U.S. patent application number 08/524148 was filed with the patent office on 2002-07-25 for cpap respiratory apparatus.
Invention is credited to BERTHON-JONES, MICHAEL, CALLUAUD, MICHEL, LYNCH, CHRISTOPHER E., SULLIVAN, COLIN E..
Application Number | 20020096173 08/524148 |
Document ID | / |
Family ID | 3775904 |
Filed Date | 2002-07-25 |
United States Patent
Application |
20020096173 |
Kind Code |
A1 |
BERTHON-JONES, MICHAEL ; et
al. |
July 25, 2002 |
CPAP RESPIRATORY APPARATUS
Abstract
The present invention discloses both a method of operating CPAP
apparatus, and the apparatus itself in which a breathable gas
delivery device, or mask (1), is connected to a gas supply pump
(14) via a conduit which includes a restriction to gas flow such as
a small bore portion (3). A pressure transducer (11) is used to
sense the gas pressure at the patient's nose and the transducer
output is used to servo-control the pump (14) to maintian the
sensed pressure substantially constant.
Inventors: |
BERTHON-JONES, MICHAEL;
(LEONAY, AU) ; CALLUAUD, MICHEL; (HUNTER'S HILL,
AU) ; LYNCH, CHRISTOPHER E.; (TURRAMURRA, AU)
; SULLIVAN, COLIN E.; (BIRCHGROVE, AU) |
Correspondence
Address: |
PILLSBURY WINTHROP LLP
INTELLECTUAL PROPERTY GROUP
1600 TYSONS BOULEVARD
MCLEAN
VA
22102
US
|
Family ID: |
3775904 |
Appl. No.: |
08/524148 |
Filed: |
September 6, 1995 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
08524148 |
Sep 6, 1995 |
|
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|
07994153 |
Dec 21, 1992 |
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Current U.S.
Class: |
128/204.23 |
Current CPC
Class: |
A61M 16/08 20130101;
A61M 16/0616 20140204; A61M 16/1045 20130101; A61M 2016/0039
20130101; A61M 16/06 20130101; A61M 16/0069 20140204; A61M 16/0633
20140204; A61M 16/00 20130101; A61M 16/0858 20140204; A61M 16/0677
20140204; A61M 16/022 20170801; A61M 2210/0618 20130101; A61M
16/0833 20140204; A61M 16/0683 20130101; A61M 16/0825 20140204 |
Class at
Publication: |
128/204.23 |
International
Class: |
A62B 007/00 |
Foreign Application Data
Date |
Code |
Application Number |
Dec 20, 1991 |
AU |
PLO148 |
Claims
1. A CPAP respiratory apparatus comprising a breathable gas
delivery device adapted to deliver breathable gas to inlet the of a
patient's respiratory system, a breathable gas supply means having
an outlet and arranged to supply breathable gas to said outlet at a
pressure above atmospheric pressure, and a flexible conduit having
an internal bore and being connected between outlet and said gas
delivery device wherein a pressure transducer is connected to said
device to sense the pressure at said respiratory system inlet, and
a servo-controller is connected to both said gas supply means and
said pressure transducer to adjust the operation of said gas supply
means to maintain the pressure at said respiratory system inlet
substantially constant.
2. Apparatus as claim 1, wherein said gas delivery device comprises
a nose mask.
3. Apparatus as claimed in claim 1, wherein said flexible conduit
includes a pressure drop inducing means.
4. Apparatus as claimed in claim 3, wherein said pressure drop
inducing means comprises at least that portion of said conduit
closest to said gas delivery device which has an internal bore
which is relatively small compared with the remainder of said
conduit.
5. Apparatus as claimed in claim 4, wherein said small bore portion
is joined to the remainder of said conduit by a swivel joint.
6. Apparatus as claimed in claim 4, wherein said small bore portion
has a flattened non-circular profile.
7. Apparatus as claimed in claim 4, wherein said small bore portion
is arranged to pass between the eyes of said patient.
8. Apparatus as claimed in claim 6, wherein said small bore portion
is bifurcated and includes two parts which each extend from behind
the head of said patient past the corresponding cheek to said gas
delivery device.
9. Apparatus as claimed in claim 4, wherein said small bore portion
includes a pressure port and/or a transducer cable.
10. Apparatus as claimed in claim 3, wherein said pressure drop
inducing means is selected from the class consisting of a bend in
said conduit, a swivel joint in said conduit, a pressure
transducer, a humidifier, a filter, baffle means, a flow measuring
orifice and an adapter to connect portions of said conduit of
different effective internal diameters.
11. A method of operating a breathable gas supply means of a CPAP
respiratory apparatus comprising a breathable gas delivery device
adapted to deliver breathable gas to the inlet of a patient's
respiratory system and connected by a flexible conduit to an outlet
of said gas supply means to receive breathable gas therefrom at a
pressure above atmospheric pressure, said method comprising the
steps of sensing the pressure supplied to said respiratory system
inlet by said gas delivery device, and using the sensed pressure to
servo-control said gas supply means to maintain pressure at said
respiratory system inlet substantially constant.
12. A method as claimed in claim 11, wherein said gas delivery
device comprises a nose mask having a nose receiving cavity, and
said sensed pressure is the pressure within said cavity.
13. A method as claimed in claim 11, including the step of locating
a pressure drop inducing means in said conduit.
Description
BACKGROUND OF THE INVENTION
[0001] The present invention relates to an improved CPAP
respiratory apparatus which will increase patient comfort and
therefore compliance.
[0002] The fundamental disclosure of CPAP is made in the
specification of PCT/AU82/00063 published under WO 82/03548 which
discloses the supply of air to the nose of the patient at an
elevated pressure, the air being supplied through a large bore
inlet tube. The elevated pressure at which the air is supplied is
approximately 10 cm water gauge although pressures in the range of
approximately 5-20 cm water gauge are encountered. However, this
pressure is measured while the patient is not breathing and as the
patient inspires and expires the pressure in the patient's mask
rises and falls typically by approximately 1-2 cm above and below
the steady state level. The large bore inlet tube has an
unrestricted internal diameter of approximately 20 mm and thus does
not introduce unacceptably high pressure drops and swings in the
gas delivery system during breathing. All commercially available
devices have standardised to this size and arrangement.
[0003] For the patient, the work of breathing increases in
proportion to the size of the pressure swing during the respiration
cycle. In particular, the discomfort experienced by the patient
also increases in proportion to the increase in mask pressure
during breathing out. In order to deliver the patient's breathing
air requirements without significant pressure loss in the supply
tube, which would create a relatively large pressure swing during
the breathing cycle, the delivery tube and inlet to the nose mask
were selected to be substantially unrestricted and to have the
large bore of approximately 20 mm.
[0004] However, this arrangement and tubing size are not
particularly convenient as far as the comfort of the patient and
control of the treatment are concerned. In practice, patients
wearing nose masks or equivalent devices including such tubing can
turn only from side to side and the freedom of movement of the
patient is impaired by the tubing. If the tubing and nose mask
could be made smaller, and more acute changes in the direction of
air flow tolerated, a much more comfortable and acceptable air
delivery system would result. Also if a humidifier and/or a filter
could be placed between the pump and the mask, then patient comfort
could be increased. Similarly, if a flow measuring device could be
so located, control of treatment could be enhanced.
[0005] It is the object of the present invention to substantially
overcome or ameliorate the above mentioned difficulties by the
provision of a CPAP respiratory apparatus which maintains the
pressure of air or other breathable gas at the point of immediate
access to the patient's respiratory system substantially constant
notwithstanding in-line components which introduce appreciable
pressure drops.
[0006] It is appreciated that increasing the resistance to flow in
the supply tube results in an increased pressure drop between the
"pump end" and "patient end" of the delivery tube. In order to
compensate for this pressure drop between the ends of the delivery
tube whilst maintaining flow, the present invention seeks to
maintain the air pressure at the "patient end" substantially
constant. This is done by sensing the pressure within the nose
mask, or equivalent device, itself.
[0007] Two known commercially available CPAP respiratory devices
involve some pressure or air flow control. One of these is the
device sold by RESPIRONICS of the USA under the trade name BiPAP in
which the supply pressure can be switched between a lower pressure
and a higher pressure in accordance with the patient's respiratory
cycle in order to assist the patient's breathing effort. This
switching is achieved by sensing air flow through a sensor in the
pump of the air supply system. Another commercially available
device sold by HEALTHDYNE also of the USA has a control mechanism
which controls the pressure at the outlet of the air pump.
[0008] Both of these commercially available devices use the
standard large bore 20 mm inlet tubing which is substantially
unrestricted downstream of the pump outlet and will not operate
satisfactorily with pressure drop inducing components such as small
bore tubing. This is thought (as will be apparent from the
experimental data given hereafter) to be due to the large pressure
drop which causes large pressure swings in the nose mask as the
patient inspires and expires. In particular, because these prior
art devices do not attempt to derive the signal to control the
operation at the air pump as near to the patient's respiratory
system as possible, and downstream of all pressure drop inducing
components, there is a problem of time lags and phase shifts as
regards the supply of air to and from the patient. It has been
experimentally determined by the applicant that by sensing the
pressure at the patient's mask and servo-controlling same to be
substantially constant, the problems introduced by the pressure
drop created in the supply tubing, can be substantially
overcome.
SUMMARY OF THE INVENTION
[0009] In accordance with the first aspect of the present invention
there is disclosed a CPAP respiratory apparatus comprising a
breathable gas delivery device adapted to deliver breathable gas to
the inlet of a patient's respiratory system, a breathable gas
supply means having an outlet and arranged to supply breathable gas
to said outlet at a pressure above atmospheric pressure, and a
flexible conduit having an internal bore and being connected
between said outlet and said gas delivery device wherein a pressure
transducer is connected to said device to sense the pressure at
said respiratory system inlet, and a servo-controller is connected
to both said gas supply means and said pressure transducer to
adjust the operation of said gas supply means to maintain the
pressure at said respiratory system inlet substantially
constant.
[0010] Preferably, at least that portion of said conduit closest to
said nose mask has an internal bore which is relatively small
compared with the remainder of the conduit.
[0011] In accordance with a second aspect of the present invention
there is disclosed a method of operating a breathable gas supply
means of a CPAP respiratory apparatus comprising a breathable gas
delivery device adapted to deliver breathable gas to the inlet of a
patient's respiratory system and connected by a flexible conduit to
an outlet of said gas supply means to receive breathable gas
therefrom at a pressure above atmospheric pressure, said method
comprising the steps of sensing the pressure supplied to said
respiratory system inlet by said gas delivery device, and using the
sensed pressure to servo-control said gas supply means to maintain
the pressure at said respiratory system inlet substantially
constant.
[0012] Preferably, at least one pressure drop inducing device is
located in the gas supply line between the pump and patient.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] Some embodiments of the present invention will now be
described with reference to the drawings in which:
[0014] FIG. 1 is a schematic perspective view of the nose mask and
air supply tube of the CPAP respiratory apparatus of a first
embodiment;
[0015] FIG. 2 is a partial perspective view of the mask only with
its membrane distended;
[0016] FIGS. 3 and 4 are cross-sectional views along the lines
III-III and IV-IV of FIG. 1 respectively;
[0017] FIG. 5 is a perspective view of the nose mask, harness and
supply conduit of a second embodiment;
[0018] FIG. 6 is a view similar to FIG. 5, but of a third
embodiment;
[0019] FIG. 7 is a view similar to FIG. 5, but of a fourth
embodiment;
[0020] FIG. 8 is a view similar to FIG. 5, but of a fifth
embodiment;
[0021] FIG. 9 is an enlarged view of the branched connector of FIG.
8;
[0022] FIG. 10 is a front view of the nose mask of FIG. 8;
[0023] FIG. 11 is a side elevation of an alternative nose mask;
[0024] FIG. 12 is a plan view of the nose mask of FIG. 11;
[0025] FIG. 13 is a cross-sectional view taken along the line
XIII-XIII of FIGS. 5, 6 and 11;
[0026] FIG. 14 is a cross-sectional view taken along the line
XIV-XIV of FIG. 7;
[0027] FIG. 15 is a cross-sectional view taken along the line XV-XV
of FIGS. 9 and 10; and
[0028] FIG. 16 is a view similar to FIG. 1 but illustrating a
further embodiment having various different types of pressure drop
inducing components.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0029] As seen in FIG. 1 a nose mask 1 is of generally known
configuration and is substantially as disclosed in Australian
Patent Application No. 77110/91. The mask 1 takes the form of a
shell 2 of firm plastics which is shaped to fit over at least the
nose region of the patient. A distendable membrane 7 is mounted on
the shell 2 and forms a face contacting portion for the mask 1. The
shell 2 and membrane 7 together define a chamber which receives the
patient's nose. The chamber communicates with an air or other
breathable gas supply aperture to which a short length of supply
tube 3 is connected. The aperture is preferably provided with a
swivel joint 4 so that the supply tube 3 can rotate relative to the
remainder of the face mask 1. This prevents the supply tube 3 from
becoming inadvertently twisted. The nose mask 1 is retained on the
patient 5 by means of conventional straps 6.
[0030] In the vicinity of the swivel joint 4 are located a series
of apertures 8 through which air or other breathable gas exits to
atmosphere as indicated by the arrows in the drawing. Pressure is
sensed in the interior chamber of mask 1 by a thin flexible pipe 10
which is connected a pressure transducer 11 which provides an
electrical output signal carried on cable 18 to a servo-controller
17 for the pump 14.
[0031] The supply tube 3 is of a small bore (typically having an
effective internal diameter of 9-15 mm) and thus the patient whilst
sleeping cannot roll onto an uncomfortable large bore tube. As
indicated in FIG. 3 the small bore supply tube 3 in this embodiment
has a substantially triangular cross-sectional shape and is
flexible. The term "effective internal diameter" means the diameter
of a tube of circular internal cross-sectional shape which has the
same internal cross-sectional area.
[0032] Preferably a swivel joint 12 connects the small bore supply
tube 3 to a substantially conventional large bore supply tube 13.
The pipe 10 which typically has a very small bore, or the cable 18
can conveniently be connected alongside the supply tubes 3,13. This
supports the pipe 10 yet enables the pressure transducer 11 to be
located either at, or remote from, the nose mask 1. If desired, the
pipe 10 and tube 3 can be combined in a single moulding as
indicated by broken lines on FIG. 3. Alternatively, if the pressure
transducer 11 is located within, or adjacent to, the mask the
electrical outputs signal cable 18 of the transducer can be
conveyed to the servo-controller 17 via small pipe 10.
[0033] The large bore supply tube 13 is connected to a pump 14
which consists essentially of an electric motor 15 and fan 16. The
pump 14 preferably supplies air, however, other breathable gases
such as mixtures of air and oxygen can be supplied in known
fashion. The term "air" shall be used hereafter for such gases. The
electric motor 15 is controlled by a substantially conventional
servo-controller 17 which receives as an input, the output from the
pressure transducer 11. If desired, the pipe 10 can be sufficiently
long to locate the transducer 11 at the pump 14.
[0034] It will be apparent to those skilled in the art that the
pressure transducer 11 and servo controller 17 enable the operation
of the electric motor 15 to be controlled so as to maintain the air
pressure within the nose mask 1 substantially constant. As a
result, the electric motor 15 accommodates in its operation the
fluctuating internal pressure drop created by both the patient's
breathing and the small bore of the supply tube 3. In particular,
the supply conduit interconnecting the mask 1 and air pump 14 can
now have a small bore (in the range of from 9 to 15 mm in internal
diameter) over at least part of its length, particularly over that
section in the region of the patient's face and head. This
represents a decrease in available cross-sectional area of the
supply tube 3 from 43.75% to 79.75% respectively.
[0035] Because the supply tube 3 has such a reduced bore, the tube
is much more flexible and comfortable for the user and can
conveniently be fixed to the straps 6 used for holding the nose
mask on the patient's face. In particular, it is not generally
possible to lie upon the 20 mm large bore tubing without feeling
discomfort, however, with the relatively small bore supply tube 3
this is possible. As a consequence, the patient's comfort is
substantially increased. This increases the patient's compliance,
especially after the more pronounced symptoms of sleep apnea have
been initially ameliorated. The increased compliance is of
particular importance in the long term treatment of the
patient.
COMPARATIVE TESTS
[0036] The above described apparatus was tested alongside the above
mentioned commercially available BiPAP (Respironics) device and
TRANQUILITY PLUS device (the trade name of the Healthdyne
product).
[0037] For the experiment, the large bore supply tube 13 took the
form of standard 20 mm bore tubing. The length of the small bore
supply tube 3 was 17 cm. All three units were tested with the same
breathing simulator which delivered a substantially sinusoidal air
flow having a 500 ml tidal volume at 12 cycles/minute. The peak
flow during both inspiration and expiration was 50-60 liters per
minute.
[0038] For each air pump arrangement (BiPAP, TRANQUILITY PLUS and
air pump 14) three types of masks were used. The first was a
conventional mask with a 20 mm constant diameter supply tube (in
the case of BiPAP and TRANQUILITY PLUS the mask and tube were as
supplied with the equipment). The second mask was the mask 1 with
the supply tube 3 being of circular cross-section and of 15 mm
internal diameter. The third mask was the mask 1 but with 9 mm
internal diameter for the supply tube 3.
[0039] The results for 5 different levels of CPAP pressure (0, 5,
10, 15 and either 17 or 20 cm water gauge) are set out in Table 1.
The figures given are air pressures in cm of water gauge with
P.sub.stat being the average or static pressure within the mask
whilst .DELTA.P.sub.tot is the combined pressure swing during the
inspiration/expiration cycle of the breathing simulator.
[0040] It can be seen that the combined pressure swing
.DELTA.P.sub.tot increases significantly with decreasing tubing
diameter with the HEALTHDYNE and BiPAP units, while the
servo-controlled unit 14 maintains pressure in the mask 1 generally
to better than 1 cm total swing for all sizes of tubing. It follows
therefore that an improved result allowing the use of the more
comfortable small bore tubing, has been achieved.
[0041] A second embodiment is illustrated in FIG. 5 where like
parts are indicated by a designator increased in magnitude by 20.
Thus, the mask 21 of the second embodiment is a face mask and
includes a pressure transducer 11 located within the mask 21 as
indicated by broken lines in FIG. 5. The transducer 11 is located
within the mask 21 and between the patient's nose and the apertures
8. A substantially similar arrangement of straps 26 retains the
nose mask 21 in position. As indicated in FIG. 13, the
cross-sectional shape of the small bore inlet tube 23 is circular.
Again, the small bore inlet tube 23 is connected to the
conventional large bore inlet tube 13 by means of a substantially
conventional swivel joint 12.
[0042] A third embodiment is illustrated in FIG. 6 in which the
nose mask 21 and small bore inlet tube 23 are substantially as in
FIG. 5. However, a flow orifice 111 (preferably of the type
disclosed in U.S. Pat. No. 4,006,635 [Billette]) only is located in
the mask 21 and is connected by two small tubes 210 to a flow
transducer 110. The tubes 210 are located one upstream and one
downstream of the flow orifice 111. As before, the pressure
transducer 11 is connected to the mask 21 via the tube 10. In
addition, a cap 29 with straps 36 is provided for the patient in
order to secure the small bore inlet tube 23.
[0043] A fourth embodiment is illustrated in FIG. 7 in which like
parts have their designator increased in magnitude by 40 relevant
to the embodiment of FIG. 1. It will be seen that the configuration
of the nose mask 41 is changed so as to provide a swivel joint 49
which is sufficiently large to accommodate the pressure transducer
11 which is again located downstream of the apertures 48. The
configuration of the straps 46 is also different and provides an
alternative securing arrangement.
[0044] FIGS. 8-10 illustrate a fifth embodiment in which a nose
mask 51 is supplied by means of a split or dual inlet tubes 53 each
of which is supplied from a branch swivel connector 54 illustrated
in more detail in FIG. 9. The connector 54 is located to the rear
of the patient's head and the nose mask 51 is secured in position
by means of a forehead strap 56.
[0045] As seen in FIG. 9, the branch connector 54 includes an elbow
61 which swivels as indicated by the arrow in FIG. 9, relative to a
Y-piece 62. The inlet tubes 53 are sealed directly to the Y-piece
62.
[0046] FIG. 10 illustrates further detail of the nose mask 51 and,
in particular, illustrates the cavity 64 which receives the
patient's nose. The flow orifice 111 is located within the inlet to
the cavity 64 as are the exit apertures 68. It will be seen that
the inlet tubes 53 extend across each cheek of the patient and
alongside the nose mask 51. As seen in FIG. 15, the inlet tubes 53
preferably have a flat configuration and are provided with a
plurality of internal ribs 69 which prevent the inlet tube 53 being
crushed between the pillow and the patient's head.
[0047] Turning now to FIGS. 11 and 12, a still further embodiment
of the nose mask 71 is illustrated. The nose mask 71 has a
substantially rigid outer shell 72 which has an inlet 73 of
substantially circular cross-section which includes exit apertures
78 and is sufficiently large to accommodate the pressure transducer
11 as illustrated (or the flow transducer 110--not illustrated).
Sealingly connected to the outer shell 72 is a soft membrane 77
which is shown in FIGS. 11 and 12 in its distended position and has
a nose receiving aperture 79. Once the nose of the patient is
inserted into the aperture 79, the membrane 77 then conforms itself
to the surface of the patient's skin thereby providing an effective
seal.
[0048] As indicated in FIG. 14, if desired the inlet tube 3, and
equivalents, can be provided with two internal passageways 80 which
can be used either to transmit pressure from the region adjacent
the patient's nose or to locate the electric cable(s) from
transducer(s).
[0049] With the above described distendable mask, the deformable
membrane has hitherto stretched and compressed with changes in the
mask pressure. This oscillation is somewhat disturbing to the
patient and is substantially eliminated in accordance with the
above since the servo-controller 17 maintains the mask pressure
substantially constant.
[0050] Furthermore, most of the noise escaping from a CPAP device
comes either from the air inlet or air outlet. This can be reduced
by placing baffles in the air inlet and/or the air outlet, but with
the prior art devices this is at the expense of increasing the
pressure drop and pressure swings in the mask during inspiration
and expiration.
[0051] In accordance with the above described arrangements, this
additional baffling can be added and the pressure swings that would
otherwise result can be compensated for by servo-controlling the
pressure in the mask. Since mask comfort and noise level are the
two most important determinants of patient comfort and compliance,
this represents a substantial advantage.
[0052] Like the small bore tube 3,23 and the connector 54, such
baffles represent pressure drop inducing components. As indicated
in FIG. 16, such components can take the form of baffles 301, sharp
bends 302, a filter 303, a high pressure drop air outlet diffuser
304 having a diverting tube to direct flow away from a sleeping
partner, a flow orifice 111 and a humidifier 306 such as a
hydroscopic condensing humidifier made by ICOR AB of Sweden. The
pressure drop introduced by any or all of these "accessories" can
be accommodated so as to maintain the pressure at the patient's
nose substantially constant.
[0053] If desired, the transducers 11,110 can be located at or near
the mask as illustrated and connected by cables 18 to the control
apparatus 17. Alternatively, the tubes 10,210 can be sufficiently
long to enable the transducers 11,110 to be located adjacent the
pump 14. This arrangement has the advantage that no electric cables
are located near the patient.
[0054] In addition, if the positions of the flow orifice 111 and
humidifier 306 shown in FIG. 16 are reversed, then a combined
sensing arrangement is possible. In this arrangement the flow
orifice 111 is connected to the flow transducer 110 as before via
two tubes 210. The downstream one of the tubes 210 is branched to
provide the tube 10 for the pressure transducer 11.
[0055] The foregoing describes only some embodiments of the present
invention and modifications, obvious to those skilled in the art
can be made thereto without departing from the scope of the present
invention.
[0056] For example, although a nose mask is described and
illustrated in detail, a full face mask or nasal prongs can also be
used.
1 TABLE I Pstat .DELTA.Ptot Pstat .DELTA.Ptot Pstat .DELTA.Ptot
Pstat .DELTA.Ptot Pstat .DELTA.Ptot BIPAP UNIT Conv. Mask 5.0 1.00
10.0 1.20 15.0 1.40 20.00 2.40 New Mask 15 1.20 1.30 1.40 2.00 New
Mask 9 2.20 2.70 3.80 5.40 HEALTHDYNE TRANQUILITY PLUS Conv. Mask
0.0 0.70 5.0 0.85 10.0 1.10 15.0 1.35 17.00 1.40 New Mask 15 1.20
1.40 1.80 2.10 2.20 New Mask 9 2.20 3.20 4.20 4.80 5.10
SERVO-CONTROLLED UNIT 14 Conv. Mask 0.0 0.40 5.0 0.35 10.0 0.45
15.0 0.60 20.00 0.90 New Mask 15 0.75 0.48 0.52 0.65 0.95 New Mask
9 0.90 1.05 0.65 0.75 0.90
* * * * *