Browsing by Subject "Lithotripsy"

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    A model-based simulation framework for coupled acoustics, elastodynamics, and damage with application to nano-pulse lithotripsy
    (International Journal of Solids and Structures, 2024-03-01) Liu, Y; Zhong, P; Lopez-Pamies, O; Dolbow, JE
    We develop a model for solid objects surrounded by a fluid that accounts for the possibility of acoustic pressures giving rise to damage on the surface of the solid. The propagation of an acoustic pressure in the fluid domain is modeled by the acoustic wave equation. On the other hand, the response of the solid is described by linear elastodynamics coupled with a gradient damage model, one that is based on a cohesive-type phase-field description of fracture. The interaction between the acoustic pressure and the deformation and damage of the solid are represented by transmission conditions at the fluid–solid interface. The resulting governing equations are discretized using a finite-element/finite-difference method that pays particular attention to the spatial and temporal scales that need to be resolved. Results from model-based simulations are provided for a benchmark problem as well as for recent experiments in nano-pulse lithotripsy. A parametric study is performed to illustrate how damage develops in response to the driving force (magnitude and location of the acoustic source) as a function of the fracture resistance of the solid. The results are shown to be qualitatively consistent with experimental observations for the location and size of the damage fields on the solid surface. A study of limiting cases also suggests that both the threshold for damage and the critical fracture energy are important to consider in order to capture the transition from damage initiation to complete localization. A low-cycle fatigue model is proposed that degrades the fracture resistance of the solid as a function of accumulated tensile strain energy, and it is shown to be capable of capturing damage localization in simulations of multi-pulse nano-pulse lithotripsy.
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    ItemOpen Access
    Effect of lithotripter focal width on stone comminution in shock wave lithotripsy.
    (J Acoust Soc Am, 2010-04) Qin, Jun; Simmons, W Neal; Sankin, Georgy; Zhong, Pei
    Using a reflector insert, the original HM-3 lithotripter field at 20 kV was altered significantly with the peak positive pressure (p(+)) in the focal plane increased from 49 to 87 MPa while the -6 dB focal width decreased concomitantly from 11 to 4 mm. Using the original reflector, p(+) of 33 MPa with a -6 dB focal width of 18 mm were measured in a pre-focal plane 15-mm proximal to the lithotripter focus. However, the acoustic pulse energy delivered to a 28-mm diameter area around the lithotripter axis was comparable ( approximately 120 mJ). For all three exposure conditions, similar stone comminution ( approximately 70%) was produced in a mesh holder of 15 mm after 250 shocks. In contrast, stone comminution produced by the modified reflector either in a 15-mm finger cot (45%) or in a 30-mm membrane holder (14%) was significantly reduced from the corresponding values (56% and 26%) produced by the original reflector (no statistically significant differences were observed between the focal and pre-focal planes). These observations suggest that a low-pressure/broad focal width lithotripter field will produce better stone comminution than its counterpart with high-pressure/narrow focal width under clinically relevant in vitro comminution conditions.
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    Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter.
    (Proc Natl Acad Sci U S A, 2014-04-01) Neisius, Andreas; Smith, Nathan B; Sankin, Georgy; Kuntz, Nicholas John; Madden, John Francis; Fovargue, Daniel E; Mitran, Sorin; Lipkin, Michael Eric; Simmons, Walter Neal; Preminger, Glenn M; Zhong, Pei
    The efficiency of shock wave lithotripsy (SWL), a noninvasive first-line therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E+) of 40 mJ. The -6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters.
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    Optimization of treatment strategy used during shockwave lithotripsy to maximize stone fragmentation efficiency.
    (J Endourol, 2011-09) Yong, Daniel Z; Lipkin, Michael E; Simmons, W Neal; Sankin, Georgy; Albala, David M; Zhong, Pei; Preminger, Glenn M
    BACKGROUND AND PURPOSE: Previous studies have demonstrated that treatment strategy plays a critical role in ensuring maximum stone fragmentation during shockwave lithotripsy (SWL). We aimed to develop an optimal treatment strategy in SWL to produce maximum stone fragmentation. MATERIALS AND METHODS: Four treatment strategies were evaluated using an in-vitro experimental setup that mimics stone fragmentation in the renal pelvis. Spherical stone phantoms were exposed to 2100 shocks using the Siemens Modularis (electromagnetic) lithotripter. The treatment strategies included increasing output voltage with 100 shocks at 12.3 kV, 400 shocks at 14.8 kV, and 1600 shocks at 15.8 kV, and decreasing output voltage with 1600 shocks at 15.8 kV, 400 shocks at 14.8 kV, and 100 shocks at 12.3 kV. Both increasing and decreasing voltages models were run at a pulse repetition frequency (PRF) of 1 and 2 Hz. Fragmentation efficiency was determined using a sequential sieving method to isolate fragments less than 2 mm. A fiberoptic probe hydrophone was used to characterize the pressure waveforms at different output voltage and frequency settings. In addition, a high-speed camera was used to assess cavitation activity in the lithotripter field that was produced by different treatment strategies. RESULTS: The increasing output voltage strategy at 1 Hz PRF produced the best stone fragmentation efficiency. This result was significantly better than the decreasing voltage strategy at 1 Hz PFR (85.8% vs 80.8%, P=0.017) and over the same strategy at 2 Hz PRF (85.8% vs 79.59%, P=0.0078). CONCLUSIONS: A pretreatment dose of 100 low-voltage output shockwaves (SWs) at 60 SWs/min before increasing to a higher voltage output produces the best overall stone fragmentation in vitro. These findings could lead to increased fragmentation efficiency in vivo and higher success rates clinically.