2012 International Conference and Exposition on Electrical and Power Engineering (EPE 2012), 25-27 October, Iasi, Romania
Study upon Electromagnetic Interferences inside an
Intensive Care Unit
PhD.Student BioEng. Ctlina Luca
Faculty of Electrical Engineering, “Gheorghe Asachi”
Technical University of Iasi, Romania
luca.katalina@yahoo.com
Abstract— Electromagnetic compatibility (EMC) – the ability of
electronic systems and devices to function well in close proximity
of one to another – is an important item to be considered in the
design and construction of healthcare facilities. Hospitals contain
a large variety of equipment, such as electro-surgery units that
are known to produce high levels of electromagnetic interferences
(EMI) and other devices such as ECG (Electrocardiography) and
EEG (Electroencephalography) , which are known to be
particularly sensitive to electromagnetic disturbances. Despite
the existence of standards and regulations, there is often no
collaboration between the designers of the buildings and the
users of the equipment therein. In this paper, we show how an
understanding of EMC enables us to prevent interference
problems and protect critical systems. We discuss about
installation and maintenance practices such as the use of zoning
and safe distances, aiming to ensure that adequate levels of EMI
are achieved in the hospital environment.
In our paper are presented results of measurements upon the
electromagnetic field in an intensive therapy room, while
observing the influences of the electromagnetic field generated by
an external source (GSM phone) on the functionality of medical
devices in the lounge. We created a map of the electromagnetic
field and we proposed solutions to reduce the influence of EMI on
medical devices.
Keywords - Intensive therapy room, electromagnetic
interferences , mobile phone interferences.
I. INTRODUCTION
Although electromagnetic interferences in hospitals are
often regarded as no more than a minor nuisance, there are
documented cases in which equipment failures due to
electromagnetic interference (EMI) have lead to personal
injury or even death. Some examples follow:
• In 1992, a patient attached to a monitor-defibrillator
in an ambulance died because interference from the
ambulance radio prevented the machine from
working [1].
• In 1993, a patient fitted with a pacemaker went into
ventricular fibrillation shortly after being scanned
with a metal detector outside a courtroom [2].
978-1-4673-1172-4/12/$31.00 ©2012 IEEE
Prof.Dr.Eng. Alexandru Slceanu
Faculty of Electrical Engineering, “Gheorghe Asachi”
Technical University of Iasi, Romania
As in many other fields, the amount and complexity of
electronics in hospitals and other medical environments is
increasing year by year. Despite this, the number of reported
incidents of EMC problems fortunately does not appear to be
growing. This is probably because most manufacturers and
designers of medical electronic products have developed a
good awareness of EMC.
With respect to the legislation in place, electro-medical
equipment carries the CE marking demonstrating compliance
with the Medical Devices Directive (MDD) [3], the Active
Implantable Medical Devices Directive (AIMD) [4] or the In
Vitro Diagnostic Medical Directive. The compliance is in
most cases demonstrated by meeting the requirements of EN
60601-1-2 or EN 55011 in the case of Industrial, Scientific
and Medical (ISM) equipment.
In terms of Romanian legislation, there is law no.
176/2000 of the Medical Devices, amended in 2005, that
defines medical devices and equipment, specifying that any
electro-medical equipment with the CE mark can be used in
hospitals. This law does not set out anything about the
emission of electromagnetic radiation allowed on medical
device or the values of the electromagnetic field affecting or
damaging the equipment.
There is an European standard workable to medical
equipment. This is STD EN60601-1-2, defining the emission
limits and immunity to electromagnetic radiations of medical
equipment, medical electrical systems and ICT equipment
used in hospitals. This standard specifies the minimum limit of
immunity to electromagnetic field of medical equipment to be
3V / m.[ 5]
EMC should also be an integral part of the design process
when planning for the construction of healthcare facilities: the
electrical internal power wiring of hospitals can be quite
varied and complex and it is important to ensure that the
power line does not provide a path to propagate EMI
throughout the building. The use of many electronic devices in
close proximity of the hospital environment means that the
general EMC difficulties could be here also encountered.
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However there are some special features of the hospital
EM environment:
• Failure of medical devices can lead to injury or death.
• In the European Union, medical products are not
covered by the EMC Directive.
• Some equipment found in hospitals is intentionally
designed to emit electromagnetic energy, in particular
for therapy. Other equipment, which may be located
nearby, is designed to detect very small physiological
signals. This combination has the potential to create
EMC problems.
• Also in hospitals, there is the question of whether to
ban or restrict the use of mobile phones. They
improve communications but can interfere with
critical equipment.
• Many medical devices are connected directly to
patients. For mains-powered devices, the designer
must prevent electric shock as well as ensure EMC.
II. GENERAL NATURE OF EMI
It is quite impossible to imagine a civilized place on the
Earth that is not increasingly dependent on the use of electrical
and electronic equipment. Whether it is in the home, or in
industry and commerce, everybody is being affected by this
trend. As our society becomes increasingly dependent upon
electrical/electronic systems of different types for its day-to-
day activities, the number and diversity of EMI sources can
also be expected to increase; the corresponding effects of EMI
are likely to become more varied, and possibly more subtle.
These effects cause particular concern if they form a direct
threat to public health and safety, or if they cause key
electrical/electronic systems to malfunction, e.g. in healthcare
facilities, manufacturing industry or communications.
Additionally, if the levels of EMI exceed specified limits,
without necessarily giving rise to malfunctions, this is also a
cause for concern since it will provide an EMI environment
which is more severe than that assumed in specifications and
standards; new equipment and systems subsequently
introduced into that environment thus have a higher
probability of malfunctioning . [6]
In general, EMI sources affecting a particular electrical or
electronic system can be classified under the two headings of
‘internal’ EMI and ‘external’ EMI. Internal EMI is associated
with the devices and components which are present within the
system, e.g. resistors, transistors etc.
External EMI is generated by sources outside the system in
question. Typical sources could be fluorescent lighting,
electrical motors or generators, microcomputers,
thunderstorms, solar disturbances.[6]
III. EMI PROPAGATION MECHANISM
For electromagnetic disturbances to cause interference, they
must be propagated in some way. The three main physical
mechanisms of electromagnetic propagation are:
• Conduction
• Reactive coupling
• Radiation.
In the next figure we have the schematic description of
main physical mechanisms of electromagnetic propagation,
between two medical devices, one is the victim and the other
one is the source of EMF. Equipment not just influence each
other, they are influenced by the power cable, signal cables or
peripherals.
Fig.1: Schematic description of EMI coupling paths
(adapted from [7])
Conduction
Electromagnetic energy may be conducted in either
common mode or differential mode. This can be via power
cables, earth conductors, signal cables, antenna feeders or
other low impedance paths. There is greater risk from
conducted interference at frequencies below 30 MHz. Above
this frequency conducted interference suffers substantial
attenuation and other propagation mechanisms become
dominant. In a hospital, EMI can often be propagated via the
mains distribution network. As was noted above, the type of
cables used and the way they are laid out can have a big effect
on levels of conducted interference. [7]
Reactive coupling
Electromagnetic energy may also be propagated by
reactive coupling, either inductive or capacitive. The precise
effects depend upon distance, orientation, size, grounding and
other factors, all of which will tend to be unique to the system.
Reactive coupling may exist within a system or between
systems. Generally speaking, inductive coupling tends to be
associated with high current and low impedance situations,
whilst capacitive coupling tends to occur with high voltages
and high impedance. Reactive coupling between wires is
called crosstalk, and often occurs when different types of
cables are bundled together over long distances.[7]
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 Radiation
For frequencies above about 30 MHz, radiation tends to be
the dominant propagation mechanism. There are two types of
radiating emitters: intentional and unintentional. Intentional
emitters, such as radio and radar, produce spurious emissions
together with their intended signal. These may be in the form
of harmonics or inter-modulation products of the intended
signal and are directly associated with the primary function of
the equipment. Practical radio transmitters also radiate
broadband noise. Unintentional emitters, for example personal
computers or thyristor drives, generate emissions as a by-
product of the primary function of the equipment. [7]
IV. SOURCES OF EMI
Typical sources in hospitals include motors, fluorescent
lights, switch-gear and equipment fitted with switched mode
power supplies. Electro-surgery, also known as electrocauter
or surgical diathermy, is a great source of EMI in hospitals,
[8]. Currents of over 1A and EMFs of over 4kV are used to
cut and coagulate tissue. A typical frequency is 500 kHz,
which is high enough not to give the patient electric shocks.
However it also means that the equipment radiates harmonics
of this frequency, especially between 1 and 10MHz. This type
of equipment is so good at creating EMI that it was adapted
during the Second World War for jamming radar. It can
generate fields of 40- 50V/m at 1m [9], making it difficult to
use monitors in the same room. Pacemakers can also be
affected. Shielding is not feasible because the patient forms
part of the radiating antenna.
Other sources of EMI are mobile radio transmitters -
cellular phones and emergency services radios. These generate
very high field strengths but only at short distances.
Theoretically the field gain with the distance from the antenna.
However there is some evidence that hospital corridors have a
‘guiding’ effect on the radiation and that the fields fall off
slightly more slowly than this. A number of studies in the
1990s showed that a wide range of equipment can be
susceptible to RFI from mobile radio transmitters. Fortunately,
EMI from cellular phones is unlikely at distances of greater
than 2m. High field strengths are produced not only by
handsets but also by the transmitters on ambulances and other
emergency vehicles, [10].
V. VICTIMS OF EMI
Any piece of equipment could fail if subjected to a large
enough disturbances. Digital circuits are generally more
immune, but fail more “irreversible” when they eventually do
so. Circuit failure is not necessarily hazardous to patients. A
wobbly picture on a monitor would probably be regarded as
no more than a nuisance, whereas failure of a ventilator,
infusion pump or automated defibrillator could be fatal.
Devices designed to pick up electric or magnetic fields are
obviously vulnerable. An example is a hearing aid fitted with a
telecoil option or ‘T-switch’ [11] .This enables the aid to pick
up magnetic fields from telephones and also from specially
fitted induction loops in meeting halls, churches etc.
Unfortunately this system is susceptible to low frequency
radiation fields from motor drives, telecommunications cables
and computer monitors, which are not covered by EMC
standards because they are below 150 kHz.
Physiological-monitoring equipment is vulnerable to pulsed
RF, which can be demodulated by non-linear elements in
amplifier circuits. Some monitors are connected directly to the
patient in order to detect small physiological signals, as shown
in the following table:
Measurements Typical
voltage
Electrocardiography (ECG) 1mV
Electroencephalography 100μV
(EEG)
Electromyography (EMG) 10μV
Evoked potentials 1μV
EEG is known to be very sensitive to EMI. External
pacemakers incorporate ECG sensors and have been shown to
be vulnerable to the 17Hz pulse rate of the TETRA system for
private radio, which is currently being taken up by the police
and other emergency services, [12]. Mains-powered
equipment, including ventilators, anaesthesia machines and
syringe pumps, are also vulnerable to conducted interference
on the mains supply. Battery/mains equipment, which runs on
a battery with continuous charging from the mains, has very
good immunity to mains voltage variations such as drop-outs
and sags, [13].
VI. ELECTROMAGNETIC FIELD MEASUREMENTS
IN A THERAPY ROOM
1.Materials and Methods
The study took place in two phases. First our team tried a
mapping in terms of electromagnetic field intensity an
Intensive Care room.
Measurements were made at the Regional Level III
Neonatal Intensive Care Unit , Clinical Hospital of Obstetrics
and Gynecology "Cuza Voda " Iasi, in Room III, N.I.C.U.
Measurements were done in a room without patients, in order
not to influence their condition.
These measurements were subject to medical devices:
1. Infusion Pump B / Braun.
2. Acutronic Fabian conventional ventilation type
3. Dash 2500Vital Care Monitor
4. Neonatal Isolette Incubator type C-2000
5. EEG brain monitor type BRAINTZ 3
Besides those mentioned, there are a few equipments in the
room: a ventilation system, a video camera, a sink for washing
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hands with electric photocell, a console with electrical outlets
and sources of oxygen, medical air and vacuum. On this map we observe that the highest electromagnetic
For the measurement of electromagnetic field we used a field values are in the area with medical devices all turned on.
smart Field Meter with the following features: The EM field strength was measured and mapped around
electrical devices in a two beds neonatal ICR furnished with
Meter, Probe Frequency Field Strength Range standard equipment (ventilator, monitor, infusion pumps,
response heated airbed, humidifier). The overall flux density in the
Smart 50 KHz - 18 0.2-800 V/m (depending on the patient area was assessed by measuring the field intensity at
Fieldmeter® GHz probe) the patient's head during one hour.
Digital Meter: (depending on
Model: RFP- the probe).
05 VII. ELECTROMAGNETIC INTERFERENCES ON
Probe: PI-03 3 MHz - 18 GHz 0.8 – 800 V/m MEDICAL DEVICES
Probe: PI-02 2 MHz - 12.5 0.5 – 800 V/m
GHz
The second study was to observe the influence of mobile
Probe: PI-01 0.2 MHz - 3 GHz 0.2 – 600 V/m phone use on medical equipment operating parameters in an
Probe: PI- 900-1900 MHz. 0.4 – 400 V/m intensive care room and to measure the electromagnetic field
01V Dual GSM band. produced by them.
Probe PI-01 50 KHz – 3 GHz Measurements were made in the same Intensive Care Unit,
(LF Option) in a room without patients to not influence their condition.
These measurements were subject to medical devices:
All medical devices subject study were mounted and set
for operation in the same way as they were connected to a 1. Infusion Pump B / Braun.
patient. We tried to identify areas with the highest value of the 2. Acutronic Fabian conventional ventilation type
electromagnetic field, when all the medical devices were 3. Dash 2500 Vital care Monitor
turned on. 4. Isolette Incubator type C-2000
5. EEG brain monitor type BRAINTZ 3
2. Measurements and Results .
The purpose of these measurements is to identify areas 1. EMC testing protocol for medical devices
where the most powerful electromagnetic field in room. The Medical devices were not connected to patient. The
room was divided in approximately symmetrical points were protocol proceeds as follows:
measurements were performed. We have to mention that the 9 We set up the device to represent a normal working
device used to measure electromagnetic field computes the mode (clinically sensible parameters including
average . alarms). We prepared a simple but repeatable mean
After the measurements we obtained a map of the points of of accurately measuring the distance between the
maximum intensity for the electromagnetic field. device and the phone unit. We ensured that the phone
batteries are fully charged before starting the tests.
9 Previous to our testing, we recorded the type of
device, manufacturer, model and serial number using
a test results sheet drafted by us.
9 We started the EMC test at the front main surface
(not quite touching) of the device, the ‘near field’
case. We dialled the free phone number supplied to
us with the phone. During dialling and initial
communication, the digital phone systems will be
operating at maximum transmitted power. We’ve
noted any effects observed on the test result sheet.
For an observed effect we determined the distance
over witch the effect occurs. We examined the device
settings and noted before the start of the test to
determine any alterations.
9 We repeated the above test at a distance of 0.5 meters
and one meter.

2. Test results
We obtained the following test results, for each type of
Fig.2 The EMF values obtained in 10 measured points. medical device:

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 1. The infusion pumps type B / Braun measurements
were made for four devices simultaneously with the
series number SN: 83033, 83040, 83018 and 83044.
Test phone closed and in standby mode was done
with two preset values of volume infused: minimum
value of 0.1 ml / h and a maximum of 99 ml / h. It
was staged infusion syringe containing 50 ml glucose
5%. In phone call mode, preset volume infused was
99 ml / h, which is the highest. Conclusions of the
tests: we noticed changes in the rate of infusion, three
of four devices at a maximum volume administrated,
variations ranging from 0.45 ml and 1.20 ml.
2. Ventilator type Fabian Plus Serial Number: 02-0404
fitted with test lung (for a better patient connection
simulation), in ventilation IPPV mode, set the
following parameters: FiO2 = 21%, respiratory rate
(Resp) = 16 beat / min, inspiratory pressure (PIP) =
18 , expiratory pressure (PEEP) = 5 and a Tidal
Volume = 500 ml. Conclusions of the tests: there
were changes in Tidal Volume with a variation
between 35 ml and 54 ml, depending on the distance
from the source.
3. Cardiomonitor (Vital Functions Parameters Monitor)
Dash 2500 which has attached an oxygen saturation
sensor SpO2 and ECG electrodes. Were preset alarm
limits and I lead set it in EKG. Conclusions of the
tests: no major changes were observed in ECG signal.
4. Neonatal Isolette Incubator type C-2000 SN:
TW12218 and QT17756 with air temperature set at
33 ° C and humidity set at 40%. Conclusions of the
tests: small deviations were observed in 2% -5%
humidity and air temperature inside the incubator.
The normal inside the Incubator temperature that
baby needs is 33° C, so he maintains a body
temperature of 36.5° C. If the incubator temperature
has a variation of 2 to 5 degrees, correlated with a
humidity variation, the baby's body temperature
changes significantly. For a newborn infant, a 0.5
degree variation might be significant.
5. EEG brain monitor BRAINTZ type 3 has a test head,
not to place the electrodes on a real patient and
submit an electromagnetic field. Conclusions of the
tests: we’ve noticed significant changes in EEG in
both hemispheres of the brain, at a short distance
from the source.
VIII. CONCLUSIONS AND RECOMMENDATIONS
The ICU environment is at risk from electromagnetic
pollution, the long stay patients and their day-long exposure
being additional risk factors. EMF drops off as the distance
from the equipment is increased, according to the inverse
square law and the exposure risk may be minimized by
keeping a safety distance from the EMF source. The actual
value of that safety distance may be variable and depends on
several factors:
1. type of equipment,
2. orientation of equipment,
3. equipment over- crowding
4. available space in every bed space.
The magnetic flux density should be monitored regularly in
every ICU for the specific design of each unit.
Hospitals will need to formulate local policies, based on
the medical devices in use, the communications equipment
and the local environment.
EMC is a concern not just for manufacturers, but also for
those who install, use, modify or maintain medical equipment.
The existence of directives and standards has encouraged good
EMC design practices, but should not be relied on to prevent
EMI problems owing to the nature of the hospital EM
environment.
Much more can be done by promoting awareness of EMI,
also underlying coupling mechanisms. Many potential
problems can be solved by ensuring adequate separation of
sources and victims of interferences: for example by placing
SW diathermy or electro-surgery in a different part of the
building than EEG and other sensitive equipment, by
implementing reasonable restrictions on mobile phones and by
avoiding crosstalk problems when installing mains and data
cables.
At this time we can not forbid to use a cell-phone in any
Romanian Hospital, but the cell-phone should always be
switched off in the following locations:
9 Operating theatres and treatment areas were sensitive
devices may be used.
9 In the patients’ neighbourhood, mainly when the
patient is connected to any electro-medical device.
9 Other designed areas where could be a perceived risk.
It is important that users, patients and visitors to be
informed about these restrictions; restricted areas must be
clearly signed; staff should be aware of the possibility of
affecting medical devices due to EMI from mobile phones.
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539
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