Electromagnetic radiation therapy for Parkinson's disease tremor reduction- systematic reviews and Bayesian meta-analyses for comparing the effectiveness of electric, magnetic and light stimulation methods

PURPOSE

Tremor is one of the key characteristics of Parkinson's disease (PD), leading to physical disabilities and often showing limited responses to pharmacological treatments. To suppress tremors in PD patients, several types of non-invasive and non-pharmacological methods have been proposed so far. In the current systematic review, three electromagnetic-based radiation strategies including electrical stimulation, magnetic stimulation, and light stimulation methods were reviewed and compared.

METHODS

Major databases were searched to retrieve eligible studies. For the meta-analysis, a random-effect Bayesian framework was used. Also, heterogeneity between studies was assessed using I2 statistic, prediction interval, and tau2. Publication bias was assessed using funnel plot, and the effectiveness of methods for reducing tremor was compared using network Bayesian meta-analysis.

RESULTS AND CONCLUSION

Thirty-one studies were found for qualitative analysis, and 16 studies were found for quantitative synthesis. Based on the suppression ratio, methods can be ordered as electrical stimulation, light therapy, and magnetic stimulation. Furthermore, the results showed that electrical and magnetic stimulation were more effective for tremor suppression at early stages of PD, while light therapy was found to be more effective during the later stages of PD.

Comparison of image quality of 3D ultrasound: motorized acquisition versus freehand navigated acquisition, a phantom study

PURPOSE

Intra-operative assessment of resection margins during oncological surgery is a field that needs improvement. Ultrasound (US) shows the potential to fulfill this need, but this imaging technique is highly operator-dependent. A 3D US image of the whole specimen may remedy the operator dependence. This study aims to compare and evaluate the image quality of 3D US between freehand acquisition (FA) and motorized acquisition (MA).

METHODS

Multiple 3D US volumes of a commercial phantom were acquired in motorized and freehand fashion. FA images were collected with electromagnetic navigation. An integrated algorithm reconstructed the FA images. MA images were stacked into a 3D volume. The image quality is evaluated following the metrics: contrast resolution, axial and elevation resolution, axial and elevation distance calibration, stability, inter-operator variability, and intra-operator variability. A linear mixed model determined statistical differences between FA and MA for these metrics.

RESULTS

The MA results in a statistically significant lower error of axial distance calibration (p < 0.0001) and higher stability (p < 0.0001) than FA. On the other hand, the FA has a better elevation resolution (p < 0.003) than the MA.

CONCLUSION

MA results in better image quality of 3D US than the FA method based on axial distance calibration, stability, and variability. This study suggests acquiring 3D US volumes for intra-operative ex vivo margin assessment in a motorized fashion.

Bayesian Adaptive Beamformer for Robust Electromagnetic Brain Imaging of Correlated Sources in High Spatial Resolution

Reconstructing complex brain source activity at a high spatiotemporal resolution from magnetoencephalography (MEG) or electroencephalography (EEG) remains a challenging problem. Adaptive beamformers are routinely deployed for this imaging domain using the sample data covariance. However adaptive beamformers have long been hindered by 1) high degree of correlation between multiple brain sources, and 2) interference and noise embedded in sensor measurements. This study develops a novel framework for minimum variance adaptive beamformers that uses a model data covariance learned from data using a sparse Bayesian learning algorithm (SBL-BF). The learned model data covariance effectively removes influence from correlated brain sources and is robust to noise and interference without the need for baseline measurements. A multiresolution framework for model data covariance computation and parallelization of the beamformer implementation enables efficient high-resolution reconstruction images. Results with both simulations and real datasets indicate that multiple highly correlated sources can be accurately reconstructed, and that interference and noise can be sufficiently suppressed. Reconstructions at 2-2.5mm resolution (  ∼  150K voxels) are possible with efficient run times of 1-3 minutes. This novel adaptive beamforming algorithm significantly outperforms the state-of-the-art benchmarks. Therefore, SBL-BF provides an effective framework for efficiently reconstructing multiple correlated brain sources with high resolution and robustness to interference and noise.

Localization of reference points in electromagnetic tracking data and their application for treatment error detection in interstitial breast brachytherapy

BACKGROUND

Electromagnetic tracking (EMT) is a promising technology that holds great potential to advance patient-specific pre-treatment verification in interstitial brachytherapy (iBT). It allows easy determination of the implant geometry without line-of-sight restrictions and without dose exposure to the patient. What it cannot provide, however, is a link to anatomical landmarks, such as the exit points of catheters or needles on the skin surface. These landmarks are required for the registration of EMT data with other imaging modalities and for the detection of treatment errors such as incorrect indexer lengths, and catheter or needle shifts.

PURPOSE

To develop an easily applicable method to detect reference points in the positional data of the trajectory of an EMT sensor, specifically the exit points of catheters in breast iBT, and to apply the approach to pre-treatment error detection.

METHODS

Small metal objects were attached to catheter fixation buttons that rest against the breast surface to intentionally induce a local, spatially limited perturbation of the magnetic field on which the working principle of EMT relies. This perturbation can be sensed by the EMT sensor as it passes by, allowing it to localize the metal object and thus the catheter exit point. For the proof-of-concept, different small metal objects (magnets, washers, and bushes) and EMT sensor drive speeds were used to find the optimal parameters. The approach was then applied to treatment error detection and validated in-vitro on a phantom. Lastly, the in-vivo feasibility of the approach was tested on a patient cohort of four patients to assess the impact on the clinical workflow.

RESULTS

All investigated metal objects were able to measurably perturb the magnetic field, which resulted in missing sensor readings, that is two data gaps, one for the sensor moving towards the tip end and one when retracting from there. The size of the resulting data gaps varied depending on the choice of gap points used for calculation of the gap size; it was found that the start points of the gaps in both directions showed the smallest variability. The median size of data gaps was ⩽8 mm for all tested materials and sensor drive speeds. The variability of the determined object position was ⩽0.5 mm at a speed of 1.0 cm/s and ⩽0.7 mm at 2.5 cm/s, with an increase up to 2.3 mm at 5.0 cm/s. The in-vitro validation of the error detection yielded a 100% detection rate for catheter shifts of ≥2.2 mm. All simulated wrong indexer lengths were correctly identified. The in-vivo feasibility assessment showed that the metal objects did not interfere with the routine clinical workflow.

CONCLUSIONS

The developed approach was able to successfully detect reference points in EMT data, which can be used for registration to other imaging modalities, but also for treatment error detection. It can thus advance the automation of patient-specific, pre-treatment quality assurance in iBT.

A novel approach to wireless electromagnetic tracking using frequency modulation radio communication

PURPOSE

Electromagnetic tracking (EMT) is beneficial in image-guided interventions to reduce the use of ionising radiation-based imaging techniques. Enabling wirelessly tracked sensors will increase the usability of these systems for catheter tracking and patient registration systems. This work introduces a novel method of wirelessly transmitting sensor data using a frequency modulation (FM) radio.

METHODS

The proposed technique was tested using the open-source Anser EMT system. An electromagnetic sensor was connected in parallel to an FM transmitter prototype and wired directly to the Anser system for comparison. The performance of the FM transmitter was evaluated on a grid of 125 test points using an optical tracking system as a gold standard.

RESULTS

An average position accuracy of 1.61 ± 0.68 mm and angular rotation accuracy of 0.04° for the FM transmitted sensor signal was obtained over a 30 cm × 30 cm × 30 cm volume, in comparison with the 1.14 ± 0.80 mm, 0.04° accuracy previously reported for the Anser system. The FM transmitted sensor signal had an average resolved position precision of 0.95 mm while the directly wired signal was found to have an average precision of 1.09 mm. A very low frequency (∼ 5 mHz) oscillation in the wirelessly transmitted signal was observed and compensated for by performing a dynamic scaling of the magnetic field model used for solving the sensor pose.

CONCLUSIONS

We demonstrate that FM transmission of an electromagnetic sensor signal can be used to achieve similar tracking performance to a wired sensor. FM transmission for wireless EMT is a viable alternative to digital sampling and transmission over Bluetooth. Future work will create an integrated wireless sensor node using FM communication that is compatible with existing EMT systems.

Estimating follow-up CTs from geometric deformations of catheter implants in interstitial breast brachytherapy: A feasibility study using electromagnetic tracking

BACKGROUND

Electromagnetic tracking (EMT) systems have been shown to provide valuable information on the geometry of catheter implants in breast cancer patients undergoing interstitial brachytherapy (iBT). In the context of an extended patient-specific, pre-treatment verification, EMT can play a key role in determining the potential need and, if applicable, the appropriate time for treatment adaptation. To detect dosimetric shortcomings the relative position between catheters, and target volume and critical structures must be known. Since EMT cannot provide the anatomical context and standard imaging techniques such as cone-beam CT are not yet available in most brachytherapy suites, it is not possible to detect anatomic changes on a daily or fraction basis, so the need for adaptive planning cannot be identified.

PURPOSE

The aim of this feasibility study is to develop and evaluate a technique capable of estimating follow-up CTs at any time based on the initial treatment planning CT (PCT) and surrogate information about changes of the implant geometry from an EMT system.

METHODS

A deformation vector field is calculated from two different implant reconstructions acquired in treatment position through EMT, the first immediately after the PCT and the second at another time point during the course of treatment. The calculation is based on discrete displacement vectors of pairs of control and target points. These are extrapolated by means of different radial basis functions in order to cover the entire CT volume. The adequate parameters for the calculation of the deformation field were identified. By warping the PCT according to the deformation field, one obtains an estimated CT (ECT) that reflects the geometric changes. For the proof of concept, ECTs were computed for the time point of the clinical follow-up CT (FCT) that is embedded in the treatment workflow after the fourth fraction.

RESULTS

ECT and clinical FCTs of 20 patients were compared to each other quantitatively in terms of absolute Hounsfield unit differences in the planning target volume (PTV) and in a convex hull (CH) enclosing the catheters. The median differences were 31.2  and 29.5 HU for the CH and the PTV, respectively.

CONCLUSION

The proposed ECT approach was able to approximate the "anatomy of the day" and therefore, in principle, allows a dosimetric appraisal of the treatment plan quality before each fraction. In this way, it can contribute to a more detailed patient-specific quality assurance in iBT of the breast and help to identify the timing for a potential treatment adaptation.

Electromagnetic source imaging predicts surgical outcome in children with focal cortical dysplasia

OBJECTIVE

To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD).

METHODS

We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-associated DRE who underwent intracranial EEG and surgery. We localized spikes using equivalent current dipole (ECD) fitting, dipole clustering, and dynamical statistical parametric mapping (dSPM) on EMSI, electric source imaging (ESI), and magnetic source imaging (MSI). We calculated the distance from the seizure onset zone (DSOZ) and resection (DRES). We estimated receiver operating characteristic (ROC) curves with Youden's index (J) to predict outcome.

RESULTS

EMSI presented shorter DSOZ (15.18 ± 9.06 mm) and DRES (8.56 ± 6.24 mm) compared to ESI (DSOZ: 25.04 ± 16.20 mm, p < 0.009; DRES: 18.88 ± 17.30 mm, p < 0.03) and MSI (DSOZ: 23.37 ± 8.98 mm, p < 0.03; DRES: 15.51 ± 10.11 mm, p < 0.02) for clustering in patients with good outcome. Clustering showed shorter DSOZ and DRES compared to ECD fitting and dSPM (p < 0.05). EMSI had higher performance as outcome predictor (J = 70.63%) compared to ESI (J = 41.27%) and MSI (J = 33.33%) for clustering.

CONCLUSIONS

EMSI provides superior localization and improved predictive performance than individual modalities.

SIGNIFICANCE

EMSI can help the surgical planning and facilitate the localization of epileptogenic foci.

CT Navigation for Percutaneous Needle Placement: How I Do It

CT navigation (CTN) has recently been developed to combine many of the advantages of conventional CT and CT-fluoroscopic guidance for needle placement. CTN systems display real-time needle position superimposed on a CT dataset. This is accomplished by placing electromagnetic (EM) or optical transmitters/sensors on the patient and needle, combined with fiducials placed within the scan field to superimpose a known needle location onto a CT dataset. Advantages of CTN include real-time needle tracking using a contemporaneous CT dataset with the patient in the treatment position, reduced radiation to the physician, facilitation of procedures outside the gantry plane, fewer helical scans during needle placement, and needle guidance based on diagnostic-quality CT datasets. Limitations include the display of a virtual (vs actual) needle position, which can be inaccurate if the needle bends, the fiducial moves, or patient movement occurs between scans, and limitations in anatomical regions with a high degree of motion such as the lung bases. This review summarizes recently introduced CTN technologies in comparison to historical methods of CT needle guidance. A "How I do it" section follows, which describes how CT navigation has been integrated into the study center for both routine and challenging procedures, and includes step-by-step explanations, technical tips, and pitfalls.

Cyberknife Radiosurgery for Prostate Cancer after Abdominoperineal Resection (CYRANO): The Combined Computer Tomography and Electromagnetic Navigation Guided Transperineal Fiducial Markers Implantation Technique

In this technical development report, we present the strategic placement of fiducial markers within the prostate under the guidance of computed tomography (CT) and electromagnetic navigation (EMN) for the delivery of ultra-hypofractionated cyberknife (CK) therapy in a patient with localized prostate cancer (PCa) who had previously undergone chemo-radiotherapy for rectal cancer and subsequent abdominoperineal resection due to local recurrence. The patient was positioned in a prone position with a pillow under the pelvis to facilitate access, and an electromagnetic fiducial marker was placed on the patient's skin to establish a stable position. CT scans were performed to plan the procedure, mark virtual points, and simulate the needle trajectory using the navigation system. Local anesthesia was administered, and a 21G needle was used to place the fiducial markers according to the navigation system information. A confirmatory CT scan was obtained to ensure proper positioning. The implantation procedure was safe, without any acute side effects such as pain, hematuria, dysuria, or hematospermia. Our report highlights the ability to use EMN systems to virtually navigate within a pre-acquired imaging dataset in the interventional room, allowing for non-conventional approaches and potentially revolutionizing fiducial marker positioning, offering new perspectives for PCa treatment in selected cases.

Localized estimation of electromagnetic sources underlying event-related fields using recurrent neural networks

Objective. To use a recurrent neural network (RNN) to reconstruct neural activity responsible for generating noninvasively measured electromagnetic signals.Approach. Output weights of an RNN were fixed as the lead field matrix from volumetric source space computed using the boundary element method with co-registered structural magnetic resonance images and magnetoencephalography (MEG). Initially, the network was trained to minimise mean-squared-error loss between its outputs and MEG signals, causing activations in the penultimate layer to converge towards putative neural source activations. Subsequently, L1 regularisation was applied to the final hidden layer, and the model was fine-tuned, causing it to favour more focused activations. Estimated source signals were then obtained from the outputs of the last hidden layer. We developed and validated this approach with simulations before applying it to real MEG data, comparing performance with beamformers, minimum-norm estimate, and mixed-norm estimate source reconstruction methods.Main results. The proposed RNN method had higher output signal-to-noise ratios and comparable correlation and error between estimated and simulated sources. Reconstructed MEG signals were also equal or superior to the other methods regarding their similarity to ground-truth. When applied to MEG data recorded during an auditory roving oddball experiment, source signals estimated with the RNN were generally biophysically plausible and consistent with expectations from the literature.Significance. This work builds on recent developments of RNNs for modelling event-related neural responses by incorporating biophysical constraints from the forward model, thus taking a significant step towards greater biological realism and introducing the possibility of exploring how input manipulations may influence localised neural activity.

Multiscalar electrical spiking in Schizophyllum commune

Growing colonies of the split-gill fungus Schizophyllum commune show action potential-like spikes of extracellular electrical potential. We analysed several days of electrical activity recording of the fungus and discovered three families of oscillatory patterns. Very slow activity at a scale of hours, slow activity at a scale of 10 min and very fast activity at scale of half-minute. We simulated the spiking behaviour using FitzHugh-Nagume model, uncovered mechanisms of spike shaping. We speculated that spikes of electrical potential might be associated with transportation of nutrients and metabolites.

[Explored the Function of Electromagnetic Compatibility (EMC) of Medical Devices from the Perspective of Test]

OBJECTIVE

To improve the electromagnetic compatibility (EMC) quality of medical devices, improve the efficiency of EMC testing, and promote the speed of market approval.

METHODS

The unqualified cases of EMC test items of medical devices in recent years were statistically analyzed, and the reasons of low EMC quality of medical devices were analyzed from the perspective of test.

RESULTS

Based on the analysis of the reasons, the suggestions were given from the perspectives of medical device manufacturers and testing organizations.

CONCLUSIONS

In order to ensure the quality of EMC of medical devices, medical device manufacturers, regulatory authorities and inspection and testing institutions should strengthen the monitoring and evaluation of medical device electromagnetic compatibility, to ensure the safety of products work together to promote the development of the medical device industry healthily and orderly.

Risk of occurrence of electromagnetic interference from the application of transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief. But electrical TENS currents are also a source of electromagnetic interference (EMI). Thus, TENS is considered to be contraindicated in implantable cardioverter-defibrillator (ICD) patients. However, data might be outdated due to considerable advances in ICD and cardiac resynchronization therapy (CRT) filtering and noise protection algorithm technologies. The aim of this pilot safety study was to re-evaluate the safety of TENS in patients with modern ICDs.

METHODS AND RESULTS

One hundred and seven patients equipped with 55 different models of ICD/CRT with defibrillators from 4 manufacturers underwent a standardized test protocol including TENS at the cervical spine and the thorax, at 2 stimulation modes-high-frequency TENS (80 Hz) and burst-mode TENS (2 Hz). Potential interference monitoring included continuous documentation of ECG Lead II, intracardiac electrograms and the marker channel. Electromagnetic interference was detected in 17 of 107 patients (15.9%). Most frequent were: interpretations as a premature ventricular beats (VS/S) in 15 patients (14%), noise reversion in 5 (4.6%) which resulted in temporary asynchronous pacing in 3 (2.8%), interpretation as ventricular tachycardia/ventricular fibrillation in 2 (1.9%), and premature atrial beat in 2 (1.9%) patients. Electromagnetic interference occurrence was influenced by position (chest, P < 0.01), higher current intensity (P < 0.01), and manufacturer (P = 0.012).

CONCLUSION

Overall, only intermittent and minor EMI were detected. Prior to the use of TENS in patients with ICDs, they should undergo testing under the supervision of a cardiac device specialist.

Enabling ambulatory movement in wearable magnetoencephalography with matrix coil active magnetic shielding

The ability to collect high-quality neuroimaging data during ambulatory participant movement would enable a wealth of neuroscientific paradigms. Wearable magnetoencephalography (MEG) based on optically pumped magnetometers (OPMs) has the potential to allow participant movement during a scan. However, the strict zero magnetic field requirement of OPMs means that systems must be operated inside a magnetically shielded room (MSR) and also require active shielding using electromagnetic coils to cancel residual fields and field changes (due to external sources and sensor movements) that would otherwise prevent accurate neuronal source reconstructions. Existing active shielding systems only compensate fields over small, fixed regions and do not allow ambulatory movement. Here we describe the matrix coil, a new type of active shielding system for OPM-MEG which is formed from 48 square unit coils arranged on two planes which can compensate magnetic fields in regions that can be flexibly placed between the planes. Through the integration of optical tracking with OPM data acquisition, field changes induced by participant movement are cancelled with low latency (25 ms). High-quality MEG source data were collected despite the presence of large (65 cm translations and 270° rotations) ambulatory participant movements.

Dynamic monitoring of dielectric properties during two phase immiscible displacements in sand packs using frequency domain electromagnetic sweeps

Electromagnetic heating is a promising soil remediation method especially in thin formations. The lack of a wide-spread adoption of this method stems from insufficient knowledge of how the complex dielectric properties, that govern propagation of the electromagnetic waves through porous media, change with changing frequency, water saturation, displacement types and flow regimes. To breach these gaps several sets of spontaneous deionized (DI) water imbibition experiments, followed by the primary drainage floods, that were followed by the secondary DI water imbibition floods in confined uniform sand packs were performed. The frequency domain relative dielectric constant and conductivities were extracted from the two-port complex S-parameter measurements taken with the vector network analyzer during these immiscible displacements at various water saturation levels at ambient conditions. A novel coaxial transmission line core holder was designed and commissioned, and a modified version of a plane-invariant dielectric extraction algorithm was developed for this purpose. Series, parallel and semi-disperse mixing models were applied to fit the water saturation dependent relative dielectric constant and conductivity values sampled at 500 MHz from the extracted frequency domain spectra. The Maxwell-Garnett parallel model was proved to be the most flexible because it could capture the sampled conductivity values in all secondary imbibition floods before and after the breakthroughs, where the inflection points were observed. These inflection points were attributed to silica production and a potential shear-stripping flow. This observation was further confirmed by conducting a single-phase Darcy's law analysis of two DI water imbibition floods.

Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy

PURPOSE

To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis.

MATERIALS AND METHODS

A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm).

RESULTS

The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°.

CONCLUSIONS

Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.

Real-time monitoring of middle ear prosthesis coupling

INTRODUCTION

In reconstructive middle ear surgery, acoustic quality has received a high level of attention in recent years. Careful intraoperative selection and positioning of passive middle ear prostheses during tympanoplasty with ossiculoplasty is essential to ensure satisfactory sound transmission and postoperative hearing outcome. The reconstruction quality of the ossicular chain (OC) can be evaluated intraoperatively using a surgical assistance system which is based on a real-time monitoring system (RTM system) that acquires the transmission (middle ear transfer function (METF)) with electromagnetic excitation of the OC. In this experimental study, the METF with electromagnetic excitation of the (reconstructed) OC was compared to usual acoustic excitation and the benefit of the RTM system was investigated for the implantation of partial (PORP) and total (TORP) prostheses.

METHODS

Laser Doppler vibrometry (LDV) was used to measure the middle ear transfer function (METF) in 18 human temporal bones (TB). The RTM system uses electromagnetic excitation of the OC with a magnet placed on the umbo. Comparatively, measurements with the usual acoustical excitation, using an earphone in the external auditory canal, were performed. The measurements began with the intact OC, followed by real-time monitoring guided OC reconstruction with PORP and TORP. In addition, during the simulation of an intraoperative setting, the influence of the influence of opening (tympanomeatal flap lifted and pushed anteriorly) and closing (tympanomeatal flap folded back) the tympanic membrane on the measurements with the RTM system was determined.

RESULTS

Electromagnetic and acoustic excitation of the intact and the reconstructed OC provided comparable METF. The application of the RTM system significantly improved the quality of the OC reconstruction. The METF increased by up to 10 dB over the entire frequency range during implantation of the PORP with positioning control by the RTM system. When using the TORP, the METF could be improved by up to 15 dB. The opening of the tympanomeatal flap did not affect the measurements with the RTM system at the reconstructed OC.

CONCLUSION

In this TB study, we demonstrated that the quality of OC reconstruction (improved METF as a benchmark for improved transmission) could be significantly increased by means of a RTM system. Intraoperative studies should now be conducted to investigate to which quantitative extent the intraoperative reconstruction quality can be improved and whether or not this improvement also manifests in an increased (long-term) hearing outcome. This will enable conclusions to be drawn about the contribution of the intraoperative reconstruction quality to the (long-term) hearing outcome in the context of the conglomerate of various factors influencing the postoperative hearing outcome.

Evaluation of electromagnetic navigational bronchoscopic biopsy of lung lesions performed by a thoracic surgical service

BACKGROUND

With the increasing use of computed tomography scans for lung cancer screening and surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. Electromagnetic navigational bronchoscopy-guided lung biopsy is a relatively new technique for bronchoscopic biopsy. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy-guided lung biopsy.

METHODS

We conducted a retrospective review of patients who underwent an electromagnetic navigational bronchoscopy biopsy, performed by a thoracic surgical service, and evaluated its safety and diagnostic accuracy.

RESULTS

In total, 110 patients (men 46, women 64) underwent electromagnetic navigational bronchoscopy sampling of pulmonary lesions (n = 121; median size 27 mm; interquartile range 17-37 mm). There was no procedure-related mortality. Pneumothorax requiring pigtail drainage occurred in 4 patients (3.5%). Ninety-three (76.9%) of the lesions were malignant. Eighty-seven (71.9%) of the 121 lesions had an accurate diagnosis. Accuracy increased with increased lesion size (P = .0578) with a yield of 50% for lesions <2 cm, increasing to 81% for lesions ≥2 cm. The lesions that demonstrated a positive "bronchus sign" had a yield of 87% (45/52) compared with 61% (42/69) in lesions with a negative "bronchus sign" (P = .0359).

CONCLUSION

Thoracic surgeons can perform electromagnetic navigational bronchoscopy safely, with minimal morbidity and with good diagnostic yields. Accuracy increases with the presence of a bronchus sign and increasing lesion size. Patients with larger tumors and the bronchus sign may be candidates for this approach to biopsy. Further work is required to define the role of electromagnetic navigational bronchoscopy in the diagnosis of pulmonary lesions.

Selectivity of Protein Interactions Stimulated by Terahertz Signals

It has been established that Terahertz (THz) band signals can interact with biomolecules through resonant modes. Specifically, of interest here, protein activation. Our research goal is to show how directing the mechanical signaling inside protein molecules using THz signals can control changes in their structure and activate associated biochemical and biomechanical events. To establish that, we formulate a selectivity metric that quantifies the system performance and captures the capability of the nanoantenna to induce a conformational change in the desired protein molecule/population. The metric provides a score between -1 and 1 that indicates the degree of control we have over the system to achieve targeted protein interactions. To develop the selectivity measure, we first use the Langevin stochastic equation driven by an external force to model the protein behavior. We then determine the probability of protein folding by computing the steady-state energy of the driven protein and then generalize our model to account for protein populations. Our numerical analysis results indicate that a maximum selectivity score is attained when only the targeted population experiences a folding behavior due to the impinging THz signal. From the achieved selectivity values, we conclude that the system response not only depends on the resonant frequency but also on the system controlling parameters namely, the nanoantenna force, the damping constant, and the abundance of each protein population. Based on the selectivity metric, the nanoantenna must be tuned to a frequency that is not necessarily the resonant frequency of the protein. The presented work sheds light on the potential associated with the electromagnetic-based control of protein networks, which could lead to a plethora of applications in the medical field ranging from bio-sensing to targeted therapy.

Intrapulmonary Feeding Tube Placements While Using an Electromagnetic Placement Device: A Review (2019-2021)

BACKGROUND

Intrapulmonary placements of feeding tubes inserted with use of an electromagnetic placement device (EMPD) continue to occur.

OBJECTIVE

To describe circumstances and outcomes associated with intrapulmonary feeding tube placements during use of an EMPD.

METHODS

A retrospective review of reports to the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database of intrapulmonary feeding tube placements during use of an EMPD from 2019 through 2021. Complications, outcomes, operator training, interference from anatomical variations and medical devices, and the use and accuracy of radiographs in identifying pulmonary placements were recorded.

RESULTS

Sixty-two cases of intrapulmonary tube placement were identified; 10 were associated with a fatal outcome. Pneumothorax occurred in 35 cases and feedings were delivered into the lung in 11 cases. User error was cited in 6 cases and was implicit in most others. Little information was provided about operator training. Four intrapulmonary placements were associated with anatomical variations and 1 with a left ventricular assist device. Radiographic follow-up was described in 28 cases and correctly identified 23 of the intrapulmonary placements.

CONCLUSIONS

User error was a significant factor, which highlights the need for empirical data to clarify the amount of training needed to safely credential EMPD operators. Clearer information is needed about anatomical variations that may contraindicate use of an EMPD, as well as medical devices that may interfere with an EMPD. Use of follow-up radiographs, interpreted by qualified personnel, is supported to increase the probability of identifying intrapulmonary tube placements.

Coordinate-based fast lightweight path search algorithm for electromagnetic navigation bronchoscopy

Electromagnetic navigation bronchoscopy (ENB) uses electromagnetic positioning technology to guide the bronchoscope to accurately and quickly reach the lesion along the planned path. However, enormous data in high-resolution lung computed tomography (CT) and the complex structure of multilevel branching bronchial tree make fast path search challenging for path planning. We propose a coordinate-based fast lightweight path search (CPS) algorithm for ENB. First, the centerline is extracted from the bronchial tree by applying topological thinning. Then, Euclidean-distance-based coordinate search is applied. The centerline points are represented by their coordinates, and adjacent points along the navigation path are selected considering the shortest Euclidean distance to the target on the centerline nearest the lesion. From the top of the trachea centerline, search is repeated until reaching the target. In 50 high-resolution lung CT images acquired from five scanners, the CPS algorithm achieves accuracy, average search time, and average memory consumption of 100%, 88.5 ms, and 166.0 MB, respectively, reducing search time by 74.3% and 73.1% and memory consumption by 83.3% and 83.0% compared with Dijkstra and A* algorithms, respectively. CPS algorithm is suitable for path search in multilevel branching bronchial tree navigation based on high-resolution lung CT images.

Influence of Na+ disorder on cytoplasmic conductivity and cellular electromagnetic (EM) energy absorption of human erythrocytes (PONE-D-21-36089)

Cytoplasmic conductivity of human erythrocytes may be significantly disturbed by the composition of the external suspending media. Effects of external NaCl on cytoplasmic conductivity of human erythrocyte (Human Red Blood Cells, HRBC) were investigated in a simple NaCl system. Using thermodynamic theory cytoplasmic conductivities could be calculated from internal [K+], [Na+], [Cl-] and [HCO3-]. Effect of cell volume and cell water changes were introduced and allowed for using the Debye-Hückel-Onsager relation and Walden's rule of viscosity. Cell volume and cell water change of HRBCs were measured in suspending isotonic solutions with conductivities from 0.50 S m-1 up to hypertonic solutions of conductivity of 2.02 S m-1 at selected temperatures of 25°C (standard benchmark temperature) and 37°C (physiological temperature). In isotonic solutions, cytoplasmic conductivity of human erythrocyte decreases with rise in the external media ionic concentration and vice versa for hypertonic solutions. The HRBC is capable of rapidly regulating its volume (and shape) over quite a wide range of osmolality. Specific Absorption Rate (SAR, 900 MHz) values (W kg-1) of electromagnetic radiation are below safe limits at non-physiological 25°C but above legal limits at 37°C [National Council on Radiation Protection and Measurements, NCRP]. However, at 37°C under both hypertonic [Na+] and isotonic but low [Na+], SAR increases further beyond legal limits.

[Diagnostic Value and Safety of Electromagnetic Navigation Bronchoscopy in Peripheral Pulmonary Lesions: A Meta-analysis]

BACKGROUND

The incidence and mortality of lung cancer have always been at the forefront of malignant tumors. With the development of lung cancer detection techniques, more peripheral pulmonary lesions (PPLs) have been detected. The diagnostic accuracy of procedures for PPLs keeps controversial. This study aims to systematically evaluate the diagnostic value and the safety of electromagnetic navigation bronchoscopy (ENB) in the diagnosis of PPLs.

METHODS

The relevant literatures in the diagnostic yield of PPLs by ENB were systematically retrieved from Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, Embase, PubMed, Cochrane Library and Web of Science. The software of Stata 16.0, RevMan 5.4 and Meta-disc 1.4 were used to conduct the meta-analysis.

RESULTS

A total of 54 literatures with 55 studies were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ENB in the diagnosis of PPLs were 0.77 (95%CI: 0.73-0.81), 0.97 (95%CI: 0.93-0.99), 24.27 (95%CI: 10.21-57.67), 0.23 (95%CI: 0.19-0.28) and 104.19 (95%CI: 41.85-259.37), respectively. The area under curve (AUC) was 0.90 (95%CI: 0.87-0.92). Meta-regression and subgroup analyses indicated that the potential heterogeneity resulted from study type, additional localization techniques, sample size, lesion size and type of sedation. The use of additional localization techniques and general anesthesia have improved the diagnostic efficiency of ENB in PPLs. The incidence of adverse reactions and complications associated with ENB was very low.

CONCLUSIONS

ENB provides well diagnostic accuracy and safety.

Human Motor Noise Assessed by Electromagnetic Sensors and Its Relationship with the Degrees of Freedom Involved in Movement Control

Motor variability is a prominent feature of the human movement that, nowadays, can be easily measured through different sensors and analyzed using different types of variables, and it seems to be related to functional and adaptative motor behavior. It has been stated that motor variability is related to the system's flexibility needed to choose the right degrees of freedom (DoFs) to adapt to constant environmental changes. However, the potential relationship between motor variability and DoFs is unknown. The aim of this study was to analyze how motor variability, both the amount and structure, changes depending on the mechanical DoFs involved in the movement control. For this purpose, movement variability was assessed by a tracking sensor in five tasks with different DoFs, and the amount, using standard deviation, and the structure of variability, through fuzzy entropy and detrended fluctuation analysis, were also assessed. The results showed a higher amount of variability and a less predictable and more auto-correlated variability structure in the long-term when more mechanical DoFs are implied. The studies that analyze motor variability should consider the type of movement and the DoFs involved in the analyzed task since, as the findings have shown, both factors have a noticeable influence on the amount and the structure of motor variability.