Modelling of the Current Density Distributions during Cortical Electric Stimulation for Neuropathic Pain Treatment

In the last two decades, motor cortex stimulation has been recognized as a valuable alternative to pharmacological therapy for the treatment of neuropathic pain. Although this technique started to be used in clinical studies, the debate about the optimal settings that enhance its effectiveness without inducing tissue damage is still open. To this purpose, computational approaches applied to realistic human models aimed to assess the current density distribution within the cortex can be a powerful tool to provide a basic understanding of that technique and could help the design of clinical experimental protocols. This study aims to evaluate, by computational techniques, the current density distributions induced in the brain by a realistic electrode array for cortical stimulation. The simulation outcomes, summarized by specific metrics quantifying the efficacy of the stimulation (i.e., the effective volume and the effective depth of penetration) over two cortical targets, were evaluated by varying the interelectrode distance, the stimulus characteristics (amplitude and frequency), and the anatomical human model. The results suggest that all these parameters somehow affect the current density distributions and have to be therefore taken into account during the planning of effective electrical cortical stimulation strategies. In particular, our calculations show that (1) the most effective interelectrode distance equals 2 cm; (2) increasing voltage amplitudes increases the effective volume; (3) increasing frequencies allow enlarging the effective volume; and (4) the effective depth of penetration is strictly linked to both the anatomy of the subject and the electrode placement

Occupational exposure to electromagnetic fields: risk assessment of operators performing Transcranial Magnetic Stimulation (TMS) treatments

The assessment of the risk from occupational exposure to electromagnetic fields (EMF) has attracted the attention of those involved in safety in the workplace, in particular after the updating of European legislation, with the publication for EMFs, of Directive 2013/35/EU1 of the European Parliament and of the Council, which made the risk assessment mandatory for this type of physical agents. The issue is made even more relevant by the proliferation of industrial and health applications using EMF even of considerable intensity. However, the rapid technological development has not always been accompanied by adequate growth in the culture of prevention and safety. Many devices expose both operators and persons of the general public to significant risks, but often, these risks are not adequately reported by the manufacturer, nor mentioned in the instruction manual, as would be expressly required by the harmonized standards. In this general framework is placed this Ph.D. research project, whose aim is to analyze possible conditions of risk in the workplace, considering only the environment where the EMF sources potentially expose the operator to risk. The research project involves a joint collaboration between two Institutions: the National Institute for Insurance against Accidents at Work - INAIL and of course Sapienza University of Rome. The project is developed in a multidisciplinary manner, providing experimental and numerical investigations to achieve the required goals, also considering the literature review and comparison for a more realistic analysis of the risk, in terms of human exposure to EMF. The work is based on a multiphysics approach to obtain a complete evaluation of the risk in the workplace, with the prospective to improve the current approach in the assessment of the risk and eventually suggest some indications to the operator for better use of the device under test. Therefore, the starting point has been a review of the workplaces to identify any gaps and critical issues in relation to the risk assessment and therefore for which it is considered necessary to deepen the protectionist issues. A literature analysis of the state of the art on the risk in the workplace is first carried out. This has been followed by numerical and accurate modeling of the device under test as well as the workers in a real reproduced work condition of exposure. Of paramount importance is the understanding of all the parameters that can affect the distribution of the induced EM quantities, which are essential for the risk assessment and the verification of compliance with the regulations system. To do this, it was necessary to study human exposure in-depth, also using different human body models available for dosimetric analysis on dedicated software. All the research has traveled on two parallel tracks, on the one hand, the need to fill the scientific gaps in the research area of exposure assessment of workers and on the other one to take into account the regulatory aspects, essential for a correct evaluation of professional exposure. Therefore, as a last step of the overall work, a possible new protocol of risk assessment analysis is proposed to move forward on the improvement of safety and security in the workplace