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1. Figure 3 2 Patient Information Dialog Box Patient Information Tab The information entered in the Patient Information dialog box is used to track the patient to help in analyzing the test results and to generate reports The Patient Information dialog box contains the following Last Name Required Type the last name of the patient First Name Required Type the first name of the patient Birth Month Required Type the 1 or 2 digit month of birth for the patient Day Required Type the 1 or 2 digit day of birth for the patient ICS Chartr 200 VNG ENG Operator s Manual 39 Section 3 40 Year Gender Address City State Zip Code Country Phone Number Identification Operator Buttons New Patient OK Cancel Help Establishing and Maintaining Records Required Type the 4 digit year of birth for this patient Required Select the gender male or female Type the street address of the patient Type the city name Type the state or 2 digit state code Type the zip code up to 15 digits Type the country name Type the patient s telephone number Type identifying information such as a social security number Select the name of the operator performing the test from the list of available operators Clear the text box and prepare the system for new patient information Accept the information in all three tabs of this dialog box and save it to the database Close the dialog box w
2. 14 1 2 3 Reinstalling ICS Chartr 200 VNG ENG Software 15 1 2 4 Demo Database c cccccccccccssssececccecessesssecececeesensaeeeeeeeens 15 1 3 Workstation and Network Considerations ccccccsssecceeeeeeenees 16 Section 2 Gettine Started in V NG ws ccsccsssieateveseeseeseuserecacess en e aaae 17 2 1 Patient Select On 2 ncccecdsvstsswscacdedetss siueeanadieseta oiveesecdieucsdsdterccieenesees 17 2 2 VNG Main Window ccccecssssccccececeeeesscccecececsesessnsaeceseeseseees 19 2 2 1 New Test Tabs icisicescdecoctassucsevpekeisrcdisavsesstacseress odvsenstiedeeeses 22 22 2 REVIEW La sericis maiii einai E NE 23 22 3 Toolbar BUON Sonicin ia 24 2 3 Menu Bar Commands ccccccccessssececcceeeesesssececeeeeeesensaeeeeeeeens 26 23M File MCI ice ceccscsicdeveeiceecsebiedecasdieeess sive dvecsb ness basiweseeeeenasees 26 23 2 Database Menu suecos renine E ace ana eateediieee 27 2 3 3 drt Men c2csesssclactesddieiiaasiectenc cdi vissaciasdendes a a 28 23A Test MENU seeriana e EEEE AEE EEE 29 233 Waveform Ment vuurrooi aena EEEE AE 30 2 3 6 Video Meine nnion anana a a e 31 2 3 1 Diagnostics Men seisirerniicensinisearaiiia iieii 32 23 8 Analysis Memilsstiscsitesescciaseseed iaddedutsdindedecdapeetetatecwestaddoeeloanse 33 23 9 Signal MEM cs sei cect stendestavsees eneee 35 2 310 Interpreter Menu i s c csc ssssesieccesseacsetessecsuustutetzesresseceseeasensstene 35 ZS AT Help MEMU sesievstisecec
3. Pressure Both Eyes Head Shake Both Eyes Rotary Chair Both Eyes Rotary Swing Both Eyes Dix Hallpike Individual Eyes Position Individual Eyes Sa Spontaneous Both Eyes Note The available tests are specific to a particular hardware configuration e g two or four channels ICS Chartr 200 VNG ENG Operator s Manual 211 Appendix B VNG Tests B 2 Saccade Tests Table B 1 Procedure Saccade Both Eyes Horizontal Random Light target moving randomly each Horizontal Eye Position Vertical Eye Position Position 1 25 seconds over a 34 arc Target Position Vertical Random Light target moving randomly each 1 25 Horizontal Eye Position Vertical Eye Position Position seconds over a 34 arc Target Position Horizontal 10 Light target moving 10 degrees right or left Horizontal Eye Position Vertical Eye Position of center each 1 25 seconds Target Position Horizontal 15 Light target moving 15 degrees right or left Horizontal Eye Position Vertical Eye Position of center each 1 25 seconds Target Position Vertical 10 Light target moving 10 degrees up or Horizontal Eye Position Vertical Eye Position down from center each 1 25 seconds Target Position Vertical 15 Light target moving 15 degrees up or Horizontal Eye Position Vertical Eye Position down from center each 1 25 seconds Target Position Horizontal Random Target moved at random intervals to Horizontal Eye Position Ver
4. The patient results were within normal limits Close Save Delete ikek y Figure 7 15 Define Macro Dialog Box Drop down list Text box Done Save Delete Default Type the up to 12 character name of a new macro or select an existing macro from the list Type the text for the macro or edit existing macro text Exit the dialog box and save any changes Save the currently displayed macro Delete the currently displayed macro Replace the current operator macros with the macros defined for the Default Operator ICS Chartr 200 VNG ENG Operator s Manual 161 Section 7 Working With Reports To define a word processor macro 1 2 Select Tools Define Macro to display the Define Macro dialog box Type an up to 12 character alphanumeric name for the macro Type the text in the text box Press Enter to start a new line Note Add new macros by typing over any word already entered in the box and saving it Press Save to save the macro name and text Press Done to exit the dialog box 7 6 2 Inserting Macros Once a macro is defined the operator may insert the macro text anywhere within the word processor portion of a patient report Macros are inserted from the Get Macro dialog box x Gi Get Macro The patient results were within normal limits Insert Cancel Figure 7 16 Get Macro Dialog Box Drop down list Display a list of existing macro n
5. 6 Press F12 Save to save the analysis and exit the review mode for the selected test Note Press F12 Save to save the analysis to the database and overwrite any previously done analysis of the test Press F9 Cancel to exit the Analysis mode without saving the analysis ICS Chartr 200 VNG ENG Operator s Manual 145 Section 6 6 11 146 Reviewing Analyzing Test Results Renaming Protocols The VNG ENG software provides a Rename option A test may be renamed and analyzed appropriately if it is misnamed Any of the test protocols that do not require the use of a light bar stimulus can be renamed The rename a protocol option is available in the Review mode To rename a test 1 Select the test from the directory to highlight it 2 Press F5 Rename or select Test Rename Test from the Menu bar to display the Protocol Rename dialog box Protocol Rename x Select a protocol to rename the current test OK Position Head Hanging Eyes Open Position Head Hanging Eyes Closed Caloric Right Ear Cool abe Caloric Right Ear Warm Caloric Left Ear Warm Help Caloric Temperature Switched Cool Warm 5 Caloric Temperature Switched Warm Cool Ice Caloric Right Ear 7 Supine Ice Caloric Left Ear Supine il Ice Caloric Right Ear Prone Ice Caloric Left Ear 7 Prone Pressure Right xj D eanna Diakt Danika Figure 6 31 Protocol Rename Dialog Box 3 Select a protocol name from the list
6. 8 Click Preview to display the Print Preview mode Print Preview J Prevos Page weaPase Coe Este Page Padone hame Brown Sanara Padene ID Session Dave 1112997 Saccade Both Eyes ortzontal Ranaoe Poston EXRRRRESO POS SISESE Figure 7 20 Print Preview Mode Test Result Page While in Print Preview mode the operator may a Click Print to send the report to the printer Working With Reports b Click Previous Page and Next Page to preview each page of the report c Click Exclude Page Include Page to exclude or include individual pages from the report Excluded pages are not part of the printed report page count and Excluded displays instead of the page number on the preview page Excluded pages are only valid when printing from the Print Preview mode d Click Close to exit the Print Preview Mode and return to the Print Report dialog box 9 Click Printer Setup to display the Printer dialog box 10 Select the printer at which the report will be printed and the paper size Letter or A4 All VNG reports print in the Portrait mode 11 Click Print to print the report 170 GN Otometrics Section 7 Working With Reports 7 9 Creating Custom Reports In the Review Mode individual waveforms may be copied and pasted into a temporary custom waveform report Although the resulting report may be printed the system does not save an electronic version The waveform report is deleted whe
7. Click on a specific test and signal to highlight it then click the Select button to place the name of the selected protocol and signal in the Selected text box Alternate Double click on a signal to place it in the Selected Test box This represents the location on the report page where the selected protocol and signal results will display Click on the New Page button to add a new page to the report Continue selecting tests and placing tests until satisfied with the report setup Click OK to save the format and return to the Report Setup dialog Click Done to exit the Report Setup mode or repeat Steps 2 through 8 until you have selected and set up the page format for each protocol to be included in the report GN Otometrics Section 7 Working With Reports 7 8 Printing a Report Reports can be set up to include the word processor report page the clinical information report the test results or selected combinations of these Individual test results choices for test result pages include caloric Butterfly and or Pods views and a combination saccade and tracking page Note Both the Saccade Horizontal Random Position and the Tracking Sine Horizontal protocols must have been run to print the combination Saccade Tracking page Other viewing options can be selected including the option to use Raw Averaged or Raw and Averaged data from Saccade and Tracking Analyses or to include results from previous test sessions for the patient
8. Figure 4 4 Hardware Startup Warning Dialog Box GN Otometrics Section 4 Setup and System Options Summary of Hardware Problems View a list of missing hardware and or problem hardware All of the required hardware must be installed and working properly in order to collect VNG ENG data Do Not Display This Warning Next Time Do not check this option to enable the system to display this dialog box only if a hardware problem is detected when the ICS Chartr 200 VNG ENG software is started Check this option if you do not want to see a list of missing hardware the next time ICS Chartr 200 VNG ENG is started OK Save selected option and close the dialog box ICS Chartr 200 VNG ENG Operator s Manual 69 Section 4 Setup and System Option 4 4 System Options Peak Frequency GDT Interface Tab The System Options Peak Frequency GDT Interface Tab is used to select the program language peak frequency calculation options and German GDT interface settings To change these settings select the Edit System Options Peak Frequency GDT Interface Tab System Options Operator Settings Test Battery Workstation Settings Peak Frequency GDT Interface Program Language English United States zi Peak Frequency Calculation Caloric Frequency Butterfly G Claussen Haid Stoll Freyss IV Show Peak Frequency for Non Caloric Tests I Subtract Spontaneous Nystagmus from Frequency Minimum Spontaneous Frequency 10 C SPV F
9. H 3 Deleting Video To permanently delete a video recording 1 Select the desired test in the Review Tab 2 Select Video Delete in the Menu Bar A dialog appears asking you to confirm the deletion of the video file Select Yes to delete the file or No to preserve it Video deletion has no effect on the test or the tracings Note Once deleted a video file cannot be recovered H 4 Archiving Recorded Video When a database is archived all video associated with it is also archived There are two ways in which you can preserve video recordings when archiving your database Export individual video recordings of interest Archive Patient Records 262 GN Otometrics Appendix H Video Files H 5 Exporting Video The Video Export feature enables you to save a copy of a video recording to a file of your choosing Exported video files may then be used for purposes such as conferring with colleagues or experts or teaching When a video recording is exported a new copy of that video including caption information is created This copy is detached from the patient s record in the Chartr database Exported video files are stored in the industry standard Audio Video Interleave AVI file format Video data may be compressed at some loss of image quality during the export operation to reduce the size of the exported video file During Video Export a progress dialog displays the status of the export operation This dialog contains a
10. ICS Chartr 200 VNG ENG Operator s Manual VNG Tests Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Posit
11. Right Cool Peak SPY 37 deg s s 404 i pacan w 304 h P z ja H 20 a Tm oaa wa 1an v r N a E 0 5 S ta 104 s fa 10 a Z ni o 201 el A 7 30 E g 40 21 deg s 0O 20 40 60 80 100 120 140 Seconds 20 oma emo lt Aa oCOorm lt e morrv gorv B 4S o O S o ALeft Warm Peak SPY 37 deg s Left Cool Peak SPV 21 deg s 0 20 40 60 80 100 120 140 Seconds Figure 6 19 Baseline Shift Example For each caloric test you must determine if the patient has pre existing nystagmus with eyes closed in the caloric test position If so you must move the baseline by an amount equal to the slow phase velocity of the pre existing nystagmus If you fail to do this your calculation of gain asymmetry will be inaccurate GN Otometrics Section 6 6 8 1 6 Gain Asymmetry Sometimes the peak intensities of caloric responses in one direction are significantly stronger than the peak intensities of responses in the other direction This is called directional preponderance DP It has two components The first component is baseline shift which is due to pre existing nystagmus with eyes closed in the caloric test position Caloric responses are in fact equally strong in both directions but the baseline is shifted by an amount equal to the slow phase velocity of the pre existing nystagmus so the peak intensities of responses in the direction of the shift are higher than the
12. Start and stop data collection Save test results Calibrate or center a waveform Accept and save test results Access the New Test and Review tabs on the Main Window Move from one test to another in the New Test and Review tabs Check the electrode impedance and video and auto adjust options Place Event E Eyes Open EO and Vision Denied VD markers on the waveform ICS Chartr 200 VNG ENG Operator s Manual 103 Section 5 Test Preparation and Data Collection To record video using the remote control 1 Start a collection in VNG 2 Press the top Start button on the remote to begin video recording Note While a video is recording press the Start button again to restart the video recording 3 Press the top Stop button on the remote to stop a video recording while in progress When not using the remote control place it in the cradle See Appendix D for more information 104 GN Otometrics Section 6 Reviewing Analyzing Test Results 6 1 This section provides information on how to review and analyze test results Overview Sophisticated review and analysis of tracings is part of the ICS Chartr 200 VNG ENG system This section provides information on the review and analysis of tests conducted during a session All of the tests conducted and saved during a patient test session are available for review and analysis in the Review Analysis mode In addition to test results all cal
13. 60173 County U S A Phone Fax Email Report Header Application Startup Hardware Messages Normal Display waming message at startup if CHARTR hardware cannot be accesst C Suppress Do not display message at startup if CHARTR hardware cannot be acces Diagnostic Mode Display accessible hardware message each time application is start Figure 4 3 System Options Workstation Settings Tab 4 3 1 Workstation Settings Workstation specific settings include Workstation Name Name assigned to this workstation The assigned name must correspond to your network naming conventions if this workstation is connected to a network Chartr Window Size Select the display window size for this application on this workstation grayed options are not available on this workstation 1024 x 768 at normal DPD 1280 x 960 at normal DPI or 1280 x 960 large DPI only Show Database Size Warning at Startup 75 and 512 MB Select to have the system display an alert when the database reaches 75 and 512 MB ICS Chartr 200 VNG ENG Operator s Manual 65 Section 4 Setup and System Option Order Tests in Review Tab by Test Date Time Select to display the order of the tests in the review tab sorted by the time date they were collected from first collected to last collected To rename a workstation 1 Select Menu System Options from the Menu Bar to display the System Options dialog box 2 Select the Workstation Setting
14. An isolated temperature effect does not adversely affect calculations of the response parameters such as UW and DP However other types of technical errors may become more difficult to identify in the presence of temperature effect If significant temperature effect is observed frequently the irrigator should be checked and if necessary the irrigation temperature calibrated Also the examiner should review the test procedures to ensure that they are not different for the different irrigations For example the exact same procedure should be followed if eye movements are recalibrated between temperature changes ICS Chartr 200 VNG ENG Operator s Manual 129 Section 6 130 6 8 1 5 Baseline Shift Reviewing Analyzing Test Results Some patients have pre existing nystagmus with eyes closed in the caloric test position The best time to observe this nystagmus is just after the onset of the caloric irrigation because the irrigation alerts the patient When the tympanic membrane is intact the caloric response itself does not begin until about 20 seconds after the onset of the irrigation If the patient has pre existing nystagmus the baseline of the caloric responses is no longer zero it is the slow phase velocity of the pre existing nystagmus In this example the patient has left beating spontaneous nystagmus with rightward slow phase velocities of 10 deg sec The baseline of the caloric responses is shifted upward by that amount
15. Cancel Accept Function Access Operator s Manual Decrease or increase stimulus speed during calibration Center the waveform during calibration Only in systems with a pre amp Cancel the calibration without saving results Accept the calibration Table G 6 Function Keys Calibration Accept F4 F12 Function Key Action Resume Stop Function Resume calibration i e redo active calibration stage Stop the calibration Table G 7 Function Keys Calibration Stop F1 F3 F4 F5 F6 F7 F8 F9 F10 F11 F12 Function Key Action Default Resume Enlarge Shrink Down Cancel Overlap Waves Spread Waves wn Cc xr D 5 a 5 Function Access Operator s Manual Use default calibration settings Resume or restart calibration Increase size of wave Reduce size of wave Move selected tracing up Move selected tracing down Cancels that calibration Overlap all waveforms Spread all waveforms Save calibration and access the next channel to calibrate or if all changes have been calibrated return to Test mode 256 GN Otometrics Appendix G Table G 8 Function Keys Review Mode Function Keys Function Key Action F1 Help F2 New Patient F3 Existing Patient F4 New Test F5 Rename F6 Report F7 Filter Unfilter F8 Review Calib F9 Switch Eye F10 Previous Test F11 Next Test F12 Analysis Function
16. Convert Database to Latest Version Upgrade a database on your hard drive to the 2 3 3 Edit Menu most recent database version available The Edit Menu is used to establish and or configure hardware and software settings and report formats Patient Info Patient Report Operator Info Switch Operator System Options Update Maximum Test Duration Mark Report Complete Referring Physicians Referring Facilities Figure 2 9 Edit Menu Patient Info Patient Report Mark Report Complete Operator Info Switch Operator Referring Physicians Referring Facilities Display the Patient Information dialog box for the selected patient Display an editable copy of the test result report for the selected patient Mark the patient file as having a completed report Display the Edit Operators dialog box to add or modify operator information Display Operator Select dialog box Select an operator from the List of Available operators available only when a patient record is open Display the Referring Physician Selection dialog box and edit or add new physicians Display the Referring Facility Selection dialog box and edit or add new facilities GN Otometrics Section 2 Getting Started in VNG System Options Display the System options dialog box Select and edit operator workstation and GDT Interface options Update Maximum Test Duration Enter a maximum test duration for the selected
17. Figure 6 9 Caloric Analysis Pods Butterfly Views Note In Pods Caloric Weakness and Gain Asymmetry information display in the VNG Main Window Information Area located in the lower left portion of the window Directional Preponderance is an operator option and the information only displays if that option is selected in the Operator Settings Test Battery Tab The Butterfly chart is a nomograph of caloric results two intersecting lines one representing cool stimulations and one representing warm stimulations The vertical axis of the chart represents slow phase velocity the horizontal axis is percent caloric weakness The box in the center of the chart represents normal values By default these values are plus or minus 25 for caloric weakness plus or minus 6 degrees per second for implied asymmetry The lines in the graph are connections between the values of the peak responses from right ear caloric stimulations plotted on the left edge and the left ear responses plotted on the right edge of the chart A normal response presents an intersection point within the normal box Caloric weaknesses of more than 25 have intersections to the left or right of the normal box implying a right or left ear caloric weakness respectively Abnormal average implied asymmetry unnormalized gain asymmetry or spontaneous nystagmus presents intersections above or below the normal box A right asymmetry falls above the box and a left asymmetry has its inter
18. GN Otometrics Appendix B VNG Tests B 5 Optokinetic Tests Table B 7 Procedure Optokinetic Both Eyes 20 sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 20 per second 20 sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 20 per second 20 sec Up Multiple light targets moving upward at 20 Horizontal Eye Position Vertical Eye Position per second 20 sec Down Multiple light targets moving downward at Horizontal Eye Position Vertical Eye Position 20 per second 30 sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 30 per second 30 sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 30 per second 40 sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 40 per second 40 sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 40 per second 60 sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 60 per second 60 sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 60 per second Accelerating External stimulus provided by operator Horizontal Eye Position Vertical Eye Position ICS Chartr 200 VNG ENG Ope
19. N 0 1 o f0 20 30 wW o f0 20 30 R Saccade Amplitude DEG L R Saccade Amplitude DEG L Figure 6 29 Saccade Latency Accuracy and Peak Velocity Individual Eye Test Select Analysis Raw Averaged or Raw and Averaged from the Menu bar to display different views of the data Click directly on a data point to move the tracing to correspond with the analysis result 6 Press F12 Save to save the analysis and exit the Analysis mode for the selected test Note Press F12 Save to save the analysis to the database and overwrite any previously performed analysis of the test for that operator ICS Chartr 200 VNG ENG Operator s Manual 143 Section 6 Reviewing Analyzing Test Results 6 10 Analyzing Sinusoidal Tracking The purpose of this procedure is to evaluate eye movements in response to a sinusoidally moving stimulus in terms of velocity gain and to compare them to normal values The stimulus for the test is a light target moving in a sinusoidal pattern including 3 cycles at each of the following frequencies 0 2 0 3 0 4 0 5 0 6 0 7 Hz The amplitude of the movement is 16 7 degrees Once completed the sequence of sine waves repeats until the test is terminated The maximum test length is 200 seconds 3 minutes 20 seconds During analysis the stimulus and the eye movements elicited are compared The phase of the fundamental frequency of the eye movement is computed from a Discrete Fourier
20. S Display the Save dialog box Ctrl Z Undo the previous action Ctrl X Cut the selected text and place it on the clipboard Ctrl C Copy the selected text to the clipboard Ctrl V Paste the text from the clipboard to the cursor location in the document Ctrl F Display the Find dialog box Ctrl H Display the Replace dialog box Ctrl M Display the Get Macro dialog box ICS Chartr 200 VNG ENG Operator s Manual 251 Appendix F Keyboard Shortcuts Keyboard Shortcuts Using the Alternate Key These keyboard shortcuts are available for use with menu and submenu options 1 Press the Alternate Alt key followed by the underscored menu letter to display the indicated Menu Press the underscored letter in a submenu option to activate the option For example to use the Format Menu to display the Paragraph Format dialog box a Press Alt o to display the Format Menu b Press P to display the Paragraph Format dialog box 252 GN Otometrics Appendix G Function Keys Chartr VNG ENG software function keys provide keyboard access and control during testing and while reviewing results The function keys are located along the bottom of the Main Window F3 F4 F5 F6 F7 F8 F9 Delete Enlarge Shrink Up Down Close Analysis Help Reanalyze Figure H 1 Chartr VNG ENG Software Function Keys To use a function key either press the keyboard equivalent key or place the cursor over the on screen function key button and singl
21. Selecting an Existing Physician Editing Physician Information 3 2 1 Referring Physician Information Dialog Box The Referring Physician Information dialog box is accessed from the Patient Information Physician s Order tab dialog box by clicking the Referring Physician Info button or by selecting Setup Referring Physicians from the Empty Main window Referring Physician Information Last Name First Name Address City State Zip Code Country Identification Phone 1 Phone 2 Phone 3 Phone 4 Phone 5 Figure 3 5 Referring Physician Information Dialog Box Last Name Type the last name and degree if desired of the referring physician First Name Type the first name of the referring physician ICS Chartr 200 VNG ENG Operator s Manual 47 Section 3 48 Address City State Zip Code Country Identification Phone 1 Phone 2 Phone 3 Phone 4 Phone 5 Fax Email Buttons OK New Delete Cancel Help Establishing and Maintaining Records Type the street address of the physician Type the city name Type the state or 2 digit state code Type the zip code up to 15 digits Type the country name Type any identifying information Type the primary phone number Type another phone number if available Type another phone number if available Type another phone number if available Type another phone number if av
22. italic I or underline U style to selected text Assign paragraph justification to selected text Assign bullet or numbered list style to a paragraph GN Otometrics Section 7 Working With Reports 7 2 4 Word Processor Ruler Bar The word processor ruler bar allows the operator to set tabs and adjust the page margins Select numbered list or bullet Select paragraph sytle Select font syle Eile Edit Format Tools Help Normal v Times New Roman Left margin for paragraph first line Tab set Right margin Select tab type left right decimal center Figure 7 8 Word Processor Ruler Bar First click anywhere in the text of the report to display the left right margin triangles The two small triangles on the left side of the ruler bar indicate the paragraph s left margin CLick and drag the triangles to adjust the left margin Click and drag the top triangle to indent only the first line of a paragraph The larger single triangle on the right side of the ruler bar indicates the paragrph s right margin Click and drag this triangle to adjust the right margin ICS Chartr 200 VNG ENG Operator s Manual 153 Section 7 Working With Reports 7 3 Using Find and Replace The Find option allows the operator to search a report to locate a specific word number or phrase The Replace option allows the operator to find a specific word number or phrase and replace it with another operator defined word number or phras
23. Backup completed successfully Database Conversion in progress Converting main database Please wait Main database converted Converting Model database Please wait Model database converted Press Next to continue Figure 1 17 Database Conversion Complete Dialog Box Installation Wizard GN Otometrics Section 1 Introduction to the VNG System q Installation Complete After the software and drivers are installed and the existing databases are converted click Finish to conclude the installation process Installation Complete ICS CHARTR 200 ENG VNG has been successfully installed Press the Finish button to exit this installation Figure 1 18 Installation Complete Dialog Box Installation Wizard 6 Click OK to restart Windows when prompted Note Make sure the Chartr system hardware is connected and turned on Install This system must be restarted to complete the installation Press the OK button to restart this computer Press Cancel to return to Windows without restarting Corci Figure 1 19 Restart Windows Prompt ICS Chartr 200 VNG ENG Operator s Manual 11 Section 1 Introduction to the VNG System 7 Use the Found New Hardware Wizard to install drivers for any new hardware identified when Windows restarted If the identified hardware came with an installation CD insert it Select an installation option and click Next to continue Found New Hardware Wizard Welcome to th
24. Click Cancel to stop the printing process 7 11 Printing an Analysis In the Analysis mode an analyzed test result can be sent directly to a printer To print an analysis 1 2 Click the Review tab to access the Review Analysis mode Select File Print Analysis from the Menu Bar to display a prompt indicating the printer to which the analysis is being sent The waveform will print to the indicated printer Click Cancel to stop the printing process if desired ICS Chartr 200 VNG ENG Operator s Manual 175 Section 7 Working With Reports 7 12 Printing a Calibration Calibration waveforms can be sent directly to the printer and printed immediately Note This procedure can only be done from the Calibration mode after the calibration is finished or while a calibration is being reviewed To print a calibration 1 Select File Print Calibration from the Menu Bar 2 A prompt displays listing the name of the calibration and the printer to which it is being sent Note The print order is spooled and will print as soon as the system resources are available so that if a patient test is in process it will not be interrupted 3 The waveform will print to the indicated printer Click Cancel if you want to stop the printing process 176 GN Otometrics Section 8 Exporting Importing and Archiving Records 8 1 This section provides information and procedures for exporting importing and archiving patient and database
25. Continue running the calibration for two to three more cycles in order to verify the accepted calibration Press F12 Stop to save the current channel s calibration and proceed to the next channel or complete the calibration if all channels are calibrated Before performing a calibration consider the following The option to calibrate is only available at the start of a new test and not during data collection Two stimulus speeds are available fast 0 30 Hz and slow 0 20 Hz Fast is the default setting The operator may change the speed during calibration however the calibration stimulus speed will only change at a peak or trough of the stimulus There are two parts to the calibration process a calibration stage during which the system adjusts the gain based on the signal from the eyes followed by a verification stage during which the system displays the gain for a particular calibration Verification is the responsibility of the operator Each time the stimulus crosses zero degrees on a downward swing the system adjusts the gain and offset The system monitors the stimulus peak to peak and the patient s peak to peak amplitudes These amplitudes are used to automatically adjust the gain of the patient s eye movement to match the stimulus The baseline offset is based on the center of the patient s peak to peak amplitude When the operator presses F12 Accept an Event Marker is immediately placed in t
26. Date Modified 11 13 2007 11 47 AM File and Folder Tasks ra Text Document Text Document Move the selected items Copy the selected items Publish the selected items to the Web Q E mail the selected items YK Delete the selected items Other Places Details 2items selected Total File Size 10 8 KB readmeVNG_ENU txt E readmeVNG_DEU txt E INSTALL LOG ChartrExceptionLog txt E ChartrUsB sys ChartrUSB inf J vngtemplate_DEU rtf w template rtf W InterpretationAssistantTempl Wi interpretationAssistantTempl chartrENG_ENU hip chartrENG_DEU hip EB chartrENG_ENU cnt B chartrENG_DEU cnt 9 ResourceENU dll S ResourceDEU dil GPUNWISE EXE Text Document Text Document Text Document System file Setup Information Rich Text Format Rich Text Format Rich Text Format Rich Text Format Rich Text Format Help File Help File CNT File CNT File Application Extension Application Extension Application Figure C 3 vngtemplate_ENU rtf in Windows Explorer Note 10 11 2007 11 50 AM 10 11 2007 11 50 AM 11 13 2007 11 46 AM 11 9 2007 2 57 AM 10 11 2007 1 28 PM 10 11 2007 1 28 PM 4 28 2006 10 13 AM 9 11 2007 3 32 PM 4 28 2006 10 13 AM 4 28 2006 10 13 AM 9 11 2007 3 32 PM 10 11 2007 11 50 AM 10 11 2007 11 50 AM 10 11 2007 11 50 AM 10 11 2007 11 50 AM 10 11 2007 11 50 AM 10 11 2007 11 50 AM 2 22 1999 5 46 PM 2 My Computer You may also open this file in another
27. Delete a tracking cycle Increase the gain of the wave Reduce the gain of the wave Move selected wave up Move selected wave down Prompts to save analysis Clicking No will go back to Review state without saving Move the tracing to the previous cycle Move the tracing to the next cycle Save analysis Table G 11 Function Keys Saccade Individual Analysis Function Key Action F1 Help F2 Reanalyze F3 Delete Saccade F4 Right Eye Gain Left Eye Gain r i F12 Save Function Access Operator s Manual Clear previous analysis and begin a new analysis Delete analysis results of selected saccade Toggle between a display in the Information area of the gain and number of saccades accepted for the right or the left eye This also determines which eye the enlarge shrink up down function keys affect Increase the gain of the wave Reduce the gain of the wave Move selected wave up Move selected wave down Prompts to save analysis Clicking No will go back to Review state without saving Move the tracing to the previous saccade Move the tracing to the next saccade Save analysis GN Otometrics Appendix G Function Keys Table G 12 Function Keys Saccade Both Analysis Function Key Action i i i F i F12 Save Function Access Operator s Manual Clear previous analysis and begin a new analysis Delete analysis results of selected sa
28. Figure 6 1 Review Tab The sign in front of a listing indicates that the listing can be expanded to show the individual test protocols A sign indicates the list is completely expanded Click directly on a sign to show the name of each protocol within the procedure or session Click on the sign to hide the individual protocols back to the procedure or session level If multiple tests of the same protocol were conducted during a test session each test and the time the test was conducted displays under the session Bold text indicates that a test is designated as primary Only the primary test results will be included in the patient report GN Otometrics Section 6 Reviewing Analyzing Test Results 6 3 Working with Multiple Test Results If multiple tests are run during a test session one set of test protocol results must be designated as primary The primary test results are included in the patient report For caloric protocols the primary test also determines which test is used to analyze caloric test results The system automatically assigns the primary status however the operator may change the primary assignment of a test result at any time To change the status of a test protocol to primary 1 Open an existing patient record and access the Main Window 2 Select the Review tab to display a list of procedures protocols 3 Expand the procedure list to display the desired protocol and click on the protocol to
29. ICS Chartr 200 VNG ENG Operator s Manual 13 Section 1 Introduction to the VNG System 1 2 2 Uninstalling ICS Chartr 200 VNG ENG Software Use the following procedure if you need to uninstall the existing ICS VNG ENG software from your hard drive This procedure uses the Windows Uninstall Wizard that is located in the Windows Control Panel Note This procedure only removes the ICS VNG ENG software program files It will not remove the patient database file chartrENG mdb video files or the demo database file CA Chartr Data Demo if it is installed When you reinstall ICS VNG ENG your patient database will still be available You must delete the patient database and videos manually if you want to remove them from your system To uninstall the ICS VNG ENG software 1 2 14 Click the Start button on the Windows Task bar to display a list of options Select Settings Control Panel to display the Control Panel dialog box Select the Install Uninstall tab to display that dialog Double click on the Add Remove Programs icon to display the Add Remove Program Properties dialog box Scroll through the list of software that can be automatically removed by Windows and select ICS Chartr 200 ENG VNG Click the Add Remove button and the system will prompt with Are you sure you want to completely remove ICS ENG VNG for Windows and all of its components Click Yes to let windows remove the existing version of ICS VNG ENG fro
30. Power Supply AC DC Adapter Type FW7362M 15 from Friwo Input 100 240 VAC 50 60 Hz 700 mA Output 15V DC 2A ICS Chartr 200 VNG ENG Operator s Manual 205 Section 11 Isolation Transformer Isolation transformer System Capabilities Inputs Coupling Resolution Linearity Sampling Rate Eye Range Tracked Software Optimal Stimulus Including Light Bar Other stimulators Weights Operating Mode Warm up time Mode of operation 206 Technical Specifications Powertronix Isolation Station from GN Otometrics A S 2 Eyes 4 Channels Full Binocular Testing Simultaneous Collection of both Left and Right Eye Signals DC Response 0 1 Typical Horizontal and Vertical 1 Full Scale Horizontal 1 2 Full Scale Vertical Full 60 Hz for All Tests 30 Windows Graphical User Interface High Performance Analysis Software Database Storage of Test Data Sophisticated Patient and Test Data Management Additional Capabilities See through for External Targets Vision denied for Testing in Complete Darkness Database Storage of Test Data Patient To Bar Distance 4 feet 1 2 m Ultrasonic Range Sensing Target Position Gaze Targets 30 Pursuit and Saccades 16 Computer Controlled Target Size Less than 1 2 of Arc Brightness Software Controlled Optokinetic 6 Targets Rotation 90 Horizontal or Vertical Designed for connection to caloric stimulators Chartr 200 Unit 2 7 kg
31. Referring facility ction 1 Pagel 1 Linel Cold Figure 7 1 Report in Word Processor 7 2 1 Word Processor Functions The word processor includes the following e Basic text editing options such as cut paste and copy Text formatting by font and paragraph Spell checking 148 Tabs programmable Creating and applying macros GN Otometrics Section 7 Working With Reports 7 2 2 Word Processor Menus The Word Processor menu bar contains these menus File e Edit Format Tools Help File Menu The word processor File Menu allows the operator to create a new document save a report file save a report as a rich text format rtf file and exit the report mode Files may be saved in the default folder or in a folder selected by the operator Note Rich text format files can be opened in most Windows word processors and Internet browser applications These files retain their font and format attributes regardless of the application used to view the file File New Save Ctri S Save As Print Report Print Setup Exit Figure 7 2 Word Processor File Menu New Use the report template file to create a new report Save Save the report in the database Save As Save the report as an RTF file Use this command to apply special formatting to the report through a word processor program of your choice Note that the special formatting will not be saved in the da
32. Section 2 Getting Started in VNG This section is designed to orient you to the ICS Chartr 200 VNG ENG program The section includes detailed descriptions of the Main Window and the Menu Bar commands along with information on using function keys and dialog boxes 2 1 Patient Selection When ICS Chartr 200 VNG ENG opens the Patient Selection dialog box is displayed on top of the Main Window The Patient Selection dialog box is also displayed when an operator opens an existing patient record Patient Selection Select patient from ICS database chartr mdb Patient Name Report Last Tested VNG Data ENG Data EP Data Birthdate test test 3 22 2003 x x 3 6 1971 Demo 10 MLR 12 3 2008 3 24 1954 Demo 11 P300 9 3 2008 6 2 1957 Demo 15 EP System Dx T 8 15 2008 3 6 1980 Demo 12 VEMP 8 14 2008 8 3 1988 Demo 9 Electrocochleoor 8 14 2008 8 3 1988 Demo 7 Adult ABR 8 8 2008 10 2 1984 Demo 6 Baseline Shift 7 19 2007 x s 5 12 1938 Demo 5 CNS VNG 5 3 2007 i a 2 21 1928 Demo 4 UW VNG 3 26 2007 a 6 24 1952 Demo 1 Normal VNG 3 7 2007 g ba 8 26 1969 Demo 13 Normal ASSR 6 18 2004 4 25 2004 Demo 14 Conductive ASSR 6 18 2004 5 18 2004 n Demo 3 BPP VNG 8 31 2001 z 1 1 1950 Demo 8 Infant Click 3 9 2000 7 19 2000 Demo 2 Normal ENG 10 10 1997 x x 9 4 1960 These patients have historic sessions and cannot be distinguished as ENG or VNG Figure 2 1 Patient Selection Dialog Box The Patient Selection dialog box lists
33. The target and the signal waveforms should overlap This may take 5 to 10 seconds before they overlap You may spread the waveforms to make sure both signals are displayed 9 Verify that the Pass light on the text fixture is illuminated 10 Press F9 Cancel to stop the current calibration Then press F3 Default to move onto the next channel SOS Gi Ee TEST TST i D oee Sow ise Fame vest Fest Deptped Tet Tae bon 00 10 ve 00 20 Dani Colma atong naratas woane Accept Caite sisan Over tange r n n Fil Hoe _ Care Accom Crean Loree MoE Cater dar me Sperat Cl ak Cpr at Figure 9 3 Test Dialog Box 11 Repeat this process for all channels 12 IMPORTANT In order to begin patient data collection click Diagnostics USB Unit Loopback and HW Diagnostics Change the Loopback setting to None 13 Contact GN Otometrics for technical support if the target and signal waveforms do not mirror each other Note If you continue to have problems and the system passes the diagnostic evaluation the problem may reside with the electric leads the electrodes or the patient electrode junction ICS Chartr 200 VNG ENG Operator s Manual 187 Section 9 Troubleshooting 9 2 2 ENG Board Check The board check diagnostics option is used to verify the operating status of the amplifier board in the Chartr 200 Note This diagnostic test should be used only in conjunction with or under the direction of GN Otometrics personnel Se
34. for each patient Indicates the number assigned to this patient record in the database Open the record for the selected patient Access the Patient Information dialog box to start a new patient record See Section 3 1 3 Establishing a New Patient Record for additional information Delete the records for the selected patient from the VNG ENG database Close the record for the selected patient Exit this dialog box Opens the Operator s Manual GN Otometrics Section 3 Establishing and Maintaining Records 3 1 2 Patient Information Dialog Box The Patient Information dialog box is a repository for all patient and patient related information including referring physician referring facility and clinical information Note This dialog box may also be accessed by selecting Edit Patient Info The Patient Information dialog box has three tabs located directly under the Title Bar Patient Information Physician s Order Clinical Information Three buttons OK Cancel and Help located at the bottom of the dialog box display regardless of the tab accessed Patient Information X Patient Information Physician s Order Clinical Information Last New ae Patient Eirst Name Birth Month 0 Day 0 Year 0 Gender Female C Male Address City State Zip Code Country Phone Number Identification Operator Operator Default la
35. please copy this token from the file C Program Files ICS MedicaNnterpretation Assistant rtf and paste it in the engtemplate rtf file ICS Chartr 200 VNG ENG Operator s Manual 237 Appendix C Customizing the Word Processor Report C 5 Report Template Database Tags The following is a list of the VNG ENG database access tags and the information each retrieves into a patient report Table C 1 Patient Report Database Access Tags lt IA_RESULTS gt Caloric test interpretation derived by the Caloric Test Interpretation Assistant lt Caloric_Weak gt Caloric unilateral weakness lt Dir_Prepond gt Directional preponderance lt Salutation gt Salutation 238 GN Otometrics Appendix D Setting up the ICS Chartr 200 Hardware Several hardware configurations are possible with the VNG ENG system All system components connect to the rear of the ICS Chartr 200 or the PC via connecting cables included See Figures D 1 D 2 and D 3 for illustrations of the setup of the various ICS Chartr 200 VNG ENG components Contact GN Otometrics Customer Support if you need assistance Warning Connection of parts other than those supplied for this instrument by GN Otometrics can degrade the performance and safety of the system ICS Chartr 200 VNG ENG Operator s Manual 239 Appendix D Setting up the ICS Chartr 200 Hardware D 1 240 ICS Chartr 200 VNG ENG Video Monitors N AR Light Bar C Cable from ICS Chartr 200 hardw
36. 0 C irrigating the left ear Horizontal Eye Position Vertical Eye Position 222 GN Otometrics Appendix B VNG Tests B 11 Pressure Tests Table B 14 Procedure Pressure Both Eyes Right Rapid change from positive to negative Horizontal Eye Position Vertical Eye Position pressure in the right ear Right Positive A rapid increase in pressure in the right Horizontal Eye Position Vertical Eye Position ear Right Negative A rapid decrease in pressure in the right Horizontal Eye Position Vertical Eye Position ear Left Rapid change from positive to negative Horizontal Eye Position Vertical Eye Position pressure in the left ear Left Positive Positive A rapid increase in pressure in the left ear Horizontal Eye Position Vertical Eye Position Left CONN A rapid decrease in pressure in the left Horizontal Eye Position Vertical Eye Position ear ICS Chartr 200 VNG ENG Operator s Manual 223 Appendix B VNG Tests B 12 Other Tests Table B 15 Procedure Head Shake Both Eyes Active Patient shakes head in horizontal plane Horizontal Eye Position Vertical Eye Position Patient s head is shaken in horizontal Horizontal Eye Position Vertical Eye Position plane by operator Table B 16 Procedure Rotary Chair Both Eyes Rigt Clockwise rotation about the vertical axis Horizontal Eye Position Vertical Eye Position E Counterclockwise rotation about the Horizontal Eye Position Vertical Eye Position
37. 1 2 Select File Print Report from the Menu Bar to display the Print Report dialog box Click Word Processor Page to select it and include patient information in the report A Y indicates an option is selected Click Clinical Information Page to select it and include the general information in the report A Y indicates an option is selected Click on a test procedure to select it and include the test results in the report A VW indicates an option is selected Note If multiple protocols are run within a procedure e g Saccade Horizontal Random and Saccade Horizontal 10 then all of the protocols from that procedure will be printed Note If a section of tracing is to be printed the section chosen will be the section in the middle of the window when the protocol was last reviewed Click on Current Session to include only results from the active session or click All Sessions to include results from all of the sessions under the active physician order for the patient A dot indicates an option is selected Click on Raw Averaged or Raw and Averaged to display that view of the data for all saccade and tracking analysis data included in the report Select the Print page numbers option if page numbers need to be included on each page of the report The page numbers will be centered at the bottom of the report in the format x of x A Y indicates an option is selected ICS Chartr 200 VNG ENG Operator s Manual 169 Section 7
38. 2 Newest Tab risa sects treba ites a tegetay redeete testes bceee de ueetones TTI 5 3 Physician s Orders and Test Sessions cecsceceseceesteeesteceeeeeeees 79 5 3 1 Setting up a New Physician s Order 79 5 3 2 TES SESSIONS osi terere e aia te eea a a ea 80 5 4 Checking R ge inea nr k a E E E AEO EE E Es 80 5 5 TBICCHOES i kaneron eree eaa a Ei E ERES 82 5 5 1 Applying Electrodes iriccieisieciernietesciiiieeiiiviS e 82 S52 El ctrod Testiiccs cnc na oi nein ee a 83 5 5 3 Checking FlectrOdes 25 0c ccccesscsesesesseesnnssgatteavtgevennttsdevsectss 84 Table of Contents GN Otometrics Table of Contents Section 6 9 6 NNG Modes Josie ie nenene hein Gane ta nae tes 85 SGT Setting sUPVNG iretsi sas deceseccateeeds sche sia daveh EEE E 85 5 6 2 Vid o Gogglesi scsi obi a eis 86 5 6 3 Video Image Controls 2 0 0 eeccceesceceeececeeeeeenaeceeaeeceeneeees 88 5 6 4 Video Adjustments for Monocular Testing eee 90 5 6 5 Cleaning the Goggles 0 0 cece eeeeeeceeeneeeneeeneeeeecnaesnaeenaeees 91 5 1 Calibrating a Patient tienen edie bi incites tis ith Rive eee 93 5 8 Conducting a Test Collecting Data eee ceeeeeeeeeereeeneeeneeenees 96 5 8 1 Selecting the Test Eye eeceeseeereeeneeeneecnsecnaeeeaeens 98 5 8 2 Conduct a Test and Collect Data ee eeeeeesseceneceeees 99 5 9 Recording a Video mage eee eeeesecsseceseceeceeceeceseeeseeeeeeeees 100 5 10 Using the Footswitch oe eee eseesesseeseecsse
39. 3 2 Database Menu The Database Menu allows you to perform functions related to the patient database Using this menu you can archive a database export a patient file and open archived files Database v Open Main Database Open Archive Export Database Open Floppy Disk Patient Export Patient to Database Import Patients From Database Export Patient to Floppy Disk Import Patients from Floppy Disk Archive and Start New Database Convert Database to Latest Version Figure 2 8 Database Menu Open Main Database Open the active database and view patient records Open Archive Export Database Open an archived database file or view previously exported patient records Open Floppy Disk Patient Open a database file stored on a floppy disk and view the archived patient records Export Patient to Database Copy the current patient record to a database on your hard drive Import Patients from Database Copy one or more patient records from a database file on your hard drive or CD ROM to your main database ICS Chartr 200 VNG ENG Operator s Manual 27 Section 2 28 Getting Started in VNG Export Patient to Floppy Disk Copy the current patient file to a floppy disk Import Patients from Floppy Disk Copy one or more patient records stored on a floppy disk to your main database Archive and Start New Database Create an archive file of the current database and prepare the system to start a new database
40. 5 Ibs 7 oz Lightbar 7 kg 15 Ibs Video Goggles 0 4 kg 14 5 0z lt 2 min Continuous GN Otometrics Section 11 Operating Environment Temperature Rel Humidity Warm up time Air Pressure Technical Specifications 15 C to 35 C 59 F to 95 F 30 to 90 non condensing lt 2 min 600 hPa to 1060 hPa Operations at temperatures below 20 C 4 F or above 60 C 140 F may cause Storing and Handling Temperature Rel Humidity Air Pressure Dimensions ICS Chartr 200 HxWxD Weight Calibration None Required Standards Safety System EMC ICS Chartr 200 VNG ENG Operator s Manual permanent damage 20 C to 60 C 4 F to 140 F lt 90 non condensing 500 hPa to 1060 hPa 4 9 cm x 34 2 cm x 28 7 cm 2 x 13 6 x 11 3 2 7 kg 5 Ibs 7 02 EN 60601 1 UL2601 1 CAN CSA C22 2 NO 601 1 90 ICS Chartr 200 EN 60601 1 Class II Type BF IPXO Power Supply EN 60601 1 Class II IPXO EN 60601 1 1 EN 60601 1 2 207 Section 11 Accessories 208 Chartr 200 Starter Kit Nuprep 4 oz tubes pkg 3 1 tube supplied in starter kit Five snap lead package 24 length 2 ch ENG Seven snap lead package 24 length 4 ch ENG Snap disposable electrodes qty 20 VNG optical cleaning cloth Audiowipes Technical Specifications 7590030 3 75903 18 24 5 75903 18 24 7 8 64 21602 7590527 8 62 43002 GN Otometrics Appendix A
41. An optional microphone connects to the Audio Input port on the Chartr 200 e VG 40 Video Goggles connect via a video cable to the Video Goggles port on the Chartr 200 hardware The goggles have manual controls that are used to make all the adjustments needed to properly align the patient s eyes prior to a test session The operator accesses the VNG Video Adjustments dialog box in the software to change the video brightness and contrast settings for each patient ICS Chartr 200 VNG ENG Operator s Manual 85 Section 5 Test Preparation and Data Collection 86 5 6 2 Video Goggles The VNG video goggles are positioned on the patient as shown in Figure 5 5 The video goggles contain video camera lenses and mirrors The video image displays on the monitor Adjustments are done through the control knobs located on the video goggles and through the software The operator views the adjustment process by looking at each eye on the video image that displays in the Video Adjustments dialog box Figure 5 6 and optionally on the monochrome monitors 5 6 2 1 Proper Positioning of the VG 40 Goggles on the Patient Please follow these instructions to achieve quality data collection and reduce the risk of damage to the goggles Consider having a supply of the following e Make up remover The crosshairs seek out the darkest area of the eye Dark make up such as eyeliner and mascara may provide a secondary dark area that will compete
42. Cancel button that permits the export operation to be aborted Exported video is viewable on any platform that has Windows Media Player 6 0 or later installed and High Color thousands of colors or True Color millions of colors display Video File Export Dialog When the Video Export menu item is selected the Video File Export dialog box is displayed This dialog can be used to export the video file The patient s name written to the exported video file can be changed via this dialog This provides for protection of patient confidentiality when exported video is to be used for teaching The dialog also allows for selection and configuration of a codec to compress the exported video Uncompressed video is quite large 1 1 megabytes second for VNG eye movements so it may be necessary to sacrifice some image quality in order to reduce the size of the exported video file Video File Export Select export video FOLDER location Browse Select PATIENT FILE name will be inserted in avi caption text BPPY Video Sample VNG Data Video Compression Settings Codec None Uncompressed X Quality a Cancel Help Figure H 2 Video File Export ICS Chartr 200 VNG ENG Operator s Manual 263 Appendix H 264 Video Files These options are available from the Video File Export dialog Exported Video Location Patient File Name Codec Configure Quality OK Cancel Help Specify the folder where th
43. Click the Technical comment hyperlink to generate a warning message Technical Comments A WARNING It is unlikely for nystagmus with and without vision in one head position to be in different directions The test is probabaly invalid We suggest you proceed as follows 1 Clean the nystagmus slow phase velocity tracings and make sure the peak response is identified correctly eo Consider repeating the test and alerting the patient more vigorusly for tests done without vision 3 Consider the rare abnormality where nystagmus changes direction in a single head position We suggest you repeat the test while recording for several minutes to determine if nystagmus changes direction Figure 6 24 Interpretation Assistant Technical Comment 4 Finish the interpretation a Select the Vertical Nystagmus radio button to generate an interpretation for the vertical channel Select the Horizontal Nystagmus button to generate an interpretation for the horizontal channel Note If no test data for a channel has yet been analyzed the Interpretation Assistant will generate the following message The tracings for this channel have not been analyzed An interpretation cannot be provided Static Position Test Interpretation Vertical Nystagmus The tracings for this channel have not been analyzed An interpretation cannot be provided C Horizontal Nystagmus Figure 6 25 Interpretation Assistant Tracings for requested ch
44. Compression Controls The Save Video As Dialog Box allows for selection and configuration of the codec to be used to compress the exported video The codec dropdown displays a list of the installed codecs that support Chartr VNG video files Use this control to select the desired codec The Compression Configure button is enabled if the codec selected in the codec dropdown supports its own proprietary configuration dialog Selecting this button displays the configuration dialog for the selected codec The Compression Quality Controls edit box and spin control are enabled if the selected codec supports additional quality configuration If quality configuration is supported by the selected codec the codec s default quality factor from 0 to 100 will be displayed Any number from 0 to 100 inclusive may be entered in the Quality edit box The Quality spin control up down arrows may be used to increment or decrement the quality by multiples of 5 ICS Chartr 200 VNG ENG Operator s Manual 267
45. Information eee 53 3 4 Operator Informationerne eredet iei ee ria orei 54 3 4 1 Edit Operators Dialog BOX eile ceseceseceseceeeeeseeeeeeeees 54 3 4 2 Establishing a New Operator cece cesceseceneceseeeeeeeeeeeees 56 3 4 3 Selecting an Existing Operator eee eseeeseceneceteeeeeees 57 3 4 4 Editing Existing Operator Information cee eee 58 Setup and System Options sissiiiors ionii eie eia iaeiei 59 AT QVGEVICW ccs scicalh se iaeei tentai Eee hra EEEE EEEE EARE Lia 59 4 2 System Options Operator Settings Tab 60 4 2 1 Operator Settings Test Battery Tab 60 4 2 2 Establishing Operator Test Battery 0 0 eee eeeereeereees 63 4 3 Workstation Settings Tab eee ceeceeeceseeeeeeeeeeeeeeeeaeeseeeaeeenaes 65 4 3 1 Workstation Settings cceccccsccessseceenceceeeeeeseeeeenaeceeeeeees 65 43 2 Video Seung v2 ccsc sess ceiasate aden een neta oe 66 4 3 3 Facility Information ceccceecceesseceeneeceeeeeeeeeeeneeceeneeees 67 4 3 4 Application Startup Hardware Warning Selection 68 4 4 System Options Peak Frequency GDT Interface Tab 000 0 0 70 4 5 pelectan Operator seere ne E i E oan ieee da te eieenss 73 4 6 Referring Physician eriseeria teeta eee enh e 74 AT Referrin Facility eh erronei enaner e errn 75 4 80 a Dt DYE S EA EAA E E N A T A T 76 Test Preparation and Data Collection eee ee eeeceseceneceseeeeeeeseeeeneeeaes 77 Sl SOVESTVICW susie eer ooe aaar ree ee a aere ier AETI EEEN EE 77 5
46. J Murofushi T and Curthoys I S 2000 Isolated Directional Preponderance of Caloric Nystagmus I Clinical Significance Am J Otol 21 pp 559 567 5 Jacobson GP Shepard NT Balance Function Assessment and Management Plural Publishing San Diego 2008 6 Stockwell CW ENG Workbook Mosby Year Book St Louis 1983 For caloric tests when all 4 caloric tests have been analyzed this tool can interpret the results and provide information such as test validity and whether any irrigations should be repeated For position tests a separate interpretation is provided for horizontal and vertical nystagmus Even a single analyzed position test can be interpreted If the results are valid the operator will be allowed to paste the interpretation to the patient report The interpretation may be edited if needed ICS Chartr 200 VNG ENG Operator s Manual 123 Section 6 Reviewing Analyzing Test Results 6 8 1 Interpreting Caloric Tests 6 8 1 1 Conducting an Interpretation for Caloric Tests To use the Interpretation Assistant for caloric tests 1 Collect all four caloric tests Right Ear Warm Right Ear Cool Left Ear Warm Left Ear Cool 2 Select the Review tab then review and analyze each caloric test 3 Click F5 Move Baseline Up or F6 Move Baseline Down or use the arrow keys to adjust the baseline if needed Click F7 Set Baseline Shift to accept and save the new baseline 4 Click F4 PODS Butterfly to
47. Keys Function keys are used extensively in ICS VNG ENG for quick keyboard access and control during testing and analysis The actions of many of the function keys change depending on the mode or situation that is in use and the activities being performed To use a function key either press the keyboard equivalent key or place the cursor over the on screen Function Key button and single click the primary mouse button 36 GN Otometrics Section 3 Establishing and Maintaining Records 3 1 This section provides information and procedures that are used to establish and maintain patient records Patient Information 3 1 1 Patient Selection Dialog Box The Patient Selection dialog box is used to select an existing patient record or to open a new patient record The dialog box is displayed when the program opens It can also be accessed from the Main Window through the File Menu Existing Patient or the Function Key F3 Existing Patient Patients may be selected directly from the Patient Name list area A small camera icon appears next to the name of VNG patients who have tests with recorded video See Section 3 1 3 Establishing a New Patient Record for additional information Patient Selection Select patient from ICS database chartr mdb Patient Name Report LastTested VNGData ENGData EPData Bithdate test test 3 22 2009 x x 3 6 1971 Demo 10 MLA 12 3 2008 3 24 1954 Demo 11 P300 9 3 2008 6 2 1957 De
48. Light VNG Toggles the Fixation Light on or off Available only during Caloric testing on USB systems with VG40 Goggles F12 Stop Stop the test GN Otometrics Appendix G Table G 3 Function Keys Collection Pause Function Keys Function Key Action F1 Help F4 Resume F7 Hide Wave F8 Show Wave F9 Cancel Test F10 Overlap Waves F11 Spread Waves F12 Save Function Access Operator s Manual Resume testing or calibration Make the selected wave invisible Make the selected wave visible Cancel the test and do not save results Overlap all waveforms Display all waveforms Save test data and move to next protocol Table G 4 Function Keys Calibration Initial Function Key F1 Help F2 Default F5 Range F7 Electrode Test Video Adjustments F8 Close F9 Switch Eye F10 Previous Channel F11 Next Channel F12 Start Function Access Operator s Manual Use default calibration settings Access Range dialog box Access Electrode Test dialog box ENG mode only Access Video Adjustments dialog box VNG mode only Exit Calibration mode Switches the test eye during monocular testing Return to previous channel Display next channel Begin calibration ICS Chartr 200 VNG ENG Operator s Manual 255 Appendix G Function Keys Table G 5 Function Keys Calibration Start FA F5 F7 FQ F12 Function Key Action Help Slower Faster Center
49. Otometrics Section 6 Reviewing Analyzing Test Results Help Opens the Operator s Manual Default Sets the cutoff value sliders to default locations marked by center ticks Cancel Cancels current changes and restores previous values OK Applies current changes and dismisses the dialog The OK button is disabled when working with read only databases ICS Chartr 200 VNG ENG Operator s Manual 133 Section 6 Reviewing Analyzing Test Results 134 6 8 2 Interpreting Static Position Tests The Static Position Test Interpretation Assistant is a Chartr VNG ENG feature that provides suggestions to the user about the validity and the clinical significance of the VNG ENG test results In the Review mode select Interpreter Interpret Tests or press F3 Interpret Tests to open the Interpretation Assistant At least one position test with a designation of With Vision or Without Vision must be analyzed to get a partial interpretation The Interpretation Assistant for Static Position testing currently provides interpretation only for head positions that have been tested and analyzed A complete static position test requires testing in at least four head positions sitting supine head right and head left both with and without vision For an incomplete static position test the Interpretation Assistant provides only a partial interpretation The Interpretation Assistant for Static Position testing assumes that the peak SPV for each head positio
50. Page numbers can be included on or excluded for each page And all of the report pages can be previewed on line prior to printing Reports can be printed on either Letter or A4 size paper Printer paper size is established during printer setup typically from the Printer Properties dialog box Reports always print in the Portrait mode on Letter or A4 paper even if another option is set during printer set up Note Printing a report is context sensitive to the active physician order session Grayed procedures indicate that the test was completed but no report format has been set up for these tests For information on how to format each test result page in the report see Section 7 7 Report Setup Optokinetic Both Eyes Help Saccade Both Eyes V Dix Hallpike Both Eyes Print Report Report Pages v Preview Caloric Both Eyes PODS amp Butterfly Saccade And Tracking Printer Setup MGaze Both Eyes Position Both Eyes Cancel MTracking Both Eyes Sessions to print Current session Select All Pages Clear All Pages C All sessions Options Saccade and Tracking Analysis Data CR V Print page numbers aw Averaged C Raw and Averaged Figure 7 19 Print Report Dialog Box ICS Chartr 200 VNG ENG Operator s Manual 167 Section 7 Report Pages Word Processor Page Clinical Information Page Test Procedures Pages Sessions to print Current Session All Sessions Working With Re
51. SPV tests other than calorics i e gaze spontaneous position optokinetic dix hallpike Subtract Spontaneous Nystagmus from Frequency Available only if the Calculate Peak Frequency per 30 seconds options is selected Select to enable subtraction of a frequency based spontaneous nystagmus from the caloric test values Note The system expects the operator to first perform a spontaneous nystagmus test followed by the four caloric tests The spontaneous test must be analyzed before the caloric tests in order to calculate a frequency based spontaneous nystagmus value Then when the caloric tests are analyzed the system will locate the current spontaneous nystagmus test the primary test will be identified if more than one spontaneous test is found The peak frequency from the identified spontaneous test will be subtracted from each caloric test taking into account the correct sign for left and right beating Minimum Spontaneous Frequency Select to define the minimum spontaneous frequency value that will be considered applicable If the spontaneous nystagmus results in a peak frequency that is equal to or above the indicated minimum the value will be subtracted from the calorics If the spontaneous nystagmus results in a peak frequency that is below the indicated minimum the value will NOT be subtracted from the calorics Caloric Frequency Butterfly Select the type of caloric butterfly diagram will display on the PODS
52. The age of the calibration displays in the Information Area The age is calculated from the end of the calibration process to the time the displayed test was saved An Event marker A displays at the point that the operator pressed F12 Accept during the calibration session Note See Section 5 7 for additional information on conducting a calibration session 6 6 1 Calibration Review Uncalibrated Uncalibrated eye movements or where default calibration has been applied are indicated by a flat eye movement signal and a saccade stimulus as shown in Figure 6 4 R20 RIQ ml 0 20 Figure 6 4 Uncalibrated Display In the Test Review mode the calibration status of the active signal is shown in the Information Area If uncalibrated it reads e g Active Signal H uncalibrated In the Calibration Review mode the calibration status is displayed in the Workspace title If uncalibrated the title reads e g Calibration Review H default GN Otometrics Section 6 Reviewing Analyzing Test Results 6 6 2 Calibration Review Calibrated During a test review session the calibration for the active signal may be reviewed and modified Use F5 Enlarge and F6 Shrink to increase or decrease the gain of the signal in relation to the target Use F7 Up and F8 Down to move the waveform in relation to the target Saving these changes will only affect the associated test Note Modifying a calibration using the enlarge and shrink options
53. This is called lossy compression If a lossy compressed file is decompressed the resulting file is not identical to the original Whether the differences are significant depend on the type of image the person viewing the image and the technique used to compress the image Lossy codecs generally try to discard data that the human eye is not likely to notice Different codecs use different strategies for discarding data producing varying results There are four main areas in which codecs can be compared Size of the compressed video file smaller better Speed of compression process faster better Quality of the compressed video image clearer better Compatibility with other applications i e Macintosh QuickTime The following table compares the standard Windows 98 codecs using these criteria Codec Size Speed Quality Compatibility None Uncompressed Microsoft Video 1 Indeo video 5 04 Cinepak Codec by Radius Intel Indeo R Video R3 2 Key O Best O Medium O Worst Other codecs may be purchased or downloaded from the Internet However keep in mind that not all codecs support the video format used by Chartr VNG Also a compressed video file cannot be played back without the codec used to compress it Use of third party codecs is not recommended unless you are sure that the proper codec is installed on the system where the video will be played back GN Otometrics Appendix H Video Files H 8 Video Export
54. Transform and compared to the phase of the stimulus If phase shift is greater than 3 degrees leading or more than 20 degrees lagging the cycle is rejected as an artifact This is based on empirical observations of the effects of patient non compliance with instructions For gain the velocity of the stimulus over its fastest 250 milliseconds is compared to the eye movements over the same period Saccades defined as movements of more than 15 degrees second faster than the stimulus are eliminated from the calculations Average values for gains from accepted cycles are plotted and compared to values from age and sex matched normals To analyze a sinusoidal tracking protocol 1 Click on the Review tab to display the test battery for the selected patient 2 Click the sign in front of the desired Physician s Order Test Session 3 Click the sign in front of a test procedure to display a list of individual test protocols 4 Click on a specific test to select it and click on a waveform handle to select it Then press F12 Analysis to access the Analysis mode for the selected test and waveform COWES CHARTR 200 WING Johnton Veronica ENG data fie Fostyss Waveform interpreter tiep olaja mele clelmlx elo orl elele sisle ml 2 Jwdrly Ele New Test Rew Phpucan Doder Date OSASI Sine Horizontal 1213 45 PH D Halphe Both Eyes Posten Bah yer Lolt Ea 7 Cool 3928 AM Right Ear Wam 945 59 AM Lolt Ear
55. Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position 225 Appendix B VNG Tests Table B 19 Procedure Position Individual Eyes e pe ee SOS Supine w Vision Patient supine with nose toward the Horizontal Eye Position Vertical Eye Position ceiling with vision Supine w o Vision Patient supine with nose toward the Horizontal Eye Position Ver
56. box a question mark displays next to all suspect electrodes that is they are part of a pair that tests out of the range of acceptable offset potentials The table at the bottom of the dialog box provides a continually updating status report of the offset values in millivolts of the four pairs of electrodes Values exceeding 19 millivolts are unacceptable To determine the exact site of the electrodes look at the combinations with a question mark For example if the HB and the HR readings are high check the right electrode Electrode Tost Electrode Test orange green orange green red black blue red black blue white brown white brown H chan 1 red blue 0 049 mV HB chan 1 red blue 0 026 mV v chan 2 green brown 1 918 mV HR chan 2 red black 0 537 mV VR chan 3 orange while 18 929 mV VL chan 4 green brown 1 522 mV s p n wa Figure 5 4 Electrode Test Dialog Box 2 channel and 4 channel systems The millivolt readings are useful for monitoring drift Rapid drift more than 2 0 millivolts in 5 seconds makes data collection difficult The patient s eyes should be fixated when making electrode test readings The operator can set up to use 2 channel up to 5 electrodes or 4 channel up to 7 electrodes recordings Unused channels are read as bad a question mark or as rapidly changing millivolt values If only one vertical channel is used it is important to connect to
57. display the Pods Butterfly views of the caloric results 5 Select F3 Interpret or Interpreter Interpret Tests to view the results of the Interpretation Assistant validation and analysis in the Caloric Test Interpretation dialog box Note Ifall 4caloric analyses are not available the system will generate this message ICS CHARTR 200 VNG A The Caloric Test Interpretation Assistant cannot show an interpretation until all 4 irrigation results are available Please run all irrigations first Figure 6 10 Caloric Test Interpretation Assistant Message 6 Ifall 4 irrigations are analyzed and the results are within the user defined cutoff values the following dialog box displays Go to step 7 If the results are not within the cutoff values go to step 8 Caloric Test Interpretation Total response from the right 48 deg sec Total response from the left 70 deg sec Baseline Shift 0 deg sec Unilateral Weakness 19 in the right ear Gain Asymmetry 17 to the left The caloric test shows no abnormality Paste To Report Figure 6 11 Caloric Test Interpretation No Abnormalities Section 6 Reviewing Analyzing Test Results 7 Finish the caloric interpretation a Click OK to close the dialog box b Select Paste to Report to place the Interpretation results into the patient report where the text can be edited if needed and saved to the database Report ty Fle Edt Format Tool Hele E Vs wz u eal elmj f
58. eG CHARTR 200 VNG ENG Chartr 200 VNG ENG User Manual Doc no 7 60 0810_05 Part no 7 60 08100 e CE otometrics 0459 MADSEN AURICAL ICS Copyright notice No part of this Manual or program may be reproduced stored in a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise without the prior written con sent of GN Otometrics A S Copyright 2011 GN Otometrics A S Printed in Denmark by GN Otometrics A S Denmark All information illustrations and specifications in this manual are based on the latest product information available at the time of publication GN Otometrics A S reserves the right to make changes at any time with out notice Version release date 13 September 2011 Trademarks The GN Otometrics logo is a trademark of GN Otometrics Chartr 200 is a trademark of GN Otometrics Windows is a registered trademark of Microsoft Corporation Technical support Please contact your supplier FM template version 01 02 2010 Table of Contents Section 1 Introduction to the VNG System oo ee ceeceeecseeceseeeeeeeeneesseesaeeeaeeeaeeees 1 V0 TPO dU CHOI wissen sctbied uc iceetss e EEEE LE EE E EEEE 1 Fale Intended UsSecenierinrii tiine ea dace Ps neh hsp onens 1 1 2 Installing Reinstalling ICS Chartr 200 VNG ENG Software 2 1 2 1 Installing ICS Chartr 200 VNG ENG Software 2 1 2 2 Uninstalling ICS Chartr 200 VNG ENG Software
59. external ear canal Does the patient have a tympanic membrane perforation in the left ear Does the patient have excess cerumen in the left external ear canal Does the patient have a narrow left external ear canal Yes No Don t Know Don t Know Don t Know Hearing Assessment Fitting Systems GN Otometrics North America 1 800 289 2150 sales gnotometrics com Se otometrics GN Otometrics Appendix B VNG Tests This appendix provides a descriptive list of all of the VNG ENG test protocols by procedure The procedures are listed in the same order found in the Test Battery In addition this appendix provides a list of the test protocols in the default Test Battery as supplied by GN Otometrics B 1 Overview All of the ICS VNG ENG test protocols available to an operator when setting up a Test Battery are listed and described in this appendix In addition this appendix provides a list of the test protocols in the original default operator s Test Battery The procedures are listed in the order found in the Test Battery as follows e Saccade Both Eyes e Saccade Individual Eyes Gaze Both Eyes Gaze Individual Eyes Tracking Both Eyes Tracking Individual Eyes Optokinetic Both Eyes Okan Test Both Eyes Dix Hallpike Both Eyes Position Both Eyes Caloric Both Eyes Caloric Temperature Switched Both Eyes Sa Sa Ice Caloric
60. eyes Windows Media Player version 10 1 2 3 4 5 Press the Stop button In the Menu Bar click on the down arrow in the upper right corner of the screen Select Play Captions and Subtitles On if available Press the Play button The caption will be visible If necessary enlarge the caption window by grabbing the top and dragging it towards the image of the eyes Windows Media Player version 11 1 2 3 4 Press the Stop button Right Click on title bar to see Play menu Select Play Lyrics Captions and Subtitles On if Available Press the Play button The caption will be visible If necessary enlarge the caption window by grabbing the top and dragging it towards the image of the eyes ICS Chartr 200 VNG ENG Operator s Manual 265 Appendix H Video Files H 7 Choosing a Codec 266 Compression involves finding patterns in data i e text or video files and storing them more efficiently Text compresses extremely well it is possible to achieve high rates of compression without discarding any data If a compressed text file is decompressed the resulting file is identical to the original uncompressed file This kind of compression is called reversible or lossless compression Patterns in video data are more difficult to find so a lossless compressed video file tends not to be much smaller than the original In order to compress video data to any significant degree some of the data has to be discarded
61. goggle cover closed 12 Ask the patient to move his her eyes side to side up and down Make sure the crosshairs follow the pupils with as little jitter as possible For more details on operation and safety aspects see the User manual for the VG 40 goggles on the CD provided ICS Chartr 200 VNG ENG Operator s Manual 87 Section 5 Test Preparation and Data Collection 5 6 3 Video Image Controls For ICS Chartr 200 VNG to work properly the mirrors and video camera lenses in the goggles must be properly aligned with the patient s eyes and the images must be focused In the Video Adjustments dialog box the patient s eyes are properly aligned in VNG when both eye images are in the square region of interest and focused as the patient looks straight ahead at the center of the light bar positioned at 4 feet 1 2 m All video adjustments are viewed from the Right Eye and Left Eye viewing areas on the Video Adjustments dialog box within the application This dialog box which is active when F7 Video Adjust is selected provides the operator with the ability to independently adjust and fine tune the displayed image and settings for each eye VNG provides two types of video adjustment controls e Manual controls located on the video goggles allow the operator to make sure both eye images display center both pupils in the region of interest and focus the eye images Software controls located on the Video Adjustments dialog box allow t
62. information on the properties of the selected printer if available Indicates the readiness status of the selected printer Indicates the name of the default printer Indicates the default printer port Provides additional printer information if available Select the default paper size for reports printed at this printer from the drop down list of available paper sizes Select the default paper source for this printer from the drop down list of available paper sources Select the default paper orientation setting portrait or landscape VNG always prints on Letter or A4 size paper in portrait orientation Click OK to save the printer settings and exit the Print Setup dialog box Exit the dialog box without saving settings Note If your printer supports both raster and vector graphics select the raster graphics option The report will not print correctly if the printer is set to vector graphics 76 GN Otometrics Section 5 Test Preparation and Data Collection This section provides information on pre test activities and data collection during a test session 5 1 Overview This section provides information on the process of preparing a patient for testing and collecting data The procedures in this section assume that all of the patient related information has been entered as described in Section 3 5 2 New Test Tab The New Test tab contains a list of the test procedures in the operator s test battery in the
63. mode Display the Protocol Rename dialog box used to change the name of a test available only in Review mode Combine test from one session into another session Delete the currently selected test This option permanently deletes all of the collected data and analysis for the selected test from the database Display the Electrode Test dialog box available only in ENG Test and Calibration modes Display the Light Bar Range Sensor dialog box which indicates the patient s distance from the light bar available only in Test and Calibration modes Display the Video Adjustments dialog box available only in VNG Test and Calibration modes The Waveform Menu is only available in the Review mode The Menu allows the operator to use the keyboard or mouse to manipulate the tracings or waveforms Keyboard alternates are shown when available Waveform Filter Unfilter Overlap Spread CTRL 0 CTRL 5S 30 Hide Waveform Show Waveform Copy WaveForm CTRL C Wave Text CTRL W Figure 2 11 Waveform Menu GN Otometrics Section 2 Event Event Eyes Open Event Vision Denied Filter Unfilter Overlap Spread Hide Waveform Show Waveform Copy Waveform Wave Text 2 3 6 Video Menu Getting Started in VNG Add an event marker E to the waveform available in Collection only Add an event marker EO to the waveform available in Collection only Add an event marker VD to the wavefor
64. not slip during positional testing GN Otometrics Section 5 Test Preparation and Data Collection 8 Straighten the top head strap and tighten it Adjusting the top head strap can also assist in positioning the pupils in the box The top head strap will raise and lower the goggles on the patient s face 9 Fine tuning can be performed by using the 3 knobs H F V on the goggles Caution Tightening the knobs to the maximum position may cause damage to the adjustment pieces holding the mirror If the pupils are out of the video adjust box physically move the goggles on the patient s head and then fine tune with the knobs if needed Figure 5 5 VNG Video Goggles a Horizontal knob Adjusts the distance between the patient s eyes The horizontal distance may need to be adjusted if the patient has wide set or close set eyes b Focus knob Adjusts the distance between the cameras and the patient s pupils The focus may need to be adjusted if the patient has deep set or protruding eyes c Vertical knob Adjusts the camera up and down The vertical distance is the most common adjustment to fine tune the placement of the pupil in the box 10 Click on Auto Adjust in the video adjust screen Manually adjust threshold brightness and contrast if needed to improve the quality of the tracking The pupil should be the only area covered in blue Note If there is a lot of light in the room do the auto and manual adjust with the
65. peak intensities of those in the other direction The second component is gain asymmetry in which the responses really are stronger in one direction than in the other direction Baseline shift is common and gain asymmetry is rare Reviewing Analyzing Test Results FRight Cool Peak SPV 21 deg s R 40 a w 30 i A 20 A wr be ae E 10 had Tiag v wv v E ei 5 OPTi C ay a 1 10 aL Fo y 4 a 20 sa a E a 30 Awe E ma h E 40 ai aRight Warm Peak SPV 39 deg s 0 20 40 60 80 100 120 Seconds 140 d Left Warm Peak SPV 22 deg s s 40 f w 30 P a 20 eh S taag E 40 Fi i v we a E ors a L eA aana D Laced C p 5 10 we Se Y on y Ead w ER A aR E40 a Left Cool Peak SPV 38 deg s 2 40 60 s 100 120 Seconds Figure 6 20 Gain Asymmetry Example ICS Chartr 200 VNG ENG Operator s Manual 131 Section 6 Reviewing Analyzing Test Results 6 8 1 7 Caloric Test Cutoff Values The Interpretation Assistant compares caloric test results to a pre determined set of cutoff values Before running the Interpreter cutoff values can be reviewed and adjusted if needed Select Interpreter Cutoff Values from the menu bar to display the Cutoff Values dialog box Note The default system supplied Cutoff Values were researched and selected by a team of experts Great care should be taken before adjusting these values Cutoff Values Caloric Tests Bilateral Weakness
66. records in ICS Chartr VNG ENG Overview ICS Chartr 200 VNG ENG saves all patient records to a database The database typically resides on the hard drive of the workstation It may also reside on a file server in a networked environment When the number of patient records reaches 75 MB the patient records should be archived and moved to an offline storage media such as CD ROM backup or another hard drive The archived patient records can be restored from offline storage at a later time Some facilities may want to archive records on a regular scheduled basis Regardless of the reason for the archive the process used to archive the records is the same This section provides information on how to transfer individual patient records to other workstations and how to archive store and retrieve database records The section is organized as follows Exporting Patient Records e Reviewing Exported Patient Records Importing Patient Records e Archiving an Entire ICS Database Working with Archived Databases ICS Chartr 200 VNG ENG Operator s Manual 177 Section 8 Exporting Importing and Archiving Records 8 2 Exporting Patient Records Individual patient records can be transferred from one system to another via floppy disks memory sticks and CD ROMs for review and analysis Note Older systems used floppy disks or tape drives Newer systems typically use hard drives CD ROMs or memory sticks to transfer data The examples i
67. related dialog box or to initiate an action For keyboard access press the underlined letter of the desired item File File New Patient Existing Patient Close Patient Report Layout Printer Setup Print Report Print Report Print Waveform Print Calibration Exit Exit Figure 2 7 File Menu from Main Window File Menu when Reviewing a Calibration New Patient Display the Patient Information dialog box Patient Information tab Existing Patient Display Patient Selection dialog box Close Patient Close the open patient record Report Layout Display Report Setup dialog box Modify operator specific printed report layout Print Setup Display Print Setup dialog box Send setup information directly to the printer Print Report Display Print Report dialog box in order to begin the report printing process GN Otometrics Section 2 Getting Started in VNG Print Waveform Send displayed waveform for an active patient record directly to the printer available only when a test is being reviewed Print Analysis Send analysis information directly to the printer available only in Analysis mode Print Calibration Send calibration results directly to the printer available only in the Review Calibration mode Select F8 Review Calibration then click File Close Analysis Close the current analysis and return to Review available only in Review Analysis Exit Close and exit ICS Chartr 200 VNG ENG 2
68. remotely start or restart the video recording You may also use the remote control to center a tracing Selecting a caloric test from the New Test tab automatically selects the correct temperature warm or cool on the caloric stimulator An Interpretation Assistant for reviewing ICS static positional and caloric VNG ENG tests is available in VNG and ENG All related tests to be interpreted LW RW LC RC calorics or static positionals must be performed during the same test session See Section 6 8 for information on using this feature See Section 2 3 4 for information on moving a test from one session to another 96 GN Otometrics Section 5 Test Preparation and Data Collection If a system has the range sensor installed it is activated during tests that use the light bar The sensor indicates whether the patient is located at the 4 foot 1 2 m distance during testing If a test was run with the patient out of range for more than 10 of the test a technical comment similar to the following displays at the end of the test The ranging function is activated or deactivated through the System Options Operator Settings Test Battery tab dialog box Patient test test Procedure Optokinetic Left Eye Protocol 20 degrees sec Right Displayed Test Time from 00 00 to 00 02 Patient out of range 100 of test time H uncalibrated Y uncalibrated Figure 5 9 Ranger Technical Comment Although the light bar is n
69. sseessesssesssessseesseessessseesseesseessressress 178 8 3 Reviewing Export Database Patient Records csseeceeeeeeees 179 8 4 Importing Patient Records 0 elec ceseceseceeeeeseeeeeeeeeeeeseeeaeeenees 180 8 5 Archiving an Entire Database ee eeccceesseceneeceeeeeesaeeeeeeeeteees 181 8 6 Working with Archived Patient Records 0 ccc eeecceesseceeneeeeees 184 ErOu DICSHOOUN 8 553 256 neee ea pa er naoa e ae ie ee ina ee st 185 OD COVEI EWN tean E Eao A Le E E A A ORE a 185 9 2 Diagnostic Testien enrii ens shies ea ee N E a 186 ODED Sele TESt enea otee ee aE eier ia 186 9 22 ENG Board Check ciiise teniet ne tiii i E eE diate 188 9 2 3 USB Diagnostics and Internal Loopback eee 190 Table of Contents GN Otometrics Table of Contents Section 10 Section 11 Appendix A Appendix B Appendix C 9 3 Breht Bat recess esc n Ee Linen alee eee Nin a 191 OA RINSET loereier egi eo e sabebbin cite seadaces vat AERE sateen 193 9 5 Tin gator ssi hails ee tn ee ees 195 9 67 VIAE si a a debdetei ote let tuctvd ue ests goblets sade ie hloths 197 9 6 1 Video Diagnostics oe iener sa 197 9 6 2 Video Equipment Connection Problems eee 199 9 7 Database Repair Utility asic scgaesiietiiei tie inhi ive hades 200 Safety oe erene ee ei e EEE E E samc ssacacabbanssaceessacedenad E NEE 201 10 1 Symbols Used nnne pe insani winds eer 201 10 2 Warming Notes sc cena ateta einen eine a 202 TO 3 Mantibacturent
70. test 2 3 4 Test Menu The Test Menu items are available only in the Test and Review modes The menu items vary depending on the activity currently underway Calibrate Review Calibration Analysis Next Test Previous Test Rename Test Move to Session Delete Test Range Video Adjust Figure 2 10 Test Menu Calibrate Display the Calibration dialog box and begin a calibration Review Calibration Display the saved calibration Analysis Display analysis of currently selected test available only in Review mode Start Begin a test session for the selected test available only in Test mode Stop Stop the current collection Save Save collected test data Cancel Stop collection and discard collected data ICS Chartr 200 VNG ENG Operator s Manual 29 Section 2 Fixation Next Test Previous Test Assign Primary Rename Test Move to Session Delete Test Electrode Test Range Video Adjust 2 3 5 Waveform Menu Getting Started in VNG For VNG turns on the fixation light in the goggles and marks when fixation starts For ENG only marks when fixation starts Access the next protocol on the New Test list available only in Test mode Return to the preceding test on the New Test list or return to the preceding test in Review list Change the currently selected protocol status to primary bold The primary protocol is included in the report test results available only in Review
71. test protocols list box Click the Default button to use only the facility default s test battery or options maintained under the special operator named Default operator If editing the Default Operator account the Default button will bring up the system defaults Continue selecting and moving test protocols until satisfied with your selections 9 Click OK to save the entries in the Operator Settings Test Battery tab GN Otometrics Section 4 Setup and System Options 4 3 Workstation Settings Tab The ICS Chartr 200 VNG ENG workstation name is used to help identify the source of the test information Workstation names are established at system installation The workstation name and other workstation settings can be changed using the Workstation Settings tab Edit System Options Workstation Settings tab System Options Operator Settings Test Battery Peak Frequency GDT Interface Workstation Settings Video Settings Workstation Name wendy Goggle Model z ir z moner f ItSee goggle label CHARTA Window amp H feces c c Fixation Light VG 40 only Show Database Size Waming at Startup 75 and 512 M MBI a I Order Tests in Review Tab by Test Date Ti Dect Ma ete Ce Maximum Video Recording Time secs 120 Facility Information Practice Name GN Otometiics Demo Facility Street Address 125 Commerce Dr City Schaumburg State Province Ilinois Postal Zip Code
72. the dictionary that the spell checker will use and define and use macros Spell Check Dictionary Options Define Macro Get Macro Ctrl M Figure 7 5 Word Processor Tools Menu Spell Check Initiate a spell check Dictionary Options Display the Dictionary Options dialog box Select the dictionary you want to use American English British English French German Spanish Define Macro Display the Define Macro dialog box Get Macro Display the Get Macro dialog box Help Menu Access help information on how to use the word processor and keyboard shortcuts Using Word Processor Keyboard Shortcuts Figure 7 6 Word Processor Help Menu Using Word Processor Display help information on how to use the word processor Keyboard Shortcuts Display help information on keyboard shortcuts within the word processor environment ICS Chartr 200 VNG ENG Operator s Manual 151 Section 7 152 Working With Reports 7 2 3 Word Processor Toolbar The word processor toolbar allows the operator to use the toolbar components to perform most of the editing and formatting functions available through the menu bar Normal v Times New Roman 1 v B fou m uhl uii i 8 Xe 4 iti i II El 4 Figure 7 7 Word Processor Toolbar Use the toolbar elements to Times New A Tines NewRoman gt Assign a font to selected text M_E Assign a font size to selected text BZ U ae l Assign bold B
73. the Main Window when patient data is displayed ICS Chartr 200 VNG ENG Operator s Manual 113 Section 6 Reviewing Analyzing Test Results 6 7 Analyzing Slow Phase Velocity Measurements The purpose of this analysis procedure is to provide a quantified record of the strength of nystagmus A 140 second section of the tracing is identified and for each second the slow phase velocity of the individual beats of nystagmus are measured Once measured each velocity is displayed graphically within a 140 second time frame to show the time course of the response Slow phase velocity SPV displays adapt to the size of the waveform as follows The scaling measurement used in the Slow Phase Velocity window varies from 0 to 20 0 to 40 0 to 80 or 0 to 160 depending on the size of the largest SPV beat If the system detects an SPV beat that is greater than 80 deg sec the waveform display zooms In the zoom view the grid that usually represents 1 second now represents 500 ms This change is indicated in the display window There are several ways to select a specific beat on the waveform display and place it directly under the vertical cursor Scroll through the tracing or press the lt gt arrow keys to move the tracing left or right until the beat to be measured is under the vertical cursor Use F10 Previous Beat and F11 Next Beat to move through the tracing Click on a specific beat in the Slow Phase Velocity lower cha
74. the Selected test protocols list box System defaults are applied if the Default Operator record itself is being modified Print Prints a copy of the selected test protocols for the current operator OK Accepts and saves the test battery that is displayed in the Selected test protocols list box Cancel Closes the dialog box without saving and returns to the Operator Information tab 4 2 2 Establishing Operator Test Battery All Chartr VNG ENG systems have a list of available protocols These protocols differ for 2 channel and 4 channel ENG VNG and monocular VNG systems For example Individual Eye tests is not available on 2 channel ENG and monocular VNG systems Each system has a factory default test battery which is a list of commonly used protocols Note When you first install the system and if your facility has a different protocol than what is set up in the default test battery it is recommended that you first setup the default operator test battery Then add all other operators and they will inherit the default test battery If desired each operator s test battery can be further customized If desired each facility can establish a unique facility default test battery that consists of a sequenced list the protocols commonly used at that facility The facility default test battery will be active when the system is started In addition an operator can establish an operator specific test battery The process for establishi
75. the patient name with the last test date for all patients already in the VNG ENG database ICS Chartr 200 VNG ENG Operator s Manual 17 Section 2 Getting Started in VNG In the Patient Selection dialog box e Access an existing patient record including test results by double clicking on the patient name or highlighting the patient name and clicking Open Click Delete to remove patient records from the database e Click New to initiate the entry of a new patient in the database and prepare the patient record file prior to testing Click Close to close the selected patient record Note See the procedure in Section 3 1 3 Establishing a New Patient Record for specific instructions When you are finished working in ICS Chartr 200 VNG ENG it is very important that you properly close the application When you close the application the system automatically saves the patient data To end a work session select File Exit on the Menu bar or click the Close button on the Title bar 18 GN Otometrics Section 2 Getting Started in VNG 2 2 VNG Main Window The Chartr 200 VNG ENG Main Window is the primary workspace It is displayed when the program is opened Testing and test analysis activities are performed directly from the Main Window Other activities such as entering and modifying patient data are done in dialog boxes that sit on top of the Main Window The Main Window contains patient test and analysis information when
76. validation and analysis in the Static Positional Test Interpretation dialog box Note If at least one position test with a designation of With Vision or Without Vision is not available the system will generate this message ICS CHARTR 200 VNG t least one positional test with a designation of wi Vision or wto Vision must be analyzed for an interpretation to be provided Please analyze at least one test with a designation Figure 6 22 Positional Test Message a The results of Interpreter for a position test with a technical error are shown below Static Position Test Interpretation Horizontal Nystagmus With Vision Without Vision Interpretation Sitting 0 deg sec 7 deg sec Significant leftbeating nystagmus without vision suppressed with vision Supine 10 deg sec 6 deg sec Significant leftbeating nystagmus without vision not suppressed with vision Head Right 0 deg sec 2 deg sec Leftbeating nystagmus without vision not strong enough to be significant Head Left lSdeg sec 7deg sec Significant rightbeating nystagmus with vision and leftbeating nystagmus without vision Click Technical Comment fg more informatid The static position test results for horizontal nystagmus are probably invalid Horizontal Nystagmus Vertical Nystagmus Figure 6 23 Static Position Test Interpretation Horizontal Nystagmus ICS Chartr 200 VNG ENG Operator s Manual 135 Section 6 Reviewing Analyzing Test Results b
77. video recording Video recording may be started at any time during data collection The video controls are in the Video Recording Control dialog box To record an eye movement video 1 Click the New Test tab and select a protocol 2 Click F12 Start to begin data collection and display the Video Recording Control dialog box Right Eye Left Eye AR v Record Time 2 00 Figure 5 11 Video Recording Control Dialog Box Both Eyes Right Eye Left Eye Roe TRN Record Time 20 2 00 e o e Figure 5 12 Video Recording Control Dialog Box One Eye 3 Click the Record e button to start the video recording option The system puts an event marker V on the tracing at the point video recording begins Note the available recording time at the bottom of the Video Recording Control dialog box Note You may also use the optional footswitch to start or restart a video recording 100 GN Otometrics Section 5 Test Preparation and Data Collection 4 Monitor video collection activity and the right and left eye movement a Monitor the remaining recording time b Click the Restart button to discard any recorded video and to begin video recording c Click the Stop oO button to stop recording video d Click Cancel Test to stop the recording and discard any recorded video and tracings Right Eye Left Eye b gt v Y l Record Time aao 1 46 olle Figure 5 13 Video Recording Cont
78. with a small square around it in each of the charts The numeric value of the saccade in the dimension being presented is displayed in the upper right corner of each chart ICS Chartr 200 VNG ENG Operator s Manual 141 Section 6 Reviewing Analyzing Test Results To analyze a saccade protocol 1 Click on the Review tab to display the test performed for the selected patient 2 Click the sign in front of the desired Physician s Order Test Session 3 Click the sign in front of a test procedure to display a list of individual protocols 4 Click on a specific saccade protocol to select it and click on the handle of the waveform to be analyzed Then press F12 Analysis to access the analysis for the selected test and waveform oS CHARTR 200 WG Brown Sandra ENG data Eie Faas Waveform ipterpester tele D 2 x elal Nev save Goa wo Carce S we a posi Fe fadam Position 120912 PM text Soccode Brevous saccade f2 PM bem Pu 33 PH Delete Anateis p 1231 56 PM Agrogd je Fight 1233 29 PM Rar re Lett 127352 PM Avoda fes Postion Both E yes Siling w Vision 1237 08 PH Rigreased Ampituse Deg Lae 4 Ragheaars Ampiftete es Latur Cabec Bath Eyes Rapt Ea Cool 147 25 PM Wage dptemncnn chery Dupiyed Te 00 00 to 00 06 ne aenneren Pucmdee Saceade Both Eyes Wavelam Horizontal casiorated Puio Horizontai Random Postion Acopeted 52 of U9 soccodot Cursor 1 3 seconds Ampli
79. 119 6 7 4 Analyzing Caloric Test Results eee ceeeeseereeereeeneee 120 6 7 6 Fixation Index c cc eset asl notin ce nee ee alee eee 122 6 8 Interpretation Assistant cecceeccecesecesseceeeeceeeeecseeeeaeceeaeeeeees 123 6 8 1 Interpreting Caloric Tests ceecesecesecereeeneeeeeeneeenees 124 6 8 2 Interpreting Static Position Tests 0 eee eeeeseeeseceneceeees 134 6 8 3 Unable to Paste Interpretation into the Patient Report 139 6 9 Analy zins S accades yi ae weioiatiee caters hacen tues E 141 6 10 Analyzing Sinusoidal Tracking 20 00 eecceesseceeceeeeeceenceceeneeenes 144 6 11 Renaming Protocols eee ceseceseceseceseceseeeseeeseeeeaeesseseaeeenaeenaes 146 ICS Chartr 200 VNG ENG Operator s Manual Section 7 Section 8 Section 9 Working with Reports is02 n nnanis Latte denise ein 147 DA OVERVIEW set vz ssrcsekshcstebsiacceebsalatat eeaeee E EE E AEREE 147 7 2 Accessing the Word Processor cesceeseesceeseecrseceseceseceeeeeeeeees 148 7 2 1 Word Processor Functions 2 00 sceeeeeeceeeeeeeeeeeeeeeeeneeenees 148 7 2 2 Word Processor Menus csceeceseseceeseeeeeeeeeeeeeeeeeenaes 149 7 2 3 Word Processor Toolbat cccccceesceceeceeceeeeeesteceeaeeeeenees 152 7 2 4 Word Processor Ruler Bat ceeeeceeeeeeereeereeeneeeneeenees 153 7 3 Using Findsand Replace ss cs scccccassctescieccetsscatecectecesepetaasbesctsaeeess 154 TBA Eind Option sizes sete eee ieee ete Ge ieee eels setenes 15
80. 4 E32 Replace Optio sninen iodo etnies 155 74 Working with TeX siiente tot anonte ann a eiat 156 TAA Moditying FOnts set cii ce8 chee te iedenarnlen EEE 156 7 4 2 Formatting Paragraphs 0 0 0 cee ceeceseceeeeeeeeeeseeeeeeaeeenaes 157 7 5 Using Word Processor Spell Check 158 7 5 1 Spell Check Dictionaries 00 0 eee ceseeeeeeeseeeseeeneeeneeenees 158 7 5 2 Spell Check a Document cece eeceeeeeeeeeeeeeeeeneeeneeenees 158 PB Wits Macros erareto ar aTa Er AE E ean 161 LOA Definins MacroSsersiniee teniet Teton d E leas 161 1 6 2 gt Ins rting Maci Sinsenen annene eine 162 df Report Setpro ae e eaaa E SE raea 164 7 71 1 Report Setup Dialog BOX ssseseesesereeresreerrsrresrrrresreersres 164 7 1 2 Report Page Setup Dialog BOX eeecsrcsrerrsrererersre 165 7 1 3 Setting Up a Report Template 0 eee eeeeereeereeeneee 166 7 8 Printing aRepoit eneee neea E N A a 167 7 9 Creating Custom Repotts sseeseeseeseereseesresrrerrsresserrreserrssreeresrs 171 7 9 1 Custom Page Dialog oninurere iresnissrer r 171 7 9 2 Creating a Custom Waveform Report 173 7 10 Printing a Waveform eesesseeeseseesissresresresresresreesesreeserreesreesses 175 711 Printing an Analysis ennenen noar na EE SA 175 7 12 Printing a Calibratiotssnenusorne ene ie n 176 Exporting Importing and Archiving Records ceecceeesceesteceeeeeees 177 Sal OVETVICW sass ees tia reae aa sich socal TE rE aE R E 177 8 2 Exporting Patient Records e
81. 4 8 Referring Facility Selection Dialog Box Please select a referring facility Click on the drop down list of facilities to display the facilities listed in the system If the None option is selected a new facility can be created If an existing facility is selected this facility s information can be edited OK Save the selected facility and display the Referring Facility Information dialog box for the selected facility See Section 3 3 3 for information on completing the Referring Facility Information dialog box Cancel Exit the dialog box without selecting a facility Help Opens the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual 75 Section 4 4 8 Printer Setup and System Option The Print Setup option is used to set the default printer for the workstation Selecting File Print Setup displays the Print Setup dialog box Print Setup BE m Printer Name let 500C Printer Properties Status Default printer Ready Type HP DeskJet 500C Printer Where LPT1 Comment m Paper Orientation Size Letter x Portrait Source fin Tray x C Landscape Cancel Figure 4 9 Print Setup Dialog Box This dialog box allows the operator to set the default values for the printer Name Properties Status Type Where Comment Size Source Orientation OK Cancel Select the printer from the drop down list of installed printers Click to display a dialog box that provides
82. 50 Mains connected equipment T a except EN IEC 60601 1 certified equipment must be powered from the Powertronix Isolation Station A The Chartr 200 should only be connected to power adapter type FW73623M 15 mee ar from Friwo For continued protection against fire hazard replace fuse with the O rX same type and rating only e There are no user serviceable parts inside the ICS Chartr 200 cabinet For the sake of safety and in order not to void the warranty the cabinets should only be opened and serviced by authorized service personnel In case of defects please make a detailed description of the defect s and contact your supplier Do not use a defective instrument Keep ICS Chartr 200 VNG ENG away from liquids Do not allow moisture inside the instrument Do not use the instrument in the presence of flammable anesthetics gases Unwanted noise may occur if ICS Chartr 200 VNG ENG is exposed to a strong radio field Such noise may interfere with the process of recording correct measurements Many types of electrical devices e g mobile telephones may generate radio fields We recommend that the use of such devices in the vicinity of ICS Chartr 200 VNG ENG is restricted as much as possible No parts may be eaten burnt or in any way used for purposes other than videonystagmography and electronystagmography testing ICS Chartr VNG ENG can be disposed of as normal electronic waste according to local regulations For saf
83. ADATA Figure 1 8 Choose Destination Location Dialog Box Installation Wizard h Choose Video Location Place the video components in the default program folder unless you decide to use a different folder Click Next to continue Choose Video Location Setup will create folder C CHARTRSDATAVideo for storage of video recordings To select a different folder click Browse and select another folder You can choose not to install ICS CHARTR 200 ENG VNG by clicking Cancel to exit Setup Destination Folder C ACHARTRADATA Wideo Figure 1 9 Choose Video Location Dialog Box Installation Wizard 6 GN Otometrics Section 1 Introduction to the VNG System i Select Program Folder Place the program icons in the default program folder GN Otometrics unless you decide to use a different directory Click Next to begin the installation process Note To make it easier for technical support to assist you if needed it is best to install the software in the default location Select Program Manager Group Enter the name of the Program Manager group to add ICS CHARTR 200 ENGANG icons to GN Otometrics Adobe Autostart Coreco Imaging Java Web Start TX Text Control 13 0 Verwaltung Zubeh r Figure 1 10 Select Program Manager Group Dialog Box Installation Wizard j Start Installation Click Next to begin installing ICS Chartr VNG ENG Start Installation You are now ready to install
84. Access Operator s Manual Create new patient record display Patient Information dialog box Access an existing patient record display Patient Selection dialog box Access New Test mode Rename an existing test display Protocol Rename dialog box Display word processor portion of patient report Add or remove effect of a filter on all tracings Display most recent calibration associated with the test being reviewed Switches the test eye during monocular testing Access and display the previous test listed for that session Access and display the next test listed for that session Begin analysis for the current test Table G 9 Function Keys Calibration Review Function Key Action F1 Help F3 Original Calibration F5 Enlarge F6 Shrink F7 Up F8 Down F9 Cancel F12 Save Function Access Operator s Manual Return to original calibration i e the calibration saved prior to manipulation Increase the gain of the wave Reduce the gain of the wave Move selected wave up Move selected wave down Cancel any adjustment and do not save results Save the changes to the calibration and reaccess the current test ICS Chartr 200 VNG ENG Operator s Manual 257 Appendix G 258 Function Keys Table G 10 Function Keys Tracking Analysis Function Key Action i i i F i F12 Save Function Access Operator s Manual Clear previous analysis and begin a new analysis
85. Add to add the word in red in the Syntax area to the current custom Dictionary Once a word is added the Spell Checker will not consider it misspelled 3 Look at the word s listed in the Suggestions area and click on a word to highlight it ICS Chartr 200 VNG ENG Operator s Manual 159 Section 7 Working With Reports 4 Click Change to change the existing word s in the report to the Suggested word or click Change All to change all occurrences of the misspelled word in the report to the suggested word 5 Repeat steps 1 through 4 for each word that displays in red in the Syntax area When the spell checker has completed the entire report the buttons turn gray and the Quit button changes to Done 6 Click Done or Quit to close the spell checker and return to the report and display this message Click OK CHARTRENG i The spelling check is complete Figure 7 14 Spelling Check Complete Message 160 GN Otometrics Section 7 7 6 Using Macros Working With Reports Word processor macros are operator defined shortcuts that can be used to insert strings of text within a patient report and from one report to another Any macros defined for the default operator are copied to the report setup for each new operator Operators should check the macros available and make changes on an as needed basis 7 6 1 Defining Macros Macros are established in the Define Macro dialog box Define Macro NORMAL z
86. Analysis Menu The Analysis Menu is only available in the Review Analysis mode after accessing F12 Analysis The available Analysis Menu items vary depending on the type of test being analyzed The description of the action of each item and its function key equivalent is shown below Set Baseline Save Cancel Display SPY Graph v Display PODS Locate Peak SPY Set Peak SPY Baseline Down Baseline Up Next Beat Previous Beat Insert Beat Delete Beat Reanalyze Remove All Beats Delete Analysis Figure 2 14 Analysis Menu and Caloric Analysis Menu Begin Begin analyzing data Set Baseline Set the Baseline shift available only in caloric PODS SPV analysis Save Save the analysis results in the database ICS Chartr 200 VNG ENG Operator s Manual 33 Section 2 34 Cancel Display SPV Graph Display PODS Locate Peak SPV Set Peak SPV Next Saccade Previous Saccade Insert Beat Delete Saccade Baseline Down Baseline Up Next Beat Previous Beat Reanalyze Remove all Beats Delete Analysis Next Cycle Previous Cycle Averaged Raw Averaged amp Raw Getting Started in VNG Close analysis without saving and return to the review screen Display the SPV measurement dialog available only in caloric PODS SPV analysis Display the SPV PODS dialog available only in caloric PODS SPV analysis Automatically locate SPV peak available only in SPV analysis Select to set the peak SPV v
87. Click OK to begin a new test session for the patient If test records from previous test sessions are available the list of test records will display in the Review Test area of the Main Window 3 1 6 Deleting a Patient Record Use this procedure to delete a patient record from the VNG ENG database Note Any video recordings for the patient will be deleted without further confirmation Deleting a patient in Chartr EP does not delete any video recordings for that patient Chartr EP never deletes any VNG ENG test data To delete a patient record from the database 1 2 46 Access the Patient Selection dialog box Select the patient whose record you want to delete and make sure the patient name is highlighted Click the Delete button to display a dialog box that prompts Are you sure you want to delete patient Last Name First Name Click OK to delete the patient record or click Cancel to stop the deletion GN Otometrics Section 3 Establishing and Maintaining Records 3 2 Physician Information Referring Physician information is stored in the VNG ENG database The name address and contact information is entered and maintained in the Referring Physician dialog box The physician order date and the test session date are the basis for retrieving multiple records for the same patient This section contains a description of the Physician Information dialog box and the procedures for Establishing a New Physician
88. Clinical Information This appendix contains the questions asked in the Clinical Information tab of the Patient Information dialog box See the last page of this appendix for a printable version of these questions ICS Chartr 200 VNG ENG Operator s Manual 209 Appendix A 210 Clinical Information CHARTR 200 VNG ENG CLINICAL INFORMATION General Has the patient taken tranquilizers sedatives or vestibular suppressants within 48 hours Has the patient consumed alcohol within 48 hours Has the patient taken drugs that can cause labyrinthine hypofunction Is the patient currently taking other drugs that can cause eye movement abnormalities Is the Dix Hallpike maneuver contraindicated Has the patient had right eye surgery Has the patient had left eye surgery Eye Movement Examination Does the patient have restricted deviation of the right eye Does the patient have restricted deviation of the left eye Does the patient have nystagmus on center gaze Does the patient have nystagmus on rightward gaze Does the patient have nystagmus on leftward gaze Does the patient have nystagmus on upward gaze Does the patient have nystagmus on downward gaze Does the patient have disconjugate eye movements during saccades Ear Examination Does the patient have a tympanic membrane perforation in the right ear Does the patient have excess cerumen in the right external ear canal Does the patient have a narrow right
89. GN Otometrics customer support The CORECO Framegrabber board is not being recognized by the drivers Try the following a Reboot the computer and restart VNG b Re install the VNG software from CD ROM If this does not remedy the situation please contact GN Otometrics customer support Resume calibration or adjust the calibration prior to saving it Error Messages Reposition the patient with respect to the light bar The goal range is 44 to 52 inches 112 to 132 cm Possible Cause Solution The cable connections from the goggles to the Chartr 200 may be loose Check the connections between the goggles the Video Distribution Amplifier and the computer Exit VNG From the Windows desktop restart VNG The system should identify the VNG equipment Missing or malfunctioning software drivers Try steps a and b If that does not solve the problem contact GN Otometrics customer support Missing or malfunctioning hardware Try steps a and b If that does not solve the problem contact GN Otometrics customer support GN Otometrics Appendix E Error Messages Table E 3 Database Error Messages Database Error Unable to switch to a new Contact GN Otometrics Customer Support for assistance operator Unable to add or update the database It is Close any open patient records and exit the VNG ENG recommended that you shut down the program Contact GN Otometrics Customer Support for application and c
90. Hyperactivity Abnormal Baseline Shift yee 6 deg sec 12 deg sec Help 140 deg sec Default I Unilateral Weakness J 235 Cancel Gain Asymmetry e Ice Water Caloric eae 6 deg sec Figure 6 21 Cutoff Values Dialog Box Bilateral Weakness Hyperactivity Abnormal Baseline Shift Unilateral Weakness Gain Asymmetry Ice Water Caloric 132 Bilateral weakness is present when total responses from the right and the left ear are both less than the cutoff value Default 12 deg sec Caloric responses are hyperactive when total responses from either the right ear or the left ear exceed the cutoff value Default 140 deg sec The baseline shift is abnormal when it exceeds the cutoff value Default 6 deg sec Unilateral weakness is present when the normalized difference between the right and left ear responses exceeds the cutoff value Default 25 Gain asymmetry is present when the normalized difference between right beating and left beating responses exceeds the cutoff value Default 25 Ice water caloric testing should be performed on any ear with an intact tympanic membrane that does not respond to standard bithermal caloric stimuli The purpose of this test is to confirm the results of the bithermal caloric test Ice water caloric testing is recommended when the warm response plus the cool response of one ear is less than the cutoff value Default 6 deg sec GN
91. ICS CHARTR 200 ENG VNG Press the Next button to begin the installation or the Back button to reenter the installation information Figure 1 11 Start Installation Dialog Box Installation Wizard ICS Chartr 200 VNG ENG Operator s Manual Section 1 Introduction to the VNG System k Software Application Installation The Initializing Wise Installation Wizard notice will display The Current file being loaded on the hard drive along with the time remaining will display Installing Current File Copying CHARTR ENG for Windows Help C CHARTR ENG for Windows chartENG_DEU hip All Files Time Remaining 0 minutes 5 seconds Figure 1 12 Software Installation Installation Wizard 1 Hardware Driver Installation Depending on the application you selected the Installation Wizard will prompt you to start loading the appropriate drivers Click Next to begin the installation 2 Start Installation You are now ready to install ICS USB YNG Driver Press the Next button to begin the installation Figure 1 13 Start Hardware Installation Dialog Box Installation Wizard GN Otometrics Section 1 Introduction to the VNG System m Installation Complete After all of the applications and hardware drivers are installed click Finish to complete this phase of the installation process 2 Installation Complete ICS USB VNG Driver has been successfully installed Press the Finish butt
92. K Troubleshooting For GN Otometrics technical support use only Moves the light bar light to the Gaze Left 30 position Moves the light bar light to the left approximately 16 7 position Moves the light bar light to the center Moves the light bar light to the right approximately 16 7 position Moves the light bar light to the Gaze Right 30 position Moves the light bar light to the Gaze Up 30 position light bar rotated vertically Moves the light bar light to the Gaze Down 30 position light bar rotated vertically Select one of the brightness settings Off Turn light off Low Use lowest setting Medium Use medium setting High Use highest setting For GN Otometrics technical support use only For GN Otometrics technical support use only Exit the dialog box Lightbar Diagnostics User Information The arrow keys and mouse may be used to manually move the slider and the light bar light will follow The buttons can be used to select gaze lights left right sides of the light bar and turn the light bar off 192 GN Otometrics Section 9 Troubleshooting 9 4 Ranger The Ranger diagnostic function is used to test the light bar ranging function During a patient test session the Ranger status is conveyed to the operator as Under Range an actual distance or Over Range In addition a clicking sound can be heard when the ranger is operating Note This diagnostic test should b
93. Lists the channel number Provides the hexadecimal reading for each channel Provides the decimal reading for each channel Begin a diagnostic session Stop the active diagnostic session Pause the active diagnostic session while holding the Display Count Resume the diagnostic session and continue to increment the Display Count Opens the Operator s Manual Exit the dialog box ICS Chartr 200 VNG ENG Operator s Manual 189 Section 9 Troubleshooting 9 2 3 USB Diagnostics and Internal Loopback The USB and USB Internal Loopback and USB Diagnostics options are used to verify the operating status of the USB hardware Note This diagnostic test should be used only in conjunction with or under the direction of GN Otometrics personnel Select Diagnostics USB or Diagnostics USB Loopback and HW Diagnostics to display the USB Hardware Diagnostic Results and Loopback Settings dialog box USB Unit Hardware Diagnostic Results and Loopback Settings Loopback Settings Diagnostic Results This setting allows internal or external loopback circuits to be enabled in the hardware for troubleshooting purposes For normal operation the loopback setting should be set to none Loopback Setting none X Hardware diagnostics are performed when the hardware is powered on The results are shown below If the tests were unable to be run the results will show as unknown Contact customer support if any of thes
94. Referring Facility for additional information GN Otometrics Section 3 9 10 11 12 Establishing and Maintaining Records Click the Clinical Information tab to display the Clinical Information dialog box Click the General button and answer each question Click Next to move to the next dialog box Click Finish when you have answered all the questions Repeat Step 10 for the Eye Movement Examination and Ear Examination buttons Click OK at the bottom of the dialog box to accept and save all of the information entered in all three Patient Information dialog boxes 3 1 4 Editing Patient Information The Editing Patient Information procedure provides instructions for editing patient data in the Patient Information dialog boxes To edit existing patient information 1 10 11 12 Select Edit Patient Info to display the Patient Information dialog box with the data for the currently selected patient Select the Patient Information tab Review the patient personal data and make any required changes in the text boxes Click the Physician s Order tab to display the Physician s Order dialog box Review the physician order information and make any required changes Click the Referring Physician Info button to display the Referring Physician Information dialog box Review the physician information and make any required changes in the text boxes Click OK to return to the Physician s Order dialog box Cli
95. Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position 2 Channel systems only collect Horizontal Right Eye Position Horizontal Left Eye Position and Target Position Not available for VNG ICS Chartr 200 VNG ENG Operator s Manual 213 Appendix B VNG Tests B 3 Gaze Tests Table B 3 Procedure Gaze Both Eyes e e e E w o Vision Light target 30 right of center without Horizontal Eye Position Vertical Eye Position vision ptet Light target 30 left of center Horizontal Eye Position Vertical Eye Position a w o Vision Light target 30 left of center without Horizontal Eye Position Vertical Eye Position vision u u target 30 up from center Horizontal Eye Position Vertical Eye Position C w o Vision Light target 30 up from center without Horizontal Eye Position Vertical Eye Position vision Down Light target 30 down from center Horizontal Eye Positi
96. Right Repeat Head Left Repeat Sitting Sitting w Vision Sitting w o Vision Supine Supine w Vision Supine w o Vision Head Right Head Right w Vision Head Right w o Vision Head Left Head Left w Vision Head Left w o Vision Head Hanging Head Hanging w Vision Head Hanging w o Vision GN Otometrics Appendix B Caloric Both Eyes Ice Caloric Both Eyes Pressure Both Eyes Spontaneous Both Eyes VNG Tests Right Side Right Side w Vision Right Side w o Vision Left Side Left Side w Vision Left Side w o Vision Other Other w Vision Other w o Vision Right Ear Cool Left Ear Cool Right Ear Warm Left Ear Warm Right Ear Supine Left Ear Supine Right Ear Prone Left Ear Prone Right Left With Vision Vision Denied B 13 3 Chartr 200 M VNG Default Test Battery This list of tests is the default standard battery of tests for Chartr 200 M VNG The test battery can be installed and modified from the System Options Operator Settings Test Battery Tab dialog box see Section 4 2 Saccade Both Eyes Gaze Both Eyes Tracking Both Eyes Optokinetic Both Eyes ICS Chartr 200 VNG ENG Operator s Manual Horizontal Random Position Right Left Up Down Sine Horizontal 20 sec Right 20 sec Left 40 sec Right 40 sec Left 231 Appendix B 232 Dix Hallpike Both Eyes Position Both Eyes Caloric Both Eyes Spontaneous Both Eyes VNG Tests He
97. Section 2 24 Getting Started in VNG 2 2 3 Toolbar Buttons Use the Toolbar buttons as alternates to the Menu Bar commands see Section 2 3 A D 4 amp Dy co tel t PIA lole K K z g oje Figure 2 6 Toolbar Buttons A D rm e gt i Te OCR g Me ig a EA Orr Allows user to set a default font for demographic facility and report information This may be required for central European character sets Displays Printer Setup dialog box Displays Print Report options Prints current waveform analysis or calibration Displays Patient Information screen Displays word processor Report Marks the patient file as having a completed report Displays New Patient Information screen Displays Existing Patient Selection screen Saves current waveform Cancels current test or calibration Goes to previous item test channel beat etc Goes to next item test channel beat etc Displays the Video Adjustments dialog box Displays Range window Displays Calibration window Starts a test or calibration Accepts the current calibration or baseline GN Otometrics Section 2 YNG SO SA ss Si aes Stops or closes the current test calibration or analysis Analyzes the test Locate peak SPV Displays the Caloric PODS and Butterfly analysis window Runs the Interpreter Assistant Displays both eyes or the eye right or left currently being evaluated Se
98. TSS gt token is not in the report template file ICS Chartr 200 VNG ENG Operator s Manual 139 Section 6 140 Reviewing Analyzing Test Results To add the lt IA_RESULTS gt token to the report template files Note See Appendix C for more information on how to work with the template files Open the ENG VNG template files template rtf and vngtemplate rtf These files are located in the same folder as the application executable The default application executable folder is C Program Files ICS Medical Open the sample template file InterpretationAssistantTemplate rtf also located in the same folder as the application executable Search for the token lt I A_RESULTS gt in InterpretationAssistantTemplate rtf and copy it using the Copy command Paste the token using the Paste command into the ENG VNG template files where you would like the interpretation text to appear If you are not sure where to paste the token use the file InterpretationAssistantTemplate rtf as a reference for location of the token lt IA_RESULTS gt Save all files that were changed and close all files Try using the Interpretation Assistant again to see if the problem is fixed If the problem persists contact GN Otometrics Customer Support GN Otometrics Section 6 Reviewing Analyzing Test Results 6 9 Analyzing Saccades The total possible length of a recording for the various saccade tests is 200 seconds 3 min 20 sec Saccadic eye
99. Video Adjustments for Monocular Testing Adjusting the video image in monocular VNG systems using the Video Adjustments dialog box is similar to VNG systems with these exceptions The Adjust Both Eyes checkbox is not available Only the test eye video displays The display area for the untested eye is gray The slider controls for the untested eye are disabled Video Adjustments Right Eye al gt a gt Brightness Ki a all E gt Contrast Help Auto Adjust Figure 5 7 Video Adjustments Dialog Monocular VNG Systems 90 GN Otometrics Section 5 Test Preparation and Data Collection 5 6 5 Cleaning the Goggles Proper care and maintenance of the video goggles involves disinfecting the goggle parts that make contact with the patient s skin and cleaning the goggle components Cleaning and disinfecting should be done before placing the goggles on the patient Note Follow all of the cleaning procedures in this section to avoid damaging the goggles Face cushion Clean and disinfect using a pre moistened non alcohol based pad i e AudioWipe or apply the solution to a soft cloth or pad before placing the goggles on the next patient Note The face cushion of the VG 40 goggles can be replaced in the field This should be done every 6 months or anytime the face cushion shows significant wear See the VG 40 Goggle User Manual Dichroic mirror surfaces Use a lens cleaning cl
100. Worm 94924 AM 144 Targa Freeney OT Potert Johnson Veronica ENG data Procedien Tracking Both Fyas Displayed Tene 00 00 to 00 15 Warelom Morizontal caiibr ated Procol Sine Horizontai Accepted 36 of 30 cycies Gaix 738 UV deg Offset 0 00 deg e fr 8 re fe Delete Eriege Stork Up A Frequency 0 20 Hz Phase Shift 1 8 Right Gain 0 90 Loft Gein 0 05 r Down Database chart db Figure 6 30 Sinusoidal Tracking Analysis Average Rightward Gain 0 81 Average Lottward Oain 0 77 r rio Coxe Prenas Cpe m New Oye F2 Seve Operator perator otat GN Otometrics Section 6 Reviewing Analyzing Test Results 5 During the analysis a number of options are available a b Press F2 Reanalyze to reanalyze the test after making adjustments to the data Press F3 Delete Cycle to remove the outlined cycle Press F5 Enlarge and F6 Shrink to adjust the gain of the tracing in relation to the target Press F7 Up and F8 Down to move the wave up or down on the tracing Press F9 Cancel to end the analysis session for the selected test without saving the results Press F10 Previous Cycle and F11 Next Cycle to move from one cycle to another Select Analysis Raw Averaged or Raw and Averaged from the Menu bar to display different views of the data Click directly on a data point to move the tracing to correspond with the analysis result
101. a Before you begin data collection consider the following You may stop and start data collection at any time during the data collection process Suggested minimum times in order to have enough data to analyze are 1 minute 30 seconds for Saccade tests and 2 minutes for Tracking tests Run other tests for 20 seconds or longer if needed Note The tests have a maximum time limit and when this limit is reached collection stops Saccade and Tracking tests can be recorded for up to 200 seconds all other tests for up to 400 seconds VNG ENG Both Eyes and Monocular VNG protocols collect two channels Horizontal H and Vertical V VNG ENG 4 channel Individual Eye protocols collect four signals Horizontal Right HR Horizontal Left HL Vertical Right VR and Vertical Left VL e Start recordings for caloric tests at the onset of stimulation This allows observation of spontaneous nystagmus during stimulation The system adjusts the temperature of the irrigator If an ICS caloric stimulator is properly connected to the ICS Chartr 200 PC starting the test from the caloric handset or footswitch will initiate both units simultaneously This function is also possible for non caloric tests as long as the power to the caloric stimulator is on ENG Note After a test is started press the handset or footswitch to remotely center a tracing VNG Note After a test is started press the handset footswitch or remote control to
102. a drop of lens cleaning solution on a cotton swab Wipe the surface gently with the cotton swab using a rotary motion until the surface is clean Note Lens cleaning solution is available at camera photography stores To clean the goggle housing 1 2 92 Moisten a cloth with a mild detergent and water solution until damp Wipe the soiled surfaces gently with the damp cloth until clean Wipe the goggles with a clean damp cloth moistened with plain water Dry the goggles using a dry cloth GN Otometrics Section 5 Test Preparation and Data Collection 5 7 Calibrating a Patient The sine wave calibration used by ICS Chartr 200 VNG is an almost completely automated process In real time while a patient follows a light stimulus the system automatically adjusts the gain and offset of the signal being calibrated in order to match that of the stimulus The calibration signal is a light target moving in a sinusoidal pattern Calibration occurs automatically immediately after pressing F12 Start In this stage of the calibration the program adjusts the gain and offset of the eye signal to match the target Press F7 Center to center the waveform during a calibration When there is a good match between the amplitudes of the eye and target traces for a full cycle press or click F12 Accept to accept the calibration When F12 Accept is pressed an A event marker is automatically placed into the data stream and is seen on the screen
103. a patient record is open When the Main Window is empty of patient information it is called the Empty Main Window The Empty Main Window is accessed by selecting Cancel or Close Patient at the Patient Selection dialog box or File Close Patient from the Main Window Title bar Menu bar Maximize Minimize J Close buttons Toolbar WHG lt no patient selected gt Tibag Tet Weve deo opos ee J 16 Old ia J e New Test Neview Function keys Ota ase mB Somer Figure 2 2 VNG ENG Empty Main Window ICS Chartr 200 VNG ENG Operator s Manual 19 Section 2 Getting Started in VNG The Main Window provides useful information and can be thought of as having several key areas that either provide on screen information display test results or allow the operator to access additional features and information New Test Review tabs Test Review workspace VNG Damo 1 Normal VNG base Cdt Test Waele Video Qeposis tee ojsjulx s ein olola ja ejzj jej e New Review Test List Sportaneour Both Eyes Information area Eye image area 7 Pi Eye Lah Eye Patent Demo 4 Normal VNO Procedue Succads Doth Eyes Protest Hortrental Random Position Dipha Tet Tire hore to Text comments Se ol i 1 m Function keys Status bar Figure 2 3 Main Window with Patient Data Displayed The major componen
104. ack to the Clipboard Area and remove the waveform from the selected Display Area Display the Custom Page Title dialog box Type the new custom report title in the text box and click OK to place the title on the report Add another page to the custom report Remove all of the waveforms from the Display Areas on the current page Remove the current page from the custom report Show the preceding page of the custom report Show the subsequent page of the custom report Close the Custom Page Dialog and return to the Review Mode This does not delete the custom report The report is deleted only when the selected patient record is closed a new patient is selected a new physician order is selected another session is selected or when the ICS Chartr 200 VNG ENG application is closed Send the custom report directly to the printer and print a paper copy Opens the Operator s Manual GN Otometrics Section 7 7 9 2 Creating a Custom Waveform Report The following procedure provides instructions for using the Custom Page Dialog to create a custom waveform report for a selected patient This type of report can only be created while in the Review Mode The report is temporary in that the system will not save an electronic copy when the selected patient record is closed To create a custom waveform report 1 2 Open a patient record and select the Review tab Locate a waveform segment that you want to print Clic
105. ad Right Head Left Head Right Repeat Head Left Repeat Sitting Sitting w Vision Sitting w o Vision Supine Supine w Vision Supine w o Vision Head Right Head Right w Vision Head Right w o Vision Head Left Head Left w Vision Head Left w o Vision Right Side Right Side w Vision Right Side w o Vision Left Side Left Side w Vision Left Side w o Vision Other Other w Vision Other w o Vision Head Hanging Head Hanging w Vision Head Hanging w o Vision Right Ear Cool Left Ear Cool Right Ear Warm Left Ear Warm With Vision Vision Denied GN Otometrics Appendix C Customizing the Word Processing Report This appendix provides information on how to customize the word processor portion of a patient report C 1 Overview This appendix explains how to customize the template that is used to produce the word processor portion of a patient report Use the procedure in this appendix to create a template that reflects your specific report requirements and includes unique identifying elements such as a logo for your facility There are two elements of the word processor portion of the patient report that can be customized Page layout and design including margins font selection etc Position of the data elements that extract patient specific information from the database such as the patient name address etc ICS Chartr 200 VNG ENG Operator s Manual 233 Appendix C C 2 Default Page Layou
106. ade latency accuray and peak velocity values 8 New System Options dialog accessible from toolbar to configure operator and workstation options including a Display of averaged Tracking and Saccade values b Graphing of right ear caloric values in red and Figure 1 4 Read Me First Dialog Box Installation Wizard d Choose Destination Location Places the application in the default destination folder example C CHARTR ENG for Windows unless you select a different destination folder Click Next to continue Note To make it easier for technical support to assist you if needed it is best to install the software in the default location Choose Destination Location Setup will install ICS CHARTR 200 ENG VNG in the following folder To install into a different folder click Browse and select another folder You can choose not to install ICS CHARTA 200 ENG VNG by clicking Cancel to exit Setup Destination Folder C CHARTR ENG for Windows Figure 1 5 Choose Destination Location Dialog Box Installation Wizard 4 GN Otometrics Section 1 Introduction to the VNG System e Select Setup Type Click on a setup type Networked Workstation or Standalone Workstation to highlight it then click Next to continue Standalone Demo is the default setting Select Setup Type Setup Type Standalone Network Network Demo Please select the directory on your workstation where your CHARTR database is to be i
107. ailable Type the fax number if available Type the email address if available Accept the information in this dialog box and save it to the database Clear the text boxes and prepare the system for new physician information Delete the physician from the database A referring physician cannot be deleted if associated with an existing patient record Close the dialog box without saving the information Opens the Operator s Manual GN Otometrics Section 3 Establishing and Maintaining Records 3 2 2 Establishing a New Physician Use the following procedure to enter physician information in the Referring Physician Information dialog box To establish a new physician 1 2 Access the Patient Information dialog box Click on the Physician s Order tab at the top of the dialog box Click the Info button next to the Referring Physician drop down list arrow to display the Referring Physician Information dialog box Click the New button to clear the text boxes and prepare the system for a new physician Place the cursor in the Last Name text box and type the referring physician s last name and degree Note Keyboard alternate press Tab to move the cursor from one text box to the next and from one button to the next press Shift Tab to return to the previous text box Place the cursor in the First Name text box and type the first name of the referring physician Continue moving from one text box to the n
108. al Preponderance Select to display directional preponderance measurements in the caloric pods review screen Show Right Ear in Red Select to display right ear irrigations in red and left ear in blue on caloric graphs Note By default Chartr VNG displays all graph data for warm caloric irrigation tests in red and cool irrigations in blue Available test protocols Contains a list of all available VNG test procedures and protocols for a specific hardware configuration Selected test protocols Contains a list of all VNG test protocols selected by the operator Applies the standard default as defined in the Default Operator s record test options System defaults are applied if the Default Operator record itself is being modified GN Otometrics Section 4 Setup and System Options Insert gt gt Moves the selected test protocol from the Available test protocols list and inserts it beneath the highlighted procedure or protocol in the Selected test protocols list box If an entire procedure is highlighted the procedure and all its protocols are inserted in the Selected test protocols list box lt lt Remove Removes the highlighted test protocol or entire procedure from the Selected test protocols list box Remove All Removes all of the test procedures and protocols from the Selected test protocols list box Default Battery Applies the standard recommended default as defined in the Default Operator s record test battery to
109. alog box Place the cursor in the text box where information needs to be modified and make the changes Note Keyboard alternate press Tab to move the cursor from one text box to the next and from one button to the next press Shift Tab to return to the previous text box Continue moving from one text box to the next until you have updated all of the existing physician information Click OK to save the modified referring physician information in the database GN Otometrics Section 3 Establishing and Maintaining Records 3 3 Referring Facility Information The name address and contact information for the referring facility is entered and maintained in the Referring Facility Information dialog box This section provides a description of the Referring Facility dialog box and the procedures related to the referring facility including Establishing a New Referring Facility Selecting an Existing Referring Facility Editing Existing Referring Facility Information 3 3 1 Referring Facility Information Dialog Box The Referring Facility Information dialog box is usually accessed from the Patient Information Physician s Order tab by clicking the Referring Facility Info button It may also be accessed by selecting Setup Referring Facilities from the Empty Main window Referring Facility Information Name Address City State Zip Code Country Phone Number Contact Person Figure 3 6 Re
110. alue based on an average from a 10 second window around the user selected SPV value Select next saccade available only in saccade analysis Select the previous saccade available only in saccade analysis Insert a nystagmus beat available in SPV analysis Delete the saccade available only in saccade analysis Move the baseline down available only in caloric analysis Move the baseline up available only in caloric analysis Select next beat in SPV analysis available only in SPV analysis Select previous beat in SPV analysis available only in SPV analysis Redo the analysis of the current test after adjusting Delete all of the beats in the SPV analysis Delete the analysis of the current test permanently The analysis will be deleted from the database Select next cycle in tracking tests available only in tracking analysis Select previous cycle in tracking tests available only in tracking analysis If selected display only the average data points available only during saccade and tracking analysis If selected display the individual data points available only during saccade and tracking analysis If selected display the individual and average data points available only during saccade and tracking analysis GN Otometrics Section 2 Getting Started in VNG 2 3 9 Signal Menu The Signal menu is only available in the Review Analysis mode after accessing F12 Analysis during saccade and tracking anal
111. ames Text box Display the text attached to the selected macro name Insert Place the macro text at the cursor position in the patient report Cancel Exit the dialog box without inserting the macro in the patient report 162 GN Otometrics Section 7 Working With Reports To insert a macro in a patient report 1 Place the cursor at the place you want to insert text in the patient report 2 Select Tools Get Macro or press Ctrl M to display the Get Macro dialog box 3 Select the macro from the list of available macros in the drop down list box Check the macro text and make sure the correct macro is selected 4 Click Insert to place the macro text in the patient report Note The macro text will be assigned the font and paragraph attributes that are active at the point of insertion For example if the cursor is on a line that is Times bold 12 pt and centered the macro text will display as Times bold 12 pt centered Once the macro is in the report the operator may change the font and paragraph attributes ICS Chartr 200 VNG ENG Operator s Manual 163 Section 7 Working With Reports 7 7 Report Setup The report setup feature allows the operator to plan and designate the order in which the test results waveforms will appear in the printed report Each operator should establish and maintain a template which will be used for all reports produced by that operator If the operator does not define a set of report template
112. annel not analyzed b Resolve any identified technical issues 136 GN Otometrics Section 6 Reviewing Analyzing Test Results 4 Finish the positional interpretation a Ifno technical errors were identified click Paste to Report to place the Interpretation results into the patient report where the text can be edited if needed and saved to the database b Click OK to close the dialog box 6 8 2 2 Static Position Test Interpretation Dialog Box Upon the completion of a caloric test interpretation the results first display in the Static Position Test Interpretation dialog box Note The test results cannot be edited in this dialog box However once the results are pasted into the patient word processing report the text can be modified as needed Static Position Test Interpretation Horizontal Nystagmus With Vision Without Vision Interpretation Sitting 0 deg sec Not Available No horizontal nystagmus with vision There is no significant horizontal nystagmus with or without vision in the static position test Horizontal Nystagmus Paste To Report C Vertical Nystagmus Figure 6 26 Static Position Test Interpretation Dialog Box Horizontal Nystagmus Displays the interpretation for the horizontal channel Vertical Nystagmus Displays the interpretation for the vertical channel Paste To Report Copies and pastes the interpretation to the word processor report This button is disabled if a technical error occurs Hel
113. ard copy saved However the system does not save an electronic copy of this report In addition to the above reports an operator is able to print individual waveforms analyses or calibrations during or after a test session using the Print Waveform Print Analysis or Print Calibration command This section provides information on how to access and use the word processor procedures for generating editing and formatting reports procedures for generating a custom waveform report and procedures for printing waveforms analyses and calibrations ICS Chartr 200 VNG ENG Operator s Manual 147 Section 7 7 2 Accessing the Word Processor Working With Reports The word processing program included in ICS VNG prepares an initial report by drawing data from the patient record in the database The operator may use the word processor to modify the patient information and add test result summary information to the report To access the word processor Press F6 Report if in the Review mode or Select Edit Patient Report from the Menu Bar if in either the New Test or Review modes Title bar Menu bar Toolbar File Edit Format TBols Help Normal Report area Ruler Tabs Status bar en Otometrics Demo Facility 125 Commerce Dr Schaumburg Ilinois 60173 USA Tel Patient Report VNG Patient ID Patient Demo 1 Normal VNG Birthdate 8 26 1969 Gender Male Address Phone Physician
114. are Cable from laptop computer Cable from to power source 20 S Printer pS N 8 a Caloric Stimulator Laptop Computer 7 NS A NE c tr ovu W SChar 15 2 o Footswitch Powertronix Isolation Station Medical grade AC outlet 13 Figure D 1 ICS Chartr 200 System Interconnections for VNG Systems 1 Cable to microphone optional 2 Cable to speaker optional 3 Monitor cable to left video monitor optional 4 Monitor cable to right video monitor optional 5 Video goggle cable to video goggles 6 GN Otometrics caloric stimulator cable to ICS Chartr 200 hardware or footswitch 7 USB cable to ICS Chartr 200 hardware 8 Light bar cable to port on ICS Chartr 200 hardware 9 Patient cable 10 Cable to loopback test fixture 11 ICS Chartr 200 hardware power cord to DC power supply AC DC converter 12 DC power supply cable to medical grade outlet 13 Isolation transformer cable to medical grade outlet 14 Caloric stimulator power cable to medical grade outlet 15 Footswitch cable to remote connector on caloric stimulator 16 Printer cable to printer port on laptop 17 Printer power cable to isolation transformer 18 Laptop power cable to isolation transformer 19 Video monitor power cable to isolation transformer 20 Video monitor power cable to isolation transformer GN Otometrics Appendix D Setting up the ICS Chartr 200 Hardware D 2 ICS Chartr 200 VNG ENG Rear Panel Co
115. atient Click on the sign in front of the desired Physician Order Test Session Click on the sign in front of a test procedure to display a list of protocols Click on a specific protocol to select it and display the test results Click on the handle of the waveform to be analyzed to select the waveform Press F12 Analysis to access the analysis for the selected test Use the scroll bar to move the tracing and cursor to select a starting point for the analysis Note For calorics it is best to start the measurement at the point of initiation of stimulation This will provide a common reference for all four tests Move the green cursor line to determine where to begin analysis and then press F12 Begin to activate the analysis process for the selected test R30 R20 R10 A lv Slow Phase Velocity 80 40 age Aetna ar a V ot a a a wales ane ia S aat OA ay 80 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 seconds Figure 6 6 SPV Analysis The system automatically measures as many beats as it is able to identify and plots the beats on the lower Slow Phase Velocity chart one beat per one second section is represented Once completed the system returns to the point marked as the beginning The Number of Beats identified displays in the Information Area of the Main Window The system analysis of individual beats can be overridden or measurements of additional beats not identified by the sy
116. ble B 9 Procedure Dix Hallpike Both Eyes Head Right Rapid movement of the patient from sitting Horizontal Eye Position Vertical Eye Position with head turned right to supine head hanging turned right Head Left Rapid movement of the patient from sitting Horizontal Eye Position Vertical Eye Position with head turned left to supine head hanging turned left Head Right Up Rapid movement of the patient from head Horizontal Eye Position Vertical Eye Position hanging right to sitting position Head Left Up Rapid movement of the patient from head Horizontal Eye Position Vertical Eye Position hanging left to sitting position Head Right Repeat Rapid movement of the patient from sitting Horizontal Eye Position Vertical Eye Position with head turned right to supine head hanging turned right Head Left Repeat Rapid movement of the patient from sitting Horizontal Eye Position Vertical Eye Position with head turned left to supine head hanging turned left Head Right Up Rapid movement of the patient from head Horizontal Eye Position Vertical Eye Position Repeat hanging right to sitting position Head Left Rapid movement of the patient from head Horizontal Eye Position Vertical Eye Position Up Repeat hanging left to sitting position ICS Chartr 200 VNG ENG Operator s Manual 219 Appendix B VNG Tests B 8 Position Tests Table B 10 Procedure Position Both Eyes e pe ee SUS Supine w Vision Patient supin
117. caloric review screen Four peak frequency based diagrams Claussen Stoll Haid and Freyss and one SPV based diagram Freyss are available Peak frequency based diagrams are only available if the peak frequency calculation option is selected German GDT Interface Settings only for use in Germany Enable German Interface to Practice Management System Select to enable the file based interface to a German Practice Management System PMS The interface is based on the documented GDT standard When selected an external PMS can be used to launch Chartr VNG and open or create a specific patient When the VNG test is complete a report is returned to the PMS system and Chartr VNG is exited 71 Section 4 72 PMS System Name Setup and System Option Chartr VNG System Name Type the short 4 character name used in the GDT interface files to identify the Chartr VNG system Type the short 4 character name used in the GDT interface files to identify the PMS system File Transfer Timeout secs Indicate the timeout length in seconds to be applied when processing messages via the GDT interface Character Set Select the character set to be applied when processing messages via the GDT interface GDT Local File Transfer Directories OK Cancel Help Incoming Messages PMS gt CHARTR VNG Specify the folder location for incoming GDT messages Chartr VNG will pick up messages from this folder The specified folder must exit
118. can be done when the operator is not able to recollect the calibration and wants to analyze saccades or tracking If a calibration is modified it will only be for that test It is best to recollect calibration and test data if a faulty calibration has occurred Select F3 Original Calib to view the calibration signal prior to adjustment A calibrated signal display is similar to that shown in Figure 6 5 An Event marker A is placed at the point on the tracing at which the operator pressed F12 Accept during a calibration session R20 R10 110 E 0 Figure 6 5 Calibrated Display In the Test Review mode the calibration status of the active signal is shown in the Information Area e g Active Signal H In the Calibration Review mode the Workspace title says e g Calibration Review H and the Information Area shows the actual calibration values Calibration age is the length of time elapsed between the calibration and the time at which the displayed test was saved 6 6 3 Printing a Calibration A Print Calibration option is available only while reviewing a calibration This option generates a single printed page that contains the selected calibrated waveform along with the Gain Offset and Calibration Age information To use the Print Calibration option select File Print Calibration from the Menu Bar Note This information also displays in the Information Area at the lower left side of
119. ccade Increase the gain of the wave Reduce the gain of the wave Move selected wave up Move selected wave down Prompts to save analysis Clicking No will go back to Review state without saving Move tracing to the previous saccade Move tracing to the next saccade Save analysis Table G 13 Function Keys SPV Initial Function Key Action i z F12 Begin Function Access Operator s Manual Cancel the analysis and return to the Review mode Start analysis at the time defined by the cursor ICS Chartr 200 VNG ENG Operator s Manual 259 Appendix G Table G 14 Function Keys SPV Analysis Function Keys Function Key Action F1 Help F2 Reanalyze F3 Remove All Beats F3 Interpret Tests F4 Pods Butterfly F5 Locate Peak F6 Set Peak F7 Delete F8 Insert F9 Close F10 Previous Beat F11 Next Beat F12 Save Function Access Operator s Manual Clear previous analysis and begin a new analysis Removes all beats for that test Invoke Interpretation Assistant to interpret results Currently this option is available only when PODS Butterfly is displayed To initiate Interpreter during Positional tests use the menu bar or interpret icon Display pod summary views of caloric analysis Identify the area representing the average of the fastest beats Mark peak velocity where the cursor is currently set Delete the selected SPV beat measurement Inser
120. ce Name Enter the name of the practice or clinic as it will display in reports Address Enter the address of the practice City Enter the name of the city in which the practice is located State Enter the name or abbreviation of the state in which the practice is located Postal Zip Code Enter the up to 15 character zip code identifier for the practice Country Enter the name of the country in which the practice is located Phone Number Enter the primary phone number of the practice Fax Enter the fax number for the practice Email Enter the e mail address of the practice Report Header Enter the information that will appear at the top of the report The first two lines of this field appear on the report OK Save the settings and exit the dialog box Cancel Exit the dialog box without saving the settings Help Opens the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual 67 Section 4 Setup and System Option 68 4 3 4 Application Startup Hardware Warning Selection The Application Startup Hardware Warning Selection option is used to select a startup mode warning message option Select the hardware message option that will be activated each time the ICS Chartr 200 VNG ENG software is started Normal Display startup warning if CHARTR hardware cannot be accessed Recommended Select this option to display the Hardware Startup Warning dialog box see Figure 4 2 any time the CHARTER hardware is not acces
121. cesecsseceseeeeesseeeseeseeeeees 102 5 10 1 Footswitch Operations eee cee ceseeeeeeeeeeeeeeeeeeeeeeeenaes 102 5 10 2 Record Video Using the Footswitch oo eeeeseereeneee 102 5 11 Using the Remote Control cece eseessecsseceseceeceeeeseeeseeeseeeees 103 Reviewing Analyzing Test Results ees eeseeseesecrsecsseceseeeeeeseeeees 105 Gil OVENI EW niesi eiretiers erang eene ee eei Eaire e 105 6 2 Review Pabs c isc tacit Seren a T eens 106 6 3 Working with Multiple Test Results cic eeceeeeeeesteceeneeeeees 107 6 4 Working with Waveforms ccc ceeceeeceseceeeeeeeeeeeeeeaeeeaeeeneeenaes 108 6 4 1 Waveform Handles eee eeeseeseeeneeeseecneecnseceaecnaeenseees 108 64 2 Wavetorin Texterna es en ee ed edi 109 6 4 3 Printing Waveforms eee eeeeeseeeseeeneeeneeenaeceaecnaeenaeees 109 6 5 Reviewing Test Results 00 ccc cceccecsscessteceseeceeeeeceeeeeenaeeeeaeeeees 110 6 6 Reviewing Calibrations 0 00 0 cccccceecceeseeceeneeceeeeecseeeeaeeneaeeeees 112 6 6 1 Calibration Review Uncalibrated cccccccceeeeseeeeeeeee 112 6 6 2 Calibration Review Calibrated 0 cccccceeeseseseeeseeseeees 113 6 6 3 Printing a Calibration 0 eee cseeseeneeencecneeceseceaeenneens 113 6 7 Analyzing Slow Phase Velocity Measurements eeeeeeeeee 114 6 7 1 Locating Versus Selecting Peak SPV 115 6 7 2 Measuring Slow Phase Velocity 116 6 7 3 Analyzing Peak Frequency eeeeeseesseeseceecesecseeeneees
122. ch status Reads pressed if the footswitch or the button on the head of the irrigator is pressed Temperature Select Cool or Warm to change the temperature stimulus on the irrigator Start Begin the countdown on the timer of both stimulators OK Exit the dialog box 196 GN Otometrics Section 9 Troubleshooting 9 6 Video 9 6 1 Video Diagnostics The Video Diagnostic option is used to verify the operation of the video equipment when operating VNG under the direction of a GN Otometrics support technician The Video diagnostic mode is used to test the video equipment and determine whether all of the channels are operating To display the Video Diagnostics dialog box close any open patient records to display the Empty Main Window Select Diagnostics Video to display a dialog box similar to the one shown in Figure 9 9 VIDEO TWO EYES 1 01 Video Version 0 Num Ports 0 BusType PCI IRQ Num 10 Base Port 0 Channels 6 Sample Rate Hz Display Rate 30Hz Max Sample Rate 60Hz Display Count 000077 Hex Decimal 007f 127 0065 101 ffb8 72 tffe 4 0000 0 0000 0 He HB HR VR YL TR TL Start Figure 9 9 Video Diagnostics Dialog Box The status information displays in the upper portion of the window The test results display in the lower portion of the window During operation the hex and decimal values from all six channels display in the lower portion of the window The numbers a
123. ck the Referring Facility Info button to display the Referring Facility Information dialog box Review the facility information and make any required changes in the text boxes Click OK to return to the Physician s Order dialog box Click the Clinical Information tab to display the Clinical Information dialog box Click on each of the clinical information buttons and review the answers Make changes as needed Click Finish to close the clinical information session and return to the Clinical Information dialog box Click OK when you are finished modifying all of the patient information in the three Patient Information dialog boxes ICS Chartr 200 VNG ENG Operator s Manual 45 Section 3 Establishing and Maintaining Records 3 1 5 Selecting an Existing Patient This section provides instructions for selecting and opening an existing patient record file To open an existing patient file from the Main Window 1 Select File Existing Patient from the Menu Bar or press F3 Existing Patient if available to display the Patient Selection dialog box Select a patient name from the list of available patients in the Patient Selection dialog box Click OK to access the selected patient s records and display the Patient Information dialog box Review the patient information in all three Patient Information dialog boxes and make any needed modifications See Section 3 1 4 Editing Patient Information for additional information
124. cond over a 34 arc Light target moving 10 20 30 40 50 and 60 per second over a 34 arc Light target moving sinusoidally at 0 25 Hz over a 34 arc Light target moving sinusoidally at 0 25 Hz over a 34 arc VNG Tests Horizontal Eye Position Vertical Eye Position Target Position Horizontal Eye Position Vertical Eye Position Target Position Horizontal Eye Position Vertical Eye Position Target Position Horizontal Eye Position Vertical Eye Position Target Position Horizontal Eye Position Vertical Eye Position Target Position Horizontal Eye Position Vertical Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position
125. cords Patient records that have been exported to a database file can be reviewed and analyzed on any other workstation To review a patient record in an export database 1 Select Database Open Archived Database or Exported Patient The Open File dialog will allow you to select an archived database or an export database 2 Select the desire database and click OK to display the Patient Selection dialog box containing a list of the patient records on the floppy disk 3 Select the desired patient record to view 4 Select File Close Patient to close the active patient record when finished ICS Chartr 200 VNG ENG Operator s Manual 179 Section 8 Exporting Importing and Archiving Records 8 4 Importing Patient Records Data in an archived database or exported patient database can be returned to the original database for storage or viewing To import a patient record from a database file 1 Select Database Import Patients from Database The Open File dialog will allow you to select the archived database or export database containing the patient records you wish to import pi Open Archive Export Database Jeg Look in demo x fa img Es SS CHARTRDEMO_VIDEO B chartrdemo Filename fi Files of type ICS Database Files mdb x Cancel Y Figure 8 3 Open Archive Export Database Dialog Box 2 Click OK to display the Import Patient Selection dialog box containing a list of the pa
126. ction 1 3 for additional information When the operator selects a caloric test from the software the system automatically sets the correct bath or temperature on the stimulator In turn the first depression of the head of the irrigator or the footswitch starts the recording and the irrigation Subsequent depressions of the button on the irrigator head or footswitch remotely center the tracings For non caloric tests the footswitch can be used to remotely start and center tracings if the power to the irrigator is on From the Empty Main Window select Diagnostics Irrigator to display an Irrigator dialog box similar to the one shown in Figure 9 8 COMPACT 4 1 0 Irrigator Version 88 Num Ports 32 BusType ISA IRQ Number 11 Base Port 330 FootSwitch Temperature Help C Cool Warm Daie OK Figure 9 8 Irrigator Dialog Box The status information displays in the upper portion of the window The test results display in the lower portion of the window The Irrigator dialog box provides the following information Version Lists the version number for this component Num Ports Lists the number of ports for this component Bus Type Lists the active bus type for this component IRQ Number Lists the IRQ number assigned to the irrigator ICS Chartr 200 VNG ENG Operator s Manual 195 Section 9 Troubleshooting Base Port Lists the base port I O address for the irrigator Footswitch Lists the current footswit
127. cussion of Report Setup options Patient Info Patient Report Mark Report Complete Operator Info Switch Operator Referring Physicians Referring Facilities System Options Update Maximum Test Duration Figure 4 1 Edit Menu ICS Chartr 200 VNG ENG Operator s Manual 59 Section 4 Setup and System Option 4 2 System Options Operator Settings Tab 60 The operator settings and test battery options are found in the three tables on the System Options dialog box Operator Settings Test Battery e Workstation Settings see Section 4 3 Peak Frequency GDT Interface see Section 4 4 4 2 1 Operator Settings Test Battery Tab Each operator is able to use the default settings and protocol or to select operator settings and a test battery that will be unique to the operator A Test Battery is a list of test protocols arranged in the sequence the operator wants to conduct the tests A Test Battery is unique to each operator Once established a Test Battery remains the same for all patients tested by an operator until the battery is changed by the operator The Operator Settings Test Battery tab is used to establish the operator specific testing sequence Select and move tests between the Available test protocols and the Selected test protocols list boxes Access this dialog box by selecting Edit System Options or clicking the System Options i icon on the Toolbar System Op
128. dialog box GN Otometrics Section 9 Troubleshooting 9 6 2 Video Equipment Connection Problems If the system senses a problem with the cable connections between the goggles the video distribution amplifier the ICS Chartr 200 or any related video equipment the following error message will display ICS CHARTR VNG f No response from the video goggles Please check to see if the video goggles are connected Then exit and restart YNG to restore normal operation Figure 9 10 Video Connection Error Message If this message displays Make sure the Chartr 200 is powered on and communicating with the computer green light If the ICS Chartr 200 is powered up but connecting to the computer the light will be blue e Make sure the cable connections between the goggles and video port on the back of the ICS Chartr 200 are firmly in place and connected according to Figures D 1 and D 2 Close and exit the VNG application Then from the Windows Desktop restart the VNG application This will allow the program to sense the presence of the video equipment and setup the necessary system components needed to operate the VNG application ICS Chartr 200 VNG ENG Operator s Manual 199 Section 9 Troubleshooting 9 7 Database Repair Utility A Database Repair Utility installed on the system hard drive attempts to correct ICS Chartr 200 VNG ENG database problems Use this utility only when instructed by an error message wh
129. ducted The Captioning Area may also display a comment from the Text Area of the Main Window The Seek Bar lies beneath the Captioning Area It indicates the progress of video playback relative to the beginning and end of the video clip The progress indicator may be dragged to change the current position in the video clip Pushbuttons to Play Pause and Stop playback are beneath the Seek Bar The Status Line is at the bottom of the dialog It displays the current state of the player for example Playing Paused or Stopped the current position in the video clip and the total duration of the video clip in seconds Note that there is no correlation between the current position in the video clip and the time into the test For example a display of 00 08 00 40 means that playback is currently 8 seconds into a 40 second clip It does not mean that the video image was recorded 8 seconds into the test ICS Chartr 200 VNG ENG Operator s Manual 261 Appendix H Video Files H 2 Adding a Comment to a Video Recording The last line of the caption in the Video Playback Dialog is reserved for user comments To enter a comment 1 Select the test in the Review Tab 2 Click in the Text Area of the Main Window located on the right side of the screen just above the function key bar 3 Type in the desired comments 4 Double click on the test s entry in the Review Tab or select Video Play in the Menu Bar to begin video playback
130. e s s AE Seed POSED DIP MIN eT wT A ii Patient ID Paene Buthdate Gender Address Pheae Phyacian Nowe Refernng facility Nese Referral reason Operator Delat Operator Report date 1 30 2006 Resutts ft 55 deg sec gt in the right enw L deg sec rightward Gain Asymenetry 0 e to the right The edont tem shows ne sbnormabty gt Poe i ine 7 td TWE Figure 6 12 Interpretation Assistant Caloric Analysis in Patient Report 8 If caloric results cannot be explained by any known physiology or pathophysiology of the vestibular system the following technical error message displays with suggestions to clean the PODS adjust the baseline shift and repeat poor irrigations Technical Comments A WARNING These caloric test results cannot be explained by any known physiology or pathophysiology of the vestibular system They are probably invalid We suggest that you proceed as follows Clean the pods and make sure peak caloric responses are identified correctly Inspect the position test in the supine position without fixation and the beginning of each caloric irrigation If nystagmus is observed adjust the baseline shift accordingly Repeat poor irigations We recommend that you repeat Right Cool If that does not solve the problem repeat Right Warm Ignore Abort Figure 6 13 Caloric Test Interpretation Technical Error Invalid Test Results a Select More Info to ope
131. e Both options are accessed from the word processor Edit Menu 7 3 1 Find Option To use the Find option 1 Select Edit Find from the word processor Edit Menu to access the Find dialog box Find 21x Find what m Direction Cancel M Match case C Up Down Figure 7 9 Find Dialog Box 2 Type the search word s and or number s in the Find what text box 3 Select Match case if the search is to be case sensitive A V indicates the option is selected 4 Select Up or Down to set the direction of the search in the document A dot indicates the selected option 5 Click Find Next to move the cursor to the next occurrence of the Find what text string 6 Click X or Cancel to close the Find dialog box Section 7 Working With Reports 7 3 2 Replace Option To use the Replace option 1 Select Edit Replace from the word processor Edit Menu to access the Replace dialog box Replace 27 xi Find what Patient ID Find Next Replace with Patient Identificatior Replace Replace All Cancel MV Match case cce Figure 7 10 Replace Dialog Box 2 Type the word s and or number s to be replaced in the Find what text box 3 Type the word s or number s that will replace the found text string in the Replace with text box 4 Click Find Next to find the next occurrence of the text string in the Find what text box 5 Click Replace to substitute the Replace with text string for the found text C
132. e Found New Hardware Wizard This wizard helps you install software for ICS ENG VNG USB hardware Q if your hardware came with an installation CD Q or floppy disk insert it now What do you want the wizard to do Install the software automatically Recommended Install from a list or specific location Advanced Click Next to continue tes Coes Figure 1 20 Found New Hardware Wizard Dialog Box 8 Click Finish when the hardware installation is complete Found New Hardware Wizard Completing the Found New Hardware Wizard The wizard has finished installing the software for E ICS ENG VNG USB hardware d Click Finish to close the wizard Figure 1 21 Hardware Installation Complete 12 GN Otometrics Section 1 Introduction to the VNG System 9 Click on the ICS CHARTR VNG or the ICS CHARTR ENG icon to begin a work session ICS CHARTR ICS CHARTR ENG for YNG For Figure 1 22 ICS Chartr VNG and ENG Desktop Icons This prompt displays the first time the program starts Workstation Registration x Before you can run this product you must register your workstation Please enter a unique workstation name Cancel Figure 1 23 Workstation Registration Dialog Box 10 Type a descriptive name that identifies the workstation in the Workstation text box and click OK If the system is running on a network the name you supply must be unique The software is now installed and ready for use
133. e click the primary mouse button F10 Previous Cycle F11 Next Cycle F12 Save The actions of many of the function keys change depending on the mode or situation that is in use and the activities being performed The following tables show the function keys organized by mode or situation ICS Chartr 200 VNG ENG Operator s Manual 253 Appendix G 254 Function Keys Table G 1 Function Keys Collection Initial Function Key Action Function F1 Access Operator s Manual F2 Create new patient record display Patient Information dialog box F3 Access an existing patient record display Patient Selection dialog box F4 Access the Review mode F5 Perform a calibration F6 Access Range dialog box F7 Electrode Test Display Electrode Test dialog box ENG mode only Video Adjust Display Video Adjustments dialog box VNG mode only F9 Switches the test eye during monocular testing F10 Return to previous test F11 Display next test F12 Start Begin a test Table G 2 Function Keys Collection Run Function Key Action Function F1 Access Operator s Manual F2 Mark Event E on the tracing F3 Mark Eyes Open EO on test tracing F4 Mark Vision Denied VD on test tracing F5 Center the waveform F7 Make the selected wave invisible F8 Make the selected wave visible F9 Cancel the test and do not save results F10 Overlap all waveforms F11 Spread all waveforms F11 Fixation
134. e database archive is being saved does not have enough capacity to make a new archive Exit the program and remove unneeded files from the hard drive Open VNG ENG and try the archive again The export database can not be copied to the Check to make sure the file is not read only Check the temporary directory available hard drive space The floppy disk database can not be copied to Verify the floppy disk is inserted into the floppy drive the floppy disk Verify the floppy disk is not full The patient record can not be exported Use a blank formatted floppy disk because there is not enough free space on the floppy disk Your ICS database was archived to file You have created an archived database that can be XXXXX mdb Videos were moved to the folder transferred to a CD ROM DVD or another hard drive or XXXXX mdb We recommend you burn the storage media Burn the archived database and videos archived database and videos to CD ROM DVD to a CD ROM DVD or use the Windows Explorer to move the archived files to a new hard drive or toa location in the network Consult the instructions supplied with your storage media i e CD ROM DVD burner to transfer the archived file to a new location GN Otometrics Appendix E Error Messages Table E 5 Hard Drive Data Storage Error Messages Error Message You have less than 5 MB of free disk space available There might not be enough space to save your test results It is recommended
135. e default destination folder and default naming conventions However you may assign a name and store an archive in a folder of your choosing Note 2 If you select an existing ICS database file the following dialog box will display Save Export As C CHARTRIDATA demo chud Andy_2006_Mar_06_export mdb already exists Do you want to replace it Yes Figure 8 6 Save Export As message Click Yes to replace the old database file with the current database file Click No to return to the Select Archive Destination dialog box without saving the current database file 182 GN Otometrics Section 8 Exporting Importing and Archiving Records 5 Click Save to store the archive file in the destination folder A message will display announcing that the database archive was successful and the archived database and video files may now be moved to another storage medium such as CD DVD ROM The archived database and videos may now be moved to an offline storage option such as CD DVD ROM Once copied to a new destination the archived database on the hard drive should be deleted in order to free up disk space e Use Windows Explorer to copy the archived database and videos to another location or use your CD DVD ROM burning software to burn the database and videos to CD DVD ROM Use the instructions supplied by the manufacturer to copy the archived database to another storage option ICS Chartr 200 VNG ENG Operator s Manua
136. e exported video file will be placed The Browse button may be used to locate the desired folder Specify the name of exported video file By default the patient s name appears here but change the name if patient privacy is desired Select the desired codec from the Codec dropdown list Displays the configuration dialog for the selected codec Not all codecs have configuration dialogs Select the desired compression quality The Quality Controls are only enabled if the selected codec supports quality configuration Reducing the quality value can result in smaller exported files but a lower quality image may not be as crisp as the original Export Video and dismiss dialog Cancel the Video Export operation Opens the Operator s Manual GN Otometrics Appendix H Video Files H 6 Configuring Windows Media Player for Caption Display Exported video files contain a caption consisting of a label for each eye the name of the patient the name of the test the date and time at which the test was conducted and an optional comment In order to view the caption in an exported video file closed captioning display must be enabled Windows Media Player version 9 1 2 3 4 Press the Stop button In the Menu Bar select Play Captions and Subtitles On if available Press the Play button The caption will be visible If necessary enlarge the caption window by grabbing the top and dragging it towards the image of the
137. e impedance video adjust auto adjust Figure D 3 Remote Control Keypad 14 Event marker 15 Eyes open marker 16 Vision denied marker Note See Section 5 11 for more information on using the remote control 242 GN Otometrics Appendix E Error Messages This section contains some commonly encountered Error Messages It provides possible causes and suggests actions that the operator could take to address the problem The Error Messages are grouped as follows Patient Testing Error Messages Table E 1 Video Related Error Messages Table E 2 Database Error Messages Table E 3 Archiving Exporting and Importing Error Messages Table E 4 e Hard Drive Data Storage Error Messages Table E 5 Other Error Messages Table E 6 ICS Chartr 200 VNG ENG Operator s Manual 243 Appendix E 244 Table E 1 Patient Testing Error Messages The calibration is not within tolerance Adjusting or resuming calibration is suggested The patient was out of range for xx of the test Table E 2 Video Related Error Messages Error Message No response from the video goggles Please check to see if the video goggles are connected and powered up Then exit and restart ENG to restore normal operation The CORECO Framegrabber drivers were not loaded on this system Try the following a Reboot the computer and restart VNG b Re install the VNG Software from CD ROM If this does not remedy the situation please contact
138. e keypad Click directly on the protocol name Use the mouse to place the cursor in the New Test Menu area then use the NW keys to move through procedures and protocols Within a test session a protocol may be repeated by selecting it more than once or skipped by not selecting it 78 GN Otometrics Section 5 Test Preparation and Data Collection 5 3 Physician s Orders and Test Sessions Physician s Orders and Test Sessions are used to organize patient test information in the system A physician s order binds the patient data report and identifying information together in the database The physician order date is assigned when the Physician s Order tab in the Patient Information dialog box is completed and a new patient record is established in the database See Section 3 1 2 Patient Information Dialog Box for additional information Test Sessions are conducted under the existing Physician s Order until a new Physician s Order is established See Section 6 for additional information on using Physician s Orders and Test Sessions during a test analysis session 5 3 1 Setting up a New Physician s Order When needed a new Physician s Order may be established and tests may be run and maintained under the new order A new Physician s Order is automatically started when a new patient record is created When retesting a patient a new Physician s Order needs to be started by the operator To establish a Phys
139. e signal is out of the acceptable tolerance range a technical comment displays suggesting a recalibration or adjustment of the accepted calibration Press F4 Resume if the calibration is unacceptable and to continue the calibration process Repeat steps 9 11 Press F5 Enlarge and F6 Shrink to adjust the calibration Enlarge will increase the size of the waveform and Shrink will reduce it Press F7 Up and F8 Down to move the wave up or down Press F10 Overlap and F11 Spread to overlap and spread the waves Note The calibration gain and offset displays in the Information Area of the Main Window ENG only Note Use the default calibration if a patient cannot be calibrated Press F3 Default to set the sensitivity at 150 microvolts per 10 degrees for the horizontal both channel Horizontal individual left and right channels are set at 75 microvolts per 10 degrees and vertical left and right channels are set at 100 microvolts per 10 degrees Press F12 Save when you are satisfied with the calibration to save the results of the calibration and prepare for calibration of the next channel Note When all channels are calibrated press F12 Save to return to the test mode Press F9 Done to return to the test mode immediately Press F10 Next Channel or F11 Previous Channel to calibrate the next or previous channel ICS Chartr 200 VNG ENG Operator s Manual 95 Section 5 Test Preparation and Data Collection 5 8 Conducting a Test Collecting Dat
140. e tests failed or were unable to run CPLD register access FX2 RAM access FPGA register access Cancel Help Figure 9 5 USB Hardware Diagnostic Results and Loopback Settings Dialog Box The USB Hardware Diagnostic Results and Loopback Settings dialog box provides the following information Loopback Settings Diagnostic Results Enable loopback circuits for hardware troubleshooting The options are none for normal operations and external and internal for diagnostic troubleshooting Indicates diagnostic test results for the CPLD register access FX2 RAM access and FPGA register access The results will be listed as passed if the hardware is performing properly failed if the hardware is not performing properly unknown if the system was unable to run the tests Note Contact GN Otometrics Customer Support for assistance if any of these tests failed or were unable to run 190 GN Otometrics Section 9 Troubleshooting 9 3 Light Bar The Light Bar diagnostic option is used to verify the hardware operation of the light bar Note This diagnostic test should be used only in conjunction with or under the direction of GN Otometrics personnel The light bar contains a series of LED lights The lights are arranged in a specific pattern and are activated based on the requirements of the test being conducted The manual diagnostic test checks to determine whether all of the LEDs are working properly for each type
141. e used only in conjunction with or under the direction of GN Otometrics personnel The diagnostic test function described in this section involves a dynamic test of the ranger accuracy When the test is started the range values change and the software collates how many samples were in and out of the goal range The goal range is 44 to 52 inches 111 76 to 132 08 cm At the end of a test the results of the in and out samples display as a percent These values are used to guide the technical comment that displays at the end of a patient test Out of Range more than xx of the goal range during the test From the Empty Main Window select Diagnostics Ranger to display a dialog box similar to the one shown in Figure 9 7 VIDEO TWO EYES V2 00 Ranger Version 0 3 Num Ports n a BusType USB IRQ Number n a Base Port n a Not Ranging Goal Range 44 00 52 00 111 76 cm 132 08 cm In Range Out Of Range In Range Percent Laer OK Figure 9 7 Ranger Dialog Box The Status is shown in the upper portion of the window Click Start to begin the Ranger diagnostic test While ranging a value displays Click Stop to end the test and display the test result which is a display of the number of samples sampling is done every 3 seconds measured that were in and out of range In addition the in range percent value displays ICS Chartr 200 VNG ENG Operator s Manual 193 Section 9 194 Vers
142. e with nose toward the Horizontal Eye Position Vertical Eye Position ceiling with vision Supine w o Vision Patient supine with nose toward the Horizontal Eye Position Vertical Eye Position ceiling without vision Head Right Patient supine with head turned 90 to Horizontal Eye Position Vertical Eye Position right Head Right w Vision Patient supine with head turned 90 to Horizontal Eye Position Vertical Eye Position right with vision Head Right w o Patient supine with head turned 90 to Horizontal Eye Position Vertical Eye Position Vision right without vision Head Left Patient supine with head turned 90 to left Horizontal Eye Position Vertical Eye Position Head Left w Vision Patient supine with head turned 90 to left Horizontal Eye Position Vertical Eye Position with vision Head Left w o Vision Patient supine with head turned 90 to left Horizontal Eye Position Vertical Eye Position without vision Right Side Patient on his right side Horizontal Eye Position Vertical Eye Position Right Side w Vision Patient on his right side with vision Horizontal Eye Position Vertical Eye Position Right Side w o Patient on his right side without vision Horizontal Eye Position Vertical Eye Position Vision Head Hanging w Patient supine with head hanging with Horizontal Eye Position Vertical Eye Position Vision vision Head Hanging w o Patient supine with head hanging without Horizontal Eye Pos
143. eText dialog box Edit WaveT ext Ea Cancel Test showed no abnormalities and was con Pi Figure 6 3 Edit WaveText Dialog Box Waveform notes can be viewed and edited by operators and are included in patient reports To create or edit waveform notes in the review mode 1 Double click on the selected waveform handle or select Waveform Wave Text to display the Edit WaveText dialog box 2 Type directly in the Text box 3 Click OK to save the waveform text and exit the dialog box Note An operator may type up to 2 lines of text in the Text Area just below the Test Review Workspace on the Main Window See Section 2 2 VNG Main Window 6 4 3 Printing Waveforms During a Review Analysis work session the operator may print a waveform as needed Select File Print Waveform to send the current waveform information directly to the printer ICS Chartr 200 VNG ENG Operator s Manual 109 Section 6 Reviewing Analyzing Test Results 6 5 Reviewing Test Results The results for all tests can be reviewed before and after the test results are analyzed Select the Review Tab in the Main Window to access the Review mode In the Review mode The operator may view the entire tracing select and manipulate waveforms access the calibration results and begin an analysis session If the patient record is changed or closed or if another test is selected for review ICS VNG automatically saves the current position of the
144. ecking Range The range sensor provides a continuous display of patient to light bar distance The sensor indicates whether a patient is located at the 4 foot 121 9 cm distance required for testing Note The ranging function is only activated during tests that use a light bar stimulus The ranging function is not available for all system light bars When the range sensor is activated a dialog box displays and prompts with one of the following status designations Over Range Under Range x xXx xx cm distance in feet and inches and centimeters 4 0 121 9 cm Figure 5 2 Range Dialog Box The range sensor is constantly sampling patient to bar distance while a test is being conducted The range distance displays during the test in the Information Area of the Main Window This distance is updated every 3 seconds If the patient moves out of the acceptable range of 3 feet 8 inches to 4 feet 4 inches 111 8 cm to 132 1 cm the displayed value will change to Over Range or Under Range to prompt the operator to make an adjustment If a test was run with the patient out of range for more than 10 of the test a message displays at the conclusion of the test announcing the out of range status Note An incorrect patient to bar distance can distort the data as the patient is calibrated to a 4 foot 121 9 cm distance from the light bar GN Otometrics Section 5 Test Preparation and Data Collection Use
145. ection 3 58 Establishing and Maintaining Records 3 4 4 Editing Existing Operator Information Use this procedure to modify previously entered operator information including the Test Battery and Operator Options To edit existing operator information 1 2 Select Edit Operator Info to display the Edit Operators dialog box Select the desired operator and make sure the operator s name displays in the text box Place the cursor in the text box where information needs to be modified and make the changes Note Keyboard alternate press Tab to move the cursor from one text box to the next and from one button to the next press Shift Tab to return to the previous text box Continue moving from one text box to the next until you have updated all of the existing operator information Click OK to save the modified operator information in the database Go to Section 4 2 for information on how to modify operator options GN Otometrics Section 4 Setup and System Options 4 1 Overview Many of the setup and system options are available through the Edit Menu on the Menu Bar The Edit Menu is available from both the Empty Main window and from the New Test Review mode however the active menu options vary The Print setup options are available through the File Menu This section covers the options available in the Empty Main window and all of the New Test Review mode options except Report Note See Section 7 7 for a dis
146. ed when the test is stopped Automatic Analysis Select to have the data automatically analyzed when the test is stopped The data can always be reanalyzed Automatic Analysis Display Select to have the data automatically display the analysis screen once the data is analyzed This option requires that Auto Analyze also be selected Automatic Waveform Filtering Select to use automatic filtering during review If selected a low pass digital filter is applied to the tracings during review This eliminates high frequency noise and provides a cleaner appearance to the data Maximum Saccade Latency Select the Maximum Latency setting for a saccade to be accepted from the list of available choices 600 through 900 milliseconds applies to saccade latency measurements Caloric Countdown Timer Select to have a countdown timer appear between caloric tests Note that you can not access analysis or other software features while the timer is active Omit GN Logo from Printed Report Select this option to omit the GN Otometrics logo on the printed patient report Operator Specific Settings ICS Chartr 200 VNG ENG Operator s Manual Require Calibration Before Collection Select this option to require manual calibration before testing a patient Center Tracings Every x Seconds Select this option to have the system autocenter the ENG or VNG waveform tracings every x seconds during a test Specify the interval in seconds between eac
147. elled word s from the report in red text Suggestions Displays suggested correct spellings for the word s in red in the Syntax area Undo Edit Changes the previously corrected word in the report back to the original form Ignore Skips the currently highlighted word s in the report listed in red in the Syntax area and moves to the next not found word Ignore All Skips the currently highlighted word s in the report listed in red in the Syntax area every time it finds it in the report Add Adds the currently highlighted word in the report listed in red in the Syntax area to the custom dictionary Change Replaces the currently highlighted word in the report listed in red in the Syntax area with the highlighted word in the Suggestions area Change All Replaces the currently highlighted word every time it appears in the report listed in red in the Syntax area with the highlighted word in the Suggestions area AutoCorrect Disabled Replaces all system found spelling errors with system selected words based on the currently selected Dictionary Quit Close and exit the Spell Check option To spell check a report 1 Select Tools Spell Checker from the Menu Bar to display the Spell Checking Document dialog box 2 Look at the word s in red text in the Syntax area and decide whether changes are needed in the report Note Click Ignore or Ignore All to skip the word in the Syntax area and not change it in the report Click
148. en beats Press F9 Close to end the review Press F12 Save to save the analysis results and exit the Analysis mode for the selected test Note Pressing F12 Save will save the analysis to the database and overwrite any previously performed analysis of the test for that operator Press F9 Cancel to exit the Analysis mode without saving the analysis Repeat this procedure for each test in which measurements of nystagmus slow phases are desired GN Otometrics Section 6 Reviewing Analyzing Test Results 6 7 3 Analyzing Peak Frequency In order to choose to analyze peak frequency make sure the Calculate peak frequency per 30 seconds option is selected in the System Options Operator Settings Test Battery tab dialog box When analyzing for peak frequency the system looks at the 30 second window that contains the most beats 1 30 2 31 3 32 second windows SPV measurements For example Peak Frequency 11 at 15s Where left beating right beating 11 number of beats in the 30 second window 15 time in seconds of the center of the window Caloric Frequency 30 sec Where f 80s number of beats in the 30 second window left beating right beating t s time in seconds in the center of the window In the System Options dialog box the Calculate peak frequency per 30 seconds option must be selected for the software to provide this measurement To provide the peak frequency option for other tests i e Spon
149. ety reasons accessories connected to the equipment s outlet fittings must be identical to the type supplied with the system To comply with EN 60601 1 1 the computer printer etc must be connected to the isolation transformer GN Otometrics Section 10 Note 9 Note 10 Note 11 Note 12 Note 13 Safety Conductive parts with patient connection must not be in contact with other conductive parts at any time No defibrillators or HF surgical equipment should be applied to the patient when connected to ICS Chartr 200 VNG ENG at any time Connection to network or modem components may compromise the safety or effectiveness of this system Use fiber optic network connections to install the computer on a network Installation of any third party software applications programs or utilities other than those specified by GN Otometrics can compromise the safety or effectiveness of this system The device is disconnected from the mains by pulling the plug from the wall outlet Avoid accidental contact between connected but unapplied parts VG 40 video goggle and electrodes including connections and other conductive parts ICS Chartr 200 VNG ENG Operator s Manual 203 Section 10 Safety 10 3 Manufacturer GN Otometrics A S 9 Hoerskaetten DK 2630 Taastrup Denmark Phone 45 45 75 55 55 Fax 45 45 75 55 59 www otometrics com 10 3 1 Responsibility of the Manufacturer The manufacturer is to be considered respons
150. ext until you have entered all of the physician information requested Click OK to save the referring physician information in the database ICS Chartr 200 VNG ENG Operator s Manual 49 Section 3 Establishing and Maintaining Records 3 2 3 Selecting an Existing Physician Use this procedure to select a physician from the existing list of physicians To select an existing physician 1 2 Access the Patient Information dialog box Click on the Physician s Order tab at the top of the Patient Information dialog box Click the Referring Physician drop down list arrow to display a list of physicians Select the patient s referring physician from the list of available physicians Make sure the physician s name displays in the Referring Physician text box Note Ifthe physician is not in the list of available referring physicians see Section 3 2 2 Establishing a New Physician for additional information Click the OK button at the bottom of the Patient Information dialog box to accept the selected physician 3 2 4 Editing Physician Information Use this procedure to edit previously entered physician information To edit existing physician information 1 2 50 Access the Patient Information dialog box Click on the Physician s Order tab at the top of the Patient Information dialog box Click the Info button next to the Referring Physician drop down list arrow to display the Referring Physician Information di
151. ferring Facility Information Dialog Box Name Type the name of the referring facility Address Type the street address of the facility Multiple lines may be entered in the text box City Type the city name State Type the state or 2 digit state code Zip Code Type the zip code up to 15 digits ICS Chartr 200 VNG ENG Operator s Manual 51 Section 3 52 Establishing and Maintaining Records Country Type the country name Phone Number Type the facility s telephone number Contact Person Type the name of the contact person for the facility Buttons OK Accept the information in this dialog box and save it to the database New Clear the text box and prepare the system for new facility information Delete Delete the facility from the database A referring facility cannot be deleted if it is associated with an existing patient record Cancel Close the dialog box without saving the information Help Opens the Operator s Manual 3 3 2 Establishing a New Referring Facility Use the following procedure to enter referring facility information in the Referring Facility dialog box To establish a new referring facility 1 2 Access the Patient Information dialog box Click on the Physician s Order tab at the top of the Patient Information dialog box Click the Info button next to the Referring Facility drop down list arrow to display the Referring Facility Information dialog box Click the New button to clear
152. fined in the report template for the text portion of a patient report are shown in Figure C 2 A complete list of the database tags and a description of the data each retrieves is at the end of this appendix Database access tag I template rtf WordPad File Edit View Insert Format Help oela SQ a eld Sl Arial m e Aule 2z kFAC_NAME gt lt FAC_ADDRESS gt lt FAC_CITY gt lt FAC_STATE gt lt FAC_ZIP gt lt FAC_COUNTRY gt Tel lt FAC_TELEPHONE gt Patient Report lt MODALITY gt Patient ID lt PATIENT_ID gt Patient lt LAST gt lt FIRST gt Birthdate lt BIRTHDATE gt Gender lt GENDER gt Address lt ADDRESS1 gt lt ADDRESS2 gt Phone lt PHONE gt Physician lt PHYS_LAST gt lt PHYS_FIRST gt Referring facility lt REF_FACILITY gt Referral reason lt REF_REASON gt Operator lt OPER_LAST gt lt OPER_FIRST gt Report date lt REPORT_DATE gt For Help press F1 Figure C 2 Default Report Template The words within the brackets lt gt are the database access tag and the brackets signal that the enclosed information is requested from the database The brackets do not appear in the word processed version of the report For example lt PHYS_LAST gt retrieves the last name of the referring physician from the database ICS Chartr 200 VNG ENG Operator s Manual 235 Appendix C Customizing the Word Processor Report C 4 Customizing the Report Template Within a pat
153. ftware that fixation began GN Otometrics Section 6 Reviewing Analyzing Test Results 6 8 Interpretation Assistant The Interpretation Assistant a proprietary tool provided with Chartr 200 assists users in interpreting the results of caloric and static position VNG ENG tests The Interpretation Assistant first validates the test results If the results are valid the Assistant continues with the analysis during which the test results are compared to the pre determined cutoff values The output from the analysis can be viewed immediately and can be included in the patient report IMPORTANT The Interpretation Assistant does not suggest diagnosis Diagnosis can be made only when a licensed physician incorporates the interpretation from the VNG ENG test with the results from other tests such as audiometric evaluations MRI CT scan blood tests etc The Interpretation suggestions provided by the Chartr VNG ENG feature are based on many studies that have been accumulated during the past 50 years The following books and review articles summarize the results of these studies 1 Baloh RW Honrubia V Clinical Neurophysiology of the Vestibular System F A Davis Philadelphia 1990 2 Barber HO Stockwell CW Manual of Electronystagmography C V Mosby St Louis 1980 3 Barin K and Stockwell C W Directional Preponderance Revisited Insights in Practice February 2002 pp 1 6 4 Halmagyi G M Cremer P D Anderson
154. g and Maintaining Records Clinical Information Tab The Clinical Information tab contains three buttons that display a series of dialog boxes that will prompt you to answer questions and supply clinical information related to the patient See Appendix A for a list of the clinical information questions Note This dialog box can be accessed by clicking the New Patient button or by selecting Edit Patient Info Patient Information Patient Information Physician s Order Clinical Information Categories General Eye Movement Examination Ear Examination Physician Order Date 6 3 2004 1 24 51 PM OK Cancel Help Figure 3 4 Clinical Information Dialog Box To use the Clinical Information tab 1 Click the General button and answer all questions Click Finish to complete this section 2 Click the Eye Movement Examination button and answer all questions Click Finish to complete this section 3 Click the Eye Examination button and answer all questions Click Finish to complete this section 4 Click OK to close and save the information on all 3 tabs of the Patient Information dialog box Note A button is raised if the clinical questions are answered and the operator clicks Finish This happens when creating a new patient record and when editing an existing patient record 42 GN Otometrics Section 3 Establishing and Maintaining Records The three Clinical Information categories are General Pro
155. h autocentering event Setting this value too low may cause jittery tracings Note Waveforms for Gaze Saccade and Tracking tests will NOT be automatically centered if this setting is selected 61 Section 4 Setup and System Option 62 Footswitch Irrigator Button Center Waveform during Collection VNG only Select to choose to have the 2 press of the footswitch or irrigator button center the tracing If this option is not selected the 2 press of the footswitch or irrigator button will start the video recording Display Lightbar Center Fixation Light Select to use the fixation light during testing If selected turns on a center light on the light bar whenever it is not being used for other forms of optical stimulation Enable Distance Ranger Select to use the light bar ranging function during testing Lightbar Brightness Select the desired light bar brightness from the list of available choices Low Medium High Show Averaged Saccade and Tracking Values Select to turn on off the display of the following average rightward and leftward values for a test Saccade Accuracy Latency and Peak Velocity Tracking Gain Caloric Test Only Settings Test Battery Buttons Default Settings Automatic Fixation Light On Off secs VNG only Select to have the fixation light come on in the goggles Select the second in the tracing that the fixation light will come on and go off Show Caloric Direction
156. he operator to fine tune the video image for each eye Video Adjustments Right Eye Left Eye Threshold a E gt Brightness aj gt Contrast Adjust Help E BahEVes Auto Adjust Figure 5 6 Video Adjustments Dialog Box 88 GN Otometrics Section 5 Test Preparation and Data Collection To display the Video Adjustments dialog box access the New Test mode and press F7 Video Adjust Right Eye Left Eye Threshold Video image of the right eye Video image of the left eye Slide the control to fine tune the threshold setting for both eyes Slowly move the threshold slider until the on screen color of only the pupil area of each eye is blue Brightness right and left eyes Slide each control to fine tune the on screen image brightness for the right and left eyes Contrast right and left eyes Adjust Both Eyes Auto Adjust OK Help ICS Chartr 200 VNG ENG Operator s Manual Slide the controls to fine tune the on screen image contrast for the right and left eyes Check this option to change the brightness or contrast of the eye images in tandem Do not select this option if you want to adjust each eye separately Click to automatically adjust the system to track the pupils by moving the threshold brightness and contrast controls Accept the video adjustment settings and exit the dialog box Opens the Operator s Manual 89 Section 5 Test Preparation and Data Collection 5 6 4
157. he recording and calibration is suspended although data collection continues ICS Chartr 200 VNG ENG Operator s Manual 93 Section 5 Test Preparation and Data Collection Once a calibration is accepted a software comparison between the target and eye positions is made If the accepted amplitude of the patient s peak to peak eye signal is more than 10 different from the target s peak to peak amplitude the calibration technical comment dialog box Figure 5 9 will display and prompt for a recalibration or adjustment of the current calibration Technical Comment Ea The calibration is not within tolerance Adjusting or resuming calibration is suggested Figure 5 8 Calibration Technical Comment F12 Stop stops data collection If the calibration is saved the last 10 seconds are saved to document calibration validity The Event Marker marks the acceptance point If F12 Stop occurs more than 10 seconds after F12 Accept the event marker and the actual accepted cycle will not be displayed in calibration or calibration review Monocular VNG Calibration Note Calibration in monocular VNG systems is the same as in VNG systems except that only one eye can be calibrated at a time Calibrating for one eye overwrites the calibration for the other eye Thus you must recalibrate every time you change the test eye The system will prompt to you calibrate if you attempt to run a test using an eye that has not been calibrated Use
158. he screen resolution must be at least 1280x960 pixels Unable to load the word processor Try to The system can not access the built in word processor reinstall the software If unsuccessful contact See Section 1 for instructions on reinstalling the program GN Otometrics Customer Support Contact GN Otometrics Customer Support for assistance The workstation was not registered A workstation name was not supplied when the program was originally installed GN Otometrics Appendix F Keyboard Shortcuts F 1 Activate Keyboard Shortcut Feature The procedure in this appendix provides instructions for activating the keyboard shortcut options This feature allows you to use the keyboard to display menus and menu options When this option is on an underscore appears under a letter in each menu option To use the keyboard press the Alt key plus the underscored letter Help Contents Contents About About Figure F 1 Help Menu Keyboard Shortcuts On and Off If you do not see the underscored letters use the following procedure to activate this feature To activate the keyboard shortcuts feature 1 Close all open programs 2 Select Start Control Panel 3 Select the Switch to Classic View option Pick a category i Appearance and Printers and Other er hemes Hardware T Figure F 2 Control Panel Dialog Box ICS Chartr 200 VNG ENG Operator s Manual 249 Appendix F 4 Double click the Display icon 5 Clic
159. he system See Section 4 2 information on how to select and set operator options including the test battery See Section 7 7 for information on how to format the report 3 4 1 Edit Operators Dialog Box The Edit Operators dialog box is accessed by selecting Edit Operator Info Complete the Edit Operators dialog box information to save operator specific information in the VNG ENG database Edit Operators Select Operator Operator Default Audiologist Otometrics Operator Info Last Name Default Eirst Name Operator Address 125 Commerce Drive City Schaumburg State IL Zip Code 60173 Country USA Phone Number 847 534 2150 Identification Cancel Help Figure 3 7 Edit Operators Dialog Box Select Operator Select an operator from the list The database information associated with the selected operator will display Last Name Type the last name and degree of the operator First Name Type the first name of the operator GN Otometrics Section 3 Establishing and Maintaining Records Address Type the street address of the operator Multiple lines may be entered City Type the city name State Type the state or 2 digit state code Zip Code Type the zip code up to 15 digits Country Type the country name Phone Number Type the operator s telephone number Identification Type any identifying information Buttons New Clear the text boxe
160. her w Vision Other w o Vision Right Ear Cool Left Ear Cool Right Ear Warm Left Ear Warm Right Ear Supine Left Ear Supine Right Ear Prone Left Ear Prone Right Left Head Right Head Left Head Right Repeat Head Left Repeat Sitting Sitting w Vision Sitting w o Vision Supine Supine w Vision Supine w o Vision Head Right Head Right w Vision Head Right w o Vision Head Left Head Left w Vision Head Left w o Vision Right Side Right Side w Vision Right Side w o Vision Left Side Left Side w Vision Left Side w o Vision Other Other w Vision Other w o Vision Head Hanging Head Hanging w Vision Head Hanging w o Vision With Vision Vision Denied 229 Appendix B 230 VNG Tests B 13 2 Chartr 200 ENG Default Test Battery This list of tests is the default standard battery of tests for Chartr 200 ENG The test battery can be installed and modified from the System Options Operator Settings Test Battery Tab dialog box see Section 4 2 Saccade Both Eyes Saccade Individual Eyes Gaze Both Eyes Gaze Individual Eye Tracking Both Eyes Tracking Individual Eyes Optokinetic Both Eyes Dix Hallpike Both Eyes Position Both Eyes Horizontal Random Position Horizontal Random Position Right Left Up Down Right Left Up Down Sine Horizontal Sine Horizontal 20 sec Right 20 sec Left 40 sec Right 40 sec Left Head Right Head Left Head
161. ible for effects on safety reliability and performance of the equipment ONLY IF All assembly operations extensions re adjustments modifications or repairs are carried out by the equipment manufacturer or personnel authorized by the manufacturer The electrical installation to which the equipment is connected complies with EN IEC requirements The equipment is used in accordance with the instructions for use The manufacturer reserves the right to disclaim all responsibility for the operating safety reliability and performance of equipment serviced or repaired by other parties 204 GN Otometrics Section 11 Technical Specifications ICS Chartr ENG CMR Ratio gt 100 dB at 50 60 Hz Channel Frequency Response 12dB octave low pass filter with a cutoff frequency of 35 Hz Input Impedance Channel 1 gt 5 5 Mohms Channel 2 3 4 gt 8 Mohms Note Channel I electrode input is actually shared between two of the channels and has a reference to isolated ground which lowers its input impedance Input Sensitivity A measurement of eye movement as small as 10 uV can be observed on the PC display Typical voltage measurement from a human eye is between 100 and 400 uV A gain of 500 is used to amplify the input signal Hence the eye movement seen on the PC display is usually between 50 mV and 200 mV ICS Chartr 200 Interface USB to PC Type Identification ICS Chartr 200 is Type 1068 from GN Otometrics A S
162. ibrations are saved and are available for review Test results may be reviewed immediately after the test is conducted and saved or recalled at a later time for review and analysis During review and analysis the operator is able to compute the slow phase velocity of nystagmus analyze saccades and analyze tracking test results Note All analyses are operator specific allowing for multiple opinions and interpretations of the same test results Refer to Section 3 for instructions on how to change the active operator to obtain a different view of the test results ICS Chartr 200 VNG ENG Operator s Manual 105 Section 6 6 2 Review Tab The Review tab contains a list of all the tests for this patient in the database listed by Physician s Order date and Session date The organization is similar to the directory in the 106 New Test tab Reviewing Analyzing Test Results Note Specific tests consist of a procedure e g Saccade Caloric etc and a protocol e g Right Ear Cooll Note For additional information see Section 5 2 New Test Tab and Section 4 2 Operator Options Test Battery Tab New Test Review Physician Order Date 3 7 2007 Session 3 7 2007 9 50 28 AM Saccade Both Eyes Saccade Individual Eyes Gaze Both Eyes Tracking Both Eyes Optokinetic Both Eyes Dis Hallpike Both Eyes Position Both Eyes Caloric Both Eyes Te a a Right Ear 7 Warm 10 17 12 AM Left Ear Z Warm 10 22 13 AM
163. ician Order 1 Access the Patient Selection dialog box 2 Select an existing patient and click OK to display the Patient Information dialog box for that patient 3 Click the Physician s Order tab to display Physician s Order dialog box 4 Click the New Order button to establish a new Physician s Order for the selected patient A system prompt informs the operator that a new physician s order is being started and the current order will be closed The system automatically assigns the current date to the new order 5 Enter all information required in the Referral Reason text box 6 Select a Referring Physician and a Referring Facility for this Physician s Order 7 Click the Clinical Information tab and complete the General Eye Movement Examination and the Ear Examination questionnaires 8 Click OK to exit the Patient Information dialog box and return to the Main Window with the selected patient s record open ICS Chartr 200 VNG ENG Operator s Manual 79 Section 5 Test Preparation and Data Collection 80 5 3 2 Test Sessions Test records and results are organized by the Physician s Order date and the test session date A test session is an uninterrupted series of tests or protocols run on a patient Multiple test sessions may be run under one physician s order In addition a test may be conducted multiple times within a test session See Section 5 for additional information on working with session dates Ch
164. ick Diagnostics USB Unit Loopback and HW Diagnostics Diagnostics USB Unit USB Unit Loopback and HW Diagnostics Lightbar Ranger Irrigator Figure 9 1 Diagnostics Menu 5 Select External and click OK ti at SS Lo ee P USE Unit Hardware Dixenostic Results and Loopback Settings EJ Loceback Seltegs This tatting aces resna or estana Inooback cocut to ba arabied n the hardware to bowtleshcotng papare For noma operation Pe loopback am seting thoukd be net 1o none 4 Loopback Sening morena reena y Diagnostic Rests none j Worl Hanne dogs we petane when te hardware s pomamed on q ih CPLD yeguler secese paused PO PAM socer parsed FPGA giim coast patsed x Carcel Hee Dagia Tast Tene tom OO 00 w 00 10 a Wasio Horizontal uneaibretess Prescot Sine Horizontal Wave Tat fe fe fa 0 Repat f EE New Hera ooy Ceiteation Waren Test Tet FI R F3 Help New Eiry Patent Poet Figure 9 2 USB Unit Hardware Diagnostic Results and Loopback Settings Dialog Box f 5 ZA Urthe m f2 Not Andyn Tet LOCPGACK MoE Database chartr mdb Operator De ak perator 186 GN Otometrics Section 9 Troubleshooting 6 Open an existing patient file select a protocol and press F5 Calibrate to access the Calibration Mode 7 Press F12 Start to run a calibration Do NOT click Accept 8 Check the on screen tracings
165. ient report the placement of the information on the page the font selection and sizes and the paragraph styles are all predefined in a Report Template The information and format of each report may be changed in the VNG ENG word processor However the template must be changed in order to implement a global change that will apply to all of the reports produced at a workstation or at a facility Report templates cannot be changed while working in ICS VNG ENG for Windows Use a standard word processing program such as Word WordPerfect or WordPad included with Windows to make changes to the report template To access and modify the report template Note The file name of the report template is vyngtemplate_ENU The file extension is rtf rich text format This format can be opened and displayed in a variety of word processing applications 1 Close ICS VNG ENG and access the Windows Desktop 2 Click the Windows Explorer icon or select Start Programs Windows Explorer to open Windows Explorer 3 Expand the Program Files Folder 4 Expand the ICS Medical Folder under Program Files to display the ICS CHARTR ENG for Windows Folder 5 Click on ICS CHARTR ENG for Windows to display the contents amp C Program Files ICS Medical CHARTR ENG for Windows File Edit View Favorites Tools Help a Qa CE B Psahn 5 Foes Ez Address C Program Files ICS Medical CHARTR ENG for Windows Name Type E VNGENGINST LOG Go
166. ile attempting to access or save information to the database Warning Do not run this utility unless necessary Running the repair program ona database that is not experiencing problems may actually corrupt the database To run the Database Repair Utility 1 Select File Exit to close the ICS VNG ENG for Windows application 2 Click Start and select GN Otometrics CHARTR Database Repair to access the Database Repair Utility and display this prompt CHARTR Database Repair x 2 Are you sure you want to repair the database Figure 9 11 CHARTR Database Repair Prompt 3 Click Yes to repair the database or click No to close the Database Repair Utility without repairing the database No further operator action is required 4 Click Start and select GN Otometrics ICS VNG ENG to restart the application after the database repair is completed Note If you continue to have database problems contact GN Otometrics Customer Support for assistance 200 GN Otometrics Section 10 Safety This Operator s Manual contains information and warnings that must be followed to ensure the safe performance of ICS Chartr 200 VNG ENG Local government rules and regulations if applicable should also be followed at all times 10 1 Symbols Used ICS Chartr 200 Symbols ICS Chartr 200 VNG ENG is marked with this symbol to indicate compliance with Type BF of the safety standard EN 60601 1 ICS Chartr 200 VNG ENG is marked with this
167. ill have to repeat the irrigation When you are satisfied with your data repeat the analysis If your data looks good and the result still comes up invalid inspect the position test in the supine position without fixation and the beginning of each caloric irrigation If nystagmus is observed adjust the baseline shift accordingly If the data is still invalid you probably have one or more bad responses due to poor irrigation or low patient alertness We suggest that you repeat those irrigations and then repeat the analysis If you are unable to repeat any more irrigations at this time we suggest that you ask the patient to return at a later date and repeat the entire caloric test One type of technical error shown below occurs when one caloric response is significantly weaker than the other three responses Pods Butterfly Right Cool Peak SPV 40 deg s ALeft Warm Peak SPV 40 deg s 80 6 805 i a W 604 w 60 R i H H 40 wth a 40 matral S EFi X S we Wy E wer E a a 204 p vy 20 A ey y i we Ne k Pa ag 5 rarr ant ae A m sa te ast 5 ee r 204 1 204 Wer we y M i Sew i pae e 404 o 40 b E E 6 7 604 60 c 80 c 804 4 Right Warm Peak SPV 8 deg s L Left Cool Peak SPV 41 deg s 0 20 40 60 80 100 120 140 0 20 40 60 8 amp 0 100 120 140 Seconds Seconds Figure 6 16 Caloric Test Technical Error One Weak Response GN Otometrics Section 6 Reviewing Analyz
168. ing Test Results Another type of technical error occurs when one caloric response is significantly stronger than the other three responses Right Cool Peak SPY 51 deg s 4Left Warm Peak SPV 25 deg s 80 E 804 w 60 w 60 P z P hag Ao ay R40 S Ki s 5290 y7 Gad E 20 P RTA E we ee E a stalin r asat 5 oia I i p z c 9 ae c ae 2 at aha 204 hadid f 20 ape f 20 merere aie 40 40 Pe tees E80 E 804 ARight Warm Peak SPV 26 deg s Left Cool Peak SPV 25 deg s o 20 40 60 80 100 120 140 o 20 40 60 8 amp 0 100 120 140 Seconds Seconds Figure 6 17 Caloric Test Technical Error One Strong Response 6 8 1 4 Temperature Effect Another type of technical error occurs when caloric responses for one irrigation temperature are significantly different compared to the responses for the other temperature This temperature effect is shown below Right Cool Peak SPV 9 degi s A Left Warm Peak SPV 23 degls 404 40 304 30 204 20 ice ae fake S ls ag v 10 v 10 cart ined eer tee tee i aoe D ga we X D E 0 z 5 ow WV wee i ae n megy a e 104 karr a s 10 aad i ual E taataa mta lc 204 G 20 304 30 404 40 Right Warm Peak SPV 20 deg s Left Cool Peak SPV 11 deg s E r g r gt r gt gt r g gt d 0 20 40 60 80 100 120 140 0 20 40 60 80 100 120 140 seconds seconds Figure 6 18 Caloric Test Technical Error Temperature Effect
169. ion Num Ports Bus Type IRQ Number Base Port Not Ranging In Range Out Of Range In Range Percent Goal Range Start Stop OK Troubleshooting The Ranger dialog box provides the following information Lists the version number for the ranger Lists the number of ports for the ranger component Lists the active bus type for the ranger Lists the IRQ number assigned to the ranger Lists the base port I O address for the ranger Indicates the ranger is stopped Indicates the ranger is working Also indicates the distance to the target Indicates the distance to the target is not within the accepted range Indicates the percentage of the active time that the target was within the accepted range Indicates the patient to light bar distance that is used as the standard or goal Begin the ranger diagnostic session Stop the ranger diagnostic session Exit the Ranger dialog box GN Otometrics Section 9 Troubleshooting 9 5 Irrigator The irrigator diagnostic test evaluates the control of a GN Otometrics NCA 200 air or NCI 480 water caloric stimulator The test examines the communication between the software and the selection of warm and cool temperatures on the stimulator Note This diagnostic test should be used only in conjunction with or under the direction of GN Otometrics personnel The PC and the irrigator communicate operating status and temperature information through an interconnecting cable see Se
170. ion Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position 215 Appendix B B 4 Tracking Tests Table B 5 Procedure Tracking Both Eyes Protocols Sine Horizontal Sine Vertical Linear Horizontal Linear Vertical Sine Horizontal 0 25 Hz Sine Vertical 0 25 Hz Light target moving sinusoidally at frequencies of 0 2 0 3 0 4 0 5 0 6 and 0 7 Hz over a 34 arc Light target moving sinusoidally at frequencies of 0 2 0 3 0 4 0 5 0 6 and 0 7 Hz over a 34 arc Light target moving 10 20 30 40 50 and 60 per second over a 34 arc Light target moving 10 20 30 40 50 and 60 per second over a 34 arc Light target moving sinusoidally at 0 25 Hz over a 34 arc Light target moving sinusoidally at 0 25 Hz over a 34 arc Table B 6 Procedure Tracking Individual Eyes Protocols Sine Horizontal Sine Vertical Linear Horizontal Linear Vertical Sine Horizontal 0 25 Hz Sine Vertical 0 25 Hz 216 Light target moving sinusoidally at frequencies of 0 2 0 3 0 4 0 5 0 6 and 0 7 Hz over a 34 arc Light target moving sinusoidally at frequencies of 0 2 0 3 0 4 0 5 0 6 and 0 7 Hz over a 34 arc Light target moving 10 20 30 40 50 and 60 per se
171. irectory Select Deselect New Page Clear Page Defaults Next Page Previous Page OK Cancel Help ICS Chartr 200 VNG ENG Operator s Manual Lists each procedure Move the selected test protocol and signal to the highlighted text box Remove the test protocol and signal from the highlighted text box Adds a new page to the report for this protocol Removes all protocols and signals from the report page If Clear Page is pressed on the last page of a multiple page report the last page is deleted Loads the default page layout for this procedure Access the next page of the report for this procedure Access the previous page of the report for this procedure Save the format and exit the dialog box Exit the dialog box without saving the changes Opens the Operator s Manual 165 Section 7 166 Working With Reports 7 7 3 Setting Up a Report Template Follow these steps to set up a template that will define the page format for each procedure included in a report To set up an operator specific report template 1 Select File Report Layout from the Menu Bar to display the Report Setup dialog box See Figure 7 17 Select a procedure from the list of available procedures and click Edit to display the Report Page Setup procedure name dialog box See Figure 7 18 Click on the sign in front of a protocol to expand the list Click on a text box on the right hand side of the window to select it
172. is an archive warning that will appear when the database reaches 75 and 512 MB This option is located in the System Options Workstation Settings tab dialog box To archive patient records 1 Open the Database Menu Database Open Main Database Open Archive Export Database Open Floppy Disk Patient Export Patient to Database Import Patients From Database Export Patient to Floppy Disk Import Patients From Floppy Disk Archive and Start New Database Convert Database to Latest Version Figure 8 4 Database Menu ICS Chartr 200 VNG ENG Operator s Manual 181 Section 8 Exporting Importing and Archiving Records 2 Select Database Archive and Start New Database to display the Select Archive Destination dialog box Destination name here E CHARTRDEMO_YIDEO Bl chartrdemo File name here File name hartr_2006_Mar_23_archive mdb Files of type ICS Database Files mdb v Cancel A Figure 8 5 Select Archive Destination Dialog Box 3 Select a destination folder for the archive 4 Choose the default archive name or type a new name in the Archive Destination Save As dialog If the Note 1 The system automatically assigns a name based on the year month day to the archive Example chartr_2006_Mar_23_arachive mdb is an archive created March 23 2006 The archive file extension is always mdb For consistency and accuracy we recommend that you use the archiv
173. is procedure to edit previously entered referring facility information To edit referring facility information 1 Access the Patient Information dialog box 2 Click on the Physician s Order tab at the top of the Patient Information dialog box 3 Click the Info button next to the Referring Facility drop down list arrow to display the Referring Facility Information dialog box 4 Place the cursor in the text box where information needs to be updated or edited and make the changes Note Keyboard alternate press Tab to move the cursor from one text box to the next and from one button to the next press Shift Tab to return to the previous text box 5 Continue moving from one text box to the next until you have updated all of the existing facility information 6 Click OK to save the modified referring facility information in the database ICS Chartr 200 VNG ENG Operator s Manual 53 Section 3 Establishing and Maintaining Records 3 4 Operator Information 54 The process for establishing an operator includes more than entering name address and associated information in a dialog box Each operator may set up a unique test battery test options and report formats Note The Default Operator settings will apply if an operator chooses not to customize the test battery test options and report formats This section includes a description of the Edit Operators dialog box and the procedures for establishing a new operator in t
174. ithout saving newly entered information Opens the Operator s Manual GN Otometrics Section 3 Physician s Order Tab Establishing and Maintaining Records Select the Physician s Order tab to display the following Patient Information Patient Information Clinical Information Referring Physician lt none gt Referring Facility lt none gt Referring Notes lt Physician Order Date 6 3 2004 1 20 23 PM Figure 3 3 Physician s Order Dialog Box Referring Physician Referring Facility Referring Notes Buttons Info Referring Physician Info Referring Facility New Order OK Cancel Help ICS Chartr 200 VNG ENG Operator s Manual Select the desired physician from the list of available physicians Select the desired facility from the list of available facilities Type any notes provided by the referring physician or facility for the named patient Access the Referring Physician dialog box Access the Referring Facility dialog box Begin a Physician Order A prompt warns that a new Physician s Order is being started and the current order will be closed The current date is used as the Physician s Order date Accept the information in all three tabs of this dialog box and save it to the database Close the dialog box without saving information in all three tabs of this dialog box Opens the Operator s Manual 41 Section 3 Establishin
175. ition Vertical Eye Position Vision vision 220 GN Otometrics Appendix B VNG Tests B 9 Bithermal Caloric Tests Table B 11 Procedure Caloric Both Eyes Right Ear Cool A medium below body temperature Horizontal Eye Position Vertical Eye Position irrigating the right ear Left Ear Cool A medium below body temperature Horizontal Eye Position Vertical Eye Position irrigating the left ear Right Ear Warm A medium above body temperature Horizontal Eye Position Vertical Eye Position irrigating the right ear Left Ear Warm A medium above body temperature Horizontal Eye Position Vertical Eye Position irrigating the left ear Table B 12 Procedure Caloric Temperature Switched Both Eyes Temp Switched Cool Irrigation using cool water followed by Horizontal Eye Position Vertical Eye Position warm water Temp Switched Irrigation using warm water followed by Horizontal Eye Position Vertical Eye Position Warm cool water ICS Chartr 200 VNG ENG Operator s Manual 221 Appendix B VNG Tests B 10 Ice Water Caloric Tests Table B 13 Procedure Ice Caloric Both Eyes Right Ear Supine A fluid near 0 C irrigating the right ear Horizontal Eye Position Vertical Eye Position Left Ear Supine A fluid near 0 C irrigating the left ear Horizontal Eye Position Vertical Eye Position Right Ear Prone A fluid near 0 C irrigating the right ear Horizontal Eye Position Vertical Eye Position Left Ear Prone A fluid near
176. ividual Eyes Optokinetic Both Eyes Dix Hallpike Both Eyes Position Both Eyes Calotic Both Eyes Ice Caloric Both Eyes Pressure Both Eyes Dix Hallpike Individual Eyes Position Individual Eyes Spontaneous Both Eyes 2A 2 S E 2 S A 2 S a e e o Figure 2 4 New Test Tab Getting Started in VNG GN Otometrics Section 2 Getting Started in VNG 2 2 2 Review Tab Click the Review Tab to display a list of completed procedures and protocols in the New Review Test List of the Main Window New Test Review When using the Review tab list Physician Order Date 3 7 2007 Session 3 7 2007 9 50 28 AM Select a Physician Order date in the Physician Order drop Fe adel cee down list box to display the list of test sessions conducted Gaze Both Eyes G TreckingBoth Eyes under that order Optokinetic Both Eyes Dix Hallpike Both Eyes g i Postioniiolh Ejas Click on the symbol in front of a session date to expand the M Left Ear 7 Cool 10 10 41 AM directory tree and display a list of procedures that were included Lett Ear Wam 10 22 13 AM in that session Click on the symbol in front of a procedure to display a list of test protocols Bold text indicates the protocol is designated as primary See Section 6 for more information Select a test protocol to display the results in the Test Review Workspace Figure 2 5 Review Tab ICS Chartr 200 VNG ENG Operator s Manual 23
177. k F9 Copy Waveform to display the Custom Page Dialog box with the current waveform displayed in the Clipboard Area Click on a Display Area or use the arrow keys to select it A black border appears around the selected box Click Paste to copy the waveform from the Clipboard Area to the selected Display Area Note You may continue to select paste and unpaste waveforms into the custom report as long as the selected patient record is open Click Done to close the Custom Page Dialog box and return to the Review mode Repeat steps 2 through 6 until all of the waveforms that will be included in the custom report are copied to the Custom Page Dialog To change the order of waveforms in a custom report a Select a waveform and click Unpaste to move the selected waveform to the Clipboard Area Select the desired Display Area and click Paste to copy the waveform to the selected Display Area b Click New Page to add another page to the report Click Delete Page to remove the current page from the custom report c Click Page Title to display the Custom Page Title dialog box Type the new title and click OK to place the title at the top of the first page of the report ICS Chartr 200 VNG ENG Operator s Manual 173 Section 7 Working With Reports Custom Page Title X Title of Custom Report Page Cancel Figure 7 22 Custom Page Title Dialog Box Note The Patient Name Patient ID number and Physician Order Date wi
178. k the Appearance tab then click the Effects button 250 Fle Edt View Favortes Tools Mep O A Len Erim TF Bo w amp 2 oi Aime CMI ude Oste and Tma Tools Contig oa D come Steet Keybowd Options amp Cortrobee s Network NVIDIA riiew Phone and Power Options Printers and Connectors Desktop Modem raves 2 Figure F 3 Select the Display Option Display Properties Inactive Window Active Window Message Box Windows and buttons Color scheme Default blue x Eont size Normal Effects Advanced Apply Figure F 4 Display Properties Appearance Tab Keyboard Shortcuts GN Otometrics Appendix F Keyboard Shortcuts 6 Click the Hide underlined letters for keyboard option to clear i e remove the check mark from this option Effects Use the Following transition effect for menus and tooltips Fade effect v Use the following method to smooth edges of screen fonts Standard v Cluse large icons Show shadows under menus Show window contents while dragging Figure F 5 Effects Dialog Box 7 Click OK to save the new Effects setting F 2 Use Keyboard Shortcuts Table F 1 Keyboard Shortcuts for Menu Submenu Items Press the Control Ctrl key then the letter Available from the Data Collection Window Ctrl O Overlap waveforms Ctrl S Spread waveforms Ctrl W Add waveform text Available from the Report Window Ctrl
179. l 183 Section 8 Exporting Importing and Archiving Records 8 6 Working with Archived Patient Records 184 Archived records can be accessed directly from the ICS VNG system and reviewed at any time To view an archived database 1 Select Database Open Archive Export Database to display the Select Archive Source dialog box Select Archive Source Look in a Archive 7 El c E ia Chartr 19970815 mdb Filename Chartr 19970815 mdb Files of type CHARTR Database Archive mdb 7 Cancel Figure 8 7 Select Archive Source Dialog Box 2 Select the archived file to be opened Make sure it displays in the File name text box 3 Click Open to display the Patient Selection dialog box 4 Select a patient from the list of available patients and click OK to view the selected patient s record 5 Select File Close Patient to close the patient record 6 Select Database Open Main Database to exit the archived database and return to the main database Note Refer to the procedure Exporting Patient Records for instructions on how to move an archived database offline again GN Otometrics Section 9 Troubleshooting 9 1 This section provides information on how to work with the built in system software and hardware diagnostic options to troubleshoot the system Overview The diagnostic options available in ICS Chartr 200 VNG ENG are used to ensure the proper function of the system components An o
180. lect Diagnostics USB to display a dialog box similar to the one shown in Figure 9 4 VIDEO TWO EYES V2 00 Video Nols Before running the diagnostic make sure the goggles are on the patient and are tracking the pupils Version 0 3 Num Ports BusType USB IRQ Num Base Port n a Channels 6 Sample Rate 60Hz Display Rate 30Hz Max Sample Rate 60 Hz Display Count 0 Channel Decimal 1 0 Stop Pause Resume Figure 9 4 USB Unit Dialog Box On the USB unit dialog box the status is shown in the upper portion of the window During collection the hex and decimal values from all two or four channels display in the lower portion of the window The numbers are updated at the display rate The USB unit dialog box provides the following information Version Lists the current version Num Ports Lists the number of active ports Bus Type Lists the bus type used by the board IRQ Num Lists the IRQ number assigned to the board 188 GN Otometrics Section 9 Base Port Channels Sample Rate Display Rate Max Sample Rate Display Count Channel Hex Decimal Buttons Start Stop Pause Resume Help OK Troubleshooting Provides the Base Port I O address Lists the number of active available channels Displays the sample rate in Hz Displays the display rate in Hz Displays the maximum sample rate in Hz Displays the number of times the display is updated The number increments during a diagnostic test
181. lect the eye s to be tested Centers the waveform on the page Spreads the waveforms apart Overlaps the waveforms Displays the Copy Waveform options Marks an event E on the waveform Applies a low pass filter to the waveform Displays the System Options window Displays the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual Getting Started in VNG 25 Section 2 Getting Started in VNG 2 3 Menu Bar Commands 26 This section describes the commands and functions of each of the drop down menus on the Menu Bar The number and type of menus and menu items vary depending on the current VNG ENG status For example the File menu items available during testing may be different than the File menu items available during analysis or calibration There are multiple ways to access some commands and functions In addition to the Menu Bar menus many of the functions may be accessed or activated using the function keys the toolbar or alternate keyboard actions For example to display the File menu click File on the Menu Bar or type Alt F on the keyboard Note If you do not see the underscored letters or the keyboard option is not working you may need to activate this function See Appendix F for instructions on how to activate the keyboard options for accessing the menus 2 3 1 File Menu To display the File menu click File on the Menu Bar or type Alt F on the keyboard Then click on the desired menu item to access the
182. lick Replace All to replace each occurrence of the Find what text string with the Replace with text string 6 Click X or Cancel to close this dialog box ICS Chartr 200 VNG ENG Operator s Manual 155 Section 7 Working With Reports 7 4 Working with Text The ICS VNG word processor is designed to allow the operator to easily manipulate the text elements by changing font and paragraph characteristics 7 4 1 Modifying Fonts By modifying font types styles and sizes the reports produced within the ICS VNG system can be customized to meet your requirements Fonts are changed and modified using the Fonts dialog box at anytime within a document Select Format Font to display the following dialog box Fonts Sizes C a 7 a Arial Black 8 Cancel Arial Narrow 9 ia Comic Sans MS gt he Attributes Position T Normal Underline Normal MV Bold Strike out Superscript T Italic Subscript Figure 7 11 Fonts Dialog Box Fonts Change the font type of the selected text Choose from the list of available fonts loaded in the system Sizes Change the font size of the selected text Select or type a size Attributes Select all of the font attributes that will apply to the selected text A Y indicates an option is selected Position Select one of the following positions for the font placement on the line Normal Superscript above the line or Subscript below the line OK Save the font settings and retur
183. ll always print on the top line of the report The Title will print in a large font above the waveforms Information about each waveform including the waveform name and time will print above and below the individual waveforms d Click Previous Page or Next Page to preview each page of the report e Click Clear Page to remove all of the waveforms from the Display Areas on the current page 9 Click Print to send the custom report to the printer 10 Click Done to close the Custom Page Dialog and return to the Review Mode Note The temporary custom waveform report will remain available until you change the Physician s Order in a session close the selected patient select another patient or close ICS Chartr 200 VNG ENG Section 7 Working With Reports 7 10 Printing a Waveform Displayed waveforms can be sent directly to the printer and printed immediately This printout begins from the current position to the end of the waveform The waveform data will print on as many pages as needed The ending time for each waveform segment is also printed To print a waveform 1 2 Select File Print Waveform from the Menu Bar A prompt displays listing the name of the waveform and the printer to which it is being sent Note The print order is spooled and will print as soon as the system resources are available so that if a patient test is in process it will not be interrupted The waveform will print to the indicated printer
184. low phases i e Right Cool and Left Warm or the most negative leftward moving slow phases i e Right Warm and Left Cool The second that has the fastest average value becomes peak and is represented by the square on the Slow Phase Velocity chart Since the peak is an average value there may not be a data point in the square The operator may choose to override the system determined peak To select a new peak click on a SPV to move it under the vertical cursor and click F6 Set Peak The system computes the average of the highest SPVs in the 10 second window around the selected slow phase velocity value This average becomes the new peak Note Remember that the number of slow phase velocities used to determine peak is set in the System Options Operator Settings Test Battery tab dialog box For non caloric tests e g positionals the SPV algorithm determines whether there are more positive or negative slow phase velocities Following the same procedure the system calculates the fastest positive or negative slow phase velocity average and places a box at that second ICS Chartr 200 VNG ENG Operator s Manual 115 Section 6 116 Reviewing Analyzing Test Results 6 7 2 Measuring Slow Phase Velocity This analysis procedure is used to review any test results that contain nystagmus for the selected patient To analyze nystagmus beats 1 2 Click on the Review tab to display the tests that were performed for the selected p
185. m available in Collection only Apply or remove a filter for all waveforms in that test available in Review only Superimpose all waveforms in the Test Review workspace Ctrl O Evenly spread all waveforms in the Test Review workspace Ctrl S Hide the active waveform currently selected signal handle as indicated by the colored box attached to the waveform at the far right side of the workspace from the Test Review workspace Display the active waveform in the Test Review workspace Display the Custom Page Dialog Ctrl C to create a custom waveform report Repeat as needed during a review session to add waveforms to the custom report Display the Edit Wave Text dialog box Ctrl W to enter comments specific to the waveform The comments will display with the associated waveform The Video menu is used to assist in operating the video functions Video Video Adjust Figure 2 12 Video Menu Video Adjust Display the Video Adjustments dialog box available only in VNG Test and Calibration modes ICS Chartr 200 VNG ENG Operator s Manual 31 Section 2 32 Record Stop Recording Restart Recording Play Export Delete Show All Clips Hide All Clips Close All Clips Getting Started in VNG Start a video recording during collection Stop a video recording during collection Restart a video recording during collection Play the video recording for the current test available only i
186. m your hard drive The system may prompt you to confirm the deletion of files that could be shared by other programs Click Yes if the file is not shared by other applications If you are not sure click No Repeat the above steps to remove each of the following programs if they are present e Keyspan Remove Sapera LT Chartr XP tower only ICS Chartr 200 VNG Driver Chartr 200 hardware only Click OK to close the Add Remove Properties dialog box Note This procedure will only remove the software program files It will not remove the patient database or videos GN Otometrics Section 1 Introduction to the VNG System 1 2 3 Reinstalling ICS Chartr 200 VNG ENG Software If it becomes necessary to reinstall the ICS VNG ENG software you will need to uninstall the version of the software that is currently on your hard drive Uninstalling ICS VNG for Windows will remove all of the software programs from the hard drive It will not remove the existing patient database When you reinstall the software your patient database will not be replaced If you want to replace the patient database you must remove that database manually before reinstalling ICS Chartr 200 VNG ENG for Windows 1 2 4 Demo Database The demo ICS CHARTR database is installed on your system in the Demo folder This folder is located under the folder that contains the ICS CHARTR database i e C CHARTR DATA DEMO Note The demo CHARTR database is used for traini
187. mo 15 EP System Dx T 8 15 2008 3 6 1980 Demo 12 VEMP 8 14 2008 8 3 1988 Demo 9 Electrocachleoar 8 14 2008 8 3 1988 Demo 7 Adult ABR 8 8 2008 10 2 1984 Close Patient Demo 6 Baseline Shift 7 19 2007 x 5 12 1938 Demo 5 CNS VNG 5 3 2007 z s 2 21 1928 Demo 4 UW VNG 3 26 2007 G 6 24 1952 Demo 1 Normal VNG 377 2007 i 8 26 1969 Demo 13 Normal ASSR 6 18 2004 4 25 2004 Help Demo 14 Conductive ASSR 6 18 2004 5 18 2004 Demo 3 BPPV VNG 8 31 2001 1 1 1950 Demo 8 Infant Click 99 2000 7719 2000 Demo 2 Normal ENG 10 10 1997 e s 9 4 1960 These patients have historic sessions and cannot be distinguished as ENG or YNG Figure 3 1 Patient Selection Dialog Box Note Click on the Patient Name heading box to sort the Patient Name list alphabetically Click on the Date Last Tested heading box to sort the list chronologically Click the heading boxes again to sort the lists in ascending or descending order ICS Chartr 200 VNG ENG Operator s Manual 37 Section 3 38 Information Area Patient Name Last Tested Data Birthdate DB Buttons OK New Delete Patient Close Patient Cancel Help Establishing and Maintaining Records Contains a list of all patients in the database Select the desired patient from the list of existing patients Patient records are maintained and sorted by the date last tested Indicates the type of data ENG VNG EP Only Lists the date of birth month day year
188. movements are analyzed in terms of amplitude peak velocity accuracy and latency The results are then compared to normal values The saccade analysis terms are defined as follows Amplitude Movement of the eyes in degrees between the initial position and the first stop of more than 75 milliseconds ms Peak Velocity Maximum velocity reached in a saccadic movement as measured over an 18 75 ms period Accuracy Amplitude of the patient saccade divided by the amplitude of target movement expressed in percent Latency Time between stimulus movement and the first eye movement of more than 108 degrees second The stimulus is a light on the light bar moving pseudo randomly The range of target amplitude is 5 degrees to 30 degrees and measurement can be made on from 1 to 160 identified saccades Results are summarized in graphic form The algorithm rejects as artifacts eye movements that occur too early 250 ms before through 75 ms after target movement too late default is more than 600 ms after target movement or in the wrong direction Note The operator can specify when a saccade is too late in the System Options Operator Settings Test Battery tab dialog box as described in Section 4 2 Each saccade analyzed generates one data point in each of the analysis charts Peak Velocity Accuracy and Latency The data point for the specific saccade that occurred at the time shown by the green vertical line on the tracing display appears
189. mpts for general condition information Eye Movement Examination Prompts for information related to this patient s eye movements Ear Examination Prompts for information related to this patient s ear examination findings The date of the active Physician Order in effect is located below the button area on this dialog box Buttons OK Accept the information in all three tabs of this dialog and save it to the database Cancel Close the three dialog boxes without saving the information Help Opens the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual 43 Section 3 Establishing and Maintaining Records 44 3 1 3 Establishing a New Patient Record A patient record needs to be established for every new patient A patient record may contain multiple Physician Orders and multiple sessions The VNG ENG system assigns a Physician Order date when the patient record is established Test records and results are organized by the Physician Order date and test session date A test session is an uninterrupted series of tests or protocols run on a patient To establish a new patient record 1 Access the Patient Selection dialog box a At the Patient Selection dialog box click New or b From the Main window select File New Patient from the Menu Bar if available or c Select F2 New Patient if available 2 Place the cursor in the Last Name text box and type the last name of the patient Note Keyboard alternate press Tab to mo
190. n Review mode Display the Export Video dialog box available only in Review mode Enter the patient file and click OK to save only the video to disk Display a prompt to confirm that this video clip should be deleted available only in Review mode Display all video clips for this test sessions available only in Review mode Do not display the video clips for this test sessions available only in Review mode Close all open video clips available only in Review mode 2 3 7 Diagnostics Menu The Diagnostics Menu is only available when a patient is not selected The Diagnostics Menu is used to assist in troubleshooting the system hardware and assessing system performance Diagnostics Video Lightbar Ranger Irrigator USB Unit Loopback and HW Diagnostics Figure 2 13 Diagnostics Menu Compact A2D Video USB Unit Does not apply to ICS Chartr 200 VNG ENG Does not apply to ICS Chartr 200 VNG ENG Display the Video Diagnostics dialog box VNG systems Display the USB Unit dialog box for Chartr 200 ENG GN Otometrics Section 2 Getting Started in VNG A2D Internal Loopback Does not apply to ICS Chartr 200 VNG ENG USB Loopback and HW Diagnostics Display the USB Hardware Diagnostic Results and Loopback Settings dialog box for Chartr 200 VNG ENG Light Bar Display the Light Bar dialog box Ranger Display the Ranger dialog box Irrigator Display the Irrigator dialog box 2 3 8
191. n progress VNG associates the footswitch with the Record Video Restart Video button in the Video Recording Control Dialog Pressing the footswitch or the irrigator hand switch during a VNG test will cause video recording to start or restart The footswitch cannot be used to stop or cancel video recording Recording will stop automatically after the maximum recording time has elapsed or you may press Stop Video or Cancel in the Video Recording Control dialog To conduct a test and record video 1 Select the New Test tab in the Main Window 2 Click on the sign in front of a procedure to display a list of test protocols and click on a protocol to select it 3 Click F12 Start or press the footswitch to begin the selected protocol 4 Press the foot switch to initiate video recording Note If you wish to replace recorded video with a different segment later in the test press the foot switch to restart video recording 5 Press F12 Save to save the test data and any recorded video GN Otometrics Section 5 5 11 Using the Remote Control Test Preparation and Data Collection A wireless remote control can be used to initiate some specific video actions without using a mouse and keyboard OO STOP O r O 4 Figure 5 14 Remote Control with Cradle Use the remote control to initiate these actions Start pause restart and stop a video recording Turn the fixation light on and off caloric tests only
192. n represents the intensity of typical nystagmus beats for that head position The operator must make sure that the slow phase velocity tracings are cleaned and the peak response represents the intensity of typical nystagmus beats The Interpretation Assistant currently does not detect nystagmus that changes direction in a single head position This is a rare but significant finding The operator must recognize this type of nystagmus and interpret it accordingly The Interpretation Assistant currently does not differentiate between transient nystagmus that may be provoked due to head movements or BPPV and steady state nystagmus typical of static position testing The operator must make sure that the peak response does not include the transient part of the nystagmus The operator must also take appropriate actions for testing and interpreting the transient response GN Otometrics Section 6 Reviewing Analyzing Test Results 6 8 2 1 Conducting a Static Position Interpretation To activate the Interpretation Assistant for static position tests 1 Collect one or more static position tests Note To use the Interpretation Assistant for static position tests the tests for w vision and w o vision have to be done as separate tests You can not collect one tracing with both conditions present 2 Select the Review tab and review and analyze each static position test 3 Select F3 Interpret Tests to view the results of the Interpretation Assistant
193. n the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual 125 Section 6 Reviewing Analyzing Test Results b Select Ignore to continue with the interpretation and display a Warning dialog similar to the following Caloric Test Interpretation Sanaa AAARAASAS INN WARNING III t22444e0e488888 You have chosen to get an interpretation on caloric responses that do not represent a valid test and indicate the possibility of a technical error AAKAAAAAAAAAAAKAAAKKAKKAAREEAAAAAAAAAAR AA AAA AAA AAA Total response from the right 41 deg sec Total response from the left 74 deg sec Baseline Shift 0 deg sec Unilateral Weakness 29 in the right ear Gain Asymmetry 11 to the left Right unilateral caloric weakness Caloric responses of the right ear are 29 weaker than those of the left ear asst Figure 6 14 Caloric Test Interpretation Dialog Technical Error If you agree there is a technical error follow the Interpreter s suggestions and repeat the procedure c Select Abort to close the Technical Error dialog and end the Interpreter session 126 GN Otometrics Section 6 Reviewing Analyzing Test Results 6 8 1 2 Interpreting Caloric Tests Results Upon the completion of a caloric test interpretation the results first display in the Caloric Tests Interpretation dialog box Note The test results cannot be edited in this dialog box However once the results are pasted into the patient word proces
194. n the patient record is closed another patient is selected or the current Physician s Order of the session is changed 7 9 1 Custom Page Dialog To display the Custom Page Dialog select a patient access the Review mode and click F9 Copy Waveform Clipboard Area Display Area Custom Page Dialog racking Bath Efe Sine Horizontal lt Unpaste Page Title Page 1 of 1 Figure 7 21 Custom Page Dialog Box Clipboard Area Displays the waveform that is available to be copied to the selected Display Area Report Title Displays the title that will appear on the printed report The default title is the name of the first copied waveform Click the Page Title button to display the Custom Page Title dialog box and type the new report name Display Area Displays individual waveforms as they will be printed on the custom report Click on a Display Area to select it or use the arrow keys to move through and select a Display Area Then click the Paste button to copy the waveform from the Clipboard Area to the selected Display Area ICS Chartr 200 VNG ENG Operator s Manual 171 Section 7 172 Buttons Paste UnPaste Page Title New Page Clear Page Remove Page Previous Page Next Page Done Print Help Working With Reports Copy the waveform that is in the Clipboard Area to the selected Display area Copy a waveform from a selected Display Area b
195. n this section will use a hard drive file To export a patient record to a hard drive or memory stick 1 Access the Patient Selection dialog box and select the patient whose records will be transferred 2 Click OK to access the Patient Information dialog box and click OK to open the patient record 3 Select Database Export Patient to Database The Save Export As dialog will prompt you to select the database file to export to Select an existing database file or a new empty file r Save Export As Save in O demo X a e e E CHARTRDEMO VIDEO Bl chartrdemo File name Fisher jim_2006_Feb_22_export Save as type ICS Database Files mdb MA Cancel A Figure 8 1 Save Export As Dialog Box Note If you select an existing ICS database file the following dialog box will display CHARTR ENG x 2 The export database already contains a patient record 6 Do you wish to append the patient record to the database Yes Append patient record No Overwrite patient record No Cancel Figure 8 2 Contains a Patient Record Message Click Yes to append the patient record to the existing database or click No to overwrite the existing patient record s and replace it with the current patient record 4 Click Save to save the patient record to the selected database 178 GN Otometrics Section 8 Exporting Importing and Archiving Records 8 3 Reviewing Export Database Patient Re
196. n to the report Cancel Exit the Font dialog box without saving the changes 156 GN Otometrics Section 7 Working With Reports 7 4 2 Formatting Paragraphs The characteristics that are applied to a paragraph in the report can be changed using the Paragraph Format dialog box Select Format Paragraph to display the following dialog box Paragraph Format x m Line spacing Alignment x OK z Pane ok g kz bat C One and ahalflines Right Cancel C Two lines C Centered Free 1 00 lines Justified I ininches Indents Distances Left fo c00 inch Top 0 000 inch Right 0 000 inch Bottom 0 000 inch First line fo 000 inch Figure 7 12 Pa Line spacing Free In inches Alignment Indents Distances OK Cancel ICS Chartr 200 VNG ENG Operator ragraph Format Dialog Box Select from the available options to set the distance between lines on the report Single line One and a half line Two lines Enter the number of lines that will not be used 1 0 is the default Enter the distance in inches for the left and right margins Select one of the following paragraph alignment options Left Right Centered or Justified Enter the distance in inches that all of the lines in the paragraph will be indented from the left side of the page and the right side of the page Enter the distance the first line will be indented compared to the rest of the lines of the
197. ng operator settings and options in the VNG ENG system includes Entering the name address and contact information for the operator Section 3 4 Selecting the operator determined options for conducting tests Setting up the test battery sequence Use the following procedure to establish operator options and setup a test battery ICS Chartr 200 VNG ENG Operator s Manual 63 Section 4 64 Setup and System Option To establish operator options and a test battery 1 2 8 Select Edit System Options to display the System Options dialog box Select the Operator Options Test Battery tab Select an operator from the list If the name is not on the list see Section 3 4 Select the desired Settings Shared by Operator options Note Click the Default Settings buttons to return the operator settings to the original system settings Select the desired Operator Specific Settings Select the desired Caloric Test Only options Use the mouse to select a test procedure or protocol in the Available test protocol list box and click the Insert button to move the procedure or protocol to the Selected test protocol list box Highlight the procedure or protocol in the Selected test protocol list box beneath which you want the new item inserted Note Click the Remove button to remove a selected protocol from the Selected test protocols list box Click the Remove All button to remove all of the test protocols from the Selected
198. ng purposes If you need to view the demo patient data follow the steps below See Section 8 for information on how to import patient data for analysis To view the demo database if not installed initially 1 Select Database Open Archive Export Database from the Menu bar 2 Navigate through the list of folders and files and find the Demo folder The default location is C CHARTR DATA DEMO 3 Select the file called chartrdemo mdb 4 Click OK to open the demo database and view the demonstration records 5 Select Database Open Archive Export Database to close the demo database and open the normal patient database 6 This will allow the demo database to be viewed but not reanalyzed To reanalyze the data the patients must be imported ICS Chartr 200 VNG ENG Operator s Manual 15 Section 1 Introduction to the VNG System 1 3 Workstation and Network Considerations 16 Installation of ICS Chartr 200 VNG ENG on networked workstations requires these considerations e Assign a unique name to each workstation Use fiber optic network connections to install data acquisition workstations on a network This will preserve the patient s electrical isolation Fiber optic connections are not required when installing review only workstations no data acquisition hardware on a network The insulation precautions are not necessary because there will be no physical contact between the patient and the workstation GN Otometrics
199. nnections VNG components connect to the rear panel of the ICS Chartr 200 sy A g w OG i va te Wi ara St Figure D 2 ICS Chartr 200 VNG ENG Rear Panel Connections 4 Audio input Audio output Video output left Video output right Video goggles Caloric stimulator USB N DO oO BR W PD ICS Chartr 200 VNG ENG Operator s Manual 10 11 12 13 14 10 P PC laptop USB Light bar Patient cable Loopback test fixture Power input fuse DC power input 241 Appendix D Setting up the ICS Chartr 200 Hardware D 3 ICS Chartr 200 Remote Control The wireless remote control consists of a transmitter and a keypad The keypad allows the operator to remotely operate many VNG ENG data collection and video activities 1 2 Description Function NA Fo E 15 1 Stop video recording STOP START 13 ee 16 2 Start restart video recording ie ie Z 3 Turn fixation light ff urn fixation light on or o Z VIA g tl 3 4 Start data collection 12 FIXATION d PREVIOUS 4 5 Save the results 11 NEXT a START 6 Center calibrate ae 7 Accept results 4 p 10 NEw CANCEL SAVE 5 8 Stop data collection STOP 9 OK OK 3 SX 6 10 New Test tab Review tab 4 ACCEPT 11 Next test 2 7 ee Po Previous test 13 Electrod
200. nstalled Choose this setup type if you are installing the system w demo database on a standalone workstation lt Back Cancel Figure 1 6 Select Setup Type Dialog Box Installation Wizard Note If you select a Demo setup type the Demo database becomes the active database and demo data will be available for training purposes Any new patient or collected data will be stored in this database The demo patient data can be deleted at a later time if desired f Choose the default language Select the language the system will use When installing on an English system the default is English When installing on a German system the default is German Click Next to continue Select Language Please select the language you would like the system Figure 1 7 Select Language Dialog box Installation Wizard ICS Chartr 200 VNG ENG Operator s Manual 5 Section 1 Introduction to the VNG System g Choose Destination Database Location Place the database in the default folder C CHARTR DATA unless you decide to use a different folder Click Next to continue Note To make it easier for technical support to assist you if needed it is best to install the software in the default location Choose Destination Database Location Setup will install the ICS CHARTR 200 ENG VNG Database in the following folder To install into a different folder click Browse and select another folder r Destination Folder C ACHARTR
201. of available names to highlight it 4 Click OK to rename the selected protocol in the directory The system will prompt for confirmation of the rename CHARTR ENG Application x N Are you sure you want to rename this test protocol Cancel Figure 6 32 Rename Protocol Prompt 5 Click OK to rename the protocol GN Otometrics Section 7 Working with Reports 7 1 This section provides information on how to work with the reporting features and options available in ICS Chartr 200 VNG ENG A built in word processor allows the operator to customize reports and includes a spell check option Overview The report writing features of ICS Chartr 200 VNG ENG are extensive Reports can be set up to include patient information and test results There are two elements to each report The patient information portion of the report is system generated The operator may edit or modify the patient information by using the ICS VNG ENG word processor The test results portion of the report is system generated according to the format established by the operator Another type of report that may be generated is a temporary custom waveform report page This report contains up to eight waveform segments for a selected patient and is created using the Copy Waveform option available in the Review mode The operator selects specific waveforms and copies pastes them into a custom report page The custom report can be printed and the h
202. of test To display the Lightbar dialog box close any open patient records to display the Empty Main Window Select Diagnostics Lightbar to display a dialog box similar to the one shown in Figure 9 6 Version 88 Num Ports 32 BusType ISA IRQ Number 11 Base Port 330 Interrupt Rate 400 Hz r Manual na Brightness p Calibration Lightbar C Off Data Port Value 0191F A uP Low Keil seo Gaze Left Left Side Center Right Side Gaze Right High DN Gaze Down Off C Optokinetic r Automatic Linear Bi directional Start C a0 Hz C OPK Sweep 10deg sec Help C 0 05 Hz sE C 010Hz Saccade 3 positions C 0 25Hz OK Figure 9 6 Lightbar Dialog Box Status information is shown in the upper portion of the window Manual and automatic operations are shown in the lower portion of the window The Lightbar dialog box provides the following information Version Lists the current version of the light bar Num Ports Lists the number of active ports Bus Type Lists the bus type used by the light bar IRQ Num Lists the IRQ number assigned to the light bar Base Port Provides the Base Port I O address Interrupt Rate Provides the interrupt rate for the light bar ICS Chartr 200 VNG ENG Operator s Manual 191 Section 9 Manual Operations Data Port Value Gaze Left Left Side Center Right Side Gaze Right Gaze Up Gaze Down Brightness Calibration Lights Automatic Operations O
203. on Vertical Eye Position E target 30 down from center without Horizontal Eye Position Vertical Eye Position vision Rebound Right Gaze 30 right for 20 seconds followed by Horizontal Eye Position Vertical Eye Position a return to center Rebound Left Gaze 30 left for 20 seconds followed bya Horizontal Eye Position Vertical Eye Position return to center Rebound Up Gaze 30 up for 20 seconds followed by a Horizontal Eye Position Vertical Eye Position return to center Rebound Down Gaze 30 down for 20 seconds followed Horizontal Eye Position Vertical Eye Position by a return to center 214 GN Otometrics Appendix B Table B 4 Procedure Gaze Individual Eyes Center w o vision Right w o vision Left w o vision Down w o vision Light target centered Light target centered without vision Light target 30 right of center Light target 30 right of center without vision Light target 30 left of center Light target 30 left of center without vision Light target 30 up from center Light target 30 up from center without vision Light target 30 down from center Light target 30 down from center without vision Gaze 30 right for 20 seconds followed by a return to center Gaze 30 left for 20 seconds followed by a return to center Gaze 30 up for 20 seconds followed by a return to center Gaze 30 down for 20 seconds followed by a return to center
204. on the depressed toolbar button represents the eye currently selected for testing THG R A z o Figure 5 10 Eye Selection Toolbar Buttons Right Eye Selected The test eye cannot be changed clicking on the toolbar will have no effect and the depressed button will not change During calibration When data is being collected After calibration collection but before the collected data is saved F9 Switch Eye Function Key When the F9 function key is labeled Switch Eye press the F9 key on the keyboard or click the F9 function key on the screen to change the test eye The corresponding button on the toolbar will be depressed to indicate the selected eye GN Otometrics Section 5 Test Preparation and Data Collection 5 8 2 Conduct a Test and Collect Data Use this procedure to conduct a test and collect data 1 2 Select the New Test tab Click on the sign in front of a test procedure to display a list of test protocols Click on a specific protocol to select it Click F12 Start to access the test mode for the selected test During data collection the operator can a Press F5 Center if necessary to center the tracing b Press F2 Event to place an event arrow labeled E on the tracing c Press F3 Eyes Open to place an eyes open EO label on the tracing d Press F4 Vision Denied to mark an eyes open in the dark VD label on the tracing e Press F11 Fixation Light currently a
205. on 4 Setup and System Option 4 6 Referring Physician The Referring Physician Setup option is used to update physician information Select Edit Referring Physicians to display the Referring Physician Selection dialog box Referring Physician Selection Ea Please select a referring physician if Cancel Help Figure 4 7 Referring Physician Selection Dialog Box Richards Benjamin Please select a referring physician Click on the drop down list of physicians to display the physicians listed in the system If the None option is selected a new physician can be created If an existing physician is selected this physician s information can be edited OK Save the selected physician and display the Referring Physician Information dialog box for the selected physician See Section 3 2 2 for information on completing the Referring Physician Information dialog box Cancel Exit the dialog box without selecting a physician Help Opens the Operator s Manual 74 GN Otometrics Section 4 Setup and System Options 4 7 Referring Facility The Referring Facility Setup option is used to update referring facility information You may select the default facility from the list of available facilities Select Edit Referring Facilities to display the Referring Facility Selection dialog box Referring Facility Selection x Please select a referring facility Cancel Riverdale Medical Clinic ihe Help Figure
206. on Index The Fixation Index is calculated at the point at which the Fixation Light is turned on If the Fixation Light was turned on more than once during the course of a single test the point at which the Fixation Light was turned on last shall be used to calculate the Fixation Index The formula for calculating the Fixation Index is FI SPV fx SPVnorix where SPV pix is the average of the largest SPV beats in the 5 seconds after the Fixation Light was turned on and SPV nofix is the average of the largest SPV beats in the 5 seconds immediately before the Fixation Light was turned on The second at which the fixation event was triggered is not used in the calculation The Fixation Index will be calculated once the peak SPV is set or located The Fixation Index will be displayed in the same window as the peak SPV values If the fixation event is within 5 seconds of the analysis start or end time the Fixation Index will not be calculated Five seconds of data must be available on either side of the fixation event for Fixation Index to be calculated The fixation index can be calculated for ENG as well However it is important that the patient fixates as soon as the Fixation F11 or remote control button is selected Since the Fixation Index is calculated the 5 seconds immediately before the software marks the F1 the fixation index will only be accurate if the patient began fixation at the point where the clinician selected Fixation told the so
207. on to exit this installation Figure 1 14 Installation Complete Dialog Box Installation Wizard n Start Database Conversion The system is now ready to start converting the database The system will locate any previous databases on your system and will first backup the database and then convert the database for use with this version of the software Click Next to continue Start Database Conversion CHARTR Database Conversion will now perform the following steps to convert your existing databases to the new format 1 Backup your databases 2 Convert your databases When the process completes it will remove the backup copies Press the Next button to continue Figure 1 15 Start Database Conversion Dialog Box Installation Wizard ICS Chartr 200 VNG ENG Operator s Manual 9 Section 1 10 Introduction to the VNG System o Database Conversion in Progress Once the system locates the existing database click Convert to continue Database Conversion CHARTR Database Conversion is now ready to convert your existing databases Press Convert to continue Figure 1 16 Database Conversion Dialog Box Installation Wizard p Database Conversion Complete The progress of each database conversion will display When the conversion process is complete click Next to continue Database Conversion CHARTR Database Conversion is now ready to convert your existing databases Backing up your databases
208. ontact GN Otometrics Customer assistance Support All VNG test and analysis records for this patient The patient information portion of this record name address have been removed However the patient clinical information etc was not deleted from the database information records will be kept since the when the test and analysis data was deleted The patient database has data collected for other modalities information is referenced in some other record in the under this patient s name database and cannot be deleted unless all associated information is deleted For example Evoked potential data may be associated with the patient s record The database version is not compatible The system is unable to access the database Try reinstalling the program See Section 1 for information If the problem persists contact GN Otometrics Customer Support for assistance You can t delete this referring facility It is The facility you are deleting is associated with other patient associated with a patient in the database records and can not be deleted You can t delete this referring physician It is The physician you are deleting is associated with other associated with a patient in the database patient records and can not be deleted The model database can not be copied to the The hard disk might not have enough free space for the temporary directory operation Delete any unnecessary files and try again You can t delete this o
209. or s Manual 227 Appendix B B 13 Default Test Battery 228 VNG Tests B 13 1 Chartr 200 VNG Default Test Battery This list of tests is the default standard battery of tests for Chartr 200 VNG The test battery can be installed and modified from the System Options Operator Settings Test Battery Tab dialog box see Section 4 2 Saccade Both Eyes Saccade Individual Eyes Gaze Both Eyes Gaze Individual Eye Tracking Both Eyes Tracking Individual Eyes Optokinetic Both Eyes Dix Hallpike Both Eyes Position Both Eyes Horizontal Random Position Horizontal Random Position Right Left Up Down Right Left Up Down Sine Horizontal Sine Horizontal 20 sec Right 20 sec Left 40 sec Right 40 sec Left Head Right Head Left Head Right Repeat Head Left Repeat Sitting Sitting w Vision Sitting w o Vision Supine Supine w Vision Supine w o Vision Head Right Head Right w Vision Head Right w o Vision Head Left Head Left w Vision Head Left w o Vision Head Hanging Head Hanging w Vision Head Hanging w o Vision Right Side Right Side w Vision Right Side w o Vision Left Side GN Otometrics Appendix B Caloric Both Eyes Ice Caloric Both Eyes Pressure Both Eyes Dix Hallpike Individual Eyes Position Individual Eyes Spontaneous Both Eyes ICS Chartr 200 VNG ENG Operator s Manual VNG Tests Left Side w Vision Left Side w o Vision Other Ot
210. order the operator selected them Note Specific tests consist of a procedure e g Saccade Caloric etc and a protocol e g Right Ear Cool Note For additional information see Section 3 4 Operator Information and Section 4 2 System Options Operator Settings Tab The sign in front of a listing indicates that the listing can be expanded to show the individual test protocols A sign indicates the list is completely expanded e Click directly on a sign to show the name of each protocol within the procedure e Click on a sign to collapse the individual protocols back to the procedure level ICS Chartr 200 VNG ENG Operator s Manual 77 Section 5 New Tea Rov Saccade Both Eyes Horizontal Random Position Saccade Individual Eyes Gaze Both Eyes GazeIndividual Eyes Tracking Bath Eyes Tracking Individual Eyes Optokinetic Both Eyes Dix Hallpike Both Eyes Position Both Eyes Calotic Both Eyes Ice Caloric Both Eyes Pressure Both Eyes Dix Hallpike Individual Eyes Position Individual Eyes Spontaneous Both Eyes Figure 5 1 New Test Tab Test Preparation and Data Collection Use the scroll bars to view the entire name of a procedure or protocol if it is partially hidden or place the mouse cursor directly over a protocol name to reveal the entire name To select a specific protocol and activate the test mode Using the mouse Using th
211. ormally turned off between tests a fixation light option is available through the System Options Operator Settings Test Battery tab dialog box If the fixation light option is selected one light in the middle of the light bar is left on between tests During testing the Pause and Resume options are available Resume is also available if data collection was stopped Waveforms can be adjusted Spread Overlap Hide Show move handles during data collection Multiple tests may be run during a patient test session The first test run is called the primary the others are secondaries The primary test is listed in bold text in the Review Tab To make a secondary test a primary test the current primary becomes a secondary select Test Assign Primary option on the Menu bar Only primary test results print when the Print Report option is used In addition the primary test for calorics make up the four tests in the PODS display To reject recordings press F9 Cancel Do not press F12 Save a recording may not be deleted once it is saved After a test is saved F12 Save VNG advances to the next protocol ICS Chartr 200 VNG ENG Operator s Manual 97 Section 5 Test Preparation and Data Collection 98 5 8 1 Selecting the Test Eye When performing a monocular VNG system select the test eye using the R right or L left eye button on the toolbar or the F9 Switch Eye function key Toolbar Eye Selection Buttons When using the toolbar butt
212. oth provided with the goggles Improper cleaning may scratch the mirror surfaces Video camera lenses The camera lenses rarely require cleaning since they are protected within the goggle housing Use only a cotton swab with an appropriate lens cleaning solution Never dry wipe an optical surface as the coating can be easily scratched if improperly cleaned Avoid using excessive amounts of the solution it can get between the lens components Goggle housing The housing is made of molded PVC material which can be cleaned using a damp cloth moistened with a mild detergent and water solution Never spray or immerse the goggle components with the cleaning solutions This could contaminate the electronics and or optics To clean the face cushion 1 Use a pre moistened non alcohol based pad e g Audiowipes or apply the solution to a soft cloth Wipe the face cushion and all areas of the goggles that come in contact with the patient gently with the pad or cloth until clean This is done to remove dirt and disinfect the goggles Dispose of the pad or cloth properly after each use ICS Chartr 200 VNG ENG Operator s Manual 91 Section 5 Test Preparation and Data Collection To clean the dichroic mirror surfaces 1 Wipe the surface gently with the cloth provided with the goggles using a rotary motion until the surface is clean 2 Repeat step 1 for the other side of the mirror To clean the video camera lenses Place
213. p Opens the Operator s Manual OK Close the dialog ICS Chartr 200 VNG ENG Operator s Manual 137 Section 6 Reviewing Analyzing Test Results 138 6 8 2 3 Static Position Cutoff Values The Interpreter compares static position test results to a pre determined set of cutoff values Before running an Interpretation cutoff values can be reviewed and adjusted if needed Select Interpreter Cutoff Values to display the Cutoff Values Static Position Tests dialog box Cutoff Values Static Position Tests Li Lt Horizontal Vision _ 0 deg sec 1 1 Horizontal No Vision 6 deasec Vertical Vision __ O deg sec Lt i 1 Vertical No Vision 7 deg sec 1 1 Horizontal Ratio 50 Vertical Raia A 50 Figure 6 27 Cutoff Values Static Position Tests Dialog Box Note The default system supplied Cutoff Values were researched and selected by a team of experts Great care should be taken before adjusting these values Horizontal Vision Normal limit for horizontal nystagmus with vision Default 0 deg sec Horizontal No Vision Normal limit for horizontal nystagmus without vision Default 6 deg sec Vertical Vision Normal limit for vertical nystagmus with vision Default 0 deg sec Vertical No Vision Normal limit for vertical nystagmus without vision Default 7 deg sec Horizontal Ratio Normal limit for with without vision ratio for horizontal nystagmus Default 50 Ve
214. paragraph Enter the distance in inches that will be used as top and bottom margins on each page of the report Save the paragraph formatting options and return to the report Exit the Paragraph Format dialog box without saving the changes s Manual 157 Section 7 Working With Reports 7 5 Using Word Processor Spell Check Spell Check is a word processing option that checks the report for spelling errors 7 5 1 Spell Check Dictionaries The spell checker uses the active or default dictionary Several dictionaries are available including e American English British English French German Spanish To change the active dictionary 1 Select Tools Dictionary Options to display the Dictionary Options dialog box 2 Click the drop down arrow to display a list of available dictionaries 3 Select the desired dictionary to highlight it 4 optional Click Set Default to change the selected dictionary to the default dictionary 5 Click OK to activate the selected dictionary and close the dialog box 7 5 2 Spell Check a Document To access the spell check option select Tools Spell Check to display the following dialog box Spell Checking Document Syntax Undo Edit Ignore All Suggestions Add dress Change Change All EE EE AutoCorect Figure 7 13 Spell Checking Document Dialog Box 158 GN Otometrics Section 7 Working With Reports Syntax Displays the possible missp
215. perator It is associated The operator you are deleting is associated with other with a patient in the database patient records and can not be deleted Unable to save analysis test data etc The The system is unable to save the current data test application was unable to save information to the analysis calibration etc to the database database Contact GN Otometrics Customer Support for assistance Please close the application and contact GN Otometrics Customer Support A new ICS database can not be created The hard disk might not have enough free space Delete any unnecessary files and try again Note If a database error message prompts you to run the Database Repair Utility see Section 9 7 for instructions ICS Chartr 200 VNG ENG Operator s Manual 245 Appendix E Error Messages 246 Table E 4 Archiving Exporting and Importing Error Messages An unknown error occurred The import Confirmation to the operator after canceling the export export or archive operation was canceled or import operation An archive database already exists with the You are attempting to create a new archive using a same filename Choose another archive name that is already assigned to another archive Use database filename the system supplied default archive file name or enter another unique name for the new archive There is not enough disk space available to The storage space on the disk drive to which the archive th
216. perator options GN Otometrics Section 3 Establishing and Maintaining Records 3 4 3 Selecting an Existing Operator There are several ways to select an operator depending on where you are in the VNG ENG program Typically the operator is selected when a new patient record or new Physician Order or test session are started However multiple operators can also view analyze and prepare reports for the same set of test data The following procedures describe the process for selecting an operator prior to conducting tests and during a test session To select an operator prior to testing 1 Access the Patient Information dialog box 2 Click on the drop down list arrow next to the Operator text box to display a list of available operators 3 Select the desired operator and make sure the name appears in the text box 4 Click OK to select the operator and begin a test session To select an operator during a test session 1 Select Edit Switch Operator on the Menu Bar to display the Operator Select dialog box Operator Selection Select an operator Figure 3 8 Operator Select Dialog Box 2 Select an operator from the list of available operators The name of the selected operator should display in the text box 3 Click OK to close the dialog box The name of the selected operator will display in the brackets next to the patient name on the Title bar ICS Chartr 200 VNG ENG Operator s Manual 57 S
217. perator uses these options to help troubleshoot the system This section covers the online diagnostics for ICS Chartr 200 VNG ENG hardware and ICS CHARTER systems and systems that include video The diagnostic information obtained from the tests is used in conjunction with the troubleshooting and error message information found in this section to help in resolving system problems This section also contains information on attempting to fix a corrupted database Use the database repair procedure only if the system prompts with an error message see Appendix E while attempting to access or save information to the database Contact GN Otometrics Customer Support for additional technical assistance Note The items enabled in the diagnostics menu relate to the specific system hardware being used ICS Chartr 200 VNG ENG Operator s Manual 185 Section 9 Troubleshooting 9 2 Diagnostic Tests The diagnostic tests verify the status of system components These tests are performed on the hardware components of the system and are used to help isolate defective system components 9 2 1 Self Test The self check diagnostic test is used to make sure the system is working properly and able to collect data To conduct a self test 1 Launch the ENG software 2 Plug the loopback test fixture into the back of the Chartr 200 box denoted by this symbol Q 3 Plug the ENG patient cable into the loopback test fixture 4 In the ENG software cl
218. ports Select to include the text portion of the patient report Select to include the clinical information questions in the report listed by procedure name Select each of the test procedures to be included in the report Select to display only the test procedures from the current test session Select to display a list of the test procedures from all of the test sessions of the current Physician s Order for this patient in the database Options Saccade and Tracking Analysis Data Raw Averaged Raw and Averaged Print Page numbers Buttons Select All Pages Clear All Pages Print Preview 168 Select to print Saccade and Tracking Analysis data in the report in raw view only Select to print Saccade and Tracking Analysis data in the report in averaged view Select to print both raw and averaged views of the Saccade and Tracking Analysis data in the report Select to include page numbers on each page of the report Place a check mark in front of all of the listed Report pages Remove the check mark in front of all of the listed Report pages Send the report directly to the printer Display the Print Preview mode Display each page of the report as it will be printed GN Otometrics Section 7 Working With Reports Printer Setup Display the Windows Print Setup dialog box Cancel Exit the dialog box without printing the report Help Opens the Operator s Manual To print a patient report
219. rator s Manual 217 Appendix B VNG Tests B 6 Okan Tests Table B 8 Procedure Okan Both Eyes 40 sec 30sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 40 per second for 30 seconds then turned off 40 sec 30sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 40 per second for 30 seconds then turned off 40 sec 60sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 40 per second for 60 seconds turned off 40 sec 60sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 40 per second for 60 seconds then turned off 60 sec 30sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 60 per second for 30 seconds then turned off 60 sec 30sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 60 per second for 30 seconds then turned off 60 sec 60sec Right Multiple light targets moving rightward at Horizontal Eye Position Vertical Eye Position 60 per second for 60 seconds then turned off 60 sec 60sec Left Multiple light targets moving leftward at Horizontal Eye Position Vertical Eye Position 60 per second for 60 seconds then turned off 218 GN Otometrics Appendix B VNG Tests B 7 Dix Hallpike Tests Ta
220. re updated at the display rate The Video dialog box provides the following information Version Lists the version number for the Frame Grabber board Num Ports Lists the number of ports for the Frame Grabber board Bus Type Lists the active bus type for the Frame Grabber board IRQ Number Lists the IRQ number assigned to the Frame Grabber board Base Port Lists the base port I O address for the Frame Grabber board ICS Chartr 200 VNG ENG Operator s Manual 197 Section 9 198 Channels Sample Rate Display Rate Max Sample Rate Display Count Channel Hex Decimal Start Stop Pause Resume Help OK Troubleshooting Lists the number of active available channels Displays the sample rate in Hz Displays the display rate in Hz Displays the maximum sample rate in Hz Displays the number of times the display is updated The number increments during a diagnostic test Lists each of the six active channels by type and number H horizontal V vertical and T torsional Torsional channels are not active in this version of VNG and will report as a flat line Provides the hexadecimal reading for each channel Provides the decimal reading for each channel Begin a diagnostic session Stop the active diagnostic session Pause the active diagnostic session while holding the Display Count Resume the diagnostic session and continue to increment the Display Count Opens the Operator s Manual Exit the
221. retation shall be pasted into the word processor report only when working with the main database Therefore if you are not using the main database the Paste To Report button will be disabled in interpretation dialog Are the Tests Invalid When the test results cannot be explained by any known physiology or pathophysiology of the vestibular system the test is considered invalid If the Interpretation Assistant determined that your test results are invalid based on current settings of cutoff values the Paste To Report button is disabled and the interpretation cannot be copied to the word processor report 6 8 3 2 Interpretation Text Token lt IA_RESULTS gt Not in the Report Template Is the lt I A_RESULTS gt token in the word processor template The word processor report is generated by replacing place holder tokens in the ENG VNG word processor template file with information such as patient name facility etc These tokens can be moved around in the template files to customize the word processor report During a software upgrade the template files are not overwritten or replaced because a facility may have chosen to customize their word processor reports When you click the Paste to Report button the Interpretation Assistant locates the lt A_RESULTSS gt token and replaces it with the interpretation text If the Interpretation text is not added to the word processor report it is likely that that the lt A_RESUL
222. reyss German GDT Interface Settings I Enable GDT Interface to Pratice Management System CHARTR VNG System Name File Transfer Timeout secs 3 PMS System Name F Character Set ASC v GDT Local File Transfer Directories Incoming Messages PMS gt CHARTR VNG CAGDT Dutgoing Messages CHARTR VNG gt PMS CAGDT Figure 4 5 System Options Peak Frequency GDT Interface Tab Program Language Click the drop down arrow to display a list of languages Click on a language to select it English or German Peak Frequency Calculation Calculate Peak Frequency per 30 seconds Select to calculate the peak in addition to the SPVs when an SPV test analysis The first 140 seconds of the test is analyzed and the 30 second window with the highest frequency of nystagmus is identified In Analysis mode click the Begin button to start the 140 second window Note If this option was not selected before a test was analyzed and saved the peak frequency will not be displayed To include the peak frequency in an analysis select this option and then click the Reanalyze button to regenerate the SPV and Frequency analyses 70 GN Otometrics Section 4 ICS Chartr 200 VNG ENG Operator s Manual Setup and System Options Show Peak Frequency for Non caloric Tests Available only if the Calculate Peak Frequency per 30 seconds options is selected Select to display the calculated peak frequency value for
223. rol Dialog Box Recording 5 Click Stop Video 6 Click F12 Save to save the collected data and video recording To open the video playback dialog and play a video 1 Access the Review tab and select or double click the desired test 2 Select Video Play to start the video ICS Chartr 200 VNG ENG Operator s Manual 101 Section 5 Test Preparation and Data Collection 5 10 Using the Footswitch 102 Systems with a footswitch provide the operator with an alternate way to initiate some specific actions without using a mouse and keyboard Note If the footswitch is connected to the caloric stimulator the caloric stimulator must be turned on prior to using the footswitch 5 10 1 Footswitch Operations Use the footswitch to initiate these specific actions Press the footswitch to start a test If the test involves caloric stimulation pressing the footswitch will start both the test and the caloric stimulator Note that the button on the handset of the caloric stimulator has the same function as the footswitch During collection press the footswitch again to center the waveform VNG ENG or start the video VNG Note The VNG option of centering waveforms or starting the video is set up in the System Options 5 10 2 Record Video Using the Footswitch The footswitch or irrigator hand switch serves two different functions in VNG It may be used to start a test or to start or restart video recording Once a test is i
224. rt to move to that section of the tracing The vertical cursor in the lower chart moves to that beat The slope line and vertical cursor in the upper chart are then aligned with the actual SPV being represented and the SPV value between the charts represents this value Click on a section of the waveform in the upper chart to move to that section of the tracing The actual SPV of the beat under the cursor is not represented and needs to be manually verified by the operator Note Each time the position of the slope cursor is changed click F8 Insert to allow the system to accept the new slope cursor position 114 GN Otometrics Section 6 Reviewing Analyzing Test Results 6 7 1 Locating Versus Selecting Peak SPV When selecting F5 Locate Peak the system goes through a series of calculations to locate the peak value It searches all the identified slow phase velocities in the 140 second time window At each second moving from left to right for 140 seconds it calculates the velocity for that second and for velocities 5 seconds to the left and 4 seconds to the right It then sorts these velocities from highest to lowest for that 10 second window and determines the average of the 3 fastest velocities Note The default value for the sample size is three The operator may change the samples in SPV setting in the Operator Information Options tab dialog box Next the system identifies the most positive of the 140 averages rightward moving s
225. rtical Ratio Normal limit for with without vision ratio for vertical nystagmus Default 50 Neck Effect Limit to determine the neck rotation effect on horizontal nystagmus currently not available Default 6 deg sec Help Opens the Operator s Manual Default Sets the cutoff value sliders to default locations marked by center ticks Cancel Cancels current changes and restores previous values OK Applies current changes and dismisses the dialog The OK button is disabled when working with read only databases GN Otometrics Section 6 Reviewing Analyzing Test Results 6 8 3 Unable to Paste Interpretation into the Patient Report There are several situations that could make it difficult for you to paste the Interpretation Results into a patient report 6 8 3 1 Paste to Report Button Disabled Grayed Are you using the main database Copying the interpretation to the word processor means that the report will be modified and saved in the database In order to save anything to the database it should be considered writable by the VNG software Archived databases exported patient databases and floppy disk databases are not considered writable by the VNG software Although one may choose to get an interpretation on a test from an archived exported patient or floppy disk database this interpretation cannot be pasted into the word processor report Only the main database is considered writable and a test interp
226. s cf c2 scast alae suadetasts tacsth ii satertibeseeesen incetasaageslid sacabhes 204 10 3 1 Responsibility of the Manufacturer eee eeeeeeereee 204 Technical Specifications nason e e ET a 205 ICS Chartr ENG pine nea al is A ee E 205 ICS Chartr 200 asisewis a ee iee aetna he acacia 205 AN CCESSOTIES oroar ias e e EE E eE EEEE T E e E eat R teave 208 Clinical Information ssa iiaia a E hdc 209 MING TeSt e eerie eet ena oE E E E A EEE 211 Bel OVVIE Women eiia A AEA T RNa 211 B 2 Saccade Tests casi eenia ee er E E a Raw edt 212 B3 G ze Vests eriten esner osese ae eean eeni ea a eaaa 214 Bid Tracking Testsion oiire a a ines footie eee 216 B5 Optokinetic Tests eo rnin e ana e aE ee on 217 B6 Okan Tests eee oerna re arreirar ie i aineenaan 218 B 7 Dix Hallpike T stS eccone nnn neninn ent 219 B 8 Position Tests oren n aa ities adn hele 220 B 9 Bithermal Caloric Tests cceeccccescceesseceeneeceeeeeceeeeesaeceeaeceeeeeees 221 B 10 Ice Water Caloric Tests cic ceecseeseseneeeseeeeeeseecnaecsaecsaeeneeeseeeees 222 Bel UPr ssure Tests sess cit cess csethistve thantinweistel tines a R iste eats 223 Bil 2 Other T CSt8 oesceccesseaccoe ses Gasausscceseont aeee r aeret a ee aain e eaea 224 B 13 Default Test Battery cisien teienei e o a E aii 228 B 13 1 Chartr 200 VNG Default Test Battery oes 228 B 13 2 Chartr 200 ENG Default Test Battery eee 230 B 13 3 Chartr 200 M VNG Default Test Battery 0 00 231 Customizing the Word Proce
227. s Use the browser button to select the folder Outgoing Messages CHARTR VNG gt PMS Specify the folder location for outgoing GDT messages Chartr VNG will place outgoing messages in this folder to be picked up by the PMS system The specified folder must exits Use the browser button to select the folder Save selected options and close the dialog box Exit the dialog box without saving options Opens the Operator s Manual GN Otometrics Section 4 Setup and System Options 4 5 Select an Operator The Operator Select option is used to select the default operator or an operator from the list of operators Select Edit Switch Operator to display the Operator Select dialog box Note To modify operator information select Edit System Options Operator Settings Tab Operator Select Ea Please select an operator Cancel Default Operator Help e Figure 4 6 Operator Select Dialog Box Please select an operator Click on the drop down list of operators to display the list of operators already in the system If no operators are listed choose the Default Operator option OK Save the selected operator and display the Operator Information dialog box for the selected operator See Section 3 4 for information on completing the Operator Information dialog box Cancel Exit the dialog box without selecting an operator Help Opens the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual 73 Secti
228. s a default template set is used The default set is defined in the Default Operator All or only some of the test results may be included in the report A waveform for each included test displays on the report in the order determined by the active template Note The patient information section of the report is formatted in the word processor For information on how to customize the report format for a specific facility see Appendix C of this manual 7 7 1 Report Setup Dialog Box Select File Report Layout from the Main Window to display the Report Setup dialog box Report Setup Select a procedure Caloric Temperature Switched Both Eves Dix Hallpike w Torsional Individual Eyes Dix Hallpike Both Eyes Gaze Both Eyes Gaze Individual Eyes Head Shake Both Eyes Ice Caloric Both Eyes Okan Both Eyes Optokinetic Both Eyes Positional w TorsionalIndividual Eyes Position Both Eyes Pressure Both Eyes Rotary Chair Both Eyes Rotary Swing Both Eyes Spontaneous Both Eyes Available on This workstation C All workstations Figure 7 17 Report Setup Dialog Box Select a procedure Displays a list of procedures Edit Open the Report Page Setup procedure name dialog box Done Save the changes and exit the dialog box Help Opens the Operator s Manual Available on This workstation Lists procedures available for the hardware in this workstation Available on All workstations Lists the procedures available on all ne
229. s and prepare the system for new operator information Delete Delete the operator from the database An operator cannot be deleted if an existing patient record is associated with the operator OK Accept the information in this dialog and save it to the database Cancel Close the dialog box without saving the information Help Opens the Operator s Manual ICS Chartr 200 VNG ENG Operator s Manual 55 Section 3 56 Establishing and Maintaining Records 3 4 2 Establishing a New Operator Use the following procedure to enter operator information in the Edit Operator dialog box See Section 4 2 to setup operator determined options for conducting tests and a test battery To establish a new operator 1 2 Select Edit Operator Info to display the Edit Operators dialog box Click the New button to clear the text boxes and prepare the system for a new operator Place the cursor in the Last Name text box and type the last name of the operator Note Keyboard alternate press Tab to move the cursor from one text box to the next and from one button to the next press Shift Tab to return to the previous text box Place the cursor in the First Name text box and type the first name of the operator Continue moving from one text box to the next until you have entered all of the operator information requested Click OK to save the operator information in the database Go to System Options to setup the test battery and other o
230. s tab 3 Change the name in the Workstation Name edit box 4 Click OK to save the new name to the database and close the dialog box 4 3 2 Video Settings The video settings including the model of the video goggle used on this workstation should be designated as part of the setup process Several models of video goggles are available for use the ICS Chartr 200 VNG ENG system Note The model number of ICS Chartr 200 VNG system video goggles is listed on the label of the video goggle itself See the example shown in the Video Settings portion of the Workstation Settings tab Goggle Model Click on the drop down arrow to display a list of goggle models Select the model found on the label on the video goggles that will be used with your system Fixation Light VG 40 only Select Left Eye or Right Eye Maximum Video Recording Time in secs Type the maximum amount of time from 10 to 300 seconds for each video recording session on this workstation 66 GN Otometrics Section 4 Setup and System Options 4 3 3 Facility Information The Facility Information option is used to enter and maintain information about the test site facility at which the ICS Chartr 200 VNG ENG workstation is located It is also the address information appearing on the report Select Edit System Options Workstation Settings Tab to display the Facility Information dialog box Complete the information in the Facility Information dialog box as follows Practi
231. section below the box The table of numeric results on the right displays the values used for the graph and the resultant Caloric Weakness Asymmetry in this table is calculated by averaging the Right Cool Left Cool Right Warm and Left Warm values ICS Chartr 200 VNG ENG Operator s Manual 121 Section 6 Reviewing Analyzing Test Results 122 6 7 6 Fixation Index VG40 Goggles and later come equipped with a built in Fixation Light that can be triggered from the software in systems with USB unit hardware All protocols support the Fixation Light feature 6 7 6 1 Setting the Fixation Light to Turn on in the Left or Right Eye The Fixation Light can be turned on in either the left or the right eye In the monocular version of the software the Fixation Light will always turn on in the eye being tested In the full version of the software the eye can be set by the tester To set the Fixation Light eye access System Options Workstation Settings Fixation Light The eye cannot be changed in the middle of a test 6 7 6 2 Invoking the Fixation Light To turn on the Fixation Light during the collection invoke F11 Fixation Light Invoking F11 again will turn off the light or use fixation button on the remote control When the Fixation Light is turned on an FI marker will be placed on the tracing When the Fixation Light is turned off during a collection the tracing will be marked with a Fo marker 6 7 6 3 Calculating the Fixati
232. select it 4 Select Test Assign Primary from the Menu Bar The assigned protocol displays in bold type Note This menu item is only applicable when a secondary non bolded protocol is selected ICS Chartr 200 VNG ENG Operator s Manual 107 Section 6 Reviewing Analyzing Test Results 6 4 Working with Waveforms During a review analysis session a waveform tracing for each tested channel displays in the Main Window Workspace 6 4 1 Waveform Handles Each waveform has a handle located at the far right side of the waveform that can be manipulated by the operator Selected waveform handle N Figure 6 2 Waveform Handles The handles are square boxes with letter designations indicating the channel The selected waveform handle is a colored box To move waveforms Use the mouse to select a waveform handle and drag the waveform to the desired location In Review mode the W arrow keys may be used to move the active waveform up or down Use the Function Keys as indicated to overlap spread show or hide waveforms or from the Menu Bar select Waveform Overlap Spread Hide Waveform or Show Waveform Press Ctrl O or Ctrl S to overlap and spread the displayed waveforms 108 GN Otometrics Section 6 Reviewing Analyzing Test Results 6 4 2 Waveform Text During a review analysis session the operator may write notes specific to a waveform in the Edit Wav
233. sible when the ICS Chartr 200 VNG ENG software is started This is the default setting Suppress Do not display startup warning Select this option to skip the Hardware Startup Warning each time the ICS Chartr 200 VNG ENG software is started This setting is not recommended for normal use This option maybe selected on Demo Read Only systems that do not require all of the hardware needed to run a VNG ENG test Diagnostic Mode Display list of accessible hardware each time application is started for GN Otometrics Support use Select this option to display the Hardware Startup Warning dialog box each time the ICS Chartr 200 VNG ENG software is started A list of all of the hardware present or absent on your system that is needed to run a VNG ENG test You may be asked to select this mode by a GN Otometrics technician attempting to conduct a remote troubleshooting session Hardware Startup Warning Dialog Box The Hardware Startup Warning Dialog Box displays if the option is selected in the System Options Workstation Settings Tab and the system cannot find all of the Chartr hardware when the system is started r Hardware Startup Warning J The application was unable to detect hardware components necessary for collection The application will run as a read only system See the list below for a summary of hardware problems detected USB YNG Device Not Found l Do Not Display This Warming Next Time
234. sing report the text can be modified as needed Caloric Test Interpretation Total response from the right 48 deg sec Total response from the left 70 deg sec Baseline Shift 0 deg sec Unilateral Weakness 19 in the right ear Gain Asymmetry 17 to the left The caloric test shows no abnormality Paste To Report Figure 6 15 Caloric Test Interpretation Dialog Box Paste To Report Copy and paste the interpretation results into the word processor report This button is disabled if a technical error occurred during the interpretation Help Opens the Operator s Manual OK Close the dialog box without saving the results ICS Chartr 200 VNG ENG Operator s Manual 127 Section 6 128 Reviewing Analyzing Test Results 6 8 1 3 Correcting a Caloric Test Technical Error Caloric test results are probably invalid when they cannot be explained by any known physiology or pathophysiology of the vestibular system We suggest that you proceed as follows First check your data Caloric responses differ in strength and direction but they always have the same shape They start about 20 sec after the onset of the irrigation if the tympanic membrane is intact rise to a peak about 60 to 90 sec after the onset of the irrigation and thereafter decline to baseline If your caloric responses don t look like this we suggest that you clean up your data If any response doesn t contain enough data points to work with then you w
235. ssing Report ce eeesseesseceseceeeeeeeeeneeees 233 CoD SOVEPVIEW nearness eona e cde eeo er e aen aae ae ete eoo eSt 233 C 2 Default Page Layout and Design eseeeseeeeeeeeereeresresreserrresreereses 234 C 3 Database Information ee eee e AE era 235 C 4 Customizing the Report Template eee essecsseceneceneeeeeees 236 C 5 Report Template Database Tags 0 ccc eecceceeeeeeeteceeteeceeaeeeeeeeees 238 ICS Chartr 200 VNG ENG Operator s Manual Appendix D Appendix E Appendix F Appendix G Appendix H vi Setting up the ICS Chartr 200 Hardware 00 eee ceeceeeeeeeeeeeeeeeeee 239 D 1 ICS Chartr 200 VNG ENG 0w eee eeeeeeesecnsecesecnseceeeseeeeseeeeeeeees 240 D 2 ICS Chartr 200 VNG ENG Rear Panel Connections 241 D 3 ICS Chartr 200 Remote Control oe ceseceseceseceseceseeeeeeeeeeeees 242 Error Messa g s n acces E E EET AE Nib E E E on 243 Keyboard Shortc ts seenen i ieir a 249 F 1 Activate Keyboard Shortcut Feature 249 F 2 Use Keyboard Shortcuts 0 0 esecssecsseceseceeceseceeeeseeeseeeseeeees 251 Function K yS re alcn ieceres ueria eal AT EEE EA EAA 253 Video FUES h aray sere o ane aE aS EEE AE E ATSE Ea 261 H 1 Video Playback Dial g inei atten ede 261 H 2 Adding a Comment to a Video Recording cee ceeceeeeeeeeeeeeeees 262 H 3 Del tine Video nureen iw ne kate 262 H 4 Archiving Recorded Video 0 eee essecsseceseceseceeceseeeeeeeseeeseeeees 262 H5 Bxporting VideO eeir o
236. stem can be added manually Note The vertical cursor in the middle of the top chart and the moveable vertical cursor on the bottom chart always indicate the same point in time GN Otometrics Section 6 Reviewing Analyzing Test Results 9 To measure the slope of a beat and enter a new measurement a Scroll through the tracing or press the gt arrow keys to move the tracing left or right until the beat to be measured is under the vertical cursor or use F10 Previous Beat and F11 Next Beat to move through the tracing or point and click on a specific beat in the Slow Phase Velocity lower chart to move the selected beat under the vertical cursor or point and click on a section of tracing in the upper chart to move to that section Note Holding down the left or right arrow keys moves the tracing in that direction at an accelerating rate Press the MW arrow keys to raise and lower the velocity measuring line if needed Press Ctrl and or Ctrl gt to change the angle of the velocity measuring line until it is parallel with the slow phase of the beat d Press F8 Insert to accept the new SPV value of the beat Vertical cursor Velocity measuring slope line R30 R20 R10 o L10 L20 In Slow Phase Velocity 80 Ane omo omo lt mo p t 80 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 seconds Figure 6 7 Measuring the SPV of an Individual Beat Pa
237. symbol when it is important that the user refers to associated information given in this manual CE XXXX ICS Chartr 200 VNG ENG is CE marked according to the Medical Devices Directive 93 42 EEC The switch alternates between On and Stand by mode Green the switch is on pushed in and the USB connection unit is ready Blue the switch is in Stand by mode pushed in with no USB connection Clear the switch is Off pushed out The instrument is marked with this symbol to indicate that it is electronic equipment covered by the Directive 200296 EC on waste electrical and electronic equipment WEEE ICS Chartr 200 VNG ENG is marked with this symbol to indicate it is suitable for direct current Symbols on the ICS Chartr 200 VNG ENG back panel see Section D 2 ICS Chartr 200 VNG ENG Operator s Manual 201 Section 10 Safety 10 2 Warning Notes Equipment connected to the displayed connectors must be certified to relevant JA amp EN IEC safety standards e g EN IEC 60950 Mains connected equipment O O O except EN IEC 60601 1 certified equipment must be powered from the Powertronix Isolation Station Note 1 Note 2 Note 3 Note 4 202 Note 5 Note 6 Note 7 Note 8 t O Equipment connected to the displayed connectors must be certified to relevant ee e EN IEC safety standards e g EN IEC 609
238. t and Design The text portion of the ICS Chartr 200 VNG ENG patient report is formatted based on the page layout and design defined in a report template In addition the database information in the report is also defined in the template Customizing the Word Processor Report Report File Edit Format Tools Help a ui Page 1 Times New Roman x fu GN Otometrics 125 Commerce Drive J o z ul E alls T alele f E h 2 Schaumburg IL 60173 USA Tel 847 534 2150 Patient ID Patient Birthdate Gender Address Phone Physician Referring facility Line 10 Col 28 100 Patient Report VNG Johnson Veronical 9 4 1960 Female 3908 W Main Street Valley View IL 66056 None None NUM Figure C 1 Default Report Page Using the VNG ENG word processor the operator may change the font selection and the paragraph appearance of each individual report The operator may also add modify and delete information in the report However the changes the operator makes only apply to the report the operator is currently working on and will not apply to any other reports created by the operator See Section 7 for more information on how to access the report and modify it in the word processor 234 GN Otometrics Appendix C Customizing the Word Processor Report C 3 Database Information The database fields and access tags de
239. t the selected SPV beat measurement Prompts to save analysis Clicking No will go back to Review state without saving Move the cursor to preceding measured beat Move the cursor to the next measured beat Save analysis Table G 15 Function Keys SPV Pods Butterfly Function Key Action F1 Help F3 Interpret Tests F4 SPV Graph F5 Baseline Up F6 Baseline Down F7 Set Baseline F9 Close F12 Save Function Access Operator s Manual Interpret caloric results Return to SPV measurement state Moves baseline up green line on PODS graph Moves baseline down green line on PODS graph Saves the baseline at current position F12 Save must be pressed to save baseline to the database Cancel the analysis and return to the Review mode Save the PODS information 260 GN Otometrics Appendix H Video Files H 1 Video Playback Dialog The video playback dialog contains several distinct regions ICS Medical Video Recording File View Play Help Patient Name Murray Lucille Test Di 00 01 00 40 ced Figure H 1 Medical Video Recording Dialog Box Sa Sa The Video Area is beneath the dialog s Menu Bar This region displays the recorded eye movements The Captioning Area is beneath the Video Area It displays a label for each eye and identifies the name of the patient the name of the test and the date and time at which the test was con
240. tabase Print Report Display Print Report dialog box in order to begin the report printing process Print Setup Display the Print Setup dialog box Exit Exit the word processor prompts to save changes ICS Chartr 200 VNG ENG Operator s Manual 149 Section 7 Working With Reports Edit Menu The word processor Edit Menu allows the operator to perform the following editing functions Undo Cut Copy Paste Clear Find and Replace Undo Ctr Cut Ctrl Copy Ctrl C Paste Ctrl V Clear Del Find Ctrl F Replace Cti H Figure 7 3 Word Processor Edit Menu Undo Clear the most recent action Cut Copy the selected text to the clipboard for temporary storage and delete from the report Copy Place the selected text on the clipboard for temporary storage This does not delete the selected text from the report Paste Place the clipboard information in the document Clear Delete the selected text Find Display the Find dialog box Replace Display the Replace dialog box Format Menu The word processor Format Menu allows the operator to assign font or paragraph attributes to selected text Format Font Paragraph Figure 7 4 Word Processor Format Menu Font Paragraph 150 Display the Fonts dialog box Display the Paragraph Format dialog box GN Otometrics Section 7 Working With Reports Tools Menu The word processor Tools Menu allows the operator to conduct a spell check select
241. taneous the Show peak frequency for non caloric tests option must be selected ICS Chartr 200 VNG ENG Operator s Manual 119 Section 6 Reviewing Analyzing Test Results 6 7 4 Analyzing Caloric Test Results For caloric tests the peak responses are identified and saved for use in the system s calculation of caloric unilateral weakness and gain asymmetry directional preponderance When all four calorics have been measured the routine will calculate and display caloric weakness and gain asymmetry Directional preponderance can be selected in the System Options Operator Settings Test Battery tab dialog box The formulas used to calculate unilateral weakness gain asymmetry and directional preponderance are For unilateral weakness and gain asymmetry PEAK caloric PEAK Baseline Shift Note that baseline shift is not adjusted in Directional Preponderance and RC right ear cool RW right ear warm LC left ear cool LW left ear warm RC RW LW LC Unilateral Weakness UW x 100 RC RW LW LC RC LW RW LC Gain Asymmetry GA x 100 RC RW LW LC RC LW RW LC Directional Preponderance DP x 100 RC RW LW LC Note The system designates values of positive or negative based on the direction of the slow phase not the beat The exact value as designated is used in the formulas The analysis routine cannot measure beats that have zero velocity or where dis
242. tesesces ausvedsblacesarseaiendeeetoussesassoneltacecaweeiad 36 2A PUnCtHOn Key 8 ereccicacsisiccccn thectdasiesstteciacsbesia sete aasidewni ce itesinasbaibels 36 Section 3 Establishing and Maintaining Records ccccceeesseceeceeeeeeeeeeeeeaeeeeees 37 3 1 Patient Information 4 scscicicsceeseescseebesndecedencedseacsesseovenccdesbevnascevencce 37 3 1 1 Patient Selection Dialog BOX cceeceeeeeeeeeteceeneeeeeeeeeees 37 3 1 2 Patient Information Dialog BOX cece ceecceeeseeetteeeeeeeeees 39 3 1 3 Establishing a New Patient Record 0 ce eeeceesseceereeeeees 44 3 1 4 Editing Patient Information 0 0 eee eeeceeeteeeseteceeeeeeees 45 3 1 5 Selecting an Existing Patient ec ceeececceesseceeneceeeeeeees 46 3 1 6 Deleting a Patient Record eeecceeseceeeeeeeteeesnneceeneeeees 46 ICS Chartr 200 VNG ENG Operator s Manual Section 4 Section 5 3 2 Physician Information sunnere elastance 47 3 2 1 Referring Physician Information Dialog BOX 47 3 2 2 Establishing a New Physician sesers 49 3 2 3 Selecting an Existing Physician s 50 3 2 4 Editing Physician Information 0 000 ce ceeceseeeeeeeseeeeeeeees 50 3 3 Referring Facility Information eee eeceeeeeneeeneeeneeceseeeseeeaeees 31 3 3 1 Referring Facility Information Dialog BOX 51 3 3 2 Establishing a New Referring Facility 0 0 eee 52 3 3 3 Selecting an Existing Referring Facility oe 53 3 3 4 Editing Referring Facility
243. tet earnest esei 263 H 6 Configuring Windows Media Player for Caption Display 265 H 7 Choosing a Code ses taatntnteucs a a a a a 266 H 8 Video Export Compression Controls esseeeeseeeeeseereeerereereereees 267 Table of Contents GN Otometrics Section 1 Introduction to the VNG System 1 0 1 1 This section provides an introduction to the ICS Chartr 200 VNG ENG system and the fundamentals of using the ICS Chartr 200 VNG ENG software Introduction The ICS VNG vestibularnystagmography ENG electronystagmography and M VNG monocular vestibularnystagmography eye movement testing systems provide sophisticated yet easy to use diagnostic tools in a Windows operating environment This VNG version includes the ability to conduct Videonystagmography testing using special equipment Note Throughout this manual VNG means either VNG or ENG unless expressly specified in the text While using the system is easy familiarity with the Windows operating environment and the ICS VNG software is important GN Otometrics highly recommends that users of the system read this document prior to attempting tests Note To comply with HIPAA regulations the Windows XP system offers password protection Intended Use The ICS Chartr 200 VNG ENG is a nystagmograph that is intended to measure record and display involuntary movement nystagmus of the eyeball ICS Chartr 200 VNG ENG Operator s Manual 1 Section 1 Introd
244. that you archive and start a new database or delete any unneeded files off your hard drive The hard disk is out of space There is not enough free space on the hard disk to complete the import export operation 5 MB minimum is required ICS Chartr 200 VNG ENG Operator s Manual Possible Cause Solution The active hard drive has less than 5 MB of storage space available and needs to be archived Archive the current database and move it to another location See Section 8 for additional information The hard disk does not have enough available memory to complete the requested operation Exit the program and delete unnecessary files to free up more space Reopen the program and archive the current database Move the archive to another hard drive or storage destination A minimum of 5 MB of free space is needed to perform an import export operation Exit the program and delete any unnecessary files to free up more space 247 Appendix E Error Messages 248 Table E 6 Other Error Messages Error Message Possible Cause Solution The VNG application cannot run with the current The monitor settings do not meet the minimum monitor monitor display settings display specifications Right click on the Desktop to show the Window Display properties Click on the Setup tab The color quality must be 32 bit modify the color palette and display size At 96 dpi the screen resolution must be at least 1024x768 pixels At 120 dpi t
245. the Setup program WARNING This program is protected by copyright law and international treaties Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maximum extent possible under law Figure 1 2 Welcome Dialog Box Installation Wizard b Select Installation Options Select ICS CHARTR 200 USB or the MCU 90 XP tower Make sure the correct option is selected Next select the application s you want to install VNG or ENG Click Next to continue Select Install Specify VNG ENG Hardware MCUSO XP tower ICS CHARTR 200 USB Select Software to be Installed IV VNG ENG Figure 1 3 Select Install Dialog Box Installation Wizard ICS Chartr 200 VNG ENG Operator s Manual 3 Section 1 Introduction to the VNG System c Read Me First Read the about the enhancements and features available in this version of the software Click Next to continue Read Me File GN Otometrics ICS CHARTR ENG VNG Version 6 2 Build 1385 September 17 2007 1 Intrepretation Assistant for Static Positional Tests 2 Test data displayed in new test information window SPV s caloric values fixation index 3 Toolbar icons for quick access to common functions 5 Printing of SPY values reports and print analysis 6 Printing of test and analysis comments 7 Support for Averaged Tracking Gain value as well as Sacc
246. the eye that was selected when the test was run 110 GN Otometrics Section 6 Reviewing Analyzing Test Results To review test results 1 2 Click the Review tab to access the Review Mode Select a Physician Order date then select a Session under that Physician Order Click the sign in front of a procedure to display the test protocols under that procedure Select a protocol to display the test results Once displayed the operator may a Use the waveform handles to move waveforms or create edit waveform text b Use the scroll bars or left and right arrow keys to move through the displayed waveform c Use the available function keys to access and review the calibration access the next or previous test results begin an analysis session etc ICS Chartr 200 VNG ENG Operator s Manual 111 Section 6 Reviewing Analyzing Test Results 6 6 Reviewing Calibrations 112 When a test is saved the current calibration is saved with that test From the Review mode while reviewing a test the saved calibration may also be reviewed The calibration is signal specific The calibration for the active signal is reviewed To review a calibration 1 Access the Review tab and select a specific protocol to display the test results for that protocol 2 Press F8 Review Calib to show the calibration that was active at the beginning of the selected test Each calibration record contains the last 10 seconds of the calibration
247. the following procedure to calibrate a patient prior to a test session To calibrate a patient 1 2 94 Select the New Test tab to access the test mode Select a specific test from the list of tests Make sure the light bar is positioned properly horizontally or vertically Position the patient to face the bar at a distance of 4 feet 1 2 m from the bar Press F5 Calibrate to access the calibration mode Note If using monocular systems click F9 Switch Eye to select the eye to be tested the eye that is grayed out is the currently selected Instruct the patient to follow the dot of light on the bar without moving his her head GN Otometrics Section 5 7 10 11 12 13 14 15 16 Test Preparation and Data Collection Press F12 Start to begin the calibration The system will move the light bar target Based on the associated eye movements the system will adjust position and gain During the calibration press F5 Faster Slower to adjust the speed if needed Press F7 Center only on ENG systems to center the waveform during calibration Press F12 Accept to place an event marker at the point of acceptance and lock in gain Calibration gain is based on the full cycle immediately preceding the event marker Continue running the calibration for a few more cycles to verify an acceptable calibration Press F12 Stop to end the verification The system reviews the calibration and if the accepted ey
248. the following procedure to check the range Repeat this procedure as often as needed during a test session To check the range 1 Click on the New Test tab to access the Test mode 2 Click on the sign in front of a test procedure to display a complete list of individual protocols 3 Select the desired test 4 Position the patient in front of the light bar for testing 5 Click F6 Range to display the Range dialog box and activate the Range Sensor on the light bar 6 Click OK to close the range dialog box ICS Chartr 200 VNG ENG Operator s Manual 81 Section 5 Test Preparation and Data Collection 5 5 Electrodes 5 5 1 Applying Electrodes The GN Otometrics ICS ENG system is capable of simultaneously recording 2 or 4 channels of eye movement information depending upon the model being used The channel designations are described below and relate to the placement of the electrodes shown in Figure 5 3 Channel Electrode cable connections Horizontal both HB red blue Vertical right VR orange white Vertical left VL green brown Horizontal right HR red black Horizontal left HL blue black Orange Green Red Blue White Brown Figure 5 3 Normal Electrode Placement 4 channels 82 GN Otometrics Section 5 Test Preparation and Data Collection 5 5 2 Electrode Test ICS ENG systems measure the offset potential between a pair of electrodes In the Electrode Test dialog
249. the green and brown left eye inputs on the electrode cable as this is the vertical channel read by the software For the majority of recordings horizontal both and vertical left eye channels are used ICS Chartr 200 VNG ENG Operator s Manual 83 Section 5 84 Test Preparation and Data Collection 5 5 3 Checking Electrodes To test the electrodes 1 2 Click the New Test tab to access the Test mode Select a test protocol Click F7 Electrode Test to display the Electrode Test dialog box Check the status of the electrode connections Reapply any electrodes if indicated by a question mark Click OK to exit the Electrode Test dialog box when satisfied with the results GN Otometrics Section 5 Test Preparation and Data Collection 5 6 VNG Mode The ICS Chartr 200 VNG system uses video goggles instead of electrodes to obtain eye movement information An additional feature of VNG is that during a test optional video recordings may be taken for future reference The patient s eyes can also be monitored in real time from the Video Eye Display or on the two monochrome monitors attached to the system 5 6 1 Setting Up VNG The VNG setup requirements for systems using ICS Chartr 200 are as follows Note See Sections 5 6 2 and 5 6 3 for additional information Two optional 9 inch 23 cm black and white monitors connect to the Video output left and the Video output right ports on the Chartr 200
250. the text boxes and prepare the system for a new facility Place the cursor in the Name text box and type the referring facility s name Note Keyboard alternate press Tab to move the cursor from one text box to the next and from one button to the next press Shift Tab to return to the previous text box Continue moving from one text box to the next until you have entered all of the facility information requested Click OK to save the referring facility information in the database GN Otometrics Section 3 Establishing and Maintaining Records 3 3 3 Selecting an Existing Referring Facility Use this procedure to identify the referring facility and attach the facility information to a specific patient record To select an existing referring facility 1 Access the Patient Information dialog box 2 Click on the Physician s Order tab at the top of the Patient Information dialog box 3 Click the Referring Facility drop down list arrow to display a list of facilities 4 Select the name of the facility that referred the patient from the list of available facilities Make sure the facility name displays in the Referring Facility text box Note Ifthe facility is not in the list of available referring facilities see Section 3 3 2 Establishing a New Referring Facility 5 Click the OK button at the bottom of the Patient Information dialog box to accept the selected facility 3 3 4 Editing Referring Facility Information Use th
251. tical Eye Position Position and Time random positions Target Position 212 GN Otometrics Appendix B Table B 2 Procedure Saccade Individual Eyes Protocols Horizontal Random Position Vertical Random Position Horizontal 10 Horizontal 15 Vertical 10 Vertical 15 Horizontal Random Position and Time Horizontal Random Direct Recording Light target moving randomly each 1 25 seconds over a 34 arc Light target moving randomly each 1 25 seconds over a 34 arc Light target moving 10 degrees right or left of center each 1 25 seconds Light target moving 15 degrees right or left of center each 1 25 seconds Light target moving 10 degrees up or down from center each 1 25 seconds Light target moving 15 degrees up or down from center each 1 25 seconds Target moved at random intervals to random positions Light target moving randomly each 1 25 seconds over a 34 arc Note uses special montage VNG Tests Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Target Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical
252. tical Eye Position ceiling without vision Head Right Patient supine with head turned 90 to Horizontal Eye Position Vertical Eye Position right Head Right w Vision Patient supine with head turned 90 to Horizontal Eye Position Vertical Eye Position right with vision Head Right w o Patient supine with head turned 90 to Horizontal Eye Position Vertical Eye Position Vision right without vision Head Left Patient supine with head turned 90 to left Horizontal Eye Position Vertical Eye Position Head Left w Vision Patient supine with head turned 90 to left Horizontal Eye Position Vertical Eye Position with vision Head Left w o Vision Patient supine with head turned 90 to left Horizontal Eye Position Vertical Eye Position without vision Right Side Patient on his right side Horizontal Eye Position Vertical Eye Position Right Side w Vision Patient on his right side with vision Horizontal Eye Position Vertical Eye Position Right Side w o Patient on his right side without vision Horizontal Eye Position Vertical Eye Position Vision Head Hanging w Patient supine with head hanging with Horizontal Eye Position Vertical Eye Position Vision vision Head Hanging w o Patient supine with head hanging without Horizontal Eye Position Vertical Eye Position Vision vision 226 GN Otometrics Appendix B VNG Tests Table B 20 Procedure Spontaneous Both Eyes ICS Chartr 200 VNG ENG Operat
253. tient Demo 1 Normal YNG Analysis Window secs 65 to 85 Procedure Caloric Both Eyes Waveform Horizontal calibrated Protocol Right Ear Cool Cursor 75 seconds RW SPY 27 is at 82s Slope 71 LW SPY 26 s at 72s Beat SPY 27 6 sec RC SPY 29 s at 75s Fl 49 LC SPY 37 s at 76s Fl 27 Figure 6 8 Caloric peak values in Information Area ICS Chartr 200 VNG ENG Operator s Manual 117 Section 6 118 Reviewing Analyzing Test Results 10 During review several options are available 11 a Press F2 Reanalyze to clear the analysis and begin a new analysis for the selected test Press F3 Interpret Tests only available in PODS Butterfly views Press F4 SPV Graph to view the caloric summary screen display only available for caloric tests horizontal channel Press F5 Locate Peak to have the computer calculate and move to the area of the greatest average SPV Click on a different SPV measurement and press F6 Set Peak to set the peak to the current beat under the vertical cursor Press F8 Insert or F7 Delete to add or remove beats from the analysis Press F8 Insert to insert a beat measurement on the bottom chart or to insert the new SPV value after altering the slope of a beat The Number of beats number in the Information Area increases each time a beat is inserted if adding a new beat and decreases when F7 Delete is used to delete a beat Press F10 Previous Beat or F11 Next Beat to move betwe
254. tient records in the archive export database 3 Select the desired patient record s to be imported Click OK to import the patient record s To import patient records into Chartr 200 systems 1 Select Database Import Patients from Database 2 Select the database mdb and click Open A prompt operator specific information will not be imported displays Click OK 3 Highlight all patients select the top case on the list hold the Shift key and left click on the bottom case and click Import 4 Click OK Importing may take a few minutes if there are video files 180 GN Otometrics Section 8 Exporting Importing and Archiving Records 8 5 Archiving an Entire Database The ICS VNG system includes an archiving option that allows the operator to archive all of the patient records in the main database The archived records can be re imported easily Note Operator referring physician and other non patient records are archived with the patient records and are also maintained to the new empty main database Typical reasons for archiving records include System Requirements When the storage capacity of the database is filled system resources are impacted This affects the ability of the system to successfully conduct review and analyze tests Periodic Storage Some facilities may want to schedule archives of patient records on a regular basis for example archiving monthly quarterly or annually There
255. tinct slow phases and fast phases could not be identified Therefore some sections appear without measured beats If the algorithm finds no beats in an entire tracing it places a beat of zero degrees per second at a time of one second to indicate zero velocity for that test Sometimes in tracings a few artifacts will be measured If these are not overridden or deleted the analysis may be incorrect 120 GN Otometrics Section 6 Reviewing Analyzing Test Results Caloric test results can be shown in PODS Butterfly views Press F4 PODS Butterfly to display the caloric results Y RightCool Peak SPV 29 degis A LeftWam Peak SPV 27 degis 80 80 60 60 40 0 s s ort F Baga Rol Ma v 20 wn v 20 Ae attasnas E o Ta E o 1 x to G a ka G ree F M ai f Soret a vo 20 A atna typa 20 Tor z 4 T 3 EE m T 40 40 604 60 80 80 A Right Warm Peak SPV 27_degis __LettCool Peak SPV 39 degis O 20 40 60 80 4100 120 140 o 20 40 60 80 100 120 140 seconds seconds Caloric Analysis Velocity Graph ysi 80 acre eo Patient Demo 1 Normal YNG Procedure Caloric Both Eyes Press F3 for Interpreter TotR 56 degis Peak SPV Om omo lt 20 Oz 4eme 420 2 TotL 66 deg s SPY s FI A Z RC 29 42 Ea i UW 8 in the right ear Lc 39 26 E BS 0 deg s Rw 27 T a laa a GA 8 to the right LW 27 E T N 6 Right Ear Left Ear
256. tions Dperator Settings Test Battery Workstation Settings Peak Frequency GDT Interface Operator Defaut OPetor Specie Settings Selings M Require Calibration Before Colection I Certe TracingsEvey 30 Sec lencept gaze saccade Settings Shared by all Operators Beats Averagedin Peak SPY Cae 3 E H 3 10 I Display Lightbar Center Fixation Light Lightbar Brightness I Automatic Save re IV Enable Distance Ranger Medium x I Automatic Analysis I Show Averaged Saccade Tracking Values secs I Automatic Analysis Display Caloric Tests Only F Automatic Wavelom Fiering T Automatic Fixation Light On Off secs On 99 or 100 Manimum Saccade Latency 600 x I Show Directional Preponderance T Omit GN Logo from Printed Report I Show Right Ear Data in Red Test Battery Available test protocols Selected test protocols Insert gt gt lt lt Remove Remove All Default Battery Print Battery Cancel Help Figure 4 2 System Options Operator Settings Test Battery Tab GN Otometrics Section 4 Operator Setup and System Options Select an existing operator Settings Shared by All Operators Beats Averaged in Peak SPV Calc 3 10 Select the number of SPV beats to be averaged in SPV to calculate slow phase peak velocity Choose from the list of available choices 3 through 10 beats Automatic Save Select to have the data automatically sav
257. ts of the Main Window are Title bar Lists program patient and operator information Menu bar Lists available menus by category Toolbar Contains shortcut buttons New Test Review tabs Toggle between testing and review modes New Review Test List Displays test procedures available New Test tab or performed Review tab Test Review workspace Displays test data for the selected protocol The name of the procedure displays directly above this workspace Information area Announces current status or testing information 20 GN Otometrics Section 2 Getting Started in VNG Text comments Provides space for entering up to two lines of text associated with the selected protocol Eye viewing area Displays left and or right eye images during testing Function keys Activates VNG ENG patient testing and analysis activities The available function keys vary by activity Status bar Displays on screen prompts Note The procedures for conducting tests and analyzing test results begin in Section 5 of this manual ICS Chartr 200 VNG ENG Operator s Manual 21 Section 2 2 2 1 New Test Tab Click the New Test tab to display a list of test procedures and protocols from the operator s test battery in the New Review Test List of the Main Window 22 New Test tab New Test Review Saccade Both Eyes Horizontal Random Position Saccade Individual Eyes Gaze Both Eyes Gaze Individual Eyes Tracking Both Eyes Tracking Ind
258. tude Gain 218 uVNO dog Offset 0 00 deg re e Sherk Up 8 a f rio Dom f Ose Penan ostabere arr mdb Figure 6 28 Saccade Analysis Displaying Raw and Averaged Values 6 During the analysis a number of options are available a Press F2 Reanalyze to reanalyze the test after making adjustments to the data b Press F3 Delete Saccade to remove the outlined saccade c Press F4 Left Right Eye Gain to display the calibration gain for each eye in the Information Area this applies to individual eye tests only d Press F5 Enlarge and F6 Shrink to adjust the gain of the tracing in relation to the target In effect this adjusts calibration and changes peak velocity and accuracy values e Press F7 Up and F8 Down to move the tracing up or down Section 6 Reviewing Analyzing Test Results f Press F9 Cancel to end the analysis session for the selected test without saving the results Press F10 Previous Saccade and F11 Next Saccade to move from one saccade to another If an individual saccade test protocol is selected click on the Latency Accuracy and Peak Velocity Tabs on the lower chart to display these analyses separately for the right and left eyes this applies to individual eye tests only Latency Accuracy Peak Velocity soo ight 422 Left 328 a i 3 N 0 ozoomo omm omo n ozoomo omm omo ps t
259. tworked systems Section 7 Working With Reports 7 7 2 Report Page Setup Dialog Box The Report Page Setup dialog box is used to establish a template which determines the placement of each protocol s results on a report page The operator places the protocols and signals into the various text boxes Report Page Setup Position Both Eyes Horizontal Vertical Sitting w Vision Sitting w o Vision Supine Supine w Vision Supine w o Vision Head Right Head Right w Vision Head Right w o Vision Head Left Head Left w Vision Head Left w o Vision Right Side Right Side w Vision Right Side w o Vision Left Side Left Side w Vision Left Side w o Vision Other Other w Vision Other w o Vision Head Hanging Medtech ed a Select gt lt Deselect Sitting w Vision Supine w Vision _ Horizontal Horizontal New Page Clear Page Sitting w o Vision Supine w o Vision Defaults Horizontal Horizontal Head Right w Vision Head Left w Vision Horizontal Horizontal Head Right w o Vision Head Left w o Vision Horizontal Horizontal Page 1 of 1 Figure 7 18 Report Page Setup procedure name Dialog Box Note Saccades tracking and caloric tests use report pages are fixed by GN Otometrics The operator cannot define report setup for these procedures Procedure D
260. uction to the VNG System 1 2 Installing Reinstalling ICS Chartr 200 VNG ENG Software 1 2 1 Installing ICS Chartr 200 VNG ENG Software Use the following procedure if you need to reinstall the ICS Chartr 200 VNG ENG software To install ICS VNG software 1 Access the Windows desktop 2 Insert the ICS Chartr 200 VNG ENG CD ROM in the CD ROM drive of the PC The installation program will automatically start up Go to step 5 If the installation program does not start in approximately 30 seconds go to Steps 3 and 4 3 Click the Start button at the bottom left corner of the screen and select Run to display the Run dialog box Type the name of a program folder or document and Windows will open it for you Open D Setup ba Cancel Browse Figure 1 1 Run Dialog Box for ICS VNG ENG Installation 4 Type D Setup where D the CD ROM drive in the space provided as shown in Figure 1 1 and click OK 5 Follow the on screen instructions 2 GN Otometrics Section 1 Introduction to the VNG System a Welcome Introduces the Install program Read the instructions and click Next to continue Welcome Welcome to ICS CHARTR 200 ENG VNG Setup B program This program will install ICS CHARTR 200 ENGANG on your computer It is strongly recommended that you exit all Windows programs before running this Setup Program Click Cancel to quit Setup and close any programs you have running Click Next to continue with
261. vailable only during caloric tests to turn on the Fixation Light and place a fixation index FI label on the tracing available during caloric tests when using the VG 40 goggles Note 1 You may also use the Fixation button on the remote control ICS Chartr 200 systems to place a fixation index FI label on the tracing Note 2 This fixation light function is only enabled during caloric tests when using the VG 40 goggles and an ICS Chartr 200 system f Press F7 Hide Wave or F8 Show Wave to hide or show the selected wave during the test g Press F10 Overlap Waves or F11 Spread Waves to overlap or spread the waves Click on a waveform handle and hold the left mouse button down to drag a waveform up or down directly on the tracing h Press F9 Cancel to stop data collection or when stopped exit the test mode without saving the test data i Press F12 Stop to stop data collection and display the tracing 5 Press F12 Save to save the test data and advance to the next protocol 6 Repeat Steps 3 through 5 of this procedure for each protocol test in the Test Battery ICS Chartr 200 VNG ENG Operator s Manual 99 Section 5 Test Preparation and Data Collection 5 9 Recording a Video Image ICS VNG records eye movement video for each test and saves the recording with the patient record A small camera icon amp next to a patient name in the Patient Selection dialog or protocol in the Review tab indicates the existence of a
262. ve the cursor from one text box to the next and from one button to the next Press Shift Tab to move the cursor to the previous text box 3 Place the cursor in the First Name text box and type the first name of the patient Last and First Names Birthdate and Gender are required The other items are optional 4 Continue moving from one text box to the next until all of the patient information requested or available is entered 5 Click the Operator drop down list arrow to display a list of available operators Select the operator who will be conducting the test Note 1 See Section 3 4 2 Establishing a New Operator for additional information Note 2 Default Operator can be used if no operator specific options are to be established 6 Click the Physician s Order tab to display the Physician s Order dialog box 7 Click the Referring Physician drop down arrow to display a list of available physicians and select the desired physician Note Ifthe physician is not listed click the Referring Physician Info button to access the Physician Information dialog box See Section 3 2 2 Establishing a New Physician for additional information 8 Click the Referring Facility drop down arrow to display a list of available facilities and select the desired facility Note Ifthe facility is not listed press the Referring Facility Info button to access the Referring Facility Information dialog box See Section 3 3 2 Establishing a New
263. vertical axis Table B 17 Procedure Rotary Swing Both Eyes 200 Passive rotation with 200 peak to peak Horizontal Eye Position Vertical Eye Position excursion 224 GN Otometrics Appendix B Table B 18 Procedure Dix Hallpike Individual Eyes Head Right Head Left Head Right Up Head Left Up Head Right Repeat Head Left Repeat Head Right Up Repeat Head Left Up Repeat Rapid movement of the patient from sitting with head turned right to supine head hanging turned right Rapid movement of the patient from sitting with head turned left to supine head hanging turned left Rapid movement of the patient from head hanging right to sitting position Rapid movement of the patient from head hanging left to sitting position Rapid movement of the patient from sitting with head turned right to supine head hanging turned right Rapid movement of the patient from sitting with head turned left to supine head hanging turned left Rapid movement of the patient from head hanging right to sitting position Rapid movement of the patient from head hanging left to sitting position ICS Chartr 200 VNG ENG Operator s Manual VNG Tests Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position Vertical Left Eye Position Torsional Right Eye Position Torsional Left Eye Position Horizontal Right Eye Position Horizontal Left Eye Position Vertical Right Eye Position
264. waveforms in time It also saves the position and the configuration of the waveforms hidden or shown and the position of the waveform handle A filtering option F7 Filter Unfilter is available During data collection displays show unfiltered data If the Automatic Filter option is selected in the System Options Operator Settings Test Battery tab dialog box the system displays filtered data as the Review mode default Using F7 the operator can toggle between filtered and unfiltered views This function is only for review of the unanalyzed tracings as the analysis incorporates automatic filtering that is not under the control of the operator Note Procedures for analyzing the major test types slow phase velocity saccades and tracking are found later in this section Physician Order Date The Physician s Order date is the date assigned by the system the first time a patient is tested Multiple tests sessions may be recorded under one Physician Order date The Physician s Order date will remain in effect for a patient record until the Operator sets up a new Physician Order Technically a new Physician Order should be started for a patient record each time that patient is referred for testing Monocular VNG Review Test Tab When the Review Test tab is active the review workspace waveform display will be labeled with the eye that was used to collect the data for the selected test Each protocol in the review test tab is labeled with
265. with the pupils and cause the crosshairs to jump between areas This will result in noisy data Have patients remove their makeup White eyeliner pencil See above Have patients cover any permanent makeup like tattooed eyeliner with white eyeliner pencil Eyelash curler Thick long eyelashes can obscure pupil movements leading to noisy data and or flat line responses Curl eyelashes up To position the goggles 1 Loosen the back and top head straps on the goggles 2 Make sure the mirror is clean If needed clean with the VG 40 optical cleaning cloth 3 Click on Video Adjust or press F7 to monitor the placement onscreen 4 Hold the goggle with one hand taking the back head strap in the other hand Take care not to touch the mirror Place the goggles on the bridge of the patient s nose ensuring the patient can still breathe 5 Pull the back head strap over the back of the patient s head below the inion bump on lower part of the back of the skull 6 Move the goggles on the patient s head to center and level the pupils Use the video adjust window to verify that the pupils are inside the boxes as close to center as possible Both pupils should be in the same horizontal plane 7 Tighten the back strap until the goggles are snugly attached to the head The goggles should not be painful but you may see a red mark from the face cushion after removal A snug goggle placement is necessary to ensure that the goggles do
266. word processing application GN Otometrics Appendix C Customizing the Word Processor Report 6 Locate and double click the vngtemplate_ENU rtf for English file to open the file in a word processing program Warning DO NOT change any of the brackets lt gt or the information in the brackets It must remain exactly as written in order to retrieve information from the database You may however delete these items change the font and paragraph characteristics or change their placement on the page 7 Make changes to the font selection and size as desired Make changes to the paragraph appearance as desired 8 Make changes to the placement of data on the page as desired Notes A logo can be added to the template Insert the logo into the template and move it to the desired location The logo should be smaller than 500 KB Use the font icon on the Toolbar to change the font used for the report 9 Save the changes made to file vngtemplate_ENU rtf for English and save the file as Rich Text Format rtf Any other format will not work with the Chartr VNG ENG software 10 Close the file and exit the word processing program Special Note regarding Interpretation Assistant Caloric Test Word Processor Reports In order to generate a caloric test word processor report via the Caloric Test Interpretation Assistant a new token lt IA_RESULTS gt must be added to the engtemplate rtf file on your system If this token in not listed
267. ysis Use the Adjust menu to modify the displayed waveform The description of the action of each item and its function key equivalent is shown below Enlarge Shrink Up Down Figure 2 15 Signal Menu Enlarge Increase the size of the waveform Shrink Decrease the size of the waveform Up Move the waveform up on the grid Down Move the waveform down on the grid 2 3 10 Interpreter Menu The Interpreter Menu is available only for caloric and position tests For caloric tests this menu is available in the SPV Pods dialog For position tests this menu is available in the SPV Initial and SPV Measurement dialogs The Interpreter Menu activates the Interpretation Assistant feature which validates and analyzes caloric test results See Section 6 8 for information on using the Interpretation Assistant Interpreter Cutoff values Interpret Tests Figure 2 16 Interpreter Menu Cutoff Values Display the Cutoff Values dialog to select values for parameters used by the Interpretation Assistant Interpret Tests Interpret the test results ICS Chartr 200 VNG ENG Operator s Manual 35 Section 2 Getting Started in VNG 2 3 11 Help Menu The Help menu can be accessed by clicking on Help on the Menu Bar or by selecting F1 Help using the mouse or the keyboard Contents About Figure 2 17 Help Menu Contents Opens the Operator s Manual About Display the About ICS Chartr VNG dialog box e g software version 2 4 Function

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