eyecubed. QUICK REFERENCE GUIDE‘Terms used in this quick reference guide that are known, or suspected, to be trademarks are listed below. Use of a term in this quick reference guide should not be regarded as affecting the validity of any trademark or service mark. [ Every efor fas been made To eneure he formation nts quick reference gud Te accurate but the [formation tustretions, abies, drawings, and speciation are suet to change without notice ‘This quick reference guide provides information on the most commonly used functions of the Eye Cubed VS ultrasound imaging system. It is not intended to replace the user guide. Please read the User guide in its entirety before operating this product as it contains important safety, regulatory and operation information, Do not hesitate to contact the following, or your local distributor as appropriate, if you have any questions or encounter difficulties: 0086 AN |:) Manufactured By: Ellex inc. ‘9940 Business Park Drive Suite 165 ‘Sacramento CA 95827 USA Phone: #1-916-363 074 Fax: +1-916-363-3815 Head Office: Ellex Medical Pty Ltd 82 Gilbert Street Adelaide, SA 5000 AUSTRALIA Phone: +461-8-8104 5200 Fax: +61-8-8221 5645 Email eservice@ellex.com Website: wrww.ellex.com European Office: Ellex Services Europe SARL 108, avenue Manx Dormoy {63000 Clermont-Ferrand FRANCE Phone: 483 47.94 18.55 Fax: 433 473.93 21 98 This quick reference guide is Part No: QR 09-100, Rev B, © August 2008. It contains confidential and proprietary information of Ellex and may net be reproduced in whole or part without their written approvalChange Record ‘The change record for this manual is shown below. Refer to the ECO log for effective date: ie Exod ees |B 510 | ULuktuke ‘Addition of Biometry mode information A [418 B Blue | Updated the Power button images throughout 0 || Bue | Fvoanton of Becamecontents 1.0 i 2.0 System setup and admit 24 22 28 2.4 25 26 3.0 System controls. 48 46 47 48 49 4.10 Introduction. System description, 44a 1412 148 114 14.5 116 Posterior segment diagnostic B-scan mode (10 MHz) Anterior segment diagnostic 8-scan mode (20 MHz) Standardized equivalent diagnostic A-scan mode Biometry A-scan mode : Biometry manual vs. automatic freeze Avallable biometry measurement modes (eye types) ration .. Setting up the equipment Starting up the system. Logging on to the system Creating user accounts. Setting preferences Shutting down the system. Keyboard commands. Imaging controls. Caliper measurements. Patient data management. Recalling stored patients. Saving scans Printing scans. Performing 8-scan measurements. 444 Cross vector method 44.2 Cross hair caliper method Other functions and controls... Zooming and penning images Archiving patient data Restoring archived patient data, Exporting scans on the system Exporting selected scans on a specific patient. @pyrnnuid Noooua 8 12 18 18 16 16 16 18 18 16 16 16 a7 7 18 18 Eye Oubed quick reference guide4.11. Exporting individual scans or movies. 5.0 Performing scans 5.1 10MHz posterior B-scan. 5.2 B-scan probe posttion protocol 5.2.4 5.22 5.23 624 5.25 5.26 5.27 528 529 Position 1 Position 2. Position 8. Position 4... Position 5. : Additionallongitudinal scans Additional transverse scans - oblique ... Axial scans. Reference, 5.3. Biometry A-scan 6.34 Entering physician lens data... ‘OR 09-100, eve (¢€¢€¢ € € Mere eeeseraere mee eae ¢1 1 System description ‘The Eye Cubed™ version 3 is an advanced, microprocessor controlled, digital ophthalmic ultrasound instrument. Four distinct ultrasonic imaging modes are available, including Posterior B-scan mode with electronic measurement calipers and simultaneous Cross-vector A-scan, Anterior Segment B-scan mode for imaging anterior segment structures, Axial Length Biometry A-scan mode with Holladay-I, SKIT, Hotfer-Q, ‘and Haigis IOL power calculations, and. Standardized Equivalent Diagnostic A-scan mode for tissue characterization. Movies and/or single-frame images are stored on an internal hard disk and may be archived or exported to either external USB drives or to a network. Image date is later recalled for additional evaluation. Hardcopy output is available via laser or thermal printer. Figure1 Eye Cubed V3 images 1.1.1 Posterior segment diagnostic B-scan mode (10 MHz) The system produces a two dimensional, 52-degree, geometrically accurate sector Image with superior real time, resolution, and gray scale qualities. The image extends 48mm into the eye allowing imaging of objects ‘anywhere from the lens to the orbit, B-mode images may be displayed with or without a Cross-vector A- scan. The Cross-vector may be positioned anywhere in the B-scan or expanded to an A-scan view for accurate measurements. Two sets of electronic crosshair measurement calipers may be used to make accurate measurements on the B-scan itself and measurement velocities are adjustable,Introduction. 4.1.2 Anterior segment diagnostic B-scan mode (20 MHz) ‘This mode is also called Wide Field, The vertically displayed sector image has a 30-degree angle. The image is magnified 4x as compared to Posterior 8-scan mode. The 12mm deep image has a 7mm focal zone allowing imaging of the cornea, ciliary structures, and other anterior ocular structures. The electronic measurement caliper and the measurement scale are available. There is no Cross-Vector A-scan measurement available in the Anterior Segment B-scan mode. 1.1.3 Standardized equivalent diagnostic A-scan mode In Diagnostic A-mode the system produces an A-scan using an amplifier transfer function that is designed to aliow a “Standardized” method of evaluating tissue density. Using this mode in conjunction with a standard ‘examination protocol provides an industry-recognized method of diagnosing various types of ocular tumors ‘and pathology. Accurate two gate measurements may be performed in milimeters using a user-adjustable measurement velocity. Two distinct magnifications are available: EYE (45ps (microsecond) maximum depth), for imaging ocular structures, and ORBIT (70s maximum depth) for imaging the orbit. 1.1.4 Biometry A-scan mode In all Biometry modes, the system produces an A-scan with superior clinical quality for accurate axial length measurements of the eye. The instrument is easily set up for either immersion or contact biometry, and is. designed to ensure that internal processes used to validate measurements are visible to the user. A very important example of this is the visible indication of which echoes the electronic measurement calipers (or "gates’) are measurng. Another example is the on-soreen display of the ultrasonic velocity used to calculate the measurements reported. These features help the user to recognize high-quality scans that produce accurate measurements (and conversely, to recognize when to reject low quality scans), 1.1.5 Biometry manual vs. automatic freeze Manual-freeze mods is preferred for Immersion Biometry because it allows the user to be more discriminating. In manual-reeze modes the operator decides when to stop scanning by pressing a footswitch to freeze the scan, and then scrolls back through the movie to obtain the best image. Auto-freeze mode is best for Ccntact Biometry on difficult patients, The instrument will automatically decide when to stop scanning, and consequently will freeze as soon as a minimally acceptable scan is present. If possible, first use Manual Made and go back through the hundreds of scans in the movie to see if scan with good image pattern can be found. 400, Fav14.6 Available biometry measurement modes (eye types) ‘The Ellex Innovative Imaging biometry system can automatically measure a patient whose eyes have @ natural lens (phakic), no lens (aphakic), and eyes with several types of implanted lenses (Pseudophakic). Customizable measurement velocity modes are available for nearly infinite measurement capabilities. The ‘currently selected eye type and the associated measurement methad are displayed with the A-scan at all times, Measurements are displayed only when the A-scan pattern meets the requirements of the bullt-in patter recognition software. In Phakic modes the unit produces an anatomically accurate simultaneous 4-gate measurement of the ‘axial length, lens thickness and anterior chamber depth using velocities of 1532/1641/1532 meters per second (rs) ‘The Phakic Average mode uses a single average velocity of 1550 m/s and is useful for patients on whom auto-freeze scans are dificult to obtain. ‘The Aphakic mode is used for patients with no lens and uses a single velocity of 1832 mvs. ‘The Pseudophakic modes are used to produce measurements for pseudophakic patients. There are ‘modes for four types of IOL material: PMMA, Acrylic, Silicone Low Velocity (older style lenses), and Silicone Hi-Velocity (modern lenses). ‘The Phakic Custom and Aphakic Custom modes allow selection of custom vitreous and/or lens velocities, allowing measurement of nearly any imaginable eye type including eyes with silicone oiGR 09-100, Reve2: 2.0 System setup and administration - 2.1 Setting up the equipment i Perform these tasks when setting up the system for the frst time. = Unpack the cart and assemble it as per the following figure placing the external flat screen monitor on top of the console. It is preferred to place the system fiat on the cart when placing a monitor on top of = ‘the console. Figure 2 Instrument and cart setup => Unpack the printer and insert the toner cartridge and paper into it. Connect the printer to the system using the cables provided. Place the printer on the bottom shelf of the cart Unpack the large white box and put the ultrasound console on the top shelf of the cart. Place the keyboard on cart handles (Veloro) and run the cord under the ultrasound, Place the mouse on the mouse shelf and run the cable under the rear leg of the ultrasound, Use the two stick-on clips (provided), on the side of the cart (user installed) to hold the mouse cable. Unpack the monitor and pace it on top of the ultrasound console, Plug in the cables that connect the monitor to the system. Unpack the probes and plug them in to the receptacles at the front of the instrument. puyuutouy ‘Tum the instrument on. Refer to Starting up the system below for more information.System setup and administration 22 23 2.4 Log in using the user name ISAdministrator, the password is Eye3Admin, The user name and password are both case-sensitive. Starting up the system [ Peon these taste when sarng up the sytem each day u uuu vuug Leave the power switches on the console, printer and monitor in the ON mode. Use the one switch on the power strip or isolation transformer located on the middle shelf of the cart to tum the system as a whole ON or OFF. Logging on to the system Press the power button D) to tu on the system, The internal monitor screen is sorbed for about 30 seconds, Then the Windows XP Login screen appears. Click on the desired user name and enter the case sensitive password to log in. ‘The uttrasound system starts automatically; the Mode tab is displayed, ‘The system ships with two pre-configured user names: iAdministrator, password EyeSAdmin and igsystem, password iSsystem Creating user accounts This is an administrate task that requires advanced system knowledge. Exercise due ‘caution in performing administrative tasks. Incorrect system administration may lead to irrecoverable patient data loss or system corruption. Log in to the system as an administrator. Click on the Preferences tab. Enter name ot practice at bottom of screen. This name appears on top of the report page. In the Date Format box, select the preferred date format for display on the report. Formats available lnclude MM-CD-YYYY and DD-MM -YYYY. lick User Account at the bottom right of the screen. ‘The Create User Account screen appears, Click Pick a Task > Create A New Account. Under Name the New Account enter either the practice name or an abbreviation of the practice name. The user namie may only be 20 characters long. Click Next. Make all users Limited.25 u u yuu Click Create User, Close the User Accounts window and log ott ‘The newly created user account appears on the Windows Login screen. Click Tum Off Computer. Click Restart. Setting preferences Log in tothe system as the newly created user. Glick on the Preferences tab. © Preferences must be set for each user. Depending on the modes avaliable on each instrument, certain preferences must be set. © General ‘+ _ Inthe Date Format box, select the preferred date format for display on the report. Formats available MM-DD-YYYY and DD-MM -YYYY. Note change at bottom of screen, © 10 MHz Posterior Segment B-scan ‘+ Default gain is 90 dB (maximum) which is needed to image vitreous pathology. Adjust gain lower as needed to improve resolution. © 20MlHz Anterior segment B-scan + Set default gain to 55 (or as needed to obtain clear image) © Biometry A-scan «From the Preferences tab, click on the Biometry tab at the right. ‘+ For Immersion Biometry set Default Mode to Manual. + Set defautt gain to 70 (or lower it echoes are saturated) Set Default Caliper range to Immersion 1 (for eye lengths from 20 ~ 85 mm) or Immersion 2 (for shorter eyes such as pediatric patients with lengths from 15 ~ 30 mr), For Contact Biometry initially set Default Mode to Manual (Ellex suggests to begin with Manual and ‘switch to Auto only if needed) Sot Default Gain to 73 (Gain may be raised or lowered as needed.) Set Default Caliper range to Contact 4 (for eye lengths from 20 ~ 35 mm) or Contact 2 (for shorter eyes such as pediatric patients with lengths from 15 ~ $0 mr) Diagnostic A-scan needs no additional setting. Tissue Sensitivity value should correspond to Tissue Model image provided.System setup and adirinistration.. 2.6 Shutting down the system Close the Eye Cubed window by clicking on the X in the top right corner. ‘The Confirm Exit Eye Cubed dialog box appears. Click Yes. After the uitrasound application closes, remember to close Windows. Click on Turn Off Computer on the Windows desktop. In the Shut Down Windows dialog box, click Shut Down. puuuuauy ‘Tum off the power strip or isolation transformer switch after the following message appears: Itis safe to tum off computer. Improper shut down may corrupt patient data causing complete loss of patient data,3.0 System controls 3.1. Keyboard commands ‘The keyboard is the primary control input for the instrument. Keys are logically grouped into mode keys, function keys, and alphanumeric keys. The mode keys are used to switch to the various display screens, ‘while function keys invoke commonly used features. The alphanumeric keys are used for entering patient data and for numeric input for IOL power calculations. ‘As a general rule, continued pressing of a mode key or function key will cyole the user through several avaliable settings, eventually retuming to the starting point, Many common PC keys will perform as expected. For example the Enter or Tab keys may be used to move ‘he cursor from field to field. The arrow keys, Home, End, Page Up, Page Down, and the Insert keys should all behave as expected. Table 1 Function key commands Post-8 | Cycles through 10MHz Posterior Segment B-scan modes: B-CV, B+CV, and CV-A. Ant-B | Activates 20MHz Anterior Segment B-scan mode Diag-A | Toggles between Diagnostic-A Eye and Orbit modes. ‘Toggles between Biometry Automatic and Manual Freeze modes. The default biometry oe | mode may be selected on the Biometry Preferences page. | New | Clears all previously loaded data and switches to the Patient Record tab, ready to Patient | begin entering a new Patient Record F6 OD/OS | Toggle eye between OD (right) and OS (eft Toggles between the Patient Record (the current patient) and Database (ist of patients) vows ofthe Patient tab Patient Data Fa Image | Toggles between the Image (the current image) and Database (ist of images) views of Data | the Scan tab. Fa___Print | From F8 image Data ist, use CTL+Cliok to select up to 4 images. Additional data may Report be added prior to printingSystem controls. CoC Selects first measurement caliper marker for movement. Repeated presses oycie r10 | CPE | trough arate aror Vilar lon Toft nec ay ove anon ‘Scary " Fit freeze Starts or stops the ultrasound system scanning. Stores the ant image frame onl ria | S| crete cure nage tare on secon | TREK ache oj or nd Pot Boon modes Ech Shift+F2, Contrast ‘successive setting increases image contrast while reducing dynamic. range. | Resets caliper poston (rozen) and gain (scanning) to the default values . callie eee Default gains may be set in the Preferences tab. | iS jeune] Se ee eee : | shiners Contact | Biometry: Switch between two avalable contact caliper settings. Calips immers | Biomety: Switch between two available immersion caliper settings. shiners Calips ShifteF7 | Physiclan Used to enter, eal, or view stored Physician and 1OL Constant data. hiteF® Arche __ Stitch tothe Archive tab to archive selected patient and/or image records to an external disk or network drive. Shift+Fo Export Switch to the Export tab to expor patient data and/or individual image files to extemal media, AltsFo Exports the currently displayed image as an AVI movie. Exports the currently displayed image frame as a PC compatible format. Available formats include BMP, JPG, TIFF, and several other formats. | Ctrl4F9 Export image shiteFi0 Calipers. Tums measurement calipers on or off. The caliper cannot be turned off in| On/Of _the Biometry A-scan modes or in the Cross-vector A-scan mode. Shift+F11 Store Movie Stores the current ultrasound frames as a movie file, System ‘Setup DSPlavs the User Preferences tab. | ShifteF12Table 3 Non Function-key keyboard commands ‘While in the Scan tab, the Page Up and Page Down 7 upfate ,—Newinage eye ar sora hen or reve maze ne caret age st Ctrl + Next screen Ctrl+left arrow and Ctri+right arrow select the next and <> 12 prevous ab ae op the sren, (Opens the Print dialog box to print the current screen. Increase or decrease gamma to increase or decrease brightness of printed image. Note: Log in as an Administrator to install printer. Displays the software version in the system status line. iternet for available software updates. Software | Requires an active network connection. Software update _updates also require a password that must be obtained from Ellex Innovative Imaging prior to installation, ‘Check theSystem controls. 3.2 Imaging controls Table BR F12, ShifteFtt ‘THRESHOLO ov Up/Down t arrows + 4 Imaging controls Press the Scan/Freeze (left) footswitch or F11 to start and stop the probe. Use the red-capped Gain/Caliper knob to adjust the image gain, Use the Override button to adjust gain while frozen Press the Store Scan (ght) footswitch or F12 to store a single frame: Image. Press Store Movie Shift+F11 or Shift+Lett Footswitch) to store a movie fe. The Threshold/GV-A control has three functions: 1. Cross-vector Position: In the 8-scan with Cross-Vector Mode, the Threshold/CVA knob adjusts the B-scan cross-vector position up or down, 2. Threshold Function: Move B-scan calipers or A-scan Threshold line up/down, 3. Cine Frame Number: Selects the movie frame number. Press B-scan Contrast to select one of the preset contrast adjustment values (LOG, S-1, or S-2), This function is available in all B-scan modes. ‘While frozen, press Default Reset to reset the caliper postions, image: processing, and cross-vector position back to the default values. When ‘scanning, this key resets the gain back to the default valve.3.3 Caliper measurements Table 5 Caliper measurements ke De! = Calipers The Caliper On/Off key tums measurement calipers on calipers shineF10.__ oro Tho capers may not be ned of inthe CVA trade an tha Biomaty A-scan modes, Use the Caliper Select key to select a measurement caliper for movement. Calipers blink when they are ready for movement, and wil stop blinking after about six seconds. Use the red-capped Gain/Caliper knob or the Left and Fight arrow keys to adjust the lettight postion of a blinking caliper. Use the Threshold/CV-A knob or the Up and Down ‘arrow keys to adjust the vertical postion ofa binking caliper. Measurement | iq Glick on the Measurement Velocity to edit. The velocity Velocity | may be edited within a range of 900 and 1700 m/s. | ena Ee hit Shifte Print Screen opens the Print calog box. Position Print Screen | putt erragn | ond Size image as desired. Click OK to print screen contentsGA 09-100, Rev 44.0 Patient data management 44 4.2 43 44 Recalling stored patients = Click Patient at the top and Database on the right. The list of patients appears, (Patient /Database) = Double click on the patient of choice and the patient record appears, = Click Scan at the top and Database on the right and the list of scans done on that patient appears. (Scan/Database). = Double click on the scan of choice and the scan will open in the Scan/Image screen ‘© Movies must load completely before you can control them. Saving scans = Save selected scans from the movie by clicking Save Frame at the selected scan, = Aprobe orientation box will open. and you may label the scan. = Click OK. Printing scans = To print, go to the Scan tab at the top and the Database tab on the right (Scan/Database). = Click on one scan you want to print, then hold the Ctr! Key down and click on up to three more soans. = Press F9 (Print Report. = Areferral tempiate will pen. Enter the information or leave it blank. Press Print Preview. => Click Print. Performing B-scan measurements 4.4.1 Cross vector method = When making a scan, center the elevated lesion to be measured. => _ Press F1 and the cross vector line will display.Patient data management 45 46 => Use the threshold knob (bottom knob) to align the vector through the greatest apical height of the lesion to be measured, = Press F'1 again and the vector A-scan will be displayed and the first caliper will be blinking, => Move the calipers with the gain (<->) and threshold (TY) knobs until the caliper electronically attaches. to the spike and valid edge numbers (right side middle of soreen) are both displayed (1 & 2), => Read apical height at top left. = Press F1 to retum to normal B-scan. 4.4.2 Cross hair caliper method = When performing a scan, center the elevated lesion. = Press F10 to:um on first set of calipers. u Move the calipers with the gain (—») and threshold (TW) knobs. u Calipers give a running measurement between the two. Place the frst caliper on the apex (anterior aspect of the pathology/anatomy to be measured Pace the second caliper on the posterior aspect of the pathology/anatomy to be measured, Press Shif'+F10 to tur the second set of calipers on, Move the calipers to the basal diameter ofthe pathology/anatomy to be measured. Read measurements at top let of soreen. vuuutuy Press Shift+F10 to tum off calipers. Other functions and controls = To play a movie click Play on the screen or press P on the keyboard. = To stop a morie click Stop on the screen or press either P or the space bar on the keyboard. = To over-ride the gain click Override (under gain designation) with the mouse. => Change the gain by turning the red Gain knob. Zooming and panning images = Zoom the image and Pan it across the sereon, = Glick Zoom/Pan on the right of the ScarVImage screen. = 100% the lowest zoom and 200% is the highest. = Click the pan arrows to move the image around = Remember to close the Zoom/Pan utility before controling the image (click Reset or Close)47 48 Archiving patient data = With the Eye Cubed ultrasound powered on, click on the Archive tab. = Click on Create Archive at the bottom, A search window appears. = Locate the removable drive and click on the drive letter. = Click Create New Folder to make an archive folder if desired. > Rename the new folder by dragging the mouse across the folder name and highlighting it. > Type in new name, and press Enter. > Click OK. = The patients to be archived will appear in the upper half of the Archive screen. = Click Select All on the middle bar or select individual patients. = Click the Down Arrow on the middle bar. This moves all the patient scans selected to the bottom halt of the screen, = When all desired patients or scans are in the bottom half of the screen, Click Archive at the bottom, => When archive is complete, a dialog box will prompt you to delete archived records. => To retain patient data on the internal hard dive, click No. => To delete patient data from the internal hard drive click, Yes. Restoring archived patient data u With the Eye Cubed ultrasound powered on, click on the Archive tab. Glick on Open Archive at the bottom. A search window will open. Find the archive on the thumb drive (one of the removable drives) and click it once. Glick OK. The archived scans will appear in the lower half of the Archive screen. Click Select All on the middle bar or select individual patients Glick the Up arrow on the middle bar. Click Restore at the bottom, ‘This will place all selected patient scans into the patient database. vuuvudvuuyuyuas Click Patient at the top and Database on the right and the list of patients will be shown (Patient MPatabase). Double click on the patient of choice and the patient record will be shown. u => Click Scan at the top and Database on the right and the list of scans done on that patient will be shown (Scan/Database),Patient date management... => Double click on the scan of choice and the scan will open in the Scan/Image screen. => Movies must lnad completely before you can control them, 4.9 Exporting scans on the system = Click on the Export tab at the top. This is very similar to the archive function. Click Select Export Destination button at the bottom, Choose the dive where the thumb drive is located. u u = Select Single mage format default (PNG, JPG, TIFF = For movies, use 8 bit AVL = Select patients atthe top hal ofthe soreen to archive (internal Database) = Press the Down arrow inthe middle of the soreen (or SelectAll button} = The patients will appear in the bottom half ofthe sereen (Records For Export = Press Exportbutton at bottom of soreen. = The batch export function may take some time depending on the number of patients/scans to be exported. 4.10 Exporting selected scans on a specific patient = Click the Export tab, = Select the patient from the list on the Hard Drive at the top of the screen that you want to take scans from, u Press the Down arrow in the middle of the screen to send the patient to the lower half of the screen u Glick on the Scans tab on the upper right. Al'scans stored on this patient wil be shown, Select the scans you DO NOT wish to export and click the Up arrow in the mile ofthe soreen, The remainder are the scans you DO wish to export Click Export uuug 4.11 Exporting individual scans or movies To export a single frame: = _ From the Soan/Image tab press Control F9 to export a single frame. = Select the target drive to send the exported file, © You must select an external drive = Name the folder.=> Select file type (PNG, JPG, TIFF, or BMP}. = Click Save. To export a movie: = From the Scar/Image tab press Alt F9 to export a movie. = Select the target drive to send the exported fie. = You must select an external dive. = Name the folder. = Select filetype (@ bit AVN), Click Save. 9Patient data management. GR 08-100, Reve 205.0 Performing scans 5A te uvuug 10 MHz posterior B-scan Power: Press the front panel switch or the mobile cat's power strip or isolation transformer switch and an incicator wil ight. Click on the user name, enter password {ff necessary). The Eye Cubed power-up screen will appear after boot up. Select desired mode from Mode screen. The New Patient screen appears, New Patient Screen: A patient ID must be entered (minimum), then press Enter. Press Enter to Add New Patient. Patient data can now be entered if desired. Press Save to save patient data. The instrument will proceed to the made selected on the MODE ‘screen, ‘Step on the Left Footswitch to activate scan. Perform the desired scan. Instrument will store the last 10 seconds of the examination as a movie. Step on the Left Footswitch to freeze scan. ‘Threshold knob can be tumed to advance or rewind scan movie. Press F12 or Right Footswitch or click Save Frame on the display monitor to save single image. Press Shift F11 or click Save Movie on the display monitor to save movie. ‘The Probe Orientation field will open, enter Probe Orientation or click OK or Press Enter. This closes the Probe Orientation field To print, go to the Scan tab at the top and the Database tab on the right. Click on one scan that is to be printed. Hold the Ctrl key down and click on a maximum of three more scans. Press F9 (Print Report) A referral template will open. Enter the information or leave it blank and press Print Preview. Press Print. To examine another patient, press FS (New Patient) Improper shut down may corrupt patient data causing complete loss of patient data.Performing scans 5.2 B-scan probe position protocol 5.2.1 Position 1 Horizontal Transverse ~ Probe Marker Nasal Place probe at 6:00 limbus with the patient looking up. Locate the optic nerve void (shadow) ‘Top of screen is NASAL, bottom of screen is TEMPORAL. Slowly sweep the probe inferior, thereby sweeping the acoustic section superior. ‘Scans are labelsd 12:00, with notation of exact position (e.g. posterior, equator, ora serrata, etc. - see Figure 3, page 24. 5.2.2 Position 2 Horizontal Transverse ~ Probe Marker Nasal. lace probe at 12:00 limbus with the patient looking down, Locate the optic nerve void. Top of screen is NASAL, bottom of screen is TEMPORAL. ‘Slowly sweep the probe superiorly, sweeping the acoustic section inferiorly, ‘Scans are labelad 6:00 with notation of exact position: 5.2.3 Position 3 Vertical Transverse ~ Probe Marker Superior. Place probe at ‘emporal limbus with the patient looking nasally Locate the optic nerve void. Top of screen is SUPERIOR, bottom of screen is INFERIOR, ‘Slowly sweep the probe temporally, sweeping the acoustic section nasally OD scans are labeled 3:00 with notation of exact position; OS scans are labeled 9:00 with notation of exact position. 5.2.4 Position 4 Vertical Transverse ~ Probe Marker Superior. Place the probe at nasal imbus with the patient looking temporally. Locate the optic nerve void. ‘Top of screen is SUPERIOR, bottom of screen is INFERIOR. Slowly sweep the probe nasally, sweeping the acoustic section temporally. (OD scans are labeled 9:00 with notation of exact position, OS scans are labeled 3:00 with notation of exact position. a 2.5 Positicn 5 Longitudinal of the Macula ~ Probe Marker Toward the Cornea. lace probe nasally with patient looking temporally. Locate optic nerve void at bottom of screen, and lateral rectus muscle, ‘Top of screen is ANTERIOR PERIPHERY, bottom of screen is OPTIC NERVE. OD ~ Marker tomard 9:00. OD scans are labeled L9 MAC. (OS - Marker toward 3:00. OS scans are labeled L3 MAC. ogee5.2.6 Additional longitudinal scans Each clock hour may be scanned iongitudinally in order to determine the anterior and posterior extent of a lesion or detachment, and to look for the insertions of membranes. This position allows the acoustic section to be better aligned with many membranes than with transverse scans. Each meridian is scanned by having the patient look to the clock hour to be examined and the probe is placed opposite with the marker directed ‘toward that meridian. The image is displayed with the optic nerve at the bottom of the screen and the anterior periphery at the top of the screen. 5.2.7 Additional transverse scans - oblique These scans are used to center a lesion within the acoustic section when located away from 12:00, 3:00, 6:00, and 9:00. For optimal imaging and measurement, lesions should always be centered in the image. 5.2.8 Axial scans ‘Axial scans are used primarily to document the presence of a lesion relative to the lens and optic nerve, Axial ‘scans may be horizontal, vertical, or oblique. However, both a crystalline and an intraocular lens will interfere with the transmission of sound causing artifacts in the echogram. The natural lens may cause pseudo elevations of the peripheral retina due to refraction of the sound beam. An |OL will cause significant reverberation artifacts (multiple signals) throughout the vitreous cavity. Therefore, most diagnostic B-scans are performed using transverse and longitudinal scans, thus avoiding the lens. Horizontal Probe marker nasal, placed on center of comea with the patient in primary gaze. Center posterior lens ‘capsule and optic nerve. Macula is just below (temporal) to the optic nerve, The scan is labeled HAX. Vertical Probe marker superior, placed on the center of the comea with the patient in primary gaze. Center the posterior lens capsule and optic nerve. Macula is not inthis scan plane. The scan is labeled VAX. Shifting sound plane sightly temporally produces a vertical macula scan without optic nerve and is labeled VMAC.Performing scans... 5.3 Figure Acoustic labelling scan diagram Courtesy of: Sandra Frazier Byrne, Director of COMS Echography Center 5.2.9 Reference For a more detailed description of these techniques, refer to this book: Ultrasound of the Eye and Orbit by Sandra Frazier Byme and Ronald L. Green, MD ~ Mosby Year-Book Inc. St. Louis, MO (800) 426-4545 Biometry A-scan Press the power switch on the power strip or isolation transformer to tur on/off all components ‘The applicaticn wil open and the Mode screen appears. ‘Select Blomeity A-scan (Auto for Contact and Manual for Immersion You wil be forced to the New Patient sereen. Enter a Patirt ID in the ID field and press Enter or Tab. ‘A pop-up willopen asking Add New Patient. Click Yes. Enter patient name and other demographic data as desired ‘The lower hail ofthe screen is strity for Biometry. You MUST choose an operative eye. ‘Tab from the Operative Eye field to the Post Op Refractive Error field OD and either enter a value or leave Plano, ‘Tab to the Kt field and enter K1. vuuvuUEOUD u uvuuey vuug Tab to the K2 field and enter K2. Repeat for OS. ‘Tab to the Physician field and dlick the drop down arrow to select the appropriate surgeon. Click Save to go to the Scan screen Step on Left Footswitch or press F11 to activate the scan ‘Align probe to acquire an acceptable scan. ‘Auto mode (contact) wil freeze the scan when the retina echo reaches 80% height. Evaluate the echo and Store with the Right Footswitch or F412 or Step on the Left Footswitch or F11 to re-acquire another echo. Manual mode (immersion) will alow you to adjust the probe/shell assembly to acquire maximum spike height. Step on the Left Footswitch or press F'11 to activate the scan. Align probe to acquire an acceptable scan. ‘Scroll through the movie of your scans with the lower knob and evaluate the quality and accuracy of your scans and select a representative scan to calculate. Evaluate the echo and Save with the Right Footswitch or F12. Click on the 1OL tab on the Right and the Selection screen will open. Double click on the selected scan for each eye and the scan will appear in the boxes at the top. lick on the Calculations tab at the bottom and the Calculations screen will open, ‘Make sure the Comparative button is checked (green) to calculate all three formulas or select the desired formula from the drop down box. Click Save to save the report Click Print to print the calculations. A print preview will open, Press Print. 5.3.1 Entering physician lens data vuug vuug lick on the Physician tab atthe top. (Click on New on the middle bar. Enter surgeon name. Click Save, Repeat for all surgeons with |OL data. Click on the surgeon whose name you wish to appear fist (2. does the most cataract). Click on the Set Default button on the midale bar. ‘With the surgeon's name stil highlighted, cick New on the bottom of the screenPerforming scans u vuuy Enter IOL name. 1OLs willbe sorted numerically, then alphabetically. In order to meke IOLs appear in the desired order, place the number 1 and a space before the lens. ‘name and the lenses will stay in the listed order. Place the number 2, 3, 4 etc. before other lenses in the sequence of printing, Make sure the Auto-Complete button at the bottom right is selected (green) and enter A-Constant for the listed lens, Press Tab three times. Press Save. Repeat above process for each lens. Select next surgeon at the top and repeat for each lens for each surgeon clicking Save after the entry of each lens.