Shock-induced collapse of a gas bubble in shockwave lithotripsy

Numerical study of cavitation shock wave emission in the thin liquid layer by power ultrasonic vibratory machining

In the field of power ultrasonic vibration processing, the thin liquid layer nestled between the tool head and the material serves as a hotbed for cavitation shock wave emissions that significantly affect the material's surface. The precise manipulation of these emissions presents a formidable challenge, stemming from a historical deficit in the quantitative analysis of both the ultrasonic enhancement effect and the shock wave intensity within this niche environment. Our study addresses this gap by innovatively modifying the Gilmore-Akulichev equation, laying the groundwork for a sophisticated bubble dynamics model and a pioneering shock wave propagation model tailored to the thin liquid layer domain. Firstly, our study investigated the ultrasound enhancement effect under various parameters of thin liquid layers, revealing an amplification of ultrasound pressure in the thin liquid layer area by up to 7.47 times. The mathematical model was solved using the sixth-order Runge-Kutta method to examine shock wave velocity and pressure under different conditions. our study identified that geometric parameters of the tool head, thin liquid layer thickness, ultrasonic frequency, and initial bubble radius all significantly influenced shock wave emission. At an ultrasonic frequency of 60 kHz, the shock wave pressure at the measurement point exhibited a brief decrease from 182.6 to 179.5 MPa during an increase. Furthermore, rapid attenuation of the shock wave was found within the range of R0-3R0 from the bubble wall. This research model aims to enhance power ultrasonic vibration processing technology, and provide theoretical support for applications in related fields.

Investigation of the ultrasound-induced collapse of air bubbles near soft materials

A numerical investigation into the ultrasound-induced collapse of air bubbles near soft materials, utilizing a novel multi-material diffuse interface method (DIM) model with block-structured adaptive mesh refinement is presented. The present work expands from a previous five-equation DIM by incorporating Eulerian hyperelasticity. The model is applicable to any arbitrary number of interacting fluid and solid material. A single conservation law for the elastic stretch tensor enables tracking the deformations for all the solid materials. A series of benchmark cases are conducted, and the solution is found to be in excellent agreement against theoretical data. Subsequently, the ultrasound-induced bubble-tissue flow interactions are examined. The bubble radius was found to play a crucial role in dictating the stresses experienced by the tissue, underscoring its significance in medical applications. The results reveal that soft tissues primarily experience tensile forces during these interactions, suggesting potential tensile-driven injuries that may occur in relevant treatments. Moreover, regions of maximal tensile forces align with tissue elongation areas. It is documented that while early bubble dynamics remain relatively unaffected by changes in shear modulus, at later stages of the penetration processes and the deformation shapes, exhibit notable variations. Lastly, it is demonstrated that decreasing standoff distances enhances the interaction between bubbles and tissue, thereby increasing the stress levels in the tissue, although the behavior of the bubble dynamics remains largely unchanged.

Prediction of shock heating during ultrasound-induced bubble collapse using real-fluid equations of state

Numerical simulations of collapsing air bubbles considering complex and more accurate equations of state (EoS) for estimating the properties of both the liquid and gas are presented. The necessity for utilising such EoSs in bubble collapse simulations is illustrated by the unphysical (spurious) liquid temperature jump formed in the vicinity of the bubble-air interface when simplified EoSs are used. The solved fluid flow equations follow the mechanical equilibrium multiphase method of Kapila. The solver is coded in the AMReX platform, enabling high-performance computation with parallel processing and Adaptive Mesh Refinement for speeding up simulations. It is initially demonstrated that the frequently used Stiffened Gas (SG) EoS overpredicts the liquid temperature at high compression. More sophisticated EoS models, such as the International Association for the Properties of Water and Steam (IAPWS), the Modified Noble Abel Stiffened Gas (MNASG) and a modified Tait EoS introduced here, are also implemented into the flow solver and their differences are highlighted for bubble collapse cases for the first time. Subsequently, application of the developed model to cases of practical interest is showcased. More specifically, simulations of bubble collapse near a solid wall are presented for conditions simulating shock wave lithotripsy (SWL). It is concluded that for such cases, a maximum increase of 25 K of the liquid temperature in contact along the solid wall is caused during the collapse of the air bubble due to shock wave focusing effects. It is also highlighted that the maximum liquid heating varies depending on the initial bubble-wall stand-off distance.

Numerical investigation of shock-induced bubble collapse dynamics and fluid-solid interactions during shock-wave lithotripsy

In this paper we investigate the bubble collapse dynamics under shock-induced loading near soft and rigid bio-materials, during shock wave lithotripsy. A novel numerical framework was developed, that employs a Diffuse Interface Method (DIM) accounting for the interaction across fluid-solid-gas interfaces. For the resolution of the extended variety of length scales, due to the dynamic and fine interfacial structures, an Adaptive Mesh Refinement (AMR) framework for unstructured grids was incorporated. This multi-material multi-scale approach aims to reduce the numerical diffusion and preserve sharp interfaces. The presented numerical framework is validated for cases of bubble dynamics, under high and low ambient pressure ratios, shock-induced collapses, and wave transmission problems across a fluid-solid interface, against theoretical and numerical results. Three different configurations of shock-induced collapse applications near a kidney stone and soft tissue have been simulated for different stand-off distances and bubble attachment configurations. The obtained results reveal the detailed collapse dynamics, jet formation, solid deformation, rebound, primary and secondary shock wave emissions, and secondary collapse that govern the near-solid collapse and penetration mechanisms. Significant correlations of the problem configuration to the overall collapse mechanisms were found, stemming from the contact angle/attachment of the bubble and from the properties of solid material. In general, bubbles with their center closer to the kidney stone surface produce more violent collapses. For the soft tissue, the bubble movement prior to the collapse is of great importance as new structures can emerge which can trap the liquid jet into induced crevices. Finally, the tissue penetration is examined for these cases and a novel tension-driven tissue injury mechanism is elucidated, emanating from the complex interaction of the bubble/tissue interaction during the secondary collapse phase of an entrapped bubble in an induced crevice with the liquid jet.

Green Synthesis and Antiproliferative Activity of Gold Nanoparticles of a Controlled Size and Shape Obtained Using Shock Wave Extracts from Amphipterygium adstringens

In this study, green chemistry was used as a tool to obtain gold nanoparticles using Amphipterygium adstringens extracts as a synthesis medium. Green ethanolic and aqueous extracts were obtained using ultrasound and shock wave-assisted extraction. Gold nanoparticles with sizes ranging between 100 and 150 nm were obtained with ultrasound aqueous extract. Interestingly, homogeneous quasi-spherical gold nanoparticles with sizes between 50 and 100 nm were achieved with shock wave aqueous-ethanolic extracts. Furthermore, 10 nm gold nanoparticles were obtained by the traditional methanolic macerate extraction method. The physicochemical characteristics, morphology, size, stability, and Z potential of the nanoparticles were determined using microscopic and spectroscopic techniques. The viability assay in leukemia cells (Jurkat) was performed using two different sets of gold nanoparticles, with final IC50 values of 87 µM and 94.7 µM, reaching a maximum cell viability decrease of 80% The results do not indicate a significant difference between the cytotoxic effects produced by the gold nanoparticles synthesized in this study and vincristine on normal lymphoblasts (CRL-1991).

Monitoring cavitation dynamics evolution in tissue mimicking hydrogels for repeated exposures via acoustic cavitation emissions

A 700 kHz histotripsy array is used to generate repeated cavitation events in agarose, gelatin, and polyacrylamide hydrogels. High-speed optical imaging, a broadband hydrophone, and the narrow-band receive elements of the histotripsy array are used to capture bubble dynamics and acoustic cavitation emissions. Bubble radii, lifespan, shockwave amplitudes are noted to be measured in close agreement between the different observation methods. These features also decrease with increasing hydrogel stiffness for all of the tested materials. However, the evolutions of these properties during the repeated irradiations vary significantly across the different material subjects. Bubble maximum radius initially increases, then plateaus, and finally decreases in agarose, but remains constant across exposures in gelatin and polyacrylamide. The bubble lifespan increases monotonically in agarose and gelatin but decreases in polyacrylamide. Collapse shockwave amplitudes were measured to have different-shaped evolutions between all three of the tested materials. Bubble maximum radii, lifespans, and collapse shockwave amplitudes were observed to express evolutions that are dependent on the structure and stiffness of the nucleation medium.

Numerical study of real gas effects during bubble collapse using a disequilibrium multiphase model

An explicit density-based solver of the Euler equations for inviscid and immiscible gas-liquid flow media is coupled with real-fluid thermodynamic equations of state supporting mild dissociation and calibrated with shock tube data up to 5000 K and 28 GPa. The present work expands the original 6-equation disequilibrium method by generalising the numerical approach required for estimating the equilibrium pressure in computational cells where both gas and liquid phases co-exist while enforcing energy conservation for all media. An iterative numerical procedure is suggested for taking into account the properties of the gas content as derived from highly non-linear real gas equations of state and implemented in a tabulated form during the numerical solution. The developed method is subsequently used to investigate gaseous bubble collapse cases considering both spherical and 2D asymmetric arrangements as induced by the presence of a rigid wall. It is demonstrated that the predicted maximum temperatures are strongly influenced by the equations of state used; the real gas model predicts a temperature reduction in the bubble interior up to 41% space-averaged and 50% locally during the collapse phase compared to the predictions obtained with the aid of the widely used ideal gas approximation.

Cavitation erosion by shockwave self-focusing of a single bubble

The ability of cavitation bubbles to effectively focus energy is made responsible for cavitation erosion, traumatic brain injury, and even for catalyse chemical reactions. Yet, the mechanism through which material is eroded remains vague, and the extremely fast and localized dynamics that lead to material damage has not been resolved. Here, we reveal the decisive mechanism that leads to energy focusing during the non-spherical collapse of cavitation bubbles and eventually results to the erosion of hardened metals. We show that a single cavitation bubble at ambient pressure close to a metal surface causes erosion only if a non-axisymmetric energy self-focusing is at play. The bubble during its collapse emits shockwaves that under certain conditions converge to a single point where the remaining gas phase is driven to a shockwave-intensified collapse. We resolve the conditions under which this self-focusing enhances the collapse and damages the solid. High-speed imaging of bubble and shock wave dynamics at sub-picosecond exposure times is correlated to the shockwaves recorded with large bandwidth hydrophones. The material damage from several metallic materials is detected in situ and quantified ex-situ via scanning electron microscopy and confocal profilometry. With this knowledge, approaches to mitigate cavitation erosion or to even enhance the energy focusing are within reach.

Focused, radial and combined shock wave therapy in treatment of calcific shoulder tendinopathy

Objective: The aim of this work is to compare the clinical, functional, and ultrasonographic outcomes of focused, radial, and combined extracorporeal shock-wave therapy (ESWT) in the treatment of calcific shoulder tendinopathy.Methods: we enrolled 45 patients with calcific shoulder tendinopathy, their ages ranged from 30 to 68 (50.93 ± 9.44) years, classified according to the line of treatment into three groups, all received four sessions of ESWT 1 week apart.Group I: 15 patients received focused shock waves (F-SW) 1500 shocks.Group II: 15 patients received radial shock waves (R-SW) 2000 shocks.Group III: 15 patients received combined focused and radial shock waves (C-SW). All patients were evaluated by musculoskeletal ultrasound (MSK US) before treatment, at 1 week and at 3 months after the last session.Results: In the three studied groups, there was a significant improvement in shoulder pain, active range of motion (ROM), and shoulder function by shoulder disability questionnaire (SDQ) at 1 week after the end of treatment and after 3 months follow up. Moreover, there was a significant sonographic reduction in calcification size in the three groups. At the end of the study, the best improvement as regards a decrease of calcification size was obtained in group III when compared with group I and group II.Conclusion: These results demonstrated clinical, functional, and sonographic improvement in all groups. The best therapy in calcific shoulder tendinopathy appears to be combined focused and radial ESWT compared to interventions alone. Level 1 Evidence Randomized control study.

Mechanically Induced Cavitation in Biological Systems

Cavitation bubbles form in soft biological systems when subjected to a negative pressure above a critical threshold, and dynamically change their size and shape in a violent manner. The critical threshold and dynamic response of these bubbles are known to be sensitive to the mechanical characteristics of highly compliant biological systems. Several recent studies have demonstrated different biological implications of cavitation events in biological systems, from therapeutic drug delivery and microsurgery to blunt injury mechanisms. Due to the rapidly increasing relevance of cavitation in biological and biomedical communities, it is necessary to review the current state-of-the-art theoretical framework, experimental techniques, and research trends with an emphasis on cavitation behavior in biologically relevant systems (e.g., tissue simulant and organs). In this review, we first introduce several theoretical models that predict bubble response in different types of biological systems and discuss the use of each model with physical interpretations. Then, we review the experimental techniques that allow the characterization of cavitation in biologically relevant systems with in-depth discussions of their unique advantages and disadvantages. Finally, we highlight key biological studies and findings, through the direct use of live cells or organs, for each experimental approach.

Experimental investigations of three laser-induced synchronized bubbles

Herein, we investigated experimentally the dynamics of three laser-induced, same-sized, symmetrically aligned, and synchronized bubbles. Three synchronized laser beams split from the same beam using a Diffractive Optical Element splitter were focused on water, and then we obtained three bubbles. Another nanosecond laser pulse was used to probe the bubbles to obtain shadowgraphs. The exact delay of the excited and detected light was controlled using a delay generator. The results revealed that the maximum volumes of bubbles in arrays decrease as the normalized distance falls, while the lifetimes and translation increase. It was explained by the interaction between the acoustic radiation of bubbles and the surrounding bubbles. The shrinkage of linear bubble arrays exists an anomaly. The center bubbles were stretched, to ellipsoid, stick, even fractured, by the peripheral bubbles. The closer they are, the more distinct is the above phenomenon. However, when the normalized distance was sufficiently small, instead of being stretched, the center bubbles were compressed to disk shape and thus shrank with the whole array. Finally, the dependence of the distance on the energy transfer of the bubble system is also discussed.

The interaction of shockwaves with a vapour bubble in boiling histotripsy: The shock scattering effect

Boiling histotripsy is a High Intensity Focused Ultrasound (HIFU) technique which uses a number of short pulses with high acoustic pressures at the HIFU focus to induce mechanical tissue fractionation. In boiling histotripsy, two different types of acoustic cavitation contribute towards mechanical tissue destruction: a boiling vapour bubble and cavitation clouds. An understanding of the mechanisms underpinning these phenomena and their dynamics is therefore paramount to predicting and controlling the overall size of a lesion produced for a given boiling histotripsy exposure condition. A number of studies have shown the effects of shockwave heating in generating a boiling bubble at the HIFU focus and have studied its dynamics under boiling histotripsy insonation. However, not much is known about the subsequent production of cavitation clouds that form between the HIFU transducer and the boiling bubble. The main objective of the present study is to examine what causes this bubble cluster formation after the generation of a boiling vapour bubble. A numerical simulation of 2D nonlinear wave propagation with the presence of a bubble at the focus of a HIFU field was performed using the k-Wave MATLAB toolbox for time domain ultrasound simulations, which numerically solves the generalised Westervelt equation. The numerical results clearly demonstrate the appearance of the constructive interference of a backscattered shockwave by a bubble with incoming incident shockwaves. This interaction (i.e., the reflected and inverted peak positive phase from the bubble with the incoming incident rarefactional phase) can eventually induce a greater peak negative pressure field compared to that without the bubble at the HIFU focus. In addition, the backscattered peak negative pressure magnitude gradually increased from 17.4 MPa to 31.6 MPa when increasing the bubble size from 0.2 mm to 1.5 mm. The latter value is above the intrinsic cavitation threshold of -28 MPa in soft tissue. Our results suggest that the formation of a cavitation cloud in boiling histotripsy is a threshold effect which primarily depends (a) the size and location of a boiling bubble, and (b) the sum of the incident field and that scattered by a bubble.

Physical and chemical characterization of shock-induced cavitation

A strong impact on a water surface induces a shock wave propagation with a significant pressure variation leading to cavitation bubble formation. A new shock induced cavitation reactor described in this work was characterized by physical and chemical techniques. Water hammer model verification with Joukowsky approach allowed to determine the wave speed propagation and gas fraction in water submitted to shock. These values were used for frequency analysis and compared with direct bubble visualization in order to estimate the influence of the experimental parameters on the shock-induced cavitation. Thereby, the shock wave contains a broad spectrum as decomposed into frequencies. This multi-frequency nature induces heterogeneous bubbles with calculated radii of 0.01 to 3.5 mm and observed radii of 0.01 to 2.8 mm depending on experimental conditions (initial pressure, impact height, gas atmosphere). For the first time, the formation of hydroxyl radicals was proven under impact-induced cavitation. The concentration of radicals increases with increasing number of successive impacts, reaching ca. 1.3 µmol.L^-1 after 500 impacts in the presence of 20% O₂-Ar as saturating gas. Radical generation seems to be relatively independent of the impact height but strongly depend on the type of gas saturating water, being substantially lower in the presence of air. Moreover, radical generation increases when decreasing the initial pressure and depends on the frequency at which water is impacted by the piston. Nevertheless, yield of OH radicals during shock-induced cavitation remains much lower than that produced by power ultrasound.

High-speed video microscopy and numerical modeling of bubble dynamics near a surface of urinary stone

Ultra-high-speed video microscopy and numerical modeling were used to assess the dynamics of microbubbles at the surface of urinary stones. Lipid-shell microbubbles designed to accumulate on stone surfaces were driven by bursts of ultrasound in the sub-MHz range with pressure amplitudes on the order of 1 MPa. Microbubbles were observed to undergo repeated cycles of expansion and violent collapse. At maximum expansion, the microbubbles' cross-section resembled an ellipse truncated by the stone. Approximating the bubble shape as an oblate spheroid, this study modeled the collapse by solving the multicomponent Euler equations with a two-dimensional-axisymmetric code with adaptive mesh refinement for fine resolution of the gas-liquid interface. Modeled bubble collapse and high-speed video microscopy showed a distinctive circumferential pinching during the collapse. In the numerical model, this pinching was associated with bidirectional microjetting normal to the rigid surface and toroidal collapse of the bubble. Modeled pressure spikes had amplitudes two-to-three orders of magnitude greater than that of the driving wave. Micro-computed tomography was used to study surface erosion and formation of microcracks from the action of microbubbles. This study suggests that engineered microbubbles enable stone-treatment modalities with driving pressures significantly lower than those required without the microbubbles.

For Whom the Bubble Grows: Physical Principles of Bubble Nucleation and Dynamics in Histotripsy Ultrasound Therapy

Histotripsy is a focused ultrasound therapy for non-invasive tissue ablation. Unlike thermally ablative forms of therapeutic ultrasound, histotripsy relies on the mechanical action of bubble clouds for tissue destruction. Although acoustic bubble activity is often characterized as chaotic, the short-duration histotripsy pulses produce a unique and consistent type of cavitation for tissue destruction. In this review, the action of histotripsy-induced bubbles is discussed. Sources of bubble nuclei are reviewed, and bubble activity over the course of single and multiple pulses is outlined. Recent innovations in terms of novel acoustic excitations, exogenous nuclei for targeted ablation and histotripsy-enhanced drug delivery and image guidance metrics are discussed. Finally, gaps in knowledge of the histotripsy process are highlighted, along with suggested means to expedite widespread clinical utilization of histotripsy.

Shock wave-induced permeabilization of mammalian cells

Controlled permeabilization of mammalian cell membranes is fundamental to develop gene and cell therapies based on macromolecular cargo delivery, a process that emerged against an increasing number of health afflictions, including genetic disorders, cancer and infections. Viral vectors have been successfully used for macromolecular delivery; however, they may have unpredictable side effects and have been limited to life-threatening cases. Thus, several chemical and physical methods have been explored to introduce drugs, vaccines, and nucleic acids into cells. One of the most appealing physical methods to deliver genes into cells is shock wave-induced poration. High-speed microjets of fluid, emitted due to the collapse of microbubbles after shock wave passage, represent the most significant mechanism that contributes to cell membrane poration by this technique. Herein, progress in shock wave-induced permeabilization of mammalian cells is presented. After covering the main concepts related to molecular strategies whose applications depend on safer drug delivery methods, the physics behind shock wave phenomena is described. Insights into the use of shock waves for cell membrane permeation are discussed, along with an overview of the two major biomedical applications thereof-i.e., genetic modification and anti-cancer shock wave-assisted chemotherapy. The aim of this review is to summarize 30 years of data showing underwater shock waves as a safe, noninvasive method for macromolecular delivery into mammalian cells, encouraging the development of further research, which is still required before the introduction of this promising tool into clinical practice.

Bubble-Induced Color Doppler Feedback Correlates with Histotripsy-Induced Destruction of Structural Components in Liver Tissue

Bubble-induced color Doppler (BCD) is a histotripsy-therapy monitoring technique that uses Doppler ultrasound to track the motion of residual cavitation nuclei that persist after the collapse of the histotripsy bubble cloud. In this study, BCD is used to monitor tissue fractionation during histotripsy tissue therapy, and the BCD signal is correlated with the destruction of structural and non-structural components identified histologically to further understand how BCD monitors the extent of treatment. A 500-kHz, 112-element phased histotripsy array is used to generate approximately 6- × 6- × 7-mm lesions within ex vivo bovine liver tissue by scanning more than 219 locations with 30-1000 pulses per location. A 128-element L7-4 imaging probe is used to acquire BCD signals during all treatments. The BCD signal is then quantitatively analyzed using the time-to-peak rebound velocity (tprv) metric. Using the Pearson correlation coefficient, the tprv is compared with histologic analytics of lesions generated by various numbers of pulses using a significance level of 0.001. Histologic analytics in this study include viable cell count, reticulin-stained type III collagen area and trichrome-stained type I collagen area. It is found that the tprv metric has a statistically significant correlation with the change in reticulin-stained type III collagen area with a Pearson correlation coefficient of -0.94 (p <0.001), indicating that changes in BCD are more likely because of destruction of the structural components of tissue.

Pressure and tension waves from bubble collapse near a solid boundary: A numerical approach

The acoustic waves being generated during the motion of a bubble in water near a solid boundary are calculated numerically. The open source package OpenFOAM is used for solving the Navier-Stokes equation and extended to include nonlinear acoustic wave effects via the Tait equation for water. A bubble model with a small amount of gas is chosen, the gas obeying an adiabatic law. A bubble starting from a small size with high internal pressure near a flat, solid boundary is studied. The sequence of events from bubble growth via axial microjet formation, jet impact, annular nanojet formation, torus-bubble collapse, and bubble rebound to second collapse is described. The different pressure and tension waves with their propagation properties are demonstrated.

Multiphase fluid-solid coupled analysis of shock-bubble-stone interaction in shockwave lithotripsy

A novel multiphase fluid-solid-coupled computational framework is applied to investigate the interaction of a kidney stone immersed in liquid with a lithotripsy shock wave (LSW) and a gas bubble near the stone. The main objective is to elucidate the effects of a bubble in the shock path to the elastic and fracture behaviors of the stone. The computational framework couples a finite volume 2-phase computational fluid dynamics solver with a finite element computational solid dynamics solver. The surface of the stone is represented as a dynamic embedded boundary in the computational fluid dynamics solver. The evolution of the bubble surface is captured by solving the level set equation. The interface conditions at the surfaces of the stone and the bubble are enforced through the construction and solution of local fluid-solid and 2-fluid Riemann problems. This computational framework is first verified for 3 example problems including a 1D multimaterial Riemann problem, a 3D shock-stone interaction problem, and a 3D shock-bubble interaction problem. Next, a series of shock-bubble-stone-coupled simulations are presented. This study suggests that the dynamic response of a bubble to LSW varies dramatically depending on its initial size. Bubbles with an initial radius smaller than a threshold collapse within 1 μs after the passage of LSW, whereas larger bubbles do not. For a typical LSW generated by an electrohydraulic lithotripter (p_max  = 35.0MPa, p_min  =- 10.1MPa), this threshold is approximately 0.12mm. Moreover, this study suggests that a noncollapsing bubble imposes a negative effect on stone fracture as it shields part of the LSW from the stone. On the other hand, a collapsing bubble may promote fracture on the proximal surface of the stone, yet hinder fracture from stone interior.

Review on Lithotripsy and Cavitation in Urinary Stone Therapy

Cavitation is the sudden formation of vapor bubbles or voids in liquid media and occurs after rapid changes in pressure as a consequence of mechanical forces. It is mostly an undesirable phenomenon. Although the elimination of cavitation is a major topic in the study of fluid dynamics, its destructive nature could be exploited for therapeutic applications. Ultrasonic and hydrodynamic sources are two main origins for generating cavitation. The purpose of this review is to give the reader a general idea about the formation of cavitation phenomenon and existing biomedical applications of ultrasonic and hydrodynamic cavitation. Because of the high number of the studies on ultrasound cavitation in the literature, the main focus of this review is placed on the lithotripsy techniques, which have been widely used for the treatment of urinary stones. Accordingly, cavitation phenomenon and its basic concepts are presented in Section II. The significance of the ultrasound cavitation in the urinary stone treatment is discussed in Section III in detail and hydrodynamic cavitation as an important alternative for the ultrasound cavitation is included in Section IV. Finally, side effects of using both ultrasound and hydrodynamic cavitation in biomedical applications are presented in Section V.

Bubbles with shock waves and ultrasound: a review

The study of the interaction of bubbles with shock waves and ultrasound is sometimes termed 'acoustic cavitation'. It is of importance in many biomedical applications where sound waves are applied. The use of shock waves and ultrasound in medical treatments is appealing because of their non-invasiveness. In this review, we present a variety of acoustics-bubble interactions, with a focus on shock wave-bubble interaction and bubble cloud phenomena. The dynamics of a single spherically oscillating bubble is rather well understood. However, when there is a nearby surface, the bubble often collapses non-spherically with a high-speed jet. The direction of the jet depends on the 'resistance' of the boundary: the bubble jets towards a rigid boundary, splits up near an elastic boundary, and jets away from a free surface. The presence of a shock wave complicates the bubble dynamics further. We shall discuss both experimental studies using high-speed photography and numerical simulations involving shock wave-bubble interaction. In biomedical applications, instead of a single bubble, often clouds of bubbles appear (consisting of many individual bubbles). The dynamics of such a bubble cloud is even more complex. We shall show some of the phenomena observed in a high-intensity focused ultrasound (HIFU) field. The nonlinear nature of the sound field and the complex inter-bubble interaction in a cloud present challenges to a comprehensive understanding of the physics of the bubble cloud in HIFU. We conclude the article with some comments on the challenges ahead.

Targeted microbubbles: a novel application for the treatment of kidney stones

Kidney stone disease is endemic. Extracorporeal shockwave lithotripsy was the first major technological breakthrough where focused shockwaves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine? The logical progression was to manufacture these powerful microbubbles ex vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: (i) bisphosphonates attach to hydroxyapatite crystals with high affinity; and (ii) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to pre-emptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging methods, especially useful in high-risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine.

Tandem shock waves to enhance genetic transformation of Aspergillus niger

Filamentous fungi are used in several industries and in academia to produce antibiotics, metabolites, proteins and pharmaceutical compounds. The development of valuable strains usually requires the insertion of recombinant deoxyribonucleic acid; however, the protocols to transfer DNA to fungal cells are highly inefficient. Recently, underwater shock waves were successfully used to genetically transform filamentous fungi. The purpose of this research was to demonstrate that the efficiency of transformation can be improved significantly by enhancing acoustic cavitation using tandem (dual-pulse) shock waves. Results revealed that tandem pressure pulses, generated at a delay of 300 μs, increased the transformation efficiency of Aspergillus niger up to 84% in comparison with conventional (single-pulse) shock waves. This methodology may also be useful to obtain new strains required in basic research and biotechnology.

Shock-induced collapse of a bubble inside a deformable vessel

Shockwave lithotripsy repeatedly focuses shockwaves on kidney stones to induce their fracture, partially through cavitation erosion. A typical side effect of the procedure is hemorrhage, which is potentially the result of the growth and collapse of bubbles inside blood vessels. To identify the mechanisms by which shock-induced collapse could lead to the onset of injury, we study an idealized problem involving a preexisting bubble in a deformable vessel. We utilize a high-order accurate, shock- and interface-capturing, finite-volume scheme and simulate the three-dimensional shock-induced collapse of an air bubble immersed in a cylindrical water column which is embedded in a gelatin/water mixture. The mixture is a soft tissue simulant, 10% gelatin by weight, and is modeled by the stiffened gas equation of state. The bubble dynamics of this model configuration are characterized by the collapse of the bubble and its subsequent jetting in the direction of the propagation of the shockwave. The vessel wall, which is defined by the material interface between the water and gelatin/water mixture, is invaginated by the collapse and distended by the impact of the jet. The present results show that the highest measured pressures and deformations occur when the volumetric confinement of the bubble is strongest, the bubble is nearest the vessel wall and/or the angle of incidence of the shockwave reduces the distance between the jet tip and the nearest vessel surface. For a particular case considered, the 40 MPa shockwave utilized in this study to collapse the bubble generated a vessel wall pressure of almost 450 MPa and produced both an invagination and distention of nearly 50% of the initial vessel radius on a 𝒪(10) ns timescale. These results are indicative of the significant potential of shock-induced collapse to contribute to the injury of blood vessels in shockwave lithotripsy.

Homogeneous nucleation in water in microfluidic channels

It has been an experimental challenge to test the rupture of liquids with homogeneous nucleation of vapor bubbles. Many prior studies suffered from the ubiquitous presence of impurities in liquids or at container surfaces that spontaneously nucleate and grow under tension. Here, we propose a microfluidic approach to eliminate such impurities and obtain homogeneous bubble nucleation. We stretch the liquid dynamically via the interaction between a laser-induced shock and an air-liquid interface in a microchannel. Reproducible observations of the nucleation of vapor bubbles are obtained, supporting our claim of homogeneous nucleation. From comparisons of the distribution of vapor cavities with Euler flow simulations, the nucleation threshold for water at room temperature is predicted to be -60 MPa.

Relationship between plasmid size and shock wave-mediated bacterial transformation

Bacterial transformation is a fundamental tool in molecular biology; nevertheless, there is still a lack of efficient methods for gene delivery. The use of shock waves has been proposed as an alternative. Recently, our group demonstrated that shock wave-induced transfer of deoxyribonucleic acid (DNA) into bacteria can be increased by enhancing acoustic cavitation; however, so far, little information exists about the effects of shock waves on DNA. The objective of this study was to identify the size regimes of plasmids (DNA molecules that are separate from the chromosomal DNA), which promote shock wave-induced transformation. The transformation efficiency of shock waves and the integrity of DNA were studied for six different plasmid sizes, using the parameters that led to the best results in our previous study.

Modified shock waves for extracorporeal shock wave lithotripsy: a simulation based on the Gilmore formulation

Extracorporeal shock wave lithotripsy (SWL) is a reliable therapy for the treatment of urolithiasis. Nevertheless, improvements to enhance stone fragmentation and reduce tissue damage are still needed. During SWL, cavitation is one of the most important stone fragmentation mechanisms. Bubbles with a diameter between about 7 and 55μm have been reported to expand and collapse after shock wave passage, forming liquid microjets at velocities of up to 400m/s that contribute to the pulverization of renal calculi. Several authors have reported that the fragmentation efficiency may be improved by using tandem shock waves. Tandem SWL is based on the fact that the collapse of a bubble can be intensified if a second shock wave arrives tenths or even a few hundredths of microseconds before its collapse. The object of this study is to determine if tandem pulses consisting of a conventional shock wave (estimated rise time between 1 and 20ns), followed by a slower second pressure profile (0.8μs rise time), have advantages over conventional tandem SWL. The Gilmore equation was used to simulate the influence of the modified pressure field on the dynamics of a single bubble immersed in water and compare the results with the behavior of the same bubble subjected to tandem shock waves. The influence of the delay between pulses on the dynamics of the collapsing bubble was also studied for both conventional and modified tandem waves. For a bubble of 0.07mm, our results indicate that the modified pressure profile enhances cavitation compared to conventional tandem waves at a wide range of delays (10-280μs). According to this, the proposed pressure profile could be more efficient for SWL than conventional tandem shock waves. Similar results were obtained for a ten times smaller bubble.

Enhanced shock wave-assisted transformation of Escherichia coli

The objective of the study was to demonstrate that shock wave-induced transfer of DNA into bacteria can be increased by enhancing cavitation using dual-pulse (tandem) shock waves. Escherichia coli and plasmid were transferred to test vials. Competent cells were prepared at different concentrations of CaCl(2). Single pulses and tandem shock waves were compared as were three treatment temperatures: 0, 10 and 25 °C. Three delays (250, 500, 750 μs) between double pulses were tested. Characterization was achieved by using a plasmid that provided green fluorescent protein expression. At 0 °C double pulses generated at a delay of 750 μs significantly increased the number of fluorescent colonies compared with single pulses. In general, the lowest temperature enhanced the mean number of transformants compared with the two higher temperatures. A strong influence of the CaCl(2) concentration on the transformation efficiency was also found. The main conclusion is that gene transfer to target cells may be increased up to 50 times at 0 °C by enhancing cavitation using pairs of shock waves.

Simulation of the effects of cavitation and anatomy in the shock path of model lithotripters

We report on recent efforts to develop predictive models for the pressure and other flow variables in the focal region of shock wave lithotripters. Baseline simulations of three representative lithotripters (electrohydraulic, electromagnetic, and piezoelectric) compare favorably with in vitro experiments (in a water bath). We proceed to model and investigate how shock focusing is altered by the presence of material interfaces associated with different types of tissue encountered along the shock path, and by the presence of cavitation bubbles that are excited by tensile pressures associated with the focused shock wave. We use human anatomical data, but simplify the description by assuming that the tissue behaves as a fluid, and by assuming cylindrical symmetry along the shock path. Scattering by material interfaces is significant, and regions of high pressure amplitudes (both compressive and tensile) are generated almost 4 cm postfocus. Bubble dynamics generate secondary shocks whose strength depends on the density of bubbles and the pulse repetition frequency (PRF). At sufficiently large densities, the bubbles also attenuate the shock. Together with experimental evidence, the simulations suggest that high PRF may be counterproductive for stone comminution. Finally, we discuss how the lithotripter simulations can be used as input to more detailed physical models that attempt to characterize the mechanisms by which collapsing cavitation models erode stones, and by which shock waves and bubbles may damage tissue.

Structure and dynamics of shock-induced nanobubble collapse in water

Shock-induced collapse of nanobubbles in water is investigated with molecular dynamics simulations based on a reactive force field. We observe a focused jet at the onset of bubble shrinkage and a secondary shock wave upon bubble collapse. The jet length scales linearly with the nanobubble radius, as observed in experiments on micron-to-millimeter size bubbles. Shock induces dramatic structural changes, including an ice-VII-like structural motif at a particle velocity of 1  km/s. The incipient ice VII formation and the calculated Hugoniot curve are in good agreement with experimental results.

Shock-induced bubble jetting into a viscous fluid with application to tissue injury in shock-wave lithotripsy

Shock waves in liquids are known to cause spherical gas bubbles to rapidly collapse and form strong re-entrant jets in the direction of the propagating shock. The interaction of these jets with an adjacent viscous liquid is investigated using finite-volume simulation methods. This configuration serves as a model for tissue injury during shock-wave lithotripsy, a medical procedure to remove kidney stones. In this case, the viscous fluid provides a crude model for the tissue. It is found that for viscosities comparable to what might be expected in tissue, the jet that forms upon collapse of a small bubble fails to penetrate deeply into the viscous fluid "tissue." A simple model reproduces the penetration distance versus viscosity observed in the simulations and leads to a phenomenological model for the spreading of injury with multiple shocks. For a reasonable selection of a single efficiency parameter, this model is able to reproduce in vivo observations of an apparent 1000-shock threshold before wide-spread tissue injury occurs in targeted kidneys and the approximate extent of this injury after a typical clinical dose of 2000 shock waves.

Lithotripsy

Shock wave lithotripsy (SWL) is the process of fragmentation of renal or ureteric stones by the use of repetitive shock waves generated outside the body and focused onto the stone. Following its introduction in 1980, SWL revolutionized the treatment of kidney stones by offering patients a non-invasive procedure. It is now seen as a mature technology and its use is perceived to be routine. It is noteworthy that, at the time of its introduction, there was a great effort to discover the mechanism(s) by which it works, and the type of sound field that is optimal. Although nearly three decades of subsequent research have increased the knowledge base significantly, the mechanisms are still controversial. Furthermore there is a growing body of evidence that SWL results in injury to the kidney which may have long-term side effects, such as new onset hypertension, although again there is much controversy within the field. Currently, use of lithotripsy is waning, particularly with the advent of minimally invasive ureteroscopic approaches. The goal here is to review the state of the art in SWL and to present the barriers and challenges that need to be addressed for SWL to deliver on its initial promise of a safe, effective, non-invasive treatment for kidney stones.

Numerical simulations of non-spherical bubble collapse

A high-order accurate shock- and interface-capturing scheme is used to simulate the collapse of a gas bubble in water. In order to better understand the damage caused by collapsing bubbles, the dynamics of the shock-induced and Rayleigh collapse of a bubble near a planar rigid surface and in a free field are analysed. Collapse times, bubble displacements, interfacial velocities and surface pressures are quantified as a function of the pressure ratio driving the collapse and of the initial bubble stand-off distance from the wall; these quantities are compared to the available theory and experiments and show good agreement with the data for both the bubble dynamics and the propagation of the shock emitted upon the collapse. Non-spherical collapse involves the formation of a re-entrant jet directed towards the wall or in the direction of propagation of the incoming shock. In shock-induced collapse, very high jet velocities can be achieved, and the finite time for shock propagation through the bubble may be non-negligible compared to the collapse time for the pressure ratios of interest. Several types of shock waves are generated during the collapse, including precursor and water-hammer shocks that arise from the re-entrant jet formation and its impact upon the distal side of the bubble, respectively. The water-hammer shock can generate very high pressures on the wall, far exceeding those from the incident shock. The potential damage to the neighbouring surface is quantified by measuring the wall pressure. The range of stand-off distances and the surface area for which amplification of the incident shock due to bubble collapse occurs is determined.