Contents. Chapter 1 Some basic laser physics... 1

Transcription

1 Contents Chapter 1 Some basic laser physics Energy Electromagnetical radiation Wavelength and frequency Photon energy The electomagnetic spectrum The optical field Radiation risks Can electromagnetic radiation cause cancer? Protective mechanisms Various sources of radiation Natural sources of radiation Man-made sources of radiation The light-emitting diode (LED) The laser Laser design The properties of laser light Coherence Polarisation Output power Continuous and pulsed lasers The pulse peak power Average power output Power density Collimation Risk of eye injury Decisive in the risk of eye injury Laser types in medicine and surgery The surgical lasers The carbon dioxide laser (CO 2 -laser) Carbon dioxide lasers in surgery Carbon dioxide lasers in dental applications The Nd:YAG laser Nd:YAG lasers in surgery Nd:YAG lasers in dentistry Ho:YAG lasers Er:YAG lasers Argon laser Copper vapour laser KTP/532-laser (frequency doubled Nd:YAG laser) Ruby laser Alexandrite High power semiconductor lasers Dye laser Excimer laser Thearpeutic lasers The Helium-Neon laser (HeNe) Indium-Gallium-Aluminium-Phosphide lasers (InGaAlP) Gallium-Aluminium-Arsenide lasers (GaAlAs) The Gallium-Arsenide laser (GaAs) The defocused strong lasers Some exotic lasers The krypton laser The nitrogen laser... 47

2 Chapter 2 Therapeutic instruments A customer's guide History What will tomorrow s lasers look like Handheld laser and automatic devices Which type of laser is best suited for which task? HeNe laser and InGaAIP laser GaAs laser GaAlAs lasers Combination probes Therapeutic CO 2 -lasers Which laser should I buy? Stronger = better? How much should a laser cost? Is a therapeutic laser really worth the money? Do you need to update your laser? Microcomputer features Ten points to consider when choosing an instrument How do I maintain my laser? Chapter 3 Biostimulation History A few words on mechanisms Photoreceptors What parameters to use Laser parameters Which wavelength? Output power Average output power Power density Energy density Treatment dose Calculation of doses Dose ranges Calculation of treatment time for a desired dose Ready reckoner Dose per point Pulsed or continuous light Pulse repetition rate (PRR) Patient parameters Treatment area Treatment intervals Pre- or postoperative treatment? Treatment method parameters Local treatment Shallow problems Deeper problems Treating inside the body Systemic treatments Acupuncture Trigger points Spinal processes Dermatome Blood irradiation Irradiation of lymph nodes Irradiation of ganglions Combination treatment

3 3.3.5 Interaction with medication Other considerations What about collimation? Depth of penetration, greatest active depth Factors that reduce penetration Tissue compression How deep does the light penetrate? Laser light irradiation through clothes The importance of the tissue and cell condition The importance of ambient light In vitro/in vivo Laser Therapy with high output lasers Laser therapy with carbon dioxide lasers Laser therapy with Nd:YAG lasers Laser therapy with ruby lasers Laser therapy with Er:YAG lasers Laser therapy with surgical diode lasers Risks and side effects The importance of a correct diagnose Cancer Cytogenetic effects? A false picture of health Tiredness Pain reaction Do high doses of laser therapy damage tissue? Is it only an effect of temperature? Protection against radiation injury How to measure effects of laser therapy Thermography Magnetic resonance imaging High resolution digitised ultrasound B-scan Tensile strength Other objective methods "Is laser therapy effective?" Does laser therapy really work? Why the controversy? Does it have to be a laser? FDA (Food and Drug Administration) How well documented? Confused? Experience and attitudes The funding of research Chapter 4 Medical indications Who and what can be treated? Acne Allergy Arteriosclerosis Arthritis Asthma Blood preservation Blood pressure Bone and cartilage regeneration Cancer Cardiac conditions Carpal tunnel syndrome Cell transplants Cerebral palsy

4 Crural and venous ulcers Delayed onset muscular soreness (DOMS) Depression, psychosomatic problems Diabetes Duodenal/gastric ulcer Epicondylitis Erythema multiforme major Fibrositis/fibromyalgia Gynaecologic indications Headache/Migraine Haemorrhoids Hair loss Herpes simplex Immune system modulation Inflammation Inner ear conditions Laryngitis Lichen Low back pain Microcirculation Morbus Sluder Mucositis Muscle regeneration Mycosis Nerve conduction Nerve regeneration and function Oedema Ophthalmic problems Pain Plantar fasciitis Salivary glands Sinuitis Spinal cord injuries Snake bites Sports injuries Stem cells Stroke - irradiation of the brain Tendinopathies Tinnitus, vertigo, Ménière s disease Tonsillitis Trigeminal neuralgia Thrombophlebitis Tuberculosis Urology Warts Whiplash-associated disorders Vitiligo Wound healing Zoster Indications in the pipeline Alzheimer s disease Bisphosphonate-induced osteonecrosis Botox failures Cellulites Cholesterol reduction Eczema Erectile dysfunction Familial amyotrophic lateral sclerosis (FALS)

5 4.2.9 Obesity Parkinson s disease Post-menstrual stress Withdrawal periods Wrinkles Chapter 5 Dental LPT The dental laser literature On which patients can LPT be used? Dental indications Alveolitis Anaesthetics Aphthae (canker sores) Bleeding Caries Dentitio dificilis (pericoronitis) Endodontics Extraction Gingivitis Herpes zoster Hypersensitive dentine Implantology Jaw fractures Leukoplakia Lingua geographica (glossitis) Lip wounds Mucositis Nausea Nerve injury Oedema Oral surgery Orthodontics Pain Mild dental pain Paediatric dental treatment Periodontics Prosthetics Secondary dentine formation Temporo-mandibular disorders (TMD) Other dental laser applications Dental photo dynamic therapy Composite curing Tooth bleaching Caries detection Case reports Chapter 6 Non-coherent light sources Light Emitting Diodes Linear polarised light Chapter 7 Veterinary use Chapter 8 Contra indications Pacemaker Pregnancy Epilepsy Thyroid gland

6 8.5 Children Cancer Irradiation of the brain Radiation therapy patients Diabetes Tatoos Chapter 9 Laser therapy on the internet Laser therapy on the Internet Internet discussion groups Tinnitus Wavelength Coherence Polarisation Laser power Light emitting diodes (LED) Pulse frequencies FDA approval HeLa cells Soliton waves Chapter 10 The difficult dose and intensity Basics about energy Output power Power density The laser beam The laser probe Pulsed lasers Energy density Treatment dose The dose does not depend on the intensity Dose per point More about treatment technique Chapter 11 The Mechanisms Are the biostimulative effects laser specific? Is it possible to prove that laser therapy doesn't work? Comparisons between coherent and non-coherent light What is the importance of the length of coherence? Hode's hamburger Hode's big burger Abrahamsson's apple Moonlight How deep does light penetrate into tissue? Bright Light Phototherapy Similarities and differences Possible primary mechanisms Polarisation effects What characterises the light in a laser speckle Porphyrins and polarised light Cell cultures and tissue have different optical properties The effect of heat development in the tissue Macroscopic heating The microscopic heat effect Mechanical forces Excitation effects Primary reactions due to excitation

7 Secondary reactions due to cell signaling Fluorescence luminescence Multi-photon effects Lasing effects in tissue Non linear optical effects Opto-acoustic waves Secondary mechanisms Effects on pain Effects on blood circulation Stimulatory and regulatory mechanisms Effects on the immune system Other interesting possibilities Summary of mechanisms Diagnostics with Therapy Lasers Photodynamic Therapy PDT Other medical uses of lasers Chapter 12 A guide for scientific work Methodology of a trial Parameters Technical parameters Treatment parameters Medical parameters Closer description of the technical parameters ) Name of instrument (producer) ) Laser type and wavelength ) Laser beam characteristics ) Number of sources ) Beam delivery system ) Pulsed or continuous emission ) Output power ) Power density at probe aperture ) Calibration of the instrument Closer description of the treatment parameters ) Treatment area ) Dose: Energy density ) Dose per treatment and total dose ) Intensity: Power density ) Treatment method ) Treatment distance (spot size), type of movement, scanning ) Sites of treatment ) Number of treatment sessions ) Frequency of treatment sessions Closer description of the medical parameters ) Description of the problem to be treated ) Patients (number, age, sex) ) Exclusion criteria ) Inclusion criteria ) Condition of patient ) Pre-, parallel- or post-medication ) Treated with other methods before ) Drop-out rate ) Follow up ) Outcome measures ) Statistical Analysis ) Economy Recommendations of WALT The World Association for Laser Therapy Conclusion

8 Chapter 13 The laser phototherapy literature Are all the negative studies really negative? I heard it through the grapevine Positive from negative Negative from negative Dose development Pitfalls Low outputs Inclusion criteria Lack of proper control groups Therapeutic technique Systemic effects Tissue condition Power density Mixed parameters The influence of ambient light Premature conclusions Meta-analyses Confusion between groups Our comments: Conclusion Litterature: The Cochrane LPT analyses can they be improved? An evaluation of the evaluators Poor documentation compared to what? Can you trust your laser? English language books on LPT Books in other languages, with ISBN Laser phototherapy journals Chapter 14 References Abbreviations Numeric references referred to in the book Alphabetical register of references Abbreviations