The present invention relates to the field of in vivo devices. More specifically, the present invention relates to a device, system and method for selectively activating or altering the operational mode of an in vivo device, for example, in response to in vivo conditions.
Certain in vivo devices may be introduced into a body in a location remote to the area where their sensing, diagnosing or other functions may be performed. For example, an in vivo device for imaging areas of the small intestine may be introduced into a body through the mouth and pass through the stomach and other parts of the gastrointestinal (GI) tract by way of peristalsis until reaching the small intestine. Similarly, an in vivo device may be introduced into a body wherein the location of an area of interest or of a suspected pathology may be unknown or uncertain, thereby necessitating that an in vivo device pass from its point of introduction and locate the area of pathology where its sensing functions or other functions may be required for diagnosing pathologies or performing other functions.
In vivo devices such as sensors are generally configured to capture sensory data on a fixed schedule that may be set or programmed into the in vivo sensor before it may be introduced into a body. For example, an in vivo image sensor may be configured to capture images at fixed intervals beginning with the time that it is introduced into the body. Typically, an in vivo sensor may be activated by a doctor or medical practitioner who assists in introducing such sensor into the body. Other in vivo sensors may be activated before ingestion, for example, automatically upon their removal from their original packaging. As a result, an in vivo sensor introduced to a location in the body that may be remote from an area of interest or suspected pathology in a body, may perform its sensing functions or other functions in locations other than the area of interests for example where no pathology or suspected pathology exists. The performance of such superfluous sensing may inefficiently utilize the power supply, data collection, data transfer (bandwidth), data storage capacity and/or other of the sometimes limited resource of the in vivo sensor. Redundant data may be required to be reviewed by the physician, increasing the overall review time.
The capturing of data by an in vivo sensor based on a fixed schedule may result on the one hand, in superfluous data being collected in areas that may be of little diagnostic or other interest, and, on the other hand, in insufficient sensory data being captured of in vivo areas that may be of particular diagnostic or other interest. For example, an in vivo image capturing system may be programmed to capture in vivo images at a rate of, for example, two frames per second. While such frame capture rate may be for example sufficient to generally capture adequate images of most of the small bowel, such frame capture rate may be too slow to achieve the level of imaging detail that may be required for areas such as the esophagus or other areas.
There is therefore a need for a system and method for allowing an efficient and effective operation of an in vivo device.
There is thus provided according to one embodiment of the invention, a system for in vivo sensing including for example an in vivo sensing device with a condition tester, and a controller. The condition sensor may for example be operatively linked with the controller so as to control for example an operational mode of the in vivo sensing device.
It is also provided according to an embodiment of the invention, a method for controlling, for example an in vivo imaging device by, for example, sensing a condition in vivo and triggering an event in the in vivo imaging device based on the sensing.
The present invention will be understood and appreciated more fully from the following detailed description taken in conjunction with the appended drawings in which:
In the following description, various aspects of the present invention will be described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the present invention. However, it will also be appreciated by one skilled in the art that the present invention may be practiced without the specific details presented herein. Furthermore, well-known features may be omitted or simplified in order not to obscure the present invention.
According to some embodiments of the invention, a system, method and device are provided for triggering an event such as, for example, activating or altering the operational mode of an in vivo device and/or a receiving (and/or processing, and/or reviewing) unit, typically located outside a patient's body, in response to in vivo conditions as may be detected by an in vivo condition tester. Such activating, deactivating or altering operational modes may include for example, activating or deactivating one or more components of the in vivo device and/or the receiving unit, increasing or decreasing the power consumption, increasing or decreasing the level of illumination, increasing or decreasing the rate of sensing, such as, for example, increasing the data capture rate from, for example, 2 images per second to for example, 14 images per second, or altering the sensing parameters such as, for example, in the case of an in vivo image sensor, increasing or decreasing the illumination intensity of the light sources or altering the image plane of the image sensor. Other operational modes may be changed and other data capture rates may be used. In certain embodiments, more than one in vivo sensor may be included in a single device. A change in the operational mode of the device may in such embodiments include activating or deactivating one or both of such sensors or alternating the activation of such more than one sensor. For example, an in vivo image sensor may include two image sensors. A change in operational mode may in such example mean activating or deactivating one or both of such image sensors, or alternating the activation of such image sensors. In other embodiments, one in vivo device may activate or deactivate one or more components in second in vivo device. Communication between two or more in vivo devices may be for example through one or more external receivers or may be through for example direct communication between one or more in vivo devices.
In certain embodiments changes in the operational mode may for example include changes in the methods or procedures of processing sensory data obtained, and optionally transmitted, from the in vivo device. For example, sensory data such as images or ultrasound readings from endo-luminal areas that have villi may return distorted images as a result of the irregular surfaces of the villi. In certain cases, such distortions may be corrected through changes in the methods of processing of the sensory data by the data processor. For example, specific image processing algorithms may be activated. According to one embodiment methods of processing sensory data may be executed, for example, in an external receiving unit. In another embodiment the change may be in the mode of the data presentation (reviewing mode), e.g. presentation of the images in double image vs. single image mode.
The invention according to certain embodiments, comprises an in vivo device such as, for example, an in vivo image capture system, an in vivo condition tester such as, for example, any of an in vivo pH tester, blood detector, thermometer, pressure tester, spectral analytic image sensor, biosensor for biosensing, accelerometer, or motion detector, and a controller for linking the condition tester with the in vivo device and for signaling the change to be made in the operational mode of the in vivo device. Other condition testers may also be used as well as a combination of two or more condition sensor may be used. In one exemplary embodiment a biosensor may be used to sense, for example, colon specific flora in a colon. In another exemplary embodiment a pressure tester may be used to sense, for example, a change in pressure, such as a change in pressure pattern. For example, a drop in pressure may be sensed by a pressure tester, for example, when the device moves from the small intestine to the cecum (at the beginning of the colon). Various signals emitted by the condition tester such as mechanical, electrical, electromagnetic, chemical, or optical signals may also be used.
Embodiments of the present invention may be used with in vivo devices and recording/receiving and display systems such as various embodiments described in U.S. Pat. No. 5,604,531, assigned to the common assignee of the present application and incorporated herein by reference, and/or Publication Number WO 01/65995, also assigned to the common assignee of the present application and incorporated herein by reference. Other in vivo systems, having other configurations, may be used.
Embodiments of the device may be typically autonomous and typically self-contained. For example, the device may be a capsule or other units where all the components are substantially contained within a container or shell, and where the device does not require any wires or cables to, for example, receive power or transmit information. The device may communicate with an external receiving and display system to provide display of data, control, or other functions. For example, power may be provided by an internal battery or a wireless receiving system. Other embodiments may have other configurations and capabilities. For example, components may be distributed over multiple sites or units. Control information may be received from an external source.
An in vivo imaging system for example, that may be included in an ingestible device such as a capsule may capture and transmit images of the GI tract while the capsule may pass through the GI lumen. In addition to the imaging system, a device such as a capsule may include, for example, an optical system for imaging an area of interest onto the imaging system and a transmitter for transmitting the image output of the image sensor. A capsule may pass through the digestive tract and operate as an autonomous video endoscope. It may image difficult to reach areas of the GI tract, such as the small intestine. Other devices may be included, and devices including sensors other than image sensors may be used. Configurations other than capsules may also be used.
Reference is made to
In certain embodiments, image sensor 46 may be a CCD or a CMOS image sensor that may have arrays of various typically color pixels. Other suitable image sensors or no image sensors may be used. In one embodiment of the invention, image sensor 46 may also function as a condition tester. For example, an image sensor may be used to detect for example, blood vessel structures typically found in colon, or villi structures typically found in small intestine. Detection of such structures, detection of lack of such structures, or detection of other structures or colors such as for example color specific to content in the intestine may be used to trigger an event in the in vivo device. Other suitable structures or colors detected may be used as a trigger. Detection, according to an embodiment of the invention, could be aided by appropriate image processing algorithms and/or suitable software.
In other configurations of device 40, components such as capsule receiver 43, power source 45, in vivo memory unit 39 or other units may be omitted.
Typically, device 40 is swallowed by a patient and traverses a patient's GI tract. Other suitable body lumens or cavities may be imaged or examined.
Reference is now made to
External receiver 12 may also be equipped with processing unit 11, such as for example signal processing unit and/or control software or for example a control mechanism or circuit emulating such functionality that may control for example, evaluate and respond to signals transmitted by device 40. External receiver 12 may also include a transmitter and receiver transmitter 17 that may enable external receiver 12 to transmit signals such as control signals to device 40. External receiver 12 may also include a user interface (not shown) that may inter alia provide indications to a user or patient as to changes made in the operational mode of a device. For example, passage of a capsule through the stomach may be identified by changes detected in pH levels that may for example trigger a change in the operational mode of a sensor such as an image sensor. A patient may be signaled via a user interface that such mode change is being made and prompted to take certain actions such as for example, changing positions (such as for example, changing from a sitting position to a reclining position), ingesting a laxative, or certain liquids, etc.
Reference is now made to
Typically, device 40 may capture an image and transmit the image by using, for example, radio frequencies, to receiver antenna(s) 15. In alternate embodiments external receiver 12 is an integral part of data processor 14. Typically, the image data recorded and transmitted is digital color image data, although in alternate embodiments other suitable image formats (e.g., black and white image data, infrared image data, etc.) may be used. In one embodiment, each frame of image data may include 256 rows of 256 pixels each, each pixel including data for color and brightness, according to known methods. For example, color may be represented in each pixel by a mosaic of four sub-pixels, each sub-pixel corresponding to primaries such as red, green, or blue (where one primary is represented twice). The brightness of each sub-pixel may be recorded by, for example, a one byte (i.e., 0-255) brightness value. Other data suitable formats may be used. In one embodiment, image sensor 46 may capture or transmitter 47 may transmit image or other data in a diluted mode, capturing or transmitting for example, 16 rows of 16 pixels each.
In an embodiment, in vivo transmitter 47 may include at least a modulator (not shown) for modulating the image signal from the image sensor 46, a radio frequency (RF) amplifier (not shown), and an impedance matcher (not shown). The modulator may convert the input image signal that may have for example, a cutoff frequency fc of less than 5 MHz to an RF signal having a carrier frequency fr, that may typically be in the range of 1 GHz. The carrier frequency may be in other bands, e.g. a 400 MHz band. The modulated RF signal may typically have an appropriate bandwidth of ft. The impedance matcher may match the impedance of the circuit to that of the antenna. Other suitable transmitters or arrangements of transmitter components may be used, utilizing different signal formats and frequency ranges. In one embodiment of device 40, transmission may occur at a frequency for example of 434 MHz, using for example Phase Shift Keying (PSK) or MSK (Minimal Shift Keying). In alternate embodiments, other suitable transmission frequencies and methods, such as for example AM or FM may be used.
External receiver 12 may detect a signal having the carrier frequency fr and the bandwidth fc such as described hereinabove. External receiver 12 may be similar to those found in televisions or it may be one similar to those described on pages 244-245 of the book “Biomedical Telemetry” by R. Stewart McKay and published by John Wiley and Sons, 1970. The receiver may be digital or analog. In alternate embodiments, other receivers, responding to other types of signals, may be used.
In certain embodiments, condition tester 49 may be an in vivo pH tester, as is well known in the art, for example a pH tester using the technology used in known pH measuring capsules. Such pH tester may utilize as electrodes an external ring electrode made of antimony and the zinc-silver chloride electrode of the battery that powers the tester. A saline solution such as for example, a 0.9% physiologic saline solution may be introduced into the electrode chamber immediately prior to the testing. The potential difference that develops between the two electrodes and that depends on the pH may be applied to a transistor as a frequency-determining measuring voltage.
Other pH testers, such as ion selective field effect transistors (ISFET), may also be used as condition tester 49 to evaluate pH in areas adjacent to the location of the device 40. ISFET sensor chips that may be used for in vivo pH detection are known in the art as may be described, for example, in Wang, L., Integrated Micro-Instrumentation for Dynamic Monitoring of the Gastro-Intestinal Tract, as presented at the IEEE Instrumentation and Measurement Technology Conference, May 2002, retrieved on Oct. 15, 2002 from the Internet: <URL: http://www.see.ac.uk/naa.publications.html>. Other suitable pH testers may also be used. An ISFET sensor serving as condition tester 49 may be operatively connected to ASIC 50 or otherwise may be connected directly to image sensor 46. In a typical embodiment, an ISFET sensor serving as condition tester 49 may be situated adjacent to the outer wall of the device 40 so as to maximize the exposure of such condition tester 49 to the in vivo conditions outside of such wall of device 40.
In some embodiments, controller 48 may be substituted or complimented by an external controller located out of the body. For example the external controller may be an integral part of processor 11. In such embodiments, triggering may be external triggering. Condition tester 49 may transmit a signal to in vivo transmitter 47 that transmits such signals to receiver antenna(s) 15. External receiver 12 may process such signals and transmit back triggering signal such as instructions by way of receiver transmitter 17 to in vivo receiver 43. In vivo receiver 43 may then direct a change in the mode of operation of device 40. In some embodiments, external receiver 12 may be capable of overriding or initiating a change in the mode of operation of device 40 in response to a signal that is input to receiver by medical personnel.
A condition tester such as for example, a pressure sensor may use a strain gauge as a condition detector, such as for example, a thin foil, typically a semiconductor or a piezoelectric material. Such strain gauge may accept power through a wire and provide a variable strain signal on such wire.
In other embodiments, condition tester 49 may take the form of a condition sensitive, color-changing material. Reference is now made to
In an embodiment, the temperature-sensitive, color-changing material 202 may be a Thermotropic Liquid Crystal (TLC) paint or coating, such as are offered by Hallcrest, Inc. of Glenview, Ill. The TLCs, that may, for example, be cholesteric (including sterol-derived chemicals) or chiral nematic (including non-sterol based chemicals) liquid crystals, or a combination of the two, provide color changes in response to temperature changes. These color changes may be reversible or hysteretic. In certain embodiments that include materials 202 that may be capable of reversible color changes, controller 48 may be programmed to reverse or further alter the operational mode changes in image sensor 46 in the event that a condition tester ceases to detect the changed color of material 202.
The TLC can be used in several forms according to several embodiments, including but not limited to paints, microencapsulated coatings and slurries, TLC coated polyester sheets, and unsealed films.
As shown in
In the course of the function of capsule 200, light from a light source 204 may be directed towards material 202. Light source 204 may include one or several components, preferably light emitting diodes (LEDs) that may be placed in various locations within capsule 200. Light source 204 may also be used as or provided by illumination source 42 shown in
Changes in in vivo conditions, such as, for example, changes in temperature, pH, pressure, the presence of blood and the like (depending on the nature of material 202), may in certain embodiments cause various materials that can be used as color-changing material 202, to change color. Image sensor 46 detects the appearance of the new color when light from light source 204 is reflected back from material 202 onto image sensor 46. Referring to
When a designated change in color of material 202 is detected by a subgroup of pixels 206, a signal may be sent to controller 48 by such a subgroup of pixels 206 or by another component operatively connected to a subgroup of pixels 206. In certain embodiments, a subgroup of pixels 206 may be replaced or supplemented by a spectral analyzer that is capable of detecting color changes in material 202. Other color-sensitive detectors may also be used. Such detection or processing may also be aided or performed by a processor or circuitry located in ASIC 50, external receiver 12 or data processor 14.
In certain embodiments, a range of color sensitive pixels, some of which may be sensitive to the various colors that can appear on material 202 may be situated on pixel array 210 of image sensor 46. Signals produced by each of such specific pixels 206 may vary depending on the color appearing on material 202. Controller 48 may detect and differentiate between such various signals, for example by utilizing appropriate image processing algorithms, and issue instructions to a sensor in response to each thereof. According to one embodiment a change of color may be detected in the in vivo environment that is being imaged. For example, a spot of bleeding may appear in a certain image. The change of color, that may indicate, for example, pathology in the GI tract, may be recognized by known methods. For example, controller 48 or data processor 14 may generate a probability indication of presence of colorimetric abnormalities on comparison of color content of the images and at least one reference value, for example, as described in PCT publication WO 02/073507, published on 19 Sep., 2002, that is assigned to the common assignee of the present invention. According to some embodiments, once a color change may be detected the controller 48 or data processor 14 may initiate a change in the mode of operation of device 40, of the external receiver 12, of both or of any other component or combination of components of the system. In other embodiments, a photodiode maybe used to detect changes in material 202. Such photodiode may in certain embodiments be connected to an amplifier that may be further connected to a comparator. A mode change may thereby be triggered by analog rather than digital electronics.
In one embodiment of the invention, one or more photodiodes may be used to detect light, such as for example, visible light, IR light, or other ranges of light illuminated for example externally through the skin toward an in vivo area of interest. A photodiode or other light detecting unit, for example incorporated in an in vivo device may sense illumination when approaching for example toward such area of interest. Such detection may trigger a change in operational mode. Other suitable signals besides light may be used to penetrate the skin or other tissue and other suitable detection units may be used to pick up penetrated signal in vivo. For example, an acoustic signal may be used.
In an embodiment, capsule 200 may operate in a low power consumption mode until a color change in material 202 may be detected. For example, until such color change may be detected, light sources 204 may be set to illuminate once every second, thereby consuming less power than used by the overall capsule 200 during full operation that might in certain embodiments illuminate several times a second or more. In response to a signal that may be detected from specific pixels 206, controller 48 (or another component located in capsule 200, external receiver 12 or data processor 14) may alter the mode of operation of capsule 200 or of any other component of the system. For example, in certain embodiments, any or both of light source 204 and image sensor 46 may be directed to increase the rate of capture of images in order to more fully image the endo-luminal vicinity wherein a specific condition may have been detected. Controller 48 may direct other activations or alterations in the mode or operation of capsule 200. In other embodiments, the response of controller 48 to signals from specific pixels 206, may be, for example, any of turning on the image sensor 46 that may theretofore have been inactive, changing mode of image sensor or transmitter, collecting samples of in vivo liquids or other materials, releasing encapsulated drugs that were held in capsule 200 or performing other functions.
In some embodiments, the pixels receiving the color indication may be, for example, the regular pixels of image sensor 46. Post processing circuitry or software located in capsule 200, external receiver 12 or data processor 14 may analyze the signals from the set of pixels (set being understood to include one unit) and make a mode change determination therefrom.
Other embodiments besides calorimetric changes may include, for example, temperature measurement using devices such as thermistors (located in a capsule for example as a discrete component or as part of ASIC) or using pH electrodes, and other embodiments.
Reference is now made to
In certain embodiments, controller 48 may be configured to delay issuing operational mode change orders to until more than one signal from condition detector 49 may have been received. In an embodiment of the present invention, controller 48 may be configured with a delay mechanism in the form of for example a counter 51 that causes controller 48 to delay activating or altering the operational mode of image sensor 304 until several signals from condition tester 202 may have been received, or until signals signifying that a certain condition exists may be received over the course of a certain period of time. Such activation may, for example, reduce the chance that a false reading or fleeting condition activates image sensor 304, or may provide “debouncing” in case conditions may change in a variable manner between one relatively steady state and another. For example, in one embodiment, capsule 300 may operate in a first mode (e.g., low power consumption, or at a first frame capture rate) in the mouth and esophagus, where the pH is generally approximately 7-8. When capsule 300 reaches the stomach, where the pH is typically about 2, a pH detector on or within capsule 300 may detect a change in pH, and the operational mode may change, for example to a different power consumption, or a different frame capture rate. Later, when capsule 300 reaches the small intestine, capsule 300 may detect a change in pH to, for example 7-8, and the operational mode may change again. A change in pH may cause alteration in the operational mode only if received for, for example, one minute (other suitable time periods may be used). Other methods of debouncing or guarding against fleeting conditions may be used.
Controller 48 may in certain embodiments be a software controller embedded into ASIC 50. In other embodiments, controller 48 may be a simple switch or circuit connected to for example a condition tester such as a thermistor 800. The controller may include, for example, an amplifier 802 and a comparator 804, comparing the measured signal to some pre-defined threshold 806, as are depicted forth, for example, in
In a further embodiment, the switch from one condition and then back to another may be the trigger for a mode change. For example, in case a high pH is detected for a period, then a low pH, then again a high pH, the mode change may occur only on the third condition change. Other suitable signals or series of signals may be used to trigger other suitable functionalities. Further, altering the mode based on detection of a condition change may be combined with, for example, a delay. For example, capsule 300 may wait, for example, one hour after detecting a condition change to effect a mode change.
Dissolvable material 402 may cover any or all of a sensor 408, such as for example, a pH sensor, a switch 412, such as for example a switch that turns on an image sensor, an encapsulated drug compartment 410 that releases its contents or a sampling inlet 414 that lets surrounding fluids enter a compartment where such fluids may be sampled, captured or evaluated by a sensor. When dissolvable material 402 dissolves, sensor 408 may be exposed, switch 412 may be activated, sampling inlet 414 may be opened or an encapsulated drug compartment 410 may release its contents into the surrounding area. In other embodiments, the dissolving of dissolvable material 402 may facilitate contact between electrical leads that had theretofore been separated, such contact may signal a change in operational mode. According to another embodiment a magnet may be held in the vicinity of the capsule 400 such that it affects the ON/OFF status of the capsule. In some embodiments the magnet may be embedded in a dissolvable coating, such as dissolvable material 402, such that while the coating is intact, the capsule is OFF. When the coating dissolves, for example, in response to environmental pH, the magnet may be freed and may become dissociated from the capsule allowing the capsule to be ON. In other embodiments other suitable environmental triggers may cause the dissolving of coatings.
Another embodiment is schematically illustrated in
According to one embodiment, a capsule may have a fluid chamber such as for example a floatation compartment 502 that may be filled with a fluid, a gas, or other suitable material that is lighter than the endo-luminal fluid, for example, air. In certain embodiments, floatation compartment may be as small as 5% of the volume of capsule 500. Other suitable volumes may be used. The floatation compartment 502 may have a valve 504 keeping the compartment 502 closed and the capsule 500 floating. Upon triggering, valve 504 may be opened (see
A number of mechanisms for opening valve 504 may be implemented, such as, electronic, mechanical or chemically based mechanisms. For example instant heating (requiring only a small amount of battery energy) may be applied, melting material of valve 504. The signal for effecting the change may be as described above.
In its initial state 602, the flag of software controller may be set to 0, the counter may be set to 0 and the activator may be set to 0. In such settings, image sensor 46 may not be capturing images or may be in some other reduced mode of operation. In step 604, condition tester 49 may detect a changed condition in the in vivo area surrounding capsule 40 and may signal software controller 48 as to such changed condition. Such signal increments counter to 1 Step 604 may be repeated by condition tester 49 at periodic intervals that match the sampling rate of condition tester 49. Each signal delivered by condition tester 49 that indicates the changed condition may increment the counter by 1 (605). Once the counter reaches a designated threshold in step 606, the flag switches to 1 in step 608. Such switch by the flag to 1 switches the sensor activator to 1 as in Step 610. The activator may then change the mode of operation of image sensor 46. Such change may for example be an increase in the frame capture rate of image sensor 46 or any other suitable change in the operational mode of the sensor.
In certain embodiments, the counter may be decremented each time condition tester 49 sends a signal to controller 48 that indicates the absence of an elevated condition, thereby possibly indicating that conditions may have returned to pre-defined normal levels. Once the counter may have been decremented below a pre-defined threshold level, the flag may revert to 0 and may reset the activator to its initial setting so that such sensor may resume the operational mode that was in effect prior to the change described above, or some other suitable operational mode.
In other embodiments, condition tester 49 may be, for example, a clock such as for example an internal clock embedded into ASIC 50 or otherwise operatively connected to image sensor 46. In such case, controller 48 may be a component such as for example a switch operatively attached to such embedded clock that may turn on once a designated period has elapsed. Such elapsed period may be the estimated time that it takes capsule 300 to pass through the stomach and into the small intestine where the desired image capturing may take place. Other periods may also be designated depending on where in the GI tract the desired image capturing may be designated to begin.
In yet further embodiments, an ingestible capsule may be meant for imaging or otherwise sensing distal portions of the GI tract, such as the large intestine. A method for economically using an imaging (or other sensing) capsule is provided according to an embodiment of the invention.
According to some embodiments activating the capsule may cause a signal to be transmitted (703) to an external receiving unit so as to activate an alert 730 (e.g., a beep or a flashing light), that may alert a patient to start or stop an action for example to stop drinking the cold or hot drink (740). Also, the patient may then be prepared for the expected imaging or otherwise sensing of the large intestine, for example, the patient may thus be warned to begin taking a laxative.
Reference is made to
Reference is made to
It will be appreciated by persons skilled in the art that the present invention is not limited by what has been particularly shown and described herein above. Rather the scope of the invention is defined by the claims.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/IL03/01080 | 12/16/2003 | WO | 4/27/2004 |
Number | Date | Country | |
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60433586 | Dec 2002 | US |