Innovations in shock wave lithotripsy technology

描述（由申请人提供）：在上一个资助期内，我们进行了一系列重要的调查，以帮助描述碎石机冲击波（LSW）产生的应力波和空化在石头粉碎中的作用；腔内气泡扩张致小血管损伤的机制冲击波碎石术（SWL）中不同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，我们开发了两种新技术，即微秒串联脉冲碎石和原位脉冲叠加，以改善碎石粉碎，同时减少SWL伴随的侧支组织损伤。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。在此基础上，我们提出了四个新的具体目标，以进一步研究应力波与空化之间的协同相互作用，并研究残余碎片横向扩散对SWL中整体岩石粉碎的影响。我们还将优化电磁环形阵列（EMAA）冲击波发生器、反射器插入件和声学掩模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，从而有效地治疗收集系统中不同位置的肾结石。我们的具体目标如下：目标1。碎石机产生的应力波与石料粉碎空化的协同作用——残余碎片横向扩散对SWL整体成功的影响目标2。开发可与HM-3碎石机集成的EMAA冲击波发生器-探索微秒串联脉冲碎石机的全部潜力。目标3。HM-3型碎石机治疗肾结石和输尿管上段结石的脉冲剖面和光束尺寸优化。目标4。改进的HM-3碎石机中优化的脉冲剖面、压力分布和序列对石头粉碎和组织损伤的体内评估。预计这些研究的完成将为现有临床碎石机的合理使用提供坚实的基础，并为开发创新的SWL技术提供平台，使所有结石患者受益。

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.