Clinical In-Service Training
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Clinical In-Service Training UPDATE v.24 March 2010 PB-1076090_A
Clinical In-Service Training
Agenda
Laser Safety
Laser Tissue Interaction Laser Operations – Platform & Handpieces Clinical Protocols - LHR & PFB Lumenis & You – A Partnership for Success Questions?
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Laser Safety
ANSI Laser Classifications ANSI Laser Classification
Laser Safety
Description
Examples
Class I
Generally do not pose a hazard
(i.e., CD, DVD)
Class II
Generally do not pose a hazard unless viewed directly for extended period of time
(i.e., checkout scanners)
Class IIIa
Generally pose low hazard risk
(i.e., laser pointers)
Class IIIb
Can produce hazard if viewed directly
(i.e., low wattage eye lasers)
Class IV
Can produce hazard from direct or specular reflection – also pose skin hazards
(i.e., most medical lasers)
ANSI: American National Standards Institute. 4
Laser Safety
LSO Establishes Controls Every facility must have a Laser Safety Officer (LSO) appointed Administrative Controls Documentation, training programs, etc. Procedural Controls Policies, Safety Glasses, Signs, etc. Engineering Controls (by Mfg) Interlocks, standby, emission indicators 5
LSO: Laser Safety Officer
LSO Verifies Documentation
Laser Safety
Facility LSO is responsible for Laser Log, to include (not limited to): System and Equipment Audits Laser Maintenance Records Safety Audits Education – Initial and On-going Competency – Skills Check Lists
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NHZ: Nominal Hazard Zone
Laser Safety
NHZ is the actual area (boundary) where someone could be injured by the laser beam ANSI Laser Standards state that the entire room is the NHZ NHZ depends on factors such as: Wavelength Power Spot Size and Divergence Angles Exposure Time MPE (maximum permissible exposure) 7
Verify Proper Eye Protection
Laser Safety
Ensure all persons in treatment room are wearing protective eyewear OD 5, wavelength 790–830 nm
If patient‘s face is treated they must wear opaque or metal eye goggles or shields Laser beam can cause severe retinal injury
Do not treat within bony orbit of eye Do not treat eyebrows or eyelashes
Ocular Hazard Zone: 164 feet / 50 m Laser light focused by the lens of the eye onto retina has a high fluence 8
Protective Eyewear Required
Laser Safety
Operator Glasses: OD 5 for 800 nm wavelength
Patient Goggles or Shields: Opaque or metal 9
Calibration for LightSheer ET & HS
Laser Safety
Calibration is required: At start up, when system is first turned on When new handpiece is attached After 25,000 pulses in one ‗power on‘ session Calibration is recommended prior to the start of each treatment Verify port is clean and handpiece is properly seated prior to calibration To ensure accuracy of calibration To avoid damage to calibration port 10
Calibration Instructions
Laser Safety
Remove the handpiece and reinsert into the calibration port Verify hp is perpendicular to port and not seated at an angle; improves accuracy, avoids damage
Touch screen prompts, follow each step Press enable button on handpiece Press and hold trigger until calibration complete 11
‗Vacuum Purge‘ for LightSheer HS Vacuum Purge is required: At start up and before any treatments To ensure proper function of vacuum assist technology Vacuum Purge is also recommended as needed between treatments To clear system and prevent build up of debris 12
Laser Safety
Upgrade planned for Q2 2010 will include a reminder screen for system operators.
‗Vacuum Purge‘ Instructions
Select ‗Utility‘ on Main Screen ‗System Operating Tools‘ on Utility Menu ‗Vacuum Purge‘ on System Tools Screen
Follow on screen instructions until purge is complete. 13
Laser Safety
General Safety Guidelines
Laser Safety
‗Laser in Use‘ warning sign on door Pair of operator glasses outside of door Enclosed room with opaque fire resistant window coverings Allow any flammable liquids used for cleaning the skin to fully evaporate before treatment Have a fire extinguisher available Water must be available (e.g., running or in bowl)
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Laser Classification & Standards
Laser Safety
LightSheer Duet classification Class IV laser by Center for Devices and Radiological Health (CDRH) Class 4 laser by European Standard (EN 60825-1)
Follow ANSI, OSHA, European standards Contact Laser Institute of America (LIA) (800) 34LASER for current ANSI and OSHA standards http://www.laserinstitute.org i.e., ANSI Z136.3, ANSI Z136.1 and EN 207
ANSI: American National Standards Institute 15
Laser Tissue Interaction
Permanent Hair Reduction Defined
Laser Tissue Interaction
Hair growth has three phases Anagen (active/growth) Catagen (transition/regression) Telogen (resting)
Growth cycle Depends on body part Lasts anywhere from 4 to 12 months
Hair reduction is considered permanent when a significant amount of hair does not return for longer than the complete growth cycle
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How Does It Work?
Laser Tissue Interaction
Based on the theory of Selective Photothermolysis The target chromophore is melanin Present in the hair shaft Also present in the upper third of the follicular epithelium
Heat generated in the hair shaft diffuses to the follicular epithelium to cause the damage that is desired
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Goal is to Damage Hair to Kill Point
A normal follicle
Laser Tissue Interaction
A damaged follicle
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Pulse Width Considerations
Laser Tissue Interaction
PW must be equal to or shorter than Thermal Relaxation Time (TRT) of the target (hair follicle) to confine thermal damage Depends on hair diameter (i.e., fine vs. coarse) PW must be matched with appropriate amount of fluence to cause follicular damage while sparing surrounding tissue Depends on melanin content in skin vs. surrounding tissue Note: maximum tolerated fluence is generally inversely proportional to melanin content in skin for a given pulse width
In general, Treat fine/thin hair, lighter skin types with shorter pws Treat coarse/dense hair, darker skin types with longer pws
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