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L ight

A mplification by the
S timulated
E mission of
R adiation

L stands for Light
many colors
doesn't come in a narrow beam
cant be focused to as a small spot
cant be as intense as a laser without
expending tremendous amounts of
energy.
one color
thin beam
can be focused to a tiny spot.
can be made very intense / not intense
at all

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.
in laser stands for radiation.

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
Continuous Wave
Time ( sec )
Power (W)
100
BEAM TYPE
Shuttered Continuous Wave
Time ( sec )
Power (W)
100
BEAM TYPE
Pulsed
Time ( msec )
Power (W)
1000
BEAM TYPE
Superpulsed
Time ( msec )
Power (W)
2000
BEAM TYPE
Q-Switched
Time ( nsec )
Power (W)
1 x 10
6
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
CO
2
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 CO
2
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 40
o
C : no effect
- 40
o
53
o
C : Protein Denaturation


- 55
o
60
o
C : Protein Degradation
- 63
o
90
o
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.

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/cm
2
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
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.