Evoked Potentials For Galileo NT

Galileo System
Operator Manual
EP_NT
Evoked Potentials for Galileo NT
PROGRAM FUNCTIONING
SECTION
B8300031001
Rev. G
(BOOKLET)
0051
EDITION:
September 2008
EBNeuro
-FLORENCE-
ITALY
Galileo System
Operator Manual
EP_NT
Evoked Potentials for Galileo NT
PROGRAM FUNCTIONING
SECTION
B8300031001
Rev. G
(BOOKLET)
0051
EBNeuro
-FLORENCE-
ITALY
EP_NT
TABLE OF CONTENTS
WARNING
INFORMATION ABOUT THE MANUAL 1

MANUAL CONTENTS 2
INTRODUCTION
THE GALILEO_NT ENVIRONMENT 1
CHAPTER 1 - QUICK START
1.1 GENERAL 1-1

1.2 ACQUIRING A NEW EP TRACE 1-2
1.2.1 ENTERING A NEW PATIENT IN THE ARCHIVE 1-2
1.2.2 STARTING A NEW EP RECORDING FROM THE PATIENT
MANAGEMENT SYSTEM (PMS) 1-5
1.2.3 CONFIGURE/MODIFY THE STIMULATION PRESET 1-6
1.2.4 PERFORMING A NEW EP RECORDING WITH THE
WIZARD (ASSISTED ACQUISITION) 1-7
1.2.5 PERFORMING A NEW EP RECORDING WITH THE
WIZARD (ASSISTED ACQUISITION) 1-9
1.2.6 ACQUIRING AN EP TRIAL 1-11
1.2.7 MEASURE, TOOLS AND MAP 1-14
1.2.8 SAVING THE ACQUISITION IN THE CURRENT TRACE 1-16
1.2.9 GENERATING AND PRINTING A REPORT 1-16
1.2.10 EXITING FROM THE EP MODE 1-18
1.3 READING A TRACE FROM AN EXISTING EP 1-19
CHAPTER 2 - SCREEN ORGANIZATION
2.1 GENERAL 2-1

2.2 MENUS 2-2
2.2.1 FILE MENU 2-2
2.2.2 TRACES MENU 2-4
2.2.2.1 Colors 2-4
2.2.2.2 Font 2-5
2.2.2.3 View 2-5
2.2.2.4 Grid 2-6
2.2.3 REPORT MENU 2-6
2.2.3.1 Create/Append/Open 2-7
2.2.3.2 Import 2-7
2.2.3.3 Formatting 2-8
2.2.4 WINDOW MENU 2-8
2.2.5 HELP MENU 2-8
2.2.6 POP-UP MENU (UNDER THE TRACES WINDOW) 2-9
2.2.6.1 Save exam / Load exam 2-9
2.2.6.2 Comment 2-10
2.2.6.3 Trace's settings 2-11
2.2.6.4 View / Hide acquisitions 2-12
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2.2.6.5 View/Hide seq. numbers 2-12

2.2.6.6 Resize screen / Print screen 2-12
2.3 UPPER TOOLBARS 2-13
2.3.1 AMPLIFIERS TOOLBAR 2-13
2.3.2 ACQUISITION TOOLBAR 2-15
2.3.3 GENERAL TOOLBAR 2-17
2.3.4 MACRO TOOLBAR 2-17
2.4 LOWER TOOLBARS 2-18
2.5 SCREEN AREA 2-19
2.5.1 WINDOWS TRACES 2-19
2.5.2 AVERAGE WINDOW 2-22
CHAPTER 3 - MANAGING PRESET
3.1 GENERAL 3-1

3.2 GENERAL TAB 3-2
3.2.1 ACQUISITION 3-3
3.2.2 AVERAGE 3-4
3.2.3 WATERFALL 3-5
3.2.4 EXAMINATION 3-5
3.2.5 SPLIT SCREEN 3-8
3.3 TAB MONTAGES 3-10
3.3.1 MAP 3-13
3.3.2 NAME 3-14
3.3.3 CONNECTION 3-15
3.4 TAB AMPLIFIERS 3-16
3.4.1 SENS/DIV 3-16
3.4.2 SENSM 3-16
3.4.3 LOW & HIGH FILTERS 3-17
3.4.4 NOTCH 3-17
3.4.5 RECTIFY 3-17
3.4.6 POLARITY 3-17
3.4.7 CHANGE FILTERS 3-18
3.5 TAB STIMUL. 3-19
3.5.1 ELECTRIC STIMULATOR (SOMATOSENSORY) 3-19
3.5.2 ACOUSTIC STIMULATOR 3-20
3.5.2.1 Tone 3-20
3.5.2.2 Click 3-21
3.5.2.3 General 3-22
3.5.2.4 EARPHONE 3-22
3.5.2.5 BAEP 3-23
3.5.2.6 Test 3-23
3.5.3 FLASH STIMULATOR 3-24
3.5.4 PATTERN STIMULATOR 3-25
3.5.4.1 Trigger 3-26
3.5.4.2 Stimulation 3-26
3.5.5 EXTERNAL STIMULATOR 3-31
3.6 MACRO 3-32
3.6.1 DEFAULT MACRO 3-33
3.6.2 IMPORT/EXPORT MACRO 3-34
3.7 RAW DATA 3-35
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CHAPTER 4 - MEASURES AND PROCESSES
4.1 GENERAL 4-1

4.2 MEASURES 4-2
4.2.1 FAST MEASURES 4-2
4.2.2 POSITIONING MARKERS 4-4
4.2.3 EDITING MARKERS 4-5
4.3 TOOLS 4-11
4.3.1 TRACE SELECTION 4-12
4.3.2 SMOOTHING 4-12
4.3.3 ARITHMETIC 4-13
4.3.4 GRAND AVRG 4-14
4.3.5 BASE LINE 4-15
4.3.6 TRACE’S COLOR 4-16
4.3.7 TRACE’S STYLE 4-17
4.3.8 CLEAR 4-18
4.3.9 UNDO 4-19
4.4 MAP 4-20
CHAPTER 5 - EP GRAND AVERAGE
5.1 GENERAL 5-1

5.2 CREATING AN EP GRAND AVERAGE 5-2
5.2.1 ENTERING A VIRTUAL PATIENT IN THE ARCHIVE 5-2
5.2.2 SELECTING TRACES IN THE ARCHIVE AND
CALCULATING THE EP GRAND AVERAGE 5-2
5.2.3 EXITING THE EP GRAND AVERAGE MODE 5-8
5.3 READING AN EP GRAND AVERAGE TRACE 5-8
5.3.1 COUNTER SPECIFICATION 5-11
5.4 INCREASING THE SIGNIFICANCE OF THE GRAND AVERAGE 5-13
CHAPTER 6 – EP TRENDING
6.1 ACQUIRING AN EP TRENDING EXAM 6-1
6.1.1 CREATING A NEW MACRO 6-3
6.1.2 LOADING AN EXISTING MACRO 6-7
6.2 ACQUISITION MANAGEMENT 6-8
6.3 CHECK THE EP TRENDS 6-12
6.4 SCAN TRACES DURING ACQUISITION 6-13
6.5 MAIN WINDOW ORGANIZATION 6-14
6.5.1 TRACE WINDOW 6-14
6.5.2 TREND WINDOW 6-16
6.5.3 ACQUISITION MANAGEMENT BUTTONS 6-17
6.5.4 TREND DISPLAY CONTROLS 6-18
6.5.5 TREND MANAGEMENT BUTTONS 6-18
6.6 TREND OPTIONS AND DEDICATED REPORT 6-25
6.6.1 TREND EXPORT 6-25
6.6.2 DEDICATED TREND REPORT 6-27
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APPENDIX A – THE P300 PROTOCOL

A.1 GENERAL A-1
A.2 STIMULI A-1
A.3 P300 MACRO EXAMPLE A-2
APPENDIX B – THE CNV PROTOCOL

B.1 GENERAL B-1
B.2 STIMULI B-2
B.3 CNV MACRO EXAMPLE B-3
APPENDIX C – THE ERP/CNV PROTOCOL

C.1 GENERAL C-1
APPENDIX D – ERP EXAMS FROM BACK AVERAGING SW

D.1 GENERAL D-1
D.2 DATA TRANSFER PROCEDURE D-1
D.2.1 EXPORT THE SINGLE TRACE D-2
D.2.2 EXPORT ALL TRACES TOGETHER D-3
D.3 ADDITIONAL ERP INFORMATIONS D-5
APPENDIX E – DOUBLE STEP ACQUISITION

E.1 GENERAL E-1
E.2 CONFIGURATING DOUBLE STEP ACQUISITION E-1
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WARNING
INFORMATION ABOUT THE MANUAL

This document contains proprietary information. No part of this publication may
be photocopied or reproduced without the prior written permission of EBNeuro.
Information in this document is subject to change and revision without notice.
Issues:
First edition: B8300031001 -Rev. A - May 2000

B8300031001 - Rev. B - May 2002
B8300031001 - Rev. C - April 2004
B8300031001 - Rev. D - July 2005
B8300031001 - Rev. E - March 2007
B8300031001 - Rev. F - November 2007
B8300031001 - Rev. G- September 2008
This manual is to be considered as a component of the equipment. When installing

the equipment for the first time, the user should accurately check the content of
the Manual in order to verify its integrity and completeness.
In the event the Operator Manual should be ruined, incomplete or inadequate,

please contact EBNeuro in order to immediately restore or replace the not
compliant Manual.
The official versions of the Operator Manual, of which EBNeuro is directly

responsible, are the Italian and the English versions. For countries in which
languages other than Italian or English are spoken, the official Manual is the one
in the English version. EBNeuro does not undertake any responsibility for any
translations in other languages made by distributors or users.
The observance of the operating procedures and of the warnings described in this
Manual is a basic requirement for the correct working of the equipment and to
guarantee the patient’s and the user’s safety.
The Manual must be read in every part in front of the equipment before using it,
in order to become familiar with the operating procedures, the commands, the
connections to the peripheral instruments, and the precautions for a correct and
safe usage.
The Operator Manual should be kept, complete and readable in every part, in a
safe place, and, at the same time, it should be rapidly accessible to the user when
using the equipment.
Warning 1
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Conventions
NOTE
The notes contain important information to be underlined with respect to the rest
of the text. They generally contain information useful for the user to correctly
perform and use the operating procedures of the equipment.
WARNING
Warning messages appear in the Manual prior to procedures or operations that
should be observed in order to avoid any data losses or damages to the
equipment.
ATTENTION
Attention messages appear in the Manual with reference to the description of

procedures or operations that, if not performed correctly, could cause damages to
the user or the patient.
MANUAL CONTENTS
This document is intended as a guide to understand the features of the Galileo
EPNT software, describing the operations and the commands required for data
acquisition and analysis.
The manual begins with a section called “Quick Start”, with has the purpose of
enabling the user to perform an EP test using a pre-defined preset (macro),
applying the default markers, generate and print the report (that is, the routine
work).
The four following sections allow the user to understand in detail the meaning of
each part and each function available in this software.
In particular, the second section explains the screen organization and the function
of all the available commands.
The third section is focused on describing all the parameters that can be modified
and saved in the macros.
The fourth section deals with the “processing”, i.e. all the operations that are
performed on the traces: fast markers, measurements, mathematics and mapping.
The last fifth section describes in details the “Grand Average” statistic function on
already acquired EP tracings.
2 Warning
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NOTE
This manual relates indifferently to the description of NeMus 2 and Myto Plus
Advance devices . From now on, the Myto Plus Advance name will be omitted and
replaced with Nemus 2 .
Warning 3
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For your notes:
4 Warning
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INTRODUCTION
THE GALILEO NT ENVIRONMENT
Galileo NT provides a structured environment for the management of several

kinds of neurophysiological testing, like Electroencephalography and
Polysomnography, Evoked Potentials, Electromyography, and others.
The main component of the Galileo NT environment –the Database Manager –is
common to all the examination types, while each kind of testing is managed by a
specific application within the Galileo NT framework.
This allows achieving an overall optimization, which leads to an unparalleled

flexibility and modularity of all the Galileo NT systems.
Evoked Potentials testing is performed through the Galileo EP NT software,

which is automatically invoked from the Database Manager whenever the user
chooses to record or to review an EP trace.
This program allows to set all the acquisition parameters (i.e. sensitivity, filters),
to program the stimulators (audio, pattern reversal, flash, electric…), and to
collect the EP data from the patient. The same program can then review and
analyze (measure, mathematical operations…) the acquired data.
Introduction 1
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For your notes:
2 Introduction
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CHAPTER 1
QUICK START
1.1 GENERAL
GALILEO_NT is a EBNeuro product prevalently designed to acquire and process
biological signals (and store, display and print them at a later stage).
In particular, the program has been designed to manage encephalic signals.
At a "patient/registered data" management level, the system employs a new and

efficient database, developed in the Borland Interbase SQL Server 6.0
environment. Its points of strength lie in the solidity offered when
accessing/exchanging the data on the network, in its safety in terms of privacy, in
the user-friendliness of its user interface and in the speed with which queries can
be performed within large databases.
The data connected to each patient of the database are generally divided into:
• Traces (or Recordings ) • Patient Reports or Histories

• Sub Recordings • Trace Reports
• Analyses • Comments
• Exams
In terms of Evoked Potentials, the smallest "unit" managed by the GALILEO_NT

Database is the "EP Trace" that contains all the EP recordings performed within a
single session. The EP Trace can be divided into a series of "acquisitions" called
Sub Recordings, which individually correspond a specific acquired EP potential
(former SEP, BAEP, VEP, P300, CNV...). The user can define the start and the
end of a session and continue the acquisitions on the same trace or create a new
EP trace.
An "EP exam" is instead an aggregation of data connected to the same patient,

which contains both traces and (generally) images (TAC, NMR).
The "EPNT" traces management software is automatically started when the user
creates a new EP exam ("EP EXAM") or "recalls" an existing one (the EPNT
software will be loaded also for similar recordings like "ERP EXAMs").
The sections below briefly describe the steps that have to be performed to be able
to immediately use the EP Management Software in a correct manner.
Quick Start 1-1

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1.2 ACQUIRING A NEW EP TRACE
An EP trace can be acquired in two different ways: by creating a new patient or

by adding an EP trace to an existing patient.
There is also a simplified procedure that enables to create a new patient in the
GALILEO_NT database and simultaneously create an EP trace without having to
take into account the options and performances made available in the database.
This simplified procedure is described in the following section, while the mode to
be followed to create a new EP trace for an existing patient is described in the
sections that follow.
1.2.1 ENTERING A NEW PATIENT IN THE ARCHIVE
Start GALILEO_NT and insert the password in the logon phase to access the
selected archive, along with the User name.
To access the archive, press the corresponding button.
1-2 Quick Start

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The system displays the main window of the Patient Management System (PMS).
Click button New patient to access the wizard that enables to enter a new patient
in the archive.
Quick Start 1-3

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Complete all the required fields of the areas labeled Identification Data and
Address, then click Confirm (it is useful to notice that only fields Lastname,
Firstname and Birthdate are required, the others are optional and may be left
blank by the operator).
At this point, the insertion of the patient in the archive is complete.
NOTE
It is also possible to press button "New Data" instead of "Confirm" to save the new
patient and to immediately access the next window that displays the wizard that
enables to acquire a new trace.
1-4 Quick Start

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1.2.2 STARTING A NEW EP RECORDING FROM THE PATIENT MANAGEMENT

SYSTEM (PMS)
Select the patient to be associated to the new recording.
The fastest way consists in ordering the list of patients by their LastName (by
pressing the key on the header of the related column) and in typing the first letters
of the full last name and first name of the patient. The system will immediately
select the desired patient. This procedure can only be used if the patient is already
present in the archive. After completing the operation, press button New data.
The window that displays enables to select the type of acquisition to perform.
Scroll the drop down list as far as EP EXAM.
Click OK to continue or Cancel to cancel the operation.
Quick Start 1-5

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NOTE
It is also possible to select EP Grand Average. This acquisition mode will be
described in further detail in the next chapters. This example is based on a generic
EP EXAM .
1.2.3 RESUME AN EP RECORDING
The software allows to continue the acquisition of an EP EXAM previously

acquired.
From the “data list” of Galileo PMS it is necessary to select the data “EP EXAM”
of which it is request to continue the acquisition and then, from the “Data” menu
select the command “Continue Acquisition”. In this way the acquisition starts
again and it is possible to work on any of the “EP TRACE” already acquired.
This procedure can be repeated unlimited times, during a prefixed period of time
since the “EP EXAM” first registration. This time is the same used for the EEG
“continue acquisition” shown in the field “Continue Acquisition” in the Galileo
NT Configuration Utility, folder EEG (expressed in hours).
1-6 Quick Start

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1.2.4 CONFIGURE/MODIFY THE STIMULATION PRESET
It's possible to use a similar procedure of the EEG recording preset: choose the
Configuration item of the Galileo PMS menu bar, and then the Presets board.
On the Data Presets section choose the EP EXAM Rec. type and then press the
Modify Presets button.
The system displays a new window where it is possible to select the type of
hardware (from the list, in case of multiple hardware presence on the current
system) and the type of data connection (either PCMCIA card or BENET) to use
for the future recording or leave the box unchecked
Quick Start 1-7

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After this (eventual) configuration, the Trace's Settings Panel control will then
appear.
This Main panel control will show only the windows which are used for Macro
configuration, the remaining controls (which are dedicated for acquisition,
average performing, post elaboration, reporting), will be disabled.
To close the Preset configuration modality, press the X button of the main
window.
1-8 Quick Start

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1.2.5 PERFORMING A NEW EP RECORDING WITH THE WIZARD (ASSISTED

ACQUISITION)
The Assisted acquisition window is accessible both during the logon phase at the
time the program is started and at a later stage within the management window.
This button is in fact present in both windows.
The following panel displays.
If complete data (or partial data) is inserted, the Patient Management System
(PMS) searches for all the patients whose data match those entered within the
archive. If the search is successful, the result is displayed in a new window that
shows a list of patients.
If the search is unsuccessful, the program displays a pop-up warning that prompts
the operator to insert the data of the new patient.
After completing the form, the operator must select the type of recording.
Select EP EXAM.
Quick Start 1-9
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NOTE
If a patient with matching data is found in the archive, it is sufficient to press OK in
the selection window to access directly the acquisition pane related to the type of
pre-set recording and displayed in the Assisted acquisition window. It is advisable
to always determine ahead the type of recording to perform.
The system displays a new window where it is possible to select the type of
hardware (from the list, in case of multiple hardware presence on the current
system) and the type of data connection (either PCMCIA card or BENET) to use
for the recording or leave the box unchecked.
NOTE
The selection of option "None" is used only if the acquired traces are read with
equipment that are permanently or temporarily not equipped with an acquisition
unit.
Select the acquisition hardware available. The system displays the EPNT Control
panel that allows to record potential evoked traces.
1.2.6 ACQUIRING AN EP TRIAL
The screen of the EP mode displays as shown in the figure below.
1-10 Quick Start

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Click button Macro on the right toolbar.
The Macro Window opens.
Select the macro that corresponds to the EP trial to be performed, then click Load
(alternatively, it is also possible to double click the name of the desired macro).
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At this point, it is possible to start the acquisition by pressing Run and Media on
the toolbar to start the accumulation and averaging process.
A window with the average parameters displays.
1-12 Quick Start

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The user can display or hide the real time signal (by enabling or disabling button
Real) or the result of the averaging process (by enabling or disabling button
Media).
Press button Pause to temporarily suspend the acquisition, while continuing to

perform the stimulation.
Disable button Run to stop the current exam and the stimulation.
To acquire a new "trial" with exactly the same acquisition/stimulation parameters,
it is necessary to press button Next.
NOTE
The acquisition and stimulation parameters can be changed in between trials. The
report will take into account all the changes applied.
During acquisition, it is possible to change the position of each trace by simply

clicking the "label" of the trace and dragging up or down.
It is also possible to perform "fast" measures by inserting two markers (latency

and amplitude) while simultaneously pressing key CTRL on the keyboard and
clicking the desired point on the trace. Markers can be easily moved by "clicking
and dragging" the corresponding labels. To enter a note for a trace, it is sufficient
to right click the trace and enter the comment. To complete the operation, press
key RETURN.
The sections that follow provide a detailed description of all the commands.
Quick Start 1-13

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1.2.7 MEASURE, TOOLS AND MAP
Once the acquisition of the potential is complete, press button Measure to

automatically display the markers previously defined in the current macro.
The position of each marker can be adjusted with the mouse (dragged and
dropped).
Section Tools allows to perform further processing operations on the traces

(deletion, smoothing, mathematical operations, grand-averaging).
The option MMN (“Mismatch Negativity”) is activated for each EP exam with 2
traces acquired on each channel, allowing the calculation of the difference.
If the registered exam is a P300 exam, the function enables to calculate the MMN
between frequent and rare stimuli acquired on the channels set in the montage.
1-14 Quick Start

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Section Map allows to display the potential acquired by means of a dynamic 3D

map with several view and evaluation angles corresponding to different latencies.
NOTE
Function Map is enabled only if a sufficient number of channels has been acquired.
The default number of channels is 8.
Quick Start 1-15

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1.2.8 SAVING THE ACQUISITION IN THE CURRENT TRACE
Once the potential has been acquired, it is possible to save the acquisition within
the current trace. This can be done by selecting Save exam in menu File or by
pointing the mouse on any point of the trace area, and by right clicking and
selecting option Save exam.
After saving the EP acquisition, it is possible to acquire another EP (of any type)
by following the procedures described above (loading a macro, starting the
acquisition, and saving the data). All the saved EP traces will form the content of
the current "EP exam".
It is also possible to generate and print a "report" after selecting an exam from
those performed within the current trace.
1.2.9 GENERATING AND PRINTING A REPORT
Select Create in menu Report to display the following screen.
1-16 Quick Start

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This screen enables to select the acquisitions related to the current traces that have
to be inserted in the report. It is also possible to select (or deselect) the traces to
print by checking (or unchecking) the check boxes present in the last right column
(9) displaying the symbol of the printer ( ).
Press button WordProc to open the Report management window that displays
several display samples for the selected report.
Select the type of model and press OK to confirm the selection or Cancel to
return to the previous window.
The report is generated and automatically sent to the word processor currently
defined (Word, Wordpad , …..).
Quick Start 1-17

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At this point, the report can be edited (for information on the use of the word
processor application, see the relevant User's Manual), and printed by pressing
Print from the File menu or clicking the print button provided for this purpose.
1.2.10 EXITING FROM THE EP MODE
To exit from the EP mode and return to Galileo_NT’s Database (to review another
trace, create new traces, etc.) select Exit from the File menu or click the "x" in
the upper right corner of the EP Mode window.
1-18 Quick Start

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1.3 READING A TRACE FROM AN EXISTING EP

From the Patient Management System (PMS) it is possible to select the EP
EXAM of the desired patient in two different ways: by double click the selected
line of the patient or by pressing View data.
Window EPNT displays with an empty pane showing the montage preset related
to the loaded exam. The trace can be loaded at a later stage by selecting one of the
following modes: by selecting Load exam from the File menu or by pointing the
mouse on any point of the trace area, right clicking the mouse and selecting the
option Load exam.
The system displays the list of EP traces present in the current EP EXAM.
Quick Start 1-19

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Select the desired trace, then press button Load to load the trace, Delete to delete
the trace from the EP EXAM and Cancel to cancel the Overview.
In order to allow a quick comparison between several traces EP, the software has
the possibility to open several review windows. From Galileo PMS, it is possible
to select individually all traces to be reviewed, left double clicking on the row of
the desired data, or clicking the button “View Data” after the choice. Each trace
will be presented in a different review window EPNT.
1-20 Quick Start

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CHAPTER 2
SCREEN ORGANIZATION
2.1 GENERAL
If the EP mode has been enabled (Acquisition or Replay), the screen displays the
main Control Panel called EPNT.
The Control Panel contains several items, specifically (from top to bottom) the
Menu Bar, the Toolbar and several secondary windows, the main one of which is
the one called Traces.
The following pages will describe each of the above-mentioned items.
Screen Organization 2-1

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2.2 MENUS
The "Main Bar" in the upper section of the EPNT Control Panel displays the
available commands and options.
Some commands are also accessible through shortcuts, i.e. by a combination of

accelerator keys that enable advanced users to quickly perform specific operations
by simply pressing a key.
The available menus are:
It displays commands that enable to perform operations on the files

File
and control the printing
Traces It displays commands and options related to traces
Report It displays commands that enable to manage reports
Window It displays commands that enable to manage window
It displays the On-line Help and the release information of the
Help
software
2.2.1 FILE MENU
The File Menu mainly allows to perform several operations on the files, which are
explained as follow.
First section: it contains the possibility to load an EP Exam from the current trace
(by selecting option Load Exam) and save the potential displayed within the
current trace (by selecting option Save Exam), in the native Galileo NT format.
Second section: it’s also possible to copy into the clipboard folder the current
trace displayed (by selecting option Copy to EP Clipboard) in order to reuse it
i.e. for traces comparing (by selecting option Insert from EP Clipboard).
2-2 Screen Organization

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In the first case a wait bar for saving traces will be displayed
In the second case the Insert from EP Clipboard line will be enabled only when
there is at least one EP trace in the clip folder.
By selecting the line, a new panel control will appear, making possible to select
and import the interested trace (by clicking the Load button), to eliminate it (by
clicking the Delete button) or to exit from the preview without changes (by
clicking the Cancel button).
Third section: it is also possible to export the trace displayed in another format,
for example in Ascii format (by selecting the option Export in Ascii format); to
make a trace screen-shot and to export it like a bitmap in a specified folder (by
selecting the option Export in BMP format) or to leave it in the clipboard in
order to choose where do we want to paste it (by selecting the option Copy
graphics to clipboard).
This option offers the possibility of accessing the data and the images in an
alternative manner in order to perform processes using programs other than those
made available by Galileo NT's analysis (this is important in particular in the
ambit of clinical research)

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Fourth section : the last option allows to exit from the EP Mode and return to the
Manager of the Galileo NT Database (Exit).
NOTE
EP traces can also be saved and loaded by right clicking any point of the Traces
window. The pop-up menu that displays contains some of the main commands
used to manage traces.
2.2.2 TRACES MENU
This menu displays all the options that enable to display the traces within the
Traces window. This menu is divided into the "submenus" described here below.
2.2.2.1 Colors
This option allows to set the favorite colors for each graphical item of the Traces
panel.

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2.2.2.2 Font
This option allows to select the favorite font label both for traces and markers.
2.2.2.3 View
This option allows to display or hide the Real signal and/or its Average, along
with the Grid or the Base line (isoelectric).
If checked, option Artifact reduction (available only for BE and BE Light

families) allows to apply a user-defined numerical filter to the traces displayed in
window Traces, within the time domain.
This option is specifically designed to significantly attenuate the artifact that

forms in the first milliseconds of each stimulation performed during each
recording, which is usually referred to as "stimulus artifact".
The additional control window that displays allows to manage the parameters of
the filter. The Traces window displays an additional marker, corresponding to the
filter applied, which facilitates the use of the filter itself. To show this panel, press
"CTRL+ F" from keyboard.

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2.2.2.4 Grid
This option allows to display the Traces window as a full grid (Full) or only as
intersections (Crossed).

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2.2.3 REPORT MENU
This menu allows the operator to configure the management of the reports of a
patient, from the generation of a new report to the definition of the required
parameters.
This menu is divided into the submenus described here below.
2.2.3.1 Create/Append/Open
Each of these commands allows to access the Word application set by the operator
in order to compile and/or add the comments, traces and parameters processed
during the Replay phase.
If a report has already been created for the current trace (through command
Create), option Open allows to recall it while option Append allows to add
current information to it).

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2.2.3.2 Import
This option defines the parameters that have to be inserted in the report, if
defined.
NOTE
Additional parameters will be included in case of non standard exams like P300,
CNV and ERP/CNV (the dedicated stimulation protocol section that appears on the
"Tab General" of the "Trace's Settings" panel control). The EP Trending exam will
not import any standard measures because this feature is disabled (for more
details see the dedicated 6th chapter of this manual) but only several selected
instants each one with the dedicated trend visualization. In case of ERP TRACES, it
will be possible to import also original measurements made from the Back
Averaging SW (internal measures and reaction time values).
2.2.3.3 Formatting
When checked the Page Break option allows to separate the newly created report
exams with a page break.

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2.2.4 WINDOW MENU
This menu displays commands that enable to manage the windows displayed in
the main Control Panel, according to Windows 98/NT/2000/ME/XP standards.
For example, if a window is hidden by another one (minimized), it is sufficient to

select it from this menu to display it (or resume it).
2.2.5 HELP MENU
This menu allows to select the "Help on line", that contains this manual in
electronic format. It also possible to see some information about the current
installed release by using the "About" command.
2.2.6 POP-UP MENU (UNDER THE TRACES WINDOW)
Right clicking any point in the Traces area allows to display the "pop-up menu"
shown below.

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2.2.6.1 Save exam / Load exam
Options Save exam and Load exam perform the same functions of the commands
in the File Menu, because they enable to save the EP exam within the current
trace or load a new one from the current trace.
In the latter case, window Trace preview displays the list of EP traces present in
the current EP EXAM.
Select the desired trace and press Load to load the trace, Delete to delete the trace
from the EP/ERP EXAM trace and Cancel to cancel the Preview.
2.2.6.2 Comment
A comment of a few lines on the traces can be entered by using the pop up menu
and selecting option Comment.
The additional text box that displays above the Traces window allows to edit
some of the recorded notes from the keyboard.

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It's possible to perform some text ( as little clinical evaluation of the current
exam) by introducing measures of the interested included markers (like, AMP,
LAT, AREA). In this case a specified string will be included within % special
string. These markers will be automatically upgraded in case of time shifting of
the markers (when Measure button is enabled). This little "dynamic" comment
will be interpreted and will show into the related report the correct values (see
next figure).
To close the Comment window, select "Comment" from the "pop up" menu or
point it with the mouse and click symbol "x" in the upper right corner.

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NOTE
The comment is saved with the traces when option “Save exam” is selected.
2.2.6.3 Trace's settings
This option allows to access the configuration window of the traces related to the
current Macro in order to display/edit its parameters. This window can also be
opened by "double clicking" the Traces area.
NOTE
A more exhaustive description of the Trace's setting panel control is provided in
the following chapter.
2.2.6.4 View/Hide acquisitions
This option allows a selective method to view/hide traces from the traces area,
simply selecting/deselecting the numeric circles into the View/Hide acquisition
menu as below.
2.2.6.5 View/Hide seq. numbers
If selected, this option allows a selective method to view/hide the sequence

number of the traces from the trace area.
NOTE
This feature is disabled in case of EP Trending exam, because the real sequence
information is due to the chronological time comment introduced on each trial, and
to the related trend graph.

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2.2.6.6 Resize screen / Print screen
If the dimensions of the Traces window have been changed, it is possible to open
the pop up and option Resize screen to restore the original dimensions.
Option Print screen allows instead to save the image of the Traces window and
automatically open (to insert edits and/or comments) the graphical program that
manages the images (Paint by default).

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2.3 UPPER TOOLBARS

The toolbars (also called Command panel) can be found under the Menu bar.
These can be used to quickly perform the main operations available within the
software, like changing the filters, starting and stopping the acquisition, etc.
2.3.1 AMPLIFIERS TOOLBAR
This toolbar displays the parameters of the traces. Sensi/Div, BandPass & Notch
Filters, Polarity inversion & Rectification, can be changed for all traces or only
for the selected trace. To select a trace, it is sufficient to highlight its "label" with
the mouse.
If one of the parameters of the toolbar is different for each channel, its general
display will be replaced by “*******”. To view the set value, it is necessary to
select each single channel.
In order to see all different value configurations (for each channel), select the
dedicated blue triangle on the lower right side of the trace area: a new additional
column (on the right side of the window) which shows the display configuration
will appear.

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If the polarity visualization of the selected channel is inverted respect to the

standard montage, the montage label of the left column of the trace will be
underlined.
The selection of the icon on the far left resets the selection of the traces. Thus
channels will be regarded as edited in batch mode ( ALL mode).
Parameter SensM specifies the multiplication factor of the "averaged" signal

(when present) as compared to the sensitivity of the signal in Real time.
Unlike other settings, filtering parameters Low Filter and High Filter can also be
edited through the related section of the Trace's settings.

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2.3.2 ACQUISITION TOOLBAR
This toolbar displays the commands that enable to start and stop the acquisition
and the averager, and to create a new "trial".
This button starts and stops the EP acquisition. If the averager is not
Run enabled (Media button not pressed), only the "Real" signal is
displayed.
This button starts the averager and displays a small window (see
following chapter). A second selection of the button closes the
Media averager window and resets the averager (the same conditions occur
even if averager window is closed). A "dialogue box" prompts the
operator to select whether to cancel the operation or continue.
This button temporarily pauses the acquisition leaving the stimulation
Pause
active.
This button clean the screen visualization and also reset the average
Clear
accumulators.
This button allows to add a new "trial" to those that have already been
Next acquired. The type of stimulation and the related parameters can be
changed between the end of one trial and the beginning of a new one.
NOTE
The Clear facility allows also to select manually the desired average of the channel
which to be deleted ( see next first figure). There is also the possibility to delete the
entire channel from the trace area y simply press the right click of the mouse
pointer on the left column of the trace area (see second next figure.).

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2.3.3 GENERAL TOOLBAR
This button allows to measure the contact impedance of the acquired

electrodes. The measured value is represented by means of a colored
circle that can either be green (good), yellow (average) or red
Ohmete (excessively high impedance). The Montages tab will be used to show
r the impedance check: bipolar channels impedance check legend will
be green circle ("+"= ref electrode, "-" = active electrode) near the
palette color bar .The appropriate scale (horizontal palette color) will
be displayed on the lower part of this window.
This button displays a window where it is possible to set the

Stimul
stimulators and edit the stimulation parameters.
2.3.4 MACRO TOOLBAR
This toolbar displays the commands that enable to manage the EP preset (Macro),
the markers and measures (Measure), the mathematics and the post-processing
(Tools.), and the maps (Map).

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2.4 LOWER TOOLBARS
The lower toolbars are displayed below each window within the main Control
Panel. These toolbars are mainly constituted by indicators, which are always
displayed in the foreground, and by the general settings of the trace configuration:
• Current date and clock time
• current time base of the selected channel
• current delay
• stim link
• trace scroll
• current macro
The button in the center, labeled Stim., displays a window that allows to quickly
access the electric, flash and acoustic stimulators, thus facilitating the operations
of the operator who can decide to immediately edit the stimulation level.
Electric stimulator Flash LED stimulator Acoustic stimulator
Toolbar Exam allows instead to quickly browse, during the replay phase, the "EP
Traces" of the "EP Exam" currently loaded.

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2.5 SCREEN AREA

The "screen area" may display several "child" windows, each with a specific
content and function.
2.5.1 WINDOWS TRACES
This window displays the traces. The left section of the window shows the labels
of the traces. The window can be "resized" with the mouse by dragging the
borders or corners with the mouse.
Single labels can be selected by clicking them. At this point, all the properties can
be individually edited through the "Main Toolbar". It is also possible to perform
multiple selections (by selecting with the mouse pointer the single labels while
pressing key CTRL).
Select and drag a label to move the corresponding trace up and down.
By double clicking the "label" area of the traces, it is possible to display the
Trace's settings control panel and in particular the Montages section that allows
to view and/or change the montage configuration of the electrodes and the
association of the channels on the head of the acquisition equipment.
A new column on the right side of the trace area will show the main scale
representation (time base, Sensitivity/DIV for the single trace, sensitivity factor
for the average) for each channel simply by clicking the dedicated blue triangle
which is located on the lower right angle of the trace viewer.

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Right click the traces area to display the pop up menu described in the sections
above.
By using the mouse pointer and simultaneously selecting a specific trace with the
right button (also during the acquisition phase), it is possible to insert a short
comment on the selected trace (this feature is not available on the trace viewer for
EP Trending exams, but has been implemented on the trend viewer).
By keeping key CTRL pressed and simultaneously selecting a trace, it is possible

to display a window named Fast measures that allows to quickly control the
amplitude and latency values of the trace markers under examination.
NOTE
The Fast Measures panel control will be available only in case of Run Mode; in
replay mode the same operations used for Fast measure will open the standard
Measure sheet window (see next figure).

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2.5.2 AVERAGE WINDOW
This small window displays when the averager is active (the averager can be
enabled or disabled by selecting button Media on the Acquisition toolbar). It
allows to edit the parameters for the number of "accumulations" that have to be
performed and for the rejection threshold (level).
The window displays the number of "responses" successfully accumulated in

indicator Counter. Indicator Rejected displays the accumulated responses that do
not fall within the rejection threshold.
Buttons Real and Media enable to display or hide the real time and averaged
signal.
In case of non standard examinations, which requires a double counter both for
accepted and rejected trials (P300, ERP/CNV), the average window will appear as
below:
Exam Left indicator Right indicator
P300 Frequent stimulus Rare stimulus
ERP/CNV S1 stimulus S2 stimulus

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For your notes:

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CHAPTER 3
MANAGING PRESETS
3.1 GENERAL
All the parameters used for acquisitions can be managed through an additional
control panel that integrates the windows described in the previous chapter. This
control panel is called Trace's settings.
NOTE
The Trace's settings window is displayed automatically when EPNT is started,
minimized and placed in the lower left section of the EPNT control panel.
The set of these parameters can be stored in a structure called Macro that can be
assigned a specific name. A Macro can be called at any time by pressing a button
or selecting it from the list with the mouse.
Window Trace's settings displays several "pages" (panes or tabs). Each tab
contains the parameters related to the acquisition configuration.
The tabs included in the panel are:

• General
• Montages
• Amplifiers
• Stimulators
• Macro
• Raw Data (available only for BE and BE Light family devices)
NOTE
On the right upper side of the same Trace's settings panel control a string (e.g.:
"BE40") which shows the real system configuration ("device" + "stimulator") is
shown. That's useful in order to identify all tab parameters and find if the system
does work with the correct existent devices. This string is also showed in replay
mode.
To "build" a new macro, it is necessary to set all the "general" (baseline, type of
exam, etc.), the amplification and montage parameters, and the stimulation
parameters, and save them after assigning to the new macro an appropriate name.
Alternatively, it is possible the save the new data on an existing macro that will
therefore be changed.
Managing Preset 3-1

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For this reason, it is advisable to start from an existing macro and change only the
parameters that differs to the new macro from the source one and save it with a
new name.
The sections here below provide an explanation of each page displayed in this
window.
3.2 GENERAL TAB
Tab General groups all the main management parameters for the type of exam to
be performed.
3-2 Managing Preset

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3.2.1 ACQUISITION
The Acquisition section allows to set the control values like the Time base and
the Delay related to the trigger when present.
The Time base allows the user to choose the range (in milliseconds) of the time
interval that provides a better display of the potential evoked for the selected
exam. Available Time Base values are shown on the table below.
NOTE
The table below refers to the real matching between timebase and sampling rate.
These parameters are useful only in case of devices which uses raw data modality:
BE and BE Light families. Other old headboxes does not support completely this
table.
Sampling Rate [Hz]

BE/BE LIGHT
128 256 512 1K 2K 4K 8K 16K 32K
1 ▲
2 ▲ ▲
3 ■▲ ▲ ▲
5 ■▲ ■▲ ▲ ▲
7 ■▲ ■▲ ▲ ▲
10 ■▲ ■▲ ■▲ ▲ ▲
20 ■▲ ■▲ ■▲ ■▲ ▲ ▲
Time Base [ms]
30 ■▲ ■▲ ■▲ ■▲ ▲ ▲
50 ■▲ ■▲ ■▲ ■▲ ■▲ ▲ ▲
70 ■▲ ■▲ ■▲ ■▲ ■▲ ▲
100 ■▲ ■▲ ■▲ ■▲ ■▲ ■▲ ▲
200 ■▲ ■▲ ■▲ ■▲ ■▲ ■▲ ■▲
300 ■▲ ■▲ ■▲ ■▲ ■▲ ■▲
500 ■▲ ■▲ ■▲ ■▲ ■▲ ■▲
700 ■▲ ■▲ ■▲ ■▲ ■▲
1000 ■▲ ■▲ ■▲ ■▲ ■▲
2000 ■▲ ■▲ ■▲ ■▲
3000 ■▲ ■▲ ■▲
5000 ■▲ ■▲
■ Available configuration only for BE family devices
Legend
■ Default configuration only for BE family devices

▲ Available configuration only for BE Light family devices
▲ Default configuration only for BE Light family devices
The Delay option enables instead to set a maximum of 5DIV (in partitions of the
time base) in pre and post trigger in the Traces window. A vertical bar displays to
indicate the exact time when the trigger event occurs, if this function is enabled.
Managing Preset 3-3

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3.2.2 AVERAGE
The Average section allows to set the values of controls like the Preset and the
possible Rejection level related to the amplitude of the acquired signal. In
addition, for standard EP exams (like acoustic, electric, visual exams) there is the
possibility to manage differently the odd traces respect to the event ones. In order
to do this the Odd/Even checkbox must be enabled: in this case (like P300
protocols) each channel will have two averages, one for the Odd trial, one for the
even trials (an additional comment will be included on each averaged trace).
The Preset represents the number of set traces on which the average will be
calculated, while the rejection level is an amplitude filter that enable to reject
from the calculation of averages those traces whose amplitude value is above the
defined parameter, up to a maximum of 10DIV (partitions of the set sensitivity) .
3-4 Managing Preset

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3.2.3 WATERFALL
The section Waterfall allows, if enabled, to show a cascade number of traces for
each channel. This number is configured by using the appropriate control. In
addition, there is the possibility to manage the trial elaboration directly with the
spacebar of the pc: in this case the simple pressing of this bar will automatically
close the trial and will start to perform the next average.
3.2.4 EXAMINATION
The sub-window Examination allows to select the type of recording for the
evoked potentials that have to been performed.
The system displays a series of standard recordings like Acoustic, Somatosensory,

Visual, BAEP Waterfall and other types of recordings that requires the
configuration of additional parameters in function of the stimulation that needs to
be performed, for example P300 , CNV, ERP/CNV and EP Trending.
NOTE
Particular examinations will be described deeply in separated chapters and
appendices:
• Chapter 6: EP Trending
• Appendix A: P300
• Appendix B: CNV
• Appendix C: ERP/CNV
There is also the possibility to manage as well any eventual external stimulator
(use in this case the External examination).
In the latter only a sub-window named Stimul. will be displayed above the
Examination, showing additional controls.
Managing Preset 3-5

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The sections here below provide a brief explanation of the types of examinations
available:
Acoustic/Somatosensory/Visual
These are "standard" examinations. The selection of these

options does not significantly affect the remaining
parameters (as the type actually depends on the stimulator
used) but is required and used only for classification
purposes (within the database management).
BAEP Waterfall This examination is used to determine the hearing

threshold, as it enables to record a set of BAEP tests
(from 2 to 9, defined in the section related to acoustic
stimulators) with a stimulus level that decreases in Steps
of dB SPL value configured in the Decr. control (defined
values : 5,10,15,20).
P300 The selection of this type of examination displays P300

Stimulation.
A frequent and rare stimulation can be selected (along

with the related parameters) by pressing buttons “[…]“ in
the P300 Stimulation window.
The shortest and longest interval (in milliseconds)

between two frequent and rare stimuli is set by means of
the ISI control related to the rare stimulus. The F/R ratio
value, which can be defined by the user, represents the
average value of the ratio between frequent and rare
stimuli at the end of the examination. The preset refers to
the number of rare stimuli.
By subtracting "off-line" the result attained for the rare

stimulus from the one evoked by the frequent stimulus,
you attain a negative value, the so-called Mismatch
Negativity MMN (typically present for acoustic stimuli).
This value is not affected by the attention performance and
can therefore be used to study the memory and
discriminate stimuli. It can be calculated using through
section Tool
3-6 Managing Preset

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CNV The selection of this type of examination will display the

Cognitive stimulation window. To select the Warning and
Conditioning stimulator (along with the related
parameters), it is sufficient to click buttons “…“ in the
Cognitive stimulation window. Parameters ITI (Inter-
Trial-Interval) e ISI (Inter-Stimulus-Interval) can be set
using the related controls provided.
ERP/CNV The selection of this type of examination will display the

ERP/CNV stimulation window. To select the S1 and S2
stimulators (along with the related parameters), it is
sufficient to click buttons “…“ in the ERP/CNV
stimulation window. Parameters ITI (Inter-Trial-Interval)
e ISI (Inter-Stimulus-Interval) can be set using the related
controls provided.
Managing Preset 3-7

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EP Trending The selection of this type of examination displays the EP

trending stimulation window. The use of a
neurophysiological monitoring (for example during
surgery) enables to accurately detect the temporal trend of
some characteristic parameters that the surgeon requires to
diagnose potential cerebral disturbances. The monitoring
of the potential evoked signals usually takes into account
the variation, in terms of latency and amplitude, of the
first two components found on the trace (that are taken as
reference model or template, for example N20-P25) and
compared it with the "base" evaluation attained at the
beginning of the monitoring. It is possible to monitor up to
a maximum of 4 channels and set an alternate stimulation
in order to allow the operator to decide which channels
have to be assigned to one stimulus or to both.
3.2.5 SPLIT SCREEN
The sub-window Split screen enables the operator to reduce, both in run and
replay mode, part of the Traces window while leaving unaltered the sensitivity on
the remaining part of the screen. This tool is useful for acquired potentials that are
known to have a high amplitude in the first milliseconds from the stimulus, and
for which the response of the following milliseconds, with a lower amplitude, is
far more important. This tool enables to correctly select the sensitivity on the
basis of the desired potential amplitude without the visual disturbance that is
typical of a high initial response.
The figures below show an example (that is purely indicative) of a trace before
and after the enabling of option Split screen.
3-8 Managing Preset

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The Traces window displays a vertical hatched bar to indicate the temporal
separation between the current sensitivity (on the right) and the attenuation (on
the left).
Managing Preset 3-9

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3.3 TAB MONTAGES
The graphic interface of this tab is designed to facilitate the setting of an electrode
montage aimed at recording the evoked potentials. The window is organized so
that the electrodes can be viewed on the head along with their potential positions
(referred to the 10-10 system) on the head.
The montage is built by selecting with the mouse the first electrode followed by
the second one of each trace.
All the operations performed are displayed in table Traces, in the lower section,
where the first column corresponds to the Montage performed and the second
column to the Label that needs to be placed.
To simplify the work of the operator during the montage phase, it is possible to
reference the electrode of the head to a 10-10 ( 10-20) system position, by
selecting it with a right click of the mouse. The system displays a table showing
the correct positions (see the electrode list below).
3-10 Managing Preset

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The arrangement of the head in the upper right of the window reflect the actual
arrangement of the head on the acquisition unit. The first column of electrodes,
named with the first letters of the alphabet, corresponds to a bipolar montage,
while the remaining 32 electrodes, identified by means of numbers, correspond to
a single-pole montage.
During the montage phase, it is always possible to automatically reference all the
electrodes to the same reference by selecting the related check box next to the
single-pole montage side or by using button “RF” (or "NE") in the same position.
Each available device will show a different head pinout. Here below some
existent EP configurations are displayed, which show the channels enabled to be
used for EP recordings. Numerical inputs are considered as monopolar channels;
Alphabetical inputs are considered as bipolar channels.
BE LIGHT / MMS BE 25 CH / MMS BE 40 CH / MMS
WB 32 CH / MMS MYTO 4 CH MYTO 2 CH
Managing Preset 3-11

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NEMUS 2
The left section of the window displays the following three items:
• Map
• Name
• Connections
Each of these displays the user-defined montage in a different way.
NOTE
For Nemus 2 device the bipolar montage does not contemplate together EMG
channels and EP monopolar channels.

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3.3.1 MAP
The “small head” displays as free the electrodes used for the montage, while the
“head” shows the actual associations with the 10-10 (10-20) system.
Traces shows the number of traces acquired, the montage carried out and the
associated label.
In case of EP Trending examinations, the Traces sheet increase its columns:
• Standard stimulation → [ Montage | Label | Trend ]
• Alternate stimulation → [ Montage | Label | Trend | Stim A | Stim B]

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The Standard Stimulation will give the possibility to use available stimulators of
the existent system; in this case there is the possibility to chose the channels for
trend analysis (up to 4 trend elaborations)
The Alternate Stimulation is available only in case of double electric MMS unit:
in this situation the only showed stimulator configuration board will be the
electrical board; in this case there is the possibility to chose the channels for trend
analysis (up to 4 trend elaborations), and the their stimulus relation.
3.3.2 NAME
The “small head” displays the actual positions of the electrodes associated to the
10-10 (10-20) system, while the “head” shows the relation between the actual
position of the electrode on the skin of the patient and the number of electrode
associated to the “small head”.

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3.3.3 CONNECTION
The “small head” displays as free the electrodes used for the montage, while the
“head” shows the connection between the electrodes and the actual montage.

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3.4 TAB AMPLIFIERS
This tab enables to set and edit the amplification parameters of each acquired
channel. Both single and multiple selections are available. All the changes apply
only to the selected channel/s.
The left side displays a pane containing all the controls related to the
amplification parameters, which will be briefly explained in the sections that
follow.
3.4.1 SENS/DIV
The Sensitivity parameter is related to the amplitude of the displayed evoked

potential signal. It is possible to set a general value in the “scroll down bar”
ranging between 5 μV and 2 mV:
Sensitivity/Division [Volt]:
[5 μ, 7μ, 10μ, 14μ, 20μ, 50μ, 70μ, 100μ, 200μ, 500μ, 700μ, 1.0m, 1.4m, 2.0m ]

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3.4.2 SENSM
SensM is a control related to the amplitude sensitivity of the average signal

generated, which can by multiplied by 2n ( n=1,..,7) according to the actual value
of the potential.
[x1, x2, x4, x8, x16, x32, x64, x128 ]
3.4.3 LOW & HIGH FILTERS
If set, this option applies a pass-low filter in the configured domain (time or
frequency), which is selected from the list of values set in the “scroll down box”.
If set, this option applies a pass-high filter in the configured domain (time or
frequency), which is selected from the list of values set in the “scroll down box”
3.4.4 NOTCH
If enabled, it disables from the display of the signal the range of frequencies
within 50 and 60 Hz that are typical of electric mains.
3.4.5 RECTIFY
If enabled, it makes the possibility to change the polarity of the part of the trace
under the baseline.
3.4.6 POLARITY
It enables to decide whether to display the signal as it is acquired (“Normal”) or

as a negative signal (“Inverted”).

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3.4.7 CHANGE FILTERS
The selection of button Change filters opens a new window with two columns and
a check box where it is possible to customize the parameters by selecting up to a
maximum of 12 frequencies for high and low filters, according to the settings
deemed more appropriate.

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3.5 TAB STIMUL.

Tab Stimul. enables to set all configuration parameters related to stimulation. The
stimulation types available are:
• Electric
• Acoustic
• Flash
• Pattern
• External
3.5.1 ELECTRIC STIMULATOR (SOMATOSENSORY)
Managed by two stimulators (Stim A and Stim B), this case only appears on fully
configured MMS unit. It is possible to set, for each of these, the duration of the
impulse (expressed in μs, in an overall range of [5,1000] with steps of 5 μs) and
the stimulation frequency ( Rate in ms, in an overall range of [100,10000), with
steps of 1 ms).
The level of intensity of stimulation ranges from 0.0 to 100 mA. For electric
stimulation, it is also possible to control directly the stimulation (see Lower
TOOLBARS in the previous chapter).
In order to create dedicated presets both for upper and lower side stimulation
(which have different sensitivity), a configurable "current safe" limitation is
available in this tab: Minimum and Maximum intensity stimulations and step
variation are configurable.

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3.5.2 ACOUSTIC STIMULATOR
In the left side of the window, the user can select the mode for acoustic
stimulation: Click and Tone.
The selection of these options allows to enable respectively the "Click" and
"Tone" sections.
3.5.2.1 Tone
The waveform that contains the tone (or tone envelope) can either be Linear or
Sinusoidal. The user must also configure the following parameters:
Frequency [Hz]:
[250, 500, 750, 1K, 2K, 3K, 4K, 6K, 8K]
Plateau [ms]: it corresponds to the duration of the stimulus and is within the [0,
200]ms range, with 1 ms steps.
Rise Fall [ms] It corresponds to the envelope (linear or sinusoidal) of the tone
signal, that is to the rise and fall time of the tone. It can be value within the
maximum range of [0,100] ms, with 1 ms steps.

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The figure below show a tone with sinusoidal envelop by way of example.
3.5.2.2 Click
The parameters that need to be set in Click mode are the Duration of the impulse
(in a range of [50,1000] μs, with 10 μs steps) and the polarity (Compressed,
Rarefied or Alternate).

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3.5.2.3 General
Section General on the right side enables to set the stimulation rate (Rate, in a
[10,1000]ms range, with 1 ms steps) and the Level of the stimulus (in a [0,132]dB
SPL range with 1 dB steps).
For acoustic stimulation, it is also possible to control the stimulation level directly
(see Lower TOOLBARS in the previous chapter).
3.5.2.4 EARPHONE
Section Earphone determines the mode by which the stimulus is presented to the
headphone, with or without masking noise. This section offers also the possibility
of setting all the possible combinations for Noise and Signal for each acoustic
channel. If the masking noise is used, there will be also another section in which
the user can select the intensity in dB SPL ([-40,+10]dB range with dB steps) and
the type of noise to employ. For Pink noise it is also necessary to set the filter
disabling frequency.
New facility is to allows also pneumatic earphones: in this particular case the
delay due to the propagation of the sound in the air is calculated by the insertion
of the aero-tube (cm).
The applied used formula is the following: the rate propagation of the sound in the
air is equal to 340 meter/second.
With this new value ( which is the real transmission delay) we are able to
synchronize as well the trigger of the signal in order to obtain standard evoked
acoustic potentials.

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3.5.2.5 BAEP
Section BAEP is used for "BAEP Waterfall" EP examinations (see sections

above). It enables to determine the number of decreasing steps that need to be
acquired (from a minimum of 2 to a maximum of 9). It's also possible to set the
step dimension of waterfall (in dB SPL) within this set: [5, 10, 15, 20] dB
3.5.2.6 Test
Button Test enables to active stimulation example every time the settings are
changed.

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3.5.3 FLASH STIMULATOR
The user can set the stimulation Rate (in a [20,1000] ms range with 1 ms steps)
and the Pulse Width (in a [1,20]ms range with 1 ms steps).

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3.5.4 PATTERN STIMULATOR
This tab allows to set and change the parameters related to the Pattern stimulation.
There are two independent Frames for the stimulation, which can be selected by
means of the related check box.
The window is mainly divided into two parts: the left part refers to the pattern
stimulation mode, while the right one displays the tools that can be used to create
and display a preview of the pattern stimulation frames.
A pattern stimulation is generally a stimulus whose average luminance remains

unaltered in time.
Luminance can be briefly be regarded as the component of the video composite

signal that contains information on the black and white signal of the TV screen.
Average luminance influences the form of the response evoked by the potential
and more specifically the amplitude, producing significant differences on the
latencies of the response peaks. The first increases while the second decreases as
the average luminance increases.
For this reason, it is very important to make sure that the average luminance is
calibrated accurately. The electronic controls on the monitor are usually non
linear while the contrast introduces variations in terms of luminance.
Parameter Contrast is a control that is displayed on the left side of the window
and is defined by the following formula:
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Lmax − Lmin
Contrast =
Lmax + Lmin
Where Contrast is the contrast and Lmax and Lmin the maximum and minimum
luminance. For the control, it is also possible to set a percentage contrast as
compared to the defined contrast, with a variation ranging from 10 to 100% and
variation steps of 10% (respective range [1,10], with 1). Another important
parameter is the Distance of the visual stimulator of the patient, which is
expressed in cm and has a range that can be set between 70 and 170 cm. To obtain
a correct stimulation angle (and the related spatial frequency) it is also necessary
to set the Screen size for the screen used in the pattern stimulation.
Monitor Dimension [inches "] Distance [cm]

13 94,59
14 101,87
A
15 109,14
17 123,70
19 138,25
21 152,80
Squares
Visual Angle [']
H V
15 64 48
B
30 32 24
60 16 12
90 10,66 8
Not
Pattern Monitor Resolution has been fixed as 640x480
e
Table above describe as well standard Visual angles (B) which are use in clinical
visual stimulation protocols. For each visual angle the table will shows one
possible configuration by taking into account all elements of the equation (A)
(e.g.: pattern monitor dimension, patient distance, …)

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In order to give an additional quick help, four main standard visual angles are
available ( after the selection of the relation monitor dimension) on the dedicated
"predefined angle" section.
Parameter Angle varies according to the distance and the size of the screen.
Spatial frequency is also a parameter that depends on other parameters

(Distance, Screen Size, Angle). It is expressed in cycles per space unit, where the
space unit is represented by a view angle.
Parameter Rate corresponds to the stimulation frequency. It indicates the

frequency with which the stimulation frame changes. It can be set within a range
of [100,10000) ms with steps of 1 ms.
Select check box Mask: to apply to the frame to display a circular mask so that
the fixation area of the pattern stimulation can be reduced.
Select Fixation point: to decide whether to display or hide the fixation point. This
point can be resized and positioned in any point of the screen.
The other sections on the left of tab Pattern of stimulators are related to the
Trigger and Stimulation.

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3.5.4.1 Trigger
Select parameter T to generate a trigger every time the same frame (for example
for alternate stimulation with two independent frames) is displayed. In this case
the trigger is generated for every pattern stimulation period. If T/2 is selected, the
trigger will be generated for each frame change, equivalent to half of the
stimulation period.
3.5.4.2 Stimulation
Set mode Inverted to display only the frame A . The stimulation frequency is
related only to the frame that will alternated with its opposite.
Set mode Alternate to perform the stimulation by alternating the two frames A
and B defined by the operator.
In Alternate mode, any eventual change of palette colors into a frame ( A or B)

will automatically impose the same palette color in the other one.
The right side of tab Pattern is related, as explained above, to the building of the
frame/s that will be used in the actual stimulation phase.
The larger pane provides a preview of the screen that will be used (as with graphic
editors) to draw the figure with the tools around it.
The screen can be divided in several ways by selecting the ring box in the upper
left of the Preview window. Possible configurations are:
Full, Midfield X, Midfield Y, Quadrant.
Full corresponds to the full screen, which means that the screen is not divided into
sections; Midfield X and Y respectively indicate the vertical and horizontal
partition of the screen, while Quadrant offers the operator the opportunity of
dividing the screen into four parts.
At this point, it is possible to change the division into quadrants or half-screens by

press the button with the arrow symbols
The system displays in the preview one (or two) red bars that delimit the selected
section. The bar can be dragged by pressing the mouse pointer.
If the fixation point is enabled, it is also possible to move the read point with the
mouse to any position on the screen or easily resize it.

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The fixation point can be moved to a specific location on the screen, exactly in the
center of the quadrants or of the screen itself. To do so, it is sufficient to select the
related option in the pop up menu that displays when the right button of the mouse
is clicked on any area of the screen.
A graphic bar, divided into several parts, displays above the Preview window.
The drawing tools is represented by four icons, each representative of a typical

morphology, like full screen, chessboard, horizontal and vertical bars. The full
screen configuration prevents the color inversion from being applied during the
stimulation phase.
If the sinusoidal icon is selected, the variation of the colors in the pattern will
have a sinusoidal shape (only in grayscale, the palette color is disabled in this
situation), passing from the first to the second color instead of being distinctly
separated (this applies only to bars and strips).
The user can also use a palette by selecting the bucket option.
At this point, the system enables the vertical menu bar where it is possible to set
two colors from 16 available. Checkbox Inv enables to invert the combination of
colors set while checkbox Σ creates a specific color resulting from the average of
the two defined ones.
NOTE
If more quadrants are selected, it is also possible to associate to each of them a
different combination of colors by enabling the bucket symbol.

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Button Apply enables the operator to check if the built frame is compliant also on
the stimulation screen, which applies the settings entered by the user.

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3.5.5 EXTERNAL STIMULATOR
It is also possible to set a stimulator other than the MMS stimulator provided
with the machine.
The external stimulator must generate both the stimulus and the trigger that will
be acquired by the recording unit for the segmentation of traces and the formation
of the related averages.
NOTE
For Mizar units, it is necessary to use an appropriate cable to interface the
stimulator and system.

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3.6 MACRO
The set parameters can be saved into an existing Macro or in a new one.
To save the parameters in an existing Macro, it is necessary to select with the

mouse the name of the Macro from the first column in the table and press button
Save.
To create a new macro, it is necessary to select the last line (empty) of the first
column, enter the name of the macro configured and press Save to store it in
memory. To delete the macro, press Delete.
Press Save. The second field displays a table next to the newly created macro and
a label that describes the type of examination to which it refers with the aim of
facilitating the use of macros.
At this point, it is sufficient to press button Load to recall the created macro and
use it to record an EP monitoring.
The Control Panel displays with two subwindows. The left one displays the traces
to acquire while the right one corresponds to the acquisition trends.
The default macros relating to BE PLUS acquisition module are related both to
the mask of “10-10” system and to the mask of “10-20” system applied on the
amplifier, with the prefix “B+(10-10)” and “B+(10-20)” in the name to
distinguish them to the other used with previous amplifiers (Basis BE, Be-Light).

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NOTE
The spectral characteristic of the BAEP signal doesn’t allow to use the hardware
Be Plus for this kind of EP, since the maximum sampling frequency of 4 kHz
(bandwidth 1 kHz ) is not sufficient to analyse properly the signal.
During BAEP recordings with the hardware NeMus 2, it is suggest to use EMG
bipolar channels because of their larger bandwidth in comparison with monopolar
channels.
NOTE
The maximum number of channel managed by the EP software is 64, so with Be
Plus configurations is used only the Master Be Plus, to which both the optic fiber
and the power supply have to be connected.
3.6.1 DEFAULT MACRO
It is possible to set a default macro that the program of evoked potentials

automatically selects every time it is started. This features has the advantage of
facilitating the execution of frequent examinations because it enables to right click
the item that displays when a specific macro is highlighted.

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3.6.2 IMPORT/EXPORT MACRO
It is possible manage the macro showed on the list of the current system and also
the macros which are included in external systems. The import/ export
functionality allows to transfer the selected macro very easily. Only the
compatible macro from the source system to the target system will be rally
transferred and then used in order to EP examinations..
The Import procedure allows to select the desired path and the filename of the
macro presets.
The Export procedure allows to select the interested macro from a dedicated list
and the to chose the final path.

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3.7 RAW DATA
This tab is showed only in case of BE and BE Light families, which use the raw
data modality.
Each montage already created will be configured separately ( in in different

closed groups) in order to select amplifier's settings like :
• coupling (AC/DC)
• Fmax ( see the relative table at the beginning of this chapter)
• Time base (each montage accept different time base respect to the other
montages)
• Dynamic Range

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For your notes:

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CHAPTER 4
MEASURES AND PROCESSES
4.1 GENERAL
This chapter describes the application tools that enable operators to perform
mathematical and graphical measures and processes on the acquired traces.
These functions are available on the Elaboration toolbar section of the main bar.
Measures and processes 4-1

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4.2 MEASURES
The section dedicated to Measures can be divided into two subparts, respectively
used during the acquisition and replay phases.
4.2.1 FAST MEASURES
During the trace acquisition it’s possible to perform Fast measures that provide
information on the latency and amplitude of two markers and their related
differences.
Markers can be placed on the screen by pressing CTRL while selecting with the
mouse the point of the trace where the marker has to be inserted.
After the insertion of a marker, a small windows displays on the right of the trace
area. The window shows the latency and amplitude of the two markers along with
the differences in terms of latency (dLat) and amplitude (dAmp).
4-2 Measures and processes

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The first time, this operation enables to insert the first marker, while the second
time it enables to insert the second marker. If the operation is performed a third
time, the first marker is again repositioned and so on.
Once they have been positioned, markers can be moved by dragging the small
"boxes" situated close to the lower and right borders of the trace area. Drag boxes
"L1" and "L2" to move the markers along the time axis or boxes "A1" and "A2"
enables to move the markers along the amplitude axis.

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NOTE
The acquisition in progress will not be affected by measures. The screen will be
updated as soon as the mouse button is released.

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4.2.2 POSITIONING MARKERS
To perform the measures, it is necessary to press the button with the same name.
The system displays a new panel next to the Traces window, which contains an
empty spreadsheet with several fields (Trace, Label, Lat., Amp. and Area) and
additional selectable buttons.
To enter a marker, it is sufficient to follow the procedure described for the Fast
measures detailed in the paragraph above. Upon completion of the operation, a
new marker with a default label will be inserted.
The position of the marker can be adjusted more accurately by dragging it with
mouse. The related label can be changed by pressing button Label and by typing
the new label.
NOTE
If the marker has been set in the current macro, it is possible to select button
Measures on the related toolbar to automatically place a series of markers on the
desired traces and display the corresponding measures in a window on the right of
the trace viewer.

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4.2.3 EDITING MARKERS
To adjust the position of the markers, click the marker to edit and drag it to the
desired position. The information displayed in window Measure will be
automatically updated.
To delete a marker, select the line in the measure table and press button Clear.
Button Clear all to delete all the markers.
To enter a differential measure press button Differential, then select the lines of
the table of the measures for which the differential has to be calculated. The
result, which shall also include the label, will be shown on the first line below
these lines.
It is also possible to calculate ratios between differential measures that have

already been calculated. To perform this calculation, press Ratio, then select the
lines of the table of the differential measures. The result, which shall also include
the label, will be shown on the first line below these lines.
Press button Space to enter an empty line, which can be useful to separate sets of
measures. The same line will be displayed in the ratio.
NOTE
The Measure function is not completely available in case of EP trending exams. N
this particular case only the “Fast measures” functions are able to be used, and
the clinical report will not include these parameters.

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The section on the right below tool Measure displays a button named TRC related
to the recorded traces. This button allows to move the measures performed up to a
specific interval of time within a trace to the next trace, within a marker position
range [-1/2DIV.+1/2 DIV]. This enables the operator to easily and quickly
identify the traces that contain the most significant marker measures.
Select button Report to decide which of the calculated measures must be entered
in the medical report of the patient.
The Measure window will display on the left of the table a column of check boxes
where it is possible to decide whether to enable or disable the report-related
measure.
Select button Save/Restore to display a new section of the Measure window.

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NOTE
If the acquired trace does not have any stored macro on the current system, the
“Save/Restore” operation will automatically save both the macro and the
measurements. This feature is useful in case of imported traces from external
softwares (e.g. Back Averaging).
Option Restore enables to reapply the saved markers to the current traces and
ignore all the changes made after the saving operation.
Markers and measures can also be saved within the current macro by pressing
button Save. Button Cancel enables to return to the ordinary Measure window.
Once the user has defined the desired set of markers and labels, the content of the
screen (traces + marker) can be saved in the file containing the current trace by
selecting button Save exam from the File menu (or by right clicking any point of
the Traces area and selecting Save exam from the pop up menu).

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Measurement of Area.
The user has the possibility to choose the calculation modality of the area
subtended by the trace between two markers.
With the checkbox in figure (“Unbiased Area”) it is possible to chose if in the

calculation the amplitude values are obtained subtracting the amplitude of the first
marker, or if it is used the absolute values respect the base line of the traces: in the
former method the summation of the differences between the amplitude of each
point and the amplitude of the first marker is calculated, while in the latter the
amplitude of each point respect the base line are accumulated (in absolute value).
With the check box marked the result is the following:

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Without the mark in the check box the result is the following:
The setting used for the calculation is not linked to the file but to the program
interface, so the last modality set in the interface is proposed at the next reopening
of the program.
It is also possible to show the calculated area, enabling or disabling this function
with the combination SHIFT+A

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4.3 TOOLS
This section allows to perform a series of mathematical operations and selections

on the acquired traces.
Select button Tools to display a processing tool next to window Traces.
Press one of the buttons displayed in the lower section of the tool to display a
brief comment on the operation of the command.
The sections here below provide a brief explanation of each item of the Tool.
menu.

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4.3.1 TRACE SELECTION
This feature allows to manage as well the trace selection in order to apply any
kind of elaboration is available on the Toll panel control.
It will be possible to use the standard buttons for the whole trace selection (press
“All”) and its inversion, or to select the traces by using their particular properties:
• Type of trace (single trial, average, grand average, rare avg, frequent
avg)
• Numerical sequence
• Any comment applied on each single trace
4.3.2 SMOOTHING
This option enables to apply a low-pass filter to the selected traces. Select one or
more traces, then press [ + ] to perform a series of smoothing operations in
sequence or [ - ] to return back by one step.

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4.3.3 ARITHMETIC
This option allows to add or subtract traces acquired with the same montage.
Select the first trace, the desired operator ( + or - ), the second trace of the
same montage, then press Enter ( ).
The Traces window displays the result of the operation performed.

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4.3.4 GRAND AVRG
Among the traces acquired with the same montage, select those on which the
grand average operation must be performed. Press button Enter ( ) to obtain
the related "Grand Average".
In this situation there are two different modalities to do average:
• Weighted:
o the system will take into account the number of trials of each
average (si) as bias (wi) in order to obtain the proper correct grand
N
∑w ⋅s i i
average: S avg = i =1
N
∑w i =1
i
• Raw:
o The system will consider each average selected as weight “1” in

∑
N
s
order to compute a standard arithmetical average: S avg = i =1 i
N

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4.3.5 BASE LINE
This option allows to display, for the montages of the Traces window, the
horizontal lines corresponding to the isolectric lines of the traces (lines can also be
changed at any time).

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4.3.6 TRACE’S COLOR
This option allows to change the color appearance of single trace or a group of
traces by using the dedicated “trace selection” listbox or by using a manual
selection of the traces with the mouse pointer. In order to chose the desired color,
press the dedicated “Enter” button.
After the colour application, any trace which have the selected properties will be
showed with the newest colour.

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4.3.7 TRACE’S STYLE
This option allows to change the style appearance of single trace or a group of
traces by using the dedicated “trace selection” listbox or by using a manual
selection of the traces with the mouse pointer.
The available styles are showed on the dedicated section of the Tool window
when the Trace’s style button is pressed.

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4.3.8 CLEAR
This option enables to selectively delete some traces.
Select the traces to delete by highlighting them with the mouse or using one of the
dedicated buttons (Avrg, MedRare, GrMed, MedFreq, ..), then press button
Enter to delete the desired traces.
NOTE
Dedicated buttons are useful because they enable to select traces with the same
characteristics. For P300 recordings, buttons MedRare and MedFreq are used to
respectively select rare and frequent averages.

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4.3.9 UNDO
Button Undo restores the traces in their original condition.

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4.4 MAP
If at least 8 channels (electrodes) have been acquired, it is possible to represent the

potential acquired in the form of a 3D map, with different view angles and in
function of different positions of the trace.
The selection of button Map displays a cursor in the Traces window and a new
window that shows the 3D map of the potential referred to the point of the trace
highlighted by the cursor.
The map is updated when the cursor is moved by dragging the mouse.
The lower section of window Map enables to select the desired color range (Gray,
Red/Blue or Rainbow).
In each chromatic scale it is possible to invert the color of the map. The inversion
of the color in the potential map can be enabled\disabled in the following way:
with the map window opened, the right click on the map area or on the panel of
the chromatic scales allows the visualization of the command “Invert Color
Palette” to select\deselect the inversion.

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The Interval scale is calculated automatically unless the Manual box is not
"unchecked". In this case, the user can specify the minimum and maximum values
of the scale.
If the current exam is a P300 exam, section TRC enables to choose whether to
build the map on the data related to the frequent and rare stimuli.
To view the potential in all its aspects, it is possible to rotate the head by dragging
any point of it with the mouse. The head can be enlarged or reduced by using keys
"+" and "-" on the numerical keypad.
Press the button representing a camera to copy the map in its current format
(snapshot) into the right column.
It is possible to save up to 10 different snapshots. To delete the last snapshot,

press button Clear.
The button for the snapshot of the map allows to save in the right column the
corresponding map, with the indicated trace name (with a number of characters
limited to 4, if this is the length of the label, or up to 3, with the character “..”
added, if the length is more) and the latency value. Selecting the snapshot the
cursor in the trace area will be placed with the corresponding latency value.
To view all the snapshots, use the scroll bar on the right of the table listing the
snapshots.

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Press the icon representing the printer to open the image management program set
in Windows (for example Paintbrush). The system displays an image containing
all the snapshots along with the traces and the cursor showing the point of the
trace to which the snapshots are related.
The image can be printed (or processed) using the ordinary commands of the
image management program.

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NOTE
The name visualized in the title bar and on the snapshots is the name of the trace
in the first channel.

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For your notes:

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CHAPTER 5
EP GRAND AVERAGE
5.1 GENERAL
Besides recording standard evoked potentials, it is also possible to perform a
statistic operations on the EP exams acquired such as the Grand Average
operation.
In brief terms, statistics consists in a survey method that enables to estimate or

infer, to use statistical jargon, the characteristics of a whole "population" by
observing those of a limited number of individuals that are chosen as "samples".
The theory of probability is the mathematical tool used in this field, as it enables
to estimate the characteristics of a sample randomly selected from a known
population.
The quality of the measure, that is its reliability, varies in function of the
procedures used to take the sample. It is instead necessary to make sure that the
conditions in which the measures are repeated are maintained consistent to
guarantee that the element to be measured and consequently the population of the
measured results remain stable in time.
In our specific case, the EP Grand Average mainly consists in performing an

arithmetic average (as if we were using a consistent and efficient estimator) of all
the EP traces recorded and selected for the patients examined in order to study
particularly significant elements for research purposes.
The statistic relevance of the EP Grand Average lies in the fact that it enables to
group traces with consistent acquisition characteristics and montage settings (or in
other words traces that have been measured using the same macro for recording
purposes) in order to attain a new trace that provides information on the
variations, in terms of latency and amplitude, related to the most significant peaks.
These results can then be compared with the values of the individual patients.
For further information on the topic, please read the following sections that
provide more details on the steps that have to be performed to be able to
immediately and correctly use the EP Grand Average.
EP Grand Average 5-1

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5.2 CREATING AN EP GRAND AVERAGE

Creating a new EP Grand Average trace implies following the same procedure
described for EP traces, which means creating a virtual patient with the
characteristics of the traces related to him.
5.2.1 ENTERING A VIRTUAL PATIENT IN THE ARCHIVE
A simplified procedure enables to create a new patient in the Galileo NT's

database and to simultaneously create an EP trace without taking into account the
options and features made available by the database.
This procedure has already been described in the Quick Start section in Chapter 1
of this Manual (the sections below show a simulation by way of example).
5.2.2 SELECTING TRACES IN THE ARCHIVE AND CALCULATING THE EP

GRAND AVERAGE
After creating a new virtual patient, it is necessary to access the Data list of the
Patient Management System (PMS), and select the desired EP traces by right
clicking them with the mouse.
The system displays a pop up menu that enables to select/deselect the exams to
be processed (EP Grand Average) and filed.
Select option "Add this value to the process list" for the desired trace (the line will
turn to another color), performing the same procedure for all the other traces.
5-2 EP Grand Average

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Once the selection of the traces is complete, perform the same procedure to
acquire an EP trace.

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The procedure can only be performed if the patient is already present in the
database. For this specific example, we will be using the virtual patient created
above.
At this point, it is necessary to press button New data .
The window that displays enables to select the type of acquisition to perform.
Scroll the list as far as EP GRAND AVERAGE.
Click OK to continue or Cancel to cancel the operation.
The user will then be asked whether he wants to add the current selection, which
is related to the selected traces, to the selected group, which corresponds to the
virtual user created for the Grand Average processing.
Click Yes to continue or No to cancel the operation and return to PMS.
At this point the system opens the EPNT Control Panel where it is possible to
record the evoked potential traces.
NOTE
The hardware selection does not need to be set because the EP Grand Average is
substantially a post-processing process of traces that have already been acquired.

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If the user has not selected at least one EP Trace, EP BACKAVG, ERP Trace
or EP Grand Average trace, the system signals the error by displaying a warning
window and automatically closing the EP program.
The user can access the EP program directly that automatically opens the
overview window displaying all the traces examined.
NOTE
Traces that are not part of categories EP Trace or EP Grand Average are
automatically skipped and do not therefore appear in the overview of window
Traces.
Window Overview displays the traces that are not part of the macro selected as
reference for the Grand Average calculation in gray (as shown in the figure
above). It is however possible to set another macro as reference for the process by
selecting one of the traces of the list labeled with the desired macro.

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Right click the selected option. The system displays a pop up warning that
prompts the user to set the trace macro as reference macro for processing.
At this point, the system automatically enables the new traces connected with the
selected macro, displaying the remaining ones of the list in gray.

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The user can now choose which of the selected traces will be used to calculate the
Grand Average by simply displaying the overview and checking the desired lines
in the column of the list on the right of the window, below the summation
symbol.( ∑ )
Press button Calculate to perform the Grand Average calculation.
The result of the average calculation is displayed in the Traces area with a
different color as compared to ordinary traces.

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At this point the user can perform other measures, using the mathematical
function or the maps, and even save the EP Grand Average exam following the
instructions given in the previous chapters of this manual.
5.2.3 EXITING THE EP GRAND AVERAGE MODE
To exit the EP mode and return to Galileo NT's Database (in order to review
another trace or create new ones), select Exit from the File menu or click the "x"
in the upper right corner of the EP mode window.

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5.3 READING AN EP GRAND AVERAGE TRACE

From the Patient Management System (PMS) it is possible to select the EP Grand
Average for the virtual patient created in two different ways: by double clicking
the selected line displaying the patient or by pressing View data.
The EPNT window opens showing the results of the EP Grand Average
calculated in the Traces window.
By right clicking the Traces area it is possible to load both the EP Grand Average
and all the traces that were part of it.

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It is useful to notice that the overview window only displays the traces that have
been selected for the calculation of the Grand Average, along with the result of
the calculation at the end of the list (in a different color as compared to the
others).

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NOTE
EP Grand Average has both the characteristics of the EP EXAM and of the EP
Trace. During the reading phase, in the overview window, it is considered
equivalent to a trace with highlighted macro and recording types.
5.3.1 COUNTER SPECIFICATION
The EP Grand Average is calculated by accumulating the parts of the signal that
were part of the EP Trace average. This operation is done for each selected EP
Trace, taking into account the Counter value in the Average window.
A virtual accumulator is then used to accumulate all the traces that were part of
the EP Trace together with a counter that is the sum of the counters of the EP
Trace, in order to attain a true arithmetical average of the real signals.
This systems guarantees therefore the accuracy and significance of the resulting
Average (the EP Grand Average can be regarded as the actual arithmetical
average of all the real traces divided by their number).

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5.4 INCREASING THE SIGNIFICANCE OF THE GRAND AVERAGE

To increase the significance of the Grand Average it is possible to add new traces
to an existing EP Grand Average, save the exam with a new name or overwrite it
on the existing one.
This operation is possible, because, in mathematical and statistical terms, the new
EP Grand Average is calculated on the basis of the number of selected traces in
a manner similar to the one used to calculate a EP Grand Average consisting of
single EP Traces.
To perform this operation, it is necessary to select in the Data list of the PMS
Database the EP Grand Average whose significance has to be enhanced and
select the required EP Traces (or other EP Grand Average traces) with the same
characteristics (same source macro) of the Grand Average taken as new reference
for the processing.
NOTE
The procedures for the selection, creation and reading of a new processed value
are similar to those explained in the former sections of this chapter.

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For your notes:

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CHAPTER 6
EP TRENDING
6.1 ACQUIRING AN EP TRENDING EXAM
If the EP mode has been enabled (Acquisition or Replay), the screen displays the
main Control Panel called EPNT.
The Control Panel contains several items, specifically (from top to bottom) the
Menu Bar, the Toolbar and several secondary windows, the main is that called
Traces.
Click on Macro button to configure acquisition
EP Trending 6-1
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A new form called “Trace’s settings” appears, showing the Macro tab. This tab
enables to choose the acquisition mode.
It’s possible to operate in two different ways::
• Creating a new Macro of EP Trending;

• Loading an already existing EP Trending Macro.
6-2 EP Trending
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6.1.1 CREATING A NEW MACRO
Select General tab. This section allows to set several parameters related to the
selected acquisition.
In the “Examination” section select the EP Trending option.
The EP Trending stimulation section, will be automatically enabled. To manage

Alternate Stimulation, check the correspondent box.
EP Trending 6-3
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NOTE
The Alternate Stimulation modality is available only for electrical stimulators: in
this particular case the double electric option of the MMS unit is required (the
stimulator tab will show only the electrical stimulator board settings). If the
Alternate Stimulation checkbox is disabled, the stimulator tab will show all
available stimulators.
Click on the “Montages” tab to choose the channels to acquire
In the Traces table, (extended clicking the small arrow on the left) the user can
select for which channel to compute a trend, simply checking it on the “Trend”
column.
6-4 EP Trending
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NOTE
The remaining two columns of the Traces panel control are dedicated only for the
electrical stimulator of the MMS module. In case of alternate stimulation it’s
possible to choose which channel to relate to a specified stimulator (Stim A is
always the 1st that starts stimulation).
To configure the electric stimulation parameters open the Stimulator tab in the
Trace's setting window and select the Electric option.
EP Trending 6-5
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This section enables to choose the electric stimulator and the related following
parameters:
Parameters Range Step

Stimulation level [0.1 , 100 ] mA 0.1 mA
Min Stim level (user limitation) [0.1 , 100 ] mA 0.1 mA
Max Stim level (user limitation) [0.1 , 100 ] mA configurable
Pulse width [ 5 , 1000 ] μsec 5 μsec
Rate [100 , 10000 ) msec 1 msec
NOTE
In case of alternate stimulation, the configuration of both electrical stimulators is
required.
To save this configuration, open the Macro tab again and select the first empty
line in the macros list, using the pointer of the mouse.
Typing the name of the just configured macro in the first column and then click
on Save button to save it.
6-6 EP Trending
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NOTE
It's possible to change all the parameters of an existing macro and then save again
the macro, following the previous described steps.
After clicking the Save button, in the second column, nearby the name of the
macro, the type of the exam appears to making the macros management easier.
At this point, click on Load button to recall the just created macro.
6.1.2 LOADING AN EXISTING MACRO
To load an existing macro, select the Macro tab in the Trace's setting window.
Select the desired macro in the list using the mouse and then click the Load
button.
It's possible to control all parameters related to the loaded macro in the Trace's
setting window and changing those parameters which do not satisfy to the
requirements.
Then it's possible to save again the macro with the same name or create a new
macro.
Now it's possible to start the acquisition by pressing the Run button on the upper
toolbar.
In the left part of the EPNT control panel a Trace Area appears and displays one
or more trace segments (Traces), while in the right part a Trend Area appears and
shows the related acquisition trends.
EP Trending 6-7
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6-8 EP Trending
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6.2 ACQUISITION MANAGEMENT

Once acquisition starts, traces will be displayed by the program on the left
window of the Control panel, called Traces.
After an initial free acquisition (waiting for the signal to get steady), to start the
true recording of an EP trending, it is necessary to press the Average button, that
will show the related window. The signal average will be computed depending on
the Preset value sets in the Macro, and using the stimulator trigger signal to
separate the trace single trials.
Once the average has been created, the acquisition is temporarily suspended
("Pause" button enabled).
Now, the EP trending software automatically identifies, on the 1st averaged trace
of the Trace window, the most relevant waves (1A e 1B) corresponding to the
negative and positive variation of the acquired signal.
The automatic peak detection uses these components as Template to study and
check during acquisition, under the hypothesis that the detected peak is stable and
valuable (e.g.: N20 and P25 peaks for superior SEP exams).
EP Trending 6-9
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If the detected peaks does not match with the selected components of the
Template, it's possible to move the markers by using the mouse pointer.
Press the "Start" button to start acquisition.
From this point the acquisition management is controlled by the vertical bar on
the right side of the Trend window.
During the acquisition session, the program will acquire several traces (shown in
the left window) and automatically will auto detect the markers, whose variation
for latency and amplitude, is shown in the right panel ("Trend" window).
The Template, as trace to take as reference for the following traces, is now
created. From this point, the program, basing on the template markers, will look
for the main peaks in the following acquisition. The peak components will be
found normally within [-1/4Div ; 1/4Div] time range starting (as relative zero)
from the marker position of the previous trace.
6-10 EP Trending
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When the system detect correctly the peak a new graphic symbol will be
associated (with a different marker color for the first and he second peak).
If the peak-detector doesn't identify the wanted peak, the missing peak will be
associated to a different "named" marker waiting to move this in order to have a
good association for the trend.
In this case, before the Counter in the Average window reaches the Preset value,
the user can move the marker symbol (using the mouse) to a better position; if this
is not possible, the marker will be "loosed" with its corresponding trace, and its
symbol will be different.
NOTE
When the marker is not automatically detected, the system generates an acoustic
signal (beep) from the audio out of the computer, so to recall user attention.
The Trend window, during acquisition (and replay) will show the amplitude and
latency time-variation of the markers, starting from the correspondent template
values.
EP Trending 6-11
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Press the "Stop" button to stop acquisition. To save the recording: right-click with
the mouse on the Trace window, selecting the "Save exam" item, or use the same
item under the "File" menu.
If the recording is not good, before proceeding with a new one, cancel the
previous trace and trend using the "Clear" button.
NOTE
After the Stop acquisition it's also possible to continue the trending session by
using the Run button of the main menu of the epnt panel control: in this particular
case the system will ask if the user want to clean the trend viewer in order to reset
the ep trending session, or restart the acquisition starting from the previous trend
values in order to continue the existent session.
6-12 EP Trending
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6.3 CHECK THE EP TRENDS

During the trend session the user can introduce two different type of alarms,
related to particular Latency (ms) and Amplitude (%) threshold values of the
detected peak components respect to the template markers.
This configuration is available by selecting appropriate parameters in the

"Threshold type" section of the "Option" frame.
Alarm criteria is quickly described here below:
Latency Positive variation that should be controlled (expressed as difference,

in ms, from the template latency)
Amplitude Negative variation (expressed in percentage of the template

amplitude) that should be controlled
Once set these values, if during acquisition, one of (or both) the two parameters,
overcome its thresholds, for more than twice consecutively, a red flickering bar
will appear on the left of its trend graph.
In the figure below, an electrode has been removed from the head-box, and the
system realizes an amplitude decreasing, that under-runs the threshold value. This
situation is shown on the figure below.
EP Trending 6-13
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When this situation happens, the system insert a spot (“>!”) in the Navigator Bar
(upper part of the trend area)
This situation could be recovered in two different ways:

manually by user: clicking the red “Reset” button (this will be written in the
event bar, with a “Reset” spot);
automatically by the system: if the consecutive two values of the over ranged
trend does not overcome the threshold parameters (this will be written in the
event bar with this spot: “!<”).
6-14 EP Trending
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6.4 SCAN TRACES DURING ACQUISITION

In this contest it will be helpful the possibility to scan traces during the
acquisition and trend performing session.
With the “Scan” button (available only after the creation of the 1st trace) a cursor
appears on the Trend window, and - if pressed - the trace window will be splitted
in two separated windows: the “Trace” window (which shows the trend
elaboration of the acquisition session), and the “Scan” window (which shows a
little "replay" function allowing to scroll the performed trials with the
correspondent cursor position).
Here below a simulated data with the "scan mode during acquisition" is shown.
Different displacement of the Scan window, during recording, can be set in the
specific frame of the “Options” window, before starting the acquisition procedure.
EP Trending 6-15
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6.5 MAIN WINDOW ORGANIZATION

We are going to show you the main windows management.
6.5.1 TRACE WINDOW
In the “Trace” window, the selected channels in the Montages tab are visualized
with their specific labels. Like the standard trace viewer, any constraint about the
maximum number of trials to acquire is not introduced, but there is a limitation
concerning the trend window: up to 4 channel of the montage list are available
for trend elaboration.
The main description of the trace area is available on the chapter 2 (screen
organization) of this manual.
During the trend performing each channel which is related to the trend elaboration
will show the template trace in a fixed position followed by the real time trace and
below the trial cascade of the already acquired traces. There is limitation about the
number of waterfall trials; this value is set in the “Option” window, where, under
the “Trace waterfall” section, the user can choose one element within the list.
The waterfall trace number will take into account also the template trace, which is
distingued by a different color.
6-16 EP Trending
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On the right of every acquired trace there is the correspondent acquisition time
(which will be associated at the absolute or relative time, depending on the
“Time” section of the “Options” frame.
On the Template signal, in addition to the acquisition time there is also the
recording date.
For quick access to several functions, right click with the mouse on any point on
the Trace window: the pop up menu below will appear.
All elements of this list have been described on the chapter 2.
EP Trending 6-17
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6.5.2 TREND WINDOW
On the Trend window, for each selected channel, time variation for latency and
amplitude of specific peaks, found by the program and identified by proper
markers on the acquiring traces, are displayed. The scale representation for
latency and amplitude, in the corresponding graph is shown in the figure below.
This window is divided in two columns:
On the left column, amplitude and latency graphs are represented for every
selected channel (not more than 4). For every channel these trends are displayed
on a Cartesian graph, with different colors and in a different scale.
Before the Template creation, the Trend window is made of N vertical bars (N is
the number of selected channel) representing the two parameters, and no
horizontal line (the time axis) is present.
Once set the Template, the marker values will be used to fix the baseline of each
trend graph. This baseline will be taken as reference for the trend of both the
parameters. Amplitude and Latency template values, will be displayed under and
above the time axis, for each channel
NOTE
The X-range of the trend is limited by 260 traces (averages) computed during
acquisition. When this limit is overcome the program automatically enables the
“Stop” button and stop acquisition. Now the only thing to do is to save the exam
and exit the EP program.
6-18 EP Trending
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Over trend graphs there is a small event bar related to the trend acquisition.
The red triangles show when the template was set; if during acquisition or replay
mode Events and/or Comments are inserted then vertical black bars appear with
the corresponding text
On the right column we can find all the controls related to trend management,
setting and recording of EP trending exam (the correspondent icons are showed
here below).
Set:
This control allows to set the Template to be used as reference for EP trending.
This button is enabled only during the 1st trace acquisition, when user decides
(before the average count reaches the preset value) that the acquired trace is
adequate as template.
Pressing the “Set” button, acquisition will be temporarily stopped (“Pause”), and
the program automatically calculates the peak values, setting the related markers.
It is possible to adjust the marker positions, just dragging them with the mouse
cursor, to the desired position. “Set” button is automatically pressed when the
average count reaches the preset value, and it will be disabled for all the
recording.
6.5.3 ACQUISITION MANAGEMENT BUTTONS
Start:
It allows to start acquisition of EP trending.
Pause :
It allows to temporarily suspend the acquisition, and to start it again (by another
pression) with the same template.
EP Trending 6-19
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Stop:
It allows to stop definitively the EP Trending acquisition. It is automatically

pressed when the maximum number of traces has been acquired (260).
Clear:
It allows to cancel all the traces and trends of the recording.
If the Scan button is enabled, the Clear button is dedicated to remove the "blue"
selected trace from the trace area (and consequently the trend elaboration will be
upgraded).
6.5.4 TREND DISPLAY CONTROLS
Lat:
This control enables to change the latency sensitivity range, over all the selected
channels (using the up/down small arrows). This range goes from 0.25xTL to
10.00xTL (TL=template latency), with a step=0,25xTL.
To enable/disable the latency trend from the graphs it is necessary pressing the
“Lat” label in the center of this control.
Amp
This control enables to change the amplitude sensitivity range, over all the
selected channels (using the up/down small arrows). This range goes from
0.25xTA to 10.00xTA (TA=template amplitude), with a step=0,25xTA.
To enable/disable the amplitude trend from the graphs it is necessary pressing the
“Amp” label in the center of this control.
6.5.5 TREND MANAGEMENT BUTTONS
Scan :
This button is enabled in two different modalities:
• Replay mode
• Recording mode
6-20 EP Trending
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Replay mode:
When this button is pressed, a cursor appears and can be moved on the graphs
along the horizontal axis; the amplitude and latency values for that position is
simultaneously displayed, whether on the Trace Area all the traces scroll down
and the current trace is shown with a different color.
Recording mode:
When this button is pressed an additional "scan" window will appear with the
minimal functionalities of the standard scan window if the "replay mode".
With this new panel a preliminary overview of the recorded trials during the
trending elaboration will be possible, in base of he type of scan view is selected
on the dedicated "scan window" section of the "Option" frame (see the "Options"
paragraph of this chapter fro more details).
Events: When this button is pressed the following form appears .
When an event is generated (during acquisition or replay), it’s possible to insert a

dedicated comment in that related instant, by clicking on Comment button.
In the small event bar over trend graphs a vertical black bar will appear and it will
be possible to edit a short event description.
EP Trending 6-21
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The Set button (during acquisition or replay) allows to select the current trace as
reference for previous and successive traces.
In this case a vertical dashed bar will be displayed on all the graphs and will
indicate the new trace used as template. During a replay, to calculate again all the
trends, it’s necessary select a new template, dragging it with the pointer of the
mouse and then clicking the marker two times. A warning window displays and
enables to confirm or not the operation.
NOTE
This feature allow also to change the template for tre trend elaboration during the
recording session, by using the Stop button, change the reference template and
then press the Run button and choose to continue the recording starting from the
last one (e.g.: figure below).
6-22 EP Trending
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During the replay mode, to calculate again all the trends, it’s necessary select a
new template, dragging it with the pointer of the mouse and then clicking the
marker two times. A warning window displays to confirm or not the operation.
The Reset button allows to restore the template related to the first trace, ignoring
all the changes made afterwards
The Reset button allows to restore the template related to the first trace, ignoring
all changes made afterwards.
The ® button allows to insert a dedicated event in order to choose how many
instants are inserted for the report.
In this case all ® events found on the navigation bar of the Trend window will be
considered during the report procedure, and a picture with the trace window and
trend frame will be generated and imported for each selected instant.
EP Trending 6-23
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NOTE
For additional information about the dedicated EP trending report, see the report
paragraph.
Options: When this button is pressed, the following window appears:
In this window all the parameters related to the traces and trends display can be
defined.
In particolar:
• Whether the latency type is differential (obtained by difference between two
markers of the same trace) or absolute (time interval (msec) from the marker
to the event trigger).
• For the threshold value section see the paragraph 2.1.
• Whether the Time is solar (clock of the acquisition system) or relative (
referred to the template acquisition time).
• The number of the traces displayed on cascade in the Trace Area (waterfall
mode).
• Whether the Scan window is Overlay (fig. A -trace area is in background
respect to the Scan area during acquisition scanning), or Tile x (fig B1-B2- if
they are tiled vertically ), or Compress (fig C - see the figure below).
6-24 EP Trending
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Fig. (A)
fig (B1): Tile 1/2
EP Trending 6-25
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fig(B2): Tile 2/3
fig (C)
6-26 EP Trending
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6.6 TREND OPTIONS AND DEDICATED REPORT
6.6.1 MEASURE
during the replay, after the selection of the point of the trend where to add
measures (using the “scan” modality activated by the button “Scan” in the Trend
menu bar), it is possible to open the measure window to place the marker on the
trace clicking the button “Measure” in the Trace menu bar.
when the measures have been added, closing the measure window the program
asks to save them, corresponding the to instant selected in the trend. Saving the
measures, on the “Navigation Bar” placed on the top of the Trend window, a
marker as the following is inserted:
jointly, the window opened clicking the button “Events” in the Trend menu bar
shows a button with the same icon “±” on state ON.
EP Trending 6-27
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deselecting this button it is possible to cancel the measures saved for the instant in
the trend.
6.6.2 TREND EXPORT
In order to give the possibility to use the trend elaboration for external additional
purposes, the trend performance of the selected traces can exported in a standard
text tabulated file.
In order to do this, press the right button of the mouse on the Trend window and
select the "Export" operation.
The system will ask to choose the filename and the desired final path.
The final result will be the complete information of the trend values in three
different ways (each for all channels used for trend):
• Absolute values
• Relative values
• Percentage values
Each group will contains all elements of Amplitude, Latency and Area.
In the final part of the tabulated file additional parameters (one related to its
column) will be included, like:
• Min
• Max
• Mean
• Standard Deviation
6-28 EP Trending
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This file can be finally imported in a specified worksheet on order to perform

other operations (see below graph trends obtained by using Excel package).
EP Trending 6-29
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6-30 EP Trending
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6.6.3 DEDICATED TREND REPORT
This paragraph would be only and additional compendium of the standard report
elaboration of the EPNT software.
The Ep Trending exam allows to introduce on its dedicated report several frames
of the whole trend elaboration, simply by using the navigation bar of the Trend
window in order to select the interested instants to be imported.
In order to do this, the only way is to use the Scan button of the vertical menu bar
and move the time instant line on the trend viewer (see figure below).
Once a particular event was found during the manual scan, if this frame is
considered as useful for clinical reporting, then press the Events button and select
the ® symbol.
A new event will be included on the navigation upper bar of the trend viewer, and
the selected time interval (as picture with the trace are and the trend area) will be
included on the EP report.
Any eventual comment of the selected trace instant will be included on the report
if edited by using the Comment button on the Events section.
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NOTE
The comment function of the trace area in this case is not available because the
same function is transferred into the Comment trend viewer during the manual
offline scan mode.
The comment insertion procedure will be also used in order to remove from the
navigation bar the ® symbols and consequently upgrade the number of trend
instants to be imported on the clinical report.
6-32 EP Trending
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the button highlighted on the next figures allows to set the measures to be
exported in the report; before to create the report it is necessary to save the exam
In the “Navigation Bar” a new event is inserted, with the icon “±®”
and the events window shows the same icon “®” on state ON.
The exportation of measures in the report can be enabled/disabled also toggling

the button “®” corresponding to the instant of the trend with valid measures
(close the events window before proceeding to create the report).
It is necessary to save the exam in order to save all changes on the trend
(measures, export to report).
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For your notes:
6-34 EP Trending
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APPENDIX A
THE P300 PROTOCOL
A.1 GENERAL
The P300 (P3, Late Positive Component) response has been associated with a
variety of cognitive activities, including decision making, signal probability,
attention, discrimination, uncertainty resolution, stimulus relevance, and
information delivery. In fact, so many cognitive events have been related to P300
and other late waves. If one were to look for a common factor to which the
various cognitive activities associated with P300 were related, it would be
"information processing" (Donchin et al., 1983).
P300 is an electrophysiological response which appears at the end of a complex

cognitive elaboration sequence by the evocation of a stimulation paradigm and the
periodic presentation of the "expected" stimulus signal.
Standard literature use the terms Frequent for the standard stimulus, and the label
Rare for the random expected stimulus, which evoked the P300 potential.
The Latency of this potential is then the evaluation of the time occurred for the
patient in order to finalize the complete detection of the expected stimulus,
whereas the Amplitude depends of a probability of appearing (both objective and
subjective) of the stimulus and also "how many information" does it transmit at
the patient.
NOTE
Its important to verify that the subject has been understood the task to do (to
ignore the frequent stimuli and to detect the rare stimuli), because the P300
response requires a complete collaboration of the patient.
The P300 Protocol A-1

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A.2 STIMULI
The P300 component is widely independent to the stimulation modality, and it can
be obtained by using acoustic, visual or somestesic stimuli inserted in many
different stimulation paradigms.
For a "clinical use", the more simple stimulation paradigm used is the "OddBall"
paradigm, which is generally carry out by bi-aural acoustic stimulation.
P300 acoustic "OddBall" paradigm:
Sequence I.S.I [ms] Stimuli
Duratio Occurrence Intensity

Stimulation Type Freq [Hz]
n [ms] Probability [%] [dBHL]
Ton
randomized 1500-2500 F Acoustic 1000 50 70-80 65-70
e
Ton
R Acoustic 2000 50 20-30 65-70
e
Legend
I.S.I = Inter Stimulus Interval
F = Frequent
R = Rare (expected)
NOTE
For dB HL we intend the Hearing Level Threshold ( in dB scale ) of each patient.
Our Acoustic stimulators works with SPL (Sound Pressure Level) intensity scale,
so in order to have the correct value you must start at the lowest value (0 dB) and
rise up until the patient will hear the minimum acoustic signal, then we will able to
increment this relative "zero" intensity up to the value showed on the table.
A-2 The P300 Protocol

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A.3 P300 MACRO EXAMPLE

In order to make a P300 paradigm, you must start to choose P300 examination
into the General Tab of the Trace's Setting Panel control.
The selection of this type of examination displays P300 Stimulation.
A Frequent and Rare stimulation can be selected (along with the related
parameters) by pressing buttons “…“ in the P300 Stimulation window. (see figure
below)
The shortest and longest interval (in milliseconds) between two Frequent and Rare
stimuli is set by means of the I.S.I. control related to the Rare stimulus.
The "F/R ratio" value, which can be defined by the user, represents the average
value of the ratio between Frequent and Rare stimuli at the end of the
examination.
The Preset value into the Average section refers to the number of Rare stimuli.
The standard time base must include 100-200 ms "before-stimulus" and 700-1000
ms "after-stimulus".
The standard montage include 3 electrodes placed on the median line of the head
(Fz, Cz, Pz - using 10-20 system reference position), referred to a bi-auricular
electrodes, with the additional channel which is used for the ocular rejection
(EOG).

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The result of the P300 recording is similar to the following figure

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By subtracting "off-line" the result attained for the Rare stimulus from the one
evoked by the Frequent stimulus, you attain a negative value, the so-called
Mismatch Negativity MMN (typically present for acoustic stimuli).
This value is not affected by the attention performance and can therefore be used
to study the memory and discriminate stimuli.
It can be calculated using through section Tool

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APPENDIX B
THE CNV PROTOCOL
B.1 GENERAL
Steady Potential Shift (SPS), is the Contingent Negative Variation (CNV), first
described by Water, Cooper, Aldridge, McCallum and Winter (1964). The CNV
may be observed when subjects are told that they must respond to an event some
time after a warning signal is given.
One type of SPS, the CNV, has been found maximal over the central cortex and
less pronounced at frontal and parietal areas (Cohen, 1969). Simson et al. (1977)
confirmed that the later segment of the CNV is localized primarily over the
central cortex. Delineation of CNV generators is very complicated because these
slow negative potentials have contributions from sensory, motor, and association
cortex that vary in relative magnitude according to the nature of the stimuli, the
task, and motor response requirements. Large slow potentials (greater than 10 µV)
have electrical sources mainly in extended cortical regions. Sub cortical neurons
may contribute to activity measured at the scalp, but they account for only a small
part of a response. However, generators that are capable of triggering widespread
cortical activity may be located in sub cortical areas (e.g. thalamus or other brain
stem areas)
Typical method for obtaining CNV involves the presentation of a Warning

Stimulus (S1), followed within a fixed time period (Inter Stimulus Interval, I.S.I.)
by a second Conditioning Stimulus (S2) to which the subject responds. The S1
may be a light, S2 may be a tone. The interval between S1-S2 might be 1,5 sec.
The CNV is maximally recorded with a scalp lead at Cz (vertex) with an
appropriate reference site. An important consideration in the measurement of
CNV is the time constant (TC) used. The TC should be long with respect to the
physiological event being recorded.
One suggestion is that the TC should be three time the S1-S2 interval.
The CNV may be obtained by averaging of 6-12 combinations (trials) of S1 and

S2. Electrical potentials produced by eye movements and blinks are possible
sources of contamination on ERPs, especially the CNV. The measurement of
these potentials and exclusion of contaminated trials produces satisfactory results.
NOTE
Its important to verify that the subject has been understood the task to do, because
the CNV response requires a complete collaboration of the patient.
The CNV Protocol B-1

EP_NT
NOTE
The CNV protocol does not work with MYTO device and NeMus 2 device . The
Pattern stimulator is not available with this type of exam.
B.2 STIMULI
The CNV component is widely independent to the stimulation modality, and it

can be obtained by using normally acoustic and visual stimuli inserted in many
different stimulation paradigms.
For a "clinical use", the more simple stimulation paradigm used is the "standard"
paradigm, which is generally carry out by bi-aural acoustic stimulation and visual
flash stimulation.
CNV "standard" paradigm:
I.T.I I.S.I
Stimuli
[ms] [ms]
Stimulation Specification
W Flash 10 ms pulse
6500 1500
Tone 1000 Hz, 100 ms Plateau, 10 ms Rise/Fall, 500
C Acoustic
ms Rate, 65-70 dB HL intensity
Legend
I.T.I = Inter Trial Interval
I.S.I = Inter Stimulus Interval
W = Warning
C = Conditioning
NOTE
For dB HL we intend the Hearing Level Threshold ( in dB scale ) of each patient.
Our Acoustic stimulators works with SPL (Sound Pressure Level) intensity scale,
so in order to have the correct value you must start at the lowest value (0 dB) and
rise up until the patient will hear the minimum acoustic signal, then we will able to
increment this relative "zero" intensity up to the value showed on the table.
B-2 The CNV Protocol

EP_NT
B.3 CNV MACRO EXAMPLE

In order to make a CNV paradigm, you must start to choose CNV examination
into the General Tab of the Trace's Setting Panel control.
The selection of this type of examination displays CNV Stimulation.
A Warning and Conditioning stimulation can be selected (along with the related
parameters) by pressing buttons “…“ in the CNV Stimulation window. (see figure
below)
The time interval (in milliseconds) between two Warning and Conditioning
stimuli is set by means of the I.S.I.
The time interval (in milliseconds) between the Warning stimulus of the current
trial and the next one is set by means of the I.T.I.
The Preset value into the Average section refers to the number of Warning
stimuli.
The standard time base must include 300-500 ms "before-stimulus" and 3000-
5000 ms "after-stimulus".
The standard montage include 3 electrodes placed on the median line of the head
(Fz, Cz, Pz - using 10-20 system reference position), referred to a bi-auricular
electrodes, with the additional channel which is used for the ocular rejection
(EOG).

EP_NT

EP_NT

EP_NT
The result of the CNV recording is similar to the following figure

EP_NT
APPENDIX C
THE ERP/CNV PROTOCOL
C.1 GENERAL
According to the general information of P300 and CNV protocols (see Appendix
A and B), this new exam will only give the possibility to perform a little part of
complex stimulation sequences of event related potentials (ERPs).
For these reasons this new type of exam has been named "ERP/CNV".
This new exam will use the general rules of the CNV exam and the possibility
(from P300 exam) to obtain both the first and the second trace on the same
channel during the trial stimulation
One Trial (time interval which contains one periodic stimulation) involves the
presentation of a First Stimulus (S1) followed within a fixed time period (Inter
Stimulus Interval, I.S.I.) by a Second Stimulus (S2).
Each trial will be generated after I.T.I (Inter Trial Interval) milliseconds.
In order to perform properly this session, the followed contraints must be

considered:
Constraints: Legend:
• I.S.I = S2 - S1 Tb = timebase [ms]
• I.S.I. > Tb ITI = Inter Trial Interval [ms]
• I.T.I ≥ I.S.I + 2·Tb I.S.I. = Inter Stimulus Interval [ms]
NOTE
The CNV protocol does not work with MYTO device. The Pattern stimulator is not
available with this type of exam.
During The ERP/CNV exam session the trace related to the first stimulus will be
showed on the Area viewer with the additional comment "S1" and the trace
related to the second stimulus (after ISI ms) will be showed below the first one
with the additional comment "S2", in order to discriminate them.
The ERP/CNV Protocol C-1

EP_NT
For your notes:
C-2 The ERP/CNV Protocol

EP_NT
APPENDIX D
ERP EXAMS FROM BACK AVERAGING SW
D.1 GENERAL
This additional part has been developed in order to describe as well the
functionality of this "new" type of exam. The EPNT software allows to manage
both internal and external exams.
In this specific case, there is a dedicated link to the Galileo Back Averaging
software, which mainly allows to perform ERPs averages starting from cognitive
EEG recordings. In order to do this, a specific export from Back Averaging sw to
EPNT sw has been performed.
This possibility to export the ERPs traces will consider more features which are
included in the EPNT package:
• Measures
• Overlay trace
• Style and color change
• Report
• Many others…
ERP Exams from Back Averaging SW D-1

EP_NT
D.2 DATA TRANSFER PROCEDURE
Here below a dedicated section of the Back Averaging sw Operator manual has
been reported in order show how can we export the ERPs traces (see the figure
below: P300 potential) and save them on the Galileo Database.
The new type of exam, labeled ERP EXAM, have the same meaning of the
original EPNT type of exam (EP EXAM).
The data transfer procedure will take into account any compatibility control.
• channels
• sampling rate
• time base and pre-trigger values
• number of trials used to perform the average
The result will be the correct exported average on the EPNT viewer.
In order to do this we are two different modalities:
D-2 ERP Exams from Back Averaging SW

EP_NT
D.2.1 EXPORT THE SINGLE TRACE
With this procedure only the trace showed in the trace area will be exported and
displayed automatically on the EPNT viewer, by using the Measure button
on the main bar of the Back Averaging Sw.
During the transfer procedure, the system will import the trace into the database
(In this case a new ERP EXAM session and its ERP TRACE recording related
to the ERP GALNT trace will be generated.).

EP_NT
D.2.2 EXPORT ALL TRACES TOGETHER
With this procedure the whole ERP Galnt processed traces will be exported on the
Galileo PMS by using the “Export Averages to EPNT” item on the Trial menu
In this case a new ERP EXAM session and its ERP TRACE recordings, each
related to the ERP GALNT trace will be generated.
In order to all links between the original EEG GALNT trace and its elaboration,
select the EEG recording on the Galileo PMS and press the Data Info button.

EP_NT
In this case only the first tree level will be displayed. The same procedure will be
used to show additional links of the first level analysis of the EEG, like the ERP
EXAM session data info:

EP_NT
D.3 ADDITIONAL ERP INFORMATIONS

The transferred ERP TRACE will contains in the "comment" field of each channel
the label of the segmentation macro used on the Back Averaging SW, in order to
use this option to discriminate any eventual ERP trace overlay with other ERPs.
To distinguish the type of exam on the general tab of the EPNT viewer, the ERP
Trace will b considered as "External" exam.
The macro name of the ERP Trace will be (as the same meaning of the comment
field) the segmentation macro name of the back averaging software.
Any eventual Reaction Time shown on the ERP GALT trace will be automatically
copied and pasted on the Comment field of the ERP Trace.

EP_NT

EP_NT
In this modality the EP traces are saved with the name of the macro used for the
back-averaging macro, that usually include an indication of the trigger event, and
so they are not unique as in the case of the stimulus-related evoked potential; to
each trace corresponds formally a different EP macro.
It is necessary to create reference macros in which set the standard parameters

useful for a series of back-averaging elaborations (for instance the parameters
used for a “stroop test”), therefore this feature has been introduced with the
following steps:
- starting from a reference exam it is possible to create an EP macro with the

proper filter setting, sensibility, visualization parameters (trace inverted or
rectified) and measures
- this reference macro can be used to set automatically the same parameters
on all EP exams with the same characteristics.
This features avoids to repeat the same settings on exams of the same type, as it
were available.
To create a macro for the specific back-averaging group , the user can follow the
steps below:
1) open a reference exam in the EP program, and set the desired parameters and
measures.

EP_NT
2) save a new macro with a reference name (e.g. Template)
3) open an exam of the same type, on which it is necessary to apply the same
settings
4) Open the Macro Menu, select the reference macro (Template) and then press
the button “Apply”.

EP_NT
The settings of the template are applied on the new exam, so as the measures.

EP_NT
APPENDIX E
DOUBLE STEP ACQUISITION
E.1 GENERAL
The request to acquire a VEP exam comparing directly the stimulation of the right
eye with the stimulation of the left eye has guided the developing of a particular
type of test, that is realised generically in the following way: whatever is the
stimulator, the acquisition on maximum 2 channels can be divided in two sections
that allow to group traces in two different groups, in the same trace area.
This test is described below, considering a 1 channel VEP exam with the
following characteristic: the same full field stimulation is used in subsequent
times for the recording of VEP with only 1 eye open; only 1 acquisition channel
is used, the same for the stimulation with the right eye open and for the
stimulation with the left eye open; on the same trace area it is possible to record
several repetitions of VEPs with both the stimulations, with the possibility to
group the acquisitions for the right eye and the left eye separately; the two groups
have different label automatically (for example right and left)
E.2 CONFIGURATING DOUBLE STEP ACQUISITION

This exam can be done with the new test as following:
In the tab “general” of the macro preset there is a section named “Double Step”,
not available in the same time with the “waterfall” option. In this section there are
two editable fields, where it is possible to write for instance the label “dx” (right)
and “sx” (left). These labels correspond to two buttons added in the menu area of
the program user interface, and to the trace labels.
Double Step Acquisition E-1

EP_NT
The test preset follows the usual procedure of the other tests, and the setting up is
valid for the two steps: there is a limitation to the maximum number, (=2), of the
channels in the montage; a warning message appears saving the macro if more
than 2 channels are set.
E-2 Double Step Acquisition

Evoked Potentials For Galileo NT

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Galileo System

INFORMATION ABOUT THE MANUAL 1

THE GALILEO_NT ENVIRONMENT 1

CHAPTER 1 - QUICK START

1.1 GENERAL 1-1

CHAPTER 2 - SCREEN ORGANIZATION

2.1 GENERAL 2-1

Table of contents i-1

2.2.6.5 View/Hide seq. numbers 2-12

CHAPTER 3 - MANAGING PRESET

3.1 GENERAL 3-1

i-2 Table of contents

CHAPTER 4 - MEASURES AND PROCESSES

4.1 GENERAL 4-1

CHAPTER 5 - EP GRAND AVERAGE

5.1 GENERAL 5-1

Table of contents i-3

APPENDIX A – THE P300 PROTOCOL

APPENDIX B – THE CNV PROTOCOL

APPENDIX C – THE ERP/CNV PROTOCOL

APPENDIX D – ERP EXAMS FROM BACK AVERAGING SW

APPENDIX E – DOUBLE STEP ACQUISITION

i-4 Table of contents

INFORMATION ABOUT THE MANUAL

Information in this document is subject to change and revision without notice.

First edition: B8300031001 -Rev. A - May 2000

This manual is to be considered as a component of the equipment. When installing

In the event the Operator Manual should be ruined, incomplete or inadequate,

The official versions of the Operator Manual, of which EBNeuro is directly

Attention messages appear in the Manual with reference to the description of

For your notes:

THE GALILEO NT ENVIRONMENT

Galileo NT provides a structured environment for the management of several

This allows achieving an overall optimization, which leads to an unparalleled

Evoked Potentials testing is performed through the Galileo EP NT software,

For your notes:

In particular, the program has been designed to manage encephalic signals.

At a "patient/registered data" management level, the system employs a new and

• Traces (or Recordings ) • Patient Reports or Histories

In terms of Evoked Potentials, the smallest "unit" managed by the GALILEO_NT

An "EP exam" is instead an aggregation of data connected to the same patient,

Quick Start 1-1

1.2 ACQUIRING A NEW EP TRACE

An EP trace can be acquired in two different ways: by creating a new patient or

1.2.1 ENTERING A NEW PATIENT IN THE ARCHIVE

To access the archive, press the corresponding button.

1-2 Quick Start

Quick Start 1-3

At this point, the insertion of the patient in the archive is complete.

1-4 Quick Start

1.2.2 STARTING A NEW EP RECORDING FROM THE PATIENT MANAGEMENT

Select the patient to be associated to the new recording.

Click OK to continue or Cancel to cancel the operation.

Quick Start 1-5

1.2.3 RESUME AN EP RECORDING

The software allows to continue the acquisition of an EP EXAM previously

1-6 Quick Start

1.2.4 CONFIGURE/MODIFY THE STIMULATION PRESET

Quick Start 1-7

1-8 Quick Start

1.2.5 PERFORMING A NEW EP RECORDING WITH THE WIZARD (ASSISTED

The following panel displays.

1.2.6 ACQUIRING AN EP TRIAL