Abstract: According to at least one aspect, a method for computed tomography (CT) fluoroscopy can include acquiring a plurality of pairs of projections of an interventional device using CT fluoroscopy. Each pair of the projections can be obtained at a predetermined first angular separation greater than a second angular separation used for a full dose CT scan of a target object, by rotating a gantry of a CT scanner. The method can include identifying a position of the interventional device in real time for each pair of the projections, using back-projection of images of the interventional device from the respective pair of projections. The method can include superimposing an image of the interventional device on a 3-D image of an anatomical region at an identified position of the interventional device.

Abstract: An apparatus for collecting super-sampled imaging data includes an imaging scanner, a bed, and a first motor. The imaging scanner includes a plurality of detectors arranged substantially circumferentially about a scanner axis. The bed has a plane and a central axis that is generally in the plane of the bed. However, the bed is oriented so as to form a first non-zero degree angle between the central axis and the scanner axis. The first motor translates the bed along the central axis, and a second motor may translate the bed along an axis orthogonal to the central axis and scanner axis. Since the voxels pass through the scanner in different relative positions of the bed, additional information may be acquired during the scan.

Abstract: An apparatus for generating a medical device implantation warning includes a processor to automatically generate a spatial implantation envelope of a first medical device. The envelope defines a spatial extent of a region of implantation around a first medical device prior to, during, and/or after deployment of the first medical device for implantation. If a second medical device, such as a pigtail catheter, strays into the area, an alarm is generated to warn a medical professional to withdraw the pigtail catheter, before deployment continues.

Abstract: An imaging system generates a first radiograph based on a first pattern of radiation detected by a Linear Diode Array (LDA) radiation detector positioned to detect a radiation beam emitted by a radiation generator. The LDA radiation detector comprises a plurality of modules. Each respective module of the plurality of modules comprises a respective plurality of photodiodes corresponding to pixels. Furthermore, the imaging system may determine, based on the first radiograph, a size of a gap between two of the modules of the LDA radiation detector. After determining the size of the gap, the imaging system may generate a second radiograph based on a second pattern of radiation detected by the LDA radiation detector. The imaging system may generate a third radiograph by modifying, based on the size of the gap, the second radiograph to compensate for the gap.

Abstract: A mobile platform and a mobile base designed to support a device such as an X-ray machine is provided. The platform or base is configured to move using a motor-driven system associated with a navigation system. The navigation system enables the platform or base and any device supported by the platform or base (if any) to be moved automatically and with precision from one position to another within any defined space such as an examination, hybrid or operation room. An X-ray machine configured for mounting on the base is also provided. The X-ray machine is configured to move about the patient while at the same time keeping the region to be subjected to radiography within an X-ray beam.

Abstract: A system includes a storage device storing a set of instructions and at least one processor in communication with the storage device, wherein when executing the instructions, the at least one processor is configured to cause the system to determine a first scan area on a scanning object. The system may also acquire raw data generated by scanning the first scan area on the scanning object and generate a positioning image based on the raw data. The system may also generate a pixel value distribution curve based on the positioning image, and determine a second scan area on the scanning object based on the pixel value distribution curve. The system may also scan the second scan area on the scanning object.

Abstract: Disclosed are a mammography system and a mammography imaging method that can prevent a subject from being exposed to radiation more than necessary by setting an optimum imaging condition according to a thickness of a subject's breast, and can obtain a high-quality medical image by setting an optimum FOV and correcting projection data according to the thickness of the breast. The mammography system includes: a mammography imaging device including a detector and an X-ray tube, and obtaining X-ray image data of a subject's breast from multiple angles; a thickness obtaining unit obtaining information on a thickness of the breast; and a rotation angle calculator calculating a rotation angle range of the X-ray tube, based on the information of the thickness of the breast, wherein the mammography imaging device obtains the X-ray image data from multiple angles by performing radiography while rotating the X-ray tube within the rotation angle range.

Abstract: A 2D mammogram image is synthesized from at least one of tomosynthesis projection images and/or the tomosynthesis reconstructed image data. In a simplest form, the mammogram may be synthesized by selecting one of the tomosynthesis projection images for display as a synthesized mammogram. Other methods of synthesizing a mammogram include re-projecting and filtering projection data and/or reconstructed data. The synthesized mammogram is advantageously displayed together with at least a portion of the reconstructed data to aid in review of the reconstructed data. The present invention thus provides a familiar image which may be used to facilitate review of a tomosynthesis data set.

Abstract: Disclosed herein is a computed tomography system, comprising: a table with a hole therein, wherein the table is configured to support a person lying face down thereon, with at least one of the person's breasts projecting through the hole; an X-ray source; an X-ray detector comprising a plurality of pixels; wherein the X-ray source is configured to rotate around the at least one of the person's breasts.

Abstract: A radiological imaging device that includes a gantry defining an analysis zone in which at least part of a patient is placed, a source suitable to emit radiation defining a central axis of propagation; a detector suitable to receive the radiation, a translation mechanism adapted to translate the source and the detector in a direction of movement substantially perpendicular to the central axis of propagation; and a control unit adapted to acquire an image from data signals received continuously from the detector while the translation mechanism continuously translates the source emitting the radiation and the detector receiving the radiation, so as to scan the at least part of the patient.

Abstract: A computer-implemented method for determining and evaluating an objective tumor response to an anti-cancer therapy using cross-sectional images can include receiving cross-sectional images of digital medical image data and identifying target lesions within the cross-sectional images. For each of the target lesions, a target lesion type and anatomical location is identified, a segmenting tool is activated for segmenting the target lesions into regions of interest, lesion metrics are automatically extracted from the regions of interest according to tumor response criteria, and conformity of target lesion identification is monitored using rules associated with the tumor response criteria, prompting a user to address any nonconforming target lesion. The method also includes receiving a presence/absence of metastases, determining changes in lesions metrics, and deriving an objective tumor response based on the tumor response criteria.

Abstract: A PET/CT imaging system is provided. The imaging system includes a PET detection system having a plurality of detector rings and an axial gap between at least two adjacent detector rings within the plurality of detector rings. The imaging system includes a CT system having an x-ray generator and a CT detection system positioned within the axial gap between the at least two detector rings. The system is configured to collect PET data and CT data on the same volume of interest substantially simultaneously.

Abstract: An imaging system includes an x-ray assembly having one or more x-ray sources configured to be energized at multiple positions. A control program energizes the one or more x-ray sources in a programmed sequence and controls the timing of the sequence.

Abstract: A radiographic image photographing system includes: a radiation generating device configured to emit radiation; a radiographic image photographing device including a plurality of radiation detecting elements arranged in a two-dimensional pattern and configured to read signal values from the radiation detecting elements; a dose detecting unit arranged between the radiation generating device and the subject and configured to detect a dose of radiation emitted to the subject; and a control unit configured to control the radiation generating device such that the dose of the radiation emitted to the subject becomes a target dose, wherein the control unit sets a tube current or a mAs value of the radiation generating device such that the dose of the radiation becomes the target dose, and corrects and sets the tube current or the mAs value in a case where a difference occurs between the dose of the radiation detected and the target dose.

Abstract: According to one embodiment, a medical image diagnostic apparatus includes a holding device, a driving unit, a first encoder, a second encoder, and processing circuitry. The holding device holds an X-ray generator and an X-ray detector such that the X-ray generator and the X-ray detector are rotatable. The driving unit transmits a rotating force of a driving motor to a rotation axis through a power transmission mechanism. The first encoder detects a rotation of the driving motor. The second encoder detects a rotation of the rotation axis. The processing circuitry detects an abnormal state of the power transmission mechanism, based on a time difference between a first pulse output from the first encoder and a corresponding second pulse output from the second encoder.

Abstract: The present disclosure provides a medical/healthcare system which comprises an electronic stethoscope and a medical host under a medical/healthcare environment. The electronic stethoscope comprises an auscultation module for recording a sound from internal body of a patient to form an auscultation data, a reader for obtaining a patient information from the patient, a processor module to receive and associate the patient information to the auscultation data to form an auscultation file, a storage for storing the auscultation file, a display module to display the auscultation file for selection, a control input interface for selecting the auscultation file for playback, an output module for playing the auscultation file by outputting the sound corresponding to the auscultation file when selected, and a power module to provide electricity to all the others.

Abstract: A medical instrument includes a printed ultrasound sensor, a surface, at least one non-conductive material, and at least one pair of contacts. The ultrasound sensor includes an array of ultrasound transducers printed on a non-conductive surface of the medical instrument. The medical instrument contains multiple conductive and nonconductive layers. The at least one pair of contacts are electrically coupled to the ultrasound sensor and operably coupled to the conductive layer, the conductive layer coupled to a measurement device, which converts electrical signals from the ultrasound sensor into images displayed on a display unit. The location of the medical instrument can be visualized in real time on the display unit.

Abstract: Rotational intravascular ultrasound (IVUS) imaging devices and systems are provided. The IVUS imaging devices include catheters having a rotating drive cable with a transducer disposed at a distal end thereof for imaging a bodily vessel of interest. In some embodiments, a lubricious coating is applied on the drive cable to promote uniform rotation of the drive cable and the transducer. In some embodiments, the drive cable is coated with a polymer layer to promote uniform rotation of the drive cable and the transducer. In some embodiments, radiopaque markers are affixed on the drive cable for accurate placement of the transducer within of the vessel and for accurate measurement of internal dimensions and lesion lengths within the body of the patient.

Abstract: A wireless intelligent ultrasound fetal imaging system includes an ultrasound transducer, an ultrasound AFE module, a ZYNQ module, a machine vision module and a mobile device. The mobile device controls the system by transmitting control parameters values to the system over a wireless link. The ZYNQ module receives and applies the parameters, and outputs processing results to a FPGA processor. Controlled by the parameters, the FPGA processor causes the AFE module to transmit ultrasound wave toward a pregnant mother, and receive and process echoing wave. The FPGA processor then conducts imaging processing. The processed image data is then recognized by machine vision module. The processed image data is integrated before it is sent to and displayed the mobile terminal device.

Abstract: Disclosed herein is an ultrasound probe including a transducer array configured to generate ultrasonic waves, an integrated circuit disposed on a back surface of the transducer array by using an adhesive member, a printed circuit board connected to the integrated circuit and configured to output a signal to the integrated circuit, and a pad bridge disposed on front surfaces of the printed circuit board and the integrated circuit by using the adhesive member and configured to electrically connect the printed circuit board with the integrated circuit. An area of a region of the ultrasound probe contacting the human body may be reduced without reducing the size of the transducer array, and the integrated circuit and the printed circuit board may be integrally connected by using the adhesive member.

Abstract: An ultrasonic probe includes an ultrasonic transducer array and a multilayer body for extracting an electric wiring from each electrode. Transducers are classified into at least a first group and a second group. The multilayer body includes a first FPC layer on which the array is stacked and a second FPC layer on which the first FPC layer is stacked. The first FPC layer and the second FPC layer include upper surface connection pads and lower surface electrode pads which maintain a uniform level at positions spatially corresponding to the respective transducers. FPC layers constituting an FPC multilayer body are bonded to each other to be integrally formed in a region corresponding to the width of the array. On the other hand, the respective FPC layers are not bonded to each other and separated from each other outside the region corresponding to the width of the array.

Abstract: An information providing method which is implementable by using an ultrasound apparatus includes obtaining ultrasound image data which relates to an object; displaying, on a first area of a screen, a gain setup window for setting a gain of the obtained ultrasound image data; receiving a gain which is set by a user on the gain setup window; and displaying, on a second area of the screen, an ultrasound image of the object to which the set gain is applied.

Abstract: Various methods of performing ultrasound contrast assisted therapy are provided. One such method includes delivering a plurality of microbubble-based ultrasound contrast agents to a target area and disrupting the microbubble-based ultrasound contrast agents by delivering tone bursts of ultrasound to the target area. The oscillation of the microbubble-based ultrasound contrast agents can be achieved by delivering ultrasound tone bursts of greater than 5 acoustic cycles with a pulse repetition frequency of between 0.01 and 20 Hz, with pressure greater than 0.3 MPa.

Abstract: The disclosure provides a color ultrasound system and a method and a device thereof for obtaining beam-forming line data. The method comprises: a processor sending a control command according to a currently triggered color ultrasonograph mode; the processor receiving the digital ultrasonic echo signal data obtained according to the control command, wherein the digital ultrasonic echo signal data is a digital signal obtained by performing analog-to-digital conversion on an analog ultrasonic echo signal; and the processor performing beam-forming processing on the digital ultrasonic echo signal data to obtain corresponding beam-forming line data. With the disclosure, the color ultrasound system hardware is simple in design and flexible, and resource conservation and cost reduction are achieved during technical update.

Abstract: A biopsy device includes a probe, a holster, and a tissue sample holder for collecting tissue samples. The probe includes a needle and a hollow cutter. The tissue sample holder includes a housing having a plurality of chambers that are configured to receive a plurality of strips connected by at least one flexible member. The flexible member is configured to permit the strips to pivot relative to each other such that the strips can shift between a flat configuration and a arcuate configuration. The tissue sample holder is rotatable to successively index each chamber to the cutter lumen such that tissue samples may be collected in the strips. The strips may be removed from the tissue sample holder and placed in a tissue sample holder container for imaging of tissue samples.

Abstract: A method is provided for calibrating a surgical biopsy system. The biopsy system includes a biopsy instrument and control unit. The biopsy instrument includes a piercer, rotatable cutter, and a port for receiving tissue samples. The method comprises the steps of translating the cutter distally until the translation of the cutter is stopped at an extended position and recording the extended position. The cutter is then translated from the extended position proximally until the translation of the cutter is stopped at a retracted position proximal to the extended position. The retracted position is recorded. The method further comprises the step of rotating the cutter to a rotation speed while the cutter is located at the retracted position and, if determined that the rotation speed is within a predetermined rotation speed range, a feedback signal is provided on the display allowing the operator to progress to the next procedural step.

Abstract: An apparatus and method for harvesting bone and bone marrow are provided. The apparatus may include a driver operable to be releasably engaged with an intraosseous device. The intraosseous device may include a cannula having a first end operable to penetrate bone and bone marrow and to allow retrieval of portions of bone and/or bone marrow. The cannula may have a second end operable to be releasably engaged with bone marrow sampling equipment. The apparatus may include a removable trocar. The removable trocar may have an inner channel operable to convey portions of bone and/or bone marrow. The removable trocar may have an inner channel and a side port communicating with the inner channel. The removable trocar may have a first end operable to penetrate bone and bone marrow.

Abstract: A surgical instrument includes a selectively rotatable housing, an adaptor, and a shaft including an end effector. The adaptor is coupled to the housing and is selectively movable between a first position and a second position. The shaft is coupled to one or both of the housing and the adaptor. The end effector is articulable in response to the selective rotation of the housing. The end effector is articulable toward a first direction when the adaptor is positioned in the first position and articulable toward a second direction when the adaptor is positioned in the second position. The first and second directions are different.

Abstract: The present disclosure relates to improved capabilities for stabilizing and regulating atrial pressure with a shunt in the atrial septum or a stent in the coronary sinus. The disclosure also includes sensing, monitoring, drug therapy and control capabilities to provide improved treatment of patients with heart disease and other cardiac related conditions.

Abstract: A microcatheter deliverable implant is provided formed of an elongated wire of a diameter capable of delivery through the axial passage of such a microcatheter. A first portion of the formed implant forms a coiled first section larger in diameter than an anomaly to be blocked. A second portion formed by the coiled wire engages the implant between the first and second portions to block communication of fluid through the anomaly.

Abstract: The invention is a septal implant that can accommodate variable thicknesses of the patient's atrial septum as well the variable thicknesses of septums across a population. The invention is able to accomplish this result by having flexible annular flanges that define a gap into which the septum fits. Due to the flexible nature of the annular flanges, the gap is adjustable.

Abstract: A retractor having an elongated body that provides access to a surgical location within a patient. The elongate body includes a plurality of segments that are connected to one another through a plurality of ratcheting mechanisms. The ratcheting mechanisms permit relative movement of the segments with respect to one another when expander dilators are inserted within the retractor. The segments are surrounded and retained by a resilient elastomeric sleeve or bands. The distal end surfaces of the segments include thin edges that are configured to mobilize, dissect, split and retract the terminal tissues in the surgical area. The retractor may be used in conjunction with a shim.

Abstract: A device for suturing an opening in a tissue, having an elongated shaft, at least two arms movable to a deployed positioning which the arms are non-perpendicular to the shaft, the arms having needle receiving portions; and needles advanceable longitudinally along the shaft toward the needle receiving portions, the needles exiting through side walls of the shaft at a location proximal to the arms.

Abstract: The present disclosure relates to devices, systems and methods for endoscopic suturing or stitching through an access tube or the like. An endoscopic stitching device is provided and includes a handle assembly; an elongate shaft supported by and extending from the handle assembly; and an end effector supported on a distal end of the elongate shaft. The end effector includes a neck assembly configured and adapted for articulation in one direction between a substantially linear configuration and an off-axis configuration, and a pair of juxtaposed jaws pivotally associated with one another. Each jaw defines a suture needle receiving recess formed in a tissue contacting surface thereof.

Abstract: The invention involves an instrument with a set of grasping jaws such as found on surgical needle drivers, hemostats, grasping forceps, and clamps. In addition to the grasping jaws for holding and grasping material, it includes a set of cutting shears or scissors that operate in the same main working jaws. It functions as a standard needle holder with grasping and locking functions with the use of two main actuating limbs. When desired, the instrument is easily converted by a simple action of the operator from a grasping device into a cutting device and then can be used in a familiar fashion, such as employed for scissors, to repeatedly cut sutures or material. Again, with a simple action by the operator, the instrument can be converted back to a grasping device. Both grasping and cutting functions take place in the same location on the device.

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: The present invention provides a linear stapler having a multi-functional retaining pin subassembly. The linear stapler comprises a handle stem connecting an anvil to a handle, and the retaining pin subassembly is movably supported on the handle stem and comprises a connecting cover having a retaining pin extending from the connecting cover. The present invention also provides a multi-functional retaining pin subassembly. The retaining pin subassembly can achieve cartridge alignment and tissue retention during the firing of the stapler and protect tissue from unintended damage.

Abstract: A surgical instrument is disclosed. In one form, the surgical instrument comprises an elongate shaft assembly and an end effector that is configured for selective rotation relative to the axis of the elongate shaft assembly. The surgical instrument can include a rotary locking system for locking the surgical end effector in rotary orientations about the shaft axis upon application of axial locking and axial unlocking motions to the rotary locking system. The surgical instrument may further comprise a rotary drive system that is configured to apply rotary control motions to a firing member as well as to apply rotary positioning motions to the surgical end effector.

Abstract: Shaft assembly arrangements for surgical instruments are disclosed. A surgical instrument assembly can comprise a proximal shaft assembly comprising a distal coupling portion. The surgical instrument assembly can also comprise a distal shaft assembly comprising a proximal coupling portion configured to be releasably coupled to the distal coupling portion. The distal shaft assembly can also include an articulation joint and an end effector configured to articulate about the articulation joint.

Abstract: An engaging element for engaging tissue that includes a first member and a second member. The first member includes at least one tissue engaging portion at a first free end. The first tissue engaging member is movable between an open position and a closed position and has a second free end. The first tissue engaging member is restrained in movement at an intermediate position between the first free end and the second free end. A lock portion is operatively associated with the first member with the lock portion maintaining a spacing between the first member and the second member and inhibiting movement of the first member to the open position. The lock portion is operatively associated with a portion of the first tissue engaging member proximal the intermediate position.

Abstract: A wound closure device includes a shaft, a sleeve, a suture, and a cartridge. The sleeve is disposed about the shaft and defines first and second sleeve arms movable between a retracted position, wherein the sleeve arms extend along the shaft, and a deployed position, wherein the sleeve arms extend outwardly from the shaft. The cartridge includes a base and first and second cartridge arms. The base is configured for releasable coupling with the shaft and defining a pocket configured to retain an intermediate portion of the suture. The first and second cartridge arms are configured for positioning adjacent the respective first and second sleeve arms and are configured to move in conjunction with the respective first and second sleeve arms between the retracted and deployed positions. The first and second cartridge arms are configured to retain first and second ends of the suture, respectively.

Abstract: Circular and curved surgical stapling instruments are disclosed comprising circular and curved stapling configurations. A circular staple cartridge comprises a plurality of staples arranged in an inner row, an intermediate row, and an outer row. Staples in certain rows can have different unformed heights. Some arrangements include deck features that protrude from the staple cartridge deck. Various anvil arrangements are also disclosed to attain staples having different formed heights.

Abstract: An adapter assembly for connecting an end effector to a handle assembly includes first, second, and third drive assemblies configured for converting rotational motion from the handle assembly to linear motion for performing first, second, and third functions. Each of the first, second, and third drive assemblies defining a longitudinal axes, wherein at least two of the longitudinal axes of the first, second, and third drive assemblies are co-axial.

Abstract: A surgical stapling device comprising a housing, an elongated portion, an end effector, and a movable handle disposed in mechanical cooperation with the housing and movable between a first open position and a second approximated position for affecting a function of the end effector. A ratchet mechanism is disposed in mechanical cooperation with the movable handle and is configured to substantially prevent the movable handle from moving towards its first open position until the movable handle reaches a predetermined position.

Abstract: Devices, methods, and systems are provided for occluding a collateral flow channel between a target lung compartment and an adjacent lung compartment. A video-assisted thoracoscopic device is inserted into a thoracic cavity of a patient and positioned at a fissure between a target lung compartment and an adjacent lung compartment. A collateral flow channel between the target lung compartment and the adjacent lung compartment is then identified using the video-assisted thoracoscopic device and an agent is injected into the collateral flow channel, thereby reducing the collateral flow channel.

Abstract: The present disclosure concerns embodiments of an implantable perfusion device that can be implanted in an injured blood vessel to control bleeding without occluding the vessel. In one specific implementation, the perfusion device can be implanted percutaneously into a patient's descending aorta to control bleeding at the site of a ruptured portion of the aorta (known as torso hemorrhage) while still allowing for the antegrade flow of blood from a location upstream of the ruptured portion of the aorta to a location downstream of the ruptured portion of the aorta. The perfusion device can be left inside the patient as the patient is transported to a medical facility where the injury can be repaired. Following repair of the vessel, the perfusion device can be withdrawn from the patient.

Abstract: The present invention provides for implant device delivery apparatuses and related methods of use. The delivery systems of the present invention incorporate a stretch resistant tube that advantageously makes the implant device, such as an embolic coil, stretch resistant while a delivery system is being used to position the implant device at a desired target site.

Abstract: A method and device for reducing the damaging effects of radiant energy, blast, or concussive events includes applying pressure to at least one jugular vein to reduce the egress of blood from the cranial cavity during or before the incidence of the imparting event. Reducing blood outflow from the cranial cavity increases intracranial volume and/or pressure of the cerebrospinal fluid to reduce the risk of traumatic brain injury and injuries to the spinal column. Reducing blood outflow further increases the intracranial pressure and volume, and thereby increases the pressure and volume of the cochlear fluid, the vitreous humor and the cerebrospinal fluid to thereby reduce the risk of injury to the inner ear, internal structure of the eye and of the spinal column. In addition, increasing intracranial pressure and volume reduces the likelihood of brain injury and any associated loss of olfactory function.

Abstract: According to an exemplary embodiment, a cutting block for cutting the femur during knee arthroplasty surgery may be provided. The cutting block may include a cutting guide having a number of slots for guiding a cutter to cut the femur and further comprising a slide extending from the frame of the cutting guide. The cutting block may further include a body that may have a groove with flanges, wherein the space defined by the groove and the flanges may receive the slide extending from the frame of the cutting guide. Further, a feeler gauge may include a support block receiving a pointer arm, wherein the pointer arm may include a pointer that may be configured to make contact with patient bone tissue. A foot including a pair of spaced apart flanges configured to engage the posterior condyles of the patient's femur may also be included in the cutting block.

Abstract: Disclosed herein is a surgical device. The surgical device includes a cutting burr, a flexible/deflectable shaft, an elongated fluted shaft, a sheath, and an outer tube. The cutting burr has a fluted extension. The flexible/deflectable shaft has a distal end and a proximal end, the distal end is configured to be connectable to the fluted extension of the cutting burr. The elongated fluted shaft is configured to be connectable to the proximal end of the flexible shaft. The sheath is configured to receive all or portion of the flexible shaft and the elongated fluted shaft. The outer tube is configured to receive the sheath such that there is enough space for fluid irrigation between the outer tube and the sheath.