Innovations in Shock Wave Lithotripsy Technology

冲击波碎石技术的创新

• 批准号: 9039747
• 负责人: PEI ZHONG
• 金额: $ 65.92万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9039747
• 关键词: Acoustics; American; Animal Experiments; Animal Model; Area; Award; Biological; Blood Vessels; CHRM3 gene; Calculi; Cells; Clinical; Clinical Treatment; Collaborations; Coupling; Development; Devices; Disease; Educational process of instructing; Electromagnetics; Engineering; Equipment; Fracture; Frequencies; Gases; Generations; Goals; Injury; Instruction; Interdisciplinary Study; Kidney Calculi; Laboratories; Lasers; Lithotripsy; Manufacturer Name; Mechanics; Medical; Methods; Motion; Patients; Performance; Physiologic pulse; Procedures; Progress Reports; Research; Risk; Rupture; Safety; Science; Shock; Societies; Surface; System; Technology; Time; Tissues; Translational Research; Universities; Ureter; Urologist; Validation; Water; Width; Work; base; design; engineering design; fundamental research; improved; in vitro testing; innovation; lens; models and simulation; next generation; pressure; professor; prototype; respiratory; technology development; transmission process; treatment strategy; urolithiasis

During the first period of the MERIT Award, we have completed most of the studies described in the four specific aims of the original application. We have designed a new acoustic lens that significantly improves the performance and safety of the Siemens lens based on in vitro tests and animal experiments. We have demonstrated the feasibility of a steerable and non-axisymmetric acoustic field in treating stones in the ureter or under the influence of respiratory motion. We have built a prototype electromagnetic annual ring shock wave generator and assessed the benefit of microsecond tandem pulse technology in stone comminution. We have investigated the effects of gas concentration in the coupling water and pulse repetition frequency (PRF) on the transmission of the lithotripter shock waves into the patient and resultant stone fragmentation. We have identified optimal treatment strategy to maximize stone comminution while minimizing tissue injury. We have further devised methods to mitigate the influence of cavitation bubbles along the beam path of the lithotripter in the coupling medium so that the treatment can be performed successfully at higher PRF (thus reducing treatment time) without increasing the risk of tissue injury. In addition, we have determined that average peak pressure is a critical parameter for stone comminution. This important finding provides the physical basis for understanding the benefit of broad focal width/low peak pressure lithotripters, such as the Dornier HM3 in clinical treatment. This extensive body of work has been carried out through synergistic collaborations between engineers, mathematicians, and urologists with the technical and equipment support of Siemens - one of the leading lithotripter manufacturers. In the extension application of this MERIT Award, we will continue fundamental research in the area of surface wave-induced stone fracture, cavitation-produced injury at cellular level and in small blood vessels. We will further expand on technology development in the area of steerable beam formation and wet coupling device that can be readily integrated in contemporary shock wave lithotripters. This new line of research will be carried out through engineering design innovation, multiphysics model simulation and experimental validations both in laboratory systems and in animal models. The overarching goal of this MERIT Award is to combine synergistically fundamental studies with technology innovations and translational research to improve the clinical performance and safety profile of contemporary shock wave lithotripters. RELEVANCE (See instructions); Shock wave lithotripsy (SWL) is a non-invasive procedure and remains to be the first-line therapy for the treatment of kidney stone disease. We will continue the fruitful multidisciplinary collaboration to combine fundamental research with technology innovation that can be translationed to the next-generation shock wave lithotripters. This work will significantly improve the quality of clinical treatment for urolithiasis patients worldwide.

在优秀奖的第一期，我们已经完成了最初申请的四个具体目标所述的大部分研究。在体外实验和动物实验的基础上，我们设计了一种新的声学透镜，显著提高了西门子透镜的性能和安全性。 我们已经证明了可操纵的非轴对称声场在治疗输尿管结石或呼吸运动影响下的可行性。建立了一台电磁环形冲击波发生器样机，并对微秒级串联脉冲技术在石材粉碎中的效益进行了评估。我们研究了耦合水中气体浓度和脉冲重复频率(PRF)对碎石机冲击波进入患者和所产生的结石粉碎的影响。我们已经确定了最佳的治疗策略，以最大限度地增加结石粉碎，同时将组织损伤降至最低。我们进一步设计了减少耦合介质中碎石机光束路径上的空化气泡影响的方法，以便在不增加组织损伤风险的情况下，在较高的PRF下成功进行治疗(从而减少治疗时间)。此外，我们还确定了平均峰值压力是石材粉碎的关键参数。这一重要发现为理解宽焦宽/低峰压碎石机(如Dornier HM3)在临床治疗中的益处提供了物理基础。这项广泛的工作是通过工程师、数学家和泌尿科医生在西门子的技术和设备支持下协同合作完成的，西门子是领先的碎石机制造商之一。 在此次优秀奖的推广应用中，我们将继续在表面波诱导的结石骨折、细胞水平的空化损伤和小血管损伤领域进行基础研究。 我们将进一步扩大在可控波束形成和湿式耦合设备领域的技术开发，这些设备可以很容易地集成到当代冲击波碎石机中。这一新的研究路线将通过工程设计创新、多物理模型模拟和实验室系统和动物模型的实验验证来进行。该优秀奖的首要目标是将基础研究与技术创新和转化性研究相结合，以提高当代冲击波碎石机的临床性能和安全性。 相关性(见说明)； 冲击波碎石术(SWL)是一种非侵入性的治疗方法，仍是治疗肾结石疾病的一线治疗方法。我们将继续进行富有成效的多学科合作，将基础研究与技术创新结合起来，可以转化为下一代冲击波碎石机。这项工作将显著提高全球尿石症患者的临床治疗质量。