Bio-effects and safety of low-intensity, low-frequency ultrasonic exposure

Low-frequency (LF) ultrasound (20-100 kHz) has a diverse set of industrial and medical applications. In fact, high power industrial applications of ultrasound mainly occupy this frequency range. This range is also used for various therapeutic medical applications including sonophoresis (ultrasonic transdermal drug delivery), dentistry, eye surgery, body contouring, the breaking of kidney stones and eliminating blood clots. While emerging LF applications such as ultrasonic drug delivery continue to be developed and undergo translation for human use, significant gaps exist in the coverage of safety standards for this frequency range. Accordingly, the need to understand the biological effects of LF ultrasound is becoming more important. This paper presents a broad overview of bio-effects and safety of LF ultrasound as an aid to minimize and control the risk of these effects. Its particular focus is at low intensities where bio-effects are initially observed. To generate a clear perspective of hazards in LF exposure, the mechanisms of bio-effects and the main differences in action at low and high frequencies are investigated and a survey of harmful effects of LF ultrasound at low intensities is presented. Mechanical and thermal indices are widely used in high frequency diagnostic applications as a means of indicating safety of ultrasonic exposure. The direct application of these indices at low frequencies needs careful investigation. In this work, using numerical simulations based on the mathematical and physical rationale behind the indices at high frequencies, it is observed that while thermal index (TI) can be used directly in the LF range, mechanical index (MI) seems to become less reliable at lower frequencies. Accordingly, an improved formulation for the MI is proposed for frequencies below 500 kHz.     

Scientific basis for the Soviet and Russian radiofrequency standards for the general public

The former Soviet Union (USSR) and the USA were the first countries to introduce standards limiting exposure to radiofrequency (RF) fields. However, the exposure limits in the USSR standards were always much lower than those in the USA and other countries. The objective of this article is to provide a history of the development of the Soviet and Russian RF standards. In addition, we summarize the scientific evidence used to develop the original USSR RF and subsequent Russian public health standards, as well as the mobile telecommunications standard published in 2003, but we do not critique them. We also describe the protective approaches used by the Soviet and Russian scientists for setting their limits. A translation of the papers of the key studies used to develop their standards is available in the online version of this publication. Bioelectromagnetics 33:623–633, 2012. © 2012 Wiley Periodicals, Inc.     

Exposure of the Human Body to Professional and Domestic Induction Cooktops Compared to the Basic Restrictions

We investigated whether domestic and professional induction cooktops comply with the basic restrictions defined by the International Commission on Non‐Ionizing Radiation Protection (ICNIRP). Based on magnetic field measurements, a generic numerical model of an induction cooktop was derived in order to model user exposure. The current density induced in the user was simulated for various models and distances. We also determined the exposure of the fetus and of young children. While most measured cooktops comply with the public exposure limits at the distance specified by the International Electrotechnical Commission (standard IEC 62233), the majority exceeds them at closer distances, some of them even the occupational limits. The maximum current density in the tissue of the user significantly exceeds the basic restrictions for the general public, reaching the occupational level. The exposure of the brains of young children reaches the order of magnitude of the limits for the general public. For a generic worst‐case cooktop compliant with the measurement standards, the current density exceeds the 1998 ICNIRP basic restrictions by up to 24 dB or a factor of 16. The brain tissue of young children can be overexposed by 6 dB or a factor of 2. The exposure of the tissue of the central nervous system of the fetus can exceed the limits for the general public if the mother is exposed at occupational levels. This demonstrates that the methodology for testing induction cooktops according to IEC 62233 contradicts the basic restrictions. This evaluation will be extended considering the redefined basic restrictions proposed by the ICNIRP in 2010. Bioelectromagnetics 33:695–705, 2012. © 2012 Wiley Periodicals, Inc.     

Quantification of risk from fetal exposure to diagnostic ultrasound

Biomedical ultrasound may induce adverse effects in patients by either thermal or non-thermal means. Temperatures above normal can adversely affect biological systems, but effects also may be produced without significant heating. Thermally induced teratogenesis has been demonstrated in many animal species as well as in a few controlled studies in humans. Various maximum ‘safe’ temperature elevations have been proposed, although the suggested values range from 0.0 to 2.5° C. Factors relevant to thermal effects are considered, including the nature of the acoustic field in situ, the state of perfusion of the embryo/fetus, and the variation of sensitivity to thermal insult with gestational stage of development. Non-thermal mechanisms of action considered include acoustic cavitation, radiation force, and acoustic streaming. While cavitation can be quite destructive, it is extremely unlikely in the absence of stabilized gas bodies, and although the remaining mechanisms may occur in utero, they have not been shown to induce adverse effects. For example, pulsed, diagnostic ultrasound can increase fetal activity during exposure, apparently due to stimulation of auditory perception by radiation forces on the fetal head or auditory structures. In contrast, pulsed ultrasound also produces vascular damage near developing bone in the late-gestation mouse, but by a unknown mechanism and at levels above current US FDA output limits. It is concluded that: (1) thermal rather than nonthermal mechanisms are more likely to induce adverse effects in utero, and (2) while the probability of an adverse thermal event is usually small, under some conditions it can be disturbingly high.     

External ultrasonic lipoplasty: an effective method of fat removal and skin shrinkage

External ultrasonic lipoplasty is an effective method for the removal of localized fat and the fat due to moderate obesity. The ultrasound is externally applied and transmitted through the skin surface. The acoustic waves are selectively absorbed by previously injected tumescent fluid and fat. It is the combination of this acoustic wave and ultrasound-induced fluid streaming that facilitates fat removal. Multiple, 2.5- to 3.7-mm incisions are made, through which standard thin (2.3 to 3.5 mm) suction lipectomy cannulae are used to aspirate the emulsified fat and oil. A major advantage of this procedure is that superficial subdermal liposuction can be used safely, which enhances the thoroughness of fat removal and the contraction of the overlying skin. A total of 160 consecutive patients successfully underwent this procedure. Recovery was rapid, and patients returned to full activities within 24 to 48 hours. The skin remained soft, with minimal to no bruising throughout the entire postoperative period. The problems seen with internal ultrasonic liposuction, such as end hits and skin burns, were avoided. The large incisions required for internal ultrasound liposuction were not necessary. Previous models of externally applied ultrasound support current observations of the safety of external ultrasound lipoplasty. Only one small seroma was seen. External ultrasound lipoplasty is a safe, effective, and low-cost method of ultrasound-assisted removal of localized fat and the fat due to moderate obesity. Physician and patient satisfaction is high.     

Implementation of the 1990 recommendations of ICRP in the countries of the European community

The International Commission on Radiological Protection (ICRP) has published new Recommendations in ICRP Publication 60. These 1990 Recommendations provide a System of Radiological Protection that takes account of the most recent information on the effects on health of exposure to ionising radiation and trends in the setting of safety standards. Within the European Community the Recommendations fo the ICRP are implemented through a Euratom Directive which is binding on member states, a draft of which has been accepted by the Article 31 Group and must eventually be ratified by the Council of Ministers. It is expected that the new directive will broadly endorse the principles of protection given in the 1990 Recommendations together with the dose limits for both workers and members of the public. There are likely to be some modifications to the 1990 Recommendations that are mainly related to their practical application. As it will be some time before the directive is incorporated into national regulations, a number of member states have taken independent initiatives. The development of dose constraints for occupational, medical and public exposure is being seen by national organisations in many countries as a significant new approach to improving standards of radiation protection.     

Metrology for ultrasonic applications

This paper provides a review of current metrological capability applied to the characterisation of the acoustic output of equipment used within medical ultrasonic applications. Key measurement devices, developed to underpin metrology in this area, are the radiation force balance, used to determine total output power, and the piezo-electric hydrophone, used to resolve the spatial and temporal distribution of acoustic pressure. The measurement infrastructure in place within the United Kingdom ensuring users are able to carry out traceable measurements of these quantities in a meaningful way, is described. This includes the relevant primary standards, the way international equivalence of national standards is demonstrated and the routes by which the standards are disseminated to the user community. Emerging measurement techniques that may in future lead to improved measurement capability, are also briefly discussed.     

Medical sonography: reproductive effects and risks

While it is clear that the levels and types of medical sonography that have been used in the past have no measurable risks, it would be inaccurate to label the modality of ultrasound as totally safe regardless of exposure. Most agents have reproductive risks and even teratogenic risks if the exposure is raised sufficiently. Thus the prudent use of sonography means that clinicians and designers of equipment have to maintain exposures far below the risks that have been demonstrated in animal studies and from the knowledge obtained about the physical changes that can be produced in humans as the absorbed dose is elevated. The reproductive risks were evaluated using five criteria: 1) human epidemiology, 2) secular trend data, 3) animal experiments, 4) dose response relationships, and 5) biologic plausibility. The analysis reveals that the human epidemiology does not indicate that diagnostic ultrasound presents a measurable risk to the developing embryo or fetus. Animal studies also indicate that diagnostic levels of ultrasound are safe and do not elevate the fetal temperature into the region where deleterious embryonic and fetal effects will occur. Because higher exposures of ultrasound can elevate the temperature of the embryo, the use of diagnostic procedures and the design of sonographic equipment should take into consideration the hyperthermic potential of higher exposures of ultrasound and the hypothetical additional risk of performing sonography on pregnant patients who are febrile. It would appear that if the embryonic temperature never exceeds 39 degrees C, then there is no measurable risk. We suggest that sonography (the field) and sonogram (the procedure) are the most appropriate and least anxiety provoking terms.     

Sister chromatid exchange and proliferation pattern after ultrasound exposure in vivo.

The sister chromatid exchange (SCE) frequency and cell-cycle specific metaphase patterns were investigated in PHA-stimulated lymphocytes in vitro after in vivo exposure of 15 patients to diagnostic ultrasound. No significant differences were found in SCE rates before and after ultrasound exposure. The evaluation of cell-cycle specific metaphase patterns, differentiating cells which passed one, two, or more cell cycles, gave no evidence for a cell-growth inhibitory effect. Since SCE is regarded as a highly sensitive method for the detection of mutagenic effects, our data confirm previous reports on the genetic safety of diagnostic ultrasound.     

Noninvasive Characterization of Locally Advanced Breast Cancer Using Textural Analysis of Quantitative Ultrasound Parametric Images

PURPOSE: The identification of tumor pathologic characteristics is an important part of breast cancer diagnosis, prognosis, and treatment planning but currently requires biopsy as its standard. Here, we investigated a noninvasive quantitative ultrasound method for the characterization of breast tumors in terms of their histologic grade, which can be used with clinical diagnostic ultrasound data. METHODS: Tumors of 57 locally advanced breast cancer patients were analyzed as part of this study. Seven quantitative ultrasound parameters were determined from each tumor region from the radiofrequency data, including mid-band fit, spectral slope, 0-MHz intercept, scatterer spacing, attenuation coefficient estimate, average scatterer diameter, and average acoustic concentration. Parametric maps were generated corresponding to the region of interest, from which four textural features, including contrast, energy, homogeneity, and correlation, were determined as further tumor characterization parameters. Data were examined on the basis of tumor subtypes based on histologic grade (grade I versus grade II to III). RESULTS: Linear discriminant analysis of the means of the parametric maps resulted in classification accuracy of 79%. On the other hand, the linear combination of the texture features of the parametric maps resulted in classification accuracy of 82%. Finally, when both the means and textures of the parametric maps were combined, the best classification accuracy was obtained (86%). CONCLUSIONS: Textural characteristics of quantitative ultrasound spectral parametric maps provided discriminant information about different types of breast tumors. The use of texture features significantly improved the results of ultrasonic tumor characterization compared to conventional mean values. Thus, this study suggests that texture-based quantitative ultrasound analysis of in vivo breast tumors can provide complementary diagnostic information about tumor histologic characteristics.     

Benchmark dose calculation from epidemiological data

A threshold for dose-dependent toxicity is crucial for standards setting but may not be possible to specify from empirical studies. Crump (1984) instead proposed calculating the lower statistical confidence bound of the benchmark dose, which he defined as the dose that causes a small excess risk. This concept has several advantages and has been adopted by regulatory agencies for establishing safe exposure limits for toxic substances such as mercury. We have examined the validity of this method as applied to an epidemiological study of continuous response data associated with mercury exposure. For models that are linear in the parameters, we derived an approximative expression for the lower confidence bound of the benchmark dose. We find that the benchmark calculations are highly dependent on the choice of the dose-effect function and the definition of the benchmark dose. We therefore recommend that several sets of biologically relevant default settings be used to illustrate the effect on the benchmark results and to stimulate research that will guide an a priori choice of proper default settings.     

Assessment of Validation Studies from a Fractionator''s Point of View

NAT testing has become an integral part in the safety programs of both plasma fractionators and transfusion services. NAT testing for HCV RNA is now mandatory for plasma fractionators in Europe and for transfusion services in Germany and Austria. Before NAT testing of plasma could become mandatory, a defined environment had to be created to allow comparison of different NAT procedures. To create such an environment, international virus standards, as well as guidelines for validation, assessment of robustness, and quality assurance of NAT have been released. This paper is a critical review of currently available standards and national reference preparations, detection limits, and national regulations of NAT in view of the specific nature of NAT.     

A comparative analysis of the impact on biota and man in the 30 km zone of the Chernobyl NPP

A methodological approach is described for a comparative assessment of ionizing radiation effects on man and biota, based on the use of indices of radiation impact--ratios of actual exposure doses to environmental objects (including humans) and critical ones. As such doses, standards limiting radiation exposure and doses at which phenotypical effects were absent after the Chernobyl accident were employed, respectively for man and biota. For the test site chosen within the 30 km ChNPP zone (region of the Borshchovka settlement), dose burdens to reference biota species and the population (with and without evacuation) and the corresponding radiation impact indices were calculated. For the long term period after the accident radiation safety standards for man are shown to ensure radiation safety for biota as well. At the same time in the early period after the accident the emergency regulations do not guarantee adequate protection of nature, some species of which can be subject to irradiation more than man, even if countermeasures like evacuation are not applied. A conclusion has been made on the necessity of a more detailed and comprehensive analysis of situations when the anthropocentric principle "if radiation standards protect man then biota are also adequately protected" is violated.     

Translational Analysis of Effects of Prenatal Cocaine Exposure on Human Infant Cries and Rat Pup Ultrasonic Vocalizations

Spectral and temporal features of human infant crying may detect neurobehavioral effects of prenatal cocaine exposure (PCE). Finding comparable measures of rodent ultrasonic vocalizations (USVs) would promote translational analyses by controlling the effects of correlated variables that confound human studies. To this end, two studies examined the sensitivity of similar acoustic structures in human infant and rat pup vocalizations to effects of PCE. In Study 1, cry sounds of 107 one month-old infants were spectrum analyzed to create a novel set of measures and to detect the presence of hyperphonation - a qualitative shift to an atypically high fundamental frequency (basic pitch) associated with neurobehavioral insult. Infants with PCE were compared to infants with prenatal polydrug-exposure (PPE) without cocaine and with infants in a standard comparison (SC) group with no prenatal drug exposure. In Study 2, USVs of 118 five day-old rat pups with either PCE, prenatal saline exposure or no prenatal exposures were spectrum analyzed to detect the presence of frequency shifts – acoustic features that have a frequency waveform similar to that of hyperphonation. Results of study 1 showed PCE had two sets of sex-dependent effects on human infants: PCE males had higher pitched cries with more dysphonation (turbulence); PCE females had longer pauses between fewer cry sounds that were of lower amplitude than comparison groups. PCE and PPE infants had more cries with hyperphonation than SC infants. In study 2, PCE pups had a greater percentage of USVs with shift in the acoustic structure than pups in the two control groups. As such, the novel measures of human infant crying and rat pup USVs were sensitive to effects of PCE. These studies provide the first known translational analysis of similar acoustic structures of vocalizations in two species to detect adverse effects of prenatal drug exposure.     

Beta声学指数的特征和应用

随着录音设备性能的提高和硬件价格的降低,基于录音评估声景来反映生境特征和生物多样性的方法得到快速发展。声学指数是对声音整体特征的量化,受到录音生境和生物组成的共同影响,因此可构建声学指数与生境特征和生物组成的关联。按照作用的尺度,声学指数可分为两类:反映录音内信息的alpha声学指数和比较不同录音之间差异的beta声学指数。随着录音设备的普及,以及在大尺度上进行生物监测工作的增加,对不同时间、不同地点的录音进行比较的需求日益迫切。因此,beta声学指数的开发和应用是声学指数研究的重要方向。本文介绍了11个常用的beta声学指数,并探讨了这些指数的数学特征(非负性、同一性、对称性、直递性、有限性)。本文还通过文献检索获取了beta声学指数在实证中的应用情况,发现研究中常使用beta声学指数反映时间节律、生境特征的差异或生物组成的改变。最后,本文指出了beta声学指数研究/应用中迫切需要发展的3个方向:开发新的指数、优化已有指数的计算方式、增加实证研究。     

新型声学造影剂在常规诊断超声频率下对在 体肾脏及离体培养细胞影响的研究

目的：评价新型超声造影剂在常规诊断超声频率下对组织细胞结构的影响。资料和方法：体外培养的人近曲小管上皮细胞分为造影剂无超声照射组,单纯超声照射组,MI 1．5,造影剂加超声照射组。MI 0．28,造影剂加超声照射组,MI 1．5。超声照射时间为10分钟。实验完后用2.5％的戊二醛固定4小时,送电镜室做扫描电镜。正常免肾经耳缘静脉按0．02ml／kg团注脂氟显（新桥医院超声科实验室自制）,用6MHz的超声频率照射,MI 0．28。照射10分钟。活体取肾皮质。放入3．0％的戊二醛溶液中固定,送电镜室做投射电镜。结果：离体培养的人近端小管上皮细胞单纯超声照射、单纯加造影剂、造影剂加超声照射MI 0．28和MI 1．5时扫描电镜观察细胞形态无改变,细胞表面未见异常。透射电镜观察免肾小囊腔和肾小管上皮细胞超微结构未见特异性政变。结论：新型脂质体声学造影剂在诊断剂量超声照射下不会对组织细胞结构产生影响。新型脂质体声学造影剂在诊断剂量下是安全的。     

Towards Harmonisation of Critical Laboratory Result Management - Review of the Literature and Survey of Australasian Practices

Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide.Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes.In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories are expected to follow in order to provide high quality and safe service to patients.     

How safe is diagnostic ultrasonography?

Health care workers and patients alike are concerned about the safety of diagnostic ultrasonography in clinical practice. Evidence published to date on the immediate and possible long-term biologic effects of exposure to ultrasound in diagnostic procedures is reviewed in this paper. No harmful effect in the human fetus, child or adult following the diagnostic use of pulsed ultrasound has been reported. However, the question of long-term biologic effects cannot yet be answered. Continued vigilance and further research are required.     

The effect of ultrasound on the attractiveness of acoustic mating signals

Abstract. Previous laboratory studies ( Nolen & Hoy 1986b ) have shown that the phonotactic responses of flying crickets are influenced by the relative intensities of attractive (mating signal) and repulsive (predator) stimuli. At the functional level, these results suggest that predator cues (ultrasound) can change the attractiveness of a calling song. Using extracellular recordings from cervical connectives it was shown that, like other field crickets, Gryllus rubens (south-eastern field cricket) is sensitive to ultrasound. This ultrasonic sensitivity has probably evolved in response to predation pressure from echolocating bats. Using acoustic playback under field conditions, it was tested whether the relative attractiveness of two male calling songs was influenced by the simultaneous broadcast of ultrasound. A simulated male calling song of G. rubens was broadcast at two different intensities (109 and 103 dB) from two sound traps that caught flying crickets attracted to the songs. Simulated bat ultrasound was broadcast simultaneously with the high-intensity calling song (109 dB) and the relative catch in each of the two traps was measured. The intensity of the ultrasound was varied on different nights. The relative attractiveness of the high-intensity sound trap decreased significantly as the intensity of the ultrasound broadcast with it was increased. For the lowest of the ultrasound broadcast levels, the relative attractiveness did not differ from that expected for two calling songs broadcast without ultrasound. Thus, increased levels of simulated predation risk decreased the attractiveness of the calling song associated with it. These are the first field experiments to show that predation risk in the form of simulated bat ultrasound influences the phonotactic behaviour of flying crickets.