Contributors |
|
xv | |
Foreword |
|
xvii | |
Introduction |
|
xxiii | |
Part One Introduction to biocompatibility in medical devices |
|
1 | (46) |
|
1 Strategies to accelerate medical market access and manage risks of biocompatibility |
|
|
3 | (14) |
|
|
|
|
3 | (1) |
|
1.2 Medical device development process and significance of material selection |
|
|
3 | (1) |
|
1.3 Accelerating time to market |
|
|
4 | (1) |
|
1.4 Concept of biocompatibility and impact on market access |
|
|
5 | (3) |
|
1.5 Examples of device recalls or alerts during the last decade in which biocompatibility issues were considered |
|
|
8 | (3) |
|
1.6 Challenges in biocompatibility evaluation and novel materials |
|
|
11 | (3) |
|
|
14 | (1) |
|
|
15 | (1) |
|
|
15 | (2) |
|
2 Making use of a biological safety evaluation plan |
|
|
17 | (6) |
|
|
|
17 | (1) |
|
2.2 The fundamentals of safety evaluation planning |
|
|
17 | (1) |
|
2.3 Safety evaluation planning for biomaterials |
|
|
18 | (1) |
|
2.4 Developing and documenting plans |
|
|
19 | (2) |
|
2.5 Using safety evaluations |
|
|
21 | (1) |
|
|
22 | (1) |
|
2.7 Sources of further information and advice |
|
|
22 | (1) |
|
3 Biomechanical and biochemical compatibility in innovative biomaterials |
|
|
23 | (24) |
|
|
|
|
|
23 | (1) |
|
3.2 Selection of biomaterials |
|
|
23 | (2) |
|
3.3 Three generations of biomedical materials |
|
|
25 | (1) |
|
3.4 State-of-the-art development |
|
|
26 | (8) |
|
|
34 | (6) |
|
|
40 | (1) |
|
|
41 | (5) |
|
|
46 | (1) |
Part Two Evaluation and characterization of biocompatibility in medical devices |
|
47 | (256) |
|
4 A practical approach to analytical chemistry of medical devices |
|
|
49 | (52) |
|
|
|
49 | (3) |
|
4.2 The role of analytical chemistry in establishing biocompatibility |
|
|
52 | (5) |
|
4.3 Fulfilling the requirements of ISO 10993 |
|
|
57 | (7) |
|
4.4 Characterization of materials |
|
|
64 | (14) |
|
4.5 The changing milieu of E&L testing |
|
|
78 | (2) |
|
4.6 Future trends and international approaches |
|
|
80 | (4) |
|
4.7 Biocompatibility: To test or not to test |
|
|
84 | (1) |
|
4.8 Using chemical and material characterization to demonstrate equivalency |
|
|
85 | (3) |
|
4.9 Acceptance criteria for equivalency |
|
|
88 | (3) |
|
4.10 Risk assessment of extracts |
|
|
91 | (5) |
|
4.11 Conclusion and future trends |
|
|
96 | (1) |
|
|
97 | (4) |
|
5 Tolerable intake values for leachables: Practical use of ISO 10993-17 standard |
|
|
101 | (22) |
|
|
|
101 | (2) |
|
5.2 Process for setting tolerable intake (TI) values for compounds released from medical device materials |
|
|
103 | (4) |
|
5.3 Derivation of non-cancer TI values |
|
|
107 | (5) |
|
5.4 Derivation of cancer-based TI values |
|
|
112 | (2) |
|
5.5 Use of the TTC approach to derive default non-cancer- and cancer-based TI values |
|
|
114 | (1) |
|
5.6 Derivation of TI values for local effects |
|
|
115 | (1) |
|
5.7 Other issues to consider |
|
|
115 | (3) |
|
|
118 | (1) |
|
|
118 | (5) |
|
6 In vivo and in vitro testing for the biological safety evaluation of biomaterials and medical devices |
|
|
123 | (44) |
|
|
|
|
|
123 | (2) |
|
6.2 Pretesting considerations |
|
|
125 | (5) |
|
|
130 | (1) |
|
|
131 | (9) |
|
|
140 | (19) |
|
6.6 Immunotoxicity (ISO/TS 10993-20:2006) |
|
|
159 | (1) |
|
6.7 Nanomaterials (ISO/TR 10993-22:2017) |
|
|
160 | (2) |
|
|
162 | (1) |
|
|
162 | (4) |
|
|
166 | (1) |
|
7 Practical approach to blood compatibility assessments: General considerations and standards |
|
|
167 | (40) |
|
|
|
|
167 | (1) |
|
7.2 Background: Blood composition |
|
|
167 | (7) |
|
7.3 Critical distinguishing factors presented by blood-contacting medical devices |
|
|
174 | (6) |
|
7.4 Responses in fluid blood in contact with medical devices |
|
|
180 | (5) |
|
7.5 Responses by materials, or upon their surfaces, in contact with blood |
|
|
185 | (6) |
|
7.6 Assessing hemocompatibility according to international standards |
|
|
191 | (8) |
|
7.7 Conclusion and future trends |
|
|
199 | (1) |
|
7.8 Sources of further information and advice |
|
|
199 | (1) |
|
|
200 | (4) |
|
|
204 | (3) |
|
8 Quality strategies that fasten devices access to global markets |
|
|
207 | (16) |
|
|
|
8.1 Quality management system compliance for medical device development |
|
|
207 | (2) |
|
8.2 System-thinking for QMS deployment |
|
|
209 | (3) |
|
8.3 Risk-based approach for medical device development |
|
|
212 | (1) |
|
8.4 Risk-based QMS elements that add limited value prior to medical device safety testing |
|
|
213 | (2) |
|
8.5 Risk-based QMS elements that should he implemented prior to medical device safety testing |
|
|
215 | (2) |
|
8.6 Risk-based approach for device testing |
|
|
217 | (3) |
|
|
220 | (1) |
|
|
221 | (2) |
|
9 Accelerating medical device biocompatibility evaluation: An industry perspective |
|
|
223 | (40) |
|
|
|
|
|
223 | (1) |
|
9.2 Developing a biological evaluation plan |
|
|
224 | (2) |
|
9.3 Implementing a biological evaluation plan |
|
|
226 | (4) |
|
9.4 Biological safety testing |
|
|
230 | (2) |
|
9.5 Creating a biological evaluation report |
|
|
232 | (2) |
|
|
234 | (6) |
|
|
240 | (3) |
|
9.8 Conclusion and future trends |
|
|
243 | (3) |
|
|
246 | (7) |
|
|
253 | (4) |
|
|
257 | (5) |
|
|
262 | (1) |
|
10 Overcoming negative test results during manufacture |
|
|
263 | (6) |
|
|
|
263 | (1) |
|
10.2 Goodbye to cardio medical |
|
|
264 | (1) |
|
10.3 The biological safety program |
|
|
264 | (1) |
|
10.4 Extractables and leachables |
|
|
265 | (1) |
|
10.5 Controlling risk at the manufacturing level |
|
|
265 | (1) |
|
10.6 Sterilization residuals |
|
|
266 | (1) |
|
|
267 | (2) |
|
11 Methods for the characterization and evaluation of drug-device combination products |
|
|
269 | (34) |
|
|
|
269 | (1) |
|
11.2 What is a combination product? |
|
|
269 | (1) |
|
11.3 How are combination products regulated? |
|
|
270 | (1) |
|
11.4 Demonstrating safety and efficacy of combination products |
|
|
271 | (2) |
|
11.5 Pre-clinical testing of combination products |
|
|
273 | (19) |
|
11.6 Aspects to consider in the manufacture of combination products |
|
|
292 | (3) |
|
11.7 Clinical studies for combination products |
|
|
295 | (2) |
|
11.8 Future outlook for combination products and their evaluation |
|
|
297 | (1) |
|
|
298 | (5) |
Part Three Testing and interpreting the performance of medical devices |
|
303 | (108) |
|
12 Efficient evaluations of bone implants performances |
|
|
305 | (34) |
|
|
|
305 | (1) |
|
|
305 | (2) |
|
|
307 | (1) |
|
12.4 Principles for the selection of an in vivo model to evaluate performance of bone implants |
|
|
307 | (5) |
|
12.5 Key parameters to accelerate bone devices performance assessment |
|
|
312 | (5) |
|
12.6 Selection of comparators |
|
|
317 | (1) |
|
12.7 Osteoinductive and osteogenic performances |
|
|
317 | (1) |
|
12.8 Limitations of in vitro models |
|
|
318 | (2) |
|
12.9 Fracture repair models |
|
|
320 | (3) |
|
12.10 Evaluation of medical devices used for spinal fusion |
|
|
323 | (2) |
|
12.11 Cylindrical bone defect models |
|
|
325 | (1) |
|
12.12 Segmental bone defect repair models |
|
|
326 | (1) |
|
12.13 Evaluating the antimicrobial performances of bone repair devices |
|
|
327 | (1) |
|
12.14 Bioabsorbable and biodegradable materials |
|
|
328 | (1) |
|
12.15 Bone debris and implant performances |
|
|
329 | (1) |
|
|
330 | (1) |
|
|
331 | (6) |
|
|
337 | (2) |
|
13 Performance studies for dental implants: Methodological approach |
|
|
339 | (32) |
|
|
13.1 Introduction and definitions |
|
|
339 | (1) |
|
13.2 Importance of performance evaluation studies for dental implants |
|
|
340 | (1) |
|
13.3 Experimental design of a performance trial for dental implants |
|
|
341 | (8) |
|
|
349 | (2) |
|
13.5 Statistical power calculation and analysis |
|
|
351 | (3) |
|
|
354 | (9) |
|
13.7 Translation from animal studies to human clinical trials |
|
|
363 | (1) |
|
Sources of further information and advice |
|
|
364 | (1) |
|
|
365 | (1) |
|
|
365 | (6) |
|
14 Optimizing the design of preclinical safety and performance studies-Examples in soft tissues and cardio-vascular implants |
|
|
371 | (22) |
|
|
|
|
14.1 Preclinical studies in the device development lifecycle |
|
|
371 | (1) |
|
14.2 Preclinical study objectives |
|
|
372 | (1) |
|
14.3 Starting point: Use the right documentation to write a strong protocol |
|
|
373 | (1) |
|
14.4 Tips to design successful compliant studies |
|
|
374 | (12) |
|
14.5 Appropriate evaluation methods and tools to generate robust data |
|
|
386 | (3) |
|
14.6 Optimizing the value of your preclinical data and reduce time to market |
|
|
389 | (1) |
|
|
390 | (1) |
|
|
391 | (2) |
|
15 Mechanical testing for soft and hard tissue implants |
|
|
393 | (18) |
|
|
|
393 | (1) |
|
15.2 Principles of setting up a mechanical test |
|
|
394 | (4) |
|
15.3 Implant-specific mechanical performance testing |
|
|
398 | (8) |
|
15.4 Advanced therapy products (ATPs)-Cartilage |
|
|
406 | (1) |
|
15.5 Conclusion and future trends |
|
|
406 | (1) |
|
15.6 Sources of further information and advice |
|
|
407 | (1) |
|
|
407 | (4) |
Part Four International regulation of medical devices |
|
411 | (78) |
|
16 Biological evaluation and regulation of medical devices in the European Union |
|
|
413 | (28) |
|
|
|
413 | (1) |
|
16.2 The regulatory and legislative framework |
|
|
413 | (4) |
|
16.3 General safety and performance requirements |
|
|
417 | (12) |
|
|
429 | (11) |
|
|
440 | (1) |
|
17 Biological evaluation and regulation of medical devices in Japan |
|
|
441 | (34) |
|
|
|
|
441 | (1) |
|
17.2 Outline of biological safety testing in Japan |
|
|
442 | (4) |
|
17.3 General requirements for biological safety tests |
|
|
446 | (22) |
|
17.4 How to properly use ISO standard, FDA guidance and ASTM standard in Japan |
|
|
468 | (1) |
|
17.5 Relationship between classification, examination, and certification in Japan |
|
|
469 | (1) |
|
17.6 Outline of the medical device good laboratory practice (GLP) |
|
|
469 | (2) |
|
|
471 | (1) |
|
|
472 | (3) |
|
18 Medical device regulations in China |
|
|
475 | (14) |
|
|
|
|
475 | (1) |
|
18.2 Biological evaluation regulations in China |
|
|
475 | (2) |
|
18.3 Outline of biological safety testing in China |
|
|
477 | (8) |
|
|
485 | (1) |
|
|
486 | (2) |
|
|
488 | (1) |
Part Five Histopathology principles for biocompatibility and performance studies |
|
489 | (56) |
|
19 Current considerations in medical device pathology |
|
|
491 | (54) |
|
|
|
|
|
491 | (1) |
|
19.2 Morphologic assessment in the safety studies of biomaterials and medical devices |
|
|
492 | (10) |
|
19.3 Assessment of the performance of biomaterials and medical devices |
|
|
502 | (7) |
|
19.4 Processing and sectioning of specimens |
|
|
509 | (1) |
|
19.5 Staining recommendations |
|
|
510 | (3) |
|
19.6 Qualitative and quantitative pathology used in the evaluation of biomaterials and medical devices |
|
|
513 | (7) |
|
19.7 Ultrastructural pathology |
|
|
520 | (4) |
|
19.8 From digitization to digitalization in medical device pathology |
|
|
524 | (1) |
|
19.9 Evaluation of regional draining lymph nodes (RDLs) in non-clinical studies |
|
|
525 | (6) |
|
19.10 Morphologic assessment of ocular medical devices |
|
|
531 | (6) |
|
19.11 Concluding comments |
|
|
537 | (1) |
|
|
538 | (1) |
|
|
538 | (7) |
Index |
|
545 | |