Diathermy

Last updated
Diathermy
Pronunciationdi´ah-ther″me
ICD-9-CM 93.34
MeSH D003972

Diathermy is electrically induced heat or the use of high-frequency electromagnetic currents as a form of physical therapy and in surgical procedures. The earliest observations on the reactions of high-frequency electromagnetic currents upon the human organism were made by Jacques Arsene d'Arsonval. [1] [2] [3] The field was pioneered in 1907 by German physician Karl Franz Nagelschmidt, who coined the term diathermy from the Greek words dia and θέρμη therma, literally meaning "heating through" (adj., diather´mal, diather´mic).

Contents

Diathermy is commonly used for muscle relaxation, and to induce deep heating in tissue for therapeutic purposes in medicine. It is used in physical therapy to deliver moderate heat directly to pathologic lesions in the deeper tissues of the body.

Muscle contractile soft tissue of mammals

Muscle is a soft tissue found in most animals. Muscle cells contain protein filaments of actin and myosin that slide past one another, producing a contraction that changes both the length and the shape of the cell. Muscles function to produce force and motion. They are primarily responsible for maintaining and changing posture, locomotion, as well as movement of internal organs, such as the contraction of the heart and the movement of food through the digestive system via peristalsis.

Diathermy is produced by three techniques: ultrasound (ultrasonic diathermy), short-wave radio frequencies in the range 1–100 MHz (shortwave diathermy) or microwaves typically in the 915 MHz or 2.45 GHz bands (microwave diathermy), the methods differing mainly in their penetration capability. [4] It exerts physical effects and elicits a spectrum of physiological responses.

Ultrasound vibrations with frequencies above the human hearing range

Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies from person to person and is approximately 20 kilohertz in healthy young adults. Ultrasound devices operate with frequencies from 20 kHz up to several gigahertz.

Microwave form of electromagnetic radiation

Microwaves are a form of electromagnetic radiation with wavelengths ranging from about one meter to one millimeter; with frequencies between 300 MHz (1 m) and 300 GHz (1 mm). Different sources define different frequency ranges as microwaves; the above broad definition includes both UHF and EHF bands. A more common definition in radio engineering is the range between 1 and 100 GHz. In all cases, microwaves include the entire SHF band at minimum. Frequencies in the microwave range are often referred to by their IEEE radar band designations: S, C, X, Ku, K, or Ka band, or by similar NATO or EU designations.

The same techniques are also used to create higher tissue temperatures to destroy neoplasms (cancer and tumors), warts, and infected tissues; this is called hyperthermia treatment. In surgery diathermy is used to cauterize blood vessels to prevent excessive bleeding. The technique is particularly valuable in neurosurgery and surgery of the eye.

Neoplasm Abnormal mass of tissue as a result of abnormal growth or division of cells

A neoplasm is a type of abnormal and excessive growth, called neoplasia, of tissue. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and it persists growing abnormally, even if the original trigger is removed. This abnormal growth usually forms a mass. When it forms a mass, it may be called a tumor.

History

The idea that high-frequency electromagnetic currents could have therapeutic effects was explored independently around the same time (1890-91) by French physician and biophysicist Jacques Arsene d'Arsonval and Serbian American engineer Nikola Tesla. [1] [2] [3] d'Arsonval had been studying medical applications for electricity in the 1880s and performed the first systematic studies in 1890 of the effect of alternating current on the body, and discovered that frequencies above 10 kHz did not cause the physiological reaction of electric shock, but warming. [2] [3] [5] [6] He also developed the three methods that have been used to apply high-frequency current to the body: contact electrodes, capacitive plates, and inductive coils. [3] Nikola Tesla first noted around 1891 the ability of high-frequency currents to produce heat in the body and suggested its use in medicine. [1]

Nikola Tesla Serbian American inventor

Nikola Tesla was a Serbian-American inventor, electrical engineer, mechanical engineer, and futurist who is best known for his contributions to the design of the modern alternating current (AC) electricity supply system.

By 1900 application of high-frequency current to the body was used experimentally to treat a wide variety of medical conditions in the new medical field of electrotherapy . In 1899 Austrian chemist von Zaynek determined the rate of heat production in tissue as a function of frequency and current density, and first proposed using high-frequency currents for deep heating therapy. [2] In 1908 German physician Karl Franz Nagelschmidt coined the term diathermy, and performed the first extensive experiments on patients. [3] Nagelschmidt is considered the founder of the field. He wrote the first textbook on diathermy in 1913, which revolutionized the field. [2] [3]

Electrotherapy use of electricity for medical purposes

Electrotherapy is the use of electrical energy as a medical treatment. In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments.

Until the 1920s noisy spark-discharge Tesla coil and Oudin coil machines were used. These were limited to frequencies of 0.1 - 2 MHz, called "longwave" diathermy. The current was applied directly to the body with contact electrodes, which could cause skin burns. In the 1920s the development of vacuum tube machines allowed frequencies to be increased to 10 - 300 MHz, called "shortwave" diathermy. The energy was applied to the body with inductive coils of wire or capacitive plates insulated from the body, which reduced the risk of burns. By the 1940s microwaves were being used experimentally.

Uses

Shortwave diathermy machine, 1933 Diathermy machine 1933.jpg
Shortwave diathermy machine, 1933

Physical therapy

The three forms of diathermy employed by physical therapists are ultrasound, short wave and microwave. The application of moderate heat by diathermy increases blood flow and speeds up metabolism and the rate of ion diffusion across cellular membranes. The fibrous tissues in tendons, joint capsules, and scars are more easily stretched when subjected to heat, thus facilitating the relief of stiffness of joints and promoting relaxation of the muscles and decrease of muscle spasms.

Ultrasound

Ultrasound diathermy employs high-frequency acoustic vibrations which, when propelled through the tissues, are converted into heat. This type of diathermy is especially useful in the delivery of heat to selected musculatures and structures because there is a difference in the sensitivity of various fibers to the acoustic vibrations; some are more absorptive and some are more reflective. For example, in subcutaneous fat, relatively little energy is converted into heat, but in muscle tissues there is a much higher rate of conversion to heat.

The therapeutic ultrasound apparatus generates a high-frequency alternating current, which is then converted into acoustic vibrations. The apparatus is moved slowly across the surface of the part being treated. Ultrasound is a very effective agent for the application of heat, but it should be used only by a therapist who is fully aware of its potential hazards and the contraindications for its use.

Short wave

Short wave diathermy machines use two condenser plates that are placed on either side of the body part to be treated. Another mode of application is by induction coils that are pliable and can be molded to fit the part of the body under treatment. As the high-frequency waves travel through the body tissues between the condensers or the coils, they are converted into heat. The degree of heat and depth of penetration depend in part on the absorptive and resistance properties of the tissues that the waves encounter.

Short wave diathermy operations use the ISM band frequencies of 13.56, 27.12, and 40.68 megahertz. Most commercial machines operate at a frequency of 27.12 MHz, a wavelength of approximately 11 meters.

Short wave diathermy usually is prescribed for treatment of deep muscles and joints that are covered with a heavy soft-tissue mass, for example, the hip. In some instances short wave diathermy may be applied to localize deep inflammatory processes, as in pelvic inflammatory disease. Short wave diathermy can also be used for hyperthermia therapy, as an adjuvant to radiation in cancer treatment. Typically, hyperthermia would be added twice a week before radiation, as shown in the photograph from a 2010 clinical trial at Mahavir Cancer Sansthan in Patna, India.

Clinical trial of hyperthermia and radiation at the Mahavir Cancer Sansthan, Patna, India Diathermy unit for hyperthermia treatment.jpg
Clinical trial of hyperthermia and radiation at the Mahavir Cancer Sansthan, Patna, India

Microwave

Microwave diathermy uses microwaves, radio waves which are higher in frequency and shorter in wavelength than the short waves above. Microwaves, which are also used in radar, have a frequency above 300 MHz and a wavelength less than one meter. Most, if not all, of the therapeutic effects of microwave therapy are related to the conversion of energy into heat and its distribution throughout the body tissues. This mode of diathermy is considered to be the easiest to use, but the microwaves have a relatively poor depth of penetration.

Microwaves cannot be used in high dosage on edematous tissue, over wet dressings, or near metallic implants in the body because of the danger of local burns. Microwaves and short waves cannot be used on or near persons with implanted electronic cardiac pacemakers.

Hyperthermia induced by microwave diathermy raises the temperature of deep tissues from 41 °C to 45 °C using electromagnetic power. The biological mechanism that regulates the relationship between the thermal dose and the healing process of soft tissues with low or high water content or with low or high blood perfusion is still under study. Microwave diathermy treatment at 434 and 915 MHz can be effective in the short-term management of musculo-skeletal injuries.

Hyperthermia is safe if the temperature is kept under 45 °C or 113 °F. The absolute temperature is, however, not sufficient to predict the damage that it may produce.

Microwave diathermy-induced hyperthermia produced short-term pain relief in established supraspinatus tendinopathy.

The physical characteristics of most of the devices used clinically to heat tissues have been proved to be inefficient to reach the necessary therapeutic heating patterns in the range of depth of the damage tissue. The preliminary studies performed with new microwave devices working at 434 MHz have demonstrated encouraging results. Nevertheless, adequately designed prospective-controlled clinical studies need to be completed to confirm the therapeutic effectiveness of hyperthermia with large number of patients, longer-term follow-up and mixed populations. [7]

Microwave diathermy is used in the management of superficial tumours with conventional radiotherapy and chemotherapy. Hyperthermia has been used in oncology for more than 35 years, in addition to radiotherapy, in the management of different tumours. In 1994, hyperthermia was introduced in several countries of the European Union as a modality for use in physical medicine and sports traumatology. Its use has been successfully extended to physical medicine and sports traumatology in Central and Southern Europe.

Surgery

Surgical diathermy is usually better known as "electrosurgery". (It is also referred to occasionally as "electrocautery", but see disambiguation below.) Electrosurgery and surgical diathermy involve the use of high-frequency A.C. electric current in surgery as either a cutting modality, or else to cauterize small blood vessels to stop bleeding. This technique induces localized tissue burning and damage, the zone of which is controlled by the frequency and power of the device.

Some sources [8] insist that electrosurgery be applied to surgery accomplished by high-frequency alternating current (AC) cutting, and that "electrocautery" be used only for the practice of cauterization with heated nichrome wires powered by direct current (DC), as in the handheld battery-operated portable cautery tools.

Types

Diathermy used in surgery is of typically two types. [9]

  • Monopolar, where electric current passes from one electrode near the tissue to be treated to other fixed electrode (indifferent electrode) elsewhere in the body. Usually this type of electrode is placed in contact with buttocks or around the leg. [10]
  • Bipolar, where both electrodes are mounted on same pen-like device and electric current passes only through the tissue being treated. Advantage of bipolar electrosurgery is that it prevents the flow of current through other tissues of the body and focuses only on the tissue in contact. This is useful in microsurgery and in patients with cardiac pacemaker.

Diathermy risks

Burns from electrocautery generally arise from a faulty grounding pad or from an outbreak of a fire. [11] Monopolar electrocautery works because radio frequency energy is concentrated by the surgical instrument's small surface area. The electrical circuit is completed by passing current through the patient's body to a conductive pad that is connected to the radio frequency generator. Because the pad's surface area is large relative to the instrument's tip, energy density across the pad is reliably low enough that no tissue injury occurs at the pad site. [12] Electrical shocks and burns are possible, however, if the circuit is interrupted or energy is concentrated in some way. This can happen if the pad surface in contact is small, e.g. if the pad's electrolytic gel is dry, if the pad becomes disconnected from the radio frequency generator, or via a metal implant. [13] Modern electrocautery systems are equipped with sensors to detect high resistance in the circuit that can prevent some injuries.

As with all forms of heat applications, care must be taken to avoid burns during diathermy treatments, especially in patients with decreased sensitivity to heat and cold. With electrocautery there have been reported cases of flash fires in the operating theatre related to heat generation meeting chemical flash points, especially in the presence of increased oxygen concentrations associated with anaesthetic.

Concerns have also been raised regarding the toxicity of surgical smoke produced by electrocautery. This has been shown to contain chemicals which may cause harm to patients, surgeons and/or operating theatre staff. [14]

For patients that have a surgically implanted Spinal Cord Stimulator (SCS) system, diathermy can cause tissue damage through energy that is transferred into the implanted SCS components resulting in severe injury or death. [15]

Military

Medical diathermy devices were used to cause interference to German radio beams used for targeting nighttime bombing raids in World War II during the Battle of the Beams.

See also

Related Research Articles

The industrial, scientific and medical (ISM) radio bands are radio bands reserved internationally for the use of radio frequency (RF) energy for industrial, scientific and medical purposes other than telecommunications. Examples of applications in these bands include radio-frequency process heating, microwave ovens, and medical diathermy machines. The powerful emissions of these devices can create electromagnetic interference and disrupt radio communication using the same frequency, so these devices are limited to certain bands of frequencies. In general, communications equipment operating in these bands must tolerate any interference generated by ISM applications, and users have no regulatory protection from ISM device operation.

Radio wave type of electromagnetic radiation

Radio waves are a type of electromagnetic radiation with wavelengths in the electromagnetic spectrum longer than infrared light. Radio waves have frequencies as high as 300 gigahertz (GHz) to as low as 30 hertz (Hz). At 300 GHz, the corresponding wavelength is 1 mm, and at 30 Hz is 10,000 km. Like all other electromagnetic waves, radio waves travel at the speed of light. They are generated by electric charges undergoing acceleration, such as time varying electric currents. Naturally occurring radio waves are emitted by lightning and astronomical objects.

Cauterization is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or minimize other potential medical harm, such as infections when antibiotics are unavailable.

Jacques-Arsène dArsonval French physicist and physician

Jacques-Arsène d'Arsonval was a French physician, physicist, and inventor of the moving-coil D'Arsonval galvanometer and the thermocouple ammeter. D'Arsonval was an important contributor to the emerging field of electrophysiology, the study of the effects of electricity on biological organisms, in the nineteenth century.

Oudin coil

An Oudin coil, also called an Oudin oscillator or Oudin resonator, is a resonant transformer circuit that generates very high voltage, high frequency alternating current (AC) electricity at low current levels, used in the obsolete medical field of electrotherapy around the turn of the 20th century. It is very similar to a Tesla coil, with the difference being that the Oudin coil was connected as an autotransformer. It was invented in 1893 by French physician Paul Marie Oudin as a modification of physician Jacques Arsene d'Arsonval's electrotherapy equipment and used in quack medicine until perhaps 1930. The high voltage output terminal of the coil was connected to an insulated handheld electrode which produced luminous brush discharges, which were applied to the patient's body to treat various medical conditions in electrotherapy.

Dielectric heating

Dielectric heating, also known as electronic heating, radio frequency heating, and high-frequency heating, is the process in which a radio frequency (RF) alternating electric field, or radio wave or microwave electromagnetic radiation heats a dielectric material. At higher frequencies, this heating is caused by molecular dipole rotation within the dielectric.

Paul Marie Oudin (1851–1923) was a French physician and medical researcher. He was born, and later died, in Épinal. He conducted research in the Victorian era medical field of high frequency electrotherapy, the application of radio frequency electric currents to the body, and collaborated with the founder of the field, pioneering physiologist and biophysicist Dr. Jacques Arsene d'Arsonval. In 1893 he modified d'Arsonval's electrotherapy equipment by the addition of a wire coil resonator to produce higher potentials, inventing the Oudin coil. This device, very similar to a Tesla coil, could produce very high voltages from several hundred thousand to a million volts. In use, the brush discharges from a pointed electrode attached to the high voltage terminal of the coil would be played over various parts of the body to treat a variety of medical conditions. The Oudin coil was used in electrotherapy and diathermy through the 1920s.

Bioelectromagnetics, also known as bioelectromagnetism, is the study of the interaction between electromagnetic fields and biological entities. Areas of study include electrical or electromagnetic fields produced by living cells, tissues or organisms, including bioluminescent bacteria; for example, the cell membrane potential and the electric currents that flow in nerves and muscles, as a result of action potentials. Others include animal navigation utilizing the geomagnetic field; the effects of man-made sources of electromagnetic fields like mobile phones; and developing new therapies to treat various conditions. The term can also refer to the ability of living cells, tissues, and organisms to produce electrical fields and the response of cells to electromagnetic fields.

Electrosurgery application of a high-frequency alternating polarity, electrical current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue

Electrosurgery is the application of a high-frequency alternating polarity, electrical current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue.. Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.

High-intensity focused ultrasound hifu

High-intensity focused ultrasound (HIFU) is a non-invasive therapeutic technique that uses non-ionizing ultrasonic waves to heat tissue. HIFU can be used to increase the flow of blood or lymph, or to destroy tissue, such as tumors, through a number of mechanisms. The technology can be used to treat a range of disorders and as of 2015 is at various stages of development and commercialization.

Heat therapy, also called thermotherapy, is the use of heat in therapy, such as for pain relief and health. It can take the form of a hot cloth, hot water bottle, ultrasound, heating pad, hydrocollator packs, whirlpool baths, cordless FIR heat therapy wraps, and others. It can be beneficial to those with arthritis and stiff muscles and injuries to the deep tissue of the skin. Heat may be an effective self-care treatment for conditions like rheumatoid arthritis.

Hyfrecator

A hyfrecator is a low-powered medical apparatus used in electrosurgery on conscious patients, usually in an office setting. It is used to destroy tissue directly, and to stop bleeding during minor surgery. It works by emitting low-power high-frequency high-voltage AC electrical pulses, via an electrode mounted on a handpiece, directly to the affected area of the body. A continuous electrical spark discharge may be drawn between probe and tissue, especially at the highest settings of power, although this is not necessary for the device to function. The amount of output power is adjustable, and the device is equipped with different tips, electrodes and forceps, depending on the electrosurgical requirement. Unlike other types of electrosurgery, the hyfrecator does not employ a dispersive electrode pad that is attached to the patient in an area not being treated, and that leads back to the apparatus. It is designed to work with non-grounded (insulated) patients.

Therapeutic ultrasound refers generally to any type of ultrasonic procedure that uses ultrasound for therapeutic benefit. This includes HIFU, lithotripsy, targeted ultrasound drug delivery, trans-dermal ultrasound drug delivery, ultrasound hemostasis, cancer therapy, and ultrasound assisted thrombolysis It may use focused ultrasound (FUS) or unfocused ultrasound.

Hyperthermia therapy

Hyperthermia therapy is a type of medical treatment in which body tissue is exposed to higher temperatures in an effort to treat Lyme disease and cancer.

Microwave burns are burn injuries caused by thermal effects of microwave radiation absorbed in a living organism. In comparison with radiation burns caused by ionizing radiation, where the dominant mechanism of tissue damage is internal cell damage caused by free radicals, the primary damage mechanism of microwave radiation is by heat.

Non-ionizing radiation electromagnetic radiation that does not carry enough energy per quantum to ionize atoms or molecules

Non-ionizingradiation refers to any type of electromagnetic radiation that does not carry enough energy per quantum to ionize atoms or molecules—that is, to completely remove an electron from an atom or molecule. Instead of producing charged ions when passing through matter, non-ionizing electromagnetic radiation has sufficient energy only for excitation, the movement of an electron to a higher energy state. Ionizing radiation which has a higher frequency and shorter wavelength than nonionizing radiation, has many uses but can be a health hazard; exposure to it can cause burns, radiation sickness, cancer, and genetic damage. Using ionizing radiation requires elaborate radiological protection measures which in general are not required with nonionizing radiation.

Microwave ablation is a form of thermal ablation used in interventional radiology to treat cancer. MWA uses electromagnetic waves in the microwave energy spectrum to produce tissue-heating effects. The oscillation of polar molecules produces frictional heating, ultimately generating tissue necrosis within solid tumors. It is generally used for the treatment and/or palliation of solid tumors in patients who are nonsurgical candidate.

History of the Tesla coil

Nikola Tesla patented the Tesla coil circuit on April 25, 1891. and first publicly demonstrated it May 20, 1891 in his lecture "Experiments with Alternate Currents of Very High Frequency and Their Application to Methods of Artificial Illumination" before the American Institute of Electrical Engineers at Columbia College, New York. Although Tesla patented many similar circuits during this period, this was the first that contained all the elements of the Tesla coil: high voltage primary transformer, capacitor, spark gap, and air core "oscillation transformer".

Medical applications of radio frequency (RF) energy, in the form of electromagnetic waves or electrical currents, have existed for over 125 years, and now include diathermy, hyperthermy treatment of cancer, electrosurgery scalpels used to cut and cauterize in operations, and radiofrequency ablation. Magnetic resonance imaging (MRI) uses radio frequency waves to generate images of the human body.

References

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