Needle length determination and calibration for insertion guidance system

Description

BRIEF SUMMARY

Briefly summarized, embodiments of the present invention are directed to an integrated catheter placement system configured for accurately placing a catheter within the vasculature of a patient. The integrated system employs at least two modalities for improving catheter placement accuracy: 1) ultrasound-assisted guidance for introducing the catheter into the patient's vasculature; and 2) a tip location system (“TLS”), or magnetically-based (e.g., via permanent magnet(s) or electromagnet(s)) tracking of the catheter tip during its advancement through the vasculature to detect and facilitate correction of any tip malposition during such advancement.

In one embodiment, the integrated system comprises a system console including a control processor, a tip location sensor for temporary placement on a portion of a body of the patient, and an ultrasound probe. The tip location sensor senses a magnetic field of a stylet disposed in a lumen of the catheter when the catheter is disposed in the vasculature. The ultrasound probe ultrasonically images a portion of the vasculature prior to introduction of the catheter into the vasculature. In addition, the ultrasound probe includes user input controls for controlling use of the ultrasound probe in an ultrasound mode and use of the tip location sensor in a tip location mode.

In another embodiment, a third modality, i.e., ECG signal-based catheter tip guidance, is included in the system to enable guidance of the catheter tip to a desired position with respect to a node of the patient's heart from which the ECG signals originate.

In addition, embodiments of the present disclosure are also directed to a guidance system for assisting with the insertion of a needle or other medical component into the body of a patient. The guidance system utilizes ultrasound imaging or other suitable imaging technology.

In one embodiment, the guidance system comprises an imaging device including a probe for producing an image of an internal body portion target, such as a subcutaneous vessel, for instance. One or more sensors are included with the probe. The sensors sense a detectable characteristic related to the needle, such as a magnetic field of a magnet included with the needle.

The system includes a processor that uses data relating to the detectable characteristic sensed by the sensors to determine a position and/or orientation of the needle in three spatial dimensions. The system includes a display for depicting the position and/or orientation of the needle together with the image of the target.

In addition to magnet-based detection, other modalities for detecting the medical component are disclosed, including optically-based and electromagnetic signal-based systems. In yet another embodiment, systems and methods for determining the length of a needle or other medical component to be guided by the guidance system are disclosed. Yet further embodiments disclose techniques for calibrating the guidance system in the presence of needles of other medical components including magnetic elements.

These and other features of embodiments of the present invention will become more fully apparent from the following description and appended claims, or may be learned by the practice of embodiments of the invention as set forth hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

A more particular description of the present disclosure will be rendered by reference to specific embodiments thereof that are illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. Example embodiments of the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:

FIG. 1 is a block diagram depicting various elements of an integrated system for intravascular placement of a catheter, according to one example embodiment of the present invention;

FIG. 2 is a simplified view of a patient and a catheter being inserted therein with assistance of the integrated system of FIG. 1;

FIGS. 3A and 3B are views of a probe of the integrated system of FIG. 1;

FIG. 4 is a screenshot of an ultrasound image as depicted on a display of the integrated system of FIG. 1;

FIG. 5 is a perspective view of a stylet employed in connection with the system of FIG. 1 in placing a catheter within a patient vasculature;

FIG. 6 is an icon as depicted on a display of the integrated system of FIG. 1, indicating a position of a distal end of the stylet of FIG. 5 during catheter tip placement procedures;

FIGS. 7A-7E depict various example icons that can be depicted on the display of the integrated system of FIG. 1 during catheter tip placement procedures;

FIGS. 8A-8C are screenshots of images depicted on a display of the integrated system of FIG. 1 during catheter tip placement procedures;

FIG. 9 is a block diagram depicting various elements of an integrated system for intravascular placement of a catheter, according to another example embodiment of the present invention;

FIG. 10 is a simplified view of a patient and a catheter being inserted therein with assistance of the integrated system of FIG. 9;

FIG. 11 is a perspective view of a stylet employed in connection with the integrated system of FIG. 9 in placing a catheter within a patient vasculature;

FIGS. 12A-12E are various views of portions of the stylet of FIG. 11;

FIGS. 13A-13D are various views of a fin connector assembly for use with the integrated system of FIG. 9;

FIGS. 14A-14C are views showing the connection of a stylet tether and fin connector to a sensor of the integrated system of FIG. 9;

FIG. 15 is a cross sectional view of the connection of the stylet tether, fin connector, and sensor shown in FIG. 14C;

FIG. 16 is simplified view of an ECG trace of a patient;

FIG. 17 is a screenshot of an image depicted on a display of the integrated system of FIG. 9 during catheter tip placement procedures;

FIG. 18 is a block diagram depicting various elements of an ultrasound-based guidance system for needles and other medical components, according to one embodiment;

FIG. 19 is a simplified view of a patient and a catheter being inserted therein, showing one possible environment in which the guidance system of FIG. 18 can be practiced;

FIG. 20 is a top view of the ultrasound probe of the guidance system of FIG. 18;

FIG. 21A is a side view of a needle for use with the guidance system of FIG. 18, according to one embodiment;

FIG. 21B is an end view of the needle of FIG. 21A;

FIGS. 22A and 22B are simplified views of the ultrasound probe of the guidance system being used to guide a needle toward a vessel within the body of a patient;

FIGS. 23A and 23B show possible screenshots for depiction on the display of the guidance system, showing the position and orientation of a needle according to one embodiment;

FIG. 24 shows various stages of a method for guiding a needle to a desired target within the body of a patient according to one embodiment;

FIG. 25 shows a sensor array for attachment to an ultrasound probe and associated display, according to one embodiment;

FIG. 26 is a simplified view of a needle holder gun for use with the guidance system of FIG. 18, according to one embodiment;

FIG. 27 is a simplified view of an ultrasound probe and needle including elements of an optical guidance system, according to one embodiment;

FIG. 28 shows operation of the ultrasound probe and needle of FIG. 27, according to one embodiment;

FIG. 29 is a simplified view of an ultrasound probe and needle including elements of an electromagnetic signal-based guidance system, according to one embodiment;

FIG. 30 is a simplified view of an ultrasound probe and needle including elements of an electromagnetic signal-based guidance system, according to another embodiment;

FIGS. 31A-31D are various views of a needle and associated components for use with a needle guidance system, according to one embodiment;

FIG. 32 is a side view of a needle for use with a needle guidance system, according to one embodiment;

FIGS. 33A and 33B are various views of a needle for use with a needle guidance system, according to one embodiment;

FIGS. 34A-34G are views of variously shaped magnetic elements for use with a needle guidance system according to one embodiment;

FIG. 35 is a simplified side view of the ultrasound probe of the guidance system of FIG. 18, including a component length determination system according to one embodiment;

FIGS. 36A-36C shows various views of a needle guide assembly including a fixture for holding a needle as part of the component length determination system according to one embodiment; and

FIG. 37 is a perspective view of the needle guide/fixture assembly as attached to the probe of FIG. 35.

DETAILED DESCRIPTION OF SELECTED EMBODIMENTS

Reference will now be made to figures wherein like structures will be provided with like reference designations. It is understood that the drawings are diagrammatic and schematic representations of exemplary embodiments of the present invention, and are neither limiting nor necessarily drawn to scale.

For clarity it is to be understood that the word “proximal” refers to a direction relatively closer to a clinician using the device to be described herein, while the word “distal” refers to a direction relatively further from the clinician. For example, the end of a needle placed within the body of a patient is considered a distal end of the needle, while the needle end remaining outside the body is a proximal end of the needle. Also, the words “including,” “has,” and “having,” as used herein, including the claims, shall have the same meaning as the word “comprising.”

I. Assisted Catheter Placement

Embodiments of the present invention are generally directed to a catheter placement system configured for accurately placing a catheter within the vasculature of a patient. In one embodiment, the catheter placement system employs at least two modalities for improving catheter placement accuracy: 1) ultrasound-assisted guidance for introducing the catheter into the patient's vasculature; and 2) a tip location/navigation system (“TLS”), or magnetically-based tracking of the catheter tip during its advancement through the tortuous vasculature path to detect and facilitate correction of any tip malposition during such advancement. The ultrasound guidance and tip location features of the present system according to one embodiment are integrated into a single device for use by a clinician placing the catheter. Integration of these two modalities into a single device simplifies the catheter placement process and results in relatively faster catheter placements. For instance, the integrated catheter placement system enables ultrasound and TLS activities to be viewed from a single display of the integrated system. Also, controls located on an ultrasound probe of the integrated device, which probe is maintained within the sterile field of the patient during catheter placement, can be used to control functionality of the system, thus precluding the need for a clinician to reach out of the sterile field in order to control the system.

In another embodiment, a third modality, i.e., ECG signal-based catheter tip guidance, is included in the integrated system to enable guidance of the catheter tip to a desired position with respect to a node of the patient's heart from which the ECG signals originate. Such ECG-based positional assistance is also referred to herein as “tip confirmation.”

Combination of the three modalities above according to one embodiment enables the catheter placement system to facilitate catheter placement within the patient's vasculature with a relatively high level of accuracy, i.e., placement of the distal tip of the catheter in a predetermined and desired position. Moreover, because of the ECG-based guidance of the catheter tip, correct tip placement may be confirmed without the need for a confirmatory X-ray. This, in turn, reduces the patient's exposure to potentially harmful x-rays, the cost and time involved in transporting the patient to and from the x-ray department, costly and inconvenient catheter repositioning procedures, etc.

Reference is first made to FIGS. 1 and 2 which depict various components of a catheter placement system (“system”), generally designated at 10, configured in accordance with one example embodiment of the present invention. As shown, the system 10 generally includes a console 20, display 30, probe 40, and sensor 50, each of which is described in further detail below.

FIG. 2 shows the general relation of these components to a patient 70 during a procedure to place a catheter 72 into the patient vasculature through a skin insertion site 73. FIG. 2 shows that the catheter 72 generally includes a proximal portion 74 that remains exterior to the patient and a distal portion 76 that resides within the patient vasculature after placement is complete. The system 10 is employed to ultimately position a distal tip 76A of the catheter 72 in a desired position within the patient vasculature. In one embodiment, the desired position for the catheter distal tip 76A is proximate the patient's heart, such as in the lower one-third (⅓^rd) portion of the Superior Vena Cava (“SVC”). Of course, the system 10 can be employed to place the catheter distal tip in other locations. The catheter proximal portion 74 further includes a hub 74A that provides fluid communication between the one or more lumens of the catheter 72 and one or more extension legs 74B extending proximally from the hub.

An example implementation of the console 20 is shown in FIG. 8C, though it is appreciated that the console can take one of a variety of forms. A processor 22, including non-volatile memory such as EEPROM for instance, is included in the console 20 for controlling system function during operation of the system 10, thus acting as a control processor. A digital controller/analog interface 24 is also included with the console 20 and is in communication with both the processor 22 and other system components to govern interfacing between the probe 40, sensor 50, and other system components.

The system 10 further includes ports 52 for connection with the sensor 50 and optional components 54 including a printer, storage media, keyboard, etc. The ports in one embodiment are USB ports, though other port types or a combination of port types can be used for this and the other interfaces connections described herein. A power connection 56 is included with the console 20 to enable operable connection to an external power supply 58. An internal battery 60 can also be employed, either with or exclusive of an external power supply. Power management circuitry 59 is included with the digital controller/analog interface 24 of the console to regulate power use and distribution.

The display 30 in the present embodiment is integrated into the console 20 and is used to display information to the clinician during the catheter placement procedure. In another embodiment, the display may be separate from the console. As will be seen, the content depicted by the display 30 changes according to which mode the catheter placement system is in: US, TLS, or in other embodiments, ECG tip confirmation. In one embodiment, a console button interface 32 (see FIGS. 1, 8C) and buttons included on the probe 40 can be used to immediately call up a desired mode to the display 30 by the clinician to assist in the placement procedure. In one embodiment, information from multiple modes, such as TLS and ECG, may be displayed simultaneously, such as in FIG. 17. Thus, the single display 30 of the system console 20 can be employed for ultrasound guidance in accessing a patient's vasculature, TLS guidance during catheter advancement through the vasculature, and (as in later embodiments) ECG-based confirmation of catheter distal tip placement with respect to a node of the patient's heart. In one embodiment, the display 30 is an LCD device.

FIGS. 3A and 3B depict features of the probe 40 according to one embodiment. The probe 40 is employed in connection with the first modality mentioned above, i.e., ultrasound (“US”)-based visualization of a vessel, such as a vein, in preparation for insertion of the catheter 72 into the vasculature. Such visualization gives real time ultrasound guidance for introducing the catheter into the vasculature of the patient and assists in reducing complications typically associated with such introduction, including inadvertent arterial puncture, hematoma, pneumothorax, etc.

The handheld probe 40 includes a head 80 that houses a piezoelectric array for producing ultrasonic pulses and for receiving echoes thereof after reflection by the patient's body when the head is placed against the patient's skin proximate the prospective insertion site 73 (FIG. 2). The probe 40 further includes a plurality of control buttons 84, which can be included on a button pad 82. In the present embodiment, the modality of the system 10 can be controlled by the control buttons 84, thus eliminating the need for the clinician to reach out of the sterile field, which is established about the patient insertion site prior to catheter placement, to change modes via use of the console button interface 32.

As such, in one embodiment a clinician employs the first (US) modality to determine a suitable insertion site and establish vascular access, such as with a needle or introducer, then with the catheter. The clinician can then seamlessly switch, via button pushes on the probe button pad 82, to the second (TLS) modality without having to reach out of the sterile field. The TLS mode can then be used to assist in advancement of the catheter 72 through the vasculature toward an intended destination.

FIG. 1 shows that the probe 40 further includes button and memory controller 42 for governing button and probe operation. The button and memory controller 42 can include non-volatile memory, such as EEPROM, in one embodiment. The button and memory controller 42 is in operable communication with a probe interface 44 of the console 20, which includes a piezo input/output component 44A for interfacing with the probe piezoelectric array and a button and memory input/output component 44B for interfacing with the button and memory controller 42.

FIG. 4 shows an example screenshot 88 as depicted on the display 30 while the system 10 is in its first ultrasound modality. An image 90 of a subcutaneous region of the patient 70 is shown, depicting a cross section of a vein 92. The image 90 is produced by operation of the piezoelectric array of the probe 40. also included on the display screenshot 88 is a depth scale indicator 94, providing information regarding the depth of the image 90 below the patient's skin, a lumen size scale 96 that provides information as to the size of the vein 92 relative to standard catheter lumen sizes, and other indicia 98 that provide information regarding status of the system 10 or possible actions to be taken, e.g., freeze frame, image templates, data save, image print, power status, image brightness, etc.

Note that while a vein is depicted in the image 90, other body lumens or portions can be imaged in other embodiments. Note that the US mode shown in FIG. 4 can be simultaneously depicted on the display 30 with other modes, such as the TLS mode, if desired. In addition to the visual display 30, aural information, such as beeps, tones, etc., can also be employed by the system 10 to assist the clinician during catheter placement. Moreover, the buttons included on the probe 40 and the console button interface 32 can be configured in a variety of ways, including the use of user input controls in addition to buttons, such as slide switches, toggle switches, electronic or touch-sensitive pads, etc. Additionally, both US and TLS activities can occur simultaneously or exclusively during use of the system 10.

As just described, the handheld ultrasound probe 40 is employed as part of the integrated catheter placement system 10 to enable US visualization of the peripheral vasculature of a patient in preparation for transcutaneous introduction of the catheter. In the present example embodiment, however, the probe is also employed to control functionality of the TLS portion, or second modality, of the system 10 when navigating the catheter toward its desired destination within the vasculature as described below. Again, as the probe 40 is used within the sterile field of the patient, this feature enables TLS functionality to be controlled entirely from within the sterile field. Thus the probe 40 is a dual-purpose device, enabling convenient control of both US and TLS functionality of the system 10 from the sterile field. In one embodiment, the probe can also be employed to control some or all ECG-related functionality, or third modality, of the catheter placement system 10, as described further below.

The catheter placement system 10 further includes the second modality mentioned above, i.e., the magnetically-based catheter TLS, or tip location system. The TLS enables the clinician to quickly locate and confirm the position and/or orientation of the catheter 72, such as a peripherally-inserted central catheter (“PICC”), central venous catheter (“CVC”), or other suitable catheter, during initial placement into and advancement through the vasculature of the patient 70. Specifically, the TLS modality detects a magnetic field generated by a magnetic element-equipped tip location stylet, which is pre-loaded in one embodiment into a longitudinally defined lumen of the catheter 72, thus enabling the clinician to ascertain the general location and orientation of the catheter tip within the patient body. In one embodiment, the magnetic assembly can be tracked using the teachings of one or more of the following U.S. Pat. Nos. 5,775,322; 5,879,297; 6,129,668; 6,216,028; and 6,263,230. The contents of the afore-mentioned U.S. patents are incorporated herein by reference in their entireties. The TLS also displays the direction in which the catheter tip is pointing, thus further assisting accurate catheter placement. The TLS further assists the clinician in determining when a malposition of the catheter tip has occurred, such as in the case where the tip has deviated from a desired venous path into another vein.

As mentioned, the TLS utilizes a stylet to enable the distal end of the catheter 72 to be tracked during its advancement through the vasculature. FIG. 5 gives an example of such a stylet 100, which includes a proximal end 100A and a distal end 100B. A handle is included at the stylet proximal end 100A, with a core wire 104 extending distally therefrom. A magnetic assembly is disposed distally of the core wire 104. The magnetic assembly includes one or more magnetic elements 106 disposed adjacent one another proximate the stylet distal end 100B and encapsulated by tubing 108. In the present embodiment, a plurality of magnetic elements 106 is included, each element including a solid, cylindrically shaped ferromagnetic stacked end-to-end with the other magnetic elements. An adhesive tip 110 can fill the distal tip of the tubing 108, distally to the magnetic elements 106.

Note that in other embodiments, the magnetic elements may vary from the design in not only shape, but also composition, number, size, magnetic type, and position in the stylet distal segment. For example, in one embodiment, the plurality of ferromagnetic magnetic elements is replaced with an electromagnetic assembly, such as an electromagnetic coil, which produces a magnetic field for detection by the sensor. Another example of an assembly usable here can be found in U.S. Pat. No. 5,099,845 entitled “Medical Instrument Location Means,” which is incorporated herein by reference in its entirety. Yet other examples of stylets including magnetic elements that can be employed with the TLS modality can be found in U.S. application Ser. No. 11/466,602, filed Aug. 23, 2006, and entitled “Stylet Apparatuses and Methods of Manufacture,” which is incorporated herein by reference in its entirety. These and other variations are therefore contemplated by embodiments of the present invention. It should appreciated herein that “stylet” as used herein can include any one of a variety of devices configured for removable placement within a lumen of the catheter to assist in placing a distal end of the catheter in a desired location within the patient's vasculature.

FIG. 2 shows disposal of the stylet 100 substantially within a lumen in the catheter 72 such that the proximal portion thereof extends proximally from the catheter lumen, through the hub 74A and out through a selected one of the extension legs 74B. So disposed within a lumen of the catheter, the distal end 100B of the stylet 100 is substantially co-terminal with the distal catheter end 76A such that detection by the TLS of the stylet distal end correspondingly indicates the location of the catheter distal end.

The TLS sensor 50 is employed by the system 10 during TLS operation to detect a magnetic field produced by the magnetic elements 106 of the stylet 100. As seen in FIG. 2, the TLS sensor 50 is placed on the chest of the patient during catheter insertion. The TLS sensor 50 is placed on the chest of the patient in a predetermined location, such as through the use of external body landmarks, to enable the magnetic field of the stylet magnetic elements 106, disposed in the catheter 72 as described above, to be detected during catheter transit through the patient vasculature. Again, as the magnetic elements 106 of the stylet magnetic assembly are co-terminal with the distal end 76A of the catheter 72 (FIG. 2), detection by the TLS sensor 50 of the magnetic field of the magnetic elements provides information to the clinician as to the position and orientation of the catheter distal end during its transit.

In greater detail, the TLS sensor 50 is operably connected to the console 20 of the system 10 via one or more of the ports 52, as shown in FIG. 1. Note that other connection schemes between the TLS sensor and the system console can also be used without limitation. As just described, the magnetic elements 106 are employed in the stylet 100 to enable the position of the catheter distal end 76A (FIG. 2) to be observable relative to the TLS sensor 50 placed on the patient's chest. Detection by the TLS sensor 50 of the stylet magnetic elements 106 is graphically displayed on the display 30 of the console 20 during TLS mode. In this way, a clinician placing the catheter is able to generally determine the location of the catheter distal end 76A within the patient vasculature relative o the TLS sensor 50 and detect when catheter malposition, such as advancement of the catheter along an undesired vein, is occurring.

FIGS. 6 and 7A-7E show examples of icons that can be used by the console display 30 to depict detection of the stylet magnetic elements 106 by the TLS sensor 50. In particular, FIG. 6 shows an icon 114 that depicts the distal portion of the stylet 100, including the magnetic elements 106 as detected by the TLS sensor 50 when the magnetic elements are positioned under the TLS sensor. As the stylet distal end 100B is substantially co-terminal with the distal end 76A of the catheter 72, the icon indicates the position and orientation of the catheter distal end. FIGS. 7A-7E show various icons that can be depicted on the on the console display 30 when the magnetic elements 106 of the stylet 100 are not positioned directly under a portion of the TLS sensor 50, but are nonetheless detected nearby. The icons can include half-icons 114A and quarter-icons 114B that are displayed according to the position of the stylet magnetic assembly, i.e., the magnetic elements 106 in the present embodiment, relative to the TLS sensor 50.

FIGS. 8A-8C depict screenshots taken from the display 30 of the system 10 while in TLS mode, showing how the magnetic assembly of the stylet 100 is depicted. The screenshot 118 of FIG. 8A shows a representative image 120 of the TLS sensor 50. Other information is provided on the display screenshot 118, including a depth scale indicator 124, status/action indicia 126, and icons 128 corresponding to the button interface 32 included on the console 20 (FIG. 8C). Though the icons 128 in the present embodiment are simply indicators to guide the user in identifying the purpose of the corresponding buttons of the button interface 32, in another embodiment the display can be made touch-sensitive so that the icons themselves can function as button interfaces and can change according to the mode the system is in.

During initial stages of catheter advancement through the patient's vasculature after insertion therein, the distal end 76A of the catheter 72, having the stylet distal end 100B substantially co-terminal therewith, is relatively distant from the TLS sensor 50. As such, the display screenshot will indicate “no signal,” indicating that the magnetic field from the stylet magnetic assembly has not been detected. In FIG. 8B, the magnetic assembly proximate the stylet distal end 100B has advanced sufficiently close to the TLS sensor 50 to be detected thereby, though it is not yet under the sensor. This is indicated by the half-icon 114A shown to the left of the sensor image 120, representing the stylet magnetic assembly being positioned to the right of the TLS sensor 50 from the perspective of the patient.

In FIG. 8C, the magnetic assembly proximate the stylet distal end 100B has advanced under the TLS sensor 50 such that its position and orientation relative thereto is detected by the TLS sensor. This is indicated by the icon 114 on the sensor image 120. Note that the button icons 128 provide indications of the actions that can be performed by pressing the corresponding buttons of the console button interface 32. As such, the button icons 128 can change according to which modality the system 10 is in, thus providing flexibility of use for the button interface 32. Note further that, as the button pad 82 of the probe 40 (FIG. 3A, 3B) includes buttons 84 that mimic several of the buttons of the button interface 32, the button icons 128 on the display 30 provide a guide to the clinician for controlling the system 10 with the probe buttons 84 while remaining in the sterile field. For instance, if the clinician has need to leave TLS mode and return to US (ultrasound) mode, the appropriate control button 84 on the probe button pad 82 can be depressed, and the US mode can be immediately called up, with the display 30 refreshing to accommodate the visual information needed for US functionality, such as that shown in FIG. 4. This is accomplished without a need for the clinician to reach out of the sterile field.

Reference is now made to FIGS. 9 and 10 in describing the integrated catheter placement system 10 according to another example embodiment. As before, the integrated system 10 includes the console 20, display 30, probe 40 for US functionality, and the TLS sensor 50 for tip location functionality as described above. Note that the system 10 depicted in FIGS. 9 and 10 is similar in many respects to the system shown in FIGS. 1 and 2. As such, only selected differences will be discussed below. The system 10 of FIGS. 9 and 10 includes additional functionality wherein determination of the proximity of the catheter distal tip 76A relative to a sino-atrial (“SA”) or other electrical impulse-emitting node of the heart of the patient 70 can be determined, thus providing enhanced ability to accurately place the catheter distal tip in a desired location proximate the node. Also referred to herein as “ECG” or “ECG-based tip confirmation,” this third modality of the system 10 enables detection of ECG signals from the SA node in order to place the catheter distal tip in a desired location within the patient vasculature. Note that the US, TLS, and ECG modalities are seamlessly combined in the present system 10 and can be employed in concert or individually to assist in catheter placement.

FIGS. 9 and 10 show the addition to the system 10 of a stylet 130 configured in accordance with the present embodiment. As an overview, the catheter stylet 130 is removably predisposed within the lumen of the catheter 72 being inserted into the patient 70 via the insertion site 73. The stylet 130, in addition to including a magnetic assembly for the magnetically-based TLS modality, includes an ECG sensor assembly proximate its distal end and including a portion that is co-terminal with the distal end of the catheter tip for sensing ECG signals produced by the SA node. In contrast to the previous embodiment, the stylet 130 includes a tether 134 extending from its proximal end that operably connects to the TLS sensor 50. As will be described in further detail, the stylet tether 134 permits ECG signals detected by the ECG sensor assembly included on a distal portion of the stylet 130 to be conveyed to the TLS sensor 50 during confirmation of the catheter tip location as part of the ECG signal-based tip confirmation modality. Reference and ground ECG lead/electrode pairs 158 attach to the body of the body of the patient 70 and are operably attached to the TLS sensor 50 to enable the system to filter out high level electrical activity unrelated to the electrical activity of the SA node of the heart, thus enabling the ECG-based tip confirmation functionality. Together with the reference and ground signals received from the ECG lead/electrode pairs 158 placed on the patient's skin, the ECG signals sensed by the stylet ECG sensor assembly are received by the TLS sensor 50 positioned on the patient's chest (FIG. 10). The TLS sensor 50 and/or console processor 22 can process the ECG signal data to produce an electrocardiogram waveform on the display 30, as will be described. In the case where the TLS sensor 50 processes the ECG signal data, a processor is included therein to perform the intended functionality. If the console 20 processes the ECG signal data, the processor 22, controller 24, or other processor can be utilized in the console to process the data.

Thus, as it is advanced through the patient vasculature, the catheter 72 equipped with the stylet 130 as described above can advance under the TLS sensor 50, which is positioned on the chest of the patient as shown in FIG. 10. This enables the TLS sensor 50 to detect the position of the magnetic assembly of the stylet 130, which is substantially co-terminal with the distal tip 76A of the catheter as located within the patient's vasculature. The detection by the TLS sensor 50 of the stylet magnetic assembly is depicted on the display 30 during ECG mode. The display 30 further depicts during ECG mode an ECG electrocardiogram waveform produced as a result of patient heart's electrical activity as detected by the ECG sensor assembly of the stylet 130. In greater detail, the ECG electrical activity of the SA node, including the P-wave of the waveform, is detected by the ECG sensor assembly of the stylet (described below) and forwarded to the TLS sensor 50 and console 20. The ECG electrical activity is then processed for depiction on the display 30. clinician placing the catheter can then observe the ECG data to determine optimum placement of the distal tip 76A of the catheter 72, such as proximate the SA node in one embodiment. In one embodiment, the console 20 which includes the electronic components, such as the processor 22 (FIG. 9) necessary to receive and process the signals detected by the stylet ECG sensor assembly. In another embodiment, the TLS sensor 50 can include the necessary electronic components processing the ECG signals.

As already discussed, the display 30 is used to display information to the clinician during the catheter placement procedure. The content of the display 30 changes according to which mode the catheter placement system is in: US, TLS, or ECG. Any of the three modes can be immediately called up to the display 30 by the clinician, and in some cases information from multiple modes, such as TLS and ECG, may be displayed simultaneously. In one embodiment, as before, the mode the system is in may be controlled by the control buttons 84 included on the handheld probe 40, thus eliminating the need for the clinician to reach out of the sterile field (such as touching the button interface 32 of the console 20) to change modes. Thus, in the present embodiment the probe 40 is employed to also control some or all ECG-related functionality of the system 10. Note that the button interface 32 or other input configurations can also be used to control system functionality. Also, in addition to the visual display 30, aural information, such as beeps, tones, etc., can also be employed by the system to assist the clinician during catheter placement.

Reference is now made to FIGS. 11-12E in describing various details of one embodiment of the stylet 130 that is removably loaded into the catheter 72 and employed during insertion to position the distal tip 76A of the catheter in a desired location within the patient vasculature. As shown, the stylet 130 as removed from the catheter defines a proximal end 130A and a distal end 130B. A connector 132 is included at the proximal stylet end 130A, and a tether 134 extends distally from the connector and attaches to a handle 136. A core wire 138 extends distally from the handle 136. The stylet 130 is pre-loaded within a lumen of the catheter 72 in one embodiment such that the distal end 130B is substantially flush, or co-terminal, with the catheter opening at the distal end 76A thereof (FIG. 10), and such that a proximal portion of the core wire 138, the handle 136, and the tether 134 extend proximally from a selected one of the extension tubes 74B. Note that, though described herein as a stylet, in other embodiments a guidewire or other catheter guiding apparatus could include the principles of the embodiment described herein.

The core wire 138 defines an elongate shape and is composed of a suitable stylet material including stainless steel or a memory material such as, in one embodiment, a nickel and titanium-containing alloy commonly known by the acronym “nitinol.” Though not shown here, manufacture of the core wire 138 from nitinol in one embodiment enables the portion of the core wire corresponding to a distal segment of the stylet to have a pre-shaped bent configuration so as to urge the distal portion of the catheter 72 into a similar bent configuration. In other embodiments, the core wire includes no pre-shaping. Further, the nitinol construction lends torqueability to the core wire 138 to enable a distal segment of the stylet 130 to be manipulated while disposed within the lumen of the catheter 72, which in turn enables the distal portion of the catheter to be navigated through the vasculature during catheter insertion.

The handle 136 is provided to enable insertion/removal of the stylet from the catheter 72. In embodiments where the stylet core wire 138 is torqueable, the handle 136 further enables the core wire to be rotated within the lumen of the catheter 72, to assist in navigating the catheter distal portion through the vasculature of the patient 70.

The handle 136 attaches to a distal end of the tether 134. In the present embodiment, the tether 134 is a flexible, shielded cable housing one or more conductive wires electrically connected both to the core wire 138, which acts as the ECG sensor assembly referred to above, and the tether connector 132. As such, the tether 134 provides a conductive pathway from the distal portion of the core wire 138 through to the tether connector 132 at proximal end 130A of the stylet 130. As will be explained, the tether connector 132 is configured for operable connection to the TLS sensor 50 on the patient's chest for assisting in navigation of the catheter distal tip 76A to a desired location within the patient vasculature.

As seen in FIGS. 12B-12D, a distal portion of the core wire 138 is gradually tapered, or reduced in diameter, distally from a junction point 142. A sleeve 140 is slid over the reduced-diameter core wire portion. Though of relatively greater diameter here, the sleeve in another embodiment can be sized to substantially match the diameter of the proximal portion of the stylet core wire. The stylet 130 further includes a magnetic assembly disposed proximate the distal end 130B thereof for use during TLS mode. The magnetic assembly in the illustrated embodiment includes a plurality of magnetic elements 144 interposed between an outer surface of the reduced-diameter core wire 138 and an inner surface of the sleeve 140 proximate the stylet distal end 130B. In the present embodiment, the magnetic elements 144 include 20 ferromagnetic magnets of a solid cylindrical shape stacked end-to-end in a manner similar to the stylet 100 of FIG. 2. In other embodiments, however, the magnetic element(s) may vary from this design in not only shape, but also composition, number, size, magnetic type, and position in the stylet. For example, in one embodiment the plurality of magnets of the magnetic assembly is replaced with an electromagnetic coil that produces a magnetic field for detection by the TLS sensor. These and other variations are therefore contemplated by embodiments of the present invention.

The magnetic elements 144 are employed in the stylet 130 distal portion to enable the position of the stylet distal end 130B to be observable relative to the TLS sensor 50 placed on the patient's chest. As has been mentioned, the TLS sensor 50 is configured to detect the magnetic field of the magnetic elements 144 as the stylet advances with the catheter 72 through the patient vasculature. In this way, a clinician placing the catheter 72 is able to generally determine the location of the catheter distal end 76A within the patient vasculature and detect when catheter malposition is occurring, such as advancement of the catheter along an undesired vein, for instance.

The stylet 130 further includes the afore-mentioned ECG sensor assembly, according to one embodiment. The ECG sensor assembly enables the stylet 130, disposed in a lumen of the catheter 72 during insertion, to be employed in detecting an intra-atrial ECG signal produced by an SA or other node of the patient's heart, thereby allowing for navigation of the distal tip 76A of the catheter 72 to a predetermined location within the vasculature proximate the patient's heart. Thus, the ECG sensor assembly serves as an aide in confirming proper placement of the catheter distal tip 76A.

In the embodiment illustrated in FIGS. 11-12E, the ECG sensor assembly includes a distal portion of the core wire 138 disposed proximate the stylet distal end 130B. The core wire 138, being electrically conductive, enables ECG signals to be detected by the distal end thereof and transmitted proximally along the core wire. A conductive material 146, such as a conductive epoxy, fills a distal portion of the sleeve 140 adjacent the distal termination of the core wire 138 so as to be in conductive communication with the distal end of the core wire. This in turn increases the conductive surface of the distal end 130B of the stylet 130 so as to improve its ability to detect ECG signals.

Before catheter placement, the stylet 130 is loaded into a lumen of the catheter 72. Note that the stylet 130 can come preloaded in the catheter lumen from the manufacturer, or loaded into the catheter by the clinician prior to catheter insertion. The stylet 130 is disposed within the catheter lumen such that the distal end 130B of the stylet 130 is substantially co-terminal with the distal tip 76A of the catheter 72, thus placing the distal tips of both the stylet and the catheter in substantial alignment with one another. The co-terminality of the catheter 72 and stylet 130 enables the magnetic assembly to function with the TLS sensor 50 in TLS mode to track the position of the catheter distal tip 76A as it advances within the patient vasculature, as has been described. Note, however, that for the tip confirmation functionality of the system 10, the distal end 130B of the stylet 130 need not be co-terminal with the catheter distal end 76A. Rather, all that is required is that a conductive path between the vasculature and the ECG sensor assembly, in this case the core wire 138, be established such that electrical impulses of the SA node or other node of the patient's heart can be detected. This conductive path in one embodiment can include various components including saline solution, blood, etc.

In one embodiment, once the catheter 72 has been introduced into the patient vasculature via the insertion site 73 (FIG. 10) the TLS mode of the system 10 can be employed as already described to advance the catheter distal tip 76A toward its intended destination proximate the SA node. Upon approaching the region of the heart, the system 10 can be switched to ECG mode to enable ECG signals emitted by the SA node to be detected. As the stylet-loaded catheter is advanced toward the patient's heart, the electrically conductive ECG sensor assembly, including the distal end of the core wire 138 and the conductive material 146, begins to detect the electrical impulses produced by the SA node. As such, the ECG sensor assembly serves as an electrode for detecting the ECG signals. The elongate core wire 138 proximal to the core wire distal end serves as a conductive pathway to convey the electrical impulses produced by the SA node and received by the ECG sensor assembly to the tether 134.

The tether 134 conveys the ECG signals to the TLS sensor 50 temporarily placed on the patient's chest. The tether 134 is operably connected to the TLS sensor 50 via the tether connector 132 or other suitable direct or indirect connective configuration. As described, the ECG signal can then be process and depicted on the system display 30 (FIG. 9, 10). Monitoring of the ECG signal received by the TLS sensor 50 and displayed by the display 30 enables a clinician to observe and analyze changes in the signal as the catheter distal tip 76A advances toward the SA node. When the received ECG signal matches a desired profile, the clinician can determine that the catheter distal tip 76A has reached a desired position with respect to the SA node. As mentioned, in one embodiment this desired position lies within the lower one-third (⅓rd) portion of the SVC.

The ECG sensor assembly and magnetic assembly can work in concert in assisting a clinician in placing a catheter within the vasculature. Generally, the magnetic assembly of the stylet 130 assists the clinician in generally navigating the vasculature from initial catheter insertion so as to place the distal end 76A of the catheter 72 in the general region of the patient's heart. The ECG sensor assembly can then be employed to guide the catheter distal end 76A to the desired location within the SVC by enabling the clinician to observe changes in the ECG signals produced by the heart as the stylet ECG sensor assembly approaches the SA node. Again, once a suitable ECG signal profile is observed, the clinician can determine that the distal ends of both the stylet 130 and the catheter 72 have arrived at the desired location with respect to the patient's heart. Once it has been positioned as desired, the catheter 72 may be secured in place and the stylet 130 removed from the catheter lumen. It is noted here that the stylet may include one of a variety of configurations in addition to what is explicitly described herein. In one embodiment, the stylet can attach directly to the console instead of an indirect attachment via the TLS sensor. In another embodiment, the structure of the stylet 130 that enables its TLS and ECG-related functionalities can be integrated into the catheter structure itself. For instance, the magnetic assembly and/or ECG sensor assembly can, in one embodiment, be incorporated into the wall of the catheter.

FIGS. 13A-15 describe various details relating to the passage of ECG signal data from the stylet tether 134 to the TLS sensor 50 positioned on the patient's chest, according the present embodiment. In particular, this embodiment is concerned with passage of ECG signal data from a sterile field surrounding the catheter 72 and insertion site 73, which includes the stylet 130 and tether 134, and a non-sterile field, such as the patient's chest on which the TLS sensor is positioned. Such passage should not disrupt the sterile field so that the sterility thereof is compromised. A sterile drape that is positioned over the patient 70 during the catheter insertion procedure defines the majority of the sterile field: areas above the drape are sterile, while areas below (excluding the insertion site and immediately surrounding region) are non-sterile. As will be seen, the discussion below includes at least a first communication node associated with the stylet 130, and a second communication node associated with the TLS sensor 50 that operably connect with one another to enable ECG signal data transfer therebetween.

One embodiment addressing the passage of ECG signal data from the sterile field to the non-sterile field without compromising the sterility of the former is depicted in FIGS. 13A-15, which depict a “through-drape” implementation also referred to as a “shark fin” implementation. In particular, FIG. 14A shows the TLS sensor 50 as described above for placement on the chest of the patient during a catheter insertion procedure. The TLS sensor 50 includes on a top surface thereof a connector base 152 defining a channel 152A in which are disposed three electrical base contacts 154. A fin connector 156, also shown in FIGS. 13A-13D, is sized to be slidingly received by the channel 152A of the connector base 152, as shown in FIGS. 14B and 15. Two ECG lead/electrode pairs 158 extend from the fin connector 156 for placement on the shoulder and torso or other suitable external locations on the patient body. The drape-piercing tether connector 132 is configured to slidingly mate with a portion of the fin connector 156, as will be described further below, to complete a conductive pathway from the stylet 120, through the sterile field to the TLS sensor 50.

FIGS. 13A-13D show further aspects of the fin connector 156. In particular, the fin connector 156 defines a lower barrel portion 160 that is sized to be received in the channel 152A of the connector base 152 (FIGS. 14B, 15). A hole 162 surrounded by a centering cone 164 is included on a back end of an upper barrel portion 166. The upper barrel portion 166 is sized to receive the tether connector 132 of the stylet 130 (FIGS. 14C, 15) such that a pin contact 170 extending into a channel 172 of the tether connector 132 (FIG. 15) is guided by the centering hole until it seats within the hole 162 of the fin connector 156, thus interconnecting the tether connector with the fin connector. An engagement feature, such as the engagement feature 169 shown in FIGS. 13C and 13D, can be included on the fin connector 156 to engage with a corresponding feature on the tether connector 132 to assist with maintaining a mating between the two components.

FIG. 13D shows that the fin connector 156 includes a plurality of electrical contacts 168. In the present embodiment, three contacts 168 are included: the two forward-most contact each electrically connecting with a terminal end of one of the ECG leads 158, and the rear contact extending into axial proximity of the hole 162 so as to electrically connect with the pin contact 170 of the tether connector 132 when the latter is mated with the fin connector 156 (FIG. 15). A bottom portion of each contact 168 of the fin connector 156 is positioned to electrically connect with a corresponding one of the base contacts 154 of the TLS sensor connector base 152.

FIG. 14B shows a first connection stage, wherein the fin connector 156 is removably mated with the TLS sensor connector base 152 by the sliding engagement of the lower barrel portion 160 of the fin connector with the connector base channel 152A. This engagement electrically connects the connector base contacts 154 with the corresponding fin contacts 168.

FIG. 14C shows a second connection stage, wherein the tether connector 132 is removably mated with the fin connector 156 by the sliding engagement of the tether connector channel 172 with the upper barrel portion 166 of the fin connector. This engagement electrically connects the tether connector pin contact 170 with the back contact 168 of the fin connector 156, as best seen in FIG. 15. In the present embodiment, the horizontal sliding movement of the tether connector 132 with respect to the fin connector 156 is in the same engagement direction as when the fin connector is slidably mated to the sensor connector base channel 152A (FIG. 14B). In one embodiment, one or both of the stylet 130/tether connector 132 and the fin connector 156 are disposable. Also, the tether connector in one embodiment can be mated to the fin connector after the fin connector has been mated to the TLS sensor, while in another embodiment the tether connector can be first mated to the fin connector through the surgical drape before the fin connector is mated to the TLS sensor.

In the connection scheme shown in FIG. 14C, the stylet 130 is operably connected to the TLS sensor 50 via the tether connector 132, thus enabling the ECG sensor assembly of the stylet to communicate ECG signals to the TLS sensor. In addition, the ECG lead/electrode pairs 158 are operably connected to the TLS sensor 50. In one embodiment, therefore, the tether connector 132 is referred to as a first communication node for the stylet 130, while the fin connector 156 is referred to as a second communication node for the TLS sensor 50.

Note that various other connective schemes and structures can be employed to establish operable communication between the stylet and the TLS sensor. For instance, the tether connector can use a slicing contact instead of a pin contact to pierce the drape. Or, the fin connector can be integrally formed with the TLS sensor. These and other configurations are therefore embraced within the scope of embodiments of the present disclosure.

As seen in FIG. 15, a sterile drape 174 used during catheter placement to establish a sterile field is interposed between the interconnection of the tether connector 132 with the fin connector 156. As just described, the tether connector 132 includes the pin contact 170 that is configured to pierce the drape 174 when the two components are mated. This piercing forms a small hole, or perforation 175, in the sterile drape 174 that is occupied by the pin contact 170, thus minimizing the size of the drape perforation by the pin contact. Moreover, the fit between the tether connector 132 and the fin connector 156 is such that the perforation in sterile drape made by piercing of the pin contact 170 is enclosed by the tether connector channel 172, thus preserving the sterility of the drape and preventing a breach in the drape that could compromise the sterile field established thereby. The tether connector channel 172 is configured so as to fold the sterile drape 174 down prior to piercing by the pin contact 170 such that the pin contact does not pierce the drape until it is disposed proximate the hole 162 of the fin connector 156. It is noted here that the tether connector 132 and fin connector 156 are configured so as to facilitate alignment therebetween blindly through the opaque sterile drape 174, i.e., via palpation absent visualization by the clinician of both components.

Note further that the fin contacts 168 of the fin connector 156 as shown in FIG. 15 are configured to mate with the sensor base contacts 154 in such a way as to assist in retaining the fin connector in engagement with the sensor base channel 152A. This in turn reduces the need for additional apparatus to secure the fin connector 156 to the TLS sensor 50.

FIG. 16 shows a typical ECG waveform 176, including a P-wave and a QRS complex. Generally, the amplitude of the P-wave varies as a function of distance of the ECG sensor assembly from the SA node, which produces the waveform 176. A clinician can use this relationship in determining when the catheter tip is properly positioned proximate the heart. For instance, in one implementation the catheter tip is desirably placed within the lower one-third (⅓rd) of the superior vena cava, as has been discussed. The ECG data detected by the ECG sensor assembly of the stylet 130 is used to reproduce waveforms such as the waveform 176, for depiction on the display 30 of the system 10 during ECG mode.

Reference is now made to FIG. 17 in describing display aspects of ECG signal data on the display 30 when the system 10 is in ECG mode, the third modality described further above, according to one embodiment. The screenshot 178 of the display 30 includes elements of the TLS modality, including a representative image 120 of the TLS sensor 50, and can the icon 114 corresponding to the position of the distal end of the stylet 130 during transit through the patient vasculature. The screenshot 178 further includes a window 180 in which the current ECG waveform captured by the ECG sensor assembly of the stylet 130 and processed by the system 10 is displayed. The window 180 is continually refreshed as new waveforms are detected.

Window 182 includes a successive depiction of the most recent detected ECG waveforms, and includes a refresh bar 182A, which moves laterally to refresh the waveforms as they are detected. Window 184A is used to display a baseline ECG waveform, captured before the ECG sensor assembly is brought into proximity with the SA node, for comparison purposes to assist the clinician in determining when the desired catheter tip location has been achieved. Windows 184B and 184C can be filed by user-selected detected ECG waveforms when the user pushes a predetermined button on the probe 40 or the console button interface 32. The waveforms in the windows 184B and 184C remain until overwritten by new waveforms as a result of user selection via button pushes or other input. As in previous modes, the depth scale 124, status/action indicia 126, and button icons 128 are included on the display 30. An integrity indicator 186 is also included on the display 30 to give an indication of whether the ECG lead/electrode pairs 158 are operably connected to the TLS sensor 50.

As seen above, therefore, the display 30 depicts in one embodiment elements of both the TLS and ECG modalities simultaneously on a single screen, thus offering the clinician ample data to assist in placing the catheter distal tip in a desired position. Note further that in one embodiment a printout of the screenshot or selected ECG or TLS data can be saved, printed, or otherwise preserved by the system 10 to enable documentation of proper catheter placement.

Although the embodiments described herein relate to a particular configuration of a catheter, such as a PICC or CVC, such embodiments are merely exemplary. Accordingly, the principles of the present invention can be extended to catheters of many different configurations and designs.

II. Assisted Guidance for Needle/Medical Component

Embodiments of the present invention described herein are generally directed to a guidance system for locating and guiding a needle or other medical component during ultrasound-based or other suitable procedures for accessing with the needle a subcutaneous vessel of a patient, for instance. In one embodiment, the guidance system enables the position, orientation, and advancement of the needle to be superimposed in real-time atop the ultrasound image of the vessel, thus enabling a clinician to accurately guide the needle to the intended target. Furthermore, in one embodiment, the guidance system tracks the needle's position in five degrees of motion: x, y, and z spatial coordinate space, needle pitch, and needle yaw. Such tracking enables the needle to be guided and placed with relatively high accuracy.

Reference is first made to FIGS. 18 and 19, which depict various components of an ultrasound-based needle guidance system (“system”), generally designated at 1110, configured in accordance with one embodiment of the present invention. As shown, the system 1110 generally includes an ultrasound (“US”) imaging portion including a console 1120, display 1130, and probe 1140, each of which is described in further detail below. Note that the system 1110 bears similarity to the system 10 shown in FIG. 1 with respect to some components, in one embodiment. It should be noted, however, that the ultrasound imaging portion can be configured in one of a variety of ways in addition to what is shown and described herein.

The ultrasound imaging portion of the system 1110 is employed to image a targeted internal portion of a body of a patient prior to percutaneous insertion of a needle or other device to access the target. As described below, in one embodiment insertion of the needle is performed prior to the subsequent insertion of a catheter into a vein or other portion of the vasculature of the patient. It is appreciated, however, that insertion of a needle into the body of a patient can be performed for a variety of medical purposes.

FIG. 19 shows the general relation of the above-described components to a patient 1170 during a procedure to ultimately place a catheter 1172 into the patient vasculature through a skin insertion site 1173, according to one embodiment. FIG. 19 shows that the catheter 1172 generally includes a proximal portion 1174 that remains exterior to the patient and a distal portion 1176 that resides within the patient vasculature after placement is complete. The system 1110 is employed to ultimately position a distal tip 1176A of the catheter 1172 in a desired position within the patient vasculature. In one embodiment, the desired position for the catheter distal tip 1176A is proximate the patient's heart, such as in the lower one-third (⅓^rd) portion of the Superior Vena Cava (“SVC”). Of course, the system 1110 can be employed to place the catheter distal tip in other locations.

The catheter proximal portion 1174 further includes a hub 1174A that provides fluid communication between the one or more lumens of the catheter 1172 and one or more extension legs 1174B extending proximally from the hub. As mentioned, placement of a needle into the patient vasculature at the insertion site 1173 is typically performed prior to insertion of the catheter, though it is appreciated that other placement methods can be employed. Further, it is appreciated that the above discussion is only one example for use of the system 1110; indeed it can be employed for a variety of uses, such as the placement of needles preparatory to insertion of a catheter as above, the insertion of a needle for other uses, or for the insertion of other medical components into the body of a patient, including x-ray or ultrasound markers, biopsy sheaths, ablation components, bladder scanning components, vena cava filters, etc.

In greater detail, the console 1120 houses a variety of components of the system 1110 and it is appreciated that the console can take one of a variety of forms. A processor 1122, including non-volatile memory such as EEPROM for instance, is included in the console 1120 for controlling system function and executing various algorithms during operation of the system 1110, thus acting as a control processor. A digital controller/analog interface 1124 is also included with the console 1120 and is in communication with both the processor 1122 and other system components to govern interfacing between the probe 1140 and other system components.

The system 1110 further includes ports 1152 for connection with additional components such as optional components 1154 including a printer, storage media, keyboard, etc. The ports in one embodiment are USB ports, though other port types or a combination of port types can be used for this and the other interfaces connections described herein. A power connection 1156 is included with the console 1120 to enable operable connection to an external power supply 1158. An internal battery 1160 can also be employed, either with or exclusive of an external power supply. Power management circuitry 1159 is included with the digital controller/analog interface 1124 of the console to regulate power use and distribution.

The display 1130 in the present embodiment is integrated into the console 1120 and is used to display information to the clinician during the placement procedure, such as an ultrasound image of the targeted internal body portion attained by the probe 1140. In another embodiment, the display may be separate from the console. In one embodiment, a console button interface 1132 and control buttons 1184 (FIG. 19) included on the probe 1140 can be used to immediately call up a desired mode to the display 1130 by the clinician to assist in the placement procedure. In one embodiment, the display 1130 is an LCD device.

FIG. 19 further depicts a needle 1200 used to gain initial access to the patient vasculature via the insertion site 1173. As will be described in further detail below, the needle 1200 is configured to cooperate with the system 1110 in enabling the system to detect the position, orientation, and advancement of the needle during an ultrasound-based placement procedure.

FIG. 20 depicts features of the probe 1140 according to one embodiment. The probe 1140 is employed in connection with ultrasound-based visualization of a vessel, such as a vein, in preparation for insertion of the needle 1200 and/or catheter 1172 into the vasculature. Such visualization gives real time ultrasound guidance and assists in reducing complications typically associated with such introduction, including inadvertent arterial puncture, hematoma, pneumothorax, etc.

The handheld probe 1140 includes a head 1180 that houses a piezoelectric array for producing ultrasonic pulses and for receiving echoes thereof after reflection by the patient's body when the head is placed against the patient's skin proximate the prospective insertion site 1173 (FIG. 19). The probe 1140 further includes a plurality of control buttons 1184 (FIG. 19) for controlling the system, thus eliminating the need for the clinician to reach out of the sterile field, which is established about the patient insertion site prior to establishment of the insertion site, to control the system 1110.

As such, in one embodiment a clinician employs the ultrasound imaging portion of the system 1110 to determine a suitable insertion site and establish vascular access, such as with the needle 1200, prior to introduction of the catheter 1172 for ultimate advancement thereof through the vasculature toward an intended destination.

FIG. 18 shows that the probe 1140 further includes a button and memory controller 1142 for governing button and probe operation. The button and memory controller 1142 can include non-volatile memory, such as EEPROM, in one embodiment. The button and memory controller 1142 is in operable communication with a probe interface 1144 of the console 1120, which includes a piezo input/output component 1144A for interfacing with the probe piezoelectric array and a button and memory input/output component 1144B for interfacing with the button and memory controller 1142.

As seen in FIG. 20, the probe 1140 includes a sensor array 1190 for detecting the position, orientation, and movement of the needle 1200 during ultrasound imaging procedures, such as those described above. As will be described in further detail below, the sensor array includes a plurality of magnetic sensors 1192 embedded within the housing of the probe. The sensors 1192 are configured to detect a magnetic field associated with the needle 1200 and enable the system 1110 to track the needle. Though configured here as magnetic sensors, it is appreciated that the sensors 1192 can be sensors of other types and configurations, as will be described. Also, though they are shown in FIG. 20 as included with the probe 1140, the sensors 1192 of the sensor array 1190 can be included in a component separate from the probe, such as a separate handheld device. In the present embodiment, the sensors 1192 are disposed in a planar configuration below a top face 1182 of the probe 1140, though it is appreciated that the sensors can be arranged in other configurations, such as in an arched or semi-circular arrangement.

In the present embodiment, each of the sensors 1192 includes three orthogonal sensor coils for enabling detection of a magnetic field in three spatial dimensions. Such three dimensional (“3-D”) magnetic sensors can be purchased, for example, from Honeywell Sensing and Control of Morristown, N.J. Further, the sensors 1192 of the present embodiment are configured as Hall-effect sensors, though other types of magnetic sensors could be employed. Further, instead of 3-D sensors, a plurality of one dimensional magnetic sensors can be included and arranged as desired to achieve 1-, 2-, or 3-D detection capability.

In the present embodiment, five sensors 1192 are included in the sensor array 1190 so as to enable detection of the needle 1200 in not only the three spatial dimensions (i.e., X, Y, Z coordinate space), but also the pitch and yaw orientation of the needle itself. Note that in one embodiment, orthogonal sensing components of two or more of the sensors 1192 enable the pitch and yaw attitude of the magnetic element 1210, and thus the needle 1200, to be determined.

In other embodiments, fewer or more sensors can be employed in the sensor array. More generally, it is appreciated that the number, size, type, and placement of the sensors of the sensor array can vary from what is explicitly shown here.

FIGS. 21A and 21B show details of one example of the needle 1200 that can be used in connection with the guidance system 1110 in accessing a targeted internal body portion of the patient, as shown in FIG. 19, according to one embodiment. In particular, the needle 1200 includes a hollow cannula 1202, which defines a proximal end 1202A and a distal end 1202B. A hub 1204 is attached to the proximal end 1202A of the cannula 1202 and includes an open end 1204A that is configured as a connector for connecting with various devices, in the present embodiment. Indeed, the open end 1204A of the hub 1204 is in communication with the hollow cannula 1202 such that a guide wire, stylet, or other component may be passed through the hub into the cannula.

As shown in FIGS. 21A and 21B, a magnetic element 1210 is included with the hub 1204. As best seen in FIG. 21B, the magnetic element 1210 in the present embodiment is a permanent magnet, including a ferromagnetic substance for instance, and is ring-shaped so as to define hole 1212 that is aligned with the hollow cannula 1202. So configured, the magnetic element 1210 produces a magnetic field that is detectable by the sensor array 1190 of the ultrasound probe 1140 so as to enable the location, orientation, and movement of the needle 1200 to be tracked by the system 1110, as described further below.

In other embodiments, it is appreciated that many other types, numbers, and sizes of magnetic elements can be employed with the needle 1200 or other medical component to enable tracking thereof by the present guidance system.

Reference is now made to FIGS. 22A and 22B, which show the ultrasound probe 1140 of the system 1110 and the needle 1200 in position and ready for insertion thereof through a skin surface 1220 of a patient to access a targeted internal body portion. In particular, the probe 1140 is shown with its head 1180 placed against the patient skin and producing an ultrasound beam 1222 so as to ultrasonically image a portion of a vessel 1226 beneath the patient skin surface 1220. The ultrasonic image of the vessel 1226 can be depicted on the display 1130 of the system 1110 (FIG. 19).

As mentioned above, the system 1110 in the present embodiment is configured to detect the position, orientation, and movement of the needle 1200 described above. In particular, the sensor array 1190 of the probe 1140 is configured to detect a magnetic field of the magnetic element 1210 included with the needle 1200. Each of the sensors 1192 of the sensor array 1190 is configured to spatially detect the magnetic element 1210 in three dimensional space. Thus during operation of the system 1110, magnetic field strength data of the needle's magnetic element 1210 sensed by each of the sensors 1192 is forwarded to a processor, such as the processor 1122 of the console 1120 (FIG. 18), which computes in real-time the position and/or orientation of the magnetic element 1210.

Specifically, and as shown in FIGS. 22A and 22B, the position of the magnetic element 1210 in X, Y, and Z coordinate space with respect to the sensor array 1190 can be determined by the system 1110 using the magnetic field strength data sensed by the sensors 1192. Moreover, FIG. 22A shows that the pitch of the magnetic element 1210 can also be determined, while FIG. 22B shows that the yaw of the magnetic element can be determined. Suitable circuitry of the probe 1140, the console 1120, or other component of the system can provide the calculations necessary for such position/orientation. In one embodiment, the magnetic element 210 can be tracked using the teachings of one or more of the following U.S. Pat. Nos. 5,775,322; 5,879,297; 6,129,668; 6,216,028; and 6,263,230. The contents of the afore-mentioned U.S. patents are incorporated herein by reference in their entireties.

The above position and orientation information determined by the system 1110, together with the length of the cannula 1202 and position of the magnetic element 1210 with respect to the distal needle tip as known by or input into the system, enable the system to accurately determine the location and orientation of the entire length of the needle 1200 with respect to the sensor array 1190. Optionally, the distance between the magnetic element 1210 and the distal needle tip is known by or input into the system 1110. This in turn enables the system 1110 to superimpose an image of the needle 1200 on to an image produced by the ultrasound beam 1222 of the probe 1140. FIGS. 23A and 23B show examples of such a superimposition of the needle onto an ultrasound image. Specifically, FIGS. 23A and 23B each show a screenshot 1230 that can be depicted on the display 1130 (FIG. 19), for instance. In FIG. 23A, an ultrasound image 1232 is shown, including depiction of the patient skin surface 1220, and the subcutaneous vessel 1226. The ultrasound image 1232 corresponds to an image acquired by the ultrasound beam 1222 shown in FIGS. 22A and 22B, for instance.

The screenshot 1230 further shows a needle image 1234 representing the position and orientation of the actual needle 1200 as determined by the system 1110 as described above. Because the system is able to determine the location and orientation of the needle 1200 with respect to the sensor array 1190, the system is able to accurately determine the position and orientation of the needle 1200 with respect to the ultrasound image 1232 and superimpose it thereon for depiction as the needle image 1234 on the display 1130. Coordination of the positioning of the needle image 1234 on the ultrasound image 1232 is performed by suitable algorithms executed by the processor 1122 or other suitable component of the system 1110.

The sensors 1192 are configured to continuously detect the magnetic field of the magnetic element 1210 of the needle 1200 during operation of the system 1110. This enables the system 1110 to continuously update the position and orientation of the needle image 1234 for depiction on the display 1130. Thus, advancement or other movement of the needle 1200 is depicted in real-time by the needle image 1234 on the display 1130. Note that the system 1110 is capable of continuously updating both the ultrasound image 1232 and the needle image 1234 on the display 1130 as movements of the probe 1140 and the needle 1200 occur during a placement procedure or other activity.

FIG. 23A further shows that in one embodiment the system 1110 can depict a projected path 1236 based on the current position and orientation of the needle 1200 as depicted by the needle image 1234. The projected path 1236 assists a clinician in determining whether the current orientation of the needle 1200, as depicted by the needle image 1234 on the display 1130, will result in arriving at the desired internal body portion target, such as the vessel 1226 shown here. Again, as the orientation and/or position of the needle image 1234 changes, the projected path 1236 is correspondingly modified by the system 1110. A target 1238, indicating the point where the projected path 1236 crosses the plane of the ultrasound image 1232, can also be depicted on the display 1130 by the system 1110. As shown in FIG. 23A, in the present example the target 1238 is located within the vessel 1226 depicted in the ultrasound image 1232. Note that the position of the target 1238 on the display 1130 can also be modified as the needle 1200 and/or the ultrasound image 1232 are adjusted. The screenshot 1230 also includes an area of probability 1239, here depicted as a box, which indicates any possible margin of error of the system due to needle length, needle rigidity and flex, field strength of the magnetic element, magnetic interference, possible discrepancy in alignment of the magnetic axis of the magnetic element with the longitudinal axis of the needle, orientation of the sensor array with respect to the ultrasound imaging plane, etc.

FIG. 23B shows that, in one embodiment, the screenshot 1230 can be configured such that the ultrasound image 1232 and the needle image 1234 are oriented so as to be displayed in a three dimensional aspect. This enables the angle and orientation of the needle 1200, as depicted by the needle image 1234, to be ascertained and compared with the intended target imaged by the ultrasound image 1232. It should be noted that the screenshots 1230 are merely examples of possible depictions produced by the system 1110 for display; indeed, other visual depictions can be used. Note further that the particular area of the body being imaged is merely an example; the system can be used to ultrasonically image a variety of body portions, and should not be limited to what is explicitly depicted in the accompanying figures. Further, the system as depicted and described herein can be included as a component of a larger system, if desired, or can be configured as a stand-alone device. Also, it is appreciated that, in addition to the visual display 1130, aural information, such as beeps, tones, etc., can also be employed by the system 1110 to assist the clinician during positioning and insertion of the needle into the patient.

As mentioned above, in one embodiment it is necessary for the system 1110 to know the total length of the needle 1200 and the location of the magnetic element 1210 thereon in order to enable an accurate depiction of the needle image 1234 and other features of the screenshots 1230 of FIGS. 23A and 23B to be made. The system 1110 can be informed these and/or other pertinent parameters in various ways, including scanning by the system of a barcode included on or with the needle, the inclusion of a radiofrequency identification (“RFID”) chip with the needle for scanning by the system, color coding of the needle, manual entry of the parameters by the clinician into the system, etc. For instance, an RFID chip 1354 is included on the needle 1200 shown in FIG. 33A. The probe 1140 or other component of the system 1110 can include an RFID reader to read the information included on the RFID chip 1354, such as the type or length of the needle 1200, etc. These and other means for inputting the needle parameters into the system 1110 or detecting the parameters are therefore contemplated.

In one embodiment, a length of the needle (or other aspect of a medical component) can be determined by measurement by the probe/system of a characteristic of the magnetic element, such as its field strength. For instance, in one embodiment the magnetic element of the needle can be positioned at a predetermined distance from the probe or at a predetermined location with respect to the probe. With the magnetic element so positioned, the sensor array of the probe detects and measures the field strength of the magnetic element. The system can compare the measured field strength with a stored list of possible field strengths corresponding to different lengths of needles. The system can match the two strengths and determine the needle length. The needle location and subsequent needle insertion can then proceed as described herein. In another embodiment, instead of holding the magnetic element stationary at a predetermined location, the magnetic element can be moved about the probe such that multiple field strength readings are taken by the probe. Aspects that can be modified so as to impart different field strengths to a set of magnetic element include size, shape, and composition of the magnetic element, etc.

Further details are given here regarding use of the system 1110 in guiding a needle or other medical device in connection with ultrasonic imaging of a targeted internal body portion (“target”) of a patient, according to one embodiment. With the magnetic element-equipped needle 1200 positioned a suitable distance (e.g., two or more feet) away from the ultrasound probe 1140 including the sensor array 1190, the probe is employed to ultrasonically image, for depiction on the display 1130 of the system 1110, the target within the patient that the needle is intended to intersect via percutaneous insertion. A calibration of the system 1110 is then initiated, in which algorithms are executed by the processor 1122 of the console 1120 to determine a baseline for any ambient magnetic fields in the vicinity of where the procedure will be performed. The system 1110 is also informed of the total length of the needle 1200, and/or position of the magnetic element with respect to the distal needle tip such as by user input, automatic detection, or in another suitable manner, as has been discussed above.

The needle 1200 is then brought into the range of the sensors 1192 of the sensor array 1190 of the probe 1140. Each of the sensors 1192 detects the magnetic field strength associated with the magnetic element 1210 of the needle 1200, which data is forwarded to the processor 1122. In one embodiment, such data can be stored in memory until needed by the processor. As the sensors 1192 detect the magnetic field, suitable algorithms are performed by the processor 1122 to calculate a magnetic field strength of the magnetic element 1210 of the needle 1200 at predicted points in space in relationship to the probe. The processor 1122 then compares the actual magnetic field strength data detected by the sensors 1192 to the calculated field strength values. Note that this process is further described by the U.S. patents identified above. This process can be iteratively performed until the calculated value for a predicted point matches the measured data. Once this match occurs, the magnetic element 1210 has been positionally located in three dimensional space. Using the magnetic field strength data as detected by the sensors 1192, the pitch and yaw (i.e., orientation) of the magnetic element 1210 can also be determined. Together with the known length of the needle 1200 and the position of the distal tip of the needle with respect to the magnetic element, this enables an accurate representation of the position and orientation of the needle can be made by the system 1110 and depicted as a virtual model, i.e., the needle image 1234, on the display 1130. Note that the predicted and actual detected values must match within a predetermined tolerance or confidence level in one embodiment for the system 1110 to enable needle depiction to occur.

Depiction of the virtual needle image 1234 of the needle 1200 as described above is performed in the present embodiment by overlaying the needle image on the ultrasound image 1232 of the display 1130 (FIGS. 23A, 23B). Suitable algorithms of the system 1110 as executed by the processor 1122 or other suitable component further enable the projected path 1236, the target 1238, and area of probability 1239 (FIGS. 23A, 23B) to be determined and depicted on the display 1130 atop the ultrasound image 1232 of the target. The above prediction, detection, comparison, and depiction process is iteratively performed to continue tracking the movement of the needle 1200 in real-time.

In light of the foregoing and with reference to FIG. 24, it is appreciated that in one embodiment a method 1240 for guiding a needle or other medical component includes various stages. At stage 1242, a targeted internal body portion of a patient is imaged by an imaging system, such as an ultrasound imaging device for instance.

At stage 1244, a detectable characteristic of a medical component such as a needle is sensed by one or more sensors included with the imaging system. In the present embodiment, the detectable characteristic of the needle is a magnetic field of the magnetic element 1210 included with the needle 1200 and the sensors are magnetic sensors included in the sensor array 1190 included with the ultrasound probe 1140.

At stage 1246, a position of the medical component with respect to the targeted internal body portion is determined in at least two spatial dimensions via sensing of the detectable characteristic. As described above, such determination is made in the present embodiment by the processor 1122 of the console 1120.

At stage 1248, an image representing the position of the medical component is combined with the image of the targeted internal body portion for depiction on a display. Stage 1250 shows that stages 1244-1248 can be iteratively repeated to depict advancement or other movement of the medical component with respect to the imaged target, such as percutaneous insertion of the needle 1200 toward the vessel 1226 (FIGS. 23A, 23B), for instance.

It is appreciated that the processor 1122 or other suitable component can calculate additional aspects, including the area of probability 1239 and the target 1238 (FIGS. 23A, 23B) for depiction on the display 1130.

It is appreciated that in one embodiment the sensor array need not be incorporated natively into the ultrasound imaging device, but can be included therewith in other ways. FIG. 25 shows one example of this, wherein an attachable sensor module 1260 including the sensors 1192 of the sensor array 1190 is shown attached to the ultrasound probe 1140. Such a configuration enables needle guidance as described herein to be achieved in connection with a standard ultrasound imaging device, i.e., a device not including a sensor array integrated into the ultrasound probe or a processor and algorithms configured to locate and track a needle as described above. As such, the sensor module 1260 in one embodiment includes a processor and algorithms suitable for locating and tracking the needle or other medical component and for depicting on a display the virtual image of the needle for overlay on to the ultrasound image. In one embodiment, the sensor module 1260 can be included with a module display 1262 for depiction of the needle tracking. These and other configurations of the guidance system are therefore contemplated.

FIG. 26 shows that in one embodiment, a needle holder can be employed to hold and advance the needle 1200 during the ultrasound imaging and needle guidance procedure performed by the system 1110 as has been described. As shown, the needle holder 1270 is pistol-shaped and includes a trigger 1272 for selectively advancing the needle 1200 or other suitable medical component by moving the needle longitudinally away from the barrel of the holder upon pressing of the trigger. So configured, the needle holder 1270 facilitates ease of needle handling with one hand of the clinician while the other hand is grasping and manipulating the ultrasound probe 1140. In addition, the needle holder 1270 can provide needle movement/rotation assistance such as via a motor, ratcheting, hydraulic/pneumatic drivers, etc. Moreover, a clocking feature can be included on the needle holder 1270 to assist with determining the orientation of the distal tip of the needle 1200 and for facilitating rotation of the needle.

In one embodiment, the needle holder 1270 can be operably connected to the system 1110 such that advancement by the needle holder is automatically stopped when the distal end 1202B of the needle cannula 1202 reaches the targeted internal body portion or the needle intercepts the ultrasound plane. In yet another embodiment the magnetic element can be included with the needle holder instead of the needle itself. The needle, when temporarily attached to the needle holder, can thus be located and guided by the guidance system without the need for a magnetic element to be attached directly to the needle.

FIGS. 27 and 28 depict components of the guidance system 1110 according to another embodiment, wherein an optical-based interaction between the probe 1140 and the needle 1200 is employed to enable tracking and guidance of the needle. In particular, the probe 1140 includes a optical/light source, such as an LED 1280, and a photodetector 1282 positioned on the probe surface. It is appreciated that the light source and detector can be configured to produce and detect light signals of a variety of ranges including visible, infrared, etc.

The needle hub 1204 includes a reflective surface 1286 capable of reflecting light produced by the LED 1280 and incident thereon. As shown in FIG. 28, light emitted by the LED 1280 is reflected by the reflective surface 1286 of the needle 1200, a portion of which is received and sensed by the photodetector 1282. As in previous embodiments, the processor 1122 of the system console 1120 can be employed to receive the sensed data of the photodetector 1282 and compute the position and or orientation of the needle 1200. As before, the length of the needle 1200 and/or the position of the reflective surface with respect to the distal end of the needle 1200 are input into or otherwise detectable or known by the system 1110. Note that the reflective surface can be included at other locations on the needle.

In light of the above, it is appreciated that in the present embodiment the detectable characteristic of the needle 1200 includes the reflectivity of the reflective surface 1286, in contrast to the magnetic field characteristic of the magnetic element 1210 of previous embodiments, and the sensor includes the photodetector 1282, in contrast to the magnetic sensors 1192 of previous embodiments. It should be appreciated that in one embodiment, the above-described configuration can be reversed, wherein an optical source is included with the needle or medical component. In this case, light is emitted from the needle and detected by the photodetector 1282 included with the probe 1140 so as to enable location and tracking of the needle. A power source can be included with the needle, such as a watch battery or the like, in order to power the light source of the needle.

More generally, it is appreciated that the needle or medical component can include one or more of these or other detectable characteristics to enable the needle to be tracked and guided toward a target within the body of the patient. Non-limiting examples of other detectable characteristic modalities include electromagnetic or radiofrequency (“RF”) (see, e.g., FIGS. 29-30 below), and radioactivity. With respect to RF modalities, it is appreciated that one or more synchronously or asynchronously pulsed frequency sources can be included with the needle as to enable detection thereof by a suitable sensor(s). Or, an RF first source can be coupled with a passive magnet as a second source.

FIGS. 29 and 30 depict components of a guidance system according to one embodiment, wherein EM signal interaction between the probe 1140 and the needle 1200 is employed to enable tracking and guidance of the needle. In particular, in FIG. 29 the needle 1200 includes a stylet 1298 disposed therein. The stylet 1298 includes an EM coil 1290 that is operably connected to the probe 1140 via a tether 1292. In this way, the EM coil 1290 can be driven by suitable components included in the probe 1140 or system console 1120 such that the EM coil emits an EM signal during operation.

A sensor 1294 suitable for detecting EM signals emitted by the EM coil 1290 of the stylet 1298 is included in the probe 1140. In the present embodiment, the sensor 1294 is a three-axis sensor for detecting corresponding orthogonal components of the EM signal, though other coil and sensor configurations can also be employed. So configured, the position and orientation of the needle 1200 can be determined, by EM signal triangulation or other suitable process, and displayed by the system in a manner similar to that already described above. As in previous embodiments, the processor 1122 of the system console 1120 (FIG. 18) can be employed to receive the sensed data of the EM sensor 1294 and compute the position and/or orientation of the needle 1200. As before, the length of the needle 1200 and/or the position of the EM coil 1290 with respect to the distal end of the needle 1200 are input into or otherwise detectable or known by the system.

FIG. 30 shows a variation of the EM configuration of FIG. 29, wherein the respective positions of the EM components is reversed: the EM coil 1290 is included in the probe 1140 and the EM sensor 1294 is included with the stylet 1298 disposed in the needle 1200. Note that in the embodiments of FIGS. 29 and 30, the operable connection between the EM coil 1290 and the EM sensor 1294 via the tether 1292 enables the component disposed in the stylet 1298 to be driven by the system 1110. This also enables correspondence of the particular EM frequency/frequencies emitted by the EM coil 1290 and detected by the EM sensor 1294 to be made. In one embodiment, the configuration shown in FIG. 29 can be varied, wherein no tether operably connects the EM coil and the EM sensor; rather, the EM coil of the stylet operates as a separate component from the probe and its EM sensor and is powered by an independent power source, such as a battery. In this case, the probe/system includes suitable signal processing components configured to detect the EM signal emitted by the EM coil and to process it as necessary in order to locate the needle.

Note that the EM coil and EM sensors can be included at other locations than what is depicted herein. For instance, the EM coil can be included on the needle itself, or on a connector that is attachable to the proximal end of the needle.

FIGS. 31A-31D give further details of the needle 1200 configured according to one embodiment, wherein the needle includes a hub 1304 from which extends the cannula 1202. A magnetic element 1310 defining a hole 1312 is included in a cavity 1314A of a housing 1314. The housing 1314 includes threads so as to threadably engage the needle hub 1304 or other suitable component of the needle or medical component. In this way, the magnetic element 1310 is removably attachable to the needle 1200 via the housing 1314. Thus, the magnetic element 1310 need not be permanently affixed or included with the needle 1200, but rather can be removed therefrom when magnetic-based needle guidance is no longer needed. In addition, this enables the magnetic element to be attached to many different types and sizes of needles. Note that in the present embodiment the needle 1200 further includes a distally slidable needle safety component 1320 for safely isolating the distal tip of the needle upon removal of the needle from the patient. Note further that other removable magnetic elements can be employed in addition to what is explicitly shown and described herein.

FIGS. 32-33B give further examples of the needle 1200 including a magnetic element. In FIG. 32, two bar-like magnetic elements 1340 are disposed so as to orthogonally extend from a hub 1334 of the needle 1200, illustrating that the magnetic element need not be oriented parallel to the longitudinal axis of the needle. In FIGS. 33A-33B, four magnetic elements 1350 are included in the needle hub 1344, showing that more than one magnetic element can be included with the needle. Such a configuration may be employed, for example, where limited space prevents one magnetic element from being used. Note the number, shape, and placement of the magnetic elements here is only one example of many possible configurations.

FIGS. 34A-34G give various example configurations of a magnetic element 1360 that defines a hole for receiving the cannula of the needle therethrough. Various shape configurations for the magnetic element 1360 are shown, including a square (FIG. 34A), a hexagon (FIG. 34B), a triangle (FIG. 34C), a rectangle (FIG. 34D), an oval (FIG. 34E), an octagon (FIG. 34F), and a four-sided pyramid (FIG. 34G). The magnetic elements shown in the accompanying figures are merely examples of the broad number of geometric and other shapes that can be used to define the magnetic element; indeed other shapes not shown explicitly herein are also contemplated.

FIGS. 35-37 describe various details relating to a component length measurement system for use with the guidance system described herein. As has been described, the above guidance system is employed to locate and guide a needle or other medical component during ultrasound-based or other suitable procedures for accessing with the needle a subcutaneous vessel of a patient, for instance. In one embodiment, the guidance system enables the position, orientation, and advancement of the needle to be superimposed in real-time atop the ultrasound image of the vessel, thus enabling a clinician to accurately guide the needle to the intended target. Furthermore, in one embodiment, the guidance system tracks the needle's position in five degrees of motion: x, y, and z spatial coordinate space, needle pitch, and needle yaw. Such tracking enables the needle to be guided and placed with relatively high accuracy. Various details of the guidance system 1110 have been described above in connection with FIGS. 18 and 19 et al.

As was discussed above, the position and orientation information determined by the system 1110, together with the length of the needle 1200 and position of the magnetic element 1210 with respect to the distal tip 1202B of the needle cannula 1202 as known by or input into the system, enable the system to accurately determine the location and orientation of the entire length of the needle 1200 with respect to the sensor array 1190. In accordance with present embodiments, the length of the needle can be quickly and readily determined by the present needle length determination system to be described below, thus allowing for accurate tracking of the needle by the guidance system.

In view of the above, a needle length determination system 1500 is described herein for determining the length of the needle 1200. In particular, components of the system 1500 are shown in FIG. 35, which also depicts many of the components of the guidance system 1110, such as the probe 1140, its sensor array 1190, the needle 1200, and the magnetic element 1210.

In detail, a needle retention fixture 1510 is included, shown attached to the probe 1140 proximate the head portion 1180. The needle retention fixture 1510 includes a channel or other suitable opening that is configured to removably receive therein a distal portion of the needle 1200 such that the cannula 1202 thereof defines a predetermined angle θ with a plane in which the sensor array 1190 is disposed, as seen in FIG. 35. In the present embodiment, the array 1190 of sensors 1192 are disposed on a sensor board 1522 and so the sensor board can be considered as defining the plane of the sensors.

FIGS. 36A-36C describe various details of the needle retention fixture 1510 according to one embodiment, wherein the fixture is included with a needle guide assembly 1516. As shown, the needle retention fixture 1510 is implemented as a channel 1512 including an open proximal end 1512A through which the needle cannula 1202 is received and a closed distal end 1512B. The channel 1512 is disposed on a top face of the needle guide assembly 1516, which itself includes a guide channel 1518. FIG. 37 shows a distal portion of the needle cannula 1202 received into the channel 1512 such that the distal end 1202B of the cannula is disposed proximate the closed distal end 1512B of the channel. The needle 1200 of FIG. 35 is similarly disposed in the channel 1512, enabling the length of the needle 1200 to be determined by the system 1500, as discussed further below.

Note that the particular size, shape, and design of the needle guide assembly and needle retention fixture can vary from what is shown and described here. Also, the location of the needle retention fixture on the probe can vary, as can the position of the sensors and/or the sensor board. In addition, note that the length of other medical components can be ascertained by use of the needle length determination system. In such cases, a suitably designed retention fixture would be employed with the ultrasound probe.

Disposal of the distal portion of the needle cannula 1202 in the channel 1512 of the needle retention fixture 1510 as shown in FIG. 35 positions the needle 1200 at a predetermined angle θ with respect to the plane of the sensors 1192, the plane substantially corresponding to the sensor board 1522, and further positions the cannula distal tip 1202B at a position known by the length determination system 1500, i.e., substantially proximate close to the vertex of the angle θ.

With the needle 1200 positioned as shown in FIG. 35, it is seen that a right triangle is formed an x-y-z coordinate space between the needle and a plane defined by the sensor board 1522 on which the sensors 1192 of the sensor array 1190 are disposed. The sensor board is thus considered by the system 1500 as a reference plane in determining needle length, as will be seen.

The triangle referred to above includes side x indicating an orthogonal distance between the sensor plane of the sensor board 1522 and the magnetic element 1210 of the needle 1200, side y indicating the distance between the point of intersection of side x with the sensor plane and the vertex of angle θ, and side l substantially indicating the length of the needle 1200. Note that in the present embodiment side l does not fully extend to the vertex of angle θ due to the offset between the sensor plane and the distal tip 1202B of the needle cannula 1202 as disposed in the fixture channel 1512. As such, the needle length determination system 1500 is configured in one embodiment to account for this offset in calculating the needle length, as seen in the below equations. Angle θ is bounded by sides l and y, while right angle φ is bounded by sides x and y. Side l therefore defines the hypotenuse of the right triangle.

Note that side y of the virtual triangle described above corresponds in the present embodiment with the above-mentioned reference plane, which plane in the present embodiment is co-planar with the sensor board 1522. Note further that the reference plane, and thus side y of the virtual triangle shown in FIG. 35, can be defined by the system 1500 to be located in positions other than what is shown here. Further, the orientation of the triangle within the x-y-z coordinate space can be selected by the user, the needle length determination system and/or the guidance system to be different from what is shown and described here, in one embodiment.

As mentioned, it is thus seen that the position of the distal end 1202B of the needle cannula 1202 and the angle θ are known by the system 1500 when the needle 1200 is disposed in the fixture channel 1512 as shown in FIG. 35. In one embodiment, the distal end 1202B and the angle θ are constants, given the fixed nature of the fixture 1510. In another embodiment, the fixture can be adjustable to one or more positions; in such a case, the system can be informed of the position of the fixture so as to determine the angle θ, for instance.

The insertion guidance system 1110 as described further above is able to detect the position of the magnetic element 1210 of the needle 1200 in the x-y-z coordinate space, as was described further above. As such, the system 1110 can readily determine the length values of triangle sides x and y. Note that determination of the length of side y is assisted by the knowledge of the position of the distal end 1202B of the needle cannula 1202 in the fixture channel 1512. Angle θ is also known by virtue of placement of the needle 1200 into the fixture channel 1512, as earlier described. With the angle φ as a right triangle, two or more of the above known values of x, y, and angle θ can be used to derive the length, l, of the needle 1200, using one or more of the following equations:

x²+y²=l²=>l=√(x²+y²)−l₁ (1)
sin θ=x/l=>l=x/sin θ−l₁ (2)
cos θ=y/l=>l=y/cos θ−l₁ (3)

Note that inclusion in the above equations of the offset distance l₁is necessary in the present embodiment disclosed in FIG. 35 to account for the offset between the tip of the virtual triangle that defines the vertex of the angle θ and the distal tip 1202B of the needle 1200. It is appreciated that, in other embodiments, the system 1500 can be configured to consider line y to intersect the distal tip of the needle when disposed in the needle retention fixture, thus obviating the need for the above offset factor l₁. These and other offset variations are therefore contemplated.

One or more of the above calculations can be performed by the processor 1122 or other suitable component of the guidance system 1110 or needle length determination system 1500 to determine the length of the needle 1200. Note that in one embodiment, the needle length determination system 1500 and the guidance system 1110 are integrated as a single system.

According to one embodiment and with reference to FIG. 35, length determination of the needle 1200 proceeds as follows: the guidance system 1110 is first calibrated to account for any ambient magnetic fields that may be present. The needle 1200 is then placed in the fixture channel 1512, disposed on the needle guide assembly 1516, such that the distal end 1202B of the cannula 1202 contacts the closed distal end 1512B of the channel. The position of the magnetic element 1210 of the needle 1200 in x-y-z coordinate space is determined by the system 1110 (described further above in connection with FIGS. 18-24), which yields the lengths of sides x and y of the virtual triangle of FIG. 35. The lengths of sides x and y, together with the known angle θ by virtue of the placement of the needle 1200 into the fixture channel 1512, enable the processor 1122 (FIG. 18) or other suitable component to calculate the length of the needle using one or more of equations (1)-(3) above. Determination of needle length in this manner is also referred to herein as triangulation.

Once the length of the needle 1200 has been determined as described above, the system uses this value in accurately tracking and depicting the needle on the display together with the ultrasound image, as described above, during the ultrasound-assisted needle placement procedure. The needle image depicted on the ultrasound display is thus accurately sized, which assists in accurate guidance thereof by the guidance system 1110. The needle length and other above-described parameters can be permanently or temporarily stored, such as in the processor/memory 1122 for example for future use with the same or similar needles. In one embodiment, the user can assign the stored needle length to a button or other system interface component such that when a similar needle is used in the future, the system can readily recognize it.

Note that, in addition to those set forth above, other suitable equations, including trigonometric, algebraic, and geometric equations, can also be employed to determine the needle length. For instance, the law of Sines can be used in one embodiment to determine needle length in instances where the virtual triangle is not a right triangle. In the present embodiment, the needle retention fixture, e.g., the channel 1512 of FIG. 35, is included as part of the needle guide assembly 1516 attachable to the probe. In another embodiment, however, the fixture is a stand-alone device as attached to the probe. The needle retention fixture can be removably or permanently attached to the probe. Also, in one embodiment, the fixture can be pre-attached to the needle so that a user simply attaches the fixture to the probe with the needle already in place within the fixture. Note further that the angle θ can vary in magnitude from what is shown in FIG. 4 and should therefore not be so limited.

In one embodiment, known offsets will be factored into the determination of needle length, including for example any offset of the distal tip of the needle from the y-plane when the needle is fully seated in the fixture. These and other possible factors to be entered into the computation of needle length are therefore contemplated. Note also that in other embodiments the magnetic element can include other components, such as an electromagnetic signal-emitting source that is detectable by one or more electromagnetic signal-sensing sensors of the ultrasound probe. Moreover, in other embodiments, the fixture can be included at another location other than the probe or is configured to receive therein another portion of the needle other than the needle tip, such as the needle hub for instance. Thus, the embodiments should not be limited to what is explicitly shown and described.

Determination of the needle length by the needle length determination system 1500 prior to tracking and insertion of the needle 1200 into the patient, as described above, provides additional flexibility to the needle guidance system 1110. In particular and as mentioned above, calibration of the guidance system 1110 typically occurs before the needle 1200 including the magnetic element 1210 is brought into proximity with the sensor array 1190 disposed in the probe 1140 (FIG. 35). In another embodiment, however, calibration of the guidance system 1110 can occur with the needle 1200 disposed proximate to the sensors 1192 of the sensor array 1190, such as when the needle is disposed in the fixture channel 1512, provided the needle length has already been determined by the needle length determination system 1500.

In further detail, the ambient magnetic environment about the probe 1140 can be generally represented as:

Z′=A+Z, (4)

where Z′ is the ambient magnetic environment as detected by the sensor array 1190, A is the magnetic field of the magnetic element 1210 of the needle 1200 that is sensed by the sensor array 1190 (in connection with needle length determination as described further above in connection with FIGS. 35-37) when the distal end of the needle is seated in the fixture channel 1512 as shown in FIG. 35, and Z is the desired ambient magnetic environment, i.e., the environment without the field of the needle's magnetic element 1210.

Determination of the length of the needle 1200 by the needle length determination system 1500 as described further above in connection with FIG. 35 includes sensing the magnetic field of the magnetic element 1210 of the needle 1200, which is indicated as A in equation (4). Thus, as part of the subsequent calibration process, the guidance system 1110 in the present embodiment can account for the magnetic field A of the needle's magnetic element 1210—which was found during determination of the needle length (or by a separate procedure in some instances)—and cancel it out during detection of the ambient magnetic environment Z′, as generally shown by the following equation:

Z=Z′−A (5)

In other words the guidance system 1110, knowing the magnetic field A of the needle's magnetic element 1210, can account for that field and eliminate it from the measured ambient magnetic environment Z′, thus resulting in the desired ambient magnetic environment Z, which is necessary for accurate tracking of the needle 1200 by the guidance system 1110 after needle movement by the clinician commences. Thus, it is appreciated that in one embodiment the needle guidance system can be calibrated to determine the ambient magnetic environment even when the needle—which includes a magnetic element—is disposed in relatively close proximity to the sensor array of the system. In one embodiment the magnetic field of the magnetic element of the needle is determined during the same imaging and needle insertion procedure. In another embodiment, the magnetic field of the magnetic element has been previously determined and saved in the memory of the needle guidance system.

It should be appreciated that determination of needle length as described herein can also be achieved with guidance systems that do not employ permanent magnets, such as the permanent magnet implemented in the magnetic element 1210 of the embodiment described in connection with FIGS. 35-37. Examples of other guidance systems are shown in FIGS. 27-30, for instance. Further, note that the magnetic element can be disposed at different locations along the length of the needle, in one embodiment.

Embodiments of the invention may be embodied in other specific forms without departing from the spirit of the present disclosure. The described embodiments are to be considered in all respects only as illustrative, not restrictive. The scope of the embodiments is, therefore, indicated by the appended claims rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.

Claims

1. A method for placing a medical component using an ultrasound imaging system, the ultrasound imagine system including an ultrasound probe having a plurality of magnetic sensors, the medical component including a magnetic element, the method comprising: positioning the medical component in a predetermined orientation with respect to the ultrasound probe such that a first angle is defined between the medical component and the ultrasound probe;detecting a magnetic field of the magnetic element by the plurality of magnetic sensors in order to generate magnetic field strength data;determining a position of the magnetic element relative to the magnetic sensors in two spatial dimensions using the magnetic field strength data;calculating a length of the medical component using the first angle and the determined two-dimensional position; anddepicting on a display a position of the medical component with respect to an ultrasound image produced by the ultrasound imaging system based on the calculated length of the medical component.
2. The method for placing a medical component as defined in claim 1, wherein positioning the medical component in a predetermined orientation includes positioning a portion of the medical component in a fixture attached to the ultrasound probe.
3. The method for placing a medical component as defined in claim 2, wherein the fixture is positioned proximate a head portion of the ultrasound probe.
4. The method for placing a medical component as defined in claim 1, wherein the determined two-dimensional position of the medical component and the first angle cooperate to define a triangle.
5. The method for placing a medical component as defined in claim 1, wherein calculating the length of the medical component includes calculating a magnitude of a hypotenuse of a right triangle defined by the first angle, an x-component of the two-dimensional position, and a y-component of the two-dimensional position.
6. The method for placing a medical component as defined in claim 1, wherein the medical component includes a needle, wherein the plurality of magnetic sensors are disposed in a plane within the ultrasound probe, and wherein at least one dimension of the two-dimensional position is co-planar with the plane of the magnetic sensors.
7. The method for placing a medical component as defined in claim 6, wherein the magnetic element is disposed proximate a proximal end of the needle.
8. The method for placing a medical component as defined in claim 1, further comprising saving the length of the medical component in a memory location of the ultrasound imaging device for future reference.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent application Ser. No. 13/118,033, filed May 27, 2011, and titled “Insertion Guidance System for Needles and Medical Components,” which claims the benefit of U.S. Provisional Patent Application No. 61/349,771, filed May 28, 2010, and titled “Needle Insertion Guidance System,” and which is a continuation-in-part of U.S. patent application Ser. No. 12/323,273, filed Nov. 25, 2008, and titled “Integrated System for Intravascular Placement of a Catheter,” now U.S. Pat. No. 8,388,541, which claims the benefit of the following: 1) U.S. Provisional Patent Application No. 60/990,242, filed Nov. 26, 2007, titled “Integrated Ultrasound and Tip Location System for Intravascular Placement of a Catheter;” 2) U.S. Provisional Patent Application No. 61/045,944, filed Apr. 17, 2008, titled “Drape-Breaching Electrical Connector;” 3) U.S. Provisional Patent Application No. 61/091,233, filed Aug. 22, 2008, titled “Catheter Including Preloaded Steerable Stylet;” 4) U.S. Provisional Patent Application No. 61/095,451, filed Sep. 9, 2008, titled “Catheter Assembly Including ECG and Magnetic-Based Sensor Stylet;” and 5) U.S. Provisional Patent Application No. 61/095,921, filed Sep. 10, 2008, titled “System and Method for Placing a Catheter Within a Vasculature of a Patient.” This application also claims the benefit of U.S. Provisional Patent Application No. 61/505,036, filed Jul. 6, 2011, and titled “Determination of Needle Length and Calibration for a Needle Insertion Guidance System.” Each of the aforementioned applications is incorporated herein by reference in its entirety.

US Referenced Citations (1488)

Number	Name	Date	Kind
3133244	Wojtulewicz	May 1964	A
3297020	Mathiesen	Jan 1967	A
3625200	Muller	Dec 1971	A
3674014	Tillander et al.	Jul 1972	A
3817241	Grausz	Jun 1974	A
3847157	Caillouette et al.	Nov 1974	A
3868565	Kuipers	Feb 1975	A
3896373	Zelby	Jul 1975	A
3902501	Citron et al.	Sep 1975	A
3986373	Goodlaxson	Oct 1976	A
3995623	Blake et al.	Dec 1976	A
4003369	Heilman et al.	Jan 1977	A
4063561	McKenna	Dec 1977	A
4072146	Howes	Feb 1978	A
4114601	Abels	Sep 1978	A
4149535	Volder et al.	Apr 1979	A
4173228	Steenwyk et al.	Nov 1979	A
4175566	Millar	Nov 1979	A
4181120	Kunii et al.	Jan 1980	A
4224949	Scott et al.	Sep 1980	A
4244362	Anderson	Jan 1981	A
4289139	Enjoji et al.	Sep 1981	A
4317078	Weed et al.	Feb 1982	A
4327722	Groshong et al.	May 1982	A
4327723	Frankhouser	May 1982	A
4362166	Furler et al.	Dec 1982	A
4365639	Goldreyer	Dec 1982	A
4380237	Newbower	Apr 1983	A
4407294	Vilkomerson	Oct 1983	A
4417886	Frankhouser et al.	Nov 1983	A
4429693	Blake et al.	Feb 1984	A
4431005	McCormick	Feb 1984	A
4431214	Buffington	Feb 1984	A
4445501	Bresler	May 1984	A
4459854	Richardson et al.	Jul 1984	A
4469106	Harui	Sep 1984	A
4483343	Beyer et al.	Nov 1984	A
4491137	Jingu	Jan 1985	A
4565201	Lass	Jan 1986	A
4572198	Codrington	Feb 1986	A
4577634	Gessman	Mar 1986	A
4582067	Silverstein et al.	Apr 1986	A
4587975	Salo et al.	May 1986	A
4588394	Schulte et al.	May 1986	A
4593687	Gray	Jun 1986	A
4595012	Webler et al.	Jun 1986	A
4601706	Aillon	Jul 1986	A
4608989	Drue	Sep 1986	A
4608992	Hakim et al.	Sep 1986	A
4619247	Inoue et al.	Oct 1986	A
4622644	Hansen	Nov 1986	A
4644960	Johans	Feb 1987	A
4652820	Maresca	Mar 1987	A
4660571	Hess et al.	Apr 1987	A
4665925	Millar	May 1987	A
4667230	Arakawa et al.	May 1987	A
4674518	Salo	Jun 1987	A
4676249	Arenas et al.	Jun 1987	A
4681106	Kensey et al.	Jul 1987	A
4681117	Brodman et al.	Jul 1987	A
4688578	Takano et al.	Aug 1987	A
4692148	Kantrowitz et al.	Sep 1987	A
4697595	Breyer et al.	Oct 1987	A
4700997	Strand	Oct 1987	A
4706681	Breyer et al.	Nov 1987	A
4710708	Rorden et al.	Dec 1987	A
4733669	Segal	Mar 1988	A
4737794	Jones	Apr 1988	A
4741356	Letzo et al.	May 1988	A
4742356	Kuipers	May 1988	A
4753247	Kirsner	Jun 1988	A
4770185	Silverstein et al.	Sep 1988	A
4771788	Millar	Sep 1988	A
4781685	Lehmann et al.	Nov 1988	A
4784646	Feingold	Nov 1988	A
4787070	Suzuki et al.	Nov 1988	A
4787396	Pidorenko	Nov 1988	A
4790809	Kuntz	Dec 1988	A
4793361	DuFault	Dec 1988	A
4794930	Machida et al.	Jan 1989	A
4796632	Boyd et al.	Jan 1989	A
4798588	Aillon	Jan 1989	A
4798598	Bonello et al.	Jan 1989	A
4809681	Kantrowitz et al.	Mar 1989	A
4809713	Grayzel	Mar 1989	A
4813729	Speckhart	Mar 1989	A
4821731	Martinelli et al.	Apr 1989	A
4836214	Sramek	Jun 1989	A
4840182	Carlson	Jun 1989	A
4840622	Hardy	Jun 1989	A
4841977	Griffith et al.	Jun 1989	A
4849692	Blood	Jul 1989	A
4850358	Millar	Jul 1989	A
4852580	Wood	Aug 1989	A
4856317	Pidorenko et al.	Aug 1989	A
4856529	Segal	Aug 1989	A
4860757	Lynch et al.	Aug 1989	A
4867169	Machida et al.	Sep 1989	A
4869263	Segal et al.	Sep 1989	A
4869718	Brader	Sep 1989	A
4873987	Djordjevich et al.	Oct 1989	A
4887606	Yock et al.	Dec 1989	A
4887615	Taylor	Dec 1989	A
4889128	Millar	Dec 1989	A
4899756	Sonek	Feb 1990	A
4901725	Nappholz et al.	Feb 1990	A
4905698	Strohl, Jr. et al.	Mar 1990	A
4911173	Terwilliger	Mar 1990	A
4911174	Pederson et al.	Mar 1990	A
4917669	Bonaldo	Apr 1990	A
4924870	Wlodarczyk et al.	May 1990	A
4943770	Ashley-Rollman et al.	Jul 1990	A
4945305	Blood	Jul 1990	A
4947852	Nassi et al.	Aug 1990	A
4957110	Vogel et al.	Sep 1990	A
4957111	Millar	Sep 1990	A
4961433	Christian	Oct 1990	A
4966148	Millar	Oct 1990	A
4967753	Haase et al.	Nov 1990	A
4977886	Takehana et al.	Dec 1990	A
4989608	Ratner	Feb 1991	A
4989610	Patton et al.	Feb 1991	A
4995396	Inaba et al.	Feb 1991	A
4998916	Hammerslag et al.	Mar 1991	A
5004456	Botterbusch et al.	Apr 1991	A
5005592	Cartmell	Apr 1991	A
5016173	Kenet et al.	May 1991	A
5025799	Wilson	Jun 1991	A
5029585	Lieber et al.	Jul 1991	A
5040548	Yock	Aug 1991	A
5042486	Pfeiler et al.	Aug 1991	A
5045071	McCormick et al.	Sep 1991	A
5046497	Millar	Sep 1991	A
5050607	Bradley et al.	Sep 1991	A
5057095	Fabian	Oct 1991	A
5058583	Geddes et al.	Oct 1991	A
5058595	Kern	Oct 1991	A
5067489	Lind	Nov 1991	A
5076278	Vilkomerson et al.	Dec 1991	A
5078140	Kwoh	Jan 1992	A
5078148	Nassi et al.	Jan 1992	A
5078149	Katsumata et al.	Jan 1992	A
5078678	Katims	Jan 1992	A
5078714	Katims	Jan 1992	A
5084022	Claude	Jan 1992	A
5092341	Kelen	Mar 1992	A
5099845	Besz et al.	Mar 1992	A
5099850	Matsui et al.	Mar 1992	A
5100387	Ng	Mar 1992	A
5105829	Fabian et al.	Apr 1992	A
5109862	Kelen et al.	May 1992	A
5114401	Stuart et al.	May 1992	A
5121750	Katims	Jun 1992	A
5125410	Misono et al.	Jun 1992	A
5134370	Jefferts et al.	Jul 1992	A
5144955	O'Hara	Sep 1992	A
5156151	Imran	Oct 1992	A
5158086	Brown et al.	Oct 1992	A
5160342	Reger et al.	Nov 1992	A
5161536	Vilkomerson et al.	Nov 1992	A
5174295	Christian et al.	Dec 1992	A
5174299	Nelson	Dec 1992	A
5184601	Putman	Feb 1993	A
5190045	Frazin	Mar 1993	A
5202985	Goyal	Apr 1993	A
5205830	Dassa et al.	Apr 1993	A
5211165	Dumoulin et al.	May 1993	A
5211636	Mische	May 1993	A
5212988	White et al.	May 1993	A
5214615	Bauer et al.	May 1993	A
5217026	Stoy et al.	Jun 1993	A
5220924	Frazin	Jun 1993	A
5233994	Shmulewitz	Aug 1993	A
5235987	Wolfe	Aug 1993	A
5239464	Blair et al.	Aug 1993	A
5240004	Walinsky et al.	Aug 1993	A
5243995	Maier	Sep 1993	A
5246007	Frisbie et al.	Sep 1993	A
5246426	Lewis et al.	Sep 1993	A
5247171	Wlodarczyk et al.	Sep 1993	A
5251635	Dumoulin et al.	Oct 1993	A
5255680	Darrow et al.	Oct 1993	A
5257636	White	Nov 1993	A
5257979	Jagpal	Nov 1993	A
5261409	Dardel	Nov 1993	A
5265610	Darrow et al.	Nov 1993	A
5265614	Hayakawa et al.	Nov 1993	A
5267569	Lienhard	Dec 1993	A
5270810	Nishimura	Dec 1993	A
5271404	Corl et al.	Dec 1993	A
5273025	Sakiyama et al.	Dec 1993	A
5273042	Lynch et al.	Dec 1993	A
5274551	Corby, Jr.	Dec 1993	A
5275053	Wlodarczyk et al.	Jan 1994	A
5279129	Ito	Jan 1994	A
5279607	Schentag et al.	Jan 1994	A
5280786	Wlodarczyk et al.	Jan 1994	A
5287331	Schindel et al.	Feb 1994	A
5289373	Zarge et al.	Feb 1994	A
5292342	Nelson et al.	Mar 1994	A
5307072	Jones, Jr.	Apr 1994	A
5311871	Yock	May 1994	A
5313949	Yock	May 1994	A
5318025	Dumoulin et al.	Jun 1994	A
5325860	Seward et al.	Jul 1994	A
5325873	Hirschi et al.	Jul 1994	A
5330496	Alferness	Jul 1994	A
5331966	Bennett et al.	Jul 1994	A
5333614	Feiring	Aug 1994	A
5337678	Grout et al.	Aug 1994	A
5341807	Nardella	Aug 1994	A
5343865	Gardineer et al.	Sep 1994	A
5345940	Seward et al.	Sep 1994	A
5348020	Hutson	Sep 1994	A
5350352	Buchholtz et al.	Sep 1994	A
5357961	Fields et al.	Oct 1994	A
5365935	Righter et al.	Nov 1994	A
5366443	Eggers et al.	Nov 1994	A
5368048	Stoy et al.	Nov 1994	A
5375596	Twiss et al.	Dec 1994	A
5376083	Mische	Dec 1994	A
5377678	Dumoulin et al.	Jan 1995	A
5385053	Wlodarczyk et al.	Jan 1995	A
5391199	Ben-Haim	Feb 1995	A
5394876	Ma	Mar 1995	A
5394877	Orr et al.	Mar 1995	A
5395366	D'Andrea et al.	Mar 1995	A
5398683	Edwards et al.	Mar 1995	A
5398691	Martin et al.	Mar 1995	A
5411485	Tennican et al.	May 1995	A
5413107	Oakley et al.	May 1995	A
5417208	Winkler	May 1995	A
5422478	Wlodarczyk et al.	Jun 1995	A
5423334	Jordan	Jun 1995	A
5423877	Mackey	Jun 1995	A
5425367	Shapiro et al.	Jun 1995	A
5425370	Vilkomerson	Jun 1995	A
5425382	Golden et al.	Jun 1995	A
5427114	Colliver et al.	Jun 1995	A
5429132	Guy et al.	Jul 1995	A
5429617	Hammersmark et al.	Jul 1995	A
5431641	Grozinger et al.	Jul 1995	A
5433729	Adams et al.	Jul 1995	A
5437276	Takada et al.	Aug 1995	A
5437277	Dumoulin et al.	Aug 1995	A
5438873	Wlodarczyk et al.	Aug 1995	A
5443066	Dumoulin et al.	Aug 1995	A
5443489	Ben-Haim	Aug 1995	A
5445150	Dumoulin et al.	Aug 1995	A
5445166	Taylor	Aug 1995	A
5450846	Goldreyer	Sep 1995	A
5453575	O'Donnell et al.	Sep 1995	A
5453576	Krivitski	Sep 1995	A
5456256	Schneider	Oct 1995	A
5456718	Szymaitis	Oct 1995	A
5464016	Nicholas et al.	Nov 1995	A
5474065	Meathrel et al.	Dec 1995	A
5476090	Kishi	Dec 1995	A
5480422	Ben-Haim	Jan 1996	A
5487729	Avellanet et al.	Jan 1996	A
5490522	Dardel	Feb 1996	A
5492538	Johlin, Jr.	Feb 1996	A
5494038	Wang et al.	Feb 1996	A
5500011	Desai	Mar 1996	A
5500012	Brucker et al.	Mar 1996	A
5505205	Solomon et al.	Apr 1996	A
5509822	Negus et al.	Apr 1996	A
5513637	Twiss et al.	May 1996	A
5515160	Schulz et al.	May 1996	A
5515853	Smith et al.	May 1996	A
5517989	Frisbie et al.	May 1996	A
5522878	Montecalvo et al.	Jun 1996	A
5522880	Barone et al.	Jun 1996	A
5526812	Dumoulin et al.	Jun 1996	A
5531664	Adachi et al.	Jul 1996	A
5536248	Weaver et al.	Jul 1996	A
5540230	Vilkomerson	Jul 1996	A
5540681	Strul et al.	Jul 1996	A
5542938	Avellanet et al.	Aug 1996	A
5546949	Frazin et al.	Aug 1996	A
5546951	Ben-Haim	Aug 1996	A
5555618	Winkler	Sep 1996	A
5558091	Acker et al.	Sep 1996	A
5568809	Ben-haim	Oct 1996	A
D375450	Bidwell et al.	Nov 1996	S
5570671	Hickey	Nov 1996	A
5575291	Hayakawa et al.	Nov 1996	A
5588442	Scovil et al.	Dec 1996	A
5592939	Martinelli	Jan 1997	A
5598846	Peszynski	Feb 1997	A
5599299	Weaver et al.	Feb 1997	A
5600330	Blood	Feb 1997	A
5603333	Konings	Feb 1997	A
5610967	Moorman et al.	Mar 1997	A
5617866	Marian, Jr.	Apr 1997	A
5622169	Golden et al.	Apr 1997	A
5622170	Schulz	Apr 1997	A
5622184	Ashby et al.	Apr 1997	A
5623931	Wung et al.	Apr 1997	A
5624430	Eton et al.	Apr 1997	A
5626554	Ryaby et al.	May 1997	A
5626870	Monshipouri et al.	May 1997	A
5630419	Ranalletta	May 1997	A
5638819	Manwaring et al.	Jun 1997	A
5644612	Moorman et al.	Jul 1997	A
5645065	Shapiro et al.	Jul 1997	A
5651047	Moorman et al.	Jul 1997	A
5654864	Ritter et al.	Aug 1997	A
D383968	Bidwell et al.	Sep 1997	S
5662115	Torp et al.	Sep 1997	A
5665103	Lafontaine et al.	Sep 1997	A
5665477	Meathrel et al.	Sep 1997	A
5666473	Wallace	Sep 1997	A
5666958	Rothenberg et al.	Sep 1997	A
5669383	Johnson	Sep 1997	A
5669388	Vilkomerson	Sep 1997	A
5676159	Navis	Oct 1997	A
5676673	Ferre et al.	Oct 1997	A
5682890	Kormos et al.	Nov 1997	A
5691898	Rosenberg et al.	Nov 1997	A
5694945	Ben-Haim	Dec 1997	A
5695479	Jagpal	Dec 1997	A
5697377	Wittkampf	Dec 1997	A
5699801	Atalar et al.	Dec 1997	A
5700889	Blair	Dec 1997	A
5701898	Adam et al.	Dec 1997	A
5702433	Taylor et al.	Dec 1997	A
5711299	Manwaring et al.	Jan 1998	A
5713362	Vilkomerson	Feb 1998	A
5713363	Seward et al.	Feb 1998	A
5713858	Heruth et al.	Feb 1998	A
5713946	Ben-Haim	Feb 1998	A
5715817	Stevens-Wright et al.	Feb 1998	A
5716389	Walinsky et al.	Feb 1998	A
5718241	Ben-Haim et al.	Feb 1998	A
D391838	Bidwell et al.	Mar 1998	S
5722412	Pflugrath et al.	Mar 1998	A
5727550	Montecalvo	Mar 1998	A
5727552	Ryan	Mar 1998	A
5727553	Saad	Mar 1998	A
5729055	Manning	Mar 1998	A
5729129	Acker	Mar 1998	A
5729584	Moorman et al.	Mar 1998	A
5730129	Darrow et al.	Mar 1998	A
5731996	Gilbert	Mar 1998	A
5733323	Buck et al.	Mar 1998	A
5738096	Ben-Haim	Apr 1998	A
5740808	Panescu et al.	Apr 1998	A
5742394	Hansen	Apr 1998	A
5744953	Hansen	Apr 1998	A
5748767	Raab	May 1998	A
5749835	Glantz	May 1998	A
5749938	Coombs	May 1998	A
5751785	Moorman et al.	May 1998	A
5752513	Acker et al.	May 1998	A
5758650	Miller et al.	Jun 1998	A
5762064	Polvani	Jun 1998	A
5767669	Hansen et al.	Jun 1998	A
5767960	Orman et al.	Jun 1998	A
5769786	Wiegel	Jun 1998	A
5769843	Abela et al.	Jun 1998	A
5769881	Schroeppel et al.	Jun 1998	A
5771896	Sliwa, Jr. et al.	Jun 1998	A
5775322	Silverstein	Jul 1998	A
5775332	Goldman	Jul 1998	A
5776064	Kalfas et al.	Jul 1998	A
5776080	Thome et al.	Jul 1998	A
5779638	Vesely et al.	Jul 1998	A
5782767	Pretlow, III	Jul 1998	A
5782773	Kuo et al.	Jul 1998	A
5785657	Breyer et al.	Jul 1998	A
5792055	McKinnon et al.	Aug 1998	A
5795297	Daigle	Aug 1998	A
5795298	Vesely et al.	Aug 1998	A
5795632	Buchalter	Aug 1998	A
5797849	Vesely et al.	Aug 1998	A
5800352	Ferre et al.	Sep 1998	A
5800410	Gawreluk	Sep 1998	A
5800497	Bakels et al.	Sep 1998	A
5803089	Ferre et al.	Sep 1998	A
5810733	Van Creveld et al.	Sep 1998	A
RE35924	Winkler	Oct 1998	E
5817022	Vesely	Oct 1998	A
5817024	Ogle et al.	Oct 1998	A
5820549	Marian, Jr.	Oct 1998	A
5824031	Cookston et al.	Oct 1998	A
5827192	Gopakumaran et al.	Oct 1998	A
5829444	Ferre et al.	Nov 1998	A
5830145	Tenhoff	Nov 1998	A
5831260	Hansen	Nov 1998	A
5833608	Acker	Nov 1998	A
5833622	Meathrel et al.	Nov 1998	A
5835561	Moorman et al.	Nov 1998	A
5836882	Frazin	Nov 1998	A
5836990	Li	Nov 1998	A
5840024	Taniguchi et al.	Nov 1998	A
5840025	Ben-Haim	Nov 1998	A
5840030	Ferek-Petric et al.	Nov 1998	A
5840031	Crowley	Nov 1998	A
5842986	Avrin et al.	Dec 1998	A
5842998	Gopakumaran et al.	Dec 1998	A
5843076	Webster, Jr. et al.	Dec 1998	A
5843153	Johnston et al.	Dec 1998	A
5844140	Seale	Dec 1998	A
5846198	Killmann	Dec 1998	A
5855553	Tajima et al.	Jan 1999	A
5859893	Moorman et al.	Jan 1999	A
5865748	Co et al.	Feb 1999	A
5868673	Vesely	Feb 1999	A
5873822	Ferre et al.	Feb 1999	A
5876328	Fox et al.	Mar 1999	A
5879297	Haynor et al.	Mar 1999	A
5893363	Little et al.	Apr 1999	A
5897495	Aida et al.	Apr 1999	A
5899860	Pfeiffer et al.	May 1999	A
5902238	Golden et al.	May 1999	A
5907487	Rosenberg et al.	May 1999	A
5908385	Chechelski et al.	Jun 1999	A
5910113	Pruter	Jun 1999	A
5910120	Kim et al.	Jun 1999	A
5913820	Bladen et al.	Jun 1999	A
5913830	Miles	Jun 1999	A
5919141	Money et al.	Jul 1999	A
5919170	Woessner	Jul 1999	A
5928145	Ocali et al.	Jul 1999	A
5929607	Rosenberg et al.	Jul 1999	A
5931788	Keen et al.	Aug 1999	A
5931818	Werp et al.	Aug 1999	A
5931863	Griffin, III et al.	Aug 1999	A
5941858	Johnson	Aug 1999	A
5941889	Cermak	Aug 1999	A
5941904	Johnston et al.	Aug 1999	A
5944022	Nardella et al.	Aug 1999	A
5944023	Johnson et al.	Aug 1999	A
5951598	Bishay et al.	Sep 1999	A
5953683	Hansen et al.	Sep 1999	A
5957857	Hartley	Sep 1999	A
5961923	Nova et al.	Oct 1999	A
5967978	Littmann et al.	Oct 1999	A
5967980	Ferre et al.	Oct 1999	A
5967991	Gardineer et al.	Oct 1999	A
5969722	Palm	Oct 1999	A
5971933	Gopakumaran et al.	Oct 1999	A
5978705	KenKnight et al.	Nov 1999	A
5983126	Wittkampf	Nov 1999	A
5984908	Davis et al.	Nov 1999	A
5991693	Zalewski	Nov 1999	A
5997473	Taniguchi et al.	Dec 1999	A
5997481	Adams et al.	Dec 1999	A
6006123	Nguyen et al.	Dec 1999	A
6011988	Lynch et al.	Jan 2000	A
6014473	Hossack et al.	Jan 2000	A
6014580	Blume et al.	Jan 2000	A
6015414	Werp et al.	Jan 2000	A
6017496	Nova et al.	Jan 2000	A
6019724	Gronningsaeter et al.	Feb 2000	A
6019725	Vesely et al.	Feb 2000	A
6023638	Swanson	Feb 2000	A
6026312	Shemwell et al.	Feb 2000	A
6031765	Lee et al.	Feb 2000	A
6032070	Flock et al.	Feb 2000	A
6039694	Larson et al.	Mar 2000	A
6050718	Schena et al.	Apr 2000	A
6052610	Koch	Apr 2000	A
6052618	Dahlke et al.	Apr 2000	A
D424693	Pruter	May 2000	S
6059718	Taniguchi et al.	May 2000	A
6064905	Webster, Jr. et al.	May 2000	A
6066094	Ben-Haim	May 2000	A
6068599	Saito et al.	May 2000	A
6073043	Schneider	Jun 2000	A
6074367	Hubbell	Jun 2000	A
6075442	Welch	Jun 2000	A
6076007	England et al.	Jun 2000	A
6081737	Shah	Jun 2000	A
6082366	Andra et al.	Jul 2000	A
6083170	Ben-Haim	Jul 2000	A
6099524	Lipson et al.	Aug 2000	A
6100026	Nova et al.	Aug 2000	A
6102044	Naidyhorski	Aug 2000	A
6107699	Swanson	Aug 2000	A
6112111	Glantz	Aug 2000	A
6112115	Feldman et al.	Aug 2000	A
6113504	Kuesters	Sep 2000	A
6115624	Lewis et al.	Sep 2000	A
6120445	Grunwald	Sep 2000	A
6122533	Sliwa, Jr. et al.	Sep 2000	A
6128174	Ritter et al.	Oct 2000	A
6129668	Haynor et al.	Oct 2000	A
6132378	Marino	Oct 2000	A
6132379	Patacsil et al.	Oct 2000	A
6135961	Pflugrath et al.	Oct 2000	A
6136274	Nova et al.	Oct 2000	A
6138681	Chen et al.	Oct 2000	A
6139496	Chen et al.	Oct 2000	A
6139502	Fredriksen	Oct 2000	A
6144300	Dames	Nov 2000	A
6148823	Hastings	Nov 2000	A
6152933	Werp et al.	Nov 2000	A
6157853	Blume et al.	Dec 2000	A
6165144	Talish et al.	Dec 2000	A
6165977	Mochly-Rosen	Dec 2000	A
6166496	Lys et al.	Dec 2000	A
6166806	Tjin	Dec 2000	A
6167765	Weitzel	Jan 2001	B1
6172499	Ashe	Jan 2001	B1
6173199	Gabriel	Jan 2001	B1
6173715	Sinanan et al.	Jan 2001	B1
6175756	Ferre et al.	Jan 2001	B1
6176829	Vilkomerson	Jan 2001	B1
6187744	Rooney	Feb 2001	B1
6190370	Tsui	Feb 2001	B1
6191136	Marban	Feb 2001	B1
6193743	Brayton et al.	Feb 2001	B1
6200305	Berthiaume et al.	Mar 2001	B1
6203499	Imling et al.	Mar 2001	B1
6208884	Kumar et al.	Mar 2001	B1
6211626	Lys et al.	Apr 2001	B1
6211666	Acker	Apr 2001	B1
6212426	Swanson	Apr 2001	B1
6216027	Willis et al.	Apr 2001	B1
6216028	Haynor et al.	Apr 2001	B1
6216029	Paltieli	Apr 2001	B1
6223087	Williams	Apr 2001	B1
6226547	Lockhart et al.	May 2001	B1
6230042	Slettenmark	May 2001	B1
6230046	Crane et al.	May 2001	B1
6231518	Grabek et al.	May 2001	B1
6233476	Strommer et al.	May 2001	B1
6233994	Roy et al.	May 2001	B1
6236883	Ciaccio et al.	May 2001	B1
6238344	Gamelsky et al.	May 2001	B1
6241673	Williams	Jun 2001	B1
6246231	Ashe	Jun 2001	B1
6246898	Vesely et al.	Jun 2001	B1
6248072	Murkin	Jun 2001	B1
6248074	Ohno et al.	Jun 2001	B1
6248075	McGee et al.	Jun 2001	B1
6253770	Acker et al.	Jul 2001	B1
6258035	Hoeksel et al.	Jul 2001	B1
6259941	Chia et al.	Jul 2001	B1
6261231	Damphousse et al.	Jul 2001	B1
6263230	Haynor et al.	Jul 2001	B1
6266550	Selmon et al.	Jul 2001	B1
6266551	Osadchy et al.	Jul 2001	B1
6266552	Slettenmark	Jul 2001	B1
6266563	KenKnight et al.	Jul 2001	B1
6270493	Lalonde et al.	Aug 2001	B1
6271833	Rosenberg et al.	Aug 2001	B1
6272371	Shlomo	Aug 2001	B1
6272374	Flock et al.	Aug 2001	B1
6275258	Chim	Aug 2001	B1
6275724	Dickinson et al.	Aug 2001	B1
6277077	Brisken et al.	Aug 2001	B1
6284459	Nova et al.	Sep 2001	B1
6285898	Ben-Haim	Sep 2001	B1
6287260	Hascoet et al.	Sep 2001	B1
6288704	Flack et al.	Sep 2001	B1
6292678	Hall et al.	Sep 2001	B1
6292680	Somogyi et al.	Sep 2001	B1
6292901	Lys et al.	Sep 2001	B1
6293955	Houser et al.	Sep 2001	B1
6296604	Garibaldi et al.	Oct 2001	B1
6298261	Rex	Oct 2001	B1
6304768	Blume et al.	Oct 2001	B1
6306097	Park et al.	Oct 2001	B1
6306105	Rooney et al.	Oct 2001	B1
6311082	Creighton, IV et al.	Oct 2001	B1
6315709	Garibaldi et al.	Nov 2001	B1
6315727	Coleman et al.	Nov 2001	B1
6319668	Nova et al.	Nov 2001	B1
6323769	Dames et al.	Nov 2001	B1
6323770	Dames et al.	Nov 2001	B1
6324416	Seibert	Nov 2001	B1
6325540	Lounsberry et al.	Dec 2001	B1
6325762	Tjin	Dec 2001	B1
6329139	Nova et al.	Dec 2001	B1
6329916	Dames et al.	Dec 2001	B1
6330467	Creighton, IV et al.	Dec 2001	B1
6332089	Acker et al.	Dec 2001	B1
6332874	Eliasen et al.	Dec 2001	B1
6340588	Nova et al.	Jan 2002	B1
6340868	Lys et al.	Jan 2002	B1
6341231	Ferre et al.	Jan 2002	B1
6346081	Vilkomerson	Feb 2002	B1
6348911	Rosenberg et al.	Feb 2002	B1
6350160	Feuersanger et al.	Feb 2002	B1
6352363	Munger et al.	Mar 2002	B1
6354999	Dgany et al.	Mar 2002	B1
6355026	Mick	Mar 2002	B1
6356791	Westlund et al.	Mar 2002	B1
6360123	Kimchi et al.	Mar 2002	B1
6361499	Bates et al.	Mar 2002	B1
6364823	Garibaldi et al.	Apr 2002	B1
6364839	Little et al.	Apr 2002	B1
6366804	Mejia	Apr 2002	B1
6368285	Osadchy et al.	Apr 2002	B1
6370411	Osadchy et al.	Apr 2002	B1
6373240	Govari	Apr 2002	B1
6373388	Dames et al.	Apr 2002	B1
6374134	Bladen et al.	Apr 2002	B1
6374670	Spelman et al.	Apr 2002	B1
6375606	Garibaldi et al.	Apr 2002	B1
6375639	Duplessie et al.	Apr 2002	B1
6377857	Brayton et al.	Apr 2002	B1
6379302	Kessman et al.	Apr 2002	B1
6379303	Seitz et al.	Apr 2002	B1
6379307	Filly et al.	Apr 2002	B1
6381485	Hunter et al.	Apr 2002	B1
6385472	Hall et al.	May 2002	B1
6385476	Osadchy et al.	May 2002	B1
6398736	Seward	Jun 2002	B1
6398738	Millar	Jun 2002	B1
6401723	Garibaldi et al.	Jun 2002	B1
6406422	Landesberg	Jun 2002	B1
6406442	McFann et al.	Jun 2002	B1
6412978	Watanabe et al.	Jul 2002	B1
6412980	Lounsberry et al.	Jul 2002	B1
6417839	Odell	Jul 2002	B1
6418332	Mastrototaro et al.	Jul 2002	B1
6418335	Avrin et al.	Jul 2002	B2
6423002	Hossack	Jul 2002	B1
6423050	Twardowski	Jul 2002	B1
6427079	Schneider et al.	Jul 2002	B1
6428551	Hall et al.	Aug 2002	B1
6430315	Makram-Ebeid	Aug 2002	B1
6432069	Godo et al.	Aug 2002	B1
6438411	Guttman et al.	Aug 2002	B1
6442416	Schultz	Aug 2002	B1
6445943	Ferre et al.	Sep 2002	B1
6456874	Hafer et al.	Sep 2002	B1
6459919	Lys et al.	Oct 2002	B1
6463121	Milnes	Oct 2002	B1
6466815	Saito et al.	Oct 2002	B1
6471656	Shalman et al.	Oct 2002	B1
6471658	Daniels et al.	Oct 2002	B1
6471700	Burbank et al.	Oct 2002	B1
6473167	Odell	Oct 2002	B1
6474341	Hunter et al.	Nov 2002	B1
6475152	Kelly, Jr. et al.	Nov 2002	B1
6475223	Werp et al.	Nov 2002	B1
6477402	Lynch et al.	Nov 2002	B1
6484118	Govari	Nov 2002	B1
6487916	Gomm et al.	Dec 2002	B1
6491671	Larson, III et al.	Dec 2002	B1
6493573	Martinelli et al.	Dec 2002	B1
6494832	Feldman et al.	Dec 2002	B1
6496715	Lee et al.	Dec 2002	B1
6498944	Ben-Haim et al.	Dec 2002	B1
6500141	Irion et al.	Dec 2002	B1
6505062	Ritter et al.	Jan 2003	B1
6506159	Hascoet et al.	Jan 2003	B2
6507751	Blume et al.	Jan 2003	B2
6508802	Rosengart et al.	Jan 2003	B1
6511413	Landesberg	Jan 2003	B2
6512958	Swoyer et al.	Jan 2003	B1
6514226	Levin et al.	Feb 2003	B1
6514249	Maguire et al.	Feb 2003	B1
6515657	Zanelli	Feb 2003	B1
6516212	Bladen et al.	Feb 2003	B1
6516231	Flammang	Feb 2003	B1
6516807	Panescu et al.	Feb 2003	B1
6517520	Chang et al.	Feb 2003	B2
6522906	Salisbury, Jr. et al.	Feb 2003	B1
6522907	Bladen et al.	Feb 2003	B1
6522909	Garibaldi et al.	Feb 2003	B1
6524303	Garibaldi	Feb 2003	B1
6528954	Lys et al.	Mar 2003	B1
6528991	Ashe	Mar 2003	B2
6529761	Creighton, IV et al.	Mar 2003	B2
6529766	Guendel	Mar 2003	B1
6534982	Jakab	Mar 2003	B1
6535625	Chang et al.	Mar 2003	B1
6537192	Elliott et al.	Mar 2003	B1
6537196	Creighton, IV et al.	Mar 2003	B1
6538634	Chui et al.	Mar 2003	B1
6540699	Smith et al.	Apr 2003	B1
6542766	Hall et al.	Apr 2003	B2
6544251	Crawford	Apr 2003	B1
6545678	Ohazama	Apr 2003	B1
6546270	Goldin et al.	Apr 2003	B1
6546279	Bova et al.	Apr 2003	B1
6546787	Schiller et al.	Apr 2003	B1
6552841	Lasser et al.	Apr 2003	B1
6556858	Zeman	Apr 2003	B1
6562019	Sell	May 2003	B1
6564087	Pitris et al.	May 2003	B1
6569101	Quistgaard et al.	May 2003	B2
6569103	Hoeksel et al.	May 2003	B2
6569160	Goldin et al.	May 2003	B1
6569862	Marban	May 2003	B1
6571004	Florent et al.	May 2003	B1
6574518	Lounsberry et al.	Jun 2003	B1
6575908	Barnes et al.	Jun 2003	B2
6577080	Lys et al.	Jun 2003	B2
6577896	Werner et al.	Jun 2003	B2
6584343	Ransbury et al.	Jun 2003	B1
6593754	Steber et al.	Jul 2003	B1
6593884	Gilboa et al.	Jul 2003	B1
6597943	Taha et al.	Jul 2003	B2
6599249	Nordgren et al.	Jul 2003	B1
6607488	Jackson et al.	Aug 2003	B1
6610058	Flores	Aug 2003	B2
6611141	Schulz et al.	Aug 2003	B1
6615071	Casscells, III et al.	Sep 2003	B1
6615155	Gilboa	Sep 2003	B2
6616610	Steininger et al.	Sep 2003	B2
6618612	Acker et al.	Sep 2003	B1
6626832	Paltieli et al.	Sep 2003	B1
6626834	Dunne et al.	Sep 2003	B2
6626902	Kucharczyk et al.	Sep 2003	B1
6630879	Creighton, IV et al.	Oct 2003	B1
6635027	Cragg et al.	Oct 2003	B1
6645148	Nguyen-Dinh et al.	Nov 2003	B2
6648875	Simpson et al.	Nov 2003	B2
6649914	Moorman et al.	Nov 2003	B1
6652505	Tsugita	Nov 2003	B1
6652506	Bowe et al.	Nov 2003	B2
6660024	Flaherty et al.	Dec 2003	B1
6662034	Segner et al.	Dec 2003	B2
6663661	Boneau	Dec 2003	B2
6666828	Greco et al.	Dec 2003	B2
6672308	Gaspari	Jan 2004	B1
6677752	Creighton, IV et al.	Jan 2004	B1
6679857	Bastia et al.	Jan 2004	B1
6684176	Willins et al.	Jan 2004	B2
6685644	Seo	Feb 2004	B2
6687531	Ferre et al.	Feb 2004	B1
6689119	Di Caprio et al.	Feb 2004	B1
6690963	Ben-Haim et al.	Feb 2004	B2
6690964	Bieger et al.	Feb 2004	B2
6690968	Mejia	Feb 2004	B2
6694167	Ferre et al.	Feb 2004	B1
6695786	Wang et al.	Feb 2004	B2
6701179	Martinelli et al.	Mar 2004	B1
6701918	Fariss et al.	Mar 2004	B2
6702804	Ritter et al.	Mar 2004	B1
6704590	Haldeman	Mar 2004	B2
6709390	Marie Pop	Mar 2004	B1
6711429	Gilboa et al.	Mar 2004	B1
6711431	Sarin et al.	Mar 2004	B2
6719699	Smith	Apr 2004	B2
6719724	Walker et al.	Apr 2004	B1
6719756	Muntermann	Apr 2004	B1
6720745	Lys et al.	Apr 2004	B2
6733458	Steins	May 2004	B1
6733511	Hall et al.	May 2004	B2
6736782	Pfeiffer et al.	May 2004	B2
6738656	Ferre et al.	May 2004	B1
6740103	Hall et al.	May 2004	B2
6743177	Ito	Jun 2004	B2
6754596	Ashe	Jun 2004	B2
6755789	Stringer et al.	Jun 2004	B2
6755816	Ritter et al.	Jun 2004	B2
6755822	Reu et al.	Jun 2004	B2
6757557	Bladen et al.	Jun 2004	B1
6763261	Casscells, III et al.	Jul 2004	B2
6764449	Lee et al.	Jul 2004	B2
6768496	Bieger et al.	Jul 2004	B2
6772001	Maschke	Aug 2004	B2
6774624	Anderson et al.	Aug 2004	B2
6783536	Vilsmeier et al.	Aug 2004	B2
6784660	Ashe	Aug 2004	B2
6785571	Glossop	Aug 2004	B2
6786219	Garibaldi et al.	Sep 2004	B2
6786870	Miyaki et al.	Sep 2004	B2
6788967	Ben-Haim et al.	Sep 2004	B2
6794667	Noshi	Sep 2004	B2
6799066	Steines et al.	Sep 2004	B2
6815651	Odell	Nov 2004	B2
6816266	Varshneya et al.	Nov 2004	B2
6817364	Garibaldi et al.	Nov 2004	B2
6834201	Gillies et al.	Dec 2004	B2
6844713	Steber et al.	Jan 2005	B2
6845142	Ohishi	Jan 2005	B2
6856823	Ashe	Feb 2005	B2
6860422	Hull et al.	Mar 2005	B2
6862467	Moore et al.	Mar 2005	B2
6869390	Elliott et al.	Mar 2005	B2
6875179	Ferguson et al.	Apr 2005	B2
6879160	Jakab	Apr 2005	B2
6887206	Hoeksel et al.	May 2005	B2
6889091	Hine et al.	May 2005	B2
6895268	Rahn et al.	May 2005	B1
6902528	Garibaldi et al.	Jun 2005	B1
6905469	Hascoet et al.	Jun 2005	B2
6908433	Pruter	Jun 2005	B1
6911026	Hall et al.	Jun 2005	B1
6923782	O'Mahony et al.	Aug 2005	B2
6926673	Roberts et al.	Aug 2005	B2
6926674	Tenerz et al.	Aug 2005	B2
6934575	Ferre et al.	Aug 2005	B2
6936010	Fang et al.	Aug 2005	B2
6939313	Saadat et al.	Sep 2005	B2
6940379	Creighton	Sep 2005	B2
6941166	MacAdam et al.	Sep 2005	B2
6947788	Gilboa et al.	Sep 2005	B2
6950689	Willis et al.	Sep 2005	B1
6953754	Machida et al.	Oct 2005	B2
6958677	Carter	Oct 2005	B1
6959214	Pape et al.	Oct 2005	B2
6962566	Quistgaard et al.	Nov 2005	B2
6968846	Viswanathan	Nov 2005	B2
6975197	Creighton, IV	Dec 2005	B2
6976962	Bullis	Dec 2005	B2
6976987	Flores	Dec 2005	B2
6980843	Eng et al.	Dec 2005	B2
6980852	Jersey-Willuhn et al.	Dec 2005	B2
6980921	Anderson et al.	Dec 2005	B2
6986739	Warren et al.	Jan 2006	B2
6986744	Krivitski	Jan 2006	B1
6999821	Jenney et al.	Feb 2006	B2
7001355	Nunomura et al.	Feb 2006	B2
7008418	Hall et al.	Mar 2006	B2
7010338	Ritter et al.	Mar 2006	B2
7015393	Weiner et al.	Mar 2006	B2
7017584	Garibaldi et al.	Mar 2006	B2
7019610	Creighton, IV et al.	Mar 2006	B2
7020512	Ritter et al.	Mar 2006	B2
D518574	Chaggares	Apr 2006	S
7022075	Grunwald et al.	Apr 2006	B2
7022082	Sonek	Apr 2006	B2
7026927	Wright et al.	Apr 2006	B2
7027634	Odell	Apr 2006	B2
7028387	Huynh et al.	Apr 2006	B1
7029446	Wendelken et al.	Apr 2006	B2
7033603	Nelson et al.	Apr 2006	B2
D520139	Chaggares	May 2006	S
D520140	Chaggares	May 2006	S
7038398	Lys et al.	May 2006	B1
7038657	Rosenberg et al.	May 2006	B2
7043293	Baura	May 2006	B1
7048733	Hartley et al.	May 2006	B2
7054228	Hickling	May 2006	B1
7065403	Mouchawar et al.	Jun 2006	B1
7066914	Andersen	Jun 2006	B2
7066924	Garibaldi et al.	Jun 2006	B1
7069072	Jansen et al.	Jun 2006	B2
D525363	Chaggares	Jul 2006	S
7070565	Vaezy et al.	Jul 2006	B2
7072704	Bucholz	Jul 2006	B2
7082325	Hashimshony et al.	Jul 2006	B2
7090639	Govari	Aug 2006	B2
7096059	Geddes et al.	Aug 2006	B2
7096148	Anderson et al.	Aug 2006	B2
7096870	Lamprich et al.	Aug 2006	B2
7098907	Houston et al.	Aug 2006	B2
7103205	Wang et al.	Sep 2006	B2
7104980	Laherty et al.	Sep 2006	B1
7106043	Da Silva et al.	Sep 2006	B1
7106431	Odell	Sep 2006	B2
7106479	Roy et al.	Sep 2006	B2
7107105	Bjorklund et al.	Sep 2006	B2
7112197	Hartley et al.	Sep 2006	B2
7128734	Wilson et al.	Oct 2006	B1
7132804	Lys et al.	Nov 2006	B2
7137976	Ritter et al.	Nov 2006	B2
7141019	Pearlman	Nov 2006	B2
7141812	Appleby et al.	Nov 2006	B2
7142905	Slayton et al.	Nov 2006	B2
7148970	de Boer	Dec 2006	B2
7153291	Bierman	Dec 2006	B2
7161453	Creighton, IV	Jan 2007	B2
7162291	Nachaliel	Jan 2007	B1
7167738	Schweikard et al.	Jan 2007	B2
7169107	Jersey-Willuhn et al.	Jan 2007	B2
7169109	Jansen et al.	Jan 2007	B2
7174201	Govari et al.	Feb 2007	B2
7175646	Brenneman et al.	Feb 2007	B2
7180252	Lys et al.	Feb 2007	B2
7184820	Jersey-Willuhn et al.	Feb 2007	B2
7189198	Harburn et al.	Mar 2007	B2
7189205	McMorrow et al.	Mar 2007	B2
7189208	Beatty et al.	Mar 2007	B1
7190819	Viswanathan	Mar 2007	B2
7194295	Vilsmeier	Mar 2007	B2
7204798	Zdeblick et al.	Apr 2007	B2
7206064	Rogers et al.	Apr 2007	B2
7207941	Sharf	Apr 2007	B2
7211082	Hall et al	May 2007	B2
7214191	Stringer et al.	May 2007	B2
7215326	Rosenberg	May 2007	B2
7221104	Lys et al.	May 2007	B2
7223256	Bierman	May 2007	B2
7229400	Elliott et al.	Jun 2007	B2
7231243	Tearney et al.	Jun 2007	B2
7236157	Schena et al.	Jun 2007	B2
7236816	Kumar et al.	Jun 2007	B2
7236820	Mabary et al.	Jun 2007	B2
7237313	Skujins et al.	Jul 2007	B2
7241267	Furia	Jul 2007	B2
7244234	Ridley et al.	Jul 2007	B2
7248032	Hular et al.	Jul 2007	B1
7248914	Hastings et al.	Jul 2007	B2
7252633	Obata et al.	Aug 2007	B2
7264584	Ritter et al.	Sep 2007	B2
7270662	Visram et al.	Sep 2007	B2
7274958	Jutras	Sep 2007	B2
7276044	Ferry et al.	Oct 2007	B2
7286034	Creighton	Oct 2007	B2
7291146	Steinke et al.	Nov 2007	B2
7297140	Orlu et al.	Nov 2007	B2
7300430	Wilson et al.	Nov 2007	B2
7302288	Schellenberg	Nov 2007	B1
7308296	Lys et al.	Dec 2007	B2
7310150	Guillermo et al.	Dec 2007	B2
7311702	Tallarida et al.	Dec 2007	B2
7321228	Govari	Jan 2008	B2
7326241	Jang	Feb 2008	B2
7327872	Vaillant et al.	Feb 2008	B2
7342058	Peppmoller et al.	Mar 2008	B2
7349732	Kil et al.	Mar 2008	B1
7355716	de Boer et al.	Apr 2008	B2
7360427	Drinkwater et al.	Apr 2008	B2
7366376	Shishkov et al.	Apr 2008	B2
7366562	Dukesherer et al.	Apr 2008	B2
7366563	Kleen et al.	Apr 2008	B2
7373271	Schneider	May 2008	B1
7381204	Wilson et al.	Jun 2008	B2
7382949	Bouma et al.	Jun 2008	B2
7384407	Rodriguez et al.	Jun 2008	B2
7418169	Tearney et al.	Aug 2008	B2
7447408	Bouma et al.	Nov 2008	B2
7452331	Pruter	Nov 2008	B1
7452358	Stern et al.	Nov 2008	B2
7454244	Kassab et al.	Nov 2008	B2
D585556	Kosaku	Jan 2009	S
7479141	Kleen et al.	Jan 2009	B2
7519424	Dennis et al.	Apr 2009	B2
7529584	Laske et al.	May 2009	B2
7534223	Boutilette et al.	May 2009	B2
7538859	Tearney et al.	May 2009	B2
7543239	Viswanathan et al.	Jun 2009	B2
7547282	Lo et al.	Jun 2009	B2
7551293	Yelin et al.	Jun 2009	B2
D603050	Chen	Oct 2009	S
7599730	Hunter et al.	Oct 2009	B2
7606615	Makower et al.	Oct 2009	B2
7616992	Dennis et al.	Nov 2009	B2
7627376	Dennis et al.	Dec 2009	B2
7635336	Pruter	Dec 2009	B1
7637163	Fetzer et al.	Dec 2009	B2
7640053	Verin	Dec 2009	B2
7651469	Osborne et al.	Jan 2010	B2
7652080	Peppmoller et al.	Jan 2010	B2
7660623	Hunter et al.	Feb 2010	B2
7665893	Buchalter	Feb 2010	B2
7668583	Fegert et al.	Feb 2010	B2
7697972	Verard et al.	Apr 2010	B2
7699782	Angelsen et al.	Apr 2010	B2
7699829	Harris et al.	Apr 2010	B2
7715925	Hafer et al.	May 2010	B2
7727192	Tokumoto et al.	Jun 2010	B2
7729743	Sabczynski et al.	Jun 2010	B2
7751865	Jascob et al.	Jul 2010	B2
7766839	Rogers et al.	Aug 2010	B2
7771437	Hogg et al.	Aug 2010	B2
7774051	Voth	Aug 2010	B2
7774055	Min	Aug 2010	B1
7794407	Rothenberg	Sep 2010	B2
7798970	Lo et al.	Sep 2010	B2
7819810	Stringer et al.	Oct 2010	B2
7828528	Estes et al.	Nov 2010	B2
7831294	Viswanathan	Nov 2010	B2
7833168	Taylor et al.	Nov 2010	B2
7833214	Wilson et al.	Nov 2010	B2
D629526	Ladwig et al.	Dec 2010	S
D629527	Crunkilton	Dec 2010	S
7846157	Kozel	Dec 2010	B2
7850613	Stribling	Dec 2010	B2
D630756	Kitayama	Jan 2011	S
D630757	Kitayama	Jan 2011	S
7869854	Shachar et al.	Jan 2011	B2
7873402	Shachar	Jan 2011	B2
7909815	Whitmore, III et al.	Mar 2011	B2
7931596	Rachlin et al.	Apr 2011	B2
7947040	Davies et al.	May 2011	B2
7962196	Tuma	Jun 2011	B2
7966063	Oshima	Jun 2011	B2
7976469	Bonde et al.	Jul 2011	B2
7976518	Shaughnessy et al.	Jul 2011	B2
7981038	Kanade et al.	Jul 2011	B2
7988633	Hossack et al.	Aug 2011	B2
8016814	Blakstvedt et al.	Sep 2011	B2
8046052	Verard et al.	Oct 2011	B2
8057394	Dala-Krishna	Nov 2011	B2
8060185	Hunter et al.	Nov 2011	B2
8078274	Kassab	Dec 2011	B2
8078279	Dennis et al.	Dec 2011	B2
8082032	Kassab et al.	Dec 2011	B2
8088072	Munrow et al.	Jan 2012	B2
8090430	Makower et al.	Jan 2012	B2
8099161	Kassab	Jan 2012	B2
8114143	Kassab et al.	Feb 2012	B2
8118743	Park et al.	Feb 2012	B2
8123691	Mine et al.	Feb 2012	B2
8133698	Silver	Mar 2012	B2
8142417	Pajunk et al.	Mar 2012	B2
8150522	Echauz et al.	Apr 2012	B2
8152724	Ridley et al.	Apr 2012	B2
8165366	Haimerl	Apr 2012	B2
8204582	Zantos et al.	Jun 2012	B2
8214018	Markowitz et al.	Jul 2012	B2
8221402	Francischelli et al.	Jul 2012	B2
8240211	Zeitner et al.	Aug 2012	B2
8241274	Keogh et al.	Aug 2012	B2
8244339	Shen et al.	Aug 2012	B2
8255035	Cao et al.	Aug 2012	B2
8260395	Markowitz et al.	Sep 2012	B2
8262577	Munrow et al.	Sep 2012	B2
8298149	Hastings et al.	Oct 2012	B2
8303502	Washburn et al.	Nov 2012	B2
8303505	Webler et al.	Nov 2012	B2
8326419	Rosenberg et al.	Dec 2012	B2
8340751	Markowitz et al.	Dec 2012	B2
8369922	Paul et al.	Feb 2013	B2
8388541	Messerly	Mar 2013	B2
8388546	Rothenberg	Mar 2013	B2
8391956	Zellers et al.	Mar 2013	B2
8401616	Verard et al.	Mar 2013	B2
8409103	Grunwald et al.	Apr 2013	B2
8425425	Hagy et al.	Apr 2013	B2
8437833	Silverstein	May 2013	B2
8439873	Donovan	May 2013	B1
8442621	Gorek et al.	May 2013	B2
8447384	Xu et al.	May 2013	B2
D684265	Cadera	Jun 2013	S
8456182	Bar-Tal et al.	Jun 2013	B2
8478382	Burnside et al.	Jul 2013	B2
8485980	Sinderby et al.	Jul 2013	B2
8494608	Markowitz et al.	Jul 2013	B2
8496592	Ridley et al.	Jul 2013	B2
8504139	Jacobsen et al.	Aug 2013	B2
8512256	Rothenberg	Aug 2013	B2
8527036	Jalde et al.	Sep 2013	B2
8538509	Harlev et al.	Sep 2013	B2
8644907	Hartmann et al.	Feb 2014	B2
8734440	Wu	May 2014	B2
8774907	Rothenberg	Jul 2014	B2
8781555	Burnside et al.	Jul 2014	B2
8784336	Bown et al.	Jul 2014	B2
8801693	He et al.	Aug 2014	B2
8849382	Cox et al.	Sep 2014	B2
8858455	Rothenberg	Oct 2014	B2
8934961	Lakin et al.	Jan 2015	B2
9125578	Grunwald	Sep 2015	B2
20020010392	Desai	Jan 2002	A1
20020019447	Renn et al.	Feb 2002	A1
20020022777	Crieghton et al.	Feb 2002	A1
20020032391	McFann et al.	Mar 2002	A1
20020049488	Boneau	Apr 2002	A1
20020055680	Miele et al.	May 2002	A1
20020082559	Chang et al.	Jun 2002	A1
20020113555	Lys et al.	Aug 2002	A1
20020123679	Dominguez	Sep 2002	A1
20020128554	Seward	Sep 2002	A1
20020129952	Matsudate et al.	Sep 2002	A1
20020133079	Sandhu	Sep 2002	A1
20020156363	Hunter et al.	Oct 2002	A1
20020156376	Wang et al.	Oct 2002	A1
20020165448	Ben-Haim et al.	Nov 2002	A1
20020165534	Hayzelden et al.	Nov 2002	A1
20020165537	Kelley et al.	Nov 2002	A1
20020198568	Hafer et al.	Dec 2002	A1
20030009132	Schwartz et al.	Jan 2003	A1
20030011359	Ashe	Jan 2003	A1
20030013966	Barnes et al.	Jan 2003	A1
20030013986	Saadat	Jan 2003	A1
20030036696	Willis et al.	Feb 2003	A1
20030040671	Somogyi et al.	Feb 2003	A1
20030040743	Cosman et al.	Feb 2003	A1
20030072805	Miyazawa et al.	Apr 2003	A1
20030073901	Simon et al.	Apr 2003	A1
20030076281	Morgan et al.	Apr 2003	A1
20030083698	Whitehurst et al.	May 2003	A1
20030088195	Vardi et al.	May 2003	A1
20030100849	Jang	May 2003	A1
20030114742	Lewkowicz et al.	Jun 2003	A1
20030114777	Griffin et al.	Jun 2003	A1
20030120150	Govari	Jun 2003	A1
20030120154	Sauer et al.	Jun 2003	A1
20030139661	Kimchy et al.	Jul 2003	A1
20030149328	Elliott et al.	Aug 2003	A1
20030149368	Hennemann et al.	Aug 2003	A1
20030152290	Odell	Aug 2003	A1
20030160721	Gilboa et al.	Aug 2003	A1
20030163037	Bladen et al.	Aug 2003	A1
20030163142	Paltieli et al.	Aug 2003	A1
20030171691	Casscells et al.	Sep 2003	A1
20030173953	Ashe	Sep 2003	A1
20030181892	Pajunk et al.	Sep 2003	A1
20030184544	Prudent	Oct 2003	A1
20030191392	Haldeman	Oct 2003	A1
20030191460	Hobbs et al.	Oct 2003	A1
20030195420	Mendlein et al.	Oct 2003	A1
20030199746	Fuimaono et al.	Oct 2003	A1
20030208142	Boudewijn et al.	Nov 2003	A1
20030216639	Gilboa et al.	Nov 2003	A1
20030220557	Cleary et al.	Nov 2003	A1
20030220578	Ho et al.	Nov 2003	A1
20030229298	Iwami et al.	Dec 2003	A1
20030233042	Ashe	Dec 2003	A1
20040010189	van Sloun et al.	Jan 2004	A1
20040015070	Liang et al.	Jan 2004	A1
20040024301	Hockett et al.	Feb 2004	A1
20040030319	Korkor et al.	Feb 2004	A1
20040054278	Kimchy et al.	Mar 2004	A1
20040059237	Narayan et al.	Mar 2004	A1
20040082916	Jenkins	Apr 2004	A1
20040087877	Besz et al.	May 2004	A1
20040088136	Ashe	May 2004	A1
20040092962	Thornton et al.	May 2004	A1
20040097803	Panescu	May 2004	A1
20040097804	Sobe	May 2004	A1
20040097805	Verard et al.	May 2004	A1
20040097806	Hunter et al.	May 2004	A1
20040116809	Chow et al.	Jun 2004	A1
20040127805	MacAdam et al.	Jul 2004	A1
20040131998	Marom et al.	Jul 2004	A1
20040133111	Szczech et al.	Jul 2004	A1
20040133130	Ferry et al.	Jul 2004	A1
20040135069	Odell	Jul 2004	A1
20040138557	Le et al.	Jul 2004	A1
20040138564	Hwang et al.	Jul 2004	A1
20040138570	Nita et al.	Jul 2004	A1
20040147837	Macaulay et al.	Jul 2004	A1
20040150963	Holmberg et al.	Aug 2004	A1
20040152972	Hunter	Aug 2004	A1
20040155609	Lys et al.	Aug 2004	A1
20040158140	Fuimaono et al.	Aug 2004	A1
20040171924	Mire et al.	Sep 2004	A1
20040176688	Haldeman	Sep 2004	A1
20040186461	DiMatteo	Sep 2004	A1
20040199069	Connelly et al.	Oct 2004	A1
20040210289	Wang et al.	Oct 2004	A1
20040225233	Frankowski et al.	Nov 2004	A1
20040230131	Kassab et al.	Nov 2004	A1
20040230271	Wang et al.	Nov 2004	A1
20040234453	Smith	Nov 2004	A1
20040243018	Organ et al.	Dec 2004	A1
20040243116	Joye et al.	Dec 2004	A1
20040243118	Ayers et al.	Dec 2004	A1
20040253365	Warren et al.	Dec 2004	A1
20040254470	Drinkwater et al.	Dec 2004	A1
20040254495	Mabary et al.	Dec 2004	A1
20040260174	Keene	Dec 2004	A1
20040267086	Anstadt et al.	Dec 2004	A1
20050004450	Ben-Haim et al.	Jan 2005	A1
20050021019	Hashimshony et al.	Jan 2005	A1
20050033150	Takahashi et al.	Feb 2005	A1
20050038355	Gellman et al.	Feb 2005	A1
20050043640	Chang	Feb 2005	A1
20050049486	Urquhart et al.	Mar 2005	A1
20050049510	Haldeman et al.	Mar 2005	A1
20050063194	Lys et al.	Mar 2005	A1
20050070788	Wilson et al.	Mar 2005	A1
20050075561	Golden	Apr 2005	A1
20050085716	Hamm et al.	Apr 2005	A1
20050085718	Shahidi	Apr 2005	A1
20050085720	Jascob et al.	Apr 2005	A1
20050090746	Ohtake	Apr 2005	A1
20050101868	Ridley et al.	May 2005	A1
20050101869	Burba et al.	May 2005	A1
20050105081	Odell	May 2005	A1
20050105101	Duling et al.	May 2005	A1
20050112135	Cormier et al.	May 2005	A1
20050113669	Helfer et al.	May 2005	A1
20050113676	Weiner et al.	May 2005	A1
20050113700	Yanagihara et al.	May 2005	A1
20050113873	Weiner et al.	May 2005	A1
20050113874	Connelly et al.	May 2005	A1
20050113876	Weiner et al.	May 2005	A1
20050148836	Kleen et al.	Jul 2005	A1
20050149002	Wang et al.	Jul 2005	A1
20050151489	Lys et al.	Jul 2005	A1
20050154308	Quistgaard et al.	Jul 2005	A1
20050159644	Takano	Jul 2005	A1
20050159790	Shalev	Jul 2005	A1
20050165301	Smith et al.	Jul 2005	A1
20050165313	Byron et al.	Jul 2005	A1
20050175665	Hunter et al.	Aug 2005	A1
20050175703	Hunter et al.	Aug 2005	A1
20050178395	Hunter et al.	Aug 2005	A1
20050178396	Hunter et al.	Aug 2005	A1
20050182295	Soper et al.	Aug 2005	A1
20050197674	McCabe et al.	Sep 2005	A1
20050203368	Verin	Sep 2005	A1
20050203396	Angelsen et al.	Sep 2005	A1
20050205081	Barker et al.	Sep 2005	A1
20050215901	Anderson et al.	Sep 2005	A1
20050215945	Harris et al.	Sep 2005	A1
20050222532	Bertolero et al.	Oct 2005	A1
20050240102	Rachlin et al.	Oct 2005	A1
20050245811	Scheffler	Nov 2005	A1
20050256398	Hastings et al.	Nov 2005	A1
20050256451	Adams et al.	Nov 2005	A1
20050256521	Kozel	Nov 2005	A1
20050256541	Stypulkowski	Nov 2005	A1
20050283216	Pyles	Dec 2005	A1
20050288586	Ferek-Petric	Dec 2005	A1
20060009759	Chrisitian et al.	Jan 2006	A1
20060015003	Moaddes et al.	Jan 2006	A1
20060025677	Verard et al.	Feb 2006	A1
20060025697	Kurzweil et al.	Feb 2006	A1
20060058633	Hoshino et al.	Mar 2006	A1
20060068074	Stefandl	Mar 2006	A1
20060084867	Tremblay et al.	Apr 2006	A1
20060106306	Essner et al.	May 2006	A1
20060116571	Maschke et al.	Jun 2006	A1
20060116576	McGee et al.	Jun 2006	A1
20060116578	Grunwald et al.	Jun 2006	A1
20060122514	Byrd et al.	Jun 2006	A1
20060142656	Malackowski et al.	Jun 2006	A1
20060149134	Soper et al.	Jul 2006	A1
20060173251	Govari et al.	Aug 2006	A1
20060173329	Irioka et al.	Aug 2006	A1
20060173407	Shaughnessy et al.	Aug 2006	A1
20060176242	Jaramaz et al.	Aug 2006	A1
20060184074	Vaezy et al.	Aug 2006	A1
20060206037	Braxton	Sep 2006	A1
20060211944	Mauge et al.	Sep 2006	A1
20060217655	Vitullo et al.	Sep 2006	A1
20060224188	Libbus et al.	Oct 2006	A1
20060247746	Danek et al.	Nov 2006	A1
20060258895	Maschke	Nov 2006	A1
20060276867	Viswanathan	Dec 2006	A1
20070010753	MacAdam	Jan 2007	A1
20070016007	Govari et al.	Jan 2007	A1
20070016013	Camus	Jan 2007	A1
20070016068	Grunwald et al.	Jan 2007	A1
20070016069	Grunwald et al.	Jan 2007	A1
20070016070	Grunwald et al.	Jan 2007	A1
20070016072	Grunwald et al.	Jan 2007	A1
20070032746	Sell	Feb 2007	A1
20070038113	Oonuki et al.	Feb 2007	A1
20070049822	Bunce et al.	Mar 2007	A1
20070049846	Bown et al.	Mar 2007	A1
20070055141	Kruger et al.	Mar 2007	A1
20070055142	Webler	Mar 2007	A1
20070060992	Pappone	Mar 2007	A1
20070062544	Rauk Bergstrom et al.	Mar 2007	A1
20070066888	Maschke	Mar 2007	A1
20070073155	Park et al.	Mar 2007	A1
20070087038	Richardson et al.	Apr 2007	A1
20070093710	Maschke	Apr 2007	A1
20070100236	McMorrow et al.	May 2007	A1
20070100285	Griffin et al.	May 2007	A1
20070112282	Skujins et al.	May 2007	A1
20070123805	Shireman et al.	May 2007	A1
20070129770	Younis	Jun 2007	A1
20070135803	Belson	Jun 2007	A1
20070135886	Maschke	Jun 2007	A1
20070156205	Larson et al.	Jul 2007	A1
20070161853	Yagi et al.	Jul 2007	A1
20070161914	Zdeblick et al.	Jul 2007	A1
20070161915	Desai	Jul 2007	A1
20070167738	Timinger et al.	Jul 2007	A1
20070167762	Kim et al.	Jul 2007	A1
20070167769	Ikuma et al.	Jul 2007	A1
20070167801	Webler et al.	Jul 2007	A1
20070167997	Forsberg et al.	Jul 2007	A1
20070197891	Shachar et al.	Aug 2007	A1
20070197905	Timinger et al.	Aug 2007	A1
20070208255	Ridley et al.	Sep 2007	A1
20070219453	Kremliovsky et al.	Sep 2007	A1
20070225589	Viswanathan	Sep 2007	A1
20070225610	Mickley et al.	Sep 2007	A1
20070232882	Glossop et al.	Oct 2007	A1
20070232896	Gilboa et al.	Oct 2007	A1
20070238984	Maschke et al.	Oct 2007	A1
20070239018	Fetzer et al.	Oct 2007	A1
20070244413	Biggins	Oct 2007	A1
20070247454	Rahn et al.	Oct 2007	A1
20070249911	Simon	Oct 2007	A1
20070255270	Carney	Nov 2007	A1
20070265526	Govari et al.	Nov 2007	A1
20070280974	Son et al.	Dec 2007	A1
20070282196	Birk et al.	Dec 2007	A1
20070282197	Bill	Dec 2007	A1
20070299352	Harlev et al.	Dec 2007	A1
20070299353	Harlev et al.	Dec 2007	A1
20080004652	Abboud et al.	Jan 2008	A1
20080008745	Stinchcomb et al.	Jan 2008	A1
20080009720	Schefelker et al.	Jan 2008	A1
20080015442	Watson et al.	Jan 2008	A1
20080027320	Bolorforosh et al.	Jan 2008	A1
20080033283	Dellaca et al.	Feb 2008	A1
20080033316	Kassab et al.	Feb 2008	A1
20080033350	Wilson et al.	Feb 2008	A1
20080045908	Gould et al.	Feb 2008	A1
20080051626	Sato et al.	Feb 2008	A1
20080077158	Haider et al.	Mar 2008	A1
20080081958	Denison et al.	Apr 2008	A1
20080082136	Gaudiani	Apr 2008	A1
20080097232	Rothenberg	Apr 2008	A1
20080108949	Beasley et al.	May 2008	A1
20080114095	Peppmoller et al.	May 2008	A1
20080125772	Stone et al.	May 2008	A1
20080139944	Weymer et al.	Jun 2008	A1
20080146939	McMorrow et al.	Jun 2008	A1
20080146940	Jenkins et al.	Jun 2008	A1
20080146942	Dala-Krishna	Jun 2008	A1
20080154100	Thalmeier et al.	Jun 2008	A1
20080166453	Steele et al.	Jul 2008	A1
20080171934	Greenan et al.	Jul 2008	A1
20080183075	Govari et al.	Jul 2008	A1
20080188830	Rosenblatt et al.	Aug 2008	A1
20080190438	Harlev et al.	Aug 2008	A1
20080195169	Pinter et al.	Aug 2008	A1
20080200754	Buchalter	Aug 2008	A1
20080228082	Scheirer et al.	Sep 2008	A1
20080236598	Gobel	Oct 2008	A1
20080255404	Nogawa et al.	Oct 2008	A1
20080255475	Kondrosky et al.	Oct 2008	A1
20080269581	Wood et al.	Oct 2008	A1
20080269611	Pedrizzetti et al.	Oct 2008	A1
20080275465	Paul et al.	Nov 2008	A1
20080275765	Kuchar	Nov 2008	A1
20080288038	Paul et al.	Nov 2008	A1
20080294041	Kassab	Nov 2008	A1
20080319350	Wallace et al.	Dec 2008	A1
20090005674	Saadat et al.	Jan 2009	A1
20090005675	Grunwald et al.	Jan 2009	A1
20090018497	Birchard et al.	Jan 2009	A1
20090024018	Boyden et al.	Jan 2009	A1
20090030380	Binmoeller	Jan 2009	A1
20090043205	Pelissier et al.	Feb 2009	A1
20090062684	Gregersen et al.	Mar 2009	A1
20090082661	Saladin et al.	Mar 2009	A1
20090084382	Jalde et al.	Apr 2009	A1
20090101577	Fulkerson et al.	Apr 2009	A1
20090118612	Grunwald et al.	May 2009	A1
20090118637	Kassab et al.	May 2009	A1
20090118706	Schweikert et al.	May 2009	A1
20090124901	Fink et al.	May 2009	A1
20090143736	Mittermeyer et al.	Jun 2009	A1
20090156926	Messerly et al.	Jun 2009	A1
20090163810	Kanade et al.	Jun 2009	A1
20090171217	Kim et al.	Jul 2009	A1
20090177083	Matsumura	Jul 2009	A1
20090177090	Grunwald et al.	Jul 2009	A1
20090203989	Burnside et al.	Aug 2009	A1
20090204113	MacAdam et al.	Aug 2009	A1
20090209872	Pop	Aug 2009	A1
20090209950	Starksen	Aug 2009	A1
20090221908	Glossop	Sep 2009	A1
20090227952	Blakstvedt et al.	Sep 2009	A1
20090234328	Cox et al.	Sep 2009	A1
20090247861	Manus	Oct 2009	A1
20090253976	Harlev et al.	Oct 2009	A1
20090258171	Uang	Oct 2009	A1
20090259124	Rothenberg	Oct 2009	A1
20090262982	Markowitz et al.	Oct 2009	A1
20090270729	Corbucci et al.	Oct 2009	A1
20090270746	Min	Oct 2009	A1
20090275828	Shachar et al.	Nov 2009	A1
20090297441	Canham et al.	Dec 2009	A1
20100004543	Ahlund et al.	Jan 2010	A1
20100004547	Scholz et al.	Jan 2010	A1
20100010355	Kassab	Jan 2010	A1
20100010444	Bettuchi	Jan 2010	A1
20100010612	Gelbart et al.	Jan 2010	A1
20100016726	Meier	Jan 2010	A1
20100036227	Cox et al.	Feb 2010	A1
20100036284	Laynes et al.	Feb 2010	A1
20100041973	Vu et al.	Feb 2010	A1
20100041984	Shapland et al.	Feb 2010	A1
20100049062	Ziv	Feb 2010	A1
20100055153	Majmudar	Mar 2010	A1
20100055184	Zeitels et al.	Mar 2010	A1
20100057157	Govari et al.	Mar 2010	A1
20100060472	Kimura et al.	Mar 2010	A1
20100063401	Nishina et al.	Mar 2010	A1
20100076305	Maier-Hein et al.	Mar 2010	A1
20100076328	Matsumura et al.	Mar 2010	A1
20100081934	Soltani et al.	Apr 2010	A1
20100083719	Peppmoller et al.	Apr 2010	A1
20100094116	Silverstein	Apr 2010	A1
20100106011	Byrd et al.	Apr 2010	A1
20100114573	Huang et al.	May 2010	A1
20100117659	Osadchy et al.	May 2010	A1
20100143119	Kooijman et al.	Jun 2010	A1
20100152596	Griffiths et al.	Jun 2010	A1
20100168557	Deno et al.	Jul 2010	A1
20100185097	Hall	Jul 2010	A1
20100198048	Togawa	Aug 2010	A1
20100198346	Keogh et al.	Aug 2010	A1
20100204569	Burnside et al.	Aug 2010	A1
20100210938	Verard et al.	Aug 2010	A1
20100210950	Dunbar et al.	Aug 2010	A1
20100217116	Eck et al.	Aug 2010	A1
20100222664	Lemon et al.	Sep 2010	A1
20100222786	Kassab	Sep 2010	A1
20100234724	Jacobsen et al.	Sep 2010	A1
20100234733	Wahlheim	Sep 2010	A1
20100249598	Smith et al.	Sep 2010	A1
20100258033	Yang et al.	Oct 2010	A1
20100268059	Ryu et al.	Oct 2010	A1
20100273895	Stinchcomb et al.	Oct 2010	A1
20100291521	Simon	Nov 2010	A1
20100298702	Rogers et al.	Nov 2010	A1
20100298704	Pelissier et al.	Nov 2010	A1
20100298705	Pelissier et al.	Nov 2010	A1
20100298712	Pelissier et al.	Nov 2010	A1
20100312086	Beatty et al.	Dec 2010	A9
20100317981	Grunwald	Dec 2010	A1
20100318026	Grunwald	Dec 2010	A1
20100331712	Rothenberg	Dec 2010	A1
20110015527	Heasty et al.	Jan 2011	A1
20110015533	Cox et al.	Jan 2011	A1
20110034823	Gelbart et al.	Feb 2011	A1
20110034940	Payner	Feb 2011	A1
20110040212	Dietz et al.	Feb 2011	A1
20110052694	Stinchcomb et al.	Mar 2011	A1
20110087105	Ridley et al.	Apr 2011	A1
20110087106	Ridley et al.	Apr 2011	A1
20110087107	Lindekugel et al.	Apr 2011	A1
20110112396	Shachar et al.	May 2011	A1
20110136242	Marx et al.	Jun 2011	A1
20110137156	Razzaque et al.	Jun 2011	A1
20110196235	Dunbar et al.	Aug 2011	A1
20110196248	Grunwald	Aug 2011	A1
20110196255	Kassab	Aug 2011	A1
20110237935	Kalpin et al.	Sep 2011	A1
20110245659	Ma et al.	Oct 2011	A1
20110282187	Harlev et al.	Nov 2011	A1
20110282188	Burnside	Nov 2011	A1
20110295108	Cox et al.	Dec 2011	A1
20110306867	Gopinathan et al.	Dec 2011	A1
20110313293	Lindekugel et al.	Dec 2011	A1
20120004564	Dobak, III	Jan 2012	A1
20120035460	Stangenes et al.	Feb 2012	A1
20120046562	Powers et al.	Feb 2012	A1
20120059249	Verard et al.	Mar 2012	A1
20120059270	Grunwald	Mar 2012	A1
20120071751	Sra et al.	Mar 2012	A1
20120071759	Hagy et al.	Mar 2012	A1
20120071782	Patil et al.	Mar 2012	A1
20120078342	Vollkron et al.	Mar 2012	A1
20120095319	Kondrosky et al.	Apr 2012	A1
20120108950	He et al.	May 2012	A1
20120143029	Silverstein et al.	Jun 2012	A1
20120143078	Kassab et al.	Jun 2012	A1
20120172727	Hastings et al.	Jul 2012	A1
20120220854	Messerly et al.	Aug 2012	A1
20120283582	Mahapatra et al.	Nov 2012	A1
20120296200	Shachar et al.	Nov 2012	A1
20120310052	Mahapatra et al.	Dec 2012	A1
20120310066	Shachar et al.	Dec 2012	A1
20120316440	Munrow et al.	Dec 2012	A1
20130018248	Hurezan	Jan 2013	A1
20130035590	Ma et al.	Feb 2013	A1
20130041269	Stahmann et al.	Feb 2013	A1
20130060116	Messerly et al.	Mar 2013	A1
20130085416	Mest	Apr 2013	A1
20130102890	Dib	Apr 2013	A1
20130123597	Rothenberg	May 2013	A1
20130169272	Eichler et al.	Jul 2013	A1
20130217999	Burnside et al.	Aug 2013	A1
20130245434	Messerly et al.	Sep 2013	A1
20130296691	Ashe	Nov 2013	A1
20130303896	Kalpin et al.	Nov 2013	A1
20130317338	Silverstein	Nov 2013	A1
20130324841	Kamen et al.	Dec 2013	A1
20130338503	Cohen et al.	Dec 2013	A1
20130338517	Rothenberg	Dec 2013	A1
20130345555	Kanade et al.	Dec 2013	A1
20140031674	Newman et al.	Jan 2014	A1
20140046261	Newman et al.	Feb 2014	A1
20140094694	Moctezuma de la Barrera	Apr 2014	A1
20140094768	Stangenes et al.	Apr 2014	A1
20140107475	Cox et al.	Apr 2014	A1
20140163356	Burnside et al.	Jun 2014	A2
20140180074	Green et al.	Jun 2014	A1
20140188133	Misener	Jul 2014	A1
20140228689	Ishikawa et al.	Aug 2014	A1
20140243659	Rothenberg	Aug 2014	A1
20140275957	Lupotti	Sep 2014	A1
20140275990	Hagy et al.	Sep 2014	A1
20140303492	Burnside et al.	Oct 2014	A1
20140309624	Bown et al.	Oct 2014	A1
20140343398	He et al.	Nov 2014	A1
20150005621	Liu	Jan 2015	A1
20150018701	Cox et al.	Jan 2015	A1
20150025402	Rothenberg	Jan 2015	A1
20150051489	Caluser et al.	Feb 2015	A1
20150080716	Powers et al.	Mar 2015	A1
20150297114	Cox et al.	Oct 2015	A1

Foreign Referenced Citations (191)

Number	Date	Country
642647	Nov 1990	AU
1860597	Jun 1999	AU
20009592	Sep 2000	AU
20015250	Jun 2001	AU
768362	Dec 2003	AU
2001229024	Sep 2005	AU
2001283703	May 2006	AU
2006202149	Jun 2006	AU
2006904933	Sep 2006	AU
2006283022	Feb 2012	AU
2420676	Feb 2002	CA
2619909	Jan 2014	CA
2031655	Feb 1989	CN
1672649	Sep 2005	CN
102209490	Oct 2011	CN
102802514	Nov 2012	CN
102821679	Dec 2012	CN
103037761	Apr 2013	CN
103037762	Apr 2013	CN
103118591	May 2013	CN
103189009	Jul 2013	CN
4319033	Jun 1994	DE
0359697	Mar 1990	EP
0362821	Apr 1990	EP
0399536	Nov 1990	EP
0823261	Feb 1998	EP
0928976	Jul 1999	EP
1025805	Aug 2000	EP
1311226	May 2003	EP
1504713	Feb 2005	EP
1932477	Jun 2008	EP
2313143	Apr 2011	EP
2337491	Jun 2011	EP
2440122	Apr 2012	EP
2464407	Jun 2012	EP
2482719	Aug 2012	EP
2575610	Apr 2013	EP
2575611	Apr 2013	EP
2603145	Jun 2013	EP
2605699	Jun 2013	EP
2632360	Sep 2013	EP
2219526	Mar 2014	EP
2712547	Apr 2014	EP
2545349	Nov 1984	FR
01097440	Apr 1989	JP
03173542	Jul 1991	JP
4090741	Aug 1992	JP
9-503054	Mar 1997	JP
09-094298	Apr 1997	JP
10043310	Feb 1998	JP
10290839	Nov 1998	JP
11128237	May 1999	JP
2001161683	Jun 2001	JP
2001-514533	Sep 2001	JP
2001-524339	Dec 2001	JP
2001340334	Dec 2001	JP
2002-529133	Sep 2002	JP
2002-541947	Dec 2002	JP
2003-010138	Jan 2003	JP
2003501127	Jan 2003	JP
2003061752	Mar 2003	JP
2003299654	Oct 2003	JP
2003334191	Nov 2003	JP
2002520893	Feb 2004	JP
2004505748	Feb 2004	JP
2004515298	May 2004	JP
2006508744	Mar 2006	JP
2006-338526	Dec 2006	JP
2007-000226	Jan 2007	JP
2007-068989	Mar 2007	JP
2009271123	Nov 2009	JP
5010604	Jun 2012	JP
2012-529929	Nov 2012	JP
2013-518676	May 2013	JP
2013-526959	Jun 2013	JP
2013-526961	Jun 2013	JP
8002376	Nov 1980	WO
9112836	Sep 1991	WO
9203090	Mar 1992	WO
9403159	Feb 1994	WO
9404938	Mar 1994	WO
9605768	Feb 1996	WO
9607352	Mar 1996	WO
9641119	Dec 1996	WO
9729683	Aug 1997	WO
9743989	Nov 1997	WO
9825159	Jun 1998	WO
9829032	Jul 1998	WO
9835611	Aug 1998	WO
9916495	Apr 1999	WO
9927837	Jun 1999	WO
9949407	Sep 1999	WO
0019906	Apr 2000	WO
0027281	May 2000	WO
0040155	Jul 2000	WO
0063658	Oct 2000	WO
0074775	Dec 2000	WO
0113792	Mar 2001	WO
0139683	Jun 2001	WO
0176479	Oct 2001	WO
0215973	Feb 2002	WO
0219905	Mar 2002	WO
0225277	Mar 2002	WO
02085442	Oct 2002	WO
03061752	Jul 2003	WO
03077759	Sep 2003	WO
03088833	Oct 2003	WO
03091495	Nov 2003	WO
2004002303	Jan 2004	WO
2004049970	Jun 2004	WO
2005033524	Apr 2005	WO
2005033574	Apr 2005	WO
2005117690	Dec 2005	WO
2005117733	Dec 2005	WO
2006074509	Jul 2006	WO
2006074510	Jul 2006	WO
2006078677	Jul 2006	WO
2006103661	Oct 2006	WO
2006111056	Oct 2006	WO
2007002541	Jan 2007	WO
2007005976	Jan 2007	WO
2007014447	Feb 2007	WO
2007034196	Mar 2007	WO
2007067324	Jun 2007	WO
2007069168	Jun 2007	WO
2007109123	Sep 2007	WO
2007126536	Nov 2007	WO
2007144894	Dec 2007	WO
2008005480	Jan 2008	WO
2008024596	Feb 2008	WO
2008028253	Mar 2008	WO
2008083111	Jul 2008	WO
2008097767	Aug 2008	WO
2008118992	Oct 2008	WO
2008126074	Oct 2008	WO
2008129326	Oct 2008	WO
2008131017	Oct 2008	WO
2008136008	Nov 2008	WO
2009000439	Dec 2008	WO
2009002514	Dec 2008	WO
2009003138	Dec 2008	WO
2009009064	Jan 2009	WO
2009057774	May 2009	WO
2009063166	May 2009	WO
2009067654	May 2009	WO
2009070616	Jun 2009	WO
2009100158	Aug 2009	WO
2009123819	Oct 2009	WO
2009126340	Oct 2009	WO
2009129475	Oct 2009	WO
2009129477	Oct 2009	WO
2009134605	Nov 2009	WO
2009137262	Nov 2009	WO
2010002313	Jan 2010	WO
2010018500	Feb 2010	WO
2010022370	Feb 2010	WO
2010027349	Mar 2010	WO
2010027471	Mar 2010	WO
2010029906	Mar 2010	WO
2010030820	Mar 2010	WO
2010132857	Nov 2010	WO
2010132985	Nov 2010	WO
2010143196	Dec 2010	WO
2010144922	Dec 2010	WO
2011019760	Feb 2011	WO
2011041450	Apr 2011	WO
2011044421	Apr 2011	WO
2011057289	May 2011	WO
2011064209	Jun 2011	WO
2011084593	Jul 2011	WO
2011097312	Aug 2011	WO
2011128052	Oct 2011	WO
2011150358	Dec 2011	WO
2011150376	Dec 2011	WO
2012021542	Feb 2012	WO
2012024577	Feb 2012	WO
2012039866	Mar 2012	WO
2012040487	Mar 2012	WO
2012058461	May 2012	WO
2012083245	Jun 2012	WO
2012088535	Jun 2012	WO
2012110955	Aug 2012	WO
2012173697	Dec 2012	WO
2013006713	Jan 2013	WO
2013006817	Jan 2013	WO
2013034175	Mar 2013	WO
2014052894	Apr 2014	WO
2014062728	Apr 2014	WO
2014138652	Sep 2014	WO
2014138918	Sep 2014	WO
2015120256	Aug 2015	WO

Non-Patent Literature Citations (467)

Entry
U.S. Appl. No. 12/878,915, filed Sep. 9, 2010 Non-Final Office Action dated Mar. 15, 2012.
Valdivieso, J.R. Perez, et al., Evaluation of a formula for optimal positioning of a central venous catheter inserted through the right internal jugular vein, Rev. Esp. Anestesiol. Reanim. 2003; 50: 77-79.
VasoNova Inc, Vascular navigation system for accurate placement of PICCs, Start-Up Emerging Medical Ventures, pp. 44-45, vol. 14 No. 7, Jul.-Aug. 2009.
Vesely, Thomas M. et al., Central Venous Catheter Tip Position: A Continuing Controversy, J Vasc Intery Radiol 2003; 14:527-534.
VIASYS Health Care Inc. Cortrak© Fact Sheet, 2005.
VIASYS Healthcare MedSystems, Navigator® Benefits, 2008.
VIASYS Healthcare MedSystems, Navigator® Research in Cost Justification, 2008.
VIASYS MedSystems, Cortrak™ Systems Brochure, 2005.
Volcano ComboMap Features and Benefits/Technical Specifications, 2 pages, 2011.
Watters, et al. “Use of Electrocardiogram to Position Right Atrial Catheters During Surgery.” Annals of Surgery, vol. 225, No. 2, pp. 165-171, 1997.
Welch Allyn Cardioperfect® PC-Based Resting ECG, 2003.
Wilson, R. G. et al, Right Atrial Electrocardiography in Placement of Central Venous Catheters, The Lancet, pp. 462-463, Feb. 27, 1988.
Wong, Jeffrey J. et al., Azygos Tip Placement for Hemodialysis Catheters in Patients with Superior Vena Cava Occlusion, Cardiovasc Intervent Radiol (2006) 29:143-146.
Worley, Seth J. “Use of a Real-Time Three-Dimensional Magenetic Navigation System for Radiofrequency Ablation of Accessory Pathways.” PACE, vol. 21 pp. 1636-1643, Aug. 1998.
Yilmazlar A et al, Complications of 1303 Central Venous Cannulations, J R Soc Med, pp. 319-321, vol. 90 No. 6, Jun. 1997 (Abstract only).
Yoon, SZ et al, Usefulness of the Carina as a Radiographic Landmark for Central Venous Catheter Placement in Paediatric Patients, Br J Anaesth, Jul. 2005.
Yoshida, Teruhisa et al, Detection of Concealed Left Sided Accessory Atrioventricular Pathway by P Wave Signal Averaged Electrocardiogram, J Am Coll Cardiol, pp. 55-62, 1999.
Zaaroor, et al. “Novel Magnetic Technology for Intraoperative Intracranial Frameless Navigation: In Vivo and In Vitro Results.” Neurosurgery, vol. 48, No. 5. pp. 1100-1107, May 2001.
Zachariou, Zacharias et al., Intra-atrial ECG recording: a new and safe method for implantation of Broviac catheters in children, Pediatr Surg Int (1994) 9: 457-458.
PCT/US2011/052793 filed Sep. 22, 2011 Written Opinion dated Jan. 6, 2012.
PCT/US2011/067268 filed Dec. 23, 2011 International Search Report and Written Opinion dated Apr. 27, 2012.
Pennington, C.R., Right Atrial Thrombus: a Complication of Total Parenteral Nutrition, British Medical Journal, pp. 446-447, vol. 295, Aug. 15, 1987.
Petersen, J et al, Silicone Venous Access Devices Positioned with their Tip High in the Superior Vena Cava are More Likely to Malfunction, Am J Surg, pp. 38-41, vol. 178 No. 1, Jul. 1999.
Pittiruti, et al, Intracavitary EKG Monitoring: A reliable method for controlling tip position during and after PICC Insertion presentation in Catholic University, Rome, Italy in 2008.
Pittiruti, et al. “The EKG Method for Positioning the Tip of PICCs: Results from Two Preliminary Studies.” JAVA, vol. 13, No. 4, pp. 179-185, 2008.
Polos, PG et al, Tips for Monitoring the Position of a Central Venous Catheter—How Placement can go awry—even when the anatomy is normal, J Crit Illn, pp. 660-674, vol. 8 No. 6, Jun. 1993 (Abstract only).
Popp, M. B. et al., Accuracy of implanted port placement with the use of the electromagnetic CathTrack® catheter locator system, The Journal of Vascular Access 2005; 6: 9-12.
Randolph AG et al, Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature, Critcal Care Medicine, pp. 2053-2058, vol. 24, Dec. 1996.
Reece, A et al, Posititioning Long Lines: Contrast Versus Plain Radiography, Arch Dis Child Fetal Neonatal Ed, pp. 129-130, vol. 84 No. 2, Mar. 2001.
Reynolds, N et al, Assessment of Distal Tip Position of Long Term Central Venous Feeding Catheters using Transesophageal Echocardiology, JPEN J Parenter Enteral Nutr, pp. 39-41, vol. 25 No. 1, Jan.-Feb. 2001.
Ruschulte, Heiner et al, Prevention of Central Venous Catheter related infections with chlorhex idine gluconate impregnated wound dressings: A randomized controlled trial, presented as an abstract at the Annual meeting of the European Society of Anaesthesiologists (ESA) in Madrid, Spain in Jun. 2006, 12 pages, Annals of Hematology, Jul. 14, 2008.
Rutherford, J. S. et al., Depth of Central Venous Catheterization: An Audit of Practice in a Cardiac Surgical Unit, Anaesth Intens Care 1994; 22: 267-271.
Sacolick, et al. “Electromagnetically Tracked Placement of a Peripherally Inserted Central Catheter.” SPIE Medical Imaging, 2004 Proceedings.
Salem, et al. “A New Peripherally Implanted Subcutaneous Permanent Central Venous Access Device for Patients Requiring Chemotherapy.” Journal of Clinical Oncology, vol. 11, No. 11, pp. 2181-2185, Nov. 1993.
Savary, D et al, Intra-atrial Monitoring to Add Insertion of a Central Venous Line in Pre-Hospital Emergency Care Journal Europeen des Urgences, pp. 75-78, vol. 17 No. 2, 2004.
Schafer et al. “Incorrect placement of a vena cava catheter and its prevention by intra-atrial ECG.” Anaesthesist. Jan. 1998;37(1):49-51.
Schummer, et al. “Central Venous Catheters—The inability of ‘intra-atrial ECG’ to prove adequate positioning.” British Journal of Anaesthesia, vol. 93, No. 2, pp. 193-198, 2004.
Schummer, W et al, ECG-guided Central Venous Catheter Positioning: Does it detect the Pericardial Reflection rather than the Right Atrium?, Eur J Anaesthesiol, pp. 600-605, vol. 21 No. 8, Aug. 2004 (Abstract only).
Schummer, W et al, Intra-Atrial ECG is not a Reliable Method for Positioning Left Internal Jugular Vein Catheters, Br J Anaesth, pp. 481-486, vol. 91 No. 4, Oct. 2003.
Schummer, W, Central Venous Catheter—the Inability of “Intra-Atrial ECG” to prove Adequate Positioning, Br J Anaesth, pp. 193-198, vol. 93 No. 2, Aug. 2004.
Schuster, M. et al., The carina as a landmark in central venous catheter placement, British Journal of Anaesthesia 85 (2): 192-4 (2000).
Siela, Debra, Using Chest Radiography in the Intensive Care Unit, Crit Care Nurse Aug. 1, 2002 vol. 22 No. 4, pp. 18-27.
Simon, et al., “Central Venous Catheter Placement in Children: Evaluation of Electrocardiography Using J-Wire.” Paediatric Anaesthesia vol. 9, pp. 501-504, 1999.
Smith, Brigham, et al., Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters, Journal of Electrocardiology 43 (2010) 274-278.
Stark, DD et al, Radiographic Assessment of Venous Catheter Position in Children: Value of the Lateral View, Pediatric Radiology, pp. 76-80, vol. 14 No. 2, 1984.
Starkhammar et al. “Cath-Finder Catheter Tracking System: A New Device for Positioning of Central Venous Catheters. Early Experience from Implantation of Brachial portal Systems.” Acta Anaesthesiol Scandinavia, vol. 34, No. 4 pp. 296-300, May 1990.
Starkhammer, H et al, Central Venous Catheter Placement using Electromagnetic Position Sensing: A Clinical Evaluation, Biomed. Instrum Technol, vol. 30 No. 2, pp. 164-170; Mar.-Apr. 1996.
Starr, David S et al, EKG Guided Placement of Subclavian CVP Catheters Using J-Wire, pp. 673-676, Ann. Surg, Dec. 1986.
Stas, M et al, Peroperative Intravasal Electrographic Control of Catheter Tip Position in Access Ports Placed by Venous Cut-Down Technique, EJSO, pp. 316-320, vol. 27, 2001.
Stereotaxis Magetic Navigation System with Navigant™ User Interface, 2005 Brochure.
Stereotaxis, Expanding the Possibilites of Interventional Medicine: Remote Navigation and Automation, pp. 1-8, Apr. 2011.
Tepa® Health Innovation PC based ECG System Introduction and Technical Specifications, EKG Master USB, 2 pages, Nov. 2003.
The FloWire Doppler Guide Wire located <http://www.volcanocorp.com/products/flowire-doppler-guide-wire.php>, 2011.
Traxal Technologies, Tracking Technology website overview: www.traxal.com/rd/rd—classroom—trackingtechnology.htm, last accessed Dec. 1, 2006.
UAB Health Systems, Arrhythmias, retrieved from http://www.health,uab.edu/14564/ on Nov. 15, 2007, 12 pages.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Advisory Action dated Jun. 22, 2009.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Final Office Action dated Apr. 8, 2010.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Final Office Action dated Jan. 30, 2009.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Non-Final Office Action dated Sep. 25, 2009.
U.S. Appl. No. 11/552,094, filed Oct. 23, 2006 Notice of Allowability dated Apr. 2, 2010.
U.S. Appl. No. 11/552,094, filed Oct. 23, 2006 Non-Final Office Action dated Apr. 27, 2009.
U.S. Appl. No. 11/552,094, filed Oct. 23, 2006 Notice of Allowance dated May 20, 2010.
U.S. Appl. No. 12/104,253, filed Apr. 16, 2008 Final Office Action dated Jul. 27, 2011.
U.S. Appl. No. 12/104,253, filed Apr. 16, 2008 Non-Final Office Action dated Nov. 29, 2010.
U.S. Appl. No. 12/323,273, filed Nov. 25, 2008 Non-Final Office Action dated Jun. 8, 2012.
U.S. Appl. No. 12/369,625, filed Feb. 11, 2009 Final Office Action dated Feb. 23, 2012.
U.S. Appl. No. 12/369,625, filed Feb. 11, 2009 Non-Final Office Action dated Jul. 20, 2011.
U.S. Appl. No. 12/427,244, filed Apr. 21, 2009 Non-Final Office Action dated Jan. 19, 2012.
U.S. Appl. No. 12/557,401, filed Sep. 10, 2009 Non-Final Office Action dated Apr. 24, 2012.
CN 200980144663.8 filed May 9, 2011 Fifth Office Action dated May 26, 2015.
CN 200980144663.8 filed May 9, 2011 Fourth Office Action dated Nov. 15, 2014.
CN 201080035659.0 filed Feb. 10, 2012 Second Office Action dated Oct. 9, 2014.
CN 201080035659.0 filed Feb. 10, 2012 Third Office Action dated Mar. 19, 2015.
CN 201080053838.7 filed May 28, 2012 Fourth Office Action dated Jun. 2, 2015.
CN 201080053838.7 filed May 28, 2012 Second Office Action dated Jun. 17, 2014.
CN 201080053838.7 filed May 28, 2012 Third Office Action dated Dec. 4, 2014.
CN 201180016462.7 filed Sep. 27, 2012 Second Office Action dated Dec. 9, 2014.
CN 201180016462.7 filed Sep. 27, 2012 Third Office Action dated Jun. 10, 2015.
CN 201180037065.8 filed Jan. 28, 2013 First Office Action dated Jun. 2, 2015.
CN 201180037065.8 filed Jan. 28, 2013 First Office Action dated Sep. 28, 2014.
CN 201180037068.1 filed Jan. 28, 2013 First Office Action dated Apr. 20, 2015.
CN 201180037068.1 filed Jan. 28, 2013 First Office Action dated Sep. 9, 2014.
CN 201180040151.4 filed Feb. 19, 2013 First Office Action dated Oct. 28, 2014.
CN 201180040151.4 filed Feb. 19, 2013 Second Office Action dated Jun. 19, 2015.
CN 201180043512.0 filed Mar. 8, 2013 First Office Action dated Jul. 31, 2014.
CN 201180043512.0 filed Mar. 8, 2013 Second Office Action dated Apr. 14, 2015.
CN 201180052587.5 filed Apr. 28, 2013 First Office Action dated Jan. 26, 2015.
CN 201180068309.9 filed Aug. 22, 2013 First Office Action dated Oct. 16, 2014.
CN 201180068309.9 filed Aug. 22, 2013 Second Office Action dated May 6, 2015.
EP 11 818 828.3 filed Mar. 18, 2013 Extended European Search Report dated Dec. 10, 2014.
EP 11787515.3 filed Dec. 12, 2012 partial European search report dated Jun. 23, 2015.
EP 11787527.8 filed Dec. 19, 2012 partial European search report dated May 26, 2015.
EP 11837113.7 filed May 28, 2013 Extended European Search Report dated Apr. 24, 2014.
EP 12177438.4 filed Jul. 23, 2012 European Search Report dated Jun. 7, 2015.
EP 12177438.4 filed Jul. 23, 2012 Examination Report dated Dec. 5, 2014.
EP 12807886.2 filed Jan. 15, 2014 Extended European Search Report dated Feb. 6, 2015.
EP14197136.6 filed Dec. 10, 2014 Extended European Search Report dated May 26, 2015.
JP 2012-515222 filed Dec. 9, 2011 Office Action dated Feb. 23, 2015.
JP 2012-552060 filed Aug. 1, 2012 Office Action dated Nov. 12, 2014.
JP 2013-512046 filed Nov. 26, 2012 First Office Action dated Mar. 23, 2015.
JP 2013-512051 filed Nov. 26, 2012 First Office Action dated Mar. 23, 2015.
JP 2013-524999 filed Jan. 22, 2013 First Office Action dated Jun. 1, 2015.
Moureau, Nancy L. et al., “Electrocardiogram (EKG) Guided Peripherally Inserted Central Catheter Placement and Tip Position: Results of a Trial to Replace Radiological Confirmation,” Journal of the Association for Vascular Access, pp. 8-14, vol. 15, No. 1, 2010.
MX/a/2012/013858 filed Nov. 28, 2012 First Office Action dated Sep. 26, 2014.
MX/a/2012/013858 filed Nov. 28, 2012 Second Office Action dated Jun. 10, 2015.
Pittiruti, et al, “The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study,” J Vasc Access, pp. 1-9, Nov. 21, 2011.
Pittiruti, et al. “The electrocardiographic method for positioning the tip of central venous catheters” JAVA, pp. 1-12, Feb. 12, 2011.
RU 2011150917 filed Dec. 15, 2011 Second Office Action dated Aug. 28, 2014.
US 1/118,033, filed May 27, 2011 Non-Final Office Action dated Jul. 8, 2015.
U.S. Appl. No. 12/426,175, filed Apr. 17, 2009 Examiner's Answer dated Oct. 7, 2014.
U.S. Appl. No. 12/545,762, filed Aug. 21, 2009 Non-Final Office Action dated Nov. 7, 2014.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Advisory Action dated Mar. 5, 2015.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Final Office Action dated Dec. 23, 2014.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Non-Final Office Action dated Jun. 1, 2015.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Advisory Action dated Sep. 8, 2014.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Non-Final Office Action dated Mar. 16, 2015.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Advisory Action dated Aug. 15, 2014.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Final Office Action dated Jan. 15, 2015.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Non-Final Office Action dated Sep. 25, 2014.
AU 2008329807 exam requested Aug. 13, 2012 Examination Report No. 1 dated Feb. 15, 2013.
AU 2008329807 exam requested Aug. 13, 2012 Notice of Acceptance dated Feb. 14, 2014.
AU 2010300677 filed Mar. 12, 2012 First Examination Report dated Mar. 9, 2014.
AU 2011289513 filed Jan. 21, 2013 Examiner's Report dated Jul. 5, 2013.
AU 2012202293 filed Apr. 19, 2012 Examination Report No. 1 dated Apr. 24, 2013.
AU 2013201648 filed Mar. 19, 2013 Examiner's Report dated Mar. 5, 2014.
AU 2013201648 filed Mar. 19, 2013 Examiner's Report dated Oct. 14, 2013.
AU 2013202824 filed Apr. 6, 2013 First Examiner's Report dated Mar. 10, 2014.
AU 2013204243 filed Apr. 12, 2013 Examiner's Report dated Jun. 5, 2013.
Benzadon, M. N. et al: “Comparison of the Amplitude of the P-Wave from Intracardiac Electrocardiogram Obtained by Means of a Central Venous Catheter Filled With Saline Solution to That Obtained Via Esophageal Electrocardiogram”, American Journal of Cardiology, Canners Publishing Co., Newton, MA, US, vol. 98, No. 7, Oct. 1, 2006, pp. 978-981.
CA 2,619,909 filed Aug. 24, 2006 Examiner's Report dated Oct. 26, 2012.
CN 200880012117.4 filed Apr. 16, 2008 Second Office Action dated Oct. 8, 2012.
CN 200880012117.4 filed Apr. 16, 2008 Third Office Action dated Apr. 27, 2013.
CN 200880125528.4 filed Nov. 25, 2008 Second Office Action dated Mar. 6, 2013.
CN 200880125528.4 filed Nov. 25, 2008 Third Office Action dated Jul. 1, 2013.
CN 200980123021.X filed Dec. 17, 2010 First Office Action dated Nov. 19, 2012.
CN 200980123021.X filed Dec. 17, 2010 Second Office Action dated Aug. 13, 2013.
CN 200980123021.X filed Dec. 17, 2010 Third Office Action dated Apr. 22, 2014.
CN 200980144663.8 filed May 9, 2011 First Office Action dated Dec. 5, 2012.
CN 200980144663.8 filed May 9, 2011 Second Office Action dated Aug. 22, 2013.
CN 200980144663.8 filed May 9, 2011 Third Office Action dated May 4, 2014.
CN 201080035659.0 filed Feb. 10, 2012 First Office Action dated Jan. 26, 2014.
CN 201080053838.7 filed May 28, 2012 First Office Action dated Jan. 6, 2014.
CN 201180016462.7 filed Sep. 27, 2012 First Office Action dated Mar. 21, 2014.
EP 08855396.1 filed Jun. 15, 2010 Intent to Grant dated Jul. 5, 2013.
EP 09707467.8 supplemental European search report dated Jun. 18, 2013.
EP 09808901.4 filed Aug. 21, 2009 Examination Report dated May 10, 2013.
EP 09813632.8 filed Apr. 5, 2011 Office Action dated Apr. 30, 2013.
EP 09813632.8 filed Apr. 5, 2011 Summons to Attend Oral Proceedings dated Apr. 16, 2014.
EP 10 808 660.4 filed Feb. 15, 2012 Extended European Search Report dated Mar. 4, 2014.
EP 10786978.6 filed Dec. 19, 2011 Extended European Search Report dated Mar. 7, 2014.
EP 12177438.4 filed Jul. 23, 2012 Communication dated Jan. 13, 2014.
EP 12177438.4 filed Jul. 23, 2012 European Search Report dated Dec. 4, 2012.
EP 12177438.4 filed Jul. 23, 2012 extended European Search Report dated Mar. 25, 2013.
EP 13194818.4 filed Nov. 28, 2013 extended European search report dated Feb. 28, 2014.
EP 14151268.1 filed Jan. 15, 2014 European Search Report dated Feb. 21, 2014.
Jeon, Yunseok et al., “Transesophageal Echocardiographic Evaluation of ECG-guided Central Venous Catheter Placement,” Canadian Journal of Anesthesia, vol. 53, No. 10, Oct. 1, 2006, pp. 978-983.
JP 2010-504220 filed Sep. 3, 2009 Final Office Action dated Apr. 18, 2013.
JP 2010-535117 filed May 26, 2011 First Office Action dated Aug. 5, 2013.
JP 2012-515222 filed Dec. 9, 2011 Office Action dated Mar. 24, 2014.
PCT/US13/62409 filed Sep. 27, 2013 International Search Report and Written Opinion dated Feb. 24, 2014.
PCT/US2009/041051 filed Apr. 17, 2009 International Preliminary Report on Patentability dated Apr. 8, 2014.
PCT/US2011/038391 filed May 27, 2011 International Preliminary Report on Patentability and Written Opinion dated Dec. 4, 2012.
PCT/US2011/038391 filed May 27, 2011 International Search Report dated Sep. 21, 2011.
PCT/US2011/038415 filed May 27, 2011 International Preliminary Report on Patentability dated Dec. 13, 2012.
PCT/US2011/047127 filed Aug. 9, 2011 International Preliminary Report on Patentability dated Apr. 18, 2013.
PCT/US2011/048403 filed Aug. 19, 2011 International Preliminary Report on Patentability dated Jul. 30, 2013.
PCT/US2011/052793 filed Sep. 22, 2011 International Preliminary Report on Patentability dated Apr. 4, 2013.
PCT/US2011/058138 filed Oct. 27, 2011 International Preliminary Report on Patentability dated May 10, 2013.
PCT/US2011/067268 filed Dec. 23, 2011 International Preliminary Report on Patentability dated Jul. 4, 2013.
PCT/US2013/065121 filed Oct. 15, 2013 International Search Report and Written Opinion dated Jan. 16, 2014.
PCT/US2014/022019 filed Mar. 7, 2014 International Search Report and Written Opinion dated Jun. 11, 2014.
RU 2011150917 filed Dec. 15, 2011 First Office Action dated Apr. 24, 2014.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Final Office Action dated Oct. 28, 2013.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Non-Final Office Action dated Mar. 28, 2013.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Notice of Allowance dated Dec. 3, 2012.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Notice of Allowance dated Mar. 14, 2014.
U.S. Appl. No. 12/426,175, filed Apr. 17, 2009 Advisory Action dated Nov. 26, 2013.
U.S. Appl. No. 12/426,175, filed Apr. 17, 2009 Final Office Action dated Aug. 2, 2013.
U.S. Appl. No. 12/426,175, filed Apr. 17, 2009 Final Office Action dated Jan. 31, 2014.
U.S. Appl. No. 12/426,175, filed Apr. 17, 2009 Non-Final Office Action dated Dec. 3, 2012.
U.S. Appl. No. 12/545,762, filed Aug. 21, 2009 Final Office Action dated Mar. 7, 2013.
U.S. Appl. No. 12/545,762, filed Aug. 21, 2009 Non-Final Office Action dated Dec. 13, 2013.
U.S. Appl. No. 12/557,401, filed Sep. 10, 2009 Non-Final Office Action dated Jan. 6, 2014.
U.S. Appl. No. 12/575,456, filed Oct. 7, 2009 Non-Final Office Action dated Oct. 5, 2012.
U.S. Appl. No. 12/715,556, filed Mar. 2, 2010 Final Office Action dated Oct. 2, 2013.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Advisory Action dated Oct. 4, 2013.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Final Office Action dated Jul. 26, 2013.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Non-Final Office Action dated Jan. 22, 2013.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Non-Final Office Action dated Jul. 2, 2014.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Final Office Action dated Aug. 15, 2013.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Final Office Action dated Jul. 1, 2014.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Non-Final Office Action dated Jan. 29, 2013.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Non-Final Office Action dated Jan. 29, 2014.
U.S. Appl. No. 12/878,915, filed Sep. 9, 2010 Notice of Allowance dated Jan. 8, 2013.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Final Office Action dated Jun. 18, 2014.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Non-Final Office Action dated Dec. 24, 2013.
U.S. Appl. No. 12/900,750, filed Oct. 8, 2010 Non-Final Office Action dated Jun. 3, 2013.
U.S. Appl. No. 13/019,939, filed Feb. 2, 2011 Final Office Action dated Apr. 2, 2014.
U.S. Appl. No. 13/019,939, filed Feb. 2, 2011 Non-Final Office Action dated Oct. 11, 2013.
U.S. Appl. No. 13/118,033, filed May 27, 2011 Non-Final Office Action dated Aug. 1, 2013.
U.S. Appl. No. 13/118,033, filed May 27, 2011 Non-Final Office Action dated May 22, 2014.
U.S. Appl. No. 13/118,138, filed May 27, 2011 Final Office Action dated Apr. 3, 2013.
U.S. Appl. No. 13/213,622, filed Aug. 19, 2011 Final Office Action dated Feb. 19, 2013.
U.S. Appl. No. 13/213,622, filed Aug. 19, 2011 Non-Final Office Action dated May 22, 2014.
U.S. Appl. No. 13/283,395, filed Oct. 27, 2011 Non-Final Office Action dated Apr. 23, 2013.
U.S. Appl. No. 13/336,919, filed Dec. 23, 2011 Advisory Action dated May 23, 2013.
U.S. Appl. No. 13/336,919, filed Dec. 23, 2011 Final Office Action dated Mar. 1, 2013.
U.S. Appl. No. 13/336,919, filed Dec. 23, 2011 Non-Final Office Action dated Dec. 27, 2013.
U.S. Appl. No. 13/337,987, filed Dec. 27, 2011 Non-Final Office Action dated Mar. 15, 2013.
U.S. Appl. No. 13/469,932, filed May 11, 2012 Non-Final Office Action dated Jan. 3, 2014.
U.S. Appl. No. 13/665,420, filed Oct. 31, 2012 Non-Final Office Action dated Jan. 6, 2014.
U.S. Appl. No. 13/737,806, filed Jan. 9, 2013 Notice of Allowance dated Oct. 31, 2013.
U.S. Appl. No. 13/887,166, filed May 3, 2013 Final Office Action dated Jun. 23, 2014.
U.S. Appl. No. 13/887,166, filed May 3, 2013 Non-Final Office Action dated Jan. 7, 2014.
U.S. Appl. No. 13/969,265, filed Aug. 16, 2013 Non-Final Office Action dated Dec. 19, 2013.
U.S. Appl. No. 13/969,265, filed Aug. 16, 2013 Notice of Allowance dated Jun. 23, 2014.
U.S. Appl. No. 14/141,046, filed Dec. 26, 2013 Non-Final Office Action dated Jun. 20, 2014.
U.S. Appl. No. 29/428,649, filed Aug. 1, 2012 Notice of Allowance dated Jul. 5, 2013.
U.S. Appl. No. 13/019,939, filed Feb. 2, 2011 Non-Final Office Action dated Feb. 9, 2015.
U.S. Appl. No. 13/118,033, filed May 27, 2011 Non-Final Office Action dated Feb. 3, 2015.
U.S. Appl. No. 13/118,138, filed May 27, 2011 Non-Final Office Action dated Jul. 15, 2015.
U.S. Appl. No. 13/118,138, filed May 27, 2011 Non-Final Office Action dated Oct. 9, 2014.
U.S. Appl. No. 13/240,171, filed Sep. 22, 2011 Final Office Action dated Jun. 10, 2015.
U.S. Appl. No. 13/240,171, filed Sep. 22, 2011 Non-Final Office Action dated Dec. 26, 2014.
U.S. Appl. No. 13/283,395, filed Oct. 27, 2011 Advisory Action dated Jan. 28, 2014.
U.S. Appl. No. 13/283,395, filed Oct. 27, 2011 Final Office Action dated Nov. 14, 2013.
U.S. Appl. No. 13/336,919, filed Dec. 23, 2011 Final Office Action dated Dec. 19, 2014.
U.S. Appl. No. 13/336,919, filed Dec. 23, 2011 Non-Final Office Action dated Jul. 9, 2015.
U.S. Appl. No. 13/469,932, filed May 11, 2012 Non-Final Office Action dated Jul. 31, 2014.
U.S. Appl. No. 13/665,420, filed Oct. 31, 2012 Non-Final Office Action dated Oct. 9, 2014.
U.S. Appl. No. 13/887,166, filed May 3, 2013 Advisory Action dated Aug. 27, 2014.
U.S. Appl. No. 13/887,166, filed May 3, 2013 Examiners Answer dated Jul. 16, 2015.
U.S. Appl. No. 13/890,158, filed May 8, 2013 Non-Final Office Action dated Aug. 15, 2014.
U.S. Appl. No. 14/141,046, filed Dec. 26, 2013 Non-Final Office Action dated Feb. 11, 2015.
U.S. Appl. No. 14/270,241, filed May 5, 2014 Non-Final Office Action dated Apr. 23, 2015.
U.S. Appl. No. 14/317,501, filed Jun. 27, 2014 Final Office Action dated Jul. 1, 2015.
U.S. Appl. No. 14/317,501, filed Jun. 27, 2014 Non-Final Office Action dated Mar. 3, 2015.
U.S. Appl. No. 14/317,501, filed Jun. 27, 2014 Non-Final Office Action dated Sep. 12, 2014.
U.S. Appl. No. 14/449,061, filed Jul. 31, 2014 Non-Final Office Action dated Apr. 27, 2015.
U.S. Appl. No. 14/548,151, filed Nov. 19, 2014 Non-Final Office Action dated Jun. 5, 2015.
Zaidi, Naveed A., et al. “Room temperature magnetic order in an organic magnet derived from polyaniline.” 2004, Polymer, vol. 45, pp. 5683-5689.
CA 2,721,715 filed Apr. 17, 2009 Examiner's Report dated Aug. 18, 2015.
CN 201180052587.5 filed Apr. 28, 2013 Second Office Action dated Aug. 19, 2015.
MX/a/2012/013672 filed Nov. 23, 2012 First Office Action dated Aug. 10, 2015.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Final Office Action dated Aug. 21, 2015.
U.S. Appl. No. 13/240,171, filed Sep. 22, 2011 Advisory Action dated Aug. 18, 2015.
U.S. Appl. No. 13/469,932, filed May 11, 2012 Non-Final Office Action dated Sep. 4, 2015.
U.S. Appl. No. 13/665,420, filed Oct. 31, 2012 Non-Final Office Action dated Jul. 9, 2015.
U.S. Appl. No. 13/890,158, filed May 8, 2013 Non-Final Office Action dated Jul. 9, 2015.
U.S. Appl. No. 14/317,501, filed Jun. 27, 2014 Advisory Action dated Sep. 16, 2015.
U.S. Appl. No. 12/545,762, filed Aug. 21, 2009 Non-Final Office Action dated Sep. 11, 2015.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Non-Final Office Action dated Sep. 10, 2015.
U.S. Appl. No. 14/309,511, filed Jun. 19, 2014 Non-Final Office Action, dated Sep. 24, 2015.
U.S. Appl. No. 14/506,552, filed Oct. 3, 2014 Non-Final Office Action dated Oct. 1, 2015.
EP 10821193.9 filed Mar. 27 2012 Partial European Search Report dated Oct. 9, 2015.
EP 11787527.8 filed Dec. 19 2012 Extended European Search Report dated Oct. 9, 2015.
Micronix Pty Ltd “CathRite” Guiding Styled Core Manufacturing, Jun. 15, 2006.
Murthy, Vrudhula et al, Analysis of Power Spectral Densities of Electrocardiograms, Mathematical Biosciences, pp. 41-51, vol. 12 No. 1-2, Oct. 1971.
Nadroo, AM et al, Changes in Upper Extremity Position Cause Migration of Peripherally Inserted Central Catheters in Neonates, Pediatrics, pp. 131-136, vol. 110, Jul. 2002.
Nakatani, K et al, Accurate Placement of Central Venous Catheters—ECG-guided method vs Patient Height Method, Masui, pp. 34-38, vol. 51 No. 1, Jan. 2002.
Nazarian, GK et al, Changes in Tunneled Catheter Tip Position when a patient is Upright, J Vasc Interv Radiol, pp. 437-441, vol. 8 No. 3, May-Jun. 1997.
NEUROMETER® CPT, Clinical Applications. Neurotron , Inc. website: www.neurotron.com/CLINAPS.html, last accessed Oct. 23, 2006.
NEUROMETER® CPT, Frequently Asked Questions. Neurotron , Inc. website: www.neurotron.com/CPTFAQ/html, last accessed Oct. 23, 2006.
NEUROMETER® CPT, Products Page. Neurotron , Inc. website: www.neurotron.com/products.html, last accessed Oct. 23, 2006.
NEUROMETER® Electrodiagnostic Neuroselective Sensory Nerve Evaluation: Charts, Tables, Documents & Downloads. Neurotron , Inc. website: www.neurotron.com/downloads.html, last accessed Oct. 23, 2006.
Odd, De et al, Does Radio-opaque Contrast Improve Radiographic localisation of Percutaneous Central Venous Lines?, Arch Dis Child Fetal Neonatal Ed, pp. 41-43, vol. 89 No. 1, Jan. 2004.
Palesty, JA et al, Routine Chest Radiographs Following Central Venous Recatherization over a Wire are not Justified, Am J Surg, pp. 618-621, vol. 176 No. 6, Dec. 1998.
Paliotti, Roberta P. et al, Intravascular Doppler Technique for Monitoring Renal Venous Blood Flow in Man, J Nephrol, pp. 57-62, 2003.
Parker, K.H. et al, Cardiovascular Fluid Dynamics, Department of Bioengineering, National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Cardiovascular Haemodynamics, pp. 1-28, Sep. 26, 2005.
Pawlik, et al., “Central Venous Catheter Placement: Comparison of the Intravascular Guidewire and the Fluid Column Electrocardiograms.” European Journal of Anaesthesiology, vol. 41, pp. 594-599, 2004.
PCT/US2006/033079 filed Aug. 24, 2006 International Preliminary Report on Patentability dated Feb. 26, 2008.
PCT/US2006/033079 filed Aug. 24, 2006 Search Report dated Dec. 19, 2006.
PCT/US2006/033079 filed Aug. 24, 2006 Written Opinion dated Dec. 19, 2006.
PCT/US2008/060502 filed Apr. 16, 2008 International Search Report and Written Opinion dated Oct. 16, 2008.
PCT/US2008/084751 filed Nov. 25, 2008 International Preliminary Report on Patentability dated Jun. 1, 2010.
PCT/US2008/084751 filed Nov. 25, 2008 Search Report dated May 20, 2009.
PCT/US2008/084751 filed Nov. 25, 2008 Written Opinion dated May 20, 2009.
PCT/US2009/033116 filed Feb. 4, 2009 International Preliminary Report on Patentability dated Aug. 10, 2010.
PCT/US2009/033116 filed Feb. 4, 2009 Search Report dated Mar. 13, 2009.
PCT/US2009/033116 filed Feb. 4, 2009 Written Opinion dated Mar. 13, 2009.
PCT/US2009/041051 filed Apr. 17, 2009 Search Report dated Jul. 28, 2009.
PCT/US2009/041051 filed Apr. 17, 2009 Written Opinion dated Jul. 28, 2009.
PCT/US2009/054687 filed Aug. 21, 2009 International Preliminary Report on Patentability dated Feb. 22, 2011.
PCT/US2009/054687 filed Aug. 21, 2009 Search Report dated Oct. 6, 2009.
PCT/US2009/054687 filed Aug. 21, 2009 Written Opinion dated Oct. 6, 2009.
PCT/US2009/056567 filed Sep. 10, 2009 International Preliminary Report on Patentability dated Mar. 15, 2011.
PCT/US2009/056567 filed Sep. 10, 2009 Search Report dated Nov. 6, 2009.
PCT/US2009/056567 filed Sep. 10, 2009 Written Opinion dated Nov. 6, 2009.
PCT/US2010/038555 filed Jun. 14, 2010 Search Report dated Oct. 5, 2010.
PCT/US2010/038555 filed Jun. 14, 2010 Written Opinion dated Oct. 5, 2010.
PCT/US2010/045084 filed Aug. 10, 2010 International Preliminary Report on Patentability dated Feb. 23, 2012.
PCT/US2010/045084 filed Aug. 10, 2010 Search Report dated Apr. 14, 2011.
PCT/US2010/045084 filed Aug. 10, 2010 Written Opinion dated Apr. 14, 2011.
PCT/US2010/050773 filed Sep. 29, 2010 Search Report dated Jan. 24, 2011.
PCT/US2010/050773 filed Sep. 29, 2010 Written Opinion dated Jan. 24, 2011.
PCT/US2010/051917 filed Oct. 8, 2010 Search Report dated Nov. 29, 2010.
PCT/US2010/051917 filed Oct. 8, 2010 Written Opinion dated Nov. 29, 2010.
PCT/US2011/023497 filed Feb. 2, 2011 Search Report dated Jun. 6, 2011.
PCT/US2011/023497 filed Feb. 2, 2011 Written Opinion dated Jun. 6, 2011.
PCT/US2011/038415 filed May 27, 2011 International Search Report dated Sep. 28, 2011.
PCT/US2011/038415 filed May 27, 2011 Written Opinion dated Sep. 28, 2011.
PCT/US2011/047127 filed Aug. 9, 2011 International Search Report dated Feb. 29, 2012.
PCT/US2011/047127 filed Aug. 9, 2011 Written Opinion dated Feb. 29, 2012.
PCT/US2011/048403 filed Aug. 19, 2011 International Search Report dated Dec. 15, 2011.
PCT/US2011/048403 filed Aug. 19, 2011 Written Opinion dated Dec. 15, 2011.
PCT/US2011/052793 filed Sep. 22, 2011 International Search Report dated Jan. 6, 2012.
DELTEC Cath-Finder® Tracking System Operation Manual, 1994.
Egelhof, Petra, Effects of Somatostatin on Portal Blood Flow and Portal Vein Pressure in Patients with Portal Hypertension due to Liver Cirrhosis Invasive Monitoring during TIPPSS Procedures, Dissertation submitted to: Technical University of Munich, Faculty of Medicine, May 13, 2002; Date of examination: Feb. 26, 2003.
Engelhardt, W et al, ECG-Controlled Placement of Central Venous Catheters in Patients with Atrial Fibrallation, Anaesthesist, pp. 476-479, vol. 38 No. 9, Sep. 1989 (Abstract only).
EP 09808901.4 filed Aug. 21, 2009 European Search Report dated May 23, 2012.
EP 09813632.8 filed Apr. 5, 2011 European Search Report dated Jul. 4, 2012.
Fearon, William F et al, Evaluating Intermediate Coronary Lesions in the Cardiac Catheterization Laboratory, vol. 4, No. 1, 7 pages, Reviews in Cardiovascular Medicine, 2003.
Felleiter P et al, Use of Electrocardiographic Placement Control of Central Venous Catheters in Austria, Acta Med Austriaca, pp. 109-113, vol. 26 No. 3, 1999 (Abstract only).
Forauer, AR et al, Change in Peripherally Inserted Central Catheter Tip Location with Abduction and Adduction of the Upper Extremity, J Vasc Interv Radiol, pp. 1315-1318, vol. 11 No. 10, Nov.-Dec. 2000.
Frassinelli, P et al, Utility of Chest Radiographs after Guidewire Exchanges of Central Venous Catheters, Crit Care Med, pp. 611-615, vol. 26 No. 3, Mar. 1998.
Frazin L et al, A Doppler Guided Retrograde Catheterization System, Cathet. Cardiovasc Diagn, pp. 41-50, May 1992.
French, PJ et al, Sensors for Catheter Applications, Sensors Update, vol. 13 Issue 1 pp. 107-153, Dec. 2003.
GB Application 0800474.9 filed Aug. 24, 2006 Office Action dated Aug. 9, 2010.
GB Application 0800474.9 filed Aug. 24, 2006 Office Action dated Mar. 17, 2010.
Gebauer, B et al, Ultrasound and Fluoroscopy-guided Implantation of Peripherally Inserted Central Venous Catheters (PICCs), ROFO, pp. 386-391, vol. 176 No. 3, Mar. 2004 (Abstract only).
Gebhard, et al., “The accuracy of Electrocardiogram-Controlled Central Line Placement.” The International Anesthesia Research Society, vol. 104, No. 1 Jan. 2007.
Gjendemsjo, Anders, et al., Energy and Power, The Connexions Project, Version 1.2, Feb. 20, 2004.
Gladwin, MT et al, Cannulation of the Internal Jugular Vein: is postpocedural chest radiography always necessary?, Crit Care Med, 33 pages, Oct. 2000.
Gonzales, et al. “Peripherally Inserted Central Catheter Placement in Swine Using Magnet Detection.” Journal of Intravenous Nursing, vol. 22, No. 3, May/Jun. 1999.
Greenall, M.J. et al, Cardiac Tamponade and Central Venous Catheters, British Medical Journal, pp. 595-597, Jun. 14, 1975.
Guillory, “Basic Principles of Technologies for Catheter Localization.” C.R. Bard internal paper, Oct. 20, 2004.
Guth, AA, Routine Chest X-rays after Insertion of Implantable Long-Term Venous Catheters: Necessary or Not?, Am Surg, pp. 26-29, vol. 67 No. 1, Jan. 2001 (Abstract only).
Hill, Bradley et al, Abstract of article discussing Vasallova VPS as guide for placement of PICCs. 2009.
Hill, Bradley, Identifying the Caval-Atrial Junction Using Smart-Catheter Technology presentation, 22nd Annual Scientific Meeting of the AVA in Savannah, Georgia, Sep. 13, 2008.
Hoffman, Thomas et al, Simultaneous Measurement of Pulmonary Venous Flow by Intravascular Catheter Doppler Velocimetry and Transesophageal Doppler Echocardiography: Relation to Left Atrial Pressure and Left Atrial and Left Ventricular Function, pp. 239-249, J Am Coll Cardiol, Jul. 1995.
Hoffmann, et al. “New Procedure in Transesophageal Echocardiography: Multiplane Transesophageal Echocardiography and Transesophageal Stress Echocardiography.” Herz, vol. 18, No. 5, pp. 269-277, Oct. 1993.
Iacopino, Domenico Gerardo et al, Intraoperative Microvascular Doppler Monitoring of Blood Flow within a Spinal Dural Arteriovenous Fistula: A Precious Surgical Tool, vol. 10, 5 pages, Neurosurg. Focus, Feb. 2001.
Joosting, Jean-Pierre, “Dual-interface RFID-compatible EEPROM enables remote access to electronic device parameters,” EE Times, Mar. 8, 2010.
JP 2008-528151 filed Aug 24, 2006 Notice of Grant dated May 6, 2012.
JP 2010-504220 filed Sep. 3, 2009 Office Action dated May 21, 2012.
Kim, Ko et al, Positioning Internal Jugular Venous Catheters using the Right Third Intercostal Space in Children, Acta Anaesthesiol Scand, pp. 1284-1286, vol. 47 No. 10, Nov. 2003.
Kjelstrup T et al, Positioning of Central Venous Catheters using ECG, Tidssk Nor Laegeforen, pp. 599-601, vol. 111 No. 5, Feb. 1999 (Abstract only).
Kofler, Julia, et al., Epinephrine application via an endotracheal airway and via the Combitube in esophageal position, Critical Care Medicine: May 2000, vol. 28: Issue 5, pp. 1445-1449.
Kowalski, CM et al, Migration of Central Venous Catheters: Implications for Initial Catheter Tip Positioning, J Vasc Intery Radiol, pp. 443-447, vol. 8 No. 3, May-Jun. 1997.
Leowenthal, MR et al, The Peripherally Inserted Central Catheter (PICC): A Prospective Study of its Natural History after Fossa Insertion, Anaesth Intensive Care, pp. 21-24; vol. 30 No. 1, Feb. 2002.
Lepage Ronan et al. ECG Segmentation and P-wave Feature Extraction: Application to Patients Prone to Atrial Fibrillation, IEEE/EMBS Proceedings, 23rd Annual Conference, Istanbul, Turkey, Oct. 25-28, 2001.
Liu , Ji-Bin et al, Catheter-Based Intralumincal Sonography, J Ultrasound Med, pp. 145-160, vol. 23, 2004.
Lucey, B et al, Routine Chest Radiographs after Central Line Insertion: Mandatory Postprocedural Evaluation or Unnecessary Waste of Resources?, Cardiovasc Intervent Radiol, pp. 381-384, vol. 22 No. 5, Sep.-Oct. 1999.
Lum, Phillip, A New Formula-Based Measurement Guide for Optimal Positioning of Central Venous Catheters, JAVA, vol. 9, No. 2, pp. 80-85, 2004.
Lynch, RE et al, A Procedure for Placing Pediatric Femoral Venous Catheter Tips near the Right Atrium, Pediatr Emerg Care, pp. 130-132, vol. 18 No. 2, Apr. 2002.
Madan, et al. “Right Atrial Electrocardiography: A Technique for the Placement of Central Venous Catheters for Chemotherapy or Intravenous Nutrition.” British Journal of Surgery, vol. B1, pp. 1604-1605, 1994.
Madias, John E, Intracardiac (Superior Vena Cava/Right Atrial) ECGs using Saline Solution as the Conductive Medium for the Proper Positioning of the Shiley Hemodialysis Catheter: Is it Not Time to Forego the Postinsertion Chest Radiograph?, pp. 2363-2367, Chest, 2003.
Markovich, Mary B., Central Venous Catheter Tip Placement: Determination of Posterior Malposition-A Case Study, JAVA, vol. 11, No. 2, pp. 85-89, 2006.
Martin, Roy W, An Ultrasoundic Catheter for Intravascular Measurement of Blood Flow: Technical Details, IEEE Transactions on Sonics and Ultrasonics, vol. SU-27, No. 6, pp. 277-286, Nov. 1980.
McDonnall, “Intra-Atrial Electrocardiography (ECG) for Catheter Placement.” Literature review prepared for Bard Access Systems, Oct. 2007.
McGee et al., “Accurate Placement of Central Venous Catheters: A Prospective, Randomize, Multicenter Trail.” Critical Care Medicine, vol. 21 No. 8, Aug. 1993.
MedGraphics, CardioPerfect® Resting/Stress ECG System, 3 pages, 2001.
Michenfelder, John et al, Air Embolism During Neurosurgery—An Evaluation of Right-Atrial Catheters for Diagnosis and Treatment, JAMA, pp. 1353-1358, vol. 208, No. 8, May 26, 1969.
Michenfelder, John et al, Air Embolism During Neurosurgery. A New Method of Treatment, Anesthesia and Analgesia. Current Researches, pp. 390-395, vol. 45, No. 4, Jul.-Aug. 1966.
Microbird™ Miniaturized DC Magnetic Sensors for Intra-body Navigation and Localization, Specifications, 2005.
Micronix CathRite™ Cardiac Access Device Brochure. Jun. 2004.
CN 200880125528.4 filed Nov. 25, 2008 First Office Action dated Jun. 5, 2012.
EP 08855396.1 filed Jun. 15, 2010 European Search Report dated Jul. 31, 2012.
Konings, MK, et al., Development of an intravascular impedance catheter for detection of fatty lesions in arteries, IEEE Trans Med Imaging Aug. 1997; 16(4):439-46.
PCT/US2011/058138 filed Oct. 27, 2011 International Search Report dated Feb. 7, 2012.
PCT/US2011/058138 filed Oct. 27, 2011 Written Opinion dated Feb. 7, 2012.
PCT/US2012/045814 filed Jul. 6, 2012 International Search Report and Written Opinion dated Oct. 1, 2012.
Pop, Gheorghe A. et al., Catheter-based impedance measurements in the right atrium for continuously monitoring hematocrit and estimating blood viscosity changes; an in vivo feasibility study in swine, Biosensors and Bioelectronics 19 (2004) 1685-1693.
U.S. Appl. No. 11/466,602, filed Aug. 23, 2006 Appeal Board Decision dated Sep. 17, 2012.
U.S. Appl. No. 12/369,625, filed Feb. 11, 2009 Notice of Allowance dated Oct. 5, 2012.
U.S. Appl. No. 12/369,625, filed Feb. 11, 2009 Notice of Panel Decision dated Aug. 1, 2012.
U.S. Appl. No. 12/545,762, filed Aug. 21, 2009 Non-Final Office Action dated Aug. 1, 2012.
U.S. Appl. No. 12/715,556, filed Mar. 2, 2010 Non-Final Office Action dated Sep. 13, 2012.
U.S. Appl. No. 12/878,915, filed Sep. 9, 2010 Final Office Action dated Sep. 26, 2012.
U.S. Appl. No. 13/118,138, filed May 27, 2011 Non-Final Office Action dated Oct. 3, 2012.
U.S. Appl. No. 13/213,622, filed Aug. 19, 2011 Non-Final Office Action dated Jul. 31, 2012.
U.S. Appl. No. 13/336,919, filed Dec. 23, 2011 Non-Final Office Action dated Oct. 16, 2012.
“Ascension to Launch New 3D Guidance™ Tracker at TCT 2006.” Press Releases from Ascension website: www.ascension-tech.com/news/press—101106.php, last accessed Dec. 1, 2006.
Acuson—The Value of Vision, AcuNav Diagnostic Ultrasound Catheter, 2000.
Advertising flyer for GAVECELT—The Italian Group for Long Term Venous Access Devices, for program on International Meeting on PICC's, Midline Catheters and Long Term Venous Access Devices in Catholic University, Rome, Italy on Dec. 3, 4, 5, 2008.
Alexander, GD et al, The Role of Nitrous Oxide in Postoperative Nausea and Vomiting, Collection of Abstracts Presented at the International Anesthesia Research Society by various speakers, 58th Congress, Mar. 12-14, 1984, Anesthesia and Analgesia, pp. 175-284, vol. 63, 1984.
Allan, P.L. et al, Role of Ultrsound in the Assessment of Chronic Venous Insufficiency, Ultrasound Quarterly, vol. 17, No. 1, pp. 3-10, 2001.
Andropoulos, et al. “A Controlled Study of the Transesophageal Echocardiography to Guide Central Venous Catheter Placement in Congetital Heart Surgery Patients.” The International Anesthesia Research Society, vol. 89, pp. 65-70, 1999.
Anonymous author, Correct Catheter Placement with a low-impact, reliable and economical method, <http://www.cvc.partner.com/index.cfm?103A955CC6844BF58ACFE3C9C1471959>, last accessed Dec. 22, 2011.
Arai, J et al, Detection of Peripherally Inserted Central Catheter Occlusion by in-line Pressure Monitoring, Paediatr Anaesth, pp. 621-624, vol. 12 No. 7, Sep. 2002.
Arrow International, Inc., The Arrow-Johans RAECG Adapter-Making Proper Central Venous Catheter Placement More Reliable (Modle No. EG-04900), Technical Report 1987, USA.
Aslamy, et al. “MRI of Central Venous Anatomy: Implications for Central Venous Catheter Insertion.” American College of Chest Physicians, Jun. 8, 2009.
AU 2006283022 filed Aug. 24, 2006 Office Action dated Dec. 22, 2010.
AURORA® System Technical Specifications 2004.
B. Braun Website, “The Optimal Position of the Central Venous Catheter.” http://www.cvcpartner.com/index.cfm18F1BDEA1310466194960A39F4E90968 (2009).
B. Braun, Certofix Central Venous Catheter for Placement Using the Seldinger Technique with Simultaneous ECG Lead Option, Feb. 2010.
Bailey, SH et al, Is Immediate Chest Radiograph Necessary after Central Venous Catheter Placement in a Surgical Intensive Care Unit?, Am J Surg, pp. 517-522, vol. 180 No. 6, Dec. 2000.
Bankier, Alexander A., Azygos Arch Cannulation by Central Venous Catheters: Radiographic Detection of Malposition and Subsequent Complications, Journal of Thoracic Imaging 12:64-69 (1997).
Barber, JM et al, A Nurse led Peripherally Inserted Central Catheter Line Insertion Service is Effective with Radiological Support, Clin Radiol, pp. 352-354, vol. 57 No. 5, May 2002.
Bard Access Systems, Sherlock Tip Location System, 5 pages, 2006.
Bard Access Systems, Site Rite Vascular Acess Ultrasound System, 4 pages, 2005.
Benchimol, Alberto at al, Right Atrium and Superior Vena Cava Flow Velocity in Man Measured with the Doppler-Catheter Flowmeter-Telemetry System, The Amer Journal of Medicine, pp. 303-309, vol. 48, Mar. 1970.
BioAdvance Lumen Vu, Greenhouse Fund Feb. 2004 Recipient, www.bioadvance.com <http://www.bioadvance.com>, 2005.
Borgobello, Bridget, App allows users to view electrocardiograms on smartphones dated Oct. 15, 2010; printed from http://www.gizmag.com/app-to-view-electrocardiograms-on-smartphones/16664/ on Feb. 4, 2011.
Buehrle, Douglas, PICC Placement in Humans using Electromagnetic Detection, <http://www.corpakmedsystems.com/supplement—material/supplementpages/navigator/navarticle.html>, 2008.
C.R. Bard, CathTrack™ Catheter Location System at www.bardaccess.com <http://www.bardaccess.com>, last accessed Apr. 28, 2011.
C.R. Bard, Inc., Bard Electrophysiology Product Catalogue, Bard Catheters, pp. 74-75 (2002), USA.
Cadman, A et al, To Clot or Not to Clot? That is the question in Central Venous Catheters, Clinical Radiology, pp. 349-355, vol. 59 No. 4, Apr. 2004.
Calvert, N et al, The Effectiveness and Cost-effectiveness of Ultrasound Locating Devices for Central Venous Access: a Systematic Review and Economic Evaluation, Health Technology Assessment, vol. 7, No. 12, 2003.
Cardella, John F. et al., Interventinal Radiologic Placement of Peripherally Inserted Central Catheters, Journal of Vascular and Interventional Radiology 1993; 4:653-660.
Carlon, R et al, Secondary Migration of a Central Venous Catheter—A Case Report, Minerva Anestesiol, pp. 927-931, vol. 69 No. 12, Dec. 2003.
Caruso, LJ et al, A Better Landmark for Positioning a Central Venous Catheter, J Clinical Monitoring and Computing, pp. 331-334, vol. 17 No. 6, Aug. 2002.
Cavatorta, et al., “Central Venous Catheter Placement in Hemodialysis: Evaluation of Electrocardiography Using a Guidewire.” The Journal of Vascular Access, vol. 2, pp. 45-50, 2001.
Chalkiadis, GA et al, Depth of Central Venous Catheter Insertion in Adults: An Audit and Assessment of a Technique to Improve Tip Position, Anaesth Intensive Care, pp. 61-66, vol. 26 No. 1, Feb. 1998.
Chamsi-Pasha, Hassan et al, Cardiac Complications of Total Parenteral Nutrition: The Role of Two-Dimensional Echocardiography in Diagnosis, Annals of the Royal College of Surgeons of England, pp. 120-123, vol. 71, 1989.
Chang, Thomas C. et al., Are Routine Ch Ladiographs Necessary After Image-Guided Placement of Internal Jugular Central Venous Access Devices?, AJR Feb. 1998;170:335-337.
Chaturvedi et al., “Catheter Malplacement During Central Venous Cannulation Through Arm Veins in Pediatric Patients.” Journal of Neurosurgical Anesthesiology, vol. 15, No. 3 pp. 170-175, Jan. 2003.
Chen, Zhongping et al, Optical Doppler Tomography: Imaging in vivo Blood Flow Dynamics Following Pharmacological Intervention and Photodynamic Therapy, 7 pages, vol. 67, Photochemistry and Photobiology, 1998.
Cheng, Ki et al, A Novel Approach of Intravenous Electrocardiograph Technique in Correct Position the Long-Term Central Venous Catheter, Kaohsiung J Med Sci, pp. 241-247, vol. 16 No. 5, May 2000 (Abstract only).
Cheung, P., et al., The Effect of a Disposable Probe Cover on Pulse Oximetry, Anaesth Intensive Care 2002; 30: 211-214.
Chu, et al., “Accurate Central Venous Port-A Catheter Placement: Intravenous Electrocardiography and Surface Landmark Techniques Compared by Using Transesophageal Echocardiography.” The International Anesthesia Research Society, vol. 98, pp. 910-914, 2004.
Claasz, Antonia et al, A Study of the Relationship of the Superior Vena Cava to the Bony Landmarks of the Sternum in the Supine Adult: Implications for Magnetic Guidance Systems, Journal, vol. 12 No. 3, JAVA, Jul. 24, 2007.
Clifford, et al. “Assessment of Hepatic Motion Secondary to Respiration for Computer Assisted Interventions.” Computer Aided Surgery, vol. 7, pp. 291-299, 2002.
CN 200880012117.4 filed Apr. 16, 2008 First Office Action dated Dec. 23, 2011.
Colley, Peter S et al, ECG-Guided Placement of Sorenson CVP Catheters via Arm Veins, Anesthesia and Analgesia, pp. 953-956, vol. 63, 1984.
Collier, PE et al, Cardiac Tamponade from Central Venous Catheters, Am J Surg, pp. 212-214, vol. 176 No. 2, Aug. 1998.
ComboWire® Pressure/Flow Guide Wire Ref 9500 Series, Instructions for Use, Apr. 2011.
Corsten, et al., “Central Placement Catheter Placement Using the ECG-Guided Cavafix-Certodyn SD Catheter.” Journal of Clinical Anesthesiology, vol. 6, Nov./Dec. 1994.
Cucchiara, Roy et al, Time Required and Success Rate of Percantaneous Right Atrial Catherization: Description of a Technique, Canad. Anaesth. Soc. J., pp. 572-573, vol. 27, No. 6, Nov. 1980.
Cullinane, DC et al, The Futility of Chest Roentgenograms Following Routine Central Venous Line Changes, Am J Surg, pp. 283-285, vol. 176 No. 3, Sep. 1998.
Curet, Myriam J. et al., University and Practice-based Physicians' Input on the Content of a Surgical Curriculum, The American Journal of Surgery® vol. 178 Jul. 1999, 78-84.
David, et al., “Is ECG-Guidance a Helpful Method to Correctly Position a Central Venous Catheter During Prehospital Emergency Care?” ACTA Anaesthesiologica Scandinavica, vol. 49, pp. 1010-1014, 2005.
CN 201180037068.1 filed Jan. 28, 2013 Office Action dated Oct. 19, 2015.
CN 201180040151.4 filed Feb. 19, 2013 Office Action dated Dec. 10, 2015.
CN 2011800525875 filed Apr. 28, 2013 Office Action dated Feb. 24, 2016.
CN 201180068309.9 filed Aug. 22, 2013 Office Action dated Sep. 2, 2015.
EP 11787515.3 filed Dec. 12, 2012 partial European search report dated Oct. 27, 2015.
JP 2012-552060 filed Aug. 1, 2012 Office Action dated Nov. 6, 2015.
JP 2013-512046 filed Nov. 26, 2012 Office Action dated Dec. 8, 2015.
U.S. Appl. No. 12/545,762, filed Aug. 21, 2009 Non-Final Office Action dated Feb. 16, 2016.
U.S. Appl. No. 12/815,331, filed Jun. 14, 2010 Final Office Action dated Nov. 4, 2015.
U.S. Appl. No. 12/854,083, filed Aug. 10, 2010 Non-Final Office Action dated Feb. 1, 2016.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Final Office Action dated Mar. 25, 2016.
U.S. Appl. No. 13/240,171, filed Sep. 22, 2011 Non-Final Office Action dated Dec. 1, 2015.
U.S. Appl. No. 14/040,205, filed Sep. 27, 2013 Non-Final Office Action dated Mar. 10, 2016.
U.S. Appl. No. 14/141,046, filed Dec. 26, 2013 Non-Final Office Action dated Nov. 5, 2015.
U.S. Appl. No. 14/201,300, filed Mar. 7, 2014 Non-Final Office Action dated Jan. 6, 2016.
U.S. Appl. No. 14/270,241, filed May 5, 2014 Notice of Allowance dated Oct. 7, 2015.
U.S. Appl. No. 14/449,061, filed Jul. 31, 2014 Final Office Action dated Nov. 6, 2015.
U.S. Appl. No. 14/498,887, filed Sep. 26, 2014 Non-Final Office Action dated Feb. 19, 2016.
CN 201180037065.8 filed Jan. 28, 2013 Third Office Action dated Nov. 24, 2015.
CN 201280033189.3 filed Jan. 3, 2014 First Office Action dated Apr. 3, 2014.
CN 201280033189.3 filed Jan. 3, 2014 Second Office Action dated Sep. 14, 2015.
CN 201410009216.4 filed Jan. 8, 2014 Second Office Action dated Sep. 25, 2015.
EP 09743249.6 filed Oct. 18, 2010 Extended European Search Report dated Jan. 13, 2016.
EP 11740309.7 filed Aug. 23, 2012 Extended European Search Report dated Aug. 3, 2015.
EP 15179061.5 filed Jul. 30, 2015 Extended European Search Report dated Jan. 14, 2016.
JP2013-530322 filed March18, 2013, First Office Action dated Jul. 31, 2015
MX/a/2013/001317 filed Jan. 31, 2013 First Office Action dated Nov. 26, 2015.
U.S. Appl. No. 13/118,033, filed May 27, 2011 Final Office Action dated Apr. 1, 2016.
U.S. Appl. No. 13/118,138, filed May 27, 2011 Final Office Action dated Apr. 1, 2016.
U.S. Appl. No. 13/469,932, filed May 11, 2012 Final Office Action dated Apr. 7, 2016.
U.S. Appl. No. 13/665,420, filed Oct. 31, 2012 Final Office Action dated Apr. 8, 2016.
U.S. Appl. No. 14/449,061, filed Jul. 31, 2014 Notice of Allowance dated Apr. 13, 2016.
CN 201180037065.8 filed Jan. 28, 2013 Fourth Office Action dated May 5, 2016.
JP 2013-512046 filed Nov. 26, 2012 Office Action dated May 16, 2016.
JP 2014-519081 filed Dec. 27, 2013 First Office Action dated Apr. 26, 2016.
JP2013-530322 filed Mar. 18, 2013, Office Action dated May 2, 2016.
KR 10-2012-7000866 filed Jan. 11, 2012 First Office Action dated Jun. 16, 2016.
RU 2013158008 filed Dec. 26, 2013 First Office Action dated May 27, 2016.
U.S. Appl. No. 12/893,916, filed Sep. 29, 2010 Advisory Action dated Jun. 2, 2016.
U.S. Appl. No. 13/240,171, filed Sep. 22, 2011 Final Office Action dated May 6, 2016.
U.S. Appl. No. 13/469,932, filed May 11, 2012 Advisory Action dated Jun. 27, 2016.
U.S. Appl. No. 14/141,046, filed Dec. 26, 2013 Final Office Action dated May 11, 2016.
U.S. Appl. No. 14/201,300, filed Mar. 7, 2014 Final Office Action dated May 5, 2016.
U.S. Appl. No. 14/317,501 filed Jun. 27, 2014 Examiner's Answer dated Jun. 30, 2016.
U.S. Appl. No. 14/498,887 filed Sep. 26, 2014 Final Office Action dated Jun. 15, 2016.

Related Publications (1)

	Number	Date	Country
	20130006102 A1	Jan 2013	US

Provisional Applications (7)

Number	Date	Country
60990242	Nov 2007	US
61045944	Apr 2008	US
61091233	Aug 2008	US
61095451	Sep 2008	US
61095921	Sep 2008	US
61349771	May 2010	US
61505036	Jul 2011	US

Continuation in Parts (2)

	Number	Date	Country
Parent	13118033	May 2011	US
Child	13543586		US
Parent	12323273	Nov 2008	US
Child	13118033		US

Needle length determination and calibration for insertion guidance system

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

Agents

CPC

Field of Search

CPC

International Classifications

Term Extension

Abstract