Device for shock waves treatment.

The invention relates to an apparatus for shock wave treatment as 423 534. from the subsequently published, the state of the art under Article 54 (3) EPC belonging EP-A1-0. The same has two locating devices, namely an ultrasound locating device and an X-ray locating device which pierce the cap of the shock wave transducer and extend into the flow path thereof. The X-ray locating device includes a delay line arranged inside the tube, which is closed at its end directed towards the membrane with a balloon. Tube and balloon are opposite the coupling medium of the delay line and sealed with a gas such. As air can be filled to dampen serving for locating X-rays as little. During operation of the device tube and balloon are so filled with gas that the balloon on the inside of the membrane and thus indirectly invests in the body being treated, whereby it is achieved that the liquid contained within the coupling member, the X-ray high-damping coupling medium is almost completely displaced from the X-ray beam path.

By this measure the X-ray location is to a considerable extent improved because the distance the gas passing X-rays experience a much lower damping than would be the case with a liquid coupling medium. As disadvantage it has proved that the tube due to its necessary for a good X-ray localization length occludes a relatively large part of the soundfield of the shock wave transducer. Such shadowing also passes through the balloon, so that a shortening of the tube with a corresponding enlargement of the balloon is not an improvement, at least in terms of shading, since the balloon has to be dilated to X-ray locating such an extent that he no longer can adjust the X-ray cone and a relatively large portion of the sound field shades. It has been shown that such a shading of the sound field can affect the efficiency of shock wave therapy.

Proceeding from this, the invention has the object, in particular the X-ray locating device in the known device in such a way that both the shockwave and the X-ray localization can be performed without mutual interference under optimal conditions.

This object is achieved in that the tube is formed within the forward stage adjustable in length in its axial direction. This makes it in the shockwave therapy possible to reduce the identified requirement in accordance with the tube with respect to its length so much that the sound field of shock wave transducer is not or only slightly restricted. While the shortening of the X-ray tube allows the continued use of the X-ray locating device but with the restriction that due to the contained within the X-ray beam path liquid Ankoppelmediums the resolution of the X-ray image is reduced. If higher resolution is required, the length of the tube to displace the liquid coupling medium must be increased in the direction of the membrane. The invention allows to operate in an optimal way by the change in length of the tube, both the X-ray location as well as the shock wave therapy.

Further advantageous embodiments of the invention are characterized by the features listed in the dependent claims.

Advantageously, the change in length of the tube is accomplished by a telescopic design of the same. This enables the tube length to be continuously changed. The inventive construction of the tube further has the great advantage that even no structural changes be made to the X-ray source, whereby z. B. generic devices of older design can easily be retrofitted.

Appropriately, the tube made of telescoping concentric pipe sections whose diameters are selected according to the towards the membrane widening ray.

Advantageously, the length of the X-ray tube can be varied by applying a positive or negative pressure. This allows on the one hand achieves a stepless change in length of the tube and on the other to complicated mechanical drive means in the range of the delay line are omitted. By caused by vacuum and pressure change in length of the X-ray tube in the direction of the diaphragm, the dome final, it is also unproblematic that dissipate through the tube in the coupling member coupling medium displaced or this in turn supplied to the delay line at shortening the tube length. For this purpose, divided into two chambers a surge tank may be provided, of which one chamber communicates with the flow path and whose other chamber is connected with the closed by an elastic diaphragm or the like Tubusinneren via lines. Such compensation system is described in German Patent Application P 39 34 105.4, which are incorporated herein by reference.

In particularly advantageous manner, the X-ray tube according to the invention is equipped with an inflatable balloon, which runs inside the X-ray tube along the tube wall and in a simple manner, for example by means of a clamping ring, is fixed to the end of the tube kalottennahen gas-tight against the Tubusinnenwand. Thus, the change in length of the tube over this balloon by applying a positive or negative pressure can occur. By the use of the balloon can each other on an additional sealing of the tube with respect to the coupling medium located within the flow path, in particular a complicated sealing of the individual telescopic tube sections, be dispensed with. The balloon can be configured in particular in the area of ​​the tube wall relatively thin because it is supported over its entire circumference through the tube wall.

In order to make a change in length of the tube, the balloon must be secured in addition next to the attachment to the kalottennahen end of the tube at the free end for example by means of a clamping ring.

The invention is described below with reference to an embodiment shown in the figures described, the further advantageous embodiments of the invention illustrated. Show it:<dl id="dl0001"><dt>figure 1</dt><dd>part of an integrated in the canopy of a shock wave transducer X-ray locating device with an X-ray tube according to the invention,</dd><dt>figure 2</dt><dd>the schematic representation of the cap of a shock wave transducer in section, with the X-ray tube in the first end position,</dd><dt>figure 3</dt><dd>the cap of the shock wave transducer according to Figure 2 with partially telescopically extended X-ray tube,</dd><dt>figure 4</dt><dd>the cap of the shock wave transducer according to Figure 2 with the X-ray tube in the second end position.</dd></dl>

The only partially illustrated in FIGS generic device comprises a shock wave transducer with a focusing cap 2 with an adjoining filled with a liquid coupling medium 3 and a shown in Figures 2 to 4 membrane 4 outwardly sealed flow path in a known manner ,

To carry out a shock wave treatment, it is necessary to locate the concretion to be treated 24 or tissue and bring into focus the dome. 2 For this purpose, two locating devices, namely an X-ray locating device 5 and an ultrasound locating device 6 are provided which are penetrating the cranium 2 or set forth in this and protrude into the standoff.

The present invention is the formation of the X-ray locating device 5, which is why the ultrasound locating device is not described in detail here 6. It may optionally contain other locating devices can be provided, also is the ultrasound locating device 6 course not mandatory.

The X-ray locating device 5 has a substantially outside of the cap 2 arranged X-ray source 7 whose length-adjustable tube 8 extends into the filled through the coupling medium 3 standoff. The X-ray tube 8 in the illustrated embodiment consists of three concentrically arranged and reciprocally insertable pipe sections 9, 10 and 11, which form a telescope system (see Figure 1). Depending on requirements, the number of pipe sections and whose dimensions may be chosen larger or smaller. Within the tube formed by the sections 9, 10 and 11 are X-ray tube 8, an elastic, the interior of the X-ray tube 8 with respect to the coupling medium 3 sealing balloon 12 is disposed. The balloon 12 is connected at its open end by a disposed within the kalottennahen pipe section 9 first clamping ring 13 fixed to the X-ray tube 8, the clamping ring 13 the surrounding balloon 12 presses the gas-tight seal against the inside of the pipe section. 9

Of the tube 8 gas- and liquid-tight final balloon 12 is a collar placed over the end of the tubular portion 11 and defined by an on the outside of the pipe section 11 arranged second clamping ring 14 thereto.

The X-ray tube 8 with its tube section 9 is inserted via rubber seals 15 tightly into a socket 16, which is firmly and tightly in the dome. 2 The X-ray tube 8 is closed at its end by a spherical cap X window 17 sealed against the X-ray source. 7

Within the socket 16 and the tube portion 9, a channel 18 is provided, which connects the Tubusinnere 21 and 22 through the terminal 19, and the valves with the pump 23rd

The valves 21 and 22 can with the two chambers of a surge tank to the German patent application P 39 34 105.4 are connected, the chambers are filled with gas on the one hand and on the other with the liquid coupling medium. 3

By introducing gas into the X-ray tube 8 whose length can be adjusted continuously to the second end position illustrated in Figure 4, in which the X-ray tube the final balloon end abuts the membrane 4, displaced from said first end position shown in FIG. 2 By further supply of gas of the example is existing 8-fitting and radially supported by the tube sections 9,10,11 radiopaque balloon 12 deployed from the latex in the inner wall of the X-ray tube completely, whereby the liquid coupling medium is completely displaced and the balloon to the membrane 4 of the dome rests. By evacuating the balloon 12 through the channel 18 and the line 20 of the X-ray tube 8 can be reduced to its shortest length.

Figures 2 to 4 show different operating positions of the ultrasonic locating device 6 and the X-ray locating device 5. In the position shown in Figure 2, both the ultrasound locating device 4 and the X-ray tube 8 of the X-ray locating device 5 are accommodated in a membrane-distant position, in which no, or the least possible shading of the sound field is given. In this position, an in situ X-ray and ultrasound localization as well as a particularly efficient shock wave application is possible.

Figure 3 shows the ultrasound locating device 6 in the membrane-proximal position, wherein the length of the X-ray tube 8 of the X-ray locating device 5 is reduced to about half the length. In this position there for the ultrasound locating device 6 optimal and for the X-ray locating device 5 a relative to the position shown in Figure 2 improved image quality, while the efficiency of shock wave application due to the caused by the locating devices 5 and 6 shadowing the sound field only slightly degraded and for a effective shockwave treatment is still acceptable.

Figure 4 shows a position, abut in which both the ultrasonic locating device 6 as well as the X-ray locating device 5 on the diaphragm 4th In this position, the best picture is the added within the body of lying person to be treated the calculus 24 or tissue, in which position is no longer possible due to the strong shading of the sound field by the locating devices 5 and 6 an efficient shockwave treatment.

By the continuously length-adjustable X-ray tube 8, the shading of the sound field can be minimized, for purposes of therapy and the resolution of the X-ray locating device 5 are optimized for the purpose of positioning. Depending on the application, the therapist between the respective Optima can freely choose and to optimize the treatment by locating the concretion or tissue 24 on the one hand and the destruction of the concretion 24 by shock waves on the other.