Acoustic Feedback Techniques to Improve SWL Outcomes

Instaictlons)； 尽管研究表明改变方案可以改善结石粉碎和减少组织 在冲击波碎石术(SWL)中，这种变化已经慢慢被采用。一个重要的原因是 用户没有关于协议改变的影响的实时反馈。因此，我们建议 开发各种反馈技术以改善患者的预后。在特定目标(SA)1中，我们 建议开发一种新的成像技术，有望实现结石的实时定位 小到2毫米，如果不是更小的话。我们已经发现(或重新发现)了一种叫做“闪烁”的艺术品 当使用多普勒超声对生成了多色图像的石头进行成像时发生 准确地复制了石头的大小。在SA2中，我们建议开发一种工具，通过 碎石机聚焦，超声脉冲将被反射，随后只有当结石 位于焦点上；使用这些脉冲作为触发器，冲击波将只应用于石头，并且 因此可以解释石头的移动，包括呼吸的影响。在SA3中，我们建议开发一个 被动声学接收器，用于询问所施加的冲击波从石头上散射出来的声音 并将该声音的频率内容与碎片的大小相关联。这一概念将允许 用户需要了解结石何时被充分粉碎并可以终止治疗。在SA4中， 我们解决了残留的结石碎片和目前碎石者在治疗下部结石方面面临的挑战。 Calyx，特别是通过利用辐射力在收集系统内移动石头和碎片 肾脏本身。最后，在SAS中，我们提出了一种新的冲击波诱导组织的机制 损伤；即由拉伸而不是压缩引起的应力。我们的初步研究已经 证明血管空化损伤可能是由于血管壁凹陷所致。 当气泡破裂时，而不是由气泡膨胀或可再入液体射流施加的压力。 总体而言，该提案采用了新的概念，量化了基本的科学技术，并产生了实用的 在临床碎石和患者预后方面可以取得显著改善的领域的解决方案。 相关性(请参阅说明)： 冲击波碎石术(SWL)是一种最常见的治疗肾结石的方法。然而，就像 在其他治疗中，SWL也有副作用。该提案的目标是为泌尿科医生提供新的反馈，因此- 可以最大限度地减少影响，可以治疗更广泛的患者。对公众健康意愿的影响 成功结果的增加，再治疗、并发症和昂贵替代方案的减少 治疗。

Instaictlons); Although research has demonstrated protocol changes to improve stone comminution and reduce tissue injury in shock wave lithotripsy (SWL), such changes have been slowly adopted. An important reason Is that the users do not have real-time feedback on the effect of a protocol change. Accordingly, we propose the development of a variety of feedback techniques to improve patient outcomes. In Specific Aim (SA) 1, we propose to develop a novel imaging technique that promises to permit real-time localization of stones as small as 2 mm, if not smaller. We have discovered (or rediscovered) an artifact, called "twinkling" that occurs when Doppler ultrasound is used to image a stone in which a multi-colored image is generated that accurately replicates the size of the stone. In SA2, we propose to develop an instrument to send, through the lithotripter focus, ultrasound pulses that would be reflected and subsequently detected only when a stone was located at the focus; using these pulses as a trigger, shock waves would only be applied to stones, and would thus account for stone movement, including the effects of respiration. In SA3, we propose to develop a passive acoustic receiver that interrogates the sound scattered from the stone by the applied shock waves and correlates the frequency content of this sound with the size of the fragments. This concept would permit the user to learn when the stone was sufficiently comminuted and treatment could be terminated. In SA4, we address residual stone fragments and the challenge to current lithotripters in treating stones in the lower calyx, specifically by utilizing radiation forces to move stones and fragments within the collecting system of the kidney itself. Finally, in SAS, we propose to investigate a new mechanism for shock-wave-induced tissue injury; viz., stresses induced by tension, rather than compression. Our preliminary studies have demonstrated that cavitation damage to blood vessels probably results from invagination ofthe vessel wall when the bubble collapses, rather than stresses imposed by bubble expansion or reentrant liquid jets. Overall, the proposal takes novel concepts, quantifies basic science techniques, and generates practical solutions to areas where significant improvement can be made in clinical lithotripsy and patient outcomes. RELEVANCE (See Instructions): Shock wave lithotripsy (SWL) is the most common treatment for a prevalent disease, kidney stones. Yet like other treatments, SWL has side-effects. The proposal goal is to provide urologists new feedback so side- effects can be minimized and a broader spectrum of patients can be treated. The effect on public health will be an increase in successful outcomes and a decrease in retreatments, complications, and costly alternative treatments .