NASA Human Research Program Investigators' Workshop (2012) 4208.pdf SMART THERAPEUTIC ULTRASOUND FOR MISSION-CRITICAL MEDICAL CARE L. A. Crum1, J.D. Harper2, M.D. Sorensen2, B. W. Cunitz1, Y.-N. Wang1, J.C. Simon1, O.A. Sapozhnikov1,3, and M. R. Bailey1 1 Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th Street, Seattle, WA, 98105 (bailey@apl.washington.edu); 2Department of Urology, University of Washington; 3Physics Faculty, Moscow State University The Human Research Roadmap contains these risks that we address: inability to adequately recognize or treat an ill or injured crewmember, risk of renal stone formation, and risk of radiation carcinogenesis. Specifically here we report progress on user-friendly, minimal upmass technology to monitor for and if necessarily prophylactically treat renal stones. A prototype device has been engineered from a commercially available diagnostic ultrasound imager and probe. Preliminary results in animal models show we can localize and safely reposition stones from the lower calyx to the ureteropelvic juncture (UPJ) in less than 20 minutes. Current work is directed toward human clinical trials, and we have entered into the investigational device approval process for an investigator-driven feasibility study. Effort is also underway to demonstrate the technologies on ISS. ExMC has researched openarchitecture, software-based ultrasound systems for ISS and found benefits in radiation hardening and integration of NASA and NSBRI developed countermeasures. Our new technologies in imaging and therapy/prevention have since been built on a COTS open-architecture, software-based ultrasound system. However, demonstrations of simplified versions of both technologies can be completed with the ultrasound system currently onboard ISS. A B C Fig. 1. Fluoroscopic observation of stone repositoning produced by focused ultrasound. The 4-mm stone begins in the lower pole calyx of the pig’s right kidney; iodinated contrast has washed out of all but the central portion of the collecting system and the instrumented ureter through which the stone was inserted. The ultrasound source is pointed up and to the right pushing the stone to the UPJ at which point the stone actually falls down into the ureteral access sheath. Arrow indicates the stone position.Ultrasound is applied for less than 1 s, and the stone moves approximately 1 cm/s. No indication of tissue injury was observed in histological analysis of kidney sections collected immediately after treatment and stained with H&E staining. The work has considerable earthbound potential as well. Ten percent of the U.S. population will develop kidney stones. Three million Americans seek treatment each year, and total treatment cost is over $2B. Essentially all treatments leave fragments to pass, and stones will recur in half the patients within 5 years. Most small stone fragments in the renal pelvis pass naturally, but fragments located in the lower calyces are more likely to remain and become problematic. Our technology would first be used to expel residual stone fragments and ultimately prophylactically to remove small stones. Our technology also provides a safe alternative to the ionizing radiation of plane X-ray and computerized tomography (CT). This work supported by the National Space Biomedical Research Institute through NASA NCC 9-58 and by NIH grants DK43881 and DK092197.