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Akshay Randad

Transducer Engineer




2000-present and while at APL-UW

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., EOR, doi:10.1089/end.2018.0516, 2019.

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1 Feb 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.

Impact of stone type on caviation in burst wave lithotripsy

Hunter, C., A.D. Maxwell, B. Cunitz, B. Dunmire, M.D. Sorensen, J.C. Williams Jr., A. Randad, M. Bailey, and W. Kreider, "Impact of stone type on caviation in burst wave lithotripsy," Proc. Mtgs. Acoust., 35, 020005, doi:10.1121/2.0000950, 2018.

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26 Dec 2018

Proceedings, 176th Meeting of the Acoustical Society of America, 5-9 November 2018, Victoria, BC, Canada.

Non-invasive kidney stone treatments such as shock wave lithotripsy (SWL) and burst wave lithotripsy (BWL) rely on the delivery of pressure waves through tissue to the stone. In both SWL and BWL, the potential to hinder comminution by exciting cavitation proximal to the stone has been reported. To elucidate how different stones alter prefocal cavitation in BWL, different natural and synthetic stones were treated in vitro using a therapy transducer operating at 350 kHz (peak negative pressure 7 MPa, pulse length 20 cycles, pulse repetition frequency 10 Hz). Stones were held in a confined volume of water designed to mimic the geometry of a kidney calyx, with the water filtered and degassed to maintain conditions for which the cavitation threshold (in the absence of a stone) matches that from in vivo observations. Stone targeting and cavitation monitoring were performed via ultrasound imaging using a diagnostic probe aligned coaxially with the therapy transducer. Quantitative differences in the extent and location of cavitation activity were observed for different stone types — e.g., stones (natural and synthetic) that are known to be porous produced larger prefocal cavitation clouds. Ongoing work will focus on correlation of such cavitation metrics with stone fragmentation.

Design of a transducer for fragmenting large kidney stones using burst wave lithotripsy

Randad, A.P., M.A. Ghanem, M.R. Bailey, and A.D. Maxwell, "Design of a transducer for fragmenting large kidney stones using burst wave lithotripsy," Proc. Mtgs. Acoust., 35, 020007, doi:10.1121/2.0000954, 2018.

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5 Nov 2018

Proceedings, 176th Meeting of the Acoustical Society of America, 5-9 November 2018, Victoria, BC, Canada.

Burst wave lithotripsy (BWL) is a potential noninvasive treatment for breaking kidney stones. BWL requirements of high-pressure output, limited aperture for acoustic window, and specific focal length and frequency constrain the focal beam width. However, BWL is most effective only on stones smaller than the beam width. We tested a porous piezoelectric material (PZ36) to increase the output power and designed acoustic lenses that broaden the beam. A weighted iterative angular spectrum approach was used to calculate the source phase distribution needed to generate desired cross sectional focal beam profiles each of 12 mm width. The phase calculations were then 3D printed as holographic lenses placed over a circular aperture of 80-mm diameter, 350 kHz PZ36 to produce the desired beam at 85 mm depth. The difference in simulated beam width and that measured by hydrophone was <1 mm, and the structural–similarity index value was greater than 0.65. The differences in structures were due not to shape and size of the 6-dB contours but to amplitude distribution within the contour. In conclusion, this design approach combined with 3D printing provides a way to tailor focal beam profiles for lithotripsy transducers.

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