ENERGETIC MODULATION OF NERVES

1 . A system to modulate an autonomic nerve in a patient utilizing transcutaneous ultrasound energy delivery, the system comprising:

a processor comprising:

an input for receiving information regarding energy and power to be delivered to a treatment region containing the nerve; and

an output for outputting a signal;

wherein the processor is configured to determine a position of a reference target from outside the patient to localize the nerve relative to the reference target;

a therapeutic energy device comprising:

a transducer for delivering ultrasound energy from outside the patient;

a controller to control an aiming of the transducer based at least in part on the signal from the processor; and

an imaging system coupled to the processor or the therapeutic energy device.

2 . The system of claim 1 , wherein the processor is configured to determine the position during an operation of the therapeutic energy device.

3 . The system of claim 1 , further comprising a patient interface configured to position the therapeutic device so that the transducer is aimed toward a blood vessel connected to a kidney from a position between ribs superiorly, a iliac crest inferiorly, and a vertebral column medially.

4 . The system of claim 1 , wherein the therapeutic energy device is configured to deliver focused ultrasound.

5 . The system of claim 1 , wherein the reference target is at least a portion of a blood vessel traveling to or from a kidney, and the nerve is a renal nerve.

6 . The system of claim 5 , wherein the transducer is configured to focus the ultrasound energy at a distance from 6 cm to 18 cm.

7 . The system of claim 1 , wherein the transducer is configured to deliver the ultrasound energy to a renal blood vessel at an angle ranging between about −10 degrees and about −48 degrees relative to a horizontal line connecting transverse processes of a spinal column.

8 . The system of claim 1 , wherein the ultrasound energy from the therapeutic energy device ranges between 100 W/cm2 and 2500 W/cm2.

9 . The system of claim 1 , wherein the reference target is an indwelling vascular catheter.

10 . The system of claim 1 , wherein the imaging system is a magnetic resonance imaging system.

11 . The system of claim 1 , wherein the imaging system is an ultrasound imaging system.

12 . The system of claim 1 , wherein the processor is a part of the therapeutic energy device.

13 . The system of claim 1 , wherein the processor is a part of the imaging system.

14 . A system to inhibit a function of a nerve surrounding a renal artery comprising:

a detector to detect a positional signal indicative of a location of the renal artery from a position external to a patient;

an ultrasound component to deliver therapeutic energy through a skin of the patient to the nerve surrounding the renal artery; and

a processing unit configured to:

obtain information regarding a three dimensional coordinate space containing the ultrasound component,

obtain the location of the renal artery, and

determine a direction and an energy level for the therapeutic energy based on the information and the location of the renal artery.

15 . The system of claim 14 , further comprising an intravascular catheter configured to communicate with the detector.

16 . The system of claim 15 , wherein the intravascular catheter is configured to provide the position signal for detection by the detector.

17 . The system of claim 14 , wherein the processing unit is configured for focusing the therapeutic energy on two sides of the renal artery.

18 . The system of claim 14 , wherein the processing unit is configured to provide an output to instruct the ultrasound component to create a lesion in which a major axis of the lesion is along a longitudinal length of the renal artery.

19 . The system of claim 18 , wherein the processing unit is configured to provide the output to instruct the ultrasound component to deliver multiple lesions around the renal artery simultaneously.

20 . The system of claim 14 , wherein the processing unit is configured to provide an output to instruct the ultrasound component to create a circumferential lesion around the renal artery.

21 . The system of claim 18 , wherein the lesion is around the renal artery just proximal to a bifurcation of the renal artery.

22 . The system of claim 14 , further comprising a fiducial, locatable from a position outside the patient, adapted to be temporarily placed in the artery of the patient, and to communicate with the detector to provide the indication of the location of the renal artery in a three dimensional reference frame.

23 . A method to stimulate or inhibit the function of a nerve traveling to or from the kidney comprising:

identifying an acoustic window at the posterior region of a patient in which renal arteries can be visualized;

transmitting a first energy through a skin of the patient from the posterior region of the patient;

imaging an arterial region using the first transmitted energy; and

applying a second transmitted energy to an arterial adventitia based on the imaged arterial region.

24 . The method of claim 23 , wherein the act of imaging is performed repeatedly to track the arterial region.

25 . A method to locate a position of a blood vessel in a body of a patient comprising:

applying a first wave of ultrasound, from a first direction, to a region of a blood vessel from outside of the patient, and detecting its return signal;

comparing the applied first wave and its return signal;

simultaneously, or sequentially, applying a second wave of ultrasound from a second direction to the blood vessel, and detecting a its return signal; and

integrating the return signal from the first wave and the return signal from the second wave to determine the position, in a three dimensional coordinate reference, of the blood vessel.

26 . The method of claim 25 , further comprising instructing a therapeutic ultrasound transducer to apply energy to the position of the blood vessel.