UVR

1. ULTRA-VIOLET
RADIATION

2. INTRODUCTION
• Ultra violet radiation are electromagnetic
radiation with wavelength between 10 nm to
400 nm (visible rays – x-ray).
• The Therapeutic part of electromagnetic
spectrum is divided into
• UVA (315-400 nm)
• UVB (280-315 nm)
• UVC (below 280 nm)

3. ULTRA-VIOLET GENERATORS
HIGH PRESSURE MERCURY VAPOUR
BURNER
• It is a U-shaped burner tube which is made up
of Quartz material.
• Enclosed in the tube is Argon Gas at a Low
pressure.
• A small quantity of Mercury is also enclosed
inside the tube & an electrode is sealed on the
either end.

4. HIGH PRESSURE MERCURY VAPOUR
BURNER
• Surrounding the ends are two metal caps across
which a high potential difference is applied in
order to ionize the Argon.
• As Argon is extremely stable and inert & has a
full outer shell of electrons, so in order to pass a
current through the tube the Argon atoms must
be ionized.
• This is accomplished by applying a very high
potential difference across the tube of 400 volts
via the Initial ionizing voltage.

5. HIGH PRESSURE MERCURY VAPOUR
BURNER
• This causes the stripping of an electron
(negative ion) & positive ion from the outer
shell of the Argon atom.
• Once the Argon has been Ionized the normal
mains voltage between the electrodes causes the
positive & negative ion to move through the
burner so constituting the electric current.
• As the two way movement of charged particles
takes place it causes collision with other neutral
Argon atoms causing further ionization so that
there is continuous generation of ionized
particles to sustain the current flow across the
tube.

6. HIGH PRESSURE MERCURY VAPOUR
BURNER
• This current flow can be seen as a glow
discharge and as with any electrical current
considerable heat is produced ( Joules Law).
Eventually sufficient heat is produced to
vaporize the liquid mercury inside the tube and
this mercury vapour itself becomes ionized.
• This process of ionizing of Argon atoms &
mercury vaporization leads to increase in the
pressure in the tube.

7. HIGH PRESSURE MERCURY VAPOUR
BURNER
• UV radiation is produced partly by the energy
released by the recombination of Argon
electrons & positive Mercury ions, &
Partly by the Photons released when excited
electrons return from a higher energy shell to
their normal shell within Mercury atoms.
• At the same time visible & infra-red
electromagnetic waves are produced &
ultraviolet forms only a portion of the total
output.

8. HIGH PRESSURE MERCURY VAPOUR
BURNER
TRIDYMITE FORMATION –
• The heat produced by the burner causes the
quartz to change to another form of silica called
tridymite.
• Tridymite is opaque to ultra-violet rays and
therefore the total output of the lamp gradually
falls as the proportion of tridymite increases.
• As a crude method of compensation a variable
resistance is included in the burner circuit and as
the quartz changes to tridymite the resistance is
reduced, thus increasing the intensity of the
current across the tube ( OHM’s Law)

9. HIGH PRESSURE MERCURY VAPOUR
BURNER
COOLING :-
• As a considerable portion of the Lamp is I.R
which when absorbed by the Human body is
converted to heat.
• Consequently if the lamp is air-cooled the
closest it can safely be placed is 50 cm.

10. HIGH PRESSURE MERCURY VAPOUR
BURNER
OZONE FORMATION :-
• A Toxic gas emitted by Ultra-violet radiation &
is Hazardous to health when inhaled.
• This can be prevented by providing good
ventilation.

11. THE KROMAYER LAMP
CONSTRUCTION :-
• The Kromayer Lamp has working principle
same as High Pressure Mercury Vapour Lamp
except that it is completely enclosed in a jacket
of circulating distilled water, the purpose of
which is to absorb the I.R.
• After use the water circulation is continued for 5
minutes after the burner is switched off in order
to cool the lamp.

12. THE KROMAYER LAMP
CONSTRUCTION :-
• At the front of the Kromayer Head the water
circulates between the Quartz window which
allow the ultraviolet to emerge.
• If a sinus is to be treated an applicator of quartz
is fixed to the window via a special attachment.
• This applicators convey the UV rays to their tip
via total internal reflection, but as they are long
thay inevitably absorb some ultraviolet rays and
considerably longer dose must be given.

13. FLUORESCENT TUBES
• The Fluorescent tubes produce long UV Rays.
• Each tube is 120 cm long & made of a type of
glass which allows Long UV rays to pass.
• The inside of the tube is coated with special
phosphor which absorbs the produced short UV
rays & re-emits at a Longer wavelength.
• There are 2 apparatus which consists this type
of tubes-
THERAKTIN TUNNEL
PUVA APPARATUS

14. FLUORESCENT TUBES
THERAKTIN TUNNEL
• It is a semi-cylindrical frame in which are
mounted four fluorescent tubes.
• Each tube is mounted in the reflector in such a
way that an even irradiation of the patient is
produced, allowing treatment of the whole
body into two halves
• Normally fluorescent tubes with a spectrum of
280-400 nm is used.

15. FLUORESCENT TUBES
PUVA APPARATUS
• This apparatus consists of the fluorescent tubes
mounted in a vertical box on its four sides
totally surrounding the patients.
• This form of ultra-violet is usually given two
hours after the patient has taken a photoactive
drug such as psoralen, hence the term PUVA
(Psoralen + Ultraviolet A)

16. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(1) CANCER :-
• Carcinogenesis can occur due to long exposure
to UVB or UVC, as these rays have an effect
on DNA and thus on cell replication.
• Even the longer wave UVA is a prominent
carcinogenic agent.

17. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(2) ERYTHEMA :-
• Damage to the cells causes release of
Histamine like substances from the epidermis
& superficial dermis.
• A gradual diffusion of this chemical takes
place until sufficient chemical has accumulated
around the blood vessels in the skin to make
them dilate. This accounts for the latency of
erythema.

18. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(3) PIGMENTATION :-
• It develops within two days of irradiation.
• UV stimulates the melanocytes in the skin to
produce melanin, which produces an umbrella
over the nucleus of the cell to protect it from
UV radiation : pigmentation thus substantially
reduces the penetration of UV rays.

19. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
Standard doses of UV (E1-E4) classified by erythema reaction
Dose Latent
Period
(hours)
Appearance Pigmentation Desquamation/
peeling
E1 Upto
12
Slightly
pink
Nil Nil
E2 4-6 Red Slight Powdery
E3 1-4 Fiery, Red
& Painful
Marked In sheets
E4 2 As E3 but with the formation of Blisters

20. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(4) THICKENING OF EPIDERMIS :-
• Sudden over-activity of the basal layer of the
epidermis causes a marked thickening, particularly at
the stratum corneum (outermost layer) which may
become as much as three times its normal thickness &
thus reduces the UV penetration.
• So in order for subsequent treatments to have the
same effect the dose must be increased.
• For eg- an E1 dose must be increased by 25 %,
• E2 by 50% and E3 by 75 %.

21. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(5) PEELING:-
• The increased thickness of the epidermis is
eventually lost as desquamation (peeling).
When this happens the resistance of the skin
to UV is substantially lowered.

22. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(6) PRODUCTION OF VITAMIN D :-
• In the presence of UV, 7-Dehydrocholesterol
in the sebum is converted to Vitamin D in the
skin.
• Vitamin D is necessary for the absorption of
calcium and so has a role to play in the normal
formation of bones & teeth.

23. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(7) SOLAR ELASTOSIS & AGEING :-
• The normal ageing process of the skin is
accelerated if there is continued exposure to
UV. There is thinning of the epidermis, loss of
epidermal ridges, loss of melanocytes, dryness
as a result of poor function of sebaceous &
sweat glands & wrinkling from lack of dermal
connective tissue.

24. PHYSIOLOGICAL EFFECTS OF
ULTRAVIOLET
(8) ANTIBIOTIC EFFECT :-
• Short Ultraviolet rays can destroy Bacteria &
other small organisms such as fungi commonly
found in wounds.

25. INDICATIONS :-
1) ACNE :-
• Acne is a skin condition which presents with
Papules, Pustules & Comedones blocking the
Hair follicles & sebaceous glands on the face,
back & chest.

26. INDICATIONS :-
1) ACNE :-
An E2 Dose of UVR can be given with the
following aims
• An erythema will bring more blood to the skin
& so improve the condition of the skin.
• Desquamation will remove comedones &
allow free drainage of sebum thus reducing the
number of lesions.
• UVR will have a sterilizing effect on the skin.

27. INDICATIONS :-
2) PSORIASIS :-
Psoriasis is a skin condition which presents localized
plaques in which the rate of turnover from the basal
layer through to the superficial layer is too rapid.
• The aim of UVR is to decrease the rate of DNA
synthesis in the cells of the skin & thus slow down
the proliferation.
 Treatment can be given using the Goeckerman’s
Regimen or Leeds regimen or PUVA.

28. INDICATIONS :-
2) PSORIASIS :-
 The GOEKERMAN’S REGIMEN :-
It consists of Coal Tar applications 2 or 3
times a day with general (total body) UVB
radiation given once a day as a Suberythemal
or (half E1) Dose.

29. INDICATIONS :-
2) PSORIASIS :-
 The INGRAM or LEEDS REGIMEN :-
In Leeds regimen the sensitivity of the skin to
UVR is increased by the Local application of
Coal Tar, added to a bath prior to the
treatment. Diathranol cream is applied to the
lesions after the treatment.
A suberythemal dose (half E1) is given
to the patient, using a theraktin tunnel or air
cooled lamp.

30. INDICATIONS :-
2) PSORIASIS :-
 PUVA REGIMEN :-
• Patients on a PUVA regimen take a sensitizing
drug Psoralen orally 2 hours before exposure
to UVA rays.
• In the nucleus of the cell the Psoralen binds to
DNA in the presence of UVA, & this inhibits
DNA synthesis & cell division.

31. INDICATIONS :-
2) PSORIASIS :-
 PUVA REGIMEN :-
Dosage of PUVA is measured using J/cm2.
Dosage depends on patient’s skin type as below.
I – Always burn, never Tan.
II – Always burn, Slight Tan.
III – Sometimes Burn, Always Tan.
IV – Never Burn, Always Tan.
V – Moderately pigmented Skin.
VI – Heavily pigmented Skin.

32. INDICATIONS :-
3) SKIN WOUNDS :-
----- Infected Wounds -----
UVR is used in case of infected skin wounds
as Ulcers, pressure sores or Surgical incisions.
• The aim of UVR is to destroy bacteria,
remove the slough (infected dead material) and
promote repair.
• UVB is used to achieve this being applied
locally to the lesion using a Kromayer lamp
and an E3 or E4 dose.

33. INDICATIONS :-
3) SKIN WOUNDS :-
----- Non-Infected Wounds -----
• Once infection has cleared , or if it was never
present, the aim of UVR is to stimulate the
growth of granulation tissue & thus speed up
repair.
• Short UVB rays damage granulation tissue
whereas Long UVA rays stimulate its growth.
• Thus in a UVR machine a filter such as Blue
Uviol Glass/ Cellophane is used to filter UVA
rays & not UVB which is not desirable.

34. INDICATIONS :-
4) PRESSURE SORE :-
Intact skin can be treated with UVA if it is in a
pressure area that is likely to break down.
• An E1 Dose is given in order to increase the
circulation through the area & improve skin
conditions.

35. INDICATIONS :-
5) COUNTER-IRRITATION :-
• UVR produces a strong Counter-irritation
effect over the site of deep seated pain (eg –
Lumbar spine).
• An E3 or E4 Dose can be given which causes
mild erythema over the skin.
• Thus the superficial pain produced by the
erythema masks the deep pain & also the
Descending pain suppression system (release
of Body Opiates) provides relief from deep
pain.

36. INDICATIONS :-
6) VITILGO :-
Vitilgo is a condition in which destruction of
melanocytes in local areas causes white patches
to appear on the skin.
• Both UVA & UVB stimulate Melanocyte
activity & an E2 or E3 Dose can be given.
• UVA causes a longer lasting tanning effect &
UVB provokes thickening of the skin.

37. CONTRAINDICATIONS :-
1) HYPERSENSITIVITY TO SUNLIGHT :-
• Some people react adversely to sunlight so are
not treated with UVR.

38. CONTRAINDICATIONS :-
2) DXT :-
• Deep X-Ray therapy produces local
hypersensitivity to UV and patients are not
treated with UVR for three months following
deep X-ray treatment.

39. CONTRAINDICATIONS :-
3) ERYTHEMA :-
• If patients skin still presents an erythema from
either UVR or IR, the reaction to UV is
dramatically increased. Consequently UV is
contraindicated until erythema has subsided.

40. CONTRAINDICATIONS :-
4) ACUTE SKIN CONDITIONS :-
• Acute Eczema, dermatitis, Herpes simplex.
5) SYSTEMIC LUPUS ERYTHEMATOSUS.
6) ACUTE FEBRILE ILLNESS.
7) RECENT SKIN GRAFTS.

41. DANGERS :-
1) EYES :-
• If UVR are allowed to fall on the eyes,
conjunctivitis & Cataracts may occur.
• To prevent this the Physiotherapist always
wears protective goggles when the lamp is on.

42. DANGERS :-
2) OVERDOSE :-
A number of factors may result in the patient
receiving a stronger dose than that given at a
previous treatment.
• Using a different lamp with a stronger output.
• Moving a lamp closer to a patient, thus giving
more intense dose.
• A change in the patient’s Drug regimen.
• Poor timing technique.

43. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
• It is used to assess individual patient’s reaction
to ultraviolet irradiation.
• The technique is similar for Air-cooled lamp,
Kromayer Lamp or Theraktin tunnel. Only the
distances & timings vary.

44. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
AIR COOLED LAMP :-
• A suitable area of the skin is selected for the test
dose eg :- Flexor aspect of the forearm/ Medial
aspect of Arm or Thigh/ Abdomen.
• Three differently shaped holes are cut in a
material resistant to passage to UVR Eg- paper /
lint.
• The middle hole should be approx. 2 cm by 2
cm ; with the hole on one side larger and the
other smaller.

45. TECHNIQUES OF APPLICATION :-
TEST DOSE :-

46. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
AIR COOLED LAMP :-
The Lamp has an average E1 dose of 60
seconds at 100 cm.
• So to find the E1 dose of the skin response to
UVR we have to follow Inverse square Law i.e :-
Half of the distance requires a quarter of
time for the same effect., thus E1 ( 60 seconds
at 100 cm) of lamp is 15 seconds at 50 cm for
the skin.

47. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
AIR COOLED LAMP :-
• Thus finding the E1 dose; the E2, E3 & E4 dose
time can be found.
• E2 Time = E1 Time x 21/2
• E3 Time = E1 Time x 5
• E3 Time = E1 Time x 10.
Thus to find the E2 Dose at 50 cm, the E1 time
is multiplied by 21/2 , giving 371/2 seconds.

48. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
AIR COOLED LAMP :-
The cut out test paper or lint is applied on the patient’s
forearm & rest of body is screened.
• The 1st hole receives a calculated E1 Dose.
• The 2nd hole receives a calculated E2 Dose.
• The 3rd hole receives a calculated E3 Dose.
 The procedure is carefully recorded on the patient’s
card & the patient is given drawing of the 3 holes &
asked to record on it when erythema appears, how
severe it is & how long it lasts.

49. TECHNIQUES OF APPLICATION :-
Test applied
11.00 am today
Monday
Monday Tuesday
3 pm 7 pm 11 pm 7 am 11 am
Look at the areas at the times shown & place a tick in the
box if any redness is seen. If no redness is seen put a
cross.

50. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
THERAKTIN TUNNEL:-
• The test procedure is very similar to Air cooled
lamp, but larger holes (4cm x 4cm) are used, &
are placed on the abdomen, the rest of the body
being screened.

51. TECHNIQUES OF APPLICATION :-
TEST DOSE :-
KROMAYER LAMP :-
• Testing of the dosage can be done with the
Kromayer Lamp in contact with the skin, so
very small holes are used, i.e 0.25 x 0.25 cm,
since exposure times need to be very small.