Background and objective

The purpose of this study was to compare the ablation of cortical bone at wavelengths across the near and midinfrared region.

Study design/materials and methods

An free electron laser generating 4-micros macropulses at specific wavelengths between 2.9 and 9.2 microm was used to ablate cortical bone. The same pulse intensity, repetition rate, radiant exposure, number of pulses, and delivery was used for each wavelength. Tissue removal, collateral thermal injury, and morphologic characteristics of the ablation sites were measured by light and scanning electron microscopy, and compared with the infrared absorption characteristics of cortical bone.

Results

Within the parameters used, bone ablation was found to be wavelength dependent. Incisions were deepest where protein has strong absorption, and were most shallow where mineral is a strong absorber. No char was observed on ablation surfaces where 3.0, and 5.9-6.45 microm wavelengths were used.

Conclusions

The use of wavelengths in the 6.1-microm amide I to 6.45-microm amide II region, with the pulse characteristics described, were the most efficient for cutting cortical bone and produced less collateral thermal injury than cutting with a surgical bone saw. This study confirms previous observations that the ablation mechanism below plasma threshold is consistent with an explosive process driven by internal vaporization of water in a confined space and demonstrates that ablation is enhanced by using wavelengths that target the protein matrix of cortical bone.

Heat transfer rate at the skin-air interface is of critical importance for the benefits of cryogen spray cooling in combination with laser therapy of shallow subsurface skin lesions, such as port-wine stain birthmarks. With some cryogen spray devices, a layer of liquid cryogen builds up on the skin surface during the spurt, which may impair heat transfer across the skin surface due to relatively low thermal conductivity and potentially higher temperature of the liquid cryogen layer as compared to the spray droplets. While the mass flux of cryogen delivery can be adjusted by varying the atomizing nozzle geometry, this may strongly affect other spray properties, such as lateral spread (cone), droplet size, velocity, and temperature distribution. We present here first experiments with sequential cryogen spraying, which may enable accurate mass flux control through variation of spray duty cycle, while minimally affecting other spray characteristics. The observed increase of cooling rate and efficiency at moderate duty cycle levels supports the above described hypothesis of "isolating" liquid layer, and demonstrates a novel approach to optimization of cryogen spray devices for individual laser dermatological applications.

Cryogen spray cooling (CSC) can protect the epidermis from non-specific thermal injury during laser treatment of port wine stains and other hypervascular cutaneous malformations. Knowledge of skin internal temperatures in response to CSC is essential for optimization of this technique. We used an epoxy resin compound to construct a skin phantom and measured its internal temperatures in response to cooling with different cryogens at various spurt durations, spraying distances, and ambient humidity levels. The measured temperature distributions during CSC were fitted by a mathematical model based on thermal diffusion theory. For spurt durations up to 100 ms, temperature reduction within the phantom remained confined to the upper 200 μm, and was affected by spraying distance. Depending on the cryogen used, temperature reductions up to 45 °C could be measured 20 μm below the surface at the end of a 100 ms spurt. However, the cryogen film temperature on the epoxy resin surface was up to 35 °C lower, indicating lack of perfect thermal contact at the cryogen film-phantom interface. Theoretical predictions were within 10% of measured temperatures. Ice formation occurred following termination of the spurt and was influenced by the ambient humidity level.

Goal is to investigate how delivery nozzle design influences the cooling rate of cryogen spray as used in skin laser treatments. Cryogen was sprayed through nozzles that consist of metal tubes with either a narrow or wide diameter and two different lengths. Fast-flashlamp photography showed that the wide nozzles, in particular the long wide one, produced a cryogen jet (very small spray cone angle) rather than a spray (cone angles of about 15° or higher) and appeared to atomize the cryogen less finely than the narrow nozzles. We measured the cooling rate by spraying some cryogen on an epoxy-block with thermocouples embedded. The heat extraction rate of the wide nozzles was higher than that of the narrow nozzles. The results suggest that finely atomized droplets produced by the narrow nozzles do not have enough kinetic energy to break through a layer of liquid cryogen accumulated on the object, which may act as a thermal barrier and, thus, slow down heat extraction. Presumably, larger droplets or non-broken jets ensure a more violent impact on this layer and therefore ensure an enhanced thermal contact. The margin of error for the heat extraction estimate is analyzed when using the epoxy-block. We introduce a complementary method for estimating heat extraction rate of cryogen sprays.

Optical coherence tomography (OCT) was used to image the internal structure of a rat cochlea (ex vivo). Immediately following sacrifice, the temporal bone of a Sprague-Dawley rat was harvested. Axial OCT cross sectional images (over regions of interest, 1×1 mm to 2×8 mm) were obtained with a spatial resolution of 10-15 μm. The osseous borders of the lateral membranous labyrinth overlying the cochlea and the scala vestibuli, media, and tympani which were well demarcated by the modiolus, Reissner's and the basilar membranes were clearly identified. OCT can be used to image internal structures in the cochlea without violating the osseous labyrinth, and may potentially be used to diagnose inner ear pathology in vivo in both animal and human subjects.

The laser irradiation of cartilage results in a plastic deformation of the tissue allowing for the creation of new stable shapes. During photothermal stimulation, mechanically deformed cartilage undergoes a temperature dependent phase transition, which results in accelerated stress relaxation of the tissue matrix. Cartilage specimens thus reshaped can be used to recreate the underlying framework of structures in the head and neck. Optimization of this process has required an understanding of the biophysical processes accompanying reshaping and also determination of the laser dosimetry parameters, which maintain graft viability. Extensive in vitro, ex-vivo, and in vivo animal investigations, as well as human trials, have been conducted. This technology is now in use to correct septal deviations in an office-based setting. While the emphasis of clinical investigation has focused on septoplasty procedures, laser mediated cartilage reshaping may have application in surgical procedures involving the trachea, laryngeal framework, external ear, and nasal tip. Future directions for research and device design are discussed.

In this study, we attempted to determine the critical temperature [Tc] at which accelerated stress relaxation occurred during laser mediated cartilage reshaping. During laser irradiation, mechanically deformed cartilage tissue undergoes a temperature dependent phase transformation which results in accelerated stress relaxation. When a critical temperature is attained, cartilage becomes malleable and may be molded into complex new shapes that harden as the tissue cools. Clinically, reshaped cartilage tissue can be used to recreate the underlying cartilaginous framework of structures such as the ear, larynx, trachea, and nose. The principal advantages of using laser radiation for the generation of thermal energy in tissue are precise control of both the space-time temperature distribution and time-dependent thermal denaturation kinetics. Optimization of the reshaping process requires identification of the temperature dependence of this phase transformation and its relationship to observed changes in cartilage optical, mechanical, and thermodynamic properties. Light scattering, infrared radiometry, and modulated differential scanning calorimetry (MDSC) were used to measure temperature dependent changes in the biophysical properties of cartilage tissue during fast (laser mediated) and slow (conventional calorimetric) heating. Our studies using MDSC and laser probe techniques have identified changes in cartilage thermodynamic and optical properties suggestive of a phase transformation occurring near 60°C.

Pulsed photothermal radiometry (PPTR) can be used for non-invasive depth profiling of port wine stain (PWS) birthmarks, aimed towards optimizing laser therapy on an individual patient basis. Reconstruction of laser-induced temperature profile from the experimentally obtained radiometric signal involves the skin absorption coefficient in the infrared detection band. In the commonly used 3-5 μm detection band (InSb), the absorption coefficient varies by two orders of magnitude, while assumed to be constant in the reconstruction algorithms used thus far. We discuss the problem of choosing the effective absorption coefficient value to be used under such conditions. Next, we show how to account explicitly for the strong spectral variation of the infrared absorption coefficient in the image reconstruction algorithm. Performance of such improved algorithm is compared to that of the unaugmented version in a numerical simulation of photothermal profiling. Finally, we analyze implementation of a bandpass filter which limits the detection band to 4.5-5 μm. This reduces the absorption coefficient variation to a level that permits the use of unaugmented algorithm. An experimental test of the latter approach for in vivo characterization of the depth of PWS lesion and epidermal thickness will be presented, including a novel technique that uses two laser excitation wavelengths in order to separate the epidermal and vascular components of the radiometric signal.

Quantitative data regarding photothermal and damage processes during pulsed laser irradiation of blood are necessary to achieve a better understanding of laser treatment of cutaneous vascular lesions and improve numerical models. In this study, multiple experimental techniques were employed to quantify the effects of single-pulse KTP laser (λ = 532 nm, τp = 10 ms) irradiation of whole blood in vitro: high-speed temperature measurement with a thermal camera in line-scan mode (8 kHz); optical coherence tomography (for determination of coagulum morphology); and transmission measurement with a co-aligned laser beam (λ = 635 nm). Threshold radiant exposures for coagulation (4.4-5.0 J/cm2) and ablation (approximately J/cm2) were identified. Thermal camera measurements indicated threshold coagulation temperatures of 90-100 °C, and peak temperatures of up to 145 °C for sub-ablation radiant exposures. Significant changes in coagulum thickness and consistency, and a corresponding decrease in transmission, were observed with increasing radiant exposure. The Arrhenius equation was shown to produce accurate predictions of coagulation onset (using appropriate rate process coefficients). The significance of dynamic effects such as evaporative loss and dynamic changes in optical properties was indicated. Implications for numerical modeling are discussed. Most importantly, the threshold temperatures typically quoted in the literature for pulsed laser coagulation (60-70 °C) and ablation (100 °C) of blood do not match the results of this study.

The main goal of this study was to demonstrate the feasibility of using back-side infrared imaging to estimate the spatial cryogen temperature distribution during a cryogen spurt. Calculations from numerical models showed that the front-side temperature distribution could be identified at the back side of a thin aluminum sheet. Infrared images were obtained at various timepoints during a cryogen spurt from the back side of a 800-μm aluminum sheet and the temperature distribution estimated. The temperature distribution was approximately gaussian in shape. A secondary goal was to calculate the temperature distribution in skin for two cases: 1) uniform cryogen temperature distribution, essentially representative of a 1-D geometry assumption; and 2) nonuniform distribution. At the end of a 100-ms spurt, calculations showed that, for the two cases, large discrepancies in temperatures at the surface and at a 60-μm depth were found at radii greater than 2.5 mm. These results suggest that it is necessary to consider spatial cryogen temperature gradients during cryogen spray cooling of tissue.