Energetic modulation of nerves

Abstract

A system for applying focused ultrasound energy to a nerve surrounding an artery of a patient includes a piezoelectric array comprising a plurality of piezoelectric elements, a controller configured to control at least a subset of the piezoelectric elements so that at least one of the piezoelectric elements in the subset is in a signal transmitting mode, in a signal sensing mode, or both, a first platform on which the piezoelectric elements are coupled and a second platform, wherein the second platform is configured to support at least a part of the patient, a programmable generator configured to generate output power for one or more of the piezoelectric elements, and a programmable processor configured to process a signal sensed by at least one of the piezoelectric elements.

1 . A system for applying focused ultrasound energy to a nerve surrounding an artery of a patient comprising:
 a piezoelectric array comprising a plurality of piezoelectric elements;   a controller configured to control at least a subset of the piezoelectric elements so that at least one of the piezoelectric elements in the subset is in a signal transmitting mode, in a signal sensing mode, or both;   a first platform on which the piezoelectric elements are coupled and a second platform, wherein the second platform is configured to support at least a part of the patient;   a programmable generator configured to generate output power for one or more of the piezoelectric elements; and   a programmable processor configured to process a signal sensed by at least one of the piezoelectric elements.   
     
     
         2 . The system of  claim 1 , wherein a first one of the piezoelectric elements is configured to generate the signal, and a second one of the piezoelectric elements is configured to sense the signal after it has been reflected from tissue in the patient. 
     
     
         3 . The system of  claim 1 , wherein one of the piezoelectric elements is configured to both generate the signal, and to sense the signal after it has been reflected from the tissue. 
     
     
         4 . The system of  claim 1 , wherein the platform is compatible in a magnetic field. 
     
     
         5 . The system of  claim 4 , wherein the magnetic field is a permanent magnetic field with a field strength less than 1.0 Tesla. 
     
     
         6 . The system of  claim 1 , wherein at least one of the piezoelectric elements is optimized to receive signals from a depth of greater than 8 cm and less than 14 cm from a skin of the patient. 
     
     
         7 . The system of  claim 1 , wherein the controller is configured to control a phasing of at least some of the piezoelectric elements based at least in part on the signal; and
 wherein the generator is configured to generate the output power which drives the one or more of the piezoelectric elements at a power sufficient for high intensity focused ultrasound.   
     
     
         8 . The system of  claim 1 , wherein the piezoelectric elements are controlled by the controller to focus therapeutic ultrasound energy at a target in the patient greater than 7 cm from a skin of the patient, and wherein the signal comprises a flow signal from a renal artery. 
     
     
         9 . The system of  claim 1 , wherein the processor is coupled to the piezoelectric array, and the processor is configured to determine a speed of blood, a direction of blood flow, or both. 
     
     
         10 . The system of  claim 1 , further comprising a mechanical motion actuator coupled to the first platform, the mechanical motion actuator configured to mechanically move the piezoelectric array to follow a movement of the artery within the patient. 
     
     
         11 . The system of  claim 1 , wherein at least one of the piezoelectric elements is configured to receive an ultrasound signal from an intravascular piezoelectric transmitter; and
 wherein the processor is configured to determine an acoustic parameter based at least in part on the signal.   
     
     
         12 . The system of  claim 1  wherein the first platform is automatically moveable to track a motion of the artery based on the signal after the signal is processed by the processor. 
     
     
         13 . The system of  claim 1  wherein the programmable generator is configured to transmit a phased output power sufficient to cause the piezoelectric elements to transmit a focused ultrasound output to the nerve to inhibit a function of the nerve. 
     
     
         14 . The system of  claim 1 , wherein the programmable processor is configured to process the signal to determine a temperature, or an elastography parameter. 
     
     
         15 . The system of  claim 1  wherein the signal comprises a Doppler flow signal; and
 wherein the programmable processor is configured to determine a position at which energy from the piezoelectric array is focused based on the Doppler flow signal, the position being inside the vessel. 
 
     
     
         16 . The system of  claim 1  wherein the signal comprises a Doppler flow signal, and the first platform is configured to move to track the Doppler flow signal. 
     
     
         17 . The system of  claim 1  wherein the signal comprises a Doppler flow signal, and the controller is configured to control the piezoelectric elements based on a phasing pattern so that energies from the piezoelectric elements are focused in different positions to at least partially surround the artery. 
     
     
         18 . A system for delivering energy to nerves surrounding a blood vessel in a patient comprising:
 a first ultrasound transducer configured to apply therapeutic energy across the blood vessel to heat nerves on both sides of the blood vessel;   a receiver configured to receive reflected energy resulting from an ultrasound pulse; and   a processor configured to
 receive first data from the receiver at a first time point, 
 receive second data from the receiver at a second time point, 
 compare the first data with the second data, and 
 provide an output signal to a mover to control a position of the first ultrasound transducer. 
   
     
     
         19 . The system of  claim 18 , further comprising a mover, wherein the mover is inside of a table, and the table is configured to support a patient while allowing the first ultrasound transducer to couple to the patient. 
     
     
         20 . The system of  claim 18 , further comprising a mover, wherein the mover comprises a ball and socket mechanism. 
     
     
         21 . The system of  claim 20 , wherein the ball and socket mechanism is lockable. 
     
     
         22 . A system for applying focused ultrasound energy to a patient comprising:
 a piezoelectric array comprising a plurality of piezoelectric elements;   a controller configured to control at least a subset of the piezoelectric elements so that at least one of the piezoelectric elements in the subset is in a signal transmitting mode, in a signal sensing mode, or both;   a first platform on which the piezoelectric elements are coupled, and a second platform, wherein the second platform is configured to support at least a part of the patient;   a programmable generator configured to generate output power for one or more of the piezoelectric elements;   a programmable processor configured to process a signal sensed by the at least one of the piezoelectric elements; and   a medium storing a treatment plan, wherein the treatment plan is configured to be processed by the programmable processor to cause the piezoelectric array to deliver ultrasound energy through a skin of the patient about a circumference of a blood vessel in the patient, to thereby affect a function of one or more nerves surrounding the blood vessel.   
     
     
         23 . The system of  claim 22 , wherein the blood vessel leads to a kidney. 
     
     
         24 . The system of  claim 22 , wherein the signal comprises a Doppler flow signal. 
     
     
         25 . The system of  claim 22 , wherein the at least one of the piezoelectric elements is configured to sense the signal from an indwelling catheter. 
     
     
         26 . The system of  claim 22 , wherein the treatment plan is configured to be processed by the programmable processor to cause the piezoelectric array to deliver the ultrasound energy to the blood vessel at a depth from about 7 cm to about 14 cm by utilizing varying outputs from the generator to the piezoelectric array. 
     
     
         27 . The system of  claim 22 , wherein the treatment plan is configured to be processed by the programmable processor to cause the piezoelectric array to deliver the ultrasound energy to the circumference of the blood vessel over a blood vessel length of about 1-2 cm. 
     
     
         28 . The system of  claim 22 , wherein the at least one of the piezoelectric elements is configured to emit an ultrasound pulse, and receive the ultrasound pulse as the signal after the ultrasound pulse is reflected from a region of the blood vessel. 
     
     
         29 . The system of  claim 22 , wherein the second platform has a shape configured for allowing delivery of focused ultrasound by the piezoelectric array through a back of the patient to the blood vessel that leads to a kidney. 
     
     
         30 . The system of  claim 22 , further comprising:
 a first mover, the first mover configured to move the first platform to track a movement of the blood vessel to maintain ultrasound foci about the blood vessel; and   a second mover, the second mover configured to move the first platform in at least one direction that is substantially parallel to the patient.