CAVITATION MONITORING AND CONTROL IN LITHOTRIPSY

碎石术中的空化监测和控制

• 批准号: 7108514
• 负责人: LAWRENCE A CRUM
• 金额: $ 40.05万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7108514
• 关键词: biomedical equipment safety; biophysics; extracorporeal circulation; human tissue; imaging /visualization /scanning; kidney circulation; kidney function; lithotripsy; luminescence; mechanical pressure; monitoring device; nephrolithiasis; physical process; sound frequency; swine; ultrasonography; ultrasound biological effect

Shock wave lithotripsy (SWL) is the treatment of choice for renal stone disease and has been a widely accepted and effective treatment. However, as manufacturers seek to deliver new and improved devices, they have generally migrated from units that produce broad focal volumes with moderately-high shock wave amplitudes to tight focal volumes with high shock wave amplitudes. This approach is intended to enhance stone comminution and reduce tissue injury. However, it appears that these manufacturers have discounted the role of cavitation in either stone comminution or tissue injury. Over the past several years, this PPG team has undertaken a broad and comprehensive study of both the physical and the biological mechanisms associated with SWL; this particular project has made considerable progress in examining the role of cavitation and find it to be the dominant mechanism of action. Although we have made much progress, there is still much that is not understood, and this proposal details our continued search to understand the physical mechanisms through which SWL can continue to provide a safe and effective treatment for stone disease. In order for our scientific progress to be optimized, we have concentrated on a general direction meant to transition our discoveries from the laboratory to the manufacturer. Accordingly, in this proposal we seek ways to improve the devices and the approaches to SWL and to disseminate to manufacturers and the general public specific recommendations for such improvements. To this end, our specific aims are summarized as follows: 1) to develop techniques and devices that would provide monitoring feedback on cavitation, blood flow, and stone comminution to clinicians in real-time 2) to use our dual-pulse lithotripter to test our hypothesis that localizing and intensifying the cavitation field will maximize comminution while minimizing tissue injury; 3) to determine whether lithotripter shock waves or the forces produced by cavitation cluster collapse produce the greatest stresses within the stone; 4) to measure the individual effects of the various components of the shock-wave waveform and from this knowledge, design an optimal waveform; and 5) to expand our cavitation model capability by introducing the effect of evaporation within the bubble, and from these studies, obtain estimates of the level of free radical production by SWL.

冲击波碎石术（SWL）是肾结石疾病的首选治疗方法，并且已被广泛接受且有效的治疗方法。然而，当制造商寻求提供新的和改进的设备时，他们通常已经从产生具有中等高冲击波振幅的宽焦点体积的装置迁移到具有高冲击波振幅的紧密焦点体积的装置。这种方法旨在增强结石粉碎并减少组织损伤。然而，这些制造商似乎低估了空化在结石粉碎或组织损伤中的作用。在过去的几年里，PPG 团队对与 SWL 相关的物理和生物机制进行了广泛而全面的研究；这一特定项目在审查以下方面的作用方面取得了相当大的进展 空化并发现它是主要的作用机制。尽管我们已经取得了很大进展，但仍有很多问题尚不清楚，该提案详细介绍了我们为了解物理机制而不断进行的研究，通过这些物理机制，SWL 可以继续为结石病提供安全有效的治疗。为了优化我们的科学进步，我们专注于一个总体方向，旨在将我们的发现从实验室转移到制造商。因此，在本提案中，我们寻求改进设备和 SWL 方法的方法，并向制造商和公众传播有关此类改进的具体建议。为此，我们的具体目标概括如下：1）开发能够提供监测反馈的技术和设备。 向临床医生实时提供空化、血流和结石粉碎情况 2) 使用我们的双脉冲碎石机来检验我们的假设，即定位和强化空化场将最大限度地粉碎碎石，同时最大限度地减少组织损伤； 3) 确定碎石机冲击波或空化簇塌陷产生的力是否在结石内产生最大应力； 4) 测量冲击波波形各个组成部分的单独影响，并根据这些知识设计最佳波形； 5) 通过引入气泡内的蒸发效应来扩展我们的空化模型能力，并从这些研究中获得 SWL 产生的自由基水平的估计。