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1 CHAPTER 13. ULTRAVIOLET RADIATION

2 2 Figure The electromagnetic spectrum ranges from low frequencies in the hertz range to over 1023 Hz, with wavelengths varying from over 10,000 km to less than 1 pm.

3 3 Physical properties of UV radiation

4 Figure Bands of ultraviolet (UV) radiation. ELF, Extremely low frequency; IR, infrared.

5 Physical properties of UV radiation 5 Electromagnetic radiation with a frequency range of 7. 5 x to over Hz wave length from 400nm ~ 290nm between X-ray and visible light 3 bands UVA (320 ~ 400 nm) : long wave UV, fluorescence ( 형광생성 ) UVB (290 ~ 320 nm) : middle wave UV, erythema ( 홍반생성 ) UVC ( < 290 nm) : short wave UV, germicidal ( 살균 ) physical effects by non-thermal mechanism Most significant source of UV by Sun UVA, UVB : reach the earth ` UVC : filter out by ozone layer

6 Physical properties of UV radiation Factor influenced on physiological effects of UV Wave length of the radiation intensity of radiation reaching the skin depth of penetration high intensity of UV

6 6 Physical properties of UV radiation Factor influenced on physiological effects of UV Wave length of the radiation intensity of radiation reaching the skin depth of penetration high intensity of UV radiation reaching the patient s skin high power lamp close to the patient perpendicular to the surface of the skin Deepest penetration of UV - highest intensity - longer wavelength - lowest frequency - UVA : several milimeters of skin But UVB, UVC : less deeply and are almost entirely absorbed in the superficial epidermal layer

7 Snell 의굴절법칙 7 개요. 광선및전파가서로다른매질의경계면을입사하여통과할때입사각과굴절각의관계식

8 Lambert 의흡수의법칙 8 빛의세기가 I 인빛이두께가 d 인물질층을통과할때빛의흡수로인한투과하는빛의세기의감소에관한관계 log (I 0 /I) = μd 입사광의세기 I 0 투과광의세기 I 흡수층의두께 d 흡수계수 ( 농도 ) μ 물질의두께가두껍고, 흡수계수가큰물질일수록투과되는광선이적다 광선치료시여과기 filter) 를선택할경우흡수계수와두께를고려할것

9 Lambert s cosine law 9 광원과물체가이루는각도에따라광선의세기는달라진다법선과입사광선사이에존재하는각 Θ가있다면빛의세기 ( 반사되지않고투과되는빛에너지 ) 는 cos Θ값에비례한다. cosine 각이클수록효율 (cos Θ) 은적어진다. 광원과환자의표면이이루는각이90 (cos0 =1) 로갈수록효율은커진다.

10 거리제곱반비례의법칙 (inverse square law) 10 t 1 / d 12 = t 2 /d 2 2 광원에서나온빛은한방향으로직진하는것이아니라, 사방으로퍼지기때문에광원에서물체까지가거리가멀수록광선의효율은떨어지게된다. 예 ) 광선복사를 20 cm에서 60 초로노출했다면, 10 cm의거리에서는몇초동안노출해야처음의강도와같을것인가?

11 11 Effects of UV radiation

12 Effects of UV radiation 12 skin absorption of electromagnetic energy photobiological process Skin erythema Tanning Epidermal hyperplasia Vitamin D synthesis Bactericidal effects ( 살균작용 )

Erythema production 13 A result of dilation of the superficial blood cell caused by the release of histamine UVB exposure or UVA exposure after drug sensitization Mechanism of UV-induced erythema

13 Erythema production 13 A result of dilation of the superficial blood cell caused by the release of histamine UVB exposure or UVA exposure after drug sensitization Mechanism of UV-induced erythema Prostaglandin release from epidermis DNA-damaging effects of UV radiation Symptom of severe erythma - blistering( 물집 ), tissue burning, pain, risk of cell damage Minimal erythemal dose (MED) : smallest dose of UV to produce erythema within 8 hrs within 24 hrs

14 홍반반응의측정 2400 ~ 3200 Å 홍반하용량 (Suberythemadose) 최소홍반용량 (minimal erythema dose, MED), 1 도홍반용량, 강장용량 (tonic dose) 2 도홍반용량 (2nd erythema dose) : 경미한 sunburn reaction 3 도홍반용량 (3rd erythema dose) : 반대자극용량 (counter irritant dose) 4 도홍반용량 (4th erythma dose) : 파괴용량 (destructive dose)

15 홍반 2400 ~ 3200 Å 정도반응출현시간시각반응지속시간검사 1 도 Minimal erythema Tonic effect 6~8 시간 약간붉은색 24~36시간 검사 전신치료 2도 경미한 sunburn 4~6시간 붉은색 2~3일 전신치료 국소치료 3도 Counter irritation 3~4시간 붉은색, 부종 1주일 국소치료 4도 destructive effect 2시간 강한발적, 물집, 괴사 수주일 국소치료

16 Tanning 16 Delayed pigmentation of the skin by UV exposure Mechanism of tanning production and upward migration of melanin granules oxidation of premelanin in the skin the penetration of UV to deeper tissue layers protective response of the body

17 색소침착 2800 ~ 3300 Å 2800 ~3300 Å 광선이기저세포층에흡수 멜라닌아세포에의해 tyrosine 이 melanin 으로전환된다. : 색소침착은피부암에대한방어작용 (tanning effect ) 3100 Å 이하 : 세포구조의변화, 멜라닌색소형성인자의자극 3100 ~ 4200 Å: 표면멜라닌의흑화현상 (darkening) 태양, 탄소방전등 : 갈색의색소침작수은증기등 : 회색의색소침착 색소침착의기전 - UVA ( 즉각적인표피천부로멜라닌이동 ), UVB(2~3일, 지연적 ) - 스트레스 - 내분비기능장애 ex) 부신, 간기능저하 Tanning effect ~4400 Å ( 3400 Å 에서최대 ) 2540 Å : 2~3 주지속, 2970 Å : 1~5 개월지속

18 Epidermal hyperplasia 18 Thickening of the superficial layer of the skin - occurs a approximately 72 hours after exposure to UV radiation - by repeated exposure Mechanism release of prostaglandin precursors leading to increased DNA synthesis by epidermal cells epithelial cell turnover and cellular hyperplasia Most UVB exposure Protective response to UV exposure Progressive higher doses of UV radiation are generally need during a course of UV Tx

19 Vitamin D synthesis 19 Conversion of ingested provitamin D to active vitamin D Vitatmin D - essential vitamin for bone formation ( control of calcium absorption) - brain, kidney, intestine, endocrine, immune, and cellular function Deficiency of Vitamine D - poor intestinal absorption of calcium - if severe, rickets ( by failure of bone mineralization)

20 20 Figure Conversion of provitamin D to active vitamin D and some of the physiologic roles of vitamin D.

21 비타민 D 3 의형성, 항구루병효과 3200 Å 이하 자외선은피부의상층, 모낭, 피지선과땀샘에있는 plant sterol, ergosterol, 7-hydro cholesterol 등에흡수되어부산물로 Vt D 합성 Vt D 생성 3200 Å 이하, 2830 Å 에서최대 ( Stillwell : 2400 ~ 3000 Å, Scott : 2700~ 3100 Å) 비타민 D3의활성화 2700~ 3000 Å 비타민 D 기능 - 칼슘과인의흡수를촉진, 조직중의인산을칼슘과결합시켜뼈에침착 - 조직중의칼슘축적을조정하는부갑상선의기능을원만하게함 - 구루병, 충치, 골절예방

22 Bactericidal effects 22 UVC in adequate dose Standard hospital cleaners, open wound, wound healing

23 살균효과 2900 Å 이하 (abiotic ray) 2400 Å에서최저살균효과 2652 Å 에서최대살균효과 ( 2537 Å : 90% 살균효과 ) 만성궤양, 욕창 : 2537 Å 3000 Å 이상에서는살균효과적음 기전광선 (2900 Å 이하 ) 의흡수에의한핵산파괴에의함 (abiotic ray ) 표피의천층에서흡수되어약 2mm 정도로침투되기때문에그깊이이후에는살균효과가나타나지않음 cf) 2900 Å 이상 : biotic ray 살균효과 - 피부상처나감염치료에효과적, 공기소독 - 3, 4도홍반용량사용

24 Other effects of UV radiation 24 UVB - immune system. - Dose dependent low dose: immune response suppress high dose : activated UVA inhibit cyclooxygenase 2 expression and prostaglandin E 2 production - psoralen with UVA(PUVA) in the treatment : scleroderma( 경피증 ), vitiligo( 백반증 ) PUVA: melamocyte의성장을위한적절한환경을조성 UVA: melanocyte의 proliferation과 migration의직접자극

25 강장효과 2900 Å 이상 2900 Å 이상 : biotic ray

26 반자극에의한진통효과 3 도홍반용량, 국소치료시는크로마이어등사용 만성염증부위, 외상후부작용을치료할목적 ex. 퇴행성관절염, 류마티스관절염에서나타나는심부조직의동통완화건염 (tendinitis), 섬유증 (fibrositis)

27 기타효과 2800 ~3400 Å : 피부암유발 2900 Å 이상 : 감염에대한체내저항성증가대내성효과 (esophylatic effect)

28 28 Clinical indication for UV radiation Psoriasis Wounding healing

29 Psoriasis Common benign, acute or chronic inflammation skin disease that appears to be based on genetic predisposition bright red plagues with silvery scales, usually on the knee, elbow, and scalp, mild itching, psoriatic arthritis Phototherapy - inactivate cell division and inhibit the DNA synthesis and mitosis of hyperproliferating epidermal cells that are characteristic of psoriasis Most responsive to PUVA and narrowband UVB alone (311 ~ 313 nm) Not responsive to UVC and minimal responsive to UVA without drug sensitization

30 30 Robbins and Cotran pathologic basis of disease, Psoriatic plaques

31 Psoriasis 31 Side effects of PUVA - epidermal pigmentation - hyperplasia - immune suppression - release of free radical - carcinogenic ( 발암성의 )

32 Wound healing 32 UVC is the frequency band most commonly chosen because it may contribute to wound healing while causing little erythema of tanning

33 33 Contraindications and precautions for the use of UV radiation

34 Contraindications for the use of ultraviolet radiation Irradiation of eyes - UV opaque goggles for Tx - UV sensitizing drug (psoralen) 를복용한환자는복용후 12시간동안 UV opaque eye protection을계속해서착용해야한다. Skin cancer Pulmonary tuberculosis ( 폐결핵 ) Cardiac, kidney, or liver disease Systemic lupus erythematosus ( 루프스 ) Fever

35 Precautions for the use of UV radiation 35 Photosensitizing medications and dietary supplements Photosensitivity Recent X-ray therapy No dose of UV radiation should be repeated until the effects of the previous dose have disappeared

36 36 Adverse effects of UV radiation Burning Premature aging of skin Carcinogenic Eye damage Adverse effects of psoralen with UVA

37 37 Figure Actinic skin damage ( 광과민성피부질환 )

38 Application technique 38 The same lamp that will used for treatment should be used to assess a person s UV sensitivity Dose response assessment

39 Dose response assessment 39 Suberythemal dose( SED) : no change in skin redness occurs in the 24 hours after UV exposure Minimal erythemal dose (MED) The smallest dose producing erythema within 8 hours after exposure that disappears within 24 hours after exposure First degree erythema(e1) Definite redness with some mild desquamation appears within 6 hours after exposure and last for 1 to 3 days. This dose is generally about 2 ½ times the MED Second degree erythema(e2) Intense erythema with edema, peeling, and pigmentation appears within 2 hours or less after treatment and is like a severe sunburn. This dose is generally about 5 times the MED Third degree erythema(e3) Erythema with severe blistering, peeling and exudation. This dose is generally about 10 times the MED

40 40 Figure Set-up for ultraviolet sensitivity assessment

41 41 Application technique 13-1 Determining of MED of UV for an individual 13-1

42 42 UV therapy application Using UVB Using Psoralen with UVA`

43 Dosimetry for the treatment of psoriasis with UV radiation Repeated exposure 로 Tx 진행됨에따라, tanning, epidermal hyperplasia 등의결과로서 MED 증가하게됨 To maintain effective treatment with consistent proportion of MED - exposure time, 10% ~ 50 % of MED - distance of the lamp from skin

44 Using UVB 44 Dose - vary from 50% of the MED to E1 dose (about 2 ½ times the MED) - three to five times weekly - 15~ 20 treatment to 50% clearance of psoriatic plagues (total clearance several weeks ) - painful erythema 나타나면 Tx stop

45 Using Psoralen with UVA 45 Treatment time : 2 hours after ingestion of drug Response to PUVA : Delayed onset comparing UVB-induced erythma) 24~48 hours after exposure 2 or 3 times per week Generally whole body 40%~ 70% of the MED 에서치료시작반응을유지하기위하여매주 10~40% 증가시킨다. Complete clearance : about 6 weeks

46 Documentation 46 If and how psoralen was given Area of the body treatment Type of UV radiation used Serial number of the lamp Distance of the lamp from the patient Treatment duration Response to treatment

47 47 UV lamp Selecting lamp Lamp maintenance

48 자외선치료기구 탄소방전등 (carbon arc lamp) : 자외선치료에열적용 수은증기방전등 열형석영수은등 (hot quarts mercury lamp) : air cool type, 그룹치료 ( 센트로솔 ) 크로마이어등 (Kromayer lamp) : water-cool type, 국소용 공냉식크로마이어등 (aero kromayer lamp): air cool type, 국소용 냉형석영수은등 (cold quarts mercury lamp) : air cool type, 살균용 태양광선등 (sunlight lamp): 전구형텅스텐필라멘트, 가정치료용 형광관그룹치료용필립관 UV-B 등

49 광화학치료 (PUVA) 광화학치료는광독성약물인 psoralen을바르거나먹은후, UVA 를조사하여병을치료하는새로운치료방법 UVA (340~400 nm) 중최대작용파장은 340~380 nm 홍반반응 : 치료 48~72시간에최고도달최소광독량 (MPD, minimal photoxic dose) 이용하여광량결정 색소반응 광독성반응, 홍반색소침착강하게일으키며, DNA 합성억제 건선 (psoriasis), 백반증 (vitiligo)

50 Selecting lamp Broad spectrum UVA with 320~400 nm Wide band (250~320 nm) Narrowband (311~312 nm) UVB UVC with 200~290 nm with a peak at 250nm Arc, Fluorescent type Arc type : small, emit radiation of consistent intensity fluorescent type: long, higher intensity radiation in the middle than ends Single arc lamp : small area Fluorescent tube : not recommend variability of intensity along the length narrow band of radiation, uniform treatment of area within a resoneable amount of time

51 UV ramp 51 B, Handheld UVA/UVB wand C, UVB cabinet for whole body therapy A, Fluorescent.

52 Laser therapy 정의 : 유도방출에의한광증폭장치로써통증완화와상처치유에좋은효능을가진다. 일반적인특성 : 단색광지향성 : 빛이퍼지지않는다. 고휘도 : 단위입체각에서나오는빛의출력밀도결합력 ( 응집성 ) : 광자의파동위상이시간적으로공간적으로일치함일반적인광선의성질 ( 반사, 산란, 전도, 흡수 ) 레이저치료기의구성활성매질 + 여기장치 + 광학강 + 출력장치 + 냉각장치

53 의료용레이저의종류 CO 2 Laser 지혈과동시에수술이가능, 파장 10.6 μm He-Cd Laser 파장 4416Å Ar Laser 파장 4,885~5254Å Kr Laser 파장 6,471Å, 선택적인세포응결 He-Ne Laser 파장 6,328Å, 한방의침술, 온열자극효과, 물리치료용 YAG 파장 1.06 μm혈우병, 혈소판감소증, 출혈이많은곳의수술 루비 Laser 치과의충치, 치석제거, 구강종양 N2 Laser 생화학기초연구 색소 Laser 안과영역, 내과의내시경사용, 선택적응결

54 Laser 적용방법 치료에너지량 (J/ cm2 ) = 장비의출력 (W) 치료시간 (second)/ 치료부위의면적 ( cm2 ) 치료방법조사방법에따라 : 접촉법과비접촉법 치료면적에따라 : - 격자조사법 : 작은부위에적용하는방법으로피하지방조직치료에사용 - 주사선조사법 : 막대운동으로이동하면서치료궤양, 화상, 개방성상처등에이용 -점조사법: 근막통

55 Laser 의치료적효과 손상조직치유기간단축인체의직접적인생체자극으로원인치료가능영양효과증진진통효과말초신경재생속도촉진외상성부종이나혈종감소효과

56 적응증및금기증 적응증 : 금기증 임산부복부조사 눈주위치료 악성종양 바이러스 고환, 난소, 갑상선, 췌장, 부신선등 월경증 간질 심장조혈기착용 neoplasm 주위 18세미만의골단부위 심부전증, 갑성선장애, 중증의정맥성질환자

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