Focused Ultrasound and Lithotripsy

Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 880)


Shock wave lithotripsy has generally been a first choice for kidney stone removal. The shock wave lithotripter uses an order of microsecond pulse durations and up to a 100 MPa pressure spike triggered at approximately 0.5–2 Hz to fragment kidney stones through mechanical mechanisms. One important mechanism is cavitation. We proposed an alternative type of lithotripsy method that maximizes cavitation activity to disintegrate kidney stones using high-intensity focused ultrasound (HIFU). Here we outline the method according to the previously published literature (Matsumoto et al., Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, pp 290–299, 2002; Ikeda et al., Ultrasound Med Biol 32:1383–1397, 2006; Yoshizawa et al., Med Biol Eng Comput 47:851–860, 2009; Koizumi et al., A control framework for the non-invasive ultrasound the ragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), pp 4511–4516, 2009; Koizumi et al., IEEE Trans Robot 25:522–538, 2009). Cavitation activity is highly unpredictable; thus, a precise control system is needed. The proposed method comprises three steps of control in kidney stone treatment. The first step is control of localized high pressure fluctuation on the stone. The second step is monitoring of cavitation activity and giving feedback on the optimized ultrasound conditions. The third step is stone tracking and precise ultrasound focusing on the stone. For the high pressure control we designed a two-frequency wave (cavitation control (C-C) waveform); a high frequency ultrasound pulse (1–4 MHz) to create a cavitation cloud, and a low frequency trailing pulse (0.5 MHz) following the high frequency pulse to force the cloud into collapse. High speed photography showed cavitation collapse on a kidney stone and shock wave emission from the cloud. We also conducted in-vitro erosion tests of model and natural kidney stones. For the model stones, the erosion rate of the C-C waveform showed a distinct advantage with the combined high and low frequency waves over either wave alone. For optimization of the high frequency ultrasound intensity, we investigated the relationship between subharmonic emission from cavitation bubbles and stone erosion volume. For stone tracking we have also developed a non-invasive ultrasound theragnostic system (NIUTS) that compensates for kidney motion. Natural stones were eroded and most of the resulting fragments were less than 1 mm in diameter. The small fragments were small enough to pass through the urethra. The results demonstrate that, with the precise control of cavitation activity, focused ultrasound has the potential to be used to develop a less invasive and more controllable lithotripsy system.


Lithotripsy Focused Ultrasound 


  1. Abolmaesumi P, Salcudean SE, Zhu WH, Sirouspour M, DiMaio S (2002) Image-guided control of a robot for medical ultrasound. IEEE Trans Robot Autom 18:11–23CrossRefGoogle Scholar
  2. Aoki Y, Kaneko K, Sakai T, Masuda K (2010) A study of scanning the ultrasound probe on body surface and construction of visual servo system based on echogram. J Robot Mech 22:273–279Google Scholar
  3. Arnold P, Preiswerk F, Fasel B, Salomir R, Scheffler K, Cattin P (2011) 3D organ motion prediction for MR-guided high intensity focused ultrasound. Med Image Comput Comput Assist Interv 14:623–630PubMedGoogle Scholar
  4. Bailey MR (1997) Control of acoustic cavitation with application of lithotripsy. PhD dissertation, University of Texas at Austin, Austin.Google Scholar
  5. Bailey MR, Blackstock DT, Cleveland RO, Crum LA (1999) Comparison of electrohydraulic lithotripters with rigid and pressure-release ellipsoidal reflectors. II Cavitation fields. J Acoust Soc Am 106:1149–1159CrossRefPubMedGoogle Scholar
  6. Bailey MR, Couret LN, Sapozhnikov OA, Khokhlova VA, ter Haar G, Vaezy S, Shi X, Martin R, Crum LA (2001) Use of overpressure to assess the role of bubbles in focused ultrasound lesion shape in vitro. Ultrasound Med Biol 27:695–708CrossRefPubMedGoogle Scholar
  7. Bailey MR, Pishchalnikov YA, Sapozhnikov OA, Cleveland RO, McAteer JA, Miller NA, Pishchalnikova IV, Connors BA, Crum LA, Evan AP (2005) Cavitation detection during shock-wave lithotripsy. Ultrasound Med Biol 31:1245–1256CrossRefPubMedGoogle Scholar
  8. Brix L, Ringgaard S, Sorensen TS, Poulsen PR (2014) Three-dimensional liver motion tracking using real-time two-dimensional MRI. Med Phys 41:042303CrossRefGoogle Scholar
  9. Carnel MT, Alcock RD, Emmony DC (1993) Optical imaging of shock waves produced by a high-energy electromagnetic transducer. Phys Med Biol 38:1575–1588CrossRefGoogle Scholar
  10. Cathignol D, Tavakkoli J, Birer A, Arefiev A (1998) Comparison between the effects of cavitation induced by two different pressure-time shock waveform pulses. IEEE Trans Ultrason Ferroelectr Freq Control 45:788–799CrossRefPubMedGoogle Scholar
  11. Chahine GL, Duraiswami R (1992) Dynamical interactions in a multi-bubble cloud. J Fluids Eng 114:680–686CrossRefGoogle Scholar
  12. Chaussy C, Brendel W, Schiemdt E (1980) Extracorporeally induced destruction of kidney stones by shock waves. Lancet 2:1265–1268CrossRefPubMedGoogle Scholar
  13. Church CC (1989) A theoretical study of cavitation generated by an extracorporeal shock wave lithotripter. J Acoust Soc Am 86:215–227CrossRefPubMedGoogle Scholar
  14. Cleveland RO, Bailey MR, Fineberg N, Hartenbaum B, Lokhandwalla M, McAteer JA, Sturtevant B (2000a) Design and characterization of a research electrohydraulic lithotripter patterned after the Dornier HM3. Rev Sci Instrum 71:2514–2525CrossRefGoogle Scholar
  15. Cleveland RO, Sapozhnikov OA, Bailey MR, Crum LA (2000b) A dual passive cavitation detector for localized detection of lithotripsy-induced cavitation in vitro. J Acoust Soc Am 107:1745–1758CrossRefPubMedGoogle Scholar
  16. Coleman AJ, Saunders JE, Crum LA, Dyson M (1987) Acoustic cavitation generated by an extracorporeal shockwave lithotripter. Ultrasound Med Biol 13:69–76CrossRefPubMedGoogle Scholar
  17. Coleman AJ, Choi MJ, Saunders JE (1996) Detection of acoustic emission from cavitation in tissue during clinical extracorporeal lithotripsy. Ultrasound Med Biol 22:1079–1087CrossRefPubMedGoogle Scholar
  18. Crum LA (1988) Cavitation microjets as a contributory mechanism for renal calculi disintegration in ESWL. J Urol 140:1587–1590PubMedGoogle Scholar
  19. d’Agostino L, Brennen CE (1988) Acoustical absorption and scattering cross sections of spherical bubble clouds. J Acoust Soc Am 84:2126–2134CrossRefGoogle Scholar
  20. d’Agostino L, Brennen CE (1989) Linearized dynamics of spherical bubble clouds. J Fluid Mech 199:155–176CrossRefGoogle Scholar
  21. Duryea AP, Maxwell AD, Roberts WW, Xu Z, Hall TL, Cain CC (2011) In vitro comminution of model renal calculi using histotripsy. IEEE Trans Ultrason Ferroelectr Freq Control 58:971–980CrossRefPubMedGoogle Scholar
  22. Duryea AP, Roberts WW, Cain CC, Hall TL (2013) Controlled cavitation to augment SWL stone comminution mechanistic insights in vitro. IEEE Trans Ultrason Ferroelectr Freq Control 60:301–309PubMedCentralCrossRefPubMedGoogle Scholar
  23. Eisenmenger W (2001) The mechanisms of stone fragmentation in ESWL. Ultrasound Med Biol 27:683–693CrossRefPubMedGoogle Scholar
  24. Eisenmenger W, Du XX, Tang C, Zhao S, Wang Y, Rong F, Dai D, Guan M, Qi A (2002) The first clinical results of “wide-focus and low pressure” ESWL. Ultrasound Med Biol 28:769–774CrossRefPubMedGoogle Scholar
  25. Evan AP, Lynn R, Willis LR, McAteer JA, Bailey MR, Connors BA, Shao Y, Lingeman JE, Williams JC Jr, Fineberg NS, Crum LA (2002) Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy. J Urol 168:1556–1562CrossRefPubMedGoogle Scholar
  26. Gateau J, Aubry JF, Pernot M, Fink M, Tanter M (2011) Combined passive detection and ultrafast active imaging of cavitation events induced by short pulses of high-intensity ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 58:517–532PubMedCentralCrossRefPubMedGoogle Scholar
  27. Ginhoux R, Gangloff J, Mathelin M, Soler L, Sanchez MMA, Marescaux J (2005) Active filtering of physiological motion in robotized surgery using predictive control. IEEE Trans Robot 21:67–79CrossRefGoogle Scholar
  28. Gracewski SM, Dahake G, Ding Z, Burns SJ, Everbach EC (1993) Internal stress wave measurements in solids subjected to the lithotripter pulses. J Acoust Soc Am 94:652–661CrossRefPubMedGoogle Scholar
  29. Ikeda T, Yoshizawa S, Tosaki M, Allen JS, Takagi S, Ohta N, Kitamura T, Matsumoto Y (2006) Cloud cavitation control for lithotripsy using high intensity focused ultrasound. Ultrasound Med Biol 32:1383–1397CrossRefPubMedGoogle Scholar
  30. Kato H, Konno A, Maeda M, Yamaguchi H (1996) Possibility of quantitative prediction of cavitation erosion without model test. J Fluids Eng 118:582–588CrossRefGoogle Scholar
  31. Knapp RT (1955) Recent investigation on the mechanics of cavitation and erosion damage. Trans ASME 77:1045–1054Google Scholar
  32. Koizumi N, Seo J, Suzuki Y, Lee D, Ota K, Nomiya A, Yoshizawa S, Yoshinaka K, Sugita N, Homma Y, Matsumoto Y, Mitsuishi M (2009a) A control framework for the non-invasive ultrasound theragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), St. Louis, USA, pp 4511–4516Google Scholar
  33. Koizumi N, Warisawa S, Nagoshi M, Hashizume H, Mitsuishi M (2009b) Construction methodology for a remote ultrasound diagnostic system. IEEE Trans Robot 25:522–538CrossRefGoogle Scholar
  34. Koizumi N, Seo J, Lee D, Funamoto T, Nomiya A, Yoshinaka K, Sugita N, Homma H, Matsumoto Y, Mitsuishi M (2011) Robust kidney stone tracking for a non-Invasive ultrasound theragnostic system –servoing performance and safety enhancement. Proceedings of the 2011 IEEE International Conference on Robotics and Automation (ICRA), Shanghai, China, pp 2443–2450Google Scholar
  35. Koizumi N, Seo J, Funamoto T, Nomiya A, Ishikawa A, Yoshinaka K, Sugita N, Homma Y, Matsumoto Y, Mitsuishi M (2013) Construction methodology for NIUTS ―Bed servoing system for body targets. J Robot Mech 25:1088–1096Google Scholar
  36. Koizumi N, Funamoto T, Seo J, Lee D, Tsukihara H, Nomiya A, Azuma T, Yoshinaka K, Sugita N, Homma H, Matsumoto Y, Mitsuishi M (2014) A novel robust template matching method to track and follow body targets for NIUTS. Proceedings of the 2014 IEEE International Conference on Robotics and Automation (ICRA), Hong Kong, China, pp 1929–1936Google Scholar
  37. Konno A, Kato H, Yamaguchi H, Maeda M (2002) On the collapsing behavior of cavitation bubble clusters. JSME Int J B 3:631–637CrossRefGoogle Scholar
  38. Krupa A, Fichtinger G, Hager G (2009) Real-time motion stabilization with B-mode ultrasound image speckle information and visual servoing. Int J Robot Res 28:1334–1354CrossRefGoogle Scholar
  39. Kubota Y, Matsumura A, Fulahori M, Minohara S, Yasuda S, Nagahashi H (2014) A new method for tracking organ motion on diagnostic ultrasound images. Med Phys 41:092901CrossRefPubMedGoogle Scholar
  40. Li R, Jia X, Lewis JH, Gu X, Folkerts M, Men C, Jiang SB (2010) Real-time volumetric image reconstruction and 3D tumor localization based on a single x-ray projection image for lung cancer radiotherapy. Med Phys Lett 37:2822–2826Google Scholar
  41. Loske AM, Prieto FE, Fernández F, van Cauwelaert J (2002) Tandem shock wave cavitation enhancement for extracororeal lithotripsy. Phys Med Biol 47:3945–3957CrossRefPubMedGoogle Scholar
  42. Matsumoto Y, Yoshizawa S (2005) Behavior of bubble cluster in an ultrasound field. Int J Numer Methods Fluids 47:591–601CrossRefGoogle Scholar
  43. Matsumoto Y, Yoshizawa S, Ikeda T (2002) Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, International Society for Therapeutic Ultrasound (ISTU), Seattle, USA, pp290–299Google Scholar
  44. Maxwell AD, Cunitz BW, Kreider W, Sapozhnikov OA, Hsi RS, Harper JD, Bailey MR, Sorensen MD (2015) Fragmentation of urinary calculi in vitro by burst wave lithotripsy. J Urol 193(1):338–344CrossRefPubMedGoogle Scholar
  45. McAteer JA, Williams JC, Cleveland RO, Van Cauwelaert J, Bailey MR, Lifshitz DA, Evan AP (2005) Ultracal-30 gypsum artificial stones for research on the mechanisms of stone breakage in shock wave lithotripsy. Urol Res 33:429–434CrossRefPubMedGoogle Scholar
  46. Mørch KA (1981) Cavity cluster dynamics and cavitation erosion. Proceedings of ASME Cavitation polyphase flow forum, ASME, Boulder, Colorado, pp 1–10Google Scholar
  47. Mura M, Ciuti G, Ferrari V, Dario P, Menciassi A (2014) Ultrasound-based tracking strategy for endoluminal devices in cardiovascular surgery. Int J Med Robot, doi: 10.1002/rcs.1603. [Epub ahead of print]Google Scholar
  48. Nakamura Y, Kishi K, Kawakami H (2001) Heartbeat synchronization for robotic cardiac surgery. IEEE Int Conf Robot Autom (ICRA) 2:2014–2019Google Scholar
  49. Omta R (1987) Oscillations of a cloud of bubbles of small and not so small amplitude. J Acoust Soc Am 82:1018–1033CrossRefGoogle Scholar
  50. Ozhasoglu C, Saw CB, Chen H, Burton S, Komanduri K, Yue NJ, Huq SM, Heron DE (2008) Synchrony – cyberknife respiratory compensation technology. Med Dosim 33:117–123CrossRefPubMedGoogle Scholar
  51. Philip A, Delius M, Scheffczyk C, Vogel A, Lauterborn W (1993) Interaction of lithotripter-generated shock waves with air bubbles. J Acoust Soc Am 93:2496–2509CrossRefGoogle Scholar
  52. Pishchalnikov YA, Sapozhnikov OA, Bailey MR, Williams JC Jr, Cleveland RO, Colonius T, Crum LA, Evan AP, McAteer JA (2003) Cavitation bubble cluster activity in the breakage of kidney stones by lithotripter shockwaves. J Endourol 17:435–446PubMedCentralCrossRefPubMedGoogle Scholar
  53. Reisman GE, Brennen CE (1996) Pressure pulses generated by cloud cavitation. ASME FED 236:319–328Google Scholar
  54. Reisman GE, Wang YC, Brennen CE (1998) Observation of shock waves in cloud cavitation. J Fluid Mech 355:255–283CrossRefGoogle Scholar
  55. Sapozhnikov OV, Khokhlova VA, Williams JC Jr, McAteer JA, Cleveland RO, Crum LA (2002) Effect of overpressure and pulse repetition frequency on cavitation in shock wave lithotripsy. J Acoust Soc Am 112:1183–1195CrossRefPubMedGoogle Scholar
  56. Seo J, Koizumi N, Yoshinaka K, Sugita N, Nomiya A, Homma Y, Matsumoto Y, Mitsuishi M (2010) Three-dimensional computer controlled acoustic pressure scanning and quantification of focused ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 57:883–891CrossRefPubMedGoogle Scholar
  57. Seo J, Koizumi N, Funamoto T, Sugita N, Yoshinaka K, Nomiya A, Ishikawa A, Homma Y, Matsumoto Y, Mitsuishi M (2011) Visual servoing for a US-guided therapeutic HIFU system by coagulated lesion tracking: a phantom study. Int J Med Robot Comput Assist Surg 7:237–247CrossRefGoogle Scholar
  58. Shimada M, Matsumoto Y, Kobayashi T (2000) Influence of the nuclei size distribution on the collapsing behavior of the cloud cavitation. JSME Int J B 43:380–385CrossRefGoogle Scholar
  59. Sokolov DL, Bailey MR, Crum LA (2001) Use of a dual-pulse lithotripter to generate a localized and intensified cavitation field. J Acoust Soc Am 110:1685–1695CrossRefPubMedGoogle Scholar
  60. Sokolov DL, Bailey MR, Crum LA (2003) Dual-pulse lithotripter accelerates stone fragmentation and reduces cell lysis in vitro. Ultrasound Med Biol 29:1045–1052CrossRefPubMedGoogle Scholar
  61. Soyama H, Kato H, Oba R (1992) Cavitation observations of severely erosive vortex cavitation arising in a centrifugal pump. Proceedings of third IMechE International Conference on Cavitation, IMechE, London, UK, pp 103–110Google Scholar
  62. ter Haar G (2001) Acoustic surgery. Phys Today, 54(12), pp. 29–34Google Scholar
  63. Thienphrapa P, Ramachandran B, Elhawary H, Popovic A, Taylor RH (2014) Guidance of a high dexterity robot under 3d ultrasound for minimally invasive retrieval of foreign bodies from a beating heart. IEEE International Conference on Robotics and Automation (ICRA), Hong Kong, China, pp 4869–4874Google Scholar
  64. To G, Mahfouz MR (2013) Quaternionic attitude estimation for robotic and human motion tracking using sequential Monte Carlo methods with von Mises-Fisher and nonuniform densities simulations. IEEE Trans Biomed Eng 60:3046–3059CrossRefPubMedGoogle Scholar
  65. Tuna E, Franke T, Bebek O, Shiose A, Fukamachi K, Cavusoglu M (2013) Heart motion prediction based on adaptive estimation algorithms for robotic-assisted beating heart surgery. IEEE Trans Robot 29:261–276PubMedCentralCrossRefPubMedGoogle Scholar
  66. van Wijngaarden L (1964) On the collective collapse of a large number of gas bubbles in water. Proceedings of 11th International Conference on Applied Mechanics, SpringerVerlag, Berlin, Germany, pp 854–861Google Scholar
  67. Wang YC, Brennen CE (1995) The noise generated by the collapse of a cloud of cavitation bubbles. ASME FED 226. In: Cavitation and gas-liquid flow in fluid machinery devices, ASME, South Carolina, USA, pp 17–29Google Scholar
  68. Wang YC, Brennen CE (1999) Numerical computation of shock waves in a spherical cloud of cavitation bubbles. ASME J Fluids Eng 121:872–880CrossRefGoogle Scholar
  69. Williams JC, Stonehill MA, Colmenares K, Evan AP, Andreoli SP, Cleveland RO, Bailey MR, Crum LA, McAteer JA (1999) Effect of macroscopic air bubbles on cell lysis by shock wave lithotripsy in vivo. Ultrasound Med Biol 25:473–479CrossRefPubMedGoogle Scholar
  70. Xi X, Zhong P (2000) Improvement of stone fragmentation during shock-wave lithotripsy using a combined EH/PEAA shock-wave generator – in vivo experiments. Ultrasound Med Biol 26:457–467CrossRefPubMedGoogle Scholar
  71. Yoshizawa S, Ikeda T, Takagi S, Matsumoto Y (2004) Nonlinear ultrasound propagation in a spherical bubble cloud. Proceedings of IEEE International ultrasonics symposium 2004, Montreal, Canada, vol 2, pp 886–889Google Scholar
  72. Yoshizawa S, Ikeda T, Ito A, Ota R, Takagi S, Matsumoto Y (2009) High intensity focused ultrasound lithotripsy with cavitating microbubbles. Med Biol Eng Comput 47:851–860CrossRefPubMedGoogle Scholar
  73. Zhong P, Chuong CJ, Goolsby RD, Preminger GM (1992) Microhardness measurements of renal calculi: regional differences and effects of microstructure. J Biomed Mater Res 26:1117–1130CrossRefPubMedGoogle Scholar
  74. Zhong P, Cocks FH, Cioanta I, Preminger GM (1997) Controlled, forced collapse of cavitation bubbles for improved stone fragmentation during shock wave lithotripsy. J Urol 158:2323–2328CrossRefPubMedGoogle Scholar
  75. Zhu S, Cocks FH, Preminger GM, Zhong P (2002) The role of stress waves and cavitation in stone comminution in shock wave lithotripsy. Ultrasound Med Biol 28:661–671CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Central Research LaboratoryHitachi Ltd.TokyoJapan
  2. 2.Department of Communications EngineeringTohoku UniversitySendaiJapan
  3. 3.Department of Mechanical EngineeringThe University of TokyoTokyoJapan

Personalised recommendations