Abstract: A tomographic image forming apparatus is disclosed, which divides light output from a light source inside the apparatus into measurement light and reference light, and which generates a cross-sectional image of an imaging target, based on light intensity of interference light obtained from reflected light obtained by emitting the measurement light to the imaging target and the reference light. A second image is generated by converting a first image in which line data generated based on the light intensity and having information in a direction of a first axis which serves as a depth direction of the imaging target is arranged in a direction of a second axis, into a frequency domain. An artifact is removed or reduced by performing filtering on the second image. A third image is generated by inversely converting the processed second image into a spatial domain.

Abstract: The disclosure is related to a portable apparatus, and a system for measurement of cardiovascular health, and a method for the same. The portable apparatus is preferably a cuff-less blood pressure device that includes an electrode-based module and a piezoelectric sensor module. The electrode-based module has two electrodes that are used to contact skin of human for generating a first set of data by measuring a target heartbeat. The piezoelectric sensor module is used to generate a second set of data by measuring a pulse wave produced by the target heartbeat corresponding to the first set of data. When the two sets of data are received by a processor, it is able to calculate cardiovascular health value in accordance with cardiovascular health marker that is selected from arterial stiffness, blood pressure, heart rate, pulse transit time, and pulse wave velocity.

Abstract: A method for cardiovascular-dynamics correlated imaging includes receiving a time series of images of at least a portion of a patient, receiving a time series of cardiovascular data for the patient, evaluating correlation between the time series of images and the time series of cardiovascular data, and determining a property of the at least a portion of a patient, based upon the correlation. A system for cardiovascular-dynamics correlated imaging includes a processing device having: a processor, a memory communicatively coupled therewith, and a correlation module including machine-readable instructions stored in the memory that, when executed by the processor, perform the function of correlating a time series of images of at least a portion of a patient with a time series of cardiovascular data of the patient to determine a property of the at least a portion of a patient.

Abstract: A disclosed state display method includes: obtaining first data representing first temporal change of a degree of a depth of sleep in a sleep state and second data representing second temporal change of a degree of an amount of activity in a non-sleep state, the first data and the second data being data measured for a subject; generating, according to time information represented in the first data and the second data, a graph in which the first temporal change represented in the first data is rendered at a first side of a time axis so that greater depth of sleep makes the graph more away from the time axis, and the second temporal change represented in the second data is rendered at a second side of the time axis so that a greater amount of activity makes the graph more away from the time axis; and displaying the generated graph.

Abstract: An X-ray imaging apparatus including a sensor unit with a sensor array configured to generate a signal corresponding to X-rays and a sound-production unit configured to make a notification by sound production causes the sound-production unit to execute sound production in response to detection of an event. If an event including a sound-production request occurs during a period including a period of reading out a signal from the sensor array, the X-ray imaging apparatus restricts execution of sound production by the sound-production unit.

Abstract: Systems and methods for providing sensitive and specific alarms indicative of glycemic condition are provided herein. In an embodiment, a method of processing sensor data by a continuous analyte sensor includes: evaluating sensor data using a first function to determine whether a real time glucose value meets a first threshold; evaluating sensor data using a second function to determine whether a predicted glucose value meets a second threshold; activating a hypoglycemic indicator if either the first threshold is met or if the second threshold is predicted to be met; and providing an output based on the activated hypoglycemic indicator.

Abstract: An X-ray imaging apparatus according to an embodiment of the present invention includes an X-ray generator that irradiates an object with X-rays during an exposure period; an X-ray detector that detects X-rays transmitted through the object; and a movement unit that moves the X-ray generator and the X-ray detector, wherein the X-ray generator is moved along an arc having a radius of curvature within a range with respect to a rotational axis, wherein the motion along the arc starts at a first time point and ends at a second time point, wherein the X-ray detector is moved in a linear direction having an angle with respect to a plane of the arc during at least a partial period of a period between the first time point and the second time point, wherein the motion in a linear direction starts at a third time point that is the same as or later than the first time point and ends at a fourth time point that is the same as or earlier than the second time point, and a first difference between the first time point and t

Abstract: An probe body comprising: one or more light sources; one or more light sensors; an x-ray detector configured to detect, using at least one of the one or more light sensors, light from a scintillator for converting extra-orally applied x-rays to light; and a lower energy light detector configured to detect, using at least one of the one or more light sensors, light from an object illuminated by at least one of the one or more light sources.

Abstract: The present invention relates to an intraoral sensor for intraoral X-ray photography, and provides an intraoral sensor bending along an intraoral structure during intraoral X-ray photography, wherein the degree of bending of a first region corresponding to a part facing the major axis differs from that of a second region corresponding to the remaining part.

Abstract: The present invention provides an oral sensor device comprising: a sensor assembly which is bendable and generates an electrical signal by detecting an X-ray; and a window cover comprising a base portion and a side wall, the base portion being positioned on the front of a sensor panel with respect to the traveling direction of the X-ray, and covering the sensor panel, and the side wall protruding toward the rear from the lateral side of the edge of the base portion so as to cover the lateral surface of the sensor panel, and having a plurality of grooves formed on at least a part thereof.

Abstract: The present invention provides an X-ray image sensor comprising: a sensor panel which is bendable, generates an electrical signal by detecting an X-ray, and has a first elasticity; a printed circuit board which transmits the electrical signal to the outside, has a second elasticity that is smaller than the first elasticity, and has a flexible property; and an elastic adjustment member which is made of an elastic material having a third elasticity that is larger than the first elasticity, and which adjusts the elasticity of the sensor panel and the printed circuit board so as to be greater than or equal to the third elasticity.

Abstract: The invention relates to an image plate readout device, the readout device comprising receiver elements for the reception of an image plate and/or a transfer element intended for an image plate. In connection with the readout device is provided, for detecting an object, at least one sensing element, which is in turn set in data communication with the readout device in such a way that, upon detecting an object, the sensing element delivers a signal to the readout device. In response to being triggered by a signal delivered by the sensing element, the readout device executes some function.

Abstract: A method and a device are disclosed for controlling a scanning region of a medical imaging system for subsequent recording of a region of interest of an examination object. Depth image data of the examination object are captured. 2-D image data of at least one 2-D image of the examination object are created and the 2-D image is displayed. The 2-D image data and the depth image data of the examination object are registered to each other at least in some regions. By using the 2-D image, at least one limit position of the scanning region is then determined. Finally, on the basis of the depth image data and the limit position in the 2-D image of the examination object, a limit contour line extending through the limit position is determined and displayed such that the limit contour line is superimposed on the 2-D image of the examination object.

Abstract: A method and apparatus is provided to decompose spectral computed tomography (CT) projection data into material components using singles-counts and total-counts projection data. The singles-counts projection data more accurately solves the material decomposition problem, but can produce multiple results only one of which is correct. The total-counts projection data generates a unique result, but is less precise. The total-counts projection data is used to disambiguate the multiple results of the singles-counts projection data providing a unique results that is also precise.

Abstract: An image processing apparatus according to an embodiment includes processing circuitry. The processing circuitry performs a fluid analysis using image data including a blood vessel to calculate an index value relating to blood flow in the blood vessel. The processing circuitry specifies a plurality of target sites in the blood vessel in the image data. The processing circuitry changes analysis conditions for the fluid analysis corresponding to the positions of the target sites. The processing circuitry causes a display to display, in a comparative manner, the index value relating to blood flow calculated under the changed analysis conditions for the target sites.

Abstract: Devices, methods, and systems are provided for analyzing lung imaging data. A server computing device receives imaging data of a lung over a network from a client computing device and analyzes the imaging data to identify lung, airways, and blood vessels, segment the lung into lobes, subtract airways, calculate volumes, calculate emphysema scores, identify fissure locations, calculate fissure completeness scores. A reconstruction of the fissures indicating locations where the fissures are incomplete and a report comprising fissure scores, volumes, and emphysema scores are created.

Abstract: The present invention relates to a device (1) for determining image quality of a radiogram image, the device comprising: an acquiring module (10), which is configured to acquire the radiogram image; a segmentation module (20), which is configured to segment a thoracic bone structure on the acquired radiogram image into segmented thoracic bone structure contours and a tissue structure on the acquired radiogram image into segmented tissue structure contours; and a quality-determination module (30), which is configured to determine a image quality coefficient for the acquired radiogram image based on a comparison of a first position of the segmented thoracic bone structure contours with a second position of the segmented tissue structure contours.

Abstract: A stethoscope head with adjustable audio frequency, comprises: a head body having an annular step and a sound collecting surface at a front side of the head body; an annular fastener; and a diaphragm having an annular step and a footing, the diaphragm disposed on the sound collecting surface of the head body by the annular fastener which cooperates with the head body by screw threads, wherein, when the stethoscope head is in operation, the footing of the diaphragm is deformed in response to rotation of the annular fastener relative to the head body along the screw threads to regulate an audio frequency received by the diaphragm. The stethoscope head of the invention is convenient to assemble and the sound effect can be adjusted continuously.

Abstract: According to the present invention, a displacement measurement unit measures, on the basis of a reception signal corresponding to a tracking wave reception beam obtained from a reception unit, the displacement of a tissue inside a subject after the generation of a shear wave. A fluctuation detection unit detects periodic displacement on the basis of the displacement measurement result obtained from the displacement measurement unit. A shear wave speed calculation unit calculates the propagation speed of a shear wave in the subject on the basis of the measurement result obtained from the displacement measurement unit and the detection result obtained from the fluctuation detection unit.

Abstract: A tissue positioning system for contouring a patient tissue volume includes an axially displaceable interface having a surface configured to engage a breast or other tissue volume. A low pressure source applies a partial low pressure to the surface of the displaceable interface to secure the tissue volume to the surface, and the axially displaceable interface is biased to pull and contour the tissue volume when the tissue volume is secured to the surface. The axially displaceable interface is typically mounted on a telescoping support and the biasing is provided by the same low pressure used to secure the tissue volume.

Abstract: A high frequency ultrasound probe includes a substrate having a number of transducer elements on it and a ground plane that is electrically coupled by one or more vias to a conductive frame that supports the substrate. The conductive frame is electrically coupled to a ground plane of a printed circuit having conductors that are coupled to the transducer elements.

Abstract: An ultrasound diagnostic apparatus according to an embodiment includes processing circuitry. The processing circuitry causes an ultrasound probe to execute first ultrasound scanning to acquire blood flow information within a first scanning area and causes the ultrasound probe to execute second ultrasound scanning to acquire tissue shape information within a second scanning area. The processing circuitry receives an instruction for changing a flow-velocity value to be displayed in display of the blood flow information. When, because of a change of the flow-velocity value according to the instruction, a time for transmitting/receiving ultrasound per scanning line in the first ultrasound scanning exceeds a transmitting/receiving time before the change, the processing circuitry assigns a time corresponding to the excess to at least one of the first ultrasound scanning and the second ultrasound scanning.

Abstract: Shear wave propagation is used to estimate the speed of sound in a patient. An ultrasound scanner detects a time of occurrence of a shear wave at each of multiple locations. The difference in time of occurrence, given tissue stiffness or shear velocity, is used to estimate the speed of sound for the specific tissue of the patient.

Abstract: An ultrasonic diagnostic device according to an embodiment includes transmission and reception circuitry and processing circuitry. The transmission and reception circuitry repeatedly executes first scanning in which a subject is scanned along a plurality of scanning lines. The processing circuitry controls generating a color Doppler image based on reflected wave data collected through the first scanning. The processing circuitry controls obtaining a wait time of the first scanning based on a repetition period of the first scanning and a required time of the first scanning. The transmission and reception circuitry executes second scanning different from the first scanning during the wait time obtained by the processing circuitry.

Abstract: An ultrasonic diagnostic apparatus that transmits/receives an ultrasonic wave to/from a subject using an ultrasonic probe and generates an image includes: a transmission unit that converts a pulsed transmission signal including a fundamental wave component into a transmission ultrasonic wave and transmits the transmission ultrasonic wave to the inside of the subject; a receiving unit that generates a reception signal based on a reflected ultrasonic wave from the subject; a separation unit that separates the reception signal into first and second components; a phase control unit that generates a third component by controlling a phase of the second component such that a time at which amplitude is maximized is the same between the first and second components; a combining unit that combines the first and third components to generate a composite reception signal; and an image generation unit that generates an image based on the composite reception signal.

Abstract: A control system for controlling an ultrasonic probe includes a module for assigning address parameters respectively to ultrasonic transducers of the probe according to a physical position order of the ultrasonic transducers, a module for arranging the address parameters in an activation sequence, and a module for generating activating signals each corresponding to a respective address parameter. Sequential two address parameters in the activation sequence correspond to two ultrasonic transducers that are non-sequential to each other in the physical position order. Each activating signal is transmitted to a respective ultrasonic transducer that is assigned with the address parameter to which the activating signal corresponds.

Abstract: Systems and methods for improving the quality of ultrasound images made up of a combination of multiple sub-images include giving more weight to sub-image information that is more likely to improve a combined image quality. Weighting factor information may be determined from the geometry (e.g., angle or path length) of a location of one or more specific transducer elements relative to a specific point within a region of interest or a region of an image. In some embodiments, any given pixel (or other discrete region of an image) may be formed by combining received echo data in a manner that gives more weight to data that is likely to improve image quality, and/or discounting or ignoring data that is likely to detract from image quality (e.g., by introducing noise or by increasing point spread).

Abstract: Imaging devices, systems, and methods are provided. Some embodiments of the present disclosure are particularly directed to removing artifacts caused by longitudinal motion of a sensor during imaging. In some embodiments, a medical sensing system includes a de-seaming engine operable to receive a first signal at a first point and second signal at a second point. The first and second points are offset from the pixel in the longitudinal direction. The de-seaming engine corrects for movement in the longitudinal direction by determining a weighted average of the first signal and the second signal. The engine determines a first probability based on the first signal and the weighted average and determines a second probability based on the second signal and the weighted average. The engine selects one of the first and second signal intensities as an intensity of the pixel based on the first and second probabilities.

Abstract: Some embodiments provide a method of providing ultrasound energy having a stable power output. The method can comprise providing ultrasound energy from a ultrasound transducer; determining a power level threshold of the ultrasound energy; monitoring a power level of the ultrasound energy over time of the ultrasound energy; communicating a power level to a controller; adjusting the frequency of the ultrasound energy upon a change in the power level; and maintaining the power level threshold of the ultrasound energy.

Abstract: A container (1) for collecting faecal specimens comprises an extraction portion (2) suitable for containing an extraction solution (3) and a closure portion (8) for closing the container (1). A connection means (9) is interposed between the extraction portion (2) and the closure portion (8) and configured to define a closed configuration of the container (1). A shaped wand (10) suitable for collecting the specimens is axially inserted into the extraction portion (2) when the container (1) is in the closed configuration. A filtering element (17) divides a solubilization chamber (18) from a sampling chamber (19) and is suitable for enabling a flow (F) of the extraction solution from the solubilization chamber (18) to the sampling chamber (19).

Abstract: Provided is a device for elasticity detection, comprising a processor (1), an imaging device (2), an ultrasonic transducer (3) and a puncturing device (4). The ultrasonic transducer (3) is connected to the processor (1) and is configured to detect and obtain morphology characteristic information and elasticity characteristic information of a tissue. The imaging device (2) is connected to the processor (1) and is configured to obtain a morphology image and an elasticity image of the tissue according to the morphology characteristic information and the elasticity characteristic information, respectively, under the control of the processor (1), and merge and display the elasticity image in the morphology image. The puncturing device (4) is connected to the processor (1) and is configured to determine a puncture position according to guidance of the merged image and perform a puncturing and sampling on the tissue.

Abstract: A coiled shaft for tissue disruption is described herein where a flexible aspiration cannula has a first portion and a second portion formed of the coiled shaft. The cannula is configured in a particular embodiment to rotate over the length of the cannula to disrupt the matrix of bone marrow without the cannula buckling or collapsing. The cannula also includes a disruption tip coupled to the coiled shaft. The disruption tip has a radiused portion along a distal tip face of the disruption tip.

Abstract: The dual syringe with percutaneous cannula is a medical device for harvesting and transferring cells for autologous transplantation without the requirement of a surgical setting or ambulatory care. The dual syringe is a closed sterile system that allows for the harvesting syringe to harvest the cells/tissue from a first location of a patient which is then centrifuged to aggregate the cells. The aggregated cell pellet is transferred to a transfer syringe. The cell pellet is then reinjected by the transfer syringe into the patient at a second location for therapeutic purpose. The percutaneous cannula permits insertion of a cannula, with the assistance of a needle, without the need of a surgical incision or trocar.

Abstract: Embodiments of the present disclosure relate to apparatuses, systems, and methods for safely delivering and deploying an intravascular device. An apparatus for controlling an intravascular device may include a body having rotating assembly disposed through the body. The rotating assembly may be configured to hold a proximal end of an elongate mandrel. The rotating assembly may be rotationally connected to the body by a one-way bearing.

Abstract: A medical device for repairing soft tissue is disclosed. The medical device includes a cannulated probe positionable a tear in the soft tissue and a stop. The cannulated probe has an inlet about a proximal end and at least one outlet about a distal end with a lumen therethrough. The inlet is operatively connectable to an adhesive source to receive the adhesive therein. The outlet(s) is/are positionable about the tear to emit the adhesive about the tear. The stop is disposable about a periphery of the probe a distance from the inlet, and is positionable adjacent a surface of the soft tissue to terminate advancement of the cannulated probe into the soft tissue whereby a delivery portion of the cannulated probe is positionable about the soft tissue to deliver the adhesive about the tear.

Abstract: Systems and methods for preventing the seeding of cancerous cells during morcellation of a tissue specimen inside a patient's body and removal of the tissue specimen from inside the patient through a minimally-invasive body opening to outside the patient are provided. One system includes a cut-resistant tissue guard removably insertable into a containment bag. The tissue specimen is isolated and contained within the containment bag and the guard is configured to protect the containment bag and surrounding tissue from incidental contact with sharp instrumentation used during morcellation and extraction of the tissue specimen. The guard is adjustable for easy insertion and removal and configured to securely anchor to the body opening. Protection-focused and containment-based systems for tissue removal are provided that enable minimally invasive procedures to be performed safely and efficiently.

Abstract: Devices and methods for sternal retraction that reduces bleeding from the cut edges of a sternum and reduces fracturing of the sternum during retraction. The devices and methods involve the use of sternal retractor blades having a certain geometry and inserts placed inside the sternal retractor blades during retraction of the sternotomy incision. The blades and inserts act to tamponade the blood flow from the cut sternal edge and reduce fracturing of the sternum during retraction.

Abstract: A septal closure and port device for implantation in the atrial septum of a patient's heart includes an expandable frame having a central portion defining a lumen, and first and second opposing end portions. The frame is configured to expand and contract between a compressed, tubular configuration for delivery through the patient's vasculature and an expanded configuration in which the first and second end portions extend radially outwardly from the opposite ends of the central portion. The device can further include a valve member supported on the frame and positioned to block at least the flow of blood from the left atrium to the right atrium through the lumen of the frame. The valve member is configured to permit a medical instrument to be inserted through the lumen and into the left atrium, such as for performing a subsequent medical procedure in the left side of the heart.

Abstract: A novel posterolateral inter-muscular approach has been developed to access the cervical spine. The approach includes elevating the splenius capitis and trapezios muscles dorsally to create a window for deep spine access, wherein the window comprises: i) an anterior superior border of the trapezius muscle; ii) an anterior inferior border of the splenius capitis muscle, and iii) a posterior superior border of the levator scapulae muscle. Preferably, a device such as an implant or an instrument is then passed through the window to manipulate the spine.

Abstract: An endoscopic portal protective shield assembly has an elongate portal shaft and an elongated protective shield. The elongate portal shaft has a viewing portal. The shaft has a slotted tubular body with interior surfaces. The shaft has a distal end and a proximal end and a slotted opening at the distal end extending partially along the slotted tubular body toward the proximal end. The elongated protective shield has a longitudinal shield body, a proximal end and a distal end. The protective shield is configured to be slid into the slotted opening of the tubular body with an interior portion of the longitudinal shield body being inserted inside the tubular body while maintaining the viewing portal open.

Abstract: Suture constructs and methods for soft tissue to bone repairs. The suture construct is a soft, suture-based anchor which is self-cinching and has a specific, accordion-type configuration (i.e., with the ability to fold from a first, extended position to a second, folded or compressed position). The suture-based anchor may be formed essentially of a flexible material such as a high strength surgical suture, suture chain, or suture.

Abstract: A surgical anchor and methods of use are disclosed. A variety of surgical techniques may be practiced to repair torn connections between soft tissue, such as tendons and ligaments, and bone. The surgical anchor simplifies the surgical techniques by channeling repair sutures from the soft tissue through a bore in the surgical anchor and then immobilizing the repair sutures between the surgical anchor and the bone.

Abstract: An apparatus and method for minimally invasive suturing is disclosed. A suturing device for minimally invasive suturing includes proximal section having a proximal end, a distal end, and a longitudinal axis therebetween; a suture head assembly extending from the distal end of the proximal section; a suturing needle having a pointed end and a blunt end, the suturing needle capable of rotating about an axis approximately perpendicular to a longitudinal axis of the proximal section, wherein the pointed end of the suturing needle is positioned within the suture head assembly prior to and after rotation of the suturing needle; and an actuator extending from the proximal end of the proximal section to actuate a drive mechanism having a needle driver for engaging and rotating the suturing needle.

Abstract: A tissue ligating device comprises a first fixation part to which a base end part of a suture thread is fixed and a second fixation part configured to allow insertion of the suture thread therethrough and allow to be crimped so as to newly fix a part of the suture thread, and thereby to define a loop starting from the base end part, in a state after ligation of tissue is performed. The second fixation part includes a back side wall part, a front side wall part, and a curved wall part turning back from the back side wall part to the front side wall part. An end part of the front side wall part far from the curved wall part is inclined or curved towards a front side.

Abstract: A surgical instrument that comprises an elongate shaft assembly that defines a shaft axis. A surgical end effector is pivotally coupled to the elongate shaft assembly for selective pivotal travel about an articulation axis that extends transversely relative to the shaft axis. First and second articulation drivers are supported for selective longitudinal travel relative to the elongate shaft assembly. A first end effector link is movably coupled to the surgical end effector and is coupled to the first articulation driver for axial and pivotal travel relative thereto. A second end effector link is movably coupled to the surgical end effector and is coupled to the second articulation driver for axial and pivotal travel relative thereto.

Abstract: A surgical instrument that comprises an elongate shaft assembly that defines a shaft axis. A surgical end effector is pivotally coupled to the elongate shaft assembly for selective pivotal travel about an articulation axis that extends transversely relative to the shaft axis. An articulation driver is supported for selective longitudinal travel relative to the elongate shaft assembly in a distal direction and a proximal direction. A central articulation link is movably coupled to a distal end of the elongate shaft assembly. The central articulation link is operably coupled to the articulation driver and an end effector driver link. The end effector driver link is operably coupled to the surgical end effector for selective pivotal and axial travel relative thereto.

Abstract: A surgical instrument that comprises an elongate shaft assembly that defines a shaft axis. A surgical end effector is pivotally coupled to the elongate shaft assembly for selective pivotal travel relative thereto about an articulation axis that is laterally offset from the shaft axis and extends transversely relative thereto. An end effector driver link is operably coupled to the surgical end effector and an articulation driver that is supported for longitudinal travel in distal and proximal directions upon application of articulation motions thereto. A flexible de-articulation member is coupled to the elongate shaft assembly and the surgical end effector to apply de-articulation motions to the surgical end effector.

Abstract: A surgical instrument comprising an elongate shaft assembly that defines a shaft axis. The surgical instrument includes a surgical end effector that has a distal end and a proximal end. The proximal end is pivotally coupled to the elongate shaft assembly for selective pivotal travel about an articulation axis that extends transversely relative to the shaft axis. The surgical end effector is selectively pivotable about the articulation axis from an unarticulated position wherein the distal end of the surgical end effector is located an unarticulated distance from the articulation axis to articulated positions wherein the distal end of the surgical end effector is located a corresponding articulated distance from the articulation axis that is less than the unarticulated distance.

Abstract: A surgical instrument that comprises an elongate shaft assembly that defines a shaft axis. A surgical end effector is pivotally coupled to the elongate shaft assembly for selective pivotal travel about an articulation axis that extends transversely relative to the shaft axis. The surgical instrument further includes an articulation system that comprises a single articulation driver that is supported for longitudinal travel along a path that is laterally offset from the shaft axis. A cross link is coupled to the articulation driver and extends transversely across the shaft axis to be coupled to the surgical end effector.

Abstract: A surgical instrument that comprises an elongate shaft assembly that defines a shaft axis. A surgical end effector is pivotally coupled to the elongate shaft assembly such that the surgical end effector is selectively movable between an unarticulated position and a fully articulated position relative to the shaft axis. A firing beam is movably supported within a pathway in the elongate shaft assembly for selective longitudinal travel therein. The pathway is configured to position a portion of the firing beam exiting the distal end of the elongate shaft member to an off axis position relative to the shaft axis.