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Some ultrasound therapy methods have uncertain, possibly multiple mechanisms, including skin permeabilization for drug delivery and low-intensity pulsed ultrasound, which can accelerate the healing of bone fractures. Nonthermal applications are then reviewed, including extracorporeal shock wave lithotripsy, intracorporeal lithotripsy and lower power kilohertz frequency ultrasound devices. This is followed by a discussion of ultrasound treatment methods using heating, which include physical therapy, hyperthermia and high-intensity focused ultrasound. The fundamental basis behind the ultrasound mediated deposition of energy and mechanisms for biological effects are discussed. A list of therapy applications with FDA approved devices in clinical use is provided in Table 1. by the Food and Drug Administration (FDA) in the United States) for marketing suitable treatment devices.
Therapeutic applications of ultrasound may be used clinically after government approval (e. The purpose of this review is to briefly outline the recent development of therapeutic ultrasound applications and specialized devices, which have been approved for use, together with associated safety considerations. Therefore, standardization, ultrasound dosimetry, benefits assurance and side-effects risk minimization must be carefully considered in order to insure an optimal outcome for the patient. The potent application of ultrasound for therapeutic efficacy also carries the risk of unintentional adverse bioeffects which can lead to significant, even life threatening patient injury. Subsequently, the development of therapeutic ultrasound has accelerated with a wide range of methods now in use. By the 1970’s, the use of therapeutic ultrasound was established for physiotherapy, and research continued on more difficult applications in neurosurgery ( Wells, 1977), and for cancer treatment ( Kremkau, 1979).
Over the following decades, scientific advances allowed improved methods for effective treatment of Meniere’s disease by destruction of the vestibular nerve, and of Parkinson’s disease using focused ultrasound for localized tissue destruction in the brain ( Fry et al. Early applications were tried for various conditions using the mechanism of tissue heating ( Lehmann, 1953). Medical uses of ultrasound for therapy began to be explored in the 1930s. Ultrasound has seen development not only as a diagnostic imaging modality but as a therapeutic modality in which energy is deposited in tissue to induce various biological effects. In this overview, the Bioeffects Committee outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for assuring therapeutic ultrasound safety.
Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the AIUM, to the medical ultrasound community. However, safety information can be scattered, confusing or subject to commercial conflict of interest. Therapeutic ultrasound typically has well-defined benefits and risks, and therefore presents a tractable safety problem to the clinician. In all these therapeutic applications for bioeffects of ultrasound, standardization, ultrasound dosimetry, benefits assurance and side-effects risk minimization must be carefully considered in order to insure an optimal benefit to risk ratio for the patient. Undesirable bioeffects can occur including burns for thermal-based therapies and significant hemorrhage for mechanical-based therapies (e. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. In the 1980s, high pressure-amplitude shockwaves came into use for mechanically resolving kidney stones, and “lithotripsy” rapidly replaced surgery as the most frequent treatment choice. Low power ultrasound of about 1 MHz frequency has been widely applied since the 1950s for physical therapy in conditions such as tendinitis or bursitis. Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years.
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