Medical Light Sources for Diagnostic and Therapy(Robert ... · Medical Light Sources for Diagnostic and Therapy Robert Brüninghoff 07.05.2014. Overview • Introduction ... Neonatal

Medical Light Sourcesfor Diagnostic and Therapy

Robert Brüninghoff07.05.2014

Overview

• Introduction• Diagnostic• Deseases & Therapy

07/05/2014 FH Münster, Incoherent Light Sources 2

Introduction

• Light: 380 – 780 nm = visible spectral range• UVA (315‐380 nm) & UVB (280‐315 nm)• IR‐A (780‐1400 nm)


Introduction• (Sun‐) Light is important for (human) being

– brightness / illumination (VIS)– heat (IR)– day‐night‐rhythm (melatonin)– vitamin D production (UVB)

• deficiency symptoms: depression, tiredness and sleepdisturbances, pain (bones, muscles), immunodeficiency, etc.

– (good) mood


Introduction• Heliotherapy (gr. helios = sun)

‐> sunbath in ancient times(old egypt, greek, romans)

• (Sun)light therapy

Medicine Nobel Price 1903: Niels Ryberg Finsen Treatment of lupus vulgaris (skin tuberculosis)


Diagnosis Application• Optical microscopy


incandescent and halogen lamps

Source: Carl Zeiss Microscopy GmbH

• Diagnostic lamp (penlight)


Diagnosis Application

Source: DocCheck Shop

incandescent lampsLED

• Endoscopy


Diagnosis Applicationrequirements: ‐ bright light

‐ no heat production

cold‐light‐projector:

halogen lamp xenon lamp LED

Larygoscope: LED, Incandescent lamp

• Digital multifunctional camera

compact handheld device for diagnosis‐ eye‐ skin‐ ENT

LEDs (circular array)



Source: Optomed Oy (Ltd)

• Pulse oximetry

non‐invasive monitoring of arterial O2 saturation

photometric measurement of light absorbance(Lambert‐Beer‘s Law: ∗ )

O2 saturation = oxygenated haemoglobin / total haemoglobin660 nm: oxygenated haemoglobin940 nm: desoxygenated haemoglobin

red and IR LED



• Test for photodermatosis („sun allergy“) andphotodermatitis („photoallergy“)

‐ hypersensitivity reaction of the skin caused by UVA radiation(320‐400nm): erythema, cyst, itching

‐ allergic response due to a photoactivated allergen (e.g. sulfonamides (antibiotic), amber (Johanniskraut))



• Test for photodermatosis („sun allergy“) and photodermatitis(„photoallergy“)

test: exposure of a small skin areal to UVA‐radiation (60‐100 J/cm2)

UVA radiation sources: Hg low‐pressure dischargelamps with phosphor:

e.g.: LaMgAl11O19:Ce3+



Source: PISA Database, FH Münster, Prof. Jüstel

• Optical Coherence Tomography (OCT)

non‐invasiv imaging method: ‐ retina examination‐ dermatology‐ intravascular imaging

principle: reflection of coherent light pulses (λ = 600 – 1700 nm) at strewing histoid(analysis via interferometer); penetration depth 1‐3 mmadvantages: fast, cheap, no direct contact to patient (eye), high resolution (1‐15 µm)

light source: broad band emitting superluminescent diodes or laser



• Optical Coherence Tomography (OCT)



Source: Augenklinik Tausendfensterhaus

• X‐ray image & computed tomography (CT)

X‐rays: electromagnetic waves (10 nm – 1 pm) no „light“ in definition

X‐ray tube:



TherapyLight therapy: seasonal depression

(SAD = „winter depression“)

symptoms: melancholy, sadness, sleep disorder,…

therapy: 10.000 lux, 30 min, morning white light (blue light might be important)

light: regulation serotonin production/melatonin supression

fluorescent lamps (4000 K); UV filter


Source: Terman M, Terman JS. CNS Spect. Vol 10, No 8. 2005

TherapyLight therapy:Philips: TL “Natural Daylight”, 6500 K color temperature

‐> studies about non‐seasonal depression, bulimia, circadian sleep phase disorder‐> jet lag, shift‐worker syndrome


Source: Philips Lighting

TherapyNeonatal jaundice (icterus)cause: incorporation of fat‐soluble (unconjugated) bilirubin in histoid

bilirubin (yellow): decomposition product of haem conversion to water‐soluble (conjugated) bilirubin in liver


TherapyNeonatal jaundice (icterus) higher bilirubin values: short erythrocytes lifetime, incomplete liver function excessive concentration: damage of brain (kernicetrus)


TherapyNeonatal jaundice (icterus)

phototherapy: treatment with blue light (400‐500 nm)photoisomerisation of bilirubin: water soluble product

fluorescent lamp or LED with max. ≈ 450 nm


TherapyIR‐Therapytreatment of several diseases with IR‐A radiation (780 – 1400 nm):muscle pain, ankylosis, blood flow disorder, distortion, haematoma, chronic bronchitis, sinusitis, several allergies & dermatologic diseases(contraindication: acute inflammation)

‐ analgesic, anti‐inflammatory: increase of circulation (T > 37 °C)

IR‐A radiation: penetration depth 5‐6 mm skin

15 – 30 min


TherapyPhototherapy: skin diseases

• Psoriasis

‐ inflammatory, chronic dermatosis‐ scurfs, itching‐ scalp, elbows, knees‐ 2 % of all light‐skinned people‐ incurable


TherapyPhototherapy: Psoriasis

• PUVA (photochemotherapy, Psoralens + UVA)

UV‐sensitizing psoralens: e.g. 8‐MOP (8‐Methoxypsoralen)drug: oral or topically (creme)

fluorescent lamps e.g. Philips TL/09 lamps (broad band, λ 350

side effects: e.g. skin ageing, danger of skin burns, increased risk of skin cancer (e.g. malignant melanoma)


TherapyPhototherapy: Psoriasis• broatband or narrowband UVB phototherapy

optimum: 305‐315 nm, right dose

fluorescent lamps: e.g. TL/01 UVB Narrowband or TL/12 UVB Broadband

side effects: erythema (less for narroband therapy), skin ageing and dryness


Source: Philips Lighting

TherapyPhototherapy: broatband or narrowband UVB phototherapy

• Vitiligo (NB UVB)autoimmune diseasedestruction of melanocytes

• Pruritus

• Atopic dermatitis


TherapyPhototherapy: skin diseases

• Neurodermatitis (atopic eczema)

‐ chronic skin disease‐ red eczemas, scurfs (weeping)‐ itching‐ incurable


TherapyPhototherapy: Neurodermatitis (atopic eczema)

additional therapy

UVA and/or UVB therapy: 300 – 400 nm

narrowband UVB therapy (311 nm): presumed safety(‐> children therapy possible)

‐ anti‐inflammatory effect‐ fluorescent lamps


Therapy• Acne treatment

Acne vulgaris = inflammation of skin glands and hair follicles

Several studies about positive effects of (UVA, UVB and) VIS radiation (415 nm + 660 nm)

low intensity fluorescent lamps


TherapyLASER in medicine (Light Amplification by Stimulated Emission of Radiation)

coagulation, operate, ablation

• opthalmology (e.g. glaucoma; LASIK )

• dermatology (e.g. naevus flammeus, tattoo excision)

• treatment of tumors (e.g. in gastroenterology, pulmology, ENT, neurosurgery)

Ar‐Ion‐Laser (488nm or 514 nm), Nd:YAG‐Laser (1064 nm), CO2‐Laser (10,6 µm)


Further Applications

• DesinfectionLow pressure mercury lamps: TUV (tubular germicidal lamps)

(UV transmissive glass, no phosphor layer)

UVC: 95 % energy emission in 254 nm Hg linemaxiumum for DNA absorption: 265 nm

inactivation of micro‐organisms

alternative for chemical desinfection (e.g. chlorine)


Further Applications

• Desinfection

desinfection drinking & waste water air (ultra clean air) laboratories

danger:‐ O3 formation‐ skin damage, eye damage

skin cancer, blindess


References• Script: Incoherent light sources, Prof. Dr. T. Jüstel, FH Münster• http://www.klausmoeller.net/lernen/farbenlehre/_img/spektrum.png• http://www.nobelprize.org/nobel_prizes/medicine/laureates/1903/finsen‐facts.html• http://www.aerzteblatt.de/nachrichten/53921/Nuklearmediziner‐warnen‐vor‐Vitamin‐D‐Mangel• https://www.aok.de/bundesweit/gesundheit/behandlung‐nichtmedikamentoese‐und‐alternative‐

therapien‐heliotherapie‐8100.php• https://www.micro‐shop.zeiss.com• https://www.doccheckshop.de/Klinik/Diagnostikleuchten/DocCheck‐Penlight‐LED‐Diagnostikleuchte.html• https://www.karlstorz.com/cps/rde/xbcr/SID‐FDED8AF0‐

51271B10/karlstorz/2974480_2974480_2974480_6.pdf• http://www2.hs‐esslingen.de/~johiller/pulsoximetrie/prinzip.htm• ftp://ftp.lrz‐muenchen.de/pub/local/tu‐

muenchen/VL_Biosignalverarbeitung/VL_5_SS_2008__Pulsoximetry.pdf• http://www.aerzteblatt.de/archiv/literatur?id=81074#nr5• http://www.ptt.ruhr‐uni‐bochum.de/forschung/projekte/Optische_Kohaerenztomographie/• http://www.izfp‐d.fraunhofer.de/assets/downloads/oct.pdf• Terman M, Terman JS. CNS Spect. Vol 10, No 8. 2005• http://www.apotheken‐umschau.de/Depression/Lichttherapie‐bei‐Depressionen‐192791.html• http://www.augenklinik‐tausendfensterhaus.de/html/oct.html


References• https://www.fh‐muenster.de/fb1/personal/professoren/juestel/LISA.php• https://www.fh‐muenster.de/fb1/personal/professoren/juestel/pisa.php• http://www.lighting.philips.com/pwc_li/main/application_areas/assets/phototheraphy/phototherapy_tre

atment.pdf• http://emedicine.medscape.com/article/178841‐overview• http://www.baby‐und‐familie.de/Neugeborenengelbsucht• http://criglernajjar.altervista.org/PhotoIsomer.gif• http://www.pharmazeutische‐zeitung.de/index.php?id=1406• http://www.derma.de/fileadmin/derma/pdfs/photoptherapie07.pdf• P.Reiter, Optik&Photonik 1, 2009, LED Lichtquellen in der Medizin• http://www.optomed.com/fundus+camera2/• http://www.uni‐duesseldorf.de/WWW/MedFak/LaserMedizin/Laserkurs/skript/Kapitel4.PDF• www.wikipedia.de/www.wikipedia.com



Medical Light Sources for Diagnostic and Therapy

Robert Brüninghoff07.05.2014

Back‐up

• OCT: Interferometer


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Medical Light Sources for Diagnostic and Therapy(Robert ... · Medical Light Sources for Diagnostic and Therapy Robert Brüninghoff 07.05.2014. Overview • Introduction ... Neonatal