A non-axisymmetric, elongated pressure distribution in the lithotripter focal plane enhances stone comminution in vitro during simulated respiratory motion

Abstract

A challenge in clinical shock wave lithotripsy (SWL) is stone translation due to a patient’s respiratory motion, in a direction perpendicular to shockwave propagation, which may negatively affect stone comminution while increasing the risk of tissue injury. We have developed a method using external masks and a modified lens geometry to transform the axisymmetric pressure distribution in the focal plane of an electromagnetic lithotripter into a non-axisymmetric elliptical distribution. At equivalent acoustic pulse energy (46 mJ), the peak pressure was reduced from 44 MPa to 38 MPa while the −6 dB focal width was increased from 7.4 mm for the original to 11.7 mm (major axis) and 7.9 mm (minor axis) of the modified field. In vitro stone comminution was performed in a tube holder (d = 14 mm) using a translation pattern with 12 breaths per minute and 15 mm in excursion distance. Stone comminution after 1000 shocks are 71.2 ± 4.4% and 65.2 ±8.3% (p < 0.05) along the major- and minor-axis of the modified field, respectively, compared to 62.6 ± 7.2% for the original axisymmetric field. These results suggest that an elongated pressure field aligned along the direction of stone motion may enhance stone comminution in SWL. [Work supported by the NIH and the NSF GRFP.]