J.E. Saunders

ACOUSTIC CAVITATION GENERATED BY AN EXTRACORPOREAL SHOCKWAVE LITHOTRIPTER

Evidence is presented of acoustic cavitation generated by a Dornier extracorporeal shockwave lithotripter. Using x-ray film, thin aluminum sheets, and relatively thick metal plates as targets, evidence of liquid jet impacts associated with cavitation bubble collapse was observed. The jet impact was violent enough to puncture thin foils and deform metal plates. Furthermore, numerous jet impacts were generated over a volume of greater than 200 cm3. It is likely that such violent cavitation will also occur in tissue, and observed biological effects (e.g. renal calculus disintegration and tissue trauma) may be related to cavitation damage.

A survey of the acoustic output of commercial extracorporeal shock wave lithotripters

A survey of the pressures and intensities generated by different commercial extracorporeal shock wave (ESWL) lithotripters is reported. The lithotripters included in the survey are the Dornier HM3, Wolf Piezolith 2200 and 2300, Siemens Lithostar, Technomed Sonolith 2000 and 3000, and EDAP LT-01. Measurements were made using a polyvinylidene difluoride (PVdF) membrane hydrophone in water. The zero crossing frequency of one complete cycle of the focused pulse from ESWL equipment is in the range 0.1 to 1 MHz. Spatial-peak temporal-peak positive and negative pressures up to 114 MPa and 10 MPa, respectively, have been measured and the rise times of the positive pressure half cycle at maximum output settings are 30 ns or less. The mean spatial-peak temporal-average intensity of the lithotripters is 5.0 x 10(2) W m-2 when operated at a pulse repetition frequency of 1 Hz. The spatial-peak pulse-average intensity ranges from 6.6 x 10(7) to 1.24 x 10(9) W m-2. The estimated acoustic energy in a single pulse (at the focus) at the maximum output setting of the lithotripters varies from 2.0 x 10(-3) J to about 9.0 x 10(-2) J. The beam area in the focal plane varies by a factor of 100 on different lithotripters and the temporal-peak pressure at the position of the skin at the entry point of the beam by a factor of 30. Measurement problems associated with hydrophone damage and the uncertainties in the hydrophone calibration at high pressures are discussed and an estimate of the total uncertainty in the absolute measurements of the spatial-peak temporal-peak positive pressure is given as +/- 36%.

Acoustic emission and sonoluminescence due to cavitation at the beam focus of an electrohydraulic shock wave lithotripter

The acoustic emission from cavitation in the field of an extracorporeal shock wave lithotripter has been studied using a lead zirconate titanate piezoceramic (PC4) hydrophone in the form of a 100-mm diameter focused bowl of 120-mm focal length. With this hydrophone directed at the beam focus of an electrohydraulic lithotripter radiating into water, it is possible to identify signals well above the noise level, at the 1-MHz resonance of the hydrophone, which originate at the beam focus. Light emission, attributed to sonoluminescence, is also shown to originate at the focal region of the lithotripter, and the signal obtained from a fast photomultiplier tube directed at the focus has similarities in structure and timing to the detected acoustic signals. The multiple shock emission resulting from a single discharge of an electrohydraulic source is shown to result in two separate bursts of cavitational activity separated by a period of 3-4 ms. The signal burst corresponding to the primary shock has a duration of about 600 microseconds with little noticeable structure. The signal burst associated with the secondary shock has a reproducible structure with two distinct peaks separated by about 200 microseconds depending on the shock amplitude. THe timing and structure of each burst is shown to be in reasonable agreement with the theoretical predictions made by Church (1989) based on the Gilmore model of bubble dynamics. In particular, it is shown that it is possible to obtain precise measurements of the time delay between the separate peaks within the signal burst detected following the secondary shock and this may, as predicted, provide a method of determining the size of bubbles remaining after the primary shock.

The cavitation threshold of human tissue exposed to 0.2-MHz pulsed ultrasound: Preliminary measurements based on a study of clinical lithotripsy

Evidence of acoustic cavitation was identified in the form of transient echoes in ultrasound B-scan images of patients receiving extracorporeal shock-wave lithotripsy treatment on a Storz Modulith SL20. This lithotripter generates 10-microseconds duration pulses with a centre frequency of 0.2 MHz at a pulse repetition frequency of 1 Hz. The visual appearance of B-scan images was examined in a total of 30 patients and a quantitative analysis of echogenicity changes was carried out in six cases involving lithotripsy treatment of stones in the renal pelvis. In these patients new echoes were identified in images unaffected by movement artefacts and were found to occur in perinephric fat and adjacent muscle and kidney tissue at positions close to the axis of the shock-wave field between 1 and 2 cm in advance of the indicated beam focus of the lithotripter. The echogenicity within each region increased significantly above the background level when the output of the lithotripter was increased above a threshold value. The acoustic pressures corresponding to this threshold were measured in water using a calibrated PVDF membrane hydrophone. After correction for attenuation in tissue the cavitation thresholds, in terms of the temporal peak negative pressure, are found to lie between 1.5 MPa and 3.5 MPa in all six cases. Interpretation of the measured values in terms of the likely threshold at the higher frequencies used in diagnostic ultrasound is considered using a theoretical model.

Detection of acoustic emission from cavitation in tissue during clinical extracorporeal lithotripsy

A 1-MHz focused hydrophone has been used to search for acoustic emission expected to arise from cavitation occurring in tissue during clinical extracorporeal shock-wave lithotripsy (ESWL). The hydrophone is acoustically coupled to the patients skin and the focus directed at depth in tissue under ultrasound guidance. The measured amplitude-time variation of the acoustic emission from tissue near the shock-wave focus of the Storz Modulith SL20 lithotripter has been examined in four patients. There is evidence of increased amplitude acoustic emission at 1 MHz from regions within tissue that also appear hyperechoic in simultaneously acquired ultrasound images. The acoustic emission from these regions decays from an initial peak to the noise level in about 500 microseconds following each shock-wave pulse. Within this period, a second peak, often of higher amplitude than the first, is typically observed about 100 microseconds after the shockwave. The time between the initial and second peaks is found to increase with increasing shock-wave amplitude. The results are similar to those previously observed from cavitation induced by shock-wave exposure in water and indicate that the 1-MHz acoustic emission arises from inertial cavitation in tissue during clinical ESWL.

Pressure waveforms generated by a Dornier extra-corporeal shock-wave lithotripter.

Pressure waveforms in the acoustic field generated by a Dornier (HM3) shock-wave lithotripter have been measured using a bilaminar shielded PVDF membrane hydrophone in water. Using these waveforms, values of the peak-positive (p+) and peak-negative pressure (p-) at various positions in the field have been estimated. At the focus, p+ is 38.6 MPa (standard deviation = 9.0 MPa) and p- is 10.1 MPa (standard deviation = 1.0 MPa) at 20 kV discharge potential and an electrode separation in the range 1.3 to 2.4 mm. The peak-positive pressure is found to fall to 50% (-6 dB level) at about 60 mm either side of the focus on the major axis of the reflector and on a 10 mm radius circle around the focus in the focal plane. A shot-to-shot variation of +/- 25% in p+ is attributed to the inherent variability of the electrical discharge which may result in changes in the exact position and strength of the acoustic field. The results reported are considered to be more accurate than those of previous measurements due to the relatively flat frequency response of this type of hydrophone.

THE INFLUENCE OF FLUID PROPERTIES AND PULSE AMPLITUDE ON BUBBLE DYNAMICS IN THE FIELD OF A SHOCK WAVE LITHOTRIPTER

This study concerns the radial dynamics of a bubble driven by pulsed ultrasound of the type generated during extracorporeal shock wave lithotripsy. In particular, a numerical model has been used to examine the sensitivity of the bubble oscillations to changes in both the amplitude of the driving field and the physical conditions of the fluid surrounding the bubble: viscosity, surface tension, temperature and gas content. It is shown that, at high negative pressures (p- = 10 MPa) as in lithotripsy, the timing and amplitude of bubble collapses have a considerably reduced sensitivity to the initial bubble size and all fluid parameters, except gas content, compared with those expected in lower-amplitude fields (p- = 0.2 MPa). This study indicates that, in the lithotripsy fields, the differences in the viscosity, surface tension and temperature of body fluids and the initial bubble size will have little effect on bubble dynamics compared with those expected in water.

The spatial distribution of cavitation induced acoustic emission, sonoluminescence and cell lysis in the field of a shock wave lithotripter

This study examines the spatial distribution of various properties attributed to the cavitation field generated by a shock wave lithotripter. These properties include acoustic emission and sonoluminescence, which result from violent bubble collapse, and the degree of cell lysis in vitro, which appears to be related to cavitation. The acoustic emission detected with a 1 MHz, 12 cm diameter focused hydrophone occurs in two distinct bursts. The immediate signal is emitted from a small region contained within the 4 MPa peak negative pressure contour. A second, delayed, burst is emitted from a region extending further along the beam axis. The delay between these two bursts has also been mapped, and the longest delay occurs at positions close to the regions of maximum peak negative pressure. Sonoluminescence from both single and multiple shocks occurs in a broader region than the acoustic emission but the measurement technique does not allow time resolution of the signal. Cell lysis occurs in a relatively small region that correlates closely with the immediate acoustic emission for a shock propagating in a gelatine solution.

Estimation of fetal lung volume using enhanced 3-dimensional ultrasound: a new method and first result

Objective To measure fetal lung volume using a computer based, enhanced, 3‐dimensional ultrasound imaging system.

Acoustic performance and clinical use of a fibreoptic hydrophone.

Initial clinical experience with the use of an optical fibre hydrophone for in vivo ultrasound dosimetry is reported. The hydrophone, originally described by Beard and Mills (1997), operates as an extrinsic, low-finesse Fabry-Perot optical sensor where acoustically-induced thickness changes in a polymer film modulate the phase difference between light beams reflected from the two surfaces of the film. The pressure waveforms from the sensor are compared with those from a calibrated piezoelectric polymer membrane hydrophone. The sensor is found to have a frequency resonance at around 12 MHz, corresponding to the thickness mode of the 50-micron polymer film. The directional responses at 0.16 MHz, 1.0 MHz and 5.0 MHz are found to be similar to those predicted for a plane piston receiver with the same diameter as that of the polymer film (400 microns). The performance of the sensor as a broad-band hydrophone is degraded by the relatively low acoustical impedance of the adhesive used in the fibre-film bond. The hydrophone was used in the clinic for measurement of acoustic pressures within the ureter of 4 patients undergoing clinical extracorporeal shock-wave lithotripsy on a Dornier HM3 lithotripter. Pressures in the range 0.5 to 5.0 MPa were recorded in the ureter at positions over 10 cm from the renal pelvis. Problems related to the clinical use of the sensor, including instability in the sensitivity of the sensor following handling and its mechanical strength in high-amplitude acoustic fields, are discussed.