Acoustic Feedback Techniques to Improve SWL Outcomes

Instaictlons）; 虽然研究已经证明了协议的变化，以改善结石粉碎和减少组织 在冲击波碎石术（SWL）中的损伤，这种变化已经慢慢被采用。一个重要原因是 用户不具有关于协议改变的效果的实时反馈。因此，我们建议 开发各种反馈技术，以改善患者的治疗效果。具体目标（SA）1，我们 我建议开发一种新的成像技术，该技术有望实现结石的实时定位， 小到2毫米，如果不是更小。我们已经发现（或重新发现）了一种人工制品，称为“闪烁”， 当使用多普勒超声对结石进行成像时， 精确地复制了石头的大小在SA 2中，我们建议开发一种工具，通过 碎石机焦点，超声脉冲将被反射，并随后检测到只有当石头 位于焦点处;使用这些脉冲作为触发器，冲击波只会应用于石头， 因此可以解释结石的移动，包括呼吸的影响。在SA 3中，我们建议开发一个 无源声学接收器，其询问由所施加的冲击波从石头散射的声音 并将该声音的频率内容与碎片的大小相关联。这一概念将允许 使用者可以知道何时结石被充分粉碎并且治疗可以终止。在SA 4中， 我们讨论了残余结石碎片和目前碎石机治疗下尿路结石的挑战， 花萼，特别是通过利用辐射力移动收集系统内的石头和碎片， 肾脏本身。最后，在SAS中，我们提出了一种新的机制，冲击波诱导的组织 损伤;即，由拉伸而不是压缩引起的应力。我们的初步研究表明 表明血管的空泡损伤可能是由于血管壁内陷所致 当气泡破裂时，而不是由气泡膨胀或重入液体射流施加的应力。 总的来说，该提案采用了新颖的概念，量化了基本的科学技术，并产生了实用的 针对可以显着改善临床碎石术和患者结局的领域提供解决方案。 相关性（见说明）： 冲击波碎石术（SWL）是最常见的治疗流行病，肾结石。然而像 其他治疗，SWL有副作用。该提案的目标是为泌尿科医生提供新的反馈， 可以最小化影响，并且可以治疗更广泛的患者。对公众健康的影响将 增加成功结局，减少再治疗、并发症和昂贵的替代治疗 治疗。

Instaictlons); Although research has demonstrated protocol changes to improve stone comminution and reduce tissue injury in shock wave lithotripsy (SWL), such changes have been slowly adopted. An important reason Is that the users do not have real-time feedback on the effect of a protocol change. Accordingly, we propose the development of a variety of feedback techniques to improve patient outcomes. In Specific Aim (SA) 1, we propose to develop a novel imaging technique that promises to permit real-time localization of stones as small as 2 mm, if not smaller. We have discovered (or rediscovered) an artifact, called "twinkling" that occurs when Doppler ultrasound is used to image a stone in which a multi-colored image is generated that accurately replicates the size of the stone. In SA2, we propose to develop an instrument to send, through the lithotripter focus, ultrasound pulses that would be reflected and subsequently detected only when a stone was located at the focus; using these pulses as a trigger, shock waves would only be applied to stones, and would thus account for stone movement, including the effects of respiration. In SA3, we propose to develop a passive acoustic receiver that interrogates the sound scattered from the stone by the applied shock waves and correlates the frequency content of this sound with the size of the fragments. This concept would permit the user to learn when the stone was sufficiently comminuted and treatment could be terminated. In SA4, we address residual stone fragments and the challenge to current lithotripters in treating stones in the lower calyx, specifically by utilizing radiation forces to move stones and fragments within the collecting system of the kidney itself. Finally, in SAS, we propose to investigate a new mechanism for shock-wave-induced tissue injury; viz., stresses induced by tension, rather than compression. Our preliminary studies have demonstrated that cavitation damage to blood vessels probably results from invagination ofthe vessel wall when the bubble collapses, rather than stresses imposed by bubble expansion or reentrant liquid jets. Overall, the proposal takes novel concepts, quantifies basic science techniques, and generates practical solutions to areas where significant improvement can be made in clinical lithotripsy and patient outcomes. RELEVANCE (See Instructions): Shock wave lithotripsy (SWL) is the most common treatment for a prevalent disease, kidney stones. Yet like other treatments, SWL has side-effects. The proposal goal is to provide urologists new feedback so side- effects can be minimized and a broader spectrum of patients can be treated. The effect on public health will be an increase in successful outcomes and a decrease in retreatments, complications, and costly alternative treatments .