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Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter.

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Date
2014-04-01
Authors
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
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(11 total)
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Abstract
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.
Type
Journal article
Subject
electromagnetic lithotripter
lens modification
stone fragmentation
Animals
Electromagnetic Phenomena
Equipment Design
Female
Lenses
Lithotripsy
Motion
Respiration
Skin
Sus scrofa
Permalink
https://hdl.handle.net/10161/8403
Published Version (Please cite this version)
10.1073/pnas.1319203111
Publication Info
Neisius, Andreas; Smith, Nathan B; Sankin, Georgy; Kuntz, Nicholas John; Madden, John Francis; Fovargue, Daniel E; ... Zhong, Pei (2014). Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter. Proc Natl Acad Sci U S A, 111(13). pp. E1167-E1175. 10.1073/pnas.1319203111. Retrieved from https://hdl.handle.net/10161/8403.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Lipkin

Michael Eric Lipkin

Cary N. Robertson, MD, Associate Professor
Madden

John Francis Madden

Associate Professor of Pathology
Preminger

Glenn Michael Preminger

James F. Glenn, M.D. Distinguished Professor of Urology
1. Minimally invasive management of urologic diseases 2. Minimally invasive management of renal and ureteral stones 3. Medical management of nephrolithiasis 4. Bioeffects of shock wave lithotripsy 5. Basic physics of shock wave lithotripsy 6. Intracorporeal lithotripsy for stone fragmentation 7. Minimally invasive management of urinary tract obstruction, including ureteropelvic junction obstruction and ureteral strictures 8. Enhanced imaging modalities f
Simmons

Walter Neal Simmons

Gendell Family Professor of the Practice
Zhong

Pei Zhong

Professor in the Department of Mechanical Engineering and Materials Science
My research focuses on engineering and technology development with applications in the non-invasive or minimally invasive treatment of kidney stone disease via shock wave and laser lithotripsy, high-intensity focused ultrasound (HIFU) and immunotherapy for cancer treatment, acoustic and optical cavitation, and ultrasound neuromodulation via sonogenetics.  We are taking an integrated and translational approach that combines fundamental research with engineering and applied technol
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