Strategies to Maximize Burst Wave Lithotripsy (BWL) Success

最大化突发波碎石术 (BWL) 成功率的策略

• 批准号: 10452582
• 负责人: Vera Khokhlova
• 金额: $ 38.75万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-03-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452582
• 关键词: Acoustics; Address; Affect; American; Anesthetics; Behavior; Clinical; Clinical Research; Clinical Trials; Complex; Coupled; Data; Decision Making; Detection; Development; Disease; Economic Burden; Effectiveness; Electroconvulsive Therapy; Environment; Excision; Exposure to; Family suidae; Feedback; Fracture; Frequencies; Geometry; Healthcare Systems; Image; In Vitro; Injury; Injury to Kidney; Kidney; Kidney Calculi; Laboratories; Lead; Liquid substance; Lithotripsy; Measurement; Mechanics; Modeling; Monitor; Operative Surgical Procedures; Patients; Performance; Physiologic pulse; Public Health; Resources; Retreatment; Role; Series; Shock; Solid; Surface; System; Techniques; Technology; Testing; Time; Tissues; Transducers; Ultrasonography; Ureter; Ureteroscopy; Urinary Calculi; Urologist; Validation; Width; Work; base; common treatment; design; effective therapy; experimental study; improved; in vivo; individual patient; minimally invasive; optical imaging; optimal treatments; porcine model; pressure; safety study; simulation; success; tool; treatment strategy; ultrasound

PROJECT SUMMARY / ABSTRACT – Project 2 Kidney stone disease affects about 1 in 11 Americans and imposes a significant economic burden on the healthcare system. The most common treatments are shock wave lithotripsy (SWL) and ureteroscopy (URS), which use noninvasive or minimally invasive techniques to break stones so that small fragments either pass naturally or can be removed. Although these approaches provide significant improvements over open surgery, they often involve retreatment, can cause injury to the kidney or ureter, and require significant resources such as a surgical suite and anesthetics. To address these limitations, burst wave lithotripsy (BWL) may provide an effective, safe, in-office treatment approach for a urologist to break stones. BWL is a new noninvasive approach that is currently in development toward clinical trials. BWL treatments can be delivered by a small system that is readily integrated with other ultrasound technologies for stone imaging and pushing. BWL uses short bursts of sub-megahertz ultrasound to break stones into uniform fragments and has been demonstrated to reliably break many types of natural stones with exposures that produce little, if any, injury in porcine kidneys. As BWL continues to advance toward clinical use, challenges related to variability among individual patients should be addressed to maximize the success of a given treatment and to expand the range of treatable conditions. For current implementations of BWL, variability in vivo has been observed in the onset of cavitation behaviors that may lead to both injury and shielding of the stone from effective treatment. Because treatment monitoring with ultrasound (US) imaging has been shown to enable real-time detection of the onset of injurious cavitation activity, the potential to adaptively select and modify BWL treatment parameters is apparent. The first Aim of this proposal comprises a series of in vitro and in vivo experiments to understand how stones affect cavitation and to correlate cavitation metrics derived from US imaging and backscatter with fragmentation. These data will be supplemented by simulations from Aim 3 with a validated numerical model of cavitation in the vicinity of the stone to develop strategies for adapting treatment parameters. Aims 2 and 3 of this proposal focus on understanding and exploiting mechanisms of stone fracture to develop advanced BWL treatment strategies. Aim 2 involves experimental testing of strategies for spatially and temporally manipulating BWL exposures to improve fragmentation. Aim 3 employs numerical simulation tools to identify fracture mechanics in different stone geometries and inform strategies for inducing and detecting fracture in other Aims. The proposed studies are designed synergistically with clinical trials in Projects 1 and 3, studies on stone imaging and manipulation in Project 1, and studies on BWL-related injury in Project 3. The work will benefit public health by improving the success of BWL as a noninvasive alternative for stone patients.

项目摘要/摘要 – 项目 2 大约十分之一的美国人患有肾结石病，给美国人带来了沉重的经济负担 最常见的治疗方法是冲击波碎石术（SWL）和输尿管镜检查（URS）， 使用无创或微创技术来破碎结石，以便小碎片通过 虽然这些方法比开放手术有显着的改善， 它们通常涉及再治疗，可能对肾脏或输尿管造成损伤，并且需要大量资源，例如 作为手术套件和麻醉剂，突发波碎石术（BWL）可以提供一种解决这些局限性的方法。 BWL 是泌尿科医生有效、安全的诊室碎石治疗方法，是一种新的非侵入性方法。 目前正在开发用于临床试验的 BWL 治疗方法，可以通过一个小型系统来提供。 易于与其他超声技术集成，用于结石成像和推动。BWL 使用短脉冲。 亚兆赫超声波可将结石破碎成均匀的碎片，并已被证明可以可靠地破碎 许多类型的天然结石，其暴露对猪肾脏造成的伤害即使有也很少。 随着临床应用的不断推进，与个体患者差异相关的挑战应该得到解决 旨在最大限度地提高特定治疗的成功率并扩大可治疗病症的范围。 目前 BWL 的实施中，在空化行为的发生中观察到了体内的变异性， 可能会导致伤害并阻碍石头的有效治疗，因为治疗监测。 超声（US）成像已被证明能够实时检测有害空化活动的发生， 自适应选择和修改 BWL 治疗参数的潜力是显而易见的。 包括一系列体外和体内实验，以了解结石如何影响空化并关联 来自 US 成像和带有碎片的反向散射的空化指标将得到补充。 通过 Aim 3 的模拟，使用经过验证的宝石附近的空化数值模型来开发 该提案的目标 2 和 3 侧重于理解和调整治疗参数。 目标 2 涉及利用结石破裂机制来开发先进的 BWL 治疗策略。 对空间和时间操纵 BWL 暴露以改善策略的实验测试 目标 3 采用数值模拟工具来识别不同石材的断裂力学。 几何形状并为其他目标中诱导和检测断裂的策略提供信息。 与项目 1 和 3 中的临床试验协同设计，关于结石成像和操作的研究 项目 1 以及项目 3 中关于 BWL 相关伤害的研究。这项工作将通过改善 BWL 作为结石患者的无创替代方案取得了成功。