WHAT IS A SURGICAL LIGHT? BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US***
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1 WHAT IS A SURGICAL LIGHT? BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 1
2 LIGHT SOURCE The first thing we need in a surgical light is light. Light is measured by the number of lux produced by the light source.. For example, on a Mediterranean beach, in August, at noon, we can measure 100,000 lx. An office light fixture produces around 500 lx. But a true surgical light also requires other parameters, which will be presented in the following pages. BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 2
3 A PAGE OF HISTORY The first surgical operations took place in daylight, e.g. between 10,000 and 80,000 lx At the end of the 19th century, with the advent of electricity, light bulbs replaced direct sunlight and allowed more freedom from the level of sun. In the sixties, the marketing of surgical lights with halogen light bulbs led to an increase in the amount of light available on the operating table. By then, surgical lights had reached 100,000 lx, and will keep on climbing In the late nineties, with the arrival on the market of discharge lamps, some surgical lights had reached almost 200,000 lx! BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 3
4 WHAT IS A SURGICAL LIGHT MADE OF? 1. Obviously, the first component of a surgical light is a source that produces light, a lot of light Red tissue absorbs 90% of the emitted light. So to be able to see at the bottom of the cavity requires a large amount of it. 2. How much actually? Weren t the 10,000 lx of the first operating rooms enough? Aren t the 200,000 lx of the late nineties (twice the amount of the sun!) too dangerous? 3. To answer to these questions (and many others), a committee of international experts met in 1990 to devise a standard defining surgical lights. This document, named IEC Standard has been in application since December BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 4
5 IEC IEC Standard An international working group was set up in 1990, on the basis of a French project Participants: GERMANY (HERAEUS - BERCHTOLD) UK (BRANDON) USA (STERIS GETINGE) JAPAN(YAMADA) USSR FRANCE (ALM + ANGENIEUX) 1997: All the manufacturing partners finally reached an agreement Last step (1998): Submission to vote, publication and application starting in December 1999 This standard concerns the safety of Surgical Lights and Examination Lights. International Electro technical Commission (IEC) Worldwide organization for standardization comprising all national electro technical committees. Its objective is to promote international cooperation on all questions concerning standardization. The documents produced are presented as recommendations for international use. IEC National committees undertake to apply IEC International standards transparently to the widest extent in their national and regional standards. Any divergence shall be clearly indicated. IEC provides no marking procedure to indicate its approval. IEC does not accept responsibility for any equipment declared to be in conformity with one of its standards. BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 5
6 ILLUMINATION According to the standard, maximum central illumination, called Ec, measured on a surgical light, must be between 40,000 and 160,000 lx. This value is measured with a luxmetre placed at the centre of the light patch, 1 metre away from the lighthead D10 D50/D10 > 0,5 Another important characteristic is the light field diameter. Depending on the type of surgery performed, a smaller or larger light patch will be required. The light patch is the area where illumination is equal to or higher than 10% of the maximum illumination (Ec). This diameter is called D10. Moreover, the light patch must also be uniform. It cannot be brighter in the centre and lighter on the edges. This could place a strain on the eyes; it could reduce contrast and cause a glare. Therefore, the diameter will be measured where illumination is 50% of the Ec (this is called D50), and a D50/D10 ratio will be given. According to the standard, this ratio must not be under 0.5. D10 Light patch o Centre of light patch BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 6
7 SHADOW MANAGEMENT Now that we have enough light to see, we notice that our light creates shadows, and in these shadows we see less! This is clearly unacceptable in surgery, because the operating staff will be standing between the light and the operating field. So we will need to get rid of these shadows. There are two types of shadows: cast shadows and contour shadows. With contour shadows Without contour shadows Contour shadows allow us to distinguish the volume of objects; they help us see in three dimensions! Therefore, cast shadows must disappear, but contour shadows must remain. Contour Shadows Cast Shadow BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 7
8 LIGHT GUIDES Different elements combine to give us good shadow management: the surface of the light source, the number of light sources (the more sources there are, the more the shadows are diluted), the optical principle guiding light towards the operating field Shadow management is achieved by using lenses to guide the light rays. The more light beams there are, the better the shadow dilution. This can be accomplished with micro lenses or Fresnel lenses (like lighthouses on the coast). Micro lenses Fresnel lenses Therefore, the quality of a surgical light depends on the amount of light found inside the cavity. That s the useful light. It is linked to both the amount of light released Without and contour the quality shadows of shadow management. To help compare different surgical lights in this respect, the IEC has developed the mask tests. These tests compare the useful light, called Es, to the emitted light (Ec) under different conditions: with the shadow of one surgeon s head, two heads, and in both cases with or without cavity. Mask test BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 8
9 THE VOLUME OF LIGHT So far we have enough light and a nicely uniform light patch without any cast shadows. But the human body is in three dimensions! So we need a lighthead that illuminates in three dimensions. To solve this problem, we will once again guide the light beams to create several light patches, shining at the same time, with the same strength, at different heights. This is called the volume of light. Volume of light This last aspect is very important. Indeed, depending on the technology used, variations in the volume of light can occur. To deal with this issue, there are two main techniques: convergence and divergence Convergence Very popular in the past, this technique relies on a faceted reflector to converge all the light rays towards one same area. Divergence Without contour shadows Through the use of lenses (Fresnel or others) all the light patches are brought together to overlap in one single zone, like a stack of pancakes. 1ML2L1EmaxE1 = 20%EmaxE1 = 20%Emax E1 = 20%Emax L1 1M Once more, the IEC standard will give us a way to measure this depth of illumination: L1 + L2. E max L1 is defined as the distance between Ec and the point where illuminance is measured at 20% going towards the lighthead. L2 is defined as the distance between Ec and the point where illuminance is measured at 20% going away from the lighthead. E1 = 20%Emax L2 BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 9
10 HIGH VOLUME OF LIGHT Without contour shadows Of course, the best surgical light will have the highest volume of light. Especially since the light head is rarely placed 1 metre away from the patient. It is often further. BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 10
11 HEAT MANAGEMENT Since light is a source of energy, it produces heat. This heat is focused on two places: on the light patch and in the light head. Heat on the light patch This heat is mainly derived from the infrared component of light. Obviously this heat needs to be reduced to a minimum, because it heats the surgeon s neck and dries the patient s tissues (this is called desiccation ). To reduce heat, infrared filters have been added to lights using halogen and discharge lamps. Without contour shadows BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 11
12 HEAT MANAGEMENT Irradiance Lights using LEDs don t need filters. We call it cool light because LEDs don t produce infrared rays. Once these infrareds are eliminated, some heat still remains on the light patch. It s called irradiance. This energy is measured in watts per square metre (W/m²). For a surgical light, this energy (irradiance) must not exceed 500W/m², according to the IEC. But this heat also depends on the number of lux. More we have lux, more the total irradiance will be high. Therefore this energy, called radiant energy, is quantified in milliwatts per square metre per lux (mw/m².lx). For example, if a light radiates an energy of 3.6mW/m².lx with an Ec max of 160,000 lx, total irradiance will reach 3.6x = 576W/m². That s much too hot! The patient could be burned with a surgical light with that kind of technical Without contour specification. shadows BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 12
13 HEAT MANAGEMENT Contact heat Since lightheads contain a source of light and are driven by electronics, they radiate heat. This heat also needs to be reduced to prevent the lighthead from being too hot when touched. Two techniques are used to deal with this problem: Conduction: heat transfer through physical contact between the various elements making up the lighthead (hood, fork ) Convection: heat transfer between the surface of the lighthead and the air. Without contour shadows BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 13
14 COLOUR Another important aspect of surgical lighting is good colour rendition and stable colour perception. Two issues are involved: First, the emitted colour must be consistent with what we want to see. If we were to shine a green light on a red wound, it would be hard to analyse what we see. This colour of light is measured in Kelvin (K). That s what we call the colour temperature expressed in K. For example, the colour temperature of daylight is 4,300 K. It is an index of radiation, but it has no relation with the heat radiated by the surgical light. The IEC has set the colour temperature of a surgical light between 3,000 and 6,700 K. > K Lightning, elect. welding 6500 K Direct solar radiation 3300 K Without contour shadows 4300 K 4300 K Daylight 1800 K candle 800 K Ember (blistering coal) 600 K Blistering hotplate Second, when we shine a red light, we must be sure that the light reflected is also red. That s what we call the colour rendering index, or CRI. The IEC standard recommends that the CRI be between 85 and 100. BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 14
15 CRI The color rendering index (CRI) is a quantitative measure of the ability of a light source to reproduce the colors of various objects faithfully in comparison with an ideal or natural light source. The 8 The CRI is an average of results obtained from the following colours: R1: Light greyish red R5: Light bluish green Without contour shadows R2: Dark greyish yellow R6: Light blue R3: Strong yellow green R7: Light violet R8: Light reddish purple (R9: Strong Red) R4: Moderate yellowish green R8: Light reddish purple (R9: Strong red) BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 15
16 FAIL-SAFE Fail-safe: Capability of an equipment to provide a minimum illuminance (40,000 lx) and to be directed on the operation area even in single fault condition. Fail-safe equipment shall be so designed that even in single fault condition (no safety hazard exists), main functions (illumination, maneuverability) are preserved. During single fault condition and after 5s of any interruption, fail-safe equipment shall provide central illuminance of not less than 40,000 lx. Without contour shadows Single luminaries without any protection against light under a single fault condition are not fail-safe. interruption BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 16
17 CONCLUSION Without contour shadows So, a surgical light must consist in 2 light heads, 2 power supplies and a battery back up. BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 17
18 THANK YOU FOR YOUR ATTENTION! MAQUET SAS Parc de Limère Avenue de la Pomme de Pin CS Ardon Orléans Cedex 2 France Phone: BASIC_ELEARN_ORLIGHTS_ORLIGHTSWhat_is_a_surgical_light_EN_REV01_ ***NOT FOR USE IN THE US*** 18
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