# US 5,284,143 A · Apparatus for treating bone pathologies with acoustic energy

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- Number: US 5,284,143 A
- Document ID: US5284143A
- Status: Granted
- Kind: A
- Application number: 07/885,749
- Filed: 1992-05-19
- Granted: 1994-02-08
- Earliest claimed: 1991-06-13
- Assignees: Siemens Aktiengesellschaft
- Inventors: Manfred Rattner
- Web page: https://patentgrep.com/patent/US5284143A

## CPC

- A61N 7/00: Ultrasound therapy (lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 {; using ultrasound for introducing media into the body A61M37/0092})
- A61N 2007/0013: {Fracture healing}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)

## Abstract

An apparatus for treating bone pathologies with acoustic waves includes a source of focused acoustic waves, a system for displacing the focus of the acoustic waves, and a system for locating the boundary surface between the bone to be treated and surrounding tissue. The locating system generates signals corresponding to the position of the boundary surface. A control unit, which operates the focused displacing system, is supplied with the signals identifying the position of the boundary surface, so that the focused displacing system is controlled to maintain the focus substantially at the boundary surface, independently of the position of the acoustic wave source.

## Claims

### Claim 1

An apparatus for treating bone pathologies in situ with acoustic energy comprising:
a source of focused acoustic waves;
means for displacing the focus of said acoustic waves;
means for locating the boundary surface between a bone to be treated with said acoustic waves and surrounding tissue and for generating signals corresponding to the position of said boundary surface; and
control means, supplied with said signals, for actuating and controlling said means for displacing the focus for maintaining said focus substantially in said boundary surface independently of the position of said source while treating said bone with said acoustic waves.

### Claim 2 (depends on 1)

An apparatus as claimed in claim 1 wherein said source of acoustic waves has an acoustic axis and wherein said focus lies on said acoustic axis, wherein said means for locating includes means for identifying the intersection of said acoustic axis and said boundary surface, and wherein said means for displacing is a means for displacing the focus of said acoustic waves along said acoustic axis to cause said focus and said intersection to substantially coincide.

### Claim 3 (depends on 1)

An apparatus as claimed in claim 1 further comprising:
means for adjusting the position of said source of focused acoustic waves operated by said control means;
wherein said means for locating includes means for identifying the path of a zone of said bone to be treated and for generating signals, supplied to said control means, corresponding to said path of said zone; and
wherein said control means includes means for operating said means for adjusting said source so that said source is adjusted in at least one degree of freedom with said focus always located in said zone to be treated independently of the position of said source with respect to other degrees of freedom.

### Claim 4 (depends on 3)

An apparatus as claimed in claim 3 wherein said means for operating said means for positioning said source operates said means for positioning so that said focus is always located in a region of said zone to be treated which is closest to said source.

### Claim 5 (depends on 3)

An apparatus as claimed in claim 3 wherein said means for operating said means for positioning said source operates said means for positioning to move said focus along said path of said zone to be treated.

### Claim 6 (depends on 1)

An apparatus as claimed in claim 1 further comprising:
said means for locating including a pressure sensor disposed in the propagation path of said acoustic waves;
means for pulse-like actuating said source for causing said source to generate at least one pulse-like acoustic wave, said pulse-like acoustic wave causing said pressure sensor to generate a first pulse-like output signal as said pulse-like acoustic wave propagates toward said bone to be treated and causing said pressure sensor to generate a second pulse-like output signal upon reflection of said pulse-like acoustic wave; and
means for measuring the time between said first and second pulse-like output signals of said pressure sensor.

### Claim 7 (depends on 6)

An apparatus as claimed in claim 6 wherein said means for actuating said source to generate at least one pulse-like acoustic wave is a means for actuating said source to generate at least one pulse-like acoustic wave having an intensity which is reduced in comparison to acoustic waves generated for treatment of said bone.

### Claim 8 (depends on 1)

An apparatus as claimed in claim 1 wherein said means for locating comprises:
means for generating a plurality of ultrasound image slices each containing said focus;
means for identifying an intensity discontinuity in each of said slices corresponding to said boundary layer; and
means for comparing the location of said intensity discontinuity to the location of said focus in each ultrasound slice.

### Claim 9 (depends on 1)

An apparatus as claimed in claim 1 further comprising:
means for adjusting the position of said source of focused acoustic waves, operated by said control means;
wherein said means for locating includes ultrasound means for generating an ultrasound slice having a defined position relative to said source;
means for marking a region of said bone to be treated contained in the said ultrasound slice, and means for generating signals corresponding to said marked region; and
electronic calculating means, to which said signals corresponding to said marked region are supplied, for calculating a set of control signals and supplying said control signals to said control means for operating said means for positioning said source such that said focus lies in the marked region.

### Claim 10 (depends on 9)

An apparatus as claimed in claim 9 wherein said ultrasound means includes an ultrasound applicator, and wherein said ultrasound means generates a plurality of said slices at respectively different positions of said ultrasound applicator relative to said bone to be treated, said apparatus further comprising an image memory in which said plurality of ultrasound images are stored, and wherein said electronic calculating means includes means for calculating the spatial path and spatial position of at least one of a zone of said bone to be treated or said boundary surface within said zone to be treated with respect to said marked region, and wherein said spatial path and said spatial position comprise said control signals for operating said means for adjusting the position of said source.

### Claim 11 (depends on 9)

An apparatus as claimed in claim 9 wherein said ultrasound means includes an ultrasound applicator, and wherein said source of focused acoustic waves has a central bore in which said ultrasound applicator is received.

### Claim 12 (depends on 1)

An apparatus as claimed in claim 1 wherein said means for locating includes means for generating an x-ray beam in which said bone to be treated is disposed, and a radiation receiver disposed to receive said x-ray beam attenuated by said bone to be treated and for generating an x-ray image from the received radiation, and means for moving said means for generating an x-ray beam and said radiation receiver in coordination to produce a plurality of said x-ray images from different angles.

### Claim 13 (depends on 12)

An apparatus as claimed in claim 12 further comprising:
an image memory for storing two of said x-ray images obtained at respectively different angles;
means for marking a path of a zone of said bone to be treated in said x-ray images and for generating signals corresponding to the marked path; and
electronic calculating means, supplied with said signals corresponding to said marked path, for calculating the spatial path and spatial position of at least one of said zone or said boundary surface within said zone, and for generating signals supplied to said control means for actuating and controlling said means for displacing the focus.

### Claim 14 (depends on 1)

An apparatus as claimed in claim 1 further comprising means for adjusting the position of said source of focused acoustic waves along a circular path surrounding said bone to be treated while treating said bone with said acoustic waves.

### Claim 15 (depends on 14)

An apparatus as claimed in claim 14 further comprising means for adjusting the position of said source along an axis which intersects a plane containing said circular path at a right angle while treating said bone with said acoustic waves.

### Claim 16 (depends on 1)

An apparatus as claimed in claim 1 wherein said source of focused acoustic waves has an acoustic axis, and wherein said means for displacing the focus is a means for displacing said source along said acoustic axis.

### Claim 17 (depends on 1)

An apparatus as claimed in claim 1 wherein said means for displacing the focus comprises:
an acoustic lens having a variable focal length contained in said source of focused acoustic waves; and
means for adjusting said focal length of said acoustic lens.

### Claim 18 (depends on 1)

An apparatus as claimed in claim 1 wherein said means for locating the boundary surface between said bone to be treated with acoustic waves and surrounding tissue is a means for ultrasonically locating said boundary surface.

### Claim 19 (depends on 1)

An apparatus as claimed in claim 1 wherein said means for locating the boundary surface between said bone to be treated with said acoustic waves and surrounding tissue is a means for radiologically locating said boundary surface.

### Claim 20 (depends on 1)

An apparatus as claimed in claim 1 further comprising:
means for immobilizing said bone to be treated with acoustic waves.

### Claim 21 (depends on 1)

An apparatus as claimed in claim 1 further comprising:
means for immobilizing said bone to be treated, said means for immobilizing having an outer surface;
means for adjusting the position of said source of focused acoustic shockwaves along a circular path surrounding said means for immobilizing; and
means for coupling said acoustic waves from said source of focused acoustic waves into said means for immobilizing, said means for coupling being in contact with said outer surface of said means for immobilizing and sliding over said outer surface as said source is adjusted along said circular path.

### Claim 22 (depends on 1)

An apparatus as claimed in claim 1 wherein said source of focused acoustic waves is a source of focused shockwaves.

### Claim 23

A method for treating bone pathologies in situ with acoustic waves comprising the steps of:
generating focused acoustic waves;
locating the boundary surface between a bone to be treated with said acoustic waves and surrounding tissue and generating signals corresponding to the position of said boundary surface; and
displacing said focus, based on said signals, to maintain said focus substantially in said boundary surface independently of the position of said source while treating said bone with said acoustic waves.

### Claim 24 (depends on 23)

A method as claimed in claim 23 wherein the step of generating focused acoustic waves is further defined by generating focused acoustic waves propagating along an acoustic axis, wherein the step of locating said boundary surface is further defined by identifying the intersection of said acoustic axis and said boundary surface, and wherein the step of displacing said focus is further defined by displacing said focus along said acoustic axis to cause said focus and said intersection to substantially coincide.

### Claim 25 (depends on 23)

A method as claimed in claim 23 wherein the step of generating focused acoustic waves is further defined by generating focused acoustic waves emanating from a source, wherein the step of locating said boundary surface is further defined by identifying the path of a zone of said bone to be treated and generating signals corresponding to said path of said zone, and wherein the step of displacing said focus is further defined by adjusting the position of said source and thereby displacing said focus so that said source is adjusted in at least one degree of freedom with said focus always located in said zone to be treated independently of the position of said source with respect to other degrees of freedom.

### Claim 26 (depends on 25)

A method as claimed in claim 25 wherein the step of displacing said focus is further defined by adjusting the position of said source so that said focus is always located in a region of said zone to be treated which is closest to said source.

### Claim 27 (depends on 25)

A method as claimed in claim 25 wherein the step of displacing said focus is further defined by adjusting the position of said source to move said focus along said path of said zone to be treated.

### Claim 28 (depends on 23)

A method as claimed in claim 23 comprising the additional steps of:
generating at least one of said acoustic waves as a pulse-like acoustic wave;
identifying a first point in time at which said pulse-like acoustic waves passes a selected location as said pulse-like acoustic wave propagates toward said bone to be treated;
identifying a second point in time at which said pulse-like acoustic wave again passes said selected location after being reflected; and
measuring the duration between said first and second points in time.

### Claim 29 (depends on 28)

A method as claimed in claim 28 wherein the steps of identifying said first and second points in time are further defined by identifying said first and second points in time using a pressure sensor disposed in the propagation path of said pulse-like acoustic wave.

### Claim 30 (depends on 28)

A method as claimed in claim 28 wherein the step of generating said at least one pulse-like acoustic wave is further defined by generating at least one pulse-like acoustic wave having an intensity which is reduced in comparison to acoustic wave generated for treatment of said bone.

### Claim 31 (depends on 23)

A method as claimed in claim 23 wherein the step of locating said boundary surface is further defined by ultrasonically locating said boundary surface.

### Claim 32 (depends on 31)

A method as claimed in claim 31 comprising the additional steps of:
generating a plurality of ultrasound image slices each containing said focus;
identifying an intensity discontinuity in each of said slices corresponding to said boundary layer; and
comparing the location of said intensity discontinuity to the location of said focus in each ultrasound slice for locating said boundary surface.

### Claim 33 (depends on 31)

A method as claimed in claim 31 wherein the step of generating focused acoustic waves is further defined by generating focused acoustic waves emanating from a source, and comprising the additional steps of:
generating an ultrasound slice having a defined position relative to said source;
marking a region of said bone to be treated contained in said ultrasound slice and generating signals corresponding to said marked region; and
adjusting the position of said source, based on said signals corresponding to said marked region, to position said source so that said focus lies in said marked region.

### Claim 34 (depends on 31)

A method as claimed in claim 31 wherein the step of ultrasonically locating said boundary surface is further defined by ultrasonically locating said boundary surface using an ultrasound field generated by an ultrasound applicator, and comprising the additional steps of:
generating a plurality of said ultrasound slices at respectively different positions of said ultrasound applicator relative to said bone to be treated;
storing said plurality of ultrasound images;
calculating the spatial path and spatial position of at least one of a zone of said bone to be treated or said boundary surface within said bone to be treated with respect to said marked region; and
adjusting the position of said source based on said spatial path and said spatial position calculations.

### Claim 35 (depends on 23)

A method as claimed in claim 23 wherein the step of locating said boundary surface is further defined by radiologically locating said boundary surface.

### Claim 36 (depends on 35)

A method as claimed in claim 35 wherein the step of radiologically locating the boundary surface is further defined by generating a plurality of x-ray images of said bone to be treated from different angles.

### Claim 37 (depends on 36)

A method as claimed in claim 36 comprising the additional steps of:
storing two of said x-ray images obtained at respectively different angles;
marking a path of a zone of said bone to be treated in said x-ray images and generating signals corresponding to the marked path; and
calculating a spatial path and spatial position of at least one of said zone or said boundary surface within said zone, and displacing said focus based on said spatial path and spatial position calculations.

### Claim 38 (depends on 23)

A method as claimed in claim 23 wherein the step of generating focused acoustic waves is further defined by generating focused acoustic waves emanating from a source, and comprising the additional step of:
moving said source along a circular path surrounding said bone to be treated while treating said bone with said acoustic waves.

### Claim 39 (depends on 38)

A method as claimed in claim 38 comprising the additional step of:
moving said source along an axis which intersects the plane containing said circular path at a right angle while treating said bone with said acoustic waves.

### Claim 40 (depends on 23)

A method as claimed in claim 23 wherein the step of generating focused acoustic waves is further defined by generating focused acoustic waves emanating from a source and propagating along an acoustic axis, and wherein the step of displacing said focus is further defined by displacing said source along said acoustic axis.

### Claim 41 (depends on 23)

A method as claimed in claim 23 wherein the step of generating focused acoustic waves is further defined by generating focused acoustic waves using a variable focal length acoustic lens, and wherein the step of displacing said focus is further defined by displacing said focus by adjusting said focal length of said acoustic lens.

### Claim 42 (depends on 23)

A method as claimed in claim 23 comprising the additional step of:
immobilizing said bone to be treated.

### Claim 43

An apparatus for treating bone pathologies in situ with acoustic energy comprising:
a source of focused acoustic waves propagating along an acoustic axis, including an acoustic lens with an adjustable focal length;
means for adjusting the position of said source along said acoustic axis;
means for generating an x-ray beam in which a bone to be treated is disposed;
means for detecting said x-ray beam, attenuated by said bone, and for generating an x-ray image of said bone;
means for moving said means for generating an x-ray beam and said means for detecting said x-ray beam around said bone for generating two of said x-ray images from respective positions offset by a known angle;
means for identifying the three-dimensional position and extent of a selected feature in said two x-ray images having a relationship to the boundary surface between said bone and surrounding tissue, and for generating signals corresponding thereto;
means for moving said source around said bone in a plane while treating said bone with said acoustic waves;
means for moving said source along an axis perpendicular to said plane; and
means, supplied with said signals, for coordinating movement of said source around said bone and along said perpendicular axis and simultaneously controlling adjustment of at least one of said focal length of said acoustic lens or said position of said source along said acoustic axis for maintaining said focus in said boundary layer while treating said bone with acoustic waves.

### Claim 44

An apparatus for treating bone pathologies in situ with acoustic energy comprising:
a source of focused acoustic waves propagating along an acoustic axis;
means for adjusting the position of said source along said acoustic axis;
an ultrasound applicator for generating an ultrasound field in which a bone to be treated is disposed;
means for processing signals from said ultrasound applicator to generate an ultrasound image of said bone;
means for moving said ultrasound applicator to generate a plurality of said ultrasound images from different positions;
means for identifying the three-dimensional position and extent of a selected feature in said plurality of ultrasound images having a relationship to the boundary surface between said bone and surrounding tissue, and for generating signals corresponding thereto;
means for moving said source around said bone in a plane while treating said bone with said acoustic waves;
means for moving said source along an axis perpendicular to said plane; and
means, supplied with said signals, for coordinating movement of said source around said bone and along said perpendicular axis and simultaneously controlling adjustment of said position of said source along said acoustic axis for maintaining said focus in said boundary layer while treating said bone with acoustic waves.