Teaching of laser-medical
topics: Latvian experience
Janis Spigulis
University of Latvia, Department of
Physics, Raina Blvd. 19, Riga, LV-1586, Latvia
ABSTRACT
Pilot program for Master’s studies on Biomedical Optics has been developed and launched at University of Latvia in 1995. The Curriculum contains several basic subjects like Fundamentals of Biomedical Optics, Medical Lightguides, Anatomy and Physiology, Lasers and Non-coherent Light Sources, Optical Instrumentation for Healthcare, Optical Methods for Patient Treatment, Basic Physics, etc. Special English Terminology and Laboratory-Clinical Praxis are also involved, and the Master Theses is the final step for the degree award. Recently a new extensive short course for medical laser users “Lasers and Bio-optics in Medicine” has been prepared in the PowerPoint format and successfully presented in Latvia, Lithuania and Sweden.
Keywords: biomedical optics education, Master’s study programs, short courses on lasers in medicine.
1. INTRODUCTION
Physics post-graduate program at University of Latvia offers a number of study sub-programs. Biomedical Optics as a very rapidly developing inter-disciplinary research and application area was also included there in 1995. Detailed description of its basic course - Fundamentals of Biomedical Optics – was presented previously 1. This paper gives a deeper insight in the other courses and in the whole Curriculum design. Some internationalization of this program was initiated in frame of a European TEMPUS project 2, and continued in frame of European LEONARDO DA VINCI and Swedish-Baltic VISBY projects.
Recently a new short course for medical laser users “Lasers and Bio-optics in Medicine” in English was created in the PowerPoint file format. It can be offered in three versions – as extensive 8-hour course with 180 colour slides (26 MB), basic 4-hour course with 140 slides (22 MB), or brief 2-hour course with 95 slides (15 MB). This course is formally recognized by Medical Laser Centre of Lund University and has been approbated internationally in Latvia, Lithuania and Sweden.
2. THE CURRICULUM
The Curriculum for the two-year/four-semester Biomedical Optics Master’s studies presently includes following subjects (with the corresponding credits):
No. SEMESTER SUBJECT PART CREDITS EXAM/PASS
1. 1 Fundamentals of Biomedical Optics – I (Tissue Optics, A 4 P
Optical Sensing for Diagnostics and Monitoring)
2. 1 Basic Physics A 4 E
3. 1 Optical Instrumentation for Healthcare A 4 E
4. 1 Computer Skills B 3 P
5. 1 Fundamentals of Opto-electronics B 3 P
6. 2 Anatomy and Physiology A 4 E
7. 2 Lasers and Non-coherent Light Sources A 4 E
8. 2 Medical Lightguides A 4 P
(to be continued on the next page)
(continued)
No. SEMESTER SUBJECT PART CREDITS EXAM/PASS
9. 2 Special English Terminology B 3 P
10. 2 Methods of Experimental Spectroscopy B 3 P
11. 3 Fundamentals of Biomedical Optics – II A 4 E
(Laser-Tissue Interaction, Laser Medicine)
12. 3 Optical Methods for Patient Treatment A 4 E
13. 3 Laboratory – Clinical Praxis A 3 P
14. 3 Special English B 3 P
15. 3 Optical Sensors and Analytical Devices B 3 P
16. 4 Techniques of Laser Medicine A 4 P
17. 4 Master Thesis A 32 D
______________________________________________
Abbreviations:
A - compulsory subjects, P – pass without mark,
B – free choice subjects. E – exam with mark,
D – public defense of the Thesis.
To receive the Master’s degree, students must collect at least 80 credits – to pass 10 compulsory (A) and 3 free choice (B) subjects out of 6, and to defend their Master Thesis. To start the Master studies, the Bachelor degree in physics, engineering or life sciences is required. Brief abstracts of the basic compulsory courses are given below.
Fundamentals of Biomedical Optics 1 as the largest course (8 credits) is divided into two parts. The first part includes Tissue Optics (propagation of optical radiation in tissues, skin optics, blood optics, eye optics and optics of the hard tissues) and Optical Sensing for Diagnostics and Monitoring (photoplethysmography, pulse oximetry, laser-Doppler blood flowmetry, NIR monitoring of cerebral oxygenation, optical sensors of physical and biochemical parameters, spectrometric sensors and fluorosensors). The second part covers laser-tissue interactions and laser treatment (medical lasers, laser safety, laser bio-stimulation, laser photodynamic therapy - PDT, laser applications in cosmetology, surgery, dentistry and other medical specialties).
Optical Instrumentation for Healthcare is a course giving overview on the basic principles and design solutions of the optical equipment used in clinical environment - microscopes, polarimeters, spectrometers, neftelometers, etc.
Anatomy and Physiology course is addressed mainly to the students with physics and engineering background. Its anatomy part regards the composition of human body, structure of brain, heart, kidneys and other organs, as well as the neural, respiratory, reproductive and other essential living systems. The physiology part includes homeostasis, blood supply, muscle dynamics, cellular structures and physiological functions of the basic human organs.
Medical Lightguides is a course concerning basic of fiber optics and applications of fiber lightguides in various medical devices – fibroendoscopes, “cold light” and non-shadow illuminators, medical laser delivery systems, phototherapy units, bio-optical sensors, etc.
Optical Methods for Patient Treatment is a clinically oriented course on thermal and non-thermal laser interactions with living tissues. Laser therapy (including laser acupuncture and combined magneto-optical procedures) and laser surgery (including eye surgery) are regarded in details in frame of this course.
The other courses included in the Curriculum are of a major importance, as well; however, their content will dot be discussed in this paper.
3. SOME PRACTICAL ASPECTS
A team of eight lecturers teaches the Biomedical Optics sub-program; five of them are the professor-level teachers. Typically up to ten students formed the 1st semester group annually. Regarding their backgrounds - the physics, engineering and life science backgrounds were distributed nearly equally. Two distinct age groups of the students were identified – one of just graduated (23…25 years) students, the other of more experienced (30...40 years) persons. Female to male relation in groups was roughly 2 : 1.
One of the biggest teaching problems was and still is the lack of suitable textbooks in the profile topics. The field is emerging very dynamically, and regular studies of the periodicals (e. g. the journals “Biomedical Optics” and “Biophotonics”) are always necessary. However, there is also a lot of proved and established knowledge which is mainly available in review articles, and only few specialized books can be recommended for students. Our Biomedical Optics library now consists of about 200 units – books (or copies of their chapters), conference proceedings and periodicals. Several collected books are cited here 3-20, and selected chapters at some of them 3-5, 10-15 we find quite suitable for the students as the basic literature sources.
Acquisition of practical skills is a very important aspect of the teaching process. Laboratory-Clinical Praxis is included in the part A of the study plan at the 3rd semester. During this praxis students spend certain time (at least 6 full days) in real laboratory or clinical environment dealing independently with some particular problem. If this work is successful, it is usually extended at the Master’s project. A further step to increase the role of practical activities is development of the student’s laboratory on Biomedical Optics. Several student practicals concerning optical properties of tissues (laser light scattering from tissue samples and phantoms; light penetration, transmission and absorption in tissues; laser-excited tissue fluorescence) and the non-invasive optical diagnostics (photoplethysmography, pulse oximetry, laser-Doppler blood flowmetry) are going to be worked-out.
The development of the specialized library and student’s laboratory on Biomedical Optics was possible thanks to financial support from the European structures in frame of the TEMPUS project 2 incorporating five Baltic universities and two from the EU countries (Linkoping University, Sweden, and King’s College London, UK). University of Latvia is recognized as the regional center of excellence on Biomedical Optics teaching in frame of this project. International links are developed also with other European universities, e. g. Lund University (Sweden), University College London (UK), University of Patras (Greece). Development of specialized regional or international centers seems to be a future trend of providing Master’s education on narrow inter-disciplinary subjects, and University of Latvia eventually might be such a center in the field of Biomedical Optics education in future. Besides, a new Leonardo da Vinci project on biomedical physics vocational training (including chapters on tissue optics, clinical applications of lasers and medical lightguides) is running now in collaboration with our Lithuanian, Polish and German colleagues.
Several problems in the Biomedical Optics teaching area have been identified and extensively discussed:
· substantial differences in student’s background knowledge levels, especially on physics; medical graduates sometime have difficulties to follow the lectures on special subjects, even after passing the Basic Physics course at the 1st semester;
· the Curriculum does not cover all aspects of the area; in particular, Medical Imaging and probably some more subjects ought to be added in future, thus changing the existing balance of subjects;
· the Master’s study program is fairly time-consuming (2 years), and many students cannot afford to spend all their time for studies; therefore the mean successful output rate for this sub-program has been only about 30 %;
· the research activities on the subject should be developed more actively, and additional research funding is needed;
· the program has relatively weak support by the local clinical and medical institutions;
· the program offers only academic degree without any professional certificate (which sometimes can be of value, e. g. for the young clinicians);
· the social need for this kind of specialists is relatively low, but it will definitely grow in future.
4. THE POWER-POINT SHORT COURSE “LASERS AND BIO-OPTICS
IN MEDICINE”
To avoid laser accidents in hospitals and clinics, all medical laser users should have basic core knowledge on laser principles, laser-tissue interactions, laser safety matters and related items. Obviously, special certified short course is needed for that, preferably not exceeding 4-8 hours. There is a lack of European standards and internationally recognized course programs of this kind. Therefore a special attempt was taken to work out such course targeted to medical professionals with little or no background regarding lasers and their clinical applications, titled “Lasers and Bio-optics in Medicine”. This work was done in collaboration with Lund University Medical Laser Centre in frame of the Baltic-Swedish VISBY project. The elaborated program (see below) can be presented more or less detailed, as one of three options - extensive 8-hour course with 180 color slides (26 MB), basic 4-hour course with 140 slides (22 MB), or brief 2-hour course with 95 slides (15 MB). All materials are in English and are intended for modern presentation technology – computer projection, using the MS PowerPoint format files.
The short course program was officially accepted by the Board of Medical Laser Centre, Lund University, and was approbated in Sweden, Latvia and Lithuania. Recently it was successfully presented at the international EUROGIN-EAST conference (Vilnius, September 2001), and was recommended for further international implementation in future.
Certification program for medical laser users
1. Introduction
2. Laser principles, designs and parameters.
- How the laser works
- Basic types of lasers and their designs
- Gas discharge lasers
- Solid state lasers
- Diode lasers
- The most important laser parameters
3. Basics of tissue optics
- Light absorption and scattering in tissues
- Wavelength effects, the therapeutic window
- Light penetration in tissues
- Absorbing agents in tissues and blood, their spectra
- Skin optics, response to the UV radiation
- Optical parameters of tissues
4. Laser-tissue interactions.
- Photo-thermal effects; examples
- Photo-mechanical effects; examples
- Photo-chemical effects; examples
5. Medical laser systems
- The medical lasers
- Beam delivery systems
- Auxiliary sub-systems
6. Laser and UV safety regulations
- Harmful effects of laser and UV radiation
- Laser safety classes
- The caution and warning signs
- Protective goggles and shields
7. Clinical aspects of laser applications (invited MD's)
- Lasers in therapy and surgery
- Lasers in dermatology and cosmetology
- Lasers in oncology
8. Laboratory training with lasers and tissue samples or phantoms.
9. Certification test/exam.
5. CONCLUSIONS
1. Master’s education on Biomedical Optics at University of Latvia has proved its viability.
2. The Curriculum (80 credits) covers the basic topics of the field; however, regular updating of the Curriculum and the course Syllabi would be necessary.
3. To provide further improvements of the teaching quality, the specialized Biomedical Optics library and student’s laboratory are under development.
4. Several practical problems associated with Master’s teaching in Biomedical Optics have been identified and discussed.
5. International collaboration in the Biomedical Optics education is rapidly developing; any suggestions, proposals and comments on this would be highly appreciated.
6. A new internationally recognized short course for medical laser users “Lasers and Bio-optics in Medicine” has been created and successfully approbated; it is helpful for efficient certification of medical professionals dealing with lasers in different countries.
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