Acoustic Feedback Techniques to Improve SWL Outcomes

改善 SWL 结果的声学反馈技术

• 批准号: 8378228
• 负责人: Michael Bailey
• 金额: $ 18.8万
• 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/8378228
• 关键词: Accounting; Acoustics; Acute; Address; Adopted; Adverse effects; Age; Anesthesia procedures; Animal Model; Animals; Area; Arteries; Atrophic; Attention; Back; Basic Science; Bathing; Bladder; Blood Vessels; Blood capillaries; Calculi; Chronic; Cicatrix; Clinical; Color; Conscious Sedation; Coupled; Data; Deposition; Detection; Development; Devices; Diabetes Mellitus; Disease; Doppler Ultrasound; Dose; Duct (organ) structure; Effectiveness; Electroconvulsive Therapy; Family suidae; Feedback; Film; Fire - disasters; Fluoroscopy; Focused Ultrasound Therapy; Frequencies; Geographic Locations; Glycerol; Goals; Growth; Hemorrhage; Histology; Hospitalization; Hypertension; Image; Imaging Device; Imaging Techniques; In Vitro; Incidence; Infusion procedures; Injury; Injury to Kidney; Instruction; Intestines; Kidney; Kidney Calculi; Kidney Part; Lead; Learning; Lesion; Link; Liquid substance; Literature; Lithotripsy; Liver; Location; Lung; Measures; Methods; Modeling; Monitor; Morphologic artifacts; Motion; Movement; Muscle; Organ; Outcome; Outpatients; Pancreas; Paper; Papillary; Pathology; Patients; Photography; Physiologic pulse; Positioning Attribute; Prevalence; Principal Investigator; Procedures; Program Research Project Grants; Protocols documentation; Public Health; Published Comment; Race; Radiation; Reporting; Research; Research Personnel; Residual state; Respiration; Rest; Retreatment; Role; Rupture; Scrotum; Shock; Signal Transduction; Skin; Solutions; Source; Speed; Stream; Stress; System; Techniques; Testing; Time; Tissues; Travel; Treatment Cost; Treatment outcome; Ultrasonography; Ureter; Urine; Urologist; Urology; Veins; Water; Woman; alternative treatment; brushite; capillary; common treatment; follow-up; functional loss; improved; in vivo; indexing; instrument; men; novel; research study; respiratory; response; sex; sound; tongue papilla; vasoconstriction

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 .

指令）； 尽管研究已经证明方案的改变可以改善结石粉碎并减少组织 在冲击波碎石术（SWL）损伤中，这种改变已慢慢被采用。一个重要原因是 用户无法实时反馈协议变更的影响。据此，我们建议 开发各种反馈技术以改善患者的治疗效果。在具体目标 (SA) 1 中，我们 提议开发一种新颖的成像技术，有望实现结石的实时定位 小至 2 毫米，甚至更小。我们发现（或重新发现）了一种名为“闪烁”的神器 当使用多普勒超声对石头进行成像时会发生这种情况，其中会生成多色图像 准确地复制了石头的尺寸。在 SA2 中，我们建议开发一种工具，通过 碎石机聚焦，超声波脉冲只有在结石出现时才会被反射并随后被检测到 位于焦点处；使用这些脉冲作为触发器，冲击波只会施加到石头上，并且 因此可以解释石头的运动，包括呼吸的影响。在 SA3 中，我们建议开发一个 无源声学接收器，通过施加的冲击波询问从石头散射的声音 并将该声音的频率内容与片段的大小相关联。这个概念将允许 用户了解结石何时被充分粉碎并且可以终止治疗。在SA4中， 我们解决残留的结石碎片以及当前碎石机在治疗下颌结石方面面临的挑战 花萼，特别是利用辐射力在花萼的收集系统内移动石头和碎片 肾脏本身。最后，在 SAS 中，我们建议研究冲击波诱导组织的新机制 受伤;即，由拉力而非压缩引起的应力。我们的初步研究有 证明血管的空化损伤可能是由于血管壁内陷造成的 当气泡破裂时，而不是由气泡膨胀或再入液体射流施加的应力。 总体而言，该提案采用新颖的概念，量化基础科学技术，并产生实用的 可以显着改善临床碎石术和患者预后的领域的解决方案。 相关性（参见说明）： 冲击波碎石术 (SWL) 是治疗肾结石这一流行病的最常见治疗方法。然而又喜欢 与其他治疗方法相比，SWL 有副作用。该提案的目标是为泌尿科医生提供新的反馈，以便 可以将影响降到最低，并且可以治疗更广泛的患者。对公众健康的影响将会 成功结果的增加以及治疗、并发症和昂贵替代方案的减少 治疗。