The key was using extremely powerful ultrasound to produce negative pressure of more than 20 megapascals, delivered in short bursts measured in microseconds—but separated by relatively long gaps, between a millisecond and a full second long. These parameters created bubbles that quickly formed and collapsed, tearing apart nearby cells and turning the tissue into a kind of slurry, while avoiding heat buildup. The result was a form of incisionless surgery, a way to wipe out tumors without scalpels, radiation, or heat.
“The experiments worked,” says Xu, now a professor at Michigan, “but I also destroyed the ultrasound equipment that I used,” which was the most powerful available at the time. In 2009, she cofounded a company, HistoSonics, to commercialize more powerful ultrasound machines, test treatment of a variety of diseases, and make the procedure, called histotripsy, widely available.
So far, the killer app is fighting cancer. In 2023, HistoSonics’ Edison system received FDA approval for treatment of liver tumors. In 2026, clinicians will conclude a pivotal kidney cancer study and apply for regulatory approval. They’ll also launch a large-scale pivotal trial for pancreatic cancer, considered one of the deadliest forms of the disease with a five-year survival rate of just 13 percent. An effective treatment for pancreatic cancer would represent a major advance against one of the most lethal malignancies.
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