UC Irvine Radiation Safety Division

Laser Safety

LASER SAFETY IN MEDICAL & CLINICAL

APPLICATIONS AT UC IRVINE

The use of lasers in medical and clinical applications has grown considerably in recent years.
Attendant to this increased use has been the need to train all of the physicians, nurses, and
technicians who operate lasers, or who work in surgical rooms in which they are operated,
regarding general laser safety principles. This document is intended to assist with that effort.

A. LASER SAFETY TRAINING

There are two components of laser safety training:

1. General laser safety training:

All persons who operate Class 3b and/or Class 4 research lasers on the UC Irvine main campus are
required to take the Laser Safety Online course (http://www.uclc.uci.edu/) listed under
“Catalog & Enrollment”). General laser safety principles are covered including all forms of laser
safety controls, biological effects of laser radiation, frequent causes of laser accidents, non-beam
hazards, and human behavioral factors as they relate to laser safety (fatigue, carelessness,
hurrying, horseplay, etc.).

The UC Irvine main campus Laser Safety Program does not provide primary oversight for
medical and clinical laser procedures performed at the Beckman Laser Institute, Gottschalk
Medical Plaza, or UCI Medical Center. The UCI Medical Center Radiation Safety Office
oversees those facilities. Thus, laser personnel there are not required by the main campus Laser
Safety Officer to take the Laser Safety Online course. It is highly recommended, however, that
they do take the course even though the principal focus of the material covered is research laser
safety. Much of this material applies, as well, to medical and clinical lasers.

2. On-the-job/hands-on training:

This is to be conducted by the laser system vendor and persons well experienced in the safe
operation of the specific medical/clinical lasers to be used. All persons who will be using the
lasers must be provided with adequate on-the-job training so that they are sufficiently competent
to operate them independently and safely, and to feel comfortable doing so. All appropriate
operational procedures need to be covered in this training including needed safety equipment and
other safety-related considerations.

√ All references to “EH&S” in the remainder of this document imply main campus EH&S.

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B. WARNING SIGNS AND ACCESS CONTROL

All rooms in which lasers are used in medical procedures must have permanent door-type warning
signs, slider-type warning signs, or illuminated “Laser On”/”Laser Operating” warning signs posted.
If sliders are used, they need to indicate that lasers are in use when they are and then be returned to the
other position (laser no longer in use) once the procedures have ended. EH&S provides doorknob-type
warning signs (“Do not enter, Laser operating inside”) on request for use temporarily in cases when
persons intending to enter procedure rooms need to be prominently alerted regarding potentially
enhanced hazards inside.

In cases in which illuminated warning signs are present outside procedure rooms, these signs should
only be turned on during laser use. Otherwise, they become part of the landscape and are ignored.

Only physicians, nurses and technicians needed to perform the procedures are permitted inside
laser use areas with the patient. All others, especially casual visitors/family members and persons
not trained in laser safety, must be excluded. Ideally, the door to the laser procedure room should be
locked during laser use.

C. MEDICAL LASER SAFETY PROCEDURES

Before the procedure

 Make sure that only persons who need to be there and who are sufficiently trained are present.
 Make sure any windows in the laser procedure room are covered and the laser use area is isolated
from other areas of the rooms by screens or barriers.
 Make sure the illuminated warning sign is on (if present) or the slider is in the correct position,
and that the door is locked.
 The person using the laser should remove all unnecessary reflective items from the area in which
the beam will be located to avoid unwanted reflections/stray radiation. This includes shiny medical
instruments, jewelry, watches, plastic ID card, etc.
 Ensure that there are sufficient pairs of protective eyewear available for physicians, nurses,
technicians, and patients and that each pair is the correct type with regards to the laser wavelength
to be used and the laser power. Contact EH&S at (949) 824-6098 with any questions concerning
protective eyewear.
 Airborne contaminant control systems (local exhaust suction, etc.) must be operational.
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During the procedure

 Everybody present who has a reasonable likelihood of being exposed to laser radiation must wear
protective eyewear. Keep protective eyewear on during the entire process. This includes the
patient being treated especially if the treatment area is near his/her face.
 The beam must be carefully controlled at all times.
 Never leave a laser operating and unattended in an unsafe condition.
 Laser firing foot pedals and finger switches must be separate from any similar switches to avoid
confusion.
 Keep in mind that the most dangerous lasers are the invisible beam lasers, particularly near-
infrared lasers. Use a high degree of caution when operating these types of lasers.

After the procedure

 Keep protective eyewear on until the laser system is off or placed into a safe mode (standby).
 Remove the temporary alignment doorknob warning sign or move the slider to the laser-off
position.
 Always store the protective eyewear near the lasers for which it is worn such that it will not get
lost, scratched, or broken. Keep the eyewear in protective cases, if possible, in a clean and dry
location.

D. PROTECTIVE EYEWEAR

Contact EH&S or the laser eyewear vendors for assistance in selecting eyewear including calculating
the optical density (OD) needed for adequate laser radiation filtration. Complete the attached Laser
Safety Eyewear Evaluation form and return it to EH&S for assistance in determining the needed OD.

The protective eyewear vendors below have good eyewear selections and excellent customer service.
They supply all types of laser eye protection and they frequently give discounts on eyewear to
educational institutions like UC Irvine:

NoIR Laser Company Laservision USA

P.O. Box 159, South Lyon, MI 48178 595 Phalen Blvd., St. Paul, MN 55101
Phone: 800-521-9746 ; Fax: 734-769-1708 Phone: 800-393-5565 ; Fax 651-357-1830
Web: www.noirlaser.com Web: http://www.lasersafety.com/

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Laser Safety

Kentek Corporation
1 Elm Street, Pittsfield, NH 03263
Phone: 800-432-2323
Web: www.kenteklaserstore.com

Newport Corporation
1791 Deere Avenue, Irvine, CA 92606
Phone: 949-863-3144
Web: www.newport.com

* Note: Special M-rated eyewear is needed for ultrafast lasers (pulse duration < 1 nanosecond).

E. CONTROL OF NON-BEAM HAZARDS

1. Electrical hazards

Only persons experienced in electrical maintenance and repair may perform these tasks on medical
lasers. EH&S offers a course in High Voltage Safety; interested persons can register at
www.ted.uci.edu. High voltage power supplies should only be serviced when personnel
knowledgeable in performing cardiopulmonary resuscitation (CPR) are present. The Anteater
Recreation Center on campus offers CPR and First Aid classes (http://www.campusrec.uci.edu/).

2. Fire hazards

Class 4 visible and infrared beams with irradiances above 10 W/cm2 can ignite combustible
materials like paper, drapes, plastic endotracheal tubes, and clothing. Keep combustible materials
including all organic solvents like rubbing alcohol and all flammable anesthetic gases away from
laser use areas. A fire extinguisher must be present for use in the event of a fire. There have been
reports of ignition in vivo of anesthetic gases and intestinal gas during laser procedures so caution
must be exercised regarding that potential hazard.

3. Chemical hazards

Fluorine and chlorine gases are used with excimer lasers; these need to be stored in approved
ventilated gas cabinets. Dye solutions used with pulsed dye lasers need to be mixed in a properly
functioning fume hood by personnel wearing personal protective equipment; ideally, the vendor
will provide dye mixtures. Material Safety Datasheets for toxic materials must be reviewed prior
to using them: http://www.ehs.uci.edu/msds.html

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Laser Safety

4. Laser-generated air contaminants

These are potentially toxic substances generated when high power laser beams strike target
materials such as plastic and tissue. Enhanced general dilution ventilation and local exhaust
ventilation/suction are two means of controlling this hazard. In rare cases, respirators need to be
worn. Keep in mind that surgical masks are not intended to be completely protective against
smoke generated from laser beam/tissue interactions. A more substantial respirator is needed for
that purpose especially since the plume emitted from tissue during laser surgery can contain
pathogens (bacteria, viruses) in addition to other combustion products. Local exhaust removal with
a suction system is the best means of control.

5. Collateral radiation

Some laser systems can generate x-rays, ultraviolet radiation, intense non-coherent visible
radiation, or radiofrequency radiation. Contact EH&S if you have any concerns regarding this.
Exposure of bone to laser radiation might result in a low level of collateral ultraviolet radiation.

6. Noise

Some lasers can emit loud noise during pulsing. Contact the Industrial Hygiene Division of EH&S
at (949) 824-6200 for assistance with hearing protection and noise control methods.

F. EMERGENCY PROCEDURES

In the event that you or somebody else in your group suffers an eye or skin injury:

1. Turn off the laser involved in the accident immediately and unplug it. Post a “Do not use!” sign on
the laser to ensure it is not used again until it can be determined that it is safe.
2. Keep the injured person calm. If an eye injury is suspected, keep the person in an upright position.
3. Make sure the injured person receives immediate medical treatment if the injury is serious –
injured persons need to be seen by a doctor as soon as possible.
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4. Arrange for transportation of a seriously injured person to a medical facility. The victim might be
in shock or have impaired vision so self-transportation is contraindicated. See the UC Irvine
Injuries and Medical Treatment poster (http://www.ehs.uci.edu/MedEmergPoster.pdf) for
locations for emergency treatment.
5. If the injury is life-threatening (electrocution), call 911 immediately. Call the UC Irvine Police at
(949) 824-5222. Perform CPR if you are trained to do so.
6. Minor skin injuries can often be treated by rendering First Aid in the laboratory.
7. Notify persons who need to be informed about the accident (Medical Director of facility, UCI
Laser Safety Officer (for main campus incidents only), UCI Medical Center Radiation Safety
Officer (for incidents at UCIMC), Nursing Supervisor, etc.).

G. MOST COMMON CAUSES OF MEDICAL/CLINICAL LASER ACCIDENTS

1. Poor control of laser beam; hand-held beam delivery wand not well managed.
2. Fatigue, rushing through procedure.
3. Laser operator not sufficiently trained.
4. Eye protection not worn or the wrong eyewear worn.
5. Laser procedure area not optically isolated from other nearby areas and entryways.
6. Manufacturer and laser user installed safety features removed or bypassed.
7. Laser system not properly maintained.
8. Inattention to potential electrical and fire hazards.
9. Hand accidentally placed in beam and burned.
10. Stray radiation off of reflective medical instruments.

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H. SPECIFIC LASER SAFETY PROCEDURES

Please add below any appropriate laser safety-related procedures specific to your medical
or clinical laser applications that are not covered by the above general safety procedures.
These should include any special laser system startup, alignment, and shutdown
procedures including all safety-related and patient-related steps:

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 UC IRVINE MEDICAL LASER SAFETY CHECKLIST

PHYSICIAN, TECHNICIANS, AND NURSES SUFFICIENTLY TRAINED

DOOR LOCKED AND WARNING SIGN POSTED/WARNING LIGHT ILLUMINATED

BEAM WELL CONTROLLED AND LASER USED BY PHYSICIAN ONLY

OTHER AREAS ISOLATED BY SCREENS OR BARRIERS; WINDOWS COVERED

LASER “POWER UP” WARNING LIGHTS CLEARLY VISIBLE

FOOT PEDAL OR FINGER SWITCH LABELED/GUARDED/WELL CONTROLLED SO

NO ACCIDENTAL FIRING OF LASER

ONLY ANODIZED/BLACKENED/MATTE FINISH RETRACTORS IN BEAM AREA

UNNEEDED REFLECTIVE ITEMS REMOVED FROM BEAM AREA AND HANDS

PROTECTIVE EYEWEAR AVAILABLE AND USED BY EVERYBODY PRESENT

ALL NEEDED SUPPLIES READILY AVAILABLE

ALCOHOL AND WET IODINE PREPS DRY BEFORE FIRING LASER

ELECTRICAL, FIRE, COMPRESSED GAS, AND CHEMICAL HAZARDS PROPERLY

CONTROLLED

CAUTION USED WHEN HANDLING SALINE OR OTHER CONDUCTIVE FLUIDS

NEAR ELECTRICAL SYSTEMS

SYSTEMS TO REDUCE LASER GENERATED AIR CONTAMINANTS OPERATIONAL

(LOCAL EXHAUST, ETC.)

PHYSICIAN/SURGEON TESTS LASER BEFORE USE TO CHECK SPOT SIZE,

FLUENCE, ETC., POSSIBLY USING A TONGUE DEPRESSOR OR BEAM
CARD/PAPER

Checklist completed by__________________________________________

Date_____________

Notes________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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
LASER SAFETY EYEWEAR EVALUATION

Person Requesting Evaluation___________________________ Date___________

Principal Investigator/Physician__________________________________

Department/Medical Facility__________________________________________

LASER DATA Laser 1 Laser 2

Type of Laser (Nd:YAG, Argon, HeNe, etc.)
Class of Laser (3b or 4)
Wavelength(s) Produced (nm)
Operation: Continuous Wave, Single Pulsed,
Repetitively-pulsed, Q-Switched, Mode-
locked (more than one might apply)
For Continuous Wave Laser:
Maximum Power (mW or W)
For Pulsed Laser:
Maximum Pulse Energy (µJ, mJ or J)
Pulse Duration
Pulse Repetition Frequency (Hz)
Maximum Exposure Duration*
Optical Density (OD) Needed*

* To be determined by EH&S

Return to the Laser Safety Officer, EH&S, Zot Code 2725

[Or call (949) 824-6200 if you have any related questions]
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UC Irvine Radiation Safety Division

SOME COMMON LASERS USED IN MEDICAL APPLICATIONS

Target Organs  Parts of body that can be injured by inadvertent exposure to laser
radiation

Carbon Dioxide (CO2) Laser

Far infrared beam – 10,600 nm
Target organs – cornea of eye, skin (thermal burns)
Generally continuous wave operation, sometimes pulsed
Can be focused to cut tissue, or defocused to ablate or shave tissue
 Uses: Removal of skin lesions, as laser scalpel, surgery for snoring (rhinophyma),
skin shaving/resurfacing, wrinkle removal, cutting/vaporizing tissue, endoscopic
surgery, dental treatments

Argon Laser
Blue-green visible light (488 nm, 514 nm)
Target organs – retina of eye, skin (thermal burns)
Continuous wave or pulsed
 Uses: Retinal/ear surgery; port wine birthmark removal; spider vein removal,
photodynamic therapy (shrink/dissolve tumors)

YAG Lasers:

Nd:YAG
Near infrared beam (1064 nm or 1320 nm)
Target organs – retina of eye, skin (thermal burns)
Continuous wave or pulsed
 Uses: Tattoo removal, hair removal
KTP/YAG
Green visible light (532 nm)
Target organs – retina of eye, skin (thermal burns)
Continuous wave or pulsed
 Uses: Removal of prominent veins, cuts tissue, red/orange tattoo removal,
endoscopic surgery
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Erbium YAG
Middle infrared beam (2940 nm)
Target organs – Cornea of eye, skin (thermal burns)
Generally pulsed
 Uses: Cosmetic laser resurfacing, remove superficial skin lesions; used in dentistry
Holmium:YAG
Middle infrared beam (2070 nm)
Target organs – Cornea of eye, skin (thermal burns)
Generally pulsed
 Uses: Ablate bone and cartilage, orthopedic, urological, ENT, dental applications

Ruby Laser
Red visible beam (694 nm)
Target organs – retina of eye, skin (thermal burns)
Pulsed
 Uses: Tattoo and pigmented lesion removal, hair removal
Alexandrite Laser
Red visible beam (755 nm)
Target organs – retina of eye, skin (thermal burns)
Pulsed
 Uses: Tattoo and hair removal
Pulsed Dye Laser
Yellow visible beam (577 – 585 nm)
Target organs – retina of eye, skin (thermal burns)
Pulsed
 Uses: Port wine stain and scar removal, and vascular lesion treatments (facial
spider veins, Rosacea)

Copper Vapor Laser

Green visible beam (511 nm, 577 nm)
Target organs – retina of eye, skin (thermal burns)
Pulsed
 Uses: Vascular lesion treatments

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Laser Safety

Diode Laser
Near-infrared beam (800 – 900 nm)
Target organs – retina of eye, skin (thermal burns)
Pulsed or continuous wave
 Uses: Hair removal, periodontal surgery, superficial vein removal
Excimer Laser
Ultraviolet beam (193 nm most common)
Target organs – cornea/lens of eye, skin (photochemical burn)
Pulsed
 Uses: LASIK, PRK (eye surgeries)

Intense Pulsed Light

Intense Pulsed Light (IPL) is currently being used as an alternative to coherent laser light
to treat a variety of skin conditions including tattoos and spider/leg veins as well as for hair
removal. Basically the IPL device is an intense flashlamp attached to a power source.
Pulses of broadband light are applied through colored filters which can be adjusted to
match the patient's skin type and the targeted lesion. The cost of the devices and of IPL
procedures are similar to those of comparable lasers and clinical laser procedures.
Although fast and versatile, IPL devices are as a rule somewhat less effective for a given
task than a laser dedicated to the purpose. Protective eyewear needs to be worn during
IPL treatments such as these types below.

http://www.rli.com/products/eyewearitemdetail.asp?Heading=Laser_Eyewear&item=E-G-
9624

http://www.lasermet.com/safety_eyewear_ipl.htm

================================================================
 Contact the UCI Laser Safety Officer at 949-824-6200 regarding any
questions concerning the contents of this document.
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