Incidental Findings in Head and Brain MRI of Military Pilots and Applicants: Consequences for Medical Flight Fitness.

INTRODUCTION: With improved imaging technology, the number of incidental findings detected in cerebral MRI is increasing. This is a challenge that the German Air Force has to deal with in the context of standardized MRI examinations of young pilot candidates and pilots.METHODS: The German Air Force Centre of Aerospace Medicine hosted a 2-d conference to develop recommendations and procedures for the handling of some of the most frequently encountered cerebral incidental findings.RESULTS: Radiological MRI findings from a total of 2724 routine examinations of the skull of pilots and pilot applicants (26.8 ± 10.6 yr old; range from 16 to 62; over 80% range from 17 to 33; 96% men) revealed that in 28.1% of the examinations, one or more incidental findings were discovered. For seven of the following categories of incidental findings, decision guidelines could be established: white matter hyperintensities (N = 393; prevalence 14.4%; 95% CI 13.11-15.75), pinealis cysts (317; 11.6%; 10.43-12.84), developmental venous anomalies (64; 2.3%; 1.78-2.92), cavernomas (15; 0.6%; 0.27-0.83), aneurysms (14; 0.5%; 0.25-0.78), cholesterol granulomas (22; 0.8%; 0.47-1.14), and heterotopias of the gray matter (6; 0.2%; 0.04-0.4).CONCLUSION: Considering pilots health and aviation safety, a waiver decision is often possible after thorough discussion, depending on the specific criteria of the incidental finding and of the type of license.Kühn S, Sönksen S-E, Noble H-J, Knopf H, Frischmuth J, Waldeck S, Müller-Forell W, Weber F, Bressem L. Incidental findings in head and brain MRI of military pilots and applicants: consequences for medical flight fitness. Aerosp Med Hum Perform. 2022; 93(5):450-457.

Radio-frequency exposure of the yellow fever mosquito (A. aegypti) from 2 to 240 GHz.

Fifth generation networks (5G) will be associated with a partial shift to higher carrier frequencies, including wavelengths comparable in size to insects. This may lead to higher absorption of radio frequency (RF) electromagnetic fields (EMF) by insects and could cause dielectric heating. The yellow fever mosquito (Aedes aegypti), a vector for diseases such as yellow and dengue fever, favors warm climates. Being exposed to higher frequency RF EMFs causing possible dielectric heating, could have an influence on behavior, physiology and morphology, and could be a possible factor for introduction of the species in regions where the yellow fever mosquito normally does not appear. In this study, the influence of far field RF exposure on A. aegypti was examined between 2 and 240 GHz. Using Finite Difference Time Domain (FDTD) simulations, the distribution of the electric field in and around the insect and the absorbed RF power were found for six different mosquito models (three male, three female). The 3D models were created from micro-CT scans of real mosquitoes. The dielectric properties used in the simulation were measured from a mixture of homogenized A. aegypti. For a given incident RF power, the absorption increases with increasing frequency between 2 and 90 GHz with a maximum between 90 and 240 GHz. The absorption was maximal in the region where the wavelength matches the size of the mosquito. For a same incident field strength, the power absorption by the mosquito is 16 times higher at 60 GHz than at 6 GHz. The higher absorption of RF power by future technologies can result in dielectric heating and potentially influence the biology of this mosquito.

Frequency of positive anti-PF4/polyanion antibody tests after COVID-19 vaccination with ChAdOx1 nCoV-19 and BNT162b2.

Vaccination using the adenoviral vector COVID-19 vaccine ChAdOx1 nCoV-19 (AstraZeneca) has been associated with rare vaccine-induced immune thrombotic thrombocytopenia (VITT). Affected patients test strongly positive in platelet factor 4 (PF4)/polyanion enzyme immunoassays (EIAs), and serum-induced platelet activation is maximal in the presence of PF4. We determined the frequency of anti-PF4/polyanion antibodies in healthy vaccinees and assessed whether PF4/polyanion EIA+ sera exhibit platelet-activating properties after vaccination with ChAdOx1 nCoV-19 (n = 138) or BNT162b2 (BioNTech/Pfizer; n = 143). In total, 19 of 281 participants tested positive for anti-PF4/polyanion antibodies postvaccination (All: 6.8% [95% confidence interval (CI), 4.4-10.3]; BNT162b2: 5.6% [95% CI, 2.9-10.7]; ChAdOx1 nCoV-19: 8.0% [95% CI, 4.5% to 13.7%]). Optical densities were mostly low (between 0.5 and 1.0 units; reference range, <0.50), and none of the PF4/polyanion EIA+ samples induced platelet activation in the presence of PF4. We conclude that positive PF4/polyanion EIAs can occur after severe acute respiratory syndrome coronavirus 2 vaccination with both messenger RNA- and adenoviral vector-based vaccines, but many of these antibodies likely have minor (if any) clinical relevance. Accordingly, low-titer positive PF4/polyanion EIA results should be interpreted with caution when screening asymptomatic individuals after vaccination against COVID-19. Pathogenic platelet-activating antibodies that cause VITT do not occur commonly following vaccination.

Do arachnoid cysts grow? A retrospective volumetric study.

OBJECTIVE: Arachnoid cysts (ACs) are frequent incidental findings and may be associated with neuropsychiatric symptoms. Usually growth of the ACs with pressure on adjacent brain tissue is regarded as cause of the symptoms. This study was undertaken to identify if and which ACs grow with time. METHODS: We used a large database of cranial MRIs for a retrospective analysis. RESULTS: During a period of 10 years, we collected 166 ACs of 50 persons, mean observational period was 2.5 years. Among these, only larger cysts at the temporal pole, i.e., Galassi II ACs, grew with a rate of 0.3 ml a year (ß = 0.32, SE 0.07, p = 0.003); all other ACs remained constant in size or became smaller. All cysts were clinically silent. CONCLUSIONS: Most ACs remain constant in size or become smaller. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that the majority of arachnoid cysts does not grow.

Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate anticoagulation.

INTRODUCTION: Ionized calcium (iCa) concentration is often used in critical care and measured using blood gas analyzers at the point of care. Controlling and adjusting regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) involves measuring the iCa concentration in two samples: systemic with physiological iCa concentrations and post filter samples with very low iCa concentrations. However, modern blood gas analyzers are optimized for physiological iCa concentrations which might make them less suitable for measuring low iCa in blood with a high concentration of citrate. We present results of iCa measurements from six different blood gas analyzers and the impact on clinical decisions based on the recommendations of the dialysis' device manufacturer. METHOD: The iCa concentrations of systemic and post filter samples were measured using six distinct, frequently used blood gas analyzers. We obtained iCa results of 74 systemic and 84 post filter samples from patients undergoing RCA for CRRT at the University Medicine of Greifswald. RESULTS: The systemic samples showed concordant results on all analyzers with median iCa concentrations ranging from 1.07 to 1.16 mmol/L. The medians of iCa concentrations for post filter samples ranged from 0.21 to 0.50 mmol/L. Results of >70% of the post filter samples would lead to major differences in decisions regarding citrate flow depending on the instrument used. CONCLUSION: Measurements of iCa in post filter samples may give misleading information in monitoring the RCA. Recommendations of the dialysis manufacturer need to be revised. Meanwhile, little weight should be given to post filter iCa. Reference methods for low iCa in whole blood containing citrate should be established.

Heating characteristics of antenna arrays used in microwave ablation: A theoretical parametric study.

A numerical study of the performance of antenna arrays used in microwave ablation (MWA) is carried out. Double-slot coaxial antennas in triangular and square configurations are studied. Clinical (healthy vs. malignant) and experimental (in vs. ex vivo) scenarios for hepatic cancer treatment are modeled, and further application in bone and lung tissue is examined. It is found that triangular arrays can create spherical ablation zones, while square configurations result in flatter ones. Thresholds in power and application times for creating continuous ablation zones are calculated, and the characteristics of the latter are quantified.

Antenna design and tissue parameters considerations for an improved modelling of microwave ablation in the liver.

Microwave ablation is a technique used in treating hepatocellular carcinoma, especially in cases where surgical removal is impossible. In the present study we are investigating the effects of design characteristics of a coaxial slot antenna (single- versus double-slot, slot-to-tip distance and slot size) on the ablation zone characteristics (dimensions and shape). The specific absorption rate field and the temperature rises are calculated for a variety of application times and powers. A plateau in the ablation zone dimensions in healthy and cirrhotic liver models is predicted, but not in malignant ones. It is found that the value of the perfusion rate (which is different for each clinical case) is of crucial importance in order to correctly estimate the ablation zone. An underestimation of dimensions is expected, if higher perfusion rates are used (i.e., values for healthy tissue rather than malignant). In contrast, an exact determination of the values of relative permittivity and conductivity is less significant for predicting the ablation zone.

Head exposure system for a human provocation study to assess the possible influence of UMTS-like electromagnetic fields on cerebral blood circulation using near-infrared imaging.

A head exposure setup for efficient and precisely defined exposure of human subjects equipped with a near-infrared imaging (NIRI) sensor is presented. In a partially shielded anechoic chamber the subjects were exposed to Universal Mobile Telecommunications System (UMTS)-like electromagnetic fields (EMF) by using a patch antenna at a distance of 4 cm from the head. The non-contact design of the exposure setup enabled NIRI sensors to easily attach to the head. Moreover, different regions of the head were chosen for localised exposure and simultaneous NIRI investigation. The control software enabled the simple adaptation of the test parameters during exploratory testing as well as the performance of controlled, randomised, crossover and double-blind provocation studies. Four different signals with a carrier frequency of 1900 MHz were chosen for the exposure: a simple continuous wave signal and three different UMTS signals. Furthermore, three exposure doses were available: sham, low (spatial peak specific absorption rate (SAR) = 0.18 W/kg averaged over 10 g) and high (spatial peak SAR = 1.8 W/kg averaged over 10 g). The SAR assessment was performed by measurement and simulation. Direct comparison of measurement and numerical results showed good agreement in terms of spatial peak SAR and SAR distribution. The variability analysis of the spatial peak SAR over 10 g was assessed by numerical simulations. Maximal deviations of -22% and +32% from the nominal situation were observed. Compared to other exposure setups, the present setup allows for low exposure uncertainty, combined with high SAR efficiency, easy access for the NIRI sensor and minimal impairment of test subjects.

Estimation of head tissue-specific exposure from mobile phones based on measurements in the homogeneous SAM head.

The maximum spatial peak exposure of each commercial mobile phone determined in compliance with the relevant safety and product standards is publicly available. However, this information is not sufficient for epidemiological studies aiming to correlate the use of mobile phones with specific cancers or to behavioral alterations, as the dominant location of the exposure may be anywhere in the head between the chin to above the ear, depending on the phone design. The objective of this study was to develop a methodology to determine tissue-specific exposure by expanding the post-processing of the measured surface or volume scans using standardized compliance testing equipment, that is, specific absorption rate (SAR) scanners. The transformation matrix was developed using the results from generic dipoles to evaluate the relation between the SAR in many brain regions of the Virtual Family anatomical phantoms and in virtual brain regions mapped onto the homogeneous SAM head. A set of transformation factors was derived to correlate the SAR induced in the SAM head to the SAR in the anatomical heads. The evaluation included the uncertainty associated with each factor, arising from the anatomical differences between the phantoms (typically less than 6 dB (4×)). The applicability of these factors was validated by performing simulations of four head models exposed to four realistic mobile phone models. The new methodology enables the reliable determination of the maximum and averaged exposure of specific tissues and functional brain regions to mobile phones when combined with mobile phone power control data, and therefore greatly strengthens epidemiological evaluations and improves information for the consumer.

Assessment of the radio-frequency electromagnetic fields induced in the human body from mobile phones used with hands-free kits.

In this study, the radiation emission from mobile phones when used with wireless and wired hands-free kits (HFK) was evaluated to determine the necessity for a dedicated compliance procedure and the extent to which the use of wired and wireless HFK can reduce human exposure. The specific absorption rates (SAR) from wireless HFK were determined experimentally. Wired HFK were evaluated dosimetrically while connected to mobile phones (GSM900/1800, UMTS1950) under maximized current coupling onto the HFK cable and various wire routing configurations. In addition, experimentally validated simulations of a wired HFK and a mobile phone operating on anatomical whole-body models were performed. The maximum spatial peak SAR in the head when using wired HFK was more than five times lower than ICNIRP limits. The SAR in the head depends on the output power of the mobile phone, the coupling between the antenna and cable, external attenuation and potential cable specific attenuation. In general, a wired HFK considerably reduces the exposure of the entire head region compared to mobile phones operated at the head, even under unlikely worst-case coupling scenarios. However, wired HFK may cause a localized increase of the exposure in the region of the ear inside the head under worst-case conditions. Wireless HFK exhibit a low but constant exposure.

Assessment of induced radio-frequency electromagnetic fields in various anatomical human body models.

The reference levels for testing compliance of human exposure with radio-frequency (RF) safety limits have been derived from very simplified models of the human. In order to validate these findings for anatomical models, we investigated the absorption characteristics for various anatomies ranging from 6 year old child to large adult male by numerical modeling. We address the exposure to plane-waves incident from all major six sides of the humans with two orthogonal polarizations each. Worst-case scattered field exposure scenarios have been constructed in order to test the implemented procedures of current in situ compliance measurement standards (spatial averaging versus peak search). Our findings suggest that the reference levels of current electromagnetic (EM) safety guidelines for demonstrating compliance as well as some of the current measurement standards are not consistent with the basic restrictions and need to be revised.