JPH0852151A - Lithiasis crushing device and lithiasis position determiningdevice - Google Patents

Abstract

PROBLEM TO BE SOLVED: To accurately localize the target focus assuring coincidence with the shock wave generator. SOLUTION: There is provided a means for determining the coincidence of the exact location of a calculus 17 with the target focus of a shock wave generator 19. This means for determining coincidence generates a shock wave that is converged by reflection into another target focus positioned apart from a spark gap terminal 21, where the shock wave generator 19 is positioned in a single wave source focus of an oblong reflector 22. A device for determining the calculus position, with a scanner for an ultrasound converter 23 mounted on the oblong reflector 22 with a distance apart from an axis 38 of the oblong reflector 22, obtains different views of the calculus in different positions of the scanner of the ultrasound converter 23 around the axis 38 of the oblong reflector 22.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to extracorporeal crushing of kidney stones, and more particularly to calculi for detecting the position of calculi used in connection with a shock wave generator employed in lithotripsy for crushing calculi. The present invention relates to a position determining device and a calculus crushing device having this calculus position determining device.

[0002]

2. Description of the Related Art One of human suffering is that stones made of stones or aggregates can be formed in the body. The most common organs in which such stones grow are the renal system and gallbladder. Some of these stones, if done, are unnoticed and do not cause any harm. However, stones grown in the kidney, bladder, or the conduits leading to the kidney, bladder, and outside the body cause pain or impair the functioning of body organs. Therefore, stone removal is essential. Conventionally, the only method for removing these calculi has been internal surgery, but the development of imaging technology has made it possible to apply the transdermal method for the removal of many calculi. The percutaneous method is also applied inside the body and requires the insertion of means such as a nephrotomy catheter for stone removal. The catheter is equipped with a device for grasping a calculus or a device such as an ultrasonic generator for vibrating and crushing the calculus while approaching the calculus. Recently, external shock wave lithotripsy has been applied to crush and remove renal stones.
An apparatus for such lithotripsy has a pair of substantially orthogonal X-ray generators and is designed to precisely position the stones to be removed. The patient moves three-dimensionally in the bath so that the crosshairs of each of the two images displayed on the device overlap the stone. The crosshairs are each on the line projection of the focal point of the shock wave generator. The patient moves until the crosshairs are overlaid on the image of the stone; at the time of overlap, the shockwave generator is triggered and a shockwave is generated in the focal direction to wash the stone out of the body with normal physical functioning. It is crushed to size. The imaging devices used today for calculus location have room for improvement. Above all, it is desirable to reduce the exposure of patients to X-rays. Today patients are exposed to X-rays to confirm the presence of stones, which is problematic and can be removed by lithotripsy. X-rays are used to align the stones with the focal point of the shock wave generator, which then confirms that the application of the shock waves breaks the stones into debris that can be processed by the body's natural actions. Used to Therefore, when such a process is performed, a relatively large amount of X-ray is emitted. Therefore, in lithotripsy it is desirable to reduce the X-ray radiation dose. To this end, attempts have been made to use ultrasound, but the results have been unsatisfactory. The emission of ultrasonic waves
It is more effective in imaging gallstones than in the case of X-ray radiation.

[0003]

In a conventional attempt to use ultrasonic waves as a medium for determining the position of calculi, different acoustic windows are used for the ultrasonic wave generator and the shock wave generator. In this case, no correction means was provided for the distortion of the ultrasonic wave signal and the shock wave due to the passing speed of the ultrasonic wave signal and the shock wave that pass through refraction and / or different media. Further, no means in the prior art was conceived to image multiple surfaces with a single transducer to ascertain the exact location of the stone. Similarly, there was no provision for changing the field of view of the respective transducers that produced the various screens needed when exploring the stones and centering the found stones on the crosshairs. Therefore, an object of the present invention is to provide a calculus position determining device and a calculus crushing device that can accurately position a calculus at a target focus of a shock wave generator.

[0004]

Thus, according to the present invention, a shock wave generator means for generating a shock wave to destroy a calculus, and to obtain an image of the calculus and to determine the position of the calculus in the patient. A lithotripsy device having a calculus position determining device for use with the shock wave generator means, wherein the shock wave generator means has an elliptical reflector having a longitudinal axis and an ellipsoidal reflector along the axis. A spark gap terminal located at the source focus,
The target position is located away from the spark gap terminal, the calculus position determining device, ultrasonic transducer scanning means for transmitting ultrasonic waves and receiving echo waves, and an image of calculi in the patient's body This means comprises means for using the echo waves from the ultrasonic transducer scanning means to obtain the position and means for confirming the true position of the calculus and the target focus of the shock wave generator means. Confirmation means
Mounting the ultrasonic transducer scanning means on the elliptical reflector away from the axis of the elliptical reflector to obtain different views of the calculi at different positions of the ultrasonic transducer scanning means around the axis of the elliptical reflector. Means and
Means for modifying the refraction of the wave by changing the position of the patient to keep the calculus at the position of the target focus in the different fields of view. Also,
What is claimed is: 1. An ultrasonic calculus position determining device which is operated in combination with a shock wave generator means, wherein the shock wave generator means is a target, in a calculus crushing device including a water bath for breaking a patient's calculus immersed therein. An ellipsoidal reflector for collecting a shock wave generated at a wave source focus on a target focus to destroy a calculus located at the focus and having a longitudinal axis, wherein the ultrasonic calculus locating device is a patient. An ultrasonic transducer that emits an ultrasonic beam and receives an echo signal for acquiring an image of a stone, which is mounted on the elliptical reflector away from the axis of the elliptical reflector, and The ultrasonic transducer has at least one revolution about the axis of the elliptical reflector to obtain different views of the calculus to confirm the match between the position of Means for rotating about the axis of the elliptical reflector to swivel the minutes so that the ultrasonic transducer is focused over the target focal point of the elliptical reflector through a portion of at least one revolution of the transducer. And correction means for correcting the refraction when acquiring a calculus image in each of the different fields of view, this correction means, from the ultrasonic transducer to one image calculus at the target focus Means for obtaining the angle α1 between a straight line crossing the skin surface of the patient and the normal to the skin surface of the patient, means for obtaining sin α1, means for obtaining the quotient by dividing sin α1 by the sound velocity V1 in water, and the above quotient Is a means for obtaining the sin α2 by integrating the sound velocity V2 in the living tissue, where α2 is the refraction angle and arcsin
means for calculating α2 to determine the refraction angle α2; means for correcting the image position of the calculus by using the determined refraction angle α2 to obtain the true position of the calculus; and true position of the calculus. And means for moving the patient to move the patient to the target focus. Further provided is a calculus localization device used in combination with a shock wave generator means for locating and destroying a calculus of a patient undergoing lithotripsy, wherein the shock wave generator means is generated at a source focus. An elliptical reflector having a longitudinal axis for focusing a shock wave on a target focus;
An ultrasonic transducer which comprises a spark gap terminal positioned at a wave source focal point along the axis of the elliptical reflector to generate a shock wave, and the calculus position determining device transmits an ultrasonic beam to receive an echo signal. Which is attached to the elliptical reflector away from the axis of the ellipsoidal reflector, and an ultrasonic transducer for obtaining different views of the stone to confirm the true position of the stone and the image position. Is a means for swiveling a portion having at least one revolution about the axis of the elliptical reflector, the central beam of the ultrasonic beam being transmitted through the portion having at least one revolution of the transducer to achieve a target focus. Place the ultrasonic transducer in a position such that it passes through, and a means for using the echo signal to acquire an image at the stone position of the patient, and Stones in move is characterized in that comprises means to move the patient to match the target focal. These and other features and objects of the invention will become more apparent with reference to the preferred embodiments of the invention described in connection with the accompanying drawings.

[0005]

BEST MODE FOR CARRYING OUT THE INVENTION In FIG. 1 (A), the whole of an extracorporeal calculus breaking device 11 is shown in a longitudinal sectional view and a block diagram. The device shown has a bath 12 in which a patient 13 lies lying submerged during treatment. The hydraulic or mechanical device for supporting and moving the patient 13 in the X, Y and Z directions is shown as bed 14, and the axes of movement X, Y and Z are generally indicated at 16. A patient having a calculus 17 in a living organ 18 such as the bladder, kidney or gallbladder is designated by the number 13. A shock wave generator 19 is provided.
The shock wave generator 19 has a pair of spark gap terminals indicated by numeral 21. The position of this spark gap terminal 21 is at the focal point of the semi-elliptical reflector 22.
The target focus generated at the source focus and reflected by the elliptical wall is at the position of the calculus 17. The patient 13 moves by the movement of the support (bed) 14 until the calculus reaches the target focal position. The calculus is inside the living organ 18. Although the spark gap terminal 21 is shown to be inside the elliptical reflector 22, in principle the shock wave may be generated by any means and the appropriate reflector reaches the target focus and the stone 17 is targeted. Try to reach the focus. Means for imaging the calculus 17, more specifically an ultrasonic transducer 23, is provided. The ultrasonic transducer 23 is, in one embodiment, a fan-scan transducer whose focal point coincides with the target focal point of the shock wave generator 19 at some point during scanning. Echoes received from the calculus 17 and from the whole body are processed and displayed as images on the display means 24 in the usual manner of processing ultrasonic echo signals. This image includes an image 17 'of stones present in the image 18' of body organs. Stones generally generated in ultrasonic waves due to difference in velocity and refraction of ultrasonic signal and shock wave passing through different media between ultrasonic transducer 23 and stone 17
Means are provided to correct 17 position errors. The unique means for this is the computing means shown in block 26, or the positioning means for positioning the ultrasonic transducer 23 to have the same acoustic window as the shock wave generated by the shock wave generator 19, or both. is there. The computing means 26 may be the ones that perform the actual calculations based on the data obtained by the echo signals or based on the data stored in the computer used with this imaging device.

In FIG. 1A, the position setting means of the ultrasonic transducer 23 for correcting the position error of the calculus 17 is a moving member 27.
It is interlocked with. The moving member 27 has a hole 28 and an elliptical portion 29. Alternate movement of the holes 28 or elliptical portions 29 can be performed by various means, for example, rotation of the moving member 27 or reciprocating movement of the moving member 27 in a linear direction. Thus, the moving member 27 can rotate about the axis 31 or can reciprocate such that the elliptical portion overlaps the elliptical reflector 22. The elliptical portion 29 ensures that the shock wave produced by the spark gap edge 21 has more specular surfaces. Alternatively, the holes 28 allow ultrasonic signals to be transmitted and echoes to be received. The illustrated correction means 26 is a moving member.
The rotation or reciprocation of 27 is adjusted and synchronized so that shock waves and ultrasonic signals are not generated at the same time. In this way, the ultrasound and shock waves have substantially the same acoustic window for the patient. Thus, if there is refraction acting on the ultrasonic wave, almost the same refraction acts on the shock wave, and the positional error due to the refraction of the ultrasonic signal is canceled by the positional error of the shock wave. The ultrasonic transducer 23 is provided with means for rotation about its own longitudinal axis 33, which is transduced in order to image one or more planes. It coincides with the line of sight between the vessel 23 and the target focus. This means is shown in FIG.
Shown generally at (A) as a gear 32, the illustrated gear 32 is capable of rotating the ultrasonic transducer 23 about its longitudinal axis 33. By having the ability to rotate the ultrasonic transducer 23, the position of the stone 17 is correctly grasped,
Make sure 17 is in the correct position. When the calculus 17 is correctly positioned, the rotation of the ultrasonic transducer 23 does not affect the position of the crosshairs in the calculus image 17 '.

FIG. 1B is a front view of a single ultrasonic transducer 23 showing two modes of treatment used with a calculus 17 lithotripsy device: (1) exploration and (2). It enables accurate positioning. First mode (small diameter dish)
Has a relatively deep field of view and a medium for focusing on the location of organs and stones therein. The other mode (larger diameter dish) has a sharp focus and a short field of view for precise positioning of the stone at the target focus. The ultrasonic transducer 23 is shown as a circle. Preferably a piezo-electric crystal type transducer, two active zones-an inner circular zone 25 surrounded by an annulus 30 (30 mm dish in a preferred embodiment).
Focused on about 200mm. The internal area 25 is used only for exploration (exploration mode). For positioning, a combination of inner zone and annulus is used in the preferred embodiment. The combination is a 50mm tray. Alternatively, two separate transducers may be used.

In the embodiment of FIG. 2, the ultrasonic transducers 23 are separated by the exact window positions of the shock waves produced by the spark gap terminals 21. The numbers used in Figure 2 are
The same thing as that of FIG. 1 (A) is shown. In FIG. 2, the correction means 26 ′ is shown instead of the correction means 26. This is because there is no movable member 27 in FIG. Instead, numerical or computational corrections are made to correct the stone position error. The modification by unit 26 'is described in detail below. Another method for correcting the calculus position error is provided in FIG. 2 to rotate the ultrasonic transducer 23 about the axis of the shock wave generator 19. More specifically, means are provided for rotating the ultrasonic transducer 23 about a longitudinal axis 38 of the elliptical reflector 22 of the shock wave generator 19. This means is shown as gear 36,
The gear is arranged on the top of the cylindrical body 37 fixed to the shock wave generator 19. The shock wave generator 19 responds to the control of the central control unit of the lithotripsy device and rotates under this control about a longitudinal axis 38. The ultrasonic transducer 23 is rotated about the vertical axis 38 by the rotation of the shock wave generator 19, but its focus coincides with the focus of the shock wave generator 19, that is, the position of the crosshair indicating the position of the calculus 17. Hold. The actual difference in imaged stone 17 position is averaged, reducing stone position error.

1A and 2 show a shock wave generator 19 set on the patient 13 when the patient 13 is placed in the bath 12.
And an ultrasonic transducer 23. But this shockwave generator
The assembly of 19 and ultrasonic transducer 23 may simply be provided at the bottom of the bath 12 as shown in FIG. 3 shows that the ultrasonic transducer 23 uses an acoustic window similar to the shock wave generator, but the ultrasonic transducer 23 window is removed from the shock wave generator window and instead as seen in FIG. It is to be understood that it is possible to make some computational corrections and just provide the shockwave generator-ultrasonic transducer assembly at the bottom of the bath 12, unlike the example of FIG. Also, if a braid system is provided at the bottom of the bath, sufficient care must be taken during rotation of the transducer and / or shock wave generator to prevent leakage. However, the procedures required in such cases are well known to those skilled in the art. The reference numbers in FIG. 3 correspond to those used in FIG.

One feature of the present invention is that an X-ray device is included in addition to an ultrasonic device for locating stones. This system allows the discovery of calculi that may be missed if only one type of radiation is used. In addition, X-ray equipment is also useful for correcting stone position errors when using ultrasound equipment. Thus, the X-ray device can also be used as a landmark after the ultrasound device is aimed at the calculus. The x-ray device includes a pair of x-ray tubes arranged to emit x-rays toward a target focus of a shock wave generator. The X-ray tubes 41 and 42 are
The radiation is arranged at an angle to each other, preferably at a right angle. X-ray tube is a central control unit
It is powered by high voltage generators 43,44 under the control of 45. Data acquisition and imaging devices 46 and 46a are provided for the patient 13 in opposite directions to each of the X-ray tubes. The data acquisition device 46 comprises detection means, such as an image intensifier 47, which converts the X-rays that have passed through the patient into position-related light intensity signals.

Means, such as a video camera 48, are used to convert the position related light intensity signals into pixel electrical signals. Video processor means 49 converts the pixel electrical signals into an image displayed on monitor 50. A crosshair 51 is shown on the monitor. The crosshairs are the visual projection lines of the target focus detected by device 46. Device 46a is a device
It is a pair with 46. Both devices are under the control of unit 45. The hybrid system of FIG. 3 can detect the position of the calculus and focus it on a target by ultrasound, X-rays, or a combination of ultrasound and X-rays. Triggering means 45a is provided to minimize movement of the patient or the body organs of the patient. The triggering means may, for example, trigger the ECG signal so that it is activated only when a predetermined physical variation occurs. Assemble the shock wave generator and ultrasonic transducer,
Means for use in the moveable probe can be provided.
More specifically, probe 61 is shown in FIG. The probe is attached to and supported by a gantry generally designated by the numeral 62. The handle 63 is used to move the probe and the probe is a spark terminal.
With 64. Terminal 64 is fixed to the shock source focus in a reflecting and focusing mirror, such as the elliptical mirror shown at 65. The elliptical reflector 65 has a second or target focus 66 at a location remote from the fixed location source focus 64. The ultrasonic transducer 67 is also focused on the target focus 66.
The ultrasonic transducer is shown to have the same acoustic window as the shockwave generator; that is, the transducer is mounted directly on the back of the spark gap terminal 64. In the illustrated example, a part of the mirror is removed and replaced with a part of the converter scanning unit.

Alternatively within the scope of the invention, FIG.
The device of (A) may be used; that is, ellipses and holes may be staggered in front of the transducer. Alternatively, the transducer may be located on the side and have a slightly different window than the shockwave generator. The position error correction unit 68 operates in connection with the echo of the ultrasound system, generally designated 69, and under the control of the processor 70 the display means.
Produces an image at 71. A part of the patient's body is number 72,
It is shown lying on a support bed or table 73. The configuration of probe 61 including the shock wave generator and transducer assembly eliminates the need to position the patient in a water bath. Instead, the assembly 61 has water inside and is retained within the probe 61 by a septum 74. A jelly body is placed between the patient 72 and the diaphragm 74 to minimize shock wave and ultrasonic signal resistance from the probe,
Make it easy for patients to respond. Of course, the probe can also be used in a water bath.

FIG. 5 illustrates a correction calculation for correcting the stone position error caused by the difference in velocity of ultrasonic signals in different media passing between the transducer and the patient's stone. . Ultrasonic transducer in FIG. 5 (A)
81 projects a beam as it scans the arc. The beam is represented by the central beam 82. The beam produces echoes at, for example, tissue boundaries. Stones produce such echoes. This device normally processes beams and echoes as if they were straight ahead. In reality, the calculus 83, which actually exists at location 83r, appears to be at location 83i due to the difference in sound velocity in water and in tissue. Therefore, there are angular errors α2-α1 and distance errors d1-d2.

Where α1 is the angle between the beam 82 and the normal 84 of the skin surface 86 at point P, and α2 is the refracted beam 8
2'is the angle with the perpendicular 84 of the skin surface 86 at point P, d
1 is the distance from the point P to the apparent stone position 83i,
d2 is the distance from the point P to the actual stone position 83r. These angles and velocities have the following relation from Snell's formula. In the formula, V1 is the sound velocity in water, 1500 m / sec, and V2 is the average sound velocity in the tissue, 1540 m / sec. The distance d2 is easily determined. The echo time t1 returning from the calculus is known. The product of this time and the average sound velocity in the tissue is the beam.
The distance to the stone along the 82 '. The distance between the source focus and the target focus using a single velocity is usually in error due to Snell's equation along the direction of the vector and the direction of angular excursion. By first framing several times, the ultrasound system detects the position 86 on the skin surface. As is well known, the location of the skin surface is represented by the first strong echo received.

FIG. 5B shows an embodiment of the apparatus for calculating the angle between the ultrasound beam and the normal to the skin surface for all imaging vectors. A curve is applied to the data obtained to show the skin surface 86. The curve applying means may be any known curve applying means, for example an averaging operator using data obtained on the skin. After being applied to the curve, the angle α1 formed by the normal to the skin and the beam from the transducer to the patient is obtained by means 92. This angle is obtained for each angle of incidence of the beam on the skin. The sine value of angle α1 is calculated at 93 and divided by the value V1 at 94. This quotient is multiplied by V2 at 96, which gives the value of sin α2. The angle α2 is obtained from this value at 97. The value of α2 makes it possible to detect the solid line of each heme (ie line 82 '), whereby the actual stone position is obtained. Similar calculations can correct the target focus of the shock wave generator for velocity differences and position errors due to refraction. The modified transducer focus is set to match the modified target focus.

According to the invention, a probe having an assembly of an ultrasonic transducer and a shock wave generator is used to determine the position of the calculus and to destroy the calculus by lithotripsy with shock waves generated outside the body. . The actual location of the calculus is by using the same window for shock waves and ultrasonic waves,
By using the two transducers and averaging the calculus positions by averaging the calculus positions obtained by rotating the transducer along the axis of the shock wave generator, It can be obtained by calculating the true position from the data obtained, or by combining these methods. The actual position is shown in the image, causing the patient or probe to move until the crosshairs on the image match the stones imaged. At this time, the trigger of the shock wave generator should be triggered. After a series of shock waves have been sent to the calculus to crush the calculus, the image will check to see if the calculus is indeed crushed and if any debris must be broken into smaller pieces. Although the present invention has been described with respect to particular embodiments, it should be understood that these embodiments are merely illustrative and that the invention is not limited thereto.

[0017]

An ultrasonic calculus position determining device for use with a spark gap shock wave generator for crushing stones whose position has been determined as described above, wherein a true position of the calculus and a target focus of the shock wave generator are provided. Of the shock wave that is focused by reflection to a target focal point located away from the spark gap terminal located at one source focal point of the elliptical reflector. The calculus position determining device mounts the ultrasonic transducer scanning means on the elliptical reflector away from the axis of the elliptical reflector, and disposes the ultrasonic transducer scanning means around the axis of the elliptical reflector at different positions. , Either by obtaining a different view of the calculus in, or by swiveling a portion with at least one rotation about the axis of the elliptical reflector. Since obtaining a different field of view, stones and can accurately position the stone to the target focus of the shockwave generator.

[Brief description of drawings]

1A is a vertical cross-sectional view of a calculus position determining apparatus using an ultrasonic transducer and a shock wave generator that use the same acoustic window, and FIG. 1B is a front view of the ultrasonic transducer. .

FIG. 2 is another vertical cross-sectional view of the calculus position determining device showing the ultrasonic transducer excluding the shock wave generator window.

FIG. 3 is a longitudinal cross section of another embodiment of a calculus position determining device having an ultrasonic transducer and a shock wave generator at the bottom of a crushed stone bath, which has an X-ray tube and is thereby capable of determining the position of a mixed X-ray calculus. It is a figure.

FIG. 4 is a block diagram of a calculus localization device in combination with a mobile shock wave generator, having a probe and not necessarily a bath.

FIG. 5A is a diagram illustrating a position error caused by ultrasonic signal velocities passing through different media, and FIG. 5B is a diagram for correcting a position error used in a calculus position determining device. It is a block diagram explaining the calculation means of.

[Explanation of symbols]

12 ... Bath 13 ... Patient 14 ... Patient moving means (bed) 17 ... Stone 17 '... Stone image 19 ... Shock wave generator 21 ... Spark gap terminal 22 ... Elliptical reflector 23 ... Ultrasonic transducer 24 ... Check Means (display means) 26 '... Correction means 36 ... Rotation means (gear) 38 ... Vertical axis 92 ... Means for obtaining angle α1 93 ... Means for obtaining sinα1 94 ... Means for obtaining quotient 96 ... Means for obtaining sinα2 97 … Refraction angle α2
Means to determine

 ─────────────────────────────────────────────────── ———————————————————————————————————————————————————————————— Abraham Brooke, Haifa Perez Marquish Street 7

Claims (5)

[Claims] Claim: What is claimed is: 1. A shock wave generator means for generating a shock wave to destroy a calculus, and stone position determination for use with the shock wave generator means for obtaining an image of this stone and for locating the stone in a patient. A lithotripsy device having a device, wherein said shock wave generator means comprises an elliptical reflector having a longitudinal axis, a spark gap terminal located along the axis at a source focus within the elliptical reflector, The target position is located away from the spark gap terminal, and the calculus position determining device is an ultrasonic transducer scanning means for transmitting an ultrasonic wave and receiving an echo wave, and an image position of the calculus in the patient's body. Means for using the echo waves from the ultrasonic transducer scanning means to obtain the true position of the calculus and the target focus of the shock wave generator means. This coincidence confirmation means is an ellipse away from the axis of the elliptical reflector in order to obtain different views of the calculi at different positions of the ultrasonic transducer scanning means around the axis of the ellipsoidal reflector. A means for mounting the ultrasonic transducer scanning means on a reflector; and means for modifying the refraction of the waves by changing the position of the patient to keep the calculus at the position of the target focus in the different fields of view. Characteristic stone crushing device. 2. The ultrasonic transducer scanning means comprises a single ultrasonic transducer, and the coincidence confirming means comprises the single ultrasonic transducer for obtaining different views of a stone imaged at a target focus. Means for determining an average position of the image of said stone between at least two different angular positions by rotating the ultrasonic transducer about the axis of the elliptical reflector, and imaging at the target focus in said different field of view. Means for determining the average position of the image of said stones having means for measuring the change in the position of the patient required to hold said stones; means for averaging this measured change; Means for using the measured changes as changes to obtain the average position, and means for changing the position of the patient to position the stone at the target focus in the different fields of view, Stone lithotripsy apparatus according to claim 1, wherein comprising a means having a means for positioning the average position stones to move the location. 3. The ultrasonic transducer scanning means comprises a plurality of ultrasonic transducers, and each ultrasonic transducer is arranged at an angle away from other ultrasonic transducers, and these ultrasonic transducer groups are arranged. 2. The lithotripsy device of claim 1, wherein the ultrasonic wave transducers are arranged to focus the waves and each of the ultrasonic transducers is arranged with the ultrasonic transducers focused on a target focus of a shock wave generator. 4. An ultrasonic calculus position determining device, which is operated in combination with a shock wave generator means, in a calculus calculus device including a water bath for breaking a patient's calculus immersed therein. The instrument means is an elliptical reflector for collecting a shock wave generated at the source focus on the target focus to destroy the calculus located at the target focus and having a longitudinal axis, and the ultrasonic calculus position The determining device is an ultrasonic transducer that transmits an ultrasonic beam to receive an image of a patient's stone and receives an echo signal, and is mounted on the elliptical reflector away from the axis of the elliptical reflector. In order to confirm the coincidence between the true position of the calculus and the image position, the ultrasonic transducer is reduced around the axis of the elliptical reflector in order to obtain different fields of view of the calculus. Means for rotating about the axis of the elliptical reflector to swivel the one-turn portion, the ultrasonic transducer being directed through the at least one-turn portion of the transducer onto the target focus of the elliptical reflector. It consists of a unit for positioning in focus, and a correcting unit for correcting refraction when acquiring a calculus image in each of the different fields of view. One image means for obtaining the angle α1 between the straight line across the skin surface and the normal to the skin surface of the patient, a means for obtaining sinα1, and a means for dividing sinα1 by the speed of sound V1 in water to obtain the quotient. , The sound velocity V2 in the living tissue is added to the above quotient to obtain sin α
2 is a means for obtaining a refraction angle, α2 is a refraction angle, a means for determining the refraction angle α2 by calculating arcsin α2, and the image position of the calculus is corrected by using the refraction angle α2 thus determined. An ultrasonic calculus position determining apparatus comprising: a means for determining the true position of the calculus and a means for moving a patient to move the true position of the calculus to a target focus. 5. A calculus position determining device used in combination with a shock wave generator means for locating and destroying a calculus of a patient undergoing lithotripsy, wherein the shock wave generator means is a wave source. An elliptical reflector for focusing the shock wave generated at the focal point on the target focus, which has a longitudinal axis, and is located at the source focus along the axis of the elliptical reflector for generating the shock wave. A spark gap terminal, wherein the calculus position determining device is an ultrasonic transducer that transmits an ultrasonic beam and receives an echo signal, and is attached to the elliptical reflector away from the axis of the elliptical reflector. , The ultrasonic transducer is centered around the axis of the elliptical reflector in order to obtain different fields of view of the stone in order to confirm the coincidence between the true position of the stone and the image position. A means for rotating a portion having at least one rotation by means of ultrasonic conversion to a position such that the central beam of the ultrasonic beam transmitted through the portion having at least one rotation passes through the target focal point. Device and means for using the echo signal for image acquisition at the stone location of the patient, and means for moving the patient to move the stone in the image to match the target focus. A stone position determining device.