Acoustic Feedback Techniques to Improve SWL Outcomes

改善 SWL 结果的声学反馈技术

• 批准号: 8378228
• 负责人: Michael Bailey
• 金额: $ 18.8万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8378228
• 关键词: Accounting; Acoustics; Acute; Address; Adopted; Adverse effects; Age; Anesthesia procedures; Animal Model; Animals; Area; Arteries; Atrophic; Attention; Back; Basic Science; Bathing; Bladder; Blood Vessels; Blood capillaries; Calculi; Chronic; Cicatrix; Clinical; Color; Conscious Sedation; Coupled; Data; Deposition; Detection; Development; Devices; Diabetes Mellitus; Disease; Doppler Ultrasound; Dose; Duct (organ) structure; Effectiveness; Electroconvulsive Therapy; Family suidae; Feedback; Film; Fire - disasters; Fluoroscopy; Focused Ultrasound Therapy; Frequencies; Geographic Locations; Glycerol; Goals; Growth; Hemorrhage; Histology; Hospitalization; Hypertension; Image; Imaging Device; Imaging Techniques; In Vitro; Incidence; Infusion procedures; Injury; Injury to Kidney; Instruction; Intestines; Kidney; Kidney Calculi; Kidney Part; Lead; Learning; Lesion; Link; Liquid substance; Literature; Lithotripsy; Liver; Location; Lung; Measures; Methods; Modeling; Monitor; Morphologic artifacts; Motion; Movement; Muscle; Organ; Outcome; Outpatients; Pancreas; Paper; Papillary; Pathology; Patients; Photography; Physiologic pulse; Positioning Attribute; Prevalence; Principal Investigator; Procedures; Program Research Project Grants; Protocols documentation; Public Health; Published Comment; Race; Radiation; Reporting; Research; Research Personnel; Residual state; Respiration; Rest; Retreatment; Role; Rupture; Scrotum; Shock; Signal Transduction; Skin; Solutions; Source; Speed; Stream; Stress; System; Techniques; Testing; Time; Tissues; Travel; Treatment Cost; Treatment outcome; Ultrasonography; Ureter; Urine; Urologist; Urology; Veins; Water; Woman; alternative treatment; brushite; capillary; common treatment; follow-up; functional loss; improved; in vivo; indexing; instrument; men; novel; research study; respiratory; response; sex; sound; tongue papilla; vasoconstriction

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 .

Instaictlons）; 尽管研究表明方案的变化以改善石材粉碎并减少组织 冲击波岩石疗法（SWL）的损伤，这种变化被缓慢地采用。一个重要的原因是 用户对协议更改的影响没有实时反馈。因此，我们提出了 开发各种反馈技术以改善患者的预后。在特定目标（SA）1中，我们 建议开发一种新型的成像技术，该技术有望将石头实时定位为 小至2毫米，即使不是较小。我们已经发现（或重新发现）一个人工制品，称为“闪烁” 当使用多普勒超声来形象成像一块多色图像的石头时，就会发生 准确地复制石头的大小。在SA2中，我们建议开发一种通过 岩石磨牙焦点，超声脉冲，这些脉冲将被反映并随后仅在石头时检测到 位于焦点；将这些脉冲作为触发器，冲击波仅应用于石头，然后 因此，将解释石材的运动，包括呼吸的影响。在SA3中，我们建议开发 被动的声音接收器通过施加的冲击波询问从石头散射的声音 并将此声音的频率内容与片段的大小相关联。这个概念将允许 用户可以学习何时足够粉红色并可以终止治疗。在SA4中， 我们解决了残留的石材碎片以及对当前岩石磨牙的挑战，以处理下部的石头 花萼，特别是利用辐射力在收集系统中移动石头和碎片 肾脏本身。最后，在SAS中，我们建议研究一种新的冲击波诱导组织的机制 受伤;即由张力引起的应力，而不是压缩。我们的初步研究 证明对血管的空化损害可能是由于血管壁的内脏而导致的 当气泡崩溃时，而不是气泡膨胀或重入液体喷气机施加的压力。 总体而言，该提案采用新颖的概念，量化基础科学技术并产生实用性 解决临床写碎石和患者结局可以大幅改善的领域的解决方案。 相关性（请参阅说明）： 冲击波碎石疗法（SWL）是对流行疾病肾结石的最常见治疗方法。但是喜欢 其他治疗方法，SWL具有副作用。提案的目标是为泌尿科医生提供新的反馈，因此 可以最大程度地减少效果，并可以治疗更广泛的患者。对公共卫生的影响将 取得成功的结果增加，并减少撤退，并发症和昂贵的替代方案 治疗。