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Just the mention of kidney stones can cause a person to cringe. They are often painful and sometimesdifficult to remove, and 10 percent of the population will sufferfrom them. In space, the risk of developing kidney stones isexacerbated due to environmental conditions. The health risk iscompounded by the fact that resource limitations and distance fromEarth could restrict treatment options. Scientists with the National Space Biomedical Research Institute(NSBRI) are developing an ultrasound technology that could overcomesome medical care challenges associated with kidney stonetreatment. The new technology detects stones with advancedultrasound imaging based on a process called "Twinkling Artifact"and provides treatment by "pushing" the stone with focusedultrasound. This technology could not only be beneficial for healthcare in space, but could also alter the treatment of kidney stoneson Earth. The project is led by NSBRI Smart Medical Systems and TechnologyTeam Principal Investigator Dr. Lawrence Crum and Co-InvestigatorDr. Michael Bailey; both are researchers at the Applied PhysicsLaboratory at the University of Washington (APL-UW). Bailey saidtheir technology is based on equipment currently available. "We have a diagnostic ultrasound machine that has enhancedcapability to image kidney stones in the body," said Bailey, aprincipal engineer at APL-UW. "We also have a capability that usesultrasound waves coming right through the skin to push small stonesor pieces of stones toward the exit of the kidney, so they willnaturally pass, avoiding surgery." Currently on Earth, the preferred removal method is for patients todrink water to encourage the stones to pass naturally, but thisdoes not always work, and surgery is often the only option. Inspace, the threat from kidney stones is greater due to thedifficulty of keeping astronauts fully hydrated. Another factor isthat bones demineralize in the reduced-gravity environment ofspace, dumping salts into the blood and eventually into the urine.The elevated concentration of salts in the urine is a risk factorfor stones. Crum, who is a principal physicist at APL-UW, said kidney stonescould be a serious problem on a long-duration mission. "It ispossible that if a human were in a space exploration environmentand could not easily return to Earth, such as a mission to anasteroid or Mars, kidney stones could be a dangerous situation,"Crum said. "We want to prepare for this risk by having a readilyavailable treatment, such as pushing the stone via ultrasound." Before a stone can be pushed, it needs to be located. Standardultrasound machines have a black and white imaging mode calledB-mode that creates a picture of the anatomy. They also have aDoppler mode that specifically displays blood flow and the motionof the blood within tissue in color. In Doppler mode a kidney stonecan appear brightly colored and twinkling. The reason for this isunknown, but Crum and Bailey are working to understand what causesthe Twinkling Artifact image. "At the same time, we have gone beyond Twinkling Artifact andutilized what we know with some other knowledge about kidney stonesto create specific modes for kidney stones," Bailey said. "Wepresent the stone in a way that looks like it is twinkling in animage in which the anatomy is black and white, with one brightlycolored stone or multiple colored stones." Once the stones are located, the ultrasound machine operator canselect a stone to target, and then, with a simple push of a button,send a focused ultrasound wave, about half a millimeter in width,to move the stone toward the kidney's exit. The stone moves aboutone centimeter per second. In addition to being an option tosurgery, the technology can be used to "clean up" after surgery. "There are always residual fragments left behind after surgery,"Bailey said. "Fifty percent of those patients will be back withinfive years for treatment. We can help those fragments pass." The ultrasound technology being developed for NSBRI by Crum andBailey is not limited to kidney stone detection and removal. Thetechnology can also be used to stop internal bleeding and ablate(or destroy) tumors. Crum said the research group has innovativeplans for the technology. "We envision a platform technology thathas open architecture, is software-based and can use ultrasound fora variety of applications," he said. "Not just for diagnosis, butalso for therapy." NSBRI's research portfolio includes other projects seeking todevelop smart medical systems and technologies, such as new usesfor ultrasound, that provide health care to astronauts in space.Crum, who served eight years as an NSBRI Team Leader, said theinnovative approaches to overcome the restrictive environment ofspace can make an impact on Earth. "Space has demanded medical care technology that is versatile,low-cost and has restricted size. All of these requiredspecifications for use in a space environment are now almostdemanded by the general public," Crum said. "One of the reasonsthat translation from one site to another is possible is because ofNSBRI's investment." The ultrasound work by Crum and Bailey has also received supportfrom the Defense Advance Research Projects Agency, the NationalInstitutes of Health, and the University of Washington andfoundations associated with it to promote commercialization. Additional References Citations. 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