1
|
Sallam A, Shahab S. Nonlinear Acoustic Holography With Adaptive Sampling. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1516-1526. [PMID: 37703162 DOI: 10.1109/tuffc.2023.3315011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Accurate and efficient numerical simulation of highly nonlinear ultrasound propagation is essential for a wide range of therapeutic and physical ultrasound applications. However, due to large domain sizes and the generation of higher harmonics, such simulations are computationally challenging, particularly in 3-D problems with shock waves. Current numerical methods are based on computationally inefficient uniform meshes that resolve the highest harmonics across the entire spatial domain. To address this challenge, we present an adaptive numerical algorithm for computationally efficient nonlinear acoustic holography. At each propagation step, the algorithm monitors the harmonic content of the acoustic signal and adjusts its discretization parameters accordingly. This enables efficient local resolution of higher harmonics in areas of high nonlinearity while avoiding unnecessary resolution elsewhere. Furthermore, the algorithm actively adapts to the signal's nonlinearity level, eliminating the need for prior reference simulations or information about the spatial distribution of the harmonic content of the acoustic field. The proposed algorithm incorporates an upsampling process in the frequency domain to accommodate the generation of higher harmonics in forward propagation and a downsampling process when higher harmonics are decimated in backward propagation. The efficiency of the algorithm was evaluated for highly nonlinear 3-D problems, demonstrating a significant reduction in computational cost with a nearly 50-fold speedup over a uniform mesh implementation. Our findings enable a more rapid and efficient approach to modeling nonlinear high-intensity focused ultrasound (HIFU) wave propagation.
Collapse
|
2
|
Maxwell AD, Kim GW, Furrow E, Lulich JP, Torre M, MacConaghy B, Lynch E, Leotta DF, Wang YN, Borofsky MS, Bailey MR. Development of a burst wave lithotripsy system for noninvasive fragmentation of ureteroliths in pet cats. BMC Vet Res 2023; 19:141. [PMID: 37660015 PMCID: PMC10474658 DOI: 10.1186/s12917-023-03705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are increasingly prevalent in pet cats and are difficult to manage. Surgical procedures to address obstructing ureteroliths have short- and long-term complications, and medical therapies (e.g., fluid diuresis and smooth muscle relaxants) are infrequently effective. Burst wave lithotripsy is a non-invasive, ultrasound-guided, handheld focused ultrasound technology to disintegrate urinary stones, which is now undergoing human clinical trials in awake unanesthetized subjects. RESULTS In this study, we designed and performed in vitro testing of a modified burst wave lithotripsy system to noninvasively fragment stones in cats. The design accounted for differences in anatomic scale, acoustic window, skin-to-stone depth, and stone size. Prototypes were fabricated and tested in a benchtop model using 35 natural calcium oxalate monohydrate stones from cats. In an initial experiment, burst wave lithotripsy was performed using peak ultrasound pressures of 7.3 (n = 10), 8.0 (n = 5), or 8.9 MPa (n = 10) for up to 30 min. Fourteen of 25 stones fragmented to < 1 mm within the 30 min. In a second experiment, burst wave lithotripsy was performed using a second transducer and peak ultrasound pressure of 8.0 MPa (n = 10) for up to 50 min. In the second experiment, 9 of 10 stones fragmented to < 1 mm within the 50 min. Across both experiments, an average of 73-97% of stone mass could be reduced to fragments < 1 mm. A third experiment found negligible injury with in vivo exposure of kidneys and ureters in a porcine animal model. CONCLUSIONS These data support further evaluation of burst wave lithotripsy as a noninvasive intervention for obstructing ureteroliths in cats.
Collapse
Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Ga Won Kim
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Eva Furrow
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Jody P Lulich
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Marissa Torre
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Brian MacConaghy
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Elizabeth Lynch
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Daniel F Leotta
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | | | - Michael R Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA.
| |
Collapse
|
3
|
Rassweiler-Seyfried MC, Mayer J, Goldenstedt C, Storz R, Marlinghaus E, Heine G, Alken P, Rassweiler JJ. High-frequency shock wave lithotripsy: stone comminution and evaluation of renal parenchyma injury in a porcine ex-vivo model. World J Urol 2023; 41:1929-1934. [PMID: 37284842 PMCID: PMC10352427 DOI: 10.1007/s00345-023-04441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The electrohydraulic high-frequency shock wave (Storz Medical, Taegerwilen, Switzerland) is a new way to create small fragments with frequencies up to 100 Hertz (Hz). This study evaluated the efficacy and safety of this method in a stone and porcine model. MATERIALS AND METHODS BEGO stones were put in a condom in a specifically designed fixture treated with different modulations to see stone comminution. Standardized ex vivo porcine model with perfused kidneys with 26 upper and lower poles of 15 kidneys was treated with the following modulations: voltage 16-24 kV, capacitor 12 nF and frequency up to 100 Hz. 2000-20,000 shock waves were applied to each pole. The kidneys were perfused with barium sulfate solution (BaSO4) and x-ray was performed to quantify the lesions using pixel volumetry. RESULTS There was no correlation between the number of shock waves and the powdering degree or the applied Energy and the grade of pulverization in the stone model. Regarding the perfused kidney model, the number of shock waves, applied voltage and frequency had no direct correlation with the occurrence of parenchymal lesions The detected lesions of the renal parenchyma were minimal, technical parameters had no significant impact and the lesions did not differ from the results of former experiments using 1-1.5 Hz in the same model. CONCLUSIONS High-frequency shock wave lithotripsy can produce small stone fragments to pass in a very short time. The injury to the renal parenchyma is comparable to the results of the conventional SWL using 1-1.5 Hz.
Collapse
Affiliation(s)
- Marie-Claire Rassweiler-Seyfried
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
| | | | | | | | | | | | - Peter Alken
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | | |
Collapse
|
4
|
Harper JD, Lingeman JE, Sweet RM, Metzler IS, Sunaryo PL, Williams JC, Maxwell AD, Thiel J, Cunitz BW, Dunmire B, Bailey MR, Sorensen MD. Fragmentation of Stones by Burst Wave Lithotripsy in the First 19 Humans. J Urol 2022; 207:1067-1076. [PMID: 35311351 PMCID: PMC9078634 DOI: 10.1097/ju.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We report stone comminution in the first 19 human subjects by burst wave lithotripsy (BWL), which is the transcutaneous application of focused, cyclic ultrasound pulses. MATERIALS AND METHODS This was a prospective multi-institutional feasibility study recruiting subjects undergoing clinical ureteroscopy (URS) for at least 1 stone ≤12 mm as measured on computerized tomography. During the planned URS, either before or after ureteroscope insertion, BWL was administered with a handheld transducer, and any stone fragmentation and tissue injury were observed. Up to 3 stones per subject were targeted, each for a maximum of 10 minutes. The primary effectiveness outcome was the volume percent comminution of the stone into fragments ≤2 mm. The primary safety outcome was the independent, blinded visual scoring of tissue injury from the URS video. RESULTS Overall, median stone comminution was 90% (IQR 20, 100) of stone volume with 21 of 23 (91%) stones fragmented. Complete fragmentation (all fragments ≤2 mm) within 10 minutes of BWL occurred in 9 of 23 stones (39%). Of the 6 least comminuted stones, likely causative factors for decreased effectiveness included stones that were larger than the BWL beamwidth, smaller than the BWL wavelength or the introduction of air bubbles from the ureteroscope. Mild reddening of the papilla and hematuria emanating from the papilla were observed ureteroscopically. CONCLUSIONS The first study of BWL in human subjects resulted in a median of 90% comminution of the total stone volume into fragments ≤2 mm within 10 minutes of BWL exposure with only mild tissue injury.
Collapse
Affiliation(s)
- Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - James E. Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert M. Sweet
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Ian S. Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Peter L. Sunaryo
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Department of Urology, Northwest Permanente, Portland, Oregon
| | - James C. Williams
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam D. Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Bryan W. Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Mathew D. Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| |
Collapse
|
5
|
Bailey MR, Maxwell AD, Cao S, Ramesh S, Liu Z, Williams JC, Thiel J, Dunmire B, Colonius T, Kuznetsova E, Kreider W, Sorensen MD, Lingeman JE, Sapozhnikov OA. Improving burst wave lithotripsy effectiveness for small stones and fragments by increasing frequency: theoretical modeling and ex vivo study. J Endourol 2022; 36:996-1003. [PMID: 35229652 DOI: 10.1089/end.2021.0714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE In clinical trial NCT03873259, a 2.6-mm lower pole stone was treated transcutaneously and ex vivo with 390-kHz burst wave lithotripsy (BWL) for 40 minutes and failed to break. The stone was subsequently fragmented with 650-kHz BWL after a 4-minute exposure. This study investigated how to fragment small stones and why varying BWL frequency may more effectively fragment stones to dust. METHODS A linear elastic model was used to calculate the stress created inside stones from shock wave lithotripsy (SWL) and different BWL frequencies mimicking the stone's size, shape, lamellar structure, and composition. To test model predictions about the impact of BWL frequency, matched pairs of stones (1-5 mm) were treated at 1) 390 kHz, 2) 830 kHz, and 3) 390 kHz followed by 830 kHz. The mass of fragments greater than 1 and 2 mm was measured over 10 minutes of exposure. RESULTS The linear elastic model predicts that the maximum principal stress inside a stone increases to more than 5.5 times the pressure applied by the ultrasound wave as frequency is increased, regardless of composition tested. The threshold frequency for stress amplification is proportionate to the wave speed divided by the stone diameter. Thus, smaller stones may be likely to fragment at higher frequency, but not lower frequency below a limit. Unlike with SWL, this amplification in BWL occurs consistently with spherical and irregularly shaped stones. In water tank experiments, stones smaller than the threshold size broke fastest at high frequency (p=0.0003), whereas larger stones broke equally well to sub-millimeter dust at high, low, or mixed frequency. CONCLUSIONS For small stones and fragments, increasing frequency of BWL may produce amplified stress in the stone causing the stone to break. Using the strategies outlined here, stones of all sizes may be turned to dust efficiently with BWL.
Collapse
Affiliation(s)
- Michael R Bailey
- University of Washington, Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, 1013 NE 40th St., Seattle, Washington, United States, 98105;
| | - Adam D Maxwell
- University of Washington School of Medicine, 12353, Department of Urology, 1013 NE 40th St, Seattle, Washington, United States, 98105;
| | - Shunxiang Cao
- California Institute of Technology, Dept. of Mechanical Engineering, Pasadena, California, United States;
| | - Shivani Ramesh
- University of Washington Applied Physics Lab, Center for Industrial and Medical Ultrasound, Seattle, Washington, United States;
| | - Ziyue Liu
- Indiana University School of Medicine, Biostatistics, Indianapolis, Indiana, United States;
| | - James Caldwell Williams
- Indiana Univ Sch Med, Anatomy & Cell Biology, 635 Barnhill Dr MS5035, Department of Anatomy & Cell Biology, Indianapolis, Indiana, United States, 46202-5120.,United States;
| | - Jeff Thiel
- University of Washington School of Medicine, Radiology, Seattle, Washington, United States;
| | - Barbrina Dunmire
- University of Washington, Applied Physics Lab, 1013 NE 40th St, Seattle, Washington, United States, 98105;
| | - Tim Colonius
- California Institute of Technology, Dept. of Mechanical Engineering, Pasadena, California, United States;
| | - Ekaterina Kuznetsova
- University of Washington Applied Physics Lab, Center for Industrial and Medical Ultrasound, Seattle, Washington, United States;
| | - Wayne Kreider
- University of Washington Applied Physics Lab, Center for Industrial and Medical Ultrasound, Seattle, Washington, United States;
| | - Mathew D Sorensen
- University of Washington, Department of Urology, 1959 NE Pacific Street, Box 356510, Seattle, Washington, United States, 98195;
| | - James E Lingeman
- Indiana University School of Medicine, Dept. of Urology, 1801 North Senate Blvd., Suite 220, Indianapolis, Indiana, United States, 46202;
| | - Oleg A Sapozhnikov
- University of Washington Applied Physics Lab, Center for Industrial and Medical Ultrasound, Seattle, Washington, United States.,Moscow State University, 64935, Department of Acoustics, Physics Faculty, Moskva, Moskva, Russian Federation;
| |
Collapse
|
6
|
Raskolnikov D, Bailey MR, Harper JD. Recent Advances in the Science of Burst Wave Lithotripsy and Ultrasonic Propulsion. BME FRONTIERS 2022; 2022. [PMID: 37090444 PMCID: PMC10117400 DOI: 10.34133/2022/9847952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nephrolithiasis is a common, painful condition that requires surgery in many patients whose stones do not pass spontaneously. Recent technologic advances have enabled the use of ultrasonic propulsion to reposition stones within the urinary tract, either to relieve symptoms or facilitate treatment. Burst wave lithotripsy (BWL) has emerged as a noninvasive technique to fragment stones in awake patients without significant pain or renal injury. We review the preclinical and human studies that have explored the use of these two technologies. We envision that BWL will fill an unmet need for the noninvasive treatment of patients with nephrolithiasis.
Collapse
Affiliation(s)
- Dima Raskolnikov
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
7
|
Harper JD, Metzler I, Hall MK, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC, Bailey MR, Sorensen MD. First In-Human Burst Wave Lithotripsy for Kidney Stone Comminution: Initial Two Case Studies. J Endourol 2021; 35:506-511. [PMID: 32940089 PMCID: PMC8080914 DOI: 10.1089/end.2020.0725] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To test the effectiveness (Participant A) and tolerability (Participant B) of urinary stone comminution in the first-in-human trial of a new technology, burst-wave lithotripsy (BWL). Materials and Methods: An investigational BWL and ultrasonic propulsion system was used to target a 7-mm kidney stone in the operating room before ureteroscopy (Participant A). The same system was used to target a 7.5 mm ureterovesical junction stone in clinic without anesthesia (Participant B). Results: For Participant A, a ureteroscope inserted after 9 minutes of BWL observed fragmentation of the stone to <2 mm fragments. Participant B tolerated the procedure without pain from BWL, required no anesthesia, and passed the stone on day 15. Conclusions: The first-in-human tests of BWL pulses were successful in that a renal stone was comminuted in <10 minutes, and BWL was also tolerated by an awake subject for a distal ureteral stone. Clinical Trial NCT03873259 and NCT02028559.
Collapse
Affiliation(s)
- Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ian Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael Kennedy Hall
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tony T. Chen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Adam D. Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Bryan W. Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - James C. Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Mathew D. Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Urology, VA Puget Sound Health Care System, Seattle, Washington, USA
| |
Collapse
|