text:
|Publication number
|Publication type
|Application number
|Publication date
|Oct 16, 2001
|Filing date
|Nov 20, 2000
|Priority date
|Nov 12, 1997
|Fee status
|Also published as
|Publication number
|Walter M. Blume, Rogers C. Ritter, Peter R. Werp, Bevil J. Hogg
|Original Assignee
|Stereotaxis, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (100), Classifications (9), Legal Events (8)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a division of application Ser. No. 09/189,646, filed Nov. 10, 1998, now U.S. Pat. No. 6,212,419, and which claims the benefit of U.S. Provisional Application No. 60/065,103, filed Nov. 12, 1997, entitled "Method and Apparatus Using Shaped Field of Repositionable Magnet to Guide Implant," and which is herein incorporated by reference in its entirety.
1. Field of the Invention
This invention relates to devices and methods for using a magnetic field to guide a surgical implant, and more specifically to devices and methods for using the near field and transition field of a repositionable magnet to move, guide, and/or steer a magnetic seed, catheter or other magnetic delivery vehicle (MDV) for therapeutic or surgical purposes.
2. Description of Related Art
In the field of surgery, there exists a need to control the orientation, forces, and/or motion of internally implanted devices. One method that has been used to control such implanted devices is the application of a magnetic field from an external magnet. In this method, the magnetic field acts upon the implanted device, which itself comprises magnetic material, which may be in the form of a permanent magnet. In accordance with prior art practice, a physician surgically implants the device comprising magnetic material and then guides the position of the implanted device by moving an external permanent magnet and observing the resultant movement directly with an X-ray fluoroscope. Examples of the prior art may be found in a review article by Gillies et al., "Magnetic Manipulation Instrumentation for Medical Physics Research," Rev. Sci. Instrum. 65, 533 (1994), and references cited therein. See also McNeil et al., "Functional Design Features and Initial Performance Characteristics of a Magnetic-Implant Guidance System for Stereotactic Neurosurgery," IEEE Trans. Biomed Engrg., 42, 793 (1995); Tillander, "Magnetic Guidance of a Catheter with Articulated Steel Tip," Acta Radiologa 35, 62 (1951); Frei et al, "The POD (Para-Operational Device) and its Applications," Med. Res. Eng. 5,11 (1966); U.S. Pat. No. 3,358,676 to Frei et al., issued Dec. 19, 1967, entitled "Magnetic Propulsion of Diagnostic or Therapeutic Elements Through the Body Ducts of Animal or Human Patients"; Hilal et al., "Magnetically Guided Devices for Vascular Exploration and Treatment," Radiology 113, 529 (1974); Yodh, et al., "A New Magnet System for Intravascular Navigation," Med. & Biol. Engrg., 6, 143 (1968); Montgomery et al., "Superconducting Magnet System for Intravascular Navigation," Jour. Appl. Phys. 40, 2129 (1969); U.S. Pat. No. 3,674,014 to Tillander, issued Jul. 4, 1972, entitled "Magnetically Guidable Catheter-Tip and Method"; and U.S. Pat. No. 3,794,041 to Frei et al., issued Feb. 26, 1974, entitled "Gastrointestinal Catheter." The full content of each of the cited documents are herein incorporated by reference in their entirety.
Unfortunately, the above-described technique requires the physician to react to the movement of the implanted device after the fact. There is no precise correlation of the imaging system with the medical magnetic manipulation, and no way to apply fields and/or force gradients precisely in needed directions. With hand-held magnets, the only feedback the surgeon could have was his observation of motion of a magnetic implant by x-ray or ultrasonic imaging in response to his movement of the magnet. The field producing magnet, so guided without direct visual display of the field lines, is controlled by the operator's estimate of the field direction and magnitude at a particular location of the implant. Since many combinations are possible, this essentially "blind operation" is bound to result in a somewhat random position and angulation as related to the needed field line direction and magnitude to provide guidance and/or pulling force. In difficult interference situations, it is difficult without such imaging guidance to provide even a reasonable guess as to a correct direction for the magnet axis to obtain field alignment with the intended path. The large electromagnet of Yodh et al. is one attempt to minimize the "blindness" of the approach just described, but the Yodh et al. approach still relies on operator judgment and vision, and is subject to such error. While multiple coil arrangements such as the magnetic stereotaxis system (MSS) described in McNeil et al. can be used to provide such guidance, it is difficult in such systems to provide a combined guiding force and force-applying field gradient in the same desired direction.
Clearly, both operation time and risk to a patient could be reduced if an apparatus and method were available to more accurately and rapidly guide or move a magnetic surgical implant. This device and method can either provide feedback to the physician guiding the implant so that the physician could predict the movement of the implanted device rather than react to it after the fact, or it can be used more automatically with computer-controlled motion along a physician-selected planned path. It would also be advantageous if simpler hardware and software could be used to locate the external magnet and provide more effective field solutions. The moveable magnet location should take into account an exclusion volume around the patient in which the magnet may not be located. In the case of neurosurgery, for example, the magnet cannot be located too closely to the patient's head, nor in the path of imaging X-rays.
It is thus an object of the invention to provide a rapid interactive display of the aligning torque and magnetic pulling directions of a magnet acting on a volume.
It is a further object of the invention to provide a physician with devices and methods that facilitate the prediction of the movement of a magnet implant in response to an externally applied magnetic field.
It is yet another object of the invention to provide devices and methods that facilitate rapid and appropriate adjustment of the position of an external magnet to steer a magnet internal to the body of a patient.
It is still another object of the invention to provide a moveable field-producing magnet that can be located and angled so as to provide flexibility in avoiding interference with imaging systems which may change between and during various surgical procedures.
It is another object of the invention to provide means whereby a physician can use voice control or other non-tactile control to govern path choice at arterial branches or lumenal branches so that both hands are available for other needs, in intravascular navigation applications.
It is yet a further object of the invention to provide an external magnet adapted to provide a magnetic field of sufficient strength and appropriate angular spread to provide flexibility in positioning and orienting the external magnet, even while respecting exclusion volumes around a patient's body.
These and other objects are achieved by the inventive methods and apparatuses to guide an implant disclosed herein. The invention provides rapid interactive display of the aligning torque and magnetic pulling directions of a permanent, a superconducting, or a resistive wire magnet acting on a volume, which volume may include a portion of a patient's body. The invention allows a hand-held, hand-positionable or servo-controlled external magnet to be moved external to the volume, while the resultant magnetic forces are displayed in real-time (essentially instantaneously, or at least as rapidly as is needed for effective surgical control) on a computer screen. In this way, a physician can rapidly adjust the position of an external magnet to steer a magnet internal to the body.
By placing a set of fixed fiducial marks on the magnet and using a device that can localize these marks in three dimensions, the position of the magnet can be associated with the treatment volume. The volume's position can be associated with the magnet by placing fiducial marks on the volume and "registering" these marks with the localizer, or by putting the volume in a standard place relative to the localizer. A second method of localizing the magnet includes putting magnetic sensors at appropriate fiducial points.
The magnetic field of any magnet can be simply measured and suitably mapped in three dimensions. At run time a pre-measured map can be superimposed on the imaging volume using the registration established by the fiducial marks.
Assuming that the volume has a set of images associated with it and fiducial marks that can be registered in the imaging volume, the magnetic field and force can be displayed and updated as the magnet is moved relative to the imaging volume. The field can be displayed at any point in the image set, and updated as the magnet is moved. Commercial ultrasonic and infrared localizers exist at present that give great accuracy (on the order of a millimeter) to this technique. One such localizer is described in U.S. Pat. No. 5,383,454, issued Jan. 24, 1995 to Richard D. Bucholz, which is hereby incorporated in its entirety by reference.
In one embodiment, an apparatus in accordance with the invention comprises a moveable magnet assembly having a plurality of fiducial marks thereon; a localizer comprising a plurality of imaging sensors configured to sense a position in three-dimensional space of the fiducial marks to thereby provide an indication of a location of the moveable magnet; and a processor including memory having stored therein a pre-measured representation of a magnetic field generated by the magnet assembly and a display configured to present a graphical representation of the magnetic field, the processor being configured to be responsive to the indication of the location of the moveable magnet provided by the localizer so that the display provides an indication of the magnetic field within a selected volume of space resulting from the magnet assembly when the magnet is at a position indicated by the localizer.
In accordance with another embodiment of the invention, a method for providing a rapid interactive display of the aligning torque and magnetic pulling directions of a magnet comprises the steps of providing a plurality of fiducial marks on the magnet assembly; sensing a location and orientation of the fiducial marks; computing a magnetic field in a selected volume of space produced by the magnet assembly when the magnetic assembly is in the sensed location and orientation; and displaying a representation of the magnetic field in the selected volume of space. This inventive method embodiment may further comprise the steps of placing a magnetic seed in a tissue of a living body; providing fiducial marks on an external surface of the living body proximate the tissue; sensing a location and orientation of the living body; and selecting the selected volume of space to include the tissue of the living body.
In another variation of the invention, the field lines need not be displayed. Instead, a vascular or other lumenal path displayed on the screen is surgeon identified as being the path of choice. The computer is then able to "know" in the treatment volume the direction needed for the guiding field at each point along the path. It can then provide orientation and positioning of the external, field-generating magnet as needed for navigation along the path. At arterial or other lumenal branch points, the surgeon can further assist the delicate navigational needs by voice commands understandable by the computer.
In other variations of the inventive methods and apparatuses, means are provided for locating and angling the external field producing magnet while avoiding interference with the imaging means, which may include an exclusion volume about a patient's body. In yet another variation, a permanent, superconducting, or resistive wire external field-generating magnet provides a "shaped" field, i.e., the near (and/or transition) field of the magnet is produced by a specially shaped coil and/or core to provide magnetic fields of sufficient strength and appropriate angular spread to provide additional flexibility in positioning the magnet during surgery. In the case of a superconducting magnet, the winding shape is adjusted. For a resistive wire magnet, the windings and core of the magnet may both be adjusted to accomplish the shaping.
These and other embodiments of the invention may be fully understood by those skilled in the art by reference to the drawings and to the detailed explanation that follows.
FIG. 1 is a block diagram representation illustrating an embodiment of a device in accordance with the invention;
FIG. 2 is a block diagram showing how coordinate systems relative to a magnet, a set of localizers (cameras), and an image on a display are related;
FIG. 3 is a block diagram illustrating another embodiment of a device in accordance with the invention;
FIG. 4A is a side plan view of an embodiment of an electromagnet having a shaped magnetic field in accordance with the invention;
FIG. 4B is a side plan view of the electromagnet of FIG. 4A showing how "magnetic lensing" is accomplished;
FIG. 4C is an illustration of a representative field of a single coil magnet showing off-axis field lines;
FIG. 5A is an illustration of a typical exclusion zone for neurosurgery; and
FIG. 5B is another illustration of the exclusion zone of FIG. 5A showing both a typical cumulative mechanical zone of exclusion and a typical maximal operating volume for a magnetic catheter in a brain.
As used herein in this description and in the claims that follow, unless otherwise explicitly qualified or made clear by the context in which it appears, the term "magnet," when referring to a magnet external to a patient, is intended to include both single magnets (of either the permanent or electromagnetic variety) and assemblies of a plurality of magnets in which the individual magnets of the assembly are used in conjunction with one another to produce an effective magnetic field.
FIG. 1 is a schematic representation of an embodiment of a device 10 in accordance with the invention. A moveable magnet assembly 12 including a magnet 14 is provided. Magnet assembly 12 may be a gantry supporting the weight of magnet 14. Magnet 14 may be either a strong permanent magnet, a superconducting electromagnet, or a resistive wire electromagnet, although a strong permanent magnet may require additional articulation to compensate for its lack of current control and magnitude. Motion of the magnet assembly 12 may be automatically controlled, such as with a computer- or servo-controlled robotic arm 16 or other equivalent mechanical manipulation device to provide the needed orientation, location, and consequent coil current required to align its magnetic field with the desired motion of a magnetic object 30 to be guided. However, automatic control is not required by the invention. Thus, magnet assembly 12 may simply comprise a permanent magnet 14 at the end of a wand 16 (rather than a robotic arm) that a surgeon manipulates by hand. If automatic control or gantry support is provided, however, the apparatus can smoothly manage relatively large electromagnetic coils 14, and can therefore apply strong magnetic fields, so as to provide guidance or force deeper into the body 26.
Device 10 further comprises a plurality of localizers 20, which may be mounted on a localizer assembly 18. The plurality of localizers 20 each comprise a camera-like sensor (such as a commercial infrared, optical, or ultrasonic sensor) that senses fiducial marks 22 on magnet assembly 12. A general discussion of localizer technology of a type that may be employed in the present invention will be found in previously-mentioned U.S. Pat. No. 5,383,454. Fiducial marks 22 on magnet assembly 12 may be any marker that can be located by the plurality of localizers 20, and may preferably comprise lighted LEDs (light emitting diodes). Optionally, additional fiducial marks 24 may be applied to a patient's body 26 or part thereof (in the illustrated case, a patient's head). Fiducial marks 24 may either be screw-in or stick-on markers. Screw-in markers are preferable for the greater accuracy that may be obtained. Alternately, anatomical landmarks can be used, especially if the location of the volume of interest 28 is known relative to localizers 20 and a CAT, X-ray or MRI medical imaging device is used in conjunction with the localizers 20 (as is normally contemplated). However, the use of anatomical landmarks may result in less accurate display of the magnetic field of magnet 14 relative to the patient's body 26 and any magnetic seed 30 or other surgical device embedded in the patient's body. (The term "seed" is intended to encompass all types of magnetic probe masses or other magnetically guided or pulled implanted surgical, diagnostic, or therapeutic objects in the body.)
While mounting of localizers 20 on a localizer assembly 18 is desirable, any alternate means of positioning and directing the localizers at a specified volume of space in which fiducial marks 22 may be located when magnet assembly 12 is in use may be used. It is only necessary that fiducial marks 22 be positioned in such a way that the position and orientation of the magnet 14 in three-dimensional space can be sensed by localizer 20 relative to a specified volume of interest 28. In practice, this volume of interest 28 would include the location within which the portion of the patient's body 26 in which a seed 30 or magnetic guidance tip (such as at the end of a catheter) is embedded when an operation is performed, and is preferably within a magnetic resonance imaging (MRI) or other area sensed by such means as would normally be employed during magnetic surgery. Seed 30 or magnetic guidance tip may comprise a permanent magnet, or an induced magnet of a permeable material. For simplicity, either type of material may be referred to as a "magnet" for purposes of describing the implant. Fiducial marks 24 must either be located by tracking them with a lighted probe (such as a probe with LEDs) or by touching a calibrated portion of the magnet to each in turn. A sufficient number of localizers 20 and fiducial marks 22 are provided to enable a processor 32 receiving signals from localizers 20 to accurately determine the position and orientation of magnet 14. If fiducial marks 24 are provided on the patient's body 26 for the purpose of locating the position and orientation of the patient's body 26 relative to magnet 14, a sufficient number of these such marks 24 are also provided to enable the processor 32 to make a determination of the location and orientation of the patient's body 26. Any fiducial marks 24 provided on patient's body 26 would be of a type that would also appear in a CAT, X-ray, or MRI scan in order for these images to be registered.
Localizers 20, whether optical, infrared, ultrasonic, magnetic, or otherwise, detect the position of the markers 22 on magnet assembly 12 and provide a signal or signals to processor 32. It will be understood that the nature of the communications link between localizers 20 and processor 32 is not critical, nor is it critical as to whether a separate link is provided between each localizer 20 and processor 32 or whether data from all the localizers 20 is combined and sent through a single link. Processor 32 is also provided with memory 34 in which is provided data representative of the magnetic field in three dimensions produced by magnet 14, and memory 36 in which is provided a stored program containing instructions for processor 32. (Memory 34 and memory 36 in FIG. 1 may be any suitable, conventional form of memory and may comprise different addresses or locations in the same physical memory element.) The representation for the magnetic field may be a set of measured data or a set of parameters for magnet 14 from which the magnetic field can be calculated. If magnet 14 can be one of several magnets of varying strength or size, data or parameters for several representations of magnetic field, each representing a different magnet, may be stored in memory 34. If magnet 14 is an electromagnet rather than a permanent magnet, the data or parameters in memory 34 may be scaled in accordance with an amount of current flowing through magnet 14. Data representing this amount of current would be made available as an input (not shown) to processor 32, preferably as a signal obtained from a power supply of magnet 14 or an ammeter (neither of which is shown).
In some modes of operation, the processor 32 will, in addition to the above tasks, calculate the current needed by the electromagnet 14 to optimally provide a field at the location of seed 30. The position, orientation, and current of magnet 14 will be optimized simultaneously by processor 32 so as to yield the needed navigation with a minimum of magnet motion. In such modes, the processor will send a signal (not shown) to the electromagnet power supply.
The program provided in memory 36 instructs processor 32 to calculate, from the localizer inputs that result from fiducial marks 22, the location and orientation of magnet 14 relative to the volume of interest 28. From this location and orientation, the program further instructs processor 32 to provide a display representative of the resulting magnetic field within the volume of interest 28. In "manual mode," i.e., the mode in which a surgeon navigates visually rather than by directing overall computer navigation choices, this display would be shown on the surgeon's display 40. Otherwise, a second engineering display (not shown) would present these features. Preferably, the location of fiducial marks 24 on the patient's body 26 are also displayed. The representative display of the magnetic field is preferably graphical, and is presented in a fashion that is useful to a surgeon during an operation. For example, a two-dimensional view in a plane including seed 30, or a rotatable three-dimensional perspective view may be provided. A selection of one or more different types of views may be provided, based upon operator input, such as through a keyboard, a mouse, a joystick, or other input device or devices 42 communicating with processor 32. The input device or devices 42 may also be used in a manner described below to initialize the necessary coordinate system transformations to be performed by processor 32.
Data received from localizers 20, and the processing by processor 32 to present a graphical representation on display 40 of the magnetic field produced by magnet 14 must be fast enough to provide "real-time" feedback for a surgeon; i.e., the feedback must be rapid enough to allow decisions to be made during a surgical procedure involving the movement of the implanted magnetic device 30. The method of Procrustes is used to compute the 4�4 rigid body transformation between coordinates in the imaging system and coordinates in the localizer system. Thereafter, the 4�4 matrix may be applied to transform a pre-stored representation of a magnetic field into a magnetic field having the position and orientation sensed by localizers 20 using standard programming techniques on a presently-available Intel PENTIUM�-based processor (such as a typical PC), or a Silicon Graphics workstation, with the transformation being accomplished in sufficient time to provide a display that is updated rapidly enough for surgical purposes.
Preferably, at least three, or even more preferably, four fiducial marks 22 are provided on magnet assembly 12, and the same number of fiducial marks 24 on the patient's body 26. Also preferably, display 40 may also provide a display of a simultaneously obtained CAT, X-ray, or MRI image. The CAT, X-ray, or MRI image can be superimposed upon the display of the magnetic field. If the fiducial markers 24 on the patient's body 26 are of a type that shows up on the CAT, X-ray, or MRI image (e.g., metal screw-in markers), then the magnetic field display and the CAT, X-ray, or MRI image may be aligned or registered either automatically by processor 32 or manually by the surgeon. Alternately, or in addition to the CAT, X-ray, or MRI imaging device, a magnetic locating device such as that described in U.S. Pat. No. 5,558,091, issued Sep. 24, 1996 to Acker et al. (which is hereby incorporated by reference in its entirety) may be used for determining and displaying a position and orientation of implanted seed 30. It is also possible to use the magnet being used to guide the implant as the source of the magnetic field for determining the location of the implant, in accordance with the devices and methods disclosed in "Method and Device for Locating Magnetic Implant by Source Field," a U.S. Patent Application to R. Ritter et al. filed on even date herewith and hereby incorporated in its entirety by reference.
A typical use of the inventive apparatus would proceed as follows: First, a patient's head (or other body part to undergo magnetically aided surgical procedure) would be supported in a fixed position in space relative to localizers 20, with fiducial marks 24 (or anatomical landmarks) on patient 26 visible to localizers 20. A representation of the field of view of localizers 20 then appears on display 40. Fiducial marks (or anatomical landmarks) are then identified on display 40 by touching the actual physical locations on patient 26 with magnet 14 or in some other suitable fashion. The image coordinates are related to localizer coordinates using the method of Procrustes. Next, the location of magnet 14 is determined by localization of fiducial markers 22. Once the location of the magnet 14 is known, processor 32 then relates the coordinate system of the stored representation of the magnetic field in memory 34 to the coordinate system of the images using simple matrix multiplications. A representation of the magnetic field of magnet 14 in the coordinate system of display 40 is then presented on display 40, preferably together with a representation of the part of the body of patient 26, fiducial markers 22 and 24, and magnetic seed or guidance magnet 30. As the magnet 14 is moved, positions of the fiducial markers 22 change and are detected by localizers 20, and the resulting magnet 14 positions determined. In manual mode, display 40 is continuously updated to show the resulting magnetic field in the coordinate system of display 40. In automatic mode, the equivalent information is updated within processor 32. Preferably, a current location of seed or guidance magnet 30 is also shown on display 40.
FIG. 2 shows, in block diagram form, the relationship between various coordinate systems of interest in the inventive system. The magnet coordinate system refers to a coordinate system referenced to magnet 14. The representation of the magnetic field of magnet 14 that is stored in memory 34 is likely to be most conveniently represented relative to this coordinate system. The camera coordinate system refers to the coordinate system of localizers 20, and may be fixed depending upon the construction and positioning of localizer assembly 18. The image coordinate system refers to the three-dimensional coordinate system of the image of the patient on display 40. Because the positions of the LEDs (or other fiducial markers 22) on magnet assembly 12 are known in advance relative to the magnet coordinate system, once the actual positions of the LEDs are known, the magnetic field can be converted easily to the other coordinate systems using transformations Tm, Ti, or a combination of both transformations (which may be applied in a single step, rather than two separate transformations). These transformations are normally carried out by multiplications involving 4�4 transformation matrices. Typically, the LEDs that may be used as fiducial markers 22 may be infrared LEDs that are detected by cameras sensitive to infrared radiation and used as localizers 20. Processor 32 receives information from localizers 20 from which it can compute the position of the LEDs (or the localizer array may contain its own processor to do this and supply processor 32 with this information directly). When the patient's body is fixed in position and fiducial markers 24 touched by a point known relative to the magnet, the positions of fiducial markers 24 relative to the LEDs (i.e., fiducial markers 22, the positions of which are known in advance) are determined. The identification of the corresponding marks on display 40 identifies the corresponding positions in the image coordinate system. Ti, is then computed using the method of Procrustes. Finally, as the magnet 14 is moved, the positions of the LEDs are changed and detected by the array of localizers 20, and the transformation Tm is determined and continuously updated. Concatenations of transformations of Tm and Ti are continuously performed to update display 40 or the processor control memory.
FIG. 3 is a block diagram of another embodiment of the inventive apparatus 10′. In this embodiment, a joystick 42′ is used as an operator input to processor 32, possibly in conjunction with other standard input devices such as a keyboard (not separately shown). More than one magnet assembly 12 may be provided, each with a separate magnet or magnets 14, in which case memory 34 may be provided with a plurality of magnetic field representations, each representing a particular magnet or magnets 14 on a magnet assembly 12, or it may be provided with only one magnetic field representation, if the magnetic fields of magnets 14 are sufficiently similar. Magnet assemblies 12 in this case are moved in this embodiment under control of operator input device 42′ or another suitable input device or devices, and if magnets 14 are electromagnets, the current through magnets 14 may also be controlled via operator inputs. Localizers 20 and processor 32 are configured to locate each of the magnets 14, and processor 32 is configured to compute the magnetic fields from each of the magnets 14, compute a resultant total magnetic field, and display the representation of the resultant total magnetic field on displays 40 and 40′. (In this embodiment two displays [40 and 40′] are provided as an aid to the surgeon. It will be understood that as many displays as are deemed necessary may be provided.) Possibly different colored LEDs may be provided on the individual magnet assemblies 12 so that their separate locations are more readily determined. Preferably, if a plurality of magnet assemblies 12 are provided, they may be used either independently or in unison, as required.
Processor 32 also controls two X-ray tubes 44 (one for each display 40, 40′). For each X-ray tube 44, there is one sensor (camera), not shown, the output of which is the signal sent to processor 32 to provide the displays. These X-rays provide real-time imaging of patient 26 as well as a surgical device 46 being steered by the magnetic fields of magnets 14. Preferably, the fluoroscopic imaging system is immune to magnetic fields, because of the presence of the strong fields from nearby magnet 14. Sensors for fluoroscopic imaging systems meeting this requirement include charge coupled devices (CCDs), micro channel plates (MCPs), and amorphous silicon technologies. In this case, surgical device 46 is a catheter having a magnetic tip 30. Images provided by X-ray from tubes 44 are superimposed on the magnetic field image on displays 40 and 40′ to indicate the progress of the surgical procedure to allow a surgeon to determine how to position magnet assemblies 12 (and possibly control currents in magnets 14) as the operation proceeds. The images provided by X-ray tubes 44 may be provided by sensors (not shown) that provide image inputs to processor 32. It will be recognized that many components, such as magnets 14, X-ray tubes 44, displays 40 and 40′, input devices 42′, etc., may be provided in such numbers as needed, if processor 32 (which itself may comprise a plurality of processors) is provided with the appropriate stored program.
In each of the embodiments of the invention, magnet or magnets 14 are orientable and positionable about a patient's body 26. The best orientation is commensurate with the display, and with avoiding imaging equipment (including X-ray tubes 44 and corresponding sensors) and parts of body 26 itself, which in prior art methods would interfere with adequate positioning and orientation of a magnet. Often, in common usage, a magnet which pulls or aligns an object does so along its axis, but the inventive apparatuses and methods disclosed herein do not require this limitation. These apparatuses and methods provide optimization of the magnetic field strength and minimization of current needed for energization of external magnet 14 (or the plurality of external magnets 14, if more than one is provided).
Several versions of the control of the manipulation can be employed. In a form employing the least amount of automatic control, screens 40 and 40′ display magnetic field lines, either in two (preferably orthogonal) projections, or in a three dimensional representation that can be rotated or otherwise manipulated on a screen. A surgeon-operator manipulates magnet 14 (such as by moving magnet assembly 12), which in turn moves the magnetic field line display on the display screen or screens (such as screens 40 and 40′), so that the field direction at the location of the implant is made to agree with a desired and displayed direction of motion of the implant. The ability to accomplish this directional agreement, even in the presence of restraints set by potentially interfering imaging components and parts of the body, is greatly facilitated by the shape of the magnetic field lines.
In moving away from the axis of an electromagnetic coil used for magnet 14, magnetic field lines increasingly curve away from the straight line of the on-axis field of the coil. These magnetic field lines have azimuthal symmetry about the coil axis, which often adds to the freedom of coil orientation. Thus, locating and orienting the field source magnet 14 so that a curved field line falls on the location of the magnet, makes possible a direction control that would otherwise be geometrically impossible, because of spatial constraints in many cases, if the axis of magnet 14 had to align with the motion direction of seed 30.
If attainment of a specific field strength is required by the control program, the use of current control (and/or closeness of magnet 14) provides an accommodation to the use of the curved field line. In a typical coil, the field strength of the magnetic field at a given distance from the coil is reduced as an implant 30 is moved off axis and to a location of more curved field lines. For a purely manual version of control, the position of and/or current in the magnet 14 may be adjusted by the operator in response to marked regions of the displayed lines, which may be marked in distinctive colors. Distinctive colors or other suitable markings may be displayed to indicate avoidance regions, i.e., regions so close to a seed 30 or other implant that an undesired magnitude of field or gradient is present at the seed or implant. By avoiding positioning of magnets 14 in the avoidance region or regions, means other than the imposition of a magnetic force or torque on the implant (such as mechanical motion of a catheter to which the magnetic seed 30 is attached at an end) may be used for moving it, if desired. Segmentally colored lines on display 40 and/or 40′ may also be used to help guide an operator in his manual manipulation of a magnet or coil by facilitating the choice of more advantageous position and angle combinations for magnet 14 for applying a specified magnetic field magnitude and direction at the location of seed or implant 30.
In use, the inventive apparatus causes the magnetic seed or implant 30 to align with the magnetic field direction at its location in the body 26. In addition, if a pulling force is required, the direction of the gradient on the aligned implant is also along the field line (in an antiparallel direction). If seed 30 is a magnetically permeable implant or an appropriately oriented permanent magnet implant, the implant 30 is naturally guided along the field line and pulled along it, if desired.
By "shaping" of a magnetic field, it is meant that magnetic field lines of either the near field or the transition field of the magnet, or both, are given a known or readily determinable shape useful for manipulating magnetic seed 30, particularly in positions where it would be difficult to apply an on-axis field of proper orientation and magnitude due to an exclusion region, or where it is desirable to guide or pull the magnetic seed 30 along a curved path corresponding to a field line of the shaped magnetic field. The "near field" of a magnet is defined as the field of the magnet that is close enough to the source (which may be an electromagnetic winding) such that it does not correspond to a sufficiently close approximation of the standard dipole field shape for surgical guidance purposes. The near field of a finite source differs from a point dipole field significantly, for present purposes, when the field point is within 3 to 4 times the largest dimensions of the finite source, such as the greater of the width or length of a coil. A "transition field" is also defined between the near field and the dipole field, if the magnet is a single coil, or between the near field and the higher multipole field, in the case of a multicoil system. It is contemplated that computer or processor 32 (see, e.g., FIG. 1) will preferably have sufficient data and instructions in software to compute the near and transition fields of a magnet 14 for use for automatic control of magnet 14 or for display on display units 40, 40′ in the case of manual control. Of course, guidance and pulling of a seed 30 may also be accomplished using the far field of magnet 14, but with the additional information that is preferably available to processor 32, the off-axis components of the magnetic field of magnet 14 may also become useful for guidance and pulling of seed 30.
One embodiment of a magnet 14 configured to provide a "shaped" magnetic field suitable for use with the inventive apparatus is shown in FIG. 4A. Winding 60, which may be a resistive wire winding, is wound in the shape of a sphere. With automated winding equipment, a spherical winding may be readily made by winding more layers in a central portion of the sphere to produce a bulge in the middle section of winding 60. For a superconductive winding, the special form of winding 60 alone, without a core, is adequate to provide a sufficiently "shaped" magnetic field. For a resistive winding, a core 62 of permeable magnetic material is provided to shape the magnetic field in conjunction with the special form of winding 60. The embodiment illustrated here has a mushroom-like shape. Of course, other embodiments are possible, including those in which magnet 14 is a permanent magnet of predetermined shape.
A permanent or resistive wire magnet 14 can be made to provide "magnetic lensing." A segment of permeable material, such as core 62, may be inserted in winding 60 (or in a hollow permanent magnet) and moved longitudinally along the front of the permanent magnet or inside the winding of the resistive wire magnet to change the shape of the field lines to accomplish a particular procedure. Different segments of permeable material may also be substituted to provide different amounts of shaping of the magnetic field. Spacer rings 64 may be provided, as shown in FIG. 4B, to prevent "suck-in" of the core material 62 that would otherwise occur with a permanent magnet 60, or when a winding 60 is energized.
Control of the magnetic field strength applied to seed 30 is easily accomplished. In a manual embodiment, the operator manipulates the external magnet 14 in response to the magnetic field lines displayed on the display system 40, 40′ so that the magnetic field lines and magnitude of the magnetic field are configured to provide the correct magnitude and direction at the location of seed 30 to provide the desired motion or guidance of seed 30. Control of the magnetic field may also be done by software running in control computer 32. In this case, the screen display 40, 40′ provides confirmation of the operation of the system to the operator.
In yet another embodiment of the inventive apparatus, display system 40, 40′ is less important, and it is not used in the same manner. Instead, the computer 32 is provided with an optimization program in software that processes the input information of the implant position and direction of the desired motion, and processes this information with predetermined motion algorithms to effect a desired motion. In this mode, the forbidden regions (i.e., the regions including the body and the imaging system that must be avoided by magnet system 12) are provided as data to computer 32 or are determined by computer 32 in some suitable manner. The computer 32 then, through software control, provides the desired alignment in a manner similar to that described above. Off-axis field lines of magnet 14 (such as lines 102 of a single coil magnet as shown in FIG. 4C) may be used to greatly increase the effective directions of the magnet, and in fact provide complete coverage of the procedure region in patient 26 despite the forbidden exclusion regions.
FIG. 5A is an illustration of a typical exclusion region in a neurosurgical procedure. The exclusion region 70, in which X-ray beams pass, is defined by two cones 72 and 74. The tips of the two cones 72, 74 are separated by about 6″. The conical regions are slightly offset from one another, so that near the patient's neck, the intersection is about 2 inches lower than at the top of the head. This detail is better shown in FIG. 5B, and is represented as dimension C. (For present purposes, it may be assumed that other exclusion regions exist, including one that encompasses the entire body 26. However, magnet 14 and magnetic assembly 12 neither of which is shown in FIGS. 5A or 5B, may be provided with mechanical limitations that would prevent their positioning that far away from the patient's head 26A. Therefore, it is not necessary to provide a control computer with data detailing the shape of exclusion regions beyond the limits of motion of magnet 12 and magnetic assembly 14.) In FIGS. 5A and 5B, dimension A is typically about 6 or 7 inches, and angles B are typically about 30�. The illustrated exclusion zone 70 comprising cones 72, 74 provides ample room for manipulation of a magnet 14 having a shaped field on the left, right, and top of the head 26A, and perhaps some other areas, without interfering with an imaging apparatus, parts of which are typically located above and below the patient's head. The exclusion zone 70 shown here represents the typical cumulative mechanical zone of exclusion and imaging beam zone of exclusion to accommodate 2″ X-ray equipment. FIG. 5B better shows the typical maximal operating volume 26B of a magnetic catheter (not shown) with respect to exclusion zone 70.
The inventive apparatus may be used to perform magnetic surgery by a method comprising the steps of implanting a magnetic seed in the body of a patient, producing a medical image (such as an X-ray image) of the region of the patient's body including the implanted seed, superimposing a representation of the magnetic field lines of an external magnet (i.e., magnet 14) on the medical image, aligning a portion of the superimposed representation, such as a near-field magnetic field line of the external magnet, along an intended path of the seed, and moving the external magnet into a position to produce the represented superimposed magnetic field to effect guidance or movement of the seed. If the magnet is a permanent magnet, the alignment and movement steps would occur simultaneously. If the external magnet is an electromagnet, either normally conducting or superconducting, the alignment step may occur first, followed by servo-controlled movement of the magnet.
The inventive apparatus may also be used in a method comprising the steps of implanting a magnetic seed in a patient's body; imaging a region of the patient's body including the implanted seed to thereby produce a medical image; storing information indicative of a path to be taken by the seed in a memory of a computer having a display; displaying a representation of the path and a current location of the seed on the display; calculating orientations and currents of an external electromagnet required to provide a magnetic field to the seed to move the seed along the path; activating a servo-controlled motor to move the external electromagnet to the calculated orientations; providing the calculated currents to the electromagnet; and updating the display to provide current locations of the seed relative to the path. Commands may be provided to the computer by non-tactile means, such as by an operator speaking into a voice recognition unit that provides input to the computer.
One skilled in the art would recognize that numerous modifications are possible to the specific embodiments described herein while remaining within the
|Citing Patent
|Filing date
|Publication date
|Jan 23, 2002
|Dec 13, 2005
|Stereotaxis, Inc.
|Rotating and pivoting magnet for magnetic navigation
|May 3, 2002
|Oct 2, 2007
|Stereotaxis, Inc.
|System and methods for advancing a catheter
|Oct 20, 2003
|Oct 9, 2007
|Magnetecs, Inc.
|System and method for radar-assisted catheter guidance and control
|Mar 24, 2006
|Mar 11, 2008
|Stereotaxis, Inc.
|Magnetic medical devices with changeable magnetic moments and method of navigating magnetic medical devices with changeable magnetic moments
|Dec 27, 2005
|Mar 18, 2008
|Stereotaxis, Inc.
|Electrophysiology catheter
|Jul 11, 2006
|Aug 26, 2008
|Sterotaxis, Inc.
|Magnetically shielded x-ray tube
|Aug 10, 2006
|Feb 24, 2009
|Stereotaxis, Inc.
|Method and apparatus for dynamic magnetic field control using multiple magnets
|Dec 30, 2005
|Apr 28, 2009
|Depuy Products, Inc.
|Magnetic sensor array
|Sep 11, 2007
|May 26, 2009
|Stereotaxis, Inc.
|Automated mapping of anatomical features of heart chambers
|Jun 6, 2005
|Jun 2, 2009
|Stereotaxis, Inc.
|User interface for remote control of medical devices
|Feb 2, 2007
|Jul 28, 2009
|Stereotaxis, Inc.
|Global input device for multiple computer-controlled medical systems
|Jul 7, 2006
|Oct 20, 2009
|Stereotaxis, Inc.
|Magnetic navigation and imaging system
|Aug 23, 2005
|Dec 1, 2009
|Stereotaxis, Inc.
|Methods and apparatus for steering medical device in body lumens
|Oct 17, 2003
|Jan 5, 2010
|Medtronic, Inc.
|Fiducial marker devices, tools, and methods
|Jul 7, 2006
|Apr 6, 2010
|Stereotaxis, Inc.
|Apparatus for pivotally orienting a projection device
|Jan 11, 2006
|May 4, 2010
|Stereotaxis, Inc.
|Navigation using sensed physiological data as feedback
|Feb 25, 2003
|May 18, 2010
|Medtronic, Inc.
|Fiducial marker devices, tools, and methods
|May 5, 2006
|Jun 22, 2010
|Stereotaxis, Inc.
|Voice controlled user interface for remote navigation systems
|Feb 2, 2007
|Jun 29, 2010
|Stereotaxis, Inc.
|Control for, and method of, operating at least two medical systems
|Dec 20, 2005
|Jul 6, 2010
|Stereotaxis, Inc.
|Contact over-torque with three-dimensional anatomical data
|Feb 7, 2006
|Jul 13, 2010
|Stereotaxis, Inc.
|Registration of three dimensional image data to 2D-image-derived data
|Sep 4, 2007
|Jul 20, 2010
|Stereotaxis, Inc.
|Method for safely and efficiently navigating magnetic devices in the body
|Jun 28, 2007
|Aug 3, 2010
|Stereotaxis, Inc.
|System and methods for advancing a catheter
|Jul 15, 2003
|Aug 3, 2010
|Magnetics, Inc.
|Apparatus and method for catheter guidance control and imaging
|Jun 29, 2006
|Aug 3, 2010
|Stereotaxis, Inc.
|Method of treating cardiac arrhythmias
|Nov 21, 2006
|Aug 10, 2010
|Stereotaxis, Inc.
|Method for safely and efficiently navigating magnetic devices in the body
|Feb 24, 2009
|Aug 10, 2010
|Stereotaxis, Inc.
|Method and apparatus for dynamic magnetic field control using multiple magnets
|Jun 4, 2003
|Aug 31, 2010
|Medtronic, Inc.
|Fiducial marker devices, tools, and methods
|Feb 7, 2007
|Oct 19, 2010
|Stereotaxis, Inc.
|Method and apparatus for multi-system remote surgical navigation from a single control center
|Oct 7, 2004
|Nov 9, 2010
|Stereotaxis, Inc.
|System and method of surgical imagining with anatomical overlay for navigation of surgical devices
|Feb 23, 2006
|Jan 11, 2011
|Magnetecs, Inc.
|Apparatus for magnetically deployable catheter with MOSFET sensor and method for mapping and ablation
|Jan 13, 2006
|Jan 18, 2011
|Magnetecs, Inc.
|System and method for a magnetic catheter tip
|Oct 9, 2007
|Jan 18, 2011
|Magnetecs, Inc.
|System and method for radar-assisted catheter guidance and control
|Aug 21, 2007
|Jun 14, 2011
|Stereotaxis, Inc.
|Method of three-dimensional device localization using single-plane imaging
|Jul 13, 2010
|Jun 14, 2011
|Stereotaxis, Inc.
|Registration of three-dimensional image data to 2D-image-derived data
|Jan 26, 2007
|Jun 21, 2011
|Stereotaxis, Inc.
|Rotating and pivoting magnet for magnetic navigation
|Jun 27, 2008
|Sep 20, 2011
|Stereotaxis, Inc.
|Remote control of medical devices using real time location data
|May 27, 2005
|Sep 27, 2011
|Magnetecs, Inc.
|Apparatus and method for shaped magnetic field control for catheter, guidance, control, and imaging
|Nov 16, 2009
|Oct 4, 2011
|Medtronic, Inc.
|Fiducial marker devices, tools, and methods
|Jul 20, 2007
|Nov 15, 2011
|Stereotaxis, Inc.
|Method of navigating medical devices in the presence of radiopaque material
|Dec 21, 2006
|Nov 29, 2011
|Depuy Products, Inc.
|Method and system for registering a bone of a patient with a computer assisted orthopaedic surgery system
|Mar 29, 2010
|Dec 6, 2011
|Medtronic, Inc.
|Fiducial marker devices, tools, and methods
|Dec 21, 2009
|Feb 14, 2012
|Stereotaxis, Inc.
|Systems and methods for medical device advancement and rotation
|Oct 18, 2007
|Mar 13, 2012
|Stereotaxis, Inc.
|Location and display of occluded portions of vessels on 3-D angiographic images
|Feb 18, 2009
|Apr 3, 2012
|Depuy Products, Inc.
|Magnetic sensor array
|Mar 21, 2007
|May 22, 2012
|Medtronic, Inc.
|Fiducial marker devices, tools, and methods
|Jul 11, 2006
|Jun 5, 2012
|Stereotaxis, Inc.
|Estimation of contact force by a medical device
|Jun 24, 2008
|Jun 12, 2012
|Stereotaxis, Inc.
|Variable magnetic moment MR navigation
|Nov 5, 2008
|Jul 31, 2012
|Stereotaxis, Inc.
|Magnetically guided energy delivery apparatus
|Feb 2, 2007
|Aug 14, 2012
|Stereotaxis, Inc.
|System state driven display for medical procedures
|Feb 2, 2007
|Aug 14, 2012
|Stereotaxis, Inc.
|Coordinated control for multiple computer-controlled medical systems
|Sep 10, 2007
|Sep 25, 2012
|Stereotaxis, Inc.
|Impedance-based cardiac therapy planning method with a remote surgical navigation system
|May 15, 2012
|Nov 13, 2012
|Pulse Therapeutics, Inc.
|Magnetic-based systems for treating occluded vessels
|May 15, 2012
|Nov 20, 2012
|Pulse Therapeutics, Inc.
|Magnetic-based methods for treating vessel obstructions
|Jul 6, 2010
|Feb 5, 2013
|Stereotaxis, Inc.
|Contact over-torque with three-dimensional anatomical data
|May 17, 2005
|Apr 16, 2013
|Stereotaxis, Inc.
|Magnetically navigable balloon catheters
|Oct 7, 2009
|May 7, 2013
|Bard Access Systems, Inc.
|Percutaneous magnetic gastrostomy
|Nov 25, 2008
|Jun 4, 2013
|Magnetecs, Inc.
|System and method for a catheter impedance seeking device
|Feb 11, 2009
|Jul 2, 2013
|C. R. Bard, Inc.
|Systems and methods for positioning a catheter
|Sep 9, 2010
|Aug 20, 2013
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|May 31, 2012
|Sep 10, 2013
|Pulse Therapeutics, Inc.
|Methods of controlling magnetic nanoparticles to improve vascular flow
|Nov 2, 2010
|May 6, 2014
|Pulse Therapeutics, Inc.
|Devices for controlling magnetic nanoparticles to treat fluid obstructions
|Jan 9, 2013
|Jul 8, 2014
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Mar 2, 2010
|Jul 15, 2014
|C. R. Bard, Inc.
|System for placement of a catheter including a signal-generating stylet
|Aug 23, 2006
|Jul 22, 2014
|C. R. Bard, Inc.
|Stylet apparatuses and methods of manufacture
|May 8, 2007
|Aug 5, 2014
|Stereotaxis, Inc.
|Workflow driven method of performing multi-step medical procedures
|Oct 27, 2011
|Aug 12, 2014
|C. R. Bard, Inc.
|Bioimpedance-assisted placement of a medical device
|May 9, 2007
|Aug 12, 2014
|Stereotaxis, Inc.
|Workflow driven display for medical procedures
|Sep 10, 2009
|Sep 30, 2014
|C. R. Bard, Inc.
|Apparatus and display methods relating to intravascular placement of a catheter
|Aug 16, 2013
|Oct 14, 2014
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Dec 30, 2005
|Oct 14, 2014
|DePuy Synthes Products, LLC
|Method for determining a position of a magnetic source
|Sep 6, 2013
|Jan 6, 2015
|Pulse Therapeutics, Inc.
|Controlling magnetic nanoparticles to increase vascular flow
|Oct 31, 2007
|Feb 24, 2015
|Acclarent, Inc.
|Methods and apparatus for treating disorders of the ear, nose and throat
|Apr 8, 2013
|Mar 3, 2015
|C. R. Bard, Inc.
|Systems and methods for positioning a catheter
|Jul 7, 2008
|Aug 18, 2015
|Stereotaxis, Inc.
|Management of live remote medical display
|Feb 2, 2011
|Sep 8, 2015
|Bard Access Systems, Inc.
|Apparatus and method for catheter navigation and tip location
|Jul 29, 2002
|Jan 29, 2004
|Mazzocchi Rudy A.
|Fiducial marker devices, tools, and methods
|Jul 15, 2003
|Jan 29, 2004
|Yehoshua Shachar
|Apparatus and method for catheter guidance control and imaging
|Oct 20, 2003
|May 5, 2005
|Yehoshua Shachar
|System and method for radar-assisted catheter guidance and control
|Jul 19, 2005
|Feb 16, 2006
|Viswanathan Raju R
|Method of, and apparatus for, controlling medical navigation systems
|Aug 23, 2005
|Apr 6, 2006
|Viswanathan Raju R
|Methods and apparatus for steering medical devices in body lumens
|Oct 7, 2004
|Apr 13, 2006
|Viswanathan Raju R
|Surgical navigation with overlay on anatomical images
|Jan 13, 2006
|Jun 1, 2006
|Yehoshua Shachar
|Apparatus and method for generating a magnetic field
|Jul 20, 2005
|Jul 6, 2006
|Anthony Aliberto
|Magnetic navigation manipulation apparatus
|Jul 21, 2005
|Jul 6, 2006
|Ferry Steven J
|Micro-catheter device and method of using same
|Feb 7, 2006
|Nov 30, 2006
|Viswanathan Raju R
|Registration of three dimensional image data to 2D-image-derived data
|May 5, 2006
|Dec 14, 2006
|Viswanathan Raju R
|Voice controlled user interface for remote navigation systems
|May 5, 2006
|Dec 14, 2006
|Viswanathan Raju R
|User interfaces and navigation methods for vascular navigation
|Jul 7, 2006
|Jan 25, 2007
|Charles Wolfersberger
|Apparatus for pivotally orienting a projection device
|Jul 11, 2006
|Feb 8, 2007
|Munger Gareth T
|Magnetically shielded x-ray tube
|Jul 7, 2006
|Feb 15, 2007
|Creighton Francis M Iv
|Magnetic navigation and imaging system
|Mar 7, 2006
|Feb 15, 2007
|Ritter Rogers C
|Method and device for locating magnetic implant source field
|Aug 10, 2006
|Feb 15, 2007
|Ilker Tunay
|Method and apparatus for dynamic magnetic field control using multiple magnets
|Jul 11, 2006
|Feb 22, 2007
|Viswanathan Raju R
|System and network for remote medical procedures
|Sep 1, 2005
|Mar 8, 2007
|Viswanathan Raju R
|Method and system for optimizing left-heart lead placement
|Jun 2, 2006
|Mar 22, 2007
|Viswanathan Raju R
|Electrophysiology catheter and system for gentle and firm wall contact
|Oct 2, 2006
|Apr 19, 2007
|Plasse Terry F
|Appetite stimulation and reduction of weight loss in patients suffering from symptomatic hiv infection
|Mar 24, 2006
|Apr 19, 2007
|Sterotaxis, Inc.
|Magnetic medical devices with changeable magnetic moments and method of navigating magnetic medical devices with changeable magnetic moments
|May 17, 2006
|Sep 6, 2007
|Acclarent, Inc.
|Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses
|Aug 1, 2012
|Mar 17, 2015
|C. R. Bard, Inc.
|Cap for an ultrasound probe
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Jan 17, 2002
|Apr 4, 2005
|Fee payment
Year of fee payment: 4
|Apr 16, 2009
|Fee payment
Year of fee payment: 8
|Dec 6, 2011
Owner name: SILICON VALLEY BANK, ILLINOIS
Free format text: SECURITY AGREEMENT;ASSIGNOR:STEREOTAXIS, INC.;REEL/FRAME:027332/0178
Effective date: 20111130
|Dec 8, 2011
Owner name: COWEN HEALTHCARE ROYALTY PARTNERS II, L.P., AS LEN
Free format text: SECURITY AGREEMENT;ASSIGNOR:STEREOTAXIS, INC.;REEL/FRAME:027346/0001
Effective date: 20111205
|May 24, 2013
|Maintenance fee reminder mailed
|Oct 16, 2013
|Lapse for failure to pay maintenance fees
|Dec 3, 2013
|Expired due to failure to pay maintenance fee
Effective date: 20131016


text:
42 U.S. Code § 13882 - Definitions
In this part—
"child" means a person who is less than 7 years of age.
"community correctional facility" means a residential facility that—
(D) provides to inmates and their children—
(ii) pediatric and adult medical care consistent with medical standards for correctional facilities;
(iii) programs to improve the stability of the parent-child relationship, including educating parents regarding—
(v) programs and support services to help inmates—
(A) has been sentenced to a term of imprisonment of not more than 7 years or is awaiting sentencing for a conviction punishable by such a term of imprisonment; and
(B) has not engaged in conduct that—
(A) a parent who has consistently assumed responsibility for the housing, health, and safety of a child prior to incarceration; or
(B) a woman who has given birth to a child after or while awaiting her sentencing hearing and who expresses a willingness to assume responsibility for the housing, health, and safety of that child,
a parent who, in the best interest of a child, has arranged for the temporary care of the child in the home of a relative or other responsible adult shall not for that reason be excluded from the category "primary caretaker".
"State" means a State, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, American Samoa, Guam, and the Northern Mariana Islands.
Source(Pub. L. 103–322, title III, § 31903,Sept. 13, 1994, 108 Stat. 1893.)
LII has no control over and does not endorse any external Internet site that contains links to or references LII.

subset: commoncrawl


text:
|Print Page
Westridge Mine lays off 102 workers
But how many for how long? A longwall move is reportedly under way
English class is not what it used to be
Missing man found Friday; was spending time alone in mountains
A local man missing for more than a week was found early Friday morning.
HEAT application period open until end of April
Home Energy Assistance Target (H.E.A.T.) applications will be accepted through the end of April, 2013 or until funds are exhausted, the Housing and Community Development Division announced....
Members of the Veterans of Foreign Wars, American Legion and Marine Corps League conducted commemorative ceremonies at the Price Peace Gardens, Pinnacle Nursing, Parkdale Care Center and Heirloom Inn on Sunday....
Fire destroys shop in Helper
Helper fire fighters douse the flames that gutted the Main Street Auto Repair shop at 15 N. Main St. Monday morning. A vehicle was also reportedly destroyed in the blaze. The Helper crew was assisted by a team of fire fighters from Price. No one w...
Gas prices down slightly
Average retail gasoline prices in Utah have fallen 3.2 cents per gallon in the past week, averaging $3.69/g Sunday. This compares with the national average that has fallen 3.2 cents per gallon in the last week to $3.46/g, according to gasoline price ...
Cold temperatures mean fire prevention time
As the temperatures begin plummet residents of Carbon County rely on various types of heating appliances to keep their homes warm. Most heating appliances are designed to operate safely if properly maintained; however they can pose some serious ri...
|Print Page


text:
MGH Hotline 02.04.11 THORALF M. SUNDT III, MD, has been named chief of the Division of Cardiac Surgery.
Chief of Cardiac Surgery named
Sundt, photo courtesy of the Mayo Clinic
THORALF M. SUNDT III, MD, has been named chief of the Division of Cardiac Surgery. Beginning Feb. 7, he succeeds Douglas Mathisen, MD, who will continue as chief of the Division of Thoracic Surgery. Sundt currently is vice chair of the Department of Surgery, director of the Cardiovascular Surgical Research Laboratory, co-director of the Marfan and Thoracic Aortic Clinic, and a professor of surgery at the Mayo Clinic, where he has been on staff for 10 years. His appointment marks a return to the MGH, where he completed a residency in general surgery in 1991.
"Thor is widely acknowledged as one of the most prominent and respected cardiac surgeons in the country," says Andrew L. Warshaw, MD, surgeon-in-chief and chair of the Department of Surgery. "We are proud to welcome him to lead the clinical and research efforts in cardiac surgery at the MGH."
Sundt earned his undergraduate degree from Princeton University and his medical degree from the Johns Hopkins University School of Medicine. In addition to his MGH residency, Sundt also trained in thoracic surgery at the Washington University School of Medicine and completed fellowships at the National Cancer Institute and at Harefield Hospital in London, England. Beginning in 1994, Sundt held appointments with the Barnes-Jewish Hospital and Washington University School of Medicine until joining the Mayo Clinic in 2001.
Sundt is associated with nearly all of the major organizations in his field and currently is secretary of the American Association for Thoracic Surgery. He has served on the editorial boards of multiple surgical publications and at present is an editorial board member of Current Problems in Surgery and the Journal of Cardiac Surgery. Sundt has published more than 200 peer-reviewed articles and more than 30 book chapters.
His clinical focus is on acquired heart disease in the adult with particular interest in diseases of the aorta, including aortic arch replacement and repair of thoracoabdominal aortic aneurysms. His research interests include bicuspid aortic valve disease, human factors and medical error.
"The MGH played a critical role in establishing the foundation of my career," says Sundt. "I'm delighted to return to this wonderful institution and once again work with its talented surgical staff – a number of whom are longtime friends." n
U.S. News & World Report ranks Mass General the #1 hospital in America based on our quality of care, patient safety and reputation in 16 different specialties. Learn more about why we're #1
Search the archive for previously published news articles, press releases and publications.
Departments and Centers at Mass General have a reputation for excellence in patient care. View a list of all departments.


text:
Chris Kyle:
" Yo Dawg! I heard you have PTSD.
So I put a gun in your gun hand,
so you can shoot me with a gun,
while I help you recover from shooting guns. "
Moderators: Blitzen, Almighty Benny, Silent-sigfig
Tzan wrote:Quantumsurfer wrote:I generally agree with TzanWarhead wrote:I agree with QuantumSmurfer.
I agree with Warhead.
Tzan wrote:Chris Kyle:
" Yo Dawg! I heard you have PTSD.
So I put a gun in your gun hand,
so you can shoot me with a gun,
while I help you recover from shooting guns. "
Warhead wrote: I'd love to see what they had to say about this shooting.
His book has been in my "will read soon" queue for a while now.
R.I.P soldier
Mine too.
This is so incredibly sad. That poor loving family. Dude survives BUD/S, all the training to become a SEAL, four fucking tours in Iraq during some of the bloodiest years, and he's killed by some hosed in the head vet who he's trying to help.
SinstralRifleman wrote:There are lots of vets with PTSD that aren't a threat to anyone. I've read before about veterans groups using shooting or hunting as a way to decompress or rebuild confidence. If we stigmatize all vets with PTSD as dangerous or make them prohibited possessors more just wont seek help at all.
"I always seemed more vulnerable at home. After every deployment, something would happen to me, usually during training. I broke a toe, a finger, all sorts of little injuries. Overseas, on deployment, in the war, I seemed invincible."
stubby wrote:omg noob, balrogs are maiars too, don't you know anything
Users browsing this forum: No registered users and 2 guests


text:
Wool Cask V-Neck (Men's) (out-of-stock)
Out of Stock Product Number: 26770
The Men's Wool Cask V-Neck by Patagonia features a touch of cashmere makes anything softer, including this wool/cashmere V-neck that will become a wardrobe staple.
Two of nature's most durable, heat-holding fibers built into one of mankind's most useful pieces of clothing. The Wool Cask V-neck - classic, un-stuffy, capable of making the most down-trodden dirtbag look at least 25% decent - is made of beefy 9-gauge wool with 5% cashmere to up the warmth and strength index, and to soften the hand. Jersey knit construction with rib-knit cuffs, hem and neckline secure the fit and retain shape wear after wear.
* This product does not qualify for shipping to all countries.
- Soft wool blended with 5% cashmere
- Jersey knit V-neck sweater with rib-knit on cuffs, bottom hem and neckline
- Heathered colors
Gender: Men's
Material: Wool with a 5% cashmere blend
Fit: Regular Fit
Season: F12
Vendor ProductId: 50555
Review ProductId: 26770


text:
The time has come to get back into some serious pro style maps again, so without further ado we bring you Furious Heights. This will be the first map that we have hosted which was designed and built by the QuakeLive Team. It is also one of the most popular maps in the duel community, having been used on the pro circuit for QuakeCon 2010 and IEM5.
This event starts at 18:00 PDT, with check-in beginning at 17:00 PDT. We will not be increasing the brackets anymore due to players being in school and/or working in the morning. The wait-listed players will be able to check in 15 min prior to closing.
I would prefer to see all matches played on private servers with passwords in order to not have any disruptions! Hope to see you all sign up!
Who: CSN
What: Duel - Double Elimination
When: 18:00 PDT, 16 October 2012
Where: QuakeLive - North America Only
Why: Skydiving anyone??
Live Stream: Targetquake TV


text:
2014-2015 Big Ten Basketball Outlook
Spring football is over, the month long party from the Final Four weekend has ended and there is next to nothing going on in the college sports world. So let's start thinking about next year's Big Ten hoops season! Its of course... read more »


text:
Win a copy of EA Sports FIFA 13, a Sony PlayStation 3 and more in the May Goal of the Month competition.
Arsenal manager Arsene Wenger has described continued criticism of his side as "very, very, very, very boring" and
John Giles says Arsenal are going nowhere with Mezut Özil in their team, describing the midfielder's effort against
John Giles, Liam Brady and Eamon Dunphy analyse Manchester United's 2-1 win over Wolfsburg in the UEFA Champions Le
Watch the highlights of Manchester United's 2-1 win over Wolfsburg in the UEFA Champions League at Old Trafford. (R
Highlights of the six games across the UEFA Champions League on Wednesday night, excluding Manchester United and Ma
Juan Mata pulled off an audacious flick to allow Chris Smalling give Man United the lead in their UEFA Champions Le
Highlights from Tuesday night's games around the UEFA Champions League as Arsenal fell to a second European defeat
Watch Roma's Alessandro Florizzi score a spectacular goal from way out on the sideline to embarrass Barcelona goalk


text: Open and delivering 365 days a year, our staff is always standing by, ready to help you with your gift to Donner Lake, California. Place your Donner Lake, California order with confidence quickly, safely and easily. Our checkout process is a breeze! Every order is handled with care Donner Lake CA Flower Delivery Express® to ensure the highest quality and best service. The end result is a beautiful gift delivered when you want it in Donner Lake, California. In some areas, Donner Lake CA Flower Delivery Express® uses their extensive network of preferred local florists to provide the highest quality products and ensure timely delivery.


text:
Science Friday® is produced by the Science Friday Initiative, a 501(c)(3) nonprofit organization.
Science Friday® and SciFri® are registered service marks of Science Friday, Inc. Site design by Pentagram; engineering by Mediapolis.
A tiny invasive beetle is on the march. It's moving into Pennsylvania, which is bad for baseball. Most ash baseball bats come from wood grown in the state. Sven-Erik Spichiger, an entomologist for the Pennsylvania Department of Agriculture, is tracking the bug.


text:
LCD BacPac (out-of-stock)
Out of Stock Product Number: 31941
The LCD BacPac is a detachable LCD screen for HD HERO & HD HERO2 cameras. As a removable accessory, the LCD BacPac keeps your camera as small and light as possible, yet provides the convenience of an LCD screen when attached.
* This product does not qualify for shipping to all countries.
- Enhanced Convenience
- Framing complex scenes; see what you are shooting
- Playback video and photos directly on your HD HERO camera
- Use your HD HERO camera as a powerful everyday camera
- LCD BacPac Attaches to 1080p HD HERO cameras featuring the rear HERO Port
- LCD BacPac Features Simple one button design allows for easy on/off and playback control
- LCD BacPac Features Normal speed, fast forward, and fast reverse video and photo playback
- LCD BacPac Features Integrated speaker with volume controlFits current HD HERO & HD Wrist housings when used with included LCD backdoors.&What's Included:1 LCD BacPac screen,1 Waterproof LCD backdoor for HD HERO housing,1 Waterproof LCD backdoor for HD Wrist housing,1 Non-waterproof LCD Skeleton backdoor for HD HERO housing,1 Non-waterproof LCD Skeleton backdoor for HD Wrist housing&1 Year Warranty& NOTE: Original HD HERO owners may require a firmware upgrade. To determine what camera you have, click here. NOT compatible with the HD HERO 960 camera.
Gender: Unisex
Season: F12
Vendor ProductId: ALCDB-001
Review ProductId: 31941


text:
What is the base of your irrigation system?
Order within 0hrs 0mins for same-day shipping!
*Not available with backorder/drop-ship items. See Shipping Policy
Galcon's 6000 S are the ultimate user-friendly, irrigation system for municipalities and landscapers. The 6000 product range is suitable for irrigating lawns, public gardens, traffic islands, etc.


text:
Escape to the white sands and clear waters of Grand Cayman with this 4-star resort, and save 65% on peak season rates. This property -- located on the renowned Seven Mile Beach -- cuts rates on four night stays as low as $175-$191 per night.
The deal from The Westin Grand Cayman Seven Mile Beach Resort & Spa, which also includes a $75 resort credit, is available over the following dates:
Upgraded room types are also discounted.
The resort recently underwent a multimillion dollar renovation that includes upgrades to guest rooms as well as public spaces and the fitness center and pool. It boasts the largest freshwater pool on the island, and is across from Governor's Reef -- a popular scuba and snorkeling destination.
This deal is not available on: July 7-11.
Note: A 4-Night minimum length of stay is required for this deal.
Please go to your email and confirm your subscription.


text:
We're sorry, we didn't find items that match your search. Please try again.
If you would like our assistance, please feel free to contact us at our toll free number 888-455-2940 or send us an e-mail
Thank you for shopping at Fabric.com.
Description: Designed by Anna Maria Horner for Free Spirit Fabrics, this ultra soft velveteen fabric is perfect for skirts, dresses, jackets and fashion accessories or home décor such as light upholstery, pillow covers and draperies. Colors include brown, lime and light ...
go to product
Explore Fabric.com
We're here to help
Discover Fabric.com
Sewing Center
Give the gift of creativity.
A Fabric.com gift certificate is the perfect gift! Gifts from $10 and up.
#MadeWithFabric #SewInLove


text:
I have a web site where the user can navigate to an offsite URL, but I need to apply "http://mysite.com/?url=" to the start of every URL in the target page's source (images, links, forms, etc). I'm assuming the best way to do this is using regular expressions, but I haven't the slightest idea as to what pattern I should use.
The alternative would be to use the standard string manipulation functions to do the trick, but I'd imagine that to be several more lines of code and hold a longer execution time. Any hints?


text:
What is the Frugal Event Calendar?
The Frugal Event Calendar is a calendar of frugal events in the Indiana area, including nationwide events, consisting of workshops, classes, festivals, consignments sales, and more.
Go to the Main Calendar.
- This event has passed.
Wacky Wednesday Storytime (Noblesville)
October 31, 2012 @ 11:00 AM - 12:00 PM| FREE
Event Navigation
Please join us for Storytime at Barnes & Noble.
Add a Frugal Event
Know of a great frugal event going on in the Indiana area? You can now add your frugal events to the the Frugal Event Calendar easily.
Need help? Read How to Add Events.


text:
Photographic Process 4.0: The Woodburytype
In part 4.0 of our photo process series we're looking at the Woodburytype. We're exploring the invention of the process and talking with our curators and historians, who help us put these processes into historical and cultural contexts.
The Woodyburytype process was invented in 1864 by Walter Woodbury – a photo mechanical process that combines photography and the press producing a continuous tone image.
Up next The Platinum Print, and The Gelatin Silver Print.


text:
Hunt & Hunt has helped the Export Council of Australia (ECA) to develop the "FTA Tool", a website for Australian exporters that simplifies the use of the 10 Free Trade Agreements (FTAs) signed between Australia and other nations.
The new FTA Tool is designed to help Australian exporters navigate the basics of Australia's FTAs quickly and easily, increasing utilisation of FTAs.
We are also proud to be supporting the Premier's NSW Export Awards and encourage all NSW business engaged in international business to apply and be recognised for your export success.


text:
Naturally, many of the finalists are daydreaming about how they would spend the cash. Jenene Nagy, known for her ambitious sculptural installations, would love to take "a long trip for two someplace warm and sexy like Bora Bora," although she concedes that if she did win the money, she'd probably just pay off debt and take business trips to promote her art career. Arnold Kemp, whose paintings on paper made a big splash last year at PDX Contemporary, would like to buy some property, see the Venice Biennale this summer, or help out a fellow struggling artist. Multi-talented mixed-media artist Sean Healy would hire an assistant for his artwork or use the money to pay for his wedding next year. Jaq Chartier, whose pseudoscientific stain-based paintings are shown at Elizabeth Leach, would love to travel to Berlin, London or Japan, "but more likely I'd just hoard it like a miser to buy more time in the studio." Narrative photographer Holly Andres would buy new photography gear and travel across the country with friends, while photorealist painter Sherrie Wolf would make a pilgrimage to see the Prado Museum in Madrid, the Rijksmuseum in Amsterdam, and others across Europe. Anna Fidler, known for her trippy mixed-media collages, wants to sock the money away into a college fund for the baby she's expecting in March. And while abstract painter G. Lewis Clevenger yearns to visit Argentina and Brazil, he says that "realistically, my conservative side tells me to put enough aside to cover studio expenses for a year and supplement my health insurance."
Whatever their pipe
dreams and practical realities, we wish the finalists good luck and
congratulate Laing-Malcolmson on her diverse and thoughtful selection.
See this space for more information about the CNWAA as the summer grows
Contemporary Northwest Art Award 2011 finalists: Holly Andres, Chris Antemann, John Buck, Jaq Chartier, Glenn L. Clevenger, James Coupe, Tannaz Farsi, Anna Fidler, Justin Gibbons, Charles Gill, John Grade, Robert Hanson, Sean Healy, Jerry Iverson, Arnold Kemp, Scott Kolbo, Cynthia Lahti, Isaac Layman, Lead Pencil Studio (Annie Han and Daniel Mihalyo), Susie Lee, Megan Murphy, Jenene Nagy, Ryan Pierce, Michelle Ross, Heidi Schwegler, Susan Seubert, Eric Stotik and Sherrie Wolf.


text:
Item # 110636_SALE
Fit Squad Jacket
$98.00 $39.99
Product Actions
Additional InformationProduct Details
Warming up never looked so stylishly sporty! Our Fit Squad Jacket is a spruced-up hoodie you're going to love. Soft, woven Tencel back and brushed knit terry front combine to give this jacket a unique look. Plus, our jacket has a rib waistband and cuffs, plus double welt woven pockets.
Fabric & Care
- 54% TENCEL® lyocell 41% spandexbrushed terry knit/60% cotton/40% polyester
- Machine wash cold, with like colors
- Tumble dry low
- Imported


text:
- Northern New York Newspapers
- Watertown
- Ogdensburg
- Massena-Potsdam
- Lowville
- Carthage
- Malone
- NNY Business
- NNY Living
- NNY Ads
When offered the opportunity to once again coach at the collegiate level in baseball, it didnt take Paul Alteri long to make up his mind.
Alteri, a Watertown native and longtime area coach in baseball and football, pondered the offer for barely a couple days before making the decision to return to coaching on the diamond.
This is something Ive been itching to do again for a while now, said Alteri after being named Tuesday as the new manager for the Watertown Rams of the Perfect Game Collegiate Baseball League.
When (Rams co-owner and general manager) Todd Kirkey called me just last week and said would you consider coaching? I said yes, Im interested almost right away, Alteri said. So it was just perfect timing, and Im ready to get back into it.
Alteri returns to coach for the summer collegiate league team after he managed the Rams, known then as the Watertown Wizards, from 2001-03.
Ive been ready for something like this for the last year, and Ive seriously been considering getting back into coaching, said Alteri, a former head baseball coach at Jefferson Community College, who teaches criminal justice at the school. So when this came up, I jumped on it.
Kirkey actively sought out Alteri, hoping he would return to the franchise and got his wish.
The Cape Cod League does a nice job of getting solid local guys to coach that have the knowledge to do it, said Kirkey, referring to the most well-known summer collegiate baseball league. This provides teams with stability. Paul is the type of person who we hope will do this for a while for us. Weve turned over coaches more than the other teams in our league the last couple years, and I think thats been a bit of a problem.
Alteri left the Wizards so he could spend more time with his son, Santino, who went on to star at Immaculate Heart Central in baseball and football and won a gold medal with Team USA in the United States Specialty Sports Association Under-18 World Baseball Invitational in July 2011 on a team coached by Paul.
With Santino now a freshman in college at Mount Olive in North Carolina, where hell play baseball at the Division II level, Alteri believes that now he has the time to return to the coaching ranks.
I feel pretty good about the decision, especially with the support of my family, said Alteri, who coached baseball at JCC for 13 years through 2009. Im looking forward to it and Im ready to go.
Alteri coached the Wizards when the team was a member of the New York Collegiate Baseball League. With the teams name recently changed to Rams, Watertown will compete for the third season in the PGCBL.
Ive been to some games the last few years and I think the quality has increased greatly, Alteri said. The league is more organized and more professionally run ... I see this as a much better organization then the league they had 10 years ago. The players are better, the quality of the game is better and I like the game plan the Watertown management has. I think theyre doing things the right way and Im glad to be part of it.
The Watertown franchise hasnt made the playoffs since 2007 as a member of the NYCBL, something Kirkey hopes Alteri can help improve on this season.
Any time we can bring good local people into our organization, thats a winning situation for us, Kirkey said. And theres not a lot of guys around here who have the experience of coaching that caliber of players ... so I think were fortunate that Paul has that good experience and hell be a good fit for us.
Alteri replaces Nathan Kafka, who led the then Wizards to an 18-27 record and a ninth-place finish in the PGCBL last season in his only year with the club.
Thousands of readers like you have made Northern New York Newspapers the number one ranked website* for local news and sports coverage in the north country.
You can continue on to this article in a few seconds, or you can visit one of our websites:


text:
Receive alerts from our resorts.
Receive snow alerts, and check out quickly and easily.
If you own a PEAKS card or Season Pass, you're already in our system.
Please wait a moment while we load your cart.
There was an error with your request.Please refresh the page and try again.curr =vail
You have no items in your cart.
Please select a product.
Last updated 0 hours ago
Mostly Clear
Partly Cloudy
Mostly Cloudy
Express Lift Coffee House - just steps away from Gondola One in Vail Village. Serving breakfast, lunch and apres!
Cuisine Type:
Vail Village
Before you hop on Gondola One to start your day, stop by the Express Lift in Mountain Plaza to grab a breakfast sandwich, muffin, danish, croissant, fruit bread or bagel, as well as Starbuck's coffee, espresso, cappuccino or latte! For lunch, we have brats, hot dogs, paninis, soup and chili. Be sure and come to Express Lift for après to cozy up around the fireplace or sit on the outdoor patio and watch skiers and riders try to brave the black faces of Pepi's and Head First. This is an excellent place to unwind at the end of day. We have a wide variety of import, Colorado micro and domestic beers, as well as wine and several hand-crafted cocktails. Open winter only.
To get the best possible experience using our websites we recommend that you upgrade to a newer browser. A list of the most popular web browsers can be found below.
Click on an icon to go to the download page.


text:
PBS Documentary & Book
The Wisdom Through Adversity researchers based at the University of Virginia are studying individuals who suffer from chronic pain and physicians who have been involved in a serious medical error, in an effort to understand the path through adversity to wisdom. These groups represent highly challenging yet very different circumstances.
Please explore the results of our work through the resources here. They offer sources of inspiration for anyone facing their own difficult journey and for those who seek to aid them along the way.
Choosing Wisdom: The Path Through Adversity, a documentary exploring the themes of our work, premiered on National Public Television in 2012.
Please check a station near you for dates and times. You can see a few clips from the film here.
The film highlights just a few of the individuals we discovered who found creative, meaningful and wise ways to move through their most difficult struggles. We hope to show that ordinary people in difficult circumstances can respond to adversity in a way that leaves the world a better place. By showing people who have struggled, we hope to soften the world, creating in viewers a more compassionate and less judgmental view of themselves and others. We also hope to foster curiosity about wisdom and, ultimately, to assure viewers (like you) that, if faced with adversity, you too can survive and even flourish. Positive growth is accessible to everyone.
Choosing Wisdom: Strategies and Inspiration for Growing Through Life-Changing Difficulties
Plews-Ogan M, Owens JE, May N. Templeton Press, 2012.
Available at online booksellers.
To be Featured at the 2013 Virginia Festival of the Book
March 21, 2013 - 6:00 PM
"A must-read for medical professionals, patients, and anyone
interested in cultivating their own self-awareness and appreciation of
our deep connections to the sufferings and joys of our fellow human


text:
Waylen Jacket (Men's) (out-of-stock)
Out of Stock Product Number: 30898
The puffy men's prAna Waylen is lightweight but heavily insulated, keeping you cozy as a fireside mug of hot chocolate on even the coldest day. A sherpa lined collar leaves no comfort neglected, while a DWR coating adds performance benefits.
* This product does not qualify for shipping to all countries.
- Contrast corduroy front yoke, back yoke and front welt pockets
- Sherpa lining along inside collar
- 100 gram insulation
- DWR coating
- Standard Fit
Gender: Men's
Material: 100% Polyester WATER REPELLENT
Fit: Standard fit
Season: F12
Vendor ProductId: M2WAYL312
Review ProductId: 30898


text:
You are hereHome ›
Narrow Search
Now showing results 1-10 of 69
This project engages students in the science and engineering processes used by NASA Astrobiologists as they explore our Solar System and try to answer the compelling question, "Are we Alone?" Students will identify science mission goals and select... (View More) an astrobiologically significant target of interest: Mars, Europa, Enceladus or Titan. Students will then design their mission to this target in search of their chosen biosignature(s). Students will encounter the same considerations and challenges facing NASA scientists and engineers as they search for life in our Solar System. Students will need to balance the return of their science data with engineering limitations such as power, mass and budget. Risk factors play a role and will add to the excitement in this interactive science and engineering activity. Astrobiobound! will help students see how science and systems engineering are integrated to achieve a focused scientific goal. Includes an alignment document for NGSS and Common Core State Standards. (View Less)
This series of laboratory lessons and activities uses authentic solar imagery and data to introduce students to solar science. Students are asked to explore details in imagery, including how to deal with the issues of noise and resolution, and... (View More) understand scale. They are introduced to the concept of space weather and how that affects both observing instruments and the Earth. Students learn about spectra, how helium and coronium were discovered, and go on to explore real spectra from the Sun. Most activities are mathematically based, and targeted for grades 9-10. Imagery is included from NASA/ESA's SOHO mission, NASA's SDO mission, and Japan's Hinode satellite. (View Less)
Materials Cost: Free
This is an activity about planning a planetary mission. Learners will play a card game to design a mission to Mars. This game will allow them to experience the fundamentals of the engineering design process as they use collaboration and... (View More) problem-solving skills to develop a mission that meets constraints (budget, mass, power) and criteria (significant science return). This activity can introduce many activities in technology education, including robotics and rocketry. The lesson models scientific inquiry using the 5E instructional model and includes teacher notes, vocabulary, student journal and reading. (View Less)
Materials Cost: Free
This activity is about planetary rovers. Learners will simulate the challenges in communications that engineers face when driving a rover on Mars. They will particpate as part of a rover team to design and execute a series of commands that will... (View More) guide a rover made of people through an obstacle course simulating the Martian surface. Students will learn the limitations of operating a planetary rover and problem solving solutions by using this simulation. The lesson models the engineering design process using the 5E instructional model and includes teacher notes, vocabulary, student journal and reading. (View Less)
Using three images from the Wide-field Infrared Survey Explorer (WISE) mission, students measure and analyze infrared light from objects to identify Brown Dwarfs and Ultra-Luminous Infrared Galaxies (ULIRGs). The lesson includes a teacher's guide,... (View More) student worksheet and PowerPoint presentation (which contains the three images to be analyzed). (View Less)
Materials Cost: Free
This program uses NASA data and resources to promote authentic classroom research experiences. These two complementary guides lead students through the process of conducting their own inquiry-based research on an Earth-focused topic. In their... (View More) guidebook, students read content and answer questions about each step in the research process- from formulating a question to sharing results. The separate guide for teachers provides explicit instructions, lists the standards addressed, and includes additional hints, resources and websites. (View Less)
This is a lesson about generating hypotheses and testable questions. Learners will use critical thinking and a collaborative approach to pose questions related to the study of Mars and evaluate the quality of their questions. They will explore... (View More) remote-sensing data collected by a camera orbiting Mars - the Thermal Emission Imaging System (THEMIS) and develop a team science question. Students will practice critical thinking skills, use a collaborative approach to this first critical step of the scientific process. Exploring the images of the surface of Mars in Visible (VIS) images, students will come up with a topic of study, their team science question and hypotheses. The lesson models scientific inquiry using the 5E instructional model and includes teacher notes and vocabulary. (View Less)
Learners will take and then compare the images taken by a camera - to learn about focal length (and its effects on field of view), resolution, and ultimately how cameras take close-up pictures of far away objects. Finally, they will apply this... (View More) knowledge to the images of comet Tempel 1 taken by two different spacecraft with three different cameras, in this case Deep Impact and those expected/obtained from Stardust-NExT. This lesson could easily be adapted for use with other NASA missions. (View Less)
This is a lesson about using evidence to construct sequences of geologic events. Learners will interpret real NASA science data to identify features on the surface of Mars, determine the surface history of the area, calculate the size of features,... (View More) and develope investigable questions. Students will study images taken by NASA's Mars Thermal Emission Imaging System (THEMIS) camera orbiting Mars. Students will use the THEMIS images to analyze the surface features and geological history of Mars. The lesson models scientific inquiry using the 5E instructional model and includes teacher notes and vocabulary. (View Less)
This is a lesson about using light to identify the composition of an object. Learners will use a spectrograph to gather data about light sources. Using the data they've collected, students are able to make comparisons between different light... (View More) sources and make conjectures about the composition of a mystery light source. The activity is part of Project Spectra, a science and engineering program for middle-high school students, focusing on how light is used to explore the Solar System. (View Less)


text:
John L. Grove College of BusinessShippensburg University1871 Old Main DriveGrove 124Shippensburg, PA 17257-2299
Contact Form
The new federal government's recruiting tools now falls
under a program called Pathways Programs, which Office of Personnel Management
kicked off in May 2012. These programs
include the Pathways Internship Program, which is designed for current
students, and Pathways Recent Graduates Program, which is designed for
individuals who are soon to graduate or have graduated within the past 2 years
(or 6 years for veterans).
Both Internship and Recent Graduates programs require all
positions to be posted on USAJOBs.
We recommend students and alumni become familiar with
this website, and create an account and search agent. The search agent can be established to e-mail
them notification whenever Internship or Recent Graduates jobs become
available, so they do not miss a chance to apply.
Below are links to documents/websites that will assist candidates with this
This page is an official publication of Shippensburg University: A member of the Pennsylvania State System of Higher Education.
Shippensburg University - 1871 Old Main Drive - Shippensburg, PA 17257 - (717) 477-7447
Ask a Question/Provide Feedback | Right-to-Know Policy | Privacy Statement | View on Mobile


text:
Log in here to view your account.
KOA stands out from our competitors in many ways.
Stay in these unique lodgings and enjoy a truly one-of-a-kind camping experience.
Get camping related news, tips, recipes and more right at your fingertips.
412 24th Street
Alamogordo, NM 88310
Reserve: 800-562-3452
Info: 575-437-3003
We are on the Northside of Alamogordo (in town) on 24th Street, 1-1/2 blocks East of White Sands Blvd (Hwy 54/70) Look for the KOA sign. (Do not take the relief route.)
Purchase your one year membership now for only $27.
Send a KOA Gift Card or check out what special deals our Partners have cooked up especially for you.
Get camping related news, tips, recipes and more delivered right to your inbox each month.