Ultrasound Therapy:

Definition
Ultrasound seem waves vibrating at frequencies higher than those that the human ear can hear, higher than 20,000cycles for every second (hertz, Hz).
Therapeutic ultrasound is that which is employed for therapeutic (relatively than diagnostic) uses and is commonly created at one million cycles per 2nd or one megacycle (MHz). Typically US frequency is between .seven and 3.three MHz.

Introduction
Ultrasound was initially investigated in Europe and was introduced to the United States in the early 1950`s, given that this time, the use of ultrasound has developed, and it stays a really well-known modality currently.

Mechanism of motion
US is generated by a high-frequency alternating present getting utilized to a crystal designed of quartz or a artificial (i.e. barium titanate or direct zirconate). The latest causes the crystal to bend, 1st in just one route and then the other, as the present-day alternates. This deformation of the crystal generates what is named piezoelectric energy. The vibration electrical power is transferred to a metal plate, usually nickel-plated brass, and then the patient’s tissue. The crystal and steel plate are housed in the transducer or seem head of the device.

Actual physical attributes
It is not transmitted by a vacuum
It is transmitted inadequately through gases
It is transmitted very best via gas-cost-free liquids and large-density solids

The console
Similar to a radio transmitter.
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Has an oscillator that generates electromagnetic wave at high frequencies.
Transducer head
Converts electromagnetic waves into sound waves.
Bigger transducer surface is superior (7-13cm*), but compact plenty of to retain pores and skin contact.
Waves are emitted in a cylindrical beam perpendicular to traducer surface area. Hence hold the transducer head parallel to tissue area.
Under no circumstances enable the beam to shoot straight into the air with no gel or h2o as this may possibly destruction the crystal.

To check crystal: water on the head, flip up the depth the water should stream.

Coupling agents
Air does not carry out very well, ought to use a coupling medium. Use a business gels, not mineral oil and some gels will incorporate substances that can promote therapeutic these as, vit E, aloe.

Attenuation
As US travels as a result of human tissue, it progressively decreases in depth because of to attenuation. Attenuation is the outcome of absorption, reflection and refraction, with absorption accounting for about fifty percent of attenuation.

– Proteins are the main absorbers of US
– Enhance protein content material increase absorption
– Tissues with higher h2o articles minimize absorption (waves go via)
– Homogenous tissues reduce absorption (excess fat)
– Heterogeneous tissues, fascia planes boost absorption
e.g. bone periosteum, unwanted fat muscle, diff muscle teams.
– Bone demonstrates waves, which meet up with incoming waves: resonance therefore warmth creation (periosteal burning)
– Metallic artefacts reflects waves but absorb heat thus warning

Absorption
Conversion of the mechanical vitality of US into heat is expressed as an absorption coefficient and is dependent on tissue type and frequency. This coefficient is expressed in decibels/cm and is greatest for tissues with the highest collagen material and enhance in proportion to the US frequency.

Absorption coefficients in decibels/cm at 1 and three MHz
50 percent depth
The depth of tissue at which the US depth is half its preliminary intensity is frequency and tissue variety dependent
50 percent depths in mm at 1 and three MHz

Reflection
Is the redirection of an incident beam away from a reflecting surface at an angle equal and reverse to the angle of incidence. US waves are reflected at tissue interfaces with most reflection taking place wherever there is the best distinction among the acoustic impedance of adjacent tissues.

There is one hundred% reflection of US at an air-skin interface and only a .1% reflection at few medium- pores and skin interface. In the overall body most reflection approx 35% takes place at comfortable tissue-bone interface.

Refraction
The redirection of a wave at an interface
When refraction happens, the US wave enters the tissue at just one angle and carries on by way of the tissue at a various angle.

Frequency
The selection of compressions-rarefactions cycles for every unit of time expressed as (hertz). Increasing the frequency decreases the depth of penetration.
Use 1 MHz for tissue up to 5 cm deep and 3 MHz for tissue one to 2 cm deep.

Dosage
There is no specified way of precisely calculating how significantly power is absorbed in any specific tissue, the final decision about dosage is a subject of judgement to some extent. This judgement should be dependent on the known elements governing ultrasound absorption and is based mostly on the next:

Manner of supply:
– Continuous output
Constant shipping and delivery of US all through the cure interval
Made use of sub acute and continual levels

– Pulsed output
Audio on and off alternately (variable ratio)
I.e. twenty% or 1:5 duty cycle is on twenty% of the time off 80% of the time: on for 2ms off for 8ms

When ultrasound is sent in at pulse mode, with a twenty% responsibility cycle or decrease the heat generated in the course of the time on is dispersed all through the off time.
Employed more for acute and sub-acute stage the place heat is not appealing. Also pulsed US has been shown to increase cellular permeability additional the constant US (see underneath) especially at 1:5 at an intensity of .five-.seventy five W/cm.

Electricity
The amount of money of acoustic vitality for each unit time (Watts)

Depth
The power per unit location of the transducer head expressed in Watts/cm and is constrained to 3W/cm

The depth applied should be altered in accordance with the character of the lesion (persistent larger than acute) tissue style (see earlier mentioned) lower intensities for better absorbers.

When implementing US for non-thermal effects procedures of thumb, use .5 to 1. W/cm. For thermal consequences when making use of a frequency of one MHz use an depth of concerning one.five to 2. W/cm, at a 3MHz frequency typically an depth of .5 W/cm is ample due to the strength staying absorbed in a lesser much more superficial volume of tissue. When looking to achieve thermal outcomes you count on the affected individual to feel a moderate warming right after two to three minutes of procedure, if this does not consider position improve the depth.

Time
The quantity of electricity applied to the tissues and consequently the effects is dependent not only the depth but also the length of time utilized. In basic, cure period really should be amplified when reduce intensities or lessen frequencies are employed.

Minimum amount cure periods are deemed to be 1-two min, greatest ten-fifteen min. It is also instructed that long-term lesions benefit from longer treatment situations.

Effects of US on human tissue

Thermal results

The friction prompted by the vibration of the molecules in just the patient’s tissues will generate heat. For that reason US can be made use of as a thermal agent to boost the temperature of deep tissues on average smooth tissue temperature has been proven