MIL-therapy / Publications / Biophotometer in laser device «MILTA-F» for determining individual irradiation doses and for diagnostics
Biophotometer in laser device «MILTA-F» for determining individual irradiation doses and for diagnostics
Yu.V.Alexeev, V.F.Balakov, A.K.Polonsky,
Dear Ladies and Gentlemen,
The aim of the present talk is to show new possibilities and fields of application of biophotometry in laser therapy.
The main idea of present talk is to give information about peculiarities and our experience of working with therapeutic laser "MILTA-F" which has an in-built photoregistor.
This laser device has been elaborated and is serially produced by “Scientific Production Alliance - Space Device Construction” in co-operation with “Symbol, Ltd.” in Russia.
Medical co-performers are Moscow Medical Stomatology Institute named after Semashko N.A. and Moscow Scientific Research Institute for Emergency and First Medical Aid named after Sklifosovski N.V. The device has successfully passed all required medical and technical trials and has got positive findings from many leading clinics in Russia.
Devices of "Milta-F" type are known and actively used in hundreds of medical institutions in Russia and abroad. Dozens of thousands of patients had a possibility to feel its positive effect.
You can see the view of this apparatus on Fig.1 It consists of a control unit and a terminal.
Specific features are:
- three factors of the irradiation: namely, from a constant magnetic field, from a low-power pulsed laser and from continuous light-emitting diodes in infrared range of the spectrum. As it has been proven in many scientific centers and in leading clinics of Russia and abroad, where these devicees are in use , a combined effect of the three above mentioned factors in "MILTA-F" device allows to increase laser therapy efficiency by 1,3-1,5 times.
- The device has an in-built biophotometer which measures reflected infrared irradiation from a bioobject.
Main technical parameters of "MILTA-F-8-01" device are presented in the table on Fig.2.
The in-built biophotometer allows to decide the following tasks:
- to determine and to set the defined level of power of LED irradiation;
- to determine a reflection coefficient from the skin and underlying tissues;
- to determine an individual dose of infrared energy absorbed by a patient during the procedure;
- to detect some pathological changes in tissues ( tumour, purulent focus, inflammations, etc.) considering the value of reflection coefficient;
- to control laser therapy efficiency as well as to diagnose the onset of postoperative complications at early stages.
Devices of "MILTA-F" type are protected by Russia patents No.2072879 with a priority dated February 9, 1990 and No.2143993 with a priority dated March 13, 1999. Patent-holders are “Scientific Production Alliance - Space Device Construction" and “Symbol, Ltd.” in Russia.
The latest modification of "MILTA-F-8-02" has a biophotometer with two channels for receiving the information. Fig.3 shows a scheme of the terminal. The terminal (1) has a chamber (2) in which there is a pulsed semiconductor laser (5), light-emitting diodes (3) and photodiodes (4). The chamber (2) passes through a constant magnet (6) in holes of which photodiodes (7) are placed.
Reflected, re-emitted signals are delivered to a biophotometer indicator inlet either from photodiodes (4) - the first reception channel, or from photodiodes (7) - the second reception channel.
When the terminal is put on a bioobject and the first channel is used, an integral signal of photodiodes (3) irradiation reflected mainly from the patient's skin (8) located directly under the camera (2) is delivered to the photoreceptor. It allows to measure a coefficient of reflection from the irradiated surface. Values of the reflection coefficient, and of infrared emitter power, and of exposure time are used to calculate an individual dose - an amount of energy absorbed by a patient during one procedure.
Changes in the reflection coefficient seen at every next procedure and during the procedure itself give the information about laser therapy efficiency.
While comparing values of the reflection coefficient taken contralaterally at a patient's body, one can reveal a pathologic focus.
However, when you use the first channel of information reception, you should keep in mind than a portion of signal - dissipated, re-reflected by sudermal layers - is only a small part of a summarized signal which reaches a biophotometer inlet. So, it makes diagnostics of inner pathology not so easy.
But when you use the second channel - in this case signals are accepted by photodiodes (7) located outside the camera (2) - practically, no signals reflected from the irradiated area reach the biophotometer inlet. If the terminal is tightly pressed to the body, these photodiodes (7) receive only LED infrared signals which are dissipated and re-reflected by subdermal structures of the organism.
It has to be noted that up to now there is no clear understanding as to the mechanisms of reflection, re-reflection, dissipation, re-irradiation of infrared light which take place in complex biostructures having this or that pathology. Physicians who have worked with this device and used it for treatment and diagnostics have an opinion that the main factor influencing the reflection coefficient is blood supply of the irradiated tissues, mainly vessels of the subcutaneous fat layer.
It has been noted that any mechanical or thermal irritation of skin considerably changes signals from deeper structures ( via the second channel) - these signals become less powerful ( absorption is increased). However, in ischemia or in vascular spasm - vice versa.
When the first channel is used, changes in the signal (in the reflection coefficient) much depend on blood circulation activity, on the presence of congestive hyperemia, tissue edema or hollow organs. Differentiation of the abovementioned status may be performed with other objective investigations.
Interesting diagnostic data may be obtained when the reflection coefficient is measured in two contralateral points on patient's body. For example, when we investigated a psoriatic patch with a small infiltrate, changed signals came mostly from the first channel ( a reflection coefficient); while in a marked infiltrate these changes came from both channel - first and second. Moreover, signal reflection increased by 30% and more comparing to healthy skin. A sharp change in the reflection coefficient was seen in kelloid scarring, in thrombophlebitis of deep veins, in postinjection infiltrates, in muscular edema of the lumber area, in adnexitis, arthroso-arthritis of large joints as well as in focal pneumonia.
The character of changes in signals coming from the photoregistor show the dynamics of the inflammatory process under laser therapy. So, a physician may predict results of treatment.
Interesting data have been obtained for mascular edema when clear, unidirectional changes in signals during one procedure demonstrate the effectiveness of treatment and determine a number of procedures including manual procedures. Levelling off the reflection coefficients in contralateral points certify the effectiveness of therapy applied.
One more area for biophotometry application is diagnostic measuring of skin scarification tests, Mantu reaction, etc. Thanks to this apparatus physicians can follow and control the efficiency of antihistamine preparations and desensitizing therapy. Namely, this device was used to evaluate the state of vegetative nerve system under scarification skin tests using vasoactive substances. It was for the first time when we had a method which helped to quickly and reliably determine vegeto -vascular damages and their character and to find out adequate doses of medicamentous preparations; it also helped to control other methods of treatment applied in similar disorders.
In conclusion, I would like to add some other peculiarities of the device:
- there is a possibility to use different lightguides (Fig.4) which allow to deliver laser light directly to a pathologic focus (gynecologic, proctologic, stomatologic, otorhynolaryngologic, acupuncture);
- there is a possibility to use the second terminal which is absolutely equivalent to the first one; it reduces the time of the procedure and increases the efficiency of treatment when we irradiate large skin zones, large joints ( coxofemoral, knee);
- there is a possibility to adapt this device with computer.
Thank you for your attention.
|Fig.2. Main parameters for the device "MILTA-F-8-01" type
|Wavelength of pulsed laser irradiation and sumerluminescent light-emitting diodes, within the range
|Output power of continuous light-emitting diodes radiation. Tunable (in the terminal aperture)
|Power density of light-emitting diodes radiation (in the terminal aperture)
|Laser radiation pulse duration
|Laser pulse frequency
in inner launching
in outer launching
|Output laser radiation power in the impulse ( in the terminal aperture); not less than
|Average power of laser radiation in the terminal aperture
in pulse frequency 5000Hz
|Average power density of laser radiation in the terminal aperture
in pulse frequency 5000Hz
in pulse frequency 5 Hz
|Magnet induction of the magnet axisin the terminal aperture
|Size of the terminal aperture
|Photoregistor digital rate(depends on the apparatus model)
|Duration of a single exposure (depends on the apparatus model)
||0,25; 0,5; 1; 2; 5; 10; 15 or about 2,5
||220±10% (50)or110±10% (60)
||not more than 25
S E T
of lightguides (attachments) for magnet-laser therapeutic device
with a photoregister "MILTA-F"
The set consists of six lightguide attachments and an adapter with thread to connect the attachments to the terminal in the device "MILTA-F". The attachments deliver laser and lightdiode irradiation directly to the target area on patient's organs (the uterine cervix, rectum, tonsil glands, etc.). Laser lightguide attachments are used in medical practice according to the accepted rules to treat different diseases of the inflammatory ethiology (see, for example, Illarionov V.E. Approaches and techniques in laser therapy".Reference book.Moscow: 1994, p. 178)The attachments are supplied with "MILTA-F" device either as a complete set or in any combination according to customer's wish.
-Attachment No.1 for treating uterine cervix pathology
-Attachment No.2 for treating vagina pathology (vulva craurosis, etc.)
-Attachment No. 3 for treating the vagina and rectum
-Attachment No.4 with a rubber bush for otorhinolaringology
-Attachment No.5 for stomatology
-Attachment No.6 for acupuncture
The attachments are cleaned manually before their sterilisation according to the current Standard Operating Procedure (developed by Healthcare Ministry)
Instruments are disinfected with a gauze wet in a disinfecting solution.
Lightguide attachments are sterilised in 6% hydrogen peroxide solution. Sterilisation regime corresponds to Standard Operating Procedure (developed by Healthcare Ministry OST 42-21-2-85). It is also allowed to sterilise the attachments sinking them into 0,5% chrolinehexydine solution in 70% alcohol for 3-5 minutes.
After sanitary treatment the face plane of the attachment ( on the side of laser irradiation entrance into the terminal) must not have any white settling. If such settling is present, it is wiped with a dry gauze.
A condom is put on gynecological and proctological lightguide instruments No.1, 2 and 3. A special rubber tube may be put on attachments No.4 and 5 which allows to fix these attachments in the mouth with patient's teeth.
An irradiation transmission coefficient in the attachments for the wavelength range 0,80-0,92 mkm is not less than 0,5.
Fig.2. A scheme of terminal and bioobject
1.Terminal. 2.Terminal chamber. 3. Light-emitting diodes. 4.Photodiodes. 5 Laser. 6.Magnet.7.Photodiodes. 8. Bioobject ( a target)
Terminal (1) has a chamber (2) in which there is a pulsed semiconductor laser (5), IR-lightguides (3) and photodiodes (4).
Chamber (2) passes through a ring of constant magnet in holes of which in special tubes there are photodiodes (7)
- Terminal chamber
- Light-emitting diodes
Fig.3. A general view of the terminal from the side of the aperture.