System for Comminution of Biomineralizations Using Microbubbles

A system for causing comminution of a biomineralization in a target region in an internal volume of a subject in a plurality of macrocycles, each macrocycle including a bubble placement stage followed by an insonation stage, the bubble placement stage and the insonation stage repeated in an alternating manner during the plurality of macrocycles, comprising:

• an external ultrasound source configured to be placed on a skin of the subject;
• a microbubble source configured and arranged to introduce microbubbles into the target region only during the bubble placement stage of each macrocycle such that the microbubbles are not introduced into the target region during the insonation stage of each macrocycle;
• a controller coupled to the external ultrasound source, the controller configured and arranged to cause the external ultrasound source to insonate the microbubbles with a treatment beam during the insonation stage of each macrocycle, the treatment beam delivering ultrasonic energy to the target region to cause inertial cavitation (IC) of at least some of the microbubbles only during the insonation stage of each macrocycle, the controller causing the external ultrasound source to emit the ultrasonic energy at selected times during the insonation stage of each macrocycle and not causing the external ultrasound source to emit the ultrasonic energy during the bubble placement stage of each macrocycle;
• and
• an acoustic sensor having a focal depth configured to be dynamically changed to measure an IC amplitude with respect to the focal depth to determine a depth of the biomineralization with respect to the acoustic sensor,
• wherein:
• the biomineralization has an initial size and mass,
• the external ultrasound source is configured and arranged to be translated and/or pivoted on the skin so as to change a spatial alignment of the external ultrasound source with respect to the biomineralization based on the IC amplitude measured by the acoustic sensor,
• the controller is configured and arranged to dynamically adjust the treatment beam, including a position and a spatial alignment of the treatment beam, based on the depth and relative position of the biomineralization, and
• the delivered ultrasonic energy and IC are configured and arranged to break the biomineralization into pieces having less size and mass than the initial biomineralization size and mass.