Shockwave treatment apparatus

A shock wave treatment apparatus, in which a shock wave generator generates a shock wave toward a living body having an object to be disintegrated by the shock wave, and an ultrasonic wave probe transmits an ultrasonic wave toward the living body and receives an ultrasonic wave echo from the living body, in which a B-mode processor forms a B-mode section image from the ultrasonic wave echo, and a color flow mapping processor forms a color flow mapping image from the ultrasonic wave echo, and in which the B-mode section image and the color flow mapping image are displayed on a display. A processor for obtaining doppler information from the ultrasonic wave echo to reproduce doppler sounds from the doppler information may be also provided.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
The present invention relates to a shock wave treatment apparatus for a 
treatment such as disintegration of an object such as a cancer, a 
concretion or the like present within a living body by concentrating shock 
waves on the object located in a focal region or point. 
2. Description of the Background Art 
In FIG. 1, there is shown a conventional shock wave generator 1 for 
destruction or disintegration of a concretion or the like within a living 
body, as disclosed in Japanese Patent Laid-Open Specification No. 
62-49843. In this shock wave generator 1, a shock wave transducer 2 having 
a spherical concave front surface of a certain curvature includes a 
central through hole 2a of a certain shape, and the transducer 2 is 
supported by a backing member 3 adhered to the back surface of the 
transducer 2. A ultrasonic wave probe 4 for scanning the living body to 
obtain a B-mode section image or the like is provided with an ultrasonic 
wave transmitting-receiving surface or alley 4a in its one end, and the 
alley 4a is positioned at the same curved plane of the spherical surface 
of the transducer 2 or retracted therefrom so as to be positioned behind 
the curved plane. The shock wave generator 1 applies shock waves to a 
living body 6 via a water bag 5 containing water therein. 
When a concretion within a living body is to be disintegrated using the 
above described shock wave generator 1, a concentration point positioning 
procedure must be performed. That is, the concentration point of the shock 
waves generated by the transducer 2 must be adjusted such that it 
coincides with the concretion. This concentration point positioning 
procedure is effected by displaying a B-mode section image of the living 
body including the concretion and a target mark representing the 
concentration point of the shock waves on the display and by adjusting the 
target mark to coincide with the, B-mode image of the concretion on the 
display. In this case, the target mark is geometrically determined 
depending on the ultrasonic wave generator 1. 
However, in this case, in practice, it is not easy to confirm the position 
of the concretion in the B-mode image on the display and the actual 
concentration point of the shock waves generated by the tranducer is often 
somewhat different or shifted from the position represented by the target 
mark. Therefore the actual concentration point of the shock waves can not 
be confirmed. Further, after the generation of the shock waves to the 
concretion, it is difficult to confirm how much of the concretion has been 
disintegrated. 
SUMMARY OF THE INVENTION 
It is therefore an object of the present invention to provide a shock wave 
treatment apparatus free from the aforementioned defects and disadvantages 
of the prior art, which is capable of readily confirming a position of an 
object to be disintegrated and an actual concentration point of shock 
waves generated by a shock wave transducer, and confirming results of the 
shock wave generation to the object. 
In accordance with one aspect of the present invention, there is provided a 
shock wave treatment apparatus, comprising means for generating a shock 
wave toward a living body having an object to be disintegrated by the 
shock wave, an ultrasonic wave probe for transmitting an ultrasonic wave 
toward the living body or receiving an ultrasonic wave echo from the 
living body, means for forming a B-mode section image of the living body 
on the basis of the ultrasonic wave echo, means for obtaining an 
ultrasonic wave doppler alteration frequency from the ultrasonic wave echo 
and for performing a color flow mapping process on the basis of the 
ultrasonic wave doppler alteration frequency to form a color flow mapping 
image of the living body, and means for displaying at least one of the 
B-mode section image and the color flow mapping image. 
In accordance with another aspect of the present invention, there is 
provided a shock wave treatment apparatus, comprising means for generating 
a shock wave toward a living body having an object to be disintegrated by 
the shock wave, an ultrasonic wave probe for transmitting an ultrasonic 
wave toward the living body or receiving an ultrasonic wave echo from the 
living body, means for performing a phase detection of the ultrasonic wave 
echo to obtain doppler information, and means for reproducing sound from 
the doppler information.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Referring now to the drawings, wherein like reference characters designate 
like or corresponding members throughout the several views and thus the 
repeated description thereof may be omitted for brevity, there is shown in 
FIG. 2 a first embodiment of a shock wave treatment apparatus according to 
the present invention. 
In FIG. 2, a shock wave generator 16 includes a shock wave transducer 16a 
having a spherical concave surface for generating shock waves therefrom 
and a water bag 16b having flexible bellows 16c for performing an 
effective transmission of the shock waves to a living body P, for 
instance, in order to disintegrate a concretion 31 of an object 32 such as 
a kidney or the like. The shock wave transducer 16a is formed with a 
central hole therein. In this embodiment, various devices such as a 
vibrator having a concave semisphere form, an electromagnetic induction 
type sound source including a combination of a spiral coil and a metal 
membrane arranged close thereto, and the like, can be used to provide the 
shock wave transducer 16a. An ultrasonic wave probe 17 having a ultrasonic 
wave transmitting-receiving surface or alley 17a in its end is arranged in 
the central hole portion of the shock wave transducer 16a. The ultrasonic 
wave probe 17 transmits an ultrasonic wave toward the living body P and 
receives an ultrasonic wave echo therefrom to effect a scanning of the 
living body P for obtaining a B-mode section image, a CFM (color flow 
mapping) image and an M-mode image. 
A timing controller 20 outputs a shock wave generation timing signal to a 
delay counter 19 and a pulser 21. The pulser 21 sends a drive signal to 
the shock wave transducer 16a in order to drive the same, and its driving 
timing is controlled by the shock wave generation timing signal fed from 
the timing controller 20. The delay counter 19 outputs a delayed pulse DP 
to an RPG (rate pulse generator) the delay pulse DP timing being delayed 
by a certain period of time after the shock wave generation timing. The 
delay timing of the delayed pulse DP output by the delay counter 19 is 
controlled by a delay timing set 18. 
The RPC 10 generates a delayed frame pulse DFP to a transmit-receive 
controller 11 and a DSC (digital scan converter) 14 in synchronization 
with the delayed pulse DP output from the delay counter 19. The 
transmit-receive controller 11 controls the ultrasonic wave probe 17 to 
transmit or receive the ultrasonic wave to or from the living body P. The 
transmit-receive controller 11 comprises a transmitter and a receiver. The 
transmitter includes a transmission delay device for setting a certain 
delay time for the transmission of the delayed frame pulse and a pulser 
for generating a pulse for driving the alley 17a of the ultrasonic wave 
probe 17 in synchronization with the delay time given by the transmission 
delay device. The receiver includes a preamplifier for amplifying a 
ultrasonic wave echo received by the ultrasonic wave probe 17, a receipt 
delay device for setting a certain delay time for the output of the 
amplified ultrasonic wave echo, and an adder for adding the delayed 
echoes. 
A B-mode processor 12 includes a detector for performing an amplitude 
detection of an output addition signal of the transmit-receive controller 
11, and an A/D (analog-digital) converter for converting the amplitude 
detected signal to a digital detected signal to obtain a monochrome B-mode 
section image. The operated results of the B-mode processor 12 are sent to 
the DSC 14. A CFM (color flow mapping) processor 13 includes a phase 
detector for effecting a phase detection of the ultrasonic wave echo, an 
MTI (moving target indication) filter for removing a clutter component of 
the output signal of the phase detector, an auto correlator for performing 
an auto correlation of the output signal of the MTI to obtain an 
ultrasonic wave doppler alteration frequency, and a processor for 
operating an average speed and a power of a moving object according to the 
ultrasonic wave doppler alteration frequency to obtain a CFM (color flow 
mapping) image. That is, the CFM processor 13 performs the color flow 
mapping process to obtain a CFM image. The obtained result of the CFM 
processor 13 is fed to the DSC 14. 
The DSC 14 is provided with a frame memory (FM) 14a, in which the scan 
conversion between the sampling and display systems is carried out. The 
writing timing of the data into the FM 14a of the DSC 14 is determined by 
the delayed frame pulse DFP output from the RPG 10. The data of the B-mode 
section image and the CFM image is stored in the FM 14a of the DSC 14. The 
scan conversion result in the DSC 14 is fed to a color display 15. On the 
color display 15, the monochrome B-mode section image 15a and the CFM 
image 15b overlapped thereon are reproduced. 
When the shock waves are generated by the shock wave transducer 16a, a 
large pressure such as several 100 to 1000 bar is exerted at the 
concentration point. As shown in FIG. 3, soon after the shock wave 33 
traveling in a direction F hits an object 31 such as a concretion to be 
disintegrated, the object 31 receives a large pressure and is moved in the 
direction F. Then, after the shock wave 33 passes through the object 31, 
the object 31 is pulled back in a direction F' opposite the direction F by 
a negative pressure component created as the shock wave 33 travels in the 
direction F', as shown in FIG. 4. Thus, the object 31 performs damped 
oscillation. 
When the object 31 is not disintegrated by the shock wave 33, the object 31 
performs damped oscillation while the object 31 retains its original form. 
However, when the object is disintegrated by the shock wave 33, as shown 
in FIG. 5, the disintegrated pieces of the object are moved in all 
directions depending on their relative positions with respect to the 
concentration point of the shock wave and the surrounding conditions 
thereof. Hence, the behavior of the disintegrated pieces can be observed 
by transmitting an ultrasonic wave to a certain region containing the 
disintegrated pieces, obtaining frequency alteration information of the 
ultrasonic wave and analyzing the obtained frequency alteration 
information. 
According to the present invention, an ultrasonic wave doppler alteration 
frequency of an ultrasonic wave is obtained from a received ultrasonic 
wave echo, and a CFM (color flow mapping) process is effected on the basis 
of the ultrasonic wave doppler alteration frequency. The result of the CFM 
process is overlapped on a B-mode section image on a display, and this is 
used as a monitory image during a shock wave treatment, as hereinafter 
described in detail. 
The operation of the above described apparatus will now be described in 
detail. 
The ultrasonic wave probe 17 effects the transmission and receipt of the 
ultrasonic wave to and from the living body P by the transmit-receive 
controller 11, and the transmit-receive controller 11 obtains the 
ultrasonic wave echo. The B-mode processor 12 outputs the result of the 
B-mode process to the DSC 14, and the B-mode section image 15a of the 
living body P is stored in the FM 14a of the DSC 14. Then, the data of the 
B-mode section image 15a is read out of the FM 14a and is sent to the 
display 15 to display the B-mode section image 15a thereon. 
When the shock wave transducer 16a is driven by sending the shock wave 
generation timing signal to the pulser 21, the shock wave transducer 16a 
generates the shock waves to concentrate on the concretion 31 of the 
object such as the kidney in the living body P. 
In the CFM processor 13, the ultrasonic wave doppler alteration frequency 
in the living body P is operated from the ultrasonic wave echo obtained by 
the transmit-receive controller 11, and the CFM process is carried out on 
the basis of the ultrasonic wave doppler alteration frequency. The 
resulting data of the CFM process is fed to the DSC 14, and the CFM image 
is stored in the FM 14a of the DSC 14. In the DSC 14, the CFM image is 
mixed with the monochrome B-mode section image, and the monochrome B-mode 
section image and the CFM image overlapped thereon are displayed on the 
display 15. 
The writing of the data of the B-mode section image and the CFM image into 
the FM memory 14a of the DSC 14 with respect to the shock wave generation 
operation is performed as follows. 
That is, the delayed frame pulse DFP is fed from the RPC 10 to the DSC 14 
at the timing delayed by the predetermined period of time after the timing 
of the shock wave generation. The DSC 14 is started to store the data into 
the FM 14a at the timing of input of the delayed frame pulse DFP, and, 
when one frame of the data is stored in the FM 14a, the storing of the 
data is stopped. This step is repeated for every input of the delayed 
frame pulse DFP into the DSC 14 or every shock wave generation in the 
shock wave transducer 16a. The data writing timing by the delayed frame 
pulse DFP or the delayed pulse DP can be freely determined by the delay 
timing set 18, as described above. That is, in this embodiment, the 
reproducing and displaying of the still picture images such as the B-mode 
section image and the CFM image can be carried out at the best timing so 
that the best mode of the shock wave concentration positioning, the shock 
wave generation results and the disintegration state of the concretion or 
the like can be readily determined or adjusted and observed. 
The CFM image display is effected as follows. 
Different colors such as red and blue signify the approaching and going 
away of the concretion and surrounding tissue thereof to or from the 
ultrasonic wave probe 17, and the average speed or power of the moving 
concretion and surrounding tissue are signified by varying the display 
brightness. Since the concretion and surrounding tissue thereof are 
different in acoustic impedance, the concretion is moved more than the 
tissue thereby making it is easy to discriminate the moving concretion 
from the moving tissue in the CFM image 15b. 
In this case, it is considered that the doppler signal of the concretion is 
larger with respect to that of the other tissue, particularly, the 
surrounding tissue, and hence the position of the concretion can be 
readily confirmed in the CFM image 15b by generating relatively weak shock 
waves during the positioning of the concretion. Also, even when the strong 
shock waves are generated in order to disintegrate the concretion after 
the positioning of the concretion, the concretion is moved more than the 
tissue because of the acoustic impedance difference, and hence the 
position of the concretion can be easily confirmed in the CFM image 15b. 
Also, when the strong shock waves are imparted to the tissue of the living 
body P the tissue is deformed and moved, and this appears in the CFM image 
15b. Hence, the concentration region or point where the shock waves are 
actually generated can be easily confirmed in the CFM image 15b. 
Further, since the moving condition of the concretion against the shock 
waves is different, it is readily known whether the concretion is 
disintegrated or not. When the concretion is disintegrated, the sizes, 
moving directions and degree of dispersion of the disintegrated concretion 
pieces can be readily confirmed in the CFM image 15b by the extent of 
color mixture and the hue variation. 
As described above, it is readily understood that by monitoring the B-mode 
section image and the CFM image overlapped thereon on the display during 
the shock wave treatment, the position of the object such as the 
concretion within the living body can be readily confirmed, and the 
position of the concentration point of the actual shock waves can be 
readily confirmed on the display. Hence, the positioning of the 
concentration point of the actual shock waves on the object can be readily 
performed. Also, the shock wave generation results of the object and 
extent and state of the disintegrated pieces of the object can be readily 
confirmed on the display. Therefore, the time and accuracy of the 
positioning of the concretion and the positioning of the shock waves on 
the concretion can be largely improved, and ineffective operations and 
operator's burden can be largely reduced. 
In FIG. 6, there is shown a second embodiment of a shock wave treatment 
apparatus according to the present invention, having a similar structure 
to the first embodiment shown in FIG. 2, except an M-mode processor 22 for 
obtaining an M-mode image is also included. 
In this embodiment, a first clock pulse generator 20a outputs a first clock 
pulse CP1 to a second clock pulse generator 20b. An RPG (rate pulse 
generator) 10 outputs a rate pulse as a frame pulse FP to a 
transmit-receive controller 11, a DSC (digital scan converter) 14 and the 
second clock pulse generator 20b. The second clock pulse generator 20b 
outputs a second clock pulse CP2 having the same interval as that of the 
first clock pulse CP1 as a shock wave generation timing signal to a delay 
counter 19 and a pulser 21 in synchronization with the frame pulse FP 
output from the RPG 10. The delay counter 19 outputs a freeze signal FS at 
a timing delayed by a certain period of time after the shock wave 
generation timing in sychronization with the frame pulse FP. In FIG. 7, 
there are schematically shown the first clock pulse CP1, the frame pulse 
FP, the second clock pulse CP2 and the freeze signal FS. The delay timing 
of the freeze signal FS output from the delay counter 19 is controlled to 
determine to integral number times as much as the interval of the frame 
pulse FP by a delay timing set 18. 
The M-mode processor 22 includes a detector for performing an amplitude 
detection of an output addition signal of the transmit-receive controller 
11, and an A/D (analog-digital) converter for converting the amplitude 
detected signal to a digital detected signal to obtain a monochrome M-mode 
image. The operated results of the M-mode processor 22 are sent to the DSC 
14. In this case, a CFM processor 13 performs the CFM process in both the 
B-mode and M-mode imagings. The CFM processor 13 can discriminate between 
the B-mode and M-mode image signals and mix or overlap the monochrome 
B-mode or M-mode image signals and the CFM signals to obtain the B-mode 
and M-mode images, as shown in FIG. 10. 
In the M-mode imaging process, doppler signals are picked up from the 
ultrasonic wave echo and are processed with respect to only a certain 
direction such as, in practice, a shock wave concentration point direction 
d, as shown in FIG. 10a, in a depth of the living body P to obtain the 
M-mode image. One example of the M-mode image is shown in FIG. 10b. In 
this embodiment, in addition to the B-mode section image and the CFM 
image, the M-mode image can be utilized. 
In case of the CFM imaging, the doppler signals are processed over a 
certain area to display the CFM image on the display. Hence, the 
reproduccable number of the frame images per second is approximately 10, 
which may be somewhat varied depending on the various conditions. In case 
of the M-mode imaging, the doppler signals are operated only along one 
direction such as, in practice, the direction the shock wave concentration 
point is positioned, and thus a much greater number of the frame images 
can be reproduced compared with that of the CFM imaging, that is, the 
resolving power per unit time can be largely improved, resulting in that 
the doppler signals can be observed with a high resolving power in the 
M-mode image. 
In this embodiment, the writing of the data obtained in the B-mode 
processor 12, the CFM processor 13 and the M-mode processor 22 into the 
frame memory 14a of the DSC 14 with respect to the timing of the shock 
wave generation operation is carried out at the desired timing by using 
the freeze signal FS output from the delay counter 19 in a similar manner 
to the first embodiment described above. Hence, in this case, the 
reproducing and displaying of the still picture images can be carried out 
at the best timing so that the best mode of the shock wave concentration 
positioning, the shock wave generation results and the disintegration 
state of the concretion or the like can be readily determined or adjusted 
and observed. In this embodiment, the same effects and advantages as those 
of the first embodiment can be obtained. 
In FIG. 8, there is shown a third embodiment of a shock wave treatment 
apparatus according to the present invention, having a similar structure 
to the first and the second embodiments described above. 
In this embodiment, a timing controller 20 outputs a clock pulse CP as a 
shock wave generation timing signal to a delay counter 19 and a pulser 21. 
A delay counter 19 outputs a delayed clock pulse DCP to an RPG 10 at a 
timing delayed by a certain period of time after a shock wave generation 
timing. The delay timing of the delayed clock pulse DCP output by the 
delay counter 19 is continuously controlled by a delay timing set 18. 
In this case, in the RPG 10, a timing of a delayed frame pulse DFP is 
controlled by the delayed clock pulse DCP fed from the delay counter 19 in 
order to compulsorily synchronize with the timing of the delayed clock 
pulse DCP. In FIG. 9, there are schematically shown the clock pulse CP as 
the shock wave generation timing signal, the delayed clock pulse DCP and 
the delayed frame pulse DFP. In this embodiment, the writing of the data 
obtained in the B-mode processor 12, the CFM processor 13 and the M-mode 
processor 22 into the frame memory 14a of the DSC 14 with respect to the 
timing of the shock wave generation operation is carried out at the 
desired timing by using the delayed frame pulse DFP output from the RPG 10 
in a similar manner to the above described embodiments. 
In this embodiment, the delay timing of the delayed clock pulse DCP can be 
continuously changed, and hence more accurate control can be performed as 
compared with the second embodiment described above. In this case, the 
same effects and advantages as those of the first and second embodiments 
can be obtained. 
In FIG. 11, there is shown a fourth embodiment of a shock wave treatment 
apparatus according to the present invention, having a similar 
construction to the first embodiment described above, except that a 
doppler processor 29 for outputting doppler information in an audio signal 
form is provided. 
In this embodiment, a timing controller 20 outputs a timing control signal 
TCS as a shock wave generation timing signal to a pulser 21 and a switch 
27 for performing an open-close control in synchronization with the timing 
control signal TCS. A clock pulse generator 26 generates a clock pulse to 
a frequency divider 24 which outputs a frequency divided signal FDS to the 
timing controller 20. An RPG (rate pulse generator) 10 generates a rate 
pulse as a frame pulse FP to a transmit-receive controller 11, a DSC 
(digital scan converter) 14 and a delay circuit 23. The delay circuit 23 
sets back the frame pulse FP a certain period of time and sends a delayed 
frame pulse DFP to the timing controller 20. 
In this case, the timing controller 20 outputs the shock wave generation 
timing signal TCS to the pulser 21 at a timing delayed by a desired period 
of time t after the timing of the frame pulse FP. Hence, the reproducing 
and displaying of the still picture images can be effected at the best 
timing in the same manner as described above. In FIG. 12, there are 
schematically shown the frame pulse FP, the delayed frame pulse DFP, the 
frequency divided signal FDS and the timing control signal TCS along with 
on and off modes of the switch 27. A system controller 25 controls the 
operation of the whole system of the shock wave treatment apparatus. 
In the DSC, the writing of the data obtained in the B-mode processor 12 
into a frame memory (FM) 14a with respect to the shock wave generation 
timing is started by the frame pulse FP fed from the RPG, and, when one 
frame of the data is stored in the FM 14a, the data storing is stopped. 
This step is repeated. 
A doppler processor 29 includes a phase detector for effecting a phase 
detection of an ultrasonic wave echo sent from the transmit-receive 
controller 11, and a processor for setting a sample gate position. In the 
doppler processor 29, audio signals representing doppler information in 
the sample gate position is picked up from the ultrasonic wave echo. The 
audio signals are fed from the doppler processor 29 to a speaker 28 via 
the switch 27, and the speaker 28 reproduces doppler sounds from the audio 
signals. The doppler processor 29, the speaker 28 and the switch 27 may 
constitute first, second and third means, respectively. 
The operation of this apparatus will now be described in detail in 
connection with FIGS. 11 and 12. 
The delay circuit 23 outputs the delayed frame pulse DFP to the timing 
controller 20, and the frequency divider 24 sends the frequency divided 
signal FDS to the timing controller 20. After the frequency divided signal 
FDS is turned to the high level, the timing controller 20 outputs the 
timing control signal TCS as the shock wave generation timing signal at 
the timing of the following delayed frame pulse DFP, i.e., in 
synchronization with the leading edge of the delayed frame pulse DFP. The 
shock wave transducer 16a is driven to generate the shock waves at the 
timing of the leading edge of the shock wave generation timing signal TCS. 
By using this timing control, the affecting area direction or path of the 
shock waves in a B-mode section image can be freely controlled. For 
instance, that is, although it is not effective or practical for treating 
an object such as a concretion, by varying the delay time of the frame 
pulse FP in the delay circuit 23, the affecting area direction or path of 
the shock waves can be positioned in a right hand side end portion 15c in 
the B-mode section image 15 a, as shown in FIG. 11. 
When the ultrasonic wave echo is sent from the transmit-receive controller 
11 to the doppler processor 29, the phase detection of the ultrasonic wave 
echo is effected and the doppler information is picked up in the form of 
the audio signals in the doppler processor 29. The audio signals are sent 
to the speaker 28 through the switch 27, and the speaker 28 reproduces the 
doppler sounds from the audio signals. By monitoring the doppler sounds, 
the extent and state of the shock wave generation and disintegrated object 
pieces and so forth can be readily confirmed. 
In this embodiment, the doppler information pickup is carried out by using 
the pulsed wave doppler method, and the doppler information in the sample 
gate position determined in the B-mode section image is obtained. That is, 
by setting the sample gate position to a portion containing the 
disintegrated object pieces in advance, the doppler information of or near 
the disintegrated object pieces can be effectively obtained. 
Further, in this embodiment, the continuous wave doppler method may be also 
applied. In this case, a particular vibrator for the continuous wave 
doppler information pickup may be provided near the ultrasonic wave probe 
17. Alternatively, a part 17b of the vibrator elements of the alloy 17a of 
the ultrasonic wave probe 17 may be used for the continuous wave doppler 
information pickup only, as shown in FIG. 13. 
It is considered that, when the shock wave components are mixed with the 
doppler sounds to be output from the speaker 28, it becomes difficult to 
monitor the doppler sounds. In order to prevent this problem, the switch 
27 is turned off in synchronization with the shock wave generation timing 
signal output from the timing controller 20 to remove the shock wave 
components from the doppler sounds. That is, as shown in FIG. 12, the 
switch 27 is turned off at the timing of the loading edge of the timing 
control signal TCS fed from the timing controller 20 to prevent the shock 
wave components from mixing in the doppler sounds, with the result of 
clearly monitoring the doppler sounds. Further, by making the OFF period 
of time of the switch 27 to be variable, more accurate or precise control 
for removing the shock wave component can be performed. 
According to the present invention, a CFM processor 13 and/or an M-mode 
processor 22 of the second embodiment may be also provided in the 
apparatus described above, with the result of obtaining the same effects 
and advantages as those of the first and second embodiments. 
In FIG. 14, there is shown a fifth embodiment of a shock wave treatment 
apparatus according to the present invention, having the same structure as 
the fourth embodiment shown in FIG. 11, except a doppler phonocardiograph 
30 is provided. 
In this case, the doppler phonocardiograph 30 includes a ultrasonic 
transmit-receive member 30a, a doppler phonocardiograph body 30b and a 
speaker 30c, which are coupled in series. The ultrasonic transmit-receive 
member 30a transmits a ultrasonic wave toward an object 31 such as a 
concretion within an internal organ such as a kidney 32 in a living body P 
and receives a reflected component. The body 30b picks up doppler 
information from the reflected component, and the doppler information is 
reproduced in the sound form by the speaker 30c. The body 30b and the 
speaker 30c may constitute first and second means, respectively. 
In this embodiment, the body 30b includes a device for preventing shock 
wave components from mixing in the doppler sounds in synchronization with 
the shock wave generation timing signal output from the timing controller 
20, this shock wave preventing device having a similar construction to 
that of the fourth embodiment shown in FIG. 11, with the result of clearly 
monitoring the doppler sounds. The body 30b may constitute third means. In 
this embodiment, the same effects and advantages as those of the fourth 
embodiment can be obtained. 
Although the present invention has been described in its preferred 
embodiments with reference to the accompanying drawings, it is readily 
understood that the present invention is not restricted to the above 
described preferred embodiments, and various changes and modifications may 
be made in the present invention by those skilled in the art without 
departing from the spirit and scope of the present invention.