{'fraction_non_alphanumeric': 0.019246190858059342, 'fraction_numerical': 0.00681635926222935, 'mean_word_length': 5.413881748071979, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter

Significance Electromagnetic (EM) shock wave lithotripters are widely used for noninvasive treatment of kidney stone patients. Here, we report the design of a new acoustic lens to rectify three fundamental drawbacks in contemporary EM lithotripters, based on in situ pulse superposition, leading to significantly improved stone comminution both in vitro and in vivo with minimal tissue injury. The new lens design improves the pressure distribution around the lithotripter focus with better alignment of the peak pressure and cavitation activities with the kidney stones under clinically relevant treatment conditions. The general principle of the new lens design is applicable to different lenses or reflectors and with further optimizations may enhance the performance and safety of contemporary EM lithotripters. The efficiency of shock wave lithotripsy (SWL), a noninvasive first-line therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E+) of 40 mJ. The −6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters.