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45 results about "Guided intervention" patented technology

System and Method for Alignment of Instrumentation in Image-Guided Intervention

The invention provides systems and methods for aligning or guiding instruments during image-guided interventions. A volumetric medical scan (image data) of a patient may first be registered to patient space data regarding the patient obtained using a tracking device. An ultrasound simulator fitted with position indicating elements whose location is tracked by the tracking device is introduced to the surface of the anatomy of the patient and used to determine an imaginary ultrasound scan plane for the ultrasound simulator. This scan plane is used to reformat the image data so that the image data can be displayed to a user in a manner analogous to a handheld ultrasound transducer by re-slicing the image data according to the location and orientation of the ultrasound simulator. The location of an instrument fitted with position indicating elements tracked by the tracking device may be projected onto the re-sliced scan data.
Owner:PHILIPS ELECTRONICS LTD

Cardiac and or respiratory gated image acquisition system and method for virtual anatomy enriched real time 2d imaging in interventional radiofrequency ablation or pace maker replacement procecure

The present invention refers to the field of cardiac electrophysiology (EP) and, more specifically, to image-guided radio frequency ablation and pacemaker placement procedures. For those procedures, it is proposed to display the overlaid 2D navigation motions of an interventional tool intraoperatively obtained from the same projection angle for tracking navigation motions of an interventional tool during an image-guided intervention procedure while being navigated through a patient's bifurcated coronary vessel or cardiac chambers anatomy in order to guide e.g. a cardiovascular catheter to a target structure or lesion in a cardiac vessel segment of the patient's coronary venous tree or to a region of interest within the myocard. In such a way, a dynamically enriched 2D reconstruction of the patient's anatomy is obtained while moving the interventional instrument. By applying a cardiac and / or respiratory gating technique, it can be provided that the 2D live images are acquired during the same phases of the patient's cardiac and / or respiratory cycles. Compared to prior-art solutions which are based on a registration and fusion of image data independently acquired by two distinct imaging modalities, the accuracy of the two-dimensionally reconstructed anatomy is significantly enhanced.
Owner:KONINKLIJKE PHILIPS ELECTRONICS NV

Automated Neuroaxis (Brain and Spine) Imaging with Iterative Scan Prescriptions, Analysis, Reconstructions, Labeling, Surface Localization and Guided Intervention

ActiveUS20070223799A1Easy procedureMislocating a surgical site, is avoidedImage enhancementImage analysisDiagnostic Radiology ModalitySystems design
Automated spine localizing, numbering and autoprescription system enhances correct location of diseased or injured tissue, even allow multi-spectral diagnosis. Externally located this tissue is facilitated by an integrated self adhesive spatial reference and skin marking system that is designed for a variety of modalities to include MRI, CT, SPECT, PET, planar nuclear imaging, radiography, XRT, thermography, optical imaging and 3D space tracking. The device ranges from a point localizer to a more multifunctional and complex grid / phantom system. The specially designed spatial reference(s) is affixed to an adhesive strip with corresponding markings so that after applying the unit to the skin / surface and imaging, the reference can be removed leaving the skin appropriately marked. The localizer itself can also directly adhere to the skin after being detached from the underlying strip. A spine autoprescription process performs image analysis that is able to identify vertebrae and discs even in the presence of abnormalities.
Owner:ABSIST +1

System and method for abdominal surface matching using pseudo-features

InactiveUS20110274324A1Enhanced guidance informationFacilitates extensive pre-procedural planningImage enhancementImage analysisAbdominal surfaceOrgan surface
A system and method for using pre-procedural images for registration for image-guided therapy (IGT), also referred to as image-guided intervention (IGI), in percutaneous surgical application. Pseudo-features and patient abdomen and organ surfaces are used for registration and to establish the relationship needed for guidance. Three-dimensional visualizations of the vasculature, tumor(s), and organs may be generated for enhanced guidance information. The invention facilitates extensive pre-procedural planning, thereby significantly reducing procedural times. It also minimizes the patient exposure to radiation.
Owner:PATHFINDER THERAPEUTICS +1

Methods and devices for endosonography-guided fundopexy

ActiveUS20060282087A1Reduce gastroesophageal refluxEasily drawnSuture equipmentsWound clampsFlexible endoscopeEsophageal wall
The present invention relates to a tissue securement system, device and method for endoscopy or endosonography-guided transluminal interventions whereby a ligation or anchor is placed and secured into soft tissue. An objective of this invention is to provide a method to reduce gastroesophageal reflux by endosonography-guided intervention. Specifically, endosonography is used to insert a ligation element through the esophageal wall, through the diaphragmatic crus and into the fundus of the stomach. This ligation element placed from the esophagus and around the angle of His that may create a barrier to gastroesophageal reflux.
Owner:ADVENT MEDICAL

Registration method and apparatus for navigation-guided medical interventions, without the use of patient-associated markers

A registration method and an apparatus for navigation-guided interventions employing an X-ray device and a position acquisition system and avoid the use of patient-associated markers. By means of a defined arrangement of a carrying arm proceeding from a support mount at the X-ray device and a defined arrangement of an X-ray calibration phantom at the carrying arm, the coordinate transformation between a coordinate system allocated to the support mount and a coordinate system allocated to the X-ray calibration phantom is known. On the basis of the acquisition and evaluation of 2D projections of the X-ray calibration phantom with the X-ray device, a coordinate transformation between the coordinate system allocated to the support mount and a coordinate system allocated to a measurement volume of the X-ray device is produced. By arranging a device detectable by the position acquisition system at the support mount, a coordinate transformation between the coordinate system allocated to the measurement volume and a coordinate system allocated to the calibration phantom is determined for the navigation.
Owner:SIEMENS AG

Image guided intervention

Image guidance on a computer screen in the patient's vascular system with reduced use of toxic contrast agent and X-ray radiation is obtained by providing anatomical and functional images obtained preferably from an MR Imaging system. A fibre optic device which uses strain measurement to provide an image of the shape and location of the fiber is used to provide spatial information of the elongate guide member as it is pushed through the vascular system with this spatial information being registered to the image of the vascular system by registering the location of the fiber / guide in the image prior to insertion using markers visible in the MR image.
Owner:IMRIS

Method for operating a safety system of a motor vehicle and motor vehicle

A method for operating a safety system of a motor vehicle includes the steps of determining a target trajectory of the motor vehicle to be realized with the safety system after an unavoidable collision, wherein the target trajectory is assigned to a target position of the motor vehicle, which target position is safe with regard to secondary collisions, and performing at least one autonomous and / or supporting driving intervention in the form of at least one of a longitudinally guiding intervention and a transverse guiding intervention after the collision for realizing the target trajectory.
Owner:AUDI AG

Detection and tracking of interventional tools

InactiveCN101809618AImage enhancementImage analysisVoxel volumeFluorescence
The present invention relates to minimally invasive X-ray guided interventions, in particular to an image processing and rendering system and a method for improving visibility and supporting automatic detection and tracking of interventional tools that are used in electrophysiological procedures. According to the invention, this is accomplished by calculating differences between 2D projected image data of a preoperatively acquired 3D voxel volume showing a specific anatomical region of interest or a pathological abnormality (e.g. an intracranial arterial stenosis, an aneurysm of a cerebral, pulmonary or coronary artery branch, a gastric carcinoma or sarcoma, etc.) in a tissue of a patient's body and intraoperatively recorded 2D fluoroscopic images showing the aforementioned objects in the interior of said patient's body, wherein said 3D voxel volume has been generated in the scope of a computed tomography, magnet resonance imaging or 3D rotational angiography based image acquisition procedure and said 2D fluoroscopic images have been co-registered with the 2D projected image data. After registration of the projected 3D data with each of said X-ray images, comparison of the 2D projected image data with the 2D fluoroscopic images - based on the resulting difference images - allows removing common patterns and thus enhancing the visibility of interventional instruments which are inserted into a pathological tissue region, a blood vessel segment or any other region of interest in the interior of the patient's body. Automatic image processing methods to detect and track those instruments are also made easier and more robust by this invention. Once the 2D-3D registration is completed for a given view, all the changes in the system geometry of an X-ray system used for generating said fluoroscopic images can be applied to a registration matrix. Hence, use of said method as claimed is not limited to the same X-ray view during the whole procedure.
Owner:KONINK PHILIPS ELECTRONICS NV

Needle holder

A needle holder for use in an image guided intervention procedure. The needle holder includes a clip for holding a needle and a guide arrangement for supporting the clip and directing the needle at a desired angle relative to a patient's body. The clip includes a releasable connection such that the needle can be disengaged from the guide arrangement by a lateral movement of the clip and / or the guide arrangement relative to the longitudinal axis of the needle.
Owner:NEORAD BV

Angiographic image acquisition system and method with automatic shutter adaptation for yielding a reduced field of view covering a segmented target structure or lesion for decreasing X-radiation dose in minimally invasive X-ray-guided interventions

The present invention refers to an angiographic image acquisition system and method which can beneficially be used in the scope of minimally invasive image-guided interventions. In particular, the present invention relates to a system and method for graphically visualizing a pre-interventionally virtual 3D representation of a patient's coronary artery tree's vessel segments in a region of interest of a patient's cardiovascular system to be three-dimensionally reconstructed. Optionally, this 3D representation can then be fused with an intraoperatively acquired fluoroscopic 2D live image of an interventional tool. According to the present invention, said method comprises the steps of subjecting the image data set of the 3D representation associated with the precalculated optimal viewing angle to a 3D segmentation algorithm (S4) in order to find the contours of a target structure or lesion to be examined and interventionally treated within a region of interest and automatically adjusting (S5) a collimator wedge position and / or aperture of a shutter mechanism used for collimating an X-ray beam emitted by an X-ray source of a C-arm-based 3D rotational angiography device or rotational gantry-based CT imaging system to which the patient is exposed during an image-guided radiographic examination procedure based on data obtained as a result of said segmentation which indicate the contour and size of said target structure or lesion. The aim is to reduce the region of interest to a field of view that covers said target structure or lesion together with a user-definable portion of the surrounding vasculature.
Owner:KONINKLIJKE PHILIPS ELECTRONICS NV

Cognitive Collaboration with Neurosynaptic Imaging Networks, Augmented Medical Intelligence and Cybernetic Workflow Streams

The invention integrates emerging applications, tools and techniques for machine learning in medicine with videoconference networking technology in novel business methods that support rapid adaptive learning for medical minds and machines. These methods can leverage domain knowledge and clinical expertise with cognitive collaboration, augmented medical intelligence and cybernetic workflow streams for learning health care systems. The invention enables multimodal cognitive communications, collaboration, consultation and instruction between and among heterogeneous networked teams of persons, machines, devices, neural networks, robots and algorithms. It provides for both synchronous and asynchronous cognitive collaboration with multichannel, multiplexed imagery data streams during various stages of medical disease and injury management—detection, diagnosis, prognosis, treatment, measurement, monitoring and reporting, as well as workflow optimization with operational analytics for outcomes, performance, results, resource utilization, resource consumption and costs. The invention enables cognitive curation, annotation and tagging, as well as encapsulation, saving and sharing of collaborated imagery data streams as packetized medical intelligence. It can augment packetized medical intelligence through recursive cognitive enrichment, including multimodal annotation and [semantic] metadata tagging with resources consumed and outcomes delivered. Augmented medical intelligence can be saved and stored in multiple formats, as well as retrieved from standards-based repositories. The invention can incorporate and combine various machine learning techniques [e.g., deep, reinforcement and transfer learning, convolutional and recurrent neural networks, LSTM and NLP] to assist in curating, annotating and tagging diagnostic, procedural and evidentiary medical imaging. It also supports real-time, intraoperative imaging analytics for robotic-assisted surgery, as well as other imagery guided interventions. The invention facilitates collaborative precision medicine, and other clinical initiatives designed to reduce the cost of care, with precision diagnosis and precision targeted treatment. Cybernetic workflow streams—cognitive communications, collaboration, consultation and instruction with augmented medical intelligence—enable care delivery teams of medical minds and machines to ‘deliver the right care, for the right patient, at the right time, in the right place’—and deliver that care faster, smarter, safer, more precisely, cheaper and better.
Owner:SMURRO JAMES PAUL

Cardiac- and/or respiratory-gated image acquisition system and method for virtual anatomy enriched real-time 2D imaging in interventional radiofrequency ablation or pacemaker placement procedures

The present invention refers to the field of cardiac electrophysiology (EP) and, more specifically, to image-guided radio frequency ablation and pacemaker placement procedures. For those procedures, it is proposed to display the overlaid 2D navigation motions of an interventional tool intraoperatively obtained from the same projection angle for tracking navigation motions of an interventional tool during an image-guided intervention procedure while being navigated through a patient's bifurcated coronary vessel or cardiac chambers anatomy in order to guide e.g. a cardiovascular catheter to a target structure or lesion in a cardiac vessel segment of the patient's coronary venous tree or to a region of interest within the myocard. In such a way, a dynamically enriched 2D reconstruction of the patient's anatomy is obtained while moving the interventional instrument. By applying a cardiac and / or respiratory gating technique, it can be provided that the 2D live images are acquired during the same phases of the patient's cardiac and / or respiratory cycles. Compared to prior-art solutions which are based on a registration and fusion of image data independently acquired by two distinct imaging modalities, the accuracy of the two-dimensionally reconstructed anatomy is significantly enhanced.
Owner:KONINK PHILIPS ELECTRONICS NV

Detection and tracking of interventional tools

The present invention relates to minimally invasive X-ray guided interventions, in particular to an image processing and rendering system and a method for improving visibility and supporting automatic detection and tracking of interventional tools that are used in electrophysiological procedures. According to the invention, this is accomplished by calculating differences between 2D projected image data of a preoperatively acquired 3D voxel volume showing a specific anatomical region of interest or a pathological abnormality (e.g. an intracranial arterial stenosis, an aneurysm of a cerebral, pulmonary or coronary artery branch, a gastric carcinoma or sarcoma, etc.) in a tissue of a patient's body and intraoperatively recorded 2D fluoroscopic images showing the aforementioned objects in the interior of said patient's body, wherein said 3D voxel volume has been generated in the scope of a computed tomography, magnet resonance imaging or 3D rotational angiography based image acquisition procedure and said 2D fluoroscopic images have been co-registered with the 2D projected image data. After registration of the projected 3D data with each of said X-ray images, comparison of the 2D projected image data with the 2D fluoroscopic images—based on the resulting difference images—allows removing common patterns and thus enhancing the visibility of interventional instruments which are inserted into a pathological tissue region, a blood vessel segment or any other region of interest in the interior of the patient's body. Automatic image processing methods to detect and track those instruments are also made easier and more robust by this invention. Once the 2D-3D registration is completed for a given view, all the changes in the system geometry of an X-ray system used for generating said fluoroscopic images can be applied to a registration matrix. Hence, use of said method as claimed is not limited to the same X-ray view during the whole procedure.
Owner:KONINKLIJKE PHILIPS ELECTRONICS NV

System and method for decomposed temporal filtering for x-ray guided intervention application

A method for temporally filtering medical images during a fluoroscopy guided intervention procedure includes providing a mask image, a fluoroscopy intervention image acquired at a current time during a medical intervention procedure, forming a subtraction image by subtracting the mask image from the intervention image, calculating a motion image of a moving structure in the subtraction image, forming a residual image by subtracting the motion image from the subtraction image, temporally filtering the residual image with a filtered image from a previous time, and adding the motion image to the temporally filtered residual image.
Owner:SIEMENS HEALTHCARE GMBH

System and method for decomposed temporal filtering for X-ray guided intervention application

A method for temporally filtering medical images during a fluoroscopy guided intervention procedure includes providing a mask image, a fluoroscopy intervention image acquired at a current time during a medical intervention procedure, forming a subtraction image by subtracting the mask image from the intervention image, calculating a motion image of a moving structure in the subtraction image, forming a residual image by subtracting the motion image from the subtraction image, temporally filtering the residual image with a filtered image from a previous time, and adding the motion image to the temporally filtered residual image.
Owner:SIEMENS HEALTHCARE GMBH

System and methods for planning and performing three-dimensional holographic interventional procedures with three-dimensional tomographic and live imaging

A method and a system for image-guided intervention such as a percutaneous treatment or diagnosis of a patient may include at least one of a pre-registration method and a re-registration method. The pre-registration method is configured to permit for an efficient virtual representation of a planned trajectory to target tissue during the intervention, for example, as a holographic light ray shown through an augmented reality system. In turn, this allows the operator to align a physical instrument such as a medical probe for the intervention. The re-registration method is configured to adjust for inaccuracy in the virtual representation generated by the pre-registration method, as determined by live imaging of the patient during the intervention. The re-registration method may employ the use of intersectional contour lines to define the target tissue as viewed through the augmented reality system, which permits for an unobstructed view of the target tissue for the intervention.
Owner:MEDIVIEW XR INC

Method and system for adaptive image guided intervention

A method and system for generating imaging data during a medical intervention are provided. An external optical sensor is attached on the patient's body, and includes at least one external orientation fiber core configured to measure an orientation of the external optical sensor relative to a point of reference. The external optical sensor is interrogated to generate external sensor orientation information during the medical intervention. That information is used to estimate an orientation of the external optical sensor, which is then displayed during the medical intervention.
Owner:KONINKLJIJKE PHILIPS NV

Cognitive collaboration with neurosynaptic imaging networks, augmented medical intelligence and cybernetic workflow streams

The invention integrates emerging applications, tools and techniques for machine learning in medicine with videoconference networking technology in novel business methods that support rapid adaptive learning for medical minds and machines. These methods can leverage domain knowledge and clinical expertise with cognitive collaboration, augmented medical intelligence and cybernetic workflow streams for learning health care systems. The invention enables multimodal cognitive communications, collaboration, consultation and instruction between and among cognitive collaborants, including heterogeneous networked teams of persons, machines, devices, neural networks, robots and algorithms. It provides for both synchronous and asynchronous cognitive collaboration with multichannel, multiplexed imagery data streams during various stages of medical disease and injury management—detection, diagnosis, prognosis, treatment, measurement and monitoring, as well as resource utilization and outcomes reporting. The invention acquires both live stream and archived medical imagery data from network-connected medical devices, cameras, signals, sensors and imagery data repositories, as well as multiomic data sets from structured reports and clinical documents. It enables cognitive curation, annotation and tagging, as well as encapsulation, saving and sharing of collaborated imagery data streams as packetized medical intelligence. The invention augments packetized medical intelligence through recursive cognitive enrichment, including multimodal annotation and [semantic] metadata tagging with resources consumed and outcomes delivered. Augmented medical intelligence can be saved and stored in multiple formats, as well as retrieved from standards-based repositories. The invention provides neurosynaptic network connectivity for medical images and video with multi-channel, multiplexed gateway streamer servers that can be configured to support workflow orchestration across the enterprise—on platform, federated or cloud data architectures, including ecosystem partners. It also supports novel methods for managing augmented medical intelligence with networked metadata repositories [inclduing imagery data streams annotated with semantic metadata]. The invention helps prepare streaming imagery data for cognitive enterprise imaging. It can be incorporate and combine various machine learning techniques [e.g., deep, reinforcement and transfer learning, convolutional neural networks and NLP] to assist in curating, annotating and tagging diagnostic, procedural and evidentiary medical imaging. It also supports real-time, intraoperative imaging analytics for robotic-assisted surgery, as well as other imagery guided interventions. The invention facilitates collaborative precision medicine, and other clinical initiatives designed to reduce the cost of care, with precision diagnosis [e.g., integrated in vivo, in vitro, in silico] and precision targeted treatment [e.g., precision dosing, theranostics, computer-assited surgery]. Cybernetic workflow streams—cognitive communications, collaboration, consultation and instruction with augmented medical intelligence—enable care delivery teams of medical minds and machines to ‘deliver the right care, for the right patient, at the right time, in the right place’ - and deliver that care faster, smarter, safer, more precisely, cheaper and better.
Owner:SMURRO JAMES PAUL

Personalized RF coil array for mr imaging guided interventions

The invention relates to a method of manufacturing a personalized RF coil array for MR imaging guided interventions. The method comprises the steps of: —acquiring diagnostic image data reflecting the anatomy of a portion of a patient's body (10); —planning an intervention on the basis of the diagnostic image data, wherein a field of the intervention within the patient's body (10) portion is determined; —arranging one or more RF antennae (11, 12, 13) on a substrate (19), which is adapted to the patient's anatomy, in such a manner that the signal-to-noise ratio of MR signal acquisition via the one or more RF antennae (11, 12, 13) from the field of the intervention is optimized. Moreover, the invention relates to a computer program and to a computer workstation.
Owner:KONINKLIJKE PHILIPS ELECTRONICS NV

Detection and tracking of interventional tools

The present invention relates to minimally invasive X-ray guided interventions, in particular to an image processing and rendering system and a method for improving visibility and supporting automatic detection and tracking of interventional tools that are used in electrophysiological procedures. According to the invention, this is accomplished by calculating differences between 2D projected image data of a preoperatively acquired 3D voxel volume showing a specific anatomical region of interest or a pathological abnormality (e.g. an intracranial arterial stenosis, an aneurysm of a cerebral, pulmonary or coronary artery branch, a gastric carcinoma or sarcoma, etc.) in a tissue of a patient's body and intraoperatively recorded 2D fluoroscopic images showing the aforementioned objects in the interior of said patient's body, wherein said 3D voxel volume has been generated in the scope of a computed tomography, magnet resonance imaging or 3D rotational angiography based image acquisition procedure and said 2D fluoroscopic images have been co-registered with the 2D projected image data. After registration of the projected 3D data with each of said X-ray images, comparison of the 2D projected image data with the 2D fluoroscopic images—based on the resulting difference images—allows removing common patterns and thus enhancing the visibility of interventional instruments which are inserted into a pathological tissue region, a blood vessel segment or any other region of interest in the interior of the patient's body. Automatic image processing methods to detect and track those instruments are also made easier and more robust by this invention. Once the 2D-3D registration is completed for a given view, all the changes in the system geometry of an X-ray system used for generating said fluoroscopic images can be applied to a registration matrix. Hence, use of said method as claimed is not limited to the same X-ray view during the whole procedure.
Owner:KONINK PHILIPS ELECTRONICS NV

Whole set SNP for predicting preeclampsia and application thereof

The invention discloses a whole set SNP for predicting preeclampsia and an application thereof. The whole set SNP provided by the invention is composed of rs7412, rs2070744, rs1800896, rs1799724, rs4762, rs2549782, rs1800629 and rs1695. The whole set SNP can be used for predicting the risk of PE of Chinese. Experiments verify that combination of the whole set SNP and combination of the whole set SNP and age for predicting the risk of PE of a to-be-detected object have a high accuracy, specificity, sensitivity and an area under the curve. The whole set SNP provided by the invention can evaluate risk of illness of the preeclampsia so as to guide intervention as soon as possible and prevention of preeclampsia, so that the morbidity of morbidity and harm to mothers and infants by preeclampsia are reduced.
Owner:深圳金蕊科技有限公司

Fluid powered master-slave actuation for mri-guided interventions

PendingUS20210007817A1Minimizes imaging interferenceLow costDiagnosticsFluid-pressure actuatorsEffective solutionMedicine
Systems and methods for an effective solution to MR safe actuation in all MRI-guided (robot-assisted) procedures are provided. The present integrated hydraulic transmission method or system uses piston-based cylinders (101,102,201,308(C1), 309(C2),310(C3), 402, 501) to provide continuous bi-lateral rotation with unlimited range in an MRI environment. Positional and torque control can also be achieved. The system includes a master unit and a slave unit each comprising: a plurality of cylinders (101,102,201,308(C1), 309(C2), 310(C3), 402, 501), a piston (105,301,302,303,401,502) inserted within the bottom surface of each cylinder (101,102,201,308(C1), 309(C2), 310(C3), 402, 501), a seal positioned with each cylinder (101,102,201,308(C1), 309(C2), 310(C3), 402, 501) between the piston (105,301,302,303,401,502) and the top surface of the cylinder (101,102,201,308(C1), 309(C2), 310(C3), 402, 501) to inhibit a fluid from passing across the seal, and a plurality of tubes (103) connecting the master unit cylinders and slave unit cylinders (402).
Owner:VERSITECH LTD

Deriving mean brain frequency as a measure of homeostasis and providing guided interventions to correct thoughts,perceptions,and stimuli effecting the user's neuro signals

Disclosed is a method, apparatus and neuro-feedback system for processing neuro-signals of a user's brain to derive mean brain frequency that correspond to a homeostasis condition of the user's Autonomic Nervous System (ANS). The derived mean brain frequency from the neuro-signals or bio signals of the user's brain correspond to Brain Frequency Variability (BFV) index that also correspond to a homeostasis condition of the user's ANS like the mean brain frequency. The disclosed system can be used to train the user's brain using one or more guided interventions in response to the derived mean brain frequency or the BFV index to correct thoughts, perceptions, and stimuli that influences state of the user's neuro-signals.
Owner:BOULTON GRAHAM +1
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