LUMENIS LightSheer Duet Installation guide

Clinical In-Service Training
UPDATE v.24 March 2010
PB-1076090_A
High Speed

Clinical In-Service Training
Laser Safety
Laser Tissue Interaction
Laser Operations –Platform & Handpieces
Clinical Protocols - LHR & PFB
Lumenis & You –A Partnership for Success
Questions?
Agenda
2

Laser Safety

ANSI Laser Classifications
ANSI Laser
Classification
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.
Laser Safety
4

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
LSO: Laser Safety
Officer
Laser Safety
5

LSO Verifies Documentation
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
Laser Safety
6

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)
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Verify Proper Eye Protection
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
Laser Safety
8

Protective Eyewear Required
Operator Glasses:
OD 5 for 800 nm
wavelength
Patient Goggles
or Shields:
Opaque or metal
Laser Safety
9

Calibration for LightSheer ET & HS
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
Laser Safety
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
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‗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
Laser Safety
Upgrade planned for Q2 2010 will include
a reminder screen for system operators.
12

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.
‗Vacuum Purge‘ Instructions Laser Safety
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General Safety Guidelines
‗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)
Laser Safety
14

Laser Classification & Standards
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
Laser Safety
15

Laser Tissue Interaction

Permanent Hair Reduction Defined
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
Laser Tissue Interaction
17

How Does It Work?
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
Laser Tissue Interaction
18

A normal follicle A damaged follicle
Laser Tissue Interaction
Goal is to Damage Hair to Kill Point
19

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
Pulse Width Considerations Laser Tissue Interaction
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