Innovative strategies for improved outcomes in nephrolithiasis

Abstract

Edwin Carstensen, Ph.D., was an advisor of NIH NIDDK Program Project Grant DK043881, created to investigate shock wave lithotripsy (SWL). We now develop solutions to improve all aspects of the management of stone disease. Our goal in this paper is to report progress built on Dr. Cartsensen's advice and inspiration. The work ranges from numerical simulation to clinical trials and from device development to bioeffects and metrology. Much of our work involves bubbles and cavitation. This work has contributed to the body of knowledge defining limits for the safe use of ultrasound which Dr. Carstensen worked hard to establish. Specifically, an update will be given on the development of ultrasound to image, fragment, trap, and reposition stones. In particular, we demonstrated bubbles contribute to the twinkling artifact used by NASA and others to image stones, and we drew on Dr. Carstensen's paper [UMB, 19(2) 147-165 1993] to demonstrate that breathing the elevated carbon dioxide levels present in NASA vehicles suppresses this signal making stone imaging more difficult. We have since developed imaging countermeasures and pushing and breaking technologies that appear less dependent on cavitation than SWL.