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Jeff Thiel

Research Scientist/Engineer II

Email

jthiel@apl.uw.edu

Education

B.S. Diagnostic Medical Ultrasound, Seattle University, 1992

Publications

2000-present and while at APL-UW

Quantitative assessment of effectiveness of ultrasonic propulsion of kidney stones

Dai, J.C., M.D. Sorensen, H.C. Chang, P.C. Samson, B. Dunmire, B.W. Cunitz, J. Thiel, Z. Liu, M.R. Bailey, and J.D. Harper, "Quantitative assessment of effectiveness of ultrasonic propulsion of kidney stones," J. Endourol., 33, doi:10.1089/end.2019.0340, 2019.

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15 Oct 2019

Ultrasonic propulsion is an investigative modality to noninvasively image and reposition urinary stones. Our goals were to test safety and effectiveness of new acoustic exposure conditions from a new transducer, and to use simultaneous ureteroscopic and ultrasonic observation to quantify stone repositioning.

During operation, ultrasonic propulsion was applied transcutaneously, whereas stone targets were visualized ureteroscopically. Exposures were 350 kHz frequency, ≤200 W/cm2 focal intensity, and ≤3-second bursts per push. Ureteroscope and ultrasound (US) videos were recorded. Video clips with and without stone motion were randomized and scored for motion ≥3 mm by independent reviewers blinded to the exposures. Subjects were followed with telephone calls, imaging, and chart review for adverse events.

The investigative treatment was used in 18 subjects and 19 kidneys. A total of 62 stone targets were treated ranging in size from a collection of "dust" to 15 mm. Subjects received an average of 17 ñ 14 propulsion bursts (per kidney) for a total average exposure time of 40 ñ 40 seconds. Independent reviewers scored at least one stone movement ≥3 mm in 18 of 19 kidneys (95%) from the ureteroscope videos and in 15 of 19 kidneys (79%) from the US videos. This difference was probably because of motion out of the US imaging plane. Treatment repositioned stones in two cases that would have otherwise required basket repositioning. No serious adverse events were observed with the device or procedure.

Ultrasonic propulsion was shown to be safe, and it effectively repositioned stones in 95% of kidneys despite positioning and access restrictions caused by working in an operating room on anesthetized subjects.

An in vivo demonstration of efficacy and acute safety of burst wave lithotripsy using a porcine model

Wang, Y.-N., W. Kreider, C. Hunter, B.W. Cunitz, J. Thiel, F. Starr, J.C. Dai, Y. Nazari, D. Lee, J.C. Williams, M.R. Bailey, and A.D. Maxwell, "An in vivo demonstration of efficacy and acute safety of burst wave lithotripsy using a porcine model," Proc. Mtgs. Acoust., 35, 02009, doi:10.1121/2.0000975, 2018.

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5 Nov 2018

Proceedings, 176th Meeting of the Acoustical Society of America, 5-9 November 2018, Victoria, BC, Canada.

Burst wave lithotripsy (BWL) is a new non-invasive method for stone comminution using bursts of sub-megahertz ultrasound. A porcine model of urolithiasis and techniques to implement BWL treatment has been developed to evaluate its effectiveness and acute safety. Six human calcium oxalate monohydrate stones (6–7 mm) were hydrated, weighed, and surgically implanted into the kidneys of three pigs. Transcutaneous stone treatments were performed with a BWL transducer coupled to the skin via an external water bath. Stone targeting and treatment monitoring were performed with a co-aligned ultrasound imaging probe. Treatment exposures were applied in three 10-minute intervals for each stone. If sustained cavitation in the parenchyma was observed by ultrasound imaging feedback, treatment was paused and the pressure amplitude was decreased for the remaining time. Peak negative focal pressures between 6.5 and 7 MPa were applied for all treatments. After treatment, stone fragments were removed from the kidneys. At least 50% of each stone was reduced to <2 mm fragments. 100% of four stones were reduced to <4 mm fragments. Magnetic resonance imaging showed minimal injury to the functional renal volume. This study demonstrated that BWL could be used to effectively fragment kidney stones with minimal injury.

Retrospective comparison of measured stone size and posterior acoustic shadow width in clinical ultrasound images

Dai, J.C., B. Dunmire, K.M. Sternberg, Z. Liu, T. Larson, J. Thiel, H.C. Chang, J.D. Harper, M.R. Bailey, M.D. Sorensen, "Retrospective comparison of measured stone size and posterior acoustic shadow width in clinical ultrasound images," World J. Urol., 36, 727-732, doi:10.1007/s00345-017-2156-8, 2018.

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1 May 2018

Purpose

Posterior acoustic shadow width has been proposed as a more accurate measure of kidney stone size compared to direct measurement of stone width on ultrasound (US). Published data in humans to date have been based on a research using US system. Herein, we compared these two measurements in clinical US images.

Methods

Thirty patient image sets where computed tomography (CT) and US images were captured less than 1 day apart were retrospectively reviewed. Five blinded reviewers independently assessed the largest stone in each image set for shadow presence and size. Shadow size was compared to US and CT stone sizes.

Results

Eighty percent of included stones demonstrated an acoustic shadow; 83% of stones without a shadow were ≤5 mm on CT. Average stone size was 6.5 ± 4.0 mm on CT, 10.3 ± 4.1 mm on US, and 7.5 ± 4.2 mm by shadow width. On average, US overestimated stone size by 3.8 ± 2.4 mm based on stone width (p < 0.001) and 1.0 ± 1.4 mm based on shadow width (p < 0.0098). Shadow measurements decreased misclassification of stones by 25% among three clinically relevant size categories (≤ 5, 5.1–10, > 10 mm), and by 50% for stones ≤ 5 mm.

Conclusions

US overestimates stone size compared to CT. Retrospective measurement of the acoustic shadow from the same clinical US images is a more accurate reflection of true stone size than direct stone measurement. Most stones without a posterior shadow are ≤ 5 mm.

More Publications

Acoustics Air-Sea Interaction & Remote Sensing Center for Environmental & Information Systems Center for Industrial & Medical Ultrasound Electronic & Photonic Systems Ocean Engineering Ocean Physics Polar Science Center
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