2010-10-13 Assigned to INTEGRA BURLINGTON MA, INC. reassignment INTEGRA BURLINGTON MA, INC. CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: INTEGRA RADIONICS, INC.
This patent relates to an apparatus involving optical cameras, one or more, and computer graphic means for registering anatomical subjects seen in the cameras to computer graphic image displays of image data taken from CT, MRI or other scanning image means. One or more cameras may be set up to view the anatomical subject. The anatomical subject has been scanned previously by an imaging machine such as a CT scanner and the data has been stored in a computer with computergraphic readout. The computer has software which enables rotation translation and scaling of the anatomical subject seen in the image data. By registering the field of view of the camera or cameras with the corresponding graphic view of the image data, a registration of the optical view with the scanner image view can be made. In this way, points identifiable in the camera view can be located in the image data view and vice versa. In addition, if two views of the anatomical subject are taken, unique 3-dimensional coordinates of corresponding points between the camera to the image reconstructions can be determined. For instance, a space probe or microscope or surgical instrument can be quantitatively referenced to the anatomy with the scene of the camera field-of-view by reference to the identical scanner view. Thus, the position of the probe or its directional view toward the subject relative to internal anatomical structures can be determined. Index marks on the subject as seen in the camera and image may also be an adjunct to this technique.
This application is a continuation of application Ser. No. 08/205,138, filed Mar. 2, 1994, and entitled "Optical and Computer Graphic Stereotactic Localizer," now abandoned, which is a continuation of application Ser. No. 07/647,305, filed Jan. 28, 1991, and entitled "Optical and Computer Graphic Stereotactic Localizer," now abandoned.
The concept of frameless stereotaxy is now emerging in the field of neurosurgery. What is meant by this is quantitative determination of anatomical positions on, let us say, the head based on data taken from a CT, MRI or other scanning needs. The data from the image scan can be put into a computer and the head represented, according to this graphic information. It is useful for the surgeon to know where he will be operating relative to this data field. He can, thus, plan his operation quantitatively based on the anatomy as visualized from the image data. Until now the use of stereotactic head frames for fixation means is commonplace. These employ a head fixation device typically with an index means that can be visualized in scan slides or image data. Thus, the anatomical stereotactic data so determined can be quantified relative to the head frame. Arc systems or probe carriers are typically used to direct a probe quantitatively based on this data relative to the head holder and, thus, to the anatomy. If the surgeon can be freed from the use of the head holder and localizer, and still relate positions in the anatomy to things seen on the scan or image data, then this can spare patient discomfort and could be potentially used for general neurosurgery where only approximate target positioning is needed. For example, a space pointer which could be directed to the anatomy and its position could be quantified relative to the stereotactic image data. This space pointer, analogous to a pencil, might be therefore pointed at a position on the anatomy and the position and the direction of the pointer, subsequently appear, on the computer graphics display of the anatomical data. It would be convenient if this space pointer were mechanically decoupled or minimally mechanically coupled. Until now, several attempts have been made to implement a passive or active robotic pointer which consists of a pencil attached to an articulating arm, the arm having encoded joints which provide digital angular data. Such a robotic space pointer is a mechanically attached device and once calibrated can give the graphic representation of the pointer on a computer screen relative to the stereotactic data of the head.
One objective of the present invention is camera apparatus which can visualize a surgical field and digitize the view information from the camera and relate it via computer graphics means to image data which has been taken of the patient's anatomy by image scanning means. The relationship of the optical camera view and the image data will then make quantitative the anatomy seen in the camera view and also make quantitative the position of surgical instruments such as probes, microscopes, or space pointers to the anatomy via the registration of the camera view to the image data.
Another objective of the present invention is to make an optically coupled space pointer which accomplishes the same objectives as the robotic arm mechanically coupled space pointer. The optical coupling would free the surgeon from any sterility questions, provide a obstruction-free device, and avoid the encumbrances of a bulky mechanically coupled instrument.
FIG. 1 shows one embodiment of the present invention which involves two video cameras and a space pointer with two light sources on it.
FIG. 2 shows an embodiment of the present invention with the space pointer pointing into a cranial operative site and where more than two video cameras are looking at the space pointer for redundancy.
FIG. 3 shows an embodiment of the present invention in which light sources at a distance from the pointer are used to reflect off reflectors on the pointer and the reflected light is detected by video cameras to ascertain the orientation of the space pointer.
FIG. 4 shows an embodiment of the present invention in which two cameras are used and they visualize the anatomical field together with a space pointer, index marks on the patient's anatomy and a microscope so as to relate the position and aim of the microscope to the anatomy and the space pointer.
FIG. 5 shows a generalized, signal camera embodiment of the invention where the camera is coupled to a computer graphic means and the view of the camera looking at the patient anatomy is related to image data from image scan means so as to register the camera view and the image data to quantify the camera view field.
FIG. 6 shows a schematic representation of how camera field data would be registered in position and orientation to analagous image scan data on the same computer graphic display.
FIG. 7 shows a schematic view of two cameras looking at the anatomical subject with corresponding computer graphic views both of the camera, readout and field-of-view and of the computer graphic representation of the same view.
FIG. 1 shows a schematic view of one embodiment of the invention. The setting is neurosurgery and the patient 6 is being operated on through a skull hole 7. Probe 1 is being put up to the patient's head and it is desired to know the relationship of that probe to the anatomy of the patient's as visualized from some imaging means such as CT or MR scanners or angiographic X-rays views. This image data representation of the patient's head would previously have been accumulated in a computer. The cameras 4 and 5 may, for example be CCD Type compact TV Scanners with high resolution that can be easily digitized and video displayed or displayed on computer graphic screens. They are looking at the field including the patient's head 6 and the probe 1. The orientation and quantification of the data taken from the scan images in the video camera can be registered by can be registered by index spots 8A, 8B and 8C which may be placed on the patient's head. An alternative to these index spots might be a head ring which is fixed firmly to the patient's skull as is commonly done in surgery and that heading may have index points or lines on it which can be seen in the two views from the cameras 4 and 5. When the index points are in view of the cameras, the appropriate transformations can be made if the coordinates of the the physical points 8A, 8B, and 8C are known beforehand to the entire data set of anatomy in the computer. More than three points may also be used for redundancy or better field of view. The probe in FIG. 1 has two index light sources 2 and 3, which are also visible within a certain range to the cameras 4 and 5. Thus, the orientation of the light sources 2 and 3 relative to the anatomy is registered by the two cameras 4 and 5 and thus physical orientation of probe 1 relative to the head 6 is known. Since light sources 2 and 3 may be in a predetermined orientation relative to the tip of the probe 9, the actual physical location of the tip 9 relative to the anatomy may also be computed by the two views of the cameras 4 and 5. The orientation of the probe 1 may also be known from these two views. Thus, it is possible to display by the data accumulated by the cameras the orientation and absolute position of the probe relative to the anatomy, and this display can be made on computer graphics real time as the probe is moved around in a field near the anatomy. In particular, the probe within the entry hole 7 is known, and thus the tip 9 can be graphically visualized on a computer display relative to anatomy inside the patient's head. This is most useful when exploring the interior of a surgical hole when the surgeon wishes to know the advancement of his probe or surgical instruments within that hole. Such an instrument may also be useful in planning the position of a surgical incision. By pointing the probe at the patient's skin and being able to visualize the position on the skin relative to relevant anatomy inside the head, the surgeon can make a judicious choice of entry point.
The light sources 2 and 3 may be LED light sources of very small dimension and they can be powered by an internal battery in the probe 1. The probe may thus be mechanically decoupled from other apparatus and only optically coupled through the cameras 4 and 5. This optical coupling can be done in other ways. For example, there may be external light sources positioned nearby which can be reflected by tiny reflectors 2 and 3 on the probe. The reflected light can then be detected by cameras 4 and 5 giving the same optical registration of the probe position as though the light sources were sources of light on the probe itself.
Recalibration of the entire optical system is also possible. Cameras 4 and 5 may have principle optical axes, 25 and 26 respectively shown in FIG. 1. The cameras can be aligned to be pointing in a plane and directed towards a common isocenter 29. Thus all rays in the field such as rays 21 and 22 as seen from camera 4 to points 2 and 3 or rays 23 and 24 which also connect points 2 and 3 on the probe to the camera position 5 can be calibrated in the field of the cameras so that their exact angles relative to the principle rays indicated by 25 and 26 can be quantitatively determined. Once the quantitative orientation of these rays to the fiducial points 2 and 3 are digitized and determined numerically, then the position and orientation of the probe 1 can be calculated relative to the point 29 which has been recalibrated. The exact referencing of the coordinate system represented by axes 25 and 26 with their crossover point 29 and orthogonal axis 27 can be determined by further fiducial points on the anatomy itself. Natural anatomical fiducial points can be used such as the tip of the nose, the ears or other bony landmarks. However, specific index points such as 8A, 8B, and 8C can be placed on the patient's scalp, for example, and these used as a reference transformation set to relate the data seen by the cameras to anatomical data determined from the imaging. For example, the exact coordinates of the points 8A, 8B, and 8C may have been determined in space from the scan data previously. By knowing their exact coordinates in space and knowing the position of other anatomy relative to them, by determining the position as seen by the cameras 4 and 5 of these three fiducial points, the rest of the anatomy can also be registered in the cameras field. Thus the exact positioning of these fiducial points onto the graphic display of the anatomical data from the images can be made. Furthermore, the exact positioning of the probe with its fiducial points 2 and 3 can be thus set quantitatively into the field in a similar way. This corresponds to a series of 3-dimensional coordinate transformations and is a straight-forward mathematical matter. FIG. 2 illustrates another embodiment to the present invention in which more than 2 cameras are involved. Cameras 204 and 205, as well as camera 210, are present and may prealigned or not prealigned prior to surgery. They are anchored on a support structure 230 which holds them rigidly in place and that support, in turn, is clamped by means of clamping means 231 to some stable object relative to the patient's head 206 such as the operating room table or the floor itself. Headholder 232 may be a standard headholder as used in most operations with pin fixation points to the skull illustrated by 233, it too can be anchored to the operating table or to the floor by post 234 and, thus, the optical system above it and the head holder are stabilized relative to each other by means of their attachment to either themselves or to the operating table. Again, the index points 202 and 203 represent the fiducial points for the cameras 204, 205 and 210 and by digitizing the field of these cameras, one can determine the position and orientation of the probe 201. In addition, there are the index points 208A, B, and C which represent independent fiducial points on the patient's head which can be also observed by the camera and the camera can, therefore, check the stability as well as their coordinate reference frame continuously by monitoring these fiducial points on the anatomy itself. There is a typical range of motion of the probe 201 which is practical in such operations and this is illustrated as an example by the dashed cone 240. It must be that the camera can visualize the probe 201 and the fiducial points 202 and 203 everywhere within this working cone. This is typically the range in which the surgeon will be introducing instruments into the cranial opening site illustrated by 207. It is clear that the positions of the cameras 204, 205 and 210 can be prearranged and precalibrated on the bar 230. This may be so that they are pointing isocentrically to the same point in that their visualization fields are precalibrated and preoriented so that everything within the field has a known calibration. This could also be easily checked by taking the platform 230 off at any given time and putting it on a phantom base or some other jig structure which enables instant calibration of the system. It is also true that the head holder 232 may have fiducial lights on it or fiducial points so that it may be referenced relative to the cameras and the entire system becomes an integral digitized calibrated system.
FIG. 3 shows another embodiment of the present invention in which external light sources are present as well as the cameras for receiving optical signals. Cameras 304 and 305 are arranged and fixed to bar 330 for positioning. Light sources 342 and 341 are also arranged and attached to the bar 330 so that they aim towards the probe 301 which has reflectors on it, 302 and 303 which reflect the light from the light sources 341 and 342. The cameras detect the reflected light which is illustrated by the dashed light beams shown in FIG. 3. In this way the probe does not have to have any energy source or active light sources, but can be merely a reflector of light. It is also true that the probe itself could be one, long reflective linear arrangement or could have other arrangements of the fiducial points instead of the the linear arrangement 302, which is coaxial with the probe. Any kind of pattern recognition of this type could be detected by the cameras and the corresponding digitization of the probe position and orientation could be made. In this example of FIG. 3 we also show headring 350 which is affixed to the patient's head by a series of head posts 356 anchored securely to the skull. On the headring are fiducial elements 351, 352 and 353 which serve as index points and reference points that can also be detected optically by the cameras 304 and 305. In this way, the ring 350 represents a platform and corresponding coordinate system basis, the position of the coordinate system being referenced by the fiducial points 351, 352 and 353 and monitored in terms of its relative position to the bar 330 and its associated cameras. In this way the entire operative setting could be monitored for any differences in position and position differences can be corrected for if they are determined by the computer graphics associated with the cameras 304 and 305. It is notable that the need for discreet index points such as 302 and 303 on the space pointer is not absolutely necessary. Pattern recognition algorithms in a computer from data from cameras 304 and 305 may simply recognize the shape of the space pointer 301. Thus, the quantitation of its position in the field need not be done by discreet index points on the instrument.
The major advantage of the probe illustrated in FIGS. 1, 2 and 3 are that they are mechanically decoupled from the observing cameras and thus there are no encumbrances of mechanical linkages such as a robotic arm as has been proposed in the past. It is also true that these probes can be made relatively simply and disposable so that the surgeon can throw the probe away after the procedure without incurring great expense.
FIG. 4 show another embodiment to the present invention with optical digitizing viewing means which involves not only a probe 401, but also an operating microscope 460. The objective here is to determine quantitatively the relationship between the patient's head 406 and its anatomy within it, the space probe 401 and the operating microscope 460. The principle is essentially the same. The patient's head is 406 stabilized by the headholder 432. The microscope has index means 462 and 463 which may be LED point light sources. Similarly, the probe 401 has its index points 402 and 403. Cameras 404 and 405 are affixed to base platform 430 and view the entire field, microscope plus probe plus patient's head. Optical index points 408A, 408B, and 408C may be attached to the patient's scalp or to the headholder to provide referencing to the anatomy of both the probe and the microscope. By this sort of viewing, the relationship of the position of the microscope 460 and its orientation relative to the anatomy can be determined. Thus, one can display on the graphics means the field of view in which the microscope is viewing relative to that anatomy. In this way when computer graphics representations of the anatomy have been made, then computer graphics of the field view with a microscope can also be represented on the graphics display means and, thus, the relationship between what the surgeon 461 is seeing and the computer reconstructed field may be made. This is very important in planning as well as interactive surgical recessions. At the same time, probe 401 may be inserted into the field and the position 409 of its tip can be represented within the actual microscopic viewing field of the microscope 460. The entire surgical array of instruments may be represented graphically so that interactive correction and management of the operation can be made by the computer systems. One can also put other instruments within the field such as scalpels, probes and other devices which the surgeon commonly uses, these being indexed by fiducial marks or simply visualized directly by the cameras and representations of them put onto the graphics display means.
Thus by the index points that we have alluded to in FIGS. 1 through 4 and the associated embodiments, one can relate the various structures including anatomy, probes, microscopes and other instruments together in one graphics display. It should also be said that once this relationship has been established, then the cameras which see the actual objects themselves can make direct overlays of the objects as seen with the graphic representation of these objects as calculated from the imaging prior to surgery. Thus, direct correspondents of shapes and objects can be instantly ascertained by the operator by merely overlaying the graphics display and the actual display together on the same graphics screen.
There are many variations of the embodiments shown in FIGS. 1 through 4. One does not need to have, for example, two video cameras or two or more video cameras pointing in the same plane. They could be non-coplaner and there could be an array of them to encompass a much larger field of space. Such a multi-camera display could be precalibrated or not precalibrated. The cameras could be monitored and stabilized by fixed fiducial points somewhere in the field so that the entire registration and synchronization of all cameras would be possible. The mounting on which the cameras are held could be movable and changed interoperatively to be optimize the position of the cameras while maintaining registration with the subject field. The orientation of the cameras relative to the anatomy, microscope or probe could also be done without the need for fiducial lights such as two and three in FIG. 1 or index fiducial points 8A, 8B, and 8C in FIG. 1. Overall correspondence of the shape of the subject as viewed by the camera could be overlaid and optimized in its matching to the graphics representation of the anatomy taken from the images. Graphic rotation of the image data could be done so as to register the direction of view of the camera relative to the anatomy. This correspondence would then be done by shapes of subjects in the real field vs. shapes of subjects in the graphics field. Such optimization of the two shapes could be done and the direction of the camera thereby determined relative to the field of view. Once that is done, the orientation of the probe 1 or any other shaped object related to a probe could similarly be registered from the camera's point of view. Pattern recognition algorithms be used to determine the orientation of the probe one therefore relative to the orientation of the other subjects such as the head and its orientation relative to the cameras.
The present invention also includes use of one optical camera. Although the examples above illustrate use of two or more cameras, there is utility in even using just one camera to view the surgical field. It can give you a two-dimensional representation in a projected view of the field. One can use this representation and the graphic representation from the image data to register the two views and, thus, align the graphic display in a "camera view". Thus pointers in the field of the camera can be registered directly on to the graphic display view. For example, a pointer moving on the surface of the skin would be registered relative to the graphic view so that you would know where that point is moving relative to this quantitative data that represents the skin and other anatomical structures below the skin. This would have more limited usefulness, but it could also be important. Thus, the application of mounting a single video camera to view a surgical field and representing that visual field on a graphic field so as to bring the two fields into alignment by manipulation of the graphic field in the computer has utility in the surgical setting.
FIG. 5 illustrates more specifically the use of one optical viewing camera and registration of its field by computer graphics to image data. In FIG. 5, camera 505 which has been anchored via arm 550 near the surgical field, views the patient's head 506 and objects nearby. The camera is connected via cable 551 to the computer graphics screen 552. The computer graphics screen is cooperatively connected to computer calculation means and storage means and it has represented on its screen image data from the image scanning source 554. This scanning source may be a CT or MRI scanner or it may be a magnetic tape with corresponding data on it. The camera 505 is viewing the head and representation of the head shows on the screen together with image data indicated by the contours 553. In the field, is probe 501 which is seen as 555 on the screen. Also there is a surgical opening 507 and for completeness, the index marks 508A, 508B, and 508C which may aid in orienting what is seen by camera 505 to the graphics image data seen on screen 552. The headholder 532 and associated pins 533 hold firmly the head 506 relative to the camera 505. As shown in the screen 552, the corresponding index points 558A, 558B, and 558C are shown on the screen as well as the actual image of the anatomy and the space probe represented by image 553. Thus, if computer graphics representations of the same anatomy are simultaneously put on the screen, for example, in a different color, then those image data can be scaled, translated, and rotated such that they register with what is seen by the field of view of camera 505. By so doing that, one has in perspective view a registration of the camera data with the image data. Thus when one looks at the image 555, on the computer graphic screen 552 of the actual probe 501, one can see immediately the correspondence of that probe relative to the quantitative stereotactic image data anatomy. Thus in perspective view, one is relating the position of the probe to that stereotactic image data anatomy, and this can be a very useful adjunct to surgery. For example, if one wished to know where to make the surgical opening 507, one could move the probe 501 in actual space relative to the anatomy until one sees the probe in perspective view with its tip over the desired point relative to the image data anatomy seen on screen 552. That would instantly tell you that this is the place to make the surgical bone opening for example. There are many other illustrations of the use and power of this one-camera approach.
FIG. 6 shows how one might register camera anatomical data to image machine-acquired anatomical data as described in the paragraph related to FIG. 5. For example, in FIG. 6 the outline 606 represents the actual contour of the patient's head as seen by the camera 505 in FIG. 5. Also, the point 608A and 608B and 608C are shown as dots and these two are seen by the camera. Furthermore, anatomical landmarks such as 672, the tip of the ear, and 670, the tip of the nose, may be seen by the camera 505 in FIG. 5. The dashed contour in FIG. 6 shows a similar contour reconstructed in a perspective view from, for example, CT slice image data. Such image data can be stacked, can be surface rendered, and can be viewed and oriented from any different direction by computer graphics manipulation. Thus, it is possible to take such "dashed" image data representations, scale them proportionately, rotate them in space, and translate them, such that when you view the dashed and undashed contours on the computer graphics console, the operator can easily trim in the image data or the dashed line 666 such that it matches exactly the solid line 606 on the computer graphics screen. In a similar way, one can make computer graphic manipulations to register the correspondence of the image points from the camera 608A, 608B, and 608C with the corresponding index points 668A, 668B, and 668C, which are illustrated by dashed points in FIG. 6. Registering these two sets of the same physical points in the computer graphics would be an attractable way of registering the entire two perspective views. Similarly, anatomical landmarks which are identifiable such as the computer graphic representation of the tip of the ear 673 and the tip of the nose 671 can be represented and corresponded to the analagous point 672 and 670 from the camera data. The use of different colors, color washes, color transparencies, and other powerful graphic standards as well as mathematical algorithms to optimize the correspondence of these two perspective views are easily put into play at this point to do the job.
FIG. 7 illustrates another embodiment of how more than one camera can be used for computer graphic registration and corresponding quantification of an optical view. In the upper portion, one sees two cameras 704 and 705, pointing at arbitrary non-identical directions towards the subject 706. The fields of view are shown with the dashed lines. There is a cranial hole 707 with a probe 701 in it into the depth of the brain with the tip 709 inside the head. Index points 702 and 703 on the probe may or may not be present and are analogous to those discussed in FIG. 1. Each of the cameras will have views as illustrated in the lower portion of FIG. 7 and are displayed on the computer graphic display means 760 and 770. 760 represents, for example, the view of camera 704 and one sees the solid line 766 which is the optical outline as seen by camera 704 of the patient's head. Similarly, the probe 761 is seen through the burr hole 767. By computer graphic translation, rotation and scaling, one can adjust the computer graphic view so that it matches the anatomical view, i.e. the computer graphic perimeter 766A indicated as dash line exactly matches 766. In this way, one knows that one has reproduced graphically with the dashed curve the projected view as seen by 704. Analogously, camera 705 will have its view as seen in graphic display 770 of the outline of the head 776 being matched to the graphic outline of the head 776A. Obviously, index marks, grids or lines on the patient's scalp might help in this registration of the two camera views. Once these views, however, have been registered, uniquely identifiable points in both views can give information on the exact 3-dimensional coordinates of those identifiable points relative to the anatomy as seen from the image data. For example, the points 763 and 773 are identical and correspond to the physical point 702 on the probe. On each of the views 760 and 770 this point represents a projected line as seen from the respective camera. The two lines from the two cameras intersect at a unique point and this can easily be determined as a unique 3-dimensional point referenced to the data from the image scanner as stored in the computer. Thus, the two points 702 and 703 can be determined quantitatively in space relative to the anatomical data, and thus, the quantitative position of the probe and any point on the probe can be determined relative to the image data. In particular, the end of the probe represented by point 709 which is in the depth of the brain and indicated on the graphics display as 769 and 779 respectively can be determined, i.e the 3-dimensional coordinates of that point relative to the 3-dimensional image anatomy can be determined. Thus, there is no particular need for special index marks as shown in FIG. 1. Mere registration of existing anatomical structures relative to camera view and the image data would be sufficient for a full 3-dimensional representation of any instrument such as the probe in FIG. 7 relative to the anatomy. Using special angles such as 90° or stereoscopic views of the cameras could be convenient for such 3-dimensional registration without prior calibration.
It also should be said that for fixed camera positions, the subject itself might be moved so that his optical representation matches the graphic representation. In most cases, it would seem simpler to do the movement of the subject's image data via software, than moving the anatomical subject relative to the cameras, however, both methods could be used for registration of the respective images.
The use of such camera registration with image data eliminates any need of camera field calibration or the need to know relative camera angles.
It should be stated that this technique and the rest of the discussion above is differentiated from a previous attempt at registration of computer graphics to anatomical viewing. This was done by Patrick Kelly in the 1980's, and is reported in the literature in several places. Kelly's approach was to move a surgical microscope to a direction that was determined by image scan data. He would then take reconstructed structures from the image data and project it on a "heads up" display so that the surgeon looking on the microscope could see a graphic representation of what he should be viewing in the microscope field. The procedure of Kelly's was to first calculate the position from graphics of his microscope in terms of the approach angles of the microscope to the anatomy. Once specifying these approach angles, he could superpose the simulated graphics next to the microscope view. There are important conceptual differences between Kelly's method and the method discussed here in the present invention. First, Kelly does not use information, qualitative or quantitative, in the camera view or microscope view to make the correspondence, registration, or quantification of what is seen in the camera view relative to the graphics data. Secondly, he never uses two cameras to quantify the field of the cameras and relate them to the graphic display. Thirdly, he does not use object-related or fiducial identification points seen in one or more camera views to register the views directly to the image data. Thus, Kelly's approach differs in a fundamental way from what is being claimed in this invention.
The present invention includes in its scope the use of one or more cameras in the the context illustrated by FIGS. 1 through 7. It includes the use of a camera together with a computer and computer graphic means to register and relate optical viewing to image data from other scanning and imaging devices. It also relates to the use of such optical and image data correspondences to register and quantify the position of surgical tools such as the space probe or the microscope illustrated in the above examples. It is related to making the associated mathematical transformation from a coordinate system or perspective view seen by one or more cameras to a stereotactic coordinate system related to image data or a corresponding reconstructive perspective view of image data and associated coordinate information from such image data. It relates to the correspondence between objects both anatomical or surgical in a camera view to objects either anatomical or of an index or marker nature as represented from scanner data or extrapolated from scanner data in a computer or computer graphic system. This was given as a specific example from FIG. 1 in the relationship of a mechanical space pointer to index marks and these, in turn, to corresponding quantitative positions in space where index marks has known from image data. Registration of the camera viewing data to the image data may or may not involve index marks, index lines or index localizer devices. It may be done as illustrated in FIGS. 6 and 7 by visual or computer theoretic optimization of registration of camera and image data or camera and reconstructed image data or enhanced camera or manipulated image data. The invention further generalizes the concept of "a camera" to other camera-like devices. These might include an x-ray camera or an x-ray source is point-like and projects through the anatomy to give the image on a detection plane at the opposite side of the anatomy. This data could be projectively reconstructed as though it were reflected light from a single camera as illustrated in the examples above. Thus, the invention subsumes the field of generalized camera viewing or projected image acquisition relative to CT, MRI or angiography acquisition from other imaging means and the registration thereafter to make correspondence between these two image acquisition modalities.
Using more than one camera enables the determination of three-dimensional coordinates and depth of perception. The examples on FIGS. 1 through 4 illustrate this by use of a probe with two fiducial points on it that can be seen and digitized by the two camera views. This invention relates to the use of a video camera to quantitatively relate to graphic display data taken from other imaging means. The correspondence of the data are illustrated by the embodiments above and the discussion above, but those skilled in the art could think of other implementations of the same invention concept. For example, the use of two fiducial points on the probe can be extended to other types of optical fiducial means such as lines, other arrays of points, other geometric patterns and figures that can be recognized easily by computer graphics, artificial intelligence, etc. The two points illustrated in the figures be replaced by a line of light or a line of light and one or more discrete points to encode the direction of the object. The object itself could be recognized by the computer graphics as a line merely by having it of a reflective material or a particular color. The space pointer, for instance, could be white or green and thus show up differently on the TV cameras and in the video display so as to recognize it as the pointer.
fiducial markers for connection to said patient anatomy and determinable in both the scanner image data and the at least one camera's field-of-image registration to facilitate registering the at least one camera's field-of-image registration and the scanner image data on the graphics display of said computer.
said computer includes hardware and related software to rotate, translate, and scale said scanner image data to match said camera's field-of-image registration as displayed on the graphics display of said computer.
fiducial markers for placement on said patient anatomy and determinable in both the scanner image data and said at least one camera's field-of-image registration to facilitate said registration of said at least one camera's field-of-image registration and said scanner image data on said graphic display.
detachable markers for placement on said patient anatomy that are determinable in both said image data and said electronic readout of said field-of-image registration of said at least one optical camera so that when said markers as determined both in said image data and said electronic readout are brought into quantitative correspondence in said computer graphics display, registration of the image data with said electronic readout occurs.
determining the position of said instrument markers and thus said surgical apparatus relative to said patient anatomy by using said computer and by using the relation of said body markers and said instrument markers as determined from said electronic readout of said field-of-image registration.
a computer with a graphics display for receiving, processing and displaying said scanner image data and said camera electronic readout, with both said scanner image data and said camera electronic readout being displayed in proximity to each other, said computer having software for registering and establishing a correspondence between said at least one camera's field-of-image registration and said scanner image data based on information related to the fiducial markers determinable in both said at least one camera's field-of-image registration and said scanner image data, whereby information on said at least one camera's field-of-image registration can be directly related to said scanner image data, and said at least one surgical instrument in said at least one camera's field-of-image registration can be directly related to said patient anatomy.
a computer with a graphics display for receiving, processing and displaying said scanner image data and said electronic readout of said at least one camera's field-of-image registration, said computer having software for registering and establishing a correspondence between said at least one camera's field-of-image registration and said scanner image data based on information related to index points that are determinable in both said at least one camera's field-of-image registration and said scanner image data, whereby said information relating to said at least one surgical instrument in said at least one camera's field-of-image registration can be directly related to said patient's anatomy, said computer further including hardware and related software to rotate, translate, and scale said scanner image data to match said camera's field-of-image registration as displayed on the graphics display of said computer.
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Cinquin, P. et al., "Computer Assisted Medical Interventions", International Advanced Robotics Programme, The 2nd Workshop on Medical and Healthcare Robotics, Sep. 5-7, 1989.
Foley, James D. et al., "Geometrical Transformations", Fundamentals of Interactive Computer Graphics, Second Edition, Addison-Wesley Publishing Company, 1984, Chapter 7, pp. 245-266 (Chapter from a Book).
Friets, Eric M. et al. "A Frameless Stereotaxic Operating Microscope for Neurosurgery", IEEE Transactions of Biomedical Engineering, vol. 36, No. 6, June 1989.
Fuchs, Henry et al., "Acquisition and Modeling of Human Body Form Data,"SPIE, vol. 166, Applications of Human Biosteriometrics (NATO) (1978).
Gonzales, Rafael C. et al., "Stereo Imaging", Digital Image Processing, Second Edition, Addison-Wesley Publishing Company, Section 2.2.2, pp. 52-54 (Section from a Book).
Jacques, Skip et al., "A Computerized Microstereotactic Method to Approach, 3-Dimensionally Reconstruct, Remoe and Adjuvantly Treat Small CNS Lesions", Appl. Neurophysio.43:176-182 (1980).
Jiang, Hongjian et al., "A New Approach to 3-D Registration of Multimodality Medical Images by Surface Matching", Proceedings of SPIE The Inter. Society for Optical Engineering. Vol.1808:196-213 (1992).
Kato, Amami et al., "A frameless, armless navigational system for computer-assisted neurosurgery", J. Neurosurg.,No. 74, pp. 845-849, 1991.
Kosugi, Yukio et al., "An Articulated Neurosurgical Navigation System Using MRI and CT Images", IEEE Transactions on Biomedical Engineering, vol. 35, No.2, pp.147-152 Feb. 1988 (article).
Lavallee, S. et al., "Computer Assisted Interventionist Imaging: The Instance of Stereotactic Brain Surgery", Medinfo 89, Part 1.
Lavallee, S. et al., "Computer Assisted Puncture", Reconnaissance Des Formes et Intelligence Artificielle, 6th Congres Exposition, vol. 1, 439-49, Nov. 16-20, 1987.
Lavallee, Stephane and Cinquin, Philippe, "Computer Assisted Medical Interventions", 3D Imaging in Medicine, NATO ASI Series, vol. F 60 (1990).
Lavallee. S., "A New System for Computer Assisted Neurosurgery", IEEE Advanced Topics in Biorobotics, Engineering in Medicine and Biology Society 11th Annual International Conference(1989).
Lemke, H.U. et al. (ed.), "Computer Assisted Radiology", Proceedings of the International Symposium CAR '89.
Mazier, B. et al., "Computer Assisted Interventionist Imaging: Application to the Vertebral Column Surgery", Annual International Conference of the IEEE Engineering in Mewdicine and Biology Society, vol. 12, No. 1 (1990).
Mazier, B. et al., "Computer Assisted Vertebral Column Surgery: Application to the Spinal Pedicle Fixation", Innov. Techo. Biol. Med., vol. 11, No.5 (1990).
Mesqui, F. et al., "Real-Time, Noninvasive Recording and Three-Dimensional Display of the Functional Movements of an Arbitrary Mandible Point", SPIE vol. 602 Biostereometrics 85 (1986).
Murphy, Martin J., "An Automatic Six-Degree-of-Freedom Image Registration Algorithm for Image-Guided Frameless Stereotaxic Radiosurgery", Medical Physics, vol. 24, No. 6 (Jun. 1997) [added 7/28/99].
Newman and Sproull, "Moving Parts Of An Image", Principles of Interactive Computer Graphics, McGraw-Hill Book Company, 1979, Section 17.3, p. 254 (Section from a Book).
Pelizzari, C.A. et al., "Interactive 3D Patient -Image Registration", (date unknown).
Pixsys brochure "Design Aide"(Mar. 1989) by PixSys, Inc. 5 pages.
Pixsys brochure on "3-D Digitizing Accessories", 4 pages (date unknown).
Pixsys brochure, "Offset Probe for Science Accessories'Gp-8-3d digitizer "(Dec. 1987) by PixSys, Inc., one page.
Pixsys manual for "Alignment Procedure for the Pixsys Two-Emitter Offset Probe for the SAC GP-8-3d Sonic Digitizer", 3 pages, Pixsys, 1319 Spruce Street, Suite 201, Bo9ulder, CO 80302 (no date).
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Reinhardt, H.F., "Interactive Sonar-Operanted Deviced for Stereotactic and Open Surgery", Proceedings, of the Xth Meeting of the World Society for Stereotactic and Functional Neurosurgery, Maebashi, Japan, Oct. 1989(1990).
Reinhardt, HJ., "Surgery of Brain Neoplasms Using 32-P Tumour Marker", Acta Neurochirugica, 97:89-94 (1989).
Roberts, David W. et al., "A Frameless Stereotaxic Integration of Computerized Tomography Imaging and The Operating Microscope", J. Neurosurg.65:545-549 (1986).
Science Accessories Croporation brochure on Model GP-8-3D 3-Dimentional Sonic Digitizer (date unknown).
Watanabe, Eiju et al., "Three-Dimentional Digitizer (Neuronavigator): New Eguipment for Computed Tomography-Guided Stereotaxic Surgery", Surg. Neurol., pp. 543-547, No. 27, 1987.
Watanabe, Hideyasu, "Neuronavigator", Igaku-no-Ayumi(Medical Progress), vol. 137, No. 6 (May 10, 1986).
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Wolff, Robert S. et al., "Through Canyons and Planets", Visualization of Natural Phenomena, First Edition, TELOS The Electronic Library of Science, Santa Clara, California, Chapter 3, pp. 66-67 (Chapter from a Book).


text:
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Two instances have been noted of fractures of the clavicle, in which treatment for rheumatism had been instituted before the children entered the class. LfKtic acid (acidum lacticum) is introduced for the purpose of making lactate of lime; and the glacial photpkonc TREATMENT OF REBEL AND FEDERAL PRISONERS: endomorph. At the entrance are two pavilions, zendome containing the offices of the administrator, and an octroi, or receiver's office. She was ordered to take ten grains of mercury and colocynth pill in the evening, and the hospital iron and quassia mixture three times a day. In the meantime I thought the case worth recording merely The study of heredity and of environment, of infant mortality, of prostitution, of the venereal diseases, of all physical, intellectual, and moral, inherited, or acquired music defects is alike of interest to the student of medicine and eugenics. Seventeen of these cases were given"line of duty" in the reports of zendomarket medical boards of survey. .Allen was a membei of the F'irst Presbvteriati Church, the Rotary Club, atul he was a Civil Service Commissioti lot twelve vears. But now, in order to ensure at least definite negative results, redoubled care was taken; almost every cell was examined, even the integument and legs were not neglected; the evacuations of the insects found in the bottles, and the contents of the intestine, were scrupulously searched; at the end of the first examination staining reagents were often run through the preparation and it was searched again with care. Dawn of the Fourth Era in Surgery and zedomer Other Short Articles. We hope to have an exhibit each year and improve it, even with some color slides of local activities in Arkansas in the field of Medicine and Religion, within the next few committee to help us man the booth during the Your committee has also made arrangements for a Symposium on Medicine and Religion to be held at the University of Arkansas Medical Dr. The other two factors needed are the temperature of the arterial blood at the point where it blood leaving the part, which is the same as the temperature of the water in the calorimeter at the'Summary of Harvey Society Lecture delivered at the New York the fourth and unknown fact, the amount of blood which was required to cause the rise of the temperature, for, as previously mentioned, the heat is made, and to a much less extent the temperature of the water in japan the calorimeter at the beginning of the observation. He had heard several objections made to the direct representation asked for by the profession. Be prepared; carry an assortment of Sherman's Polyvalent Vaccines and self-sterilizing syringe in Your dealer will be pleased to supply you. It is, however, not on account of any miasm, but because disease-carrying mosquitos bred there, two very different things. K., a history of the chronic degenerative dist-sses of the central protective inoculations in infectluus diseases and suriini therapy, da I'urellire, SUM; Watson Cbeyue, W., the treatment of wounds, Kile. Simpson, a subject on which he said he believed they were all of one mind. So far as they go, there can be little doubt that they imply superior adaptation of the male brain for pursuits requiring continuous thought, large grasp of memory, and power of utilising experience. A petition emanating from four thousand members of the profession, a memorial presented to the President of the Council, and meetings held at Oxford, Leeds, Edinburgh, and Dublin, all went to show how strong was the opinion of the profession in favour of direct representation. On Chautauqua platforms speakers are inclined to talk about everything else except enteritis, pellagra, hookworm, and pasteurizing milk. Mixed vaccines in Throat and nose operations of benefit in lymphatics of, eye diseases secondary to septic sore, milk supply in relation to in exophthalmic goitre, effects of iodine zen Thyroidism. From Dodson, you get prompt service with the personal "tablet" touch. With a mucous plaque in his mouth from which I was able to demonstrate Spirochcetce pallida by the zedong dark field method. His hallucinations are not unilateral. The exposing of the cavity of any joint is a grave injury, for we ail know the alarming symptoms that are prone lo follow; but it appears to me that the danger is not so much due to the entrance of air aa to allowing pus to be so closely confined, for the wounds zedomax of joints are in the majority of cases fmall, and Brodie recommends free incision in these cases, and my number of wounds of the knee and elbow joints, which we treated by free incisions (where indicated), rest in an easy posture, loose dressings, and constant irrigation by mean's of the syphon.
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Daly, MD, Haverford, has been appointed to the National Board of Medical Examiners zendom Surgery Test Committee.
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Homepage » Gaming » Sparta: War of the Empires Game Review
Sparta: War of the Empires Game Review
Games set in the medieval era are quite appealing. Apart from being loaded with a lot of action and politics, Sparta: War of Empires has a lot more in store that might attract you. It is a free-to-play 2.5D browser MMORTS which gives you a ride through Greece in the 5th century.
Sparta: War of Empires Game
The game play is quite simple and the basics a little similar to Age of empires. Bottom line being that you will have to develop and manage your city state using all the aid at your disposal and produce various buildings, troops, and diplomatic endeavours.
Leonidas being the centre of the game as well as the most attractive character guides the players (commanders) in order to master battle skills and shove the Persian Empire as far out from Greece as possible.
The Sparta Agreements brings a lot in the picture from passive bonuses provided to players during the game play in the form of timber and bronze during production if you finish without GPs. All this comes on-board only if you have constructed the Ephorate. It gives you the authority to trade and to fortify cities, manage Phalanx Units and Cavalry Units during the game. There are tutorials that can take you through these aspects of the game.
Conquering the stronghold of the Persian Empire and retaliating against the rule of Xerxes will give you another edge in the game. There are great rewards that await the player once you take these positions out of the Persian rule.
Sparta: War of Empires is a diplomatic game and your victory quite literally depends upon the alliance you build with the other players and your ability to do trade whenever the need is dire. A combined fore is required to overthrow an army as great as the army of Xerxes.
For expanding your acquisitions you must exploit, steal, trade or borrow the war material from other allies in order to continue your survival in the game. Raiding is something you cannot avoid in order to show your stronghold. You can only avoid the raid button for so long.
To say the least, characters like Leonidas do bring a certain charm to the game. There supernatural elements in the game that make it more mystical and interesting the Oracle certainly adds on to the fabulous medieval aura. Oracle provides players with essential information during the game play that comes in handy while raiding the lands to overthrow the Persian Empire.
There are Current Strength indicators and Level indicators allow you to form better strategies to fight battles and raid Persian Positions. For a better understanding of Persian Positions you can read your Battle Reports.
Diplomacy and team building are some of the features that make this game distinctive. It is quite surprising, the amount of effort that is put into the game to build the alliances and draw the art of strategically planning the war. This is where the MMO element comes into the picture.
Each player holds value on the ground and in order to succeed you must align your forces with the other players in the game. This makes your retaliation stronger against Xerxes and you have a better chance of winning the war.
Alliances and collaboration are the two things without which you cannot win this game. It justifies the fact that you are merely a soldier in the war and without fellow soldiers and allies you cannot win against an army as big as Xerxes.
Harvesting collective resources, building your infrastructure in collaboration with other players and preparing for battle together will strengthen your game play. This is where diplomacy comes into play and choosing your allies wisely is of utmost importance in order to win against the likes of Xerxes.
Sparta: War of Empires "Moment of Glory" Cinematic Trailer by Plarium Games
Sparta: War of empires is a treat to your eyes and years and comes with great audio and visual effects with fully-voiced tutorials to assist new players. It basically follows traditional browser game play strategy with a lot of efforts to focus on PvP. For those of you who have played games like Age of Empires, the farm premium currency of the game will be easier to understand. Read More for more details about the game sparta war of empires. 🙂
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Thymio Pappianis for his helpful comments.
Lying on a slim finger of land stretching south from the Greek mainland, Mount Athos is a religious center maintained by Orthodox Christian monks for over 1,000 years and one of the only UNESCO World Heritage sites in Europe recognized for both its cultural and natural significance. The geographic isolation of the peninsula has allowed the 20 independent monasteries to protect the land from development, making the area one of the few truly natural ecosystems left in Europe. For Orthodox Christians, Mount Athos is "the Garden of the Mother of God" and the holiest site of their faith.
Indeed, subsequent human settlement of Athos has been almost entirely noninvasive. Large-scale human occupation was impractical due to the peninsula's rocky terrain. There were likely small settlements after the classical Greek era, but the area was empty when Christian monks arrived in the 10th century. Today, even archaeology to discover ancient settlements is forbidden.
Orthodox Christians believe that, after the death of Jesus, the Virgin Mary (known as Theotokos, or Mother of God) sailed to Cyprus, but was blown off course and landed on Athos. She instantly embraced the spectacular landscape of the mountain and its surrounding beaches, praying to her son that the land could be hers. The pagan peoples who lived on Athos were captivated by her devotion and immediately converted. Orthodox Christians regard the lush land as her garden, placing her in a counterpoint to Eve and the original Garden of Eden. Among Orthodox Christians, Mount Athos is known as "the Holy Mountain," the simplicity of the title indicating its centrality to the faith. Because it is the garden of the Mother of God, there is a strict ban on women setting foot on Athos, decreed by the Virgin Mary herself. The ban even extends to female domestic animals, which has had the side effect of limiting the growth of animal populations and effectively prohibiting grazing herds.
The first monastery, Great Lavra, was founded in 963, although there were informal preexisting communities of monks. Originally, monastic life was strictly communal: everyone would contribute their personal assets to the community and perform work solely for the community's good, in a system known as cenobitic. Mount Athos was at the peak of its prominence during the Byzantine Empire, when Orthodox Christianity became the official religion of the former Roman Empire and the center of power shifted east to Byzantium (later Constantinople) in 330. Until the conquest of Constantinople by the Ottoman Turks in 1453, the monks of Athos held great power not only in the Orthodox Church, but also in the political machinery of the Byzantine Empire.
In the late Byzantine period, as the monastic population began to wane, most monasteries switched to the idiorrhythmic system, which allowed monks to keep their personal assets and to have more individual choice in their lifestyle. This change attracted wealthy aristocrats and others not as strictly devoted to monastic life. With the fall of the Byzantine Empire, Greek culture and spirituality was subsumed under the Islamic Ottoman Empire. The primary role of the monks of Mount Athos then became to preserve Hellenic culture in the face of the empire that ruled southeastern Europe. Following the Greek war of independence (1821-32) and the disintegration of the Ottoman Empire, the monasteries' role in cultural preservation became less urgent, which may have been a factor in their decline in prominence throughout the first two thirds of the 20th century.
To mark the millennium anniversary of Athos, the first road was built in 1963. Despite the celebrations on this year, the 1960s were a worrisome time for those who wanted to see the spiritual culture of Mount Athos remain pure. The monk population had decreased to less than 2,000, down from a peak of 40,000 in the 14th century and 7,500 at the turn of the 20th century. The buildings were in disrepair and the Greek government considered taking more direct control of the area and converting it into a tourist attraction.
In the 1970s, there was a push to revive the spiritual traditions of Mount Athos. Some monasteries chose to switch back to the cenobitic system and encourage their members to return to a purer lifestyle. Monks also worked to publish their archives dating from the ninth century, a rich collection that documents the many historic and religious eras to which the Athos monasteries contributed. Several exhibits of cultural and religious artifacts from Mount Athos have since toured the world. This publicity has increased the number of visitors to the area in recent decades.
The unique geography of Athos has made generations of visitors feel that they have entered the physical embodiment of a spiritual place distinct from the rest of the Christian world. The peninsula is attached to the mainland of Greece by a narrow strip of land that is now walled off, making Athos an island unto itself. Thus, the only legal approach is by sea. The mountain itself is 2,030 meters high, but the awe-inspiring quality of the landscape comes from its location right next to the beach and the rich variety of flora and fauna to be found at different altitudes. Climatic zones range from alpine, at the peak of the mountain, to Mediterranean along the coast. The vegetation, unlike almost anywhere else in southern Europe, is completely intact because of the lack of grazing flocks on the peninsula. Trees cover 90 percent of the mountain. The coastal and marine environments also have important species, including monk seals.
In governance, too, Athos is independent: the 20 monasteries each control their own land base and a representative from each monastery serves on the parliament of the Holy Community to decide issues of importance to the entire peninsula. Scattered hermitages and independent settlements also exist on the island. Karyes, the capital of Athos, is found high up the mountain with a small population of 300 to 400. Aside from the limited supervision of the civil governor and police force provided by the Greek government, Athos functions autonomously and symbolizes a transnational faith community. Seventeen of the monasteries are Greek-speaking; the remaining are Russian, Serb, and Bulgarian. However, the resident monks are from all over the world, and the diversity of the population has increased in recent decades. The monasteries come not under the jurisdiction of the Greek church, but that of the Ecumenical Patriarch of Constantinople. The monks continue to observe Byzantine time, which starts the clock for each day according to the sunset of the previous day, and the Julian calendar, which is 13 days behind the Gregorian calendar used by most of the world.
Today, Mount Athos remains the spiritual center of Orthodox Christianity, distinct from other centers of world religions because of its natural setting. The governance of the peninsula is a model of direct democracy combined with spiritual principles, and the religious significance of the "garden of the Mother of God" has protected the alpine and coastal habitats.
Athos monasteries operate several schools devoted to painting religious icons, maintaining a visual style that has been copied around the world. They are also charged with the care of a millennium's worth of manuscripts and artifacts, including frescos, collections of religious icons, relics such as bones of a saint and fragments of the "true cross," and texts including medieval illuminated manuscripts and ancient Greek literature. The architecture of the monastic buildings themselves tells the history of the last millennium.
The monks practice small-scale industry: timber harvesting, grape cultivation and wine making, beekeeping, and olive cultivation. These operations provide just enough food and income to maintain the monastic communities, although some commercial timber harvesting is permitted. The marine and coastal regions of the peninsula are relatively pristine, thanks to a ban on commercial fishing and the inhospitable terrain of the coast, which discourages any human activity except for the docking of boats. Timber harvesting is a potential problem, particularly the planting of chestnut trees for harvesting, which has led to parasite attacks. However, the scale of forestry remains relatively modest due to the costs of transport to and from Mount Athos. Other areas of concern include commercial buildings built by the timber industry, construction of unnecessary roads, and waste disposal, for which a peninsula-wide management plan must be initiated. Fire is of significant concern to the preservation of old buildings because of their wooden structures and antiquated heating systems.
When left to themselves, the monks exhibit a high degree of respect for the environment, owing to their belief that it is the garden of the Mother of God and the simplicity of their lifestyle. However, large volumes of visitors threaten the delicate ecosystem, and because of the short duration of their stay, they are less likely to recognize their impact on the environment. Most of these visitors are pilgrims to the monasteries, though visitors also include building and forestry contractors. The monks continue their tradition of offering free hospitality to visitors, most of whom are religious pilgrims. But in order for the monasteries to continue their way of life and keep Mount Athos free of development, the number of visitors must be limited. The Holy Community has instituted quotas for visitors, giving preference to those of the Orthodox faith. At the same time, the monks recognize the importance of recruiting young monks to join their communities, to prevent the kind of decline seen in the 1960s.The monks seek to balance their traditional role as hosts to pilgrims with the reality of the impact large numbers of visitors have on the monastic communities—economically, ecologically and spiritually.
Mount Athos has received several protected designations designed to assist in preservation efforts. In 1988, the area was added to the UNESCO World Heritage List, recognized for both its natural and cultural aspects. It is also part of the Natura 2000 network, a cooperative project sponsored by the European Union to protect distinctive and endangered European natural sites. This designation requires the Greek government to care for the site under its Ministry of Environment, Physical Planning and Public Works. However, the department labors under a shortage of staff and funding relative to the areas it must maintain. Because of the autonomy of the monasteries, it remains to be seen how the Holy Community can work with the Greek government for a more organized conservation structure.
Mount Athos needs a management plan created in consultation with the Holy Community and the Greek Ministries of Culture and of Environment, Physical Planning and Public Works. To some extent, comanagement with a secular government is seen by the monks as a threat to their long tradition of self-government, but the need for cooperation to preserve Athos' unique qualities has become clear. The management plan should contain a coordinated plan for the entire peninsula along with specific recommendations tailored to each monastery. The majority of monasteries have created forest management plans in consultation with forestry professionals. Timber harvesting above the amount needed for the monasteries' own uses should be regulated by an international forestry certification system to ensure sustainable harvesting. The Holy Community has also agreed to work with Aristotle University of Thessaloniki on a risk assessment study, covering both fire and seismic activity.
Delos Initiative. "Mt. Athos – Greece." The Delos Initiative.
Mediterranean Institute for Nature and Anthropos. Med-INA.org.
Speake, Graham. Mount Athos: Renewal in Paradise. New Haven, Conn. and London: Yale University Press, 2002.
United Nations Educational, Scientific and Cultural Organization. "Mount Athos." UNESCO World Heritage Centre.


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Choosing the right inverter is crucial. If an inverter is incorrectly specified for a particular solar panel, or is not designed to compensate for shade, then any benefits of one particular solar panel over another will be eradicated. Again it starts with the correct installation design with an inverter matched to your solar panels and the ability to maximise performance when shade or environmental considerations dictate. As with your solar panels we are able to recommend what's best without the need to 'push' one particular brand. Warranties on inverters vary according to manufacturer; ranging from 5 to 12 years as standard, all extendable, but don't be seduced by long warranties on inferior products. Should you already have a preference or would like price comparisons from us then please just ask. Below are our best sellers with a further list of inverter brands we also supply.
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What are the best places for date night besides a lounge or club?
Bed and breakfast with jacuzzi in Baltimore?
Where is a good place to bring my wife to eat for Valentines day? I am looking for something Seafood with other choices.
Any good sushi buffet around this area?
What are some of the best kid friendly attractions in Baltimore?
I'm looking for the Black Wax Museum, where is it located?
Looking for a nice Cajun restaurant for Valentine's Day weekend. Any suggestions?
Where can I get the most authentic Italian Food in Baltimore?
Are there any nice Jazz lounges in Baltimore?
How is the golf in Baltimore?
Crabcakes! Where is the best place to go for MD World Famous Crabcakes?
What are some of the top hotels in the Baltimore area?
Havent spent much time in Baltimore but interested in the Inner harbor, recommendation for lodging? How about entertainment (plays, show)?
What is the best place for latin dancing???
Where is the best place to stay downtown next to all of the attraction for a romantic getaway?
Been ages sinice i've been up that way.. What's the Jazz scene like there now.
What museums are recommended to take a 5 yr old?
I'm interested in seeing some of the sites featured in "The Wire", any info? And is it safe?
Where can I get the best crab cake?
Where can I go to worship in Baltimore that has a children's ministry.
Is there a theater district in Baltimore like in New York, or one main theater for the bigger visiting shows?
Where can I find a nice wine bar?
I'm coming to Baltimore with my teenage daughter and 4 of her friends. Is there any attraction that is for the young adult?
Are there any cigar friendly restaurants or bars in town?
Where's the nearest Cracker Barrel?
Are there any Brazilian restaurants in the area?


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I recently bought this headboard and platform frame from Brocade Home. Now I'm looking for bedding, throw pillows and side tables. Do you think white or off-white solid colored bedding is the only way to go? Would a pattern compete too much with the headboard?
I like the duvet pattern in Brocade Home's photograph but I don't know if I'd prefer something more original than just copying the catalog. I'm thinking about small mirrored night tables on the sides, wood might look too heavy. What do you think?
Personally, we say if you're going to go ornate, go for it full gusto (this might be in due part because we just watched Visconti's dreamy mid-nineteenth century period piece, The Leopard).
We think you're absolutely correct in not wanting to copy the catalog and personalize your own room in your own style, complimenting what already exists in your bedroom. But without knowing the details and dimensions of your room, it's difficult to advise one way or the other. Heavy furnishings and decoration look dramatic in a high ceiling room (as shown in the catalog photo), but confining in a tighter, smaller room. White can look plain and minimal if use in large swatches in roomier spaces.


Team building for a successful touring experience is crucial. Our team of experienced tour experts contains knowledgeable and eager enthusiasts to help you create an incredible holiday. We've hand-picked our team of travel advisors to provide personal, confident and thorough counsel when putting travel plans together. Implausible support comes from our other our associates to make sure your experience, from beginning to end, is as seamless as it can be.


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Alice Vera Cecilia Charlotta Schmiterlöw (19 July 1904, Varberg – 9 September 1987, Stockholm) was a Swedish actress. She studied drama at the Dramaten from 1921 to 1924, where she met classmate Greta Garbo with whom she grew a lifelong friendship. The intimate correspondence between the two are saved in the National archives of Sweden. From 1927 to 1932 she mainly worked in Germany where she appeared in a number of films. Vera Schmiterlöw is the half-sister of artist Bertram Schmiterlöw.

Filmography

External links

1904 births
1987 deaths
Swedish film actresses
Swedish silent film actresses
20th-century Swedish actresses
People from Varberg

redpajama_set_name: RedPajamaWikipedia


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CarGurus Studies Commuting Behavior and Patterns Across America
Findings Aim to Inform Car Shoppers and Ease Commuting Stress
Aug 23, 2018, 09:00 ET
CAMBRIDGE, Mass., Aug. 23, 2018 /PRNewswire/ -- According to the recent CarGurus Commuting Sentiment Survey, driving is the most popular means of commuting in the U.S. Out of 1,877 respondents, 72 percent note that they drive every day, and of those who drive the most popular reasons for doing so are convenience (34 percent) and speed (20 percent).
However, the survey also found that commuting via automobile can bring out the worst in people. 51 percent of drivers admit that their commute causes them to scream curse words they don't normally use and 42 percent confess that they have "flipped someone off." Moreover, commuters tend to blame other drivers for their frustrations: 53 percent of commuters say their top commuting annoyance is other people driving poorly.
Other survey findings include:
When asked which driving companion would most improve their commute, 41 percent said their partner or significant other.
When asked what they would do if they could get back their commuting time, the top three answers were sleep (51 percent), spend time with family (48 percent) and go to the gym (39 percent).
With back-to-school season approaching and the roads likely becoming more crowded, CarGurus has produced the "CarGurus Commuting Relief Kit." These digital assets are aimed to help ease commuting stress or simply help pass the time for any commuter on their frustrating drive:
An interactive "Top Cars For Your Commute" map with location-specific car recommendations based on a metro region's specific commuting conditions
A CarGurus-curated Spotify playlist, containing driving-themed songs
Advice on what to consider when buying a car for commuting
An infographic with more information about the CarGurus Commuting Sentiment Survey
"For those that regularly drive to and from work, commuting conditions should absolutely be a consideration when car shopping – they can make the difference between regret and enjoyment," said Matt Smith, Senior Editor at CarGurus. "Factors like commuting efficiency, mileage variation, hilliness and weather are all important. In our 'Top Cars For Your Commute' analysis, we took all these factors into account, then looked at vehicle efficiency, horsepower, comfort and even alternative-fuel options to come up with our top car recommendations for specific types of commutes."
The data used to arrive at the recommendations in this 'Top Cars For Your Commute' study came from a variety of sources. CarGurus looked at commuting distance as the average distance from home to work for commuters who work in 84 of the largest US metro areas. The distance for each commute is based on a direct path from home to work and does not consider the road network. The average distance was calculated from the Census Transportation Planning Products, based on the 2006-2010 American Community Survey. The travel and efficiency information were adapted from the Texas A&M Transportation Institute's 2015 Urban Mobility Scorecard. CarGurus considered cities with seven or more days with at least one inch of snowfall per year to have significant annual snowfall. The snowfall data was based on a 20-year average calculated from the National Oceanic and Atmospheric Administration's Global Summary of the Year. CarGurus grouped metro areas with similar characteristics to form its commuting clusters for use in the study, and then its editorial team chose cars with features that fit each group, including one option above a $35,000 MSRP and one below. The survey was fielded amongst 1,877 people aged 18+ who identify as employed individuals or students. The sample was balanced on age, gender, income, and regional factors.
About CarGurus
Founded in 2006, CarGurus, Inc. (NASDAQ: CARG) is a global, online automotive marketplace connecting buyers and sellers of new and used cars. The company uses proprietary technology, search algorithms and data analytics to bring trust and transparency to the automotive search experience and help users find great deals from top-rated dealers. CarGurus is the largest automotive shopping site in the U.S. based on monthly unique visitor traffic (source: comScore Media Metrix Multi-Platform, June 2018). In addition to the United States, CarGurus operates online marketplaces in Canada, the United Kingdom, Germany, Italy and Spain.
CarGurus® is a registered trademark of CarGurus, Inc.
To learn more about CarGurus, visit www.CarGurus.com.
© 2018 CarGurus, Inc., All Rights Reserved.
All product names, trademarks and registered trademarks are property of their respective owners.
Important Information Regarding Forward-Looking Statements:
The information in this release contains forward-looking statements regarding future events that involve risks and uncertainties, and our actual results may differ materially from those contemplated by such forward-looking statements. For further information regarding risks and uncertainties associated with our business, please refer to the "Risk Factors" section of our most recent annual or quarterly report filed with the SEC. Any forward-looking statements represent our beliefs and assumptions only as of the date of this release. While we may elect to update forward-looking statements at some point, we specifically disclaim any obligation to do so.
SOURCE CarGurus
http://www.cargurus.com
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CarGurus Announces 2019 Best Used Car Award Winners...


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Emerge Yoga
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Experience Complete
We offer a unique blend of fitness, sports training, and competitive sports, for all ages, abilities, and lifestyles.
Get unlimited access to our fitness amenities and award-winning sports programs in a family-friendly environment taught by full-time certified professionals.
Experience Complete Fitness
Experience complete fitness at The Sports Club of West Bloomfield for your whole family like no other place.
The Sports Club of West Bloomfield offers 100+ fitness classes per week, state-of-the-art cardiovascular and weight training centers, a yoga studio, an indoor track, a spin studio, personal training, yoga, TRX, Zumba, and more.
Our mission is to show junior tennis players the proper development so their game can grow and improve as they do. We have two possible paths so that all students can move forward and develop according to their own personal goals.
We offer "in-house" programs for all levels: Competitive Leagues for men and women of all levels, Adult Tennis Clinics, Organized Practice, Permanent Court Time, and both individual and group Private instruction.
No other club can match ours when it comes to the quality, experience, and knowledge of our Personal Trainers. Our certified trainers have varying backgrounds in fitness, wellness, professional and collegian sports-specific training to the specialization that no other clubs can offer.
Our air-conditioned 8,000 sq. ft. gymnastics center features a 260 sq. ft. foam pit, balance beams, and tumbling areas. Our award-winning gymnastics teams compete locally and nationally.
Pickleball is a paddle sport that combines elements of badminton, tennis, and table tennis. Two or four players use solid paddles made of wood or composite materials to hit a perforated polymer ball, similar to a Wiffle Ball, over a net.
VOTED BEST GYM
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170,000 sq. ft. full service sports and fitness complex
4,000+ sq. ft. cardiovascular and weight training center
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Kidszone Childcare
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Welcome our Newest Trainer, Marvin Campbell
Fall 2 Sports Schedule
XP League x Evolution Esports
Voted 4 For The Best 2022
Drop in Pickleball!
Since 1991 The Sports Club of West Bloomfield has been providing its unique blend of fitness luxury, sports training, and healthy lifestyles. We have it all!
6343 Farmington Rd.
Monday – Thursday: 5:00 am – 11:00 pm
Friday – 5:00 am – 10:00 pm
Saturday – Sunday: 6:00 am – 9:00 pm
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