Clinical Plasma Medicine 7–8 (2017) 16–23

Contents lists available at ScienceDirect

Clinical Plasma Medicine

journal homepage: www.elsevier.com/locate/cpme

Original research article

Human health risk evaluation of a microwave-driven atmospheric plasma jet T

as medical device
A. Lehmann , F. Pietag, Th. Arnold
⁎

Leibniz Institute of Surface Modification, Permoserstrasse 15, 04308 Leipzig, Germany

ARTICLE INFO ABSTRACT

Keywords: Purpose: The aim of this study was the characterisation of a microwave-driven atmospheric plasma jet (APJ)
Atmospheric plasma dedicated for medical applications. The scientific focus includes harmless sterilization of surfaces and ther-
Plasma medicine apeutic treatments in dentistry.
Methodes: The plasma was investigated with respect to potential health risks for human beings, which could
occur especially by the gas temperature, heat flow, patient leakage current, UV emission and ozone emission
from the plasma jet, according to DIN SPEC 91315:2014-06 (General requirements for plasma sources in
medicine) [1].
Results: The results of the experiments indicate a high potential of the plasma jet to be used as a medical device
exhibiting low gas temperatures up to 34 °C. The calculated leakage currents are mostly below the 10 μA
threshold. The limiting UV exposure duration for the APJ with a calculated maximum effective irradiance of 2.6
μW/cm2 is around 19 min, based on the exposure limits of the international commission on non-ionizing ra-
diation protection guidelines (ICNIRP) [2]. A significant ozone concentration was observed mainly in the axial
effluent gas flow. Ozone concentration strongly decreases with increasing distance from the plasma source exit
nozzle.
Conclusion: The investigated APJ exhibits physical properties that might not constitute health risks to humans,
e.g. during treatment in dentistry. Thus, the APJ shows a high potential for application as a device in dental
therapy.

1. Introduction microorganisms has been successfully tested (Lactobacillus casei, Strep-

tococcus mutans, Candida albicans and Escherichia coli). Escherichia coli
Beside the wide range of plasma application in many fields ex- were included as reference [27]. Surface temperatures occurring during
tensively described by Woedtke et al. [3], the medical applications of APJ irradiation were measured by means of infrared-camera thermo-
atmospheric plasmas are ever-expanding in the last years. The scientific scopy (Optris PI, Optris, Germany) at the point of contact to the re-
focus in the medical field includes among others plasma coagulation spective sample surfaces. Hence, temperatures below the biological
[4–6], wound healing [7–9], preventive medicine for decontamination, tolerance threshold were assured. However, in order to ensure a com-
sterilization and disinfection in healthcare [10–13], experimental mercial launch with CE marking in future, among others an expansive
cancer research [14–19], in HIV research [20] as well as sterilization risk evaluation of APJ is necessary as first step [30]. The estimation of
and therapeutic treatments in dentistry [21]. Contemporary aspects of risk factors allows the comparison of different plasma sources and
plasma application in dentistry, like the modification of dental implant clarifies future minimal standards [31]. In the present paper the APJ is
surfaces, enhancing of adhesive qualities, decontamination, root canal characterised with respect to risks for patients according to DIN SPEC
disinfection and tooth bleaching, were described and reviewed by dif- 91315:2014-06 (General requirements for plasma sources in medicine)
ferent authors [22–24]. The successful application of our atmospheric [1], which standardises a set of experiments in order to estimate the
plasma jet (APJ) in dental experiments has been published in several health hazard potential of APJs due to their physical and chemical
scientific articles focusing on the effective removal of biofilms, killing of properties namely gas temperature, thermal output and heat flow to
adherent oral microbes, and surface activation of teeth [25–29]. The treated surface, patient leakage current, UV radiation and ozone
biological effectiveness of APJ on a wide range of important oral emission.

⁎
Corresponding author.
E-mail address: [email protected] (A. Lehmann).

https://doi.org/10.1016/j.cpme.2017.06.001
Received 1 March 2017; Received in revised form 19 May 2017; Accepted 1 June 2017
2212-8166/ © 2017 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

Fig. 1. a) Atmospheric pressure plasma jet – APJ (IOM, Leipzig, Germany); made by NTG GmbH, Gelnhausen, Germany, b) sketch of the APJ source.

2. Material and methods 2.3. Heat flow

2.1. Atmospheric plasma jet (APJ) Measurements of the plasma jet heat flow were accomplished uti-
lizing the fiber optic temperature monitoring system mentioned in the
The plasma system comprising the plasma source and a 2.45 GHz section above, while the fiber tip was connected to a copper body (mass
microwave pulse generator used for the investigations has been de- m: 0.35 g; thermal capacity c w : 385 J/kg K) according to DIN SPEC
scribed earlier by Lehmann et al. [26]. Microwave power was coupled 91315. The heat flow (P) of the APJ was determined by fitting the slope
into the plasma source in the form of rectangular pulses by a coaxial of the transient temperature curve ∆T/∆t in the near-linear region
cable, where pulse peak power (PP) was 200 W and the pulse repetition during the heating-up phase and calculating P according to
frequency (fP) was 1.46 kHz. The pulse width (tP) was adjusted to 5 µs.
P = m cw T / t. (2)
The used parameters resulted in a mean input power (PM) of 1.5 W
according to Eq. (1): Fig. 2 shows an example of a transient temperature measurement.
The experimental setup is shown in Fig. 3a.
PM = tP PP fP (1)

Pulse shape and frequency were monitored using an oscilloscope 2.4. Patient leakage current
(TPS2024, Tektronix, Bracknell, U.K.). The carrier gas was helium with gas
flow rates of 1.5, 2.0 or 3.0 slm. Nitrogen was used as peripheral shielding The DIN SPEC 91315 [1] refers to IEC DIN EN 60601 [37] in order
gas with flow rates between 0.2 and 0.4 slm. With the given set of electrical to evaluate the patient leakage current from the plasma jet. Equipment's
and gas parameters a plasma jet was generated exhibiting a visible length of provided with not more than one connection to a particular mains
7–8 mm and a diameter of approx. 1 mm (see Fig. 1a). A sketch of the supply and used for compensation or alleviation of disease, injury or
plasma source under investigation is shown in Fig. 1b. All measured disability have to be certificated according to IEC DIN EN 60601 [37].
quantities described below were determined along the jet axis for different An investigation according to this fundamental norm in Europe [54] is
distances from the nozzle exit (working distance). necessary to ensure save operation of the plasma jet as medical-elec-
trical equipment [9]. In Table 1 the regulatory limits of patient leakage
2.2. Gas temperature current for standard condition (N.C.) and single fault condition (S.F.C.)
for devices of type B are given. Type B describes a component (body),
Plasma gas temperature is a main factor to characterize an atmo- which is not designed to transmit current to human body however a
spheric plasma source especially for medical applications. For this ap- power transmission is conceivable [38]. Four types of leakage currents
plication cold plasmas are used. In literature [32–34] the temperature are described (ground leakage current, housing leakage current, patient
model of such non-thermal low temperature plasma discharges is de- leakage current, and patient auxiliary current), whereas in this study
scribed. One of the main characteristic of these plasmas is that the only the patient leakage current for standard condition was examined.
applied electrical energy primarily generates energetic electrons. These
energetic electrons produce excited species, ions, as well as additional
electrons. In case of cold plasma jets the entire gas stream is less heated
than in thermal plasmas, since heavy particles are slightly heated by a
few elastic collisions [33] and remain in a low-energetic state [35].
The temperature measurements were carried out by means of a
FOTEMP1-4, fiber optic temperature monitoring system (Optocon AG,
Germany). The fiber optic thermometer offers complete immunity to
microwave radiation [36]. Hence, undisturbed measurement values are
ensured. The temperature-sensitive fiber tip was 1 mm in diameter.
Hence, the system is suitable for spatially resolved determination of
plasma gas temperatures. Data sample rate was chosen to be 1/s. For
measurement of the radial temperature distributions two perpendicular
cross section line scans of the APJ across the fiber optic were carried out
with a scan velocity of 0.1 mm/s.
Axial temperature distribution at the respective positions of the
maximum radial temperature was recorded at intervals of 1 mm along
the visible jet axis, between distances of 1 mm and 5 mm. Fig. 2. Example for calculation of the heat flow of the APJ.

17
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

Fig. 3. Experimental setups, a) for calorimetric measurements, b) electrical human body model and c) for UV emission measurements.

Table 1 wavelength range of 250–800 nm. The spectral range of 250 nm to

Regulatory limits of patient leakage current according to IEC DIN EN 60601 for 400 nm was investigated, since it includes the following types of UV
devices of type B. emission bands: UVC between 100 nm to 280 nm, UVB from 280 nm to
Type B 315 nm, and UVA from 315 nm to 400 nm [12], respectively. The range
between 100 nm and 250 nm could not be observed because of spectral
Standard condition (N.C.) Single fault condition (S.F.C.) limitations of the spectrometer. The experimental setup (Fig. 3c) de-
scribed in DIN SPEC 91315 was adopted for these measurements. The
AC 10 µA 50 µA
DC 100 µA 500 µA quantitative determination of the effective irradiance and permissible
exposure time to skin within an 8 h period is described in detail by the
ICNIRP. Measured spectral irradiance Eλ (µW cm−2 nm−1) of a broad
An overview of effects of current on human beings and livestock is band UV source is weighted against the relative spectral effectiveness,
published by DIN VDE V 0140-479-1 [39]. For the human body re- which is a function of spectral weighting factors S(λ) to obtain the ef-
sistance the simplified human body model described in IEC DIN EN fective irradiance Eeff (µW/cm2). Since ultraviolet radiant exposure in
60601-1 according to Eisner et al. [40] was built (see Fig. 3b). An the spectral region 180–400 nm incidents upon the unprotected eyes
isolated graphite slab served as an electrically conducting surface which should not exceed 3 J/cm2, the permissible exposure time in seconds
was carried by a metal box containing the electric circuit emulating the may be computed by dividing the limit mentioned above by Eeff [2,42].
body resistance. This circuit consists of resistor R2 (1 kΩ), followed by In order to calibrate the spectral intensity scale of the spectrometer,
an RC-filter formed by resistor R1 (10 kΩ) and capacitor C1 (0.015 µF). reference measurements were carried out using a calibrated spot light
Such a circuit takes into account the human body and the risk of ven- UV source (LC8 HAMAMATSU PHOTONICS K.K., Japan). The UV light
tricular fibrillation [40]. The transmitted current was determined by source associated with the condenser lens E7658-01 and set to 50% of
the measurement of voltage V. The resulting patient body leakage irradiance emits an integrated irradiance of 169 mW/cm2 at a center
currents were calculated from the monitored transient voltage by in- wavelength of 365 nm and a distance d of 10 mm in front of the exit
tegration over time, as follows: lens. Assuming a linear response from the spectrometer detector within
tint the spectral range of 250 nm to 400 nm the integrated intensity of APJ
1 V (t )
IPulse = t spectra can be normalized to the integrated intensity of the UV lamp.
tint t=0
R2 (3) A fused silica glass plate with thickness of 2 mm was located at a
distance d of 10 mm in front of the spectrometer entrance lens for
ILeakage = IPulse tint fP (4) measurements of UV light emerging from the lamp as well as from the
where IPulse is the current pulse, tint the integration time, V the voltage, APJ. The glass plate was equipped with a black mask exhibiting a cir-
Δt the inverse count rate and fP the pulse repetition frequency. cular aperture of 1.5 mm in diameter in order to maintain equal solid
angle conditions for the detection of radiation from both UV sources
2.5. UV emission under investigation. A sketch of the experimental configuration for UV
emission measurements of the APJ is shown in Fig. 3c.
Medical application of ultraviolet radiation is found e.g. in dentistry
for photocuring of composites by UVA, and in dermatology (all UV 2.5.1. Ozone emission
bands) [41]. Since atmospheric plasmas are known to emit UV radia- Ozone is generated in atmospheric plasma jets by its reactive species
tion, it is necessary to obtain a quantitative measure of UV light emitted that react with the oxygen of the surrounding air. It is on the one hand
by the gas discharge. The international commission on non-ionizing side an antimicrobial effective gas for air disinfection in food industry
radiation protection guidelines (ICNIRP) is an independent organiza- [43,44]. Beside reactive oxygen species (ROS) and reactive nitrogen
tion of scientific experts for advising and guiding about health and species (RNS), UV radiation, electrical fields and currents, ozone has a
environmental effects from non-ionizing radiation (NIR) (which means direct impact on the cells of microorganisms [45] and effects superficial
electromagnetic radiation), in order to protect people and the en- tissues [46]. The concentration of ozone is strongly depending on the
vironment from it. The limits in this guideline were based on scientific used parameters, like device setup, power of plasma excitation and gas
data [2]. In order to quantify the UV radiation in terms of an irradiance composition [47]. On the other hand, ozone is an important toxic gas
E (W/cm2) for continuous exposure of eye and skin generated by the with harmful effects to human respiratory. According to EU directives
plasma, we have regarded the ICNIRP guidelines on limits of exposure (2002/3/EG) ozone constitutes no health risk at concentrations up to
to ultraviolet radiation of wavelengths between 180 nm and 400 nm 0.055 ppm (110 µg/m3), or by Suva up to 0.1 ppm for long-time ex-
(incoherent optical radiation). Therefore, optical spectroscopic mea- position, usually over a period of eight hours, respectively [31,42].
surements were performed. An optical spectrometer (AOS 4-1, IFU For the measurements of the ozone concentration generated by the
GmbH, Germany) was employed that is capable to detect radiation in a APJ a Thermo Environmental Instruments Model 49C Ozone Analyzer

18
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

Fig. 4. Experimental setup for detection of ozone concentrations at different measuring angles.

Thermo Scientific, Germany was used. It measures ozone concentra- Table 2

tions via UV absorbance at 254 nm with a precision of 1 ppb in a range Calculated Reynolds numbers Re, according to the He-flow rate and the kine-
of 0–0.05 to 200 ppm. The actual ozone concentrations were detected matic viscosity [50].
under three different measuring angles at a fixed distance of 10 mm He-flow rate [slm] Kinematic viscosity [m2/s] Re
between APJ and the probe as well as in dependence of different dis-
tances between the plasma source and the ozone probe on the jet axis at
−4
1.5 1.4181 × 10 1430
2.0 1.3950 × 10−4 1937
180°. The experimental setups were arranged according to DIN SPEC
3.0 1.3360 × 10−4 3037
91315 and are shown in Fig. 4.

3. Results tube and v is the kinematic viscosity of helium [50] according to the in
situ measured jet temperature at a distance of 1 mm for each gas flow
3.1. Temperature measurements rate, respectively. Table 2 shows the data for kinematic viscosity from
literature and the calculated Reynolds numbers. In literature, the Rey-
Temperature measurements were carried out at fixed power para- nolds number of approximately 2000 is referred as the ‘‘critical’’ Rey-
meters and varying gas flow parameters. An example of a radial tem- nolds number (Recr) for a transition from laminar to turbulent flow
perature profile is shown in Fig. 5a. From the respective measured ra- regime [51,52]. The results exhibit the transition from laminar jet
dial temperature profiles the maximum temperatures at the working conditions at 1.5 slm and 2.0 slm He-flow rates towards to a turbulent
distances were calculated. The results for the axial temperature dis- regime at a He-flow rate of 3.0 slm.
tribution are shown in Fig. 5b. A cooling effect is supported by the All graphs in Fig. 5b show a temperature gradient with the working
transient discharges using short electric pulses, followed by pulse distance. An ascending temperature profile with the maximum tem-
pauses with not ignited gas stream. As expected, a temperature decrease perature of 59 °C near the tip of the APJ was registered at gas flow rates
is observed resulting from an increase of the gas flow. The gas flow is of 1.5 slm He and 0.2 slm N2. An increased gas flow of 2.0 or 3.0 slm He
applied through the discharge zone; hence the plasma temperature re- and 0.2 or 0.4 slm N2 led to gas temperatures profiles which decrease
mains low because of convective cooling [48]. The inner diameter of towards the visible plasma jet tip. Thereby, the temperature gradient is
the micro-wave powered inner capillary pipe is 0.314 mm. For an es- higher with increasing turbulent gas flow of 3.0 slm He. For the highest
timation of the flow condition we have calculated the exit flow Rey- gas flow rates temperatures in the range of 34 °C at the tip to 44 °C near
nolds numbers of the inner gas stream as follows: the plasma source were obtained. This allows applications in a bio-
compatible regime. Furthermore, the diagrams show that the visible jet
VL length was influenced by the gas flow. High flow rates resulted in
Re =
v (5) longer visible length (approx. 8 mm). All final measurement points re-
[49], where V is the mean fluid velocity, L the inner diameter of the present the visible length of the plasma jet.

Fig. 5. Temperature measurements by means of fiber optic thermometer, a) radial jet profile and b) maximum temperatures along the APJ axis from nozzle to plasma
tip for each gas parameter.

19
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

Fig. 7. Average of 128 single voltage pulses measured at human body resistance
Fig. 6. Calorimetric measurements for evaluation of the heat flow of APJ, taken model from Fig. 3b at different axial distances from the plasma source nozzle.
at 3 mm from the nozzle with variation of frequency.
visible plasma zone (active plasma region), which contains primarily
3.2. Measurement of heat flow energetic electrons and reactive species, like OH, N2* and N2+ (see
Fig. 9) [56,57]. A closer look to the electron properties and dynamics in
For these measurements the same set of gas flow parameters were atmospheric helium plasma jets is given by Hübner et al. [58] and
adjusted as for the temperature measurements. No significant changes Boeuf et al. [59]. The working distance of 6 mm is in region of the tip of
of the heat flow in dependence of the distance between the copper body the visible jet. At this distance a transition from the active plasma re-
connected to the fiber optic and the plasma jet source was detected. gion into a more positive plasma afterglow occurs. There the air pro-
Therefore the axial distance for measurements presented in Fig. 6 was portion is much higher [60,61] and relative long-living radicals, like
fixed to 3 mm. OH, O, O3, NO and more [56] are present.
With this gas flow and working distance parameters, the influence Fig. 8 shows the calculated leakage current along the APJ axis as
of the pulse repetition frequency was tested (Fig. 6). well as for varied gas flows from the data in Fig. 7. All graphs show the
The heat flow significantly increases at rising pulse repetition fre- same trend. The calculated leakage currents are mostly below the
quencies and decreasing gas flows, indicating the large influence of the threshold of 10 µA. Obviously, the gas flow has a significant influence
total gas flow rate for cooling the plasma irradiated surface. to the patient body leakage current. The leakage current increases with
Analogously to temperature measurements a decrease of the heat flow increasing gas flows at the jet axis between 2 mm and 6 mm.
was observed by the increase of the gas flow rate from 2.0 slm to 3.0 slm
He and 0.2 slm to 0.4 slm N2, respectively. 3.4. Measurement of UV emission
With respect to the application temperature, the favored application
parameters of 1.46 kHz and a flow rate of He of 3.0 slm and N2 of Optical emission spectra from 250 nm up to 800 nm were measured
0.4 slm show a thermal output of about 165 mW which is similar to at different axial positions of the APJ with gas flows of He of 3.0 slm
results in literature [31]. In addition to results of temperature mea- and N2 of 0.4 slm (Fig. 9). The spectra consist mainly of atomic emission
surements, this set of parameters seems to be optimal for effective but lines and molecular bands which can be attributed to He, the second
harmless application being independent of the distance of the plasma positive system of N2, and OH [41,62].
source to the surface. The UV emission was quantified on a basis of these spectra between
250 nm and 400 nm. Within the spectral limitations of the spectrometer
3.3. Measurement of leakage current no emitted lines were detected between 250 and 290 nm (UVC region).
UVB and UVA emission lines between 295.8 nm and 400 nm were de-
Leakage currents are main factors of concern in the application of tected and can be ascribed to the second positive system of N2 [62] and
electrical devices to the human body. Electrical current has very dif-
ferent effects to human bodies. Beside the controlled medical applica-
tion electrical current flowing through the body can cause a slight
tingling right up to stimulation of muscles and nerves, resistive heating
of tissue and electrochemical burns or even electric shock [53,54].
Different influence of ambient conditions, such as the humidity and
conditions of skin, the size of contact area and the dwell time play an
important role. In literature an average total resistance of skin and in-
ternal resistance of 1 kΩ (AC) are described [53,55]. The threshold
currents are described by DIN EN 60601 to be 100 µA (DC) and 10 µA
(AC) [25,38]. Fig. 7 shows an example of the average of 128 single
voltage pulses measured with the human body resistance model de-
picted in Fig. 3b, where variable positions along the APJ axis and a gas
flow rate of 3.0 slm of He and 0.4 slm N2, respectively, were chosen.
The graphs clearly show the influence of the RC-filter. The originally
input pulse length of 5 µs (marked by the grey box) turns into a current
pulse with a rise time of about 18.6 µs. Further it can be seen, that the
voltage appears more negative in distance range from 1 mm to 5 mm Fig. 8. Leakage current measurements at different working distances along the
and turns to positive again at 6 mm. Atmospheric plasma jets show a APJ axis.

20
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

Fig. 11. Ozone concentration measured under different angles at a distance of

Fig. 9. Optical emission spectrum of APJ between 250 nm and 800 nm.
10 mm to the plasma source.

first order ultra violet OH band [41]. The presence of OH is due to

natural water vapor in the open air system.
Fig. 10 shows the calculated irradiance of the APJ between 250 and
400 nm depending on the working distance. The maximum calculated
effective irradiance (Eeff) at a distance of 1 mm is 2.6 µW/cm2. Towards
the distance of 5 mm, Eeff is decreasing to 1.9 µW/cm2. The limiting UV
exposure duration for the APJ with a maximum effective irradiance of
2.6 µW/cm2 is around 19 min, based on the exposure limits of the in-
ternational commission on non-ionizing radiation protection guidelines
(ICNIRP) [2].

3.4.1. Measurement of ozone concentration

Fig. 11 shows the result of the ozone measurements at the APJ for
three different measuring angles with respect to the jet axis (45°, 90°
and 180°).
Measurements at angles of 45° and 90° show no significant differ-
ences with values between 0.7 and 1.7 ppm. However, the ozone con- Fig. 12. Ozone concentration at a measuring angle of 180° with varying dis-
centrations in direction of the APJ axis (180°) show strong increase. At tances of the probe to plasma source.
the lowest gas flow the highest concentration of 16 ppm was detected.
The change of ozone concentration depending on the axial distance
4. Discussion
between the plasma source and the gas probe is shown in Fig. 12. It
reveals that the ozone concentration is similarly decreasing for all gas
The presented study gives an overview of features of the APJ as a
flow rates with the distance down to values of around 4 ppm at a dis-
potential medical device. Different investigations were done to evaluate
tance of 16 mm.
the risk for humans during a treatment by APJ.
The APJ works at patient-friendly temperatures and the thermal
output of about 165 mW is similar to results in literature [31]. The low
gas temperature is caused by high gas flow rates and low input power.
Mentioned above, the temperature gradient is higher with increasing
gas flows. Cheng et al. [19] describes the characteristics of the laminar
argon plasma jet impinging normally upon a flat substrate located in air
surroundings. The plasma parameters (temperature, axial velocity,
mass fraction, etc.) are affected by the presence of a substrate, mainly in
the near-substrate region. The decay rates of these plasma parameters
at a turbulent impinging jet are often appreciably larger than in laminar
jets, because more ambient air is entrained into the turbulent jet [19].
In case of the investigated plasma jet we observed a lager gradient of
the jet temperature at a gas flow rate of 3.0 slm of He, which is more
turbulent than the others.
For the leakage current measurement a simple equivalent circuit of
human body resistance has been assumed. The resistance depends on
different factors, such as current path, temperature, humidity of skin,
size of contact area. Not all of these factors have been considered in the
present study. However, especially humidity of skin is a main factor at
Fig. 10. Irradiance Eeff of the APJ in dependence of the working distances (in medical applications. In future an adapted equivalent circuit of human
range of 250–400 nm). body impedance is necessary for specific applications. Further

21
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

Table 3
Comparison of the used APJ with different CE marked cold plasma medical devices,.
Unit APJ kINPen MED® Plasma Derm® Micro Plaster β

Plasma generation Microwave plasma jet DC plasma jet Volume DBD Microwave plasma torch
Plasma gas He, N2 Ar Ambient Air Ar
Gas flow [slm] 3, 0.2–0.4 5 2.2
Working distance [mm] 3 7–10 Millimeter 1
Plasma gas temperature [°C] 38 35–40 < 40 °C at a distance of
20 mm
Heat fLow [mW] 165 145–160, at the visible tip of
plasma jet
2
Effective UV irradiation [µW/cm ] 2.6 35 ± 5 0.04 21.1
Leakage current* [µA] 10 < 50 100
Ozone concentration [ppm] < 1.6 and < 12.5, depending on measurement > 0.2 and (< 0.055 at larger < 100 µg/m3
direction distances)
Reference [31,63] [64] [65,66]

kINPen MED® (INP Greifswald/neoplas tools GmbH, Greifswald, Germany), Plasma Derm® VU-2010 (CINOGY GmbH, Duderstadt, Germany) and Micro Plaster β
(Adtec Healthcare©), Hounslow, UK.; Leakage current in * rms (root mean square).

investigations according to IEC DIN EN 60601 (classification of applied 14971 in order to accomplish the required Medical Device Directive
parts, type B) are necessary in order to ensure save operation of the (MDD) for CE marking.
plasma jet as medical-electrical equipment.
Optical emission investigations have shown an occurrence of Ethical Statement
dominant nitrogen bands in the region of UVB and UVA, due to the
admixture of nitrogen as shielding gas. However, according to [2] an Not applicable for this article.
application of this APJ for about 19 min is possible with the calculated
irradiance Eeff of 2.6 µW/cm2. That is sufficient for antimicrobial ap- Conflict of interest
plications in dentistry, as described by Rupf et al. [22]. Weltmann et al.
[31] discussed that the exposure limits and threshold values are de- The authors have no conflict of interest to declare.
pendent on the velocity and the movement of the plasma source over
the skin and the condition of the skin. Furthermore, Weltmann et al. Financial disclosure
[31] and Brandenburg et al. [47] describe a strong variation of UV
emission depending on feed gas conditions and capillary outlet espe- On behalf of all authors I certify that we have no financial interest to
cially for atmospheric pressure plasma. For that reason all plasma de- declare.
vices have to be carefully evaluated for the dedicated medical appli-
cation. Acknowledgements
Despite of the nitrogen shielding a significant ozone concentration
mainly at a measuring angle of 180° was observed. This has to be taken The authors want to thank Dr. T. Berndt for supply of the ozone
in to account in the final implementation of a medical device. measurement system and Dr. U. Decker for supply of the UV spot light.
A further important point of future investigations is the measure- This study was supported by grants from the Zentrales Innovations
ment of microwave leakage of this equipment. With usually used Programm Mittelstand (ZIM - BMWI), Germany (BMWI; FKZ
measurement devices (Microwave Survey Meter MM3001B-110AB, KF207401KJ3).
Muegge, Germany) we have not detected microwave radiation, yet.
Time resolved measurements are proposed to detect the microwave References
power per pulse.
According to DIN SPEC 91315, these results provide a first estima- [1] DIN SPEC 91315, General Requirements For Plasma Sources In Medicine, 2014, pp.
tion of the applicability of the APJ as medical plasma source. In lit- 1–16.
[2] ICNIRP GUIDELINES, On Limits of exposure to ultraviolet radiation of wavelengths
erature, two basic plasma device principles were described, established between 180 nm and 400 nm (Incoherent optical radiation), Health Physics, 87(2),
in research and also used in first practical applications: the volume 2004, pp. 171–186.
dielectric barrier discharge (DBD) and the atmospheric pressure plasma [3] Th von Woedtke, S. Reuter, K. Masura, K.-D. Weltmann, Plasmas for medicine, Phys.
Rep. 530 (2013) 291–320.
jets (APPJ) [3,9,35]. A comparison of the used APJ with different CE [4] K. Miyamoto, S. Ikehara, H. Takei, Y. Akimoto, H. Sakakita, K. Ishikawa, M. Ueda,
marked cold plasma medical devices is shown in Table 3. Beside the J. Ikeda, M. Yamagishi, J. Kim, T. Yamaguchi, Red blood cell coagulation induced
different application parameters of atmospheric plasmas, the resulting by low-temperature plasma treatment, Arch. Biochem. Biophys. 605 (2016)
95–101.
tested physical criteria can be seen. Different working conditions result
[5] J. Raiser, M. Zenker, Argon plasma coagulation for open surgical and endoscopic
for each plasma source with respect to the physical and chemical applications: state of the art, J. Phys. D: Appl. Phys. 39 (2006) 3520–3523.
plasma characteristics, for instance coming from the different discharge [6] Argon Plasma Coagulation, A New Paragon In Flexibility and Efficiency, ERBE
Elektromedizin GmbH, ERBE USA, Inc. 2225 Northwest Parkway, Marietta, GA,
and electrode configuration, type of plasma and gas as well as the used
30067-9317.
excitation frequency [57]. [7] Y. Akimoto, S. Ikehara, T. Yamaguchi, J. Kim, H. Kawakami, N. Shimizu, M. Hori,
H. Sakakita, Y. Ikehara, Galectin expression in healing wounded skin treated with
low-temperature plasma: comparison with treatment by electronical coagulation,
5. Conclusions Arch. Biochem. Biophys. 605 (2016) 86–94.
[8] Y.-W. Hung, L.-T. Lee, Y.-C. Peng, C.-T. Chang, Y.-K. Wong, K.-C. Tung, Effect of a
nonthermal-atmospheric pressure plasma jet on wound healing: an animal study, J.
In summary, the investigated APJ exhibits physical properties that Chin. Med. Assoc. 79 (6) (2016) 320–328.
might not constitute health risks to humans, e.g. during treatment in [9] G. Isbary, W. Stolz, T. Shimizu, R. Monetti, W. Bunk, H.-U. Schmidt, G.E. Morfill,
T.G. Klämpfl, B. Steffes, H.M. Thomas, J. Heinlin, S. Karrer, M. Landthaler,
dentistry. Thus, the APJ shows a high potential for application as a J.L. Zimmermann, Cold atmospheric argon plasma treatment may accelerate wound
device in dental therapy. It motivates further investigation, e.g. certi- healing in chronic wounds: results of an open retrospective randomized controlled
fication by ISO 13485 and the risk assessment according to DIN EN ISO study in vivo, Clin. Plasma Med. 1 (2013) 25–30.

22
A. Lehmann et al. Clinical Plasma Medicine 7–8 (2017) 16–23

[10] J.L. Hueso, V.J. Rico1, J.E. Frías, J. Cotrino, A.R. González-Elipe, Ar + NO mi- Nutztiere, Verlag Europa-Lehrmittel 2008, Aus der Technikredaktion, 1–11.
crowave plasmas for Escherichia coli sterilization, J. Phys. D: Appl. Phys. 41 (2008) [39] DIN IEC/TS 60479-1:2007-05, VDE V 0140-479-1:2007-05, Effects of Current on
092002. Human Beings and Livestock – Part 1: General Aspects (IEC/TS 60479-1:2005 +
[11] G.E. Morfill, M.G. Kong, J.L. Zimmermann, Focus on plasma medicine, New J. Phys. Corrigendum October 2006).
11 (2009) 115011. [40] L. Eisner, R.M. Brown, D. Modi, Leakage Current Standards Simplified. MDDI in
[12] M. Laroussi, F. Leipold, Evaluation of the roles of reactive species, heat, and UV Regulatory and Compliance, 2004.
radiation in the inactivation of bacterial cells by air plasmas at atmospheric pres- [41] I.E. Kieft, E.P. v d Laan, E. Stoffels, Electrical and optical characterization of the
sure, Int. J. Mass Spectrom. 233 (2004) 81–86. plasma needle, New J. Phys. 6 (2004) 149.
[13] M. Laroussi, X. Lu, Room-temperature atmospheric pressure plasma plume for [42] Suva, Grenzwerte am Arbeitsplatz, Bereich Arbeitsmedizin 2015.
biomedical application, Appl. Phys. Lett. 87 (113902) (2005) 1–3. [43] A.-Y. Moon, S. Noh, S.Y. Moon, S. You, Feasibility study of atmospheric-pressure
[14] D. Xu, X. Luo, Y. Xu, Q. Cui, Y. Yang, D. Liu, H. Chen, M.G. Kong, The effects of cold plasma treated air gas package for grape's shelf-life improvement, Curr. Appl. Phys.
atmospheric plasma on cell adhesion, differentiation, migration, apoptosis and drug 16 (2016) 440e445.
sensitivity of multiple myeloma, Biochem. Biophys. Res. Commun. 473 (4) (2016) [44] F.D.L. Almeida, R.S. Cavalcante, P.J. Cullen, J.M. Frias, P. Bourke,
1125–1132. F.A.N. Fernandes, S. Rodrigues, Effects of atmospheric cold plasma and ozone on
[15] J.W. Chang, S.U. Kang, Y.S. Shin, K.I. Kim, S.J. Seo, S.S. Yang, J.-S. Lee, E. Moon, prebiotic orange juice, Innov. Food Sci. Emerg. Technol. 32 (2015) 127–135.
S.J. Baek, K. Lee, C.-H. Kim, Non-thermal atmospheric pressure plasma induces [45] B.G. Dasan, I.H. Boyaci, M. Mutlu, Inactivation of aflatoxigenic fungi (Aspergillus
apoptosis in oral cavity squamous cell carcinoma: involvement of DNA-damage- spp.) on granular food 3 model, maize, in an atmospheric pressure fluidized bed
triggering sub-G1arrest via the ATM/p53 pathway, Arch. Biochem. Biophys. 545 plasma system, Food Control (2016), https://doi.org/10.1016/j.foodcont.2016.05.
(2014) 133–140. 015.
[16] M. Keidar, R. Walk, A. Shashurin, P. Srinivasan, A. Sandler, S. Dasgupta, R. Ravi, [46] T. Kisch, A. Helmke, S. Schleusser, J. Song, E. Liodaki, F.H. Stang, P. Mailaender,
R. Guerrero-Preston, B. Trink, Cold plasma selectivity and the possibility of a R. Kraemer, Improvement of cutaneous microcirculation by cold atmospheric
paradigm shift in cancer therapy, Br. J. Cancer 105 (2011) 1295–1301. plasma (CAP): results of a controlled, prospective cohort study, Microvasc. Res. 104
[17] S. Mashayekh, H. Rajayi, M. Akhlaghi, B. Shokri, Z.M. Hassan, Atmospheric-pres- (2016) 55–62.
sure plasma jet characterization and applications onmelanoma cancer treatment (B/ [47] R. Brandenburg, H. Lange, T. von Woedtke, M. Stieber, E. Kindel, J. Ehlbeck,
16-F10), Phys. Plasmas 22 (2015) 093508. K.D. Weltmann, Antimicrobial effects of UV and VUV radiation of nonthermal
[18] J. Duan, X. Lu, G. He, The selective effect of plasma activated medium in an in vitro plasma jets, IEEE Trans. Plasma Sci. 37 (6) (2009) 877–883.
co-culture of liver cancer and normal cells, J. Appl. Phys. 121 (2017) 013302. [48] E. Stoffels, I.E. Kieft, R.E.J. Sladek, M.A.M.J. Van Zandvoort, D.W. Slaaf, Cold gas
[19] H.-R. Metelmann, D.S. Nedrelow, C. Seebauer, M. Schuster, T. von Woedtke, K.- plasma in biology and medicine, in: R. d´Agostino, P. Favia, Y. Kawai, H. Ikegami,
D. Weltmann, S. Kindler, P.H. Metelmann, Head and neck cancer treatment and N. Sato, F. Arefi-Khonsari (Eds.), Advanced Plasma Technology, Wiley-VCH Verlag
physical plasma, Clin. Plasma Med. 3 (1) (2015) 17–23. GmbH & Co., KGaA, Weinheim, 2008, pp. 301–318.
[20] O. Volotskova, L. Dubrovsky, M. Keidar, M. Bukrinsky, Cold atmospheric plasma [49] Z. Fang, C. Ruan, T. Shao, C. Zhang, Two discharge modes in an atmospheric
inhibits HIV-1 replication in macrophages by targeting both the virus and the cells, pressure plasma jet array in argon, Plasma Sources Sci. Technol. 25 (2016) 01LT01.
PLoS One (2016), https://doi.org/10.1371/journal.pone.0165322. [50] 〈http://www.mhtl.uwaterloo.ca/old/onlinetools/airprop/airprop.html〉.
[21] Y. Zhang, Q. Yu, Y. Wanga, Non-thermal atmospheric plasmas in dental restoration: [51] G. Ben-Dov, J. Cohen, Critical reynolds number for a natural transition to turbu-
improved resin adhesive penetration, J. Dent. 42 (2014) 1033–1042. lence in pipe flows, Phys. Res. Lab. 98 (2007) 064503.
[22] S. Cha, Y.-S. Park, Plasma in dentistry, Clin. Plasma Med. 2 (2014) 4–10. [52] VDI-Wärmeatlas, Wärmeübertragung bei der Strömung durch Rohre, Ga1, 10.
[23] R.E.J. Sladek, E. Stoffels, R. Walraven, P.J.A. Tielbeek, R.A. Koolhoven, Plasma Auflage, Springer-Verlag, Berlin-Heidelberg, 2006.
treatment of dental cavities: a feasibility study, IEEE Trans. Plasma Sci. 32 (2004) [53] R.M. Fish, L.A. Geddes, Conduction of electrical current to and through the human
1540–1543. body: a review, Open Access J. Plast. Surg. (2009).
[24] C. Schaudinn, D. Jaramillo, M.O. Freire, P.P. Sedghizadeh, A. Nguyen, P. Webster, [54] W.H. Olsen, Electrical safety, in: G. John (Ed.), Medical Instrumentation
J.W. Costerton, C. Jiang, Evaluation of a non-thermal plasma needle to eliminate ex Application and Design, 4th ed., Webster, 2009, pp. 638–675 (ISBN-13 978-0-471-
vivo biofilms in root canals of extracted human teeth, Int. Endod. J. 46 (10) (2013) 67600-3).
930–937. [55] G. Faure, S.M. Shkol’nik, Determination of rotational and vibrational temperatures
[25] A.N. Idlibi, F. Al-Marrawi, M. Hannig, A. Lehmann, A. Rueppell, A. Schindler, in a discharge with liquid non-metallic electrodes in air at atmospheric pressure, J.
H. Jentsch, S. Rupf, Destruction of oral biofilms formed in situ on machined tita- Phys. D: Appl. Phys. 31 (1998) 1212–1218.
nium (Ti) surfaces by cold atmospheric plasma, Biofouling 29 (4) (2013) 369–379. [56] X. Lu, G.V. Naidis, M. Laroussi, S. Reuter, D.B. Graves, K. Ostrikov, Reactive species
[26] A. Lehmann, A. Rueppell, A. Schindler, I.-M. Zylla, H.J. Seifert, F. Nothdurft, in non-equilibrium atmospheric-pressure plasmas: generation, transport, and bio-
M. Hannig, S. Rupf, Modification of enamel and dentin surfaces by non-thermal logical effects, Phys. Rep. 630 (2016) 1–84.
atmospheric plasma, Plasma Process Polym. 10 (2013) 262–270. [57] J. Winter, R. Brandenburg, K.-D. Weltmann, Atmospheric pressure plasma jets: an
[27] S. Rupf, A. Lehmann, M. Hannig, B. Schäfer, A. Schubert, U. Feldmann, overview of devices and new directions, Plasma Sources Sci. Technol. 24 (064001)
A. Schindler, Killing of adherent oral microbes by a non-thermal atmospheric (2015).
plasma jet, J. Med. Microbiol. 59 (2010) 206–212. [58] S. Hübner, J. Santos Sousa, V. Puech, G.M.W. Kroesen, N. Sadeghi, Electron prop-
[28] S. Rupf, A.N. Idlibi, N. Umanskaya, M. Hannig, F. Nothdurft, A. Lehmann, A. erties in an atmospheric helium plasma jet determined by Thomson scattering, J.
Schindler, L.V. Müller, W. Spitzer, Desinfektion und Entfernung oraler Biofilme von Phys. D: Appl. Phys. 47 (432001) (2014).
mikrostrukturiertem Titan mit kaltem atmosphärischem Plasma. Deutscher Ärzte- [59] J.-P. Boeuf, L.L. Yang, L.C. Pitchford, Dynamics of a guided streamer (‘plasma
Verlag, zzi, Z Zahnärztl Impl, 27(2), 2012, pp. 14–24. bullet’) in a helium jet in air at atmospheric pressure, J. Phys. D: Appl. Phys. 46
[29] S. Rupf, A.N. Idlibi, F. Al Marrawi, M. Hannig, A. Schubert, L.V. Mueller, W. Spitzer, (015201) (2013).
H. Holtmann, A. Lehmann, A. Rueppell, A. Schindler, Removing biofilms from [60] D. Riès, G. Dilecce, E. Robert, P.F. Ambrico, S. Dozias, J.-M. Pouvesle, LIF and fast
microstructured titanium ex vivo: a novel approach using atmospheric plasma imaging plasma jet characterization relevant for NTP biomedical applications, J.
technology, PLoS One 6 (10) (2011) e25893. Phys. D: Appl. Phys. 47 (275401) (2014).
[30] K.-D. Weltmann, Th. v. Woedtke, Basic requirements for plasma sources in medi- [61] D. Li, A. Nikiforov, N. Britun, R. Snyders, M.G. Kong, C. Leys, OH radical production
cine, Eur. Phys. J. Appl. Phys. 55 (1) (2011), https://doi.org/10.1051/epjap/ in an atmospheric pressure surface micro-discharge array, J. Phys. D: Appl. Phys. 49
2011100452. (455202) (2016).
[31] K.-D. Weltmann, E. Kindel, R. Brandenburg, C. Meyer, R. Bussiahn, C. Wilke, [62] N. Bibinov, P. Rajasekaran, P. Mertmann, D. Wandke, W. Viöl, P. Awakowicz, Basics
T.V. Woedtke, Atmospheric pressure plasma jet for medical therapy: plasma para- and biomedical applications of Dielectric Barrier Discharge (DBD), in:
meters and risk estimation, Contrib. Plasma Phys. 49 (9) (2009) 631–640. A.N. Laskovski (Ed.), Biomedical Engineering, Trends in Materials Science, InTech,
[32] C. Tedero, C. Tixir, P. Tristant, J. Desmaison, P. Leprince, Atmospheric pressure 2011, pp. 123–150, , https://doi.org/10.5772/13192.
plasmas: a review, Spectrochem. Acta Part B 61 (2006) 2–30. [63] M.S. Mann, R. Tiede, K. Gavenis, G. Daeschlein, R. Bussiahn, K.-D. Weltmann,
[33] A. Fridman, A. Chirokov, A. Gutsol, Non-thermal atmospheric pressure discharges, S. Emmert, Th von Woedtke, R. Ahmed, Introduction to DIN-specification 91315
J. Phys. D: Appl. Phys. 38 (2005) R1–R24. based on the characterization of the plasma jet kINPen® MED, Clin. Plasma Med. 4
[34] A. Rutscher, Characterization of low-temperature plasmas under non-thermal (2016) 35–45.
conditions – a short summery, in: R. Hippler, S. Pfau, K.H. Schoenbach (Eds.), Low [64] S. Emmert, F. Brehmer, H. Hänßle, A. Helmke, N. Mertens, R. Ahmed, D. Simon,
Temperature Plasma Physics, Fundamental Aspects and Applications, Wiley-VCH D. Wandke, W. Maus-Friedrichs, G. Däschlein, M.P. Schön, W. Viöl, Atmospheric
Verlag Berlin GmbH, Berlin, 2001, pp. 15–28. pressure plasma in dermatology: ulcus treatment and much more, Clin. Plasma
[35] K.-D. Weltmann, Th von Woedtke, Plasma medicine—current state of research and Med. 1 (2013) 24–29.
medical application, Plasma Phys. Control Fusion 59 (014031) (2017). [65] G. Isbary, G. Morfill, J. Zimmermann, T. Shimizu, W. Stolz, Cold atmospheric
[36] 〈http://www.optocon.de/en/products/fiber-optic-temperature-signal- plasma a successful treatment of lesions in hailey-hailey disease, Arch. Dermatol.
conditioners/fotemp1-4-fiber-optic-single-channel-thermometer/〉. 147 (4) (2011) 388–390.
[37] DIN EN 60601-1-12:2015, Medical electrical equipment – Part 1-12: General re- [66] G. Isbary, J. Heinlin, T. Shimizu, J.L. Zimmermann, G. Morfill, H.-U. Schmidt,
quirements for basic safety and essential performance – Collateral Standard: R. Monetti, B. Steffes, W. Bunk, Y. Li, T. Klaempfl, S. Karrer, M. Landthaler,
Requirements for medical electrical equipment and medical electrical systems in- W. Stolz, Successful and safe use of 2 min cold atmospheric argon plasma in chronic
tended for use in the emergency medical services environment, 2015. wounds: results of a randomized controlled trial, Br. Assoc. Dermatol. 167 (2012)
[38] P. Sonntag, 103 | Wirkung des elektrischen Stromes auf den Menschen und 404–410.

23