The fundamental difference lies in the stability of the light output and the specific power metric required for calculation. Continuous Wave (CW) technology delivers a constant intensity, allowing dosage to be calculated directly from the rated power. Pulsed Wave (PW) technology, however, modulates the light through varying peak power and frequencies, which mandates the use of average power—not peak power—to accurately determine the total energy delivered.
Core Insight: In phototherapy, the method of delivery dictates the math. While Continuous Wave is straightforward, Pulsed Wave requires you to calculate dosage based on average power to ensure the correct energy density (J/cm²) is delivered for effective biostimulation without causing thermal damage.
The Mechanics of Delivery
Continuous Wave (CW) Consistency
Continuous Wave technology operates exactly as the name implies: it provides a constant intensity of light output over the duration of the treatment.
Because the flow of energy is uninterrupted, the power output remains stable at the device's rated level. This makes the calculation of energy density linear and predictable.
Pulsed Wave (PW) Variability
In contrast, Pulsed Wave technology delivers energy in distinct bursts. It operates by varying the peak power and the pulse frequency (how often the pulses occur).
Between these pulses of light, there are intervals where no energy is delivered. Consequently, the peak power during a pulse is significantly higher than the actual amount of energy tissue receives over time.
The Calculation Distinction
The Danger of Peak Power in PW
A common error in clinical practice is calculating Pulsed Wave dosage based on the peak power setting. Doing so drastically overestimates the amount of energy the patient is receiving.
Because the laser is "off" for a portion of the treatment time, the average power is always lower than the peak power.
The Necessity of Average Power
To determine the accurate total energy density (J/cm²) for Pulsed Wave treatments, you must use the average power.
This metric accounts for the "off" cycles in the pulse frequency. Using average power is the only way to ensure the calculated dosage aligns with the actual biostimulation requirements of the tissue.
Understanding the Trade-offs: Safety vs. Efficacy
Managing Thermal Accumulation
One of the primary reasons for selecting a specific wave type involves heat management. Continuous Wave delivers energy constantly, which can lead to rapid heat buildup in the tissue.
Pulsed Wave technology mitigates this by allowing tissue to cool slightly between pulses.
Ensuring Biostimulation
However, if the dosage calculation for Pulsed Wave is incorrect (i.e., using peak instead of average power), you risk under-dosing the patient.
Accurate calculation ensures you provide the necessary energy for biostimulation while simultaneously preventing excessive thermal accumulation. Balancing these two factors is the ultimate goal of selecting the correct power metric.
Making the Right Choice for Your Goal
The choice between technologies often comes down to how you manage heat and how you calculate the required energy dose.
- If your primary focus is simplified dosage calculation: Continuous Wave allows you to calculate dosage directly based on the rated power without complex conversion.
- If your primary focus is managing tissue temperature: Pulsed Wave is preferable for preventing thermal accumulation, provided you strictly use average power to calculate the total energy density.
Ultimately, precision in phototherapy comes down to matching your calculation method to the physics of the wave form you are using.
Summary Table:
| Feature | Continuous Wave (CW) | Pulsed Wave (PW) |
|---|---|---|
| Energy Delivery | Constant, uninterrupted intensity | Intermittent bursts/pulses |
| Dosage Metric | Rated/Constant Power | Average Power (not Peak) |
| Calculation Complexity | Simple & Linear | Requires pulse/frequency adjustment |
| Heat Management | High potential for thermal buildup | Lower; allows tissue cooling between pulses |
| Primary Clinical Benefit | Straightforward dosage control | Prevention of thermal damage |
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References
- Denise Hawkins, Heidi Abrahamse. Phototherapy — a treatment modality for wound healing and pain relief. DOI: 10.4314/ajbr.v10i2.50626
This article is also based on technical information from Belislaser Knowledge Base .
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