18th IAA Humans in Space Symposium (2011)
2010.pdf
Preventative ultrasonic detection and expulsion of kidney stones
J.C. Simon1, L. A. Crum1, A. Shah2, B. W. Cunitz1, Y.-N. Wang1, P. J. Kaczkowski1,
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);
2
Department of Urology, University of Washington;
Capability to treat renal stones is risk #21 of the Human Research Program Integrated
Research Plan and is a “shall” for lunar sortie and outpost and for contingencies on ISS in the
Constellation Medical Condition Master Clinical Priority List. We propose a new solution for
kidney stones: new ultrasound imaging to sensitively detect small stones and focused
ultrasound to expel forming stones from the kidney. 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 5 minutes. Current work is directed toward human
clinical trials.
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 openarchitecture, 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
D
Fig. 1. (A) Diagram of a synthetic stone (8.5 mm x 6.5 mm) in a water-filled void in a
tissue phantom with ultrasound transducer shown at the bottom. (B-D) After
application of ultrasound, the stone traveled 2 cm in about one second within the
“collecting system” of the kidney phantom.
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. Initial success rates range from ~70% to greater than 90% depending on the
type of treatment performed, but stones will recur in half the patients within 5 years. Follow-up
surgical management of stones is complex and individualized but expends significant resources,
creates additional discomfort and can expose the patient to X-rays many times. Small stone
fragments in the renal pelvis have a good chance of passing 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 to prophylactically 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 DK086371.