Laser Tissue Interaction

Light Interacts Matter

 Interaction will be based on Light source (wave length, spot size, pulse duration) Tissue characters (optical properties of tissue such as absorption coefficient, scattering coefficient, refractive index)

 Each tissue has specific absorption characteristics based on composition and chromophore contents Major Chromophores are
Hemoglobin Melanin Water Protein

ABSORPTION
During absorption, the intensity of an incident electromagnetic wave is attenuated in passing through a medium. The absorbance of a medium is defined as the ratio of absorbed and incident intensities. Absorption is due to a partial conversion of light energy into heat motion or certain vibrations of molecules of the absorbing material. A perfectly transparent medium permits the passage of light without any absorption, i.e. the total radiant energy entering into and emerging from such a medium is the same. Among biological tissues, cornea and lens can be considered as being highly transparent for visible light.

 Laser light entering the biological tissue is either scattered or absorbed. Scattering is a process by which energy in a beam is redirected without a change in its wavelength. Generally scattering and absorption affect the distribution of photons in the tissue target, but absorption alone determines the effect of the radiation. Absorption of a photon may alter the electronic structure of a molecule. The electrons on the outer shell will jump to a higher energy level. An excited molecule usually looses the excess energy by
Chemical reaction (photochemical ) Collides with another molecule or atom Releases a photon in a spontaneous emission The excess electron energy is converted into increased relative motion which in turn leads to heat production thermal effect

 Laser effects in biological tissues may be divided into three general categories
1. Photochemical 2. PhotoThermal 3. Photo Ionization

Flowchart of photothermochemical processes in thermal interaction of laser light with biological tissues.

Penetration power of Medical Laser

Photoablation
It is a Photochemical effect The surface will be removed layer by layer in a very precise manner. Photons from a laser have sufficient energy to break chemical bonds between molecules at the target site The photon energy breaking the bond and ejects molecular fragments from the target site at supersonic velocities (2000 m/s) E.g
For corneal Photoablation: ArF excimer laser 193 nm and 248nm Krypton KrF

Photocoagulation
Photocoagulation is thermal effect Temperature rise in irradiated tissue is proportional to light absorption in that tissue Closure of blood vessels Heats hemoglobin, collagen and surrounding connective tissues Caution: thermal injuries

Photo disruption
Photo disruption is ionizing effect Irradiate the tissue by laser This irradiances are obtained by using a very small spot sizes and extremely brief durations ranging from 30 to 20 ps (Pico seconds). The high irradiance ionizes material Collections of ions and electron to form plasma The plasma absorbs or scatters radiation and mechanically disrupts tissue Additional disruption occurs because of latent stress present in the tissue when the laser incision occurs. E.g. ND-YAG 1064 nm

Pathology of laser reaction in skin

Tissue necrosis Steam bubbles in superficial portion of tissues Thrombosis and a decrease in number of vascular channels in the target areas No specific changes in blood vessel wall other than rupture Circulation changes No specific effect on enzymes but temperature may affect Non-specific fibrosis (but Ruby, Neodymium pulsed Laser, Argon & CO2 cw laser are not produce fibrosis ) Dermatitis, . Etc (different laser produce different pathological reaction)

Thermal and non-thermal effects of laser irradiation

Thermal Interactions
Thermal interactions are most important aspect Effects will be based on
Time duration Area of exposure

37 C +21 C = 58 C --- produce cell destruction for exposure longer than 10sec Tissue can withstand temp up to 70 C if the duration of exposure very short less than 1 sec

Factors for the Thermal Effects

The absorption and scattering coefficients of the tissues at the laser wavelength. Irradiance or radiant exposure of the laser beam. Duration of the exposure and pulse repetition characteristics. Extent of the local vascular flow. Size of the area irradiated.

Basic mechanisms
The basic mechanisms of thermally induced tissue destruction result from
Denaturation of cell protein Interference with basic cell metabolism Interference with vascular blood supply

Thermal effect on the tissue

Reversible hyperthermia (T>31o C) some functions of the tissue can be perturbed but the effect is reversible Irreversible hyperthermia (T>42o C) some fundamental functions of the tissue can be destroyed irreversibly Coagulation (T>60o C) the tissue becomes necrotic Vaporization (T100o C) Carbonization (T>150o C) [conversion of an organic substance into carbon or a carbon-containing residue] Pyrolysis (T>300o C) (Pyrolysis is a thermochemical decomposition of organic material at elevated temperatures without the participation of oxygen)

Parameters to be considered
Source:

Energy Focus optics Beam divergence Pulse duration, etc

Absorption coefficient Scattering coefficient Refractive index Reflection, etc

Target area:

Non-Thermal interactions
Without producing heat ex:
Photo Dynamic Therapy (PDT) Biostimulation

Photo chemical interations

Bio-stimulatory effects of laser

The promotion of healing of wounds. Treatment of skin infections. Treatment of ulcers. Laser may have an enhancing effect on healing

wherever inflammation is present.

Effects of Laser Light on Tissue

Accelerated Tissue Repair (Stimulate removal and regeneration by stimulation of ATP) Rapid Formation of Collagen (stimulate fibroblast cells) Beneficial Effect on Nerve Cells and the Production of B-Endorphins, enchephalins Accelerated Lymphatic System Activity and Reduction in Edema Formation of New Capillaries and Increased Blood Flow