Abstract:
The present invention is directed to systems, apparatus, methods and procedures for the noninvasive treatment of tissue, including treatment using microwave energy. In one embodiment of the invention a medical device and associated apparatus and procedures are used to treat dermatological conditions using, for example, microwave energy.

Description:
RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Patent Application Ser. No. 61/208,315, filed Feb. 23, 2009, and entitled “Systems, Apparatus, Methods And Procedures For The Noninvasive Treatment Of Tissue Using Microwave Energy,” which is expressly incorporated herein by reference in its entirety. 
     This application also claims the benefit of PCT Application Serial No. PCT/US2008/013650, filed Dec. 12, 2008, and entitled “Systems, Apparatus, Methods And Procedures For The Noninvasive Treatment Of Tissue Using Microwave Energy,” which is expressly incorporated herein by reference in its entirety. 
     This application also claims the benefit of U.S. Provisional Patent Application Ser. No. 61/196,948, filed Oct. 22, 2008, and entitled “Systems And Methods For Creating An Effect Using Microwave Energy To Specified Tissue, Such As Sweat Glands,” which is expressly incorporated herein by reference in its entirety. 
     This application also is a continuation-in-part of co-pending U.S. patent application Ser. No. 12/107,025, filed Apr. 21, 2008, and entitled “Systems And Methods For Creating An Effect Using Microwave Energy To Specified Tissue,” which claims the benefit of each of U.S. Provisional Patent Application Ser. No. 60/912,899, filed Apr. 19, 2007, and entitled “Methods And Apparatus For Reducing Sweat Production;” and U.S. Provisional Patent Application Ser. No. 61/013,274, filed Dec. 12, 2007, and entitled “Methods, Devices And Systems For Non-Invasive Delivery Of Microwave Therapy;” and U.S. Provisional Patent Application Ser. No. 61/045,937, filed Apr. 17, 2008, and entitled “Systems And Methods For Creating An Effect Using Microwave Energy In Specified Tissue.” All of the above priority applications are expressly incorporated by reference in their entirety. 
     Co-pending U.S. patent application Ser. No. 12/107,025 also claims priority to each of PCT Application Serial. No. PCT/US08/60935, filed Apr. 18, 2008, and entitled “Methods And Apparatus For Sweat Production”; and PCT Application Serial No. PCT/US08/60929, filed Apr. 18, 2008, and entitled “Methods, Devices, And Systems For Non-Invasive Delivery Of Microwave Therapy”; and PCT Application Serial No. PCT/US08/60940, filed Apr. 18, 2008, and entitled “Systems And Methods For Creating An Effect Using Microwave Energy To Specified Tissue”; and PCT Application Serial No. PCT/US08/60922, filed Apr. 18, 2008, and entitled “Systems And Methods For Creating An Effect Using Microwave Energy To Specified Tissue.” All of the above priority applications are expressly incorporated by reference in their entirety. 
    
    
     FIELD OF THE INVENTION 
     The present application relates to methods, apparatuses and systems for non-invasive delivery of energy, including microwave therapy. In particular, the present application relates to methods, apparatuses and systems for non-invasively delivering energy, such as, for example, microwave energy, to the epidermal, dermal and sub-dermal tissue of a patient to achieve various therapeutic and/or aesthetic results. 
     DESCRIPTION OF THE RELATED ART 
     It is known that energy-based therapies can be applied to tissue throughout the body to achieve numerous therapeutic and/or aesthetic results. There remains a continual need to improve on the effectiveness of these energy-based therapies and provide enhanced therapeutic results with minimal adverse side effects or discomfort. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention will be understood from the following detailed description of preferred embodiments, taken in conjunction with the accompanying drawings, wherein: 
         FIG. 1  is an illustration of a system including a generator, applicator and disposable according to an embodiment of the invention. 
         FIG. 2  is a perspective view of a medical treatment device, including an applicator and disposable, according to an embodiment of the invention. 
         FIG. 3  is an end on view of the distal end of a medical treatment device, including an applicator and the disposable according to an embodiment of the invention. 
         FIG. 4  is an exploded perspective view of a medical treatment device according to an embodiment of the invention. 
         FIG. 5  is a view of a medical treatment device according to an embodiment of the invention including a cutaway view of applicator according to an embodiment of the invention. 
         FIG. 6  is a perspective view of a disposable according to an embodiment of the invention. 
         FIG. 7  is a view of a proximal side of a disposable according to an embodiment of the invention. 
         FIG. 8  is a side view of one end of a disposable according to an embodiment of the invention. 
         FIG. 9  is a side view of one end of a disposable according to an embodiment of the invention. 
         FIG. 10  is a view of a distal side of a disposable according to an embodiment of the invention. 
         FIG. 11  is a side view of a disposable according to an embodiment of the invention. 
         FIG. 12  is a cutaway side view of a disposable according to an embodiment of the invention. 
         FIG. 13  is a cutaway side view of a disposable according to an embodiment of the invention. 
         FIG. 14  is a cutaway perspective view of a disposable according to an embodiment of the invention. 
         FIG. 15  is a top perspective view of a proximal end of a disposable according to an embodiment of the invention. 
         FIG. 16  is a perspective view of an antenna array according to an embodiment of the invention. 
         FIG. 17  is an end view of a portion of an antenna array according to an embodiment of the invention. 
         FIG. 18  is a cutaway side view of a portion antenna array according to an embodiment of the invention. 
         FIG. 19  is a cutaway side view of a portion antenna array according to an embodiment of the invention. 
         FIG. 20  is a simplified cutaway view of a medical treatment device with tissue engaged according to an embodiment of the invention. 
         FIG. 21  is a simplified cutaway view of a medical treatment device with tissue engaged according to an embodiment of the invention. 
         FIG. 22  is a simplified cutaway view of a medical treatment device with tissue engaged according to an embodiment of the invention. 
         FIG. 23  is a graphical illustration of a pattern of lesions in tissue according to an embodiment of the invention. 
         FIG. 24  illustrates a treatment template according to an embodiment of the invention. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Although the disclosure hereof is detailed and exact to enable those skilled in the art to practice the invention the physical embodiments herein disclosed merely exemplify the invention which may be embodied in other specific structures. While the preferred embodiment has been described, the details may be changed without departing from the invention which is defined by the claims. 
       FIG. 1  is an illustration of a system  2309  including a generator  2301 , applicator  2320  (which may also be referred to as re-usable) and disposable  2363  according to an embodiment of the invention. According to an embodiment of the invention applicator  2320  and disposable  2363  may comprise a medical treatment device  2300 . According to an embodiment of the invention generator  2301  may operate in the ISM band of 5.775 to 5.825 GHz. According to an embodiment of the invention generator  2301  may have a Frequency centered at approximately 5.8 GHz. According to an embodiment of the invention generator  2301  includes circuitry for setting and controlling output power; measuring forward and reverse power and setting alarms. According to an embodiment of the invention generator  2301  may have a power output of between approximately 40 Watts and approximately 100 Watts. According to an embodiment of the invention generator  2301  may have a power output of between approximately 40 Watts and approximately 100 Watts where said output is measured into a 50 ohm load. According to an embodiment of the invention generator  2301  may have a power output of approximately 55 Watts measured into a 50 ohm load. According to an embodiment of the invention disposable  2363  and applicator  2320  may be formed into two separable units. According to an embodiment of the invention disposable  2363  and applicator  2320  may be formed into a single unit. According to an embodiment of the invention when combined disposable  2363  and applicator  2320  may form a medical treatment device  2300 . According to an embodiment of the invention generator  2301  may be a microwave generator. According to an embodiment of the invention in system  2309  applicator  2320  may be connected to generator  2301  by applicator cable  2334 . According to an embodiment of the invention in system  2309  applicator cable  2334  may include coolant conduit  2324 , energy cable  2322 , coolant thermocouple wires  2331 , cooling plate thermocouple wires  2330  and antenna switch signal  2481 . According to an embodiment of the invention in system  2309  coolant conduit  2324  may be connected to a coolant source  2310  (which may be, for example, a Nanotherm industrial recirculation chiller with 8 pounds per square inch pump output pressure available from ThermoTek, Inc). According to an embodiment of the invention in system  2309  energy cable  2322  may be connected to generator  2301  by microwave output connector  2443 . According to an embodiment of the invention in system  2309  antenna switch signal  2481  may be connected to generator  2301  by antenna switch connector  2480 . According to an embodiment of the invention in system  2309  disposable  2363  may be connected to generator  2301  by vacuum tubing  2319  which may include generator bio-barrier  2317 , which may be, for example, a hydrophobic filter. According to an embodiment of the invention in system  2309  vacuum tubing  2319  may be connected to generator  2301  by vacuum port connector  2484 . According to an embodiment of the invention in system  2309  front panel  2305  of generator  2301  may include power control knob  2454 , vacuum control knob  2456 , antenna select switch  2462  (which may include both display elements and selection switches), vacuum meter  2486 , antenna temperature display  2458 , coolant temperature display  2460 , pre-cool timer  2468  (which may include both display elements and time set elements), energy timer  2470  (which may include both display elements and time set elements), post-cool timer  2472  (which may include both display elements and time set elements), start button  2464 , stop button  2466 , ready indicator  2476  and fault indicator  2474 . According to an embodiment of the invention an error signal is sent to generator  2301  if a measured signal is outside of the specification for the requested power set by the power control knob  2454  on front panel  2305 . According to an embodiment of the invention vacuum tube  2319  may include a flexible vacuum hose  2329  and a generator bio-barrier  2317 . According to an embodiment of the invention flexible vacuum hose  2329  is adapted to collect fluids, such as, for example sweat or blood, which may escape disposable  2363  so that such fluids do not reach generator  2301 . According to an embodiment of the invention generator bio-barrier  2317  may include a hydrophobic filter to keep fluids out of vacuum port connector  2484  of generator  2301 . According to an embodiment of the invention generator bio-barrier  2317  may include a hydrophobic filter, such as, for example, a Millex FH Filter made of 0.45 micrometer hydrophobic PTFE which is available from Milipore. According to an embodiment of the invention generator bio-barrier  2317  may be positioned in vacuum tube  2319  between flexible vacuum hose  2329  and vacuum port connector  2484 . According to an embodiment of the invention applicator cable  2334  may connect generator  2301  to applicator  2320 . According to an embodiment of the invention cooling plate thermocouple wires  2330  and coolant thermocouple wires  2331  may be connected to generator  2301  by temperature connector  2482 . According to an embodiment of the invention coolant conduit  2324  may convey cooling fluid from a coolant source  2310  to applicator  2320 . According to an embodiment of the invention applicator cable  2334  may convey microwave switch selection data to applicator  2320  and temperature data from thermocouples in applicator  2320  to generator  2301 . According to an embodiment of the invention applicator cable  2334  may comprise one or more separate cables and connectors. According to an embodiment of the invention a generator connector may be designed and adapted to connect applicator cable  2334  to generator  2301 , including connections for cooling conduit  2324 , antenna switch signal  2481 , energy cable  2322 , cooling plate thermocouple wires  2330  and coolant thermocouple wires  2331 . 
       FIG. 2  is a perspective view of a medical treatment device  2300  including an applicator  2320  and disposable  2363  according to an embodiment of the invention. According to an embodiment of the invention applicator  2320  may be attached to disposable  2363  by latching mechanism  2365 . According to an embodiment of the invention applicator  2320  may include applicator cable  2334 . According to an embodiment of the invention disposable  2363  may include vacuum tubing  2319 , tissue chamber  2338  and tissue interface surface  2336 . 
       FIG. 3  is an end on view of a distal end of a medical treatment device  2300  including an applicator  2320  and disposable  2363  according to an embodiment of the invention. According to an embodiment of the invention disposable  2363  may include tissue bio-barrier  2337 . According to an embodiment of the invention applicator  2320  may include cooling plate  2340 , which may be, for example, positioned behind tissue bio-barrier  2337 . According to an embodiment of the invention tissue bio-barrier  2337  may form a portion of tissue interface surface  2336 . According to an embodiment of the invention latching mechanism  2365  may be used to facilitate the connection of disposable  2363  to applicator  2320 . 
       FIG. 4  is a perspective view of a medical treatment device  2300  including an exploded perspective view of an applicator  2320  and a view of disposable  2363  according to the present invention. According to an embodiment of the invention applicator  2320  may include a cooling plate  2340 , separation ribs  2393 , intermediate scattering elements  3393 , antenna cradle  2374 , waveguide assembly  2358  and antenna switch  2357 . According to an embodiment of the invention waveguide assembly  2358  may include antennas  2364 ( a - d ). According to an embodiment of the invention disposable  2363  may include vacuum tubing  2319 , latching elements  2359  and vacuum seal  2348 . 
       FIG. 5  is a view of a medical treatment device  2300  according to an embodiment of the present invention including a cutaway view of applicator  2320  and disposable  2363 . According to an embodiment of the invention applicator  2320  may include antenna array  2355 , antenna switch  2357  and applicator cable  2334 . According to an embodiment of the invention applicator cable  2334  may include cooling plate thermocouple wires  2330 , coolant thermocouple wires  2331 , coolant supply tubing  2312 , coolant return tubing  2313 , antenna switch signal  2481 , energy cable  2322 . According to an embodiment of the invention cooling plate thermocouple wires  2330  may include one or more thermocouple wires which may be attached to an or more thermocouples positioned opposite an output of antenna array  2355 . According to an embodiment of the invention coolant thermocouple wires  2331  may include one or more thermocouple wires attached to an or more cooling path thermocouples  2326  which may be positioned to measure coolant fluid, such as, for example, in coolant return tubing  2313 . According to an embodiment of the invention one or more cooling path thermocouples  2326  may be positioned to measure the temperature of cooling fluid  2361  after it passes through coolant chamber  2360 . According to an embodiment of the invention one or more cooling path thermocouples  2326  may be located in coolant return tubing  2313 . According to an embodiment of the invention cooling path thermocouples  2326  may function to provide feedback to generator  2301  indicative of the temperature of cooling fluid  2361  after cooling fluid  2361  passes through coolant chamber  2360 . According to an embodiment of the invention disposable  2363  may include latching element  2359 . According to an embodiment of the invention applicator cable  2334  may include interconnect cables  2372  to transmit signals to antenna array  2355 . According to an embodiment of the invention antenna array  2355  may include antenna cradle  2374 . 
       FIG. 6  is a perspective view of disposable  2363  according to an embodiment of the invention.  FIG. 7  is a view of the proximal side of disposable  2363  according to an embodiment of the invention.  FIG. 8  is a side view of one end of disposable  2363  according to an embodiment of the invention.  FIG. 9  is a side view of one end of disposable  2363  according to an embodiment of the invention.  FIG. 10  is a view of the distal side of disposable  2363  according to an embodiment of the invention.  FIG. 11  is a side view of disposable  2363  according to an embodiment of the invention.  FIG. 12  is a cutaway side view of disposable  2363  according to an embodiment of the invention.  FIG. 13  is a cutaway side view of disposable  2363  according to an embodiment of the invention.  FIG. 14  is a cutaway perspective view of disposable  2363  according to an embodiment of the invention.  FIG. 15  is a top perspective view of a proximal end of disposable  2363  according to an embodiment of the invention. 
     According to an embodiment of the invention disposable  2363  may include tissue interface surface  2336 , tissue chamber  2338  and alignment features  3352 . According to an embodiment of the invention tissue interface surface  2336  may form a back wall of tissue chamber  2338 . According to an embodiment of the invention tissue interface surface  2336  may include tissue bio-barrier  2337  and vacuum passage  3333 . According to an embodiment of the invention vacuum passage  3333  may also be referred to as a lip or rim. According to an embodiment of the invention disposable  2363  may include alignment features  3352  and vacuum tubing  2319 . According to an embodiment of the invention disposable  2363  may include compliant member  2375 . According to an embodiment of the invention chamber walls  2354  may include a compliant member  2375 . According to an embodiment of the invention compliant member  2375  may be formed from a compliant material, such as, for example, rubber, coated urethane foam (with a compliant plastic or rubber seal coating), silicone, polyurethane or heat sealed open cell foam. According to an embodiment of the invention compliant member  2375  may be positioned around the outer edge of tissue chamber  2338  to facilitate the acquisition of tissue. According to an embodiment of the invention compliant member  2375  may be positioned around the outer edge of chamber opening  2339  to facilitate the acquisition of tissue. According to an embodiment of the invention compliant member  2375  may facilitate the engagement of tissue which is not flat, such as, for example tissue in the axilla. According to an embodiment of the invention compliant member  2375  may facilitate the engagement of tissue which is not flat, such as, for example tissue in the outer regions of the axilla. According to an embodiment of the invention compliant member  2375  may provide improved sealing characteristics between the skin and tissue chamber  2338 , particularly where the skin is not flat. According to an embodiment of the invention compliant member  2375  may speed the acquisition of tissue in tissue chamber  2338 , particularly where the skin is not flat. According to an embodiment of the invention compliant member  2375  may have a height of between approximately 0.15 inches and approximately 0.40 inches above chamber opening  2339  when compliant member  2375  is not compressed. According to an embodiment of the invention compliant member  2375  may have a height of approximately 0.25 inches above chamber opening  2339  when compliant member  2375  is not compressed. According to an embodiment of the invention alignment features  3352  may be positioned at a distance which facilitate appropriate placement of applicator  2320  during treatment. According to an embodiment of the invention alignment features  3352  may be positioned approximately 30.7 millimeters apart. According to an embodiment of the invention alignment features  3352  may be further positioned and may be designed to assist a physician in positioning applicator  2320  prior to the application of energy. According to an embodiment of the invention alignment features  3352  on disposable  2363  assist the user in properly positioning the applicator prior to treatment and in moving the applicator to the next treatment region during a procedure. According to an embodiment of the invention alignment features  3352  on disposable  2363 , when used with marks or landmarks in a treatment region facilitate the creation of a continuous lesion. According to an embodiment of the invention alignment features  3352  may be used to align medical treatment device  2300  before suction is applied. According to an embodiment of the invention an outer edge of compliant member  2375  may assist a user in aligning medical treatment device  2300 . 
     According to an embodiment of the invention compliant member  2375 , which may also be referred to as a skirt or flexible skirt, may be manufactured from silicone. According to an embodiment of the invention compliant member  2375  may extend approximately 0.25″ from rigid surface  3500 . According to an embodiment of the invention a counter sink or dovetail notch  2356  may be positioned in rigid disposable surface  3500  around the outer edge of chamber opening  2339  to assist in alignment of compliant member  2375 . According to an embodiment of the invention the compliant member  2375  may have a durometer density rating (softness) of approximately A60 which may help compliant member  2375  to maintain its shape better while being easier to mold. According to an embodiment of the invention colorant may be used in compliant member  2375  to contrast with skin viewed through compliant member  2375 , making it easier for user, such as a physician to distinguish between skin and a distal surface of compliant member  2375 . According to an embodiment of the invention colorant may be used in compliant member  2375  to make it easier for user, such as a physician to distinguish between skin and an outer edge of compliant member  2375 . According to an embodiment of the invention colorant may be used in compliant member  2375  to help a user distinguish an edge of compliant member  2375  from surrounding skin and assist in aligning of medical treatment device  2300 . According to an embodiment of the invention the angle of compliant member  2375  relative to rigid surface  3500  may be approximately 53 degrees when compliant member  2375  is not compressed. 
     According to an embodiment of the invention disposable  2363  includes applicator chamber  2346 . According to an embodiment of the invention disposable  2363  may include an applicator chamber  2346  which may be formed, at least in part, by tissue bio-barrier  2337 . According to an embodiment of the invention disposable  2363  may include applicator bio-barrier  2332  (which may be, for example, a polyethylene film, available from Fisher Scientific), and vacuum passage  3333 . According to an embodiment of the invention a counter bore may positioned between applicator bio-barrier  2332  and applicator chamber  2346 . 
     According to an embodiment of the invention vacuum passage  3333  connects vacuum channel  3350  to tissue chamber  2338 . According to an embodiment of the invention vacuum channel  3350  may also be referred to as a reservoir or vacuum reservoir. According to an embodiment of the invention vacuum connector  2328  is connected to vacuum passage  3333  through vacuum channel  3350 . According to an embodiment of the invention vacuum channel  3350  may connect vacuum passages  3333  connect vacuum connector  2328  in tissue chamber  2338 . According to an embodiment of the invention vacuum passages  3333  form a direct path to tissue interface surface  2336 . According to an embodiment of the invention vacuum passages  3333  and vacuum channel  3350  may be adapted to restrict the movement of fluids from tissue chamber  2338  to applicator bio-barrier  2332 . According to an embodiment of the invention vacuum connector  2328  may be positioned on the same side of disposable  2363  as applicator bio-barrier  2332 . According to an embodiment of the invention applicator bio-barrier  2332  may be designed to prevent fluids from tissue chamber  2338  from reaching applicator chamber  2346 , particularly when there is back pressure caused by, for example, a vacuum created in tissue chamber  2338  as tissue is pulled away from tissue interface surface  2336 . According to an embodiment of the invention vacuum pressure may be used to support tissue acquisition in tissue chamber  2338 . According to an embodiment of the invention vacuum pressure may be used to pull tissue into tissue chamber  2338 . According to an embodiment of the invention vacuum pressure may be used to maintain tissue in tissue chamber  2338 . According to an embodiment of the invention vacuum channel  2350  may surround tissue interface surface  2336 . According to an embodiment of the invention applicator bio-barrier  2332  may be positioned between vacuum passages  3333  and applicator chamber  2346 . According to an embodiment of the invention applicator bio-barrier  2332  may be a membrane which may be adapted to be permeable to air but substantially impermeable to biological fluids such as, for example, blood and sweat. According to an embodiment of the invention applicator bio-barrier  2332  may be a hydrophobic membrane filter. According to an embodiment of the invention applicator bio-barrier  2332  may be made of polyethylene film, nylon or other suitable materials. According to an embodiment of the invention applicator bio-barrier  2332  may include pores having sizes sufficient to pass enough air to substantially equalize the vacuum pressure in applicator chamber  2346  and in tissue chamber  2338  without passing biological fluids from tissue chamber  2338  to applicator chamber  2346 . According to an embodiment of the invention applicator bio-barrier  2332  may include pores having sizes of approximately 0.45 micrometers. According to an embodiment of the invention when the vacuum is turned on, and before pressure is equalized, applicator bio-barrier  2332  may induce a minimal pressure drop between vacuum passages  3333  and the applicator chamber  2346 . According to an embodiment of the invention applicator chamber  2346  and tissue chamber  2338  may be separated, at least in part, by tissue bio-barrier  2337 . According to an embodiment of the invention tissue chamber  2338  may include tissue interface surface  2336  and chamber wall  2354 . 
     According to an embodiment of the invention tissue chamber opening  2339  has dimensions which facilitate the acquisition of tissue. According to an embodiment of the invention tissue chamber  2339  may be sized to facilitate tissue acquisition while being large enough to prevent interference with energy radiated from waveguide antennas  2364  in antenna array  2355  when applicator  2320  is attached to disposable  2363 . According to an embodiment of the invention a vacuum circuit  3341  may include vacuum passages  3333 , vacuum channel  3350  and may encircle tissue chamber  3338 . According to an embodiment of the invention vacuum channel  3350  may be positioned around tissue chamber  2338 . According to an embodiment of the invention vacuum passage  3333  may be positioned around a proximal end of tissue chamber  2338 . According to an embodiment of the invention vacuum passage  3333  may be positioned around a proximal end of tissue chamber  2338  between tissue bio-barrier  2337  and a proximal end of chamber wall  2354 . According to an embodiment of the invention an opening to vacuum passage  3333  may be approximately 0.020 inches in height. According to an embodiment of the invention an opening to vacuum passage  3333  may be approximately 0.010 inches in height when disposable  2363  is attached to applicator  2320  and tissue bio-barrier  2337  is stretched into tissue chamber  2338  by a distal end of applicator  2320 . According to an embodiment of the invention vacuum passage  3333  may have an opening height which is too small for tissue to invade when a vacuum is applied. 
     According to an embodiment of the invention disposable  2363  may be manufactured from a clear or substantially clear material to assist a user, such as a physician in viewing tissue engagement. According to an embodiment of the invention the disposable  2363  may have an outer angle to allow a user to see alignment features  3352  on compliant member  2375  to assist a user in aligning medical treatment device  2300 . According to an embodiment of the invention an angle around the outside of disposable  2363  provides a user with a direct view of alignment features  3352 . According to an embodiment of the invention tissue chamber  2338  may have dimensions of approximately 1.54 inches by approximately 0.7 inches. According to an embodiment of the invention the 4 corners of tissue chamber  2338  may have a radius of 0.1875 inches. According to an embodiment of the invention antenna array  2335  may include four antennas and may have dimensions of approximately 1.34 inches by approximately 0.628 inches. According to an embodiment of the invention the dimensions of the waveguide array  2335  and tissue chamber  2338  may be optimized to minimizing stray fields forming at the edges of waveguide array  2335  as well as optimizing the effective cooling area of tissue interface surface  2336 . According to an embodiment of the invention tissue chamber  2338  may be optimized to facilitate tissue acquisition without adversely impacting cooling or energy transmission. 
       FIG. 16  is a perspective view of antenna array  2355  according to an embodiment of the invention. According to an embodiment of the invention antenna array  2355  may include antenna cradle  2374 . According to an embodiment of the invention antenna cradle  2374  may include reservoir inlet  2384  and antenna chamber  2377 . According to an embodiment of the invention waveguide assembly  2358  may include one or more spacer  3391  (which may be, for example, copper shims) positioned between waveguide antennas  2364 . According to an embodiment of the invention spacer  3391  may be positioned between waveguide antenna  2364   a  and waveguide antenna  2364   b . According to an embodiment of the invention spacer  3391  may be positioned between waveguide antenna  2364   b  and waveguide antenna  2364   c . According to an embodiment of the invention spacer  3391  may be positioned between waveguide antenna  2364   c  and waveguide antenna  2364   d . According to an embodiment of the invention microwave energy may be supplied to each waveguide antenna through feed connectors  2388 . According to an embodiment of the invention waveguide assembly  2358  may be held together by a waveguide assembly frame  2353 . According to an embodiment of the invention waveguide assembly frame  2353  may include feed brackets  2351  and assembly bolts  2349 . According to an embodiment of the invention antenna array  2355  may include antenna cradle  2374  and least one waveguide antenna  2364 . According to an embodiment of the invention antenna array  2355  may include one or more spacer  3391 . According to an embodiment of the invention antenna array  2355  may include four waveguide antennas  2364   a ,  2364   b ,  2364   c  and  2364   d . According to an embodiment of the invention the heights of waveguide antennas  2364  in antenna array  2355  may be staggered to facilitate access to feed connectors  2388 . According to an embodiment of the invention one or more waveguide antenna  2364  in antenna array  2355  may include tuning element  2390 . 
       FIG. 17  is an end view of a portion of antenna array  2355  according to an embodiment of the invention.  FIG. 18  is a cutaway side view of a portion antenna array  2355  according to an embodiment of the invention.  FIG. 19  is a cutaway side view of a portion antenna array  2355  according to an embodiment of the invention. According to an embodiment of the invention antenna array  2355  includes coolant chambers  2360  (for example coolant chambers  2360   a ,  2360   b ,  2360   c  and  2360   d ), intermediate scattering elements  3393 , separation ribs  2393  and scattering elements  2378  (for example scattering elements  2378   a ,  2378   b ,  2378   c  and  2378   d ). According to an embodiment of the invention scattering elements  2378  may also be referred to as central scattering elements. According to an embodiment of the invention coolant chambers  2360   a - 2360   d  may be located beneath waveguide antenna  2364   a - 2364   d . According to an embodiment of the invention coolant chambers  2360  may include separation ribs  2393  on either side of antenna array  2355  and intermediate scattering elements  3393  between antennas  2364 . According to an embodiment of the invention an intermediate scattering element  3393  may be positioned between waveguide antenna  2364   a  and waveguide antenna  2364   b . According to an embodiment of the invention an intermediate scattering element  3393  may be positioned between waveguide antenna  2364   b  and waveguide antenna  2364   c . According to an embodiment of the invention an intermediate scattering element  3393  may be positioned between waveguide antenna  2364   c  and waveguide antenna  2364   d . According to an embodiment of the invention cooling fluid flowing through coolant chambers  2360  may have a flow rate of between approximately 200 milliliters per minute and approximately 450 milliliters per minute and preferably approximately 430 milliliters per minute. According to an embodiment of the invention coolant chambers  2360  may be designed to ensure that the flow rate through each coolant chamber  2360  is substantially the same. According to an embodiment of the invention coolant the flow rate of cooling fluid through coolant chamber  2360   a  is the same as the flow rate of cooling fluid through coolant chamber  2360   b . According to an embodiment of the invention coolant the flow rate of cooling fluid through coolant chamber  2360   a  is the same as the flow rate of cooling fluid through coolant chambers  2360   b ,  2360   c  and  2360   d . According to an embodiment of the invention cooling fluid flowing through coolant chamber  2360  may have a temperature of between approximately 8 degrees centigrade and approximately 22 degrees centigrade and preferably approximately 15 degrees centigrade. According to an embodiment of the invention coolant chambers  2360  may be positioned between an aperture of waveguide antenna  2364  cooling plate  2340 . According to an embodiment of the invention scattering elements  2378  may extend into at least a portion of coolant chambers  2360 . According to an embodiment of the invention scattering elements  2378  may extend through coolant chambers  2360 . According to an embodiment of the invention scattering elements  2378  and intermediate scattering elements  3393  may extend through coolant chambers  2360  to contact a proximal surface of cooling plate  2340 . According to an embodiment of the invention elements of coolant chamber  2360  may be smoothed or rounded to promote laminar fluid flow through coolant chambers  2360 . According to an embodiment of the invention elements of coolant chambers  2360  may be smoothed to reduce the generation of air bubbles in coolant chamber  2360 . According to an embodiment of the invention scattering elements  2378  which extend into coolant chambers  2360  may be rounded to promote laminar flow and prevent the buildup of bubbles in coolant chamber  2360 . According to an embodiment of the invention scattering elements  2378  may be formed in the shape of ovals or racetracks. According to an embodiment of the invention square edges or sharp corners in coolant chamber  2360  may result in undesirable flow characteristics, including the generation of air bubbles, as cooling fluid moves through coolant chamber  2360 . According to an embodiment of the invention intermediate scattering elements  3393  may be positioned between separate individual coolant chambers  2360 . According to an embodiment of the invention intermediate scattering elements  3393  may be positioned such that they facilitate equalized cooling across cooling plate  2340 . According to an embodiment of the invention intermediate scattering elements  3393  may be sized such that they have a width which is equal to or less than the separation distance between apertures of waveguide antennas  2364 . According to an embodiment of the invention intermediate scattering elements  3393  may be sized and positioned such that they are not positioned an aperture of waveguide antenna  2364 . According to an embodiment of the invention intermediate scattering elements  3393  may be sized and positioned such that they modify a microwave field as it travels through coolant chamber  2360 . According to an embodiment of the invention intermediate scattering elements  3393  may be sized and positioned such that they modify a microwave field radiated from waveguide antenna  2364 . According to an embodiment of the invention intermediate scattering elements  3393  may be sized and positioned such that they spread out a microwave field as it travels through coolant chamber  2360 . According to an embodiment of the invention intermediate scattering elements  3393  may cause disruption or perturbation of microwave energy radiated from waveguide antenna  2364 . According to an embodiment of the invention intermediate scattering elements  3393  may be made of materials which will not rust or degrade in cooling fluid. According to an embodiment of the invention intermediate scattering elements  3393  may be made of materials which improve the SAR pattern in tissue. According to an embodiment of the invention intermediate scattering elements  3393  may be made of materials, such as dielectric materials, which are used to form scattering elements  2378 . According to an embodiment of the invention  FIGS. 17 through 19  may also include waveguide assembly  2358 , feed connectors  2388 , antenna chamber  2377 , spacers  3391 , cradle channels  2389  and antenna cradle  2374 . 
     According to an embodiment of the invention intermediate scattering elements  3393  may be positioned between waveguide antennas  2364 . According to an embodiment of the invention the size and shape of the intermediate scattering elements  3393  may be designed to optimize the size and shape of lesions developed in the skin between waveguide antennas  2364 . According to an embodiment of the invention intermediate scattering elements  3393  may make lesions created in tissue between waveguide antennas  2364  larger and more spread out. According to an embodiment of the invention intermediate scattering elements  3393  may make lesions created in tissue between waveguide antennas  2364  narrower. According to an embodiment of the invention intermediate scattering elements  3393  may have an optimal length which is shorter than the length of scattering elements  2378 . According to an embodiment of the invention scattering elements  2378  may be approximately 7 millimeters in length. According to an embodiment of the invention intermediate scattering elements  3393  may have an optimal length which is approximately 6.8 millimeters. According to an embodiment of the invention intermediate scattering elements  3393  may be manufactured from, for example, alumina. According to an embodiment of the invention intermediate scattering elements  3393  may be manufactured from, for example, a material which is approximately 96% alumina. According to an embodiment of the invention intermediate scattering elements  3393  may be manufactured from, for example, silicone. According to an embodiment of the invention the intermediate scattering elements  3393  may be manufactured from a material having the same dielectric constant as scattering elements  2378 . According to an embodiment of the invention the intermediate scattering elements  3393  may be manufactured from a material having approximately the same dielectric constant as scattering elements  2378 . According to an embodiment of the invention intermediate scattering elements  3393  may be manufactured from a material having a dielectric constant of approximately 10. According to an embodiment of the invention intermediate scattering elements  3393  may be manufactured from a material having a dielectric constant of approximately 3. According to an embodiment of the invention increasing the dielectric constant of intermediate scattering element  3393  may reduce the size of a lesion created in skin between waveguide antennas  2364 . According to an embodiment of the invention intermediate scattering elements  3393  may be inserted into tung and grove slots between wave antennas  2364 . According to an embodiment of the invention thermocouples may be positioned beneath one or more of intermediate scattering elements  3393 . According to an embodiment of the invention thermocouples may be positioned each of intermediate scattering elements  3393 . 
       FIGS. 20 ,  21  and  22  are simplified cutaway views of a medical treatment device  2300  with tissue engaged according to an embodiment of the invention. According to an embodiment of the invention skin  1307  is engaged in treatment device  2300 . According to an embodiment of the invention dermis  1305  and hypodermis  1303  are engaged in medical treatment device  2300 . According to an embodiment of the invention skin surface  1306  is engaged in medical treatment device  2300  such that skin surface  1306  is in thermal contact with at least a portion of cooling plate  2340 . According to an embodiment of the invention skin surface  1306  is engaged in medical treatment device  2300  such that skin surface  1306  is in contact with at least a portion of tissue interface  2336 . According to an embodiment of the invention a vacuum pressure may be used to elevate dermis  1305  and hypodermis  1303 , separating dermis  1305  and hypodermis  1303  from muscle  1301 . According to an embodiment of the invention vacuum pressure may be used to elevate dermis  1305  and hypodermis  1303 , separating dermis  1305  and hypodermis  1303  from muscle  1301  to, for example, protect muscle  1301  by limiting or eliminating the electromagnetic energy which reaches muscle  1301 . According to an embodiment of the invention waveguide assembly  2358  may include one or more waveguide antennas  2364 . According to an embodiment of the invention electromagnetic energy, such as, for example, microwave energy may be radiated into dermis  1305  by medical treatment device  2300 . According to an embodiment of the invention medical treatment device  2300  may include coolant chamber  2360  and cooling plate  2340 . According to an embodiment of the invention a peak which may be, for example, a peak SAR, peak power loss density or peak temperature, is generated in first tissue region  1309 . According to an embodiment of the invention first tissue region  1309  may represent a lesion created by energy, such as, for example, microwave energy radiated from medical treatment device  2300 . According to an embodiment of the invention first tissue region  1309  may represent a lesion created by microwave energy radiated from one or more of waveguide antennas  2364 . According to an embodiment of the invention first tissue region  1309  may be initiated in skin  1307  between first waveguide antenna  2364  and a second waveguide antenna  2364 . According to an embodiment of the invention first tissue region  1309  may be initiated in skin  1307  between first waveguide antenna  2364   a  and a second waveguide antenna  2364   b . According to an embodiment of the invention first tissue region  1309  may be initiated in skin  1307  underlying intermediate scattering element  3393 . According to an embodiment of the invention a reduced magnitude which may be, for example, a reduced SAR, reduced power loss density or reduced temperature, is generated in second tissue region  1311  with further reduced magnitudes in third tissue region  1313  and fourth tissue region  1315 . As illustrated in  FIGS. 20 through 22 , dermis  1305  is separated from hypodermis  1303  by interface  1308 . As illustrated in  FIGS. 20 through 22  interface  1308  may be idealized as a substantially straight line for the purposes of simplified illustration however in actual tissue, interface  1308  may be a non-linear, non continuous, rough interface which may also include many tissue structures and groups of tissue structures which cross and interrupt tissue interface  1308 . According to an embodiment of the invention electromagnetic radiation may be radiated at a frequency of, for example, between 5 and 6.5 GHz. According to an embodiment of the invention electromagnetic radiation may be radiated at a frequency of, for example, approximately 5.8 GHz. According to an embodiment of the invention scattering element  2378  may be located in coolant chamber  2360  and intermediate scattering elements  3393  may be located between coolant chambers  2360 . According to an embodiment of the invention scattering element  2378  and intermediate scattering elements  3393  may be used to, for example, spread and flatten first tissue region  1309 . According to an embodiment of the invention scattering element  2378  and intermediate scattering elements  3393  may be used to, for example, spread and flatten a region, such as first tissue region  1309 , of peak SAR in tissue. According to an embodiment of the invention scattering element  2378  and intermediate scattering elements  3393  may be used to, for example, spread and flatten a region, such as first tissue region  1309 , of peak power loss density in tissue. According to an embodiment of the invention scattering element  2378  and intermediate scattering elements  3393  may be used to, for example, spread and flatten a region, such as first tissue region  1309 , of peak temperature in tissue. According to an embodiment of the invention scattering element  2378  and scattering elements  3393  may be used to, for example, spread and flatten lesions formed in first tissue region  1309 . According to an embodiment of the invention the creation of lesions, such as for example, a lesion in tissue region  1309  may be used to treat the skin of patients. According to an embodiment of the invention the creation of lesions, such as for example, a lesion in tissue region  1309  may be used to damage or destroy structures, such as, for example, sweat glands in the skin of a patient. 
       FIG. 23  is a graphical illustration of a pattern of lesions in tissue according to an embodiment of the invention. According to an embodiment of the invention lesions may be created in a predetermined order, such as, for example A-B-C-D where: A represents a lesion initiated directly under waveguide antenna  2364   a ; B represents a lesion initiated directly under waveguide antenna  2364   b ; C represents a lesion initiated directly under waveguide antenna  2364   c ; D represents a lesion initiated directly under waveguide antenna  2364   d . According to an embodiment of the invention lesions may be created in a predetermined order such as, for example, A-AB-B-BC-C-CD-D where: A represents a lesion initiated directly under waveguide antenna  2364   a ; AB represents a lesion initiated under the intersection between waveguide antenna  2364   a  and waveguide antenna  2364   b ; B represents a lesion initiated directly under waveguide antenna  2364   b ; BC represents a lesion initiated under the intersection between waveguide antenna  2364   b  and waveguide antenna  2364   c ; C represents a lesion initiated directly under waveguide antenna  2364   c ; CD represents a lesion initiated under the intersection between waveguide antenna  2364   c  and waveguide antenna  2364   d ; and D represents a lesion initiated directly under waveguide antenna  2364   d . According to an embodiment of the invention a lesion AB may be created between waveguide antenna  2364   a  and waveguide antenna  2364   b , by driving waveguide antenna  2364   a  and waveguide antenna  2364   b  simultaneously in phase and with a balanced output from each antenna. According to an embodiment of the invention a lesion BC may be created between waveguide antenna  2364   b  and waveguide antenna  2364   c , by driving waveguide antenna  2364   b  and waveguide antenna  2364   c  simultaneously in phase and with a balanced output from each waveguide antenna. According to an embodiment of the invention a lesion CD may be created between waveguide antenna  2364   c  and waveguide antenna  2364   d , by driving waveguide antenna  2364   c  and waveguide antenna  2364   d  simultaneously in phase and with a balanced output from each waveguide antenna. 
       FIG. 24  is a treatment template  2483  according to an embodiment of the invention. According to an embodiment of the invention treatment template  2483  may include axilla outline  2497 , anesthesia injection sites  2485 , landmark alignment marks  2497 , device alignment points  2498  and device alignment lines  2499 . According to an embodiment of the invention axilla outline  2497  may be matched to the hair bearing area of a patient to select an appropriate treatment template  2483 . According to an embodiment of the invention anesthesia injection sites  2485  may be used to identify appropriate points in the axilla for the injection of anesthesia. According to an embodiment of the invention landmark alignment marks may be used to align treatment template  2483  to landmarks, such as, for example, tattoos or moles on the axilla. According to an embodiment of the invention device alignment points  2498  may be used in conjunction with alignment features  3352  to properly align medical treatment device  2300 . According to an embodiment of the invention device alignment lines  2499  may be used in conjunction with an outer edge of compliant member  2375  to properly align medical treatment device  2300 . According to an embodiment of the invention treatment template  2384  provides guidance and placement information for medical treatment device  2300  in matrix format. 
     According to an embodiment of the invention A medical device disposable may include: a tissue chamber may have a tissue opening at a distal end and a rigid surface surrounding the tissue opening; an applicator chamber; a flexible bio-barrier at a proximal end of the tissue chamber the flexible bio-barrier separating the tissue chamber and the applicator chamber, a portion of the flexible bio-barrier forming a tissue contacting surface; a compliant member surrounding the tissue opening, the compliant member may have a proximal opening adjacent the tissue opening and a distal opening, wherein the distal opening may be larger than the proximal opening. 
     According to an embodiment of the invention the medical device disposable compliant member may be positioned at an angle of approximately fifty-three degrees with respect to the rigid surface. According to an embodiment of the invention the compliant member may include a wall connecting the proximal opening and the distal opening and the wall may be angled approximately fifty-three degrees with respect to the rigid surface. According to an embodiment of the invention the compliant member may further include an outer rim positioned around the distal opening. According to an embodiment of the invention: the outer rim may extend a distance of approximately 0.033 inches from the distal opening; the compliant member may have a height of approximately 0.25 inches; the tissue opening may have a long axis and a short axis, the tissue opening long axis may be approximately 1.875 inches and the tissue opening short axis may be approximately 1.055 inches; the distal opening in the compliant member may have a long axis and a short axis, the distal opening long axis may be approximately 2.429 inches and the distal opening short axis may be approximately 1.609 inches; the tissue contact surface may have a long axis and a short axis, the long axis may be approximately 1.54 inches and the short axis may be approximately 0.700 inches. According to an embodiment of the invention the wall may be substantially straight. According to an embodiment of the invention the compliant member may include one or more alignment marks, at least one of the alignment marks may be positioned on a long side of the compliant member. According to an embodiment of the invention the alignment marks may be positioned on a wall of the skirt and may extend from approximately the rim toward the tissue opening. According to an embodiment of the invention the alignment marks may move with respect to an applicator positioned in the applicator chamber when the medical device disposable is pressed against tissue with sufficient pressure to compress the compliant member. According to an embodiment of the invention the wall may have a thickness of approximately 0.050 inches. According to an embodiment of the invention the tissue chamber may include a chamber wall extending from the tissue opening to approximately the tissue contact surface, the wall may also include a substantially smooth, radiused surface. According to an embodiment of the invention the radiused surface may have a radius of approximately three-sixteenths of an inch. According to an embodiment of the invention the compliant member may have durometer density rating of approximately A60. 
     According to an embodiment of the invention A medical device disposable may include: a tissue chamber including a tissue contact surface at a proximal end of the tissue chamber and a tissue opening at a distal end of the tissue chamber; an applicator chamber; a flexible bio-barrier at a proximal end of the tissue chamber the flexible bio-barrier separating the tissue chamber and the applicator chamber, the flexible bio-barrier forming at least a portion of the tissue contact surface; a vacuum port; a vacuum circuit connecting the tissue chamber, the applicator chamber and the vacuum port, the vacuum circuit including a vacuum passage. 
     According to an embodiment of the invention the vacuum circuit may include: a vacuum passage positioned around the tissue contact surface; a vacuum channel positioned around the vacuum passage, the vacuum channel positioned between the vacuum passage and the vacuum port; an applicator bio-barrier positioned between the vacuum port and the applicator chamber, the applicator bio-barrier being substantially permeable to air and substantially impermeable to fluids. According to an embodiment of the invention the vacuum passage may completely surround the tissue interface surface. According to an embodiment of the invention the vacuum passage may substantially surrounds the tissue interface surface. According to an embodiment of the invention the vacuum passage may be positioned in a wall of the tissue chamber adjacent the tissue contact surface. According to an embodiment of the invention vacuum port may be connected to a vacuum tube. According to an embodiment of the invention the vacuum tube may include a generator bio-barrier. According to an embodiment of the invention the generator bio-barrier may be substantially permeable to air and being substantially impermeable to fluids. According to an embodiment of the invention the vacuum channel may include a well region adapted to collect fluids from the tissue chamber. According to an embodiment of the invention a compliant member may surround the tissue opening, the compliant member may have a proximal opening adjacent the tissue opening and a distal opening, wherein the distal opening may be larger than the proximal opening. According to an embodiment of the invention the vacuum passage may be an opening between a wall of the tissue chamber and the tissue bio-barrier. According to an embodiment of the invention the vacuum passage may be approximately 0.020″ inches wide. According to an embodiment of the invention the vacuum passage may be greater than approximately 0.010″ inches when the medical device disposable may be attached to an applicator. According to an embodiment of the invention the tissue surface may have an area greater than an outer area of an antenna array in an applicator affixed to the medical device disposable. According to an embodiment of the invention the tissue surface may have an area greater than an aperture area of an antenna array in an applicator affixed to the medical device disposable. 
     According to an embodiment of the invention a method of creating a lesion in skin is described, the method including the steps of: positioning an apparatus including a plurality of antennas adjacent a skin surface; supplying energy to a first antenna at a first power level for a first time period; supplying energy to a second antenna at a second power level for a second time period; supplying energy simultaneously to both the first antenna and the second antenna for a third time period, wherein, during the third time period the energy may be supplied to the first antenna at a third power level and the energy may be supplied to the second antenna at a fourth power level. According to an embodiment of the invention the energy supplied to the first antenna may be in phase with the energy supplied to the second antenna. According to an embodiment of the invention the energy supplied to the first antenna may be phase shifted from the energy supplied to the second antenna. According to an embodiment of the invention the energy supplied to the first antenna may be phase shifted approximately one hundred eighty degrees from the energy supplied to the second antenna. According to an embodiment of the invention the energy supplied to the first antenna may be phase shifted between one and one hundred eighty degrees from the energy supplied to the second antenna. According to an embodiment of the invention the energy output from the first antenna may be substantially in phase with energy output from the second antenna. According to an embodiment of the invention the energy supplied to the first antenna may be phase shifted from the energy supplied to the second antenna, the phase shift being sufficient to cause energy output from the first antenna to be in phase with energy output from the second antenna. According to an embodiment of the invention the energy supplied to the first and second antennas may be microwave energy having a frequency of approximately 5.8 GHz. According to an embodiment of the invention the first and second antennas may be microwave antennas. According to an embodiment of the invention the first and second antennas may be waveguide antennas. According to an embodiment of the invention the first and the second power levels may be substantially equal. According to an embodiment of the invention the first power level may be greater than the second power level. According to an embodiment of the invention the power emitted by the first antenna may be substantially equal to power emitted by the second antenna. 
     According to an embodiment of the invention a medical device applicator may include: an antenna array including at least two antenna apertures; at least one intermediate scattering element positioned outside the apertures wherein the at least one intermediate scattering element may be further positioned between the apertures. According to an embodiment of the invention each of the apertures may be substantially rectangular in shape, the apertures including a long axis and a short axis. According to an embodiment of the invention each of the intermediate scattering elements may include a long axis and a short axis wherein the long axis of the at least one intermediate scattering element may be substantially parallel to the long axis of the aperture. According to an embodiment of the invention the medical device applicator may include a cooling plate and the intermediate scattering element may be positioned between the antenna apertures and the cooling plate. According to an embodiment of the invention the medical device applicator may further include one or more coolant chambers positioned between the cooling plate and the antenna aperture. According to an embodiment of the invention the medical device applicator may include at least two central scattering elements positioned under the aperture wherein the at least one intermediate scattering element may be positioned between the central scattering elements. According to an embodiment of the invention the central scattering elements may be positioned substantially in a center of one of the antenna apertures. According to an embodiment of the invention the long axis of the intermediate scattering element may be shorter than the longest dimension of the central scattering element. According to an embodiment of the invention the intermediate scattering element may be manufactured from a material which may have the same dielectric constant as the central scattering element. According to an embodiment of the invention the intermediate scattering element may be made from alumina. According to an embodiment of the invention the intermediate scattering element may be made from a material which may be more than 90 percent alumina. According to an embodiment of the invention the intermediate scattering element may be made from a material which may be approximately 96 percent alumina. According to an embodiment of the invention the intermediate scattering element may be made from, for example silicone. According to an embodiment of the invention one or more temperature measurement devices may be positioned on the cooling plate under the intermediate scattering element. According to an embodiment of the invention the one or more temperature measurement device may be one or more thermocouples. 
     According to an embodiment of the invention a medical device applicator may include at least a first and a second waveguide antenna and at least a first electrically conductive shim positioned between the waveguide antennas. According to an embodiment of the invention each of the waveguide antennas may include: a dielectric core having four sides; metal plating on three sides of the dielectric core, the fourth side of the dielectric core forming an antenna aperture. According to an embodiment of the invention the electrically conductive shim may be copper. According to an embodiment of the invention the electrically conductive shim may be approximately 0.025 inches thick. According to an embodiment of the invention the electrically conductive shim may be positioned between the first and second waveguide antennas such that an edge of the electrically conductive shim may be adjacent the antenna apertures. According to an embodiment of the invention an intermediate scattering element may be positioned under the conductive shim. According to an embodiment of the invention central scattering elements may be positioned under the antenna apertures. According to an embodiment of the invention the medical device applicator may include a cooling plate. According to an embodiment of the invention the intermediate scattering element and the central scattering element may be positioned between the antenna apertures and the cooling plate. According to an embodiment of the invention the medical device applicator may include a coolant chamber positioned between the antenna apertures and the cooling plate. According to an embodiment of the invention the medical device applicator may include temperature sensors positioned on the cooling plate.