Journal: European Urology

Article Title: Shock Wave Technology and Application: An Update ☆

doi: 10.1016/j.eururo.2011.02.033

Figure Lengend Snippet: Comparison of technical details of new lithotripters

Article Snippet: Factors influencing efficacy According to acoustic properties, shock wave efficacy depends on various factors , including how shock waves are generated and the size of the focal zone used. table ft1 table-wrap mode="anchored" t5 caption a7 Factor for success Options Specific modifications Advantages Comments/problems Shock wave generation and focussing Electrohydraulic with ellipsoid reflector Spark electrode Large focus Variability of pulses One electrode per session Twin heads Lower energy density Coupling from two sites is difficult Electroconductive No variability of pulses 40 000 shock waves - Electromagnetic Coil membrane with acoustic lens Extension of focal zone by prolonged pulse duration Advantage of larger focal zone not clinically proven Cylinder with paraboloid reflector Dual focus by different pulse duration (ie, for renal and ureter stones) Advantage of dual focus not clinically proven Spherical element Very large focal zone Not available in Europe Piezoelectric Spherical alignment with two layers Three focal sizes Advantage of triple focus not clinically proven Coupling of shock waves Water bath Complete (Dornier HM3) Ideal coupling No multifunctional use Partial (EDAP TMS No longer manufactured Sonolith 2000, Richard Wolf PiezoLith 2200) Water cushion Gel pad (abandoned) Multifunctional use 20% attenuation of shock wave energy Coupling gel Warm ultrasound gel from container High amounts on cushion Shave skin of patient Check quality of coupling by inline ultrasound Stone localisation Fluoroscopic C-arm Automated positioning Reduction of x-ray exposure Fluoroscopy first choice worldwide Inline fluoroscopy Optical tracking Reduction of x-ray exposure Camera checks position of shock wave source Acoustic tracking Adaptation to external C-arm Five piezoelectric elements track the position of the shock wave source Inline ultrasound - Real-time shock wave application Difficult in obese patients and midureteral stones Control of coupling quality Lateral ultrasound Tri-mode localisation - 5 mm tolerance (range: 3–9 mm) to inline ultrasound system (isocentric) Open in a separate window Factors influencing the success of extracorporeal shock wave lithotripsy 3.3.1.

Techniques:

Journal: European Urology

Article Title: Shock Wave Technology and Application: An Update ☆

doi: 10.1016/j.eururo.2011.02.033

Figure Lengend Snippet: Factors influencing the success of extracorporeal shock wave lithotripsy

Article Snippet: Factors influencing efficacy According to acoustic properties, shock wave efficacy depends on various factors , including how shock waves are generated and the size of the focal zone used. table ft1 table-wrap mode="anchored" t5 caption a7 Factor for success Options Specific modifications Advantages Comments/problems Shock wave generation and focussing Electrohydraulic with ellipsoid reflector Spark electrode Large focus Variability of pulses One electrode per session Twin heads Lower energy density Coupling from two sites is difficult Electroconductive No variability of pulses 40 000 shock waves - Electromagnetic Coil membrane with acoustic lens Extension of focal zone by prolonged pulse duration Advantage of larger focal zone not clinically proven Cylinder with paraboloid reflector Dual focus by different pulse duration (ie, for renal and ureter stones) Advantage of dual focus not clinically proven Spherical element Very large focal zone Not available in Europe Piezoelectric Spherical alignment with two layers Three focal sizes Advantage of triple focus not clinically proven Coupling of shock waves Water bath Complete (Dornier HM3) Ideal coupling No multifunctional use Partial (EDAP TMS No longer manufactured Sonolith 2000, Richard Wolf PiezoLith 2200) Water cushion Gel pad (abandoned) Multifunctional use 20% attenuation of shock wave energy Coupling gel Warm ultrasound gel from container High amounts on cushion Shave skin of patient Check quality of coupling by inline ultrasound Stone localisation Fluoroscopic C-arm Automated positioning Reduction of x-ray exposure Fluoroscopy first choice worldwide Inline fluoroscopy Optical tracking Reduction of x-ray exposure Camera checks position of shock wave source Acoustic tracking Adaptation to external C-arm Five piezoelectric elements track the position of the shock wave source Inline ultrasound - Real-time shock wave application Difficult in obese patients and midureteral stones Control of coupling quality Lateral ultrasound Tri-mode localisation - 5 mm tolerance (range: 3–9 mm) to inline ultrasound system (isocentric) Open in a separate window Factors influencing the success of extracorporeal shock wave lithotripsy 3.3.1.

Techniques: