Acoustic field characterization of the Duolith: Measurements and modeling of a clinical shock wave therapy device

Perez, Camilo; Chen, Hong; Matula, Thomas J.; Karzova, Maria M.; Khokhlova, Vera A.

doi:10.1121/1.4812885

Cited by 35 publications

(34 citation statements)

References 50 publications

(60 reference statements)

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“…It is well known that radial shock waves do not fulfill the characteristics set out by this physical definition of real shock waves (see also Figure 1). 29,40 Some ESWT devices generate pressure waves that fulfill the characteristics set out by this physical definition of real shock waves, whereas others do not 29,40,41. Among those ESWT devices that do not produce real shock waves is the electromagnetic Duolith ® device (Storz Medical)41 that has recently been introduced into ESWT for cellulite 16.…”

Section: Discussionmentioning

confidence: 99%

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

Schlaudraff¹,

Kiessling²,

Császár³

et al. 2014

CCID

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BackgroundExtracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient’s individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height.MethodsFourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast® device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5–4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.ResultsThe mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient’s condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age.ConclusionRadial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient’s individual cellulite grade at baseline, BMI, weight, height, or age.

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Section: Discussionmentioning

confidence: 99%

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

Schlaudraff¹,

Kiessling²,

Császár³

et al. 2014

CCID

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“…The boundary condition to the KZK equation is specified on a plane: a spherical segment with a uniform distribu tion of the amplitude of vibrational velocity and a con stant phase is replaced by a plane circle with constant pressure amplitude; focusing is done by changing the phase according to a parabolic law as a function of the radial coordinate. Note that with special modifications to the boundary condition, the KZK method yields highly accurate results even when describing fields of strongly focused transducers [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Effect of the angular aperture of medical ultrasound transducers on the parameters of nonlinear ultrasound field with shocks at the focus

2015

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Certain modern applications of high intensity focused ultrasound (HIFU) in medicine use the nonlinear effect of shock front formation in the focal waveform. However, an important problem remains unsolved: determination of transducer parameters that provide the given pressure levels of the shock wave field at the focus required for a specific application. In this paper, simulations based on the KhokhlovZabolotskaya equation are performed to test and confirm the hypothesis that angular aperture of the trans ducer is the main parameter that determines the characteristic amplitude of the shock front and correspond ing values for the peak positive and negative pressures at the focus. A criterion for formation of a developed shock in the acoustic waveform, as well as a method for determining its amplitude is proposed. Quantitative dependences of the amplitude of the developed shock and the peak pressures in the wave profile on the angu lar aperture of the transducer are calculated. The effects of saturation and the range of changes of the shock waveform parameters at the focus are analyzed for a typical HIFU transducer.

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“…The acoustic wavelength of 1.5 mm at 1 MHz in water is much larger than a characteristic size of a bacteria (1–2 μ m). However, the width of a 60-MPa shock front balanced by non-linear and thermoviscous effects, and estimated using weak-shock theory, is about 0.15 μ m (Perez et al 2013), which is much less than the bacterial dimensions. Propagation of shocks through the volume of bacteria thus can result in inhomogeneous stress and strain distributions over their surface.…”

Section: Discussionmentioning

confidence: 96%

Inactivation of Planktonic Escherichia coli by Focused 1-MHz Ultrasound Pulses with Shocks: Efficacy and Kinetics Upon Volume Scale-Up

Brayman

MacConaghy

Wang

et al. 2018

Ultrasound in Medicine & Biology

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This study addresses inactivation of E. coli in either 5- or 10-mL volumes, which were 50- to 100-fold greater than used in an earlier study (Brayman et al. 2017). Cells were treated with 1-MHz pulsed high-intensity focused ultrasound (10 cycles, 2-kHz repetition frequency, +65/−12.8 MPa focal pressures). The surviving fraction was assessed by coliform assay, and inactivation demonstrated curvilinear kinetics. The reduction of surviving fraction to 50% required 2.5 or 6 min in 5- or 10-mL samples, respectively. Exposure of 5 mL for 20 min reduced the surviving fraction to ~1%; a similar exposure of 10-mL samples reduced the surviving fraction to ~10%. Surviving cells from 5-min exposures appeared normal under light microscopy, with minimal debris; after 20 min, debris dominated. Transmission electron microscopy images of insonated samples showed some undamaged cells, a few damaged but largely intact cells and comminuted debris. Cellular damage associated with substantive but incomplete levels of inactivation can be variable, ranging from membrane holes tens of nanometers in diameter to nearly complete comminution.

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Acoustic field characterization of the Duolith: Measurements and modeling of a clinical shock wave therapy device

Cited by 35 publications

References 50 publications

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

Effect of the angular aperture of medical ultrasound transducers on the parameters of nonlinear ultrasound field with shocks at the focus

Inactivation of Planktonic Escherichia coli by Focused 1-MHz Ultrasound Pulses with Shocks: Efficacy and Kinetics Upon Volume Scale-Up

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