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Laser-Tissue Interactions Fundamentals and Applications - Markolf H. Niemz

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biological and medical physics, biomedical engineering

biological and medical physics, biomedical engineering

The fields of biological and medical physics and biomedical engineering are broad, multidisciplinary and dynamic. They lie at the crossroads of frontier research in physics, biology, chemistry, and medicine. The Biological and Medical Physics, Biomedical Engineering Series is intended to be comprehensive, covering a broad range of topics important to the study of the physical, chemical and biological sciences. Its goal is to provide scientists and engineers with textbooks, monographs, and reference works to address the growing need for information.

Books in the series emphasize established and emergent areas of science including molecular, membrane, and mathematical biophysics; photosynthetic energy harvesting and conversion; information processing; physical principles of genetics; sensory communications; automata networks, neural networks, and cellular automata. Equally important will be coverage of applied aspects of biological and medical physics and biomedical engineering such as molecular electronic components and devices, biosensors, medicine, imaging, physical principles of renewable energy production, advanced prostheses, and environmental control and engineering.


Elias Greenbaum, Oak Ridge National Laboratory,

Oak Ridge, Tennessee, USA

Editorial Board:

Masuo Aizawa, Department of Bioengineering, Tokyo Institute of Technology, Yokohama, Japan

Olaf S. Andersen, Department of Physiology,

Biophysics & Molecular Medicine,

Cornell University, New York, USA

Robert H. Austin, Department of Physics, Princeton University, Princeton, New Jersey, USA

James Barber, Department of Biochemistry,

Imperial College of Science, Technology

and Medicine, London, England

Howard C. Berg, Department of Molecular

and Cellular Biology, Harvard University, Cambridge,

Massachusetts, USA

Victor Bloomf ield, Department of Biochemistry, University of Minnesota, St. Paul, Minnesota, USA

Robert Callender, Department of Biochemistry,

Albert Einstein College of Medicine,

Bronx, New York, USA

Britton Chance, Department of Biochemistry/

Biophysics, University of Pennsylvania,

Philadelphia, Pennsylvania, USA

Steven Chu, Department of Physics,

Stanford University, Stanford, California, USA

Louis J. DeFelice, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, USA

Johann Deisenhofer, Howard Hughes Medical Institute, The University of Texas, Dallas, Texas, USA

George Feher, Department of Physics,

University of California, San Diego, La Jolla,

California, USA

Hans Frauenfelder, CNLS, MS B258,

Los Alamos National Laboratory, Los Alamos,

New Mexico, USA

Ivar Giaever, Rensselaer Polytechnic Institute,

Troy, New York, USA

Sol M. Gruner, Department of Physics, Princeton University, Princeton, New Jersey, USA

Judith Herzfeld, Department of Chemistry,

Brandeis University, Waltham, Massachusetts, USA

Mark S. Humayun, Doheny Eye Institute,

Los Angeles, California, USA

Pierre Joliot, Institut de Biologie Physico-Chimique, Fondation Edmond de Rothschild, Paris, France

Lajos Keszthelyi, Institute of Biophysics, Hungarian Academy of Sciences, Szeged, Hungary

Robert S. Knox, Department of Physics and Astronomy, University of Rochester, Rochester, New York, USA

Aaron Lewis, Department of Applied Physics,

Hebrew University, Jerusalem, Israel

Stuart M. Lindsay, Department of Physics

and Astronomy, Arizona State University, Tempe,

Arizona, USA

David Mauzerall, Rockefeller University,

New York, New York, USA

Eugenie V. Mielczarek, Department of Physics

and Astronomy, George Mason University, Fairfax,

Virginia, USA

Markolf Niemz, Medical Faculty Mannheim,

University of Heidelberg, Mannheim, Germany

V. Adrian Parsegian, Physical Science Laboratory, National Institutes of Health, Bethesda, Maryland, USA

Linda S. Powers, NCDMF: Electrical Engineering, Utah State University, Logan, Utah, USA

Earl W. Prohofsky, Department of Physics, Purdue University, West Lafayette, Indiana, USA

Andrew Rubin, Department of Biophysics,

Moscow State University, Moscow, Russia

Michael Seibert, National Renewable Energy

Laboratory, Golden, Colorado, USA

David Thomas, Department of Biochemistry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

Samuel J. Williamson, Department of Physics, New York University, New York, New York, USA

Markolf H. Niemz

Laser-Tissue Interactions

Fundamentals and Applications

Third, Enlarged Edition

With 175 Figures, 33 Tables, 40 Problems and Solutions


Professor Dr. Markolf H. Niemz

University of Heidelberg

MABEL – Mannheim Biomedical Engineering Laboratories


E-mail: Markolf.Niemz@urz.uni-heidelberg.de

Library of Congress Control Number: 2007930040

2nd Printing of the 3rd, enlarged edition (ISBN 3-540-40553-4) ISSN 1618-7210

ISBN 978-3-540-72191-8 3rd Edition Springer Berlin Heidelberg New York

ISBN 3-540-42763-5 2nd Edition Springer Berlin Heidelberg New York

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable for prosecution under the German Copyright Law.

Springer is a part of Springer Science+Business Media


© Springer-Verlag Berlin Heidelberg 2004, 2007

The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Typesetting by the authors

Production: LE-TEX Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany

Cover: eStudio Calamar Steinen

Printed on acid-free paper

SPIN 11878070

57/3180/YL - 5 4 3 2 1 0

Foreword to the First Edition

Dr.Markolf Niemz has undertaken the formidable task of writing a monograph on virtually all aspects of the current use of lasers in medicine, using laser–tissue interaction mechanisms as a guide throughout this book. The professional background of the author is in physics, in bioengineering, and in biomedical optics. In 1995, he was awarded the Karl–Freudenberg Prize by the Heidelberg Academy of Sciences, Germany, for his basic studies on laser–tissue interactions. Such a background is excellently suited to achieving the goals of this book, which are to o er an interdisciplinary approach to the basics of laser–tissue interactions and to use this knowledge for a review of clinical laser applications including laser safety.

His own research applying ultrashort laser pulses has enabled the author to provide profound discussions on photoablation, plasma-induced ablation, and photodisruption. Several aspects of related e ects were first described by himself. Moreover, photodynamic therapy, photothermal applications, and laser-induced interstitial thermotherapy are extensively addressed in this book. The reader thus obtains a comprehensive survey of the present state of the art.

This book is intended mainly for scientists and engineers in this field, but medical sta will also find many important aspects of interest. There is no doubt that this book will fulfil a need for all of us working in the field of lasers in medicine, and I expect that it will be received very well.

Academic Medical Center

Martin J.C. van Gemert

Amsterdam, 1996

Director of the Laser Center

Dedicated to my wife Alexandra


Do you like the idea of scrabble? Well, let’s just give it a try:













o r















I like playing around with words and letters. You probably know that LASER is an artificial word derived from “Light Amplification by Stimulated Emission of Radiation”. When starting my lecture on “Laser–Tissue Interactions” I tend to write this derivation on the board. I continue with “LIGHT: Lasers Irradiate Germinated and Healthy Tissues”.

Why? Lasers cut everything, if appropriate laser parameters are selected. There is no shield around healthy tissue. And there is no laser that fits all sizes as some clothes do. Lasers never have been some kind of wonder instruments. A wrong selection of laser parameters easily induces more damage than cure.

Congratulations! You are just reading the third edition of the textbook “Laser–Tissue Interactions”. Its main improvement is that a total of 40 comprehensive questions and solutions have been added to Chaps. 2 through 5. With these questions you can immediately test your acquired knowledge or prepare yourself for related exams.

Compared to the second edition, minor changes have been made throughout the book and a few figures have been modified. The new soft cover design helps to reduce costs. Thus, the third edition is now a ordable by students looking for a textbook to lighten up their lectures.

Let there be light. Laser light. Or what about: “LIGHT: Love Is God’s Hint to Trust” ...



September 2003

Markolf H. Niemz

Preface to the Second Edition

Since the publication of the first edition of this book six years ago both research and applications in laser medicine have undergone substantial growth. The demand for novel techniques based on minimally invasive surgery has increased tremendously, and there is no end to it yet. Therefore, as the first edition ran out of stock, the publisher has asked me to prepare a second edition taking all these new developments into account.

Well, here it is. Although minor changes and corrections have been made throughout the book, major changes have been limited to Chap. 4. The reason is that the theory presented in Chaps. 2 and 3 is basically complete and does not need any further modifications, except that the discussion on laserinduced interstitial thermotherapy (LITT) in Sect. 3.2 has been extended by the technique of a multi-fiber treatment. On the other hand, the contents of Chap. 4 – the chapter on applications – strongly depend on the current state of the art. The second edition of this book covers all applications addressed in the first edition plus novel techniques for refractive corneal surgery and the treatment of caries.

The success in refractive corneal surgery has significantly increased since the introduction of laser in situ keratomileusis (LASIK) described in Sect. 4.1. The quality of caries removal can be improved with the application of ultrashort laser pulses with durations in the femtosecond range as discussed in

Sect. 4.2. Furthermore, descriptive graphics have been added as in Sects. 3.2 and 4.10, and the reference section has been updated with the newest citations available on each topic.

Enjoy reading your second edition ...



January 2002

Markolf H. Niemz

Preface to the First Edition

This book has emerged from the need for a comprehensive presentation of the recently established field of laser–tissue interactions. So far, only publications dealing with specific issues and conference proceedings with contributions by several authors have been available for this subject. From these multi-author presentations, it is quite di cult for the reader to get to the bottom line of such a novel discipline. A textbook written by a single author is probably better suited for this purpose, although it might not provide the reader with all the details of a specific application.

The basic scope of the book was outlined during several lectures on biomedical optics which I held at the University of Heidelberg in the years 1992–1995. I have tried to include the most significant studies which are related to the field of laser–tissue interactions and which have been published during the past three decades. This comprises the description of experiments and techniques as well as their results and the theoretical background. Some parts of this book, especially the detailed discussion of ultrashort laser pulses, are naturally influenced by my own interests.

Due to the rapidly increasing number of medical laser applications, it is almost impossible to present a complete survey of all publications. Thus, this book will mainly serve as a starting guide for the newcomer and as a quick reference guide for the insider. For discussion of the newest techniques and results, the reader should consult the latest issues of scientific journals rather than a textbook. Regular coverage is provided by the journals Lasers in Surgery and Medicine, Lasers in Medical Science, Biomedical Optics, and the SPIE Proceedings on Biomedical Optics. Apart from these, related articles frequently appear in special issues of other journals, e.g. Applied Physics B and the IEEE Journal of Quantum Electronics, as well.

I wish to thank all authors and publishers who permitted me to reproduce their figures in this book. Some of the figures needed to be redrawn to improve readability and to obtain a uniform presentation. My special thanks are addressed to the participants of the seminar on Biomedical Optics of the

Studienstiftung des Deutschen Volkes (German National Fellowship Foundation) which was held in Kranjska Gora, Slovenia, in September 1995. Furthermore, I acknowledge Prof.Dr.J.Bille and his students for their valuable advice concerning the manuscript, Dr.T.Pioch for providing several of the