Principle of Laser

Application in Medicine
& LASER SAFETY
Peter Hasan H.W., MD.
Laser Clinic, Dept. of Surgery,
Pluit Hospital, Jakarta, Indonesia.
 APA LASER ITU ?
Singkatan dari :
L ight
A mplification by the
S timulated
E mission of
R adiation.
 Laser =/= X-ray
=/= Gamma-ray
=Usual light with unique character

Wavelength from far infra-red to

visible light and near ultra violet
 SINAR LASER

Sama seperti sinar biasa

Ciri Unik :
Monokromatik
Kolimasi
Koheren
 Thermal Injury to cells

< 43 C : the skin remain unharmed

43 - 50 C : tissue necrosis (after several
minutes)
45 C : fibroblast die after about 20
minutes
70 - 100 C : irreversible thermal damage
 Laser Effect on Tissue
Collagen Reaction to Temperature Elevation
- Less than 40o C : no effect
- 40o 53o C : Protein Denaturation
- 55o 60o C : Protein Degradation
- 63o 90o C : Protein Coagulation.
- 90 = 100 C : Evaporization
- > 200 C : Carbonization
 Coagulation
Maybe reversible or irreversible
61 63 C :
reversible non-lethal thermal damage =
collagen shrinkage
61- 71 C :
The goal of laser resurfacing
Achieve the desired shrinkage of collagen
without completely denaturating collagen
 Vaporization
70 - 100 C : irreversible thermal
damage and denaturation
tissue necrosis
100 C : vaporization
100 - 120 C : fluctuation between
vaporization and charring
120 - 200 C : charring occurs
 Thermal Injury to cells

< 43 C : the skin remain unharmed

43 - 50 C : tissue necrosis (after several
minutes)
45 C : fibroblast die after about 20
minutes
70 - 100 C : irreversible thermal damage
 INTENSE
LASER
COHERENT
SYSTEM
LIGHT

POTENTIAL HAZARDS

SKIN EYE OTHERS

 Comparison :
Sunlight, Light Bulb, and Laser
source DISTANCE IRRADIANCE
D = 1.0 m. 0.2 mwatt / cm2
-------------------------
Light Bulb 100 w light bulb ( 0.002 )

D = 150,607,200 km 0.1 watt / cm2

Sunlight
------------------------------- (1.0 )

The Sun

D = ??? 130 watt / cm2

LaserBeam -------------------------
1.0 Watt Laser ( 1,300 )
 LASER Hazards Recorded
in USA (1964 -1982)

53 cases of Laser incidents.

15 cases were Medical Laser Incidents
involving : - patients
- medical personnel
- laser representative
- observer
 MEDICAL LASER HAZARDS
Burns : Skin, eye, drapes, etc.
Blindness : - Total
- Partial
- Temporary
- Permanent
Explosion : - Airway
- Digestive tract
- intra-cavity
- Endoscopic, flammable anesthetics.
 Laser is Hazardous to Eye
Eye function : to see
Cornea/oculi/retina unprotected by overlying
skin, living organ exposed to environment
The Eye = highest risk to be injured
Self protection by build in blinking
reflex/aversion response = 0,25 sec
Not enough to prevent macular burn if>MPE
Hazards are depending on Wavelength used.
Hazards correspond -Wavelength
Type of LASER Wavelength Damage

Excimer/UV 200-315 Photokeratitis

315-400nm Cataract formation

Argon, KTP, Pulse Dye, Retinal (Macular) burn

HeNe, Krypton, Ruby, dsb. 400-700 nm. (Visible) injury
IR, Diode 700-780 nm.
Alexandrite, Nd.YAG,
Er.Glass 780-1400 nm. Retinal burn, Cataract

Corneal burn, Aqueous

Ho.YAG, Er.YAG 1400-3000 nm. flare, Cataract formation

Carbondioxide 3000-80000 nm. Corneal burn

 A.N.S.I.
(American National Standards Institute)

N.C.D.R.H.
(National Center for Devices and Radiological Health)

ANSI/NCDRH Standard : Laser Classification :

4 Major Hazard Categories / Class
 Class I Laser
Low energy laser
Cannot emit radiation of known hazard (eye)
Less than MPE (= Maximum Permissible Exposure)
No need for control, no safety requirement.
Example : - Completely enclosed diagnostic
laboratory equipment.
- Video laser disc player
- etc.
 Class II Laser
Low power laser, visible, up to 1-2 mW.
Incapable to cause injury within aversion
reflex/response of the eye (0,25sec.)
Hazard can exist only if stares directly into
the laser beam or point directly to the eye.
Need to have a CAUTION label and
indicator light.
Example : laser pointer/alignment
 Class III Laser

Medium Power laser

Capable to cause injury to the eye within 0,25
sec.
Divided into 2 subgroups:
- Class IIIA laser
- Class IIIB laser
 Class IIIA Laser

Output in the range 1-5 mW

Not hazardous if exposed in short period.
Low laser beam density (irradiance) less than
2.5 mW/cm2
Usually large beam diameter/expanded
diameter (with diffusing/diverging lens)
Need a CAUTION label
 Class IIIB Laser
Power range 1-500 mW.
Can be hazardous if eye expose to direct
laser beam.
Need a DANGER & Laser Aperture
label
Examples : - Laser pain attenuator
- Laser acupuncture apparatus
- Ophthalmic laser photo-coagulator
 Class IV Laser
High Power laser
Are Hazardous to view either directly or
indirectly
Most surgical lasers are Class IV laser
Can cause serious damage to skin and eye
within less than 0.25 sec.
Need a DANGER & Laser Aperture"
label
 MEDICAL LASER PROTECTION
Organ prone to laser injury : - Skin
- Eye

Protection toward :
Skin = wet gauge, inflammable drape, etc.
avoid direct or indirect exposure to laser
Eye : CO2 laser = Ordinary Goggles
Argon, KTP, Nd.YAG, Ruby lasers =
Goggles for specific wavelength.
Avoid using flammable material.
Use black coated /non reflecting instrument
 LASER DANGERS
No comprehensive list
Each procedure have : - different situations
- different conditions
- different hazards
To achieve successful laser applications :
Mastering Laser Physics, Laser Tissue
Interactions, Laser Safety, Laser Operating
Principles/Technique is a MUST
 Qualification and Training
Staff / Personnel involve in Laser Treatment
should have laser safety training.
Only Qualified and Authorized Operators are
permitted to operate the laser.
Every Safety precaution provided by the
manufacturer of each individual laser
equipment should be followed routinely,
particularly Class III & IV Lasers.
 Conclusion
Laser Applications/treatment are beneficial
and superior to conventional treatment when
done in Good Hands and Correct indications.
In the Contrary Laser Treatment have the
potential to harm the Patient, the Operator as
well as the Personnel assisting the Laser
Treatment.
 Pedoman bagi Pemula
Pahami Fisika Laser dan Interaksi Jaringan
Gunakan jenis laser yang sesuai
Gunakan tehnik dan asesori yang sesuai
Set daya seuai kebutuhan, mulai dengan
daya yang paling rendah yang masih
berkhasiat
Tingkatkan daya secara bertahap setelah
mendapat pengalaman/perasaan(feeling)