James W. Tunnell

Optimum pulse duration and radiant exposure for vascular laser therapy of dark port-wine skin: a theoretical study

Laser therapy for cutaneous hypervascular malformations such as port-wine stain birthmarks is currently not feasible for dark-skinned individuals. We study the effects of pulse duration, radiant exposure, and cryogen spray cooling (CSC) on the thermal response of skin, using a Monte Carlo based optical-thermal model. Thermal injury to the epidermis decreases with increasing pulse duration during irradiation at a constant radiant exposure; however, maintaining vascular injury requires that the radiant exposure also increase. At short pulse durations, only a minimal increase in radiant exposure is necessary for a therapeutic effect to be achieved because thermal diffusion from the vessels is minimal. However, at longer pulse durations the radiant exposure must be greatly increased. There exists an optimum pulse duration at which minimal damage to the epidermis and significant injury within the targeted vasculature occur. For example, the model predicts optimum pulse durations of approximately 1.5, 6, and 20 ms for vessel diameters of 40, 80, and 120 microm, respectively. Optimization of laser pulse duration and radiant exposure in combination with CSC may offer a means to treat cutaneous lesions in dark-skinned individuals.

Methodology for estimation of time-dependent surface heat flux due to cryogen spray cooling

AbstractCryogen spray cooling (CSC) is an effective technique to protect the epidermis during cutaneous laser therapies. Spraying a cryogen onto the skin surface creates a time-varying heat flux, effectively cooling the skin during and following the cryogen spurt. In previous studies mathematical models were developed to predict the human skin temperature profiles during the cryogen spraying time. However, no studies have accounted for the additional cooling due to residual cryogen left on the skin surface following the spurt termination. We formulate and solve an inverse heat conduction (IHC) problem to predict the time-varying surface heat flux both during and following a cryogen spurt. The IHC formulation uses measured temperature profiles from within a medium to estimate the surface heat flux. We implement a one-dimensional sequential function specification method (SFSM) to estimate the surface heat flux from internal temperatures measured within an in vitro model in response to a cryogen spurt. Solution accuracy and experimental errors are examined using simulated temperature data. Heat flux following spurt termination appears substantial; however, it is less than that during the spraying time. The estimated time-varying heat flux can subsequently be used in forward heat conduction models to estimate temperature profiles in skin during and following a cryogen spurt and predict appropriate timing for onset of the laser pulse.

Epidermal protection with cryogen spray cooling during high fluence pulsed dye laser irradiation: An ex vivo study

Higher laser fluences than currently used in therapy (5–10 J/cm2) are expected to result in more effective treatment of port wine stain (PWS) birthmarks. However, higher incident fluences increase the risk of epidermal damage caused by absorption of light by melanin. Cryogen spray cooling offers an effective method to reduce epidermal injury during laser irradiation. The objective of this study was to determine whether high laser incident fluences (15–30 J/cm2) could be used while still protecting the epidermis in ex vivo human skin samples.

Instrumentation for Multi-modal Spectroscopic Diagnosis of Epithelial Dysplasia

Reflectance and fluorescence spectroscopies have shown great promise for early detection of epithelial dysplasia. We have developed a clinical reflectance spectrofluorimeter for multimodal spectroscopic diagnosis of epithelial dysplasia. This clinical instrument, the FastEEM, collects white light reflectance and fluorescence excitation-emission matrices (EEMs) within a fraction of a second. In this paper we describe the FastEEM instrumentation, designed for collection of multi-modal spectroscopic data. We illustrate its performance using tissue phantoms with well defined optical properties and biochemicals of known fluorescence properties. In addition, we discuss our plans to develop a system that combines a multi-spectral imaging device for wide area surveillance with this contact probe device.

Assessing epithelial cell nuclear morphology by using azimuthal light scattering spectroscopy

We describe azimuthal light scattering spectroscopy (phi/LSS), a novel technique for assessing epithelial-cell nuclear morphology. The difference between the spectra measured at azimuthal angles phi = 0 degrees and phi = 90 degrees preferentially isolates the single backscattering contribution due to large (approximately 10 microm) structures such as epithelial cell nuclei by discriminating against scattering from smaller organelles and diffusive background. We demonstrate the feasibility of using phi/LSS for cancer detection by showing that spectra from cancerous colon tissue exhibit significantly greater azimuthal asymmetry than spectra from normal colonic tissues.

Effects of droplet velocity, diameter, and film height on heat removal during cryogen spray cooling.

Cryogen spray cooling (CSC) is an effective method to reduce or eliminate epidermal damage during laser treatment of various dermatoses. This study sought to determine the effects of specific cryogen properties on heat removal. Heat removal was quantified using an algorithm that solved an inverse heat conduction problem from internal temperature measurements made within a skin phantom. A nondimensional parameter, the Weber number, characterized the combined effects of droplet velocity, diameter, and surface tension. CSC experiments with laser irradiation were conducted on ex vivo human skin samples to assess the effect of Weber number on epidermal protection. An empirical relationship between heat removal and the difference in droplet temperature and the substrate, droplet velocity, and diameter was obtained. Histological sections of irradiated ex vivo human skin demonstrated that sprays with higher Weber numbers increased epidermal protection. Results indicate that the cryogen film acts as an impediment to heat transfer between the impinging droplets and the substrate. This study offers the importance of Weber number in heat removal and epidermal protection.

Methodology for characterizing heat removal mechanism in human skin during cryogen spray cooling.

AbstractCryogen spray cooling (CSC) reduces epidermal damage during laser treatment of various dermatoses. The goal of this study was to determine the heat removal mechanism in skin and quantify the amount in response to CSC. Thermocouples were imbedded in four model substrates with a range of thermal diffusivities, greater than three orders of magnitude in difference, to measure the temperature profiles in response to CSC and sapphire contact cooling, which removes heat completely by conduction. An algorithm solving an inverse heat conduction problem was subsequently used to quantify the amount of heat removal from the substrates using the measured temperatures. The interface thermal conductance and internal temperatures within the substrates were computed by a finite difference algorithm that solved the heat conduction equation. Results verify a marked increase in heat removal and interface thermal conductance with increasing thermal diffusivity. By estimation from the model substrate results, heat removal and interface thermal conductance values for skin were obtained. Data demonstrate that during CSC, evaporation is the dominant heat transfer mechanism in materials with higher thermal diffusivities; however, conductive cooling dominates in substrates with lower thermal diffusivities such as skin.

In-vivo study of epidermal protection by cryogen spray cooling during pulsed-laser irradiation at high radiant exposures

Cryogen spray cooling (CSC) offers a means to selectively cool the epidermis during laser therapy and has been used in conjunction with pulsed laser irradiation to treat light skin patients (Fitzpatrick Type I-TV) at moderate radiant exposures ( 15 J/cm2). Normal abdominal skin on twenty anesthetized individuals undergoing transverse rectus abdominis myocutaneous (TRAM) flap procedures with various skin types (Fitzpatrick type I-VT) were irradiated using incident radiant exposures of 8-30 J/cm2 without and with CSC. Assessment of tissue damage was based on histologic analysis. Epidermal damage was observed as basal epidermal cell vacuolization, epidermal basal layer separation, and epithelial cell spindling. For lighter skin patients (Fitzpatrick type IIV) the epidermal damage threshold was increased to as much as 30 J/cm2 when using CSC. However, complete epidermal protection in the darkest skin patients (Fitzpatrick type V-VT) could not be achieved with cryogen spurt durations as long as 300 ms using cunent CSC protocols.

Thermal response of human skin epidermis in different skin types to 595-nm laser irradiation and cryogen spray cooling: An ex-vivo study

Improved laser treatment of port wine stains is expected by utilizing higher incident dosages, longer pulse durations, and longer wavelengths than those currently used in clinical settings. However, higher incident dosages also increase the risk of nonspecific thermal injury to the epidermis. Using ex-vivo human skin samples, we investigated the thermal respone of human skin epidermis in different skin types ot 595-nm wavelength laser irradiation at high incident dosages (up to 20 J/cm2) and long pulse durations (1.5 to 40 milliseconds) in conjunction with cryogen spray cooling (CSC). Human skin samples (Fitzpatrick types I-VI) from consenting adult females undergoing trans-rectus abdominis myocutaneoues flap procedures were irradiated at the incident dosages D0=4, 6, 10, 15, and 20 J/cm2, pulse durations τlaser=1.5, 10, and 40 milliseconds without and with CSC (Refrigerant-134A, spurt duration τCSC=100 milliseconds). Thermal injury to the epidermis was evaluated by histological observations. Experimental results showed that thermal injury to the epidermis could not be avoided in skin type VI even at D0 = 4 J/cm2 in conjunction with CSC. However, CSC allowed utilization of high incident dosages (15 - 20 J/cm2) in skin types I-IV. Under the same incident dosage, longer pulse durations led to decreased degree of thermal injury to the epidermis. Threshold values for irradiation parameters that resulted in thermal injury to the epidermis for each skin type were obtained.

Thermal and fluid characteristics during cryogen spray cooling

Cryogen spray cooling (CSC) is a technique to protect the epidermis from non-specific thermal injury during laser treatment of various dermatoses. Successful application of CSC in conjunction with laser treatment of heavily pigmented individuals, and high radiant exposures which may be required for effective therapeutic outcomes, requires enhancement of heat removal. We have investigated the thermal mechanisms, and effects of droplet size, density and velocity on heat removal during CSC. Our results suggest that although the inherent thermal diffusivity of skin may be a limiting factor in heat removal, parameters such as droplet size, density, and velocity are important, and should be optimized for maximum heat removal.