LASERS & LASER Physics
Lasers are a form of Electromagnetic Radiation
Laser light is non-ionizing like these forms of radiation: (Incandescent
Light Sunlight – Heat - Radio Waves )
Not like : Nuclear radiation , along with gamma rays and x-rays are
ionizing forms of radiation, meaning the exposure to them can cause cell
mutation and/or death.
Laser light has three properties that make it different from ordinary light...
1st Laser Light is Coherent
2nd Laser Light isMonochromatic
3rd Laser Light is Collimated
There are Four Basic Components to Every Laser :
Lasing Medium
Optical Cavity
Power Source
Delivery System
Lasing Medium or the substance that produces the laser beam could be:
GAS such as the CO2 or Argon laser
SOLID such as the ND:YAG or Alexandrite laser
LIQUID such as the Tunable Dye laser
Two Types of Lasers :
Continuous Wave
Pulsed
Power Source :
what is used to excite, or stimulate the lasing medium to produce the laser
beam
Power sources include:
- Electricity
- Flash lamps
- Other lasers
Delivery Systems :
what is used to modify or alter the laser beam and get it to the patient, so it
can do it’s work for us
Delivery systems include:
- Articulated arms
- Optical fibers
- Micromanipulators
- Focusing handpieces
- Lenses
Laser Effect on Tissue : Reflection - Scattering – Transmission – Absorption
LASER : Tissue Interactions :
Photoablation
- Heats so intensely, tissue is ablated CO2 Er:YAG
Photothermal
- Light is transformed to heat
Photoacoustic
- Pulse is so fast, shock wave is created “Q” Switch
Photochemical
- Light energy energises photosensitiser ( ALA, PPIX PDT )
Laser Spot Size vs. Power Density :
Large Spot Size Decreased Power + Density
Smaller Spot Size Increased Power + Density
Intensity :
Laser energy is normally described in units of : -
Watts
Joules :
- J/cm2 for surface treatments
- J/cm for lineal treatments
( 1 Joule = 1 Watt x 1 Second )
Selective Photothermolysis :
Anderson and Parrish
Use LASER wavelength that is absorbed by : Chromophore of interest.
Selectively heat target Chromophore.
Leave LASER on only long enough to heat the target.
Pulse Length
Thermal Relaxation Time (TRT)
- Defined as the time it takes for a target structure to dissipate 50% of the
energy absorbed into the surrounding tissue.
Longer pulses for larger structures .
TRT :
- Pulse length should be approximately equal to the TRT of the target
- Too long and cannot heat target
- Too short can have interesting consequences
Laser Safety
Window Protection
- All windows in a laser treatment room should be protected from beam
ransmission.
Laser Signs
- All doors to a laser treatment room are to be closed and have a laser
specific danger sign along with a pair of laser eyewear.
Hazards
Lasers Are Classified in Four Broad Groups:
Class I No known biological hazard
Class II Chronic viewing hazard only
Class III Direct viewing hazard
Class IV Direct and reflected hazard
Eye Protection
AORN Recommended Practice II
“Eyes of patients and health care workers should be protected from laser beams.”
Interpretive Statement I
“Laser-safe eye protection with appropriate wavelength and optical density
should be worn by all health care workers and all patients and labeled to protect
against improper use.”
Laser Accident Summary
Eye Injury 70%
Skin Injury 11%
Electrical 6%
No-harm Exposure 4%
Others 2%
Fire 2%
Occular Hazards
Er:YAG 2940nm or CO2 10,600nm
- Corneal / Sclerol damage due to water absorption
400-1400nm Visible and Near-infrared
- Retinal damage
- Laser retinal burns can be painless
- Appropriate eye protection required
Patient Eye Protection :
- Laser Eye Wear
- Moist Sponges
- Wet Towel
ANSI Standards for Eye Safety
Class III Helium-Neon
- Dangerous only if viewed directly
Class IV Argon, YAG, CO2 ,Diode
- Dangerous to view
- Scattered radiation
- Goggles mandatory
Fire Hazard :
Be on the Lookout for Flammable or Combustable:
- Anesthetics
- Prep Solutions
- Drying Agents
- Ointments
- Plastics
- Resins
- Hair
Electrical Safety :
- High Voltage Electricity
- Accidental Discharge Can be Fatal
- Electrical Charges Retained For a Long Time
Laser safety considerations :
Electrosurgical Unit
- Bovie pad
- Implants
- Touching metal
- Fire
- Shock
- Healthy tissue
- Pre solution “pooling”
Laser
- Laser sign
- Doors closed
- Windows covered
- Eye protection
- Basin of water
- Standby mode
- Fire
Nursing Education :
General Staff
- Initial in-service on equipment
- Periodic updates
Laser Specialists
- In-depth training in laser technology
Treatment Room
Safety Equipment
- Fire extinguisher
- Emergency cart
Miscellaneous Equipment
- Dressings, ointments, ice packs
- 0.5% Tetracaine eye drops, eye shields
- irror, scissors, tape
- Local anesthesia equipment
Plume Issues
Plume Greater with Er:YAG than CO2
Need Excellent Smoke Evacuation
Wall Suction Inadequate
Use of Laser Protective Masks (0.1μ) :
To decrease inhalation of particulate matter
Pumped Air to Clear Handpiece
Controlling Plume Hazard
Thermal destruction of tissue creates smoke byproduct.
Plume can contain toxic gases and vapors such as benzene, hydrogen
cyanide and formaldehyde, bioaerosols, dead and live cellular materials
including blood fragments and viruses.
At high concentrations, the smoke causes ocular and upper respiratory tract
irritation in health care personnel and creates visual problems for the
surgeon. The smoke has unpleasant odors and has been shown to have
mutagenic potential.
General room ventilation is not sufficient enough to capture contaminants.
Smoke evacuators should have high efficiency in airborne particle
reduction.
HEPA filter or equivalent is recommended for trapping particulates.
Generally, the use of smoke evacuators are more effective than room suction
systems to control plume
