In the last decade, cutaneous carotenoid measurements have become increasingly popular, as carotenoids were found to be a biomarker of nutrition rich in fruits and vegetables, permitting monitoring of the influence of various stress factors. For such measurements, in addition to the specific and selective resonance Raman spectroscopy (RRS), newly developed low expensive small and mobile sensors that are based on spatially resolved reflectance spectroscopy (SRRS) are used for cutaneous carotenoid measurements. Human volunteers of different age exhibiting skin types I to III were investigated using RRS and two SRRS-based sensors to determine the influence of these parameters on the measuring results. In two studies on volunteers of either the same age or skin type, however, the respective other parameter being varied and no significant influences of age or skin type could be detected. Furthermore, the kinetic changes resulting from the intake and discontinued intake of a vegetable extract rich in carotenoids showed a good correlation among the three sensors and with the detected blood carotenoids. This illustrates that the SRRS-based sensors and RRS device provide reliable cutaneous carotenoid values independent of age and skin types I to III of the volunteers.
This article [J. Biomed. Opt.. 19, (2 ), 027007 (2014)] was originally published online on 18 February 2014 with an error in the abstract. The values for highest sensitivity and specificity were stated to be 91% and 81%, respectively, but these were based on an earlier data analysis. The correct values were reported in the body of the paper. The values in the abstract have been corrected to align with those reported in the body of the paper, which are 89% for sensitivity and 86% for specificity.
This article was corrected online on 14 March 2014.
Raman spectroscopy based discrimination of cervical precancer and normal tissue has been shown previously in vivo with fiber probe based measurements of colposcopically selected sites. With a view to developing in vivo large area imaging, macro raster scans of native cervical cone biopsies with an average of 200 spectra per sample are implemented (n=16 ). The diagnostic performance is evaluated using histopathological mapping of the cervix surface. Different data reduction and classification methods (principal component analysis, wavelets, k-nearest neighbors, logistic regression, partial least squares discriminant analysis) are compared. Using bootstrapping to estimate confidence intervals for sensitivity and specificity, it is concluded that differences among different spectra classification procedures are not significant. The classification performance is evaluated depending on the tissue pathologies included in the analysis using the average performance of different classification procedures. The highest sensitivity (89%) and specificity (86%) is obtained for the discrimination of normal squamous epithelium and high-grade precancer. When other non-high-grade tissue sites, such as columnar epithelium, metaplasia, and inflammation, are included, the diagnostic performance decreases.
A novel fiber probe for spatially resolved reflectance measurements is presented, which uses simultaneously
read-out spectrometers for each source-detector separation. Therefore, with this fiber probe and a Monte
Carlo simulation, it is possible to determine spectrally resolved absorption and reduced scattering coefficients
from various skinsites. The absolute calibration is done by using an integrating sphere but a phantom based
calibration procedure was undertaken to compare the results of different calibration techniques. For tissue
measurements, a standard SMA adaptor with a one inch diameter face can be used to provide a stable base for
placing the probe onto the tissue and the possibility to apply pressure. The evaluation process was carried out
by comparing the measured absorption and scattering of silicone and liquid phantoms to their reference
values, obtained by integrating sphere spectroscopy. In addition, preliminary skin measurements are
presented.
Chromophore concentrations from skin contain information about the blood parameters, for example
total hemoglobin content or antioxidant status of the skin. Deviations from the normal values of the
concentrations may indicate pathologies. As the chromophore concentrations are determined from skin
absorption coefficients, the optical absorption spectra of the isolated skin chromophores have to be
known in advance, enabling least squares fitting of the basis spectra to the skin absorption coefficient.
It could be shown that spectrally and spatially resolved reflectance in combination with a
determination of absorption and reduced scattering coefficients from a look-up table provides a means
for quantification of chromophores, although the accuracy largely depends on the tissue model. Good
qualitative results can also be obtained with the homogenous tissue model used here. For example, it
could be shown that the hemoglobin basis spectra determined from human whole blood and the pure
water absorption fit very well to the skin absorption coefficients, but the ex vivo carotene spectra does
not. Therefore it was examined how the carotene spectra change from ex vivo to in vivo. Interindividual
and interpositional variation of the optical parameters could also be evaluated using this method as
well as the dependence of determined optical parameters on the source-detector separation.
We present a new variant of a noncontact, oblique incidence spatially resolved reflectance setup. The continuously variable source detector separation enables adaptation to high and low albedo samples. Absorption (μa) and reduced scattering coefficients (μ′s) are determined in the wavelength range of 400-1000 nm using a lookup table, calculated by a Monte Carlo simulation of the light transport. The method is characterized by an silicone phantom study covering a wide parameter range 0.01 mm−1 ≤ μa ≤ 2.5 mm−1 and 0.2 mm−1 ≤ μ′s ≤ 10 mm−1, which includes the optical parameters of tissue in the visible and near infrared. The influence of the incident angle and the detection aperture on the simulated remission was examined. Using perpendicular incidence and 90-deg detection aperture in the Monte Carlo simulation in contrast to the experimental situation with 30-deg incidence and 4.6-deg detection aperture is shown to be valid for the parameter range μ′s > 1 mm−1 and μa < 1.2 mm−1. A Mie calculation is presented, showing that a decreasing reduced scattering coefficient for increasing absorption can be the consequence of real physics instead of cross talk.
Plasma osmolarity influences the volume and shape of red blood cells (RBCs). The volume change is inversely related to the hemoglobin concentration and as a consequence to the complex refractive index within the cell. These morphological changes can be linked to changes in the optical behavior of the cells. The optical parameters, absorption coefficient µa, scattering coefficient µs, and effective scattering phase function of red blood cells are investigated in dependence on osmolarity in the spectral range from 250 to 1100 nm. Integrating sphere measurements of light transmittance and reflectance in combination with inverse Monte-Carlo simulations are carried out for osmolarities from 225 to 400 mosmol/L. Osmolarity changes have a significant influence on the optical parameters, which can in part be explained by changes in the complex refractive index, cell shape, and cell volume. Spherical forms of RBCs induced by low osmolarity show reduced scattering effects compared to the normal RBC biconcave disk shape. Spinocytes, which are crenated erythrocytes induced by high osmolarity, show the highest scattering effects. Even only a 10% change in osmolarity has a drastic influence on the optical parameters, which appears to be of the same order as for 10% hematocrit and oxygen saturation changes.
Intrinsic Raman spectra of biological tissue are distorted by the influences of tissue absorption and scattering, which significantly challenge signal quantification. A combined Raman and spatially resolved reflectance setup is introduced to measure the absorption coefficient µa and the reduced scattering coefficient µ of the tissue, together with the Raman signals. The influence of µa and µ on the resonance Raman signal of -carotene is measured at 1524 cm−1 by tissue phantom measurements and Monte Carlo simulations for µa=0.01 to 10 mm−1 and µ=0.1 to 10 mm−1. Both methods show that the Raman signal drops roughly proportional to 1/µa for µa>0.2 mm−1 in the measurement geometry and that the influence of µ is weaker, but not negligible. Possible correction functions dependent on the elastic diffuse reflectance are investigated to correct the Raman signal for the influence of µa and µ, provided that µa and µ are measured as well. A correction function based on the Monte Carlo simulation of Raman signals is suggested as an alternative. Both approaches strongly reduce the turbidity-induced variation of the Raman signals and allow absolute Raman scattering coefficients to be determined.
Aesthetic restorations require dental restorative materials to have optical properties very similar to those of the teeth. A method is developed to this end to determine the optical parameters absorption coefficient µa, scattering coefficient µs, anisotropy factor g, and effective scattering coefficient µ of dental restorative materials. The method includes sample preparation and measurements of transmittance and reflectance in an integrating sphere spectrometer followed by inverse Monte Carlo simulations. Using this method the intrinsic optical parameters are determined for shade B2 of the light-activated composites TPH® Spectrum®, Esthet-X®, and the Ormocer® Definite® in the wavelength range 400 to 700 nm. By using the determined parameters µa, µs, and g together with an appropriate phase function, the reflectance of samples with 1-mm layer thickness and shade B2 could be predicted with a very high degree of accuracy using a forward Monte Carlo simulation. The color perception was calculated from the simulated reflectance according to the CIELAB system. We initiate the compilation of a data pool of optical parameters that in the future will enable calculation models to be used as a basis for optimization of the optical approximation of the natural tooth, and the composition of new materials and their production process.
An experimental set-up is presented for wavelength and spatially resolved reflectance measurements (SRR) via optical
fibers and imaging optics. In order to characterize the set-up, we made a set of silicone rubber phantoms with different
absorber and scatterer concentrations. The remission profiles gained from the phantoms are the input for a look-up table
(LUT) based "inverse Monte-Carlo simulation" to deduce absorption μa and reduced scattering coefficients μs'. As an independent method for determination of μa and μs' we also made measurements with an 'integrating sphere
spectrometer' (ISS). Our normalization procedure of the SRR measurements is presented and the validity of this method
is discussed.
Raman signals of biological tissues are distorted by the influence of tissue absorption and scattering properties, which
significantly challenges signal quantification. We investigated the influence of the tissue optical properties on the
resonance Raman signal of β-carotene with tissue phantom measurements and Monte Carlo simulations. Both methods
show that the Raman signal drops roughly proportional to 1/μa for absorption coefficients (μa) in the range of 0.1-4mm-1.
The influence of the reduced scattering coefficient in the range of 0.1-8mm-1 is less strong, but not negligible. We
introduce combined Raman and spatially resolved reflectance measurements to measure both Raman signals and tissue
optical properties. The optical properties were deduced from the spatially resolved reflectance measurements by a Monte
Carlo-based lookup table (LUT). For the signal correction we applied correction functions derived from the Monte Carlo
simulations. We corrected in vivo resonance Raman measurements of carotenoids in caucasian skin (n=9) with respect to
the mean optical properties of the group. The magnitude of the average correction effect was found to be 18±11% on the
minimal pigmented palm.
With a cardanically mounted micromirror a confocal laser scanning microscope for in vivo imaging was built. A
resolution of 0.6 μm laterally and 10 μm axially allows to image tissue and cells in good quality. Samples of skin and
adhered cells are imaged either in reflection or in fluorescence with an excitation wavelength of 682 nm. Fluorescence
of Indocyanine Green is detected in the wavelength range above 730 nm.
The intrinsic optical parameters absorption coefficient µa, scattering coefficient µs, anisotropy factor g, and effective scattering coefficient µ were determined for human red blood cell (RBC) suspensions of hematocrit 33.2% dependent on the oxygen saturation (SAT O2) in the wavelength range 250 to 2000 nm, including the range above 1100 nm, about which there are no data available in the literature. Integrating sphere measurements of light transmittance and reflectance in combination with inverse Monte Carlo simulation were carried out for SAT O2 levels of 100 and 0%. In the wavelength range up to 1200 nm, the absorption behavior is determined by the hemoglobin absorption. The spectral range above the cells' absorption shows no dependence on SAT O2 and approximates the absorption of water with values 20 to 30% below the respective values for water. Parameters µs and g are significantly influenced by the SAT O2-induced absorption changes. Above 600 nm, µs decreases continuously from values of 85 mm−1 to values of 30 mm−1 at 2000 nm. The anisotropy factor shows a slight decrease with wavelengths above 600 nm. In the spectral regions of 1450 and 1900 nm where water has local absorption maxima, g shows a significant decrease down to 0.85, whereas µ increases.
The intrinsic optical parameters—absorption coefficient µa, scattering coefficient µs, anisotropy factor g, and effective scattering coefficient µ—are determined for human red blood cells of hematocrit 42.1% dependent on the shear rate in the wavelength range 250 to 1100 nm. Integrating sphere measurements of light transmittance and reflectance in combination with inverse Monte-Carlo simulation are carried out for different wall shear rates between 0 and 1000 s−1. Randomly oriented cells show maximal µa, µs, and µ values. Cell alignment and elongation, as well as the Fahraeus effect at increasing shear rates, lead to an asymptotical decrease of these values. The anisotropy factor shows this behavior only below 600 nm, dependent on absorption; above 600 nm, g is almost independent of shear rate. The decrease of µ is inversely correlated with the hemoglobin absorption. Compared to randomly oriented cells, aggregation reduces all parameters by a different degree, depending on the hemoglobin absorption. It is possible to evaluate the influence of collective scattering phenomena, the absorption within the cell, and the cell shape.
Intestinal tumors exhibit cell surface properties that differ from neighboring healthy epithelia and thus allow tumor cell-specific
molecular targeting. Ganglioside GM1 is such a discriminatory target. Although expressed in the apical membrane
of all intestinal epithelial cells it is accessible for particle conjugated ligands on tumor cells only. In order to
exploit this phenomenon we want to develop a nanoparticulate optical contrast agent equipped with a peptidic GM1
binding ligand. For identification of ligand peptides a novel screening platform was devised where potential ganglioside
GM1-binding peptides are generated on glass capillary plates using microfluidic non-contact arraying techniques and
screened in situ for binding of fluorophor-labeled GM1. These three-dimensional supports are easy to handle and show better sensitivity than either flat glass or membrane supports because of their large inner surface and low interference
with readout systems. A custom fluorescence reader was designed to comply with the specific optical behaviour of
peptide arrays synthesized on microcapillary plates. This reader uses a small numerical aperture for excitation and a large
numerical aperture for detection in epifluorescence-mode. Background noise from fluorescence and Raman scattering is
reduced by time gated photon counting. Peptides showing affinity to ganglioside GM1 will be conjugated to a nano-particulate
carrier bearing a fluorescent dye. The resulting optical contrast agent shall be used for fluorescence endoscopic intestinal tumor screening.
The optical parameters absorption coefficient, scattering coefficient, and the anisotropy factor of platelets (PLTs) suspended in plasma and cell-free blood plasma are determined by measuring the diffuse reflectance, total and diffuse transmission, and subsequently by inverse Monte Carlo simulation. Furthermore, the optical behavior of PLTs and red blood cells suspended in plasma are compared with those suspended in saline solution. Cell-free plasma shows a higher scattering coefficient and anisotropy factor than expected for Rayleigh scattering by plasma proteins. The scattering coefficient of PLTs increases linearly with the PLT concentration. The existence of physiological concentrations of leukocytes has no measurable influence on the absorption and scattering properties of whole blood. In summary, red blood cells predominate over the other blood components by two to three orders of magnitude with regard to absorption and effective scattering. However, substituting saline solution for plasma leads to a significant increase in the effective scattering coefficient and therefore should be taken into consideration.
A new combined Laser and Ultrasound Surgical Therapy (LUST) device for an endoscopically suitable coagulation and tissue fragmentation based on the transmission of laser radiation and ultrasound via flexible silica glass fibers was developed at the LMTB. The ultrasound tissue interaction is based on the well-known CUSA-technology, which enables the surgeon to cut various types of tissue with different degrees of effectiveness. This selective cutting performance is a very useful feature, e.g. for a brain tumor extirpation, where it must be guaranteed that vessels and nerves are not affected while ensuring a fast reduction of the tumor mass. Application fields are in oncology, neurosurgery and angioplasty. The laser radiation can be used for tissue coagulation purposes and homeostasis. With a fiber based LUST-system working at a resonance frequency of 30 kHz, using a laser-vibrometer, velocity amplitudes of up to 20 m/s could be detected at the distal end which corresponds to an elongation of more than 100 micrometers . The investigations have shown that the velocity amplitude, next to suction, frequency and cross section of the active fiber tip, has the greatest impact on the fragmentation rate. With a suction setting of 5 W, the following tissue fragmentation rates could be achieved with a 1.3 mm2 fiber cross section and a tip amplitude velocity of 12 m/s: brain tissue 50 mg/s, liver 4,5 mg/s and kidney 4 mg/s. Laser radiation up to 25 watt was sufficient to coagulate soft tissue. This new approach in developing an application system for the therapeutical use of laser radiation and ultrasound via optical waveguides offers new possibilities in minimally invasive surgery, providing a complete new working sphere for the surgeon. The flexible opto-acoustic waveguide (400 - 1700 micrometers ) can be bent making areas accessible which were inaccessible before. The surgeon can use the laser radiation for tissue coagulation or cutting and the ultrasound for tissue fragmentation and tissue reduction without changing the instrumentation.
A theoretical study of the longitudinal vibration response of a bent fiber used as an active element of a medical applicator for laser ultrasound surgical therapy (LUST) is presented. An important problem concerns taking into account fiber bending which may appear due to applications in endoscopy. NIR laser radiation and low frequency ultrasound (20 - 50 kHz) with amplitudes of up to 100 micrometers can be transmitted by silica glass fibers. The fiber cross- section is much smaller than the longitudinal wavelength. Wave propagation in the bent fiber is described by the governing second-order equations of motion which neglect the flexure effect. In contest to numerous works on bent rods, the case of an arbitrary continuous curvative distribution along the fiber is investigated. A simple analytical formula for the transfer function (the ratio of displacements at the working end of the fiber divided by those at the driven end) is obtained. The transfer function depends on frequency, fiber length, output impedance, loss factor, and the mean- square curvative of the fiber. The behavior of this function is investigated applied to some fibers whose lengths are of the order 1 m. If the displacement at the driven end of the fiber is known, the acoustical power output of the applicator can be found from the known values of the tissue impedance and the transfer function.
Superficial vessels are labeled with the fluorescence marker indocyanine green. Using an intensity modulated laser diode (775 nm, 220 MHz) the fluorescence is excited. The emitted modulated fluorescence intensity originating from the vessel is detected form a small area around the incident laser beam. The intensity and relative phase shift is obtained. By two dimensional scanning the course of the vessels inside the tissue can be calculated. Further a simple method describes how mean optical parameters can be calculated from backscattering data.
Flexible acoustic waveguides for selective tissue fragmentation are not yet commercially available. Experimental studies have shown the possibility of transmission of acoustical transients via optical silica glass fibers. The aim of this project is the development of a new endoscopic application system that would enable surgeons to use the laser and the ultrasound technique for therapy simultaneously. The concept of this application system is based on the transmission of laser radiation and ultrasound power via flexible silica glass fibers. Theoretical and experimental results on the feasibility of such an application system for an ultrasonic power delivery system are presented. Piezo-electric transducers are used to provide a high efficiency in generating the ultrasonic power. With reference to the CUSA-technique, a special flexible guiding system has been designed for providing aspiration at the tip and for protection of the fiber. The system transmits via an optical fiber up to 100 Watt Nd:YAG laser radiation. The axial oscillation of the fiber tip is +/- micrometers at a frequency of 27 kHz. First results of in vitro experiments are presented. The parenchymatous cells of liver can be fragmented without destruction of the collagenous matrix. The laser can be optionally used to coagulate bleedings or to cut collagenous tissues in contact. Applications for an acoustical and optical waveguide in ultrasonic surgery are demonstrated. This new approach in developing a first application system for the therapeutical use of laser radiation and power ultrasound in minimal invasive surgery via optical waveguides offers new possibilities in surgery. The laser ultrasonic surgical therapy (LUST) with its thin and flexible applicator provides new working fields especially for neuro or liver surgery. The tip can be bent and thus areas which could not be treated before have now been made accessible. Without changing the instrumentation, the surgeon can use the laser for tissue coagulation or cutting, next to the selective ultrasonic tissue fragmentation, where nerves or vessels will not be affected. Such a LUST-application system could be ready for clinical use in two to four years.
Laser-induced coagulation in biological tissue leads to a significant change of the reduced scattering coefficient (mu) s. This change can be monitored by phase-demodulation imaging and cw-transillumination techniques in bulk tissue. First results are presented using a 2D optical tomography and a linear scanning system.
This paper presents an ongoing investigation of laser induced xenofluorescence using a fluorescent marker to detect objects in turbid media. The aim is the development and validation of a method for imaging vessels using near infrared fluorescence angiography techniques in strongly scattering media. The main purpose is to show the course of blood and lymph vessels in the head and neck region of tumor patients. The first step was the selection of the best method and a suitable fluorescence dye to image these vessels. Using a phantom with the optical parameters similar to skin and fat tissue different methods of fluorescence excitation and detection were investigated. The following experiments were performed: whole area two-dimensional excitation and detection (CCD camera) as well as a focused excitation with scanned detection (photo diode). Furthermore investigations of the improvement of the vessel detection using a phase demodulation technique were performed. The measurements were simultaneously accompanied by analytic calculations using diffusion approximation. The photophysical investigations of several dyes have led to the use of tsAlClPc as fluorescence dye for the technical comparison of the investigated methods. Since this phthalocyanine is phototoxic a clinical certified dye (probably Indocyanine green) will be used for future experiments. The methods with focused excitation and scanned detection have shown the best resolution, but they are slow and expensive in comparison to the CCD camera technique. Further experiments should give more information about the application dependent decision which method is best suited.
This paper looks back on the transmission of acoustical shock waves via optical fibers. After that it presents recent results on an optical and acoustical system of a new combined endoscopical laser and ultrasound surgical therapy (LUST) for coagulation and tissue disintegration. Theoretical calculations concerning the transmission of acoustic energy via optical fibers are shown. In first experiments on the transmission of high power ultrasound via a silica fiber of 800 mm length a longitudinal elongation of up to 30 micrometers at the distal end with a simultaneous laser transmission was achieved. A magnetostrictive ultrasound transducer with a frequency of 26 kHz and a Nd:YAG laser (25 W cw) was used.
The temperature of the reaction zone is one of the main parameters for the characterization of laser-tissue-interaction. IR-radiometry, a noncontact temperature measurement method, is used to determine the temperature of the reaction zone. To be able to measure the inside of cavities, especially of hollow organs, we used IR-fibers to guide the temperature radiation to the complex receiver device. During the laser-tissue interaction the IR-radiation field of the reaction zone is focused on an IR-optical fiber made of AgClxBr1-x. The temperature is measured for Nd:YAG laser application with different power densities and compared with standard thermographic equipment.
This paper presents an overview of the important processes which are responsible for stone fragmentation. The efficiency of these processes in dependence of wavelength and laser pulse duration is discussed. Beside shockwaves and cavitation phenomena the role of a compressional shock acting on the stone and the plasma confinement is emphasized. As a conclusion the concept of a passively Q-switched solid state laser with a fiber-based resonator which prolongs the pulse duration is presented.
This paper presents recent results on a combined optical and acoustical system for a new endoscopic controlled laser and ultrasound surgical therapy (LUST). The goal is the combined employment of the cavitation ultrasonic surgical aspiration (CUSA) and the laser in endoscopic surgery. With such a system the CUSA technique can be used for selective tissue cutting and the laser for blood coagulation, vaporization, general tissue cutting (all this with cw lasers) and photoablation (with pulsed lasers). The transmission of acoustical energy via optical fibers is theoretically calculated. First experimental results on the transmission of high power ultrasound (US) via a silica fiber are shown. Furthermore future biomedical applications including angioplasty and endoscopic surgery are discussed.
Some physical phenomena which occur during the fragmentation of calculi by laser induced optical break down are presented. With in vitro experiments it could be shown that the energy of the laser induced plasma and of the cavitation bubble (induced by the plasma) depends by the nature of the tissue. The laser induced plasma and the cavitation bubble generate shock waves. These sound waves are transferred via the laser fiber and detected with a piezo- electrical sensor at the proximal end. The acoustic signal contains information on the potential energy of the bubble, which depends on the energy of the plasma. The possibility of measuring the energy dependent acoustic transients allows to distinguish between hard and soft tissue and by this it is suitable for controlling the laser lithotripsy process. The transmission of acoustic transients through silica glass fibers is investigated by theoretical calculations. It shows the feasibility of silica glass fibers as an acoustic wave guide.
Fiber optics are used in medicine in power transmission for therapeutic use as well as in signal transmission for diagnostics. Fibers are the key component of the applicators which find a wide and varied use. Applicators with optical fibers are part of the standard equipment used with the various continuous and pulsed medical laser systems. Recently, optical fiber applicators for the Er:YAG, CO, and CO2 laser have become available. A combination of therapeutic and diagnostic fibers promises, for example in lithotripsy and angioplasty, not only to improve the safety level, but also to ensure the accuracy of the dosage and the precision of the laser energy applied. For the design of commercial fiber optic components a practical definition of the engineering damage threshold including a reasonable safety factor is given. With respect to this engineering damage threshold an overview of existing fiber technology with respect to the fields of application is presented and two examples of feedback systems to increase safety are discussed.
The effect of long pulsed Nd:YAG laser (pulse duration 300 ns) with the fundamental and second harmonic wavelength on the fragmentation of different urological and gall stones has been investigated. With 200 and 400 micrometers fibers in a contact application, all types of stones could be fragmented with energies less than 120 mJ (400 micrometers fiber) or 45 mJ (200 micrometers fiber). By use of a double pulse-simultaneous application of second harmonic and fundamental radiation the efficiency of fragmentation could be increased and the energy threshold decreased.
There are currntly several methods in the field of laser lithotripsy which operate not only at different
wavelengths and pulse lengths but also with various types of optical front ends and various irrigation
fluids'6. The methods can be divided into two main groups:
First, those which utilize stone absorption and plasma formation on the stone surface to initiate
stone fragmentation, such as dye lasers.
Second, those which generate shock waves and caviatation in the surrounding fluid and which require
additional means to produce aplasma (e.g. irrigation, focussing fiber end or metal surfaces).
The pulsed Nd:YAG laser belongs to this group.
The method presented here is the double pulse technique which is a combination of both methods.
It uses two laser pulses with a short time delay transmitted by means of a fiber to destroy body concrements.
The first pulse is the first harmonic of the Nd:YAG laser (532nm) which improves the
coupling efficiency of the laser radiation with the stone. The second pulse is in the fundamental
mode of the laser (1064 nm) delivering the high energy for the stone disruption.
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