Patent Grant
10307074
The present invention relates to a method and apparatus for use in analysing impedance measurements performed on a subject, and in particular to a probe that can be used in determining a limb impedance profile, which can in turn be used in determining the presence, absence or degree of oedema in a subject's limb.
The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as an acknowledgment or admission or any form of suggestion that the prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates.
Lymphoedema is a condition characterised by excess protein and oedema in the tissues as a result of reduced lymphatic transport capacity and/or reduced tissue proteolytic capacity in the presence of a normal lymphatic load. Acquired, or secondary lymphoedema, is caused by damaged or blocked lymphatic vessels. The commonest inciting events are surgery and/or radiotherapy.
For example, upper limb lymphoedema is a common sequela of treatment for breast cancer. Estimates of the incidence of breast cancer lymphoedema vary in the medical literature from low values in the range of 9%-10% to those that exceed 50%. Lymphoedema is associated with a reduced quality of life, particularly emotional, social and physical function, as well as body image and lifestyle.
The condition is incurable and has been found difficult to treat with drugs or surgery but symptomatic treatment by complex physical therapy has been shown to benefit patients. Critical to patient management is that the extent of lymphoedema be measured regularly to assess patient's progress. A decrease in limb size not only indicates that treatment is beneficial but also helps encourage patient compliance with a demanding treatment programme. Additionally, onset of lymphoedema is unpredictable and may develop within days of its cause or at any time during a period of many years after that cause.
Accordingly, there is a need to be able to easily monitor for and diagnose the presence or degree of lymphoedema. A variety of methods have been used ranging in complexity from sophisticated imaging techniques such as MRI to simple geometrical volume calculations from limb circumference measurements. However, these techniques are either too costly, in the case of MRI, or insufficiently accurate in the case of limb circumference.
One existing technique for determining biological parameters relating to a subject, such as fluid levels, involves the use of bioelectrical impedance. This involves measuring the electrical impedance of a subject's body using a series of electrodes placed on the skin surface. Changes in electrical impedance at the body's surface are used to determine parameters, such as changes in fluid levels, associated with the cardiac cycle or oedema.
WO00/79255 describes a method of detection of oedema, such as lymphoedema by measuring bioelectrical impedance at two different anatomical regions in the same subject at a single low frequency alternating current. The two measurements are analysed to obtain an indication of the presence of tissue oedema by comparing with data obtained from a normal population.
However, whilst such techniques can be used to determine the presence of oedema over an entire limb, lymphoedema can be highly localised, and as the resolution of such techniques can be limited, this makes the detection of such localised oedema difficult.
In a first broad form the present invention provides a probe method for use in performing impedance measurements on a subject, the probe including:
Typically the housing is an elongate housing, the contact surface is provided at a first end of the housing and the connector is provided at a second opposing end of the housing.
Typically the housing is formed from an insulating material.
Typically the housing is formed from a perspex tube.
Typically the contact surface has a convex shape.
Typically the contact surface includes a moving member for moving relative to the subject.
Typically the moving member is a roller ball, and wherein the housing includes a shaped mounting for receiving the roller ball.
Typically the moving member is a cylindrical roller mounted on an axle.
Typically the probe includes a contact for electrically connecting the moving member to the connecter.
Typically the contact is a spring.
Typically the probe includes a sensor for sensing movement of the moving member.
Typically the sensor includes at least one of:
Typically the connector is for connecting to a lead of a measuring device.
Typically, in use, the probe is moved along a segment of the subject to thereby allow an impedance profile representing variations in impedance along the segment to be determined.
Typically, in use, the probe is connected to a measuring device the measuring device including, a processing system for:
In a second broad form the present invention provides a method of performing impedance measurements on a subject using a probe, the probe including a housing configured to be held by an operator in use, a contact surface for contacting the subject and a connector for connecting the contact surface to a measuring device, the method including:
Typically the method includes, in the measuring device:
Typically the method includes, in the measuring device:
Typically the method includes, in the measuring device: using an indication of the first and second signals to determine an impedance profile, the impedance profile representing variations in measured impedance along the segment.
In a third broad form the present invention provides a method for use in analysing impedance measurements performed on a subject, the method including, in a processing system:
Typically the method includes, in the processing system, displaying a representation of the impedance profile to thereby allow the impedance profile to be used in determining a presence, absence, degree or location of oedema in the subject.
Typically the method includes in the processing system:
Typically one of the second electrodes is a probe, and wherein the method includes determining an indication of at least some of the second electrical signals as the probe is moved along the segment.
Typically the method includes:
Typically the method includes, in the processing system:
Typically the impedance parameter values include at least one of:
Typically the method includes, in the processing system, determining the impedance parameter values at least in part using the equation:
Typically the representation includes at least one of:
Typically the method includes, in the processing system:
Typically the subject details include at least one of:
Typically one of the second electrodes is formed from a band electrode including:
Typically the method includes measuring the sequence of second electrical signals via the contact pads.
In a fourth broad form the present invention provides apparatus for use in analysing impedance measurements performed on a subject, the apparatus including a processing system for:
Typically the apparatus includes:
Typically at least one of the second electrodes is a probe, the probe including:
In a fifth broad form the present invention provides a probe for use in diagnosing oedema in a body segment of a subject, the probe including:
In a sixth broad form the present invention provides a method of diagnosing oedema in a body segment of a subject using a probe, the probe including a housing configured to be held by an operator in use, a contact surface for contacting the subject and a connector for connecting the contact surface to a measuring device, the method including:
In a seventh broad form the present invention provides a method for use in diagnosing oedema in a body segment of a subject, the method including, in a processing system:
In an eighth broad form the present invention provides apparatus for use in diagnosing oedema in a body segment of a subject, the apparatus including a processing system for:
It will be appreciated that the broad forms of the invention may be used individually or in combination, and may be used for diagnosis of the presence, absence or degree of a range of conditions and illnesses, including, but not limited to oedema, lymphoedema, body composition and the like.
An example of the present invention will now be described with reference to the accompanying drawings, in which: —
An example of apparatus suitable for performing an analysis of a subject's bioelectric impedance will now be described with reference to
As shown the apparatus includes a measuring device 100 including a processing system 102 coupled to a signal generator 111 and a sensor 112. In use the signal generator 111 and the sensor 112 are coupled to first electrodes 113, 114, and second electrodes 115, 116, provided on a subject S, via respective first leads 123, 124, and second leads 125, 126. In this example, the second electrode 116 is in the form of a probe electrode 116 that can be moved over the subject S, during the impedance measurement procedure, as will be described in more detail below.
The connection may be via a switching device 118, such as a multiplexer, allowing the leads 123, 124, 125, 126 to be selectively interconnected to signal generator 111 and the sensor 112, although this is not essential, and connections may be made directly between the signal generator 111 and the first electrodes 113, 114, and the sensor 112 and the second electrodes 115, 116.
An optional external interface 103 can be used to couple the measuring device 100, via wired, wireless or network connections, to one or more peripheral devices 104, such as an external database or computer system, barcode scanner, or the like. The processing system 102 will also typically include an I/O device 105, which may be of any suitable form such as a touch screen, a keypad and display, or the like.
In use, the processing system 102 is adapted to generate control signals, which causes the signal generator 111 to generate one or more alternating signals, such as voltage or current signals, which can be applied to a subject S, via the first electrodes 113, 114. The sensor 112 then determines the voltage across or current through the subject S, using the second electrodes 115, 116 and transfers appropriate signals to the processing system 102.
Accordingly, it will be appreciated that the processing system 102 may be any form of processing system which is suitable for generating appropriate control signals and interpreting an indication of the measured signals to thereby determine the subject's bioelectrical impedance, and optionally determine other information such as the presence, absence or degree of oedema, or the like.
The processing system 102 may therefore be a suitably programmed computer system, such as a laptop, desktop, PDA, smart phone or the like. Alternatively the processing system 102 may be formed from specialised hardware, such as an FPGA (field programmable gate array), or a combination of a programmed computer system and specialised hardware, or the like.
It will be appreciated that the processing system 102, the signal generator 111 and the sensor 112 may be integrated into a common housing and therefore form an integrated device. Alternatively, the processing system 102 may be connected to the signal generator 111 and the sensor 112 via wired or wireless connections. This allows the processing system 102 to be provided remotely to the signal generator 111 and the sensor 112. Thus, the signal generator 111 and the sensor 112 may be provided in a unit near, or worn by the subject S, whilst the processing system 102 is situated remotely to the subject S.
In use, the first electrodes 113, 114 are positioned on the subject to act as drive electrodes allowing one or more signals to be injected into the subject S. The location of the first electrodes 113, 114 will depend on the segment of the subject S under study, and can include for example, positioning electrodes on the wrist and ankles of a subject, to allow the impedance of limbs to be determined.
Once the second electrodes 115, 116 are also positioned as will be described below, one or more alternating signals are applied to the subject S, via the first leads 123, 124 and the first electrodes 113, 114. The nature of the alternating signal will vary depending on the nature of the measuring device and the subsequent analysis being performed.
For example, the system can use Bioimpedance Analysis (BIA) in which a single low frequency current is injected into the subject S, with the measured impedance being used directly in the assessment of oedema. In contrast Bioimpedance Spectroscopy (BIS) devices utilise frequencies ranging from very low frequencies (4 kHz) to higher frequencies (1000 kHz), and can use 256 or more different frequencies within this range, to allow multiple impedance measurements to be made within this range.
Thus, the measuring device 100 may either apply an alternating signal at a single frequency, at a plurality of frequencies simultaneously, or by apply a number of alternating signals at different frequencies sequentially, depending on the preferred implementation. The frequency or frequency range of the applied signals may also depend on the analysis being performed.
In one example, the applied signal is a frequency rich current from a current source clamped, or otherwise limited, so it does not exceed a maximum allowable subject auxiliary current. However, alternatively, voltage signals may be applied, with a current induced in the subject being measured. The signal can either be constant current, impulse function or a constant voltage signal where the current is measured so it does not exceed the maximum allowable subject auxiliary current.
A potential difference and/or current are measured between the second electrodes 115, 116. The acquired signal and the measured signal will be a superposition of potentials generated by the human body, such as the ECG, and potentials generated by the applied current.
Optionally the distance between the second electrodes may be measured and recorded. Similarly, other parameters relating to the subject may be recorded, such as the height, weight, age, sex, health status, any interventions and the date and time on which they occurred. Other information, such as current medication, may also be recorded.
To assist accurate measurement of the impedance, buffer circuits may be placed in connectors that are used to connect the second electrodes 115, 116 to the second leads 125, 126, as will be described in more detail below. This ensures accurate sensing of the voltage response of the subject S, and in particular helps eliminate contributions to the measured voltage due to the response of the second leads 125, 126, and reduce signal loss.
This in turn greatly reduces artefacts caused by movement of the second leads 125, 126, which is particularly important in some applications such as monitoring fluid levels during dialysis, in which sessions usually last for several hours and the subject will move around and change positions during this time, as well as being important during movement of the probe 116.
A further option is for the voltage to be measured differentially, meaning that the sensor used to measure the potential at each second electrode 115, 116 only needs to measure half of the potential as compared to a single ended system.
The measurement system may also have buffers placed in the connectors between the first electrodes 113, 114 and the first leads 123, 124. In one example, current can also be driven or sourced through the subject S differentially, which again greatly reduced the parasitic capacitances by halving the common-mode current. Another particular advantage of using a differential system is that the micro-electronics built into the connectors for each first electrode 113, 114 also removes parasitic capacitances that arise when the subject S, and hence the leads first 123, 124, move.
The acquired signal is demodulated to obtain the impedance of the system at the applied frequencies. One suitable method for demodulation of superposed frequencies is to use a Fast Fourier Transform (FFT) algorithm to transform the time domain data to the frequency domain. This is typically used when the applied current signal is a superposition of applied frequencies. Another technique not requiring windowing of the measured signal is a sliding window FFT.
In the event that the applied current signals are formed from a sweep of different frequencies, then it is more typical to use a processing technique such as multiplying the measured signal with a reference sine wave and cosine wave derived from the signal generator, or with measured sine and cosine waves, and integrating over a whole number of cycles. This process rejects any harmonic responses and significantly reduces random noise.
Other suitable digital and analog demodulation techniques will be known to persons skilled in the field.
In the case of BIS, impedance or admittance measurements are determined from the signals at each frequency by comparing the recorded voltage and current signal. The demodulation algorithm will produce an amplitude and phase signal at each frequency.
An example of the operation of the apparatus to generate an impedance profile will now be described with reference to
In this example, at step 200 the processing system 102 causes a current signal to be applied to the subject S, with the induced voltage across the subject S being measured at step 210, with signals representing the measured voltage and the applied current being returned to the processing system 102 for analysis.
This is typically performed for at least a segment of the subject S that is suspected of being susceptible to oedema, and may also be repeated for a separate healthy segment of the subject. Thus, for example, in the case of limb oedema, this is typically performed on the affected or “at risk” limb (hereinafter generally referred to as the “affected” limb), and may also be performed on the contra-lateral limb.
During this process, the probe electrode 116 will be moved along the length of the respective limb or limb segment, so that a number of measurements are taken over the entire limb or segment length. In one example, the measurements for a single limb or segment are taken over a time period such as 20 seconds, with measurements being made at a sampling rate of 1 ms, thereby providing a total of 20,000 readings for the limb, with the readings being distributed along the limb length. However, any suitable number of readings may be used, although it will be appreciated that the greater the number of measurements made, the higher the resolution of the impedance profile.
It will be appreciated that the application of the current and voltage signals may be controlled by a separate processing system to that used in performing the analysis to derive an impedance profile, and that the use of a single processing system is for the purpose of example only.
At step 220, measured voltage and current signals are used by the processing system 102 to determine a sequence of measured impedance values. In one example, this includes first impedance values representing the impedance profile of the unaffected limb or limb segment and second impedance values representing the impedance profile of the affected limb or limb segment, although this is not essential, and in one example, impedance measurements are only made for the affected limb or limb segment.
Once the impedance values are determined, these are used by the processing system 102, to derive an impedance profile. This may be achieved in any one of a number of ways depending on the preferred implementation.
In one example, the impedance profile is in the form of a graphical representation showing the variation in the measured impedance values along the length of the limb or limb segment. It will be appreciated that in one example, this involves measuring the position of the probe along the limb or limb segment, allowing the impedance value to be plotted against position. However, a number of variations on this are possible.
For example, it can be assumed that movement of the probe along the limb is performed at a relatively constant rate, in which case subsequently sampled measurements will be evenly spaced with respect to each other, on the resulting profile. Alternatively, the position can be derived from the impedance values themselves, as some portions of limbs, such as elbow or knee joints, have different impedance values to other portions of the limb, allowing the elbow or knee to be easily identified.
Additionally, or alternatively, the impedance profile can be based on parameters derived from measured impedance values, such as the impedance at zero, characteristic or infinite frequencies (R0, Zc, R∞).
The impedance profile can be based solely on the impedance measured for the “affected” limb or limb segment. However, alternatively, the impedance profile can also include an indication of the impedances measured for the unaffected limb or limb segment, thereby allowing comparison between the limbs or segments. It will be appreciated that in a healthy person, the impedance of both limbs or corresponding limb segments will be similar, and consequently, differences in the impedance profiles can be used to help identify the presence, absence, degree and/or location of any oedema.
Additionally, and/or alternatively, the impedance profile can include a baseline or other reference. The baseline is typically a previous impedance profile measured for the same limb, or limb segment of the subject S, whereas the reference is typically determined from a reference population of healthy individuals, as will be described in more detail below.
Once the impedance profile is determined, a representation of the impedance profile can be displayed to an operator at step 230, as will be described in more detail below.
A first example of a probe electrode for use in determining an impedance profile will now be described with reference to
In this example, the probe electrode 116 is formed from a housing 300 and a contact surface 301. The contact surface 301 is connected via an electrical connection 302 to a connector 303 which allows onward connection to the lead 126 shown in
In use the contact surface 301 is designed to be placed against the subject S, in contact with the subject's skin surface. To ensure accurate measurements are obtained, it is important to ensure good electrical contact between the contact surface 301 and the subject S, and accordingly, the contact surface 301 is typically formed from an electrically conductive material, such as stainless steel or the like, and may also be coated with an electro-conductive gel. In this example, the contact surface 301 is formed from a convex curved smooth surface, to assist with smooth transit across the subject's skin, as the probe 116 is moved along the length of the subject's limb, as well as to maximise contact between the contact surface and the subject's skin, thereby ensuring good electrical connection.
The housing is configured to allow an operator to hold the probe electrode whilst it is placed in contact with the subject. To ensure that this does not interfere with measurements, the housing is typically formed from an electrically insulating material such as a Perspex tube, or the like, although a wide variety of probe arrangements may be used.
Alternative probe arrangements are shown in
In the example of
A compression spring 313 is mounted in the housing a mounting (not shown), so that the spring is urged into contact with the roller ball 312 thereby ensuring good electrical contact between the roller ball 312 and the spring 313. The spring 313 is then connected via an electrical connection 314 to a connector 315 which in turn allows the probe to be connected to the lead 126. However, any suitable method of electrically connecting the roller ball 312 and the lead 126 may be used, such as brushes, or the like.
In addition to the provision of the roller ball 312, in this example the probe 116 also includes a motion sensing system 316 configured to sense motion of the roller ball 312 and return an indication of the motion via an electrical connection 317. This would typically involve transferring signals indicative of movement of the roller ball 312, via the lead 126, or an appropriate other connection, to the measuring device 100.
It will be appreciated by persons skilled in the art that the mechanism for sensing motion of the roller ball 312 may be any appropriate mechanism. Thus, for example, the sensor 316 can include optical sensors adapted to optically detect movement of the roller ball. Alternatively, one or more moving elements, such as wheels, can be placed in contact with the roller ball 312 such that movement of the moving element can be detected. It will be appreciated that the ability to detect motion of a roller ball 312 is technology known from computer mouse or trackball peripheral devices, or the like, and accordingly this will not be described in any further detail.
A third example probe arrangement is shown at
In this example, motion of the roller 322, for example to detect the distance moved by the probe 116 along a limb, can be detected in any one of a number of ways. In this example the roller 322 includes an aperture 325 extending therethrough. The aperture 325 is positioned so that once per revolution of the roller 322 the aperture 325 aligns with a radiation source 326, such as an LED (light emitting diode) and a corresponding detector 327. Accordingly, when the aperture 325 aligns with the radiation source 326 and detector 327, the detector 327 will detect radiation emitted by the source by allowing revolutions of the roller 322 to be counted. Again information regarding this can be transferred back to the measuring device utilising appropriate connections (not shown).
Operation of the probe 116 for use in determining the impedance profile of the subject's limb will now be described with reference to
In this example, at step 400 subject details are optionally determined and provided to the processing system 102. The subject details will typically include information such as limb dominance, details of any medical interventions, as well as information regarding the subject as the subject's age, weight, height, sex, ethnicity or the like. The subject details can be used in referencing previous measurements made for the subject, for selecting other baselines or reference normal population values, as well as for generating reports, or the like.
It will be appreciated that the subject details may be supplied to the processing system 102 via appropriate input means, such as the I/O device 105. Thus, each time a subject measurement is performed this information can be input into the measuring device 100.
However, more typically the information is input a single time and stored in an appropriate database, or the like, which may be connected as a peripheral device 104 via the external interface 103. The database can include subject data representing the subject details, together with information regarding previous impedance profiles, baseline measurements or impedance measurements recorded for the subject.
In this instance, when the operator is required to provide subject details, the operator can use the processing system 102 to select a search database option allowing the subject details to be retrieved. This is typically performed on the basis of a subject identifier, such as a unique number assigned to the individual upon admission to a medical institution, or may alternatively be performed on the basis of name or the like. Such a database is generally in the form of an HL7 compliant remote database, although any suitable database may be used.
In one example, the subject can be provided with a wristband or other device, which includes coded data indicative of the subject identifier. In this case, the measuring device 100 can be coupled to a peripheral device 104, such as a barcode or RFID (Radio Frequency Identification) reader allowing the subject identifier to be detected and provided to the processing system 102, which in turn allows the subject details to be retrieved from the database. The processing system 102 can then display an indication of the subject details retrieved from the database, allowing the operator to review these and confirm their accuracy before proceeding further.
As part of this process, an affected limb, or “at risk” limb, may be determined. This may be achieved in any one of a number of ways depending on the preferred implementation. Thus, for example, the affected limb can be indicated through the use of appropriate input means, such as the I/O device 105. Alternatively this information can be derived directly from the subject details, which may include an indication of the affected limb, or details of any medical interventions performed, which are in turn indicative of the affected limb.
At step 410 an operator positions the first electrodes 113, 114, and the second electrode 115 on the subject S, and connects these electrodes to the corresponding leads 123, 124, 125. The probe is also connected to the lead 126, if required.
The general arrangement is to provide electrodes on the hand at the base of the knuckles and between the bony protuberances of the wrist, as shown in
As a result of the electrode positioning, as the probe 116 is moved from the wrist towards the shoulder along the right arm 631, the value of the measured impedance will tend to drop, as the theory of equal potentials, indicates that the potential measured at the electrode 115 will be similar to the potential at the shoulder of the right arm 631.
It will be appreciated that using an electrode arrangement in this manner allows the electrode positions to provide reproducible results for impedance measurements. For example when current is injected between electrodes 113 and 114 in
This is advantageous as it greatly reduces the variations in measurements caused by poor placement of the electrodes by the operator. It also greatly reduces the number of electrodes required to perform segmental body measurements, as well as allowing the limited connections shown to be used to measure each of limbs separately.
However, it will be appreciated that any suitable electrode and lead arrangement may be used.
At step 420 the impedance probe is positioned at a start measuring point. The start measuring point may vary depending on the particular measurements being made. Thus for example, in determining an arm limb impedance profile the probe 116 is initially located at the ulnar styloid process. Once the impedance probe is appropriately positioned the monitoring process is activated at step 430, typically using an appropriate input command provided to the measuring device 100, for example, via the I/O device 105.
At step 440 the measuring device 100 applies a current signal to the subject via the first electrodes 113, 114 and concurrently measures the voltage induced across the subject using the second electrode 115 and the probe 116. It will be appreciated that in practice the signal generator 111, and the sensor 112, return signals to the processing system 102 indicative of the applied current and the measured voltage, allowing impedances to be determined.
At step 450 the measuring device 100 will optionally determine positional information from the probe. This may be achieved for example by having either the position sensor 316, or signals from the detector 327 transferred to the measuring device 100 and interpreted appropriately.
At step 460 the measuring device 100 determines if the process is complete and if not returns to step 440 to allow further measurements to be performed.
It will be appreciated by persons skilled in the art that whilst this is being performed the operator will slide or roll the probe 116 along the dorsal skin surface towards the acromion, allowing an impedance profile of the entire limb to be determined. In one example, the probe is held stationery at the beginning and end points for 5 seconds to allow stable end point readings to be determined. In this example, the measurement of an impedance profile typically takes approximately 20 seconds, although this of course depends on the preferred implementation.
Once the probe has been positioned at the acromion, the user can select an appropriate input command utilising the I/O device 105, allowing the measuring device 100 to determine the process is complete at step 460.
At step 470 the measuring device 100 will determine appropriate impedance parameter values, using these to generate impedance profiles at step 480. The manner in which this is achieved will depend on the nature of the impedance measurements performed.
In the case of BIS analysis, the impedance profile can be based on impedance parameter values, such as values of the impedance at zero, characteristic or infinite frequencies (R0, Zc, R∞). These values can be derived based on the impedance response of the subject, which at a first level can be modelled using equation (1), commonly referred to as the Cole model:
However, the above represents an idealised situation which does not take into account the fact that the cell membrane is an imperfect capacitor. Taking this into account leads to a modified model in which:
The value of the impedance parameters R0 and R∞ may be determined in any one of a number of manners such as by:
Alternatively, in the case of a BIA analysis, the impedance profile is based on the actual measured impedance values, or parameters derived therefrom using suitable techniques.
It will be appreciated that whilst BIS analysis generally leads to an improved range of information, time constraints may limit its usage. For example, some examples measuring devices can take up to 800 msec to complete a frequency scan, in which case the probe may have to be moved at a rate that is too slow for practical purposes to prevent the probe moving a significant distance along the limb during a frequency scan. This in turn effects the usability of the process. Accordingly, in many cases it is preferred to perform measurements at a single selected frequency in the range 5 kHz to 1 MHz at a sampling rate of 1 reading per msec. Using this arrangement, with a twenty second measurement protocol allows 20,000 readings to be established along the length of the arm, thereby allowing a suitable profile to be established. It will be appreciated however that a greater or lesser number of measurements made be used depending for example on the intended use of the measurements.
Examples of derived profiles will now be described. For the purpose of this example, the profiles are compared to limb volumes, which are currently a preferred mechanism for determining the presence, absence or degree of oedema.
In this regard, the volume of a cylindrical body can be determined from measurements of its length and impedance according to the relationship:
Since a short segment of a limb approximates a cylinder, if the impedance (Z) of the segment is measured then the volume of the limb segment can be estimated. The value of ρ may be obtained from regression of the impedance quotient, L2/Z, against limb volume, measured by a reference technique, such as DEXA (Dual Energy X-ray Absortiometry), MRI (Magnetic Resonance Imaging), perometry, or the like, in an independent group of subjects.
Example profiles are shown in
The impedance profile along the arm is the inverse of that seen for segment volume as expected from Equation (3), with a high correlation between the impedance and volume measurements being demonstrated. The position of the elbow, indicated by a change in volume and impedance is clearly discernable.
An example of the impedance profile of the arms of a subject with unilateral lymphoedema is shown in
It will be appreciated from this that when the measuring device 100 presents a measured impedance profile, it can include a reference or baseline measurement.
For example, a baseline is typically a previous impedance profile created from an impedance profile measurement that has significance in the treatment history of the subject. A common baseline in use might be an impedance profile measurement made on a patient suffering from lymphoedema before they start a course of management therapy. This measurement allows the practitioner to gauge accurately how much the patient has improved from the start of their treatment to the present measurement.
Baseline measurements may also be made pre-surgery and hence pre-lymphoedema, in which case the baseline impedance profile establishes the “normal” healthy impedance profile for the individual patient and can be used thereafter as a benchmark from which to monitor progress of the patient. Baselines can also be set using a single measurement or be created from the average of a number of measurements specified by the user.
The reference is typically formed from an impedance profile derived from a normal population (subject's not suffering from oedema) that is relevant to the subject under study. Thus, the normal population is typically selected taking into account factors such as medical interventions performed, ethnicity, sex, height, weight, limb dominance, the affected limb, or the like.
Therefore if the test subject has unilateral lymphoedema of the dominant arm and is female then the normalised data drawn from the normal population database will be calculated from the dominant arm measurements from female subjects that are present in the in the normal population database.
Accordingly, at this stage the processing system 102 typically accesses reference populations stored in the database, or the like. This may be performed automatically by the processing system 102 using the subject details. Thus for example, the database may include a look-up table that specifies the normal population that should be used given a particular set of subject details. Alternatively selection may be achieved in accordance with predetermined rules that can be derived using heuristic algorithms based on selections made by medically qualified operators during previous procedures. Alternatively, this may achieved under control of the operator, depending on the preferred implementation.
Operators may also have their own reference normal populations stored locally. However, in the event that suitable populations are not available, the processing system 102 can be used to retrieve a reference from a central repository, for example via an appropriate server arrangement. In one example, this may be performed on a pay per use basis.
The reference may also need to be scaled to take into account differing limb lengths of subjects measured, which can be determined from probe positional information if this is present.
In this instance, the measured impedance profile can be displayed concurrently with reference impedance profiles representing healthy limbs and representing subjects with oedema, to thereby highlight to the operator whether oedema is likely, and if so, where on the limb this has occurred, or is most severe.
Additionally, and/or alternatively, in the case of unilateral oedema, impedance profiles can be displayed for each limb, thereby allowing comparison between contra-lateral limbs. Thus, in this example, the impedance profile of a healthy limb acts as a baseline or reference against which the profile of the affected limb can be compared.
Display of the representation may be achieved in a number of ways, such as by presenting the representation on a suitable display, for example, using the I/O device 105, or alternatively by providing the representation in a hard copy form using an appropriate printer, although any suitable technique may be used.
An example of comparable cumulative volume measurements are shown in
Furthermore, as impedance analysis in the above described manner can be used to focus on the levels of extracellular fluid in the limb, this tends to provide a more accurate assessment of fluid distributions within the limb than volume measurements alone.
In particular, it can be seen that whilst the volumetric measurements in
In the example of
Accordingly, by correlating the impedance measurements with the distance traveled along the arm or other limb it is possible not only to detect that the limb is lymphoedematous but also the particular location of lymphoedema within the limb thereby rendering it easier to detect the presence, absence, degree or location of oedema using impedance profiling than volumetric measurements.
In the above described examples, impedance measurements along the limb or other body segment are achieved by moving a probe along the respective body segment. However, this is not essential, and as an alternative, a sequence of second electrodes may be placed along the subject's limb, to allow impedance measurements to be recorded at a number of different locations along the limb.
Whilst the electrodes can be standard electrodes, positioned as required by the operator, an alternative electrode configuration suitable for performing this will now be described with reference to
In this particular example the electrode is a band electrode 700, which includes a number of separate electrodes. In this example the electrode is formed from an elongate substrate 710 such as a plastic polymer coated with shielding material and an overlaying insulating material.
A number of electrically conductive tracks 720 are provided on the substrate extending from an end of the substrate 711 to respective conductive contact pads 730, spaced apart along the length of the substrate in sequence. This allows a connector to be electrically coupled to the tracks 720 and provide onward connectivity to leads, such as leads 126.
The tracks 720 and the contact pads 730 may be provided on the substrate 710 in any one of a number of manners, including for example, screen printing, inkjet printing, vapour deposition, or the like, and are typically formed from silver or another similar material. It will be appreciated however that the tracks and contact pads should be formed from similar materials to prevent signal drift. Furthermore, whilst circular contact pads 730 are shown, in practice these could be of any suitable shape.
Following the application of the contact pads 730 and the tracks 720, an insulating layer 740 is provided having a number of apertures 750 aligned with the electrode contact pads 730. The insulating layer is typically formed from a plastic polymer coated with shielding material and an overlaying insulating material.
To ensure adequate conduction between the contact pads 730, and the subject S, it is typical to apply a conductive gel 760 to the contact pads 730. It will be appreciated that in this instance gel can be provided into each of the apertures 750 as shown.
A removable covering 770 is then applied to the electrode, to maintain the electrode's sterility and/or moisture level in the gel. This may be in the form of a peel off strip or the like which when removed exposes the conductive gel 760, allowing the electrode to be attached to the subject S.
In order to ensure signal quality, it is typical for each of the tracks 720 to comprise a shield track 721, and a signal track 722, as shown. This allows a shield on the leads 126 to be connected to the shield track 721, with the lead core being coupled to the signal track 722. This allows shielding to be provided on the electrode, to help reduce interference between applied and measured signals.
In use, the band electrode may be attached to a limb segment of the subject, such as the subject's arm, as shown in
Once positioned, the band electrode can be connected to the switching device 118 via respective leads 126, with a separate lead being provided for each contact pad 730. In this instance, it will be appreciated that in this instance, the measuring device 100 can control the switching device 118 so that readings are taken from each of the contact pads 730 in turn. This allows readings along the entire body segment to be taken automatically by the measuring device 100, without requiring operator intervention, for example, by requiring the operator move the probe 116 along the subject's body segment.
In one example, the band electrode 700 provides sufficient electrodes to allow an impedance profile to be measured. In the above example, the band electrode includes six electrodes, however any suitable number may be used depending on the preferred implementation.
It will be appreciated that the use of a band electrode will generally not allow as great a resolution to be achieved as compared to the use of the probe described above, simply as readings can only be sampled at each of the contact pad locations, as opposed to continuous sampling along the length of the limb. However, the use of a band electrode does have some advantages.
Firstly, the contact pads are provided at definite positions on the band electrode, thereby allowing for easy and accurate determination of the position at which each impedance measurement is made.
Secondly, as the contact pads can be held in position for a longer period of time, this makes the band electrode particularly suited for performing BIS analysis over a large number of frequencies, in which readings at each position may take some time.
It will also be appreciated that as an alternative to using a band electrode, separate discrete electrodes may be positioned along the length of the limb.
Persons skilled in the art will appreciate that numerous variations and modifications will become apparent. All such variations and modifications which become apparent to persons skilled in the art, should be considered to fall within the spirit and scope that the invention broadly appearing before described.
Thus, for example, it will be appreciated that features from different examples above may be used interchangeably where appropriate. Furthermore, whilst the above examples have focussed on a subject such as a human, it will be appreciated that the measuring device and techniques described above can be used with any animal, including but not limited to, primates, livestock, performance animals, such race horses, or the like.
The above described processes can be used for determining the health status of an individual, including the body composition of the individual, or diagnosing the presence, absence or degree of a range of conditions and illnesses, including, but not limited to oedema, lymphoedema, or the like. It will be appreciated from this that whilst the above examples use the term impedance profile, this is for the purpose of example only and is not intended to be limiting. Accordingly, the impedance profile can be referred to more generally as an indicator when used in analysing impedance measurements with respect to more general health status information such as body composition, or the like.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2007902109 | Apr 2007 | AU | national |
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/AU2008/000539 | 4/17/2008 | WO | 00 | 2/4/2010 |
| Publishing Document | Publishing Date | Country | Kind |
|---|---|---|---|
| WO2008/128281 | 10/30/2008 | WO | A |
| Number | Name | Date | Kind |
|---|---|---|---|
| 3316896 | Thomasset | May 1967 | A |
| 3834374 | Ensanian | Sep 1974 | A |
| 3851641 | Toole | Dec 1974 | A |
| 3866600 | Rey | Feb 1975 | A |
| 3868165 | Gonser | Feb 1975 | A |
| 3871359 | Pacela | Mar 1975 | A |
| 4008712 | Nyboer | Feb 1977 | A |
| 4032889 | Nassimbene | Jun 1977 | A |
| 4034854 | Bevilacqua | Jul 1977 | A |
| 4082087 | Howson | Apr 1978 | A |
| 4121575 | Mills | Oct 1978 | A |
| 4144878 | Wheeler | Mar 1979 | A |
| RE30101 | Kubicek et al. | Sep 1979 | E |
| 4169463 | Piquard | Oct 1979 | A |
| 4184486 | Papa | Jan 1980 | A |
| 4233987 | Feingold | Nov 1980 | A |
| 4291708 | Frei et al. | Sep 1981 | A |
| 4314563 | Wheeler | Feb 1982 | A |
| 4365634 | Bare et al. | Dec 1982 | A |
| 4407288 | Langer et al. | Oct 1983 | A |
| 4407300 | Davis | Oct 1983 | A |
| 4450527 | Sramek | May 1984 | A |
| 4458694 | Sollish et al. | Jul 1984 | A |
| 4486835 | Bai et al. | Dec 1984 | A |
| 4537203 | Machida | Aug 1985 | A |
| 4539640 | Fry et al. | Sep 1985 | A |
| 4557271 | Stoller et al. | Dec 1985 | A |
| 4583549 | Manoli | Apr 1986 | A |
| 4602338 | Cook | Jul 1986 | A |
| 4617939 | Brown et al. | Oct 1986 | A |
| 4638807 | Ryder | Jan 1987 | A |
| 4646754 | Seale | Mar 1987 | A |
| 4686477 | Givens et al. | Aug 1987 | A |
| 4688580 | Ko et al. | Aug 1987 | A |
| 4763660 | Kroll et al. | Aug 1988 | A |
| 4793362 | Tedner | Dec 1988 | A |
| 4836214 | Sramek | Jun 1989 | A |
| 4890630 | Kroll et al. | Jan 1990 | A |
| 4895163 | Libke et al. | Jan 1990 | A |
| 4905705 | Kizakevich et al. | Mar 1990 | A |
| 4911175 | Shizgal | Mar 1990 | A |
| 4922911 | Wada | May 1990 | A |
| 4924875 | Chamoun | May 1990 | A |
| 4942880 | Slovak | Jul 1990 | A |
| 4951682 | Petre | Aug 1990 | A |
| 4981141 | Segalowitz | Jan 1991 | A |
| 5020541 | Marriott | Jun 1991 | A |
| 5025784 | Shao et al. | Jun 1991 | A |
| 5063937 | Ezenwa et al. | Nov 1991 | A |
| 5086781 | Bookspan | Feb 1992 | A |
| 5101828 | Welkowitz et al. | Apr 1992 | A |
| 5143079 | Frei et al. | Sep 1992 | A |
| 5184624 | Brown et al. | Feb 1993 | A |
| 5197479 | Hubelbank et al. | Mar 1993 | A |
| 5233982 | Kohl | Aug 1993 | A |
| 5246008 | Mueller | Sep 1993 | A |
| 5272624 | Gisser et al. | Dec 1993 | A |
| 5280429 | Withers | Jan 1994 | A |
| 5282840 | Hudrlik | Feb 1994 | A |
| 5284142 | Goble et al. | Feb 1994 | A |
| 5305192 | Bonte et al. | Apr 1994 | A |
| 5309917 | Wang et al. | May 1994 | A |
| 5311878 | Brown et al. | May 1994 | A |
| 5335667 | Cha et al. | Aug 1994 | A |
| 5351697 | Cheney et al. | Oct 1994 | A |
| 5353802 | Ollmar | Oct 1994 | A |
| 5372141 | Gallup et al. | Dec 1994 | A |
| 5381333 | Isaacson et al. | Jan 1995 | A |
| 5390110 | Cheney et al. | Feb 1995 | A |
| 5415164 | Faupel et al. | May 1995 | A |
| 5421344 | Popp | Jun 1995 | A |
| 5421345 | Lekholm et al. | Jun 1995 | A |
| 5423326 | Wang et al. | Jun 1995 | A |
| 5427113 | Hiroshi | Jun 1995 | A |
| 5449000 | Libke et al. | Sep 1995 | A |
| 5454377 | Dzwonczyk et al. | Oct 1995 | A |
| 5465730 | Zadehkoochak et al. | Nov 1995 | A |
| 5469859 | Tsoglin et al. | Nov 1995 | A |
| 5503157 | Sramek | Apr 1996 | A |
| 5505209 | Reining | Apr 1996 | A |
| 5526808 | Kaminsky | Jun 1996 | A |
| 5529072 | Sramek | Jun 1996 | A |
| 5544662 | Saulnier et al. | Aug 1996 | A |
| 5557242 | Wetherell | Sep 1996 | A |
| 5575929 | Yu et al. | Nov 1996 | A |
| 5588429 | Isaacson et al. | Dec 1996 | A |
| 5596283 | Mellitz et al. | Jan 1997 | A |
| 5611351 | Sato et al. | Mar 1997 | A |
| 5615689 | Kotler | Apr 1997 | A |
| 5626146 | Barber et al. | May 1997 | A |
| 5704355 | Bridges | Jan 1998 | A |
| 5718231 | Dewhurst et al. | Feb 1998 | A |
| 5730136 | Laufer | Mar 1998 | A |
| 5732710 | Rabinovich et al. | Mar 1998 | A |
| 5735284 | Tsoglin et al. | Apr 1998 | A |
| 5746214 | Brown et al. | May 1998 | A |
| 5759159 | Masreliez | Jun 1998 | A |
| 5788643 | Feldman | Aug 1998 | A |
| 5800350 | Coppleson et al. | Sep 1998 | A |
| 5807251 | Wang et al. | Sep 1998 | A |
| 5807270 | Williams | Sep 1998 | A |
| 5807272 | Kun et al. | Sep 1998 | A |
| 5810742 | Pearlman | Sep 1998 | A |
| 5876353 | Riff | Mar 1999 | A |
| 5919142 | Boone et al. | Jul 1999 | A |
| 5947910 | Zimmet | Sep 1999 | A |
| 5957861 | Combs et al. | Sep 1999 | A |
| 5964703 | Goodman et al. | Oct 1999 | A |
| 5994956 | Concorso | Nov 1999 | A |
| 6011992 | Hubbard et al. | Jan 2000 | A |
| 6015389 | Brown | Jan 2000 | A |
| 6018677 | Vidrine et al. | Jan 2000 | A |
| 6101413 | Olson | Aug 2000 | A |
| 6115626 | Whayne et al. | Sep 2000 | A |
| 6122544 | Organ | Sep 2000 | A |
| 6125297 | Scionolfi | Sep 2000 | A |
| 6129666 | DeLuca et al. | Oct 2000 | A |
| 6142949 | Ubby | Nov 2000 | A |
| 6151523 | Ferrer et al. | Nov 2000 | A |
| 6167300 | Cherepenin et al. | Dec 2000 | A |
| 6173003 | Whikehart et al. | Jan 2001 | B1 |
| 6208890 | Sarrazin et al. | Mar 2001 | B1 |
| 6228033 | Koobi et al. | May 2001 | B1 |
| 6233473 | Shepherd et al. | May 2001 | B1 |
| 6236886 | Cherepenin et al. | May 2001 | B1 |
| 6248083 | Smith et al. | Jun 2001 | B1 |
| 6253100 | Zhdanov | Jun 2001 | B1 |
| 6256532 | Cha | Jul 2001 | B1 |
| 6280396 | Clark | Aug 2001 | B1 |
| 6292690 | Petrucelli et al. | Sep 2001 | B1 |
| 6308097 | Pearlman | Oct 2001 | B1 |
| 6339722 | Heethaar et al. | Jan 2002 | B1 |
| 6354996 | Drinan et al. | Mar 2002 | B1 |
| 6376023 | Mori | Apr 2002 | B1 |
| 6432045 | Lemperle et al. | Aug 2002 | B2 |
| 6440084 | Gentempo | Aug 2002 | B1 |
| 6459930 | Takehara et al. | Oct 2002 | B1 |
| 6469732 | Chang et al. | Oct 2002 | B1 |
| 6472888 | Oguma et al. | Oct 2002 | B2 |
| 6496725 | Kamada et al. | Dec 2002 | B2 |
| 6497659 | Rafert | Dec 2002 | B1 |
| 6501984 | Church et al. | Dec 2002 | B1 |
| 6511438 | Bernstein et al. | Jan 2003 | B2 |
| 6512949 | Combs et al. | Jan 2003 | B1 |
| 6516218 | Cheng et al. | Feb 2003 | B1 |
| 6522910 | Gregory | Feb 2003 | B1 |
| 6532384 | Fukuda | Mar 2003 | B1 |
| 6551252 | Sackner et al. | Apr 2003 | B2 |
| 6556001 | Wiegand | Apr 2003 | B1 |
| 6560480 | Nachaliel et al. | May 2003 | B1 |
| 6561986 | Baura et al. | May 2003 | B2 |
| 6564079 | Cory et al. | May 2003 | B1 |
| 6569160 | Goldin et al. | May 2003 | B1 |
| 6584348 | Glukhovsky | Jun 2003 | B2 |
| 6602201 | Hepp et al. | Aug 2003 | B1 |
| 6615077 | Zhu et al. | Sep 2003 | B1 |
| 6618616 | Iijima et al. | Sep 2003 | B2 |
| 6623312 | Merry et al. | Sep 2003 | B2 |
| 6625487 | Herleikson | Sep 2003 | B2 |
| 6631292 | Liedtke | Oct 2003 | B1 |
| 6633777 | Szopinski | Oct 2003 | B2 |
| 6636754 | Baura et al. | Oct 2003 | B1 |
| 6643543 | Takehara et al. | Nov 2003 | B2 |
| 6658296 | Wong et al. | Dec 2003 | B1 |
| 6714813 | Ishigooka et al. | Mar 2004 | B2 |
| 6714814 | Yamada | Mar 2004 | B2 |
| 6723049 | Skladnev et al. | Apr 2004 | B2 |
| 6724200 | Fukuda | Apr 2004 | B2 |
| 6725089 | Komatsu et al. | Apr 2004 | B2 |
| 6753487 | Fujii et al. | Jun 2004 | B2 |
| 6760617 | Ward et al. | Jul 2004 | B2 |
| 6763263 | Gregory et al. | Jul 2004 | B2 |
| 6768921 | Organ et al. | Jul 2004 | B2 |
| 6788966 | Kenan et al. | Sep 2004 | B2 |
| 6790178 | Mault et al. | Sep 2004 | B1 |
| 6807443 | Keren | Oct 2004 | B2 |
| 6829501 | Nielsen et al. | Dec 2004 | B2 |
| 6829503 | Alt | Dec 2004 | B2 |
| 6840907 | Brydon | Jan 2005 | B1 |
| 6845264 | Skladnev et al. | Jan 2005 | B1 |
| 6870109 | Villarreal | Mar 2005 | B1 |
| 6875176 | Mourad | Apr 2005 | B2 |
| 6906533 | Yoshida | Jun 2005 | B1 |
| 6922586 | Davies | Jul 2005 | B2 |
| 6936012 | Wells | Aug 2005 | B2 |
| 6940286 | Wang et al. | Sep 2005 | B2 |
| RE38879 | Goodman et al. | Nov 2005 | E |
| 6980852 | Jersey-Willuhn et al. | Dec 2005 | B2 |
| 6980853 | Myoshi | Dec 2005 | B2 |
| 7065399 | Nakada | Jun 2006 | B2 |
| 7079889 | Nakada | Jul 2006 | B2 |
| 7096061 | Arad | Aug 2006 | B2 |
| 7113622 | Hamid | Sep 2006 | B2 |
| 7122012 | Bouton et al. | Oct 2006 | B2 |
| 7130680 | Kodama et al. | Oct 2006 | B2 |
| 7132611 | Gregaard | Nov 2006 | B2 |
| 7148701 | Park et al. | Dec 2006 | B2 |
| 7149573 | Wang | Dec 2006 | B2 |
| 7164522 | Kimura et al. | Jan 2007 | B2 |
| 7169107 | Jersey-Willuhn | Jan 2007 | B2 |
| 7184820 | Jersey-Willuhn et al. | Feb 2007 | B2 |
| 7184821 | Belalcazar et al. | Feb 2007 | B2 |
| 7186220 | Stahmann et al. | Mar 2007 | B2 |
| 7206630 | Tarler | Apr 2007 | B1 |
| 7212852 | Smith et al. | May 2007 | B2 |
| 7214107 | Powell et al. | May 2007 | B2 |
| 7233823 | Simond et al. | Jun 2007 | B2 |
| 7251524 | Hepp et al. | Jul 2007 | B1 |
| 7270580 | Bradley et al. | Sep 2007 | B2 |
| 7288943 | Matthiessen et al. | Oct 2007 | B2 |
| D557809 | Neverov | Dec 2007 | S |
| 7313435 | Nakada et al. | Dec 2007 | B2 |
| 7317161 | Fukuda | Jan 2008 | B2 |
| 7336992 | Shiokawa | Feb 2008 | B2 |
| 7353058 | Weng et al. | Apr 2008 | B2 |
| 7390303 | Dafni | Jun 2008 | B2 |
| 7440796 | Woo et al. | Oct 2008 | B2 |
| 7457660 | Smith et al. | Nov 2008 | B2 |
| 7477937 | Iijima et al. | Jan 2009 | B2 |
| 7496450 | Ortiz Aleman et al. | Feb 2009 | B2 |
| 7499745 | Littrup et al. | Mar 2009 | B2 |
| D603051 | Causevic | Oct 2009 | S |
| 7603158 | Nachman | Oct 2009 | B2 |
| 7603171 | Eror et al. | Oct 2009 | B2 |
| 7628761 | Gozani et al. | Dec 2009 | B2 |
| 7638341 | Rubinsky et al. | Dec 2009 | B2 |
| 7657292 | Baker, Jr. | Feb 2010 | B2 |
| 7660617 | Davis | Feb 2010 | B2 |
| 7706872 | Min et al. | Apr 2010 | B2 |
| 7711418 | Garber et al. | May 2010 | B2 |
| 7729756 | Mertelmeier et al. | Jun 2010 | B2 |
| 7733224 | Tran | Jun 2010 | B2 |
| 7860557 | Istvan | Dec 2010 | B2 |
| 7917202 | Chamney et al. | Mar 2011 | B2 |
| D641886 | Causevic | Jul 2011 | S |
| 7983853 | Wang et al. | Jul 2011 | B2 |
| D647208 | Rothman | Oct 2011 | S |
| 8055335 | Stylos | Nov 2011 | B2 |
| 8068906 | Chetham | Nov 2011 | B2 |
| 8172762 | Robertson | May 2012 | B2 |
| 8233617 | Johnson | Jul 2012 | B2 |
| 8233974 | Ward | Jul 2012 | B2 |
| D669186 | Gozani | Oct 2012 | S |
| D669187 | Gozani | Oct 2012 | S |
| 8285356 | Bly et al. | Oct 2012 | B2 |
| D674096 | Gaw | Jan 2013 | S |
| 8467865 | Gregory | Jun 2013 | B2 |
| 8744564 | Ward et al. | Jun 2014 | B2 |
| D718458 | Vosch | Nov 2014 | S |
| D719660 | Vosch | Dec 2014 | S |
| D728801 | Machon | May 2015 | S |
| 20010007056 | Linder et al. | Jul 2001 | A1 |
| 20010007924 | Kamada et al. | Jul 2001 | A1 |
| 20010020138 | Ishigooka et al. | Sep 2001 | A1 |
| 20010021799 | Ohlsson | Sep 2001 | A1 |
| 20010025139 | Pearlman | Sep 2001 | A1 |
| 20010051774 | Littrup | Dec 2001 | A1 |
| 20020022773 | Drinan | Feb 2002 | A1 |
| 20020022787 | Takehara et al. | Feb 2002 | A1 |
| 20020035334 | Meij | Mar 2002 | A1 |
| 20020072686 | Hoey et al. | Jun 2002 | A1 |
| 20020079910 | Fukuda | Jun 2002 | A1 |
| 20020093992 | Plangger | Jul 2002 | A1 |
| 20020106681 | Wexler | Aug 2002 | A1 |
| 20020109621 | Khair et al. | Aug 2002 | A1 |
| 20020111559 | Kurata | Aug 2002 | A1 |
| 20020123694 | Organ et al. | Sep 2002 | A1 |
| 20020138019 | Wexler | Sep 2002 | A1 |
| 20020161311 | Ward et al. | Oct 2002 | A1 |
| 20020163408 | Fujii et al. | Nov 2002 | A1 |
| 20020194419 | Rajput et al. | Dec 2002 | A1 |
| 20030004403 | Drinan | Jan 2003 | A1 |
| 20030009111 | Cory | Jan 2003 | A1 |
| 20030023184 | Pitts-Crick et al. | Jan 2003 | A1 |
| 20030028221 | Zhu et al. | Feb 2003 | A1 |
| 20030036713 | Bouton | Feb 2003 | A1 |
| 20030050570 | Kodama | Mar 2003 | A1 |
| 20030068914 | Merry et al. | Apr 2003 | A1 |
| 20030073916 | Yonce | Apr 2003 | A1 |
| 20030105410 | Pearlman | Jun 2003 | A1 |
| 20030105411 | Smallwood et al. | Jun 2003 | A1 |
| 20030120170 | Zhu et al. | Jun 2003 | A1 |
| 20030120182 | Wilkinson et al. | Jun 2003 | A1 |
| 20030173976 | Wiegand | Sep 2003 | A1 |
| 20030176808 | Masuo | Sep 2003 | A1 |
| 20030216661 | Davies | Nov 2003 | A1 |
| 20030216664 | Suarez | Nov 2003 | A1 |
| 20040015095 | Li et al. | Jan 2004 | A1 |
| 20040019292 | Drinan et al. | Jan 2004 | A1 |
| 20040059220 | Mourad | Mar 2004 | A1 |
| 20040073127 | Istvan et al. | Apr 2004 | A1 |
| 20040073130 | Bohm | Apr 2004 | A1 |
| 20040077944 | Steinberg et al. | Apr 2004 | A1 |
| 20040116819 | Alt | Jun 2004 | A1 |
| 20040127793 | Mendlein | Jul 2004 | A1 |
| 20040158167 | Smith et al. | Aug 2004 | A1 |
| 20040167423 | Pillon et al. | Aug 2004 | A1 |
| 20040171691 | Smith | Sep 2004 | A1 |
| 20040181163 | Acumen | Sep 2004 | A1 |
| 20040181164 | Smith et al. | Sep 2004 | A1 |
| 20040186392 | Ward et al. | Sep 2004 | A1 |
| 20040204658 | Dietz et al. | Oct 2004 | A1 |
| 20040210150 | Virtanen | Oct 2004 | A1 |
| 20040210158 | Organ et al. | Oct 2004 | A1 |
| 20040220632 | Burnes | Nov 2004 | A1 |
| 20040234113 | Miga | Nov 2004 | A1 |
| 20040236202 | Burton | Nov 2004 | A1 |
| 20040242987 | Liew | Dec 2004 | A1 |
| 20040242989 | Zhu | Dec 2004 | A1 |
| 20040243018 | Organ et al. | Dec 2004 | A1 |
| 20040252870 | Reeves et al. | Dec 2004 | A1 |
| 20040253652 | Davies | Dec 2004 | A1 |
| 20040260167 | Leonhardt | Dec 2004 | A1 |
| 20040267333 | Kronberg | Dec 2004 | A1 |
| 20040267344 | Stett et al. | Dec 2004 | A1 |
| 20050033281 | Bowman et al. | Feb 2005 | A1 |
| 20050039763 | Kraemer et al. | Feb 2005 | A1 |
| 20050070778 | Lackey et al. | Mar 2005 | A1 |
| 20050080460 | Wang | Apr 2005 | A1 |
| 20050085743 | Hacker et al. | Apr 2005 | A1 |
| 20050098343 | Fukuda | May 2005 | A1 |
| 20050101875 | Semler et al. | May 2005 | A1 |
| 20050107719 | Arad (Abbound) et al. | May 2005 | A1 |
| 20050113704 | Lawson et al. | May 2005 | A1 |
| 20050117196 | Kimura et al. | Jun 2005 | A1 |
| 20050124908 | Belalcazar et al. | Jun 2005 | A1 |
| 20050137480 | Alt et al. | Jun 2005 | A1 |
| 20050151545 | Park et al. | Jul 2005 | A1 |
| 20050177061 | Alanen et al. | Aug 2005 | A1 |
| 20050177062 | Skrabal et al. | Aug 2005 | A1 |
| 20050192488 | Bryenton et al. | Sep 2005 | A1 |
| 20050201598 | Harel | Sep 2005 | A1 |
| 20050203435 | Nakada | Sep 2005 | A1 |
| 20050203436 | Davies | Sep 2005 | A1 |
| 20050215918 | Frantz | Sep 2005 | A1 |
| 20050228309 | Fisher | Oct 2005 | A1 |
| 20050251062 | Choi | Nov 2005 | A1 |
| 20050261743 | Kroll | Nov 2005 | A1 |
| 20050270051 | Yee et al. | Dec 2005 | A1 |
| 20050283091 | Kink et al. | Dec 2005 | A1 |
| 20060004300 | Kennedy | Jan 2006 | A1 |
| 20060025701 | Kasahara | Feb 2006 | A1 |
| 20060041280 | Stahmann et al. | Feb 2006 | A1 |
| 20060041789 | Takehara | Mar 2006 | A1 |
| 20060052678 | Drinan | Mar 2006 | A1 |
| 20060064029 | Arad (Abboud) | Mar 2006 | A1 |
| 20060070623 | Wilkinson | Apr 2006 | A1 |
| 20060085048 | Cory et al. | Apr 2006 | A1 |
| 20060085049 | Cory et al. | Apr 2006 | A1 |
| 20060100532 | Bae | May 2006 | A1 |
| 20060110962 | Powell et al. | May 2006 | A1 |
| 20060111652 | McLeod | May 2006 | A1 |
| 20060116599 | Davis | Jun 2006 | A1 |
| 20060122523 | Bonmassar et al. | Jun 2006 | A1 |
| 20060122540 | Zhu et al. | Jun 2006 | A1 |
| 20060128193 | Bradley et al. | Jun 2006 | A1 |
| 20060135886 | Lippert et al. | Jun 2006 | A1 |
| 20060151815 | Graovac et al. | Jul 2006 | A1 |
| 20060184060 | Belalcazar | Aug 2006 | A1 |
| 20060197509 | Kanamori et al. | Sep 2006 | A1 |
| 20060200033 | Keren et al. | Sep 2006 | A1 |
| 20060224079 | Washchuk | Oct 2006 | A1 |
| 20060224080 | Oku et al. | Oct 2006 | A1 |
| 20060241513 | Hatlestad et al. | Oct 2006 | A1 |
| 20060241719 | Foster | Oct 2006 | A1 |
| 20060247543 | Cornish | Nov 2006 | A1 |
| 20060252670 | Fiorucci | Nov 2006 | A1 |
| 20060253016 | Baker | Nov 2006 | A1 |
| 20060258952 | Stahmann et al. | Nov 2006 | A1 |
| 20060264775 | Mills et al. | Nov 2006 | A1 |
| 20060264776 | Stahmann et al. | Nov 2006 | A1 |
| 20060270942 | Mcadams | Nov 2006 | A1 |
| 20060293609 | Stahmann et al. | Dec 2006 | A1 |
| 20070007975 | Hawkins | Jan 2007 | A1 |
| 20070010758 | Matthiessen et al. | Jan 2007 | A1 |
| 20070024310 | Tokuno et al. | Feb 2007 | A1 |
| 20070027402 | Levin et al. | Feb 2007 | A1 |
| 20070043303 | Osypka et al. | Feb 2007 | A1 |
| 20070049993 | Hofmann et al. | Mar 2007 | A1 |
| 20070087703 | Li et al. | Apr 2007 | A1 |
| 20070088227 | Nishimura | Apr 2007 | A1 |
| 20070106342 | Schumann | May 2007 | A1 |
| 20070118027 | Baker, Jr. | May 2007 | A1 |
| 20070156061 | Hess | Jul 2007 | A1 |
| 20070188219 | Segarra | Aug 2007 | A1 |
| 20070246046 | Teschner et al. | Oct 2007 | A1 |
| 20070270707 | Belalcazar | Nov 2007 | A1 |
| 20080001608 | Saulnier | Jan 2008 | A1 |
| 20080002873 | Reeves et al. | Jan 2008 | A1 |
| 20080004904 | Tran | Jan 2008 | A1 |
| 20080009757 | Tsoglin et al. | Jan 2008 | A1 |
| 20080009759 | Chetham | Jan 2008 | A1 |
| 20080027350 | Webler | Jan 2008 | A1 |
| 20080039700 | Drinan et al. | Feb 2008 | A1 |
| 20080048786 | Feldkamp | Feb 2008 | A1 |
| 20080051643 | Park et al. | Feb 2008 | A1 |
| 20080064981 | Gregory | Mar 2008 | A1 |
| 20080091114 | Min | Apr 2008 | A1 |
| 20080139957 | Hubbard et al. | Jun 2008 | A1 |
| 20080183098 | Denison | Jul 2008 | A1 |
| 20080200802 | Bhavaraju et al. | Aug 2008 | A1 |
| 20080205717 | Reeves et al. | Aug 2008 | A1 |
| 20080221411 | Hausmann | Sep 2008 | A1 |
| 20080247502 | Liao | Oct 2008 | A1 |
| 20080252304 | Woo et al. | Oct 2008 | A1 |
| 20080262375 | Brown | Oct 2008 | A1 |
| 20080270051 | Essex et al. | Oct 2008 | A1 |
| 20080287823 | Chetham | Nov 2008 | A1 |
| 20080306400 | Takehara | Dec 2008 | A1 |
| 20080319336 | Ward et al. | Dec 2008 | A1 |
| 20090018432 | He | Jan 2009 | A1 |
| 20090043222 | Chetham | Feb 2009 | A1 |
| 20090069708 | Hatlestad et al. | Mar 2009 | A1 |
| 20090076343 | James et al. | Mar 2009 | A1 |
| 20090076345 | Manicka et al. | Mar 2009 | A1 |
| 20090076350 | Bly et al. | Mar 2009 | A1 |
| 20090076410 | Libbus et al. | Mar 2009 | A1 |
| 20090082679 | Chetham | Mar 2009 | A1 |
| 20090084674 | Holzhacker et al. | Apr 2009 | A1 |
| 20090093730 | Grassl | Apr 2009 | A1 |
| 20090105555 | Dacso et al. | Apr 2009 | A1 |
| 20090143663 | Chetham | Jun 2009 | A1 |
| 20090177099 | Smith et al. | Jul 2009 | A1 |
| 20090209828 | Musin | Aug 2009 | A1 |
| 20090209872 | Pop | Aug 2009 | A1 |
| 20090216140 | Skrabal | Aug 2009 | A1 |
| 20090216148 | Freed | Aug 2009 | A1 |
| 20090234244 | Tanaka | Sep 2009 | A1 |
| 20090240163 | Webler | Sep 2009 | A1 |
| 20090264727 | Markowitz | Oct 2009 | A1 |
| 20090264745 | Markowitz | Oct 2009 | A1 |
| 20090264776 | Vardy | Oct 2009 | A1 |
| 20090264791 | Gregory | Oct 2009 | A1 |
| 20090275854 | Zielinski | Nov 2009 | A1 |
| 20090275855 | Zielinski | Nov 2009 | A1 |
| 20090287102 | Ward | Nov 2009 | A1 |
| 20090306535 | Davies | Dec 2009 | A1 |
| 20090318778 | Dacso et al. | Dec 2009 | A1 |
| 20090326408 | Moon | Dec 2009 | A1 |
| 20100007357 | Ammari et al. | Jan 2010 | A1 |
| 20100049077 | Sadleir | Feb 2010 | A1 |
| 20100056881 | Libbus et al. | Mar 2010 | A1 |
| 20100094160 | Eror et al. | Apr 2010 | A1 |
| 20100100003 | Chetham et al. | Apr 2010 | A1 |
| 20100100146 | Blomqvist | Apr 2010 | A1 |
| 20100106046 | Shochat | Apr 2010 | A1 |
| 20100109739 | Ironstone et al. | May 2010 | A1 |
| 20100145164 | Howell | Jun 2010 | A1 |
| 20100152605 | Ward | Jun 2010 | A1 |
| 20100168530 | Chetham et al. | Jul 2010 | A1 |
| 20100191141 | Aberg | Jul 2010 | A1 |
| 20100228143 | Teschner et al. | Sep 2010 | A1 |
| 20100234701 | Cho et al. | Sep 2010 | A1 |
| 20110025348 | Chetham | Feb 2011 | A1 |
| 20110034806 | Hartov et al. | Feb 2011 | A1 |
| 20110046505 | Cornish et al. | Feb 2011 | A1 |
| 20110054343 | Chetham | Mar 2011 | A1 |
| 20110054344 | Slizynski | Mar 2011 | A1 |
| 20110060239 | Gaw | Mar 2011 | A1 |
| 20110060241 | Martinsen et al. | Mar 2011 | A1 |
| 20110082383 | Cory et al. | Apr 2011 | A1 |
| 20110087129 | Chetham | Apr 2011 | A1 |
| 20110118619 | Burton et al. | May 2011 | A1 |
| 20110190655 | Moissl | Aug 2011 | A1 |
| 20110208084 | Seoane Martinez | Aug 2011 | A1 |
| 20110230784 | Slizynski | Sep 2011 | A2 |
| 20110245712 | Patterson | Oct 2011 | A1 |
| 20110251513 | Chetham | Oct 2011 | A1 |
| 20110274327 | Wehnes et al. | Nov 2011 | A1 |
| 20110282180 | Goldkuhl et al. | Nov 2011 | A1 |
| 20120071772 | Chetham | Mar 2012 | A1 |
| 20120165884 | Xi | Jun 2012 | A1 |
| 20120238896 | Garber et al. | Sep 2012 | A1 |
| 20130102873 | Hamaguchi | Apr 2013 | A1 |
| 20130165760 | Erlinger et al. | Jun 2013 | A1 |
| 20130165761 | De Limon et al. | Jun 2013 | A1 |
| 20140148721 | Erlinger | May 2014 | A1 |
| 20140371566 | Raymond et al. | Dec 2014 | A1 |
| Number | Date | Country |
|---|---|---|
| 2231038 | Nov 1999 | CA |
| 2613524 | Jan 2007 | CA |
| 2615845 | Jan 2007 | CA |
| 2638958 | Nov 2011 | CA |
| 1180513 | May 1998 | CN |
| 1236597 | Dec 1999 | CN |
| 1329875 | Jan 2002 | CN |
| 1366694 | Aug 2002 | CN |
| 101385203 | Mar 2009 | CN |
| 2912349 | Oct 1980 | DE |
| 249823 | Dec 1987 | EP |
| 0 339 471 | Nov 1989 | EP |
| 339471 | Nov 1989 | EP |
| 349043 | Jan 1990 | EP |
| 357309 | Mar 1990 | EP |
| 377887 | Jul 1990 | EP |
| 0 581 073 | Feb 1994 | EP |
| 581073 | Feb 1994 | EP |
| 662311 | Jul 1995 | EP |
| 0 865 763 | Sep 1998 | EP |
| 865763 | Sep 1998 | EP |
| 869360 | Oct 1998 | EP |
| 1 078 597 | Feb 2001 | EP |
| 1078597 | Feb 2001 | EP |
| 1 080 686 | Mar 2001 | EP |
| 1080686 | Mar 2001 | EP |
| 1 112 715 | Jul 2001 | EP |
| 1 118 308 | Jul 2001 | EP |
| 1112715 | Jul 2001 | EP |
| 1114610 | Jul 2001 | EP |
| 1146344 | Oct 2001 | EP |
| 1177760 | Feb 2002 | EP |
| 1219937 | Jul 2002 | EP |
| 1238630 | Sep 2002 | EP |
| 1 247 487 | Oct 2002 | EP |
| 1247487 | Oct 2002 | EP |
| 1283539 | Feb 2003 | EP |
| 1 329 190 | Jul 2003 | EP |
| 1329190 | Jul 2003 | EP |
| 1338246 | Aug 2003 | EP |
| 1452131 | Sep 2004 | EP |
| 1553871 | Jul 2005 | EP |
| 1629772 | Mar 2006 | EP |
| 1903938 | Apr 2008 | EP |
| 1909642 | Apr 2008 | EP |
| 1948017 | Jul 2008 | EP |
| 1 353 595 | Aug 2008 | EP |
| 2486386 | Jan 1982 | FR |
| 2748928 | Nov 1997 | FR |
| 1441622 | Jul 1976 | GB |
| 2131558 | Jun 1984 | GB |
| 2260416 | Apr 1993 | GB |
| 2426824 | Dec 2006 | GB |
| 20080030 | Jan 2010 | IT |
| 04-096733 | Mar 1992 | JP |
| 06-000168 | Jan 1994 | JP |
| H0674103 | Oct 1994 | JP |
| 8191808 | Jul 1996 | JP |
| 9051884 | Feb 1997 | JP |
| 9220209 | Aug 1997 | JP |
| 10000185 | Jan 1998 | JP |
| 10014898 | Jan 1998 | JP |
| 10014899 | Jan 1998 | JP |
| 10-080406 | Mar 1998 | JP |
| 10-225521 | Aug 1998 | JP |
| 11070090 | Mar 1999 | JP |
| 11-513592 | Nov 1999 | JP |
| 2000107138 | Apr 2000 | JP |
| 2000139867 | May 2000 | JP |
| 2001037735 | Feb 2001 | JP |
| 2001-070273 | Mar 2001 | JP |
| 2001061804 | Mar 2001 | JP |
| 2001-224568 | Aug 2001 | JP |
| 2001245866 | Sep 2001 | JP |
| 2001204707 | Oct 2001 | JP |
| 2001321352 | Nov 2001 | JP |
| 2002-350477 | Apr 2002 | JP |
| 2002-238870 | Aug 2002 | JP |
| 2002330938 | Nov 2002 | JP |
| 2003116803 | Apr 2003 | JP |
| 2003116805 | Apr 2003 | JP |
| 2003-230547 | Aug 2003 | JP |
| 2003-075487 | Dec 2003 | JP |
| 2004-61251 | Feb 2004 | JP |
| 2005099186 | Apr 2005 | JP |
| 2005-143786 | Jun 2005 | JP |
| 2008022995 | Feb 2008 | JP |
| 2112416 | Jun 1998 | RU |
| 2138193 | Sep 1999 | RU |
| 1132911 | Jan 1985 | SU |
| 1988007392 | Oct 1988 | WO |
| 9119454 | Dec 1991 | WO |
| 9318821 | Sep 1993 | WO |
| 199318821 | Sep 1993 | WO |
| 1993018821 | Sep 1993 | WO |
| 9401040 | Jan 1994 | WO |
| 9410922 | May 1994 | WO |
| 9601586 | Jan 1996 | WO |
| 199601586 | Jan 1996 | WO |
| 1996001586 | Jan 1996 | WO |
| 1996012439 | May 1996 | WO |
| 1996032652 | Oct 1996 | WO |
| 9711638 | Apr 1997 | WO |
| 1997011638 | Apr 1997 | WO |
| 1997014358 | Apr 1997 | WO |
| 9724156 | Jul 1997 | WO |
| 9806328 | Feb 1998 | WO |
| 199806328 | Feb 1998 | WO |
| 1998006328 | Feb 1998 | WO |
| 9812983 | Apr 1998 | WO |
| 1998023204 | Jun 1998 | WO |
| 9833553 | Aug 1998 | WO |
| 1998033553 | Aug 1998 | WO |
| 9851211 | Nov 1998 | WO |
| 1998051211 | Nov 1998 | WO |
| 9942034 | Aug 1999 | WO |
| 9948422 | Sep 1999 | WO |
| 0019886 | Apr 2000 | WO |
| 2000040955 | Jul 2000 | WO |
| 0078213 | Dec 2000 | WO |
| 2000079255 | Dec 2000 | WO |
| 0127605 | Apr 2001 | WO |
| 2001027605 | Apr 2001 | WO |
| 0152733 | Jul 2001 | WO |
| 2001050954 | Jul 2001 | WO |
| 2001067098 | Sep 2001 | WO |
| 0178831 | Oct 2001 | WO |
| 2001082323 | Nov 2001 | WO |
| 2002047548 | Jun 2002 | WO |
| 02053028 | Jul 2002 | WO |
| 2002-053028 | Jul 2002 | WO |
| 2002062214 | Aug 2002 | WO |
| 2002094096 | Nov 2002 | WO |
| 2002100267 | Dec 2002 | WO |
| 2004000115 | Dec 2003 | WO |
| 2004002301 | Jan 2004 | WO |
| 2004006660 | Jan 2004 | WO |
| 2004021880 | Mar 2004 | WO |
| 2004030535 | Apr 2004 | WO |
| 2004-032738 | Apr 2004 | WO |
| 2004026136 | Apr 2004 | WO |
| 2004030535 | Apr 2004 | WO |
| 2004032738 | Apr 2004 | WO |
| 2004-043252 | May 2004 | WO |
| 2004047635 | Jun 2004 | WO |
| 2004047636 | Jun 2004 | WO |
| 2004-047636 | Jun 2004 | WO |
| 2004047638 | Jun 2004 | WO |
| 2004048983 | Jun 2004 | WO |
| 2004047638 | Jun 2004 | WO |
| 2004049936 | Jun 2004 | WO |
| 2004084087 | Sep 2004 | WO |
| 2004083804 | Sep 2004 | WO |
| 2004084723 | Oct 2004 | WO |
| 2004084723 | Oct 2004 | WO |
| 2004084724 | Oct 2004 | WO |
| 2004-098389 | Nov 2004 | WO |
| 2004112563 | Dec 2004 | WO |
| 2005010640 | Feb 2005 | WO |
| 2005027717 | Mar 2005 | WO |
| 2005018432 | Mar 2005 | WO |
| 2005051163 | Jun 2005 | WO |
| 2005051194 | Jun 2005 | WO |
| 2005084539 | Sep 2005 | WO |
| 2005122881 | Dec 2005 | WO |
| 2005122881 | Dec 2005 | WO |
| 2005122888 | Dec 2005 | WO |
| 2006045051 | Apr 2006 | WO |
| 2006056074 | Jun 2006 | WO |
| 2006129108 | Dec 2006 | WO |
| 2006129116 | Dec 2006 | WO |
| 2007002991 | Jan 2007 | WO |
| 2007002992 | Jan 2007 | WO |
| 2007002993 | Jan 2007 | WO |
| 2007009183 | Jan 2007 | WO |
| WO 2007002991 | Jan 2007 | WO |
| 2007014417 | Feb 2007 | WO |
| 2007041783 | Apr 2007 | WO |
| 2007045006 | Apr 2007 | WO |
| 2007-056493 | May 2007 | WO |
| 2007070997 | Jun 2007 | WO |
| 2007089278 | Aug 2007 | WO |
| 2007105996 | Sep 2007 | WO |
| 2007128952 | Nov 2007 | WO |
| 2008011716 | Jan 2008 | WO |
| 2008064426 | Jun 2008 | WO |
| 2008119166 | Oct 2008 | WO |
| 2008119166 | Oct 2008 | WO |
| 2008138062 | Nov 2008 | WO |
| 2008149125 | Dec 2008 | WO |
| 2009018620 | Feb 2009 | WO |
| 2009027812 | Mar 2009 | WO |
| 2009036369 | Mar 2009 | WO |
| 2009059351 | May 2009 | WO |
| 2009068961 | Jun 2009 | WO |
| 2009100491 | Aug 2009 | WO |
| 2009100491 | Aug 2009 | WO |
| 2009112965 | Sep 2009 | WO |
| 2010003162 | Jan 2010 | WO |
| 2010029465 | Mar 2010 | WO |
| 2010051600 | May 2010 | WO |
| 2010060152 | Jun 2010 | WO |
| 2010069023 | Jun 2010 | WO |
| 2010076719 | Jul 2010 | WO |
| 2011018744 | Feb 2011 | WO |
| 2011022068 | Feb 2011 | WO |
| 2011050393 | May 2011 | WO |
| 2011075769 | Jun 2011 | WO |
| 2011113169 | Sep 2011 | WO |
| 2011136867 | Nov 2011 | WO |
| 2014176420 | Oct 2014 | WO |
| Entry |
|---|
| U.S. Appl. No. 12/302,914, filed Apr. 8, 2010, McGree. |
| U.S. Appl. No. 12/516,876, filed Jul. 1, 2010, Chetham. |
| U.S. Appl. No. 12/600,224, Chetham. |
| U.S. Appl. No. 12/672,893, filed Feb. 24, 2011, Cornish. |
| U.S. Appl. No. 10/029,015, filed Oct. 31, 2002, Ward, U.S. Pat. No. 6,760,617. |
| U.S. Appl. No. 10/767,825, filed Sep. 23, 2004, Ward. |
| Forslund et al., Evaluation of modified multicompartment models to calculate body composition in healthy males, Am. J. of Clin. Nutrition, 1996; 63:856-62. |
| Van Loan et al., Use of bioelectrical impedance spectroscopy (BIS) to measure fluid changes during pregnancy, J. Appl. Physiol., 1995; 78:1037-42. |
| De Lorenzo et al., Predicting body cell mass with bioimpedance by using theoretical methods: a technological review, J. Appl. Physiol., 1997; 82(5):1542-58. |
| Zhu et al., Segment-specific resistivity improves body fluid volume estimates from bioimpedance spectroscopy in hemodialysis patients, J. Appl. Physiol., Oct 27, 2005; 100:717-24. |
| Thomas et al., Bioimpedance Spectrometry in the Determination of Body Water Compartments: Accuracy and Clinical Significance, Applied Radiation and Isotopes, 1998; 49(5/6):447-455, Elsevier Science Ltd., Oxford, GB. |
| Cornish et al., Data analysis in multiple-frequency bioelectrical impedance analysis, Physiological Measurement, 1998; 19(2):275-283, Institute of Physics Publishing, Bristol, GB. |
| Ulgen et al., Electrical Parameters of Human Blood, Proc. of the 20th Annual Int'l Conference of the IEEE Engineering in Medicine and Biology Soc., 1998; 20(6):2983-2986, IEEE Piscataway, NJ. |
| Bracco et al., Bedside determination of fluid accumulation after cardiac surgery usign segmental bioelectrical impedance, 1998, Critical Care Medicine, vol. 26 No. 6, pp. 1065-1070. |
| Chiolero et al., Assessmetn of changes in body water by bioimpedance in acutely ill surgical patients, 1992, Intensive Care Medicine, vol. 18, pp. 322-326. |
| Chumlea et al., Bioelectrical impedance and body composition: present status and future directions, 1994 Nutrition Reviews, vol. 52, No. 4, pp. 123-131. |
| Cornish et al., Bioelectrical impedance for monitoring the efficacy of lymphoedema treatment programmes, 1996, Breast Cancer Research and Treatment, vol. 38, pp. 169-176. |
| Cornish et al., Quantification of lymphoedema using multi-frequency bioimpedance, 1998, Applied Radiation and Isotopes, vol. 49 No. 5/6, pp. 651-652. |
| De Luca et al., Use of low-frequency electrical impedance mesurements to determine phospholipid content in amniotic fluid, 1996, Physics in Medicine and Biology, vol. 41, pp. 1863-1869. |
| Derwent Abstract No. 97-474414, JP 09 220209 A (Sekisui Chem Ind Co Ltd) Aug. 26, 1997, see abstract. |
| Derwent Abstract No. 99-138541, JP 10 014898 A (Sekisui Chem Ind Co Ltd) Jan. 20, 1998, see abstract. |
| Derwent Abstract No. 99-138542, JP 10 014899 A (Sekisui Chem Ind Co Ltd) Feb. 20, 1998, see abstract. |
| Derwent Abstract No. 99-247542, JP 11 070090 A (Sekisui Chem Ind Co Ltd) Mar. 16, 1999, see abstract. |
| Duerenberg et al., Multi-frequency bioelectrical impedance: a comparison between the Cole-Cole modelling and Hanai equations with the classical impedance index approach, 1996, Annals of Human Biology, vol. 23, No. 1, pp. 31-40. |
| Kim et al., Bioelectrical impedance changes in regional extracellular fluid alterations, 1997, Electromyography and Clinical Neurophysiology, vol. 37, pp. 297-304. |
| Rigaud et al., Biolectrical impedance techniques in medicine, 1996, Critical Reviews in Biomedical Engineering, vol. 24 (4-6), pp. 257-351. |
| Steijaert et al., The use of multi-frequency impedance to determine total body water and extracellular water in obese and lean female individuals, 1997, International Journal of Obesity, vol. 21, pp. 930-934. |
| Ward et al., Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy, 1992, European Journal of Clinical Investigation, vol. 22, pp. 751-754. |
| Liu et al., Primary multi-frequency data analyze in electrical impedance scanning, Proceedings of the IEEE-EMBS 2005, 27th Annual Int'l Conference of the Engineering in Med. and Biology Soc., Shanghai, China, Sep. 4, 2005; 1504-1507. |
| Gudivaka et al., Single- and multifrequency models for bioelectrical impedance analysis of body water compartments, J. Appl. Physiol., 1999; 87(3):1087-96. |
| Gerth et al., A Computer-based Bioelectrical Impedance Spectroscopic System for Noninvasive Assessment of Compartmental Fluid Redistribution, Third Annual IEEE Symposium on Computer-Based Medical Systems Track 6: Clinical Assessment and Risk Evaluation/Session 13, 1990; 446-453. |
| Kanai et al., Electrical measurement of fluid distribution in legs and arms, Dept. of Electrical Engineering, Sophia University, 1987; Medical Progress through Technology 12: 159-170, Copyright Martinus Nijhoff Publishers, Boston, MA USA. |
| European Search Report for EP 07718972.8-1265 / 2020918 (Impedimed, Ltd.), dated Mar. 2, 2010, 4 pages. |
| Brown et al.; Relation between tissue structure and imposed electrical current flow in cervical neoplasis; The Lancet; Mar. 11, 2000; vol. 355, Issue 9207: pp. 892-895. |
| Ellis et al.; Human hydrometry: comparison of multifrequency biolectrical impedance with 2H2O and bromine dilution; Journal of Applied Physiology; 1998; 85(3): 1056-1062. |
| Jones et al.; Extracellular fluid volume determined by bioelectric impedance and serum albumin in CAPD patients; Nephrology Dialysis Transplantation; 1998; 13: 393-397. |
| Thomas B.J.; Future technologies; Asia Pacific Journal Clinical Nutrition; 1995; 4: 157-159. |
| Schneider, I.; Broadband signals for electrical impedance measurements for long bone fractures; Engineering in Medicine and Biology Society, 1996. Bridging Disciplines for Biomedicine. Proceedings of the 18th Annual International Conference of the IEEE; Oct. 31, 1996; 5: 1934-1935. |
| Woodrow et al.; Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis; Nephrology Dialysis Transplantation; 2000; 15: 862-866. |
| Boulier et al.; Fat-Free Mass Estimation by Two Electrode Impedance Method; American Journal of Clinical Nutrition; 1990; 52: 581-585. |
| McDougal et al.; Body Composition Measurements from Whole Body Resistance and Reactance; Surgical Forum; 1986; 36: 43-44. |
| Tedner, B.; Equipment using Impedance Technique for Automatic Recording of Fluid-Volume Changes during Hemodialysis; Medical & Biological Engineering & Computing; 1983; 285-290. |
| Lukaski et al.; Estimation of Body Fluid Volumes using Tetrapolar Bioelectrical Impedance Measurements; Aviation, Space, and Environmental Medicine; Dec. 1988; 1163-1169. |
| Lozano et al.; Two-frequency impedance plethysmograph: real and imaginary parts; Medical & Biological Engineering & Computing; Jan. 1990; 28(1): 38-42. |
| Chaudary et al.; Dielectric Properties of Normal & Malignant Human Breast Tissues at Radiowave and Microwave Frequencies; Indian Journal of Biochemistry & Biophysics; 1984; 21(1): 76-79. |
| Jossinet et al.; A study for breast imaging with a circular array of impedance electrodes; Proc. Vth Int. Conf. Bioelectrical Impedance, 1981, Tokyo, Japan; 1981; 83-86. |
| Jossinet et al.; Technical Implementation and Evaluation of a Bioelectrical Breast Scanner; Proc. 10.supth Int. Conf. IEEE Engng. Med. Biol., 1988, New Orleans, USA (Imped. Imaging II); 1988; 1: 289. |
| Man et al.; Results of Preclinical Tests for Breast Cancer Detection by Dielectric Measurements; XII Int. Conf. Med. Biol. Engng. 1979, Jerusalem, Israel. Springer Int., Berlin; 1980; Section 30.4. |
| Pethig et al.; The Passive Electrical Properties of Biological Systems: Their Significance in Physiology, Biophysics and Biotechnology; Physics in Medicine and Biology; 1987; 32: 933-970. |
| Piperno et al.; Breast Cancer Screening by Impedance Measurements; Frontiers of Medical & Biological Engineering; 1990; 2: 111-117. |
| Skidmore et al.; A Data Collection System for Gathering Electrical Impedance Measurements from the Human Breast; Clinical Physics Physiological Measurement; 1987; 8: 99-102. |
| Sollish et al.; Microprocessor-assisted Screening Techniques; Israel Journal of Medical Sciences; 1981; 17: 859-864. |
| Surowiec et al.; Dielectric Properties of Breast Carcinima and the Surrounding Tissues; IEEE Transactions on Biomedical Engineering; 1988; 35: 257-263. |
| Al-Hatib, F.; Patient Instrument Connection Errors in Bioelectrical Impedance Measurement; Physiological Measurement; May 2, 1998; 19(2): 285-296. |
| Gersing, E.; Impedance Spectroscopy on Living Tissue for Determination of the State of Organs; Bioelectrochemistry and Bioenergetics; 1998; 45: 145-149. |
| Mattar, J.A.; Application of Total Body Impedance to the Critically Ill Patient; New Horizons; 1996; 4(4): 493-503. |
| Ott et al.; Bioelectrical Impedance Analysis as a Predictor of Survival in Patients with Human Immunodeficiency Virus Infection; Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology; 1995; 9: 20-25. |
| Thomas et al.; Bioelectrical impedance analysis for measurement of body fluid volumes—A review; Journal of Clinical Engineering; 1992; 17(16): 505-510. |
| Ward et al.; There is a better way to measure Lymphedema; National Lymphedema Network Newsletter; Oct. 1995; 7 (4): 89-92. |
| Cornish et al.; Alteration of the extracellular and total body water volumes measured by multiple frequency bioelectrical impedance analysis; Nutrition Research; 1994; 14(5): 717-727. |
| Cornish et al.; Early diagnosis of lymphedema using multiple frequency bioimpedance; Lymphology; Mar. 2001; 34: 2-11. |
| Cornish et al.; Early diagnosis of lymphoedema in postsurgery breast cancer patients; Annals New York Academy of Sciences; May 2000; 571-575. |
| Brown et al.; Relation between tissue structure and imposed electrical current flow in cervical neoplasia; The Lancet; Mar. 11, 2000; 355 (9207): 892-895. |
| Iacobellis, G. et al.; Influence of excess fat on cardiac morphology and function: Study in Uncomplicated obesity; Obesity Research; Aug. 8, 2002; 10 (8): 767-773. |
| Bella, J. N. et al.; Relations of left ventricular mass to fat-free and adipose body mass: The Strong Heart Study; Circulation; Dec. 12, 1998; 98: 2538-2544. |
| Yoshinaga, M. et al.; Effect of total adipose weight and systemic hypertension on left ventricular mass in children; American Journal of Cardiology; Oct. 15, 1995; 76: 785-787. |
| Karason, K. et al.; Impact of blood pressure and insulin on the relationship between body fat and left ventricular structure; European Heart Journal; Jan. 1, 2003; 24: 1500-1505. |
| Abdullah M. Z.; Simulation of an inverse problem in electrical impedance tomography using resistance electrical network analogues; International Journal of Electrical Engineering Education; Oct. 1999; 36 (4): 311-324. |
| Dines et al.; Analysis of electrical conductivity imaging; Geophysics; Jul. 1981; 46 (7): 1025-1036. |
| Osterman et al.; Multifrequency electrical impedance imaging: preliminary in vivo experience in breast; Physiological Measurement; Feb. 2000; 21 (1): 99-109. |
| Ward et al.; Determination of Cole parameters in multiple frequency bioelectrical impedance analysis using only the measurement of impedances; Four-frequency fitting; Physiological Measurement; Sep. 2006; 27 (9): 839-850. |
| Bernstein; A new stroke volume equation for thoracic electrical bio impedance; Critical Care Medicine; 1986; vol. 14; pp. 904-909. |
| McAdams et al.; Tissue Impedance: a historical overview; Physiological Measurement, Institute of Physics Publishing, Bristol, GB; 16 (3A); pp. A1-A13; Aug. 1, 1995. |
| D'Entremont et al. “Impedance spectroscopy: an accurate method of differentiating between viable and ischaemic or infarcted muscle tissue” Med. Biol. Eng. Comput., 2002, 40: 380-87. |
| Zhu et al., “Dynamics of segmental extracellular volumes during changes in body position by bioimpedance analysis”; J. App. Physiol.; 1998, vol. 85, pp. 497-504. |
| McCullagh, W. A., et al., Bioelectrical impedance analysis measures the ejection fraction of the calf muscle pump, IFMBE Proceedings, 2007; vol. 17, p. 619. |
| U.S. Appl. No. 13/128,631, Essex et al. |
| U.S. Appl. No. 13/131,859, Gaw. |
| U.S. Appl. No. 12/090,078, filed Feb. 12, 2009, Chetham. |
| English Translation of CN1180513A published May 6, 1998. |
| English Translation of CN12336597 published Dec. 1, 1999. |
| English Translation of CN1329875A published Jan. 9, 2002. |
| English Translation of JP2001037735 published Feb. 13, 2001. |
| English Translation of JP2001061804 published Mar. 13, 2001. |
| English Translation of JP2002502274 published Jan. 22, 2002. |
| English Translation of JP2003502092 published Jan. 21, 2003. |
| English Translation of JP2006501892 published Jan. 19, 2006. |
| English Translation of JP2008502382 published Jan. 31, 2008. |
| English Translation of JP2010526604 published Aug. 5, 2010. |
| English Abstract for WO9948422 published Sep. 30, 1999. |
| English Abstract for WO0152733 published Jul. 26, 2001. |
| Bernstein, “A new stroke volume equation for thoracic electrical bioimpedance: Theory and rationale,” Critical Care Medicine,1986, pp. 904-909, vol. 14, No. 10. |
| Blad and Baldetorp, “Impedance spectra of tumour tissue in comparison with normal tissue; a possible clinical application for electrical impedance tomography,” Physiol. Meas., 1996, pp. A105-A115, vol. 17. |
| Lorenzo et al., “Determination of Intracelllar Water by Multifrequency Bioelectrical Impedance,” Ann. Nutr. Metab., 1995, pp. 177-184, vol. 39. |
| Edwards, “A Modified Pseudosection for Resistivity and IP,” Geophysics, Aug. 1977, pp. 1020-1036, vol. 42, No. 5. |
| Hansen, “On the influence of shape and variations in conductivity of the sample on four-point measurements,” Appl. Sci. Res., 1959, pp. 93-104, Section B, vol. 8. |
| Igel, “On the Small-Scale Variability of Electrical Soil Properties and its Influence on Geophysical Measurements,” Dissertation, University of Frankfurt, 2007, pp. 1-188. |
| Kyle et al., “Bioelectrical impedance analysis—part I: review of principals and methods,” Clinical Nutrition, 2004, pp. 1226-1243, vol. 23. |
| Loke and Barker, “Least-squares deconvolution of apparent resistivity pseudosections,” Geophysics, Nov.-Dec. 1995, pp. 1682-1690, vol. 60, No. 6. |
| McAdams and Jossinet, “Tissue impedance: a historical overview,” Physiol. Meas., 1995, pp. A1-A13, vol. 16. |
| McEwan and Holder, “Battery powered and wireless Electrical Impedance Tomography Spectroscopy Imaging using Bluetooth,” IFMBE Proceedings, 2007, pp. 798-801, vol. 16. |
| Roy and Apparao, “Depth of investigation in direct current methods,” Geophysics, Oct. 1971, pp. 943-959, vol. 36, No. 5. |
| Wilson et al., “Feasibility studies of electrical impedance spectroscopy for monitoring tissue response to photodynamic therapy,” SPIE, May 1998, pp. 69-80, vol. 3247. |
| Scharfetter, Effect of postural changes on the reliability of volume estimations from bioimpedance spectroscopy data, Kidney International Apr 1997, vol. 51, No. 4, pp. 1078-1087. |
| Ezenwa, Multiple frequency system for body composition measurement, Medical Informatics, Ethics, Cardiology, Instrumentation., Proceedings of the Annual International Conference of the Engineering in Medicine and Biology Society, Oct. 28, 1993, vol. 15, Part 02. |
| Yamakoshi, Non-Invasive Cardiovascular Hemodynamic Measurements, Sensors in Medicine and Health Care, 2004, pp. 107-160. |
| Ivorra, Bioimpedance dispersion width as a parameter to monitor living tissues, Physiological Measurement, 2005, vol. 26, S165-S173. |
| Golden, J, et al., Assessment of peripheral hemodynamics using impedance plethysmogrphy, Physical Therapy, 1986, vol. 66, No. 10, pp. 1544-1547. |
| Kim, Y et al., Impedance tomography and its application in deep venous thrombosis detection, IEEE Engineering in Medicine and Biology Magazine, IEEE Service Center, Pisacataway, NJ, US, Mar. 1, 1989, vol. 8, No. 1, pp. 46-49. |
| Fenech, M, et al., Extracellular and intracellular volume variations during postural change measured by segmental and wrist-ankle bioimpedance spectroscopy, IEEE transactions on biomedical engineering, IEEE Service Center, Piscataway, NJ, US, Jan. 1, 2004, vol. 51, No. 1, pp. 166-175. |
| Stanton, AWB, et al., Non-invasive assessment of the lymphedematous limb, Lymphology, The International Society of Lymphology, 2000, vol. 33, No. 3 pp. 122-135. |
| Cornish, Bruce H, et al., A new technique for the quantification of peripheral edema with application in both unilateral and bilateral cases, Angiology, 2002, vol. 53, No. 1, pp. 41-47. |
| Seo, A, et al., Measuring lower leg swelling: Optiumum frequency for impedance method, Medical & Biological Engineering & Computing, Mar. 1, 2001, vol. 39, pp. 185-189. |
| Smith, JG, et al., A pilot study for tissue characterization using bio-impedance mapping, 13th International Conference on Electrical Bio-impedance and the 8th Conference on Electrical Impedance Tomography 2007, pp. 146-149. |
| Nawarycz, T, et al., Triple-frequency electroimpedance method for evaluation of body water compartments, Medical & Biological Engineering & Computing, Jan. 1, 1996, vol. 34, No. Supp. 01, Pt 02, pp. 181-182. |
| Noshiro, M, et al., Electrical impedance in the lower limbs of patients with duchenne muscular dystrophy: A preliminary study, Medical & Biological Engineering & Computing, Mar. 1, 1993, vol. 31, No. 2, pp. 97-102. |
| Seoane, F, et al., Current source for wideband electrical bioimpedance spectroscopy based on a single operational amplifier, World Congress on Medical Physics and Biomedical Engineering 2006, Jan. 1, 2007, vol. 14 pp. 707-710. |
| Cornish, BH, et al., Optimizing electrode sites for segmental bioimpedance measurements, Physiological Measurement, Institute of Physics, Aug. 1, 1999, vol. 20, No. 3, pp. 241-250. |
| Number | Date | Country | |
|---|---|---|---|
| 20100152605 A1 | Jun 2010 | US |
