Basic principles of lasers
Gary Thomas Richard Isaacs

Learning objectives
After reading this article you should be able to: C describe the structural components of a laser C understand how a laser beam is produced C list the three principal properties of a laser beam C outline the safety measures employed when a laser is used during a surgical procedure

The word laser is an acronym of Light Amplification by Stimulated Emission of Radiation. A laser emits a beam of electromagnetic radiation that is always monochromatic, collimated and coherent in nature. Lasers consist of three main components: a lasing medium (solid, liquid or gas), a stimulating energy source (pump) and an optical resonator; and have a wide variety of uses in clinical medicine. Lasers cause tissue damage by various mechanisms and these are mainly determined by power density (irradiance) of the beam and exposure time. It is imperative to be aware of the risks associated with laser use in terms of tissue damage (burns and eye injuries) and fire hazards. Strict controls should be implemented governing the safe use of lasers in hospital practice, and all staff must be familiar with all safety measures to prevent injury and fires.

produce or amplify a beam of narrow, convergent light with a well-defined wavelength within the electromagnetic spectrum. Wavelengths in the infrared, visible and ultraviolet regions of the spectrum are most commonly used for commercial applications.

Laser design
A laser consists of three main components (Figure 1): Lasing medium: which may be solid (crystals or semiconductors), liquid (organic dyes) or a gas (or gas mixture). Excitation system or ‘pump’: this creates the conditions for light amplification by supplying the necessary energy to the lasing medium. There are different kinds of pumping systems: optical (flash lamps, continuous arc lamps, tungsten-filament lamps or even other lasers), electrical (gas discharge tubes, electric current in semiconductors), or chemical pumps. Optical resonator: which in its simplest form consists of two mirrors arranged such that the photons pass back and forth along the length of the lasing medium. Typically, one mirror is partially transparent to allow the beam to exit (output coupler).

Keywords Damage; fire; lasers; physics; properties; safety

“Suddenly a light from hell appeared in the middle of the ruby. Then, from the end of a cylinder, a hundred thousand times brighter than the sun, burst forth a thin red light, a perfectly parallel monochromatic beam. Maiman and his assistants were silent for some time, enthralled by the beauty of this spectacle. ‘Einstein was right’ he murmured, ‘light can be concentrated and coherent.” This newspaper extract describes the public demonstration of the first working laser constructed by Theodore Maiman in 1960.1 It consisted of a ruby crystal shaped into a rod 4 cm long and 0.5 cm diameter. The ends were polished, flat and parallel, with one fully silvered and the other partially silvered. An electronic flash tube was coiled around the ruby. Ruby is a crystalline form of aluminium oxide in which chromium atoms have replaced some of the aluminium atoms to give the crystal its red colour. The flashlight excites electrons in the chromium atoms to higher energy levels. Upon returning to their normal state, the electrons emit their characteristic ruby-red light. The mirrors reflect this light back and forth inside the crystal, stimulating other excited chromium atoms to produce more light until the crystal’s stored energy is eventually dissipated. The word laser is an acronym of Light Amplification by Stimulated Emission of Radiation and aptly describes the theory behind the mechanics of laser generation. Lasers are devices that

Laser physics
A lasing medium can be considered as consisting of atoms with a central nucleus of protons and neutrons surrounded by electrons in discrete orbital shells. These electrons move between different energy levels as the atom absorbs or releases external energy. Three different mechanisms exist which highlight the interaction between electrons and photons of energy (Figure 2).  Absorption: an electron in its ground-state energy level (E1) absorbs a photon of energy hv and moves to an upper level (E2). h is Planck’s constant (6.63 Â 10À24J/s) and v is frequency.  Spontaneous emission: an electron in an upper level (E2) can decay spontaneously to the lower level (E1). In so doing, a photon of energy hv that has a random direction and phase is emitted.  Stimulated emission: an incident photon causes an upperlevel electron to decay, emitting a ‘stimulated’ photon whose properties (direction, wavelength and phase) are identical to those of the incident photon. Hence, duplication of the photon. These three mechanisms are always present concurrently. An incident photon has an equal chance of being absorbed by a ground-state electron as being duplicated by interacting with an

Gary Thomas MB BCh (Wales) FRCA is a Consultant Anaesthetist at The Princess of Wales Hospital, Bridgend, Wales. Conflicts of interest: none declared. Richard Isaacs MB BChir (Cantab) BSc (St And) FRCA is a Specialist Trainee 6 in Anaesthesia on the Wessex rotation, England. Conflicts of interest: none declared.



Ó 2011 Elsevier Ltd. All rights reserved.

This is achieved by the input of energy from the pump.PHYSICS Structural components of a laser Fully reflective mirror Fully reflective mirror Emitted laser beam via output coupler Laser medium Partially reflective mirror Fully reflective mirror Pumping source Figure 1 excited-state electron. . that is. The optical resonator. with its arrangement of mirrors. Damage mechanisms Lasers cause tissue damage through various mechanisms. For a laser to function. absorption and stimulated emission are two reciprocal processes subject to the same probability. mainly determined by power density or irradiance (W/cm2) and exposure time. The laser light travels to and fro along the same axis with some photons eventually exiting the partially silvered mirror at one end. which may be supplied continuously. All rights reserved. Figure 2 ANAESTHESIA AND INTENSIVE CARE MEDICINE 12:12 575 Ó 2011 Elsevier Ltd. conditions have to favour stimulated emission over absorption and spontaneous emission. so that there are more excited-state electrons than those in the ground-state (‘population inversion’). Properties of a laser beam The three Cs can be used as a simple aide-mmoire: e  Colour: consisting of just one wavelength of light (monochromatic)  Coherence: all light particles (photons) are in phase  Collimated: the photons minimally diverge from their point of origin and are considered as being parallel. or intermittently in the case of a pulsed laser. allows amplification or optical gain to occur as photons stimulate the emission of more and more photons.

Ultraviolet light (<400 nm) tends to be absorbed in the cornea and lens. and stated that his ruby laser had the power of ‘2 Gillette’. brief pulse of laser light results in an explosive expansion of tissue. 1M. advising on safety.e. yttrium aluminium garnet. tattoo removal and scar treatment Corneal vision correction Ho:YAG Nd:YAG 2100 1064 Mid infrared Near infrared Solid Solid Laser diode Flash lamp. . lasers have been classified by maximum output power into four broad classes according to their ability to harm unprotected persons. peripheral iridotomy for acute glaucoma and treatment of posterior capsular opacification post.PHYSICS  Photoacoustic or photomechanical e a high-power. 3R. 3B. Infrared light (>1060 nm) is particularly dangerous as it will not elicit the protective blink reflex due to its invisibility.cataract surgery Prostate surgery. This measure was simply the number of razor blades through which the laser could burn a hole! Since the 1970s. Nd. spider naevi Retinal phototherapy and glaucoma. haemangiomas). All rights reserved. arteriovenous malformations. KTP. holmium. The MPE is measured at the cornea of the human eye or at the skin.  A laser protection supervisor (LPS) should be appointed for every clinical area in which a laser is used.  Photothermal e occurs from less intense but more sustained laser pulses and causes tissue coagulation or vaporization. 4).2 This standard defines seven Safety measures Protocols should exist within hospitals that govern the safe use of lasers in surgery. reactive oxygen compounds are generated which can cause selective cell lysis. implemented in 2002 is part of the revised International Electrotechnical Commission standard 60825 (2007). laser diode Argon 500 Blue-green Gas Electrical current Dye Excimer (Ar:F) 390e640 193 Yellow Ultraviolet Liquid Gas Other laser. YAG. The duty of the Physical characteristics and medical applications of lasers in medicine Laser CO2 Wavelength (nm) 10. argon:fluoride. Most of the light is absorbed by melanin in the pigment epithelium just behind the photoreceptors and causes painless burns on the retina. for example the holmium:YAG (yttrium aluminium garnet) laser used to disrupt urinary calculi by the heating of water contained within. for a given wavelength and exposure time. implementing protocols and investigating clinical incidents. removal of vascular lesions (i. neodymium. gastrointestinal. skin cancers.  Photodissociation e the non-thermal breakdown of covalent bonds within protein molecules.  A laser protection advisor should be appointed with responsibility for assessing risk. It is usually about 10% of the dose that has a 50% chance of creating damage. dentistry Surgery for bronchial tumours. for example the CO2 laser used to cut tissue and secure haemostasis. Laser safety Maiman recognized the hazards of lasers at an early stage.3 The key safety measures are as follows:  The category of a laser in use and its hazard classification should be clearly marked on its outer casing. potassium titanylphosphate. The maximum permissible exposure (MPE) is the highest power or energy density (W/cm2 or J/cm2) of a laser that is considered safe. The eye is most susceptible to damage. Table 1 ANAESTHESIA AND INTENSIVE CARE MEDICINE 12:12 576 Ó 2011 Elsevier Ltd. for example ophthalmological lasers used for corneal reshaping. GI. When irradiated by the laser.  Photodynamic e a photosensitizer is a chemical compound that can be excited by light of a specific wavelength. pumping for other lasers Port-wine stain removal. 2M.600 Spectrum Far infrared Medium Gas Pumping Electrical Clinical uses Removal of dermatological lesions. Ho. lithotripsy. ranging from class 1 (no hazard during normal use) to class 4 (severe hazard for eyes and skin). Red and nearinfrared light (400e1400 nm) can be focussed up to 2 Â 105 times greater intensity by the lens onto the retina. where it can produce burn injuries and cataracts at relatively low powers due to photochemical damage. flash lamp Electrical current Ar:F. The revised system. 2. GI bleeding. endometriosis. Examples of lasers and their practical applications in medicine are given in Table 1. laser diode KTP 532 Green Solid Flash lamp. port-wine stains. neurosurgical vascular tumours Tissue ablation. classes of lasers based on the maximum permissible exposure levels and effects on the eyes and skin (1. tumours of naso-oro-laryngo-tracheal area.

During tissue vaporization. http://prn1. BSI. 5th edn. DB 2008(03) Guidance on the safe use of lasers.html. An appropriate non-water-based fire extinguisher should be immediately available in the clinical area in which the laser is used. Laserfest: celebrating 50 years of laser innovation. A Fire hazards Fires are a very real risk during laser surgery.laserfest. skin preparation) may cause a theatre or airway fire. http://www. drapes. it is also possible to generate particulates and metal fumes which may cause ocular and upper respiratory tract irritation. circuit. Nature 1960. All rights reserved. 3 Medicines and Healthcare products Regulatory Agency. Also available at: http://www.mhra. Methods employed to reduce risk include:  avoiding use of nitrous oxide  minimum acceptable inspired oxygen concentration  non-reflective matt-black instruments to reduce stray reflected beams (specular reflection)  protecting surrounding tissues with wet swabs  saline-filled cuffs on laser-resistant tubes to which methylene blue dye may be added to identify inadvertent cuff perforation  water-based lubricants and gel coating on facial hair  short laser bursts to reduce energy  low-power laser aiming beam to avoid inadvertent damage. (accessed 22 October 2010). dead cellular material or viruses. The triad of heat (laser energy). All staff should wear suitable eye protection when a laser is in use. FURTHER READING Davis PD. to absorb the appropriate wavelength range. Oxford: Butterworth-Heinemann. nitrous oxide) and fuel (tube.univ-lemans.) e ANAESTHESIA AND INTENSIVE CARE MEDICINE 12:12 577 Ó 2011 Elsevier Ltd. University of Maine. eds. France. 2 BS EN 60825-1:2007 Safety of laser products. Basic physics and measurement in anaesthesia. All doors should be locked and all windows covered to protect those outside the treatment area. (An online educational resource designed by physicists Francois ‚ Balembois and Sbastien Forget. Stimulated optical radiation in ruby. Eyewear must be selected for the specific type of laser. 2003. IPL systems and . Kenny GNC. the laser can generate airborne contaminants such as gaseous toxic compounds. In orthopaedics and dentistry. lasers. Non-beam hazards Lasers are high-voltage devices. (accessed 21 October 2010). High-pressure water necessary for cooling the laser and other associated electrical equipment can pose greater risks of electrocution and burns than the beam itself. oxidizing agent (oxygen.PHYSICS     LPS is to ensure that the laser is used safely and that clinical staff are instructed in its use. 2007. Laser warning signs should be clearly visible to denote a ‘laser controlled zone’. Laser: DeviceBulletins/ optique/M1G1_FBalembois_ang/co/M1G1_anglais_web. 187: 493e4. ranging from 400 V for lowenergy pulsed lasers to several kilovolts in higher-powered REFERENCES 1 Maiman TH. org. Equipment classification and requirements. hence a requirement for proper ventilation or smoke evacuators. (accessed 1 November 2010).

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