Innovations in shock wave lithotripsy technology

描述(申请人提供)：在上一个资助期，我们进行了一系列关键研究，以帮助阐明碎石冲击波(LSW)产生的应力波和空化在结石粉碎中的作用；腔内气泡扩张导致小血管损伤的机制；以及冲击波碎石(SWL)中治疗策略对结石粉碎和组织损伤的影响。基于这些重要的观察结果，我们开发了两种新的技术，即微秒级串联脉冲碎石和原位脉冲叠加，以改善SWL中结石的粉碎，同时减少伴发的组织损伤。我们已经进行了初步的原理验证实验，证明了这些新的SWL技术在体外和体内的有效性。在这些成果的基础上，我们提出了四个新的具体目标，以进一步研究应力波和空化之间的协同作用，并检查残余碎片的横向扩散对SWL中整体结石粉碎的影响。我们还将优化电磁环形阵列(EMAA)冲击波发生器、反射器插件和声学面罩的工程设计和系统集成，以定制HM-3碎石机中的压力波形、分布和脉冲序列，以有效治疗收集系统中不同位置的肾结石。我们的具体目标如下：目的1.碎石机产生的应力波和碎石过程中的空化之间的协同作用-残余碎石的侧向扩散对SWL整体成功的影响。目的2.研制可与HM-3型碎石机集成的EMAA冲击波发生器，探索微秒级串联脉冲碎石的全部潜力。目的3.优化HM-3型碎石机治疗肾结石和输尿管上段结石的脉冲波形和射束大小。目的4.在改进的HM-3型碎石机中，对优化的脉冲波形、压力分布和顺序所产生的结石粉碎和组织损伤进行活体评估。预计这些研究的完成将为合理使用现有的临床碎石机提供坚实的基础，并为开发可造福所有结石患者的创新SWL技术提供一个平台。

DESCRIPTION (provided by applicant): In the last funding period, we have performed a series of critical investigations that help to delineate the role of lithotripter shock wave (LSW) generated stress waves and cavitation in stone comminution; the mechanism of vascular injury in small blood vessels due to intraluminal bubble expansion; and the effect of treatment strategy on stone comminution and tissue injury in shock wave lithotripsy (SWL). Based on these important observations, we have developed two novel technologies, namely microsecond tandem pulse lithotripsy and in-situ pulse superposition, to improve stone comminution while reducing concomitantly collateral tissue injury in SWL. We have performed preliminary proof-of-principle experiments that demonstrate the validity of these new SWL technologies both in vitro and in vivo. Built on these accomplishments, we propose four new specific aims to further investigate the synergistic interaction between stress waves and cavitation, and to examine the effect of lateral spreading of residual fragments on overall stone comminution in SWL. We will also optimize the engineering design and system integration of an electromagnetic annular array (EMAA) shock wave generator, reflector inserts, and acoustic masks to customize the pressure waveform, distribution, and pulse sequence in an HM-3 lithotripter for effective treatment of kidney stones in various locations in the collection system. Our specific aims are as follows: Aim 1. Synergistic interaction between lithotripter generated stress waves and cavitation in stone comminution - the effect of lateral spreading of residual fragments on overall success of SWL. Aim 2. Development of an EMAA shock wave generator that can be integrated with an HM-3 lithotripter - exploring the full potential of microsecond tandem pulse lithotripsy. Aim 3. Optimization of pulse profile and beam size of an HM-3 lithotripter for the treatment of renal and upper ureteral stones. Aim 4. In vivo assessment of stone comminution and tissue injury produced by the optimized pulse profile, pressure distribution, and sequence in an upgraded HM-3 lithotripter. It is anticipated that the completion of these studies will provide a solid foundation for the rational use of existing clinical lithotripters and a platform for the development of innovative SWL technologies that can benefit all stone patients.