| Peer-Reviewed

Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions

Received: 13 March 2017    Accepted: 14 March 2017    Published: 23 March 2017
Views:       Downloads:
Abstract

Background: Sound travels in waves that transport energy from one location to another. Ultrasound is the name given to sound waves that have frequencies greater than 20000Hz. It's too high pitched for human hearing, but many animals, such as dogs, cats and bats can hear ultrasound. As the ultrasound waves travel through tissues, they are partly transmitted to deeper structures, partly reflected back to the transducer as echoes, partly scattered, and partly transformed to heat. The amount of echo returned after hitting a tissue interface is determined by a tissue property called acoustic impedance which is an intrinsic physical property of a medium defined as the density of the medium times the velocity of ultrasound wave propagation in the medium. Physiologic effect of US: The thermal therapeutic ultrasound include increased tissue temperature, hyperdynamic tissue metabolism, increased local blood flow, increased extensibility of collagen fibers, and reduced viscosity of fluid elements in the tissue. The nonthermal mechanisms include ultrasonic cavitation, gas body activation and mechanical stress or frequency resonance nonthermal processes. Therapeutic effects of US: Therapeutic ultrasound is delivered in two modes; the continuous mode in which the delivery of ultrasound is non-stop throughout the treatment period and the pulsed mode in which the delivery of ultrasound is intermittently interrupted. Essential treatment parameters for therapeutic ultrasound include frequency, intensity, treatment mode, treatment time. Clinical applications: US in damaged muscle accelerates the repair process due to the decrease in the response and number of inflammatory cells and increases the proliferation and differentiation of muscle cell lines together with the formation of the connective tissue, improving mechanical resistance in the early stages. US is used also in chronic pain syndrome, tissue repair and wound healing and extra and intracorporeal shock wave lithotripsy. Cancer therapy: High-intensity focused ultrasound is a noninvasive therapy that makes entire coagulative necrosis of a tumor in deep tissue. HIFU ablation can destroy all proliferating tumor cells and their feeding blood vessels at the same time; this may break interdependent vicious cycle of tumor angiogenesis and tumor growth. Conclusion: Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years. While therapeutic ultrasound is safe for treating many clinical conditions, it may cause substantial bioeffects and patients should be fully informed of possible benefits and risks.

Published in Journal of Surgery (Volume 5, Issue 3-1)

This article belongs to the Special Issue Minimally Invasive and Minimally Access Surgery

DOI 10.11648/j.js.s.2017050301.22
Page(s) 61-69
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Ultrasound, Therapeutic, Physiological Role, Clinical Applications, Precautions

References
[1] O'Brien WD, Jr. Ultrasound—biophysics mechanisms. Prog Biophys Mol Biol. 2007; 93 (1-3): 212–255.
[2] Baker KG, Robertson VJ, Duck, FA. A Review of Therapeutic Ultrasound: Biophysical Effects. J Womens Health Phys Therap. 2010, 34 (3): 111–118
[3] Hendee WR, Ritenour ERII. (2002). Medical Imaging physics. Fourth Edition.., New York, USA. Wiley-Liss, Inc.
[4] Watson, T. "Ultrasound in contemporary physiotherapy practice." Ultrasonics.2008, 48 (4): 321-329.
[5] Chan V, Perlas A. (2011). Basics of Ultrasound Imaging. In: Narouze SN(ed.), Atlas of Ultrasound-Guided Procedures in Interventional Pain Management, © Springer Science+Business Media, LLC, Pp: 13-19
[6] Morishita K, Karasuno H, Yokoi Y, Morozumi K, Ogihara H, Ito T, Fujiwara T, Fujimoto T, Abe K. Effects of Therapeutic Ultrasound on Intramuscular Blood Circulation and Oxygen Dynamics. J Jpn Phys Ther Assoc. 2014; 17 (1): 1–7.
[7] Speed CA. Therapeutic ultrasound in soft tissue lesions. Rheumatology (Oxford) (2001) 40 (12): 1331-1336.
[8] Wessman MS, Kottke FJ.: The effects of indirect heating on peripheral blood flow, pulse rate, blood pressure and temperature. Arch Phys Med Rehabil. 1967, 48: 567-576.
[9] Ebadi S, Ansari NN, Naghdi S, et al. The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial. BMC Musculoskeletal Disorders. 2012; 13: 192. doi:10.1186/1471-2474-13-192.
[10] Chan AK, Myrer JW, Measom GJ, Draper DO. Temperature Changes in Human PatellarTendon in Response to Therapeutic Ultrasound. J Athl Training. 1998; 33 (2): 130–135.
[11] Miller D, Smith N, Bailey M, Czarnota G, Hynynen K, Makin I, American Institute of Ultrasound in Medicine Bioeffects Committee. Overview of Therapeutic Ultrasound Applications and Safety Considerations. J Ultrasound Med. 2012; 31 (4): 623–634.
[12] Johns LD. Nonthermal Effects of Therapeutic Ultrasound: The Frequency Resonance Hypothesis. J Athl Train. 2002; 37 (3): 293–299.
[13] Love L A, Kremkau F W. Intracellular temperature distribution produced by ultrasound. J Accoust Soc Am. 1980; 67: 1045–1050.
[14] Ter Haar G. Ultrasound bioeffects and safety. Proc Inst Mech Eng H 2010; 224 (2): 363-73.
[15] Byl NN, McKenzie AL, West JM et al. Low dose ultrasound effect on wound healing: a controlled study with Yucatan pigs. Arch Phys Med Rehab, 1992, 73: 656–64.
[16] Shankar H, Pagel PS, Potential Adverse Ultrasound-related Biological Effects: A Critical Review. Anesthesiology. 2011; 115 (5): 1109-1124.
[17] Zhou S, Schmelz A, Seufferlein T, Li Y, Zhao J, Bachem MG. Molecular mechanisms of low intensity pulsed ultrasound in human skin fibroblasts. J Biol Chem. 2004 24; 279 (52): 54463-9.
[18] Kloth LC. Roles of Physical Therapists in Wound Management, Part III: Select Biophysical Technologies and Management of Patients With Diabetic Foot Ulceration. J Am College Certified Wound Specialists. 2009; 1 (3): 80-83.
[19] Kim Y, Rhim H, Choi MJ, Lim HK, Choi D. High-Intensity Focused Ultrasound Therapy: an Overview for Radiologists. Korean J Radiol. 2008 Aug; 9 (4): 291–302.
[20] Dalecki D. Mechanical bioeffects of ultrasound. Annu Rev Biomed Eng. 2004; 6: 229–248.
[21] Cordeiro ER, Cathelineau X, Thüroff S, Marberger M, Crouzet S, de la Rosette JJ. High-intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer. BJU Int. 2012; 110 (9): 1228-42.
[22] Feril LB, Jr, Kondo T. Biological effects of low intensity ultrasound: the mechanism involved, and its implications on therapy and on biosafety of ultrasound. J Radiat Res. 2004; 45: 479–489.
[23] Vásquez B, Navarrete J, Farfán E, Cantín M. Effect of pulsed and continuous therapeutic ultrasound on healthy skeletal muscle in rats. Int J Clin Exp Pathol. 2014; 7 (2): 779-783.
[24] Knight LK, Draper OD.: Therapeutic Modalities. The Art and Science 2th ed, Chap 14. Therapeutic ultrasound, Philadelphia Lippincott Williams & Wilkins, 2013, pp. 252-282.
[25] Piedade MC, Galhardo MS, Battlehner CN, Ferreira MA, Caldini EG, de Toledo OM. Effect of ultrasound therapy on the repair of Gastrocnemius muscle injury in rats. Ultrasonics. 2008; 48: 403–11.
[26] Ebadi S, Ansari NN, Henschke N, Naghdi S, van Tulder MW. The effect of continuous ultrasound on chronic low back pain: protocol of a randomized controlled trial. BMC Musculoskeletal Disorders. 2011; 12: 59. doi:10.1186/1471-2474-12-59.
[27] Ebadi S, Henschke N, Nakhostin Ansari N, Fallah E, van Tulder MW. Therapeutic ultrasound for chronic low-back pain. Cochrane Database Syst Rev. 2014 14; (3): CD009169. doi: 10.1002/14651858.CD009169.pub2.
[28] Jia Y. L., Liu X., Yan J. Y., Chong L. M., Li L., Ma A. C., Zhou L., Sun Z. Y. The alteration of inflammatory markers and apoptosis on chronic prostatitis induced by estrogen and androgen. Int. Urol. Nephrol. 2015; 47: 39–46. doi: 10.1007/s11255-014-0845-4.
[29] Lin G, Reed-Maldonado AB, Lin M, Xin Z, Lue TF. Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome. Cho WC, ed. International Journal of Molecular Sciences. 2016; 17 (7): 1057. doi:10.3390/ijms17071057.
[30] Maxwell L. Therapeutic Ultrasound: Its Effects on the Cellular and Molecular Mechanisms of Inflammation and Repair. Physiotherapy. 1992, 10;78 (6): 421–6.
[31] Leung MC, Ng GY, Yip KK. Effect of ultrasound on acute inflammation of transected medial collateral ligaments. Arch Phys Med Rehabil. 2004; 85 (6): 963–6.
[32] Zhou S, Schmelz A, Seufferlein T, Li Y, Zhao J, Bachem MG. Molecular mechanisms of low intensity pulsed ultrasound in human skin fibroblasts. J Biol Chem. 2004 Dec 24; 279(52): 54463–9.
[33] Nussbaum E. The influence of ultrasound on healing tissues. J Hand Ther. 1998 Jun; 11 (2): 140–7.
[34] Maan ZN, Januszyk M, Rennert RC, et al. Noncontact, Low-Frequency Ultrasound Therapy Enhances Neovascularization and Wound Healing in Diabetic Mice. Plastic and reconstructive surgery. 2014; 134 (3): 402e-411e. doi:10.1097/PRS.0000000000000467.
[35] Lowe G, Knudsen BE. Ultrasonic, pneumatic and combination intracorporeal lithotripsy for percutaneous nephrolithotomy. J Endourol. 2009;23:1663–1668.
[36] Kremkau FW. Cancer therapy with ultrasound: a historical review. J Clin Ultrasound. 1979;7 (4): 287-300.
[37] Wu F. High intensity focused ultrasound: A noninvasive therapy for locally advanced pancreatic cancer. World Journal of Gastroenterology : WJG. 2014; 20 (44): 16480-16488. doi:10.3748/wjg.v20.i44.16480.
[38] Wu F, Chen WZ, Bai J, Zou JZ, Wang ZL, Zhu H, Wang ZB. Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound. Ultrasound Med Biol. 2001; 27: 1099–1106.
[39] Kennedy JE. High-intensity focused ultrasound in the treatment of solid tumours. Nat Rev Cancer. 2005; 5: 321–327.
[40] Barati AH, Mokhtari-Dizaji M, Mozdarani H, Bathaie SZ, Hassan ZM. Treatment of murine tumors using dual-frequency ultrasound in an experimental in vivo model. Ultrasound Med Biol. 2009; 35 (5): 756-63.
[41] Keane MG, Bramis K, Pereira SP, Fusai GK. Systematic review of novel ablative methods in locally advanced pancreatic cancer. World J Gastroenterol. 2014; 20: 2267–2278.
[42] Shen, Z., Wu, M., Zhang, Y., Shen, K., & Xia, G. Treatment of hepatic carcinoma by low-frequency ultrasound and microbubbles: A case report. Oncology Letters, 2015. 9, 1249-1253.
[43] Dubinsky TJ, Cuevas C, Dighe MK, Kolokythas O, Hwang JH. High-Intensity Focused Ultrasound: Current Potential and Oncologic Applications. Am J Roentgenology 2008 190: 1, 191-199.
[44] Marberger M. Ablation of renal tumours with extracorporeal high-intensity focused ultrasound. BJU Int. 2007 May;99(5 Pt B):1273-6.
[45] Wu F. Extracorporeal high intensity focused ultrasound in the treatment of patients with solid malignancy. Minim Invasive Ther Allied Technol. 2006; 15 (1): 26-35.
[46] Guan L, Xu G. Damage effect of high-intensity focused ultrasound on breast cancer tissues and their vascularities. World J Surg Oncol. 2016 26; 14 (1): 153.
[47] Li S, Pei-Hong W. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer. Chin J Cancer. 2013; 32 (8): 441–52.
[48] Zhou Y-F. High intensity focused ultrasound in clinical tumor ablation. World Journal of Clinical Oncology. 2011; 2(1): 8-27. doi:10.5306/wjco.v2.i1.8.
[49] Kyung Won Kim KW, Lee JK, Lee JM, Jeon YS, Choi YS, Park J, Kim H, Han JK, Choi BI, High-intensity Focused Ultrasound Ablation of Soft-tissue Tumors and Assessment of Treatment Response with Multiparametric Magnetic Resonance Imaging: Preliminary Study Using Rabbit VX2 Tumor Model. J Med Ultrasound 2014, 22, (2): 99–105.
[50] Maruf F. A., Umunnah J. O., Akosile C. O. Potential Hazards and Possible Safety Precautions inElectrotherapy. AJPARS, 2013, 5, (1 & 2): 8–15.
[51] Joy J / Cooke I, Love M. Is ultrasound safe? The Obstetrician & Gynaecologist. 2011, 8, (4): 222–227.
[52] Ahmadi F, McLoughlin IV, Chauhan S, ter-Haar G. Bio-effects and safety of low-intensity, low-frequency ultrasonic exposure. Prog Biophys Mol Biol. 2012; 108 (3): 119-38.
[53] Michelle H. Cameron. (2013). Physical Agents in Rehabilitation From Research to Practice. Fourth edition. Saunders (ISBN13: 9781416032571).
[54] Houghton PE, Nussbaum EL, Hoens AM. Electrophysical agents – contraindications and precautions: An evidence-based approach to clinical decision making in physical therapy. Physiother Can. 2012; 62 (5): 1-80.
Cite This Article
  • APA Style

    Asmaa Aly Saber, Aly Saber. (2017). Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions. Journal of Surgery, 5(3-1), 61-69. https://doi.org/10.11648/j.js.s.2017050301.22

    Copy | Download

    ACS Style

    Asmaa Aly Saber; Aly Saber. Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions. J. Surg. 2017, 5(3-1), 61-69. doi: 10.11648/j.js.s.2017050301.22

    Copy | Download

    AMA Style

    Asmaa Aly Saber, Aly Saber. Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions. J Surg. 2017;5(3-1):61-69. doi: 10.11648/j.js.s.2017050301.22

    Copy | Download

  • @article{10.11648/j.js.s.2017050301.22,
      author = {Asmaa Aly Saber and Aly Saber},
      title = {Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions},
      journal = {Journal of Surgery},
      volume = {5},
      number = {3-1},
      pages = {61-69},
      doi = {10.11648/j.js.s.2017050301.22},
      url = {https://doi.org/10.11648/j.js.s.2017050301.22},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.s.2017050301.22},
      abstract = {Background: Sound travels in waves that transport energy from one location to another. Ultrasound is the name given to sound waves that have frequencies greater than 20000Hz. It's too high pitched for human hearing, but many animals, such as dogs, cats and bats can hear ultrasound. As the ultrasound waves travel through tissues, they are partly transmitted to deeper structures, partly reflected back to the transducer as echoes, partly scattered, and partly transformed to heat. The amount of echo returned after hitting a tissue interface is determined by a tissue property called acoustic impedance which is an intrinsic physical property of a medium defined as the density of the medium times the velocity of ultrasound wave propagation in the medium. Physiologic effect of US: The thermal therapeutic ultrasound include increased tissue temperature, hyperdynamic tissue metabolism, increased local blood flow, increased extensibility of collagen fibers, and reduced viscosity of fluid elements in the tissue. The nonthermal mechanisms include ultrasonic cavitation, gas body activation and mechanical stress or frequency resonance nonthermal processes. Therapeutic effects of US: Therapeutic ultrasound is delivered in two modes; the continuous mode in which the delivery of ultrasound is non-stop throughout the treatment period and the pulsed mode in which the delivery of ultrasound is intermittently interrupted. Essential treatment parameters for therapeutic ultrasound include frequency, intensity, treatment mode, treatment time. Clinical applications: US in damaged muscle accelerates the repair process due to the decrease in the response and number of inflammatory cells and increases the proliferation and differentiation of muscle cell lines together with the formation of the connective tissue, improving mechanical resistance in the early stages. US is used also in chronic pain syndrome, tissue repair and wound healing and extra and intracorporeal shock wave lithotripsy. Cancer therapy: High-intensity focused ultrasound is a noninvasive therapy that makes entire coagulative necrosis of a tumor in deep tissue. HIFU ablation can destroy all proliferating tumor cells and their feeding blood vessels at the same time; this may break interdependent vicious cycle of tumor angiogenesis and tumor growth. Conclusion: Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years. While therapeutic ultrasound is safe for treating many clinical conditions, it may cause substantial bioeffects and patients should be fully informed of possible benefits and risks.},
     year = {2017}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Therapeutic Ultrasound: Physiological Role, Clinical Applications and Precautions
    AU  - Asmaa Aly Saber
    AU  - Aly Saber
    Y1  - 2017/03/23
    PY  - 2017
    N1  - https://doi.org/10.11648/j.js.s.2017050301.22
    DO  - 10.11648/j.js.s.2017050301.22
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 61
    EP  - 69
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.s.2017050301.22
    AB  - Background: Sound travels in waves that transport energy from one location to another. Ultrasound is the name given to sound waves that have frequencies greater than 20000Hz. It's too high pitched for human hearing, but many animals, such as dogs, cats and bats can hear ultrasound. As the ultrasound waves travel through tissues, they are partly transmitted to deeper structures, partly reflected back to the transducer as echoes, partly scattered, and partly transformed to heat. The amount of echo returned after hitting a tissue interface is determined by a tissue property called acoustic impedance which is an intrinsic physical property of a medium defined as the density of the medium times the velocity of ultrasound wave propagation in the medium. Physiologic effect of US: The thermal therapeutic ultrasound include increased tissue temperature, hyperdynamic tissue metabolism, increased local blood flow, increased extensibility of collagen fibers, and reduced viscosity of fluid elements in the tissue. The nonthermal mechanisms include ultrasonic cavitation, gas body activation and mechanical stress or frequency resonance nonthermal processes. Therapeutic effects of US: Therapeutic ultrasound is delivered in two modes; the continuous mode in which the delivery of ultrasound is non-stop throughout the treatment period and the pulsed mode in which the delivery of ultrasound is intermittently interrupted. Essential treatment parameters for therapeutic ultrasound include frequency, intensity, treatment mode, treatment time. Clinical applications: US in damaged muscle accelerates the repair process due to the decrease in the response and number of inflammatory cells and increases the proliferation and differentiation of muscle cell lines together with the formation of the connective tissue, improving mechanical resistance in the early stages. US is used also in chronic pain syndrome, tissue repair and wound healing and extra and intracorporeal shock wave lithotripsy. Cancer therapy: High-intensity focused ultrasound is a noninvasive therapy that makes entire coagulative necrosis of a tumor in deep tissue. HIFU ablation can destroy all proliferating tumor cells and their feeding blood vessels at the same time; this may break interdependent vicious cycle of tumor angiogenesis and tumor growth. Conclusion: Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years. While therapeutic ultrasound is safe for treating many clinical conditions, it may cause substantial bioeffects and patients should be fully informed of possible benefits and risks.
    VL  - 5
    IS  - 3-1
    ER  - 

    Copy | Download

Author Information
  • Department of Physical Therapy, Port-Fouad General Hospital, Port-Said, Egypt

  • Department of General Surgery, Port-Fouad General Hospital, Port-Said, Egypt

  • Sections