Size and location of defects at the coupling interface affect lithotripter performance

Guangyan Li, James C. Williams, Yuri A. Pishchalnikov, Ziyue Liu, James A. McAteer

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


OBJECTIVE • To determine how the size and location of coupling defects caught between the therapy head of a lithotripter and the skin of a surrogate patient (i.e. the acoustic window of a test chamber) affect the features of shock waves responsible for stone breakage. MATERIALS AND METHODS • Model defects were placed in the coupling gel between the therapy head of a Dornier Compact-S electromagnetic lithotripter (Dornier MedTech, Kennesaw, GA, USA) and the Mylar (biaxially oriented polyethylene terephthalate) (DuPont Teijin Films, Chester, VA, USA) window of a water-filled coupling test system. • A fibre-optic probe hydrophone was used to measure acoustic pressures and map the lateral dimensions of the focal zone of the lithotripter. • The effect of coupling conditions on stone breakage was assessed using gypsum model stones. RESULTS • Stone breakage decreased in proportion to the area of the coupling defect; a centrally located defect blocking only 18% of the transmission area reduced stone breakage by an average of almost 30%. • The effect on stone breakage was greater for defects located on-axis and decreased as the defect was moved laterally; an 18% defect located near the periphery of the coupling window (2.0 cm off-axis) reduced stone breakage by only 15% compared to when coupling was completely unobstructed. • Defects centred within the coupling window acted to narrow the focal width of the lithotripter; an 8.2% defect reduced the focal width 30% compared to no obstruction (4.4 mm vs 6.5 mm). • Coupling defects located slightly off centre disrupted the symmetry of the acoustic field; an 18% defect positioned 1.0 cm off-axis shifted the focus of maximum positive pressure 1.0 mm laterally. • Defects on and off-axis imposed a significant reduction in the energy density of shock waves across the focal zone. CONCLUSIONS • In addition to blocking the transmission of shock-wave energy, coupling defects also disrupt the properties of shock waves that play a role in stone breakage, including the focal width of the lithotripter and the symmetry of the acoustic field • The effect is dependent on the size and location of defects, with defects near the centre of the coupling window having the greatest effect. • These data emphasize the importance of eliminating air pockets from the coupling interface, particularly defects located near the centre of the coupling window.

Original languageEnglish (US)
Pages (from-to)E871-E877
JournalBJU International
Issue number11 C
StatePublished - Dec 2012


  • Acoustic coupling
  • Shock-wave lithotripsy
  • Stone breakage

ASJC Scopus subject areas

  • Urology

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