Chapter-4

Physiotherapy and Radiotherapy equipment

4.1 High Frequency Heat Therapy

Physical stimulus commonly employed in the practice of physiotherapy is in the form of heat,
either by simple heat radiation or by the application of the high frequency energy obtained
from special generators. The use of high frequency energy in thermotherapy has the advantage
of considerable penetration as compared to simple heat application. Thus, with high frequency
energy, deeper laying tissue, e.g. muscle, bones, internal organs etc. can be provided heat.

The high frequency heat can be obtained from various ways. It may be from the shortwave
therapy unit making use of either the condenser field or the inductor field method. Microwave
and ultrasonic waves are also used for heating purpose in special cases.

4.2 Short Wave Diathermy

Diathermy in medical application is used in following ways:

1. Diathermy in physiotherapy
 Short Wave Diathermy
 Microwave Diathermy
 Ultrasonic therapy unit
2. Diathermy in surgery

Diathermy means ‘through heating’ or producing deep heating directly in the tissue of the
body. Externally applied source of heat like hot towels, infrared lamps and electric heating pads
often produce discomfort and skin burns long before the adequate heat has penetrated to the
deeper tissue. But in diathermy technique, the subject’s body becomes part of the electrical
circuit and the heat is produced within the body and not transferred through the skin.

Another advantage of diathermy is that the treatment can be controlled precisely. The careful
placement of the electrodes permits localization of the heat in the region to be treated. The
amount of the heat can be adjusted by adjusting the circuit parameters. The heating of tissue is
achieved by the use of high frequency current and high frequency current does not stimulate
motor or sensory nerve nor do they produce muscle contraction. Thus no discomfort is caused
to the subject.

The short wave diathermy machine consists of two main circuits: an oscillating circuit which
produces a high frequency current and a patient circuit which is connected to oscillating circuit
through which the electrical energy is transferred to the patient.
 The most common method of short
wave diathermy is to operate in
capacitor plate method and inductive
method.

In capacitor plate method the short-

wave diathermy machine is connected to metal electrodes which are positioned on the body
over the region to be treated. These electrodes are also called PADS. The pads are not directly
connected with the skin, usually a layer of towels are used between the pads and skin. The
portion of the body to be treated is generally sandwiched between the pads and this method is
called contra planar capacitor method and in coplanar capacitor method the pads are placed
side by side but with adequate distance between them. In both methods metal part acts as two
plates of capacitor and body tissue to be treated as dielectric. When current is applied to the
capacitor plate, it causes vibration or ions, rotation of electrolytes (dipoles) and molecular
distortion which can be said to be dielectric lose in capacitor and this dielectric lose of capacitor
produces heat in the tissue.

Figure Contra planar capacitor method Figure Coplanar capacitor method

Figure Inductothermy
In another method the output of the diathermy machine may be connected to a flexible cable
instead of pads. This cable is coiled around the effected portion. When RF current is passed
through such cable, an electrostatic field is setup between ends and a magnetic field around
the centre. Deep heating in the tissue results from electrostatic action whereas the heating of
the superficial tissue is obtained by eddy currents setup by a magnetic effect. This technique is
known as inductothermy.

Diathermy machine has several limitations like burns if high output energy is sustained for even
a brief time. To achieve increased energy output while avoiding the danger of heat can be
achieved by a machine called “Pulsed Short wave therapy”.

4.3 Microwave Diathermy

Microwave diathermy consists of irradiating the tissue of the patient’s body with very short
wireless waves having frequency in microwave region of electromagnetic spectrum. The
microwave frequency lies between 300-30,000 MHz and most common therapeutic heating is
2450 MHz.

In many cases the results of the heat produced by microwave for therapy are similar to that of
short waves where as in other cases better than the short waves. In microwave diathermy, the
microwave is transmitted form a emitter and are directed towards the portion of the body to be
treated. No pads/ electrodes are required for this purpose. These waves are passed through the
intervening air space and are absorbed by the surface of the body producing heating effect. The
special design of the transmitting heads and shape focuses the field directly to the target area.
Generally circular and rectangular design of transmitter is often found. Circular is used for
higher peripheral heat and rectangular for elongated area.

Microwave is produced by high frequency currents and has the same frequency as the currents
which produce them. Such currents cannot be produced by oscillator so a special device called
‘magnetron’ is used for production of high frequency current of higher power.

Microwave penetrated more deeply than infrared rays but not as short wave diathermy, so
microwave is not suitable for deeply placed structures.

4.4 Ultrasonic Therapy Unit

In ultrasonic therapy unit heat is produced due to the absorption of the ultrasonic energy by
the tissue. The effect of the ultrasound in the on this tissue is thus a high speed vibration of
micro massage. Massage as a modality in physical medicine has been used in treatment of soft
tissue lesions for centuries. The electrical power required in most of the application is usually
less than 3W/cm2 of the transducer area that is in contact with the part of the body to be
treated.

The transducer through which the ultrasonic energy is applied to the patient is made of
piezoelectric crystal.

A high frequency alternating current (.75-3MHz) is applied to the crystal whose acoustic
vibration causes the mechanical vibration of a transducer head, which is located directly infront
of the crystal. These mechanical vibrations then pass through metal cap and into the body
through coupling medium.

The main part of the ultrasonic therapy unit is a timed oscillator which produces the electrical
oscillations of the required frequency. The oscillator output is given to a power amplifier which
drives the piezo-electric crystal to generate ultrasonic waves.

A full wave rectifier comes in circuit for continuous operation of the system. In pulse mode the
oscillator is provided by the half-wave rectifier.

4.5 Electro Diagnostic and Therapeutic apparatus

Electrodiagnosis

If a normal muscles or motor nerve is stimulated with a current of adequate intensity, it results
in its contraction. In case of disease of injury to motor nerve or muscle, alteration can be
observed in response to electrical stimulus. By observing the response of current in motor
nerve of muscle, it is possible to determine the degeneration, regeneration or normal
functioning of muscles.

A curve is used to examine the condition of excitability which is known as “Intensity-Time curve
(i-t Curves)”. The i-t curve has plot of intensity of current against the time. The i-t Curves have
the shapes and deviations from the standard form which leads to an indication of the state of
tissue.
 Figure 1 i-t curve

In the given graph Rheobase is the minimum intensity of current that will produce a response if
the stimulus is of infinite duration, in practice an impulse of 100ms being adequate for
estimating this. Whereas chronaxie is the minimum duration of impulse that will produce a
response with a current of double the rheobase. For example if the rheobase is 6mA,, the
chronaxie is the duration of the shortest impulse that will produce a muscle contraction with a
current of 12mA.

Accommodation: Accommodation is the property of the neuro-muscular unit being able to

respond less strongly to a slow increasing current impulse.

Type of waveform required for electrodiagnosis are:

Galvanic current:- for qualitative and quantitative determination of rheobase and

chronaxie.

Rectangular pulse: for checking nervous conduction.

Exponentailly progressive current: for checking the accommodability.

Faradic current: for qualitative and quantitative determination of faradic excitability.

Electrotherapy:

Electrotherapy is use of low voltage, low frequency impulse current in management of many
disease affecting muscle and nerves. This technique is used for the treatment paralysis with
totally or partially degenerated muscles, for treatment of pain, muscular spasm and peripheral
circulatory disturbances and for several other applications.
Different types of waveforms are used for carrying out specific treatments. The most commonly
used pulse waveforms are discussed below:

Galvanic Current: When a steady flow of direct current is passed through tissue it causes
movement of ions and their collection where electrodes are placed and ultimately results
increased blood flow. The duration of treatment is around 10-20 Min.

Faradic Current: It is a sequence of pulse with a defined shape and current intensity. Triangular
waveform pulse with a pulse duration of 1mSec and interval of 20mSec is used. The effect
produced by the faradic current in motor nerve and muscle tissue results in muscle contraction
with no chemical effect and in galvanic current. This is used for treatment of atrophy and
weakening of muscles after lengthy immobilization.

Surging Current: If the peak current intensity applied to the patient increases and decreases
rhythmically and the rate of increase and decrease of the peak amplitude is slow, the resulting
shape of current waveform is called a surging current and used for treatment of pain and
spasm.

Exponentially progressive current: This method is used for selective stimulation of the paralyzed
muscles without stimulating the tissue in neighborhood. The slope of the exponential curve is
kept variable.

Biphasic Stimulation: The recovery of cells can be speedup with a stimulus of low intensity
current of opposing polarity for period of time. The opposing polarity results in net quantity of
electricity to be zero. Such type of positive and negative pulses is called biphasic stimulation.
Electrodiagnosis and Electrotherapy Apparatus

Different type of commercial units is available which give specific output waveforms for specific
applications; however the recent trend is having a versatile apparatus with various output
currents. The apparatus must be either a constant current of a constant voltage type and the
outputs should be reproducible.

Radiotherapy Equipment

Radiation therapy (or radiotherapy) is the treatment of cancer using radiation. During radiation
treatment, radiation is directed to the target tissue and transmits energy that damages and
destroys the cancer cells. It does this by damaging the genetic material of the cells which
triggers cell death. The radiation damages genetic material in both normal and malignant cells
and does not discriminate between them. However, normal cells are able to recover from the
damage, whilst the cancer cells do not. Radiation therapy aims to maximize the number
of cancer cells destroyed, while minimizing the damage to nearby normal cells.

The main type of radiation used for the treatment of skin cancers are x-rays. X-rays can be
generated with different energy levels. High energy x-rays are able to penetrate deep into the
body, and are used to treat internal cancers. In contrast, low energy x-rays do not penetrate
very deep into the body and transmit most of their energy into the skin and are therefore used
for the treatment of skin cancers. These low energy x-rays are often called superficial or
orthovoltage x-rays.

Megavoltage X-rays are produced by linear accelerators ("linacs") operating at voltages in

excess of 1000 kV (1 MV) range, and therefore have an energy in the MeV range. Beams with
the voltage range of 4-25 MV are used to treat deeply buried cancers.

Orthovoltage x-rays are produced by x-ray tubes operating at voltages in the 200–500 kV

range, and therefore the x-rays have an energy in the 200–500 keV range. orthovoltage X-rays,
are used to treat more superficial cancers.