TISSUE TEMPERATURE DETECTION FOR BIPOEAR SEAEING USING
INFRARED TEMPERATURE SENSOR
FIELD
[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63/589,529, filed 11 October 2023, the entire content of which is incorporated herein by reference.
[0002] The present technology is generally related to the field of medical devices, systems, and methods for use in surgical procedures. More specifically, this disclosure relates to surgical devices, units, systems, and methods that can provide for tissue temperature monitoring during procedures relating to hemostasis or sealing of bodily tissues.
BACKGROUND
[0003] This disclosure relates generally to the field of medical devices, systems, and methods for use in surgical procedures. More specifically, this disclosure relates to surgical devices, units, systems, and methods that can provide for hemostasis or sealing of bodily tissues, including bone, while continuously, simultaneously, or periodically monitoring the temperature of the tissue or bone.
[0004] The management and control of intraoperative bleeding can include the techniques of coagulation, hemostasis, or sealing of tissues and are often performed with the aid of electrodes energized from a suitable power source. Typical electrosurgical devices apply an electrical potential difference or signal between an active electrode and a return electrode on the grounded body of the patient or between an active electrode and a return electrode on the device to deliver electrical energy to the area where tissue is to be affected. Electrosurgical devices pass electrical energy through tissue between the electrodes to provide coagulation to control bleeding and hemostasis to seal tissue. The electrosurgical devices are usually held by the surgeon and connected to the power source, such as an electrosurgical unit having a power generator, via cabling.
[0005] Dry-tip electrosurgical devices can adversely affect tissue and surgical procedures by desiccating or perforating tissue, causing tissue to stick to the electrodes, burning or charring tissue, and generating smoke at the surgical site. More recently, fluid- assisted electrosurgical devices have been developed that use saline to inhibit such undesirable effects as well as to control the temperature of the tissue being treated and to electrically couple the device to the tissue. Fluid-assisted electrosurgical devices have been developed which, when used in conjunction with an electrically conductive fluid such as saline, may be moved along a tissue surface without cutting the tissue to seal tissue to inhibit blood and other fluid loss during surgery.
[0006] Fluid-assisted electrosurgical devices apply radiofrequency (RF) electrical energy and electrically conductive fluid to provide for sealing of soft tissues and bone in applications of orthopedics (such as total hip arthroplasty, or THA, and total knee arthroplasty, or TKA), spinal oncology, neurosurgery, thoracic surgery, and cardiac implantable electronic devices as well as others such as general surgery within the human body. The combination of RF energy and the electrically conductive fluid permits the electrosurgical device to operate at approximately 100 degrees Celsius, which is nearly 200 degrees Celsius less than traditional electrosurgical devices. Typically, hemostasis is performed with fluid-assisted devices having electrodes in the bipolar arrangement that are referred to as bipolar sealers. By controlling bleeding, bipolar sealers have been demonstrated to reduce the incidence of hematoma and transfusions, help maintain hemoglobin levels, and reduce surgical time in a number of procedures, and may reduce the use of hemostatic agents.
[0007] However, a lack of real-time or near real-time temperature monitoring solutions are available for the electrode(s) as well as for the tissue under sealing. With a lack of or minimal options to monitor the electrode(s) and tissue, patients run a higher risk of overheating, burning, etc., which can be highly avoided with more efficient or effective monitoring techniques. Thus, there is a need for more effective electrode and tissue temperature monitoring solutions.
SUMMARY
[0008] The techniques of this disclosure generally relate to the field of medical devices, systems, and methods for use in surgical procedures. More specifically, this disclosure relates to surgical devices, units, systems, and methods that can provide for hemostasis or sealing of bodily tissues, including bone, while continuously, simultaneously, or periodically monitoring the temperature of the tissue or bone. [0009] In one aspect, the present disclosure provides a surgical device, comprising a handle including at least one user input mechanism and a shaft extending distally from the handle, the shaft including a distal end. In examples, a thermal assembly can be operably coupled to the distal end of the shaft, including a heating element, wherein the thermal assembly includes at least one heating element and is electrically coupled to the at least one user input mechanism. In examples, a temperature monitoring mechanism can in coupled to the handle, wherein the temperature monitoring mechanism includes temperature monitoring technology such that a temperature of at least one of the thermal assembly or a targeted tissue area of a patient is monitored during a procedure with the surgical device, wherein the temperature monitoring technology includes at least one infrared sensor.
[0010] In another aspect, the present disclosure provides a method for operating a surgical device, comprising providing hemostatic sealing of tissue, at a targeted area of a patient, with a thermal assembly operably coupled to a distal end of a shaft, the thermal assembly including a heating element, wherein the heating element is electrically coupled to at least one user input mechanism. In examples, the method further comprising coupling the user input mechanism to a handle, wherein the shaft extends distally and monitoring and determining the temperature of the targeted tissue area or the thermal assembly during hemostatic sealing.
[0011] The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.
BRIEF DESCRIPTION OF DRAWINGS
[0012] FIG. 1 is a schematic view illustrating a surgical system, according to examples. [0013] FIG. 2 is a side view illustrating an example of a surgical device of the system of FIG. 1, including a thermal assembly with an internal temperature monitoring mechanism, according to examples.
[0014] FIG. 3 illustrates an example block diagram method for temperature detection and monitoring during homeostatic or sealing procedures, according to examples. DETAILED DESCRIPTION
[0015] FIG. 1 is a schematic view illustrating an example surgical system 10 that can include a handheld surgical device to deliver thermal energy to provide hemostasis or sealing of body tissues, including bone, with or without the constant (e.g., having a consistent, adjustable flow rate) or periodic use of fluid dispersal. In examples, periodic use of fluid dispersal can include dispersing fluid at a given interval of time, every ‘C’ seconds/minutes/etc., on demand of a clinician (e.g., via a user input), etc. In examples, system 10 can be included within a handheld surgical device. In examples, system 10 can include a selectively dispersed fluid, e.g., a fluid can be dispersed at the discretion of the clinician or operator of system 10. In examples, the dispersed fluid can be implemented to constantly be dispersed while the device is activated. In examples, the fluid can disburse constant fluid at a flow rate selectively determined by the clinician or operator. In embodiments, the fluid can be water, saline, or other fluidlike substance that can cool or otherwise reduce the temperature of the area that is undergoing hemostasis or sealing procedures.
[0016] System 10 can include a source of thermal energy 12 coupled to a heating element 14. In one example, the source of thermal energy 12 can include a source of electrical energy electrically coupled to the heating element 14. In examples, heating element 14 can be configured as part of heating assembly on a distal tip of a surgical device, e.g., handheld surgical device 100 of FIG. 2. Heating element 14 can include a resistive material that is configured to rise in temperature when an electrical current is passed through heating element 14. The source of thermal energy 12 can be selectively activated via a switch, button, lever, directional pad, or any other input mechanisms to apply the electrical current to the heating element 14. Activation of the thermal assembly can quickly heat heating element 14 into the temperature range of about 80 degrees Celsius to about 110 degrees Celsius, such as to a preselected temperature within that range. In one example, the heating element 14 can include a low thermal mass or heat capacity so that heating element 14 can heat to the preselected temperature or temperature range within a predetermine or set period of time (e.g., between one or two seconds of activation) and can cool to a safe temperature (e.g., below a threshold temperature) within a predetermined or set period of time (e.g., between one or two seconds) of deactivation. [0017] System 10 can include a temperature monitoring mechanism 16 operably coupled to detect the temperature of heating element 14 and/or bodily tissue that is subject to the hemostasis or sealing of the patient. Temperature monitoring mechanism 16 can indirectly (i.e., non-contact) determine the temperature of the heating element 14 or bodily tissue of the patient, which is described in greater detail below. Temperature monitoring mechanism 16 can be operably coupled to a controller 18 to monitor the temperature of the heating element 14 and the temperature of the tissue of the patient. Controller 18 can include a processor 19 and memory 20 to receive signals, information, data, etc. transmitted by the temperature monitoring mechanism 16 and to execute a set of instructions in an application to monitor the temperature of the heating element 14 and the temperature of the tissue of the patient. In examples, system 10 can include a display or a data output couplable to an external monitor to provide graphical or indications of temperature or other information as determined by the controller 18. In examples, display or output can be external to or coupled with the surgical device, e.g., handheld surgical device 100. For example, display or output can include a continuous or periodic monitoring display of the temperature at the targeted tissue area or heating element 16. In examples, temperature monitoring can be done in parallel with the use of the heating element 14 during hemostasis or sealing procedures.
[0018] In examples, system 10 can include an alerting mechanism coupled to the system 100 (e.g., LED light, internal speaker, display, etc.) that can produce an alert, such as a visual or audio alert (e.g., activating a light, a continuous flashing light, produce a sound, such as an alarm or alert indication, etc.) when the controller detects the temperature of the heating element 14 or tissue of the patient exceeding a threshold temperature. In examples, the threshold temperature can be shown via display electrically or wirelessly coupled to the alerting mechanism. If the threshold temperature is reached or exceeded, the alert can be seen or heard by the clinician during hemostasis or sealing procedures and be prompted to stop, at least temporarily, the procedure. In examples, the clinician can stop the procedure, based on the alert, or apply additional fluid to the treatment area to allow the temperature of the heating element 14 or the tissue of the patient to cool down to an acceptable temperature level, prior to continuing hemostasis or sealing procedures. In examples, if the threshold temperature is reached or exceeded, an action can be taken automatically or manually by the clinician during hemostasis or sealing procedures. In embodiments, if the threshold temperature is reached or exceeded, power supplied to heating element 14 can be reduced or turned off automatically. In embodiments, if the threshold temperature is reached or exceeded, fluid can be automatically supplied to heating element 14 or targeted tissue area automatically. In examples, the clinician can stop the procedure, at least temporarily, based on the alert or action taken. In examples, the threshold temperature can be modified, either dynamically or automatically, depending on the type of tissue and the location of the procedure being performed within the patient.
[00+9] In examples, system 10 can provide for a selective application of fluid if desired by a surgeon. Fluid may be provided from a fluid source that can include a bag of fluid through a drip chamber to delivery tubing and to a handheld surgical device. In one example, the fluid includes saline and can include physiologic saline such as sodium chloride (NaCl) 0.9% weight/volume solution. Saline is an electrically conductive fluid, and other suitable electrically conductive fluids can be used. In other examples, the fluid may include a nonconductive fluid, such as deionized water.
[0020] Fig. 2 illustrates an example of a surgical device 100 having thermal assembly 102 that can be used in conjunction with system 10. Thermal assembly 102 can include an exposed conductive surface configured to be electrically coupled to a source of electrical energy supplied from a power source that is not necessarily in the RF range. In examples, thermal assembly 102 can be electrically coupled to the power source via one or more power cables 104. Thermal assembly 102 can be configured to provide for an electrode/tissue interface of a patient. Thermal assembly 102 can be formed to optimize hemostatic sealing of tissue, including bone, without fluid, or in conjunction with selected or constant delivery of fluid,
[0021] Surgical device 100 can include a handpiece 106. Handpiece 106 includes a handle 106 that can include a finger or hand grip portion (e.g., with ridges) on the lower surface or bottom portion of the surgical device 100 and intended to be held in the hand of the surgeon or clinician. In examples, the device 100 can be wired (e.g., power cables 104) or can be wireless and include the features of a thermal control system within handpiece 104. Handpiece 104 can include a proximal end 108 for balance and to receive electrical communication from power source 12, via power cables 104 or wirelessly (e.g., batteries). In examples, handpiece 104 can comprise a sterilizable, rigid, electrically insulative material, such as a synthetic polymer (e.g., polycarbonate, acrylonitrile-butadiene-styrene). [0022] Handle 106 can include an upper surface that is opposite the lower surface. A controller 110, for example, can include one or more input operating mechanisms, such as one or more buttons, switches, etc. (not shown) and can be coupled to circuitry such as on a printed circuit board. In examples, input operating mechanisms can be disposed on the upper or lower surface and configured to be operated by the user (e.g., via the thumb or finger of the user to control one or more functions of the surgical device 100). In examples, input operating mechanisms can provide binary activation (on/off) control for each function and can be configured as a pushbutton, switch lever, etc. For example, user input mechanisms can be pushed or switched to activate thermal assembly 102 and released or repushed to deactivate thermal assembly 102. In examples, an additional switch or input (not shown) can be used selectively activate fluid dispersal.
[0023] In examples, surgical system 100 can include temperature monitoring technology 112 (e.g., reflecting the same or similar capabilities to temperature monitoring mechanism 16), such that the temperature of thermal assembly 102 or the temperature of the tissue under hemostasis or sealing can be determined and monitored during surgical procedures (e.g., hemostasis or sealing of tissue, including bone). In examples, temperature monitoring technology 112 can include at least one infrared (IR) temperature sensor. One or more IR temperature sensors can include at least one active or passive infrared sensor. In examples, additional or alternative user input mechanism can be used to selectively control temperature monitoring technology 112. In examples, temperature monitoring technology 112 can be activated (e.g., simultaneously when the surgical device 100 is activated). Temperature monitoring technology 112 can continuously or periodically monitor and detect the temperature of thermal assembly 102 or tissue under sealing 114 while surgical device 100 is activated. In examples, monitoring and detecting of thermal assembly 102 or tissue under sealing 114 can be deactivated upon deactivation of surgical device 100. In examples, temperature monitoring technology 112 can be independently activated and periodically monitor and detect the temperature of thermal assembly 102 or tissue under sealing 114 while the surgical device 100 is in use. In examples, periodic monitoring can include, manually activating and deactivating the monitoring, activating monitoring ‘X’ number of times within a certain time period, or activate monitoring every ‘Y’ seconds/minutes, etc. [0024] In examples, temperature monitoring technology 112 can be coupled with surgical device 100 (e.g., coupled with handle 106 or a probe assembly 122). In examples, temperature monitoring technology 112 can be coupled with surgical device 100 such temperature monitoring technology 112 is positioned to provide a field of view 116 that can monitor the temperature of the targeted tissue area 114. In examples, the temperature monitoring technology 112 can be positioned to monitor the temperature of the tissue area of a patient, which can include the target tissue subject to hemostasis or sealing and a portion of the tissue area surrounding the targeted tissue area, via field of view 116. In examples, the temperature monitoring technology 112 can include a field of view 116 that can monitor the temperature of the thermal assembly 102. In examples, the temperature monitoring technology 112 (e.g., including at least one IR temperature sensor) can be positioned, angled, or otherwise coupled with surgical device 100 such that an accurate, precise, or at least near-precise field of view 116 to the thermal assembly 102 or the tissue under sealing 114 can be achieved and temperature determined. In examples, temperature monitoring technology 112 includes a field of view 116 that is sufficient to for the clinician to monitor the temperature of thermal assembly 102 or tissue under sealing 114 accurately with near precision. It should be understood that other functions and control of surgical device 100 and temperature monitoring technology 112 are contemplated.
[0025] In examples surgical device 100 can include probe assembly 122 extending distally from the handpiece 104. Probe assembly 122 can include a shaft 122. The shaft 122, or other portions of device 100 can include one or more elements forming a subassembly to be generally one or more of rigid, bendable, fixed-length, variable-length (including telescoping or having an axially-extendable or axially -retractable length) or other configuration. Shaft 122 can be configured to communicate a source of thermal energy to the thermal assembly 102. Shaft 122 carries one or more electrical conductors to a distal end 124 including the thermal assembly 102. Electrical pathways of the handpiece 104 and probe assembly 120 can be formed as conductive arms, wires, traces, other conductive elements, and other electrical pathways formed from electrically conductive material (e.g., metal, stainless steel, titanium, gold, silver, platinum or any other suitable material). In examples, surgical device 100 can selectively disperse fluid via at least one fluid lumen coupled within shaft 122 and can extend into the handpiece 104 to delivery tubing in a cable extending from proximal end 108. The fluid lumen can include an outlet port disposed on or proximate thermal assembly 102 for selectively dispersing fluid at or near the targeted tissue area 114.
[0026] In examples, during operations of surgical device 100, incoming reflected IR radiation at a location or device being monitored (e.g., reflected from the targeted tissue area 114 or the thermal assembly 102) can be received or detected by temperature monitoring technology 112. For example, when a temperature changes, due to heating (e.g., hemostatic or sealing) at the target tissue area 114 or increased temperature changes of thermal assembly 102, the IR radiation can be received and processed as temperature data. The detected and determined temperature data, based on the IR radiation received by the IR sensor(s), can be transmitted and, for example, processed by temperature control 18. In examples, a precise or near precise value of the received IR radiation can be processed and an accurate measure of the temperature of the monitored targeted tissue area 114 or thermal assembly 102 can be detected or indicated.
[0027] In examples, based on the temperature data, a precise control system can be designed to control the temperature to control the rate of flow of saline distributed to targeted tissue area 114 or thermal assembly 102. In examples, if the change in the tissue temperature exceeds a threshold temperature, which may cause tissue bum, an alert for the clinician may be implemented. In examples, an alert can include generating a sound, activating a visual indicator (e.g., blinking light optionally coupled with or to surgical device 100) and other alerting mechanisms such that the clinician is notified to perform an action (e.g., introduce additional saline to the monitored area) or to cease an action (e.g., halt, at least temporarily, surgical procedures). In examples, an action (e.g., reducing power supplied to thermal assembly 102 or expelling fluid) can be automatically triggered and implemented if the measured temperature reaches or exceeds a threshold temperature. In examples, measured or calculated temperature data can be sent or displayed to the clinician (e.g., via a user interface), such as the previous temperature of the monitored area, the new or current temperature of the monitored area, the change in temperature of the monitored area, and other temperature data. It should be understood that additional alerting mechanisms and data associated with surgical procedures are contemplated.
[0028] FIG. 3 illustrates an example block diagram method for temperature detection and monitoring during homeostatic or sealing procedures, according to examples. In examples, the surgical device 100 can be available and used during a homeostasis or sealing procedures. At 202, the clinician can initiate homeostasis or sealing of tissue procedures and activate the surgical device 100 at 204. In examples, homeostasis or sealing of tissue, including bone is commenced at or near a target tissue area.
[0029] At 206, the temperature at or near the target area or the thermal assembly can be monitored by temperature monitoring technology (e.g., including at least one IR sensor). In examples, temperature monitoring technology receives and processes incoming infrared radiation reflected from at or near the target area for homeostasis or sealing procedures or reflected from the thermal assembly. At 208, the incoming infrared radiation can be received by the temperature monitoring technology and can be processed to determine a change in temperature or current temperature at or near the target area or thermal assembly.
[0030] At 210, if the determined temperature or change in temperature exceeds a threshold temperature, an alert can be activated. In examples, an alert can be any one of a visual or audio activation, such that the alert gains the attention of the clinician or others in the vicinity of the homeostasis or sealing procedure. In examples, the alert can indicate the clinician to cease, at least temporarily, the homeostasis or sealing procedure. In examples, the alert can initiate an action to automatically distribute additional fluid, such as saline, to the target area. In examples, the alert can trigger an action to automatically deactivate the surgical device or reduce power, such that the temperature of the thermal assembly is reduced.
[0031] This process, the repetition of 206, 208, and 210 can be repeated until the homeostasis or sealing procedure has been completed. In examples, the temperature monitoring technology coupled with the surgical device can be a real time or near real-time temperature monitoring system to monitor and control the temperature of the thermal assembly or targeted tissue area to create a closed-loop control of the temperature (e.g., for automatically or manually activating the distribution of fluid, such as saline, or deactivating or reducing the power supplied via the thermal assembly. Thus, automatic or manual monitoring, control, and management of the temperature of the thermal assembly or targeted tissue area can be achieved. At 212 the surgical device can be deactivated and the homeostasis or sealing procedure complete.
[0032] Example 1, includes a surgical device, comprising: a handle including at least one user input mechanism; a shaft extending distally from the handle; a thermal assembly operably coupled to a distal end of the shaft, including a heating element, wherein the thermal assembly includes at least one heating element and is electrically coupled to the at least one user input mechanism; and a temperature monitoring mechanism, wherein the temperature monitoring mechanism includes temperature monitoring technology such that a temperature of at least one of the thermal assembly or a targeted tissue area of a patient is contactlessly monitored during a procedure with the surgical device, wherein the temperature monitoring technology includes at least one infrared sensor configured to receive infrared radiation within a field of view.
[0033] Example 2 includes the surgical device of example 1, wherein the thermal assembly is configured to provide hemostatic sealing of tissue and monitors the temperature of at least one of the thermal assembly or the target tissue area of the patient.
[0034] Example 3 includes the surgical device of example 2, wherein the temperature monitoring mechanism continuously monitors and determines the temperature of the at least one of the thermal assembly or the targeted tissue area of the patient via the at least one infrared sensor.
[0035] Example 4 includes the surgical device of example 2, wherein the temperature monitoring mechanism periodically monitors and determines the temperature of the at least one of the thermal assembly or the targeted tissue area of the patient via the at least one infrared sensor.
[0036] Example 5 includes the surgical device of example 1, wherein the at least one infrared sensor includes at least one active infrared sensor.
[0037] Example 6 includes the surgical device of example 1, wherein the at least one infrared sensor includes at least one passive infrared sensor.
[0038] Example 7 includes the surgical device of example 1, wherein the temperature of at least one of the thermal assembly or the target tissue area exceeds a threshold temperature, issue an alert.
[0039] Example 8 includes the surgical device of example 7, wherein the threshold temperature exceeds 110 degrees Celsius.
[0040] Example 9 includes the surgical device of example 1, wherein the temperature of at least one of the thermal assembly or the target tissue area exceeds a threshold temperature, automatically reduce power delivered to the surgical device. [0041] Example 10 includes the surgical device of example 1, wherein the temperature of at least one of the thermal assembly or the target tissue area exceeds a threshold temperature, automatically expel fluid to the targeted tissue area.
[0042] Example llincludes a method for operating a surgical device, comprising: providing hemostatic sealing of tissue, at a targeted area of a patient, with a thermal assembly operably coupled to a distal end of a shaft, the thermal assembly including a heating element, wherein the heating element is electrically coupled to at least one user input mechanism; coupling the user input mechanism to a handle, wherein the shaft extends distally; and monitoring and determining, via a temperature monitoring mechanism, the temperature of at least one of the targeted tissue area or the thermal assembly during hemostatic sealing procedures.
[0043] Example 12 includes the method of example 11, further comprising monitoring the temperature using at least one infrared sensor coupled to the surgical device, wherein the at least one infrared sensor is configured to receive infrared radiation within a field of view.
[0044] Example 13 includes the method of example 12, further comprising the at least one infrared sensor including at least one active infrared sensor.
[0045] Example 14 includes the method of example 12, further comprising the at least one infrared sensor including at least one passive infrared sensor.
[0046] Example 15 includes the method of example 11, further comprising continuously monitoring and determining the temperature of at least one of the targeted tissue area or the thermal assembly by the temperature monitoring mechanism, wherein the temperature monitoring mechanism includes at least one infrared sensor configured to receive infrared radiation within a field of view.
[0047] Example 16 includes the method of example 11, further comprising periodically monitoring and determining the temperature of at least one of the targeted tissue area or the thermal assembly by the temperature monitoring mechanism, wherein the temperature monitoring mechanism includes at least one infrared sensor configured to receive infrared radiation within a field of view.
[0048] Example 17 includes the method of example 11, further comprising issuing an alert when the temperature of at least one of the targeted tissue area or thermal assembly exceeds a determined threshold temperature.
[0049] Example 18 includes the method of example 17, further comprising exceeding the determined threshold temperature of 110 degrees Celsius. [0050] Example 19 includes the method of example 11, further comprising automatically reducing power delivered to the surgical device when at least one of the targeted tissue area or the thermal assembly exceeds a determined threshold temperature.
[0051] Example 20 incudes the method of example 11, further comprising automatically expelling fluid to the targeted tissue area when at least one of the targeted tissue area or the thermal assembly exceeds a determined threshold temperature.
[0052] It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques). In addition, while certain aspects of this disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the techniques of this disclosure may be performed by a combination of units or modules associated with, for example, a medical device.
[0053] In one or more examples, the described techniques may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit. Computer-readable media may include non-transitory computer-readable media, which corresponds to a tangible medium such as data storage media (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer).
[0054] Instructions may be executed by one or more processors, such as one or more digital signal processors (DSPs), general purpose microprocessors, application specific integrated circuits (ASICs), field programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuitry. Accordingly, the term “processor” as used herein may refer to any of the foregoing structure or any other physical structure suitable for implementation of the described techniques. Also, the techniques could be fully implemented in one or more circuits or logic elements.