Why we should care about soft tissue interfaces when applying ultrasonic diathermy: an experimental and computer simulation study

BACKGROUND: One goal of therapeutic ultrasound is enabling heat generation in tissue. Ultrasound application protocols typically neglect these processes of absorption and backscatter/reflection at the skin/fat, fat/muscle, and muscle/bone interfaces. The aim of this study was to investigate the heating process at interfaces close to the transducer and the bone with the aid of computer simulation and tissue-mimicking materials (phantoms). METHODS: The experimental setup consists of physiotherapeutic ultrasound equipment for irradiation, two layers of soft tissue-mimicking material, and one with and one without an additional layer of bone-mimicking material. Thermocouple monitoring is used in both cases. A computational model is used with the experimental parameters in a COMSOL® software platform. RESULTS: The experimental results show significant temperature rise (42 °C) at 10 mm depth, regardless of bone layer presence, diverging 3 °C from the simulated values. The probable causes are thermocouple and transducer heating and interface reverberations. There was no statistical difference in the experimental results with and without the cortical bone for the central thermocouple of the first interface [t(38) = −1.52; 95% CI = −0.85, 0.12; p = 14]. Temperature rise (>6 °C) close to the bone layer was lower than predicted (>21 °C), possibly because without the bone layer, thermocouples at 30 mm make contact with the water bath and convection intensifies heat loss; this factor was omitted in the simulation model. CONCLUSIONS: This work suggests that more attention should be given to soft tissue layer interfaces in ultrasound therapeutic procedures even in the absence of a close bone layer.