Strategies to Maximize Burst Wave Lithotripsy (BWL) Success

最大化突发波碎石术 (BWL) 成功率的策略

• 批准号: 10452582
• 负责人: Vera Khokhlova
• 金额: $ 38.75万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-03-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452582
• 关键词: Acoustics; Address; Affect; American; Anesthetics; Behavior; Clinical; Clinical Research; Clinical Trials; Complex; Coupled; Data; Decision Making; Detection; Development; Disease; Economic Burden; Effectiveness; Electroconvulsive Therapy; Environment; Excision; Exposure to; Family suidae; Feedback; Fracture; Frequencies; Geometry; Healthcare Systems; Image; In Vitro; Injury; Injury to Kidney; Kidney; Kidney Calculi; Laboratories; Lead; Liquid substance; Lithotripsy; Measurement; Mechanics; Modeling; Monitor; Operative Surgical Procedures; Patients; Performance; Physiologic pulse; Public Health; Resources; Retreatment; Role; Series; Shock; Solid; Surface; System; Techniques; Technology; Testing; Time; Tissues; Transducers; Ultrasonography; Ureter; Ureteroscopy; Urinary Calculi; Urologist; Validation; Width; Work; base; common treatment; design; effective therapy; experimental study; improved; in vivo; individual patient; minimally invasive; optical imaging; optimal treatments; porcine model; pressure; safety study; simulation; success; tool; treatment strategy; ultrasound

PROJECT SUMMARY / ABSTRACT – Project 2 Kidney stone disease affects about 1 in 11 Americans and imposes a significant economic burden on the healthcare system. The most common treatments are shock wave lithotripsy (SWL) and ureteroscopy (URS), which use noninvasive or minimally invasive techniques to break stones so that small fragments either pass naturally or can be removed. Although these approaches provide significant improvements over open surgery, they often involve retreatment, can cause injury to the kidney or ureter, and require significant resources such as a surgical suite and anesthetics. To address these limitations, burst wave lithotripsy (BWL) may provide an effective, safe, in-office treatment approach for a urologist to break stones. BWL is a new noninvasive approach that is currently in development toward clinical trials. BWL treatments can be delivered by a small system that is readily integrated with other ultrasound technologies for stone imaging and pushing. BWL uses short bursts of sub-megahertz ultrasound to break stones into uniform fragments and has been demonstrated to reliably break many types of natural stones with exposures that produce little, if any, injury in porcine kidneys. As BWL continues to advance toward clinical use, challenges related to variability among individual patients should be addressed to maximize the success of a given treatment and to expand the range of treatable conditions. For current implementations of BWL, variability in vivo has been observed in the onset of cavitation behaviors that may lead to both injury and shielding of the stone from effective treatment. Because treatment monitoring with ultrasound (US) imaging has been shown to enable real-time detection of the onset of injurious cavitation activity, the potential to adaptively select and modify BWL treatment parameters is apparent. The first Aim of this proposal comprises a series of in vitro and in vivo experiments to understand how stones affect cavitation and to correlate cavitation metrics derived from US imaging and backscatter with fragmentation. These data will be supplemented by simulations from Aim 3 with a validated numerical model of cavitation in the vicinity of the stone to develop strategies for adapting treatment parameters. Aims 2 and 3 of this proposal focus on understanding and exploiting mechanisms of stone fracture to develop advanced BWL treatment strategies. Aim 2 involves experimental testing of strategies for spatially and temporally manipulating BWL exposures to improve fragmentation. Aim 3 employs numerical simulation tools to identify fracture mechanics in different stone geometries and inform strategies for inducing and detecting fracture in other Aims. The proposed studies are designed synergistically with clinical trials in Projects 1 and 3, studies on stone imaging and manipulation in Project 1, and studies on BWL-related injury in Project 3. The work will benefit public health by improving the success of BWL as a noninvasive alternative for stone patients.

项目概要/摘要-项目2 肾结石疾病影响约1/11的美国人，并对他们造成重大的经济负担。 医疗保健系统。最常见的治疗是冲击波碎石术（SWL）和输尿管镜检查（URS）， 其使用非侵入性或微创技术来破碎结石， 自然地或可以被移除。尽管这些方法提供了相对于开放手术的显著改进， 它们通常涉及再治疗，可能导致肾脏或输尿管损伤，并需要大量资源， 作为手术室和麻醉剂为了解决这些局限性，爆破波碎石术（BWL）可以提供 有效，安全，在办公室的治疗方法，泌尿科医生打破结石。BWL是一种新的非侵入性方法 目前正处于临床试验阶段。BWL治疗可以通过一个小型系统进行， 易于与其他超声技术集成，用于结石成像和推送。BWL使用短脉冲串， 亚兆赫超声波将结石破碎成均匀的碎片，并已被证明可以可靠地破碎 许多类型的天然结石暴露在猪肾中几乎不会产生损伤。作为BWL 继续向临床应用发展，与个体患者之间的变异性相关的挑战应该是 目的是最大限度地提高给定治疗的成功率，并扩大可治疗疾病的范围。为 在BWL的当前实施方式中，已经在空化行为的开始中观察到体内的可变性， 可能导致损伤和结石无法得到有效治疗。因为治疗监测 已经显示超声（US）成像能够实时检测有害空化活动的开始， 自适应地选择和修改BWL治疗参数的潜力是显而易见的。本提案的第一个目的 包括一系列体外和体内实验，以了解结石如何影响空化， 从US成像和具有碎裂的反向散射导出的空化度量。这些数据将得到补充 通过Aim 3中的模拟，在结石附近建立经过验证的空化数值模型， 调整治疗参数的策略。本提案的目标2和3侧重于理解和 开发结石断裂机制，开发先进的BWL治疗策略。目标2涉及 空间和时间操纵BWL暴露的策略的实验测试，以改善 碎片化目的3采用数值模拟工具来识别不同岩石的断裂力学 几何形状和通知其他目标中的诱导和检测断裂的策略。拟议的研究是 与项目1和3中的临床试验协同设计， 项目1和项目3中的与生化武器有关的伤害研究。这项工作将通过改善 BWL作为结石患者非侵入性替代治疗的成功。