X-PLANE AND 3D IMAGING FOR ASYMMETRIC APERTURES

20210307721 · 2021-10-07

    Inventors

    Cpc classification

    International classification

    Abstract

    An intraluminal imaging device is provided. In one embodiment, the imaging device includes a flexible elongate member having a distal portion and a proximal portion. The flexible elongate member can be positioned within a vessel. The imaging device an imaging assembly that can be mounted within the distal portion. The imaging assembly includes a side-looking array of imaging elements and a micro-beamformer IC that is coupled to the side-looking array of imaging elements. The micro-beamformer IC can control the array of imaging elements, can determine a first angle and a second angle, and can perform beam forming for the array of imaging elements. The micro-beamformer IC can receive the first imaging signals associated with a first plane (410) at the first angle (+45°), and the second imaging signals associated with a second plane (420) at the second angle(−45°). In some embodiments, the first and second angles are selected to satisfy predetermined criteria.

    Claims

    1. A method of intraluminal imaging, the method comprising: receiving imaging signals by an array of imaging elements positioned within a distal portion of an intraluminal imaging device; beamforming, with a micro-beamformer integrated circuit (IC) coupled to the array of imaging elements, first imaging signals received by the array of imaging elements, the first imaging signals associated with a first plane at a first oblique angle relative to an axial direction of an aperture of the array of imaging elements; beamforming, with the micro-beamformer integrated circuit (IC) coupled to the array of imaging elements, second imaging signals received by the array of imaging elements, the second imaging signals associated with a second plane at a second oblique angle relative to the axial direction of the aperture of the array of imaging elements; generating a first image from the first imaging signals; and generating a second image from the second imaging signals.

    2. The method of claim 1, wherein the first oblique angle is perpendicular to the second oblique angle.

    3. The method of claim 2, wherein the first oblique angle is about +45 degree and the second oblique angle is about −45 degree.

    4. The method of claim 1, further comprising: selecting the first angle as an angle corresponding to a 2D plane viewed immediately prior to the selection; determining the second angle as close as possible to orthogonal to the first angle and avoiding a predefined exclusion angle range.

    5. The method of claim 1, further comprising: selecting the first angle and the second angle to satisfy a predetermined criterion.

    6. The method of claim 1, further including: beamforming a plurality of imaging signals received by the array of imaging elements, the plurality of imaging signals associated with a plurality of planes between the first plane and the second plane; and generating a 3D volume image between the first plane and the second plane from the received plurality of imaging signals.

    7. The method of claim 1, further comprising: displaying the first image adjacent to the second image on a display.

    8. The method of claim 1, further comprising: displaying a third image adjacent to at least one of the first image or the second on a display, wherein the third image is generated from third imaging signals received by the array of imaging elements, the third imaging signals associated with a third plane aligned with the axial direction of the aperture of the array of imaging elements.

    9. The method of claim 1, wherein the aperture is asymmetrical.

    10. The method of claim 9, wherein the array of imaging elements is a two-dimensional array having a length greater than a width, wherein the axial direction of the aperture of the array of imaging elements is aligned with the length of the two-dimensional array.

    11. An intraluminal imaging device, comprising: a flexible elongate member configured to be positioned within a vessel, the flexible elongate member including a proximal portion and a distal portion; and an imaging assembly mounted within the distal portion of the flexible elongate member, the imaging assembly comprising: an array of imaging elements; and a micro-beamformer integrated circuit (IC) coupled to the array of imaging elements, wherein the micro-beamformer IC is configured to: beamform first imaging signals received by the array of imaging elements, the first imaging signals associated with a first plane at a first oblique angle relative to an axial direction of an aperture of the array of imaging elements; beamform second imaging signals received by the array of imaging elements, the second imaging signals associated with a second plane at a second oblique angle relative to the axial direction of the aperture of the array of imaging elements.

    12. The device of claim 11, wherein the first oblique angle is perpendicular to the second oblique angle.

    13. The device claim 12, wherein the first oblique angle is about +45 degree and the second oblique angle is about −45 degree.

    14. The device of claim 11, wherein the aperture is asymmetrical.

    15. The device of claim 14, wherein the array of imaging elements is a two-dimensional array having a length greater than a width, wherein the axial direction of the aperture of the array of imaging elements is aligned with the length of the two-dimensional array.

    16. The device of claim 15, wherein the array of imaging elements includes more than 800 imaging elements.

    17. The device of claim 11, wherein the micro-beamformer IC includes a plurality of microchannels delay lines that are configured to apply a plurality of predetermined delays to the imaging signals received by the array of imaging elements.

    18. The device of claim 18, wherein the micro-beamformer IC is further configured to: beamform a plurality of groups of imaging signals received by the array of imaging elements, wherein each group of imaging signals is associated with a plane between the first plane and the second plane.

    Description

    BRIEF DESCRIPTION OF THE DRAWINGS

    [0023] Illustrative embodiments of the present disclosure will be described with reference to the accompanying drawings, of which:

    [0024] FIG. 1 is a schematic diagram of an intraluminal imaging system according to aspects of the present disclosure.

    [0025] FIG. 2 is a perspective view of an imaging assembly according to aspects of the present disclosure.

    [0026] FIG. 3 is a top view of a tip member according to aspects of the present disclosure.

    [0027] FIG. 4A is a schematic diagram illustrating two imaging planes extending at oblique angles relative to a longitudinal axis of an asymmetric aperture of an imaging array according to aspects of the present disclosure.

    [0028] FIG. 4B is a schematic diagram illustrating two imaging planes extending coplanar with and at a right angle relative to a longitudinal axis of an asymmetric aperture of an imaging array according to aspects of the present disclosure..

    [0029] FIG. 5 shows ultrasound images at 0 degree and 90 degree planes relative to an asymmetric aperture of an imaging array according to aspects of the present disclosure.

    [0030] FIG. 6 shows ultrasound images at 0 degree and +45 degree planes relative to an asymmetric aperture of an imaging array according to aspects of the present disclosure.

    [0031] FIG. 7 shows a 3D volume image according to aspects of the present disclosure.

    [0032] FIG. 8 is a flow diagram of a method of performing intraluminal imaging with an intraluminal device according to aspects of the disclosure.

    DETAILED DESCRIPTION

    [0033] For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It is nevertheless understood that no limitation to the scope of the disclosure is intended. Any alterations and further modifications to the described devices, systems, and methods, and any further application of the principles of the present disclosure are fully contemplated and included within the present disclosure as would normally occur to one skilled in the art to which the disclosure relates. For example, while the ICE system is described in terms of intraluminal imaging, it is understood that it is not intended to be limited to this application. In particular, it is fully contemplated that the features, components, and/or steps described with respect to one embodiment may be combined with the features, components, and/or steps described with respect to other embodiments of the present disclosure. For the sake of brevity, however, the numerous iterations of these combinations will not be described separately.

    [0034] FIG. 1 is a schematic diagram of an intraluminal imaging system 100 according to embodiments of the present disclosure. The system 100 may include an intraluminal imaging device 110, a connector 124, a control and processing system 130, such as a console and/or a computer, and a monitor 132. The intraluminal imaging device 110 includes an imaging assembly 102 at the tip of a flexible elongate member 108, and a handle 120. The flexible elongate member 108 includes a distal portion 104 and a proximal portion 106. The distal end of the distal portion 104 is attached to the imaging assembly 102. The proximal end of the proximal portion 106 is attached to the handle 120 for example, by a resilient strain reliever 112, for manipulation of the intraluminal imaging device 110 and manual control of the intraluminal imaging device 110. The imaging assembly 102 can include an imaging core with ultrasound transducer elements and associated circuitry. The handle 120 can include actuators 116, a clutch 114, and other steering control components for steering the intraluminal imaging device 110, such as deflecting the imaging assembly 102 and the distal portion 104, as described in greater details herein.

    [0035] The handle 120 is connected to the connector 124 via another strain reliever 118 and a connection cable 122. The connector 124 may be configured in any suitable configurations to interconnect with the control and processing system 130 and the monitor 132 for processing, storing, analyzing, manipulating, and displaying data obtained from signals generated by the imaging core at the imaging assembly 102. The control and processing system 130 can include one or more processors, memory, one or more input devices, such as keyboards and any suitable command control interface device. The control and processing system 130 can be operable to facilitate the features of the intraluminal imaging system 100 described herein. For example, the processor can execute computer readable instructions stored on the non-transitory tangible computer readable medium. The monitor 132 can be any suitable display device, such as liquid-crystal display (LCD) panel or the like.

    [0036] In operation, a physician or a clinician advances the flexible elongate member 108 into a vessel within a heart anatomy. The physician or clinician can steer the flexible elongate member 108 to a position near the area of interest to be imaged by controlling the actuators 116 and the clutch 114 on the handle 120. For example, one actuator 116 may deflect the imaging assembly 102 and the distal portion 104 in a left-right plane and the other actuator 116 may deflect the imaging assembly 102 and the distal portion 104 in an anterior-posterior plane, as discussed in greater details herein. The clutch 114 provides a locking mechanism to lock the positions of the actuators 116 and in turn the deflection of the flexible elongate member while imaging the area of interest.

    [0037] The imaging process may include activating the ultrasound transducer elements on the imaging assembly 102 to produce ultrasonic energy. A portion of the ultrasonic energy is reflected by the area of interest and the surrounding anatomy, and the ultrasound echo signals are received by the ultrasound transducer elements. The connector 124 transfers the received echo signals to the control and processing system 130 where the ultrasound image is reconstructed and displayed on the monitor 132. In some embodiments, the processing system 130 can control the activation of the ultrasound transducer elements and the reception of the echo signals. In some embodiments, the control and processing system 130 and the monitor 132 may be part of the same system.

    [0038] The system 100 may be utilized in a variety of applications such as transseptal lumen punctures, left atrial appendage closures, atrial fibrillation ablation, and valve repairs and can be used to image vessels and structures within a living body. Although the system 100 is described in the context of intraluminal imaging procedures, the system 100 is suitable for use with any catheterization procedure, e.g., ICE. In addition, the imaging assembly 102 may include any suitable physiological sensor or component for diagnostic, treatment, and/or therapy. For example, the imaging assembly can include an imaging component, an ablation component, a cutting component, a morcellation component, a pressure-sensing component, a flow-sensing component, a temperature-sensing component, and/or combinations thereof.

    [0039] In some embodiment, the intraluminal imaging device 110 includes a flexible elongate member 108 that can be positioned within a vessel. The flexible elongate member 108 having a distal portion 104 and a proximal portion 106. The intraluminal imaging device 110 includes an imaging assembly 102 that is mounted within the distal portion 104 of the flexible elongate member 108.

    [0040] In some embodiments, the intraluminal imaging system 100 is used for generating 2D and 3D images. In some examples, the intraluminal imaging system 100 is used for generating x-plane images at two different viewing directions perpendicular to each other.

    [0041] FIG. 2 is a perspective view of the imaging assembly 102 positioned for coupling according to embodiments of the present disclosure. The imaging assembly 102 is illustrated with the imaging core 262 in position within the tip member 200. The imaging core 262 is coupled to the electrical cable 266 via the electrical interconnection 264. The electrical cable 266 extends through the alignment portion 244 and the interface portion 246 of the inner cavity 250. The electrical cable 266 can further extend through the flexible elongate member 108 as shown in FIG. 1.

    [0042] The configuration and structure of the tip member 200 described above provide several benefits such as safe and easy delivery for catheterization, improved tensile strength for steering or navigation, consistent or automatic alignment, and improved image quality. For example, the outer geometry of the tip member 200 is configured to provide smooth surfaces and smooth edges with small radii. The smooth edges reduce friction when the tip member 200 traverses a vessel during insertion. The smooth surfaces prevent tears and/or damages to tissue structures during the insertion. In addition, the smooth edges and smooth surfaces can facilitate crossing of a septum or other anatomical feature during a catheterization procedure. The material type and the wall thickness of the tip member 200 are selected to minimize acoustic distortion, attenuation, and/or reflection. The internal geometry of the tip member 200 is configured to facilitate alignment during manufacturing. The tip member 200 can also include other features, for example, a guidewire lumen, holes, or other geometry to accommodate additional devices or features such as pressure sensors, drug delivery mechanisms, and/or any suitable interventional features.

    [0043] FIG. 3 is a top view of an imaging assembly 102 according to embodiments of the present disclosure. The imaging assembly 102 is illustrated with the imaging core 262 having an array of imaging elements 302 and micro-beamformer IC 304 coupled to the array of imaging elements 302. The imaging assembly 102 also shows the electrical cable 266 coupled to the electrical interconnection 264. In some examples, the electrical cable 266 is coupled through an interposer 310 to the micro-beamformer IC 304. In some examples the interposer 310 is connected to the micro-beamformer IC 304 through wire bonding 320. In some examples, the imaging assembly 102 is configured such that the electrical cable 266 is directly coupled to the micro-beamformer IC 304.

    [0044] In some examples, imaging assembly 102 includes an array of imaging elements 302 in the form of an array of more than 800 imaging elements. In this regard, the imaging elements 302 may be arranged in a 2-dimensional array having a length greater than width such that more imaging elements 302 extend along the length of the array than across the width. As a result, the array of imaging elements 302 may have an asymmetrical aperture. In some embodiments, the array of imaging elements 302 is an array of ultrasound imaging transducers that are directly flip-chip mounted to the micro-beamformer IC 304. The transmitters and receivers of the ultrasound imaging transducers are on the micro-beamformer IC 304 and are directly attached to the transducers. In some examples, mass termination of the acoustic elements are done at the micro-beamformer IC 304.

    [0045] In some embodiments, the micro-beamforming IC 304 lies directly underneath the array of acoustic elements 302 and is electrically connected to them. The array acoustic elements 302 may be piezoelectric or micromachined ultrasonic transducer (MUT) elements. Piezoelectric elements typically would be attached to the IC by flip-chip mounting an assembly of acoustic layers and sawing into individual elements. MUT elements may be flip-chip mounted as a unit or grown directly on top of the micro-beamforming IC 304. In some examples, the cable bundle may be terminated directly to the micro-beamforming IC 304, or may be terminated to an interposer 310 of suitable material such as a rigid or flexible printed circuit assembly. The interposer 310 may then be connected to the micro-beamforming IC 304 via any suitable means such as wire bonding 320.

    [0046] FIG. 4A is a schematic diagram 400 illustrating two imaging planes extending at oblique angles relative to a longitudinal axis of an asymmetric aperture of an imaging array according to aspects of the present disclosure. In particular, FIG. 4A shows imaging planes 410 and 420 extending at +45 degree and −45 degree angles, respectively, relative to a longitudinal axis 430 of the aperture 404. In other embodiments, the imaging planes 410 and 420 may extend at other oblique angles relative to the longitudinal axis 430 and/or a short axis 440 of the aperture 404 that extends perpendicular to the longitudinal axis 430. In some instances, the imaging planes 410 and 420 are at perpendicular angles relative to one another to facilitate x-plane and/or 3D imaging. In some instances, the imaging planes 410 and 420 extend at an oblique angle relative to one another. The diagram 400 shows the catheter tip 402 consistent with the tip 200 in FIG. 2 and also shows the aperture 404 of the array of imaging elements, which are arranged in a two-dimensional rectangular array. However, the diagram 400 can be representative of any asymmetric aperture of an imaging array for intraluminal imaging.

    [0047] FIG. 4B is a schematic diagram 450 illustrating two imaging planes extending coplanar with and at a right angle, respectively, relative to a longitudinal axis of an asymmetric aperture of an imaging array. In particular, FIG. 4B shows imaging planes 460 and 470 extending at +90 degree and 0 degree angles, respectively, relative to the longitudinal axis 430 of the aperture 404 of the array of imaging elements.

    [0048] FIG. 5 shows x-plane images at 0 degree and 90 degree. The images 500 are side by side images from 0 degree and 90 degree views, with the 0 degree view image 510 being on the left. As shown the image 510, 0 degree view, has a better resolution compared with the 90 degree view image 520 on the right.

    [0049] FIG. 6 shows x-plane images at 0 degree and +45 degree. The images 600 are side by side images from 0 degree and +45 degree views, with the 0 degree view image 610 being on the left. As shown the 0 degree view image 610 and the +45 degree view image 620 have a comparable resolution. In some examples when displaying one or both of the +45 degree view and the −45 degree view images, one of the 0 degree view or the 90 degree view images is also displayed alongside of them to mentally help the view to realize the orientation.

    [0050] FIG. 7 shows a 3D volume image 710. The image 710 is a 3D volume image similar to a volume image between −45 degree and +45 degree. In some examples, the acquisition planes are at +45 degree and for each acquisition, the acquisition plane is moved orthogonal to the +45degree plane, i.e., moves in the −45 degree plane. In some other examples, the acquisition planes are at −45 degree and for each acquisition, the acquisition plane is moved orthogonal to the −45 degree plane, i.e., moves in the +45 degree plane.

    [0051] In some examples, the micro-beamformer integrated circuit (IC) 304 can control the array of imaging elements 302 and can perform beam forming for the array imaging elements 302.

    [0052] In some embodiments, the electrical cable 266 further includes one or more power lines for feeding power to the micro-beamformer IC 304, one or more control lines for communicating control signals to the micro-beamformer IC 304, and one or more signal lines for transferring imaging signals.

    [0053] In some embodiments, the array imaging elements 302 is a two dimensional array. In some examples, the array imaging elements 302 is symmetric such that it has equal number of rows of imaging elements and columns of imaging elements. In some other examples, the array imaging elements 302 is asymmetric such that it has different number of rows of imaging elements and columns of imaging elements.

    [0054] In some embodiments, the delay elements in use consist of a number of repeated elements, and the number of these elements determines the maximum available delay. Since the acoustic array may be flip-chip mounted to the micro-beamformer IC 304, all of the processing, including the delay, for any given element can reside in the area occupied by that one element.

    [0055] In some examples, a plurality of imaging signals, received by the array of imaging elements, are beam formed. The plurality of imaging signals are associated with a plurality of planes between the first plane and the second plane. A 3D volume image is generated from the plurality of imaging signals such that the 3D image corresponds to a volume image between the first plane and the second plane.

    [0056] FIG. 8 provides a flow diagram illustrating a method 800 of intraluminal imaging of a vessel. The method 800 can be performed with reference to FIGS. 1, 2, 3, 4A, and 4B. At step 802, imaging signals are transmitted and received at a side-looking array of imaging elements, e.g., the array of imaging elements 302. The array of imaging elements 302 can be positioned within the distal portion 104 of an intraluminal imaging device 110. In some examples, a micro-beamformer IC 304 is directly coupled to the array of imaging elements 302 and transmits and receives imaging signals, e.g., ultrasound signals. In some examples, the array of imaging elements 302 is an array of ultrasonic transducers.

    [0057] At step 804 of the method 800 the first imaging signals received by the array of imaging elements 302 are beamformed. The beamforming can be performed with reference to FIGS. 3 such that the micro-beamformer IC 304 can be coupled, e.g., from beneath, to the array imaging elements 302 and can provide the required beamforming delays. The micro-beamformer IC 304 can command the array imaging elements 302 and can transmit and receive signals, e.g., ultrasound signals. The micro-beamformer IC 304 can also include a plurality microchannels delay lines. The micro-beamformer IC 304 can supply the required delays for beamforming from one or more of the microchannels delay lines to the array of imaging elements 302. In some examples, the beamforming is performed during both transmitting and receiving. In some other examples, the beamforming is performed during the receiving. In some examples, the ultrasound signals received by the imaging elements are beamformed by applying the required delays to construct a first beam-formed signal associated with a first plane at a first angle relative to an axial direction of an aperture of the side-looking array of imaging elements.

    [0058] At step 806 of the method 800 the second imaging signals received by the array of imaging elements 302 are beamformed. As noted, the beamforming can be performed with reference to FIGS. 3. The micro-beamformer IC 304 can supply the required delays to provide beamforming for the second imaging signals such that beamforming is provided by applying the required delays to the signals of each of the imaging elements of the array of imaging elements 302. In some examples, the ultrasound signals received by the imaging elements are beamformed by applying the required delays to construct a second beam-formed signal associated with a second plane at a second angle relative to an axial direction of an aperture of the side-looking array of imaging elements.

    [0059] At step 808 of the method 800, a first image and a second image are generated. The first image is generated from the first imaging signals and the second image is generated from the second imaging signal. The first image corresponds to a view at first plane and the second image corresponds to a view at the second plane.

    [0060] At step 810 of the method 800, the first angle and the second angles are determined. In some examples, the angles are determined based on a determined criterion between the first image and the second image. In some examples, the first angle and the second angle are predefined and for example they are set at −45 degree and +45 degree. In some other examples, the angles are determined based on a criterion. The predetermined criterion may constitute a relation between the first image and the second image such as a quality or quantity relationship between the first and second image. For example, the criterion can be related to the resolution of the two images. As noted the typical x-plane images at 0 degree and 90 degree may not have a similar resolution when the aperture of the array of imaging elements 302 is not symmetric, e.g., rather than being square it is rectangular. In some examples, the first angle and the second angle are selected such that the first and second images have comparable resolution and at the same time they are essentially perpendicular to each other, such as +45 degree and −45 degree relative to the longitudinal dimension of the array.

    [0061] In some examples, the first angle is identical to the 2D plane that was viewed immediately before entering the x-plane mode, and the second angle is as close to orthogonal to the first angle as possible within the constraint that the second angle is not within a pre-determined range of angle around the transverse (short aperture) dimension of the array. At least one of the image planes may be manually adjusted in rotation angle and/or tilt after the system selects the default image planes, and the manual adjustment can include the angle range that was excluded by the default image plane selection. The exclusion angle range for the default position of the second image plane could also be adjusted by the user as a setup parameter, to accommodate the user's tolerance for reduced resolution imaging. As noted, the resolution is noticeably worse but acceptable up to 60 degree, and degrades rapidly from 60 degree to 90 degree. In some examples, the exclusion angle range is from 45 degree to 90 degree. In some other examples, the exclusion angle range is from 60 degree to 90 degree.

    [0062] In some embodiments, the first angle is selected as an angle corresponding to an angle of a 2D plane viewed immediately prior to this selection. In some examples, the first angle is manually selected. In some embodiments, the second angle is determined as close as possible to orthogonal to the first angle and additionally avoiding the noted exclusion angle range.

    [0063] In some embodiments, the side-looking array of imaging elements is a phased-array transducer array and the imaging signals are ultrasound signals.

    [0064] In some examples, the first plane and the second plane are essentially at right angles.

    [0065] In some embodiments, a connection cable 122 couples the flexible elongate member 102 to a control and processing system 130. The micro-beamformer IC 304 may send the first imaging signals and the second imaging signals through the connection cable 122 to a control and processing system 130 that is configured to construct the first image and the second image.

    [0066] In some embodiments, the control and processing system 130 is configured to send one or more commands including beam forming commands to the micro-beamformer 304.

    [0067] As described, for a very asymmetrical aperture, such as a catheter side-looking matrix transducer, x-plane mode can default to ±45 degree planes instead of 0 degree and 90 degree, so both images have good resolution while still being 90 degree apart. The 3D acquisition planes can also be rotated 45 degree for the asymmetrical aperture, so 3D volume rendering and MPR planes have good resolution from either of viewing directions (along the acquisition planes at 45 degree and orthogonal to the acquisition planes at −45 degree). This means that x-plane and 3D/MPR are not oriented the same as the previously viewed single 2D image, which is typically aligned with the long aperture dimension. But this may be a reasonable trade-off to make x-plane and 3D modes more clinically useful.

    [0068] In some embodiments, systems and methods of the invention provide controls for adjusting the imaging planes or angles. In some examples, the electronic controls for adjusting 2D scan plane rotation angle are buttons on the transducer handle. In some embodiments, the invention provides for controls that are not positioned or available on the disposable catheter or the catheter handle. For example, it may not be desirable to include those controls on the catheter because of cost constraints for a disposable product. In some embodiments, the control for the catheter imaging planes is positioned on the imaging system itself. For example, there can be a control for scan plane rotation angle on the ultrasound console control panel. In some embodiments, systems of the invention provide a control panel that is not associated with the handle or the imaging system. In some examples, the control panel for adjusting the imaging plane could be implemented as a footswitch (such as a dual footswitch, for up and down) operated by the doctor who is manipulating the imaging catheter. In addition to the 2D scan plane rotation angle, the footswitch could also be programmed to control other much-used functions such as x-plane rotation or tilt angle.

    [0069] Since the imaging system including the console is typically controlled by a third party who is not the doctor but it may be the doctor who controls the ICE catheter, even if the console or a remote control panel was within the doctor's reach, it may not be useful because typically the doctor's hands are fully occupied manipulating the catheters. Continually verbally requesting scan plane rotation angle changes, when the console operator does not know what the doctor wants to see in the image, is a very inefficient work flow. As noted, the footswitch control panel is desirable and solves the problem.

    [0070] Persons skilled in the art will recognize that the apparatus, systems, and methods described above can be modified in various ways. Accordingly, persons of ordinary skill in the art will appreciate that the embodiments encompassed by the present disclosure are not limited to the particular exemplary embodiments described above. In that regard, although illustrative embodiments have been shown and described, a wide range of modification, change, and substitution is contemplated in the foregoing disclosure. It is understood that such variations may be made to the foregoing without departing from the scope of the present disclosure. Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the present disclosure.