Exposure classification of MRI workers in epidemiological studies

We estimate that there are about 100,000 workers from different disciplines, such as radiographers, nurses, anesthetists, technicians, engineers, etc., who can be exposed to substantial electromagnetic fields (compared to normal background levels) around magnetic resonance imaging (MRI) scanners. There is a need for well‐designed epidemiological studies of MRI workers but since the exposure from MRI equipment is a very complex mixture of static magnetic fields, switched gradient magnetic fields, and radiofrequency electromagnetic fields (RF EMF), it is necessary to discuss how to assess the exposure in epidemiological studies. As an alternative to the use of job title as a proxy of exposure, we propose an exposure categorization for the different professions working with MRI equipment. Specifically, we propose defining exposure in three categories, depending on whether people are exposed to only the static field, to the static plus switched gradient fields or to the static plus switched gradient plus RF fields, as a basis for exposure assessment in epidemiological studies. Bioelectromagnetics 34:81–84, 2013. © 2012 Wiley Periodicals, Inc.     

Rapporteur report: cellular, animal and epidemiological studies of the effects of static magnetic fields relevant to human health

Three talks were presented in the session on “Cellular, Animal and Epidemiological Studies of the Effects of Static Magnetic Fields Relevant to Human Health”. The first talk presented the in vitro effects of static magnetic fields on cell cultures. The second talk presented the in vivo evidence obtained from animal studies. The final, third talk, presented the evidence obtained from epidemiological studies.

The overall conclusion of the three presentations and the following general discussion was that the scientific evidence available to date is weak and contains large gaps in knowledge either due to the poor quality of published studies or because of the lack of published research on certain health-related topics.

It was emphasized that the rapid development of new technological applications of static magnetic fields (e.g. magnetic levitation trains or magnetic resonance imaging—MRI) results in the human population at large, in certain occupations, and in a selected population of clinical patients being exposed to ever increasing static magnetic field strengths. It is of concern that the knowledge presently available concerning the health effects of these strong static magnetic fields is lagging a long way behind technological development.

In conclusion, it was suggested that there is an urgent need to perform new studies in all research areas (in vitro, in vivo and epidemiology) in order to fill the present gaps in knowledge and provide assurance that this technology will not cause any unwanted and unexpected health side effects.     

Rapporteur report: implications for exposure guidelines

There is a paucity of information regarding the long-term health effects associated with exposure to static magnetic fields. Perceptual and other acute effects have been demonstrated above a threshold of about 2 T, and these form the basis for human exposure standards at present. Exposures well above this threshold are increasingly becoming more common as the technology associated with magnetic resonance imaging advances. Therefore, priority should be given to assessing the health risks associated with exposures to such fields. Studies should include a prospective cohort study investigating cancer risks of workers and patients exposed to fields in excess of 2 T, a study investigating effects on human cognitive performance from repeated exposures, and a molecular biology study investigating acute changes in genomic responses in volunteers exposed to fields of up to 8 T. Studies investigating the effects of long-term exposure on cancer, and on neurobehavioural development are also recommended using animals, where the use of transgenic models is encouraged. In addition, dosimetric studies should be conducted using high-resolution male, female and pregnant voxel phantoms, as should theoretical studies investigating the local currents induced in the eye and in the heart by movement during exposure. Finally, studies are recommended to investigate further the ability of static magnetic fields to significantly affect radical pair reactions in biological systems.     

Evaluation of Non Ionizing Radiation Around the Dielectric Heaters and Sealers: A Case Report

Dielectric heaters and sealers present the most common source of occupational exposure to excessive radio frequency (RF) fields. These systems are used industrially to heat or melt dielectric materials. Nowadays, the effects of high frequency electromagnetic (EM) fields on the health have been discussed frequently but there are few health studies done for workers around dielectric heaters and sealers. In this study, the leakage fields around dielectric heaters and sealers (27.12?MHz) were measured in MKE – Mechanical and Chemical Industry Corporation, Gazi Rocket Factory and evaluated in terms of standards. It has been observed that operators exposed to same RF fields with occupational exposure limits. Many workers have health complaints, such as elevated body temperatures in the factory. Safe distances or areas for workers should be recommended in these systems. Protective measures could be implemented to minimize these exposures. Further measurements and occupational exposure studies of RF exposed women and men are needed to demonstrate the levels of exposed Radio Frequency Radiation (RFR). Precautions should therefore be taken either to reduce the leakage fields or minimise the exposed fields.     

Evaluation of non ionizing radiation around the dielectric heaters and sealers: a case report

Dielectric heaters and sealers present the most common source of occupational exposure to excessive radio frequency (RF) fields. These systems are used industrially to heat or melt dielectric materials. Nowadays, the effects of high frequency electromagnetic (EM) fields on the health have been discussed frequently but there are few health studies done for workers around dielectric heaters and sealers. In this study, the leakage fields around dielectric heaters and sealers (27.12?MHz) were measured in MKE--Mechanical and Chemical Industry Corporation, Gazi Rocket Factory and evaluated in terms of standards. It has been observed that operators exposed to same RF fields with occupational exposure limits. Many workers have health complaints, such as elevated body temperatures in the factory. Safe distances or areas for workers should be recommended in these systems. Protective measures could be implemented to minimize these exposures. Further measurements and occupational exposure studies of RF exposed women and men are needed to demonstrate the levels of exposed Radio Frequency Radiation (RFR). Precautions should therefore be taken either to reduce the leakage fields or minimise the exposed fields.     

Effects function analysis of ELF magnetic field exposure in the electric utility work environment

The incomplete understanding of the relation between power-frequency fields and biological responses raises problems in defining an appropriate metric for exposure assessment and epidemiological studies. Based on evidence from biological experiments, one can define alternative metrics or effects functions that embody the relationship between field exposure patterns and hypothetical health effects. In this paper, we explore the application of the “effects function” approach to occupational exposure data. Our analysis provides examples of exposure assessments based on a range of plausible effects functions. An EMDEX time series data set of ELF frequency (40–800 Hz) magnetic field exposure measurements for electric utility workers was analyzed with several statistical measures and effects functions: average field strength, combination of threshold and exposure duration, and field strength changes. Results were compared for eight job categories: electrician, substation operator, machinist, welder, plant operator, lineman/splicer, meter reader, and clerical. Average field strength yields a different ranking for these job categories than the ranks obtained using other biologically plausible effects functions. Whereas the group of electricians has the highest exposure by average field strength, the group of substation operators has the highest ranking for most of the other effects functions. Plant operators rank highest in the total number of field strength changes greater than 1 μT per hour. The clerical group remains at the lowest end for all of these effects functions. Our analysis suggests that, although average field strength could be used as a surrogate of field exposure for simply classifying exposure into “low” and “high,” this summary measure may be misleading in the relative ranking of job categories in which workers are in “high” fields. These results indicate the relevance of metrics other than average field strength in occupational exposure assessment and in the design and analysis of epidemiological studies. Bioelectromagnetics 18:365–375, 1997. © 1997 Wiley-Liss, Inc.     

Static magnetic fields: animal studies

Various experimental studies carried out over the last 30–40 years have examined the effects of the chronic or acute exposure of laboratory animals to static magnetic fields. Many of the earlier studies have been adequately reviewed elsewhere; few adverse effects were identified. This review focuses on studies carried out more recently, mostly those using vertebrates, particularly mammals. Four main areas of investigation have been covered, viz., nervous system and behavioural studies, cardiovascular system responses, reproduction and development, and genotoxicity and cancer. Work on the role of the natural geomagnetic field in animal orientation and migration has been omitted.

Generally, the acute responses found during exposure to static fields above about 4 T are consistent with those found in volunteer studies, namely the induction of flow potentials around the heart and the development of aversive/avoidance behaviour resulting from body movement in such fields. No consistently demonstrable effects of exposure to fields of 1 T and above have been seen on other behavioural or cardiovascular endpoints. In addition, no adverse effects of such fields on reproduction and development or on the growth and development of tumours have been firmly established. Overall, however, far too few animal studies have been carried out to reach any firm conclusions.     

Extremely low frequency electric fields and cancer: Assessing the evidence

Much of the research and reviews on extremely low frequency (ELF) electric and magnetic fields (EMFs) have focused on magnetic rather than electric fields. Some have considered such focus to be inappropriate and have argued that electric fields should be part of both epidemiologic and laboratory work. This paper fills the gap by systematically and critically reviewing electric‐fields literature and by comparing overall strength of evidence for electric versus magnetic fields. The review of possible mechanisms does not provide any specific basis for focusing on electric fields. While laboratory studies of electric fields are few, they do not indicate that electric fields should be the exposure of interest. The existing epidemiology on residential electric‐field exposures and appliance use does not support the conclusion of adverse health effects from electric‐field exposure. Workers in close proximity to high‐voltage transmission lines or substation equipment can be exposed to high electric fields. While there are sporadic reports of increase in cancer in some occupational studies, these are inconsistent and fraught with methodologic problems. Overall, there seems little basis to suppose there might be a risk for electric fields, and, in contrast to magnetic fields, and with a possible exception of occupational epidemiology, there seems little basis for continued research into electric fields. Bioelectromagnetics 31:89–101, 2010. © 2009 Wiley‐Liss, Inc.     

Effects of static magnetic fields at the cellular level

There have been few studies on the effects of static magnetic fields at the cellular level, compared to those of extremely low frequency magnetic fields. Past studies have shown that a static magnetic field alone does not have a lethal effect on the basic properties of cell growth and survival under normal culture conditions, regardless of the magnetic density. Most but not all studies have also suggested that a static magnetic field has no effect on changes in cell growth rate. It has also been shown that cell cycle distribution is not influenced by extremely strong static magnetic fields (up to a maximum of 10 T). A further area of interest is whether static magnetic fields cause DNA damage, which can be evaluated by determination of the frequency of micronucleus formation. The presence or absence of such micronuclei can confirm whether a particular treatment damages cellular DNA. This method has been used to confirm that a static magnetic field alone has no such effect. However, the frequency of micronucleus formation increases significantly when certain treatments (e.g., X-irradiation) are given prior to exposure to a 10 T static magnetic field. It has also been reported that treatment with trace amounts of ferrous ions in the cell culture medium and exposure to a static magnetic field increases DNA damage, which is detected using the comet assay. In addition, many studies have found a strong magnetic field that can induce orientation phenomena in cell culture.     

Interaction of static and extremely low frequency electric and magnetic fields with living systems: health effects and research needs

An international seminar was held June 4-6, 1997, on the biological effects and related health hazards of ambient or environmental static and extremely low frequency (ELF) electric and magnetic fields (0-300 Hz). It was cosponsored by the World Health Organization (WHO), the International Commission on Non-Ionizing Radiation Protection (ICNIRP), the German, Japanese, and Swiss governments. Speakers provided overviews of the scientific literature that were discussed by participants of the meeting. Subsequently, expert working groups formulated this report, which evaluates possible health effects from exposure to static and ELF electric and magnetic fields and identifies gaps in knowledge requiring more research to improve health risk assessments. The working groups concluded that, although health hazards exist from exposure to ELF fields at high field strengths, the literature does not establish that health hazards are associated with exposure to low-level fields, including environmental levels. Similarly, exposure to static electric fields at levels currently found in the living and working environment or acute exposure to static magnetic fields at flux densities below 2 T, were not found to have demonstrated adverse health consequences. However, reports of biological effects from low-level ELF-field exposure and chronic exposure to static magnetic fields were identified that need replication and further study for WHO to assess any possible health consequences. Ambient static electric fields have not been reported to cause any direct adverse health effects, and so no further research in this area was deemed necessary.     

A Review of the Epidemiology of Trichloroethylene and Kidney Cancer

The occupational epidemiological studies of trichloroethylene (TCE) exposure and kidney cancer are reviewed. Seven occupational cohort studies, conducted in the U.S., Finland, and Sweden involving over 130,000 workers, do not report statistically increased risks of kidney cancer among TCE-exposed workers. These studies were based on well-defined cohorts and exposure assessments involving urine biomonitoring or some type of job exposure matrix. In contrast, two German studies reported eight- to eleven-fold increased risks for renal cancer among TCE-exposed workers. However, numerous methodological and analytical shortcomings severely limit any interpretation of the German studies. We conclude that the more reliable epidemiologic data do not support a causal relationship between kidney cancer and TCE exposure.     

Occupational exposures and reproductive health: 2003 Teratology Society Meeting Symposium summary

Assuring reproductive health in the workplace challenges researchers, occupational safety and health practitioners, and clinicians. Most chemicals in the workplace have not been evaluated for reproductive toxicity. Although occupational exposure limits are established to protect 'nearly all' workers, there is little research that characterizes reproductive hazards. For researchers, improvements in epidemiologic design and exposure assessment methods are needed to conduct adequate reproductive studies. Occupational safety and health programs' qualitative and quantitative evaluations of the workplace for reproductive hazards may differ from standardized approaches used for other occupational hazards in that estimates of exposure intensity must be considered in the context of the time-dependent windows of reproductive susceptibility. Clinicians and counselors should place the risk estimate into context by emphasizing the limitations of the available knowledge and the qualitative nature of the exposure estimates, as well as what is known about other non-occupational risk factors for adverse outcomes. This will allow informed decision-making about the need for added protections or alternative duty assignment when a hazard cannot be eliminated. These policies should preserve a worker's income, benefits, and seniority. Applying hazard control technologies and hazard communication training can minimize a worker's risk. Chemical reproductive hazard training is required for workers by the Occupational Safety and Health Administration's Hazard Communication Standard. The National Institute for Occupational Safety and Health (NIOSH) has formed a National Occupational Research Agenda Team to promote communication and partnering among reproductive toxicologists, clinicians and epidemiologists, to improve reproductive hazard exposure assessment and management, and to encourage needed research.     

Occupational health problems among migrant and seasonal farm workers.

Migrant and seasonal farm workers are one of the most underserved and understudied populations in the United States. The total US population of such farm workers has been estimated at 5 million, of whom about 20% live or work in California. Farm workers perform strenuous tasks and are exposed to a wide variety of occupational risks and hazards. Low socioeconomic status and poor access to health care also contribute to existing health problems in this population. Potential farm work-related health problems include accidents, pesticide-related illnesses, musculoskeletal and soft-tissue disorders, dermatitis, noninfectious respiratory conditions, reproductive health problems, health problems of children of farm workers, climate-caused illnesses, communicable diseases, bladder and kidney disorders, and eye and ear problems. Few epidemiologic studies exist of these occupational health problems. No comprehensive epidemiologic studies have assessed the magnitude of occupational health problems among migrant and seasonal farm workers and their dependents. Although the migratory nature of this population makes long-term studies difficult, the development of standardized data collection instruments for health consequences and scientific assessment of farm work exposures and working conditions are vital to characterize and reduce the occupational health risks in farm workers.     

ELF magnetic fields in a city environment

Some epidemiological studies indicate an association between extremely low frequency electromagnetic field (ELF-EMF) exposure and cancer risks. These studies have mainly taken residential and occupational exposure into consideration. Outdoor environments are often considered as low level areas, but in this paper we show that this is not true in a city environment. We have mapped the ELF magnetic flux densities along certain stretches of sidewalk in central G?teborg City, Sweden. About 50% of the investigated street length shows flux densities of the same order of magnitude (0.2 microT and above) as those associated with increased risks of cancer in epidemiological studies. We conclude that the outdoor exposures in a city environment also should be considered in exposure assessments and risk evaluations. These elevated flux densities are probably due to stray currents. We also found strong magnetic flux densities (> 1.0 microT) close to ordinary distribution pillars, power substations, shoplifting alarms, and other electrical devices.     

Comparison of indices of ambient exposure to 60-hertz electric and magnetic fields

Occupational, environmental, or domestic exposure of human beings to extremely low-frequency (50- or 60-Hz) electric and magnetic fields varies continuously over time. In epidemiological studies of possible health effects, exposures over long durations must be aggregated in terms of simple summary indices. However, there are many different, biologically plausible, ways of aggregating the data. While awake, each of 20 electric utility personnel and 16 office workers had provided minute-by-minute measures of incident electric (V/m) and magnetic (muT) fields over a 7-day period via personal dosimeters. Once the measures were aggregated as means, medians, peaks, and other indices, intercorrelations between all index pairs were calculated; correlation matrices are presented for the utility and office workers both by group and when pooled. Product-moment coefficients (r) greater that .80 were found between the time-weighted arithmetic mean (TWA) and indices that explicitly emphasize short but highly intense exposures, such as peak values and time above thresholds. Medians and geometric means were less highly correlated with the TWA. Use of only a few indices, perhaps the TWA alone, may sacrifice but little statistical power in most epidemiological studies of utility workers exposed to ELF fields. However, correlations between electric-field strength and magnetic-field density were generally quite weak, as were correlations of either with high-frequency transients; these findings underscore the need to measure each of these variables in epidemiological studies. Indices of exposure incurred outside the workplace were less strongly correlated, which may indicate the need to use several indices in general-population studies.     

A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus

This paper presents an overview of the application of and risks of exposure to Magnetic Resonance Imaging (MRI) in pregnancy. It reviews the risks to the fetus by considering the hazards in terms of the three main components of an MRI system. These are the static magnetic field, the time-varying magnetic gradient fields and the pulsed radio frequency fields. The hazards discussed are biological effects, miscarriage, heating effects and acoustic noise exposure. This paper also presents a survey of MRI sites within the United Kingdom to ascertain the extent of MRI usage in pregnancy. To validate the situation of MRI in pregnancy a survey was sent to 352 MR units throughout the United Kingdom. The questions were grouped to assess (a) maternal MRI diagnosis (b) fetal MRI and (c) work practices for pregnant MRI staff. The results showed that 91% of sites were imaging pregnant women in need of diagnosis in the second and third trimester. This paper highlights that MRI can add information for fetal central nervous system abnormalities identified by ultrasound screening, however within the UK direct fetal imaging was only performed in 8% of sites. This paper indicates the need for research to be undertaken for specific MRI clinical conditions. It also advises that risk assessment for pregnant staff working in MRI is performed, and that there is a clear need for further research into the effects of MRI in pregnancy as there is a need for clear authoritive advice.     

Occupational exposure to electromagnetic fields and adult leukaemia: a review of the epidemiological evidence

The relationship between occupational exposure to extremely low-frequency electromagnetic fields and adult leukaemia has been studied extensively during the last decade. The first studies were based on crude exposure assessments, estimated through job titles, with no or only limited control of confounding factors. The results were often inconsistent, indicating no effects in about 50% of the studies, while the other half showed only small to moderate effects. Concern has been raised that crude exposure-assessment methods might have diluted the effect estimates, and that improvement of the methods used for exposure assessment would result in more consistent associations. The present review emphasises the latest studies with considerably improved exposure assessments, as well as the control of confounding factors. Results from studies where exposure was assessed through measurements of the magnetic fields at the workplace are still inconsistent. These studies provide some support for the hypothesis of an association between magnetic field exposure and adult leukaemia, especially for chronic lymphocytic leukaemia, but inconsistencies between and within studies weaken the evidence. The lack of consistency regarding the type of leukaemia associated with magnetic field exposure might be explained by differences between the study designs or the populations studied, but based on the existing evidence, no firm conclusions can be drawn. Received: 23 February 1996 / Accepted in revised form: 21 June 1996     

Evaluating alternative exposure indices in epidemiologic studies on extremely low-frequency magnetic fields

Choosing the right exposure index for epidemiological studies on 50–60 Hz magnetic fields is difficult due to the lack of knowledge about critical exposure parameters for the biological effects of magnetic fields. This paper uses data from a previously published epidemiological investigation on early pregnancy loss (EPL) to study the methods of evaluating the exposure-response relationship of 50 Hz magnetic fields. Two approaches were used. The first approach was to apply generalized additive modeling to suggest the functional form of the relationship between EPL and magnetic field strength. The second approach evaluated the goodness of fit of the EPL data with eight alternative exposure indices: the 24 h average of magnetic field strength, three indices measuring the proportion of time above specified thresholds, and four indices measuring the proportion of time within specified intensity windows. Because the original exposure data included only spot measurements, estimates for the selected exposure indices were calculated indirectly from the spot measurements using empirical nonlinear equations derived from 24 h recordings in 60 residences. The results did not support intensity windows, and a threshold-type dependence on field strength appeared to be more plausible than a linear relationship. In addition, the study produced data suggesting that spot measurements may be used as surrogates for other exposure indices besides the time average field strength. No final conclusions should be drawn from this study alone, but we hope that this exercise stimulates evaluation of alternative exposure indices in other planned and ongoing epidemiological studies. © 1996 Wiley-Liss, Inc.     

Coronary heart diseases: Assessment of risk associated with work exposure to ultralow-frequency magnetic fields

The present analysis was stimulated by previous findings on the possible influence of natural ultralow-frequency (ULF; 0.001–10 Hz) geomagnetic field variations on the cardiovascular system and indications of an effect of man-made ULF magnetic fields on the rate of myocardial infarction. In the present study, we considered the occupational health hazards of the strongest ULF magnetic fields in densely populated urban areas. Measurements of ULF magnetic field fluctuations produced by trains powered by DC electricity were performed by means of a computer-based, highly sensitive, three-component magnetometer. We found that the magnitude of magnetic field pulses inside the driver's cab of electric locomotives (ELs) could be ≥ 280 μT in the horizontal component perpendicular to the rails and up to approximately 130 μT in the vertical component, and, in the driver's compartment of electric motor unit (EMU) trains, they were approximately 50 and 35 μT, respectively. We have investigated the relationships between the occupational exposure to ULF magnetic field fluctuations produced by electric trains and cardiovascular diseases (CVDs) among railroad workers in the former Soviet Union. We have analyzed medical statistical data for a period of 3 years for approximately 45,000 railroad workers and 4,000 engine drivers. We have also analyzed 3 years of morbidity data for three subgroups of engine drivers (∼4,000 in each group) operating different types of trains. We find that EL drivers have a twofold increase in risk (2.00 ± 0.27) of coronary heart diseases (CHDs) compared with EMU drivers. Because our analysis of major CVDs shows that the examined subpopulations of drivers can be considered to have had equal exposure to all known risk factors, the elevated CHD risk among EL drivers could be attributed to the increased occupational exposure to ULF magnetic fields. © 1996 Wiley-Liss, Inc.     

Genotoxic effects of 3 T magnetic resonance imaging in cultured human lymphocytes

The clinical and preclinical use of high-field intensity (HF, 3 T and above) magnetic resonance imaging (MRI) scanners have significantly increased in the past few years. However, potential health risks are implied in the MRI and especially HF MRI environment due to high-static magnetic fields, fast gradient magnetic fields, and strong radiofrequency electromagnetic fields. In this study, the genotoxic potential of 3 T clinical MRI scans in cultured human lymphocytes in vitro was investigated by analyzing chromosome aberrations (CA), micronuclei (MN), and single-cell gel electrophoresis. Human lymphocytes were exposed to electromagnetic fields generated during MRI scanning (clinical routine brain examination protocols: three-channel head coil) for 22, 45, 67, and 89 min. We observed a significant increase in the frequency of single-strand DNA breaks following exposure to a 3 T MRI. In addition, the frequency of both CAs and MN in exposed cells increased in a time-dependent manner. The frequencies of MN in lymphocytes exposed to complex electromagnetic fields for 0, 22, 45, 67, and 89 min were 9.67, 11.67, 14.67, 18.00, and 20.33 per 1000 cells, respectively. Similarly, the frequencies of CAs in lymphocytes exposed for 0, 45, 67, and 89 min were 1.33, 2.33, 3.67, and 4.67 per 200 cells, respectively. These results suggest that exposure to 3 T MRI induces genotoxic effects in human lymphocytes.