostic technique and the performance of different sampling tools used during the procedure.

METHODS

We recruited 160 consecutive patients who underwent ENB for peripheral lung lesions (PLL) at a tertiary care centre. The diagnostic performance of ENB and sampling tools was assessed using a logistic regression model and a ROC-curve in which the dependent variable was diagnostic success. A multivariate model was built to predict diagnostic success before performing ENB to select the best candidates for the procedure.

RESULTS

Most patients with PLLs in the study were male (65%), with a mean age of 67.9 years. The yield was 66% when the most common techniques were used together as suction catheter + transbronchial biopsy forceps (TBBx) + bronchoalveolar lavage + bronchial washing (p < 0.001) and increased to 69% when transbronchial needle aspiration (TBNA) and cytology brush were added (p < 0.001). Adding diagnostic techniques such as TBBx and TBNA resulted in an increase in diagnostic performance, with a statistically significant trend (p = 0.002). The logistic model area-under the ROC-curve for diagnostic success during ENB was 0.83 (95% CI:0.75-0.90; p < 0.001), and a logit value ≥ 0.12 was associated with ≥ 50% probability of diagnostic success.

CONCLUSIONS

ENB, as a stand-alone diagnostic tool for the evaluation of PLLs when performed by experienced operators using a multi-modality technique, has a good diagnostic yield. The probability of having a diagnostic ENB could be assessed using the proposed model.

Surgeon and Radiologist Evaluation of Electromagnetic Chip Localization for Benign and Malignant Breast Lesions

BACKGROUND

SmartClipTM is a food and drug administration-approved, electromagnetic chip (EMC) localization system that provides three-dimensional navigation for the excision of soft tissue lesions. The purpose of this study was to analyze the accuracy and feasibility of EMC radiologic and surgical localization for benign and malignant breast lesions.

PATIENTS AND METHODS

An institutional review board-approved, single institution, prospective study from October 2020 to September 2022 of 38 women undergoing breast conserving surgery with EMC localization of a single lesion > 5 mm on mammogram (MMG) or ultrasound (US) imaging. Surveys from performing breast radiologists and breast surgeons were collected after image-guided localization and surgical excision.

RESULTS

Seventy-six survey responses from nine radiologists and four surgeons were received. The deployment needle and EMC were highly visible in 86.8% and 76.3% of procedures, respectively. There was no difficulty in deployment for 92.1% of procedures. The EMC was in the correct location on postdeployment MMG in 97.4% of cases. Three instances of EMC migration occurred, one 1 cm from target lesion. The targeted mass and EMC were within the surgical specimen in 97.4% of cases. On specimen radiograph, 39.5% of the EMCs were 0-1 mm from the center of the target lesion, 18.4% were within 2-4 mm, and 23.7% were within 5-10 mm. Mean operating room time for all cases was 65 min. One case required US to localize the target due to console malfunction.

CONCLUSION

There was successful EMC deployment by radiologists with accurate visualization and successful surgical excision in most cases. The EnVisioTM SmartClipTM system is a reproducible and accurate localization method for benign and malignant breast lesions.

[The inverse stochastic resonance in a small-world neuronal network under electromagnetic stimulation]

Electromagnetic stimulation is an important neuromodulation technique that modulates the electrical activity of neurons and affects cortical excitability for the purpose of modulating the nervous system. The phenomenon of inverse stochastic resonance is a response mechanism of the biological nervous system to external signals and plays an important role in the signal processing of the nervous system. In this paper, a small-world neural network with electrical synaptic connections was constructed, and the inverse stochastic resonance of the small-world neural network under electromagnetic stimulation was investigated by analyzing the dynamics of the neural network. The results showed that: the Levy channel noise under electromagnetic stimulation could cause the occurrence of inverse stochastic resonance in small-world neural networks; the characteristic index and location parameter of the noise had significant effects on the intensity and duration of the inverse stochastic resonance in neural networks; the larger the probability of randomly adding edges and the number of nearest neighbor nodes in small-world networks, the more favorable the anti-stochastic resonance was; by adjusting the electromagnetic stimulation parameters, a dual regulation of the inverse stochastic resonance of the neural network can be achieved. The results of this study provide some theoretical support for exploring the regulation mechanism of electromagnetic nerve stimulation technology and the signal processing mechanism of nervous system.

Outcomes of the electromagnetic navigation bronchoscopy using forceps for lung lesion suspected malignancy: A retrospective study

Many studies have reported electromagnetic navigation bronchoscopy (ENB) diagnostic yields and the importance of size and computed tomography (CT) bronchus sign. This study aimed to determine the diagnostic yield of ENB alone, using forceps biopsy and cytology. We analyzed the factors associated with yield and complications according to gross specimen size. This retrospective study included patients who underwent ENB using forceps for suspected lung lesions on CT between January 2020 and December 2022 in South Korea. Factors related to the ENB diagnostic yield and complications were evaluated, and the impacts of gross specimen size and cytology were analyzed. A total of 276 patients were analyzed. The final diagnostic yield was 75.5% after excluding indeterminate cases. Sensitivity and specificity were 74.2% and 100%, respectively. Pneumothorax developed in 1.4% (4/276) of cases, with no grade 3 or higher bleeding. Univariable analysis showed that the number of biopsies and the size of the gross specimen were related to the diagnosis. Multivariable analyses showed that a larger lesion size on CT was a significant factor for diagnosis. The gross size of the specimens was not significantly associated with epinephrine use. ENB had acceptable diagnostic yield and safety for diagnosing lung lesions with suspected malignancy. Obtaining more tissue through biopsy may not increase bleeding or pneumothorax complications. Identifying patients with lesion characteristics, including CT bronchus sign, would help increase ENB diagnostic yield.

Radial Endobronchial Ultrasound and Electromagnetic Navigation Bronchoscopy with Fluoroscopy for the Diagnosis of Peripheral Lung Lesions

Diagnosing lung cancer using a flexible bronchoscope is a safe procedure with a very low risk of complications. Bronchoscopy has high diagnostic accuracy for endobronchial lesions, but it falls short when sampling peripheral lesions. Therefore, several modalities have been invented to guide the bronchoscope to the lesion and confirm the location of the tumor before tissue sampling. Fluoroscopy is used during bronchoscopy to provide a 2D X-ray image of the thorax during the procedure. The bronchoscope and tools will be visible, as well as lesions if larger than 2.0-2.5 cm. Radial endobronchial ultrasound (rEBUS) consists of an ultrasound probe, small enough to be inserted into the working channel of the bronchoscope. The ultrasound probe is used to differentiate between consolidated tissue, such as tumor tissue, and normal air-filled lung parenchyma. Electromagnetic navigation bronchoscopy (ENB) creates a 3D model of the bronchial tree from computed tomography (CT) scans of the patient. Prior to the bronchoscopy, a route from the trachea to the lesion is planned, to create real-time guidance of the bronchoscope to the lesion during the procedure, similar to the Global Positioning System. The aim of this article is to describe a stepwise approach to performing bronchoscopy with rEBUS and fluoroscopy, bronchoscopy with ENB, rEBUS, and fluoroscopy. In the discussion section, the pros and cons of each modality will be discussed.

Evaluation the results of electromagnetic compatibility of a prototype device for ear stimulation in patients with tinnitus

<b><br>Aim:</b> The aim of the study was to evaluate the results of electromagnetic compatibility of a prototype device for ear stimulation in patients with tinnitus.</br> <b><br>Material and methods:</b> The electromagnetic compatibility tests of the prototype device for electro- and magnetostimulation of the hearing organ were carried out at the Center for Attestation and Certification Tests OBAC Sp. z o. o. in Gliwice in 2020. The following product standards were used: PN-EN 60601-1-2:2015-11 - medical electrical equipment (general requirements for basic safety and essential functioning; PN-EN 55011:2012 - industrial, scientific and medical equipment [characteristics of radio frequency disturbances] ) PN-EN 61000-3-2:2014-10 - electromagnetic compatibility (EMC), permissible levels of harmonic current emissions (phase load current ≤ 16 A).</br> <b><br>Results:</b> The level of expanded uncertainty in the measurement of conducted disturbances in the range of 0.150-30MHz does not exceed the level specified in the PN-EN-55016-4-2:2011 standard. In the study of the emission of radiated disturbances up to 1GHz in the frequency range of 30-1000MHz (PN-EN 55011:2012 standard), it was found that the setting of the EUT during the tests was in accordance with the requirements of the standard. The level of expanded uncertainty in the measurement of radiated disturbances in the 30-1000MHz range does not exceed the level specified in the PN-EN 55016-4-2:2011 standard. The measured current harmonic levels (phase power supply current ≤16A) with a frequency range of 50Hz-2kHz do not exceed the permissible levels specified in the PN-EN 61000-3-2:2014-10 standard. The test of resistance to the magnetic field at the frequency of the power grid (PN-EN 61000-4-8: 2010 standard also showed that the setting of the EUT during the tests was in accordance with the requirements of the standard and the result was positive.</br> <b><br>Conclusions:</b> Testing of immunity to radiated radio frequency electromagnetic field (PN-EN 61000-4-3:2007 +A1:2008+A2:2011 standard) and testing of resistance to magnetic field at power frequency (PN-EN 61000-4-8 standard :2010) did not exceed the level specified in the standard and showed a positive result. The measured harmonic levels of the network current (phase supply current ≤16A) with the frequency range 50Hz-2kHz do not exceed the permissible levels specified in the PN-EN 61000- 3-2:2014-10 standard for a class A device.</br>.

Electromagnetic force investigation of electromagnets with variable pole area in an electromagnetic diaphragm pump

Electromagnetic diaphragm pump is a kind of widely applied diaphragm pump that has promising sealing performance, simple structure and low power loss. Planar pole electromagnet is a significant component of the electromagnetic diaphragm pump. However, the sharply changing displacement-force characteristics of the planar pole electromagnet do not match the constant load characteristics of the electromagnetic diaphragm pump. Herein, an electromagnet with variable pole area is put forward. A theoretical relationship between structural parameters, the Ampere turns and the electromagnetic force of the electromagnet with variable pole area is determined by analyzing the equivalent magnetic circuit of the electromagnet with variable pole area. The experimental results imply that the initial electromagnetic force of the electromagnet with variable pole area is 32.51% larger than the planar pole electromagnet, the engaging electromagnetic force of the electromagnet with variable pole area is 22.3% smaller than the planar pole electromagnet and the displacement-force characteristics of the electromagnet with variable pole area match the constant load characteristics of the electromagnetic diaphragm pump.

Prediction of experimental cardiac magnetostimulation thresholds using pig-specific body models

PURPOSE

Modern high-amplitude gradient systems can be limited by the International Electrotechnical Commission 60601-2-33 cardiac stimulation (CS) limit, which was set in a conservative manner based on electrode experiments and E-field simulations in uniform ellipsoidal body models. Here, we show that coupled electromagnetic-electrophysiological modeling in detailed body and heart models can predict CS thresholds, suggesting that such modeling might lead to more detailed threshold estimates in humans. Specifically, we compare measured and predicted CS thresholds in eight pigs.

METHODS

We created individualized porcine body models using MRI (Dixon for the whole body, CINE for the heart) that replicate the anatomy and posture of the animals used in our previous experimental CS study. We model the electric fields induced along cardiac Purkinje and ventricular muscle fibers and predict the electrophysiological response of these fibers, yielding CS threshold predictions in absolute units for each animal. Additionally, we assess the total modeling uncertainty through a variability analysis of the 25 main model parameters.

RESULTS

Predicted and experimental CS thresholds agree within 19% on average (normalized RMS error), which is smaller than the 27% modeling uncertainty. No significant difference was found between the modeling predictions and experiments (p < 0.05, paired t-test).

CONCLUSION

Predicted thresholds matched the experimental data within the modeling uncertainty, supporting the model validity. We believe that our modeling approach can be applied to study CS thresholds in humans for various gradient coils, body shapes/postures, and waveforms, which is difficult to do experimentally.

Optimizing phosphorus fertigation management zones using electromagnetic induction, soil properties, and crop yield data under semi-arid conditions

The impact of climate change on water resource availability and soil quality is more and more emphasized under the Mediterranean basin, mostly characterized by drought and extreme weather conditions. The present study aims to investigate how electromagnetic induction technique and soil mapping combined with crop yield data can be used to optimize phosphorus (P) use efficiency by chickpea crop under drip fertigation system. The study was carried out on a 2.5-ha agricultural plot and the agronomic experiments in two growing cycles of chickpea crop. Soil spatial variability was first assessed by the measurement of soil apparent electrical conductivity (ECa) using the CMD Mini-Explorer sensor, and then, soil physicochemical properties were evaluated based on an oriented soil sampling scheme to explore other soil spatial variabilities influencing chickpea yield and quality. Data from the first agronomic experiment were used in geostatistical, multiple linear regression (MLR), and fuzzy c-means unsupervised classification algorithms to properly identify P drip fertigation management zones (MZs). Results from the Person's correlation analysis revealed that chickpea grain yield was more influenced by soil ECa (r = - 0.56), pH (r = - 0.84), ECe (r = - 0.6), P content (r = 0.72), and calcium (Ca) content (r = - 0.83). The proposed MLR-based model to predict chickpea grain yield showed good performances with a normalized root mean square error (NRMSE) of 0.11% and a coefficient of determination (R2) equal to 0.69. The identified MZs were verified by the one-way variance analysis for the studied soil and plant attributes, revealing that the first MZ1 presents a high grain yield, high soil P content, and low ECa. The low fertility MZ2 located in the south part of the studied site presented a low chickpea grain yield due to the low P content and the high ECa. Moreover, the application of P-variable rate fertigation regimes in the second field experiment significantly improved P use efficiency, chickpea grain yield, seed quality, and farmer income by 18%, 12%, 9%, and 136 $/ha, respectively, as compared to the conventional drip fertigation practices. The approach proposed in this study can greatly contribute to optimizing agro-input use efficiency under drip fertigation system, thereby improving farmers' incomes, preserving the ecosystem, and ensuring sustainable cropping systems in the Mediterranean climate.