Patent Publication Number: US-11033191-B2

Title: Medical device including manipulable portion with connected elongate members

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of prior U.S. patent application Ser. No. 16/258,996, filed Jan. 28, 2019, now U.S. Pat. No. 10,716,477, issued Jul. 21, 2020, which is a continuation of prior U.S. patent application Ser. No. 15/978,609, filed May 14, 2018, now U.S. Pat. No. 10,278,590, issued May 7, 2019, which is a continuation of prior U.S. patent application Ser. No. 14/579,234, filed Dec. 22, 2014, now U.S. Pat. No. 9,993,160, issued Jun. 12, 2018, which claims priority benefit of U.S. Provisional Application No. 61/924,525, filed Jan. 7, 2014. The entire disclosure of the applications cited in this paragraph is hereby incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     Aspects of this disclosure generally are related to a medical device system including a manipulable portion that includes connected elongate members. In some embodiments, a structure of the manipulable portion includes the elongate members, and the structure is selectively movable between a delivery configuration and an expanded or deployed configuration. 
     BACKGROUND 
     Cardiac surgery was initially undertaken using highly invasive open procedures. A sternotomy, which is a type of incision in the center of the chest that separates the sternum, was typically employed to allow access to the heart. In the past several decades, more and more cardiac operations are performed using intravascular or percutaneous techniques, where access to inner organs or other tissue is gained via a catheter. 
     Intravascular or percutaneous surgeries benefit patients by reducing surgery risk, complications and recovery time. However, the use of intravascular or percutaneous technologies also raises some particular challenges. Medical devices used in intravascular or percutaneous surgery need to be deployed via catheter systems which significantly increase the complexity of the device structure. Accordingly, a need in the art exists for improved intravascular or percutaneously deployed catheter systems. 
     SUMMARY 
     At least the above-discussed need is addressed and technical solutions are achieved by various embodiments of the present invention. In some embodiments, a medical system includes a shaft member and a structure. The shaft member may include a portion sized to be delivered through a bodily opening leading to a bodily cavity. The structure may be physically coupled to the shaft member. The structure may include a plurality of elongate members. Each elongate member of the plurality of elongate members may include a proximal end, a distal end, and a respective intermediate portion positioned between the respective proximal end and the respective distal end. The structure may be selectively moveable between a delivery configuration in which the structure is suitably sized to be delivered through the bodily opening to the bodily cavity, and an expanded configuration in which the structure has a size too large to be delivered through the bodily opening to the bodily cavity. The respective intermediate portions of at least two of the plurality of elongate members may be angularly spaced with respect to one another about an axis when the structure is in the expanded configuration. The structure may include at least two flexible couplings. Each flexible coupling may extend transversely (e.g., in a direction having a directional component extending transversely) from the intermediate portion of a respective one of the at least two of the plurality of elongate members. Each location on the intermediate portion from which the flexible coupling extends transversely may be spaced from each of the proximal and distal ends of the respective one of the at least two of the plurality of elongate members. The flexible coupling extending transversely from the intermediate portion of at least a first one of the at least two of the plurality of elongate members may form at least a part of a first closed loop arranged to receive a portion of the flexible coupling of a second one of the at least two of the plurality of elongate members therethrough to limit a spacing between the intermediate portions of the first and the second ones of the at least two of the plurality of elongate members to not exceed a defined amount when the structure is in the expanded configuration. 
     In some embodiments, the flexible coupling extending transversely from the intermediate portion of the second one of the at least two of the plurality of elongate members forms at least part of a second closed loop. In some embodiments, no portion of the flexible coupling extending transversely from the intermediate portion of the first one of the at least two of the plurality of elongate members is received through the second loop at least when the spacing between the respective locations of the first and the second ones of the at least two of the plurality of elongate members is sized by the defined amount. In some embodiments, no portion of the flexible coupling extending transversely from the intermediate portion of the first one of the at least two of the plurality of elongate members is received through the second loop when the flexible coupling extending transversely from the intermediate portion of the first one of the at least two of the plurality of elongate members is tensioned. In some embodiments, each of the first and the second closed loops extends along a respective continuous closed path, each respective continuous closed path not encircling the other respective continuous closed path. In some embodiments, the continuous closed path of the first closed loop does not pass through the continuous closed path of the second closed loop. In some embodiments, the continuous closed path of the second closed loop does pass through the continuous closed path of the first closed loop. 
     In some embodiments, at least another part of the first closed loop is formed by at least a part of the intermediate portion of the first one of the at least two of the plurality of elongate members. 
     In some embodiments, the flexible coupling extending transversely from the intermediate portion of the first one of the at least two of the plurality of elongate members includes a first end portion, a second end portion, and an elongate portion extending between the first end portion and the second end portion, at least one of the first end portion and the second end portion physically coupled to the intermediate portion of the first one of the at least two of the plurality of elongate members. In some embodiments, the intermediate portion of the first one of the at least two of the plurality of elongate members includes a plurality of material layers and each of the at least one of the first end portion and the second end portion is physically coupled to the intermediate portion of the first one of the at least two of the plurality of elongate members at a location between a respective pair of adjacent ones of the plurality of material layers. 
     In some embodiments, the flexible coupling extending transversely from the intermediate portion of the first one of the at least two of the plurality of elongate members includes a first end portion, a second end portion, and an elongate portion extending between the first end portion and the second end portion, each of the first end portion and the second end portion physically coupled to the intermediate portion of the first one of the at least two of the plurality of elongate members. 
     In some embodiments, the intermediate portion of at least the second one of the at least two of the plurality of elongate members includes a thickness, a first side, a second side, and an aperture extending across the thickness from the first side to the second side, the first closed loop arranged to extend through the aperture in the intermediate portion of the second one of the at least two of the plurality of elongate members. 
     In some embodiments, the intermediate portion of at least the second one of the at least two of the plurality of elongate members comprises a thickness, a first side, a second side, and an aperture extending across the thickness from the first side to the second side, and wherein the first closed loop extends along a path from the intermediate portion of the first one of the at least two of the plurality of elongate members through the aperture from the second side to the first side of the intermediate portion of the second one of the at least two of the plurality of elongate members to a location where the portion of the flexible coupling of the second one of the at least two of the plurality of elongate members is arranged to extend through the first closed loop. The second side may face inwardly toward the axis when the structure is in the expanded configuration and the first side may face outwardly away from the axis when the structure is in the expanded configuration. 
     In some embodiments, the intermediate portion of at least the second one of the at least two of the plurality of elongate members includes a thickness, a first side, a second side, and an aperture extending across the thickness from the first side to the second side, and wherein the first closed loop is arranged to extend through the aperture from the second side to the first side of the intermediate portion of the second one of the at least two of the plurality of elongate members, and wherein the aperture is sized to restrict movement of the first closed loop through the aperture from the first side toward the second side of the intermediate portion of the second one of the at least two of the plurality of elongate members when the portion of the flexible coupling of the second one of the at least two of the plurality of elongate members extends through the first closed loop. In some embodiments, the medical system may include one or more transducers located on the first side of the intermediate portion of the second one of the at least two of the plurality of elongate members. 
     In some embodiments, the medical system includes one or more transducers located on the structure. In some embodiments, the medical system includes one or more transducers located on each of at least one of the at least two of the plurality of elongate members. 
     Various systems may include combinations and subsets of all the systems summarized above. 
     In some embodiments, some or all of any of the systems or devices summarized above or otherwise described herein, or one or more combinations thereof, may be controlled by one or more control methods for executing some or all of the functionality of such systems or devices summarized above or otherwise described herein. In some embodiments, a computer program product may be provided that includes program code portions for performing some or all of any of such control methods, when the computer program product is executed by a computing device. The computer program product may be stored on one or more computer-readable storage mediums. In some embodiments, each of the one or more computer-readable storage mediums is a non-transitory computer-readable storage medium. In some embodiments, such control methods are implemented or executed in part or in whole by at least one data processing device or system upon configuration thereof by one or more programs executable by the at least one data processing device or system and stored in one or more computer-readable storage mediums. In some embodiments, each of the one or more computer-readable storage mediums is a non-transitory computer-readable storage medium. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       It is to be understood that the attached drawings are for purposes of illustrating aspects of various embodiments and may include elements that are not to scale. 
         FIG. 1  is a schematic representation of a system according to example embodiments, system including a data processing device system, an input-output device system, and a memory device system. 
         FIG. 2  is a cutaway diagram of a heart showing a manipulable portion percutaneously placed in a left atrium of a heart according to example embodiments. 
         FIG. 3A  is a partially schematic representation of a medical device system according to example embodiments, the medical device system including a data processing device system, an input-output device system, a memory device system, and a manipulable portion having a plurality of transducers and an expandable structure shown in a delivery or unexpanded configuration. 
         FIG. 3B  is the medical device system of  FIG. 3A  with the expandable structure shown in a deployed or expanded configuration, according to example embodiments. 
         FIG. 4  is a schematic representation of a transducer-based device that includes a flexible circuit structure according to example embodiments. 
         FIGS. 5A, 5B, 5C, 5D, 5E, 5F, 5G, 5H-1, and 5H-2  illustrate apparatus for, among other things, connecting the elongate members of a manipulable portion, such as that shown in  FIGS. 2, 3A, and 3B , which may limit spacing between elongate members according to example embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     In the following description, certain specific details are set forth in order to provide a thorough understanding of various embodiments of the invention. However, one skilled in the art will understand that the invention may be practiced without one or more of these details. In some instances, well-known structures have not been shown or described in detail to avoid unnecessarily obscuring descriptions of various embodiments of the invention. 
     Reference throughout this specification to “one embodiment” or “an embodiment” or “an example embodiment” or “an illustrated embodiment” or “a particular embodiment” and the like means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, the appearances of the phrases “in one embodiment” or “in an embodiment” or “in an example embodiment” or “in this illustrated embodiment” or “in this particular embodiment” and the like in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures or characteristics of different embodiments may be combined in any suitable manner to form one or more other embodiments. 
     Unless otherwise explicitly noted or required by context, the word “or” is used in this disclosure in a non-exclusive sense. In addition, unless otherwise explicitly noted or required by context, the word “set” is intended to mean one or more, and the word “subset” is intended to mean a set having the same or fewer elements of those present in the subset&#39;s parent or superset. 
     Further, the phrase “at least” is used herein merely to emphasize the possibility that other elements may exist besides those explicitly listed. However, unless otherwise explicitly noted (such as by the use of the term “only”) or required by context, non-usage herein of the phrase “at least” nonetheless includes the possibility that other elements may exist besides those explicitly listed. For example, the phrase ‘based at least upon A’ includes A as well as the possibility of one or more other additional elements or functions besides A. In the same manner, the phrase, ‘based upon A’ includes A, as well as the possibility of one or more other additional elements or functions besides A. However, the phrase, ‘based only upon A’ includes only A. For another similar example, each of the phrases ‘configured at least to A’ and ‘configured to at least A’ includes a configuration to perform A, as well as the possibility of one or more other additional actions besides A. In the same manner, the phrase ‘configured to A’ includes a configuration to perform A, as well as the possibility of one or more other additional actions besides A. However, the phrase ‘configured only to A’, for example, means a configuration to perform only A. 
     The word “ablation” as used in this disclosure should be understood to include, for example, any disruption to certain properties of tissue. Most commonly, the disruption is to the electrical conductivity and is achieved by heating, which can be generated with resistive or radio-frequency (RF) techniques for example. However, any other technique for such disruption may be included when the term “ablation” is used, such as mechanical, chemical, or optical techniques. 
     The word “fluid” as used in this disclosure should be understood to include, for example, any fluid that can be contained within a bodily cavity or can flow into or out of, or both into and out of a bodily cavity via one or more bodily openings positioned in fluid communication with the bodily cavity. In the case of cardiac applications, fluid such as blood flows into and out of various intra-cardiac cavities (e.g., a left atrium or right atrium). 
     The phrase “bodily opening” as used in this disclosure should be understood to include, for example, a naturally occurring bodily opening or channel or lumen; a bodily opening or channel or lumen or perforation formed by an instrument or tool using techniques that can include, but are not limited to, mechanical, thermal, electrical, chemical, and exposure or illumination techniques; a bodily opening or channel or lumen formed by trauma to a body; or various combinations of one or more of the above. Various elements having respective openings, lumens or channels and positioned within the bodily opening (e.g., a catheter sheath or catheter introducer) may be present in various embodiments. These elements may provide a passageway through a bodily opening for various devices employed in various embodiments. 
     The phrase “bodily cavity” as used in this disclosure should be understood to mean a cavity in a body. The bodily cavity may be a cavity provided in a bodily organ (e.g., an intra-cardiac cavity or chamber of a heart). The bodily cavity may be provided by a bodily vessel. 
     The word “tissue” as used in some embodiments in this disclosure should be understood to include, for example, any surface-forming tissue that is used to form a surface of a body or a surface within a bodily cavity, a surface of an anatomical feature or a surface of a feature associated with a bodily opening positioned in fluid communication with the bodily cavity. The tissue can include, for example, part or all of a tissue wall or membrane that defines a surface of the bodily cavity. In this regard, the tissue can form an interior surface of the cavity that surrounds a fluid within the cavity. In the case of cardiac applications, tissue can include, for example, tissue used to form an interior surface of an intra-cardiac cavity such as a left atrium or right atrium. In some embodiments, tissue is non-excised tissue. In some embodiments, the word tissue can refer to a tissue having fluidic properties (e.g., blood). 
     The term “transducer” as used in this disclosure should be interpreted broadly as any device capable of distinguishing between fluid and tissue, sensing temperature, creating heat, ablating tissue, measuring electrical activity of a tissue surface, stimulating tissue, or any combination thereof. A transducer can convert input energy of one form into output energy of another form. Without limitation, a transducer can include, for example, an electrode that functions as, or as part of, a sensing device included in the transducer, an energy delivery device included in the transducer, or both a sensing device and an energy delivery device included in the transducer. A transducer may be constructed from several parts, which may be discrete components or may be integrally formed. 
     The term “program” in this disclosure should be interpreted as a set of instructions or modules that can be executed by one or more components in a system, such as a controller system or data processing device system, in order to cause the system to perform one or more operations. The set of instructions or modules can be stored by any kind of memory device, such as those described subsequently with respect to the memory device system  130  shown in  FIG. 1 . In addition, instructions or modules of a program may be described as being configured to cause the performance of a function or action. 
     The phrase “configured to” in this context is intended to include, for example, at least (a) instructions or modules that are presently in a form executable by one or more data processing devices to cause performance of the function (e.g., in the case where the instructions or modules are in a compiled and unencrypted form ready for execution), and (b) instructions or modules that are presently in a form not executable by the one or more data processing devices, but could be translated into the form executable by the one or more data processing devices to cause performance of the function (e.g., in the case where the instructions or modules are encrypted in a non-executable manner, but through performance of a decryption process, would be translated into a form ready for execution). The word “module” can be defined as a set of instructions. 
     The word “device” and the phrase “device system” both are intended to include, for example, one or more physical devices or sub-devices (e.g., pieces of equipment) that interact to perform one or more functions, regardless of whether such devices or sub-devices are located within a same housing or different housings. In this regard, the word “device” may equivalently be referred to as a “device system”. 
     Further, the phrase “in response to” may be used in this disclosure. For example, this phrase might be used in the following context, where an event A occurs in response to the occurrence of an event B. In this regard, such phrase includes, for example, that at least the occurrence of the event B causes or triggers the event A. 
       FIG. 1  schematically illustrates a system  100 , according to some embodiments. The system  100  may be a medical system and may include a data processing device system  110 , an input-output device system  120 , and a processor-accessible memory device system  130 . The processor-accessible memory device system  130  and the input-output device system  120  are communicatively connected to the data processing device system  110 . 
     The data processing device system  110  includes one or more data processing devices that implement methods by controlling, driving, or otherwise interacting with various structural components described herein, including, but not limited to, one or more of the various structural components illustrated in  FIGS. 2, 3A, 3B, 4, and 5 . Each of the phrases “data processing device”, “data processor”, “processor”, and “computer” is intended to include any data processing device, such as a central processing unit (“CPU”), a desktop computer, a laptop computer, a mainframe computer, a tablet computer, a personal digital assistant, a cellular phone, and any other device for processing data, managing data, or handling data, whether implemented with electrical, magnetic, optical, biological components, or otherwise. 
     The memory device system  130  includes one or more processor-accessible memory devices configured to store information, including the information needed to execute various methods implemented by the data processing device system  110 . The memory device system  130  may be a distributed processor-accessible memory device system including multiple processor-accessible memory devices communicatively connected to the data processing device system  110  via a plurality of computers and/or devices. On the other hand, the memory device system  130  need not be a distributed processor-accessible memory system and, consequently, may include one or more processor-accessible memory devices located within a single housing or data processing device. 
     Each of the phrases “processor-accessible memory” and “processor-accessible memory device” is intended to include any processor-accessible data storage device, whether volatile or nonvolatile, electronic, magnetic, optical, or otherwise, including but not limited to, registers, floppy disks, hard disks, Compact Discs, DVDs, flash memories, ROMs, and RAMs. In some embodiments, each of the phrases “processor-accessible memory” and “processor-accessible memory device” is intended to include or be a processor-accessible (or computer-readable) data storage medium. In some embodiments, each of the phrases “processor-accessible memory” and “processor-accessible memory device” is intended to include or be a non-transitory processor-accessible (or computer-readable) data storage medium. In some embodiments, the memory device system  130  may be considered to include or be a non-transitory processor-accessible (or computer-readable) data storage medium system. 
     The phrase “communicatively connected” is intended to include any type of connection, whether wired or wireless, between devices, data processors, or programs in which data may be communicated. Further, the phrase “communicatively connected” is intended to include a connection between devices or programs within a single data processor, a connection between devices or programs located in different data processors, and a connection between devices not located in data processors at all. In this regard, although the memory device system  130  is shown separately from the data processing device system  110  and the input-output device system  120 , one skilled in the art will appreciate that the memory device system  130  may be located completely or partially within the data processing device system  110  or the input-output device system  120 . Further in this regard, although the input-output device system  120  is shown separately from the data processing device system  110  and the memory device system  130 , one skilled in the art will appreciate that such system may be located completely or partially within the data processing system  110  or the memory device system  130 , depending upon the contents of the input-output device system  120 . Further still, the data processing device system  110 , the input-output device system  120 , and the memory device system  130  may be located entirely within the same device or housing or may be separately located, but communicatively connected, among different devices or housings. In the case where the data processing device system  110 , the input-output device system  120 , and the memory device system  130  are located within the same device, the system  100  of  FIG. 1  can be implemented by a single application-specific integrated circuit (ASIC) in some embodiments. 
     The input-output device system  120  may include a mouse, a keyboard, a touch screen, a computer, a processor-accessible memory device, some or all of a catheter device system (e.g.,  FIGS. 2, 3A, 3B, 4, 5 ), or any device or combination of devices from which a desired selection, desired information, instructions, or any other data is input to the data processing device system  110 . The input-output device system  120  may include a user-activatable control system that is responsive to a user action. The input-output device system  120  may include any suitable interface for receiving a selection, information, instructions, or any other data from other devices or systems described in various ones of the embodiments. In this regard, the input-output device system  120  may include various ones or portions of other systems or devices described in various embodiments. 
     The input-output device system  120  also may include an image generating device system, a display device system, a processor-accessible memory device, some or all of a catheter device system (e.g.,  FIGS. 2, 3A, 3B, 4, 5 ), or any device or combination of devices to which information, instructions, or any other data is output by the data processing device system  110 . In this regard, if the input-output device system  120  includes a processor-accessible memory device, such memory device may or may not form part or all of the memory device system  130 . The input-output device system  120  may include any suitable interface for outputting information, instructions, or any other data to other devices or systems described in various ones of the embodiments. In this regard, the input-output device system  120  may include various other devices or systems described in various embodiments. 
     Various embodiments of catheter systems are described herein. It should be noted that any catheter system described herein may also be referred to as a medical system. Some of the described devices of such systems are medical devices that are percutaneously or intravascularly deployed. Some of the described devices are deployed through a bodily opening that is accessible without puncturing, cutting or otherwise perforating bodily tissue to create an access to the bodily opening. Some of the described devices employ transducer-based devices or device systems. Some of the described devices are moveable between a delivery or unexpanded configuration in which a portion of the device is sized, shaped, or both for passage through a bodily opening leading to a bodily cavity, and an expanded or deployed configuration in which the portion of the device has a size, shape, or both too large for passage through the bodily opening leading to the bodily cavity. An example of an expanded or deployed configuration is when the portion of the catheter system is in its intended-deployed-operational state inside the bodily cavity. Another example of the expanded or deployed configuration is when the portion of the catheter system is being changed from the delivery configuration to the intended-deployed-operational state to a point where the portion of the device now has a size, shape, or both too large for passage through the bodily opening leading to the bodily cavity. 
     In some example embodiments, the catheter system includes transducers that sense characteristics (e.g., convective cooling, permittivity, force) that distinguish between fluid, such as a fluidic tissue (e.g., blood), and tissue forming an interior surface of the bodily cavity. Such sensed characteristics can allow a medical device system to map the cavity, for example using positions of openings or ports into and out of the cavity to determine a position or orientation (i.e., pose), or both of the portion of the device in the bodily cavity. In some example embodiments, the described devices are capable of ablating tissue in a desired pattern within the bodily cavity. In some example embodiments, the devices are capable of sensing characteristics (e.g., electrophysiological activity) indicative of whether an ablation has been successful. In some example embodiments, the devices are capable of providing stimulation (e.g., electrical stimulation) to tissue within the bodily cavity. Electrical stimulation may include pacing.  FIG. 2  shows a medical system, according to some embodiments, which may be a portion of a catheter system, according to some embodiments, such portion including a transducer-based device  200 , which may be at least part of a medical device useful in investigating or treating a bodily organ, for example a heart  202 , according to some example embodiments. The transducer-based device  200  may also be referred to as a manipulable portion, due to its ability to have its size, shape, or both size and shape altered, according to some embodiments described below. Transducer-based device  200  can be percutaneously or intravascularly inserted into a portion of the heart  202 , such as an intra-cardiac cavity like left atrium  204 . 
     In the example of  FIG. 2 , the illustrated portion of the catheter system also includes a catheter  206 , which may be inserted via the inferior vena cava  208  and may penetrate through a bodily opening in transatrial septum  210  from right atrium  212 . In other embodiments, other paths may be taken. 
     Catheter  206  includes an elongated flexible rod or shaft member appropriately sized to be delivered percutaneously or intravascularly. Various portions of catheter  206  may be steerable. Catheter  206  may include one or more lumens. The lumen(s) may carry one or more communications or power paths, or both. For example, the lumens(s) may carry one or more electrical conductors  216  (two shown in this embodiment). Electrical conductors  216  provide electrical connections to transducer-based device  200  that are accessible externally from a patient in which the transducer-based device  200  is inserted. 
     In various embodiments, transducer-based device, or manipulable portion,  200  includes a frame or structure  218 , which assumes an unexpanded configuration for delivery to left atrium  204 . Structure  218  is expanded (i.e., shown in a deployed or expanded configuration in  FIG. 2 ) upon delivery to left atrium  204  to position a plurality of transducers  220  (three called out in  FIG. 2 ) proximate the interior surface formed by tissue  222  of left atrium  204 . In this regard, it can be stated that one or more of the transducers  220  are moveable with one or more parts of the transducer-based device, or manipulable portion,  200 . In some embodiments, at least some of the transducers  220  are used to sense a physical characteristic of a fluid (i.e., blood) or tissue  222 , or both, that may be used to determine a position or orientation (i.e., pose), or both, of a portion of transducer-based device  200  within, or with respect to left atrium  204 . For example, transducers  220  may be used to determine a location of pulmonary vein ostia (not shown) or a mitral valve  226 , or both. In some embodiments, at least some of the transducers  220  may be used to selectively ablate portions of the tissue  222 . For example, some of the transducers  220  may be used to ablate a pattern or path around various ones of the bodily openings, ports or pulmonary vein ostia, for instance to reduce or eliminate the occurrence of atrial fibrillation. 
       FIGS. 3A and 3B  show a medical system, according to some embodiments, which may include a catheter system (i.e., a portion thereof shown schematically) that includes a transducer-based device  300  according to some embodiments. The transducer-based device  300  may correspond to the transducer-based device  200  and, in this regard, may also be referred to as a manipulable portion, due to its ability to have its size, shape, or both size and shape altered, according to some embodiments described below. Transducer-based device  300  may include a plurality of elongate members  304  (three called out in each of  FIGS. 3A and 3B ) and a plurality of transducers  306  (only some called out in each of  FIGS. 3A and 3B , and some are indicated with a lowercase letter after the reference numeral  306 ). As will become apparent, the plurality of transducers  306  are positionable within a bodily cavity. For example, in some embodiments, the transducers  306  are able to be positioned in a bodily cavity by movement into, within, or into and within the bodily cavity, with or without a change in a particular configuration of the plurality of transducers  306 . In some embodiments, the plurality of transducers  306  are arrangeable to form a two- or three-dimensional distribution, grid or array of the transducers capable of mapping, ablating, or stimulating an inside surface of a bodily cavity or lumen without requiring mechanical scanning. As shown, for example, in  FIG. 3A , the plurality of transducers  306  are arranged in a distribution receivable in a bodily cavity, as the transducer-based device  300  and its plurality of transducers  306  are located within the catheter sheath  312 . Stated differently, in  FIG. 3A , for example, the plurality of transducers  306  are arranged in a distribution suitable for delivery to a bodily cavity. (It should also be noted, however, that the expanded or deployed configuration (e.g.,  FIGS. 2, 3B ) may also be considered to have the transducers  306  arranged in a distribution receivable in a bodily cavity, as the transducer-based device  300  and its transducers  306  may be returned to the delivery configuration of  FIG. 3A , for example.) In some embodiments, each of the transducers  306  includes an electrode  315  having an energy transmission surface  319  suitable for transmitting energy in various directions. (Some of the electrodes  315  are illustrated with a lowercase letter following the reference numeral  315 . Similarly, some of the energy transmission surfaces  319  are illustrated with a lowercase letter following the reference numeral  319 .) In some embodiments, tissue-ablating energy is transmitted toward or away from an electrode  315 . In some embodiments, tissue-based electrophysiological energy is transmitted toward an electrode  315 . 
     The elongate members  304  form part of a manipulable portion, and in various embodiments, are arranged in a frame or structure  308  that is selectively moveable between an unexpanded or delivery configuration (e.g., as shown in  FIG. 3A ) and an expanded or deployed configuration (e.g., as shown in  FIG. 3B ) that may be used to position portions of various ones of the elongate members  304  against a tissue surface within the bodily cavity or position portions of various ones of the elongate members  304  in the vicinity of or in contact with the tissue surface. In this regard, it may also be stated that the transducer-based device, or manipulable portion,  300  is selectively moveable between an unexpanded or delivery configuration (e.g., as shown in  FIG. 3A ) and an expanded or deployed configuration (e.g., as shown in  FIG. 3B ). In some embodiments, the transducer-based device, or manipulable portion,  300 , (e.g., the structure  308  thereof) has a size, shape, or both a size and a shape in the unexpanded or delivery configuration suitable for percutaneous delivery through a bodily opening (for example, via catheter sheath  312 , not shown in  FIG. 3B ) to the bodily cavity. In some embodiments, structure  308  has a size, shape, or both a size and a shape in the expanded or deployed configuration too large for percutaneous delivery through a bodily opening (i.e., via catheter sheath  312 ) to the bodily cavity. The elongate members  304  may form part of a flexible circuit structure (i.e., also known as a flexible printed circuit board (PCB) circuit). The elongate members  304  can include a plurality of different material layers. The structure  308  can include a shape memory material, for instance Nitinol. The structure  308  can include a metallic material, for instance stainless steel, or non-metallic material, for instance polyimide, or both a metallic and non-metallic material by way of non-limiting example. The incorporation of a specific material into structure  308  may be motivated by various factors including the specific requirements of each of the unexpanded or delivery configuration and expanded or deployed configuration, the required position or orientation (i.e., pose) or both of structure  308  in the bodily cavity, or the requirements for successful ablation of a desired pattern. The number of elongate members  304  depicted in  FIG. 3B  is non-limiting. 
       FIG. 4  is a schematic side elevation view of at least a portion of a transducer-based device  400  that includes a flexible circuit structure  401  that is employed to provide a plurality of transducers  406  (two called out) (which may correspond to transducers  306 ) according to some embodiments. The transducer-based device  400  may be all or a portion of a medical device, according to some embodiments. In some embodiments, the flexible circuit structure  401  may form part of a structure (e.g., structure  308 ) that is selectively moveable between a delivery configuration sized for percutaneous delivery and an expanded or deployed configuration sized too large for percutaneous delivery. In some embodiments, the flexible circuit structure  401  may be located on, or form at least part of, of a structural component (e.g., elongate member  304 ) of a transducer-based device system. 
     The flexible circuit structure  401  can be formed by various techniques including flexible printed circuit techniques. In some embodiments, the flexible circuit structure  401  includes various layers including flexible layers  403   a ,  403   b  and  403   c  (i.e., collectively flexible layers  403 ). In some embodiments, each of flexible layers  403  includes an electrical insulator material (e.g., polyimide). One or more of the flexible layers  403  can include a different material than another of the flexible layers  403 . In some embodiments, the flexible circuit structure  401  includes various electrically conductive layers  404   a ,  404   b  and  404   c  (collectively electrically conductive layers  404 ) that are interleaved with the flexible layers  403 . In some embodiments, each of the electrically conductive layers  404  is patterned to form various electrically conductive elements. For example, electrically conductive layer  404   a  is patterned to form a respective electrode  415  of each of the transducers  406 . Electrodes  415  (which may correspond to electrodes  315 ) have respective electrode edges  415 - 1  that form a periphery of an electrically conductive surface associated with the respective electrode  415 .  FIG. 3B  shows another example of electrode edges  315 - 1  and illustrates that the electrode edges can define electrically-conductive-surface-peripheries of various shapes. 
     Returning to  FIG. 4 , electrically conductive layer  404   b  is patterned, in some embodiments, to form respective temperature sensors  408  for each of the transducers  406  as well as various leads  410   a  arranged to provide electrical energy to the temperature sensors  408 . In some embodiments, each temperature sensor  408  includes a patterned resistive member  409  (two called out) having a predetermined electrical resistance. In some embodiments, each resistive member  409  includes a metal having relatively high electrical conductivity characteristics (e.g., copper). In some embodiments, electrically conductive layer  404   c  is patterned to provide portions of various leads  410   b  arranged to provide an electrical communication path to electrodes  415 . In some embodiments, leads  410   b  are arranged to pass though vias in flexible layers  403   a  and  403   b  to connect with electrodes  415 . Although  FIG. 4  shows flexible layer  403   c  as being a bottom-most layer, some embodiments may include one or more additional layers underneath flexible layer  403   c , such as one or more structural layers, such as a steel or composite layer. These one or more structural layers, in some embodiments, are part of the flexible circuit structure  401  and can be part of, e.g., elongate member  304 . In addition, although  FIG. 4  shows only three flexible layers  403   a - 403   c  and only three electrically conductive layers  404   a - 404   c , it should be noted that other numbers of flexible layers, other numbers of electrically conductive layers, or both, can be included. 
     In some embodiments, electrodes  415  are employed to selectively deliver RF energy to various tissue structures within a bodily cavity (e.g., an intra-cardiac cavity). The energy delivered to the tissue structures may be sufficient for ablating portions of the tissue structures. The energy delivered to the tissue may be delivered to cause monopolar tissue ablation, bipolar tissue ablation or blended monopolar-bipolar tissue ablation by way of non-limiting example. 
     Energy that is sufficient for tissue ablation may be dependent upon factors including tissue characteristics, transducer location, size, shape, relationship with respect to another transducer or a bodily cavity, material or lack thereof between transducers, et cetera. 
     In some embodiments, each electrode  415  is employed to sense an electrical potential in the tissue proximate the electrode  415 . In some embodiments, each electrode  415  is employed in the generation of an intra-cardiac electrogram. In some embodiments, each resistive member  409  is positioned adjacent a respective one of the electrodes  415 . In some embodiments, each of the resistive members  409  is positioned in a stacked or layered array with a respective one of the electrodes  415  to form at least part of a respective one of the transducers  406 . In some embodiments, the resistive members  409  are connected in series to allow electrical current to pass through all of the resistive members  409 . In some embodiments, leads  410   a  are arranged to allow for a sampling of electrical voltage in between each resistive member  409 . This arrangement allows for the electrical resistance of each resistive member  409  to be accurately measured. The ability to accurately measure the electrical resistance of each resistive member  409  may be motivated by various reasons including determining temperature values at locations at least proximate the resistive member  409  based at least on changes in the resistance caused by convective cooling effects (e.g., as provided by blood flow). In some embodiments in which the transducer-based device is deployed in a bodily cavity (e.g., when the transducer-based device  300  is part of a catheter system and may be arranged to be percutaneously or intravascularly delivered to a bodily cavity via a catheter), it may be desirable to perform various mapping procedures in the bodily cavity. For example, when the bodily cavity is an intra-cardiac cavity, a desired mapping procedure can include mapping electrophysiological activity in the intra-cardiac cavity. Other desired mapping procedures can include mapping of various anatomical features within a bodily cavity. An example of the mapping performed by devices according to various embodiments may include locating the position of the ports of various bodily openings positioned in fluid communication with a bodily cavity. For example, in some embodiments, it may be desired to determine the locations of various ones of the pulmonary veins or the mitral valve that each interrupts an interior surface of an intra-cardiac cavity such as the left atrium. 
     Referring to  FIGS. 3A, 3B , transducer-based device or manipulable portion  300  may communicate with, receive power from, or be controlled by a control system  322 . In some embodiments, elongate members  304  can form a portion of an elongated cable  316  of control leads  317 , for example by stacking multiple layers, and terminating at a connector  321  or other interface with control system  322 . The control leads  317  may correspond to the electrical connectors  216  in  FIG. 2  in some embodiments. The control system  322  may include a controller  324  that may include a data processing device system  310  (e.g., data processing device system  110  from  FIG. 1 ) and a memory device system  330  (e.g., memory device system  130  from  FIG. 1 ) that stores data and instructions that are executable by the data processing device system  310  to process information received from transducer-based device  300  or to control operation of transducer-based device  300 , for example activating various selected transducers  306  to ablate tissue. Controller  324  may include one or more controllers. 
     In some embodiments, the controller  324  may be configured to control deployment, expansion, retraction, or other manipulations of the shape, positioning, or both shape and positioning of the transducer-based device (e.g., manipulable portion)  300  at least by driving (e.g., by an electric or other motor) movement of various actuators or other catheter system components. 
     In this regard, in some embodiments, some of which are described later in this disclosure, the controller  324  is at least part of a control system, which may include one or more actuators, configured to advance at least part of the transducer-based device (e.g.,  200 ,  300 , or  400 ), at least a portion of which may be considered a manipulable portion, out of the catheter sheath  312 , retract at least part of the transducer-based device back into the catheter sheath  312 , expand, contract, or otherwise change at least part of the shape of the transducer-based device. 
     Control system  322  may include an input-output device system  320  (e.g., an example of  120  from  FIG. 1 ) communicatively connected to the data processing device system  310  (i.e., via controller  324  in some embodiments). Input-output device system  320  may include a user-activatable control that is responsive to a user action. Input-output device system  320  may include one or more user interfaces or input/output (I/O) devices, for example one or more display device systems  332 , speaker device systems  334 , keyboards, mice, joysticks, track pads, touch screens or other transducers to transfer information to, from, or both to and from a user, for example a care provider such as a health care provider or technician. For example, output from a mapping process may be displayed on a display device system  332 . 
     Control system  322  may also include an energy source device system  340  including one or more energy source devices connected to transducers  306 . In this regard, although  FIG. 3A  shows a communicative connection between the energy source device system  340  and the controller  324  (and its data processing device system  310 ), the energy source device system  340  may also be connected to the transducers  306  via a communicative connection that is independent of the communicative connection with the controller  324  (and its data processing device system  310 ). For example, the energy source device system  340  may receive control signals via the communicative connection with the controller  324  (and its data processing device system  310 ), and, in response to such control signals, deliver energy to, receive energy from, or both deliver energy to and receive energy from one or more of the transducers  306  via a communicative connection with such transducers  306  (e.g., via one or more communication lines through catheter body  314 , elongated cable  316  or catheter sheath  312 ) that does not pass through the controller  324 . In this regard, the energy source device system  340  may provide results of its delivering energy to, receiving energy from, or both delivering energy to and receiving energy from one or more of the transducers  306  to the controller  324  (and its data processing device system  310 ) via the communicative connection between the energy source device system  340  and the controller  324 . 
     In any event, the number of energy source devices in the energy source device system  340  may be fewer than the number of transducers in some embodiments. The energy source device system  340  may, for example, be connected to various selected transducers  306  to selectively provide energy in the form of electrical current or power (e.g., RF energy), light or low temperature fluid to the various selected transducers  306  to cause ablation of tissue. The energy source device system  340  may, for example, selectively provide energy in the form of electrical current to various selected transducers  306  and measure a temperature characteristic, an electrical characteristic, or both at a respective location at least proximate each of the various transducers  306 . The energy source device system  340  may include various electrical current sources or electrical power sources as energy source devices. In some embodiments, an indifferent electrode  326  is provided to receive at least a portion of the energy transmitted by at least some of the transducers  306 . Consequently, the indifferent electrode  326  may be communicatively connected to the energy source device system  340  via one or more communication lines (not shown in  FIG. 3A ) in some embodiments. In addition, although shown separately in  FIG. 3A , indifferent electrode  326  may be considered part of the energy source device system  340  in some embodiments. In some embodiments, the indifferent electrode  326  is provided outside the body (e.g., on a skin-based surface) or at least the bodily cavity in which the transducer-based device (e.g.,  200 ,  300 , or  400 ) or catheter system  500  is, at least in part, located. 
     In some embodiments, the energy source device system  340  may include one or more driving motors configured to drive movement, in response to instructions from the controller  324 , of various actuators or other catheter system components to control deployment, expansion, retraction, or other manipulations of the shape, positioning, or both shape and positioning of the transducer-based device (e.g., manipulable portion)  300 . In some embodiments, various manually operated or other catheter system components may be employed to control deployment, expansion, retraction, or other manipulations of the shape, positioning, or both shape and positioning of the transducer-based device (e.g., manipulable portion)  300 . It is understood that input-output device system  320  may include other systems. 
     In some embodiments, input-output device system  320  may optionally include energy source device system  340 , transducer-based device  300  or both energy source device system  340  and transducer-based device  300  by way of non-limiting example. 
     Structure  308  of transducer-based device  300  can be delivered and retrieved through a catheter member, for example, a catheter sheath  312 . In some embodiments, the structure  308  provides expansion and contraction capabilities for a portion of a medical device (e.g., an arrangement, distribution or array of transducers  306 ). The transducers  306  can form part of, be positioned or located on, mounted or otherwise carried on the structure and the structure may be configurable to be appropriately sized to slide within a lumen of catheter sheath  312  in order to be deployed percutaneously or intravascularly.  FIG. 3A  shows one embodiment of such a structure. In some embodiments, each of the elongate members  304  includes a respective distal end  305  (only one called out), a respective proximal end  307  (only one called out) and an intermediate portion  309  (only one called out) positioned between the proximal end  307  and the distal end  305 . The respective intermediate portion  309  of each elongate member  304  includes a first or front surface  318   a  that is positionable to face an interior tissue surface within a bodily cavity and a second or back surface  318   b  opposite across a thickness of the intermediate portion  309  from the front surface  318   a . In various embodiments, the intermediate portion  309  of each of the elongate members  304  includes a respective pair of side edges of the front surface  318   a , the back surface  318   b , or both the front surface  318   a  and the back surface  318   b , the side edges of each pair of side edges opposite to one another, the side edges of each pair of side edges extending between the proximal end  307  and the distal end  305  of the respective elongate member  304 . In some embodiments, each pair of side edges includes a first side edge  327   a  (only one called out in  FIG. 3A ) and a second side edge  327   b  (only one called out in  FIG. 3A ). In some embodiments, each of the elongate members  304 , including each respective intermediate portion  309 , is arranged front surface  318   a -toward-back surface  318   b  in a stacked array during an unexpanded or delivery configuration (e.g.,  FIG. 3A ). In many cases, a stacked array allows the structure  308  to have a suitable size for percutaneous or intravascular delivery. A stacked array can allow structure  308  to have a spatially efficient size for delivery through a lumen of catheter sheath  312 . In some embodiments, the elongate members  304  are arranged to be introduced into a bodily cavity distal end  305  first. For clarity, not all of the elongate members  304  of structure  308  are shown in  FIG. 3A . A flexible catheter body or shaft  314  is used to deliver structure  308  through catheter sheath  312 . In some embodiments, each elongate member includes a twisted portion proximate proximal end  307 . 
     In some embodiments, the elongate members  304  are arranged in a fanned arrangement  370  in  FIG. 3B , e.g., where they are angularly spaced with respect to one another about an axis. Such an axis, in some embodiments of  FIG. 3B , may pass through opposite ‘poles’ of the fanned arrangement  370 , like axis  375  shown, for example, as a broken line in  FIG. 3B . However, other embodiments are not limited to any particular fanning axis. In some embodiments, the fanned arrangement  370  is formed during the expanded or deployed configuration in which the transducer-based device (e.g., manipulable portion)  300  or structure  308  thereof is manipulated to have a size, shape, or both size and shape too large for percutaneous or intravascular delivery, for example a size, shape, or both size and shape too large for percutaneous or intravascular delivery toward a bodily cavity, or a size, shape, or both size and shape too large for percutaneous or intravascular delivery away from a bodily cavity. In some embodiments, the fanned arrangement  370  is formed during the expanded or deployed configuration in which the transducer-based device (e.g., manipulable portion)  300  or structure  308  thereof is manipulated to have a size, shape, or both size and shape too large for delivery through a lumen of catheter sheath  312 , for example, a size, shape, or both size and shape too large for delivery through a lumen of catheter sheath  312  toward a bodily cavity, or a size, shape, or both size and shape too large for delivery through a lumen of catheter sheath  312  away from a bodily cavity. 
     In some embodiments, the transducer-based device (e.g., manipulable portion)  300  or structure  308  thereof includes a proximal portion  308   a  having a first domed shape  309   a  and a distal portion  308   b  having a second domed shape  309   b  when the transducer-based device (e.g., manipulable portion)  300  or structure  308  thereof is in the expanded or deployed configuration. In some embodiments, the proximal and the distal portions  308   a ,  308   b  include respective portions of elongate members  304 . In some embodiments, the transducer-based device (e.g., manipulable portion)  300  or structure  308  thereof is arranged to be delivered or advanced distal portion  308   b  first into a bodily cavity when the transducer-based device (e.g., manipulable portion)  300  or structure  308  thereof is in the unexpanded or delivery configuration as shown in  FIG. 3A . In some embodiments, the proximal and the distal portions  308   a ,  308   b  are arranged in a clam shell configuration in the expanded or deployed configuration shown in  FIG. 3B . In various example embodiments, each of the front surfaces  318   a  of the intermediate portions  309  of the plurality of elongate members  304  face outwardly from the structure  308  when the structure  308  is in the deployed configuration. In various example embodiments, each of the front surfaces  318   a  of the intermediate portions  309  of the plurality of elongate members  304  are positioned adjacent an interior tissue surface of a bodily cavity in which the structure  308  (i.e., in the deployed configuration) is located. In various example embodiments, each of the back surfaces  318   b  of the intermediate portions  309  of the plurality of elongate members  304  face an inward direction when the structure  308  is in the deployed configuration. 
     The transducers  306  may be arranged in various distributions or arrangements in various embodiments. In some embodiments, various ones of the transducers  306  are spaced apart from one another in a spaced apart distribution in the delivery configuration shown in  FIG. 3A . In some embodiments, various ones of the transducers  306  are arranged in a spaced apart distribution in the deployed configuration shown in  FIG. 3B . In some embodiments, various pairs of transducers  306  are spaced apart with respect to one another. In some embodiments, various regions of space are located between various pairs of the transducers  306 . For example, in  FIG. 3B  the transducer-based device  300  includes at least a first transducer  306   a , a second transducer  306   b  and a third transducer  306   c  (all collectively referred to as transducers  306 ). In some embodiments each of the first, the second, and the third transducers  306   a ,  306   b  and  306   c  are adjacent transducers in the spaced apart distribution. In some embodiments, the first and the second transducers  306   a ,  306   b  are located on different elongate members  304  while the second and the third transducers  306   b ,  306   c  are located on a same elongate member  304 . In some embodiments, a first region of space  350  is between the first and the second transducers  306   a ,  306   b . In some embodiments, the first region of space  350  is not associated with any physical portion of structure  308 . In some embodiments, a second region of space  360  associated with a physical portion of device  300  (i.e., a portion of an elongate member  304 ) is between the second and the third transducers  306   b ,  306   c . In some embodiments, each of the first and the second regions of space  350 ,  360  does not include a transducer of transducer-based device  300 . In some embodiments, each of the first and the second regions of space  350 ,  360  does not include any transducer. It is noted that other embodiments need not employ a group of elongate members  304  as employed in the illustrated embodiment. For example, other embodiments may employ a structure having one or more surfaces, at least a portion of the one or more surfaces defining one or more openings in the structure. In these embodiments, a region of space not associated with any physical portion of the structure may extend over at least part of an opening of the one or more openings. In other example embodiments, other structures may be employed to support or carry transducers of a transducer-based device such as a transducer-based catheter device. For example, an elongated catheter member may be used to distribute the transducers in a linear or curvilinear array. Basket catheters or balloon catheters may be used to distribute the transducers in a two-dimensional or three-dimensional array. 
     In some embodiments, a manipulable portion, such as, but not limited to, a transducer-based device (e.g.,  200  or  300 ) is manipulated to transition between a delivery configuration (e.g.,  FIG. 3A ) and an expanded or deployed configuration (e.g.,  FIG. 3B ) manually (e.g., by a user&#39;s manual operation) or at least in part by way of motor-based driving (e.g., from the energy source device system  340 ) of one or more actuators or other catheter system components. Motor-based driving may augment or otherwise be in response to manual actions, may be responsive to automated control of a data processing device system (e.g.,  110  in  FIG. 1 or 310  in  FIGS. 3A and 3B ), or may use a hybrid manual-automated approach. 
       FIG. 5  illustrate mechanisms for, among other things, limiting spacing between elongate members (e.g.,  304 ), according to some embodiments of the present invention. In this regard,  FIG. 5  illustrate all or one or more portions of a medical system, according to various embodiments. 
       FIG. 5A  illustrates an intermediate portion  509  of an elongate member  504 , which may correspond to an intermediate portion  309  of an elongate member  304  in some embodiments. The elongate member  504  may include transducers  506 , which may correspond to the transducers  220 ,  306 , or  406 . The elongate member  504  may include material layers  505 , which may correspond to the layers  404  and  403 .  FIG. 5A  shows only two material layers  505   a ,  505   b  for example purposes only, although, as shown in  FIG. 4 , more layers may be present. In some embodiments one material layer (e.g.,  505   a ) may correspond to a flexible layer  403  from  FIG. 4 , an electrically conductive layer  404  from  FIG. 4 , or both a flexible layer  403  and an electrically conductive layer  404  from  FIG. 4 . 
     The elongate member  504  may include a first surface or side  518   a  and a second surface or side  518   b , which may respectively correspond to the front surface  318   a  and rear surface  318   b . In some embodiments, the elongate member  504  includes a notch  503  in at least one of the layers  505  (the notch  503  is shown in  FIG. 5A  through only one layer for example purposes only). Some instances of the notch  503  are called out in  FIG. 3B , although more are present. In some embodiments, the notch  503  includes an aperture  502  which passes through the elongate member  504  from the first side  518   a  to the second side  518   b . It should be noted that the shape of aperture  502  may take other forms than the pill shape shown in the figures, such as round, square, triangular, rectangular, or any other shape. In some embodiments, the aperture  502  extends across a thickness of the elongate member  504  from the first side  518   a  to the second side  518   b . In this regard, the first side  518   a  may be considered to include the exposed top or front (e.g., tissue facing) surfaces of multiple ones of the layers  505 , according to some embodiments. In the example of  FIG. 5A , the first side  518   a  may be considered to include the exposed front (e.g., tissue facing) surface of the front-most layer  505   a  in addition to the exposed front (e.g., tissue facing) surface of the layer  505   b  underlying layer  505   a  where the notch  503  resides, such that the aperture  502  is considered to pass through the elongate member  504  from the first side  518   a  to the second side  518   b.    
     In some embodiments, the elongate member  504  includes a flexible coupling  501 , which may be a tie line, made from a material such as Dyneema (a Trademark of DSM IP Assets B.V. LIMITED LIABILITY COMPANY NETHERLANDS Het Overloon 1 NL-6411 TE HEERLEN NETHERLANDS) Purity. The tie line may have a braid specification: 4×25 dtex 25 PPI, for example as manufactured by Cortland Limited having a place of business at 44 River Street, Cortland, N.Y. 13045, USA. A few instances of the flexible coupling  501  are shown in  FIG. 3B , although others may be present. The flexible coupling  501  may include portions  520  (shown in broken lines in  FIG. 5A ) located between adjacent material layers  505  (shown between a bottom layer  505   b  and top layer  505   a  in  FIG. 5A  for example purposes only, although in embodiments including more than two layers, the portions  520  may be located between at least two adjacent ones of those layers) in order to secure the flexible coupling  501  to the elongate member  504 . In some embodiments, the portions  520  located between layers  505  may terminate at separate first and second ends, where the first end is represented with reference numeral  511 , and the second end is represented with reference numeral  512 . The portions  520  of the flexible coupling  501  located between layers  505  may be formed at such location as part of the process of manufacturing the elongate member  504 , so that the portions  520  (or first and second ends  511 ,  512  in some embodiments) are physically coupled to the intermediate portion  509  of the elongate member  504 , for example, by lamination, an adhering process, or other sealing process between adjacent material layers  505 . The portions  520  of the flexible coupling  501  located between layers  505  may be formed at such location as part of the process of manufacturing the elongate member  504 , so that the portions  520  (or first and second ends  511 ,  512  in some embodiments) are, for example, laminated, adhered, or otherwise sealed between a flexible circuit assembly layer and a support structure layer. 
     The flexible coupling  501  may exit from between layers  505  at points  521 , lay across the aperture  502  (i.e., not pass through aperture  502  in some embodiments), and extend transversely from the intermediate portion  509  of the elongate member  504 , the flexible coupling  501  extending with an elongated portion  513  to form at least a portion of a part  515  of a closed loop  510   a  that follows a continuous closed path. In some embodiments, another part (or the rest)  514  of the closed loop  510   a  is formed by the elongate member  504 . In some embodiments, the part  514  may be an elongate portion of the elongate member  504  extending between a first end portion (e.g.,  511  or  520 ) and a second end portion (e.g.,  512  or the other  520 ) of the flexible coupling  501 . In some embodiments, the first end portion, the second end portion, or both includes a respective terminating end of the flexible coupling  501 . In some embodiments, the first end portion, the second end portion, or both does not include a respective terminating end of the flexible coupling  501 . In some embodiments, the part  514  may be at least part of the intermediate portion  509  of the elongate member  504  between the layers  505  and between the portions  520 , such part  514  being laminated, adhered, or otherwise sealed together to close the loop  510   a  or the continuous closed path thereof, according to some embodiments. In some embodiments, the part  514  of the closed loop  510   a  is formed by the flexible coupling itself, for example, in some embodiments where the portions  511 ,  512  of the flexible coupling  501  are connected to each other so that the entire flexible coupling  501  is a closed loop, instead of having portions  511 ,  512  separated as shown in  FIG. 5A . 
       FIG. 5B  illustrates a connection between a first elongate member  504   a  and a second elongate member  504   b , each of which represents an instance of elongate member  504 . In this regard, each of a first flexible coupling  501   a  of the first elongate member  504   a  and a second flexible coupling  501   b  of the second elongate member  504   b  represents an instance of flexible coupling  501  (flexible coupling  501  is shown in  FIG. 5A ). Collectively, elongate members  504   a ,  504   b  may represent two adjacent elongate members  304 . 
     In  FIG. 5B , first flexible coupling  501   a  extends under (i.e., along the second side  518   b  of) the second elongate member  504   b  and then up and through the aperture  502  (i.e., from the second side  518   b  to the first side  518   a ) of the second elongate member  504   b , thereby creating a loop  525  at an end of the first flexible coupling  501   a  through which the second flexible coupling  501   b  is received and passes. (Note that the broken lines in  FIG. 5  represent either the passing of a flexible coupling  501  under an elongate member or between layers  505  of an elongate member.) As shown in  FIG. 5C , this looping arrangement with loop  525  limits a spacing between the elongate members  504   a  and  504   b  (e.g., at least the intermediate portions  509  thereof) so as not to exceed a defined amount (e.g., when the structure  308  or a similar structure comprising elongate members  504  is in its expanded or deployed configuration or when the first flexible coupling  501   a  is in a tension state). 
     In some embodiments, the first closed loop  510   a  extends along a path from the intermediate portion  509  of the first elongate member  504   a  through the aperture  502  (i.e., from the second side  518   b  to the first side  518   a  of the intermediate portion) of the second elongate member  504   b  to a location where a portion of the flexible coupling  501   b  of the second elongate member  504   b  is arranged to extend or pass through the first closed loop  510   a  (e.g., loop  525 ). 
     In some embodiments, the aperture  502  of at least the second elongate member  504   b  is sized to restrict movement of the first closed loop  510   a  through the aperture  502  from the first side  518   a  toward the second side  518   b  of the intermediate portion  509  of the second elongate member  504   b  when a portion of the flexible coupling  501   b  of the second elongate member  504   b  extends or passes through the first closed loop  510   a . For example, as shown in  FIGS. 5B and 5C , the loop  525  is restricted from returning from the first side  518   a  toward the second side  518   b  of the intermediate portion  509  of the second elongate member  504   b  through the aperture  502  of the second elongate member  504   b . For another example, in some embodiments, the aperture  502  has a size sufficient to allow two portions or segments of a flexible coupling (e.g., two opposing portions of loop  525  of flexible coupling  501   a  fitting through aperture  502 ) to fit within it, but insufficient to allow four portions or segments of a flexible coupling (e.g., two portions or segments of flexible coupling  501   b ) to fit within it. (Note that the thickness of the flexible couplings (e.g.,  501 ,  501   a ,  501   b ) illustrated in the figures, the size of the aperture  502  illustrated in the figures, or both, may be different than that shown, as the illustrated dimensions are for purposes of illustrating aspects of some embodiments.) In this regard, in some embodiments, when the flexible coupling  501   b  of the second elongate member  504   b  extends through loop  525 , the loop  525  may be prevented from returning through the aperture  502  of the second elongate member  504   b  not only by the flexible coupling  501   b  extending through it, but also by a limited size of the aperture  502 , which may be sized to prevent both flexible couplings  501   a  and  501   b  from passing therethrough. 
     In  FIGS. 5B and 5C , the flexible coupling  501   b  extending transversely from the intermediate portion  509  of the second elongate member  504   b  may form at least part of a second closed loop  510   b , according to some embodiments. In this regard, as shown in  FIG. 5C , in some embodiments, no portion of the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is received through the second loop  510   b  at least when the spacing between the respective locations of the first and second elongate members  504   a ,  504   b  is sized by a defined amount. In some embodiments, according to  FIG. 5C , no portion of the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is received through the second loop  510   b  when the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is tensioned. In some embodiments according to  FIGS. 5B and 5C , each of the first and the second closed loops  510   a ,  510   b  extends along a respective continuous closed path, each respective continuous closed path not encircling the other respective continuous closed path. For example, in some embodiments according to  FIGS. 5B and 5C , at least a portion of the flexible coupling  501   a  exists outside of the continuous closed path of the flexible coupling  501   b , and vice versa. In some embodiments according to  FIGS. 5B and 5C , the continuous closed path of the first closed loop  510   a  does not pass through the continuous closed path of the second closed loop  510   b  (for example, at least when (a) the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is tensioned; (b) the flexible coupling  501   b  extending transversely from the intermediate portion  509  of the second elongate member  504   b  is tensioned; or both (a) and (b)). In some embodiments according to  FIGS. 5B and 5C , the continuous closed path of the second closed loop  510   b  does pass through the continuous closed path of the first closed loop  510   a  (for example, at least when (a) the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is tensioned; (b) the flexible coupling  501   b  extending transversely from the intermediate portion  509  of the second elongate member  504   b  is tensioned; or both (a) and (b)). In some embodiments, as shown in  FIGS. 5B and 5C , the first closed loop  510   a  surrounds a portion of the second closed loop  510   b  at loop  525 , but not vice versa, at least when (a) the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is tensioned; (b) the flexible coupling  501   b  extending transversely from the intermediate portion  509  of the second elongate member  504   b  is tensioned; or both (a) and (b)). In other words, in some embodiments, only one flexible coupling (e.g.,  501   a ) in a pair of adjacent flexible couplings (e.g.,  501   a ,  501   b ) surrounds the other flexible coupling (e.g.,  501   b ) in the pair of adjacent flexible couplings. Stated differently, in some embodiments, only one flexible coupling (e.g.,  501   b ) in a pair of adjacent flexible couplings (e.g.,  501   a ,  501   b ) passes through the other flexible coupling (e.g.,  501   a ) in the pair of adjacent flexible couplings. In other words, in some embodiments, the flexible couplings in a pair of adjacent flexible couplings (e.g.,  501   a ,  501   b ) do not (a) surround a portion of each other, (b) pass through each other, or both (a) and (b). In this regard, in some embodiments, the second closed loop  510   b  does not extend along a closed continuous path that completely surrounds any portion of the first closed loop  510   a  at least in a state where the first closed loop  510   a  extends along a closed continuous path that completely surrounds any portion of the second closed loop  501   b , or vice versa, at least when (a) the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is tensioned; (b) the flexible coupling  501   b  extending transversely from the intermediate portion  509  of the second elongate member  504   b  is tensioned; or both (a) and (b)). Stated differently, in some embodiments, the first closed loop  510   a  does not pass through any portion of the second closed loop  510   b  in a state where the second closed loop  510   b  passes through any portion of the first closed loop  510   a , or vice versa, at least when (a) the flexible coupling  501   a  extending transversely from the intermediate portion  509  of the first elongate member  504   a  is tensioned; (b) the flexible coupling  501   b  extending transversely from the intermediate portion  509  of the second elongate member  504   b  is tensioned; or both (a) and (b)). 
       FIG. 5D  illustrates a securing mechanism  517 , such as a staple or other fastening device, that may be used to terminate the daisy-chaining structure illustrated in  FIGS. 5B and 5C . In some embodiments, respective openings  531  that pass through at least a portion of the elongate member  504  (e.g., notch  503 , one or more layers  505 , such as bottom layer  505   b  shown in  FIG. 5A ) are configured to receive respective ends  532  of the securing mechanism  517 . As shown in  FIG. 5E , the flexible coupling  501   b  of the second elongate member  504   b  may be terminated at a third elongate member  504   c  (which may be an instance of elongate members  504 ) by being tied to, or looped around, the securing mechanism  517 . In this regard,  FIG. 5F  illustrates plan and side views of the elongate members  504   a ,  504   b , and  504   c , according to some embodiments.  FIG. 3B  also illustrates an instance of the securing mechanism  517 , according to some embodiments. In various embodiments in which securing mechanism  517  includes a staple-like form, various ones of the legs of the staple-like form may be secured to the elongate member  504  by various techniques including welding, adhesive bonding, or a combination thereof. 
       FIGS. 5G, 5H-1, and 5H-2  illustrate some embodiments where a flexible coupling  501  connecting adjacent elongate members  504  is itself formed as a closed loop. For example,  FIGS. 5G, 5H-1, and 5H-2  illustrate some embodiments where separated portions  511 ,  512  shown, for example, in  FIG. 5A  are connected, not separated. In this regard, the flexible coupling may be caused to form such a closed loop by knotting, adhering, fusing, or otherwise connecting the ends of such flexible coupling. 
     While  FIGS. 5G, 5H-1, and 5H-2  illustrate some embodiments where the flexible couplings  501  are connected to elongate members  504  via apertures  502  without any portion of the flexible couplings  501  located between material layers  505  of an elongate member  504 , it should be noted that other embodiments may locate one or more portions of a flexible coupling  501  between material layers  505  at least as discussed above with respect to  FIGS. 5A-5F . 
     In some embodiments according to  FIG. 5G , the flexible coupling  501   a  is arranged as a closed loop that passes through the aperture  502   a  of the elongate member  504   a  with one portion  572   a  of the flexible coupling  501   a  exiting the aperture  502   a  in a direction heading above the first (e.g., front) surface  518   a  of the elongate member  504   a , and another portion  572   b  of the flexible coupling  501   a  exiting the aperture  502   a  in a direction heading underneath the second (e.g., rear) surface  518   b  of the elongate member  504   a . The flexible coupling  501   a  may then extend underneath the adjacent elongate member  504   b  (e.g., as shown by the corresponding broken line in  FIG. 5G ) to a location  572   c  where the flexible couplings  501   a  and  501   b  link to each other, according to some embodiments. For example, flexible coupling  501   b  may pass through the closed loop of flexible coupling  501   a  at location  572   c  according to some embodiments. In some embodiments, flexible coupling  501   b  is connected to elongate member  504   b  via aperture  502   b  in a manner that is similar to, or the same as, that employed to couple flexible coupling  501   a  to elongate member  501   a  in  FIG. 5G . The flexible coupling  501   b  may then extend toward a next elongate member (not shown) adjacent elongate member  504   b , in some embodiments. In this regard, portion  572   d  of flexible coupling  501   b  may link to a flexible coupling (not shown) of the next elongate member (not shown) in a similar or same manner as flexible coupling  501   a  is linked to flexible coupling  501   b  in  FIG. 5G . Accordingly, this process of connecting adjacent elongate members according to  FIG. 5G  may be repeated to connect many elongate members, just as the processes of the other  FIG. 5  may be repeated (e.g., repeating  FIG. 5C  to a termination point as shown in  FIG. 5F ) to connect many elongate members. Also as with the other  FIG. 5  (e.g.,  FIGS. 5D-5F ), the connection process of  FIG. 5G  may terminate at a securing mechanism  517 , according to some embodiments. It is noted that in some embodiments, at least part of flexible coupling  501   a  of  FIG. 5G  may extend through aperture  502   b  of adjacent elongate member  504   b . For example, flexible coupling  501   a  may extend through aperture  502   b  of adjacent elongate member  504   b  and terminate at a securing mechanism (e.g.,  517 ), according to some embodiments. 
       FIGS. 5H-1 and 5H-2  illustrate some other embodiments in which at least flexible coupling  501   a  is formed as a closed loop.  FIG. 5H-1  illustrates the flexible coupling  501   a  in an intermediate, loose, state where it is not connected to an adjacent elongate member, according to some embodiments.  FIG. 5H-2  illustrates the flexible coupling  501   a  of  FIG. 5H-1  in a tensioned state where such flexible coupling  501   a  is connected or coupled to adjacent elongate member  504   b , according to some embodiments. As shown in  FIG. 5H-1 , according to some embodiments, the flexible coupling  501   a  includes a first loop portion  570   a  that passes through a second loop portion  570   b  of the flexible coupling  501   a . The second loop portion  570   b  has passed up through aperture  502   a  from the second (e.g., rear) side  518   b  to the first (e.g., front) side  518   a  of the elongate member  504   a  when the first loop portion  570   a  passes through the second loop portion  570   b , according to some embodiments. After passing through the second loop portion  570   b , according to some embodiments, the first loop portion  570   a  is then pulled over the second loop portion  570   b  in the direction of the arrow  571  towards an adjacent elongate member (e.g.,  504   b ) as shown in  FIG. 5H-2 . In this regard, in some embodiments, the first loop portion  570   a  may pass underneath the adjacent elongate member (e.g.,  504   b ), as shown by the corresponding broken lines of portion  570   a  in  FIG. 5H-2 , and loop around the flexible coupling (e.g.,  501   b ) of the adjacent elongate member (e.g.,  504   b ) at location  570   c , according to some embodiments. With reference to  FIG. 5H-2 , flexible coupling  501   b  may be connected to elongate member  504   b  in the same or similar manner that flexible coupling  501   a  is coupled to elongate member  504   a . The flexible coupling  501   b  may extend toward a next elongate member (not shown) adjacent elongate member  504   b , in some embodiments. In this regard, portion  570   d  of flexible coupling  501   b  may link to a flexible coupling (not shown) of the next elongate member (not shown) in the same or similar manner as flexible coupling  501   a  is linked to flexible coupling  501   b . Accordingly, this process of connecting adjacent elongate members according to  FIGS. 5H-1 and 5H-2  may be repeated to connect many elongate members, just as the processes of the other  FIG. 5  may be repeated (e.g., repeating  FIG. 5C  to a termination point as shown in  FIG. 5F ) to connect many elongate members. Also as with the other  FIG. 5  (e.g.,  FIGS. 5D-5F ), the connection process of  FIGS. 5H-1 and 5H-2  may terminate at a securing mechanism (e.g.,  517 ), according to some embodiments. 
     As will be appreciated by a person of ordinary skill in the art, it is noted that the illustrations of flexible couplings  501  shown in various ones of  FIGS. 3B and 5  may include distortions for clarity, such as the thickness, cross-sectional shape or size, or the manner and degree of bending, propagation, or linking of one or more flexible couplings  501 . For one example, the illustration of the linking of flexible couplings  501   a  and  501   b  in  FIG. 5H-2  is shown in a looser state than may be present in practice in order to more clearly show an example of how such flexible couplings  501   a  and  501   b  may be linked. Corresponding comments apply to at least  FIG. 5G . Accordingly, some embodiments are not limited to the particular thickness, cross-sectional shape or size, or the manner and degree of bending, propagation, or linking of one or more flexible couplings  501  illustrated in the figures. 
     Advantageously, couplings such as couplings  501   a  and  501   b  can be easily formed with a desired tensioned length that allows a spacing between adjacent elongate members  504  to be maintained at a predetermined or defined amount in the expanded or deployed configuration. For example, a coupling such as coupling  501   a  or  501   b  may be accurately made by looping a tie line around an offset fixture pin and sandwiching the loose ends of the tie line between various layers that form the elongate member (e.g., as described above). Advantageously, flexible couplings such as couplings  501   a  and  501   b  greatly facilitate the assembly of the elongate members into the final structure (e.g., structure  308 ), at least because continuous long lengths of tie line that connect many elongate members need not be employed. In this regard, each of the flexible couplings (e.g.,  510 ) of some embodiments may be relatively shorter than some conventional applications which use a long tie line to connect many elongate members, as each flexible coupling according to some embodiments, need only connect to the adjacent elongate member (e.g.,  504 ). Multiple shorter distinct flexible couplings, e.g.,  501  as according to some embodiments of the present invention, can be easier to manufacture than a single longer flexible coupling since couplings between the elongate members may be concurrently made as the elongate members are assembled into the final structure (e.g., structure  308 ) rather than after the elongate members are assembled into the final structure. 
     While some of the embodiments disclosed above are described with respect to an intra-cardiac cavity, the same or similar embodiments may be used for other bodily cavities, for example, gastric, bladder, arterial, or any lumen or cavity into which the devices according to any embodiment of the present invention may be introduced. 
     While some of the embodiments discussed above illustrate a particular number of elongate members that may be daisy-chained using respective flexible couplings  501 , it should be noted that the invention is not limited to any particular number of elongate members that may be connected. In addition, while some embodiments discussed above illustrate a particular number of connection points (e.g., apertures  502 ) per elongate member by which the elongate member may be connected to one or more other elongate members, it should be noted that the invention is not limited to any particular number of such connection points per elongate member. 
     While the embodiments discussed above illustrate the connection of elongate members comprising transducers, the present invention is not limited to this configuration and may be applied to any expandable manipulable portion of an intra-cavity device that includes at least two elongate members. 
     While the embodiments discussed above illustrate the connection of elongate members along an equatorial intermediate region, the present invention is not limited to connecting elongate members in this region, and other regions may be used to connect the elongate members. 
     Subsets or combinations of various embodiments described above can provide further embodiments. 
     These and other changes can be made to the invention in light of the above-detailed description. In general, the terms used herein should not be construed to limit the invention to the specific embodiments disclosed in the specification, but should be construed to include other medical device systems including all medical treatment device systems and medical diagnostic device systems. Accordingly, the invention is not limited by the disclosure.