A study of stone fragmentation in shock wave lithotripsy by customizing the acoustic field and waveform shape

Shock wave lithotripsy is the preferred treatment modality for kidney stones in the United States. Despite clinical use for over twenty-five years, the mechanisms of stone fragmentation are still under debate. A piezoelectric array was employed to examine the effect of waveform shape and pressure distribution on stone fragmentation in lithotripsy. The array consisted of 170 elements placed on the inner surface of a 15 cm-radius spherical cap. Each element was driven independently using a 170 individual pulsers, each capable of generating 1.2 kV. The acoustic field was characterized using a fiber optic probe hydrophone with a bandwidth of 30 MHz and a spatial resolution of 100 μm. When all elements were driven simultaneously, the focal waveform was a shock wave with peak pressures p+ =65±3MPa and p−=−16±2MPa and the −6 dB focal region was 13 mm long and 2 mm wide. The delay for each element was the only control parameter for customizing the acoustic field and waveform shape, which was done with the aim of investigating the hypothesized mechanisms of stone fragmentation such as spallation, shear, squeezing, and cavitation. The acoustic field customization was achieved by employing the angular spectrum approach for modeling the forward wave propagation and regression of least square errors to determine the optimal set of delays. Results from the acoustic field customization routine and its implications on stone fragmentation will be discussed.

Dual-energy computed tomography with advanced postimage acquisition data processing: improved determination of urinary stone composition.

INTRODUCTION: The characterization of urinary calculi using noninvasive methods has the potential to affect clinical management. CT remains the gold standard for diagnosis of urinary calculi, but has not reliably differentiated varying stone compositions. Dual-energy CT (DECT) has emerged as a technology to improve CT characterization of anatomic structures. This study aims to assess the ability of DECT to accurately discriminate between different types of urinary calculi in an in vitro model using novel postimage acquisition data processing techniques. METHODS: Fifty urinary calculi were assessed, of which 44 had >or=60% composition of one component. DECT was performed utilizing 64-slice multidetector CT. The attenuation profiles of the lower-energy (DECT-Low) and higher-energy (DECT-High) datasets were used to investigate whether differences could be seen between different stone compositions. RESULTS: Postimage acquisition processing allowed for identification of the main different chemical compositions of urinary calculi: brushite, calcium oxalate-calcium phosphate, struvite, cystine, and uric acid. Statistical analysis demonstrated that this processing identified all stone compositions without obvious graphical overlap. CONCLUSION: Dual-energy multidetector CT with postprocessing techniques allows for accurate discrimination among the main different subtypes of urinary calculi in an in vitro model. The ability to better detect stone composition may have implications in determining the optimum clinical treatment modality for urinary calculi from noninvasive, preprocedure radiological assessment.

Effect of lithotripter focal width on stone comminution in shock wave lithotripsy.

Using a reflector insert, the original HM-3 lithotripter field at 20 kV was altered significantly with the peak positive pressure (p(+)) in the focal plane increased from 49 to 87 MPa while the -6 dB focal width decreased concomitantly from 11 to 4 mm. Using the original reflector, p(+) of 33 MPa with a -6 dB focal width of 18 mm were measured in a pre-focal plane 15-mm proximal to the lithotripter focus. However, the acoustic pulse energy delivered to a 28-mm diameter area around the lithotripter axis was comparable ( approximately 120 mJ). For all three exposure conditions, similar stone comminution ( approximately 70%) was produced in a mesh holder of 15 mm after 250 shocks. In contrast, stone comminution produced by the modified reflector either in a 15-mm finger cot (45%) or in a 30-mm membrane holder (14%) was significantly reduced from the corresponding values (56% and 26%) produced by the original reflector (no statistically significant differences were observed between the focal and pre-focal planes). These observations suggest that a low-pressure/broad focal width lithotripter field will produce better stone comminution than its counterpart with high-pressure/narrow focal width under clinically relevant in vitro comminution conditions.

Optimization of treatment strategy used during shockwave lithotripsy to maximize stone fragmentation efficiency.

BACKGROUND AND PURPOSE: Previous studies have demonstrated that treatment strategy plays a critical role in ensuring maximum stone fragmentation during shockwave lithotripsy (SWL). We aimed to develop an optimal treatment strategy in SWL to produce maximum stone fragmentation. MATERIALS AND METHODS: Four treatment strategies were evaluated using an in-vitro experimental setup that mimics stone fragmentation in the renal pelvis. Spherical stone phantoms were exposed to 2100 shocks using the Siemens Modularis (electromagnetic) lithotripter. The treatment strategies included increasing output voltage with 100 shocks at 12.3 kV, 400 shocks at 14.8 kV, and 1600 shocks at 15.8 kV, and decreasing output voltage with 1600 shocks at 15.8 kV, 400 shocks at 14.8 kV, and 100 shocks at 12.3 kV. Both increasing and decreasing voltages models were run at a pulse repetition frequency (PRF) of 1 and 2 Hz. Fragmentation efficiency was determined using a sequential sieving method to isolate fragments less than 2 mm. A fiberoptic probe hydrophone was used to characterize the pressure waveforms at different output voltage and frequency settings. In addition, a high-speed camera was used to assess cavitation activity in the lithotripter field that was produced by different treatment strategies. RESULTS: The increasing output voltage strategy at 1 Hz PRF produced the best stone fragmentation efficiency. This result was significantly better than the decreasing voltage strategy at 1 Hz PFR (85.8% vs 80.8%, P=0.017) and over the same strategy at 2 Hz PRF (85.8% vs 79.59%, P=0.0078). CONCLUSIONS: A pretreatment dose of 100 low-voltage output shockwaves (SWs) at 60 SWs/min before increasing to a higher voltage output produces the best overall stone fragmentation in vitro. These findings could lead to increased fragmentation efficiency in vivo and higher success rates clinically.

Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam.

The T2K experiment observes indications of ν(μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3)  eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.

Killing fields. [Review of Rebel land: among Turkey's forgotten peoples by Christopher de Bellaigua]

Alev Adil explores a region still enraged by a 'crime on the sly'

[Book Review] The Patience Stone, by Atiq Rahimi trans. Polly McLean

The Patience Stone, By Atiq Rahimi and translated by Polly McLean. Book review by Alev Adil.

A small screen alternative to stone and bronze: The Great War series and British television

This article examines the first major British television series about the First World War, The Great War (BBC, 1964), in terms of its cultural, historical and aesthetic significance. As a central component of the BBC`s 50th anniversary commemorative programme to mark the outbreak of war, the series was a major media event -a small-screen memorial cast in sounds and images instead of stone and bronze. This article looks at how the British television audience responded to this form of on-screen commemoration. Material for this article was derived from the series' extensive production records housed in the BBC Written Archives Centre at Caversham, Berkshire. This was supplemented by, among other sources, material from interviews and correspondence with several surviving members of the production team. This allows a broader understanding of the motivations of those involved in the production of a groundbreaking historical series, while acknowledging the wide-ranging nature of its audience. [From the Publisher]

Contributions to the bryological flora of the tropical and subtropical forests from the Argentina (Bryophyta, Musci).

The authors present here a list of 32 mosses belonging to 15 families: Brachytheciaceae, Cryphaeaceae, Entodontaceae, Hedwigiaceae, Hypnaceae, Leptodontaceae, Meteoriaceae, Neckeraceae, Pilotrichaceae, Polytrichaceae, Pterobryaceae, Racopilaceae, Rigodiaceae, Stereophyllaceae, and Trachypodaceae, all collected in the mountainous forests of the Yungas of the NW of the Argentina (Jujuy, Salta, Catamarca and Tucumán provinces), and also in the rainforests from the NE of the country (Misiones province). Eight species: Atrichum polycarpum, Chrysohypnum elegantulum, Pilosium chlorophyllum, Pilotrichella flexilis, Porotrichodendron lindigii, Pseudotrachypus martinicensis, Steerecleus scariosus, and Thamnobryum fasciculatum are new records for the bryologic flora from Argentina. Braunia imberbis and Squamidium brasiliense are two new records for the bryophytic flora of the Catamarca province; Porotrichodendron superbum is new for the Salta province, while Forsstroemia coronata is the first record for the Catamarca and Jujuy provinces. Aerolindigia capillacea, Braunia reflexifolia, Chryso-hypnum diminutivum, Meteorium deppei and Meteoridium remotifolium are five new citations for the Jujuy province, and Schoenobryum concavifolium is new for the bryophytic flora of the Misiones province. Many studied species occur more frequently in the Yungas than in the NE rainforests; others show separated distribution but live in both areas, the Yungas and Paranaense area, and others are more or less restricted to the Paranaense rainforest of the NE of Argentina. The taxonomy of species is updated, and comments are included on bibliographical precedents, ecology and chorology of each taxon.