Ultrasound Tissue Erosion for Cardiac Applications

描述(申请人提供)：本申请的主要目标是开发一种高度受控的非侵入性超声程序，以机械细分和移除组织，主要用于心脏应用。正在开发的方法可以被认为是类似于软组织碎石术。受控超声组织侵蚀(CUT)过程与大多数软组织治疗性超声程序的根本不同之处在于，必须精确地切除组织，而不是在原位产生热坏死。其潜在的机制不同于那些产生热坏死的机制，需要充分阐明，以便合理地优化侵蚀过程。这是该提案的全球目标。初步结果表明，以下机械假设构成了本文提出的实验工作的基础。1.CUIT过程依赖于启动的“气泡云”和超声辐射之间的协同作用，其中声学参数可以被精细地调谐(优化)以最有效地利用传播的能量；2.必须通过适当的声学参数调整使被启动的气泡云保持在最佳状态；3.过去的暴露历史可以为将来的最佳暴露预先准备该过程；4.脉冲超声波是组织辐射以最佳地维持这组复杂的合作现象的最有效方法。我们建议通过：1.充分探索声学参数空间，寻找最佳参数以最大化传播能量的治疗效果；2.用先进的光学和声学技术直接观测“气泡云”，从而研究这些令人着迷的声和气泡团的相互作用。如果我们能够充分了解这些合作过程，我们就能够更有效地优化该过程，以适用于具体的临床应用。受控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。这些应用远远超出了心脏病学的范畴，尽管具体的心脏应用是最有希望的。

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.