The interaction of shockwaves with a vapour bubble in boiling histotripsy: The shock scattering effect

Boiling histotripsy is a High Intensity Focused Ultrasound (HIFU) technique which uses a number of short pulses with high acoustic pressures at the HIFU focus to induce mechanical tissue fractionation. In boiling histotripsy, two different types of acoustic cavitation contribute towards mechanical tissue destruction: a boiling vapour bubble and cavitation clouds. An understanding of the mechanisms underpinning these phenomena and their dynamics is therefore paramount to predicting and controlling the overall size of a lesion produced for a given boiling histotripsy exposure condition. A number of studies have shown the effects of shockwave heating in generating a boiling bubble at the HIFU focus and have studied its dynamics under boiling histotripsy insonation. However, not much is known about the subsequent production of cavitation clouds that form between the HIFU transducer and the boiling bubble. The main objective of the present study is to examine what causes this bubble cluster formation after the generation of a boiling vapour bubble. A numerical simulation of 2D nonlinear wave propagation with the presence of a bubble at the focus of a HIFU field was performed using the k-Wave MATLAB toolbox for time domain ultrasound simulations, which numerically solves the generalised Westervelt equation. The numerical results clearly demonstrate the appearance of the constructive interference of a backscattered shockwave by a bubble with incoming incident shockwaves. This interaction (i.e., the reflected and inverted peak positive phase from the bubble with the incoming incident rarefactional phase) can eventually induce a greater peak negative pressure field compared to that without the bubble at the HIFU focus. In addition, the backscattered peak negative pressure magnitude gradually increased from 17.4 MPa to 31.6 MPa when increasing the bubble size from 0.2 mm to 1.5 mm. The latter value is above the intrinsic cavitation threshold of –28 MPa in soft tissue. Our results suggest that the formation of a cavitation cloud in boiling histotripsy is a threshold effect which primarily depends (a) the size and location of a boiling bubble, and (b) the sum of the incident field and that scattered by a bubble.     

High-speed observation of cavitation bubble clouds near a tissue boundary in high-intensity focused ultrasound fields

Cavitation bubble clouds generated near a tissue boundary by high-intensity focused ultrasound (HIFU) were studied using high-speed photography. In all, 171 image series were captured during the initial 100 ms of continuous HIFU exposure, which showed that cavitation bubble clouds at the tissue boundary organized into two structures - “cone-shape bubble cloud structure” recorded in 146 image series and “crown-shape bubble cloud structure” recorded in 18 image series. The remaining 7 image series showed the interchanging of these two structures. It was found that when cavitation bubbles first appeared at the tissue boundary, they developed to cone-shape bubble cloud. The cone-shape bubble cloud structure was characterized by a nearly fixed tip in front of the tissue boundary. When the cavitation bubbles initially appeared away from the tissue boundary they evolved into a crown-shape bubble cloud. Deformation of tissue boundary was shown in all the recorded image series.     

High-speed observation of cavitation bubble cloud structures in the focal region of a 1.2 MHz high-intensity focused ultrasound transducer

Cavitation bubble clouds in the focal region of HIFU play important roles in therapeutic applications of HIFU. Temporal evolution and spatial distribution of cavitation bubble clouds generated in the focal region of a 1.2 MHz single element concave HIFU transducer in water are investigated by high-speed photography. It is found that during the initial 600 micro s insonation cavitation bubble clouds organize to the "screw-like structure" or "cap-like structure". The screw-like structure is characterized by a nearly fixed tip at the geometrical focus of the HIFU transducer, and the cap-like structure is marked by a dent formed in the direction of ultrasound transmission. After 600 micro s, another two structures are recorded - "streamer structure" and "cluster structure". The streamer structure is also featured by a nearly fixed bottom position at the focus, while the cluster structure is distinguished by agglomerations of bubbles around the focus.     

Effects of acoustic parameters on bubble cloud dynamics in ultrasound tissue erosion (histotripsy)

High intensity pulsed ultrasound can produce significant mechanical tissue fractionation with sharp boundaries ("histotripsy"). At a tissue-fluid interface, histotripsy produces clearly demarcated tissue erosion and the erosion efficiency depends on pulse parameters. Acoustic cavitation is believed to be the primary mechanism for the histotripsy process. To investigate the physical basis of the dependence of tissue erosion on pulse parameters, an optical method was used to monitor the effects of pulse parameters on the cavitating bubble cloud generated by histotripsy pulses at a tissue-water interface. The pulse parameters studied include pulse duration, peak rarefactional pressure, and pulse repetition frequency (PRF). Results show that the duration of growth and collapse (collapse cycle) of the bubble cloud increased with increasing pulse duration, peak rarefactional pressure, and PRF when the next pulse arrived after the collapse of the previous bubble cloud. When the PRF was too high such that the next pulse arrived before the collapse of the previous bubble cloud, only a portion of histotripsy pulses could effectively create and collapse the bubble cloud. The collapse cycle of the bubble cloud also increased with increasing gas concentration. These results may explain previous in vitro results on effects of pulse parameters on tissue erosion.     

Sonothrombolysis with an acoustic net-assisted boiling histotripsy: A proof-of-concept study

Whilst sonothrombolysis is a promising and noninvasive ultrasound technique for treating blood clots, bleeding caused by thrombolytic agents used for dissolving clots and potential obstruction of blood flow by detached clots (i.e., embolus) are the major limitations of the current approach. In the present study, a new sonothrombolysis method is proposed for treating embolus without the use of thrombolytic drugs. Our proposed method involves (a) generating a spatially localised acoustic radiation force in a blood vessel against the blood flow to trap moving blood clots (i.e., generation of an acoustic net), (b) producing acoustic cavitation to mechanically destroy the trapped embolus, and (c) acoustically monitoring the trapping and mechanical fractionation processes. Three different ultrasound transducers with different purposes were employed in the proposed method: (1) 1-MHz dual focused ultrasound (dFUS) transducers for capturing moving blood clots, (2) a 2-MHz High Intensity Focused Ultrasound (HIFU) source for fractionating blood clots and (3) a passive acoustic emission detector with broad bandwidth (10 kHz to 20 MHz) for receiving and analysing acoustic waves scattered from a trapped embolus and acoustic cavitation. To demonstrate the feasibility of the proposed method, in vitro experiments with an optically transparent blood vessel-mimicking phantom filled with a blood mimicking fluid and a blood clot (1.2 to 5 mm in diameter) were performed with varying the dFUS and HIFU exposure conditions under various flow conditions (from 1.77 to 6.19 cm/s). A high-speed camera was used to observe the production of acoustic fields, acoustic cavitation formation and blood clot fragmentation within a blood vessel by the proposed method. Numerical simulations of acoustic and temperature fields generated under a given exposure condition were also conducted to further interpret experimental results on the proposed sonothrombolysis. Our results clearly showed that fringe pattern-like acoustic pressure fields (fringe width of 1 mm) produced in a blood vessel by the dFUS captured an embolus (1.2 to 5 mm in diameter) at the flow velocity up to 6.19 cm/s. This was likely to be due to the greater magnitude of the dFUS-induced acoustic radiation force exerted on an embolus in the opposite direction to the flow in a blood vessel than that of the drag force produced by the flow. The acoustically trapped embolus was then mechanically destructed into small pieces of debris (18 to 60 μm sized residual fragments) by the HIFU-induced strong cavitation without damaging the blood vessel walls. We also observed that acoustic emissions emitted from a blood clot captured by the dFUS and cavitation produced by the HIFU were clearly distinguished in the frequency domain. Taken together, these results can suggest that our proposed sonothrombolysis method could be used as a promising tool for treating thrombosis and embolism through capturing and destroying blood clots effectively.     

The Relationship of Cavitation to the Negative Acoustic Pressure Amplitude in Ultrasonic Therapy

The relationship between the cavitation and acoustic peak negative pressure in the high-intensity focused ultrasound(HIFU)Held is analyzed in water and tissue phantom.The peak negative pressure at the focus is determined by a hybrid approach combining the measurement with the simulation.The spheroidal beam equation is utilized to describe the nonlinear acoustic propagation.The waveform at the focus is measured by a fiber optic probe hydrophone in water.The relationship between the source pressure amplitude and the excitation voltage is determined by fitting the measured ratio of the second harmonic to the fundamental component at the focus,based on the model simulation.Then the focal negative pressure is calculated for arbitrary voltage excitation in water and tissue phantom.A portable B-mode ultrasound scanner is applied to monitor HIFU-induced cavitation in real time,and a passive cavitation detection(PCD)system is used to acquire the bubble scattering signals in the HIFU focal volume for the cavitation quantification.The results show that:(1)unstable cavitation starts to appear in degassed water when the peak negative pressure of HIFU signals reaches 13.5 MPa;and(2)the cavitation activity can be detected in tissue phantom by B-mode images and in the PCD system with HIFU peak negative pressures of 9.0 MPa and 7.8 MPa,respectively,which suggests that real-time B-mode images could be used to monitor the cavitation activity in two dimensions,while PCD systems are more sensitive to detect scattering and emission signals from cavitation bubbles.     

B模式实时成像定量监控超声空化时空行为的研究

提出一种采用B超图像实现高强聚焦超声(HIFU)治疗时声空化的时空量化监控的方法。首先,采用B模式实时成像系统对不同声辐照能量下的HIFU在凝胶仿体中引发的超声空化进行实验监测;接着,利用二维数字图像处理算法消除高强聚焦超声(HIFU)在B超图像中产生的干涉条纹,并在此基础上,对B超成像中观察到的高亮区域的面积变化情况进行量化分析;最后,进一步讨论了驱动声压或脉冲宽度对超声空化产生的高亮区域的生成速度和面积大小的影响。结果显示该方法可以有效去除B超图像中的干涉条纹,并对HIFU引发的空化现象进行实时监测。实验结果还表明辐照声能量的提高将引发更强烈的声空化行为,并且显著缩短HIFU引发的空化泡群的初始生成时间。研究结果对进一步优化HIFU治疗有重要意义。      

Ultrasound line-by-line scanning method of spatial–temporal active cavitation mapping for high-intensity focused ultrasound

This paper presented an ultrasound line-by-line scanning method of spatial–temporal active cavitation mapping applicable in a liquid or liquid filled tissue cavities exposed by high-intensity focused ultrasound (HIFU). Scattered signals from cavitation bubbles were obtained in a scan line immediately after one HIFU exposure, and then there was a waiting time of 2 s long enough to make the liquid back to the original state. As this pattern extended, an image was built up by sequentially measuring a series of such lines. The acquisition of the beamformed radiofrequency (RF) signals for a scan line was synchronized with HIFU exposure. The duration of HIFU exposure, as well as the delay of the interrogating pulse relative to the moment while HIFU was turned off, could vary from microseconds to seconds. The feasibility of this method was demonstrated in tap-water and a tap-water filled cavity in the tissue-mimicking gelatin–agar phantom as capable of observing temporal evolutions of cavitation bubble cloud with temporal resolution of several microseconds, lateral and axial resolution of 0.50 mm and 0.29 mm respectively. The dissolution process of cavitation bubble cloud and spatial distribution affected by cavitation previously generated were also investigated. Although the application is limited by the requirement for a gassy fluid (e.g. tap water, etc.) that allows replenishment of nuclei between HIFU exposures, the technique may be a useful tool in spatial–temporal cavitation mapping for HIFU with high precision and resolution, providing a reference for clinical therapy.     

A feasibility study of temperature rise measurement in a tissue phantom as an alternative way for characterization of the therapeutic high intensity focused ultrasonic field

The feasibility that temperature field measurements in vitro as an alternative way to characterize the high intensity focused ultrasound (HIFU) field used in therapeutic applications has been explored in a phantom study. Thermocouples (copper-constantan, diameter 0.125 mm) are embedded in a phantom filled with tissue mimicking material that simulates the thermal and acoustic properties of soft-tissue. The temperature rises as a function of ultrasound exposure time near the focus of a HIFU transducer (1.1 MHz, active radius a = 32 mm, geometric focal length = 62 mm) of various acoustic powers up to 30 W are measured and compared with predicted values using a simple nonlinear Gaussian model. The experimental results can be explained well by the model if no acoustic cavitation takes place. When the acoustic power become higher (>5 W) and the local temperature elevation >15 °C and the local temperature is >40 °C at the focal point, cavitation vapor bubbles appear. The presence of the cavitation bubbles may increase the temperature rise rate initially. The bubble aggregates may form along the beam axis under sonication and then eventually makes the temperature elevation reach a saturated value. When acoustic cavitation occurs, the bubble-assisted enhancement of the initial temperature rise (exposure time t < 2 s) can still be predicted by the theory.     

Controlled tissue emulsification produced by high intensity focused ultrasound shock waves and millisecond boiling

In high intensity focused ultrasound (HIFU) applications, tissue may be thermally necrosed by heating, emulsified by cavitation, or, as was recently discovered, emulsified using repetitive millisecond boiling caused by shock wave heating. Here, this last approach was further investigated. Experiments were performed in transparent gels and ex vivo bovine heart tissue using 1, 2, and 3 MHz focused transducers and different pulsing schemes in which the pressure, duty factor, and pulse duration were varied. A previously developed derating procedure to determine in situ shock amplitudes and the time-to-boil was refined. Treatments were monitored using B-mode ultrasound. Both inertial cavitation and boiling were observed during exposures, but emulsification occurred only when shocks and boiling were present. Emulsified lesions without thermal denaturation were produced with shock amplitudes sufficient to induce boiling in less than 20 ms, duty factors of less than 0.02, and pulse lengths shorter than 30 ms. Higher duty factors or longer pulses produced varying degrees of thermal denaturation combined with mechanical emulsification. Larger lesions were obtained using lower ultrasound frequencies. The results show that shock wave heating and millisecond boiling is an effective and reliable way to emulsify tissue while monitoring the treatment with ultrasound.     

Cavitation bubble behavior and bubble–shock wave interaction near a gelatin surface as a study of in vivo bubble dynamics

The collapse of a single cavitation bubble near a gelatin surface, and the interaction of an air bubble attached to a gelatin surface with a shock wave, were investigated. These events permitted the study of the behavior of in vivo cavitation bubbles and the subsequent tissue damage mechanism during intraocular surgery, intracorporeal and extracorporeal shock wave lithotripsy. Results were obtained with high-speed framing photography. The cavitation bubbles near the gelatin surface did not produce significant liquid jets directed at the surface, and tended to migrate away from it. The period of the motion of a cavitation bubble near the gelatin surface was longer than that of twice the Rayleigh's collapse time for a wide range of relative distance, L/R_max, excepting for very small L/R_max values (L was the stand-off distance between the gelatin surface and the laser focus position, and R_max was the maximum bubble radius). The interaction of an air bubble with a shock wave yielded a liquid jet inside the bubble, penetrating into the gelatin surface. The liquid jet had the potential to damage the gelatin. The results predicted that cavitation-bubble-induced tissue damage was closely related to the oscillatory bubble motion, the subsequent mechanical tissue displacement, and the liquid jet penetration generated by the interaction of the remaining gas bubbles with subsequent shock waves. The characteristic bubble motion and liquid jet formation depended on the tissue's mechanical properties, resulting in different damage mechanisms from those observed on hard materials.     

Near threshold nucleation and growth of cavitation bubbles generated with a picosecond laser

The nucleation and growth of cavitation bubbles few micrometers in size in water generated by a 60 ps 515 nm fiber laser is observed and visualized near nucleation threshold. The study is performed by monitoring the plasma size, the cavitation bubble size and the emitted shock waves. The latter two aspects are supported by the Gilmore model using a Noble-Abel-stiffened-gas (NASG) equations of state. For the first time, two types of cavitation events are identified and visualized that exhibit a difference of more than two orders of magnitude in the excitation energy converted to mechanical effects with minimal change in excitation laser pulse energy. The result is localized cavitation and reduced mechanical stress on water-based media with potentially positive implications for laser treatments of biological tissue.     

Bubble proliferation in the cavitation field of a shock wave lithotripter

Lithotripter shock waves (SWs) generated in non-degassed water at 0.5 and 2 Hz pulse repetition frequency (PRF) were characterized using a fiber-optic hydrophone. High-speed imaging captured the inertial growth-collapse-rebound cycle of cavitation bubbles, and continuous recording with a 60 fps camcorder was used to track bubble proliferation over successive SWs. Microbubbles that seeded the generation of bubble clouds formed by the breakup of cavitation jets and by bubble collapse following rebound. Microbubbles that persisted long enough served as cavitation nuclei for subsequent SWs, as such bubble clouds were enhanced at fast PRF. Visual tracking suggests that bubble clouds can originate from single bubbles.     

Cavitation clouds created by shock scattering from bubbles during histotripsy

Histotripsy is a therapy that focuses short-duration, high-amplitude pulses of ultrasound to incite a localized cavitation cloud that mechanically breaks down tissue. To investigate the mechanism of cloud formation, high-speed photography was used to observe clouds generated during single histotripsy pulses. Pulses of 5-20 cycles duration were applied to a transparent tissue phantom by a 1-MHz spherically focused transducer. Clouds initiated from single cavitation bubbles that formed during the initial cycles of the pulse, and grew along the acoustic axis opposite the propagation direction. Based on these observations, we hypothesized that clouds form as a result of large negative pressure generated by the backscattering of shockwaves from a single bubble. The positive-pressure phase of the wave inverts upon scattering and superimposes on the incident negative-pressure phase to create this negative pressure and cavitation. The process repeats with each cycle of the incident wave, and the bubble cloud elongates toward the transducer. Finite-amplitude propagation distorts the incident wave such that the peak-positive pressure is much greater than the peak-negative pressure, which exaggerates the effect. The hypothesis was tested with two modified incident waves that maintained negative pressure but reduced the positive pressure amplitude. These waves suppressed cloud formation which supported the hypothesis.     

A novel method for estimating the focal size of two confocal high-intensity focused ultrasound transducers

Estimating the focal size and position of a high-intensity focused ultrasound (HIFU) transducer remains a challenge since traditional methods, such as hydrophone scanning or schlieren imaging, cannot tolerate high pressures, are directional, or provide low resolution. The difficulties increase when dealing with the complex beam pattern of a multielement HIFU transducer array, e.g., two transducers facing each other. In the present study we show a novel approach to the visualization of the HIFU focus by using shockwave-generated bubbles and a diagnostic B-mode scanner. Bubbles were generated and pushed by shock waves toward the HIFU beam, and were trapped in its pressure valleys. These trapped bubbles moved along the pressure valleys and thereby delineated the shape and size of the HIFU beam. The main and sidelobes of 1.1- and 3.5 MHz HIFU beams were clearly visible, and could be measured with a millimeter resolution. The combined foci could also be visualized by observing the generation of sustained inertial cavitation and enhanced scattering. The results of this study further demonstrate the possibility of reducing the inertial cavitation threshold by the local introduction of shock wave-generated bubbles, which might be useful when bubble generation and cavitation-related bioeffects are intended within a small region in vivo.     

The inception of cavitation bubble clouds induced by high-intensity focused ultrasound

In many therapeutic applications of high-intensity focused ultrasound (HIFU) the appearance of cavitation bubbles is unavoidable, whereas the dynamics of the bubbles induced by HIFU have not been clarified. The objective of the present work is to observe the inception process of cavitation bubble clouds generated by HIFU transducer in water using high-speed photography. Sequential images captured within 600 micros after the onset of ultrasound transmission show the dynamics of cavitation bubbles' generation, growth, deformation, expansion and collapse in the focal region. However, when the observation time is narrowed to the initial 145 micros, both the still and streak images reveal that the cavitation bubbles astonishingly stay stable in the focal region for at least 60 micros. The results imply that through adjusting the HIFU exposure time while other physical parameters are appropriately chosen, it might be possible to control the generation of stable cavitation bubbles locally in the focal region.     

Physical and chemical characterization of shock-induced cavitation

A strong impact on a water surface induces a shock wave propagation with a significant pressure variation leading to cavitation bubble formation. A new shock induced cavitation reactor described in this work was characterized by physical and chemical techniques. Water hammer model verification with Joukowsky approach allowed to determine the wave speed propagation and gas fraction in water submitted to shock. These values were used for frequency analysis and compared with direct bubble visualization in order to estimate the influence of the experimental parameters on the shock-induced cavitation. Thereby, the shock wave contains a broad spectrum as decomposed into frequencies. This multi-frequency nature induces heterogeneous bubbles with calculated radii of 0.01 to 3.5 mm and observed radii of 0.01 to 2.8 mm depending on experimental conditions (initial pressure, impact height, gas atmosphere). For the first time, the formation of hydroxyl radicals was proven under impact-induced cavitation. The concentration of radicals increases with increasing number of successive impacts, reaching ca. 1.3 µmol.L⁻¹ after 500 impacts in the presence of 20% O₂-Ar as saturating gas. Radical generation seems to be relatively independent of the impact height but strongly depend on the type of gas saturating water, being substantially lower in the presence of air. Moreover, radical generation increases when decreasing the initial pressure and depends on the frequency at which water is impacted by the piston. Nevertheless, yield of OH radicals during shock-induced cavitation remains much lower than that produced by power ultrasound.     

Numerical study of the synergistic effect of cavitation and micro-abrasive particles

In ultrasonic-assisted machining, the synergistic effect of the cavitation effect and micro-abrasive particles plays a crucial role. Studies have focused on the investigation of the micro-abrasive particles, cavitation micro-jets, and cavitation shock waves either individually or in pairs. To investigate the synergy of shock waves and micro-jets generated by cavitation with micro-abrasive particles in ultrasonic-assisted machining, the continuous control equations of a cavitation bubble, shock wave, micro-jet, and micro-abrasive particle influenced by the dimensionless amount (R/R₀), a particle size-velocity–pressure model of the micro-abrasive particle was established. The effects of ultrasonic frequency, sound pressure amplitude, and changes in particle size on micro-abrasive particle velocity and pressure were numerically simulated. At an ultrasonic frequency of 20 kHz and ultrasonic sound pressure of 0.1125 MPa, a smooth spherical SiO₂ micro-abrasive particle (size = 5 µm) was obtained, with a maximum velocity of 190.3–209.4 m/s and pressure of 79.69–89.41 MPa. The results show that in the range of 5–50 μm, smaller particle sizes of the micro-abrasive particles led to greater velocity and pressure. The shock waves, micro-jets, and micro-abrasive particles were all positively affected by the dimensionless amount (R/R₀) of cavitation bubble collapse, the larger the dimensionless quantity, the faster their velocity and the higher their pressure.     

Impact of Treatment Trajectory on Temperature Field Uniformity in Biological Tissue Irradiated by Ultrasound Pulses with Shocks

High intensity focused ultrasound (HIFU) treatments typically involve the ablation of tissue volumes comprising multiple focal sites. One aspect of treatment planning involves the definition of a sequence of ultrasound pulses and corresponding focal sites as the sonication trajectory. Here, numerical simulations of the thermal effects of different trajectories are performed for HIFU exposures delivered to an ex vivo bovine liver sample by a clinical array (Sonalleve V2 3.0T system, Profound Medical Corp., Canada). Simulations consider boiling histotripsy regime with millisecond-long pulses that include shocks. Focusing of the ultrasound beam in tissue was modeled by the Westervelt equation, and the temperature field was modeled by the bioheat equation. To explore different treatment strategies, trajectories were considered with discrete foci located along two or four concentric circles with radii from 2 to 8 mm. Two approaches for traversing these focal sites were compared: In the first approach each discrete focus was sonicated by a sequence of 15 pulses before moving to the next site in the trajectory. In the second approach, each focus was sonicated once before moving to the next site, with sonications over the whole trajectory repeated 15 times. The influence of the trajectory’s size and the pulsing strategy on the temperature field was analyzed. It is shown that the structure of the temperature field is more uniform with a longer time interval between repeated irradiation of each focus, and the optimal time interval ranges from three to six pulse repetition periods.

     

Modified shock waves for extracorporeal shock wave lithotripsy: a simulation based on the Gilmore formulation

Extracorporeal shock wave lithotripsy (SWL) is a reliable therapy for the treatment of urolithiasis. Nevertheless, improvements to enhance stone fragmentation and reduce tissue damage are still needed. During SWL, cavitation is one of the most important stone fragmentation mechanisms. Bubbles with a diameter between about 7 and 55 μm have been reported to expand and collapse after shock wave passage, forming liquid microjets at velocities of up to 400 m/s that contribute to the pulverization of renal calculi. Several authors have reported that the fragmentation efficiency may be improved by using tandem shock waves. Tandem SWL is based on the fact that the collapse of a bubble can be intensified if a second shock wave arrives tenths or even a few hundredths of microseconds before its collapse. The object of this study is to determine if tandem pulses consisting of a conventional shock wave (estimated rise time between 1 and 20 ns), followed by a slower second pressure profile (0.8 μs rise time), have advantages over conventional tandem SWL. The Gilmore equation was used to simulate the influence of the modified pressure field on the dynamics of a single bubble immersed in water and compare the results with the behavior of the same bubble subjected to tandem shock waves. The influence of the delay between pulses on the dynamics of the collapsing bubble was also studied for both conventional and modified tandem waves. For a bubble of 0.07 mm, our results indicate that the modified pressure profile enhances cavitation compared to conventional tandem waves at a wide range of delays (10-280 μs). According to this, the proposed pressure profile could be more efficient for SWL than conventional tandem shock waves. Similar results were obtained for a ten times smaller bubble.