Medicīnas lāzeru drošības klases un tām atbilstošie audu bojājumi. Lāzeru drošības noteikumi un standarti. Aizsargbrilles un citi drošības līdzekĝi.
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1 RTU un LU starpaugstskolu maăistrantūras studiju modulis Medicīnas fizika Līgums 2006/0250/VPD1/ESF/PIAA/06/APK/ /0079/0007 Medicīnas lāzeru drošības klases un tām atbilstošie audu bojājumi. Lāzeru drošības noteikumi un standarti. Aizsargbrilles un citi drošības līdzekĝi. 10. lekcija
2 Draudu veidi 1) Acs traumas; 2) Ādas apdegumi, kancerogēna iedarbība ; 3) Ėīmiskie; 4) Elektriskais lāzeros ierosmei var tikt izmantots vairāku tūkst. V spriegums; 5) Ugunsdraudi lielas jaudas lāzerstarojums var izraisīt apkārtējo priekšmetu (apăērba) aizdegšanos; 6) eksplozijas draudi lāzera starojums ar izraisīt anestēzijas gāzu aizdegšanos 7) Infekcijas draudi
3 Papildus riski Plastmasu, krāsu, kosmētikas u.c. vielu aizdegšanās Dūmi un toksiskās gāzes, kas izdalās lāzeru operācijās no audiem Negaidīti atstarojumi no pulētām virsmām rokas pulksteħiem, gredzeniem, aprocēm,
4 Apdraudētie un draudu avoti Visvairāk apdraudēti ir pacienti (~72% ), medicīnas personāls (~10%), tehniskais personāls (10%) un citi; Visvairāk negadījumu oftalmoloăijā (~21%); Lāzeri, ar ko visbiežāk notiek negadījumi: Nd:YAG (32%) CO 2 (26%) Ar (13%);
5 Draudi acīm Iedarbība atkarīga no viĝħa garuma: nm, daĝēji UVA( nm) absorbē radzene, ilgstoša iedarbība var izraisīt fotofobiju, apsārtumu, epitēlija šūnu slāħa šėelšanos, fotokeratītu (radzenes iekaisums); nm starojumu absorbē lēca, kas var izraisīt kataraktu; - Redzamajā un tuvajā IS ( nm) diapazonā starojums tiek fokusēts uz tīklenes, kas uz radzenes krītošā starojuma jaudas blīvumu tīklenē var pastiprināt ~ reizes; - Ilgstoša IS starojuma iedarbība var izraisīt radzenes apdegumus
6 Acu bojājumi
7 Bīstamība acīm For wavelengths that focus on the retina (400 to 1400 nm) the optical gain of the eye is about 100,000 times! If the irradiance entering the eye is 1 mw/cm 2 then the irradiance at the retina will be 100 W/cm 2.
8 Acs optiskā caurlaidība (līdz tīklenei)
9 Bīstamības klasifikācija Starojuma iedarbība uz acīm vaiādu Uguns Toksiskās gāzes Letālais augstsprieguma šoks
10 Bīstamības klasifikācija - 1 Starojuma iedarbība uz acīm vaiādu Tiešais stars uz ādas vai acīm Atstarotais stars no optikas vai darba virsmas Tuvie infrasarkanie un redzamie lāzeri (400nm 1400nm) var iespiesties līdz acu tīklenei Nd:YAG, Yb fiber, Cu-vapor, diode, HeNe
11 Bīstamības klasifikācija - 2 Tīklenes bojājums ir bīstamāks nekā radzenes bojājums Bez bojājumiem Radzenes bojājums Tīklenes bojājums
12 Acu aizsardzība Bīstams var būt arī atstarotais starojums, tāpēc visiem vienā telpā ar starojuma avotu esošajiem jālieto aizsargbrilles (atbilstoši manipulācijās izmantotā lāzera viĝħa garumam); Pacientam var tikt uzvilkti metāla vai akrila aizsargi; Drošības sienas;
13 Aizsardzības līdzekĝi Lāzerbrilles ViĜĦa garums un optiskais blīvums
14 Aizsargbrilles un filtri Ārstiem, personālam un pacientiem pie ieslēgta lāzera brilles ir obligātas Nav universālu aizsargbriĝĝu visiem lāzeriem, jāizvēlas atbilstoši starojuma viĝħu garumam Bloėējošie krāsu filtri jāizmanto instrumentos (piemēram, mikroskopos), arī durvju logos
15 Durvju aizsargbarjera
16 1) Apdegumi; Āda 2) Starojums kā mutogēns (UV); Jākontrolē staru gaita, strādāt, tā, lai pēc iespējas mazāka daĝa ādas būtu atkailināta;
17 Ādas bojājumu riski Reflektivitāte ( albedo ) pie lāzerstarojuma viĝħu garuma ir noteicošā Tumši pigmentētai ādai apdeguma risks lielāks UVB and UVC papildus eritēma; 248 nm: kancerogēns? Kosmētiskie krēmi un losjoni var uzliesmot (alkohols)
18 Ādas atstarošana
19 Lāzeru traumas
20 Ėīmiskie draudi 1) Izmantojot lāzeru ėirurăiskajās operācijās lielas temperatūras apstākĝos veidojas toksiski un kancerogēni sadegšanas produkti, kas var apdraudēt gan personālu, gan arī pacientu, īpaši veicot operācijas ar endoskopa palīdzību; 2) Dūmos, kas veidojas lāzeroperāciju laikā, atrodamas daĝiħas, kas pat 16 reizes mazākas par ėirurga sejas maskas porām; daĝiħas, uzkrājoties plaušās, var izraisīt virkni slimību; Galvenais veids, kā pasargāties no 1) un 2) izmantot gaisa atsūcējus ar filtriem
21 Elektrotraumas Lāzeros var tikt izmantots vairāku kv liels spriegums, kas ir bīstams cilvēka dzīvībai (ir bijuši pat letāli gadījumi); Lāzeru apkope jāuztic apmācītam personālam (tieši tāpat kā jebkuru elektroierīci) ; Veicot remontdarbus barošanas blokā, jāuzmanās no augstsprieguma kondensatoriem; Daudzos lāzeros iestrādāta drošības sistēma atverot vāku, izslēdzas barošana
22 Uguns un eksplozijas draudi Ja pacientam tiek pievadīts skābeklis, palielinās ugunsdraudi īpaši veicot operācijas sejas rajonā; jāsargā mati; Lielas jaudas lāzeri var izraisīt apkārtējo priekšmetu aizdegšanos jāizvairās no viegli uzliesmojošu materiālu izmantošanas; Nedrīkst izmantot viegli uzliesmojošas anestēzijas vielas; Pat anestēzijas gāze var eksplodēt plaušās
23 Infekcijas draudi 1) Veicot darbus ar lielas jaudas lāzeriem, tvaiki var iestumt dziĝāk brūcē bojātos vai inficētos audus; 2) Lāzerėirurăijas dūmos var atrasties dzīvotspējīgas apstrādāto audu šūnas un arī izturīgākie vīrusi ; Infekcijas draudi nav lieli, bet tas ir vēl viens iemesles, kāpec nepieciešams izmantot gaisa atsūcēju; 3) Personālam jālieto sejas maskas
24 Brīdinājuma zīmes
25 Lāzeru bīstamības klasifikācija Class 1 - Nav bīstams nepārtrauktai skatīšanai - Parasti nav pieejami atklāta veidā
26 Lāzeru klasifikācija Class 2 - Zemas jaudas gaismas lāzeri, nav bīstami ja apstarošana ir īslaicīga. - Jauda: < 1mw
27 Class 3a Lāzeru klasifikācija - Parasti acīm nav kaitīgi ja apstarošana ir īslaicīga, bet ja tiek izmantota fokusējoša optika ir bīstami - Jauda: < 5mW (Tipiskais lāzerpointers)
28 Class 3b Lāzeru klasifikācija - Ir bīstami ja lāzerstarojums trāpīts acī tiešā tēmējumā, va atstarots no spoguĝvirsmas. Izkliedētais starojums no baltas lapas nav bīstams - Jauda: < 500mW - Lielas jaudas pointeri - He-Ne laser
29 Class 4 Lāzeru klasifikācija - Bīstams ne tikai tiešais vai atstarotais trāpījums acī, bet arī difūzi atstarotais starojums. - Boja ādu, var radīt uguns briesmās
30 Teksti uz brīdinājuma zīmēm - 1 CLASS 1 LASER PRODUCT LASER RADIATION DO NOT STARE INTO BEAM CLASS 2 LASER PRODUCT LASER RADIATION DO NOT STARE INTO BEAM OR VIEW DIRECTLY WITH OPTICAL INSTRUMENTS CLASS 3A LASER PRODUCT
31 Teksti uz brīdinājuma zīmēm - 2 LASER RADIATION AVOID EXPOSURE TO BEAM CLASS 3B LASER PRODUCT LASER RADIATION AVOID EYE OR SKIN EXPOSURE TO DIRECT OR SCATTERED RADIATION CLASS 4 LASER PRODUCT
32 Brīdinājuma zīmes: kur un kad Uz lāzera starotāja ( galvas ) Uz durvīm telpai, kurā atrodas lāzers Uz pagaidu ierobežojuma ap lāzeroperācijas galdu Papildus brīdinājumi, tikko tiek ieslēgts lāzers sarkana mirgojoša gaisma, brīdinājums pie durvīm no ārpuses,
33 Lāzeroperācija
34 Īpašie drošības pasākumi medicīnas lāzeriem Kājas slēdzis: vienmēr ārsta kontrolē Avārijas poga: uzkrītoši liela, viegli aizsniedzama Durvju kontakts lāzera barošanas ėēdē Necaurspīdīgs pagaidu norobežojums ap lāzeroperācijas vietu Anti-refleksijas pārklājumi instrumentiem Gāzu atsūknētāji - vienmēr ātri pieslēdzami Nedegoši materiāli halātiem, cimdiem u.c.
35 Pointeru izmantošana Lekcijās Prezentācijās TēmēkĜos u.c.
36 Lāzerpointeru lielā un vienkāršā Maksā <20$ pieejamība Elektroniskas rotaĝlietas FDA pieprasa, lai tiktu liktas brīdinājumu zīmes uz lāzerpointeriem
37 Lāzerpointeru sekundārie efekti Iespīdina lāzerpointeri automašīnas vadītāja acīs Iespīdina sportistam acīs Psiholoăiskā reakcija uz iespīdināšanu acīs
38 ALI uzskata Jāierobežo lāzerpointeru izmantošana un pārdošana Jāizglīto sabiedrība Nedrīkst spīdināt acīs Neizmantot citiem mērėiem Nespīdināt uz atstarojošām virsmām Nepirkt, ja nav uzliktas brīdinājuma zīmes
39 Lāzeru drošības standarti International IEC (1999) Guidelines for the safe use of medial laser equipment European EN , IEC 60825, EN 208 National: ANSI-Z (2000) in USA - AS/NZS 2211 (1997) in Australia /New Zeland - BS EN (2001) in UK - DIN EN (1997) in Germany -...
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