Clinical In-Service Training - Testmart
High SpeedClinical In-Service TrainingUPDATE v.24 March 2010PB-1076090 A
Clinical In-Service TrainingAgendaLaser SafetyLaser Tissue InteractionLaser Operations – Platform & HandpiecesClinical Protocols - LHR & PFBLumenis & You – A Partnership for SuccessQuestions?2
Laser Safety
ANSI Laser ClassificationsANSI LaserClassificationLaser SafetyDescriptionExamplesClass IGenerally do not pose a hazard(i.e., CD, DVD)Class IIGenerally do not pose a hazardunless viewed directly forextended period of time(i.e., checkoutscanners)Class IIIaGenerally pose low hazard risk(i.e., laser pointers)Class IIIbCan produce hazard if vieweddirectly(i.e., low wattage eyelasers)Class IVCan produce hazard fromdirect or specular reflection –also pose skin hazards(i.e., most medicallasers)ANSI: American National Standards Institute.4
Laser SafetyLSO Establishes ControlsEvery facility must have a LaserSafety Officer (LSO) appointedAdministrative ControlsDocumentation, trainingprograms, etc.Procedural ControlsPolicies, Safety Glasses, Signs,etc.Engineering Controls (by Mfg)Interlocks, standby, emissionindicators5LSO: Laser SafetyOfficer
LSO Verifies DocumentationLaser SafetyFacility LSO is responsible for Laser Log, toinclude (not limited to):System and Equipment AuditsLaser Maintenance RecordsSafety AuditsEducation – Initial and On-goingCompetency – Skills Check Lists6
NHZ: Nominal Hazard ZoneLaser SafetyNHZ is the actual area (boundary) where someonecould be injured by the laser beamANSI Laser Standards state that the entire room isthe NHZNHZ depends on factors such as:WavelengthPowerSpot Size and Divergence AnglesExposure TimeMPE (maximum permissible exposure)7
Verify Proper Eye ProtectionLaser SafetyEnsure all persons in treatment room are wearingprotective eyewearOD 5, wavelength 790–830 nmIf patient‘s face is treated they must wearopaque or metal eye goggles or shieldsLaser beam can cause severe retinal injuryDo not treat within bony orbit of eyeDo not treat eyebrows or eyelashesOcular Hazard Zone:164 feet / 50 mLaser light focused by the lens of the eye ontoretina has a high fluence8
Protective Eyewear RequiredLaser SafetyOperator Glasses:OD 5 for 800 nmwavelengthPatient Gogglesor Shields:Opaque or metal9
Calibration for LightSheer ET & HSLaser SafetyCalibration is required:At start up, when system is first turned onWhen new handpiece is attachedAfter 25,000 pulses in one ‗power on‘ sessionCalibration is recommended prior to the startof each treatmentVerify port is clean and handpiece is properlyseated prior to calibrationTo ensure accuracy of calibrationTo avoid damage to calibration port10
Calibration InstructionsLaser SafetyRemove the handpiece and reinsert into thecalibration portVerify hp is perpendicular to port and not seated at anangle; improves accuracy, avoids damageTouch screen prompts, follow each stepPress enable button on handpiecePress and hold trigger until calibration complete11
‗Vacuum Purge‘ for LightSheer HSVacuum Purge is required:At start up and before anytreatmentsTo ensure proper functionof vacuum assist technologyVacuum Purge is alsorecommended as neededbetween treatmentsTo clear system and preventbuild up of debris12Laser SafetyUpgrade planned for Q2 2010 will includea reminder screen for system operators.
‗Vacuum Purge‘ InstructionsSelect‗Utility‘ on Main Screen‗System Operating Tools‘ on UtilityMenu‗Vacuum Purge‘ on System ToolsScreenFollow on screen instructions untilpurge is complete.13Laser Safety
General Safety GuidelinesLaser Safety‗Laser in Use‘ warning sign on doorPair of operator glasses outside of doorEnclosed room with opaque fire resistantwindow coveringsAllow any flammable liquids used for cleaningthe skin to fully evaporate before treatmentHave a fire extinguisher availableWater must be available (e.g., running or inbowl)14
Laser Classification & StandardsLaser SafetyLightSheer Duet classificationClass IV laser by Center for Devices andRadiological Health (CDRH)Class 4 laser by European Standard(EN 60825-1)Follow ANSI, OSHA, European standardsContact Laser Institute of America (LIA)(800) 34LASER for current ANSI and OSHAstandardshttp://www.laserinstitute.orgi.e., ANSI Z136.3, ANSI Z136.1 and EN 207ANSI: American National Standards Institute15
Laser Tissue Interaction
Permanent Hair Reduction DefinedLaser Tissue InteractionHair growth has three phasesAnagen (active/growth)Catagen (transition/regression)Telogen (resting)Growth cycleDepends on body partLasts anywhere from 4 to 12 monthsHair reduction is considered permanent when asignificant amount of hair does not return forlonger than the complete growth cycle17
How Does It Work?Laser Tissue InteractionBased on the theory of SelectivePhotothermolysisThe target chromophore is melaninPresent in the hair shaftAlso present in the upperthird of the follicular epitheliumHeat generated in the hair shaftdiffuses to the follicular epitheliumto cause the damage that is desired18
Goal is to Damage Hair to Kill PointA normal follicleLaser Tissue InteractionA damaged follicle19
Pulse Width ConsiderationsLaser Tissue InteractionPW must be equal to or shorter than Thermal Relaxation Time(TRT) of the target (hair follicle) to confine thermal damageDepends on hair diameter (i.e., fine vs. coarse)PW must be matched with appropriate amount of fluence to causefollicular damage while sparing surrounding tissueDepends on melanin content in skin vs. surrounding tissueNote: maximum tolerated fluence is generally inverselyproportional to melanin content in skin for a given pulse widthIn general,Treat fine/thin hair, lighter skin types with shorter pwsTreat coarse/dense hair, darker skin types with longer pws20
Laser OperationLightSheer Duet Platform
Main Screen with Two Options22LS ET & LS HS
Two Distinct Handpieces: ET & HSLightSheer ETIntroductionLightSheer HS9 X 9 mm treatment area10 -100 J/cm25 - 400 msec pulse widthsChillTip coolingFull LS ET functionalityField replaceable22 X 35 mm treatment areaUp to 12 J/cm230 - 400 msec pulse widthsVacuum Assist technologyGreater Speed, ComfortField replaceable23
LS ET & LS HSUser Friendly InterfaceLightSheer HSLightSheer ETHS Treatment ScreenET Treatment Screen24
Laser OperationLightSheer ET Handpiece
How to Operate the HandpieceLightSheer ETPress enable buttonPosition tip onpatient‘s skin,apply light pressureDepress pulse triggerto begin treatment26
Higher Fluence & Contact CoolingLightSheer ETLightSheer ET Handpiece delivers up to 100 J/cm2with 5-400 ms pulse durations & Contact CoolingContact Cooling with ChillTip reduces temperatureCompressionReduces competing chromophore, oxyhemoglobinBlanches vessels, eliminates energy lost into this targetRotates follicle closer to surface, so laser light hits broadside,penetrates deeper into the hair shaftMelanin in follicle is heated to point of thermal damage27
Clinical Indications: Starting PresetsLightSheer ETUserPresetsLumenisPresets28
Clinical Indications: Saving PresetsLightSheer ETUser pre-setsSave user pre-setSample of Saved User Preset29
Treatment Parameters: GUI SettingsLightSheer ETSelect: Rate (Hz), OptiPulse (ms), Fluence (J/cm2)ResetPulseCounterVerify inReady ModeVerify ChillTip(Blue is ON)30NOTE: CHILLTIP MUST REMAIN ON DURINGLASER HAIR REMOVAL TREATMENT.
Treatment Parameters: What to Select LightSheer ETRate (Hz)Fast (1—3 Hz), Med (0.5—1 Hz), Slow(0.5 Hz)Rate will adjust based on pulse duration andfluence; maximum rate is 3 HzFluence (J/cm2)AUTO, 30 ms and 100 ms will allow up to 60 J/cm²400 ms pulse duration will allow up to 100 J/cm²The highest tolerable fluence will provide thegreatest efficacyHigher fluence Higher risk, perform test spotsand titrate carefully31
Treatment Parameters: What to Select LightSheer ETPulse Width (ms)Auto: 1/2 fluence rate, 5 ms to 30 ms; provides the highestefficacy for fair skin, shallow/fine hair30ms: deeper, terminal / coarse hair100-400ms: darker skin types, tanned skin, dense hairTip CounterCounts total pulses on handpiece and pertreatmentDuring treatment, the system operatormust visually check tip every 50-100pulses and keep tip clean at all timesPulse counter will produce a warningmessage after 1000 pulses to check tipand clean if necessary (a reminder only)Press ‗ok‘ to continue treatment32
Before Treatment: Perform Test SpotsLightSheer ETPrep skinRecommend patient shave area to be treated day beforeprocedure; clinician to verify prior to treatmentApply gel if desiredAvoid contact between laser tip and any areas of blood fromshavingPress enable buttonPosition tip on patient‘s skin, apply moderatepressureDepress pulse trigger to begin treatmentPerform test spotWait and observe tissue responseSee ‗Clinical Protocols‘ for additional detail33
Handpiece Placement: How to MoveLightSheer ET―Pick and Place‖ TechniquePlace on skin, pulse laser, release trigger,handpiece is then picked up from skin, moved tothe next treatment area, and lowered against theskin―Bounce & Glide‖ TechniquePlace on skin, hold trigger in ON position, the tipis kept continuously in contact with the skin andbounced along skin tissue in cadence with theaudible beep that signifies firing of laserDo not remove laser tip from skin surface whenusing this technique34
During Treatment: Safety GuidelinesLightSheer ETCheck if ChillTip is activatedPhysically touch the tip to check for cooling beforetreating patientChillTip must be cleaned oftenSinged hair can collect on tip causing excessiveheatingCan occur after several pulses or up to one full run,depending on the amount of hair extrusionVisually check the tip for any debris every 50-100pulses, without looking directly into tipClean more frequently in areas of high hair density‗Warning‘ after 1000 pulses only serves as a reminder35
Handpiece ChillTip: How to CleanLightSheer ETCleaning should be performed with gauzepads moistened with distilled water or a mildalcohol solutionCaution: While operating the LightSheer system, never look directly intothe laser aperture at the distal end of the handpiece, even if you arewearing laser safety glasses. Serious eye injury or blindness could result.36
Laser OperationLightSheer HS (High Speed) Handpiece
Enables Treatment Speed & ComfortLightSheer HS‗High Speed‘ handpiece22 mm x 35mm spot sizeVacuum Assist technologyEnhances light absorptionImproves treatment comfortDisposable tip / insert protects VA technologyReplace disposable insert between patientsAlso replace during treatment if insert or filtersbecome dirty/cloggedDo not use treatment gel with ‗HS‘ hp38
How to Operate the HandpieceLightSheer HSEnsure new, clean insert in HS handpiece prior to treatmentPress ENABLE buttonPosition HS opening on patient‘s skinObtain vacuum contactPress and hold trigger for desired pulsesMove to next treatment spotNote: A fine mist of mineral spring water may be applied to skin priorto treatment to maximize patient comfort39
Lower Fluence & Vacuum AssistLightSheer HSHS Handpiece delivers up to 12 J/cm2and 30-400 ms pulse durations with Vacuum AssistVacuum assist technology gentlypulls skin up into handpiece. Skinsenses vacuum pressure instead oflaser pulse.Skin is stretched thin. Hair is pulledcloser to energy source.Density of melanocytes in skin isreduced. Less energy will beabsorbed by the epidermis.Vacuum pressure temporarilycompresses tissue and surroundingvessels.Blood is temporarily displaced. Lessenergy will be absorbed byoxyhemoglobin.Less energy is lost to competingchromophores. More photons areable to reach target melanin in hair,which absorbs the energy.Heat builds up, damages hairfollicle and its ability to regrow.40
Clinical Indications: Starting PresetsLightSheer HSUserPresetsLumenisPresets41
Clinical Indications: Saving PresetsLightSheer HSUser pre-setsSave user pre-setSample of Saved User Preset42
Treatment Parameters: GUI SettingsLightSheer HSSelect: No. of Pulses, Vacuum, OptiPulse (ms), Fluence (J/cm2)ResetPulseCounterVerify inReady ModeVerify Vacuum(Green is ON)43
Treatment Parameters: What to SelectLightSheer HSNumber of Pulses (pulse stacking)User selects number of pulses emitted per triggerpressRecommend beginning with one pulseThe additional pulses will emit additional energiesand should only be increased with cautionIf desired clinical endpoints are not reached usingsingle pulse at max. fluence, move to pulse stackingand repeat test spot procedure at fluence level 2J/cm2 lower, then titrate as neededTrigger needs to be held through multiple pulsesAdditional pulses will extend treatment time44
Treatment Parameters: What to SelectLightSheer HSVacuum LevelHigh (18 inHg)Medium (12 inHg)Low (8 inHg)Pulse Duration (ms)30 ms: Fastest Pulse Duration Fluence max 6 JCustom: Most common setting, automatic PDselection30-70 ms based on fluence level selectedActual will be indicated at column bottom100 ms: Darker skin types and tans400 ms: Darker skin types and tans45
Treatment Parameters: What to SelectLightSheer HSFluence4.5 - 6 J/cm²When 30 ms pulse duration is selected4.5 - 12J/cm²When Custom (30-70ms);100 ms;400 ms pulse durations areselectedTip CounterCounts total pulses on handpiece and pertreatmentDuring treatment, the system operator mustvisually check insert frequently (e.g., every5-10 pulses) and keep clean at all timesPulse counter will produce a warningmessage after 500 pulses to check tip/insertand clean if necessary (as a reminder only)press OK to continue treatment46
Before Treatment: Perform Test SpotsLightSheer HSPrep skin: shave to skin surface, clean skinPress ENABLE buttonPosition handpiece on patient‘s skinDepress pulse trigger to begin treatmentPerform test spotObserve laser tissue interactionWait and observe tissue responseSee ‗Clinical Protocols‘ for additional details47
Handpiece Coverage: How to Move48LightSheer HS
During Treatment: Safety GuidelinesLightSheer HSKeep the diode window and disposable insert clean atall times during treatmentWhenever you see any contamination on the windowsurface:using lint free gauze pad moistened with alcohol,clean the HS handpiece windowand then clean with dry gauze padFrequently observe disposable insert for damage andreplace it if necessary49
Laser OperationHS Handpiece & Disposable InsertCare Guidelines
HS Handpiece & Disposable InsertNEW disposable insert withglass window designed to beeasier to clean and last longerper treatmentProduct UpdateNEW Disposable Insert(with glass window; available)Released in March 2010;available NOWFORMER disposable insert withall plastic designNo longer sold; replaced withNEW insert aboveFORMER Disposable Insert(all plastic; obsolete)
HS Handpiece & Disposable Insert CareCautionDebris or particles, including fingerprints, adheringto the inside of the disposable insert duringapplication of energy could lead to absorption oflight and overheating and/or burning of thedisposable insert.FORMER Disposable w/all plastic :NEW Disposable w/glass window:Sample after approx. 2000 laser pulses.Easier to clean; last longer per treatment.This product is no longer sold; obsolete.52
HS Handpiece & Disposable Insert CareCautionUse of the LightSheer Duet with a damageddisposable insert can damage your HS handpieceand compromise treatment quality.‗Damaged‘ sample of former disposable w/all plastic;no longer sold, obsolete.53
HS Handpiece & Diode Window CarePre-TreatmentPre-treatment RequirementsThoroughly shave and clean the treatment area toremove any pieces of hair or other debris.While the system is OFF, inspect the handpiece.The diode window should be clean and free ofdebris.54
HS Handpiece & Diode Window CareCautionIF THE DIODE GLASS WINDOW IS NOT CLEANRemove disposable insert using outer edge/lipCaution: when removing disposable insert with glass window afterfiring the laser, DO NOT TOUCH the backside that faces diodewindow; insert bottom backside will get very HOT after firing thelaser.Clean the diode window with lint-free gauze moistened withalcohol solution.Then wipe clean with a dry gauze pad to remove anyfingerprints, stray hairs or debris.55
HS Handpiece & Disposable Insert Care Pre-TreatmentInsert a new and clean disposable insert with agloved hand (note: use powder-less gloves).Avoid creating fingerprints or having debriscontaminate the insert.How to InsertNote: ‘Disposable tip’ in photo same as ‘disposable insert’.56
HS Handpiece & Disposable Insert CareDuring TxDuring TreatmentFrequently observe the disposable insert for debris or damage– more often when treating coarse hair.Throughout the treatment, check the disposable insert every5-10 pulses. Wipe away any contamination with a dry gauze.If the dry gauze does not clean the insert, clean with alcoholmoistened gauze.If any discoloration or debris is observed on the disposableinsert, clean with alcohol and then wipe with dry gauze.Caution: While operatingthe LightSheer system,never look directly into thelaser aperture at the distalend of the handpiece, evenif you are wearing lasersafety glasses. Serious eyeinjury or blindness couldresult.57
HS Handpiece & Disposable Insert CareDuring TxDuring Treatment (continued)After firing the laser, if smoke is visible, or whiteflash is seen, check the disposable insert andclean again or change as necessary.If the disposable insert cannot be completelycleaned with alcohol, discard and insert a newone.Caution: when removing the disposable insert withglass window after firing the laser, use outer edge/lip;DO NOT TOUCH the backside that faces diode windowas this will get very HOT after firing the laser.58
HS Handpiece & Disposable Insert CareCautionWhite Flash Stop & Replace InsertIf during treatment the clinician sees a bright white flash fromthe handpiece, the disposable insert* should be replacedimmediately.Caution: when removing the disposable insert with glass window afterfiring the laser, use outer edge/lip; DO NOT TOUCH the backside thatfaces diode window as this will get very HOT after firing the laser.A. Red Flash – NORMALB. White Flash – REPLACE INSERT*For Demonstration purposes only.Do not attempt.59
HS Handpiece & Disposable Insert CareB. Contaminated Inserts – CLEANA. Clean Inserts – USEC. Burned Insert - REPLACEOverviewD. Burned Insert - REPLACENote: C & D above are ‗damaged‘ samples of former/obsolete disposable (all plastic);no longer sold and replaced with new disposable insert (w/glass window).60
HS Handpiece & Diode Window CareOverviewA. Diode Window isCLEAN: Ready to UseB. Diode Window is DIRTY:Clean prior to UseC. Clean Diode Window: withalcohol moistened cotton61
HS Handpiece & Diode Window CareContact ServiceIF Diode Window Can NOT Be CleanedDO NOT USECALL Customer ServiceIn the US: 1-877-LUMENISOutside the US: contact your local service representative.62
HS Handpiece & Disposable Insert Care Post TreatmentPost TreatmentDispose of the insert after each patient treatment.Caution: when removing the disposable insert with glasswindow after firing the laser, use outer edge/lip; DO NOTTOUCH the backside that faces diode window as this will getvery HOT after firing the laser.Apply a new and clean insert into headpiece andplace in system holster / cradle.A. Use edge/lip to removeB. New Insert for next treatment63
Clinical ProtocolsLaser Hair Removal
Manage Patient ExpectationsPrior to TxNo two patients are alike, treatmentoutcome cannot always be predictedNever promise 100% reductionClearly define permanent hair reductionDescribe need for multiple treatmentsMultiple treatments are required (e.g., avg. 5-7)For darker skin types IV-VI, more treatmentsmay be needed (e.g., can be as many as 12)Discuss possible side effects and obtain signedpatient consent65
Pre Treatment GuidelinesRecommendedTake baseline photographsRecommend patient shave area to be treated day beforeprocedure (clinician to verify prior to treatment)Avoid contact between laser tip and any area of blood from shaving skinClean skin surface to remove any hair debrisNote: a lint roller may be helpful to remove hair particles, debris; then wipeskin w/alcohol solution to remove tackinessPerform test spot, wait 15 – 30 minutes for skin types I - IV; allowAT LEAST 48 hours for skin types V-VI to observe skin responsebefore conducting treatmentUse topical anesthetic if desirede.g., ET hp with higher fluence over longer treatments, or very sensitive areaseither hpApply prior to treatment, following prescription guidelines; and completelyremove before treatmentOptional: use caution if marking area treated with pencil, avoidany pigment (i.e., use white, not black)66
Patient Consultation & SelectionTo ConsiderObtain complete patient historyManage patient‘s expectationsDiscuss number of treatmentsDiscuss contraindicationsDiscuss complications & possible side effectsRecord clinical indicationsSkin typeHair colorHair densityHair diameter67
Patient Skin TypesTo ConsiderLightSheer is cleared to treat all skin types(Fitzpatrick I-VI), including tanned skinRefer to physician recommended treatmentparameters (e.g., presets)Use added caution with darker skin typesAvoid treating patients with recent or lengthyexposure to sun or artificial UV lightDO NOT TREAT patients with artificial tan on skinPerform the recommended test spot protocolbefore treatment to verify the appropriateparameter settings68
Fitzpatrick Scale Skin TypingSkin TypeTo ConsiderGenetic DispositionReaction to Sun,Tanning HabitsIWhite; very fair; red or blond hair; blueeyes; frecklesAlways burns,never tansIIWhite; fair; red or blond hair; blue, hazelor green eyesUsually burns,tans with difficultyIIICream white; fair with any eye or haircolor; very commonSometimes mildburn, gradually tansIVBrown; typical Mediterranean CaucasianskinRarely burns,tans with easeVDarker Brown; Middle Eastern skin types;(Non-Caucasian skin)Very rarely burns,tans very easilyVIBlackNever burns,tans very easilySource: Fitzpatrick TB: Soleil et peau. J Med Esthet 1975;2:33034.69
Fitzpatrick Skin Typing w/Updates*Skin TypeTo ConsiderGenetic DispositionReaction to Sun, Tanning HabitsIWhite; very fair; red or blond hair; blue eyes;frecklesAlways burns,never tansIIWhite; fair; red or blond hair; blue, hazel orgreen eyesAlways or Usually burns,tans with difficulty, tan fades rapidlyIIICream white; fair with any eye or hair color; verycommonSometimes mild burn, always or usuallytans, tan stays for weeksIVBrown; typical Mediterranean Caucasian skin;moderately pigmented and may include Asian,Middle Eastern, Indian, HispanicRarely burns,tans with ease, tan stays for monthsVDarker Brown; Middle Eastern skin types; darkerskin type and may include Asian, Middle Eastern,Indian, Hispanic, Mediterranean (Non Caucasian)Very rarely burns,tans very easilyVIDarkest Brown, Black; (Non Caucasian)Never burns,tans very easily*Note: Lumenis recommends conservative approach to darker skin types IV-VI; perform test spots & wait; then adjustparameters to optimize treatment. If uncertain about skin type IV, approach as if skin type V for test spots to verify.70
Patient Hair Diameter & ColorTo ConsiderPigmented HairBlack, brown, red, dark blonde can achieve longlasting resultsLight blonde or white can experience temporaryloss for up to 3 monthsRecommend electrolysis as a treatment forpermanent removal of discrete white hairTerminal hair, not vellous (short, fine lightcolored hairs)Lumenis does not recommend treating hair that islighter than surrounding tissue71
To ConsiderHair Growth Cycle DurationRichards-Meharg TableAREA OF BODYScalpBeard/ChinUpper LipEyebrowsEarLegsArmsAxillaPubicANAGEN2-6 Years52 weeks16 Weeks4-8 Weeks4-8 Weeks24 Weeks18 Weeks4 Months3 MonthsTELOGEN3-4 Months10 Weeks6 Weeks3 Months3 Months16 Weeks13 Weeks3 Months4 MonthsNote: Other hair cycle duration tables are in use and vary,but show similar variance per anatomical site.72
Caution AdvisedClinical ContraindicationsActive infection in the treatment areaActive infection or a history of herpes simplex in thearea to be treatedUse of oral Isotretinoin (e.g., Accutane, others)within the preceding 6 monthsHistory of keloid formationsHistory of livedo reticularis, an autoimmune vasculardiseaseHypersensitivity at the treatment site to any agents,solutions, or gel used in the treatment, if noalternative existsUse of anticoagulants before the washout period, perpackage insert, and at the physician‘s discretionPatient with personal history of melanoma must firstpass a skin screen (of area to be treated) by alicensed dermatologist prior to treatment73
Clinical Contraindications (cont‘d.)Caution AdvisedDysplastic nevi in the area to be treatedHistory of bleeding disordersHistory of collagen, vascular or immunosuppressiondisordersTattoos at the treatment sites: stay more than ¼inch away from tattoo borderSignificant concurrent skin conditions affecting areasto be treated or any inflammatory skin conditionsActive cold sores, open lacerations or abrasions onthe area to be treatedHistory of immune deficiency (including HIV infectionor AIDS)74
Related ContraindicationsCaution AdvisedHistory of erythema ab igne; an acquired persistentreticulated erythematous and pigmented rash of theskin produced by prolonged or repeated exposure tomoderately intense heat of infrared radiationUse of depilatories or other hair removal treatments(i.e., waxing, plucking, tweezing, or electrolysis) inthe treatment area within the preceding 6 weeksChronic or cutaneous viral, fungal, or bacterialinfections in the treatment areaPhotosensitivity disorder that can be exacerbated byinfrared lightHistory of skin cancer or pre-cancerous lesions at thetreatment sitesUse of medications, herbal supplements, perfumes orcosmetics that may affect sensitivity to light75
Complications & Possible Side EffectsCaution AdvisedErythema, edema and perifollicular edema may occurimmediately after treatment and typically resolve in afew daysHypo- or Hyperpigmentation rare and usually transient;usually resolves in a few months; fluence and skin typedependentIrritation, itching, burning sensation or discomfortduring or following treatment may occurSuperficial erosions of the treated area may be visibleafter laser treatmentBurns, crusting and blistering of the treated areaTransient exacerbation of hair growthPurpura confined to the exposure area may be evidentfor several days following treatment76
Complications & Possible Side EffectsCaution AdvisedErythema ab igne, which is the development of anacquired persistent reticulated erythematous andpigmented rash of the skin produced by prolonged orrepeated exposure to moderately intense heat ofinfrared radiationPruritis may occur in rare casesContact dermatitis or irritant dermatitis may occur insome casesInfection at the treatment siteMild to moderate pain may occur during or aftertreatmentAs with the use of any laser scarring is a possibility,but rare77
In the Event of Serious InjuryContact UsCAUTION is advised when treating patientswith any of the listed contraindications.In the event of adverse outcomes, CONTACTLUMENISIn the US @ 1-877-LUMENIS (586-3647)Outside the US, contact your localCustomer Support, Sales, and Servicerepresentative78
Positive Clinical End PointsLS ET / LS HSSmell or visualize singed hairHair from follicle ejected or vaporizedSinged hair on skin or in disposable tip (HS only)Gel becomes brownish from singed hairs (ET only)Odor of singed hair presentPerifollicular edema and erythemaMay be Mild (HS hp) to Moderate (ET hp)79
Positive Clinical End PointsLS ET ResultsPerifollicular erythemaInitial redness from ChillTip and pressureErythema around treated hair increasesafter a few minutes80
Positive Clinical End PointsLS ET ResultsPerifollicular edemaSwelling around the follicle (bumps)several minutes after treatment81
Positive Clinical End PointsLS HS ResultsWhen using LightSheer HS hp, lowerfluence is used and laser energy lost tocompeting chromophores is minimizedTherefore, LightSheer HS tissue response(i.e., edema and erythema) may be mild incomparison to the patient‘s previousexperienceProactively counsel patients to expectmilder response to minimize any potentialconcern82
L/R Comparison of Clinical EndpointsLS HS / LS ETImmediate ReactionLightSheer HS hp(8-11 j/cm2, custom)LightSheer ET hp(34-38j/cm2, auto-30ms)Courtesy of Girish Munavalli, MD, MHS, FAAD83
Monitor Laser-Tissue InteractionDuring TxMonitor laser-tissue interaction throughouttreatment, adjust if and as neededSince no two patients are exactly alike, donot rely solely on written parametersClinical end-points that indicate fluenceand/or pulse width must be changed include:Skin grayingSkin separation84
Post-Treatment ConsiderationsTo RememberSunburned sensation is commonSuggest cool compresses, soothing cream orgel (i.e., aloe vera)Crusty spots may occurClean area 2 x daily with mild soapSunscreen for 6 weeks on treatment areaMay experience singed hair and sheddingprocess in days following85
The Treatment ofPseudofolliculitis Barbae
Pseudofolliculitis Barbae (PFB)DescriptionCommonly referred to as ‗razor bumps‘Medical term for persistent irritation due toshavingProblematic for men of African descent,others with curly hairInflammatory foreign body response to asharp hair shaft87
LightSheer Treatment of PFBSkin Types IV-VILightSheer ET Results ShownBefore TreatmentAfter TreatmentPhotos courtesy of Fran E. Cook-Bolden, MD88
Lumenis & You –A Partnership for Success
A Partnership for Success Over TimeLumenis & YouLumenis is Committed to Your Clinical SuccessIn office training by a Clinical Application SpecialistAdvanced training with preceptors, workshops andWebinarsLumenis is Committed to Your Practice SuccessLumenis Physician Portal for information andpractice building tools with
Mar 24, 2010 · 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 .
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Clinical Training and Placement Handbook Table of Contents I INTRODUCTION 5 1.0 Purpose of this Handbook 5 1.1 Students' Personal Preparation 5 II FRAMEWORK FOR PROGRAM AND CLINICAL TRAINING EXPERIENCE 6 2.0 What is the Clinical Training Experience 6 2.1 Systemic/Relational Base for Training 6
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The clinical audit engages with clinical and non-clinical stakeholders. 4.1 Where possible, clinical audit should review the practice of all clinical disciplines in the service unit or team whose work is relevant to the audit topic area. Most healthcare practice happens in teams with various disciplines and
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