Ms.

SINDU DIVAKARAN
ASSISTANT PROFESSOR
DEPARTMENT OF BIOMEDICAL
ENGINEERING SCHOOL OF BIO AND
CHEMICAL ENGINEERING
⦿ Phototherapy (light treatment) is the
process of
using light to eliminate bilirubin in the
blood.
⦿ Baby's skin and blood absorb these light
waves.
⦿ Light waves absorbed convert bilirubin into
products, which can pass through their
system.
⦿ Lamps emitting light between the
wavelengths of 400 - 500 nanometres
(peak at 460nm) are specifically used for
administering phototherapy as bilirubin
⦿ Bilirubin, are present in the interstitial spaces and
superficial capillaries of the skin, subcutaneous
tissues.
⦿ During the phototherapy, these molecules are
exposed to
light.
⦿ Photons of energy are absorbed by the pigment,
bilirubin.
⦿ Leads to a sequence of photochemical reactions;
configurational isomerisation, structural
isomerisation and photo-oxidation.
⦿ Energy converts bilirubin into its nontoxic isomers
such as photobilirubin ,lumilirubin which are more
polar and thus water soluble.
⦿ Photo-isomers are eliminated from the body more
easily without undergoing the process of
conjugation in the liver.
⦿ As formation of lumirubin is the rate limiting step,
less amount of lumirubin is formed.
⦿ Measure the irradiance at the skin
with a phototherapy radiometer.
⦿ The irradiance level varies
depending on where the
measurement is taken.
⦿ Irradiance should be measured in 3
places where the infant will be lying
and an average of the measurements
should be made.
⦿ The higher the irradiance the larger the
rate of bilirubin decline.
⦿ Radiometer should read between 0.5 to
0.9 µ W/cm2 /nm under normal
⦿ [Link] Halogen lights -Positioned
above the infant and can deliver 10 to
30 µ W/cm2
/nm.
⦿ Quartz halogen bulb
⦿ Tendency to become hot
⦿ Positioned at 52cm away from baby.
⦿ 2. 2 Blue and 2 White Fluorescent
lights - Blue light is the most
effective light for reducing the
bilirubin.
⦿ Delivers 12µW/cm2 /nm.
⦿ Light should not be delivered from the
⦿ [Link] - Blue Halogen light -Uses a
halogen
bulb directed into a fiberoptic mat.
⦿ Filter removes the ultraviolet and
infrared components and the eventual light
is a blue-green colour.
⦿ Blanket to give double phototherapy and
increases
the surface area exposed.
⦿ [Link] – Blue Fluorescent light -Blue
fluorescent tube is fitted into a plastic crib
with a stretched plastic cover over the top for
the baby to lie on.
⦿ Baby is dressed in the Bilicombi baby suit and
nursed
on the soft plastic cover.
⦿ progressive and gradual damage
to your skin on a molecular level.
⦿ risk of developing skin cancer.
⦿ lead to immunosuppression.
⦿ eyes more sensitive to light
⦿ Laser treatment increases the potential for
laser
accidents also increases.
⦿ The Joint Commission EC.02.02.01

 The hospital minimizes risks associated

with selecting and using hazardous
energy sources.

 This includes ionizing (radiation and x-

ray equipment) and non-ionizing
equipment (LASER’s and MRI’s)
 Hazardous effects related to unintentional
direct
contact with the laser beam

⦿ Eye related
⦿ Interaction hazards (Plume and Fire)
⦿ Skin related
⦿Corneal/Sclera Injury:caused by wavelengths that
do not pass through fluid (roughly above 1400 nm
and below 400 nm)
⦿Retinal Burns Injury:caused by wavelengths that do
pass through fluid from (roughly 400-1400nm)
 Injury can result from exposure to:
 direct beam
 mirror reflection (surgical instruments)
 diffuse beam (tissue reflection)

⦿Damage dependent on:

 intensity - lens of eye can focus beam onto the
retina
 wavelength - absorbed by different parts of the
eye
 duration - fraction of second, before you can
⦿Plume - smoke from vaporization
Creates a visibility problem
Can cause nausea
⦿ Can be Carbon, Aerosolized blood, Gases –
including benzene, toluene and
formaldehyde
⦿particle size - 0.1 microns
⦿smoke evacuator is the preferred
control method
⦿ Canoccur if the laser beam comes into
contact with combustible or volatile
materials, such as:
🗉 gauge pads
🗉 surgical drapes
🗉 gowns
🗉 alcohol
🗉 anesthetic gases
🗉 plastic trach tubes
🗉Thermal burn
🗉 Laser effects on tissue are dependent
on 4 factors:
🗉power density of laser beam
🗉wavelength
🗉duration of exposure
🗉effects of circulation and
conduction
Hazards associated with the generation of
the laser beam
 Electrical
 High voltage – many lasers require high
voltage to generate the laser
beam.
 Accidental exposure can result in
electrical shock or death
 Chemical
 Dye lasers use hazardous dyes to
generate the laser beam
(hazardous waste)
⦿
Engineerin
⦿ control
measures that are built into the
g-
laser system, such as:
⦿ enclosing the electrical system, within a
cabinet
⦿ enclosing
the beam within fiber optics
or mechanical arms
⦿ Administrative
Control
a. Controlled Entry-
 Closing doors and covering windows (when
required)
 Posting of the PROPER “Laser in Use” signs
outside
all entries.
⦿ B. Education-
⦿ All personnel that may be exposed to the laser
shall be required to attend regular “in-services” on
operating the laser and laser safety.
⦿ C. Standards-
⦿ Each medical facility should develop their own set of
operating standards.
⦿ Eyewear
⦿ Each laser requires specific eyewear that is capable
of absorbing laser light of that specific wavelength
⦿ Everyone in the laser OR must wear eye protection
including the patient.
⦿ Patient – the patient’s eye’s can be
protected by:
🗉 covering with moist towels
🗉 goggles
🗉 intra-ocular shields
⦿The surgeon must have eye protection,
even
during microscopic and endoscopic
procedures.
⦿ Barriers

🗉 Clothing
🗉 Gloves
🗉 Fire resistant gowns
🗉 Fire resistant surgical drapes
🗉 Moist gauze and drapes around surgical area
⦿ all gauze and drapes around the surgical area
should be moistened with sterile saline.
⦿smoke evacuators filter out the smallest particles
(0.1 µ) found in the laser plume
⦿Smoke evacuator suction tube must be
placed as near to the site of laser ablation as
possible
⦿ Biostimulation, also known as LILT or LLLT
Low Intensity(Level) Laser Therapy,
improves post operative healing and
yields excellent antalgic effects.
⦿ Also called photobiology
⦿ Biostimulation is obtained using a
defocalised beam with low energy
density.
⦿ Light energy is absorbed by tissues, and
stimulates the metabolic processes
inducing tissue regeneration.
⦿ It emits no heat, sound, or vibration.
⦿ Also called as cold laser therapy
⦿ Low levels of light does not heat the
body tissue.
⦿ Level of light is low when compared to
other forms of laser therapy, such as
those used to destroy tumors and
coagulate tissue.
⦿ Superficial tissue is commonly treated
with wavelengths between 600 and
700 nanometers (nm).
⦿ For deeper penetration,
wavelengths between 780 and
⦿ Generates light of a single wavelength.
⦿ No temperature elevation within the tissue,
but rather produce their effects from
photobiostimulation effect within the
tissues.
⦿ Low-level lasers do not cut or ablate the
tissue.
⦿ LLLT devices include the gallium arsenide,
gallium aluminum arsenide infrared
semiconductor (gallium- aluminum-arsenide),
and helium-neon lasers.
⦿ Output powers range from 50 to 500 mW with
wavelengths in the red and near infrared of
the electromagnetic spectrum, from 630 to
980 nm with pulsed or continuous-wave
emission.
⦿ Application in periodontics including
⦿ Biostimulatory and inhibitory effects of LLLT
are governed by the Arndt-Schulz law.
⦿ Law states that low-dose will increase physiologic
processes, and strong stimuli will inhibit
physiological activity.
⦿ Represents a set of structural, biochemical and
functional changes in living microorganisms.
⦿ Acts directly on stimulating components of the
so- called antenna pigments of the respiratory
chain and manifest as an immediate effect cell
vitalization by adenosine triphosphate (ATP)
mitochondrial production increase.
⦿ Induces intracellular metabolic changes,
resulting in faster cell division, proliferation
rate, migration of fibroblasts and rapid matrix
production.
⦿ 1. Increases ATP synthesis
⦿ 2. Stimulates cell growth
⦿ 3. Increases cell metabolism
⦿ 4. Improves cell regeneration
⦿ 5. Invokes an anti-inflammatory
response
⦿ 6. Promotes edema reduction
⦿ 7. Reduces fibrous tissue formation
⦿ 8. Stimulates nerve function
⦿ Previouslyhelium-neon (HeNe) laser of <1 mW.
⦿ Limited by the need for an optic fiber, the size of
the machine and the still rather low power
option
⦿ Replaced by the indium-gallium-aluminum-
phosphide laser, a diode producing red laser in
the range 600- 700 nm and able to deliver as
much as 500 mW.
⦿ Frequently used in dentistry is the gallium-
aluminum-
arsenide laser.
⦿ Operates in the spectrum between 780 and 830
nm.
The output is typically between 10 and 500 mW.
⦿ Advantage of the diode lasers is the small size
and option for battery operation, making
them rather handy and portable. T
⦿ Reduction of inflammation: It can
occur within hours to days.
⦿ Pain relief
⦿ Accelerated tissue regeneration: LLLT
stimulates cell proliferation of
fibroblasts , keratinocytes ,
endothelial cells and lymphocytes.
⦿ Wound healing in a range of sites, like
surgical wounds, extraction sites,
recurrent aphthous ulcerations -
Dental
⦿ Minor injuries and sprains
⦿ Sports medicine and physical therapy practices often use cold laser therapy
in the
treatment of minor injuries and sprains, such as:
⦿ ligament sprains
⦿ muscle strains
⦿ Tendonitis
⦿ tennis elbow
⦿ neck pain
⦿ lower back pain
⦿ knee pain
⦿ pain associated with muscle spasms
⦿ It’s also used to help reduce swelling and promote healing of the joints
and soft tissue
⦿ Inflammation
⦿ Dentists use cold lasers to treat inflamed tissues in the mouth and to
heal ulcerations. Doctors use it to treat inflammation caused by
rheumatoid arthritis
(RA) and other chronic autoimmune diseases.
⦿ Aches and pain
⦿ Pain clinics use cold laser therapy to help people with acute or chronic
pain from
conditions such as fibromyalgia and carpal tunnel syndrome.
⦿ Skin rejuvenation
⦿ Cold laser therapy is used to encourage skin rejuvenation.
Dermatologists use it to treat various skin problems,
including:
⦿ acne and acne scars
⦿ psoriasis
⦿ burns
⦿ vitiligo
⦿ edema, or swelling of the skin
⦿ Dermatitis and rashes
⦿ Wound healing
⦿ Cold laser therapy is also used to treat difficult-to-heal
wounds,
including wounds related to diabetes.
⦿ Acupuncture
⦿ Acupuncturists use cold laser therapy for clients who are
uncomfortable with needles. The low-level laser beams
can stimulate your acupoints the same way needles do,
but without piercing your skin.
⦿A treatment that uses a drug, called a
photosensitizer or photosensitizing
agent, and a particular type of light.
⦿ When photosensitizers are exposed to a
specific wavelength of light,
photoactivation causes the formation
of singlet oxygen, which produces
peroxidative reactions that can cause
cell damage and death.
⦿ Each photosensitizer is activated by light
of a specific wavelength.
⦿ This wavelength determines how far the
light can travel into the body.
⦿3 steps : –
⦿ [Link] of photosensitizer drug. 2.
Incubation. –
[Link] activation
⦿ In the first step of PDT for cancer
treatment, a photosensitizing agent is
injected into the bloodstream.
⦿ Agent is absorbed by cells all over the body
but stays
in cancer cells longer than it does in normal
cells.
⦿ Approximately 24 to 72 hours after injection,
when most of the agent has left normal cells
but remains in cancer cells, the tumor is
exposed to light.
⦿ Photosensitizer in the tumor absorbs the light
⦿ Inaddition to directly killing cancer
cells, PDT appears to shrink or
destroy tumors in two other ways.
⦿ The photosensitizer can damage blood
vessels in the tumor, thereby
preventing the cancer from receiving
necessary nutrients.
⦿ PDT also may activate the immune
system to attack the tumor cells.
⦿ Light used for PDT include laser, intense
pulsed light, light-emitting diodes (LEDs),
blue light, red light, and many other visible
lights (including natural sunlight).
⦿ Laser light can be directed through fiber
optic cables (thin fibers that transmit
light) to deliver light to areas inside the
body.
⦿ A fiber optic cable can be inserted through
an endoscope (a thin, lighted tube used to
look at tissues inside the body) into
the lungs or esophagus to treat cancer in
these organs.
⦿ Other light sources include light-emitting
diodes (LEDs), which may be used for
surface tumors, such as skin cancer
⦿ Type I Reaction:-
⦿ Direct reaction with substrate
(cell membrane or molecule)
⦿ Transfer of H atom to form
radicals
⦿ Radical react either O2 to form
oxygenated products
⦿ Type II reaction:-
⦿ Transfer of oxygen to form singlet
oxygen
⦿ Type of PDT in which a machine is used to
collect the patient’ s blood cells, treat them
outside the body with a photosensitizing
agent, expose them to light, and then
return them to the patient.
⦿ FDA has approved ECP to help lessen the
severity of skin symptoms of cutaneous T-
cell lymphoma that has not responded to
other therapies.
⦿ Studies are under way to determine if ECP
may have some application for other
blood cancers, and also to help reduce
rejection after transplants.
⦿ Selectivity to tumor
cells
⦿ Photostability
⦿ Biological stability
⦿ Good tissue
penetration
⦿ Photochemical
Efficiency
⦿ No cytotoxicity during
⦿ Porfimer sodium - most widely used and studied
photosensitizer.
⦿ Activated by red light from a laser.
⦿ Cancer of the esophagus and Barrett esophagus
⦿ A type of non-small cell lung cancer that affects the lining
of the
large breathing tubes (the bronchi) called endobronchial
cancer.
⦿ Benzoporphyrin derivative & Aminolevulinic acid :-
Aminolevulinic acid is a drug that’ s put right on the
skin. It’ s used to treat actinic keratosis (AK), a skin
condition that can become cancer, and is used only on
the face or scalp. A special blue light, rather than laser
light, is used to activate this drug.
⦿ Methyl ester of ALA-
⦿ A disadvantage of the older forms of ALA is that they
do not get
into the cancer cells very easily.
⦿ Approved by the FDA for treatment of some types of
actinic
⦿ No long term side effects
when used properly.
⦿ Less invasive than surgery.
⦿ Takes only a short time and is most
often done as an outpatient.
⦿ Targeted very precisely.
⦿ PDT can be repeated many times at the
same site if needed.
⦿ Little or no scarring after the site heals.
⦿ Costs less than other cancer treatments.
⦿ Light needed to activate most
photosensitizers cannot pass through
more than about one-third of an inch of
tissue (1 centimeter).
⦿ PDT is usually used to treat tumors on or
just under the skin or on the lining of
internal organs or cavities.
⦿ PDT is also less effective in treating other
tumors, because the light cannot pass
far into these tumors.
⦿ PDT is a local treatment and generally
cannot be used to treat cancer that has
spread
⦿ Skin and eyes sensitive to light for
approximately 6 weeks after
treatment
⦿ Photosensitizers tend to build up in
tumors and the activating light is
focused on the tumor. As a result,
damage to healthy tissue is minimal.
⦿ PDT can cause burns, swelling, pain,
and scarring in nearby healthy
tissue.
⦿ Other side effects include coughing,
painful breathing, trouble swallowing,
stomach pain, or shortness of breath;
these side effects are usually
⦿ Obstructive Esophageal Cancer-
⦿ Palliation of partially or totally obstructing
tumors in the esophagus.
⦿ Photofrin powder, is dissolved in 5%
dextrose for injection.
⦿ 48 h post injection the photosensitizer
localized to
the tumor is activated by light at
630 nm (laser) that is directed via a single-
quartz fiber optic and delivered to the tumor
through the biopsy channel of an
endoscope.
⦿ Light is scattered laterally to the tumor on the
wall of the esophagus or the fiber may be
inserted directly into the tumor.
⦿ Experience mild to severe chest pain, fever,
abdominal pain
⦿ Early Stage Endobronchial Tumors –
⦿ Treatment of microinvasive, nonsmall
cell endobronchial tumors using
Photofrin-PDT
⦿ Patients received 2 mg/kg Photofrin and
2 d later were treated endoscopically
using a diffuser fiber (usually 1 to 2.5
cm) delivering 200 J/cm of diffuser
length at 630 nm.
⦿ Because these lesions are very thin, the
fiber was held in the lumen adjacent to
the lesion.
⦿ Obstructing Endobronchial
Tumors (Nonsmall Cell
Lung Cancer-
⦿ Palliative treatment of
obstructive endobronchial
tumors.
⦿ Photofrin, 630 nm light
treatment 48 h later
⦿ 2 days following treatment patients are
re- endoscoped, and all necrotic tumor
debris and exudate must be removed
because they can further obstruct the
airway.
⦿ Early Stage Esophageal Cancer-
⦿ Barrett’s esophagus
⦿ Endoscopic PDT was applied using a
specially designed balloon light
applicator.
⦿ Balloon is inserted, deflated and then
inflated in place to an appropriate
pressure to allow “unfolding” of the
esophageal wall without shutting
down the blood flow.
⦿ Cholangiocarcinoma- Bile duct cancer
⦿ Head and Neck Cancer- adjuvant to
surgery in an attempt to “clean up”
the remaining cancer cells in the
operative bed.
⦿ Brain Tumors- glioblastoma or
astrocytoma.
⦿ Mesothelioma - asbestos-induced
disease.
⦿ ALA- -Aminolevulinic acid – Skin
cancer, Bladder cancer.
⦿ mTHPc (Foscan)- chlorin-
type photosensitizer- Oral
Cancer
⦿ Injected with mTHPc (0.15 mg/kg) and
72 to 96 h later treated with varying
light doses at 652 nm
⦿ SnET2 – Breast cancer