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ELECTRICITY
Chapter
Chapter
Chapter
Chapter
Chapter
FIELDS
Chapter 6: Electric and Magnetic Fields
Chapter 7: Therapeutic Fields: Shortwave Diathermy
Chapter 8: Non-Diathermic Fields
WAVES
Chapter 9: Sound and Electromagnetic Waves
Chapter 10: Therapeutic Waves: Ultrasound
Chapter 11: Electromagnetic Waves for Therapy
GENERAL
Chapter 12: Dosage and Safety Considerations
Chapter 13: Electrical Safety
Appendices: Quantities, Units and Prefixes
SOME FUNDAMENTALS
Conductors are familiar to us in everyday life: the filament of a light bulb,
connected to car batteries and copper wire in the cables leading to
appliances are a few examples. If we picture atoms as consisting
charged nucleus together with electron 'shells' surrounding the nucleus
of conductors have a characteristic feature.
Good conductors (iron, copper and other metals are examples) share the common
feature that the outermost electrons of the atoms are only loosely bound to the nucleus.
For this reason they can readily transmit electrons. A good way to picture this is to
COMPONENTS
An electronic device such as a radio, TV set or CD player can be very
complex but the complexity lies in the arrangement and total number of
components. When we examine a typical circuit we find only a few
different kinds of components.
Resistors are the most common circuit components: they come in a
variety of shapes and sizes and usually have their values coded in the
form of three or four coloured stripes on the body. High power resistors
are larger and usually have the resistance and power rating stamped on
the body. Rheostats and potentiometers are variable resistors having
two or three terminals respectively.
1
F = 10-6 F
1 000 000
1 nF =
1
F = 10-9 F
1 000
1 pF =
1
F = 10-12 F
1 000 000
Electrolytic capacitors are polarized; that is, they have definite positive and negative
terminals and can only be connected one way around in a circuit. Ordinary capacitors
(mica, polyester, etc.) are non-polarized and can be connected either way around.
Inductors and transformers form our third category of components. An inductor is
simply a coil of wire: the wire may be wound on various kinds of core, depending on
the specific role for which it is intended. An example is shown.
The unit of inductance is the henry (H). You will also see the terms millihenry (mH)
and microhenry (H) used frequently.
1 mH =
1
H = 10-3 H
1000
1 H =
1
mH = 10-6 H
1000
When two inductors are wound on the same core in close proximity or
overlapping we have a transformer.
Valves, Transistors and Diodes are the 'workhorses' of any electronic
circuit, the devices which have permitted the development of long distance
voice communication, radio and television, computers and space
exploration, guided missiles and the reproduction of music to name a few of
the more obvious applications.
Today valves are seldom used except for special applications: they are
bulky and inefficient and have largely been superseded by transistors, their
semiconductor equivalents. The transistor performs much the same job as
a valve but is physically much smaller.
ClRCUITS
The electronic components we have met so far are typically
found with a complex maze of interconnections between them.
The particular way in which they are connected defines a
circuit and the form that the circuit takes will depend on the job
it is designed to do. If we consider, for example, a radio, the
job it has to perform is exceedingly complex. It must pick up
radio transmissions, convert the radio waves to electrical
signals, amplify them and convert them to audible sound
waves. Not only that but it must also be capable of selecting a
particular frequency of radio wave (the one from the radio
station you wish to tune-in on) and ignoring the remainder.
Needless to say, the circuitry required to perform these tasks
is very complex.
In the next section we will consider extremely simple circuits in
order to examine the characteristic behaviour of some of the
components discussed so far. But first a few words on
circuits themselves and their physical construction.
The earliest circuits, those found for example in a valve radio receiver, were made up
of a large number of bulky components - the transformer, valves, etc., and the circuit
interconnections reflected this bulkiness. Large components such as the transformer
were bolted to a metal frame or chassis along with sockets for the valves, and the
circuit was built-up by interconnecting with smaller components (resistors and
capacitors) and lengths of wire.
With the advent of the transistor and the consequent trend to miniaturization which this
permitted, it was found to be more convenient and simpler to replace most of the
wiring with copper strips firmly attached to an insulating board having holes drilled in
appropriate places. All of the miniature components (transistors, resistors,
capacitors) could then be mounted on the board and soldered to the copper
conductors. Only a limited number of bulky components (transformer, volume control
and speaker in a mains-powered radio) need then to be mounted on a chassis or
casing.
Circuits assembled on these printed circuit hoards can be rapidly mass produced
and easily put together. Consequently they are used almost exclusively by
manufacturers. When integrated circuits are used rather than transistors a further
reduction in size is achieved. The printed circuit boards can be made smaller as the
l.C.'s themselves are small and relatively few external components are required.
electrons. The difference between reality and convention is not important as it has no
effect on the magnitudes of currents and voltages in a circuit.
Under normal circumstances
the flow of current through the
lamp will cause it to glow - the
normal purpose of such a
circuit. If a break occurs in the
wire for example, or the wire is
not secured to the battery,
current will not flow and we
have an open circuit. If the wire
connected to one terminal of
the lamp comes loose and
touches the other wire, current
can flow directly through the
wires and bypass the lamp this condition is known as a
short circuit. The switch on a
torch is just a means of
introducing an open circuit
condition at will: preventing the flow of current and thus conserving the electrical
energy stored in the battery.
Going one step further than the circuit shown in figure 1.1 we may add a resistor to
produce the circuits shown in figure 1.2. Note the circuit symbol (zig-zag line) for a
resistor.
Figure 1.2(a) shows the resistor in series with the lamp, i.e. the resistor and lamp are
connected end to end so that current must flow through both the lamp and the
resistor. In 1.2(b) the resistor is connected in parallel with the lamp so that some
current can flow through the lamp and some through the resistor. The resistor is thus
allowing part of the current to bypass the lamp and return to the opposite terminal of
the battery.
Figure 1.1
A very simple circuit and its
representation using a circuit
diagram
RESISTORS IN SERIES
Two or more resistors may be connected in series or in parallel. When the
resistors are connected in series as in figure 1.3 the current must pass through
each resistance in turn and the total resistance offered by the circuit is equal to the
sum of the individual resistances.
Figure 1.2
Two less simple circuits. (a) a
series and (b) a parallel
arrangement.
In general for a circuit having n resistors connected in series the total resistance
of the circuit, R, is equal to the sum of the individual resistances i.e.
R = R1 + R2 + R3 ........ + Rn
.... (1.1)
Figure 1.3
Resistors in series
10
RESISTORS IN PARALLEL
When a number of resistors are connected in parallel as in figure 1.4 the
current flowing in each resistor may be different. In this case the total
resistance of the circuit, R, is given by the equation
1
1
1
1
=
+
+
R1 R2 R3
R
or more generally, where there are n resistors in parallel in a circuit
1
1
1
1
1
=
+
+
..... +
R1 R2 R3
Rn
R
.... (1.2)
Figure 1.4
Resistors in parallel
Although the current in each resistor may be quite different, the voltage or
potential difference across each resistor is the same and is equal to the
battery voltage. This must be so since the ends of each resistor are
connected directly to the terminals of the battery. The largest amount of
current will flow through the smallest resistance when resistors are
connected in parallel.
OHM'S LAW
The relationship between potential difference (V), resistance (R) and current (I )
through a resistor is summarized by Ohm's law which states that the current flowing
through a resistor is proportional to the potential difference across the resistor and is
inversely proportional to the resistance.
The equivalent mathematical expression of Ohm's law is
I =
V
R
.... (1.3)
11
where I is the current in amperes, V is the potential difference in volts and R is the
resistance in ohms.
Example 1. If, in figure 1.3, R1 is 50 ohms, R2 is 100 ohms and R3 is 150 ohms then
the total resistance R is
R = 50 + 100 + 150 = 300
If these are connected to a 10 volt battery the current flow will be
I =
V
10
=
= 0.033 amps or 33 milliamps.
R 300
Here we have calculated the total current drawn from the battery which is equal to the
current flowing through each resistor. The battery gives a total potential difference of
10 volts across the combination of resistors. If we wish to calculate the potential
difference across each individual resistor we again use equation 1.3 but apply the
equation to each resistor in turn.
For example, for the 50 ohm resistor we know that
V
V
becomes
= 0.033 and hence V = 50 x 0.033 = 1.7 volts.
R
R
To calculate the current in each individual resistor we use the fact that the
potential difference across each resistor is the full 10 volts. Then for the 50
ohm resistor we have
I =
V
10
=
= 0.20 amps.
R
50
10
= 0.10 amps
100
V
10
=
= 0.07 amps
R
150
12
13
.... (1.4)
This formula can be usefully used with Ohm's law to calculate the maximum values
for voltage or current for a particular resistor of known resistance and power rating.
Alternatively if we know any two of the values of V, I or R for a given resistor, we can
calculate the power dissipated in the resistor using equation 1.4 or the two
expressions obtained by solving equations 1.3 and 1.4. These are:
P =
V2
R
.... (1.5)
.... (1.6)
14
With these three alternative formulae for calculating power we would choose the
equation which gives the required answer with a minimum of calculations.
Consider the three resistors connected in series as in example 1 previously. If we
wish to calculate the power dissipated in each resistor we would first calculate the
current (which is the same for each resistor) and then use equation 1.6. In example 2
previously the resistors are in parallel and the potential difference is the same for
each resistor. Equation 1.5 is thus the choice for power calculation.
Figure 1.5
Resistors in a series/parallel
arrangement
15
across R3. The potential difference across R1 plus that across the R2/R3 combination
must equal the battery voltage.
Example 3. If we have a resistor combination like that shown in
figure 1.5, with the resistance values and battery voltage are as
shown alongside:
(i)
(ii)
1
1
3
200
1
=
+
=
so R =
= 67
100
200
200
3
R
V
10
=
= 0.085 A
R
117
All of this current flows through the 50 resistor so the current through it is 0.085 A
or 85 mA.
The potential difference across the 50 resistor is V = I.R = 0.085 x 50 = 4.3 V,
which answers question iii above.
The potential difference across the 100 /200 parallel combination is 10 - 4.3 =
5.7 V.
(ii)
16
V
5.7
=
= 0.057 A
R
100
V
5.7
=
= 0.029 A
R
200
The total current through the 100 /200 parallel combination is 0.057 + 0.029
= 0.086 A which (allowing for rounding errors as we have used two-figure
accuracy) agrees with the value calculated for the 50 resistor.
Figure 1.6
Direct current as from a battery
17
1
T
.... (1.7)
18
Thus the appliances we plug into the mains must have a rating of 240 volts AC.
Since the voltage is rapidly oscillating between + 340 and -340 volts the current
through a light globe connected to the mains will flow alternately in one direction and
then the other and the globe will flicker in brightness according to the voltage. It is
only because the frequency of fluctuation is sufficiently rapid that this effect is not
noticeable.
Figure 1.8
(a) Circuit symbol and (b)
construction of a transformer
19
The power from the mains comes from two cables, the active cable
(colour coded brown) and the neutral cable (colour-coded blue).
The neutral cable is earthed at the power station and at distribution
substations. That is, the neutral cable is physically connected to
the ground through a metal conductor (for example, a thick length
of wire connected to a metal stake or water supply pipe buried in
the ground). The neutral cable is thus kept at zero volts potential.
The problem with this arrangement is that if a connection is
inadvertently made between the active cable and earth, such as by
a person accidentally touching the active cable, this will complete a
circuit and current will flow from the active wire through the person
to earth, giving an 'earth' shock. To obtain a shock from the 'earth
free' power supplied at the transformer secondary it would be
necessary for the person to touch both terminals simultaneously.
As long as there is no connection between the primary and secondary windings,
touching only one secondary terminal and thus making a connection between the
secondary circuit and earth will not complete a circuit and no current can flow, hence
no shock. Mains supply and the mechanisms of electric shock are described in more
detail in a later chapter.
EXERCISES
1
The lamp shown in figure 1.1 has a resistance of 3.0 and is connected to a 1.5
V battery. Calculate the current flowing through the lamp and the power
dissipated.
An electric jug draws a current of 1.2 amps when connected to the 240 volts
mains supply. Calculate the resistance and power rating of the heating element.
Three resistors are connected in series as shown in figure 1.3. The battery
voltage is 12 V. The resistors have values R1 = 100 , R2 = 500 and R3 = 600
. Draw a diagram of the circuit and label the values of the components.
What is:
(a) the current through each resistor
(b) the potential difference across each resistor
(c) the power dissipated in each resistor
Do the values calculated in (b) add to equal the battery voltage?
Three resistors are connected in parallel as shown in figure 1.4. The battery
voltage is 5 V and the resistors have values R1 = 50 , R2 = 100 and R3 = 75
. Calculate:
(a) the current through each resistor
(b) the potential difference across each resistor
(c) the power dissipated in each resistor
(d) the total resistance of the circuit and hence
(e) the total current drawn from the battery.
Figure 1.9
Isolation with a power
transformer
Current can only flow along
the 'active' wire if it can
simultaneously return via
the 'neutral' wire. Because
the neutral wire is earthed,
anything touching the earth
is provided with a return
pathway via the neutral wire.
20
21
(a)
(b)
10
(a)
(b)
(c)
22
23
Figure 2.1
Circuit symbol for (a) a
capacitor and (b) an inductor.
The capacitance tells us how much charge a capacitor will accumulate for a given
battery voltage. Capacitance (C), charge (q) and voltage (V) are related by the formula
C =
q
V
.... (2.1)
Once charged, a capacitor can store the charge indefinitely. If the battery is
disconnected, the charge on the capacitor and can only leak away if we connect an
external resistance.
The circuit shown in figure 2.2 can be used to observe the discharge of a capacitor.
24
Voltage on the
25 F capacitor
12
10.2
8.7
7.4
6.3
5.4
4.6
3.9
3.3
2.8
2.4
Voltage on the
50 F capacitor
12
11.1
10.2
9.4
8.7
8.0
7.4
6.8
6.3
5.8
5.4
Figure 2.2
A circuit for measuring the
discharge of a capacitor
Table 2.1
Measured voltages for the
discharge of capacitors through
a resistance of 500 k
25
1/2 C
Other experiments, where the resistance through which
the capacitor discharges is varied, show that the time
for half-discharge is also proportional to the resistance
(R) through which the capacitor discharges. That is,
1/2 R
Combining these equations we have that the time for
half discharge is directly proportional to the product of
the resistance and the capacitance. In symbols
1/2 R.C
.... (2.2)
Figure 2.3
Discharge of capacitors
through a resistance
Notice that for a short period of time, such as 1/50th of a second, the 25 F capacitor
in table 2.1 will not have discharged appreciably. If it discharges by 0.9 volt in the first
second, in l/50th of a second it will discharge by less than 0.02 volt. The importance
of this and the previous ideas will be considered later.
26
We will have more to say about magnetic fields (and their effects on tissues) in later
chapters.
27
Capacitors and inductors are useful because their resistance to alternating current
depends on the frequency of the AC. Next we examine this frequency dependence.
Knowing the physical construction of capacitors and inductors we can predict what
resistance they offer when connected in a circuit to a battery. The capacitor, with an
insulator between its plates, offers an extremely high (virtually infinite) resistance to
DC. Current can not flow from one plate to the other. Inductors, being simply coils of
conducting wire, have an extremely low resistance to DC (almost zero).
For alternating current the resistance of these components is not predicted quite so
simply. Instead of attempting a prediction let us look at some experimental
observations with AC.
When we talk about resistance to the flow of alternating current we no longer use the
term 'resistance' but impedance. The impedance is still measured in ohms but we
reserve 'resistance' for use when talking about DC. The symbol Z is usually used for
impedance. Impedance can be calculated from measurements using a circuit such
as that shown in figure 2.4. The potential difference across R and that across C are
found to depend on the AC frequency. The two values added equal the potential
difference produced by the AC source.
The voltage across the resistor can be used to calculate the current flowing around
the circuit (using Ohm's Law, I = V/R). Since C and R are in series, this equals the
current flowing to the capacitor. The impedance of the capacitor is then calculated
using
V
Z =
.... (2.3)
Figure 2.4
A circuit for measuring the
impedance of a capacitor
If the capacitor in figure 2.4 is replaced by an inductor, impedance values for the
inductor can be calculated in a similar manner. Table 2.2 gives the measured
impedance of a 20 millihenry (mH) inductor and a 1 microfarad (F) capacitor at
various frequencies.
28
Frequency
f (kHz)
Impedance of 1 F
capacitor (ohms)
Impedance of 20 mH
inductor (ohms)
0.2
0.3
0.4
0.6
1.0
2.0
3.0
4.0
5.0
795
530
398
265
159
79.5
53.0
39.8
31.8
25.1
37.7
50.2
75.4
126
251
377
502
628
and
Zf
Z 1/f
29
.... (2.4)
1
2fC
.... (2.5)
From equations 2.4 and 2.5 we can see that it is predicted that doubling the
value of inductance would double the impedance at all frequencies. Doubling
the value of capacitance would halve the impedance at all frequencies. These
predictions are easily confirmed experimentally.
Figure 2.5
Impedance versus frequency
graph for (a) a 1 F capacitor
and (b) a 20 mH inductor
Two important points to note from the equations (or the graphs) are that
capacitors have an infinite impedance to direct current (zero frequency) whereas
inductors have zero impedance to DC. This is in agreement with our previous
predictions based on the physical construction of each.
30
RESONANT CIRCUITS
A traditional and simple way of producing alternating
current relies on the properties of capacitors and
inductors and their behaviour when connected
together in a circuit. An inductor and capacitor
combined in parallel as in figure 2.6 forms what is
called a parallel resonant circuit.
The impedance of the inductor increases with
frequency while the impedance of the capacitor
decreases with increasing frequency (figure 2.5). The
parallel combination will have a low impedance at
low frequencies (because of the inductor) and at high
frequencies (because of the capacitor). At an
intermediate frequency the combination has a
maximum impedance. This is when the impedances
of the components are equal. The peak in the graph
shown in figure 2.6 occurs at this frequency.
A formula for calculating the frequency at which the
impedances of the capacitor and inductor are equal
is obtained as follows. The impedance of the
capacitor is given by equation 2.5, and the impedance
of the inductor by equation 2.4.
When the
impedances of the components are equal
1
2fC
= 2fL
1
4 2LC
Figure 2.6
A parallel resonant circuit and how its
impedance varies with AC frequency
or
f =
1
2
L C
31
.... (2.6)
Figure 2.7
Initial current flow in a
resonant circuit
32
reverse direction to that in figure 2.7, producing a magnetic field which would collapse
and re-charge the capacitor to its original state (figure 2.7(a). The process would
repeat indefinitely.
If this were the whole story the circuit would resonate, generating a continuous
alternating flow of current through the inductor. A graph of current versus time would
be an undamped sine wave as shown in figure 2.8(a). A graph of voltage across the
capacitor against time would also resemble figure 2.8(a).
In practice, capacitors and inductors are not
ideal. The inductor will have some DC
resistance and the capacitor will allow some
leakage of current so that energy is lost
during each oscillation. The oscillations will
be damped and must eventually come to an
end. The net result will be a damped
oscillation as shown in figure 2.8(b).
The natural frequency of oscillation is the
same frequency indicated by the peak in the
graph shown in figure 2.6: the resonant
frequency. This is also the frequency at
which the impedances of the capacitor and
inductor are equal (where the graphs
intersect in figure 2.5).
[A graph similar to that in figure 2.6 could be arrived at simply by adding impedances
graphically, say by using figure 2.5. The method gives a correct qualitative result. It
does not give a correct quantitative prediction as no consideration is given to the
phase relationship between the current in each component. The 'resonant frequency'
obtained is correct but the height of the impedance peak is not. A rigorous
mathematical treatment shows that, for ideal components, the impedance is infinite at
the resonant frequency. For real components the impedance will be finite because of
the resistance of the inductor and leakage of the capacitor].
Figure 2.8
(a) undamped and
(b) damped sinewaves
33
Figure 2.9
A series resonant circuit and how its
impedance varies with AC frequency
In order for transformer action to operate most efficiently the signal produced by circuit
1 should have the same frequency as the resonant circuit. This means either that the
frequency of circuit 1 can be adjusted to match that of the resonant circuit or that the
frequency of the resonant circuit can be adjusted to match that of circuit 1. The latter
would require the inductor or capacitor in the resonant circuit to be variable so that the
resonant frequency could be adjusted to suit.
34
Figure 2.10
Coupling with a resonant circuit.
SUSTAINED OSCILLATION
By appropriate choice of the capacitor and inductor a resonant circuit can be
made to generate any frequency of sine wave. A resonant circuit alone is not
sufficient, however, to generate a sustained oscillation. To produce a continuous,
steady supply of alternating current (as in figure 2.8a) we must arrange for the
resonant circuit to be continuously supplied with energy to overcome the losses
in the components and keep it oscillating.
By use of an amplifying circuit, we can provide the energy to overcome the circuit
losses and prevent the oscillations from dying. An amplifier provides positive
feedback. Amplifiers and positive feedback are considered in chapter 5.
35
PIEZOELECTRIC CRYSTALS
So far our discussion of oscillators has been restricted to resonant circuits in the form of
inductor and capacitor combinations. Unfortunately, such combinations tend to drift in
frequency over a period of time and with changes in ambient temperature. The effect is
only slight and not very important at low frequencies unless high accuracy is required. The
effect is much more significant at radio frequencies (greater than 500 kHz) where it is very
important to have good frequency stability - imagine switching on your radio and never
knowing quite where to find your favourite radio station!
The effect is really quite serious in TV and radio transmission and communications. The
frequencies allocated to users are quite closely spaced and any drift in transmission
frequency could result in overlap with adjacent transmitters. Similarly the shortwave
diathermy equipment used in physiotherapy operates at radio frequencies and radiates a
certain amount of energy as radio waves - for this reason only certain frequencies are
permitted for their operation and little deviation or drift is permitted.
Good frequency stability can be achieved by use of a piezoelectric crystal. These crystals
have the special property that when squeezed or stretched, a potential difference is
produced between each surface. This piezo-electric effect is illustrated in figure 2.11.
The other side of the coin with piezoelectric crystals is that if a potential difference is
applied to their opposite sides, they change in thickness. Thus in the example shown in
figure 2.11, if a potential difference is applied to an unstressed crystal and the voltage is
positive on top, the crystal will shrink in thickness. If the potential difference is applied
negative on top in this example, the crystal will expand.
An interesting thing happens if a potential difference is suddenly and briefly applied. The
piezoelectric crystal reacts like a bell which is struck by a hammer and starts ringing. The
thickness of the crystal changes when the voltage is applied but the molecules have a
momentum which causes them to overshoot their equilibrium positions. They are pulled
back and overshoot in the opposite direction. The cycle continues and the result is that the
crystal vibrates continuously. Figure 2.12 illustrates the process and what would be
observed in practice.
Figure 2.11
A piezo-electric crystal
compressed and stretched
36
1/2 R.C
.... (2.2)
Figure 2.12
(a) The change in thickness of a
piezoelectric crystal in response
to (b) a briefly applied voltage
37
When a capacitor is charged through a resistor, equation 2.2 also applies to the
charging behaviour. Hence in a circuit such as that shown in figure 2.13, when the
switch is closed the voltage across the capacitor will increase as shown.
The voltage across the capacitor increases and approaches the battery voltage
asymptotically. For the graph shown the battery voltage is 12 V. From the graph, 1/2
is approximately 6 seconds.
The reason that the graph has this shape is that the current flowing to charge the
capacitor decreases as the capacitor charges. Initially, the capacitor is uncharged so
when the switch is closed, the potential applied to the left side of the resistor is 12 V
and the potential on the right side is zero. The potential difference across the resistor
is maximum (in this circuit, 12 V) so the current flow is maximum. When the capacitor
has charged to, say, 3 V, the potential difference across R is 9 volts, so the current
38
flow (calculated using Ohm's law or measured directly) is less. When the capacitor is
charged to 9 V, the potential difference across R is only 3 V and the current is onequarter of its original value. The closer the capacitor comes to fully charged, the
smaller is the potential difference across R and the smaller is the charging current.
Consequently, the rate of charging, determined by the current flow through the
resistor, becomes smaller and smaller as the capacitor approaches fully charged
and the capacitor voltage approaches the battery voltage but never quite gets there.
Next consider what happens
if a pulsed voltage is applied
to the resistor-capacitor
combination shown in figure
2.14.
At the start of the pulse, the
current flow through the
resistor is high and the
capacitor charges rapidly.
As the capacitor charges,
the rate of charge decreases
and the potential difference
across the capacitor (VC ) approaches a
plateau (figure 2.14a). A graph of
current flow through the resistor or
potential difference across the resistor
versus time mirrors the graph of V C
(figure 2.14b). The initial charging
current is high but reduces rapidly as
the capacitor charges.
Figure 2.14
A pulsed voltage applied to a
resistor-capacitor combination.
(a) potential difference across the
capacitor and (b) current through
the resistor versus time.
Note that the current flow through the resistor is AC. Current flows through the
resistor as the capacitor charges and an equal amount flows in the reverse (negative)
direction as the capacitor discharges.
39
The pulse duration in this example is significantly greater than the halfdischarge/half-charge time, 1/2 so the pulse is able to (almost) completely
charge the capacitor
before coming to an
end and allowing the
capacitor to discharge.
If the RC time constant
(and hence 1/2) of the
resistor-capacitor combination was comparable to the pulse
width, the capacitor
would not fully charge
(figure 2.15b) and the
current flow through
the resistor would be
more sustained.
[The dashed lines in
figure 2.15 indicate the
voltage across the
capacitor when it is
fully charged (in this
case, it is the pulse
voltage).]
If the RC time constant
was greater than the
pulse width, the capacitor would charge minimally (figure 2.15c) and the
current flow through the resistor would be well sustained.
The importance of the RC time constant will be apparent when we consider
transcutaneous electrical nerve stimulation in subsequent chapters.
Figure 2.15
Response of the circuit shown in figure
2.14 when the pulse duration is (a)
much greater than R.C, (b) comparable
to R.C and (c) less than R.C.
A final point which should be noted is that in each example in figure 2.15, the current
through R is AC. The capacitor charges by a certain amount then discharges, so the
net movement of charge is zero. Whatever charge flows through R during the pulse
must flow back afterwards.
EXERCISES
1
Plot a graph of voltage against time for comparison with figure 2.3.
How long does it take for the 50 F capacitor to discharge to half the
original voltage?
What would the unknown resistance need to be to give the results shown
above?
40
41
a 10 F capacitor
a 0.047 F capacitor
a 10 H inductor
a 2 mH inductor
at a frequency of 1 kHz?
How would the impedance change if the frequency was doubled?
4
100 Hz
1 MHz.
a 10 mH inductor
a 50 mH inductor.
Use the values in table 2.2 to plot a graph of impedance versus frequency for a 1
F capacitor. On the same graph draw curves relating impedance and
frequency for:
(a)
(b)
a 0.5 F capacitor
a 2 F capacitor.
Figures 2.6 and 2.9 show the variation of impedance with frequency for series
and parallel resonant circuits. Explain the shape of each graph in terms of the
variation of impedance with frequency of the individual inductors and capacitors.
10
11
12
Two circuits are coupled together as shown in figure 2.10. The values of the
components are C = 100 pF and L = 1 mH.
(a)
42
13
(b)
(c)
If C was increased to 500 pF, what would be the new frequency for
maximum power transfer?
14
(a)
why does the graph of current flow through the resistor droop so rapidly?
(b)
(c)
if the capacitance was increased, how would this affect the shape of the
graph of current through R? Why?
(d)
under what circumstances will the graph of current flow through the
resistor resemble that of the applied voltage?
43
(a)
(b)
what can you conclude about the RC time constant for this circuit?
if the RC time constant was reduced (by decreasing C or R) how would
this affect the shape of the graph of potential difference or current flow
through the resistor? Give an explanation of your reasoning.
44
45
46
Figure 3.1
Some important features of skin.
47
Figure 3.2
An electrical model for
transcutaneous stimulation.
48
49
Question 1:
How much steady direct current would flow in a
typical 'real life' situation if the applied DC
voltage is 50 V and electrodes with an area of 10
cm 2 are used?
Information:
Skin capacitance is proportional to the electrode
area. A typical value for the capacitance per unit
area is 0.05 F.cm-2, so for a 10 cm2 electrode
area, the capacitance, C, is 0.5 F. Skin
resistance is inversely proportional to the
electrode area. The larger the area, the greater
the number of conductive channels through the
stratum corneum and the lower the total
resistance. The parallel resistance x unit area
might typically be 10 k.cm 2 , so for a 10 cm2
electrode area, the parallel resistance, Rp , is
about 10 k.cm2/10 cm2 = 1 k. The resistance
of the tissue volume beneath the stratum
corneum is typically about 200 .
Answer:
Under steady-state conditions, the capacitors
are charged so no current flows to the capacitors
and the value of C is irrelevant. The combination
of electrodes and tissue behaves as three
resistors in series. The total resistance is (1 k
+ 200 + 1 k) = 2200 . The applied potential
difference is 50 V so the resulting current flow is,
from Ohm's Law, I = V/R = 50/2200 = 0.0227 A =
22.7 mA.
Figure 3.3
Response of the electrical model
to direct current (a) initially and (b)
after the capacitors have charged.
Question 2:
How big is the initial current flow for the 'real life' situation described in question 1?
Information:
Initially, the capacitors act as a 'short circuit'. They are uncharged and offer no
resistance to current flow. As each capacitor charges, the potential difference across
the capacitor increases and this opposes further flow of current. When fully charged,
an ideal capacitor has infinite resistance. Uncharged, the 'resistance' is zero.
Answer:
The initial flow of current is resisted only by Rs. The capacitors offer zero resistance
when they are uncharged so the current flow is I = V/R = 50/200 = 0.25 A = 250 mA.
This is more than ten times larger than the steady-state current (question 1).
Question 3:
What is the steady-state potential difference across Rp and Rs for an applied potential
difference of 50 V?
Answer:
Since the three resistors are in series, the same current (22.7 mA) flows through
each. The potential difference across each resistor can be calculated using Ohm's
Law. The resistance Rs is 200 so the potential difference across it is V = I.R s =
0.0227 x200 = 4.5 Volts. For each parallel resistance, Rp, V = I.Rp = 0.0227x1000 =
22.7 Volts.
50
51
through the skin, the tissue impedance is high (Rs + 2Rp) and the potential difference
across Rs is small.
Nerve fibres are located in the tissues underlying the stratum corneum (represented
by Rs) so the potential difference across them is small and their stimulation intensity
is low. Most of the applied voltage drop occurs across the stratum corneum (Rp ).
This is one reason why steady direct current is not used for transcutaneous nerve
stimulation. A second, more important, reason is that nerves are relatively insensitive
to steady DC because they accommodate. The firing threshold progressively
increases with a constantly applied DC stimulus, so the nerve will cease firing once
the threshold has risen above the applied DC stimulus. Accommodation is described
in more detail in chapter 4.
IONTOPHORESIS
It is for the reasons outlined above that steady direct current is not used for
transcutaneous nerve stimulation. Steady DC does, however, have an important
clinical role in iontophoresis, where drugs or other chemical agents are driven
through the skin to the underlying tissue. Iontophoresis only works if the chemical to
be driven is charged. It uses steady DC so that the chemical ions are driven
continually in one direction while no nerve stimulation (in particular, no stimulation of
pain or motor fibres) occurs.
An example is acetate ion iontophoresis for decalcification of connective tissue. A
soluble acetate, such as sodium acetate is dissolved in conductive gel. This is
applied to the skin under the positive electrode (anode). Steady DC is applied at a
current level of about 10 mA over a treatment period of 10 to 20 minutes. The
negatively charged acetate ions are driven through the skin into deeper tissue. The
calcium in calcified tissue is in the form of calcium phosphate crystals, which react
with the acetate ions to form the soluble substance, calcium acetate. In this way the
calcium phosphate crystals are removed.
If the ion to be driven through the skin was positively charged, it would be applied
under the negative electrode (the cathode).
52
Figure 3.4
Response of the electrical model to pulsed
direct current (a) when the pulse duration
is long compared to R s.C and (b) when the
pulse duration is short compared to R s.C.
53
Figure 3.4 shows examples close to the range of extremes for stimulation with
rectangular pulsed current. Note that the horizontal (time) axis scale is different in
each example. In figure 3.4(a) the time scale is relatively long compared to Rs.C and
sharp spikes are seen in the graphs of current through Rs versus time. In figure
3.4(b) the time scale is relatively short compared to Rs.C and the current through Rs
shows only a small decrease during the stimulus pulse. During the spikes in 3.4(a),
appreciable current flows through Rs, meaning that electrical energy is dissipated in
the tissue volume beneath the stratum corneum. Between spikes, little current flows
through the deeper tissue (Rs), and most of the electrical energy is dissipated in the
stratum corneum. The short duration pulse in 3.4(b) results in appreciable and
sustained current flows through Rs, so most of the electrical energy is available for
nerve stimulation.
The above is one of the reasons why modern stimulators use short duration pulses
for transcutaneous nerve stimulation. A second, perhaps more important reason is
that better discrimination between sensory, motor and pain fibre stimulation is
achieved with narrower stimulus pulses. This will be considered further in chapter 4.
Zc =
1
2fC
54
.... (2.5)
(c)
1
1
10 6
=
=
= 6400
2fC
2 x 3.142 x 50 x 0.5 x 10-6
50 x 3.142
1
1
10 6
=
=
= 640
-6
2fC
2 x 3.142 x 500 x 0.5 x 10
500 x 3.142
1
1
10 3
=
=
= 64
-6
2fC
2 x 3.142 x 5000 x 0.5 x 10
5 x 3.142
If the stratum corneum was purely capacitative, its impedance would vary as
calculated above. In fact the skin appendages provide a parallel resistive path for
current flow (Rp in figure 3.2) so the total impedance of the stratum corneum is lower,
In most descriptions of
interferential or Russian
currents, the choice of a
kilohertz frequency is justified
as being due to the low skin
impedance at kHz
frequencies. The low skin
impedance is due to the low
impedance of both the
stratum corneum and the
underlying skin layers.
55
significantly so at low frequencies. The parallel resistance x unit area of the stratum
corneum is typically about 10 k.cm 2 , so for a 10 cm2 electrode area, the parallel
resistance, Rp, is about 10 k.cm2/10 cm2 = 1 k.
At a frequency of 5 kHz, the capacitative impedance of the skin is about 64 and
placing a 1 k resistance in parallel makes virtually no difference to the total
impedance. At a frequency of 500 Hz, the capacitative impedance of the skin is about
640 and placing a 1 k resistance in parallel reduces the total impedance to
appreciably less than 640 . At a frequency of 50 Hz, the capacitative impedance of
the skin is about 6400 and placing a 1 k resistance in parallel reduces the total
impedance to less than 1 k.
Despite the effect of skin appendages offering a conductive pathway (Rp ) at low
frequencies, the total impedance of the stratum corneum (C and Rp in parallel) still
shows a dramatic decrease with increasing frequency. Thus, for a given stimulus
voltage, greater current flows at higher frequencies. This means that the current
through Rs, representing the underlying tissues, is higher at higher frequencies and
the potential difference across Rs is correspondingly higher.
Question 4:
What is the impedance of the stratum corneum at frequencies of (a) 50 Hz, (b) 500 Hz
and (c) 5 kHz?
Use the model in figure 3.2 and values of C and Rp used previously assuming an
electrode area of 10 cm2.
Use the formula for two resistances in parallel to add the two impedances.
Information:
As indicated previously, a typical value for the skin capacitance for an electrode area
of 10 cm2 is about 0.5 F. The capacitative impedance is thus 6400 , 640 and 64
at frequencies of 50 Hz, 500 Hz and 5 kHz respectively. The parallel resistance, Rp,
is about 1 k.
56
Answer:
The impedance of the stratum corneum at each frequency is the total impedance of C
and Rp in parallel. Two resistances in parallel can be added using the formula
1
1
1
=
+
RT
R1
R2
Adding the impedances of C and Rp in this way we use
1
1
1
=
+
Z
Rp
Zc
where Zc is the impedance of C at the frequency concerned.
(a)
(b)
6400 x 1000
= 985
6500
(c)
so Z =
640 x 1000
= 390
1640
so Z =
64 x 1000
= 60
1064
The impedance of the stratum corneum (C and Rp in parallel) thus shows a dramatic
decrease with increasing frequency: from about 1 k at 50 Hz to about 60 at 5 kHz.
57
Notice that at 5 kHz, the potential difference across Rs is 31.2 volts, which is more
than 60% of the applied (50 V) stimulus. At 500 Hz, the potential difference across Rs
is about 20% of the applied stimulus and at 50 Hz, about 9%. If the objective is to
stimulate nerve fibres which are located beneath the stratum corneum, the higher the
alternating current frequency, the less the energy wasted in the stratum corneum and
the greater the current through, and voltage across, the deeper tissues.
If skin impedance was the only factor, then the higher the alternating
current frequency, the lower the skin impedance and the more efficiently
nerves could be stimulated. Following this logic, if 5 kHz stimulation is
more efficient than 500 Hz, then 50 kHz should be even more so. In fact
this is not the case. The reason is that the impedance of the nerve fibre
also varies with frequency.
58
59
Figure 3.5
An electrical model for a
nerve fibre
To excite a nerve fibre, that is, to cause the nerve to fire and produce an action
potential, the membrane potential must be changed from its resting value to the
excitation threshold. For nerve excitation it is not the potential difference across the
fibre which determines this but the potential difference across the fibre membrane (C
and Rp in figure 3.5).
Since the membrane acts as a capacitor, if alternating current is used for nerve
stimulation, the potential difference across the fibre membrane will be less at higher
alternating current frequencies. The decrease in membrane impedance with
increasing frequency means that a greater potential difference will be produced
across Rs and a correspondingly lower potential difference will be produced across
C and Rp. At high frequencies, nerve fibres are less excitable because the potential
difference produced across the fibre membrane is reduced. In practical terms this
means that electrical stimulation with alternating current does not become more and
more efficient at higher alternating current frequencies. the decrease in impedance
of the stratum corneum, which results in a higher potential difference across the
60
Figure 3.6
Change in potential difference across the
nerve fibre membrane (voltage across C and
Rp in the electrical model shown in figure
3.5) when the pulse duration is (a) much
longer than R s.C and (b) shorter than R s.C.
61
higher stimulus intensity can compensate for the short pulse duration, but if the
intensity required is too large, there is the risk of skin damage. Specifically, at
stimulus intensities of several hundred volts, there is the risk of skin electrical
breakdown where tiny regions of skin under the electrodes suddenly become highly
conductive, allowing an extremely high current to flow and causing tissue damage.
The net effect is that for transcutaneous stimulation using rectangular pulses, there is
a 'window' of pulse widths between tens of microseconds and about 1 ms, outside
which stimuli are either ineffective or inefficient and potentially dangerous.
EXERCISES
1
Explain, in terms of the structure of skin, why the electrical model shown in
figure 3.2 is an appropriate model for a description of transcutaneous electrical
nerve stimulation.
(a)
(b)
(c)
Figure 3.4, page 52, shows graphs of the current flow through tissue in
response to stimulus pulses of different duration.
What is iontophoresis?
Why must the active agent be charged (i.e. in the form of an ion)?
What is the advantage of iontophoresis for application of medication?
(a)
(b)
Why is the current flow sustained when short duration pulses, as in figure
3.4(b), are applied transcutaneously?
(a)
(b)
(c)
What is the potential difference across the deep tissue, modelled as Rs, at
each of the frequencies?
If the electrode area in question 5 above was 50 cm2, what would be:
(a)
(b)
62
(a)
(b)
9
10
The skin acts as a capacitative barrier to the flow of current, meaning that the
higher the AC frequency, the lower the skin impedance. For this reason kHz
frequency sinusoidal AC is used for transcutaneous electrical nerve stimulation.
(a)
why are higher frequencies (tens or hundreds of kHz) not used clinically to
reduce skin impedance further?
(b)
Pulsed current with widths between about 50 s and 1 ms are normally used for
transcutaneous electrical nerve stimulation. Why are pulses of duration
(a) less than 50 s and
(b) greater than about 1 ms
not normally used?
63
64
If a current of sufficient intensity is passed through tissue containing a nerve fibre the
potential difference set-up across the fibre may be sufficient to cause depolarization
of the fibre membrane and the nerve is stimulated. The depolarization of the
membrane, once induced, is transmitted along the length of the nerve fibre and is
indistinguishable from a normal nerve impulse (sometimes referred to as an action
potential). The important idea is that the potential difference across the membrane
must be changed by a critical amount to produce the transient, but large, membrane
depolarization which is known as an action potential.
65
Refractory Periods
After a nerve has been stimulated there is a short
period of time, typically around 10 milliseconds for
sensory and motor neurones, during which the
sensitivity of the nerve to stimuli is decreased.
During this time the nerve membrane is said to be
refractory to a second stimulus. The threshold
potential is increased above the normal value as
shown in figure 4.2.
Figure 4.1
Response of a nerve fibre to
stimuli of increasing intensity.
66
Figure 4.2
Refractory periods for a
nerve fibre.
Accommodation
Three characteristics of an electrical impulse influence its ability to stimulate nerve
fibres:
*
the size or amplitude of the pulse,
*
the width or duration of the pulse, and
*
the rate of change (or rise) of the pulse.
Figure 4.3
The effect of stimulus rise-time on
action potential production. (a) short
stimulus rise-time, (b) lower rate of
rise of the stimulus and (c) very low
rise time.
The rate of change (or rise) of the pulse is important because, in
general, a stimulus pulse which rises slowly to its maximum
value is less effective than a sudden sharp pulse, other things
being equal. If a slow rising pulse is used then the minimum
amplitude needed to elicit an action potential will be greater. This
happens because the nerve fibre is able to accommodate to a
67
68
slow change in potential. Indeed, if the pulse rises at a sufficiently low rate, no nerve
impulse will be generated. The effect of accommodation is illustrated in figure 4.3. In
figure 4.3(a) the pulse rise-time is short and threshold is reached before any
appreciable change in threshold potential occurs. In 4.3(b) the pulse increases at a
faster rate than the threshold potential so threshold is reached after several
milliseconds. In 4.3(c) the pulse rises at the same rate as the threshold potential and
so does not 'catch up' and cannot generate an action potential: the nerve fibre has
'accommodated' to the rising stimulus intensity by becoming insensitive to electrical
stimulation.
The refractory period and accommodation both stem from the same basic molecular
process by which the nerve impulse, once generated, is terminated and the
membrane potential returns to the resting value. An explanation involves voltagesensitive 'gates' which control opening and closing of conduction channels in the
nerve fibre membrane.
Transcutaneous electrical
stimulation then, particularly
with short duration pulses
(durations less than the time
constant for muscle fibres),
preferentially recruits nerve
fibres.
Where to Stimulate?
When the aim of transcutaneous stimulation is to produce a motor response, the
electrodes are normally placed either over the nerve trunk or directly over the muscle
to be stimulated. Stimulation of the nerve trunk is described as 'indirect' and will
69
70
Figure 4.4
Current flow between anode and
cathode produces depolarization under
the cathode and hyperpolarization
under the anode.
71
72
Figure 4.5
Muscular force produced in
response to short duration
rectangular pulsed current
with frequencies in the range
2 Hz to 50 Hz.
the short rise-time of a rectangular pulse overcomes the problem of accommodation of the nerve fibre membrane.
73
Figure 4.6
A strength-duration curve for
normally innervated muscle
74
75
76
be refractory. Well above threshold, when fibres are stimulated at multiples of their
threshold intensities, firing will occur within the refractory period and the firing rate will
equal the stimulus frequency. It has been demonstrated experimentally that nerve
fibre firing rates up to the limit determined by the absolute refractory period can be
produced by stimulus intensities of only a few times threshold. Thus if the absolute
refractory period is 1 ms, the maximum firing rate would be every millisecond so the
frequency would be 1 kHz. The experimentally determined maximum firing rate of motoneurons is 800 Hz, a value in close agreement with measured absolute
refractory periods.
Nerve fibre firing rates with electrical stimulation can thus be much higher than those
produced physiologically.
In a sustained, weak voluntary contraction, firing rates of 8 - 12 Hz are typical. Lower
firing rates are found with repetitive weak contractions. For a steady, sustained
forceful contraction, an upper limit to the firing rate seems to be about 30 Hz in human
skeletal muscle. These are firing frequencies which result in a partially fused
contraction.
How, then, are smooth, controlled voluntary movements possible when low forces are
involved and the firing rates are very low? Why is it that no twitching or fluttering is
seen when the firing rates are below the fusion frequency? The answer is that the
activity of different motor units is asynchronous. Although individual motor units may
be firing at low frequency and producing a fluttering, partly fused contraction in
individual muscle fibres, there is no synchronization between different motor units. At
the level of the whole muscle, the total force is the sum of the contributions of all active
motor units so the ripples in force output from each motor unit are smoothed i.e. lost
in the total. By contrast, when muscles are activated electrically, all of the activated
fibres are synchronously activated so smooth contractions are only possible when the
induced firing frequencies are greater than, or equal to, the fusion frequency.
The very large range of force output of which human muscles are capable is only partly
due to variation in nerve firing rates. A second factor which is at least as important is
recruitment. In a weak contraction only a few motor units may be active. In a stronger
Fatigue considerations
An observation made very early in the history of electrically induced muscle contraction
is that the rate of fatigue is much greater with electrically induced contractions than
with voluntary contractions of the same magnitude. Two factors contribute to the
difference: the firing rates of the motor units and the number and nature of the motor
units which are recruited.
As discussed previously, in order to produce a smooth, non-twitching motor
response, the frequency of electrical stimuli must be higher than the fusion frequency
of the excited muscle fibres. 50 Hz is a 'ball-park' figure for most skeletal muscles. A
voluntary contraction of the same magnitude would involve lower firing frequencies
and, to compensate, greater recruitment of motor units. The difference is that
physiologically, the load is spread over more motor units which, individually, do not
have to work as hard. The result is a lower rate of fatigue.
The second difference involves different muscle fibre types. Muscle fibres are typed,
as described previously, as fast- or slow-twitch. They are further categorized
according to fatigue resistance where slow, fast-resistant and fast-fatigable fibres are
77
78
With electrical stimulation, the pattern of recruitment is very different to that which
occurs physiologically. Two factors determine the order of recruitment: proximity to the
stimulating electrode and nerve fibre diameter.
Fibres closer to the stimulating electrode will experience a higher stimulation intensity
than those further away. This is because current spreads within the tissue, resulting
in a decrease in intensity. Close to the electrodes, spreading is minimal and the
current density is highest. With increasing distance, the current density decreases.
79
I
A
...... (4.1)
Figure 4.7
The spreading of current
within a volume conductor
80
This
81
Figure 4.8
A strength-duration curve for
completely denervated muscle
82
-motoneurons are
intrinsically more sensitive to
electrical stimulation than the
smaller diameter A- and C
fibres.
83
84
Figure 4.9
The effect of electrode size on
current density in tissue. (a) small
electrodes, greater spreading of
current, (b) larger electrodes, more
uniform current density
85
the threshold for nerve excitation. This is because of current spreading and a
consequent reduction in the local stimulus intensity. Superficially located fibres are
therefore recruited at lower stimulus intensities. Figure 4.10(b) shows measurements
obtained with human subjects and transcutaneous electrical stimulation.
Note the horizontal axis (time) scale. In this figure the pulse widths are
measured in microseconds (s) and not milliseconds as have been
previously used to describe action potentials and the subsequent
refractory period. Here we are dealing with pulse widths which are
small compared to the time-course of an action potential.
Figure 4.10
Strength-duration curves for (a) different
nerve fibre types, with the nerve trunk
exposed and stimulated directly and (b)
sensory, motor and pain thresholds
measured using transcutaneous stimulation.
86
Two things are apparent from figure 4.10(b). First, that in reality the order of
recruitment is usually sensory, then motor, then pain at all pulse durations when
current is applied transcutaneously. Second, that as we go to shorter pulse durations
the separation between the curves increases.
The separation due to fibre diameter is most marked in figure 4.10(a) and indicates
that with direct nerve stimulation, by using sufficiently short pulse durations (around
500 s), the small diameter C fibres will not be stimulated at intensities which very
effectively recruit the larger A-, A- and A- fibres. A shorter pulse durations (around
50 s), neither C nor A- fibres will be stimulated at intensities which efficiently recruit
A- and A- fibres. This indicates that as one goes to smaller pulse widths, the ease
of discrimination between sensory and motor responses on the one hand, and pain
responses on the other, is increased.
The extent of discrimination evident with transcutaneous stimulation is less. As figure
4.10(b) shows, the sensory, motor and pain threshold graphs are more overlapped
and the variation occurs at smaller pulse widths. This is because the measured
response depends not just on the fibre type (and the associated diameter) but also
two other factors: the depth of the fibres within tissue and the electrical characteristics
of the skin and underlying tissues. The capacitative nature of the stratum corneum
means that longer duration pulses are not more effective for nerve stimulation
(whatever the fibre type) as the current flow in tissue beneath the stratum corneum is
transient (figure 3.4). Spikes in the current flow are produced at the start and end of
long duration pulses and increasing the pulse width does not result in a longer
duration flow of current in tissue. Thus C fibres are not as more readily recruited at
longer pulse durations as would be expected from figure 4.10(a). Nor are A- fibres,
though the effect is less. The result is a plateau in the transcutaneous sensory, motor
and pain threshold graphs at a pulse width much less than in figure 4.10(a).
The observations regarding the effect of pulse width have important practical
implication for therapy, and the results shown in figure 4.10(b) are most relevant. If
long duration pulse widths are used then only small changes in intensity will be
needed to change from a sensory response to a motor or pain response. By contrast,
87
if short duration pulses are used, much larger changes in intensity will be needed to
recruit motor and pain fibres. If the objective is to produce a sensory response with
minimal motor or pain responses then short duration pulses are preferred (less than
50 s from figure 4.10a or perhaps 'the shorter, the better' from figure 4.10b). Short
duration pulses will also be capable of producing an effective motor response with
minimum pain sensation. It is for this reason that modern electronic stimulators
produce higher voltage, shorter duration pulses than their predecessors.
A question arising from the foregoing discussion is whether very short pulses, around
2 to 10 s duration, will give better discrimination with transcutaneous stimulation
than, say, 20 s pulses. The evidence certainly indicates that pulses of duration in the
range 20 to 50 s will more effectively discriminate than pulses with duration greater
than 100 s. It is not known whether this trend continues to very short pulse
durations. Further research is needed before any firm conclusions can be drawn.
88
The Nemectrodyne
interferential stimulator was
the first on the market and
the company continues to
sucessfully market
interferential units.
More than two decades after the introduction of interferential currents, 'Russian
currents' became popular, principally due to the claims made by a Russian physician,
Yakov Kots, in the late 1970s. Kots claimed that kHz frequency AC, modulated at 50
Hz with a 1:1 duty cycle, could produce large strength gains in stimulated muscle. He
based his claims on studies made with young Russian athletes as subjects: athletes
who were hoping to qualify for the Olympic games. Russia's success in the Olympics
and the intense competitiveness which existed at the time seems to have given
weight to Kots' claims. Kots argued that an optimal AC frequency for muscle
strengthening, one which produced maximal force at the pain-tolerance threshold,
was 2.5 kHz if the muscle was stimulated directly (with the active electrode over the
muscle) or 1 kHz if the muscle was stimulated indirectly (with the active electrode over
the nerve trunk supplying the muscle).
Both Russian currents and Interferential currents continue to be used in clinical
practice. Interferential currents are popular in England, Europe and Australia.
Russian currents are, somewhat paradoxically in the light of political relations post
world war two, more popular in the USA.
Stimulation with low frequency AC is seldom used nowadays. It is particularly painful.
Nonetheless, it did experience some popularity in Europe in earlier decades. A
particular form of low-frequency AC stimulation, called 'Diadynamic current' was
popularized in Europe. The argument seems to have been that the discomfort
associated with the stimulation had therapeutic benefits resulting from a counterirritant effect.
89
90
As noted previously, nerve-fibre firing rates are well below 100 Hz during most
voluntary activities, including strenuous exercise and generally less than a few tens of
Hz on a sustained basis. With electrical stimulation at higher frequencies and
sufficiently high intensity, firing rates approaching 1 kHz can be produced. The
absolute refractory period places the limit on the maximum firing rate.
If nerve is stimulated with AC at frequencies above 1 kHz, action potentials are
produced with every second, third or fourth succeeding AC pulse. The fibre firing rate
will thus be a sub-multiple of the AC frequency. If, for example, 4 kHz AC is used, the
induced firing rate might be 100 Hz at intensities just above threshold. In this case the
firing rate is determined by the relative refractory period. At higher intensities, higher
firing rates are induced as action potentials are produced during the relative refractory
period. At the highest intensities the firing rate might approach 1 kHz i.e. fibres firing
immediately after the absolute refractory period.
91
With AC stimulus frequencies above 10 kHz or so, the physiological response of nerve
fibres become less and less while the power dissipated, and heating rate, become
larger and larger. The decreased nerve fibre response is because the membrane
capacitor has less and less time to charge during a pulse, so less depolarization is
produced. The higher tissue heating rate is because skin impedance decreases with
increasing frequency (chapter 3 previously) so the current flow is higher for a given
stimulus voltage and the power dissipation is correspondingly higher.
INTERFERENTIAL CURRENTS
Hans Nemec popularized interferential currents in the
1950s. Although Nemec published a number of
articles describing and reporting on the effect of
interferential currents, these were in German. Only
one English language article exists. It was translated
from German and published in the British Journal of
Physiotherapy in 1959. In it, Nemec described
interferential currents and made claims of therapeutic
benefits. The claims, judged in terms of modern
criteria, were inappropriately speculative i.e. were not
adequately documented.
They are, however,
intriguing and not without some credence. Here we
focus on the less speculative aspects.
An interferential stimulator has two separate,
electrically isolated circuits for applying current to the
patient. The currents are applied using two diagonally
opposed pairs of electrodes as shown in figure 4.11.
The idea is that the two currents 'interfere' within the
tissue volume, reinforcing each other and producing a
greater effect at depth than would be possible using a
single circuit. In the region of intersection (the crosshatched area in figure 4.11), the resultant intensity is
Figure 4.11
Application of interferential currents
92
Figure 4.12
Depth efficiency of (a) bipolar
and (b) quadripolar stimulation.
93
applied to the patient the two currents interfere and produce a 'beating' effect in the
patient's tissue. The interference or 'beat frequency' effect is illustrated in figure 4.13.
Figures 4.13(a) and (b) show two sinusoidal waveforms applied to the patient via
diagonally opposing pairs of electrodes as shown in figure 4.11. The total current at a
particular point in the patient's tissue is the sum of the currents from each pair of
electrodes. At points where the two currents are of equal amplitude the sum of the two
signals will be an AC waveform which is amplitude modulated as shown in 4.13(c).
The surge or modulation frequency is equal to the difference in frequency of the two
currents. The frequency, f, of waveform (a) might be 4000 Hz and the frequency (f-)
of waveform (b) might be 4000-10 = 3990 Hz. In this case the value of , the
modulation frequency is 10 Hz.
Figure 4.13
Interference of two sinusoidal
currents of different frequency.
94
Figure 4.14
Interference of two sinusoidal
currents of different frequency
and different amplitude.
Consider first the situation where two current pathways are at right angles and the
currents are equal. Nerve fibres aligned parallel to one of the current pathways will
experience an unmodulated AC stimulus as shown in figure 4.13(a) or (b). Fibres
aligned along lines midway between the current paths will experience a modulated
stimulus (figure 4.13(c)) of higher intensity. Those fibres aligned in other directions
will experience a partially modulated stimulus, similar to figure 4.14, with a depth of
modulation which depends on the fibre orientation.
Figure 4.15 shows the net current flow in different directions for the simple
configuration in figure 4.11. The length of the black arrows is proportional to the
95
fibres aligned parallel to the direction of the individual current flows will
experience a lower, but still relatively high, stimulation intensity. The stimulating
current will not be modulated.
nerve fibre firing rates will be much higher than with stimulation using single
pulses applied at low frequency. Fibres aligned parallel to the direction of the
individual current flows will fire at a rate determined by how far above threshold
is the local stimulation intensity.
Fibres aligned in directions which bisect the angle between the current
pathways will fire in bursts. The bursts of activity will be at the beat frequency
and the number of action potentials per burst will depend on how far above
threshold is the local stimulation intensity.
Figure 4.15
The variation in current intensity
and amount of modulation
with direction when using
interferential currents.
96
A widespread misconception is that with interferential currents, the nerve fibre firing
frequency is equal to the beat frequency. This would only be the case for fibres
stimulated at, or just above, their threshold. As noted previously, for stimulation
intensities above threshold, nerve fibres will fire at much higher rates. When the
stimulus intensity is modulated at low frequency, nerve fibres will fire in bursts, with
each 'beat' of the current intensity. The beat frequency only determines the burst
frequency of the action potentials. The number of action potentials per burst
depends on how far the stimulus intensity is above threshold.
Thus if a beat frequency of 50 Hz is chosen to produce repetitive, forceful muscle
contractions, the rate of fatigue will be higher than if 50 Hz single-pulses were used
as the average firing rate will be much higher.
Another widespread misconception about interferential currents is that the pattern of
stimulation is in the shape of a clover-leaf (a four-leafed clover) rather than the
rounded-diamond shape shown in figures 4.11, 4.12 and 4.15. The misconception
seems to have originated from the idea that nerve fibres are insensitive to an
unmodulated AC stimulus i.e. that modulation at low ('biological') frequencies is
necessary to produce a physiological response. Were this true, then fibres aligned
parallel to the current paths (figure 4.15) would not be excited while those aligned
along lines bisecting the angle between the current paths would be excited
maximally. The pattern of stimulation would have four lobes, each lobe pointing to a
corner of the rounded diamond shape.
In fact, the clover-leaf pattern shows the areas of maximum interference, not
maximum stimulation. The pattern applies to every small diamond shaped
segment in the region of interference. It indicates the direction in which the stimulus
intensity is greatest. It does not, in any way, represent the area of maximum
stimulation. Within each diamond-shaped segment, a clover-leaf pattern can be
drawn, showing the directions of maximum interference: in other words, the
directions in which nerve fibres must be aligned to experience maximum
stimulation. A misleading implication of the pattern is that no stimulation is
produced if the nerve fibres are aligned along either of the current paths.
97
Figure 4.16
Russian currents: 2.5 kHz
sinusoidal AC, burst
modulated at 50 Hz i.e. 10 ms
'on' and 10 ms 'off'.
98
Kots and co-workers measured the maximum force which could be elicited using AC
in the frequency range 100 Hz to 5 kHz. Current was applied either using either two
equal-sized electrodes placed over the muscle belly (referred-to as 'direct' stimulation)
or using a small 'active' electrode over the nerve trunk supplying the muscle and a
larger 'indifferent' electrode placed elsewhere, so as to avoid excitable tissue
(referred-to as 'indirect' stimulation). They established that maximal force at the paintolerance threshold was obtained at 2.5 kHz if the muscle was stimulated directly or 1
kHz if the muscle was stimulated indirectly.
Kots also advocated a '10/50/10' treatment regime i.e. 10 seconds of stimulation
followed by a 50 second rest period, repeated 10 times. His argument was that to
produce strengthening, the electrical stimulation should be non-fatiguing. He
reported that with intense stimulation for periods over 10 sec, fatigue is evident,
whereas no force decline is seen if the duration is 10 sec or less. To avoid a force
decline from one 10 sec stimulation period to the next, a rest period of 50 sec is
needed. If this rest period is allowed, no force decline is seen over the 10 repeats.
The validity of Kots' argument for the '10/50/10' treatment regime is questionable. The
quoted findings were obtained using low frequency monophasic pulsed current, not
kHz frequency AC. With AC bursts, the nerve firing rates would be expected to be
higher and, as a consequence, the rate of fatigue would be higher. The strength
gains reported by Kots are supportive, but whether the '10/50/10' treatment regime is
optimal with AC burst stimulation remains open to question.
EXERCISES
1
(a)
(b)
Compare figures 4.6 and 4.8 and explain why the chronaxie for denervated
muscle is much greater than that of typical nerve fibres.
Does this also account for the rheobase of denervated muscle being lower
than that of nerve? Explain.
Consider the strength-duration curves for sensory, motor and pain responses
shown in figure 4.10(b). What range of pulse duration should be used for
producing:
(a) A maximum sensory response with minimum motor involvement?
(b) A maximum motor response with minimum physical discomfort?
(c) A pain response with a minimum motor response?
What is a motor point and what relevance has it to (a), (b) and (c) above?
99
10
(c)
(c)
(a)
(b)
(a)
(b)
11
100
101
102
103
104
conduction to occur and their energy efficiency is much higher i.e. less
electrical energy is dissipated as heat.
Fleming's diode was an extremely important development but the next step
was even more important. By adding a 'grid' (actually a fine wire grid or mesh)
between the filament and metal plate of a diode a device which could amplify
electrical signals was invented. The development of this device (the triode
valve) is generally credited to an American, Lee de Forest. This was in 1906.
The construction of a triode valve is shown in figure 5.2. The mechanism by
which it amplifies electrical signals will be described shortly.
The triode valve, because of its ability to amplify very weak signals from a
microphone and then apply them to a transmitter, started a revolution in
science and technology. Although transmissions of signals across the Atlantic
Ocean had been made by Marconi in 1901 these transmissions strained to the
limit the detection facilities available. With amplifying valves it became
possible to transmit and receive over much greater distances and even to
amplify the signals so that they could be clearly heard without headphones,
through a loudspeaker!
By 1920 the valve had transformed wireless transmission from an extension of
electrical and telegraph practice into a new and fascinating technology.
In the 1940's when valves were a familiar part of the fields of home
entertainment, communications and science the growing pressures of
developments in science and technology had pointed up the limitations of the
valve - high power consumption, large size and excessive heat generation.
These factors became more and more critical as scientists and engineers
attempted to apply electronics to more sophisticated tasks. The first
computers were constructed using hundreds of valves, fully occupying large
rooms and requiring elaborate ventilation and cooling systems in addition to
enormous quantities of electrical power.
105
106
107
This arrangement, with the anode (the arrow in the circuit symbol) connected to the
positive terminal of the power supply and the cathode (the straight line) to the
negative terminal, is called forward biasing of the diode. When forward biased, the
diode has a very low resistance.
With the diode reversed in the circuit, that is anode and
cathode reversed, the diode is reverse biased. The
voltage across the diode would be measured as 12 volts
and the current about 0.5 microamp or 5 x 10-7 amp - too
small to register on most ammeters. For all intents and
purposes, the reverse current flow is negligible, meaning
that the resistance is close to infinite.
The diode resistance calculated from the measurements
quoted is
R=
12
V
=
= 24 x 106 = 2.4 x 107 or 24 M.
5 x 10-7
I
An ideal diode has zero resistance in the forward direction (when forward biased)
and an infinite resistance in the reverse direction (when reverse biased). Silicon
diodes come reasonably close to his ideal.
108
Figure 5.6
(a) sinusoidal alternating voltage
produced by the AC source in
figure 5.5 and (b) the resulting
current flow through the resistor, R.
The current through the resistor is DC: not like the DC produced by a battery to be
sure, but DC nonetheless because the current flow is only in one direction. A more
accurate description of this half-wave rectified current would be pulsed DC.
By placing a capacitor in parallel with the resistor as shown in figure 5.7
we can 'smooth' the pulsed DC to provide a more even flow of current.
Figure 5.8 shows the waveforms which are obtained when different size
capacitors are connected in parallel with the resistor, R.
Figure 5.7
Smoothing rectified AC with a capacitor
109
Figure 5.8
Smoothing using a capacitor.
The effect of different size
capacitors.
110
drawn from the supply is small, C can be relatively small. If R is small and a lot of
current is drawn from the supply, C would need to be relatively large to produce
adequate smoothing.
Full-wave rectified AC can be smoothed with capacitors in the same way as the
half-wave rectified AC. A smooth waveform is more easily obtained with the full-wave
rectifier because the capacitor is recharged 100 times per second rather than 50
times per second with half-wave rectified AC. Compare figure 5.10(b) with the
half-wave rectified waveform of figure 5.6(c). The R and C values are the same but
the waveform in 5.10(b) is smoother because the pulses of rectified current are
closer together.
Figure 5.9
full-wave rectification using
a diode bridge.
111
Figure 5.10
Current flow through the
resistor in figure 5.9 (a) without
a capacitor and (b) with a
capacitor as in figure 5.9(c)
AMPLIFICATION
The Triode Valve
The triode valve (figure 5.2) was the first electronic device capable of amplification. If
a relatively high voltage is applied to the plate, electrons emitted by the filament will
be attracted to, and accelerated towards, the plate, so a current will flow. The grid can
control the flow of current. If a (relatively small) negative voltage is applied to the grid,
electrons will be repelled and the flow of current will be reduced. If a small positive
voltage is applied to the grid, electrons will be attracted and the flow of current will be
increased. The grid of the valve is placed closer to the filament than to the plate, with
the result that very small changes in grid voltage produce very large changes in the
current through the valve. The valve thus functions as an amplifier.
If a small alternating voltage is applied to the grid, the result is a large fluctuation in
the current flowing through the valve. Again the small voltage applied to the grid
112
results in a large change in the current flowing through the triode. If a resistor is
connected in series with the triode, the large fluctuations in current through the triode
produce a large change in the potential difference across the resistor. A small
alternating voltage applied to the grid produces large fluctuations in the voltage
across the resistor. Thus the small signal is amplified.
The Transistor
The transistor is the semiconductor equivalent of the triode valve. It is used today in
preference to valves in almost all electrical equipment, either in the form of a discrete
component or as a part of an integrated circuit. A transistor has no filament and
hence no heating requirements, is much smaller than a valve and consumes less
power. It is more suited to low power applications, and so is used almost exclusively
in electronic stimulators and many other pieces of apparatus.
Figure 5.11 shows a transistor and its circuit symbol. The transistor (like the triode
valve) has three terminals - called the collector, base and emitter (abbreviated c, b
and e in figure 5.11). The names were given to indicate that the emitter 'emits'
electrons which are 'received' or collected by the collector. The base controls the flow
of current between emitter and collector. The arrow in the circuit symbol for the
transistor is used in the same way as for a diode (figure 5.3). It points in the direction
of easy current flow. The base-emitter junction in fact behaves just like a diode: the
resistance to current flow in the direction of the arrow is very low, the resistance in the
opposite direction is extremely high.
The resistance between collector and emitter can vary from very low to very high
depending on the current flowing between base and emitter. This 'variable
resistance' property gives the transistor its name. Transistor is an abbreviation of
trans-resistor.
Figure 5.11
(a) a transistor and (b) its
circuit symbol
The current flowing between the collector and the emitter is directly proportional to the
base-emitter current. Thus if the base to emitter current is zero, the collector to
emitter current is also zero. If a small current flows from base to emitter, a larger
current can flow between the collector and the emitter. The collector current is always
113
many multiples of the base current. The ratio (collector current/base current) is called
the current gain (or amplification) of the transistor. The amplification of the transistor
depends on how the transistor has been made, its size and other factors. Typical
values of current gain lie in the range 50 to 500.
In other words the resistance of' the transistor between collector and emitter
decreases in proportion to the base current. As the base current is made greater the
collector to emitter resistance decreases so that the collector current increases in
proportion to the base current. The transistor is thus a very good current amplifier - if
we pass a certain amount of current through the base-emitter junction a much larger
current will flow from collector to emitter.
Operational Amplifiers
It would be unusual nowadays to find a piece of electronic
equipment built entirely from discrete components. Integrated
circuits are now produced in huge numbers using automated
fabrication techniques and this has reduced their cost to a point
where it is, more often than not, cheaper to use one integrated
circuit in applications where previously several individual
transistors were used.
One of the most common integrated circuits is the operational
amplifier or op-amp for short. The operational amplifier is
comprised of many transistors, resistors and capacitors
fabricated in one tiny package with the components
interconnected to produce an amplifier of very high gain. By
adding a few external components the op-amp can be adapted
to suit a variety of particular applications.
Figure 5.12 shows an integrated circuit which contains four,
independent operational amplifiers alongside the circuit symbol
for a single operational amplifier.
Figure 5.12
(a) an integrated circuit containing
four operational amplifiers and
(b) the circuit symbol for an
operational amplifier.
114
All operational amplifiers require a power supply. For simplicity, this is not shown in
figure 5.12. Of the 14 pins on the IC shown in figure 5.12, twelve are used for
connection to the four op-amps and the remaining two are used for connection to a
power supply.
The operational amplifier has two inputs, the inverting input (labelled -) and the noninverting input (labelled +). When a signal is applied to the inverting input the output
is a much amplified and inverted version of the input signal. Signals applied to the
non-inverting input are amplified without being inverted. If the same signal is applied
to both inputs, the output is zero.
The voltage amplification or gain of an op-amp is very high, typically in the range 106
to 1014. More often than not such high gains are not required in practical electronic
circuits. The gain is easily reduced by adding a few external resistors.
Figure 5.13 shows a practical op-amp circuit which acts as an inverting
amplifier. Notice that we have again omitted the power supply connections for
simplicity. The circuit is arranged so that signals are applied to the inverting
input via resistor R1. The non-inverting input is connected to ground (earthed).
A resistor (R2 ) connects from the output, back to the inverting input. This
resistor will allow some of the output signal to feed back into the input. Note
that the output is inverted with respect to the input. This means that the signal
fed back will tend to cancel the input and so reduce both the input and output
of the op-amp. The principle being used here is that of negative feedback.
The gain (G) of the amplifier shown in figure 5.13 is given by the formula
G =
R2
R1
Figure 5.13
An inverting amplifier.
115
R2
R1
Figure 5.14
A non-inverting amplifier.
116
117
L1 and C1 form the resonant circuit and L2 is an extra inductor in close proximity to L1.
The combination of L1 and L2 is, of course, a transformer. The oscillating current in
L 1 will induce a current in L2 . The current induced in L2 produces an AC potential
difference between the two input terminals of the op-amp. The output of the op-amp,
which is an AC signal which is in synchronization with the AC in the resonant circuit,
is fed back to the resonant circuit through R and this compensates for the natural
energy loss and so keeps the resonant circuit oscillating.
A problem with this circuit is that it is unstable. If the amount of feedback is too
small, the oscillations will die-out. If the amount of feedback is too large, the
oscillations will increase out of control. In practice it is impossible to have precisely
the right amount of feedback to generate a steady, sustained oscillation.
The problem is overcome by using a
voltage controlled amplifier whose gain
is controlled by negative feedback.
Figure 5.15 shows how this is
achieved.
The AC potential difference across the
resonant circuit is rectified and
smoothed to produce a DC voltage
which is directly proportional to the AC
signal. This DC voltage is used to
control the gain of the op-amp. If the
AC signal increases, the DC voltage
applied to the op-amp increases and
its gain is reduced. This reduces the
amount of feedback and the AC signal
is reduced. If the AC signal decreases,
the DC voltage applied to the op-amp
decreases and its gain is increased.
This increases the amount of feedback
and the AC signal is increased. In this
Figure 5.15
A circuit for producing steady
continuous AC
118
positive feedback
piezoelectric
crystal
voltage
controlled
amplifier
rectifier
with
smoothing
negative feedback
Figure 5.16 shows a suitable circuit for the production of stable, high frequency
AC using a piezoelectric crystal. The LC resonant circuit of figure 5.15 is
replaced by a piezoelectric crystal which is connected directly to the voltage
controlled amplifier.
Figure 5.16
A circuit for producing stable
high frequency AC using a
piezoelectric crystal
EXERCISES
1
(a)
(b)
The circuit below is used to convert AC from the mains to DC of lower voltage.
(a)
(b)
(c)
(d)
output
119
The circuit shown below is used to convert AC from the mains to DC of lower
voltage.
(a)
(b)
In what way is this circuit more efficient than that shown in question 2?
describe two ways by which the gain of the amplifier in (a) above could be
increased to 50.
What is meant by the term 'positive feedback'? Why does positive feedback
produce instability?
120
(a)
(b)
(c)
(d)
The circuit shown in figure 5.15 can be used to produce continuous sinusoidal
121
10
(a)
(b)
Under what circumstances would the circuit shown in figure 5.16 be preferred to
that shown in figure 5.15?
122
123
124
q1.q2
r2
.... (6.1)
where F is the force experienced by two charges q1 and q2 and r is their distance
apart.
If we wish to calculate the force on a charge q due to a large number of charges q1, ....
qn, we could achieve this by using equation 6.1 and calculating the force on q due to
q 1 , the force on q due to q2 and so on and then summing the forces to obtain the
resultant force. Since forces are vector quantities the summation must be by vector
addition.
In practice we do not often come across situations which approximate to two point
charges nor even to simple distributions of charges. More often we encounter
charges spread over surfaces of different shapes where the actual charge distribution
125
We define the intensity at any point in an electric field, E, to be the force per unit
positive charge at that point. This defines the magnitude of the field and its direction.
If a small test charge is placed in a field the magnitude of the force it experiences
together with the direction of the force determine the electric field intensity at that
point. The field intensity is thus a vector quantity given by the relationship
E =
F
q'
.... (6.2)
Where q' is the magnitude of the test charge placed in the field.
Since the units of force are Newtons and the units of charge are Coulombs, the field
intensity has units of Newtons per Coulomb (written N.C-1).
The field surrounding a single positive charge q can be obtained from equations 6.1
and 6.2 as
E =
q
F
= 2
r
q'
.... (6.3)
Where E is the magnitude of the field and its direction is the same as that of the force
(in a straight line between the charges in this case).
126
127
The lines drawn in figure 6.1 indicate the direction of the field and are called lines of
force because they indicate the direction along which the electric force acts at any
point.
An important point to note is that electric fields are always produced by separation of
charges. Electrons are removed from their parent atoms to produce the charge
separation so that for every positive charge that is produced, there is a corresponding
negative charge somewhere. The electric field lines thus have their origin on charges
and can only terminate on opposite charges.
By convention we indicate the relative strengths of electric fields by the number of lines
of force going through a unit area perpendicular to them. In figure 6.1 the field lines
are closest together near the point charges so the field intensity is greatest there. In
figures 6.1(a) and (b) it is apparent that at greater distances from the point charges
the field line density is reduced meaning that the field intensity is correspondingly
decreased.
Another point worthy of note is that lines of force represent vector directions. It follows
that no two lines of force can ever cross each other - the fields at the point would
simply add by vector addition. This is just another way of saying that a point charge
placed in a field will only move in one direction it cannot be pushed in either of two
directions.
128
In this situation electric field lines will originate on the positive plate
and terminate on the negative plate. The field lines so produced will
originate perpendicular to the conductor surfaces (this is illustrated
in figure 6.2). It is generally true that at the surface of a conductor
through which no charge is moving, the field lines are perpendicular
to the conductor surface. If this were not so the lines of force would
have a component tangential to the conductor surface. The effect of
the tangential component would be to move charges, so changing
the field. The charges would continue to move and readjust the field
until there were no longer any field line components tangential to the
surface causing them to move. In insulators, where the charges are
not free to move, this does not apply and the field lines may be at
any angle to the insulator surface.
Figure 6.2 shows the pattern of electric field lines between two
capacitor plates. The field lines originate perpendicular to one plate
and terminate perpendicular to the opposite plate. If the surfaces of
each metal plate were infinitely large, the field lines would all be
straight and uniformly spaced - in other words the field intensity
would be the same at all points, not growing weaker at large
distances from the centre of the plates. In practice the plates cannot
be infinitely large and the field lines curve away from each plate at
the edges.
When the plates are close together as in figure 6.2(a) the field is
relatively uniform - only the outermost areas (near the edges of each
plate) show any curvature, or weakening, of the field pattern. In
6.2(b) the plates are more widely spaced and more weakening of
the field is evident. Only in the central region is the field uniform.
Clearly, to obtain the most uniform field intensity it is desirable to
have large capacitor plates separated by a relatively small distance.
Figure 6.2
Electric field between parallel,
equal size capacitor plates.
129
Figure 6.3 shows the field patterns expected for different sizes and arrangements of
electrodes.
130
When interpreting electric field patterns it is important to remember that not only is the
field direction shown by the lines of force but that the field intensity is by convention
indicated as the number of lines per unit cross section area.
Imagine now a small positive charge placed in the field between two capacitor plates.
The charge will experience a force in the direction along the field lines and hence will
accelerate in this direction, thus gaining kinetic energy. The gain in kinetic energy is
offset by a loss of (electrical) potential energy. In other words the charge will lose
potential energy as it moves along field lines. The change in potential energy per unit
positive charge is called the electric potential difference between the points. This
quantity is the same potential difference we have already met in chapter 1 and the unit
is, of course, the volt.
A region of positive charge is a region of high electric potential and a negative charge
region is at a low potential so that going from a positive to a negative region involves a
potential drop, i.e. a negative potential difference.
The electric field also goes from positive to negative so that moving along a field line
in the direction of the field involves travelling across a potential drop. The idea of
charges losing potential energy as they move in an electric field gives us another way
of talking about electric field intensity. Clearly an intense electric field will be
associated with a large potential difference between two points a certain distance
apart. A weak field has a lower potential difference for the same distance. The field
intensity can thus be specified in units of potential difference per unit distance: in other
words in volts per metre (V.m-1). The units of volts per metre are identical to the units
of field intensity mentioned earlier, namely newtons per coulomb.
131
132
I1.I2.L
.... (6.4)
In comparing this with Coulomb's law of electrostatics, (equation 6.1) we can see
some similarities and some differences. The table below summarizes the
corresponding features of each kind of force.
Electrostatic Force
*
*
*
*
*
Figure 6.5
Forces between two currentcarrying wires.
Magnetic Force
*
*
*
*
*
133
Inspection of figure 6.5 leads to the prediction that two current carrying
conductors placed at right angles will experience no force. This is borne out
experimentally.
Remember that the electric field near charged bodies could be mapped by
placing a test charge in the field and observing the direction of the force on the
charge - let us now consider the relationship between magnetic fields and
forces.
The use of a compass or iron filings to visualize the magnetic field around a bar
magnet is an experiment which most of us have carried-out. The compass or
iron filings line up in the direction of the magnetic field and the field lines are
readily apparent.
The same technique can be used to map the field lines around a wire carrying
an electric current. Figure 6.6 shows the sort of pattern which is obtained.
It was Ampre himself who first thought of obtaining a more intense magnetic
field by passing current through a wire wound in a closely spaced spiral. Figure
6.7 shows the magnetic field expected for a single loop of wire and a number of
loops wound as a solenoid.
Figure 6.6
Magnetic field lines around a
wire carrying current.
Figure 6.7
Magnetic field lines around a
loop and a solenoid.
134
Now let us return to consider what is happening to a small element of current in a wire
placed near to the straight wire in figure 6.6. Figure 6.8 shows the main features of
such an arrangement.
Here we have the most striking feature of magnetism:
that the force on a moving charge is perpendicular to
both the current and magnetic field directions. This
observation stands in stark contrast to our experience
with gravitational and electrostatic fields, where the
field direction is also the direction of the force
experienced by the mass or charge.
The scope of this book precludes our delving into
theories of the origin of magnetic force: its explanation
was a triumph for relativity theory in modern physics,
when the magnetic force was shown to be simply a result of the movement of
charges with their associated electric field. The theory indicates that the force
between charges in motion is slightly larger than that between stationary charges.
This slight increase in the electric force is, in fact, the 'magnetic' influence of moving
charges on one another.
Although we have, so far, only discussed electric current in the form of charges flowing
through wires, what we have described also applies to isolated charges moving in a
vacuum. A good practical example of this is in the television set. Here a stream of
electrons emitted from a glowing filament (the cathode) is accelerated by an electric
field and impinges on the screen. The phosphor coating on the screen is utilized to
convert the kinetic energy of the electrons to light energy and a visible spot is
produced on the screen. The electron beam is deflected rapidly both horizontally and
vertically by magnetic fields produced by coils or solenoids attached to the neck of the
picture tube. By applying rapidly alternating pulses of current to the coil, impulsive
forces are applied to the stream of electrons and the spot is moved accordingly.
Figure 6.8
Forces on a current element in
a magnetic field (B).
135
Since we know that movement of charge in a static magnetic field is necessary for a
force to be exerted on the charge, we might logically ask such questions as whether
the charges in a conductor will experience a force if the conductor is moved in a
magnetic field, or whether a force is exerted on a stationary charge by a moving or
changing magnetic field.
We will discuss the answers to these questions later in this chapter.
136
those of biological origin, are neither good conductors nor good insulators.
Dielectric Constant
It was found by Henry Cavendish, and later independently by Michael Faraday, that the
capacitance of a capacitor - its ability to store charge - can be increased by placing a
dielectric material between the plates. If Co is the capacitance when measured in a
vacuum and C the capacitance when the region between the plates is filled with a
dielectric, the ratio of C to Co, is found to be independent of the shape and size of the
capacitor. This ratio is dependent only on the dielectric medium itself and is called
the dielectric constant () of the material. We thus have
C
= C
o
.... (6.5)
Capacitance is defined as the amount of charge the capacitor will acquire (and store)
for each volt of applied potential difference. Mathematically this is written:
C =
q
V
.... (6.6)
where the symbols have their usual meaning. This equation tells us that if the
capacitance is changed by inserting a dielectric between two capacitor plates either
the charge will be increased or the potential will be decreased. If the capacitor plates
are connected to a battery or other power source capable of maintaining a constant
potential difference then the charge on the plates will be increased.
The increase in capacitance is very small in the case of gases at normal pressure,
but for materials such as oil the capacitance is doubled. Values of determined in
this way range from very close to 1 for gases up to 81 for pure water. Table 6.1 gives
values of for a representative range of materials.
137
Table 6.1
Dielectric constants of materials
A good insulator is a substance which offers a very high resistance to the flow of
current. This refers to how easily charges can move through a material and says
nothing about the dielectric constant.
Though good dielectrics must be reasonably good insulators the best dielectrics are
not necessarily the best insulators. For example water in table 6.1 is the substance
138
with the highest dielectric constant. Although pure water is a reasonably good
insulator the other substances in this table are all better insulators.
Figure 6.9
(a) Unpolarized dielectric and
(b) polarized dielectric
139
Consider first the effect of a single dipole on the external field. The central field line in
figure 6.10 points in the direction of the externally applied field (from left to right). The
remaining field lines, however, curve around above and below the dipole and the
arrows point in a direction opposing the external field (from right to left). The net result
is that these field lines cancel part of the externally applied field and so weaken it.
When we take into account the fields surrounding all of the dipoles in a polarized
material the net result is a weakening of the externally applied field within a dielectric.
The field inside a dielectric will be less than the externally applied field: this is
because each of the dipoles aligns to produce a field opposing the externally applied
field.
Why then should there be any effect with 'non-polar' molecules such as oil or bakelite?
The origins of the effect with these materials can best be understood by considering a
single non-polar molecule such as the one shown in figure 6.11.
In the absence of a field the electron 'cloud' around the molecule is
symmetrical: the molecule is non-polar. If now an electric field is
applied the electron cloud can distort giving rise to an induced dipole.
The molecule becomes polarized and will remain so as long as the
external electric field is maintained. Non-polar molecules will polarize
and so have the same effect on an externally applied field as polar
molecules. The dipole field produced will oppose the external field and
so weaken it. Generally the effect of non-polar molecules on an electric
field is not as great as those of polar molecules. This is because the
induced dipoles are not as strong as those of naturally polar
substances.
We thus have the general result that the field within any dielectric is less
than the field that would exist without the dielectric being present. The
next question we must ask is how the pattern of field lines is affected.
Figure 6.10
Electric field of a dipole
Figure 6.11
Polarization of a molecule
in an electric field
140
For simplicity we take the single dipole shown in figure 6.10 and
consider what happens when it is placed in a uniform field. The
original field must be added (vectorially) to that of the dipole. The
result is the field pattern shown in figure 6.12.
The most significant thing to note from figure 6.12 is that the field
lines converge towards the dipole. The field is made more intense
immediately in front of the faces perpendicular to the field direction.
Above and below the dipole the field lines are more spread out;
that is, the field here is weaker.
If now we wish to consider a large object of high dielectric constant
in an electric field we can apply the same ideas.
Figure 6.12
The effect of a dipole on a uniform electric field
Figure 6.13
Effect of a dielectric cube on a uniform electric field
141
adjacent negative 'tail'. The opposite charges so cancel each other. On the faces
perpendicular to the field, however, there is a charge imbalance. One surface has an
excess positive charge and the opposite surface has an excess negative charge. It is
on this surface charge of polarization that field lines will terminate.
The amount of surface charge produced in an electric field will
depend on the dielectric constant of the material. For a material
with a high dielectric constant the surface charge of polarization will
be high and a large proportion of field lines will terminate on the
dielectric surface. When the dielectric constant is low the
proportion of field lines which terminate will be small. This means
that the field within a dielectric is reduced in proportion to the
dielectric constant. The higher the dielectric constant, the lower is
the field within the material. In the limiting case where the
dielectric constant is extremely high the field within the material is
close to zero.
Figure 6.14 shows what happens when either a spherical or
cylindrical dielectric is placed in an electric field. Note the regions
in which the field is intensified (more field lines per unit area) and
where the field is reduced.
Figure 6.14
Effect of a dielectric sphere on a
uniform electric field
142
.... (6.7)
1.E1.cos1 = 2.E2.cos2
.... (6.8)
Figure 6.15
Refraction of an electric field line at a
boundary between two dielectrics
143
Dividing equation 6.8 by equation 6.7 and cancelling the E1s and E2s, we obtain
cos1
1. sin
or
cos2
= 2.
sin 2
1.cot1 = 2.cot2
.... (6.9)
An Example. Suppose that in figure 6.15, medium 1 is air with a dielectric constant of
1.0 and medium 2 is water with a dielectric constant of 81 (table 6.1). The field line
shown for E1 strikes the boundary at an angle 1 of 20o . We wish to calculate the
angle 2 at which the field line leaves the boundary.
Rearranging equation 6.9 we have
1
1.0
1.0
.cot20o =
.2.75 = 0.0399
cot2 = .cot1 =
81
81
2
which gives
2 = 88o
For an angle of incidence 1 of 20o, the angle of refraction, 2, is predicted to be 88o.
In this example the angle of refraction is always considerably greater than the angle of
incidence. This is because medium 2 has a much higher dielectric constant than
medium 1.
The implication is that field lines are refracted greatly on entering a medium of high
dielectric constant. For a moderate angle of refraction the angle of incidence must be
very small: in other words the field lines must enter the medium of high dielectric
constant almost at right angles.
144
Figure 6.16
Change in the electric field pattern
in the presence of a dielectric.
145
all field lines must terminate on the surface of the conductor. In this sense an
ideal conductor can be considered to be 'infinitely polarizable'. This means that
the field within a perfect conductor is zero.
For non-ideal conductors these constraints do not apply. What then are the properties
of a non-ideal conductor and what are the laws governing its behaviour?
We have already met one of the properties of a conducting medium in a previous
chapter. This is Ohm's law which states that the current in a conductor is proportional
to the potential difference between the conductor ends. The constant of proportionality
is 1/R where R is the resistance. Ohm's law was covered in chapter 1.
146
Figure 6.17
Electric field and current in a
conductor
147
Compare figure 6.18 with figure 6.15. The first condition on the electric
field is that the tangential components of the field be equal on both
sides of the boundary i.e.
E1.sin1 = E2.sin2
.... (6.11)
The second condition is that the flow of current normal to one side of
the boundary should be equal to that normal to the other side i.e.
i1.cos1 = i2cos2
This makes sense since the net current flow into the boundary from
side 1 must equal that entering side 2 from the boundary.
Using equation 6.10 to eliminate i1 and i2 from this last equation we
have:
1.E1.cos1 = 2.E2.cos2
.... (6.12)
Figure 6.18
Refraction of electric field line at a
boundary between two conductors.
.... (6.13)
Compare these equations with 6.7, 6.8 and 6.9. The close analogy between current
flow in conductors and polarization in a dielectric is quite evident from these
equations.
The implications of equation 6.13 for conductors are similar to those we found using
equation 6.9 which applies to dielectrics. Electric field lines are refracted significantly
on passing from a poor conductor to a better conductor.
148
Equation 6.13 predicts that when the conductivity of medium 2 is extremely high (when
medium 2 comes close to being an ideal conductor) the field lines in medium 1 will
enter the boundary between the two conductors almost normally (almost at right
angles). In other words, if material 2 is an ideal conductor the field lines in medium 1
will impinge on the boundary at an angle of 90o.
The similarity of equations 6.9 and 6.13 lead to the general conclusion that field lines
are refracted greatly when entering a medium of high dielectric constant or
conductivity.
To obtain an equation which takes account of both factors
simultaneously the dielectric constant and conductivity of the media must be
combined to calculate their electrical impedances. The amount of refraction then
depends on the impedance of each medium and the refraction equation has a similar
form to equations 6.9 and 6.13.
It turns out that for biological materials there is a good correlation between the
insulating properties (hence the conductivity) and the dielectric properties (dielectric
constant). Tissues with high dielectric constant are poor insulators. In general, the
higher the value of , the higher the value of . Hence if both of and increase by a
factor of 10, say, on going from one medium to another equations 6.9 and 6.14 predict
the same relationship between angle of incidence and angle of refraction. In this
case both equations correctly predict the angle of refraction and the complexity of
combining and in a single equation is avoided.
149
Table 6.2
Dielectric constants and conductivities
at 37o C and 50 MHz.
It can be seen that the field intensity is highest in the air space and
decreases markedly on entering the fatty tissue. A further reduction occurs
when the field lines enter the muscle.
In figure 6.19(a) the reduction in field intensity within the arm or leg is due to two
factors: (a) refraction of field lines at the air/fatty tissue and fatty tissue/muscle
boundaries which spreads the lines apart, so reducing the field intensity and (b)
termination of some of the field lines on surface charge of polarization of the fat and
muscle.
150
151
Note that in figure 6.19(a), in bone there are more field lines than in muscle. This is
because bone has a lower dielectric constant and conductivity than muscle and so
does not polarize to the same extent. Its electrical properties are similar to fatty tissue.
Figure 6.19(b) also shows the effects of refraction and termination of field lines.
We will return to consider the implications of these field patterns. For the moment it is
sufficient to note the diminished field intensity in materials of high dielectric constant
due to the polarization of the material and consequent termination of some field lines.
Note also the refraction of field lines on entering a material of high dielectric constant
or conductivity which can result in a focussing of the field (figure 6.19(b)) or
defocussing (figure 6.19(a)).
Iron-cored electromagnets
can generate fields up to
several thousand times as
strong as would be produced
without the iron core present.
Iron is, however, a member of a small group of elements which show such an effect
on the magnetic field. Nickel and cobalt are two others. The materials in this group
are said to be ferromagnetic. An extremely small effect on the magnetic field is found
with other substances.
152
By analogy with the electrostatic case we define the permeability of a material by its
ability to change the inductance of a solenoid. The permeability, , is the ratio of the
inductance L, to the inductance without the material being present, Lo, i.e.
=
L
Lo
.... (6.14)
The permeability of most materials is found to be extremely close to unity. Unlike the
electrostatic case (where is always greater than unity) may be less than or greater
than unity.
Table 6.3
Permeability of various materials.
153
charge experiences a force in a direction perpendicular to both the magnetic field and
the current direction (figure 6.8). This applies both to current flowing along a wire, as
in figure 6.8 and to current flow in a vacuum or near vacuum, as in a television picture
tube.
Consider the following experiments which can be performed with two loops of wire.
Figure 6.20 shows the arrangement of the apparatus which is needed. Loop 2 is
connected, through a switch, to a battery. Loop 1 is connected to a sensitive current
meter or galvanometer.
If the switch were in the closed position,
current is flowing through loop 2 and a
magnetic field exists. Since the electrons
in loop 1 are not moving, we know from
Ampere's law that there is no force on them
and hence no force on the loop.
What happens if now we move loop 1 away
from loop 2? In moving the loop upwards
we find that the galvanometer deflects
indicating a flow of current in loop 1. As
soon as we stop moving loop 1, the current
flow ceases.
If we use the three dimensional axes of
figure 6.8 and regard the direction of
movement of the loop as the current
direction we predict a force on the electrons
in loop 1 in a direction along the wire. This
then is the explanation for the induced
current in loop 1.
Figure 6.20
An experiment with moving wire loops.
154
If now we fix loop 1 in figure 6.20 and instead move loop 2 downwards what is the
effect? In this instance instead of moving electrons through a magnetic field we have
left the electrons alone and moved the field. The net result is the same as we found in
the first example: the galvanometer deflects indicating a flow of current in loop 1.
Clearly it is only the relative motion of the conductor and field which is important in
determining whether current is induced.
When moving the conductor in a fixed field or moving the field with the conductor fixed,
the essential process occurring is that charges are crossing magnetic field lines.
Whenever this happens the charges experience a force.
What happens then if we keep both loops fixed and suddenly switch off the current in
loop 2? As far as loop 1 is concerned one of two things could have happened. Either
the magnetic field disappeared because the current causing it was stopped or the
loop responsible for the field was suddenly accelerated away from the vicinity. The net
effect is the same - current is induced in loop 1 because of the changing magnetic
field.
The observation can be explained by picturing the magnetic field collapsing on loop 2.
With current flowing in loop 2 a magnetic field, represented by concentric circles
around the wire, is present (figure 6.7). When the current is switched off the circular
field lines can be visualized as shrinking; converging on the wire and disappearing
into it. Thus the field direction is in concentric circles but the direction of movement of
the field is radially inwards towards the wire of loop 2. This is illustrated in figure 6.21.
Figure 6.21
Magnetic force acting on charges when
current in in loop 2 is switched off.
155
The experiments described
demonstrate the principle of
electromagnetic induction. A current
is induced in loop 1 either by moving
the loops or by switching the current
and so causing the field to change. In
each instance the charges in loop 1
are crossing magnetic field lines.
This results in a force on the charges
and hence charge movement. The
direction of the induced current is at
right angles to both the field direction
and the direction of movement.
156
Since electric field strength is defined as the force per unit charge we could include
both insulators and conductors in our discussion by referring to the induced electric
field or electromotive force (EMF) arising as a result of changing magnetic field.
The principle of electromagnetic induction applies to any material placed in a
changing magnetic field. An electric field is always produced as a result of the change
in a magnetic field. If a conductor is in the changing magnetic field, a current will be
induced whereas if an insulator is in the changing magnetic field only polarization will
result.
When an alternating current is induced in a slab of conducting material
rather than a wire the currents are given the special name 'eddy currents'.
The term arises because the most common geometry, a conducting
cylinder placed in a solenoid as in figure 6.22, gives rise to circular current
paths at right angles to the magnetic field. Provided that the magnetic field
of the solenoid is changing i.e. the field lines are moving, force will be
produced on charges in the conductor, resulting in current flow. An
alternating current in the solenoid will result in an induced alternating
current flow in the conductor.
To understand why the induced current follows circular pathways we need
to think about the direction of the magnetic field lines and their direction of
movement. A force will be produced with a direction at right-angles to each
of these. Figure 6.7 shows the magnetic field pattern around a solenoid.
Magnetic field lines inside the solenoid run parallel along the central axis.
If alternating current flows though the solenoid, the magnetic field will
build-up then collapse, build-up in the reverse direction then collapse in
repetitive cycles. As the field builds-up, the field line loops in figure 6.7 will
grow larger as new loops form. This is illustrated in figure 6.23.
Figure 6.22
Current induced in a conductive
material placed in a solenoid.
157
Note the movement of the field lines. One field line is highlighted in red to
show how the line moves towards the central axis as the current flow (and
field intensity) increases. For field lines inside the solenoid, the field line
movement is always radially inwards as the field increases and radially
outward as the field decreases.
Figure 6.23
Movement of field lines as the current
through a solenoid increases.
Figure 6.24 shows the conductive cylindrical object in figure 6.22, viewed endon. The magnetic field lie (B), direction of movement (v) and resulting force (F)
vectors are shown at different points. The B arrows point out of the page,
directly towards you and are shown as blue circles.
Because the field, B, is always pointing out of the
page (along the cylinder axis) and v is always radially
inwards, the resulting force (EMF) always acts
around the circumference of a circle. This is why the
induced current follows circular pathways.
Figure 6.24
Direction of force and induced
current as a result of an increasing
magnetic field intensity.
The force, F, acts clockwise when v points inwards i.e. when the current and,
consequently the magnetic field is increasing, When the current decreases, the
magnetic field collapses and loops shrink towards the coil (the reverse of that shown
in figure 6.23) so the direction of v in figure 6.24 is reversed. The consequence is that
the direction of F is reversed and the induced current flow reverses direction. Thus an
alternating current is induced in the conductor as a result of the alternating magnetic
field.
The important conclusion to draw from figures 6.22 to 6.24 is that an alternating
current in the solenoid gives rise to an alternating magnetic field. This, in turn, gives
rise to an alternating EMF in the material within the solenoid. If the material is a
conductor a current will be induced which follows a circular path parallel to the current
in the solenoid. If the material is an insulator the molecules will polarize in alternating
directions along arcs parallel to the solenoid loops. In either case an induced electric
field is produced with the field direction parallel to the wires in the solenoid. The
actual amount of induced current flow will depend on the dielectric constant and
conductivity of the material.
158
159
induced current.
the dielectric constant, , which measures the 'polarizability' of a material. The
higher the dielectric constant the greater will be the amount of charge movement as a
result of polarization of the material.
A significant difference between electric and magnetic fields in tissue is that biological
tissue is 'transparent' in a magnetic field. The permeability, , is close to 1.000
meaning that the magnetic field is virtually unaffected by the presence of biological
tissue. This contrasts with biological tissue in an electric field, where the field
intensity varies according to the electrical properties of different tissues. While the
electrical properties of fat, muscle and bone are quite different, the magnetic
properties are almost identical.
This means that for a body segment in an electric field, the field within tissue will vary
according to tissue type. The field in muscle is lower than in the fatty tissue or bone
(figure 6.19). In a magnetic field, no such variation occurs. The field intensities in fat,
muscle and bone are virtually identical. Thus if, for example, a limb segment is
exposed to a magnetic field by a surrounding coil as in figure 6.22, the magnetic field
intensity (and consequently the induced EMF) within fatty tissue, muscle and bone will
be the same.
The differences between current induced by an alternating electric field and that
induced by an alternating magnetic field will be discussed further in chapter 7.
160
EXERCISES
1
.... (6.1)
where k has the value 9 x 109 N.m2.C-2. Calculate the magnitude of the force of
attraction between:
(a)
(b)
(c)
a sodium ion (Na+ ) and a chloride ion (Cl- ) in crystalline NaCI. The
distance between ions in the crystal is 0.3 nm and the charge of each ion is
1.6 x 10-19 coulomb.
161
The magnitude of the electric field around a single positive charge q is:
q
E = k. 2
r
.... (6.3)
where k has the value 9 x 109 N.m2.C-2 (see equation 6.3). Calculate the field of:
(a) one coulomb of positive charge at a distance of 1 m.
(b) one coulomb of positive charge at a distance of 1 km.
(c) one microcoulomb of positive charge at a distance of I m.
(d) a sodium ion (charge 1.6 x 10-19 C) at a distance of 0.3 nm.
4
Consider the electric field patterns shown in figure 6.3. Draw diagrams to show
the effect on the field when:
(a) the small plate in figure 6.3(a) is made smaller
(b) the angle between the plates in 6.3(b) is made greater
(c) the plates in 6.3(c) are offset further.
Two current carrying wires are separated by a distance, d, as shown. The force
of attraction between the wires is 50 N.
162
I .I .L
F k. 1 2
r
.... (6.4)
where k has the value of 10-7 N.C -2.s2 (see equation 6.4). Calculate the force
between two parallel wires of length 0.8 m. The wires each carry a current of 0.5
ampere and are separated by a distance of 2 cm.
8
Two metal plates separated by a thin air space are found to have a capacitance
of 15 pF. The plates are connected to a power supply and charged to a potential
difference of 200 V.
(a)
(b)
The power supply remains connected and the space between the plates is
filled with petroleum oil. What is the charge on each plate? What is the
potential difference between the plates?
If the power supply in question 8(b) above was disconnected before the oil was
introduced what would be:
(a) the charge on each plate
10
(b)
the potential difference between the plates after introduction of the oil?
(a)
(b)
Which of the substances listed in table 6.2 are good insulators and which
are good dielectrics?
11
Briefly describe how the dielectric constant and conductivity of a material will
change if there is a change in proportion of:
(a) polar molecules
(b) non- polar molecules
(c) ions.
12
(a)
(b)
Explain the origin of the charges shown on the dielectric surface in figure
6.13. What effect do the charges have on the field intensity within the
dielectric?
13
163
An electric field line crosses from medium I (air) to medium 2 (water) as shown
in figure 4.15. Use equation 4.9 and values of s from table 4.1 to calculate the
angle of refraction for an incident angle of:
(a) 1o
(b) 5o
(c) 15o
What general conclusion can be drawn about field lines crossing into a medium
of high dielectric constant?
15
Draw a diagram similar to figure 6.16 to show the effect of a dielectric on the field
between capacitor plates.
(a)
Label the diagram to show clearly regions where the field intensity is
increased or decreased.
(b)
16
(b)
Use equation 6.11 to calculate the electric field intensity in the material.
(c)
17
(b)
(c)
An electric field line crosses from medium 1 (conductivity 0.05 S.m-1) to medium
2 (conductivity 0.8 S.m-1) as shown in figure 6.18. Use equation 6.14 to calculate
the angle of incidence for a refraction angle of:
(a)
(b)
(c)
40 o
80 o
89 o
164
Figure 6.19 shows the pattern of field lines in a model for an arm or leg
(longitudinal section) placed between capacitor plates. Explain the pronounced
difference in field intensity in fat and muscle tissue in terms of refraction of field
lines and surface charge of polarization in each tissue.
19
Figure 6.20 shows the pattern of field lines in a model for an arm or leg
(perpendicular cross-section) between two capacitor plates. Explain why:
(a)
the field intensity in air close to the fatty tissue is greater than that without
the limb present.
(b)
the field in muscle tissue is lower than without the limb present and lower
than that in fatty tissue.
20
21
(a)
(b)
22
23
Figure 6.22 shows the pathway of induced current when a conductive material is
placed in a solenoid through which alternating current is flowing. Explain why the
(b)
(c)
165
166
SHORTWAVE DIATHERMY
167
Figure 7.1
Shortwave diathermy
apparatus (schematic).
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.
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
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).
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
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.
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)).
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.
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.
Figure 7.3
Real and displacement current
in an AC circuit.
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
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.
At a frequency of 27.12 MHz the current flow in fatty
tissue and bone is approximately 50% displacement.
In muscle and tissues of high water content the
proportions are approximately 80% real current to 20%
displacement current.
Figure 7.4 shows a revised view of figure 6.19(a) which
takes into account the two kinds of current flow which
occur. In the air spaces the current flow is entirely
displacement current. In fatty tissue and bone the
current is assumed to be one half real current and one
half displacement current. For simplicity, muscle is
shown as having entirely real current.
Figure 7.4
Current type and directions in
a model for an arm or leg.
174
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.
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.
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.
SHORTWAVE DIATHERMY
Figure 7.7
Induced currents with a spiral coil mounted
parallel to the skin surface.
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.
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.
SHORTWAVE DIATHERMY
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.
180
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
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.
SHORTWAVE DIATHERMY
183
Figure 7.12
A coplanar arrangement of electrodes.
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.
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)
Figure 7.14
A hollow dielectric between
capacitor plates.
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.
SHORTWAVE DIATHERMY
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
186
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
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.
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:
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)
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.
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.
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
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.
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.
SHORTWAVE DIATHERMY
EXERCISES
1
(b)
c)
(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?
196
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)
SHORTWAVE DIATHERMY
(b)
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)
197
Consider the hollow dielectric between capacitor plates which is shown in figure
7.14.
(a)
b)
198
SHORTWAVE DIATHERMY
15
16
17
18
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)
SHORTWAVE DIATHERMY
19
199
(a)
(b)
20
21
200
NON-DIATHERMIC FIELDS
201
8 Non-Diathermic Fields
PULSED SHORTWAVE APPARATUS
Most shortwave diathermy machines offer the option of pulsed or continuous output.
With continuous output, tissue heating is maximized as energy is transferred
continually from the apparatus to the tissue. With pulsed output, energy is delivered in
brief bursts with a long off-time between the bursts, so the average energy transferred
is low.
Pulsed shortwave is classed as non-diathermic in
that the average power dissipated in the patient's
tissue is too low to produce the appreciable
temperature rises associated with traditional
(continuous) shortwave treatment. For this reason it
is described here rather than in the previous chapter
where the emphasis was on the use of electric and
magnetic fields to produce deep heating.
Consider an example. If a burst of high frequency AC
with a duration of 1 ms is generated at a burst
frequency of 50 Hz, the period of each repetition ('on'
time + 'off' time) is 1000/50 = 20 ms so 'on' time is 1
ms and the 'off' time is 19 ms and consequently the
average energy is 1/20th of the peak energy (figure
8.1).
Figure 8.1
(a) continuous and (b) pulsed output
from shortwave machines.
NON-DIATHERMIC FIELDS
202
It is asserted, though it has not been demonstrated, that pulsed shortwave is clinically
beneficial because there are physiological effects of a 'non-thermal' nature which are
produced by the bursts of electromagnetic energy.
Figure 8.2 shows the essential features of pulsed shortwave apparatus. It is the
similar to figure 7.1 but with the addition of a gating circuit to control the output of the
27.12 MHz sinewave generator. The gating circuit switches the sinewave generator
on and off at the operator-chosen frequency (50 Hz in the previous example). It also
controls the burst duration (1 ms in the previous example). Some machines have a
predetermined burst duration, others allow operator selection.
Components and subsections within the yellow
rectangle in figure 8.2 are inside the apparatus. The
functions of each subsection are as follows:
*
Figure 8.2
Pulsed shortwave diathermy
apparatus (schematic).
NON-DIATHERMIC FIELDS
203
couples energy generated by the apparatus to the patient. Its operation was
described in chapter 7. Output from the apparatus is applied to the patient using
electrodes or an induction coil, in the same way that conventional (continuousmode) shortwave diathermy is applied.
*
NON-DIATHERMIC FIELDS
204
The average power is low and is only a small fraction, between 0.5% and 4%, of the
peak power per pulse.
Machine 2, with a pulse width of 400 microseconds, has a frequency range of 15 Hz to
200 Hz and a peak power output of 1000 W. Calculations similar to the previous
examples show that the maximum average power varies between 6 watts (at 15 Hz)
and 80 watts (at 200 Hz). Again, the average power is low and is only a small fraction,
between 0.6% and 8%, of the peak power per pulse.
The low power levels of pulsed shortwave ensure that gross heating effects, due to an
appreciable increase in tissue temperature, do not occur.
See chapter 10 of JF
Lehmann (Ed) 'Therapeutic
Heat and Cold'. Williams &
Wilkins (1982) for more
details of these studies.
NON-DIATHERMIC FIELDS
205
pulsed mode for the treatment of a number of conditions where heating as such is
either contraindicated or of dubious value. The argument is that if ultrasound can
used to advantage in pulsed mode, where non-thermal effects are the explanation for
any therapeutic benefits, then pulsed shortwave should also be beneficial. This
arguments is based on two questionable premises. First that 'non-thermal' benefits
of ultrasound treatment actually exist and second (perhaps more importantly) that
non-thermal effects will also be produced by pulsed shortwave treatment.
Biophysical Mechanisms
Although the evidence base for pulsed shortwave treatment is small, a biophysical
argument can be made for possible non-thermal effects of pulsed shortwave.
The response of ions, polar molecules and non-polar molecules to an applied electric
or magnetic field is well understood (chapter 7) and heat production in the applied
field is readily explained. What is not known is how these same molecules
responding in a biological environment can produce non-thermal cellular effects of
therapeutic value.
When electromagnetic energy is applied in brief bursts, the ions, polar molecules and
non-polar molecules will respond equally briefly, with vigorous movement during the
burst and a dying-down of activity between bursts. During the bursts, we would expect
considerable molecular movement which would not increase the average
temperature appreciably but which would markedly increase the instantaneous
temperature.
One could reasonably speculate that the transient excitation might affect concentration
gradients, movement of molecules across the cell membrane and changes in
membrane permeability in either or both of excitable cells and non-excitable cells.
There may also be transient thermal effects on the synaptic junctions of nerve cells.
These ideas remain speculative in the absence of appropriate experimental studies.
NON-DIATHERMIC FIELDS
206
NON-DIATHERMIC FIELDS
207
Figure 8.3
Low-frequency pulsed magnetic
field apparatus (schematic).
NON-DIATHERMIC FIELDS
208
Figure 8.4
The piezoelectric effect in bone.
NON-DIATHERMIC FIELDS
209
inductance. The larger is the inductance, the longer it takes for the
current to increase to maximum.
The rate of increase in current intensity in the coil is important because
this determines the induced current in tissue. Eddy currents are
produced in tissue as a result of a changing magnetic field (chapter 6).
When the magnetic field is constant, no current will be induced. Thus
when the current in the coil is changing, and only when it is changing, a
current will be induced in tissue. Figure 8.6 shows the relationship
between induced current and current in the coil for the two waveforms
shown in figure 8.5.
When the coil current suddenly starts to increase, the rapid rate of
increase (figure 8.6a) results in a high induced current. The magnetic
field around the coil builds-up rapidly so the induced current is large.
The rate of increase then drops rapidly and the induced current drops
accordingly. A current spike is induced in tissue. When the coil current
suddenly decreases, a current spike of the opposite polarity is induced
due to the decreasing magnetic field intensity. The more rapidly
changing coil current in 8.6(a) induces large current spikes but these
are of short duration as the coil current rapidly reaches a steady value.
The more slowly changing coil current in 8.6(b) induces current spikes
which are smaller in amplitude but of longer duration.
Figure 8.5
Voltage and current waveforms for (a) small
and (b) large value inductances.
Figure 8.6
Current in an induction coil and resulting
current induced in tissue for (a) small and
(b) large value inductances.
NON-DIATHERMIC FIELDS
210
The size of the induced current depends on the rate of change of the
magnetic field and thus on the rate of change of current in the coil.
If a sinusoidal current is applied
to an induction coil the induced
current will have the same
shape but be shifted in phase.
This is because the rate of
change of a sine waveform is
another sine waveform phaseshifted by one quarter of a
wavelength; in other words a
cosine waveform. This is shown
in figure 8.7(a).
Figure 8.7(b) shows the
rectangular current waveform
induced
when
triangular
waveform is passed through an
induction coil. A rectangular
waveform is induced because
the triangular waveform is alternately increasing at a constant rate
then decreasing at a constant rate. The induced current is alternately
constant and positive then constant and negative.
Treatment Parameters
No definite statements can yet be made regarding the most
appropriate current waveform for magnetic field therapy. Even in the
case of bone repair, where the clinical evidence of effectiveness is
substantial, there is uncertainty as to the best waveshape and
Figure 8.7
Induced current waveforms for (a) sinusoidal
and (b) triangular currents in an induction coil.
NON-DIATHERMIC FIELDS
211
frequency. Excellent results seem to have been obtained using a burst of highfrequency pulses (frequency approximately 4 kHz) in 5 millisecond bursts repeated at
a frequency of 15 Hz. Similar success has been achieved using single pulses and
more intense fields wit a pulse frequency of 1 Hz. Optimum treatment parameters are
yet to be established.
Since heating appears to play no role (the energies involved are too low) one cannot
predict effectiveness on the simple basis of total energy transfer. Nor can optimum
frequencies be deduced without adequate knowledge of the cellular mechanisms
involved.
A conclusion is that chronic non-union of fractured bone can be successfully treated
with low-frequency pulsed magnetic fields but that its value for the treatment of soft
tissue injury remains open to question.
EXERCISES
1
(b)
What range of output pulse widths and pulse frequencies are normally
provided?
Suppose the peak power output of a pulsed shortwave machine is 900 W and
the pulse width is 300 ms.
(a)
What is the maximum frequency which can be used if the average power
output is not to exceed 50 W?
(b)
For a pulse frequency of 200 Hz, what is the average power output?
NON-DIATHERMIC FIELDS
3
One justification which is often invoked for pulsed shortwave treatment is that
certain biological responses are 'non-linear' and exhibit a 'threshold effect'.
(a)
(b)
The average power output may be increased either by increasing the pulse
frequency or by increasing the peak power output. If threshold effects are
important, which of these adjustments would have the greatest biological
effect?
Suppose it was established that for pulsed shortwave therapy an optimum pulse
frequency was 100 Hz and a desirable peak to average power ratio was 50 to 1.
What pulse width would be necessary?
(a)
(b)
It is known that direct current promotes bone formation near the cathode. If
bone, in vivo, is loaded as in figure 8.4, in what region will bone formation be
promoted?
Figure 8.3 shows a schematic diagram of low frequency pulsed magnetic field
apparatus. Briefly explain the function of each subsection.
(a)
Explain why the current waveforms in figure 8.5 are rounded versions of the
voltage waveforms.
(b)
Explain why the induced current waveforms in tissue have the shapes
shown in figure 8.6.
The diagrams below show current waveforms in an induction coil placed near
tissue.
212
NON-DIATHERMIC FIELDS
Draw diagrams to show the waveforms of the induced current in tissue for each
of waveforms (a), (b), (c) and (d).
9
Draw diagrams showing the pathways of the induced current for biological tissue
placed (a) adjacent to an induction coil (b) within an induction coil.
213
214
Figure 9.1
Transverse oscillations in a spring.
215
.... (9.1)
The wave shown in figure 9.1 is a transverse sine wave - so called because the
displacement of the spring is perpendicular or transverse to the direction of
propagation. When the oscillations are along the direction of propagation the wave is
called longitudinal. Figure 9.2 shows a longitudinal wave generated in a spring. For a
longitudinal wave, the wavelength and velocity are easy to determine. The wavelength
is the distance between two regions of compression. The velocity is determined by
measuring how far a region of compression moves along the spring (x) in a known
time interval (t). One region of compression, moving to the right, is coloured in figure
9.2. The velocity is calculated using the formula v = x/t. The amplitude is less
apparent but, in the case of a spring, it can be determined by attaching a marker to a
point on the spring and measuring how far the marker oscillates back and forth from
its mean position.
Sound
waves
are
longitudinal
compressional waves. By their very
nature they require a material medium for
their existence as they are displacements
of the material medium - solid, liquid or
gas - about some mean position.
The human ear can detect only a
restricted range of sound frequencies,
from the lowest tones of an organ, around
16 Hz, up to some 12 to 20 kHz. The
upper frequency limit of audibility
diminishes with age.
Frequencies
greater than 20 kHz are termed ultrasonic,
although some animals can hear
frequencies up to 100 kHz.
Figure 9.2
Longitudinal waves in a spring.
216
Figure 9.3
Diagramatic representation of
a sound wave.
Figure 9.4
Diagramatic representation of
an electromagnetic wave.
217
of light: whether it was corpuscular or a wave motion, and if a wave, a wave in what?
In many way Maxwell's work formed the keystone of 19th century physics.
Maxwell had set himself the task of generalizing all of the accumulated knowledge of
electrostatics, electric current, magnetism and electromagnetism: to write a few
simple laws from which everything else could be derived. He summarized his
findings in a set of four equations which expressed the relationship between electric
and magnetic fields. In writing the equations he noticed they had a certain symmetry
about them, but that the symmetry could only be made complete by assuming the
existence of a hitherto unobserved experimental result: that a changing electric field
gives rise to a changing magnetic field. This assumption, together with other known
facts of electricity and magnetism gave rise to the four equations which bear Maxwell's
name.
Not only did Maxwell's equations account for all that was known of electricity and
magnetism, they also made one startling prediction: whenever charges are
accelerated, an electromagnetic wave is produced. It was previously known that a
moving charge produces a magnetic field which disappears when the charge stop
moving. The equations predict that in addition an electromagnetic wave is produced if
the charge accelerates and once the wave is produced its continued existence and
propagation is independent of what subsequently happens to the charge.
It is not a great step from this to the conclusion that all electromagnetic waves have
their origin in the accelerated motion of charges.
Since Maxwell's time electromagnetic waves with frequencies ranging from 5 Hz to
1024 Hz have been produced and used. Although they are produced an detected by
seemingly different means and given different names, they all have essentially the
same nature. A range of frequencies of electromagnetic waves is referred-to as an
electromagnetic spectrum. Figure 9.5 shows such a spectrum and its most familiar
regions.
Electromagnetic waves with frequencies up to 1012 Hz can be generated electrically.
For example the normal AM or FM waves received by a radio are produced by
The mathematics of
Maxwell's equations can be
found in most textbooks on
electromagnetism and will
not be discussed here.
Rather the focus is on the
implications of his equations.
218
Figure 9.5
The electromagnetic spectrum.
Production of current by electronic circuitry becomes increasingly difficult at higher
frequencies and above 10 12 Hz it is necessary to use alternative methods for
accelerating charges and producing the waves.
Infrared radiation, sometimes referred-to as 'radiant heat' is emitted by all matter.
This is because the atoms and molecules are continually moving. In a solid, for
example, the atoms are constrained but are able to vibrate about their mean position.
It is this movement energy which we call the heat energy of an object. The atomic
jiggling means that charges (negative electrons and positive nuclei) are continually
accelerating, so they radiate electromagnetic waves. At normal temperatures, most of
the electromagnetic radiation has frequencies in the infrared portion of the spectrum.
When something is heated, the molecules within it are given more energy and they
move or jiggle more vigorously. A consequence is that the electromagnetic radiation
produced has a higher average frequency. For example, if a piece of metal is heated
from room temperature it first emits only infrared radiation, but as the temperature is
increased, the metal becomes red-hot, then white, then blue hot. This is because the
219
220
221
Figure 9.6
(a) translational oscillation (b)
rotation and (c) Internal vibration
of a diatomic molecule.
222
frequency of rotation at one instant, suffer a collision and lose some rotational energy
to the other molecule, thus changing to a lower rotation frequency.
The same is true for vibration of the molecules - there is continual transfer of the
vibrational energy back and forth between molecules.
The motion of molecules within a material is, of course, what we measure as the heat
energy of an object. As we heat up a material the energy we put in results in greater
agitation and thus greater kinetic energy of the molecules. The extent to which energy
is shared between the different modes of movement will depend on whether the
material is a solid, liquid or gas and how many atoms make up molecule. For
example in the case of a large protein molecule with many atom and many bonds, a
significant proportion of the heat energy will appear as internal vibrations of the
molecule.
Even if the sound frequency differs somewhat from any average frequency of
molecular movement the natural spread of oscillation frequency of the molecules will
enable some energy to be absorbed. In addition if the difference in frequency of two
natural modes of molecular oscillation is equal to the sound frequency, energy can be
absorbed in converting one frequency of oscillation to the other.
223
PENETRATION DEPTH
In general, for any kind of wave of a certain frequency, we find that the wave energy
decreases exponentially with distance. Mathematically this is written:
E = Eoe-x/
.... (9.2)
Where Eo is the original energy and E is the energy remaining after the waves have
travelled a distance x through the medium. The quantity is called the penetration
depth of the waves in the medium. It depends on the frequency of the wave and the
properties of the medium through which the wave travels. The quantity e is a constant
which crops-up in any mathematical description of exponential increases or
decreases, in the same way that crops-up when we are dealing with circular
geometry.
e, like is an irrational
number, it cannot be
expressed as a whole
number or a simple fraction.
Its value, to an accuracy of
four significant figures, is
2.718.
224
The calculations show that as the wave travels through a material the energy is
progressively absorbed. At a distance (the 'penetration depth') the wave energy
is decreased to 37% of the original energy. At a distance 2 the wave energy is
reduced to 37% of 37% of the incident energy and so on. In other words the wave
energy is reduced by 63% every time the wave travels a distance in the medium.
The wave energy is never completely absorbed but is reduced by a certain fraction
with every centimetre it travels through the material. Clearly we cannot specify
'depth for complete absorption' of the wave energy as this will never occur.
Instead we specify the penetration depth as the depth required to absorb 63% of
the incident wave energy.
Figure 9.7
Graph showing an exponential
drop in energy, E, with distance, x.
225
5.3 cm. Use equation 9.2 to calculate the energy remaining after travelling a distance
of (a) 2 cm and (b) 10 cm through fatty tissue.
(a)
(b)
Some authors prefer to specify a 'half-value depth' rather than a penetration depth to
describe the rate of absorption of wave energy. The relationship between half-value
depth and penetration depth can be calculated from equation 9.2 as follows.
The half-value depth, the thickness required to reduce the wave energy by 50%, is d1/2
where
Eo
= Eoe-d1/2/
2
In other words we have substituted E = Eo/2 (50% of Eo) when x = d1/2 into equation
9.2.
1
= e-d1/2/
Cancelling the Eo on each side gives
2
1
d
d
d
Taking logarithms to the base e we have In = - 1/2 i.e. In 2 = 1/2 so = 1/2
2
ln2
hence = 1.44 d1/2
226
That is, the penetration depth is obtained from the half-value depth simply by
multiplying by 1.44.
their penetration depths in fatty tissue are much higher than in muscle (or other
tissues with high water and ion content).
Table 9.1 shows values of the penetration depth, , for different frequencies of
ultrasound and microwave radiation in different body tissues.
It is clear from the table that microwaves and
ultrasound are true diathermic modalities; that is,
the waves are able to penetrate deeply into tissue.
A significant proportion of the wave energy will be
available for heating of muscle and other tissues
Iying beneath the subcutaneous fat.
In considering which frequencies are most useful
for diathermy we would choose a frequency which
gives adequate penetration of the waves. We
would not, however, aim for a maximum
penetration depth since if is too large the waves
will penetrate right through the tissue with little
absorption and thus little heating. The choice of 1
MHz for therapeutic application of ultrasound is a
good compromise between adequate penetration
radiation
(cm)
in fat
(cm)
in muscle
Ultrasound 1 MHz
Ultrasound 2 MHz
Ultrasound 3 MHz
Microwave 1000 MHz
Microwave 2000 MHz
Microwave 4000 MHz
7.2
4.8
2.4
7.0
5.3
4.0
1.7
1.2
0.6
1.6
1.2
0.6
(cm)
in bone
0.22
0.15
0.07
) similar
) to
) fat
Table 9.1
Penetration depth, , for microwaves
and ultrasound in body tissues.
227
and adequate heating of underlying tissue. The pattern of heating does not, however,
depend solely on penetration depth - reflection of the waves plays an important role.
We will discuss reflection shortly.
v
3 x 1017
=
f
f
.... (9.3)
The infrared region of the spectrum extends from 700 nm wavelength up to about 400
000 nm. For therapeutic application, sources of infrared radiation are used which put
out most of their radiation at the end of the spectrum close to visible light: from about
700 nm to about 15 000 nm. This includes both the so called 'near' infrared region,
from about 700 nm to 4000 nm and part of the 'far' infrared region. The far infrared
region extends from 4000 nm to about 400 000 nm.
The penetration depth of near infrared radiation is very small. A maximum penetration
depth of a few mm is obtained at about 1200 nm wavelength, and this decreases to a
fraction of a millimetre at longer wavelengths. Wavelengths longer than 3000 nm are
absorbed by the moisture on the surface of the skin. You may have noticed that the
red end of the visible spectrum can be transmitted through the full thickness of your
228
hand: this property does not extend to the infrared region of the spectrum.
Visible and ultraviolet radiation have frequencies corresponding to natural frequencies
associated with electrons in the outer shells of atoms. Since these electrons are the
ones involved in bonding between atoms it is possible for light and ultraviolet
radiation to cause breaking of chemical bonds.
We may summarize the absorption mechanisms for infrared, visible and ultraviolet
radiations as follows:
*
Far ultraviolet radiation, at higher frequencies than visible and near ultraviolet
light, can separate electrons completely from an atom thus producing an ion. For
this reason there is some risk of causing irreversible damage to biological
molecules.
The absorption mechanism for ultraviolet and visible light means that absorption and
hence penetration depth, depends critically on frequency. Certain frequencies will be
rapidly absorbed and have small penetration depths while others will not be absorbed
so readily and hence have large penetration depths.
Clearly ultraviolet therapy is of more value in initiating chemical change than in heating
as such. Infrared radiation would be indicated when heating of superficial tissue is
required.
229
WAVES AT BOUNDARIES
So far we have discussed the absorption of a wave as it is transmitted through a
medium. A knowledge of the rate of absorption of a wave in different tissues is not,
however, sufficient to predict the amount of heating in a given tissue layer. Not all of
the radiation striking a tissue interface will be transmitted, some will be reflected. In
this section we consider the factors determining the relative proportions of reflection
and transmission which occur in tissues.
230
In the case of electromagnetic waves the properties determining the impedance are
the dielectric constant and conductivity. Consider, for example, an ideal dielectric.
The molecules will polarize in the electric field. The electron cloud will alternate about
the atomic nucleus and be drawn back to the normal position by the electrostatic
attraction of negative electrons for the positive nucleus. The polarizing of the atom is
analogous to stretching of a spring, and the polarizability (elasticity) is determined by
the dielectric constant.
For any kind of wave, the relationship between wave energy and the three quantities
amplitude (a), frequency (f) and impedance (Z) is
E a2.f2.Z
.... (9.4)
If a wave arrives at a boundary between two media of different impedance only part of
231
Figure 9.8
Reflection from a low impedance boundary.
232
ar
Z -Z
= 1 2
ai
Z1 + Z2
.... (9.5)
3Z2 - Z2
= 0.50
3Z2 + Z2
Figure 9.9
Reflection from a high impedance boundary.
STANDING WAVES
Consider what happens if a transverse wave rather than a
pulse strikes the boundary between two media. Unless the
impedances of both media are identical a reflected wave will
be produced travelling in the opposite direction. The two
waves will add together, sometimes reinforcing, sometimes
cancelling and the result is a standing wave pattern. Figure
9.10 shows the resultant waveform (in red) when two waves
of equal amplitude and frequency are travelling in opposite
directions The incident wave (blue) travels to the right and
strikes a boundary (not shown). The wave is fully reflected,
generating a wave (green) travelling in the opposite
direction. The waves add together, so that what is actually
observed is no longer two separate waves travelling in
opposite directions but a single resultant. The resultant is a
stationary wave pattern (hence the term 'standing wave').
The wave amplitude varies from instant to instant, changing
from zero to maximum and back again, but the wave crests
do not change position. At certain points (called nodes) the
wave amplitude is always zero while at other points (the
antinodes) the wave amplitude alternates rapidly between
extreme values.
Figure 9.10
A standing wave produced by interference of two
equal size waves travelling in opposite directions.
233
234
In figure 9.10(a) the incident and reflected waves are out of phase by one half of a
wavelength. In this case the two waves exactly cancel and the resultant has zero
amplitude. An instant later (figure 9.10(b)) the incident wave has moved 1/8th
wavelength to the right and the reflected wave 1/8th wavelength to the left. Now the
waves are only 1/4 of a wavelength out of phase and the resultant is non-zero. In
figure 9.10(c) the waves have moved further: now they are in phase and the resultant
has a maximum amplitude. See if you can construct the resultant waveform at two
later times when the incident and reflected waves have progressed a further 1/8th
wavelength then 1/4 wavelength.
For waves travelling at high velocity, the variation from (a) to (d) in figure 9.10 would
occur in a tiny fraction of a second and the resulting variation in amplitude would be so
fast as to be seen as a blur. This is illustrated in figure 9.11. Notice that in figure 9.11
the nodes and antinodes are readily discerned.
The nodes are one half of a wavelength apart (as are the
antinodes). One wavelength is one sinewave cycle, which
is two of the 'beats' in figure 9.11. So half a wavelength is
the distance between two antinodes or two nodes.
An everyday example of standing wave production is seen
with stretched wires or strings (for example guitar strings)
which, when plucked, resonate and produce standing
waves at any frequency for which the string length is a
multiple of half a wavelength. The mismatch in impedance
at each end of the string results in almost complete
reflection and superposition of the waves results in a
standing wave.
If a wave is not fully reflected at a boundary ( < 1 in
equation 9.5) the incident and reflected waves have different
amplitudes and the resultant will be a combination of a
standing wave and a travelling wave. This is the more
Figure 9.11
The (blurred) standing wave pattern which
would be seen when the incident and
reflected waves travel at high velocity.
235
Figure 9.12
Effect on the standing wave pattern of
unequal size incident and reflected waves.
Figure 9.13
Reflected and refracted waves at a boundary.
236
Figure 9.14
Reflection of a beam.
237
..... (9.12)
Figure 9.15
Refraction of a beam.
238
Since v1 is not necessarily equal to v2 , sin i is not equal to sin r and so the angle of
incidence is not equal to the angle of refraction. The angles of incidence and
refraction depend on the relative velocity of the waves in each medium.
Equation 9.12 is a less familiar form of the law of refraction. It is more common in the
case of light to define an 'index of refraction'. This is simply the ratio of the velocity of
light in a vacuum to its velocity in the medium. Equation 9.12 then has v1 and v2
replaced by n1 and n2, the refractive indices of each medium. The refractive index is
dictated by the wave velocity in the medium.
For light waves in air their velocity, v1 , is always greater than the velocity, v2 , in a
denser medium (glass or whatever). Consequently the angle of incidence is always
greater than the angle of refraction.
An example.
The velocity of sound in air is 340 m.s-1 and in water is close to 1500 m.s-1 (see table
10.1 in the next chapter). Use equation 9.12 to calculate the angle of refraction when
sound waves in air are incident upon water at an angle of 6o.
Substituting v1 = 340 m.s-1 and v2 = 1500 m.s-1 into equation 9.12 we have
340
sin i
=
= 0.23
..... (9.13)
1500
sin r
that is
sln i
sin r =
0.23
239
Critical Angle
From the previous discussion it is apparent that waves are refracted at a boundary
when the wave velocity is different in each medium. The relationship between incident
and refracted angle is given by equation 9.12.
Consider again the example of sound waves in air incident upon a boundary with
water. Equation 9.13 relates the incident and refracted angle in this case. If this
equation is used to calculate r for different values of i, a table similar to table 9.2 is
produced.
The results show a smooth increase in r as i increases in the range 0o to 13o . The
value i = 13o is called the critical angle for the air/water system. At this angle of
incidence the angle of refraction, r, is 90o. In other words the refracted wave travels
along the air/water boundary. For angles of incidence greater than 13o there is no real
solution to equation 9.13. Experimentally what we observe is that total reflection
occurs; that is, no refracted wave is produced. The critical angle is the largest incident
angle for which a refracted wave exists.
Although we have used the air/water system as an example, the general conclusions
apply to any pair of materials where the wave velocity in medium 2 is greater than in
medium 1. In this circumstance, the angle of refraction is greater than the angle of
incidence and at a critical angle of incidence the refracted angle will be 90o . For
angles of incidence greater than the critical angle, total reflection occurs. The actual
value of the critical angle for a given pair of materials is calculated using equation
9.12.
An example.
The velocity of sound in muscle tissue is 1550 m.s-1 and in bone is 2800 m.s-1 (table
10.1 following). Calculate the critical angle for sound waves incident upon a
muscle/bone boundary.
angle of
incidence
i
angle of
refraction
r
3o
6o
9o
12o
13o
13o
27o
44o
67o
90o
Table 9.2
Angle of incidence and
refraction for sound waves
at an air-water interface.
240
EXERCISES
1
(a)
(b)
The frequencies of some of the waves used in therapy are: ultrasound: 1 MHz,
microwave: 2450 MHz, infrared: 3 x 10 11 to 4 x 10 14 Hz, ultraviolet :0.8 x 10 15 to
1.6 x 1015 Hz
(a) Given that the speed of light is 3 x 10 8 m.s-1 and that of sound 340 m.s-1,
calculate the wavelength (or wavelength range) of these waves.
(b) For each of these waves, indicate whether the wavelength concerned is
closest in size to
a house.
a human limb.
a tissue layer.
a cell a protein molecule.
(c)
(a)
(b)
(c)
Sound waves in liquid A are absorbed more rapidly than in liquid B. What
conclusions can you draw regarding the frequencies of molecular oscillation in
each liquid?
The penetration depth of 1 MHz ultrasound in muscle tissue is 1.7 cm. Using
equation 9.2 construct a table showing fraction of energy remaining (E/Eo ) at
different depths in the muscle. Use a range of values of depth from 0 to 5 cm.
241
242
Plot a graph of E/Eo vs depth and determine the depth at which the energy is
reduced to:
(a)
(b)
(c)
(d)
(e)
8
The penetration depth of 1 MHz ultrasound in fatty tissue is 7.2 cm. Use equation
9.2 to construct a table showing the fraction of energy remaining (E/Eo ) at
different depths in the tissue. A suitable range of values of depth is from 0 to 5
cm. Plot a graph of E/Eo versus depth.
(a) Compare your graph with that obtained in question 7. What conclusions
can you draw about the relative 'absorbing power' of fatty tissue compared
with muscle for 1 MHz ultrasound?
(b)
(c)
75%
50%
37%
25%
10%
Use your graph to determine the thickness of fatty tissue required to reduce
the wave energy to 75% of the original value.
What thickness of fatty tissue is required to absorb 10% of the incident
energy?
The penetration depth of 4000 MHz microwaves in muscle tissue is 0.6 cm (table
9.1). Use equation 9.2 to calculate the thickness of muscle tissue required to
absorb:
(a) 10%
(b) 50%
(c) 90%
of the incident wave energy.
(a)
(b)
11
12
Two springs are connected together as in figure 9.8. A pulse travels along spring
1. After reflection the reflected pulse has an amplitude one fifth of the incident
amplitude.
(a) What is the reflection coefficient of the boundary?
(b) If the impedance of spring 1 is 3 x 10 3 kg.m-2.s-1 what is the impedance of
spring 2?
13
Two springs are connected together as in figure 9.8. The impedance of spring 1
is one quarter of the impedance of spring 2.
(a) Calculate the reflection coefficient of the boundary.
(b) What is the significance of the negative value for the reflection coefficient?
(c) What is the fraction of energy reflected at the spring junction?
(d) What is the fraction of energy transmitted from spring 1 to spring 2?
14
243
15
(b)
(c)
(d)
244
For each of the cases considered in question 14 above calculate the percentage
of the original energy which will be:
(a) reflected
(b) transmitted
at the boundary between the media.
16
Figure 9.10 shows the standing wave pattern produced by two waves of equal
amplitude travelling in opposite directions. The time interval between each
diagram is the same. Construct (graphically) the standing wave pattern at four
successive (equal) time intervals.
17
Figure 9.10 shows the standing wave pattern produced when incident and
reflected waves are of equal amplitude.
Construct (graphically) the
corresponding pattern produced when the reflected wave is only 2/3 the
amplitude of the incident wave.
18
19
Ultrasound waves travelling through muscle strike an interface with bone. The
transmitted wave has an angle of refraction of 80o . Given that the velocity of
sound in muscle is 1550 m.s-1 and in bone is 2800 m.s-1, calculate the angle of
incidence of the ultrasound waves.
21
Light incident on tissue at an angle of 40o has an angle of refraction of 29o. If the
speed of light in air is 3.0 x 10 8 m.s-1 , calculate the speed of light in the tissue
(using equation 9.12).
22
(a)
(b)
23
(a)
The velocity of sound in fatty tissue is 1450 m.s-1 and in muscle, 1550 m.s1. Calculate the critical angle for the fat/muscle interface.
The critical angle for an air/water interface is 13o. Given that the velocity of
sound in air is 340 m.s-1, calculate the velocity of sound in water.
(b)
24
245
246
247
The ultrasound frequencies most commonly used are 1 MHz and 3 MHz. The reasons
for these being popular operating frequencies will become apparent in later sections
of this chapter. In water and tissues of high water content the velocity of sound is
close to 1500 m.s-1 thus the wavelength of 1 MHz ultrasound is (from equation 9.1)
about 1.5 mm and that of 3 MHz ultrasound is about 0.5 mm.
Figure 10.1
An ultrasound machine (schematic).
248
All piezo-electric crystals are found to exhibit a resonance effect - that is, they vibrate
most efficiently at a certain (resonant) frequency. This natural frequency depends on
the dimensions, most importantly on the thickness, of the crystal. The resonant
frequency of the oscillator (see chapter 5) is normally adjusted during manufacture to
correspond to the crystal's resonant frequency.
In continuous mode the gating circuit is not used and the piezo-electric crystal is
supplied with high frequency AC continuously. In pulsed mode the AC is applied to
the crystal in bursts. The burst frequency is normally 100 Hz; thus the time from the
start of one burst to the start of the next is one-hundredth of a second or 10
milliseconds. The duty cycle is the ratio of 'on' time to total time ('on' plus 'off') for the
output. In other words the duty cycle is the fraction of time for which ultrasound is
being produced. Typical values of duty cycle for apparatus used in therapy are in the
range 1:2 to 1:10.
An alternative to specifying the duty cycle of pulsed ultrasound is to specify the markspace ratio. The mark-space ratio is the ratio of 'on' time to 'off' time for the output.
The rationale for the use of pulsed ultrasound will be discussed in a later section of
this chapter.
249
Every point on the transducer surface will act as a source of sound waves.
The total wave amplitude, and hence total wave energy, at point A will
depend on the contribution from all points on the transducer surface.
Waves from some points will arrive in phase and reinforce each other;
others will arrive out of phase and cancel. Figure 10.3 shows waves
originating at only two points on the transducer surface: in this case the
waves are out-of-phase and cancel.
By adding (vectorially) the waves originating from all points on the
transducer surface we can calculate the resulting intensity at any particular
point. The calculations are made complex by the fact that the surface of the
transducer does not remain planar, but flexes and undulates as it
oscillates.
Figure 10.2
Interference of sound waves from a
radiating source.
250
Figure 10.3
Intensity along the axis of a sound beam for
a transducer of diameter 2.8 cm, operated
at 1 MHz frequency in water.
Off-axis, patterns of hot-spots and cold-spots are also observed. The location of their
maxima and minima are, however, different. Averaged across the beam, the intensity
is relatively constant, only decreasing slowly with distance. So at any particular
distance, hot-spots and cold spots are produced in different locations across the
beam, while the average energy is constant.
Figure 10.4 shows another view of the energy distribution in an ultrasound beam.
This time a two-dimensional view showing the high intensity regions off the central
axis. The shaded areas indicate regions of high local ultrasound intensity. Note that
regions of low intensity on the central axis have, alongside, regions of high intensity
251
and vice-versa.
Most of the ultrasound energy is confined
within the area defined by the brown
lines. There is a slight convergence of
the beam in the near (interference) field
and a small divergence in the far field.
The complex interference pattern makes
it essential that in therapeutic application
of ultrasound the transducer be moved around over the area to be
treated. If the sound-head (ultrasound transducer) were kept stationary,
localized 'hot spots' would be produced in tissue which could result in
excessive local heating. By moving the sound-head in circular paths,
production of local areas of high temperature rise is avoided.
Figure 10.4
Variation in intensity within the ultrasound
beam described in figure 10.3.
If a hollow, doughnut-shaped
crystal were used, the
intensity pattern would again
be different to figure 10.4. In
this case the highest peak
(and the BNR) would be
lower.
252
ar
Z -Z
= 1 2
ai
Z1 + Z2
.... (9.5)
we predict that the amplitude of the reflected wave will be 0.9997 times the amplitude
of the incident wave for an air/tissue interface. Hence (0.9997)2 x 100 = 99.94 per cent
of the incident energy is reflected! Clearly the amount of energy transmitted (0.06%) is
negligible. Almost all of the wave energy is reflected back into the air.
253
Only by having a coupling medium between the transducer and tissue can efficient
transfer of energy be ensured. The coupling medium is spread on the surface of the
skin so that the ultrasound transducer contacts the skin via the coupling medium. No
air/tissue boundary is present.
Many different coupling media can be used. The desirable characteristics of the
coupling medium are:
*
It should be fluid, so as to completely fill the gap between skin and treatment
head and exclude air bubbles.
It should be viscous so that it stays on the skin rather than rapidly flowing and
spreading.
It should not inhibit heat loss from the skin otherwise high temperatures may be
produced in skin and subcutaneous tissue.
In practice the first two criteria listed above are the most important. The principal
function of a coupling medium is to eliminate air gaps and provide contact between
treatment head and tissue. Criterion three is also very important and water or water
based gels are best in this regard. Criterion four is important but most liquids have
similar values of acoustic impedance.
Water meets all the above criteria with the exception of the second (viscosity). For this
reason water is most often used either in a coupling cushion (a polythene or rubber
bag filled with water) or in a bath - when the part to be treated can be immersed.
Oils and liquid medicinal paraffin have appropriate viscosities and so can be used as
254
couplants, however they inhibit heat loss from the skin and produce greater superficial
heating than water, water based gels or glycerol.
Glycerol is viscous and has similar acoustic properties to water. It makes a very good
coupling medium.
Thixotropic couplants are solids at room temperature which liquefy when ultrasound
is applied. They are ideally suited to treatment of a vertical surface as they will not run
down the skin. A number of thixotropic couplants are available.
the rate at which energy is absorbed by the tissue - which is determined by the
penetration depth, .
the extent to which the waves are reflected back into the tissue on striking a
tissue interface: determined by the difference in impedance between the two
media.
255
where is the density and Y the modulus of elasticity (stiffness) of the medium.
The velocity of sound in the medium, v, also depends on elasticity and density
according to equation 10.2:
.... (10.2)
Combining these two equations we obtain a simple expression for the impedance in
terms of velocity and density:
Z = .v
.... (10.3)
Table 10.1 lists the acoustic properties of air, water, various tissues and steel. As
noted previously the acoustic impedance of air differs considerably from the
remaining materials.
The table also shows that there is little
difference in the acoustic impedance of muscle,
fatty tissue and water. For this reason we
expect little reflection at a fat/muscle interface.
The reflection coefficient calculated using
equation 9.5 is 0.10, thus the amount of energy
reflected is 0.1 squared or 1%.
The impedance of bone is higher than that of
muscle hence we expect significant reflection at
a muscle/bone interface.
The reflection
coefficient is 0.50 so we expect about 25% of
the energy to be reflected.
Material
Air
Fatty Tissue
Muscle
Bone
Water
Steel
velocity
(m.s-1)
340
1450
1550
2800
1500
5850
density
(kg.m-3)
impedance
(kg.m.s-1)
0.625
940
1100
1800
1000
8000
213
1.4 x 106
1.7 x 106
5.1 x 106
1.5 x 106
47.0 x 106
Table 10.1
Acoustic properties of materials.
256
negligible and equation 9.12 indicates that refraction is minimal for incident angles up
to about 50o . Thus we can consider the waves to be travelling in one direction in a
straight line through the tissue.
The wave intensity at a point is the energy per unit area per unit time; the area being
taken perpendicular to the wave direction. Since energy varies with distance
according to equation 9.2, the wave intensity I (in watts per square metre) is given by
equation 10.4:
I = Io e-x/
.... (10.4)
where x is the distance in the tissue and is the penetration depth.
The rate of heating is equal to the rate of decrease of intensity with distance. It
depends on two factors, the wave intensity at a particular point and the rate of
absorption of energy (specified, indirectly, by the penetration depth).
The rate of decrease of intensity with distance is obtained by differentiating equation
10.4 to give:
.... (10.5)
where Pv is the heat developed per unit volume per second.
We can use equations 10.4 and 10.5 together with values for (from table 9.1) to
calculate the wave intensity and heat development in different parts of a fatty
tissue/muscle combination once we know the thickness of the fat and muscle layers.
For example, suppose that we have a fat layer of uniform thickness (1 cm) on top of a
thick muscle layer and that ultrasound of frequency 1 MHz is incident upon this tissue
combination. The penetration depth in fatty tissue at this frequency is 7.2 cm (table
9.1) thus the wave intensity (equation 10.4) will be reduced by a factor of e-1/7.2 or 0.87
on traversing the fatty tissue - a decrease of only 13%. After travelling a distance of
one centimetre in the muscle the intensity would be reduced by a factor of e-1/1.7 or
257
0.56 so the intensity would be 56% of 87% or 49% of the original energy.
Figure 10.5 shows the overall reduction in wave intensity with distance in the tissue
and also the relative rate of heating of the tissue (equation 10.5). Calculated heating
rates are scaled to a value of 100% at the muscle surface (because this is where
maximum heating occurs).
Even though we have made a number of simplifying assumptions (to be discussed
shortly) the general implications of figure 10.5 are valid. It is clear that only modest
heating is produced in the fatty tissue. Greatest heating is produced
in the few centimetres of muscle tissue adjacent to the fat/muscle
interface. Using our simplified model, even after penetrating 2 cm of
muscle tissue the ultrasound is predicted to produce a higher rate of
heating than at any point in the fatty tissue.
In 2 cm of muscle the
intensity would be reduced by
a factor of e-2/1.7 = e-1.2 =
0.31 so the intensity would
be 31% of 87% or 27% of
the original value.
Figure 10.5
Wave intensity and relative rate of heating
in fat and muscle tissue with ultrasound of
frequency 1 MHz.
258
is reflected.
Figure 10.6 shows the relative rate of heating which is predicted for a
combination of 1 cm fatty tissue and 1 cm muscle overlying bone. The
reflection has two effects:
*
a greater proportion of the total wave energy is
absorbed in the fat and muscle tissue.
*
the reflected and incident waves will interfere and
produce a standing wave pattern.
The first of these effects is quite significant. Energy will
be absorbed both as the wave travels through fat and
muscle to the boundary with bone and as the reflected
wave travels back through muscle then fatty tissue.
Hence the total rate of heating of fat and muscle tissue at
any depth is greater than without the bone (compare
figures 10.6 and 10.5). The effect on fatty tissue is small.
As might be expected, in muscle the effect is larger
because the reflected wave, and thus the reflected wave
energy, is larger.
The second effect is of less practical importance.
Certainly an interference pattern will be produced but
consider the distance between nodes and antinodes
(figure 9.11). The wavelength of the standing wave
pattern is the same as that of the incident and reflected
waves with nodes and also antinodes separated by one
half of a wavelength. For ultrasound of frequency 1 MHz
the wavelength is 1.5 mm so the antinodes will be separated by 0.75
mm. The antinodes represent points of maximum wave energy and
hence maximum heat production. We have, then, that points of
maximum heat production are only 0.75 mm apart. This is too close to
be of practical significance, particularly if the treatment head is kept
Figure 10.6
Wave intensity and relative rate of heating
in fat, muscle and bone with ultrasound of
frequency 1 MHz.
259
moving. We have already seen why the treatment head can not be kept stationary:
movement is necessary to smooth out the effects of variations in ultrasound intensity
with depth shown in figure 10.4. This same movement will produce variations in
tissue thickness well in excess of 0.75 mm. The net result will be an averaging of any
standing wave pattern as the treatment head is moved: so much so that no evidence
for standing waves would be detected. In addition factors such as the pulsatile nature
of blood flow through tissue and muscle contraction will result in variations in the
thickness of tissue layers: the standing wave pattern will hence shift back and forth,
further smoothing the pattern of heat production.
The most significant feature of figure 10.6 is the high rate of heating of the bone
surface. Most of the wave energy transmitted into the bone is absorbed in the first few
millimetres. This is predicted from the value of penetration depth given in table 9.1.
The result is substantial heating. As can be seen, the heating rate is predicted to be
about three times greater at the bone surface than anywhere in the muscle tissue.
Heat development is confined to the first few millimetres of bone but is quite
substantial. In practice, heat production at the bone surface is often the factor which
limits the intensity which can be used in therapeutic application of 1 MHz ultrasound.
Too great an intensity or too prolonged a treatment can result in periosteal pain and
significant tissue damage (a periosteal burn).
The risk of periosteal burns is reduced by movement of the ultrasound transducer
(treatment head). Movement distributes the ultrasound energy over a larger area of
the bone surface, thus reducing the average energy in a specific location.
The pattern of heat production shown in figures 10.5 and 10.6 indicate the value of 1
MHz ultrasound for heating of deeply located tissue. Figure 10.6 also highlights the
risk when the soft tissue layers are thin and underlying bone is exposed to the
ultrasound beam.
If a frequency of 3 MHz is used rather than 1 MHz, values of penetration depth are
smaller (table 9.1). The ultrasound intensity decreases more rapidly so heat
production is greater in the superficial tissues. A less pronounced 'deep heating'
effect results but there is less energy remaining at depth to heat underlying bone.
260
Figure 10.7 shows the wave intensity and relative rate of heating calculated for
ultrasound of frequency 3 MHz in a tissue combination with the same dimensions as
assumed in figure 10.6. Note that with the assumptions made, the peak heating rate
at the bone surface does not exceed that at the muscle surface.
Comparison of figures 10.6 and 10.7 bears out the
qualitative observation made earlier: if a maximum depth
efficiency of heating is required then 1 MHz ultrasound is
the modality of choice. For less deeply located structures,
3 MHz ultrasound may be preferred to avoid excessive
heating of the bone.
Figures 10.6 and 10.7 indicate the great usefulness of
ultrasound for heating of joints, particularly those located
under thick tissue layers. Heat developed at the bone
surface will be transferred to heat the adjoining tissue.
Experimental work in which the temperature elevation of
the hip joint was measured directly confirms that
ultrasonic therapy is very useful in this regard.
Let us now briefly summarize the approximations made
in calculating the results shown in figures 10.6 and 10.7:
*
Figure 10.7
Wave intensity and relative rate of heating
in fat, muscle and bone with ultrasound of
frequency 3 MHz.
261
9.12 and table 10.1). Reflection at the bone surface was taken into account refraction in bone is unimportant as the penetration depth is so small.
*
We have neglected heat losses to the bloodstream and heat transfer to adjacent
tissues. These effects are considered next.
A third factor is that any temperature increase in muscle would also be expected to
trigger reflex dilation, whereby arterioles dilate to increase the blood flow in response
262
the low specific heat capacity of fatty tissue and poor thermal conductivity will
result in a greater temperature rise than indicated by the graphs. In addition the
thermal conductivity of fatty tissue is low and its vascularity is not as good as
muscle; consequently heat can not be removed as rapidly. This adds to the
temperature elevation of fatty tissue as compared to muscle.
efficient heat transfer through muscle tissue and to blood vessels will result in
more uniform heating of muscle and less temperature rise than might otherwise
be expected. At the same time heat transfer to the adjacent fatty tissue will
reduce the temperature elevation of muscle near the fat/muscle interface.
bone is a relatively good conductor of heat. The heat will be rapidly distributed in
the bone and also transferred to the periosteum. The higher thermal conductivity
partially compensates for the rapid absorption of energy near the bone surface
and reduces the selective heating. It is still possible, however, to produce a
maximum temperature elevation in the periosteum when the intervening tissue
layers are not very thick. This gives rise to the periosteal pain mentioned
previously.
Despite these limitations, some of which also apply to other diathermic modalities,
ultrasound is an effective deep-heating modality. The principal factor limiting the
temperature elevation which can be produced at depth is heating of the periosteum.
Mechanical Effects
The predominant physiological effects of ultrasound therapy are due to a rise in
temperature of the treated tissues. Certain effects are, however, produced which are
a direct result of the mechanical vibration of tissue.
263
Therapeutic ultrasound
produces large stresses in
biological tissues, acting over
distances of a fraction of a
millimetre. The stresses are
greatest in the regions shown
in figure 10.4.
Listed below are some examples of the effects of ultrasound where mechanical
stresses are thought to play a significant role. It should be emphasized that in all
instances heating contributes to the observed results: in most cases it is difficult to
ascertain the relative contribution of thermal and mechanical effects.
*
264
of
in
of
to
Ultrasound is useful in relieving pain and muscle spasm. While any form of
heating is useful in this regard, it appears that ultrasound can have an effect
other than via direct heating. The mechanism of this action has not been
conclusively established but it is interesting to note that an optimum effect
appears to be produced using pulsed ultrasound beams. The pulse frequency
normally available is 100 Hz - the same frequency used to produce analgesia by
electrical stimulation.
PULSED ULTRASOUND
Most ultrasound apparatus makes provision for either pulsed or continuous output. In
pulsed mode the ultrasound is produced in bursts, normally with a frequency of 50 or
100 Hz. If the duty cycle ('on' time to 'on + off' time) is 1:5 then the apparatus is 'on' for
only one fifth of the time: consequently the rate of transfer of energy is one fifth of that
obtained using the continuous mode at the same intensity. If the dose required
(continuous mode) necessitates treatment for 20 minutes then to obtain a similar
thermal effect using pulsed ultrasound we would have to extend the treatment time or
265
increase the intensity to compensate. An increase in the treatment time alone will not
compensate adequately. Suppose the duty cycle is 1:5 then a 20 minute (continuous)
treatment could be increased to 100 minutes (pulsed). Although the total energy (the
dose) supplied to the tissue is the same in both cases, spreading the treatment over
100 minutes will considerably reduce the temperature elevation produced.
Increasing the intensity by a factor of five will result in the same rate of energy transfer
to tissue (dose rate) but the much higher peak intensities could result in tissue
damage through gaseous cavitation - the rapid formation and collapse of tiny gas
bubbles in the tissue fluid. The cavitation effect will be described more fully in chapter
12 along with other potentially harmful effects.
Temperature elevation
depends not just on the dose
but also on the dose rate.
Proponents of the use of pulsed ultrasound argue that heat production is rarely the
sole objective of therapy and that in some applications it may even be undesirable. By
use of pulsed ultrasound, at low to moderate intensities, mechanical effects are
produced while heat production is kept to a minimum. Of course the same (low) rate
of heat production could be achieved using the continuous mode at one fifth of the
peak intensity. We would, however, expect some differences in the mechanical effects
produced: continuous mild mechanical agitation does not necessarily produce the
same effect as brief vigorous mechanical agitation. The idea is that mechanical
effects do not depend linearly on intensity: that there is a threshold intensity level
below which the mechanical effects are negligible. Pulsed ultrasound would ensure
that intensities above threshold are achieved while keeping heat production to a
minimum.
One study which indicates the possibility of therapeutically significant mechanical
effects was carried out by Dyson et al. (1968). These authors examined the rate of
tissue repair using continuous output treatment compared with pulsed mode
treatment using different duty cycles. The frequency used was 3 MHz and the output in
pulsed mode was adjusted to keep the average power the same in each experiment.
Tissue growth rate was increased using a duty cycle of 1:5 but retarded when a duty
cycle of 1:80 was used. It seems that modest duty cycles may promote repair activity
but that (for the same average power) too small a duty cycle involves peak power
levels which are damaging to tissue. The results of this and other relevant studies
266
EXERCISES
1
(a)
(b)
Figure 10.3 shows the distribution of ultrasound energy with distance along the
central axis of an ultrasound transducer. In this case the interference pattern is
generated by a 2.8 cm diameter, 1 MHz frequency, ultrasound source in water.
267
(a)
(b)
(c)
fatty tissue rather than water was used. What is the effect of the different
wave velocity in fatty tissue?
Use equation 9.5 and the impedance values given in table 10.1 to calculate the
reflection coefficient of a metal/air boundary and an air/fatty tissue boundary.
(a)
(b)
(a)
(b)
(c)
State the relative advantages and disadvantages of water, oils, glycerol and
thixotropic fluids as coupling media.
Ultrasound of frequency 1 MHz travels through water and strikes fatty tissue. Use
the data in table 10.1 to calculate the reflection coefficient of the water/fat
boundary. What percentage of the incident wave energy is transmitted?
Use equation 9.5 and the figures in table 10.1 to calculate the reflection
coefficient of ultrasound at the following boundaries:
(a) fatty tissue/muscle
(b) muscle/bone
What are the practical implications of these figures?
(a)
(b)
Refer to figure 10.5 and explain how the graph of wave intensity vs distance
can be used to obtain the graph of relative rate of heating versus distance.
What is the relationship between penetration depth (table 9.1) and relative
rate of heating (figure 10.5)?
For ultrasound of frequency 2 MHz (table 9.1) calculate the fraction of energy
remaining after travelling through:
(a) 2 cm fat
(b) 2 cm muscle
(c) 2 cm bone
10
11
12
Compare figures 10.5 and 10.6 and explain why the wave intensity appears to
diminish less rapidly with distance in fat and muscle in figure 10.6.
268
Consider figure 10.6, which shows the wave intensity at different depths in a
muscle/fat/bone tissue combination. The graph is obtained assuming that 25%
of the incident energy is reflected at the muscle/bone interface.
(a) How would the graph of intensity versus depth differ if reflection at the
muscle/bone interface was negligible?
(b)
(c)
14
Compare figures 10.6 and 10.7 and summarize the advantages and
disadvantages of 1 MHz ultrasound compared with 3 MHz ultrasound for different
thicknesses of tissue over bone.
15
The results shown in figures 10.5 to 10.7 take no account of heat losses to the
air, the bloodstream and between adjacent tissues. Redraw figure 10.7 to show,
qualitatively, the relative rate of heating when heat loss and heat transfer are
taken into account.
16
Figures 10.5 to 10.7 show the relative rate of heating of different tissue exposed
to ultrasound.
(a) What additional factor must be taken into account to predict the initial rate of
temperature increase in each tissue?
(b)
17
Draw a diagram, based upon figure 10.7 to show (qualitatively) the initial
rate of temperature increase in each tissue. You may assume that the
specific heat capacity of muscle is twice that of fatty tissue and bone.
Explain why graphs such as those shown in figures 10.5 to 10.7 can be used to
accurately predict the initial rate of temperature increase in tissue but not the final
temperature increase in therapy. What additional factors must be taken into
account to predict the final temperature elevation?
18
(a)
(b)
19
20
269
270
271
272
These are:
*
*
*
UV-C radiation is used to sterilize things when you don't want to boil them. This is
because UV-C, at sufficiently high intensities, destroys bacteria. It does this by
damaging the bacterial DNA. UV-C exposure will also damage human cells in the
same way and can produce malignancies (cancer). UV-C and, in fact, UV-B and -A
have an extremely low penetration depth, so most of the absorption of UV is by the
skin. The low penetration depth of UV is the reason that UV exposure (in particular,
exposure to UV-C) is associated with skin cancer.
The usual means of producing ultraviolet light is by the passage of an electric current
through an ionized gas or vapour. Gases at normal temperature and pressure are
very poor conductors. They can, however, be made to conduct at high temperature or
low pressure in the presence of a sufficiently strong electric field.
Ultraviolet radiation for therapeutic application is usually produced by current flow
through mercury vapour. Mercury under reduced pressure is contained in a sealed
envelope of quartz or special glass with an electrode inserted in each end. The device
is similar to the strip-lights (fluorescent lights) commonly found in the
kitchen at home and the office or tutorial room. The difference is that UV
lights operate at lower pressures than household or business lights. This
means that more energy is required to initiate conduction and charges are
accelerated over greater distances so that when they collide, the energy
release is larger and, as a result of the higher energies, UV rather than
visible light is produced. The arrangement used with a mercury vapour
lamp is shown in figure 11.1.
Figure 11.1
Schematic diagram of a mercury vapour lamp.
The reduced pressure in the lamp ensures that mercury vapour is present, but in
order for current to flow the vapour must be ionized. This means that electrons must
be separated from the parent atoms. Cosmic rays and gamma-rays are high
frequency and high energy and can 'kick' electrons from their orbitals, so producing
positive ions and free electrons. Under normal circumstances the electron returns to
its parent atom, because of the attraction between positive and negative charges.
However, in a sufficiently strong electric field (as in the lamp) the excited electron can
accelerate and collide with other atoms. If the electric field is strong enough, the
electron can gain enough energy to cause further ionization and produce an
'avalanche' effect: one electron is accelerated and collides, producing more metal
ions and free electrons which in turn accelerate, collide and cause further ionization.
273
It is generally necessary to
help initiate the avalanche, or
discharge, by pulsing the
lamp with a high voltage.
Once the discharge is started
the current must be regulated
to limit and control the output
of light from the lamp.
Also indicated in the figure are approximate proportions of ultraviolet, visible and
infrared radiation expressed as a percentage of the total energy output. The
proportions vary with the pressure of mercury vapour in the lamp or tube and with the
thickness and composition of the lamp envelope. Percentages are not shown for
fluorescent tubes ('strip lights') or incandescent lamps (normal globes) as the
274
275
Within the ultraviolet region of the spectrum there are significant differences in the
output of mercury vapour lamps and tubes:
*
Low pressure mercury vapour lamps, otherwise known as cold quartz lamps
when the envelope material is quartz, emit most of their ultraviolet radiation in the
UV-C region, at a wavelength of 253.7 nm. The operating temperature of the
lamp envelope rarely exceeds about 60oC.
High pressure mercury vapour lamps, known as hot quartz lamps when the
envelope material is quartz, put out a proportion of their ultraviolet energy at a
wavelength of 366.0 nm (in the UV-A region). There is also significant output at
specific wavelengths in the UV-B and UV-C regions. The amount of energy in
each region depends on the construction of the lamp. The normal operating
temperature of these lamps is several hundred degrees Celsius: if they are to be
used close to, or in contact with the patient they must be cooled by a water jacket
(Kromayer lamps) or an air blower.
Fluorescent ultraviolet tubes are usually low pressure mercury lamps in the form
of a long tube. The tube is coated on the inside with fluorescent substances
(phosphors). The purpose of the phosphor is to absorb the original ultraviolet
radiation and re-emit it at longer wavelengths. Different phosphors have different
wavelengths for re-emission of radiation. The commonly used ultraviolet tubes
put out most of their energy in the UV-A region. Special tubes are available which
produce a maximum output in the UV-B region. A negligible amount of UV-C
radiation is emitted from any of these light sources.
In the past carbon arcs were used extensively for the production of ultraviolet radiation.
Two carbon rods are brought into contact with each other and a current is passed
through them. With a small point of contact the high current density heats and
vapourises the carbon. The rods are then separated and the presence of carbon
vapour enables a current to flow in the form of an arc discharge between the ends of
the rod. The spectrum produced by carbon arcs has a range close to that of sunlight
(figure 11.2): the proportions of ultraviolet, visible and infrared radiation are also
similar.
276
Carbon arcs are rarely used today in physiotherapy departments: they have been
largely superseded by mercury vapour lamps which are cleaner and easier to operate.
277
278
279
nucleic acids absorb strongly at frequencies between 250 and 260 nm and at 280 nm.
An increase in metabolic rate in the superficial tissues. This is the direct effect of
temperature on the rate of chemical reactions generally. As a result there will be
an increased demand for oxygen and an increased output of waste products.
Dilatation of capillaries and arterioles due directly to the heating and also as a
reflex reaction to the presence of increased concentrations of metabolites. The
flow of blood to the superficial tissues is thus increased producing a reddening
of the skin (erythema) and an increased supply of oxygen and nutrients. The
erythema produced by infrared therapy, unlike that resulting from ultraviolet
treatment, appears quite rapidly and begins to fade soon after treatment ceases.
Sensory sedation. Mild heating has a 'sedatory' effect on sensory nerves and is
thus useful for the relief of pain.
Muscle spasm relief. This results from both the effect of heat on nerve fibres and
the direct effect of heat which is transferred to muscle from the superficial
tissues.
An increased blood supply to the skin results from dilation of the capillaries and
arterioles. Dilation does not result from heating of the tissue but as a reflex
response to destruction of cells. Cells are destroyed as a result of chemical
changes caused by the absorption of radiation, and reddening of the skin
(erythema) results. The effects are similar to the changes observed in
inflammation. Two groups of waves produce this reaction, one with wavelengths
in the UV-C region around 250 nm and one with wavelength close to 300 nm
(UV-B).
280
In laboratories and
pharmaceutical preparation
areas, contamination by
bacteria must be avoided, so
lamps producing UV-C are
used to irradiate the areas.
281
A first-degree erythema is a slight reddening of the skin which takes from six to
eight hours to develop. The erythema has faded in about twenty four hours
leaving the skin apparently unchanged. A minimum erythema dose (MED) is also
a slight reddening which takes from six to eight hours to develop but in this case
the erythema is still just visible at twenty four hours.
282
PRODUCTION OF MICROWAVES
Having considered the low penetration electromagnetic waves - infrared, visible and
ultraviolet - we now turn to lower frequency waves used in therapy; microwaves.
Microwaves occupy the region of the electromagnetic spectrum between radio waves
and infrared radiation: their wavelengths are in the range from about a centimetre to a
meter - corresponding to frequencies in the range 300 MHz to 30 000 MHz. Three main
frequencies are used for physiotherapy, 2450 MHz (wavelength 12 cm), 915 MHz
(wavelength 33 cm) and 433.9 MHz (wavelength 69 cm). Note that the wavelengths
quoted are in air. In biological tissues the wavelength is significantly lower because
the wave velocity is lower.
Radio waves can be produced by first generating a very high frequency AC signal in an
ordinary electronic circuit and then applying this signal to a suitable antenna. The high
frequency alternating current in the antenna results in radio frequency waves being
produced and radiated. The limit to the frequencies that can be produced by standard
electronic circuits is determined by the time it takes for an electron to travel through a
transistor. If the transit-time, the time taken, becomes comparable to the time of
oscillation or period of the wave we wish to produce, then the transistor can no longer
function at this frequency. Microwave frequencies are extremely high, by electronic
standards, and are at the limit of those which can be produced by transistors.
Although vacuum tubes (valves) are an older design and are generally more inefficient
than transistors, two vacuum tube devices which can operate at microwave
frequencies were developed many years ago: these are the magnetron and the
klystron. The magnetron valve, first described by Hull in 1921, was developed for radar
use during the second world war. It is more useful for high power applications than
the klystron. After the war, apparatus operating at a frequency of 2450 MHz (the
standard radar frequency) was made available to physiotherapists.
Microwave apparatus (figure 11.4) consists of a device (a magnetron or klystron),
powered by an electronic circuit. The high frequency alternating current which is
produced is fed to an antenna. The current flowing in the antenna results in the
283
The frequency of the microwaves is equal to the frequency of the AC produced by the
magnetron. This is determined by the physical construction of the magnetron and is
fixed during manufacture.
A number of differently shaped antennas and reflectors may be used for directing the
beam. Each gives a different beam shape though none gives a perfectly uniform
beam. To obtain a collimated uniform beam (like a searchlight) would require a
parabolic reflector with a point source of radiation as shown in figure 11.5(a). If a point
source of radiation is placed at the focus of the parabola the beam emerges with a
uniform cylindrical shape as shown.
In the case of microwaves used by physiotherapists, the most common frequency is
2450 MHz and the wavelength in air is 12 cm. The source of radiation is normally a
half-wave antenna; a rod shaped conductor about 6 cm long. Placed in a small
parabolic reflector the antenna would produce a highly non-uniform beam (figure
11.5b). To produce a reasonably uniform beam the antenna would need to be placed
in a reflector very much larger than its 6 cm length. A reflector with a focal length of a
284
285
Table 11.1
Dielectric constant and conductivity of tissue
at microwave frequencies.
286
The significant difference in the electrical properties of air (for which 1 and 0)
and soft tissue will result in a considerable amount of the energy incident upon the
skin being reflected. The total percentage of microwave energy absorbed deeper in
the body tissues and hence converted into heat also depends on the thickness of the
skin/fatty tissue layer. This is because a proportion of the wave energy reflected from
the fat/muscle interface will penetrate the skin and be re-radiated into the air.
Some decades ago, H. P. Schwan (see Licht (1968)) calculated the percentage of
total energy reflected at different frequencies and various thicknesses of skin and fat.
His results show that:
*
At frequencies less than 1000 MHz, 60 to 70% of the energy is reflected this
almost independently of skin and fat thickness.
Between 1000 and 3000 MHz reflection depends critically and in a complex way
on tissue thickness. Between 0 and 80% of the energy is reflected.
Above 3000 MHz around 60% of the energy is reflected - again almost
independently of tissue thickness.
One major implication of the above results is that at a frequency of 2450 MHz the
effective dosage is virtually impossible to determine in a clinical situation, due to the
practical difficulty in establishing skin and fat thickness which may vary considerably
in the treated area. Clearly a frequency above or below the range 1000 to 3000 MHz is
to be preferred on these grounds. As we will see in what follows, a lower frequency is
preferable.
287
that no bone is present. We will take bone into account in subsequent examples.
that refraction can be ignored. In other words the angle of incidence is assumed
to be zero. Refraction effects will be described separately.
The relative rate of heating can be calculated from the dielectric constant and
conductivity of each tissue: the two factors which determine the amount of reflection
and the penetration depth. The method of calculation is described by Schwan (see
Licht (1968)).
Figure 11.6 shows the pattern of heat production for microwaves at the relatively high
frequency of 8500 MHz (wavelength 3.5 cm in air). A standing-wave pattern (see
chapter 9) is produced in the fatty tissue: this is because of reflection at the fat/muscle
interface.
288
Figure 11.6
Heating pattern predicted for microwaves of
frequency 8500 MHz in a specimen of 2 cm fatty
tissue over muscle.
The standing-wave pattern in the fatty tissue is not ideal since reflection is not 100%
and the wave is progressively absorbed in its travel. The actual pattern is a
combination of an exponential decrease (determined by the penetration depth, ) and
interference of unequal size waves (figure 9.12).
At this frequency, most heat is produced in the fatty tissue close to the skin and in the
superficial region of the muscle. A reasonable heating rate is obtained at the muscle
surface but the effect extends to only a fraction of a centimetre into the muscle tissue.
The total amount of heat produced in each tissue is indicated by the area under the
curves in figure 11.6. It is evident that there is greater overall heat production in the
fatty tissue. This problem is typical of higher microwave frequencies.
The peaks in the heating pattern in the fatty tissue are separated by one half of a
wavelength (see chapter 9 - this is close to 1 cm in figure 11.6) so the wavelength of
the microwaves in fatty tissue is about 2 cm.
289
At a frequency of 2450 MHz, the frequency most commonly used in therapy, the relative
rate of heating is as shown in figure 11.7.
Figure 11.7
Heating pattern predicted for microwaves of
frequency 2450 MHz in a specimen of 2 cm fatty
tissue over muscle.
Figure 11.8
Heating pattern predicted for microwaves of
frequency 915 MHz in a specimen of 2 cm fatty
tissue over muscle.
290
At 915 MHz, a standing wave pattern is still produced in the fatty tissue but the
wavelength is so large that no peaks are evident.
Figure 11.9 shows the relative rate of heating predicted for a microwave frequency of
434 MHz in the same tissue specimen.
Figure 11.9
Heating pattern predicted for microwaves of
frequency 434 MHz in a specimen consisting
of 2 cm fatty tissue over muscle.
The depth efficiency of lower frequency microwaves
is apparent from figures 11.8 and 11.9. Both
frequencies give maximum heating in the muscle
with much the same decrease in heating rate with
distance into the tissue. The lowest frequency (434
MHz) produces least heating of fatty tissue; the
difference being most noticeable near the tissue
surface.
Both frequencies give a heating pattern which is
suitable for diathermy and dosage is reasonably
predictable.
The heating of the fatty tissue surface with 915 MHz microwaves can be compensated
for by using a contact applicator with surface cooling. The microwave director
(applicator) is designed to be used in direct contact with the patient. Cooling air is
blown through the applicator and on to the patients' skin during treatment in order to
minimize the temperature elevation of superficial tissues.
291
Figure 11.10
Heating pattern predicted for a microwave
frequency of 2450 MHz in a tissue combination
of 2 cm fat, 2 cm muscle and 2 cm bone.
Figure 11.11
Heating pattern predicted for a microwave
frequency of 915 MHz in a tissue combination
of 2 cm fat, 2 cm muscle and 2 cm bone.
292
Figure 11.12
Heating pattern predicted for a microwave
frequency of 434 MHz in a tissue combination
of 2 cm fat, 2 cm muscle and 2 cm bone.
293
Figure 11.13
Refraction of a microwave beam
at tissue interfaces.
294
Microwaves are intrinsically unsuited to heating of bone (see figures 11.10 to 11.12)
because of its electrical characteristics: for this reason joints can only be heated when
the overlying tissue layers are very thin. For heating of deeply located joints,
ultrasound or shortwave diathermy would be more effective.
As a final point it should be stressed that the graphs shown in figures 11.6 to 11.12
show where heat is produced but not the temperature increase in each tissue. The
temperature increase depends on such factors as the specific heat capacity of the
tissue and heat transfer within and between tissues and to the bloodstream (see
chapter 7).
LASERS
The acronym 'laser' stands for 'light amplification by stimulated emission of radiation'.
Lasers are electromagnetic wave amplifiers which can produce beams of electromagnetic waves with two special properties:
*
the beam is coherent. That is, all the waves in the beam are of exactly the same
frequency and wavelength and are synchronized with each other.
The pencil-like beam of the laser means that the wave energy is always concentrated
on the same area: the intensity (which is the energy per unit area) does not decreased
appreciably with distance due to beam-spreading.
295
We can summarize the differences between laser light and light from a common,
incandescent light bulb as follows. Light from a normal incandescent source has a
spectrum of frequencies and the waves are incoherent. Lasers are beams of
coherent waves of identical frequency. There is some clinical evidence that laser
296
beams can be therapeutically beneficial. What has not been established is whether
laser beams have any advantage over simpler (and cheaper) torch beams. No
comparisons have yet been reported.
Beam Intensity
The output of a laser can vary from tens of milliwatts to tens of kilowatts, depending on
the type and the physical construction. Lasers used therapeutically have power levels
between these two extremes. They are typically of relatively low power and intensity.
Intensities are normally in the range 1 mW.cm-2 to 50 mW.cm-2.
The beam diameter of the low power lasers used clinically is about 3 mm (an area of
about 7 mm2). Thus if the output intensity is, for example, 20 mW.cm-2 and the area is
7 mm2 = 0.07 cm2, the power of the beam is 20/0.07 mW 300 mW or 0.3 W.
By way of comparison, a torch might have a beam 8 cm in diameter (an area about 50
cm2) and use a 12 W light bulb. As far as visible light output is concerned, the bulb is
about 25% efficient (75% of the energy is emitted at infrared frequencies). Hence the
power of the visible light-beam is approximately 3 W. The visible-light beam intensity
is 3/50 = 0.06 W.cm-2 or 60 mW.cm-2 . The intensity of the infrared component is
approximately 180 mW.cm-2.
A torch beam thus has a similar and, if anything, a higher power and intensity than a
clinical laser but is polychromatic. The wave energy is spread over a range of
frequencies. Any clinical significance of the polychromatic/monochromatic difference
has yet to be established.
Beam Divergence
Light from a light bulb can be formed into a pencil-like beam (as in a searchlight) by
using a parabolic reflector but the beam divergence is larger than that of a laser
because of the practical difficulty of producing a perfectly shaped reflector. This
difference would be of no clinical significance for beams between a light source and
the patient, a distance of only a few centimetres or tens of centimetres.
297
Beam Diameter
The beam diameter of the low power lasers used clinically (commonly referred-to as
'low level lasers') is about 3 mm (an area of about 7 mm 2 = 0.07 cm2 ). A
consequence is that if the area of the skin surface which is to be treated is several
cm 2 , the beam must be scanned over the area. This means that both the average
intensity and the energy delivered per unit area are reduced. For example, if the area
to be treated is 5 cm x 5 cm (25 cm2), the reduction in average intensity and energy
delivered per unit area is 25/0.07 = 3500 times. By contrast, a torch beam would
illuminate the same area with no reduction in intensity or energy delivered.
Coherence
The light from a light-globe is incoherent. The radiated waves have different
frequencies (a spread of frequencies about some mean) and the waves are not 'in
synch' with each other. Synchronization is impossible because the wavelengths are
different. The coherence of a laser beam is not likely to be of practical significance as
biological tissues are quite inhomogeneous at a microscopic level. This means that
waves will be scattered and slowed to varying extents so coherence will be lost. A
coherent beam striking the skin surface will be incoherent after traversing a distance
through tissue of only a few cell diameters. Although coherence is rapidly lost in
biological tissue, the beam remains monochromatic i.e. the waves still have identical
frequencies.
298
Two types of lasers are commonly used in physiotherapy: helium-neon lasers, which,
as noted above, produce red light of wavelength 632.8 nm and gallium aluminium
arsenide diode lasers, operating at near-infrared wavelengths (normally between 810
and 850 nm).
Penetration Depth
The penetration depth of laser radiation is the same as ordinary electromagnetic
radiation of the same frequency. The wave coherence and the monochromatic nature
of the laser beam make no difference. Thus the penetration depth of visible light from
a helium-neon laser is a mm or so and most of the wave energy is absorbed in the
epidermis (figure 11.3). The infrared radiation produced by commercial GaAlAs
diodes has greater penetration depth but most of the wave energy is absorbed in the
epidermis and dermis.
This perhaps explains why laser irradiation has been shown to be of value for treating
ulcers and other skin conditions. What has not been shown, and is not likely to be
shown, is that laser treatment is any better than shining a torch beam on the area.
Similar considerations indicate that laser irradiation is not likely to be of value for
treating deeper tissue injuries.
The therapeutic benefit and relative cost effectiveness of laser therapy must thus be
questioned.
299
EXERCISES
1
(a)
(b)
What are the similarities and differences between infrared, ultraviolet and
microwave radiation?
State the wavelength range and frequency range of each kind of radiation.
Describe the mechanism whereby ultraviolet radiation is produced in the
lamp.
(b)
Why must the power supply used for the lamp be current limiting?
(c)
Compare the output of UV, visible and infrared radiation of air and water cooled
UV lamps and fluorescent tubes (figure 11.2).
(a)
(b)
(a)
(b)
What effect does the use of a reflector have on the directionality and
wavelength of the radiation produced?
(a)
(b)
Use figure 11.3 to describe the variation with frequency of the penetration
depth of near infrared radiation.
Describe the ways in which heat produced by near infrared radiation is
transferred to subcutaneous tissue. Which would you expect to be the
most efficient transfer mechanism?
Compare and contrast the principal effects of infrared and ultraviolet radiation on
tissue. How are the differences related to the wavelength of the radiation?
(a)
(b)
Figure 11.4 shows a schematic diagram of apparatus used for the production of
microwaves.
(a) Briefly describe the function of each subsection.
(b) Why is a magnetron valve rather than conventional electronic circuitry used
in microwave apparatus?
(c) What is the relationship between the size of the antenna in figure 11.4 and
the wavelength of the microwaves produced?
(d) What determines the frequency of the microwave radiation produced by the
apparatus?
10
Figure 11.5 shows the beam produced by a point source of radiation positioned
at the focus of a parabolic reflector. Draw diagrams to show the effect on the
beam shape of:
(a) mounting the point source between the focus and the reflector surface (still
on the central axis)
300
11
(b)
mounting the point source on the central axis but further from the reflector
than the focus.
(a)
Explain why parabolic reflectors are not used with microwave diathermy
apparatus.
What are the most important factors determining the size and shape of the
reflectors used with microwave diathermy apparatus?
(b)
12
(a)
(b)
301
Give a brief explanation (in molecular terms) of why tissues with high
dielectric constant and conductivity have low values of penetration depth for
microwave radiation
Refer to the figures given in table 11.1 and comment on the relative values
of penetration depth for microwaves in fat, muscle and bone. Which tissues
would be expected to have similar values of penetration depth and why?
13
It has been said that a frequency of 2450 MHz represents a very poor choice for
microwave radiation used in therapy because of the unpredictability of dosage.
Explain.
14
Using data in table 11.1 determine the thickness of fat required to absorb 50% of
the transmitted microwave energy at a frequency of:
(a) 1000 MHz
(b) 2000 MHz
(c) 4000 MHz
15
For microwaves of frequency 2000 MHz (table 9.1) calculate the fraction of energy
remaining after travelling through
(a) 2 cm fat
(b) 2 cm muscle
(c) 2 cm bone.
In which tissue is the energy absorbed most rapidly?
16
Refer to figure 11.6 and explain the origin of the peaks and troughs (maxima and
minima) in the heating pattern.
17
Refer to figure 11.6. Draw the corresponding graph of relative rate of heating
which would be expected if the reflection coefficient of the fat/muscle interface
was:
(a) 0.0
(b) 1.0
18
Compare figures 11.7, 11.8 and 11.9 and explain how the microwave wavelength
is related to the differences in heat production in each case.
19
H. P. Schwann has shown that from the point of view of reliable dose prediction
microwaves with frequencies either below 1000 MHz or above 3000 MHz are
preferred. Compare figures 11.6 and 11.9 and say whether high frequencies or
low frequencies would be preferred from the point of view of the pattern of heating
produced.
20
Compare figures 10.6 and 10.7 with figures 11.10 to 11.13 and explain the
differences in heat production in terms of:
(a)
(b)
21
Figure 11.13 shows a beam of microwaves striking an arm or leg. Briefly explain
why the beam converges in fatty tissue and muscle.
22
The diagram below shows a uniform microwave beam striking a tissue surface.
The fat and muscle layers have only slight curvature. The bone surface is
markedly curved. Fatty tissue and bone have low values of dielectric constant
and conductivity. The corresponding values for muscle are high.
302
Complete the diagram to show the refraction effects. Briefly explain what
happens to waves at each boundary and why.
303
304
It is convenient to consider dosage in two parts: the first as applied to infrared, visible
305
The dose: in other words the total energy supplied to the patient - normally
expressed in joules (J).
The dose rate: the rate at which energy is supplied. This has units of joules per
second. One joule per second (J.s-1) is one watt (W).
The irradiance: the dose rate per unit area of body surface. Normally in units of
joules per square centimetre per second (J.cm-2 .s -1 ) i.e. watts per square
centimetre (W.cm-2). When talking about radiation (sound or electromagnetic
waves) this quantity is what we call the intensity.
The general requirement in specifying dosage is that all three of these quantities be
stated, either directly or indirectly. Each gives important facts about the treatment. For
example, consider the heating effect of ultrasound. The total amount of heat
developed is determined solely by the dose. The temperature increase, however,
depends on the dose rate, the time of treatment and the area treated: that is, on all
three factors listed above. Since it is the temperature rise rather than heat production
as such which determines the physiological response, a knowledge of dose alone is
insufficient.
The therapeutic effects depend not just on the energy output of the lamp but also
on the frequency of the radiation (chapter 11). This is most noticeable with
ultraviolet radiation where only narrow ranges of frequency produce the desired
reactions.
A dose of 10 J administered
in a second or so would
evoke a marked physiological
response. The same dose
applied over a 10 minute
period would have little effect.
306
A given dosage from the same lamp will produce a greater response in some
patients than others. Again greater variation is found with ultraviolet radiation.
For infrared treatment, specifying the particular type of lamp, the reflector used, the
patient-to-lamp distance and the time of exposure is an adequate statement of
dosage. Dose, dose rate and intensity are thus specified indirectly. Generally the
intensity used is that which produces a mild, comfortable warmth after 5 minutes. If
this does not come about, the lamp-to-patient distance can be adjusted during the
treatment.
With ultraviolet therapy the maximum effects are not produced until long after
treatment is complete. For this reason no adjustment of the dose can be made
during treatment. A close estimate of the dose requirement is needed beforehand.
How can this be achieved? A measurement of the total power output of the lamps is
insufficient. Even if the output was measured at different frequencies this would take
no account of variation in sensitivity of individual patients. A more useful and direct
method is to test lamps in terms of the amount of radiation needed to produce a
specific biological response in each particular patient.
307
Specification of the dosage in this case requires a statement of the particular lamp
used, the exposure time and the patient-to-lamp distance.
Once the time and distance required for a particular lamp are known the dosage
needed to produce any other degree of erythema can be established from table 12.1.
E 1 refers to a first-degree erythema, E2 to one of seconddegree and so on. The values quoted are experimentally
determined and represent a consensus of agreement
amongst physiotherapists. To obtain the exposure time
required for a second, third or fourth degree erythema the
time for first-degree erythema production is multiplied by the
appropriate conversion factor. For example if a first-degree
erythema is produced after 6 seconds exposure, table 12.1
indicates that 5 x 6 s = 30 s exposure is required to produce
a third-degree erythema.
In table 12.1 the lamp-to-patient distance is assumed to be
the same. For different distances an inverse-square law is
applied (see below) to correct the conversion factor.
Erythema reaction
E1
E2
E3
E4
Conversion factor
2.5
10
Table 12.1
Conversion factors for different degrees of
erythema.
Table 12.2
Conversion factors for repeated exposure to
ultraviolet radiation.
Erythema reaction
E1
E2
E3
E4
Conversion factor
1.25
1.5
1.75
308
Following marked
desquamation it is common
practice to reduce the
exposure time to its original
(first exposure) value.
In psoralen-UVA (PUVA) therapy the drug is administered two hours before UV-A
exposure. The drug renders the patient UV-A sensitive and an erythema response is
readily evoked.
The dosage required to produce a minimal erythema 72 hours after exposure is
determined. This is called the minimal phototoxicity dosage (MPD). It is found by
exposing test areas of the patient's skin to predetermined dosages of UV-A (for
example 0.5, 1, 2, 3 and 4 J.cm-2) and inspecting the test areas 72 hours later.
Once the MPD has been determined, treatment can be given with the dosage
specified in J.cm-2. The present practice is to use the MPD for the first treatment and
to progress the dosage by 0.5 J.cm-2 or 1 J.cm-2 (depending on skin type) on each
subsequent treatment.
UV-A fluorescent tubes display a significant drop in output intensity, particularly over
the first 200 hours of use. For this reason it is essential that the output intensity of the
UV-A source be regularly measured. Special meters, calibrated in W.cm-2 , are
available for this purpose.
If the output intensity of the source is known the dosage in J.cm-2 can be calculated
using the relationship:
Dosage (in J.cm-2) = Intensity (in W.cm-2) x time (in s)
309
310
What happens to the wave energy which passes through the square aperture? For
infrared, ultraviolet and microwave energy there is very little absorption in air over a
distance of a few metres. In other words their penetration depths in air are large. This
means that the wave energy in the rectangular beam in figure 12.1 is virtually constant.
If the beam of radiation has an energy E at the aperture then the intensity - the energy
per unit area - is E/x2. At a distance 2s from the source this energy is spread over an
area 4x2 , so the intensity is E/4x2 or one quarter of its value at the screen. At a
distance 3s the intensity is one-ninth of the value at the screen.
An inevitable conclusion is the law of inverse squares which states that the intensity of
radiation from a point source varies inversely with the square of the distance from the
source.
o
.... (12.1)
d2
where I in the intensity at a distance d from the source and Io is the intensity at unit
distance.
I =
How is the law of inverse squares applied to dosage? Strictly speaking, the inverse
square law only holds for point sources of radiation. Sources of infrared and
ultraviolet are extended sources, usually mounted in reflectors. The effect of the
reflector is to reduce the divergence of the beam, but for the lamps used in
physiotherapy departments the effect is not too great and the law provides a rough,
rule-of-thumb, but satisfactory basis for calculations.
An Example:
Consider treatment with a high pressure mercury vapour lamp (a hot quartz lamp;
chapter 11). Suppose we know that the minimal erythema dose with a particular lamp
is 18 seconds at a distance of 1 metre and we wish to use the lamp at a distance of
311
to.d2
do2
.... (12.2)
Here t o and do refer to the original exposure time and the original distance
respectively. t is the new exposure time at the new distance d.
Figure 12.2
(a) effect of beam divergence on the angle of
incidence, . (b) effect of both beam
divergence and surface curvature.
(continued overleaf)
312
Figure 12.2
(c) effect of beam divergence and angulation of the
reflector on the angle of incidence, .
Figure 12.3
The effect of angle of incidence
on intensity.
313
When the beam is incident at right angles the energy is spread over an area x2 so the
intensity is E/x2. With the angle of incidence the area irradiated is x2/cos and the
intensity if Ecos/x2: that is, the intensity is reduced by a factor of cos. For example,
for an angle of incidence of 15o, cos = 0.97 and the intensity is reduced by 3%. Table
12.3 shows the relative intensity (as a fraction of the intensity for = 0) for different
values of .
This effect is quite noticeable when using a torch to see one's way on a dark night.
Pointing the torch downwards gives a circular beam. Shining the torch ahead gives a
larger area of illumination with an egg shape. Here the area depends on both the
distance (through the inverse square law) and the angle of incidence.
In the application of infrared and ultraviolet radiation, the therapist should be aware of
this effect. It is normal practice to keep the beam as near to perpendicular to the
treated surface as possible: thus the situation shown in figure 12.2(c) should be
avoided.
Even if a perpendicular arrangement is used, parts of the treated area near the
periphery may receive a lower dosage (figure 12.2 (a and b)). If necessary the lamp
should be moved to give additional exposure to these areas.
angle of incidence
(degrees)
relative
intensity
0
15
30
45
60
75
90
1.00
0.97
0.87
0.71
0.50
0.26
0.00
Table 12.3
Relative intensity for different
values of , the angle of
incidence.
314
importance.
In order to specify dose and dose rate we need to know first the energy produced by
the apparatus and second, the fraction of that energy which is absorbed by the body.
Unfortunately both of these quantities are not always known, as we will see.
Shortwave Diathermy
This is the modality which has been in use for the greatest length of time. It is also
the one for which the dosage is least predictable.
In the case of the capacitor field technique the energy produced by the apparatus
varies with the position and size of the electrodes and the amount and type of tissue
in the field. It is possible to simulate the conditions of therapy by placing a 'dummy
load' between the electrodes. The load must have the right electrical properties and
be correctly positioned to simulate the conditions of therapy. In this way the energy
produced can be measured, though not the energy absorbed by the patient. Scott
(see Licht (1968)) describes how a series of subjects were tested with apparatus
adjusted for a predetermined rate of energy production. The extreme variation in the
responses obtained indicates that a knowledge of energy production alone is of little
value in establishing dosage.
A further complication is that the field spreads as it passes through the body. This
results in the area treated being much larger than the electrodes used, and varying
with depth. This makes it impossible to predict accurately the heat developed in a
particular part of the tissue.
With the inductive coil technique of application the situation is just as complex - due to
the difficulty in establishing the pattern of induced electric field intensity with the
geometries used.
For the present, the most reliable estimate of correct dosage is obtained by adjusting
the intensity until the patient feels a mild, comfortable warmth in the treated area. This
is a relatively safe method of assessing dose as greatest temperature elevation is
315
produced in tissues where pain and temperature receptors are abundant. Since
temperature elevation is less in the more deeply located structures there is little risk of
overheating them without first producing pain and damage to superficial tissues. The
need to rely on physical sensations indicates why shortwave diathermy (or indeed any
diathermic modality) is contra-indicated for areas where sensory impairment is
suspected.
Ultrasound
In the case of ultrasound therapy, virtually all the energy produced by the generator is
transferred to the patient, provided that intimate contact is maintained between the
transducer and body surface (chapter 10).
Generator-produced power can be read directly from the meter on the front of the
apparatus: thus the dose is obtained simply by multiplying the power (in watts: 1 W =
1 J.s-1) by the treatment time (seconds). The irradiance or average intensity (in W.cm2 ) is not so reliably known when the usual massage technique of application is used
and the treatment head is moved in small circles over the area to be treated. The
average intensity is calculated by dividing the total power by the area treated: it will only
be a reliable figure if the therapist is able to expose all parts of the treated area for the
same length of time.
Microwaves
The power produced by a microwave source can be quite accurately measured. It can
usually be read directly from a meter on the front of the apparatus. Unfortunately, at a
frequency of 2450 MHz, the proportion of energy actually absorbed depends on a
complex way on the thickness of skin and subcutaneous fatty tissue (chapter 11).
316
Shortwave Diathermy
We considered in chapters 6 and 7 the way in which different tissues (fat, muscle and
bone) modify the field pattern and determine the magnitude of real and displacement
current. This in turn determines the pattern of heat production in tissue combinations.
The two quantities determining these effects are, as we saw, the dielectric constant
and conductivity of the tissues.
To determine the effect of a cavity or implant we need to know its depth, shape and
size and, most importantly, its electrical properties.
*
Metals have extremely high conductivities - several thousand times higher than
muscle.
317
Body Fluids can be considered equivalent to muscle and other tissues of high
water content. The differences in electrical properties are negligible as far as
shortwave diathermy is concerned.
The
318
Fluid-filled cavities in muscle or other tissues of high water content will not affect the
electric field pattern appreciably. The temperature rise in the cavity will however be
greater than in muscle because heat is not transferred efficiently to adjacent tissues
or the bloodstream.
The effect of an air-filled hollow in tissue was discussed in chapter 7 (see figure 7.14).
The field lines bend around the hollow. This results in an increased intensity in the
tissue adjacent to the sides of the hollow which are parallel to the field. The effect
proves useful when it is desired to selectively heat the surfaces of hollows, such as
the sinuses.
Ultrasound
We saw in chapter 9 that reflection of ultrasound occurs when there is a mismatch of
acoustic impedance between two adjacent tissue layers. The impedances of muscle
and fatty tissue are similar but that of bone is much higher. There is thus an
appreciable reflection of ultrasound at the muscle/bone interface.
319
In order to determine the effects of implants or cavities we need to know the acoustic
impedances of metals, air and body fluids.
*
Metals have an acoustic impedance about thirty times higher than fat or muscle
so there will be significant reflection at a tissue/metal interface. Using the figures
in table 10.1 and equation 9.5 we find that the reflection coefficient for a fat/metal
or muscle/metal interface is about 0.94. Thus about (0.94)2 x 100 or 90% of the
ultrasound energy will be reflected.
Air has an acoustic impedance which is only a tiny fraction of that of tissue so
virtually 100% of the energy incident upon a tissue/air interface will be reflected.
Body fluids have an acoustic impedance closer to that of water, muscle and fatty
tissue. Fluid-filled cavities will not pose any problems as regards reflection of
the ultrasound beam.
320
selective heating within the cavity due to poor heat dissipation, and whether this is
desirable.
Microwaves
As we saw in chapter 11, the reflection of microwaves and the rate of absorption are
determined by the electrical properties (dielectric constant and conductivity) of tissues.
Since metals have a much higher conductivity than any biological tissue, reflection at a
tissue/metallic-implant boundary will be pronounced. The high conductivity of metals
also results in rapid absorption of microwaves - penetration depths are extremely
small. The result is that pronounced reflection occurs at a tissue/metal boundary and
the transmitted wave is absorbed over a very short distance.
Microwaves penetrating metallic implants will be absorbed in a fraction of a millimetre
with significant heat production. However, metals are good conductors of heat and
the energy will be rapidly conducted throughout the metal and spread into the adjacent
tissues.
Reflection of microwaves at a tissue/metal interface will result in the production of
standing waves. The energy reflected and the resulting standing wave pattern will
produce a concentration of energy in the tissues adjacent to the metal. There is also
the risk of focussing the waves with a curved metal surface (chapter 11) which can
result in 'hot spots' being produced in the patient's tissues. The rather poor
penetration depth of 2450 MHz microwaves suggests, however, that metallic implants
located well below the surface of the body will have little effect on heat production.
The effect of an air-filled cavity is similar to that of a metal implant: reflection occurs at
the boundary and a standing wave pattern is produced. The implications of this were
discussed above.
Fluid-filled cavities within muscle and other tissues of high water content will not affect
the pattern of heat production, but may undergo a selective rise in temperature if heat
is not conducted away efficiently.
321
Sunglasses or goggles
made of plastic or glass and
painted with a filter (often
coloured blue) can effectively
block ultraviolet transmission.
322
It has been known for some time that sufficiently high intensities of microwave
radiation can bring about the formation of cataracts in the eye. Experimental work
using laboratory animals indicates a threshold intensity level for cataract formation a
little in excess of 100 mW.cm-2 for prolonged exposure.
It is common practice to avoid exposing the reproductive organs to microwave
radiation. The testes are particularly susceptible to stray radiation in therapy.
For a detailed description of the hazards of microwave exposure and references to
relevant experimental work see S. M. Michaelson in Lehmann (1982). For a more
general description of the hazards of both radio-frequency and microwave radiation
see publications by the World Health Organization (search their website at
www.who.int). These documents discuss the known biological effects of such
radiation and summarize exposure safety limits proposed or in use in different
countries.
All practicing physiotherapists should be familiar with the relevant safety standards
and their implementation. It should be noted, however, that the exposure limits
stipulated apply to the general public but not to the patient receiving treatment, nor the
therapist. For example, the maximum exposure level for a therapist using 27 MHz
shortwave diathermy apparatus is 1.2 mW.cm-2 . For non-occupationally exposed
individuals such as secretarial staff and members of the general public the stipulated
levels are one fifth of these values. For patient exposure, there is no prescribed limit.
It is assumed that the therapist has weighed the therapeutic benefits against the
potential hazards and on this basis has prescribed treatment.
323
The thickness of the boundary layer determines the velocity gradient and this in turn
depends on the rigidity of each medium. For tissues of similar stiffness, such as
muscle and fatty tissue the boundary layer is wide, the velocity gradient is small and
boundary layer heat production is minimal. For tissues of quite different stiffness,
such as muscle and bone, the velocity gradient is high and the rate of heat production
at the interface is much higher than in the bulk of the tissues.
Shear waves can be produced when an ultrasound beam strikes a boundary. They
are not produced when the wave strikes the boundary at a right angle (zero angle of
incidence), nor is production appreciable at grazing angles. Maximum production
occurs near the middle of the range.
While normal sound waves are a longitudinal wave motion, shear waves are
transverse. In other words the particle displacement is at right angles to the direction
of propagation. A further point which should be noted is that shear waves can only
exist in solids or very viscous liquids and they are absorbed more rapidly than
transverse waves.
Shear waves are produced when the wave velocity is different in two adjacent tissues.
The wave frequencies must be identical so the difference in wave velocity results in a
324
A pressure of 20 N.cm-2 is 20
x 104 N.m-2 or 20 kPa). This
is about 1/5 of atmospheric
pressure.
325
Cardiac Pacemakers
Cardiac pacemakers present a special hazard as far as diathermy is concerned. Two
kinds of pacemaker are used: the fixed rate unit which provides a constant frequency
train of stimuli to the heart and the more popular noncompetitive units which provide a
stimulus frequency based on feedback signals from the heart. Noncompetitive units
are more satisfactory medically as the heart rate is adjusted by the oxygen demand of
the patient.
There are two risks in the application of diathermy:
*
the risk of selective heating of the unit and tissues in contact with the unit and its
wires. Each diathermic modality presents this hazard when used close to the
unit.
more importantly, the risk of interfering with pacemaker action. Microwave and
shortwave diathermy present the greatest hazard in this regard. The fixed
326
EXERCISES
1
(a)
(b)
Define the terms dose, dose rate and irradiance. What are the units of each
quantity?
Use infrared therapy as an example and explain how each of the above
quantities are specified in describing the treatment conditions.
(a)
List the treatment modalities for which the response of the patient can be
used as an immediate guide as to dosage requirements.
(b)
For each treatment modality not listed in (a) above, explain why the
immediate response of the patient can not be used to assess dosage
requirements. Distinguish those cases where the immediate response is a
poor guide and where an immediate response is not normally produced.
Describe the way in which dose requirements are established for (i) ultraviolet
therapy and (ii) PUVA treatment in terms of:
(a) calibration of the lamp
(b)
A patient about to receive ultraviolet therapy is tested with a particular lamp and
found to require 25 seconds exposure at a distance of 0.6 m to produce a firstdegree erythema reaction (E1).
(a) What exposure time would be required to produce a second-degree
erythema reaction (E2) with the same lamp-to-patient distance? (See table
12.1).
(b) What exposure time would be required to again produce a second degree
erythema reaction with a subsequent treatment? (See table 12.2).
(c) What exposure time would be required to produce an E2 reaction at the
second treatment if the patient-to-lamp distance is decreased to 0.4 m?
Equation 12.1 was derived by considering light from a point source passing
through a rectangular aperture in a screen (figure 12.1). Show that the same
relationship is obtained when we consider light passing through a screen with a
circular aperture of diameter x.
Using the fact that dosage depends on the product of intensity and exposure
time, derive equation 12.2 from equation 12.1.
What are the two factors which contribute to lower the dosage when radiation is
not incident at right angles to a tissue surface?
327
(a)
(b)
(c)
328
10
A beam of light strikes a surface at right angles as shown in figure 12.3. The
light intensity at the surface is measured as 50 J.m-2. Calculate the light intensity
if the surface is tilted so that the angle of incidence is:
(a) 15 o
(b) 30 o
(c) 45 o
11
12
(a)
(b)
(c)
Draw a diagram similar to figure 6.19(a) but including a metal implant (say a
metal plate on the surface of the bone).
Draw the pattern of electric field lines and indicate clearly where the field
intensity is increased and where it is decreased.
Describe the effect of the implant on heat production in different areas of the
tissue. Why would heat production within the metal be low?
13
Assume that the electric field within a tissue layer is originally uniform and draw
diagrams to show the effect of a spherical implant or cavity for the following
cases:
(a) an air-filled cavity in muscle
(b) an air-filled cavity in fatty tissue
(c) a fluid-filled cavity in muscle
(d) a fluid-filled cavity in fatty tissue
(e) a metal implant in muscle
In each case state reasons for the effects on the field pattern which you have
shown.
14
Briefly describe the effects of shape and orientation of a metal implant in tissue
subjected to an electric field (figure 12.4). What are the implications for
shortwave diathermy treatment using parallel plate electrodes?
15
16
329
17
(b)
(c)
330
Briefly describe the effects of the following on the pattern of heat production in
tissue exposed to microwaves:
(a) an air-filled cavity
(b) a metal implant
(c) a fluid-filled cavity
What differences in temperature elevation would occur with (a) as compared to
(b)? Explain.
18
(a)
Briefly describe why the eyes must be protected from exposure to (i)
microwaves and (ii) ultraviolet radiation in therapy.
(b)
(c)
19
(a)
(b)
(c)
What is meant by the term 'velocity gradient heat production' and under what
circumstances is this effect significant?
What is a shear wave and under what circumstances is shear wave
production significant?
What effect will shear wave production and velocity gradient heat production
have on the temperature distribution in tissue?
20
(a)
(b)
21
Cardiac pacemakers present a special hazard for diathermy. What are the risks
and how do shortwave, microwave and ultrasound diathermy differ in this
regard?
331
ELECTRICAL SAFETY
332
13 Electrical Safety
Most of the apparatus used in diathermy and electrotherapy is plugged into the mains
supply - 240 volts AC with a frequency of 50 Hz. Any apparatus of this kind represents
a potential hazard: the risk of electric shock. In this chapter we consider how a shock
can occur, its likely effect and methods of shock protection.
It is convenient to distinguish two kinds of shock mechanism; these are macroshock
and microshock.
* Macroshock: The familiar mechanism which has posed a risk since the advent of
commercially supplied electricity. Here current flows from the body surface, through
the skin and into the body. In order to produce harmful effects a relatively large voltage
and current are needed. A high voltage is needed to produce a sufficiently high
current as the skin offers a high electrical impedance. A high current is needed as
current spreads as it flows through deeper tissues and it is the current density (in A.m2 or mA.cm-2) which determines the physiological effects.
* Microshock: As a result of increasing sophistication in medical technology the
patient, in a hospital setting, may be connected to a number of pieces of apparatus
some of which provide a direct electrical pathway to the heart (for example a
myocardial electrode or a transvenous catheter). A very small current applied directly
to the heart via this pathway can be fatal. Only a low voltage is needed as the
subcutaneous tissues have a low electrical impedance and the current is localized,
resulting in a high current density.
ELECTRICAL SAFETY
Suppose a person inadvertently contacts one terminal of a battery. In this situation no
shock can occur. A shock current can only flow when the person completes a circuit
and current is able to flow from one terminal through the person and ultimately to the
opposite terminal of the battery. In order for a current to flow the person must
simultaneously contact both terminals of the battery. This is illustrated in figure 13.1.
Figure 13.1
A person must 'complete a circuit' for
shock to occur.
In figure 13.1(a) a shock can not occur, regardless of the size of the battery voltage, as
there is no continuous pathway for the current to travel. In figure 13.1(b) current is able
to flow from one terminal of the battery, through the person, to the opposite terminal:
the circuit is complete and a shock can result if the current flow is large enough.
333
ELECTRICAL SAFETY
By the same token a current in excess of about 100 A (0.0001 amps) applied directly
to the heart (for example via a myocardial electrode) may be fatal. The microshock
risk threshold is more than 100 times lower than that of macroshock.
Table 13.1 shows the effect of macroshock, i.e. when current passes through the skin
and through the body: that is when the shock is not given directly to vital organs. The
values quoted refer to mains frequency (50 Hz) AC, since shock via the mains supply
is the greatest hazard in most situations which the physiotherapist will encounter. For
figures appropriate to DC and other frequencies see Standards Association
publication AS/NZS 60479:2002.
334
Table 13.1
Effects of shock current through body.
While any amount of current over 10 mA is capable of producing painful to severe
shock, currents between 50 and 250 mA are potentially lethal. At values as low as 20
mA breathing becomes laboured, finally ceasing completely even at values below 75
mA: the victim can suffocate due to uncontrollable contraction of the muscles of the
thorax and abdomen.
ELECTRICAL SAFETY
If the current exceeds about 50 mA, ventricular fibrillation of the heart is likely to occur an uncoordinated twitching of the walls of the heart's ventricles. Once ventricular
fibrillation is induced the heart will not spontaneously revert to its normal pattern of
beating. Normal cardiac rhythm can only be restored by administering a massive
current pulse from a cardiac defibrillator. The machine, which should only be
operated by qualified personnel, supplies a short (3-4 ms) current pulse with an
instantaneous amplitude of up to 40 to 80 amperes. Such high currents forcibly
clamp the heart. When the clamping action ceases the heart is more likely to revert to
its normal pattern of contraction.
335
For shock currents above about 250 milliamps, the muscular contractions are so
severe that the heart is forcibly clamped during the shock. This clamping protects the
heart from going into ventricular fibrillation and the chances of survival are improved.
From a practical viewpoint, after a person is knocked out by an electrical shock it is
impossible to tell how much current passed through the vital organs of his body.
Artificial respiration must be applied immediately if breathing has stopped: if no pulse
is detectable external cardiac massage should also be applied.
An important question is 'how much current will flow if a particular voltage is applied
externally i.e. to the skin surface'.
This depends more on the skin impedance than
on the impedance of deeper tissues. The impedance of deeper tissues depends on
their shape and volume, but does not vary a lot. Between the ears, for example, the
internal resistance at low frequencies (less the skin resistance) is 100 ohms, while
from hand to foot it is close to 500 ohms.
The skin impedance varies much more than that of the underlying tissue. For 50 Hz
AC it can be lower than 1000 ohms for moist skin to higher than 0.5 megohms for dry
skin.
The body current flowing when a person contacts the mains supply (240 volts) is
calculated from Ohm's law to vary between 0.5 mA when the skin is dry and 240 mA
when the skin is moist. If the victim is startled from an initial mild shock, sweating can
ELECTRICAL SAFETY
result in a lowering of skin resistance and a rise in current from sub-lethal to lethal
levels in a short space of time. This is one reason why it is essential, in an electric
shock situation, to terminate the shock current as quickly as is safely possible.
336
Perspiration is an unfortunate
accompaniment to pain and
fright. This lowers the skin
resistance and increases the
shock current.
The very high voltage electricity which is generated at power stations is distributed by
cables to electricity substations where step-down transformers reduce the voltage to a
lower value. A single, large step-down transformer may be used to supply the 240
volts to many buildings in a residential neighbourhood. Large buildings in a city (for
example a hospital) may have their own step-down transformers. Figure 13.2 shows
the essential features of the power supply to a building.
Figure 13.2
Mains supply to a building
(schematic)
ELECTRICAL SAFETY
One terminal of the stepped-down supply is earthed at the electricity substation. This
is called the neutral line. When the substation serves several buildings the neutral
line is normally also earthed at the fuse box in each building.
240 volts AC is thus supplied to the fuse box in a building using two wires, the active
wire and the neutral wire. The neutral wire is nominally at earth potential (zero volts)
and the active wire is at a high potential. The active line connects through a power
meter to a switch and fuse or to a circuit breaker. From the fuse box, power wires run
to light switches and power outlets. Power outlets have three terminals; an active, a
neutral and an earth terminal. The earth terminal is connected to a wire which is
physically connected to earth at the building. Figure 13.3 shows the connections of
the active, neutral and earth wires to a power outlet socket.
Figure 13.3
Wiring convention for an Australian
power outlet (viewed from the front).
337
ELECTRICAL SAFETY
are connected to the same circuit. A high current flowing in the neutral line will result
in a potential difference between the power point neutral terminal and the connection
to earth at the fuse box. This is because the resistance of the neutral cable, while
small, is not zero. If the neutral wire has a resistance R and carries a current I, the
potential difference produced is given by Ohm's law as V = I.R.
In what follows we assume that the power point is correctly wired and consider other
hazards associated with the mains supply.
338
In normal operation, when an appliance is plugged into the mains outlet, current flows
between the active and neutral terminals. The earth wires does not normally carry any
current. The earth connection is only provided as a safety measure.
The advantages of a three-terminal mains supply can be seen by inspecting figure
13.4.
Figure 13.4
Earthing of mains-powered apparatus casing.
The circuitry within the apparatus (represented by an equivalent resistance Re in
figure 13.4) is powered from the active and neutral wires. The earth wire is connected
to the casing of the apparatus to ensure that there is never any voltage on the casing.
The idea is that if the active wire within the apparatus makes accidental contact with
the casing a very high current will flow through the earth wire to ground. The low
ELECTRICAL SAFETY
resistance of the earth wire ensures that the current flow will be large enough to blow
the fuse, thus cutting off the active supply. In this way, the casing of the apparatus can
not become 'live' and present an electric shock hazard to anyone touching it.
As long as the earth wire and connections remain intact there is no risk of shock from
touching the apparatus.
Some apparatus - electric shavers and hair dryers are examples - is 'double
insulated'. The casing is usually made of a non-conducting plastic and special
precautions are taken to ensure that an electric shock is virtually impossible. The
advantage here is that no reliance is placed on an earth wire which could come loose
or break. In fact, no provision at all is made for an earth connection to the apparatus.
The use of the double insulation principle is restricted to small and easily insulated
apparatus. Any exposed metal on double insulated apparatus is not connected to
earth but is doubly isolated from the internal electrical circuitry.
All apparatus which plugs into the mains, then, is macroshock protected, either by
double insulation or by earthing. Nevertheless hazards remain in the form of faulty or
worn equipment or careless workmanship.
Figure 13.5 illustrates how an electric shock can
result when apparatus is not earthed - because
the earth wire is damaged or disconnected. The
shock hazard in figure 13.5 arises when the
active terminal short-circuits to the casing of the
apparatus. In this case two faults have occurred a break in the earth connection and a short circuit
of the active wire to the casing.
Figure 13.5
A person contacts apparatus which is not earthed
and has the active wire touching the casing.
339
ELECTRICAL SAFETY
340
Since the neutral line is earthed at the fuse box and power sub-station, a person
standing on the ground is effectively connected to the neutral terminal of the mains
supply. To complete the circuit and receive a shock, the person need only touch the
active terminal or something connected to the active terminal. Current flows from the
active terminal through the person to ground and hence to the neutral connection at
the fuse box or power substation.
Two important things should be noted about the situation illustrated in figure 13.5
*
A shock has occurred because the earth wire is damaged. If the earth
connection was intact the fuse in the active line (figure 13.2) would blow and
isolate the apparatus from the mains supply.
The fuse in the active line will not protect the person from receiving an electric
shock. The fuses used for normal apparatus have a rating of several amperes.
The person can receive a lethal shock (see table 13.1) without blowing the fuse.
A question which might occur to you is 'do both faults shown in figure 13.5 have to
exist in order for a shock to result?' The answer is no. A shock can result when the
apparatus is not earthed even though there is no direct physical contact between the
active terminal and the casing. This is because the active wire and the case must
have a small capacitance associated with them and insulation will not be perfect.
Thus it is possible for small currents to leak via the insulation to the casing. With new
and well looked-after apparatus the insulation impedance will be high and the
maximum leakage current will be very small. Bad design or deteriorating insulation
can, however, increase leakage currents to hazardous levels. Only by earthing the
casing and providing an extremely low resistance pathway to ground can the risk of
shock be minimized.
MACROSHOCK PROTECTION
From the previous discussion it should be apparent that the fuses in the mains supply
serve a protective role only when currents of several amperes are involved. For this to
ELECTRICAL SAFETY
happen the active wire must short-circuit to the earthed casing. How then can we
protect against shock involving much lower currents? There are two commonly used
ways - by using a core balance relay or a protected earth-free supply.
341
ELECTRICAL SAFETY
342
Once the core balance relay has been 'tripped', the supply remains disconnected until
the circuit breaker is manually reset.
The response time of core balance relays is quite short (less than 100 ms) and typical
units can be adjusted to trigger on an imbalance of as little as 5 mA. They are
available for permanent installation (usually inside the fuse box) and are also supplied
as portable units suitable for connecting between power points and appliances.
From the foregoing description it should be apparent that these units protect against
the 'normal' situation where a shock current flows through a person's body to earth.
They will not protect against the more unusual situation where a person inadvertently
contacts both the active and neutral lines simultaneously.
Figure 13.7
Isolation with a transformer.
ELECTRICAL SAFETY
343
touch both earth and one transformer terminal without receiving a shock.
At first glance it would seem that a person can only receive a shock if both transformer
secondary terminals are contacted simultaneously. Unfortunately this is not the case
in practice and the reasons are twofold:
*
If a piece of apparatus plugged into the power point should develop a short circuit
to earth no fuses will blow. The fault can remain unnoticed indefinitely. In the
meantime the earth free supply has been converted to an earthed supply and we
have no knowledge of which side of the transformer has become 'active' and
which 'neutral'.
Figure 13.8
Isolation with earth leakage detection.
ELECTRICAL SAFETY
344
the power point a current will flow through the detector and activate the alarm.
Of the two systems the protected earth free supply is somewhat safer than an earthed
supply fitted with a core balance relay. Unfortunately the isolation transformers and
leakage detection circuitry needed are both bulky and expensive. For this reason
protected earth free supplies are only found in areas of high shock hazard. Core
balance relays which are relatively cheap and easy to install are considered adequate
for more general use such as in physiotherapy clinics and the physiotherapy
departments of hospitals. Whichever method of protection is used it is important that
the system be checked at regular intervals to ensure that the protection mechanisms
are operating correctly.
MICROSHOCK
The use of electronic monitoring and measuring
devices in the hospital setting has proved of
immense value for patient monitoring and
assessment. It has, however, also introduced
some special risks of which the modern member
of the health care team must be aware.
Consider the patient in an intensive care unit. In
some cases the patient may have apparatus
connected by a direct electrical pathway to the
heart. One such situation is illustrated in figure
13.9. Here a very special hazard exists because of
the low current needed to cause ventricular
fibrillation. Even if all the equipment is earthed the
patient can still be electrocuted unless adequate
precautions are taken.
Figure 13.9
A microshock hazard situation.
ELECTRICAL SAFETY
345
ELECTRICAL SAFETY
A further precaution which must be taken is to ensure that any apparatus which is
used in the patient's room has been tested for earth leakage and meets the
appropriate safety standards.
346
Cardiac protected electrical areas. These are areas which are suitable for
carrying out procedures which involve direct electrical connection to the heart.
The safety requirements for both the electrical supply and apparatus to be used
in such areas are stringent (see SAA Standards AS 3200 and AS 3003). These
ELECTRICAL SAFETY
347
are described as 'Type CF' or simply 'cardiac protected' areas. In Australia and
some other countries, these used to be described as 'Class A' treatment areas.
*
Body protected electrical areas. These are areas which are suitable for
carrying out procedures which do not involve direct electrical connection to the
heart but which do involve the patient being in direct electrical contact with
electromedical apparatus. Safety requirements are more stringent than those
applying to areas where no electrical connection between patient and apparatus
is necessary. Such areas are described as 'Type BF' or simply 'body protected'
areas. They used to be known as 'class B' treatment areas.
Other patient areas. These are areas which are not specifically suited to
'cardiac type' or 'body type' procedures. Apparatus which is not electrically
connected to the patient can be used. Apparatus which is intended to connect
electrically to the patient can be used in these areas, but only if the apparatus
itself meets stringent safety requirements (equivalent to those of a cardiac
protected or body protected treatment area).
When direct electrical connection is made to the heart, shock currents as low as 100
A can be fatal. For this reason cardiac-protected treatment areas are designed to
minimize this risk. The earth wiring in these areas is constructed from heavy gauge
copper wire so that even when substantial currents (up to 1 ampere) flow in the earth
wire the potential difference between different earth terminals is kept below 100 mV.
An area which meets this and other requirements (see SAA Standard AS3003) is
described as an equipotential earth (EP) area.
In addition to the requirement for equipotential earth wiring, cardiac protected areas
must also have core-balance relay protection or have a protected earth free supply.
Body protected areas are those designed to protect patients who may be connected
directly to electromedical apparatus from macroshock currents. It is not necessary for
the area to have an equipotential earth system but the supply must have core-balance
relay protection or a protected earth free supply.
ELECTRICAL SAFETY
348
Best protection is afforded by a protected earth free supply but such installations are
expensive. Core-balance relay protection can be provided economically and gives an
adequate level of safety. Body protected areas which have appropriate core-balance
protection will have the mains supply disconnected within 60 milliseconds of the
active and neutral current imbalance exceeding 10 mA (SAA Standard AS3003).
Class CF (cardiac protected) and BF (body protected) treatment areas are normally
identified by signs displayed in, or on the doors of, the area. The signs have an
identifying symbol and the words 'CARDIAC PROTECTED ELECTRICAL AREA' or
'BODY PROTECTED ELECTRICAL AREA' printed in white letters on a green
background. The symbols for these areas are shown in figure 13.10.
Figure 13.10
Symbols used to identify different classes of
equipment or treatment area. (a) class CF
(microshock protected) (b) class BF (body protected).
ELECTRICAL SAFETY
349
A class CF patient circuit is the most safe. If the leakage current to the patient
circuit is normally below 10 A and below 50 A even when a fault condition
exists (when the earth lead is broken or the patient inadvertently contacts the
active terminal of the mains supply) the patient circuit is designated class CF. A
class CF patient circuit affords microshock protection.
ELECTRICAL SAFETY
350
flow from the patient circuit through the patient to the active terminal of the mains
supply (in the event of the patient accidentally contacting the mains active lead,
either directly or indirectly) must be below 5 mA. In other words a class B patient
circuit has adequate isolation from the mains supply to minimize the risk of
macroshock.
*
Class CF and BF patient circuits are identified by the symbols shown in figure 13.10.
The appropriate symbol is prominently displayed immediately adjacent to the patient
circuit output sockets of the machine. If no symbol is found, the patient circuit should
be assumed to be class B.
Protection in Summary
It should be apparent, from the foregoing description, that electrical safety is only
ensured if:
*
the equipment meets appropriate safety standards for the treatment procedures
involved;
the electrical supply meets appropriate safety standards for the treatment
procedures involved.
Figure 13.11 shows a flowchart summarizing the requirements for earthed mainspowered apparatus and the class of area in which it can be used.
The flowchart is based upon those of Australian Standard AS3200 and figure 5.3 of
AS2500.
ELECTRICAL SAFETY
351
START
Procedure must be carried YES Is there a possibility of an
intra-cardiac conductor
out in a class CF area.
(class CF procedure)?
NO
NO
YES
All mains powered
equipment must:
* be connected in the
same equipotential area.
* meet relevant safety
standards.
NO
YES
Use class CF or BF
patient circuit.
NO
YES
Patient circuit must be
class CF.
Figure 13.11
Flowchart for the safe application and use of electromedical equipment.
No special
precautions
ELECTRICAL SAFETY
352
The strictest safety standards are mandatory when the patient has apparatus
connected directly to the heart. In this case the mains supply should be that provided
in a Class CF area and electromedical apparatus with a patient circuit should not be
used unless either the patient circuit is class CF or there is no possibility of a direct
electrical connection with the heart. In this way the risk of microshock is minimized.
When there is no direct electrical connection to the heart it is sufficient to protect
against the risk of macroshock. This can be achieved either by using equipment with
a class CF or BF patient circuit or by treating the patient in a class CF or BF area. If the
electrical wiring in a patient treatment area is class CF or BF then patients can be
safety treated with apparatus which has a class CF, BF or B patient circuit. If the
electrical wiring in a patient treatment area is not class CF or BF then the patient
circuit must be class CF or BF. In other words if the mains supply is of the normal
household variety then electromedical apparatus should have either a class CF or BF
patient circuit.
When there is no patient circuit and no possibility of intra-cardiac connection,
electromedical equipment may be used on a normal earthed (but unprotected) mains
supply.
EXERCISES
1
(a)
(b)
Electric shocks are always described in terms of shock current rather than
voltage. Why is this so?
(a)
Consider macroshock and list the factors which will determine the size of
shock current when a person accidentally contacts the mains supply.
(b)
Table 13.1 shows the effect of different sizes of shock current. Explain why
shock currents in the range 50-250 mA represent a greater hazard than
shock currents above 250 mA.
ELECTRICAL SAFETY
A person accidentally contacts the mains supply (240 volts). Given that the skin
resistance may vary from 1000 to 0.5 M calculate the possible range of shock
currents which may result.
What is the practical significance of this in terms of terminating the shock as
quickly as possible?
Figure 13.3 shows the wiring convention for a power outlet. Given that the neutral
and earth terminals are grounded (earthed) at the fuse box in a building
according to figure 13.2, does this mean that the neutral and earth terminals are
'safe'? Explain.
(a)
(b)
(a)
(b)
(c)
353
ELECTRICAL SAFETY
8
(a)
(b)
Figure 13.5 shows a person receiving an electric shock because two faults
have occurred. What are they?
Is it possible for a person to receive a shock from apparatus in which only
one of these faults has occurred? Explain.
It has been said that fuses are included in the mains supply line only to protect
the apparatus. Is it possible for a fatal shock to be delivered without blowing the
fuse in the following two cases:
(a) when the earth wiring is damaged?
(b) when the earth wiring is undamaged?
Explain.
10
(a)
(b)
(c)
11
ELECTRICAL SAFETY
12
354
(a)
(b)
13
Consider figure 13.9 where the patient is connected to (i) the supply earth of a
blood pressure monitor via a transvenous catheter and (ii) the supply earth of an
ECG machine via an electrode attached to the right leg.
Explain how a shock hazard situation arises as a result of the ECG machine and
blood pressure monitor being connected to separate power outlets.
14
A microshock of only 200 A flowing directly through the heart can be fatal.
(a) Given that the resistance of the patient's tissues between the catheter and
the electrode applied to the right leg in figure 13.9 is about 1000 , calculate
the potential difference needed to produce a fatal shock current.
(b) The resistance of the earth wire connecting mains outlets 2 and 3 in figure
13.9 is 4.0 . Calculate the current flowing through the earth wire
connecting the outlets which would be sufficient to cause electrocution of
the patient.
(c) A cleaner plugs a vacuum cleaner into mains outlet 2 (see figure 13.9). The
leakage current of the vacuum cleaner is 70 mA. Does this represent a
microshock hazard?
15
355
ELECTRICAL SAFETY
16
17
18
(a)
(b)
(a)
(b)
(c)
Suppose you have (a) an ultrasound machine and (b) an interferential therapy
machine which are to be used with an unprotected mains supply. What electrical
safety standards apply to each machine?
356
APPENDICES
357
APPENDIX 1
Prefixes Used to Specify Multiples and Submultiples of Units.
The following table lists some important prefixes used to specify multiples and
submultiples of units in the systme internationale (SI).
Prefix
Symbol
Multiple
giga
109
mega
106
kilo
103
deci
10-1
centi
10-2
milli
10-3
micro
10-6
nano
10-9
pico
10-12
SOME EXAMPLES
109 hertz (Hz) = 1 gigahertz (GHz)
106 ohms () = 1 megohm (M)
103 joules (J) = 1 kilojoule (kJ)
10-2 metre (m) = 1 centimetre (cm)
10-3 watt (W) = 1 milliwatt (mW)
10-6 henry (H) = 1 microhenry (H)
10-12 farad (F) = 1 picofarad (pF)
Note that the prefixes deci- and centi- are considered
acceptable (due to their common usage) but are not
recommended in the SI.
APPENDICES
358
APPENDIX 2
Quantities and Units
The following tables list the quantities used in this text, their units and their symbols.
Table 1 lists quantities which are measured directly in SI base units. The quantities
listed in Table 2 have units derived from the base SI units. For a comprehensive
listing of quantities, their SI units and their definitions see Quantities and Units in
Science by O. Ogrim and A. E. Vaughan, Science Press (1977).
TABLE 1: QUANTITIES MEASURED IN Sl BASE UNITS
quantity
length
mass
time
current
temperature
amount of
substance
angle
symbol for
quantity*
l
m
s
unit
T
n
metre
kilogram#
second
ampere
kelvin##
mole
m
kg
s
A
K
mol
radian###
rad
symbol for
unit
#
##
APPENDICES
359
symbol
C
q
E
E
F
f
Q
Z
Z
B
V
P
R
c
v
Pv
unit
farad F (= C.V-1)
coulomb C (= A.s)
S.m-1 (= -1.m-1)
A.m-2
kg.m-3
V.m-1 (= N.C-1)
joule J (= N.m)
newton N (= kg.m.s-2)
hertz Hz (= s-1)
joule J (= N.m)
W.m-2 (= J m-2s -1)
ohm
kg m-2 s-1
A.m-1
m
volt V (= W.A-1)
watt W (= J.s-1)
ohm
.m
J .kg-1.K-1
m.s-1
W.m-3 ( = J m-3.s-1)
m
##