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Adam Maxwell

Research Assistant Professor, Urology

Email

maxwell@apl.washington.edu

Phone

206-221-6530

Videos

PIXUL: PIXelated ULtrasound Speeds Disease Biomarker Search

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26 Apr 2018

Accurate assessment of chromatin modifications can be used to improve detection and treatment of various diseases. Further, accurate assessment of chromatin modifications can have an important role in designing new drug therapies. This novel technology applies miniature ultrasound transducers to shear chromatin in standard 96-well microplates. PIXUL saves researchers hours of sample preparation time and reduces sample degradation.

Mechanical Tissue Ablation with Focused Ultrasound

An experimental noninvasive surgery method uses nonlinear ultrasound pulses to liquefy tissue at remote target sites within a small focal region without damaging intervening tissues.

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23 Mar 2017

Boiling histotripsy utilizes sequences of millisecond-duration HIFU pulses with high-amplitude shocks that form at the focus by nonlinear propagation effects. Due to strong attenuation of the ultrasound energy at the shocks, these nonlinear waves rapidly heat tissue and generate millimeter-sized boiling bubbles at the focus within each pulse. Then the further interaction of subsequent shocks with the vapor cavity causes tissue disintegration into subcellular debris through the acoustic atomization mechanism.

The method was proposed at APL-UW in collaboration with Moscow State University (Russia) and now is being evaluated for various clinical applications. It has particular promise because of its important clinical advantages: the treatment of tissue volumes can be accelerated while sparing adjacent structures and not injuring intervening tissues; it generates precisely controlled mechanical lesions with sharp margins; the method can be implemented in existing clinical systems; and it can be used with real-time ultrasound imaging for targeting, guidance, and evaluation of outcomes. In addition, compared to thermal ablation, BH may lead to faster resorption of the liquefied lesion contents.

Burst Wave Lithotripsy: An Experimental Method to Fragment Kidney Stones

CIMU researchers are investigating a noninvasive method to fragment kidney stones using ultrasound pulses rather than shock waves. Consecutive acoustic cycles accumulate and concentrate energy within the stone. The technique can be 'tuned' to create small fragments, potentially improving the success rate of lithotripsy procedures.

20 Nov 2014

Publications

2000-present and while at APL-UW

Evaluation of renal stone comminution and injury by burst wave lithotripsy in a pig model

Maxwell, A.D., Y.-N. Wang, W. Kreider, B.W. Cunitz, F. Starr, D. Lee, Y. Nazari, J.C. Williams Jr., M.R. Bailey, and M.D. Sorensen, "Evaluation of renal stone comminution and injury by burst wave lithotripsy in a pig model," J. Endourol., 33, doi:10.1089/end.2018.0886, 2019.

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15 Oct 2019

Burst wave lithotripsy is an experimental technology to noninvasively fragment kidney stones with focused bursts of ultrasound (US). This study evaluated the safety and effectiveness of specific lithotripsy parameters in a porcine model of nephrolithiasis.

A 6- to 7-mm human kidney stone was surgically implanted in each kidney of three pigs. A burst wave lithotripsy US transducer with an inline US imager was coupled to the flank and the lithotripter focus was aligned with the stone. Each stone was exposed to burst wave lithotripsy at 6.5 to 7 MPa focal pressure for 30 minutes under real-time image guidance. After treatment, the kidneys were removed for gross, histologic, and MRI assessment. Stone fragments were retrieved from the kidney to determine the mass comminuted to pieces <2 mm.

On average, 87% of the stone mass was reduced to fragments <2 mm. In three of five treatments, stones were completely comminuted to <2-mm fragments. In two of five treatments, stones were partially disintegrated, but larger fragments remained. One stone was not treated because no suitable acoustic window was identified. No injury was detected through gross, histologic, or MRI examination in the parenchymal tissue, although petechial damage and surface erosion were identified on the urothelium of the collecting system limited to the area around the stone.

Burst wave lithotripsy can consistently produce stone fragments small enough to spontaneously pass by transcutaneous administration of US pulses. The data suggest that such exposures produce minimal injury to the kidney and urinary tract.

Quantification of acoustic radiation forces on solid objects in fluid

Ghanem, M.A., A.D. Maxwell, O.A. Sapozhnikov, V.A. Khokhlova, and M.R. Bailey, "Quantification of acoustic radiation forces on solid objects in fluid," Phys. Rev. Appl., 12, doi:10.1103/PhysRevApplied.12.044076, 2019.

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1 Oct 2019

Theoretical models allow design of acoustic traps to manipulate objects with radiation force. A model of the acoustic radiation force by an arbitrary beam on a solid object is validated against measurement. The lateral force in water of different acoustic beams is measured and calculated for spheres of different diameters (2–6 wavelengths λ in water) and compositions. This is the first effort to validate a general model, to quantify the lateral force on a range of objects, and to electronically steer large or dense objects with a single-sided transducer. Vortex beams and two other beam shapes having a ring-shaped pressure field in the focal plane are synthesized in water by a 1.5-MHz, 256-element focused array. Spherical targets (glass, brass, ceramic, 2–6 mm dia.) are placed on an acoustically transparent plastic plate that is normal to the acoustic beam axis and rigidly attached to the array. Each sphere is trapped in the beam as the array with the attached plate is rotated until the sphere falls from the acoustic trap because of gravity. Calculated and measured maximum obtained angles agree on average to within 22%. The maximum lateral force occurs when the target diameter equals the beam width; however, objects up to 40% larger than the beam width are trapped. The lateral force is comparable to the gravitation force on spheres up to 90 mg (0.0009 N) at beam powers on the order of 10 W. As a step toward manipulating objects, the beams are used to trap and electronically steer the spheres along a two-dimensional path.

The impact of dust and confinement on fragmentation of kidney stones by shockwave lithotripsy in tissue phantoms

Randad, A., J. Ahn, W. Kreider, M.R. Bailey, J.D. Harper, M.D. Sorensen, and A.D. Maxwell, "The impact of dust and confinement on fragmentation of kidney stones by shockwave lithotripsy in tissue phantoms," J. Endourol., 33, doi:10.1089/end.2018.0516, 2019.

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1 May 2019

Objective: The goal was to test whether stone composition and kidney phantom configuration affected comminution in extracorporeal shockwave lithotripsy (SWL) laboratory tests. Confinement may enhance the accumulation of dust and associated cavitation bubbles in the fluid surrounding the stone. It is known that high shockwave delivery rates in SWL are less effective because bubbles generated by one shockwave do not have sufficient time to dissolve, thereby shielding the next shockwave.

Materials and Methods: Experiments were conducted with a lithotripter coupled to a water bath. The rate of comminution was measured by weighing fragments over 2 mm at 5-minute time points. First, plaster and crystal stones were broken in four phantoms: a nylon wire mesh, an open polyvinyl chloride (PVC) cup, a closed PVC cup, and an anatomical kidney model — the phantoms have decreasing fluid volumes around the stone. Second, the fluid volume in the kidney model was flushed with water at different rates (0, 7, and 86 mL/min) to remove dust.

Results: The efficiency of breakage of stones decreases for the dust emitting plaster stones (percentage of breakage in 5 minutes decreased from 92% ± 2% [n = 3] in wire mesh to 19% ± 3% [n = 3] in model calix) with increasing confinement, but not for the calcite crystal stones that produced little dust (percentage of breakage changed from 87% ± 3% [n = 3] in wire mesh to 81% ± 3% [n = 3] in kidney model). Flushing the kidney phantom at the fastest rate improved comminution of smaller plaster stones by 27%.

Conclusions: Phantoms restricting dispersion of dust were found to affect stone breakage in SWL and in vitro experiments should replicate kidney environments. The dust around the stone and potential cavitation may shield the stone from shockwaves and reduce efficacy of SWL. Understanding of stone composition and degree of hydronephrosis could be used to adapt patient-specific protocols.

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Inventions

Focused Ultrasound Apparatus and Methods of Use

Patent Number: 10,350,439

Adam Maxwell, Mike Bailey

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Patent

16 Jul 2019

Methods for diagnosing a pathologic tissue membrane, as well as a focused ultrasound apparatus and methods of treatment are disclosed to perform ureterocele puncture noninvasively using focused ultrasound-generated cavitation or boiling bubbles to controllably erode a hole through the tissue. An example ultrasound apparatus may include (a) a therapy transducer having a treatment surface, wherein the therapy transducer comprises a plurality of electrically isolated sections, (b) at least one concave acoustic lens defining a therapy aperture in the treatment surface of the therapy transducer, (c) an imaging aperture defined by either the treatment surface of the therapy transducer or by the at least one concave acoustic lens and (d) an ultrasound imaging probe axially aligned with a central axis of the therapy aperture.

Device and Method to Break Urinary Stones in Pets

Record of Invention Number: 48640

Mike Bailey, Dan Leotta, Elizabeth Lynch, Brian MacConaghy, Adam Maxwell

Disclosure

28 May 2019

Method to Create Patterns for Tissue Growth in Tissue Engineering

Record of Invention Number: 48638

Mike Bailey, Adam Maxwell

Disclosure

28 May 2019

More Inventions

Acoustics Air-Sea Interaction & Remote Sensing Center for Environmental & Information Systems Center for Industrial & Medical Ultrasound Electronic & Photonic Systems Ocean Engineering Ocean Physics Polar Science Center
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