| Cavitation, the growth and collapse of gas/vapor bubbles, appears to play an important role in both stone comminution and tissue injury during shock wave lithotripsy, the clinical treatment in which focused, high amplitude shock pulses are used to comminute kidney stones. The goal of this research was to characterize in vitro cavitation activity and stone and cell damage in a novel system that uses converging dual pulses, produced by two identical, confocal lithotripters, to modify the cavitation field.; The cavitation bubble dynamics were numerically calculated, and experiments were performed in a research electrohydraulic shock wave lithotripter to determine bubble size, lifetime, and pit depth created in aluminum foils by cavitation collapse. Furthermore, damage to model stones and to red blood cells was measured for both single and dual-pulses.; A single shock pulse creates a ∼15 x 100 mm cloud of bubbles in water. The greatest cavitation activity and stone damage from single-pulses was found to occur 2 cm proximal to the geometric focus, F2, where the stone is normally aligned. Therefore, a 2 cm shift in stone alignment may potentially improve stone comminution and reduce tissue injury in clinical treatment.; The dual-pulse lithotripter, on the other hand, generates a localized and intensified cavitation field that increased stone comminution efficiency at F2 by at least three times the maximum values achieved by single-pulses. At F2, acoustic pressure approximately doubled, as did bubble size, collapse time, and pit depth on foils. A significant reduction in comminution of stones suspended in glycerol indicates that cavitation activity, not the doubling of acoustic pressure, explains the increased comminution. On either side of F2, the second delayed pulse mitigated bubble collapse, resulting in little or no pitting on foils and reduced hemolysis, even when compared with single pulses. Numerical calculations of radial dynamics agreed with experimental findings. No significant bubble translation was observed or calculated. The data support the conclusion that cavitation plays an important role in efficient stone comminution and hemolysis. The dual-pulse lithotripter, because of its localized and intensified cavitation field, yields the promise of improved stone comminution efficiency, reduced tissue damage, and accelerated treatment. |
