Microwave diathermy induces mitogen-activated protein kinases and tumor necrosis factor-α in cultured human monocytes.

Although rehabilitation practice for most patients consists of a combined use of thermotherapy that is produced from diathermy devices resulting faster and deeper heating to the patient, major concerns about occupational exposure to electromagnetic radiation for the operators must be considered. In most occasions, physiotherapists have involved multi-hour treatment sessions to different patients, resulting overuse of the diathermy device. Recently, our team along with other groups have raised serious concerns about the occupational safety aspects related to microwave diathermy (MWD) use. Driven by these recent reports, in this work, we tried to investigate the in vitro effects of a physiotherapist routine MWD device regarding its potential inflammatory biological effects that could be evoked in human cultured monocytes. Our results show that MWD does not alter the integrity of the cell membrane and, consequently, the viability of monocytes as assessed by Trypan blue and MTT measurements. Then again, members of the MAPK family (p38 and ERK1/2) were activated upon MWD exposure at 5-30 min, eventually leading to a time-dependent considerable increase in TNF-α production, a key pro-inflammatory mediator. Our results are indicative of a stress-activated phenomenon of monocytes upon MWD radiation, which could trigger potential hazardous cellular outcomes due to thermal and/or non-thermal bystander effects. Our results deserve further investigation, planned by our team in due course, to delineate the clinical correlations of these findings.

Microwave diathermy in physiotherapy units: a survey on spatial and time heterogeneity of the electromagnetic field.

Microwave diathermy (MWD) is a therapeutic system that has been in use for some decades now in all physiotherapy settings, following the regulations of national facility establishments. The validity of diathermy devices is probably reduced as their working time increases, introducing the need for the device to be controlled/reset by qualified personnel in order to maintain its effectiveness in sessions and to accurately deliver the energy output that the physiotherapist asks for. However, while MWD has been a vital tool for practising physiotherapists, there is no clear evidence of a health burden due to incorrect usability. Additionally, due to the fact that physiotherapy rooms contain physiotherapeutic equipment it is observed that during the use of the diathermy device there is spatial heterogeneity in the interior space. In this work, the results are presented of the first national survey for quality control of MWD systems installed in physiotherapy rooms existing in urban and rural areas in Greece. Serious concerns about the technical status of the equipment as well as staff and patient safety, regarding the levels of non-ionising radiation emitted from MWD devices, are discussed. Additional evaluation is included of measurements in empty physiotherapy rooms while the MWD unit is transmitting at three different input powers (50 W/100 W/150 W-these are the therapeutic protocols used most frequently by physiotherapists) and in fully equipped physiotherapy rooms. Field strengths measured around MWDs normally working at different angles, distances and times compared to international limits revealed great spatial and time heterogeneity, raising serious concerns about the safety of occupational workers or other patients.

MAGNETO-THERAPY IN PHYSIOTHERAPY UNITS: INTRODUCTION OF QUALITY CONTROL PROCEDURE DUE TO LACK OF MAINTENANCE.

Rehabilitation practice for many patients consisting of a combined use of magneto therapy resulting emission of low frequency magnetic fields to the patient, elicit concerns about occupational exposure to electromagnetic radiation (EMR) for the operators. The time extended use of the device periodically leads to mechanical failures or troubleshooting of the machine which, in most cases, are not perceived by the operator of the device. All device's efficient functionality have a major impact on the completion of the treatment procedure in a large percentage of specific clinical conditions. If the device's operating condition is technically out of order or in a mode of over-activity, operators are mainly seeking solutions by reviewing the clinical case of the patient. This eliminates their contribution during the primary therapeutic plan or increases the treatment sessions. In this work, an extended survey is presented including 75 physiotherapy centres concerning usability and maintenance issues of magneto therapy devices throughout Greek territory combined with extended measurements of Electromagnetic Radiation in the unit room were performed. Physiotherapists' perceptions revealed lack of technical support, maintenance and safe use of magneto therapy devices that extract auxiliary observations upon their clinical practice routines. Additionally safety measurements have not revealed field strengths over International Reference Levels which could result health risks for users and coexisting patients. The pilot survey that conducted in Attica and Western Greece confirms that magnetic fields strength that are measured are in accordance with the statutory legislation but will, at the same time, revealed lack of maintenance of the devices. Deficiency in topics such as proper equipment function will necessitate the creation of quality safety protocols, concerning the use of magneto-therapy, with the main aim the improvement of treatment procedures for the higher performance of therapeutic rehabilitation services to patients. Finally in this work, the proposal of a QC protocol for magnetotherapy devices is proposed for evaluation.

MICROWAVE DIATHERMY IN PHYSIOTHERAPY: INTRODUCTION AND EVALUATION OF A QUALITY CONTROL PROCEDURE.

Microwave diathermies (MWDs) are electromagnetic (EM) radiation emitting systems that are used by physiotherapists for thermotherapy treatment. Although this form of therapy is widely available in most physiotherapy units worldwide, management of the equipment is not obligatory addressed either by clinical engineers or medical physicists. A novel quality control (QC) protocol for MWD equipment, examining mechanical, electrical and electronic condition, the power output and EM radiation distribution in the electrotherapy room, was used during a national QC survey. The results of the survey revealed serious concerns about the safety of users and coexisting patients. The proposed approach could result in the introduction of EM-screened rooms, ensuring that MWD users and other persons in the vicinity will not be exposed to EM radiation over reference levels. International bodies could develop specific directives for EM radiation exposure in Physiotherapy Units, to conform to the proposed acceptance and functioning criteria for MDWs.