- Frank`s Hospital Workshop
Contents
1. power and las r Classin 2525s A oi cadace ssate scart steeeessate edseanea ei ea doden ESEE aa era iae aa Eai E paaa eea Eae 24 3 1 3 Label placed on the laser cluster warning about proximity of aperture of laser of the stated wavelength power and laser ClaSS eee eeeseee eee eeceeneeeeeeeeeeeesaaeeeeeeaaeeeseaeeeeeeaaaeeeseeeaeeesneeeeneneeseeaeees 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 2 LASER THERAPY INTRODUCTION 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 LIGHT THE PRINCIPLE OF LASER LIGHT AND ITS SPECIFICS 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 e totally monochromatic maintai2. 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 Beam Operation Mode e pulse lasers very short pulses hundreds of ns peak output in watts or tens of watts e continuous lasers e 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 LASER THERAPY Page 5 of 25 Output MODULATED Output CONTINUOUS Mean _value Time Manufacturers usually offer various alternatives including the possibility of combining various modes modulated
3. cluster the equipment is able to measure the actual output of the diode and can adjust the maximum output that can be set according to the status of the laser diode If the output drops below 40 of the value stated on the cluster label because of a defect of the cluster or ageing of the diode we recommend installing a new cluster According to the value of the output just being emitted by each individual laser diode the emission of the laser diode is regulated This ensures that the value on the screen is correct and it is not necessary to use an external measuring device for the cluster Owing to the losses which occur on optical interfaces inside clusters the maximum output that can be set may be lower than the output stated on the cluster label USE OF SAFETY EYEWEAR According to the applicable standards both the therapist and patient must use safety eyewear which prevents damage to the eyes in case they are unintentionally hit by the laser beam The protective eyewear supplied by BTL was approved by the Czech Occupational Safety Research Institute and certified under the number 235 T 010 1999 SETUP OF LASER GENERATOR Page 22 of 25 O Q 3 APPENDIX 3 1WARNING LABELS PLACED ON THE CASE OF THE DEVICE AND ON THE LASER PROBE 3 1 1 Label placed on the case of the device warning about the occurrence of visible and invisible radiation of class 3B APPENDIX Page 23 of 25 N CSD 3 1 2 Label p
4. designed for laser clusters Since this attachment is not supplied as standard with the device the acupuncture measuring function is off This item serves to switch the function on E1 ot E2 vi 1 gt gt 4 gt gt 2 1 SETUP OF LASER GENERATOR Page 16 of 25 gt K2 3 3 3 4 When the acupuncture measuring function is on the acupuncture button appears among the therapy parameters in the manual settings screen After pressing this button you can start measuring acupuncture The button displays a horizontal bar graph the size of which is directly proportional to the skin resistance The acupuncture point is indicated by a local jump in the skin resistance During measuring the device generates a sound the pitch of which corresponds to the value on the bar graph Since the basic skin resistance of patients differs it is possible to change the sensitivity of measuring during the process of acupuncture measuring by the select knob To find an acupuncture point slowly sweep the probe with the acupuncture attachment above the site of the expected location of the acupuncture point After finding the acupuncture point it is possible to start therapy by pressing the button on the probe During irradiation the device suspends the search mode and returns to it after stopping the therapy or after activating a pause Owing to the fact that the acupuncture attachment significantly attenuates the passing laser beam the equipment c
5. yes LOCKING OF THE EQUIPMENT IF DOOR OPENS According to the applicable standards each laser generator must be equipped with a safety door switch which prevents generation of the laser beam if the door is open and there is a real danger of hitting an unprotected person by the laser beam SETUP OF LASER GENERATOR Page 17 of 25 ON 5 This door contact is brought to the rear panel of the device Its position depends on the current configuration of the device see table Tab 2 1 Configuration of output connectors in the BTL 4000 Series USER S MANUAL If the level on the connector s input is active e g in case of an open door the equipment for safety reasons does not allow you to run a therapy If a therapy is already running it is interrupted PAUSE status and the screen displays a warning optionally together with a sound signal The therapy can continue only after the signal on the connector s input subsides i e after closing the door and it can be cancelled by the esc button Any security equipment with voltage output can be connected to this connector Polarity of voltage does not matter the equipment detects it and adapts to it The minimum voltage is 5V maximum 35V The current in the connector is max 10mA It is possible to pre set it if the switch is considered active in the connected or disconnected status with or without voltage supply As default the switch is set to active in the connected status For det
6. 1001E20 12 2007 CONTENTS 1 LASER THERAPY mororo e aa sae eg cae ec a eee 3 1 1 MEO CICLO se 25 cess ce eert oe at geen sens t TA EAA EE E EAEE A E AEA 3 1 2 Light The Principle of Laser Light and its Specifics 00 eee ceeeee ee eneeeeeeeaeeeeeeeeeeesaeeeeeeaeeeeeneeeeessaeeeeeeaas 3 1 3 Types Of ILASGIS oo sites scetentsice tas ee nae sadsecntsnesscec sack lt atsgaateassaceanetsaceseadsark ixetocsiqgacecsaieretaaisech snails cesta ies 5 1 3 1 SOU CO AEE E caats eee acts abe cease sasgen Suniaceaanss gust tase casas EE OE AEAEE AA 5 1 3 2 Wavelength primarily semi conductor lASEPS ccccceeeceeeee eee eeeeee eae eeeeeesaeeeeeeesaeeeeeeeseaeseeeeeseaeeneeeees 5 1 3 3 Bean Operation Modesto eeren erae roa Ear Ea EA EEE a e satacacesmaieiessaaeesvaceceerasss ieee 5 1 3 4 TYPE ON BEAM sei scsceniesced ceru aia anais eraa Eae E eaa E EEE Eaa EE e EEEa e ah aaar 6 1 3 5 Laser Class defined by the OUtDUt eee eeceeeeeeceeeeeeeee eras eeeeee seas eeeeeesaaeseeeeesaaeseeeeesaaeeeneeesaeseeeesnaeeeeneees 6 1 3 6 MSS gee cece cet eee seer Sees esas AE ASEE EE E ETA E AEEA ETE AEE A 6 1 4 Basic Physical Quantities sce c sc ccccesceesscel oc isiccszsssachicescaceqessdhcsacssancstrsbenesadet lt pbageaistssacesandsieassavatsetseeeneeas ices 7 1 5 Biological Effects of a Low power Laser Non invasive Laser 0 ec eeecceeeeeeeee eee eeeeeeaeeeeeeeaeeeeeeeeeenenaeeeeeaas 8 1 6 Yale Uot Arela S EE TA danas tasbeaccocsacssetasads
7. BTL 4000 Topline Series USER S MANUAL Under the displayed current value of output there are quick jump buttons after pressing one of them the output value changes to the value written on the button and further setting goes on from this value Obviously output can be set only within the range allowed by the connected laser cluster SETUP OF LASER GENERATOR Page 12 of 25 gt e Area This therapy parameter is often changed by the user because each treated part has a different size This parameter is also available in the ergonomic mode When using a divergent probe the screen displays the distance between the probe and the surface so that the irradiated area equals the pre set one The maximum displayed distance is 25 cm and when irradiating from greater distances the diverged laser beam is too dispersed and therapeutic effects are lower If the injured area is larger it is necessary to treat it similarly as with convergent probes and continuously sweep over the affected area With convergent probes it is necessary to continuously sweep the beam over the whole injured area With laser clusters the therapy is applied contact free the aperture of the laser cluster is immediately above the injury in case of a larger injured area it is possible to sweep over it similarly as with convergent probes The area of the laser cluster is stated on the relevant tab under its picture and in the technical parameters typically 25
8. ER THERAPY Page 7 of 25 1 5BIOLOGICAL EFFECTS OF A LOW POWER LASER NON INVASIVE LASER Specific physical qualities of a laser beam result in specific clinical effects The most considerable clinical effects are e analgesic effect A e antiphlogistic effect F e antiedematous effect E e biostimulation effect B e vasodilatation effect V All these effects are based on positively established and verified mechanisms e acceleration of microcirculation e increase in intracellular activity of many enzymes particularly in the Krebs cycle e increased oxygen circulation improved glucose utilization e DNA synthesis stimulation via phytohemaglutinin stimulation e increased fibroblast activity for keloids these activated fibroblasts are able to perform resorption of fibrin e phagocytosis activation e activation of the Na K pump on the membrane e 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 e 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
9. Note The attachments are not included in standard accessories of BTL 4000 Topline series devices The attachments are not designed for laser clusters SETUP OF LASER GENERATOR Page 19 of 25 SD Q v 2 6 1 Dental Attachment ee When using the dental optical attachment it is necessary to increase the dose by 15 when using probes with wavelength of 685 nm or 830 nm 2 6 2 Gynaecological Attachment When using the gynaecological optical attachment it is necessary to increase the dose by 25 when using probes with wavelength of 685 nm or 830 nm 2 6 3 ENT Attachment When using the optical attachment for ENT it is necessary to increase the dose by 20 when using probes with wavelength of 685 nm or 830 nm Before each use it is necessary to sterilize the attachments for 10 minutes at a temperature of 120 C 2 6 4 How to Connect the Attachment Unscrew the brass cover from the probe s head In its place screw on the plastic attachment with the light waveguide plugged in Make sure that the plastic attachment is fixed fast and the light waveguide is immovable If you want to replace the attachment with another one simply loosen the head by approximately one turn take off the previous attachment put in the new one and tighten the head SETUP OF LASER GENERATOR Page 20 of 25 gt A gt 2 7 LASER CLUSTERS Laser clusters are used for laser beam therapy They are particularly suitable for the treatment of larger a
10. P OF LASER GENERATOR Page 14 of 25 gt Comparison of two DF settings a f 10Hz P 20 mW DF 50 Average output 10 mW Output mW b f 10Hz P 20 mW DF 90 Average output 18 mW Output mW Time s e Physiological Effects The symbols of effects used in the device have the following meanings A analgesic F antiphlogistic E antiedematous B biostimulation V vasodilatation For the factory preset programs and diagnoses the effects are filled in If you are not satisfied with them you can edit them and save the program as a user one SETUP OF LASER GENERATOR Page 15 of 25 CSD v 2 2 2 Laser Sequences 1 2 This item enables you to run sequences of therapies selected by the name or by the program number It is possible to create new sequences and edit existing ones A sequence is a set of individual therapies followed one after another and it is necessary to create individual programs which are to be included in the sequence before creating the sequence Unlike the ultrasound and electro sequences the laser sequences do not contain the time parameter for individual sections Time is displayed for individual sections only for information and cannot be changed because it is directly influenced by the dose which is pre set in each section and by the currently connected probe cluster That is why when the probe cluster is changed the time of individual sections and the total
11. a recommended value which is calculated from the relation between the probe s distance from the irradiated surface the divergence of the beam and the size of the irradiated area Its unit is the centimetre cm Further it is necessary to take into account the required depth of penetration which has to be subtracted from the distance between the probe and body surface When using an attachment with a lightguide not designed for laser clusters or probes with convergent beam sweep evenly over the whole pre set area During therapy let the beam if possible fall vertically on the surface of the tissue to prevent undesirable reflection and possible reduction in the energy absorbed by the tissue It is advisable to degrease the skin before therapy SETUP OF LASER GENERATOR Page 13 of 25 gt e Duration of Therapy According to the pre set parameters the device automatically calculates other parameters so that the time of therapy is if possible 1 minute Modification of the calculated time if necessary is possible but it is important to take into account that it will also influence the output of the used probe cluster so that the required dose of therapy is achieved Maximum duration of therapy is 99 minutes and 59 seconds In the pulse mode it is also possible to modify the duration of therapy by changing the duty factor DF value to shorten the therapy increase the DF After pressing the time button it is poss
12. according to various parameters See the parts concerning clinical effects and use below 1 3 4 Type of Beam 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 Laser Class defined by the output e Class 2 up to an output of 1 mW e Class 3A 3R 3M up to an output of 5 mW and output density of 25 W m e 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 Use 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 LASER THERAPY Page 6 of 25 e desk top lasers usually supplied from the mains the probe is
13. ails on setting the activity of the door switch see the chapter Door Activity Voltage is brought between the contacts of connectors 3 and 4 In case of any questions contact the authorized BTL service department It is also possible to buy the complete door switch set from the BTL supplier Patient output connector Power supply AC DC 5 35V 10mA Door contact LASER PROBES Laser probes are used for laser beam therapy There are many types manufactured of various power and customers can choose according to their needs Division of probes by wavelength e Red probes e Infrared probes Division of probes by the type of beam e Convergent point beam the probes have additional green lighting for better identification of the point of incidence of the beam e Divergent beam enables you to irradiate a larger area at a time without the need to sweep over the treated tissue these probes do not have supplementary lighting SETUP OF LASER GENERATOR Page 18 of 25 gt Q 6 power cable direction of laser beam radiation oao laser aperture label with classification and aperture START STOP button emergency laser stop indicator of laser activity Note The probes are constructed in such a way that the active surface of the button does not protrude from the outline of the probe This prevents accidental pressing e g in case of laying the probe on a flat surface such as a desk e
14. ce 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 BTL 4000 Topline Laser takes into account the mode in which the device is working when calculating the treatment time e 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 e Power density its unit is the Jicm 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 CMm irradiated area cm Knowledge of basic physical quantities which is also acquired in obligatory training significantly facilitates an understanding of laser therapy LAS
15. ch laser cluster has a limiting value of minimum and maximum laser beam output which it can generate The device reads these data from the cluster and does not allow a value to be set outside this range The cluster may consist of up to three independent output sections which can be separately adjusted i e the red section infrared section and blue supplementary lighting section Maximum outputs of individual sections are stated on the label on the cluster It is also possible to switch off individual sections and to perform therapy for example only using the red section When setting the other parameters area dose the device sets the output in a way that the therapy time is 1 minute if possible The resulting output is divided linearly among all sections of the laser cluster The displayed output is divided into individual sections which enables clear orientation The first displayed value is the output of the infrared section the second one is the output of the red section If it is necessary to set a certain output value or to switch a section on off it is possible to change the output and the device will automatically calculate the other therapy parameters After pressing the output button it is possible to set output in steps and by individual sections Zero value of output means that the section is off It is also possible to set the value directly by the numerical keyboard see the chapter Numerical keyboard of the
16. cm We recommend not setting an area smaller than stated in the technical parameters in case of a larger area increase it by multiples When calculating therapy parameters the device assumes that the whole area is irradiated evenly which is achieved by the above mentioned continuous sweeping The maximum accessible area also depends on the connected laser probe cluster for low power probes the maximum area that can be set can be reduced by the device if the maximum therapy time of 99 59 could be exceeded After pressing the area button it is possible to set the area in steps by the select knob It is also possible to set the value directly by the numerical keyboard see the chapter Numerical keyboard of the BTL 4000 Topline Series USER S MANUAL Under the displayed current value of area there are quick jump buttons after pressing one of them the area value changes to the value written on the button and further setting goes on from this value Area can also be changed directly by turning the intensity knob e Distance between the Probe Cluster and the Irradiated Surface When using convergent probes the distance is not measured because the beam is virtually parallel For the laser cluster the distance is not stated either since the distance between the laser cluster aperture and the injury should be minimal although still contact free This parameter therefore applies only to probes with divergent beam The distance is
17. 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 4BASIC PHYSICAL QUANTITIES e Wavelength one of the basic parameters of a monochromatic laser beam i e of only one wavelength Its unit is the nanometer nm e 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 sour
18. 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 LASER THERAPY Page 4 of 25 1 3 TYPES OF LASERS Lasers can be divided according to several criteria 1 3 1 Source e solid lasers ruby laser e liquid lasers e gas lasers helium neon argon e 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 Wavelength primarily semi conductor lasers e blue lasers approx 400 500 nm e green lasers approx 500 550 e red lasers approx 600 700nm e infra red lasers approx 700 950 nm Visible spectrum 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
19. ges it is non invasive painless many patients report unpleasant sensations when an acupuncture needle is being inserted and saves time even for sedative techniques the treatment lasts no more than several tens of seconds Modulation by Nogier frequencies is very useful and is commonly used in acupuncture Application of these frequencies for the most frequent diagnoses is stated below For more details see specialized literature 1 6 1 Frequencies for Laser Acupuncture According to Dr Nogier Frequency Hz Use and Area of Application U 1 14 Universal whole body Chaotic changes tissues and transitional epithelium body openings mouth nose eyes B 4 56 Nutritive effect chest and abdominal cavity C 9 12 Mesenchyma limbs gluteal area muscles and ligaments kidneys genitals D 18 3 Metabolism joints of cerebral symmetric organs E 36 5 Nerve tissue peripheral parts of spine back and top parts of head and neck Psychosomatic disorders subcortical areas lower parts of face Emotional diseases cerebral cortex nervous system frontal and temporal parts of head lateral parts of nose LASER THERAPY Page 9 of 25 2 SETUP OF LASER GENERATOR 2 1 ACCESS PASSWORD According to applicable standards each laser device must be protected against unauthorized handling In the case of the BTL 4000 Topline series it is guaranteed by the access password If the device contains a laser generator the access passwo
20. ible to set time in minutes or seconds It is also possible to set the value directly by the numerical keyboard see the chapter Numerical keyboard of the BTL 4000 Topline Series USER S MANUAL separately in minutes and in seconds Time can be also changed directly by turning the time knob e Course of Signal Duty Factor DF This button serves to display the modulation signal After pressing this button there appears a screen with the displayed waveform of the output signal If a non zero frequency is set it is possible to change the ratio between the period in which the laser beam does and does not shine the so called Duty Factor Duty factor can be changed by the select knob or by the numerical keyboard Additional information pulse ms period ms information about length of the pulse and the period calculated from the pre set frequency and duty factor frequency Hz information about the pre set frequency Duty factor DF stated in expresses the ratio of the pulse length ti to the period tp see picture it can be set only in the pulse mode Changing the value of the duty factor considerably influences the value of the average laser output The following picture shows a comparison between two different duty factor settings all other conditions being equal From the picture it is apparent that for higher DF the laser emits a higher average output which implies shorter duration of irradiation SETU
21. laced on the probe warning about proximity of aperture of laser of the stated wavelength power and laser class SACI SACI gt gt PPD ODED U 3 1 3 Label placed on the laser cluster warning about proximity of aperture of laser of the stated wavelength power and laser class cge E AEBS E ACIO ca ca APPENDIX Page 24 of 25 N 3 lt S 3 1 4 Label for marking the laser workplace warning about proximity of 3B class laser APPENDIX Page 25 of 25 N CSD
22. led continuous mode it can also be recognized visually the laser beam shines constantly and does not blink If a non zero positive value of frequency is set the equipment works in the pulse mode the laser beam is blinking Note the human eye can recognize blinking of the beam up to a frequency of approx 25 Hz higher frequencies are subjectively perceived by the human eye as continuous Frequency is the second key parameter of therapy it is also a fixed component of the program diagnosis and the device does not change it in internal calculations the user can change it freely Frequency can be set within the range stated in the technical parameters of the device The process of frequency setup is similar to that of other therapy parameters After pressing the frequency button it is possible to set frequency in steps by the select knob It is also possible to set the value directly by the numerical keyboard see the chapter Numerical keyboard of the BTL 4000 Topline Series USER S MANUAL Under the displayed current value of frequency there are quick jump buttons after pressing one of them the frequency value changes to the value written on the button and further setting goes on from this value Frequency is set by certain preset steps Setting frequency to 0 means continuous operation Acupuncture therapy requires very precise setting of frequency to values which cannot be set by steps In such case it is necessary to e
23. n settee eeeaaeeeseeeaeeesneeeeeenaeeesenaeenneeeeneea 17 2 5 Laser PrOoBe S cirsio enraiar aa ca lysed end cidenda vealed neues eclied aa ea aa ns ango ed hasan een 18 2 6 Optical Attachments for Laser Probes 0 eee eeeeeeeeeeeeeeeeeeeeeeeeaeeeseeeaeeeeaeeeeesaeeeeeeaeeeeeeeeeeesnaeeesseeeseenaeess 19 2 6 1 Dental Attachment ieies siaddees ncn ce stad banat datae asin depandan ridetar ae iaraa spirales aidian 20 2 6 2 Gynaecological Attachment ccccc ccccsctecndesscecnecicnevescaehssuceeeneeusedensegensevessecneedescsnebietcaanedebendeenceebeciiienebes 20 2 6 3 ENT Attachmenta epea ide na ea ee aeria aaae a eae eeraa aa ep aaaea 20 2 6 4 How to Connect the Attachment iccccscceccevssscccet sctees eveced coccinea yesaeeeebecneescbesaseustesdsbecesiudetesseusnseresccneevetes 20 2 7 Laser CIUStETS Linser eicae hades suman ce araa aa aa aeania aa nds sadiecd aa aa aaria re Ea ewnasecn ss 21 2 8 Use Of Safety EyOwOa oi ic cccszecyscsccdeeeivcen cased tenstee cee stiecs ea e a sa ia adea e e NEL 22 3 APPENDIX arasen aaea r a ara onde cet a E A cae een a aV Erdan Tae aaa 23 3 1 Warning Labels Placed on the Case of the Device and on the Laser Probe cseececeeeeeeeeeeeeeeeeees 23 3 1 1 Label placed on the case of the device warning about occurrence of visible and invisible radiation OMCIASS SB A E E E AA E E AAE TO E A E A EATE 23 3 1 2 Label placed on the probe warning about proximity of aperture of laser of the stated wavelength
24. ning only one wavelength LASER 635 nm BULB Intensity Intensity 400 500 600 700 800 nm 400 800 1200 1600 2000 nm LASER THERAPY Page 3 of 25 e totally polarized waves are completely spatially oriented onto a defined area Linear polarization e 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 A 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
25. nter the exact frequency value by the numeric keyboard or to choose the respective program or diagnosis Nogier in which the frequency is set to the required value SETUP OF LASER GENERATOR Page 11 of 25 CSD v e Output laser probe This therapy parameter is the most dependent on the laser probe being used Each laser probe has a limiting value of minimum and maximum laser beam output which it can generate The device reads these data from the probe and does not allow values outside this range to be set When setting the other parameters area dose the device sets the output in a way that the therapy time is 1 minute if possible If it is necessary to set a certain output value it is possible to change the output and the device will automatically calculate the other therapy parameters After pressing the output button it is possible to set output in steps by the select knob It is also possible to set the value directly by the numerical keyboard see the chapter Numerical keyboard of the BTL 4000 Topline Series USER S MANUAL Under the displayed current value of output there are quick jump buttons after pressing one of them the output value changes to the value written on the button and further setting goes on from this value Naturally output can be set only within the range allowed by the connected laser probe e Output laser cluster This therapy parameter is the most dependent on the laser cluster being used Ea
26. orrects the maximum adjustable output when irradiating in the acupuncture mode If you irradiate using the acupuncture attachment and the acupuncture mode is off it is necessary to manually recalculate the dose or output for the 85 attachment attenuation Self calibration of the Laser Probe The probes are calibrated by the manufacturer and the user cannot calibrate them The internal mechanism in the probe automatically checks the reached output during therapy and makes corrections so that the displayed output corresponds to the output generated by the laser probe cluster If for some reason the output of the probe cluster does not correspond to the pre set values and it is not possible to correct the error the probe cluster is set as defective by its internal automatics it is locked and further therapy cannot be performed with it Self calibration is a function which tries to put back into operation a probe cluster which was locked as described above If self calibration is run on an unlocked probe cluster it has no influence on its functioning CAUTION Self calibration in no case replaces the required regular calibration and check of the device by the manufacturer or authorized service of BTL 4000 Topline series devices Sound in running therapy According to the applicable standards units with laser generators have to generate sound during therapy Via this option the acoustic signalling can be disabled By default this option is set to
27. put of the probe cluster so that the therapy time is 1 minute SETUP OF LASER GENERATOR Page 10 of 25 gt A gt 2 2 1 Laser e Dose This value represents the power density to the area J cm It is a key therapy parameter therefore its value is a fixed part of the program diagnosis and the device does not change it in internal calculations the user can change it freely Dose can be changed within the range stated in the technical parameters of the device It is the maximum range and in practice with some types of probes clusters it is not possible to reach the upper limit because they do not have enough power for it and the necessary duration of therapy would exceed the limit of 99 59 After pressing the dose button it is possible to set dose in steps by the select knob It is also possible to set the value directly by the numerical keyboard see the chapter Numerical keyboard of the BTL 4000 Topline Series USER S MANUAL Under the displayed current value of dose there are quick jump buttons after pressing one of them the dose value changes to the value written on the button and further setting goes on from this value e Frequency This parameter states the number of cycles in the time interval of 1 sec its unit being the Hertz Hz The equipment works either in continuous i e uninterrupted or in pulse mode If the zero value of the laser beam output frequency is set the equipment works in the so cal
28. rd is always required after the unit is switched on The password is preset to 0000 by the manufacturer After entering the correct password and confirmation by the enter button it is possible to work with the device If an incorrect password is entered the device gives a warning and awaits a new entry The password can be changed at any time but it cannot be disabled For the process of password change see the chapter Password Setting in the BTL 4000 Topline Series USER S MANUAL Note If you happen to forget your password you can at any time use the universal one 00000000 2 2SETUP AND CONTROL OF LASER THERAPY On the therapy parameters screen it is possible to select individual laser therapies or laser sequences All pre set therapy values are interconnected by the following mathematical relation Dose Output DF 100 Time Area J cm W s cm All pre set values except frequency influence each other and the device always tries to calculate the therapy parameters in a way that the last pre set parameter is at the value set by the user Other parameters can be changed if necessary except dose which is a key therapy parameter Maximum values of parameters strongly depend on the maximum power of the connected laser probe cluster therefore some values can be set for a probe with an output of 300mW but they are not allowed for a 30mW probe When calculating therapy parameters the device tries if necessary to adjust the out
29. rea injuries where using a standard laser probe would be too laborious for the therapist because of the necessity of sweeping Laser clusters can evenly irradiate a much larger area at one time e g 25cm There are many types manufactured of various power and wavelength and customers can choose according to their needs Division of laser clusters by wavelength e red clusters e infrared clusters e combined clusters both red and infrared All laser clusters include a focusing beam which facilitates focusing of the laser beam even when using protective means A particularly useful feature is the possibility of using combined clusters both red and infrared which enables you to perform both types of therapy with one accessory START STOP button emergency laser stop power cable label with classification and aperture laser aperture direction of laser beam radiation Note The clusters are constructed in such a way that the active surface of the button does not protrude from the outline of the cluster This prevents accidental pressing e g in case of laying the cluster on a flat surface such as a desk etc SETUP OF LASER GENERATOR Page 21 of 25 CSD v Ageing of the laser cluster The semiconductor laser diodes used in this equipment have a limited lifetime During this time the diode ages which leads to a decrease in its maximum output Since all laser diodes are calibrated before mounting into the
30. snnestesnanasareecacauics A ies 9 1 6 1 Frequencies for Laser Acupuncture According to Dr Nogier ssssssssiiesrrirerrisrrrrrssrrireerrrrrerinereens 9 2 SETUP OF LASER GENERATOR sssini scade caccnzsctc ts cece e aiaee a aSa aaa Eaa ena da aa eaae ea aaraa aaia 10 2 1 ACCESS PASSWOME i oroeccsitan eenia iapa raae aaraa Or A p aiaa ri e Eana Raar iea aeae iaaea 10 2 2 Setup and Control of Laser Therapy eeeeecceeeeeneeeeeeneeeeeeeeeeeeeaaeeeeeeeaeeeseeeeeescaeeeeeeaaeeeseeeaeeesnaeesenaeeeseeeaeess 10 2 2 1 LAS OM ET seccneddceavien saddeod eases silaeesd AT E Adee fend ssa Aaa eaten ena ds 11 2 2 2 Laser SCQUENCES 3ecii ces enneescoes atigidelesvececsabvestengannceusadgee siancedey saad oe oda e eiras eere teira iiae 16 2 3 Specifi Settings esris sxteceabennevdsvesseyesbesbevace sadesebbenaecdebesadvardesescdce cadeeredengandsvssadveeysvberees esnetde chudeeedeandes aes 16 2 3 1 DOOr ACHIVILY isc cccnsesssttecoseecinacs A A E E E ak suldevascecestuebevadves segstetmeescbes 16 2 3 2 ACU PUN CEUPG su cscs co eedscctd oenen airot a eea eaei aieri eari ie Eia eA O LAE ENEE 16 2 3 3 Self calibration of the Laser Probe cccs ccccccceccececeessseeeheseseeceeeusedessegeneeessecedeedescsnevneecsavedebendeenebesscteeeebes 17 2 3 4 Sound in running therapy eeec ce cdeaesssnesect cadeeecergecdes evadeactecnececk eadhonesenbelae vd vebadvaevesbevucs cadesesendesdoeebecndes dbo 17 2 4 Locking of the Equipment If Door Opens eee eeeeeee sence ee enne ee tetki
31. tc Ageing of the laser probe The semiconductor laser diodes used in this equipment have a limited lifetime During this time the diode ages which leads to a decrease in its maximum output Since all laser diodes are calibrated before mounting into the probes the equipment is able to measure the actual output of the diode and can adjust the maximum output that can be set according to the status of the laser diode If the output drops below 40 of the value stated on the probe label because of a defect or ageing of the diode we recommend installing a new probe According to the value of the probe output just being emitted the emission of the laser diode is regulated This ensures that the value on the screen is correct and it is not necessary to use an external measuring device for the probe Owing to the losses which occur on optical interfaces inside probes the maximum output that can be pre set can be lower than the output stated on the probe label OPTICAL ATTACHMENTS FOR LASER PROBES Special lightguide attachments serve to lead the laser beam to hard to access places The range includes attachments for dentistry gynaecology and otorhinolaryngology ENT The lightguide attachments reduce the maximum achievable output of the probe which they are connected to therefore when they are used it is necessary to make adjustments to the dose or output according to the values given below in the parts concerning individual attachments
32. 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 LASER THERAPY Page 8 of 25 1 6 ACUPUNCTURE As stated above the laser beam has a specific effect on acupuncture points similar to the use of an acupuncture needle Laser acupuncture has several advanta
33. time of the sequence are changed Time changes in such a way that the needed dose is reached in each section of the sequence The total duration of a sequence is limited to 99 59 Area is set globally for the entire sequence before the start of therapy Each sequence can be saved with its physiological effects among the user programs For details see the chapter USER SEQUENCES in the BTL 4000 Topline Series USER S MANUAL SPECIFIC SETTINGS Besides common settings each generator has some specific setting items These items are included in the specific settings menu item which can differ according to which tab generator is active The following part describes specific settings for the laser generator Door Activity Here it is possible to set when the door is considered open if it is when voltage is brought or is not brought to the device see the chapter Locking of the Equipment If Door Opens The screen displays the door switch setting and its current status by opening and closing the door you can check whether the door status in the device corresponds to the actual status If not switch the door activity from positive to negative or vice versa E1 ge E wt 4 gt gt 2 i gt gt 1 In case of any questions contact the authorized BTL service department It is also possible to buy the complete door switch set from the BTL supplier Acupuncture Using a special attachment the laser generator can measure acupuncture not
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