Ultrasound Tissue Erosion for Cardiac Applications

描述（由申请人提供）：本申请的主要目标是开发一种高度控制的非侵入性超声程序，以机械地细分和去除组织，主要用于心脏应用。正在开发的方法可以被认为类似于软组织的碎石术。控制超声组织侵蚀（CUTE）过程与大多数软组织治疗超声程序有根本不同，因为必须精确地去除组织，而不是在原位产生热坏死。其潜在机制与产生热坏死的机制不同，需要充分阐明，以便合理优化侵蚀过程。这是该提案的全球目标。初步结果提出了以下机制假设，这些假设构成了本文提出的实验工作的基础。1. CUTE过程依赖于启动的“气泡云”和超声波之间的合作相互作用，其中声学参数可以被微调（优化），以最有效地利用传播能量。通过适当调整声学参数，使初始气泡云保持在最佳状态。过去的暴露史可以预先决定最佳的未来暴露过程，4。脉冲超声是组织超声最有效的方法，以最佳地维持这种复杂的合作现象。我们建议通过以下方法来研究这些声音和气泡合奏的迷人相互作用：1。充分探索声学参数空间，寻求最佳参数，使传播能量的治疗效果最大化；和2。通过复杂的光学和声学技术直接观测“气泡云”。如果我们能够充分了解这些合作过程，我们将能够更有效地优化具体的临床应用过程。控制超声组织侵蚀有望将碎石术的治疗原理扩展到所有（或大多数）软组织。虽然特定的心脏应用是最有前途的，但其应用范围远远超出了心脏病学。

DESCRIPTION (provided by applicant): The primary goal of this application is to develop a highly controlled noninvasive ultrasound procedure to mechanically subdivide and remove tissue, primarily for cardiac applications. The method being developed can be thought of as analogous to lithotripsy for soft tissues. The Controlled Ultrasound Tissue Erosion (CUTE) process is fundamentally different from most soft tissue therapeutic ultrasound procedures in that tissue must be precisely removed instead of producing thermal necrosis in situ. The underlying mechanisms are different from those producing thermal necrosis and need to be fully elucidated so that the erosion process can be rationally optimized. This is the global aim of the proposal. Preliminary results suggest the following mechanistic hypotheses that form the basis of the experimental work proposed herein. 1. The CUTE process depends on co-operative interaction between an initiated "bubble cloud" and the ultrasound insonation where acoustic parameters can be finely tuned (optimized) for the most efficient use of propagated energy, 2. The initiated bubble cloud must be maintained in an optimal state by appropriate adjustment of acoustic parameters, 3. The past history of exposure can predispose the process for optimal future exposure, 4. Pulsed ultrasound is the most effective way to organize the insonation to optimally maintain this complex set of co-operative phenomena. We propose to study these fascinating interactions of sound and bubble ensembles by, 1. Fully exploring acoustic parameter space seeking optimal parameters to maximize therapeutic effects of the propagated energy; and 2. Observing directly the "bubble clouds" by sophisticated optical and acoustic techniques. If we can fully understand these co-operative processes, we will be ably to more effectively optimize the process for specific clinical application. Controlled Ultrasound Tissue Erosion promises to extend the therapeutic rationale of Lithotripsy to all (or most) soft tissues. The applications extend far beyond cardiology although specific cardiac applications are most promising.