Simultaneous Photoacoustic Imaging and Cavitation Mapping in Shockwave Lithotripsy.

Kidney stone disease is a major health problem worldwide. Shockwave lithotripsy (SWL), which uses high-energy shockwave pulses to break up kidney stones, is extensively used in clinic. However, despite its noninvasiveness, SWL can produce cavitation in vivo . The rapid expansion and violent collapse of cavitation bubbles in small blood vessels may result in renal vascular injury. To better understand the mechanism of tissue injury and improve treatment safety and efficiency, it is highly desirable to concurrently detect cavitation and vascular injury during SWL. Current imaging modalities used in SWL ( ${e.g.}$ , C-arm fluoroscopy and B-mode ultrasound) are not sensitive to vascular injuries. By contrast, photoacoustic imaging is a non-invasive and non-radiative imaging modality that is sensitive to blood, by using hemoglobin as the endogenous contrast. Moreover, photoacoustic imaging is also compatible with passive cavitation detection by sharing the ultrasound detection system. Here, we have integrated shockwave treatment, photoacoustic imaging, and passive cavitation detection into a single system. Our experimental results on phantoms and in vivo small animals have collectively demonstrated that the integrated system is capable of capturing shockwave-induced cavitation and the resultant vascular injury simultaneously. We expect that the integrated system, when combined with our recently developed internal-light-illumination photoacoustic imaging, will find important applications for monitoring shockwave-induced vascular injury in deep tissues during SWL.