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.
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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.