Ultrasound based method and apparatus for stone detection and to facilitate clearance thereof
Described herein are methods and apparatus for detecting stones by ultrasound, in which the ultrasound reflections from a stone are preferentially selected and accentuated relative to the ultrasound reflections from blood or tissue. Also described herein are methods and apparatus for applying pushing ultrasound to in vivo stones or other objects, to facilitate the removal of such in vivo objects.
1. A non-lithotriptic method for applying an in vivo rotational force to a stone in a body, the non-lithotriptic method comprising rotating the stone in vivo, without fragmenting the stone, by applying ultrasound having an I SPTA of at least 3 W/cm 2 .
2. The non-lithotriptic method of claim 1 wherein the ultrasound has I SPTA of at least 4 W/cm 2 .
3. The non-lithotriptic method of claim 1 wherein the ultrasound has a pressure amplitude in the range of about 5 MPa to about 30 MPa.
4. The non-lithotriptic method of claim 3 wherein the ultrasound has a pressure amplitude in the range of about 10 MPa to about 20 MPa.
5. The non-lithotriptic method of claim 4 wherein the ultrasound has a pressure amplitude in the range of about 13 MPa to about 18 MPa.
6. The non-lithotriptic method of claim 1 wherein a frequency of the ultrasound is in the range of about 0.25-5 MHz.
7. The non-lithotriptic method of claim 6 wherein said frequency of the ultrasound is in the range of about 1-4 MHz.
8. The non-lithotriptic method of claim 7 wherein said frequency of the ultrasound is in the range of about 1-3 MHz.
9. The non-lithotriptic method of claim 1 wherein a duty cycle of the ultrasound pulses is greater than 1% over a period of about 1 second.
10. The non-lithotriptic method of claim 1 wherein a spatial peak pulse average intensity of the ultrasound is greater than 190 W/cm 2 .
11. The non-lithotriptic method of claim 1 wherein the spatial peak time average intensity of the ultrasound is greater than 720 W/cm 2 .
12. The non-lithotriptic method of claim 1 wherein an intensity and duration of the ultrasound does not cause thermal coagulation of tissue.
13. The non-lithotriptic method of claim 1 wherein said rotational force is applied to urge said stone toward an exit location.
14. The non-lithotriptic method of claim 13 wherein one or more stones are located in a kidney, and said exit location is an exit from the kidney.
15. The non-lithotriptic method of claim 1 wherein said rotational force is applied to urge said stone towards the ureteropelvic junction.
16. The non-lithotriptic method of claim 1 wherein said rotational force is applied to urge said stone within the ureter.
17. The non-lithotriptic method of claim 1 comprising the further step of fragmenting the stone by lithotripsy after rotating the stone.
18. The non-lithotriptic method of claim 1 comprising the further step of detecting said stone before an application of the rotational force.
19. The non-lithotriptic method of claim 18 further comprising detecting said stone through imaging.
20. The non-lithotriptic method of claim 19 wherein the imaging comprises real-time imaging.
21. The non-lithotriptic method of claim 19 wherein said imaging is accomplished with Doppler ultrasound or B-mode wherein a frequency of said imaging ultrasound is in the range of about 1-5 MHz.
22. The non-lithotriptic method of claim 21 wherein said frequency of said imaging ultrasound is in the range of about 2-4 MHz.
23. The non-lithotriptic method of claim 21 wherein said frequency of said imaging ultrasound is in the range of about 2-3 MHz.
24. The non-lithotriptic method of claim 19 wherein said imaging is accomplished by a method selected from the group consisting of fluoroscopy, computer tomography, low-dose stone protocol computer tomography, B-mode ultrasound, Doppler ultrasound, and MRI.
25. The non-lithotriptic method of claim 24 wherein said imaging is accomplished with Doppler ultrasound.
26. The non-lithotriptic method of claim 25 wherein locating the stone comprises use of a twinkling artifact of Doppler ultrasound.
27. The non-lithotriptic method of claim 24 wherein said imaging is accomplished with B-mode ultrasound.