Lung treatment

Abstract

The present invention relates to a method and system for locally treating lung tissue wounds (e.g., ARDS) and mediastinal diseases, comprising selecting a target site within the tissue requiring treatment, inserting a transbronchial catheter with a miniature ultrasound therapeutic transducer as close as possible to the target site, calibrating contact and position, and applying therapeutic ultrasound to the target site, optionally using phonophoresis and iontophoresis to deliver a drug to the wound site.

Description

[Background technology]

[0001] Related Applications This application claims the benefit of priority to Ultrasound Provisional Patent Application No. 63 / 395,380, filed August 5, 2022, the entire contents of which are incorporated herein by reference.

[0002] In some embodiments, the present invention relates to systems and methods for localized pulmonary treatment, and more particularly, but not exclusively, to transbronchial therapeutic ultrasound systems and methods for the treatment of, for example, ARDS and mediastinal thromboembolic complications (mediastinal disease).

[0003] The local non-invasive treatment of lung tissue lesions, ranging from inflammatory processes to ARDS, including tumor pathologies, remains a very important and practically unsolved problem.

[0004] Furthermore, a potential advantage of using therapeutic ultrasound is its ability to mechanically cleanse wounds, promote angiogenesis and vasomotion, and stimulate tissue regeneration processes, all criteria necessary for the local treatment of a wide variety of tissues, from the legs to the reproductive organs in diabetes.

[0005] For many years, the lungs have been considered an organ in which ultrasound is difficult to apply: the anatomical features of the lungs, namely the complete reflection of ultrasound due to the presence of air in the alveoli and the near-impermeability of the rib-muscle corset of the thorax in which the lungs are located, make the use of external therapeutic ultrasound in this organ virtually impossible.

[0006] Recently, however, diagnostic lung ultrasound (LUS) has been shown to be a potentially useful tool for the assessment of many lung diseases, as noted in the review by Laura Gargani, "Lung ultrasound: a new tool for the cardiologist." Ultrasound can be broadly divided into "diagnostic" and "therapeutic" ultrasound. Diagnostic ultrasound is used to assess disease, whereas therapeutic ultrasound is used to treat disease.

[0007] Further background on diagnostic ultrasound is provided by U.S. Patent No. 8,961,508, which discloses systems, assemblies, and methods for use in the treatment of pulmonary diseases, which aim to reduce nervous system input to distal regions of the bronchial tree within the lungs. The treatment system inflicts damage on nervous tissue to temporarily or permanently reduce nervous system input. The treatment system can also heat, cool, deliver a fluid that causes trauma to the nervous tissue, puncture, lacerate, cut, apply pressure to the nervous tissue, apply ultrasound to the nervous tissue, apply ionizing radiation to the nervous tissue, disrupt the cell membranes of the nervous tissue with electrical energy, or deliver long-acting neuroblocking chemicals to the nervous tissue. U.S. Patent No. 10,307,580 B2 discloses methods, devices, and systems for applying drugs or therapeutic agents to a living lumen (e.g., a blood vessel lumen). More specifically, the paper discloses a method for enhancing the uptake of drugs or therapeutic agents encapsulated in microbubbles in combination with ultrasonic energy, and a method for periodically administering drugs or therapeutic agents using a pulse generator to match the frequency to the pulsation of the patient's blood flow.

[0008] U.S. Patent Application No. US20180193078A1 discloses a system, method, and apparatus for treating tissue. The system includes an elongated tube having a distal portion. A treatment element is disposed on the distal portion of the elongated tube, and the treatment element is configured and arranged to treat tissue at a target site. In the scientific paper "Endobronchial high-intensity ultrasound for thermal therapy of pulmonary malignancies: simulations with patient-specific lung models," Liu et al. reported a feasibility study using acoustic and biothermal simulations to investigate the feasibility of an endobronchial ultrasound applicator for thermal ablation of lung tumors. Simulation results in this study demonstrated that thermal coagulation of tumors 2-3 cm in diameter adjacent to or accessible in the major and deep portions of the large airways was possible using an endobronchial ultrasound applicator.

[0009] In their scientific paper "Endobronchial ultrasound: A new innovation in bronchoscopy," Bakamugesh et al. report on the use of an EBUS miniprobe to analyze the multilayer structure of the bronchial wall and perform biopsies of peripheral lesions. In their scientific paper "Pushing the boundaries: transesophageal endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of intraparenchymal pulmonary micronodules," Donghi et al. present transesophageal exploration using endobronchial ultrasound (EBUS) videobronchoscopy (EUS-B-FNA).

[0010] Thus, diagnostic ultrasound has traditionally been used exclusively for the lungs.

[0011] Treatment of mediastinal thromboembolic complications, especially pulmonary embolism, remains associated with high mortality. The most advanced technology currently available involves catheter-mounted ultrasound sensors inserted into the pulmonary artery, simultaneously delivering thrombolytic drugs. This is described by Khan et al. in a paper entitled "The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism." It should be noted that, despite its invasive nature, this approach represents the state-of-the-art treatment for many patient groups. Summary of the Invention [Problem to be solved by the invention]

[0012] Below are some examples of embodiments of the present invention, but the present invention is not limited to these. The present invention also includes embodiments that do not include all of the illustrated features and embodiments that combine features of multiple examples. These combinations are included in the scope of the present invention even if not explicitly stated.

[0013] Example 1 1. A catheter system for treating a wound, the catheter system comprising: a. at least one catheter having a proximal end and a distal end, the distal end comprising: i. one or more ultrasonic transmitters; ii. an inflatable balloon covering the one or more ultrasound transmitters, the inflatable balloon comprising a first electrode located proximal to the inflatable balloon and a second electrode located distal to the inflatable balloon; iii. a plurality of first type openings located on the surface of the balloon, the locations of the first type openings corresponding to the locations of the one or more ultrasound transmitters on the catheter; iv. a plurality of second type openings located on the surface of the balloon, the positions of the second type openings coinciding with the positions of the first electrodes; Catheter system.

[0014] Example 2 further comprising at least one liquid configured to inflate the inflatable balloon. The catheter system described in Example 1.

[0015] Example 3 the at least one liquid comprises at least one drug; The catheter system described in Example 2.

[0016] Example 4 the at least one liquid is saline; The catheter system described in Example 2.

[0017] Example 5 further comprising one or more controls disposed at the proximal end of the catheter and configured to control movement of the distal end of the catheter. The catheter system according to any one of Examples 1 to 4.

[0018] Example 6 further comprising a video camera located at the distal-most end of the catheter. The catheter system according to any one of Examples 1 to 5.

[0019] Example 7 the at least one catheter is configured to perform phonophoresis therapy. The catheter system according to any one of Examples 1 to 6.

[0020] Example 8 the at least one catheter is configured to perform iontophoresis therapy. The catheter system according to any one of Examples 1 to 6.

[0021] Example 9 an external unit to which the at least one catheter is connected; The external unit comprises: a. a video unit comprising a navigation system configured to operate the at least one catheter and provide visualization from the video camera to a user; b. an electric field unit configured to generate an interference field; c. Ultrasound of about 0.5 MHz to about 3 MHz at 2 watts / cm 2 an ultrasonic unit configured to generate an ultrasonic wave at a power of up to d. a calibration unit configured to specify attenuation coefficients at different locations and further configured to provide optimal localization of the one or more ultrasonic transmitters; e. a pressure unit configured to maintain and monitor the pressure within the balloon; f. a phonophoresis medication unit configured to monitor and administer the at least one medication during phonophoresis treatment; g. an iontophoretic drug unit configured to monitor and administer the at least one drug during iontophoretic treatment; The catheter system according to any one of Examples 1 to 8.

[0022] Example 10 the electric field unit is configured to supply a current to a first catheter at a first frequency and a current to a second catheter at a second frequency; The catheter system described in Example 9.

[0023] Example 11 The first frequency is about 4000 Hz, and the second frequency is about 4100 Hz to about 4500 Hz. The catheter system of Example 10.

[0024] Example 12 the electric field unit is configured to provide a current not exceeding 13 milliamps; The catheter system described in Example 9.

[0025] Example 13 1. A method for treating a pulmonary tissue condition, a pulmonary embolism, and / or a mediastinal thromboembolic condition, comprising: a. selecting a target site in the tissue in need of treatment; b. advancing at least one catheter of Example 1 to a location near the target site; c. performing contact calibration; d. performing position calibration; e. performing ultrasound therapy; method.

[0026] Example 14 performing the contact calibration a. inflating the inflatable balloon; b. receiving signals from the first electrode and the second electrode; c. ceasing inflation of the balloon. The method described in Example 13.

[0027] Example 15 performing the position calibration a. delivering a first amount of ultrasonic energy; b. determining the damping coefficient; c. determining whether the position near the target site is an optimal position according to the result of the determination; The method of Example 13 or 14.

[0028] Example 16 The optimum position is a position where the damping coefficient is a low damping coefficient. The method described in Example 15.

[0029] Example 17 The low attenuation coefficient is about 0.18 dB / mHz*cm. The method described in Example 16.

[0030] Example 18 If the position calibration fails, further comprising repositioning the catheter to a new location near the target site. The method according to any one of Examples 13 to 17.

[0031] Example 19 administering the ultrasound treatment includes irradiating the target area with ultrasound, the irradiating being characterized by a time, an intensity, and a number of irradiation fields; The method according to any one of Examples 13 to 17.

[0032] Example 20 The irradiation is characterized to obtain a maximum therapeutic effect with minimal side effects and / or to avoid induction of cell death at the target site. The method described in Example 19.

[0033] Example 21 The irradiating includes irradiating at an intensity between about 1 MHz and about 3 MHz. The method described in Example 19.

[0034] Example 22 The irradiating step includes irradiating for about 10 seconds to about 15 minutes. The method described in Example 19.

[0035] Example 23 the irradiating includes irradiating using a focused beam of light; The method described in Example 19.

[0036] Example 24 further comprising monitoring the temperature of the target area where treatment is being performed. The method according to any one of Examples 13 to 23.

[0037] Example 25 and further comprising preventing the temperature of the target site being treated from rising above a predetermined temperature. The method according to any one of Examples 13 to 24.

[0038] Example 26 The predetermined temperature is between about 40 degrees Celsius and about 45 degrees Celsius. The method described in Example 25.

[0039] Example 27 further comprising actively controlling the temperature of the target area where treatment is performed. The method according to any one of Examples 13 to 26.

[0040] Example 28 The controlling includes varying the temperature of the target area where treatment is performed. The method described in Example 27.

[0041] Example 29 the controlling includes flowing a cold liquid to the target site when the target site reaches a predetermined temperature. The method described in Example 27.

[0042] Example 30 further comprising visually monitoring the tissue at the target site. The method according to any one of Examples 13 to 29.

[0043] Example 31 The irradiating is performed by two different catheters operated simultaneously. The method described in Example 19.

[0044] Example 32 further comprising administering phonophoresis treatment. The method according to any one of Examples 13 to 31.

[0045] Example 33 administering the phonophoresis treatment includes further inflating the inflatable balloon to a second inflation state, wherein the second inflation state opens the plurality of first type openings. The method described in Example 32.

[0046] Example 34 administering the phonophoresis treatment includes delivering at least one agent during administration of the phonophoresis treatment. The method described in Example 32.

[0047] Example 35 further comprising performing iontophoresis treatment. The method according to any one of Examples 13 to 34.

[0048] Example 36 performing the iontophoresis treatment includes further inflating the inflatable balloon to a third inflation state, wherein the third inflation state opens the plurality of second type openings; The method described in Example 35.

[0049] Example 37 performing the iontophoretic treatment includes delivering at least one agent during the iontophoretic treatment; The method described in Example 35.

[0050] Example 38 and generating an interference current by actuating two separate catheters toward the location. The method according to any one of Examples 13 to 37.

[0051] Example 39 The treatment is used to treat one or more of ARDS, pulmonary parenchymal disease, and mediastinal disease. The method according to any one of Examples 13 to 38.

[0052] Example 40 the advancing is via the esophagus and / or trachea; The method according to any one of Examples 13 to 39.

[0053] Example 1a 1. A method for treating a wound in lung tissue, comprising: a. selecting a target site in the tissue in need of treatment; b. A method comprising advancing a catheter having an ultrasound transducer at a distal end of the catheter toward the target site and irradiating the target site with ultrasound, the irradiating step being characterized by a duration and intensity configured to avoid inducing cell death at the target site.

[0054] Example 2a The method of example 1a, wherein the irradiating comprises irradiating at an intensity between about 1 MHz and about 3 MHz.

[0055] Example 3a The method of Example 1a or Example 2a, wherein the irradiating comprises irradiating for about 10 seconds to about 15 minutes.

[0056] Example 4a The method of any one of Examples 1a to 3a, wherein the irradiating comprises irradiating using a focused beam of light.

[0057] Example 5a The method of any one of Examples 1a-4a, further comprising monitoring the temperature of the target area where treatment is administered.

[0058] Example 6a The method of any one of Examples 1a to 5a, further comprising preventing the temperature of the target site of treatment from rising above a predetermined temperature.

[0059] Example 7a The method of example 6a, wherein the predetermined temperature is between about 40 degrees Celsius and about 45 degrees Celsius.

[0060] Example 8a The method of any one of Examples 1a to 7a, further comprising actively controlling the temperature of the target area where treatment is performed.

[0061] Example 9a The method of example 8a, wherein the controlling comprises altering the temperature of the target site where treatment is performed.

[0062] Example 10a The method of example 8a, wherein the controlling comprises flowing a cold liquid to the target site when the target site reaches a predetermined temperature.

[0063] Example 11a The method of any one of Examples 1a-10a, further comprising visually monitoring the tissue at the target site.

[0064] Example 12a The method of any one of Examples 1a to 11a, further comprising actively searching for new targets while performing said irradiation.

[0065] Example 13a The method of example 12a, wherein the probing and the illuminating are performed by the same device.

[0066] Example 14a The method of Example 12a, wherein the searching is performed by a diagnostic ultrasound device introduced via an additional catheter, the diagnostic ultrasound device being configured to transmit coordinates to a therapeutic ultrasound device.

[0067] Example 15a The method of example 12a, wherein the probing and irradiating are performed simultaneously.

[0068] Example 16a The method of example 12a, wherein the probing and the illuminating are performed by two different devices.

[0069] Example 17a The method of any one of Examples 1a to 16a, further comprising irradiating the target site with a laser.

[0070] Example 18a The method of example 17a, wherein the laser irradiation is performed at a different time than the ultrasound irradiation.

[0071] Example 19a The method described in Example 17a, wherein the laser irradiation is performed one-third of the total number of irradiation treatments, and the ultrasonic irradiation is performed two-thirds of the total number of irradiation treatments.

[0072] Example 20a The method of any one of Examples 1a to 19a, further comprising, prior to the irradiating, selecting one or more locations adjacent to the target at which the irradiating is to be performed.

[0073] Example 21a The method of example 20a, further comprising dividing the irradiating performance among the one or more locations.

[0074] Example 22a The method of any one of Examples 1a to 21a, further comprising, prior to said irradiating, selecting at least three locations adjacent to said target site where said irradiating will occur.

[0075] Example 23a The method of example 22a, further comprising dividing the irradiating among the at least three locations.

[0076] Example 24a The method of any one of Examples 1a to 23a, further comprising topically administering one or more agents during said treatment.

[0077] Example 25a 1. A method of treating pulmonary embolism (PE) in a patient, comprising: a. selecting at least one target site in need of treatment; b. inserting a bronchoscope into the patient and positioning a distal end of the bronchoscope as close as possible to the at least one target site; c. inserting a catheter having a distal end with a therapeutic ultrasound transmitter into the bronchoscope; d. irradiating said at least one target site according to a predetermined effective irradiation program.

[0078] Example 26a The method of Example 25a, wherein the predetermined effective irradiation program comprises irradiating at a frequency of about 1 MHz to about 3 MHz.

[0079] Example 27a The method of any one of Examples 25a and 26a, wherein the predetermined effective irradiation program comprises irradiating the target area with three irradiation fields.

[0080] Example 28a The method of Example 27a, wherein the predetermined effective irradiation program includes irradiating at least 10 points within the three irradiation fields.

[0081] Example 29a The method of Example 28a, wherein the predetermined effective irradiation program comprises irradiating for a duration of at least 10 seconds per point.

[0082] Example 30a The method of any one of Examples 25a to 29a, wherein the predetermined effective irradiation program comprises irradiating for a total of at least 5 minutes.

[0083] Example 31a The method of any one of Examples 25a to 30a, wherein the predetermined effective irradiation program comprises irradiating the target site to reach a temperature of about 42°C.

[0084] Example 32a The method of any one of Examples 25a to 31a, wherein said selecting comprises locating and visualizing the affected area.

[0085] Example 33a The method of any one of Examples 25a to 32a, wherein the irradiating comprises irradiating for about 10 seconds to about 15 minutes.

[0086] Example 34a The method of any one of Examples 25a to 33a, wherein the irradiating comprises irradiating using a focused beam of light.

[0087] Example 35a The method of any one of Examples 25a-34a, further comprising monitoring the temperature of the target area where treatment is administered.

[0088] Example 36a The method of any one of Examples 25a to 35a, further comprising preventing the temperature of the target site of treatment from increasing above a predetermined temperature.

[0089] Example 37a The method of Example 36a, wherein the predetermined temperature is about 40°C to about 45°C.

[0090] Example 38a The method of any one of Examples 25a to 37a, further comprising actively controlling the temperature of the target area where treatment is performed.

[0091] Example 39a The method of Example 38a, wherein the controlling comprises altering the temperature of the target site where treatment is performed.

[0092] Example 40a The method of Example 38a, wherein the controlling comprises flowing a cold liquid to the target site when the target site reaches a predetermined temperature.

[0093] Example 41a The method of any one of Examples 25a-40a, further comprising visually monitoring the tissue at the target site.

[0094] Example 42a The method of any one of Examples 25a to 41a, further comprising actively searching for new targets while performing said irradiation.

[0095] Example 43a The method of example 42a, wherein the probing and the irradiating are performed by the same device.

[0096] Example 44a The method of Example 42a, wherein the searching is performed by a diagnostic ultrasound device introduced through an additional catheter, the diagnostic ultrasound device being configured to transmit coordinates to a therapeutic ultrasound device.

[0097] Example 45a The method of example 42a, wherein the probing and irradiating are performed simultaneously.

[0098] Example 46a The method of example 42a, wherein the probing and the illuminating are performed by two different devices.

[0099] Example 47a The method of any one of Examples 25a-46a, further comprising irradiating the target site with a laser.

[0100] Example 48a The method of Example 47a, wherein the laser irradiation is performed at a different time than the ultrasound irradiation.

[0101] Example 49a The method described in Example 47a, wherein the laser irradiation is performed one-third of the total number of irradiation treatments, and the ultrasonic irradiation is performed two-thirds of the total number of irradiation treatments.

[0102] Example 50a The method of any one of Examples 25a to 49a, further comprising, prior to the irradiating, selecting one or more locations adjacent to the target at which the irradiating is to be performed.

[0103] Example 51a The method of example 50a, further comprising dividing the irradiating performance among the one or more locations.

[0104] Example 52a The method of any one of Examples 25a to 51a, further comprising, prior to said irradiating, selecting at least three locations adjacent to said target site where said irradiating will occur.

[0105] Example 53a The method of example 52a, further comprising dividing the performance of the irradiating among the at least three locations.

[0106] Example 54a The method of any one of Examples 25a-53a, further comprising topically administering one or more agents during said treatment.

[0107] Example 55a 1. A method for treating pulmonary parenchymal and mediastinal diseases in a patient, comprising: a. selecting at least one target site in need of treatment; b. inserting a bronchoscope or gastroscope into the patient's esophagus or stomach and positioning the distal end of the bronchoscope as close as possible to the at least one target site; c. inserting a catheter having a distal end with a therapeutic ultrasound transmitter into the bronchoscope; d. irradiating said at least one target site according to a predetermined maximum irradiation program.

[0108] Example 56a The method of Example 55a, wherein the predetermined maximum irradiation program comprises irradiating at a frequency of about 5 MHz to about 50 MHz.

[0109] Example 57a The method of any one of Examples 55a and 56a, wherein the predetermined maximum irradiation program comprises irradiating the target area with five irradiation fields.

[0110] Example 58a The method of Example 57a, wherein the predetermined maximum irradiation program includes irradiating at least 20 points within the three irradiation fields.

[0111] Example 59a The method of Example 58a, wherein the predetermined maximum irradiation program comprises irradiating for a duration of at least 30 seconds per point.

[0112] Example 60a The method of any one of Examples 55a to 59a, wherein the predetermined maximum irradiation program comprises irradiating for a total of at least 30 minutes.

[0113] Example 61a The method of any one of Examples 55a to 60a, wherein the predetermined maximum irradiation program comprises irradiating to reach a temperature of about 45°C at the target site.

[0114] Example 62a The method of any one of Examples 55a to 61a, wherein said selecting comprises locating and visualizing the affected area.

[0115] Example 63a The method of any one of Examples 55a to 62a, wherein the irradiating comprises irradiating for about 10 seconds to about 15 minutes.

[0116] Example 64a The method of any one of Examples 55a to 63a, wherein the irradiating comprises irradiating using a focused beam of light.

[0117] Example 65a The method of any one of Examples 55a-64a, further comprising monitoring the temperature of the target area where treatment is administered.

[0118] Example 66a The method of any one of Examples 55a to 65a, further comprising preventing the temperature of the target site of treatment from rising above a predetermined temperature.

[0119] Example 67a The method of Example 66a, wherein the predetermined temperature is about 40°C to about 45°C.

[0120] Example 68a The method of any one of Examples 55a-67a, further comprising actively controlling the temperature of the target area where treatment is performed.

[0121] Example 69a The method of Example 68a, wherein the controlling comprises altering the temperature of the target site where treatment is performed.

[0122] Example 70a The method of Example 68a, wherein the controlling comprises flowing a cold liquid to the target site when the target site reaches a predetermined temperature.

[0123] Example 71a The method of any one of Examples 55a-70a, further comprising visually monitoring the tissue at the target site.

[0124] Example 72a The method of any one of Examples 55a to 71a, further comprising actively searching for new targets while performing said irradiation.

[0125] Example 73a The method of example 72a, wherein the probing and the irradiating are performed by the same device.

[0126] Example 74a The method of Example 72a, wherein the searching is performed by a diagnostic ultrasound device introduced through an additional catheter, and the diagnostic ultrasound device is configured to transmit coordinates to a therapeutic ultrasound device.

[0127] Example 75a The method of example 72a, wherein the probing and irradiating are performed simultaneously.

[0128] Example 76a The method of example 72a, wherein the probing and the irradiating are performed by two different devices.

[0129] Example 77a The method of any one of Examples 55a to 76a, further comprising irradiating the target site with a laser.

[0130] Example 78a The method of Example 77a, wherein the laser irradiation is performed at a different time than the ultrasound irradiation.

[0131] Example 79a The method described in Example 77a, wherein the laser irradiation is performed one-third of the total number of irradiation treatments, and the ultrasonic irradiation is performed two-thirds of the total number of irradiation treatments.

[0132] Example 80a The method of any one of Examples 55a to 79a, further comprising, prior to the irradiating, selecting one or more locations adjacent to the target at which the irradiating is to be performed.

[0133] Example 81a 81. The method of Example 80, further comprising dividing the irradiating performance among the one or more locations.

[0134] Example 82a The method of any one of Examples 55a to 81a, further comprising, prior to said irradiating, selecting at least three locations adjacent to said target site where said irradiating will occur.

[0135] Example 83a The method of example 82a, further comprising dividing the performance of the irradiating among the at least three locations.

[0136] Example 84a The method of any one of Examples 55-83a, further comprising topically administering one or more agents during said treatment.

[0137] Example 85a The method of example 55a, wherein the selecting comprises locating and visualizing the affected area.

[0138] Example 86a 1. A method of treating a wound in lung and / or parenchymal tissue in a patient, comprising: a. selecting at least one target site in said tissue in need of treatment; b. introducing a bronchoscope into the patient and positioning the bronchoscope adjacent to the target site; c. inserting a catheter having a distal end with a therapeutic ultrasound transmitter into the bronchoscope; d. irradiating said at least one target site according to a predetermined efficient mode program.

[0139] Example 87a The method of Example 86a, wherein the predetermined efficient mode program comprises irradiating at a frequency of about 1 MHz to about 3 MHz.

[0140] Example 88a The method of any one of Examples 86a and 87a, wherein the predetermined efficient mode program includes irradiating the target area with three irradiation fields.

[0141] Example 89a The method of Example 88a, wherein the predetermined efficient mode program includes illuminating at least 10 points within the three illumination fields.

[0142] Example 90a The method of Example 89a, wherein the predetermined efficient mode program comprises irradiating for a duration of at least 10 seconds per point.

[0143] Example 91a The method of any one of Examples 86a to 90a, wherein the predetermined efficient mode program comprises irradiating for a total of at least 5 minutes.

[0144] Example 92a The method of any one of Examples 86a to 91a, wherein the predetermined efficient mode program includes irradiating to reach a temperature of about 42°C at the target site.

[0145] Example 93a The method of any one of Examples 86a to 92a, wherein said selecting comprises locating and visualizing the affected area.

[0146] Example 94a The method of any one of Examples 86a to 93a, wherein the irradiating comprises irradiating for about 10 seconds to about 15 minutes.

[0147] Example 95a The method of any one of Examples 86a to 94a, wherein the irradiating comprises irradiating using a focused beam of light.

[0148] Example 96a The method of any one of Examples 86a-95a, further comprising monitoring the temperature of the target area where treatment is administered.

[0149] Example 97a The method of any one of Examples 86a to 96a, further comprising preventing the temperature of the target site being treated from rising above a predetermined temperature.

[0150] Example 98a The method of Example 97a, wherein the predetermined temperature is about 40°C to about 45°C.

[0151] Example 99a The method of any one of Examples 86a-98a, further comprising actively controlling the temperature of the target area where treatment is performed.

[0152] Example 100a The method of Example 99a, wherein the controlling comprises changing the temperature of the target site where treatment is performed.

[0153] Example 101a The method of Example 99a, wherein the controlling includes flowing a cold liquid to the target site when the target site reaches a predetermined temperature.

[0154] Example 102a The method of any one of Examples 86a-101, further comprising visually monitoring the tissue at the target site.

[0155] Example 103a The method of any one of Examples 86a-102a, further comprising actively searching for new targets while performing said irradiation.

[0156] Example 104a The method of example 103a, wherein the searching and the irradiating are performed by the same device.

[0157] Example 105a The method described in Example 103a, wherein the searching is performed by a diagnostic ultrasound device introduced through an additional catheter, and the diagnostic ultrasound device is configured to transmit coordinates to a therapeutic ultrasound device.

[0158] Example 106a The method of example 103a, wherein the probing and irradiating are performed simultaneously.

[0159] Example 107a The method of example 103a, wherein the searching and the irradiating are performed by two different devices.

[0160] Example 108a The method of any one of Examples 86a to 107a, further comprising irradiating the target site with a laser.

[0161] Example 109a The method described in Example 108a, wherein the laser irradiation is performed at a different time than the ultrasound irradiation.

[0162] Example 110a The method described in Example 108a, wherein the laser irradiation is performed one-third of the total number of irradiation treatments, and the ultrasonic irradiation is performed two-thirds of the total number of irradiation treatments.

[0163] Example 111a The method of any one of Examples 86a-110a, further comprising, prior to the irradiating, selecting one or more locations adjacent to the target at which the irradiating is performed.

[0164] Example 112a The method of Example 111a, further comprising dividing the performance of the irradiating among the one or more locations.

[0165] Example 113a The method of any one of Examples 86a to 112a, further comprising, prior to said irradiating, selecting at least three locations adjacent to said target site where said irradiating will occur.

[0166] Example 114a The method of example 113a, further comprising dividing the performance of the irradiating among the at least three locations.

[0167] Example 115a The method of any one of Examples 86a-114a, further comprising topically administering one or more agents during said treatment.

[0168] Example 116a The method of example 115a, wherein the selecting is according to one or more of an X-ray, a CT scan, an MRI scan, and an ultrasound scan.

[0169] Unless otherwise defined, all technical and / or scientific terms used herein have the meaning commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, representative methods and / or materials are described herein. In the event of a conflict between the contents of this patent specification, including definitions, and other descriptions, the contents of this patent specification shall control. Furthermore, the materials, methods, and examples described herein are illustrative only and are not necessarily limiting.

[0170] As will be appreciated by those skilled in the art, some embodiments of the present invention may be embodied as a system, a method, or a computer program product. Accordingly, some embodiments of the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment (including firmware, resident software, microcode, etc.), or an embodiment combining software and hardware elements, which may be collectively referred to herein as a "circuit," "module," or "system." Furthermore, some embodiments of the present invention may take the form of a computer program product embodied in a computer-readable medium having computer-readable program code stored thereon. Implementations of the methods and / or systems of some embodiments of the present invention may perform or complete selected tasks manually, automatically, or a combination thereof. Furthermore, depending on the actual device and equipment of the methods and / or systems of some embodiments of the present invention, some selected tasks may be implemented by hardware, software, firmware, or a combination thereof (e.g., using an operating system).

[0171] For example, hardware for performing selected tasks in some embodiments of the present invention may be implemented as a chip or circuit. As software, selected tasks in some embodiments of the present invention may be implemented as a plurality of software instructions executed by a computer using any suitable operating system. In one embodiment of the present invention, one or more tasks according to some embodiments of the methods and / or systems described herein are performed by a data processor, such as a computing platform for executing a plurality of instructions. Optionally, the data processor includes volatile memory for storing instructions and / or data, and / or non-volatile storage, such as a magnetic hard disk and / or removable media, for storing instructions and / or data. Optionally, a network connection is also provided. Also, a display and / or a user input device, such as a keyboard or mouse, are optionally provided.

[0172] Any combination of one or more computer-readable media may be utilized for some embodiments of the present invention. The computer-readable medium may be a computer-readable signal medium or a computer-readable storage medium. The computer-readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples of computer-readable storage media include electrical connections having one or more wires, portable computer diskettes, hard disks, random access memories, read-only memories, erasable programmable read-only memories, optical fibers, portable compact disc read-only memories (CD-ROMs), optical storage devices, magnetic storage devices, or any suitable combination of the above. In the context of this specification, a computer-readable storage medium may be any tangible medium that can contain or store a program for use by or in connection with an instruction execution system, apparatus, or device.

[0173] A computer-readable signal medium may include a propagated data signal having computer-readable program code embodied therein, for example, in baseband or as part of a carrier wave. Such a propagated signal may take any of a variety of forms, including, but not limited to, electromagnetic, optical, or any suitable combination thereof. A computer-readable signal medium may also be a computer-readable medium that is not a computer-readable storage medium but can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device.

[0174] The program code embodied on the computer-readable medium and / or data used thereby may be transmitted using any suitable medium, including but not limited to wireless, wired, fiber optic cable, RF, etc., or any suitable combination of the foregoing.

[0175] Computer program code for carrying out operations for certain embodiments of the present invention may be written in any combination of one or more programming languages, including object-oriented programming languages such as Java, Smalltalk, C++, etc., and conventional procedural programming languages such as the "C" programming language or similar programming languages. The program code may run entirely on the user's computer, partially on the user's computer, as a standalone software package, partially on the user's computer and a remote computer, or entirely on a remote computer or server. In the latter case, the remote computer may be connected to the user's computer via any type of network, including a local area network (LAN) or a wide area network (WAN), and the connection may be to an external computer (e.g., via the Internet using an Internet Service Provider).

[0176] Some embodiments of the present invention may be described below with reference to flowchart diagrams and / or block diagrams that illustrate methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each block of the flowchart diagrams and / or block diagrams, and combinations of blocks in the flowchart diagrams and / or block diagrams, can be implemented by computer program instructions. These computer program instructions can be provided to a processor of a general-purpose computer, a special-purpose computer, or other programmable data processing apparatus to produce a machine. The instructions, executed by the processor of the computer or other programmable data processing apparatus, thereby form means for implementing the functions or acts identified in the flowchart and / or block diagram blocks.

[0177] These computer program instructions may also be stored on a computer-readable medium that directs a computer, other programmable data processing apparatus, or other device to operate in a particular manner, such that the instructions stored on the computer-readable medium produce an article of manufacture that includes instructions that implement the functions or acts identified in the flowchart and / or block diagram blocks.

[0178] These computer program instructions may be loaded into a computer, other programmable data processing apparatus, or other device and cause the computer, programmable apparatus, or device to perform a series of operational steps to generate a computer-implemented process, whereby the instructions executing on the computer or other programmable apparatus provide a process that implements the functions or operations identified in the flowchart and / or block diagram blocks.

[0179] Some of the methods described herein are generally designed for use solely by a computer and may be infeasible or impractical for purely manual execution by a human expert. For example, a human expert attempting to manually perform a similar task, such as providing ultrasound of the appropriate intensity to the tissue being treated, would likely use an entirely different method. For example, by leveraging the expertise and pattern recognition capabilities of the human brain, the task may be performed much more efficiently than manually performing each step of the methods described herein in sequence. [Brief explanation of the drawings]

[0180] Some embodiments of the present invention will now be described, by way of example, with reference to the accompanying drawings. In particular, and in detail referring to the drawings, it is emphasized that the particulars shown are by way of example only and are for the purpose of describing embodiments of the invention. In this regard, it will become apparent to those skilled in the art, from a consideration of this specification in conjunction with the drawings, how embodiments of the present invention may be practiced. [Figure 1] 1 is a flowchart illustrating an exemplary method of treatment according to some embodiments of the present invention. [Figure 2] 1 is a schematic diagram illustrating specific areas of treatment in accordance with some embodiments of the present invention. [Figure 3] 1 is a schematic diagram illustrating insertion of a device into the lung for diagnostic and / or therapeutic purposes in some embodiments of the present invention. [Figure 4] 1 is a schematic illustration of selected locations where therapeutic ultrasound is administered in accordance with some embodiments of the present invention; [Figure 5] FIG. 2 is a schematic diagram illustrating the interference fields generated by two CTCats in some embodiments of the present invention. [Figure 6] FIG. 6 is a schematic diagram illustrating an example of a calibration / treatment catheter (CTCat) 600 according to some embodiments of the present invention. [Figure 7] 1 is a flowchart illustrating an example of a typical use of CTCat in accordance with some embodiments of the present invention. [Figure 8] 1 is a flowchart illustrating an example of a contact calibration method according to some embodiments of the present invention. [Figure 9] 1 is a flowchart illustrating an example of a position calibration method according to some embodiments of the present invention. [Figure 10] FIG. 1 is a schematic diagram illustrating an example of interference current generation by two CTCats in accordance with some embodiments of the present invention. [Figure 11] 1 is a schematic diagram illustrating a catheter system according to some embodiments of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0181] In some embodiments, the present invention relates to systems and methods for localized pulmonary treatment, and more particularly, but not exclusively, to transbronchial therapeutic ultrasound systems and methods applicable to localized pulmonary treatment in patients with ARDS and mediastinal thromboembolic complications (mediastinal disease).

[0182] (overview) One aspect of some embodiments of the present invention relates to the localized, non-invasive treatment of lung tissue lesions, ranging from inflammatory diseases to ARDS and tumor pathologies. In some embodiments, therapeutic ultrasound, due to its invasive nature, can mechanically cleanse wounds, promote angiogenesis and vasomotion, and stimulate tissue regeneration processes, meeting all the criteria necessary for the localized treatment of a wide variety of tissues, from the legs in diabetics to the reproductive organs. More than 70% of COVID-19 patients die from pulmonary complications. Without being bound by theory, damage to pulmonary parenchymal disease in various diseases has been shown to represent a specific type of "bed healing wounds." This tendency is particularly pronounced in ARDS, where key biological markers impeding wound healing have been identified that behave similarly to poorly healing wounds with different etiologies, such as pressure ulcers, venous ulcers, and diabetic ulcers. Thus, vascular lesions in the lungs are slow-healing wounds, requiring localized treatment like other wounds. However, such treatment is currently unavailable, resulting in a high mortality rate of over 40%. In some embodiments, transbronchial therapeutic ultrasound (minimally invasive) is used alone or in combination with phonophoresis / iontophoresis and, optionally, laser therapy to provide localized treatment of pulmonary and mediastinal disorders. Additionally, in some embodiments of the present invention, calibration is performed to direct the therapeutic ultrasound to the site of the lung or mediastinal lesion. This allows for identification of a location that is as close as possible to the lesion, yet with minimal aeration and easiest passage of ultrasound. An aspect of some embodiments of the present invention relates to treating the lung using ultrasound. In some embodiments, a transbronchial therapeutic ultrasound approach is used alone or in combination with one or more of phonophoresis, iontophoresis, and / or laser to provide localized treatment of pulmonary and mediastinal disorders. In some embodiments, prior to applying a dose of ultrasound radiation, a calibration process is performed to determine a location that meets one or more of the following criteria: a location that is as close as possible to the lesion requiring treatment, and a location that meets one or more of the following criteria: ...In some embodiments of the present invention, calibration and positioning are performed by determining the attenuation coefficient, i.e., determining the area as close as possible to the focal point through which ultrasound can penetrate most easily. In some embodiments, other methods of calibration may be used. In some embodiments, ultrasound irradiation of the target site is characterized by duration, intensity, and number of irradiation fields to maximize therapeutic efficacy with minimal side effects and avoid inducing cell death at the target site. In some embodiments, treatment involves the local delivery of specific drugs using a specialized catheter, known as a "Catheter-Calibrated Therapeutic Catheter (CTCat)." This catheter is equipped with a transducer and is covered by a balloon. The balloon further contains micropores that open under specific pressure. In some embodiments, the micropores allow the drug within the balloon to pass through. In some embodiments, ultrasound simultaneously mechanically penetrates adjacent tissue, delivering the drug to the focal point of the lesion (phonophoresis). Catheter sizes vary depending on their durability and the contact pressure (the minimum pressure required for the balloon to fully contact the bronchial wall while the perforation remains closed) required. The use of contact pressure can prevent excessive thickening of the bronchial wall and ischemia (a frequent complication of balloon over-inflation). For example, a catheter with resistance R1 may have a contact pressure of 10 mm / H2O, R2 to 15 mm / H2O, or R3 to 20 mm / H2O. In some embodiments, the treatment method includes delivering an interferential current. For this reason, in some embodiments, two intermediate frequency currents are used. In some embodiments, they are used only as carrier waves to achieve deeper penetration and to generate the interferential current, without producing muscle or nerve stimulation. In some embodiments, iontophoresis uses an electric field to enhance drug penetration. Drug ions move within the field according to their charge, driving the drug toward the opposite electrode and into the tissue. This technique is based on the principle that, in a specific electric field, positively charged drug ions (cations) are repelled by the anode and move toward the cathode.For example, ketoprofen is negatively charged and therefore is repelled by the negative electrode (cathode) and migrates to the positive electrode (anode). In some embodiments, an interferometric current is used for iontophoresis. An aspect of some embodiments of the present invention relates to a system including an external unit to which one or more dedicated catheters are connected. In some embodiments of the present invention, the external unit includes dedicated control mechanisms for actuating the different mechanisms of each catheter. In some embodiments, the external unit includes the following elements: 1.Video unit with navigation system. 2. An electric field unit that generates an interference field, for example, a first pair receiving 4000 Hz and a second pair receiving in the range of 4100-4500 Hz, in some embodiments, the current strength at the same time does not exceed 13 milliamps. 3. An ultrasonic unit that emits ultrasonic waves of 0.5 to 3 MHz at 2 watts / cm 2 In some embodiments, the ultrasound unit is configured to generate ultrasound waves at a power of up to 100 W. In some embodiments, the ultrasound unit is configured to monitor the ambient temperature of the probe. In some embodiments, the ultrasound generator generates ultrasound waves in pulsed and / or non-pulsed waveforms. 4. A calibration unit configured to determine the attenuation coefficient at different localizations to provide an optimal localization of the transducer. 5. A unit for monitoring and maintaining the pressure in the balloon. 6. Drug administration and dosage monitoring unit, used to inject drugs into the catheter and monitor the dose for phonophoresis. 7. Drug administration and dosage monitoring unit, used to inject drugs into the catheter and monitor the dose for iontophoresis.

[0183] Example 25 A method for treating pulmonary embolism (PE) or other thromboembolic mediastinal complications. An aspect of some embodiments of the present invention relates to treating the lungs using ultrasound. In some embodiments, the treatment is administered from very close range to the target tissue requiring treatment. In some embodiments, the treatment is administered internally, e.g., from within the lungs. In some embodiments, a preliminary calibration process is performed prior to treatment to identify areas of the lung that exhibit high ultrasound transparency or areas as close as possible to the lesion. In some embodiments, one advantage of performing the preliminary calibration is the potential to avoid delivering ultrasound energy to areas containing air, which would reflect the ultrasound energy and potentially prevent proper treatment. In some embodiments, therapeutic ultrasound is delivered with or without the delivery of a drug or pharmaceutical agent to the lungs. In some embodiments, the calibration process includes selecting an optimal position for the ultrasound probe. In some embodiments, the optimal position is characterized by the absence of air between the probe and the target treatment area. In some embodiments, the optimal position is closest to the location where treatment is required. In some embodiments, the optimal location is one where there is no air between the probe and the location where treatment is needed and is closest to the location where treatment is needed. In some embodiments, the calibration process utilizes attenuation of delivered ultrasound energy to select a location for probe placement. In some embodiments, the pre-calibration process includes ensuring continuous contact between the ultrasound probe and the bronchial wall. In some embodiments, the electrode includes a mechanism configured to determine when both the proximal and distal ends of the region containing the ultrasound transmitter are in continuous contact with the bronchial wall. In some embodiments, the ultrasound action is configured to provide a therapeutic effect while avoiding induction of cell death. In some embodiments, the treatment is characterized by a relatively narrow and / or focused ultrasound beam. In some embodiments, imaging is optionally performed simultaneously with the treatment. In some embodiments, imaging is used to identify relevant areas requiring treatment, optionally in real time, including areas showing increased fluid levels or other signs of lung tissue dysfunction.In some embodiments, potential benefits of combining transbronchial diagnostic and therapeutic ultrasound include the potential for a better understanding of the kinetics and efficacy of treatment, as well as the potential for reducing the number of x-rays that such patients would typically need to undergo, thereby reducing the patient's radiation exposure.

[0184] In some embodiments, as described above, during treatment, the ultrasound probe is brought as close as possible to the tissue requiring treatment via an internal body (through an intubation tube, bronchoscope, endoscope, laparoscope, or robot). For example, the ultrasound probe may be brought as close as possible to the tissue requiring treatment via the esophagus and / or trachea, or optionally, to a distance of about 1 mm to about 1 cm, or optionally, to a distance of about 0.5 mm to about 3 cm, or even about 0.1 mm to about 5 cm. In some embodiments, a potential advantage of bringing the ultrasound probe closer to the tissue is that it may avoid problems caused by interfering tissue when applying treatment externally. Another potential advantage is that it may shorten the duration of a treatment session compared to external treatment. For example, the duration of a treatment session may be shortened to about 3 minutes to about 5 minutes, optionally, to about 2 minutes to about 10 minutes, and optionally, to about 1 minute to about 15 minutes. Another potential advantage is the possibility of using a focused ultrasound beam, which may improve specificity of the treatment site. Another potential advantage is the possibility of providing treatment regardless of the patient's anatomy. For example, in obese patients, external ultrasound from the chest cannot be used because bone and increased body mass result in near-zero penetration of ultrasound, yet the methods of the present invention may provide treatment for such patients.

[0185] In some embodiments, treatment allows for monitoring of temperature changes (rise or fall) within the lung, and more specifically, at the site of lung parenchyma injury. The temperature rises to about 40 to about 45°C due to the thermal effect of therapeutic ultrasound and then falls when treatment is stopped. In some embodiments, ultrasound emission is monitored and controlled, and adjusted to avoid cellular damage while providing a therapeutic effect. In some embodiments, a potential advantage of the present systems and methods is that the ultrasound probe can be placed in close proximity to the lung tissue being treated, allowing for control of the temperature at the injury site itself and application of the thermal effect of ultrasound without side effects. This thermal effect may have a beneficial effect on improving blood flow at the site of lung injury within the above temperature range. This differs from external ultrasound, which can only monitor the temperature of the transducer and skin, but cannot control the temperature at the injury site.

[0186] An aspect of some embodiments of the present invention relates to treating lung injury, optionally in patients with severe acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) who are connected to a ventilator or extracorporeal membrane oxygenation (ECMO). In some embodiments, the treatment is localized treatment to the site of injury within the lung. In some embodiments, the treatment is localized treatment provided within the lung rather than external to the patient's body. In some embodiments, the treatment is treatment of the lung parenchyma, blood vessels, and alveolar-vascular complex. In some embodiments, identifying patients as candidates for treatment includes determining levels of one or more of the following biomarkers: interleukin-6 (IL-6), matrix metalloproteinase 9 (MMP-9), tumor necrosis factor-α (TNF-α), D-dimer, and transforming growth factor-β1 (TGF-β1), which determine the severity of the eventual healing of the lesion, regardless of the cause of the injury. In some embodiments, the candidate exhibits one or more of the following parameters: elevated serum IL-6 levels, elevated serum TNF-α levels, elevated serum matrix metalloproteinase (MMP-9) levels, elevated serum D-dimer (patients requiring intubation are at higher risk of developing pulmonary embolism (PE)), elevated serum TGF-β levels. It should be understood that these parameters are exemplary only, and treatment may be offered to patients who do not fully meet these parameter criteria.

[0187] In some embodiments, blood / serum levels of the above parameters (IL-6, MMP-9, TNF-α, D-dimer, TGF-β1) are determined during and / or after the administration of treatment and used to determine the progress of the treatment. For example, a decrease in these molecular parameters compared to values measured before the start of treatment may indicate an improvement in the state of the lesion / injury. In some embodiments, the monitoring of the levels of one or more of IL-6, MMP-9, TNF-α, D-dimer, and TGF-β1 is performed compared to the initial value before the administration of treatment. In some embodiments, monitoring is performed after each treatment. In some embodiments, monitoring is performed one or two days after each treatment. In some embodiments, monitoring is performed a predetermined time after the administration of treatment, as directed by a healthcare professional.

[0188] In some embodiments, the treatment comprises therapeutic high-frequency, low-power ultrasound configured to locally treat wounds within the lungs. In some embodiments, areas of the lungs affected by wounds and / or inflammation are affected by therapeutic ultrasound, despite the fact that the lungs are filled with air and cannot conduct ultrasound because these areas are not merely filled with air but also contain fluid produced by the inflammatory process.

[0189] In some embodiments, to optimize delivery of therapeutic ultrasound, the therapeutic ultrasound probe is placed in close proximity to the bronchial tree, which is the focus of the lesion within the lung. In some embodiments, treatment involves the insertion of a very thin catheter equipped with the therapeutic ultrasound probe, allowing it to reach almost any location within the lung. As a result, obstacles that would otherwise prevent ultrasound from reaching the lesion in the lung tissue can be avoided (except for the thin walls of the bronchi). In some embodiments, a potential advantage of this method is that it can provide all of the beneficial properties of therapeutic ultrasound that are important for localized wound treatment (cleansing, anti-inflammatory, thermal, angiogenic and vasomotor effects, as well as other localized properties of ultrasound in the repair process). In some embodiments, the method is relatively minimally invasive and can optionally be combined with diagnostic ultrasound. Diagnostic ultrasound can be inserted transbronchially and used to identify lesions in the lung parenchyma and convert the coordinates of the therapeutic ultrasound, thereby improving the positional accuracy of the catheter equipped with therapeutic ultrasound. In some embodiments, treatment is administered without causing side effects. In some embodiments, a catheter equipped with therapeutic ultrasound can be inserted into the esophagus or stomach under endoscopic control, allowing for precise access to the closest pulmonary lesion. In some embodiments, taking into account the antithrombotic effects of therapeutic ultrasound, a calibration / therapeutic catheter can be maintained transbronchially or endoscopically, either alone or in combination with a local anticoagulant, to treat mediastinal thromboembolic complications (including pulmonary embolism). In some embodiments, a potential advantage of the treatment of the present invention is that it is a much less invasive procedure for treating pulmonary embolism compared to the pulmonary artery ablation performed in EKOS. Furthermore, the treatment disclosed herein utilizes the mechanical effects of ultrasound to recruit approximately 12-15% of additional atelectatic alveoli. These alveoli can then be opened by the application of ultrasound micromassage in close proximity. Another potential advantage of the treatment method of the present invention is that it overcomes the drawbacks associated with the use of external ultrasound in the thoracic lung region.External ultrasound is less effective because the presence of bone and tissue substantially blocks the passage of ultrasound. This is due to the highly echogenic nature of bone. Furthermore, the penetration capability of therapeutic ultrasound is approximately 5 cm. As will be apparent to those skilled in the art, ultrasound is virtually unable to reach lung tissue due to the thickness of the chest wall and the various tissues with different impedances that exist along the path of the ultrasound beam (e.g., skin, subcutaneous layer, fat, bone, muscle, fascia, etc.).

[0190] In some embodiments, a laser is also used simultaneously with therapeutic ultrasound. In some embodiments, a laser is also used, such as a laser probe inserted with an endobronchial catheter or inserted endoscopically, in combination with the therapeutic ultrasound described above.

[0191] An aspect of some embodiments of the present invention relates to a method for treating a wound in lung tissue, the method comprising: 1. Selecting a target site in the tissue in need of treatment; 2. advancing one or more endobronchial catheters having ultrasound transducers at their distal ends toward the target site, e.g., via the esophagus and / or trachea; 3. Calibrating and positioning the target, where the calibration and positioning includes determining an attenuation coefficient, specifically identifying a region as close as possible to the focal point where ultrasound is most readily transmitted, and irradiating the target with ultrasound, where the irradiation time, intensity, and number of irradiation fields are adjusted to maximize therapeutic efficacy, minimize side effects, and avoid inducing cell death within the target. In some embodiments, the therapeutic ultrasound method described above is further performed in conjunction with the administration of a localized drug (e.g., an anticoagulant, an anti-inflammatory, etc.). Potential advantages include ultrasound facilitating the delivery of the drug into tissue. In some embodiments, the localized drug administration is further performed using phonophoresis and / or iontophoresis. Before describing at least one embodiment of the present invention in detail, it should be understood that the application of the present invention is not necessarily limited to the details of construction, the arrangement of components, the method, and / or examples set forth in the following description and / or drawings and / or examples. The present invention is capable of other embodiments and of being practiced or carried out in various ways.

[0192] In the following paragraphs, methods of treatment are disclosed. Below, the inventive concept of the present invention is explained using an example method of treating the lungs, but the same or similar methods may be performed for different locations. For example, the method may also be used to treat the colon.

[0193] (One example of the method) Reference is now made to Figure 1, which illustrates a flow chart of an exemplary method of treatment according to some embodiments of the present invention. In some embodiments, the exemplary method of treatment includes one or more of the following acts:

[0194] Locating the location of the treatment area (step 102). For example, a visual assessment of the target organ, such as the lung, is performed to locate the location of the associated treatment area. For example, a CT scan of the lungs is performed to determine locations 202 within the lungs 204 that require or may require ultrasound treatment. FIG. 2 shows a schematic representation of this. In some embodiments, an ultrasound diagnostic catheter is inserted to locate and / or diagnose the area of interest. In some embodiments, x-ray, MRI, CT, and ultrasound are used as example methods for determining the area requiring treatment.

[0195] Providing coordinates to the device (step 104). In some embodiments, a computerized navigation system is optionally used to navigate the bronchoscope. Thus, in some embodiments, coordinates of locations within the lungs are provided to the computerized navigation system. In some embodiments, a potential advantage of using a computerized navigation system is that the navigational precision of the device allows for reaching the distal and smaller bronchi within the lungs.

[0196] The apparatus is inserted into the patient and allowed to reach the desired coordinates (step 106). In some embodiments, the device is inserted into the patient and the distal end of the device, including the ultrasound transmitter, is positioned near the location where treatment is required, for example, at a distance of about 1 mm to about 1 cm, or optionally, at a distance of about 0.5 mm to about 3 cm, or about 0.1 mm to about 5 cm from the location. FIG. 3 is a schematic diagram illustrating an example of a bronchoscope positioned at a location within the lung. In some embodiments, a diagnostic ultrasound transducer is inserted depending on the diameter of the lumen. In some embodiments, the diagnostic ultrasound transducer is operated, for example, using a frequency of about 20 MHz and a 360° field of view.

[0197] Determining Treatment Parameters (Step 108): In some embodiments, upon reaching the target location, the user determines the treatment parameters, which may include one or more of the following:

[0198] Selecting the most echogenic sites around the tissue requiring treatment, where one or more sites are selected, optionally three.

[0199] FIG. 4 is a schematic diagram of a right lung 402 and a left lung 404. The right lung 402 has a small area 406 requiring treatment, while the left lung 404 has a large area 408. FIG. 4 also shows three locations 410a, 410b, and 410c selected for administering treatment to the area 406 of the right lung 402 and three locations 412a, 412b, and 412c selected for administering treatment to the area 408 of the left lung 404. The arrows indicate the general direction of ultrasound treatment arrival. In some embodiments, optimal echogenic parameters are selected, for example, as follows: Based on CT or X-ray data, a user uses a bronchoscope to determine three to five locations that are most visible in diagnostic ultrasound during a single session. In some embodiments, these locations represent areas where extensive destruction of lung tissue has occurred. Therefore, in some embodiments, these locations have increased echogenicity, making them the optimal sites for insertion and application of therapeutic ultrasound, and treatment should begin at these locations. In some embodiments, if uniformly increased echogenicity is detected in the area of the lesion, the user selects the closest lesions and administers treatment to them according to the protocol.

[0200] In some embodiments, the selection of the location optionally depends on the transducer's maximal proximity to the target location, and optionally, on the periphery of the target location. In some embodiments, the selection of the transducer optionally depends on the location requiring treatment and the diameter of the bronchoscope channel. In some embodiments, the diameter of the transducer is typically about 2.5 mm to about 0.7 mm. In some embodiments, the treatment plan is developed taking into account the depth of the location requiring treatment, the location to which the treatment will be applied, and the size of the location requiring treatment. In some embodiments, the type of transducer is selected depending on, for example, the location and size of the lung tissue damage. In some embodiments, a radial probe, a linear probe, or a spot probe can be used. In some embodiments, the probe can be a combination of therapeutic ultrasound and laser, or laser only, or ultrasound only. In some embodiments, the size of the probe is selected depending on the location of the tissue requiring treatment in the lung, taking into account the diameter of the bronchoscope accordingly. In some embodiments, the smallest size is approximately 2 mm.

[0201] In some embodiments, the probe may include any one or more of the following: a laser and ultrasound integrated into a single probe; one to ten or more therapeutic ultrasound probes mounted in a single catheter; a laser and ultrasound separate configuration; a laser and ultrasound receiver combined; or a diagnostic ultrasound probe and a therapeutic ultrasound probe, either separated or integrated into a single probe. In some embodiments, when treatment is performed using therapeutic ultrasound alone, a five-minute treatment is performed, for example, twice daily. In some embodiments, combined laser and ultrasound treatments are optionally performed alternately depending on the tissue and patient condition. In some embodiments, the probe can be inserted transesophageally or transgastroscopically at specific localized locations near the mediastinum. In some embodiments, a bronchoscope can be used to treat tissue within the lungs transesophageally.

[0202] In some embodiments, the treatment profile, i.e., transducer activation, is also influenced by the relationship between the location requiring treatment and the location where treatment is to be administered, as well as the size of the location requiring treatment. For example, at locations requiring treatment located deeper within the tissue, the transducer may be activated at, for example, 1 MHz, while at closer locations, the transducer may be activated at, for example, 3 MHz. In some embodiments, the locations where treatment is to be administered are selected from different parts of the bronchial tree, optionally selected to be as close as possible to the location requiring treatment. In some embodiments, each location is a portion of the bronchial tree, e.g., up to 2 cm in size, and up to 10 points are selected for treatment. In some embodiments, each point is treated in a forward and backward or circular motion, e.g., for 10 seconds. Thus, in some embodiments, approximately 30 points are treated in one session, resulting in a 5-minute treatment time. In some embodiments, temperature is dynamically measured during the treatment session by a thermal sensor. In some embodiments, if the detected temperature reaches a certain value, treatment is reduced or stopped, or an active cooling operation, such as supplying a cooling liquid to the treatment area, is implemented. For example, if the detected temperature exceeds 41°C, treatment is temporarily stopped (until the detected temperature drops to a predetermined value) or the power of the delivered ultrasound is reduced. In some embodiments, for example, coolant is delivered using a separate bronchoscope / endoscope channel, optionally delivered automatically when a certain temperature value is detected. In some embodiments, a potential advantage of actively monitoring temperature is that it can be actively and precisely controlled, as described above, which is important for the success of treatment on the one hand and for patient safety on the other hand.

[0203] Processing is performed (step 110). In some embodiments, once the treatment plan is ready, the catheter with the diagnostic ultrasound transducer is removed from the bronchoscope and replaced with a therapeutic ultrasound transducer. In some embodiments, an ultrasound or laser treatment device is inserted into the bronchus and, depending on the location of the tissue requiring treatment, the device is positioned so that the probe is as close as possible to the desired location.

[0204] In some embodiments, the treatment sessions include one or more of the following parameters: Treatment Frequency: In some embodiments, treatment sessions are performed once a day, optionally twice a day, or several times a day. In some embodiments, treatment sessions are performed daily, or optionally every other day, or at any interval selected by a healthcare professional. In some embodiments, the selected locations at which treatments are performed are alternated during the first 7-10 days of treatment, depending on the size of the lesion. In some embodiments, a potential advantage of alternating treatment locations is that it allows areas to be treated from different directions while allowing the tissue necrosis process to progress in previously treated areas. Another potential advantage is that it allows for the greatest possible coverage. In some embodiments, during the first 7-10 days of treatment, the treatment target area is treated at least three times from each selected location. In some embodiments, the ultrasound beam is not uniform, but rather its characteristics change depending on the distance from the transducer. In some embodiments, the region of the ultrasound beam closest to the treatment head is referred to as the near field, interference field, or Fresnel zone. In some embodiments, the behavior of ultrasound in this region is less than regular, and there are regions where significant interference occurs. In some embodiments, the size (length) of the near field is r 2 It is calculated using the formula / λ, where r = radius of the transducer crystal and λ = wavelength of the ultrasound depending on the frequency used (e.g., 0.5 mm for 3 MHz, 1.5 mm for 1.0 MHz).

[0205] A decision is made whether to repeat or discontinue the treatment (step 112). In some embodiments, a new CT scan is performed 7 to 10 days after the start of treatment and compared. In some embodiments, if a medical professional determines a clinically favorable outcome (optionally based on the results of diagnostic imaging), treatment can be terminated after three weeks. In some embodiments, the rehabilitation period begins immediately after the patient is no longer in critical condition and continues until respiratory function is restored. In some embodiments, treatment during the rehabilitation period is performed, for example, once or twice a week. It should be noted that pulmonary fibrosis after acute respiratory distress syndrome (ARDS) can be very severe and severely impact respiratory function. However, in approximately 40% of patients, fibrotic changes are eventually replaced by normal lung tissue. In some embodiments, the rehabilitation period can continue, for example, for up to six months, or until scarring at the treated lung site is completely eliminated.

[0206] In some embodiments, if a medical professional determines that clinical results have not been achieved (optionally based on diagnostic imaging results), treatment is discontinued after 7 to 10 days, and treatment is performed on a different lung or a different site on the same lung, depending on the existing echozone conditions. In some embodiments, when laser and ultrasound treatment are used together, for example, two-thirds of the time is allocated to US irradiation and one-third of the time to laser irradiation. In this case, a catheter equipped with a laser probe is inserted instead of a catheter equipped with a therapeutic ultrasound probe.

[0207] In some embodiments, similar principles are applied to the treatment of other conditions, such as pulmonary embolism and other mediastinal vascular complications, or the use of transesophageal therapeutic ultrasound. In some embodiments, similar principles are applied to the treatment of locally administered drugs using ultrasound to penetrate diseased areas of the lung. In some embodiments, one or more drugs are administered to the patient during treatment, such as anti-inflammatory drugs, anticoagulants, etc.

[0208] 6 is a schematic diagram of a calibration / treatment catheter (CTCat) 600 according to some embodiments of the present invention. In some embodiments, the CTCat is a catheter with a dedicated distal end 602 configured to perform both calibration and treatment. In some embodiments, a potential advantage of the CTCat is that it eliminates the need for two separate treatments. Specifically, it may be possible to integrate the steps of identifying the appropriate location for treatment with the steps of placing the device that actually performs the treatment. In some embodiments, two different devices may be used: one for calibration and one for treatment.

[0209] In some embodiments, the distal end 602 comprises one or more ultrasound transducers 604. In some embodiments, the distal end 602 is covered by a balloon 606. In some embodiments, the balloon 606 can be inflated with a liquid 608 containing saline and / or a drug. In some embodiments, the balloon 606 comprises a first electrode 610 (disposed at a distal portion of the balloon 606) and a second electrode 612 (disposed at a proximal portion of the balloon 606). In some embodiments, the area of the second electrode 612 comprises a plurality of openings 614 configured to be activated during iontophoresis treatment (described in more detail below). In some embodiments, the positions of the first electrode 610 and the second electrode 612 are set as follows: the first electrode 610 is located distal to the most distally disposed transducer 604 of all the transducers 604, and the second electrode 612 is located proximally to the most proximally disposed transducer 604 of all the transducers 604. In other words, all transducers 604 are positioned between the first electrode 610 and the second electrode 612. In some embodiments, the balloon 606 further includes additional openings 616 configured to be activated during phonophoresis treatment (described in more detail below), with these openings 616 positioned to correspond to the locations of the transducers 604. In some embodiments, the distal end 602 includes a video camera 618 to assist the user in maneuvering the CTCat 600 within the patient. In some embodiments, the CTCat 600 ranges in size depending on the resistance of each catheter, resulting in different contact pressures (i.e., the minimum pressure generated within the balloon to ensure full contact with the bronchial wall). In some embodiments, a potential advantage of using contact pressure is that it can prevent hyperplasia and / or bronchial wall ischemia due to balloon over-inflation, which frequently occurs as a result of balloon over-inflation. In some embodiments, for example, the contact pressure of a catheter with resistance R1 is set to 10 mmH2O, the contact pressure of a catheter with resistance R2 is set to 15 mmH2O, and the contact pressure of a catheter with resistance R3 is set to 20 mmH2O.

[0210] (An example of how to use CTCat) 7 is a flowchart of a general method of use of a CTCat according to some embodiments of the present invention. The following paragraphs first provide a general overview of the method, followed by a detailed description of each specific operation. In some embodiments, the method includes inserting a CTCat into a patient. Optionally, a video camera 618 is used to assist in the insertion (step 702). In some embodiments, the insertion is performed, for example, transesophageal and / or transtracheal.

[0211] In some embodiments, the method includes performing a contact calibration (step 704).

[0212] In some embodiments, the method includes performing a position calibration (step 706).

[0213] In some embodiments, the method optionally includes repositioning the CTCat device to a new location and performing operations 704 and 706 again (step 708). In some embodiments, the reason for repositioning the CTCat is if contact calibration fails or if position calibration fails. In some embodiments, the method includes administering ultrasound therapy (step 710).

[0214] In some embodiments, the method optionally includes administering phonophoresis therapy (step 712).

[0215] In some embodiments, the method includes optionally performing iontophoresis treatment (step 714).

[0216] (An example of a method for contact calibration 704) 8 is a flowchart illustrating an example of a contact calibration method according to some embodiments of the present invention. In some embodiments, contact calibration is performed after the CTCat has been placed in potential locations (optionally selected based on X-ray and / or CT images). In some embodiments, contact calibration is performed to ensure that the distal end of the device is indeed in continuous contact with the bronchial wall, thereby allowing ultrasound to pass through the bronchial wall.

[0217] In some embodiments, contact calibration is performed by inflating a balloon, optionally inflating the balloon slowly (step 802) until both the first and second electrodes contact the bronchial wall. In some embodiments, when both the first and second electrodes contact the bronchial wall, a circuit between the first and second electrodes is closed, which sends a signal to the user (the user receives the signal (step 804)) notifying them that the circuit has been closed. In some embodiments, the user stops inflating the balloon (step 806). In some embodiments, the method provides the minimum pressure required for the balloon to maximally contact the bronchial wall. This pressure is hereinafter referred to as "contact pressure (Pcont)." In some embodiments, at Pcont, the balloon contacts the bronchial wall but does not overstretch the bronchial wall, causing tissue ischemia (or other complications). In some embodiments, at Pcont, the balloon contacts the bronchial wall, but neither the opening 616 used for phonophoresis therapy nor the opening 614 used for iontophoresis therapy is open.

[0218] (An example of position calibration 706) Referring to FIG. 9 , a flow chart illustrating an example of a position calibration method is shown, according to some embodiments of the present invention. In some embodiments, position calibration is performed to determine the optimal position to place the CTCat device to deliver treatment. In some embodiments, the optimal position is characterized by a position where there is no air between the distal end of the device and the area requiring treatment. In some embodiments, the optimal position is the position closest to the area requiring treatment. In some embodiments, the optimal position is the position where there is no air between the probe and the area requiring treatment, and is the position closest to the area requiring treatment. In some embodiments, the calibration process utilizes the attenuation of delivered ultrasound energy to select the position to place the probe.

[0219] Without being bound by theory, attenuation occurs as a result of multiple factors in the interaction of sound waves with tissue and tissue boundaries, including, for example, reflection, refraction, scattering, absorption, and interference. The conversion of propagating energy into another form of energy, such as heat (absorption), is the primary factor in ultrasound attenuation in biological tissue, followed by scattering. The inherent ability of a medium (e.g., tissue) to attenuate sound waves at a given frequency can be expressed by its attenuation coefficient (represented by the Greek letter alpha (α) and measured in dB / [mHz×cm]). The following are examples of attenuation coefficients and their characteristics for some commonly encountered tissues, presented as a reference for those skilled in the art to understand the present invention. Tissues with the highest attenuation coefficients: The gas-filled lung (α>34.0) forms a nearly impermeable barrier to ultrasound, as does cortical bone (α≒20.0). A reduction in the gas content of the lungs affects the degree of ultrasound attenuation. Tissues with the lowest attenuation coefficients: Water and blood attenuate ultrasound very little (α ~ 0.18). The attenuation coefficients of other soft tissues (such as organs and skeletal muscle) lie between these extremes.

[0220] Therefore, measuring the attenuation coefficient not only allows understanding of the ultrasound transparency potential of lung tissue, but also allows inference of what processes are occurring at the tissue level in the treatment area, and the composition and dosage of the drugs used (if any) can be adjusted accordingly. Thus, in some embodiments, position calibration comprises the following steps: a. Delivering a dose of ultrasonic energy (step 902). b. Measuring the damping coefficient (step 904). c. Using the measured damping coefficient, determining if the current position is the optimal position (step 906). In some embodiments, other indicia can optionally be used for calibration, examples of which include x-ray images, CT scans, etc.

[0221] (An example of ultrasound therapy) In some embodiments, as described above, the treatment profile (i.e., transducer activation) is influenced by the relationship between the site requiring treatment and the location where treatment is delivered, as well as the size of the site requiring treatment. For example, at sites requiring treatment located deeper within the tissue, the transducer may be activated at, for example, 1 MHz, while at closer sites, the transducer may be activated at, for example, 3 MHz. In some embodiments, the treatment session includes one or more of the following parameters: Treatment Frequency: In some embodiments, treatment sessions are performed once a day, optionally twice a day, or several times a day. In some embodiments, treatment sessions are performed daily, optionally every other day, or at any interval selected by the medical professional. In some embodiments, the selected site for treatment is alternated during the first 7 to 10 days of treatment, depending on the size of the lesion. In some embodiments, a potential advantage of alternating the site where treatment is performed is that it allows the site to be treated from different directions while allowing the tissue necrosis process to progress in previously treated sites. Another potential advantage is the ability to treat the largest possible area. In some embodiments, during the first 7-10 days of treatment, the treatment area is treated at least three times from each selected site. In some embodiments, the ultrasound beam is not uniform, but its characteristics change depending on the distance from the transducer. In some embodiments, the region of the ultrasound beam closest to the treatment head is called the near field, interference field, or Fresnel zone. In some embodiments, the behavior of ultrasound in this region is less regular, and there are regions where significant interference occurs. In some embodiments, the size (length) of the near field is r 2 It is calculated using the formula / λ, where r = radius of the transducer crystal and λ = wavelength of the ultrasound depending on the frequency used (e.g., 0.5 mm for 3 MHz, 1.5 mm for 1.0 MHz).

[0222] In some embodiments, performing ultrasound therapy includes performing ultrasound therapy using an interferential current. In some embodiments, two intermediate frequency currents are used. In some embodiments, these frequency currents function as carrier waves and do not cause muscle or nerve stimulation. In some embodiments, these frequency currents are used to obtain deeper penetration and / or to generate an interferential current.

[0223] 5 is a schematic illustration of an interfering electric field generated by two CTCats, according to some embodiments of the present invention. In some embodiments, the interfering electric field is used during treatment, as described above. In some embodiments, two medium frequency currents are used to generate the interfering current. Current A(f1): This is the current set by the device, and is called the "natural frequency / carrier frequency." For example, 4000Hz (2000Hz or 6000Hz are also available). Current B (f2): Same amplitude as Current A, but at a slightly higher frequency set by the user. In some embodiments, for example, f2 is variable between 4001 Hz and 4150 Hz. In some embodiments, f2 varies in frequency within a fixed range. In some embodiments, a potential advantage of this method is that it may prevent adaptation or habituation to the current. In some embodiments, F = f2 - f1, and the amplitude of F (current C) is not constant. In some embodiments, this current C is referred to as a "pulse frequency current." In some embodiments, F = f2 - f1 ranges from 1 Hz to 150 Hz, and this frequency variation range is also referred to as a "spectrum" or "sweep." In some embodiments, the region where the interference current occurs remains stationary. In some embodiments, this stationary interference region assumes a "cloverleaf" shape (see FIG. 10) as a result of the vector addition of the two currents, forming a 45° angle with respect to a line drawn perpendicular to each electrode. In some embodiments, one, two, three, four, or more electrodes are used during treatment.

[0224] In some embodiments, an electric field is used in one or more of the following: 1. Measuring contact pressure, i.e., determining the minimum pressure at which complete contact is achieved between the balloon and the bronchial wall, which is important in ultrasound therapy. In some embodiments, measuring contact pressure allows for controlling the pressure inside the balloon to prevent damage or ischemia of the bronchial mucosa due to excessive pressure. In some embodiments, this principle is applicable to any type of catheter and any location. 2. Performing iontophoresis (described in more detail below), i.e., introducing a drug deep into tissue as a means of local drug administration. In some embodiments, inflating the balloon to a pressure level, Pion (the pressure for iontophoresis), described below, opens an opening in the proximal electrode and introduces the drug via iontophoresis to the site of lung injury. In some embodiments, a potential advantage of being able to provide iontophoretic treatment is that iontophoresis can be used as a stand-alone treatment even when calibration is unable to identify an appropriate site for ultrasound treatment.

[0225] FIG. 10 is a schematic diagram illustrating the generation of an interference current by two CTCats, according to some embodiments of the present invention. In some embodiments, when generating an interference current, for example, four textile electrodes are fixed to a pair of catheters and attached to the ends of each balloon. In some embodiments, a positive charge is applied to the distal end of one balloon, resulting in a negative charge at the proximal end of the second balloon. In some embodiments, the electrodes are ring-shaped and attached to both ends of the outer portion of the balloon, as described above. A decision is made to repeat or discontinue treatment. In some embodiments, a new CT scan is performed and compared 7 to 10 days after the start of treatment. In some embodiments, if a medical professional determines that a clinically favorable outcome has been achieved (optionally based on the results of diagnostic imaging), treatment can be terminated after three weeks. In some embodiments, the rehabilitation period begins immediately after the patient recovers from critical condition and continues until respiratory function is restored. In some embodiments, treatment during the rehabilitation period is performed, for example, once or twice a week. It should be noted that pulmonary fibrosis after acute respiratory distress syndrome (ARDS) is very severe and has a significant impact on respiratory function. However, in approximately 40% of patients, it is eventually replaced by normal lung tissue. In some embodiments, the rehabilitation period can continue for up to six months, for example, or until the scarring at the treated area of the lung is completely eliminated.

[0226] (Example of regulations for therapeutic drugs currently being used) In some embodiments, the treatment optionally includes the local administration of one or more drugs / medications during treatment. In some embodiments, as described above, ultrasound treatment is performed using a CTCat with a balloon-encased transducer. The balloon has micropores located in front of the transducer that open when a certain pressure is applied. In some embodiments, these micropores allow the drug / medication to pass through. In some embodiments, this is performed while providing ultrasound treatment. In some embodiments, ultrasound mechanically drives the drug / medication into adjacent tissue, facilitating its delivery to the lesion (see phonophoresis treatment below for further details).

[0227] (An example of phonophoresis treatment) In some embodiments, phonophoresis treatment is optionally performed in addition to the ultrasound treatment. In some embodiments, a drug / medicine that inflates the balloon is provided in the liquid in addition to or instead of saline. In some embodiments, ultrasound treatment is used to deliver drugs into tissue using the principle of phonophoresis. In some embodiments, when performing phonophoresis treatment, the balloon is further inflated to open the opening 616 located in the area of the transducer 604. For example, if the contact pressure (Pcont) determined by contact calibration is 20 mmH2O, this is the pressure required for the balloon to fully contact the bronchial wall. Then, for example, an additional 5 mmH2O is added to the balloon (25 mmH2O in total), thereby opening only the opening 616 located in the area of the transducer 604 (the opening 614 in the area of the second electrode 612 is not opened). In some embodiments, this pressure is called the "phonophoresis pressure (Pphon)" and is defined as Pphon = Pcont + 5 mmH2O.

[0228] (An example of iontophoresis treatment) In some embodiments, iontophoresis treatment is optionally performed in addition to ultrasound and / or phonophoresis treatment. In some embodiments, a drug / medicine is provided in the liquid to inflate the balloon, in addition to or instead of saline. In some embodiments, iontophoresis treatment is used to deliver drugs into tissue using an interfering electric field. In some embodiments, when performing iontophoresis treatment, the balloon is further inflated to open the opening 614 in the area of the second electrode 612. For example, if the contact pressure (Pcont) determined by contact calibration is 20 mmH2O, this is the pressure required for the balloon to fully contact the bronchial wall. Next, for example, an additional 5 mmH2O is added to the balloon (a total of 25 mmH2O), and only the opening 616 in the area of the transducer 604 is opened (achieving Pphon). At this stage, the opening 614 in the area of the second electrode 612 is not opened. Adding an additional 5 mmH2O (30 mmH2O total) also opens the opening 614 in the area of the second electrode 612. In some embodiments, this pressure is referred to as the "iontophoresis pressure (Pion)" and is defined as Pcont + Pphon + 5 mmH2O. Therefore, inflating the balloon to 10 mmH2O opens the opening in the balloon's proximal electrode, and if the drug has the appropriate polarity, the iontophoresis process begins. In some embodiments, an electric field facilitates drug delivery during iontophoresis. Without being bound by theory, iontophoresis is based on the principle that drug ions move into tissue according to their charge. This technique relies on the principle that, in a specific electric field, positively charged drug ions (cations) are repelled by the anode and migrate toward the cathode. For example, ketoprofen is negatively charged and therefore repelled by the cathode and migrates toward the anode. In some embodiments, an interferometric current is used for iontophoresis.

[0229] (An example of a catheter system) 11 is a schematic illustration of a catheter system, according to some embodiments of the present invention. In some embodiments, the system includes at least one CTCat. Optionally, the system includes multiple CTCats. For example, two, three, four or more CTCats may be included.

[0230] In some embodiments, all CTCats 1104 are connected to a central control external unit 1102 that contains all the hardware necessary for the operation of the CTCats.

[0231] In some embodiments, the external unit comprises one or more of the following: a. A video unit 1106 comprising a navigation system configured to steer said at least one catheter and provide visualization from said video camera to a user. b. An electric field unit 1108 configured to generate an interference field. In some embodiments, the electric field unit is configured to supply current to a first catheter at a first frequency and to supply current to a second catheter at a second frequency. In some embodiments, the first frequency is about 4000 Hz and the second frequency is about 4100 Hz to about 4500 Hz. In some embodiments, the electric field unit is configured to supply a current not exceeding 13 milliamps. c. Ultrasonic waves of about 0.5 MHz to about 3 MHz are applied at 2 W / cm 2 an ultrasound unit 1110 configured to generate power of up to 100 keV; d. A calibration unit 1112 configured to specify attenuation coefficients at different locations and further configured to provide optimal localization of said one or more ultrasonic transmitters. e. A pressure unit 1114 configured to maintain and monitor the pressure within the balloon. f. A phonophoresis medication unit 1116 configured to monitor and administer said at least one medication during phonophoresis treatment. g. An iontophoretic drug unit 1118 configured to monitor and administer said at least one drug during iontophoretic treatment.

[0232] (Example of additional information) In some embodiments, the balloons may have different Pcont, Pphon, and Pion values. In some embodiments, the maximum amount of fluid that can be inserted into the balloon ranges from about 20 mmH2O to about 40 mmH2O, and optionally ranges from about 15 mmH2O to about 50 mmH2O, or even greater than 50 mmH2O. In some embodiments, the CTCats have different resistances and polarities. In some embodiments, because individual patients have different resistances of the bronchoalveolar system, CTCats with different balloon resistances are provided to avoid causing mechanical damage to the bronchoalveolar wall.

[0233] As used herein, the term "about" when used in connection with a quantity or numerical value means "within a range of ±20%." As used herein, the following terms have the following meanings: "comprises," "comprising," "includes," "including," "has," "having," and their conjugations mean "including, but not limited to." "consisting of" means "including, but limited to." "consisting essentially of" means that a composition, method, or structure may include additional ingredients, steps, and / or components, but only if those additional ingredients, steps, and / or components do not materially alter the basic and novel characteristics of the claimed composition, method, or structure. As used herein, the singular forms "a," "an," and "the" are intended to include the plural unless the context clearly dictates otherwise. For example, the terms "a compound" or "at least one compound" may include multiple compounds (including mixtures thereof).

[0234] Throughout this specification, embodiments of the invention may be described in a range format. It should be understood that the description of ranges is for convenience and brevity and should not be construed as a strict limitation on the scope of the invention. Accordingly, the description of a range is considered to have specifically disclosed all possible subranges and individual numerical values within that range. For example, describing a range of "1 to 6" is considered to have specifically disclosed the following subranges: "1 to 3," "1 to 4," "1 to 5," "2 to 4," "2 to 6," "3 to 6," etc. Individual numerical values within that range, e.g., 1, 2, 3, 4, 5, and 6, are also considered to have been specifically disclosed. This principle applies regardless of the breadth or narrowness of the range.

[0235] When a range of values is given herein (e.g., "10-15," "10 to 15," or a combination of values joined by other range terminology), all values within that range (including integers and decimals) are included unless the context clearly dictates otherwise. The endpoints of the range are also included. As used herein, "range / ranging / ranges between" a first value "and" a second value, and "range / ranging / ranges from" a first value "to," "up to," "until," "through" (or other range terminology) a second value, are used interchangeably and are intended to include the endpoints and all integers and decimals therebetween.

[0236] Unless otherwise specified, numerical values used herein and numerical ranges based thereon are intended to be approximations within reasonable measurement precision and rounding errors that would be understood by one of ordinary skill in the art.

[0237] As used herein, the term "method" refers to means, manners, techniques, and procedures for achieving a particular purpose, including, but not limited to, those known or readily derivable from known means, manners, techniques, and procedures by those skilled in the art of chemistry, pharmacology, biology, biochemistry, and medicine.

[0238] As used herein, the term "treating" includes arresting, substantially inhibiting, slowing, or reversing the progression of a disease, substantially ameliorating the clinical or cosmetic symptoms of a disease, or substantially preventing the onset of clinical or cosmetic symptoms of a disease.

[0239] It will be understood that certain features of the invention, which are described for clarity in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention that are described for brevity in the context of a single embodiment may also be provided separately, in any suitable subcombination, or in any compatible manner with other described embodiments of the invention. Furthermore, particular features described in the context of various embodiments should not be construed as essential features of those embodiments, unless the embodiment is inoperable without that element.

[0240] While the present invention has been described in conjunction with specific embodiments, it is evident that many alternatives, modifications, and variations will be apparent to those skilled in the art. Accordingly, the present invention is intended to embrace all such alternatives, modifications, and variations that fall within the spirit and broad scope of the appended claims.

[0241] The applicant intends that all publications, patents, and patent applications mentioned herein be incorporated by reference in their entirety, as if each were expressly incorporated individually as cited herein. Furthermore, identification of a citation or reference herein should not be construed as an admission that the citation is available as prior art to the present invention. Section headings, if used herein, should not be construed as necessarily limiting. Additionally, any priority claim document of this application is incorporated by reference in its entirety.

Claims

1. 1. A catheter system for treating a wound, the catheter system comprising: a. at least one catheter having a proximal end and a distal end, the distal end comprising: i. one or more ultrasonic transmitters; ii. an inflatable balloon covering the one or more ultrasound transmitters, the inflatable balloon comprising a first electrode located proximally of the inflatable balloon and a second electrode located distally of the inflatable balloon; iii. a plurality of first type openings located on the surface of the balloon, the locations of the first type openings coinciding with the locations of the one or more ultrasound transmitters on the catheter; and iv. a plurality of second type openings located on the surface of the balloon, the positions of the second type openings coinciding with the positions of the first electrodes; Catheter system.

2. further comprising at least one liquid configured to inflate the inflatable balloon. The catheter system of claim 1 .

3. the at least one liquid comprises at least one drug; The catheter system of claim 2 .

4. the at least one liquid is saline; The catheter system of claim 2 .

5. further comprising one or more controls disposed at the proximal end of the catheter and configured to control movement of the distal end of the catheter. The catheter system according to any one of claims 1 to 4.

6. further comprising a video camera located at the distal-most end of the catheter. The catheter system according to any one of claims 1 to 5.

7. the at least one catheter is configured to perform phonophoresis therapy; The catheter system according to any one of claims 1 to 6.

8. the at least one catheter is configured to perform iontophoresis therapy. The catheter system according to any one of claims 1 to 6.

9. an external unit to which the at least one catheter is connected; The external unit comprises: a. a video unit comprising a navigation system configured to operate said at least one catheter and to provide visualization from said video camera to a user; b. an electric field unit configured to generate an interference field; c. Ultrasound of about 0.5 MHz to about 3 MHz at 2 watts / cm ２ an ultrasonic unit configured to generate an ultrasonic wave at a power of up to d. a calibration unit configured to specify attenuation coefficients at different locations and further configured to provide optimal localization of the one or more ultrasonic transmitters; e. a pressure unit configured to maintain and monitor pressure within the balloon; f. a phonophoresis medication unit configured to monitor and administer said at least one medication during phonophoresis treatment; g. an iontophoretic drug unit configured to monitor and administer the at least one drug during iontophoretic treatment; The catheter system according to any one of claims 1 to 8.

10. the electric field unit is configured to supply a current to a first catheter at a first frequency and a current to a second catheter at a second frequency; The catheter system of claim 9.

11. the first frequency is about 4000 Hz and the second frequency is about 4100 Hz to about 4500 Hz; The catheter system of claim 10.

12. the electric field unit is configured to provide a current not exceeding 13 milliamps; The catheter system of claim 9.

13. 1. A method for treating a pulmonary tissue condition, a pulmonary embolism, and / or a mediastinal thromboembolic condition, comprising: a. selecting a target site in the tissue in need of treatment; b. advancing at least one catheter of claim 1 to a location near the target site; c. performing contact calibration; d. performing position calibration; e. performing ultrasound therapy; method.

14. performing the contact calibration a. inflating the inflatable balloon; b. receiving signals from the first electrode and the second electrode; c. stopping the inflation of the balloon. The method of claim 13.

15. performing the position calibration a. delivering a first amount of ultrasonic energy; b. determining a damping coefficient; c. determining whether the position near the target site is an optimal position according to the result of the determination; 15. The method of claim 13 or 14.

16. The optimum position is a position where the damping coefficient is a low damping coefficient.

16. The method of claim 15.

17. The low attenuation coefficient is about 0.18 dB / mHz*cm.

17. The method of claim 16.

18. If the position calibration fails, further comprising repositioning the catheter to a new location near the target site. The method according to any one of claims 13 to 17.

19. administering the ultrasound treatment includes irradiating the target area with ultrasound, the irradiating being characterized by a time, an intensity, and a number of irradiation fields; The method according to any one of claims 13 to 17.

20. The irradiation is characterized to obtain a maximum therapeutic effect with minimal side effects and / or to avoid induction of cell death at the target site.

20. The method of claim 19.

21. the irradiating includes irradiating at an intensity between about 1 MHz and about 3 MHz; 20. The method of claim 19.

22. the irradiating comprises irradiating for about 10 seconds to about 15 minutes.

20. The method of claim 19.

23. the irradiating includes irradiating using a focused beam of light; 20. The method of claim 19.

24. further comprising monitoring the temperature of the target area where treatment is being performed. The method according to any one of claims 13 to 23.

25. and further comprising preventing the temperature of the target site being treated from rising above a predetermined temperature. The method according to any one of claims 13 to 24.

26. the predetermined temperature is between about 40 degrees Celsius and about 45 degrees Celsius; 26. The method of claim 25.

27. further comprising actively controlling the temperature of the target area where treatment is performed. The method according to any one of claims 13 to 26.

28. The controlling includes varying the temperature of the target area where treatment is performed.

28. The method of claim 27.

29. the controlling includes flowing a cold liquid to the target site when the target site reaches a predetermined temperature.

28. The method of claim 27.

30. further comprising visually monitoring the tissue at the target site.

30. The method according to any one of claims 13 to 29.

31. The irradiating is performed by two different catheters operated simultaneously.

20. The method of claim 19.

32. further comprising administering phonophoresis treatment. The method according to any one of claims 13 to 31.

33. administering the phonophoresis treatment includes further inflating the inflatable balloon to a second inflated state, the second inflated state opening the plurality of first type openings; 33. The method of claim 32.

34. administering the phonophoretic treatment includes delivering at least one agent during administration of the phonophoretic treatment.

33. The method of claim 32.

35. further comprising performing iontophoresis treatment. The method according to any one of claims 13 to 34.

36. performing the iontophoresis treatment includes further inflating the inflatable balloon to a third inflation state, wherein the third inflation state opens the plurality of second type openings; 36. The method of claim 35.

37. performing the iontophoretic treatment includes delivering at least one agent during the iontophoretic treatment.

36. The method of claim 35.

38. and generating an interference current by actuating two separate catheters toward the location.

38. The method according to any one of claims 13 to 37.

39. The treatment is used to treat one or more of ARDS, parenchymal pulmonary disease, and mediastinal disease.

39. The method according to any one of claims 13 to 38.

40. the advancing is via the esophagus and / or trachea.

40. The method of any one of claims 13 to 39.

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