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We investigate the role of secondary shock waves (SSWs) generated by cavitation in lithotripsy. Acoustic pressure was measured with a fiber optic probe hydrophone and cavitation using a dual passive cavitation detector (PCD) consisting of two confocal transducers. An artificial stone (∼7 mm diameter and ∼9 mm length) was placed at the focus of an electrohydraulic lithotripter. The fiber was inserted through a hole drilled through the stone so that the tip was at the proximal surface. SSWs were identified by matching the time of arrival to that of the inertial collapse signature acquired by the PCD. Measurements of SSWs were obtained for 50% of SWs fired at 20 kV and 1 Hz. The peak positive pressure for the SSW was p+=33.7±14.8 MPa, which was comparable to the pressure induced by the incident SW (p+=42.6±6 MPa). The peak pressure in water was p+=23.2±4.4 MPa. The PCD also recorded acoustic emissions from forced collapse of pre-existing bubbles caused by the incident SW. We propose that both the reflection from the semi-rigid stone boundary and SSW from the forced collapse contribute to the observed increase in the peak pressure of the incident SW in presence of a stone. [Work supported by NIH.] [ABSTRACT FROM AUTHOR]

We report measurements of a number of different shock wave therapy (SWT) devices. Two devices were electrohydraulic (EH): one had a large shock source (HMT Ossatron) and the other was a small hand-held source (HMT Evotron). The other device was a pneumatically driven device (EMS Swiss Dolorclast) and two different hand pieces were measured, one with an ‘‘unfocused’’ head and the other with a ‘‘focused’’ head. We found that the EH sources generated focused shock waves with a positive phase about 1 microsec long and peak pressure around 40 MPa, however, the acoustic output of the HMT Evotron appeared to be independent of the power setting of the machine. For the pneumatic source the duration of the positive phase was greater than 4 microsec and the peak pressure about 7 MPa. There was no clear shock front present and the waveform had a complex tail structure that was dependent on the power setting of the machine. We found that the focused hand-piece did not generate a focused acoustic field. The results are compared to reports of measurements from electromagnetic SWT devices. We contrast measurements made with different hydrophone systems: fiber-optic probe hydrophone, PVDF membrane hydrophone and PVDF bullet-shaped hydrophone. [ABSTRACT FROM AUTHOR]