Braemar DL700 Operator's Manual

OPERATOR'S MANUAL Biomedical Systems Century Holter Analysis System C3000/C2000/C1000 Version 2.13 Revision Date: November 2008

10 1.0 Main Menu A few seconds after the Biomedical splash screen comes up, this typical Main Menu appears. At the top of the screen you will find a

100 12.7 Enhanced ST Analysis When you enter from the Main Trend screen through the tabs, you will be positioned at the current time in main trend.

101 12.7.1 ST Trend An enhanced ST event is a place in the recording with an abnormal ST event for the analyzed patient. ‘Abnormal’ in this context

102 12.7.3 Adjusting the ST Points in an Event The three enlarged beats above the ST events are 20 beat-averaged ECG beats of the start, maximum and e

103 12.7.4 Enhanced ST Options When you have many ST events on different channels, validating ST events can be difficult, since event one might be on

104 12.8 The QT Trends The QT Trend screen can be entered directly from the Main Menu or through the Select menu in trends. If you enter from the sel

105 12.8.1 The QT Histograms/ECG Tabs Below the trends is a Form with two tabs. The tabs allow a selection between ECG View and QT Histogram View. Cl

106 12.8.2 Validating and Editing QT Validating QT is done by searching the tape for possible invalid QT values while superimposing the QRS complex.

107 12.8.2.3 Editing QT Values Once the bad QT value is found, you can delete the beat from QT analysis or edit the QT measurements. Deleting means

108 12.8.3 QT Options Included Beats in Bins The QT bin defaults allow you to set the beats that are included in the QT bins. This allows inclusion o

109 12.9 12-Lead View True 12 lead view is available when working with a true 12 lead recorder. When analysing from a true 12 lead recorder you can

11

110 If you are using a 3 channel recorder the 12-lead screen is still acessible but here the scanner assumes that you placed the electrodes using an o

111 13.0 PROFILES Profiles are used to customize different aspects of the scanner. All profiles are presented in one dialog with several tabulated f

112 13.2 Analysis Profile The analysis profile sets up the scanner for analysis . The Scan Parameters Screen is accessible as part of the scan profil

113 Fast VT Rate (bpm) This value affects the run length table only. Here VT runs are split in slow and fast VT runs. By default fast VT runs have a

114 Sets the VE Dead Time, which is the period after the beat where detection of a VE beat is off. Default: 0.3 seconds R on T sensitivity (ms) Thi

115 13.2.4 Auto-Save Strip Options Here you can define how many strips that the scanner needs to save automatically. 13.3 User Profile The user prof

116 13.3.2 Display Preferences Most of the options here are also available in the menu sections in Trends. The options displayed will always override

117 13.4 The recorder profile The recorder profile is used to assign physical recorders and locations to a single button. Unlike all the other profile

118 To assign a new button, set button placement on a free position and then select a profile from the selected profile dropdown. Let us assign a VX3

119 When clicking on the ‘Set Fields’ button, you can specify which of the available information needs to be passed to the demographic info. Which fi

12 You now have the option to: - Check-out a previously analyzed patient using the current patient list box. - Check-out a previously analyzed patie

120 13.5 The account profile The account profile is useful when Holter analysis needs to be performed for different accounts with different needs. I

121 the patient file. In this case an extra file will be generated with 24 extra fields with 8 of them to be used for long fields with lengths up to 1

122 14.0 Exporting ASCII Data 14.1 ASCII Data Export The cover page and all tabular information can be output to an ASCII file so that other programs

123 Once generated, the current PDF file can be viewed from the main menu.

124 15.0 Admin Functions Admin functions can be setup through the configuration menu when you have administrator rights. This menu function will not b

125 Enables Time Outs: When the current user no longer uses the current program for a specified time, the system will be locked. A new log on is requi

126 15.2 Catalog Maintenance The catalog is a database that contains information about the patients that are available in the central patient director

127 15.3 Manage Users Here you can create different users for the system. A freshly installed system will not have any users defined, so if you want t

128 16.0 Changing the password Assuming you have the system setup for users/passwords with an admin user defined, a login screen will come up when you

129 APPENDIX A – Heart Rate Variability Heart Rate Variability measures the variability of the heart rate. It has been suggested that victims who sur

13 1.1.4 Patient demographics This button allows you to access the patient demographics. It is only accessible if a patient is checked out. 1.

130 take a bell curve shape. The narrower the bell curve, the less variability, while a broader curve signals more variability. Multiple bell curves

131 APPENDIX B – Paragraph Templates The new paragraph screen with support for templates has several additional buttons on the bottom of the screen.

132 Generating a paragraph template. Click on ‘create template’ to switch to edit mode. This will erase both edit boxes. The bottom box is the plac

133 After typing in the template you can save it by clicking on ‘Save template’ This will popup a dialog where the top lin

134 Note that the upper window still contains the default text and that items missing or incorrect in the bottom text are highlighted. Things that a

135 Here is an a more fully written template ‘Pace with no ST’

136 APPENDIX C – TRANSLATIONS - NON ANSI SUPPORT The C3000.ini and Maintext.ini the English text that is used in the program. By replacing this tex

14 2.0 Start Scan - Analyzing a new patient After clicking on the flashcard icon toolbar or selecting scan from the scan menu, you are entering the

15 2.2 Patient Demographics The Patient Demographics screen allows entry of pertinent patient information. Entries in these fields will appear on

16 Initially, the analysis date will be set to the current date. The user may edit this field. Recording Date Initially, the recording date will be

17 2.3 Downloading Holter Data How the download screen looks depends on the device you have selected, but in most cases you will get the screen bel

18 3.0 Analysis Setup Scanning begins with the program searching for a calibration pulse, searching for the most prevalent normal beat, and calibrati

19 If the system is unable to present a good averaged beat, the user can allowed to select a beat on the ECG strip as the choice for the normal beat

2 INDICATIONS FOR USE...8 CO

20 3.1.2 ST Setup The cursors on the averaged ECG complexes are used to set up ST: Click on the I button to change the Iso electric point on all th

21 3.1.4 Channel selection, inversion, gain Check boxes at the right side of each channel in the strip allow selection for: Arhythmia analysis ST a

22 The screen below is from a 12-lead recorder. If you are not using a 12-lead recorder, the screen will contain a warning message at the bottom an

23 3.1.9 Start the scan Click the Start Scan button to start scanning the tape. A pop-up will display the important settings selected. Before be

24 4.0 Analyzing 4.1 Main Analysis Screen (C3000 & C2000) The primary method of analysis on the Main Analysis screen is prospective superimposit

25 4.1.1 Counts/Arrhythmia Graph The Counts window displays the relevant counts of Normal beats and ectopic activity on the left side of the screen.

26 4.1.2 Templates Window The Templates window is the main editing tool while scanning. It allows review and editing of all templates and all of the

27 When you are reviewing templates, the program shows you the occurrence that was responsible for creating a new template (morphology). Generally th

28 4.1.3 Superimpose View This view superimposes (i.e., displays) one beat over another for validation by the operator. Normal beats are shown in Gr

29 4.1.4.1 Changing the analysis channel The Holter system allows you to independently select the channel(s) used to detect a QRS complex and the cha

3 4.1.4 CONTROLLING THE ANALYSIS...28 4.2 THE AN

30 Works as in single channel mode, no new templates are created, but beats are compared using the most stringent comparison criteria. Note: Try ArtF

31 4.2 The Analysis Options Screen Several parameters can be changed while scanning to optimize evaluation on difficult recordings. Select the Analys

32 4.2.5 Show ST Calipers Toggles the ST calipers on the Superimpose window. 4.2.6 Show QT Calipers Toggles the QT calipers on the Superimpose windo

33 4.2.18 R-on-T Sensitivity Influences the calculated value of the T-wave top position. After a Normal beat, detection of a new beat is only allow

34 4.2.24 The Arrhythmia Counts Menu and Stop Criteria The count menu provides detailed information on the current counts and allows you to program t

35 4.3 ST Screen (C3000 & C2000) The ST screen enables the user to correct the position of the ST points at any time during the scan process. You

36 4.4 QT Screen (C3000 & C2000) The QT Screen can be accessed at any time during analysis by selecting the QT button. It allows the user to valid

37 4.4.1 Measuring QT A Set of colored markers are drawn on the enlarged beat at all important points of the complex. To reposition any marker, selec

38 4.5 Diagnostic View (C3000 only) To go to Diagnostic View, click on the Diagnostic View tab from the Main Analysis screen. If you do this while be

39 4.5.1 Moving around in the Scan Home: The Home key returns to the scan position at the last beat scanned. Arrow buttons: Click on the arrow butto

4 5.1.1 SUPERIMPOSE TEMPLATES ...45 5.1.2 R

40 4.5.4 Inserting a Beat Low-amplitude VE’s that appear on the channel used for peak detection may not be classified. This is easily noticed during

41 4.5.5 Prospective Scanning For retrospective scanning all validation is completed after the Holter is scanned, such as in template editing or val

42 4.6 Page View (C3000 only) If you click the Page View tab, the view will change to page view. Page View displays three minutes of ECG on a single

43 4.6.1 Marking , relabeling a Block Single beats can be relabeled with the relabel window on the left side of your screen. To mark an episode of

44 5.0 Template Editing After the scan, the default profile will bring you in the template edit section of Trends. 5.1 Editing Templates Bins The

45 SVE Bin This bin was used in versions prior to v2.10 where it contained all single SVE occurrences. This bin is removed from template editing but

46 5.1.5 Aligning a Bin This function is only available using the keyboard. These functions adjust the r peak position of each occurrence in a bin, by

47 In the center of the screen, every beat in the selected template bin will be superimposed at high speed. You may stop at any time and use the lef

48 5.3 Review Occurrences Once you have entered this screen, press PgUp/PgDn to view 20 more beats. Use the Right/Left Arrow keys to select an event

49 5.4 Template Merging Template Merging can be done before or after editing templates. Merging templates reduces the number of template bins by merg

5 9.2 DEFINING THE REPORT PAGES ...74 9.3 CHAN

50 6.0 Validation After template editing the scanner may guide you to validation. The purpose of validation is to show all events in the Holter record

51 6.2 All example View The all example view shows all examples of the selected category with 12 examples per page. Deleted Examples show a small red

52 6.3 Single example View Single example view looks very much like a diagnostic strip and offers most of the editing possibilities also found in di

53 6.3.1 Measuring Measuring is activated by selection one of the interval ratio’s. This will bring up a set of calipers that allows the user to mak

54 If you choose to update the interval or heart rate, the corresponding property of the example will be updated. Note though that an example usually

55 6.3.3 Deleting versus re-labeling an example The single validation view has not only the possibility to delete an example, but also to relabel it,

56 7.0 Managing Strips 7.1 Saving Strips There is a universal save dialog that can be used from nearly every screen. This dialog allows saving strips

57 7.1.1 Saving strips from a marked block After selecting a block in page view the re-label box now shows a save strip button.

58 7.2 Viewing saved strips The view saved strip tab, which is both present during the scan and in trends collects all strips that are saved in diffe

59 7.2.2 Thumbnail view Strips can also be viewed as thumbnails by clicking on the thumbnail view button. As you move trough the strip list, the sel

6 12.8 THE QT TRENDS...104 12.8

60 7.3 Strip Types Diagnostic strip: 8, 16 or 24 second diagnostic strip. The saved strip has 16 extra seconds saved. (8 seconds before and 8 seconds

61 12 lead strips: These are 10 second strips saved from the 12 lead panel or the save dialog. The saved strips contain 10 sec data from all 12 channe

62 7.4 Adding a strip in view strips The last line of each strip list is always an empty line. It can be used to add a new strip manually. To do this,

63 The previewed strip is n’t taking his data from a saved strip, but from the raw data file. Notice ore bottom strip is coloured now. Currently shif

64 Once the strip is added it shows the requested 20 second format and a new line is added to the strip, ready for the next en

65 7.5 Working with saved strips Modifying: Nearly all cells in the strip list can be updated just by changing the values in the list. The strip is

66 8.0 Tables Once all edits are done, you may review the results of the analysis in the tables and verify the contents of the cover page. To do this

67 If you leave the table after a cell is edited, you will get a warning. If you answer Yes, the table changes will be kept even if

68 8.3 The tabular summary The cover page of your final report can be in tabular or paragraph format. From version v2.10 tabular format is partially

69 8.4 The Paragraph Summary This is a freeform summary that is generated from the contents of the tabular page. The paragraph page has two big windo

7 APPENDIX C - TRANSLATIONS – Non ANSI support ……………………………………………. 132

70 8.5 The physician comments Here the physician can add comments on the report. They will be added to the bottom of the cover page. Comments are to

71 8.6 Recalculate Tables Although tables are recalculated in the background frequently, you may need to explicitly request recalculating the tables.

72 9.0 Printing the report Although printing the report can be done from trends, it is recommended that you exit trends first to return to the main ce

73 The above header doesn’t have a logo by using the ‘No Logo’ selection for report logo. Above is the same header, but now using a small logo fil

74 9.2 Defining the report pages Here you can define which pages you want to print and how many copies you want to print of the cover page. 9.3 Chan

75 Full Disclosure Resolution: Full Disclosure at half resolution or printing at Max speed, is not supported by all printers, so if you use this optio

76 10.0 Patient Directory The cabinet icon on the toolbar or Patient Directory from the Main Menu will bring you in this screen. This screen shows a l

77 The delete button allows the deletion of all selected patient(s), a popup will come up so that you can precise which data needs to be deleted. This

78 10.1 Archive options Archive with Delete This removes the archived data from the central storage location if the archive copy was successful. Sel

79 11.0 Patient Archive Directory From the patient directory screen you can access the archive directory by clicking on the Patient Archive Tab. Th

8 PREFACE This manual provides operating instructions for the Century Holter Analysis System. It is designed for clinicians trained in Holter analysi

80 12.0 Trends Select the Trends icon from the Main Menu to access the retrospective analysis part of the Century Holter scanner. This screen shows u

81 12.2 Multi-Graph Display 12.2.1 Ectopic Trend Graph’s To see the Ectopic trend click on the Ectopic Trend radio button if this graph is not already

82 12.2.4 ECG and Arrhythmia strip At the bottom of the screen, part of the current minute’s ECG data is displayed. The beat at the center is the fi

83 The show saved strip option will show a vertical line on the main trend graph where the operator saved a strip. This gives you a good idea how many

84

85 A block of ECG data may also be relabeled. To do this, select the first beat in a block to be relabeled by clicking on it with the mouse, then rig

86 The Show saved strips option can also be set in this screen. Here, a different background color is given on the page location where a strip was sav

87 12.3.3 Changing the end of tape in Trends When the Holter recorder isn’t shut down BEFORE the Holter leads are removed, you may have a lot of arti

88 12.4 Diagnostic View The Diagnostic View in trends is similar to that in Analyze. The eight-second strip is displayed with a 30-second event strip

89 Go To Time will allow the user to position the ECG data at a specific time. Shift Beat will move the marked beat cursor forward or backward one be

9 CAUTION: Due to rapid changes in computer technology, the contents of this manual are subject to change without notice. Precautions The Century C30

90 Note the gray line on the arrhythmia graph marking the start of the block. The block is now marked and can be relabeled after anot

91 Zooming in/out In all diagnostic type screens ( screens with a grid as background), it is possible to change the screen resolution by hitting the

92 2.5 Search View Search view allows searching for multiple occurences of an ectopy. They will be displayed page by page with each page containing u

93 12.5.1 Notes on search 12.5.1.1 Start position of search By default, searching starts from the start of the tape but can also start from the cur

94 To see details on the small bins, you can increase the gain (or decrease the scale) in discrete steps, using a spin button control. Notice also th

95 12.6.1 Sequence filtering A very important new feature in v2.10 is to apply filters to the RR interval and the preceding interval. The intervals o

96 12.6.3 Relabeling a beat or bin(s) When you click on the re-label box or use one of the re-label shortcut keys, the following message will come

97 12.6.4 Editing RR bins Edit occurs selected bins brings editing capabilities to the RR bins, similar to those in template editing. The bins now a

98 12.6.5 Inserting and shifting beats Using the Edit/Add R-peak button it is possible to move the position of a beat or to insert a new beat.

99 After inserting the beats all intervals are correctly inserted. 12.6.7 Poincarre Graphs Just click on the ‘Graphs” button to view the patient’