ULTRASOUND THERAPY

TEJASWINI
ULTRASOUND THERAPY
WHAT IS ULTRASOUND THERAPY

Ultrasound therapy can be defined as the

treatment of the patients by ultrasound .
This means ultrasound energy is applied to
the body to bring physiological changes for
therapeutic purpose .
 NATURE OF SONIC WAVES
Human ear can appreciate sound energy
within the range of 20 - 20,000 Hz
Sound waves below the audible range is
called as infrasound
Sound waves above the audible range is
called as Ultrasound
Frequency of therapeutic ultrasound is
1MHz 3 MHz
 NATURE OF SONIC WAVES
Sonic waves are called as longitudinal
waves because they cause compression
and rarefaction in the direction of travel .
Ultrasonic waves cannot travel in the
vacuum .
Ultrasound obeys the laws of reflection ,
refraction , absorption .
PRODUCTION OF ULTRASOUND
PRINCIPLE OF PRODUCTION
It is not possible to produce ultrasound by
mechanical means ;
So the ultrasound is produced by the
application of the rapidly Alternating
Current by the piezoelectric crystal .
For the production of ultrasound barium
titanate , lead zirconate titanate crystals
are used .
 PIEZO ELECTRIC EFFECT
The word Piezo means pressure
Application of pressure, compression and
rarefaction or deformation of the crystal
produces electrical charges in the crystal .
Mechanical energy is converted into
Electrical energy.
Mechanical Energy Electrical Energy

Electrical Energy Mechanical Energy

Direct Reverse
Piezoelectric Effect Piezoelectric effect

US
 REVERSE PIEZO ELECTRIC
EFFECT
Application of electricity or P.D across the
crystal produces oscillations or
deformations or pressure changes in the
crystal .
So ultrasound point of view Reverse Piezo
Electric effect is the basic principle which
is used in the production of ultrasound .
CONSTRUCTION OF ULTRASOUND
CONSTRUCTION OF ULTRASOUND
The ultrasound generator consists of oscillator
circuit , controlling circuit , resistance circuit , co-
axial cable , transducer .
Transducer consists of link electrode , quartz
crystal , metal front plate .
Oscillator circuit produces high frequency
alternating current .
Resistance circuit controls the amplitude of the
ultrasound waves by controlling the amplitude of
the high frequency currents .
 Metal front plate
Quartz crystal
Link Electrode
Main power supply

1 MHz A.C (or)

Source of H.F US Beam
Current Coaxial Cable
TRNASDUCER OF THE U.S
CONSTRUCTION OF ULTRASOUND
Controlling circuits produces pulsed output .
Co axial cable which transfer the high
frequency current from the generator to the
crystal .
Crystal acts as the source of the ultrasound
waves .
Transducer or treatment head serves as an
applicator .
PARAMETERS ULTRASOUND
1) Main switch
2) Timer
3) Intensity control
4) Meter
5) Mode of ultrasound
6) Mark space ratio
The function of the main switch is to on
and off the machine .
The function of the timer is to adjust the
treatment time .
Coaxial cable
PARAMETERS ULTRASOUND
The function of the intensity knob is to
adjust the intensity of the sound waves .
The meter helps to measure the dosage .
Mark : space ratio can be adjusted as per
the requirements .
Usually higher output and less interval is
preferred in chronic 1:1 is for chronic and
1:4 for acute conditions .
 WORKING OF ULTRASOUND
When power is supplied to the oscillator
circuit it produces high frequency
alternating currents .
Pulse mode switch on the controlling
circuit , produces interrupted or pulsed
output .
The intensity is controlled by resistance
circuit .
 WORKING OF ULTRASOUND
The high frequency current produced by the
generator is fed to the crystal by coaxial
cable , via a linking electrode .
The crystal being fused to the metal front
plate of the treatment head .
Any change in the shape of the crystal
causes a movement of the metal front plate ,
which produces an ultrasonic wave .
TRANSMISSION OF SONIC WAVE
Us beam emitted is not uniform even in a
homogenous medium (BNR)-Beam Non
uniformity Ratio.
BNR is the ratio between peak intensity and
average intensity in the beam .
Lower the BNR more uniform is the beam .
Irregular pattern of sonic waves in the region
close to the transducer face is called as near
field / fresnal zone
Sonic field spread out and become more regular
is called as far filed / fraunhofer zone .
 NEAR FIELD
The length of near field will depend on two
factors .
1) Directly on the square of the radius of the
transducer face .
2) Inversely on the wavelength of the US
Length of near field = r2/
For e.g. a 3cm diameter transducer working at
1 MHz would have near field up to 15cm from
the treatment head .
R= 15mm , r2= 225mm
225/1.5 = 150 mm = 15cm
BNR for Near field
Peak intensity

Average intensity

BNR for Near field

BNR for Far field
Peak intensity

Average intensity

BNR for Far field

Length of near field for different sized
transducer at various frequencies

Transducer size Frequency (MHz)

Diameter Radius 0.75 1 1.5 3

(cm) (cm)
2 1 5cm 6.7cm 10cm 20cm
3 1.5 11.25 15cm 22.5cm 45cm

5 2.5 31.25 41.16 62.5cm 125cm

ABSORPTION OF SONIC WAVES
Ultrasound will increase the motions of
molecules causing more molecular vibrations
and molecular collisions resulting in heat .
Kinetic energy is converted in to thermal energy
as it passes through the tissues .
The energy will decrease with distance from the
source . So that the remaining energy will
become smaller and smaller percentage of the
initial intensity .
There is an inverse relationship B/W the
penetration of ultrasound and absorption of
ultrasound .
 HALF VALUE DEPTH
Half value depth is the depth or distance at
which half the initial energy has been
absorbed .
Half value depth will be different in different
tissues .
Absorption of sonic energy is greatest in
tissues with the largest amount of structural
proteins and lowest water content.
 PROTEIN CONTENT &
ABSORPTION OF US
Blood least protein cont least abs of US
Fat
Nerve
Muscle
Skin
Tendon
Cartilage
Bone Greatest protein cont greatest abs US
PROTEIN CONTENT &
ABSORPTION OF US
 ATTENUATION OF ULTRASOUND
Gradual reduction in the intensity of
ultrasound is called attenuation.
Attenuation depends on
1) Absorption
2) Scattering
Absorption accounts for 60-80% of the
energy loss from the beam .
Scattering is caused by reflections &
refractions .
PHYSIOLOGICAL EFFECTS OF
ULTRASOUND
 PHYSIOLOGICAL EFFECTS
When US waves are absorbed in the tissues ,
they produce physiological effects related to
their physical effects .

Ultrasound energy

Micro massage Heat

(mechanical effect ) (thermal effect )
 THERMAL EFFECTS
The amount of sonic energy which is
converted into thermal energy is proportional
to the intensity of the ultrasound
If the heat is not dissipated by the normal
physiological means a local rise in
temperature occurs and thermal effects will
result .
Non-thermal effects are achieved by using
low intensities or by pulsed output .
 EFFECTS OF TISSUE HEATING
Increase metabolism
Increase blood flow
Increase extensibility of soft tissue
Decrease viscosity of blood
Stimulate immune system
Reduce pain
Induce muscle relaxation
Thermal effects are used to relieve pain , muscle
spasm .
The extensibility of the collagen is increased by
rise in temperature and so stretching the scar
tissue or adhesions is easier following ultrasound .
NON THERMAL EFFECTS
 CAVITATION
Cavitation is the formation of tiny gas bubbles in
the tissues as a result of ultrasound
These bubbles are generally a micron 10-6 m In
diameter .
They can grow much larger under some
circumstances
There are two types of Cavitation
1) Stable Cavitation
2) Unstable transient Cavitation
STABLE & UNSTABLE CAVITATION
Stable Cavitation occurs when the bubbles
oscillate to and fro within the ultrasound
pressure waves but remains intact .
Transient Cavitation occurs when the volume
of the bubble changes rapidly and then
collapses .
Unstable Cavitation causes high pressure
and temperature changes and results in
gross damage to tissues.
Pulsed ultrasound reduces the risk of
damage due to Cavitation .
 ACOUSTIC STREAMING
This is a steady circulatory flow due to
ultrasound application .
As a result of Cavitation there is a localized ,
unidirectional fluid movement around the
vibrating bubble.
These very small fluid movements also
occurs around cells this effects are also
called as micro streaming.
 STANDING WAVES
Superimposition of reflected wave and incident
wave is called as standing waves .
Standing wave use to cause stasis of cells in the
blood vessels .
The endothelium of the blood vessels exposed to
standing waves can also cause damage leads
to thrombus formation .
There is also the possibility of marked
temperature .
Standing waves can be prevented by moving the
transducer continuously during the treatment .
 MICROMASSAGE

The waves of compression and rarefaction

may produce a form of Micromassage .
Micromassage effect is used to reduce
oedema and to break adhesions .
BIOLOGICAL EFFECTS
 BIOLOGICAL EFFECTS
US has got effect in all three stages of repair.
Inflammatory stage :
US increases the fragility of lysosome
membrane, and enhances the release of their
contained enzymes .
Enzymes will help to clear the debris and
allow next stage to occur .
 BIOLOGICAL EFFECT
Proliferative stage :
Fibroblasts are stimulated to produce the
collagen fibers to form scar tissue .
Myofibroblasts contract to pull the edges
together .
Remodelling :
US increases the tensile strength of the scar
tissue by affecting strength and elasticity of
fibers which make up scar tissue .
THERAPEUTIC USES
 THERAPEUTIC USES
Ultrasound is often used after soft tissue
injuries as the mechanical effects help to
remove exudates and reduces the danger
of adhesion formation.
Heat produced by ultrasound in large
diameter nerve fibers may reduce pain
through gate mechanism .
Accelerated protein synthesis stimulates
the rate of repair of damaged tissues .
 THERAPEUTIC USES
Scar tissue
Scar tissue is made pliable by the application
of ultrasound ,
Ultrasound allows more effective stretching of
contracted scars .
If the scar is bound on underlying structures
ultrasound may help in gaining its release .
 THERAPEUTIC USES
Chronic oedema
The mechanical effects of ultrasound have
an effect on chronic oedema.
Mechanical effects also breaks adhesions
formed between adjacent structures .
Reduce pain
Healing of wound
Break adhesions
Placebo effect
 THERAPEUTIC USES
Reduce pain
Healing of wound
Break adhesions
Placebo effect
INDICATIONS
 INDICATIONS
Tennis elbow Muscle strain
Golfers elbow Ligament sprain
Supraspinatous tendinitis Duputrens contracture
De Quervains disease Tenosynovitis
Bicipital tendinitis Tendon / muscle
Subdeltoid bursitis contracture
Subacromial bursitis Adhesion of structure
Metatarsalgia around joint .
Plantar fascitis Chronic oedema
Calcaneal spur
PULSED ULTRASOUND
 PULSED ULTRASOUND
If ultrasonic energy is applied with rest between
each and every ultrasonic beam that is called
as pulsed ultrasound .
A circuit in the ultrasound generator is arranged
to turn the ultrasound on in short bursts or
pulses .
Continuous mode : here the US is produced
continuously from transducer .
Pulsed mode : here the ultrasound is made on
for some time off for some time .
 PULSED ULTRASOUND
In pulsed ultrasound more non-thermal and
mechanical effects are obtained than thermal
effects .
Many therapeutic US produces 2 ms pulses
and varying intervals between pulses .
This pulsed US can be expressed in different
ways .
 PULSED ULTRASOUND CAN BE
EXPRESSED BY :
X seconds ON , Y seconds OFF
Mark : Space ratio is the ratio of ON and OFF
time .
Time on is called as mark
Time off is called as space
Some apparatus have fixed M:S ratio of 2:8
others may have variable mark : space ratio
of 1:1, 1:4, 1:7, 1:10 .
A common pulse regime of 2 ms ON , 8 ms
OFF gives a mark space ratio of 1:4 .
 PULSED ULTRASOUND CAN BE
EXPRESSED BY :
Duty cycle : which is the ratio of pulse length to the
total length of pulse + interval expressed as a
percentage X X 100%
X+Y
Mark : space ratio of 1:4 causes 20% of duty cycle
X - Seconds ON = 2 ms
Y- Seconds OFF = 8ms
X X 100%; 2 X 100%; 2 X 100 = 20%
X+Y 2+8 10
 PULSED ULTRASOUND
Pulse period Interval Mark : Space Duty cycle
period ratio
2 ms 2ms 1:1 50%

2 ms 8 ms 1:4 20%

2 ms 14 ms 1:7 12.5%

2ms 20 ms 1:10 9.9%

 ADVANTAGES OF PULSED
ULTRASOUND
High intensity can be safely used
Bony prominent areas can be treated
Standing waves can be prevented
Unstable cavitation can be prevented
Thermal burns can be prevented
DISADVANTAGES OF ULTRASOUND
Thermal effect cannot be achieved by pulsed
US
 COUPLING MEDIA
Ultrasonic waves not transmitted by air, thus some
coupling media which transmit ultrasound must be
placed between the treatment head and the patient
skin .
Characteristics of coupling media
an acoustic impedance must be similar to the
tissues .
High transmission of ultrasound
Low susceptibility of bubble formation
Chemically inactive nature
Hypo allergic character
Relative sterility
It should be cheap
It should be transparent
 COUPLING MEDIA

The coupling media also acts as a lubricant

to allow the treatment head to move
smoothly over the skin .
Unfortunately no coupling media affords
perfect transmission of ultrasound
Only percentage of the original intensity is
transmitted to the patient .
 Percentage of transmission of US
for various coupling media
Coupling media Percentage of transmission
Aquasonic gel 72.6%
Glycerol 67%
Distilled water 59%
Liquid paraffin 19%
Air 0%
Petroleum jelly 0%
 COUPLING MEDIA

The air will reflect ultra sound beam back

into the treatment head and setup a
standing wave which might cause
damage to the crystal .