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US 7831106 B2 Abstract A portable, lightweight digital imaging device uses a slit scanning arrangement to obtain an image of the eye, in particular the retina. The scanning arrangement reduces the amount of target area illuminated at a time, thereby reducing the amount of unwanted light scatter and providing a higher contrast image. A detection arrangement receives the light remitted from the retinal plane and produces an image. The device is operable under battery power and ambient light conditions, such as outdoor or room lighting. The device is noncontact and does not require that the pupil of the eye be dilated with drops. The device can be used by personnel who do not have specialized training in the eye, such as emergency personnel, pediatricians, general practitioners, or volunteer or otherwise unskilled screening personnel. Images can be viewed in the device or transmitted to a remote location. The device can also be used to provide images of the anterior segment of the eye, or other small structures. Visible wavelength light is not required to produce images of most important structures in the retina, thereby increasing the comfort and safety of the device. Flexible and moderate cost confocal and fluorescent imaging, multiply scattered light images, and image sharpening are further functionalities possible with the device.
Claims(23) 1. A digital retinal imaging device comprising:
a. an illumination source;
b. a scanning element operable to move a portion of an illumination pathway created by the illumination source with respect to a target;
c. at least one slit within the illumination pathway of the illumination source; and
d. a two dimensional complementary metal-oxide-semiconductor (�CMOS�) detector chip having a rolling shutter functionality.
2. The digital retinal imaging device of
3. The device of
4. The device of
5. The device of
6. The device of
7. A digital retinal imaging device comprising:
a. an illumination source and scanning element operable to move the illumination source with respect to a target;
b. a detector array operable to detect and build a first image data set relative to the target, and further operable to detect and build a second image data set relative to the target;
c. a processor operable to utilize the first image data set and the second image data set such that each line comprising the first image data set is compared to a corresponding line on the second image data set in a weighted manner such that a sharpened image is created.
8. The digital retinal imaging device of
9. The digital retinal imaging device of
10. The device of
11. The device of
12. The device of
13. The device of
14. A digital imaging device comprising:
a. an illumination source and a mechanism to cause a scanning motion of the illumination with respect to a target;
b. a CMOS array operable to select one or more leading lines or lagging lines with respect to the alignment with an optical axis of a beam from the illumination source;
c. a processor operable to combine the one or more leading lines and lagging lines selected and detected to create a multiply scattered image.
15. The device of
16. The device of
17. The device of
18. The device of
19. The device of
20. The device of
21. The device of
22. A device for digital retinal imaging, comprising:
a. an illumination source that fluoresces when excited, and operable to produce an illumination pathway;
b. a first detector array within the illumination pathway operable to detect wavelengths of irradiated energy reflected from a target within the illumination pathway;
c. a barrier filter operable to reject selected wavelengths such that only selected wavelengths reach the detector.
23. The device of
Description The present application is a U.S. National Stage Application of International Patent Application Serial No. PCT/US07/12726, filed on May 30, 2007, the contents of which are herein incorporated by reference, which claims priority to U.S. Provisional Patent Application Ser. No. 60/809,551, filed on May 31, 2006, the contents of which are herein incorporated by reference. The work leading to the invention received support from the United States federal government under National Institutes of Health Grant No. EB002346. The federal government has certain rights in the invention. The human retina is susceptible to damage from a variety of environmental factors, including laser light impact and other trauma, as well as disease. Once damaged, the cells responsible for capturing light energy and transducing it into a neural signal, the photoreceptors, do not regenerate. In fact, none of the neural cells of the retina can yet be made to readily regenerate in the adult human. When damage is severe enough, there is permanent vision loss in an area. Healthy photoreceptors do not migrate long distances toward the damaged area to replace damaged ones. If the affected region is in the central macula, known as the fovea, then the ability to see fine detail, read at rapid rates, or recognize objects at great distances may be lost. The peripheral areas of vision do not have sufficient sampling density to perform these tasks to the same degree. Thus, early detection and treatment of potentially sight-robbing damage are crucial in maintaining central vision. One of the chief problems in early detection of damage has been the difficulty of imaging a small area of retina. The macula presents a small target�6000 microns. The portion that is necessary for seeing damage that precludes observation of fine detail and reading is even smaller, about 600 microns. To examine this latter portion properly, it is desirable to image the central 20 degrees of the macula with sufficient magnification and contrast to determine whether an individual is at risk for permanent vision loss. The opthalmoscope or fundus camera has traditionally been used to view and image the retina. Originally, these devices flooded the retina with white light. Subsequent devices have used selective wavelengths that have been found suitable for viewing or imaging particular structures or contrast between structures. Regardless of the wavelength of light used, many of the past devices used flood illumination, producing images of the retina that often are subject to poor contrast due to long range scatter. The long range scatter problem was identified to occur, not only from out of plane tissues, but also from the biological tissues that are inherently scattering, especially those within and near the retina. One well-known method of reducing the long range scatter problem is to replace a flood illumination source with a scanning illumination source. Some research has suggested that the use of a double scanning optical apparatus that scans both incident and reflected light using a horizontal scanning element may be desirable. Scanning with such an element can be performed by a rotating multifaceted polygonal reflector, and a vertical scanning element, such as a reflecting galvanometer. Such an instrument is able to provide a two-dimensional output representative of reflection characteristics of the eye fundus. See, e.g., U.S. Pat. Nos. 4,768,873 and 4,764,005, as well as U.S. Pat. No. 4,768,874 each disclosing a laser scanning opthalmoscope in which a line beam is scanned across an eye. Such improvements have greatly increased the contrast of the images produced, but typically require expensive, heavy equipment that must be operated by a specialist. Improvements on the scanning illumination source technology have been embodied in the use of advanced reflectometry techniques with a scanning laser opthalmoscope (�SLO�) as developed by the inventor, Ann Elsner, and colleagues. See, for example, Elsner A. E., et al., Reflectometry with a Scanning Laser Opthalmoscope, Applied Optics, Vol. 31, No. 19 (July 1992), pp. 3697-3710 (incorporated herein by reference). The SLO is advantageous for quantitative imaging in that a spot illumination is scanned in a raster pattern over the fundus, improving image contrast significantly over flood illumination. The inventor's SLO technology can further eliminate unwanted scattered light by using confocal apertures such as a circle of variable diameter or annular apertures, depending on the desired mode. Once the light is returned through the confocal aperture, the desired light can then be transmitted to a detector. However, the optics used in confocal apertures can increase the complexity of the system, and high quality optics are an added expense. Therefore, a method for reducing or eliminating unwanted scattered light in a more cost effective manner would be greatly appreciated. Further improvements to increase contrast in retinal imaging systems include the extensive use of near infrared light as an illumination source, in lieu of other wavelengths or color images, as developed by the inventor and colleagues and described in Elsner, A. E., et al., Infrared Imaging of Sub-retinal Structures in the Human Ocular Fundus, Vision Res., Vol. 36, No. 1 (1996), pp. 191-205; Elsner, A. E., et al., Multiply Scattered Light Tomography: Vertical Cavity Surface Emitting Laser Array Used for Imaging Subretinal Structures, Lasers and Light in Opthalmology, 1998; Hartnett, M. E. and Elsner, A. E., Characteristics of Exudative Age-related Macular Degeneration Determined In Vivo with Confocal and Indirect Infrared Imaging, Opthalmology, Vol. 103, No. 1 (January 1996), pp. 58-71; and Hartnett, M. E., et al., Deep Retinal Vascular Anomalous Complexes in Advanced Age-related Macular Degeneration, Opthalmology, Vol. 103, No. 12 (December 1996), pp. 2042-2053 (all of which are incorporated by reference herein). Combining infrared imaging with SLO allows the use of reflectometry techniques to view the eye rapidly and noninvasively because infrared light is absorbed less than visible light and scatters over longer distances. Further, when implemented with scanning laser devices, infrared and near infrared imaging of sub-retinal structure in the ocular fundus has been able to reveal sub-retinal deposits, the optic nerve head, retinal vessels, choroidal vessels, fluid accumulation, hyperpigmentation, atrophy, and breaks in Bruch's membrane�features that have proven difficult or impossible to observe with flood illumination devices. In addition, because infrared illumination is absorbed by the tissues less than other wavelengths, much less illumination from the source is required to create a high contrast image. The improvements noted above, and methods for successfully imaging small retinal features were combined in U.S. Patent Application No. 60/329,731; Ser. No. 10/493,044; 60/350,836; and PCT Application No. PCT/US02/32787, incorporated by reference herein. In addition, discussions of using the techniques for detecting and localizing such features are described in the publications of the inventor and colleagues: Elsner, A. E., et al., Infrared Imaging of Sub-retinal Structures in the Human Ocular Fundus, Vision Res., Vol. 36, No. 1 (1996), pp. 191-205; Elsner, A. E., et al., Multiply Scattered Light Tomography: Vertical Cavity Surface Emitting Laser Array Used For Imaging Subretinal Structures, Lasers and Light in Opthalmology, (1998); Elsner, A. E., et al., Foveal Cone Photopigment Distribution: Small Alterations Associated with Macular Pigment Distribution, Investigalive Opthalmology & Visual Science, Vol. 39, No. 12 (November 1998), pp. 2394-2404; Hartnett, M. E. and Elsner, A. E., Characteristics of Exudative Age-related Macular Degeneration Determined In Vivo with Confocal and Indirect Infrared Imaging, Opthalmology, Vol. 103, No. 1 (January 1996), pp. 58-71; and Hartnett, M. E., et al., Deep Retinal Vascular Anomalous Complexes in Advanced Age-related Macular Degeneration, Opthalmology, Vol. 103, No. 12 (December 1996), pp. 2042-2053, incorporated by reference herein. The systems and techniques described in the inventor's previous patent applications introduced a moderately priced, portable system that provided a high contrast, digital image of the eye that could be used by non-specialists, such as paramedics or other individuals in the field. However, creating a system that is even less expensive, uses standard digital imaging technology, includes fewer high precision optics to obtain a high contrast image would be greatly appreciated in the art. In addition, studies have shown that the multiply scattered light images, that are used to reveal structures in the deeper retina, can provide more detailed images that provide additional diagnostic utility. Further, the use of the infrared spectrum can be used to image the retina without dilation of the patient's pupils, and the added potential for using multiply scattered light, particularly in cases in which the target of interest falls below a highly reflective layer, allow visualization of features difficult to see otherwise. However, previous scanning devices, including those embodied in the patent applications submitted by the inventor and her colleagues, do not readily utilize this method for producing an image without scanning not only the light illuminating the target, but also scanning the light returning from the target to the detector, which requires considerable care. Therefore, a moderately priced, portable digital retinal imaging device that is capable of producing multiply scattered light images would be greatly appreciated in the art. Existing devices specifically designed for screening of retinal disease that use flood illumination with bright lights of shorter wavelengths, and typically acquire single images at slow rates, have been shown recently to provide an unacceptable percentage of gradable images in the hands of technicians (Zimmer-Galler I, Zeimer R. Results of implementation of the DigiScope for diabetic retinopathy assessment in the primary care environment. Telemed J E Health. 2006 April; 12(2):89-98), regardless of the duration of training (Ahmed J, Ward T P, Bursell S E, Aiello L M, Cavallerano J D, Vigersky R A. The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy. Diabetes Care. 2006 October; 29(10):2205-9.) As discussed above, the embodiments of the present application address the issue of inconsistent use in the eye field. Other issues addressed by embodiments of the present application include onboard pre-processing of image and instrument parameter data for quality assurance and ease of use, addressing the issue of alignment of the instrument with respect to the target (e.g., small pupils and addressing and other issues regarding the anterior segment of the eye). The present application further addresses the prior art issue of failing to capture the images of the best existing quality, and failing to operate the instrument with optimal parameters. Therefore, a moderate cost, portable retinal imaging device that provides for the use of a scanning laser device operating with near infrared illumination and which can allow for multiply scattered light would be appreciated in the art. Further, such a device that would allow for increased ease of use by allowing a greater field of view than just 20 deg visual angle, greater field of view without sacrificing spatial resolution, as well as utilizing a non-proprietary system for producing and saving the digital image, would be greatly appreciated. The present application relates to a device designed as an improved digital retinal imaging device. In particular, the present application relates to a laser scanning digital camera (�LSDC�) intended to be smaller and/or lower in cost than previous devices, while retaining a user-friendly format that allows a non-professional to obtain a high quality digital retinal image that can be easily stored, transmitted, or printed. In addition, according to another embodiment of the present application, the improved digital retinal imaging device may be used as a general imaging device or to improve image contrast in microscopy. Further, according to another embodiment of the present application, the additional aperture configurations and image processing capabilities provide a means for providing multiply scattered light images, which are useful for detecting structures that hidden under highly reflective tissue (e.g., deep retinal or choroidal disease underlying the vitreo-retinal interface and nerve fiber layer). In addition, according to certain embodiments of the present application, the device allows for increased illumination and/or light return at the edges of the field of view, thereby allowing for a more consistent, high contrast image to be produced. Finally, according to certain embodiments of the present application, a system and device allow for an increase in field size over previous embodiments, thereby allowing quality images to be taken even if the user is not adept at accurately aligning the imaging device with the eye. Therefore, according to one aspect of the present application, the device is suitable for providing screening for eye diseases or triage for trauma and can readily interface with modern computer technology for remote or telemedicine applications. The device is able to operate in extreme heat or cold, when wet, while on a moving surface, and in a cordless, battery-powered mode. The device can be manufactured relatively inexpensively at significantly less cost than conventional scanning laser opthalmoscopes. According to one embodiment of the present application, the device includes an illumination source, a scanning arrangement, a detection arrangement, a beam separation arrangement, and a controller. The scanning arrangement is disposed on an illumination path from the illumination source to a target and is operative to scan light passed through a slit in the illumination path across a desired focal plane of the target, e.g., the retinal plane, through an entrance more narrow than the desired focal plane, e.g., the pupil. The detection arrangement is disposed to receive light remitted from the target and operative to produce an image. The beam separation arrangement is disposed on a return path from the target separated from the illumination path and is operative to receive light remitted from the target and to direct remitted light on a detection path to the detection arrangement. The beam separation arrangement is configured to space the illumination path and the return path sufficiently apart to reduce reflections from sources out of the desired focal plane and sufficiently closely to obtain an image of a sufficient desired resolution. According to one embodiment, a controller is in communication with the illumination source, the scanning arrangement, and the detection arrangement. In one embodiment, the device differs from previous instruments in that it features scanning of one or more light sources, one of which is preferably near infrared, at a much reduced cost. The device optionally includes on board digital memory or another storage device, such as is used in a digital camera. The instrument is stand-alone in one embodiment, and a personal computer is not required to operate the device. Further optionally, the data are transmitted to a computer, memory device, or other device including via wireless broadcast. A laptop and consumer grade software may be used to access the images if a computer is used. In addition, existing or large patient record systems, such as an electronic medical record system that can use image data are also a potential means of distribution or storage of data. In one embodiment, the device is minimized in weight or mass and is portable, so that it is suitable for use outside of specialized opthalmological offices and laboratories. According to certain embodiments, the device can operate solely on batteries. The device of the present application is optionally motorized for remote access, using either DC operation or AC operation, as power supply permits. The device can be made to draw its power though a single cable, such as through a computer. The computer can be a laptop or personal data assistant, which is consistent with use as a portable device. According to one embodiment of the present application, the digital imaging device is operable to provide a high contrast image by using an electronic aperture in the plane of the target or in a plane conjugate to the target, in either the input or detection pathway, or both. Optionally, the digital imaging device is further capable of providing multiply scattered light images by positioning the input and detection apertures in the plane of or near to the target, but offset with respect to each other. Alternatively, a multiply scattered light image may be obtained by positioning the input and detection apertures conjugate to the target, but offset with respect to each other, as described in further detail below. A multiply scattered light image provides diagnostic information not readily seen in the reflectance image, and may be accomplished by using a rolling shutter feature of a CMOS image array (discussed in further detail below) to sample an image line by line. This method leads to a high contrast image or a multiply scattered light image according to certain embodiments of the present application as discussed in further detail below. The contrast of an image obtained through the method and/or device of the present application can provide details about structures such as retinal blood vessels that may be useful as screening or diagnostic data. Near-infrared illumination may be used to image the retinal blood vessels, thereby eliminating the need for short wavelength sources which require higher power and lead to pupil constriction unless medication is used to dilate the pupil. Therefore, the method and device of the present application provide a more comfortable experience for the patient, as well as a higher quality image that may prove more useful for diagnosis of diseases such as diabetic retinopathy and age-related macular degeneration. If more than one wavelength of illumination is used in the device of the present application, each wavelength can correspond to differing amounts of blood absorption, thereby allowing hemorrhages and other vascular features to be visualized in the comparison image. The present application relates to a small, portable lightweight instrument or device of low cost particularly suitable for examining the retinal and subretinal layers of the eye 10 (see According to one embodiment, the light from the desired focal plane is collected and stored digitally in electronic or magnetic form and/or transmitted to a remote site if needed. The footprint of the optical components can be minimized and the device is optionally operable by DC battery power. Optionally, the main controls are few and simple, primarily a power switch, a focusing mechanism, a mechanism to increase or decrease the light level of the illumination source that may be under operator control or automatic, a mechanism to initiate acquisition of images, and a mechanism to control the storage or transferal of the images. Control electronics or mechanical adjustments, illustrated schematically at 46, allow the end user or an automatic process to control the illumination source 34, the scanning element 30, the detection pathway components 38, the display 40, and the database 48, as well as devices such as alignment or focusing monitors, synchronization circuitry, transmission using wires or wireless methods, additional image monitors, image capture or recording devices, and image storage devices that are interconnected with them. These resulting images can be fed into the database of image data 48, or used without reference to the database. The database of images 48 may be used via components 44 for telemedicine, training, and distance education concerning the status or health of the target, as the user of this instrument may be remote from a decision maker or may be unskilled in the arts of image acquisition or image interpretation of this type of image. The database can also contain normative, classification, or quantitative data and decision-making procedures concerning the outcome of the data. The separation element 36 can be any type of separation element, such as a beam splitter with the reflective portion intersecting the beam of light and directing it towards target 32, while the more transmissive portion passes the light toward the detection pathway 38, shown schematically in In As noted above, scanning the light across the target through a slit aperture (and scanning again in the detection pathway if this is performed, described further below) aids in decreasing unwanted scattered light in the resulting image. The scanning can be accomplished in a variety of ways well-known in the art. For example, a mirror component may be mounted to a rotating or oscillating element, a magnetic device, a spring, a torsion rod, or other mechanically controlled device such as a solenoid, or a gravity controlled device. The scanning element can be activated in any suitable manner, such as by a button or lever press, a sliding switch, a toggle switch, or a knob rotation by the operator. In one embodiment, the scanning element is preferably driven by a battery operated DC motor, which is an inexpensive configuration and allows the device to be portable. In one embodiment, a rotating element that rotates in one direction, such as a DC motor may be used. Such a motor may be selected to be quiet in operation and operate with little disruption from environmental vibrating. Light returning from the target 52 is separated from light striking the target at beam separation element 66. In the embodiment shown in The separation element 66 may comprise a partially or fully reflective surface that does not intersect the light directed towards the target 52. The reflective surface may comprise a mirror or a beam splitter with the reflective portion not intersecting the beam of light directed at the target, as shown. The separation element can also be any number of other separation elements, such as a beam splitter with a reflective portion intersecting the beam of light directed towards target and a transmissive portion including a mirror that reflects less than 100% of the light towards the target or a transmissive portion intersecting the beam of light directed towards the target and the reflective portion allowing the light from the target to pass. According to one embodiment of the present application, further decrease of light from unwanted planes can be obtained by directing the light on the detection pathway from the target 52 to a two-dimensional detector array 68 comprising a complementary metal-oxide-semiconductor chip (�CMOS�) (referred to as a �CMOS detector array�). The CMOS detector array operates in such a way that it acts as a �rolling shutter� because an image is formed by digitizing in an iterative line-by line fashion. Thus, as a beam of light is directed onto the CMOS detector array, only one small line or region of the image is read or exposed at any given time. Therefore, only light in phase with the particular line being read or exposed by the CMOS detector array is collected by the CMOS, thereby causing the digital image of the target to be �built� one line at a time. Optionally, if a more advanced CMOS detector can be used, allowing more than one line can be built simultaneously, and providing additional benefits and functionality discussed more thoroughly below. The use of the CMOS in lieu of a charge coupled device chip (�CCD chip�) as used in previous embodiments creates multiple unexpected benefits. While it was previously thought that synchronizing the rolling shutter feature of the CMOS detector array with the scanning slit aperture would be difficult, thereby increasing costs in production of the device, it has been found that use of the CMOS detector array itself acts as a confocal aperture due to its rolling shutter function, thereby eliminating the need for several expensive focusing and other elements that were necessary in the detection pathway in earlier embodiments. In addition, it was found that the use of the CMOS detector with a rolling shutter feature significantly reduces or eliminates blooming of an image, and further allows several additional functionalities to be present in the device that were not present in previous embodiments. According to another embodiment of the present application, an optional electronic input aperture is substituted or added to allow adjustment of the width of the slit that is scanned, as well as the width of the slit that is detected through the detection pathway. In addition, the use of a CMOS detector array allows one to eliminate elements between beam separator 66 and detector array 68. This allows for a complete change of the geometry of the device, because the rolling shutter feature reduces the need for a third scanning face and facets needed during the acquisition of each image. The elimination of these components allows for a reduction in optical aberrations that affect the resultant image, and further allow for an increased field size imaged by the device. For example, the present embodiment allows for a field of view 1.5 to 2 times wider than the twenty degree (20�) field size of the previous embodiments without otherwise significantly altering the design of the device. A greater field of view of the device translates into a more user friendly imaging system, because an operator does not need to align the device with the eye as exactly as he or she would be required with a device that was more limited in field size. Yet another functionality achieved through the use of a CMOS detector array with a rolling shutter feature is the ability to use scattered light imaging, increased sampling in the case of low signal, and image sharpening. For example, if the CMOS array is read line by line, it is possible to select a leading line or a lagging line in precise alignment with the optical axis of the illumination beam. When the illumination beam is digitally imaged, using the leading or lagging line or both together, a scattered image results. In one embodiment, two or more lines are digitally imaged in close succession to one another, or even simultaneously. Imaging these two or more lines allows for an overall image with a more precise image of a moving target, such as an eye, and allows reduction or elimination of shadowing from detection that is asymmetric. With non-moving targets, two images are acquired sequentially and then combined to provide a multiply scattered image without the use of advanced CMOS hardware. In addition, the input and detection apertures can be adjusted relative to each other to provide increased illumination control, more or less scattered light, and correction of poor illumination or return at the edges of the field. An electronic shutter can operate with sufficient speed to alter the illumination pathway within each line of the image when necessary as discussed further below. Optionally, more than one line in the CMOS detector can be activated to allow the detection of more light, with or without the additional aperture. Using the imaging method described above, one embodiment of the present application allows for image sharpening when two or more lines adjacent to the on-axis line on the CMOS output are subtracted from the on axis line. Optionally, the two lines may be subtracted in a weighted manner. While it has been known in the art to use image processing with high contrast laser images to create such image sharpening, the image processing has always been done after the image was created. The present embodiment of the device allows the sharpening and image processing to occur while the target is being imaged, thereby allowing the operator to see the sharpened image at the time the target is in front of him or her. Therefore, since the sharpened image is able to be viewed by the operator while taking the image, the operator can determine whether additional images need to be taken to ensure that a quality image results. According to yet another embodiment of the present application, a bi-directional scan is utilized, wherein multiple lines are detected and imaged sequentially (or otherwise) in differing directions. For example, a first scan sequentially detects and images lines toward the left of the starting position while a second scan sequentially detects and images lines toward the right of the starting position. Optionally, both the first and the second scan occurs simultaneously, and timing software is used to create multiply scattered light images from these scans. Utilizing a CMOS detector array 68 to detect and build an image has the additional advantage over previous embodiments in that images obtained with a device according to the present application are optionally stored to memory media that is common�even in the retail consumer market. For example, experiments utilizing certain embodiments of the present application utilized flash memory cards and digital capture cards in a typical personal computer processor or digital camera. It will be appreciated that several other conventional or non-conventional storage media well known in the art may be used to acquire images detected by the CMOS detector array. Yet another advantage to using a CMOS detector array in lieu of a CCD chip is that the CCD vertical resolution is decreased by a factor of 2 in each field, because the CMOS detector array is not interlaced as is the case with interlaced CCD chips. Progressive scan chips do not have the reduction of vertical resolution, and along with CMOS chips are preferred when target motion such as eye movements are of concern because sequential scanning and similar schemes allow an image to be built up with adjacent structures sampled at more similar points in time, compared with interlaced schemes that acquire odd lines, and then even lines. Additionally, interlaced CCD chips require a 30 Hz frame rate, whereas CMOS chips operate at a lower sampling rate, thereby allowing improvement of signal to noise ratio. Further, use of a CMOS detector array instead of a CCD chip has resulted in reduction of stray light from the several reflective surfaces required in the CCD embodiments, including those that allow the collection of light before and after the time period contributing to the image, with the CMOS embodiment thereby increasing detection of a higher proportion of light related to the target and improving image quality over sample and hold systems. Returning now to In cases in which the 2D detector array 68 has a sample and hold or other strategy that does not include timed line-by-line sampling to limit the area sampled at a given time, then a separate electronic aperture may be introduced to serve as detection pathway aperture 72 shown in For purposes of microscopy or fluorescence measurements in the eye, the electronic detection pathway 72 may optionally be made so narrow as to allow optical sectioning or wide enough to incorporate as much signal as possible, and may be configured as to include or exclude fluorescent barrier filters. The rotation of scanning element 50 shown in Turning now to The quality of the beam in imaging is important, and a slit can be formed by using only a cylindrical lens in beam shaping portion of element 54 and by slit 56 in The position of the target plane is manipulated by the movable lenses or other focusing elements, for instance lens 64 shown in As the input and exit pupils are limited to a total of about 2 mm to about 2.5 mm, light efficiency is a concern, particularly when the pupil is not dilated. According to one embodiment of the present application, scanning is done in one dimension unlike the majority of commercial devices, which scan in two dimensions. An improvement in signal to noise ratio can be achieved by reducing the speed of scanning. Unlike prior art commercial devices, which do not scan, an improvement in light efficiency may be obtained and an improved image quality is obtained by scanning. A criterion in the design of a device according to the present application is to preserve a substantial amount of light, thereby allowing a maximum amount of light to reach the detector from the eye. Using such a criterion in design allows significantly better imaging, particularly since retinal imaging according to the present application is often performed through a pupil that is not dilated�thereby creating a condition that would be considered to be �light-starved� in other systems. In addition, the scanning device can operate slowly near the range of about 1 HZ to about 30 Hz, rather than the typical devices used for retinal imaging such as a continuously moving galvonometer or rotating device that operates at about 25 Hz to about 60 Hz. The lower frequency range also allows for less power consumption and a mechanically less sophisticated device to be used for scanning. The slow scan can be done such that, when the scanning device is activated by the operator, the scanning can be done with a single or limited number of sweeps across the target. While the foregoing describes several embodiments of a device according to the present application, it will be appreciated that several other considerations may be taken to alter the application of the device, or to alter configurations of the device. For example, in another embodiment using a limited number of scans, reduced resolution is used during one or more frames to assist with light level, target positioning, and focusing faster data acquisition, and then higher resolution is used for one or more good quality still frames. Many two dimensional arrays used in consumer electronics now permit operation in more than one mode. Similarly, detector arrays offer more than one resolution. Thus, scanning and acquisition speed, light level, and gain can be traded off against resolution, as will be appreciated by those skilled in the art. It will be appreciated by those in the art that the small pupil size and small device size impose constraints on the field of view, which is most likely to be approximately about 20� to about 40� with optical resolution that supports a digital resolution of approximately 512 pixels�512 pixels or 640 pixels�480 pixels up to a 1 megapixel detector. A large depth of field is preferred for use with human patients, and the device may have intentionally limited confocal sectioning capabilities. A large depth of field reduces the need for a large input beam at the pupil, which allows for better axial resolution. Reduction of out of focus light minimizes artifact from anterior segment optics. An aperture in the plane confocal to the retinal plane is optionally used according to one aspect of the present application. Further, polarization optics are optionally used. Another way to provide sufficiently long path lengths, large depth of field, and good image quality is to use a telescoping frame or further fold mirrors. The path lengths can be extended by mirrors on or near the exterior portions of the frame that are moved, or on another movable component. Therefore, the present device according to the application avoids a disadvantage in many prior art designs�having a high f-number final lens in a position such that the pupil plane reflection is sampled in the retinal plane. Therefore, the present device does not produce images which result in a bright, unwanted reflection in the image of the retina. In the device according to the present application, the focusing mechanism is optionally kept simple to minimize complexity of use, size, and weight. Focusing may be achieved by increasing or decreasing the relation of retinal and pupil planes (the desired focal plane and the entrance plane) by the use of one or more movable mirrors and/or lenses, such as shown in According to one aspect of the present application, proper focus can be found through visually inspecting images on a display; by using an indicator to locate the brightest reflection returning from the target (without necessarily having to provide visualization of the data); or by using lower resolution images, or a small number of images acquired more rapidly, up to video rate, to find the focus quickly, after which an image having a better resolution is provided. The focus can be a manual mechanism or an autofocus mechanism well known in the art. Finally, the focus can be determined based on all or a portion of the image. According to one aspect of the present application, the device may include a display on which the user can see the image, such as a liquid crystal display (LCD). However, because an onboard LCD adds weight, may be fragile, and draws current, it may be desirable in some embodiments to eliminate a display and provide only a focus indicator. As noted above, when the retina is in focus, this layer provides the greatest light return throughout the visible spectrum and near infrared. Therefore, according to one aspect of the present application, an image can be focused by positioning the image on the anterior segment to decrease this signal, and the focal plane to sample the retina adjusted to the maximum brightness. Thus, while an image is useful for focusing, with a large depth of field, an indicator may optionally be used. The indicator may be a display, a light when a criterion is reached, a light that gets brighter or dimmer corresponding to the amount of light received, a dial, a digital read-out panel, a sound, a needle display, or any other element that can provide a signal to the user that focus has been obtained. The device may optionally include a display for viewing the image after its acquisition. The display may be a liquid crystal display (LCD) or other suitable display device. The image data may be transferred by USB, IEEE 1394, a wireless protocol, or other connection to a device or computer, as is well known in the art. The device may further optionally include one or more onboard memory devices, either in the integrated circuits or a removable memory device or film that can be transferred to an external viewing device such as indicated at 44 in According to yet another embodiment of the present application, to view structures in a plane not conjugate to the retina of the eye, modifications can optionally be made by a focusing assembly as shown by lenses 60 and 64 in According to one aspect of the present application, there are several structures in the anterior segment of the human eye that may be imaged by using ancillary or substituted focusing elements that are not in the focal range of the digital retinal imaging device of the present application. For example, the device according to the present application could be used to image corneal trauma or disease, results from corneal surgery or refractive laser surgery, a foreign body in or on the eye, a chemical injury or burn, iris neovascularization, exterior ocular injuries, burns, contact lens fit, external inflammation, infectious disease, tear duct problems, lid lesions, pterigeum, scleral or iris vessel problems, or other data needed to document the emergency or health status of a patient. In addition, it should be noted that the device as described may be optionally housed in a casing. Further optionally, controls, such as an on-off switch and a focusing control, may be accessible through the casing. The casing may be rugged and lightweight and encloses all the optical and electronic components described above. In addition, a head or chin rest can be optionally provided, and may be configured to allow a patient to hold the eye in a steady manner in alignment with the device. The head or chin rest may be operable to telescope to form a readily packed and carried portable device. In another embodiment, the head or chin rest can be folded to form a compact footprint. A further embodiment has a casing that is held by the user in a manner similar to a consumer digital camera or video game. A viewfinder may be provided for locating the eye. A control on the casing can act as a toggle switch for off and on and for various modes or resolution of image acquisition. A number of embodiments of the present device have been built and tested to determine the feasibility of obtaining acceptable eye images safely and under battery power with the capability of transferring images to a remote source. A number of embodiments were tested using a model human eye, as known in the art. The model eye was used to determine that the device is able to operate and obtain an image using an acceptable amount of light that is consistent with eye safety. The relative amount of light in the model eye has been calibrated to the human eye and is known. An embodiment similar to that described above in This application is particularly applicable within the fields of opthalmology, optometry, emergency services, military ocular screening, ocular screening in any mass situation, health care workers providing diagnoses at locations remote from eye care specialists, telemedicine, and eye examination by persons without specialty eye care skills, such as pediatricians, ER technicians, or family practitioners. A primary application of the device is for use by, for example, emergency personnel, when there is a suspicion of trauma to the eye. In such situations, it can be helpful to know if an individual with a suspected eye injury can be allowed merely to rest for a period of time or if, instead, the patient requires further emergency treatment. A further application is the remote or mass screening for potential eye disease by personnel who are not primarily specialists in the eye, such as pediatricians or family practitioners, and also including workers who have minimal medical experience and lack instrumentation or computer expertise. The device has a minimum of controls, which provides simplicity in operation, so that a high degree of training is not required to operate the device. In contrast to the present invention, current commercially available scanning laser opthalmoscopes are too large and expensive for use as a portable device in the field. Further, these devices are complex and require a user to be highly trained both in using the device and in reading the resulting ophthalmic images. The striking image quality of the large SLOs and the sectioning capabilities of tomographic devices, which spoil the signal to noise ratio, are not needed in the present device. In other embodiments of the present application, a device may utilize 3 or more light sources to illuminate the target with different wavelengths that will enhance the visibility of certain features. Imaging can optionally be performed with a device having one, two, three, or more such light sources, with each source differing to provide unique and beneficial properties, such as a different wavelength, increased power, or different polarization properties. Light sources can optionally be controlled by the control electronics 46 (see According to yet another embodiment of the present application, light from illumination sources can be directed with turning mirrors, and then combined into a single beam with beam combining elements, in a manner known in the art, published by the inventor. See, e.g. Elsner et al, 1992. Such combining elements can be reflective and transmissive elements; can be dichroic mirrors to take advantage of the wavelength differences of the illumination sources; or they can reflect or transmit according to polarization properties of the illumination sources. According to one embodiment, each of the illumination sources is combined to the next by a pair of beam combining elements. For example, a first element, such as a mirror, steers the beams and a second element combines the two beams and further steers one or the other beam. The position of the combining elements can be configured to minimize the space taken by the device or light efficiency, rather than configured for ease of optical alignment. According to one aspect of the present application, intensity of the light from the sources may be controlled in any suitable manner if desired, such as to decrease the level down from the FDA approved level for continuous viewing. The intensity of the light can also be controlled electronically, via neutral density filter or color filter, mechanically, in which case slit 56 in In an exemplary embodiment using three illumination sources, such as shown in In this embodiment, the VCSEL is of unusually small size for an illumination source in an optical imaging instrument, as VCSELs are typically used in communications and optical computing, not optical imaging instruments. The footprint of the device using this source is thus more compact, and the weight is reduced compared to conventional imaging devices. The energy efficiency of the VCSEL, being unusually high, as well as the possibility of utilizing direct current such as from a battery, also assists in reducing the weight and footprint of the present imaging device. This diameter of the laser element of a VCSEL can be as small as 50 microns, plus the associated housing and beam shaping elements that are larger; the total package except for the power supply is approximately the size of a small integrated circuit or transistor in a can mount. In this context, the VCSEL, is merely one more electronic component in the circuit. The high energy efficiency permits the output to be in the low mW range when using a single battery, such as a 9 V battery plus current limiting circuitry. Diode laser illumination source is of an intermediate size and provides an intermediate footprint and weight, and also supports the possibility of battery operation and remote use. Any infrared or near infrared source having an appropriate size, energy efficiency, power density, beam quality, and weight can be used as an illumination source to replace the sources described above. As sources with high coherence lead to interference artifacts in the slit that is scanned, these are less desirable unless these unwanted artifacts can be reduced so that there are not illumination differences along the length of the scanned slit. Superluminescent diodes are one type of source that can be used to provide low coherence. When the target is the human eye or other substance that remits near infrared or infrared light, the target can be viewed with a safe and (where applicable) comfortable amount of illumination, using illumination sources either a laser diode or a VCSEL. A near infrared source is important for penetrating thin blood layers and the lens with cataractous changes. Near infrared sources, when used to image the retina, do not lead to constriction of the human pupil, thereby providing sufficient illumination to use the imaging device in a non-mydriatic manner, with either flashed or steady-state illumination. An illumination source with near-infrared wavelength having a beam of acceptable quality produces an image of acceptable quality when used in a scanning system, such as those depicted in According to one embodiment, the illumination source 54, as depicted in In one embodiment, a laser scanning digital camera device features the ability to scan one or more light sources. Further each light source is specifically designed for detection of target characteristics according to a specific configuration of wavelength, beam shaping, illumination aperture, spatial or temporal modulation of the beam, polarization content, or structured illumination. By way of nonlimiting example, if scanning with a slit, structuring the illumination with a square aperture is optionally used to provide even illumination across the image. When even illumination is provided, target detection at any location within the field of view is possible. According to one embodiment of the present application, the electronic aperture is synchronized in a closed loop manner with the active period of the detector. This loop may be closed by prior calibration, in situ calibration, or while operating the device. The synchronization may be determined by a master signal, the scanning element, or the detector. In one embodiment, the master signal may be generated by a read-out of the position of the scanning element. The position signal may be generated when the light from the moving scanning element reaches a detector, and this signal can indicate the beginning of the image or the position within the image for even more precise control, with the detection of light returning from the target synchronized with respect to the position on the target of the illumination. This allows the device to obtain images while using exceptionally low cost optical elements that serve as mirrors in the scanning element, since the scanning slit overfills the target pathway in the direction perpendicular to the scan and the timing in the direction of the scan is variable in a rapid and accurate manner. Synchronization of the scanning element to the target that is performed on portions of the image provides rapid flexibility of aperture position. According to another embodiment of the present application, the digital image device is operable to provide a high quality image by using a series of images acquired in succession rapid enough to allow the adjustment of position of the target and instrument with respect to each other. In addition, according to certain embodiments, the images are assessed for quality and improved by the adjustment of parameters used in image acquisition. The adjustment is made more readily when the series of images is acquired in rapid succession. The adjustment is made by software, electronic circuitry, or the operator, or a combination thereof. Optionally, the digital imaging device is further capable of providing onboard or embedded control of parameters. The same control mechanism is optionally in communication with electronic circuitry or a computer with sufficient memory to allow storage of images so that selection of the highest quality images can be performed immediately after acquisition. In a moving target such as an eye, or one that is changing over time, this provides a greater probability that an image of acceptable quality is obtained. In the embodiment with a unskilled user, the acquisition of images can be adjusted to incorporate sufficient time and number of images, and requiring little action on the part of the user, to improve the chance of acquiring suitable images. The control mechanism can have the capability of processing aspects of the image to assure quality control. The control mechanism is optionally capable of performing processing on the images and then displaying and storing these images. According to one embodiment of the present application, the digital imaging device is operable to provide high contrast of features that may be used to identify a target or portions of the target that allow improved detection of the target itself, particularly in the case of a moving or changing target, or regions of interest within the target. In the embodiment, a wider field of view for imaging the retina is possible, and more precise localization of the regions within the retina becomes possible because two main features, such as the fovea and the optic nerve head, are now potentially within the field of view with sufficient spacing that localization is improved over identifying a single feature that is used in current high rate retinal tracking devices with and without polarization. In the embodiment with polarized light illumination, there is the potential for using the macular birefringence and the optic nerve head birefringence to identify two points within the retinal image of sufficient spacing to localize retinal features. The use of the electronic aperture further improves the detection of the macular and the optic nerve head birefringence by rejecting unwanted scattered light that does not contain polarized light information, but allowing sufficient light to be detected to provide a robust signal. In the embodiment with reflected light illumination, there is the potential for using the macular and the optic nerve head features to identify two points within the retinal image of sufficient spacing to localize retinal features. The use of the electronic aperture further improves the detection of the macular and the optic nerve head features with sufficient contrast by rejecting unwanted scattered light that reduces image contrast, but allowing sufficient light to be detected to provide a robust signal. In the embodiment with polarized light illumination, there is the potential for using the macular birefringence and the optic nerve head birefringence to identify two points within the retinal image of sufficient spacing to localize retinal features. The use of the electronic aperture further improves the detection of the macular and the optic nerve head birefringence by rejecting unwanted scattered light that does not contain polarized light information, but allowing sufficient light to be detected to provide a robust signal. According to another embodiment of the present application, one or more optical channels can added to the digital device to provide images using illumination differing in wavelength, beam shaping, illumination aperture, spatial or temporal modulation of the beam, polarization content, or structured illumination. The additional optical channels provide the possibility of viewing with the wider field and low cost digital device, with a flexible electronic aperture, and simultaneously providing an image with different information content or providing a visual stimulus or alignment beam. In one embodiment, the visual stimulus is used to direct the position of the retina. Additionally, the stimulus is optionally used to elicit a response for diagnostic or experimental use with humans or in situ use in biological preparation. In one embodiment, the wide field with the scanned slit illumination is of sufficiently long near infrared wavelength, low power, and low duty cycle to be rendered nearly invisible to the human eye. Such conditions do not interfere with a visual stimulus or lead to heating in the retina or a biological preparation, but provide localization of the stimulus or illumination impinging on a preparation. In As noted above, scanning the light across the target 14 through a slit aperture (and scanning again in the detection pathway if this is performed, described further below) aids in decreasing unwanted scattered light in the resulting image. The scanning can be accomplished in a variety of ways well-known in the art in addition to the method in In the optical pathway between scanning element 50 contains one or more separation elements 66, 266, and 366, to direct additional optical pathways in or out of the main pathway. Separation element 66 in Light from illumination sources 354 is directed towards the target, starting from a position outside the main optical pathway, shown here as directed towards the anterior segment of the eye and not towards target 14. Light returning from the target 14 is separated from light striking the target at separation element 66. In the embodiment shown in The separation element 66 may comprise a partially or fully reflective surface that does not intersect the light directed towards the target 14. The reflective surface may comprise a mirror or a beam splitter with the reflective portion not intersecting the beam of light directed at the target, as shown. The separation element can also be any number of other separation elements, such as a beam splitter with a reflective portion intersecting the beam of light directed towards target and a transmissive portion including a mirror that reflects less than 100% of the light towards the target or a transmissive portion intersecting the beam of light directed towards the target and the reflective portion allowing the light from the target to pass. According to one embodiment of the present application, further decrease of light from unwanted planes can be obtained by directing the light on the detection pathway from the target 14 to one or more two-dimensional detector arrays 68 comprising a complementary metal-oxide-semiconductor chip (�CMOS� or �CMOS detector array�). The detector array 68 is in synchrony with the illumination timing and of a suitable sensitivity at the wavelength or wavelengths of light returning from the target to allow detection of light returning from the target. The detector array 68 may detect light returning from the target from illumination source 154 or 254. A similar detector array 368 detects the light that is returned from a target, such as the ocular lens 24 or pupil 16, directed by separator element 366, and focused by focusing element 374 onto detector 368. The combination of illumination sources and beam shaping optics shown in A target image provides a variety of features, and to localize these better than methods using rotation or translation about a single point, two references may be used. The macula and the optic nerve head are two such major features that can be used to localize or stabilize features in the retina, for the birefringence signal radiating from the macula and the birefringence signal from the nerve fiber bundles radiating from the optic nerve head. The illumination striking the target may be patterned, and a pattern such as stripes provides a convenient method for generating the pattern. Illumination sources, such as those shown as 154 or 254 in When operating the LSDC in closed loop mode, the scanning element 50 in In one embodiment of synchronization of the image acquisition by detector array 68 to the scanning element 50, the scanning element 50 serves as the master, and the detector array 68 synchronized to it by means of a Start of Scan with a fixed point, ancillary detector. In a point scanning system, a Start of Scan is typically used for synchronization in one direction, but must be further synchronized with the scanning element in the orthogonal direction, and does not readily offer the possibility of lessening the tolerances on the position and timing of the components in a unitary scanning element 50. In a slit scanning system, such as that shown in In one alternative method of synchronization of the scanning element 50 in The description above pertains to several illustrative embodiments of the invention. Many variations of the invention may be envisioned by one skilled in the art. Accordingly, such variations and improvements are intended to fall within the compass of this disclosure. The invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. The aim of exceptionally low cost, low power requirements, smaller size, and ease of use can be applied beyond the use in the eye field. For instance, it will be appreciated that embodiments of the present application can be used as a general imaging instrument, a microscope, or an endoscope. The embodiments for eye applications include diabetic retinopathy, age-related macular degeneration, macular hole, epiretinal membrane, glaucoma, contact lens problems, ocular inflammation, infectious diseases, ocular trauma, and other conditions. An all-in-one device with increased ease of use that allows simultaneous or nearly simultaneous images of both the anterior segment and posterior segment of the eye that are readily viewed, stored, or transmitted would be greatly appreciated. Further, embodiments of the present application can also be used as a general imaging device, or for microscopy, to improve image detection of targets and potentially decrease the light level needed for image formation. When used with a scanning element, certain of the above embodiments efficiently use light and decrease the potential for unwanted scattered light. For the purpose of developing imaging applications, it is not often known with certainty how much light will be collected from the target and the characteristics of that light. The electronic aperture capability, in an optical plane conjugate to the target plane, helps control the sampling of light. The aperture allows the detection of reflected or multiply scattered light to varying degrees in a rapid manner and without mechanical parts. Similarly, the electronic aperture can be rapidly adjusted to emphasize contrast, such as by reducing the aperture size to detect mainly reflected light, or increase signal-to-noise ratio, such as by increasing aperture size to obtain more total light. Thus, the electronic aperture provides more flexibility in sampling the light, which allows an optimal setting to be determined for a na�ve user for each application. A user or instrument developer can select the setting in an unusually flexible and rapid manner, according to the needs of each application. One such use is in the field of infectious disease, in which dark field imaging has already been shown to be advantageous for the detection of malaria because it allows unstained blood to be tested (Jamjoom G A. Dark-field microscopy for detection of malaria in unstained blood films. J Clin Microbiol. 1983 May; 17(5):717-21.) The use of an embodiment of the present application optimized to take dark field imaging has the advantage of less handling of blood or other substances that may pose additional health and safety issues, as well as requiring less expertise and equipment in slide preparation. A device that detects important targets such as blood-borne diseases requiring less expertise and cost would be greatly appreciated. Further, additional embodiments include optimizing the illumination light to detect a target for use with the electronic aperture. This optimization may take place in the selection of wavelength, beam shaping, illumination aperture, spatial or temporal modulation of the beam, polarization content, or structured illumination. This allows use for a broad range of applications and rapid, less expensive prototyping for applications. Such a low cost device that is flexible and easy to use, and far lower in cost than producing and aligning a series of mechanical apertures, and can be optimized readily according to the application and the illumination source, and has equivalent or improved detection of a target, would be greatly appreciated. Yet another embodiment of the present application includes having more than one pathway for detection of light, each of which can utilize the electronic aperture. The additional detection pathways can differ in plane of focus, angle of incidence or regard, wavelength detection or filtering, sensitivity or gain, temporal or spatial properties, resolution, or polarization properties. Additional detection pathways allow optimization at reduced cost in instrumentation such as an all-in-one device for anterior and posterior segment of the eye, simultaneous confocal fluorescence and reflectance imaging, confocal multispectral imaging, stereo in the plane of choice, simultaneous detection of reflected and multiply scattered light, polarization imaging, and imaging techniques that require synchrony with target excitation or two or more detection channels. Such a device allows a more flexible means for providing near simultaneous observation of directly backscattered and multiply backscattered light than described in U.S. Pat. No. 6,236,877 and related work. As such, a low cost device that is flexible and easy to use, or that can be optimized readily according to the application, and has equivalent or improved detection of a target due to the use of two or more detection pathways would be greatly appreciated. Patent Citations
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Mutiara Digital (MD Prima/ PrintExpert) Printing Shop
Kedai Binding thesis,buku, hard cover di Shah Alam
Printing UltraHigh resolution for document, brochures, thesis & dissertation, banner, name card, business cards, tickets, labels & stickers, company profiles.
Very high quality papers, glossy & pearl white at economical rates.
Hard cover for thesis & book binding, loose bind wire binds, gold stamping & edge protectors.
Book binding for prototype Magazines, Books, Journals, Annual Reports.
Graphic design for company brochures, logo, graphics on file folders, gifts, letterheads.
Internet workstations with spacious table space & dedicated printers.
Opens 8.00am to 12.00 midnight everyday!
www.mdprima.com.my 0355233326 0122005681 firstname.lastname@example.com
ID: 104847186 Mutiara Digital (MD Prima/ PrintExpert) Printing Shop, Shah Alam
less than a month ago
less than a month ago
20 Jalan Bunga Tanjung 2/16 2-28, Shah Alam 40000, Malaysia
20 Jalan Bunga Tanjung 2/16 2-28, Shah Alam 40000, Malaysia
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Book your room at Hôtel Pullman Toulouse Centre
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Max Occupancy: 3 guests (up to 2 children)Superior Twin Room, 2 Single Beds
Max Occupancy: 3 guests (up to 2 children)Deluxe Double Room
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Max Occupancy: 2 guestsClassic Room, 1 Double Bed
Max Occupancy: 2 guests5-star luxury hotel in Toulouse near Place du Capitole
Situated in the city center, this luxury hotel is close to Toulouse National Theatre, Place du Capitole, and Basilique Saint-Sernin. Also nearby are Musee des Augustins and Place Wilson.
Hotel Features
In addition to a restaurant, Hôtel Pullman Toulouse Centre features a fitness center. Other amenities include a bar/lounge and complimentary wireless Internet access.
Room Amenities
LCD televisions come with satellite channels. Guestrooms also feature complimentary wireless Internet access, complimentary high-speed (wired) Internet access, and air conditioning.
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After seven board members and the chief curator of the Museum of Contemporary Art in Los Angeles departed this year, online magazine 'East of Borneo' set up a site to document the ongoing drama, as well as the controversial history of museums in L.A.
Contrary to what's accepted about Renaissance architect Andrea Palladio's villas—that they are ideal in form, stable in their part-to-whole ratios—architect Peter Eisenman proposes that their components had become unrecognizable by the end of Palladio's career.
38n9w Arquitectos designs a one-piece resin necklace that mimics some of the angular lines of its building projects.
The work of Santiago Calatrava finds an opulent match in the State Hermitage Museum's Winter Palace in St. Petersburg, Russia, which is exhibiting the architect's models, drawings, and sculptures.
LEDs, laser lights, mirrors, and holograms pair with Swarovski crystals at London's Design Museum in order to explore the intersection between the passing fancies of the digital era and the longer-lasting nature of gems and other tangibles.
Artist Oscar Tuazon, inspired by gritty, urban architecture brings three tree-inspired sculptures to Brooklyn Bridge Park in New York for its first site-specific installation.
Is there anything Thomas Heatherwick hasn't designed anew? A first retrospective on Britain's design darling at the Victoria and Albert Museum will feature his fanciful, redesigned London double-decker, Olympic cauldron, and biomass power station, among others.
Architects describe space without buildings, and artists describe space with architectural language in a new exhibition at the San Francisco Museum of Modern Art that revists Stan Allen's deconstructivist essay from 1996.
Wanting to examine the parks that he visited last year, Brooklyn's Mikell Fine Iles created six infographics that comparatively visualize the size and qualities of seven of the world's parks.
A survey of the University of Washington's furniture studio by Jeffrey Ochsner reveals the linkage between materials and making that defines the field of architecture.
Check out these stories, which take a close look at innovative projects that are using wood in creative ways. Proudly sponsored by reThink Wood.


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Peter Ackroyd is a bestselling writer of both fiction and nonfiction. His most recent books include the biographies Dickens, Blake, and Thomas More and the novels The Trial of Elizabeth Cree, Milton in America, and The Plato Papers. He has won the Whitbread Biography Award, the Royal Society of Literature's William Heinemann Award (jointly), the James Tait Black Memorial Prize, and The Guardian fiction prize. He lives in London.
Given the updated release of Steve Mariotti's classic The Young Entrepreneur's Guide to Starting and Running a Business on Tuesday, we decided...... READ MORE
Written by Doris Kearns Goodwin
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YMCA - South Hampton Roads - Outer Banks Family
February 2015
3000 South Croatan Highway
Nags Head, NC 27959
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Only registered riders show up on this leaderboard. If you're riding as a guest or just using the numeric ID on the bike you're missing out.


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Newegg.com - A great place to buy computers, computer parts, electronics, software, accessories, and DVDs online. With great prices, fast shipping, and top-rated customer service - once you know, you Newegg.
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Collaborative editing of text documents
If you are looking for a tool for collaborative text editing across a network, Gobby might be the Gobby lets multiple users edit text documents collaboratively and discuss the changes online.
Helpful colleagues: Knowing that the letter has to be out by the end of the business day, they have lined up behind your desk, shoulder-surfing your screen and pointing ou
typos, tacky phrasing, or whatever. The mean well, but honestly, I would prefer to complete the sentence before they jump on it – and it would be a big help if they took turns shouting!
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Cisco Releases Annual Security Report
Spammers go low-volume, and 90% of IE browsers are unpatched.
Zero Day Exploits Target Flash
Adobe scrambles to release patches for vulnerable Flash Player.
Intel Unveils Compute Stick
Four-inch-long computer on a stick lets you boot a full Linux system from any HDMI display device.
Obama Proposes Personal Data Notification Law
New statute would require companies to report break-ins to consumers.
TGXf Project Warns of File Transfer through Screen Pixels
Weird data transfer technique avoids all standard security measures.
Industry Giants Announce a Fix for the Password Mess
FIDO alliance declares the beginning of the end for old-style login authentication.
Poll: Vote for the Best Open Source Software for Photographers
The Linux New Media Awards have honored the most significant products, projects, people, and organizations for open source/Linux every year since 2000.
Debian Gets Forked
Legendary Uber-distro splits over the systemd controversy.
Linux Mint Project Releases Mint 17.1
New LTS version offers many refinements for the Cinnamon and Mate desktops and significant improvement under the hood.
CeBIT Open Source Forum Call for Papers
One of CeBIT's most successful forums returns in 2015.


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Philadelphia mayor promises more police and social services
The Associated Press
PHILADELPHIA- The mayor on Thursday promised more police and social services to help stem a surge in the city's homicide rate, while pleading with young people to "lay down your weapons."
Philadelphia's homicide rate is 7 percent higher than last year, with 226 people slain.
"You are the future of this city. Lay down your weapons. Do it now. Choose education over violence," Mayor John F. Street said in an eight-minute speech, televised live. "You will never regret it if you do, and you might not survive if you don't."
Street said the city would hire 200 new police officers, along with a new 46-member police unit deployed on nights and weekends in areas of high gun violence. Surveillance cameras would be installed in some neighborhoods, he said.
The mayor also said "violence is not just a police matter" and promised increased social services for young people.
The homicide rate during the past six years remains significantly lower than during the 1990s, and major crime is also down, Street noted. "That should give citizens confidence that the administration can and will manage the current spike in gun violence," he said.
Copyright 2015 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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LAS VEGAS (AP) -- Carrie Underwood wins big in Vegas. Twice. Underwood has won her second country music artist of the year award this year in Las Vegas. The second was last night at the inaugural American Country Awards. Her first of the year was back in April at the Academy of Country Music Awards. Fans determined the winner for both of those honors. Underwood won a total of six awards at last night's ACAs. For the ACAs, fans could "vote early and often," as they say. They could post votes every day until a couple of days before the awards show. So, she thanked her "awesome" fans, saying she and her band "have had the most amazing year out on the road but we wouldn't be doing anything if there weren't people out there sitting in that audience."


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Robert Harley
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PUBLISHED: 09 May 2013 00:26:18 | UPDATED: 09 May 2013 06:48:37PUBLISHED: 09 May 2013 PRINT EDITION: 09 May 2013Few will be hoping for an interest rate uplift in housing as much as Stockland's new managing director, Mark Steinert.
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SF Giants pitcher Jeremy Affeldt teams up with Brittani Powell, a young woman saved by a clinical trial, as ambassadors for Lazarex Cancer Foundation. Lazarex made sure Brittani could participate in the trial for the past 4 years by covering the travel expenses her family couldn't continue to afford. Jeremy encourages the public support of Lazarex Cancer Foundation.
I'm Still Here…
Lazarex Ambassadors Jeremy Affeldt and Brittani Powell.
Update: December 17, 2014 - CANCER FREE!
I'm 24 now but I was only 23 when I got diagnosed with a rare cancer called Squamous Cell Carcinoma of the Nasopharynx.
I'm truly blessed to be able to say I'm CANCER FREE!!!!! I have to give thanks to University of San Diego California Cancer Center and everyone there that had faith. I must give thanks to the Lazarex Cancer Foundation as there's no way I would have made it without their help. To everyone that donates to their program - Thank You so very much and may God bless all of you! I pray that everyone has very safe and Happy Holidays!!!
Click here to visit our Awards page!
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toll free 877-866-9523
office 925-820-4517
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Under BMW, Rolls-Royce has created an exceptional luxury vehicle with the Phantom. For its first update, Rolls-Royce makes few stylistic changes, but updates the underlying technology significantly.


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Break the Limits!
You are trapped in a room and the only thing you can do is think.
4.15 / 5.00 33,834 ViewsCap'n Marcela
Can you help Cap'n Marcela save her village from Evil Puffy shirt Morgan?
3.94 / 5.00 5,443 ViewsWARNING!: As Stated at the Main Menu, this "Tool" is intended for PLAYERS of the MMO; MapleStory!
It is a Cube Simulator, that simulates a Player using Cubes on an assortment of different Items.
This was an Intended Sequal to my Scrolling Simulator (Which you should also check out).
There are 3 Voice Tutorials with Matching Visuals, over 7+ Items to Cube, 2 Different Cubes and a Semi-Realistic Probability rate. You can choose your Level Tier, Rank, and Item Type at the Start-- and change it throughout your playthrough. This tool has ALL Potential Bonus' stricly listed to the Item Type, with a few random Etc Potentials thrown in for more Reality. The Cubes indeed do have a Chance to level up the Potential rank, and the Premium Cube dishes out it's purpose as well. You can show off your work by typing your name, and taking a Screenshot if you like.
I'm aware many people have made this Tool before, but like my previous Sim, I wanted to take the idea into my own hands, and dish it out in my Vision. Hopefully you guys enjoy, and YES this tool was intended for users of the BASILMARKET FORUM. Your welcome guys.
You may share this Tool around with Permission and Credit.
Tell me any wanted Features, Items or Suggestions.
Hope you like it, Have fun, and ENJOY.
>List of Wanted Features:
Super Miracle Cube
Legendary Miracle Cube
>List of Bugs needed to be Fixed:
is easy just add on item details settingin yellow balls Lv potencial rank and lines
I didn't understand it quite well but yeah i think it's ok too, just put some better instructions of how to play it and it could get to be a really good game
Well ok
This game is ok It is very confusing how to play it but I supose if you do it would of bean a nice game.


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HD-DVD and Blu-Ray Disappointing So Far
History will repeat itself? (469 comments)
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WORST EVER!!! My boyfriend and I were traveling home from my surprise bday weekend and ugggh our car started over heating (we were so tired from driving for ours and traffic accident had bumper to bumper traffic for over an hour) we were both sick, so we saw the HUGE SIGN $64. rooms. We decided to just stay and gain... More
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Strange Boing Sound while driving
All of a sudden, my truck is making a boing sound. It sounds like someone just grabbed my antenna and flicked it.
Last week it happened while just driving down the road and coming to a stop. Sometimes it happens when I back up out of a spot and start going again. Almost sounds like a spring popping up. It is a 2013 Tacoma no mods other than K&N TRD with only about 1600 miles on it. Some people have mentioned something about the ABS, but I don't that is it, there is no slipping. Any thoughts would be greatly appreciated. Trying to get an idea before I bring it in. |
Mine has been doing that since I first got it. For me, it only does it when the engine is cold. Once I back up and start rolling forward I get about 5 to 10 feet then .... BOING!!! Reminds me of a cartoon sound. Sounds like it might be coming from the tranny. I'm curious as to what it is, but I'm not too concerned. Been like that for almost 40K miles and she still runs fine.
I have tried and tried to let this one go, and have a dozen times already closed this in an attempt to not say anything....but I can't resist any more.
STOP STARING AT THE WOMAN'S LEGS IN THE NEXT CAR AND YOU WON'T HEAR THAT "BOING" NOISE ANYMORE! :eek: |
Legs shmegs. I'll be checking these out in the car next to me.
http://www.inquisitr.com/wp-content/...asts-first.jpg |
Can you give any more details on the noise itself? Front? Rear? Cold? hot?
I came for the boobs.... I have no opinion
Not sure where it is coming from. My directional hearing is not as good as it used to be. Almost from the center of the car. But it is fast and unexpected so I never am ready for it. I think there maybe something to the transmission. Could have something to do with the 4x4 engage system. Just a stab.
ABS kicking on??
If there was a way you could record it in a video it would be nice. Hard pressed to try and give any decent indication on what it may be otherwise. Sorry.
Happened to me the other day turning into a parking lot. At the time, I swore it sounded like the steering wheel clock spring got hung up and then released.
Anyone else hear the sound in relation to turning? |
Mine does it every time I start the truck and begin to roll. Its the ABS system doing a self test or calibrating itself. This is normal activity and you just probably noticed it.
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HBO's 'The Leftovers' Opens to Lukewarm 1.8 Million Viewers
HBO's "The Leftovers" premiered to 1.8 million viewers for its initial telecast on Sunday night, according to Nielsen estimates, putting it below the network's other high-profile dramas over the last few years.
It didn't necessarily have as strong a lead-in as HBO may have hoped, as "True Blood" drew 3.1 million viewers for its regular-timeslot airing on Sunday, down from a little over 4 million for its season premiere of the previous week.
HBO's most recent drama premiere, "True Detective" in January, drew 2.33 million viewers for its regular-timeslot telecast. "The Newsroom" 2.14 million in June 2012, and "Game of Thrones" attracted 2.22 million in 2011.
POLL: Are You a Fan of HBO's 'The Leftovers'?
When including a late-Sunday repeat, the two-episode total for "The Leftovers" was 2.1 million. In its two airings, "True Blood" grossed 3.5 million.
"The Leftovers" comes from Warner Bros. Television and was created by Damon Lindelof and Tom Perrotta, based on the novel of the same name by the latter. It centers on the fallout from the abrupt disappearance of 2% of the world's population, and the people in a suburban community who were not taken.
The cast includes Justin Theroux, Amy Brenneman and Liv Tyler, and the pilot was directed by Peter Berg.
Justin Theroux, Amy Brenneman and Liv Tyler are among the cast of "Leftovers," which centers on the fallout from the abrupt disappearance of 2% of the world's population.
Over at Showtime, the first-season finale of "Penny Dreadful" drew 856,000 viewers -- up from the previous week (799,000) and the largest audience since the show's premiere (872,000). After a handful of episodes last month, Showtime ordered a second season of "Penny" for 2015.
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Paul Tagliabue affirmed the findings of Roger Goodell in the NFL's investigation of the New Orleans Saints' bounty program but vacated all discipline issued to the players who were punished, league spokesman Greg Aiello announced on Twitter.
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Hargrove visiting Lions
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Category:Senb (hieroglyphs)
From Wikimedia Commons, the free media repository
Egyptian hieroglyphs: s n b : healthy, recover, be healhty, health, heal.
- Note: sometimes listed with the Pharaoh in scenes: Given: Ankh, Djed, Usr, Senbi, etc. A list usually ending with: "forever". Di ankh djed usr senb, djet. "Given: Life, Dominion, Power (Rule), (nation's) Welfare, ...Forever"
Media in category "Senb (hieroglyphs)"
The following 7 files are in this category, out of 7 total.