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LASER MEDICINE and SURGERY LASER MEDICINE and SURGERY …Fundamentals for Operating Rooms, Clinics & Offices THE LASER TRAINING INSTITUTE https://LaserTraining.org Editor: Gregory T. Absten B.Sc., MBA Technical Contributions by: Dan Little, CBET, CLSO/M Clinical Application Contributions by: Elliott Lach MD Brian Shumaker MD James McCaughan Jr. MD Raymond Lanzafame MD Michael Kochman MD Harvey Wigdor MS, DDS Thomas Cox MD A training division of: PROFESSIONAL MEDICAL EDUCATION ASSOCIATION, INC. “not-for-profit” education est. 1978 1982-2020 GT Absten: Professional Medical Education Association 11/2011 printing all rights reserved OH Office: PO Box 997, Grove City, OH 43123 Tel: 800-342-2704 Fax: 305-946-0232 Email: [email protected] Dedicated to the Memory of Doctor Leon Goldman 1905-1997 Doctor Goldman was my Laser “Guru”. He sponsored me as an ASLMS Fellow when he still practiced in Cincinnati, Ohio and I was affiliated with the University of Cincinnati – way back at the ASLMS 2nd meeting in Hilton Head. Many great things can be said about Doctor Goldman. I’m not eloquent enough to do justice for him in this regard, and won’t restate the many well deserved eulogies that have already been dedicated to him. I do find it particularly appropriate to dedicate this manual on “Laser Biophysics and Safety” to Doctor Goldman. He was the original course director for this program of the ASLMS. It was the first formal course I ever took on the “Biomedical Laser” and his first or second time to ever teach it. I am extremely honored to have followed in Doctor Goldman’s footsteps as the Course Director for this ASLMS’ program for a number of years. It is his spirit that I will remember the most. He was really a child at heart, and he loved anything and everything about lasers and light. This showed through his enthusiasm for laser “art”, and the ASLMS has sponsored several such exhibits at his prompting. He was truly excited about any new research in laser medicine, and stayed abreast of new developments in almost every specialty – better than anyone I’ve ever known who could keep up with such a diversity of information. He truly loved what he did. He is a significant factor that laser medicine is so far reaching today. Christian scripture mentions “Children of Light”. Doctor Goldman is truly one, and I wish him the best in his ongoing explorations and growth. Gregory T. Absten - 2 Contributing Authors: Harvey Wigdor MS, DDS Gregory T. Absten B.Sc., MBA Chief of Dental Service, Ravenswood Medical Executive Director, Professional Medical Education Center, Assoc. Professor Northwestern University, Assn. Marathon FL, Chairman, National Council on Chicago, IL. Fellow Dentist, American Society for Laser Certification, Scientific Fellow, American Laser Medicine & Surgery Society for Laser Medicine and Surgery. Previous Clinical Instructor, Dept of Ophthalmology, The Ohio State University College of Medicine, and previous J. Thomas Cox MD Clinical Instructor, Dept of Otolaryngology, University Director, Gyn Clinic Univ of Ca at Santa Barbara. of Cincinnati College of Medicine Board member ASCCP, Director of Advanced Courses - ASCCP Practice Guidelines, ALTS Steering Committee Chair & National Board of Elliott Lach MD, FACS Planned Parenthood. Associate Professor of Surgery and Pediatrics, University of Massachusetts School of Medicine, Division of Plastic and Reconstructive Surgery and Director of the Center for Advanced Clinical Michael Kochman MD Technology of the University of Massachusetts Assistant Professor of Medicine, Co-Director of GI Memorial Medical Center in Worcester, Oncology, University of PA Medical Center, Dept Massachusetts. of Gastroenterology. James McCaughan Jr., MD, FACS, FCCP Retired Thoracic / General Surgery. Founder & Director, Medical Laser Research Foundation, Columbus Ohio. Dr. McCaughan has served as a Raymond Lanzafame MD Board Member of the American Society for Laser General Surgery, Rochester General Hospital, Medicine and Surgery and was the 1993 recipient of Rochester NY, Past President American Society for their William B. Mark Memorial Award. His Laser Medicine & Surgery practice and research in Photodynamic Therapy was among the largest series in the world. Daniel Little, CBET, CLSO/M Technical Director, The Laser Training Institute™, Brian Shumaker MD and President WorldLink Biomedical, Urology, Pontiac Michigan. Past President, Buffalo, NY American Society for Laser Medicine & Surgery 3 TABLE OF CONTENTS: Laser Biophysics...................................................................................................................................................6 Physics of Light.....................................................................................................................................................8 Surgical Lasers....................................................................................................................................................14 Spontaneous & Stimulated Emission...............................................................................................................16 Unique Laser Characteristics ...........................................................................................................................19 Laser Mechanics.................................................................................................................................................24 Energy Concepts.................................................................................................................................................29 Pulsing Concepts ................................................................................................................................................33 Impact Vs Spot Size ...........................................................................................................................................36 Appendix A: Radiometric Quantities...............................................................................................................42 Laser / Tissue Interactions ................................................................................................................................46 Heat and Heat Transfer.....................................................................................................................................50 Carbon Dioxide ...................................................................................................................................................54 Erbium:Yttrium Aluminum Garnet (Er:Yag), and Hydrogen Fluoride (HF) ...........................................58 Holmium:Yttrium Aluminum Garnet (Ho:Yag) ............................................................................................58 Excimer Lasers ...................................................................................................................................................59 Diode Laser Systems..........................................................................................................................................60 Argon - KTP - Nd:Yag ......................................................................................................................................60 LASER SAFETY & CREDENTIALLING..................................................................................................................66 Safety / Regulatory Agencies............................................................................................................................67 Safety Contact Information..............................................................................................................................70 Physician Credentialling....................................................................................................................................71 Laser Nurse / LSO Credentialling....................................................................................................................74 The Laser Safety Program................................................................................................................................75 ANSI Laser Safety Standards...........................................................................................................................76 Safety for Engineers...........................................................................................................................................99 Sample Policies & Procedures .......................................................................................................................108 Sample Policies & Procedures .......................................................................................................................120 Appendix B: Laser Hazard Classifications...................................................................................................129 Clinical Laser Applications .............................................................................................................................137 An Encyclopedic Glossary of Laser Terms...................................................................................................184 COPYRIGHT © 1982-2020 by GT Absten: Professional Medical Education Association, Inc. All rights reserved. No part of this publication may be reproduced in any form in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Published by: Professional Medical Education Association,
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