MEDICAL LASERS

FUNDAMENTALS, TYPES, AND APPLICATIONS

QT 20170509 ~ Subashiny

 OUTLINE
OVERVIEW
Principle of laser

History of laser

COMMON COMPONENTS OF LASER

Laser beam characteristics

Type of laser media

Laser classification

Thermal & mechanical laser-tissue interactions

Laser in medical applications
Hazards of using laser

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 OVERVIEW
LIGHT
AMPLIFICATION
by
STIMULATED
EMISSION
of
RADIATION
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WHAT IS A LASER?
A device that transforms light of various frequencies
into a chromatic radiation in the visible, infrared, and
ultraviolet regions with all the waves in phase capable
of mobilizing immense heat power when focused at
close range.

* Lasers operate in UV, visible light and infrared range

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PRINCIPLE OF LASING

Monochromatic Coherent Directional Intense

These 4 characteristics make laser highly dangerous

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 The photons bounce between the two mirrors until enough photons
have been emitted that some pass through the semi-silvered mirror
on one end. These are the photons which are seen as the laser beam.

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 3-LEVEL LASER 4-LEVEL LASER

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HISTORY
In 1916, Albert Einstein made a
suggestion using Planks law for
absorption and spontaneous and
stimulated emission of electromagnetic
radiation.
In 1928,German physicist Rudolf
Walther Ladenburg made an
observation about stimulated emission.

At the end of 1953, Charles H. Town

demonstrated a working device that
focused excited ammonia molecules
in a resonant microwave cavity, where
they emitted a pure microwave
frequency. MASER In 1958, Townes and another scientist
called Arthur L. Schawlow made a
proposal that would eventually pioneer
the building of laser machine.

In December 1960 Ali Javan, William

Bennett, Jr., and Donald Herriott at Bell
Labs built the first gas laser, which
generated a continuous infrared beam
from a mixture of helium and neon.

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COMMON COMPONENTS OF LASER SYSTEM
(excitation mechanism)
(fully reflective)
(Partially reflective)
mirror

(Active medium)

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 Laser Delivery Hand piece
Pumping Optical Cavity System
System
Energy transferred into ~ Heart of machine
gain medium, exciting the ~ Consists of highly ~ Laser emitted from PRM ~ Delivery system
atoms reflective chamber enter this chamber. terminates in the hand
flanked by a 100% ~ May consist of: piece, which may emit the
Atoms become unstable
reflective mirror & a 50% laser as a collimated
& release energy as * Fibre optic cables
reflective mirror encasing beam or focused beam
photons
the gain medium * Articulated arms with the aid of lenses..
Higher orbit electrons ~ Photon emitted
move bck to ground state reflected back & forth
between the mirrors & in
If population inversion their course excite other
occurs, stimulated atoms stimulated
emission can be induced. emission
~ FRM reflects all
photons. PRM allows
some photons through
into delivery system

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 LASER FORMATION

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 Types of
Laser Media

The most widely used

lasers today. Emit visible or

Semiconductor
infrared light when an
electric current passes
through the diodes
junction.

Solid Liquid Gaseous

(Ruby)
the atoms responsible for generating
laser light are first excited to higher
energy states through the absorption
of photons, and the way in which
these atoms relax from their excited
states determines the quality and
quantity of laser light produced.
(dye)
Laser emission originates from
interactions between the vibrational
and electronic states of dye
molecules that split the electronic
energy levels into broad energy
bands similar to those of vibronic
lasers
(HeNe)
Common helium-neon laser contains
a small amount of neon and a much
larger amount of helium. The helium
atoms capture energy from electrons
passing through the gas and transfer
it to the neon atoms, which emit light.

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 MEDICAL LASER
Commonly used in specialist fields such as general
surgery, plastic surgery, dentistry, O&G, otology,
ophthalmology, urology, dermatology, cardiology,
physiotherapy, photodynamic therapy, etc.
Lasers in Medical
Practice

Continuous Q-
Pulsed
wave switched
Excitation medium is Technique employed to
modulated producing a produce a very high
pulse of laser radiation peak power of very short
lasting usually less duration pulse by
than 0.25sec preventing the reflection
of photons back & forth
in the active medium.

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LASER BEAM CHARACTERISTICS
Focused in a narrow beam; narrow range of wavelengths
(monochromatic); waves in phase with each other

Due to interactions between the process of stimulated

emission, the resonant cavity, and the laser medium.

The extent of beam spreading depends on both the distance

between the laser mirrors and diffraction, which scatters light
at the edge of an aperture.

Lasers can generate pulsed

or continuous beams.

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Continuous wave mode
Continuous wave lasers are usually seen in CO2 & Ar lasers.
Transmission without interruption & of low power & constant output.

Pulsed mode
Laser beam is emitted in a train of narrow, higher peak power pulses with predetermined on-off
time cycles even though the laser switch is depressed.
Higher peak power is achieved through pulsing the laser over a short period of time.
With higher peak powers, tissue incision capability is increased.
Shorter laser activation time results in collateral tissue having more time to cool down between
pulses, reducing probability of thermal damage.

Q-switch lasers
An electromagnetic/chemical switch within the laser cavity that allows the release of all the
energy in one brief powerful pulse.
Achieved through inclusion of some type of variable attenuator inside the lasers optical cavity.

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 LASER CLASSIFICATION

Laser
Classification

Power/Energy
Wavelength
of beam

Based on potential of the laser to cause injury to the eye from direct
exposure to the beam or from reflections from specular reflective
surfaces.

Laser devices are marked by labels comprising the laser symbol,

wavelength, class of laser and output power/energy. (according to IEC
60825-1:2007)
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IEC 60825-1:2007 SAFETY OF LASER
PRODUCTS EQUIPMENT CLASSIFICATION Class 1
eye-safe
under all
operating
Class 4 conditions Class 1M
Radiation & viewing of Safe for
diffuse reflection are viewing
dangerous. Capable of directly but
setting fire to hazardous to
materials onto which view with
theyre projected optical instr.

Laser
Class 3B classific Class 2
Visible lasers.
Radiation very ation Safe for
likely to be
accidental
dangerous.
viewing under all
Viewing of diffuse
operating
reflection is safe
conditions

Class 3R Class 2M
Visible laser. Safe
Radiation in
for accidental
this class is
viewing with naked
considered low
eye as long as
risk but
natural aversion
potentially
response is present
hazardous

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 Propagation of light of different wavelengths in the tissues.

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WHEN LASER BEAM IS PROJECTED AT TISSUE
Minority (apprx. 4%) of light striking skin is reflected due to refractive index of
air and skin.

When light is absorbed, it gives up its

photon to a chromophore.
The photon will cease to exist and its
quantum of energy transferred excites the
chromophore.
Without light absorption, there can be no
effect on the tissue.

Properties of light can be manipulated in terms of its , pulse duration & fluence
so that a particular chromophore is preferentially targeted, absorbing the light
energy and is destroyed while other chromophores are left intact.
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 Absorption, Penetration into
tissue

UV spectrum: Most organic

molecules display strong
absorption, so penetration is very
weak (a few microns).
VL: absorption mainly due to
hemoglobin and melanin.
Red & near infra-red (600 to 1200
nm): weakly absorbed & penetrate
deeply into the tissue
Near and far infra-red: water
absorbs intensely

VL F.IR
R&N.IR

Figure: Absorption spectrum of major chromophores in the skin

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MAIN LASER-TISSUE INTERACTIONS IN MEDICINE
Photo-chemical: occurs when the energy of photons > chemical energy bond and at very low levels of
intensity or irradiance and for high exposure times.

Photo-thermal: occurs when the energy of a photon < binding energy and by using infrared lasers or by
irradiation with pulsed lasers of durations up to s.

Photo-ablative: occurs when the intensity and wavelength of laser exceed certain threshold values
that allow the removal of layers of material from the irradiated target. Short wavelengths (190-300 nm)

Photo-dynamic Therapy: relatively selective uptake of a photosensitising drug and subsequent

irradiation with light of a suitable wavelength. In the presence of oxygen, singlet oxygen is produced with the
induction of a cytotoxic action.

Electromechanical: takes place when the laser pulses of high intensity, impinge the material that
absorbs them. Ionization effects are induced; they generate a plasma which causes cavitation effects.

Non-ablative Laser Therapy: uses a wavelength that doesnt cause water in the tissue to
evaporate but rather the laser energy heats the tissue in a controlled manner. The rise in temperature
stimulates neocollagenesis, a process in which new collagen is produced by the body.

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 THERMAL EFFECTS OF A LASER BEAM IN A LIVING TISSUE

For wavelengths longer than conversion of absorbed light to heat

VL, (red & near-IR) reflectivity
produces "primary" heat.
tends to be shorter & beam is
more penetrating

Transfer of heat through conduction by

interaction between tissue particles

1) Hyperthermia moderate Transfer of heat through conduction by

temp.rise until destruction interaction between tissue particles
2) Coagulation irreversible
necrosis; w/o immediate
tissue destruction Choosing wrong light for a tissue with a specific
3) Volatisation loss of optical coefficient can result in inefficient light
tissue material penetration to target tissues & excessive thermal
heat production in absorbent tissues.

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 Minimizing the duration of laser exposure will optimize the tissue
effects for most applications.

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EFFECT OF DIFFERENT TEMPERATURE OF A LASER BEAM IN A LIVING TISSUE

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 MECHANICAL EFFECTS OF A LASER BEAM IN A LIVING TISSUE
Production of shock wave from :-
Creation of plasma: With nano or pico sec. pulsed Nd:YAG lasers, a very high intensity of luminous flux
over a small area ionises atoms and creates a plasma. At the boundary of the ionised region, there is a very
high pressure gradient which causes the propagation of a shock wave. It is the expansion of this shock wave
which causes the destructive effect. During optic surgery.

Explosive vaporisation: When the exposure time of the laser is lower than the characteristic time of
thermal diffusion in the tissue, it produces a thermal containment, with an accumulation of heat without
diffusion and an explosive vaporisation of the target. This effect is produced during removal of tattoos with a Q-
switched Nd:YAG laser. The large particles of pigment in the skin explode and result in smaller particles which
are re-absorbed through the skin.

Phenomenon of cavitation: If a mechanical containment is added to a thermal containment, the

explosive vaporisation does not occur, and a gas bubble is created which will implode when the laser beam is
interrupted, creating the phenomenon of cavitation. This is the mechanism which is used for fragmentation of
urinary calculi by a laser emitting micro-second pulses.

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 TYPES OF LASER DELIVERY SYSTEMS ONTO TISSUE SURFACE

Laser beamed via fibre optics cable

~ Light & easily manueverable
~ Unable to transmit high intensity light because can lead to

material damage.

Laser beamed via articulated arm

~ more robust & sturdier system
~ more useful for high intensity laser transmission
operations

Free style laser beaming

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 LASERS FOR MEDICAL APPLICATIONS
PDT: treatment of cancer, age-related macular degeneration, psoriasis,
for bacteria reduction in dentistry and general surgery.
LLLT: therapeutic and/or stimulating skin treatments and involves lower
laser power doses than those generally used in surgical operations.
Surgery: to cut, coagulate and vaporize. Various types of lasers & pulse
energies used based on the absorption properties of target tissue.
Dentistry: cutting instrument or a vaporizer of tissue that it comes in
contact with. Curing a filling helps to strengthen the bond between
the filling and the tooth. Teeth whitening procedures acts as a heat
source and enhances the effect of tooth bleaching agents.

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LASERS IN MINIMAL ACCESS SURGERY
Emitted laser light is notable for its high degree of spatial and temporal
coherence, unattainable using other technologies.
Intracellular fluid is intensively heated causing the cell membrane to
explode as in cutting, or to slowly dehydrate the process of coagulation
during minimal access surgery (laparoscopy).
Highly used in lithotropsy.

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Comparison between different types of lasers & their tissue interaction
CO2 Argon Nd:YAG KTP Holmiu Diode
m

Energy = 10 600nm = 488 - 514nm = 1060nm = 532nm = 2100nm = 375-

Range Far-IR Range V.Light Range Near-IR Range V.Light IR Range 810nm
Range Near-IR Range
Cellular intensely intensely intensely absorbed intensely Intensely Intensely
absorpti absorbed by absorbed by by tissue protein & absorbed by absorbed by absorbed in
on cellular water hemoglobin and chromophore hemoglobin water tissue
melanin and melanin
Potential Results in Used in aqueous The device projects capable of permits cutting Permits
uses superficial environments, beam at right incision, and ablation of vaporization
injury to tissues such as the angles to the long coagulation, bone and and/or cutting
& enables bladder, and in the axis of the probe, and cartilage (incision,
sealing of BV & presence of thereby allowing the vaporization excision, or
lymphatics up to irrigating fluids. prostatic tissue to of tissue dissection) of
0.5mm to 1.0mm be photocoagulated dental
in D. or vaporized. elements
Clinical most efficient for enables surgeon has been used for laser ablation most efficient Soft-tissue
Applicati ablation or to photocoagulate the vaporization of urologic for application
ons vaporization of a bleeding area (ablation) of tumors applications meniscectomy &
large volumes of while irrigating to (prostatic percutaneous
tissue,eg tumor locate the source tissue) laser disc
nodules. of the bleeding. decompression

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LASER HAZARDS Type of
lasers
Type of Wavelength
targeting of the beam
tissues
Laser-
Tissue
Duration
of
Interactio Power
exposure ns density

Size of
the Fluence
beam

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LASER-TISSUE INTERACTIONS Thermal

Electromechanica Photochemical
l

Biologica
l Effects

Photodistruption Phototherm
(Acoustic) al

Photoablative

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LASER RADIATION EFFECTS

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ANCILLARY HAZARDS: BEAM HAZARDS

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 ANCILLARY HAZARDS: NON-BEAM HAZARDS

Electrical
hazards

Compressed
gas hazards

Dye laser
hazards

Noise
hazards

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NOMINAL OCULAR HAZARD DISTANCE (NOHD) &
MAXIMUM PERMISSIBLE EXPOSURE (MPE)

MPE is the highest level of laser exposure at the eye or skin that is
generally considered safe. varies acc. to laser wavelength &
exposure duration

NOHD is the space within which the irradiance of radiant exposure

exceeds the acceptable MPE.

Irradiation is the power of electromagnetic radiation per unit area

(radiation flux) incident on an surface.

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LASER CONTROLLED AREA (LCA) & LASER
SAFETY PROCEDURE (LSP)
LCA is the restricted area where protective control measures are required.
Incl. region around the equipment where MPE level maybe exceeded.

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REFERENCES
1) Jelinkova, H. Lasers For Medical Applications: Diagnostics, Therapy And
Surgery. 1st ed. Woodhead Publishers, 2013. Web. 25 May 2017.
2) Cutroneo, M. et.al. (2011) Laser Applications In Bio-medical Field. Journal
of Physics. 21(6).
3) Guidance Document on the Safe Use of Medical Lasers. January 2016.
Medical Device Authority, Ministry of Health, Malaysia.
4) Hecht, Jeff. Laser" Encyclopaedia Britannica Online. Encyclopaedia
Britannica Inc., n.d. Web. 24 May. 2017.
5) Niemz, M. "Chapter 4: Medical Applications of Lasers" Laser-Tissue
Interactions: Fundamentals and Applications. Indianapolis, IN: Springer,
2013. pp 151-247. Web. 25 May 2017

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 Thank you.
http://www.qualtech.com.tw

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