Laser/Light Science & Safety Presentation PDF

Laser/Light Science & Safety June 2021 Confidential Laser Science & Safety Learning Objectives Laser Science Overview Understanding Selective Photothermolysis Lasers vs IPL Laser/Light Tissue...

Laser/Light Science & Safety June 2021 Confidential Laser Science & Safety Learning Objectives Laser Science Overview Understanding Selective Photothermolysis Lasers vs IPL Laser/Light Tissue Interactions Laser and IPL Safety Guidelines What is a Laser? Laser is an acronym – Light Amplification by Stimulated Emission of Radiation. This describes exactly what laser light is doing in the apparatus prior to being released onto the tissue. Light in the context of a laser beam is either Invisible or Visible. Amplification is increasing energy to a certain intensity Stimulated Emission is the molecular process by which light is amplified within the laser. ( Einstein's theory ) Radiation is a broad term used to describe the emission throughout the Electromagnetic Spectrum. The Product of a Laser is LIGHT Light is composed of packets of energy known as photons. All light on earth, other than laser light, is the result of spontaneous emission of photons. 1914 Albert Einstein postulated theory of Stimulated Emission of Radiation. Stimulated emission of radiation refers to the generation of extremely high intensity energy through an atomic process that results in release of identical and unidirectional photons. 4 Lasers The Product of a Laser is Light….. 5 Lasers Basics of a Laser: Power Supply Laser Medium Cooling Supply Delivery System 6 All Lasers have a Medium The Medium of a laser is what it is named after as it is the energy source that creates the wavelength. Solid lasers – Alexandrite 755NM, Diode 800-950 NM, 1064 NM Nd:YAG and 2940 NM Er;Yag These are solid substances. Liquid lasers - PDL ( Pulsed Dye Laser 585 NM to 595 nm) Gas lasers – 532 NM KTP, 10,600 NM C02 to name a couple Understanding Selective Photothermolysis Theory of Selective Photothermolysis; Anderson & Parrish, 1983 Wavelengths Light of a Specific wavelength is selectively absorbed by the target chromophore. Pulsewidth Exposure (pulsewidth) is limited to less than the thermal relaxation time of the chromophore. Fluence Sufficient fluence (energy) reaches the chromophore to cause the desired effect. Selective Photothermolysis Selective: The procedure “selects” an abnormal area to treat in contrast to the surrounding tissue. Photo: The laser sends out light Thermo: HEAT – The light now creates heat Lysis: Refers to destruction Selective Photothermolysis refers to using light to heat and destroy tissue in a selective area of the body. 10 Electromagnetic Spectrum- WAVELENGTHS Confidential 11 EMS: Electromagnetic Spectrum This chart shows many different wavelengths for Aesthetic Lasers measured in Nanometers Nanometers is a measurement of light and measured as a billionth of a meter The EMS has 2 areas of Laser wavelengths – Visible and Invisible Visible wavelengths are what we can see with a naked eye When is comes to visible wavelengths – the shorter the wavelength the more hazardous it is to darker skin and the more heat on the surface of the skin Frequency & Wavelength Frequency Wavelength High frequency Low frequency Short wavelength Long wavelength Wavelength Depth of Penetration with Comparable Spot Sizes Used 14 Non-Ionizing VS Ionizing There is Non-Ionizing Radiation and Ionizing Radiation in the EMS Aesthetic Lasers do not use Ionizing Radiation. Ionizing Radiation – Less than 400 NM is small and fast and can get into the DNA and RNA of your cells. This type of Radiation can cause cancer cumulatively and is why we do not use it. Non-Ionizing Radiation – 400 NM to 10,600 NM is what we use in the Medical Aesthetic Industry.  Understanding Pulsewidth Different Words, Same Meaning Pulsewidth Pulse Duration The length of time the laser or light is being emitted Ms (millisecond) Time 30ms Characteristics of a Short Pulsewidth Delivers Energy is fluence/energy absorbed over a shorter more time superficially More intense tissue reaction SHORT PW Used to treat smaller targets Small target able to reach desired Less cooling time temperature quickly Characteristics of a Long Pulsewidth Delivers Energy fluence/energy penetrates over a longer time more deeply Allows for thermal relaxation time LONG PW Used to treat larger, deeper targets Larger target Safer for skin types requires more IV, V, VI time to reach desired temperature  Short PW vs. Long PW - Simplified 10ms 30ms Think… Short temper/Short PW = Aggressive Pulse Duration (Pulsewidth) Photothermal Photomechanical Selective Photothermolysis Mechanical forces Thermal confinement Target pressure Optimal heating Minimum collateral damage Minimum collateral damage Laser parameters Laser parameters 20 Strongly absorbed by target Strongly absorbed by target Wavelength Wavelength Pulse duration consistent with Pulse duration ≤ relaxation acoustic propagation time Understanding Fluence Energy fluence: The energy contained within light is expressed in joules (J). The energy fluence determines the amount of laser energy delivered in a single pulse and is expressed in joules/cm2 The fluence can be increased by the reduction of the laser beam to a smaller spot size area. However, this results in a longer treatment time. More importantly, the effective treatment fluence is reduced at smaller spot sizes Understanding Fluence The Heat and Energy is measured and set on the device as Fluence or Joules. Although they are used as a same meaning most of the time the actual breakdown is shown below. Fluence – The parameter that is adjusted based on clinical response of the skin. It is increased or decreased to achieve desired results. Joule – The total amount of energy that a laser light delivers. Fluence = Joules CM2 This formula is the energy over the spot size Laser Output Terminology Power - measured in WATTS Pulse Duration - measured in SECONDS Energy - measured in JOULES Frequency - measured in HERTZ Fluence - the amount of energy(J) applied to the tissue per unit area (cm2) or J/cm2 Power Energy Time Lasers vs. Intense Pulsed Light Lasers vs IPL Lasers produce a very specific type of light IPL devices produce a wide range of consisting of one wavelength or color of light all wavelengths of light to produce a single going in one direction, which creates a single white flash. This light is closer to natural beam like a laser pointer. light and can appear with an orange/red glow when the device is flashed against the skin, like a camera flash. Properties of a Laser Monochromatic Coherent Collimated Properties of Pulsed Light Polychromatic Incoherent / Divergent Non-Collimated / Diffused Lasers vs. Pulsed Light 28  Cynosure Correlation to IPL Wavelengths Cynosure Device Type of IPL System Purpose Wavelengths Fitzpatrick Skin Type Icon/ Max R, Rs, Intense Pulse Light IPL Hair Removal 650 NM to 1200 NM 1-6 Icon/ Max Ys Intense Pulse Light IPL Hair Removal and 525 NM to 1200 NM 1-4 Photo Facial Body Icon/ Max G Intense Pulse Light IPL Vascular, Pigment, 500nm to 670nm & 1-4 and Photo Facial 870nm to 1200nm Face, Neck, Chest  Cynosure Correlation to Laser Wavelengths Cynosure Device Type of Laser System Purpose Wavelength Fitzpatrick Skin Type Elite, Elite Plus, Elite 755 Alexandrite LHR, Pigmented 755 NM 1064 NM 1-3: 755 NM IQ 1064 Nd:YAG Laser Lesions, Vein dual laser 1-6: 1064 NM Reduction, Skin Rejuvenation Vectus 800 Diode Laser LHR 800 NM 1-6 Picosure Picosecond Laser Tattoo Removal 755 NM 1-6 532 optional Skin Rejuvenation 755 Pigmented Lesions, 1064 optional Fractional Focus Rev-Lite 532/1064 Q Switch, Tattoo Removal Skin 585, 650 Dye Laser Rejuvenation, Pigmented Lesions  Cynosure Correlation to Wavelengths Cynosure Device Type of Laser Purpose Wavelength Fitzpatrick Skin Type Sculpsure 1060 Diode Body Contouring 1060 NM 1-6 Lipolysis Smart Lipo 1064, 1320, 1440 Laser Assisted 1064 NM, 1320 NM, 1-6 Triplex,Precision,Cell Nd;YAG Lipolysis 1440 NM ulaze Smart Xide 10,600 C02 Gynecologic Use, 10,600 NM 1-6 Gynecological Mona Lisa Touch, Skin Revitalization/ 1-3 Skin AXT, Surgical Ablative, Surgical Revitalization upgrade available Smart Skin 10,600 C02 Skin Revitalization/ 10,600 NM 1-3 Ablative Lasers/Light Tissue Interactions Light and Tissue Interaction When you use a laser or IPL on the skin, the following takes place. Refection/Absorption/ Transmission/Scatter Absorption is the most important one and is directly relevant to the target chromophore present and the Spot size of the delivery. Understanding Spot Size Spot Size Larger Spot sizes are used for deeper penetration and larger targets Smaller spot sizes are used to treat shallower conditions and smaller targets Large Spot Size = Better Penetration Note difference in depth of optimal penetration. Target Chromophores 36 Target Chromophores Wavelengths that absorb Blood cauterize the vessel so it can be removed by the body Wavelengths that absorb Melanin trigger a response to rapidly proliferate cells off in the case of pigment on the face or body Melanin absorbing wavelengths also target artificial melanin in the case of a tattoo where it damages it to the point of body elimination with a wound healing response Melanin absorbing wavelengths also use the color of the hair to travel to the mother stem cell inside the follicle and perform hair reduction procedures Wavelengths that target Water, heat the tissue causing a wound and stimulating a growth of new Collagen and Elastin. This helps to reduce Acne pit scars, wrinkles, surgical scars and striae Unique Clinical Targets (Chromophore) 38 Laser/IPL Safety Guidelines Regulatory Agencies ANSI ANSI Z136.1-2014 – Safe use of Lasers ANSI Z136.3-2011 Safe use of Lasers in Healthcare ANSI Z136.8-2012 – Safe Use of Lasers in Research, Development, or Testing FDA/Center for Device and Radiological Health (CDRH) Federal Laser Product Performance Standard OSHA cites ANSI standards  LASER SYSTEMS AT CYNOSURE CO2 Laser - 10,600nm Er:YAG laser - 2940nm Nd:YAG laser - 1064nm and 532nm (dye: 585nm and650nm) Er:Glass Laser - 1540nm Diode Laser - 810nm Alexandrite Laser -755nm IPL SYSTEMS Intense Pulsed Light (IPL) – Flashlamp Not laser light Multiple wavelengths Not monodirectional 500-1200 nm range Can cause severe headaches from exposure Safety glasses required during use EYE HAZARDS Susceptible Eye Structures Laser Eye Safety Precautions Always knock on a labeled door before entering. Control access to the laser area, typically by closing the lab door. The output from Nd lasers and other IR lasers is invisible to the human eye. Laser beams should be treated like a gun – point towards floor, never at people, window Avoiding Eye Injuries NEVER look directly into handpiece in ready mode Can cause permanent eye damage by direct/reflected exposure Use caution when performing procedures around the eye System should always be OFF or in STANDBY until ready to perform the treatment Avoiding Eye Injuries Never direct a beam upwards from horizontal Aim beam at floor - think of the laser as a gun Always contain a beam in a room with appropriate curtains or shields, closed door, and proper warnings Be aware of reflective surfaces in room and keep beam away from these Root Causes of Eye/Skin Exposure Incidents Unanticipated eye/skin exposure during alignment Misaligned optics Available eye protection not in use Insufficient control of beam direction – beam not directed into safe area (directed upward, out open door, onto reflective surface, etc) Everyone must have Eye Protection CONTROL MEASURES Protective housing, Interlocks, Enclosed beam path, Signage, Engineering controls Remote interlock connector & Key control or password Administrative controls Standard Operating Procedures, Education and Training, Signs & Labels, Areas defined by Hazard Personal protective Laser safety eyewear & Protective clothing when appropriate equipment (PPE) LASER WARNING SIGNS This sign means that you are entering an area where lasers may be in use If the door is closed, knock first Safety eyewear must be used when entering these areas Safety Summary During a treatment the practitioner must control the environment Basic Rule: Treat the laser as if you would a gun Everyone in the room wears CORRECT safety eyewear Use appropriate signage Questions? Thank You! June 8, 2021 Confidential