Measurement of lithotripsy pulses through biological media

Effect of the body wall on lithotripter shock waves

PURPOSE

Determine the influence of passage through the body wall on the properties of lithotripter shock waves (SWs) and the characteristics of the acoustic field of an electromagnetic lithotripter.

METHODS

Full-thickness ex vivo segments of pig abdominal wall were secured against the acoustic window of a test tank coupled to the lithotripter. A fiber-optic probe hydrophone was used to measure SW pressures, determine shock rise time, and map the acoustic field in the focal plane.

RESULTS

Peak positive pressure on axis was attenuated roughly proportional to tissue thickness-approximately 6% per cm. Irregularities in the tissue path affected the symmetry of SW focusing, shifting the maximum peak positive pressure laterally by as much as ∼2 mm. Within the time resolution of the hydrophone (7-15 ns), shock rise time was unchanged, measuring ∼17-21 ns with and without tissue present. Mapping of the field showed no effect of the body wall on focal width, regardless of thickness of the body wall.

CONCLUSIONS

Passage through the body wall has minimal effect on the characteristics of lithotripter SWs. Other than reducing pulse amplitude and having the potential to affect the symmetry of the focused wave, the body wall has little influence on the acoustic field. These findings help to validate laboratory assessment of lithotripter acoustic field and suggest that the properties of SWs in the body are much the same as have been measured in vitro.

Prediction of far-field acoustic emissions from cavitation clouds during shock wave lithotripsy for development of a clinical device

This study presents the key simulation and decision stage of a multi-disciplinary project to develop a hospital device for monitoring the effectiveness of kidney stone fragmentation by shock wave lithotripsy (SWL). The device analyses, in real time, the pressure fields detected by sensors placed on the patient's torso, fields generated by the interaction of the incident shock wave, cavitation, kidney stone and soft tissue. Earlier free-Lagrange simulations of those interactions were restricted (by limited computational resources) to computational domains within a few centimetres of the stone. Later studies estimated the far-field pressures generated when those interactions involved only single bubbles. This study extends the free-Lagrange method to quantify the bubble–bubble interaction as a function of their separation. This, in turn, allowed identification of the validity of using a model of non-interacting bubbles to obtain estimations of the far-field pressures from 1000 bubbles distributed within the focus of the SWL field. Up to this point in the multi-disciplinary project, the design of the clinical device had been led by the simulations. This study records the decision point when the project's direction had to be led by far more costly clinical trials instead of the relatively inexpensive simulations.

The efficacy of a range of contact media as coupling agents in extracorporeal shockwave lithotripsy

OBJECTIVE

To determine if the nature of the coupling agent normally used between the lithotripter and the patient affects the stone fragmentation rate during extracorporeal shock wave lithotripsy.

MATERIALS AND METHODS

A jig designed to hold 'phantom' 10-mm stones at the focal point was fixed against the shock wave delivery point of an electromagnetic lithotripter (Dornier Compact, Germany). A layer of either petroleum jelly (Vaseline, Cheeseborough-Ponds Ltd, London, UK) ultrasonography jelly, a eutectic mixture of local anaesthetic (EMLA) cream, Instillagel (Farco-Pharma, Cologne, Germany) or a commercial water-soluble lubricating jelly was placed between the jig and shockwave head, and the number of shock waves required to fragment the stones was recorded.

RESULTS

Significantly more shock waves were required to fragment stones when petroleum jelly was used as the coupling agent than with all the other agents under test, whereas significantly fewer shock waves were required when using Instillagel or lubricating jelly than for all other agents.

CONCLUSION

The coupling agent used in water-free lithotripsy can affect the stone fragmentation rate and should not be considered inert. Ultrasonography jelly is probably the optimum agent available for use as a lithotripsy coupling agent.

In vivo pressure measurements of lithotripsy shock waves in pigs

Stone comminution and tissue damage in lithotripsy are sensitive to the acoustic field within the kidney, yet knowledge of shock waves in vivo is limited. We have made measurements of lithotripsy shock waves inside pigs with small hydrophones constructed of a 25-microm PVDF membrane stretched over a 21-mm diameter ring. A thin layer of silicone rubber was used to isolate the membrane electrically from pig fluid. A hydrophone was positioned around the pig kidney following a flank incision. Hydrophones were placed on either the anterior (shock wave entrance) or the posterior (shock wave exit) surface of the left kidney. Fluoroscopic imaging was used to orient the hydrophone perpendicular to the shock wave. For each pig, the voltage settings (12-24 kV) and the position of the shock wave focus within the kidney were varied. Waveforms measured within the pig had a shape very similar to those measured in water, but the peak pressure was about 70% of that in water. The focal region in vivo was 82 mm x 20 mm, larger than that measured in vitro (57 mm x 12 mm). It appeared that a combination of nonlinear effects and inhomogeneities in the tissue broadened the focus of the lithotripter. The shock rise time was on the order of 100 ns, substantially more than the rise time measured in water, and was attributed to higher absorption in tissue.