ABLS Trial Exam on Fundamental Laser Science / Tissue Interaction, Laser Safety and Cosmetic Laser Procedures UPDATED

Introduction

INSTRUCTIONS:

The ABLS Trial Exam has 12 knowledge questions relative to critical areas for laser practitioners. Your score will show at the end.

Question 1 asks for your name, location and email, but not street address or phone number. Your information will be kept confidential.

Questions 2-7 = fundamental laser science and bio-tissue interaction; 8-9 = laser safety; and 10-13 = cosmetic laser procedures.

When you click the "DONE" at the end, your score will show. If you score below 75%, the Board suggests consideration of the certification process. Up to 28 AMA PRA Category 1 Credits^TMare NOW available.

Practitioners must have a solid understanding of laser physics, bio-tissue interaction, and safety to maximize efficacy. The ABLS Certification provides a valuable learning experience and superior knowledge of laser and light tissue interaction at the chomophore level for optimizing treatment parameters. You can differentiate your practice to patients and augment manufacturer training. The ABLS is the world’s ONLY medical specialty board devoted to lasers and light-based energy devices. More information is available on our website at americanboardoflasersurgery.org.

The Board wishes you success!

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* 1. Please provide the following information:

Your first and last name, and medical degree:

Your medical laser specialty:

Your location (city, state/province, country):

Your email address:

How did you hear about the ABLS?

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* 2. Laser light has three unique properties. Select each choice that denotes one of these properties.

high intensity

monochromatic

coherence

refractivity

spectral distribution

collimation

converging rays

phase cohesive

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* 3. To determine the length of each laser pulse and prevent the temperature of adjacent tissue from exceeding a level at which irreversible damage occurs, it is important to understand and calculate the thermal relaxation time (TRT) of the tissue that is being irradiated. The value of this time is dependent on (check any that are correct):

The heated volume of the tissue

The thermal conductivity of the tissue

The chromophore(s) being targeted

The three-dimensional shape of the heated volume

The fluence of the laser beam

The target dissipating approx. 1/2 to 2/3 of the incident thermal energy

The penetration depth of the laser beam

The reaction of chemical bonds within cells to laser light

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* 4. The power density of the laser beam transmitted to the tissue is dependent on which of these factors:

A. whether the beam remains collimated
B. whether the beam is focused smaller
C. whether the beam spreads or diverges larger
D. the initial diameter of the beam
E. the wavelength of the laser

A and C

B and D

A, B and C

A, B, D and E

All of the above

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* 5. Check which statements are TRUE about the absorption of laser light relative to chromophore concentration in soft tissue:

The concentration of chromophores plays an important role in how the absorbed laser light impacts the photothermal laser-tissue interaction.

The concentration of hemoglobin is fairly constant as blood circulates throughout the body.

The most significant absorbers in tissue are hemoglobin and melanin.

The absorption coefficient for 75% water concentration in tissue depends on wavelength.

Hb concentration in blood is close to 150g/L.

Hb and HbO2 are present at maximum concentration only in whole blood inside blood vessel capillaries.

The average Hb and HbO2 absorption coefficient that affects light transport is reasonably high given a 10% average blood presence in the soft tissue in the body.

The epidermis' light transport properties are strongly affected by melanin absorption depending on volume fraction of melanosomes.

The volume fraction of melanosomes in darkly pigmented African skin is more than 10 times greater than in light Caucasian skin.

A hemangioma typically has twice the absorption of photons, and rate of heating, than surrounding tissue, assuming low melanin presence in the epidermis.

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* 6. When the beam of a continuous-wave Nd:YAG laser is delivered to tissue by a quartz fiber that does not touch the tissue, it is not very effective for vaporizing or cutting until some free carbon has formed by thermal breakdown of the tissue. However, it can be used for effective cutting of soft tissue if the distal end of the fiber is contoured into the shape of a needle with a small radius at the distal tip, or a conical tip of sapphire is attached to the distal end of the quartz fiber, and this tip is put in contact with the tissue. These terminations of the fiber enable the Nd:YAG laser to cut tissue effectively because: (check each correct statement)

The tapered tip acts as an optical funnel, concentrating the laser beam to a power density high enough to boil histologic water despite the low absorption coefficient (about 0.2/cm) at this wavelength (1,064 nm).

The sharp tip tears the tissue mechanically to perform cutting.

Some of the laser light is absorbed within the distal portion of the tip, heating it to a temperature of 100 degrees C or higher, so that it heats the contacted tissue by thermal conduction and causes boiling of the histologic water.

The high power density at the distal tip causes the quartz or sapphire to become optically non-linear and to shift the wavelength to the far infrared portion of the spectrum, where the absorption coefficient is higher.

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* 7. Check which statements are FALSE about the biophysical processes by which lasers or light ablates or damages living tissue:

Photovaporolysis is the basic mechanism by which most surgical lasers destroy tissue. It is defined as the absorption of light by target chromophores, and the conversion of this radiant energy into thermal energy, where the resultant temperature is between 50 degrees C and 100 degrees C.

The destruction of histologic architecture by the photonic formation of a gas-like fourth state of matter, is called photothermolysis.

Photochemolysis is the rupture of inter-atomic (electronic) bonds in complex organic molecules by the photonic energy of light at all wavelengths longer than 1,064 nm.

Low-level photochemolysis is the major cause of actinic damage to the skin of persons who regularly suntan outdoors and are exposed to UV rays.

If the pressure where the laser beam impacts the tissue exceeds 760 torr (atmospheric pressure), the boiling tissular water can rise above 100 degrees C. This can result in high levels of irradiance and the accompanying photovaporolysis can cause shock waves and other explosive effects, which are largely undesirable for laser surgery.

Photopyrolysis is the destruction of tissue by heating to temperatures above 45 degrees C but below 100 degrees C.

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* 8. Accidental laser beam trauma to unintended targets has been a major cause of injury and death during laser surgery. In the list of four possible trauma events below, check just ONE of the options A, B, C, or D for each event to denote the relative risk of that event, with A denoting the lowest risk and D the highest risk:

perforation of hollow organs: A

perforation of hollow organs: B

perforation of hollow organs: C

perforation of hollow organs: D

injury to skin: A

injury to skin: B

injury to skin: C

injury to skin: D

injury to eyes: A

injury to eyes: B

injury to eyes: C

injury to eyes: D

injury to brain, spinal cord or nerves: A

injury to brain, spinal cord or nerves: B

injury to brain, spinal cord or nerves: C

injury to brain, spinal cord or nerves: D

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* 9. Smoke is an inevitable byproduct of surgery with any device that thermally dehydrates tissue and heats it to combustion temperatures. Denote each statement below as either true (T) or false (F) by selecting either a (T) or an (F) option for each:

(T) The products of combustion are not carcinogenic.

(F) The products of combustion are not carcinogenic.

(T) 77% of all smoke-plume particles are below 1.1 micrometer in size.

(F) 77% of all smoke-plume particles are below 1.1 micrometer in size.

(T) Inhaled particles below 1.1 micrometer in size are readily exhaled.

(F) Inhaled particles below 1.1 micrometer in size are readily exhaled.

(T) Operating-room suction at the wall is adequate to remove all laser-generated smoke plumes.

(F) Operating-room suction at the wall is adequate to remove all laser-generated smoke plumes.

(T) If all other factors are equal, the KTP laser generates more smoke during laser surgery than any other type of laser.

(F) If all other factors are equal, the KTP laser generates more smoke during laser surgery than any other type of laser.

(T) An external smoke evacuator having a capacity of 28 liters / second can evacuate 99% of a laser's smoke plume if the suction tip is held within 1.0 cm of the impact site of the laser beam.

(F) An external smoke evacuator having a capacity of 28 liters / second can evacuate 99% of a laser's smoke plume if the suction tip is held within 1.0 cm of the impact site of the laser beam.

(T) It has been demonstrated that the smoke plume from a CO2 laser vaporizing a malignant tumor contains no viable malignant cells.

(F) It has been demonstrated that the smoke plume from a CO2 laser vaporizing a malignant tumor contains no viable malignant cells.

(T) Viruses range in size from about 20 to 300 nanometers.

(F) Viruses range in size from about 20 to 300 nanometers.

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* 10. Fractional lasers remove pigments by which mechanism?

Photoacoustic

Photochemical

Photodisruptive

Microscopic epidermal necrotic debris

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* 11. Match each hair removal device with the most correct description, by selecting ONE letter for each device letter that denotes that description:

A. Adequately damages non-pigmented hair at very high fluence, which makes it a good option in vellus hair removal.
B. High melanin absorption, best indicated in light skin (Fitzpatrick skin types I - III), with high power consumption and a relatively slow repetition rate.
C. Very effective in long-term hair removal. Can be safely used in skin types I-IV with some studies also demonstrating safety of long-pulsed devices in darker skin types.
D. Effective, at least short term, for a wide range of skin types due to the wide choice of different wavelengths, pulse durations and delay intervals.

Ruby lasers: A

Ruby lasers: B

Ruby lasers: C

Ruby lasers: D

Intense pulse light (IPL): A

Intense pulse light (IPL): B

Intense pulse light (IPL): C

Intense pulse light (IPL): D

Diode lasers: A

Diode lasers: B

Diode lasers: C

Diode lasers: D

Device not listed: A

Device not listed: B

Device not listed: C

Device not listed: D

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* 12. IPL devices are high-intensity, polychromatic light sources that emit pulsed light wavelengths between 400 nm and 1200 nm. Chromophore hemoglobin absorption peaks are at which of the following wavelengths: (there may be more than one correct answer)

418 nm

542 nm

580 nm

700 nm

None of the above

All of the above

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* 13. Which of the following selection criteria with respect to laser treatment of cutaneous vascular lesions has the least influence on the ability to target a specific chromophore in the skin while minimizing damage to surrounding tissue?

wavelength

pulse duration

fluence

pulse frequency

spot size

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* 14. FINAL QUESTION: Thank you for taking the Trial Exam!

Please take a moment to review the information below and tell us how you think you scored. Then click DONE and see your score. A score below 75% indicates room to improve your knowledge.

If you wish to apply, take advantage of NO application fee within 30 days (regularly $150). **We also NOW offer UP TO 28 AMA PRA CATEGORY 1 ^TM CREDIT HOURS! Please visit us for more information at: www.americanboardoflasersurgery.org or email us at lasers1060@gmail.com.

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Question Title

* 1. Please provide the following information:

Question Title

* 2. Laser light has three unique properties. Select each choice that denotes one of these properties.

Question Title

Question Title

* 4. The power density of the laser beam transmitted to the tissue is dependent on which of these factors: A. whether the beam remains collimatedB. whether the beam is focused smallerC. whether the beam spreads or diverges largerD. the initial diameter of the beamE. the wavelength of the laser

Question Title

* 5. Check which statements are TRUE about the absorption of laser light relative to chromophore concentration in soft tissue:

Question Title

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* 7. Check which statements are FALSE about the biophysical processes by which lasers or light ablates or damages living tissue:

Question Title

Question Title

* 9. Smoke is an inevitable byproduct of surgery with any device that thermally dehydrates tissue and heats it to combustion temperatures. Denote each statement below as either true (T) or false (F) by selecting either a (T) or an (F) option for each:

Question Title

* 10. Fractional lasers remove pigments by which mechanism?

Question Title

Question Title

* 12. IPL devices are high-intensity, polychromatic light sources that emit pulsed light wavelengths between 400 nm and 1200 nm. Chromophore hemoglobin absorption peaks are at which of the following wavelengths: (there may be more than one correct answer)

Question Title

* 13. Which of the following selection criteria with respect to laser treatment of cutaneous vascular lesions has the least influence on the ability to target a specific chromophore in the skin while minimizing damage to surrounding tissue?

Question Title

* 4. The power density of the laser beam transmitted to the tissue is dependent on which of these factors:

A. whether the beam remains collimated
B. whether the beam is focused smaller
C. whether the beam spreads or diverges larger
D. the initial diameter of the beam
E. the wavelength of the laser