The potential beneficial regenerative and stimulatory extracorporeal shock wave therapy (ESWT) applications to the central nervous system have garnered interest in recent years. Treatment zones for these indications are acoustically shielded by bones, which heavily impact generated sound fields. We present the results of high-resolution tissue-realistic simulations, comparing the viability of different ESWT applicators in their use for transcranial applications. The performances of electrohydraulic, electromagnetic, and piezoelectric transducers for key reflector geometries are compared. Based on density information obtained from CT imaging of the head, we utilized the non-linear wave propagation toolset Matlab k-Wave to obtain spatial therapeutic sound field geometries and waveforms. In order to understand the reliability of results on the appropriate modeling of the skull, three different bone attenuation models were compared. We find that all currently clinically ESWT applicator technologies show significant retention of peak pressures and energies past the bone barrier. Electromagnetic transducers maintain a significantly higher energy flux density compared to other technologies while low focusing strength piezoelectric applicators have the weakest transmissions. Attenuation estimates provide insights into sound field degradation and energy losses, indicating that effective transcranial therapies can readily be attained with current applicators. Furthermore, the presented approach will allow for future targeted in silico development and the design of applicators and therapy plans to ultimately improve therapeutic outcomes.

A delay or failure to heal is the most common possible complication in clavicle fractures, especially in cases primarily treated conservatively. As the current standard therapy, surgical revision achieves good healing results, but is associated with potential surgery-related complications. Shockwave therapy as a non-invasive therapy shows similar reasonable consolidation rates in the non-union of different localizations, but avoids complications. Compromised clavicle fractures in the middle and lateral third treated with focused high-energy shockwave therapy were compared with those treated with surgical revision (ORIF). In addition, a three-dimensional computer simulation for evaluating the pressure distribution during shockwave application accompanied the clinical study. A comparable healing rate in bony consolidation was achieved in both groups. Significantly fewer complications, however, occurred in the shockwave group. The simulations showed safe application in this instance, particularly in avoiding lung tissue affection. When applied correctly, shockwaves represent a safe and promising therapy option for compromised clavicle fractures in the middle and lateral third.

Background: This study aimed to optimize low-intensity extracorporeal shockwave therapy (Li-ESWT) for the treatment of penile indications through the addition of a secondary reflector. The therapeutic potential of Li-ESWT is well-established, but its efficiency is limited by uncontrolled wave propagation and reflection resulting in regions of increased tensile pressures. The objective is to manage and reduce high tensile pressure and enhance treatment efficacy by reflecting applied shockwaves back into the treatment zone using a novel reflector design. Methods: A comprehensive investigation, including numerical modeling and phantom measurements, exploring a range of improvements to traditional shockwave application by reflecting applied therapeutic shockwaves back into the treatment zone. Computational optimization was employed to identify the most suitable secondary reflector shape for potential future clinical use. Subsequent hydrophone phantom reference measurements were extended to volumetric fields using 3D simulations. Results: Traditional treatment resulted in high tensile pressures in the treatment zone, which was mitigated by introducing an impedance-matched layer (IML) while preserving the initial shockwave’s therapeutic function. The addition of the secondary reflector enabled controlled refocusing of the therapeutic shockwave back into the initial focal zone, thus either increasing the treatment volume or achieving a rapid secondary application. Choice of the reflector’s impedance allowed for the secondary refocusing of either a tensile or positive pressure wave. Conclusions: The combined modifications of employing an IML and secondary reflector eliminate uncontrolled tensile waves and reflections, provide better control over consecutive reflections, and enable repeated shockwave signals with a single applicator shot, potentially reducing the number of required shots per session.

Extracorporeal shock wave therapy (ESWT) is a well-known biophysical therapy that offers several beneficial effects, including a presumed increase in the growth of blood vessels. The chorioallantoic membrane (CAM) assay is a well-established in vivo model for studying angiogenesis. The aim of this study was to develop an experimental setup to apply ESWT to CAM in a three-step process and investigate the vascular response. First, we conducted virtual simulations of various shock-wave application setups to CAM and subsequently tested them in preliminary studies to evaluate their feasibility. In the final stage, we employed the most suitable protocol to investigate the angiogenic effects of shock wave therapy in practical applications. Our findings suggest that ESWT increases the number of vessels in CAM. In the final biological experiment (n = 16 CAM per group), ESWT increased vessel number by approximately 14.3% (p = 0.050) and branching points by approximately 13.5% (p = 0.070), while mean vessel thickness decreased by approximately 8.0% (p = 0.047); total vascular area per image remained unchanged (p = 0.760). These effects were concentrated in short-to-medium, thinner-caliber vessels rather than reflecting a uniform increase in vascularity, consistent with the emergence of a denser microvascular network. This new experimental setup paves the way for future research into the angiogenic effects of ESWT and provides a multifaceted model as an intermediate step between in vitro mechanistic studies and clinical translation.