行政院國家科學委員會補助專題研究計畫成果報告
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計畫類別：□個別型計畫 ■整合型計畫 計畫編號：NSC90－2213－E－006－098－
執行期間：90 年 8 月 01 日至 91 年 10 月 31 日
計畫主持人：張建成 共同主持人：唐一清
本成果報告包括以下應繳交之附件：
□赴國外出差或研習心得報告一份
□赴大陸地區出差或研習心得報告一份
□出席國際學術會議心得報告及發表之論文各一份
□國際合作研究計畫國外研究報告書一份
執行單位：國立成功大學航空太空工程學系（所）
中 華 民 國 91 年 10 月 24 日
具有結石追蹤系統之新型體外震波碎石機技術開發－子計畫五 即時結石追蹤系統之體外震波碎石機的臨床人體實驗
行政院國家科學委員會專題研究計畫成果報告
具有結石追蹤系統之新型體外震波碎石機技術開發－
子計畫五：即時結石追蹤系統之體外震波碎石機的臨床人體實驗 計畫編號：NSC90－2213－E－006－098
執行期限：90 年 8 月 1 日至 91 年 10 月 31 日 主持人：張建成 國立成功大學醫學系泌尿科
1. Abstr act
To evaluate the efficiency of real-time tracking system on the effect of shock wave lithotripsy, we conduct the study. The patient was randomly assigned to each tracking and non-tracking group. The stone was treated by 3000 shocks. The results showed that the stone clearance rate after 6 weeks was 81.8%
in the tracking group. It was 63.8 % in the non-tracking group. No significant difference among BUN and creatinine were found in these two group. The real-time tracking system is helpful for the shock wave lithotripsy.
Keywords: real-time tracking system, SWL
2. Introduction
For more accuracy targeting during SWL, an ultrasound based real-time tracking system was developed to help the targeting during SWL. To test how much the effect that this tracking system help for a shock wave lithortriptor, we conduct the following study.
3. Mater ials and methods
We collected patients who have renal stone. Gender and age are not restricted.
Stone is calcium stone and is larger than 0.3 cm. The patients are randomizedly distributed into A, and B group. The patients in group A will accept shock
wave lithotripsy under the help of the ultrasound-base real-time tracking system.
The patients in group B will accept shock wave lithotripsy without real-time tracking. Under sedative condition, the patients will be treated for 1500 to 3000 shocks which depended on the stone condition. After treatment, the patient will be followed in the first, and sixth week to decide whether another session of shock wave lithotripsy will be given or not after the 6th week. If the stone are larger than 0.3 cm, we will re-treat for 3000 shocks again. The patient will be followed to decide whether another session of shock wave lithotripsy will be given or not after the 12th week. If the stone are larger than 0.3 cm, we will re-treat for 3000 shocks again. Then, we follow the patient to decide the stone clearance rate. After the treatment of shock wave, the blood urea nitrogen and creatinine、will be check in the serum after the first weeks. We will follow these patients on 3, 6, and 12 months to decide the stone free rate.
4. Results
The results of tracking and non-tracking group were shown in table 1 and table 2.
Table 1. Results of tracking group A
Items sex size (L x W) shocks clearance 6 weeks BUN before Tx Cre before Tx BUN 1week CRE 1 week site
1 m 0.4 x0.4 3000 clear 15 1.3 16 1.3 r
2 m 0.7 x0.7 (D. S) 3000 residuals 14 1 13 1 r
3 m 0.7 x0.9 (D. S) 3000 residuals 12 0.9 13 0.9 l
4 m 0.5 x0.6 3000 clear 13 1 13 0.9 r
5 m 0.4 x 0.3 3000 clear 14 1.2 13 1.2 r
6 m 0.4 x0.4 3000 clear 18 1.5 18 1.5 l
7 m 0.4 x0.5 3000 clear 14 1.1 15 1.1 l
8 m 1.1 x 0.9 3000 clear 13 1.1 14 1 r
9 m 0.6 x 0.4 3000 clear 14 1.2 15 1.2 r
10 m 2.2 x 2.0 3000 clear 15 1.2 14 1.2 r
11 f 0.4 x 0.3 3000 clear 12 0.9 12 0.9 r
Average 81.80%
Table 2. Results of non-tracking B group
Items Sex size (L x W) Shocks clearance 6 weeks
BUN before Tx
Cre before Tx
BUN 1week CRE 1 week site
1 M 0.6 x0.5 3000 clear 10 1 11 1 r
2 f 0.4 x0.5 3000 clear 13 1.1 13 1.1 l
3 M 0.8 x0.6 3000 residuls 14 1.2 13 1.2 r
4 M 0.4 x0.4 3000 clear 15 1.2 15 1.2 r
5 M 0.5 x 0.5 3000 clear 13 1.1 13 1.1 l
6 M 1.2 x 0.6 3000 residuls 14 1.2 14 1.2 r
7 f 0.7 x0.5 3000 clear 12 1.1 13 1.1 r
8 M 0.6 x 0.5 3000 clear 14 1.1 15 1.2 r
9 M 1.0 x 0.8 3000 residuls 13 1.2 15 1.2 l
10 M 1.7 x 1.0 3000 residuls 14 1.1 14 1.2 r
11 f 0.6 x 0.5 3000 clear 13 1.1 14 1.1 r
Average 63.80%
5. Discussion
Stone tracking has shown that can significantly benefit from additional image features. On the extreme cases, where stone tracking may be momentarily impossible, for example when the stone is not present in the image, the current approach can resume as
soon as the stone reappears. Future research plans to follow similar methodology to further improve tracking of stones that are considered as impossible to track such as stones attached to other high gray value tissue, stones with no shadow etc.
From the ideal case it is shown that
fragmentation analysis is possible. On the other hand, the measurements on the phantom images present a similar trend but show not acceptable variation. This is believed to be due to non-standard manufacturing procedures for the phantoms and the image acquisition practice.
Procedures that can produce more standard experimentation are under investigation.
6. Conclusion
The ultrasound-based real-time tracking system for shock wave lithotriptor is very helpful for the accuracy targeting during SWL, and also showed good results for the treatment during SWL.
