Documente Academic
Documente Profesional
Documente Cultură
167
Figure 7.1
Shortwave diathermy
apparatus (schematic).
to table of contents
SHORTWAVE DIATHERMY
168
The sinewave generator consists of a power supply (chapter 5), an oscillator with
good frequency stability (chapters 2 and 5) and a power amplifier (chapter 5). The
power supply converts AC from the mains (of frequency 50 Hz) to DC which is needed
to power the equipment. It consists of a transformer (to convert the 240 V AC from the
mains to the voltage needed by the rest of the circuitry), and a rectifier to convert the AC
to DC. The DC is used to power a sinewave generator; a resonant circuit which
oscillates at 27.12 MHz and an amplifier, which boosts the current produced by the
resonant circuit to higher levels, as needed for patient treatment.
Electrical energy produced by the sinewave generator is coupled to the patient tuning
circuit by transformer action (figure 7.1). Two inductors are placed close together so
that energy produced by the power amplifier is transferred to the patient circuit. This
method of coupling ensures that DC in the apparatus is unable to reach the patient
and the risk of electric shock is minimized.
A variable capacitor, C, is included in the patient circuit so that the resonant frequency
of the patient circuit can be made equal to the frequency of the oscillator. This
ensures maximum efficiency of energy transfer (chapter 2) and reliable operation of
the apparatus. A power meter or indicator lamp shows when resonance is achieved
and maximum power is transferred. In older machines, the variable capacitor, C, was
manually adjusted with the operator adjusting a knob while observing the power
meter and adjusting for maximum power. Modern machines use electronic control of
the variable capacitor and are described as 'auto-tuning'. The principal advantage of
automatic tuning is that if the patient should move during treatment the machine will
adjust to keep the patient circuit in resonance. With manual tuning machines,
movement of the patient or electrodes can result in de-tuning and a drop in output of
the machine.
Any mains-frequency AC
produced by the apparatus is
also not conducted
appreciably to the patient
circuit as the resonant
frequency (27.12 MHz) is
vastly different to the mains
frequency (50 Hz).
The output of the apparatus is coupled to the patient via electrodes (in the capacitor
field technique represented in figure 7.1) or via an induction coil. The coil or
electrodes are connected directly to the output of the machine and the part of the
to table of contents
SHORTWAVE DIATHERMY
169
patient to be treated is positioned in the electric or magnetic field. In figure 7.1, the
area highlighted in yellow is circuitry inside the machine.
The part of the patient to be treated would be positioned between the external
capacitor plates shown in figure 7.1. The plates are normally in the form of two metal
disks, each inside a clear plastic container or envelope. The electrical characteristics
of the patient's tissue affects the capacitance of the patient circuit, as does the
electrode size and spacing. For this reason it is necessary that the apparatus be
tuned (by adjusting C in figure 7.1) with the patient positioned in the field. Similarly, if
an induction coil is used rather than capacitor plates, tuning will be necessary. This is
because when the coil is wrapped around the part of the patient to be treated, the
inductance of the coil will depend on the number of turns of the coil and their radius.
Charged Molecules
The conductivity of tissue is determined by the number of free ions in the tissue fluid.
In the presence of an electric field these ions will migrate along field lines and so
constitute an electric current. The process is not unlike electrical conduction in
metals. Metallic conduction results from the movement of free electrons. In
electrolytes the charge carriers are not electrons but ions; these are tens of
to table of contents
SHORTWAVE DIATHERMY
170
Dipolar Molecules
Dipolar molecules such as water will orient themselves in an
electrical field and if the field is alternating this will result in
backwards and forwards rotation of the dipoles. In a liquid
the molecules are continually in motion (due to their thermal
energy) and are loosely associated with each other
(coupled); thus some of the rotational energy of the
molecules will be converted to heat energy by what can be
thought of as a frictional drag between adjacent molecules.
Figure 7.2
Response of molecules to a high
frequency alternating electric field.
to table of contents
SHORTWAVE DIATHERMY
171
oscillate back and forth to each end of the molecule. Since this kind of motion does
not involve transport or rotation of the molecule as a whole it can only be coupled
indirectly with the gross molecular movement associated with heat energy.
Figure 7.2 summarizes, by illustration, the response of ions, polar molecules and
non-polar molecules to a high frequency alternating electric field. In each case there
is a net back and forth movement of charge: in other words, an alternating flow of
current.
Real current is that associated with heat production. When real current flows
through a material the rate at which electrical energy is converted to heat energy
is given by Joule's law:
P = V.I
.... (1.4)
where V is the potential difference and I is the real current flowing through the
material. P is the power dissipated (in watts), in other words the amount of
electrical energy dissipated per second (1 watt (W) = 1 joule per second (J.s-1)).
to table of contents
SHORTWAVE DIATHERMY
172
Displacement current is current flow which does not produce any heating.
In this case the power dissipated, and hence the heat generated, is zero.
Ionic materials are associated principally with real current and hence substantial
heat production. Polar substances are associated with both real and
displacement current and hence less heat production. Non-polar materials are
principally associated with displacement current and hence minimal heat
production.
An example which serves to illustrate the distinction between real and
displacement current is given in figure 7.3. Here we have a resistor and a
capacitor connected in series to a source of alternating current. In this case we
suppose that the capacitor is ideal - it comprises two metal plates separated by
a perfect insulator which can polarize and depolarize with no loss of electrical
energy to heat energy.
The magnitude of the current flowing in this circuit will depend on the voltage of
the AC source and the total impedance of the resistor/capacitor combination.
The actual impedance of the capacitor is calculated using equation 2.5. The real
current (Ir) flowing through the resistor will result in power dissipation according
to equation 1.4 and hence heat production in the resistor. The displacement
current (Id ) flowing through the capacitor (assumed ideal) gives no power
dissipation and hence no heat production as the material between the plates is
able to polarize and depolarize with no energy loss.
Figure 7.3
Real and displacement current
in an AC circuit.
In this case, then, the current flowing from the AC source appears as real current
in the resistor R and displacement current in the (ideal) capacitor C. Charges
move and heat is produced in the resistor while the charge movement
(displacement current) in the capacitor produces no heating. The two currents,
which are different forms of the same thing, are necessarily the same size.
to table of contents
SHORTWAVE DIATHERMY
For a capacitor to be ideal the material between the plates must be an ideal dielectric
- a substance capable of polarizing in an electric field and depolarizing on its removal
without any dielectric absorption. In other words, with no conversion of electrical
energy to heat energy.
Biological materials, particularly those with high water and ion content are far from
being ideal dielectrics. When placed in an electric field the induced current will be a
combination of real and displacement current. The proportions of each kind of current
will depend on the proportions of ionic, polar and non-polar molecules.
We now consider biological tissue exposed to an electric or magnetic field which
alternates at a frequency of 27.12 MHz, the frequency licensed for use in shortwave
diathermy. As we have seen, shortwave diathermy may be applied using capacitor
plates (which produce an electric field) or an inductive coil (which generates a
magnetic field).
173
to table of contents
SHORTWAVE DIATHERMY
needed. Calculation of the field pattern is much more difficult and has only been done
using simplified models: even simpler than the somewhat idealized geometries
shown in figure 6.19.
Useful qualitative pictures are nonetheless obtained by combining diagrams such as
those shown in figure 6.19, with calculated values of real and displacement current in
each tissue layer.
174
Figure 7.4
Current type and directions in
a model for an arm or leg.
to table of contents
SHORTWAVE DIATHERMY
175
When viewing diagrams such as these, bear in mind the simplifications made. The
pictures can be misleading if interpreted too literally. You should also bear in mind
that even a single tissue layer may be inhomogeneous at both the microscopic and
macroscopic level. An example of the complications introduced by tissue
inhomogeneity is seen with fatty tissue in the shortwave field.
Fatty Tissue
A practical limitation on the amount of heat which can be produced in deeply
located tissue is the heat production in fatty tissue. When using capacitor
plates the rate of heating of fatty tissue is always greater than that of the
underlying muscle tissue. Part of the reason is that fatty tissue is
inhomogeneous. The tissue is not a uniform distribution of cells but a
complex structure incorporating regions of high conductivity and dielectric
constant: the lymphatic and blood vessels.
The high conductivity and dielectric constant of the vessels will result in field
lines being focussed or channelled into them with a resulting high local field
intensity and corresponding high rate of heating in and near the vessels.
The phenomenon is illustrated in figure 7.5.
The localized high heat production will result in greater temperature
elevation of the vessels than the fatty tissue as a whole and a greater
sensation of heat than would be expected if the tissue layer was
homogenous.
Figure 7.5
Focussing of electric field lines in blood
and lymphatic vessels in fatty tissue.
to table of contents
SHORTWAVE DIATHERMY
176
limb. Figure 7.6(a) shows the inductive coil wound as a solenoid around the patient's
lower limb and figure 7.6(b) shows the current pathways in the different tissues.
The current pathways shown are predicted assuming that the alternating magnetic
field gives rise to an induced EMF in the patient's tissue. In this case the current will
follow circular paths parallel to the turns of the coil in figure 7.6(a). Note that in figure
7.6(b) the current through the fatty tissue is shown as half displacement current and
half real current while muscle is assumed to have real current only. As indicated
previously, this is only an approximation: while the proportion of real current in fatty
tissue is about 50%. in muscle it is about 80%.
If the coil in figure 7.6 had a large number of closely spaced turns and the coil
diameter was small compared to its length, then the magnetic field inside the
coil would be uniform and the induced EMF would be the same throughout the
tissue volume. Were this the case, the relative amounts of current flow in each
tissue would simply depend on the tissue impedance (which is determined by
the dielectric constant and conductivity).
Figure 7.6
Current flow induced in a limb by
inductive coil treatment.
to table of contents
SHORTWAVE DIATHERMY
177
A complication is that with more widely spaced turns and a relatively large diameter,
the magnetic field inside the induction coil will be non-uniform. In an arrangement
like that shown in figure 7.6(a), the magnetic field would be strongest close to the coil
and decreasing in intensity towards the centre. The highest field intensity is thus in
the superficial tissues of the limb.
Figure 7.7
Induced currents with a spiral coil mounted
parallel to the skin surface.
to table of contents
SHORTWAVE DIATHERMY
178
Capacitative Effects
A practical complication which occurs with inductive coil treatment,
whether with a solenoid or a spiral coil (monode), is that in addition
to the currents induced by the magnetic field there is also a
pronounced electrostatic effect.
There is a certain capacitance between the loops of the coil. In fact
whenever a cable or wire is folded back on itself or coiled we have
produced a situation where there are two conductors separated by a
space; thus we have produced a capacitor. Although in the case of a
cable wound as a coil the capacitance is very small, the effect is
quite significant at MHz frequencies. The inductive coil behaves as
an inductor in parallel with a capacitor.
At the high frequencies used for shortwave diathermy the inductance
of the coil results in a high impedance to current flow in the cable
(equation 2.4). The capacitance associated with the coil presents a
lower impedance pathway for current to take (equation 2.5). In
consequence the induced current patterns are not as simple as
those shown in figure 7.6(b). The electric field between adjacent
turns (Figure 7.8(a)) results in current flow along the field lines
shown in blue. Because the electric field is stronger closer to the
coils, greater current flows and this adds to the current induced by
the magnetic field. The consequence is greater current flow in, and
greater heating of, superficial tissue (figure 7.8(b)).
The electric field between adjacent loops is similar to that between
two small electrodes (figure 6.1(c)). The field is most intense close
to the cable. A consequence is that there is a risk of burning the
superficial tissues with the electric field of the coil rather than
Figure 7.8
Electric field pattern (blue lines) between
adjacent turns of an inductive coil.
to table of contents
SHORTWAVE DIATHERMY
179
heating deeper tissue with current induced by the alternating magnetic field.
A similar argument applies for a spiral coil. An electric field is produced between
adjacent turns within the loop. Close to the coil, the electric field is intense and
greater current flows. This adds to the current induced by the magnetic field so there
is greater current flow in, and greater heating of, superficial tissue.
Superficial heating due to the electric field can be minimized in three ways: (a) by
winding the turns of the coil close together, (b) by keeping the cable away from the
patient's skin using towelling and/or rubber spacer designed for this purpose and (c)
by using an electrostatic shield.
Electric field heating effects can also be minimized, in the case of a solenoid, by
positioning an earthed metal cylinder between the coil and the patient's limb. If a
monode is used, a flat metal plate between the monode and the patient's tissue
would be needed. The plate will screen-out the electric field while having little effect
on the magnetic field of the coil. The electric field inside the metal cylinder or behind
the metal plate would be almost nil because the metal is a good conductor and field
lines will terminate on its surface. Most metals are, however, transparent as far as
magnetic fields are concerned so the magnetic field is virtually unchanged. Some, but
not all, inductive coil applicators are supplied with an inbuilt electric field screen.
Screening is an important feature when depth efficient heating is required.
In summary, the options with inductive coil treatment are a coil wound around the part
of the patient to be treated or a flat coil (monode) positioned over the body part. The
difference is the depth efficiency of treatment. A solenoidal coil (figure 7.6) has greater
depth efficiency as far as tissue within the coil s concerned. A flat spiral coil (figure
7.7) has greater effect on superficial tissues.
With either method of application, there is the risk of excessive superficial heating due
to the electric field between adjacent turns of the coil or spiral. the risk is minimized by
spacing the coil or spiral away from the patient's superficial tissues.
to table of contents
SHORTWAVE DIATHERMY
180
The shape of the part of patient in the field. Compare Figure 6.19(a) with 6.19(b).
In addition, if the electrodes are placed over any prominence an undesirable
concentration of the field can result.
The size, spacing and orientation of the electrodes. Some examples of the
electric field in the absence of any object were shown in figures 6.2 and 6.3. We
consider below the effect when the patient is in the field.
Electrode Size
In general, it is preferable to use electrodes which are somewhat larger than the
structure to be treated. This results in the central, more uniform, part of the field being
used (figure 6.2).
The dielectric constant and conductivity of tissue are much higher than those of air
(table 4.2). Thus, with large electrodes, the field lines are bent towards the limb and
spreading of the field is minimised. The effect is illustrated in figure 7.9 where the
effect of the different tissue layers is ignored for simplicity.
to table of contents
SHORTWAVE DIATHERMY
181
Electrode Spacing
The electrode spacing should normally be as wide as
possible. In this way the problems associated with a
non-uniform field pattern are minimised. The machine
itself, however, sets the limit on the maximum spacing
which can be used. As the electrodes are moved further
apart the capacitance of the two plates decreases. In
addition the field intensity (and consequently the rate of heating) will
decrease. A point will be reached where the machine can no longer be tuned
or insufficient power is available for adequate heating: this sets the limit on
the separation of the electrodes.
Figure 7.9
Effect of electrode size: (a) correct
electrode size (b) electrodes too small
(c) arrangement for selective heating.
By use of a wide spacing the electrical properties of the tissue have a smaller
effect on the overall field pattern and the electrical properties of air play a
greater role. Thus the field pattern is more uniform and less subject to
variation with movement of the patient in the field.
Figure 7.10 illustrates the effect of electrode spacing. In 7.10(a) the electrode
to surface distance varies considerably resulting in a local high field intensity
to table of contents
SHORTWAVE DIATHERMY
182
Electrode Orientation
In the examples considered previously the
electrodes were placed parallel to each other in
order to obtain a relatively uniform heating pattern.
However if one part of the surface of a structure is
closer to an electrode, the field lines will be
concentrated in that region.
Figure 7.11 shows electrodes applied to the shoulder. Compare this with
figure 6.16. Electrodes which are parallel to each other as in figure 7.11(a) do
not give a uniform field because the air spacing varies considerably. The
dielectric constant and conductivity of each field-line pathway varies
considerably, resulting in variation in the field intensity. In figure 7.11(b) the
distance between the plates varies but the electrical characteristics of each
pathway are similar: thus the field is relatively uniform. Clearly the
arrangement shown in figure 7.11(b) is preferred when uniform heating is the
objective.
Figure 7.10
Effect of electrode spacing: (a) narrow
spacing, (b) wide spacing and (c)
unequal spacing.
to table of contents
SHORTWAVE DIATHERMY
183
Figure 7.12
A coplanar arrangement of electrodes.
to table of contents
SHORTWAVE DIATHERMY
184
Figure 7.13
The cross-fire technique.
The field lines are concentrated in the dielectric resulting in uneven heating of the
walls of the cavity. Cross-fire treatment ensures that all of the cavity wall area is
treated.
HEATING OF TISSUE
Earlier we discussed qualitatively and in molecular terms, the heating effect of a high
frequency alternating electric field. We now consider heat production and temperature
rise and take a larger scale view of matter: a view at the level of tissue rather than
molecules.
Figure 7.14
A hollow dielectric between
capacitor plates.
We saw in chapter 1 that the power dissipated by a resistor, the rate at which
electrical energy is converted to heat energy, is given by equation 1.4:
P = V.I
.... (1.4)
to table of contents
SHORTWAVE DIATHERMY
185
This expression relates the current, I, flowing through a resistor to the total power, P,
dissipated in the resistor. For resistors the current, I, is entirely real current and thus
produces heat. When we consider biological tissues we must distinguish between
real current and displacement current since only the real current results in heat
production. In additional, we are usually more interested in the rate of heating at a
particular point in the tissue rather than in the tissue as a whole. In this case a more
useful expression of equation 1.4 is equation 7.1.
Pv = E.ir
.... (7.1)
Here Pv is the power dissipated per unit volume of tissue at a particular point. The
units of Pv are thus watts per cubic metre. E is the field strength (in volts per metre)
and ir is the real component of current density (in amps per square metre) at that
point.
The power dissipated, Pv is equal to the rate of heat production. Hence, in order to
determine the rate of heating at a particular point in tissue we need to know the
electric field strength and the real current density. We begin by considering fields and
currents produced using capacitor field treatment.
to table of contents
SHORTWAVE DIATHERMY
186
Figure 7.15
Electrode/tissue configurations and their
electrical equivalent circuits. (a) coplanar
arrangement, (b) contraplanar arrangement.
In figure 7.15(a) we ignore (displacement) current flow through the air directly between
the electrodes. We also ignore current flowing directly through the fatty tissue and
bypassing the muscle. If the electrode spacing is at least twice the electrode to tissue
spacing this will be a reasonable approximation. The impedance presented by each
alternate pathway will be sufficiently high to make these currents negligible.
In figure 7.15(b) we ignore current flow through the bone, directly around the fatty
tissue or through the air around the tissue. Again this is because these pathways
have very high impedance compared to the ones shown.
With these approximations the electrical equivalent circuits in 5.16(a) and (b) are the
to table of contents
SHORTWAVE DIATHERMY
187
displacement
+ real current
in fatty tissue
displacement
+ real current
in muscle
As mentioned earlier, the proportion of real current in fatty tissue is approximately 50%
while in muscle the proportion is about 80%. Thus the amount of real current flow in
muscle is 80/50 or about one and one half times greater than in fatty tissue.
Let us take the simple case where current spreading is minimal and estimate the
relative rate of heating in fatty tissue and muscle. We need to know both the real
current density and field strength in each tissue. The field strength is estimated
below.
When resistors are connected in series the current flow in each is the same but the
voltage across each resistor will, in general, be different. The largest resistor will
have across it the greatest potential difference. The equivalent statement for tissues
of different impedance is as follows:
When tissues are arranged in series the field intensity will be greatest in the tissue
with highest impedance.
Inspection of table 6.2 shows that muscle has a higher conductivity and dielectric
constant than fatty tissue: both figures are several times higher. Now a high
conductivity and dielectric constant means a low impedance. Combining the two
to table of contents
SHORTWAVE DIATHERMY
188
figures from table 6.2 we calculate that fatty tissue has an electrical impedance some
ten times larger than muscle.
The rate of heating of each tissue is given by equation 7.1:
Pv = E.ir
.... (7.1)
The real current density in muscle is as we have seen, about one and a half times
greater than in fatty tissue, however the field intensity in fatty tissue is approximately
ten times higher. Hence the rate of heating of fatty tissue is predicted to be
approximately 10/1.5 times higher than muscle.
We thus have the general conclusion that if spreading or converging of the field is
minimal the rate of heat production in fatty tissue will be about seven times higher
than in muscle.
If the electrode/tissue configuration permits spreading of the field in muscle the
current density will be reduced and the rate of heating of muscle correspondingly
reduced. Conversely if the geometry produces convergence of the field lines in
muscle the current density will be increased and the relative rate of heating will be
increased accordingly.
to table of contents
SHORTWAVE DIATHERMY
189
muscle is not limited by the fatty tissue but depends only on the strength of the
induced electric field and the electrical characteristics of the muscle tissue. In other
words the induced currents flowing in each tissue layer are independent of each
other.
The real component of the current density, the current density which determines heat
production, is given by equation 6.10, which can be written:
ir = .E
.... (6.10)
Substituting this formula into equation 7.1 we obtain an alternate expression for the
power dissipated per unit volume:
Pv = .E2
.... (7.2)
Table 6.2 shows that the conductivity, , of muscle is some sixteen times greater than
that of fatty tissue. Hence, for the same induced electric field strength, both the real
current density and the power dissipated in muscle will be sixteen times greater than
in fatty tissue.
How large is the magnetically induced electric field? The intensity of the induced field
is determined by the rate of change of the magnetic field and the permeability, , of the
material. The permeability is close to one for biological materials (see table 6.3) so
fatty tissue and muscle are alike in this regard.
For the same strength of alternating magnetic field then, both fatty tissue and muscle
will have the same strength of induced electric field. Thus the rate of heating of
muscle in this situation will be about sixteen times greater than that of fatty tissue.
In practice such a degree of selective heating is difficult to achieve. This is for two
reasons:
to table of contents
SHORTWAVE DIATHERMY
190
Muscle is located beneath fatty tissue and so is further from the induction coil.
Thus the magnetic field is weaker in muscle and the strength of the induced
electric field is correspondingly smaller.
Fatty tissue, being closer to the induction coil may also experience an
appreciable electric field due to the capacitance between adjacent turns of the
coil. This effect was described earlier (see figure 7.8).
These two factors combine to increase the heating of fatty tissue relative to muscle so
that a sixteen to one advantage is rarely obtained. Nonetheless efficient selective
heating is achieved with close spacing of the turns of the coil and a sufficiently large
coil to patient distance. One would also expect good discrimination with applicators
which incorporate an electric field screen in front of the inductive coil.
.... (7.3)
to table of contents
SHORTWAVE DIATHERMY
191
physiological processes.
The SI unit of temperature is the kelvin (symbol K). It is related to the perhaps more
familiar degree Celsius (oC) by the expression
oC
= K - 273.15
Notice that from this definition the size of the degree Celsius is the same as the kelvin.
In other words a change in temperature of five degrees Celsius is precisely the same
as a change of five Kelvin's. When we are talking about increases in temperature
brought about by diathermy treatment the terms kelvin and degrees Celsius can be
used interchangeably to describe the increase.
to table of contents
SHORTWAVE DIATHERMY
192
Prior to the start of treatment the body tissues are in a state of dynamic equilibrium.
Cellular activity, metabolism and muscle contraction result in the steady production of
heat and the circulation of blood and tissue fluids provide an efficient means of heat
transfer. The net production of heat is balanced by net transfer of heat from the tissue
and a stable temperature is maintained.
Once treatment is started heat is produced in the tissue according to equation 7.3 and
the temperature starts to increase. An expression for the initial rate of increase in
temperature is obtained below.
Rearranging 7.4 we have Q = m.c.T
Dividing this expression by volume we obtain:
Qv = .C.T
.... (7.5)
.... (7.6)
where Qv/t is the volume rate of heating (in Joules per cubic metre per second) and
T/t is the rate of increase in temperature (in Kelvin's per second).
This equation can be used to compare the initial rate of temperature increase in fatty
tissue with that of muscle. The densities of the two tissues are similar but the heat
capacity of muscle is some 50% greater than that of fatty tissue. Thus if the rate of
heating of each tissue is the same, the initial rate of temperature increase in muscle
will be only two thirds of that of fatty tissue. To produce the same initial rate of
increase in temperature in each tissue the rate at which heat energy is produced in
muscle must be 50% greater.
to table of contents
SHORTWAVE DIATHERMY
193
.... (7.7)
Equation 7.7 shows that the initial rate of increase in temperature (T/t) in shortwave
diathermy depends on four factors:
*
*
*
*
Once the temperature of any tissue has increased appreciably two things happen:
*
Heat is transferred by the blood and tissue fluids to adjacent cooler tissues.
Both of these effects lower the rate of increase in temperature. Eventually, the stage is
reached where the temperature ceases to increase. A new dynamic equilibrium is
achieved where the net production of heat is once again balanced by the net transfer
from the tissue.
Figure 7.17 illustrates the temperature variation during treatment. There is a transient
period during which the tissue temperature increases, followed by a steady state
where a constant (elevated) temperature is produced. The transient period for tissue
volumes of interest in physiotherapy is typically of the order of twenty to thirty minutes
to table of contents
SHORTWAVE DIATHERMY
194
(see Lehmann (1982), chapter 10). Thus for treatment times of up to several minutes,
equation 7.7 gives a reasonable approximation to the real physical situation.
Application of equations 7.1 and 7.7 to quantitative prediction of
the rate of heating and rate of temperature increase in different
parts of tissue is difficult. The difficulty arises in the calculation
of the field intensity in a particular area. For a review of results
obtained using various approximations see A. W. Guy in J F
Lehmann (1982).
In patient treatment, shortwave diathermy remains something of
an art as well as a science. The physiotherapist must use a
knowledge of anatomy together with knowledge of the electrical
properties of tissues to determine the optimum placement of
electrodes or coil to give the required field pattern. Once the
field pattern is selected, the physiotherapist uses a knowledge
of the relative heating of the tissues and the patient's report of a
sensation of warmth to adjust the intensity of the applied field to
an appropriate level. With this procedure it is not possible to
accurately monitor dose or dose rate for the individual tissues.
Since this is a problem common to all diathermic modalities we
will defer further discussion of dosage until chapter eleven.
Physiological Effects
The therapeutic value of shortwave diathermy arises from the
physiological response of tissues to an increase in
temperature. A number of physiological responses are found:
*
Figure 7.16
A simple model for tissue temperature
variation during treatment.
to table of contents
SHORTWAVE DIATHERMY
the response of sensory nerves to heat is useful for the relief of pain generally.
Mild heating appears to inhibit the transmission of sensory impulses via nerve
fibres. In addition, when pain results from inflammation of tissue an increase in
the rate of absorption of exudate with increase in temperature can result in a
secondary pain-relief effect.
195
Some claims have been made that additional non-thermal effects can be produced
under the conditions used for therapy. As yet there is no clinical evidence for these
claims. Non-thermal effects seem to have been demonstrated using pulsed
shortwave treatment when the peak power level is significantly higher than used for
diathermy. The few published comparative studies indicate little or no nonthermal
effect at the low continuous power levels of conventional shortwave field treatment.
These points are considered further in chapter 8 following.
to table of contents
SHORTWAVE DIATHERMY
196
EXERCISES
1
(b)
c)
2
(a)
(b)
Figure 7.2 illustrates the response of ions, polar molecules and non-polar
molecules to a high-frequency alternating electric field.
(a)
(b)
(c)
(a)
(b)
(a)
Consider each of fatty tissue, muscle and bone in the shortwave diathermy
field. Is current flow in each tissue best described as real or displacement
current?
to table of contents
SHORTWAVE DIATHERMY
(b)
(c)
Figure 7.4 shows current pathways in a model for an arm or leg. Describe
the principal factors determining the relative rate of heating of each tissue
layer.
Describe the motion of polar, non-polar and ionic molecules when a high
frequency alternating current flows through the coil.
(b)
Figure 7.8 shows the electric field associated with two adjacent turns of an
induction coil
10
(a)
(b)
197
to table of contents
SHORTWAVE DIATHERMY
(b)
198
What are the advantages and disadvantages of using unequal size electrode
(figure 7.9(c) )?
11
(a)
(b)
What is the practical limitation on the electrode spacing which can be used?
(c)
12
Consider the electrode arrangements shown in figure 7.11. Explain why the field
intensity is non-uniform in diagrams (a) and (c). Under what circumstances will
the field intensity be uniform, as in (b)?
13
(a)
Consider the hollow dielectric between capacitor plates which is shown in figure
7.14.
(a)
b)
to table of contents
SHORTWAVE DIATHERMY
15
16
17
18
199
When coplanar electrodes are used for patient treatment the tissues can be
considered to be in series electrically (see figure 7.15(a)).
(a)
(b)
draw an electrical equivalent circuit similar to that in figure 7.15(a) for the
situation where the electrodes are close together.
(c)
how would bringing the electrodes closer together affect the relative heating
rate of muscle and fatty tissue? Justify your answer.
(a)
(b)
(a)
(b)
The relationship between heat production (Q) and current flow (I) in a conductor
is given by Joule's law: Q = V.I.t where V is the potential difference across the
conductor and t is the time interval for which current I flows.
(a)
(b)
to table of contents
SHORTWAVE DIATHERMY
19
(a)
(b)
20
21
200
to table of contents