Abstract:
The disclosure relates to a device for locating and disintegrating body anomalies and displaying real time images of a body anomaly during treatment. The images are formed between pulses of disintegrating treatment waves by an ultrasound scanner in line with a shock wave treatment beam.

Description:
CROSS REFERENCE TO PRIOR APPLICATIONS 
     This is a division of Ser. No. 037,369, filed Apr. 13, 1987, abandoned, which is a division of Ser. No. 728,905, filed Apr. 30, 1985, which is U.S. Pat. No. 4,658,828, now U.S. Pat. No. Re. 33,590 of May 21, 1991 which is a continuation-in-part of Ser. No. 674,889, filed Nov. 26, 1984, now U.S. Pat. No. 4,617,831, now Re-Examination Certificate B1-4,617,931 of Jul. 12, 1988. 
    
    
     BACKGROUND OF THE INVENTION 
     The invention proposes applying ultrasound waves to surgical examination and treatment of anatomic anomaly targets within a body through the skin; and provides a system of apparatus which combines the three functions of localizing a target structure in the zone to be treated; of treating with elastic shock waves in a well controlled way in a well defined restricted region within this zone; and simultaneously checking the progressive results of the treatment with ultrasound during treatment. 
     SUMMARY OF THE INVENTION 
     The invention combines a generator exciting a pulsed focused elastic shock wave treatment beam comprising a main wave emitter and a main transducer, with a separate echography in-line ultrasound imaging device comprising an auxiliary high frequency pulse generator associated with an auxiliary piezoelectric transducer and with means causing the zone to be treated to be swept, during treatment, by the ultrasound examination beam generated by the auxiliary transducer. 
     The invention advantageously comprises a first auxiliary ultrasound locating operation mode during which emission of the examination beam as scanning pulses by at least one auxiliary transducer is effected; and preferably a second auxiliary mode for checking the focal region, during which reduced power periodic emission of the treatment beam is effected. Echos are received by the scanner. The main emitter is synchronized by the synchronization circuit of the auxiliary generator for echographic operation. 
     During the auxiliary operating modes for obtaining accurate adjustments, the quality of the echographic image, either of the anomaly in the zone located within a body to be treated (locating mode) or of the focal region (mode for checking the restricted region), will be substantially better than during the treatment mode, during which successive images of the zone to be treated will follow each other for example at intervals of the order of up to a second, which however allows the position of the focal region to be checked satisfactorily during treatment. 
     The invention includes switching and adjusting means causing, during main power treatment and checking operations, the pulsed emission of a treatment sequence of vibration elastic shock wave discharges as a focused beam by the main transducer, energized by the main emitter, during periodic time intervals separated by time intervals during which formation of echographic images is carried out. 
     In a preferred embodiment, the auxiliary transducer is linked in line to the treatment device which may comprise a curved concave focusing surface and thus, during movement of the focusing device to aim the treatment beam and to bring the treatment focal spot into successive restricted regions of the zone, the auxiliary transducer will at all times, except when the treatment beam operates, supply a real time image of a target structure in the treated region and of the zone which surrounds it, thus allowing a continuous check of the treatment zone to be effected easily and accurately. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     Other features and advantages of the invention will be clear from the following description. 
     In the accompanying drawings: 
     FIG. 1 is a general diagram of apparatus according to a preferred embodiment of the invention; 
     FIG. 2 shows schematically in perspective the main transducer and its adjustable support device; and 
     FIG. 3 illustrates the image obtained on the display screen which the apparatus comprises. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     In FIG. 2 is shown a main transducer 1 in the form of a spherical segment concave focusing surface supported by a mount which allows it to adjust position and to move in any order along three orthogonal axes X, Y and Z. This mount has been shown schematically, its construction being within the scope of a man skilled in the art. The focal spot formed in the center F of the sphere may, with this technique, be very small (diameter of 2 or 3 mm for example) and have a position which is strictly fixed for a given position of the transducer. 
     Generally in line along or in the direction of an axis of the spherical segment in the direction of the shock wave transmission path to the target there is disposed at least one auxiliary transducer 2 of a generally cylindrical shape which preferably passes through segment 1 and is fixed thereto. The ultrasound scanning device is preferably coaxial with the treatment focusing means and lies in line along the shock wave path to the target. 
     A pocket of water P is placed between the segment 1 and a patient so that the water or the pocket wall may contact the skin surface S of the body of the patient, who is assumed to be lying flat on a horizontal plane to provide an acoustic skin coupling through a portion of the body. 
     The concave curved focusing segment 1 has for example a diameter of 200 to 300 mm and when it is an active surface is formed from a large number (300 or 400) of piezoelectric elements 10, 11, etc . . . (FIG. 1) isolated from each other and juxtaposed to form a mosaic. The elements are metallized on both faces, one of the metallizations being connected to ground and the other to connections for energization by a main emitter 3 (FIG. 1). 
     Preferably, the elements of treatment transducer 1 are divided into groups or arrays each energized by a separate emitter (rectangle 3 symbolizing the assembly of these emitters), the elements of each group being spaced apart in the same circular zone of the spherical surface. By adjusting the relative phases of emissions, it is possible to modify the energy distribution in the focusing region of the ultrasound beam. 
     Emitter 3 delivers an electric signal to form interrupted periodic high frequency shock waves (500 KHz for example) during treatment as elastic ultrasound vibration shock wave discharges separated by interruption time intervals for the echography device to form an image. Operating conditions may be provided by emitters using power transistors. 
     An input 31 to emitter 3 symbolizes means for adjustment of the emitted power and an input 32 symbolizes means for adjustment of the pulse shape or wave duration. 
     In FIG. 1 it can be seen that the ultrasound scanning auxiliary transducer 2, which may comprise an active surface, is itself connected both, to a separate high frequency electric pulse emitter 21 and to a reception amplifier 22 followed by an analog-digital converter 23, itself followed by a memory 24. Emitter 21 can be connected to and synchronized by a pulse generator 211 which delivers for example a sequence of 256 pulses during successive time intervals of 1/10 second. Each of these time intervals corresponds to a complete sweep of a given angular sector (FIG. 1) by the beam emitted by transducer 2. 
     Transducer 2 is advantageously of the type described in U.S. Pat. No. 4,418,698, granted Dec. 31, 1983, comprising an oscillating piezoelectric element 200 controlled by a motor 201, itself controlled by an electronic circuit which is shown symbolically by a rectangle 4. This circuit provides control signals for the motor 201 housed inside the case of the transducer 2 and is adapted so that a complete oscillation of the motor corresponds to the above defined duration for forming an image (1/10 second). 
     In a first operation mode (treatment and checking) switch 210 is in position 1 as well as switches 212 and 33. In position 1 of switches 33 and 212, generator 211 is synchronized by a first output 41 of circuit 4, which is adjusted by means, not shown, for generating signals at its output 43 connected to motor 201. A scan is then swept, through the body, and the echos are converted to displayed electric signals. This is followed by a time interval during which no image is formed. 
     During intervals between the sweep periods, a circuit 34 generates square waves which synchronize emitter 3, whereas during sweep periods, a circuit 213 generates square waves of 1/10 second which synchronize the generator 211. 
     Thus, in this operating mode, transducer 1 generates an interrupted shock wave beam whereas the echography device forms an image for example every second in the intervals or interruptions between the treatment waves. 
     In a second operating mode (locating) with switch 210 in position 1, switch 33 is in position 11, so that emitter 3 is not synchronized and the focused treatment beam is not emitted. Switch 212 is also in position 11 so that generator 211 is synchronized by a second output 42 of circuit 4 which is adjusted to generate signals at its output 43. The echograph sweeps are separated by intervals and images are formed from echos converted to electric signals coming from reflection of the pulses generated by transducer 2. Generator 211 delivers the signals. 
     In a third operating mode (checking the focal region), switch 210 is in position 111, so that the emitter 21 and transducer 2 do not emit. Switch 212 is again in position 11 so that generator 211 is synchronized by the output 42 of circuit 4 which is adjusted, as in the second operating mode. Switch 33 is in position 111 and consequently emitter 3 is synchronized by the generator 211 which then delivers the signals In this third operating mode, the echographic device is therefore formed by emitter 3, transducer 1 operating for emission and transducer 2 operating for reception. The result is that an image is obtained of the distribution of the concentration of energy in the focal region emitted by the transducer 1. 
     Echographic signals reflected from surfaces in the treated zone received at 22 in the first or third operating modes are, after analog-digital conversion at 23, stored line by line in memory 24, a writing addressing device 25, controlled by circuit 4, causing the respective deflection angles of the beam emitted and/or received by transducer 2 to correspond with the respective lines of the memory. A device 26 for rapid reading of the memory energizes the X and Y deflection coils of a cathode ray tube 28, so the brightness control electrode receives the corresponding contents from memory 24, transformed into an analog-signal by a digital-analog converter 27. The electrical signals from the echos are then displayed as an image of the anomaly in the zone. 
     Practical construction of all the circuits described and shown is within the scope of a man skilled in the art. 
     The apparatus which has been described operates as follows: 
     In the locating operating mode, the operator searches for and localizes the anomaly in the zone to be treated and/or altered. The display device is adapted, in a way known per se, to materialize a cursor mark on the screen of the cathode ray tube (for example by a cross) indicating the theoretical position of the focal spot of the treatment beam in the sectional plane shown, which plane passes through the axis of symmetry of transducer 1. The mark and zone are then brought into and maintained in coincidence to aim the treatment beam. The treatment transducer 1 is connected to the examination scanner 2. (It is a matter of B type echography). The operator begins aiming by moving transducer 1, in any order, for example, along axis X, until the treatment zone appears clearly on the screen, then he moves it for example along axes Y and Z, until the cursor cross mark coincides with the central region of the image in the zone of the anatomical anomaly (K, FIG. 3). 
     At this stage, the switches may be placed in position for checking the focal region: this region is then visible on the screen with a luminosity proportional to the corresponding distribution of energy concentration. Thus a representation is obtained of what the distribution of energy of the treatment wave will be during treatment which allows adjustments to be checked and perfected. 
     During treatment, the apparatus supplies, for example, only one image per second, but this rate is sufficient for substantially continuously checking the position of the focal spot. 
     It is clear that the apparatus described allows the evolution of the treatment to be checked during and after each treatment sequence. It is evident that different modifications may be made thereto, even according to other embodiments, without departing from the scope and spirit of the invention.