CaltechAUTHORS
  A Caltech Library Service

Cavitation in shock wave lithotripsy: the critical role of bubble activity in stone breakage and kidney trauma

Bailey, Michael R. and Cleveland, Robin O. and Colonius, Tim and Crum, Lawrence A. and Evan, Andrew P. and Lingeman, James E. and McAteer, James A. and Sapozhnikov, Oleg A. and Williams, James C., Jr. (2003) Cavitation in shock wave lithotripsy: the critical role of bubble activity in stone breakage and kidney trauma. In: 2003 IEEE Symposium on Ultrasonics. IEEE , Piscataway, NJ, pp. 724-727. ISBN 0-7803-7922-5. https://resolver.caltech.edu/CaltechAUTHORS:20190214-131110058

[img] PDF - Published Version
See Usage Policy.

379Kb

Use this Persistent URL to link to this item: https://resolver.caltech.edu/CaltechAUTHORS:20190214-131110058

Abstract

Objective: Shock Wave Lithotripsy (SWL) is the use of shock waves to fragment kidney stones. We have undertaken a study of the physical mechanisms responsible for stone comminution and tissue injury in SWL. SWL was originally developed on the premise that stone fragmentation could be induced by a short duration, high amplitude positive pressure pulse. Even though the SWL waveform carries a prominent tensile component, it has long been thought that SW damage to stones could be explained entirely on the basis of mechanisms such as spallation, pressure gradients, and compressive fracture. We contend that not only is cavitation also involved in SWL, bubble activity plays a critical role in stone breakage and is a key mechanism in tissue damage. Methods: Our evidence is based upon a series of experiments in which we have suppressed or minimized cavitation, and discovered that both stone comminution and tissue injury is similarly suppressed or minimized. Some examples of these experiments are (1) application of overpressure, (2) time reversal of acoustic waveform, (3) acoustically-transparent, cavitation-absorbing films, and (4) dual pulses. In addition, using passive and active ultrasound, we have observed the existence of cavitation, in vivo, and at the site of tissue injury. Results: Numerical and experimental results showed mitigation of bubble collapse intensity by time-reversing the lithotripsy pulse and in vivo treatment showed a corresponding drop from 6.1% ± 1.7% to 0.0% in the hemorrhagic lesion. The time-reversed wave did not break stones. Stone comminution and hemolysis were reduced to levels very near sham levels with the application of hydrostatic pressure greater than the near 10-MPa amplitude of the negative pressure of the lithotripter shock wave. A Mylar sheet 3-mm from the stone surface did not inhibit erosion and internal cracking, but a sheet in contact with the stone did. In water, mass lost from stones in a dual pulse lithotripter is 8 times greater than with a single lithotripter, but in glycerol, which reduces the pressures generated in bubble implosion, the enhancement is lost. Conclusion: This cavitation-inclusive mechanistic understanding of SWL is gaining acceptance and has had clinical impact. Treatment at slower SW rate gives cavitation bubble clusters time to dissolve between pulses and increases comminution. Some SWL centers now treat patients at slower SW rate to take advantage of this effect. An elegant cavitation-aware strategy to reduce renal trauma in SWL is being tested in experimental animals. Starting treatment at low amplitude causes vessels to constrict and this interferes with cavitation-mediated vascular injury. Acceptance of the role of cavitation in SWL is beginning to be embraced by the lithotripter industry, as new dual-pulse lithotripters—based on the concept of cavitation control— have now been introduced.


Item Type:Book Section
Related URLs:
URLURL TypeDescription
https://doi.org/10.1109/ultsym.2003.1293503DOIArticle
ORCID:
AuthorORCID
Colonius, Tim0000-0003-0326-3909
Additional Information:© 2003 IEEE. We gratefully acknowledge support from NIH grant #DK43381, #DK55674, and FIRCA and NSBRI SMS00203. We thank all the members of the Consortium for Shock Waves in Medicine for their contributions.
Funders:
Funding AgencyGrant Number
NIHDK43381
NIHDK55674
FIRCAUNSPECIFIED
National Space Biomedical Research InstituteSMS00203
Record Number:CaltechAUTHORS:20190214-131110058
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20190214-131110058
Official Citation:M. R. Bailey et al., "Cavitation in shock wave lithotripsy: the critical role of bubble activity in stone breakage and kidney trauma," IEEE Symposium on Ultrasonics, 2003, Honolulu, HI, USA, 2003, pp. 724-727 Vol.1. doi: 10.1109/ULTSYM.2003.1293503
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:92942
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:15 Feb 2019 05:45
Last Modified:03 Oct 2019 20:50

Repository Staff Only: item control page