Professional Documents
Culture Documents
Handbook of Medical Physics
Handbook of Medical Physics
OF
MEDICAL
PHYSICS
Graphics by:
Haseeb-ur-Rehman (LCPT)
Editor In-chief:
Rana Bilal Naeem (LCPT)
Preface
As this is our very first edition, we are happy to say this one is intended primarily
for the use of Physical therapy students, but may also be of interest to clinical Physical
therapists, especially those involved in teaching or wishing to update their knowledge.
Given that Physical therapy is increasingly becoming a subject of degree status and that
many Physical therapy colleges are being affiliated to universities and polytechnics, it
seemed logical in this edition to emphasis of the book towards those techniques of
specific interest to the physical therapist, together with the associated background
theory. The more basic Medical Physics and Electrical theory is updated and brought
together in the first chapter. We have divided this book into three sections, the first
contains Basic Medical Physics, and second sections include Applied Medical Physics and
third are preserved by Practical Section.
To bring the teaching of Physical therapy into line with Medical Physics as taught
in secondary schools, polytechnics and universities, there have been several changes of
terminology and approach is done here.
We are most grateful to all those who have helped us in the preparation of our very first
edition. Special thanks go to Dr. Hafiz Muhammad Asim as he is the one who gave us
the idea to compile whole notes of Medical Physics into a single hand book for the
convenience of students. As the syllabus of Medical Physics is scattered and
unfortunately, there is very limited resource available in the market which focuses
directly to the needs of the students.
Utmost care has been taken to avoid all kinds of mistakes, yet any suggestion, to
improve the work will be highly appreciated.
We would like to thank Dr. Hafiz Muhammad Asim for enabling us to publish
this book. Above all we want to thank our families and friends, who supported and
encouraged us in spite of all the time it took us away from them. It was a long and
difficult journey for them.
Last and not least: We beg forgiveness of all those who have been with us over
the course of the years and whose names we have failed to mention."
Haseeb-ur-Rehman
M. Babar Ikram
Komal Tariq
Sana Khalid
Rana Bilal Naeem
Table of Contents
4. ELECTROMAGNETISM ............................................................................................. 39
5. ELECTROMECHANICS .............................................................................................. 56
BASIC
MEDICAL
PHYSICS
Chapter 1 Electricity and Magnetism
1
Chapter 1 Electricity and Magnetism
In the smaller atoms, the number of neutrons is The second shell contains up to eight electrons
often equal to number of protons, but the and again is completed before a third shell is
larger atoms usually contain more neutrons commenced. So the oxygen atom, with 8
than protons. All atoms of particular element electrons, has 2 in first shell and 6 in second
do not necessarily contain the same number of shell, while Neon which has 10 electrons, has
neutrons. The nucleus of hydrogen atom most 2 in first shell and 8 in the second shell which
often consist of one proton alone, but it may is then complete. The plan is similar until there
consist of one proton and one neutron, or of are 8 electrons in the third shell, then become
one proton and two neutrons. more complex, though still following a
definite pattern.
Isotopes: Atom of an element which contain
different numbers of neutrons are known as The number in the center of each atom is the
isotopes of that atom. atomic number while each of the surrounding
circles represents an electron shell.
Atomic Mass: The protons and neutrons
form practically a; the mass of the atom and The arrangement of electron shells is
total number of protons and total number of important in determining the chemical
neutrons together gives the atomic mass of that properties of the elements. The atoms of the
element. metals have one, two or three electrons in the
outer shells, lithium, sodium, and potassium,
The number of electrons in the atom normally each with only one, having particularly similar
equals the number of protons, so the positive properties. The halogens, fluorine, chlorine,
and negative charges are equal and the atom is bromine and iodine all need one electron to
electrically neutral. Electrons can, however, be complete the outer shell and the inert gases
fairly easily displaced from or added to the helium, neon, argon, krypton and xenon have a
atom. complete outer shell of electrons.
2
Chapter 1 Electricity and Magnetism
3
Chapter 1 Electricity and Magnetism
Displacement Currents:
When the plates of a condenser are charged
there is a momentary movement of electrons
within the atoms of the dielectric as molecular
distortion takes place. When the plates are
discharged the molecules return to their
original form and again there is a movement of
electrons within the atoms. This electron
movement is known as a displacement current
and occurs only in an insulator, where the
electrons are too strongly held by the central
nuclei for them to leave the atoms. Any
change in the charge on the plates of a
condenser is accompanied by a displacement
current in the dielectric.
4
Chapter 2 Static Electricity
5
Chapter 2 Static Electricity
6
Chapter 2 Static Electricity
each other repulsive and distance themselves charged object onto the neutral object. When
from each other as far as possible. The finished, both objects were negatively charged.
perimeter the sphere is the extreme to which But what happens if a positively charged
they can go. If there was ever a conducting object is touched to a neutral object? To
pathway to a more spacious piece of real investigate this question, we consider the case
estate, one could be sure that the electrons of a positively charged aluminum plate being
would be on that pathway to the greener grass used to charge a neutral metal sphere by the
beyond. In human terms, electrons living in process of conduction.
the same home despise each other and are
always seeking a home of their own or at least The diagram below depicts the use of a
a home with more rooms. positively charged aluminum plate being
touched to a neutral metal sphere. A positively
Given this understanding of electron-electron charged aluminum plate has an excess of
repulsions, it is not difficult to predict what protons. When looked at from an electron
excess electrons on the metal sphere would be perspective, a positive ly charged aluminum
inclined to do if the sphere were touched to the plate has a shortage of electrons. In human
neutral electroscope. Once the contact of the terms, we could say that each excess proton is
sphere to the electroscope is made, a countless rather discontented. It is not satisfied until it
number of excess electrons from the sphere has found a negatively charged electron with
move onto the electroscope and spread about which to co-habitat. However, since a proton
the sphere-electroscope system. In general, the is tightly bound in the nucleus of an atom, it is
object that offers the most space in which to incapable of leaving an atom in search of that
"hang out" will be the object that houses the longed-for electron. It can however attract a
greatest number of excess electrons. When the mobile electron towards itself. And if a
process of charging by conduction is complete, conducting pathway is made between a
the electroscope acquires an excess negative collection of electrons and an excess proton,
charge due to the movement of electrons onto one can be certain that there is likely an
it from the metal sphere. The metal sphere is electron that would be willing to take the
still charged negatively, only it has less excess pathway. So when the positively charged
negative charge than it had prior to the aluminum plate is touched to the neutral metal
conduction charging process. sphere, countless electrons on the metal sphere
migrate towards the aluminum plate. There is
a mass migration of electrons until the positive
charge on the aluminum plate-metal sphere
system becomes redistributed. Having lost
electrons to the positively charged aluminum
plate, there is a shortage of electrons on the
sphere and an overall positive charge. The
aluminum plate is still charged positively; only
Fig. 2.4: Charging a neutral object by conduction it now has less excess positive charge than it
had before the charging process began.
Charging by Conduction Using a
Positively Charged Object:
7
Chapter 2 Static Electricity
8
Chapter 2 Static Electricity
least whatever charge transfer might have distance away. The dry air is more easily
occurred was not noticeable by the customary ionized and a greater quantity of electrons is
means of using an electroscope, using a charge capable of bursting through the space between
testing bulb or testing for its repulsion with a the two objects. On such occasions, a
like-charged object.) crackling sound is often heard and a flash of
light is seen if the room is darkened. This
Many might quickly suggest that they have phenomenon, occurring from several
used a charged insulator to charge a neutral centimeters away, certainly does not fit the
electroscope (or some other object) by contact. description of contact charging.
In fact, a negatively charged plastic golf tube
can used to charge an electroscope. The plastic A charged insulating object is certainly
tube is touched to the top plate of the capable of transferring its charge to another
electroscope. On most occasions, the plastic object. The result of the charge transfer will be
tube is even rubbed or rolled across the plate the same as the result of charging by
of the electroscope? Wouldn't this be regarded conduction. Both objects will have the same
as charging by conduction? No. Not really. In type of charge and the flow of electrons is in
this case, it is more than likely that the the same direction. However, the process and
charging occurred by some process other than the underlying explanations are considerably
conduction. There was not a sharing of charge different. In the case of charging an object
between the plastic tube and the metal parts of with a charged insulator, the contact is not
the electroscope. Of course, once some excess essential. Contacting the object simply reduces
charge is acquired by the electroscope, that the spatial separation between touching atoms
excess charge distributes itself about the and allows charge to arc and spark its way
surface of the electroscope. Yet the charge is between objects. Rubbing or rolling the
not uniformly shared between the two objects. insulating object across the conductor's surface
The protons and electrons within both the facilitates the charging process by bringing a
plastic golf tube and the electroscope are not greater number of atoms on the insulator in
acting together to share excess charge and close proximity to the conductor that is
reduce the total amount of repulsive forces. receiving the charge. The two materials do not
make any effort to share charge nor to act as a
The charging of an electroscope by contact single object (with a uniform electric
with a negatively charged golf tube (or any potential) in an effort to reduce repulsive
charged insulating object) would best be affects.
described as charging by lightning. Rather
than being a process in which the two objects Is this distinction between charging by
act together to share the excess charge, the conduction and charging by lightning a
process could best be described as the splitting of hairs? Perhaps. For certain, each
successful effort of electrons to burst through process involves a transfer of charge from one
the space (air) between objects. The presence object to another object, yielding the same
of a negatively charged plastic tube is capable result - two like-charged object. Yet,
of ionizing the air surrounding the tube and distinguishing between the two forms of
allowing excess electrons on the plastic tube to charging is more consistent with the
be conducted through the air to the customary view that insulators are not
electroscope. This transfer of charge can conductors of charge. It also serves to explain
happen with or without touching. In fact, on a why some insulators clearly do not always
dry winter day the process of charging the transfer their charge upon contact.
metal electroscope with the charged insulator
often occurs while the insulator is some
9
Chapter 2 Static Electricity
Construction of Capacitor:
Fig. 2.7: Charging by contact and lightening
Capacitors (Condenser):
A capacitor (originally known as condenser) is
a passive two-terminal electrical component
used to store energy in an electric field. The
forms of practical capacitors vary widely, but
all contain at least two electrical conductors
separated by a dielectric (insulator); for
example, one common construction consists of
metal foils separated by a thin layer of
insulating film. Capacitors are widely used as
parts of electrical circuits in many common
electrical devices.
The parallel plate capacitor is the simplest
When there is a potential difference (voltage) form of capacitor. It can be constructed using
across the conductors, a static electric field
two metal or metalized foil plates at a distance
develops across the dielectric, causing positive
parallel to each other, with its capacitance
charge to collect on one plate and negative
value in Farads, being fixed by the surface
charge on the other plate. Energy is stored in
area of the conductive plates and the distance
the electrostatic field. An ideal capacitor is of separation between them. Altering any two
characterized by a single constant value,
of these values alters the value of its
capacitance, measured in farads. This is the
capacitance and this forms the basis of
ratio of the electric charge on each conductor
operation of the variable capacitors.
to the potential difference between them.
The capacitance is greatest when there is a Also, because capacitors store the energy of
narrow separation between large areas of the electrons in the form of an electrical
conductor; hence capacitor conductors are charge on the plates the larger the plates
often called plates, referring to an early means and/or smaller their separation the greater will
of construction. In practice, the dielectric be the charge that the capacitor holds for any
between the plates passes a small amount of given voltage across its plates. In other words,
leakage current and also has an electric field larger plates, smaller distance, more
strength limit, resulting in a breakdown capacitance.
10
Chapter 2 Static Electricity
By applying a voltage to a capacitor and capacitor is generally made with regards to the
measuring the charge on the plates, the ratio of dielectric used between the plates. Like
the charge Q to the voltage V will give the resistors, there are also variable types of
capacitance value of the capacitor and is capacitors which allow us to vary their
therefore given as: C = Q/V this equation can capacitance value for use in radio or
also be re-arranged to give the more familiar "frequency tuning" type circuits.
formula for the quantity of charge on the
plates as: Q = C x V Commercial types of capacitor are made from
metallic foil interlaced with thin sheets of
Although we have said that the charge is either paraffin-impregnated paper or Mylar as
stored on the plates of a capacitor, it is more the dielectric material. Some capacitors look
correct to say that the energy within the charge like tubes, this is because the metal foil plates
is stored in an "electrostatic field" between the are rolled up into a cylinder to form a small
two plates. When an electric current flows into package with the insulating dielectric material
the capacitor, charging it up, the electrostatic sandwiched in between them. Small capacitors
field becomes stronger as it stores more are often constructed from ceramic materials
energy. Likewise, as the current flows out of and then dipped into an epoxy resin to seal
the capacitor, discharging it, the potential them. Either way, capacitors play an important
difference between the two plates decreases part in electronic circuits so here are a few of
and the electrostatic field decreases as the the more "common" types of capacitor
energy moves out of the plates. available.
Dielectric Capacitor:
The property of a capacitor to store charge on
its plates in the form of an electrostatic field is Dielectric Capacitors are usually of the
called the Capacitance of the capacitor. Not variable type were a continuous variation of
only that, but capacitance is also the property capacitance is required for tuning transmitters,
of a capacitor which resists the change of receivers and transistor radios. Variable
voltage across it. dielectric capacitors are multi-plate air-spaced
types that have a set of fixed plates (the stator
Units: vanes) and a set of movable plates (the rotor
vanes) which move in between the fixed
Capacity of a capacitor like that of conductor plates. The position of the moving plates with
is measured in Farads. One farad is the respect to the fixed plates determines the
capacity of a capacitor which is charged to a overall capacitance value. The capacitance is
potential difference of one volt by one generally at maximum when the two sets of
coulomb of electricity. The practical unit is plates are fully meshed together. High voltage
micro-farad. type tuning capacitors have relatively large
spacing or air-gaps between the plates with
Types of Capacitor: breakdown voltages reaching many thousands
of volts.
There are a very large variety of different
types of capacitor available in the market place
and each one has its own set of characteristics
and applications, from very small delicate
trimming capacitors up to large power metal-
can type capacitors used in high voltage power
correction and smoothing circuits. The Fig. 2.8: Variable and trimmer capacitor symbols.
comparison between the different types of
11
Chapter 2 Static Electricity
As well as the continuously variable types, well under conditions of high temperature,
preset type variable capacitors are also have smaller tolerances, a very long service
available called Trimmers. These are generally life and high reliability. Examples of film
small devices that can be adjusted or "pre-set" capacitors are the rectangular metalized film
to a particular capacitance value with the aid and cylindrical film & foil types as shown
of a small screwdriver and are available in below.
very small capacitances of 500pF or less and
are non-polarized.
Film Capacitor:
With all the above case styles available in both These film types require a much thicker
Axial and Radial Leads. dielectric film to reduce the risk of tears or
punctures in the film, and is therefore more
Film Capacitors which use polystyrene, suited to lower capacitance values and larger
polycarbonate or Teflon as their dielectrics are case sizes.
sometimes called "Plastic capacitors". The
construction of plastic film capacitors is Metalized foil capacitors have the conductive
similar to that for paper film capacitors but use film metalized sprayed directly onto each side
a plastic film instead of paper. The main of the dielectric which gives the capacitor self-
advantage of plastic film capacitors compared healing properties and can therefore use much
to impregnated-paper types is that they operate thinner dielectric films. This allows for higher
12
Chapter 2 Static Electricity
capacitance values and smaller case sizes for a the number of zero's to be added. For example,
given capacitance. Film and foil capacitors are a ceramic disc capacitor with the markings 103
generally used for higher power and more would indicate 10 and 3 zero's in Pico-farads
precise applications. which is equivalent to 10,000 pF or 10nF.
13
Chapter 2 Static Electricity
may result. All polarized electrolytic Etched foil electrolytic are best used in
capacitors have their polarity clearly marked coupling, DC blocking and by-pass circuits
with a negative sign to indicate the negative while plain foil types are better suited as
terminal and this polarity must be followed. smoothing capacitors in power supplies.
Electrolytic Capacitors are generally used in But aluminum electrolytic are "polarized"
DC power supply circuits due to their large devices so reversing the applied voltage on the
capacitances and small size to help reduce the leads will cause the insulating layer within the
ripple voltage or for coupling and decoupling capacitor to become destroyed along with the
applications. One main disadvantage of capacitor. However, the electrolyte used
electrolytic capacitors is their relatively low within the capacitor helps heal a damaged
voltage rating and due to the polarization of plate if the damage is small.
electrolytic capacitors, it follows then that they
must not be used on AC supplies. Electrolytic Since the electrolyte has the properties to self-
generally come in two basic forms; Aluminum heal a damaged plate, it also has the ability to
Electrolytic Capacitors and Tantalum re-anodize the foil plate. As the anodizing
Electrolytic Capacitors. process can be reversed, the electrolyte has the
ability to remove the oxide coating from the
Types of Electrolytic Capacitor: foil as would happen if the capacitor was
connected with a reverse polarity. Since the
1) Aluminum Electrolytic Capacitors: electrolyte has the ability to conduct
electricity, if the aluminum oxide layer was
There are basically two types of Aluminum
removed or destroyed, the capacitor would
Electrolytic Capacitor,
allow current to pass from one plate to the
a) The plain foil type other destroying the capacitor, "so be aware".
b) The etched foil type
14
Chapter 2 Static Electricity
15
Chapter 2 Static Electricity
3. When capacitors are connected in parallel (b) The resistance of the circuit through which
their Capacitance is added up. The reason it is being charged or is discharging.
is that the capacity is increased due to
larger plate surface area. The formula for This fact makes the capacitor a very useful if
parallel capacitor is same as the not vital component in the timing circuits of
resistance in series. many devices from clocks to computers.
Fig. 2.16: Capacitors connected in parallel When the switch is closed, and charging starts,
the rate of flow of charge is large (i.e. a big
When electrolytic capacitors are connected in current) and this decreases as time goes by and
parallel, check polarity connect positive to
the plates become more charged so "resisting"
positive and negative to negative.
any further charging. You should realize that
The charge and discharge of a the addition of a resistor in the circuit in series
capacitor: with the capacitor ONLY affects the TIME it
takes for the capacitor to become fully charge
It is important to study what happens while a and NOT the EVENTUAL POTENTIAL
capacitor is charging and discharging. It is the DIFFERENCE ACROSS IT – this is always
ability to control and predict the rate at which
16
Chapter 2 Static Electricity
the same and equal to the potential difference plates, the current and the rate of rise of
across the supply. potential difference both falls. (Figure 2.19 (a).
Finally no further current will flow when the
p.d. across the capacitor equals that of the
supply voltage Vo.
Fig. 2.17.
Charging of Capacitors:
As soon as the switch is closed in position 1,
Fig. 2.19 (b): Discharging of a capacitor
the battery is connected across the capacitor,
current flows and the potential difference
across the capacitor begins to rise but, as more
and more charge builds up on the capacitor
17
Chapter 2 Static Electricity
18
Chapter 3 Current Electricity
Simple Circuits with Resistors: Figure 3.1 shows the resistor in series with the
lamp, i.e. the resistor and lamp are connected
Perhaps the simplest kind of circuit which can end to end so that current must flow through
be constructed comprises a battery (a source of both the lamp and the resistor. In fig. 3.3 the
electrical energy) and a single electrical resistor is connected in parallel with the lamp
component such as a resistor or a torch globe. so that some current can flow through the
lamp and some through the resistor. The
19
Chapter 3 Current Electricity
Resistors in Series:
R = R1 + R2 + R3........ + Rn … (3.1)
20
Chapter 3 Current Electricity
21
Chapter 3 Current Electricity
22
Chapter 3 Current Electricity
using equation 3.4 or the two expressions parallel combination of R2 and R3 so equation
obtained by solving equations 3.3 and 3.4. 3.1 applies.
These are:
To calculate voltages and currents in this
.... (3.5) circuit it is important to visualize current
flowing from the positive terminal of the
battery, through R1 and then through the
Where we have eliminated I in solving the two
combination of R2 and R3 . The current flowing
expressions and
through R1 splits. Some goes through R2 and
some through R3 . The current though R2 plus
P = I2 .R .... (3.6)
the current through R3 must equal that through
R1 since the moving charges cannot disappear
Where we have eliminated V.
nor can new ones appear.
With these three alternative formulae for
Another important idea is that current (charge)
calculating power we would choose the
flows around the circuit, losing electrical
equation which gives the required answer with
potential energy in the process. Some energy
a minimum of calculations.
is lost as charges flow through R1 . The
remainder is lost as charges flow either
Consider the three resistors connected in series
through R2 or R3 . The potential difference
as in example 1 previously. If we wish to
across R2 is one-and-the-same as the potential
calculate the power dissipated in each resistor
difference across R3 . The potential difference
we would first calculate the current (which is
across R1 plus that across the R2 /R3
the same for each resistor) and then use
combination must equal the battery voltage.
equation 3.6. In example 2 previously the
resistors are in parallel and the potential
Example 3: If we have a resistor combination
difference is the same for each resistor.
like that shown in figure 3.7, with the
Equation 3.5 is thus the choice for power
resistance values and battery voltage are as
calculation.
shown alongside:
23
Chapter 3 Current Electricity
24
Chapter 3 Current Electricity
Volta respectively, is an electrochemical cell source of electrical power. By their nature they
that derives electrical energy from chemical produce direct current. For example, a lead-
reactions taking place within the cell. It acid battery contains a number of galvanic
generally consists of two different metals cells. The two electrodes are effectively lead
connected by a salt bridge, or individual half- and lead oxide.
cells separated by a porous membrane.
Lechlanche Cell:
Construction:
The Lechlanche cell is a battery invented and
A Galvanic cell consists of two half-cells. In patented by Georges Lechlanche in 1866.
its simplest form, each half cell consists of a
metal and a solution of a salt of the metal. The The battery contained a conducting solution
salt solution contains a cation of the metal and (electrolyte) of ammonium chloride, a cathode
an anion to balance the charge on the cation. (positive terminal) of carbon, a depolarizer of
For the Daniel cell, depicted in the figure, the manganese dioxide, and an anode (negative
two metals are zinc and copper and the two terminal) of zinc.
salts are sulfates of the respective metal.
Zn + Cu2 + → Zn2+ + Cu
25
Chapter 3 Current Electricity
Cathode:
Fig. 3.9: Wet Lechlanche Cell
The electrode of an electrochemical cell at
which reduction occurs
26
Chapter 3 Current Electricity
27
Chapter 3 Current Electricity
resistance of the battery is the sum of internal in parallel with each other in order to keep the
resistance of the individual cell. If there are ten internal resistance as low as possible.
cell, each with an EMF of 1.5 volts and Connection of cells in parallel has additional
internal resistance of one ohm, the EMF of the advantage that they last longer than if a single
battery is 15 volts and the internal resistance cell is used.
ten ohms.
In Parallel
Cells in Parallel:
28
Chapter 3 Current Electricity
r1 = 10 ohms
Heat produced in r2 =
r2 = 20 ohms
= = calories
Electrolysis is used in refining gold, silver,
copper, and tin, and for obtaining aluminum,
Heat produced in r2 = sodium, magnesium, and other metals from
their ores. Electroplating is the use of
= = calories electrolysis to coat a metallic object with a
thin layer of another metal. Anodizing is the
Thus more heat is generated in r2 than in r1 . use of electrolysis to coat a metallic object
29
Chapter 3 Current Electricity
with a thin layer of oxide for protection proportional to the amount of current passed
against corrosion and wear. through the solution.
Electrolysis is also used for the production of 2. The amount of a substance that is deposited
oxygen, hydrogen, chlorine, caustic soda, and is proportional to its equivalent weight (its
other substances. atomic weight divided by its valence).
30
Chapter 3 Current Electricity
31
Chapter 3 Current Electricity
32
Chapter 3 Current Electricity
semiconductor diode, the most common type Semiconductor diodes' nonlinear current–
today, is a crystalline piece of semiconductor voltage characteristic can be tailored by
material with a p–n junction connected to two varying the semiconductor materials and
electrical terminals. A vacuum tube diode is a doping, introducing impurities into the
vacuum tube with two electrodes, a plate materials. These are exploited in special-
(anode) and a heated cathode. purpose diodes that perform many different
functions.
33
Chapter 3 Current Electricity
34
Chapter 3 Current Electricity
35
Chapter 3 Current Electricity
1 μF = F = 10-6 F
36
Chapter 3 Current Electricity
1 μH = = 10-6 H
37
Chapter 3 Current Electricity
38
Chapter 4 Electromagnetism
Chapter No. 4
ELECTROMAGNETISM
Magnet:
Magnet has always been a thing of awe use
and attraction for humans. According to
history, the uses of magnets were discovered Fig. 4.2: Lodestone
by the ancient Greeks during the period of
Greek Civilization. 3. Artificial magnets :
“A substance has power of attraction for
The magnets which are made artificially are
certain materials and the tendency, when
called artificial magnets. it can be classified
free to rotate, to come to rest pointing in a
into:
north–south direction”
a). Permanent magnets:
Types of magnet:
1. Natural magnets. They are magnets retain their magnetism for a
2. Original magnets. long time is called permanent magnet. There
3. Artificial magnets. are typically four categories of permanent
a) Permanent Magnet magnets: neodymium iron boron, samarium
b) Temporary magnets. cobalt, alnico, nickel, and ceramic or ferrite
c) Electro magnets. magnets.
1. Natural magnets:
39
Chapter 4 Electromagnetism
If we break a magnet into two parts each part When a magnet is free to rotate it comes to
become a magnet with a north pole at one end rest with one end pointing towards the
and a south pole at the other end. If we break it magnetic north pole of earth, the other to the
further, we observe the same behavior. This earth’s magnetic South Pole. The end that
will continue even if we break the magnet to points north is termed the north seeking pole,
its molecular level. . commonly abbreviated to North Pole, while
that which points south is called south seeking
Each molecule of a magnetic substance is an or south pole. This property of a magnet is
independent magnet irrespective of whether utilized in a compass, the compass needle
the substance is magnetized or not. These tiny being a small magnet.
magnets are called molecular magnets.
Behavior of like and unlike poles:
In an un magnetized state (fig(a)), the Like magnetic poles repel each other and
molecular magnets are in different orientation. unlike magnetic poles attract each other. If a
Therefore the net magnetic effect is zero. In north pole of a bar magnet is brought needle,
the magnetized state (fig(b)), these molecular the later moves away from the magnet, but if
magnets are arranged in an order. All the south the south pole of the magnet approaches the
poles are aligned in one direction, and the north pole of the compass needle this end of
north poles in the other direction. Therefore a the needle swings towards the magnet. The
strong magnetic field is created. behavior of like and unlike poles is responsible
for a magnet setting in a north south direction.
The earth is gigantic magnet and its magnetic
north pole has the same magnetic property as
the south-seeking pole of magnet, thus it
attracts the north seeking pole of magnet.
40
Chapter 4 Electromagnetism
41
Chapter 4 Electromagnetism
Magnetic field around a straight wire: Magnetic field around a coil of wire:
An electric current sets up a magnetic field When current is passed through a coil of a
around the conductor through which it is wire magnetic lines of force are setup round
passing. This can be demonstrated by holding each turn of wire and their combined effects
a wire carrying a current over and parallel to a forms a magnetic field around the whole coil.
compass needle, for as the current flows the Figure1 shows a coil of a wire through which
needle in deflected to one side, indicating the the current is passing.
presence of magnetic forces. The magnetic
lines of force around a wire carrying a current
can be plotted by passing the length of wire
through a piece of card board on which iron
filling are scattered. When a current is passed,
and the card board tapped gently, the iron
filling arrange themselves along the magnetic
lines of force, which are found to form
concentric circles around the wire, in a plane
42
Chapter 4 Electromagnetism
Electromagnets:
Fig. 4.11: Magnetic field of wired around a coil
An electromagnet consists of a coil of wire
wound on soft iron bar. When a current passes
through the coil a magnetic field is setup and
the soft iron core is magnetized by induction,
so that its field is added to that produced by
the current. Thus a strong magnetic field is
formed, which can be turned on and off as
required by starting and stopping the current
flow. Soft iron is chosen for the core because
Fig. 4.12: Magnetic field of wired around a coil
it is easily magnetized and demagnetized.
Above figure shows the coil cut along the line
SN, the lower half is being seen from above. Moving Iron ammeter:
The lower turns of wire in the second diagram
Moving iron ammeters use a piece of iron
are viewed so that the observer is looking
which moves when acted upon by the
towards the positive, so the direction of the
electromagnetic force of a fixed coil of wire.
lines of force is anti clock wise. The lines of
This type of meter responds to both direct and
force are clouded together in the centre of the
alternating currents (as opposed to the moving
coil, but spread out at the sides and ends,
coil ammeter, which works on direct current
emerging from one end, which forms the
only). The iron element consists of a moving
North Pole, and returning to the other, which
van attached to a pointer, and a fixed vane,
is the South Pole. Thus the magnetic poles lie
surrounded by a coil. As alternating or direct
at the end of the coil and magnetic polarity of
current flows through the coil and induces a
each depends on:
magnetic field in both vanes, the vanes repel
1. The direction of current flow: each other and the moving vane deflects
reversal of the current reverses the against the restoring force provided by fine
direction of magnetic lines of helical springs. The non-linear scale of these
force. meters makes them unpopular.
2. The direction in which is coil is
wound. This can be worked out
when a coil wound the opposite
direction to that.
43
Chapter 4 Electromagnetism
Electromagnetic Induction:
Electromagnetic Induction was first
demonstrated by Michal Faraday in 1831 and
is the means by which electricity is produced
from magnetism. The discovery was of
considerable importance, was until that time
the only known methods of producing
electricity were be friction and by chemical
action, neither of which is suitable for the
large scale production necessary for its
extensive use.
Fig. 4.13: Moving iron type meter.
Production of EMF:
Hot wire type and Thermocouple
ammeter: Electromagnetic Induction is the production of
EMF in a conductor by interaction between the
Hot-wire and thermocouple meter movements conductor and magnetic lines of force.
both use the heating effect of current flowing Induction has previously been defined as the
through a resistance to cause meter deflection. production of electrical and magnetic
Each uses this effect in a different manner. properties in one object by another without
Since their operation depends only on the contact between them, electrostatic and
heating effect of current flow, they may be magnetic induction being examples.
used to measure both direct current and Electromagnetic Induction is the production of
alternating current of any frequency on a electrical and magnetic properties in one
single scale. The hot-wire meter movement object, which must be a conductor of
deflection depends on the expansion of a high- electricity, by the magnetic lines of force
resistance wire caused by the heating effect of surrounding another object. The two objects
the wire itself as current flows through it. A do not come in contact with each other, as it is
resistance wire is stretched taut between the only when magnetic lines of force cut across
two meter terminals, with a thread attached at the conductor, or the conductor across the
a right angle to the center of the wire. A spring lines of force, that the EMF is produced. Thus
connected to the opposite end of the thread the essential for the electromagnetic induction
exerts a constant tension on the resistance are:
wire. Current flow heats the wire, causing it to
expand. This motion is transferred to the meter A conductor
pointer through the thread and a pivot. Magnetic lines of force
Movement of one of these relative to
other
44
Chapter 4 Electromagnetism
A coil of wire is connected to miliammete to The same apparatus is used as for the
form a close circuit. A bar magnet is thrust in preceding experiment, but eh electromagnet,
to the coil, allowed to remain stationary for a which is known as the primary coil, remains
moment and then withdrawn. Deflection of the stationary within the coil connected to the
needle of the meter is observed when the meter. The latter is known as the secondary
magnet is entering and leaving the coil, but coil. An interrupted D.C. is passed through the
when magnet is stationary the needle returns to electromagnet and deflection of the needle of
zero. The coil of the wire is conductor and the the meter is observed when this current
bar magnet provides the magnetic lines of increases or decreases in intensity, but not
forces. When the magnet is moved relative to when it is flowing at constant strength. When
the coil the circuit, causing deflection of the the current in the electromagnet increases in
meter. When the magnet is stationary there is intensity magnetic lines of force spread out
no movement of the lines of forces relative to around the coil, cutting the secondary coil and
the coil and no EMF is induced. Movement of inducing an EMF in it. When the current in the
the coil of wire over the stationary magnet primary coil is of constant intensity the
produces the same results as when the coil is magnetic field remains steady, so the lines of
moved it cuts the magnetic line of forces. force are not cutting across the secondary coil
and no EMF is produced. When the current in
the electromagnet decreases in intensity the
magnetic field collapses and the lines of force
again cut the secondary coil, inducing an EMF
in it.
The preceding experiment is repeated using an In the first and second of the experiment
electromagnetic instead of a bar magnet. A described above the milliammeter needle
direct current pass through the electromagnet swings in one direction when the magnet
and sets up a magnetic lines of force which, as enters the coil, the other way when it is
the electromagnet is moved in an out of the withdrawn. In the third experiment the needle
coil, cut the turns of wire and induce EMFs in swings one way when the primary current is
them. As in the preceding experiment, increasing in intensity, the other way when it
deflection of the needle of the meter is is decreasing. The direction of the deflection
observed only when the electromagnet or the of the needle depends on the direction of the
coil is moved. induced current, so it is apparent that there is
45
Chapter 4 Electromagnetism
46
Chapter 4 Electromagnetism
Fig. 4.17: Effects of self induction Thus there is no inductive reactance with a
constant D.C., but it is present whenever the
The direction of the induce EMF like that current varies in intensity, and increases as the
induced in the secondary coil, is a accordance frequency increases.
with lenz’s law. Thus when the applied current
is rising in intensity the induced EMF is the Eddy currents: (also called Foucault
intensity of current and makes it more gradual. currents)
When the applied current is falling in intensity
of current and makes it more gradual, when Any conductor lying with in a varying
the applied current is falling in intensity the magnetic field has an EMF induced in it. If a
induce EMF is in the same direction as the conductor consists of solid piece of material
applied EMF. This ‘forward’ EMF prolongs the EMF gives rise to circular currents at right
the flow of current and makes the fall more angles to the magnetic lines of force. The
gradual. The continuous line indicates the currents are greatest near the surface of
EMF applied the dotted line the current which conductor and are known as eddy currents.
is obtained.
47
Chapter 4 Electromagnetism
Side effects:
The transformer:
A transformer is a device used to raise or
lower the voltage in a circuit without an
Fig. 4.18: Eddy Current
Appreciable energy loss. A simple transformer
Uses of eddy curre nts: is shown in Figure. It consists of two wire
coils around a common iron core.
Repulsive effects and levitation
Attractive effects: geometry the
overall force of eddy currents can be
attractive
Identification of metals: In coin
operated vending machines, eddy
currents are used to detect counterfeit
coins, or slugs.
Vibration and position Sensing:
currents are used in certain types Fig. 4.19: Transformer
of proximity sensors to observe the
vibration and position of rotating The coil used for the input power is called the
shafts within their bearings. primary coil, and the other one is denoted as
secondary coil. Either coil of a transformer can
be used as the primary or secondary coil.
Structural testing: An alternating current in the primary coil
creates a varying magnetic field in the
48
Chapter 4 Electromagnetism
transformer’s core. This varying magnetic primary current varies in intensity; otherwise
field gives place to a varying magnetic flux there is no movement of magnetic field
through the secondary coil, inducing an relative to conductor and no EMF induced in
alternating EMF or voltage in the secondary the secondary coil. There is no electrical
coil. The presence of the iron core increases connection between the primary and secondary
the magnetic field due to the electric current coils, the energy being transmitted from one to
passing through the first coil and also let all another by electromagnetic induction. The
the magnetic field lines pass through both core serves to concentrate the magnetic field.
coils. It is made of soft iron because this material is
easily magnetized and demagnetized. It is
Static transformer: laminated to prevent the eddy currents.
49
Chapter 4 Electromagnetism
The danger of shock reduces by the use of If there are fewer turns of wire in the
static transformer. The main current is passed secondary than in the primary coil the EMF
through the primary coil and induces an EMF induced in the secondary is less than that
inn secondary coil. So long as there is no applied to the primary, and the device is
electrical connection between the primary and known as step-down transformer.
the secondary coils, the later has no e.g. if the primary has four times as many
connection to earth. Thus if a connection is turns of wire as the secondary and an EMF of
inadvertently made between the secondary too volts is applied to the primary, 25 volts
circuit and earth it does not complete a circuit, will be induced in the secondary coil.
no current passes to earth and there is no
danger of earth shock. The earth does not form
any part of the conducting pathway of the
secondary current, which is said to be earth-
free. The transformer renders the current earth-
free only so long as there is no electrical
connection between the primary and secondary
coils. Should the insulation between the coils
break down the secondary circuit would be
connected to earth and there would be a
danger of earth shock. For this reason all
transformers supplying current for the
treatment of patients must be constructed in a
way which makes such an occurrence
impossible. Fig. 4.22 Step-up and step-down transformer
50
Chapter 4 Electromagnetism
the primary circuit. An increase in the EMF is the external circuit has a low resistance it is an
accompanied by a corresponding decrease in advantage to step down the voltage. A small
the intensity of current available, intensity of EMF is adequate to produce an appreciable
current. If an EMF induced in it will be 1000 current and it is desirable that a large intensity
volts, but as 1000 watts is the maximum power of current should be available if it is required.
available the intensity of the current in the
secondary circuit cannot exceed 1 ampere. If, Nature of the secondary current:
however, the secondary coil has one-tenth then
number of turns of wire of the primary, the The type of current induced in the secondary
EMF is reduced to 10 volts and the maximum coil can be deduced by the application of
intensity of current available increased to 100 Lenz’s and Faraday’s law of electromagnetic
amperes. Actually the intensity of current that induction. Graphs of the primary current and
can be obtained is rather less than that given secondary EMF are shown in figure.
above, as there is some loss of energy in the
transformer.
This is less than the maximum available and a When the primary current is rising in intensity,
current of 2 amperes flows in the external the E<C induced in the secondary coils is in
circuit. If, however, the resistance of the the opposite direction to that applied to the
external circuit is 5 ohms, then by Ohm’s law: primary (AB and CD), while when the primary
current is falling is intensity the EMF induced
in the secondary coil is in the same direction
as that applied, to the primary (BC and DE).
The intensity of the primary current rises at
The maximum current available is, however, first quickly then more slowly, so the magnetic
only 10 amperes so a current of 10 amperes field increases at first quickly, then more
flows in external circuit. slowly. Therefore the EMF induced in the
secondary is at first strong but becomes
When the resistance of the external circuit is weaker (AB and CD). When the primary
high it is an advantage to step up the voltage, current is at its maximum, here is an instant
as a large EMF is necessary to produce an when the current intensity, and so the
appreciable current. The intensity of the magnetic field, is not changing, and so the
current in the high resistance will in any case EMF in the secondary coil is at zero (B and
be low, so it is unimportant and that the D). When the intensity of the primary current
maximum that is available is reduced. When falls, it does so at first slowly, and then more
51
Chapter 4 Electromagnetism
quickly, so the secondary EMF is at first weak the ratio of turns of wire in the secondary coil
getting stronger (BC and DE). The graph to that in the primary is increased and so the
shows that the secondary current is similar to EMF induced in the secondary is increased.
that in the primary coil, but a quarter of a cycle Tapings may be taking from different points
behind it. on the secondary coil to supply different
voltages to separate circuits in the same piece
Variable transformers of apparatus, or on transformer may have
several secondary coils. This occurs in many
Tapings may be provided so that either the of the circuits in which valves are uses.
primary or secondary coil can be varied in
length. By varying the number of turns of wire Autotransformer:
in the primary coil it is possible to use the
same piece of apparatus on supplies of The autotransformer consists of a single coil of
different voltages. insulated wire would over a laminated iron
core.
52
Chapter 4 Electromagnetism
This consists of many turns of insulated wire impede the flow of such a current. The
would on a laminated soft iron frame, usually impedance offered to a low frequency or direct
on the central bar of a rectangular frame. current is considerably less than to high
When the current which is varying in intensity frequency current, and a choke coil may be
is passed through the coil, magnetic lines of included in a circuit to prevent the flow of
force are set up which cut the turns of wire and high frequency current, but at the same time
induce EMFs in them. There are many turns so allow the passage of one of the lower
wire so the coil has a considerable inductance frequency.
and the self induced EMF is large. The core
serves to concentrate the magnetic field; it is Electrical generators (dynamo):
made of soft iron so that it is easily
magnetized and demagnetized and is A machine or device that is used to convert
laminated to prevent eddy currents. mechanical energy, such as that provided by
the combustion of fuel or by wind or water,
into electricity
Construction:
Mechanical components:
High frequency choke coil: The rotor is the non-stationary part of a rotary
electric generator, which rotates because the
A high frequency current varies very rapidly wires and magnetic field of the motor are
in intensity so tends to produce a considerable arranged so that a torque is developed about
self-induced EMF. Consequently it is the rotor's axis.
unnecessary to have a great many turns of wire
in the high frequency choke coil, or to wind Stator:
them on a soft iron core. The coil usually
consist of several turns of insulated wire The stator is the stationary part of electric
would on a bobbin of some non-conducting generator. The stator may act as the field
material. magnet, interacting with the armature to create
motion. The stator may be either a permanent
magnet or an electromagnet. Where the stator
Uses of the choke coil:
is an electromagnet, the coil which energizes it
is known as the field coil or field winding.
The self-induced EMF which is set up when a
varying current is passed though a choke coil
retard the rays of current to maximum and
prolongs the current flow when the intensity of
current, which is one of the purposes for which
a choke coil is used.
53
Chapter 4 Electromagnetism
Working:
Fig. 4.28: Armature and conductor coils
The turning of a coil in a magnetic field
produces motional EMF in both sides of the
Field: coil which add. Since the component of the
The role of the "field" component is simply to velocity perpendicular to the magnetic field
create a magnetic field (magnetic flux) for the changes sinusoidally with the rotation, the
armature to interact with, so this component generated voltage is sinusoidal or AC. This
can comprise either permanent magnets, or process can be described in terms of Faraday's
electromagnets formed by a conducting coil. law when you see that the rotation of the coil
continually changes the magnetic flux through
the coil and therefore generates a voltage.
Alternating current generator:
Direct current generator:
Construction:
Construction:
The construction is same as above except a
few differences
Is same as above page no….with few
exception
Armature :
Commutator:
It is a rectangular coil of large number of turns
of wire wound on laminated soft-iron core of
high permeability and low hysteresis loss and Direct current dynamos require a Commutator
eddy current loss. on the rotating shaft to convert the alternating
current produced by the armature to direct
current. The Commutator is split into two
Slip rings:
segments. Both of these segments are insulated
54
Chapter 4 Electromagnetism
Working:
55
Chapter 5 Electro-Mechanics
56
Chapter 5 Electro-Mechanics
The current obtained from the smoothing screw. The metronome is connected in series
circuit varies lightly in intensity but is suitable with the patient in the following manner. One
for use for constant D.C treatments. wire from the battery is attached to one of the
outside cups; the middle cup is attached to the
Metal rectifiers: patient, who in turn is attached to the battery.
The third cup is not used. When the
A metal rectifier works on the same principle metronome is wound up, the pendulum swings
as semiconductor diode, and one type consists from side to side, regularly carrying the cross-
of aa copper disc coated on one surface with piece up and down. One of the attached foot-
copper oxide. Copper oxide is p-type pieces is constantly being withdrawn from and
semiconductor and copper, being a metal, as re-introduced into its corresponding cup of
free electrons, so acts like an n-type mercury, thus rhythmically making and
semiconductor. Thus when the two materials
breaking the current. The rate of the
are in contact a p .d. a set up at their junction. interruptions can be varied by means of the
When the rectifier is connected into a circuit sliding weight on the pendulum. The
with copper negative relative to the copper
clockwork interrupter is a piece of apparatus
oxide, current passes much more easily than by means of which the current is made to
when the polarity is reversed. In the latter case gradually rise from zero to a maximum and as
no current flows until EMF exceeds 8 volts. A gradually to fall back to zero, thus obviating
series of discs can be used to rectify larger sudden makes and breaks. It consists of
voltages, but must be separated from each clockwork which operates a metal arm in an
other for suitable material; otherwise the p.d.s up-and-down direction. Attached to this
developed at the contacts would cancel each
horizontal arm is a vertical platinum wire
other out. dipping into a cup of water. As the mechanism
works, this wire alternately rises and sinks.
The current passes from the wire, through the
water, to the cup, and thence through the rest
of the circuit. The resistance varies with the
depth of the wire in the water, and the current
varies with the resistance. Thus the patient is
receiving a current of regularly varying
intensity.
57
Chapter 5 Electro-Mechanics
58
Chapter 6 Classification of Currents
Each cycle consisting of 2 unequal phases: When a nerve is stimulated the stimulus causes
a fall in the PD across the membrane. When
1st of low intensity and long duration. this fall reaches a certain critical level it causes
an alteration in the permeability of membrane
2nd of high intensity and short duration. 50 Hz
to sodium ions. This results in alteration in the
frequency and 1ms.
concentration of ions inside and outside and a
Short duration interrupted direct current. further a fall in PD until a reversal of polarity
Pulse duration: 0.1 - 1 ms occurs: the membrane is now positive inside
Frequency: 50 -100 Hz and negative outside , immediately after the
activity the sodium ions are pumped out again
Modified Faradic Currents: and that part of the nerve returns to its resting
state. The difference between the active and
Always surged for the purpose of treatment to resting part of the nerve causes local electron
produce a near to normal tetanic like flow between the active and adjacent part of
contraction and relaxation of muscle. the nerve. The current flows through the
membrane in the opposite direction to the PD
Intensity of successive impulse increases across the fibers. The fiber acts as a resistance
gradually, each impulse reaching a peak with the current so that the current flow lowers
value of greater than the preceding 1, then the PD, thus making the membrane permeable
59
Chapter 6 Classification of Currents
In cellular organs the nerve moves in one The epidermis has a high resistance; 1000 ohm
direction but in nerve fibers it moves in both or more, as it contains little fluid and the
directions. superficial layers do not readily absorbed
moisture.
Effects of frequency on stimulation:
Stimulation of sensory nerves.
Increasing the frequency of the stimuli Stimulation of the motor nerves.
shortens the periods of relaxation until at Effects on muscle contraction.
frequencies exceeding 20 Hz there is not time Stimulation of de-innervated muscles.
for complete relaxation between the
contractions so that the partial tetany results. Techniques of treatment with faradic
Further increase in the frequency reduces the
Type Current:
amount of relaxation still further until at
frequency of 60 Hz, there is no perceptible Preparation of apparatus.
relaxation and the contraction is fully tetanic. Preparation of patients.
Stimulation of the motor points.
Strength of Contraction:
60
Chapter 6 Classification of Currents
Direct current is produced by sources such as Increasing range of motion and The
batteries, thermocouples, solar cells, and Prevention or Retardation of muscle
commutator-type electric machines of the Disuse Atrophy.
dynamo type. Direct current may flow in a
conductor such as a wire, but can also flow Galvanic stimulation is a method of
through semiconductors, insulators, or even applying high voltage, but overall low
through a vacuum as in electron or ion beams. amperage, direct current to alleviate pain,
The electric current flows in a constant stimulate blood flow, and promote wound
direction, distinguishing it from alternating healing
current (AC). A term formerly used for direct
current was galvanic current.
Source:
Fig. 6.2: Negative versus Positive pole galvanic
Direct current may be obtained from an
current
alternating current supply by use of a current-
switching arrangement called a rectifier, which Galvanometer:
contains electronic elements (usually) or
electromechanical elements (historically) that Definition:
allow current to flow only in one direction.
Direct current may be made into alternating A galvanometer is a type of sensitive ammeter:
current with an inverter or a motor-generator an instrument for detecting electric current.
set. It is an analog electromechanical actuator that
produces a rotary deflection of some type of
Uses in daily life: pointer in response to electric current flowing
through its coil in a magnetic field.
Direct current is used to charge batteries, and
in nearly all electronic systems, as the power
supply. Very large quantities of direct-current
power are used in production of aluminum and
other electrochemical processes. Direct current
is used for some railway propulsion, especially
in urban areas. High-voltage direct current is
used to transmit large amounts of power from
remote generation sites or to interconnect
alternating current power grids.
61
Chapter 6 Classification of Currents
Uses:
Diadynamic Currents:
62
Chapter 6 Classification of Currents
63
Chapter 6 Classification of Currents
64
Chapter 6 Classification of Currents
The patient may have a single daily a. A source of direct current of low voltage
treatment session of up to 40mins and low amperage.
duration. b. A shallow plastic tray for the anode.
The patient may stay connected to the c. A foot or arm bath for cathode.
portable TENS. d. Two large electrodes and leads.
e. Two large lint pads to cover the
Dangers: electrodes.
f. Solution of anticholinergic compounds.
Continuous application of TENS may produce
g. Distilled water.
the electrolyte reaction under the electrodes
resulting in burns.
Application:
Uses:
The machine should be tested prior to use.
TENS is useful method of reducing or Leads are attached to the terminals and held
removing pain in chronic syndromes. with free ends, not touching in a bowl of tap
water control should be turned up and the
IONTOPHORESIS: needle of the millimeter should be watched to
ensure the regulation of current.
"The techniques in which medically useful
The physiotherapist should test the current on
ions are driven through patients skin into the
herself as faradic type current.
tissues is known as iontophoresis."
Method of treatment:
Principal and techniques:
The basic principal is to place the ion under an Hands:
electrode with the same charge; e.g. negative The shallow plastic tray is placed on an arm
ions are applied under the cathode. This bath table and the patient sits alongside. The
electrode is known as "active electrode" the active electrode (anode) placed in the plastic
direct current is then applied and the ions are tray and is covered by one of the lint pad. Pads
electrically propelled into the patient's skin. should be at least of eight layers thick so, that
Although direct current is seldom used now a they make the good contact with the tissues
days. The use of tap water for the treatment of and with the electrode and are able to absorb
hyperhidrosis produces no side effects but the any chemicals which might form during the
ions in it may not inhibit the sweating treatment.
sufficiently. Therefore use anicholinergic The tray also contains enough of a 0.05 per
compounds in distilled water are cent solution of the anticholinergic compound,
recommended. The introduction of glycopyrronium bromide in distilled water to
GLYCOPYRONIUM BROMIDE under the cover the palm well. The hand is placed in the
anode has been show long lasting effects tray and the electrode connected to the positive
(Morgan 1980) the hands and feet are effected terminal of the treatment unit.
commonly and require treatment but no One of the patient's feet is placed in few cm of
attempt should be made to treat hands and feet warm water in the foot bath, on the lint pad
on same day and there should be an interval of covering the electrode which connected to the
several days between the treatments. negative terminal. The current is now switched
65
Chapter 6 Classification of Currents
Precautions: Z=1/2πfC
2. MEDIUM FREQUENCY
CURRENTS:
Interferential current
66
Chapter 6 Classification of Currents
67
Chapter 6 Classification of Currents
Precautions:
68
Chapter 6 Classification of Currents
The sine wave is produced in a burst mode that Muscle strengthening and re education
has a 50 percent duty cycle. Decrease edema
Increase blood flow
According to strength duration curve data, to Reduces muscle spasm
obtain the same stimulation effect as the
duration of the stimulus decreases, the This would make the muscle respond with a
intensity must be increased. twitch rather than a gradually increasing
mechanical contraction.
The intensity associated with this duration of
current could be considered as painful. Gradually increasing the number of bursts
interrupts the mechanical relaxation cycle of
To make this intensity of current tolerable, it is the muscle and causes more shortening to take
generated in 50 burst per second envelopes place.
with an interburst interval of 10 m-sec. this
slightly reduces the total current but allows
enough of a peak current intensity to stimulate
muscle very well. 3. HIGH FREQUENCY
The other factor affecting patient comfort is
CURRENTS:
the effect that frequency will have on the
Production by:
impedance of the tissue.
69
Chapter 6 Classification of Currents
sharp sound (ranging from a snap for a spark relationship between anode voltage and anode
plug, to a loud bang for a wider gap). The current.
spark gap also liberates light and heat.
The high working voltage makes them well
suited for radio transmitters and valves remain
in use today for very high power short wave
radio transmitters, where solid state techniques
would require many devices in parallel, and
very high DC supply currents. High power
solid state transmitters also require complex
combining and tuning networks, whereas a
valve based transmitter would use a single
Fig. 6.9: A typical spark transmitter circuit.
relatively simple tuned network. Thus while
solid state high power short wave transmitters
Capacitor - C1 and C2; Resistor - R; Inductor - L. are technically possible, economic
considerations still favor valves above 3 MHz
Operation: and 10,000 watts. Amateurs also use valve
amplifiers in the 500-1500 watt range mainly
The function of the spark gap is to present a
for economic reasons.
high resistance to the circuit initially to allow
the C1 capacitor to charge. When the
breakdown voltage of the gap is reached, it
then presents a low resistance to the circuit
causing the C1 capacitor to discharge. The
discharge through the conducting spark takes
the form of a damped oscillation, at a
frequency determined by the resonant
frequency of the C2 and L tank LC circuit.
70
Chapter 6 Classification of Currents
Valves are high voltage devices, inherently budgeting of the number of stages for a given
suitable for higher voltage circuits than most application compared to semiconductors.
semiconductors.
Short operational life:
Valves can be constructed on a scale that can
dissipate large amounts of heat, with very high In the most common applications, valves have
power models designed for water or vapor a working life of just a few thousand hours,
cooling. For this reason valves remained the much shorter than solid state parts. This is due
only viable technology for very high power, various commonplace failure mechanisms:
and especially high power/high voltage cathode depletion, open or shorts circuits -
applications such as Radio & TV transmitters notably of the heater and grid structures,
long into the age when transistors had cathode poisoning, and physical breakage of
displaced valves in most other applications. the glass envelope. Heater failure most often
However today these also are increasingly happens due to the mechanical stress of a cold
obsolete. start. Only, in certain always-on professional
application such as specialized computing and
Lower investment cost in applications like RF undersea cables, specially designed valves in
amplifiers above the kilowatt power carefully designed circuits and well cooled
range Also, large, high value power valves can environments reached operational lives of tens
to some extent be remanufactured to extend or hundreds of thousands of hours.
residual life.
Heater supplies are required for the cathodes.
Electrically very robust, they can tolerate Beside the investment cost, the share of the
overloads which would destroy bipolar power budget that goes into heating the
transistor systems in milliseconds (of cathode without contributing to output can
particular significance in military and other range from few percent points of anode
"strategically important" systems). dissipation ( in high power applications at full
output), to broadly comparable to anode
Indefinite shelf life. Even 60 year old tubes
dissipation in small signal applications.
can be perfectly functional, and many types
are available for purchase as "new-old-stock". Large circuit temperature swings in on/off
Thus, despite known reliability issues (see cycles. Massive stray heat from cathode
below), it is still perfectly possible to run most heaters in common low power tubes means
very old vacuum tube equipment. that adjoining circuits experience changes in
temperature that can exceed 100°C / 200°F.
Comparative ease of replacement. Being
This requires heat resistant components. In RF
known to be subject to a number of common
applications this also means that all frequency-
failure modes, most tubes were designed and
determining components may have to heat to
installed as plug-in devices, not soldered into a
thermal equilibrium before frequency stability
circuit. A failed tube can simply be unplugged
is reached. While at AM broadcast (medium
and replaced by a user, while the failure of a
wave) receivers and in loosely-tuned TV sets
soldered-in semiconductor may imply damage
this was not a problem, in typical radio
beyond economic repair for a whole product or
receivers and transmitters with free-running
subassembly.
oscillators at HF frequencies this thermal
Disadvantages of valves Cost: stabilization required about one hour. On the
other hand, miniature ultra-low power direct-
For most applications, tubes require both heated valves do not produce much heat in
greater initial outlay and running expense per absolute terms, cause more modest
amplification stage, requiring more attentive
71
Chapter 6 Classification of Currents
temperature swings, and allow equipment that The transistor is the fundamental building
contains few of them to stabilize sooner. block of modern electronic devices, and is
ubiquitous in modern electronic systems.
No "instant on" from a cold start. Valve Following its development in the early 1950s,
cathodes need to heat to a glow to start the transistor revolutionized the field of
conducting. In indirect-heating cathodes this electronics, and paved the way for smaller and
could take up to 20 seconds. Apart from cheaper radios, calculators, and computers,
temperature-related instability, this meant that among other things
valves would not work instantly when
powered. This led to development of always- Simplified Operations:
on preheating systems for vacuum tube
appliances that shortened the wait and may The essential usefulness of a transistor comes
have reduced valve failures from thermal from its ability to use a small signal applied
shock, but at the price of a continuous power between one pair of its terminals to control a
drain, and an increased fire hazard. On the much larger signal at another pair of terminals.
other hand, very small, ultra low power direct- This property is called gain. A transistor can
heated valves turn on in tens of a second from control its output in proportion to the input
a cold start. signal; that is, it can act as an amplifier.
Alternatively, the transistor can be used to turn
Anodes may require dangerously high current on or off in a circuit as an electrically
voltages. controlled switch, where the amount of current
is determined by other circuit elements.
High impedance / low current output
unsuitable for direct drive of many real world There are two types of transistors, which have
loads, notably various forms of electric motor slight differences in how they are used in a
circuit.
Compared to transistors, valves have the
disadvantage of being available in a single A bipolar transistor has terminals labeled
polarity only. In most processes transistors are
available in complementary polarities (e.g., base
NPN/PNP), making possible many circuit collector
configurations that cannot be realized with Emitter
valves.
A small current at the base terminal (that is,
iii) Transistors: flowing between the base and the emitter) can
control or switch a much larger current
A transistor is a semiconductor device used between the collector and emitter terminals.
to amplify and switch electronic signals and
electrical power. It is composed For a field-effect transistor, the terminals are
of semiconductor material with at least three labeled
terminals for connection to an external circuit.
gate
A voltage or current applied to one pair of the
source
transistor's terminals changes the current
drain
through another pair of terminals. Because the
controlled (output) power can be higher than A voltage at the gate can control a current
the controlling (input) power, a transistor between source and drain.
can amplify a signal. Today, some transistors
are packaged individually, but many more are The image represents a typical bipolar
found embedded in integrated circuits. transistor in a circuit. Charge will flow
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Chapter 6 Classification of Currents
High-power,high-frequency operation,
such as that used in over-the-air television
broadcasting, is better achieved in vacuum
tubes due to improved electron mobility in
a vacuum.
Solid-state devices are more vulnerable
to Electrostatic discharge in handling and
operation
A vacuum tube momentarily overloaded
will just get a little hotter; solid-state
devices have less mass to absorb the heat
due to overloads, in proportion to their
rating
Sensitivity to radiation and cosmic rays
Fig. 6.11: A simple circuit diagram to show the
(special radiation hardened chips are used
labels of an n–p–n bipolar transistor.
for spacecraft devices).
Advantages: Vacuum tubes create a distortion, the so-
called tube sound that some people find to
The key advantages that have allowed be more tolerable to the ear.
transistors to replace their vacuum tube
predecessors in most applications are SHORTWAVE DIATHERMY AND
MICRO WAVE:
No power consumption by a cathode
heater. In the natural sciences, the term diathermy
Small size and minimal weight, allowing [di´ah-ther″me] means "electrically induced
the development of miniaturized electronic heat" the use of high-frequency
devices. electromagnetic currents as a form of physical
Low operating voltages compatible with or occupational therapy and in surgical
batteries of only a few cells. procedures. The term diathermy is derived
No warm-up period for cathode heaters from the Greek words dia and therma, and
required after power application. literally means “heating through.” adj., adj
Lower power dissipation and generally diather´mal, diather´mic.
greater energy efficiency.
It is commonly used for muscle relaxation. It
Higher reliability and greater physical is also a method of heating tissue
ruggedness. electromagnetically or ultrasonically for
Extremely long life. Some transistorized therapeutic purposes in medicine. Diathermy
devices have been in service for more than is used in physical therapy and occupational
50 years. therapy to deliver moderate heat directly to
73
Chapter 6 Classification of Currents
74
Chapter 6 Classification of Currents
waves cannot be used on or near persons with physical medicine and sports traumatology. Its
implanted electronic cardiac pacemakers. use has been successfully extended to physical
medicine and sports traumatology in Central
Hyperthermia induced by microwave and Southern Europe.
diathermy raises the temperature of deep
tissues from 41°C to 45°C using Diathermy risks
electromagnetic power. The biological
mechanism that regulates the relationship As with all forms of heat applications, care
between the thermal dose and the healing must be taken to avoid burns during diathermy
process of soft tissues with low or high water treatments, especially to patients with
content or with low or high blood perfusion is decreased sensitivity to heat and cold. With
still under study. Microwave diathermy electrocautery there have been reported cases
treatment at 434 and 915 MHz can be effective of flash fires in the operating theatre related to
in the short-term management of heat generation meeting chemical flash points,
musculoskeletal injuries. especially in the presence of increased oxygen
concentrations associated with anesthetic.
Hyperthermia is safe if the temperature is kept
under 45°C. The absolute temperature is, Concerns have also been raised regarding the
however, not sufficient to predict the damage toxicity of surgical smoke produced by
that it may produce. electrocautery. This has been shown to contain
chemicals which may cause harm by
Microwave diathermy-induced hyperthermia inhalation by the patients, surgeon or operating
produced short-term pain relief in established theatre staff.
supraspinatus tendinopathy.
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Chapter 7 Mechanical Forces
Inertia:
"Tendency of an object to continue its present
state of rest or of uniform motion in a straight
line"
If a car is stop force is applied to move it. Greater the mass greater the force required;
e.g. quadriceps and gastrocnemius required
Types of Force: greater force to move.
Force applied though any external source is The greater the force the greater the
known as passive force; e.g gravity, physical acceleration will produce.
therapist's hand.
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Chapter 7 Mechanical Forces
It may be static (between two stationary Depression of the scapula is produced by the
bodies) or dynamic (between two dynamic lower fibers of trapezius pulling down and
bodies). backward and the lower fibers of serratus
anterior pulling down and forward. The
Depends upon: scapula moves down.
77
Chapter 7 Mechanical Forces
Neutral equilibrium.
78
Chapter 7 Mechanical Forces
79
Chapter 7 Mechanical Forces
the assistance of ropes, chains or cords, a required is an advantage but the small range
pulley makes moving objects upward easier. and slow speed of movement do not matter.
The direction of the force needed to lift an
object is changed from pushing up to pulling LEVERS:
down when you use a pulley system. Pulleys
are designed to make your work load more "A machine is a device by which a force
manageable and are classified as movable, applied at one point is use to overcome
fixed or combined. another force acting some other point."
As the name implies, this pulley moves with Lever is consists of a rigid bar pivoted at one
the object you are lifting. The dynamics of this point, the fulcrum. The load is placed at one
type of pulley mean it requires less effort to point on the bar, and that part of the bar
lift a load than the weight of the load itself. between the load and the fulcrum is termed the
For example, if you have a 20-lb. pound object load arm. The force, or effort that is to lift the
you need to raise, it would only require 10 lbs. load is applied at another point and that part of
of effort to lift it with a pulley. The the bar between this point and the fulcrum is
disadvantage of a movable pulley is that the termed as the effort arm.
pulley itself has to be pushed up or down.
Action of the lever:
A Fixed Pulley: The action of gravity on the load tends to
When a pulley is attached or fixed in place to cause rotation of the bar about the fulcrum in
an immovable spot, such as a wall or ceiling, it one direction (anti clock wise) the moment of
is known as a fixed pulley. Because of the force being equal to L x La.
positioning, a fixed pulley acts more like a In order to raise the load the effort must rotate
lever and does not decrease the effort needed the bar in opposite direction. The moment of
to lift the object. Its main advantage is you the force of the effort is equal to E x Ea. If this
will not have to move the pulley up or down is equal to the moment of the force exerted by
for it to function. the load, the lever balances.
A Combined Pulley: For the effort to raise the load the product of
the effort and the effort arm must be greater
A combined pulley is a combination of a fixed
than that of the load and the load arm that is:
and a movable pulley. This arrangement of
pulleys reduces the effort needed to lift an E x Ea > L x La
object by less than half its weight. The
disadvantage is that you will need more space Types of lever:
(or distance) for it to operate, because the rope
or chain is longer. You may have heard There are three different kinds of levers.
combined pulleys referred to by their other
Examples in daily life:
common name: block and tackle.
A first-class lever is a bar where the fulcrum
Functions:
is between the weight and the energy moving
It gives a mechanical advantage but speed the weight (your hands, for example). Some
disadvantages. Such a pulley system is used common first-class levers are see-saws,
for raising a patient's trunk in sling crowbars, pliers, scissors (which use two first-
suspensions, when the reduction of the effort class levers together), and a hammer pulling a
80
Chapter 7 Mechanical Forces
81
Chapter 7 Mechanical Forces
between the skull and the atlas (Vertebrae of is NOT increased. In fact, a larger force is
the spine) the spine is the fulcrum across actually needed to move a smaller weight, so
which muscles lift the head. there is a force disadvantage. The use of this
lever is in the gain in speed of movement of
the weight.
ELASTICITY:
"The tendency to regain original form and
volume after deformation is known as the
elasticity"
F = -kx
σ = Ee
83
Chapter 8 Electromagnetism
Chapter No. 8
ELECTROMAGNETIC
RADIATION
Electromagnetic Spectrum:
The wave lengths of electromagnetic waves
vary considerably, and waves of different
wavelengths have somewhat different
properties, an analysis of the rays is termed a
spectrum
84
Chapter 8 Electromagnetism
85
Chapter 8 Electromagnetism
the symbol versions, as a large number or as Frequency and wavelength are inversely
an exponent. proportional to each other. The relationship
between frequency and wavelength is that for
Symbol Number Exponent a given speed, as the frequency increases, the
1 Hz (hertz) 1 Hz 1 Hz wavelength decreases. At extremely high
frequencies, you can have very long
1 kHz wavelengths and vice versa. As the wave
1000 Hz 1*103 Hz
(kilohertz) length is the distance travelled by a wave in
1 MHz the course of one cycle. The product of
1,000,000 Hz 1*106 Hz wavelength and frequency gives the distance
(megahertz)
travelled by the wave in unit time, i.e. the
1 GHz 1,000,000,000
1*109 Hz velocity. Thus:
(gigahertz) Hz
Velocity= frequency x wavelength
Wavelengths:
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Chapter 8 Electromagnetism
"giga" or by powers of 10. A very short Reflection with gently curved spherical
wavelength is designated as a negative reflector:
exponential.
If the reflector is gently cured section of
Law of reflection, refraction and sphere the reflected rays all pass through a
absorption: focal point in front of reflector, and if a point
source of rays is placed at the focal point the
Reflection: rays which strike the reflector merge parallel
to each other.
When a ray strikes a medium, it may be
reflected, or turned back, from the surface.
When this occurs the angle of the incidence
ray to normal is equal to the angle of the
reflected ray to normal. When a group of rays
strikes a surface the proportion that are
reflected depends on the angle at which the
rays strike the surface, on the nature of surface
and on the wavelength of the rays. More rays
are reflected from mirrors and bright polished
surfaces than from dull or dark surfaces, and a
material of a particular colour reflects only the
Fig. 8.5: Reflection with gently curved spherical
rays of colour. The effect of the angle at which reflector:
the rays strikes the surface is considered under
the heading of absorption. Reflection with deeply concave spherical
reflector:
Shapes of reflectors:
87
Chapter 8 Electromagnetism
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Chapter 8 Electromagnetism
Refraction through a piece of glass: primary colors - red, orange, yellow, green,
blue, indigo and violet.
If a ray is passed through a thick piece of glass
with parallel surfaces, it bends in one direction
on entering the glass, and back an equal
amount on leaving the emergent ray is
therefore parallel to the incident ray but not in
the same straight line.
Application of refraction:
89
Chapter 8 Electromagnetism
90
Chapter 8 Electromagnetism
The cosine decreases as angle decreases, but If a certain group of rays cover a square with
not in direct in proportion to the size of the sides 1cm in length at one meter from source,
angle. at two meters the same group of rays cover a
square each side of which is 2cm in length.
This as four times the area of the square which
they covered at 1meter, and so the intensity of
the rays at 2meters from the sources a quarter
The number of rays that are reflected varies of that at 1meter. Similarly the intensity at
inversly with the number which are absorbed, 3meters is one-ninth of the intensity at one
so minimum reflection occurs when rays strike meter.
an object at a right angle. The greater the angle
between the incident ray and normal,the Application of the law of inve rse
greater the amount of rays which are reflected, squares:
and the smaller the amount absorbed. This law
This law applied to infra red, visible and
is of great importance in the application of
ultravoilet rays, so when a lamp obeys the law
infrared and ultaviolet rays. The lamp and
of inverse squares, four minutes at 2meters
patient should be arranged so that the rays
and nine minutes at 3meters whould be
strike the skin at a right angle, thus giving
required to produce the same effect as one
maximum absorption.
minute at 1meter. Whether a lamp obeys the
In accordance with the law of grotthus, rays law of inverse squares or not depends on the
must be absorbed in order to produce an effect. size of the souce of rays, as the law is true
When a ray is absorbed, it disappears, but only the rays from a point source. If a reflector
produces its chharacteristic effects at the the is used, the divergens of the rays is reduced,
point where it absorbed. Sometimes the but the law forms a satisfactory basis for the
absorption of ray is followed by the emmision calculation of doses at different distances from
of rays of alonger wave length. the majority of the lamps used in
physiotherapy department.
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Chapter 8 Electromagnetism
Convex Mirrors:
A convex mirror, fish eye mirror or diverging
mirror is a curved mirror in which the
reflective surface bulges toward the light
source. Convex mirrors reflect light outwards;
therefore they are not used to focus light. Such
mirrors always form a virtual image, since the
focus (F) and the center of curvature (2F) are
both imaginary points "inside" the mirror, Fig. 8.17: Convex mirror
which cannot be reached. Therefore images
formed by these mirrors cannot be taken on Concave mirrors:
screen (As they are inside the mirror).
A concave mirror, or converging mirror, has a
reflecting surface that bulges inward (away
from the incident light). Concave mirrors
reflect light inward to one focal point;
therefore they are used to focus light. Unlike
convex mirrors, concave mirrors show
different image types depending on the
distance between the object and the mirror.
These mirrors are called "converging" because
they tend to collect light that falls on them,
refocusing parallel incoming rays toward a
focus. This is because the light is reflected at
Fig. 8.16: Convex Mirror different angles, since the normal to the
surface differs with each spot on the mirror.
Uses:
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Chapter 8 Electromagnetism
Fig. 8.19: Use of concave mirror for teeth Lenses are classified by the curvature of the
examination. two optical surfaces.
1. A lens is biconvex (or double convex, or
Lenses: just convex) if both surfaces are convex.
2. A lens with two concave surfaces is
Lens is a piece of curved and polished glass or biconcave (or just concave).
other transparent material that forms an image
3. If one of the surfaces is flat, the lens is
by refracting and focusing light passing
Plano-convex or P lano-concave depending
through it. A simple lens consists of a single
on the curvature of the other surface.
optical element. A compound lens is an array
of simple lenses (elements) with a common 4. A lens with one convex and one concave
axis; the use of multiple elements allows more side is convex-concave or meniscus. It is
optical aberrations to be corrected than is this type of lens that is most commonly
possible with a single element. Lenses are used in corrective lenses.
typically made of glass or transparent plastic.
Elements which refract electromagnetic
radiation outside the visual spectrum are also
called lenses: for instance, a microwave lens
can be made from paraffin wax.
Most lenses are Spherical lenses: their two If the lens is biconvex or Plano-convex, a
surfaces are parts of the surfaces of spheres, collimated or parallel beam of light travelling
with the lens axis ideally perpendicular to both parallel to the lens axis and passing through
93
Chapter 8 Electromagnetism
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Chapter 8 Electromagnetism
(patient). Although there are a large number of Artificially-generated radio waves are used for
variants, the most common types are: fixed and mobile radio communication,
broadcasting, radar and other navigation
1. Spherical: short-sided, giving a relatively systems, satellite communication, computer
broad spread of light. networks and innumerable other applications.
2. Parabolic: providing a tighter, parallel beam
of light. Radio waves have the longest wavelengths in
the electromagnetic spectrum. These waves
can be longer than a football field or as short
as a football. Radio waves do more than just
bring music to your radio. They also carry
signals for your television and cellular phones.
Radio waves are the lowest frequencies in the
electromagnetic spectrum, and are used mainly
for communications.
Long Wave :
UHF (microwave):
95
Chapter 8 Electromagnetism
Dangers:
96
Chapter 8 Electromagnetism
Infrared thermometer:
97
Chapter 8 Electromagnetism
and then measures the infrared radiation Objects such as people and cars that are hotter
emitted from the eardrum and surrounding than the background can be easily tracked
tissues. even at night.
98
Chapter 8 Electromagnetism
99
Chapter 8 Electromagnetism
Navigation
Production of light:
100
Chapter 8 Electromagnetism
therapy. You also may be able to manage side UVR depth of penetration is 1 to 2 mm
effects by reducing treatment time, moving Physiologic effects are superficial
farther from your light box, taking breaks Used to treat various skin disorders
during long sessions or changing the time of
day you use light therapy. Talk to your doctor Production of rays:
for additional advice, or if side effects don't go
away or get worse. Therapeutic UV usually produced by the
passage of current through an ionized
Ultraviolet rays (UVR): vapor-often mercury vapor.
At low pressure or high temperatures.
Shorter wavelength and higher frequency than
visible light, Carry more energy than visible Devices commonly used are either:
light. Electromagnetic spectrum (2000 to 4000
Å) UVR cover a small part if electromagnetic
Air cooled(using air circulation with fan)
spectrum lying between visible light and X-ray or
region. Sunlight is the main source of ultra
Water cooled (using water jacket
violet rays.
surrounding the burner with continually
Types: circulating water).
Ultraviolet Radiation:
101
Chapter 8 Electromagnetism
Florescent lamps:
Techniques of Application:
102
Chapter 8 Electromagnetism
Signs/Symptoms:
103
Chapter 8 Electromagnetism
Increased tear production see through your bag. Hot gases in the
Spasm of the ocular muscles Universe also emit X-rays.
104
Chapter 8 Electromagnetism
Digital Sensors:
105
Chapter 8 Electromagnetism
Mammography:
106
Chapter 8 Electromagnetism
Types of radiations:
107
Chapter 8 Electromagnetism
generally less dangerous to people than always been radioactive and accounts for up to
gamma radiation. Exposure produces an effect 85% of the annual human radiation dose.
like sunburn, but which is slower to heal. Radiation arising from human activities
Beta-radioactive substances are also safe if typically accounts for up to 15% of the
kept in appropriate sealed containers. public's exposure every year. This radiation is
no different from natural radiation except that
Gamma rays: it can be controlled.
These are high-energy beams much the same Effects of radiation exposure on Human
as X-rays. They are emitted in many health:
radioactive decays and are very penetrating, so
require more substantial shielding. Gamma Although a dose of just 25 rems causes some
rays are the main hazard to people dealing detectable changes in blood, doses to near 100
with sealed radioactive materials used, for rems usually have no immediate harmful
example, in industrial gauges and radiotherapy effects. Doses above 100 rems cause the first
machines. Radiation dose badges are worn by signs of radiation sickness including:
workers in exposed situations to detect them
and hence monitor exposure. All of us receive Nausea
about 0.5-1 mSv per year of gamma radiation Vomiting
from cosmic rays and from rocks, and in some Headache
places, much more. Gamma activity in a Some loss of white blood cells
substance (e.g. rock) can be measured with a
scintillometer or Geiger counter.
X-rays: are also ionizing radiations, virtually
identical to gamma rays, but not nuclear in
origin.
Cosmic radiations: consists of very energetic
particles, mostly protons, which bombard the
Earth from outer space.
Neutrons: are mostly released by nuclear
fission (the splitting of atoms in a nuclear
reactor), and hence are seldom encountered Fig. 8.55: Nuclear wave penetration
outside the core of a nuclear reactor. Thus they
are not normally a problem outside nuclear Heat:
plants. Fast neutrons can be very destructive to
human tissue. The movement if thermal energy from a
substance at a higher temperature to another at
Sources of radiation: a lower temperature. It is thermal energy
moving from a warmer object to a cooler
Radiation can arise from human activities or object
from natural sources. Most radiation exposure
Definitions:
is from natural sources. These include:
radioactivity in rocks and soil of the Earth's Conduction:
crust; radon, a radioactive gas given out by
many volcanic rocks and uranium ore; and The transfer of heat between particles within a
cosmic radiation. The human environment has substance,
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Chapter 8 Electromagnetism
The movement that transfers heat within the The temperature at which a substance changes
water. from a liquid to a solid.
Currents caused by the rising of heated fluid The process by which matter changes from the
and sinking of cooled fluid. liquid to the gas state.
Radiation: Evaporation:
Conductor: Boiling:
A material that conducts heat well. Vaporization that occurs on and below the
surface of a liquid.
Insulator:
Boiling point:
A material that doesn't conduct heat well.
The temperature at which a liquid boils.
Specific heat:
Condensation:
The amount of heat required to raise the
temperature of one kilogram of a substance by A change from the gas state to a liquid state.
one kelvin.
Thermal expansion:
States:
The expanding of matter when it is heated.
The three forms (solid, liquid, and gas) in
which matter exists. Thermostats:
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Chapter 8 Electromagnetism
heat added or removed during a phase change Fahrenheit temperature scale is a scale
does not change the temperature. based on 32 for the freezing point of water and
212 for the boiling point of water, the interval
between the two being divided into 180 parts.
The 18th-century German physicist Daniel
Gabriel Fahrenheit originally took as the zero
The specific heat of water is 1 calorie/gram of his scale the temperature of an equal ice-salt
o
C= 4.186 joule/gram o C which is higher than mixture and selected the values of 30 and 90
any other common substance. As a result, for the freezing point of water and normal
water plays a very important role in body temperature, respectively; these later
temperature regulation. were revised to 32 and 96, but the final scale
required an adjustment to 98.6 for the latter
What are the three types of heat transfer? value.
Conduction- the transfer of heat from matter Until the 1970s the Fahrenheit temperature
to matter scale was in general common use in English-
speaking countries; the Celsius, or centigrade,
Convection- the transfer of heat from matter
scale was employed in most other countries
to air
and for scientific purposes worldwide. Since
Radiation- the transfer of heat from one point that time, however, most English-speaking
to another, such as boiling water. countries have officially adopted the Celsius
scale. The conversion formula for a
Effects of impurities and pressure temperature that is expressed on the Celsius
(C) scale to its Fahrenheit (F) representation
on melting point of water
is: F = 9/5C + 32.
Melting point decreases with pressure and
increases with impurities (like saw dust).
boiling point increases with impurities and
also increases with pressure.
Scales of Temperature:
There are three temperature scales in use Fig. 8.56
today, Fahrenheit, Celsius and Kelvin.
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Chapter 8 Electromagnetism
Specific Specific
Fig. 8.57
latent latent heat
Kelvin temperature scale is the base unit of heat of of
thermodynamic temperature measurement in fusion vaporization
the International System (SI) of measurement. (KJ kg-1 ) (KJ kg-1 )
It is defined as 1/ 273.16 of the triple point
Carbon dioxide 189 932
(equilibrium among the solid, liquid, and
gaseous phases) of pure water. The kelvin Mercury 11 296
(symbol K without the degree sign []) is also
the fundamental unit of the Kelvin scale, an Tungsten 192 4350
absolute temperature scale named for the
British physicist William Thomson, Baron Copper 205 4790
Kelvin. Such a scale has as its zero point
Water 333 2260
absolute zero, the theoretical temperature at
which the molecules of a substance have the Table 8.1: Specific latent heat of fusion and
lowest energy. Many physical laws and vaporization fo r some substances
formulas can be expressed more simply when
111
Chapter 8 Electromagnetism
As described, the difference between a solid volume of the jar. This is like a gas with
and a liquid depends on the way the molecules widely separated, rapidly moving molecules
are held together- very firmly in the case of a driven by the additional energy. Notice that it
solid, less firmly in the case of a liquid. In is both the kinetic and potential energies of the
order to change a solid to a liquid, i.e. to melt molecules that make internal energy. The
it, it is necessary to break or release the forces kinetic energy is measured by temperature but
holding the molecules together and this takes it is the potential energy which is altered in
energy. Of course, there are no mechanical melting and freezing or in boiling and
links between the molecules; it is the electrical condensing so that there is no temperature
interatomic forces that are counteracted by the change. The word latent in its sense of
added energy. In crystalline solids the remaining hidden but still present is almost
molecules or atoms are arranged in regular synonymous with potential and is thus highly
arrays. But when some of the bonding forces appropriate - well chosen by Joseph Black.
are reduced by heating, groups of molecules Since melting involves only some of the
are able to move more freely, tumbling bonding being disrupted and vaporization
higgledy-piggledy over and around one involves the loss of all bonding i might be
another. Some molecules are able to leave one expected that more energy would be needed
group for another. This is a liquid. Further for the latter process. This is always the case
heating, once melting has occurred, leads to a and is shown in table. The energy needed to
temperature rise but no further change in the effect these changes in some substances, in
average number of intermolecular bonds. At kilojoules per kilogram, shown in the table and
the vaporization temperature, boiling point, all called the specific latent heat of fusion
the remaining bonds are broken to allow wide (melting) or vaporization. The specific latent
separation of molecules, forming a gas. Again heats of fusion and vaporization ae often given
the heat energy is used in counteracting the in calories per gram, being respectively,
intermolecular or interatomic forces so that approximately 79 and 539 cals g-1 for water.
there is no rise in temperature while it occurs. The large amount of energy stored as
vaporization can be seen from the table and
To give a simple analogy of what occurs when explains why so much power can be derived
energy is added and induces a change of state; from steam turbines.
consider a large glass jar of coffee beans. At
rest, the beans occupy the bottom third of the There is another interesting and far reaching
jar and have some regularity in that the characteristic of water. Liquids have rather
rounded, thicker parts of the beans tend to fit more space between molecules than solids but
into the spaces where the ends of three or four much less than in gases. Almost all liquid
beans touch in the layer below. Thus the beans states are therefore less dense than the solid
are, to some degree, in a regular array like a states. However, water is exceptional in that
crystalline solid. If the jar is tipped through a the molecules are more closely packed
few degrees very slowly the beans stay in together at around 40 C than when the
position and no movement occurs. If, however, crystalline solid, ice, is formed. Thus ice will
the jar is vibrated or gently tapped, the beans float on water.
slide over one another and if the jar is tilted at
an angle the surface of the moving beans
becomes horizontal just like a fluid level. With
the added energy of vibration the beans are
now behaving like a liquid. If the jar is now
shaken very vigorously (with the lid on tight)
beans fly about randomly occupying the whole
112
Chapter 8 Electromagnetic Radiation
Kelvin
Newton [°N] = ([K] − 273.15) × 33⁄ 100 [K] = [°N] × 100⁄ 33 + 273.15
Celsius (centigrade)
113
Chapter 8 Electromagnetic Radiation
Fahrenheit
114
Chapter 9 Waves
Chapter No. 9
The wave shown in figure 9.1 is a transverse
WAVES
sine wave - so called because the displacement
Many kinds of wave motion are found in of the spring is perpendicular or transverse to
nature in this chapter we examine only two- the direction of propagation. When the
sound waves and electromagnetic waves. The oscillations are along the direction of
two are very different in character but share a propagation the wave is called longitudinal.
number of common properties and it is these Figure 9.2 shows a longitudinal wave
common properties which we first consider. generated in a spring. For a longitudinal wave,
the wavelength and velocity are easy to
Different kind of waves: determine. The wavelength is the distance
Any kind of wave motion, be it the ripples on between two regions of compression. The
a pond, sound or light has four characteristics velocity is determined by measuring how far a
which are fundamentally associated with the region of compression moves along the spring
wave. These are: the wavelength, frequency, (∆x) in a known time interval (∆t). One region
velocity of propagation and amplitude (or of compression, moving to the right, is colored
size). Figure 9.1 shows one kind of wave in figure 9.2. The velocity is calculated using
motion; a sinusoidal oscillation travelling in a the formula v = ∆x/∆t. The amplitude is less
finely coiled spring. apparent but, in the case of a spring, it can be
determined by attaching a marker to a point on
the spring and measuring how far the marker
oscillates back and forth from its mean
position.
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Chapter 9 Waves
represent regions of high pressure. Widely The existence of electromagnetic waves was
spaced lines represent regions of low pressure not suspected until 1864 when the Scottish
(rarefaction).These regions move through any scientist, James Clerk Maxwell published a
particular medium at a fixed velocity. For theoretical paper in which their existence was
example, all sound waves travel at 340 m.s-1 predicted. The velocity predicted for these
in air, regardless of the sound frequency. In waves turned out to be extremely close to that
water, the velocity of sound waves is close to measured experimentally for light, which led
1100 m.s-1. Maxwell to conclude that light itself was an
electromagnetic wave. Prior to this scientist
since Newton's day had puzzled over the
nature of light: whether it was corpuscular or a
wave motion, and if a wave, a wave in what?
In many ways Maxwell's work formed the
keystone of 19th century physics.
Figure 9.3 Diagrammat ic representation of a sound
Maxwell had set himself the task of
wave.
generalizing all of the accumulated knowledge
Electromagnetic waves are a very special kind of electrostatics, electric current, magnetism
of transverse wave. They consist of a and electromagnetism: to write a few simple
transverse sinusoidal electric field together laws from which everything else could be
with a transverse magnetic field. Light, radio derived. He summarized his findings in a set
waves, microwaves and X-rays are all of four equations which expressed the
electromagnetic waves with different relationship between electric and magnetic
frequencies, but the same velocity. The fields. In writing the equations he noticed they
frequency and wavelength can vary but, in a had a certain symmetry about them, but that
particular medium, the velocity is constant. the symmetry could only be made complete by
The speed of propagation of electromagnetic assuming the existence of a hitherto
waves in empty space is a universal constant unobserved experimental result: that a
on which much of the structure of modern changing electric field gives rise to a changing
physics is based. magnetic field. This assumption, together with
other known facts of electricity and magnetism
A convenient representation of an
gave rise to the four equations which bear
electromagnetic wave is shown in figure 9.4.
Maxwell's name.
The sinusoidal electric field E, is transverse to
the direction of propagation (arrow labeled v) Not only did Maxwell's equations account for
and also perpendicular to the magnetic field, all that was known of electricity and
B. magnetism, they also made one startling
prediction: whenever charges are accelerated,
an electromagnetic wave is produced. It was
previously known that a moving charge
produces a magnetic field which disappears
when the charge stop moving. The equations
predict that in addition an electromagnetic
wave is produced if the charge accelerates and
once the wave is produced its continued
Figure 9.4 Diagrammat ic representation of an existence and propagation is independent of
electro magnetic wave. what subsequently happens to the charge.
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Chapter 9 Waves
It is not a great step from this to the conclusion electromagnetic radiation has frequencies in
that all electromagnetic waves have their the infrared portion of the spectrum.
origin in the accelerated motion of charges.
When something is heated, the molecules
Since Maxwell's time electromagnetic waves within it are given more energy and they move
with frequencies ranging from 5 Hz to 1024 or jiggle more vigorously. A consequence is
Hz have been produced and used. Although that the electromagnetic radiation produced
they are produced and detected by seemingly has a higher average frequency. For example,
different means and given different names, if a piece of metal is heated from room
they all have essentially the same nature. A temperature it first emits only infrared
range of frequencies of electromagnetic waves radiation, but as the temperature is increased,
is referred-to as an electromagnetic spectrum. the metal becomes red-hot, then white, then
Figure 9.5 shows such a spectrum and its most blue hot. This is because the average
familiar regions. Electromagnetic waves with frequency of the emitted radiation increases.
frequencies up to 1012 Hz can be generated
Infrared, visible and ultraviolet light can be
electrically. For example the normal AM or
produced by heating of materials and
FM waves received by a radio are produced by
temperature elevation is the major factor in
generating an oscillating electrical current in
determining the frequency distribution of the
the transmitting aerial. Electrons are
waves.
accelerated back and forth along the wire and
the result is that electromagnetic waves are Higher frequency (visible light) radiation can
produced, radiating from the wire. also be produced by movement the outer-shell
electrons of an atom - hence the different
Production of current by electronic circuitry
colors produced when, for example, different
becomes increasingly difficult at higher
chemicals are introduced into a Bunsen flame.
frequencies and above 1012 Hz it is necessary
to use alternative methods for accelerating If atoms are bombarded with high energy
charges and producing the waves. electrons, inner shell electrons can be knocked
from their orbital, producing electromagnetic
Infrared radiation, sometimes referred-to as
waves in the ultraviolet and X- ray parts of the
'radiant heat' is emitted by all matter. This is
spectrum. Higher frequency gamma and hard-
because the atoms and molecules are
X radiation cannot be produced by knocking
continually moving. In a solid, for example,
electrons from their orbitals, but are produced
the atoms are constrained but are able to
when atomic nuclei are split, as in a nuclear
vibrate about their mean position. It is this
reactor or nuclear explosion. The spontaneous
movement energy which we call the heat
decay of naturally occurring radioisotopes also
energy of an object. The atomic jiggling
results in production of gamma and hard-X
means that charges (negative electrons and
radiation, due to the massive acceleration of
positive nuclei) are continually accelerating,
the fragments when the nucleus is split.
so they radiate electromagnetic waves. At
normal temperatures, most of the
117
Chapter 9 Waves
118
Chapter 9 Waves
concern us. We examine what happens to both The same is true for vibration of the molecules
kinds of wave in a material medium. - there is continual transfer of the vibrational
energy back and forth between molecules.
From everyday experience we know that
sound and light are absorbed as they pass The motion of molecules within a material is,
through materials. Ordinary window glass of course, what we measure as the heat energy
absorbs very little visible light - though it of an object. As we heat up a material the
certainly absorbs some - but absorbs energy we put in results in greater agitation
ultraviolet and infrared radiation quite and thus greater kinetic energy of the
strongly. Sound is absorbed by brick walls. In molecules. The extent to which energy is
this case we find that low frequency sound is shared between the different modes of
not absorbed as readily as higher frequencies. movement will depend on whether the
Absorption is related to the amount of material is a solid, liquid or gas and how many
absorbing material so it must be related to the atoms make up molecule. For example in the
density of the absorber. But it is also related to case of a large protein molecule with many
some other property of the material - otherwise atom and many bonds, a significant proportion
why does glass transmit light while cardboard of the heat energy will appear as internal
or paper does not? vibrations of the molecule.
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Chapter 9 Waves
corresponds in frequency to the sound wave travelled a distance x through the medium.
then the sound will be rapidly absorbed in the The quantity δ is called the penetration depth
medium. of the waves in the medium. It depends on the
frequency of the wave and the properties of
Even if the sound frequency differs somewhat
the medium through which the wave travels.
from any average frequency of molecular
The quantity e is a constant which crops-up in
movement the natural spread of oscillation
any mathematical description of exponential
frequency of the molecules will enable some
increases or decreases, in the same way that π
energy to be absorbed. In addition if the
crops-up when we are dealing with circular
difference in frequency of two natural modes
geometry.
of molecular oscillation is equal to the sound
frequency, energy can be absorbed in Figure 9.7 shows a graph of E against x for an
converting one frequency of oscillation to the exponential decrease.
other.
To see what is meant by equation 9.2 and the
Electromagnetic Waves in Matter term 'penetration depth', try substituting
different values for x into equation 9.2.
What happens as an electromagnetic wave
travels through a medium? Non-polar When the distance x is zero, e -x/δ is eo = 1
molecules will polarize in alternate directions since any number raised to the power zero
in the alternating field, polar molecules will is one. Thus E is equal to Eo the original
rotate back and forth and ions will try to move energy, as we might expect.
in the field direction. The energy losses in When x = δ, e -x/δ is e-1 = 1/e = 1/2.718 =
these processes will result in electromagnetic 0.37. Equation 9.2 then becomes E = Eo x
energy being converted into heat energy. 0.37. In other words the wave energy is
reduced to 37% of the incident energy at a
The absorption of electromagnetic energy as a
distance x equal to δ, the penetration
wave travels through a medium will thus
depth.
depend on the frequency of the wave and the
When x = 2δ, e -x/δ is e-2 = 1/ (2.718)2 =
electric and magnetic properties of the
(0.37)2. Equation 9.2 then becomes E = Eo
material - the dielectric constant, conductivity
x (0.37)2. In other words the wave energy
and permeability. Using this (somewhat
is reduced to 14% (37% of 37%) of the
simplified) model we predict that biological
incident energy.
tissues with low dielectric constant and
conductivity, such as fatty tissue will absorb
electromagnetic energy to a lesser extent than
substances such as muscle and other tissues
with a high dielectric constant and
conductivity.
Penetration Depth:
In general, for any kind of wave of a certain
frequency, we find that the wave energy
decreases exponentially with distance.
Mathematically this is written: Figure 9.7 Graph showing an exponential drop in
energy, E, with distance, x.
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Chapter 9 Waves
depth') the wave energy is decreased to 37% of The half-value depth, the thickness required to
the original energy. At a distance 2δ the wave reduce the wave energy by 50%, is d1/2 where
energy is reduced to 37% of 37% of the -d1/2/δ
incident energy and so on. In other words the Eo /2 = Eo e
wave energy is reduced by 63% every time the In other words we have substituted E = Eo /2
wave travels a distance δ in the medium. The (50% of Eo ) when x = d1/2 into equation 9.2.
wave energy is never completely absorbed but
is reduced by a certain fraction with every Cancelling the Eo on each side gives
centimeter it travels through the material. -d1/2/δ
1/2 = e
Clearly we cannot specify 'depth for complete
absorption' of the wave energy as this will
never occur. Instead we specify the penetration
depth as the depth required to absorb 63% of
the incident wave energy.
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Chapter 9 Waves
tissue. A significant proportion of the wave The infrared region of the spectrum extends
energy will be available for heating of muscle from 700 nm wavelength up to about 400 000
and other tissues lying beneath the nm. For therapeutic application, sources of
subcutaneous fat. infrared radiation are used which put out most
of their radiation at the end of the spectrum
In considering which frequencies are most
close to visible light: from about 700 nm to
useful for diathermy we would choose a
about 15 000 nm. This includes both the so
frequency which gives adequate penetration of
called 'near' infrared region, from about 700
the waves. We would not, however, aim for a
nm to 4000 nm and part of the 'far' infrared
maximum penetration depth since if δ is too
region. The far infrared region extends from
large the waves will penetrate right through
4000 nm to about 400 000 nm.
the tissue with little absorption and thus little
heating. The choice of 1 MHz for therapeutic The penetration depth of near infrared
application of ultrasound is a good radiation is very small. A maximum
compromise between adequate penetrations penetration depth of a few mm is obtained at
and adequate heating of underlying tissue. about 1200 nm wavelength, and this decreases
The pattern of heating does not, however, to a fraction of a millimeter at longer
depend solely on penetration depth - reflection wavelengths. Wavelengths longer than 3000
of the waves plays an important role. We will nm are absorbed by the moisture on the
discuss reflection shortly. surface of the skin. You may have noticed that
the red end of the visible spectrum can be
Infrared and Highe r Frequency transmitted through the full thickness of your
Radiation hand: this property does not extend to the
At higher frequencies than microwaves we infrared region of the spectrum.
have infrared, visible and ultraviolet radiation Visible and ultraviolet radiation have
(see figure 9.5). As we go to these 'optical' frequencies corresponding to natural
frequencies the penetration depth becomes frequencies associated with electrons in the
dependent on frequency in a complicated way; outer shells of atoms. Since these electrons are
there is no longer a smooth increase or the ones involved in bonding between atoms it
decrease in δ with frequency. is possible for light and ultraviolet radiation to
Let us consider, first, infrared radiation. The cause breaking of chemical bonds.
infrared region of the spectrum extends from We may summarize the absorption
about 3 x 1011 Hz up to 4 x 1014 Hz. mechanisms for infrared, visible and
Traditionally we refer to the wavelength of ultraviolet radiations as follows:
these radiations rather than the frequency and
the unit in popular usage is the nanometer Infrared radiation has frequencies
which is abbreviated nm. One nanometer is corresponding to molecular and atomic
10-9 meter. We can convert from frequency in motion and to differences in vibration
Hz to wavelength in nanometers by using frequency between two modes of motion.
equation 9.1. Since the speed of It can thus produce heating directly (hence
electromagnetic waves is close to 3 x 108 the term 'radiant heat') but has a very small
meters per second in most materials the depth of penetration.
wavelength, λ, in nanometers is related to the Visible and near ultraviolet radiation have
frequency, f, by frequencies corresponding to the
difference in natural frequency between
two energy states of bonding electrons in
atoms. Such radiation can initiate chemical
122
Chapter 9 Waves
reactions and is only indirectly associated It is also proportional to the square of the wave
with the production of heat. frequency, f, so we can also write:
123
Chapter 9 Waves
the electrostatic attraction of negative Figure 9.8 shows two springs of different
electrons for the positive nucleus. The impedance connected together. Spring 2 is of
polarizing of the atom is analogous to lower impedance (more elastically compliant
stretching of a spring, and the polarizability and/or lighter) than spring 1.
(elasticity) is determined by the dielectric
A pulse travels along spring 1 until meeting
constant.
the low impedance boundary. When the pulse
For any kind of wave, the relationship between hits the low impedance boundary the end of
wave energy and the three quantities spring 2 is lifted to the same height as the
amplitude (a), frequency (f) and impedance incoming pulse. The energy transferred to
(Z) is spring 2 is given by equation 9.4 as E α a2 f2 Z
so if the impedance, Z of spring 2 is lower
than spring 1 but a and f are the same, a 2 f2 Z is
Impedance and Reflection: less so the transmitted energy is lower than the
incident energy.
We now consider what happens when a wave
strikes a boundary between two media. The The energy that is not transmitted is reflected,
example of two different springs connected producing the reflected pulse in figure 9.8.
together is a useful one. If the first spring is Part of the original pulse is reflected and part
made to oscillate with a certain frequency then continues in the original direction. Note that
if any energy is transferred to the second the displacement of the reflected pulse is in the
spring, the frequency of the waves in each same direction as the original.
spring must be identical. This must be so since Figure 9.9 shows the opposite scenario,
the springs are fastened together so that the reflection at a high impedance boundary. In
oscillations in the joined ends of each spring this case spring 2 is heavier and less compliant
are the same. (has a higher impedance) than spring 1.
How would we arrange things so as to transfer In this case the stiffness of spring 2 prevents
all of the wave energy from one medium to the spring junction from moving as high as the
another? For maximum energy transfer the crest of the incoming wave. The effect is that a
wave amplitude must be a maximum in spring net downward force is exerted on spring 1
2. It cannot be larger than in spring 1 as the when the pulse reaches the junction. A
springs are joined. So for maximum energy reflected pulse is generated with the
transfer the wave amplitudes must be equal. displacement downward rather than upward as
The frequency is always the same in each in figure 9.8.
medium, so for maximum energy transfer we
require both equal amplitudes and frequencies.
The wave energy, however, depends not only
on frequency and amplitude but also on the
impedance of the medium (equation 9.4). It
follows that complete energy transfer can only
occur when the impedances of each medium
are the same.
124
Chapter 9 Waves
125
Chapter 9 Waves
126
Chapter 9 Waves
When a beam of waves is incident on a 9.14. First we look at the reflected wave. For
boundary at a certain angle (i in figure 9.13) simplicity, we consider a beam of width AB
the reflected wave will leave the boundary at chosen so that AC is exactly one wavelength
the same angle. i' in figure 9.13 is the same and we assume that the wave- crests are
size as i. The transmitted wave will be synchronized (the results are perfectly general,
refracted: that is, its direction of propagation but the maths is more complicated when the
will change. The angle of refraction, r, will not waves are not synchronized and the distances
be equal to the angle of incidence, i. do not match).
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Chapter 9 Waves
i' thus i = i' and we have the 'Law of simply the ratio of the velocity of light in a
Reflection': vacuum to its velocity in the medium.
Equation 9.12 then has v1 and v2 replaced by
Angle of incidence = Angle of reflection
n1 and n2, the refractive indices of each
Now consider figure 9.15 where the refracted medium. The refractive index is dictated by
beam is shown. the wave velocity in the medium.
Waves entering medium 2 at B will travel a For light waves in air their velocity, v1, is
distance BD where always greater than the velocity, v2, in a
denser medium (glass or whatever).
Consequently the angle of incidence is always
In the same time it takes for waves at A to greater than the angle of refraction.
travel the distance AC where When sound waves enter a denser medium,
they travel faster. Electromagnetic waves are
slowed in a denser medium.
In this case v1 is not necessarily equal to v2 so
distance BD is not equal to distance AC. Critical Angle:
Angle ABC is equal to i (as in the previous From the previous discussion it is apparent
example with reflected waves). Hence that waves are refracted at a boundary when
the wave velocity is different in each medium.
The relationship between incident and
refracted angle is given by equation 9.12.
Similarly, angle BCD is equal to r and
Consider again the example of sound waves in
air incident upon a boundary with water.
Equation 9.13 relates the incident and
refracted angle in this case. If this equation is
Dividing equation 9.10 by equation 9.11 gives:
used to calculate r for different values of i, a
table similar to table 9.2 is produced. The
results show a smooth increase in r as i
And substituting equations 9.8 and 9.9 this increase in the range 0° to 13°. The value i =
becomes
13° is called the critical angle for the air/water
system. At this angle of incidence the angle of
refraction, r, is 90°. In other words the
Which is the 'Law of Refraction' for waves at a refracted wave travels along the air/water
boundary. boundary. For angles of incidence greater
Since v1 is not necessarily equal to v2 , sin i is than 13° there is no real solution to equation
not equal to sin r and so the angle of incidence 9.13. Experimentally what we observe is that
is not equal to the angle of refraction. The total reflection occurs; that is, no refracted
angles of incidence and refraction depend on wave is produced. The critical angle is the
the relative velocity of the waves in each largest incident angle for which a refracted
medium. wave exists.
Equation 9.12 is a less familiar form of the law Although we have used the air/water system as
of refraction. It is more common in the case of an example, the general conclusions apply to
light to define an 'index of refraction'. This is any pair of materials where the wave velocity
128
Chapter 9 Waves
Speed or velocity:
The sound waveform moves at approximately
344 meters/second, 1130 feet/sec. or 770 miles
per hour at room temperature of 20o C (70o F).
Frequency (pitch):
Table 9.2 Angle of incidence and refract ion for The frequency of sound is the rate at which the
sound waves at an air-water interface. waves pass a given point. It is also the rate at
which a guitar string or a loudspeaker vibrates.
SOUND WAVES:
The relationship between velocity, wavelength
Sound is a series of longitudinal or and frequency is:
compression waves that move through air or
other materials. Sound does not travel in a Velocity = wavelength x frequency
vacuum. Amplitude:
Because sound is the vibration of matter, it
Since sound is a compression wave, its
does not travel through a vacuum or in outer
amplitude corresponds to how much the wave
space.
is compressed, as compared to areas of little
Light and radio waves are electromagnetic compression. Thus, it is sometimes called
waves. They are completely different than pressure amplitude.
sound, which is vibration of matter.
Electromagnetic waves are related to electrical
and magnetic fields and readily travel through
space. They are transverse waves. The rapid
back-and-forth vibration of an object creates
the longitudinal or compression waves of
sound. Longitudinal waves are waves that
oscillate in the same path that the sound wave
Fig. 8.1: Transverse wave (water wave)
is moving. This is different than the up and
down or transverse motion of a water wave.
129
Chapter 9 Waves
Infrasonic:
Fig. 8.3: Constructive interference
Infrasonic are the sound waves, having a
frequency below those of sound waves that
can be detected by the human ear—i.e., below
20 hertz.
130
Chapter 9 Waves
is loud, while the sound of your own breathing Ultrasonic waves have many uses. In nature,
is very soft. Loudness cannot be assigned a bats emit ultrasonic waves and listen to the
specific number, but intensity can. Intensity is echoes to help them know where walls are or
measured in decibels. to find prey. Captains of submarines and other
boats use special machines that send out and
The human ear is more sensitive to high
receive ultrasonic waves. These waves help
sounds, so they may seem louder than a low
them guide their boats through the water and
noise of the same intensity. Decibels and
warn them when another boat is near.
intensity, however, do not depend on the ear.
They can be measured with instruments. A Tone & Harmonics:
whisper is about 10 decibels while thunder is
100 decibels. Listening to loud sounds, sounds Another difference you may have noticed
with intensities above 85 decibels, may between sounds is that some sounds are
damage your ears. If a noise is loud enough, pleasant while others are unpleasant. A
over 120 decibels, it can be painful to listen to. beginning violin player sounds very different
One hundred and twenty decibels is the than a violin player in a symphony, even if
threshold of pain. they are playing the same note. A violin also
sounds different than a flute playing the same
Pitch: pitch. This is because they have a different
tone, or sound quality. When a source vibrates,
Pitch helps us distinguish between low and
it actually vibrates with many frequencies at
high sounds. Imagine that a singer sings the
the same time. Each of those frequencies
same note twice, one an octave above the
produces a wave. Sound quality depends on
other. You can hear a difference between these the combination of different frequencies of
two sounds. That is because their pitch is
sound waves.
different.
Imagine a guitar string tightly stretched. If we
Pitch depends on the frequency of a sound
strum it, the energy from our finger is
wave. Frequency is the number of
transferred to the string, causing it to vibrate.
wavelengths that fit into one unit of time.
When the whole string vibrates, we hear the
Remember that a wavelength is equal to one lowest pitch. This pitch is called the
compression and one rarefaction. Even though
fundamental. Remember, the fundamental is
the singer sang the same note, because the
really only one of many pitches that the string
sounds had different frequencies, we heard
is producing. Parts of the string vibrating at
them as different. Frequencies are measured in
frequencies higher than the fundamental are
hertz. One hertz is equal to one cycle of called overtones, while those vibrating in
compression and rarefaction per second. High
whole number multiples of the fundamental
sounds have high frequencies and low sounds
are called harmonics. A frequency of two
have low frequencies. Thunder has a
times the fundamental will sound one octave
frequency of only 50 hertz, while a whistle can
higher and is called the second harmonic. A
have a frequency of 1,000 hertz. frequency four times the fundamental will
The human ear is able to hear frequencies of sound two octaves higher and is called the
20 to 20,000 hertz. Some animals can hear fourth harmonic. Because the fundamental is
sounds at even higher frequencies. The reason one times itself, it is also called the first
we cannot hear dog whistles, while they can, is harmonic.
because the frequency of the whistle is too
Normal Hearing Band:
high be processed by our ears. Sounds that are
too high for us to hear are called ultrasonic. Hearing range usually describes the range
of frequencies that can be heard by humans or
131
Chapter 9 Waves
132
SECTION II
APPLIED
MEDICAL
PHYSICS
Chapter 10 Therapeutic Ultrasound
Of the diathermic modalities commonly used The heart of the circuit is the oscillator which
in therapy, ultrasound is the most popular. produces high frequency sinusoidal. This
This is not because ultrasound is necessarily current is amplified and applied to a piezo-
the most depth-effective. While ultrasound is a electric crystal, causing it to vibrate (change in
deep-heating modality and more depth- thickness) at the same frequency. The piezo-
efficient than superficial modalities such as electric effect was discovered in 1880 by the
hot packs, infrared lamps or lasers, the depth brothers Pierre and Paul-Jaques Curie. They
effectiveness is strictly limited. found that certain crystals display the
remarkable property of producing a small
The ultrasound frequencies most commonly potential difference between their faces when
used are 1 MHz and 3 MHz. The reasons for subjected to mechanical pressure. The reverse
these being popular operating frequencies will of this effect, namely that when a voltage is
become apparent in later sections of this applied to a piezo-electric crystal it changes in
chapter. In water and tissues of high water thickness, was discovered a short time
content the velocity of sound is close to 1500 afterwards.
m.s-1 thus the wavelength of 1 MHz
ultrasound is (from equation 10.1) about 1.5 All piezo-electric crystals are found to exhibit
mm and that of 3 MHz ultrasound is about 0.5 a resonance effect - that is, they vibrate most
mm. efficiently at a certain (resonant) frequency.
This natural frequency depends on the
dimensions, most importantly on the thickness,
Production of the waves: of the crystal. The resonant frequency of the
oscillator is normally adjusted during
The apparatus used to generate ultrasound manufacture to correspond to the crystal's
waves consists of a high frequency oscillator, resonant frequency.
a power amplifier and a piezo-electric crystal
which is mounted in a hand-held probe. A In continuous mode the gating circuit is not
gating circuit is usually interposed between the used and the piezo-electric crystal is supplied
oscillator and the power amplifier to provide with high frequency AC continuously. In
pulsing of the ultrasound output. Figure 10.1 pulsed mode the AC is applied to the crystal in
illustrates the arrangement. bursts. The burst frequency is normally 100
Hz; thus the time from the start of one burst to
the start of the next is one-hundredth of a
second or 10 milliseconds. The duty cycle is
the ratio of 'on' time to total time ('on' plus
'off') for the output. In other words the duty
cycle is the fraction of time for which
ultrasound is being produced. Typical values
of duty cycle for apparatus used in therapy are
in the range 1:2 to 1:10.
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Chapter 10 Therapeutic Ultrasound
The rationale for the use of pulsed ultrasound can calculate the resulting intensity at any
will be discussed in a later section of this particular point. The calculations are made
chapter. complex by the fact that the surface of the
transducer does not remain planar, but flexes
Patte rn of Ultrasound field: and undulates as it oscillates.
The ultrasound generator produces a beam of
ultrasonic waves by vibration of the metal end
plate of the treatment head (the transducer)
shown in figure 10.1. The plate is typically a
few centimeters in diameter - perhaps twenty
or thirty wavelengths.
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Chapter 10 Therapeutic Ultrasound
Figure 10.3 shows the variation in intensity of If the sound-head is moved in a circular path
an ultrasound beam at points along the central so as to produce a treated area of at least twice
axis. In the near field, local 'hot-spots’ or the diameter of the head, hot-spot production
regions of maximum intensity are separated by will be avoided.
'cold-spots' or regions of minimum intensity.
Off-axis, patterns of hot-spots and cold-spots
Beam Non-uniformity Ratio (BNR):
are also observed. The location of their A quantity of interest is the beam non-
maxima and minima are, however, different. uniformity ratio or BNR. This is the ratio of
Averaged across the beam, the intensity is the peak intensity to average intensity of the
relatively constant, only decreasing slowly beam. Because there are always local regions
with distance. So at any particular distance, of high intensity, the BNR is always greater
hot-spots and cold spots are produced in than 1.
different locations across the beam, while the
average energy is constant. In figure 10.4, the intensity pattern is that
which would be produced by a piezo-electric
Figure 10.4 shows another view of the energy crystal which was about the same size as the
distribution in an ultrasound beam. This time a ultrasound treatment head. If the crystal were
two-dimensional view showing the high appreciably smaller than the metal end-plate of
intensity regions off the central axis. The the ultrasound treatment head, the metal end-
shaded areas indicate regions of high local plate would vibrate differently and the pattern
ultrasound intensity. Note that regions of low shown in figure 10.4 would be different. The
intensity on the central axis have, alongside, high-intensity regions would be in different
regions of high intensity and vice-versa. positions and, more importantly, the peaks
Most of the ultrasound energy is confined would be higher. So the BNR would be
within the area defined by the brown lines. higher.
There is a slight convergence of the beam in A low BNR is clearly an advantage but
the near (interference) field and a small movement of the treatment head is of much
divergence in the far field. more crucial importance in clinical practice.
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Table 10.1 (following) lists the acoustic Many different coupling media can be used.
impedances of air, water, steel and body The desirable characteristics of the coupling
tissues. Notice that the impedance of air and medium are:
metal differ significantly from the rest with air
It should be fluid, so as to completely fill
showing by far the largest deviation.
the gap between skin and treatment head
and exclude air bubbles.
It should be viscous so that it stays on the
skin rather than rapidly flowing and
spreading.
It should not inhibit heat loss from the skin
otherwise high temperatures may be
produced in skin and subcutaneous tissue.
It should have an impedance similar to
Table 10.1 Acoustic properties of materials.
that of steel and tissue, so as to minimize
The acoustic impedance of air is only a tiny reflection.
fraction of the impedance of body tissues. For It should absorb a negligible amount of the
this reason the ultrasound transducer must be ultrasound energy: in other words, should
in intimate contact with the skin for have a high penetration depth.
appreciable transfer of energy to the tissues. If
In practice the first two criteria listed above
the transducer is separated from the skin by
are the most important. The principal function
even a tiny air gap most of the ultrasonic
of a coupling medium is to eliminate air gaps
energy will be reflected back into the
and provide contact between treatment head
transducer from the air/tissue boundary. It is a
and tissue. Criterion three is also very
useful exercise to calculate the amount of
important and water or water based gels are
energy transmitted at an air/tissue interface.
best in this regard. Criterion four is important
Using the values in table 10.1 and equation
but most liquids have similar values of
10.2
acoustic impedance.
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Chapter 10 Therapeutic Ultrasound
applied. They are ideally suited to treatment Table 10.1 lists the acoustic properties of air,
of a vertical surface as they will not run down water, various tissues and steel. As noted
the skin. A number of thixotropic couplants previously the acoustic impedance of air
are available. differs considerably from the remaining
materials.
Thermal Effects of Ultrasound:
The table also shows that there is little
In this section we ignore the effects of difference in the acoustic impedance of
different coupling media and focus attention muscle, fatty tissue and water. For this reason
on what happens to the ultrasound energy we expect little reflection at a fat/muscle
which is transmitted into tissue. interface. The reflection coefficient calculated
At the intensity levels used for therapy the using equation 10.2 is 0.10, thus the amount of
major effect of ultrasound waves on tissue is, energy reflected is 0.1 squared or 1%.
as with all diathermic modalities, the The impedance of bone is higher than that of
production of heat. The amount of heat muscle hence we expect significant reflection
generated in a particular tissue depends on two at a muscle/bone interface. The reflection
factors: coefficient is 0.50 so we expect about 25% of
the energy to be reflected.
The rate at which energy is absorbed by
the tissue - which is determined by the Heating Rate of Boneless Tissue:
penetration depth, δ.
The extent to which the waves are Consider first an ultrasound beam travelling
reflected back into the tissue on striking a through fatty tissue and muscle with no bone
tissue interface: determined by the present. Equation 10.2 tells us that reflection
difference in impedance between the two at the fat/muscle interface is negligible and
media. equation 10.6 indicates that refraction is
minimal for incident angles up to about 50°.
The amount of reflection at a tissue interface is Thus we can consider the waves to be
determined by the difference in impedance of travelling in one direction in a straight line
the two materials. The acoustic impedance (Z) through the tissue.
depends on the elasticity and density of a
medium according to equation 10.3:
Combining these two equations we obtain a Where x is the distance in the tissue and δ is
simple expression for the impedance in terms the penetration depth. The rate of heating is
of velocity and density: equal to the rate of decrease of intensity with
distance it depends on two factors, the wave
intensity at a particular point and the rate of
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Chapter 10 Therapeutic Ultrasound
A greater proportion of the total wave production are only 0.75 mm apart. This is too
energy is absorbed in the fat and muscle close to be of practical significance,
tissue. particularly if the treatment head is kept
The reflected and incident waves will moving. We have already seen why the
interfere and produce a standing wave treatment head cannot be kept stationary:
pattern. movement is necessary to smooth out the
effects of variations in ultrasound intensity
with depth shown in figure 10.4. This same
movement will produce variations in tissue
thickness well in excess of 0.75 mm. The net
result will be an averaging of any standing
wave pattern as the treatment head is moved:
so much so that no evidence for standing
waves would be detected. In addition factors
such as the pulsatile nature of blood flow
through tissue and muscle contraction will
result in variations in the thickness of tissue
layers: the standing wave pattern will hence
shift back and forth, further smoothing the
Figure 10.6 Wave intensity and relative rate of pattern of heat production.
heating in fat, muscle and bone with ult rasound of
frequency 1 MHz. The most significant feature of figure 10.6 is
the high rate of heating of the bone surface.
The first of these effects is quite significant. Most of the wave energy transmitted into the
Energy will be absorbed both as the wave bone is absorbed in the first few millimeters.
travels through fat and muscle to the boundary This is predicted from the value of penetration
with bone and as the reflected wave travels depth. The result is substantial heating. As
back through muscle then fatty tissue. Hence can be seen, the heating rate is predicted to be
the total rate of heating of fat and muscle about three times greater at the bone surface
tissue at any depth is greater than without the than anywhere in the muscle tissue. Heat
bone (compare figures 10.6 and 10.5). The development is confined to the first few
effect on fatty tissue is small. As might be millimeters of bone but is quite substantial. In
expected, in muscle the effect is larger because practice, heat production at the bone surface is
the reflected wave, and thus the reflected wave often the factor which limits the intensity
energy, is larger. which can be used in therapeutic application of
The second effect is of less practical 1 MHz ultrasound. Too great an intensity or
importance. Certainly an interference pattern too prolonged a treatment can result in
will be produced but consider the distance periosteal pain and significant tissue damage
between nodes and antinodes. The wavelength (a periosteal burn).
of the standing wave pattern is the same as that The risk of periosteal burns is reduced by
of the incident and reflected waves with nodes movement of the ultrasound transducer
and also antinodes separated by one half of a (treatment head). Movement distributes the
wavelength. For ultrasound of frequency 1 ultrasound energy over a larger area of the
MHz the wavelength is 1.5 mm so the bone surface, thus reducing the average energy
antinodes will be separated by 0.75 mm. The in a specific location.
antinodes represent points of maximum wave
energy and hence maximum heat production. The pattern of heat production shown in
We have, then, that points of maximum heat figures 10.5 and 10.6 indicate the value of 1
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Chapter 10 Therapeutic Ultrasound
MHz ultrasound for heating of deeply located of heat between and within tissues is taken
tissue. Figure 10.6 also highlights the risk into account.
when the soft tissue layers are thin and
underlying bone is exposed to the ultrasound
beam.
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Chapter 10 Therapeutic Ultrasound
high heat capacity will require more heat to expected. At the same time heat transfer
increase the temperature by 1o than a tissue to the adjacent fatty tissue will reduce the
with a low heat capacity. Muscle tissue temperature elevation of muscle near the
(principally because of its high water content) fat/muscle interface.
has a higher heat capacity than fatty tissue or Bone is a relatively good conductor of
bone. Consequently, for the same amount of heat. The heat will be rapidly distributed
heat energy, the temperature increase in in the bone and also transferred to the
muscle will be less than that of fatty tissue or periosteum. The higher thermal
bone. At the commencement of treatment, the conductivity partially compensates for the
relative rate of heating will be more or less as rapid absorption of energy near the bone
indicated in the figures. Graphs of rate of surface and reduces the selective heating.
temperature increase would, however, show an It is still possible, however, to produce a
overall lesser rate of temperature increase in maximum temperature elevation in the
muscle than fat or bone, because of the heat periosteum when the intervening tissue
capacity effect. A second factor affecting the layers are not very thick. This gives rise
rate of temperature increase in tissue is heat to the periosteal pain mentioned
loss to the surrounding tissue and, more previously.
importantly, the blood vessels. Muscle has a
Despite these limitations, some of which also
much higher vascularity and therefore volume
apply to other diathermic modalities,
rate of blood flow, than fatty tissue or bone.
ultrasound is an effective deep-heating
We would thus expect convective cooling of
muscle (i.e. heat carried away by the modality. The principal factor limiting the
temperature elevation which can be produced
bloodstream) to reduce the rate of temperature
at depth is heating of the periosteum.
increase still further. A third factor is that any
temperature increase in muscle would also be Mechanical Effects:
expected to trigger reflex dilation, whereby
arterioles dilate to increase the blood flow in The predominant physiological effects of
response to an increase in temperature. This ultrasound therapy are due to a rise in
would further decrease the rate of temperature temperature of the treated tissues. Certain
increase. effects are, however, produced which are a
direct result of the mechanical vibration of
The main points relating temperature increase tissue. As an ultrasound wave propagates the
to heating rate are as follows: particles in the medium experience rapidly
The low specific heat capacity of fatty alternating compressions and rarefactions. The
tissue and poor thermal conductivity will pressure varies with distance as shown in
result in a greater temperature rise than figure 10.8. Regions of high pressure (dark
indicated by the graphs. In addition the shading) are separated by one wavelength
thermal conductivity of fatty tissue is low about 1.5 mm for 1 MHz ultrasound.
and its vascularity is not as good as
muscle; consequently heat cannot be
removed as rapidly. This adds to the
temperature elevation of fatty tissue as
compared to muscle.
Efficient heat transfer through muscle
tissue and to blood vessels will result in Figure 10.8 Pressure variation in an ultrasound
more uniform heating of muscle and less wave.
temperature rise than might otherwise be
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Chapter 10 Therapeutic Ultrasound
For a wave intensity of 2 to 4 watts per square Experiments have shown that the
centimeter (near the upper limit for therapeutic extensibility of connective tissue can be
application) the pressure amplitude of the increased by exposure to ultrasound.
waves is about 2 to 4 atmospheres (20 to 40 Since connective tissue fibers are key
newtons per square centimeter). This means constituents of tendons, scar tissue, joint
that the pressure extremes a difference of 4 to capsules and muscle the results are of
8 atmospheres are separated in tissue by only major significance for therapy. Part of the
one half of a wavelength (0.75 mm). Any effect is attributed to the increase in
tissue component or substructure with temperature on exposure to ultrasound: the
dimensions of about one wavelength will be separation of fibers and loosening of the
subject to substantial mechanical stresses, structure as a result of the mechanical
alternating at a frequency of 1 MHz. Smaller stresses would also be expected to
structures such as tissue cells will experience contribute.
lesser, though still substantial stresses and will The rate of diffusion of ions across cell
be vibrated back and forth by the pressure membranes is found to increase on
changes. exposure to ultrasound. An effect is
observed over and above that due to
Therapeutic ultrasound produces large stresses
heating alone. A possible explanation is
in biological tissues, acting over distances of a
that a stirring effect is produced which
fraction of a millimeter. The stresses are
increases the concentration gradient of
greatest in the regions shown in figure 10.4.
ions and other materials. In any diffusion
Figures 10.4 and 10.8 are two important views process there will be a narrow region on
of the ultrasound intensity variation in a beam. either side of the membrane where the ion
Figure 10.4 is at a gross, large-scale level and concentrations are not the same as in the
shows the variation in intensity within a beam. bulk of the fluid. Another possible
Regions of high intensity (shown by the contributing factor involves the fluidity of
deepest blue coloration) are separated by the cell membrane. If we picture the cell
distances measured in centimeters and the membrane as a thixotropic barrier we
positions are stationary in the beam. Viewed predict that the fluidity, and hence the
on a smaller scale, figure 10.8 shows a sound permeability, of the cell membrane will
wave within the beam. At any point within the increase in response to the mechanical
beam shown in figure 10.4, the pressure varies agitation of the ultrasound waves.
from maximum to minimum over a distance of Ultrasound is useful in relieving pain and
half of one wavelength and regions of high muscle spasm. While any form of heating
pressure move through the medium (tissue, air is useful in this regard, it appears that
or water) at a high velocity. The sound ultrasound can have an effect other than
velocity, v, is about 1500 m.s-2 in water and via direct heating. The mechanism of this
soft tissue. action has not been conclusively
established but it is interesting to note that
Listed below are some examples of the effects
an optimum effect appears to be produced
of ultrasound where mechanical stresses are
using pulsed ultrasound beams. The pulse
thought to play a significant role. It should be
frequency normally available is 100 Hz
emphasized that in all instances heating
the same frequency used to produce
contributes to the observed results: in most
analgesia by electrical stimulation.
cases it is difficult to ascertain the relative
contribution of thermal and mechanical
effects.
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Chapter 10 Therapeutic Ultrasound
Proponents of the use of pulsed ultrasound To date, insufficient research has been done to
argue that heat production is rarely the sole quantitatively determine the relative
objective of therapy and that in some contributions of heating and mechanical
applications it may even be undesirable. By effects in different therapeutic applications of
use of pulsed ultrasound, at low to moderate ultrasound. When such information is
intensities, mechanical effects are produced available the therapist will be in a better
while heat production is kept to a minimum. position to select between pulsed and
Of course the same (low) rate of heat continuous mode and, when pulsed mode is
production could be achieved using the indicated, to choose the appropriate duty
continuous mode at one fifth of the peak cycle.
intensity. We would, however, expect some At this stage it is possible, at least, to say that
differences in the mechanical effects if ultrasound is chosen (rather than another
produced: continuous mild mechanical
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Chapter 10 Therapeutic Ultrasound
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Chapter 11 Electromagnetic Waves
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Chapter 11 Electromagnetic Waves
distances so that when they collide, the energy frequencies characteristic of the parent atom.
release is larger and, as a result of the higher The range of frequencies put out by the lamp
energies, UV rather than visible light is is modified by the pressure within the lamp
produced. The arrangement used with a and further modified in passing through the
mercury vapor lamp is shown in figure 11.1. glass envelope which contains the vapor.
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Chapter 11 Electromagnetic Waves
High pressure mercury vapor lamps, C radiation is emitted from any of these
known as hot quartz lamps when the light sources.
envelope material is quartz, put out a
In the past carbon arcs were used extensively
proportion of their ultraviolet energy at a
for the production of ultraviolet radiation. Two
wavelength of 366.0 nm (in the UV-A
carbon rods are brought into contact with each
region). There is also significant output at
other and a current is passed through them.
specific wavelengths in the UV-B and
With a small point of contact the high current
UV-C regions. The amount of energy in
density heats and vaporizes the carbon. The
each region depends on the construction of
rods are then separated and the presence of
the lamp. The normal operating
carbon vapor enables a current to flow in the
temperature of these lamps is several
form of an arc discharge between the ends of
hundred degrees Celsius: if they are to be
the rod. The spectrum produced by carbon arcs
used close to, or in contact with the patient
has a range close to that of sunlight (figure
they must be cooled by a water jacket
11.2): the proportions of ultraviolet, visible
(Kromayer lamps) or an air blower.
and infrared radiation are also similar. Carbon
Fluorescent ultraviolet tubes are usually
arcs are rarely used today in physiotherapy
low pressure mercury lamps in the form of
departments: they have been largely
a long tube. The tube is coated on the
superseded by mercury vapor lamps which are
inside with fluorescent substances
cleaner and easier to operate.
(phosphors). The purpose of the phosphor
Is to absorb the original ultraviolet Production of Infrare d Radiation:
radiation and re-emit it at longer
wavelengths. Different phosphors have Infrared radiation - sometimes referred to as
different wavelengths for re-emission of radiant heat - is produced (and absorbed) by
radiation. The commonly used ultraviolet all materials at temperatures above absolute
tubes put out most of their energy in the zero.
UV-A region. Special tubes are available
Absorption of infrared radiation results in
which produce a maximum output in the
changes in molecular and atomic motion of a
UV-B region. A negligible amount of UV-
material; the continuous agitation and changes
in the motion of molecules, and within
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Chapter 11 Electromagnetic Waves
molecules also results in the emission of and the ceramic will emit radiation. The
infrared radiation. For example, chemical ceramic, being at a lower temperature will
bonds in molecules can absorb energy and produce more far infrared radiation. The
'stretch', changing the bond length and thus the common household electric heater is usually
energy of the bonding electrons. When the of this kind. A way of producing most
bond reverts to its original size, infrared radiation in the far infrared region of the
radiation is produced at a frequency spectrum is to encase the heating element
characteristic of the bond. inside a ceramic rod or mount it behind a plate
so that the major source of radiation is the rod
[Any object will be emitting and absorbing or plate. If a reflector is used, the reflector will
infrared radiation on an ongoing basis. absorb some radiation and re-emit it at higher
Whether emission outweighs absorption wavelengths thus adding to the far infrared
depends on the temperature of the object component. These devices are often used for
relative to its surroundings.] therapy. Use is also made of incandescent
infrared lamps which produce a significantly
Any molecule may, as a result of absorption of greater proportion of near infrared radiation.
radiation or collision, change its state of
rotation or vibration, or both simultaneously. Incandescent infrared lamps (similar to
On changing to a rotation or vibration state of household lamps - consisting of a tungsten
lower energy, infrared radiation is produced. A filament mounted in a glass envelope) have
particular kind of molecule has very many maximum emission at a wavelength around
possible states of rotation and vibration and 1000 nm: some visible and ultraviolet light is
therefore many options for going from one produced but the ultraviolet is absorbed by the
state to some other. glass envelope and not transmitted. Use may
be made of specially shaped lamps with
At a given temperature a body will emit a internal reflectors. The reflectors may be
continuous spectrum of radiation – the shaped to give a floodlight beam - suitable for
maximum intensity occurring at a particular treating large areas - or a spotlight beam for
frequency but with significant intensities treatment of localized areas. Some lamps have
extending over a wide range of frequencies. a clear glass lens while others have a red lens:
The frequency of maximum production of there is little difference in the therapeutic
radiation is directly proportional to the effects of each.
absolute temperature of the source. Since
wavelength and frequency are inversely [For an ordinary household light bulb the
related (by equation 9.1, v = f.λ), it follows tungsten filament is at about 3000 K and the
that the wavelength of maximum production wavelength of maximum emission is about 960
of radiation is inversely proportional to the nm - that is, in the near infrared. For skin at
absolute temperature of the source. (This is about 300 K it would be 9600 nm, in the far
called Wien's Law). infrared.]
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Chapter 11 Electromagnetic Waves
From a penetration depth of a few millimeters (e.g. shortwave diathermy) only in the location
at 1200 nm there is a decrease to about 0.1 mm of heat production.]
at 3000 nm. Wavelengths above 3000 nm are
absorbed by moisture on the surface of the From the foregoing discussion it is clear that
skin. The trend does not continue indefinitely the major effect of infrared radiation is
and we find that in the far infrared region from thermal: to increase the temperature of
10000 to 40000 nm, the penetration depth cutaneous tissue. The penetration depth is very
increases to several centimeters. In effect, the small but some heat will be transferred to the
tissues become much more transparent. subcutaneous tissues via the capillaries.
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Chapter 11 Electromagnetic Waves
150
Chapter 11 Electromagnetic Waves
cannot be assessed in this way as erythema are at the limit of those which can be produced
production is minimal except at extremely by transistors.
high dose levels. In practice this is not a
problem as the principal use of UV-A is in Although vacuum tubes (valves) are an older
conjunction with a photosensitizing drug, 8- design and are generally more inefficient than
methoxy-psoralen, for the treatment of transistors, two vacuum tube devices which
psoriasis. For psoralen - UV-A, therapy a can operate at microwave frequencies were
special procedure is used for dose developed many years ago: these are the
characterization. magnetron and the klystron. The magnetron
valve, first described by Hull in 1921, was
[Electromagnetic waves travel more slowly in developed for radar use during the Second
biological tissues than air. The higher the World War. It is more useful for high power
dielectric constant and conductivity, the lower applications than the klystron. After the war,
the wave velocity. As we will see, a frequency apparatus operating at a frequency of 2450
of 2450 MHz is not the best choice for MHz (the standard radar frequency) was made
therapeutic applications and for some years available to physiotherapists.
the use of lower frequencies has been
advocated.] Microwave apparatus (figure 11.4) consists of
a device (a magnetron or klystron), powered
PRODUCTION OF MICROWAVES: by an electronic circuit. The high frequency
alternating current which is produced is fed to
Having considered the low penetration
an antenna. The current flowing in the antenna
electromagnetic waves - infrared, visible and
results in the production of electromagnetic
ultraviolet - we now turn to lower frequency
waves which are beamed by the reflector.
waves used in therapy; microwaves.
Microwaves occupy the region of the
electromagnetic spectrum between radio
waves and infrared radiation: their
wavelengths are in the range from about a
centimeter to a meter - corresponding to
frequencies in the range 300 MHz to 30000
MHz. Three main frequencies are used for
physiotherapy, 2450 MHz (wavelength 12
cm), 915 MHz (wavelength 33 cm) and 433.9
MHz (wavelength 69 cm). Note that the
wavelengths quoted are in air. In biological Figure 11.4: Schematic diagram: microwave apparatus
tissues the wavelength is significantly lower
because the wave velocity is lower. The frequency of the microwaves is equal to
the frequency of the AC produced by the
Radio waves can be produced by first magnetron. This is determined by the physical
generating a very high frequency AC signal in construction of the magnetron and is fixed
an ordinary electronic circuit and then during manufacture.
applying this signal to a suitable antenna. The
high frequency alternating current in the A number of differently shaped antennas and
antenna results in radio frequency waves being reflectors may be used for directing the beam.
produced and radiated. The limit to the Each gives a different beam shape though
frequencies that can be produced by standard none gives a perfectly uniform beam. To
electronic circuits is determined by the time it obtain a collimated uniform beam (like a
takes for an electron to travel through a searchlight) would require a parabolic reflector
transistor. If the transit-time, the time taken, with a point source of radiation as shown in
becomes comparable to the time of oscillation figure 11.5(a). If a point source of radiation is
or period of the wave we wish to produce, then placed at the focus of the parabola the beam
the transistor can no longer function at this emerges with a uniform cylindrical shape as
frequency. Microwave frequencies are shown.
extremely high, by electronic standards, and
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Chapter 11 Electromagnetic Waves
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Chapter 11 Electromagnetic Waves
determined by the dielectric constant and on tissue thickness. Between 0 and 80% of
conductivity of the tissue. the energy is reflected.
Above 3000 MHz around 60% of the
Because of the large difference in the electrical energy is reflected - again almost
properties (ε and σ) of air, fatty tissue, muscle independently of tissue thickness.
and bone, refraction effects will be significant [Another practical implication of the large amount of
reflection is the need to avoid unintentional exposure of
unless the microwave beam strikes each body parts (including those of the therapist).
boundary at a right angle (zero angle of
incidence). One major implication of the above results is
that at a frequency of 2450 MHz the effective
dosage is virtually impossible to determine in
a clinical situation, due to the practical
difficulty in establishing skin and fat thickness
which may vary considerably in the treated
area. Clearly a frequency above or below the
range 1000 to 3000 MHz is to be preferred on
these grounds. As we will see in what follows,
Table 11.1: Dielectric constant and conductivity of tissue a lower frequency is preferable.
at microwave frequencies.
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Chapter 11 Electromagnetic Waves
Figure 11.6: Heating pattern predicted for microwaves of Figure 11.7: Heating pattern predicted for microwaves of
frequency 8500 MHz in a specimen of 2 cm fatty tissue frequency 2450 MHz in a specimen of 2 cm fatty tissue
over muscle. over muscle.
[When unequal size waves interfere, the Again a standing wave pattern is found in the
standing-wave effect produces peaks and fatty tissue where most heat is produced. At
troughs in the heating-rate pattern, but there this lower frequency, the wavelength is greater
are no true nodes (points where the intensity is so only a single peak is seen in the heating
zero).] pattern in fatty tissue. Heat production in the
muscle tissue is improved over the 8500 MHz
The standing-wave pattern in the fatty tissue is results but is still limited to the first centimeter
not ideal since reflection is not 100% and the or so.
wave is progressively absorbed in its travel.
The actual pattern is a combination of an Evidently the lower frequency is preferable
exponential decrease (determined by the from a 'deep heating' point of view - but we
penetration depth, δ) and interference of saw earlier that frequencies in the range 1000-
unequal size waves. 3000 MHz result in uncertain dosage.
At this frequency, most heat is produced in the What of frequencies below 2450 MHz? Figure
fatty tissue close to the skin and in the 11.8 shows the relative rate of heating
superficial region of the muscle. A reasonable predicted for a microwave frequency of 915
heating rate is obtained at the muscle surface MHz in a tissue specimen w ith the same
but the effect extends to only a fraction of a dimensions as used previously.
centimeter into the muscle tissue.
[The wavelength in fatty tissue at 915 Mhz is
The total amount of heat produced in each about 18 cm so a peak and a trough would be
tissue is indicated by the area under the curves separated by 4.5 cm (one quarter of a
in figure 11.6. It is evident that there is greater wavelength).]
overall heat production in the fatty tissue. This
problem is typical of higher microwave [A standing wave pattern is still produced in
frequencies. the fatty tissue but the wavelength is so large
that no peaks are evident. Figure 11.9 shows
The peaks in the heating pattern in the fatty the relative rate of heating predicted for a
tissue are separated by one half of a microwave frequency of 434 MHz in the same
wavelength so the wavelength of the tissue specimen.]
microwaves in fatty tissue is about 2 cm.
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Chapter 11 Electromagnetic Waves
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Chapter 11 Electromagnetic Waves
properties assumed. The general implications tissue surfaces the beam intensity does not
of the figures are, however, clear: frequencies diminish as rapidly as would occur with plane
below 1000 MHz are needed if tissues located surface. Consequently the depth efficiency for
beneath a few centimeters of fat are to be heat production is greater.
effectively heated. For treating structures
located closer to the skin surface - for example
a knee or elbow joint which is not covered by
a thick layer of fat - a frequency of 2450 MHz
is adequate, though the dose will be somewhat
unpredictable. More deeply located structures
- for example, the hip joint - are not heated
appreciably at this frequency.
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Chapter 11 Electromagnetic Waves
increase depends on such factors as the means 'one color'. In most contexts this means
specific heat capacity of the tissue and heat that each wave has the same frequency.]
transfer within and between tissues and to the
bloodstream. The light emitted by burning salts is also
incoherent, meaning that electrons drop back
into their ground-state orbitals randomly so
LASERS:
there is no synchronization of the radiated
The acronym 'laser' stands for 'light electromagnetic waves. By contrast, lasers are
amplification by stimulated emission of devices which force electrons to drop back
radiation'. Lasers are electromagnetic wave into one particular orbital in an avalanche
amplifiers which can produce beams of effect, i.e. almost simultaneously. The result is
electromagnetic waves with two special that the emitted waves are all synchronized
properties: (coherent) and have the same frequency.
The beam has very little divergence. It has
a pencil-like shape. The avalanche effect and resulting coherence
The beam is coherent. That is, all the of a laser beam is achieved by bouncing waves
waves in the beam are of exactly the same back and forth between two reflectors. For
frequency and wavelength and are example, a helium-neon laser consists of a
synchronized with each other. cylindrical tube containing helium and neon
gas. Each end of the tube has a reflector, one is
[The divergence of a laser beam is so small fully reflecting and the other is partially
that a beam pointed at the moon could reflecting so as to allow some light (the laser
illuminate a target less than a meter across.] beam) to escape. The back-and-forth reflection
triggers a resonance effect where electrons to
The pencil-like beam of the laser means that drop back into a specific ground-state orbital
the wave energy is always concentrated on the synchronously and a coherent, monochromatic
same area: the intensity (which is the energy beam of waves is produced. Each wave having
per unit area) does not decreased appreciably the same frequency. To keep the laser
with distance due to beam-spreading. operating it is necessary to bump electrons out
of their ground-state orbitals and into a higher-
Production of a laser beam: energy orbital, ready to drop. For this reason a
power supply (a source of energy) is required.
Visible light can be produced by excitation of Sometimes the energy is provided by an
atoms. For example if crystals of a copper salt, electric current, sometimes by a by a burst of
such as copper sulphate, are heated in a flame, light energy. In the case of a helium neon
the flame turns blue. laser, a power supply is used to energies a
When strontium salts are heated, the flame flashlight (rather like a camera flash) which
turns violet. Sodium salts produce a yellow provides rapid-fire bursts of light energy to
coloration. This is because electrons in the push electrons into an excited state. In the case
copper, strontium or sodium atoms are kicked of diode lasers, current flow through the diode
from their 'ground state' orbitals by the heat provides the necessary energy.
energy of the flame and when they fall back
into their original orbitals, the energy released We can summarize the differences between
is radiated as light of a particular frequency. laser light and light from a common,
Because electrons may be kicked out of, and incandescent light bulb as follows. Light from
fall back to, different orbitals, the light emitted a normal incandescent source has a spectrum
is a mixture of several specific frequencies. By of frequencies and the waves are incoherent.
contrast, laser radiation has but a single Lasers are beams of coherent waves of
frequency. identical frequency. There is some clinical
evidence that laser beams can be
[The light emitted by a burning salt is usually therapeutically beneficial. What has not been
at a mixture of waves of different frequency. established is whether laser beams have any
The different frequencies correspond to advantage over simpler (and cheaper) torch
electrons returning to different 'ground state' beams. No comparisons have yet been
orbitals. The term 'monochromatic' literally reported.
157
Chapter 11 Electromagnetic Waves
158
Chapter 11 Electromagnetic Waves
Penetration Depth:
The penetration depth of laser radiation is the
same as ordinary electromagnetic radiation of
the same frequency. The wave coherence and
the monochromatic nature of the laser beam
make no difference. Thus the penetration
depth of visible light from a helium-neon laser
is a mm or so and most of the wave energy is
absorbed in the epidermis (figure 11.3). The
infrared radiation produced by commercial
GaAlAs diodes has greater penetration depth
but most of the wave energy is absorbed in the
epidermis and dermis.
159
Chapter 12 Short Wave Diathermy
160
Chapter 12 Short Wave Diathermy
advantage of automatic tuning is that if the patient's tissue. We now consider what effect
patient should move during treatment the this has on the tissue. Since an alternating
machine will adjust to keep the patient circuit magnetic field gives rise to an induced
in resonance. With manual tuning machines, alternating electrical field we first examine the
movement of the patient or electrodes can effects of an alternating electric field on the
result in de-tuning and a drop in output of the different molecules found in human tissue.
machine.
Charged Molecules:
The output of the apparatus is coupled to the
patient via electrodes (in the capacitor field The conductivity of tissue is determined by the
technique represented in figure 12.1) or via an number of free ions in the tissue fluid. In the
induction coil. The coil or electrodes are presence of an electric field these ions will
connected directly to the output of the machine migrate along field lines and so constitute an
and the part of the patient to be treated is electric current. The process is not unlike
positioned in the electric or magnetic field. In electrical conduction in metals. Metallic
figure 12.1, the area highlighted in yellow is conduction results from the movement of free
circuitry inside the machine. electrons. In electrolytes the charge carriers
are not electrons but ions; these are tens of
[When an induction coil is used, the presence thousands of times more massive than
of biological tissue in the field is irrelevant but electrons.
the tissue volume to be treated will influence
the number of turns of the coil and their Under the influence of the electric field ions
radius.] will be accelerated along field lines - but they
will not travel far before colliding with other
The part of the patient to be treated would be molecules and losing their acquired kinetic
positioned between the external capacitor energy. The repeated sequence of
plates shown in figure 12.1. The plates are accelerations and collisions is the way in
normally in the form of two metal disks, each which electrical energy is converted to heat
inside a clear plastic container or envelope. energy, which is the random-motion energy of
The electrical characteristics of the patient's the molecules. At the frequencies associated
tissue affects the capacitance of the patient with shortwave diathermy the field
circuit, as does the electrode size and spacing. alternations are so rapid that the ions oscillate
For this reason it is necessary that the about a mean position rather than undergoing
apparatus be tuned (by adjusting C in figure any large scale movement, but the alternations
12.1) with the patient positioned in the field. are not so rapid that movement is prevented
Similarly, if an induction coil is used rather and heat generation is not impaired.
than capacitor plates, tuning will be necessary.
This is because when the coil is wrapped
around the part of the patient to be treated, the
inductance of the coil will depend on the
number of turns of the coil and their radius.
161
Chapter 12 Short Wave Diathermy
162
Chapter 12 Short Wave Diathermy
Figure 7.4 Electric field lines in a model for an arm or leg (a) longitudinal cross section (b) 163
transverse cross section.
Chapter 12 Short Wave Diathermy
displacement current in a particular tissue is You should also bear in mind that even a
not difficult. Measured values of dielectric single tissue layer may be inhomogeneous at
constant and conductivity are all that are both the microscopic and macroscopic level.
needed. Calculation of the field pattern is An example of the complications introduced
much more difficult and has only been done by tissue inhomogeneity is seen with fatty
using simplified models: even simpler than the tissue in the shortwave field.
somewhat idealized geometries shown in
figure 7.4.
Fatty Tissue:
Useful qualitative pictures are nonetheless A practical limitation on the amount of heat
obtained by combining diagrams such as those which can be produced in deeply located tissue
shown in figure 7.4, with calculated values of is the heat production in fatty tissue. When
real and displacement current in each tissue using capacitor plates the rate of heating of
layer. fatty tissue is always greater than that of the
underlying muscle tissue . Part of the reason is
At a frequency of 27.12 MHz the current flow that fatty tissue is inhomogeneous. The tissue
in fatty tissue and bone is approximately 50% is not a uniform distribution of cells but a
displacement. In muscle and tissues of high complex structure incorporating regions of
water content the proportions are high conductivity and dielectric constant: the
approximately 80% real current to 20% lymphatic and blood vessels.
displacement current.
The high conductivity and dielectric constant
Figure 7.5 shows a revised view of figure of the vessels will result in field lines being
7.4(a) which takes into account the two kinds focused or channeled into them with a
of current flow which occur. In the air spaces resulting high local field intensity and
the current flow is entirely displacement corresponding high rate of heating in and near
current. In fatty tissue and bone the current is the vessels. The phenomenon is illustrated in
assumed to be one half real current and one figure 7.6.
half displacement current. For simplicity,
muscle is shown as having entirely real The localized high heat production will result
current. in greater temperature elevation of the vessels
than the fatty tissue as a whole and a greater
sensation of heat than would be expected if the
tissue layer was homogenous.
164
Chapter 12 Short Wave Diathermy
165
Chapter 12 Short Wave Diathermy
The cable supplied with the shortwave cable wound as a coil the capacitance is very
machine can, of course, also be wound into a small, the effect is quite significant at MHz
spiral and positioned to produce a similar frequencies. The inductive coil behaves as an
distribution of induced current. inductor in parallel with a capacitor.
The spiral coil placed parallel to the skin At the high frequencies used for shortwave
produces more superficial heating than the diathermy the inductance of the coil results in
solenoid coil (figure 7.7). This is because the a high impedance to current flow in the cable.
magnetic field intensity decreases rapidly with The capacitance associated with the coil
distance from the coil, as the field lines presents a lower impedance pathway for
diverge, spreading apart and looping round to current to take. In consequence the induced
the opposite side of the coil. The field current patterns are not as simple as those
spreading is similar to that which occurs at the shown in figure 7.7(b). The electric field
ends of the coils in figures 7.7. Magnetic field between adjacent turns (Figure 7.9(a)) results
lines become more separated, indicating a in current flow along the field lines shown in
weaker magnetic field further from the coil blue. Because the electric field is stronger
and consequently less induced EMF and less closer to the coils, greater current flows and
induced current. Hence although the current this adds to the current induced by the
induced in muscle is mostly real current, the magnetic field. The consequence is greater
amount of current at depth is much less than current flow in, and greater heating of,
with a solenoid. (Figure 7.7). superficial tissue (figure 7.9(b)).
166
Chapter 12 Short Wave Diathermy
167
Chapter 12 Short Wave Diathermy
The use of small electrodes results in an Figure 7.11 illustrates the effect of electrode
undesirably high field intensity in the spacing. In 7.11(a) the electrode to surface
superficial tissues. distance varies considerably resulting in a
local high field intensity in the limb. In 7.11(b)
Unequal size electrodes (can be used to
the electrode to surface distance does not vary
selectively heat tissue located closer to one
greatly and the field within the limb is more
surface of a limb. Large differences in
uniform. Clearly, if a relatively uniform field
electrode size, however, can sometimes lead to
pattern is required the arrangement shown in
difficulty in tuning or instability in machine
7.11(b) is to be preferred. The arrangements
operation.
shown in 7.11(c) and 7.12(c) are both suitable
if we wish to selectively heat one surface of a
limb. They would also be suitable for heating a
structure which is located close to one surface
of a limb or trunk - for example, the hip joint.
Electrode Spacing:
Figure 7.11 Effect of electrode spacing: (a) narrow
The electrode spacing should normally be as spacing, (b) wide spacing and (c) unequal spacing.
wide as possible. In this way the problems
associated with a non-uniform field pattern are
Electrode Orientation:
minimized. The machine itself, however, sets In the examples considered previously the
the limit on the maximum spacing which can electrodes were placed parallel to each other in
be used. As the electrodes are moved further order to obtain a relatively uniform heating
apart the capacitance of the two plates pattern. However if one part of the surface of a
decreases. In addition the field intensity (and structure is closer to an electrode, the field
consequently the rate of heating) will decrease. lines will be concentrated in that region.
A point will be reached where the machine can
no longer be tuned or insufficient power is
available for adequate heating: this sets the
limit on the separation of the electrodes.
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Chapter 12 Short Wave Diathermy
Figure 7.12 shows electrodes applied to the This effect can be minimized by using the
shoulder. Electrodes which are parallel to each cross-fire technique of treatment shown in
other as in figure 7.12(a) do not give a uniform figure 7.14.
field because the air spacing varies
Half of the treatment is given with electrodes
considerably. The dielectric constant and
in one position (figure 7.14(a)). The electrodes
conductivity of each field-line pathway varies
are then moved so that the new electric field is
considerably, resulting in variation in the field
at right angles to the old one (figure 7.14(b))
intensity. In figure 7.12(b) the distance
and the treatment is continued. In this way
between the plates varies but the electrical
deeply located tissue receives treatment for
characteristics of each pathway are similar:
twice as long as the skin. The cross-fire
thus the field is relatively uniform. Clearly the
treatment may be used, for example, on the
arrangement shown in figure 7.12(b) is
knee joint or pelvic organs. It is also
preferred when uniform heating is the
particularly useful for treating the walls of
objective.
cavities within a structure, for example the
sinuses. Figure 7.15 shows the field pattern
obtained with an object of high dielectric
constant which has an air-filled hollow at its
center.
169
Figure 7.16 Electrode/tissue configurations and their electrical equivalent circu its. (a) Coplanar
arrangement, (b) contra-planar arrangement.
Chapter 12 Short Wave Diathermy
frequency alternating electric field. We now the real current density. We begin by
consider heat production and temperature rise considering fields and currents produced using
and take a larger scale view of matter: a view capacitor field treatment.
at the level of tissue rather than molecules.
Capacitor Field Treatment:
The power dissipated by a resistor, the rate at
which electrical energy is converted to heat Whether electrodes are positioned in a
energy, is given by equation 12.1: coplanar arrangement (figure 7.13) or in a
contra-planar arrangement (figures 7.10 to
7.12) the current flow in muscle will be
determined by the total impedance of the
This expression relates the current, I, flowing
tissue combination plus the air space between
through a resistor to the total power, P,
the tissue and capacitor plates.
dissipated in the resistor. For resistors the
current, I, is entirely real current and thus Figure 7.16 shows electrical equivalent
produces heat. When we consider biological circuits for the two electrode/tissue
tissues we must distinguish between real arrangements. The quantities Za , Z f, and Z m
current and displacement current since only refer to the electrical impedances of air, fat
the real current results in heat production. In and muscle respectively.
additional, we are usually more interested in
the rate of heating at a particular point in the In figure 7.16(a) we ignore (displacement)
current flow through the air directly between
tissue rather than in the tissue as a whole. In
this case a more useful expression of equation the electrodes. We also ignore current flowing
12.1 is equation 12.2. directly through the fatty tissue and bypassing
the muscle. If the electrode spacing is at least
twice the electrode to tissue spacing this will
be a reasonable approximation. The
Here Pv is the power dissipated per unit
impedance presented by each alternate
volume of tissue at a particular point. The
pathway will be sufficiently high to make
units of P v are thus watts per cubic meter. E is
these currents negligible.
the field strength (in volts per meter) and ir is
the real component of current density (in amps In figure 7.16(b) we ignore current flow
per square meter) at that point. through the bone, directly around the fatty
tissue or through the air around the tissue.
The power dissipated, P v is equal to the rate of
Again this is because these pathways have
heat production. Hence, in order to determine
very high impedance compared to the ones
the rate of heating at a particular point in tissue shown.
we need to know the electric field strength and
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Chapter 12 Short Wave Diathermy
The rate of heating of each tissue is given by The real component of the current density, the
equation 12.2: current density which determines heat
production, is given by equation 12.3, which
can be written:
The real current density in muscle is as we
have seen, about one and a half times greater
than in fatty tissue, however the field intensity Substituting this formula into equation 12.2 we
in fatty tissue is approximately ten times obtain an alternate expression for the power
higher. Hence the rate of heating of fatty tissue dissipated per unit volume:
171
Chapter 12 Short Wave Diathermy
For the same strength of alternating magnetic In considering the therapeutic effects of
field then, both fatty tissue and muscle will diathermy it is not the heat produced, as such,
have the same strength of induced electric which determines the physiological response
field. Thus the rate of heating of muscle in but the resulting temperature rise. Temperature
this situation will be about sixteen times is a key factor in determining the rates of
greater than that of fatty tissue. chemical reactions and hence physiological
processes.
In practice such a degree of selective heating
is difficult to achieve. This is for two reasons: The SI unit of temperature is the kelvin
(symbol K). It is related to the perhaps more
Muscle is located beneath fatty tissue and
familiar degree Celsius (°C) by the expression
so is further from the induction coil. Thus
the magnetic field is weaker in muscle and
the strength of the induced electric field is
correspondingly smaller. [To convert from degrees Celsius to Kelvin's,
Fatty tissue, being closer to the induction simply add 273.15 to the Celsius temperature.]
coil may also experience an appreciable Notice that from this definition the size of the
electric field due to the capacitance degree Celsius is the same as the kelvin. In
between adjacent turns of the coil. This other words a change in temperature of five
effect was described earlier (see figure degrees Celsius is precisely the same as a
7.8). change of five Kelvin's. When we are talking
These two factors combine to increase the about increases in temperature brought about
heating of fatty tissue relative to muscle so by diathermy treatment the terms kelvin and
that a sixteen to one advantage is rarely degrees Celsius can be used interchangeably to
obtained. Nonetheless efficient selective describe the increase.
heating is achieved with close spacing of the When a fixed amount of heat is supplied to
turns of the coil and a sufficiently large coil to different substances the increase in
patient distance. One would also expect good temperature of each will, in general, be quite
172
Chapter 12 Short Wave Diathermy
173
Chapter 12 Short Wave Diathermy
174
Chapter 12 Short Wave Diathermy
175
Chapter 13 Nerve and Muscle Stimulation
176
Chapter 13 Nerve and Muscle Stimulation
Accommodation:
Three characteristics of an electrical impulse
influence its ability to stimulate nerve fibers:
177
Chapter 13 Nerve and Muscle Stimulation
178
Chapter 13 Nerve and Muscle Stimulation
179
Chapter 13 Nerve and Muscle Stimulation
stimulation of sensory fibers, where the aim is [The term 'tetanus' refers to a tetanic muscle
sensory input to the central nervous system, a contraction. It is also used to describe a
cathode proximal arrangement would be pathological condition produced by the toxin
appropriate. of a bacillus which causes tetanic muscle
contraction.]
[Two-way action potential propagation does
not happen physiologically as action Figure 13.5 illustrates the effect of a
potentials are always initiated either at a progressive increase in stimulus frequency on
synapse or a nerve ending.] the evoked muscle response. In this diagram,
the frequency has been ramped from 2 Hz to
Recruitment and Summation: 50 Hz. Note that at about 20 Hz, the response
When muscle fibers are stimulated indirectly, is almost tetanic. Above this frequency
via their nerve supply, the muscle fibers are complete tetany occurs. Note also that the
activated synchronously because their Motor tetanic force is about four times greater than
neurons are activated simultaneously. Each the isolated twitch force.
stimulus pulse activates a proportion of the
fibers in the nerve trunk and the activated
fibers evoke a twitch response in the muscle
fibers which they innervate.
Whatever the intensity, the muscle response to In the example considered, the fusion
transcutaneous electrical nerve stimulation is frequency is about 30 Hz. The fusion
critically dependent on the stimulus frequency. frequency varies between muscles and
At low frequencies (a few Hz or less), isolated depends on the muscle fiber types present. In
twitches are produced in response to each terms of twitch times, two groups of fibers are
stimulus pulse. There is time for the muscle to distinguished: fast- and slow-twitch. The
relax before the next contraction. If the contraction time, defined as the time from the
frequency is more than a few Hz, the muscle start of the contraction to peak force, is about
fibers ` do not have time to completely relax 40 ms for human fast- twitch muscle fibers
between pulses. Each successive contraction and about 120 ms for slow-twitch fibers.
occurs on the tail of the previous one and the Muscles such as soleus contain mostly (80%)
peak force is greater. With a further increase slow twitch fibers. The twitch contraction time
in the frequency it becomes more difficult to is long and consequently the fusion frequency
distinguish the effects of individual stimuli. is low. At the opposite extreme, orbicularis
The twitch responses fuse and the contraction oculi, an eye movement muscle, contains
becomes stronger still. With most human mostly (85%) fast-twitch fibers and the fusion
muscles, at a stimulus frequency of about 20 frequency is high. Fusion frequencies can thus
Hz, only small ripples are seen in the force vary from less than 20 Hz to close to 80 Hz.
record. This is described as partial tetany. Many human skeletal muscles have roughly
Between 20 Hz and 50 Hz, the ripples equal proportions of slow and fast-twitch
disappear, the contractile force reaches a fibers. For example, biceps and triceps brachii
plateau and the contraction is described as are comprised of about 60% fast-twitch fibers,
tetanic. while the figure for quadriceps is close to
50%.
180
Chapter 13 Nerve and Muscle Stimulation
181
Chapter 13 Nerve and Muscle Stimulation
Figure 13.7: (a) a strength-duration curve for Figure 13.7: (b) a strength-duration curve for
normally innervated muscle. normally innervated muscle. (Rheobase and
chronaxie shown)
Chronaxie and Rheobase:
Effect of Pulse Frequency:
Two important quantities are obtained from
the strength-duration curve, the chronaxie and We have already described the response of
the rheobase: typical skeletal muscles to nerve impulses of
different frequencies. Single muscle twitches
The rheobase is the minimum voltage (or are produced with low frequency stimuli (less
current) which will produce a response if than about 5 per second) and as the frequency
the stimulus is of infinite duration. In approaches 20 Hz, the twitches summate to
practice a pulse width of 100 ms duration produce partial tetany (see figure 13.5). At
is used, quite satisfactorily, to assess this. some frequency above 20 Hz, a tetanic
The chronaxie is the minimum duration of contraction results. Once a fused, tetanic
impulse which will produce a response contraction is induced, any further increase in
with a voltage (or current) of double the stimulus frequency does not induce any
rheobase. increase in muscle force. For typical human
muscles (which have mixed fiber types in
In figure 13.7(b) the rheobase is 25 volts so roughly equal proportions) the fusion
the chronaxie is the minimum duration frequency is around 40 Hz. For muscles with a
required with a 50 volt stimulus. In this case high proportion of fast twitch fires, the fusion
the chronaxie is 0.03 ms (see alongside). frequency is higher. For muscles with a high
Strength-duration curves and their chronaxie proportion of slow twitch fibers, the fusion
and rheobase values can be used clinically to frequency is lower.
assess and monitor muscle which may have What of stimulation at frequencies above the
suffered damage to its nerve supply. Strength- fusion frequency? At frequencies which are
duration graphs for denervated muscle are high enough that successive stimuli arrive
quite different to those of normally innervated within the refractory period, the nerve fiber
muscle, as are the chronaxie and rheobase response depends on the intensity of the
values - but more of this later. stimulus. Just at threshold, one stimulus pulse
will produce an action potential, the next will
not, as the nerve fiber will be refractory. Well
above threshold, when fibers are stimulated at
multiples of their threshold intens ities, firing
will occur within the refractory period and the
firing rate will equal the stimulus frequency. It
has been demonstrated experimentally that
nerve fiber firing rates up to the limit
182
Chapter 13 Nerve and Muscle Stimulation
determined by the absolute refractory period motor units may be active. In a stronger
can be produced by stimulus intensities of only contraction, more motor units are recruited.
a few times threshold. Thus if the absolute The gradation in force which all skeletal
refractory period is 1 ms, the maximum firing muscles exhibit is achieved by a combination
rate would be every millisecond so the of increase in firing rate and increase in
frequency would be 1 kHz. The number of motor units recruited. Different
experimentally determined maximum firing skeletal muscles rely to different extents on
rate of α- Motor neurons is 800 Hz, a value in these two strategies.
close agreement with measured absolute
refractory periods. With rapid, forceful contractions, initial nerve
fiber firing rates can be as high as 100 Hz or
Nerve fiber firing rates with electrical so, but this is never sustained. Such rates are
stimulation can thus be much higher than those only observed at the start of a contraction and
produced physiologically. drop too much lower 'steady' values within a
few seconds. With prolonged effort and
In a sustained, weak voluntary contraction, fatigue, the maximum steady firing rate might
firing rates of 8 - 12 Hz are typical. Lower
typically drop from 30 Hz to about half this
firing rates are found with repetitive weak
figure. It is interesting to note that as muscle
contractions. For a steady, sustained forceful fibers fatigue, their twitch duration increases
contraction, an upper limit to the firing rate so the associated decrease in firing rate does
seems to be about 30 Hz in human skeletal not result in a partially fused contraction
muscle. These are firing frequencies which
becoming unfused. Were this to occur, a very
result in a partially fused contraction.
large drop in force would result (figure 13.5).
How, then, are smooth, controlled voluntary Rather the decrease in firing rate seems to be
movements possible when low forces are balanced by the increase in contraction time.
involved and the firing rates are very low? [Larger muscles such as biceps brachii and
Why is it that no twitching or fluttering is seen deltoid, which contain a large number of
when the firing rates are below the fusion
motor units, rely more on recruitment than
frequency? The answer is that the activity of
smaller muscles, such as adductor pollicis and
different motor units is asynchronous. the first dorsal interosseous muscle].
Although individual motor units may be firing
at low frequency and producing a fluttering, Fatigue considerations:
partly fused contraction in individual muscle
fibers, there is no synchronization between An observation made very early in the history
different motor units. At the level of the of electrically induced muscle contraction is
whole muscle, the total force is the sum of the that the rate of fatigue is much greater with
contributions of all active motor units so the electrically induced contractions than with
ripples in force output from each motor unit voluntary contractions of the same magnitude.
are smoothed i.e. lost in the total. By contrast, Two factors contribute to the difference: the
when muscles are activated electrically, all of firing rates of the motor units and the number
the activated fibers are synchronously and nature of the motor units which are
activated so smooth contractions are only recruited.
possible when the induced firing frequencies As discussed previously, in order to produce a
are greater than, or equal to, the fusion smooth, non-twitching motor response, the
frequency. frequency of electrical stimuli must be higher
The very large range of force output of which than the fusion frequency of the excited
human muscles are capable is only partly due muscle fibers. 50 Hz is a 'ball-park' figure for
to variation in nerve firing rates. A second most skeletal muscles. A voluntary contraction
factor which is at least as important is of the same magnitude would involve lower
recruitment. In a weak contraction only a few firing frequencies and, to compensate, greater
recruitment of motor units. The difference is
183
Chapter 13 Nerve and Muscle Stimulation
that physiologically, the load is spread over contractions. In this way, an unsteady
more motor units which, individually, do not twitching contraction is avoided.
have to work as hard. The result is a lower
rate of fatigue. The order of recruitment described above
applies to steady or repetitive contractions. In
The second difference involves different sudden movements, fast-fatigable units are
muscle fiber types. Muscle fibers are typed, as activated at the beginning of the movement.
described previously, as fast- or slow-twitch. These units fire very few action potentials in a
They are further categorized according to single high-frequency burst. This produces a
fatigue resistance where slow, fast-resistant high peak force with a rapid initial rate of
and fast-fatigable fibers are distinguished. increase, such as would be needed to produce
Fatigue-resistance depends on cellular a sudden, brief acceleration of a limb segment.
metabolism. Slow fibers have a long twitch-
force duration and are fatigue-resistant. They With electrical stimulation, the pattern of
rely on aerobic glycolysis for energy recruitment is very different to that which
production. Fast-fatigable fibers are designed occurs physiologically. Two factors determine
the order of recruitment: proximity to the
to produce very high peak forces for a very
stimulating electrode and nerve fiber diameter.
short time (from a fraction of a second to a
few seconds). They rely on anaerobic Fibers closer to the stimulating electrode will
metabolism for peak energy production: an experience a higher stimulation intensity than
oxygen supply from the bloodstream is not an those further away. This is because current
immediate concern. Fast-resistant fibers are spreads within the tissue, resulting in a
relatively fatigue resistant but also have a short decrease in intensity. Close to the electrodes,
twitch-force duration and moderately high spreading is minimal and the current density is
peak force. highest. With increasing distance, the current
density decreases.
In a steady or repetitive voluntary contraction
it is the slow, highly fatigue-resistant motor The current density, i, is given by the formula
units which are recruited first. For contractile
forces up to about 20% of maximum, slow
motor units dominate. Above this level, the
contribution of fast- resistant units increases. Where I is the current (in amperes) and A the
Fast-fatigable units are the last to be recruited. area through which the current passes (in
[Henemann et al, in 1965, proposed the size square meters). The units of current density
principle of motoneuron recruitment based are thus amperes per square meter (A.m-2).
upon their own experimental work and that of Close to the electrodes the current density will
others. The principle states that with be greatest: approximately I/A o , where Ao is
increasing contractile force, recruitment the area of the electrode (figure 13.8). Further
proceeds in an orderly fashion from smallest from the electrodes the area A through which
to largest motoneuron diameter.] the current passes is larger than A o so the
Slow motor units are the smallest in terms of current density is less.
the number of fibers innervated by an Fiber diameter is important because the
individual motoneuron and also in terms of the distance between adjacent nodes of Ranvier is
motoneuron diameter. Fast-resistant motor greater for larger diameter fibers. Histological
units are larger and the motoneuron diameters measurements show that the distance between
are larger. Fast-fatigable units are the largest nodes is directly proportional to nerve fiber
on both counts. Clearly it is optimal to have diameter. As stated previously, initiation of an
small motor units with long twitch times and action potential relies on producing a potential
low fusion frequencies used for weak difference between adjacent nodes. The
greater the distance between the nodes, the
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Chapter 13 Nerve and Muscle Stimulation
greater will be the potential difference for a the type of contraction produced and the others
given stimulus intensity applied to the tissue. are in the effects of pulse shape and duration:
Larger diameter nerve fibers then, are more The contraction and subsequent relaxation
easily recruited than those of smaller diameter. of denervated muscle is more sluggish
This means that for nerve fibers at a certain than innervated muscle. This is mainly
distance from the stimulating electrode, the due to the absence of synchronization in
order of recruitment will be the reverse of that stimulation of the muscle fibers.
which occurs physiologically. The largest Denervated muscle shows a much less
diameter fibers, which innervate fast-fatigable marked accommodation effect than nerve.
motor units which have the highest fusion Thus it is not necessary to use short
frequencies, will be recruited first. duration, rectangular pulses for
stimulation. An impulse which rises
The effect of electrode-to-nerve-fiber distance
slowly in intensity can depolarize the
means that the reverse recruitment order will
muscle fiber membrane. For this reason
not be followed exactly, but fast-fatigable
impulses having, for example, saw tooth,
motor units will contribute disproportionately
trapezoidal or triangular shape and long
to an electrically induced contraction. A
duration are effective in stimulating
consequence is that a high stimulus frequency
denervated muscle. Such pulses are termed
is needed to achieve a smooth, fused response
selective because it is possible to adjust
and this inevitably induces a high rate of
fatigue. the pulse duration and intensity for
adequate stimulation of denervated muscle
with minimal stimulation of nearby intact
nerve fibers.
Denervated muscle is relatively insensitive
to short duration stimuli. This important
point is discussed next.
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Chapter 13 Nerve and Muscle Stimulation
The graph shows that painfully high voltages the critical factor, as with nerve fibers, but the
must be used to stimulate denervated muscle if time- frames are very different.
the duration is short. In contrast, if long
[The effect of stimulus frequency then is
duration pulses are used only low voltages are
somewhat simpler to explain than for nerve
needed. In this particular example, comparison
fiber stimulation, where the effects of
with figure 13.7 shows a greater sensitivity for
denervated muscle to pulses of duration above accommodation and pulses applied within the
50 ms. The increased sensitivity to long pulse relative refractory period are needed to
account for the observed variation in
duration stimuli is typical of recently
denervated muscle. The lack of neural input sensitivity.]
apparently causes an increased sensitivity of SENSORY, MOTOR AND PAIN
the muscle fiber membrane. The increase may RESPONSES:
be the result of normal control mechanisms
whereby the muscle fiber adapts-to or So far the focus has been on the motor
compensates-for changes in neural activity. response to electrical stimulation. In reality,
the forcefulness of the motor response will be
Effect of Pulse Frequency: limited by pain. Pain can be a direct result of
We saw previously that for frequencies above the muscle contraction or can be due to
about 100 Hz, the higher the frequency the less stimulation of pain fibers (nociceptive afferent
efficient pulses are for direct stimulation of nerve fibers) by the electrical stimulus.
nerve fibers. Similar behavior is observed Clearly, if pain is produced as a result of the
when muscle is stimulated directly, though the forcefulness of the muscle contraction, more
frequencies concerned are different, as is the efficient electrical stimulation will not enhance
explanation of the effect. For stimulus the motor response. On the other hand, if
frequencies above about 10 Hz the sensitivity noxious electrical stimulation is the limiting
of denervated muscle decreases with the effect factor, stimuli which preferentially recruit
becoming quite marked at frequencies above motor (A-α) fibers ahead of pain (A-δ and C)
50 Hz. fibers will be more effective. Fortunately, a
degree of selectivity can be achieved by
A simple explanation for this behavior is appropriate choice of pulse duration. The
evident from the strength-duration graph of reason is that α-motoneuron and pain fibers
denervated muscle. From figure 4.8 we see have a different range of diameters and
that for pulse durations below 100 ms the different strength-duration behavior. α-
stimulus intensity needed for contraction motoneurons have the largest diameters (range
begins to increase. For a pulse duration of 100 12-20 µm), the largest internodal spacing
ms the pulse frequency cannot exceed 1/ (100 (distance between adjacent nodes of Ranvier)
ms) = 1/ (0.1 s) = 10 Hz. This would allow no and consequently, the lowest thresholds for
'rest' time between stimuli. As the frequency electrical stimulation. The range of diameters
is increased above 10 Hz the pulse duration of sensory fibers (A-α afferents, diameters 6-
must inevitably decrease if there is to be any 17 µm) overlaps with that of α-motoneurons,
separation between the pulses. One pulse must making it virtually impossible to elicit a motor
finish before the next one is applied. response without also electrically activating
sensory fibers. When stimulation is applied
To charge the muscle fiber membrane enough
transcutaneously, a sensory response is, more
to depolarize it, the stimulus intensity needs to
often than not, elicited before a motor
be increased if the pulse duration is decreased.
response. The reason is that although motor
The membrane capacitor must be charged by a
fibers have, on average, larger diameters, they
certain amount to trigger depolarization. This
are located more deeply. Sensory fibers are in
can be achieved by a long duration pulse of
abundance near the skin surface and so will
relatively low intensity or a shorter duration
inevitably be closer to the electrodes. In other
pulse of higher intensity. Charge movement is
words, the effect of current spreading with
186
Chapter 13 Nerve and Muscle Stimulation
187
Chapter 13 Nerve and Muscle Stimulation
fibers recruited almost as soon as the motor The separation due to fiber diameter is most
fibers. marked in figure 13.11(a) and indicates that
with direct nerve stimulation, by using
As noted previously, with transcutaneous
sufficiently short pulse durations (around 500
stimulation, depth in tissue also affects the
µs), the small diameter C fibers will not be
threshold for nerve excitation. This is because
stimulated at intensities which very effectively
of current spreading and a consequent recruit the larger A-δ, A-β and A-α fibers. A
reduction in the local stimulus intensity. shorter pulse durations (around 50 µs), neither
Superficially located fibers are therefore
C nor A-δ fibers will be stimulated at
recruited at lower stimulus intensities. Figure
intensities which efficiently recruit A-β and A-
13.11(b) shows measurements obtained with
α fibers. This indicates that as one goes to
human subjects and transcutaneous electrical smaller pulse widths, the ease of
stimulation.
discrimination between sensory and motor
Note the horizontal axis (time) scale. In this responses on the one hand, and pain responses
figure the pulse widths are measured in on the other, is increased.
microseconds (µs) and not milliseconds as
have been previously used to describe action
Figure 13.11 Strength-duration curves for (a) d ifferent nerve fiber types, with the nerve trunk
exposed and stimulated direct ly and (b) sensory, motor and pain thresholds measured using
transcutaneous stimulation.
potentials and the subsequent refractory The extent of discrimination evident with
period. Here we are dealing with pulse transcutaneous stimulation is less. As figure
widths which are small compared to the 13.11(b) shows, the sensory, motor and pain
time-course of an action potential. threshold graphs are more overlapped and the
variation occurs at smaller pulse widths. This
Two things are apparent from figure 13.11(b). is because the measured response depends not
First, that in reality the order of recruitment is just on the fiber type (and the associated
usually sensory, then motor, then pain at all diameter) but also two other factors: the depth
pulse durations when current is applied of the fibers within tissue and the electrical
transcutaneously. Second, that as we go to characteristics of the skin and underlying
shorter pulse durations the separation between tissues. The capacitative nature of the stratum
the curves increases. corneum means that longer duration pulses are
not more effective for nerve stimulation
The results shown in figure 13.11(a) indicate
(whatever the fiber type) as the current flow in
that, with surgically implanted electrodes, very
tissue beneath the stratum corneum is
good discrimination between nerve fiber types
transient. (Spikes in the current flow are
can be achieved by choice of an optimal pulse
produced at the start and end of long duration
width.
pulses and increasing the pulse width does not
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Chapter 13 Nerve and Muscle Stimulation
result in a longer duration flow of current in the degree of noxious stimulation associated
tissue. Thus C fibers are not as more readily with lower frequencies.
recruited at longer pulse durations as would be
The French scientist Arsène d'Arsonval
expected from figure 13.11(a). Nor are A-δ
studied the effect of AC stimulation on nerve
fibers, though the effect is less. The result is a
and muscle, both using dissected animals and
plateau in the transcutaneous sensory, motor δ
and pain threshold graphs at a pulse width by transcutaneous stimulation of human
much less than in figure 13.11(a). subjects. He used an alternator, the first device
built for generating AC and the one which is
The observations regarding the effect of pulse used in every modern-day motor car. An
width have important practical implication for alternator works on the principle that if a coil
therapy, and the results shown in figure of wire is made to spin in a stationary
13.11(b) are most relevant. If long duration magnetic field, alternating current is produced
pulse widths are used then only small changes in the coil. d'Arsonval reported in 1891 that
in intensity will be needed to change from a with increasing frequency, the neuromuscular
sensory response to a motor or pain response. response to sinusoidal AC becomes stronger
By contrast, if short duration pulses are used, up to about 1400 Hz, is constant between 1500
much larger changes in intensity will be and 2500 Hz and decreases to 5,000 Hz. He
needed to recruit motor and pain fibers. If the also reported that a current of 1500 Hz is more
objective is to produce a sensory response with painful than 5,000 Hz but much less painful
minimal motor or pain responses then short than currents of 75 and 20 Hz.
duration pulses are preferred (less than 50 µs
d'Arsonval's observations of transcutaneous
from figure 13.11a or perhaps 'the shorter, the
better' from figure 13.11b). Short duration stimulation using human subjects and
pulses will also be capable of producing an sinusoidal AC laid the foundations for the use
of kHz frequency AC in clinical practice.
effective motor response with minimum pain
sensation. It is for this reason that modern Sinusoidal AC stimulation has figured in
electronic stimulators produce higher voltage, clinical practice since the 1950s when a
shorter duration pulses than their predecessors. German physician, Hans Nemec, began
advocating 'Interferential Currents' as a means
A question arising from the foregoing
discussion is whether very short pulses, around of producing comfortable, pain-free, muscle
2 to 10 µs duration, will give better contractions and 'promoting tissue healing'.
More recently, the use of interferential
discrimination with transcutaneous stimulation
currents for pain control has been advocated.
than, say, 20 µs pulses. The evidence certainly
Interferential currents used clinically are
indicates that pulses of duration in the range
20 to 50 µs will more effectively discriminate sinusoidal AC with frequencies around 4 or 5
kHz.
than pulses with duration greater than 100 µs.
It is not known whether this trend continues to More than two decades after the introduction
very short pulse durations. Further research is of interferential currents, 'Russian currents'
needed before any firm conclusions can be became popular, principally due to the claims
drawn. made by a Russian physician, Yakov Kots, in
the late 1970s. Kots claimed that kHz
Stimulation using sinusoidal AC:
frequency AC, modulated at 50 Hz with a 1:1
Sinusoidal alternating current has been used duty cycle, could produce large strength gains
for patient treatment almost since devices for in stimulated muscle. He based his claims on
producing AC were first marketed in the late studies made with young Russian athletes as
1800s. It was soon established that low subjects: athletes who were hoping to qualify
frequency AC produced noxious stimulation for the Olympic games. Russia's success in the
while AC in the kHz frequency range could Olympics and the intense competitiveness
produce strong muscle contractions without which existed at the time seems to have given
189
Chapter 13 Nerve and Muscle Stimulation
weight to Kots' claims. Kots argued that an As noted previously, a pulse width of 10 ms
optimal AC frequency for muscle results in little discrimination between
strengthening, one which produced maximal sensory, motor and pain thresholds. Smaller
force at the pain-tolerance threshold, was 2.5 diameter pain fibers are recruited at thresholds
kHz if the muscle was stimulated directly not much above those of the larger sensory
(with the active electrode over the muscle) or and motor fibers (figure 13.11b).
1 kHz if the muscle was stimulated indirectly
(with the active electrode over the nerve trunk As the waveform does not have an abrupt rise,
supplying the muscle). some nerve fiber accommodation will occur
meaning that a greater current intensity will be
Both Russian currents and Interferential needed to produce the same response as a 10
currents continue to be used in clinical millisecond rectangular pulse. The effect of
practice. Interferential currents are popular in accommodation is greater in large diameter
England, Europe and Australia. Russian nerve fibers so there is dropout of their
currents are, somewhat paradoxically in the contribution if sinewaves rather than square
light of political relations post world war two, waves are used. This means that there will be
more popular in the USA. less stimulation of
Stimulation with low frequency AC is seldom Large (A-α and A-β) fibers with low
used nowadays. It is particularly painful. frequency AC and, relatively, more
Nonetheless, it did experience some popularity contribution of smaller (A-δ) fibers.
in Europe in earlier decades. A particular form
of low-frequency AC stimulation, called The pulse duration will result in stimulation
which is both superficial and relatively non-
'Diadynamic current' was popularized in
discriminatory between sensory, motor and
Europe. The argument seems to have been
that the discomfort associated with the pain responses. Thus if the aim of therapy is to
stimulation had therapeutic benefits resulting stimulate superficially and to produce, say,
from a counter- irritant effect. modest muscle contraction together with
stimulation of pain fibers, or simply painful
[On the basis of his work, d'Arsonval stimulation, then 50 Hz sinusoidal AC or one
described the electric chair, recently adopted of its variants is a logical choice.
in New York state for criminal executions, as
'barbarous and unholy' as the voltage chosen Unsurged 50 Hz AC is sometimes used for a
was too low (1500 V) and death is slow.] counter irritant effect. Counter-irritation has
been dismissed as treating a patient with a sore
[The Nemectrodyne interferential stimulator right thumb by hitting the opposite, left thumb
was the first on the market and the company and producing more pain. Suddenly, the
continues to successfully market interferential patient finds the right thumb more
units.] comfortable! The point which is ignored in
this simplistic argument is whether the pain
Low Frequency Alte rnating Current:
relief persists, in which case counter-irritation
The term low frequency AC as applied in stimulation is vindicated. Unfortunately, no
therapy relates to frequencies between about 1 properly documented studies seem to have
Hz and 100 Hz. A sinusoidal current is, in addressed this question. Low frequency AC
effect, a continuous train of current pulses. For might thus have some potential in clinical
example, 50 Hz AC has one complete cycle practice. The evidence base has yet to be
every 1/50th of a second or 20 milliseconds. established.
The 20 ms sinewave has a rounded 10 ms
Medium Frequency Alternating
positive pulse followed by a rounded 10 ms
Curre nt:
negative pulse. The stimulus is therefore a
series of 10 ms pulses. Medium frequency alternating currents are
defined as currents in the frequency range 1
190
Chapter 13 Nerve and Muscle Stimulation
kHz to 100 kHz. Above 100 kHz, alternating depolarization is produced. The higher tissue
current is not able to excite nerve fibers and heating rate is because skin impedance
the only effect is one of tissue heating. decreases with increasing frequency so the
Currents above 100 kHz are classified as 'high current flow is higher for a given stimulus
frequency'. voltage and the power dissipation is
correspondingly higher.
In clinical practice, currents with frequencies
between 1 kHz and 10 kHz are commonly [Higher frequency AC (above 10 kHz) thus has
used. Frequencies above 10 kHz are not. The less direct effect on the nerve-fiber membrane
reason is that above 10 kHz or so, the nerve and more effect on the sensory receptors
fiber response diminishes while the power which detect heat.]
dissipated in tissue increases. At frequencies
INTERFERENTIAL CURRENTS:
above 10 kHz, nerve sensitivity becomes
lower while the electrical energy dissipated in Hans Nemec popularized interferential
tissue, and consequently the heating rate, currents in the 1950s. Although Nemec
increases. 10 kHz to 100 kHz is evidently the published a number of articles describing and
transition zone between direct electrical reporting on the effect of interferential
stimulation and tissue heating. currents, these were in German. Only one
English language article exists. It was
As noted previously, nerve-fiber firing rates
are well below 100 Hz during most voluntary translated from German and published in the
activities, including strenuous exercise and British Journal of Physiotherapy in 1959. In it,
Nemec described interferential currents and
generally less than a few tens of Hz on a
sustained basis. With electrical stimulation at made claims of therapeutic benefits. The
higher frequencies and sufficiently high claims, judged in terms of modern criteria,
were inappropriately speculative i.e. were not
intensity, firing rates approaching 1 kHz can
adequately documented. They are, however,
be produced. The absolute refractory period
places the limit on the maximum firing rate. intriguing and not without some credence.
Here we focus on the less speculative aspects.
If nerve is stimulated with AC at frequencies
above 1 kHz, action potentials are produced An interferential stimulator has two separate,
with every second, third or fourth succeeding electrically isolated circuits for applying
AC pulse. The fiber firing rate will thus be a current to the patient. The currents are applied
using two diagonally opposed pairs of
sub-multiple of the AC frequency. If, for
electrodes as shown in figure 13.12. The idea
example, 4 kHz AC is used, the induced firing
rate might be 100 Hz at intensities just above is that the two currents 'interfere' within the
threshold. In this case the firing rate is tissue volume, reinforcing each other and
determined by the relative refractory period. producing a greater effect at depth than would
be possible using a single circuit. In the
At higher intensities, higher firing rates are
region of intersection (the cross- hatched area
induced as action potentials are produced
during the relative refractory period. At the in figure 13.12), the resultant intensity is high
highest intensities the firing rate might as it is the sum of the contributions of each
current.
approach 1 kHz i.e. fibers firing immediately
after the absolute refractory period.
191
Chapter 13 Nerve and Muscle Stimulation
Each circuit (A and B) supplies an AC signal Figures 13.14(a) and (b) show two sinusoidal
of constant amplitude to the patient. If current waveforms applied to the patient via
spreading is not great, as is assumed in figure diagonally opposing pairs of electrodes as
13.12, the region of maximum stimulation is shown in figure 13.12. The total current at a
the cross-hatched area (the region of diamond particular point in the patient's tissue is the
shapes) in figure 13.12. This contrasts with the sum of the currents from each pair of
regions of maximum stimulation when only electrodes. At points where the two currents
one circuit is used. In this case maximum are of equal amplitude the sum of the two
stimulation is produced immediately under the signals will be an AC waveform which is
electrodes. Figure 13.13 illustrates the amplitude modulated as shown in 13.14(c).
difference.
The surge or modulation frequency is equal to
the difference in frequency of the two currents.
The frequency, f, of waveform (a) might be
4000 Hz and the frequency (f-δ) of waveform
(b) might be 4000-10 = 3990 Hz. In this case
the value of δ, the modulation frequency is 10
Hz.
Figure 13.13: Depth efficiency of (a) b ipolar and
(b) quadripolar stimulation.
To make clear which frequency we are talking
about, the terms 'carrier frequency' and 'beat
In practice, current spreading will make the frequency' are used. In this example, the
difference shown in figure 13.13 less marked. carrier frequency is 3995 Hz and the beat
The superimposition of the two currents will, frequency is 10 Hz.
however, help to counteract the reduction in
stimulus intensity with depth, thus increasing In figure 13.14, the currents are assumed to be
the depth efficiency of stimulation. of equal amplitude. In regions of tissue where
the two currents are not the same size, an
The original interferential machines produced interference effect will still be produced, but
a sinusoidal waveform with a frequency the resulting waveform will not drop to zero
around 4 kHz: thus the stimulus pulse width midway between the maxima. Figure 13.15
was 1/8000 sec or 125 µs. Some modern shows the effect of adding two currents of
machines offer a choice of AC frequencies and slightly different frequency when one current
use a rectangular pulsed AC waveform, rather is twice as big as the other. An interference
than a sinewave. There is some evidence that effect is still produced but the depth of
a rectangular pulsed waveform is more modulation of the waveform is less.
comfortable than its sinusoidal counterpart and
also evidence that optimal comfortable
stimulation is achieved at a frequency of about
9 kHz.
192
Chapter 13 Nerve and Muscle Stimulation
parallel to the nerve fibers when there is a The pattern of stimulation is clearly more
single current flow through tissue. When there complex with interferential currents than with
are two intersecting currents of equal current applied using a single pair of
amplitude, maximum stimulation occurs along electrodes. We can, however, draw some
lines midway between the current paths. The important conclusions:
reason is that the net current flow is the vector
sum of the two currents. Nerve fibers aligned in directions which
bisect the angle between the current
pathways (horizontally and vertically in
figure 13.17) will experience the greatest
stimulation intensity and the stimulus will
be a modulated AC signal.
Fibers aligned parallel to the direction of
the individual current flows will
experience a lower, but still relatively
high, stimulation intensity. The
Figure 13.16: shows the net current flow in
stimulating current will not be modulated.
different directions for the simple configuration in Nerve fiber firing rates will be much
figure 13.12 higher than with stimulation using single
pulses applied at low frequency. Fibers
Consider first the situation where two current aligned parallel to the direction of the
pathways are at right angles and the currents individual current flows will fire at a rate
are equal. Nerve fibers aligned parallel to one determined by how far above threshold is
of the current pathways will experience an the local stimulation intensity.
unmodulated AC stimulus as shown in figure Fibers aligned in directions which bisect
13.14(a) or (b). Fibers aligned along lines the angle between the current pathways
midway between the current paths will will fire in bursts. The bursts of activity
experience a modulated stimulus (figure will be at the beat frequency and the
13.14(c)) of higher intensity. Those fibers number of action potentials per burst will
aligned in other directions will experience a depend on how far above threshold is the
partially modulated stimulus, similar to figure local stimulation intensity.
13.15, with a depth of modulation which
depends on the fiber orientation. A widespread misconception is that with
interferential currents, the nerve fiber firing
The length of the black arrows is proportional frequency is equal to the beat frequency. This
to the current intensity. In the horizontal and would only be the case for fibers stimulated at,
vertical directions, the net current is maximum or just above, their threshold. As noted
and the modulation is 100%. In directions at previously, for stimulation intensities above
45o, there is no modulation and the intensity is threshold, nerve fibers will fire at much higher
some 30% lower. rates. When the stimulus intensity is
modulated at low frequency, nerve fibers will
fire in bursts, with each 'beat' of the current
intensity. The beat frequency only determines
the burst frequency of the action potentials.
The number of action potentials per burst
depends on how far the stimulus intensity is
above threshold.
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Chapter 13 Nerve and Muscle Stimulation
than if 50 Hz single-pulses were used as the Premodulated current has the advantage that it
average firing rate will be much higher. is easier to apply, as only two electrodes are
needed. The disadvantage is that there is no
Another widespread misconception about
reinforcing at depth so maximum stimulation
interferential currents is that the pattern of
is produced immediately beneath the
stimulation is in the shape of a clover-leaf (a electrodes (figure 13.13(a)).
four-leafed clover) rather than the rounded-
diamond shape shown in figures 13.12, 13.13 RUSSIAN CURRENTS:
and 13.17. The misconception seems to have
originated from the idea that nerve fibers are Russian currents are a particular form of
insensitive to an unmodulated AC stimulus i.e. electrical stimulation which became popular as
that modulation at low ('biological') a result of a talk given by Dr Y M Kots of the
frequencies is necessary to produce a Central Institute of Physical Culture, Moscow,
physiological response. Were this true, then at a conference hosted by Concordia
fibers aligned parallel to the current paths University, Montreal in 1977. He claimed
(figure 13.16) would not be excited while strength gains of up to 40% in elite athletes as
those aligned along lines bisecting the angle a result of this form of electrical stimulation.
between the current paths would be excited The term 'Russian currents' refers to sinusoidal
maximally. The pattern of stimulation would AC of frequency 2.5 kHz which is burst-
have four lobes, each lobe pointing to a corner modulated at 50 Hz. The wave- form is shown
of the rounded diamond shape. in figure 13.17. It consists of 10 ms bursts of
In fact, the clover-leaf pattern shows the areas AC separated by 10 ms 'off' periods. The
of maximum interference, not maximum waveform repeats every 20 ms (1/50th sec) so
stimulation. The pattern applies to every small the burst or modulation frequency is 50 Hz.
diamond shaped segment in the region of
interference. It indicates the direction in which
the stimulus intensity is greatest. It does not,
in any way, represent the area of maximum
stimulation. Within each diamond-shaped
segment, a clover-leaf pattern can be drawn,
showing the directions of maximum
interference: in other words, the directions in
Figure 13.18: Russian currents: 2.5 kHz sinusoidal
which nerve fibers must be aligned to
AC, burst modulated at 50 Hz i.e. 10 ms 'on' and 10
experience maximum stimulation. A
ms 'off'.
misleading implication of the pattern is that no
stimulation is produced if the nerve fibers are Kots and co-workers measured the maximum
aligned along either of the current paths. force which could be elicited using AC in the
frequency range 100 Hz to 5 kHz. Current
Pre-modulated Interferential Current: was applied either using either two equal-sized
Most interferential machines make provision electrodes placed over the muscle belly
for stimulation using either two pairs or a (referred-to as 'direct' stimulation) or using a
single pair of electrodes. Two pairs are needed small 'active' electrode over the nerve trunk
for true interferential stimulation. The term supplying the muscle and a larger 'indifferent'
'premodulated interferential current' refers to a electrode placed elsewhere, so as to avoid
current waveform as shown in figure 13.14(c), excitable tissue (referred-to as 'indirect'
which is produced inside the interferential stimulation). They established that maximal
machine and applied to the patient using a force at the pain- tolerance threshold was
single pair of electrodes. 'Premodulated obtained at 2.5 kHz if the muscle was
interferential' is thus something of a misnomer, stimulated directly or 1 kHz if the muscle was
as there are no currents interfering in tissue. stimulated indirectly.
194
Chapter 13 Nerve and Muscle Stimulation
195
Chapter 14 Pulsed Shortwave Diathermy
196
Chapter 14 Pulsed Shortwave Diathermy
The resonant circuit (the patient tuning [5.2 W is not a high power level. Imagine
circuit) couples energy generated by the shining an ordinary battery-operated torch at
apparatus to the patient. Output from the your skin from a short distance. The heat and
apparatus is applied to the patient using light energy produced by the torch has little
electrodes or an induction coil, in the same impact on your tissues.]
way that conventional (continuous- mode)
shortwave diathermy is applied. The average power is low and is only a small
A power supply is needed to convert mains fraction, between 0.5% and 4%, of the peak
supplied 50 Hz AC to DC of whatever power per pulse.
voltage is required to power the gating
Machine 2, with a pulse width of 400
circuit, sine-wave generator and amplifier.
microseconds, has a frequency range of 15 Hz
Pulsed shortwave is described as 'non- to 200 Hz and a peak power output of 1000 W.
diathermic', meaning that it does not produce Calculations similar to the previous examples
deep heating. The rationale is as follows. show that the maximum average power varies
Consider and compare two pulsed shortwave between 6 watts (at 15 Hz) and 80 watts (at 200
machines. A difference between them is in the Hz). Again, the average power is low and is
pulse frequencies which can be selected and the only a small fraction, between 0.6% and 8%, of
pulse width. Both have a peak power output of the peak power per pulse.
approximately 1000 watts. Machine 1 has a
The low power levels of pulsed shortwave
pulse width of 65 microseconds and a pulse
ensure that gross heating effects, due to an
frequency selectable between 80 Hz and 600
appreciable increase in tissue temperature, do
Hz. Machine 2 has a pulse width of 400
not occur.
microseconds and a frequency range from 15
Hz to 200 Hz.
Effects of Pulsed Shortwave Fields:
Suppose machine 1 was set to a frequency of
Pulsed shortwave treatment is advocated as
80 Hz. The pulse width is fixed, in the
therapeutically beneficia l due to non- thermal
machine, at 65 microseconds so the output is on
effects. Unfortunately, the advocates seem, in
for a total of 65 x 80 = 5200 microseconds each
the main, to be the manufacturers of the
second. When the intensity control is set to
equipment, rather than independent researchers
deliver a maximum output of 1000 W pulses
who have carried-out proper studies.
the average power output is only:
The few studies which have been undertaken
include human and laboratory animal
observations at the tissue level. Healing of
This is a tiny fraction, approximately 0.5%, of experimentally produced skin wounds and
the peak power. haematomas in laboratory animals has been
shown, in one study, to be promoted by pulsed
At a frequency of 600 Hz the average power at shortwave treatment. Another study showed
maximum output rises to: that human soft tissue injuries responded more
rapidly in comparison to control (untreated)
groups and groups of patients receiving a
similar dose (but not dose rate) of continuous
shortwave treatment. Some promising results
This is 39/1000 W which is still only 3.9% of have also been obtained in studies of rate and
the peak power. extent of nerve regeneration in laboratory
animals. These results are indicative of
197
Chapter 14 Pulsed Shortwave Diathermy
therapeutic benefit but, due to their small would markedly increase the instantaneous
number, are by no means conclusive. temperature.
Proponents of pulsed shortwave have argued [With pulsed shortwave, the instantaneous
that another diathermic modality, ultrasound, temperature increase is high but the average
has been shown to be useful when applied in temperature increase is low.]
pulsed mode for the treatment of a number of
conditions where heating as such is either One could reasonably speculate that the
contraindicated or of dubious value. The transient excitation might affect concentration
argument is that if ultrasound can used to gradients, movement of molecules across the
advantage in pulsed mode, where non-thermal cell membrane and changes in membrane
effects are the explanation for any therapeutic permeability in either or both of excitable cells
benefits, then pulsed shortwave should also be and non-excitable cells. There may also be
beneficial. This arguments is based on two transient thermal effects on the synaptic
questionable premises. First that 'non-thermal' junctions of nerve cells. These ideas remain
benefits of ultrasound treatment actually exist speculative in the absence of appropriate
and second (perhaps more importantly) that experimental studies.
non-thermal effects will also be produced by
pulsed shortwave treatment. Optimum Treatment Parameters:
198
Chapter 14 Pulsed Shortwave Diathermy
199
Chapter 14 Pulsed Shortwave Diathermy
Extensive case studies have established the induced in tissue. Figure 14.6 shows the
effectiveness of pulsed magnetic fields for the relationship between induced current and
treatment of non-united fractures. current in the coil for the two waveforms
shown in figure 14.5.
Two problems associated with the use of
implanted electrodes are the risk of infection When the coil current suddenly starts to
and the localization of bone formation in the increase, the rapid rate of increase (figure
vicinity of the electrodes. These problems are 14.6a) results in a high induced current. The
overcome by inducing current flow in tissue magnetic field around the coil builds-up rapidly
using a pulsed magnetic field. As the magnetic so the induced current is large. The rate of
field increases and decreases, eddy currents are increase then drops rapidly and the induced
produced in the tissue. current drops accordingly. A current spike is
induced in tissue. When the coil current
[Extensive case studies have established the suddenly decreases, a current spike of the
effectiveness of pulsed magnetic fields for the opposite polarity is induced due to the
treatment of non-united fractures.] decreasing magnetic field intensity. The more
rapidly changing coil current in 14.6(a) induces
Induced Current in Tissue: large current spikes but these are of short
duration as the coil current rapidly reaches a
When considering the effects of low frequency
steady value. The more slowly changing coil
pulsed magnetic fields it is important to make
current in 14.6(b) induces current spikes which
the distinction between the voltage waveform
are smaller in amplitude but of longer duration.
produced by the apparatus, the current
waveform in the induction coil and the current
induced in the patient's tissue.
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Chapter 14 Pulsed Shortwave Diathermy
The size of the induced current depends on the pulse frequency of 1 Hz. Optimum treatment
rate of change of the magnetic field and thus on parameters are yet to be established.
the rate of change of current in the coil.
Since heating appears to play no role (the
If a sinusoidal current is applied to an induction energies involved are too low) one cannot
coil the induced current will have the same predict effectiveness on the simple basis of
shape but be shifted in phase. This is because total energy transfer. Nor can optimum
the rate of change of a sine waveform is frequencies be deduced without adequate
another sine waveform phase- shifted by one knowledge of the cellular mechanisms
quarter of a wavelength; in other words a involved.
cosine waveform. This is shown in figure
14.7(a). A conclusion is that chronic non-union of
fractured bone can be successfully treated with
Figure 14.7(b) shows the rectangular current low-frequency pulsed magnetic fields but that
waveform induced when triangular waveform its value for the treatment of soft tissue injury
is passed through an induction coil. A remains open to question.
rectangular waveform is induced because the
triangular waveform is alternately increasing at
a constant rate then decreasing at a constant
rate. The induced current is alternately constant
and positive then constant and negative.
Treatment Parameters:
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Chapter 15 Dosage and Safety
When we consider the question of dosage with [As a UV lamp ages the ultraviolet output
infrared or ultraviolet radiation two problems diminishes: for this reason the average dose
arise: figure must be predetermined periodically.]
The therapeutic effects depend not just on For lamps which produce an appreciable
the energy output of the lamp but also on output of UV-B radiation tests are carried out
the frequency of the radiation. This is most to determine the amount of radiation needed to
noticeable with ultraviolet radiation where produce a first degree erythema. This will vary
only narrow ranges of frequency produce from patient to patient and even between
the desired reactions. different skin areas on a particular patient, but
A given dosage from the same lamp will an average figure for the lamp will provide a
produce a greater response in some useful starting point in determining the test
patients than others. Again greater dose requirements of an individual. Once
variation is found with ultraviolet known, the dose requirements of a particular
radiation. patient can be specified as multiples of the
first degree erythema dose.
[With infrared exposure, the intensity used is
normally that which produces mild, The dose required to produce a first-degree
comfortable warmth after 5 minutes. If this erythema is determined by exposing small
does not come about, the lamp-to patient parts of an area similar to that to be treated
distance can be adjusted during treatment.] (usually a few square centimeters) for varying
lengths of time. The patient-to-lamp distance
For infrared treatment, specifying the is kept constant. Inspection of the exposed
particular type of lamp, the reflector used, the areas after 24 hours enables the dosage to be
patient-to-lamp distance and the time of determined.
exposure is an adequate statement of dosage.
Dose, dose rate and intensity are thus specified
indirectly. Generally the intensity used is that
which produces mild, comfortable warmth
after 5 minutes. If this does not come about,
the lamp-to-patient distance can be adjusted
during the treatment. Table 15.1: Conversion factors for different
degrees of erythema.
With ultraviolet therapy the maximum effects
are not produced until long after treatment is Specification of the dosage in this case
complete. For this reason no adjustment of the requires a statement of the particular lamp
dose can be made during treatment. A close used, the exposure time and the patient-to-
estimate of the dose requirement is needed lamp distance.
beforehand. How can this be achieved? A
measurement of the total power output of the Once the time and distance required for a
lamps is insufficient. Even if the output was particular lamp are known the dosage needed
measured at different frequencies this would to produce any other degree of erythema can
take no account of variation in sensitivity of be established from table 15.1.
individual patients. A more useful and direct
method is to test lamps in terms of the amount E1 refers to a first-degree erythema, E2 to one
of radiation needed to produce a specific of second degree and so on. The values quoted
biological response in each particular patient. are experimentally determined and represent a
consensus of agreement amongst
physiotherapists. To obtain the exposure time
required for a second, third or fourth degree
erythema the time for first-degree erythema
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… (15.1)
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Chapter 15 Dosage and Safety
When this happens the amount of reflection is The beam (or part of the beam) is spread over
increased and the beam is spread over a larger a greater area in figures 15.2 (b) and (c). This
area. results in a decrease in the intensity of
radiation at the surface.
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Chapter 15 Dosage and Safety
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Chapter 15 Dosage and Safety
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Chapter 15 Dosage and Safety
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Chapter 15 Dosage and Safety
adjacent to the sides of the hollow which are ultrasound field pattern is discussed by
parallel to the field. The effect proves useful Lehmann in Licht, (1968).
when it is desired to selectively heat the
surfaces of hollows, such as the sinuses. The presence of an air-filled cavity in tissue
will have a substantial effect on the pattern of
Ultrasound: heat production. Almost total reflection will
occur at the interface and almost all of the heat
We saw in chapter 9 that reflection of will be produced in the intervening tissues.
ultrasound occurs when there is a mismatch of This has particular implications for treatment
acoustic impedance between two adjacent of the chest wall or throat.
tissue layers. The impedances of muscle and
fatty tissue are similar but that of bone is much As we saw, the presence of fluid-filled cavities
higher. There is thus an appreciable reflection has little effect on the pattern of heat
of ultrasound at the muscle/bone interface. production with ultrasound. The only factors
to be assessed are the likelihood of selective
In order to determine the effects of implants or heating within the cavity due to poor heat
cavities we need to know the acoustic dissipation, and whether this is desirable.
impedances of metals, air and body fluids.
Microwaves:
Metals have acoustic impedance about
thirty times higher than fat or muscle so The reflection of microwaves and the rate of
there will be significant reflection at a absorption are determined by the electrical
tissue/metal interface. The reflection properties (dielectric constant and
coefficient for a fat/metal or muscle/metal conductivity) of tissues. Since metals have a
interface is about 0.94. Thus about (0.94)2 much higher conductivity than any biological
x 100 or 90% of the ultrasound energy will tissue, reflection at a tissue/metallic-implant
be reflected. boundary will be pronounced. The high
Air has acoustic impedance which is only conductivity of metals also results in rapid
a tiny fraction of that of tissue so virtually absorption of microwaves - penetration depths
100% of the energy incident upon a are extremely small. The result is that
tissue/air interface will be reflected. pronounced reflection occurs at a tissue/metal
Body fluids have acoustic impedance boundary and the transmitted wave is absorbed
closer to that of water, muscle and fatty over a very short distance.
tissue. Fluid-filled cavities will not pose
any problems as regards reflection of the [The phenomenon of rapid absorption (and
ultrasound beam. consequently great heat production) can be
demonstrated quite convincingly by igniting a
[A selective build-up of heat could result, piece of steel wool in a microwave oven.]
however, if the heat cannot be transferred to
adjacent tissues or the bloodstream.] Microwaves penetrating metallic implants will
be absorbed in a fraction of a millimeter with
Whenever reflection occurs there will be an significant heat production. However, metals
increase in the ultrasound intensity adjacent to are good conductors of heat and the energy
the reflecting surface and greater heat will be rapidly conducted throughout the metal
production in this region. and spread into the adjacent tissues.
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Chapter 15 Dosage and Safety
depth of 2450 MHz microwaves suggests, hours. The effects subside over a period of
however, that metallic implants located well days. Only very large doses produce
below the surface of the body will have little permanent damage.
effect on heat production.
[As with all forms of therapy the risks
The effect of an air-filled cavity is similar to associated with UV exposure must be
that of a metal implant: reflection occurs at the calculated and weighed against the
boundary and a standing wave pattern is therapeutic benefit in deciding a course of
produced. The implications of this were treatment.]
discussed above.
It should also be borne in mind when
Fluid-filled cavities within muscle and other considering prolonged or repeated courses of
tissues of high water content will not affect the treatment with ultraviolet radiation that such
pattern of heat production, but may undergo a radiation is carcinogenic. Certain forms of
selective rise in temperature if heat is not cancer are known to occur more frequently in
conducted away efficiently. people exposed to higher levels of ultraviolet
radiation.
SOME SPECIFIC HAZARDS
Microwave therapy is contraindicated for
Electromagnetic Waves and Safety: treatment of eye conditions. Generally,
extreme caution should be exercised when
It is known from various studies that certain treating nearby structures. The susceptibility
body tissues are more susceptible than others of the eyes to damage by microwave radiation
to damage from electromagnetic waves. The is due to two factors (a) reflection and
eyes and reproductive organs are most refraction producing 'hot-spots' within the eye
frequently mentioned in this regard. cavities and (b) a relatively poor blood supply
which limits the eye's ability to conduct heat
[Sunglasses or goggles made of plastic or away.
glass and painted with a filter (often colored
blue) can effectively block ultraviolet It has been known for some time that
transmission.] sufficiently high intensities of microwave
radiation can bring about the formation of
The eyes, not having a covering of skin, are cataracts in the eye. Experimental work using
susceptible to damage by ultraviolet radiation. laboratory animals indicates a threshold
In ultraviolet therapy the eyes should always intensity level for cataract formation a little in
be protected from direct irradiation by use of excess of 100 mW.cm-2 for prolonged
glasses which reduce the visible light intensity exposure.
and absorb most of the ultraviolet radiation.
Sunglasses perform this role quite adequately. It is common practice to avoid exposing the
The only risk is of UV exposure through the reproductive organs to microwave radiation.
areas not covered by the sunglasses. For this The testes are particularly susceptible to stray
reason, protective goggles, which cover the radiation in therapy..
eyes completely, are preferred.
All practicing physiotherapists should be
Exposure of the eyes to a sufficiently high familiar with the relevant safety standards and
dose of ultraviolet radiation produces their implementation. It should be noted,
photopthalmia - acute inflammatory reactions however, that the exposure limits stipulated
of the superficial parts of the eye. This is apply to the general public but not to the
commonly known as snow-blindness (snow patient receiving treatment, nor the therapist.
reflects a large part of the UV radiation in For example, the maximum exposure level for
sunlight). It can be produced by sunlight, a therapist using 27 MHz shortwave diathermy
electric welding arcs or any other source of apparatus is 1.2mW.cm-2 . For non-
ultraviolet radiation. The reactions cause acute occupationally exposed individuals such as
pain, beginning after a latency period of a few secretarial staff and members of the general
hours and reaching a maximum in about 48 public the stipulated levels are one fifth of
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Chapter 15 Dosage and Safety
these values. For patient exposure, there is no Shear waves can be produced when an
prescribed limit. ultrasound beam strikes a boundary. They are
not produced when the wave strikes the
It is assumed that the therapist has weighed the boundary at a right angle (zero angle of
therapeutic benefits against the potential incidence), nor is production appreciable at
hazards and on this basis has prescribed grazing angles. Maximum production occurs
treatment. near the middle of the range.
Ultrasound and Boundary Effects: [In practical terms this means that shear wave
production is relatively unimportant at soft
A fundamental characteristic which tissue interfaces but is important at the
distinguishes ultrasound from other diathermic muscle/bone interface].
modalities is that the ultrasound wave is a
mechanical disturbance in a material medium. While normal sound waves are a longitudinal
Particles within the medium oscillate back and wave motion, shear waves are transverse. In
forth, undergoing large changes in velocity other words the particle displacement is at
and acceleration. This gives rise to two right angles to the direction of propagation. A
phenomena which can result in selective further point which should be noted is that
heating at or near a boundary. The processes shear waves can only exist in solids or very
are called velocity gradient heat production viscous liquids and they are absorbed more
and shear wave production. rapidly than transverse waves.
We consider first velocity gradient heat Shear waves are produced when the wave
production. Suppose an ultrasound beam is velocity is different in two adjacent tissues.
directed so as to strike a tissue boundary at a
grazing angle. In other words the waves travel The wave frequencies must be identical so the
almost parallel to the interface. At this angle of difference in wave velocity results in a
incidence little or no wave energy will be different wavelength in each tissue (by
transmitted. equation 9.1, v = f. ).
There will be a thin layer, just each side of the This means that regions of compression and
boundary where the velocity changes from rarefaction are separated by different distances
maximum to zero. Thus there is a velocity in the adjoining tissues. So at the boundary, a
gradient in this narrow region. If the boundary region of compression on one side will
region is very narrow a very high velocity periodically be aligned with a region of
gradient exists and the adjacent region are rarefaction on the other. The resulting pressure
subject to greater stresses than those outside. differential will cause particles near the
The higher oscillatory stresses give rise to boundary to oscillate in a direction transverse
greater heat production than occurs in the to the direction of the reflected and transmitted
medium in which the waves are travelling. waves. The high stresses produced at the
Hence boundary layer heat production can be interface result in greater heating than in the
significantly greater than heat production due bulk of each tissue.
to normal wave energy absorption in a
medium. The thickness of the boundary layer When an ultrasound beam in muscle strikes
determines the velocity gradient and this in the muscle/bone interface the amount of
turn depends on the rigidity of each medium. energy taken by the shear wave can be large.
For tissues of similar stiffness, such as muscle As the rate of absorption of shear wave energy
and fatty tissue the boundary layer is wide, the is much higher than that of longitudinal waves,
velocity gradient is small and boundary layer heating of the surface region of the bone is
heat production is minimal. For tissues of accentuated.
quite different stiffness, such as muscle and
bone, the velocity gradient is high and the rate In the fat/muscle/bone system, 1 MHz
of heat production at the interface is much ultrasound produces the greatest rate of
higher than in the bulk of the tissues. heating in the first few mm of bone. The
resulting temperature rise in the periosteum
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Chapter 15 Dosage and Safety
places a limit on the rate at which energy can Cardiac Pacemake rs:
be supplied to the patient. This happens when
ultrasound is incident on each tissue boundary Cardiac pacemakers present a special hazard
at a right angle and shear wave production and as far as diathermy is concerned. Two kinds of
velocity gradient effects are negligible. For pacemaker are used: the fixed rate unit which
ultrasound incident upon the bone at other than provides a constant frequency train of stimuli
a right angle, the heating rate of tissue adjacent to the heart and the more popular
to the bone will be even greater so the rate at noncompetitive units which provide a stimulus
which energy can be supplied to the patient frequency based on feedback signals from the
will be further limited. The implication is that heart. Noncompetitive units are more
in therapy, the risk of producing periosteal satisfactory medically as the heart rate is
pain and tissue damage is enhanced if the adjusted by the oxygen demand of the patient.
ultrasound beam does not strike the bone
surface at a right angle. The therapist should There are two risks in the application of
position the treatment head as close to parallel diathermy:
to the surface of the underlying bone as
possible so as to minimize velocity gradient The risk of selective heating of the unit
and shear wave effects. and tissues in contact with the unit and its
wires. Each diathermic modality presents
Ultrasound and Cavitations: this hazard when used close to the unit.
More importantly, the risk of interfering
The mechanical stresses produced when an with pacemaker action. Microwave and
ultrasound wave travels through tissue. With 1 shortwave diathermy present the greatest
MHz ultrasound at an intensity of 2 W.cm-2 , hazard in this regard. The fixed frequency
regions separated by 0.75 mm differ in pacemaker is less susceptible as it does not
pressure by about 20 N.cm-2. The large require any feedback signal.
pressure gradient can result in gaseous Noncompetitive units can change their
cavitation: the formation of tiny bubbles from frequency or cease to function completely
gas dissolved in the tissue fluid in a region of as a result of currents induced by
rarefaction (low pressure). microwave radiation or the shortwave
field.
[The formation of a gas bubble can cause
damage, tearing apart the tissue. Also, the The limited amount of research in this area to
bubble may collapse during the subsequent date indicates that shortwave and microwave
compression phase, creating a minute but radiation is contraindicated when a pacemaker
intense shock wave in the immediate area.] is present. Some units are found to cease
functioning when brought within a few meters
An upper limit to the therapeutic dose rate of of microwave apparatus. Ultrasound therapy
ultrasound is set by the threshold intensity for seems safer in this regard but extreme care
cavitation. Treatment at intensities above this should be exercised, when using this modality,
threshold could only produce the to avoid the area containing the pacemaker and
therapeutically undesirable outcome of wires.
mechanical tissue damage. In practice this
threshold is unlikely to be achieved clinically.
An intensity of 2 W.cm-2 would produce
sufficient heating for temperature elevation to
be the limiting factor.
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Chapter 16 Safety in Biomedical Instruments
Macroshock only poses a significant risk if the For shock currents above about 250 milliamps,
current level exceeds 10 mA. By the same the muscular contractions are so severe that
token a current in excess of about 100 μA the heart is forcibly clamped during the shock.
(0.0001 amps) applied directly to the heart (for This clamping protects the heart from going
example via a myocardial electrode) may be into ventricular fibrillation and the chances of
fatal. The microshock risk threshold is more survival are improved.
than 100 times lower than that of macroshock. From a practical viewpoint, after a person is
Table 16.1 shows the effect of macroshock, knocked out by an electrical shock it is
i.e. when current passes through the skin and impossible to tell how much current passed
through the body: that is when the shock is not through the vital organs of his body. Artificial
given directly to vital organs. The values respiration must be applied immediately if
quoted refer to mains frequency (50 Hz) AC, breathing has stopped: if no pulse is detectable
since shock via the mains supply is the external cardiac massage should also be
greatest hazard in most situations which the applied. An important question is 'how much
physiotherapist will encounter. current will flow if a particular voltage is
applied externally i.e. to the skin surface'. This
depends more on the skin impedance than on
the impedance of deeper tissues. The
impedance of deeper tissues depends on their
shape and volume, but does not vary a lot.
Between the ears, for example, the internal
resistance at low frequencies (less the skin
resistance) is 100 ohms, while from hand to
foot it is close to 500 ohms. The skin
impedance varies much more than that of the
underlying tissue. For 50 Hz AC it can be
Table 16.1: Effects of shock current through lower than 1000 ohms for moist skin to higher
body than 0.5 mega ohms for dry skin.
While any amount of current over 10 mA is The body current flowing when a person
capable of producing painful to severe shock, contacts the mains supply (240 volts) is
currents between 50 and 250 mA are calculated from Ohm's law to vary between
potentially lethal. At values as low as 20 mA 0.5 mA when the skin is dry and 240 mA
breathing becomes laboured, finally ceasing when the skin is moist. If the victim is startled
completely even at values below 75 mA: the from an initial mild shock, sweating can result
victim can suffocate due to uncontrollable in a lowering of skin resistance and a rise in
contraction of the muscles of the thorax and current from sub-lethal to lethal levels in a
abdomen. If the current exceeds about 50 mA, short space of time. This is one reason why it
ventricular fibrillation of the heart is likely to is essential, in an electric shock situation, to
occur an uncoordinated twitching of the walls terminate the shock current as quickly as is
of the heart's ventricles. Once ventricular safely possible.
fibrillation is induced the heart will not
spontaneously revert to its normal pattern of HOW SHOCK CAN OCCUR:
beating. Normal cardiac rhythm can only be MACROSHOCK
restored by administering a massive current
pulse from a cardiac defibrillator. The To understand the hazards associated with the
machine, which should only be operated by use of mains powered apparatus we need a
qualified personnel, supplies a short (3-4 ms) clear picture of the way in which mains
current pulse with an instantaneous amplitude electricity is supplied. The very high voltage
of up to 40 to 80 amperes. Such high currents electricity which is generated at power stations
forcibly clamp the heart. When the clamping is distributed by cables to electricity
action ceases the heart is more likely to revert substations where step-down transformers
to its normal pattern of contraction. reduce the voltage to a lower value. A single,
large step-down transformer may be used to
supply the 240 volts to many buildings in a
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Chapter 16 Safety in Biomedical Instruments
residential neighbourhood. Large buildings in Both the neutral and earth terminals of a
a city (for example a hospital) may have their power point are normally at earth or ground
own step-down transformers. Figure 16.2 potential. However, it should not be assumed
shows the essential features of the power that the active terminal (on the left in figure
supply to a building. 16.3) is the only hazardous one. For example it
is quite possible for the active and neutral
One terminal of the stepped-down supply is connections to be inadvertently interchanged
earthed at the electricity substation. This is when the power point is installed.
called the neutral line. When the substation Mainspowered equipment will still function
serves several buildings the neutral line is normally when plugged in to the power point:
the fault can only be determined by a specific
normally also earthed at the fuse box in each
test.
building. 240 volts AC is thus supplied to the
fuse box in a building using two wires, the Even when the power point is correctly wired
active wire and the neutral wire. The neutral it is possible for the neutral terminal to be
wire is nominally at earth potential (zero volts) above ground potential. This happens when
and the active wire is at a high potential. The appliances which draw a high current are
active line connects through a power meter to connected to the same circuit. A high current
flowing in the neutral line will result in a
a switch and fuse or to a circuit breaker. From potential difference between the power point
the fuse box, power wires run to light switches neutral terminal and the connection to earth at
and power outlets. Power outlets have three the fuse box. This is because the resistance of
terminals; an active, a neutral and an earth the neutral cable, while small, is not zero. If
terminal. The earth terminal is connected to a the neutral wire has a resistance R and carries
wire which is physically connected to earth at a current I, the potential difference produced is
the building. Figure 16.3 shows the given by Ohm's law as V = I.R. In what
follows we assume that the power point is
connections of the active, neutral and earth
correctly wired and consider other hazards
wires to a power outlet socket. associated with the mains supply. In normal
operation, when an appliance is plugged into
the mains outlet, current flows between the
active and neutral terminals. The earth wires
does not normally carry any current. The earth
connection is only provided as a safety
measure.
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Chapter 16 Safety in Biomedical Instruments
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Chapter 16 Safety in Biomedical Instruments
MACROSHOCK PROTECTION:
The active and neutral wires both pass through In the situation shown in figure 16.5 the
a magnetic core around which a sensing coil is person receives an electric shock because his
wound. The currents in these wires are in hand makes contact with the active line and
opposite directions and when they are equal no his feet are in contact with the ground to which
current is induced in the sensing coil. If the the neutral is connected. A question which
currents are unequal a current proportional to might occur to you is 'would it be safer if the
the difference in active and neutral current is supply neutral was not earthed?' In this case
induced in the sensing coil. The induced the earthed person could not complete a circuit
current is amplified and used to operate a by touching the active line and so would not
magnetic relay which disconnects both the receive a shock. The answer to the question is
active and neutral supply lines. a qualified 'yes'. Figure 16.7 shows how the
normal mains supply can be rendered earth
free by using an isolating transformer.
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Chapter 16 Safety in Biomedical Instruments
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Chapter 16 Safety in Biomedical Instruments
The patient, in this situation, is connected to flowing in the earth wire could raise the
two pieces of apparatus: an electrocardiograph potential at the earth terminal of outlet 2 to a
(ECG) machine and a blood pressure monitor. sufficiently high value (relative to outlet 3) to
For simplicity only the earth wires are shown. electrocute the patient.
The patient is connected to earth by two
pathways: the electrode connected to the right The solution, in this case, is to plug all
leg is earthed via the ECG machine and the apparatus around the patient into a single
fluid filled catheter is connected to a pressure power outlet or to interconnect the earth
transducer which is earthed via the blood terminal of each outlet with heavy gauge
pressure monitor. copper wire. It is also necessary to ensure that
the wiring for the power outlets in the patient's
For example, if the resistance of the earth wire room does not connect to the power outlets in
is 0.1 Ω , and a spike of leakage current of 100 adjacent rooms or corridors.
mA flows, a potential difference of 10 mV is
produced. If the resistance of the tissue is 100 A further precaution which must be taken is to
Ω , a current of 100 µA will flow. ensure that any apparatus which is used in the
patient's room has been tested for earth
The risk of shock arises when a potential leakage and meets the appropriate safety
difference exists between the earth terminals standards. PATIENT TREATMENT AND
on outlets 2 and 3. If a current I flows along ELECTRICAL SAFETY From the foregoing
the earth wire connecting the two outlets a considerations of shock and shock protection it
potential difference V will result. V is given is apparent that there are three levels of risk
by Ohm's law V = I.R where R is the associated with patient treatment. The greatest
resistance of the earth wire between the risk is to patients coupled to apparatus which
outlets. Although R is very small it is not may have a direct electrical connection to the
zero. If I is large enough the potential heart. A lower level of risk exists when there
difference produced will be sufficient to are no invasive electrical connections;
electrocute the patient - remember that however we should distinguish the patient who
currents in excess of 100 microamperes or so is coupled to electromedical apparatus by
flowing through the patient's heart may be surface electrodes from the patient who is not
fatal. electrically connected to any piece of
apparatus. The reason is that if a patient is
Normally, of course, little or no current flows connected by electrodes to, say, an
in the earth wire - it is only there to carry electrocardiograph the potential for a shock to
leakage current from the apparatus plugged-in. occur is increased by the deliberate electrical
If, however, an appliance with a high leakage connection. In addition the skin resistance has
current, such as a vacuum cleaner, is plugged been minimized by cleaning and application of
into outlet 1 a dangerous situation can result. a conductive electrode gel. In this case the
Vacuum cleaners are notorious for producing voltage needed to produce a fatal shock
current is reduced. Protection is afforded at
large leakage currents (particularly at switch-
on) because the motor is continually exposed two levels:
to dust and moisture which lower the by using apparatus which meets
insulation impedance. Visualize the situation appropriate safety standards and
where the patient in figure 13.9 is connected as
by appropriate protection built into the
shown and a cleaner, working his way down
mains supply. We consider each factor in
the corridor, plugs a vacuum cleaner into
turn. Protection and the Mains Supply
outlet I (on the corridor outside) and switches
it on. The instantaneous leakage current
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Chapter 16 Safety in Biomedical Instruments
Patient treatment areas in hospitals are treatment areas are designed to minimize this
distinguished according to the kind of risk. The earth wiring in these areas is
procedures or treatment being used and constructed from heavy gauge copper wire so
different safety standards apply to the mains that even when substantial currents (up to 1
supply in each case. Three types of treatment ampere) flow in the earth wire the potential
area are distinguished: difference between different earth terminals is
kept below 100 mV. An area which meets this
Cardiac protected electrical areas. These and other requirements (see SAA Standard
are areas which are suitable for carrying AS3003) is described as an equipotential earth
out procedures which involve direct (EP) area.
electrical connection to the heart. The
safety requirements for both the electrical In addition to the requirement for equipotential
supply and apparatus to be used in such earth wiring, cardiac protected areas must also
areas are stringent (see SAA Standards AS have core-balance relay protection or have a
3200 and AS 3003). These are described protected earth free supply.
as 'Type CF' or simply 'cardiac protected'
areas. In Australia and some other Body protected areas are those designed to
countries, these used to be described as protect patients who may be connected
'Class A' treatment areas. directly to electromedical apparatus from
macroshock currents. It is not necessary for
Body protected electrical areas. These are
the area to have an equipotential earth system
areas which are suitable for carrying out
but the supply must have core-balance relay
procedures which do not involve direct
protection or a protected earth free supply.
electrical connection to the heart but
which do involve the patient being in Best protection is afforded by a protected earth
direct electrical contact with free supply but such installations are
electromedical apparatus. Safety expensive. Core-balance relay protection can
requirements are more stringent than those be provided economically and gives an
applying to areas where no electrical adequate level of safety. Body protected areas
connection between patient and apparatus which have appropriate core-balance
is necessary. Such areas are described as protection will have the mains supply
'Type BF' or simply 'body protected' areas. disconnected within 60 milliseconds of the
They used to be known as 'class B' active and neutral current imbalance exceeding
treatment areas. 10 mA (SAA Standard AS3003).
Other patient areas. These are areas which
are not specifically suited to 'cardiac type' Class CF (cardiac protected) and BF (body
or 'body type' procedures. Apparatus protected) treatment areas are normally
which is not electrically connected to the identified by signs displayed in, or on the
patient can be used. Apparatus which is doors of, the area. The signs have an
intended to connect electrically to the identifying symbol and the words 'CARDIAC
patient can be used in these areas, but only PROTECTED ELECTRICAL AREA' or
if the apparatus itself meets stringent 'BODY PROTECTED ELECTRICAL AREA'
safety requirements (equivalent to those of printed in white letters on a green background.
a cardiac protected or body protected The symbols for these areas are shown in
treatment area). figure 16.10.
221
Chapter 16 Safety in Biomedical Instruments
222
Chapter 16 Safety in Biomedical Instruments
the mains supply to minimize the risk of when the patient has apparatus connected
macroshock. directly to the heart. In this case the mains
A class B patient circuit affords a supply should be that provided in a Class CF
minimum level of macroshock protection. area and electromedical apparatus with a
This kind of patient circuit may have one patient circuit should not be used unless either
terminal earthed. Such a circuit must have the patient circuit is class CF or there is no
leakage currents below those needed to possibility of a direct electrical connection
represent a macroshock hazard when the with the heart. In this way the risk of
apparatus is operating normally or when microshock is minimized.
the earth lead is broken. However, no
protection is offered against the situation When there is no direct electrical connection
where the patient inadvertently contacts to the heart it is sufficient to protect against the
the mains active lead. risk of macroshock. This can be achieved
either by using equipment with a class CF or
Class CF and BF patient circuits are identified BF patient circuit or by treating the patient in a
by the symbols shown in figure 16.10. The class CF or BF area. If the electrical wiring in
appropriate symbol is prominently displayed a patient treatment area is class CF or BF then
immediately adjacent to the patient circuit patients can be safety treated with apparatus
output sockets of the machine. If no symbol is which has a class CF, BF or B patient circuit.
found, the patient circuit should be assumed to If the electrical wiring in a patient treatment
be class B. Protection in Summary area is not class CF or BF then the patient
circuit must be class CF or BF. In other words
It should be apparent, from the foregoing if the mains supply is of the normal household
description, that electrical safety is only variety then electromedical apparatus should
ensured if: have either a class CF or BF patient circuit.
the equipment meets appropriate safety When there is no patient circuit and no
standards for the treatment procedures possibility of intra-cardiac connection,
involved; electromedical equipment may be used on a
the electrical supply meets appropriate normal earthed (but unprotected) mains
safety standards for the treatment supply.
procedures involved.
Figure 16.11: shows a flo wchart summarizing the requirements for earthed mains - powered
apparatus and the class of area in wh ich it can be used.
223
Chapter 17 Ionizing Radiations
Nuclear radiation arises from hundreds of X-rays: are also ionizing radiations, virtually
different kinds of unstable atoms. While many identical to gamma rays, but not nuclear in
exist in nature, the majority are created in origin.
nuclear reactions. Ionizing radiation which can
damage living tissue is emitted as the unstable Cosmic radiations: consists of very
atoms (radionuclides) change ('decay') energetic particles, mostly protons, which
spontaneously to become different kinds of bombard the Earth from outer space.
atoms.
Neutrons: are mostly released by nuclear
The principal kinds of ionizing radiation are: fission (the splitting of atoms in a nuclear
reactor), and hence are seldom encountered
Alpha particles: outside the core of a nuclear reactor. Thus they
are not normally a problem outside nuclear
These are helium nuclei consisting of two plants. Fast neutrons can be very destructive to
protons and two neutrons and are emitted from human tissue.
naturally-occurring heavy elements such as
uranium and radium, as well as from some Units of radiation and radioactivity:
man-made transuranic elements. They are
intensely ionizing but cannot penetrate the
In order to quantify how much radiation we
skin, so are dangerous only if emitted inside
are exposed to in our daily lives and assess
the body.
potential health impacts as a result, it is
necessary to establish a unit of measurement.
Beta particles: The basic unit of radiation dose absorbed in
tissue is the gray (Gy), where one gray
These are fast-moving electrons emitted by
many radioactive elements. They are more
224
Chapter 17 Ionizing Radiations
One curie was originally the activity of one The maximum annual dose allowed for
gram of radium-226, and represents 3.7 x 1010 radiation workers is 20 mSv/yr, though in
disintegrations per second (Bq). practice, doses are usually kept well below this
level. In comparison, the average dose
received by the public from nuclear power is
0.0002 mSv/yr, which is of the order of 10,000
times smaller than the total yearly dose
received by the public from background
radiation.
225
Chapter 17 Ionizing Radiations
226
Chapter 17 Ionizing Radiations
227
Chapter 17 Ionizing Radiations
62 major nuclear facilities. The NCI study was less than 100 mSv". It quoted the US Nuclear
the broadest of its kind ever conducted and Regulatory Commission that "since 1983, the
supported similar studies conducted elsewhere US nuclear industry has monitored more than
in the USA as well as in Canada and Europe. 100,000 radiation workers each year, and no
workers have been exposed to more than 50
In the UK there are significantly elevated mSv in a year since 1989."
childhood leukaemia levels near Sellafield as
well as elsewhere in the country. The reasons In addition, there is increasing evidence of
for these increases, or clusters, are unclear, but beneficial effect from low-level radiation (up
a major study of those near Sellafield has ruled to about 10 mSv/yr). This 'radiation hormesis'
out any contribution from nuclear sources. may be due to an adaptive response by the
Apart from anything else, the levels of body's cells, the same as that with other toxins
radiation at these sites are orders of magnitude at low doses. In the case of carcinogens such
too low to account for the excess incidences as ionizing radiation, the beneficial effect is
reported. However, studies are continuing in seen both in lower incidence of cancer and in
order to provide more conclusive answers. resistance to the effects of higher doses.
However, until possible mechanisms are
Low level radiation risk: confirmed, uncertainty will remain. Further
research is under way and the debate
A lot of research has been undertaken on the continues. Meanwhile standards for radiation
effects of low-level radiation. Many of the exposure continue to be deliberately
findings have failed to support the so-called conservative.
linear no-threshold hypothesis. This theory
assumes that the demonstrated relationships
between radiation dose and adverse effects at
high levels of exposure also applies to low
levels and provides the (deliberately
conservative) basis of occupational health and
other radiation protection standards.
228
SECTION III
PRACTICALS
Section III Practical
PRACTICAL NO 1: Procedure:
Ohm's discovery was that the amount of electric 2. Set up the circuit as shown above.
current through a metal conductor in a circuit is 3. Make sure that the voltmeter is connected in
directly proportional to the voltage across it, for parallel across and the ammeter is connected
any given temperature. Ohm expressed his in series with the conductor.
discovery in the form of a simple equation,
describing how voltage, current, and resistance 4. Ammeters and Voltmeters have terminals
related to each other: marked + and - which must be connected
correctly to the battery. Only close the
V = IR switch when you are sure that you have
wired the circuit properly.
Apparatus:
229
Section III Practical
PRACTICAL NO 2:
V3 = I (R1 + R2) ---- (3)
Resistors in series, and the potential We can use Equations (1) and (3) to eliminate I,
divider circuit where upon we can see that:
The two resistors are said to be arranged in V1/R1 = V3 / (R1 + R2) ---- (4)
series, because electrons leaving the battery have
to pass through both in turn in order to get back Which, when rearranged, gives us:
to the battery (remember that we can assume
that no current flows through a voltmeter). The V1/V3 = R1 / (R1 + R2) ---- (5)
total resistance in the circuit is given simply by
(R1 + R2), because the battery has to push Since (R1 + R2) is the total resistance in the
current through both in turn. The diagram shows circuit, and V3 is the "total voltage" produced by
three voltmeters connected into the circuit - one the battery, Equation (5) shows us that the
is measuring the voltage V1 across resistor R1, fraction of the total voltage across a given
one is measuring voltage V2 across resistor R2, resistor in a series circuit is equal to the fraction
and the third is measuring the voltage V3 across of the total resistance which that resistor
both resistors. represents. The bigger the value of a given
resistor, the bigger the share of the total voltage
across it, i.e. the larger the drop in potential
between one side of the resistor and the other.
The same applies to any number of resistors
arranged in series: the voltage across each one
will be in proportion to its size relative to the
total resistance.
230
Section III Practical
PRACTICAL NO 3: Analysis:
231
Section III Practical
This thermoelectric voltage depends on the This contribution describes procedure of the
temperatures of measured junction and reference evaluation of thermocouple calibration. The
junction (See Fig.1). Our task will be find out evaluation in defined fixed point is not difficult,
relation between thermoelectric voltage and because we have equal number of calibration
temperature, also we do calibration. points and unknown parameters. We can solve it
for example by applying some elimination
methods. More interesting for us is the
evaluation of calibration by comparison method.
Here we have more calibration points than
unknown parameters. For this reason has to be
used statistical evaluation method. The
Evaluation of calibration is done by the method
of least square, usually when covariance matrix
is known. However this work suggests solutions
to fill up the covariance matrix under certain
condition. Calibration is used not only for
evaluating unknown parameters, but for
determining their uncertainties, too. The main
II. Calibration of thermocouple purpose of the work is giving directions for
these. The covariance matrix contains besides
Calibration is a set of operations that establish, known values of the squares of uncertainties
under specified conditions, the relationship and covariances of Type B also uncertainties
between values of quantities indicated by a characterizing variances and covariances of the
measuring instrument (in our case the measurement (Type A uncertainties).
thermocouple) and the corresponding values
realized by standards (defined fixed points or
IV. Calibration model
interpolation instruments).
Unfortunately thermocouples has nonlinear
The thermocouple can be calibrated by more
output response, accordingly we must consider a
methods, depending on the type of
polynomial function (Eq. 1). This equation
thermocouple, the temperature range, and the
presents transformation function.
accuracy required. These methods provide
traceability to the International Temperature
E = a0 + a1t + a2t2 + . . . + apt p --- (1)
Scale of 1990 (ITS-90). In the first method,
thermocouples are calibrated in defined fixed
232
Section III Practical
E μ thermoelectric voltage (° V)
t- temperature (ČC)
a0, a1, a2,....ap μ unknown parameters
V. Conclusion
233
Section III Practical
Using a Simple Pendulum to Measure the 1. Use your results to find a value for g.
Acceleration due to Gravity 2. The accepted value for g (in Paris) is
9.81Nkg-1. Calculate the percentage
Theory suggests that the time period of a difference between your final figure for g
simple pendulum can be calculated using the and the accepted value.
following equation
3. Calculate a value for g using the result
corresponding to a pendulum of length
0.3m. Assuming that your reaction time
is 0·15s, find the uncertainty in this
where, is the length of the pendulum and
result. State the figure in the usual way
g is the acceleration due to gravity.
(g = x ± x Nkg-1). Comment on the
Assuming that this equation is correct, use a level of precision of this result compared
simple pendulum to find the acceleration with your final result.
due to gravity.
Your will probably measure the time periods
corresponding to various lengths but be sure
to have one result for a pendulum of length
0.3m.
Fig. 5
234
Section III Practical
PRACTICAL NO 6
The Law of Reflection: The law of reflection states that when a ray of
light reflects off a surface, the angle of incidence
Light is known to behave in a very predictable is equal to the angle of reflection.
manner. If a ray of light could be observed
approaching and reflecting off of a flat mirror,
then the behavior of the light as it reflects would
follow a predictable law known as the law of
reflection. The diagram below illustrates the law
of reflection.
Fig. 6
235
Section III Practical
PRACTICAL NO 7 Refraction:
To verify the law of refraction of light When we talk about the speed of light, we're
usually talking about the speed of light in
The Law of Refraction: a vacuum, which are 3.00 x 108 m/s. When light
travels through something else, such as glass,
When light travels from one medium to another, diamond, or plastic, it travels at a different
it generally bends, or refracts. The law speed. The speed of light in a given material is
of refraction gives us a way of predicting the related to a quantity called the index of
amount of bend. This law is more complicated refraction, n, which is defined as the ratio of the
than that for reflection, but an understanding of speed of light in vacuum to the speed of light in
refraction will be necessary for our future the medium:
discussion of lenses and their applications. The
law of refraction is also known as Snell's law, Index of refraction:
named for Willobrord Snell, who discovered the
law in 1621. n = c / v , where v is the speed of light in a
medium and c is the speed of light in vacuum.
Snell's law gives the relationship between angles
of incidence and refraction for a wave impinging
on an interface between two media with
different index of refraction. The law follows
from the boundary condition that a wave be
continuous across a boundary, which requires
that the phase of the wave be constant on any
given plane, resulting in
Rules of Refraction:
Fig. 7.1
236
Section III Practical
Fig. 7.5
Theory:
237
Section III Practical
Fig. 7.6
Conclusions:
238
Section III Practical
239
Section III Practical
But OG = OF =R
240
Bibliography
Dr. E., Bellis Clayton, 1974. Static Electricity. In: P. M. Scott, ed. Electrotherapy and Actinotherapy.
London: