Shortwave and Microwave Diathermy

Diathermy
Application of High-Frequency Electromagnetic Energy Used To Generate Heat In Body Tissues Heat Produced By Resistance of Tissues Also Used For Non-Thermal Effects

Physiologic Responses To Diathermy

Not Capable of Producing Depolarization and Contraction of Muscles
Wavelengths Too Short

Physiologic Responses To Diathermy

Physiologic Effects Are Those of Heat In General
Tissue Temperature Increase Increased Blood Flow (Vasodilation) Increased Venous and Lymphatic Flow Increased Metabolism Changes In Physical Properties of Tissues Muscle Relaxation Analgesia
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Diathermy Heating
Doses Are Not Precisely Controlled Thus The Amount of Heating Cannot Be Accurately Measured
Basically means amount of heating patient receives cannot be directly measured

Heating= Current2 X Resistance

Non-Thermal Effects
Pulsed SWD Used To Treat Soft Tissue Injuries and Wounds Related To Depolarization of Damaged Cells
Loss of Cell Division Loss of Proliferation Loss of Regenerative capabilities

Repolarization Corrects Cell Dysfunction Generates A Magnetic Field To Increase Na Pump Activity
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SWD Physiological Events Summary

Electromagnetic Radiation CSWD Electromag. Energy absorption Incr. molecular KE cell ion-binding properties, protein synthesis, ATP production Athermal Effect PSWD

Thermal Effect

Increased cell metabolism and function

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Enhanced soft-tissue healing

Shortwave Diathermy
Radio Transmitter With FCC Assigned Frequencies
27.12 MHz at 11 M 13.56 MHz at 22 M 40.68 MHz at 7.5 M

Shortwave Diathermy Unit

Power Supply Powers Radio Frequency Oscillator (RFO) RFO Provides Stable Drift-Free Oscillations at Given Frequency Power Amplifier Generate Power To Drive Electrodes Output Resonant Tank Tunes In The Patient for Maximum Power Transfer
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Possible Shortwave Diathermy Unit

A=Power Switch B=Timer C=Power Meter(monitors current from power supply not current entering patient-volume control) D=Output Intensity(%max power to patient) E=Tuning Control(tunes output from RFO)
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Shortwave Diathermy Unit

Power Output Should Provide Energy To Raise Tissue Temp To Therapeutic Range (40-45 deg C) (80-120 watts) Should Exceed SAR-Specific Absorption Rate (rate of energy absorbed /unit area of tissue mass)

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Adjusting Resonance of SWD Unit (Tuning)

Manual vs Automatic Tuning
When patients circuit (biologic tissue) oscillates at same frequency as device frequency Only when tuned will is the electromagnetic energy fully delivered Most automatic Can lose tuning due to movement at skin/electrode interface

Manual Tuning (adjusts patient circuit)

Set Output Intensity at 30-40% Adjust Tuning Control Until Power Output Meter Reaches Max Then Adjust Down to Patient Tolerance Which Is About 50% If More Than 50% Patient Is Out of Resonance 12

Shortwave Diathermy Unit

Generates Both an Electrical and a Magnetic Field Ratio Depends on Characteristics of Both The Generator and the Electrodes
SWD Units at 13.56 MHz= Stronger Magnetic Field SWD Units at 27.12 MHz = Stronger Electrical Field
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SWD Electrodes
Capacitor Electrodes Inductor Electrodes Selection of Appropriate Electrodes Can Influence The Treatment

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Capacitor (Condenser) Electrodes

Create Stronger Electrical Field Than Magnetic Field Ions Will Be Attracted Or Repelled Depending on the Charge of the Pole

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Capacitor Electrodes
Electrical Field Is The Lines of Force Exerted on Charged Ions That Cause Movement From One Pole To Another Center Has Higher Current Density Than Periphery

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Capacitor Electrodes
 Patient

Is Between Electrodes and Becomes Part of Circuit  Tissue Is Between Electrodes in a Series Circuit Arrangement

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Electrical Field
The Tissue That Offers The Greatest Resistance To Current Flow Develops The Most Heat
Fat Tissue Resists Current Flow Thus Fat Is Heated In An Electrical Field Precaution: electrical field may overheat area with large fat content

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Capacitor Electrodes (Air Space Plates)

Two Metal Plates Surrounded By Plastic Guard Can Be Moved 3cm Within Guard Produce High-Frequency Oscillating Current

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Air Space Plate Electrodes

Area To Be Treated Is Placed Between Electrodes Becoming Part of Circuit

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Air Space Place Electrodes

Sensation Of Heat In Direct Proportion To Distance Of Electrode From Skin Closer Plate Generates More Surface Heat Parts Of Body Low In Subcutaneous Fat Best Treated
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Capacitor Electrodes (Pad Electrodes)

Greater Electrical Field Patient Part of Circuit Must Have Uniform Contact (toweling) Spacing Equal To Crosssectional Diameter of Pads Part To Be Treated Should Be Centered 22

Pad Electrodes
Increasing The Spacing Will Increase The Depth Of Penetration But Will Decrease The Current Density Capacitive Method Good for Treating Superficial Soft Tissues
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Induction Method
Creates A Stronger Magnetic Field Than Electrical Field A Cable Or Coil Is Wrapped Circumferentially Around An Extremity Or Coiled Within n Electrode

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Induction Electrodes

Passing Current Through A Coiled Cable Creates A Magnetic Field By Inducing Eddy Currents (small circular electrical fields) That Generate Heat
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Induction Electrodes
Patient In A Magnetic Field Not Part Of A Circuit Greatest Current Flow Through Tissue With Least Resistance
Tissues react like a parallel circuit Fat does not provide as much resistance to electromagnetic energy

Tissue High In Electrolytic Content Respond Best To A Magnetic Field

Muscle and blood

Precaution: Not as much superficial sensation of heat with electromagnetic 26

Induction Electrodes (Cable Electrode)

Two Arrangements:
Pancake Coils Wraparound Coils

Toweling Is Essential Pancake Coil Must Have 6 in Center Then 5-10cm Spacing Between Turns Best Frequency
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Induction Electrodes (Drum Electrode)

One Or More Monopolar Coils Rigidly Fixed In A Housing Unit May Use More Than One Drum Depending On Area Treated Penetration
Deeper Soft Tissues

Toweling Important

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Heating With Continuous SWD

Patient Sensation Provides Basis For Recommendations Of Continuous SWD Dose I (Lowest) (<38 W) - No Sensation of Heat Dose II (Low) (~80 W)- Mild Heating Sensation Dose III (Medium) (80-300 W) - Moderate or Pleasant Heating Sensation Dose IV (Heavy) (>300 W) -Vigorous Heating Within Pain Threshold
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Pulsed SWD
Referred To By Different Names
Pulsed Electromagnetic Energy (PEME) Pulsed Electromagnetic Field (PEMF) Pulsed Electromagnetic Energy Treatment (PEMET)

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Pulsed SWD

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PSWD Mean Power Calculations

Pulse Period (Pulse on + off time) =
Peak Pulse Power (W) / Pulse Rep Freq (Hz)

Percentage On Time =
Pulse Duration (msec) / Pulse Period (msec)

Mean Power =
Peak Pulse Power (W) / Percentage on Time
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Example
Peak Pulse Power = 800 W Pulse Duration = .4 ms Pulse Frequency = 200 Hz Pulse Period = 800 W / 200 Hz = 4 ms % on time = .4 / 4 = .10 or 10% Mean Power = 10% of 800 = 80 W
End Result = thermal effect < 38 W = no heating
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Pulsed SWD
Interrupted Output Delivered In Series Of High-Frequency Bursts (40-400 usec) Pulse Rate Selected With Pulse Frequency Control (11000 Hz) Off-Time Longer Than On-Time Low Mean Power Output Uses Drum Electrode
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Shortwave Diathermy vs.Ultrasound

 Pulsed SWD

Produces The Same Magnitude And Depth Of Muscle Heating as 1MHz Ultrasound (Draper, JAT
1997)
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Treatment Time
Most Typically SWD Treatments Last For 20-30 Minutes Remember As Skin Temperature Rises Resistance Falls

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When Should Diathermy Be Used?



If The Skin Or Some Underlying Soft Tissue Is Tender And Will Not Tolerate Pressure  In Areas Where Subcutaneous Fat Is Thick And Deep Heating Is Required  Induction method  When The Treatment Goal Is To Increase Tissue Temperatures Over A Large Area
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SWD Guidelines
Indications
Continuous and Pulsed

Precautions Contraindications

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Microwave Diathermy
Two FCC Assigned Frequencies-2456 MHz and 915 MHz MWD Has Higher Frequency and Shorter Wavelength Than SWD Generates Strong Electrical Field and Relatively Little Magnetic Field Advantage: better focus wave on body, thereby more local heating affects Disadvantage: Depth Of Penetration Is Minimal In 39 Areas With Subcutaneous Fat > 1 cm

Microwave Diathermy Unit

A= Power Switch B=Timer C=Output Meter (indicates relative output in watts D= Power Output Level Knob E= Amber Light-Warming up / Red Light- Ready
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MWD Applicators (Electrodes)

Circular Shaped Applicators

4 or 6 Maximum Temperature At Periphery

Rectangular Shaped Applicators

4.5 x 5 or 5 x 21 Maximum Temperature At Center
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Microwave Applicator Set-Up

Microwave Applicator Beams Energy To Patient Must Pay Attention To Cosine Law In 915 MHz Units Applicators Placed 1 cm From Skin 2456 MHz Units Have Manufacturer Recommended Distances and Power Outputs (Uses Antenna)
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Best Treated areas for Microwave

Tendons of foot, hand and wrist AC and SC joints Patellar tendon Distal tendons of hamstrings Achilles tendon Other areas of low subcutaneous fat
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