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 Physics of the Laser
• Light energy transmitted through space as
waves that contain tiny "energy packets"
called photons
• Each photon contains a definite amount of
energy depending on its wavelength (color)
• If a photon of adequate energy level
collides with an electron of an atom it
causes atom to be in an excited state
 Physics of the Laser
• Atom stays in excited state momentarily
then releases an identical photon
• Process is called spontaneous emission
 Stimulated Emissions
• A photon released from an excited atom would
stimulate another similarly excited atom to de-
excite itself by releasing an identical photon as
long as other excited atoms are present
• For stimulated emission to occur an
environment must exist with unlimited excited
atoms this is termed population inversion
 Stimulated Emissions
•• Population
Population inversion
inversion caused
caused by
by applying
applying an
an external
external
power
power source
source to
to lasing
lasing medium
medium which
which releases
releases more
more
identical
identical photons
photons
•• To
To contain
contain and
and generate
generate more
more photons
photons mirrors
mirrors are
are placed
placed
at
at both
both ends
ends of
of aa chamber
chamber
 Stimulated Emissions
•• One
One mirror
mirror is
is totally
totally reflective
reflective while
while the
the other
other is
is
semipermeable
semipermeable
•• Photons
Photons are
are reflected
reflected within
within chamber
chamber which
which amplifies
amplifies the
the
light
light and
and stimulates
stimulates the
the emission
emission of
of other
other photons
photons from
from
excited
excited atoms
atoms
 Stimulated Emissions
•• Eventually
Eventually so
so many
many photons
photons are
are stimulated
stimulated that
that the
the
chamber
chamber cannot
cannot contain
contain energy
energy and
and photons
photons of
of aa
particular
particular wavelength
wavelength are
are ejected
ejected through
through the
the
semipermeable
semipermeable mirror
mirror producing
producing amplified
amplified light
light
through
through stimulated
stimulated emissions
emissions
 Types of Lasers
•• Classified
Classified according
according to
to the
the nature
nature of
of material
material
between
between two
two reflecting
reflecting surfaces
surfaces
–– Crystal
Crystal lasers
lasers
•• synthetic
synthetic ruby
ruby (aluminum
(aluminum oxide
oxide and
and chromium)
chromium)
•• neodymium,
neodymium, yttrium,
yttrium, aluminum,
aluminum, garnet
garnet (Nd:YAG)
(Nd:YAG)
–– Gas
Gas lasers
lasers
•• helium
helium neon
neon (HeNe)
(HeNe)
•• argon
argon
•• carbon
carbon dioxide
dioxide (CO
(CO22))
 Types of Lasers
–– Semiconductor
Semiconductor or
or diode
diode lasers
lasers
•• gallium-arsenide
gallium-arsenide (GaAs)
(GaAs)
–– Liquid
Liquid lasers
lasers use
use organic
organic dyes
dyes as
as the
the lasing
lasing
medium
medium
–– Chemical
Chemical lasers
lasers used
used for
for military
military purposes
purposes
 Laser Classification
• Laser equipment is grouped into four FDA
classes with simplified and well-
differentiated safety procedures for each
• Low power lasers used in treating sports
injuries are categorized as Class I and II
laser devices
 Laser Classification
•• Class
Class II or
or "exempt"
"exempt" lasers,
lasers, are
are considered
considered
non-hazardous
non-hazardous toto the
the body
body
–– All
All invisible
invisible lasers
lasers with
with average
average power
power outputs
outputs
of
of 11 mW
mW or or less
less are
are class
class II devices.
devices.
–– Include
Include the
the GaAs
GaAs lasers
lasers with
with wavelengths
wavelengths from
from
820
820 to
to 910
910 nm
nm
 Laser Classification
•• Class
Class II,
II, or
or "low-power"
"low-power" lasers
lasers are
are hazardous
hazardous
only
only ifif aa viewer
viewer stares
stares continuously
continuously
into
into the
the source
source
–– Includes
Includes visible
visible lasers
lasers that
that emit
emit upup to
to 11 mW
mW
average
average power,
power, such
such asas the
the HeNe
HeNe laser
laser
 Low- Vs. High-Power Lasers
• High power lasers = "hot" lasers
–– Generate
Generate thermal
thermal responses
responses
–– used
used in
in medicine
medicine for
for surgical
surgical cutting
cutting and
and
coagulation,
coagulation, ophthalmological,
ophthalmological, dermatological,
dermatological,
oncological
oncological and
and vascular
vascular specialties
specialties
• Low power lasers = “cold” lasers
–– Produce
Produce aa maximal
maximal output
output of
of less
less than
than 11 mW
mW
–– Cause
Cause photo-chemical
photo-chemical rather
rather than
than thermal
thermal effects
effects
 Laser Generators
•• Power
Power Supply
Supply
•• Lasing
Lasing Medium
Medium -- gas,
gas, solid
solid or
or liquid
liquid material
material
that
that generates
generates laser
laser light
light
•• Pumping
Pumping Device
Device -- creates
creates population
population
inversion
inversion essential
essential for
for laser
laser operation
operation
•• Optical
Optical Resonant
Resonant Cavity
Cavity -- chamber
chamber where
where
population
population inversion
inversion occurs
occurs that
that contains
contains
reflecting
reflecting surfaces
surfaces
 Helium-Neon Lasers
•• HeNe
HeNe (gas)
(gas) lasers
lasers deliver
deliver aa characteristic
characteristic
red
red beam
beam with
with aa wavelength
wavelength of of 632.8
632.8 nm.
nm.
•• Laser
Laser delivered
delivered in
in aa continuous
continuous wave wave and
and
has
has aa direct
direct penetration
penetration of of 22 to
to 55 mm
mm and
and
indirect
indirect penetration
penetration of of 10
10 to
to 15
15 mmmm
 Gallium-Arsenide Lasers
•• GaAs
GaAs (semiconductor)
(semiconductor) lasers
lasers are
are invisible
invisible
and
and have
have aa wavelength
wavelength of of 904
904 nm
nm
•• Average
Average power
power output
output ofof 0.4
0.4 milliwatts
milliwatts
•• Direct
Direct penetration
penetration of
of 11 to
to 22 cm
cm and
and an
an
indirect
indirect penetration
penetration to
to 55 cm
cm
 Techniques of Application
• Laser energy emitted from hand held
remote applicator
• Tip should be in light contact with the skin
and directed perpendicularly
 Gridding Technique
• Treatment area
divided into a grid of
cm22 with each cm22
stimulated for
specified time
• Lines and points should not be drawn on
skin because this may absorb
some energy
 Scanning Technique
•• No
No contact
contact between
between laserlaser tip
tip and
and
skin
skin
•• Applicator
Applicator tip
tip should
should be be held
held 5-10
5-10
mm
mm from
from wound
wound
•• As
As distance
distance from
from target
target increases
increases amount
amount ofof
energy
energy decreases
decreases
•• Not
Not recommended
recommended to to treat
treat at
at distances
distances greater
greater than
than
11 cm
cm
•• Beam
Beam should
should fill
fill area
area 11 cmcm22
 Wanding Technique
• A grid area is bathed with the laser in an
oscillating fashion for designated time

• As in scanning technique dosimetry

difficult to calculate if a distance of
less than 1 cm cannot be maintained
• Not recommended because of irregularities
in dosages
 Pulsed vs. Continuous Laser

•• Adjusting
Adjusting pulse
pulse rate
rate alters
alters average
average power
power which
which affects
affects the
the
treatment
treatment time
time ifif aa specified
specified amount
amount of
of energy
energy is
is required
required
•• With
With pulsed
pulsed laser
laser treatment
treatment times
times may
may bebe exceedingly
exceedingly long
long
to
to deliver
deliver same
same energy
energy density
density with
with aa continuous
continuous wave
wave laser
laser
 Laser Specifications
•• PhysioTechnology
PhysioTechnology the the
only
only manufacturer
manufacturer in in
the
the United
United States
States that
that
currently
currently produces
produces lowlow
power
power HeNe
HeNe and
and
GaAs
GaAs lasers
lasers
 Dosage
• Dosage reported in Joules per square
centimeter (J/cm22)
• One Joule is equal to one watt per second
• Dosage is dependent on
–– Output
Output of
of the
the laser
laser in
in mWatts
mWatts
–– Time
Time of
of exposure
exposure inin seconds
seconds
–– Beam
Beam surface
surface area
area of
of laser
laser in
in cm
cm22
 Dosage
•• Dosage
Dosage should
should bebe accurately
accurately calculated
calculated to
to
standardize
standardize treatments
treatments and
and to
to establish
establish
treatment
treatment guidelines
guidelines for
for specific
specific
injuries.
injuries.
•• Intention
Intention is
is to
to deliver
deliver aa specific
specific number
number of
of
J/cm
J/cm22 or
or mJ/cm
mJ/cm22
 Dosage
•• After
After setting
setting the
the pulse
pulse rate,
rate, which
which determines
determines
average
average power
power ofof laser,
laser, only
only treatment
treatment time
time per
per
cm
cm22 needs
needs toto be
be calculated
calculated

T
TAA== (E
(E /Pav)
/Pav) xx A
A
TTAA == treatment
treatment time
time for
for aa given
given area
area
EE == millijoules
millijoules of
of energy
energy per
per cm
cm22
Pav
Pav == Average
Average laser
laser power
power in
in milliwatts
milliwatts
AA == beam
beam area
area in
in cm
cm22
 Dosage
T
TAA== (E
(E /Pav)
/Pav) xx A
A
Example
Example
To
To deliver
deliver 11 J/cm
J/cm22 with
with aa 0.4
0.4 mWmW average
average power
power
GaAs
GaAs laser
laser with
with aa 0.07
0.07 cm
cm22 beam
beam area:
area:
TTAA == (1
(1 J/cm
J/cm22// .0004W)
.0004W) xx 0.07cm
0.07cm22
== 175
175 seconds
seconds or
or 2:55
2:55 minutes
minutes
 Calculating Treatment Times

•• Charts
Charts are
are available
available to
to assist
assist clinician
clinician in
in
calculating
calculating treatment
treatment times
times for
for aa variety
variety of
of pulse
pulse
rates
rates
 Depth of Penetration
•• Laser
Laser depth
depth ofof penetration
penetration
depends
depends onon type
type ofof laser
laser
energy
energy delivered
delivered
•• Response
Response that
that occurs
occurs from
from
absorption
absorption termed
termed
“Direct
“Direct effect”
effect”
•• “Indirect
“Indirect effect”
effect” is
is aa lessened
lessened
reponse
reponse that
that occurs
occurs deeper
deeper inin the
the
tissues
tissues
 Depth of Penetration
•• Absorption
Absorption ofof HeNe
HeNe occurs
occurs
within
within first
first 2-5
2-5 mm
mm ofof soft
soft
tissue
tissue with
with an
an indirect
indirect effect
effect
of
of up
up to
to 8-10
8-10 mm
mm
•• GaAs
GaAs which
which has
has aa longer
longer wavelength
wavelength
directly
directly absorbed
absorbed at
at depths
depths of
of 1-2
1-2
cm
cm and
and has
has indirect
indirect effect
effect up
up
to
to 55 cm
cm
–– Better
Better for
for treating
treating deeper
deeper tissues
tissues
 Clinical Applications
• Wound healing
• Immunological responses
• Inflammation
• Scar tissue
• Pain
• Bone healing
Suggested Treatment Application
 Safety
•• Few
Few safety
safety considerations
considerations are
are necessary
necessary with
with
low
low power
power laser
laser
•• FDA
FDA considers
considers low
low power
power lasers
lasers as
as low
low
risk
risk investigational
investigational devices
devices
•• For
For use
use inin the
the United
United States
States require
require an
an
IRB
IRB approval
approval and
and informed
informed consent
consent
prior
prior use
use
 Indications for Laser
• Facilitate wound healing
• Pain reduction
• Increasing the tensile strength of a scar
• Decreasing scar tissue
• Decreasing inflammation
• Bone healing and fracture consolidation
 Contraindications for Laser
• Cancerous tumors
• Directly over eyes
• Pregnancy