Presentation is loading. Please wait.

Presentation is loading. Please wait.

Nd:YAG LASER Wavelengths and emissions 1. Source with a very low absorption coefficient in the tissue Nd:YAG (λ = 1064 nm) WAVELENGTH 2 Nd:YAG 980 808.

Similar presentations


Presentation on theme: "Nd:YAG LASER Wavelengths and emissions 1. Source with a very low absorption coefficient in the tissue Nd:YAG (λ = 1064 nm) WAVELENGTH 2 Nd:YAG 980 808."— Presentation transcript:

1 Nd:YAG LASER Wavelengths and emissions 1

2 Source with a very low absorption coefficient in the tissue Nd:YAG (λ = 1064 nm) WAVELENGTH 2 Nd:YAG Therapeutic window Absorption coefficient CO ₂

3 Biological effects Emitted energy Tissue heating The energy density or fluence (J/cm 2 ) is the energy per unit area I (W/cm 2 ) x t (s) Nd:YAG (λ = 1064 nm) EFFECTS 3

4  Continuous emission  Chopped emission  Pulsed emission Power Time Time Power Continuous: the average power is equal to the peak power. Chopped: pulse duration t on is comparable to the period T. Pulsed: the average power is far lower than the peak power. Power Time Nd:YAG (λ = 1064 nm) EMISSION MODALITY 4

5  Continuous emission  Chopped emission  Pulsed emission In order to avoid thermal damage, emissions are characterized by low intensities for long times: Low Efficiency! Fluence (J/cm2): I (W/cm2) x t (s) Nd:YAG (λ = 1064 nm) EMISSION MODALITY 5

6 Excessive thermal increase is avoided thanks to pulses with very high intensity and very short duration: High Efficiency! High Efficiency! Fluence (J/cm2): I (W/cm2) x t (s)  Countinuous emission  Chopped emission  Pulsed emission (Hilterapia only) (Hilterapia only) Nd:YAG (λ = 1064 nm) EMISSION MODALITY 6

7 CW: Pm = 1,5 W Spot = 0,3 cm 2 Fluence in 10 s = 50 J/cm 2 Incident Intensity = 1,5 W / 0,3 cm 2 = 5 W/cm 2 PW: Pm = 1,5 W Spot = 0,3 cm 2 Fluence in 10 s = 50 J/cm 2 Pp = 1500 W τ-on = 100 μs Freq.= 10 Hz Pulse Incident Intensity = 1500 W / 0,3 cm 2 = 5000 W/cm 2 The Intensity of incident radiation is 1000 times higher in pulsed system respect to continuous system!! Comparison between continuous and pulsed systems 7

8 8 Tempo Power Pm=Pp Time Pp Pm Power Pm Pp ton toff Power Time CW Emission CW-I Emission PW Emissione Diode Laser 632,780, 810, 980, 1064 nm Pulsed Nd:YAG 1064nm (only Hilterapia ® )

9 Comparison CW/CW-I emission and Hilt ® CW- I: Pm = 10 W Spot = 0,2 cm 2 Time = 10 sec Energy = 100 J Pp = 20 W τ-on = 10 ms Freq = 50 Hz CW: Pm = 10 W Spot = 0,2 cm 2 Time = 10 sec Energy = 100 J HILT ® PULSE SH1 : Pm = 6 W Spot = 0,2 cm 2 Time = 10 sec Energy = 60 J Pp = 1000 W τ-on = 150 μs Freq = 40 Hz HILT ® PULSE HIRO 3.0: Pm = 10 W Spot = 0,2 cm 2 Time = 10 sec Energy = 100 J Pp = 3000 W τ-on = 120 μs Freq = 28 Hz 50 W/cm 2 Intensity= 10W/0,2 cm 2 = 50 W/cm W/cm 2 Intensity =20 W/0,2cm 2 = 100 W/cm W/cm 2 Intensity=1000 W/0,2 cm 2 =5000 W/cm W/cm 2 Intensity=3000 W/0,2 cm 2 =15000 W/cm 2 9

10 Hilterapia ® Technical characteristics 10

11 Hilterapia ®  Patented in USA (U.S. Patent n°6,527,797 B1)  Approved by FDA-USA 510 (k) n. K

12 INTENSE DEEPSAFE Unicity of Hilterapia ® 12

13 Hilterapia ® : why? Because pulsed technology is able to increase the intensity of incident radiation without increase the total quantity of energy delivered to the tissue, with consequently: Deeper action, high peak power promote penetration inside the tissues Elevated efficacy, due to the ability of producing biological effects even in deep tissues. Higher safety of treatment (to minimize risk of thermal damage during laser treatment). 13

14 Nd:YAG source (λ = 1064 nm) Pulsed emission Very high peak power (1-3 KW) Veru high intensity ( W/cm 2 ) High energy content ( mJ) Short duration ( µs) Low repetition frequency (10-40 Hz) Duty cycle 0,1 % - 0,6 % TECHNICAL CHARACTERISTICS of HILTERAPIA ® 14

15 Vertical delivery of energy! High peak power pulse, up to 3 kW Short duration ( µs) and long pulse interval (ms) Power Time 15

16 Low frequency: Hz Low frequencies minimize damaging thermal effects It is known that many cell types are more responsive to low frequency stimulations Power Time 16

17 High energy contents delivered in deph respecting thermal relaxation time of tissues LASER PULSATO 17

18 HILTERAPIA ® Laser-Tissue Interaction 18

19 HILT PULSE PHOTOTHERMAL INTERACTION: Increase of kinetic energy Localized increase of temperature Formation of temperature gradients PHOTOTHERMAL INTERACTION: Increase of kinetic energy Localized increase of temperature Formation of temperature gradients PHOTOMECHANICAL INTERACTION (resulting from photothermal effect): Temporary deformation of ECM (extracellular matrix) Reorganization of cellular cytoskeleton Induction of specific intracellular signals PHOTOMECHANICAL INTERACTION (resulting from photothermal effect): Temporary deformation of ECM (extracellular matrix) Reorganization of cellular cytoskeleton Induction of specific intracellular signals 19

20 ACTION ON CELLS OF CONNECTIVE TISSUES: Induction of cell differentiation (maturation process in which cells specialized themselves to perform the characteristic function of the tissue they belong to) observed in chondrocytes and stem mesenchymal cells. Exaltation of inflammatory cytokines signaling pathway, promoting reparative, regenerative and remodeling processes in tissue Increase of ECM production by fibroblasts and chondrocytes Induction of formation of very ordered arrays of fibronectin fibrils. Fibronectin is a protein that connects ECM components each other and with cell surface and constitutes a template for collagen fibres assembling. ACTION ON CELLS OF CONNECTIVE TISSUES: Induction of cell differentiation (maturation process in which cells specialized themselves to perform the characteristic function of the tissue they belong to) observed in chondrocytes and stem mesenchymal cells. Exaltation of inflammatory cytokines signaling pathway, promoting reparative, regenerative and remodeling processes in tissue Increase of ECM production by fibroblasts and chondrocytes Induction of formation of very ordered arrays of fibronectin fibrils. Fibronectin is a protein that connects ECM components each other and with cell surface and constitutes a template for collagen fibres assembling. 20

21 ACTION ON ENDOTHELIAL CELLS : Promotion of ordered cell monolayers formation, with important consequences on angiogenesis (formation of new vessels) and on endothelial function (in particular, blood-tissue exchange) ACTION ON ENDOTHELIAL CELLS : Promotion of ordered cell monolayers formation, with important consequences on angiogenesis (formation of new vessels) and on endothelial function (in particular, blood-tissue exchange) 21

22 ACTION ON NERVE FIBERS : Action on conduction mechanism of peripheral nerve fibers, inducing a dose-dependent reduction of action potential. In soft tissue can decrease sensitivity to pain ACTION ON NERVE FIBERS : Action on conduction mechanism of peripheral nerve fibers, inducing a dose-dependent reduction of action potential. In soft tissue can decrease sensitivity to pain 22

23 HILT PULSE PHOTOTHERMAL INTERACTION PHOTOMECHANICAL INTERACTION ACTION ON CELLS OF CONNECTIVE TISSUES ACTION ON ENDOTHELIAL CELLS ACTION ON NERVE FIBRES THERAPEUTIC EFFECT REPARATIVE, REGENERATIVE, REMODELING EFFECT ANTI-INFLAMMATORY EFFECT ANTI-OEDEMA EFFECT ANTALGIC EFFECT THERAPEUTIC EFFECT REPARATIVE, REGENERATIVE, REMODELING EFFECT ANTI-INFLAMMATORY EFFECT ANTI-OEDEMA EFFECT ANTALGIC EFFECT 23

24 HILTERAPIA ® Indications, contraindications and warnings 24

25 Acute pathologies Tendinopathies Muscle lesions Distortions and dislocations Post-traumatic edemas Synovitis and bursitis Osteochondral lesions Degenerative and chronic pathologies Osteoarthrosis Degenerative chondropathies Fibromyalgia syndrome THERAPEUTIC INDICATIONS 25

26 Therapy using the system is contraindicated for those patients who: have known sensitivity to the device take anticoagulants take medication that is known to increase sensitivity to sunlight have seizure disorders triggered by light are pregnant suspected of carrying serious infectious disease and/or disease where it is advisable to suppress heat or fever with hemorrhagic diatheses have HIV positive history CONTRAINDICATIONS 26

27 The device should not be used: over areas of suspicious, potentially or known cancerous tissue over areas of active hemorrhage over areas injected with steroids in the past 2-3 weeks over the thoracic area if the patient is using a pacemaker over the sympathetic ganglia over the vagus nerve over the neck (thyroid or carotid sinus region) over or near bone growth centers until bone growth is complete over area where analgesia may mask progressive pathology CONTRAINDICATIONS 27

28 The device should not be used: over anesthetic areas over an area of the spinal cord following a laminectomy, i.e., when major covering tissue have been removed on ischemic tissue where the blood supply would be unable to follow the increase in metabolic demand and tissue necrosis might result for symptomatic local pain relief unless a pain syndrome has been diagnosed or unless etiology is established CONTRAINDICATIONS 28

29 WARNINGS No direct aim into the eyes of humans or animals Patients with an implanted neurostimulation device must not be treated with or be in close proximity to any shortwave diathermy, microwave diathermy, therapeutic laser diathermy or laser diathermy anywhere on their body. Energy from diathermy can cause tissue damage and can result in severe injury or death, even if neurostimulation system is turned off. 29

30 The application on wounds has to be performed at a certain distance to avoid the spread of bacteria. Higher output levels have a greater potential for patient discomfort. Choose a lower dosage to reduce output or select a frequenced output to decrease patient discomfort. WARNINGS 30

31 ELECTROTHERAPY 1-Chemical effect 2-Thermal effect SHOCK WAVES 1-Mechanical effect MAGNETOTHERAPY 1-Chemical effect 2-Magneto-mechanical effect ULTRASOUND 1-Thermal effect 2-Mechanical effect DIATHERMY AND HYPERTHERMIA 1-Thermal effect TRADITIONAL LASER THERAPY 1-Photochemical effect 2-Photothermal effect 1- PHOTOCHEMICAL EFFECT 2- PHOTOTHERMAL EFFECT 3- PHOTOMECHANICAL EFFECT 31

32 CLINICAL EVIDENCES 32

33 Conservative treatment of low back pain caused by intervertebral disk displacement: Comparison among HILT ®, TENS e NSAID (Zati et al. Medicina dello Sport, 2004, 57: 77-82) 33

34 60 low back pain patients, divided in 3 groups. Treatment lasted 15 days. 1.HILT, n=20 pts: 10 Tx, 5 Tx/week 2.TENS, n=20 pts: 10 Tx, 5 Tx/week 3.NSAID, n=20 pts: Ketoprofene 200 mg/d. (15 days) Clinical tests: Backill and VAS at: T/0 : before treatment T/1 : 15 days after T/0 (end of treatment) T/2 : 45 days after T/0 T/3 : 180 days after T/0 Clinical protocol 34

35 Results Total Backill test scores Backill test – t scores NSAID HILT TENS 35

36 Results HILT Total VAS test scores VAS test – t scores TENS TENS HILT HILT NSAID NSAID 36

37 Results VAS score and Backill score score score TENS HILT NSAIDTENS HILT NSAID 37

38 In low back pain Hilterapia® is safe and well-tolerated. In short terms we obtained similar results using HILT ®, TENS and NSAIDs. While, in mid and long terms HILT ® allows better and longer results than TENS and NSAIDs. Hilterapia® effects are more long-lasting Conclusion 38

39 Hilterapia® for the treatment of calcifying tendonitis of the rotator cuff (Valent A., Benedetti E., Istituti Ortopedici Rizzoli, 2003) 39


Download ppt "Nd:YAG LASER Wavelengths and emissions 1. Source with a very low absorption coefficient in the tissue Nd:YAG (λ = 1064 nm) WAVELENGTH 2 Nd:YAG 980 808."

Similar presentations


Ads by Google