MICROWAVE DIATHERMY

Sagar Naik, PT

Microwave Diathermy (Notes)

Sagar Naik, PT
The microwave frequencies allotted for medical use are as follows: Frequency (MHz) 2450 915 433.9 Wavelength (cm) 12.245 32.79 69.14

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Microwave diathermy is irradiation of the tissues with radiation in the shorter wireless part of the electromagnetic spectrum (Hertzian rays), i.e., with a wavelength between infrared and short wave diathermic radiation. The group of electromagnetic radiations known as microwaves occupies that part of the electromagnetic spectrum extending from wavelength 1 m (frequency 300 MHz) to 1 mm (frequency 300 GHz). Microwave radiation behaves like other electromagnetic radiation, i.e., they are reflected and refracted at interfaces depending on the nature of the materials. It also exhibits rectilinear propagation, a necessary feature for its use as radar. They are also used in telecommunications and in tracking ships, aircrafts, rockets, and satellites as radar. Thus, microwaves can be directed to, and will penetrate, the tissues while being strongly absorbed by water. This makes it an effective method of tissue heating, especially muscles.

Production of Microwaves: High-frequency oscillating currents will produce electromagnetic radiations of radio frequencies, which can be radiated from suitable antennae as radio and television transmissions. At higher frequencies it becomes impossible for the electrons in the electric circuit to oscillate sufficiently rapidly because of the time needed for them to pass through a valve or transistor. For the higher frequencies of microwave at relatively high power a device called a magnetron is used which generates oscillating currents directly from highvelocity electron motion.

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MICROWAVE DIATHERMY

Sagar Naik, PT

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These currents are collected and fed along a coaxial cable to the antenna or emitter, which radiates microwaves. The dimensions of the coaxial cable are arranged to provide a suitable capacitance, so that microwaves of a given frequency are conveyed to the emitter with maximum efficiency. The antenna, which is simply a suitable, sized and shaped piece of wire, is mounted in front of a metal reflector so that a beam of microwaves is emitted in one direction. Varying the power supplied to the magnetron can control the output of microwave energy. Machines have an intensity control and the output is indicated on a meter, which, of course, gives no reliable indication of the heating of the tissues. The frequency of the microwaves produced depends on the structure of the magnetron and is therefore fixed. There will also be a means of switching the mains power on and off and suitable indicator lights. On some machines a delay switch may be fitted to allow time for the magnetron to reach its proper working temperature. A standby switch can be provided. Thus successive treatments may be given or adjustment of the emitter made without having to switch off the magnetron and wait for it to warm up again. The emitter, also called a director or applicator, gives out a beam of microwaves which diverges somewhat because it is technically difficult to produce a completely uniform beam. The effect of this divergence is to reduce the intensity of radiations considerably with distance (inverse square law). Microwave therapy can be in either continuous or pulsed mode. [Inverse Square Law: The intensity of radiation falling on unit surface area of the body is inversely proportional to the square of the distance of the source of energy from the surface.]

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Physiological Effects of Microwaves on the Tissues: When the electromagnetic energy of microwave radiation is absorbed in the tissues it provokes ionic movement, rotation of dipoles and electron orbit distortion, which leads to heating. The amount of heating will be proportional to the amount of radiation. Since microwaves are being applied from outside the tissues and beamed in and are strongly absorbed by water it would be expected that heating would be greatest at the surface and diminish exponentially with depth.

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MICROWAVE DIATHERMY

Sagar Naik, PT

Microwaves at 2450 MHz

Rate of heating (%)

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The relationship between the amount of radiation absorbed and that, which penetrates, is as an exponential relationship in which the half-value depth for microwave is often given as 3 cm (penetration depth 4.3 cm). This smooth change would only be true if the tissues were homogeneous, which they are definitely not. This pattern occurs because absorption of microwaves is much lower in fat (half-value about 3.5 cm) and higher in the vascular muscle tissue (halfvalue about 0.7 cm). There is also reflection from the fat-muscle and fat-bone interfaces causing standing waves, which lead to peaks in the middle of each tissue layer.

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50 1 2 3 4 5 6 Depth in tissues (mm)

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The Pattern of Microwave Absorption in the Tissues: When any radiation meets the surface of a different medium it may either be reflected or penetrate. Those radiations that do penetrate will only have an effect if they are absorbed (Grotthus Law); thus they will be ineffective if they pass right through. In the case of microwaves there is considerable reflection at the air-skin boundary and at skin-fat and fat-muscle boundaries in the tissues. The percentage of microwave radiation (at 2450 MHz) reflected varies with thickness of fat and skin from 50% to 75%. At the other frequencies in therapeutic use some 60% 70% of the energy is reflected but it is much less affected by variations in skin tissue thickness.

MICROWAVE DIATHERMY

Sagar Naik, PT

These theoretical patterns, calculated are likely to be much less clearly defined in real tissue because of the irregularities of the interfaces, the heatdistributing effects of the blood flow, especially in muscle tissue, and also the effects of conduction. These calculations do not give actual temperature changes, just the relative energy absorption.

Fat 100

Muscle

Rate of heating (%) 50

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When same calculations are made for microwaves at 915 MHz, the relatively better heating of muscle compared to fat is illustrated; microwaves of lower frequencies penetrate further. For these reason, and due to unpredictable reflection from the surface, it is considered by some that 915 MHz (and 434 MHz which gives similar pattern) are more suitable frequencies for therapeutic heating than the widely used 2450 MHz. However, skin would be heated to a greater degree than the deeper tissues in most circumstances. This ensures the safety of microwave treatments under normal circumstances, since excess heating will be felt by heat receptors in the skin.

Morphological Effects: The shape of the tissues to which the microwave beam is being applied will have sufficient effects due to both reflection and refraction:

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0 0 1 2 3 4 5 6 Depth in tissues (mm)

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Microwaves at 915 MHz
Bone

MICROWAVE DIATHERMY

Sagar Naik, PT

Beam of microwave radiation Reflected radiations

Fat layer Muscle tissue

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These effects are shown in above figure and both will be greater where the tissues have a small radius of curvature, e.g., forearm or leg. Treating tissue concavities, such as the palm with semi-flexed fingers or the popliteal space, would have opposite effects. While the generalizations described above are valid, it must be emphasized that the tissues are very irregular and microwave absorption is influenced by other factors such as the thickness of the fat layer. Consequently, absorption patterns cannot be predicted with certainty. The heating in the tissues depends not only on microwave absorption but also on the rate of heat transfer within and between the tissues.

Effect of Emitter Shape: The distribution of energy over the body surface will depend on the size and shape of the emitter.

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Refracted radiations converging in the tissues

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There is considerable reflection of therapeutic microwave radiation from skin, which is greater when it is not being applied perpendicularly to the surface. Microwave radiation passing in the tissues will be subject to refraction as the wave velocity decreases from air to skin and fat and then to muscle. The radiations are bent towards the normal; hence converging and giving relatively greater heating than would otherwise occur.

MICROWAVE DIATHERMY

Sagar Naik, PT

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Contact Emitters: To achieve better transmission to skin and to enable the emitter to be made much smaller a suitable ceramic dielectric material is used. This will enable a better match to be made between the applicator and the tissues. These contact emitters can be made quite small, 1.5 cm to 3.5 cm diameter, and will radiate microwaves directly into the tissues away from the surface of the emitter. Other small emitters can be placed in body cavities rectum, vagina, and external auditory meatus emitting radially to heat the walls of the cavity. As microwave transmission is better with these contact emitters the power that can be applied may be limited to a low level (25 W). Heating Effect: Localized microwave radiation substantially increases skin temperature and deep and superficial blood flow, which last upto 20 minutes after the treatment. Microwave is particularly effective in heating deep muscles. Thus, microwave heating is found to occur in first few centimeters to tissue to traverse especially in the muscles.

Therapeutic Effects of Microwave Diathermy: Microwave heating is suitable for superficial tissue heating, both muscle and articular structures close to the surface such as the wrist joint or anterior aspect of the knee, but it is not likely to affect deeply placed structures covered with muscle tissue like the hip joint. One of the major uses of microwave therapy is for heating muscle tissue to achieve, amongst other things, an increase in intramuscular blood flow. This, it is believed, only occurs if temperature is sufficiently raised.

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Circular emitters usually give a somewhat ring-shaped pattern. Other emitters are available which are rather longer in one direction and give an oval pattern; still other emitters of apparently similar shape may give the greatest output at the central axis, diminishing outwards. This is often the situation in practice since many body areas are convex so that the centre of the area is nearest to the emitter. Some emitters are designed to focus the radiation into the tissues and thus achieve better depth of heating. All the emitters described so far are distance emitters, which are they are applied to the tissues with an air gap.

MICROWAVE DIATHERMY

Sagar Naik, PT

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Dangers of Microwave Diathermy:
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Heating is limited by skin surface heating so that greater total heating and thus deep heating can be achieved if the heated surface is deliberately cooled. Passing cold air over the skin surface can do this. Therapeutic applicators have been made which work at 915 MHz; these have contact emitters, which contain a dielectric material with apertures through which cooling air is blown. As the emitter is used in contact with the skin the amount of scattered radiation is also diminished. These are considered by some to be efficient way of generating even heating in the deep tissues. However, with the thermal receptors in the skin deliberately cooled there is an increased risk of a burn, and extreme caution is required with this technique. As the physiological effects of microwave diathermy are similar to those of short wave diathermy, it can be used in the treatment of the same types of condition: traumatic and inflammatory lesions, in which the increase in blood supply and relief of pain and muscle spasm are of value, and bacterial infections, where the increase in blood supply brings more white blood cells and antibodies to the area and so reinforces the bodys normal defense mechanism. Microwave diathermy is most likely to be effective for lesions in the superficial tissues and those of high fluid content. It is therefore suitable for the treatment of traumatic and rheumatic conditions affecting the soft tissues and small superficial joints. As it is generally possible to irradiate only one aspect of the body at a time, it is more satisfactory for localized than for widespread conditions. The ease of application may make microwave diathermy preferably to short wave diathermy in those conditions where both are applicable.

Effects of Metal: As microwaves are strongly reflected from metal surfaces any metal placed on the tissue surface will act as a shield preventing radiations reaching the underlying tissues; this may lead to ineffective treatment. Metal may also distort and concentrate the microwave filed causing local overheating which could be dangerous. If metal is so placed that it could reflect microwave energy into the tissues it is again possible that overheating could occur. Metal embedded in the tissues, due to accident or surgery, could also cause reflections in the tissues, which might lead to overheating. However, it is generally advisable to avoid treating the region of metal implants with microwaves.

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MICROWAVE DIATHERMY

Sagar Naik, PT

Effects of Surface Moisture: Perspiration must be allowed to evaporate freely. If moisture appears on the surface from any surface, e.g., open wounds or wet dressings, it will absorb radiations, so treatment should be stopped and the moisture removed. Cardiac Pacemakers: These could be affected if microwaves were directly applied to the region but there is little, if any, risk from scattered radiation. Eyes: Due to its structure the eye selectively absorbs microwaves and is not easily able to dissipate heat and thus can become overheated. If the treatment is such that radiation may enter the eye, when treating the anterior aspect of the shoulder with a distance emitter for example, the patient should be given goggles which are impervious to microwaves. Such goggles are of two kinds A metal mesh, which reflects practically all, microwave radiation but allows sufficient light between the mesh to see clearly A thin layer of metal supported on glass, which again reflects, microwave radiations but interferes little with visible light Closing the eyes would not prevent the transmission of microwaves but would diminish them.

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Testes: Small temperature rises can interfere with spermatogenesis, so treatment of microwave over testes is avoided. It is felt that heating of 100 mW/cm2 could possibly produce testicular damage in humans; therefore direct irradiation of the testes should be avoided and care taken to prevent large amounts of reflected or scattered radiation reaching the region. The testes are more susceptible because of their exposed position and possibly their structure. The same does not apply to the deeply placed ovaries, which are unlikely to be heated by microwave treatment. Pregnancy: It is recommended that microwave should not be given to the pregnant uterus or patients attempting pregnancy. Circulatory Defects: Ischaemic areas should not be treated, because of the increased demand for oxygen, which results from the rise in temperature.

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MICROWAVE DIATHERMY

Sagar Naik, PT

Patients at particular risk of hemorrhage, thrombosis, phlebitis, and other vascular lesions should not receive microwave treatment. Contraindications of Microwave Diathermy: Diminished thermal sensation Defective arterial circulation Acute inflammation Recent hemorrhage Metal in the area under treatment Malignancy Implanted cardiac pacemakers Intrauterine devices when using a vaginal electrode Eyes and testes, due to poor heat dissipation Pregnant uterus

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