European Journal of Physiotherapy

ISSN: 2167-9169 (Print) 2167-9177 (Online) Journal homepage: http://www.tandfonline.com/loi/iejp20

Microwave diathermy in physiotherapy units: lack

of maintenance

Andreas Andrikopoulos, Adam Adamopoulos & Constantinos Koutsojannis

To cite this article: Andreas Andrikopoulos, Adam Adamopoulos & Constantinos Koutsojannis
(2018): Microwave diathermy in physiotherapy units: lack of maintenance, European Journal of
Physiotherapy, DOI: 10.1080/21679169.2018.1452979

To link to this article: https://doi.org/10.1080/21679169.2018.1452979

Published online: 19 Mar 2018.

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EUROPEAN JOURNAL OF PHYSIOTHERAPY, 2018
https://doi.org/10.1080/21679169.2018.1452979

ORIGINAL ARTICLE

Microwave diathermy in physiotherapy units: lack of maintenance

Andreas Andrikopoulosa,b, Adam Adamopoulosa and Constantinos Koutsojannisb
a
Laboratory of Medical Physics, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece; bLaboratory of Health Physics,
Department of Physiotherapy, University of Applied Sciences, Aigion, Greece

ABSTRACT ARTICLE HISTORY

Aim: Rehabilitation practice for most patients consists of a combined use of thermotherapy that is Received 8 December 2017
produced from diathermy devices resulting faster and deeper heating to the patient, considerable con- Revised 21 February 2018
cerns about occupational exposure to electromagnetic radiation for the operators has to be taken into Accepted 4 March 2018
account. In most occasions, physiotherapists have involved multi-hour treatment sessions to different Published online 19 March
2018
patients, resulting overuse of the diathermy device. The time extended use of the device periodically
leads to mechanical failures or troubleshooting of the machine which, in most cases, are not perceived KEYWORDS
by the operator of the device. All device's efficient functionality have a major impact on the comple- Query; research; clinical
tion of the treatment procedure in a large percentage of specific clinical conditions. If the device's protocol; equipment; safety;
operating condition is technically out of order or in a mode of over-activity, operators are mainly seek- quality control procedure
ing solutions by reviewing the clinical case of the patient. This is eliminating their contribution during
the primary therapeutic plan or increasing the treatment sessions. In this case, the radial burden from
the device poses health hazards for staff and patients.
Method: In this work, an extended survey is presented including 553 physiotherapy centres concerning
usability and maintenance issues of diathermy devices throughout Greek territory.
Results: Physiotherapists' perceptions on topics as technical support, maintenance and safe use of dif-
ferent kind of diathermy devices with emphasis on micro-wave diathermy (MWD) will extract auxiliary
observations upon their clinical practice routines.

Introduction the thermal effects of the absorption of electromagnetic

Rehabilitation practice for most of clinical protocols consists
of a combined use of thermotherapy that is produced from
diathermy devices resulting faster and deeper heating to the
patient [1]. Heat therapy depends on patient’s tissue sensitiv-
ity and this factor controls every time the safe dosage that
will be used by a physiotherapist for the application of each
treatment protocol [1,2]. Almost every health care profes-
sional during physical therapy routine experiences exposure
to electromagnetic field of high frequency caused by the use
of different types of devices. The user-manual includes gen-
eral instructions (maintenance, operation, precautionary prac-
tices, etc.) and intent to familiarise the operator before the
clinical use on patients [2–4]. The device is meant to be used
by a health care professional such as a physiotherapist or a
licenced practitioner – assistant from an adjacent health pro-
fessions and always under the supervision of the first one [5].
Due to pre-defined protocols, learning curve of short-wave
diathermy(SWDs) and micro-wave diathermy (MWDs) is rather
small and in many cases operators are physiotherapy assis-
tants. According to a number of studies, considerable con-
cerns about occupational exposure to electromagnetic
radiation for the operators have to be taken into account [1].
Health risks from exposure to over limited radiation occurred
in the workplace of a physiotherapy centre by improper use
of the device that is dangerously recognised and related to
energy on the human body [1]. During treatment sessions,
the most important factor is the transfer of heat to the tissue
through the power density from the device. This variable
depends on both the type of the manufacturer and the level
of power that is produced by the equipment [1,6,7]. Most of
medical equipment producers, that provide shortwave (SWD),
micro-wave (MWD) and hyperthermia devices, attach a user
manual for the operators in order to use the device in proper
way. Other related work reports that the absence of quality
control procedure of the equipment in a physiotherapy
centre and more specifically of the diathermy devices has a
negative effect on daily basis concerning the physiotherapeu-
tic clinical treatments of patients [6]. More specifically for
MWDs power output issues can affect the spatial and time
heterogeneity of electromagnetic field leading to neglectful
treatment sessions for patients and occupational overexpos-
ure in radiation for physiotherapists [1].
Additionally from 2000 to mid-2017, a downward trend
has been pointed out in the assessment of quality control of
MWDs and hyperthermia. Using keywords such as ‘micro-
wave diathermy’ and ‘quality control’ is noted that regarding
SWD there is a more documented research at the level of
quality control procedure and less for MWD and even less for
hyperthermia (Figure 1). Overview for the late devices are
based on proportional conclusions which are related either

CONTACT Andreas Andrikopoulos anandrikop@gmail.com Psaron 6, Myrtia 25100, Aigio, Greece

ß 2018 Informa UK Limited, trading as Taylor & Francis Group
2 A. ANDRIKOPOULOS ET AL.
Figure 1. Search and observation of decreasing trend based on key words: (i) micro-wave diathermy and (ii) Diathermy quality control [Source: PubMed].
to the quality control protocol of the MWDs or to researches
that are related to scientific placements in different medical
devices, which their electromagnetic field emits at the same
frequency, from other health care professions (e.g. surgeons,
oncologists, etc.) but not obligated in the practice of physio-
therapy [8]. This observation raises concerns for the quality
level of the existing applied physiotherapeutic protocols
introducing bias in the clinical research additionally with
learning curve [1,9,10].
The main objective of the present survey was to give an
insight into functionality and safe use of diathermy devices,
in physiotherapy workplaces is affected according to the
widespread use, in Greece. Consequently and according to
our results, various concerns based on the lack of mainten-
ance of MWDs on patients’ treatment sessions, and research
outcomes as well as on radiation exposure of involving staff
are discussed [1,10,11].
Method
A pilot national survey was carried out from March of
2016 to November of the same year and took place in 4
cities of the regional union of Western Greece, in 2 cities
of the regional unit of Attica and in 3 cities of the
regional unit of the Eastern Macedonia and Thrace. A
questionnaire developed in the laboratory ‘Health Physics &
Computational Intelligence’ (HPCI) of ‘Technological and
Educational Institute of Western Greece’ with closed
questions regarding the procedures used by the physio-
therapists for the use of diathermy equipment, mainten-
ance issues and acquiring knowledge about technical
standards of the equipment for which the physiotherapist
is responsible as well as classified scale questions with
only one response from a range of multiple options that
related to age, gender, years of professional experience,
type of diathermy equipment and rendering of services.
The process of distributing the questionnaire was applied
by the staff of the laboratory HPCI in collaboration with
the ‘Panhellenic Association of Physiotherapists’ where the
last one organised the procedure at an early stage to
inform all registered members for the objective of the
research that the laboratory would perform during the
time period that mentioned above. The research project
was approved by the Institutional Committee of Bioethics
in Research. Initially, a phone directory was used to deter-
mine the date of completing the questionnaire by the
physiotherapist. After the personal contact with each
physiotherapist and the owner of the clinic via telephone,
the staff of the lab was visited the place where the health
care professional was working and he/she proceeded with
the completion of the questionnaire.
Results
In the present work, 553 physiotherapy centres with their
diathermy equipment (about 10% of the total number in

Greece) were evaluated (Figure 2). Data from the question-
naire are presented in Table 1. According to these data, 81%
of the physiotherapists were male and 19% were female.
The majority of the ages practicing the profession fluctuates
from 26–30 years old (30%), 31–35 years old (18%), 41–45
years old (13%), 46–50 years old (15%) to 51–55 years old
(13%). Regarding the corresponding professional experience,
it was remarkable that only 1% had 0–5 years of relevant
experience in the field of physical therapy followed by higher
rates in other groups (31% had 5–10 years, 24% had 10–15
and 15–20 years and 20% more than 20 years).
It was notable that MWD accounted for the highest per-
centages (12% for 0 devices installed in a physiotherapy
room, 70% for 1 device, 17% for 2 devices and 1% for 3 devi-
ces) in the number and type of use of diathermy devices in
relation to SWD (33% for 0 devices installed in a physiother-
apy room, 57% for 1 device, 10% for 2 devices and 0% for 3
devices) and hyperthermia (49% for 0 devices installed in a
physiotherapy room, 48% for 1 device, 3% for 2 devices and
0% for 3 devices).
Regarding the employment of staff such as physiothera-
pists and assistants, 56% of the interviewees stated that they
were self-employed, 29% stated that they employ 2 health-
care professionals (HCP) including themselves, 8% respect-
ively 3 HCP, 5% respectively 4 HCP, 1% respectively 5 HCP
and 1% respectively 6 HCP. When the physiotherapists were
asked about the offering services by using the diathermy
device per day, 7% reported that they offered services with
the use of the device from 0 to 5 patients, 52% for 6–10
patients, 36% for 11–15 patients and 5% for more than 20
patients. In the same question but this time for the use of
the device per month, 3% reported that they offered services
with the use of the device from 0 to 10 patients each month,
51% for 11–20 patients, 35% for 21–30 patients and 11% for
more than 30 patients.
Figure 2. Map of the sample showing the regional units and the cities surveyed.
EUROPEAN JOURNAL OF PHYSIOTHERAPY 3
As far as the existence of any certified protocols for stand-
ard treatment sessions for each diathermy device, 79%
answered negatively and 21% positively. From the view of
physical therapists, 61% believed that there is a lack of safety
precautions (e.g. shielding, glasses, etc.) for staff and patients
during pregnancy and lactation, while 39% supported the
opposite. 93% of physiotherapists deemed that there are not
certificates of competence and training for staff employed in
your area of radiation protection and only a 7% believed that
there is such a thing.
With regard to the awareness if there are certified proto-
cols for staff to be protected by radiation from diathermy
devices, 9% stated that knew something about that, while
the rest 91% declared ignorance. 98% of physiotherapists
showed inadequacy in having certified diathermy test proto-
cols (e.g. magnetron lamp malfunction or damaged cable,
observation for operating situation of the device) and 2%
claimed to have maintained such a procedure.
When asked if the interviewees kept a record for dam-
ages of the diathermy devices (e.g. indicating faults, mech-
anical conversions, repairs and the staff who detected them
and those who fixed the damage), 86% answered nega-
tively due to the fact that they were not sure if they were
able to observe some of the specialised damages that men-
tioned above or they had never been able to deal with
any damages and 14% handled damages that were obvi-
ous. In the same query but from a general point of view
(e.g. quality checklist, periodic technical proofs, control after
each physiotherapeutic intervention, etc.) for each dia-
thermy, there was a relative dissimilarity with the previous
question, for as much as 95% responded negatively and
5% positively.
Finally, when the physical therapists were using a dia-
thermy device, 43% replied that they specified the radiation
dose for each clinical occasion, 21% answered that they were
4 A. ANDRIKOPOULOS ET AL.

Table 1. Data from the questionnaire for physiotherapists and assistants included in the analysis (n ¼ 553).
Variable n (%)
I. Gender
Male 450 (81)
Female 103 (19)
II. Age (years)
21–25 3 (1)
26–30 162 (30)
31–35 102 (18)
36–40 24 (4)
41–45 74 (13)
46–50 85 (15)
51–55 72 (13)
56–60 31 (6)
III. Professional experience (Years)
0–5 7 (1)
5–10 172 (31)
10–15 134 (24)
15–20 131 (24)
>20 109 (20)
1. How many diathermy devices do you have in your physiotherapy room?
Micro-wave 0 (12) – 1 (70) – 2 (17) – 3 (1)
Shortwave 0 (33) – 1 (57) – 2 (10)
Hyperthermia 0 (49) – 1 (48) – 2 (3)
2. How many health professionals/diathermy assistant users are
employed in your physiotherapy room, including yourself?
1 312 (56)
2 160 (29)
3 45 (8)
4 25 (5)
5 7 (1)
6 4 (1)
3. How many patients do you offer services with diathermy devices per day?
0–5 41 (7)
6–10 285 (52)
11–15 200 (36)
>20 27 (5)
4. How many patients do you offer services with diathermy devices per month?
0–10 16 (3)
11–20 284 (51)
21–30 194 (35)
>30 59 (11)
5. Are there any certified protocols for standard treatment sessions
for each diathermy device?
Yes 118 (21)
No 435 (79)
6. Is there a safety precaution (e.g. shielding, glasses, etc.) for staff
and patients during pregnancy and lactation?
Yes 215 (39)
No 338 (61)
7. Is there a certificate of competence and training for staff
employed in your area of radiation protection?
Yes 40 (7)
No 513 (93)
8. Are you aware if there are certified protocols for staff to be protected
by radiation from diathermy devices?
Yes 50 (9)
No 503 (91)
9. Does your physiotherapy room has certified diathermy test protocols
(e.g. magnetron lamp malfunction or damaged cable, observation for
operating situation of the device)?
Yes 10 (2)
No 543 (98)
10. Do you keep a record for damages of the diathermy devices (indicating faults,
mechanical conversions, repairs and the staff who detected them and those who fixed the damage)?
Yes 80 (14)
No 473 (86)
11. Do you keep a general record for each diathermy device (quality checklist,
periodic technical proofs, control after each physiotherapeutic intervention, etc.)?
Yes 27 (5)
12. When you’re using a diathermy device, do you specify the radiation dose for each
clinical occasion or you’re using the treatment protocols proposed by the device itself (factory settings)?
Yes 239 (43)
No 115 (21)
Both of them 199 (36)

using the treatment protocols proposed by the device itself
(factory settings) and 36% showed us that they were using
both of these approaches.
Discussion
Results of this study identified physiotherapists’ perception
on usability and maintenance issues of diathermy devices.
These findings certainly raise concerns as to how it can affect
the clinical routine of the physiotherapists. In Greece, the
profession of physical therapist has an immediate profes-
sional demand; based on the research of at least 21–25 years
it is observed that both the physiotherapist and the assistant
have already begun to practice the profession. The fact that
the professional is at least 56–60 years old, combined with
the data provided by the research in terms of professional
experience, the physiotherapist is considered to be active in
practicing the profession for at least 20 to 30 years. In com-
bination with the answers concerning the daily and monthly
services to patients by using a diathermy device, either in
long or in short terms, the device may be probably malfunc-
tioning from overuse, with the result that the physiothera-
pists will not properly apply their treatment protocols to
patients and at the same time they and their staff will come
up against risks related to radiation protection issues [1,12].
Data that indicate the number and type of diathermy devices
held by operators in their units showed that MWD, in relation
to SWD and hyperthermia, surpassed as many as it was
noted that most physiotherapists had in their possession at a
higher rate of more than two devices in relation to the other
types. Only in the case of MWD, it was observed that in most
physiotherapy centres there was installed a third device
when the other types of devices were numbered in two devi-
ces. What came up with the query concerning the amount of
Figure 3. Data from questions 5 to 11 concerning the interaction of diathermy devices with the users from a technical and safety perspective.
EUROPEAN JOURNAL OF PHYSIOTHERAPY 5
health care professionals and diathermy assistant users that
are employed in the physiotherapy room, including the
owner of the physiotherapy centre, it seems that in some
cases they were employed up to six persons from both spe-
cialties in order to cope with a large number of patients who
would have to render their services on a daily or on a
monthly basis. By combining the data analysed above about
the most prevalent type and number of diathermy devices
that were installed in physiotherapy rooms with the results
that obtained from the last question seems that appears a
further need for establishing quality control (QC) procedure
for the MWDs. It is confirmed the fact that even more physio-
therapists, including their assistants, serve an overweighted
number of patients. As a result, the increasing use of MWDs
as well as the amount of devices will be an additional radial
burden, that would jeopardise the health of the users of the
MWD or to be at a high risk the therapeutical protocols of
physiotherapists where an eventual malfunction of the device
would go unnoticed by its operator, could alter the effective-
ness of each therapeutic session that accompanied by the
device [1,11,13–15]. As shown in Table 1 in the middle of the
questionnaire to the end (Questions 5 to 11), there is a series
of questions investigating issues such as the safety of person-
nel from radiation, the existence of certified protocols, the
radiation protection training of staff and the maintenance of
the functionality of the device. Figure 3 is undoubtedly
apparent to a large extent that it is not observed by the
physiotherapists everything that is related to maintenance
issues of the diathermy devices. Although there are proposed
procedures for the maintenance of the SWD, it is noted that
the procedures are not applied in order to make the devices
more secure. Consequently for other types of diathermy devi-
ces as MWDs, which have mentioned above there are no
quality control procedures. If equipment is not calibrated, it
6 A. ANDRIKOPOULOS ET AL.
impacts the treatment of patients and raises concerns about
health hazards for physiotherapists and staff [1,13,16]. In add-
ition to lack of knowledge or non-continuous training on
issues as radiation protection or occupational safety, the
results of the presented survey conclude to possible health
hazards for both physiotherapists and patients from electro-
magnetic radiation or other equipment-related factors
[14,17,18]. Despite that, the last question accrues that there
is a large proportion of physiotherapists who use and trust
the therapeutic protocols proposed by the manufacturers.
This factor supports the risks highlighted above and it could
negatively affect future graduates of physiotherapy on issues
of clinical knowledge in the field of therapeutic rehabilitation
[4,16,19]. One of the goals of the present work is to inform
the academics that are related with the continuous education
in physiotherapy the necessity for extended suggestions con-
cerning correlation between the periodic maintenance of the
diathermy devices and the assurance of the practices in the
profession of physical therapy as well as the occupational
safety [6,8,14]. Based on the results of our study, it seems to
appear a lack of such a need by manufacturers or by govern-
mental agencies. Physiotherapy associations and state health
agencies should corporate and organise workshops in order
to train physical therapists be aware of the need for prevent-
ive maintenance of their diathermy devices.
Conclusion
Both the practice of physiotherapy and the need to rehabili-
tate the patient through the use of resources appear to be
either short-term or long-term risks for the occupational
safety of the physiotherapist and the treatment of the
patient [1,20]. According to the excessive use of MWD would
cause serious alterations in the effectiveness of treatment,
resulting not only in high risk for the quality of physiothera-
pist's treatment protocols, but the radial burden of using
MWD would affect the health both of professional therapist
and patient [1,11,13–15,21].
Disclosure statement
No potential conflict of interest was reported by the authors.
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