LASER

MADE BYREEMA PARMAR

HEMALI PATIL

NISHITA RANA

INTRODUCTION
Light Amplification Stimulated Emission of Radiation

It refers to the production of a beam of radiation which differs from ordinary light. Dr. Thedore from USA produced the 1st burst of ruby lasers Later helium neon, carbon di oxide n gallium arsenide lasers were used for therapeutic purposes

Properties of laser

Electrons can occupy only certain energy levels or shells around the nucleus If enough energy is added to the atom the electrons tend to move to a higher state When cascading down from one energy level to another they emit a photon The wavelength and energy of the photon depends upon the energy difference between the two energy levels Photons themselves if absorbed can give energy to an atom For absorption of a photon to occur its wavelength must correspond exactly to the energy difference of the two shells Similarly, if the electron is already in a higher energy state may move to a lower energy state by giving out a photon of its own identical to that of the colliding photon. this is called stimulated emission

Ruby laser Heliumneon laser Diode laser

Contains synthetic ruby as lasing medium A helical electric discharge tube containing xenon tube is wound around the ruby rod

Contains he-ne gas at low pressures. Flashgun stimulates electrons to higher level Red in color having wavelength of 632.8nm

Diode or semiconductor laser with wavelength of 904nm Can produce pulsed and continuous output

Ruby laser

Cla power -ss

1 2 3a
low

Classification of laser
effect
None or eye or skin Safe on skin.eyes protected by aversion response Viewing with optical aids may be hazardous

usage
Laser pointer Barcode reader Therapeutic lasers Laser pointers Therapeutic lasers Laser pointers

Low up to 1 mw

Low medium upto 5mw

3b

Medium up to 500 mw

Viewing may be hazardous

Therapeutic lasers

Measurement of LASER energy

The amount of energy falling on a surface [energy density] is expressed in joules per square meter. The rate at which energy is absorbed or produced is measured in joules per second i.e watts called power. The average power per unit area can be expressed as irradiance or power density. The divergence of laser beam can be expressed in terms of an angle.

Therapeutic uses of LASER

There are 2 main categories for which LASER therapy is used: Tissue Healing Pain control Within these 2 categories laser therapy is widely used in soft tissue injuries, like muscle tears, hematomas and tendinitis.

Tissue Healing
The application of LASER therapy is used for soft tissue injury and regeneration. It sends radiation through skin layers to soft tissue cells to stimulate blood flow & metabolism. The LASER energy is directed to bodys injured cells where the cells transform this energy to chemical energy promoting natural healing & pain relief through tissue repair.

Pain Control
Musculoskeletal pain LASER therapy is used for the relief of both acute & long term conditions like rheumatoid arthritis, back pain, osteoarthritis, bursitis, tennis elbow, golfers elbow, supraspinatus tendinitis etc. It is also used in fracture consolidation. Neurogenic pain LASER therapy can relieve pain caused in trigeminal neuralgia, postherpetic neuralgia, etc.

Effects of LASER
LASER radiations of 660nm, 820nm, 870nm, wavelengths encourage macrophages to release factors that stimulate fibroblast proliferation but 880nm has inhibitory effect. The LASER radiation may cause an increase in collagen formation, vasodilatation, DNA synthesis, & an increase in RNA production which help in acceleration of wound healing. Low intensity laser radiation accelerates cell proliferation.

Neurogenic pain can be relieved by laser which affects the serotonin metabolism. Pain is also treated by application of laser on acupuncture points. Acupuncture points have low skin resistance than normal.

Most low or medium-power laser sources are applied to the skin by a hand-held applicator about the size of a large marker pen. Direct application to skin ensures maximum transfer of laser energy and light pressure; squeezing blood from superficial vessels can increase the penetration further. In other types of laser the applicator may be held in a rigid but mobile stand & applied about 30cm away from the patient which is normally used to cover a relatively large area.

Preparation of the patient.

Preparation of the apparatus.

Preparation of the part.

Application-1. A key activates the machine to ensure that unauthorized people do not switch on the laser. 2.The applicator is applied to the surface before switching on. 3.It is important to maintain the laser applicator in contact with the tissues so that the beam is applied at the right angles in order to achieve maximum penetration. Termination.

 Wavelength Area of application Are fixed by the type of laser apparatus used. The energy density can be varied by the time of a single application of the probe or applicator.

 Visible red laser-superficial conditions- wounds, ulcers. Infrared laser- deeper musculoskeletal structures. ENERGY DENSITY The treatment dose is usually given in joules/ sq cm and called energy density or radiant exposure. The usual ranges are from 1 to 10J/sq cm but doses as low as 0.5J/sq cm. & upto 32J/sq cm. Higher doses are usually recommended for subcutaneous tissues.

PULSED OUTPUT
This is achieved by adjusting the pulse duration so that the low pulse rates have long pulse lengths and high rates have shorter pulse lengths. Normally low pulse frequencies and long pulse durations are used for acute conditions and higher pulse rates with short pulse durations for chronic conditions. In some machines where the mean power is said to be constant the energy introduced into the tissues will not be altered by this pulsing difference.

AREA OF TREATMENT
Discrete lesions should be treated directly over the affected part. For wounds and large areas the part is divided into cm and each area is separately stimulated or a scanning technique may be used in which the laser is moved continuously over the wound surface. PROGRESSION OF TREATMENT If there is no response to treatment the dose should be increased. 5 to 6 treatments are said to be sufficient to establish some response to treatment.

 DANGERS The main danger involving low level laser therapy is a risk of eye damage if the beam is applied directly to eye. If laser passes through the lens of the eye, the beam can become focused on a very small area, causing intense heating.

CONTRAINDICATIONSActive or suspended carcinoma Direct irradiation of the eyes Cognitive difficulties or unreliable patients Increased sensitivity to light

Irradiation over the pregnant uterus

Hemorrhage and infected tissues

 Avoid irradiation of the gonads. Avoid irradiation of the patients with a history of epilepsy. Ensure that the patient understands the nature of the treatment and related dangers. Avoid active epiphyseal regions in children. Use laser devices only in specially designated areas. Avoid reflecting the laser beam from shiny surfaces. Switch on laser only when the applicator is in contact with the skin. Use appropriate protective goggles.

Most low or medium-power laser sources are applied to the skin by a hand-held applicator about the size of a large marker pen. Direct application to skin ensures maximum transfer of laser energy and light pressure; squeezing blood from superficial vessels can increase the penetration further. In other types of laser the applicator may be held in a rigid but mobile stand & applied about 30cm away from the patient which is normally used to cover a relatively large area.

Preparation of the patient.

Preparation of the apparatus.

Preparation of the part.

Application-1. A key activates the machine to ensure that unauthorized people do not switch on the laser. 2.The applicator is applied to the surface before switching on. 3.It is important to maintain the laser applicator in contact with the tissues so that the beam is applied at the right angles in order to achieve maximum penetration. Termination.

 Wavelength Area of application Are fixed by the type of laser apparatus used. The energy density can be varied by the time of a single application of the probe or applicator.

 Visible red laser-superficial conditions- wounds, ulcers. Infrared laser- deeper musculoskeletal structures. ENERGY DENSITY The treatment dose is usually given in joules/ sq cm and called energy density or radiant exposure. The usual ranges are from 1 to 10J/sq cm but doses as low as 0.5J/sq cm. & upto 32J/sq cm. Higher doses are usually recommended for subcutaneous tissues. The existence of a therapeutic window for laser dosage has been suggested as between 0.5J/sq cm. and 4J/sq cm.

PULSED OUTPUT
On some machines the mean power output is always the same regardless of pulse frequency.

This is achieved by adjusting the pulse duration so that the low pulse rates have long pulse lengths and high rates have shorter pulse lengths. Normally low pulse frequencies and long pulse durations are used for acute conditions and higher pulse rates with short pulse durations for chronic conditions. In some machines where the mean power is said to be constant the energy introduced into the tissues will not be altered by this pulsing difference.

AREA OF TREATMENT
Discrete lesions should be treated directly over the affected part. For wounds and large areas the part is divided into cm and each area is separately stimulated or a scanning technique may be used in which the laser is moved continuously over the wound surface. PROGRESSION OF TREATMENT If there is no response to treatment the dose should be increased. 5 to 6 treatments are said to be sufficient to establish some response to treatment.

 DANGERS The main danger involving low level laser therapy is a risk of eye damage if the beam is applied directly to eye. If laser passes through the lens of the eye, the beam can become focused on a very small area, causing intense heating.

CONTRAINDICATIONSActive or suspended carcinoma Direct irradiation of the eyes Cognitive difficulties or unreliable patients Increased sensitivity to light

Irradiation over the pregnant uterus

Hemorrhage and infected tissues

 Avoid irradiation of the gonads. Avoid irradiation of the patients with a history of epilepsy. Ensure that the patient understands the nature of the treatment and related dangers. Avoid active epiphyseal regions in children. Use laser devices only in specially designated areas. Avoid reflecting the laser beam from shiny surfaces. Switch on laser only when the applicator is in contact with the skin.