GE Healthcare CASE™ V6.7 Software Version 6.
NOTE: The information in this manual only applies to CASE V6.7 systems software version 6.73. It does not apply to earlier software versions. Due to continuing product innovation, specifications in this manual are subject to change without notice. GE Medical Systems Information Technologies, Inc.
CE Marking Information CE Marking Information Compliance The product CASE bears the CE marking CE 0459, notified body GMED, indicating its conformity with the provisions of the Council Directive 93/ 42/EEC concerning medical devices and fulfills the essential requirements of Annex I of this directive. The medical device has been assigned to class IIa as specified in Annex IX of the Directive 93/42/EEC. The CE marking only covers accessories listed in the Order Information chapter.
CE Marking Information For your notes CE-2 CASE 2060290-201 Revision C
Contents 1 Introduction About This Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Revision History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Manual Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Intended Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Illustrations . . . . .
Viewing and Printing the Operator's Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17 Online Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-17 Software Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18 3 Preparing the Patient Applying Electrodes - The Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 10-Second ECG with Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7 Operating Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8 Full Disclosure ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10 Operating Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pretest Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-15 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-15 Operating Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-15 Exercise Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-16 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Audio ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-51 Waterfall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-52 3D Graph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-53 12SL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-54 Vector Loops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-7 Flow-Volume Measurement - Operating Steps . . . . . . . . . . . . . . .8-9 Bronchodilator Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-12 Spirometry Tests with the LF 501 . . . . . . . . . . . . . . . . . . . . . . . . .8-12 Post Test Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14 Test Summary . .
Performing Procedures without the Order List (Unscheduled Procedures) . . . 11-6 12 System Settings Resting ECG Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3 Acquisition Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3 Editing the Reason for Test Library . . . . . . . . . . . . . . . . . . . . . . . 12-4 Editing the Interpretation Library . . . . . . . . . . . . . . . . . . . . . . . . .
Spirometry Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-35 Acquisition Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-35 Miscellaneous Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-36 Editing the Reason for Test, Medication Library . . . . . . . . . . . . .12-36 Editing the Interpretation Library . . . . . . . . . . . . . . . . . . . . . . . .
Bicycle Ergometers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-3 Connecting ERGOLINE 900/900 L/900 EL Ergometers to the System B-3 Treadmills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-3 Blood Pressure Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-4 SpO2 Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C Order Information Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3 Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3 D Technical Description Technical Specifications – CASE System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 Revision C Introduction CASE 2060290-201 1-1
For your notes 1-2 CASE 2060290-201 Revision C
About This Manual About This Manual Revision History This manual is subject to the GE Healthcare change order service. The revision code, a letter that follows the document part number, changes with every update of the manual. Table 1: Revision History Part No./ Revision Date 2060290-201-A 2015-09-11 Initial release. 2060290-201-B 2015-11-18 Updated manual for help file. 2060290-201C 2017-06-22 Updated manual for hardware design changes.
Safety Information Safety Information Intended Use CASE is intended to be used by trained operators under direct supervision of a licensed health care practitioner on adult and pediatric patients. CASE is designed to acquire, process, record, archive, analyze and output ECG data (12 and 15 leads) during a period of physiologic stress or during a resting ECG test and acquire data from ancillary devices, such as spirometry and ambulatory blood pressure devices.
Safety Information General Information This manual is an integral part of the device. It should always be kept near the device. Close observance of the information given in the manual is a prerequisite for proper device performance and correct operation and ensures patient and operator safety. Please read the manual once in its entirety, because information pertinent to several chapters is given only once.
Safety Information requirements of this equipment may lead to a reduced level of safety of the resulting system. Considerations relating to the choice shall include: use of the accessory in the patient vicinity and evidence that the safety certification of the accessory has been performed in accordance to the appropriate IEC 60601-1 and/or IEC 60601-1-1 harmonized national standard.
Safety Information Warning Shock Hazard — Observe the following warnings. Failure to do so endangers the lives of the patient, the user, and other persons present. Revision C Only specially trained technical staff is authorized to open the connector access panel. Before putting the device into operation, the operator is required to ascertain that it is in correct working order and operating condition. The cables, in particular, must be checked for damage.
Safety Information Warning Shock Hazard — Observe the following warnings. Failure to do so endangers the lives of the patient, the user, and other persons present. 1-8 All modems connected to the system must meet the requirements of IEC 60950 or UL1950. The specific regulations valid in your country must also be observed. The modem must be installed within the medical location, but not in the patient vicinity. Disconnect the patient from the system while sending data via the modem.
Safety Information Warning Shock Hazard — Observe the following warning. Failure to do so endangers the lives of the patient, the user, and other persons present. Use only the original GE Healthcare patient cable. Do not connect other signal sources to the cable. Warning Patient Hazard — During exercise tests, a defibrillator and a pacemaker, both checked for proper functioning, should be kept at hand. Patient Hazard — The operator must be capable of using the equipment properly.
Safety Information Caution Equipment Damage — Before connecting the device to the power line, check that the voltage and frequency ratings of your power line match those indicated on the device label. Equipment Damage — Do not set up CASE in the direct vicinity of a window. Rain, humidity and sunlight may damage CASE. Do not operate CASE in the vicinity of heating appliances (radiators). Do not block air vents and do not place any objects on the monitor or equipment damage could result.
Safety Information Classification Type of protection against electrical shock class I Degree of protection against electrical shock Type BF, defibrillation-proof applied parts - ECG leads Degree of protection against harmful ingress of water enclosed equipment without protection against ingress of water Degree of safety of application in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide Not suitable for use in the presence of a flammable anesthetic mixture with
Safety Information Signal input Signal output Fuse 12V 12 V DC The number found under this symbol is the date of manufacture in the YYYYMM format. Medical Equipment — Classified with respect to electric shock, fire and mechanical hazards only in accordance with UL 60601-1/CAN/CSA C22.2 No. 601.1, CAN/CSA C22.2 No. 601-2-25, IEC 60601-2-25, IEC 60601-1-1. Authorized representative in the European Community. CE marked per the Medical Device Directive 93/42/EEC of the European Union.
Safety Information Eurasian Conformity mark. Conformity to applicable technical regulations of Customs Union. This symbol indicates that the device was tested and certified according to the Russian safety standards specified by GOST. For use by or on the order of a physician, or persons licensed by U.S. law. Supplies and Accessories Refer to the Supplies and Accessories Guide, Diagnostic Cardiology, for supplies and accessories, ordering, safety, and cleaning information for your device.
Safety Information security patch compatible with your operating system and install it on your system. Registration and download: http://prodsecdb.gehealthcare.
Service Information Service Information Service Requirements Refer equipment servicing to GE Healthcare authorized service personnel only. Any unauthorized attempt to repair equipment under warranty voids that warranty. It is the user's responsibility to report the need for service to GE Healthcare or to one of the authorized agents. Equipment Identification Every GE Healthcare device has a unique serial number for identification. The serial number appears on the device label. Fomat A is shown below.
Service Information 1-16 CASE 2060290-201 Revision C
2 Revision C Equipment Overview CASE 2060290-201 2-1
For your notes 2-2 CASE 2060290-201 Revision C
CASE System CASE System Front View A B G C H D I E F 01A A B C D E F G H I Revision C Monitor Function keypad Paper tray Console for PC keyboard and mouse Power button (non-breaking of AC power) Wheel locks Thermal writer USB drives (2) Acquisition module holder CASE 2060290-201 2-3
CASE System Rear View K L 02A K L 2-4 Connector access panel Equipotential pin, power inlet with fuses, mains switch CASE 2060290-201 Revision C
CASE System Putting the CASE System Into Service Connecting the System Components Warning Shock Hazard — Only technical staff is authorized to open the access panel. 1. Connect the cables to the system components and secure the connections with retaining screws. 2. Guide the cables through the opening in the access panel and connect them to the appropriate ports as shown on the reference diagram. 3. Close the panel. Cable clamps Reference diagram Note Coil the excess cable for storage as shown above.
CASE System Mains Connection, Power Up, Functional Test Note Before powering the system up, read the safety information in section “Safety Information” on page 1-4. Power inlet Mains power switch Potential equalization pin 85A Cable clamp Back Panel 1. Connect CASE to the power line and secure the power cord with the clamp provided. Note DO NOT turn the system on yet. 2. Connect the system to the potential equalization system. 3.
CASE System Power button Side Panel 5. Turn on CASE with the power button on the side panel. The program will start up automatically and the Windows screen appears. 6. Log on to the system. 7. Double-click the CASE icon. 8. If the local database window appears, click Cancel. 9. The initial CASE screen will appear. When you see the initial CASE screen (see “Initial Screen” on page 2-16) and no error message appears, the system is operational.
CASE System Switching the System Off Exit the CASE program: 1. Click Quit program. 2. Confirm the displayed message by clicking Yes: The system will automatically shut down. 1 2 087A Warning Loss of Data — Improper shutdown of the CASE system, e.g., turning the system off with the mains power switch before all programs are closed, may damage the databases. Note Turn off CASE with the mains power switch only if it will not be used for a prolonged period of time.
Function Keypad Function Keypad The function keypad contains the keys necessary to operate the ergometer/treadmill, to control the exercise test and print reports. 52A Following is a brief explanation of the key functions. For details on conducting an exercise test with the keypad, please refer to section “Before the Test” on page 6-9. Note Press F2 to display a softkey panel at the bottom of exercise test screens. These softkeys can be used to control the exercise test.
Function Keypad Symbol Description Press hold stage to maintain the current stage (automatic stage sequencing is stopped). Press again to turn off stage hold. Press new test to prepare the system for a new patient/a new test. Press comment to enable entry of additional information and values for the user-defined columns of the tabular summary (see “Configuring the Tabular Summary” on page 12-14). Press enter BP to enter the patient's blood pressure.
Function Keypad Symbol Description Press 12SL analysis to initiate a 12SL report (includes measurement report and interpretation - only available during pretest and recovery phases). Press arrhy doc to enable or disable automatic arrhythmia reporting (a one-page arrhythmia report is printed on the thermal writer on occurrence of an arrhythmia). Press speed w+ or w- to increase or decrease the treadmill speed or ergometer workload. Press grade up or down to increase or decrease the treadmill grade.
Desk Light Desk Light The CASE exercise testing system work surface and function keypad are both equipped with lighting. Press the button to turn the lighting on and off. Note The desk light turns off automatically after approximately one hour of keypad inactivity. Preparing the Acquisition Module 29A 1. Attach the lead label stickers to the acquisition module. There is one set of lead label stickers with AHA labeling and one set with IEC labeling. 2.
Preparing the Acquisition Module Caution Proper Leadwire Connection — Improper connection will cause inaccuracies in the ECG. Trace each individual leadwire from its acquisition module label to the colored connector and then to the proper electrode to ensure that it is matched to the correct label location. Note The ECG signal input is isolated and defibrillation-proof only in conjunction with the CAM-14 acquisition module (type BF).
Loading Writer Paper Loading Writer Paper Note A stripe appears on the writer paper when only 20 feet (7 m) of paper are left. 1. Push the release lever to the right to open the paper compartment lid. Caution The lid has a gas spring and opens automatically. 063A 2. Place fanfold paper in the paper storage compartment such that the oblong hole in the paper is at the back the blank side faces toward the roller the first fold is on the left. 064A 3.
Loading Writer Paper 065A 4. Hold the protruding paper sheet with your right hand and close the lid with your left hand: you must hear the lid lock into place. Then the paper will be transported to the next cue hole. 066A 5. The writer is now ready for operation.
Initial Screen Initial Screen A B C D E F G H 06A A New Test - Click to start a new test. B Local Database - Click to display the contents of the local database for selection of a patient and test. C Archived Data - Click to view patient records archived on a CD-ROM. D MUSE Browser - Click to display the MUSE system database. E Operator's Manual - Click to display the Operator's Manual (see “Viewing and Printing the Operator's Manual” on page 2-17).
Viewing and Printing the Operator's Manual labels and icons, or right-click any button to toggle between text labels and icons. Viewing and Printing the Operator's Manual The CASE operator's manual is available on the system. Click Operator's Manual on the initial screen to display the document. The system will load the Acrobat Reader program and display the title page of the operator's manual. Use the controls explained below to navigate through the document.
Software Options Software Options Many features are available as options which can be unlocked to enhance the CASE functionality. Following is a list of these optional features. For details, please contact your Sales Representative.
Software Options 2DWF (2D Waterfall Display) waterfall display during exercise tests and in exercise test report BRWS (MUSE Browser) Internet browser for access to the MUSE system RISK (Risk Factors) calculation of coronary heart disease and stroke risk factors Duke Treadmill Score EXPD (Data Export) export of examinations in XML or EXCEL file format EPDF (Report Export as PDF File) export of report as a PDF formatted file (we recommend Acrobat V5.
Software Options 15-lead exercise test ECGH (ECG History) display of the median beats from up to 5 selected resting ECGs for comparison or printout 3D presentation of the median beat for serial comparison XEMR (EMR Interface) software package for communication with the EMR interface DICM (DICOM Interface) software package for communication with the DICOM interface STHY (ST/HT Hysteresis) 4 more exercise stress test values (ST/HR hysteresis, HR recovery, HR reserve used, FVE recovery)
3 Revision C Preparing the Patient CASE 2060290-201 3-1
For your notes 3-2 CASE 2060290-201 Revision C
Applying Electrodes - The Basics Applying Electrodes - The Basics Careful application of the electrodes is a prerequisite for obtaining a noise-free ECG. In exercise testing, careful preparation of the patient's skin is a must (see “Preparing the Patient's Skin” on page 3-4). For resting ECGs, use GE Healthcare’s electrode application system. Use only the GE Healthcare-recommended electrodes and contact agents.
Preparing the Patient's Skin Preparing the Patient's Skin 31A 1. Shave any hair from each electrode site and degrease each site with alcohol. 2. Remove the epidermal skin layer at each site. Use an abrasive pad or skin prep cream (for example, EPICONT, Part no. 217 083 12). CAUTION Skin Lesions — Do not rub the skin vigorously to avoid inflammation or bleeding.
Applying Electrodes Applying Electrodes Lead Labels on the Acquisition Module CAM-14 AHA Label IEC Label RL N RA R LA L LL F V1 C1 V2 C2 V3 C3 V4 C4 V5 C5 V6 C6 A1 A1 A2 A2 A3 A3 A4 A4 CAUTION Proper Leadwire Connection — Improper connection will cause inaccuracies in the ECG. Trace each individual leadwire from its acquisition module label to the colored connector and then to the proper electrode to ensure that it is matched to the correct label location.
Applying Electrodes Standard 12 Lead Electrode Placement 32A AHA Label 3-6 IEC Label Electrode Placement A V1 red C1 red Fourth intercostal space at the right sternal border. B V2 yellow C2 yellow Fourth intercostal space at the left sternal border. C V3 green C3 green Midway between sites B and D. D V4 blue C4 brown Mid-clavicular line in the fifth intercostal space. E V5 orange C5 black Anterior axillary line on the same horizontal level as D.
Applying Electrodes Standard 15 Lead Electrode Placement Standard leads + right, recommended for pediatric ECGs. 33A AHA Label Electrode Placement A V1 red C1 red Fourth intercostal space at the right sternal border. B V2 yellow C2 yellow Fourth intercostal space at the left sternal border. C V3 green C3 green Midway between sites B and D. D V4 blue C4 brown Mid-clavicular line in the fifth intercostal space.
Applying Electrodes MASON-LIKAR Lead Electrode Placement (Modified Standard Leads for Exercise Tests) 34A AHA Label IEC Label Electrode Placement A V1 red C1 red Fourth intercostal space at the right sternal border. B V2 yellow C2 yellow Fourth intercostal space at the left sternal border. C V3 green C3 green Midway between sites B and D. D V4 blue C4 brown Mid-clavicular line in the fifth intercostal space. E V5 orange C5 black Anterior axillary line on the same horizontal level as D.
Applying Electrodes FRANK X, Y, Z Lead Electrode Placement To record the orthogonal FRANK leads X, Y, and Z, apply electrodes G (A3), B (A2), J (A4) and I (A1) in addition to the standard lead electrodes. 35A AHA Label A H LA black RA white B/A2 E orange Revision C IEC Label Electrode Placement L yellow R red Below the clavicle. E light blue Sternum at the level of C and D. C V4 blue C4 brown Mid-clavicular line in the fifth intercostal space.
Applying Electrodes NEHB Lead Electrode Placement For acquisition of the NEHB leads electrodes A/A1 and B/A2 must be applied in addition to the standard lead electrodes (C equals V4/C4). 36A AHA Label IEC Label Electrode Placement A/A1 A1 orange Nst white Attachment point of 2nd rib to right sternal edge. B/A2 A2 orange Nax white Fifth intercostal space on the left posterior axillary line. (Same position as V7/C7.) Nap white (C4) Mid-clavicular line in the fifth intercostal space.
Applying Electrodes CM5, CC5, ML (CML) Auxiliary Lead Electrode Placement In addition to the standard electrodes, apply one electrode on the sternum (A1) and one in location V5R/C5R (A2). 37A Electrode Revision C Electrode Placement A1 (Nst) Mid-sternum at the second intercostal space. A2 (Nax) In the fifth intercostal space in the right, anterior axillary line (V5F/ C5R).
Applying Electrodes CM5, CC5, CH (CMH) Auxiliary Lead Electrode Placement In addition to the standard electrodes, apply one electrode on the sternum (A1), one in location V5R/C5R (A2) and one on the neck (A3). 38A Electrode 3-12 Electrode Placement A1 Mid-sternum at the second intercostal space. A2 In the fifth intercostal space in the right, anterior axillary line (V5F/ C5R). A3 On either side of the neck or anywhere above the shoulders.
Attaching the Acquisition Module Attaching the Acquisition Module 47A Attach the acquisition module to the patient as shown above. Open the buckle to loosen the belt. Note The functions of buttons 1 and 2 on the acquisition module vary with the test performed: Resting ECG: Button 1: initiates ECG analysis Button 2: initiates a rhythm report Button 3: stops the writer Exercise Test: For exercise tests, different tasks can be assigned to the buttons (see “Miscellaneous 1 Tab” on page 12-24).
Attaching the Acquisition Module For your notes 3-14 CASE 2060290-201 Revision C
4 Revision C Selecting a Patient Record and Test Type CASE 2060290-201 4-1
For your notes 4-2 CASE 2060290-201 Revision C
Selecting a Patient Record from the Local Database Selecting a Patient Record from the Local Database Overview A B C D E F G H I 048A J Note Before running a new test, you are required to select a patient record from the database or to enter a new patient. Depending on the system configuration you will be working with the local database of the system or with the database of the MUSE system.
Selecting a Patient Record from the Local Database Selecting a Patient Record 5 1 2 4 3 048A 1. Enter the patient's last name or the patient ID to find a particular patient. It is sufficient to enter the first letters or numbers. 2. Select the test type. 3. Check the patient information. If it needs to be modified: a. Type over the current data and b. click Accept. 4. Follow these steps to start a test with the selected patient: a. Click New Test or b. press Enter. 5.
Retrieving a Patient Record from the MUSE System Database Retrieving a Patient Record from the MUSE System Database When you click New Test on the initial screen, the patient selection window will appear. Patient record and test type are basically selected in the same way as from the local database (see previous page). The patient selection window has one additional button: Order List (see next page). Note Revision C This is an optional feature.
Retrieving a Patient Record from the MUSE System Database Orders from the MUSE System The Order List button allows you to view a list of orders for the previously selected patient. If a patient was not selected, you will see the requested orders for all patients. A B C D E F 159A G 4-6 A Requested orders. B Your location number. C The list only shows orders for your location The list shows orders for all locations .
Entering a New Patient Entering a New Patient 048A 2 3 45 9 6 7 10 1 8 1. Click New Patient. 2. Enter the patient’s Last Name. Press the Tab key after each entry to move to the next text box. 3. Enter the patient’s first name 4. Enter the Patient ID. a. To do so, either use the keyboard or b. instruct the system to generate a random number (select the dice with the Tab key and press the spacebar). 5. Enter the date of birth, height and weight. 6.
Patient Records of External Programs Patient Records of External Programs The system only supports the GE Healthcare Holter ECG program MARS PC as well as ndd’s external spirometry test program EasyWare. Note GE Healthcare is not in a position to guarantee full compatibility of external programs with CASE. In conjunction with external programs, the patient record is always maintained in CASE while the external program handles the test data.
5 Revision C Resting ECG CASE 2060290-201 5-1
For your notes 5-2 CASE 2060290-201 Revision C
Entering Test Information Entering Test Information Overview Depending on your system configuration, the Test Information window will open automatically or you can display it with the Test Information button. These are the tabs of the menu Patient Information Test/Personnel Medications Closing a tab with Cancel or OK will bring up the acquisition screen. Patient Information Tab 1 2 051A-R 4 3 The Patient Information tab is open. 1. Verify the patient's name and ID.
Entering Test Information Test/Personnel Tab 1 2 3 5 4 6 7 052A-R 1. Click the Test/Personnel tab. 2. Type the relevant information in the Medical History field. 3. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 4. Type the physicians' and technician's names or select them from the list boxes. 5. Type any Comment about the test. 6. Answer the Extra Questions. 7. Enter an Order Number.
Entering Test Information Medications Tab 2 1 3 053A-R 1. Click the Medications tab. 2. Enter or choose a maximum of 5 medications. 3. Enter the medication dose. Note You can assign drugs to specific medication groups (see section “Editing Medication Groups, Assigning Drug Names” on page 12-6). Note Entering a medication will influence the analysis with the HEART ECG analysis program.
Recording a Resting ECG Recording a Resting ECG Overview In the upper part of the screen you see the lead check information for verification of the ECG signal quality. All 12 or 15 leads are shown. The schematic lead check torso allows you to verify the applied electrodes. The actual waveform data appears in the area below. With this modality you can acquire a 10-second resting ECG with subsequent analysis and/or you can record the full disclosure ECG for a period of up to 60 minutes.
Recording a Resting ECG E Click to start acquisition of the full disclosure ECG. F Click to terminate acquisition of the full disclosure ECG and/or to end the test and display the report. G Click to load system setups stored for different system users (see section “Custom Setups, Factory Setup” on page 12-38). H Click to display the resting ECG setup menu (see section “Resting ECG Setup” on page 12-3). I Click to return to the initial screen.
Recording a Resting ECG Operating Steps 1 2 054A-R 1. Enter the Test Information or verify the data. 2. Click ECG Acquisition to initiate acquisition and analysis of the 10second ECG. Note When you select ECG Acquisition before the system had time to save 10 seconds of ECG data, a bar graph will inform you of the ongoing storage process. The analyzed 10-second ECG appears at the top of the screen. A new tab provides the corresponding interpretation.
Recording a Resting ECG 4 5 3 6 7 055A-R 3. Check the 10-second ECG and data. 4. Select a different screen format, if necessary. 5. Display the Interpretation and check the system evaluation and ECG measurement results. 6. If necessary, repeat the procedure with ECG Acquisition. 7. If you do not wish to record the ECG for a prolonged period of time (see next page), click Stop FD/Post Test Review to terminate signal acquisition.
Recording a Resting ECG Full Disclosure ECG You can acquire the full disclosure ECG over a maximum period of 60 minutes. Operating Steps 2a 2b 1 3 056A-R 2d 2c 1. Click Start Full Disclosure ECG to initiate ECG storage. 2. While the full disclosure ECG is acquired: a. You can make an ECG recording (Rhythm Writer, Stop Writer). b. You can click Event Marker Full Disclosure to enter event marks (vertical line). c. The most recent arrhythmia is always displayed. d.
Post Test Review Post Test Review Test Summary A B C D E F G H I J K L M 057A-R Revision C A Click a tab to display the corresponding window. B Patient Information area. C Test Information area. D Measurement Results area. E Interpretation area. F Click to display patient list for a new test. G Click to display a list with more tests of the current patient (local database). H Click to display a list with more tests of the current patient (MUSE database system).
Post Test Review M Click to return to the initial screen. The Modify... buttons allow you to edit or complete the data in the respective areas. Patient Information: The Patient Information window opens. Test Information: The Test Information window opens. Measurement Results: A window opens where you can edit the measurement results. Edited measurement results are identified with the * symbol. In the same window you can select and deselect the View system evaluation feature.
Post Test Review ECG Traces On this screen you see the reference ECG. Depending on the selected screen format and speed, the waveforms may take up several screens. A B C E F D 058A-R Revision C A Click to select the screen format: With you scroll through the formats, with you open the list. Format 1 x 10s I ... aVF displays 10 seconds of the first group of 6 standard leads, format 1 x 10s V1 ... V6 displays the second group of 6 standard leads.
Post Test Review Zoom Mode A zoom factor from 2 to 12 can be selected and the selected segment can be displayed in all leads. A B C D E F 059A-R 5-14 A Click to select the lead: With you scroll through the leads, with you open the list. B Click icon to terminate the zoom function. C Click to select the zoom factor. D Click icon to print the segment. E Click icon to copy the segment to the Clipboard. F Cursor position in mV.
Post Test Review Measuring the ECG Amplitudes (mV), intervals (ms) and slopes (mV/s) can be measured on all ECG waveforms. 1 3 2 1 2 3 510A-R 1. Position the cursor on the first measurement point and click. A caliper appears. 2. Position the cursor on the second measurement point and click. Now you will see the second caliper the measuring line and the measurement results 3. Click the right mouse button to remove measurement points.
Post Test Review Medians This screen shows the median complexes of all leads as well as the measurement marks that formed the basis for analysis. You are free to perform additional measurements, if needed. A B C D E 511A-R 5-16 A Click button for a reanalysis (with the HEART ECG analysis program only, see next page). B Click button to display the tabular summary. C Click to select the gain (amplitude). D Click to select the speed. E Click icon to copy the waveform area to the Clipboard.
Post Test Review Reanalysis Reanalysis allows you to manually change the position of the ST measurement marks. The reanalysis can only be performed on ECGs analyzed with the HEART program (see section “Miscellaneous Tab” on page 12-8). On the reanalysis screen the medians of all leads are superimposed. The currently selected lead is highlighted. The measurement marks determined by the program are shown below the ECG baseline. The measurement marks above the baseline can be edited.
Post Test Review G Measurement mark. H Menu for selection of the leads to be displayed. I Table showing time intervals and position of the cursor in mV. Performing Reanalysis 1. Click the measurement mark and hold the mouse button depressed. 2. Move the measurement mark to its new position and release the mouse button. 3. Adjust the other marks in the same way. 4. Click ECG Analysis. 5. Click Reset and ECG Analysis if you wish to restore the previous analysis results.
Post Test Review Adjusting the T-offset Mark 1. Select the check box. The medians of all leads, except the selected lead, disappear. 2. Holding the mouse button depressed, move the T-offset mark to the correct position. 3. Click icon to select the leads whose T-offset marks you also wish to adjust. Adjusting the T-offset mark on this screen (page 5-19) does not affect the position of the T-offset mark on the previous screen (page 5-17).
Post Test Review Arrhythmia Review This screen shows one lead of the reference ECG at a time. A bar diagram below the signal trace indicates, for each individual QRS complex, the deviation of the RR interval from the mean RR interval. Furthermore, you can determine the HR over a selectable ECG segment. A B C D E 514A-R 5-20 A Click to select the lead: With you scroll through the leads, with you open the list.
Post Test Review Determining the Heart Rate In a normal ECG: 1. Click on a point of the ECG to mark the beginning of the interval to be measured. A marker appears. 2. Click on the end of the interval. A line appears connecting the two end points and the corresponding heart rate is displayed. 3. Click the right mouse button to remove the markers and data. In the presence of atrial fibrillation or flutter: In this situation you will have to define a cardiac cycle yourself. 1.
Post Test Review Vector Loops This screen shows the median complexes of the orthogonal FRANK leads X, Y and Z as well as the vector loops in three planes. A B C 515A-R 5-22 A Click to adjust the gain. B Median complex. C Click torso to toggle between right and left sagittal planes.
Post Test Review Full Disclosure ECG On this screen you see one lead of the full disclosure ECG. The events identified by the rhythm analysis algorithm are color-coded. On the display you will also see when filter or cubic spline were enabled or disabled, e.g. in the form of Spline OFF = Spline -, Spline ON = Spline +. A B C D E F G H I J 516A-R Revision C A Click to select the lead. B Information about filters, etc. C Click to open a list showing all identified arrhythmias.
Post Test Review Printing the Full Disclosure ECG You can either print the entire full disclosure ECG or a selected segment. Selecting an ECG Segment 1. Click to mark the beginning of the segment. A flag appears. 2. Click again to mark the end of the segment. A second flag appears. Printing 1. Click the printer icon. The print setup window opens. 6 2 3 4 8 7 5 517A-R 2. Select the paper speed. 3. Click the Format-1 option button, if you wish to print only one lead. 4. Select the lead. 5.
Post Test Review Analyzing Full Disclosure ECG Segments, Save as Resting ECGs You can select a segment in the full disclosure ECG and save this segment as an additional resting ECG in the procedure list. 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. 3. Click scale. : 10 s of the selected segment will be displayed at a larger 4. Confirm the displayed question with "Yes" to save the segment in the box as a separate resting ECG.
Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Final Report Tab” on page 12-9 for details on changing the setup permanently. 2 1 4 3 1 5 2 6 9 8 7 518A-R 1.
Post Test Review Generating the Interpretation Click Interpretation/Modify to open the window. In the left part of the window you see a number of folders with standard interpretation texts. With the Acronyms... button you can open an acronym window. The actual interpretation is generated in the right part of the window. The system generated evaluation is already shown.
Post Test Review Copying Diagnostic Statements Using Acronyms 1. Click Acronyms... to open the window. 2. Type the acronym. 3. Click Insert>> to copy the corresponding full text to the Interpretation. Note As an alternative you can double-click a text to copy it from left to right. 4. Select the check box if you wish to copy each text to a new line. Note Interpretative statements transferred to MUSE that are part of the acronym list will be replaced with the appropriate acronyms.
Post Test Review Comparing Resting ECGs You can compare the following details of two resting ECGs: the 10-second ECG the median complexes and the interpretation It is also possible to compare the medians of at least 3 and up to 6 ECGs. Comparing Two Resting ECGs The system offers two alternatives: you can compare the present ECG with an earlier recording or you can retrieve a stored examination, as described in section “Selecting Patient Records” on page 9-4, and compare it with a second ECG.
Post Test Review 10-Second ECG A B C D E F G 519A-R 5-30 A Click to select the lead: With you scroll through the leads, with you open the list. B Click tabs to compare the Medians and the Interpretation. C Acquisition date and time. D Click icon to activate the zoom function. E Click icon to copy the waveform area to the Clipboard. F Procedure 1. G Procedure 2.
Post Test Review Zoom Mode – Follow these steps to enable the zoom mode: 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. Identical segments of the two procedures are superimposed. With the scroll boxes you can shift the segment of procedure 2 horizontally and vertically. A B 520A-R Revision C A Click scroll box to move the segment of procedure 2 to the right and left. B Click scroll box to move the segment of procedure 2 up and down.
Post Test Review Medians Click the Medians tab to display the screen for comparison of the two median complexes. The scroll boxes also allow you to move the median of procedure 2 up and down and to the right and left. Interpretation Click the Interpretation tab to display the screen for comparison of the two interpretations.
Post Test Review Comparing Median Complexes from Multiple Resting ECGs It is possible to compare the medians of at least 3 and up to 6 ECGs. Note Software option ECGH is required for use of this functionality. 1. Click Compare. A window opens listing all the patient's resting ECGs. 2. Holding the Shift key down, select the procedures. 3. Click OK to clear the window. The comparison screen with the medians of the selected procedures appears. A B C D E F 522A-R Revision C A Acquisition date.
Post Test Review Zoom Mode Follow these steps to enable the zoom mode: 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. The selected median is displayed at a larger scale. A B C D E 523A-R 5-34 A Acquisition date. B Click to select the lead. C Click icon to terminate the zoom function. D Click icon to print the median. E Click button to display the 3D graph.
Post Test Review 3D Graph Click the 3D graph button to display a three-dimensional representation of the medians from all selected procedures. The scroll boxes allow you to rotate the illustration horizontally and vertically. A B C D E 524A-R Revision C A Click to select the lead. B Click icon to terminate the zoom function. C Click icon to print the illustration. D Click to select the color.
Post Test Review For your notes 5-36 CASE 2060290-201 Revision C
6 Revision C Exercise Test CASE 2060290-201 6-1
For your notes 6-2 CASE 2060290-201 Revision C
Patient Education Patient Education Before the test you should give your patient some information about what will happen in the course of the test. Click the Patient Education button on the pre-acquisition screen to display a description of what the patient can expect to happen before, during, and after the exercise test.
Entering Test Information Entering Test Information Overview Depending on your system configuration, the Test Information window will open automatically or you can display it with the Test Information button. These are the tabs of the menu Patient Information Test/Personnel Medications AHA Stroke Risk AHA CHD Risk Closing a tab with Cancel or OK will bring up the acquisition screen. Patient Information Tab 1 2 3 4 7 5 051A-S 6 The Patient Information tab is open. 1.
Entering Test Information “MUSE Tab” on page 12-55). 7. Enable or disable TWA analysis. Note The Patient Information can be assigned to the patient file or only to the pending test. Note Before initiating TWA analysis check that all TWA settings are correct (see “TWA Tab” on page 12-30) and that the electrodes are properly applied according to the instructions given in chapter “Preparing the Patient” on page 3-1.
Entering Test Information Test/Personnel Tab 1 2 3 4 6 5 7 8 052A-S 1. Click the Test/Personnel tab. 2. Type the relevant information in the Medical History field. 3. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 4. Select the Test Type. 5. Type the physicians' and technician's names or select them from the list boxes. 6. Type any comment about the test. 7. Answer the Extra Questions. 8. Enter an Order Number.
Entering Test Information Medications Tab 2 1 3 053A-S 1. Click the Medications tab. 2. Enter or choose a maximum of 10 medications. 3. Enter the medication dose. Note You can edit the libraries (see section “Editing the Comments, Test Types, Reason for Test, Reasons for Termination, Medications Library” on page 12-26). Calculating Patient Risk To calculate the patient's risk for stroke and CHD you must enter the patient's age and gender.
Entering Test Information The system automates the manual calculation of risk. You can edit the values calculated by the system. Edited values are marked with an asteriks *. 2 1 2 3 3 4 94A 2 2 1 3 4 95A 1. Click the AHA Stroke Risk or the AHA CHD Risk tab. 2. Enter the factors that influence both coronary AND stroke risks. 3. Enter the factors that influence stroke OR coronary risk. 4. Click Stroke Risk or Coronary Heart Disease Risk.
Before the Test Before the Test Pre-Acquisition Screen Overview In the upper part of the screen you see the lead check information for verification of the ECG signal quality. All 12 or 15 leads are shown. The schematic lead check torso allows you to verify the applied electrodes. The actual waveform data appears in the area below. A B C D E F G H I J K 056A-S U Revision C T S R Q P O N M L A Tabs showing the different ECG analysis data.
Before the Test E Click to select previous tests of the current patient. F Click to display Patient Education. G Click to select an exercise test protocol. A new protocol will become effective in the next phase. H Click to relearn the median complex. With Relearn Medians you can also restart the learn phase when not all electrodes are applied. I Click to load system setups stored for different system users. J Click to edit the exercise test setup. K Click to return to the initial screen.
Before the Test Note Pacemaker Patients — It is very important that you indicate on the first database screen, pictured below, whether your patient has a PACEMAKER implanted. A check indicates that the patient DOES have a pacemaker.
Before the Test Operating Steps 1. Check the applied electrodes and verify the signal quality in all leads. ST measurements and arrhythmia analysis will automatically be displayed when all necessary electrodes have been applied and signals of adequate quality are obtained (e.g. without major baseline fluctuations). If all electrodes are not being used, click Relearn Medians to manually activate ST measurement and arrhythmia analysis. 2.
During the Test During the Test Acquisition Screen Overview A B C D E F G H 57A-S I Note The acquisition screen has the same type of information in the pretest, exercise and recovery phases. A ST/Arrhy window (see section “ST/Arrhy Window” on page 6-18 for details). B Tabs to display windows with ECG test data (see “ST/Arrhy Window” on page 6-18 to “Interpretation Window” on page 6-26 for details). C Revision C Button to mark and save ECG events (see section “Arrhythmia Review” on page 6-45).
During the Test F Selected protocol, exercise clock - starts with the exercise phase and indicates its duration. G Current phase, phase clock - each new phase (pretest, exercise, recovery) resets the clock to zero. H Current stage, stage clock - restarts with each new stage. I Treadmill: belt speed and grade bicycle ergometer: pedal speed (RPM) and load METS (metabolic equivalents) see “METS Formula (Metabolic Equivalents)” on page 6-22 RPP (Rate Pressure Product).
During the Test Pretest Phase Overview The pretest phase might consist of stages configured in each protocol. Commonly used stages are: Supine Standing Hyperventilation Warm-up Blood pressure measurements can be taken manually or automatically as configured in the Protocol Editor. When manual entry is configured, the window for entry of BP values will appear automatically (see section “Protocol Editor Tab” on page 12-19).
During the Test Exercise Phase Overview The selected protocol will control the treadmill or bicycle ergometer. When you enter the exercise phase: the belt speed and grade or the bicycle load will change according to the selected protocol the exercise clock will start (phase and stage clocks restart at zero), and the system will start saving test data. This data can be viewed on the tabs at the top of the screen (see “ST/Arrhy Window” on page 6-18 to “Interpretation Window” on page 6-26).
During the Test Manual Control comment enter BP Press to enter comments to appear in the Tabular Summary. Press to enter BP readings. 12 lead Press to start an ECG recording (12 leads, 5 seconds from memory, 5 seconds of real-time data). recall Press to print a 10-second delayed recall report on the thermal writer. rhythm Press to start a continuous rhythm report on the thermal writer. stop writer Press to stop the writer or printer. medians Press to print a medians report.
During the Test ECG Data Windows ST/Arrhy Window The ST/Arrhy window displays the median complex (left) and the current arrhythmias (right). As soon as the exercise phase begins, the current median complex is superimposed on the baseline complex and both measurements are displayed. The system chooses the two leads with the greatest amplitude for arrhythmia analysis (click E to select another lead). The system starts saving arrhythmias at the beginning of the pretest (20 arrhythmias max.
During the Test Editor (see section “Protocol Editor Tab” on page 12-19). A B C 59A-S E D A Click the tab to display the Medians window. B Click option button to select different lead groups (see “Screen Tab” on page 1213 for information on how to assign the leads to the groups). C Click Superimposition to display the median complexes of the selected group superimposed (click again to restore normal presentation). D Display other median complexes.
During the Test Waterfall Window This window displays a graphic color representation of the median beat changes in the course of the test (updated at 30 second intervals). Click anywhere in the waterfall to display the median complex and measurement of the corresponding point in time (associated phase, stage, HR, BP, and METS appear at the right). A B D C E 60A-S 6-20 A Click the tab to display the Waterfall window. B Click the lead label to change the displayed leads.
During the Test Tabular Summary Window The Tabular Summary window displays test data in two tabular formats: stage format: 1 line per stage, or detailed format: 1 line minimum per 30 seconds The Tabular Summary can be configured. See “Configuring the Tabular Summary” on page 12-14 for details. Use the detailed format to enter or edit data. 1. Click the value to change. 2. Enter the new value. Edited values are bold. To enter new data: 1. Click in an empty field. 2. Enter the new value.
During the Test METS Formula (Metabolic Equivalents) Treadmill (speed x 26.8 x 0.1) + (grade/100 x 1.8 x speed x 26.8) + 3.5 METS = 3.5 speed = miles per hour grade = percent (speed x 0.1) + (grade/100 x 1.8 x speed) + 3.5 METS = 3.5 speed = meters per minute grade = percent Bicycle Ergometer METS = 12.3 x load + 3.5 x weight weight x 3.5 load = Watt weight = kg Between two stages, the METS value will be interpolated.
During the Test Trends Window The Trends window displays graphic trends of different parameters. The trends are updated in 30 second intervals. A B C 62A-S A Click the tab to display the Trends window. B Click an option button to display other trend formats. Click Custom to display user configured trends. Click ST Level/Slope to display the trend of ST level and slope versus time.
During the Test ECG Strips Window The ECG Strips window displays 10-second ECG strips stored during the last 10 seconds of each stage acquired manually, or acquired automatically as configured (see section “Protocol Editor Screen” on page 12-20). A B C 63A-S A Click the tab to display the ECG Strips window. B Click to display the other ECG strips. backward forward C 6-24 Test data of the ECG strip.
During the Test 12SL Window The 12SL window displays the 12SL resting ECG measurements and interpretation acquired by pressing 12SL during preacquisition, pretest and recovery. B A C 64A-S D E F 65A-S A Click the tab to display the 12SL window. B Click button to display the interpretation. C Click to select the recording. D 12SL measurements and interpretation. E Click to clear the Interpretation window. F Click arrows to display sections currently out of view.
During the Test Interpretation Window The Interpretation window allows the physician to enter an interpretation of the test. A B 66A-S D C C E F 67A-S H 6-26 G A Click the tab to display the Interpretation window. B Click to enter or edit the interpretation. C Enter or select summary statements for the different interpretation categories and for the Overall Impression. D Click to enter the Conclusion. E Click to confirm the test results. F Click to clear the window.
During the Test Comparing Previous Test Data At any point in the test you can compare the current data with that of a previous test: 1. Click Previous Tests Current Patient. 2. Double-click the test to review: Page 1 of the median complexes will appear in the lower part of the screen for reference. A B C D E F G 68A-S A Details of the displayed median complexes. B Click tabs to view other ECG data windows. C Click Close to clear the second test window. D Click to view more median complexes.
Recovery Phase Recovery Phase Overview Press the recovery button to advance to the recovery phase. The clock begins timing the recovery phase. In recovery, the treadmill speed and grade or the bicycle load will change according to the protocol configuration.
Test End Phase Test End Phase Overview 1. Press the test end button to end the test and start the test end phase. 2. Click Yes to confirm the test end. The Interpretation window appears with the patient's ECG waveforms below. Note After you press the test end button, the following happens: 4 1 The system no longer acquires and stores ECG measurement data. The clocks stop. Workload, speed, and grade no longer display. 3 5 3 2 6 7 67A-S Operating Steps 1.
Test End Phase 69A-S Note Real-time reports can be printed with the following buttons on the function keypad: 12 lead medians rhythm recall (data is not saved). 8. Click the test end menu tabs to review and edit the data. 9. Click Print or press test end to print the final report (see “Report Printout” on page 6-56). 10. Click Post Test Review to review the stored test information. This will end the display of the patient ECG waveforms.
After the Test — Post Test Review After the Test — Post Test Review Test Summary Overview A B C D E F G H I J K L 70A-S Revision C A Click a tab to display the corresponding window. B Patient Information area. C Test Information area. D Measurement Results area: area for exercise measurements and machine “Exercise Test Interpretation (XTI)”. E Interpretation area: area for the physician’s interpretation. F Click to display patient list for a new test.
After the Test — Post Test Review J Click to display the interpretation window where a detailed interpretation of the test can be generated. K Click to activate the online Help program. L Click to return to the initial screen. The Modify... buttons allow you to edit or complete the data in the respective areas. Patient Information: The Patient Information window opens. Test Information: The Test Information window opens.
After the Test — Post Test Review Tabular Summary The Tabular Summary window displays test data in three tabular formats: stage format: 1 line per stage, or detailed format: 1 line minimum per 30 seconds all entries The Tabular Summary can be configured. See “Configuring the Tabular Summary” on page 12-14 for details. Use Detail or All entries to enter or edit data. 1. Click the value to change. 2. Enter the new value. Edited values are bold. To enter new data: 1. Click in an empty field. 2.
After the Test — Post Test Review value, can be changed, see section “Miscellaneous 1 Tab” on page 12-24).
After the Test — Post Test Review Graphic Trends Overview A B C D E F 72A-S A Click to display the graphic trends. B Click to display other leads of the trends (not available on all screens). backward forward C Click icon to display the trend configuration window. D Click to jump to a separate full disclosure ECG window. E Click an option button to display other trend formats. Click Custom to display user configured trends.
After the Test — Post Test Review Viewing the Full Disclosure ECG By selecting the Full disclosure option on the trend screen, you can view the full disclosure ECG. The operating controls in the full disclosure window are explained in section “Full Disclosure ECG” on page 6-47.
After the Test — Post Test Review Viewing Medians, Replacing max. ST Changes 1. Locate the ST value in the trend graph of interest and click: a new window with the corresponding median complex will open. 2. Click on the ST value in the median complex window: a new window with the new and old ST values appears. 3. Click Yes and the ST value will be changed.
After the Test — Post Test Review Viewing TWA Medians, Replacing max. TWA Values 1. Locate the TWA value in the trend graph of interest and click. 2. A new window with the corresponding median complexes will open. 3. Click on the TWA value in the median complex window: a new window with the new and old TWA values appears. 4. Click Yes and the TWA value will be changed.
After the Test — Post Test Review Sample Cardiac Cycles Overview This screen shows the median complexes collected at each stage, beginning with the pretest phase. A B C D E F G H I J 73A-S Note Reanalyze the sample cardiac cycles as described under “Reanalysis” on page 6-41. Revision C A Click the lead label to change the displayed leads. B Click to display the Sample Cardiac Cycles. C Click to view more sample cardiac cycles. D Click to show and hide the measurement marks.
After the Test — Post Test Review 6-40 I Click icon to activate the zoom and reanalysis function (see next page). J Click Reset to original to discard the results of the reanalysis and return to the original measurements.
After the Test — Post Test Review Reanalysis Reanalysis allows you to manually change the position of the ST measurement marks. On the reanalysis screen the medians of all leads are superimposed. The currently selected lead is highlighted. The measurement marks determined by the system are indicated. The marks above the baseline can be edited.
After the Test — Post Test Review Performing Reanalysis 1. Click a measurement mark above the baseline and hold the mouse button depressed. 2. Move the mark to its new position and release the mouse button. 3. Adjust the other marks in the same way. 4. Select the complexes to reanalyze. 5. Click the Reanalyze button. 6. Click ...Reset and Reanalyze... to restore the original analysis results. (Reset to original restores the original results for all complexes of the entire exercise test).
After the Test — Post Test Review Sample TWA Cycles Overview This screen shows the Sample TWA Cycles. Questionable values are identified with a question mark ?. Two-headed arrows identify the position where the TWA value was determined. Individual leads can be excluded. You may then repeat the analysis without these leads. This method prevents false-positive TWA values, particularly when permanently disturbed leads are excluded. A B C D E F G H Revision C A Click to view more sample TWA cycles.
After the Test — Post Test Review ECG Strips This screen displays 10-second ECG strips G stored during the last 10 seconds of each stage acquired manually, or acquired automatically as configured in the Protocol Editor. A C D B E F G H 75A-S A Details of the selected ECG strip. B Click to display the ECG Strips window. C Click icon to delete the displayed ECG strip. D Click to change the gain. E Click to change the speed. F Click icon to print the displayed ECG strip.
After the Test — Post Test Review Arrhythmia Review The system will save a 10-second ECG strip each time an arrhythmia occurs and when the Event Marker Full Disclosure button is clicked on the acquisition screen (to a maximum of 20). When the event memory is full, the strips will be overwritten according to preset priorities. A H B C A B C E D D E F G F H I G H 76A-S A Click to view other Arrhythmia Review leads. B Details of the displayed Arrhythmia Review strips.
After the Test — Post Test Review Arrhythmias (descending priority) - patient's learned typical QRS complex QRSL ASYSTO - asystole1, limit value 3 s - ventricular fibrillation/flutter1 VFIB - ventricular tachycardia 1 VTAC - ventricular run (minimum of 3 consecutive PVCs)1 RUN - ventricular couplet (2 consecutive PVCs)1 CPLT - atrial fibrillation AFIB - pause of 2 missed beats2 PAU2 - pause of 1 missed beat2 PAU1 - ventricular bigeminy VBIG - paroxysmal supraventricular tachycardia PSVT
After the Test — Post Test Review Full Disclosure ECG Overview The system will save the full disclosure ECG only if configured (see section “Miscellaneous 1 Tab” on page 12-24). On this screen you see one lead of the full disclosure ECG. The events identified by the rhythm analysis algorithm may be color-coded. On the display you will also see when filter or cubic spline were enabled or disabled, e.g. in the form of FRF off = FRF-, Spline ON = Spline +.
After the Test — Post Test Review 6-48 I Click icon to activate the zoom function. J Click icon to print the entire full disclosure ECG or selected segments. K Click icon to go to the trend display. L Click icon to delete the full disclosure ECG. M Select the number of waveforms viewed. N Click to show and hide the arrhythmia strip markers (beginning/end). O Select or deselect the arrhythmia color coding.
After the Test — Post Test Review Printing the Full Disclosure ECG You can either print the entire full disclosure ECG or a selected segment. Selecting an ECG Segment 1. Click to mark the beginning of the segment. A flag appears. 2. Click again to mark the end of the segment. A second flag appears. Printing 1. Click the printer icon. The print setup window opens. 6 2 3 4 8 7 5 517A-R 2. Select the paper speed. 3. Click the Format-1 option button, if you wish to print only one lead. 4. Select the lead.
After the Test — Post Test Review Enabling the Zoom Mode 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. An enlarged view of the selected region appears. The operating controls basically remain the same. When you click the printer icon, however, only that page will be printed. A B 78A-S 6-50 A Click icon to print the displayed screen.
After the Test — Post Test Review Audio ECG The audio ECG allows the medical staff to assess the exercise test quickly and easily (playback not possible with CASE systems because CASE does not have the required output media). The ECG is played back at 60 times the original speed, so that you can listen to a 10-minute recording in 10 seconds. Playback of the recording is in stereo: lead V2 is assigned to the left channel, lead V5 to the right channel.
After the Test — Post Test Review Waterfall The Waterfall display is a graphic color representation of the median beat changes in the course of the test (updated at 30 second intervals). Click anywhere in the waterfall to display the median complex and measurement of the corresponding point in time (associated phase, stage, HR, BP, and METS appear at the right). A B C D E F GH 79A-S 6-52 A Click the lead label to change the displayed leads. B Median complex selected in the waterfall.
After the Test — Post Test Review 3D Graph A B C 84A-S Revision C A Click to select another lead. B Click to rotate the display horizontally. C Click to rotate the display vertically.
After the Test — Post Test Review 12SL This screen shows the measurements from the 12SL ECG analysis. A B C DE F 80A-S 6-54 A Analysis results. B Click to change the gain. C Click to change the speed. D Click to display the 12SL Report. E Click to select another 12SL ECG. F Click to view the corresponding Vector Loops (see next page).
After the Test — Post Test Review Vector Loops This screen shows the median complexes of the orthogonal FRANK leads X, Y and Z as well as the vector loops in three planes. A B C D 81A-S A Median complex. B Click torso to toggle between right and left sagittal planes. C Click to change the gain. D Click to return to the 12SL Report window. Note You can perform measurements as described in section “Measuring the ECG” on page 5-15.
After the Test — Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Final Report Tab” on page 12-23 for details on changing the setup permanently. 1 2 3 6 4 1 5 8 7 82A-S 1. Select the documents for the report (Configured Report, Tabular Summary, Graded Exercise Summary Report etc.): In the Trend Reports section, select the report formats to print. 2.
After the Test — Post Test Review Temporary changes to the selections will be lost when you close the window.
Report Formats Report Formats In-Test Reports Format Description 12SL Interpretative resting ECG with analytical statements on morphology, rhythm, and conduction. Measurements of rate, intervals and axes. Available before the test, in pretest and recovery. Formats include: 4 x 2.5; 4 x 2.5 +1, 2 x 5; H2 (5 s ECG at a speed of 50 mm/s x 6) and H1 (6-lead ECG at 12.5 mm/s, Medians at 50 mm/s). 3, 6, 12 or 15-Lead Report Presents raw ECG data in various formats: 4 x 2.5 s ECG; 4 x 2.5 +1 (2.
Report Formats Final Reports Format Description Configured Report User-configured portrait-style final report. User formats narrative text and selects data fields to create report template. Configured Report automatically merges text and data according to templates selected. For details on the Configured Report, refer to section “Report Editor” on page 12-10.
Monitoring of Remote Exercise Test Workstations Monitoring of Remote Exercise Test Workstations The program allows you to monitor an exercise test performed at remote stations from your PC. However, only one station can be viewed by one other station at a time. The data in the vital signs window reflect the settings at the remote station. Conditions for the remote view function: The Remote View function is enabled at the remote station (see section “Miscellaneous 1 Tab” on page 12-24).
Monitoring of Remote Exercise Test Workstations Revision C C Click to return to the initial screen. D Name of the remote station. E Click to change the gain. F Click to change the speed.
Monitoring of Remote Exercise Test Workstations For your notes 6-62 CASE 2060290-201 Revision C
7 Revision C Ambulatory Blood Pressure Measurement CASE 2060290-201 7-1
For your notes 7-2 CASE 2060290-201 Revision C
Ambulatory Blood Pressure Monitors Ambulatory Blood Pressure Monitors The following ambulatory blood pressure monitors can be connected to the system: TONOPORT V: blood pressure only, oscillometric method TONOPORT IVa: blood pressure, oscillometric and auscultatory method, as well as ECG For information on setup and operation of the ambulatory blood pressure monitor, please refer to the TONOPORT Operator's Manual.
Setting Up the Ambulatory Blood Pressure Monitor Setting Up the Ambulatory Blood Pressure Monitor Acquisition Screen A B C D E F G H I 181A-BP 7-4 A Measurement protocol details. B Click to connect the ambulatory blood pressure monitor to the system. C Click to activate the programming mode. If a patient is selected first, TONOPORT V devices of version 2.0 and later will automatically copy that patient’s ID number from the CASE database. D Click to download the stored data to the system.
Setting Up the Ambulatory Blood Pressure Monitor Operating Steps 1. Turn the monitor off and on again. 2. Wait for the time to be displayed, then connect the monitor to the PC. 3. Click Connect. The acquisition screen indicates the memory status of the ambulatory blood pressure monitor. A: Date and time of the monitor. B: Measurement protocol. C: Number of BP measurements and the duration of the protocol. D: Information whether or not data is stored in the monitor.
Setting Up the Ambulatory Blood Pressure Monitor 6. Select the protocol and click Programming. You can choose between two protocols. Refer to section “Editing the BP Protocol” on page 1232 for information on configuring the protocols. Note If you are using TONOPORT V devices, version 2.0 and later, check the displayed patient data to avoid data mismatch. 7. Turn the monitor off and disconnect it from the PC. 8. Connect the monitor to the patient (see TONOPORT Operator's Manual).
Post Test Review Post Test Review Downloading Data 1. Turn the monitor off and on again. 2. Wait for the time to be displayed, then connect the monitor to the PC. 3. Select the patient. Note If the patient ID has been stored in TONOPORT V devices of version 2.0 and later, you are not required to select the patient. Simply click Select and you will see the acquisition screen. Be sure to download the data to the same database from which you read the patient ID. 4. Click Connect. 5. Click Download Data.
Post Test Review Test Summary A B C D E F G H I J K L 183A-BP A Click a tab to display the corresponding window. B Patient Information area. C Test Information area. D Measurement Results (Statistics Summary). E Interpretation. F Click to display patient list for a new test. G Click to display a list with more tests of the current patient (local database). H Click to display a list with more tests of the current patient (MUSE database system).
Post Test Review Patient Information The Patient Information window opens. You can edit or complete the data. Any changes you make will be assigned to this procedure, not to the patient. Note The Patient Information can be assigned to the patient file or only to the pending test. 184A-BP Test Information The Test Information window opens.
Post Test Review Test/Personnel 1 2 4 3 5 6 052A-R 1. Type the relevant information in the Medical History field. 2. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 3. Type the physicians' and technician's names or select them from the list boxes. 4. Type any Comment about the test. 5. Answer the Extra Questions. 6. Enter an Order Number. This number will appear on the printed reports and on the Test Summary.
Post Test Review Medications 1 2 3 053A-R 1. Click the Medications tab. 2. Enter or choose a maximum of 5 medications. 3. Enter the medication dose. Note You can edit the medication library (see section “Editing the Reason for Test, Medication Library” on page 12-36). Measurement Results In this window you can temporarily modify the statistics intervals and the blood pressure limits for this report.
Post Test Review Generating or Editing the Interpretation Click Interpretation or Modify... to open the window. In the left part of the window you see a number of folders with standard interpretation texts. The system supports the creation of an interpretation by providing standard texts which can be copied to the Interpretation area on the right. In the Interpretation area you can edit the texts as needed (enter new text, copy, cut, paste, etc.).
Post Test Review Graphics The Graphics screen shows all BP values acquired over the monitoring period. The blood pressure values are shown at the top, the pulse pressure values (systolic pressure minus diastolic pressure) below. You can show or hide the pulse pressure values (see “Ambulatory Blood Pressure Measurement Setup” on page 12-31). You can choose between display formats 1, 2 and 3. This format can be preset in the System Settings and is saved as a user-specific configuration.
Post Test Review Tabular Summary Note Individual measurements in the Tabular Summary can be suppressed by double-clicking or by clicking with the right mouse button; they can be restored in the same way. Suppressed measurement data are excluded from the statistical analysis.
Post Test Review Hourly Averages The diagram shows the Hourly Averages of all measurements taken during the monitoring period. Click Tabular to view the same values in tabular format.
Post Test Review Statistics Summary The Statistics Summary shows one histogram each for the systolic values (left) and the diastolic values (right) as well as the frequency distribution given as a percentage. The table below indicates the maximum, minimum and mean values as well as the standard deviations. The percentage of readings that exceeded the set limits is shown at the bottom. Similar report pages exist for the day time, the night time and the wakeup time.
Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Miscellaneous Tab” on page 12-33 for details on changing the setup permanently. 2 1 1 3 2 4 5 191A-BP 1.
Post Test Review For your notes 7-18 CASE 2060290-201 Revision C
8 Revision C Spirometry Test CASE 2060290-201 8-1
For your notes 8-2 CASE 2060290-201 Revision C
Sensors Sensors SpiroSoft respiration flow sensor for FVC measurements LF 501 respiration flow sensor for VC and FVC measurements For information on setup and operation of the sensors, refer to the separate operator manuals. Check whether the system is set up for the correct sensor (see section “Devices Tab” on page 12-53) and connect the sensor to the configured port.
Entering Test Information Entering Test Information Overview Depending on your system configuration, the Test Information window will open automatically or you can display it with the Test Information button. These are the tabs of the menu Patient Information Test/Personnel Medications Closing a tab with Cancel or OK will bring up the acquisition screen. Patient Information Tab 1 101A-SP 3 2 The Patient Information tab is open. 1. Verify the patient's name and ID.
Entering Test Information Test/Personnel Tab 1 2 3 5 4 6 7 52A-R 1. Click the Test/Personnel tab. 2. Type the relevant information in the Medical History field. 3. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 4. Type the physicians' and technician's names or select them from the list boxes. 5. Type any Comment about the test. 6. Answer the Extra Questions. 7. Enter an Order Number.
Entering Test Information Medications 2 1 3 53A-R 1. Click the Medications tab. 2. Enter or choose a maximum of 5 medications. 3. Enter the medication dose. Note You can edit the medication library (see section “Editing the Reason for Test, Medication Library” on page 12-36).
Conducting Spirometry Tests Conducting Spirometry Tests Overview We will explain a spirometry test with the SpiroSoft respiration flow sensor. The operating steps for spirometry tests with the LF 501 sensor follow next. The flow-volume loop is recorded in the spirometry test; all diagnostically relevant values for forced inspiration and expiration can be derived from the flow-volume loop (see section “Definition of Spirometry Test Values” on page B-19).
Conducting Spirometry Tests Note A B C For flow-volume measurements, the patient's cooperation is essential. The ambient conditions should be checked every day before performing spirometry tests; the room temperature is the factor with the most impact on the test results (see section “Acquisition Tab” on page 12-35).
Conducting Spirometry Tests I Click to start the test. J Click to start the bronchodilator test. K Click to terminate the test. L Click for the post test review. M Click to load system setups stored for different system users (see section “Custom Setups, Factory Setup” on page 12-38). N Click to display the spirometry setup menu (see section “Spirometry Setup” on page 12-35). O Click to activate the online Help program. P Click to return to the initial screen.
Conducting Spirometry Tests 5. Wait for the status line to turn green. 6. Have the patient close the lips around the mouthpiece and perform the following maneuver through the sensor: a. Exhale completely. b. Slowly inhale completely. c. Exhale as vigorously and for as long as possible (forced expiratory parameters; in the ATS mode, the expiration should last 6 seconds (see information on the ATS mode)). d. Inhale as vigorously and deeply as possible (forced inspiratory parameters). 7.
Conducting Spirometry Tests The flow-volume loop of the current test and of the best test are displayed. The table shows the measuring values (Act.), the reference values and the percentage deviation of the current test. A B C D E F 202A-SP Revision C A Click option button to display the volume-time curve. B FEV1 value. C Click option button to display the Current test, the Best test or the ATS Summary. D System evaluation according to the selected interpretation mode (for Best test only).
Conducting Spirometry Tests Bronchodilator Test The bronchodilator test always consists of two measurements: one before and one after medication. After medication, measure the dilatation as follows: 1. Click Start Bronchodilator Test to start the measurement. 2. The system asks whether the previous measurement is to be the predilation test (Before Bronchodilation test); the question appears only if a spirogram of this patient has been recorded earlier the same day. 3. Answer the question with OK. 4.
Conducting Spirometry Tests FVC Measurement 1. On the acquisition screen click FVC Measure.. 2. Explain the test maneuver to the patient. 3. Check the nose clip. 4. Click Start Test and ask your patient to perform the following maneuver when the orange indicator on the sensor lights up: Revision C Inhale completely through the sensor. Exhale maximally and as quickly as possible, then inhale again completely and as quickly as possible. Then your patient may resume normal breathing.
Post Test Review Post Test Review Test Summary A B C D E F G H I J K L M N 203A-SP 8-14 A Click tab to display the flow-volume loop and tabular data. B Patient Information area. C Test Information area. D Measurement Results area. E Interpretation. F Select G Click to display patient list for a new test. H Click to display a list with more tests of the current patient (local database). I Click to display a list with more tests of the current patient (MUSE database system).
Post Test Review N Click to return to the initial screen. The Modify... buttons allow you to edit or complete the data in the respective areas, as described below: Patient Information The Patient Information window opens. You can only enter or correct data that does not affect the calculation of reference values. 184A-BP Test Information The Test Information window opens (see “Entering Test Information” on page 8-4). Note The Test Information is not assigned to the patient, but to the test data.
Post Test Review Generating or Editing the Interpretation At the end of the test the system evaluation is automatically entered in the interpretation window. Click Interpretation or Modify... to open the window. In the left part of the window you see a number of folders with standard interpretation texts. The system supports the creation of an interpretation by providing standard texts which can be copied to the Interpretation area on the right.
Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Miscellaneous Tab” on page 12-36 for details on changing the setup permanently. 1 3 2 4 5 207A-SP 1. Select the documents to be included in the report Configured Report Standard Page with Flow-Volume Loop, Volume-Time Curve, Measurements Interpretation (appears on the Standard Page) 2.
Post Test Review Comparing Two Spirograms You can compare the present spirogram with another one of the same patient recorded earlier. 1. Click Compare. A window opens listing all the patient's spirograms. 2. Select a test. 3. Click OK to clear the window. A B C 204A-SP 8-18 A Data relating to test 1 (reference test, test selected first). B Click tab to display the flow-volume loops and tabular data. C Data relating to test 2.
Post Test Review Click Spirometry/Compare/FVC Measurement to display the comparison screen with the flow-volume loop. The screen shows the two curves and the percentage deviation from the reference values or the percentage of the reference values attained. A B 209A-SP Revision C A Click option button to display the volume-time curve. B Change the tabular display from % of ref. values to % deviation from ref. values.
Post Test Review For your notes 8-20 CASE 2060290-201 Revision C
9 Revision C File Management CASE 2060290-201 9-1
For your notes 9-2 CASE 2060290-201 Revision C
Overview Overview All patient records are saved to the local database. The patient records can be viewed, edited, printed exported to another storage medium transferred to the MUSE database system or deleted Click Local Database to open the window with the names of all stored patients.
Selecting Patient Records Selecting Patient Records A B C D E F G H I J K L M N O P Q R S 101A 9-4 A Selected patient (only this patient's records are shown). B Click button to update the current list according to the selection criteria. C Click down arrow to open the list box with the option all (i.e., all records stored in the database will be shown). D Enter dates, if you wish to view only the patient records acquired in that time period.
Selecting Patient Records N Click button to save the selected patient record(s) to an external backup device. O Click button to transfer the selected patient record(s) to the MUSE database system. P Click button to send the selected patient record(s) via modem or to save it to another directory. Q Click button to export the selected patient record(s), using file formats PDF, Word, Excel or XML. R Click button to delete the selected patient record(s).
Viewing, Editing, Printing Patient Records Viewing, Editing, Printing Patient Records Click View. The Test Summary will appear first. You can edit the information. Changes are saved automatically to the local database when you exit the screen. To print the displayed patient record, click the Print button. Note You can also display a patient record by double-clicking. When working in a network environment, it is not possible to view the same patient record at multiple workstations.
Viewing, Editing, Printing Patient Records Viewing and Printing Patient Records from the MUSE System 1. Click the MUSE Browser button on the initial screen. 2. Enter the MUSE password, if prompted. The MUSE web page will appear. 3. Select Display with Frame or Display without Frame. 4. Submit query or identify the patient record to be retrieved by patient ID or name. 5. Display the individual documents of the patient record. 6.
Archiving, Exporting, Deleting Patient Records Archiving, Exporting, Deleting Patient Records First select the patient record(s). To select a series of consecutive records, hold down the Shift key and click the first and last file name of the series. To select individual records, hold down the Ctrl key and click on each single record you wish to select. To select all displayed patient records, click Select all.
Archiving, Exporting, Deleting Patient Records Transfer to MUSE To transfer the patient record(s) to a MUSE system, click the Transfer to MUSE button. Note This button is enabled only if the data transfer to the MUSE system has been enabled on the MUSE tab (see section “MUSE Tab” on page 12-55). Data sent to the MUSE system can be edited only when the program is configured accordingly (see “MUSE Tab” on page 1255). Data sent to the MUSE system can be viewed and printed with the MUSE Browser.
Archiving, Exporting, Deleting Patient Records Export Click the Export button to export patient record(s) using different file formats. A B C D E F 102A A Select option button to export data as a PDF file. B Select option button to export data as a Microsoft Word file. C Select option button to export the attached documents (ergospirometry). D Select option button to export data as a Microsoft Excel file. E Select option button to export data as an XML file.
Archiving, Exporting, Deleting Patient Records Settings A B C D E F 102A A Select the data to export as XML/Excel files. B Select check box if you wish to use the settings from the Final Report tab (see “Final Report Tab” on page 12-9 and “Final Report Tab” on page 12-23). Otherwise the setup screen for configuration of the final report will appear. C Enter the printer driver for PDF files.
Working Temporarily with the Local Database Working Temporarily with the Local Database Note This feature is not available if one of the following options is enabled: DICOM option (DICM) EMR option (XEMR) Request MUSE data Floating License If you wish to work temporarily with the offline (local) database (house call), you can copy the patient list (without any examinations) to the local database. This can be done manually or automatically. Manual 1. Connect the PC to the data network. 2.
Working Temporarily with the Local Database Automatic If you select the automatic switch to offline database check box in the Database Setup window, an additional button will be displayed when you shut down the program: Use Offline Database. 163A 164A When you terminate the program with this button, the patient list will be copied to the local database. Continue working with your PC as usual.
Working Temporarily with the Local Database For your notes 9-14 CASE 2060290-201 Revision C
10 Revision C Operation with Administrative Tools CASE 2060290-201 10-1
For your notes 10-2 CASE 2060290-201 Revision C
Overview Overview The program can be used in combination with the following administrative tools: Revision C medical reimbursement program hospital information system (HIS) EMR system (electronic medical records) CASE 2060290-201 10-3
Description Description The CASE program supports communication with administrative tools via the following interfaces: GDT (German medical device data standard) BDT (German medical data standard) HL7 (requires XEMR option) Note Please refer to the separate descriptions supplied. If the program is used in conjunction with an administrative tool, the patient file is always managed in the administrative tool while the test data are managed in the CASE program.
11 Revision C DICOM Interface CASE 2060290-201 11-1
For your notes 11-2 CASE 2060290-201 Revision C
Overview Overview DICOM (Digital Imaging and Communications in Medicine) is an open data exchange standard for medical information. DICOM standardizes both the file format for data storage as well as the communications protocol for the exchange of these data.
Performing Procedures with the Order List (Scheduled Procedures) Performing Procedures with the Order List (Scheduled Procedures) 1. Click New Test. 2. Select the patient and click Order List. 104A An order list query is automatically sent via the network. These are the default search criteria: orders for the selected patient orders for the present day (today) orders assigned to this workstation Note It is also possible to view the order list without selecting a patient first.
Performing Procedures with the Order List (Scheduled Procedures) Name of the requesting physician Name of the performing physician 6. Perform the examination according to the user instructions. 7. At the end of the examination you will be asked whether the test is a valid or an invalid test. If invalid, you must state a reason. 8. Confirm your entries.
Performing Procedures without the Order List (Unscheduled Procedures) Elements of the Order List - Explanation A B C D 109A H G F E A The content of these fields depends on the program configuration. B Search criterion for the workstation: find orders for a specific workstation or find orders for all workstations. C Search criterion date: find orders for the selected time period or find orders irrespective of a time period.
12 Revision C System Settings CASE 2060290-201 12-1
For your notes 12-2 CASE 2060290-201 Revision C
Resting ECG Setup Resting ECG Setup The settings specific to the resting ECG modality can be entered either from the resting ECG acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab” on page 12-40). Acquisition Tab The Acquisition tab with the acquisition settings is already on top. A B C D E F H G I J K L M N 91A-R Revision C A Click to print the resting ECG setup.
Resting ECG Setup Editing the Reason for Test Library In this window you can edit the library for the Reason for Test list box. You can enter a maximum of 12 statements. 1. Click Modify... to display the Reason for Test library. 2. Select a blank line. 3. Enter the text.
Resting ECG Setup Editing the Interpretation Library In this window you can edit the library of interpretative statements. 1. Click Modify... to display the Interpretation library. 2. Click a line to highlight it. 3. Click a second time to enable the edit mode and enter your changes. 4.
Resting ECG Setup Editing Medication Groups, Assigning Drug Names 1. Click Modify... to display the Medications library. 2. Click down arrow to open the list. 3. Select the medication group. 4. Click the Drug Name box and enter the medication name. Note Assigning the correct names to the groups is the responsibility of the physician.
Resting ECG Setup Lead Sequence Tab Click the Lead Sequence tab to open the window. Lead sequence is the assignment of ECG leads to the writer or screen channels. You can change the lead sequences according to your needs and save them under the same name or under a new name. You may also create new lead sequences. Note The Standard and Cabrera lead sequences cannot be modified. 1 3 2 4 5 6 7 94A-R Modifying the Lead Sequence 1. Select the number of monitored leads.
Resting ECG Setup Miscellaneous Tab A B C D E F G 95A-R 12-8 A Select the check boxes to enable the following functions: Preview before Analysis: Full-screen display of the 10-second ECG, analysis only after confirmation. Print after Analysis: Automatic printout after acquisition of the 10-second ECG. Post Test Review after Analysis: Automatic display of the test report after acquisition and analysis of the 10-second ECG.
Resting ECG Setup Final Report Tab Click the Final Reports tab for configuration of the report printout. 1 2 3 4 5 6 7 8 9 10 96A-R 1. Select the documents to be included in the report Configured Report 10-second ECG (up to 3 different formats, with or without Interpretation) Medians Vector Loops. 2. Select the screen format for the 10-second ECG. You can choose two more formats. 3. Select a report format. 4. Click Modify...
Resting ECG Setup Report Editor The Configured Report Editor allows you to create a maximum of 10 templates (e.g. letter to referring physician). Two templates (Reports 1 and 2) are preconfigured and cannot be changed. Click Modify... on the Final Report tab to display the Configured Report Editor window. You can enter text and insert report items from a list (e.g., patient name, heart rate). At the time the report is printed the program will replace these report items with the actual data.
Resting ECG Setup A B 944A A Click to select the logo. B Use arrow buttons or text fields to define the size and position of the logo. 10. Click button to save the template. To do so, enter the template name first. This name will allow you to select the template later on when configuring the printed report. If edited, Reports 1 and 2 must be saved under a new name. 11. Click to delete the template. 12. Close the Configured Report window.
Exercise Test Setup Exercise Test Setup The settings specific to the exercise test modality can be entered either from the exercise test pre-acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab” on page 12-40). Writer Tab The Writer tab with the writer settings is already on top. A B C D E F G H I J K L M N 98A-S A Click to print the exercise test setup. B Click to select the writer gain.
Exercise Test Setup Screen Tab Click the Screen tab to open the window. A B C D E F G H I K 99A-S Revision C A Click to print the exercise test setup. B Select C Select the sensitivity level to noise (noise/signal ratio): low, middle, high (electrodes with a high impedance are shown yellow). D Select the gain for the displayed ECGs. E Select the speed for the displayed ECGs. F Select a median group. Then select the leads for this group.
Exercise Test Setup Configuring the Tabular Summary You can define up to 5 columns of data in the Tabular Summary in addition to the standard 8. Select preconfigured data types or create new column headings. Click Configure Tabular Summary on the “Screen Tab” on page 12-13 to display the configuration window. 1 2 3 910A-S The highlighted items are selected for display. 1. Click a highlighted item to deselect it. 2. Click a deselected item to select it. 3. To create your own column headings: a.
Exercise Test Setup Configuring Trends Click Configure Trends on the “Screen Tab” on page 12-13 to display the configuration window. You can choose the parameters for 6 graphic trends. 1 2 3 911A-S 1. Select the parameter for the left Y axis. 2. Select the parameter for the right Y axis. 3. Choose the ECG lead for the ST-related graphic trends.
Exercise Test Setup Configuring the Vital Signs Click Configure Vital Signs on the “Screen Tab” on page 12-13 to display the configuration window. You can choose the vital signs to be displayed the order in which they are presented the font size 912A-S 1. Click Add/remove fields to select the vital signs to display. 2. Right-click a window item to choose a different font size or move the item. These are the choices in the menu: move bigger font smaller font 3.
Exercise Test Setup Lead Sequence Tab Click the Lead Sequence tab to open the window. Lead sequence is the assignment of ECG leads to the writer or screen channels. You can change the lead sequences according to your needs and save them under the same name or under a new name. You may also define different lead sequences for the screen display and the printouts. Note The first two lead sequences are fixed and cannot be modified. 3 4 1 2 5 6 7 8 913A-S Modifying the Lead Sequence 1.
Exercise Test Setup Configuring Leads Ex1, Ex2, Ex3 6. Choose unipolar or bipolar. 7. Choose the 1st electrode site for Ex1. 8. Select the 2nd electrode site for Ex1 (bipolar) (the 2nd site for unipolar leads is always CT). 9. If required, change the name of the lead sequence (step 2) and click OK to save. If you change any of the selections of an Ex lead, the sequence name is given as ???.
Exercise Test Setup Protocol Editor Tab Click the Protocol Editor tab to open the window. A D B E F C D E F 914A-S A Click to print the exercise test setup. B Click option button to select the treadmill exercise testing device. C Click option button to select the bicycle ergometer exercise testing device. D Click down arrow to select a protocol. E Phase names of the protocol. F Click to modify or delete protocols (see “Protocol Editor Screen” on page 1220).
Exercise Test Setup Protocol Editor Screen A B C D E F G H I J 915A-S Note The 12 lead and Median report formats are selected on the Writer tab. The medians saved with Store Median are included in the Medians report. 12-20 A Phase name. B Selected protocol. C Stage name. D Select or deselect a ramping phase (= continuous speed/load increase; selectable only when phase name, e.g. BRUCE, is highlighted; separately adjustable for each phase).
Exercise Test Setup E Parameter fields (corresponding to the columns from left to right). Phase/Stage name. Stage Time. Speed. Grade. 12 Lead Report: First = time of first 12-lead report. 12 Lead Report: Repeat = print interval after first report. Median Report: First = time of first median report. Median Report: Repeat = print interval after first report. BP: First = time of first BP prompt or measurement. BP: Repeat = interval after first BP prompt or measurement.
Exercise Test Setup Creating a New Phase 4 5 2 6 8 7 915A-S 1. Select a blank protocol (e.g. TEST 14). 2. Click the New Protocol button to display the window with all protocol templates. 3. Select a template from the list. Editing Stage or Phase Information 4. Click on a stage or phase to display the active data fields. 5. Enter new data for the stage or phase. 6. To delete this stage or phase, click the Delete stage or Delete phase button. 7. To add a stage, click Add stage. 8.
Exercise Test Setup Final Report Tab Click the Final Report tab for configuration of the report printout. 1 6 2 3 4 1 4 1 4 1 5 4 916A-S 1.
Exercise Test Setup Miscellaneous 1 Tab Click the Miscellaneous 1 tab to open the window. A B C D E F G H I J K 917A-S 12-24 A Select or deselect FRF (Finite Residual Filter algorithm = filtering of high and low-frequency components without altering the QRS complexes, signal delay of 1 s) or Cubic Spline (compensation of baseline fluctuation, signal delay 2 s); see section “Application Tips” on page B-6. B Select the PE Scale (Perceived Exertion).
Exercise Test Setup Revision C I Select the Max. Load Interpolation function (only possible when the exercise test is performed on a bicycle ergometer). The maximum load is the load of the last completed stage plus the duration of the last stage x load increase/stage time. Example: load of the last completed stage: 125 Watts last stage aborted after 1 minute load increase: 25 Watts stage time: 2 minutes 125 W + 1 x 25/2 = 137.5 W This value is also used to determine the percentage of the target load.
Exercise Test Setup Miscellaneous 2 Tab Click the Miscellaneous 2 tab to open the window. 918A-S Editing the Comments, Test Types, Reason for Test, Reasons for Termination, Medications Library 1. Click Modify.... to open the edit window. 2. Edit, delete or add new statements. Configuring the Measurement Results 1. Click Modify... to display the Measurement Results window. 2. Select the parameters to be included in the Measurement Results (Test Summary).
Exercise Test Setup Editing the Interpretation Library Click Modify.... to open the Interpretation Library window. Note You can edit the eight preset topics in the window on the left. Do not edit the topics, if data will be sent to MUSE. Additional statements can be entered in the window on the right. To do so, click in the blank space below the last statement. 1 2 3 4 919A-S 1. Select the topic to edit. 2. Click in the text box and edit the text. 3.
Exercise Test Setup Entering Extra Questions Click Modify.... to open the Extra Questions window. 1 2 3 920A-S 1. Click in the text box for the first question and type a text (20 characters max.). 2. Select the answer format: Alphanumeric, Numeric, Yes/No. 3. Enter the second question in the same way.
Exercise Test Setup ST/Medians / 12SL Tab Click the ST/Medians / 12SL tab to display the window for setup of ST measurement and 12SL. A B C D E F G H 922A-S Revision C A Click option button to select calculation method for E and J points. B Click option button to select calculation method for post-J point. Manual: set post-J point at D Auto: select formula at C. C Select formula for calculation of post-J point. D Manually select post-J value.
Exercise Test Setup TWA Tab Click the TWA tab to open the window. During the exercise test the TWA algorithm analyzes the data in the background. In each of the selected leads, the algorithm calculates the even and odd medians, the TWA value and the noise limit. The data is saved at intervals of 15 seconds. Verify the TWA settings on this tab before the test.
Ambulatory Blood Pressure Measurement Setup Ambulatory Blood Pressure Measurement Setup The settings specific to the ambulatory blood pressure measurement modality can be entered either from the ambulatory blood pressure acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab” on page 12-40). Acquisition Tab The Acquisition tab is already on top.
Ambulatory Blood Pressure Measurement Setup Editing the BP Protocol Click Modify to display the configuration menu. 2 3 1 4 5 6 7 8 9 10 194A-BP 1. Select the number of BP periods. 2. Select the beginning of the period. 3. Select the end of the period. 4. Choose whether measurements are to be taken at exactly or at approximately the selected intervals. 5. Select the BP interval. 6. Select the deflation rate. 7. Enter a name for the protocol. 8.
Ambulatory Blood Pressure Measurement Setup Miscellaneous Tab Click the Miscellaneous tab to open the window. A B C D F E G H I J K 195A-BP A Click to print the ambulatory blood pressure measurement setup. B Select documents to be included in the report. C Select the Configured Report format. D Click button to edit the Configured Report or create a new one (see “Report Editor” on page 12-10). E Select number of copies. F Enter Extra Question 1 (20 characters max.).
Ambulatory Blood Pressure Measurement Setup Editing the Interpretation Library In this window you can edit the library of interpretative statements. You can enter a maximum of 12 statements. 1. Click Modify... to display the Interpretation library. 2. Click a line to highlight it. 3. Click a second time to enable the edit mode and enter your changes. 4.
Spirometry Setup Spirometry Setup The settings specific to the spirometry modality can be entered either from the spirometry acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab” on page 12-40). Acquisition Tab The Acquisition tab is already on top. A B CD E F GH I J K 205A-SP A Click to print the spirometry test setup. B Select the Equation for Reference Value Calculation. C Select the Interpretation Mode.
Spirometry Setup Miscellaneous Tab Click the Miscellaneous tab to open the window. A B C D F E G H I J K 208A-SP A Click to print the spirometry test setup. B Select documents to be included in the report. C Select the Configured Report format. D Click button to edit the Configured Report or create a new one (see “Report Editor” on page 12-10). E Select number of copies. F Enter Extra Question 1 (20 characters max.). G Enter Extra Question 2 (20 characters max.).
Spirometry Setup Editing the Interpretation Library In this window you can edit the library of interpretative statements. You can enter a maximum of 12 statements. 1. Click Modify... to display the Interpretation library. 2. Click a line to highlight it. 3. Click a second time to enable the edit mode and enter your changes. 4.
Custom Setups, Factory Setup Custom Setups, Factory Setup The program allows you to save, load, and delete your personal settings for the different test modalities. From the same menu, you can restore the factory defaults. You access the setup menu by clicking the Custom Setup button on the acquisition or pre-acquisition screen, or from the the General tab of the System Configuration (see “General Tab” on page 12-40). A B C 924A A Names of stored custom setups.
Custom Setups, Factory Setup Load or Delete 1. Select the drive. 2. Select the name. 3. Click Load to load the setup, or click Delete to delete the setup. Note Be sure to save the current setup BEFORE loading one of the stored setups, or your modifications will be lost. With some bicycle ergometers, restoring the Factory Setup will delete your own exercise test protocols and phases. The following parameters cannot be loaded, stored or reset to the factory defaults.
System Configuration System Configuration Click the System Configuration button on the initial screen to display the menu. General Tab A B C D E F G H I J K L M N O P Q R S A 925A Test Patient: Select check box to run a test using simulated patient data. Select the function each time before starting a simulated test. WARNING Interpretation Hazard—Select the simulated patient data for demonstration purposes only to avoid misinterpretation of the data.
System Configuration D Trace Background: Click to select the background for the signal traces. ECG Grid: Select the grid format for the displayed ECG. Report ECG Grid: Select the grid format for the printed ECG. Screen Diagonal: Select the size of your PC monitor (custom, see “Adjusting the Screen Size for Widescreen Monitors” on page 12-42). E Enter the physician and technician IDs.
System Configuration Adjusting the Screen Size for Widescreen Monitors 1. Select custom. 2. Click . 3. Adjust the height of the displayed window to 10 cm, using a ruler. 4. Adjust the width in the same way. 5. Clear the window.
System Configuration User Administration User List (G on the General tab, on page 12-40) displays the list of all registered system users if you select the Enable Password Function check box in the preceding window. You can edit user data with Modify... (select name first), delete a user with Delete... or register a new user with New.... If you enable Use Windows User List, the user list of the specified Windows domain will appear.
System Configuration 4 5 1 2 3 6 926A Click New... to display the user registration window. 1. Enter the user name and ID number. If you enter the last name before the first name, insert a comma in between. Otherwise the name entered first becomes the first name and the name entered second becomes the last name, when the user is registered in the MUSE system. Please note that MUSE accepts first names with a maximum length of 10 characters, last names must not be longer than 16 characters.
System Configuration Receiving Resting ECGs from Other ECG Devices With the Receive Data from ECG Device function, resting ECGs acquired with other GE Healthcare ECG devices can be transferred to the local database. Note If an ECG is received without patient ID (not even blanks), it will automatically appear in the list for manual assignment with the special patient ID “000000“. 1 2 3 4 927A Click Receive Data from ECG Device (I on the General tab) to display the setup window. 1.
System Configuration A device number (e.g. 12) can be entered at the ECG recorder: to do so type hospital %12% at Hospital/Practice Name. 2. Select this option button to receive data from a storage medium and specify the directory. 3. Select this option button to receive MAC ECGs from a USB or memory card (SD card) and specify the directory. Then insert the USB or memory card adapter into the appropriate drive. B A Note Insert the SD card with the bevelled edge pointing to the front right (A).
System Configuration Note It is possible to simultaneously send the ECGs from up to 4 ECG recorders via modem to the system. To utilize this feature, an extra PC is required as the communications server. This server is part of a network through which the ECG can be routed to the system or to a MUSE system database. For details, please contact GE Healthcare Technical Support or your local Service Representative.
System Configuration Copying Patient Records With the Copy Patient Records function, patient records can be copied from the local database to a removable media or a network drive, or they can be moved from a removable media or network drive to the local database. When “moved“, the data record will be deleted from the source medium. Click Copy Patient Records (J on the General tab) to display the setup window. 2 1 4 3 928A 1. Select the patient. 2. Select the patient records to copy. 3.
System Configuration Archiving Patient Records With the Archive Patient Records function you can export patient records not currently used to an external medium. The date and test type remain included in the patient record list. An asterisk * identifies archived patient records. Do not copy the data to the root directory (e.g. d:\), create a subdirectory (e.g. d:\data\). If you want to view an archived patient record, the system will indicate the storage medium.
System Configuration Compressing Patient Records Older patient records that are seldom used can be compressed with the Compress function to free storage capacity for new data. If you select compressed patient records for viewing, they uncompress automatically. Click Compress (L on the General tab) to display the setup window. 1. Enter a date: patient records older than this date will be compressed. 2. Click the Compress... button.
System Configuration Note Access to the Date/Time Properties dialog is restricted to authorized system users. Procedure Statistics Click Procedure Statistics (N on the General tab) to display the setup window. 3 2 1 4 932A 1. Enter the date range for the statistical analysis. 2. Select the period (month, quarter, year). 3. Click to calculate the statistics. 4. Click to export the data to Microsoft Excel.
System Configuration Printer Settings Click Printer (O on the General tab, page 12-40) to display the setup window. 4 3 2 1 5 946A 1. Select the printer. 2. Select the Color Printouts check box, if desired. 3. Define the colors. 4. Select the ECG grid format. 5. Click Default to restore the initial settings. 6. Click OK to clear the window.
System Configuration Devices Tab Click the Devices tab to open the window. A B C D E F G H I J K 933A Revision C A Select check box, then select a port for the metabolic cart. B Click to select the BP monitor model and the port. C Click to select the treadmill model and the port. D Click to select the spirometry device type and the port (none indicates that the modality is inactive). E Click to select the SpO2 monitor model and the port.
System Configuration Modem Tab Click the Modem tab to open the window. A B C D E 934A A Select modem port and baud rate (same baud rate at sending and receiving units). B Select the modem type. C Field for entry of the initialization string (entered automatically for MultiTech and ELSA modems). initialization string for other modem types (e.g. MultiTech 56K): AT&FM0\X3V0S0=1 D Field for entry of the dial mode (pulse/touch tone dialing).
System Configuration MUSE Tab Click the MUSE tab to open the window. Note CASE is compatible with the following versions of the MUSE system: Pre 5C, 5C to 7.1 or 7.2 and above. N O A B C D P E Q F G H R I S T U J K L M 935A Revision C A Select to retrieve patient data and orders from the MUSE system. B Enter information required for communication with the MUSE web system. C Select, if SSL is configured at the MUSE Web server. D Box for entry of the port number.
System Configuration I Select to transfer data to a MUSE system via a network, using a shared directory (allows transfer of data to older MUSE versions via the network, a separate shared directory is required for each workstation). J Select to limit entered texts, such as in Patient Information, Test Information, to the maximum length accepted by MUSE. K Select to automatically transfer each test or each modification to a test to the MUSE system.
System Configuration The following exercise test information is not transferred to the MUSE system, because MUSE does not support this type of data: Revision C Sokolov index, QT dispersion full disclosure ECG arrhythmia review ST/HR slope ST/HR index waterfall TWA trends TWA medians CASE 2060290-201 12-57
System Configuration Option Code Tab Click the Option Code tab to open the option code window. If you have purchased additional software options, enter the option codes to activate the software options. The code numbers are given on the supplied option code sheets or on a disk. 3 5 1 4 936A 1. Click Modify.... 2. When asked Change software option. Are you sure?, click Yes to clear the window. 3. Enter the option code in the appropriate field, or 4. Click Load to load the option code from disk. 5.
System Configuration Country Settings Tab Click the Country Settings tab to open the window. Note After selecting the language, first load the factory settings to set all text libraries to the new language (Custom Setup — Factory Settings — Load). Select Chinese, Japanese, Korean, or Russian only when the operating system of your computer supports the required character sets. Revision C A Select B Select to replace the icons on the control buttons with text labels.
System Configuration EMR Tab Click the EMR tab to open the window (with XEMR option only). A B C D E F 941A 12-60 A Select to transfer data to the EMR interface via a network. B Select to transfer data to the EMR interface via a shared directory. C Set or select the communication folders (read orders from the EMR interface, write data to the EMR interface). D Click to view the error log. E Set or select the error log folder.
System Configuration Connectivity Server Tab Note Information about installing the connectivity server can be found in the Field Service Manual. Refer the installation of the connectivity server to GE Healthcare service personnel. Click the Connectivity Server tab to open the window. A B D C E F 947A Revision C A Select to automatically export data in Word, XML or PDF format as configured in the System Configuration (see “System Configuration” on page 12-40 and “Export” on page 9-10).
System Configuration D Click to open a dialog to add shared directories. You select a folder for which you have permission to save data. Normally, a user will be created and the rights needed to save data are assigned to this user. On the cart, this user is used to log onto the system. After this, the folder is regularly checked and existing data records are transferred. E Click to open a dialog to add inbound connections (see below). F Click to save the settings.
System Configuration DICOM Tab Note A valid DICOM option code will activate the DICOM interface as well as the DICOM tab. Configurations on the DICOM tab should be referred to IT/Service staff (see Field Service Manual).
System Configuration For your notes 12-64 CASE 2060290-201 Revision C
Cleaning and Maintenance: A Revision C Cleaning and Maintenance CASE 2060290-201 A-1
Cleaning and Maintenance: For your notes A-2 CASE 2060290-201 Revision C
Cleaning and Maintenance: Cleaning, Disinfection, and Maintenance Cleaning, Disinfection, and Maintenance Equipment Surface Warning Shock Hazard — Disconnect the power cord from the wall outlet before cleaning or disinfecting the system. Use a moist cloth to wipe the surface clean; do not allow liquids to enter the system. All cleaning agents and disinfectants commonly used in hospitals and containing up to 70 % alcohol are suitable.
Cleaning and Maintenance: Maintenance Maintenance Before Each Use Before each use, visually inspect the equipment, the cables and the electrodes for signs of mechanical damage. If you detect damage or impaired functions which may result in a hazard to the patient or the operator, the items must be repaired or replaced before use. The system does not require other regular maintenance. Technical Inspections For safety, the devices require regular maintenance.
Miscellaneous: B Revision C Miscellaneous CASE 2060290-201 B-1
Miscellaneous: For your notes B-2 CASE 2060290-201 Revision C
Miscellaneous: Connecting Peripheral Devices Connecting Peripheral Devices Note Ergometers and treadmills must be calibrated before being used with the system. Refer to the appropriate service manuals for calibration information. Bicycle Ergometers Connect bicycle ergometers to the COM ports.
Miscellaneous: Connecting Peripheral Devices Blood Pressure Monitor Note The blood pressure can be measured in kPa or mmHg. For selection of the blood pressure unit, see “Country Settings Tab” on page 12-59. Connect blood pressure monitors to the COM ports.
Miscellaneous: Connecting Peripheral Devices SpO2 Monitor Connect SpO2 monitors to the COM ports. Model Configuration Masimo Radical-7 Masimo Radical-7 SunTech Tango+ with SpO2 option in BP monitor The system only indicates the current SpO2 level. Configurations are performed directly at the SpO2 monitor. ECG Recorder Connect MAC 1200 (V5.21 or later) to a COM port, using a serial cable. Connect MAC 500 (V2.22 or later) to a serial port via an IR converter.
Miscellaneous: Application Tips Printers in a Network Environment Warning Patient Hazard — As stipulated in IEC 60601-1, printers operated in the patient environment must be connected via an isolation transformer or to a potential equalization system (protective earth conductor). Recommended storage capacity: 8 MB Recommended printer: HP LaserJet P3015dn. Caution The ambient conditions for the CASE system are different to those of most laser printers.
Miscellaneous: Application Tips Recording ECGs During Defibrillation The patient signal input is defibrillation-proof. Therefore, it is not necessary to remove the ECG electrodes prior to defibrillation. When using stainless steel or silver electrodes a defibrillator discharge current may cause the electrodes to retain a residual charge causing a polarization or DC offset voltage at the electrode/skin interface. This electrode polarization will block acquisition of the ECG signal for several minutes.
Miscellaneous: Exercise Test Interpretation (XTI) Exercise Test Interpretation (XTI) An exercise test on a treadmill or a bicycle delivers a large number of measurements that are valuable in predicting morbidity/mortality, in detecting coronary artery disease and in describing the functional exercise response of a patient.
Miscellaneous: Duke Treadmill Score Duke Treadmill Score 1. The system automatically generates the Duke Treadmill Score using the following standard computation. Duke Treadmill = Score (Bruce) Exercise Time – 5 (minutes) maximum ST deviation (mm) – 4 (Angina Index) Angina-Index 0 = none, 1 = non-limiting, 2 = limiting Note Maximum ST deviation refers to the amount of exercise-induced ST segment deviation, i.e., the largest elevation or depression after baseline ST levels have been subtracted.
Miscellaneous: Duke Treadmill Score References Study the following publications for a correct understanding of the Duke Treadmill Score: Gibbons et al.: ACC/AHA Guidelines For Exercise Testing. JACC, 30 (1):260 - 315, July 1997. Mark, D.B.; Shaw, L.; Harrell, F. E.; Lee, K. L.; Bengton, J.R.; McCants, C.B.; Califf, R.M.; Pryor, D.B.: Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. The New England Journal of Medicine. 325 (12): 849 853 (Sept.
Miscellaneous: Risk Factors Risk Factors According to the "Instructions of Using Coronary Risk and Stroke Risk Prediction Charts and Worksheet" proposed by the American Heart Association (AHA) (see also Physician’ s Guide to GE Stress Systems) the system automatically calculates the risk factors for coronary heart disease and myocardial infarction.
Miscellaneous: Risk Factors Male Stroke Risk Factor Values for Unknown or Out-of range Parameters Parameter Value Value Used Age unknown < 54 years > 86 years 56 54 86 Systolic Blood Pressure unknown < 95 > 213 105 95 213 HYP RX (anti-hypertensive medication) unknown no Diabetes unknown no Smoker (cigarettes) unknown no CVD (cardiovascular disease) unknown no AF (atrial fibrillation) unknown no LVH (left-ventricular hypertrophy) unknown no Female Stroke Risk Factor Values for Unk
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Spirometry Reference Value Equations, Interpretation Modes, Measurements Reference Value Equations ECCS/Zapletal This equation uses reference values developed by QUANJER (ECCS93) and ZAPLETAL. The ECCS reference values were published 1993 (ISBN 87-16-15024-4). The reference values are height and gender-related and are defined for patients aged 19 to 70 years.
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Knudson This reference value equation was published 1983 (KNUDSON et al. Am Rev Respir Dis 127 (1983) 725-734). The reference values are height and gender-related and are defined for patients aged 5 to 90 years from the ethnic groups Caucasian (Race selection: Caucasian), African American (Race selection: Black). Note Age range from 5 to 90 years.
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements The reference values by WANNE are height and gender-related and are defined for patients aged 6 to 17 years. Note Age range from 6 to 17 years. For patients younger than 6 years, the age is set to 6. A range for height is not defined. The equation defines the following reference values: MEF50, PEF, FVC, FEV1, FEV1/FVC, VC (same as FIVC).
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Interpretation Modes Note The authors of the reference values developed the interpretation modes for the reference value equations. Other reference value equations may lead to different interpretations. Europe An interpretation mode on the basis of the ECCS reference values. The flow-volume loop is analyzed according to these criteria: 1. Expiratory flow limitation? 2. Curve typical of restriction? 3.
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Curve typical of restriction Possible causes reduced lung volume (restriction), elevated pulmonary elasticity (fibrosis) Criterion FVC Act. < xx % FVC Ref. and (VC MAX/(2 x MEF50) < 0.8) Definition Interpretative Statement > 70 % normal* 50 ...
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Impaired peripheral respiration Possible causes reduced pulmonary elasticity (emphysema), impaired ventilatory distribution, peripheral airway obstruction Criterion VC MAX/(2 x MEF50) Definition Interpretative Statement T50 % = < 0.8 s normal* T50 % = 0.8 - 1 s mild expiratory flow limitation at deep expiration T50 % = > 1 s moderate to severe expiratory flow limitation at deep expiration if > 0.
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Definition of Spirometry Test Values Revision C FVC forced expiratory vital capacity FEV05 forced expiratory volume in the first 0.
Miscellaneous: Installing the Program in a Network Environment Installing the Program in a Network Environment Please contact our Customer Service for program updates. To operate the program in a network environment, the server must meet the following requirements: processor Pentium > 1.
Miscellaneous: Troubleshooting Problem Remedy USB drive not found. The ECG grid is not visible in the PDF file. Set up Acrobat Distiller as follows Acrobat V6.0: Start -> Settings -> Printer -> Adobe PDF -> menu Printer -> Document Defaults -> menu Adobe PDF Settings -> disable do not send fonts to distiller; menu Paper/Quality -> button Advanced -> Graphic and select the field Download True Type Font as Softfont. Acrobat V5.
Miscellaneous: Remote Service Remote Service In conjunction with the InSiteExC application, CASE is a system with remote service capability. For InSiteExC installation instructions, please refer to the CASE Field Service Manual. You must have access to the internet to be able to use the remote service capability. Warning Patient Hazard — Disconnect the patient from CASE during remote servicing.
Miscellaneous: Direct Fax Transmission of Printer Documents Direct Fax Transmission of Printer Documents Instead of sending documents to the printer, they can be directly routed to another PC or to a fax machine. A modem with a serial port is required for this purpose. The modems recommended by GE Healthcare include the FAX software. When installing the fax software from the original media, you can configure the fax port as the standard printer.
Miscellaneous: Related Physician’s Guides Related Physician’s Guides For detailed information on specific topics, we recommend that you refer to these physician’s guides: B-24 Physician's Guide to GE Stress Systems, Part No. 2051167-001 TWA Physician’s Guide, Part No. 2020044-067 Physician’s Guide to Audio ECG Assessment of Stress Tests, Part No. 2062179-001 HEART Resting ECG Interpretation Program, Part No. 22747702 12 SL Physician's Guide, Part No.
Order Information: C Revision C Order Information CASE 2060290-201 C-1
Order Information: For your notes C-2 CASE 2060290-201 Revision C
Order Information: Order Information Order Information Subject to change. Always refer to latest list of accessories. 2062898-001 CASE ECG analysis system incl.
Order Information: Order Information 2077699-017 Keyboard, Swedish/Finnish 2077698-001 Optical scroll mouse, USB, IPX1, black Optional Software Programs C-4 45502401 Resting ECG Interpretation (RESI), requires RESM 45502901 Remote View (ERGM) 45502701 Storage of the Full Disclosure ECG (EGMO) 45503001 Data Storage on Network Server, < 3000 tests (NETS) 2014659-001 Data Storage on Network Server, < 15000 tests (NET2), requires NETS 2014659-002 Data Storage on Network Server, unlimited numbe
Order Information: Order Information 2014659-020 EMR Interface (XEMR) 2014659-026 DICOM Interface (DICM) 2014659-027 Ergospirometry (ESPI), for CASE-ES only 2014659-028 ST/HR Hysteresis (STHY), requires ERG2 2014659-029 Exercise Test Interpretation (EXTI), requires ERG2 and STHY Cables Revision C 405535-001 Power cord, USA 401855-001 Power cord, Europe 401855-002 Power cord, GB 401855-003 Power cord, Italy 401855-004 Power cord, Israel 401855-007 Power cord, Switzerland 401855-108
Order Information: Order Information C-6 CASE 2060290-201 Revision C
Technical Description: D Revision C Technical Description CASE 2060290-201 D-1
Technical Description: D-2 CASE 2060290-201 Revision C
Technical Description: Technical Specifications – CASE System Technical Specifications – CASE System Table 1. Performance Specifications – Signal Processing Item Description Instrument type Unity-enhanced cardiac stress testing system with 14 channel acquisition and programmable lead configurations. Celeron-based and hard drive storage delivers local and MUSE database access.
Technical Description: Technical Specifications – CASE System Table 2. Performance Specifications – Data Acquisition (Continued) Item Description Dynamic range 320 mV, ±10 mV signal superimposed on ±150 mV DC offset Resolution 4.88 µV/LSB @ 500 Hz Noise < 15 µV peak-to-peak noise over 0.01 to 150 Hz (-3 dB) bandwidth Frequency response - 3dB, display and writer High pass filter 0.01 Hz (or 0.
Technical Description: Technical Specifications – CASE System Table 3. Display (Continued) Item Description Size 22'' diagonal DVI (22'' monitor) 19'' diagonal DVI (19'' monitor) Monitored leads 3, 6, or 15 Displayed leads 3, 6, 12 or 15 (Resting ECG) and 3 or 6 (Stress Test) Format 3 rhythm, 3 rhythm + medians, 3 rhythm + trends, 6 rhythm, 4 x 2.5 + 1 rhythm, 2 x 6 Speeds 25, 50 mm/s Sensitivity/Gain 2.
Technical Description: Technical Specifications – CASE System Table 4. Writer Item Description Technology “Instant” load thermal dot array Leads 3, 6, 12, or 15 (standard, NEHB, Cabrera, configurable) Speeds 5, 12.5, 25, and 50 mm/s (±2 %) Sensitivity/Gain 2.5, 5, 10, or 20 mm/mV (±5 %) Resolution Horizontal 1000 lines/s x 200 dpi dedicated local printing, 200 x 200 dpi generic printing Paper type Thermal, perforated, fanfold, 300 sheets per pack Paper size Letter size 214.6 mm x 280 mm (8.
Technical Description: Technical Specifications – CASE System Table 6. Physical Item Description Height 169 cm (66 ½ inches) with monitor attached (height adjustable, extend and retract, rotates vertical and horizontal for optimum viewing) Width 62 cm (24 in.) with paper tray removed Depth 75 cm (29 in.) Weight 66.6 kg (147.5 lbs.
Technical Description: Technical Specifications – CASE System Table 7. Safety (Continued) Item Handling of disposable supplies and other consumables Description Use only parts and accessories manufactured or recommended by GE Healthcare. Follow manufacturer’s instructions for use for disposable/consumable product. Follow local environmental guidelines concerning the disposal of hazardous materials.
Index Index Numerics Combined Report 7 Comments, Enter in Tabular Summary 17 Comparing Exercise Tests 27 Comparing Spirograms 18 Cubic Spline 10 Custom Setups, Load - Save - Delete 38 10-Second ECG With Analysis 7 10-Second ECG, View 13 12SL Analysis 54 12SL ECG Acquisition 15 3D Graph 35 D A Acquisition Module Buttons 13 Acronyms 27, 28 Administrative tools, using the program in conjunction with 1 AHA CHD Risk 8 AHA Stroke Risk 8 Ambulatory Blood Pressure Measurement Setup Acquisition Tab 31 Miscellane
Index MASON-LIKAR Lead Electrode Placement 8 NEHB Lead Electrode Placement 10 Standard 12 Lead Electrode Placement 5 Standard 15 Lead Electrode Placement 7 EMR system, using the program with a 3 Envelope, Measurement Mode 7 Equipment Check Before Each Use 4 Equipment Identification 15 Equipment Symbols 11 Event Marker 10 Examinations, Compare Resting ECGs 29 Resting ECGs, Interpretation 32 Resting ECGs, Medians 32 Resting ECGs, Multiple Medians 33 Exercise Phase 16 Exercise Test Interpretation 8 Exercise T
Index Local Database, Select Patient Records 4 Location Number 3 LW 15 O M Measurement Mark for T-offset, Adjust 19 Measurement Marks, Adjust 17 Measurement Results, Ambulatory Blood Pressure Measurement 11 Measurement Results, Configuration 26 Measurement Results, Edit Exercise Tests 33 Resting ECG 12 Measuring the ECG 15 Medians Resting ECG 16 Medical reimbursement program, using the program with a 3 Medication Groups, Edit Ambulatory Blood Pressure Measurement 33 Resting ECG 6 Spirometry Tests 36 Medi
Index Ambulatory Blood Pressure Measurement 33 Exercise Tests 26 Resting ECG 4 Spirometry Tests 36 Recording a 10-second ECG 7 Recording ECGs of Pacemaker Patients 6 Recovery Phase 28 Reference Value Equations, Spirometry 13 Remote Service 22 Remote View 60 Report Editor 10 Report Printout Ambulatory Blood Pressure Measurement 17 Exercise Tests 56 Resting ECG 26 Spirometry Tests 17 Resting ECG Setup Acquisition Tab 3 Final Report Tab 9 Lead Sequence Tab 7 Miscellaneous Tab 8 Resting ECGs, Receive from Othe
Index TWA Analysis, Enable 5 TWA Medians, view 38 U Units of Measure 59 User Administration 43 V VC Measurement 12 Vector Loops 22, 55 Virus protection 22 Vital Signs Window, Configuration 16 W Warning (Definition) 6 Waterfall Display 52 Widescreen monitor, diagonal 42 Z Zoom Factor, Select 14 Zoom Mode Exercise Tests 50 Full Disclosure ECG 24 Revision C CASE 2060290-201 Index-5
Index Index-6 CASE 2060290-201 Revision C
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