Innovations in Shock Wave Lithotripsy Technology

在MERIT奖的第一阶段，我们已经完成了原始申请中四个具体目标中描述的大部分研究。我们设计了一种新的声学透镜，基于体外测试和动物实验，显著提高了西门子透镜的性能和安全性。 我们已经证明了可控和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。我们已经建立了一个原型的电磁年轮冲击波发生器和评估的好处微秒串联脉冲技术在石头粉碎。我们研究了耦合水中的气体浓度和脉冲重复频率（PRF）对碎石机冲击波传输到患者体内以及由此产生的结石破碎的影响。我们已经确定了最佳的治疗策略，以最大限度地粉碎结石，同时最大限度地减少组织损伤。我们还设计了减轻耦合介质中沿着碎石机的射束路径的空化气泡的影响的方法，使得可以在更高的PRF下成功地执行治疗（从而减少治疗时间），而不增加组织损伤的风险。此外，我们已经确定，平均峰值压力是一个关键参数的石头粉碎。这一重要发现为理解宽焦宽/低峰值压力碎石机（如Dornier HM 3）在临床治疗中的受益提供了物理基础。这项广泛的工作是通过工程师、数学家和泌尿科医生之间的协同合作进行的，并得到了领先的碎石机制造商之一西门子的技术和设备支持。 在MERIT奖的延伸应用中，我们将继续在表面波引起的结石骨折，细胞水平和小血管中的空化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。这项新的研究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MERIT奖的总体目标是将联合收割机基础研究与技术创新和转化研究相结合，以提高当代冲击波碎石机的临床性能和安全性。 相关性（参见说明）; 冲击波碎石术（SWL）是一种非侵入性手术，仍然是治疗肾结石疾病的一线疗法。我们将继续开展富有成效的多学科合作，将联合收割机基础研究与技术创新相结合，以应用于下一代冲击波碎石机。这项工作将显著提高全世界尿石症患者的临床治疗质量。

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.