A lithotripsy device for use in thermal lithotripsy procedure and method of thermally ablating lithotripsy target

Abstract

The invention relates to a lithotripsy device for use in a thermal lithotripsy procedure and a method of thermally ablating a lithotripsy target. The lithotripsy device can include an elongate member having a proximal end and a distal end, and a first thermal lithotripsy transducer (e.g., a thermoelectric transducer such as a thermocouple) located at the distal end of the elongate member. The first thermal lithotripsy transducer is configured to heat and cool in response to an applied first electrical input signal to emit a hot lithotripsy dose toward a lithotripsy target.

Description

Technical Field

[0001] The present disclosure relates to the treatment of stones such as kidney stones during lithotripsy surgery. In particular, the present disclosure relates to a lithotripsy device that uses a thermoelectric transducer to emit a thermal lithotripsy excitation to a lithotripsy target. Background Art

[0002] Lithotripsy may involve treatment of a target such as a stone (e.g., a kidney stone or a gallstone), or treatment of a tissue portion such as for cutting or cauterizing tissue. Stones can be formed from different substances and can have different densities or hardnesses. For example, harder kidney stones may be formed from calcium oxalate or calcium phosphate, while softer kidney stones may be formed from uric acid. Kidney stones may have a softer "shell" and a harder core, or vice versa.

[0003] In such lithotripsy, laser or electromagnetic or ultrasonic energy may be emitted from a source such as a laser or ultrasonic transducer to reduce the stones into small fragments or to a dust-like consistency which may pass naturally from the body or be actively removed using a retrieval device or by flushing with a solution such as saline. Summary of the invention

[0004] This document describes systems and methods for stone ablation (lithotripsy) using thermal cycling (thermal lithotripsy). Thermal cycling (e.g., having a cycle time of 5 seconds or less) can cause harder stones (e.g., stones formed of calcium oxalate or calcium phosphate) to break or be removed from a tissue portion using cycles of one or both of thermal expansion or thermal contraction. The cycle time of the thermal cycle can be any time or duration required or suitable for a particular lithotripsy procedure. A thermal lithotripsy device used in a thermal lithotripsy procedure can include an elongated member or slender member, such as a flexible portion of a catheter or a scope (e.g., an endoscope) having a proximal end and a distal end. The lithotripsy device can be included as part or component of an endoscopic system, which can include or be connected to a flushing system, a control circuit system or similar controller or computer component, various sensors (e.g., temperature or pressure sensors), etc. The scope can include a working channel, and the elongated member can be sized and shaped to be inserted through the working channel of the scope so as to emit a thermal lithotripsy dose toward the lithotripsy target from a position at or near the distal end of the scope.

[0005] The lithotripsy device may include one or more thermal lithotripsy transducers (e.g., one or more thermoelectric transducers such as thermocouples) located at the distal end of the elongated member. The thermoelectric transducers may be configured to heat, cool, or both heat and cool in response to an applied electrical input signal. In an example, the transducer may be configured to actively heat and actively cool in response to the input signal. In another example, the transducer may be configured to actively heat and passively cool. Such thermoelectric heating and cooling may be used to emit a thermal lithotripsy dose toward a lithotripsy target, wherein such a thermal lithotripsy dose may include cyclic heating and cooling that is capable of fragmenting the lithotripsy target. Thus, thermal lithotripsy may include heating and / or cooling (e.g., actively heating and / or actively cooling) the thermal lithotripsy transducer to generate a thermal lithotripsy dose at the thermal lithotripsy transducer. A thermal lithotripsy dose (e.g., as a thermal shock wave) may then be emitted from the thermal lithotripsy transducer toward the lithotripsy target to remove and / or ablate or fragment the target.

[0006] The thermoelectric transducer may include a first conductive material, a second conductive material, and a junction between the first conductive material and the second conductive material. The lithotripsy device may include a controller circuit system or be connected to a controller circuit system. The controller circuit system is operable to control the pulses of the electrical input signal at a specific frequency, thereby operating the thermoelectric transducer to perform thermal lithotripsy on the lithotripsy target. The controller circuit system may control the electrical input signal to cause a thermal cycle to occur or repeat, for example, between a relatively high temperature and a relatively low temperature, for performing thermal lithotripsy on the lithotripsy target. For example, the thermal cycle may be between a first temperature of 0 degrees Celsius (°C) and a second temperature of 50°C, or between other first and second temperatures within the range (including the first and second temperatures).

[0007] The distal end of the elongated member carrying the thermal lithotripsy transducer may be flat, convex, dome-shaped, hemispherical, etc., so as to accommodate a plurality of thermoelectric transducers. When a plurality of thermoelectric transducers are included at the distal end or distal end of the scope, each of the plurality of thermoelectric transducers may be operated independently of one another. For example, when a second thermoelectric transducer is included in the distal end or distal end of the scope, the second thermoelectric transducer may be controlled by an applied second electrical input signal so that the second thermoelectric transducer may be operated separately from or independently of the first thermoelectric transducer. The use of thermoelectric transducers that can be operated independently of one another may allow for more precise heating and cooling. This in turn may allow for a more targeted thermal lithotripsy dose to be delivered to the target.

[0008] The amount of energy, current and voltage of the electrical input signal of a specific thermoelectric transducer can be established or adjusted, for example, it can include operating the thermoelectric transducer using duty cycle control and / or pulse width control of the electrical input signal. The electrical signal or other input signal can include a square wave, a triangular wave, or any type of desired or appropriate signal waveform. The duty cycle or pulse width can be selected or controlled and can be used to control the thermal cycle of the thermoelectric transducer (e.g., a square wave with a 50% duty cycle). The pulse width and / or the duty cycle can be automatically established or adjusted during surgery by artificial intelligence (AI) or machine learning (ML) or other algorithms (e.g., non-AI or non-ML deterministic algorithms) or processes or by a doctor manually. In an example, the process can run semi-automatically, such as under manual supervision. For example, the process can make recommendations to the doctor, who can accept or reject the recommendations at his or her will. Additionally or alternatively, a hardware-based feedback loop can be used for regulation.

[0009] A temperature sensor may be included. The temperature sensor may be configured to monitor the temperature at or near the distal end of the elongated member. The temperature sensor may also be configured to send a signal representing the monitored temperature to the control circuit system. Based on the monitored temperature, the control circuit system may adjust one or more electrical input signals to control one or more thermoelectric transducers, such as heating and cooling, to emit a thermal lithotripsy dose toward the lithotripsy target. Additionally or alternatively, the process may receive or determine a thermal lithotripsy ablation parameter of the lithotripsy target. Based on the thermal lithotripsy ablation parameter, the control circuit may adjust the frequency or period of the electrical input signal to the thermoelectric transducer to control the thermal cycle. The ablation parameter may include the size of the lithotripsy target, the composition of the lithotripsy target, the location of the lithotripsy target in the anatomical structure of a subject or patient, etc. One or more ablation parameters of the lithotripsy target may be determined using a spectral analysis of a response signal from the target (e.g., light returned from the lithotripsy target in response to an illumination signal provided to the target). Examples of determining target characteristics are described in US Patent Application No. 17 / 938,826, the contents of which are incorporated herein by reference in their entirety.

[0010] Advantages of a thermal lithotripsy device such as described herein may include providing another approach or method for treating stones. Because heating and cooling using the thermoelectric transducer may be controlled using an electrical input signal, the cycle time for the thermoelectric transducer to alternate between hot and cold states and / or dissipate heat may be very fast. Thus, the temperature gradient of a thermal lithotripsy device may be more easily controlled than the temperature gradient of a lithotripsy device using another type of energy source (e.g., a laser). Similarly, the trajectory and effect of thermal energy from a thermal lithotripsy device may be more easily controlled than energy from a laser lithotripsy device because laser energy may reflect from certain surfaces, such as a reflective surface of another medical device being used, and thus, such laser energy may be delivered to unintended tissue.

[0011] In addition, the use of ultrasonic or laser energy in lithotripsy may cause the stone to break up so that the field of vision becomes so obscured that the physician may need to spend additional time during the procedure to clear the fragments of the stone, which may increase the overall duration of the procedure. The use of thermal lithotripsy doses may allow the stone to be broken up in a more controlled manner, thereby providing the physician with a clearer field of vision, which may help to shorten the overall duration of the procedure. Finally, the disclosed lithotripsy device using one or more thermoelectric transducers in the end of the scope may be smaller than lithotripsy devices using other energy sources, which may help to improve patient comfort during surgery and may also help to improve recovery after surgery.

[0012] Throughout this disclosure, the terms thermal lithotripsy transducer and thermoelectric transducer may be used interchangeably. Similarly, the terms electrical input signal, applied electrical input signal, electrical signal, applied electrical signal, and input signal may be used interchangeably and may be understood to include current or voltage signals. BRIEF DESCRIPTION OF THE DRAWINGS

[0013] In the accompanying drawings, which are not necessarily drawn to scale, similar reference numerals may describe similar components in different views. Similar reference numerals with different letter suffixes may represent different instances of similar components. The accompanying drawings generally illustrate various embodiments discussed herein by way of example and not limitation.

[0014] Figure 1 Examples of a distal end portion of an elongated member near a rock-breaking target and examples of a thermoelectric transducer are illustrated.

[0015] Figure 2 An example of a thermal cycling graph showing voltage and temperature changes for a thermoelectric transducer is illustrated.

[0016] Figure 3 An example of a method of ablating a lithotripsy target is illustrated.

[0017] Figure 4Included is an example of a flow chart for ablating lithotripsy targets.

[0018] Figure 5 is a block diagram illustrating an example of a machine upon which one or more embodiments may be implemented.

[0019] Figure 6 A schematic diagram of an exemplary computer-based clinical decision support system (CDSS) is illustrated. DETAILED DESCRIPTION

[0020] A lithotripter is a device used to shrink or fragment targets such as kidney stones and ureteral stones. A lithotripter can be used to ablate (break up, fragment, etc.) targets using minimally invasive surgical intervention. A lithotripter can ablate the target mechanically, or can use energy or signals from an energy source, such as a laser or radiation energy source, or an ultrasound energy source. The targets can vary in size and can be located in different parts of the patient's body and / or can be composed or formed of different types of materials and, therefore, can have different hardnesses.

[0021] The thermal lithotripsy disclosed herein can perform ablation of a target (e.g., a kidney stone) using thermal cycling of a thermoelectric transducer (e.g., a thermocouple) to deliver a thermal lithotripsy dose to the target. During the thermal expansion and contraction (heating and cooling) cycle using the thermocouple, when the stone is located in a difficult location or part of the anatomical structure, the slow thermal cycle may cause the target formed of a hard substance such as calcium oxalate to be fractured or removed.

[0022] When an electrical input signal, such as an electric current, is applied to the input of a transducer, heat may be generated at one junction of the transducer and the heat may be absorbed at another junction of the transducer. In another example, the electrical input signal may be a voltage input to the transducer or the junction. Heating and cooling at a charged junction of two conductors of different materials may be referred to as the Peltier effect. When an electric current is passed through a junction between two electrical conductors, heat may be generated or removed at the junction, which may cause a thermal cycle when the current is applied or terminated.

[0023] Figure 1 An example of a distal end portion 100 of an elongated member near a lithotripsy target and an example of a thermoelectric transducer are illustrated. Figure 1In the embodiment of the present invention, the distal end portion 100 of the elongated member may include a tip 102 including a thermoelectric transducer 108. The distal end portion 100 of the elongated member may be included as part of a lithotripsy device that is included in or configured for use with a scope such as an endoscope and is used to emit a thermal lithotripsy dose toward a lithotripsy target 104. For example, the elongated member may be included in or insertable via a flexible portion of an endoscope and may be connected to a handle at the proximal end of the elongated member. The elongated member may also include a channel 106. The channel 106 may span the length of the elongated member from the proximal end portion to the distal end portion 108. As shown in FIG. Figure 1 , the proximal end of the endoscope can be connected to a handle or other component (representing the proximal end of the endoscope and all components that can be connected to the endoscope). Channel 106 may include wiring. The wiring may be used to connect the thermoelectric transducer 108 to one or more other components, such as a power supply or signal generator, a controller or control circuit system, etc. The lithotripsy target 104 may include stones, such as kidney stones to be removed, reduced and / or ablated during a lithotripsy procedure. The end 102 of the elongated member may have a flat shape, or may be convex, dome-shaped, or hemispherical. The shape of the end 102 of the elongated member may be based at least in part on the number of thermoelectric transducers included in the end 102.

[0024] The thermoelectric transducer 108 may include a first junction 110 and a second junction 116. In an example, the first junction 110 may generate heat at a first end of the thermoelectric transducer 108 in response to an electrical input signal (e.g., current) or a cycle of the electrical input signal. The second junction 116 may absorb heat at a second end of the thermoelectric transducer 108 in response to the electrical input signal (or a cycle of the electrical input signal). The first junction 110 and the second junction 116 may be arranged so that the first junction 110 is generally opposite to or across the second junction 116. Between each junction, the thermoelectric transducer 108 may include a first conductive material 112 and a second conductive material 114 of different material types. For example, the first conductive material 112 may be an N-type conductor or semiconductor (e.g., bismuth), and the second conductive material 114 may be a P-type conductor or semiconductor (e.g., telluride). Bismuth and telluride are examples of N-type and P-type conductors that may be used in the thermoelectric transducer 108, however, any P-type and N-type conductors that are capable of generating a Peltier effect may be used in the thermoelectric transducer 108. Thus, there may be a net heating at the first junction 110, and heat may be absorbed at the second junction 116 and by the rock crushing target 104. This heating and cooling results in a thermal cycle or thermal shock wave that fragments the rock crushing target 104.

[0025] When an electrical input signal, such as an electric current, passes through the circuit of the thermoelectric transducer 108 (as indicated by the arrows), heat may be generated at the first junction 110 and absorbed at the second junction 116. This is known as the Peltier effect, or the presence of heating or cooling at the electrically charged junction of two different electrical conductors. The amount of Peltier heat generated per unit time at the junction is given by the following equation:

[0026] Q = (ΠA-ΠB) I Equation (1)

[0027] In Equation 1, ΠA and ΠB are the Peltier coefficients of electrical conductors A and B (first conductive material 112 and second conductive material 114), and I is the current from A to B. The total heat generated by the thermoelectric transducer 108 may include Joule heating and thermal gradient effects, however, these contributions may be negligible or insignificant compared to Peltier heating and cooling.

[0028] Figure 2 An example of a temperature and voltage versus time graph 200 of thermal cycling is illustrated, which shows the voltage and temperature changes of a thermoelectric transducer. As illustrated in graph 200, when an electrical input signal such as a square wave is applied to the thermoelectric transducer 108, the Peltier junction temperature (as shown on the temperature versus time trace 202) can cycle between 0°C and 50°C (inclusive). Figure 2 In the embodiment of the present invention, a square wave electrical input signal 204 may be applied to cause the temperature at the junction to increase from 0°C to 50°C and then decrease from 50°C to 0°C as the current applied to the thermoelectric transducer is switched on and off.

[0029] The period of the thermal cycle 206 can be selected based on the amount of heating or cooling required during the surgical procedure (e.g., can be less than one second or a fraction of a second), and can be adjusted at any time or throughout the surgery as conditions change. For example, the input signal can be adjusted (e.g., by a controller circuit system included in or connected to the lithotripsy device) using a duty cycle or pulse width control of the electrical input signal. Additionally or alternatively, the amplitude of the input signal can be adjusted independently of the adjustment of the pulse width and / or duty cycle, or adjusted together with the adjustment of the pulse width and / or duty cycle. In an example, the input signal can be an input current. The value of the input current can be less than one ampere (e.g., one quarter ampere), and the voltage of the input signal can move or oscillate between an upper voltage value and a lower voltage value. For example, the voltage of the input signal can oscillate between 5 volts and 12 volts (including 5 volts and 12 volts).

[0030] The values ​​of the current and / or voltage can be appropriately selected and / or adjusted as needed or necessary or based on circumstances arising during the medical procedure. For example, the input signal can be adjusted based at least in part on ablation parameters of the lithotripsy target. The ablation parameters can include the size of the lithotripsy target, the location of the lithotripsy target, the material composition of the lithotripsy target, etc. In an example, the lithotripsy target can be monitored at different times during the procedure to determine ablation parameters at a first time and a subsequent second time to determine whether a change in the lithotripsy target (e.g., a change in size and / or material composition) has occurred, and the input signal (thereby adjusting the thermal cycle) is adjusted based on the change in the lithotripsy target.

[0031] The input signal can also be adjusted based at least in part on a signal received from a sensor, such as a temperature sensor, a pressure sensor, an imaging or optical sensor or any similar sensor or device, for monitoring the distal end 100 and / or the condition at or near the end 102 of the elongated member. For example, the temperature sensor can monitor the temperature of the medium where the distal end portion of the elongated member is located. The monitored temperature can be transmitted to a controller circuit device, which can appropriately or desirably adjust the input signal based on the monitored temperature to generate or absorb more heat. In another example, when using multiple thermoelectric transducers or thermocouples, at least one of the thermocouples can be used as a temperature sensor. In such an example, the thermocouple can adopt the Seebeck effect instead of the Peltier effect. The Seebeck effect can convert the temperature difference between two conductors into a voltage difference, thereby allowing the thermocouple to be used as a temperature sensor.

[0032] Figure 3 An example of a method 300 for ablating a lithotripsy target is illustrated. The method 300 may include a number of operations or steps (302 to 310). These operations are exemplary, and the method may omit one or more of the listed operations, may repeat operations, may include other operations, or may perform operations simultaneously, substantially simultaneously, or in another order, as appropriate or desired. These operations may be automatically performed by a processor or controller of a machine or computer, such as the following for Figure 5 As described.

[0033] At 302, method 300 may include receiving a first electrical input signal (e.g., a square wave) applied to a thermoelectric transducer (e.g., a thermocouple or any device capable of Peltier heating and cooling). At 304, method 300 may include thermally lithotrips a lithotripsy target (e.g., a kidney stone or other similar stone). Thermal lithotripsy may include generating a dose of thermal energy (e.g., a thermal shock wave) at the lithotripsy target or delivering the thermal energy to the lithotripsy target using the thermoelectric transducer.

[0034] At 306, method 300 may include cycling the thermoelectric transducer between a relatively high temperature and a relatively low temperature. For example, the thermoelectric transducer may cycle between 0°C and 50°C (inclusive). The cycling may be controlled using a first electrical input signal, for example by changing the amount of current and / or voltage of the first electrical output signal. The amount of current and / or voltage of the first electrical input signal may be adjusted using a duty cycle or pulse width control of the first electrical input signal to operate the thermoelectric transducer.

[0035] At 308, method 300 may include determining ablation parameters for the lithotripsy target. The ablation parameters may include the size of the lithotripsy target, the location of the lithotripsy target, the material composition of the lithotripsy target, and / or any other parameter that may affect how much energy should be directed to the lithotripsy target. The ablation parameters may also include the environment surrounding the target, such as the type of medium in which the lithotripsy target is located, the temperature and / or pressure of the medium, the location of the lithotripsy target in the patient's anatomy, etc. The ablation parameters may be determined using sensors such as temperature or pressure sensors, composition sensors, optical sensors such as spectrometers, and / or any similar sensors included on, in, or connected to the lithotripsy device.

[0036] Depending on the ablation parameters, the tip of the lithotripsy device including the thermoelectric transducer can be positioned to make physical contact with the target, or can be positioned so that the tip of the lithotripsy device does not contact or touch the target to deliver a thermal lithotripsy dose. Thus, based on one or more ablation parameters of the target, thermal lithotripsy can be non-contact.

[0037] At 310, method 300 may include adjusting the first electrical input signal based at least in part on the ablation parameter. In an example, at 308, it may be determined that the lithotripsy target is located at a location where it is desired to be removed, and the first electrical input signal may be adjusted so that the intensity of the thermal shock wave may move the lithotripsy target. In another example, a spectral or other compositional analysis of the lithotripsy target may determine that the lithotripsy target is formed of a hard substance such as calcium oxalate or calcium phosphate, and the first input signal may be adjusted based on the composition to most effectively ablate the lithotripsy target.

[0038] As a lithotripsy target is ablated, the composition of the lithotripsy target may also change. For example, a kidney stone may have a "shell" formed of one material and an inner core formed of another material, the composition of the inner core being harder or softer than the outer shell. In such an example, the amount or intensity of thermal lithotripsy required to reduce or ablate the outer shell may be different from the amount or intensity of thermal lithotripsy required to ablate the inner core. Therefore, the processing circuit system discussed above can adjust (or suggest to the user to adjust) the first electrical input signal to adjust (increase, decrease or stop) the amount or intensity of thermal lithotripsy delivered to the target.

[0039] Similarly, during a medical procedure, the conditions of the medium and / or the surgical area may change, and the amount or intensity of thermal lithotripsy delivered to the target may be adjusted based on these changes. For example, the temperature of the medium in which the lithotripsy target is located may rise to an undesirable level, and the electrical input signal may be adjusted to cause the thermoelectric transducer to absorb the heat and cool the medium, thereby terminating the generation of thermal lithotripsy, etc.

[0040] In another example, techniques that affect the surgical field may also be implemented or suggested based on the amount of thermal lithotripsy energy delivered to the lithotripsy target, such as by the processing circuit system. For example, when a certain amount of thermal lithotripsy energy is delivered to fragment or otherwise ablate the lithotripsy target (rather than move or remove the lithotripsy target), irrigation or suction may be initiated or adjusted to help keep the surgical field clean.

[0041] Figure 4 An example flow chart for ablating a lithotripsy target is included. At 400, ablation parameters, such as the ablation parameters described above, can be determined for a lithotripsy target. The ablation parameters can be determined at a first time, such as prior to a treatment, ablation, or lithotripsy procedure (e.g., during a diagnostic procedure that occurs prior to a treatment, lithotripsy, or ablation procedure). Alternatively, the ablation parameters can be determined at the beginning of the ablation procedure. For example, the size, location, and / or composition of a kidney stone can be determined during a diagnostic procedure or at the beginning of an ablation procedure, prior to ablation of the stone.

[0042] At 402, a value of an input signal to be sent to a thermoelectric transducer may be selected or determined, and at 404, thermal lithotripsy (ablation of the stone) may be performed based on the determined ablation parameters and using the selected input signal. For example, based on the size and / or material composition of the stone, an input signal may be selected that allows the thermoelectric transducer to operate with a desired thermal cycle, thereby providing an appropriate amount of heating or cooling, etc., and the ablation procedure may be initiated using the selected input signal. The progress and / or status of the target of the ablation procedure may be monitored throughout the procedure, for example, by using one or more sensors (e.g., pressure sensors, temperature sensors, imaging or optical sensors, etc.). The monitoring may be performed continuously, randomly, periodically, repeatedly, or at specific time intervals, or for any desired or appropriate duration for the procedure.

[0043] The processing circuit system utilizing the machine learning algorithm discussed herein can use the data or signal from the monitored sensor to determine whether a change in the ablation parameter has occurred at a second time after the first time at 406. For example, the processing circuit system can determine whether the size of the stone has decreased, whether the stone has moved to an undesirable location, whether the material composition of the stone has changed, etc., and adjust the input signal at 408 based on the determined change. In an example, the system can automatically adjust the input signal to change the thermal cycle, increase heat generation or heat absorption by the thermoelectric transducer, suspend, stop or otherwise terminate or cut off the thermal energy being delivered, etc.

[0044] Alternatively, the processing circuit system may make a notification or suggestion, such as issuing a suggested change to the input signal (or other setting of the electrosurgical device) to the physician on a graphical user interface (GUI). For example, together with or separately from the suggested change or updated input signal, the processing circuit system may suggest to the physician that irrigation or aspiration be performed on the surgical field, or that the position of the lithotripsy device be adjusted, etc. In such an example, at 410, when the suggestion to adjust the input signal is accepted (or not rejected within a period of time), thermal lithotripsy using the current input signal may be resumed or continued (returning to 404). When the suggested adjustment to the input signal is accepted (or when the adjustment will automatically occur), a new value for the input signal may be selected (returning to 402), and thermal lithotripsy may be resumed using the new input signal.

[0045] Figure 5 is a block diagram illustrating an example of a machine on which one or more embodiments may be implemented. In alternative embodiments, the machine 500 may operate as a standalone device or may be connected (e.g., networked) to other machines. Thus, the machine 500 may include the processing circuit system discussed above and / or be configured to provide, transmit, or send an electrical input signal to a thermoelectric transducer, determine an ablation parameter or a change in an ablation parameter of a lithotripsy target, adjust (or provide a user with a suggestion for adjustment) the input signal, or otherwise perform the operations of the processing circuit system discussed herein.

[0046] In a networked deployment, the machine 500 can operate as a server machine, a client machine, or both in a server-client network environment. In an example, the machine 500 can act as a synchronization machine in a peer-to-peer (P2P) (or other distributed) network environment. The machine 500 can be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile phone, a network device, a network router, a switch or a bridge, or any machine capable of executing instructions (sequential or otherwise) specifying the actions to be taken by the machine. In addition, although only a single machine is illustrated, the term "machine" should also be deemed to include any collection of machines that execute a set (or multiple sets) of instructions to perform any one or more methods discussed herein, such as cloud computing, software as a service (SaaS), and other computer cluster configurations, either individually or jointly.

[0047] As described herein, examples may include logic or multiple components or mechanisms, or may be operated by logic or multiple components or mechanisms. A circuit set is a collection of circuits implemented in a tangible entity including hardware (e.g., simple circuits, gates, logic, etc.). Circuit set members can flexibly change over time and underlying hardware variability. A circuit set includes members that can perform specified operations individually or in combination when operating. In an example, the hardware of a circuit set can be permanently designed to perform a specific operation (e.g., hardwired). In an example, the hardware of a circuit set may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.), which include physical modifications (e.g., magnetic, electrical, movable placement of mass-invariant particles, etc.) to encode computer-readable media for instructions for specific operations. When connecting physical components, the basic electrical properties of the hardware composition change, for example, from an insulator to a conductor, and vice versa. The instruction enables embedded hardware (e.g., an execution unit or a loading mechanism) to create members of a circuit set in hardware via variable connections to perform parts of a specific operation when operating. Thus, when the apparatus is operating, the computer-readable medium is communicatively coupled to other components of the circuit set members. In an example, any of the physical components can be used in more than one member of more than one circuit set. For example, under operation, an execution unit can be used in a first circuit of a first circuit set at one point in time and reused by a second circuit in the first circuit set, or reused by a third circuit in the second circuit set at a different time.

[0048] The machine (e.g., computer system) 500 may include a hardware processor 502 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, a field programmable gate array (FPGA), or any combination thereof), a main memory 504, and a static memory 506, some or all of which may communicate with each other via a link (e.g., a bus) 530. The machine 500 may also include a display unit 510, an alphanumeric input device 512 (e.g., a keyboard), and a user interface (UI) navigation device 514 (e.g., a mouse). In an example, the display unit 510, the input device 512, and the UI navigation device 514 may be a touch screen display. Additionally, the machine 500 may include a storage device (e.g., a drive unit) 508, a signal generating device 518 (e.g., a speaker), a network interface device 520, and one or more sensors 516 (e.g., a global positioning system (GPS) sensor, a compass, an accelerometer, or other sensor). The machine 500 may include an output controller 528, such as a serial (e.g., universal serial bus (USB), parallel or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to connect to or control one or more peripheral devices (e.g., printer, card reader, etc.).

[0049] The storage device 508 may include a machine-readable medium 522 on which is stored one or more sets of data structures or instructions 524 (e.g., software) that embody or are used by any one or more of the techniques or functionality described herein. The instructions 524 may also reside, completely or at least partially, within the main memory 504, within the static memory 506, or within the hardware processor 502 during execution of the instructions 524 by the machine 500. In an example, one or any combination of the hardware processor 502, the main memory 504, the static memory 506, or the storage device 508 may constitute a machine-readable medium.

[0050] Although machine-readable medium 522 is illustrated as a single medium, the term “machine-readable medium” may include a single medium or multiple media (eg, a centralized or distributed database, and / or associated caches and servers) configured to store one or more instructions 524 .

[0051] The term "machine-readable medium" may include any medium capable of storing, encoding or carrying instructions executed by the machine 500 and causing the machine 500 to perform any one or more of the techniques of the present disclosure, or any medium capable of storing, encoding or carrying data structures used by or associated with these instructions. Non-limiting machine-readable medium examples may include solid-state memory and optical and magnetic media. In an example, a dense machine-readable medium includes a machine-readable medium with multiple particles having a constant (e.g., stationary) mass body. Therefore, a dense machine-readable medium is not a transient propagation signal. Specific examples of dense machine-readable media may include: non-volatile memory, such as semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices; disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0052] The instructions 524 may also be transmitted or received over a communication network 526 via a network interface device 520 utilizing any of a number of transmission protocols (e.g., frame relay, Internet Protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), a mobile phone network (e.g., a cellular network), a plain old telephone (POTS) network, and a wireless data network (e.g., the Institute of Electrical and Electronics Engineers (IEEE) 802.11 known as Wi-Fi). IEEE 802.16 family of standards), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, etc. In an example, the network interface device 520 may include one or more physical jacks (e.g., Ethernet, coaxial, or telephone jacks) or one or more antennas to connect to the communication network 526. In an example, the network interface device 520 may include multiple antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) technology. The term "transmission medium" should be deemed to include any intangible medium that can store, encode, or carry instructions for execution by the machine 500, and includes digital or analog communication signals or other intangible media to facilitate the communication of such software.

[0053] Figure 6A schematic diagram of an exemplary computer-based clinical decision support system (CDSS) 600 is illustrated, which is configured to: determine information about a target (or use information provided about a target), such as the size of the target, the location of the target in the anatomy of a subject or patient, the material composition of the target, or any similar ablation parameter of the target, and select or adjust an input signal to be provided to a thermoelectric transducer as described above. In various embodiments, the CDSS 600 includes: an input interface 602, through which parameters such as the ablation parameters for a lithotripsy target discussed herein (which are specific to a patient's surgery) are provided as input features to an artificial intelligence (AI) model 604; a processor that performs an inference operation in which the parameters are applied to the AI ​​model to generate a value for the input signal or an adjusted input signal value that is transmitted or sent to the thermoelectric transducer; and an output interface 608, through which the ablation parameters, input signal values, and any recommendations can be communicated to a user, such as a clinician.

[0054] In some embodiments, the input interface 602 can be a direct data link between the CDSS 600 and one or more medical devices that generate at least some of the input features. For example, the input interface 602 can transmit ablation parameters directly to the CDSS 600 during a therapeutic and / or diagnostic medical procedure. In an example, information about the target and / or ablation parameters, the device to be used during the therapeutic and / or diagnostic medical procedure can be stored in the database 606. Additionally or alternatively, the input interface 602 can be a classic user interface that facilitates interaction between a user and the CDSS 600. For example, the input interface 602 can facilitate a user interface through which a user can manually enter information about a patient, a lithotripsy target, and / or ablation parameters. Additionally or alternatively, the input interface 602 can provide access to an electronic patient record to the CDSS 600, from which one or more input features can be extracted. In any of these cases, the input interface 602 is configured to collect one or more of input features associated with one or more of a particular patient, the type of medical procedure, the devices to be used during the procedure, etc., at or prior to the time when the CDSS 600 is used to evaluate information about targets and / or ablation parameters.

[0055] Examples of input features may include information about the lithotripsy device including the number and type of thermoelectric transducers included in the tip.

[0056] Examples of input features may include data or signals from one or more sensors included on or connected to the lithotripsy device (eg, optical sensors, temperature sensors, pressure sensors, etc.).

[0057] At 610 , examples of input features may include information regarding one or more rock crushing targets.

[0058] Examples of input features may be the type of medium in which the procedure is to be performed and / or the type of medium in which the lithotripsy device and / or the target are located.

[0059] At 612, an example of an input feature may be information regarding an ablation parameter (or a change in an ablation parameter).

[0060] Based on one or more of the above-mentioned input features, the processor can use the AI ​​model 604 to perform an inference operation to select or adjust the value of the input signal to the thermoelectric transducer. For example, the input interface 602 can deliver one or more of the input features listed above to the input layer of the AI ​​model 604, which propagates these input features to the output layer through the AI ​​model 604. The AI ​​model 604 can provide a computer system with the ability to perform tasks by inferring based on patterns found in data analysis and without explicit programming. The AI ​​model 604 explores the research and construction of algorithms (e.g., machine learning algorithms) that can learn from existing data and make predictions about new data. Such algorithms operate by building artificial intelligence models from example training data in order to make data-driven predictions or decisions, which are represented as outputs or evaluations.

[0061] Modes for machine learning (ML) can include supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples that relate inputs to outputs or outcomes) to learn the relationship between inputs and outputs. The goal of supervised ML is to aim to learn a function that, given some training data, best approximates the relationship between the training inputs and outputs so that the ML model can achieve the same relationship when given an input, thereby generating a corresponding output. Unsupervised ML is to train an ML algorithm using information that is neither classified nor labeled, and allow the algorithm to operate on the information without guidance. Unsupervised ML is useful in exploratory analysis because it can automatically identify structure in the data.

[0062] Some of the tasks used for supervised ML are classification problems and regression problems. Classification problems, also known as classification problems, aim to classify an item into one of several category values ​​(e.g., is this object an apple or an orange?). Regression algorithms aim to quantify some items (e.g., by providing a score for the value of some input). Some examples of commonly used supervised ML algorithms are logistic regression (LR), naive Bayes, random forest (RF), neural network (NN), deep neural network (DNN), matrix factorization, and support vector machine (SVM).

[0063] Some of the tasks used for unsupervised ML include clustering, representation learning, and density estimation. Some examples of unsupervised ML algorithms are K-means clustering, principal component analysis, and autoencoders.

[0064] Another type of ML is federated learning (also known as collaborative learning), which trains algorithms on multiple decentralized devices holding local data without exchanging data. This approach contrasts with other centralized machine learning techniques, where all local datasets are uploaded to a single server, and with more classical decentralized approaches, which often assume that local data samples are identically distributed. Federated learning enables multiple participants to build a common, robust machine learning model without sharing data, allowing key issues such as data privacy, data security, data access rights, and access to heterogeneous data to be addressed.

[0065] In some examples, the AI ​​model 604 can be trained continuously, repeatedly, or periodically before an inference operation is performed by the processor. Then, during the inference operation, the patient-specific input features provided to the AI ​​model 604 can be propagated from the input layer, through one or more hidden layers, and ultimately to the output layer, which corresponds to information about the target, changes to the target, and the input signal to the transducer to control the amount of thermal lithotripsy energy delivered to the target.

[0066] During and / or after the inference operation, information about the target and / or the value of the input signal is communicated to the user via output interface 608 (e.g., a user interface (UI)), and / or causes the lithotripsy device to automatically perform a selected action. For example, based on the ablation parameters or changes in ablation parameters, the system can suggest or automatically select or adjust the input signal to select or change the thermal cycle of the thermoelectric transducer, terminate or otherwise disconnect the thermal lithotripsy, move the scope or the end of the scope (or suggest scope movement), etc.

[0067] Additional Notes and Examples

[0068] Example 1 is a lithotripsy device used in a thermal lithotripsy procedure, the lithotripsy device comprising: an elongated member having a proximal end and a distal end; and a first thermal lithotripsy transducer located at the distal end of the elongated member to heat and cool in response to an applied first electrical input signal, thereby emitting a thermal lithotripsy dose toward a lithotripsy target.

[0069] In Example 2, the subject matter of Example 1 optionally includes, wherein the first thermal lithotripsy transducer comprises a thermoelectric transducer controllable to cycle between a first target temperature and a second target temperature in response to an applied first electrical input signal, wherein the first target temperature and the second target temperature and the frequency of the cycling are specified to facilitate thermal lithotripsy of the lithotripsy target.

[0070] In Example 3, the subject matter of any one or more of Examples 1 to 2 optionally includes, wherein the applied first electrical input signal is a square wave, wherein the amount of current or voltage is adjusted using pulse width modulation control of the first input electrical signal to operate the first thermal lithotripsy transducer to perform thermal lithotripsy on the lithotripsy target.

[0071] In Example 4, the subject matter of any one or more of Examples 1 to 3 optionally includes, wherein the applied first electrical input signal is a square wave, wherein the amount of current or voltage is adjusted using duty cycle control of the applied first electrical input signal to operate the first thermal lithotripsy transducer for thermal lithotripsy of a lithotripsy target.

[0072] In Example 5, the subject matter of Example 4 optionally includes a controller circuit system that is operable to achieve at least one of the following: controlling the pulse of the square wave to operate the first thermal lithotripsy transducer for performing thermal lithotripsy on the lithotripsy target; or controlling the applied first electrical input signal to maintain the thermal cycle at a temperature between 0°C and 50°C and including 0°C and 50°C, thereby operating the first thermal lithotripsy transducer for performing thermal lithotripsy on the lithotripsy target.

[0073] In Example 6, the subject matter of any one or more of Examples 1 to 5 optionally includes, wherein the first thermoelectric transducer comprises: a first conductive material; a second conductive material; and a first junction between the first conductive material and the second conductive material, wherein the first thermal lithotripsy transducer is configured to perform thermal lithotripsy on a lithotripsy target.

[0074] In Example 7, the subject matter of Example 6 optionally includes a second thermal lithotripsy transducer located at the distal end of the slender member, wherein the second thermal lithotripsy transducer includes a second thermoelectric transducer that is configured or configurable to receive an applied second electrical input signal so that the second thermoelectric transducer can be operated independently of the first thermoelectric transducer for thermal lithotripsy of the lithotripsy target.

[0075] In Example 8, the subject matter of any one or more of Examples 1 to 7 optionally includes wherein the tip of the distal portion of the elongated member has a convex shape and is configured to emit a thermal lithotripsy dose toward a lithotripsy target.

[0076] In Example 9, the subject matter of any one or more of Examples 1 to 8 optionally includes wherein the lithotripsy device is included in or configured for use with a scope to emit a thermal lithotripsy dose from a distal end of the scope toward a lithotripsy target.

[0077] In Example 10, the subject matter of Example 9 optionally includes wherein the scope includes a working channel, and the elongated member is sized and shaped to be inserted through the working channel of the scope to emit the thermal lithotripsy dose from a distal end of the scope toward a lithotripsy target.

[0078] In Example 11, the subject matter of any one or more of Examples 1 to 10 optionally includes a temperature sensor configured to monitor a temperature at or near a distal end of the elongated member, wherein the temperature sensor is configured to: transmit a signal representing the monitored temperature to a control circuit system included in or coupled to the lithotripsy device, and wherein the control circuit system is configured to: adjust the first electrical input signal based on the transmitted signal representing the monitored temperature to control the first thermal lithotripsy transducer to emit a thermal lithotripsy dose toward a lithotripsy target.

[0079] Example 12 is a method for thermally ablating a lithotripsy target during a thermal lithotripsy procedure using a scope having a distal end positionable at or near the lithotripsy target, the method comprising: receiving a first electrical input signal applied to a thermal lithotripsy transducer positionable at the distal end of the scope; performing thermal lithotripsy of the lithotripsy target, the step comprising actively heating and actively cooling the thermal lithotripsy transducer to generate a thermal lithotripsy dose, and the thermal lithotripsy dose is emitted toward the lithotripsy target.

[0080] In Example 13, the subject matter of Example 12 optionally includes controlling the first electrical input signal to cycle the thermal lithotripsy transducer between a relatively high temperature and a relatively low temperature for thermal lithotripsy of the lithotripsy target.

[0081] In Example 14, the subject matter of Example 13 optionally includes controlling the first electrical input signal to cycle the thermal lithotripsy transducer between a relatively high temperature and a relatively low temperature, the temperature being between 0°C and 50°C inclusive, for thermal lithotripsy of a lithotripsy target.

[0082] In Example 15, the subject matter of any one or more of Examples 13 to 14 optionally includes, wherein a duty cycle control of the first electrical input signal is used to adjust the amount of current or voltage of the first electrical input signal to operate the thermal lithotripsy transducer for thermal lithotripsy of a lithotripsy target, wherein the applied first input electrical signal is a square wave.

[0083] In Example 16, the subject matter of any one or more of Embodiments 12 to 15 optionally includes: determining thermal lithotripsy ablation parameters of a lithotripsy target; and adjusting the frequency or period of the first electrical input signal based at least in part on the thermal lithotripsy ablation parameters for performing thermal lithotripsy on the lithotripsy target to control the thermal cycle.

[0084] Example 17 is a lithotripsy device used in a thermal lithotripsy procedure, the lithotripsy device comprising: a first thermal lithotripsy transducer, which may be located at the distal end of a slender member, wherein the first thermal lithotripsy transducer may be configured to heat and cool in response to an applied first electrical input signal to emit a thermal lithotripsy dose toward a lithotripsy target; and a controller circuit, which is operable to achieve at least one of the following: controlling the applied first electrical input signal so that the thermal lithotripsy transducer undergoes a first thermal cycle at a temperature between 0°C and 50°C and including 0°C and 50°C; or adjusting the applied first electrical input signal based on a signal received from a sensor or at least one of the ablation parameters of the lithotripsy target.

[0085] In Example 18, the subject matter of Example 17 optionally includes a second thermal lithotripsy transducer located at the distal end of the slender member, wherein the second thermal lithotripsy transducer can be configured to receive an applied second electrical input signal so that the second thermal lithotripsy transducer can operate independently of the first thermal lithotripsy transducer for thermal lithotripsy of a lithotripsy target, wherein the controller circuit can also be operated to control a pulse width or duty cycle of at least one of the applied first electrical input signal or the applied second electrical input signal.

[0086] In Example 19, the subject matter of Example 18 optionally includes, wherein each of the first thermal lithotripsy transducer and the second thermal lithotripsy transducer comprises: a first conductive material; a second conductive material; and a first junction located between the first conductive material and the second conductive material, wherein the first thermal lithotripsy transducer is configured to perform thermal lithotripsy on a lithotripsy target.

[0087] In Example 20, the subject matter of any one or more of Examples 17 to 19 optionally includes, wherein the controller circuit is operable to adjust the applied first electrical input signal based on an ablation parameter of the lithotripsy target, wherein the ablation parameter includes at least one of a size of the lithotripsy target, a material composition of the lithotripsy target, a change in the size of the lithotripsy target, or a change in the material composition of the lithotripsy target, and wherein the ablation parameter is determined by one or more of: a signal received from a temperature sensor, a signal received from a composition sensor, or a spectral analysis of a portion of emitted light returned or reflected from the lithotripsy target.

[0088] The above detailed description includes reference to the accompanying drawings, which form a part of the detailed description. The accompanying drawings illustrate specific embodiments that can be put into practice in a diagrammatic manner. These embodiments are also referred to as "examples" in this article. These examples may include elements other than those shown or described. However, the inventors have also contemplated examples in which only those elements shown or described are provided. In addition, the inventors have also contemplated examples of any combination or arrangement of those elements (or one or more aspects thereof) shown or described relative to a specific example (or one or more aspects thereof) or relative to other examples (or one or more aspects thereof) shown or described herein.

[0089] All publications, patents, and patent documents mentioned in this document are incorporated herein by reference in their entirety, as if individually incorporated herein by reference. In the event of an inconsistency between the usages of this document and a document incorporated by reference, the usage in the incorporated reference should be considered supplementary to that of this document; for irreconcilable inconsistencies, the usage in this document controls.

[0090] In this document, as is common in patent documents, the term "a" includes one or more than one, independent of any other examples or uses of "at least one" or "one or more". In this document, the term "or" is used to refer to a non-exclusive or such a situation that "A or B" includes "A but not B", "B but not A", and "A and B", unless otherwise stated. In the appended claims, the terms "including" and "wherein" are used as the plain English equivalents of the respective terms "including" and "wherein". In addition, in the following claims, the terms "including" and "comprising" are open-ended, that is, systems, devices, articles, or processes that include elements other than the elements listed after the above terms in the claim are still considered to fall within the scope of the claim. In addition, in the following claims, the terms "first", "second", and "third", etc. are used merely as labels and are not intended to impose labeling requirements on their objects.

[0091] The above description is intended to be illustrative, not restrictive. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be used, such as by a person of ordinary skill in the art when reviewing the above description. This summary is intended to allow the reader to quickly determine the nature of the technical disclosure and is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the above detailed description, various features may be grouped together to simplify the disclosure. This should not be interpreted as an attempt to make unclaimed public features essential to any claim. On the contrary, the subject matter of the present invention may be present in less than all the features of a particular disclosed embodiment. Therefore, the following claims are hereby incorporated into the detailed description, wherein each claim is independently presented as a separate embodiment. The scope of the embodiment should be determined with reference to the appended claims and the full scope of equivalents to which these claims are entitled.

Claims

1. A lithotripsy device for use in a thermal lithotripsy procedure, the lithotripsy device comprising: an elongated member having a proximal end and a distal end; as well as A first thermal lithotripsy transducer is located at the distal end of the elongated member, the first thermal lithotripsy transducer heating and cooling in response to an applied first electrical input signal to emit a thermal lithotripsy dose toward a lithotripsy target.

2. The lithotripsy device according to claim 1, wherein: The first thermal lithotripsy transducer comprises a thermoelectric transducer controllable to cycle between a first target temperature and a second target temperature in response to an applied first electrical input signal, wherein the first and second target temperatures and a frequency of the cycling are specified to promote thermal lithotripsy of the lithotripsy target.

3. The lithotripsy device according to claim 1, wherein: The applied first electrical input signal is a square wave, wherein pulse width modulation control of the applied first electrical input signal is used to adjust the amount of current or voltage to operate the first thermal lithotripsy transducer for thermal lithotripsy of the lithotripsy target.

4. The lithotripsy device according to claim 1, wherein: The applied first electrical input signal is a square wave, wherein the amount of current or voltage is adjusted using duty cycle control of the applied first electrical input signal to operate the first thermal lithotripsy transducer for thermal lithotripsy of the lithotripsy target.

5. The lithotripsy device according to claim 4, further comprising: A controller circuit system operable to implement at least one of the following: controlling the pulse of the square wave to operate the first thermal lithotripsy transducer to perform thermal lithotripsy on the lithotripsy target; or The applied first electrical input signal is controlled to maintain the thermal cycle at a temperature between 0° C. and 50° C., inclusive, to operate the first thermal lithotripsy transducer for thermal lithotripsy of the lithotripsy target.

6. The lithotripsy device according to claim 1, wherein: The first thermal lithotripsy transducer comprises: a first conductive material; a second conductive material; and A first junction is located between the first conductive material and the second conductive material, wherein the first thermal lithotripsy transducer is configured to thermally lithotripsy the lithotripsy target.

7. The lithotripsy device according to claim 6, comprising: a second thermal lithotripsy transducer located at the distal end of the slender member, wherein the second thermal lithotripsy transducer includes a second thermoelectric transducer, the second thermoelectric transducer being configured or configurable to receive a second applied electrical input signal so that the second thermal lithotripsy transducer can operate independently of the first thermal lithotripsy transducer for thermal lithotripsy of the lithotripsy target.

8. The lithotripsy device according to claim 1, wherein: The distal end of the distal portion of the elongated member has a convex shape and is configured to emit a thermal lithotripsy dose toward a lithotripsy target.

9. The lithotripsy device according to claim 1, wherein: The lithotripsy device is included in or configured for use with a scope so as to emit the thermal lithotripsy dose from a distal end of the scope towards the lithotripsy target.

10. The lithotripsy device according to claim 9, wherein: The scope includes a working channel, and the elongated member is sized and shaped to be inserted through the working channel of the scope to emit the thermal lithotripsy dose from a distal end of the scope toward the lithotripsy target.

11. The lithotripsy device according to claim 1, comprising: a temperature sensor configured to monitor a temperature at or near the distal end of the elongated member, wherein the temperature sensor is configured to transmit a signal representative of the monitored temperature to a control circuit system included in or coupled to the lithotripsy device, and wherein the control circuit system is configured to adjust the applied first electrical input signal based on the transmitted signal representative of the monitored temperature to control the first thermal lithotripsy transducer to emit the thermal lithotripsy dose toward the lithotripsy target.

12. A method for thermally ablating a lithotripsy target using a scope having a distal portion positionable at or near the lithotripsy target during a thermal lithotripsy procedure, the method comprising: receiving a first electrical input signal applied to a thermal lithotripsy transducer, the thermal lithotripsy transducer being positionable at the distal end of the scope; as well as Thermal lithotripsy is performed on the lithotripsy target, including generating a thermal lithotripsy dose by actively heating and actively cooling the thermal lithotripsy transducer and emitting the thermal lithotripsy dose toward the lithotripsy target.

13. The method according to claim 12, comprising: The first electrical input signal is controlled to cycle the thermal lithotripsy transducer between a relatively high temperature and a relatively low temperature for performing thermal lithotripsy on the lithotripsy target.

14. The method according to claim 13, comprising: The first electrical input signal is controlled to cycle the thermal lithotripsy transducer between a relatively high temperature and a relatively low temperature between 0° C. and 50° C. inclusive, for performing thermal lithotripsy on the lithotripsy target.

15. The method according to claim 13, wherein: The amount of current or voltage of the first electrical input signal is adjusted using duty cycle control of the first electrical input signal to operate the thermal lithotripsy transducer for performing thermal lithotripsy on the lithotripsy target, wherein the first electrical input signal is a square wave.

16. The method according to claim 12, comprising: Determining thermal lithotripsy ablation parameters of the lithotripsy target; as well as Based at least in part on the thermal lithotripsy ablation parameters for thermal lithotripsy of the lithotripsy target, a frequency or period of the first electrical input signal is adjusted to control thermal cycling.

17. A lithotripsy device for use in thermal lithotripsy, the lithotripsy device comprising: a first thermal lithotripsy transducer, which can be located at a distal end of the elongated member, wherein the first thermal lithotripsy transducer can be configured to heat and cool in response to an applied first electrical input signal to emit a thermal lithotripsy dose toward a lithotripsy target; and A controller circuit system operable to implement at least one of the following: controlling the applied first electrical input signal to induce a first thermal cycle of the first thermal lithotripsy transducer at a temperature between 0°C and 50°C inclusive; or The applied first electrical input signal is adjusted based on at least one of a signal received from a sensor and an ablation parameter of the lithotripsy target.

18. The lithotripsy device according to claim 17, further comprising: a second thermal lithotripsy transducer located at the distal end of the elongated member, wherein the second thermal lithotripsy transducer is configurable to receive a second electrical input signal applied so that the second thermal lithotripsy transducer is operable independently of the first thermal lithotripsy transducer to perform thermal lithotripsy on the lithotripsy target, wherein the controller circuit system is further operable to: A pulse width or a duty cycle of at least one of the applied first electrical input signal or the applied second electrical input signal is controlled.

19. The lithotripsy device according to claim 18, wherein: Each of the first thermal lithotripsy transducer and the second thermal lithotripsy transducer comprises: a first conductive material; a second conductive material; and A first junction is located between the first conductive material and the second conductive material, wherein the first thermal lithotripsy transducer is configured to thermally lithotripsy the lithotripsy target.

20. The lithotripsy device according to claim 17, wherein: The controller circuit system is operable to adjust the applied first electrical input signal based on the ablation parameters of the lithotripsy target, wherein the ablation parameters include at least one of the size of the lithotripsy target, the material composition of the lithotripsy target, a change in the size of the lithotripsy target, or a change in the material composition of the lithotripsy target, and wherein the ablation parameters are determined by one or more of: a signal received from a temperature sensor, a signal received from a composition sensor, or a spectral analysis of a portion of emitted light returned or reflected from the lithotripsy target.

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