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UNIT – V
HEAT & PHOTON
THERAPY
EQUIPMENT

5.1 HIGH FREQUENCY HEAT THERAPY:

Physical stimulus commonly employed in the practice of physiotherapy is in the form of
heat, either by simple heat radiation or by the application of high frequency energy obtained from
special generators. The use of high frequency energy in thermotherapy has the advantage of
considerable penetration as compared with ‘simple’ heat application. Thus, with high frequency
energy, deeper lying tissues, e.g. muscles, bones, internal organs, etc. can be provided heat.
High frequency energy for heating is obtained by various ways. It may be from the
shortwave therapy unit making use of either the condenser field or the inductor field method.
Microwaves and ultrasonic waves are also used for heating purposes in special cases.

5.2 PRINCIPLE OF SURGICAL DIATHERMY:

The term ‘diathermy’ means ‘through heating’ or producing deep heating directly in the
tissues of the body. Externally applied sources of heat like hot towels, infrared lamps and electric
heating pads often produce discomfort and skin burns long before adequate heat has penetrated to
the deeper tissues. But with the diathermy technique, the subject’s body becomes a part of the
electrical circuit and the heat is produced within the body and not transferred through the skin.
Another advantage of diathermy is that the treatment can be controlled precisely. Careful
placement of the electrodes permits localization of the heat to the region that has to be treated.
High frequency currents, apart from their usefulness for therapeutic applications, can also
be used in operating rooms for surgical purposes involving cutting and coagulation. The frequency
of currents used in surgical diathermy units is in the range of 1–3 MHz. This frequency is quite
high in comparison with that of the 50 Hz mains supply. This is necessary to avoid the intense
muscle activity and the electrocution hazards which occur if lower frequencies are employed.
When the frequency is at least 300kHz, both the faradic and the electrolytic effects are
largely eliminated during the flow of current through the human tissue. This then allows the
exclusive utilization of the thermal effect in high frequency surgery providing both the
applications for cutting and coagulation.

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 Principle of surgical diathermy machine

When high frequency current flows through the sharp edge of a wire loop or band loop or
the point of a needle into the tissue, there is a high concentration of current at this point. The tissue
is heated to such an extent that the cells which are immediately under the electrode, are torn apart
by the boiling of the cell fluid. This type of tissue separation forms the basis of electrosurgical
cutting.

Various types of electro-surgery techniques commonly employed in practice

a) Cutting, b) Coagulation, c) Fulguration, d) Desiccation
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 Electrosurgical coagulation of tissue is caused by the high frequency current flowing
through the tissue and heating it locally so that it coagulates from inside. The coagulation process
is accompanied by a grayish-white discoloration of the tissue at the edge of the electrode.
The term ‘fulguration’ refers to a superficial tissue destruction without affecting deep-
seated tissues. This is undertaken by passing sparks from a needle or a ball electrode of small
diameter to the tissue. When the electrode is held near the tissue without touching it, an electric
arc is produced, whose heat dries out the tissue.
In desiccation, needle-point electrodes are stuck into the tissue and then kept steady.
Depending upon the intensity and duration of the current, a high local increase in heat will be
obtained. The tissue changes due to drying and limited coagulation.

Types of Diathermy:
Three types of diathermy used for convention heating are,

• Shortwave diathermy
• Microwave diathermy
• Ultrasonic diathermy
The first two involve electromagnetic effects and the third involves a mechanical effect.

5.3 SHORTWAVE DIATHERMY:

The heating of the tissues is carried out by high frequency alternating current which
generally has a frequency of 27.12 MHz and a wavelength of 11m. Currents of such high
frequencies do not stimulate motor (or) sensory nerves, nor do they produce any muscle
contraction. Thus, when such a current is passed through the body, no discomfort is caused to the
subject. The current being alternating, it is possible to pass through the tissues of a much greater
intensity to produce direct heating in the tissues. In this method, the output of the oscillator is
applied to the pair of patient electrodes.

Circuit Description:
The short-wave diathermy machine consists of two main circuits:
• an oscillating circuit, which produces a high frequency current,
• a patient circuit, which is connected to the oscillating circuit and through which the electrical
energy is transferred to the patient.

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Oscillating Circuit:
It consists of two transformers, whose primary coils are connected to source of AC. One is
a step-down transformer and its secondary coil supply current to the filament heating circuit of
triode valve. The other is step-up transformer and connected to Anode Circuit. Anode circuit
carries the current produced by triode valve. Here it consists of triode valve and oscillator circuit.
The tank (resonance) circuit is formed by the coil (AB) in parallel with the condenser, Cl.
To produce a current of high frequency the capacitance and inductance used must be small and is
made to charge and discharge repeatedly and for obtaining this the oscillator circuit is
incorporated along with triode valve.
There is another coil (CD) lie close to oscillator coil (AB) and has one end connected to
the grid of the triode valve and other through grid leak resistance to the filament.

Simplified circuit diagram of a short-wave diathermy unit

Patient circuit:
The patient or resonator circuit is coupled to oscillating circuit by an inductor coil (EF)
lying close to oscillator coil (AB) and also consist variable condenser, C2 which is usually in
parallel to patient terminal.

Working:
The AC from main passes through primary coils of the transformers and EMF is induced
in secondary coils. An EMF of 20–25 volts is set-up in secondary coil of step-down transformer
and produces current through filament of the valve. The filament is heated and thermionic
emission takes place and current flows through triode valve.
The EMF of about 4000 volts is induced in the secondary coil of step-up transformer and
provided that anode of valve is positive and filament is negative, current flows in anode circuit.
The electrons flow from filament to anode through triode valve, through oscillator coil in direction
A to B and to transformer back to filament.
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 The electron formed in AB will induce EMF in coil CD in direction that electrons will
move to grid of valve making it negative thus blocking the flow of electrons from filament. This
will lead to dying of current in anode circuit. This reduction in current will lead to self-induced
EMF.
According to Lenz law, this EMF will try to prevent fall in current by offering resistance to
flow of current. This will charge condenser C1. Now, when self-induced EMF totally dies away,
condensers again discharges through oscillator coil, but in opposite direction (B to A).
Flow of current from B to A induce an EMF in CD such that electrons move from C to D
and grid loses its negative charge and anode current flows again. This sequence continues and
each time condenser charges and discharges through oscillator circuit leading to production of
high frequency current.

Application Techniques of Short-wave Therapy:

The pattern of tissue heating is greatly affected by the method of short-wave diathermy
delivery. The two most common forms of application include the capacitor plate method and the
inductive method.
In the capacitor plate method, the output of the short-wave diathermy machine is
connected to metal electrodes which are positioned on the body over the region to be treated.
These pads or electrodes do not directly come into contact with the skin. Usually layers of towels
are interposed between the metal and the surface of the body. The pads are placed so that the
portion of the body to be treated is sandwiched between them.

Condenser method
The metal pads act as two plates while the body tissues between the pads as ‘dielectric’ of
the capacitor. When the radio frequency output is applied to the pads, the dielectric losses of the
capacitor display themselves as heat in the intervening tissues. This technique is called the
condenser or capacitor method.
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 In the inductive method, the output of the diathermy machine may be connected to a
flexible cable instead of pads. This cable is coiled around the arm or knee or any other portion
of the patient’s body where plate electrodes are inconvenient to use. When RF current is passed
through such a cable, an electrostatic field is set up between its ends and a magnetic field around
its centre. Deep heating in the tissue results from electrostatic action whereas the heating of the
superficial tissues is obtained by eddy currents set up by a magnetic effect. This technique is
known as ‘inductothermy’.

Inductive method
Another form of inductive heating is by a coil which is housed within a drum. The current
flowing within the coil produces a rotating magnetic field, which in turn produces eddy currents in
the tissues. Due to the friction caused by the Eddy currents, heat is produced in the tissues.

Inductive heating by a coil housed in a drum

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Applications of Short- wave diathermy
• Reduces pain and inflammation,
• Improves range of motion,
• Promote healing in the affected area.
• Reduces muscle spasms and stiffness.

Advantages of Short- wave diathermy

• This method does not produce any discomfort to patients compare to other methods such
as hot towels, infra-red lamp, electric heating pads etc.
• It is used to relieve pain and healing of deep-seated sports injury.

• It can heat through joints and can be applied to skin directly. In microwave diathermy,
spacing is required between skin and applicator.
• It penetrates fat layer easily compare to microwave.
• It does not create hot spots.
• It does not heat metals as much as microwave diathermy method.

Disadvantages of Short-wave diathermy

• There is risk of deep tissue burn. Burns are more common in using capacitance type
electrodes as patient becomes part of circuit.
• Care should be taken for patients with lower BP.
• As over dose increases pain, appropriate dose is a must during treatment.
• It requires more safety concerns for both patient and clinician. Failing to follow safety
guidelines result in inadvertent burning of patient.
• The devices for short wave diathermy are expensive.

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5.4 MICROWAVE DIATHERMY
Microwaves are a form of electromagnetic radiation with a frequency range of 300 MHz –
30 GHz and wavelengths varying from 1cm to 1 m. The most commonly used microwave
frequency for therapeutic heating is 2450 MHz corresponding to a wavelength of 12.25 cm. The
heating effect is produced by the absorption of the microwaves in the region of the body under
treatment. The effective depth of microwave penetration is about 3 mm to 3 cm.
The technique of application of microwave diathermy is very simple. Unlike the short-
wave diathermy where pads are used to bring in the patient as a part of the circuit, the microwaves
are transmitted from an emitter, and are directed towards the portion of the body to be treated.
Thus, no tuning is necessary for individual treatments. These waves pass through the intervening
air space and are absorbed by the surface of the body producing the heating effect.
Microwave penetrates more deeply than infrared rays but not deeply as shortwave
diathermy, so microwave is not suitable for deeply placed structures. As the microwaves are
strongly absorbed by water, tissues with high fluid content are heated most, while less heat is
produced for tissues with low fluid content as fat. Moreover, there is an appreciable heating of
tissues having good blood supply such as muscle.

Microwave Therapy Equipment

Production of Microwaves:
A special type of device called ‘magnetron’ is used for the production of high frequency
currents of high power. The magnetron consists of a cylindrical cathode surrounded by an anode
structure that contains cavities opening into the cathode-anode space by means of slots. The heat
produced at the anode must be removed which is usually done by using water or air as a means of
cooling.
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 Microwave Diathermy Unit:
The essential parts of a microwave diathermy unit are –
• Delay Circuit
• Magnetron Circuit
• Safety Circuit
The mains supply voltage is applied to an interference suppression filter. This filter helps to
bypass the high frequency pick-up generated by the magnetron. A fan motor is directly connected to
the mains supply. The fan is used to cool the magnetron.

Microwave Diathermy Unit

The Delay Circuit:
It is necessary for the magnetron to warm up for 3 to 4 minutes before power may be derived
from it. A delay circuit is incorporated in the apparatus which connects the anode supply to the
magnetron only after this time elapses. The arrangement is such that a lamp lights up after 4 minutes
indicating that the apparatus is ready for use.

The Magnetron Circuit:

The magnetron filament heating voltage is obtained directly from a separate secondary
winding of the transformer. The anode supply to the magnetron can be either DC or AC. A DC
voltage is obtained by a full wave rectifier followed by a voltage doubler circuit. A high wattage
variable resistance is connected in series, which controls the current applied to the anode of the
magnetron.
A directional antenna is attached to the applicator perpendicular to the face of the applicator
to assume that spacing is correct and the energy generated from the microwave unit is striking the
target treatment area at correct angle.
Emitters are of various sizes and shapes. Basically, emitters are of two shapes –
• Circular
• Rectangular
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 The circular emitter gives a beam of rays which is circular in cross-section and is more dense
in periphery than in centre. The rectangular emitter provides a beam which is oval in cross-section
and denser at the centre than at the periphery. In both cases, the density becomes less as the distance
from the emitter increases. The distance between the emitter and the skin should be 10 – 20 cm.

Emitters – A. Circular emitter; B. Rectangular emitter

Safety Circuits:
There are chances of the magnetron being damaged due to an excessive flow of current. It is
thus protected by inserting a fuse (500 mA) in the anode supply circuit of the magnetron. The
protection of both the patient and the radiator is ensured by the automatic selection of the control
range depending on the type of the radiator used.
Excessive dosage can cause skin burns. The skin should be dry as these waves are rapidly
absorbed by water. The duration of radiation generally ranges from 10 to 25 minutes.
Patients with implanted metal objects, such as pacemakers, should not receive treatment in
that area because of the possibility of overheating. Care should be exercised to restrict treatment near
the eyes and to avoid having the eyes to come in the line of sight of the reflector.

Advantages of Microwave diathermy

• The microwave diathermy technique and its machine operation is very simple. It does not require
pads, electrodes, capacitor pads or inductive coils as in short wave diathermy.
• It produces much more localized and concentrated heating effect than short wave diathermy.
• It provides more thin tissue heating effect depending on type of tissue involved. It is strongly
absorbed by tissues with high fluid content such as muscle or blood and hence they are heated
most with superficial depth of 0.7 cm. It is penetrated to greater depth by tissues with low fluid
content such as fat or bones.
• The patient does not form part of circuit in microwave diathermy and hence no tuning is necessary
as in short wave diathermy.
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• It is very comfortable treatment method for the patients.
• No overheating, if precautions are followed.
• Low frequency microwaves cause selective heating in muscles.

Disadvantages of Microwave diathermy

• No metal should be within 4 feet of microwave diathermy device, since it will interfere with the
signal.
• Various factors affect heat absorption e.g. water content, frequency, distance, laws of reflection,
refraction, absorption and inverse square.
• It is not suitable for deep structures.
• Only one aspect of the body can be treated at a time.
• There are risk of skin burns if treatment procedures and safety guidelines not followed properly.
• Patients should not look at the applicator machine during treatment. Failing so will result into
burns. It is recommended to use microwave goggles by the patient.

5.5 ULTRASONIC DIATHERMY

Ultrasonic therapy is used where short-wave treatment has failed and in cases where
localization of the heat effect is desired. The heating effect in this case is produced because of the
ultrasonic energy absorption property of the tissues.
Ultrasonic energy enables this massage to be carried out, firstly to a greater depth than is
possible manually, and secondly in acute injuries, when pressure cannot be exerted by hand
because of intolerable pain caused to the patient. The thermal effects of ultrasound are dependent
on the amount of energy absorbed, the length of time of the ultrasound application and the
frequency of the ultrasound generator.

Ultrasonic Therapy Equipment

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 Ultrasonic generators are constructed on the piezo-electric effect. A high-frequency
alternating current (e.g., 0.75-3.0 MHz) is applied to a crystal whose acoustic vibration causes the
mechanical vibration of a transducer head, which itself is located directly in front of the crystal.
These mechanical vibrations then pass through a metal cap and into the body tissue through a
coupling medium. The therapeutic ultrasonic intensity varies from 0.5 to 3.0 W/cm2. Applicators
range from 70 to 130 mm in diameter. The larger the diameter of the applicator, the smaller
would be the angle of divergence of the beam and the less the degree of penetration.

Circuit Description:
The heart of the system is a timed oscillator which produces the electrical oscillations of
the required frequency. The oscillator output is given to a power amplifier which drives the piezo-
electric crystal to generate ultrasound waves. Power amplification is achieved by replacing the
transistor in typical LC tuned Colpitt oscillator by four power transistors placed in a bridge
configuration.

Block diagram of an Ultrasonic therapy unit

The delivery of ultrasound power to the patient is controlled by incorporating a timer to
switch on the circuit. The timer can be a mechanical spring-loaded type or an electronic one,
allowing time settings from 0 to 30 minutes.
The output of the oscillator can be controlled by either of the following two methods:
• Using a transformer with a primary winding having multi-tapped windings and switching
the same as per requirement.
• Controlling the firing angle of a TRIAC placed in the primary circuit of the transformer,
and thereby varying the output of the transformer.

The machine can be operated in either continuous or pulsed mode. A full-wave rectifier
comes in the circuit for continuous operation. In pulsed mode, the oscillator supply is provided
by the half-wave rectifier and the oscillator gets the supply only for a half cycle. Thus, output 1
MHz is produced only for one half of the cycle and micro-massage is obtained effectively without
any thermal effect.
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 The transducer is made of barium titanate or lead zirconate titanate crystal, having 5-6
cm2 effective radiating area. The length of the cable connecting the transducer with the oscillator
is of critical dimension and should not be altered. In front of the crystal lies a metal face plate
which is made to vibrate by the oscillations of the crystal. Ultrasonic waves are emitted from this
plate.

Dosage Control:
The dosage can be controlled by varying any of the following variables.
• Frequency of ultrasound;
• Intensity of ultrasound; or
• Duration of the exposure.

Application Technique:
There are several ways for applying ultrasonics to the body. The probe can be put in direct
contact with the body through a couplant provided the part to be treated is sufficiently smooth and
uninjured.
In case a long area is to be treated, the probe is moved up and down, and for small areas it
is given a circular motion to obtain a uniform distribution of ultrasonic energy.
If there is a wound or an uneven part (joints etc.), the treatment may be carried out in a
water bath. This is to avoid mechanical contact with the tissues which may damage an already
injured surface. Then the probe is moved over the area at a distance or 1-2 cm from the area under
treatment.
It should be ensured that air bubbles are not present either on the probe or the skin.

Advantages of Ultrasonic diathermy

• It helps to reduce chronic inflammation and local swelling. It promotes healing of bone
fracture.
• It is inexpensive, quick and non-invasive treatment method. It can be used to detect foetus
problems.
• Ultrasound energy causes rapid contraction and expansion of microscopic gas bubbles around
the affected tissue.
• There are no hazards to patient and operator.
• Intensity and frequency of ultrasonic waves can be controlled. This helps in treatment of
specific tissues by controlling the energy to desired part and at appropriate depth.

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 Disadvantages of Ultrasonic diathermy
• Ultrasonic diathermy equipment cannot generate ultrasonic frequency above 3 MHz.
• It is not recommended for treatment of patients with open wounds or women who are
pregnant.
• Ultrasound therapy cannot be used in areas which contain gas. e.g. lungs.
• It provides wrong results in detecting physical abnormalities as it doesn't pass through bones.
• Ultrasound has limited use in head and neck region as sound waves are absorbed by bone.
The use of ultrasound is restricted to superficial structures.

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5.6 LITHOTRIPSY
Lithotripsy is a non-invasive procedure used to treat kidney stones that are too large to
pass through the urinary tract. Lithotripsy treats kidney stones by sending focused ultrasonic
energy or shock waves directly to the stone. The shock waves break a large stone into smaller
stones that will pass through the urinary system. Lithotripsy allows persons with certain types of
stones in the urinary system to avoid an invasive surgical procedure for stone removal. In order to
aim the waves, the doctor must be able to see the stones under X-ray or ultrasound.

About kidney stones:

When substances that are normally excreted through the kidneys remain in the urinary
tract, they may crystallize and harden into a kidney stone. If the stones break free of the kidney,
they can travel through, and get stuck in the narrower passages of the urinary tract. Some kidney
stones are small or smooth enough to pass easily through the urinary tract without discomfort.
Other stones may have rough edges or grown as large as a pea causing extreme pain as they travel
through or become blocked in the urinary tract. The areas most prone to trapping kidney stones
are the bladder, ureters, and urethra.
Most kidney stones that develop are small enough to pass without intervention. However,
in about 20 percent of cases, the stone is greater than 2 centimeters (about one inch) may require
treatment. Most kidney stones are composed of calcium; however, there are other types of kidney
stones that can develop.
Types of kidney stones include:
• Calcium stones. Calcium, a normal part of a healthy diet used in bones and muscles, is
normally flushed out with the rest of the urine. However, excess calcium not used by the
body may combine with other waste products to form a stone.
• Struvite stones. Struvite stones, composed of magnesium, phosphate, and ammonia, may
occur after a urinary tract infection.
• Uric acid stones. Uric acid stones may occur when urine is too acidic.
• Cystine stones. Cystine stones consist of cystine, one of the building blocks that make up
muscles, nerves, and other parts of the body.

Types of Kidney Stones

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 First Lithotripter Machine:
Lithotripsy uses the high-energy shock waves to fragment and disintegrate kidney stones. The
shock wave, created by using a high-voltage spark or an electromagnetic impulse outside of the
body, is focused on the stone. The shock wave shatters the stone, allowing the fragments to pass
through the urinary system. Since the shock wave is generated outside the body, the procedure is
termed Extracorporeal Shock Wave Lithotripsy (ESWL). The name is derived from the roots of two
Greek words, litho, meaning “stone” and trip, meaning “to break”.
ESWL is used when a kidney stone is too large to pass on its own, or when a stone becomes
stuck in a ureter (a tube that carries urine from the kidney to the bladder) and will not pass.
The original lithotripsy machines were commonly referred to as “stone baths” because the
patient was placed on a supportive frame called a gantry and partially immersed in a tub of water
which had been deionized to eliminate air bubbles.

First Lithotripter Machine

Lithotripsy consists of a large tub of warm water with the underwater electrode (spark plug)
in the ellipsoidal reflector at the base of the tub. The water provides an acoustic coupling to the patient
so that acoustic waves generated in the water penetrate the tissue and are not reflected from the skin.
The shock wave is produced when an electrical discharge occurs between two electrodes in
water. The energy deposited in the water from the electrical discharge produces a bubble of very hot,
rapidly expanding plasma which subsequently collapses after emitting a shock wave.
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 The patient is moved, partially submerged in the bath tub, on a hydraulically operated gantry
until the stone is accurately positioned at the second focus of the ellipsoid by using bi-planar
fluoroscopy.
The gantry was positioned such that the patient’s stone was within the crosshairs of an aiming
system (at the so-called F2 focal point) and electromechanical shock waves generated under water at
the F1 point by a spark gap generator travelled through the body to fragment the stone.
Ultrasound or fluoroscopy is utilized during the treatment to monitor the fragmentation
process. Once the stone or stones have been fragmented, the particles flush through the urinary tract
and are eliminated.

Modern Lithotripsy Machine:

The main components of a lithotripsy machines are –
(1) Focused shock wave source;
(2) Means for acoustic coupling of the shock wave to the body;
(3) Imaging modalities for stone localization and therapy control;
(4) A patient table with either the table or the shock wave source movable in three dimensions;
(5) Trigger generation and control system.

Lithotripsy Machine

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1. Shock Wave Sources
The three basic types of shock wave sources for lithotripsy are:
a) Plasma explosion method (Electrohydraulic)
In an electrohydraulic generator, a high-voltage electrical current passes across a spark-gap
electrode located within a water-filled container. The discharge of energy produces a
vaporization bubble, which expands and immediately collapses, thus generating a high-energy
pressure wave, in the form of a primary shock wave which spreads in a spherical pattern. These
primary shock waves are reflected by metal wall of the reflector, which focuses them on point F2.

Shock wave generation – Plasma explosion across a spark gap under water, focusing with ellipsoidal reflectors

b) Electromagnetic system:
In an electromagnetic generator, a high voltage is applied to an electromagnetic coil,
similar to the effect in a stereo loudspeaker. This coil, either directly or via a secondary coil,
induces high-frequency vibration in an adjacent metallic membrane. This vibration is then
transferred to a wave-propagating medium (i.e, water) to produce shock waves. The shock waves
are focused by an acoustic lens or by using a paraboloid reflector. The resulting shock wave is
constant.

The electrical pulse from the coil forms a magnetic field, inducing eddy currents in the metal membrane
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c) Piezo-ceramic system:
The piezo-electric principle operates by simultaneously driving several hundred piezo
elements mounted on a spherical dish, thus providing self-focusing spherical waves. In contrast to
the electro-dynamics shock tube, the useful wave field is focused with a lens immediately after its
formation.

Schematic diagram of a piezoelectric shock wave generator

2. Acoustic coupling:
A medium is used for coupling shock waves to the human body to minimize the presence
of air to provide undisturbed propagation of the acoustic pulse and to obtain good matching of
acoustic impedance.
An open bath tub provides optimal acoustic coupling, but restricts positioning and
handling of the patient. However, it necessitates the management of large volumes of clean water
and adequate safety measures to reduce electrical hazards to the patient.
Closed systems with an elastic coupling membrane also need water circulation, but
demand a significantly lower volume to isolate the patient from the source. The membrane
material is such that it matches the acoustic impedance of water. Coupling to the skin is provided
by an additional layer of an oily gel similar to the gels used in ultrasound imaging.
However, most current lithotripsy has the shock wave source mounted in a therapy head,
which is filled with water. The therapy head is capped by a thin rubber membrane pressed
against the patient and through which the shock wave passes. A coupling agent such as gel or oil
is smoothed on the rubber membrane and the patient’s skin to ensure good coupling by reducing
air pockets. The water in the therapy head of most lithotripsy is continuously re-circulated and
degassed to remove any bubbles that might interfere with the shock wave propagation.
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3. Imaging modalities:
X-ray fluoroscopy and ultrasound B-scan are used as imaging procedures in lithotripsy.
For X-ray fluoroscopy, two X-ray generators and image intensifiers are used at different imaging
planes. The radiological image appears on the high resolution computer screen mounted on the
control panel.
Advantages of ultrasound B-scan are the freedom from ionizing radiation and the
possibility of online imaging. The drawbacks are the necessity to employ personnel trained well
in ultrasound imaging to permanently watch the procedure, lower spatial resolution than with X-
rays. Besides helping to locate the calculus, the ultrasound image also permits observation during
shock wave application and consequently helps control the successful hits.
The combination of an under-table shock wave head with X-ray orientation and an over
table shock wave head with integrated ultrasound imaging offers a maximum of lithotripsy
applications.

Schematic diagram of a lithotripsy system with biplane X-ray imaging

4. Patient Table:
For treatment, the patient is positioned on a treatment table, where the stone is localised
by means of an imaging system, and the focal point of the shock wave source is positioned by
moving the patient or the shock wave source. A couple of thousand shock waves are applied with
a frequency of 60 to 120 shots per minute resulting in a treatment time of nearly one hour. Stone
position and its breakdown are checked routinely using the imaging system.

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 With two symmetrically arranged shock wave sources, the patient lies in a supine position
independent of whether the left or right kidney is treated. The patient table is motorized that
enables movement in all three directions. The table can be controlled directly from the control
panel. The table has an opening permitting the patient’s lumber area to contact an oil-coated
membrane that acoustically couples the patient with the water system.
The treatment consists of about 1500 shocks average (range, 300–2000), after which the
stone is reduced to 1 to 2-mm fragments that pass spontaneously down the ureter, usually within
30 days. The shocks are generally given in series of 100-150, followed by fluoroscopic
verification.

5. Monitoring and Trigger Generation:

Monitoring of heart is done as a preventive measure when anaesthesia is given to the
patient. The triggering of shock waves is gated to the respiratory cycle for efficient treatment. It is
done so because the kidney is displaced during respiration. The treatment typically takes about 30
to 90 minutes, not including patient preparation and associated measures.

Advantages of Lithotripsy:
• No lengthy hospital stays.
• No incisions.
• No surgery.
• No lengthy recovery periods
• It is non-invasive procedure and safe.
• No need for general anesthesia.
• Patient has time convenience.

Disadvantages of Lithotripsy:
• Somme discomfort to the patient.
• Required medicine to prevent infection.
• Passing sand-like particles in the urine for a few weeks after the lithotripsy.
• May require repeat procedures.
• Not suitable for all types of stones.
• Painful.

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5.7 LASER IN MEDICINE:
LASER is acronym for Light Amplification by Stimulated Emission of Radiation. Within
a very short time and amazing period of research and development of optical fibers changed the
area of communications completely.

Characteristics of LASER:
1. Directionality:
In conventional light sources (lamp, sodium lamp and torchlight), photons will travel in
random direction. Therefore, these light sources emit light in all directions. On the other hand, in
laser, all photons will travel in same direction.
Therefore, laser emits light only in one direction. This is called directionality of laser
light. The width of a laser beam is extremely narrow. Hence, a laser beam can travel to long
distances without spreading.

If an ordinary light travels a distance of 2 km, it spreads to about 2 km in diameter. On the

other hand, if a laser light travels a distance of 2 km, it spreads to a diameter less than 2 cm.

2. Intensity:
In an ordinary light source, the light spreads out uniformly in all directions, the intensity
of light reaching the target is very less.
In the case of laser, the light spreads in small region of space and in a small wavelength
range. Hence, due to high directionality the intensity of laser beam reaching the target is of high
intense beam.

3. Monochromatic:
Monochromatic light means a light containing a single colour or wavelength. The photons
emitted from ordinary light sources have different energies, frequencies, wavelengths, or colours.
Hence, the light waves of ordinary light sources have many wavelengths or colours. Therefore,
ordinary light is a mixture of waves having different frequencies or wavelengths.

22
 On the other hand, in laser, all the emitted photons have the same energy, frequency, or
wavelength. Hence, the light waves of laser have single wavelength or colour. Therefore, laser
light covers a very narrow range of frequencies or wavelengths.

4. Coherence:
The photons emitted from ordinary light sources have different energies, frequencies,
wavelengths, or colours. Hence, the light waves of ordinary light sources have many wavelengths.
Therefore, photons emitted by an ordinary light source are out of phase.
All the photons emitted in laser have the same energy, frequency, or wavelength. Hence,
the light waves of laser light have single wavelength or colour. Therefore, the wavelengths of the
laser light are in phase in space and time.

Thus, light generated by laser is highly coherent. Because of this coherence, a large
amount of power can be concentrated in a narrow space.

23
 Laser Surgical Devices:
1. CO2 Laser:
The laser light is generated in the gas laser tube 5m long and 2.5 cm in the diameter. The
tube contains a mixture of carbon dioxide, nitrogen and helium gases in the ratio 1:2:3 at a low
pressure maintained by the vacuum pump. The gas is continuously changed because the laser
process destroys CO2 molecules that must be replaced and it is supplied by the storage bottle.

CO2 Laser
When an electric discharge occurs in the gas, the electrons collide with nitrogen molecules
and they are raised to excited states. Now N2 molecules in the excited state collide with CO2 atoms
in ground state and excite to higher electronic, vibrational and rotational levels.
Since the excited level of nitrogen is very close to the E5 level of CO2 atom, population in
E5 level increases. As soon as population inversion is reached, any of the spontaneously emitted
photon will trigger laser action in the tube.
There are two types of laser transition possible.
• Transition E4 to E3:
This will produce a laser beam of wavelength 10.6μm.
• Transition E4 to E2:
This transition will produce a laser beam of wavelength 9.6μm. Normally 10.6μm transition
is more intense than 9.6μm transition. The power output from this laser is 10kW.

24
 Energy Band Diagram of CO2 laser
The laser light beams travelling along the axis of the tube are reflected by the mirrors at
the end, reinforcing the light along the axis and causing it to build in intensity.
One of the mirrors in the tube is partially transmitting, thereby allowing the beam to exit
the tube and travel along the optical guidance system. Such a system, called the beam manipulator,
may consist of hollow tubes articulated by elbows containing lens and mirrors that direct the laser
light around the corners down the centre of the tube.
The output of the tube is focused by an output lens system. The focal point of the output
beam must be adjusted to fall on the tissue to be cut. The size of the focal point called the spot
diameter, determines the energy density applied to the tissue for a given beam power.
The surgeon adjusts the spot diameter with the output lens system. To cut, the beam is
adjusted for a small spot diameter and to coagulate, a larger spot diameter is chosen.
The size of the spot must be adjusted before the laser is turned on because, in the case of
CO2 laser, it emits light primarily at a wavelength of 10.6μm, infrared range and thus invisible to
the eye. Therefore, low-power focusing light called the aiming light is run through the output lens
system to calibrate the focal spot before the high energy laser light is applied. A low power
helium-neon (He-Ne) laser is often used as an aiming light because it produces visible, red light.

Advantages of CO2 Laser:

• The CO2 laser offers the lowest cost per watt along with good beam quality. The high-power
levels are obtained from few watts to 15,000 watts.
• The efficiency of CO2 gas lasers is better than He-Ne and argon lasers.
• Long sealed-off lifetime of greater than 20,000 hours.
• Small size per watt of output power.
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 Disadvantages of CO2 Laser:
• Divergence of CO2 lasers is greater than He-Ne and argon laser. Usually, the divergence
ranges from 1 to 10 milli radians.
• Beam width varies from 3mm to 100mm.
• Some CO2 lasers have short and thick optical cavity.
• Cooling system is required in some configurations.
• Its cost is comparatively higher than other laser types.

Applications of CO2 Laser:

• It is widely used in material processing such as drilling, cutting, etching, welding, melting,
and annealing.
• It is used in the medical field to perform microsurgery and bloodless surgery.
• It is used in pollution monitoring, remote sensing, and in LIDAR (LIght Detection And
Ranging).
• It is widely used in open-air communication.

2. Nd-YAG Laser:
Nd:YAG laser is the short form used for Neodymium-doped Yttrium Aluminium
Garnet. Nd ion is rare earth metal and it is doped with solid state host crystal like yttrium
aluminium garnet to form Nd:YAG laser. Due to doping, yttrium ions get replaced by the
Nd3+ ions.
Its working principle is such that when optical pumping is provided to the device. Then the
Nd ions get raised to higher energy levels and their transition produces a laser beam.
This laser generally emits light of wavelength of nearly 1.064 μm.

Construction:
Nd:YAG laser is basically categorized into 3 domains that are the active medium, pumping
source and the optical resonator.
• Active medium:
This is also known as the laser medium and is the middle portion of the structure i.e.,
Nd:YAG crystal. The Nd:YAG laser rod has a length of about 10 cm with a diameter 12mm. It is
kept at one foci of an elliptical glass tube. Krypton flash lamp, the optical source is placed at the
other foci of the glass tube. It is provided with necessary power supply arrangement.
Mirrors M1 (total reflector) & M2 (output coupler) act as a resonant cavity to produce
stimulated and amplification process.
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 Nd:YAG Laser

• External Energy source:

When the external energy source is provided then the electrons from lower energy state
moves to higher energy state thereby causing lasing action to take place. Due to the difference in
the energy levels, the electrons need some external pumping in order to perform a transition from
one state to another. So, for lasing action to take place an external pump source is required.
Basically, as a source of optical pumping, xenon or krypton flash tube is taken in its case.
The Nd:YAG rod and the flash tube are placed inside an elliptical cavity so, that maximum
produced light can reach the rod.

• Optical resonator:
The two ends of the Nd:YAG rod is coated with silver. However, one end is completely
coated with silver so as to achieve maximum light reflection. While the other end is partially
coated in order to provide a path for the light ray from an external source to reach the active
medium. Thereby forming an optical cavity.

Working:
It is a 4-level systems i.e., it contains 4 energy levels. The figure below shows the 4 state
energy level diagram of Nd:YAG laser: Here, E1 is the lowest energy state while E4 is the highest
energy level. However, initially, electrons in E1 are very much higher as compared to E4.
When flash lamp is energised it gives out radiations. The Nd+3 ions get excited to higher
energy levels by absorbing 0.73 μm and 0.80μm from the input radiations (white light). Then the
electrons present in the energy state E1 gains energy and moves to energy state E4. However, as
E4 is an unstable state and it exhibits short lifespan.

27
 Therefore, electrons that were excited to this state by the application external pumping will
not stay at this state for much longer duration and comes to lower energy state E3 very fastly, but
without radiating any photon.
The energy state E3 is the metastable state and exhibits longer lifespan. So, the electrons
in this particular state will last for a longer duration. Due to this, more number of electrons will be
present at the metastable state E3. Thereby attaining population inversion.

But once the lifetime of the electrons at the metastable state gets exhausted then these
electrons by releasing photons come to lower energy state E2.
E2 also exhibit shorter lifespan like E4. Thus, electrons present in E2 state will come to
E1 without radiating energy in the form of a photon.

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 So, in this way electrons by gaining single photon of energy releases the energy of 2
photons. Also, as the system is equipped with optical resonators so, a greater number of photons
will get generated as the pumped energy will get reflected inside the active medium.
In this way, several electrons on stimulation produce photons thereby generating a
coherent laser beam of 1.064 µm.

Advantages of Nd-YAG Laser:

• It is very useful for thin materials for quick processing.
• It is useful for applications which need high power density such as metal marking.
• It offers higher energy output and very high repetition rate.
• It is very easy to attain population inversion.
• This helps in minor laser ablation process.
• Nd:YAG laser machine can cut very high reflecting materials e.g. aluminium, copper, non-
ferrous matels which can't be cut by other laser cutting machines.
• It is easy to operate and maintain.
• Purchasing cost is relatively lower.

Disadvantages of Nd-YAG Laser:

• It is not ideal to be used for materials which have moderate thickness.
• Slow production is possible for thicker materials using this laser type. Hence it offers
lower efficiency.
• It has low absorption of radiation of lighter materials very close to visible spectrum.
• Electron energy level structure of Nd3+ in YAG is complex.

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 Applications of Nd-YAG Laser:
• Material processing, such as drilling, cutting and welding steel and super alloys.
• Medical applications (hair removal, and treatment of minor vascular defects).
• For soft tissue surgeries in the oral cavity.
• In manufacturing as a means for engraving, etching, or marking a variety of metals and
plastics.
• The most common laser used in laser designators and laser rangefinders.

3. Ruby Laser:
A ruby laser is a solid-state laser that uses the synthetic ruby crystal as its laser medium and
so called ruby laser. Ruby laser is the first successful laser developed by Maiman in 1960. Ruby
laser is one of the few solid-state lasers that produce visible light. It emits deep red light of
wavelength 694.3 nm.

Construction:
A ruby laser consists of three important elements: 1. laser medium, 2. the pump source, and
3. the optical resonator.

Ruby Laser

• Laser medium or gain medium in ruby laser:

In a ruby laser, a single crystal of ruby (Al2O3 : Cr3+) in the form of cylindrical rod of length
about 5cm and diameter 0.5cm acts as a laser medium or active medium. The laser medium
(ruby) in the ruby laser is made of sapphire (Al2O3) which is doped with small amounts of
chromium ions (Cr3+).

30
• Pump source or energy source in ruby laser
The pump source is the element of a ruby laser system that provides energy to the laser
medium. In a ruby laser, population inversion is required to achieve laser emission. Population
inversion is the process of achieving the greater population of higher energy state than the lower
energy state. In order to achieve population inversion, we need to supply energy to the laser
medium (ruby).
In a ruby laser, we use flashtube as the energy source or pump source. The flashtube
supplies energy to the laser medium (ruby). When lower energy state, the electrons in the laser
medium gain sufficient energy from the flashtube, they jump into the higher energy state or
excited state.

• Optical resonator
The ends of the cylindrical ruby rod are flat and parallel. The cylindrical ruby rod is placed
between two mirrors. The optical coating is applied to both the mirrors. The process of depositing
thin layers of metals on glass substrates to make mirror surfaces is called silvering.
Each mirror is coated or silvered differently. At one end of the rod, the mirror is fully
silvered whereas, at another end, the mirror is partially silvered. The fully silvered mirror will
completely reflect the light whereas the partially silvered mirror will reflect most part of the light
but allows a small portion of light through it to produce output laser light.
The ruby rod is placed inside a xenon flash lamp. The flash lamp is connected to a
capacitor which discharges a few thousand joules of energy in a few milliseconds. This results in
power output of a few megawatts from Xenon lamp.

Working:
The ruby laser is a three level solid-state laser. In a ruby laser, optical pumping technique is
used to supply energy to the laser medium. Optical pumping is a technique in which light is used
as energy source to raise electrons from lower energy level to the higher energy level.
Consider a ruby laser medium consisting of three energy levels E1, E2, E3 with N number of
electrons. We assume that the energy levels will be E1 < E2 < E3. The energy level E1 is known as
ground state or lower energy state, the energy level E2 is known as metastable state, and the
energy level E3 is known as pump state.
Let us assume that initially most of the electrons are in the lower energy state (E1) and only
a tiny number of electrons are in the excited states (E2 and E3).

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 Energy Band diagram of Ruby Laser
When light energy is supplied to the laser medium (ruby), the electrons in the lower
energy state or ground state (E1) gains enough energy and jumps into the pump state (E3). The
lifetime of pump state E3 is very small (10-8 sec) so the electrons in the pump state do not stay for
long period. After a short period, they fall into the metastable state (E2) by releasing radiation less
energy. The lifetime of metastable state E2 is (10-3 sec) which is much greater than the lifetime of
pump state E3. Therefore, the electrons reach E2 much faster than they leave E2. This results in an
increase in the number of electrons in the metastable state E2 and hence population inversion is
achieved.
After some period, the electrons in the metastable state E2 falls into the lower energy state
E1 by releasing energy in the form of photons. This is called spontaneous emission of radiation.
When the emitted photon interacts with the electron in the metastable state, it forcefully makes
that electron fall into the ground state E1. As a result, two photons are emitted. This is called
stimulated emission of radiation.
When these emitted photons again interacted with the metastable state electrons, then 4
photons are produced. Because of this continuous interaction with the electrons, millions of
photons are produced.
In an active medium (ruby), a process called spontaneous emission produces light. The
light produced within the laser medium will bounce back and forth between the two mirrors.
This stimulates other electrons to fall into the ground state by releasing light energy. This is called
stimulated emission. Likewise, millions of electrons are stimulated to emit light. Thus, the light
gain is achieved.
The amplified light escapes through the partially reflecting mirror to produce laser light.

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 Advantages of Ruby Laser:
• They are economical.
• Beam diameter of ruby laser is comparatively less than CO2 laser type.
• Output power of ruby laser is not as less as He-Ne laser type.
• Ruby is in solid form and hence there is no chance of wasting material of the active medium.
• It has low output power.

Disadvantages of Ruby Laser:

• No significant stimulated emission occurs in ruby laser until at least half of the ground state
electrons have been excited to the metastable state.
• Efficiency of ruby laser is very low because only green component of the pumping light is
used while the rest of components are left unused.
• The laser output is not continuous but occurs in the form of pulses of microseconds duration.
• Optical cavity of this laser is short as compare to other laser types.

Applications of Ruby Laser:

• Due to low output power, they are used as toys for children.
• It can be used in schools, colleges, universities for science programs.
• It can be used as decoration piece & artistic display.
• Holographers around the world produce holographic portraits with ruby lasers.
• Ruby lasers were used extensively in tattoo and hair removal.

4. He-Ne Laser:
Helium-Neon laser is a type of gas laser in which a mixture of helium and neon gas is
used as a gain medium. Helium-Neon laser is also known as He-Ne laser.
A gas laser is a type of laser in which a mixture of gas is used as the active medium or
laser medium. Gas lasers are the most widely used lasers. The main advantage of gas lasers (eg:
He-Ne lasers) over solid state lasers is that they are less prone to damage by overheating so they
can be run continuously.
At room temperature, a ruby laser will only emit short bursts of laser light, each laser pulse
occurring after a flash of the pumping light. It would be better to have a laser that emits light
continuously. Such a laser is called a continuous wave (CW) laser. The helium-neon laser was the
first continuous wave (CW) laser ever constructed.

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 Helium-neon lasers are the most widely used gas lasers. These lasers have many industrial
and scientific uses and are often used in laboratory demonstrations of optics.
In He-Ne lasers, the optical pumping method is not used instead an electrical pumping
method is used. The excitation of electrons in the He-Ne gas active medium is achieved by
passing an electric current through the gas.
The helium-neon laser operates at a wavelength of 632.8 nanometers (nm), in the red
portion of the visible spectrum.

Construction:
The helium-neon laser consists of three essential components:
• Pump source (high voltage power supply)
• Gain medium (laser glass tube or discharge glass tube)
• Resonating cavity
a) High voltage power supply or pump source:
In order to produce the laser beam, it is essential to achieve population inversion.
Population inversion is the process of achieving more electrons in the higher energy state as
compared to the lower energy state.
In general, the lower energy state has more electrons than the higher energy state.
However, after achieving population inversion, more electrons will remain in the higher energy
state than the lower energy state. In order to achieve population inversion, we need to supply
energy to the gain medium or active medium.
In ruby lasers and Nd:YAG lasers, the light energy sources such as flashtubes or laser
diodes are used as the pump source. However, in helium-neon lasers, light energy is not used as
the pump source. In helium-neon lasers, a high voltage DC power supply is used as the pump
source. A high voltage DC supplies electric current through the gas mixture of helium and neon.

b) Gain medium (discharge glass tube or glass envelope)

The gain medium of a helium-neon laser is made up of the mixture of helium and neon
gas contained in a glass tube at low pressure. The gas mixture is mostly comprised of helium
gas. Therefore, in order to achieve population inversion, we need to excite primarily the lower
energy state electrons of the helium atoms.
In He-Ne laser, neon atoms are the active centers and have energy levels suitable for laser
transitions while helium atoms help in exciting neon atoms.
Electrodes (anode and cathode) are provided in the glass tube to send the electric current
through the gas mixture. These electrodes are connected to a DC power supply.
34
 He-Ne Laser
c) Resonating cavity:
The glass tube (containing a mixture of helium and neon gas) is placed between two
parallel mirrors. These two mirrors are silvered or optically coated.
Each mirror is silvered differently. The left-side mirror is partially silvered and is known
as output coupler whereas the right-side mirror is fully silvered and is known as the high reflector
or fully reflecting mirror.
The fully silvered mirror will completely reflect the light whereas the partially silvered
mirror will reflect most part of the light but allows some part of the light to produce the laser
beam.

Working:
In order to achieve population inversion, we need to supply energy to the gain medium. In
helium-neon lasers, we use high voltage DC as the pump source. A high voltage DC produces
energetic electrons that travel through the gas mixture.
The gas mixture in helium-neon laser is mostly comprised of helium atoms. Therefore,
helium atoms observe most of the energy supplied by the high voltage DC.
When the power is switched on, a high voltage of about 10 KV is applied across the gas
mixture. This power is enough to excite the electrons in the gas mixture. The electrons produced
in the process of discharge are accelerated between the electrodes (cathode and anode) through the
gas mixture.
In the process of flowing through the gas, the energetic electrons transfer some of their
energy to the helium atoms in the gas. As a result, the lower energy state electrons of the helium
atoms gain enough energy and jumps into the excited states or metastable states. Let us assume
that these metastable states are F3 and F5.
35
 The metastable state electrons of the helium atoms cannot return to ground state by
spontaneous emission. However, they can return to ground state by transferring their energy to
the lower energy state electrons of the neon atoms.

When the excited electrons of the helium atoms collide with the lower energy state
electrons of the neon atoms, they transfer their energy to the neon atoms. As a result, the lower
energy state electrons of the neon atoms gain enough energy from the helium atoms and jumps
into the higher energy states or metastable states (E3 and E5), whereas the excited electrons of
the helium atoms will fall into the ground state. Thus, helium atoms help neon atoms in
achieving population inversion.

36
 Likewise, millions of ground state electrons of neon atoms are excited to the metastable
states. The metastable states have the longer lifetime. Therefore, a large number of electrons will
remain in the metastable states and hence population inversion is achieved.
After some period, the metastable states electrons (E3 and E5) of the neon atoms will
spontaneously fall into the next lower energy states (E2 and E4) by releasing photons or red
light. This is called spontaneous emission.

The light or photons emitted from the neon atoms will moves back and forth between two
mirrors until it stimulates other excited electrons of the neon atoms and causes them to emit light.
Thus, optical gain is achieved. This process of photon emission is called stimulated emission of
radiation.
The light or photons emitted due to stimulated emission will escape through the partially
reflecting mirror or output coupler to produce laser light.

Advantages of He-Ne Laser:

• They are small and compact.
• They have longer life, usually 50,000 hours or more.
• They generate relatively little heat.
• They have relatively low acquisition and operating cost.
• Construction of He-Ne laser is very simple.
• It has very good coherence property.

Disadvantages of He-Ne Laser:

• Its output power is lower.
• It is a low gain device.
• It requires high voltage for its operation.

37
• In order to have operation at single wavelength, the other two wavelengths are required to be
suppressed. This requires use of special techniques and extraordinary skills. This increases
cost of the device.

Applications of He-Ne Laser:

• Free-space optical communications
• Bar-code scanners
• Hologram generation
• Fiber optic generation
• Surveillance (ie., audio surveillance)
• Tachometer (measuring the rotation speed of a shaft)
• Burglar alarm
• Gyroscope
• Laser printers.

Laser In Medical Application:

Applications of fibers in medicine depend mainly on the interaction of the light transmitted
through the fiber and the part of the human body to be treated. With respect to the interaction
between light and tissues, a lot of investigations have been made. Besides the light wavelength,
the light power and the type of tissue to be treated is also important.
Lasers in medical have wide applications under different specialties as listed below –

1) Laser in Ophthalmology:
The laser heating of tissues is used for 2 distinct surgical functions, cutting and
photocoagulation. First medical application of laser was in ophthalmology. Ophthalmologist used
to treat variety of eye problems including retinal bleeding, the excessive growth of blood vessels
in the eye caused by diabetes and also for spot welding –reattaching retinas that have become
partly detached from the back surface of the eye, the choroid.
The argon ion lasers, which emit blue green light, that is readily absorbed by the blood
are preferred for photocoagulation of small blood vessels in the eye. Nd-YAG lasers are also used
for blood vessels and tissue coagulation and have found wide applications in ophthalmology.

38
 Lasers are used for tissue interaction like,
i) Photocoagulation therapy:
To stop bleeding or to burn retinal layer, this type of therapy is used. The patients with
sugar complaint are treated. The laser can burn retina layer 4 to 5 micron for each shot.
ii) Photo disruption therapy
In this type of therapy, treatment is given to posterior capsule, just behind intraocular lens.
iii) Photo fragmentation therapy
In this technique using a small inclusion on the eye, the laser is guided through a fiber
optic cable. The laser energy is delivered to vaporize the nucleus of the cataractous lens.

2) Laser in Dermatology:
The uses of laser in Dermatology are,
1. To use laser as investigative tools for the study of skin exposures.
2. To use laser as tools for studies on the optical properties of the skin.
3. To evaluate the effect of acute and chronic laser exposures in the development of laser
safety program.
4. To evaluate lasers for dermatological surgery.
5. To determine the role of the laser as a research tool in the combined fields of biomedical
engineering and dermatology.

Lasers used:
All types of lasers have been used for investigative studies in dermatology. These include
pulsed ruby laser, Neodymium, Argon, Krypton, Helium-neon and CO2.
Port-wine lesions – Pulsed ruby laser
Tattoos – Q-Switched ruby laser, Argon laser, YAG Laser.

3) Laser in Cancer research:

A Laser is a powerful source of monochromatic light, Because of its coherent properties; it
can be used with precision in many phases of cancer research. Cancer research program have
shown that laser energy may be of value because of the following properties.
1. Due to its enormous power, laser energy can cause coagulation necrosis of any tissue.
2. Because the beam is highly collimated and may be finely focused, it may be used as a
cutting instrument.
3. Due to the monochromatic nature of the beam, darkly pigmented tissues will more readily
absorb the beam from most visible transition lasers in a selective manner.

39
 4. Due to the enormous power density of the focused beam, the laser produces tissue cuts
with a rapid cauterizing effect. i.e., the cuts are almost bloodless.

Laser Used:
Pulsed ruby laser and CO2 laser is used.

4) Laser in Neurosurgery:
Laser can also be used where other forms of surgery such as cryosurgery cannot be used.
Some examples are,
1. Laser thalamotomy.
2. Relief of intractable pain by delivering laser doses to the spinal cord.
3. Treatment of cerebral neoplasms which cannot be completely or effectively removed by
other modalities.

Laser Used:
Argon, YAG and CO2 laser.

5) Laser in Dentistry:
Another significant field of laser research is the use of laser in dentistry.
1. Initially laser dentistry is used for selective destruction of calculus and dental caries.
2. Used to prevent caries.
3. Used in study of enamel and dentine.
4. Used in examining the composition and change of the structures of the teeth.

Laser Used:
Ruby laser, CO2 Laser and Neodymium Laser.

6) Laser transillumination:
Transillumination with intense incoherent light source is a recognized procedure in clinical
medicine.
1. It is used primarily for visualization of foreign bodies, paranasal sinuses and
transillumination of the infant skull.
2. Used in diagnosis of breast tumours and location of foreign bodies in soft tissues.

Laser Used:
Helium-Neon and Krypton lasers are used.
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7) Laser exposures done in the pituitary gland:
1. Ruby laser exposures cause diffuse necrosis, sometimes in depth in a nonhomogeneous
manner.
2. Argon laser exposure will give highly specific reactions to red coloured vessels. Deep
penetrations may be seen in vascular areas.
3. CO2 lasers will have a highly specific absorption at the outer surface of the pituitary.

Laser Used:
Pulsed Ruby laser, Argon laser and CO2 Laser.

41