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At least 19 records

Replacement of Cobalt in Medical Device Sterilization: Current Trends, Opportunities and Barriers to Adoption of X-ray and E-Beam Within the Medical Device Sterilization Market

Radioactive sources, specifically Co-60, are crucially important to the medical device sterilization industry; however, their benefits must be balanced against the need to ensure that the materials are secure. Accelerator-based sterilization methods, including X-ray and E-Beam, can in many cases sufficiently replace Co-60 and ethylene oxide, the dominant modalities currently in use; however, a lack of hands-on experience with accelerators, regulations, and a lack of capacity have hampered faster adoption of these technologies. The market is likely to change, however, given public pressures against ethylene oxide and concerns over the cost and long-term supply chain robustness of Co-60. This may provide an opportunity for growth for accelerator capabilities. Current research at Sandia National Laboratories and Argonne National Laboratory, on behalf of the Department of Energy’s National Nuclear Security Administration Office of Radiological Security, is focused on developing an understanding of the medical device sterilization marketplace, the different modalities that are used to sterilize goods, and the drivers that affect the actors within it. Research at Pacific Northwest National Laboratory, in conjunction with the medical device sterilization industry, has focused on expanding the industry’s understanding of the capabilities of X-ray sterilization and developing data that can inform the industry’s consideration of a transition towards accelerator-based devices.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A Multi-Faceted Approach to Demonstrating Multi-Functional Integrated Medical Devices to Advance Earth-Independent Medical Operations

INTRODUCTION TO MIM DEVICES Multi-functional Integrated Medical (MIM) devices conveniently incorporate multiple medical system capabilities within one device. The NASA Exploration Medical Integrated Product Team (XM-IPT) sponsored a market survey and trade study which identified the Tempus ProTM and the LifeBot 10® as the MIM devices that best met the evaluation criteria of the trade study. The Tempus ProTM (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) and LifeBot 10® (LifeBot Health, Chicago, IL) both provide vital sign measurements such as blood pressure, electrocardiograms, heart rate, end tidal CO2, respiration rate, pulse oximetry and temperature along with ultrasound imaging. A video laryngoscopy capability is unique to the Tempus ProTM, while the LifeBot 10® supports connectivity with a digital stethoscope, otoscope, eye exam camera, and dermatoscope. Both devices include procedural guidance capabilities and have various data transmission and report generation features. TECHNOLOGY DEMONSTRATIONS NASA’s exploration-class missions will have severe resource constraints, long return trip durations, significant communication delays, and limited resupply opportunities. The medical systems of these missions will need to fit within an Earth-Independent Medical Operations (EIMO) construct. Key features of an EIMO medical system include: 1) technologies that support the prevention, diagnosis, and treatment of spaceflight medical events; 2) components that meet mass, volume, power and crew time/training constraints; 3) consideration of the medical skill level of the astronaut caregiver; 4) collection, storage and analysis of medical data within a central data architecture; and 5) incorporation of appropriate guidance and support tools that allow crew autonomy. Evaluations are underway to determine if it will be beneficial to include MIM devices within exploration medical systems by conducting a series of planned technical demonstrations. Exploration Atmosphere Chamber studies are being performed to determine MIM functionality in a high oxygen concentration atmosphere. A side-by-side comparison of the Tempus ProTM and LifeBot 10® will be performed during ground-based demonstrations. Use of the MIM devices within an EIMO medical scenario simulation will be practiced during ground-based demonstrations in preparation for International Space Station (ISS) demonstrations of the MIM device. These various demonstrations are designed to gather evidence for or against the inclusion of MIM devices within an EIMO medical system. EXPECTED DEMONSTRATION OUTCOMES Information will be gained about the feasibility, benefits, and challenges of using a multifunctional, all-in-one, medical device for medical diagnosis. Information will also be collected about performance differences as available ground support decreases. Gaining this understanding will allow for further development of exploration medical system capabilities, which take the EIMO construct into consideration.

B. E. Lewandowski↗

Preparation for an Earth Independent Medical Operations Demonstration using the Tempus ALS™ Medical Device

NASA’s exploration-class missions have severe resource constraints, long return trip durations, significant communication delays and limited resupply opportunities. Validation on the International Space Station (ISS) of medical devices that fit within Earth-Independent Medical Operations (EIMO) systems is a necessary preparation step. Key features of an EIMO medical system include: 1) technologies that support the prevention, diagnosis, and treatment of spaceflight medical events; 2) components that meet mass, volume, power and crew time/training constraints; 3) consideration of the medical skill level of the astronaut caregiver; 4) collection, storage and analysis of medical data within a central data architecture; and 5) incorporation of appropriate guidance and support tools that allow crew autonomy. The Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element and the Exploration Medical Integrated Product Team (XM-IPT) are planning an ISS technology demonstration to determine the feasibility of including a multifunctional medical device into an EIMO medical system. Demonstration Preparations: The Tempus ALS (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf medical device, with United States Food and Drug Administration clearance and is Conformité Européene marked in Europe. Several thousand units have been sold and are successfully operating in pre-hospital and in remote settings, such as by European Space Agency (ESA) flight surgeons and some of NASA’s commercial partners during post-flight medical operations. The Tempus ALS provides vital sign measurements such as blood pressure, electrocardiograms, heart rate, end tidal CO2, respiration rate, pulse oximetry and temperature. The device has ultrasound imaging and video laryngoscopy capabilities and has automatic or manual defibrillation modes for treating cardiac arrhythmias. It includes procedural guidance capabilities to assist in the collection of the vital sign measurements and it has various data transmission and report generation features. NASA’s HRP ExMC and XM-IPT are partnering with the ESA to demonstrate the Tempus ALS on ISS, with ESA manifesting the Tempus ALS and its accessories. ESA will compare performance of periodic health status exams and medical contingency drills performed nominally and with the Tempus ALS. NASA’s EIMO demonstration will include the use of Tempus ALS to diagnose a complaint of abdominal pain under increasingly independent circumstances. The caregiver must assess the present illness, collect vital sign measurements, and perform an abdominal ultrasound, under one of three communication situations, including real-time, with a several second delay and with a delay on the order of minutes. Expected Outcomes: Information will be gained about the feasibility, benefits, and challenges of using a multifunctional, all-in-one, medical device for medical diagnosis instead of separate devices with singular functionalities. Information will also be collected about performance differences as communication delays increase and available ground support decreases. Gaining this understanding will allow for further development of exploration medical system capabilities which takes the EIMO construct into consideration.

Beth Lewandowski↗

Connecting radiation-driven changes in structural, thermal, and mechanical properties in several medical device polymers

Stemming from security threats and shortages in supply, a recent push has emerged to develop alternatives to radioisotope Cobalt-60 gamma radiation for sterilization of polymeric medical products, including electron beam (e-beam) and X-ray machine-based sources. However, before large-scale implementation, the effects of these non-isotope-based methods must be thoroughly investigated from several perspectives, involving their potential detrimental effects on the structural, thermal, and mechanical properties of polymers in medical devices. This paper investigates such effects in commonly used medical device polymers, including polypropylene homopolymer (PPH), polyolefin elastomer (POE), low-density polyethylene (LDPE), acrylonitrile butadiene styrene (ABS), and chlorobutyl rubber (CIIR). To connect radiation-driven changes in polymer structural and thermal properties and corresponding changes in mechanical properties, several characterization techniques were utilized, including gel permeation chromatography (GPC), Fourier transform infrared spectroscopy (FTIR), dynamic mechanical analysis (DMA) and differential scanning calorimetry (DSC). We found that the tensile strength of X-ray irradiated PPH, as well as X-ray, e-beam, and gamma irradiated CIIR decreases due to chain scission, which is corroborated by GPC and DMA. The GPC results of LDPE suggest chain scission, but interestingly without a corresponding decline in tensile strength. By comparison, POE and ABS appear to undergo further crosslinking with increasing irradiation dose, which generally strengthens them. Importantly, in the vast majority of the cases, there were small to no changes in properties upon changing radiation technologies (at a given dose), i.e., no radiation source dependence. However, in a few specific cases, radiation method dependencies did arise, for instance, in terms of the molecular weight of PPH being significantly increased upon X-ray irradiation, while the melting temperature, glass transition temperature, and elongation at break reduced compared to gamma. Overall, this study provides valuable insight into radiation-driven chemical and structural changes in polymers that produce changes in physical and functional properties.

36 MATERIALS SCIENCE↗

Optimize Use of Space Research and Technology for Medical Devices

systems, and cutting-edge component technologies to conduct a wide range of scientific observations and measurements. These technologies are also considered for practical applications that benefit society in remarkable ways. At NASA Goddard, the technology transfer initiative promotes matching technologies from Earth and space science needs to targeted industry sectors. This requires clear knowledge of industry needs and priorities and social demands. The process entails matching mature technologies where there are known innovation challenges and good opportunities for matching technology needs. This requires creative thinking and takes commitment of time and resources. Additionally, we also look at applications for known hot industry or societal needs. Doing so has given us occasion to host discussions with representatives from industry, academia, government organizations, and societal special interest groups about the application of NASA Goddard technologies for devices used in medical monitoring and detection tools. As a result, partnerships have been established. Innovation transpired when new products were enabled because of NASA Goddard research and technology programs.

Optimize↗

Reverse Engineering of Medical Devices for Innovation and Advancement in Healthcare

Medical cybersecurity research addresses the critical intersection of healthcare and digital security. As medical devices expand and become increasingly interconnected, the healthcare sector is poised to become a primary target for cyber warfare. This project aims to mitigate the risks associated with a field that often underestimates the importance of cybersecurity.

Baldwin, David↗

Direct comparison of gamma, electron beam and X-ray irradiation doses on characteristics of low-density polyethylene, polypropylene homopolymer, polyolefin elastomer and chlorobutyl rubber medical device polymers

There is a growing need for increased efficiency in the sterilization of single use medical devices and other products that contain polymer components. Gamma radiation is widely used for devices suited for radiation sterilization; however, safety, throughput and cobalt-60 source availability are challenging the prospect of relying on gamma radiation to meet the anticipated needs of the industry. Use of electron beam (e-beam) and X-rays as alternatives to gamma for radiation sterilization have been hampered in part by a concern that these modalities may adversely affect polymer integrity and performance relative to the gamma method, for which the industry has had much more experience. To address this concern, the effects of sterilization-relevant doses of ebeam, X-ray and gamma radiation were directly compared using common medical device polymers found in two prototypical commercial devices currently sterilized using cobalt-60 gamma irradiation. The Becton, Dickinson and Company (BD) Vacutainer™ Plus tube contains low-density polyethylene and chlorobutyl rubber components, while the BD Vacutainer™ Push Button Blood Collection Set contains polypropylene homopolymer and polyolefin elastomer components. Injection-molded samples prepared from the polymers used in these products were exposed to target doses of 15, 35, 50 and 80 kGy using gamma, e-beam and X-ray radiation. Changes in coloration, tensile properties and hardness were measured for each condition, and the effects of e-beam and X-ray irradiation compared with the effects of gamma irradiation on these properties. Both e-beam and X-ray appear as viable alternatives to gamma irradiation for sterilization of the polymers tested.

sterilization, gamma, X-ray, electron beam, radiat↗

Temperature dependence of nickel ion release from nitinol medical devices

Abstract Nitinol exhibits unique (thermo)mechanical properties that make it central to the design of many medical devices. However, nitinol nominally contains 50 atomic percent nickel, which if released in sufficient quantities, can lead to adverse health effects. While nickel release from nitinol devices is typically characterized using in vitro immersion tests, these evaluations require lengthy time periods. We have explored elevated temperature as a potential method to expedite this testing. Nickel release was characterized in nitinol materials with surface oxide thickness ranging from 12 to 1564 nm at four different temperatures from 310 to 360 K. We found that for three of the materials with relatively thin oxide layers, ≤ 87 nm nickel release exhibited Arrhenius behavior over the entire temperature range with activation energies of 80 to 85 kJ/mol. Conversely, the fourth ''black–oxide'' material, with a much thicker, complex oxide layer, was not well characterized by an Arrhenius relationship. Power law release profiles were observed in all four materials; however, the exponent from the thin oxide materials was approximately 1/4 compared with 3/4 for the black–oxide material. To illustrate the potential benefit of using elevated temperature to abbreviate nickel release testing, we demonstrated that a > 50 day 310 K release profile could be accurately recovered by testing for less than 1 week at 340 K. However, because the materials explored in this study were limited, additional testing and mechanistic insight are needed to establish a protective temperature scaling that can be applied to all nitinol medical device components.

Saylor, David M.↗

Exploration Atmosphere Demonstration of A Multi-Functional Integrated Medical Device (Tempus Pro)

INTRODUCTION The Exploration Medical Capability (ExMC) element within the Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) within the Mars Campaign Office seek to advance medical system design and risk-informed decision-making for exploration missions. This includes assessment of candidate devices and their compatibility within a variety of increasingly Earth-independent medical scenarios. The Tempus Pro (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf (COTS), multi-functional integrated medical device capable of vital signs monitoring, with built-in procedure support (iAssist), patient record and telemedicine communication features, and medical imaging (e.g., camera, laryngoscope, ultrasound) that meets multiple exploration medical capability needs. One of several hypobaric atmospheres being considered for exploration vehicles is 8.2 psi with 34% oxygen. To assess the useability of the Tempus Pro in such environments by individuals without formal medical training, the unit was tested in May and June of 2023 at the Johnson Space Center 20-Foot Exploration Atmosphere Chamber in conjunction with the Exploration Atmospheres-2 (EA-2) study. TECHNOLOGY DEMONSTRATION Eight subjects in the EA-2 study were assigned roles as the caregiver or patient – or both in the case of a self-exam – and caregivers were asked to place sensors for 3-Lead ECG, non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and temperature using Tempus Pro’s iAssist. Depending on the procedure, additional tasks included an oropharyngeal exam of the throat with the laryngoscope and capturing ultrasound images of a cardiac subxiphoid view or of the user’s choice from a pre-specified list. Scenarios ranged from remote-guided to fully autonomous operations and surveyed the effectiveness of support, amount of support desired, and importance of support by type (e.g., written crew procedures, iAssist and device guidance, remote console guidance, etc.). Feedback from the subjects and the support personnel was also gathered to inform future designs for training and support and to determine what operations are plausible given different levels of each. An unweighted NASA task load index (TLX) was used to profile the demands of using the device, however the sample size does not support statistics. The research was exploratory in nature and qualitative information was the main goal. Calibration checks on the Tempus Pro were conducted before and after chamber testing to ensure the device was in useable condition. RESULTS All subjects performed their tasks successfully and found the Tempus Pro easy to use with the support provided. The calibration checks outside the chamber showed that the Tempus Pro remained unchanged and measurements inside the chamber were within normal values. Caregivers taking the NASA TLX reported mean scores ≤ 41/100 showing the tasks to be undemanding and less demanding with repeated use (~20/100). Novice users were able to easily connect sensors and take vital signs with the guidance from Tempus Pro’s iAssist feature. For more complex tasks, such as the oropharyngeal exam and ultrasound image acquisition, guidance beyond iAssist was needed, primarily from a supporting physician. Feedback on the importance of support types varied by person and scenario but greater than 50% of the support used by each was non-native to the device. Overall opinions were positive, but the ultrasound users expressed a lack of confidence in their results and 3 out of 4 desired more time, training, or support. Subjects found the sensors to be comfortable and comparable to prior experiences with such devices, except for the blood pressure cuff, which squeezed too tightly for uncomfortably long periods. Many observations provoked discussion, especially regarding ultrasound, that will aide decisions about future demonstrations.

R. S. Miller↗

2020 Medical Device Sterilization Workshop: Continuing the Conversation, Summary Report

Technical advancements are making accelerator-based sources of radiation viable candidates for sterilization of medical devices. Electron beams and x-rays are becoming more cost-competitive and new facilities are being built to provide needed capacity and redundancy. As the industry becomes more receptive to these modalities, there is a need for information and data to enable prospective users to evaluate these options for their products. The workshops offered in 20191 and now in 2020 strive to foster conversation between device manufacturers, equipment and service providers on needs, capabilities, and knowledge.

43 PARTICLE ACCELERATORS↗

Integrated Microbatteries for Implantable Medical Devices

Integrated microbatteries have been proposed to satisfy an anticipated need for long-life, low-rate primary batteries, having volumes less than 1 mm3, to power electronic circuitry in implantable medical devices. In one contemplated application, such a battery would be incorporated into a tubular hearing-aid device to be installed against an eardrum. This device is based on existing tube structures that have already been approved by the FDA for use in human ears. As shown in the figure, the battery would comprise a single cell at one end of the implantable tube. A small volume of Li-based primary battery cathode material would be compacted and inserted in the tube near one end, followed by a thin porous separator, followed by a pressed powder of a Li-containing alloy. Current-collecting wires would be inserted, with suitably positioned insulators to prevent a short circuit. The battery would contain a liquid electrolyte consisting of a Li-based salt in an appropriate solvent. Hermetic seals would be created by plugging both ends with a waterproof polymer followed by deposition of parylene.

Whitacre, Jay↗

Motivation and Development of a Compact Superconducting Accelerator for X-ray Medical Device Sterilization

Fermilab is developing a compact superconducting (CSRF) accelerator as a source of a high-power, high-energy electron beam to produce an x-ray beam comparable to $\geq$ 2 MCi of cobalt-60. As part of this development, we are presently assembling a 20 kW, 1.6 MeV prototype that incorporates the four enabling technologies described below. These technologies support a heat budget that is within the capacity of commercially available cryocoolers and eliminate the need for liquid cryogens. The use of superconducting technologies promises efficiencies, wall-plug to beam, of 80% or greater. A summary of the design and progress to date will be given. In addition, we will present a review of developments within the medical device sterilization industry that are motivating the development of this technology.

43 PARTICLE ACCELERATORS↗

Effects of gamma, electron beam, and X-ray irradiation on the plastic components of a universal bone cement mixer medical device

Due to market and regulatory pressures, many healthcare manufacturers are considering alternatives to cobalt-60 gamma radiation, including accelerator-based electron beam (E-beam) and X-ray radiation for product sterilization. In this work, the effects of irradiation on a representative medical product, comprised of eight distinct polymer materials, were directly compared for three radiation technologies – cobalt-60 gamma, E-beam, and X-ray – at four dose levels (15, 25, 50, and 70 kGy). The objective was to determine how radiation effects (deleterious or beneficial) are influenced by source and dose level, with the specific goal of determining whether E-beam radiation and/or X-ray radiation could be viable alternatives to gamma radiation for device sterilization. Here, the specific product considered is a single-use medical device for orthopedic surgery, the Stryker Instruments MixeVac III bone cement mixer, which is currently sterilized using gamma radiation from cobalt-60 sources. Following ASTM International standards and input from the manufacturer, we characterized the effects of the three radiation sources on product functionality as well as on the mechanical and optical properties of the constituent polymers. Results indicate that although measurable differences in properties between the standard gamma irradiated materials and the alternative E-beam and X-ray irradiated materials were observed, those differences were small. Statistically significant differences were noted in the case of yellowness index for polyvinyl chloride, high-density polyethylene, and polycarbonate, and in the case of tensile elongation at break for high impact polystyrene and polyvinyl chloride. In general, the results of this study support the viability of E-beam and X-ray radiation as alternative options to cobalt-60 gamma radiation for sterilization of Stryker single-use universal bone cement mixer medical devices.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Reverse Engineering of Medical Devices for Innovation and Advancement in Healthcare

• Medical technology is rapidly evolving and introducing new functionality and methodologies that suggest a higher risk for common vulnerability exposures (CVE) • Introduction of functionalities like Wi-Fi, Bluetooth, and internet connectivity require devices to be rigorously evaluated for vulnerabilities • Subsequently like many other fields cell-phone interconnectivity suggests a significantly higher level of risk to critical infrastructure and data security

Baldwin, David [Savannah River National Laboratory↗

Medical Devices Assess, Treat Balance Disorders

You may have heard the phrase as difficult as walking and chewing gum as a joking way of referring to something that is not difficult at all. Just walking, however, is not all that simple physiologically speaking. Even standing upright is an undertaking requiring the complex cooperation of multiple motor and sensory systems including vision, the inner ear, somatosensation (sensation from the skin), and proprioception (the sense of the body s parts in relation to each other). The compromised performance of any of these elements can lead to a balance disorder, which in some form affects nearly half of Americans at least once in their lifetimes, from the elderly, to those with neurological or vestibular (inner ear) dysfunction, to athletes with musculoskeletal injuries, to astronauts returning from space. Readjusting to Earth s gravity has a significant impact on an astronaut s ability to balance, a result of the brain switching to a different "model" for interpreting sensory input in normal gravity versus weightlessness. While acclimating, astronauts can experience headaches, motion sickness, and problems with perception. To help ease the transition and study the effects of weightlessness on the body, NASA has conducted many investigations into post-flight balance control, realizing this research can help treat patients with balance disorders on Earth as well. In the 1960s, the NASA-sponsored Man Vehicle Laboratory at the Massachusetts Institute of Technology (MIT) studied the effects of prolonged space flight on astronauts. The lab s work intrigued MIT doctoral candidate Lewis Nashner, who began conducting NASA-funded research on human movement and balance under the supervision of Dr. Larry Young in the MIT Department of Aeronautics and Astronautics. In 1982, Nashner s work resulted in a noninvasive clinical technique for assessing the cooperative systems that allow the body to balance, commonly referred to as computerized dynamic posturography (CDP). CDP employs a series of dynamic protocols to isolate and assess balance function deficiencies. The technology was based on Nashner s novel, engineering-inspired concept of balance as an adaptable collaboration between multiple sensory and motor systems. CDP proved useful not only for examining astronauts, but for anyone suffering from balance problems. Today, CDP is the standard medical tool for objectively evaluating balance control.

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