Safety and U.S. Regulatory considerations in the nonclinical use of medical ultrasound devices.

Ultrasound imaging has been used for medical purposes for over 50 years and has an excellent safety record. Ultrasonic fetal scanning is generally considered safe and is properly used when medical information on a pregnancy is needed. However, ultrasound energy delivered to the fetus cannot be regarded as completely innocuous. Even though there are no demonstrated risks from ultrasound imaging, it can produce effects on the body. Laboratory studies have demonstrated that diagnostic levels of ultrasound can produce physical effects in tissue, such as mechanical vibrations, rise in temperature and cavitation. A number of in vitro and in vivo (animal and human) biologic effects have been reported following exposure to diagnostic ultrasound devices and low intensity ultrasound used for therapeutic purposes. Most public health experts, clinicians and industry agree that exposure of the fetus to ultrasound for nonmedical purposes should be avoided. The U.S. Food and Drug Administration (FDA) supports this position.

What we know and don't know about the bioeffects of nanoparticles: developing experimental approaches for safety assessment.

The Center for Devices and Radiological Health (CDRH) of the US Food and Drug Administration (FDA) regulates nano-based medical products and therefore is required to address the safety and biological effects of nano-scale materials used in these products. Both in vitro and in vivo toxicological research studies are being conducted at the FDA to help determine the risks versus benefits of these new products. This article will briefly summarize some of the initial research findings from FDA-CDRH studies using TiO(2), polystyrene, and silicon nanoparticles.

Energy dispersive X-ray analysis of titanium dioxide nanoparticle distribution after intravenous and subcutaneous injection in mice.

In an effort to understand the disposition and toxicokinetics of nanoscale materials, we used EDS (energy dispersive X-ray spectroscopy) to detect and map the distribution of titanium dioxide (TiO2) in tissue sections from mice following either subcutaneous (s.c.) or intravenous (i.v.) injection. TiO2 nanoparticles were administered at a dose of 560 mg/kg (i.v.) or 5600 mg/kg (s.c.) to Balb/c female mice on two consecutive days. Tissues (liver, kidney, lung, heart, spleen, and brain) were examined by light microscopy, TEM (transmission electron microscopy), SEM (scanning electron microscopy), and EDS following necropsy one day after treatment. Particle agglomerates were detected by light microscopy in all tissues examined, EDS microanalysis was used to confirm that these tissues contained elemental titanium and oxygen. The TEM micrographs and EDS spectra of the aggregates were compared with in vitro measurements of TiO2 nanoparticle injection solution (i.e., in water). The nanoparticles were also characterized using dynamic light scattering in water, 10 mM NaCl, and phosphate buffered saline (PBS). In low ionic strength solvents (water and 10 mM NaCl), the TiO2 particles had average hydrodynamic diameters ranging from 114-122 nm. In PBS, however, the average diameter increases to 1-2 microm, likely due to aggregation analogous to that observed in tissue by TEM and EDS. This investigation demonstrates the suitability of energy dispersive X-ray spectroscopy (EDS) for detection of nanoparticle aggregates in tissues and shows that disposition of TiO2 nanoparticles depends on the route of administration (i.v. or s.c.).

Steam sterilization and internal count sheets: assessing the potential for cytotoxicity.

Count sheets, when placed in contact with surgical instruments during steam sterilization, can transfer ink to the instruments. To explore whether this poses a safety concern, stainless steel instruments were placed on top of completely inked paper and subjected to steam sterilization, extracted, and tested for cytotoxicity. Preprinted labels were examined in a similar fashion. Extracts from stainless steel devices exposed to ink, toner, or labels showed no significant cytotoxic response, although the ink residue on the devices after steam sterilization is difficult to remove and detrimental to the instrument. Placing a barrier between the count sheet and the devices facilitates reuse of the instruments.

Regulatory initiatives for natural latex allergy: US perspectives.

The US Food and Drug Administration (FDA) has regulatory authority over foods, human drugs, cosmetics, medical devices, radiological products, biologics, and veterinary products. Among these products, FDA believes that the use of medical devices, including medical gloves, condoms, catheters, and breathing bags, represents the greatest source of natural latex proteins to exposed individuals. A medical device is defined in the Federal Food Drug and Cosmetic Act (FFDCA) as an instrument, apparatus, implement, machine, etc., that is intended for use in the diagnosis or treatment of disease or is intended to affect the structure or any function of the body of a human or other animal, and that does not achieve any of its principal intended purposes through chemical action in the body. This article provides some brief, general background about FDA's medical device regulatory process and then addresses the issue of natural latex allergy. Finally we discuss the steps the Agency has taken to evaluate the magnitude and nature of the problem, and FDA's efforts to assist manufacturers, health professionals, and others in minimizing exposure and sensitization to natural latex proteins in medical devices.