BTL Laser 4000 Topline User manual

BTL-4000 Topline

LASER

U S E R ' S G U I D E

100IE20/12/2007

CONTENTS
1	LASER THERAPY ..............................................................................................................................................	3
1.1	Introduction....................................................................................................................................................	3
1.2	Light -The Principle of Laser Light and its Specifics ......................................................................................	3
1.3	Types of Lasers .............................................................................................................................................	5
1.3.1	Source.....................................................................................................................................................	5
1.3.2	Wavelength (primarily semi-conductor lasers).........................................................................................	5
1.3.3	Beam Operation Mode ............................................................................................................................	5
1.3.4	Type of Beam ..........................................................................................................................................	6
1.3.5	Laser Class (defined by the output).........................................................................................................	6
1.3.6	Use..........................................................................................................................................................	6
1.4	Basic Physical Quantities ..............................................................................................................................	7
1.5	Biological Effects of a Low-power Laser (Non-invasive Laser) ......................................................................	8
1.6	Acupuncture ..................................................................................................................................................	9
1.6.1	Frequencies for Laser Acupuncture According to Dr. Nogier ..................................................................	9
2	SETUP OF LASER GENERATOR ...................................................................................................................	10
2.1	Access Password ........................................................................................................................................	10
2.2	Setup and Control of Laser Therapy............................................................................................................	10
2.2.1	Laser .....................................................................................................................................................	11
2.2.2	Laser Sequences ..................................................................................................................................	16
2.3	Specific Settings ..........................................................................................................................................	16
2.3.1	Door Activity ..........................................................................................................................................	16
2.3.2	Acupuncture ..........................................................................................................................................	16
2.3.3	Self-calibration of the Laser Probe ........................................................................................................	17
2.3.4	Sound in running therapy ......................................................................................................................	17
2.4	Locking of the Equipment If Door Opens .....................................................................................................	17
2.5	Laser Probes ...............................................................................................................................................	18
2.6	Optical Attachments for Laser Probes .........................................................................................................	19
2.6.1	Dental Attachment.................................................................................................................................	20
2.6.2	Gynaecological Attachment...................................................................................................................	20
2.6.3	ENT Attachment ....................................................................................................................................	20
2.6.4	How to Connect the Attachment............................................................................................................	20
2.7	Laser Clusters .............................................................................................................................................	21
2.8	Use of Safety Eyewear ................................................................................................................................	22
3	APPENDIX........................................................................................................................................................	23
3.1	Warning Labels Placed on the Case of the Device and on the Laser Probe ...............................................	23

3.1.1Label placed on the case of the device, warning about occurrence of visible and invisible radiation

of class 3B.............................................................................................................................................

23

3.1.2Label placed on the probe, warning about proximity of aperture of laser of the stated wavelength,

power and laser class............................................................................................................................

24

3.1.3Label placed on the laser cluster, warning about proximity of aperture of laser of the stated

	wavelength, power and laser class........................................................................................................	24
3.1.4	Label for marking of the laser workplace, warning about proximity of 3B-class laser............................	25

LASER THERAPY | Page 2 of 25

1 LASER THERAPY

1 . 1 I N T R O D U C T I O N

This User's Guide is intended to make you familiar with the BTL-4000 Topline Laser device, designed to perform non-invasive, low level laser therapy. At the same time, it will give you general instructions on how to perform low level laser therapy in clinical practice.

Please note that according to applicable legislation, staff operating therapy lasers must be trained by competent institutions.

1 . 2 L I G H T - T H E P R I N C I P L E O F L A S E R L I G H T A N D I T S S P E C I F I C S

The nature and qualities of light can be interpreted in many ways, according to classic, relativistic or quantum physics. However, the basic nature of light itself as either a particle/corpuscular or an electromagnetic/wave mechanism remains unreachable for our senses and is incomparable to any other level of reality. Therefore, we can only accept the conclusions and deductions of numerous experiments.

Laser radiation has specific qualities:

•totally monochromatic: maintaining only one wavelength

LASER 635 nm

Intensity

400 500 600 700 800

	BULB
	Intensity
nm	400	800	1200	1600	2000	nm

LASER THERAPY | Page 3 of 25

•totally polarized – waves are completely spatially oriented onto a defined area

Linear polarization

•totally coherent – it is completely oriented in time - the maxima and minima of all waves are identical in time and the waveforms are the same

Coherent light

Non-coherent light

A laser beam of high output represents the “death ray” of sci-fi authors of old; it can destroy material or matter. However, a laser beam of low output (not exceeding 500 mW) shows slightly different effects on living organisms and tissues, especially a significant stimulating effect – see the part concerning clinical effects of low-power laser beam.

The word LASER stands for Light Amplification by Stimulated Emission of Radiation.

The first theoretical postulates on a laser beam were laid down by Albert Einstein in the early twentieth century, describing the theoretical possibilities of a stimulated emission of light in 1916-1917. However, the first laser unit was not constructed until 1960, following other important discoveries in the area of so-called quantum radio technology (N.G. Basov and A.M. Prochorov of the former USSR and C.H. Townes of the USA received a Nobel Prize for these discoveries in 1964).

The medical application of laser light followed soon after. At first, only high intensity laser beams were utilized. Lasers of this type provide a source of energy that can destroy (cut, shear) as well as evaporate and, using its thermal effect, cauterize tissue.

E. Mester, a Hungarian scientist, was the first to introduce the stimulating effect of a low intensity laser. He conducted his experiments - which are still of great importance - in the late sixties.

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1 . 3 T Y P E S O F L A S E R S

Lasers can be divided according to several criteria:

1 . 3 . 1 S o u r c e

•solid lasers (ruby laser)

•liquid lasers

•gas lasers - helium-neon, argon

•semi-conductor lasers (GaAs, GaAlAs) – now the most important of the non-invasive therapy lasers

The advantages of semi-conductor lasers include a significant miniaturization of the source, robustness and immunity to damage and the theoretical possibility to construct a laser unit of any wavelength, according to the user's requirements. Nevertheless, some lasers still remain at the experimental level (see below).

1 . 3 . 2 W a v e l e n g t h ( p r i m a r i l y s e m i - c o n d u c t o r l a s e r s )

•blue lasers – approx. 400-500 nm

•green lasers – approx.500-550

•red lasers – approx.600-700nm

•infra-red lasers – approx.700-950 nm

Visible spectrum

500nm 700nm

400nm 600nm

cosmic radiation; gamma-rays, X-rays, UV radiation

infrared radiation, microwaves, radio waves, very long waves

Laser beam penetration through the tissue is largely dependent on the wavelength. In general, green and blue lasers are still being developed and their clinical use is extremely limited. Most commonly used are the beams in the wavelength of red light. After 2-3 mm penetration through living tissue, their intensity is reduced to half. This predetermines red laser beams to be used especially in the therapy of mucous membrane and skin diseases. Since the output is absorbed by a very small column of tissue, devices of an output of 50 mW or lower are usually fully sufficient.

The intensity of infra-red lasers is reduced to half after penetration of 2-3 cm through tissue. These lasers are used especially in treating deeper located structures (joints, muscles, insertions...). Since the output is absorbed by the column of tissue, and since we want the intensity on the target area deep in the tissue to be sufficient, we recommend using devices of a minimum output of at least 50 mW.

See the part concerning the emitted power density below.

1 . 3 . 3 B e a m O p e r a t i o n M o d e

•pulse lasers – very short pulses – hundreds of ns, peak output in watts or tens of watts

•continuous lasers

•lasers with modulated operation – the pulse length depends on the frequency and on the duty factor; the peak output reaches up to several hundreds of mW.

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Output	Output
PULSE	MODULATED

Mean Mean value value

Time

Time

Output

CONTINUOUS

Mean value

Time

Manufacturers usually offer various alternatives, including the possibility of combining various modes modulated according to various parameters.

See the parts concerning clinical effects and use below.

1 . 3 . 4 T y p e o f B e a m

•convergent (point) beam

•divergent (widening) beam – allows irradiation of a larger area without the need to sweep the probe over the treated tissue

•laser scanners – devices for irradiation of large areas

•laser clusters – generate several independent laser beams, which may be of various wavelengths. They enable a large area to be irradiated without the necessity of sweeping over the treated tissue. To some extent they substitute laser scanners.

1 . 3 . 5 L a s e r C l a s s ( d e f i n e d b y t h e o u t p u t )

•Class 2: up to an output of 1 mW

•Class 3A (3R, 3M): up to an output of 5 mW and output density of 25 W/m2

• Class 3B:

up to 500 mW

Note

The stated values are only rough, exact classification of the hygiene class is more complicated and shall be performed according to applicable standards.

1 . 3 . 6 U s e

•simple pen lasers ("laser-pen") – usually feature only a very limited range of frequency modes. The advantage of this type is its perfect portability

•"pocket" lasers – usually designed to fit in a physician's coat pocket; in most cases the probe is connected to the device's body by a conductor – these devices largely prevail on the market, at present manufacturers can equip these devices with probes of an output up to hundreds of mW

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•desk-top lasers – usually supplied from the mains, the probe is connected to the device by a cable. The advantages of this type usually include a wide range of frequency modes and the possibility to set many different parameters. New generation devices (including BTL-4000 Topline Laser) also have the possibility of replacement of probes of various wavelengths and outputs. These devices are designed especially for rehabilitation. One of their advantages is the possibility of building "sets" of devices which can provide as wide a range of treatments as possible on a small area.

1 . 4 B A S I C P H Y S I C A L Q U A N T I T I E S

•Wavelength - one of the basic parameters of a monochromatic laser beam (i.e. of only one wavelength). Its unit is the nanometer [nm].

•Output – its unit is the mW. The given output is either peak, i.e. pulse amplitude, or mean (average). In case of the BTL 4000 Topline Laser, the screen displays the peak output value measured on the output aperture of the probe. Use of an optical attachment or light conductor causes an approximately 10% loss of output which shall be deducted from the displayed value. For each attachment supplied by the manufacturer of BTL devices, the decrease in output is stated in the attachment's technical documentation.

It is always necessary to know the output level at the active end of the probe/cluster (output aperture) – especially when the beam is transmitted by a light conductor, the resulting output can markedly differ from the output of the source! Every passage between media (source-air, source-lightguide, lightguide-air) lowers the output.

The mean output also depends on the chosen mode, i.e. continuous or pulse (The computing unit of the BTL4000 Topline Laser takes into account the mode in which the device is working when calculating the treatment time).

•Modulation frequency – its unit is the Hertz [Hz] (= number of oscillations per second), sometimes there is in addition the percentage value of the active state time ("Duty factor") and the pulse width. The most commonly used are numerical frequencies (5 Hz stimulation, 10 Hz analgesic effect), very common are also frequencies according to Dr. Nogier (previously used mainly in acupuncture).

•Power density - its unit is the J/cm2 – power emitted per unit of area. This quantity is improperly called the dose – however, this term has become so common in laser theory that also in this document the terms "emitted power dose" or "dose" are used, but they always mean "emitted power density".

Below you can see a formula for calculation of an emitted power dose: (Note: this is the dose emitted to the skin surface, not to more deeply located structures)

mean radiation output (W) x application time (s)

emitted power dose [J/cm2] = -------------------------------------------------------------------

irradiated area (cm2)

Knowledge of basic physical quantities (which is also acquired in obligatory training) significantly facilitates an understanding of laser therapy.

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1 . 5 B I O L O G I C A L E F F E C T S O F A L O W - P O W E R L A S E R ( N O N - I N V A S I V E L A S E R )

Specific physical qualities of a laser beam result in specific clinical effects. The most considerable clinical effects are:

•analgesic effect (A)

•antiphlogistic effect (F)

•antiedematous effect (E)

•biostimulation effect (B)

•vasodilatation effect (V)

All these effects are based on positively established and verified mechanisms:

•acceleration of microcirculation

•increase in intracellular activity of many enzymes, particularly in the Krebs cycle

•increased oxygen circulation, improved glucose utilization

•DNA synthesis stimulation (via phytohemaglutinin stimulation)

•increased fibroblast activity (for keloids these activated fibroblasts are able to perform resorption of fibrin)

•phagocytosis activation

•activation of the Na/K pump on the membrane

•activation of metabolic processes in the cellula: partly through affecting the Na/K pump and Ca transport, partly through direct activation of the mitochondrial system

•changes in local level of important mediators -- inflammatory (histamine substances, prostaglandins) or e.g., endorphins

When performing an in vitro experiment, no difference can be seen between laser beams applied in continuous and pulse modes. However, when performing an in vivo experiment, we observe marked differences between a continuous beam and a beam adjusted to a certain defined mode. In physical therapy, this phenomenon can be observed when performing electrotherapy or applying ultrasound. It seems that, for a complex organism with its numerous information systems and feedbacks, a physical quantity modulated to a certain frequency features one additional quality -- specific information transmitted by this frequency.

The effect of a laser beam in acupuncture is totally specific. A laser beam affects tissue in a way fully comparable with the effect of an inserted needle -- but without any pain or complications related to the needle insertion. The skin above the acupuncture point is a light conductor for the laser beam. We find it interesting that in laser acupuncture, in contrast to other forms of laser therapy, the wavelength of a laser beam is not of great importance (however, red lasers are slightly more effective) and the output of the device is of no importance at all (we can even use a laser-pen). We conclude that in this method of application, it is not the effect of the physical quantity itself, but the above-mentioned transmission of information that plays the key role.

Many treatments utilize several effects of laser light at one time (e.g. treatment of varicose ulcer combined with analgesic, stimulating, as well as bactericidal effects).

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