Patent Publication Number: US-2019167370-A1

Title: System and method for controlling a remote medical device guidance system in three-dimensions using gestures

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     Reference is made to U.S. application Ser. No. 15/252,500, filed 31 Aug. 2016 (the &#39;500 application), U.S. application Ser. No. 13/692,356, filed 3 Dec. 2012 (the &#39;356 application), U.S. application Ser. No. 13/208,924, filed 12 Aug. 2011 (the &#39;924 application), U.S. application Ser. No. 12/507,175, filed 22 Jul. 2009 (the &#39;175 application), U.S. application Ser. No. 13/637,401, filed 6 Dec. 2012 (the &#39;401 application), international application no. PCT/US11/30764, with an international filing date of 31 Mar. 2011 (the &#39;764 application), U.S. provisional application No. 61/319,795, filed 31 Mar. 2010 (the &#39;795 application). The &#39;500 application, the &#39;356 application, the &#39;924 application, the &#39;175 application, the &#39;401 application, the &#39;764 application, and the &#39;795 application are all hereby incorporated by reference as though fully set forth herein. 
    
    
     BACKGROUND 
     a. Technical Field 
     The instant disclosure relates generally to electrophysiology lab integration, and more particularly to user interfaces and devices therefore for robotic control of electrophysiology lab diagnostic and therapeutic equipment. 
     b. Background Art 
     It is known to provide an electrophysiology lab in a medical facility. Such a lab may have use of a wide variety of diagnostic and therapeutic equipment useful in rendering medical service to a patient, such as imaging systems (e.g., fluoroscopy, intracardiac echocardiography, etc.), an electro-anatomic visualization, mapping and navigation system, ablation energy sources (e.g., radio frequency (RF) ablation generator), a recording system (e.g., for ECG, cardiac signals, etc.), a cardiac stimulator and the like. In a typical configuration, as seen by reference to  FIG. 1 , a procedure room  10  (i.e., a sterile environment) may have an associated control area or room  12 , which is commonly outfitted with one or more control stations  14   1 ,  14   2 , . . .  14   n  that are operated by one or more control technicians. Each control station may include a respective display monitor, keyboard and mouse for use by the technician. Depending on the lab setup, the control station(s) may be across the room, or outside of the procedure room  10  completely, perhaps configured with a common window to allow the technician(s) to observe the procedure room through the window. These control station(s) allow access to and may be used to control the diagnostic and therapeutic equipment mentioned above. 
     In conventional practice, an electrophysiology (EP) physician  16  is scrubbed into a sterile procedure and typically manipulates one or more catheters (not shown) in a sterile drape covered body of the patient  18 . The physician&#39;s sterile gloved hands are typically engaged with the catheter handle and shaft next to the patient and he or she is therefore unable to directly make changes himself to any of the EP systems. The procedure room  10  typically includes one or more monitors (e.g., an integrated multi-display monitor  20  is shown) arranged so that the physician  16  can see the monitor  20  on which is displayed various patient information being produced by the diagnostic and therapeutic equipment mentioned above. In  FIG. 1 , multiple applications, for example, an electro-anatomic mapping application (e.g., EnSite™ Velocity™) and an EP signal acquisition and recording application, direct a visual output to a respective display area of monitor  20 . When changes to an application are needed, the physician  16  verbalizes such commands to the control technicians in the control area/room  12  who are working at the various control stations  14   1 ,  14   2 , . . .  14   n . The multiple technicians at multiple control stations use multiple keyboard/mouse sets to control the multiple applications. The verbal commands between the physician and the technician occur throughout the procedure. 
     For example, the EP physician  16  can verbally communicate (i.e., to the control technician—a mapping system operator) the desired view of the map to be displayed, when to collect points, when to separate anatomic locations, and other details of creating and viewing an anatomic map. The EP physician  16  can also communicate which signal traces to show, the desired amplitude, when to drop a lesion marker, and when to record a segment, to name a few. Where the technician is in a separate room, communication can be facilitated using radio. 
     While some commands are straightforward, for example, “LAO View”, “record that” and “stop pacing”, other commands are not as easy to clearly communicate. For example, how much rotation of a model the command “rotate a little to the right” means can be different as between the physician and the technician. This type of command therefore involves a question of degree. Also, depending on the physician-technician relationship, other requests related to the mapping system views and setup can be misinterpreted. For example, a request to “rotate right” may mean to rotate the model right (i.e., rotate view left) when originating from one physician but can alternatively mean rotate view right (i.e., rotate model left) when coming from another physician. This type of command therefore involves physician-technician agreement as to convention. Furthermore, implementation of requests for event markers, segment recordings, lesion markers and the like can be delayed by the time it takes the technician to hear, understand and act on a physician&#39;s command. Ambient discussions and/or equipment noise in and around the EP lab can increase this delay. 
     Certain catheter procedures can be performed through the use of a remote catheter guidance system (RCGS), which employs robotically-controlled movement of the catheter. The robotic control can receive input command through a user interface that can include a joystick, mouse or the like. However, there is a need for an improved user interface to control an RCGS. 
     The foregoing discussion is intended only to illustrate the present field and should not be taken as a disavowal of claim scope. 
     SUMMARY 
     One advantage of the methods and apparatuses described, depicted and claimed herein is that they provide an EP physician or other user with the capability of directly controlling a robotic catheter system. In an embodiment, a system for enabling a user to remotely control a robotic catheter system includes a motion capture apparatus and an electronic control unit. The motion capture apparatus is configured to capture motion of a user in a sensing volume and generate output data indicative of the captured user motion. The electronic control unit includes one or more processors and memory. The system further includes gesture recognition logic stored in the memory and configured to execute on the one or more processors. The gesture recognition logic is configured to recognize a user gesture based on the output data generated by the motion capture apparatus. The system further includes interpreter logic stored in the memory and configured to be executed by the one or more processors. The interpreter logic is configured to translate the recognized user gestures to a corresponding robotic catheter control command wherein the command is configured to control an aspect of the operation of the robotic catheter system. The electronic control unit is configured to communicate the command to the robotic catheter system. 
     In an embodiment, the motion capture apparatus is configured to acquire imaging of the movements of the user. For example only, the motion capture apparatus provides the capability of receiving input by way of physician gestures (e.g., hand, arm, leg, trunk, facial, etc.). 
     In an embodiment, the user motion data includes fiducial point tracking data, and wherein the gesture recognition logic is configured to identify a start pose based on fiducial point tracking data, record the motion a predetermined plurality of fiducial points after the start pose until an end pose is identified based on the fiducial point tracking data, compare the recorded motion of the predetermined plurality of fiducial points with a plurality of predefined gestures, and output the user gesture when the recorded motion matches one of the plurality of gestures. 
     The foregoing and other aspects, features, details, utilities, and advantages of the present disclosure will be apparent from reading the following description and claims, and from reviewing the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a block diagram view of a electrophysiology lab having a sterile procedure room and an associated control room. 
         FIG. 2  is a block diagram view of an embodiment of an electrophysiology lab having a bedside interface device for controlling diagnostic and therapeutic equipment. 
         FIG. 3A  is a plan view of a first embodiment of a bedside interface device comprising a touch panel computer, suitable for use in the EP lab of  FIG. 2 , and showing a first application-specific user interface. 
         FIG. 3B  is an isometric view of a sterile drape configured to isolate the touch panel computer of  FIG. 3A . 
         FIG. 4A  is a view of a monitor shown in  FIG. 2 , showing multiple inset displays associated with a plurality of diagnostic and/or therapeutic systems. 
         FIG. 4B  is a view of the monitor of  FIG. 4A , showing a zoomed-in window of the display associated with an electro-anatomic mapping system. 
         FIG. 5  is a plan view of the touch panel computer of  FIG. 3A  showing a second application-specific user interface. 
         FIG. 6  is a plan view of the touch panel computer of  FIG. 3A  showing a third application-specific user interface. 
         FIG. 7A  is a diagrammatic and block diagram view of a second embodiment of the bedside interface device comprising an electronic wand system. 
         FIG. 7B  is a diagrammatic view of a third embodiment of the bedside interface device wherein a catheter is integrated with the remote control portion of  FIG. 7A . 
         FIG. 8  is a diagrammatic and block diagram view of a fourth embodiment of the bedside interface device comprising a motion capture apparatus. 
         FIGS. 9-10  are diagrammatic views of fifth and sixth embodiments of the bedside interface device comprising touch responsive surface devices that can be covered in a sterile bag. 
         FIG. 11  is a diagrammatic view of a seventh embodiment of the bedside interface device comprising a customized joystick that can be covered in a sterile bag. 
         FIGS. 12-13  are diagrammatic views of eighth and ninth embodiments of the bedside interface device comprising holographic mouse and keyboard input devices, respectively. 
         FIG. 14  is a block diagram of an embodiment of a base interface used in connection with a system for enabling a user to control a robotic catheter system. 
         FIG. 15  is a diagrammatic and block diagram of an embodiment of a system for enabling a user to control a robotic catheter system. 
         FIGS. 16A-16B  are schematic, skeleton representations of a user showing, respectively, a distance metric between fiducial points and rotation metric relative to a fiducial point. 
         FIG. 17  is an exemplary illustration of a three dimensional input device usable with a robotic catheter system. 
         FIG. 18  is an isometric, diagrammatic view of a robotic catheter system, illustrating an exemplary layout of various system components. 
         FIG. 19  is a side view of a manipulator assembly shown in  FIG. 18 , coupled to a robotic support structure, showing side views of catheter and sheath manipulation mechanisms. 
         FIGS. 20A-20B  are isometric views of a manipulator assembly shown in  FIG. 19 , showing the catheter and sheath manipulation mechanism in greater detail. 
         FIGS. 21A-21C  are isometric views showing a sheath manipulation base of  FIGS. 20A-20B  in greater detail. 
         FIGS. 22A-22B  are isometric views showing a sheath cartridge of  FIGS. 20A-20B  in greater detail. 
         FIG. 23  is a diagrammatic and block diagram view of the sheath manipulation mechanism of  FIG. 19 . 
         FIG. 24  is a catheter manipulator assembly including a support device. 
         FIGS. 25A-25B  are isometric and related diagrammatic views of an embodiment of a robotic catheter manipulator support structure. 
         FIGS. 26A-26C  are exemplary embodiments of a touch-sensitive input device usable with a robotic catheter system. 
         FIG. 26D  is an embodiment of a touch-sensitive input device used to manage multiple displays. 
     
    
    
     DETAILED DESCRIPTION 
     Various embodiments are described herein to various apparatuses, systems, and/or methods. Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims. 
     Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation given that such combination is not illogical or non-functional. 
     It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute. 
     Referring now to the drawings wherein like reference numerals are used to identify identical or similar components in the various views,  FIG. 2  is a diagrammatic overview of an electrophysiology (EP) laboratory in which embodiments of the present invention may be used.  FIG. 2  shows a sterile procedure room  10  where an EP physician  16  is set to perform one or more diagnostic and/or therapeutic procedures. It should be understood that the separate control area/room  12  of  FIG. 1  (not shown in  FIG. 2 ) may continue to be used in conjunction with the bedside interface device to be described below.  FIG. 2  also shows multi-display monitor  20  as well as a procedure table or bed  22 . While procedure room  10  may include multiple, individual monitors, monitor  20  may be a multi-display monitor configured to display a plurality of different input channels in respective display areas on the monitor. In an embodiment, the monitor  20  may be a commercially available product sold under the trade designation VantageView™ from St. Jude Medical, Inc. of St. Paul, Minn., USA, which can have a 3840×2160 Quad-HD screen resolution with the flexibility to accept up to sixteen (16) digital or analog image inputs while displaying up to eight (8) images on one screen at one time. The procedure table  22 , which may be of conventional construction, is configured to receive a patient (not shown) on whom diagnostic and/or therapeutic procedure(s) are to be performed. 
       FIG. 2  further shows means or apparatus  24  for facilitating physician interaction with one or more diagnostic and/or therapeutic systems. Means or apparatus  24  includes a bedside interface device  26  and optionally one or more base interfaces  28 . Means or apparatus  24  provides the mechanism for the EP physician  16  to directly interact with such systems without the need for the intermediate step of verbalizing commands to a control technician, as described in connection with  FIG. 1 . In this regard, bedside interface device  26  is configured to present a user interface or other input logic with which the user (e.g., the EP physician  16 ) can directly interact or from which an input can be acquired. In multiple embodiments, various modes of interaction are presented, such as interaction via a user touch, a user multi-touch, a user gesture, a verbal command, a motion pattern of a user-controlled device, a user motion pattern and a user electroencephalogram. In addition, bedside interface device  26  can be configured to communicate with one or more of the diagnostic/therapeutic systems either wirelessly (as shown) or via a wired connection (not shown). 
     The base interface  28  is configured to interpret and/or facilitate directing the input acquired by the bedside interface device  26  to the appropriate one or more diagnostic and/or therapeutic systems (e.g., an electro-anatomic mapping system). In an embodiment, base interface  28  is centralized (as shown), wherein all communications with bedside device  26  occur through base interface  28 . In a further embodiment, base interface  28  may be functionally distributed, wherein interface functions are located within each diagnostic or therapeutic system. In a still further embodiment, communications between bedside interface  26  and certain ones of the diagnostic/therapeutic systems can be centralized, while communications with other ones of the diagnostic/therapeutic systems can occur directly (i.e., separately). 
     The means or apparatus  24  addresses a number of the shortcomings of the conventional practice as described in the Background. For example, means or apparatus  24  allows the EP physician  16  to directly input levels of degree, for example, how much to rotate a view, as opposed to trying to verbally communicate “how much” to a control technician. Further, the use of means or apparatus  24  avoids the potential confusion that can sometimes occur between the EP physician and the control technician as to convention (i.e., does “rotate right” mean rotate the view or the model?). In addition, the use of means or apparatus  24  reduces or eliminates the inherent time delay between the time when the EP physician verbally issues a command and the time when the command is understood and acted upon by the technician. 
     With continued reference to  FIG. 2 , the physician  16  will typically have access to a plurality of diagnostic and/or therapeutic systems in order to perform one or more medical procedures. In the illustrative embodiment, the physician  16  may have access to a first imaging system, such as a fluoroscopic imaging system  30 , a second imaging system, such as an intracardiac ultrasound or echocardiography (ICE) imaging system  32 , an electro-anatomic positioning, mapping, and visualization system  34 , a further positioning system, such as a medical positioning system (magnetic-field based)  36 , a patient data (electrophysiological (EP) data) monitoring and recording system  38 , a cardiac stimulator  40 , an EP data editing/monitoring system  42  and an ablation system  44 .  FIG. 2  schematically shows a communication mechanism  46  which facilitates communication between and among the various systems described above. It should be understood, however, that the communications mechanism  46  may not necessarily function to enable communications between each and every system shown. 
     The fluoroscopic imaging system  30  may comprise conventional apparatus known in the art, for example, single plane or bi-plane configurations. A display area  48  that is shown on monitor  20  corresponds to the display output of fluoroscopic imaging system  30 . 
     The intracardiac ultrasound and/or intracardiac echocardiography (ICE) imaging system  32  may also comprise conventional apparatus known in the art. For example, in one embodiment, the system  32  may comprise a commercial system available under the trade designation ViewMate™ Z intracardiac ultrasound system compatible with a ViewFlex™ PLUS intracardiac echocardiography (ICE) catheter, from St. Jude Medical, Inc. of St. Paul, Minn., USA. The system  32  is configured to provide real-time image guidance and visualization, for example, of the cardiac anatomy. Such high fidelity images can be used to help direct diagnosis or therapy during complex electrophysiology procedures. A display area  50  that is shown on monitor  20  corresponds to the display output of the ultrasound imaging system  32 . 
     The system  34  is configured to provide many advanced features, such as visualization, mapping, navigation support and positioning (i.e., determine a position and orientation (P&amp;O) of a sensor-equipped medical device, for example, a P&amp;O of a distal tip portion of a catheter). Such functionality can be provided as part of a larger visualization, mapping and navigation system, for example, an EnSite™ Velocity™ cardiac electro-anatomic mapping system running a version of EnSite™ NavX™ navigation and visualization technology software commercially available from St. Jude Medical, Inc., of St. Paul, Minn. and as also seen generally by reference to U.S. Pat. No. 7,263,397 (the &#39;397 patent), or U.S. Pat. No. 7,885,707 (the &#39;707 patent). The &#39;397 patent and the &#39;707 patent are both hereby incorporated by reference as though fully set forth herein. System  34  can be configured to perform further advanced functions, such as motion compensation and adjustment functions. Motion compensation may include, for example, compensation for respiration-induced patient body movement, as described in U.S. application Ser. No. 12/980,515, filed 29 Dec. 2010, which is hereby incorporated by reference as though fully set forth herein. System  34  can be used in connection with or for various medical procedures, for example, EP studies or cardiac ablation procedures. 
     System  34  is further configured to generate and display three dimensional (3D) cardiac chamber geometries or models, display activation timing and voltage data to identify arrhythmias, and to generally facilitate guidance of catheter movement in the body of the patient. For example, a display area  52  that is shown on monitor  20  corresponds to the display output of system  34 , can be viewed by physician  16  during a procedure, which can visually communicate information of interest or need to the physician. The display area  52  in  FIG. 2  shows a 3D cardiac model, which, as will be described below in greater detail, may be modified (i.e., rotated, zoomed, etc.) pursuant to commands given directly by physician  16  via the bedside interface device  26 . 
     System  36  is configured to provide positioning information with respect to suitably configured medical devices (i.e., those including a positioning sensor). System  36  may use, at least in part, a magnetic field based localization technology, comprising conventional apparatus known in the art, for example, as seen by reference to U.S. Pat. No. 7,386,339 (the &#39;339 patent), U.S. Pat. No. 6,233,476 (the &#39;476 patent), and U.S. Pat. No. 7,197,354 (the &#39;354 patent). The &#39;339 patent, the &#39;476 patent, and the &#39;354 patent are all hereby incorporated by reference as though fully set forth herein. System  36  may comprise MediGuide™ Technology, a medical positioning system commercially offered by MediGuide Ltd. of Haifa, Israel and now owned by St. Jude Medical, Inc. of St. Paul, Minn., USA. System  36  may alternatively comprise variants, which employ magnetic field generator operation, at least in part, such as a combination magnetic field and current field-based system such as the CARTO™ 3 System available from Biosense Webster, and as generally shown with reference to one or more of U.S. Pat. Nos. 6,498,944, 6,788,967 and 6,690,963, the entire disclosures of each of the foregoing being incorporated herein by reference as though fully set forth herein. 
     EP monitoring and recording system  38  is configured to receive, digitize, display and store electrocardiograms, invasive blood pressure waveforms, marker channels, and ablation data. System  38  may comprise conventional apparatus known in the art. In one embodiment, system  38  may comprise a commercially available product sold under the trade designation EP-WorkMate™ from St. Jude Medical, Inc. of St. Paul, Minn., USA. The system  38  can be configured to record a large number of intracardiac channels, may be further configured with an integrated cardiac stimulator (shown in  FIG. 2  as stimulator  40 ), as well as offering storage and retrieval capabilities of an extensive database of patient information. Display areas  54 ,  56  shown on monitor  20  correspond to the display output of EP monitoring and recording system  38 . 
     Cardiac stimulator  40  is configured to provide electrical stimulation of the heart during EP studies. Stimulator  40  can be provided in either a stand-alone configuration, or can be integrated with EP monitoring and recording system  38 , as shown in  FIG. 2 . Stimulator  40  is configured to allow the user to initiate or terminate tachy-arrhythmias manually or automatically using preprogrammed modes of operation. Stimulator  40  may comprise conventional apparatus known in the art. In an embodiment, stimulator  40  can comprise a commercially available cardiac stimulator sold under the trade designation EP-4™ available from St. Jude Medical, Inc. of St. Paul, Minn., USA. The display area  58  shown on monitor  20  corresponds to the display output of the cardiac stimulator  40 . 
     EP data editing/monitoring system  42  is configured to allow editing and monitoring of patient data (EP data), as well as charting, analysis, and other functions. System  42  can be configured for connection to EP data recording system  38  for real-time patient charting, physiological monitoring, and data analysis during EP studies/procedures. System  42  may comprise conventional apparatus known in the art. In an embodiment, system  42  may comprise a commercially available product sold under the trade designation EP-NurseMate™ available from St. Jude Medical, Inc. of St. Paul, Minn., USA. 
     To the extent the medical procedure involves tissue ablation (e.g., cardiac tissue ablation), ablation system  44  can be provided. The ablation system  44  may be configured with various types of ablation energy sources that can be used in or by a catheter, such as radio-frequency (RF), ultrasound (e.g. acoustic/ultrasound or HIFU), laser, microwave, cryogenic, chemical, photo-chemical or other energy used (or combinations and/or hybrids thereof) for performing ablative procedures. RF ablation embodiments may and typically will include other structure(s) not shown in  FIG. 2 , such as one or more body surface electrodes (skin patches) for application onto the body of a patient (e.g., an RF dispersive indifferent electrode/patch), an irrigation fluid source (gravity feed or pump), and an RF ablation generator (e.g., such as a commercially available unit sold under the model number IBI-1500T RF Cardiac Ablation Generator, available from St. Jude Medical, Inc.). 
       FIG. 3A  is a plan view of a first embodiment of a bedside interface device comprising a computer  26   a , suitable for use in the EP lab of  FIG. 2 , and showing a first application-specific user interface. The computer  26   a  includes a touch-responsive display panel and thus may be referred to hereinafter sometimes as a touch panel computer. The touch panel computer  26   a , as shown in inset in  FIG. 3A , includes an electronic control unit (ECU) having a processor  60  and a computer-readable memory  62 , user interface (UI) logic  64  stored in the memory  62  and configured to be executed by processor  60 , a microphone  66  and voice recognition logic  68 . In an embodiment, voice recognition logic  68  is also stored in memory  62  and is configured to be executed by processor  60 . In an embodiment, the touch panel computer  26   a  is configured for wireless communication to base interface  28  (best shown in  FIG. 2 ). In addition, the touch panel computer  26   a  is configured to draw operating power at least from a battery-based power source—eliminating the need for a power cable. The resulting portability (i.e., no cables needed for either communications or power) allows touch panel computer  26   a  to be carried around by the EP physician  16  or other lab staff to provide control over the linked systems (described below) while moving throughout the procedure room  10  or even the control room  12 . In another embodiment, touch panel computer  26   a  can be wired for one or both of communications and power, and can also be fixed to the bedrail or in the sterile field. 
     In the illustrated embodiment, the UI logic  64  is configured to present a plurality of application-specific user interfaces, each configured to allow a user (e.g., the EP physician  16 ) to interact with a respective one of a plurality of diagnostic and/or therapeutic systems (and their unique interface or control applications). As shown in  FIG. 3A , the UI logic  64  is configured to present on the touch panel surface of computer  26   a  a plurality of touch-sensitive objects (i.e., “buttons”, “flattened joystick”, etc.), to be described below. In the illustrative embodiment, the UI logic  64  produces a first, application-selection group of buttons, designated as group  70 , and which are located near the top of the touch panel. Each of the buttons in group  70  are associated with a respective diagnostic and/or therapeutic system (and control or interface application therefore). For example, the six buttons labeled “EnSite”, “WorkMate”, “EP4”, “NurseMate”, “MediGuide”, “ViewMate” correspond to electro-anatomic mapping system  34  (for mapping control), EP recording system  38  (for patient data recording control), stimulator  40  (for stimulator control), EP data editing and monitoring system  42  (for charting) and ultrasound imaging system  32  (for ultrasound control), respectively. 
     When a user selects one of the buttons in group  70 , the UI logic  64  configures the screen display of computer  26   a  with an application-specific user interface tailored for the control of and interface with the particular EP system selected by the user. In  FIG. 3A , the “EnSite” system is selected, so the UI logic  64  alters the visual appearance of the “EnSite” button so that it is visually distinguishable from the other, non-selected buttons in group  70 . For example, when selected, the “EnSite” button may appear depressed or otherwise shaded differently than the other, non-selected buttons in group  70 . This always lets the user know what system is selected. The UI logic  64 , in an embodiment, also maintains the application-selection buttons in group  70  at the top of the screen regardless of the particular application selected by the user. This arrangement allows the user to move from system (application) to system (application) quickly and control each one independently. 
     With continued reference to  FIG. 3A , UI logic  64  presents an application-specific user interface tailored and optimized for control of and interaction with system  34 . This user interface includes a second, common-task group of selectable buttons, designated group  72 , a third, view-mode group of selectable buttons, designated group  74 , a fourth, view-select group of selectable buttons, designated group  76 , a flattened joystick  78  configured to receive view-manipulation input from the user, a voice recognition control button  80 , and a settings button  82 . Each group will be addressed in turn. 
     The second group  72  of buttons includes a listing of common tasks performed by an EP physician when interacting with system  34 . Each of the buttons in group  72  are associated with a respective task (and resulting action). For example, the five buttons in group  72  are labeled “Zoom In”, “Zoom Out”, “Add Lesion”, “Freeze Point”, and “Save Point”. The “Zoom In” and “Zoom Out” buttons allow the user to adjust the apparent size of the 3D model displayed on monitor  20  (i.e., enlarging or reducing the 3D model on the monitor). 
     For example,  FIG. 4A  is a view of the monitor  20  of  FIG. 2 , showing multiple inset displays for different applications, where the display area (window)  52   1  shows the EnSite™ display output of a 3D electro-anatomic model at a first magnification level.  FIG. 4B  is a further view of monitor  20 , showing a zoomed-in view of the same display area (window), now designated  52   2 , which has an increased magnification level and thus apparent size. This change of course allows the physician to see details in window  52   2  that may not be easy to see in window  52   1 . 
     Referring again to  FIG. 3A , the “Add Lesion” button is configured to add a lesion marker to the 3D model. Other commands can be also be executed using the “Freeze Point” and “Save Point” buttons. It should be understood that variations are possible. 
     Each of the buttons in group  74  are associated with a respective display mode, which alters the display output of system  34  to suit the wishes of the physician. For example, the three selectable buttons labeled “Dual View”, “Right View”, and “Map View” re-configure the display output of system  34 , as will appear on monitor  20 . 
     Each of the buttons in group  76  are associated with a respective viewpoint from which the 3D electro-anatomic model is “viewed” (i.e., as shown in window  52  on monitor  20 ). Three of the five selectable buttons, namely those labeled “LAO”, “AP”, and “RAO”, allow the user to reconfigure the view point from which the 3D electro-anatomic model is viewed (i.e., left anterior oblique, anterior-posterior, right anterior oblique, respectively). The remaining two buttons, namely those labeled “Center at Surface” and “Center at Electrode” allow the user to invoke, respectively, the following functions: (1) center the anatomy shape in the middle of the viewing area; and (2) center the current mapping electrode or electrodes in the middle of the viewing area. 
     The flattened joystick  78  is a screen object that allows the user to rotate the 3D model displayed in the window  52 . In addition, as the point of contact (i.e., physician&#39;s finger) with the joystick object  78  moves from the center or neutral position, for example at point  83 , towards the outer perimeter (e.g., through point  84  to point  86 ), the magnitude of the input action increases. For example, the acceleration of rotation of the model or cursor will increase. While  FIG. 3A  shows the joystick object  78  as having three (3) gradations or concentric bands, it should be appreciated that this is for clarity only and not limiting in number. For example, in an embodiment, a relatively larger number of gradations or bands, such as ten (10), may be provided so as to effectively provide for a substantially continuous increase in sensitivity (or magnitude) as the point of contact moves toward the outer radius. In another embodiment, a single gradient may be continuous from the center position, point  83 , to the outer edge of the joystick object  78 , with the centermost portion of the gradient being the brightest in intensity or color and the outermost portion of the gradient being the darkest in intensity or color, for example. In yet another embodiment, a single gradient may be continuous from the center position, point  83 , to the outer edge of the joystick object  78 , with the centermost portion of the gradient being the darkest in intensity or color and the outermost portion of the gradient being brightest in intensity or color, for example. 
     In a further embodiment, UI logic  64  can be further configured to present an additional button labeled “Follow Me” (not shown), which, when selected by the user, configures the electro-anatomic mapping system  34  for “follow me” control. This style of control is not currently available using a conventional keyboard and mouse interface. For “follow me” control, UI logic  64  is configured to receive a rotation input from the user via the touch panel (e.g., joystick  78 ); however, the received input is interpreted by system  34  as a request to rotate the endocardial surface rendering (the “map”) while maintaining the mapping catheter still or stationary on the display. In an embodiment, the physician can set the position and orientation of the mapping catheter, where it will remain stationary after the “Follow Me” button is selected. 
     Another feature of the touch panel computer  26   a  is that it incorporates, in an embodiment, voice recognition technology. As described above, computer  26   a  includes microphone  66  for capturing speech (audio) and voice recognition logic  68  for analyzing the captured speech to extract or identify spoken commands. The voice recognition feature can be used in combination with the touch panel functionality of computer  26   a . The microphone  66  may comprise conventional apparatus known in the art, and can be a voice recognition optimized microphone particularly adapted for use in speech recognition applications (e.g., an echo-cancelling microphone). Voice recognition logic  68  may comprise conventional apparatus known in the art. In an embodiment, voice recognition logic  68  may be a commercially available component, such as software available under the trade designation DRAGON DICTATION™ speech recognition software. 
     In an embodiment, computer  26   a  is configured to recognize a defined set of words or phrases adapted to control various functions of the multiple applications that are accessible or controllable by computer  26   a . The voice recognition feature can itself be configured to recognize unique words or phrases to selectively enable or disable the voice recognition feature. Alternatively (or in addition to), a button, such as button  80  in  FIG. 3A , can be used to enable or disable the voice recognition feature. In this regard, the enable/disable button can be either a touch-sensitive button (i.e., screen object), or can be hardware button. 
     Voice recognition logic  68  is configured to interact with the physician or other user to “train” the logic (e.g., having the user speak known words) so as to improve word and/or phrase recognition. The particulars for each user so trained can be stored in a respective voice (user) profile, stored in memory  62 . For example, in  FIG. 3A , the currently active voice profile is listed in dashed-line box  89 . In an embodiment, each user can have unique commands, which may also be stored in the respective voice profile. In a further embodiment, the language need not be English, and can be other languages. This flexibility as to language choice enlarges the audience of users who can use the device  26   a . The voice recognition feature presents a number of advantages, including the fact that the physician  16  does not have to remove his/her hands from the catheter or other medical device being manipulated. In addition, the absence of contact or need to touch computer  26   a  maintains a sterile condition. The voice recognition feature can also be used either alone or in combination with other technologies. 
     With continued reference to  FIG. 3A , UI logic  64  also presents a “Settings” button  82 . When the “Settings” button  82  is selected, UI logic  64  generates another screen display that allows the user to adjust and/or set/reset various settings associated with the application currently selected. In an embodiment, the “Settings” button can also allow adjustment of parameters that are more global in nature (i.e., apply to more than one application). For example only, through “Settings”, the physician or another user can edit all of the phrases associated with a particular physician or specify a timeout (i.e., the elapsed amount of time, after which the computer will stop listening (or not) for voice commands). The physician or another user can also edit miscellaneous parameters, such as communication settings and the like. 
       FIG. 3B  is an isometric view of a sterile drape  88  configured to protect the touch panel computer  26   a  of  FIG. 3A  from contamination and to maintain the physician&#39;s sterility. Conventional materials and construction techniques can be used to make drape  88 . 
       FIG. 5  is a plan view of touch panel computer  26   a  showing a different application-specific user interface, now relating to EP monitoring and recording system  38  (i.e., “EP-WorkMate”). In the illustrative embodiment, UI logic  64  produces the same application-selection group  70  of buttons along the top of the touch panel, for quick and easy movement by the user between applications. A second, common-tasks group of buttons, designated as group  90 , are shown below group  70 . For example, the three buttons labeled “Record”, “Update”, and “Add Map Point” can execute the identified function. Likewise, additional groups of buttons are shown, grouped by function, for example the signals-adjustment group  92 , the events group  94 , the timer group  96  and the print group  98 . It should be understood that variations are possible, depending on the items that can be adjusted or controlled on the destination system. It warrants emphasizing that UI logic  64  thus presents a unique user interface tailored to the requirements of the particular application selected. Each group includes items that are commonly asked for by the physician. For example, in the signals group  92 , the Speed +/− buttons can be used to change the viewed waveform sweep speed as the physician may need more or less detail; the Page +/− buttons can be used to change the page of signals being viewed (e.g., from surface ECG signals to intracardiac signals); and the Amplitude +/− buttons can be used to change the signal amplitudes up or down. As a further example, in the Events group  94 , the enumerated Events buttons cause a mark to be created in the patient charting log to indicate a noteworthy (i.e., important) item or event, such as the patient was just defibrillated or entered a tachy-arrhythmia. Note that these items are all user definable and speakable (capable of being tied to the voice recognition function). The physician also needs to keep track of certain periods of time. Thus, in the Timer group  96 , the timer buttons can be used to keep track of such periods of time, for example, such as a certain time after an ablation (e.g., 30 minutes) to verify that the ablation procedure is still effective. Finally, regarding the print group  98 , various print buttons are provided so as to avoid requiring a physician to verbally indicate (e.g., by way of shouting out “print that document to the case” or the like) and to include such documents in a final report. 
       FIG. 6  is a plan view of touch panel computer  26   a  showing in exemplary fashion a further, different application-specific user interface relating to the ultrasound imaging system  32  (“ViewMate”). As with the other application-specific user interfaces, the user interface presented in  FIG. 6  repeats the common, application-selection group of buttons, designated group  70 . A further group of buttons and adjustment mechanisms are located in group  100 . The controls (buttons, sliders) provided for this user interface completely eliminate the need to have a separate ultrasound keyboard to control the console. The user interface shown can be different, independent on the kind of machine being controlled, but at a minimum may typically provide a way to control the receive gain, the depth setting, the focus zone, the TGC (i.e., time gain compensation) curve, the monitoring mode (e.g., B, M, color Doppler, Doppler), image recording, as well as other image attributes and states. Note, trackpad object  101  is shown in the center of the user interface. The capability provided by UI logic  64  to rapidly switch applications and present to the bedside user an application-specific user interface minimizes or eliminates many of the shortcomings set forth in the Background. 
     It should be understood that variations in UI logic  64  are possible. For example, certain applications can be linked (in software) so that multiple applications can be controlled with a single command (e.g., the Record command). In another embodiment, UI logic  64  can be configured to provide additional and/or substitute functions, such as, without limitation, (1) map creation; (2) collecting points; (3) segmenting regions by anatomy; (4) map view (rotate and zoom); (5) select/manipulate a number of maps and view each; (6) selection of signal trace display; (7) adjust EP signal amplitude; (8) sweep speed; (9) provide single button (or touch, multi-touch, gesture) for recording a segment, placing an event marker, and/or placing a lesion marker. 
     It should be further understood that the screen layouts in the illustrative embodiment are exemplary only and not limiting in nature. The UI logic  64  can thus implement alternative screen layouts for interaction by the user. For example, while the screen displays in  FIGS. 3A, 5 and 6  show an approach that incorporates the top level menu items on every screen, multi-level menus can also be used. For example, the screen layouts can be arranged such that a user descends down a series of screens to further levels of control. To return to upper levels (and to the “home” screen), a “Back” button or the like can be provided. Alternatively, a “Home” button can be provided. 
     In a still further embodiment, UI logic  64  can be configured for bi-directional display of information, for example, on the touch-responsive display panel. As one example, the “EnSite” user interface ( FIG. 3A ) can be configured so that the EnSite™ model is sent to the computer  26   a  and displayed on the touch-responsive display panel. The user interface provided by UI logic  64  can allow the user to drag his or her finger on the panel to rotate the model. The display of the model provides context with respect to the act of dragging. Other information can be displayed as well, such as a waveform. In various embodiments, all or a portion of the items/windows displayed on monitor  20  (see, e.g.,  FIGS. 2, 4A, and 4B ) may be displayed or mirrored on the touch-responsive display panel. For example, display area or window  52  may be displayed on the touch-responsive display panel allowing the physician or other user to directly modify the features of window  52  at the patient&#39;s bedside. Other display areas/windows, such as windows  50 ,  54 ,  56 ,  58 , and/or  48  (see  FIG. 2 ) may also be displayed and/or modified on the touch-panel display panel. One further example involves displaying feedback information or messages originating from the various devices or systems back to the touch-responsive display panel. In this regard, the UI logic  64  can configure any of the user-interfaces to have a message area, which can show informational messages, warning messages or critical error messages for viewing by the user. The message area feature provides a way to immediately alert the physician to such messages, rather than the physician having to watch for messages on multiple displays. 
       FIG. 7A  is a diagrammatic and block diagram view of a second embodiment of the bedside interface device, comprising an electronic wand system  26   b . As with touch panel computer  26   a , wand system  26   b  is configured to allow the EP physician to take control, bedside of the patient, of an EP diagnostic or therapeutic system, such as the electro-anatomic mapping system  34 . The wand system  26   b  includes a wireless remote control portion  102 , an optical emitter portion  104 , and a base interface  28   b , which may be coupled to the desired, target EP system through either a wired or wireless connection. The wand system  26   b  incorporates remote control technology, and includes the ability to detect and interpret motion of the remote control indicative of an EP physician&#39;s command or other instruction, detect and interpret key-presses on the remote control, and/or detect and interpret motion/keypress combinations. 
     Since the wand system  26   b  is contemplated as being used in the sterile procedure room, multiple embodiments are contemplated for avoiding contamination. In this regard, wand system  26   b  may be configured with a disposable remote control portion  102 , with a reusable remote control portion  102  that is contained within an enclosure compatible with sterilization procedures, with a reusable remote control portion  102  adapted to be secured in a sterilization-compatible wrapper, or with a reusable remote control portion  102  that is encased in a sterile but disposable wrapper. 
     With continued reference to  FIG. 7A , remote control portion  102  may include an optical detector  106 , an electronic processor  108 , a memory  110 , an optional accelerometer  112  and a wireless transmitter/receiver  114 . The processor  108  is configured to execute a control program that is stored in memory  110 , to achieve the functions described below. The optical emitter  104  is configured to emit a light pattern  105  that can be detected and recognized by optical detector  106 . For example, the light pattern may be a pair of light sources spaced apart by a predetermined, known distance. The control program in remote  102  can be configured to assess movement of the light pattern  105  as detected by detector  106  (e.g., by assessing a time-based sequence of images captured by detector  106 ). For example, in the exemplary light pattern described above, processor  108  can be configured to determine the locations of the light sources (in pixel space). In an embodiment, the control program in remote  102  may only discern the light pattern  105  itself (e.g., the locations in pixel space) and transmit this information to base interface  28   b , which in turn assesses the movement of the detected light pattern in order to arrive at a description of the motion of the remote  102 . In a still further embodiment, various aspects of the processing may be divided between processor  108  and a processor (not shown) contained in base interface  28   b . The processor  106  communicates with base interface  28   b  via the wireless transmitter/receiver  114 , which may be any type of wireless communication method now known or hereafter developed (e.g., such as those technologies or standards branded Bluetooth™, Wi-Fi™, etc.). The processor  108  is configured to transmit wirelessly to interface  28   b  the detected keypresses and information concerning the motion of the remote control  102  (e.g., the information about or derived from the images from the optical detector  106 ). In an embodiment, the motion of remote control  102  may also be determined, or supplemented by, readings from accelerometer  112  (which may be single-axis or multi-axis, such as a 3-axis accelerometer). In some instances, rapid motion may be better detected using an accelerometer than using optical methods. In an embodiment, electronic wand system  26   b  may be similar to (but differing in application, as described herein) a commercially available game controller sold under the trade designation Wii Remote Controller, from Nintendo of America, Inc. 
     Either the remote  102  or the base interface  28   b  (or both, potentially in some division of computing labor) is configured to identify a command applicable to the one of the EP diagnostic/therapeutic systems, such as electro-anatomic mapping system  34 , based on the detected motion of the remote  102 . Alternatively, the command may be identified based on a key press, or a predetermined motion/key press combination. Once the remote  102  and/or interface  28   b  identifies the command it is transmitted to the appropriate EP system. In an electro-anatomic mapping system embodiment, the wireless remote control  102  is configured to allow an EP physician to issues a wide variety of commands, for example only, any of the commands (e.g., 3D model rotation, manipulation, etc.) described above in connection with touch panel computer  26   a . By encoding at least some of the control through the wireless remote control  102  that the EP physician controls, one or more of the shortcomings of conventional EP labs, as described in the Background, can be minimized or eliminated. As with touch panel computer  26   a , electronic wand system  26   b  can reduce procedure times as the EP physician will spend less time playing “hot or cold” with the mapping system operator (i.e., the control technician), but instead can set the display to his/her needs throughout the medical procedure. 
       FIG. 7B  shows a further embodiment, designated interface device  26   c . Interface device  26  integrates the remote control  102  described above into the handle of a catheter  115 . Through the foregoing, the physician need not take his hands off the catheter, but rather can issue direct, physical commands (e.g., via key-presses) while retaining control of the catheter. Additionally, one or more of the keys or a slider switch on the catheter handle may serve as a safety mechanism to prevent inadvertent activation of one or more commands while operating the catheter. In such an embodiment, after advancing the catheter into a patient&#39;s body, the safety mechanism may be deactivated or otherwise turned off such that the physician can issue commands and then he or she may reactivate or turn on the safety mechanism and resume manipulating the catheter without fear of modifying the view or model shown on an on-screen display, for example. The catheter  115  may further comprise one or more electrodes on a distal portion of the catheter shaft and a manual or motorized steering mechanism (not shown) to enable the distal portion of the catheter shaft to be steered in at least one direction. In at least one embodiment, the catheter handle may be generally symmetric on opposing sides and include identical or nearly identical sets of controls on opposing sides of the handle so that a physician need not worry about which side of the catheter handle contains the keys. In another embodiment, the catheter handle may be generally cylindrical in shape and include an annular and/or rotatable control feature for issuing at least one command, again so the physician need not worry about the catheter handle&#39;s orientation in his or her hand(s). Exemplary catheters, handles, and steering mechanisms are shown and described in U.S. Pat. No. 5,861,024, U.S. application Ser. No. 12/861,555, filed 23 Aug. 2012 (the &#39;555 application), U.S. Pat. Nos. 7,465,288, and 6,671,533, each of which is hereby incorporated by reference as though fully set forth herein. 
       FIG. 8  is a diagrammatic and block diagram view of a fourth embodiment of the bedside interface device, comprising a motion capture apparatus  26   d . As with touch panel computer  26   a , wand system  26   b  and integrated system  26   c , motion capture apparatus  26   d  is configured to allow the EP physician to take control, bedside of the patient, of an EP diagnostic or therapeutic system, such as electro-anatomical mapping system  34 . The motion capture apparatus  26   d  includes a capture apparatus  116  having both an optical sub-system  118  and a microphone sub-system  120  where the apparatus  116  is coupled to a base interface  28   b . The apparatus  116  is configured to optically detect the motion or physical gestures of the EP physician or other user when such movements occur within a sensing volume  122 . The base interface  28   b  may be coupled to the desired, target EP system through either a wired or wireless connection. 
     The motion capture apparatus  26   d  includes the capability to detect hand/arm/leg/trunk/facial motions (e.g., gestures) of the EP physician or other user and translate the detected patterns into a desired command. Apparatus  26   d  also includes audio capture and processing capability and thus also has the capability to detect speech and translate the same into desired commands. In an embodiment, apparatus  26   d  is configured to detect and interpret combinations and sequences of gestures and speech into desired commands. The base interface  28   b  is configured to communicate the commands (e.g., rotation, zoom, pan of a 3D anatomical model) to the appropriate EP diagnostic or therapeutic system (e.g., the electro-anatomic mapping system  34 ). In an embodiment, the motion capture apparatus  26   d  may comprise commercially available components, for example, the Kinect™ game control system, available from Microsoft, Redmond, Wash., USA. A so-called Kinect™ software development kit (SDK) is available, which includes drivers, rich application programming interfaces (API&#39;s), among other things contents, that enables access to the capabilities of the Kinect™ device. In particular, the SDK allows access to raw sensor streams (e.g., depth sensor, color camera sensor, and four-element microphone array), skeletal tracking, advanced audio (i.e., integration with Windows speech recognition) as well as other features. 
     Since there is no contact contemplated by EP physician  16  during use of motion capture apparatus  26   d , contamination and subsequent sterilization issues are eliminated or reduced. In addition, the lack of contact with apparatus  26   d  for control purposes allows the EP physician to keep his hands on the catheter or other medical device(s) being manipulated during an EP procedure. By encoding at least some of the control through the motion capture apparatus  26   d , with which the EP physician interacts, one or more of the shortcomings of conventional EP labs, as described in the Background, can be minimized or eliminated. As with the previous embodiments, the motion capture apparatus  26   d  can reduce procedure times. 
     It should be understood that variations are possible. For example, the motion capture apparatus  26   d  can be used in concert with sensors and/or emitters in a sterile glove to assist the apparatus  26   d  to discriminate commands intended to be directed to one of the EP systems, versus EP physician hand movements that result from his/her manipulation of the catheter or medical device, versus other movement in the EP lab in general. In another embodiment, the motion capture apparatus  26   d  may discriminate such commands by being “activated” by a user when a specific verbal command is issued (e.g., “motion capture on”) and then “deactivated” by the user when another specific verbal command is issued (e.g., “motion capture off”). 
       FIGS. 9-10  are diagrammatic views of fifth and sixth embodiments of the bedside interface device, comprising touch responsive devices.  FIGS. 9 and 10  show touch-screen mouse pad devices  26   e  and  26   f , respectively. These devices can be covered in a sterile bag. The EP physician  16  can move the mouse cursor from application to application and control each such application independently. Devices  26   e ,  26   f  may comprise conventional apparatus known in the art. 
       FIG. 11  is a diagrammatic view of a seventh embodiment of the bedside interface device comprising a customized joystick  26   g . Joystick  26   g  can also be covered in a sterile bag. The device  26   g  can be used to be provide application-specific control a particular application function(s), such as rotating a 3D model (system  34 ), adding lesion markers, and the like. 
       FIGS. 12-13  are diagrammatic views of eighth and ninth embodiments of the bedside interface device comprising holographic mouse and keyboard input devices, respectively. Holographic mouse  26   h  deploys light beam pattern  124 , which is used by the mouse  26   h  to acquire user input (i.e., movement of the physician&#39;s finger, instead of moving a conventional mouse). The movement input can be used in the same manner as that obtained from a conventional mouse. Holographic keyboard  26   i  also deploys a light beam pattern  126  corresponding to a keyboard. A physician&#39;s finger can be used to “select” the key much in the same manner as a conventional keyboard, but without any physical contact. Devices  26   h ,  26   i  have the advantage of being sterile without any disposables, and can incorporate wireless communications and may be powered using batteries (i.e., no cables needed). 
     It should be understood that variations are possible. For example, in a further embodiment, primary control by the physician in manipulating or interacting with the mapping system may be through use of voice control alone (i.e., a microphone coupled with voice recognition logic), apart from its inclusion with other modes or devices for user interaction described above. In a still further embodiment, the physician can be equipped with headgear that monitors head movements to determine at what location on the screen/monitor the physician is looking. In effect, such headgear can act as a trackball to move or otherwise manipulate an image (or view of a model) on the monitor in accordance with the physician&#39;s head movements. In a yet further embodiment, the physician can be equipped with headgear that monitors head movements and/or also monitors brainwave patterns (e.g., to record a user electroencephalogram (EEG)). Such monitored data can be analyzed to derive or infer user input or commands for controlling an image (or view of a model), as described above. An EEG-based embodiment may comprise conventional apparatus known in the art, for example, commercially available products respectively sold under the trade designation MindWave™ headset from NeuroSky, Inc., San Jose, Calif., USA, or the Emotiv EPOC™ personal interface neuroheadset from Emotiv, Kwun Tong, Hong Kong. In a still further embodiment, the physician can be equipped with an eye tracking apparatus, wherein monitored eye movements constitute the user input to be interpreted by the system (e.g., the eye movements can be interpreted as a cursor movement or other command). 
     It should also be appreciated that while the foregoing description pertains to an EP physician manually controlling a catheter through the use of a manually-actuated handle or the like, other configurations are possible, such as robotically-actuated embodiments. For example, a catheter movement controller (not shown) described above may be incorporated into a larger robotic catheter guidance and control system, for example, as seen by reference to U.S. application Ser. No. 12/751,843, filed 31 Mar. 2010, which is hereby incorporated by reference as though fully set forth herein. Such a robotic catheter system may be configured to manipulate and maneuver catheters within a lumen or a cavity of a human body, while the bedside interface devices described herein can be used to access and control the EP diagnostic and/or therapeutic systems. In at least one embodiment, a bedside interface device as described herein may also be used to access and control the robotic catheter system. 
       FIG. 14  is a block diagram of a base interface, designated  128 , which may be one part of a system  127  ( FIG. 15 ) configured to enable one or more users to remotely control a robotic medical device system, such as a robotic catheter system. In an embodiment, another part of system  127  may comprise a motion capture apparatus, for example, motion capture apparatus  26   d  shown in  FIG. 15 . Motion capture apparatus  26   d  may be configured to capture the motion of one or more users in a sensing volume and generate output data indicative of the captured user motion. Base interface  128  may be configured generally to analyze the generated output data from the motion capture apparatus  26   d  to identify/recognize one or more three-dimensional (3D) gestures, and then translate such gestures into one or more robotic catheter control commands. The catheter control commands may be configured to control an aspect of the operation of the robotic catheter system. One such robotic catheter system is described in connection with  FIGS. 18-23 . 
     With continued reference to  FIG. 14 , base interface  128  includes an electronic control unit having one or more electronic processors  130  and memory  132 . Base interface  128  further includes gesture recognition logic  134  and interpreter logic  136 . Both gesture recognition logic  134  and interpreter logic  136 , in an embodiment, comprise programmed logic (e.g., software) that is stored in memory  132  and is configured to be executed by the one or more processors  130 . 
     Gesture recognition logic  134  is configured to recognize one or more three-dimensional (3D) user gestures based on an analysis of the output data generated by motion capture apparatus  26   d . In an embodiment, motion capture apparatus  26   d  comprises commercially available components, for example, the Kinect™ game control system, available from Microsoft, Redmond, Wash., USA. Gesture recognition logic  134  can, in an embodiment, comprise implementations developed using a Kinect™ software development kit (SDK), which includes drivers, rich application programming interfaces (API&#39;s), among other things, that enables access to the capabilities of the Kinect™ device. The SDK allows access to raw sensor streams (e.g., depth sensor, color camera sensor, and four-element microphone array), skeletal tracking, advanced audio (i.e., integration with Windows speech recognition) as well as other features. 
     Interpreter logic  136  is configured to translate the one or more 3D gestures recognized by gesture recognition logic  134  to one or more corresponding robotic catheter control commands. Such robotic catheter control commands may be configured to control one or more aspects of the operation of a robotic catheter system, such as the robotic catheter system described in connection with  FIGS. 18-23 . For example only, such commands can include deflection, rotation, and/or translation of one or more robotically controlled catheters and/or sheaths. Interpreter logic  136 , in an embodiment, may comprise application level code configured to use, for example, various features available in the Kinect™ SDK mentioned above. 
       FIG. 15  is a diagrammatic and block diagram view of system  127 , which includes motion capture apparatus  26   d  and base interface  128 . In at least one embodiment, motion capture apparatus  26   d  includes capture apparatus  116  having both optical sub-system  118  and microphone sub-system  120 , as described above in connection with  FIG. 8 . Motion capture apparatus  26   d  may be configured to detect (e.g., optically) the physical motion of various objects, such as a user including portions of the user such as fingers, hands, arms, etc., that occur within a sensing volume  122 . The detected physical motion can also be that of a user-controlled implement, such as a wand (e.g., part or all of electronic wand system  26   b  described above) or the like. In an embodiment, sensing volume  122  is located proximate to the motion capture apparatus  26   d . Motion capture apparatus  26   d  may be electrically connected to base interface  128  for communication thereto of user motion data. 
     The user motion data is indicative of the captured user motion. The user motion data may include imaging data as well as other information concerning the 3D posture of various objects in the sensing volume. In this regard, it should be appreciated that as updates occur over time, the resulting time-based series can be used to determine the motion patterns of the objects being tracked. Base interface  128  may be coupled to a robotic catheter system such as robotic control system  210 , as shown, over a communication mechanism  46 , as also described above. 
     In an embodiment, gesture recognition logic  134  ( FIG. 14 ) is configured to track an object, for example, a specific body part such as a user&#39;s hand. Motion capture apparatus  26   d  can define the tracked object by one or more fiducial points. For example, in an embodiment, motion capture apparatus  26   d , in combination with software functionality as implemented in base interface  128  (e.g., via the SDK), can recognize and track the time-based motion of a person&#39;s body or skeleton  138 , including the time-based tracking of one or more of a plurality of constituent joints  140   1 ,  140   2 , . . .  140   n , where n is an integer. The above-mentioned fiducial points may be taken to correspond to the joints  140   1 ,  140   2 , . . .  140   n . Gesture recognition logic  134  can track the time-based positions of these fiducial points. The tracked positions in turn can form the basis of various metrics, such as position, distance, and rotation, all to be described below. 
     In light of the above, the output data generated by motion capture apparatus  26   d  includes fiducial point tracking data associated with a plurality of fiducial points defined with respect to the user. The fiducial point tracking data includes, for each fiducial point, a respective position. Each position may include a respective three-dimensional coordinate in a reference coordinate system, for example, defined within sensing volume  122  that is monitored by motion capture apparatus  26   d . In addition and/or in the alternative, the output motion data generated by motion capture apparatus  26   d  may comprise imaging data. 
     As shown in  FIG. 16A , for example, a skeleton  138   a  shows the respective positions of two fiducial points at  140   3  and  140   4  corresponding to the separated hands of the user. Gesture recognition logic  134  is configured to determine the position of the user&#39;s hands, and also a distance  142  between the user&#39;s hands. The position and distance between the user&#39;s hands can be translated by interpreter logic  136  to a robotic catheter control command. For example, the position and distance between the user&#39;s hands can be used to control the degree of extension or retraction of a catheter and/or a sheath along a respective translation axis. Thus, more generally, a robotic catheter control command may have a characteristic that corresponds to the magnitude of the action that is to be initiated by the command. In the example of  FIG. 16A , the magnitude of the action may be defined by the distance between preselected fiducial points. The action may be a catheter extension, a catheter retraction, a sheath extension, and a sheath retraction. 
     As shown in  FIG. 16B , as a further example, a skeleton  138   b  shows a sequence of time-based positions traversed by a single fiducial point (joint  140   4 ) during the rotation of a user&#39;s wrist. The time-based positions of the tracked fiducial point (joint  140   4 ) at times t 1 , t 2 , t 3 , t 4  and t 5  are designated  140   4-1 ,  140   4-2 ,  140   4-3 ,  140   4-4 , and  140   4-5  respectively. Through tracking, gesture recognition logic  134  can determine the extent of the rotation, as indicated by rotation angle  144 . In an embodiment, gesture recognition logic  134  recognizes the rotational motion while interpreter logic  136  translates this gesture into an output command, for example only, to actuate rotation of a catheter and/or a sheath. Interpreter logic  136  can be configured to generate the output rotation command further as a function of the determined rotation angle  144  (i.e., the extent of actual catheter and/or sheath rotation can be made to correspond to the determined rotation angle  144 ). The fiducial point tracking data output from motion capture apparatus  26   d  therefore includes, for each fiducial point, a respective time-based plurality of positions. Thus, more generally, a robotic catheter control command may have a characteristic that corresponds to the rotation associated with the action to be initiated by the command. In the example of  FIG. 16B , the rotation may be defined by the rotation angle through which the preselected fiducial point rotates. The action may be a catheter or sheath rotation. 
     In an embodiment, in the case of a gesture involving wrist rotation, gesture recognition logic  134  can be additionally configured to identify and track a wand (e.g., part or all of electronic wand system  26   b  described above), a baton or a like implement being held in the hand of the user. The use of such implements can improve the ability of the motion capture apparatus  26   d  to track the user&#39;s wrist motion (rotation). For example, a wand, being generally larger and more distinct than a wrist fiducial point (joint), can be expected to provide a correspondingly larger object in the imaging data and/or other data provided by the motion capture apparatus  26   d . This effectively provides greater resolution and robustness in the tracking functionality of motion capture apparatus  26   d /gesture recognition logic  134 . 
     Gesture recognition logic  134  may be configured to operate as described below to recognize a 3D gesture. First, gesture recognition logic  134  is configured to identify a start pose based on the fiducial point tracking data. In an embodiment, the start pose may correspond to a start condition where a first set of fiducial points assumes a first relationship therebetween. For example, this condition may be satisfied when the fiducial points form a first predetermined “constellation”. Second, gesture recognition logic  134  is configured to record the motion of a predetermined plurality of fiducial points after recognition of the start pose, and continue recording until an end pose is identified, which identification is also based on the fiducial tracking data. In an embodiment, the end pose may correspond to an end condition where a second set of fiducial points assume a second relationship therebetween. For example, this condition may be satisfied when the fiducial points form a second predetermined “constellation”. 
     Third, gesture recognition logic  134  is configured to compare the recorded motion of the predetermined plurality of fiducial points (being tracked) with a plurality of predefined gestures. Each predefined gesture is itself defined by a respective motion of a respective set of fiducial points. Finally, gesture recognition logic  134  is configured to output one of the plurality of predefined gestures as the recognized gesture when the recorded motion matches one of the predefined gestures (i.e., the recognized gesture being the one that matches the recorded motion). 
     System  127  may also include various safety features. As described above, motion capture apparatus  26   d  is generally responsive to activity occurring within sensing volume  122 . In an embodiment, motion capture apparatus  26   d /gesture recognition logic  134  can be configured to be responsive only to activity in a smaller 3D volume included within sensing volume  122  (hereinafter an “action box”). The purpose of the action box is that once it is defined, system  127  will only respond to actions that occur within the action box. For example, a user can only actuate the robotic catheter system by placing his hands in the action box or otherwise causing some activity to occur in the action box. This arrangement can be expected to reduce the occurrence of unintended actuation, thereby improving safety. The action box of sensing volume  122  can be positioned above a patient table (see  FIG. 2 , which shows a patient table and patient), in a control room, for example, control area/room  12  in  FIG. 1 , or in various other locations. 
     In an embodiment, system  127  can be configured to allow the user to adjust either or both of the size and location of the action box relative to motion capture apparatus  26   d . It should be understood that motion capture apparatus  26   d  will only respond to activities occurring within the action box, and ignore all other activity outside the action box. Staff can be trained to never place their hands or any other object into the action box as it is strictly for use by a trained physician because of the potential to actuate functionality of a medical device. In this regard, the action box can be delineated by a visible construct, such as a frame. The frame can be made of solid material, in which case is also presents a physical construct, or the outlines of the frame can be illuminated, for example, via low intensity laser beams. 
     For additional safety protection, system  127  can be configured to include a user-actuatable switch such as a dead-man switch  146 . Switch  146  may include a normally open state and a user-actuatable closed state. System  127  can be configured to be active only when the dead-man switch  146  has been closed by the user. System  127  may only respond to user actions (gestures) when the switch  146  has been actuated. In a further embodiment, system  127  may be configured to at least disable communication of a robotic control command to the robotic catheter system unless switch  146  is in the closed state. The dead-man switch  146  may comprise a switch on a wand, a foot pedal, or the like. 
     Although an embodiment has been described in connection with  FIGS. 14-15  and  FIGS. 16A-16B , other motion capture mechanisms can be used. For example, alternatives include an optical-based position tracking product (e.g., object or fiducial tracking system) known by the trade designation as the POLARIS® system and a magnetic-field based product known by the trade designation as the AURORA® system, both from Northern Digital Inc. 
       FIG. 17  shows a further embodiment involving hand motion tracking where a user input device  1000  can include a spatially detected glove or stylus. In an embodiment where user input device  1000  includes a spatially detected glove, the user&#39;s/wearer&#39;s index finger can be instrumented with various sensors  1040  (e.g., position and orientation sensors, and/or accelerometers). The glove or stylus input device can be locatable in 3-D space through the use of a positioning system employing a magnetic field, an electrostatic field, or through the use of an optical positioning system. In an embodiment, the positioning system can be implemented within a liquid tank (e.g., water tank), where field generators, such as those associated with the EnSite™ NavX™ control system (a product of St. Jude Medical), are externally attached. For such embodiments, an instrumented glove or stylus can extend into the tank while, for example, the user&#39;s finger (e.g., index finger), or stylus can be instrumented with electrodes configured to measure parameters of the electric field. In an embodiment, the construction and/or placement of the sensors (e.g., EnSite™ NavX™-type electrodes) can be similar to sensors on the distal portion of the catheter. In another embodiment, the positioning system can be implemented using a magnetic positioning system. 
     In the illustrated embodiment of  FIG. 17 , a magnetic positioning system  1070  can operate, for example, by emitting several magnetic fields  1072   a - 1074   c  from an array of field generators  1074   a - 1074   c . Sensor coils (e.g., sensors  1040  or  1052 ) located on the glove or stylus can then sense the magnetic field strength emanating from each sensor coil. By selectively energizing each field generator at a different time or frequency, a processor  1080  can be able to resolve the sensor&#39;s position and orientation relative to each field generator or to a fixed reference sensor. Detected changes in the position and orientation of the glove or stylus sensor can then be registered and user motion data can be determined, and passed on to gesture recognition logic  134 . 
     In a still further embodiment, a haptic glove (not shown) with sensors can be provided in order to capture user motion, to thereby allow recognition of user gestures, as seen by reference to U.S. application Ser. No. 12/507,175, filed 22 Jul. 2009 (published as United States patent application publication no. US 2010/0073150 A1), and hereby incorporated by reference as though fully set forth herein. A haptic glove can output data that allows detection of the relative bending of the fingers and joints within the hand. Various motions of the hand can be indicators of desired motion to be input into the robotic catheter system. A haptic glove or similar devices have the potential to detect motion relative to itself, but not absolute motion relative to the physical (real) world. In an embodiment and referring again to  FIGS. 14-15 , a hybrid motion capture system is provided, wherein a haptic glove is configured to simultaneously provide relative motion such as finger bending as described above combined with an absolute location device, such as motion capture apparatus  26   d , to form composite motions or gestures (using input from both systems). Such composite motions can be provided to gesture recognition logic  134  and interpreter logic  136  to output corresponding robotic catheter control commands, for effecting precise motions of the catheter and/or sheath of the robotic catheter system. 
     As described above, user-provided gestures can also be captured and used to control other electrophysiological systems, such an electro-anatomic mapping and visualization system (e.g., an EnSite™ Velocity™ system). In the scenario where user gesture capture is contemplated for controlling multiple, different systems, such as the robotic catheter system and the Ensite™ Velocity™ system, system  127  can be configured with context switching functionality. In other words, system  127  is configured to determine when a gesture is intended to control one target system such as the robotic catheter system versus another target system such as an electro-anatomic mapping and visualization system. 
     To facilitate making such determinations, system  127  is configured to analyze the actions occurring within a context switching box  148 , shown in  FIG. 15 . As illustrated, context switching box  148  may be located near the corner of sensing volume  122 . In an embodiment, system  127  is configured to detect when the user is “tapping” in context switching box  148 . Thus, when the user “taps” a point in context switching box  148 , system  127  switches context (i.e., from the robotic catheter system as the target to the mapping system as the target) and thereafter allows user input to control an electro-anatomic mapping system target, such as the Ensite™ Velocity™ system. The act of tapping may involve the user holding his or her hand in a particular location and then ballistically moving the fingers back and forth. This tapping motion, when detected by gesture recognition logic  134 , causes an electro-anatomic system, such as system  34 — FIG. 2 , to display a context menu visible to the user. For example, such a context menu may have a series of selectable options in a “drop-down” style box. 
     In operation, the user, by moving the hand up and/or down “over” the selectable options, causes the option over which the hand hovers to become highlighted. Gesture recognition logic  134  can be further configured to recognize a second tapping motion, which finalizes the selection and closes the context menu. While the gesture itself can be captured using system  127 , other detection mechanisms, such as through the use of various sensors as described above (e.g., haptic glove, accelerometer disposed within a glove, a wand, etc.) can be alternatively used. 
     Thus, in light of the above, system  127  may include context switching logic (not shown) stored in memory  132  and configured for execution in the one or more processors  130 . The context switching logic may be configured to detect a predetermined context switching gesture (e.g., the “tapping” gesture described above) based on the output data from motion capture apparatus  26   d , but only where the context switching gesture occurs in the context switching portion of sensing volume  122 . When the context switching logic detects the context switching gesture, it may set a context switch parameter or the like. Interpreter logic  136  is accordingly configured to selectively translate, based on the state of the context switch parameter, the recognized user gesture into one of either (i) a robotic catheter control command, or (ii) an electro-anatomic mapping system control command. 
     In another embodiment, further visual feedback can be displayed on the display of the electro-anatomic system  34 , such as on the display area  52  in  FIG. 2 , showing the relative motion of the user&#39;s hands and fingers. This feedback can be through the use of a (i) special-purpose mouse pointer in addition to and visibly distinguishable from a primary mouse pointer, (ii) a graphical representation of the hands, or the like. 
     Referring to  FIG. 15 , in another embodiment, system  127  can be used in combination with an electro-anatomic system  34  ( FIG. 2 ) and further in combination with a three-dimensional (3D) display, such as that described in U.S. application No. 61/643,667, filed 7 May 2012, and hereby incorporated by reference as though fully set forth herein. This combination of functions allows for a virtual representation of the hands that could be rendered and displayed within a three-dimensional (3D) window along with representations of the catheters and/or sheaths, all with respect to a heart model. This 3D window may allow the user to perceive his or her own hands reaching into the heart of the patient. Through this facility, the user could “grab” the catheter and move it to a new location, for example, to a target location. For example, the virtual hands can be moved near the tip of one of the catheters, and by “pinching” on the tip of the catheter, the user can “grab and pull” the catheter in different directions. The target location can be specified as the location to which the rendered catheter is pulled by the user. Once the target location has been specified, this information can be passed on to the robotic control system  210  by interpreter logic  136 , wherein robotic control system  210  processes this target location as a dynamic waypoint, and thereafter automatically move the catheter to such target location. The foregoing combination, including a 3D display, provides an intuitive way for a user to manipulate a medical device within the heart. 
     In another embodiment, interpreter logic  136  can be configured to generate different commands based on the same user gesture. Interpreter logic  136  is configured to analyze the recognized use gesture in light of and as a function of the orientation of the then-visible (current) view of an anatomical model being displayed by an electro-anatomic system, such as system  34  ( FIG. 2 ). In other words, the effect of the user gesture can be view relative, such that the same gesture can actuate different, relative motions based on the current view angle or orientation displayed by the electro-anatomic system  34 . For example, the direction of translation can be different based on the current view, as shown in the examples in Table 1. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 View relative actions versus gestures 
               
            
           
           
               
               
               
            
               
                 GESTURE 
                 VIEW 
                 ACTION 
               
               
                   
               
               
                 Hand moves right-to-left 
                 anteroposterior (AP) view, 
                 Advance 
               
               
                   
                 with catheter distal tip 
               
               
                   
                 pointing left on the screen. 
               
               
                 Hand moves right-to-left 
                 posteroanterior (PA) 
                 Retract 
               
               
                   
               
            
           
         
       
     
     Exemplary RCGS System Description. 
     Referring to  FIG. 18 , RCGS  210  can be likened to power steering for a catheter system. The RCGS  210  can be used, for example, to manipulate the location and orientation of catheters and sheaths in a heart chamber or in another body cavity or lumen. The RCGS  210  thus provides the user with a similar type of control provided by a conventional manually-operated system, but allows for repeatable, precise, and dynamic movements. For example, a user such as an electrophysiologist can identify locations (potentially forming a path) on a rendered computer model of the cardiac anatomy. The system can be configured to relate those digitally selected points to positions within a patient&#39;s actual/physical anatomy, and can thereafter command and control the movement of the catheter to the defined positions. Once at the specified target location, either the user or the system can perform the desired diagnostic or therapeutic function. The RCGS  210  enables full robotic navigation/guidance and control. 
     As shown in  FIG. 18 , the RCGS  210  can generally include one or more monitors or displays  212 , a visualization, mapping and navigation (including localization) system  214 , a human input device and control system (referred to as “input control system”)  224 , an electronic control system  226 , a manipulator assembly  300  for operating a device cartridge  400 , and a manipulator support structure  500  for positioning the manipulator assembly  300  in proximity to a patient or a patient&#39;s bed. 
     Displays  212  are configured to visually present to a user information regarding patient anatomy, medical device location or the like, originating from a variety of different sources. Displays  212  can include (1) an EnSite™ Velocity™ monitor  216  (coupled to system  214 —described more fully below) for displaying cardiac chamber geometries or models, displaying activation timing and voltage data to identify arrhythmias, and for facilitating guidance of catheter movement; (2) a fluoroscopy monitor  218  for displaying a real-time x-ray image or for assisting a physician with catheter movement; (3) an intra-cardiac echo (ICE) display  220  to provide further imaging; and (4) an EP recording system display  222 . 
     The system  214  is configured to provide many advanced features, such as visualization, mapping, navigation support and positioning (i.e., determine a position and orientation (P&amp;O) of a sensor-equipped medical device, for example, a P&amp;O of a distal tip portion of a catheter). Such functionality can be provided as part of a larger visualization, mapping and navigation system, for example, an EnSite™ Velocity™ system running a version of EnSite™ NavX™ software commercially available from St. Jude Medical, Inc., of St. Paul, Minn. and as described above. System  214  can thus comprise conventional apparatus, for example, the EnSite™ Velocity™ system, or other known technologies for locating/navigating a catheter in space (and for visualization), including for example, the CARTO visualization and location system of Biosense Webster, Inc., the AURORA® system of Northern Digital Inc., a magnetic field based localization system such as the MediGuide™ Technology, a system based on technology from MediGuide Ltd. of Haifa, Israel and now owned by St. Jude Medical, Inc., or a hybrid magnetic field-impedance based system, such as the CARTO 3 visualization and location system of Biosense Webster, Inc. Some of the localization, navigation and/or visualization systems can involve providing a sensor for producing signals indicative of catheter location and/or orientation information, and can include, for example one or more electrodes in the case of an impedance-based localization system such as the EnSite™ Velocity™ system running EnSite™ NavX™ software, which electrodes can already exist in some instances, or alternatively, one or more coils (i.e., wire windings) configured to detect one or more characteristics of a low-strength magnetic field, for example, in the case of a magnetic-field based localization system such as the MediGuide™ Technology, a system using technology from MediGuide Ltd. described above. 
     The input control system  224  is configured to allow a user, such as an electrophysiologist, to interact with the RCGS  210 , in order to control the movement and advancement/withdrawal of both a catheter and sheath (see, e.g., U.S. application Ser. No. 12/751,843, filed 31 Mar. 2010 (the &#39;843 application), and PCT/US2009/038597, filed 27 Mar. 2009 (the &#39;597 application), and published 1 Oct. 2009 under publication no. WO 2009/120982. The &#39;843 application and the &#39;597 application are both hereby incorporated by reference as though fully set forth herein. Generally, several types of input devices and related controls can be employed, including, without limitation, instrumented traditional catheter handle controls, oversized catheter models, instrumented user-wearable gloves, touch screen display monitors, 2-D input devices, 3-D input devices, spatially detected styluses, and traditional joysticks. For a further description of exemplary input apparatus and related controls, see, for example, U.S. application Ser. No. 12/933,063, filed 16 Sep. 2010 (the &#39;063 application), and U.S. application Ser. No. 12/347,442, filed 31 Dec. 2008 (the &#39;442 application). The &#39;063 application and the &#39;442 application are both hereby incorporated by reference as though fully set forth herein. The input devices can be configured to directly control the movement of the catheter and sheath, or can be configured, for example, to manipulate a target or cursor on an associated display. 
     The electronic control system  226  is configured to translate (i.e., interpret) inputs (e.g., motions) of the user at an input device or from another source into a resulting movement of the catheter and/or surrounding sheath. In this regard, the system  226  includes a programmed electronic control unit (ECU) in communication with a memory or other computer readable media (memory) suitable for information storage. Relevant to the present disclosure, the electronic control system  226  is configured, among other things, to issue commands (i.e., actuation control signals) to the manipulator assembly  300  (i.e., to the actuation units—electric motors) to move or bend the catheter and/or sheath to prescribed positions and/or in prescribed ways, all in accordance with the received user input and a predetermined operating strategy programmed into the system  226 . In addition to the instant description, further details of a programmed electronic control system can be found in U.S. application Ser. No. 12/751,843, described above. It should be understood that although the exemplary EnSite™ Velocity™ system  214  and the electronic control system  226  are shown separately, integration of one or more computing functions can result in a system including an ECU on which can be run both (i) various control and diagnostic logic pertaining to the RCGS  210  and (ii) the visualization, mapping and navigation functionality of system  214 . 
     The manipulator assembly  300 , in response to such commands, is configured to maneuver the medical device (e.g., translation movement, such as advancement and withdrawal of the catheter and/or sheath), as well as to effectuate distal end (tip) deflection and/or rotation or virtual rotation. In an embodiment, the manipulator assembly  300  can include actuation mechanisms/units (e.g., a plurality of electric motor and lead screw combinations, or other electric motor configurations, as detailed below) for linearly actuating one or more control members (e.g., steering wires) associated with the medical device for achieving the above-described translation, deflection and/or rotation (or virtual rotation). In addition to the description set forth herein, further details of a manipulator assembly can be found in U.S. application Ser. No. 12/347,826, filed 31 Dec. 2008, which is hereby incorporated by reference as though fully set forth herein. Although the manipulator  300  is illustrated and described with respect to the manipulation of a single medical device (e.g., a single catheter and sheath combination), the manipulator  300  can be configured to manipulate multiple devices, such as a cardiac mapping catheter, an ablation catheter, an imaging catheter, such an intracardiac echocardiography (ICE) catheter, or the like, as seen by reference to international application no. PCT/US12/30697, with an international filing date of 27 Mar. 2012 (the &#39;697 application), which claims priority to U.S. provisional application No. 61/581,838 filed 30 Dec. 2011 (the &#39;838 application). The &#39;697 application and the &#39;838 application are both hereby incorporated by reference as though fully set forth herein. 
     A device cartridge  400  is provided for each medical device controlled by the RCGS  210 . For this exemplary description of an RCGS, one cartridge is associated with a catheter and a second cartridge is associated with an outer sheath. The cartridge is then coupled, generally speaking, to the RCGS  210  for subsequent robotically-controlled movement. In addition to the description set forth herein, further details of a device cartridge can be found in U.S. application Ser. No. 12/347,835, filed 31 Dec. 2008 (the &#39;835 application), and U.S. application Ser. No. 12/347,842, filed 31 Dec. 2008 (the &#39;842 application). The &#39;835 application and the &#39;842 application are both hereby incorporated by reference as though fully set forth herein. 
       FIG. 19  is a side view of an exemplary robotic catheter manipulator support structure, designated structure  510  (see U.S. application Ser. No. 12/347,811, filed 31 Dec. 2008, hereby incorporated by reference as though fully set forth herein). The structure  510  can generally include a support frame  512  including retractable wheels  514  and attachment assembly  516  for attachment to an operating bed (not shown). A plurality of support linkages  520  can be provided for accurately positioning one or more manipulator assemblies, such as manipulator assembly  302 . The assembly  302  is configured to serve as the interface for the mechanical control of the movements or actions of one or more device cartridges, such as catheter and sheath cartridges  402 ,  404  described below. Each device cartridge is configured to receive and retain a respective proximal end of an associated medical device (e.g., catheter or sheath). The assembly  302  also includes a plurality of manipulation bases onto which the device cartridges are mounted. After mounting, the manipulator assembly  302 , through the manipulation bases, is capable of manipulating the attached catheter and sheath. 
     Referring to  FIG. 24 , the manipulator assembly  302  may include a support device  382  positioned on the distal end of the manipulator assembly and configured to receive one or more ancillary tools, such as, for example, an introducer  384 , a guide  386 , or a hemostasis pad  388 . In an embodiment the support device  382  and ancillary tools, are configured to interact with a portion of the catheter and/or sheath between the manipulator and the patient. For example, as generally illustrated in  FIG. 24 , introducer  384  and/or guide tube  386  may direct the catheter into the patient at a fixed angle or position while allowing the manipulator to be oriented at a different relative angle. 
       FIGS. 25A-25B  are isometric and related diagrammatic views illustrating another embodiment of a manipulator support structure, designated manipulator support structure  650 . Manipulator support structure  650  may generally include a track mounted unit  652  for movement of manipulator support structure  650  and its related components. Structure  650  may include attachment assembly  654  for attachment to ceiling or otherwise mounted track  656 , and a plurality of support linkages  658  for accurately positioning robotic catheter manipulator assembly  300 . Referring to  FIGS. 25A and 25B , in use, manipulator support structure  650  may be positioned relative to operation bed  518  and locked in position during use, and moved out of the use position or otherwise re-configured to a stowed position by re-positioning of support linkages  658 . As shown in  FIG. 25B , manipulator support structure may be moved generally horizontally and vertically for positioning and removal from the area of operation bed  518 . 
     In the Figures to follow,  FIGS. 20A-20B  will show a manipulator assembly,  FIGS. 21A-21C  will show a manipulation base, and  FIGS. 22A-22B  will show a device cartridge. 
       FIG. 20A  is an isometric view, with portions omitted for clarity, of manipulator assembly  302 . Assembly  302  includes a catheter manipulator mechanism  304 , a sheath manipulator mechanism  306 , a catheter manipulation base  308 , a sheath manipulation base  310 , a first (catheter) drive mechanism  312 , a second (sheath) drive mechanism  314 , and a track  356 . As further shown, assembly  302  further includes a catheter cartridge  402  and a sheath cartridge  404 , with a catheter  406  having a proximal end opening  408  coupled to the catheter cartridge  402  and a sheath  410  coupled to the sheath cartridge  404 . 
     Catheter and sheath manipulator mechanisms  304 ,  306  are configured to manipulate the several different movements of the catheter  406  and the sheath  410 . First, each mechanism  304 ,  306  is configured to impart translation movement to the catheter  406  and the sheath  410 . Translation movement here refers to the independent advancement and retraction (withdrawal) as shown generally in the directions designated D 1  and D 2  in  FIG. 20A . Second, each mechanism  304 ,  306  is also configured to effect deflection of the distal end of either or both of the catheter and sheath  406 ,  410 . Third, each mechanism  304 ,  306  can be operative to effect a so-called virtual (omni-directional) rotation of the distal end portion of the catheter  406  and the sheath  410 . Virtual rotation can be made through the use of independent four-wire steering control for each device (e.g., eight total steering wires, comprising four sheath control wires and four catheter control wires). The distal end movement is referred to as “virtual” rotation because the outer surface of the sheath (or catheter) does not in fact rotate in the conventional sense (i.e., about a longitudinal axis) but rather achieves the same movements as conventional uni-planar deflection coupled with axial rotation. In addition to the present description of virtual rotation, further details can be found in international application no. PCT/US2009/038597, published 1 Oct. 2009, as WO 2009/120982, which is hereby incorporated by reference as though fully set forth herein. 
     Each manipulator mechanism  304 ,  306  further includes a respective manipulation base  308 ,  310  onto which are received catheter and sheath cartridges  402 ,  404 . Each interlocking base  308 ,  310  can be capable of travel in the longitudinal direction of the catheter/sheath (i.e., D 1 , D 2  respectively) along a track  356 . In an embodiment, D 1  and D 2  can each represent a translation of approximately 8 linear inches. Each interlocking base  308 ,  310  can be translated by a respective high precision drive mechanism  312 ,  314 . Such drive mechanisms can include, for example and without limitation, an electric motor driven lead screw or ball screw. 
     The manipulator mechanisms  304 ,  306  are aligned with each other such that catheter  406  can pass through sheath  410  in a coaxial arrangement. Thus, sheath  410  can include a water-tight proximal sheath opening  408 . Overall, the manipulator mechanisms  304 ,  306  are configured to allow not only coordinated movement but also relative movement between catheter and sheath cartridges  402 ,  404  (and thus relative movement between catheter and sheath). 
       FIG. 20B  is an isometric view of manipulator assembly  302 , substantially the same as  FIG. 20B  except that catheter and sheath cartridges  402 ,  404  are omitted (as well as catheter and sheath  406 ,  410 ) so as to reveal an exposed face of the manipulation bases  308 ,  310 . 
       FIG. 21A  is an isometric, enlarged view showing manipulation base  308  (and base  310 ) in greater detail. Each cartridge  402 ,  404  has an associated manipulation base  308 ,  310 . Each base  308 ,  310  can include a plurality of fingers  316 ,  318 ,  320  and  322  (e.g., one per steering wire) that extend or protrude upwardly to contact and interact with steering wire slider blocks, such as slider blocks  412 ,  414 ,  416 ,  418  best shown in  FIG. 22B , to independently tension select steering wires  420 ,  422 ,  424 ,  426 , also best shown in  FIG. 22B . Each finger can be configured to be independently actuated (i.e., moved back and forth within the oval slots depicted in  FIG. 21A ) by a respective precision drive mechanism, such as a motor driven ball screw  324 . A plate  326  provides a surface onto which one of the cartridges  402 ,  404  are seated. 
       FIG. 21B  is an isometric, enlarged view of base  308  (and base  310 ), substantially the same as  FIG. 21A  except with plate  326  omitted. Each motor-driven ball screw  324 , best shown in  FIG. 21A , for both finger control and for cartridge translation control, can further include encoders to measure a relative and/or an absolute position of each element of the system. Moreover, each motor-driven ball screw  324 , for both finger control and cartridge translation control, can be outfitted with steering wire force sensors to measure a corresponding steering wire tension. For example, a corresponding finger  316 ,  318 ,  320  or  322  can be mounted adjacent to a strain gauge for measuring the corresponding steering wire tension. Each motor-driven ball screw  324  can include a number of components, for example only, a rotary electric motor (e.g., motors  342 ,  344 ,  346  and  348 ), a lead screw  328 , a bearing  330  and a coupler  332  mounted relative to and engaging a frame  340 . In the depicted embodiments linear actuation is primarily, if not exclusively, employed. However, some known examples of systems with rotary-based device drivers include U.S. application Ser. No. 12/150,110, filed 23 Apr. 2008 (the &#39;110 application); and U.S. application Ser. No. 12/032,639, filed 15 Feb. 2008 (the &#39;639 application). The &#39;110 application and the &#39;639 application are hereby incorporated by reference in their entirety as though fully set forth herein. These and other types of remote actuation can directly benefit from the teaching of the instant disclosure. 
       FIG. 21C  is an isometric, enlarged view of base  308  (and base  310 ) that is taken from an opposite side as compared to  FIGS. 21A-21B . Bases  308 ,  310  can include components such as a plurality of electrically-operated motors  342 ,  344 ,  346  and  348 , respectively coupled to fingers  316 ,  318 ,  320  and  322 . A bearing  354  can be provided to facilitate the sliding of bases  308 ,  310  on and along track  356 . A plurality of inductive sensors (e.g. home sensors)  358  can also be provided for guiding each manipulation base to a home position. 
       FIG. 22A  is an isometric, enlarged view showing, in greater detail, sheath cartridge  404 . It should be understood that the description of sheath cartridge  404 , except as otherwise stated, applies equally to catheter cartridge  402 . Catheter  406  and sheath  410  can be substantially connected or affixed to respective cartridges  402 ,  404  (e.g., in the neck portion). Thus, advancement of cartridge  404  correspondingly advances the sheath  410  and retraction of cartridge  404  retracts the sheath  410 . Likewise, although not shown, advancement of cartridge  402  correspondingly advances catheter  406  while a retraction of cartridge  402  retracts catheter  406 . As shown, sheath cartridge  404  includes upper and lower cartridge sections  428 ,  430 . 
       FIG. 22B  is an isometric, enlarged view showing, in greater detail, sheath cartridge  404 , with upper section  428  omitted to reveal interior components. Cartridge  404  can include slider blocks (e.g., as shown for cartridge  404 , slider blocks  412 ,  414 ,  416 ,  418 ), each rigidly and independently coupled to a respective one of a plurality of steering wires (e.g., sheath steering wires  420 ,  422 ,  424 ,  426 ) in a manner that permits independent tensioning of each steering wire. Likewise, cartridge  402  for catheter  406  also includes slider blocks for coupling to a plurality (e.g., four) steering wires. Device cartridges  402 ,  404  can be provided as a disposable item that is capable of being easily positioned (e.g., snapped) into place onto a respective base  408 ,  410 . Sheath cartridge  404  can be designed in a similar manner as the catheter cartridge  402 , but will typically be configured to provide for the passage of catheter  406 . 
     Referring to  FIGS. 21A and 22A , catheter and sheath cartridges  402 ,  404  are configured to be secured or locked down onto respective manipulation bases  308 ,  310 . To couple cartridge  402  (and  404 ) with base  308  (and  310 ), one or more locking pins (e.g.,  432  in  FIG. 22A ) on the cartridge can engage one or more mating recesses  360  in the base (see  FIG. 21A ). In an embodiment, such recesses  360  can include an interference lock such as a spring detent or other locking means. In an embodiment, such other locking means can include a physical interference that can require affirmative/positive action by the user to release the cartridge. Such action can include or require actuation of a release lever  362 . Additionally, the cartridge can include one or more locator pins (not shown) configured to passively fit into mating holes on the base (e.g.,  364  in  FIG. 21A ). 
     In operation, a user first manually positions catheter  406  and sheath  410  (with catheter  406  inserted in sheath  410 ) within the vasculature of a patient. Once the medical devices are roughly positioned in relation to the heart or other anatomical site of interest, the user can then engage or connect (e.g., “snap-in”) the catheter and sheath cartridges into place on respective bases  308 ,  310 . When a cartridge is interconnected with a base, the fingers fit into the recesses formed in the slider blocks. For example, with respect to the sheath cartridge  404  and sheath base  310 , each of the plurality of fingers  316 ,  318 ,  320  or  322  fit into corresponding recesses formed between the distal edge of slider blocks  412 ,  414 ,  416 ,  418  and a lower portion of the cartridge housing (best shown in  FIG. 22B ). Each finger can be designed to be actuated in a proximal direction to respectively move each slider block, thereby placing the respective steering wire in tension (i.e., a “pull” wire). Translation, distal end bending and virtual rotation can be accomplished through the use of the RCGS  210 . 
       FIG. 23  is a diagrammatic view of a node suitable for connection to a communications bus (not shown) in RCGS  210 . The node includes an actuation unit  600 , similar to the actuation mechanisms described above (e.g., catheter actuation mechanism  304 ). In an embodiment, the RCGS  210  can have at least ten such actuation units (i.e., one for each of the four catheter steering wires, four sheath steering wires, one catheter manipulation base and one sheath manipulation base), which as described include electric motors. Of course, as described above, when the RCGS  210  is configured to manipulate multiple medical devices, each medical device will include a respective actuation assembly, suited to the type of medical device. 
       FIG. 23  shows in diagrammatic or block form many of the components described above—where appropriate, references to the earlier describe components will be made. Actuation unit  600  includes a first, slidable control member  602  (e.g., the slider as described above) that is connected to or coupled with a second, tensile control member  604  (e.g., the steering wire as described above). The slider  602  can be configured to interface with a third, movable control member  606  (e.g., the finger as described above). The finger  606  can further be operatively coupled with a portion of a sensor  608  (e.g., a force sensor), which, in turn, can be coupled with a translatable drive element  610  that can be mechanically moved. For example, without limitation, translatable drive element  610  can ride on or can otherwise be mechanically moved by a mechanical movement device  612  that, in turn, can be coupled with an electric motor  614 . The mechanical movement device  612  can comprise a lead screw while the translatable drive element  610  can comprise a threaded nut, which can be controllably translated by screw  612  in the X+ or X− directions. In another embodiment, mechanical movement device  612  can include a ball screw, while translatable drive element  610  can include a ball assembly. Many variations are possible, as will be appreciated by one of ordinary skill in the art. 
     The actuation unit  600  also includes a rotary motor position encoder  616  that is coupled to the motor  614  and is configured to output a signal indicative of the position of the motor  614 . The encoder  616  can comprise an internal, optical encoder assembly, integral with motor  614 , configured to produce a relatively high accuracy output. The motor position sensor can operate in either absolute or relative coordinates. In an embodiment, a second motor position sensor (not shown) can also be provided, such as a potentiometer (or impedance-based), configured to provide a varying voltage output proportional to the motor&#39;s rotary position. The output of the secondary position sensor can be used as an integrity check of the operating performance of the primary position sensor (encoder) during start-up or initialization of the actuation unit. 
     Actuation unit  600  also includes one or more local controllers including a bus interface  618  to facilitate exchange of information between actuation unit  600  and electronic control system  226  (via the bus). The controller communicates with the main electronic control system  226  via the bus interface and is configured, among other things, to (1) receive and execute motor actuation commands issued by the electronic control system  226  for controlling the movements of motor  614 ; and (2) receive and execute a command (issued by the electronic control system  226 ) to take a motor position sensor reading, for example, from encoder  616  and subsequently report the reading to system  226 . 
     A user interface device in the form of a touch screen monitor will now be discussed with reference to  FIGS. 26A-26D . 
     An embodiment of user interface device may include a multi-touch display interface  1100  and related hardware and software that would allow a user to physically interact with the robotic catheter system without the need for a keyboard, mouse, or other input device. Such a display may be configured to recognize multiple finger or hand contacts with or along the screen, and would allow a user to directly interface with the objects, anatomy, or devices displayed on the screen. 
     As shown in  FIGS. 26A-26B , an embodiment of the multi-touch interface  1100  may include multiple on-screen menu buttons  1102  that allow a user to toggle between various active functions within the image. Such functions may include, for example, the ability to pan, rotate, or zoom 3D objects and models within the display, select and/or direct movement of the catheter or sheath, place lesion markers, way points, virtual sensors, or automated movement targets and lines within the anatomic model. 
     In an exemplary approach, when in rotate mode, a user may rotate a 3D cardiac geometry  1104  by touching the screen with a finger and dragging across the screen to spin the 3D model about an axis orthogonal to both the surface normal of the screen and the direction of the dragging motion. When in pan mode, a dragging motion across the screen may physically move the model across the screen. Additionally, the zoom may be controlled, for example, through a pinching (zoom out) or expanding motion (zoom in) of multiple fingers, or through the use of an on-screen slider 
     As shown in  FIG. 26B , in an embodiment, the multi-touch interface  1100  may be used to control the movement of a displayed catheter  1110  or sheath  1112  by first pressing on the image of the catheter or sheath to select it, followed by dragging the selected device in the direction of intended travel. Alternatively, the catheter  1110  or sheath  1112  may be selected by using a pinching motion as if the user is virtually grabbing the image. In an embodiment, while the user is dragging a virtual representation of the catheter or sheath, a ghost image  1114  of the current position of the device may be displayed as a reference. The ghost image  1114  may be based on real-time feedback of the actual catheter position as provided by a catheter positioning system such as Ensite NavX. Once the user is satisfied with the movement, the user may release the selected catheter or sheath by removing his/her finger from the screen. The system may then be configured to move the actual catheter in accordance with the user intended motion, and may update the ghost image  1114  to reflect the actual movement. In another embodiment, the user may move a control point on the catheter or sheath and the actual catheter may be configured to track this point in real-time. 
     In an embodiment, as generally illustrated in  FIGS. 26A, 26C , the user may use the multi-touch interface  1100  to select target points  1120  within the image. These target points may be used to identify lesion points for intended or completed therapy delivery, way-points for semi-automated step-wise catheter movement, destination points for fully automated movement, or as relative markers or virtual electrophysiology sensors that may have no impact on relative movement. In an embodiment, a target point may  1120  be initially set by taping on screen in a position where a target point is desired. Once a point has been set, it may be subsequently selected by re-tapping on the point. When a point is “selected,” it may change appearance, such as selected point  1122 . If the user desires to move target point, the user may for example, select it by tapping it, and then drag the point to a new location. Additionally, after selecting a point, the software may call up a list of menu options that may allow the user to configure or view one or more parameters of the point. Such parameters may include, for example, the nature of the point (e.g. marker, lesion point, waypoint, sensor) the distance of the point above the surface, or specific data recorded or computed at the point. 
     Once a user taps the screen in the desired location of the target point, the software may be configured to place the target point  1120  directly on the surface of the model  1104  as displayed. In such a configuration, the system may know the relative depth of each pixel or primitive on the display. By touching on a displayed element, the system may map the target point directly to the anatomical surface. The software may further allow the user to specify a fixed or minimum distance from the displayed anatomical surface where the point should be located. For example, if the user specifies a distance of 10 mm prior to selecting a point, the software may locate the target point 10 mm off of the selected surface in a direction normal to the screen/viewing plane. Alternatively, the software may generate a virtual surface located 10 mm interior to the surface of the anatomical model and then map the point to the virtual surface. (i.e. 10 mm normal to the anatomical model surface). In another embodiment, as shown in  FIG. 26C , the user may select a point  1122  with one finger  1124 , and use a second finger  1126  to control a variable slider  1128  to specify a distance above the surface. The slider  1128  may likewise be located on the side of the screen and/or may appear only after a point has been selected. The display may also be configured to display a secondary projection of the catheter and model to aid the user in positioning the target point in three dimensional space (e.g. using a right anterior oblique (RAO) projection as the primary display, and a left anterior oblique (LAO) projection as the secondary display). 
     Referring back to  FIG. 26B , in an embodiment, as the user is dragging a display of the catheter  1110  (or sheath  1112 ), the user may use a second finger to modulate a slider (such as a slider generally illustrated in  FIG. 26C ) to control the catheter&#39;s distance from the anatomical surface in real time. Using this technique, the user could achieve a motion where, for example, the catheter begins in contact with the tissue, gradually lifts off from the tissue while traversing a distance, and gradually lands back on the tissue. Alternatively, for either free catheter motion, or for positioning a target point, the user may use a physical slider or wheel, apart from the display, to modulate the distance from the surface. Using the touch screen, the user may also control the extension of the catheter from the sheath by placing one finger on the catheter  1112  and a second finger on the sheath  1114  and expanding or squeezing his/her fingers together. 
     In addition to setting individual target points, as illustrated in  FIG. 26A , the user may also be able to specify a line or path  1130  along the surface of the model  1104  by touching and dragging a finger across the screen. Such generated line  1130  may be similar to a splined series of waypoints. Furthermore, in an embodiment, the user may select a point along the line and “lift” that point away from the surface by, for example, using a slider or numerical input. Points adjacent to the selected point may additionally be lifted off as if they were tied to the selected point. 
     In an embodiment, as shown in  FIG. 26D , the multi-touch interface  1100  may be used to manage multiple displays (such as displays A-D) in an integrated electrophysiology environment. Using the interface for display management purposes may include the ability to resize, move, minimize, or maximize windows that display, for example, EnSite NavX models, digital fluoroscopic displays, patient vital information, patient hospital records, real time electrocardiograph traces, CT imagery, MRI imagery, and/or any other displays desired by the user. In an embodiment, a user may move or expand a window using on-screen buttons to, for example, freeze the touch screen input for the respective displays, followed by touching and dragging the window to move it, or using a multi-finger expanding motion to, for example, expand the window. 
     In accordance with another embodiment, an article of manufacture includes a computer storage medium having a computer program encoded thereon, where the computer program includes code for acquiring or capturing motion of a user and generating corresponding output data, for recognizing a user gesture based on the user motion output data, and for translating the recognized user gesture into one or more commands for an EP diagnostic and/or therapeutic system, including at least a robotic catheter control command, or an electro-anatomic system command. Such embodiments may be configured to execute one or more processors, multiple processors that are integrated into a single system or are distributed over and connected together through a communications network, and where the network may be wired or wireless. 
     It should be understood that while the foregoing description describes various embodiments of a bedside interface device in the context of the practice of electrophysiology, and specifically catheterization, the teachings are not so limited and can be applied to other clinical settings. 
     It should be understood that the an electronic control unit as described above may include conventional processing apparatus known in the art, capable of executing pre-programmed instructions stored in an associated memory, all performing in accordance with the functionality described herein. It is contemplated that the methods described herein may be programmed, with the resulting software being stored in an associated memory and where so described, may also constitute the means for performing such methods. Implementation of an embodiment of the invention, in software, in view of the foregoing enabling description, would require no more than routine application of programming skills by one of ordinary skill in the art. Such a system may further be of the type having both ROM, RAM, a combination of non-volatile and volatile (modifiable) memory so that the software can be stored and yet allow storage and processing of dynamically produced data and/or signals. 
     Although numerous embodiments of this invention have been described above with a certain degree of particularity, those skilled in the art could make numerous alterations to the disclosed embodiments without departing from the spirit or scope of this invention. All directional references (e.g., plus, minus, upper, lower, upward, downward, left, right, leftward, rightward, top, bottom, above, below, vertical, horizontal, clockwise, and counterclockwise) are only used for identification purposes to aid the reader&#39;s understanding of the present invention, and do not create limitations, particularly as to the position, orientation, or use of the invention. Joinder references (e.g., attached, coupled, connected, and the like) are to be construed broadly and may include intermediate members between a connection of elements and relative movement between elements. As such, joinder references do not necessarily infer that two elements are directly connected and in fixed relation to each other. It is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative only and not limiting. Changes in detail or structure may be made without departing from the spirit of the invention as defined in the appended claims. 
     Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.