Strategies for Improved Shock Wave Lithotripsy

总体描述(由申请人提供)：我们建议在四个项目和两个核心之间进行协调、高度互动的多学科合作，主要目标是使冲击波碎石术(SWL)对所有患者安全有效。在这项工作中，我们将： *确定SWL对肾脏的慢性影响-对肾脏的长期影响 在治疗过程中引起急性损伤后的结构和功能 *确定碎石术是否会导致新发糖尿病，制定治疗方案 保护患者免受SWL的不良影响 *确定SWS在肾脏和输尿管近端作用部位的特性 *通过改善声学耦合来提高SWL的效率 碎石机与患者 *制定治疗方案，改善肥胖患者的SWL结局 *确定SWL损伤的治疗阈值，并制定监测方法 出现对肾脏有损害的情况 *评估一种新趋势--低压广焦区--在临床上的有效性和安全性 碎石机技术 *开发声学监测和反馈技术，以改进瞄准和射击 碎石机，以消除SWS的投放错过结石，并确定 当石头有了 中断到完成，可以结束会话 *确定血管内空化导致出血的机制 *开发数值模型，以了解空化和非空化的作用 引起组织损伤的机制

DESCRIPTION, OVERALL (provided by applicant): We propose a coordinated, highly interactive multidisciplinary collaboration between four Projects and two Cores with the main goal of making shock wave lithotripsy (SWL) safe and effective for all patients. In this work we will: * Determine the chronic effects of SWL on the kidney-the long-term effects on renal structure and function that follow induction of acute damage during a treatment session * Determine if lithotripsy induces new-onset diabetes Develop treatment protocols that protect patients from SWL adverse effects * Determine the properties of SWs at their site of action in the kidney and proximal ureter * Increase the efficiency of SWL by improving the acoustic coupling between the lithotripter and the patient * Devise treatment protocols that improve SWL outcomes for obese patients * Determine the treatment threshold for SWL injury and develop a method to monitor onset of conditions that are damaging to the kidney * Evaluate the efficacy and safety of a new trend-low-pressure wide-focal-zone-in clinical lithotripter technology * Develop acoustic monitoring and feedback techniques to improve the targeting and firing of lithotripters to eliminate the delivery of SWs that miss the stone, and to determine when the stone has broken to completion and the session can be ended * Determine the mechanism by which cavitation within a vessel causes hemorrhage * Develop numerical models to understand the role of cavitation and non-cavitational mechanisms in causing tissue damage