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Focused ultrasound to displace renal calculi: threshold for tissue injury

Yak-Nam Wang1, Julianna C Simon1, Bryan W Cunitz1

  • 1Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th Street, Seattle, WA 98105, USA.

Journal of Therapeutic Ultrasound
|June 13, 2014
PubMed
Abstract

Insights

Ultrasonic propulsion effectively repositions kidney stones, with safety thresholds significantly exceeding therapeutic levels. This technology offers a promising approach to improve stone-free rates and reduce complications from renal calculi.

Area of Science:

  • Biomedical Engineering
  • Nephrology
  • Medical Ultrasound

Background:

  • Increasing global incidence of renal calculi (kidney stones).
  • High rates of complications and re-intervention after surgical stone removal.
  • Previous studies demonstrated ultrasonic propulsion's efficacy in repositioning kidney stones in pigs.

Purpose of the Study:

  • To determine the tissue injury threshold for ultrasonic propulsion used in kidney stone repositioning.
  • To establish safety parameters for using ultrasound to facilitate spontaneous clearance of renal calculi.

Main Methods:

  • Exposure of 28 swine kidneys to varying duty cycles (0%-100%) and intensities (up to 30 kW/cm²).
  • Morphological analysis of kidney tissues by blinded experts to assess injury.
  • Evaluation of injury thresholds at specific duty cycles and spatial peak pulse average intensities.

Main Results:

  • A statistically significant injury threshold was observed at a spatial peak intensity of 16,620 W/cm² with a 3.3% duty cycle.
  • This threshold is approximately seven times higher than the maximum output of the clinical prototype used for stone repositioning.
  • No significant tissue injury was observed at therapeutic levels of ultrasonic propulsion.

Conclusions:

  • Ultrasonic propulsion for displacing renal calculi is safe and operates well below the identified tissue injury threshold.
  • The findings support the potential of ultrasound to improve stone-free rates and reduce complications associated with kidney stones.
Keywords:
Injury thresholdKidney stonesUltrasonic propulsion

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