SPECTRALIS HRA User Manual Software Version 6.0

Transcription

SPECTRALIS® HRA
User Manual
Software Version 6.0
August 2014
© Heidelberg Engineering GmbH
Art. Nr. 97327-005 US.AE14
Corporate Headquarters
Heidelberg Engineering GmbH
Tiergartenstr. 15
69121 Heidelberg/Germany
Telephone: +49 6221 6463-0
Fax: +49 6221 6463-62
USA
Heidelberg Engineering, Inc.
1808 Aston Avenue, Suite 130
Carlsbad, CA 92008
Telephone: +1 (760) 536-7000
Fax: +1 (760) 536-7100
US Service Center
Heidelberg Engineering, Inc.
10 Reservoir Road, Unit 2
Smithfield, RI 02917
Telephone: +1 (401) 349-0500
Fax: +1 (401) 349-0504
email: info@HeidelbergEngineering.com
Internet: http://www.HeidelbergEngineering.com
© Heidelberg Engineering GmbH
Supplemental instructions
Please read this user manual and follow all precautions before using
the device and the software.
Mind all safety advices on the device and in the manual while operating the SPECTRALIS.
Heidelberg Engineering hereby declares that this product conforms to
the requirements of Directive 93/42/EEC of the Council of the European Community dated 14 June 1993 regarding medical products
(MDD 93/42/EEC).
Warranty
Disclaimer
If the device is unauthorized reconstructed, or opened by someone
other than an authorized service personnel, the warranty will be void.
HEYEXTM is a trademark of Heidelberg Engineering GmbH in the
United States and other countries.
SPECTRALIS MultiColorTM is a trademark of Heidelberg Engineering
GmbH in the United States and other countries.
SPECTRALIS® HRA+OCT, SPECTRALIS® HRA, SPECTRALIS® FA
+OCT, SPECTRALIS® OCT, SPECTRALIS® OCT with BluePeak,
SPECTRALIS® OCTPLUS, SPECTRALIS® OCTPLUS with BluePeak,
BluePeakTM Blue Laser Autofluorescence, TruTrackTM Active Eye
Tracking, AutoRescanTM, Heidelberg Noise ReductionTM, FoDiTM and
NsiteTM are either registered trademarks or trademarks of
Heidelberg Engineering GmbH in the United States and other countries.
Microsoft® Windows, Microsoft® Windows XP, Microsoft® Windows 7,
Microsoft® Excel and Microsoft® Editor are either registered trademarks
or trademarks of Microsoft Corporation in the United States and/or
other countries.
Intel®, Intel® CoreTM and Pentium® are either registered trademarks or
trademarks of Intel Corporation in the United States and/or other countries.
FireWire® and the FireWire Logo are registered trademarks or trademarks of Apple Computer, Inc., registered in the United States and
other countries.
This product is manufactured under one or more of the following patents: US 5,170,276; US 5,620,000; US 7,203,351; US 7,971,999.
© Heidelberg Engineering GmbH, Art. Nr. 97327-005 US
3
Table of contents
Table of contents
1
Preface....................................................................................... 8
1.1 How to use this User Manual.............................................. 8
1.1.1 Explaining Symbols.......................................................... 8
1.1.2 Explaining Identification Marks........................................ 9
1.2 Valid User Manuals for the Current Release.................... 10
1.3 Intended Use..................................................................... 10
1.4 Qualification of Personnel................................................. 11
1.5 Contraindications.............................................................. 11
1.6 Scope of Delivery.............................................................. 11
1.7 Third Party Hardware and Software.................................. 12
1.7.1 Isolating Transformers and Multiple Socket Outlets...... 13
1.7.2 Printers........................................................................... 13
1.7.3 External Devices............................................................ 14
1.8 Software Protection........................................................... 14
1.9 Technical Description........................................................ 14
1.9.1 Confocal Laser Scanning............................................... 14
1.9.2 Heidelberg Engineering Technologies........................... 15
1.9.3 MultiColor Scanning Laser Imaging (Option)................. 16
1.10 Precision of SPECTRALIS Measurement....................... 17
1.11 Heidelberg Eye Explorer Software Platform................... 18
4
2
General Safety Messages.......................................................
2.1 Patient Safety....................................................................
2.2 Data Security....................................................................
2.3 Equipment Reliability........................................................
2.4 Laser Safety......................................................................
20
20
22
22
25
3
Preparing for Examination.....................................................
3.1 The SPECTRALIS Device................................................
3.2 Switching the Device on and off........................................
3.3 Preparing the Device........................................................
3.4 Preparing the Patient........................................................
3.5 General HEYEX Settings..................................................
3.5.1 Setting Display Options..................................................
3.5.2 Setting Plug-Ins..............................................................
3.6 Accessing Software Information.......................................
26
27
28
29
30
31
32
33
33
4
Workflow.................................................................................. 34
5
Heidelberg Eye Explorer (HEYEX).........................................
5.1 Starting HEYEX................................................................
5.2 Graphical User Interface Database Window.....................
5.2.1 Tool Bar.........................................................................
5.2.2 Changing Display Options of Database Window...........
5.3 Graphical User Interface Image Viewing Window.............
5.3.1 Tool Bar.........................................................................
5.3.2 Changing Display Options of Image Viewing Window...
35
35
37
38
38
39
40
41
Table of contents
5.4 Creating a New Patient File..............................................
5.5 Selecting and Opening Patient Files.................................
5.5.1 Selecting a Patient File..................................................
5.5.2 Selecting a Single Examination.....................................
5.5.3 Selecting Multiple Patient Files......................................
5.5.4 Selecting All Patient Files..............................................
5.6 Searching Patient Files.....................................................
5.6.1 Quick Search.................................................................
5.6.2 Searching Patient Files from Today...............................
5.6.3 Advanced Search...........................................................
5.6.4 Loading Filters...............................................................
5.7 Starting a New Examination..............................................
5.8 Continuing Examinations..................................................
5.9 Deleting Patient Files and Examinations..........................
5.10 Patient Data....................................................................
5.10.1 Updating or Changing Patient Data.............................
5.10.2 Updating or Changing Additional Patient Data............
5.10.3 Updating or Changing Comments and Anamnesis......
5.11 Examination Data............................................................
5.11.1 Updating or Changing Examination Data.....................
5.11.2 Updating or Changing Diagnosis.................................
5.12 Updating or Changing Eye Data.....................................
5.13 Moving Images between Patient Files............................
5.13.1 Merging Duplicate Patient Files...................................
5.13.2 Moving Images Stored in the Wrong Patient File.........
5.14 Using the Lightbox..........................................................
5.14.1 Adding Images to the Lightbox....................................
5.14.2 Saving the Lightbox.....................................................
5.14.3 Removing Images from the Lightbox...........................
5.14.4 Deleting the Lightbox...................................................
42
45
45
45
47
48
50
50
51
52
54
54
56
56
57
57
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60
61
61
62
63
64
64
66
67
67
67
68
68
6
Touch Panel.............................................................................
6.1 Grafical User Interface......................................................
6.2 Selecting Acquisition Modalities........................................
6.3 Selecting Acquisition Settings...........................................
70
70
72
73
7
Acquiring Images....................................................................
7.1 Setting Default Acquisition Parameters............................
7.2 Unlocking Examinations....................................................
7.3 Graphical User Interface cSLO Acquisition Window.........
7.4 Preparing the Examination................................................
7.4.1 Selecting Acquisition Modes..........................................
7.4.2 Selecting a Fixation Light...............................................
7.5 Acquiring cSLO Images....................................................
7.6 Performing an Angiography..............................................
7.7 Injection Timers.................................................................
7.8 High Magnification Images................................................
74
75
76
78
80
80
82
84
88
93
95
5
Table of contents
7.9 Acquiring a BluePeak Blue Laser Autofluorescence
Image................................................................................ 96
7.10 Acquiring a Movie......................................................... 100
7.11 Acquiring a Composite Fundus Image.......................... 103
7.12 Acquiring a Composite 3x3 Fundus Image................... 109
7.13 Acquiring a Stereo Fundus Image................................ 110
7.14 Performing a Tomography............................................ 114
7.15 Acquiring MultiColor Images (Option)........................... 117
7.15.1 Acquiring MultiColor cSLO Images............................ 118
6
8
Analyzing Images..................................................................
8.1 Preparations....................................................................
8.1.1 Setting Viewing Preferences........................................
8.1.2 Adjusting Image Settings.............................................
8.1.3 Adjusting Monitor Settings...........................................
8.1.4 Window Options...........................................................
8.1.5 Accessing Image Information.......................................
8.2 Tools...............................................................................
8.2.1 Overlays.......................................................................
8.2.2 Zoom and Pan Mode...................................................
8.2.3 Rotating Images...........................................................
8.2.4 Expanding and Extracting Images and Movies............
8.3 HRA Image Thumbnails..................................................
8.4 Analyzing cSLO Images..................................................
8.4.1 Graphical User Interface Analysis Window..................
8.4.2 Analyzing ART Composite Fundus Images.................
8.4.3 Analyzing Simultaneous Fundus Images.....................
8.4.4 Analyzing Stereo Fundus Images................................
8.4.5 Analyzing Movies.........................................................
8.5 Analyzing MultiColor Images (Option)............................
8.5.1 Showing Selective Color Laser Images.......................
8.5.2 Graphical User Interface..............................................
8.5.3 Color Balance Presets.................................................
8.5.4 Analyzing Movies.........................................................
122
123
123
124
126
127
128
129
129
139
142
142
143
144
144
146
146
147
149
150
151
152
153
154
9
Reports..................................................................................
9.1 Customizing Reports.......................................................
9.2 Printing Reports..............................................................
9.3 Exporting Reports as Image Files...................................
9.4 “Overview Report” ..........................................................
9.5 MultiColor Reports (Option)............................................
9.5.1 MultiColor Selective Color Laser Images.....................
156
156
157
160
161
161
162
10
Processing Data....................................................................
10.1 Exchanging OD/OS.......................................................
10.2 Exporting individual Examinations as E2E Files...........
10.3 Exporting Multiple Patient Files as E2E Files...............
10.4 Importing E2E Files.......................................................
163
163
164
164
165
Table of contents
10.5 Exporting Pictures.........................................................
10.6 Exporting XML-Files......................................................
10.7 Exporting Movies..........................................................
10.8 Burning Exported Data onto a CD................................
10.9 Computing Mean Images..............................................
10.10 Computing Composite Images....................................
11
167
168
169
170
170
171
Data Backup.......................................................................... 173
11.1 Archiving Images.......................................................... 173
11.2 Retrieving Images......................................................... 173
11.3 Compressing the Database.......................................... 174
12
Troubleshooting....................................................................
12.1 Display Messages HEYEX............................................
12.2 Display Messages Acquisition Window.........................
12.3 Display Messages Analysis Window.............................
12.4 Display Messages Touch Panel....................................
12.5 Display Messages Power Supply..................................
175
178
178
180
180
180
13
Service and Cleaning............................................................
13.1 Service and Maintenance.............................................
13.2 Saving the Log Information to the Archive File.............
13.3 Cleaning and Disinfection.............................................
181
181
181
182
14
Disposal................................................................................. 185
15
Technical Specifications......................................................
15.1 Electromagnetic Compatibility.......................................
15.1.1 Guidance and Manufacturer’s Declaration.................
15.1.2 Recommended Separation Distances.......................
15.2 Regulatory Standards...................................................
15.3 Labeling........................................................................
15.3.1 UL Classification Mark...............................................
16
Terms and Definitions.......................................................... 195
17
Index....................................................................................... 198
186
188
188
190
191
192
194
7
1
Preface
How to use this User Manual
1
Preface
This chapter provides an introduction to this user manual, the device,
the Heidelberg Engineering technologies, and includes:
About this Chapter
▪
▪
▪
▪
▪
▪
▪
1.1
Explaining symbols and identification marks
Qualification of personnel
Intended use
Scope of delivery
Third party hardware and software
Technical description
Software configuration of Heidelberg Engineering products
This user manual serves as a reference guide for the
Heidelberg Engineering device. Read the entire user manual to gain a
full understanding of the device and the software. It is not necessary to
read all the chapters in chronological order. Begin with a topic of
interest. Follow the links and references included in the text for guidance to other chapters.
1.1.1
Explaining Symbols
Safety Messages
L WARNING
L CAUTION
NOTICE
Safety messages are indicated by symbols in this user manual. They
are marked by a signal word and a safety alert symbol indicating the
category of hazard.
Warning indicates a hazardous situation which, if not avoided,
could result in death or serious injury.
Caution with the safety alert symbol indicates a hazardous situation which, if not avoided, could result in minor or moderate
injury.
Notice is used to address practices not related to personal injury.
The symbol indicates helpful hints for using the device and the software.
Safety messages answer the following questions:
▪ What is the hazard?
▪ What are possible consequences of not avoiding the hazard?
▪ How is the hazard avoided?
8
Preface
1
Embedded Safety Messages
Embedded safety messages are integrated into procedures or into
other non-safety information. Integrating safety messages into procedures can be particularly helpful, as the safety message can be placed
at the step in the procedure when it should be followed.
 L CAUTION! This is an embedded safety message of the type "Cau-
tion".
The embedded safety message includes the use of a signal word, the
safety alert symbol, and the message.

This is an embedded safety message of the type "Note".
Procedures  The procedure is used for supporting the reader in completing a task.
 ...
Lists ▪ The list is used for structuring information.
▪ ...
1.1.2
Explaining Identification Marks
Code
Cross-references
Elements of the graphical user
interface
Code of for example the heyex.ini file is identified by monospaced
typeface: If DefaultDevice=-1 then the recently selected device is
being chosen as default.
Cross-references are identified by parentheses: (" Chapter number
"Title", p. number), for example ( Chapter 1.1.2 “Explaining Identification Marks”, p. 9).
Elements of the graphical user interface like buttons, window names,
or file names are identified by quoted italic font: Press “Next” to confirm.
Examples are identified by a gray background over the entire width of
the page.
Examples
Keys
Menu paths
URL
Keys are identified by their symbol:
+
Menu paths of the software are identified by quoted italic font. Each
menu item is separated by a backslash: “File \ Save as”.
Information available on websites is identified by underlined text:
http://www.heidelbergengineering.com
9
1
Preface
Intended Use
1.2
Valid User Manuals for the Current Release
The following User Manuals are valid for the current SPECTRALIS
software release.
User Manual
Article number
Revision
Anterior Segment Module
97363
005 et seq.
DICOM for SPECTRALIS and HEP
97453
001 et seq.
Nsite Analytics
97366
002
SPECTRALIS HRA
97327
005 et seq.
SPECTRALIS HRA+OCT
97326
008 et seq.
SPECTRALIS OCT
97328
005 et seq.
SPECTRALIS OCTPlus
97329
005 et seq.
Software Installation and Administrator Guide
97292
004 et seq.
RegionFinder
99273
006 et seq.
Scan Planning Tool
97389
004 et seq.
Ultra-Widefield Module
97446
004 et seq.
Wide Field Lens
97373
003 et seq.
1.3
Intended Use
The SPECTRALIS is a non-contact ophthalmic diagnostic imaging
device. It is intended for viewing the posterior segment of the eye,
including two- and three-dimensional imaging, cross-sectional imaging
(SPECTRALIS HRA+OCT and SPECTRALIS OCT), fundus photography, fluorescence imaging (fluorescein angiography, indocyanine
green angiography; SPECTRALIS HRA+OCT, SPECTRALIS HRA),
autofluorescence imaging (SPECTRALIS HRA+OCT, SPECTRALIS
HRA and SPECTRALIS OCT BluePeak) and to perform measurements of ocular anatomy and ocular lesions. The device is indicated as
an aid in the detection and management of various ocular diseases,
including age-related macular degeneration, macular edema, diabetic
retinopathy, retinal and choroidal vascular diseases, glaucoma, and for
viewing geographic atrophy as well as changes in the eye that result
from neurodegenerative diseases. The SPECTRALIS HRA+OCT and
SPECTRALIS OCT include a retinal nerve fiber layer thickness normative database, which is used to quantitatively compare the retinal nerve
fiber layer in the human retina to a database of Caucasian normal subjects; the classification result is valid only for Caucasian subjects.
The optional SPECTRALIS Anterior Segment Module is an accessory
to the SPECTRALIS HRA+OCT and SPECTRALIS OCT, and is indicated for imaging the anterior segment of the eye.
10
Preface
1
Scope of Delivery
1.4
Qualification of Personnel
The device is intended to be operated by professional users with
health care background and with experience in the operation of ophthalmic imaging and diagnostic equipment, for example clinical personal, physicians, ophthalmic photographers or optometrists. The
operator must have access to the user manual, the enclosed relevant
security information and maintenance details comprising proper handling, utilization and the operation of the medical device.
To support continuing education on their equipment,
Heidelberg Engineering offers regular live and online training courses
for clinicians, researchers, photographers, technicians and office staff.
For further information, view the Heidelberg Engineering Academy program at http://www.heidelbergengineering.com.
1.5
Contraindications
Absolute contraindications
There are no known absolute contraindications for the use of
SPECTRALIS for diagnostic imaging.
When using fluorescence dyes, follow the instructions given on the
contrast agent package insert.
Relative contraindications
Photosensitive Epilepsy
While no such event was reported to Heidelberg Engineering worldwide, it is a known fact that flickering light with frequencies in the range
of the SPECTRALIS imaging frame rate can trigger epileptic seizures
in sensitive persons.
Typically these incidents are triggered if both eyes are exposed to the
light source, where during a SPECTRALIS examination only one eye is
exposed. However, particularly in imaging modes with clearly visible
light sources like MultiColor, FA, and BAF, explain to each patient that
the light is very bright and flickers. Discontinue the examination if there
are any signs of epileptic symptoms.
1.6
Scope of Delivery
The following components are included with the purchase of a
SPECTRALIS device:
▪ SPECTRALIS camera head with camera guide with break, camera
mount piston, slide, and screws
▪ SPECTRALIS instrumentation base
▪ SPECTRALIS power supply
▪ SPECTRALIS standard lens with cover and wooden box
▪ SPECTRALIS touch panel with cables
▪ External fixation light
▪ Two FireWire cables
▪ Dust cover
▪ USB software dongle
▪ CD containing operation software Heidelberg Eye Explorer (HEYEX),
Acquisition Module and Viewing Module
11
1
Preface
Third Party Hardware and Software
The following manuals are included with the purchase:
▪ SPECTRALIS User Manual, this document
The following power supply cord is included with the purchase:
Component
Manufacturer
Model
Technical Specifications
Standard
Power supply cord
Various
Various
125 V, 10 A, Hospital Grade, SJT
18AWG
UL817
Various
Various
Type H05VV-F 3G 0.75 mm2 or
IEC 60227
H05VV-F 3G 1.00
16 A
mm2,
<HAR>, 250 V,
The following components are available as optional accessory:
Component
Manufacturer
Model
Standard
Footswitch
Steute
Medizintechnik
KF
1S-MED
25 VAC, 60 VDC, IPX5, max. 30 VA
IEC
60601-1:2005
PC
Various
Various
100-240 V, 50-60 Hz, 7.5-3.5 A , max.
load 500 W
UL 60950-1
LCD monitor
Various
Various
100-240 VAC, 0.68-0.29 A, 50/60 Hz
UL 60950-1
Keyboard
Various
Various
5 V, 50 mA
UL 60950-1
1.7
L CAUTION
If software and/or hardware that has not been approved by
Heidelberg Engineering is installed on the device, bad image
quality and device failures may occur.
 Do not install third party software and/or hardware that has not
been approved by Heidelberg Engineering.
A device failure and bad image quality may lead to wrong diagnostic conclusions which may result in wrong therapeutic
approaches. Under some conditions the device could cause an
electric shock that might have a serious impact on the patient's or
the user's health.
L CAUTION
12
All external devices connected to the device must comply with
the standards IEC 60601 or IEC 60950.
Preface
1
1.7.1
Isolating Transformers and Multiple Socket Outlets
L WARNING
Incorrect use of isolating transformer or multiple socket outlet.
 Only use an isolating transformer or multiple socket outlet as
specified in this user manual.
 If the system was installed with an isolating transformer or multiple socket outlet, always make sure that all parts of the system
are connected to the isolating transformer or multiple socket
outlet.
 Do not change the correctly installed system.
 Do not put the isolating transformer or the multiple socket outlet
on the floor.
If the system is operated with a non-conforming isolating transformer or multiple socket outlet, this could cause an electric
shock that might have a serious impact on the patient's or the
user's health.
The isolating transformers shall have a degree of protection not
exceeding IPX4.
Make sure that the total power consumption does not exceed the
specified electrical power output for the isolating transformer as indicated.
For the installation of the system, it might be necessary to use an isolating transformer or a multiple socket outlet. If an isolating transformer
is necessary to limit leakage currents of system components to acceptable levels according to IEC 60601-1 it must conform to IEC
61558-2-1, except that the requirement of degree of protection IPX4
does not apply, or to IEC 60601-1:2005. If a multiple socket outlet is
used, it must conform to the requirements of IEC 60601-1:2005.
For an UL conforming system configuration, select the following isolating transformer:
1.7.2
Line Voltage
[V]
Model
Capacity [VA]
Manufacturer
115
MED R 3rd
1,000
REO Inductive
Components
AG
Printers
The device can be operated with any standard and Windows compatible color laser printer.
In order to ensure safe operation, please note that printers must have
CE and/or FCC approval.
13
1
Preface
Technical Description
1.7.3
External Devices
The device can be operated with the following external devices:
▪ USB hub
▪ USB storage device
▪ External DVD drive
In order to ensure safe operation, please note:
▪ USB hub and storage device must have CE and/or FCC approval.
▪ USB hub and storage device must be powered from USB port only.
1.8
Software Protection
Fig. 1: Software protector (dongle)
The software protector (dongle) (Fig. 1) must be connected to either
the USB port of the PC the camera is connected with or to the PC that
has access to the database. On this PC, the Heidelberg Engineering
License Manager must be installed.
Heidelberg Engineering recommends to connect the dongle with a
USB 2.0 port.
The software protector (dongle) must remain connected at all times
while operating the device. For further information, please contact your
local distributor or Heidelberg Engineering.
1.9
1.9.1
Confocal Laser Scanning
For acquiring digital confocal images, a laser beam is focused on the
retina. The laser beam is deflected periodically by means of oscillating
mirrors to sequentially scan a two-dimensional section of the retina.
The intensity of the reflected light or of the emitted fluorescent light at
each point is measured with a light sensitive detector. In a confocal
optical system, light reflected or emitted outside of the adjusted focal
plane is suppressed, resulting in high contrast images.
Furthermore – especially during indocyanine green angiographies
(ICGA) – the confocal optical system acquires a layer-by-layer threedimensional image. This system allows clinicians to image patients
with poorly or non-dilated pupils, which is especially important for diabetic patients who do not dilate well and make up a large proportion of
patients in a retina clinic.
14
Preface
1
Fluorescence dyes are excited in relatively narrow wavelength bands.
Using a laser is the most efficient way for excitation, since all the
energy is concentrated at one specific wavelength rather than in a
broad continuum as with ordinary flash photography light.
The SPECTRALIS requires considerably less retinal light exposure
than photographic systems, thus allowing for safer and more patientfriendly examination.
The laser sources of the device emit laser light with four different
wavelengths:
▪ A blue laser diode with wavelength 486 nm is used to excite the fluorescein or the intrinsic autofluorescence. A barrier filter at 500 nm separates excitation and fluorescence light. The same wavelength without
the barrier filter is used to create red-free images, also called blue
reflectance images. The SPECTRALIS is also capable of high quality
BluePeak autofluorescence imaging.
▪ A diode laser at 786 nm wavelength is used with a barrier filter at 830
nm to separate excitation from fluorescence in the retina using indocyanine green dye.
▪ A diode laser at 815 nm wavelength produces infrared reflectance (IR)
images.
▪ A diode laser at 518 nm wavelength (Option).
When using simultaneous imaging modes, each image line is scanned
individually by each laser. For example, during simultaneous fluorescein and indocyanine green angiography, only the 486 nm laser is
switched on for the first scan of a line, while during the second scan
only the 786 nm laser is switched on. In every acquisition mode, individual images, temporal image sequences, or a focal series of images
(layered three-dimensional images) can be acquired.
1.9.2
Heidelberg Engineering Technologies
Multi-modality Imaging
The HRA is a multi-modality imaging device. It combines SD-OCT with
the following fundus imaging modalities:
▪
▪
▪
▪
▪
▪
Blue reflectance imaging (BR)
Infrared reflectance imaging (IR)
BluePeak blue laser autofluorescence imaging (BAF)
Fluorescein angiography (FA)
Indocyanine green angiography (ICGA)
MultiColor imaging
(Option)( Chapter 1.9.3 “MultiColor Scanning
Laser Imaging (Option)”, p. 16)
Getting the full picture of a disease is critical to understanding complex
pathologies. Multi-modality imaging offers deep insights into structure,
function and metabolic activity of the retina and, consequently, benefits
patient flow, detection, and management of disease.
15
1
Preface
Heidelberg Noise Reduction
1.9.3
TruTrack Active Eye Tracking enables the capture of multiple images
in the exact same location. The automatic real time (ART) mean function combines these images, helping clinicians to discriminate between
image “noise” and true signals from real tissue structures. Noise is
effectively eliminated and the result are images of high contrast with
finer detail.
MultiColor Scanning Laser Imaging (Option)
MultiColor image
Blue reflectance image
Green reflectance image
Infrared reflectance image
MultiColor – Scanning Laser Imaging is the latest addition to the
SPECTRALIS multi-modality imaging platform. It is an optional retinal
fundus imaging modality for all SPECTRALIS models.
MultiColor images are composed of three selective, simultaneously
acquired color laser images: infrared, green and blue reflectance.
Based on the core technologies of confocal scanning laser, active live
eye tracking and noise reduction technology, MultiColor images demonstrate high image contrast and resolution. Without a flash light and
no need for pupil dilation this entirely non-invasive fundus imaging
modality significantly improves patient comfort as compared to color
fundus photography. In addition, simultaneous imaging with multiple
laser colors selectively captures and portraits diagnostic information
originating from different retinal structures within a single examination.
▪ Blue reflectance highlights epiretinal membranes, nerve fiber layer and
macular pigment.
▪ Green reflectance highlights blood, blood vessels and exudates.
▪ Infrared reflectance highlights drusen, RPE abnormalities and changes
in the choroid.
Along with the MultiColor image all three color laser images can be
viewed and analyzed individually in the MultiColor viewing software.
16
Preface
1
Precision of SPECTRALIS Measurement
1.10
Precision of SPECTRALIS Measurement
The reproducibility and repeatability of the various measurements provided by the SPECTRALIS were tested with the following results:
Reproducibility Data Summary
Measurement
Standard Deviation
Coefficient of Variation
Estimate
95% Confidence
Interval
Estimate
95% Confidence
Interval
HRA Distance
0.05 mm
0.04 – 0.09 mm
0.8%
0.6 – 1.3%
HRA Area
0.34 mm2
0.24 – 0.58 mm2
1.7%
1.2 – 2.9%
OCT Mean Retinal Thickness
(volume scan)
1.6 μm
1.4 – 1.8 μm
0.5%
0.4 – 0.6%
OCT Central Foveal Thickness
(volume scan)
2.6 μm
1.9 – 4.5 μm
1.1%
0.8 – 1.8%
(B-scan)
2.4 μm
1.7 – 4.1 μm
1.0%
0.7 – 1.7%
OCT RNFL Thickness (global)
1.4 μm
1.0 – 2.4 μm
1.4%
1.0 – 2.4%
OCT RNFL Thickness (in sectors)
3.9 μm
3.3 – 4.7 μm
3.5%
3.0 – 4.2%
Repeatability Data Summary
Measurement
Standard Deviation
Coefficient of Variation
Estimate
95% Confidence Estimate
Interval
95% Confidence
Interval
HRA Distance
0.02 mm
0.01 – 0.04 mm
0.3%
0.2 – 0.6%
HRA Area
0.14 mm2
0.09 – 0.26 mm2
0.7%
0.5 – 1.3%
OCT Mean Retinal Thickness
(volume scan)
1.1 μm
1.0 – 1.3 μm
0.4%
0.3 – 0.4%
(volume scan)
1.8 μm
1.2 – 3.4 μm
0.7%
0.5 – 1.4%
(B-scan)
1.7 μm
1.2 – 3.3 μm
0.7%
0.5 – 1.4%
OCT RNFL Thickness (global)
0.7 μm
0.5 – 1.4 μm
0.7%
0.5 – 1.3%
OCT RNFL Thickness (in sectors) 1.1 μm
0.9 – 1.4 μm
1.0%
0.8 – 1.2%
0.7 – 1.7%
17
1
Preface
Heidelberg Eye Explorer Software Platform
1.11
Heidelberg Engineering devices consist of the following software, modules, and plug-ins:
▪
▪
▪
▪
▪
▪
Heidelberg Eye Explorer (HEYEX)
Acquisition software
Analysis software
Network licenses (Option)
Connection of practice management software (Option)
Image Capture Module
All Heidelberg Engineering devices operate on the Heidelberg Eye
Explorer (HEYEX) platform. HEYEX hosts the patient database, from
which the user manages patient files and performs examinations.
HEYEX also hosts the image acquisition and analysis applications for
the different Heidelberg Engineering devices.
The following add-on options are available for HEYEX:
▪ Network Licenses
▪ External System Interface (Option)
▪ Additional analysis software
Acquisition and Analysis Software
In addition to the operating software, including the acquisition and
analysis software provided with each device, additional optional
viewing software is also available. This viewing software enables full
access to all images and patient data on PCs which are not connected
to the device.
Network Licenses
All Heidelberg Engineering devices can be used within a network environment. This allows users to review images from networked PCs,
often referred to as viewing stations, using the same analysis software
that is used on the instrument PC.
In a network environment the common HEYEX database containing all
patient data is located on a network server. Images acquired with the
device are saved to this database. Viewing and analyzing these
images is possible at any computer that meets the viewing station
requirements. A viewing station receives access to the database
through a network license. The network license can be fixed – permanently assigned to a computer – or floating – many viewing stations
share a defined number of licenses.
Each device includes at least two floating network licenses. If viewing
access for more concurrent users is required, additional network
licenses can be purchased.
External System Interface
(Optional)
HEYEX can exchange patient data and images with other compatible
systems in the department, e.g. Electronic Medical Record systems,
Image Management Systems, PACS, etc.
The interface is deployed via the DICOM standard or via a proprietary
interface.
18
Preface
1
The following features are included:
▪ Import of patient demographics/DICOM Modality Worklist into HEYEX
▪ Export of images and reports from HEYEX
For further information, please refer to the DICOM Interface User
Manual.
Image Capture Module
The Image Capture Module software enables the import of external
images or documents, e.g. from other devices, or Windows screenshots and adds them to the patient file in HEYEX.
Images can be imported by:
▪ Browsing to digital images, e.g. .JPEG, .TIF, .BMP
▪ Capturing screenshots
▪ Scanning-in paper files
For further information, please refer to the Image Capture Module User
Manual.
19
2
General Safety Messages
Patient Safety
2
Review the following points before handling the device:
▪ Carefully read the user manual.
▪ Keep this user manual within easy access.
▪ The inappropriate use of this device could damage the device and/or
cause severe injuries.
▪ Mind all safety advices on the device and in the user manual.
▪ Follow all precautions listed in the user manual.
A thorough understanding of how to properly use the device will reduce
examination time, increase patient comfort and support best image
quality.
2.1
Patient Safety
Follow the instructions below to ensure the patient safety and the best
examination results possible:
▪ Never leave the patient alone in the examination room during the
examination.
▪ Clean and disinfect the head rest, the chin rest, and the lens in front of
the patient. Dirty device parts can transmit pathogenic germs causing
infections.
There are no contraindications associated with normal use of the
device.
L CAUTION
Artifacts due to reflections from internal optics can be visible in
reflectance images.
 Do not mistake this artifact for a pathology.
Residual reflections from optical surfaces may appear as bright
spot artifacts in reflectance images. Central artifacts are more
likely for patients with lower fundus signal, e.g. patients with cataract or small, undilated pupils as well as for patients with high
myopia.
20
2
Patient Safety
L CAUTION
If the service mode is enabled the background of the acquisition
window is color-coded red. On the touch panel and on the power
supply a message is displayed that the service mode is switched
on and you are not supposed to use the device.
 Do not use the system.
 Contact your service technician, your local
Heidelberg Engineering partner or the Heidelberg Engineering
support.
You are not allowed to acquire images while the service mode is
enabled.
L CAUTION
If the scanner stops oscillation, a small radiation spot caused by
the laser might hit the retina.
 Check that the scanners are working properly when starting an
examination. A high tone must be audible when the camera is
switched on.
The too high load of light energy might damage the patient's
retina.
L WARNING
Incorrect patient data can lead to wrong diagnostic interpretation.
 Confirm that the correct patient data is used when starting an
examination.
 Confirm that the correct patient data is used when selecting the
examination method.
 Confirm that the correct patient data is used when drawing diagnostic conclusions.
A wrong diagnostic interpretation can result in wrong therapeutic
approaches.
L WARNING
A patient that is not optimally prepared for the examination might
cause poor examination results.
 Carefully explain the examination procedure before the beginning
of the examination so that patients suffering from a lack of concentration, elderly people or patients who are afraid of the examination can achieve good examination results.
If the examination results are poor, the examination might have to
be repeated.
L WARNING
If a diagnosis is based on a single examination method, the
examination results might be misinterpreted.
 Always consider performing additional examinations possibly
with other diagnostic devices to obtain a good clinical judgment.
A wrong diagnostic interpretation may result in wrong therapeutic
approaches.
L WARNING
If the patient is not correctly positioned in front of the device bad
image quality might occur.
 Turn the black adjustment screw and adjust the chin rest until the
patient’s eyes are level with the red marks on the head rest
column.
 Ensure that the patient's forehead touches the forehead rest.
Bad image quality may lead to wrong diagnostic conclusions
which may result in wrong therapeutic approaches.
21
2
Equipment Reliability
L WARNING
2.2
The patient's eye might get seriously injured if you move the
camera incautiously.
 Carefully move the camera towards the patient's eye.
Data Security
Follow the instructions below to ensure data security:
L CAUTION
Uncontrolled operations on the PC's operating system level may
lead to data loss.
 Only allow authorized personnel to access the HEYEX database,
the patient data and the archive media.
Lost data might not be restored.
L CAUTION
If the disk space is seriously low, images might get lost during
the acquisition because they cannot be saved.
 Ensure that enough memory is available on the disk where the
patient data are saved.
 Archive data regularly.
The acquired images might not be recovered and patients might
need to be re-examined.
L CAUTION
The software might crash during image acquisition because of a
hardware or a software failure and acquired images might get
lost.
 Repeat the image acquisition.
2.3
Follow the instructions below to ensure equipment reliability:
▪ Do not modify the device. Modifying the device in any way will automatically void the equipment warranty. Heidelberg Engineering does
not take responsibility for modified devices.
▪ Before using the device for the first time, give it a visual review. If there
are any uncertainties, optical, mechanical or electrical defects, contact
your Heidelberg Engineering partner.
▪ Do not use the device if there is a technical defect, unusual vibrations
or an unusual sound. If there are uncertainties, contact your
Heidelberg Engineering partner.
▪ Operate the system at an ambient temperature of about 18 – 25°C /
64° – 77°F.
If the device is operated in ambient temperatures which exceed the
recommended operating environmental conditions this might lead to a
longer start-up time. The device cannot be used during this period.
22
2
NOTICE
Portable and mobile RF communications equipment can affect
medical electrical equipment.
 Always heed the EMC information provided in this manual when
the device is installed and put into service.
 Avoid placing hand-held, high-frequency devices next to the
device.
There is a risk of device malfunction when the device is operated
close to electromagnetic interference fields. Medical electrical
equipment needs special precautions regarding electromagnetic
compatibility. Although the electromagnetic compatibility of the
system has been tested in accordance with IEC 60601-1-2, Electromagnetic Compliance (EMC), devices can nonetheless interfere
and cause bad data quality or electronic disruptions.
L CAUTION
L CAUTION
Only certified staff of your Heidelberg Engineering partner may
install or modify the system.
Modifications during the actual service life require evaluation to
all regulatory requirements, for example compliance with IEC
60601-1.
Do not attempt to repair the device if a problem occurs.
 For service requests, contact your Heidelberg Engineering
partner.
Only trained, qualified personnel authorized by
Heidelberg Engineering are allowed to do repairs.
L CAUTION
If software and/or hardware that has not been approved by
Heidelberg Engineering is installed on the device, bad image
quality and device failures may occur.
 Do not install third party software and/or hardware that has not
been approved by Heidelberg Engineering.
A device failure and bad image quality may lead to wrong diagnostic conclusions which may result in wrong therapeutic
approaches. Under some conditions the device could cause an
the user's health.
L CAUTION
L CAUTION
US Federal Law restricts this device to sale by, or on the order of
a physician or a practitioner. Only distributors authorized by
Heidelberg Engineering are allowed to sell
Heidelberg Engineering devices.
If the device is not transported in its original packaging it might
get damaged because it is not sufficiently protected against
mechanical shock.
 Only transport the device in its original packaging to protect it
against mechanical shock.
A device failure might lead to bad image quality and wrong diagnostic conclusions which may result in wrong therapeutic
approaches.
23
2
L CAUTION
Electricity supply must be stable and comply with the required
tolerances.
 Make sure the local electrical supply meets the equipment specifications.
An instable mains supply may lead to device failures and data
loss. A device failure might lead to bad image quality and wrong
diagnostic conclusions which may result in wrong therapeutic
approaches. Lost data might not be restored. The wrong electrical
supply can damage the device. Under some conditions the device
could cause an electric shock that might have a serious impact
on the patient's or the user's health.
L CAUTION
L WARNING
Do not simultaneously touch electro-conductive parts of connectors and a patient.
Under some conditions the device could cause an electric shock
that might have a serious impact on the patient's or the user's
health.
If the device is exposed to extreme temperature and/or humidity
changes or to not optimal operating environmental conditions
bad image quality might occur.
 Ensure that the operating environmental conditions are optimal.
 Do not expose the device to extreme temperature and/or humidity
changes.
 Allow the instrument to adjust to room temperature for at least
two hours prior to operation.
L WARNING
Do not operate the device without power plugs marked "hospital
grade" which ensures the earthing reliability.
 Always operate the system connected to power plugs marked
"hospital grade" or "hospital only". These power plugs and receptacles meet the requirements of UL 498.
If the earthing reliability is not secured the device could cause an
the user's health.
L WARNING
The hardware component housing may not be opened by some
other than trained, qualified personnel authorized by
Heidelberg Engineering.
 Do not open the hardware component housing.
If the component housing is opened without justification, the
device could cause an electric shock that might have a serious
impact on the patient's or the user's health.
24
2
Laser Safety
L WARNING
Incorrect use of isolating transformer or multiple socket outlet.
 Only use an isolating transformer or multiple socket outlet as
specified in this user manual.
 If the system was installed with an isolating transformer or multiple socket outlet, always make sure that all parts of the system
are connected to the isolating transformer or multiple socket
outlet.
 Do not change the correctly installed system.
 Do not put the isolating transformer or the multiple socket outlet
on the floor.
If the system is operated with a non-conforming isolating transformer or multiple socket outlet, this could cause an electric
shock that might have a serious impact on the patient's or the
user's health.
L WARNING
L WARNING
2.4
Do not operate the device in a network connection without an isolation in accordance with IEC 60601-1.
If the device is operated in a network connection without an isolation in accordance with IEC 60601-1, the device could cause an
the user's health.
In order to avoid risk of electric shock, the device must only be
connected to a supply mains with protective earth.
Under some conditions the device could cause an electric shock
that might have a serious impact on the patient's or the user's
health.
Laser Safety
The SPECTRALIS instrument emits visible and invisible laser light
through the objective lens at the front of the laser scanning camera.
The SPECTRALIS complies with IEC 60825-1:2007 and is a Class 1
Laser Product. It does not pose any safety hazard whatsoever.
Hazardous laser radiation may be accessible when the camera
housing is open.
L WARNING
Only use objective lenses provided by the manufacturer.
The incorrect use of lenses on the SPECTRALIS camera, or the
use of unauthorized lenses may result in the patient's retina being
exposed to hazardous laser light.
25
3
3
Preparing for Examination
About this Chapter
This chapter provides an introduction on the initial operation of the
device and instructions on preparing the device and the patient for the
examination. A well-prepared patient provides better examination
results. This chapter will also address general HEYEX settings for
examinations.
By the end of this chapter, you should be able to confidently prepare
the device and the patient for an examination.
26
3
The SPECTRALIS Device
3.1
The SPECTRALIS Device
External fixation light
Objective lens
Forehead rest
Filter wheel
Head rest column with red marks
Focus knob
Chin rest
Adjustment screw for chin rest
Touch panel with ART/Sensitivity knob
Joystick
Camera head
Setscrew; not shown
; not shown
27
3
Switching the Device on and off
3.2
Switching the Device on and off
It is not recommended to frequently switch the device on and off.
Instead, switch on the device in the morning and off in the evening
even if the device is not in constant use throughout the day.
Switching on the device  Switch on the isolating transformer
 Switch on the power supply
 Switch on the PC
.
.
and the monitor
.
The PC will start its boot sequence. The Windows start screen is displayed until the login screen is displayed.
 Select a user name and enter a password if necessary.
The message “Loading your personal settings” is displayed. If the
login sequence has finished, the Windows desktop is displayed.
 Start HEYEX ( Chapter 5.1 “Starting HEYEX”, p. 35).
 Prepare the patient ( Chapter 3.4 “Preparing the Patient”, p. 30).
 Prepare the device ( Chapter 3.3 “Preparing the Device”, p. 29).
 Start an examination ( Chapter 5.7 “Starting a New Examination”,
p. 54).
28
3
Preparing the Device
Switching off the device
NOTICE
Shut-down procedure neglected.
 Do not switch off the camera when the acquisition window is
open.
 Do not switch off the PC without closing HEYEX.
Data may be lost if shut-down procedure is not performed correctly.
 Close all HEYEX dialog boxes and windows, e.g. acquisition window or
analysis window.
 Click
to close HEYEX.
The message “Do you want to exit the program” is displayed.
 Click “OK” to confirm.
HEYEX is closed.
 Select “Start \ Turn off Computer”.
The “Turn off computer” dialog box is displayed.
 Select “Turn off” .
The PC turns off
.
 Switch off the monitor
.
 Switch off the power supply
.
 Switch off the isolating transformer
3.3
.
Preparing the Device
L WARNING
A carelessly adjusted device might lead to bad image quality.
 Adjust the device table and/or the patient's chair so that the
patient reaches the chin rest comfortably.
column.
 Adjust the camera and the focus carefully.
L WARNING
If the patient is not correctly positioned in front of the device bad
image quality might occur.
column.
 Ensure that the patient's forehead touches the forehead rest.
 Clean and disinfect the head rest, the chin rest, and the lens before the
examination.
 Adjust the height of table for the patient.
29
3
Preparing the Patient
Fig. 2: Turn the black adjustment screw so that the patient's eye are
level with the red marks
patient’s eyes are level with the red marks on the head rest column
(Fig. 2).
 Ask the patient to put their forehead against the forehead rest.
If the patient's forehead is not against the forehead rest, there will be
problems during image acquisition as there is too much distance
between the camera and the patient's eye.
3.4
Preparing the Patient
L WARNING
A patient that is not optimally prepared for the examination might
cause poor examination results.
 Carefully explain the examination procedure before the beginning
of the examination so that patients suffering from a lack of concentration, elderly people or patients who are afraid of the examination can achieve good examination results.
If the examination results are poor, the examination might have to
be repeated.
L WARNING
A patient that is not optimally prepared for the acquisition of
BluePeak blue laser autofluorescence images may cause bad
image quality.
 For best image quality, Heidelberg Engineering recommends to
acquire BluePeak blue laser autofluorescence images with dilated
pupils.
 In order to improve the image quality for patients with cataract,
dilating the pupils might improve the image quality.
30
3
General HEYEX Settings
L CAUTION
Wrong classification results caused by corrective lenses.
 Ask the patient to remove glasses or contact lenses before the
examination.
 Always consider that classification results of patients with intraocular lenses may be wrong.
Classification results may be wrong for patients wearing glasses
or contact lenses or patients with intraocular lenses. Wrong classification results may lead to wrong diagnostic conclusions
Perform the SPECTRALIS scan before other diagnostic studies that
may irritate or dry the cornea. For patients with dry eyes and contact
lens wearers, apply artificial tear fluid shortly before the examination.
Make sure that the patient is not distracted during fixation, e.g. persons
walking by.
The following explanations can help patients to understand the importance and purpose of the examination.
Explaining the Fundus Examination
The structure of the multi-layered retina in the posterior segment of the
eye cannot be examined with conventional methods. With the
SPECTRALIS fundus examination we can exactly display the retina
and provide unmatched detail and contrast in angiography and reflectance images of both, the retina and the choroid, improving the diagnosis of pathologies. The examination with the SPECTRALIS is completely safe, without touching the eye. A light beam scans the retina
and the optic nerve head.
Please put your chin on the chin rest and your forehead against the
forehead rest. For best image quality, please lean your forehead
against the forehead rest for the duration of the examination. I will
move the device close to your eye, but won’t touch it. Please look at
the blue dot. You are allowed to blink, the examination results won’t be
affected. The examination will take only a few seconds. I will let you
know when the examination has finished.
3.5
Before the first examination it is possible to set the general HEYEX
settings. At first, the display options can be set: it is possible to change
the image thumbnail display and the look of the image viewing window.
Secondly, the plug-ins for the HEYEX can be loaded, enabled or disabled. Please do not change the settings in the “Disk Space” tab.
31
3
3.5.1
Setting Display Options
 Click
to start HEYEX.
 Select “Setup \ Options” in the menu bar.
The “Options” dialog box is displayed.
 Click the “General” tab and set the following options:
▪
▪
▪
▪
“Large icon size”
“Small icon size”
“Horizontal spacing”
“Vertical spacing”
 In order to display the image number of each image, check the “Show
image number” box.
 In order to set the default split mode, open the “Default Split Mode”
drop-down list and select one of the following options:
▪ “No split”
▪ “Split exam”
▪ “Split exam & lightbox”
For further information on changing the layout of the image viewing
window, please refer to ( Chapter 5.3.2 “Changing Display Options of
Image Viewing Window”, p. 41).
 In order to get a notification when closing HEYEX, check the “Show
information on exit” box.
A dialog box will ask “Do you want to exit the program” each time
HEYEX is closed.
32
3
Accessing Software Information
3.5.2
Setting Plug-Ins
 Click
to start HEYEX.
 Select “Setup \ Options” in the menu bar.
The “Options” dialog box is displayed.
 Click the “Plug-Ins” tab.
 Click an already installed plug-in.
 In order to unload the plug-in, click “Unload” .
 In order to enable or disable the plug-in, click “Enable” or “Disable” .
 In order to check or change the setup of the plug-in, click “Setup” .
If there are uncertainties in adjusting these settings, please ask your
system administrator or contact your local distributor.
3.6
Accessing Software Information
Verify the installed version of HEYEX, the acquisition module, and the
viewing module.
 Click
to start HEYEX.
 In the database window's menu bar select “Help \ About”.
The “About Heidelberg Eye Explorer” dialog box is displayed.
 Check that the following installed modules are displayed:
▪ SPECTRALIS Viewing Module (VWM) Version 6.0
▪ SPECTRALIS Acquisition Module (AQM) Version 6.0
▪ HEYEX Version 1.9
33
4
4
34
Workflow
Workflow
5
Starting HEYEX
5
This chapter provides instructions on how to set up HEYEX before an
examination and includes an in-depth look at the functionality of the
database window and image viewing window.
About this Chapter
When starting HEYEX, the database window is displayed. This window
provides all database functionalities and allows you to prepare examinations. When opening a patient file, the image viewing window is displayed. This window provides all basic functions for working with
patient files. It shows all examinations that exist for the patient. The
examinations are organized in examination tabs by date. Each dated
examination tab contains image thumbnails for each examination on
that date. From here, examinations can be continued and the analysis
windows can be opened.
This chapter explains the simplest way to use HEYEX, but do not be
afraid to explore the software and develop a method that works best
for you. By the end of this chapter, you should be able to confidently
prepare HEYEX for an examination.
Chapter structure:
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
5.1
Starting the software
The database window and all its functions
The image viewing window and all its functions
Creating, selecting, editing, and searching patient files
Starting and continuing examinations
Deleting patient files
Updating or changing patient data
Updating or changing examination data
Updating or changing eye data
Moving images between patient files
Working with the lightbox
Starting HEYEX
Depending on your system configuration, there are several ways to
start HEYEX.
 Double-click the HEYEX desktop icon.
HEYEX starts. The database window opens.
 Open the Windows start menu and select
“Programs \ Heidelberg Eye Explorer \ Heidelberg Eye Explorer”.
35
5
Starting HEYEX
 Click
in the Windows task bar.
If the User Account Management is enabled, your logon details are
being requested when HEYEX starts. Please contact your system
administrator for your user name, your password and information on
the password policy.
Changing the password on the first
logon
If the User Account Management has been configured by your administrator who assigned a password to your account, you will be
prompted to change your password during your first logon to HEYEX.
The “Change Password” dialog box is displayed.
 Enter your current password in the “Current Password” field.
 Enter your new password in the “New Password” field.
 Repeat your new password in the “New Password (repeat)” field.
A message is displayed saying that your password has been changed.
HEYEX starts.
Changing the password in the daily  If you want to change your password, select
routine “Database \ Advanced \ User Account Management” in the database
window's menu bar.
The “Edit User Account” dialog box is displayed.
 Click “Change Password” .
The “Change Password” dialog box is displayed.
 Enter your current password in the “Current Password” field.
 Enter your new password in the “New Password” field.
 Repeat your new password in the “New Password (repeat)” field.
A message is displayed saying that your password has been changed.
36
5
Graphical User Interface Database Window
5.2
Menu bar
Selected patient files are displayed
Tool bar
All patient files are displayed
( Chapter 5.2.1 “Tool Bar”, p. 38)
Quick search
37
5
5.2.1
Tool Bar
Icon
Description
Database Window ( Chapter 5.2 “Graphical User
Interface Database Window”, p. 37)
Image Viewing Window ( Chapter 5.3 “Graphical User
Interface Image Viewing Window”, p. 39)
Filter ( Chapter 5.6.3 “Advanced Search”, p. 52)
Load Filter ( Chapter 5.6.4 “Loading Filters”, p. 54)
No Filter
Today ( Chapter 5.6.2 “Searching Patient Files from
Today”, p. 51)
Properties ( Chapter 5.10.1 “Updating or Changing
Patient Data”, p. 57)
New Patient ( Chapter 5.4 “Creating a New Patient
File”, p. 42)
New Examination ( Chapter 5.7 “Starting a New
Examination”, p. 54)
Load ( p. 45)
Unload ( p. 45)
Load all ( Chapter 5.5.4 “Selecting All Patient Files”,
p. 48)
Unload all ( Chapter 5.5.4 “Selecting All Patient Files”,
p. 48)
5.2.2
Changing Display Options of Database Window
The window partitioning can be changed:
 Hover with the mouse cursor over the separator.
 Drag-and-drop the separator to change the window partitioning.
38
5
Graphical User Interface Image Viewing Window
5.3
Examination tab
“Image”
Selected patient file
“Eye data”
Tool bar ( Chapter 5.3.1 “Tool Bar”,
p. 40)
Acquired images OD
Menu bar
Acquired images OS
“Patient” data ( Chapter 5.10.1
“Updating or Changing Patient Data”,
p. 57)
Lightbox ( Chapter 5.14 “Using the
Lightbox”, p. 67)
“Examination” data ( Chapter 5.11.1
“Updating or Changing Examination
Data”, p. 61)
39
5
5.3.1
Tool Bar
Icon
Description
Database Window ( Chapter 5.2 “Graphical User
Interface Database Window”, p. 37)
Image Viewing Window
( Chapter 5.3 “Graphical User Interface Image
Viewing Window”, p. 39)
Lock Examination
( Chapter 7.2 “Unlocking Examinations”, p. 76)
Large Icons ( Chapter 5.3.2 “Changing Display
Options of Image Viewing Window”, p. 41)
Small Icons ( Chapter 5.3.2 “Changing Display
Options of Image Viewing Window”, p. 41)
List ( Chapter 5.3.2 “Changing Display Options of
Image Viewing Window”, p. 41)
No split ( Chapter 5.3.2 “Changing Display Options of
Image Viewing Window”, p. 41)
Split Exam ( Chapter 5.3.2 “Changing Display Options
of Image Viewing Window”, p. 41)
Split Exam and Lightbox ( Chapter 5.3.2 “Changing
Display Options of Image Viewing Window”, p. 41)
40
5
5.3.2
Changing Display Options of Image Viewing Window
The image thumbnail display and the look of the image viewing window
can be changed.
 In order to display the image thumbnails and the lightbox without split-
ting in OD and OS, click
.
 In order to display the image thumbnails split in OD and OS, click
.
 In order to display the image thumbnails and the lightbox split in OD
and OS, click
.
 In order to display the image thumbnails as large icons, click
.
 In order to display the image thumbnails as small icons, click
.
 In order to display the image thumbnails as a list, click
.
The window partitioning can be changed:
 Hover with the mouse cursor over the separators of the lightbox and
OD/OS.
 Drag-and-drop the separator to change the window partitioning.
For further information on changing these settings permanently, please
refer to ( Chapter 3.5.1 “Setting Display Options”, p. 32).
41
5
Creating a New Patient File
5.4
L WARNING
Wrong classification results caused by incorrectly entered patient
data and eye data.
 Enter the patient's date of birth correctly.
 Enter the patient’s C-Curve values correctly.
Classification results may be wrong if the patient’s eye data or
date of birth is entered incorrectly. Wrong classification results
may lead to wrong diagnostic conclusions which may result in
wrong therapeutic approaches.
 Click
to start HEYEX.
 Click
in the tool bar.
Fig. 3: "Patient Data" dialog box
The “Patient Data” dialog box is displayed (Fig. 3).
Patient Data  Insert the following patient data:
▪
▪
▪
▪
▪
▪
▪
“Last” name (mandatory)
“First” name (mandatory)
“Title”
“Date of birth” (mandatory)
“Sex” (mandatory)
“Patient-ID”
“Ancestry”
For further information on entering information in the “More data” tab
and the “Memo” tab, please refer to ( Chapter 5.10.1 “Updating or
Changing Patient Data”, p. 57).
If a patient entry with the same name and date of birth already exists, a
message will prompt you to select whether you want to use the existing
entry or not.
42
5
 Select “Yes” to use the existing entry or “No” to create a new patient
file.
If you select “Yes” and then click “OK” to confirm, a message will be
displayed that you are about to change the patient information. The
patient information will then be merged in the existing patient file.
If you select “No” , enter a patient ID that is different from the patient ID
of the already existing patient in the “Patient-ID” field. A new patient
file will then be created.
Fig. 4: "Examination Data" dialog box
The “Examination Data” dialog box is displayed (Fig. 4).
Examination Data  In the “Examination Data” tab, select the device type from the
“Device” drop-down list.
 In the “Operator” field, enter the operator's name or select an already
existing entry from the drop-down list.
 In the “Study” field, enter a study or select an already existing entry
from the drop-down list optionally.
Per default, closed studies are not displayed in the “Study” drop-down
list. If you want to display closed studies, check the “Include closed
studies” box.
For further information on entering, updating or changing a study,
please refer to ( Chapter 5.11.1 “Updating or Changing Examination
Data”, p. 61).
43
5
Fig. 5: "Diagnosis" tab
 In the “Diagnosis” tab enter the patient's diagnosis (Fig. 5).
For further information on entering a diagnosis, please refer to
( Chapter 5.11.2 “Updating or Changing Diagnosis”, p. 62).
Fig. 6: "Eye Data" dialog boy
The “Eye Data” dialog box is displayed.
 Enter the patient's “C-Curve” value correctly. If the “C-Curve”
standard value 7.7 remains unchanged, examination results may
deviate from actual values.
C-Curve is the radius of curvature of the anterior corneal surface. For
an astigmatic eye, it is given by the average of the steep and the flat
corneal curvature values.
If you do not change the C-Curve values from the preset value of
7.7 mm, a message will be displayed asking to verify that both C-Curve
values are correct. Measurements will only be accurate if the C-Curve
values are correct.
All other entries are optional.
For further information on entering eye data, please refer to
( Chapter 5.12 “Updating or Changing Eye Data”, p. 63).
The acquisition window opens.
Now, you can acquire images.
44
5
Selecting and Opening Patient Files
5.5
5.5.1
Selecting a Patient File
 Click
to start HEYEX.
 In order to open a patient file or to select a patient file for review,
double-click a patient file.
The circle next to the patient name turns black. The patient file is displayed in the right part of the database window.
 Click
to open the image viewing window.
All acquired images of the selected patient can be reviewed. The
acquired images are organized by examination date in individual
examination tabs.
 In order to review an image, double-click an image thumbnail.
The analysis window opens.
 In order to unload the patient file in the database window, click
the tool bar.
5.5.2
in
Selecting a Single Examination
A single examination can be selected for review.
45
5
 Click
to start HEYEX.
 Click
in front of the patient name.
All devices the patient was examined with are displayed.
 Click
in front of the device.
All examinations are displayed.
 Double-click the desired examination.
The examination is displayed in the right part of the database window.
 Click
The single examination is displayed.
 In order to review the image, double-click the image thumbnail.
 In order to unload the single examination in the database window, click
in the tool bar.
46
5
5.5.3
Selecting Multiple Patient Files
 Click
to start HEYEX.
Fig. 7: Selecting patient files in the database window
 In order to open multiple patient files, double-click the patient files in
the left part of the database window (Fig. 7).
The circles next to the patient names turn black. The patient files are
displayed in the right part of the database window.
 Click
All acquired images of the most recently selected patient file are displayed. The acquired images are organized by examination date in
individual examination tabs.
 In order to display a specific patient file, double-click the patient file in
the right part of the database window.
Fig. 8: "Patient" drop-down list
 In order to quickly switch between the loaded patients, open the
“Patient” drop-down list.
All selected patient files are displayed.
 Select a patient file.
All acquired images of the selected patient are displayed. The acquired
images are organized by examination date in individual examination
tabs.
47
5
 In order to unload a patient file in the database window, right-click the
patient file.
The context menu opens.
 Select “Unload” .
The patient file will no longer be displayed in the right part of the database window.
 In order to unload all patient files, click
5.5.4
in the tool bar.
Selecting All Patient Files
 Click
to start HEYEX.
 In order to select all patients, click
in the tool bar.
If more than 20 patient files are selected, e.g. 146 patient files, the
message “Do you really want to load 146 patients?” is displayed.
 Click “Yes” to confirm.
All patient files are displayed in the right part of the database window.
Fig. 9: At the end of the patient list click "More"
 If HEYEX contains more than 1024 patient files, scroll down to the end
of the patient list and click “More” (Fig. 9).
The next 1024 patient files are displayed. Repeat this step until all
patient files are displayed and the “More” button is no longer displayed.
 Click
The first patient file of the patient list in the left part of the database
window is opened.
All acquired images of this patient can be reviewed. The acquired
tabs.
 In order to display a specific patient file, double-click the patient file in
the right part of the database window.
48
5
Fig. 10: "Patient" drop-down list
 In order to quickly switch between the loaded patients, open the
“Patient” drop-down list.
All selected patient files are displayed.
All acquired images of the selected patient are displayed. The acquired
tabs.
 In order to unload all patient files in the database window, click
the tool bar.
in
49
5
Searching Patient Files
5.6
5.6.1
Quick Search
 Click
to start HEYEX.
Fig. 11: "Name" field in the database window
 In order to search patient files by name, enter the patient's last name,
e.g. "Doe", into the “Name” field (Fig. 11).
 Press
or click “Update Display” .
All last names starting with "Doe" are displayed in the left part of the
database window.
 In order to search patient files by name which include a space, enter a
comma, e.g. "of Doe,".
All last names starting with "of Doe" are displayed in the left part of the
database window.
 In order to improve search results, enter the patient's last name fol-
lowed by the initial of their first name, e.g. "Doe J".
All last names starting with "Doe" and first names starting with "J" are
displayed in the left part of the database window.
The last eight entries used for the query are saved and can be
selected from the drop-down list at a later time.
50
5
Fig. 12: Recalling queries from the drop-down list
 In order to recall queries, open the drop-down list (Fig. 12).
 Select a last name, e.g. "Doe".
 Press
or click “Update Display” .
All last names starting with "Doe" are displayed.
 In order to switch off the filter, click
“Update Display” .
5.6.2
or delete the name and click
Searching Patient Files from Today
With the search functionality “Today” it is possible to filter for all
patient files that were examined on the current day. This feature could
be useful in identifying examinations that require review or billing.
 Click
to start HEYEX.
 Click
in the tool bar.
The number on the icon varies depending on today's date. On the
is displayed. On the 7th,
is displayed. On the
1st of the month,
th
30 of the month,
is displayed.
All patient files containing the day's examinations are displayed.
in the tool bar.
51
5
5.6.3
Advanced Search
The advanced search allows you to search for patients using the
examination data.
 Click
to start HEYEX.
 In order to use the advanced search, click
in the tool bar.
Fig. 13: "Database Filter" dialog box
The “Database Filter” dialog box is displayed (Fig. 13).
Applying a Database Filter  Enter the patient's name or the patient-ID in the “Name (or Pat-ID)”
field.
 Enter the referring physician's name in the “Referring physician” field.
 Enter the following parameters in the “Examination” section:
▪
▪
▪
▪
“Time”
“Diagnosis”
“Study”
“Device”
 If you want to see only examinations within a patient file that matches
to the filter settings, check the “Show only examination within the
patients that match to this filter” box.
 Click “OK” to start the query.
The search results are displayed in the left part of the database
window.
Duplicates and conflicts  In order to identify patients with missing patient-ID, click “No Pat-ID” in
the “Duplicates and Conflicts” section.
All patients with missing patient-ID are displayed in the left part of the
database window.
 In order to identify patients with duplicate patient-ID, click “Duplicate
Pat-ID” in the “Duplicates and Conflicts” section.
All patients with duplicate patient-ID are displayed in the left part of the
database window.
52
5
 In order to identify patients with duplicate name and date of birth, click
“Duplicate Name + DoB” in the “Duplicates and Conflicts” section.
All patients with duplicate name and date of birth are displayed in the
left part of the database window.
Saving a Database Filter  Click “Save as...” to save the database filter.
Fig. 14: "Save Filter" dialog box
The “Save Filter” dialog box is displayed (Fig. 14).
 Enter a name for the filter and click “OK” to confirm.
The filter is saved.
For further information on loading a saved filter, please refer to
( Chapter 5.6.4 “Loading Filters”, p. 54).
Deleting a Database Filter  In order to delete a filter, click “Load” .
Fig. 15: "Load Filter" dialog box
The “Load Filter” dialog box is displayed.
 Select a filter and click “Delete” to confirm.
The selected filter is deleted. The “Load Filter” dialog box is closed.
The “Database Filter” dialog box is displayed.
 In order to close the “Database Filter” dialog box, click “Cancel” or
.
 In order to switch off the filter and see the complete patient list, click
in the tool bar.
The complete patient list is displayed in the left part of the database
window.
53
5
Starting a New Examination
5.6.4
Loading Filters
In order to use the function “Load Filter” , a database filter must have
previously been saved ( Chapter 5.6.3 “Advanced Search”, p. 52).
 Click
to start HEYEX.
 Click
in the tool bar.
The “Load Filter” dialog box is displayed.
 Select a filter.
The filter is applied. The search results are displayed in the left part of
the database window.
5.7
in the tool bar.
L CAUTION
examination.
If the message “Examination is not of the current day!” is displayed in
the image viewing window, open the database window and start the
examination there.
If a new examination is started, a new examination tab is created. If the
data have to be part of the same examination tab, continue the examination ( Chapter 5.8 “Continuing Examinations”, p. 56).
 Click
to start HEYEX.
 Select a patient file ( Chapter 5.5 “Selecting and Opening Patient
Files”, p. 45).
 In order to start a new examination, click
in the tool bar.
A message is displayed asking whether you really want to re-examine
the selected patient or not.
54
5
Examination Data  Click “Yes” to confirm.
Fig. 16: "Examination Data" dialog box
The “Examination Data” dialog box is displayed (Fig. 16).
 In the “Examination Data” tab, select the device type from the
“Device” drop-down list.
All other entries are optional. For further information on entering examination data, please refer to ( Chapter 5.11.1 “Updating or Changing
Examination Data”, p. 61)
 In the “Diagnosis” tab enter the patient's diagnosis. For further infor-
mation on entering a diagnosis, please refer to ( Chapter 5.11.2
“Updating or Changing Diagnosis”, p. 62).
Eye Data  Click “OK” to confirm.
Fig. 17: "Eye Data" dialog box
The “Eye Data” dialog box is displayed (Fig. 17).
55
5
Deleting Patient Files and Examinations
 Enter the patient's “C-Curve” value correctly. If the “C-Curve”
standard value 7.7 remains unchanged, examination results may
deviate from actual values.
C-Curve is the radius of curvature of the anterior corneal surface. For
an astigmatic eye, it is given by the average of the steep and the flat
corneal curvature values.
If you do not change the C-Curve values from the preset value of
7.7 mm, a message will be displayed asking to verify that both C-Curve
values are correct. Measurements will only be accurate if the C-Curve
values are correct.
5.8
Continuing Examinations
If a patient is examined several times throughout a day, all examinations can be stored in the same examination tab in the image viewing
window. If the data have to be part of a new examination tab, start a
new examination ( Chapter 5.7 “Starting a New Examination”, p. 54).
L CAUTION
examination.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Select the examination tab of the current day.
 Click
in the tool bar.
A message is displayed asking whether you really want to re-examine
the selected patient or not.
 Acquire images.
The acquired images are displayed in the examination tab of the current day.
5.9
Deleting Patient Files and Examinations
L CAUTION
Data permanently deleted from the database cannot be retrieved.
 Ensure that the right data are selected before deleting them.
Data permanently deleted can disable progression series and can
lead to wrong diagnostic conclusions.
56
5
Patient Data
NOTICE
Ensure that the local regulations retaining patient data are
observed before deleting a patient file.
Images that have been archived or put into a light box cannot be
deleted.
Deleting patient files in the data-  Click
to start HEYEX.
base window
Files”, p. 45).
 Select “Record \ Delete” in the menu bar.
The “Delete Database Record” dialog box is displayed.
 Check the “Yes, I want to permanently delete this database record.”
box.
The patient file is deleted.
Deleting examinations in the image
viewing window
Images of bad quality or those which are unsuitable for use while
affected by artifacts may be deleted.
Files”, p. 45).
 Click
 Select one or several image thumbnails.
 Press
on the keyboard.
The message “Do you really want to delete the selected images?” is
displayed.
The image is deleted.
5.10
Patient Data
5.10.1
Updating or Changing Patient Data
L WARNING
data and eye data.
You can update the properties of patient files in case of false or incomplete entries.
 Click
to start HEYEX.
Files”, p. 45).
 Click
57
5
Patient Data
 Next to the patient list, click “Patient” ( Chapter 5.3 “Graphical User
Interface Image Viewing Window”, p. 39).
Fig. 18: "Patient Data" dialog box
The “Patient Data” dialog box is displayed (Fig. 18).
 Enter or change the following data:
▪
▪
▪
▪
▪
▪
▪
“Last” name (mandatory)
“First” name (mandatory)
“Title”
“Date of birth” (mandatory)
“Sex” (mandatory)
“Patient-ID”
“Ancestry”
A warning message will be displayed saying that you are about to
change the patient information.
The changes will be saved.
5.10.2
Updating or Changing Additional Patient Data
 Click
to start HEYEX.
Files”, p. 45).
 Click
The “Patient Data” dialog box is displayed.
58
5
Patient Data
Fig. 19: "More data" tab
 Click the “More data” tab (Fig. 19).
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
“Insurance”
“Additional insurance data”
“Known allergies”
“Country of birth”
“Country of residence”
“Region of residence”
“Occupation”
“Height”
“Weight”
“Smoking status”
“Referring Physician, Clinic”
The advanced search allows the search for patients using the information entered in the “Referring Physician, Clinic” field. For further information on the advanced search, please refer to ( Chapter 5.6
“Searching Patient Files”, p. 50).
 If there is no referring physician entered or in order to add a new refer-
ring physician, click
.
Fig. 20: Entering information for a new referring physician
 Enter name, address, and contact details in the opening dialog box
(Fig. 20).
59
5
Patient Data
The referring physician is saved and can now be selected from the
drop-down list.
5.10.3
Updating or Changing Comments and Anamnesis
The comments and the anamnesis entered in the “Memo” tab are not
printed on reports. For further information on entering comments
printed on reports, please refer to ( Chapter 5.11.2 “Updating or
Changing Diagnosis”, p. 62).
Comments and anamnesis cannot be searched with the advanced
search ( Chapter 5.6 “Searching Patient Files”, p. 50). Instead,
include information on the diagnosis which can be found with the
advanced search ( Chapter 5.11.2 “Updating or Changing Diagnosis”, p. 62).
 Click
to start HEYEX.
Files”, p. 45).
 Click
The “Patient Data” dialog box is displayed.
Fig. 21: "Memo" tab
 Click the “Memo” tab (Fig. 21).
 Insert or change comments and the anamnesis.
 Click “Insert time” to add date and time stamp to the comment.
60
5
Examination Data
5.11
Examination Data
It is possible to search patients using the examination data
( Chapter 5.6.3 “Advanced Search”, p. 52). Insert the examination
data and the diagnosis as detailed as possible.
5.11.1
Updating or Changing Examination Data
The properties of patient files can be updated in case of incorrect or
incomplete entries. Device type information, however, cannot be
changed.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Next to the patient list, click “Examination” ( Chapter 5.3 “Graphical
User Interface Image Viewing Window”, p. 39).
The “Examination Data” dialog box is displayed.
 Enter an operator name or select an operator from the “Operator”
drop-down list.
 Select a study from the “Study” drop-down list.
Entering a new Study  If no study is entered or in order to add a new study, click
.
 Enter a study name in the opening dialog box and click “OK” to con-
firm.
The study is saved and can now be selected from the “Study” dropdown list.
Renaming a Study  In order to rename an existing study, click
.
 Check the “Edit existing study” box and enter the new name in the
opening dialog box.
The existing study is renamed.
Deleting a Study  Select the study to be deleted from the “Study” drop-down list and
click
.
Only a study that is not assigned to any examination can be
deleted.
Changes made to the study are made throughout the entire database, not just that examination.
61
5
Examination Data
 Check the “Delete existing study” box and click “OK” to confirm in the
opening dialog box.
The study is deleted.
5.11.2
Updating or Changing Diagnosis
The comments entered in the “Diagnosis” tab will be displayed on
reports. In order to add comments that will not be displayed on reports,
please refer to ( Chapter 5.10.3 “Updating or Changing Comments
and Anamnesis”, p. 60).
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Next to the patient list, click “Examination” ( Chapter 5.3 “Graphical
The “Examination Data” dialog box is displayed.
 Click the “Diagnosis” tab.
 Select a number.
▪ “Diagnosis”
▪ “Diagn-Ext.” (Diagnosis Extension)
▪ “Comment”
 Select a diagnosis from the “Diagnosis” drop-down list.
 Click “Update” to assign the diagnosis to the selected number.
Entering a new Diagnosis  If no diagnosis is entered or in order to add a new diagnosis, click
.
 Enter a diagnosis and click “OK” to confirm in the opening dialog box.
The diagnosis is saved and can now be selected from the “Diagnosis”
drop-down list.
Renaming a Diagnosis  In order to rename an existing diagnosis, click
.
 Check the “Edit existing Diagnosis” box and enter a new name.
The existing diagnosis is renamed.
Deleting a Diagnosis  Select the diagnosis to be deleted from the “Diagnosis” drop-down list
and click
.
Only a diagnosis that is not assigned to any examination can be
deleted.
Changes made to the diagnosis are made throughout the entire
database, not just that examination.
 Check the “Delete existing Diagnosis” box and click “OK” to confirm in
the opening dialog box.
The diagnosis is deleted.
62
5
Updating or Changing Eye Data
Only 50 characters of the comment are displayed on reports. Longer
texts are abbreviated and marked by “...” .
5.12
Updating or Changing Eye Data
You can update the “Eye Data” values in case of incorrect or incomplete entries.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Next to the patient list, click “Eye Data” ( Chapter 5.3 “Graphical
Fig. 22: "Eye Data" dialog box
The “Eye Data” dialog box is displayed.
 Update or change the following eye parameters:
Parameter
Unit
Description
“C-Curve”
mm
Radius of curvature of the anterior corneal surface
“Refraction”
D
Spherical refraction of the examined eye
“Cylinder”
D
Astigmatic refraction of the examined eye
“Axis”
deg
Axis of astigmatism of the examined eye
“Pupil size”
mm
Pupil diameter of the examined
eye
“IOP”
mmHg
Intraocular pressure of the examined eye
“VFieldMean”
–
Visual field mean deviation of the
examined eye
63
5
Moving Images between Patient Files
L CAUTION
Parameter
Unit
Description
“VFieldVar”
–
Visual field variation of the examined eye
“Corrective Lens”
–
Select “None” , “Glasses” , “Hard
Contact Lenses” or “Soft Contact
Lenses” .
examination.
L WARNING
data and eye data.
“C-Curve” values are relevant to the SPECTRALIS. Keratometry is
required to get a proper transverse measurement parallel to the retinal
surface in B-scans and in HRA images. Keratometry is not necessary
to obtain correct measurements perpendicular to the retinal surface, for
example RNFL thickness measurements.
If no “C-Curve” values have been entered, the standard value is 7.7.
This value is equal to the K value of Gullstrand's model eye. The typical range of a K value is 7.2 – 8.4 mm. If a K value is wrong by
0.1 mm, the resulting error in a distance measurement parallel to the
retinal surface is 0.8 %.
5.13
It may be necessary to move images between patient files to address
the following problems:
▪ Duplicate patient files ( Chapter 5.13.1 “Merging Duplicate Patient
Files”, p. 64)
▪ Images stored in the wrong patient file ( Chapter 5.13.2 “Moving
Images Stored in the Wrong Patient File”, p. 66).
5.13.1
Merging Duplicate Patient Files
Information that is already present in the target patient file remains
unchanged.
64
5
Duplicate patient files can be resolved by moving all images into a
single patient file.
The duplicate patient file then needs to be deleted.
Before merging two patient files, identify the target patient file you
would like to keep and the source patient file you would like to delete
afterwards.
 Click
to start HEYEX.
 Select the source patient file and the target patient file.
Make sure that only the relevant patient files are loaded in the right
part of the database window.
 Click
 Select the source patient file from the “Patient” drop-down list.
 If the patient file contains examinations for both sides “OD” and “OS” ,
click
to remove the split.
 Press and hold
 Release
on the keyboard and select all image thumbnails.
and right-click a selected image thumbnail.
 Select “Change Patient” .
The “Change Patient” dialog box is displayed.
 Select the target patient file.
A message is displayed asking whether you really want to change
these examinations from the source patient file to the target patient file.
The selected images are moved to the target patient file and are no
longer displayed in the source patient file.
If an examination of the same day already exists in the target patient
file, images from the source patient file will be included in this examination. If not already present, the following information will be copied to
the target patient file:
▪ Injection timer
▪ Examination comments
▪ Eye data
 If more examination tabs exist, repeat this procedure until all examina-
tions are stored in the target patient file.
 Select the target patient file from the “Patient” drop-down list and
verify that this patient file contains all images that were moved from the
source patient file.
 In order to return to the database window, click
 In order to unload all patient files, click
in the tool bar.
in the tool bar.
 Delete the source patient file of that does not contain examinations
anymore.
For further information on deleting patient files, please refer to
( Chapter 5.9 “Deleting Patient Files and Examinations”, p. 56).
65
5
5.13.2
Moving Images Stored in the Wrong Patient File
If the wrong patient file was accidentally selected for image acquisition,
the patient's images are stored in the wrong patient file. Images may
be moved from the wrong patient file to the correct patient file.
NOTICE
Moving images to the wrong patient file may lead to inconsistent
data.
 Before moving images to patient files check that the correct
patient data and the examination data are selected.
If undetected, inconsistent data may result in erroneous diagnostic conclusions and/or erroneous treatment.
 Select the source patient file and the target patient file.
Make sure that only the relevant patient files are loaded in the right
part of the database window.
 Click
 Select the source patient file from the “Patient” drop-down list.
 Select the examination tab that contains the incorrect examination
data.
 If the examination tab contains examinations for both sides “OD” and
“OS” , click
to remove the split.
 Press and hold
thumbnails.
 Release
on the keyboard and select the desired image
 Select “Change Patient” .
The “Change Patient” dialog box is displayed and the target patient
file is automatically selected.
A message is displayed asking whether you really want to change
these examinations from the source patient file to the target patient file.
The selected images are moved to the target patient file and are no
longer displayed in the source patient file.
The selected visual field examinations are moved to the target patient
file and are no longer displayed in the source patient file.
If an examination of the same day already exists in the target patient
file, images from the source patient file will be included in this examination. If not already present, the following information will be copied to
the target patient file:
▪ Injection timer
▪ Examination comments
▪ Eye data
 If more examination tabs exist, repeat this procedure until all examina-
tions are stored in the target patient file.
66
5
Using the Lightbox
 Select the target patient file from the “Patient” drop-down list and
verify that this patient file contains the image thumbnails that were
moved from the source patient file.
5.14
in the tool bar.
Using the Lightbox
The lightbox is used to mark specific examinations for review at a later
time and for printing reports.
The lightbox can contain images from different examination days.
5.14.1
Adding Images to the Lightbox
 Click
to start HEYEX.
Files”, p. 45).
 Click
 In order to add one image to the lightbox, right-click an image thumb-
nail.
 In order to add multiple images to the lightbox, press and hold
the keyboard and click the image thumbnails.
 Release
on
 Select “Add to lightbox” .
All images are added to the lightbox.
 As an alternative, select one or multiple image thumbnails and drag-
and-drop them to the lightbox.
5.14.2
Saving the Lightbox
 Click
to start HEYEX.
 Add images to the lightbox ( Chapter 5.14 “Using the Lightbox”,
p. 67).
 Right-click an image thumbnail in the lightbox.
 Select “Save Lightbox” .
 Enter a name for the lightbox in the opening dialog box.
The lightbox is saved and will be displayed the next time the patient file
is opened. If several lightboxes have been saved, they can be selected
from the “Lightbox” drop-down list.
If the lightbox has not been saved and the image viewing window is
closed or another patient is called, the message “Do you want to save
the current lightbox?” is displayed.
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5
Using the Lightbox
 Click “Yes” to confirm or “No” to quit without changes.
Keeping the Original Lightbox
If you already have saved a lightbox and the lightbox shall be modified,
there are two ways to save this changes. Either overwrite the existing
lightbox or check the “Keep original Lightbox” box, to save the modified lightbox under a different file name. In this way, the original
lightbox is kept.
 Right-click an image thumbnail in the lightbox.
 Select “Save Lightbox” .
A message is displayed asking whether you want to save the current
lightbox.
 Check the “Keep original Lightbox” box and enter a new file name.
If the option “Keep original Lightbox” is not selected, the original
lightbox will be overwritten.
The current lightbox is saved. The lightboxes can now be selected
from the “Lightbox” drop-down list.
5.14.3
Removing Images from the Lightbox
 Click
to start HEYEX.
 Add images to the lightbox ( Chapter 5.14 “Using the Lightbox”,
p. 67).
 In order to remove images from the lightbox, right-click an image
thumbnail in the lightbox.
 Select “Remove from Lightbox” .
The image thumbnail is no longer displayed in the lightbox.
5.14.4
Deleting the Lightbox
A lightbox that has already been saved can be deleted
( Chapter 5.14.2 “Saving the Lightbox”, p. 67).
 Click
to start HEYEX.
 Select a patient file that contains one or multiple lightboxes.
 Click
 Open the “Lightbox” drop-down list and select the lightbox to be
deleted.
 Right-click an image thumbnail.
 Select “Delete Lightbox” .
A message is displayed asking whether you really want to delete this
lightbox.
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5
Using the Lightbox
69
6
Touch Panel
Grafical User Interface
6
Touch Panel
About this Chapter
This chapter provides an introduction to the touch panel, including:
▪ The graphical user interface and all its functions
▪ Selecting acquisition modalities, for example movies, tomographies,
composite images or stereopair images
▪ Selecting acquisition settings, for example high speed or high resolution, manual or automatic image brightness control
By the end of this chapter, you should be able to confidently use the
touch panel and all its functions.
Safety interlock.
▪ Restart the system.
▪ If the safety interlock persists, stop using the system and call
Heidelberg Engineering technical support.
In case of a safety interlock the message “Safety interlock, restart
system.” is displayed on the touch panel. In the acquisition window,
the message “Safety interlock. Device must be restarted.” is displayed. The patient sees four simultaneous blinking fixation lights.
6.1
70
Touch Panel
6
Acquisition modes
“More”
Laser intensity
Fixation light
Scan angle
“Inj.” Injection Timer
Acquisition modalities
Laser on/off
“Acquire” Images
Acquisition modes
Depending on the filter wheel position, different acquisition modes are
available. For further information on acquisition modes, please refer to
( Chapter 7.4.1 “Selecting Acquisition Modes”, p. 80).
Laser intensity
You can change the IR and the ICG laser intensity during an examination, for example during an angiography or if the cSLO image is overexposed.
 Press either “25%” , “50%” , “75%” , or “100%” .
Scan angle
Fixation light
Injection timer
Laser on/off
( Chapter 7.8 “High Magnification Images”, p. 95)
( Chapter 6.2 “Selecting Acquisition Modalities”, p. 72)
( Chapter 7.4.2 “Selecting a Fixation Light”, p. 82)
( Chapter 7.7 “Injection Timers”, p. 93)
The color of the button changes based on the system status. When
you switch on the device, the button is color-coded red . If you start
HEYEX and open the acquisition window,
turns to , indicating that
the camera is switched off but ready to be switched on at any time.
 In order to switch on the camera, press
.
A high tone is audible, when the scanners and the laser are switched
on. The camera starts and the cSLO image is displayed.
turns to .
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6
Touch Panel
Selecting Acquisition Modalities
6.2
Selecting Acquisition Modalities
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
( Chapter 5.7 “Starting a New Examination”, p. 54).
The acquisition window opens. After initializing,
turns to
.
.
 On the touch panel press
turns to .
 On the touch panel press “Movie” twice.
The button “Movie” may be labeled with a different acquisition
modality, e.g. “Stereo Pair” or “Composite” .
The submenu is displayed.
 Select one of the following acquisition modalities:
▪ “Movie” ( Chapter 7.10 “Acquiring a Movie”, p. 100)
The button next to “Movie” allows the adjustment of the duration of a
movie.
▪ “Tomography” ( Chapter 7.14 “Performing a Tomography”, p. 114)
The button next to “Tomography” allows the adjustment of the tomography depth scan rate.
▪ “Mean”
The button next to “Mean” allows the adjustment of the number of
frames to be averaged.
▪ “Composite 3x3” ( Chapter 7.12 “Acquiring a Composite 3x3 Fundus
Image”, p. 109)
▪ “Composite” ( Chapter 7.11 “Acquiring a Composite Fundus Image”,
p. 103)
▪ “Stereo Pair” ( Chapter 7.13 “Acquiring a Stereo Fundus Image”,
p. 110)
All selected options are highlighted blue.
 In the main menu the selected acquisition modality is displayed.
72
Touch Panel
6
Selecting Acquisition Settings
6.3
Selecting Acquisition Settings
On the touch panel, you can set the acquisition settings during an
examination. If you want to set acquisition settings as default, please
refer to ( Chapter 7.1 “Setting Default Acquisition Parameters”,
p. 75).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
.
.
turns to .
.
 Select the following acquisition settings:
▪ Resolution mode “High Speed” or “High Res.”
For further information, please refer to ( Chapter 16 “Terms and Definitions”, p. 195)
▪ Image brightness control “Manual” or “Auto”
For further information, please refer to ( Chapter 7.1 “Setting Default
Acquisition Parameters”, p. 75).
▪ Myopic Lens “0 D” , “-6 D” or “-12 D”
In order to image highly myopic eyes, shift the focus towards negative
values down to -24 D by adding myopic correction of “ -6 D ” or “-12
D” .
All selected options are highlighted blue.
 In order to return to the main menu, press
.
73
7
7
Acquiring Images
Acquiring Images
About this Chapter
This chapter provides instructions on how to acquire images using
each of the different acquisition modalities offered by the
SPECTRALIS device.
Chapter structure:
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
L WARNING
L CAUTION
Setting default acquisition parameters
Unlocking examinations
The cSLO acquisition window and all its functions
Preparing the examination
▫ Selecting acquisition modes
▫ Selecting a fixation light
Acquiring cSLO images
Performing an angiography
Acquiring a BluePeak blue laser autofluorescence image
Acquiring a movie
Acquiring a composite fundus image
Acquiring a stereo fundus image
Performing a tomography
Acquiring MultiColor images (option)
Only use objective lenses provided by the manufacturer.
The incorrect use of lenses on the SPECTRALIS camera, or the
use of unauthorized lenses may result in the patient's retina being
exposed to hazardous laser light.
reflectance images.
 Do not mistake this artifact for a pathology.
myopia.
L CAUTION
examination.
74
Acquiring Images
7
Setting Default Acquisition Parameters
In order to accelerate the volume scan acquisition, the actual number
of averaged images for ART Mean may differ from the pre-selected
number of ART Mean images. The maximum difference increases with
the absolute number of ART Mean images. This will affect image
quality only marginally.
For best image quality clean the lens before an examination.
7.1
Setting Default Acquisition Parameters
Before acquiring images for the first time with the device, set the
default acquisition parameters.
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
 Select “Setup \ Acquisition Parameters” in the menu bar.
The “Acquisition Parameter Setup” dialog box is displayed.
“Default scan resolution”  Select either “High Speed” or “High Res” .
For further information on the scan resolution modes, please refer to
( Chapter 16 “Terms and Definitions”, p. 195).
“Image Brightness Control”
By means of the image brightness control, the image brightness of the
cSLO image is controlled. Heidelberg Engineering recommends to use
the automatic image brightness control, if you are a new user and to
use the manual image brightness control, if you are an advanced user.
 Select either “Automatic” or “Manual” .
If you select “Automatic” , the laser sensitivity automatically increases
or decreases. The cSLO image is always evenly-illuminated.
. If the
If you select “Manual” , the laser sensitivity is controlled via
cSLO image is overexposed, reduce the laser sensitivity. If the cSLO
image is underexposed, increase the laser sensitivity.
 If the cSLO image is overexposed, turn
laser sensitivity.
 If the cSLO image is underexposed, turn
decrease the laser sensitivity.
clockwise to increase the
counterclockwise to
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7
Acquiring Images
Unlocking Examinations
With the cyclic buffer size, the duration in which images shall be
acquired before you press “Acquisition” on the touch panel is
adjusted. The software will save several additional images from the
cyclic buffer and add them to the beginning of the movie. Depending
on the selected cyclic buffer size and the scan resolution mode, the
number of cyclic buffer images saved varies.
“Cyclic buffer size (for movies)”
 Select either “0.5 sec” , “1 sec” , or “2 sec” .
 In order to disable the cyclic buffer, select “disable” .
“Default Acquisition Mode &
Parameters”
Select which acquisition modality shall be set as default.
 Select either “Movie” , “Tomography” , “Mean” , “Composite 3x3” ,
“Composite” , or “Stereo Pair” .
 If you select “Movie” , click
or
 If you select “Tomography” , click
scan range in mm.
and set the duration of the movie.
or
and set the tomography depth
 If you select “Mean” , click
or and set the number of frames to be
averaged when acquiring images with ART Mean.
“Default Fixation Target”  Select either “Internal” or “External” .
For further information on the fixation light, please refer to
( Chapter 7.4.2 “Selecting a Fixation Light”, p. 82).
In the acquisition memory setup, you can adjust the available free
memory used for acquiring images. If you change the “Image buffer
size” value, you have to restart the software.
“Acquisition Memory Setup”
 In order to change the “Image buffer size” value, click
or .
Heidelberg Engineering recommends to set the image buffer size to
768 MB.
 Click “Save Settings” to confirm.
7.2
When working in a network environment the examinations of loaded
patient files are locked for users, e.g. during an ongoing examination.
Therefore, these examinations cannot be processed or analyzed by a
different user at the same time. If you want to allow this file to be
opened by multiple users at the same time, you can unlock the examinations.
 Click
to start HEYEX.
Files”, p. 45).
76
Acquiring Images
7
 Click
If a red key marks the examination tab, the examinations are locked
and cannot be changed or reviewed by a different user.
 In order to unlock the examinations, click
in the tool bar.
The red key in the examination tab disappears. The examinations may
be opened and analyzed by a different user.
in the tool bar.
The patient file is loaded in the right part of the database window. The
patient file can now be opened and analyzed by a different user in the
network.
 In order to make the patient file available for a new examination for all
users, click
in the tool bar and unload the patient file.
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7
Acquiring Images
Graphical User Interface cSLO Acquisition Window
7.3
Serial number, feature code, patient
name and examination date
“ART Mean” ; only displayed if ART
Mean is active
Menu bar
“Memory” Status
Live image; only displayed if ART Mean
is active
“Inj.” Injection Timers
cSLO Image (ART Mean Image)
Control Elements
“Settings”
Settings
78
The following settings are displayed in the “Settings” section:
Acquiring Images
7
ART Mean
Parameter
Description
Eye
Examined eye, right eye OD or left eye OS
Angle
Displays the selected scan angle.
Focus
Displays the adjusted refraction.
Sens.
Displays the adjusted detector sensitivity; the
value range is between 31 and 107.
Power
Displays the laser power, e.g. “IR 100%”
Mode
Displays the selected acquisition mode setting,
e.g. “Single” , and the scan pattern.
Rate
Displays the scan rate of the live image in terms
of frames per second, e.g. “8.8/sec” .
Res.
Displays the scan resolution, e.g. “High Res.” or
“High Speed” .
With ART, mean images are created automatically, which increases
image quality due to noise reduction.
 In order to change the number of frames, move the slider to adjust the
desired number of frames.
L CAUTION! Temporal averaging of images may generate
blurred or misleading images of pulsating blood vessels and bordering tissue. Temporal averaging is used by the ART Mean, ART
Composite and the “Compute Composite” and “Compute Mean” functions. Do not mistake these effects for pathologies.
When examining cSLO images the function “Normalize” is activated
as default. The function leads to an enlargement of the gray scale and
thereby to a higher contrast ratio of the cSLO images. It is not necessary to switch off the function “Normalize” in the clinical routine, but for
special research activities. If the function “Normalize” is switched off, it
is necessary to switch on the manual image brightness control. Otherwise the effect created by “Normalize” is not visible.
Memory Status
The following information is displayed in the “Memory” section:
Parameter
Description
Images
Number of images saved in the random access
memory (RAM).
Free
Remaining free memory in the RAM in MB. The
status bar represents the used random access
memory. When the remaining free RAM memory
is low, click “Save Images” .
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Acquiring Images
Preparing the Examination
The injection timers are only relevant for fluorescein angiography or
indocyanine green angiography ( Chapter 7.7 “Injection Timers”,
p. 93).
Injection Timers
The following control elements are available in the acquisition window:
Control Elements
Button
Description
Image acquisition modes
Click the button and select an acquisition mode.
( Chapter 16 “Terms and Definitions”, p. 195)
( Chapter 7.4.2 “Selecting a Fixation Light”,
p. 82)
The color of the button changes based on the
system status.
The camera is switched on.
The camera is switched off but ready to be
switched on at any time.
The camera is switched off because the
acquisition window has not been opened or
memory is full.
7.4
7.4.1
Selecting Acquisition Modes
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
The cSLO acquisition window opens.
 In order to select an acquisition mode, turn the filter wheel either to the
filter wheel position “A” or “R” .
▪ If you select “A” the angiography and autofluorescence acquisition
modes are available.
▪ If you select “R” the reflection acquisition modes are available.
▪ If you select “P” you cannot acquire images.
▪ If you select “S” you can acquire infrared reflectance images. However, Heidelberg Engineering recommends to acquire images with the
filter wheel positions “A” or “R” .
80
Acquiring Images
7
L CAUTION
The incorrectly selected filter wheel position may lead to a misinterpretation of the examination results.
 Always turn the filter wheel to the correct position.
A wrong diagnostic interpretation may result in wrong therapeutic
approaches.
Position the filter wheel at the filter wheel position “A” or “R” correctly.
If you do not position the filter wheel correctly, a message is displayed
in the acquisition window, that an invalid filter wheel position has been
selected. Image acquisition is not possible until you position the filter
wheel correctly.
No acquisition modes are assigned to the filter wheel position “P” .
▪ Turn the filter wheel to the filter wheel position “A” or “R” correctly.
If you turn the filter wheel to the filter wheel position “P” a message is
displayed in the acquisition window, that the acquisition is currently not
possible. You are asked to check the filter wheel position and the
mounted objective.
Do not position the filter wheel at the filter wheel position “P” .
▪ Turn the filter wheel to the filter wheel position “A” or “R” correctly.
▪ Press either
on the touch panel or click
in the acquisition window
to restart the camera.
If you do not position the filter wheel correctly, a message is displayed
in the acquisition window, that an invalid filter wheel position has been
selected. The camera turns off. Image acquisition is not possible until
you position the filter wheel correctly.
Dependently on the selected filter wheel position, the following acquisition modes are displayed on the touch panel and in the acquisition
window:
Filter wheel position A
Filter wheel position R
IR
IR
FA
RedFree
ICGA
RF + IR
FA + ICGA
FA + IR
ICGA + IR
The acquisition mode “Red Free” on the touch panel corresponds to
the acquisition mode “BR” and “Blue Reflectance” in the acquisition
window.
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7
Acquiring Images
"FA" is assigned to two acquisition modes.
When “FA” is pressed and the injection timer “Inj.” is not activated,
the acquisition mode BluePeak blue laser autofluorescence starts. In
the acquisition window “BAF” and “Blue Autofluorescence” is displayed. When “FA” is pressed and the injection timer “Inj.” is activated, the fluorescein angiography starts. In the acquisition window,
“FA” and “Fluorescein Angiography” are displayed.
"ICGA" is assigned to two acquisition modes.
When “ICGA” is pressed and the injection timer “Inj.” is not activated,
the acquisition mode infrared autofluorescence starts. In the acquisition window “IRAF” and “Infrared Autofluorescence” is displayed.
When “ICGA” is pressed and the injection timer “Inj.” is activated, the
indocyanine green angiography starts. In the acquisition window,
“ICGA” and “ICG Angiography” are displayed.
Selecting acquisition modes in the  In order to select a single acquisition mode, click
acquisition window element section of the cSLO acquisition window.
in the control
The context menu opens and all available acquisition modes are displayed.
Selecting the MultiColor Mode
(Option)
The acquisition mode “MultiColor” is only available for SPECTRALIS
MultiColor devices.
 Set the filter wheel to “R” .
 Click
window.
in the control element section of the cSLO acquisition
The context menu opens and all available acquisition modes are displayed .
 Select “MColor” .
The MultiColor mode is switched on.
7.4.2
Selecting a Fixation Light
It is possible to use an internal or the external fixation light.
 In order to examine the macula or the fovea, select the central fixation
light.
 In order to examine the papilla, select the nasal fixation light.
 In order to examine an area of interest in the lower part of the eye,
select one of the upper fixation light positions.
 In order to examine an area of interest in the upper part of the eye,
select one of the lower fixation light positions.
 In order to examine an area of interest in the nasal part of the eye,
select a temporal fixation light or the external fixation light.
 In order to examine an area of interest in the temporal part of the eye,
select a nasal fixation light or the external fixation light.
82
Acquiring Images
7
 If the patient does not see the internal fixation light, select the external
fixation light.
If the patient fixates centrally, only the macula and the surrounding 30°
field can be acquired.
Selecting a Fixation Light on the  Click
to start HEYEX.
Touch Panel
Files”, p. 45).
in the tool bar
 The acquisition window opens. After initializing,
touch panel.
turns to
turns to
on the
.
.
on the touch panel.
 In order to select a fixation light, press
The “Select Target” screen is displayed. The selected fixation light is
highlighted blue.
 In order to change the position of the internal fixation light, press one of
the red squares.
 In order to switch on the external fixation light, press “External” .
The internal fixation light is switched off.
.
Select a Fixation Light in the  In order to start a new examination, click
in the tool bar
Acquisition Window ( Chapter 5.7 “Starting a New Examination”, p. 54).
 In order to select a fixation light, click
.
 In order to change the position of the internal fixation light, click one of
the blue points.
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7
Acquiring Images
Acquiring cSLO Images
 In order to switch on the external fixation light, deselect all blue points.
The internal fixation light is switched off.
7.5
Starting the examination  Switch on the device ( Chapter 3.2 “Switching the Device on and off”,
p. 28).
 Click
to start HEYEX.
 Move the camera to the farthest back position.
Files”, p. 45).
in the tool bar
touch panel and in the acquisition window.
turns to
on the
.
A high tone is audible when the scanners and the laser are switched
turns to .
Selecting an acquisition mode  Turn the filter wheel to the desired filter wheel position.
 Select a single acquisition mode, for example “IR” on the touch panel
or in the acquisition window.
For further information on the touch panel, please refer to
( Chapter 6.1 “Grafical User Interface”, p. 70)
Setting acquisition modalities  In order to select “HS” as the scan resolution, press
panel and select “High Speed” .
on the touch
 In order to select “HR” as the scan resolution, press
on the touch
panel and select “High Res.” .
 In order to select automatic image brightness control, press
touch panel and select “Auto” .
on the
The cSLO image illumination is controlled automatically.
 In order to select manual image brightness control, press
touch panel and select “Manual” .
The cSLO image illumination can be controlled via
84
on the
.
.
Acquiring Images
7
 In order to examine the right eye, move the camera to the left.
In the “Settings” section, “OD” is automatically selected due to the
left-right recognition of the camera.
 Select an internal or the external fixation light ( Chapter 7.4.2
“Selecting a Fixation Light”, p. 82).
 Ask the patient to look at the fixation light.
Aligning the camera
Fig. 23: Bright spot centered in the cSLO image
 Move the camera slightly to the left or the right and turn the joystick so
that the bright spot is centered in the cSLO image (Fig. 23).
Try to avoid pivoting the camera head.
Fig. 24: Aligning the camera correctly
 Move the camera slowly towards the patient’s eye until an evenly-illu-
minated cSLO image is displayed
.
L WARNING! Careless move of the camera might injure the
patient's eye. Adjust the camera carefully. Check the distance
between lens and the patient’s eye continuously.
 If the cSLO image has dark edges
patient's eye.
, move the camera closer to the
 If the cSLO image is too dark in the upper part, turn the joystick coun-
terclockwise to move the camera down.
 If the cSLO image is too dark in the lower part, turn the joystick clock-
wise to move the camera up.
 If the cSLO image is too dark on the right side, move the camera to the
left.
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Acquiring Images
 If the cSLO image is too dark on the left side, move the camera to the
right.
 If the cSLO image is well-illuminated but out of focus
, turn the focus
knob and adjust the patient's refraction so that the vessels and the
cSLO image are sharply displayed.
L WARNING! Wrong classification results may be caused by
wrong focus setting during image acquisition. Classification results
may be wrong if the calculation is based on incorrect refraction values.
Wrong classification results may lead to wrong diagnostic conclusions
which may result in wrong therapeutic approaches. Always check the
correct focus settings.
The refraction is displayed as the “Focus” value in the “Settings” section of the acquisition window.
 If the cSLO image is overexposed and manual image brightness con-
trol is selected, turn
until the image is illuminated correctly.
In special medical cases it might be necessary to increase the focus
and select either additional “-6 D”
range. On the touch panel press
or “-12 D” . This allows an adjustment to -24 D.
Fig. 25: Acquisition window with ART Mean activated
Acquiring images with ART Mean  In order to acquire images with ART Mean, press
panel.
on the touch
Images can be acquired before ART Mean reaches the adjusted
number of frames. Under certain circumstances, e.g. nystagmus, ART
Mean processing might fail. In these cases, acquire images without
ART Mean.
ART Mean is activated. The small live image is displayed on the left
side of the acquisition window. The progression bar increases as the
ART Mean counts to the adjusted number of frames.
 Watch the small live image for an even illumination.
86
Acquiring Images
7
Fig. 26: Keeping the hands on the device
 Keep the hands on the device and re-adjust the camera as needed
(Fig. 26).
 On the touch panel press “Acquire” .
The image is acquired.
.
ART Mean is switched off.
 In order to examine the left eye, move the camera to the right.
In the “Settings” section, “OS” is automatically selected. Re-align the
camera and repeat the previous steps.
 Click “Save images” in the menu bar.
If multiple images have been acquired and the acquisition window
has not been closed over a longer period of time, click “Save images”
to prevent data loss.
Acquiring Images without ART  In order to acquire images without ART Mean, press “Acquire” on the
Mean touch panel.
If images have been acquired without ART Mean, it is possible to compute Mean images afterwards ( Chapter 10.9 “Computing Mean
Images”, p. 170).
Quitting the examination  In order to switch off the camera, press
turns to
.
.
 In order to quit the examination, click
.
The acquired images are saved. The acquisition window closes. The
acquired images are displayed in the image viewing window in the
form of image thumbnails.
 Review the images.
in the tool bar.
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Acquiring Images
Performing an Angiography
7.6
L WARNING
The incorrect application of contrast agent may cause bad image
quality in angiography images.
 Follow the instructions given on the contrast agent package
insert.
L WARNING
Allergic reactions due to unidentified allergies or intolerances.
 Ask the patient: “Do you have allergies or intolerances?”.
 Confirm that patient allergies or intolerances are not listed as
contraindications in the contrast agent package insert.
 Follow the instructions given on the contrast agent package
insert.
 Minimize the daily injection amounts.
Possible adverse drug reactions to the contrast agent.
Acquire several autofluorescence images or infrared images before
dye injection. After the dye injection, autofluorescence imaging is not
possible.
p. 28).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
In the “Settings” section, “OD” is automatically selected.
In the “Settings” section, “OS” is automatically selected.
 Turn the filter wheel to the filter wheel position “A” .
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Acquiring Images
7
 On the touch panel select “FA” as the acquisition mode.
The acquisition mode “FA” on the touch panel corresponds to the
acquisition mode “BAF” in the acquisition window.
"FA" is assigned to two acquisition modes. When “FA” is pressed
and the injection timer “Inj.” is not activated, the acquisition mode
BluePeak blue laser autofluorescence starts. In the acquisition window
“BAF” and “Blue Autofluorescence” is displayed. When “FA” is
pressed and the injection timer “Inj.” is activated, the fluorescein
angiography starts. In the acquisition window, “FA” and “Fluorescein
Angiography” are displayed.
on the touch
on the touch
on the
on the
.
.
Aligning the camera
89
7
Acquiring Images
.
patient's eye.
left.
right.
, turn the focus
90
Acquiring Images
7
Starting the Angiography  Turn the filter wheel to the filter wheel position “A” .
 On the touch panel select an angiography mode:
▪ “FA” for fluorescein angiography
▪ “ICGA” for indocyanine green angiography
▪ “FA + ICGA” for simultaneous fluorescein angiography and indocyanine green angiography
▪ “FA + IR” for simultaneous fluorescein angiography and infrared
imaging
▪ “ICGA + IR” for simultaneous indocyanine green angiography and
infrared imaging
"FA" is assigned to two acquisition modes. When “FA” is pressed
and the injection timer “Inj.” is not activated, the acquisition mode
BluePeak blue laser autofluorescence starts. In the acquisition window
“BAF” and “Blue Autofluorescence” is displayed. When “FA” is
pressed and the injection timer “Inj.” is activated, the fluorescein
angiography starts. In the acquisition window, “FA” and “Fluorescein
"ICGA" is assigned to two acquisition modes. When “ICGA” is
pressed and the injection timer “Inj.” is not activated, the acquisition
mode infrared autofluorescence starts. In the acquisition window
“IRAF” and “Infrared Autofluorescence” is displayed. When “ICGA” is
pressed and the injection timer “Inj.” is activated, the indocyanine
green angiography starts. In the acquisition window, “ICGA” and “ICG
 Press “Inj.” on the touch panel and inject the dye immediately. If “FA +
ICGA” is selected, inject both dyes simultaneously.
In the acquisition window, the injection timers start to count in the
“Timers” section.

When performing FA + ICGA angiography, the intensity of the
indocyanine green dye has a stronger fluorescence than the fluorescence of the fluorescein dye for the first 1 – 2 minutes. In order to get a
comparable intensity of fluorescence, press
or
on the touch
panel and set the laser intensity to 50 – 75 % during the early phase.
and set the laser intensity to 100 % after 1 – 2 minutes.
Press
Heidelberg Engineering recommends to acquire a movie of the
early phase. The single image acquisition with ART Mean might fail
during this phase, as the appearance of the retina changes rapidly.
In order to acquire a movie of the early phase of the dye, select
“Movie” on the touch panel. Be aware that the image intensity varies
quickly during this initial phase.
 Ask the patient not to move.
 Re-adjust the camera.
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7
Acquiring Images
 Watch the live image.
(Fig. 29).
 On the touch panel, press “Acquire” if the fluorescence is visible.
A beep is audible during the movie acquisition.
 In order to stop the acquisition of the movie, press “Stop” on the touch
panel.
Acquiring images with ART Mean

ART Mean.
In order to acquire images with ART Mean, press
panel.
on the touch
ART Mean is activated. The small live images are displayed. The gray
progression bar increases as the ART Mean counts to 100 frames.
 Watch the small live images for an even illumination.
 Keep the hands on the device and re-adjust the camera as needed.
92
Acquiring Images
7
Injection Timers
 In order to acquire several images, press “Acquire” again.
.
turns to
.
.
.
The acquired images and movies are saved. The acquisition window
closes. The acquired images are displayed in the image viewing
window in the form of image thumbnails. The “HRA Patient Timer Log”
window is displayed.
in the tool bar.
With the SPECTRALIS device you can acquire images at a very late
stage of the angiography. Currently there are only a handful of diagnoses that require very late images after 20 or 30 minutes, such as in
cases of suspected optic nerve head edema, suspected tumors and
other rare cases. If you want to acquire images of the late phase, wait
20 or more minutes after injecting the fluorescent dye before starting
the acquisition.
7.7
Injection Timers
Setting Injection Timers
Always set the injection timers for fluorescein angiography and indocyanine green angiography when injecting the dye.
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
 Turn the filter wheel to the filter wheel position “A” .
 On the touch panel select an angiography mode, for example “FA
+ICGA” .
The button “Inj.” blinks.
 Inject the dye.
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7
Acquiring Images
Injection Timers
 On the touch panel press “Inj.” .
Fig. 31: Timers section
In the acquisition window, the timers for FA and ICGA start to count in
the “Timers” section. The information are added to the “HRA patient
timer log” .
Resetting Injection Timers
You can reset the injection timers if problems occur while injecting the
dye.
 Select “Setup \ Reset Injection Timer...”.
The message “Do you really want to reset injection timer?” is displayed.
 Click “No” to quit without changes.
In order to restart the injection timer, press “Inj.” on the touch panel.
Removing Patients from HRA
Patient Timer Log
You can delete patients from the “HRA Patient Timer Log” window.
Fig. 32: "HRA Patient Timer Log" window
 In the “HRA Patient Timer Log” window right-click a patient (Fig. 32).
 Select “Remove Patient” .
The patient is removed from the “HRA Patient Timer Log” window.
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7
Acquiring Images
High Magnification Images
7.8
High Magnification Images
Fig. 33: Images acquired with a scan angle of 30°, 20°, and 15°
High magnification images are especially useful when performing an
ICGA to locate a feeder vessel. For further information on performing
an angiography, please refer to ( Chapter 7.6 “Performing an
Angiography”, p. 88).
Selecting a higher magnification on the device works like the digital
zoom on a digital camera. The smaller the selected angle, the lower
the number of pixels used for acquiring the area of interest. The
advantage of a 15° scan angle is the higher magnification on the
screen, smaller file size and higher frame rates, which are especially
suited for movies of the early phase.
For best image details, select “High Resolution” as the scan resolution
mode when increasing the magnification.
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
 On the touch panel press either “15°” , “20°” or “30°” .
The selected option is highlighted blue.
 Acquire images.
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Acquiring Images
Acquiring a BluePeak Blue Laser Autofluorescence...
7.9
Acquiring a BluePeak Blue Laser Autofluorescence Image
L WARNING
A patient that is not optimally prepared for the acquisition of
BluePeak blue laser autofluorescence images may cause bad
image quality.
 For best image quality, Heidelberg Engineering recommends to
acquire BluePeak blue laser autofluorescence images with dilated
pupils.
 In order to improve the image quality for patients with cataract,
dilating the pupils might improve the image quality.
For BluePeak blue laser autofluorescence imaging, no dye injection is
necessary.
Always acquire BluePeak blue laser autofluorescence images before
injecting dye and performing angiographies.
p. 28).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
Selecting an Acquisition Mode  Turn the filter wheel to the wheel position “A” .
on the touch
on the touch
96
Acquiring Images
7
on the
on the
.
.
Aligning the camera
.
97
7
Acquiring Images
patient's eye.
left.
right.
, turn the focus

Inform the patient that the blue light is extremely bright.
Select “FA” as the acquisition mode on the touch panel or “BAF” as
the acquisition mode in the acquisition window.
The cSLO image gets darker.
 Turn the focus knob and decrease the focus about 1 D.
 If manual image brightness control has been selected, turn
increase sensitivity until the retinal blood vessels are outlined.
98
and
Acquiring Images
7
panel.
on the touch
ART Mean.
(Fig. 26).
.
99
7
Acquiring Images
Acquiring a Movie
turns to
.
.
.
7.10
in the tool bar.
Acquiring a Movie
p. 28).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
100
Acquiring Images
7
Acquiring a Movie
Aligning the camera
.
patient's eye.
left.
101
7
Acquiring Images
Acquiring a Movie
right.
, turn the focus
Fig. 40: Selecting movie settings on the touch panel
 On the touch panel, press “Movie” twice (Fig. 40).
 In order to change the duration of the movie, press “10 s” .
 In order to decrease the duration of the movie, press “-” . The shortest
duration of a movie is one second.
 In order to increase the duration of the movie, press “+” . The longest
duration of a movie is 60 seconds.
 Press “OK” to confirm.
The acquisition modality “Movie” is now displayed in the main menu of
the touch panel.
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Acquiring Images
7
Acquiring a Composite Fundus Image
(Fig. 41).
“Acquire” changes to “Stop” .
In order to interrupt the movie at any time, press “Stop” .
A beep is audible during the movie acquisition.
When the movie acquisition is finished, “Stop” turns to “Acquire” .
In the section “Settings” , “OS” is automatically selected. Repeat the
previous steps.
turns to
.
.
.
The acquired movie is saved. The acquisition window closes. The
acquired movie is displayed in the image viewing window in the form of
an image thumbnail.
 Review the movie ( Chapter 8.4.5 “Analyzing Movies”, p. 149).
7.11
in the tool bar.
With the acquisition modality “Composite” images large-field images of
the retina are acquired, that are made up of multiple single 30° images.
The final image size depends on the total area covered by the acquired
single 30° images. As an easier alternative, use the imaging modality
“Composite 3x3” ( Chapter 7.12 “Acquiring a Composite 3x3 Fundus
Image”, p. 109).
p. 28).
 Click
to start HEYEX.
103
7
Acquiring Images
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
Selecting the external fixation light

Use the external fixation light to acquire composite images. Do not
use the internal fixation lights.
On the touch panel press
and select “External” .
 Ask the patient to look at the external fixation light.
on the touch
on the touch
on the
on the
.
.
104
Acquiring Images
7
Aligning the camera
.
patient's eye.
left.
right.
105
7
Acquiring Images
, turn the focus
 On the touch panel press “Movie ” twice.
 Press “Composite” .
The acquisition modality “Composite” is now displayed in the main
menu of the touch panel.
 On the touch panel, press
.
Fig. 44: Composite image displayed on the right side of the acquisition
window
ART Mean is switched on. The small live image is displayed on the left
side of the acquisition window. The composite image is displayed on
the right side of the acquisition window (Fig. 44). The composite image
will get expanded by pivoting the camera head.
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Acquiring Images
7
 Position the camera head horizontally centered in the periphery.
 Pivot the camera head very slowly downwards and upwards.
 Pivot the camera head very slowly to the centered position.
 Pivot the camera very slowly to the right.
 Proceed until the whole area of interest is covered.
Fig. 45: Constructed composite image
The composite image is constructed (Fig. 45). Check the positioning
and the focus of the live image. Re-adjust settings as necessary.
 When the entire composite image is displayed in the cSLO image,
press “Acquire” .
The composite image is acquired.
.
107
7
Acquiring Images
turns to
.
.
.
108
in the tool bar.
Acquiring Images
7
Acquiring a Composite 3x3 Fundus Image
7.12
Acquiring a Composite 3x3 Fundus Image
“Composite 3x3” is an imaging modality that acquires ART composite
fundus images. For further information on ART composite fundus
imaging, please refer to ( Chapter 7.11 “Acquiring a Composite
Fundus Image”, p. 103)
 Click
to start HEYEX.
Files”, p. 45).
New Examination”, p. 54).
( Chapter 5.7 “Starting a
 Move the camera slowly towards the patient’s eye until a correctly-illu-
minated cSLO image is displayed.
 On the touch panel, press “Movie” twice.
 Press “Composite 3x3” .
The acquisition modality “Composite” is now displayed in the main
 Pivot the camera head so that the patient can see the fixation light in
the upper right.
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7
Acquiring Images
Acquiring a Stereo Fundus Image
Fig. 46: Sequence of the fixation light
The first image is acquired. The fixation light is visible in the upper
center.
 Pivot the camera head and, if necessary, change the position of the
camera so that the patient can see the fixation light.
The second image is acquired. The fixation light is visible at the next
position. Repeat image acquisition, until all nine images are acquired.
.
The message “Do you want to compute composite?” is displayed.
The composite image is computed.
 Review the images ( Chapter 8.4.2 “Analyzing ART Composite
Fundus Images”, p. 146).
7.13
The acquisition modality “Stereo Pair” acquires two images at slightly
different angles in order to construct a 3D image that may be reviewed
with stereo viewing glasses ( Chapter 8.4.4 “Analyzing Stereo
Fundus Images”, p. 147). If the acquisition modality “Stereo Pair” is
used for angiographies, practice this modality in the acquisition mode
“IR” .
p. 28).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
110
Acquiring Images
7
on the touch
on the touch
on the
on the
.
.
Aligning the camera
111
7
Acquiring Images
.
patient's eye.
left.
right.
, turn the focus
 On the touch panel, press “Movie ” twice.
112
Acquiring Images
7
 Press “Stereo Pair” .
The acquisition modality “Stereo Pair” is now displayed in the main
menu of the touch panel. The patient now sees the fixation light to the
upper right.
 In order to acquire the first image from the left side with ART Mean,
press
on the touch panel.
side of the acquisition window. The gray progression bar increases as
the ART Mean counts to four frames (Fig. 49).
The left image is acquired.
 In order to acquire the second image from the right side of the same
eye, move the camera slightly to the right of the area of interest with
the joystick.
The right image is acquired.
.
turns to
.
.
.
in the tool bar.
113
7
Acquiring Images
Performing a Tomography
7.14
Fig. 50: Tomography scans
The acquisition modality “Tomography” acquires a continuous series
of images while moving the focal plane by 1/8 mm intervals towards
the choroid from one image to the other.
p. 28).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
Selecting an Acquisition Mode  Turn the filter wheel to the desired filter wheel position.
on the touch
on the touch
on the
114
Acquiring Images
7
on the
.
.
Aligning the camera
.
patient's eye.
115
7
Acquiring Images
left.
right.
, turn the focus
Fig. 53: Selecting tomography settings on the touch panel
 On the touch panel press “Movie ” twice (Fig. 53).
 Press “Tomography” .
 In order to set the tomography depth scan range in mm, press “3 mm” .
Eight scans are taken per mm of tomography depth. If a range of 3 mm
is selected, 24 images will be acquired. The amount of acquired
images will vary with the scan depth that is selected.
 In order to decrease the tomography depth scan range, press “-” .
116
Acquiring Images
7
Acquiring MultiColor Images (Option)
 In order to increase the tomography depth scan range, press “+” .
 Press “OK” to confirm.
.
The acquisition modality “Tomography” is now displayed in the main
 Watch the cSLO image.
turns to
.
.
.
7.15
in the tool bar.
The following chapter provides an overview of the image acquisition
with the SPECTRALIS MultiColor.
L CAUTION
MultiColor images are not true color images and can appear different from color fundus photos.
MultiColor images may not be used as a surrogate of color
fundus photos for medical diagnosis. A MultiColor image is composed from reflectance images acquired with three discrete illumination wavelengths (infrared, 815 nm; green, 518 nm; blue, 486
nm). In contrast, a true color image is acquired using a continuous spectrum of light (white light) for illumination. In addition,
MultiColor images are acquired with a smaller depth of focus than
fundus camera images. Therefore, a MultiColor image does not
represent the true color of the examined structure, and significant
color differences can exist between MultiColor images and
fundus photos. The color differences depend on the examined
structure, on the pathology of the examined structure, and on the
focus setting.
“HR” cannot be selected as the scan resolution when acquiring MultiColor images.
Stereo fundus images cannot be selected as the acquisition modality
when acquiring MultiColor images.
117
7
Acquiring Images
7.15.1
Acquiring MultiColor cSLO Images
L CAUTION
MultiColor images.
 Do not mistake the artifact for a pathology.
myopia.
p. 28).
 Click
to start HEYEX.
Files”, p. 45).
in the tool bar
turns to
on the
.
turns to .
Selecting an acquisition mode  Turn the filter wheel to the filter wheel position “R” .
Setting Acquisition Modalities
MultiColor images are always acquired with the “HS” scan resolution.
“HR” cannot be selected as the scan resolution when acquiring MultiColor images.
on the
118
on the
.
.
Acquiring Images
7
Aligning the camera
.
patient's eye.
left.
119
7
Acquiring Images
right.
, turn the focus
Activating the MultiColor mode  On the touch panel press
.
 Press “MColor” .
The MultiColor mode is switched on. The cSLO image is displayed in
MultiColor. In the “Settings” section the available laser power “25%”
and “100%” are displayed.
120
Acquiring Images
7
panel.
on the touch
ART Mean.
(Fig. 26).
.
turns to
.
.
.
in the tool bar.
121
8
8
Analyzing Images
Analyzing Images
About this Chapter
This chapter provides instruction on how to analyze images acquired
with an acquisition modality and includes explanations of the cSLO
analysis window and all related functions. This chapter provides information on analyzing OCT images, including an explanation of HEYEX
functions, the OCT analysis window, tabs and all related functions.
By the end of this chapter, you will feel comfortable analyzing images
and using the functions available in the analysis window.
Chapter structure:
▪ Preparations
▫ Setting viewing preferences
▫ Adjusting image settings
▫ Adjusting monitor settings
▫ Window options
▫ Accessing image information
▪ Tools
▫ Overlays
▫ Zoom and pan mode
▫ Rotating images
▫ Extracting fundus images
▫ Expanding and extracting images
▪ Image thumbnails
▪ Analyzing cSLO images
▫ The cSLO analysis window and all its functions
▫ Analyzing composites
▫ Analyzing simultaneous fundus images
▫ Analyzing stereo fundus images
▫ Analyzing movies
▪ Analyzing MultiColor images (option)
L CAUTION
Scaling affected by corrective lenses.
examination.
 Always consider that length and area measurement results for
patients with intraocular lenses are less accurate.
Length and area measurements are less accurate for patients
wearing glasses or contact lenses or patients with intraocular
lenses.
122
Analyzing Images
8
Preparations
8.1
Preparations
8.1.1
Setting Viewing Preferences
Changes made in these settings are applied to all images.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Double-click an image thumbnail.
 Select “Options \ Preferences” in the menu bar.
Fig. 58: "Preferences" dialog box
The “Preferences” dialog box is displayed (Fig. 58).
“Analysis Center Options”
In the “Analysis Center Options” section, you can define the display
options, when opening the analysis window.
 In order to display the most recently used analysis when opening the
analysis window, select “Show most recently used analysis” .
 In order to display a certain tab, open the “Show analysis” drop-down
list and select the desired tab.
 In order to display info bubbles as a guidance through the analysis
window, check the “Display info bubbles” box.
“Default Image Settings” section  In the “Default Image Settings” section select one of the following
color display options:
▪ “Black on white”
▪ “White on black”
▪ “Color”
123
8
Analyzing Images
Preparations
 In order to display the “Custom Settings” buttons in the
“Brightness & Contrast” dialog box, check the “Show "Custom
Settings" Buttons” box.
For further information on the “Custom Settings” , please refer to
( “Saving changes as custom settings” p. 126).
 If you want to get asked whether the current settings shall be saved
when closing the analysis window, check the “Ask "Save settings" if a
scan is closed and the settings window is visible” box.
“Data Export Options” section  In order to define a standard graphic format for the XML export, open
the drop-down list in the “Graphics file format” section and select
either “tif” , “jpg” , “bmp” or “raw” .
 If patient data shall be anonymized, check the “Depersonalize” box.
For further information on the “XML Data Export” , please refer to
( Chapter 10.6 “Exporting XML-Files”, p. 168).
“Miscellaneous Options” section  In the “Miscellaneous Options” section, check the “Show image IDs”
box to display the image IDs in the image thumbnail captions.
 In order to sort thumbnails in chronological order, check the “Sort by
examination time” box.
If this box is not checked, images will be ordered by the examined
structure and image ID.
 Click “OK” to confirm or “Cancel” to quit without changes.
8.1.2
Adjusting Image Settings
L WARNING
Carelessly adjusted image brightness and image contrast might
lead to bad image quality.
 Carefully adjust the image brightness and the image contrast by
means of the settings offered in the “Brightness & Contrast”
dialog box.
Changes made in these settings are only taken over for the opened
image.
If you change the brightness and the contrast of an image and do not
close the “Brightness & Contrast” dialog box while browsing through
the images of an examination tab, your changes will automatically be
saved.
 Click
to start HEYEX.
Files”, p. 45).
 Click
124
Analyzing Images
8
Preparations
 Select “Image \ Brightness & Contrast” in the menu bar or click
the tool bar.
in
The “Brightness & Contrast” dialog box is displayed.
Changing contrast and brightness  In order to change contrast and brightness of the cSLO image, dragof the cSLO Image and-drop the point in the “HRA” section to the desired position.
The contrast and the brightness of the image changes.
 As an alternative, press and hold
on the keyboard and the left
mouse button and move the mouse over the image.
The contrast and the brightness of the image changes.
Changing the color of the cSLO  In order to change the color of the cSLO image, select one of the folImage lowing options in the “Color Table” section:
▪ “Black on White”
▪ “White on Black”
▪ “Color”
The displayed color is no true color. Images are only color-coded.
For devices with MultiColor option: The color of the MultiColor cSLO
image cannot be changed. If you want to change the color of the MultiColor cSLO image, the color balance presets can be modified. For further information, please refer to ( Chapter 8.5.3 “Color Balance Presets”, p. 153).
Sharpen the cSLO Image  In order to sharpen the image, select one of the following options in the
“Sharpen” section:
▪
▪
▪
▪
“None”
“Low”
“Medium”
“High”
Depending on the selected option, the image is sharpened.
125
8
Analyzing Images
Preparations
Modifying the noise reduction of  In order to modify the noise reduction, select one of the following
the cSLO image options in the “Noise Reduction” section:
▪
▪
▪
▪
“None”
“Low”
“Medium”
“High”
Depending on the selected option, the level of noise reduction
increases.
Saving changes as custom settings
The custom settings buttons are only displayed, if the option has been
selected in the “Preferences” dialog box ( Chapter 8.1.1 “Setting
Viewing Preferences”, p. 123).
 In order to save the adjustments as custom settings, click “Save
Custom Settings” .
The adjustments are saved and can be applied on any cSLO image
you are analyzing. If you analyze OCT images, only the settings for the
cSLO image can be saved as custom settings.
 In order to apply the custom settings to a different image, select either
“Menu \ Apply Custom Settings” in the menu bar or press
the keyboard.
 In order to reset the custom settings, click
+
on
in the toolbar.
The “Brightness & Contrast” dialog box is displayed.
 Click “Reset” .
8.1.3
Adjusting Monitor Settings
L WARNING
A monitor that is not optimally adjusted may produce images
lacking in brightness and/or sharpness.
 Adjust the monitor by means of the “Monitor Setup Tool” .
 Click
to start HEYEX.
Files”, p. 45).
 Click
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8
Preparations
 Select “Options \ Monitor Setup Tool” in the menu bar.
Fig. 59: "Monitor Setup Tool" dialog box
The “Monitor Setup Tool” dialog box is displayed (Fig. 59).
 Adjust the monitor brightness and contrast so that:
▪ At least stripes 2 and 8 are visible over the entire width.
▪ The test image is close to black on the left side.
▪ The test image is close to white on the right side.
 In order to close the monitor setup tool, click
.
 Check the displayed image and repeat the adjustment if necessary.
8.1.4
Window Options
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Double-click multiple image thumbnails.
The analysis windows are displayed.
Cascading windows  In order to cascade the multiple analysis windows, select
“Window \ Cascade” in the menu bar.
The analysis windows are displayed in a cascade.
Tiling windows  In order to display the analysis windows as tiles, select “Window \ Tile”
in the menu bar.
The analysis windows are displayed next to each other as tiles.
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Preparations
 In order to close all windows, select “Window \ Close all” in the menu
bar.
Full-screen mode  In order to review cSLO images in full-screen, click “Maximize” in the
upper right part of the analysis window.
Depending on your selected zoom factor, the image is displayed
zoomed. At the right side and on the bottom of the analysis window,
scroll bars are displayed. If you have selected “Auto” as the zoom
factor, the image is zoomed so that the width of the analysis window is
used in the most effective way.
8.1.5
Accessing Image Information
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Select “Image \ Image Information” in the menu bar or click
tool bar.
in the
Fig. 60: "Information" dialog box
The “Information” dialog box opens (Fig. 60).
 Check the image information.
The information may not be useful for the clinical routine, but for
special research activities.
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8
Tools
 Click
or
in the tool bar to quickly switch between the images of
the same examination tab.
The “Information” dialog box remains opened. The displayed information is constantly updated.
Copying Information into a spread-  In order to copy the provided information into a spreadsheet software,
sheet software press and hold
on the keyboard and click the desired rows.
 Release
and press
+
on the keyboard.
 Open a spreadsheet software and paste the information.
 Click “OK” .
The dialog box is closed.
8.2
Tools
8.2.1
Overlays
In order to quickly add overlays, the following shortcuts are available:
Overlay
Shortcut
Draw Region
+
Draw Arrow
+
Enter Text
+
Insert ETDRS-Grid
+
Measure Distance
+
Measure Circle
+
 In order to show or hide all overlays, select
“Overlay \ Show/Hide Overlays” in the menu bar.
8.2.1.1
Measuring Distances
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Click
.
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Tools
Fig. 61: Measuring distances
 Click where the start point of the measurement tool shall be positioned.
 Click where the end point of the measurement tool shall be positioned.
The value of the measured distance is displayed in mm.
 In order to change the position of the overlay, drag-and-drop it to the
desired position.
 In order to change the position of the labeling, drag-and-drop it to the
desired position.
8.2.1.2
Region Overlay
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Click
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8
Tools
Fig. 62: Drawing regions
 In order to draw a region freehand, click the start point of the region
and hold the left mouse button.
 Draw a region.
The region is closed automatically when the end point is close to the
start point.
 As an alternative, click points in the image to define a spline.
The region is closed automatically when the end point is close to the
start point.
 If the region shall not be closed, press the right mouse button.
Adding further points to the region  If a region is not closed and you want to add further points to the
region, right-click the region.
 Select “Add Point(s)” and draw the region either freehand or click
points to re-define the spline.
Closing the region  In order to close the region, right-click the line of the region.
 Select “Close Region” .
 As an alternative, double-click any point of the region.
The “Region Properties” dialog box is displayed.
 Check the “Close Region / Create Area” box and click “OK” to con-
firm.
The region is closed.
desired position.
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Tools
8.2.1.3
Text Overlay
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Click
.
 Click the area where the text will be added.
The “Text Properties” dialog box is displayed.
 Enter text into the “Text” field.
Fig. 63: Text overlay
The “Text Properties” dialog box closes. The text is displayed.
desired position.
8.2.1.4
Arrow Overlay
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Click
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Analyzing Images
Tools
Fig. 64: Arrow overlay
 Click where the start point of the arrow shall be positioned.
 Click where the arrow head shall be positioned.
desired position.
8.2.1.5
Measuring Diameters
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Click
.
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Tools
Fig. 65: Measuring diameters
 Click where the center of the circle shall be positioned.
 Click where the arc of the circle shall be positioned.
If the circle diameter is less than 1 cm, the measured value is displayed in μm. If the circle diameter is greater or equal to 1 cm, the
measured value is displayed in mm.
desired position.
desired position.
8.2.1.6
Setting an ETDRS Grid
The ETDRS (Early Treatment Diabetic Retinopathy Study) grid has
four concentric circles with radii of 360, 600, 1,800 and 3,600 microns
with two bisecting lines. ETDRS was a multicenter, randomized clinical
trial designed to evaluate argon laser photocoagulation and acetylsalicylic acid treatment in the management of patients with nonproliferative
or early proliferative diabetic retinopathy. A total of 3,711 patients were
recruited to be followed for a minimum of four years to provide longterm information on the risks and benefits of the treatments under
study. For further information, please refer to
http://clinicaltrials.gov/ct2/show/NCT00000151.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Click
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8
Tools
Fig. 66: ETDRS grid
 Click where the center of the ETDRS grid shall be positioned.
The ETDRS grid is displayed.
 In order to change the position of the overlay, click the center of the
ETDRS grid and drag-and-drop it to the desired position.
 In order to rotate the overlay, click one of the circles and move the
mouse.
8.2.1.7
Changing Overlay Properties
 In order to change the overlay properties, right-click the desired
overlay.
 Select “Overlay Properties” .
Distance measurement tool
The “Distance Properties” dialog box is displayed.
 In order to change the color of the overlay, click
tion.
in the “Color” sec-
The “Color” dialog box is displayed.
 Select a color and click “OK” to confirm.
The “Color” dialog box closes.
 In order to change the font type, click
in the “Font” section.
The “Font” dialog box is displayed.
 Select a font type, a typeface and a font size.
The “Font” dialog box closes.
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Tools
Region overlays
The “Region Properties” dialog box is displayed.
tion.
 In order to change the line width of the overlay, enter a value in the
“Thickness” field.
 If regions shall not be closed automatically, uncheck the “Close
Region / Create area” box.
 In order to fill the region with color, check the “Fill area with color” box.
 In order to display the area size in mm2, check the “Display area size
in mm² ” box.
 In order to display the mean gray value, check the “Display mean gray
value” box.
For devices with MultiColor option: When displaying the mean gray
value in MultiColor images, the values for the infrared, green and blue
channel are given. Please note that in MultiColor images the measured
gray values do not relate to the displayed gray values as the MultiColor
images are either brightened or darkened.
 In order to change the color of the labeling, right-click the text.
 Select “Overlay Properties” .
 In order to change the color of the text, click
in the “Color” section.
 In order to change font type, click
 Select a font type, a typeface and a font size and click “OK” to con-
firm.
 In order to display the text on a transparent background, check the
“Transparent” box.
Text overlays
 In order to change the color of the text, click
in the “Color” section.
 Select a font type, a typeface and a font size and click “OK” to con-
firm.
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8
Tools
 In order to display the text on a transparent background, check the
“Transparent” box.
Arrow overlays
The “Arrow Properties” dialog box is displayed.
tion.
 In order to change the type of the arrow, open the “Type” drop-down
list and select a type of arrow.
 In order to change the line width of the overlay, enter a value in the
“Thickness” field.
Diameter overlays
The “Circle Properties” dialog box is displayed.
tion.
ETDRS grid
The “ETDRS Properties” dialog box is displayed.
tion.
Confirming your changes  In order to confirm your changes, click “OK” .
8.2.1.8
Removing Overlays
 In order to remove a single overlay, right-click the desired overlay.
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Tools
 Select “Remove Overlay” .
The overlay is removed.
 In order to remove all overlays, select “Overlay \ Remove all Overlays”
in the menu bar.
8.2.1.9
Copying Overlays
8.2.1.9.1 Copying Overlays from one to another cSLO Image
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Select and draw an overlay.
 In order to copy the overlay to another image, select
“Overlay \ Copy Overlays” in the menu bar.
A message is displayed saying that the overlays have been copied to
the clipboard and that you can now open another image and paste the
overlays.
 Select the other image in the image viewing window.
 Select “Overlay \ Paste Overlay” in the menu bar.
Fig. 67: Automatically aligned images
The “Import Overlays” window is displayed.
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8
Tools
 If the images are automatically aligned and the reference points match
well, click “OK” .
 If the images are not automatically aligned, double-click each image
and set at least three reference points, e.g. blood vessels.
The overlay is copied to the other image.
 In order to close the analysis window, click
.
8.2.1.9.2 Copying Overlays from one to another Stereo Fundus Image
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Double-click a stereo fundus image thumbnail.
 Select and draw an overlay in the stereo fundus image.
 Select “Overlay \ Copy Overlays” in the menu bar.
The “Please Select an Image” dialog box is displayed.
 Select the side “Left” or “Right” that contains the overlay you want to
copy.
A message is displayed saying that the overlays have been copied to
the clipboard and that you can now open another image and paste the
overlays.
 Select the other image in the image viewing window.
 Select “Overlay \ Paste Overlay” in the menu bar.
The “Import Overlays” window is displayed. The overlay is automatically displayed in both images.
The overlay is copied to the other image.
8.2.2
.
Zoom and Pan Mode
Selecting a zoom factor  Click
to start HEYEX.
 Select a patient file ( Chapter 5.5.1 “Selecting a Patient File”, p. 45).
 Click
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Tools
Fig. 68: Selecting the zoom factor from the drop-down list
 In order to set a zoom factor, open the drop-down list and select one of
the following options (Fig. 68):
▪
▪
▪
▪
▪
▪
“Auto”
“50%”
“100%”
“200%”
“400%”
“800%”
The image is scaled in accordance with the zoom factor. If “Auto” is
selected, the image is scaled to fit the window. If the size of the
analysis window is changed, the image is re-scaled. If a fixed zoom
factor is set, for example “100%” , changing the size of the window will
change the image frame and not the scale.
When the image is not shown in full size, use the scroll bars or the pan
mode to view the full image.
The pan mode is only active if an image is zoomed in.
Unsmoothed Pixels
When an image is zoomed in, the pixel values are interpolated. A
smooth image is created. The “Unsmoothed Pixels” function can be
used to remove the interpolation and display the originally acquired
pixels as blocks.
 In order to unsmooth the cSLO image, select
“HRA Image \ Unsmoothed Pixels” in the menu bar.
The cSLO image is displayed with originally acquired pixels.
Selecting a Zoom Function
The following zoom functions are available:
Button
Description
Pan Mode: Move the enlarged image per dragand-drop.
Zoom Mode: Press and hold the left mouse
button and move the mouse to mark a zoom
area. Press and hold the mouse wheel and
move the mouse to zoom in or out.
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Tools
Button
Description
Zoom in: Zoom factor is doubled.
Zoom out: Zoom factor is halved.
You can also use the zoom functions by using the keyboard and the
mouse:
 Hover with the mouse cursor over the image.
 Press and hold
on the keyboard.
 Turn the mouse wheel.
The image zooms in and out.
 Release
.
The zoom factor is set.
 In order to pan the image, press and hold
on the keyboard.
 Press and hold the left mouse button and move the mouse to the left
and to the right.
 Release
and the left mouse button.
The image is panned.
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Analyzing Images
Tools
8.2.3
Rotating Images
 Click
to start HEYEX.
Files”, p. 45).
 Click
Fig. 69: Normal image orientation
 In order to rotate the image, click
and rotated image orientation
in the tool bar.
The image is rotated. The message “View Rotated 180°” is displayed
in the upper left corner of the analysis window .
The rotated view cannot be printed. The rotated view is not saved
after closing the analysis window.
 In order to display the image with the normal orientation, click
tool bar.
8.2.4
in the
Expanding and Extracting Images and Movies
Expanding images
In order to view the single line scans of a movie, you have to expand
the desired movie.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Select “Expand” .
The individual images of the expanded scan are displayed in the image
viewing window. In the examination tab
is displayed which is used
for returning to the image viewing window.
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8
HRA Image Thumbnails
Extracting a single image  In order to extract a line scan from a volume scan or star scan as a
single image, right-click the desired expanded image thumbnail.
 Select “Extract Single Image”.
 In order to return to the image viewing window, click
.
The extracted single image is displayed in the form of an image thumbnail in the image viewing window.
8.3
HRA Image Thumbnails
cSLO image
Movie
Simultaneous image
Simultaneous movie
Composite image
MultiColor image (option)
Stereo image
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Analyzing cSLO Images
8.4
8.4.1
Graphical User Interface Analysis Window
Patient name, date of birth, examination
date, examined eye, acquisition mode,
and C-Curve value
Zoom and pan mode
Menu bar
Overlays
Tool bar
Image information
cSLO Image
Tool bar
Zoom and pan mode
144
( Chapter 8.4.1.1 “Tool Bar”, p. 145)
( Chapter 8.2.2 “Zoom and Pan Mode”, p. 139)
Analyzing Images
8
Overlays
8.4.1.1
( Chapter 8.2.1 “Overlays”, p. 129)
Tool Bar
Icon
Description
Brightness & Contrast ( Chapter 8.1.2 “Adjusting
Image Settings”, p. 124)
Image information ( Chapter 8.1.5 “Accessing Image
Information”, p. 128)
Export as picture ( Chapter 10.5 “Exporting Pictures”,
p. 167)
Print report
Previous image in examination tab
Next image in examination tab
Add to lightbox ( Chapter 5.14 “Using the Lightbox”,
p. 67)
Delete image
Previous image in progression
Next image in progression
145
8
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8.4.2
Analyzing ART Composite Fundus Images
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Double-click a composite image thumbnail.
Fig. 70: Analysis window
The analysis window opens (Fig. 70). All analysis functions and
overlay tools, as in the cSLO image analysis, are available
( Chapter 8.4.1 “Graphical User Interface Analysis Window”, p. 144).
Measured distances, regions and diameters are given in pixels
instead of mm.
8.4.3
.
Analyzing Simultaneous Fundus Images
 Click
to start HEYEX.
Files”, p. 45).
 Click
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Analyzing Images
8
 Double-click a simultaneous fundus image thumbnail.
Splitting simultaneous images  In order to split simultaneous images, click
in the tool bar.
The image is displayed in the lightbox.
 Right-click the image thumbnail.
 Click “Split simult. images” .
Two single images are displayed in the lightbox. All lightbox functions
are available ( Chapter 5.14 “Using the Lightbox”, p. 67).
8.4.4
.
Analyzing Stereo Fundus Images
Stereo viewing glasses and/or red-cyan 3D glasses are required in
order to view the 3D effect on the stereo fundus images.
 Click
to start HEYEX.
Files”, p. 45).
 Click
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Analyzing Images
 Double-click a stereo fundus image thumbnail.
3D view with stereo viewing
glasses
Fig. 73: Example for stereo viewing glasses
 Put the stereo viewing glasses in front of the monitor (Fig. 73).
 Adjust the angle of view so that the images fill the field of view.
 In order to get a 3D view, adjust the prism of the stereo viewing
glasses.
3D view with red-cyan stereo mode
Fig. 74: Example for red-cyan 3D glasses
 Put on the red-cyan 3D glasses (Fig. 74).
 Click
and enable the red/cyan stereo mode.
 In order to find the best adjustment for the 3D view, adjust the slider
next to “Stereo Base” to the desired position (Fig. 72).
 In order to switch off the red/cyan stereo mode, click
148
.
.
Analyzing Images
8
8.4.5
Analyzing Movies
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Double-click a movie thumbnail.
Overlays can only be added to movies with corrected eye movement.
The following movie control elements are available:
Symbol
Description
Continuous play
Stop
Go to the first image
Go to the previous image
Play
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8
Analyzing Images
Analyzing MultiColor Images (Option)
Symbol
Description
Go to the next image
Go to the last image
Set speed of movie
Export as .AVI
Correct eye movements
Display eye movements
 In order to change the speed of the movie, adjust the slider to one of
the following speeds:
▪
▪
▪
▪
▪
20 frames per second
10 frames per second
5 frames per second
1 frame per second
Play in real time
Correcting the eye movements  In order to correct the eye movements, click
.
The alignment will cause slight shift to the image borders, which indicate the acquired eye movement.
Displaying eye movements  In order to display the eye movements, first click
movements and then click .
to correct the eye
The “Shift: X/Y Display” window is displayed. The upper graph represents the shift in x-direction for all images of the movie. The lower
graph represents the shift in y-direction for all images of the movie.
 Click “Display Distance / Angle” .
The “Shift: Distance / Angle” window is displayed. The shift is defined
with respect to the position of the eye at the beginning of the movie.
The upper graph represents the distance in pixels for all the images of
the movie. The lower graph represents the angle in degree for all the
images of the movie.
8.5
All analysis functions and overlay tools as in the cSLO image analysis
are available when analyzing MultiColor images.
All analysis functions and overlay tools, as in the cSLO image analysis,
are available. For further information on analyzing cSLO images,
please refer to ( Chapter 8.4.1 “Graphical User Interface Analysis
Window”, p. 144).
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Analyzing Images
8
8.5.1
Showing Selective Color Laser Images
Selective Color Laser Images in the  Click
to start HEYEX.
cSLO Analysis Window
Files”, p. 45).
 Click
 Double-click a MultiColor cSLO image thumbnail.
The cSLO analysis window opens. The MultiColor image and the three
selective color laser images are displayed.
 In order to hide the selective color laser images, click
.
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Analyzing Images
8.5.2
Graphical User Interface
Patient name and examination date
Zoom and pan mode
Menu bar
Overlays
Tool bar
Color balance presets
MultiColor image
MultiColor image
Image information
Tool Bar
152
( Chapter 8.4.1.1 “Tool Bar”, p. 145)
Analyzing Images
8
Zoom and Pan Mode
Overlays
Color Balance Presets
8.5.3
( Chapter 8.2.2 “Zoom and Pan Mode”, p. 139)
( Chapter 8.2.1 “Overlays”, p. 129)
( Chapter 8.5.3 “Color Balance Presets”, p. 153)
Color Balance Presets
L WARNING
Carelessly adjusted color balance settings might lead to bad
image quality.
 Carefully adjust the settings offered in the “Color Balance” section when selecting “User-Defined” from the drop-down list.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Double-click a MultiColor image thumbnail.
 Open the “Color Balance” drop-down list and select one of the fol-
lowing options:
▪ “Standard”
▪ “Green-Blue-Enhanced”
▪ “User-Defined”
The “User-Defined” image
can be adjusted to any color coding.
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Analyzing Images
 Click
in the tool bar.
The “Brightness&Contrast” dialog box is displayed.
 In the “Color Balance” section adjust the sliders “Red” , “Green” and
“Blue” to the desired position.
Changes made in these sections are automatically assigned to the
“User-Defined” preset.
Changes made in these settings are only taken over for the opened
image.
 In order to save the adjustments as custom settings, click “Save as
Custom Settings” .
“Save as Custom Settings” is only displayed, if the option in the
“Preferences” dialog box has been activated ( Chapter 8.1.1 “Setting
Viewing Preferences”, p. 123).
The adjustments are saved and can be applied on any image you are
analyzing.
For further information, please refer to ( Chapter 8.1.2 “Adjusting
Image Settings”, p. 124).
8.5.4
Analyzing Movies
 Click
to start HEYEX.
Files”, p. 45).
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8
Analyzing Images
 Click
The analysis window opens. The MultiColor image and the three selective color laser images are displayed.
 In order to view the movie of a certain color laser image, click the
image.
For further information on the movie control elements, eye movement
correction, and all functions offered by the analysis window, please
refer to ( Chapter 8.4.5 “Analyzing Movies”, p. 149).
155
9
Reports
Customizing Reports
9
Reports
About this Chapter
This chapter provides information on customizing and printing different
reports. By the end of this chapter, you will feel comfortable reviewing
and customizing all the different reports available for the
SPECTRALIS.
Chapter structure:
▪
▪
▪
▪
9.1
Customizing reports
Exporting reports as image files
Printing reports
Report types
Customizing Reports
The logo and the address of the medical practice or the clinic can be
added to reports as .BMP or .TXT files.
 Click
to start HEYEX.
 Click
 Select “Setup \ Customize Printout” in the menu bar.
The “Customize Header and Footer for Printouts” dialog box is displayed.
Customizing the Header  In order to customize the header of printouts within a portrait orientation, click “Browse” in the “Header \ Portrait” section.
 In order to customize the header of printouts within a landscape orien-
tation, click “Browse” in the “Header \ Landscape” section.
The “Open” dialog box is displayed.
 Select a .BMP or a .TXT file.
156
Reports
9
Printing Reports
 Click “Open” to confirm.
 In order to change the alignment of the logo, open the “Alignment”
drop-down list and select one of the following options:
▪
▪
▪
▪
“Left”
“Center”
“Right”
“Fit” , only recommended for .BMP-files
If the option “Fit” is selected, the logo will be displayed as large as
possible, preserving the original ratio.
 In order to set the size of the logo, enter the size in mm in the “Width
[mm]” and “Height [mm]” section.
Use this function only when using .BMP files.
Customizing the Footer  In order to customize the footer of printouts within a portrait orientation,
click “Browse” in the section “Footer \ Portrait” and repeat the previously described steps.
 In order to customize the footer of printouts within a landscape orienta-
tion, click “Browse” in the section “Footer \ Landscape” and repeat the
previously described steps.
The header and the footer of reports are customized.
 Print a report to review the header and the footer.
9.2
Printing Reports
Printing from the image viewing  Click
to start HEYEX.
window
Files”, p. 45).
 Click
157
9
Reports
Printing Reports
 Select “Print” .
Fig. 76: "Print Spectralis Report" dialog box
The “Print Spectralis Report” dialog box is displayed (Fig. 76).
 Open the “Language” drop-down list and select either “Deutsch” or
“English” as the language.
 In the “Printer” section open the drop-down list and select a printer.
 In the “Reports” section select a report.
 In the “Copies” section type in the number of copies of the report.
 In the “Options” section select which of the following options should be
printed on the report:
Option
Description
“Display Page Header”
Displays the title of the report and the
customized header.
“Display Patient
Information”
Displays the patient name, the patient
ID, the date of birth and the sex.
“Display Diagnosis and
Comment”
Displays the diagnosis and comments.
“Provide Space for Notes”
Displays the box for written notes.
“Add Page Margins”
Displays additional page margins.
“Automatic Page
Orientation”
The page orientation is automatically
set to landscape or portrait depending
on the report type.
 Before printing the report, always click “Preview” in order to confirm
that the correct report type has been selected and all relevant diagnostic information is displayed.
A preview of the report is displayed.
 In order to close the preview, click “Back” or
.
 In order to start printing, click “Print” .
158
Reports
9
Printing Reports
Printing from the analysis window  Double-click an image thumbnail.
 Select “Image \ Print”.
 Select a language, a printer, a report, the number of copies and the
printing options.
Printing from the lightbox  Add images to the lightbox ( Chapter 5.14 “Using the Lightbox”,
p. 67).
 Select and then right-click the images to be printed.
printing options.
If you want to generate a report with image thumbnails from different examination tabs, the diagnosis will not be displayed on the
report.
Printing OU reports  In order to generate an OU report, add one image of the left eye and
one image of the right eye to the light box ( Chapter 5.14 “Using the
Lightbox”, p. 67).
 Press and hold
nails.
 Release
on the keyboard and click the two image thumb-
printing options.
Customizing reports
If you want to customize the layout of your report, please refer to
( Chapter 9.1 “Customizing Reports”, p. 156).
159
9
Reports
Exporting Reports as Image Files
9.3
Exporting Reports as Image Files
 Click
to start HEYEX.
Files”, p. 45).
 Click
The “Print Spectralis Report” dialog box is displayed.
 Click “Preview” .
A preview of the report is displayed.
 Click “Save as” .
The “Save as” dialog box is displayed.
 Select a storage location and a file name.
 Open the drop-down list and select either .JPG or .BMP as the file
type.
 Click “Save” to confirm.
160
Reports
9
MultiColor Reports (Option)
9.4
“Overview Report”
On the “Overview Report” up to 16 images per page may be displayed.
Patient data, diagnosis and comments
Space for notes
cSLO Image with image information
9.5
All reports described in this manual are also available for the
SPECTRALIS MultiColor.
161
9
Reports
9.5.1
162
MultiColor Selective Color Laser Images
Report Type
Notes
Patient Data, Diagnosis and Comments
Examined Eye
MultiColor image
Processing Data 10
Exchanging OD/OS
10
Processing Data
About this Chapter
This chapter provides information on processing acquired and/or analyzed images and movies.
By the end of this chapter, you should be able to use all the functions
of HEYEX to process data.
Chapter structure:
▪
▪
▪
▪
▪
▪
▪
▪
10.1
Exporting individual examinations as E2E files
Exporting multiple patient files as E2E files
Importing E2E files
Exporting pictures
Exporting XML-files
Exporting movies
Computing mean images
Computing composite images
Exchanging OD/OS
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Right-click an image thumbnail, e.g. in the left part of the image
viewing window.
 Select “Exchange OD/OS” .
The image is displayed in the right part of the image viewing window.
163
10 Processing Data
Exporting Multiple Patient Files as E2E Files
10.2
Exporting individual Examinations as E2E Files
You can transfer individual examinations to other HEYEX databases.
Therefore, the patient files must be exported as E2E files before you
can import them into another database.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 If you want to export a single examination as an E2E file, right-click the
desired image thumbnail.
 If you want to export multiple examinations as E2E files, press and
hold
 Release
on the keyboard and click the desired image thumbnails.
 Select “Export \ as E2E”.
The “Export Options” dialog box is displayed.
 Click “Browse” to select an export destination.
 Enter or change patient data in the “Patient” section.
 In order to anonymize patient data, check the “Anonymize data” box.
The “Last Name” and “First Name” section become active.
 Select how you would like to anonymize the patient's data:
▪ If you want to change the patient's last name into a fixed pseudonym,
check the “Fixed” box in the “Last Name” section and enter a naming
in the field next to the box.
▪ If you want to change the patient's last name into the patient ID, check
the “Patient-ID” box in the “Last Name” section.
▪ If you want to change the patient's first name into the patient ID, check
the “Patient-ID” box in the “First Name” section.
▪ If you want to use only the first letter of the patient's first name, check
the “First letter only” box in the “First Name” section.
 If you want to include the institute's name into the exported E2E files,
enter the institute's name in the “Location” section.
A message is displayed saying that the selected E2E files are being
exported.
10.3
Exporting Multiple Patient Files as E2E Files
The batch export enables the export of multiple images from one or
multiple patient files at a time.
 Click
to start HEYEX.
 Select one or multiple patient files ( Chapter 5.5 “Selecting and
Opening Patient Files”, p. 45).
164
Processing Data 10
Importing E2E Files
 In the right part of the database window right-click a patient file.
Although only one patient file has been selected, all patient files in the
right part of the database window will be exported.
 Select “HRA/Spectralis Batch \ Export E2E”.
If a patient file contains E2E files from different devices, the E2E
files must be exported separately with different batch processes. For
example, SPECTRALIS E2E files are exported with the “HRA/
SPECTRALIS Batch” , HEP E2E files are exported with the “HEP
Batch” . The different batch processes are offered in the context menu.
The “Export Options” dialog box opens.
 Click “Browse” to select an export destination.
The “Last Name” and “First Name” section become active.
 Select how you would like to anonymize the patient's data:
▪ If you want to change the patient's last name into a fixed pseudonym,
check the “Fixed” box in the “Last Name” section and enter a naming
in the field next to the box.
▪ If you want to change the patient's last name into the patient ID, check
the “Patient-ID” box in the “Last Name” section.
▪ If you want to change the patient's first name into the patient ID, check
the “Patient-ID” box in the “First Name” section.
▪ If you want to use only the first letter of the patient's first name, check
the “First letter only” box in the “First Name” section.
The “Exporting E2E Files” dialog box is displayed. The E2E files for all
loaded patient files are exported.
 In order to export the E2E files without generating a report, click
“Close” .
 In order to export the E2E files and generate a report, click “Report” .
The “Save Batch Report” dialog box opens.
 Select a storage location and click “Save” to confirm.
The batch report is saved and can be opened with a standard Microsoft editor.
 Click “Close” to close the “Export E2E Files” dialog box.
10.4
Importing E2E Files
E2E files need to be imported to complete patient files or individual
examinations or to import the demo data provided by
 Click
to start HEYEX.
 Select “Database \ Import E2E Files...” in the menu bar.
The “Import Examination Data” dialog box is displayed.
165
10 Processing Data
Importing E2E Files
 Select the storage location and the desired E2E files.
 Click “Open” to confirm.
The “Database Import” dialog box is displayed .
Assigning Patient Data  In the “Patient” section, select the patient data to be imported with the
examination:
▪
▪
▪
▪
“Import referring physician”
“Import patient comment”
“Import patient anamnesis”
“Import patient ancestry”
Assigning Examination Data  In the “Examination” section, select the examination data to be
imported with the examination:
▪ “Import study field”
▪ “Import diagnosis”
▪ “Import examination comment”
Avoid assigning Patient IDs  If you do not want to assign a patient ID to each imported patient file,
check the “Do not import Patient ID (E2E from external Database)”
box in the “Inter-Database E2E Exchange” section.
Avoid assigning Unique Patient
Identifier
Unique patient identifiers (UIDs) are automatically generated by
HEYEX for each patient file. UIDs are not related to patient-IDs. UIDs
identify patients uniquely across multiple HEYEX databases, while the
patient-ID does not.
Do not mark the “Do not import auto-generated UID of Patient (not
recommended)” box.
 If you want to disable the UID-based matching of patients during the
E2E import, check the “Do not import auto-generated UID of Patient
(not recommended)” box in the “Inter-Database E2E Exchange” section.
Potential Patient Matches
If the patient details, for example the name, date of birth, and patientID of a patient to be imported and an already in HEYEX existing patient
file match, the “Potential Patient Matches” dialog box is displayed. In
this dialog box, the already existing patient entries are displayed.
Select one of the following options to proceed with the import of E2E
files.
 In order to create a new patient entry, select “Create New Patient
Entry” .
 In order to merge the E2E files of both, the patient file to be imported
and the already existing patient file, select the desired patient file and
then click “Use Selected Patient Entry” .
 In order to merge the E2E files and update the patient ID of the already
existing patient file, select the desired patient file and then click “Use
Selected Patient Entry and Update Patient ID” .
166
Processing Data 10
Exporting Pictures
 In order to merge the E2E files and update the name and the date of
birth of the already existing patient file, select the desired patient file
and then click “Use selected Patient Entry and Update Name and Date
of Birth” .
The message “Importing Data. Please wait.” is displayed. The E2E
files are being imported and stored into HEYEX where they are displayed in the database window.
10.5
Exporting Pictures
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Select “Export \ as Picture”.
 Select a storage location, a file name and select one of the following
file types:
▪
▪
▪
▪
BMP files
JPG files
TIF files
PNG files
When selecting a movie, the file type .AVI is available.
When selecting a single image format, e.g. .PNG, for exporting
movies, a single image is created for every movie frame.
 In order to export patient information, select the following options in the
“Options” section.
▪ “Add Info Block”
▪ “Add Patient Name”
▪ “Add Overlays”
 In order to export patient data, select the following options in the
“Displayed Patient Info” section.
▪
▪
▪
▪
▪
“Patient Name”
“Patient ID”
“Date of Birth”
“Ancestry”
“Diagnosis”
167
10 Processing Data
Exporting XML-Files
 Click “Save” to confirm.
The image is saved and can be reviewed.
Depending on your image viewing software, the exported images
might be displayed slightly pixelated.
10.6
Exporting XML-Files
Per default, the Export as XML function is not available after the
SPECTRALIS software installation. The function needs to be made
available by the following procedure where the path to the storage
location is configured. These steps do not have to be repeated each
time a XML export is performed.
Configuring the path to the storage  Click
to start HEYEX.
location
Files”, p. 45).
 Click
 In order to set the storage location of the XML-file, select
“Options \ Preferences” in the menu bar.
The “Preferences” dialog box is displayed.
 Select “Data Export Options \ XML Data Export”.
 In the “Destination folder for export files” section click “Browse” and
select a storage location.
 In the “Post-processing Application” section click “Browse” and select
the program the xml-files shall be opened with.
 If patient data shall be anonymized, check the “Depersonalize” box.
 In order to make the “Export as XML” function available in the context
menus of the database window and the image viewing window, click
to close the analysis window.
 Click
to close HEYEX.
Exporting patient data as XML files  Select a patient file ( Chapter 5.5 “Selecting and Opening Patient
Files”, p. 45).
 Click
 Select “Export \ as XML”.
The message “Exporting Data to XML. Please wait.” is displayed. The
XML-files are saved at the storage location.
168
Processing Data 10
Exporting Movies
10.7
Exporting Movies
In order to view acquired movies outside HEYEX, it is possible to
export them as movie files.
 Click
to start HEYEX.
Files”, p. 45).
 Click
 Right-click a movie thumbnail.
 Select “Export \ as Picture”.
 Select a storage location and a file name.
 Open the “Data type” drop-down list and select “AVI” .
 In order to define the video compression codec, click “Set up Codec” .
The “Video Compression” dialog box is displayed.
 Select an appropriate compressor and a compression quality.
The following AVI codes are available:
▪
▪
▪
▪
▪
Microsoft RLE
Microsoft Video 1
Intel IYUV Codec
Cinepak Codec by Radius
Full Frames (uncompressed)
 In order to adjust the compression quality, adjust the slider to the
appropriate number. The quality score ranges from 0 (very low quality)
to 100 (excellent quality).
 In order to save the video, click “Save” .
The video can be viewed with an external movie player.
Exporting Movies with Corrected
Eye Movement
In order to export the movie aligned, the option “Eye Movement
Correction” has to be set.
Files”, p. 45).
 Click
 In order to correct the eye movements, click
section.
 In order to export the movie, click
in the movie control
in the movie control section.
 Select a storage location, a file name and a video compression codec.
169
10 Processing Data
Computing Mean Images
 In order to save the video, click “Save” .
The video can be viewed with an external movie player.
10.8
Burning Exported Data onto a CD
Before you can burn patient files on a CD, you have to export them:
▪ as E2E files ( Chapter 10.2 “Exporting individual Examinations as
E2E Files”, p. 164)
▪ as pictures ( Chapter 10.5 “Exporting Pictures”, p. 167)
▪ as movies ( Chapter 10.7 “Exporting Movies”, p. 169)
 Open the Windows Explorer.
 Drag-and-drop to the exported files from the folder where the exported
files are saved to the “DVD-Ram Drive” .
 The exported data are written on the CD.
10.9
Computing Mean Images
If you have acquired images or movies without ART Mean, you can
compute mean images afterwards.
L WARNING
Failures during computing Mean images may cause image artifacts.
 For best image quality, acquire images with ART Mean.
Do not mistake these artifacts for pathology.
Computing mean images from  Click
to start HEYEX.
single images
Files”, p. 45).
 Click
on the keyboard and click the images which have
to be computed to a mean image.
 Press and hold
 Release
 Select “Compute Mean” .
The “Computing Results” dialog box is displayed. If the computing
process has been finished, the analysis window opens. The computed
mean image is displayed.
.
The computed mean image thumbnail is displayed in the image
viewing window.
Computing mean images from  Right-click a movie thumbnail.
movies
170
Processing Data 10
Computing Composite Images
 Select “Compute Mean” .
The “Align Images” dialog box is displayed. The computing of the
mean image depends on the length of the movie and may take several
minutes. When the computing process has been finished, the
“Computing Results” dialog box is displayed and the analysis window
opens. The computed mean image is displayed.
.
The computed mean image thumbnail is displayed in the image
viewing window.
10.10
If you have acquired multiple single images or a movie, you can compute composite images afterwards.
L WARNING
Failures during computing Composite images may cause image
artifacts.
 For best image quality, acquire images with the acquisition
modality “Composite” or “Composite 3x3” .
Do not mistake these artifacts for pathology.
Depending on the number of selected images and PC performance,
computing composite images may take several minutes.
Computing composite images from  Click
to start HEYEX.
multiple single images
Files”, p. 45).
 Click
on the keyboard and click the images which have
to be computed to a composite image.
 Press and hold
 Release
 Select “Compute Composite” .
The dialog box “Computing Results” is displayed. If the computing
process has been finished, the analysis window opens. The computed
composite image is displayed.
.
The computed composite image thumbnail is displayed in the image
viewing window.
Computing composite images from  Right-click a movie thumbnail.
movies
171
10 Processing Data
 Select “Compute Composite” .
The “Computing Composite Image” dialog box is displayed. The computing of the composite image depends on the length of the movie and
may take several minutes. When the computing process has been finished, the dialog box “Computing Results” is displayed and the
analysis window opens. The computed composite image is displayed.
.
The computed composite image thumbnail is displayed in the image
viewing window.
For further information on acquiring composite images, please refer to
( Chapter 7.11 “Acquiring a Composite Fundus Image”, p. 103).
172
Data Backup 11
Retrieving Images
11
Data Backup
About this Chapter
This chapter provides information on archiving data. Following these
steps will help to minimize data loss caused by hardware damages,
computer viruses, accidental deletion or unintentional overwriting.
Chapter structure:
▪ Archiving images
▪ Retrieving images
▪ Compressing the database
Heidelberg Engineering recommends to create data backups regularly.
Without frequent backup, you should assume a high probability of data
loss and take appropriate measures such as retention of paper copies.
11.1
Archiving Images
L CAUTION
Missing data backup.
 Archive data regularly.
Data loss might occur, if the software crashes or the PC hardware
breaks down. This can disable progression series and can lead to
wrong diagnostic conclusions.
L CAUTION
If the HEYEX database and the archived data are saved on the
same drive, both the HEYEX database and the archived data
might be lost if the drive is damaged.
 Do not archive the data on the same drive as the HEYEX database.
 Click
to start HEYEX.
 Select “Database \ Archive Images...” in the menu bar.
The “Archive Data” dialog box is displayed.
 Click “Archive” to start archiving.
The archiving process starts.
When the archiving process has finished, the message “The archiving
process has been finished successfully.” is displayed.
11.2
Retrieving Images
The function “Retrieve Images” is necessary, if images which are
archived on an external storage device, shall be retrieved.
173
11 Data Backup
Compressing the Database
This function is only to be used in a service case. Do not use this function in your daily routine.
 Click
to start HEYEX.
 Select “Database \ Retrieve Images” in the menu bar.
The “Retrieve Images” dialog box is displayed.
 Press and hold
retrieved.
 Release
on the keyboard and click the image objects to be
and click “OK” to confirm.
If patient files have been selected for retrieval, a message is displayed
asking whether you really want to retrieve the data for the selected
patients.
 In order to start the retrieval process for selected patient files only, click
“Yes” .
 In order to start the retrieval process for all patient files, click “No” .
The retrieval process starts.
If the retrieval process has finished, the message “The retrieval
process has been finished successfully” is displayed.
11.3
Compressing the Database
This function is only to be used in a service case. Do not use this function in your daily routine.
 Click
to start HEYEX.
 Select “Database \ Compress database...” in the menu bar.
The message “Do you really want to compress it?” is displayed.
The database gets compressed. The message “The database size has
changed.” is displayed.
174
Troubleshooting 12
12
Troubleshooting
Fault description
Cause
The device cannot be switched The power cables are not
on.
plugged in.
Remedy
Plug in the power cables.
The power cables are defective.
Exchange the power cable with another device
to verify if the cable is defective or not.
The isolating transformer is
not switched on.
Switch on the isolating transformer.
The cable of the isolating
Plug in the cable.
transformer is not plugged in.
The monitor remains black.
The monitor is switched off.
Switch on the monitor.
The monitor is not connected Connect the monitor with the device.
with the device.
The cables are not plugged
in.
Plug in the cables.
The cables are defective.
Exchange the cable with another device to
verify if the cable is defective or not.
not switched on.
The cable of the isolation
Plug in the cable.
The PC cannot be switched on. The PC is not connected to
the power supply.
Connect the PC to the power supply.
Exchange the cable with another device to
verify if the cable is defective or not.
not switched on.
The cable of the isloation
Plug in the cable.
The mouse and/or the keyboard are not working.
The footswitch and/or the joystick are not working.
in.
Plug in the cable.
The cables are defect.
Exchange the mouse and/or the keyboard.
in.
Plug in the cable.
Exchange the footswitch.
Examination cannot be started. The dongle cannot be found,
HEYEX is in demo mode.
Plug the software dongle into the USB drive
correctly.
Restart the PC and HEYEX.
175
12 Troubleshooting
Fault description
Cause
Remedy
The license manager has not Restart the PC and HEYEX.
been started.
The server where the license Start the server.
manager is installed has not
Restart HEYEX.
been started.
The patient sees four simultaneous blinking fixation targets.
The error "Interlock" occured. Restart the system.
Images cannot be opened.
The dongle has not been
found, HEYEX is in demo
mode.
If the problem persists contact your local distributor or Heidelberg Engineering.
Plug the software dongle into the USB drive
correctly.
Restart the PC.
The license manager has not Restart the PC.
been started.
The server where the license Start the server.
manager is installed has not
Restart HEYEX.
been started.
In the image viewing window
examination tabs cannot be
opened, the error message
“Sharing Violation” is displayed.
The examination has been
locked by another person in
the network environment.
Wait until the examination is unlocked.
The external fixation light is not Operating error.
working.
Switch on the external fixation light.
No acquisition modes are displayed on the touch panel.
Set the filter wheel correctly to “A” or “R” .
The filter wheel is not correctly positioned at “A” or
“R” .
In the acquisition window, click
and deselect the marked fixation light. The external
fixation light is switched on.
The camera cannot be aligned. The joystick or the micromanipulator are defective.
Contact your local distributor or
Although the right eye has
been examined, the image
thumbnail is displayed on the
left side of the image viewing
window.
The left-right recognition of
camera is malfunctioning.
Use the function “Exchange OD/OS”
( Chapter 10.1 “Exchanging OD/OS”,
p. 163).
The image thumbnail of an
examination is displayed in a
new examination tab although
it should be part of the last
examination tab.
A new examination has been Continue the examination ( Chapter 5.8
started instead of continuing “Continuing Examinations”, p. 56).
an examination.
Bad image quality during
examination.
The lens is dirty.
176
If the problem persists contact your local distributor or Heidelberg Engineering.
Clean the lens.
Troubleshooting 12
Fault description
Cause
Remedy
The chin rest is not adjusted
properly for the patient.
Adjust the chin rest for the patient.
Missing patient compliance.
Explain the procedure to the patient.
The patient has strong eye
movement.
Acquire images with ART Mean.
Increase the number of frames if necessary.
No images are displayed in the The display option “List” has In order to display images click
image viewing window.
been selected.
The date and the time of an
examination are wrong.
The table is not moving up or
down.
or
.
The Windows settings have
been changed.
Reset the windows settings and correct date
and time.
The BIOS battery is empty.
Replace the empty BIOS battery on the PC
mainboard with a new one.
The table is not connected to Connect the table to the isolating transformer.
the isolating transformer.
The cabling of the table is
improperly.
Connect the cables properly.
Imported E2E files cannot be
reviewed.
No viewer license is
installed.
The printer is not printing.
The printer is not connected
to the isolating transformer.
Connect the printer to the isolating transformer.
not switched on.
The toner or the ink is empty. Refill the toner or the ink or replace the printer
cartridge.
The error message “No
connection to camera, power
supply and touch panel.” is
displayed.
The error message “Database
cannot be found” is displayed.
The printer is out of paper.
Refill paper.
The cabling of FireWire card
is improperly.
Check the cabling of the FireWire card.
The driver of the FireWire
card is installed improperly.
Install the driver of the FireWire card again.
The power supply is not
switched on.
Switch on the power supply.
not switched on.
The external hard disk has
not been found.
Check the connection of the external hard
disk.
Restart HEYEX.
Restart HEYEX.
Restart HEYEX.
Restart HEYEX.
Restart HEYEX.
If the problem persists, contact your local distributor or Heidelberg Engineering.
The server has not been
started.
Start the server.
177
12 Troubleshooting
Display Messages Acquisition Window
Fault description
Cause
Remedy
The error message “DAO” is
displayed.
A hard disk failure occured.
Contact Heidelberg Engineering support.
The network connection
failed.
12.1
Display Messages HEYEX
Fault description
Cause
Remedy
“The disk space is
seriously low! Please stop
working and use "archive"
and "clean-up" to make new
disk space available.”
The patient data hard disk space is
low.
Select “Database \ Archive Images...” in
the menu bar and start the archiving
process.
Ensure that enough memory is available
on the archive medium.
Use a bigger hard disk for storing the
patient data.
“Warning: The database
has not been archived since
8 days! Please archive as
soon as possible.”
The database has not been archived
for 8 days. The message will be displayed every day then, until the
archiving process has been started.
Select “Database \ Archive Images...” in
the menu bar and start the archiving
process.
“Warning: The database
has not been archived since
15 days! The archiving
process will be started
now...”
The database has not been archived
for 15 days.
The archiving process starts automatically. Ensure that enough memory is
available on the archive medium.
“Cannot delete images
that have been archived or
put into a light box.”
If images have been archived, only
the images, not the corresponding
patient data are archived. The link
between HEYEX and the archive
medium will be lost if the images are
deleted in HEYEX. There would be
no possibility to recover the images.
This mechanism prevents data loss
due to an unintentional image deletion.
If the images shall be deleted, delete the
complete patient file.
12.2
Ensure that enough memory is available
on the archive medium.
Fault description
Cause
Remedy
“Acquisition in service
mode not allowed!”
The service mode is enabled. Do not use the system.
The background of the
If your service technician is on-site, contact your
acquisition window is colorservice technician.
coded red.
Restart the device.
If the problem persists and your service technician is
off-site, please contact your local
Heidelberg Engineering partner or the
Heidelberg Engineering support.
178
Troubleshooting 12
Fault description
Cause
Remedy
“Configuration Error:
The screen resolution
must be 1600 x 1200
pixels or higher.
Reconfigure your
screen resolution and
start the acquisition
module again.”
The screen resolution is not
sufficient. The monitor must
have a screen resolution of
1600 x 1200 pixels.
Check the monitor requirements.
Reconfigure your screen resolution.
Use another monitor that meets the monitor requirements.
“Don't expose patient to The service mode is enabled. Do not use the system.
laser! System is in
The background of the
If your service technician is on-site, contact your
service mode!”
acquisition window is colorservice technician.
coded red.
Restart the device.
If the problem persists and your service technician is
off-site, please contact your local
“Error: Device not
The FireWire cable (FireWire Check the cabling of the FireWire cable.
connected (not visible to 400/1394a) is not, or not coroperating system)”
rectly inserted into the socket.
“OCT module self test
running. Please wait...”
The device is not switched
on.
Switch on the device.
The FireWire card is defective.
Contact your local Heidelberg Engineering partner or
the Heidelberg Engineering support.
The FireWire driver
(IEEE1394a) is not correctly
installed.
Re-install the software.
When the device is switched
on, an internal self test is performed. While this message
is displayed, the device
cannot be used. This will only
take several seconds
Wait until the message “Press button on the touch
panel to start the live image” is displayed.
It is not recommended to frequently turn the device
on and off. Instead, switch on the device in the
morning and off in the evening even if the device is
not in constant use throughout the day.
“OCT module data
acquisition failure:
IMOD 0xe0000200”
The device has been
Switch on the device.
switched off while the camera
was switched on and the
OCT acquisition window was
opened.
“SAFETY-INTERLOCK
(No. <N>): restart
device!”
The "Interlock" error
occurred. The device cannot
be used.
Restart the system.
If the problem persists, please contact your local
179
12 Troubleshooting
Display Messages Power Supply
Fault description
Cause
Remedy
“Scan amplitude
The HRA scan amplitude
measurement failed.
cannot be measured as the
Please contact service!” amplitude is too low.
12.3
In the acquisition window, select “IR” as the acquisition mode and “30°” as the scan angle. Press
+
+
+
on the keyboard. The “Service Panel”
window opens. Check the “Large Service Mode Live
Image” box. Take a screen shot. Uncheck the
“Large Service Mode Live Image” box and close the
“Service Panel” window. Send the screen shot to
your local Heidelberg Engineering partner or the
Display Messages Analysis Window
Fault description
Cause
Remedy
“Do you really want to
delete the selected
images?”
Deleted objects will be removed and
cannot be recovered at a later time, even
if archived.
Click “Yes” to confirm or “No” to quit
without changes.
“Warning: Classification
results valid for Caucasian
eyes only!”
The data base for the classification is
only valid for Caucasians. The classification results might differ for patients of different heritage.
Please take the patient's heritage into
account when analyzing examinations.
12.4
Display Messages Touch Panel
Message
Cause
Remedy
ATTENTION! You are entering a
The service mode has been
service area. Press “Cancel” to
switchen on accidentally on the
leave! Press “Continue” to go on if touch panel.
you are a certified service engineer.
12.5
Ensure that the local regulations
retaining patient data are observed
before deleting images.
Press “Cancel” if you are no
service engineer or restart the
device.
Display Messages Power Supply
Message
Cause
Remedy
Service mode. Do not use system.
The service mode is enabled.
Do not use the system.
If your service technician is on-site,
contact your service technician.
If the problem persists and your
service technichian is off-site,
please contact your local distributor
or the Heidelberg Engineering support.
180
Service and Cleaning 13
Saving the Log Information to the Archive File
13
Service and Cleaning
13.1
Service and Maintenance
L WARNING
Insufficient maintenance of the device might lead to device failures or bad image quality.
 Heidelberg Engineering recommends an inspection of the device
every two years. The inspection shall be carried out by authorized
service personnel.
A device failure or bad image quality may lead to wrong diagnostic conclusions which may result in wrong therapeutic
approaches.
Only authorized service personnel are allowed to perform services and
repairs on the device.
If the device is opened by someone other than an authorized service
personnel, the warranty will be void.
In order to schedule a maintenance adjustment or repair of the equipment contact Heidelberg Engineering or your local distributor.
In order to ensure proper functioning of the device,
Heidelberg Engineering recommends periodic maintenance every two
years including a comprehensive quality control checkup.
For further information on the support offered by
Heidelberg Engineering, please visit the Heidelberg Engineering support website at
http://www.heidelbergengineering.com/international/support/.
13.2
Saving the Log Information to the Archive File
For immediate assistance in the event of a problem, e.g. software
crash, create an archive file and send it together with a detailed error
description by email to your local distributor.
 In the acquisition window, select “Setup \ Service” in the menu bar.
The “Info/Service” dialog box is displayed.
 If there was a software crash, check the “Include crash dump
information” box.
 Click “Save log information to archive file” .
 Select a storage location and click “Save” to confirm.
The archive file is saved as a zip file.
 In order to close the “Info/Service” dialog box, click “Close” .
 Send the zip file per email to your local distributor.
If the zip file is too large to send it by email, use a file sharing software
to transmit the information to your local distributor.
181
13 Service and Cleaning
Cleaning and Disinfection
13.3
L WARNING
Improper cleaning and disinfection of the device may cause
allergic reactions or infections caused by transmitted pathogenic
germs.
 Clean the device after each use as needed and disinfect the
device before each examination as described in this chapter.
The allergic reactions or infections may have a serious impact on
the patient's health.
L WARNING
Improper cleaning of the device might lead to device failures or
bad image quality.
 Check regularly that the device is clean.
 Clean the device regularly.
 Remove dust, dirt, and/or contrast fluid.
A device failure or bad image quality may lead to wrong diagnostic conclusions which may result in wrong therapeutic
approaches.
L CAUTION
Fluids, e.g. cleanser, in the device may cause bad image quality.
 Clean and disinfect the non-optical surfaces of the device with a
moist, not wet, cloth.
Cleaning optical surfaces
L WARNING





Using the wrong cleanser or cleaning cloth might scratch the
lens.
Always use special cleaning products for optics or pure alcohol,
for example ethanol or isopropanol, with a minimum alcohol level
of 99%.
Never use cleaning products that contain methanol.
Never use cleaning tissues or disinfectant wipes to clean the lens.
Always use a microfiber cloth for cleaning.
Never apply any pressure while wiping.
A scratched lens might lead to artifacts in reflectance images.
L CAUTION
Frequent cleaning of the lens during the service live of the device
might wear the lens and lead to deterioration of image quality .
 Avoid dirty lenses. When the device is not in use, protect the lens
with the lens cover.
The front lens may get dirty as the result of contact with eyelashes and
fingerprints.
 Check regularly that the lens is clean.
 When the device is not in use, protect the device with the dust cover.
182
Service and Cleaning 13
Disinfecting optical surfaces  Disinfect the optical surfaces with isopropyl alcohol with an alcohol
level of 70% or ethanol with an alcohol level of 80%.
 In order to ensure decontamination, follow appropriate infection control
guidelines regarding surface disinfectant contact times.
 At the end of the contact time check whether remnants of the disinfec-
tant are on the optical surfaces.
 If there are remnants of the disinfectant on the optical surfaces, clean
the optical surface as described in ( “Cleaning optical surfaces”
p. 182).
Cleaning non-optical surfaces  Clean the non-optical surfaces of the device after each examination as
needed.
Any standard cleaning product appropriate for plastic and metal surfaces which does not contain acetone or hydrogen peroxide may be
used.
Disinfecting non-optical surfaces
Heidelberg Engineering recommends Metrex CaviWipes® or other EPA
registered disinfectants with comparable active substances. Observe
the instructions of the disinfectant wipes manufacturer. Do not use
products containing acetone or hydrogen peroxide.
 Disinfect the non-optical surfaces with disinfectant wipes before each
examination.
Cleaning and disinfecting the touch
panel
NOTICE
Using the wrong cleanser might damage the touch panel's
coating.
 Do not use detergents containing organic solvents, e.g. acetone,
or hydrogen peroxide when cleaning and disinfecting the Touch
Panel.
 Clean the touch panel with a moist, well wrung out microfiber cloth.
Use a mild detergent for cleaning the touch panel.
For disinfecting the touch panel, please follow the instructions for disinfecting non-optical surfaces ( “Disinfecting non-optical surfaces”
p. 183).
183
13 Service and Cleaning
Cleaning the power supply filter
Clean the filter on the backside of the power supply every three
months:
Fig. 77: SPECTRALIS power supply
 Switch off the power supply.
 Remove four screws with a size 2.5 mm Allen key and take off the
cover plate.
 Remove the filter from the power supply.
 In order to clean the filter, carefully beat it.
 Alternatively, hold the filter under the water tab and clean it carefully.
Before re-inserting the filter into the power supply, let it dry completely.
184
Disposal 14
14
Disposal
The device complies with the directive 2012/19/EU WEEE on waste
electrical and electronic equipment. Electrical and electronic equipment
with this symbol indicate that the device may not be disposed of with
the regular household garbage. For further information, please contact
your local distributor or Heidelberg Engineering.
185
15 Technical Specifications
15
Manufacturer
Heidelberg Engineering GmbH
Tiergartenstr. 15
69121 Heidelberg / Germany
Model Type
SPECTRALIS HRA
Imaging Modes
Single Imaging Modes
Infrared reflectance imaging (IR)
Blue-reflectance imaging (BR)
Fluorescein angiography (FA)
Indocyanine green angiography (ICGA)
BluePeak blue laser autofluorescence imaging (BAF)
Simultaneous Imaging Modes
Simultaneous FA and ICGA
Simultaneous FA and IR
Simultaneous ICGA and IR
Simultaneous BAF and IR
Light Sources
IR
Laser, wavelength 815 nm, output power 0.10 mW (cw, parallel beam),
Class 1 laser product
FA, BAF, BR
ICGA
Laser, wavelength 786 nm, output power 3.80 mW (cw, parallel beam), Class
1 laser product
GR
Laser product classification according to IEC 60825-1:2007. The product complies with 21 CFR 1040.10 and
1040.11 except for deviations pursuant to Laser Notice No.50, dated June 24, 2007.
Scanning Laser Imaging Specifications
Maximum scan depth
8 mm
Transversal field of view
Scan angle [°]
30 x 30 / 20 x 20 / 15 x 15
Scan angle wide field lens [°]
55
Wide field composite image
up to 165°
Digital image size [pixels]
768 x 768 / 512 x 512 / 384 x 384
Scan time per image [ms]
96 / 64 / 48
High Speed (HS) mode
186
Technical Specifications 15
High Resolution (HR) mode
Lateral resolution (digital)
11 µm/pixel
Image rate [Hz]
9 / 12.5 / 16
Digital image size [pixels]
1,536 x 1,536 / 1,024 x 1,024 / 768 x
768
Scan time per image [ms]
192 / 128 / 96
Lateral resolution (digital)
6 µm/pixel
Image rate [Hz]
5/7/9
Height [mm]
205
Width [mm]
100
Length [mm]
235
Weight [kg]
5.6
Height [mm]
550; without fixation light
Width [mm]
325
Length [mm]
470
Weight [kg]
8.8
Height [mm]
170
Width [mm]
190
Length [mm]
340
Weight [kg]
6.5
Height [mm]
100
Width [mm]
185
Length [mm]
170
Weight [kg]
2
Dimensions and Weight
Camera head
Instrument base KT
Power Supply
Touch Panel
Electrical Data
Input Voltage
100 – 240 V
Frequency
50/60 Hz
Power consumption
140 VA
Fuses
For 240 V:
2 x T 1.6 AH, time delay, High breaking capacity 1500A @ 250VAC, ULCCN:JDYX2, UR, e.g. Littelfuse Typ 215
187
Electromagnetic Compatibility
For 120 V:
2 x T 3.15 AH, time delay, High breaking capacity 1500A @ 250VAC, ULCCN:JDYX2, UR, e.g. Littelfuse Typ 215
Power Connection
1. Type SVT, 3 x 18AWG, Hospital Grade-marked plug, UL-CCN: ZJCZ or
RTRT or AXUT, UR for US
2. Type H05VV-F 3G 0.75 mm2, IEC-320 standard power inlet connector, VDE
Power outlets (Option)
1 IEEE 1394a (Fire Wire / i.Link) port: 12 V, 1.25 A
Ingress protection rating
IPX0
Protection against electric
shock
Class 1
Applied Parts Type B
SPECTRALIS head rest
Mains Isolation Switch
Rocker switch at power supply front side
Operating Environmental Conditions
Temperature
10 – 35°C / 50 - 95°F
Relative Humidity
10 – 90% non condensing
Air Pressure
700 – 1,060 hPa
Mode of Operation
Suited for continuous operation
Non Operating Environmental Conditions
Temperature
-30 – 60°C / -22 – 140°F
Relative Humidity
10 – 95%
Air Pressure
500 – 1,060 hPa
15.1
15.1.1
Guidance and Manufacturer’s Declaration
The device is intended for use in the electromagnetic environment
specified below. The customer or the user of the device should ensure
that it is used in such an environment.
Emission Test
Compliance
Electromagnetic Environment
RF Emissions
Class B
CISPR 11
Group 1
The device uses only RF energy for internal function.
Therefore, its RF emissions are very low and are not
likely to cause interference.
RF Emissions
Class B
CISPR 11
188
The device is suitable for use in all establishments,
including those directly connected to a public low-voltage
power supply network that supplies buildings uses for
domestic purposes.
Emission Test
Compliance
Harmonic Emission
Class A
Electromagnetic Environment
IEC 61000-3-2
Voltage fluctuations / flicker
emissions
Passed
IEC 61000-3-3
Immunity Test
IEC 60601 test level
Compliance Level
Electromagnetic Environment Guidance
Electrostatic discharge
(ESD)
6 kV contact
6 kV contact
8 kV air
8 kV air
Floors should be wood, concrete or ceramic tile. If floors
are covered with synthetic
material, the relative humidity
should be at least 30 %.
2 kV for power supply
lines
±2 kV
Power quality should be consistent with a typical commercial or hospital environment.
Surge
1 kV line(s) to line(s)
1 kV line(s) to line(s)
IEC 61000-4-5
2 kV line(s) to earth
2 kV line(s) to earth
Power quality should be consistent with a typical commercial or hospital environment.
IEC 61000-4-2
Electrical fast transient/
burst
IEC 61000-4-4
Voltage dips, short inter- <5% UT (>95% dip in
Passed
ruptions and voltage
UT) for 0.5 cycle
variations on power
40% UT (60% dip in UT)
supply input lines
for 5 cycles
IEC 61000-4-11
70% UT (30% dip in UT)
for 25 cycles
<5% UT (>95% dip in
UT) for 5 sec
Power frequency (50/60
Hz) magnetic field
3 A/m
3 A/m
IEC 61000-4-8
Power quality should be consistent with a typical commercial or hospital environment. If
the user of the device requires
continued operation during
power interruptions, it is recommended that the device be
powered from an uninterruptible power supply or a battery.
Power frequency magnetic
fields should be at levels consistent with a typical commercial or hospital environment.
Portable and mobile RF communications equipment should
be used no closer to any part
of the device including cables,
than the recommended separation distance calculated from
the equation applicable to the
frequency of the transmitter.
Recommended separation distance (see below):
Conducted RF
3V
IEC 61000-4-6
150 kHz to 80 MHz
V1=3 V
189
Immunity Test
IEC 60601 test level
Compliance Level
Radiated RF
3 V/m
E1=3 V/m
IEC 61000-4-3
80 MHz to 2,5 GHz
Electromagnetic Environment Guidance
80 MHz to 800 MHz
800 MHz to 2.5 GHz, where P
is the maximum output power
rating of the transmitter in
watts (W) according to the
transmitter manufacturer and d
is the recommended separation distance in meters (m).
Field strengths from fixed RF
transmitters, as determined by
an electromagnetic site (a)
survey, should be less than the
compliance level in each frequency range. (b)
Interference may occur in the
vicinity of equipment marked
with the following symbol:
a) Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and
land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the device is used
exceeds the applicable RF compliance level above, the device should be observed to verify normal operation.
If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating
the device.
b) Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [V1] V/m.
15.1.2
Recommended Separation Distances
Recommended separation distances between portable and mobile RF
communications equipment and the device.
The device is intended for use in an electromagnetic environment in
which radiated RF disturbances are controlled. The customer or the
user of the device can help prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF
communications equipment (transmitters) and the device as recommended below, according to the maximum output power of the communications equipment.
190
Regulatory Standards
Rated maximum
output power of transmitter W
Separation distance according to frequency of transmitter [m]
150 kHz to 80 MHz
80 kHz to 800 MHz
800 kHzto 2.5 GHz
0.01
0.12
0.12
0.23
0.1
0.38
0.38
0.73
1
1.2
1.2
2.3
10
3.8
3.8
7.3
100
12
12
23
For transmitters rated at maximum output power not listed above, the
recommended separation distance (d) in meters (m) can be estimated
using the equation applicable to the frequency of the transmitter, where
P is the maximum output power rating of the transmitter in watts (W)
according to the transmitter manufacturer.
At 80 MHz and 800 MHz, the separation distance for the higher frequency applies.
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from strictures, objects
and people.
15.2
Regulatory Standards
The HRA complies with the international IEC 60601 standard series
concerning medical electrical equipment. These standards are published by the International Electrotechnical Commission (IEC) and are
the basis of most national and regional standards for medical electrical
equipment worldwide. Some local standards contain deviations from
the IEC versions.
These standards include:
▪
▪
▪
▪
▪
EN 60601-1 (EU)
ANSI/AAMI ES60601-1 (USA)
CSA C22.2 No. 60601-1-08 (Canada)
JIS T 0601-1 (Japan)
AS/NZS 3200.1.0 (Australia / New Zealand)
The list refers to the currently valid versions of these standards.
Wherever IEC 60601-Standards are mentioned inside this document,
the according regulations of respective local standards are also
implied.
The HRA complies with the directive 2011/65/EU on the restriction of
the use of certain hazardous substances in electrical and electronic
equipment.
Even though the HRA already conforms to most local standards for
medical devices in its default configuration, actual conformance can
only be ensured by buying it from an authorized local
Heidelberg Engineering distributor.
191
Labeling
15.3
Labeling
SPECTRALIS Type Plate Label
The following label is located on the power supply.
Fig. 78: SPECTRALIS type plate label
The label contains the following information:
Manufacturer
The device may not be disposed of with the regular household garbage
▪
Caution: Follow instructions for use
▪
CE mark certification, Class IIa medical device according to EU
directive 93/42/EEC
▪
▪
Camera Label
The following label is located on the camera head.
Fig. 79: Camera label
▪
▪
▪
FDA Compliance
Manufacturer
Date of manufacture
Serial number
The following label is located on the camera head.
The label contains the information that the device complies with 21
CFR 1040.10 and 1040.11 except for deviations pursuant to Laser
Notice No. 50, dated June 24, 2007.
192
Labeling
Power Supply Label
The following label is located on the power supply.
Fig. 80: Power supply label
▪ Input voltage, frequency and power consumption
▪ Fuses used in the device
Serial number
▪
▪
Date of manufacture
The [A] at the end of the serial number indicates, that the device can
only be operated with a laptop, if additional equipment is available that
powers the FireWire bus.
The following label is located on the head rest.
Head Rest Label
Fig. 81: Head rest label
▪
▪
▪
▪
Touch Panel Label
Manufacturer
Date of manufacture
Serial number
Applied parts type B
The following label is located on the touch panel.
Fig. 82: Touch panel label
▪
▪
▪
Manufacturer
Date of manufacture
Serial number
193
Labeling
15.3.1
UL Classification Mark
The UL Classification Mark appears on devices that UL has evaluated
but only with respect to specific properties, a limited range of hazards,
or suitability for use under limited or special conditions. With the UL
Classification Mark Heidelberg Engineering has demonstrated the
ability to produce a product complying with UL's requirements with
respect to one or more of the following:
▪
▪
▪
▪
▪
194
Specific risk, e.g., casualty, fire, etc.
Performance under specific conditions
Compliance with regulatory codes
Compliance with specific standards such as international standards
Other conditions, as determined by UL
Terms and Definitions 16
16
Terms and Definitions
ART Mean
If Automatic Real Time (ART) Mean is switched on, the section “ART
Mean” is displayed. With ART, mean images are created automatically, which increases image quality due to noise reduction. For performance reasons, this process has a tolerance, so the actual number
of frames used to create the mean image may vary up to ±10%.
If you want to check the number of images averaged, select
“Image \ Image Information” in the analysis window's menu bar. In the
“OCT image” section, the number of images averaged is given in the
“ART Mode” entry.
AQM
AutoRescanTM
BAF
Acquisition module
TruTrackTM active eye tracking creates a detailed retinal map each
time a patient is imaged. The AutoRescanTM feature uses this map to
automatically place follow-up scans in precisely the same location as
the baseline scan. Once a scan is marked for follow-up, the
AutoRescan feature will find the desired location, eliminating subjective
operator placement and increasing clinician ability to observe true
change over time rather than change resulting from alignment error.
AutoRescan precision has been documented in studies showing that
the SPECTRALIS system offers 1 μm measurement reproducibility
(Wolf-Schnurrbusch UE et al. Macular Thickness Measurements in
Healthy Eyes Using Six Different Optical Coherence Tomography
Instruments. Invest Ophthalmol Vis Sci. 2009;50:3432-3437).
BluePeak blue laser autofluorescence
BAF+ICGA
BluePeak blue laser autofluorescence + indocyanine green
angiography
BAF+IRAF
BluePeak blue laser autofluorescence + infrared autofluorescence
BR
BR+IR
cSLO
FA
FA+ICGA
Blue reflectance
Blue reflectance + infrared reflectance
confocal Scanning Laser Ophthalmoscopy
Fluorescein angiography
Fluorescein angiography + indocyanine green angiography
195
16 Terms and Definitions
FA+IRAF
HR
High resolution mode; if you select HR as the scan resolution mode,
images are acquired with a higher spatial scan resolution but with a
low scan rate. HR acquires more data points over a longer time period
and requires more time and space for data storage.
HS
High speed mode; if you select HS as the scan resolution mode,
images are acquired at a faster rate but will be of a lower resolution.
HS is optimized for fast image acquisition with a high frame rate and a
minimum need for data storage.
ICGA
Indocyanine green angiography
ICGA+IR
Indocyanine green angiography + infrared reflectance
IRAF+IR
Infrared autofluorescence + infrared reflectance
IR
IRAF
Infrared autofluorescence
OCT
Optical Coherence Tomography
OD
ONH
Oculus dexter, right eye
Optic nerve head
OS
Oculus sinister, left eye
OU
Oculi uterque; both eyes
PPole
PPR
RNFL
196
Fluorescein angiography + infrared autofluorescence
Posterior pole
Peripapillary retina
Retinal Nerve Fiber Layer
Terms and Definitions 16
TruTrackTM Active Eye Tracking
TSA
VWM
The SPECTRALIS platform simultaneously images the eye with two
beams of light. One beam captures an image of the retina and maps
over 1,000 points to track eye movement. Using the mapped image as
a reference, the second beam is directed to the desired location
despite blinks or saccadic eye movements. TruTrackTM dual-beam
technology mitigates eye motion artifact and ensures point-to-point correlations between OCT and fundus images without post-processing of
the data
Transverse section analysis
Viewing module
197
17 Index
17 Index
A
Composite.................................................. 72, 103
Composite 3x3........................................... 72, 109
Mean.................................................................. 72
Movie......................................................... 72, 100
Selecting acquisition modalities......................... 72
Stereo pair................................................. 72, 110
Acquisition Window
Selecting a Fixation Light................................... 83
Analysis window
Cascading windows......................................... 127
Full screen....................................................... 127
Tiling windows.................................................. 127
Window options................................................ 127
Analyzing images
Tomography............................................... 72, 114
Acquisition modes
FA...................................................................... 81
FA+IR................................................................. 81
Filter wheel......................................................... 80
ICGA.................................................................. 81
ICGA+IR............................................................. 81
IR....................................................................... 81
MultiColor (option).............................................. 82
RF / BR.............................................................. 81
RF+IR / BR+IR................................................... 81
Selecting acquisition modes.............................. 82
Selecting an acquisition mode........................... 80
Acquisition parameters
Acquisition memory setup.................................. 76
Composite.......................................................... 76
Composite 3x3................................................... 76
Cyclic buffer size for movies.............................. 76
Default acquisition mode.................................... 76
Duration of a movie............................................ 76
Fixation light....................................................... 76
Image brightness control.................................... 75
Mean.................................................................. 76
Movie................................................................. 76
Scan resolution mode........................................ 75
Stereo pair......................................................... 76
Tomography....................................................... 76
Tomography depth scan range.......................... 76
Acquisition settings
Automatic image brightness control................... 73
High resolution HR............................................. 73
High speed HS................................................... 73
Manual image brightness control....................... 73
Myopic lens........................................................ 73
Color scale....................................................... 125
Image brightness and contrast......................... 124
Image information............................................ 128
Noise reduction................................................ 126
Sharpen the cSLO image................................. 125
Viewing preferences........................................ 123
Angiographies
Acquiring a movie of the early phase................. 91
FA...................................................................... 91
FA + ICGA.......................................................... 91
FA + IR............................................................... 91
HRA patient timer log......................................... 94
ICGA.................................................................. 91
ICGA + IR........................................................... 91
Performing an angiography................................ 88
Removing patients from the HRA patient
timer log............................................................. 94
Resetting injection timers................................... 94
Setting injection timers....................................... 93
Starting the angiography.................................... 91
Anonymize patient data for export........................ 124
ART Mean
"Normalize" function........................................... 79
Adjusting ART Mean.......................................... 79
Computing mean images................................. 170
Mean images..................................................... 79
B
BAF......................................................................... 81
BluePeak blue laser autofluorescence images
Acquiring BluePeak blue laser autofluorescence images..................................................... 96
BR........................................................................... 81
198
Index 17
C
C-Curve................................................................... 64
Cleaning
Non-optical surfaces........................................ 183
Optical surfaces............................................... 182
Power Supply Filter.......................................... 184
Touch panel..................................................... 183
Composite 3x3...................................................... 109
Disinfection
Non-optical surfaces........................................
Optical surfaces...............................................
Touch panel.....................................................
Display info bubbles..............................................
Display options
Cascading windows.........................................
Full screen.......................................................
Composite fundus image...................................... 103
Composite fundus images..................................... 146
Acquiring composite 3x3 fundus images......... 109
Acquiring composite fundus images................ 103
Analysis window............................................... 146
Composite 3x3................................................. 109
Computing composite fundus images.............. 171
Creating a new patient file....................................... 42
cSLO Image color scale
Black on white.................................................. 125
Color................................................................ 125
White on black................................................. 125
cSLO Images
Acquiring cSLO images..................................... 84
Analysis window............................................... 144
Color scale....................................................... 125
Measuring a distance....................................... 129
Sharpen the cSLO image................................. 125
Custom settings
Image brightness and contrast......................... 126
Cyclic buffer size for movies................................... 76
D
Database window
Correcting patient data....................................... 57
Deleting patient files........................................... 57
Entering patient data.......................................... 57
Graphical user interface..................................... 37
Load all patient files........................................... 45
Load one patient file........................................... 45
Searching patient files........................................ 50
Starting a new examination................................ 54
Diagnoses............................................................... 62
Deleting a diagnosis........................................... 62
Entering a diagnosis.......................................... 62
Renaming a diagnosis....................................... 62
Tiling windows.................................................. 127
Dongle..................................................................... 14
E
E2E files................................................................ 165
Exporting E2E files........................................... 164
Import............................................................... 165
Enable progression cache..................................... 124
ETDRS grid........................................................... 134
Examination data.............................................. 42, 61
Examinations
Continuing examinations.................................... 56
Starting a new examination................................ 54
Expanding images and movies............................. 142
Export
E2E files........................................................... 164
Movies.............................................................. 169
Multiple Images or Patient Files as E2E Files.. 164
Extracting single images....................................... 143
Eye data.................................................................. 42
Axis of astigmatism............................................ 63
C-Curve.............................................................. 63
Corrective lens................................................... 63
Cylinder.............................................................. 63
Intraocular pressure........................................... 63
Pupil size............................................................ 63
Spherical refraction............................................ 63
Visual field mean deviation................................ 63
Visual field variation........................................... 63
F
FA............................................................................ 81
Filter wheel.............................................................. 80
Position A........................................................... 80
Position P........................................................... 80
Position R........................................................... 80
Position S........................................................... 80
183
183
183
123
127
127
199
17 Index
Fixation light............................................................ 76
Default fixation light............................................ 76
External fixation light.......................................... 82
Internal fixation light........................................... 82
Selecting a fixation light..................................... 82
Fluorescein angiography......................................... 91
Follow-up image is not compared to last visit....... 124
Fundus images
Importing images into HEYEX............................... 165
Patient-ID......................................................... 165
Indocyanine green angiography.............................. 91
IR............................................................................. 81
L
Labeling
Camera label.................................................... 192
Head rest label................................................. 193
Acquisition window............................................. 78
Power supply label........................................... 193
Touch panel label............................................. 193
Type plate label................................................ 192
Laser intensity......................................................... 71
Lightbox
Adding images to the lightbox............................ 67
Deleting the lightbox.......................................... 68
Keeping the original lightbox.............................. 67
Removing images.............................................. 68
Saving the lightbox............................................. 67
M
Marking a region with an arrow............................. 132
MColor..................................................................... 82
Measuring distances............................................. 129
Measuring the diameter of a region...................... 133
Movies................................................................... 149
Acquiring movies.............................................. 100
Analysis window............................................... 149
Computing composite fundus movies.............. 171
Computing movies........................................... 170
Correcting the eye movements........................ 150
Displaying eye movements.............................. 150
Exporting movies............................................. 169
Extracting images out of a movie..................... 149
MultiColor
Acquiring MultiColor cSLO Images.................. 118
Acquisition mode................................................ 82
Myopic lens............................................................. 73
N
Noise reduction..................................................... 126
Not compared to last visit...................................... 124
G
Graphic file format for XML export........................ 124
H
HEYEX
Database window............................................... 37
Disable plug-ins................................................. 33
Enable plug-ins.................................................. 33
Image viewing window....................................... 39
Installing plug-ins............................................... 33
Starting HEYEX................................................. 35
High magnification images...................................... 95
15° scan angle................................................... 95
20° scan angle................................................... 95
30° scan angle................................................... 95
HRA patient timer log.............................................. 94
I
ICGA....................................................................... 81
Image brightness and contrast.............................. 124
cSLO image brightness.................................... 125
cSLO image contrast....................................... 125
Image brightness control......................................... 75
Manual image brightness control....................... 75
Image information................................................. 128
Image thumbnails
HRA................................................................. 143
Image viewing window
Continuing examinations.................................... 56
Deleting images................................................. 57
Graphical user interface..................................... 39
Lightbox............................................................. 67
Locking examinations........................................ 76
Setting display options................................. 32, 41
Unlocking examinations..................................... 76
200
Index 17
O
OCT cache size.....................................................
OCT color scale
Black on white..................................................
Color................................................................
White on black.................................................
OU reports
Printing OU reports..........................................
124
123
123
123
159
Overlays................................................................ 129
Arrow tool......................................................... 132
Diameter tool.................................................... 133
Distance measurement tool............................. 129
ETDRS grid...................................................... 134
Properties......................................................... 135
Region tool....................................................... 130
Remove all overlays......................................... 137
Remove an overlay.......................................... 137
Shortcuts.......................................................... 129
Show all overlays............................................. 129
Text tool........................................................... 132
P
Patient data............................................................. 42
Patient files
Advanced search............................................... 52
Allergies............................................................. 58
C-Curve.............................................................. 42
Correcting comments......................................... 60
Correcting examination data.............................. 61
Correcting patient data....................................... 57
Country of birth.................................................. 58
Country of residence.......................................... 58
Creating a new patient file................................. 42
Deleting a diagnosis........................................... 62
Deleting a study................................................. 61
Deleting patient files........................................... 57
Duplicates.......................................................... 42
Entering additional data..................................... 58
Entering a detailed anamnesis........................... 60
Entering a diagnosis printed on reports............. 62
Entering comments not printed on reports......... 60
Entering examination data................................. 61
Entering patient data.......................................... 57
Entering study information................................. 61
Examination data...............................................
Eye data.............................................................
Height.................................................................
Insurance...........................................................
Loading search queries......................................
Moving Images between patient files.................
Opening a patient file.........................................
Patient data........................................................
42
42
58
58
54
64
45
42
Quick search...................................................... 50
Referring physician............................................ 58
Renaming a study.............................................. 61
Renaming patient files....................................... 57
Searching patient files from today...................... 51
Selecting all patient files.................................... 48
Selecting a patient file........................................ 45
Selecting multiple patient files............................ 47
Smoking status.................................................. 58
Weight................................................................ 58
Preparations
Preparing the device.......................................... 29
Preparing the patient.......................................... 30
Printing OU reports............................................... 159
Printing reports...................................................... 157
Printing from the analysis window.................... 159
Printing from the image viewing window.......... 157
Printing from the lightbox................................. 159
R
Red free.................................................................. 81
Reports
Customizing header and footer........................ 156
Customizing reports......................................... 156
OU reports....................................................... 159
Overview report................................................ 161
Printing reports................................................. 157
S
Scan angle.............................................................. 95
15°...................................................................... 95
20°...................................................................... 95
30°...................................................................... 95
Scan resolution mode
High resolution................................................... 75
High speed......................................................... 75
201
17 Index
Searching patients
Advanced search...............................................
Applying a database filter...................................
Deleting a database filter...................................
Duplicates and conflicts.....................................
Loading search queries......................................
Patients with duplicate name and date of birth. .
Patients with duplicate patient-ID.......................
52
52
53
52
54
52
52
Patients with missing patient-ID......................... 52
Quick search...................................................... 50
Saving a database filter..................................... 53
Searching patient files from today...................... 51
Selecting acquisition modes.................................... 82
Show "custom settings" buttons............................ 123
Show image IDs.................................................... 124
Show most recently used analysis........................ 123
Simultaneous fundus images................................ 146
Analysis window............................................... 146
Splitting simultaneous fundus images into
single images................................................... 146
Software protector................................................... 14
Sort examinations by examined structure............. 124
Sort examinations by image ID............................. 124
Sort examinations by time..................................... 124
SPECTRALIS Device
Components....................................................... 27
Preparations....................................................... 29
Shut-down procedure......................................... 28
Start procedure.................................................. 28
Stereo fundus images........................................... 147
3D view............................................................ 147
Acquiring stereo fundus images....................... 110
Analysis window............................................... 147
Intensify 3D view.............................................. 147
Red-cyan 3D Glasses...................................... 147
Stereo viewing glasses.................................... 147
Stereo pair............................................................. 110
Studies.................................................................... 61
Deleting a study................................................. 61
Entering a study................................................. 61
Renaming a study.............................................. 61
202
T
Tomographies
Performing a tomography................................ 114
Touch panel
Composite.......................................................... 72
Composite 3x3................................................... 72
Fixation light....................................................... 71
High resolution HR.............................................
High speed HS...................................................
Injection timer.....................................................
Laser intensity....................................................
Manual image brightness control.......................
Mean..................................................................
Movie.................................................................
Myopic lens........................................................
Selecting acquisition modalities.........................
Selecting acquisition settings.............................
Selecting a Fixation Light...................................
Stereo pair.........................................................
Tomography.......................................................
73
73
71
71
73
72
72
73
72
73
83
72
72
U
User Account Management
Changing the password..................................... 36
V
Viewing preferences
Analysis center options.................................... 123
Data export options.......................................... 124
Default image settings..................................... 123
Miscellaneous options...................................... 124
Setting viewing preferences............................. 123
W
Writing text into an image...................................... 132
Z
Zoom and pan mode
Display the originally acquired pixels as
blocks............................................................... 140
Fit the window.................................................. 139
Fixed zoom factor............................................ 139
Pan mode......................................................... 140
Shortcuts.......................................................... 140
Unsmoothed pixels.......................................... 140
Zoom factor...................................................... 139
Index 17
Zoom functions................................................ 140
Zoom in............................................................ 140
Zoom out.......................................................... 140
203
204

SPECTRALIS HRA User Manual Software Version 6.0

Transcription

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