EMS Physio

Ultrasound and how it works

Watch a Video about Ultrasound Therapy

Ultrasound Sound is mechanical vibration. The human ear responds to these vibrations in the range 20 Hz to 20 kHz. Sound above 20 kHz is called ultrasound. Therapeutic ultrasound is sound in the range 500 kHz to 5 MHz.

Sound waves are produced by some disturbance in a material medium causing the particles or molecules of the medium to vibrate. For this reason sound will not pass through a vacuum. If the vibration is continuous and regular a constant tone or frequency is produced. The vibration or sound wave propagates through the medium as particles in the medium pass on their vibration to neighbouring particles and series of compressions and rarefactions are produced in the direction of travel of the wave. Therefore, sound waves are longitudinal waves.

Sound will travel faster through media where the molecules are closer together and so the velocity is higher in solids than in liquids, and higher in liquids than in gasses. For example, the velocity of sound in stainless steel is approximately 5800 m/s, in water 1500 m/s and in air only 330 m/s.

As the sound wave passes through the medium, causing molecules to vibrate, some of the energy in the wave is converted from kinetic energy to heat. For a collimated sonic beam the intensity, power per unit area, therefore, decreases exponentially with the distance travelled.

The attenuation of the beam is also dependent upon the frequency of the sound. In solids the attenuation is proportional to frequency, whereas in liquids the attenuation is proportional to the square of the frequency. The usual method of specifying the degree of attenuation of ultrasound in different media is by the half depth. The half depth is the distance the ultrasound must travel through the medium for its intensity to be reduced to one half of its original value.

Many attempts have been made to measure the attenuation in various types of tissue with varying results. It is perhaps more important to remember which types of tissue have the highest absorption and which the lowest. With the lowest absorption first the order is, fat, muscle, skin, tendon, cartilage and bone. For soft tissue the half depth is around 50 mm at 1 MHz and 15 mm at 3 MHz.

It is also important to remember that where there is a change in medium or tissue type there will be both reflection and refraction of the ultrasound beam. In particular, there is almost 100% reflection at the interface of a solid or liquid to air at therapeutic ultrasound frequencies. Any air bubbles in coupling medium will therefore reduce the effective intensity of the ultrasound. Also bone reflects a high percentage of incident ultrasound. It is important, therefore, when applying ultrasound to keep the transducer orthogonal to the surface of the treatment area, to keep the ultrasound transducer moving and to use a good coupling medium to avoid unwanted reflections and locally high intensities.

Contraindications

• Tumours, as ultrasound affects tissue repair and could therefore encourage growth
• Infections, due to the risk of spreading the infection
• Pregnancy, treatment over the pregnant uterus as ultrasound could affect rapidly dividing cells
• Radiotherapy, sites that have received radiotherapy treatment during the last six months
• Thrombosis and impaired circulation.
• Areas of impaired sensation
• Haemorrhage, due to the risk of increased bleeding, including recently controlled bleeding and haematoma. Haemophilia
• Implanted devices such as cardiac pacemakers should be avoided due to the possibility of affecting their operation. Also some plastics used in replacement surgery may be affected by absorption of ultrasound energy. Metal implants may lead to reflections, and as a precaution low doses of ultrasound should be used near these.
• Extreme care should be taken when treating areas near the eye because of the danger of damage to the retina.
• Similarly, extreme care should be taken near the ears and reproductive organs