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ISSN 0971 - 6203

Association ofMedical Physicists of India

www.ampi.org.in

An Affiliate of Indian National Science Academyand

International Organization for Medical Physics

Medical PhysicsJournal of

Volume 34 No 2 Apr - Jun 2009

Full text at www.jmp.org.in

Journal ofMedical Physics Volume 34 Issue 1 January - Ma

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Letter to Editor

Use of mobile phone in

operating room

Mobile phones and Personal Digital Assistants (PDAs) havebecome an integral part of the physicians life. They arecommonly used for personal and professional scheduling,accessing medical information, drug information and emails.

Contrary to the belief, there is a common practice to usemobiles and PDAs by surgeons in Operating Room (OR)both for personal and professional use. Surgeons commonlyuse mobile cameras to take photographs intra-operativelyin case of non-availability of cameras. Many of the surgeonsuse mobiles and PDAs to play live or recorded music duringsurgeries. A study found 66% of surgeons using their

phones in the hospitals, including in operating theatres andintensive care units.[1]

Regarding mobile usage in OT, the question of safetyis complex and in practice, often confusing. Lot ofconcerns has been raised regarding the interference ofthe vital apparatus in OT and ICU. Many Anecdotalreports exist of interference with medical electricalequipments.[2,3] However; it is difficult to comparevarious study findings due to number of devicestested, non-uniform study designs and heterogeneoustechnological information.

The issues concerning mobile phones is the electromagneticradiation (EMR) they produce, the safe distance theyshould be from medical equipment and the ability ofmedical equipment to resist EMR.Another issue is - noisefrom mobile phones ringing during consultation or in theward disturbing staff and irritating patients.

The clinically relevant EMR is suggested to be theinterference sufficiently altering the operation ofmedical equipment endangering a patient. This includesswitching off, faulty action and interrupted functionof equipment. The studies have found that most ofthe interference related to disturbance of the signals

is on cardiac monitors.[4] Other effects were found onpacemakers, with inappropriate inhibition or atrial oversensing or misinterpretation of the mobile phone signalas atrial activity with synchronous fast pacing of theventricle, documented in both permanent and temporarysystems.[5,6]The effect on both devices was, however, foundto be transitory and completely avoidable by removing

the mobile phone away from the monitor or pacemaker.Moreover, the interference with the pacemaker occurredonly with the mobile phone at a distance of up to 10 cmfrom the equipment.[6] Studies by Medical Devices Agency(UK) also revealed clinically relevant electromagnetic

interference with the usage of mobile phones in four percent of medical electrical equipment, though testing wasnot standardized between studies and equipment testedwere not identical. The studies recommend some typeof restriction of mobile phone use in hospitals, with usegreater than one meter from equipment. The newergeneration mobile phones might be used much closer toother equipment than their predecessors. However, thesafest option is the one meter rule proposed by Irnichand Tobisch which suggested restriction of mobile phoneuse to greater than 1 meter from equipment.[7]

Most world standards relate to the United States Food

and Drug Administration (FDA), which issued a voluntarystandard in 1979 specifying that medical equipment shouldbe immune from interference in fields of up to 7 V/mwithin the frequency range of 4501000 MHz.2 Clearly,mobile phones may breach these limits if operated withinone meter, but this does not automatically translate toEMI.[2] In Europe, Asiaand Middle East, phones operatepredominantly in the 1800 MHz band. Mobile phonesoperating at 1800 MHz appear to cause clinically nonsignificant EMI and need to be closer to medical equipmentto affect it. Recent introduction of Bluetooth technologyoffers further less interference.

A study by Edelstyn and Oldershaw investigating theeffects of acute mobile phone exposure on attentionsystem found that performance was facilitated followingmobile phone exposure with no deficits evident. Anotherstudy by Lee et al, on the effect of mobile phoneson human attention suggested that exposure to theelectromagnetic field emitted by mobile phones may havea mild facilitating effect on attention functions and alsoon cognitive processing.

With technological advancement, newer equipment isbecoming less sensitive to interference as manufacturersare adopting increasingly stringent standards for

screening.[8]

Immediate access to medical information at the point ofcare can reduce costs, improve accuracy in diagnosis andtreatment, reduce errors, and optimize workflow.[9] Shortmessage service (SMS) is also a valuable asset for surgeonsto discuss management of interesting and difficult cases

Journal of Medical Physics, Vol. 34, No. 2, 2009, 101-2

Received on: 30.09.08 Review completed on: 03.03.09 Accepted on: 07.05.09 DOI: 10.4103/0971-6203.51938

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Journal of Medical Physics, Vol. 34, No. 2, 2009

with their peer.An Australian study by Lam et al. in 2004utilized mobile phone photo-messaging in 27 cases of handtrauma for communication between the registrar and theconsultant in the emergency department and recommendedthe use of mobile phone photo messaging into the clinicalpractice.

The Medicines and Healthcare Product Regulatory Agencyof United Kingdom recommends that a balanced approachis necessary to ensure that the benefits of mobile wirelesstechnology can be made to all organizations.[1]

The uniform guidelines need to be evolved to avoidpotential litigation. Further research on clinically significantelectromagnetic interference in medical equipment frommobile phones needs to be done. The medical equipmentneed to be manufactured to resist electromagneticinterference from mobile phones, with standards that takeinto account the new phone technology.

Although safety of mobile phones in operating rooms is acomplex issue, according to recent literature, the risk ofelectromagnetic interference from mobile phones appearsto be minimal and controllable. There is no clinicallyrelevant electromagnetic interference as long as they aremore than a meter away from sensitive equipments. Theyare not as hazardous as believed and we will have to adopta more sensible, evidence-based balanced policy towardsmobile phone usage in our clinical practice.

Sanjay Saraf

Department of Plastic Surgery,

NMC Specialty Hospital, Dubai, U.A.E.

E-mail: drsaraf@hotmail.com

References

1. Kidd AG, Sharratt C, Coleman J. Mobile communication regulationsupdated: How safely are doctors telephones used? Qual Saf HealthCare 2004;13:478.

2. Clifford KJ, Joyner KH, Stroud DB, Wood M, Ward B, FernandezCH. Mobile telephones interfere with medical electrical equipment.

Australas Phys Eng Sci Med 1994;17:23-7.3. Irnich W, Batz L, Mller R, Tobisch R. Electromagnetic interference

of pacemakers by mobile phones. Pacing Clin Electrophysiol1996;19:1431-46.

4. Tri JL, Hayes DL, Smith TT, Severson RP. Cellular phone interferencewith external cardiopulmonary monitoring devices. Mayo Clin Proc2001;76:11-5.

5. Altamura G, Toscano S, Gentilucci G, Ammirati F, Castro A, PandoziC, et al. Influence of digital and analogue cellular telephones onimplanted pacemakers. Eur Heart J 1997;18:1632-41.

6. Naegeli B, Osswald S, Deola M, Burkart F. Intermittent pacemakerdysfunction caused by digital mobile telephones. J Am Coll Cardiol1996;27:1471-7.

7. Irnich WE, Tobisch R. Mobile phones in hospitals. Biomed InstrumTechnol 1999;33:28-34.

8. Tri JL, Severson RP, Firl AR, Hayes DL, Abenstein JP, et al. Cellulartelephone interference with medical equipment. Mayo Clin Proc2005; 80:1286-90.

9. Personal Digital Assistants in Medicine: Critical Data in the Palm ofyour Hand. Chaudry ZA, UK Health Informatics Today, 2004;45:4-6.

Letter to Editor

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