Optimization of shock wave effects to improve lithotripsy treatments

描述(申请人提供)：体外冲击波碎石术(ESWL)已被常规用于治疗肾结石患者近20年。尽管ESWL在临床上得到了广泛的应用，但ESWL中结石粉碎和组织损伤的潜在物理机制尚不完全清楚。事实上，虽然最近在开发更好的碎石机和碎石治疗方案方面取得了一些进展，但这些新机器也导致了治疗IME和软组织损伤的增加；使最初的Dornier HM3碎石机成为ESWL的黄金标准。缺乏改善的一个可能原因是，绝大多数ESWL研究主要集中在实验方法上，而在能够捕捉冲击波传播、聚焦、空化及其与肾结石和周围组织相互作用的基本物理过程中，现实和准确的数学模型的发展非常有限。我们的目标是开发和实验验证这样一个全面的模型，其中ESWL中的所有重要机制都将被考虑并耦合在一起。该模型将包括纯冲击波传播、吸收、流动、空化和气泡动力学产生的效应，以及与石头中产生的弹性应力有关的效应。它还将快速和准确地模拟现实的ESWL治疗，而不需要超级计算机。这项研究与公共卫生的相关性在于，一旦开发出这一模型，就可以显著提高我们对ESWL如何工作的基本知识，它可以为提高现有系统的治疗效果和安全性提供相当大的指导，它还可以帮助设计下一代碎石机。

DESCRIPTION (provided by applicant): Extracorporeal shock wave lithotripsy (ESWL) has been used routinely for the treatment of kidney stone patients for almost two decades. Despite the widespread clinical application, the underlying physical mechanisms of stone comminution and tissue injury in ESWL have not been fully understood yet. In fact, although some progress has been made recently on the development of better lithotripters and treatment protocols for stone fragmentation, these new machines have also resulted in an increase in both treatment imes and soft tissue injuries; leaving the original Dornier HM3 lithotripter as the gold standard for ESWL. A possible reason for this lack of improvement is that the great majority of ESWL studies have been focused primarily on experimental approaches while, in contrast, there has been a very limited development in realistic and accurate mathematical models that can capture the essential physics of shock wave propagation, focusing, cavitation, and their interactions with renal calculi and surrounding tissue. Our goal is to develop, and experimentally validate, such a comprehensive model where all the important mechanisms in ESWL will be accounted for and coupled together. The model will include effects deriving from pure shock propagation, absorption, streaming, cavitation and bubble dynamics, as well as those associated with the elastic stresses generated in the stone. It will also be fast and accurate in simulating realistic ESWL treatments without the need of supercomputers. The relevance of this research to public health is that, once developed, this model could significantly advance our basic knowledge of how ESWL works, it could provide considerable guidance for improving the treatments' efficacy and safety of existing systems, and it could aid in the design of the next generation lithotripters.