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L ight

A mplification by the
S timulated
E mission of
R adiation
L stands for Light

many colors one color


doesn't come in a narrow beam thin beam
cant be focused to as a small spot can be focused to a tiny spot.
cant be as intense as a laser without can be made very intense / not intense
expending tremendous amounts of at all
energy.
A in laser stands for amplification
A very bright intense beam of light can be created.
The laser may be activated by a few photons, but then many,

many more are generated.


The initial light is amplified to make a very bright compact beam.
S in laser stands for stimulated.
Stimulated the photons are amplified by stimulating an
atom to release more photons
The atom is stimulated by another photon to release its
photon.
Emission giving off of photons.
The excited atom emits a photon when another photon comes by.
In 1917, Einstein Stimulated Emission.
Radiation bad reputation.
For lasers radiation refers to
the photons which are being
emitted.
Monochromatic
Collimation
Coherence
Continues wave : emisi terus menerus.

Shuttering : mekanisme buka tutup

Pulsed/superpulsed : sejumlah emisi intensitas


tinggi dengan interval
waktu.

Q-Switched : energi dikumpulkan di optic


cavity sebelum diemisikan
BEAM TYPE

Power (W)

100

Time ( sec )

Continuous Wave
BEAM TYPE

Power (W)

100

Time ( sec )

Shuttered Continuous Wave


BEAM TYPE

Power (W)

1000

Time ( msec )

Pulsed
BEAM TYPE

Power (W)

2000

Time ( msec )

Superpulsed
BEAM TYPE

Power (W)

1 x 106

Time ( nsec )

Q-Switched
TISSUE OPTICS
TYPICAL CHROMOPHORE
BIOLOGIC EFFECT
SELECTIVE PHOTOTHERMOLYSIS
PARAMETERS OF LASER LIGHT
REFLECTION
ABSORPTION
SCATTERING
TRANSMISSION
REFLECTION

- about 4-6% of light reflected


ABSORPTION
The transformation of radiant energy to another form of
energy ( usually heat) by interacting with matter
the most important step to achieve any reaction
Grothus Draper Law (No Absorption No Effect)
result : thermal or non-thermal reaction
based on the beers law, 90% of lights is absorbed in
epidermis
SCATTERING

Imprecise absorption of laser energy by a biologic system


resulting in a diffuse effect on tissue
mainly forward in direction
may result in light passing back through the medium (back-
scattering)
wavelength 600 1200 nm = optical windows low
scattering
TRANSMISSION
The passage of laser energy through a biologic
tissue without producing any effect
wavelength < 300nm-400nm penetrating < 0,1 mm
wavelength 600-1200nm penetrating deeper with
less scattering
Tissue/Cell content : 70 - 80 % are water
CO2 Laser irradiation --> immediately
* Absorb by water in the cell
* Convert to Heat --> vapor
* Build up intracellular pressure
* Cell Explosion
Explosion ->Evaporation/ablation
Depth of Penetration :
Pulse CO2 Laser --> 50 - 100 micron
Ebrium YAG Laser --> 10 - 30 micron
LSR requirement :
* High Power Density
* Short Irradiation Time --->Shorter than
Thermal Relaxation Time
Light-tissue interactions can be
broken down into :

The transport of light in tissue


Absorption of light and heat generation
in tissue
Localized temperature elevation in
the target tissue
Diffusion away from the target
Hemoglobin and oxy-hemoglobin
Melanin, Melanosome
Collagen
Water
Tatto Ink
Absorption of Chromophoresgraph
Photothermal
Thermal injury to cells
Coagulation
Vaporization
Photo Chemical
Photodynamic reactions
Photostimulation
Photomechanical
Tissue interactions Transformation
of Light Energy into Thermal Energy.
Effect : destroy pathologic tissue -->
Coagulate, Vaporize, Ablate, Cut.
THERMAL EFFECT .
1967 : Endre Mester -- Carcinogenic Effect
---> observered hair growth after laser
irradiation in depilated mice.
He named it LASER BIOSTIMULATION
NON - THERMAL EFFECT
Low Power Laser Irradiation
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
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.
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
"photo light
"thermo heat
"lysis destruction.
Selective photothermolysis therefore refers to the
precise targeting of a structure or tissue using a specific
wavelength of light with the intention of absorbing light
into that target area alone. The energy directed into the
target area produces sufficient heat to damage the target
while allowing the surrounding area to remain relatively
untouched.
WAVELENGTH
PULSED DURATION
ENERGY FLUENCE
IRRADIANCE
SPOT SIZE
TISSUE COOLING
WAVELENGTH
Spesific wavelength will be absorbed
by specific chromophore
If more than 1 chromophore
absorption will be divided
competitive absorption
Wavelength should be near the max. absorption
of target chromophore & minimum competitive
from other chromophore
PULSE DURATION
Pulse Duration or pulse width is the amount of
time it takes to deliver the energy.
The pulse duration must be shorter than the
thermal relaxation time of the target. If the pulse
duration is longer than the thermal relaxation
time, the surrounding tissue receives thermal
damage.
THERMAL RELAXATION TIME (TRT)
= waktu yang dibutuhkan untuk jaringan
yang dilaser kehilangan 50 % dari
panasnya melalui difusi.
Besaran waktu : 100 mikro detik hingga
10 millidetik.
ENERGY FLUENCE
The energy delivered per unit area
As it increases the destructive force
increases
For most pulsed lasers

ENERGY FLUENCE = Laser power output x pulse duration


Laser beam cross-sectional area

ENERGY FLUENCE = Joules = Watts x sec


cm cm
IRRADIANCE
The rate of energy delivery per unit area to an
object = Power Density
Generally used when referring to continuous
wave laser, ec. CO2 Laser

IRRADIANCE = ______Laser power output____ = Watts


Laser beam cross-sectional area cm

WATTS = Joules
Sec
SPOT SIZE
Defined as the width of the laser beam.
Spot size determines the area to be treated.
Lasers vary widely on the spot sizes available for use.
Spot sizes determine the depth of penetration.
The larger the spot size of the laser beam, the more
fluence must be used to achieve the same result.
Lasers have limits as to the amount of energy that can
be used with the larger spot sizes. Another advantage of
the larger spot size is the ability to treat larger areas of
the body very quickly.
TISSUE COOLING

Cooling Method
Cold air cooling
Contact cooling
Dynamic cooling
The Role of Cooling

Reduce discomfort during treatment,


protect epidermis and collateral dermal
damage, allow using higher fluence and
reducing number of treatments
TERMINOLOGI

POWER = ukuran kemampuan kerja


yang diukur dalam Joule/detik = Watt.
POWER DENSITY = besar daya yang
disampaikan per satuan luas yang diukur
dalam Watt/cm2
ENERGY = kapasitas kerja diukur dalam
JOULE / watt x waktu
FLUENCE = total energi yang di-
sampaikan per-unit luas = Joule/cm2
SPOT SIZE = besar bercak laser pada
target diukur diameternya namun dalam
perhitungan dalam satuan luas (mm2)
PULSE ENERGY = energi dari satu pulsa
dari SuperPulse atau UltraPulse -- mjoule
-> pulsa sangat pendek, Peak Power
tinggi

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