THE HAND SURGERY LANDSCAPE

On Emerging Technology: What to Know

When Your Patient Has a Microchip
in His Hand
Brianna R. Fram, MD,*† Michael Rivlin, MD,*† Pedro K. Beredjiklian, MD*†

Radio-frequency identification (RFID) technology uses an antenna to respond to an incoming

signal by sending an outgoing message. This technology has been in use for over 50 years and
is common in daily activities such as tapping a credit card to a reader, swiping an ID badge to
open a door, paying highway tolls, and operating keyless entry cars. This technology can be
implanted, such as in the microchips used to identify domestic pets. Since 1998, RFID chips
have also been implanted in humans. This practice is little studied but appears to be
increasing; rice-sized implants are implanted by hobbyists and even offered by some em-
ployers for uses ranging from access to emergency medical records to entry to secured
workstations. These implants are of special concern to hand surgeons because they are most
commonly placed in the subcutaneous dorsal first web space. The US Food and Drug
Administration first approved this technology in 2004, with stated potential risks including
adverse tissue reaction, migration of the implanted transponder, compromise of information
security, electrical hazards, and magnetic resonance imaging incompatibility. Here, we
explain implanted RFID technology, its potential uses, and what is and is not known about its
safety. We present images of a patient with an RFID chip who presented to our clinic for acute
metacarpal and phalangeal fractures, to demonstrate the clinical and radiographic appearance
of these chips. (J Hand Surg Am. 2020;-(-):-e-. Copyright Ó 2020 by the American
Society for Surgery of the Hand. All rights reserved.)
Key words Hand microchip, microchip implant, MRI safety, radiofrequency identification,
RFID.

R
(RFID) tech-
ADIO-FREQUENCY IDENTIFICATION chips do not have an energy source and do this
nology has been in use for over 50 years. The passively, signaling only when they receive an
technology involves a microchip attached to incoming query of the appropriate frequency.1 First
an antenna, which responds to an incoming signal pioneered during World War II, the use of this tech-
from a reader by sending an outgoing signal. Most nology has become commonplace in daily activities
such as tapping a credit card to a reader, swiping
an ID badge to open a door, paying highway tolls,
From the *Department of Orthopaedic Surgery, Thomas Jefferson University; and the
†Rothman Institute of Orthopedics, Philadelphia, PA and operating keyless entry cars.2 The technology is
Received for publication June 22, 2019; accepted in revised form January 15, 2020.
increasingly being used for health care applications
including monitoring hand hygiene compliance,
No benefits in any form have been received or will be received related directly or
indirectly to the subject of this article. tracking medical equipment, identifying retained sur-
Corresponding author: Brianna R. Fram, MD, Department of Orthopaedic Surgery, gical instruments, and tracking and labeling valuable
Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107; drugs and biological samples.3e5
e-mail: [email protected]. Although implanted RFID chips have been used for
0363-5023/20/---0001$36.00/0 several decades in veterinary medicine to track and
https://doi.org/10.1016/j.jhsa.2020.01.008
identify household pets and livestock, human

Ó 2020 ASSH r Published by Elsevier, Inc. All rights reserved. r 1

2 RFID MICROCHIP

implantation of these devices has not been routinely such as between the scapulae in cats and dogs, but
studied.1 Despite the lack of knowledge regarding the also submuscularly in animals such as birds. There
safety profiles of these implants, RFID chips are are case reports of microchip-associated fibrosarcoma
increasingly being implanted in humans. The first re- in cats, dogs, rodents and an Egyptian fruit bat
ported RFID implanted into a human was done in 1998 (Albrecht, presented at the 2010 IEEE International
on Professor Kevin Warwick, now of Coventry Uni- Symposium on Technology and Society).14e18 There
versity. The US Food and Drug Administration wrote is also one reported case of spinal cord injury
an industry guidance document on implantable RFID developing acutely after microchip placement in a
devices in 2004 and first approved the use of this cat, in which the chip was found compressing the
technology that same year in the form of the VeriChip spinal canal and had to be surgically removed.19 The
system (VeriChip Corporation, Delray Beach, FL), RFID microchips have also been implanted in birds
with stated potential risks of adverse tissue reaction, and amphibians with few reported complications.20,21
migration of the implanted transponder, compromise of There is scarce evidence on the safety of implanted
information security, failure of the implanted tran- microchips in humans in the peer-reviewed literature.
sponder or its inserter or scanner, electromagnetic A publication on the use of RFID chips to localize
interference, electrical hazards, and magnetic resonance breast lesions for surgical biopsy reported successful
imaging (MRI) incompatibility.6 Although VeriChip results and no complications such as migration.22
stopped producing the chips in 2010, implantable chips
remain available for purchase online through com- Compromise of information security
panies such as Dangerous Things, whose site contains a Use of RFID chips containing personal information
disclaimer that the implants they sell have “not been may put participants at risk for theft. As early as
certified by any government regulatory agency for 2006, Wired magazine23 published an article on the
implantation or use inside the human body.”7,8 ease of hacking information from an RFID door key
The microchips, which are the size of a grain of card, RFID tracking devices within library books, and
rice, are designed to be placed using a large injecting even an encrypted VeriChip implanted in a human
syringe, most often in the subcutaneous tissues over upper arm. Furthermore, in some cases the hackers
the dorsal first web space or over the posterior tri- were able to write new information or edit existing
ceps.7 Whereas most receiving these implanted de- information on the chips. The potential for hacking of
vices are hobbyists and so-called biohackers, several RFID chips containing protected health information
employers and even the Mexican government have is of particular concern.
offered the implants to employees.9,10 The increase in
implantation has received broad press coverage, and Failure of implanted transponder or its scanner
although there are no clear figures, the Swedish There are no human data on the failure rates of
company BioHax (BioHax International, Helsing- implanted RFID chips. In the veterinary literature, in a
borg, Sweden) claims nearly 4,000 customers with population of 538 microchipped domestic cats, 99.8%
RFID implants and US-based Dangerous Things re- of implanted RFIDs were still functional 6 months
ports over 10,000 chips sold.11,12 Reported uses of after placement.24 However when using the chips as
RFID chips in humans include access to medical and ID devices, such as in lost animals, there is ongoing
vaccination records, identification of patients with concern in the veterinary field that not all chips used in
mental status changes, no-touch payment, and entry the United States emit the same frequency, and that
to secured doors and workstations.10,11 even universal scanners tend to have sensitivities at
only about 95% for detecting the RFID chips, and
even lower for lower-frequency (125-kHz) chips.25
THE POTENTIAL ISSUES The US government and health care providers
Local tissue concerns should be cognizant of this if the medical use of these
Most reports online detail nonmedical personnel, chips increases, because it could create difficulty with
such as piercing professionals or hobbyists, intro- using this technology to carry patient medical history
ducing these devices into one another outside a health or legal representative contact information.
care setting, which raises concern about the sterility
of insertion and awareness of known underlying Electromagnetic and electrical interference
anatomic structures.13 Published literature on animals There are no data in the human or veterinary literature
has limited reports of adverse events. These RFID on the safety of using monopolar or bipolar electro-
chips are most commonly placed subcutaneously, cautery devices in proximity to these implants. This

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 RFID MICROCHIP 3

FIGURE 1: Radiographs of a patient recently seen in our hand clinic with fourth and fifth metacarpal and middle and little finger
proximal phalanx fractures who had implanted an RFID chip into the hand. He reported using the chip to unlock his front door and drive
his keyless entry car. He underwent operative fixation of the fractures without incidence. Electrocautery was not used during his case.

FIGURE 2: Clinical radiographs of the patient from Figure 1 during routine follow-up. The RFID chip can be seen in the subcutaneous
tissue overlying the dorsal first web space. It was easily palpable and moderately mobile on examination.

could theoretically lead to increased fire risk, cauter- function without data loss after MRI and did not show
ization of unintended structures, or damage to the major heating or movement, but increasing the mag-
microchip. There is variability in the composition of netic field strength caused impairment in assessing
microchips, although the commercially available ones nearby structures such as nerves and tendons.29e32
typically contain a ferrite coil encased in biocompatible Similar studies on external RFID devices in computed
glass with or without a polymer coating to prevent chip tomography scanners have shown low levels of artifact
migration.1 Regarding MRI safety, researchers have and no alterations in chip function.29,30 However, most
tested common brands of veterinary RFID chips in up authors still recommend monitoring patients continu-
to 3T scanners. They found that measurable translation ously during examination and using caution when
and torque of the chips occurred and the chips generated performing MRI in the sedated patient with an implant.
artifact that could interfere with imaging of nearby
structures, but that the scanners did not cause notable
heating or affect microchip function.26e28 Multiple WHAT THE HAND SURGEON NEEDS TO KNOW
authors also tested externally worn patient ID tags The presence of microchip implants in patients’
containing RFID chips in humans using MRI scanners hands raises several concerns for hand surgeons in
ranging from 0.3 to 3T. The devices continued to particular. Overall, the hand surgeon should be aware

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4 RFID MICROCHIP

that these devices exist and ought to be cognizant of 3. SwipeSense. Available at: https://www.swipesense.com/. Accessed
May 30, 2019.
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surgical intervention. Hand surgeons should be portunities and challenges for modern cancer care. Asian Pac J
familiar with the appearance of RFID chips radio- Cancer Prev. 2012;13(12):6533e6537.
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fication of implantable radiofrequency transponder system for patient
setting of soft tissue defects, leading to unnecessary identification and health information. final rule. Fed Regist.
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thema over an implanted RFID chip should raise 7. RFID & NFC human chip implantsebiohacking. Available at:
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