WO2008068509A2 - Appareil et technique de traitement de calculs biliaires et de calculs rénaux - Google Patents

Appareil et technique de traitement de calculs biliaires et de calculs rénaux Download PDF

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Publication number
WO2008068509A2
WO2008068509A2 PCT/GB2007/004700 GB2007004700W WO2008068509A2 WO 2008068509 A2 WO2008068509 A2 WO 2008068509A2 GB 2007004700 W GB2007004700 W GB 2007004700W WO 2008068509 A2 WO2008068509 A2 WO 2008068509A2
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WO
WIPO (PCT)
Prior art keywords
medical condition
transmitter
treatment
signal
khz
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/GB2007/004700
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English (en)
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WO2008068509A3 (fr
Inventor
Duncan Billson
Shengci Li
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University of Warwick
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University of Warwick
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Filing date
Publication date
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Publication of WO2008068509A2 publication Critical patent/WO2008068509A2/fr
Publication of WO2008068509A3 publication Critical patent/WO2008068509A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Clinical applications
    • A61B8/0833—Clinical applications involving detecting or locating foreign bodies or organic structures
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01S—RADIO DIRECTION-FINDING; RADIO NAVIGATION; DETERMINING DISTANCE OR VELOCITY BY USE OF RADIO WAVES; LOCATING OR PRESENCE-DETECTING BY USE OF THE REFLECTION OR RERADIATION OF RADIO WAVES; ANALOGOUS ARRANGEMENTS USING OTHER WAVES
    • G01S15/00—Systems using the reflection or reradiation of acoustic waves, e.g. sonar systems
    • G01S15/88—Sonar systems specially adapted for specific applications
    • G01S15/89—Sonar systems specially adapted for specific applications for mapping or imaging
    • G01S15/8906—Short-range imaging systems; Acoustic microscope systems using pulse-echo techniques
    • G01S15/899—Combination of imaging systems with ancillary equipment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/225—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
    • A61B17/2256—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves with means for locating or checking the concrement, e.g. X-ray apparatus, imaging means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00137—Details of operation mode
    • A61B2017/00154—Details of operation mode pulsed
    • A61B2017/00159—Pulse shapes
    • A61B2017/00168—Spike
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B2017/22005—Effects, e.g. on tissue
    • A61B2017/22011—Combined types of vibration, e.g. ultrasonic and electrohydraulic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound

Definitions

  • the invention relates to apparatus and methods for treating medical conditions comprising build up of bodies treatable using ultrasound, such as gallstones and kidney-stones.
  • Gallstones and kidney-stones are a common problem, and can be extremely painful and indeed debilitating until they are diagnosed and treated.
  • the common method for treating gallstones is surgery, and for kidney-stones is shock-wave lithotripsy; this involves focussing a high-powered acoustic shock wave onto the stones, through the abdomen. A series of pulses breaks the stones up into small pieces that can subsequently passed through urination.
  • One of the difficulties of applying this technique is the accuracy that most systems can achieve in hitting the stone. Not focussing the shock wave onto the stone will, firstly increase the treatment time unduly, will decrease the efficacy of the treatment, and will increase damage to the tissue surrounding the stone.
  • the beam is commonly focussed using either x-rays or diagnostic ultrasound to determine the accurate position of the stone, however as the patient moves, or as the stone moves or disintegrates within the patient, this focus position will need to be changed, which is not particularly easy throughout a single treatment.
  • the treatment commonly lasts for several 10's of minutes, and may need to be repeated several times until the stones are sufficiently broken-up.
  • the new apparatus and treatment technique described uses a technique where stones are disintegrated into powder using a combination of ultrasonic frequencies, having particular novelty in respect of the delivery and monitoring of the ultrasound.
  • Figure 1 is a schematic view of detected ultrasonic signal and three component parts of that signal
  • Figure 2 is a schematic drawing of the detected ultra sonic signal using apparatus according to the invention and various Fourier transforms of that signal;
  • Figure 3 comprises parts A and B showing the ability of the apparatus to provide an ultrasonic sectoral scan of a patient thereby to view the position of the focus of transmitted ultrasonic waves;
  • Figure 4 is a schematic block diagram of a first embodiment of an apparatus according to the invention.
  • Figure 5 is a schematic block diagram of apparatus according to a second embodiment of the invention.
  • apparatus 10 is for the treatment of a medical condition such as gallstones and/or kidney stones.
  • the medical conditions include ailments susceptible to treatment by ultrasound, such as hard deposits including uric acid, urates, calcium slats such as calcium oxalate and/or calcium phosphate, magnesium phosphate, silica, alumina, systine, xanthine, fibrin, cholesterol, fatty acids, bile pigments, .
  • the apparatus 10 comprises a high power transmitter driver 12 coupled to a transmitter 14 in the form of transducer for emitting sound waves and in particular ultrasonic sound waves you interlay patient.
  • Apparatus 10 further comprises a single detector 16 in particular an ultrasonic transducer for receiving ultrasonic sound waves in the patient and passing a signal to amplify 18.
  • Apparatus 10 further comprises a filter 20, an output display 24 and a sound apple box 26.
  • Sound apple box 26 preferably comprises a mixer 28 coupled to the filter 20, a carrier wave generator 30, an amplifier 32 and a loudspeaker 34.
  • Figure 4 Also shown in Figure 4 is the prior art configuration of an X-ray assembly which is described, is very difficult for an operator (such as a surgeon) to use in order to obtain real time positioning of the medical condition M such as a gallstone or kidney stone throughout any treatment procedure. However, the X-ray equipment can be used to set up the patient initially for proceeding to use the ultrasonic apparatus 10.
  • apparatus 10' is substantially similar to apparatus 10 shown in Figure 4 except a phased-array and stone-decay monitoring transducer is used in the form of the second transducer or detector 16'.
  • This is coupled to amplifier 36 which is able to provide a sectoral scan, or ultrasound image, as shown in Figures 3A and 3B, to be displayed to an operator (surgeon) on display 38.
  • the ultrasonic signal detector by transducer 16 or 16' is shown as amplitude versus time.
  • a transform into the frequency domain, such as via a Fourier transformation shows that the ultrasonic signal detected by transducer 16, 16' comprises fundamentally three components namely (a) the basic ultrasonic frequencies apply such as a 5OkI and 30OkI signal, (b) harmonics of these fundamental frequencies as created through non-linear processes in the interaction of the fundamental frequencies with tissue in the patient, and (c) a broad spectrum from the disintegration of the stones resulting from the efficacy of the treatment in the application of the ultrasonic signals from the primary transducer (transmitter 40).
  • the basic ultrasonic frequencies apply such as a 5OkI and 30OkI signal
  • harmonics of these fundamental frequencies as created through non-linear processes in the interaction of the fundamental frequencies with tissue in the patient
  • the ultrasonic signal in the time domain can be seen as all three components super imposed as shown in image filter 20 can be a band pass filter so purely to the harmonics as shown in Figure 2c thereby to generate a signal shown in Figure 2d of the harmonics only which result only from interactions of the ultrasonic signal emitted by transmitter 14, close to the focus of the ultrasonic, by doing an inverse Fourier transform, an amplitude versus time signal as shown in Figure 2e which can be used to provide an output to an operator of the proximity of the focused beam to the medical condition.
  • the technique mixes 2 high-power ultrasonic beams, of different frequencies, and the interaction between them on the stone is to erode the surface of the stone into a fine powder.
  • the powder particles are sufficiently small to be easily passed from the body using natural processes; via the urinary tract for kidney stones, and into the alimentary canal for gallstones.
  • the pulses are predominantly ultrasonic rather than a single acoustic pulse, they can be more tightly focussed, allowing more energy to be applied to the offending stone rather than to the surrounding tissue and fluids, increasing the efficiency of stone reduction, and minimising damage to other tissue.
  • Particular innovation centres around an improved method of monitoring the ultrasonic beam, and the interaction between the ultrasonic beam and the stones. This firstly allows much better control over the accuracy of the focus (in real-time), and secondly allows the operator to modify the parameters of the ultrasonic field in real-time to optimise the efficiency of breaking down the stones.
  • the monitoring technique relies on the detection of acoustic and ultrasonic signals produced by the interaction of the applied ultrasonic beam and the tissue /stone within the body.
  • the ultrasonic energy enters the body, there will be three sources of ultrasonic energy radiating from the stone, and from the surrounding tissue:
  • the first will simply be a reflected signal at the same frequency as the applied ultrasonic field. Similar ultrasound will also be scatter/reflected throughout the insonified tissue, and picked up by a receiving transducer, making it difficult to use this ultrasound alone to give information as to the position or state of the stone.
  • a sketch of the frequency spectra from this source is given in figure 1 A
  • the second source is generated as a non-linear interaction between the ultrasound and its environment, this predominantly produces "harmonics" of the applied ultrasound (at known, specific frequencies). Such harmonics arise only close to the focus of the ultrasonic field. As the frequencies of such harmonics are different to the frequencies of the applied ultrasound, simple electronic filtering techniques allow such harmonics to be easily isolated and identified. A sketch of the frequency spectra from this source is given in figure 1 B.
  • the third source will be acoustic/ultrasonic energy generated by the disintegration of the stones, this will be over a continuous range of frequencies, and again can be easily isolated and identified by filtering out the other frequencies described above. Both the frequency spectrum, and the amplitude of this sound will depend on the interaction between the impinging ultrasonic field and the stone.
  • a sketch of the frequency spectra from this source is given in figure 1 C.
  • a simplified sketch showing the effect of filtering is shown in figure 2
  • the technique described in this invention can look at the third source of acoustic energy alone (that arising from the disintegration of the stone), using a single receiver.
  • the signal can either be displayed on a suitable visual display (as a frequency spectra, or a simple amplitude bar), or can be represented by an audible signal, (possibly using frequency mixing with a variable carrier wave, such as is found in a "bat detector").
  • a suitable visual display as a frequency spectra, or a simple amplitude bar
  • an audible signal possibly using frequency mixing with a variable carrier wave, such as is found in a "bat detector"
  • This tells the operator when the focus of the therapeutic ultrasonic beam is on the stone, and how well the disintegration of the stone is progressing.
  • the operator can, for example move the focus slightly from side- to-side to maximise the signal, "fine-tuning" the focus.
  • the operator can also modify the ultrasonic source (changing the amplitude, frequency and pulse- length
  • the 3 signals may be used in conjunction with diagnostic ultrasonic imaging technology (phased-array transducers), and equipment similar to the equipment used for standard ultrasonic imaging may be used for this purpose.
  • diagnostic ultrasonic imaging technology phased-array transducers
  • equipment similar to the equipment used for standard ultrasonic imaging may be used for this purpose.
  • standard ultrasonic image of the stone and surrounding tissue may be obtained (pulses may need to be locked to distinguish the ultrasound from the diagnostic transducer, from the high power beam).
  • the diagnostic transducer or a separate imaging ultrasonic transducer
  • would also be used to image the focus of the ultrasonic beam using electronic frequency-filtering as described above to separate this ultrasonic source from the others), and this would be superimposed on the standard image, perhaps in another colour. This is akin to the Doppler measurements that are used to image blood flow in the body.
  • the diagnostic transducer and the high-power transducers could be integrated into a single unit.
  • the focusing and alignment of the high power ultrasonic source may be performed either manually or automatically (using a motorised jig)
  • the focusing and alignment of the high-power ultrasonic source may be adjusted electronically (if the source is built as a phased-array)
  • the diagnostic techniques may be used in 2-D and 3- D modes
  • FIG. 4 A typical embodiment of the simplest arrangement described in this patent application is given in Figure 4.
  • the problematic stones M within the patient are therapeutically insonified by the high-power transducer in order to break them up into a powder.
  • the initial alignment and monitoring of the stones is achieved by an x-ray system (although a separate phased array ultrasonic system may be used in place of the x-ray system).
  • ultrasound is given off across a range of frequencies (as described previously), which is picked up by the receiving transducer.
  • the output from the transducer is first amplified, and then filtered to detect only the sound generated by the disintegration of the stones.
  • This signal is then displayed on an output device (such as a simple meter), but may also be input into a "sound output box", where the signal (at ultrasonic frequencies) is converted into audible sound by mixing it with a carrier wave.
  • the operator surgeon manipulating the transmitting transducer
  • the operator then has real feedback on the operation of the system, which he (or she) can use to optimise the positioning and focus of the transmitting transducer, and the transmitter-driver parameters to produce the best possible treatment.
  • Figure 5 shows a further embodiment where the second transducer is now a combined phased-array and stone-decay monitoring transducer. This allows the surgeon to image the stones using ultrasound, eliminating the need for an x-ray system. This system can also form an image using only the ultrasound generated by the disintegration of the stones. This can show exactly which part of the stones are being disintegrated, allowing the operator more information to optimise the treatment further.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Physics & Mathematics (AREA)
  • Radar, Positioning & Navigation (AREA)
  • Remote Sensing (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Acoustics & Sound (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
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  • General Health & Medical Sciences (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • General Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
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Abstract

La présente invention concerne un appareil permettant de traiter des pathologies telles que des calculs biliaires ou des calculs rénaux chez un patient, l'appareil étant équipé d'un émetteur conçu pour concentrer des ondes sonores sur la pathologie dont souffre le patient afin de réduire celle-ci, d'un détecteur conçu pour recevoir un signal sonore de traitement généré lors du processus de réduction de la pathologie, et d'une unité de traitement de signaux conçue pour envoyer un signal de sortie à un opérateur, indicatif de l'intérêt du traitement de la pathologie subordonné au signal sonore de traitement capté par le détecteur.
PCT/GB2007/004700 2006-12-07 2007-12-07 Appareil et technique de traitement de calculs biliaires et de calculs rénaux Ceased WO2008068509A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GBGB0624439.6A GB0624439D0 (en) 2006-12-07 2006-12-07 Technique for treatment of gall-and kidney-stones
GB0624439.6 2006-12-07

Publications (2)

Publication Number Publication Date
WO2008068509A2 true WO2008068509A2 (fr) 2008-06-12
WO2008068509A3 WO2008068509A3 (fr) 2008-12-18

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PCT/GB2007/004700 Ceased WO2008068509A2 (fr) 2006-12-07 2007-12-07 Appareil et technique de traitement de calculs biliaires et de calculs rénaux

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GB (1) GB0624439D0 (fr)
WO (1) WO2008068509A2 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113598876A (zh) * 2021-07-26 2021-11-05 费兴伟 一种输尿管超声碎石设备

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0367116B1 (fr) * 1988-10-26 1994-06-08 Kabushiki Kaisha Toshiba Dispositif de traitement par ondes de choc
EP0449138B1 (fr) * 1990-03-24 1997-01-02 Kabushiki Kaisha Toshiba Dispositif pour traitement médical par ondes ultrasoniques
EP0460536B1 (fr) * 1990-05-31 1994-10-12 Kabushiki Kaisha Toshiba Dispositif pour la lithotripsie
DE10234144A1 (de) * 2002-07-26 2004-02-05 Dornier Medtech Gmbh Lithotripter
DE10304904A1 (de) * 2003-02-06 2004-08-05 Siemens Ag Ultraschall-Stosswellen-Lithotripter

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113598876A (zh) * 2021-07-26 2021-11-05 费兴伟 一种输尿管超声碎石设备
CN113598876B (zh) * 2021-07-26 2023-08-22 青岛健新医疗科技有限公司 一种输尿管超声碎石设备

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WO2008068509A3 (fr) 2008-12-18
GB0624439D0 (en) 2007-01-17

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