非侵入性且恢復期短的微整形手術-雷射美容是近幾年來最蓬勃發展的項目之一。現今的臨床醫師進行雷射除斑手術時，大都以肉眼辨識斑點位置，然後以徒手操作治療裝置對位，如此方式不易精準將雷射打在患部上面，而且全程需要配戴護目鏡保護眼睛，因此也增加辨識及擊中斑點的困難度；同時雷射光斑重疊導致劑量累積，則易產生副作用。本研究目的主要應用影像輔助肉眼辨識患部位置，然後透過飛點掃描自動導引雷射至標的，降低光斑偏移的誤差，再將光斑直徑縮小至1 mm，減少光斑重疊面積，期望降低操作的負擔並減少副作用。本研究實現影像導引雷射除斑系統設計與建構，解決臨床需求之功能如(1)降低副作用：以光學元件將光斑縮小，減少副作用；(2)提高對位精確：經由影像擷取與定位輔助，提高雷射擊中患部的準確度；和(3)簡化操作介面：實現友善人機介面，以增加操作的便利性。經由實驗結果，本系統具有如下特點：(1)平均光斑為1.008mm，(2)掃描頻率為6 Hz(受限於雷射源重複頻率)，和X與Y軸誤差掃描模組誤差分別為-8.85μm~ 7.51μm與 -9.42μm~8.73μm。本系統未來可以從(1)自動黑斑辨識和(2)光機系統輕量化等面向進一步加以研究改進。

In recent years, using laser for non-invasive and fast-recovering micro-plastic surgery has been a rapid advancing issue. During the pigmentation removal, both identifying the pigmentation by eyes and moving hand piece with free-hand that makes this procedure difficult. In addition, wearing goggles for eye-protection from laser exposure would also make the identification and targeting of pigmentation difficult. The overlapped laser spots would easily cause some side effects because of over dosage. The purpose of this study is firstly to design and develop an image assisted laser system for visual identification of pigmentation. Then, the flying spot of laser may be automatically guided to the pigmentation target with the reduced shifting error. Afterwards, the diameter of spot size is reduced to 1 mm for decreasing the overlapping spot area such that the operation of apparatus may be eased and the side effect may be alleviated. This study realizes the design and building of image guided laser system for pigmentation removal so as to meet the clinical needs: (1) to reduce the side effects by decreasing the spot size with the improved optical system, (2) to improve the accuracy of identification with the image acquisition and auto targeting, and (3) to ease the operation with friendly user interface. From the experimental results, the proposed system have the features which (1) the average spot size is 1.008 mm, (2) the scanning frequency is 6 Hz (limited by repetition rate of laser source), and (3) the error along X and Y axes of scanning module are -8.85μm~ 7.51μm and -9.42μm~8.73μm, respectively. Further studies such as (1) automatic pigmentation detection and (2) Opto-mechanical system miniaturization may be performed to improve the proposed system.

[1] A. Mehrabian and M. Wiener, “Decoding of inconsistent communications,” Journal of Personality and Social Psychology, Vol. 6, No.1, p.p. 109-114, 1967.
[2] 林秀美, 民生報, 2006
[3] 李希敏, 醫學美容市場發展趨勢與商機探討-儀器設備, 工研院IEK, 2005.
[4] 黃彥臻, 2009~10醫療器材產業年鑑；工研院產經與趨勢研究中心, 2009.
[5] R.R. Anderson and J.A. Parrish, “Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation,” Science, Vol. 220, p.p. 524–527, 1983.
[6] 行政院國家科學委員會光電小組, 雷射醫學-原理及臨床應用, 行政院國家科學委員會, 2001.
[7] The Oregon Medical Laser Center (OMLC) from: omlc.ogi.edu
[8] B. C. Wilson and G. Adam, “A Monte Carlo model for the absorption and flux distributions of light in tissue,” Medical Physics, Vol.10, No. 6, p.p. 824-830, 1983.
[9] 台大皮膚科部, 實用皮膚醫學-第二版, 國立台灣大學醫學院, 2006.
[10] P. Harrington, “Phil Harrington Physics for Chiropractors, Part 3：Can Laser Therapy Damage Tissue?,” Dynamic Chiropractic-Journal 1, Vol. 28, Issue 1, 2010.
[11] M. H. Niemz, Laser-Tissue Interactions: Fundamentals andApplications. Third Edition, Springer-Verlag, 2007.
[12] J. M. Gillbro and M. J. Olsson, “The melanogenesis and mechanisms of skin-lightening agents – existing and new approaches,” International Journal of Cosmetic Science, Vol. 33, Issue 3, p.p. 210–221, 2011.
[13] A. K. Thiruvenkadan, N. Kandasamy, and S. Panneerselvam, ”Coat colour inheritance in horses,” Livestock Science, Vol. 117, Issues 2–3, p.p. 109–129, 2008.
[14] G. Ara, R. R. Anderson, K. G. Mandel, M. Ottesen, and A. R. Oseroff, “Irradiation of pigmented melanoma cells with high intensity pulsed radiation generates acoustic waves and kills cells,” Lasers in Surgery and Medicine, Vol 10, Issue 1, p.p. 52–59, 1990.
[15] V. Vejjabhinanta, M. L. Elsaie, S. S. Patel, A. Patel, C. Caperton, and K. Nouri, ”Comparison of short-pulsed and long-pulsed 532 nm lasers in the removal of freckles,” Lasers in Medical Science, Vol. 25, Issue 6, p.p. 901-906, 2010.
[16] 曾東, 余文林, 畢媛, 楊傳紅, 賴晃文, 胡志奇, “激光脫毛動物模型的建立”, 南方醫科大學 Vol.29, No.4, p.p. 697-700, 2009.
[17] T. S. Alster, H. Bryan, and C. M. Williams, “Long-Pulsed Nd:YAG Laser-Assisted Hair Removal in Pigmented Skin,” A Clinical and Histological Evaluation,” Archives Dermatology, Vol.137, p.p. 885-889, 2001.
[18] V. B. Campos , C. C. Dierickx, W. A. Farinelli, T. Y. Lin, W. Manuskiatti, and R. R. Anderson, “Hair removal with an 800-nm pulsed diode laser,” Journal of the American Academy of Dermatology, Vol. 43, Issue 3, p.p. 442-447, 2000.