Prof. Dr.

Markolf Niemz - Lecture notes - Exam preparation -

Introduction / literature Chap. 1: Basics of laser physics Chap. 2: Matter acting on light Chap. 3: Light acting on matter Chap. 4: Medical laser applications Chap. 5: Laser safety

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Electromagnetic spectrum

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LASER: Light Amplified by Stimulated Emission of Radiation

transition rates at photon density n and transition probabilities A12, A21 and B21: A12nN1 B21N2 A21nN2

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Laser beam characteristics

monochromaticity

collinearity

spatial and temporal coherence

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Matter acting on light

reflection and refraction absorption and scattering

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Reflection und refraction

law of reflection: law of refraction:

= n1 sin = n2 sin n1 n2

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Absorption
tissue absorption according to Lambert-Beer: I(z) = I0 exp (z)

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Scattering
Rayleigh scattering: Mie scattering: I() ~ 4 I() ~ x with 0.4 < x < 0.5 Rayleigh scattering

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Light acting on matter

process

interaction type

mechanism

non-ionizing processes

photochemical interaction thermal interaction photoablation plasma-induced ablation photodisruption

photokatalysis increase in temperature UV photodissociation plasma ionization shock wave generation

ionizing processes

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Laser-tissue interactions
examples: cataract keratomileusis sclerostomy

coagulation

photodynamic therapy

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Photochemical interaction

photodynamic therapy (PDT)

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Thermal interaction
temperature effect 37 oC > 42 oC hyperthermia oC > 60 coagulation oC 100 vaporization > 100 oC carbonization

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Extra: Laser-induced interstitial thermotherapy (LITT)

temperature effect 37 oC > 42 oC hyperthermia > 60 oC coagulation oC 100 vaporization oC > 100 carbonization

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Photoablation

excitation: AB + h (AB)*

deactivation: (AB)* A + B + Ekin

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Plasma-induced ablation

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Photodisruption
pulse duration: energy density: power density: electric field strength: 1015 10 9 sec 1 1000 J/cm2 1011 1013 W/cm2 107 108 V/cm

H2O

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Laser applications in medicine

ophthalmology: dentistry: neurosurgery: gynecology: retinal detachment, cataract, glaucoma, wrong-sightedness caries, feeling of pain brain tumor cervical intraepithelial neoplasia (CIN), endometriosis, obstruction of the uterine tube, twin-syndrome urology: angioplasty: dermatology: orthopedics: otorhinolaryngology: bladder tumor, benign prostatic hyperplasia (BPH) atherosclerosis, stenosis port wine stain, tattoo, skin cancer arthrosis, herniated disc, otosclerosis laryngeal tumor, otosclerosis

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Laser applications in ophthalmology

indications: retinal detachment cataract glaucoma wrong-sightedness

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Wrong-sightedness

air cornea aqueous humor lens vitreous

index of refraction 1.00 1.37 1.33 1.42 1.33

cornea is responsible for 70 % of refractive power minimally invasive surgery of cornea is possible

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Refractive power of the eye

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Techniques in refractive corneal surgery

alternatives to glasses and contact lenses

advantages: expensive eyewear becomes needless strongly deviating wrong-sightedness curable as well

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Model of keratomileusis - part II

ablation depth: ca. 10 m per diopter (ymax = 2.5 mm) D (dpt) 1 2 3 4 5 6 7 8 9 10 Rf (mm) 7.965 8.137 8.316 8.504 8.700 8.906 9.121 9.347 9.585 9.835 d(0) (m) 9.0 17.9 26.8 35.7 44.6 53.4 62.2 71.0 79.7 88.4 ablation curve of the cornea (ArF laser, 193 nm)

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fs-LASIK: Laser in situ keratomileusis with the femtosecond laser

advantages: original surface without scalpel without UV light

laser parameters: Nd:Glass laser (500 fs) 3 J / pulse

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Laser applications in dentistry

indications: caries feeling of pain (biostimulation)

pain caused by mechanical drill

vibrations (typ. 100 1000 Hz) increase in temperature due to friction (at T > 5 oC) without vibrations (contactless) increase in temperature negligible at ultrashort pulse durations

dental surgery with laser light

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Painfree caries therapy: Investigated laser systems

Ho:YAG laser = 2.12 m = 250 s E = 300 mJ n = 100

Er:YAG laser = 2.94 m = 60 s E = 50 mJ n=2

Nd:YLF laser = 1.053 m = 30 ps E = 1 mJ n = 16 000

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Caries diagnostics by plasma spectroscopy

LIBS: Laser-Induced Breakdown Spectroscopy

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Plasma spectroscopy

healthy tooth

carious tooth

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Laser applications in neurosurgery

indication: brain tumor

potential therapies of a brain tumor

radiotherapy (inaccurate deposition of energy) chemotherapy (difficult due to blood-brain-barrier) mechanical resection (not minimally invasive, bleeding) coagulation and ablation with laser light (under investigation)

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Laser safety

spectral range UVC: 100 280 nm UVB: 280 315 nm UVA: 315 400 nm VIS: 400 780 nm

eye keratitis (inflammation) keratitis (inflammation) cataract retinal burn retinal burn, cataract retinal burn, cataract corneal burn

skin erythema, skin cancer erythema, pigmentation pigmentation skin burn skin burn skin burn skin burn

IRA: 780 1400 nm IRB: 1.4 3.0 m IRC: 3.0 10 m

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Laser safety of the eye

VIS, IRA

IRB, IRC, UVB, UVC

UVA

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Laser safety of the skin

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Laser safety classes

class 1 2 3a 3b

threshold < 0.4 W < 1 mW < 5 mW < 0.5 W

laser types capsuled lasers, low power lasers soft lasers (defined in VIS only) lasers for alignment purposes medium power lasers

protection none natural reflex of the eye lid safety glasses safety glasses skin protection (UV) safety glasses skin protection (UV)

> 0.5 W

high power lasers

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Realized laser safety

laser safety officer laser safety equipment: 1) warning sign and warning lamp 2) safety curtain 3) safety glasses

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Determination of safety glasses

example: Nd:YAG laser (80 mJ, 15 nsec)

MPE = 5 10 6 J/cm2 (from table) H0 = 80 mJ / r 2 = 80 mJ / (0.35 cm) 2 = 0.21 J/cm2 OD = log (H0 / MPE) = log (0.21 / 5E6) = 4.6 recommended filter density: 5

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University of Heidelberg

Mannheim Technical University Medical Center of Mannheim

Biomedical engineering: Medical physics: Laser medicine:

characterization and processing of biomaterials internet database for tissue parameters design of medical applicators and sensors bioelectrical multichannel measurement devices laser-tissue interactions medical applications of ultrashort laser pulses

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