Stethoscope App Manual 1.0
Contents
1. To continue recording press Record Stethoscope adds a short silent gap the continues recording Consider Trimming the recording before continuing to delete unwanted segments however be careful not to trim desired sound S amp Thinklabs Medical LLC 2010 Page 14 Support Thinklabs offers support for all our products via our website http thinklabsmedical com gt Apps thinklabsmedical com 800 918 1088 4 303 220 9882 Please contact us with any product support questions We try to respond to emails within a few hours and email therefore provides the quickest response You may also call us at 800 918 1088 Address and Contact Thinklabs Medical LLC 6571 South Pontiac Court Centennial CO 80111 USA S amp Thinklabs Medical LLC 2010 Page 15 Data Security Stethoscope generates data that is time stamped only Users may add identifying personal information to recorded data The safety and confidentiality of this data and compliance with any applicable privacy laws is the sole responsibility of the user of Stethoscope App Guidelines In general the iPod iPhone is a much more closed system than the typical computer system This does provide a certain degree of data security compared to personal computers However mobile devices can be lost or stolen and the user should take appropriate steps to protect data and devices Any Saved files are backed up to any computer used to sync the iPhone Tou2. buttons allow you to pick an email address from your contacts The emails sent by Stethoscope App include a wav formatted sound file which can be opened played on any computer or music device and several graphs in png format which makes them simple to print and share You can edit the notes and other data in the email You can also delete unneeded graphs or photos prior to sending Graphs The graphs attached to emails are labeled in 0 1 Second intervals with the time 0 0 seconds corresponding to the start of the sound wav file The first graph in the email always shows the screen view zoom level when the email was sent Use this feature to select a view that clearly shows the most relevant segment of the recording before sending your email S amp Thinklabs Medical LLC 2010 Page 9 Graphs are labeled in the upper left corner showing date time along with the left to right width of the graph in Seconds File names are shown for any saved files Graphs have distinct regions for waveforms and spectrograms frequency content On the iPhone Touch display these are shown overlaid in the same screen area but with the added space on a printed report the regions are separated Note that graphs are attached to emails in a form ready to print with a white background rather than the dark background on the screen version The purpose is to facilitate economical printing Sound Data Waveform Phonocardi
3. Audio Source will be recorded with real time display Stethoscope iPod Touch screen will be black unless an external mic audio source is connected 4 Stop Pause Review Tap screen anywhere to Stop Pause Recording gt Play loops display segment Continue Recording HIGH AUDIO PLAYBACK QUALITY REQUIRES GOOD SEALED HEADPHONES 5 Save Email Menus provide options for Saving or Emailing Recordings B ei Send Email Send Email Cancel Cancel S ra Thinklabs Medical LLC 2010 Page 3 Instructions for Use Setup 1 Purchasing Downloading Stethoscope App Purchase Stethoscope App from the Apple App Store Go to http www itunes com app TBD and search for Thinklabs You can install the App on any iPhone or iPod Touch 2G using OS 3 1 or later For general information on downloading apps see Downloading Apps Once you have downloaded Stethoscope App you will see Stethoscope S App s icon right on your iPhone Touch screen There can be multiple a screens of apps on your device Scroll Home screens to find the App if necessary Stethoscope 2 Hardware stethoscope and audio input accessory You can test the App without a stethoscope or other hardware to familiarize yourself with the controls When a stethoscope is not connected the App simply accepts input from the default audio source such as built in mic on the iPhone On the iPod Touch the recording screen will be
4. amp Thinklabs Stethoscope App 1 0 for iPod Touch and iPhone Raising the Power of the Stethoscope Thinklabs and Thinklabs logo are Registered Trademarks of Thinklabs Medical LLC Apple iPhone and iPod Touch are Registered Trademarks of Apple Inc Thinklabs Medical LLC 2010 iS1 0 pdf Contents Quick Start If you never read manuals 3 Instructions for Use 4 Setup 4 Using Stethoscope App 5 Action Menu 6 Edit Menu 6 Sound Display What the waveforms show 6 Recording Tips 7 Saving and Opening Files 8 Emailing 9 Using Email 9 Graphs 9 Sound Data Waveform Phonocardiogram RMS Power 10 Spectrogram Power Spectrum 11 Adding Photos 13 General Tips and Tricks 14 Support 15 Address and Contact 15 Data Security 16 Electrical Safety 17 Disclaimer 17 S amp Thinklabs Medical LLC 2010 Page 2 Quick Start If you never read manuals Stethoscope App is extremely intuitive to use Nevertheless it has many features and we recommend that you read this Manual to learn the full power of the App However we know you like to get started immediately so here is a very quick introduction for those who are very familiar with iPhone iPod Touch S 1 Install Download Stethoscope App to your iPhone Touch a Stethoscope 2 Audio Source use either default input mic on iPhone none on Touch external mic or connect a stethoscope via an accessory compatible with iPhone iPod Touch S 3 Record Tap a and default
5. blank but when you touch the screen to stop recording the controls and menus will appear normally and you can navigate the App To listen to heart sounds breath sounds and other body sounds use a compatible electronic stethoscope The Ihinklabs ds32a Digital Stethoscope in conjunction with an audio input accessory compatible with the iPhone Touch will provide excellent results Simply connect the audio input accessory to the iPhone Touch and connect a stethoscope to the input on the accessory using the cable supplied with your stethoscope Note that not all electronic stethoscopes have the required output to use Stethoscope App Thinklabs ds32a Digital Stethoscope Please contact us for more information and we can assist you in getting the best solution for your needs 3 Playback Connect high quality sealed eartip headphones or suitable stethoscope to the headphone jack for proper reproduction of body sounds Open style headphones or loudspeakers are inadequate for such low frequency sounds S ra Thinklabs Medical LLC 2010 Page 4 Using Stethoscope App S 1 Start Recording TAP G to launch Stethoscope App and Start Recording Stethoscope The launch screen right will appear briefly followed by a real time display of the recording waveform You are now recording The App will capture the previous 20 seconds of sound If recording accessory is not connected to the iPod Touch a black screen will Thinklabs appea
6. You can set up default Email addresses and note text emails Since each email has a default title of the current date and time these preferences can speed up email use See Action gt Email Settings Add photos to any recording This allows you to document the recording by taking a picture of the subject or by taking a picture of paperwork etc Edit gt Add Photo iPhone only e Stethoscope App includes a number of Reference sounds open these with the Action menu When you Open a file any existing recording that is not saved is discarded e To start over simply quit Stethoscope App and relaunch it You can also swipe to the start of the sound and press Record e Emails and saved files use the screen as shown on the screen to generate a phonocardiogram for emailing so zoom to a definitive view before you Save or Email e The default email includes 2 3 phonocardiograms You can increase this to show up to 5 images see Email Settings e RMS power The default display of Stethoscope App includes a simple plot of the sound Amplitude vs Time By selecting RMS power in Settings Stethoscope App will show Power vs Time This can often be more useful when trying to spot subtle details Trimming Recordings After recording there will sometimes be some unwanted segment of the recording Simply Pinch and Drag the display to show a desired segment then Edit gt Trim to Displayed to remove anything not displayed
7. being displayed on the screen S amp Thinklabs Medical LLC 2010 Page 7 Saving and Opening Files After recording you can save the sound and images into a file stored on the iPhone Touch You can then Open and review or email saved files You email a saved sound by simply opening it then emailing it S4 Fourth Heart Sound overwritten and enter notes To save a file use the Action menu and select Save File A dialog appears allowing you to name the file a date based name is automatically filled in but is easily Notes S4 occurs just prior to S1 clearly i audible as 2 sounds S4 quickly The file is saved so that later opening it will bring you back to followed by S1 the file exactly as you saved it You can save as many files as you like however it is recommended that you email files To open a file for viewing tap gt Open File or Open Reference Open File allows you to open a file that you saved while opening a Reference File allows you to open files that are included with Stethoscope App You can delete saved files from your iPod with the Edit button at the top right of the Open File screen Deleted files cannot be recovered The small icon pictures next to the descriptions are based on Stethoscope s screen at the time you saved the file Any notes you add to a saved file will be included in emails sent of the saved file Saved files are backed up when s
8. ch Thus if identifying data is entered and saved with Stethoscope App care must be taken to ensure the reliability and security of both the iPod iPhone AND any computer to which it connects Emails are sent by Stethoscope App using the standard email system on the iPhone Touch This system can and should be set up to use security such as SSL to transmit email to a trusted email server Emails that have been generated by Stethoscope App but not yet sent will remain on the iPhone Touch until they are sent In addition copies of sent emails are often kept in various sent folders on various systems iPhones and iPods have various security features such as remote wipe the ability to instruct a lost iPhone to erase all data user passcodes so that unwanted users cannot use an iPhone Touch and various encryption services The iPhone 3Gs encrypts all data on the phone at all times However in many cases it is the user s responsibility to activate many of the features For additional information please see the PDF available from Apple iPhone Security Overview S ral Thinklabs Medical LLC 2010 Page 16 Electrical Safety When capturing sounds ensure that all equipment is electrically floating i e disconnected from any mains powered power supplies Disclaimer Thinklabs Stethoscope App is intended for information gathering purposes only The software is provided on an as is basis Stethoscope App includes no diagnostic algo
9. ls and yellow orange red show increasing levels of signal energy In the plot below the low frequency energy is greatest during S1 and S2 If additional sounds such as S3 or S4 are present one would expect to see evidence of low frequency energy at times other than S1 and S2 See plot next page The plot below shows a normal heart 10 year old followed by a condition known as Pericarditis 2009 11 13 18 56 21 L to R 2 0 s Hz 0 5s 1 0s 1 5s Pericarditis friction rub L to R 2 0 s Ad IN an Wht M i W i l IMP I Mu ii a i M R i nn I i AM ll ivi Lt h id Thinklabs Medical LLC 2010 Page 11 The difference between these two heart sounds is striking Looking at the Power spectrum the upper portion of the two graphs notice that the normal heart sound has well defined lower frequency S1 and S2 components The rubbing sound of Pericarditis shows more high frequency components Review the included Reference sounds to further improve your understanding of Spectrograms and heart sounds Another way to understand the power spectrum is to run Stethoscope App without a stethoscope attached and play a few notes on a piano Middle C is 244 Hz and playing that note will result in a distinct band across the middle of the power spectrum Alternatively vocalize tones f
10. ogram RMS Power The green turquoise colored plot on the screen can show either the time domain waveform phonocardiogram of sound Amplitude vs Time or RMS Power vs Time Normal mode Amplitude vs Time Phonocardiogram In Normal mode RMS off in the Settings Stethoscope App shows a line graph of the sound signal as recorded over time This is the typical display of phonocardiograms seen in textbooks RMS Power mode In RMS mode RMS on in the Settings Stethoscope App shows the instantaneous signal power This setting can potentially produce easier to read graphs as extraneous information tends to be suppressed by power signals The RMS power more closely approximates what you actually hear the rise and fall of sound intensity The graphs show the same sound in each mode Normal left RMS Power right Congestive Heart Failure S3 L to R 1 2 s 5s 5 0s S G Thinklabs Medical LLC 2010 Page 10 Spectrogram Power Spectrum The Power Spectrum Spectrogram is shown below Spectrograms show both the Frequency tone of a sound and the Power Intensity of the sound Frequency is shown on the vertical axis to the right of the plot the higher the tone the higher the bright color will be on the plot In the example below the frequencies of S1 and S2 are extremely low as expected The Power Intensity of the various frequencies is shown by color spectrum purple blue represents lower energy leve
11. ording Then TAP the screen to STOP recording e Recording continues indefinitely but Stethoscope App only saves the last 20 seconds To continue recording press Record Stethoscope adds a short silent gap the continues recording Consider Trimming the recording before continuing to delete unwanted segments however be careful not to trim desired sound e Listen to your recording by connecting a ds32a Stethoscope or high quality sealed headphones into the headphone jack on your iPhone Touch Stethoscope App always loops through what you have on the screen so Zoom to listen to one segment repeatedly or expand the display with a Double Tap to hear the entire recording If you are looking at a Saved or Reference file and press Record Stethoscope App starts from scratch and makes a new recording e While recording Stethoscope App always shows a 4 second wide window After recording zoom into the phonocardiogram using multi touch gestures See Page 5 e Trimming Recording After recording you may have unwanted segments such as a a noisy start as you were adjusting the stethoscope etc At the end of the recording there might be a small segment of noise as you remove the stethoscope Tap to stop recording To Trim the recording Zoom to show the desired segment of sound and select Edit gt Trim to Desired Any non displayed parts of the recording will be deleted Time Display The top left corner always show the scale of time
12. r with no sound recording 2 Stop Pause Recording TAP the screen to Stop Pause Recording The screen below will appear and you can now Manage your Recording 3 Manage Your Recording The Figure below provides a Quick Reference of Stethoscope App s features Explore menus and functions especially MULTI TOUCH Controls Refer to later sections for further details l Annotation Flags Action Menu e ienr Time scale Manage Recordings _ rim Recording Add Drag and place Conti screen width Del Dran toto Save Email Add Photo ontinue ee p Preferences RECORD Loop po PLAY STOP TAP Anywhere AMPLITUDE ZOOM Amplitude Power vs Time PINCH Vertically Frequency Content MULTI TOUCH Control Time SCROLL TIME ZOOM TIME SCALE ZOOM ALL PREVIOUS DRAG FLICK Left Right PINCH Horizontally DOUBLE TAP S Anywhere S ra Thinklabs Medical LLC 2010 Page 5 Action Menu Send Email Send Email of sound plots and notes Opens a new Email attaches screen image and other waveform images png and attaches audio file wav Add notes to the email and Send Email must be set up on your iPhone Touch Email Settings Set up default settings for emails such as ap Send Email default recipients subject notes and which Send Email plots are attached Send Email then creates Email Settings emails with entries already set to save time Open File Open a previously Saved Recording Open File onl
13. rithms or diagnostic indications Using Stethoscope App for diagnostic purposes is entirely the responsibility of the end user Medical diagnosis should be done exclusively by qualified and licensed medical professionals only Thinklabs Stethoscope App is not intended to be a substitute for professional advice and may not be used by for medical diagnosis Extensive effort has been exerted to make this software as accurate as possible This software is to be used as a guide only and healthcare professionals should use sound clinical judgement and individualize therapy to each specific patient care situation The authors make no claims whatsoever expressed or implied as to the authenticity accuracy reliability completeness or timeliness of the material software text graphics and links given INNO EVENT SHALL THE AUTHORS BE LIABLE TO ANY PARTY FOR DIRECT INDIRECT SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES INCLUDING LOST PROFITS ARISING OUT OF THE USE OF THIS SOFTWARE AND ITS DOCUMENTATION EVEN IF THE AUTHORS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGE THE AUTHORS SPECIFICALLY DISCLAIM ANY WARRANTIES INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE THE SOFTWARE PROVIDED HEREUNDER IS ON AN AS IS BASIS AND THE AUTHORS HAVE NO OBLIGATIONS TO PROVIDE MAINTENANCE SUPPORT UPDATES ENHANCEMENTS OR MODIFICATIONS S amp Thinklabs Medical LLC 2010 Page 17
14. rom very low to very high and watch the bright regions change position from lower down on the screen to further up higher frequency 2009 11 27 12 37 28 L to R 2 0 s ah N s1 S2 Emails include graphics ready for printing Here an S4 sound is clearly seen before S1 and is flagged Thinklabs Medical LLC 2010 Page 12 Adding Photos You can add a few photos to a Recording to more completely document the case This allows you to take an image of the subject or perhaps a related document iPhone only Added photos cannot be edited or deleted however you can delete any email attachment prior to sending Photos are saved with the file when you save a file for later use PN Thinklabs Medical LLC 2010 Trim to Displayed Add Photo Cancel Page 13 General Tips and Tricks This list highlights quick and efficient ways to use Stethoscope App To Zoom Out to the full recording or Zoom In the previous zoom level Double Tap e Pinch and Swipe your fingers to explore the Recording e Add S1 S2 and Flag by Dragging them from the top of the screen e Delete Flags by Dragging them off the top of the screen e Listen to Recordings by connecting a suitable electronic stethoscope into the headphone jack and pressing Play gt Stethoscope App always loops through the sound shown on screen e Save recordings for later playback Add descriptive notes and titles
15. y appears when there are Saved files Save File Save the current Recording with Title and Notes Cancel Open Reference Open a Reference Recording files provided with Stethoscope App as example Recordings Edit Menu Trim to Displayed Cuts the Recording to only that portion which is currently on the screen Trim will remove any recording to the left of right of the currently displayed waveform Add Photo Starts the Camera App so a photograph can be iPhone only taken and added to an Email Settings Same as Email Settings above Help Stethoscope App Help information Cancel Sound Display What the waveforms show For an explanation of the waveforms and Spectrogram display of sounds please see the discussion on Pages 9 12 Time Waveform and Spectrogram are overlaid on the screen When reports are emailed Waveform and Spectrogram are plotted separately S ral Thinklabs Medical LLC 2010 Page 6 Recording Tips e When recording from the Thinklabs ds32a Digital Stethoscope make sure the ds32a iS powered on and you can hear the heart or other sounds you are targeting The stethoscope powers off automatically in 2 minutes This setting can be changed to up to 5 minutes See hitp www thinklabsmedical com gt Support gt Manuals e Hold the stethoscope probe steady on the chest making good skin contact when recording Listen and watch the display simultaneously until you have a few seconds of clean consistent rec
16. yncing the iPod on a desktop or laptop computer and limit the number of files saved on your iPhone Touch You can modify a previously saved file by opening it making changes and saving it with the identical filename 2009 11 16 11 35 06 PERU UDE Congestive Heart Failure S3 S4 Fourth Heart Sound Reference files can be opened viewed and played but not deleted e Thinklabs Medical LLC 2010 Page 8 Emailing Stethoscope App can email recordings effortlessly Emails automatically attach the wav sound file and images that are ready to print Using Email Email needs to be set up on the iPod iPhone Stethoscope App will not show the email items in the Action menu unless email has been set up on the iPhone Touch Launch the Mail application and follow the instructions Once email is set up you can use Stethoscope App to send emails Your iPod si fownneansoua Touch or iPhone does not have to be ina T hisce 725 2 GEED GUSTS WIFI or other wireless mode to use this em 51 clearly audible as 2 sounds S4 quickly followed by S1 feature unsent emails will be saved in your nos Outbox and sent when the device finds an i internet connection at some later time This allows you to use the email feature in locations with no wireless service You should set up the Email Settings with default email addresses and notes to save time if you always send emails to the same recipient s The
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