Transcranial magnetic stimulation safety from operator exposure perspective

A simulated model of a commercial transcranial magnetic stimulation (TMS) coil is analyzed to determine electromagnetic field (EMF) exposure for an operator while holding or adjusting the coil. Induced EMF strengths are calculated using a commercial figure-8 coil geometry and pulse configuration, with geometrical representations of the subject's head and the operator's head, torso, and hand. Exposure levels are compared to experimental results in the literature and international guidelines for occupational EMF exposure limits. Exposure limit guidelines of 0.8 V/m rms are exceeded at approximately 24.6 cm from the coil for the torso model and at 20.3 cm for the head model measured perpendicular to the plane of the coil. In the plane of the coil, the operator can approach closer without exceeding guidelines. The results in the hand model along the edge of the coil give 9.9 V/m and 88.5 V/m for average and peak field strength, respectively. A discussion of the potential consequences of operator exposure to fields exceeding published guidelines concludes that since the guidelines are only concerned with acute effects and do not suggest any potential chronic effects, occupational exposure in the context of delivering TMS treatment may be considered reasonable. Graphical abstract A model of an operator's head/torso was moved in space relative to a standard TMS coil and subject. Positions at which safety guidelines are exceeded were calculated. The maximum induced electric field was also calculated in a hand model placed in a position commonly used to hold TMS coils during treatments.