Page 1 GE Healthcare CASE™ V6.7 Software Version 6.73 Operator’s Manual 2060290-201 ENG Revision C...
Page 2 NOTE: The information in this manual only applies to CASE V6.7 systems software version 6.73. It does not apply to earlier software versions. Due to continuing product innovation, specifications in this manual are subject to change without notice. GE Medical Systems GE Medical Systems Information Technologies, Inc.
Page 3 CE Marking Information CE Marking Information Compliance The product CASE bears the CE marking CE 0459, notified body GMED, indicating its conformity with the provisions of the Council Directive 93/ 42/EEC concerning medical devices and fulfills the essential requirements of Annex I of this directive. The medical device has been assigned to class IIa as specified in Annex IX of the Directive 93/42/EEC.
Page 4 CE Marking Information For your notes CE-2 CASE Revision C 2060290-201...
Page 5: Table Of Contents
Contents Introduction About This Manual ........... 1-3 Revision History .
Page 6 Viewing and Printing the Operator's Manual ......2-17 Online Help ..........2-17 Software Options .
Page 7 Overview ........... . 5-6 10-Second ECG with Analysis .
Page 8 Pretest Phase ..........6-15 Overview .
Page 9 Audio ECG ......... . 6-51 Waterfall .
Page 10 Overview ........... .8-7 Flow-Volume Measurement - Operating Steps .
Page 11 Performing Procedures without the Order List (Unscheduled Procedures) . . . 11-6 System Settings Resting ECG Setup ..........12-3 Acquisition Tab .
Page 12 Spirometry Setup ..........12-35 Acquisition Tab .
Page 13 Bicycle Ergometers ..........B-3 Connecting ERGOLINE 900/900 L/900 EL Ergometers to the System Treadmills .
Page 14 Order Information Order Information ........... . C-3 Accessories .
Page 15 Introduction Revision C CASE 2060290-201...
Page 16 For your notes CASE Revision C 2060290-201...
Page 17: Illustrations
About This Manual About This Manual Revision History This manual is subject to the GE Healthcare change order service. The revision code, a letter that follows the document part number, changes with every update of the manual. Table 1: Revision History Part No./...
Page 18: Safety Information
Safety Information Safety Information Intended Use CASE is intended to be used by trained operators under direct  supervision of a licensed health care practitioner on adult and pediatric patients. CASE is designed to acquire, process, record, archive, analyze and ...
Page 19: General Information
The warranty does not cover damage resulting from the use of  unsuitable accessories and consumables from other manufacturers. GE Healthcare is responsible for the effects on safety, reliability, and  performance of the device, only if: assembly operations, extensions, readjustments, modifications, ...
Page 20: Definition
Safety Information requirements of this equipment may lead to a reduced level of safety of the resulting system. Considerations relating to the choice shall include: use of the accessory in the patient vicinity and  evidence that the safety certification of the accessory has been ...
Page 21 In the patient vicinity, the printer installed on the  system cart must meet the requirements of IEC 60601, or it must be a GE Healthcare modified printer with a connected protective earth conductor (potential equalization). Observe the installation instructions supplied with the printer.
Page 22 Safety Information Warning Shock Hazard — Observe the following warnings. Failure to do so endangers the lives of the patient, the user, and other persons present. All modems connected to the system must meet the  requirements of IEC 60950 or UL1950. The specific regulations valid in your country must also be observed.
Page 23 Shock Hazard — Observe the following warning. Failure to do so endangers the lives of the patient, the user, and other persons present. Use only the original GE Healthcare patient cable.  Do not connect other signal sources to the cable.
Page 24 Safety Information Caution Equipment Damage — Before connecting the device to the power line, check that the voltage and frequency ratings of your power line match those indicated on the device label. Equipment Damage — Do not set up CASE in the direct vicinity of a window.
Page 25: Classification
Safety Information Classification Type of protection against electrical shock class I Degree of protection against electrical Type BF, defibrillation-proof applied shock parts - ECG leads Degree of protection against harmful enclosed equipment without protection ingress of water against ingress of water Degree of safety of application in the Not suitable for use in the presence of a presence of a flammable anesthetic mixture...
Page 26 Safety Information Signal input Signal output Fuse 12 V DC The number found under this symbol is the date of manufacture in the YYYY- MM format. Medical Equipment — Classified with respect to electric shock, fire and mechanical hazards only in accordance with UL 60601-1/CAN/CSA C22.2 No.
Page 27: Supplies And Accessories
All parts of the product and all accessories described in this manual that come in contact with the patient during the intended use of the product, fulfill the biocompatibility requirements of the applicable standards. If you have questions in this matter, please contact GE Healthcare or its representatives. Technical Maintenance For technical data and other detailed technical information, please refer to the Service Manual.
Page 28 Safety Information security patch compatible with your operating system and install it on your system. Registration and download: http://prodsecdb.gehealthcare.com 1-14 CASE Revision C 2060290-201...
Page 29: Service Information
Refer equipment servicing to GE Healthcare authorized service personnel only. Any unauthorized attempt to repair equipment under warranty voids that warranty. It is the user's responsibility to report the need for service to GE Healthcare or to one of the authorized agents. Equipment Identification Every GE Healthcare device has a unique serial number for identification.
Page 30 Service Information 1-16 CASE Revision C 2060290-201...
Page 31: Equipment Overview
Equipment Overview Revision C CASE 2060290-201...
Page 32 For your notes CASE Revision C 2060290-201...
Page 33: Case System
CASE System CASE System Front View Monitor Function keypad Paper tray Console for PC keyboard and mouse Power button (non-breaking of AC power) Wheel locks Thermal writer USB drives (2) Acquisition module holder Revision C CASE 2060290-201...
Page 34: Rear View
CASE System Rear View Connector access panel Equipotential pin, power inlet with fuses, mains switch CASE Revision C 2060290-201...
Page 35: Putting The Case System Into Service
CASE System Putting the CASE System Into Service Connecting the System Components Warning Shock Hazard — Only technical staff is authorized to open the access panel. 1. Connect the cables to the system components and secure the connections with retaining screws. 2.
Page 36: Mains Connection, Power Up, Functional Test
CASE System Mains Connection, Power Up, Functional Test Note Before powering the system up, read the safety information in section “Safety Information” on page 1-4. Power inlet Mains power switch Potential equalization pin Cable clamp Back Panel 1. Connect CASE to the power line and secure the power cord with the clamp provided.
Page 37 CASE System Power button Side Panel 5. Turn on CASE with the power button on the side panel. The program will start up automatically and the Windows screen appears. 6. Log on to the system. 7. Double-click the CASE icon. 8.
Page 38: Switching The System Off
CASE System Switching the System Off Exit the CASE program: 1. Click Quit program. 2. Confirm the displayed message by clicking Yes: The system will automatically shut down. 087A Warning Loss of Data — Improper shutdown of the CASE system, e.g., turning the system off with the mains power switch before all programs are closed, may damage the databases.
Page 39: Function Keypad
Function Keypad Function Keypad The function keypad contains the keys necessary to operate the ergometer/treadmill, to control the exercise test and print reports. Following is a brief explanation of the key functions. For details on conducting an exercise test with the keypad, please refer to section “Before the Test”...
Page 40 Function Keypad Symbol Description Press hold stage to maintain the current stage (automatic stage sequencing is stopped). Press again to turn off stage hold. Press new test to prepare the system for a new patient/a new test. Press comment to enable entry of additional information and values for the user-defined columns of the tabular summary (see “Configuring the Tabular Summary”...
Page 41 Function Keypad Symbol Description Press 12SL analysis to initiate a 12SL report (includes measurement report and interpretation - only available during pretest and recovery phases). Press arrhy doc to enable or disable automatic arrhythmia reporting (a one-page arrhythmia report is printed on the thermal writer on occurrence of an arrhythmia).
Page 42: Desk Light
Desk Light Desk Light The CASE exercise testing system work surface and function keypad are both equipped with lighting. Press the button to turn the lighting on and off. Note The desk light turns off automatically after approximately one hour of keypad inactivity.
Page 43 Preparing the Acquisition Module Caution Proper Leadwire Connection — Improper connection will cause inaccuracies in the ECG. Trace each individual leadwire from its acquisition module label to the colored connector and then to the proper electrode to ensure that it is matched to the correct label location.
Page 44: Loading Writer Paper
Loading Writer Paper Loading Writer Paper Note A stripe appears on the writer paper when only 20 feet (7 m) of paper are left. 1. Push the release lever to the right to open the paper compartment lid. Caution The lid has a gas spring and opens automatically. 063A 2.
Page 45 Loading Writer Paper 065A 4. Hold the protruding paper sheet with your right hand and close the lid with your left hand: you must hear the lid lock into place. Then the paper will be transported to the next cue hole. 066A 5.
Page 46: Initial Screen
Initial Screen Initial Screen New Test - Click to start a new test. Local Database - Click to display the contents of the local database for selection of a patient and test. Archived Data - Click to view patient records archived on a CD-ROM. MUSE Browser - Click to display the MUSE system database.
Page 47: Viewing And Printing The Operator's Manual
Viewing and Printing the Operator's Manual labels and icons, or right-click any button to toggle between text labels and icons. Viewing and Printing the Operator's Manual The CASE operator's manual is available on the system. Click Operator's Manual on the initial screen to display the document. The system will load the Acrobat Reader program and display the title page of the operator's manual.
Page 48: Software Options
Software Options Software Options Many features are available as options which can be unlocked to enhance the CASE functionality. Following is a list of these optional features. For details, please contact your Sales Representative. RESI (Resting ECG Interpretation) interpretation of the measured resting ECG with detailed ...
Page 49 Software Options 2DWF (2D Waterfall Display) waterfall display during exercise tests and in exercise test report  BRWS (MUSE Browser) Internet browser for access to the MUSE system  RISK (Risk Factors) calculation of coronary heart disease and stroke risk factors ...
Page 50 Software Options 15-lead exercise test  ECGH (ECG History) display of the median beats from up to 5 selected resting ECGs  for comparison or printout 3D presentation of the median beat for serial comparison  XEMR (EMR Interface) software package for communication with the EMR interface ...
Page 51: Preparing The Patient
Preparing the Patient Revision C CASE 2060290-201...
Page 52 For your notes CASE Revision C 2060290-201...
Page 53: Applying Electrodes - The Basics
(see “Preparing the Patient's Skin” on page 3-4). For resting ECGs, use GE Healthcare’s electrode application system. Use only the GE Healthcare-recommended electrodes and contact agents. The signal acquisition screen will show the applied electrodes and the signal quality after the right-arm electrode has been applied.
Page 54: Preparing The Patient's Skin
Preparing the Patient's Skin Preparing the Patient's Skin 1. Shave any hair from each electrode site and degrease each site with alcohol. 2. Remove the epidermal skin layer at each site. Use an abrasive pad or skin prep cream (for example, EPICONT, Part no. 217 083 12). CAUTION Skin Lesions —...
Page 55: Applying Electrodes
Applying Electrodes Applying Electrodes Lead Labels on the Acquisition Module CAM-14 AHA Label IEC Label CAUTION Proper Leadwire Connection — Improper connection will cause inaccuracies in the ECG. Trace each individual leadwire from its acquisition module label to the colored connector and then to the proper electrode to ensure that it is matched to the correct label location.
Page 56: Standard 12 Lead Electrode Placement
Applying Electrodes Standard 12 Lead Electrode Placement AHA Label IEC Label Electrode Placement V1 red C1 red Fourth intercostal space at the right sternal border. V2 yellow C2 yellow Fourth intercostal space at the left sternal border. V3 green C3 green Midway between sites B and D.
Page 57: Standard 15 Lead Electrode Placement
Applying Electrodes Standard 15 Lead Electrode Placement Standard leads + right, recommended for pediatric ECGs. AHA Label IEC Label Electrode Placement V1 red C1 red Fourth intercostal space at the right sternal border. V2 yellow C2 yellow Fourth intercostal space at the left sternal border. V3 green C3 green Midway between sites B and D.
Page 58: Mason-Likar Lead Electrode Placement
Applying Electrodes MASON-LIKAR Lead Electrode Placement (Modified Standard Leads for Exercise Tests) AHA Label IEC Label Electrode Placement A V1 red C1 red Fourth intercostal space at the right sternal border. B V2 yellow C2 yellow Fourth intercostal space at the left sternal border. C V3 green C3 green Midway between sites B and D.
Page 59: Frank X, Y, Z Lead Electrode Placement
Applying Electrodes FRANK X, Y, Z Lead Electrode Placement To record the orthogonal FRANK leads X, Y, and Z, apply electrodes G (A3), B (A2), J (A4) and I (A1) in addition to the standard lead electrodes. AHA Label IEC Label Electrode Placement LA black L yellow...
Page 60: Nehb Lead Electrode Placement
Applying Electrodes NEHB Lead Electrode Placement For acquisition of the NEHB leads electrodes A/A1 and B/A2 must be applied in addition to the standard lead electrodes (C equals V4/C4). AHA Label IEC Label Electrode Placement A/A1 A1 orange Nst white Attachment point of 2nd rib to right sternal edge.
Page 61: Cm5, Cc5, Ml (Cml) Auxiliary Lead Electrode Placement
Applying Electrodes CM5, CC5, ML (CML) Auxiliary Lead Electrode Placement In addition to the standard electrodes, apply one electrode on the sternum (A1) and one in location V5R/C5R (A2). Electrode Electrode Placement A1 (Nst) Mid-sternum at the second intercostal space. A2 (Nax) In the fifth intercostal space in the right, anterior axillary line (V5F/ C5R).
Page 62: Cm5, Cc5, Ch (Cmh) Auxiliary Lead Electrode Placement
Applying Electrodes CM5, CC5, CH (CMH) Auxiliary Lead Electrode Placement In addition to the standard electrodes, apply one electrode on the sternum (A1), one in location V5R/C5R (A2) and one on the neck (A3). Electrode Electrode Placement Mid-sternum at the second intercostal space. In the fifth intercostal space in the right, anterior axillary line (V5F/ C5R).
Page 63: Attaching The Acquisition Module
Attaching the Acquisition Module Attaching the Acquisition Module Attach the acquisition module to the patient as shown above. Open the buckle to loosen the belt. Note The functions of buttons 1 and 2 on the acquisition module vary with the test performed: Resting ECG: Button 1: initiates ECG analysis Button 2: initiates a rhythm report...
Page 64 Attaching the Acquisition Module For your notes 3-14 CASE Revision C 2060290-201...
Page 65: Selecting A Patient Record And Test Type
Selecting a Patient Record and Test Type Revision C CASE 2060290-201...
Page 66 For your notes CASE Revision C 2060290-201...
Page 67: Selecting A Patient Record From The Local Database
Selecting a Patient Record from the Local Database Selecting a Patient Record from the Local Database Overview 048A Note Before running a new test, you are required to select a patient record from the database or to enter a new patient. Depending on the system configuration you will be working with the local database of the system or with the database of the MUSE system.
Page 68: Selecting A Patient Record
Selecting a Patient Record from the Local Database Selecting a Patient Record 048A 1. Enter the patient's last name or the patient ID to find a particular patient. It is sufficient to enter the first letters or numbers. 2. Select the test type. 3.
Page 69: Retrieving A Patient Record From The Muse System Database
Retrieving a Patient Record from the MUSE System Database Retrieving a Patient Record from the MUSE System Database When you click New Test on the initial screen, the patient selection window will appear. Patient record and test type are basically selected in the same way as from the local database (see previous page).
Page 70: Orders From The Muse System
Retrieving a Patient Record from the MUSE System Database Orders from the MUSE System The Order List button allows you to view a list of orders for the previously selected patient. If a patient was not selected, you will see the requested orders for all patients.
Page 71: Entering A New Patient
Entering a New Patient Entering a New Patient 048A 1. Click New Patient. 2. Enter the patient’s Last Name. Press the Tab key after each entry to move to the next text box. 3. Enter the patient’s first name 4. Enter the Patient ID. a.
Page 72: Patient Records Of External Programs
The system only supports the GE Healthcare Holter ECG program MARS PC as well as ndd’s external spirometry test program EasyWare. Note GE Healthcare is not in a position to guarantee full compatibility of external programs with CASE. In conjunction with external programs, the patient record is always maintained in CASE while the external program handles the test data.
Page 73: Resting Ecg
Resting ECG Revision C CASE 2060290-201...
Page 74 For your notes CASE Revision C 2060290-201...
Page 75: Entering Test Information
Entering Test Information Entering Test Information Overview Depending on your system configuration, the Test Information window will open automatically or you can display it with the Test Information button. These are the tabs of the menu Patient Information  Test/Personnel ...
Page 76: Test/Personnel Tab
Entering Test Information Test/Personnel Tab 052A-R 1. Click the Test/Personnel tab. 2. Type the relevant information in the Medical History field. 3. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 4. Type the physicians' and technician's names or select them from the list boxes.
Page 77: Medications Tab
Entering Test Information Medications Tab 053A-R 1. Click the Medications tab. 2. Enter or choose a maximum of 5 medications. 3. Enter the medication dose. Note You can assign drugs to specific medication groups (see section “Editing Medication Groups, Assigning Drug Names” on page 12-6).
Page 78: Recording A Resting Ecg
Recording a Resting ECG Recording a Resting ECG Overview In the upper part of the screen you see the lead check information for verification of the ECG signal quality. All 12 or 15 leads are shown. The schematic lead check torso allows you to verify the applied electrodes. The actual waveform data appears in the area below.
Page 79: 10-Second Ecg With Analysis
Recording a Resting ECG Click to start acquisition of the full disclosure ECG. Click to terminate acquisition of the full disclosure ECG and/or to end the test and display the report. Click to load system setups stored for different system users (see section “Custom Setups, Factory Setup”...
Page 80: Operating Steps
Recording a Resting ECG Operating Steps 054A-R 1. Enter the Test Information or verify the data. 2. Click ECG Acquisition to initiate acquisition and analysis of the 10- second ECG. Note When you select ECG Acquisition before the system had time to save 10 seconds of ECG data, a bar graph will inform you of the ongoing storage process.
Page 81 Recording a Resting ECG 055A-R 3. Check the 10-second ECG and data. 4. Select a different screen format, if necessary. 5. Display the Interpretation and check the system evaluation and ECG measurement results. 6. If necessary, repeat the procedure with ECG Acquisition. 7.
Page 82: Full Disclosure Ecg
Recording a Resting ECG Full Disclosure ECG You can acquire the full disclosure ECG over a maximum period of 60 minutes. Operating Steps 056A-R 1. Click Start Full Disclosure ECG to initiate ECG storage. 2. While the full disclosure ECG is acquired: a.
Page 83: Post Test Review
Post Test Review Post Test Review Test Summary 057A-R Click a tab to display the corresponding window. Patient Information area. Test Information area. Measurement Results area. Interpretation area. Click to display patient list for a new test. Click to display a list with more tests of the current patient (local database).
Page 84 Post Test Review Click to return to the initial screen. The Modify... buttons allow you to edit or complete the data in the respective areas. Patient Information: The Patient Information window opens.  Test Information: The Test Information window opens. ...
Page 85: Ecg Traces
Post Test Review ECG Traces On this screen you see the reference ECG. Depending on the selected screen format and speed, the waveforms may take up several screens. 058A-R Click to select the screen format: With you scroll through the formats, with you open the list.
Page 86: Zoom Mode
Post Test Review Zoom Mode A zoom factor from 2 to 12 can be selected and the selected segment can be displayed in all leads. 059A-R Click to select the lead: With you scroll through the leads, with you open the list. Click icon to terminate the zoom function.
Page 87: Measuring The Ecg
Post Test Review Measuring the ECG Amplitudes (mV), intervals (ms) and slopes (mV/s) can be measured on all ECG waveforms. 510A-R 1. Position the cursor on the first measurement point and click. A caliper appears. 2. Position the cursor on the second measurement point and click. Now you will see the second caliper ...
Page 88: Medians
Post Test Review Medians This screen shows the median complexes of all leads as well as the measurement marks that formed the basis for analysis. You are free to perform additional measurements, if needed. 511A-R Click button for a reanalysis (with the HEART ECG analysis program only, see next page).
Page 89: Reanalysis
Post Test Review Reanalysis Reanalysis allows you to manually change the position of the ST measurement marks. The reanalysis can only be performed on ECGs analyzed with the HEART program (see section “Miscellaneous Tab” page 12-8). On the reanalysis screen the medians of all leads are superimposed. The currently selected lead is highlighted.
Page 90: Performing Reanalysis
Post Test Review Measurement mark. Menu for selection of the leads to be displayed. Table showing time intervals and position of the cursor in mV. Performing Reanalysis 1. Click the measurement mark and hold the mouse button depressed. 2. Move the measurement mark to its new position and release the mouse button.
Page 91 Post Test Review Adjusting the T-offset Mark 1. Select the check box. The medians of all leads, except the selected lead, disappear. 2. Holding the mouse button depressed, move the T-offset mark to the correct position. 3. Click icon to select the leads whose T-offset marks you also wish to adjust.
Page 92: Arrhythmia Review
Post Test Review Arrhythmia Review This screen shows one lead of the reference ECG at a time. A bar diagram below the signal trace indicates, for each individual QRS complex, the deviation of the RR interval from the mean RR interval. Furthermore, you can determine the HR over a selectable ECG segment.
Page 93: Determining The Heart Rate
Post Test Review Determining the Heart Rate In a normal ECG: 1. Click on a point of the ECG to mark the beginning of the interval to be measured. A marker appears. 2. Click on the end of the interval. A line appears connecting the two end points and the corresponding heart rate is displayed.
Page 94: Vector Loops
Post Test Review Vector Loops This screen shows the median complexes of the orthogonal FRANK leads X, Y and Z as well as the vector loops in three planes. 515A-R Click to adjust the gain. Median complex. Click torso to toggle between right and left sagittal planes. 5-22 CASE Revision C...
Page 95: Full Disclosure Ecg
Post Test Review Full Disclosure ECG On this screen you see one lead of the full disclosure ECG. The events identified by the rhythm analysis algorithm are color-coded. On the display you will also see when filter or cubic spline were enabled or disabled, e.g.
Page 96: Printing The Full Disclosure Ecg
Post Test Review Printing the Full Disclosure ECG You can either print the entire full disclosure ECG or a selected segment. Selecting an ECG Segment 1. Click to mark the beginning of the segment. A flag appears. 2. Click again to mark the end of the segment. A second flag appears. Printing 1.
Page 97: Analyzing Full Disclosure Ecg Segments, Save As Resting Ecgs
Post Test Review Analyzing Full Disclosure ECG Segments, Save as Resting ECGs You can select a segment in the full disclosure ECG and save this segment as an additional resting ECG in the procedure list. 1. Click the zoom icon. 2.
Page 98: Report Printout
Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Final Report Tab” on page 12-9 for details on changing the setup permanently.
Page 99: Generating The Interpretation
Post Test Review Generating the Interpretation Click Interpretation/Modify to open the window. In the left part of the window you see a number of folders with standard interpretation texts. With the Acronyms... button you can open an acronym window. The actual interpretation is generated in the right part of the window.
Page 100: Copying Diagnostic Statements Using Acronyms
Post Test Review Copying Diagnostic Statements Using Acronyms 1. Click Acronyms... to open the window. 2. Type the acronym. 3. Click Insert>> to copy the corresponding full text to the Interpretation. Note As an alternative you can double-click a text to copy it from left to right.
Page 101: Comparing Resting Ecgs
Post Test Review Comparing Resting ECGs You can compare the following details of two resting ECGs: the 10-second ECG  the median complexes and  the interpretation  It is also possible to compare the medians of at least 3 and up to 6 ECGs. Comparing Two Resting ECGs The system offers two alternatives: you can compare the present ECG with an earlier recording or you can retrieve a stored examination, as...
Page 102 Post Test Review 10-Second ECG 519A-R Click to select the lead: With you scroll through the leads, with you open the list. Click tabs to compare the Medians and the Interpretation. Acquisition date and time. Click icon to activate the zoom function. Click icon to copy the waveform area to the Clipboard.
Page 103 Post Test Review Zoom Mode – Follow these steps to enable the zoom mode: 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. Identical segments of the two procedures are superimposed. With the scroll boxes you can shift the segment of procedure 2 horizontally and vertically.
Page 104 Post Test Review Medians Click the Medians tab to display the screen for comparison of the two median complexes. The scroll boxes also allow you to move the median of procedure 2 up and down and to the right and left. Interpretation Click the Interpretation tab to display the screen for comparison of the two interpretations.
Page 105: Comparing Median Complexes From Multiple Resting Ecgs
Post Test Review Comparing Median Complexes from Multiple Resting ECGs It is possible to compare the medians of at least 3 and up to 6 ECGs. Note Software option ECGH is required for use of this functionality. 1. Click Compare. A window opens listing all the patient's resting ECGs.
Page 106 Post Test Review Zoom Mode Follow these steps to enable the zoom mode: 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. The selected median is displayed at a larger scale. 523A-R Acquisition date.
Page 107 Post Test Review 3D Graph Click the 3D graph button to display a three-dimensional representation of the medians from all selected procedures. The scroll boxes allow you to rotate the illustration horizontally and vertically. 524A-R Click to select the lead. Click icon to terminate the zoom function.
Page 108 Post Test Review For your notes 5-36 CASE Revision C 2060290-201...
Page 109: Exercise Test
Exercise Test Revision C CASE 2060290-201...
Page 110 For your notes CASE Revision C 2060290-201...
Page 111: Patient Education
Patient Education Patient Education Before the test you should give your patient some information about what will happen in the course of the test. Click the Patient Education button on the pre-acquisition screen to display a description of what the patient can expect to happen before, during, and after the exercise test.
Page 112: Entering Test Information
Entering Test Information Entering Test Information Overview Depending on your system configuration, the Test Information window will open automatically or you can display it with the Test Information button. These are the tabs of the menu Patient Information  Test/Personnel ...
Page 113 Entering Test Information “MUSE Tab” on page 12-55). 7. Enable or disable TWA analysis. Note The Patient Information can be assigned to the patient file or only to the pending test. Note Before initiating TWA analysis check that all TWA settings are correct (see “TWA Tab”...
Page 114: Test/Personnel Tab
Entering Test Information Test/Personnel Tab 052A-S 1. Click the Test/Personnel tab. 2. Type the relevant information in the Medical History field. 3. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 4. Select the Test Type. 5.
Page 115: Medications Tab
Entering Test Information Medications Tab 053A-S 1. Click the Medications tab. 2. Enter or choose a maximum of 10 medications. 3. Enter the medication dose. Note You can edit the libraries (see section “Editing the Comments, Test Types, Reason for Test, Reasons for Termination, Medications Library”...
Page 116 Entering Test Information The system automates the manual calculation of risk. You can edit the values calculated by the system. Edited values are marked with an asteriks *. 1. Click the AHA Stroke Risk or the AHA CHD Risk tab. 2.
Page 117: Before The Test
Before the Test Before the Test Pre-Acquisition Screen Overview In the upper part of the screen you see the lead check information for verification of the ECG signal quality. All 12 or 15 leads are shown. The schematic lead check torso allows you to verify the applied electrodes. The actual waveform data appears in the area below.
Page 118 Before the Test Click to select previous tests of the current patient. Click to display Patient Education. Click to select an exercise test protocol. A new protocol will become effective in the next phase. Click to relearn the median complex. With Relearn Medians you can also restart the learn phase when not all electrodes are applied.
Page 119 Before the Test Note Pacemaker Patients — It is very important that you indicate on the first database screen, pictured below, whether your patient has a PACEMAKER implanted. A check indicates that the patient DOES have a pacemaker. We recommend the following filter setting for exercise tests: FRF ON ...
Page 120: Operating Steps
Before the Test Operating Steps 1. Check the applied electrodes and verify the signal quality in all leads. ST measurements and arrhythmia analysis will automatically be displayed when all necessary electrodes have been applied and signals of adequate quality are obtained (e.g. without major baseline fluctuations).
Page 121: During The Test
During the Test During the Test Acquisition Screen Overview 57A-S Note The acquisition screen has the same type of information in the pretest, exercise and recovery phases. ST/Arrhy window (see section “ST/Arrhy Window” on page 6-18 for details). Tabs to display windows with ECG test data (see “ST/Arrhy Window”...
Page 122 During the Test Selected protocol, exercise clock - starts with the exercise phase and indicates its duration. Current phase, phase clock - each new phase (pretest, exercise, recovery) resets the clock to zero. Current stage, stage clock - restarts with each new stage. Treadmill: belt speed and grade bicycle ergometer: pedal speed (RPM) and load METS (metabolic equivalents) see...
Page 123: Pretest Phase
During the Test Pretest Phase Overview The pretest phase might consist of stages configured in each protocol. Commonly used stages are: Supine  Standing  Hyperventilation  Warm-up  Blood pressure measurements can be taken manually or automatically as configured in the Protocol Editor. When manual entry is configured, the window for entry of BP values will appear automatically (see section “Protocol Editor Tab”...
Page 124: Exercise Phase
During the Test Exercise Phase Overview The selected protocol will control the treadmill or bicycle ergometer. When you enter the exercise phase: the belt speed and grade or the bicycle load will change according to  the selected protocol the exercise clock will start (phase and stage clocks restart at zero), ...
Page 125: Manual Control
During the Test Manual Control Press to enter comments to appear in the Tabular Summary. comment Press to enter BP readings. enter BP Press to start an ECG recording (12 leads, 5 seconds from memory, 5 12 lead seconds of real-time data). recall Press to print a 10-second delayed recall report on the thermal writer.
Page 126: Ecg Data Windows
During the Test ECG Data Windows ST/Arrhy Window The ST/Arrhy window displays the median complex (left) and the current arrhythmias (right). As soon as the exercise phase begins, the current median complex is superimposed on the baseline complex and both measurements are displayed. The system chooses the two leads with the greatest amplitude for arrhythmia analysis (click E to select another lead).
Page 127 During the Test Editor (see section “Protocol Editor Tab” on page 12-19). 59A-S Click the tab to display the Medians window. Click option button to select different lead groups (see “Screen Tab” on page 12- 13 for information on how to assign the leads to the groups). Click Superimposition to display the median complexes of the selected group superimposed (click again to restore normal presentation).
Page 128: Waterfall Window
During the Test Waterfall Window This window displays a graphic color representation of the median beat changes in the course of the test (updated at 30 second intervals). Click anywhere in the waterfall to display the median complex and measurement of the corresponding point in time (associated phase, stage, HR, BP, and METS appear at the right).
Page 129: Tabular Summary Window
During the Test Tabular Summary Window The Tabular Summary window displays test data in two tabular formats: stage format: 1 line per stage, or  detailed format: 1 line minimum per 30 seconds  The Tabular Summary can be configured. See “Configuring the Tabular Summary”...
Page 130: Mets Formula (Metabolic Equivalents)
During the Test METS Formula (Metabolic Equivalents) Treadmill (speed x 26.8 x 0.1) + (grade/100 x 1.8 x speed x 26.8) + 3.5 METS = speed = miles per hour grade = percent (speed x 0.1) + (grade/100 x 1.8 x speed) + 3.5 METS = speed = meters per minute grade = percent...
Page 131: Trends Window
During the Test Trends Window The Trends window displays graphic trends of different parameters. The trends are updated in 30 second intervals. 62A-S Click the tab to display the Trends window. Click an option button to display other trend formats. Click Custom to display user configured trends.
Page 132: Ecg Strips Window
During the Test ECG Strips Window The ECG Strips window displays 10-second ECG strips stored during the last 10 seconds of each stage  acquired manually, or  acquired automatically as configured (see section “Protocol Editor  Screen” on page 12-20). 63A-S Click the tab to display the ECG Strips window.
Page 133: 12Sl Window
During the Test 12SL Window The 12SL window displays the 12SL resting ECG measurements and interpretation acquired by pressing 12SL during preacquisition, pretest and recovery. 64A-S 65A-S Click the tab to display the 12SL window. Click button to display the interpretation. Click to select the recording.
Page 134: Interpretation Window
During the Test Interpretation Window The Interpretation window allows the physician to enter an interpretation of the test. 66A-S 67A-S Click the tab to display the Interpretation window. Click to enter or edit the interpretation. Enter or select summary statements for the different interpretation categories and for the Overall Impression.
Page 135: Comparing Previous Test Data
During the Test Comparing Previous Test Data At any point in the test you can compare the current data with that of a previous test: 1. Click Previous Tests Current Patient. 2. Double-click the test to review: Page 1 of the median complexes will appear in the lower part of the screen for reference.
Page 136: Recovery Phase
Recovery Phase Recovery Phase Overview Press the recovery button to advance to the recovery phase. The clock begins timing the recovery phase. In recovery, the treadmill speed and grade or the bicycle load will change according to the protocol configuration. 6-28 CASE Revision C...
Page 137: Test End Phase
Test End Phase Test End Phase Overview 1. Press the test end button to end the test and start the test end phase. 2. Click Yes to confirm the test end. The Interpretation window appears with the patient's ECG waveforms below. Note After you press the test end button, the following happens: The system no longer acquires and stores ECG measurement...
Page 138 Test End Phase 69A-S Note Real-time reports can be printed with the following buttons on the function keypad: 12 lead medians rhythm recall (data is not saved). 8. Click the test end menu tabs to review and edit the data. 9.
Page 139: After The Test - Post Test Review
After the Test — Post Test Review After the Test — Post Test Review Test Summary Overview 70A-S Click a tab to display the corresponding window. Patient Information area. Test Information area. Measurement Results area: area for exercise measurements and machine “Exercise Test Interpretation (XTI)”.
Page 140 After the Test — Post Test Review Click to display the interpretation window where a detailed interpretation of the test can be generated. Click to activate the online Help program. Click to return to the initial screen. The Modify... buttons allow you to edit or complete the data in the respective areas.
Page 141: Tabular Summary
After the Test — Post Test Review Tabular Summary The Tabular Summary window displays test data in three tabular formats: stage format: 1 line per stage, or  detailed format: 1 line minimum per 30 seconds  all entries  The Tabular Summary can be configured.
Page 142 After the Test — Post Test Review value, can be changed, see section “Miscellaneous 1 Tab” on page 12-24). 6-34 CASE Revision C 2060290-201...
Page 143: Graphic Trends
After the Test — Post Test Review Graphic Trends Overview 72A-S Click to display the graphic trends. Click to display other leads of the trends (not available on all screens). backward forward Click icon to display the trend configuration window. Click to jump to a separate full disclosure ECG window.
Page 144: Viewing The Full Disclosure Ecg
After the Test — Post Test Review Viewing the Full Disclosure ECG By selecting the Full disclosure option on the trend screen, you can view the full disclosure ECG. The operating controls in the full disclosure window are explained in section “Full Disclosure ECG”...
Page 145: Viewing Medians, Replacing Max. St Changes
After the Test — Post Test Review Viewing Medians, Replacing max. ST Changes 1. Locate the ST value in the trend graph of interest and click: a new window with the corresponding median complex will open. 2. Click on the ST value in the median complex window: a new window with the new and old ST values appears.
Page 146: Viewing Twa Medians, Replacing Max. Twa Values
After the Test — Post Test Review Viewing TWA Medians, Replacing max. TWA Values 1. Locate the TWA value in the trend graph of interest and click. 2. A new window with the corresponding median complexes will open. 3. Click on the TWA value in the median complex window: a new window with the new and old TWA values appears.
Page 147: Sample Cardiac Cycles
After the Test — Post Test Review Sample Cardiac Cycles Overview This screen shows the median complexes collected at each stage, beginning with the pretest phase. 73A-S Note Reanalyze the sample cardiac cycles as described under “Reanalysis” on page 6-41. Click the lead label to change the displayed leads.
Page 148 After the Test — Post Test Review Click icon to activate the zoom and reanalysis function (see next page). Click Reset to original to discard the results of the reanalysis and return to the original measurements. 6-40 CASE Revision C 2060290-201...
Page 149: Reanalysis
After the Test — Post Test Review Reanalysis Reanalysis allows you to manually change the position of the ST measurement marks. On the reanalysis screen the medians of all leads are superimposed. The currently selected lead is highlighted. The measurement marks determined by the system are indicated. The marks above the baseline can be edited.
Page 150: Performing Reanalysis
After the Test — Post Test Review Performing Reanalysis 1. Click a measurement mark above the baseline and hold the mouse button depressed. 2. Move the mark to its new position and release the mouse button. 3. Adjust the other marks in the same way. 4.
Page 151: Sample Twa Cycles
After the Test — Post Test Review Sample TWA Cycles Overview This screen shows the Sample TWA Cycles. Questionable values are identified with a question mark ?. Two-headed arrows identify the position where the TWA value was determined. Individual leads can be excluded.
Page 152: Ecg Strips
After the Test — Post Test Review ECG Strips This screen displays 10-second ECG strips stored during the last 10 seconds of each stage  acquired manually, or  acquired automatically as configured in the Protocol Editor.  75A-S Details of the selected ECG strip. Click to display the ECG Strips window.
Page 153: Arrhythmia Review
After the Test — Post Test Review Arrhythmia Review The system will save a 10-second ECG strip each time an arrhythmia occurs and when the Event Marker Full Disclosure button is clicked on the acquisition screen (to a maximum of 20). When the event memory is full, the strips will be overwritten according to preset priorities.
Page 154 After the Test — Post Test Review Arrhythmias (descending priority) - patient's learned typical QRS complex QRSL ASYSTO - asystole , limit value 3 s VFIB - ventricular fibrillation/flutter VTAC - ventricular tachycardia - ventricular run (minimum of 3 consecutive PVCs) CPLT - ventricular couplet (2 consecutive PVCs) - atrial fibrillation...
Page 155: Full Disclosure Ecg
After the Test — Post Test Review Full Disclosure ECG Overview The system will save the full disclosure ECG only if configured (see section “Miscellaneous 1 Tab” on page 12-24). On this screen you see one lead of the full disclosure ECG. The events identified by the rhythm analysis algorithm may be color-coded.
Page 156 After the Test — Post Test Review Click icon to activate the zoom function. Click icon to print the entire full disclosure ECG or selected segments. Click icon to go to the trend display. Click icon to delete the full disclosure ECG. Select the number of waveforms viewed.
Page 157: Printing The Full Disclosure Ecg
After the Test — Post Test Review Printing the Full Disclosure ECG You can either print the entire full disclosure ECG or a selected segment. Selecting an ECG Segment 1. Click to mark the beginning of the segment. A flag appears. 2.
Page 158: Enabling The Zoom Mode
After the Test — Post Test Review Enabling the Zoom Mode 1. Click the zoom icon. 2. Position the magnifying glass on the region of interest and click. An enlarged view of the selected region appears. The operating controls basically remain the same. When you click the printer icon, however, only that page will be printed.
Page 159: Audio Ecg
After the Test — Post Test Review Audio ECG The audio ECG allows the medical staff to assess the exercise test quickly and easily (playback not possible with CASE systems because CASE does not have the required output media). The ECG is played back at 60 times the original speed, so that you can listen to a 10-minute recording in 10 seconds.
Page 160: Waterfall
After the Test — Post Test Review Waterfall The Waterfall display is a graphic color representation of the median beat changes in the course of the test (updated at 30 second intervals). Click anywhere in the waterfall to display the median complex and measurement of the corresponding point in time (associated phase, stage, HR, BP, and METS appear at the right).
Page 161: 3D Graph
After the Test — Post Test Review 3D Graph 84A-S Click to select another lead. Click to rotate the display horizontally. Click to rotate the display vertically. Revision C CASE 6-53 2060290-201...
Page 162: 12Sl
After the Test — Post Test Review 12SL This screen shows the measurements from the 12SL ECG analysis. 80A-S Analysis results. Click to change the gain. Click to change the speed. Click to display the 12SL Report. Click to select another 12SL ECG. Click to view the corresponding Vector Loops (see next page).
Page 163: Vector Loops
After the Test — Post Test Review Vector Loops This screen shows the median complexes of the orthogonal FRANK leads X, Y and Z as well as the vector loops in three planes. 81A-S Median complex. Click torso to toggle between right and left sagittal planes. Click to change the gain.
Page 164: Report Printout
After the Test — Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Final Report Tab” on page 12-23 for details on changing the setup permanently.
Page 165 After the Test — Post Test Review Temporary changes to the selections will be lost when you close the window. Revision C CASE 6-57 2060290-201...
Page 166: Report Formats
Report Formats Report Formats In-Test Reports Format Description 12SL Interpretative resting ECG with analytical statements on morphology, rhythm, and conduction. Measurements of rate, intervals and axes. Available before the test, in pretest and recovery. Formats include: 4 x 2.5; 4 x 2.5 +1, 2 x 5; H2 (5 s ECG at a speed of 50 mm/s x 6) and H1 (6-lead ECG at 12.5 mm/s, Medians at 50 mm/s).
Page 167: Final Reports
Report Formats Final Reports Format Description Configured Report User-configured portrait-style final report. User formats narrative text and selects data fields to create report template. Configured Report automatically merges text and data according to templates selected. For details on the Configured Report, refer to section “Report Editor”...
Page 168: Monitoring Of Remote Exercise Test Workstations
Monitoring of Remote Exercise Test Workstations Monitoring of Remote Exercise Test Workstations The program allows you to monitor an exercise test performed at remote stations from your PC. However, only one station can be viewed by one other station at a time. The data in the vital signs window reflect the settings at the remote station.
Page 169 Monitoring of Remote Exercise Test Workstations Click to return to the initial screen. Name of the remote station. Click to change the gain. Click to change the speed. Revision C CASE 6-61 2060290-201...
Page 170 Monitoring of Remote Exercise Test Workstations For your notes 6-62 CASE Revision C 2060290-201...
Page 171: Ambulatory Blood Pressure Measurement
Ambulatory Blood Pressure Measurement Revision C CASE 2060290-201...
Page 172 For your notes CASE Revision C 2060290-201...
Page 173: Ambulatory Blood Pressure Monitors
Ambulatory Blood Pressure Monitors Ambulatory Blood Pressure Monitors The following ambulatory blood pressure monitors can be connected to the system: TONOPORT V: blood pressure only, oscillometric method  TONOPORT IVa: blood pressure, oscillometric and auscultatory  method, as well as ECG For information on setup and operation of the ambulatory blood pressure monitor, please refer to the TONOPORT Operator's Manual.
Page 174: Setting Up The Ambulatory Blood Pressure Monitor
Setting Up the Ambulatory Blood Pressure Monitor Setting Up the Ambulatory Blood Pressure Monitor Acquisition Screen 181A-BP Measurement protocol details. Click to connect the ambulatory blood pressure monitor to the system. Click to activate the programming mode. If a patient is selected first, TONOPORT V devices of version 2.0 and later will automatically copy that patient’s ID number from the CASE database.
Page 175: Operating Steps
Setting Up the Ambulatory Blood Pressure Monitor Operating Steps 1. Turn the monitor off and on again. 2. Wait for the time to be displayed, then connect the monitor to the PC. 3. Click Connect. The acquisition screen indicates the memory status of the ambulatory blood pressure monitor.
Page 176 Setting Up the Ambulatory Blood Pressure Monitor 6. Select the protocol and click Programming. You can choose between two protocols. Refer to section “Editing the BP Protocol” on page 12- 32 for information on configuring the protocols. Note If you are using TONOPORT V devices, version 2.0 and later, check the displayed patient data to avoid data mismatch.
Page 177: Post Test Review
Post Test Review Post Test Review Downloading Data 1. Turn the monitor off and on again. 2. Wait for the time to be displayed, then connect the monitor to the PC. 3. Select the patient. Note If the patient ID has been stored in TONOPORT V devices of version 2.0 and later, you are not required to select the patient.
Page 178: Test Summary
Post Test Review Test Summary 183A-BP Click a tab to display the corresponding window. Patient Information area. Test Information area. Measurement Results (Statistics Summary). Interpretation. Click to display patient list for a new test. Click to display a list with more tests of the current patient (local database).
Page 179: Patient Information
Post Test Review Patient Information The Patient Information window opens. You can edit or complete the data. Any changes you make will be assigned to this procedure, not to the patient. Note The Patient Information can be assigned to the patient file or only to the pending test.
Page 180 Post Test Review Test/Personnel 052A-R 1. Type the relevant information in the Medical History field. 2. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 3. Type the physicians' and technician's names or select them from the list boxes.
Page 181: Measurement Results
Post Test Review Medications 053A-R 1. Click the Medications tab. 2. Enter or choose a maximum of 5 medications. 3. Enter the medication dose. Note You can edit the medication library (see section “Editing the Reason for Test, Medication Library” on page 12-36).
Page 182: Generating Or Editing The Interpretation
Post Test Review Generating or Editing the Interpretation Click Interpretation or Modify... to open the window. In the left part of the window you see a number of folders with standard interpretation texts. The system supports the creation of an interpretation by providing standard texts which can be copied to the Interpretation area on the right.
Page 183: Graphics
Post Test Review Graphics The Graphics screen shows all BP values acquired over the monitoring period. The blood pressure values are shown at the top, the pulse pressure values (systolic pressure minus diastolic pressure) below. You can show or hide the pulse pressure values (see “Ambulatory Blood Pressure Measurement Setup”...
Page 184: Tabular Summary
Post Test Review Tabular Summary Note Individual measurements in the Tabular Summary can be suppressed by double-clicking or by clicking with the right mouse button; they can be restored in the same way. Suppressed measurement data are excluded from the statistical analysis. 188A-BP 7-14 CASE...
Page 185: Hourly Averages
Post Test Review Hourly Averages The diagram shows the Hourly Averages of all measurements taken during the monitoring period. Click Tabular to view the same values in tabular format. 189A-BP Revision C CASE 7-15 2060290-201...
Page 186: Statistics Summary
Post Test Review Statistics Summary The Statistics Summary shows one histogram each for the systolic values (left) and the diastolic values (right) as well as the frequency distribution given as a percentage. The table below indicates the maximum, minimum and mean values as well as the standard deviations.
Page 187: Report Printout
Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Miscellaneous Tab” on page 12-33 for details on changing the setup permanently.
Page 188 Post Test Review For your notes 7-18 CASE Revision C 2060290-201...
Page 189: Spirometry Test
Spirometry Test Revision C CASE 2060290-201...
Page 190 For your notes CASE Revision C 2060290-201...
Page 191: Sensors
Sensors Sensors SpiroSoft respiration flow sensor for FVC measurements  LF 501 respiration flow sensor for VC and FVC measurements  For information on setup and operation of the sensors, refer to the separate operator manuals. Check whether the system is set up for the correct sensor (see section “Devices Tab”...
Page 192: Entering Test Information
Entering Test Information Entering Test Information Overview Depending on your system configuration, the Test Information window will open automatically or you can display it with the Test Information button. These are the tabs of the menu Patient Information  Test/Personnel ...
Page 193: Test/Personnel Tab
Entering Test Information Test/Personnel Tab 52A-R 1. Click the Test/Personnel tab. 2. Type the relevant information in the Medical History field. 3. Enter the Reason for Test or select one from the list box. Multiple selections are permitted. 4. Type the physicians' and technician's names or select them from the list boxes.
Page 194: Medications
Entering Test Information Medications 53A-R 1. Click the Medications tab. 2. Enter or choose a maximum of 5 medications. 3. Enter the medication dose. Note You can edit the medication library (see section “Editing the Reason for Test, Medication Library” on page 12-36).
Page 195: Conducting Spirometry Tests
Conducting Spirometry Tests Conducting Spirometry Tests Overview We will explain a spirometry test with the SpiroSoft respiration flow sensor. The operating steps for spirometry tests with the LF 501 sensor follow next. The flow-volume loop is recorded in the spirometry test; all diagnostically relevant values for forced inspiration and expiration can be derived from the flow-volume loop (see section “Definition of Spirometry Test Values”...
Page 196 Conducting Spirometry Tests Note For flow-volume measurements, the patient's cooperation is  essential. The ambient conditions should be checked every day before  performing spirometry tests; the room temperature is the factor with the most impact on the test results (see section “Acquisition Tab”...
Page 197: Flow-Volume Measurement - Operating Steps
Conducting Spirometry Tests Click to start the test. Click to start the bronchodilator test. Click to terminate the test. Click for the post test review. Click to load system setups stored for different system users (see section “Custom Setups, Factory Setup” on page 12-38).
Page 198 Conducting Spirometry Tests 5. Wait for the status line to turn green. 6. Have the patient close the lips around the mouthpiece and perform the following maneuver through the sensor: a. Exhale completely. b. Slowly inhale completely. Exhale as vigorously and for as long as possible (forced expiratory parameters;...
Page 199 Conducting Spirometry Tests The flow-volume loop of the current test and of the best test are displayed. The table shows the measuring values (Act.), the reference values and the percentage deviation of the current test. 202A-SP Click option button to display the volume-time curve. FEV1 value.
Page 200: Bronchodilator Test
Conducting Spirometry Tests Bronchodilator Test The bronchodilator test always consists of two measurements: one before and one after medication. After medication, measure the dilatation as follows: 1. Click Start Bronchodilator Test to start the measurement. 2. The system asks whether the previous measurement is to be the pre- dilation test (Before Bronchodilation test);...
Page 201 Conducting Spirometry Tests FVC Measurement 1. On the acquisition screen click FVC Measure.. 2. Explain the test maneuver to the patient. 3. Check the nose clip. 4. Click Start Test and ask your patient to perform the following maneuver when the orange indicator on the sensor lights up: Inhale completely through the sensor.
Page 202: Post Test Review
Post Test Review Post Test Review Test Summary 203A-SP Click tab to display the flow-volume loop and tabular data. Patient Information area. Test Information area. Measurement Results area. Interpretation. Select to display and print the system evaluation, or deselect Click to display patient list for a new test. Click to display a list with more tests of the current patient (local database).
Page 203: Patient Information
Post Test Review Click to return to the initial screen. The Modify... buttons allow you to edit or complete the data in the respective areas, as described below: Patient Information The Patient Information window opens. You can only enter or correct data that does not affect the calculation of reference values.
Page 204: Generating Or Editing The Interpretation
Post Test Review Generating or Editing the Interpretation At the end of the test the system evaluation is automatically entered in the interpretation window. Click Interpretation or Modify... to open the window. In the left part of the window you see a number of folders with standard interpretation texts.
Page 205: Report Printout
Post Test Review Report Printout Click the Print button to print the report. The print setup window opens where you can temporarily adjust the settings for the printout. Refer to section “Miscellaneous Tab” on page 12-36 for details on changing the setup permanently.
Page 206: Comparing Two Spirograms
Post Test Review Comparing Two Spirograms You can compare the present spirogram with another one of the same patient recorded earlier. 1. Click Compare. A window opens listing all the patient's spirograms. 2. Select a test. 3. Click OK to clear the window. 204A-SP Data relating to test 1 (reference test, test selected first).
Page 207 Post Test Review Click Spirometry/Compare/FVC Measurement to display the comparison screen with the flow-volume loop. The screen shows the two curves and the percentage deviation from the reference values or the percentage of the reference values attained. 209A-SP Click option button to display the volume-time curve. Change the tabular display from % of ref.
Page 208 Post Test Review For your notes 8-20 CASE Revision C 2060290-201...
Page 209: File Management
File Management Revision C CASE 2060290-201...
Page 210 For your notes CASE Revision C 2060290-201...
Page 211: Overview
Overview Overview All patient records are saved to the local database. The patient records can be viewed, edited, printed  exported to another storage medium  transferred to the MUSE database system or  deleted  Click Local Database to open the window with the names of all stored patients.
Page 212: Selecting Patient Records
Selecting Patient Records Selecting Patient Records 101A Selected patient (only this patient's records are shown). Click button to update the current list according to the selection criteria. Click down arrow to open the list box with the option all (i.e., all records stored in the database will be shown).
Page 213 Selecting Patient Records Click button to save the selected patient record(s) to an external backup device. Click button to transfer the selected patient record(s) to the MUSE database system. Click button to send the selected patient record(s) via modem or to save it to another directory.
Page 214: Viewing, Editing, Printing Patient Records
Viewing, Editing, Printing Patient Records Viewing, Editing, Printing Patient Records Click View. The Test Summary will appear first. You can edit the information. Changes are saved automatically to the local database when you exit the screen. To print the displayed patient record, click the Print button.
Page 215: Viewing And Printing Patient Records From The Muse System
Viewing, Editing, Printing Patient Records Viewing and Printing Patient Records from the MUSE System 1. Click the MUSE Browser button on the initial screen. 2. Enter the MUSE password, if prompted. The MUSE web page will appear. 3. Select Display with Frame or Display without Frame. 4.
Page 216: Archiving, Exporting, Deleting Patient Records
Archiving, Exporting, Deleting Patient Records Archiving, Exporting, Deleting Patient Records First select the patient record(s). To select a series of consecutive records, hold down the Shift key and  click the first and last file name of the series. To select individual records, hold down the key and click on each Ctrl ...
Page 217: Transfer To Muse
Archiving, Exporting, Deleting Patient Records Transfer to MUSE To transfer the patient record(s) to a MUSE system, click the Transfer to MUSE button. Note This button is enabled only if the data transfer to the MUSE system has been enabled on the MUSE tab (see section “MUSE Tab”...
Page 218: Export
Archiving, Exporting, Deleting Patient Records Export Click the Export button to export patient record(s) using different file formats. B C D 102A Select option button to export data as a PDF file. Select option button to export data as a Microsoft Word file. Select option button to export the attached documents (ergospirometry).
Page 219 Archiving, Exporting, Deleting Patient Records Settings 102A Select the data to export as XML/Excel files. Select check box if you wish to use the settings from the Final Report tab (see “Final Report Tab” on page 12-9 and “Final Report Tab” on page 12-23).
Page 220: Working Temporarily With The Local Database
Working Temporarily with the Local Database Working Temporarily with the Local Database Note This feature is not available if one of the following options is enabled: DICOM option (DICM)  EMR option (XEMR)  Request MUSE data  Floating License ...
Page 221 Working Temporarily with the Local Database Automatic If you select the automatic switch to offline database check box in the Database Setup window, an additional button will be displayed when you shut down the program: Use Offline Database. 163A 164A When you terminate the program with this button, the patient list will be copied to the local database.
Page 222 Working Temporarily with the Local Database For your notes 9-14 CASE Revision C 2060290-201...
Page 223: Operation With Administrative Tools
Operation with Administrative Tools Revision C CASE 10-1 2060290-201...
Page 224 For your notes 10-2 CASE Revision C 2060290-201...
Page 225: Overview
Overview Overview The program can be used in combination with the following administrative tools: medical reimbursement program  hospital information system (HIS)  EMR system (electronic medical records)  Revision C CASE 10-3 2060290-201...
Page 226: Description
The patient is admitted to the administrative tool with last name, first name, patient ID, date of birth, height and weight. Note GE Healthcare is not in a position to guarantee full compatibility of administrative tool with CASE in all situations. 10-4...
Page 227: Dicom Interface
DICOM Interface Revision C CASE 11-1 2060290-201...
Page 228 For your notes 11-2 CASE Revision C 2060290-201...
Page 229: Overview
Overview Overview DICOM (Digital Imaging and Communications in Medicine) is an open data exchange standard for medical information. DICOM standardizes both the file format for data storage as well as the communications protocol for the exchange of these data. The following functions are supported: performing procedures on the basis of the order list (scheduled ...
Page 230: Performing Procedures With The Order List (Scheduled Procedures)
Performing Procedures with the Order List (Scheduled Procedures) Performing Procedures with the Order List (Scheduled Procedures) 1. Click New Test. 2. Select the patient and click Order List. 104A An order list query is automatically sent via the network. These are the default search criteria: orders for the selected patient ...
Page 231 Performing Procedures with the Order List (Scheduled Procedures) Name of the requesting physician  Name of the performing physician  6. Perform the examination according to the user instructions. 7. At the end of the examination you will be asked whether the test is a valid or an invalid test.
Page 232: Elements Of The Order List - Explanation
Performing Procedures without the Order List (Unscheduled Procedures) Elements of the Order List - Explanation 109A The content of these fields depends on the program configuration. Search criterion for the workstation: find orders for a specific workstation or find orders for all workstations. Search criterion date: find orders for the selected time period or find orders irrespective of a time period.
Page 233: System Settings
System Settings Revision C CASE 12-1 2060290-201...
Page 234 For your notes 12-2 CASE Revision C 2060290-201...
Page 235: Resting Ecg Setup
Resting ECG Setup Resting ECG Setup The settings specific to the resting ECG modality can be entered either from the resting ECG acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab”...
Page 236: Editing The Reason For Test Library
Resting ECG Setup Editing the Reason for Test Library In this window you can edit the library for the Reason for Test list box. You can enter a maximum of 12 statements. 1. Click Modify... to display the Reason for Test library. 2.
Page 237: Editing The Interpretation Library
Resting ECG Setup Editing the Interpretation Library In this window you can edit the library of interpretative statements. 1. Click Modify... to display the Interpretation library. 2. Click a line to highlight it. 3. Click a second time to enable the edit mode and enter your changes. 4.
Page 238: Editing Medication Groups, Assigning Drug Names
Resting ECG Setup Editing Medication Groups, Assigning Drug Names 1. Click Modify... to display the Medications library. 2. Click down arrow to open the list. 3. Select the medication group. 4. Click the Drug Name box and enter the medication name. Note Assigning the correct names to the groups is the responsibility of the physician.
Page 239: Lead Sequence Tab
Resting ECG Setup Lead Sequence Tab Click the Lead Sequence tab to open the window. Lead sequence is the assignment of ECG leads to the writer or screen channels. You can change the lead sequences according to your needs and save them under the same name or under a new name.
Page 240: Miscellaneous Tab
Resting ECG Setup Miscellaneous Tab 95A-R Select the check boxes to enable the following functions: Preview before Analysis: Full-screen display of the 10-second ECG, analysis only after confirmation. Print after Analysis: Automatic printout after acquisition of the 10-second ECG. Post Test Review after Analysis: Automatic display of the test report after acquisition and analysis of the 10-second ECG.
Page 241: Final Report Tab
Resting ECG Setup Final Report Tab Click the Final Reports tab for configuration of the report printout. 96A-R 1. Select the documents to be included in the report Configured Report  10-second ECG (up to 3 different formats, with or without ...
Page 242: Report Editor
Resting ECG Setup Report Editor The Configured Report Editor allows you to create a maximum of 10 templates (e.g. letter to referring physician). Two templates (Reports 1 and 2) are preconfigured and cannot be changed. Click Modify... on the Final Report tab to display the Configured Report Editor window.
Page 243 Resting ECG Setup 944A Click to select the logo. Use arrow buttons or text fields to define the size and position of the logo. 10. Click button to save the template. To do so, enter the template name first. This name will allow you to select the template later on when configuring the printed report.
Page 244: Exercise Test Setup
Exercise Test Setup Exercise Test Setup The settings specific to the exercise test modality can be entered either from the exercise test pre-acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab”...
Page 245: Screen Tab
Exercise Test Setup Screen Tab Click the Screen tab to open the window. 99A-S Click to print the exercise test setup. Select or deselect display of the 1-mV calibration pulse. Select the sensitivity level to noise (noise/signal ratio): low, middle, high (electrodes with a high impedance are shown yellow).
Page 246: Configuring The Tabular Summary
Exercise Test Setup Configuring the Tabular Summary You can define up to 5 columns of data in the Tabular Summary in addition to the standard 8. Select preconfigured data types or create new column headings. Click Configure Tabular Summary on the “Screen Tab”...
Page 247: Configuring Trends
Exercise Test Setup Configuring Trends Click Configure Trends on the “Screen Tab” on page 12-13 to display the configuration window. You can choose the parameters for 6 graphic trends. 911A-S 1. Select the parameter for the left Y axis. 2. Select the parameter for the right Y axis. 3.
Page 248: Configuring The Vital Signs
Exercise Test Setup Configuring the Vital Signs Click Configure Vital Signs on the “Screen Tab” on page 12-13 to display the configuration window. You can choose the vital signs to be displayed  the order in which they are presented ...
Page 249: Lead Sequence Tab
Exercise Test Setup Lead Sequence Tab Click the Lead Sequence tab to open the window. Lead sequence is the assignment of ECG leads to the writer or screen channels. You can change the lead sequences according to your needs and save them under the same name or under a new name.
Page 250: Configuring Leads Ex1, Ex2, Ex3
Exercise Test Setup Configuring Leads Ex1, Ex2, Ex3 6. Choose unipolar or bipolar. 7. Choose the 1st electrode site for Ex1. 8. Select the 2nd electrode site for Ex1 (bipolar) (the 2nd site for unipolar leads is always CT). 9. If required, change the name of the lead sequence (step 2) and click OK to save.
Page 251: Protocol Editor Tab
Exercise Test Setup Protocol Editor Tab Click the Protocol Editor tab to open the window. 914A-S Click to print the exercise test setup. Click option button to select the treadmill exercise testing device. Click option button to select the bicycle ergometer exercise testing device. Click down arrow to select a protocol.
Page 252: Protocol Editor Screen
Exercise Test Setup Protocol Editor Screen 915A-S Note The 12 lead and Median report formats are selected on the Writer tab. The medians saved with Store Median are included in the Medians report. Phase name. Selected protocol. Stage name. Select or deselect a ramping phase (= continuous speed/load increase; selectable only when phase name, e.g.
Page 253 Exercise Test Setup Parameter fields (corresponding to the columns from left to right). Phase/Stage name. Stage Time. Speed. Grade. 12 Lead Report: First = time of first 12-lead report. 12 Lead Report: Repeat = print interval after first report. Median Report: First = time of first median report. Median Report: Repeat = print interval after first report.
Page 254: Creating A New Phase
Exercise Test Setup Creating a New Phase 915A-S 1. Select a blank protocol (e.g. TEST 14). 2. Click the New Protocol button to display the window with all protocol templates. 3. Select a template from the list. Editing Stage or Phase Information 4.
Page 255: Final Report Tab
Exercise Test Setup Final Report Tab Click the Final Report tab for configuration of the report printout. 916A-S 1. Select the documents to be included in the report Configured Report  Graded Exercise Summary Report  Selected Medians Report  Tabular Summary (stage/detail) ...
Page 256: Miscellaneous 1 Tab
Exercise Test Setup Miscellaneous 1 Tab Click the Miscellaneous 1 tab to open the window. 917A-S Select or deselect FRF (Finite Residual Filter algorithm = filtering of high and low-frequency components without altering the QRS complexes, signal delay of 1 s) or Cubic Spline (compensation of baseline fluctuation, signal delay 2 s); see section “Application Tips”...
Page 257 Exercise Test Setup Select the Max. Load Interpolation function (only possible when the exercise test is performed on a bicycle ergometer). The maximum load is the load of the last completed stage plus the duration of the last stage x load increase/stage time. Example: load of the last completed stage: 125 Watts last stage aborted after 1 minute...
Page 258: Miscellaneous 2 Tab
Exercise Test Setup Miscellaneous 2 Tab Click the Miscellaneous 2 tab to open the window. 918A-S Editing the Comments, Test Types, Reason for Test, Reasons for Termination, Medications Library 1. Click Modify..to open the edit window. 2. Edit, delete or add new statements. Configuring the Measurement Results 1.
Page 259: Editing The Interpretation Library
Exercise Test Setup Editing the Interpretation Library Click Modify..to open the Interpretation Library window. Note You can edit the eight preset topics in the window on the left. Do not edit the topics, if data will be sent to MUSE. Additional statements can be entered in the window on the right.
Page 260: Entering Extra Questions
Exercise Test Setup Entering Extra Questions Click Modify..to open the Extra Questions window. 920A-S 1. Click in the text box for the first question and type a text (20 characters max.). 2. Select the answer format: Alphanumeric, Numeric, Yes/No. 3.
Page 261: St/Medians / 12Sl Tab
Exercise Test Setup ST/Medians / 12SL Tab Click the ST/Medians / 12SL tab to display the window for setup of ST measurement and 12SL. 922A-S Click option button to select calculation method for E and J points. Click option button to select calculation method for post-J point. Manual: set post-J point at D Auto: select formula at C.
Page 262: Twa Tab
Exercise Test Setup TWA Tab Click the TWA tab to open the window. During the exercise test the TWA algorithm analyzes the data in the background. In each of the selected leads, the algorithm calculates the even and odd medians, the TWA value and the noise limit. The data is saved at intervals of 15 seconds.
Page 263: Ambulatory Blood Pressure Measurement Setup
Ambulatory Blood Pressure Measurement Setup Ambulatory Blood Pressure Measurement Setup The settings specific to the ambulatory blood pressure measurement modality can be entered either from the ambulatory blood pressure acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab”...
Page 264: Editing The Bp Protocol
Ambulatory Blood Pressure Measurement Setup Editing the BP Protocol Click Modify to display the configuration menu. 9 10 194A-BP 1. Select the number of BP periods. 2. Select the beginning of the period. 3. Select the end of the period. 4.
Page 265: Miscellaneous Tab
Ambulatory Blood Pressure Measurement Setup Miscellaneous Tab Click the Miscellaneous tab to open the window. 195A-BP Click to print the ambulatory blood pressure measurement setup. Select documents to be included in the report. Select the Configured Report format. Click button to edit the Configured Report or create a new one (see “Report Editor”...
Page 266: Editing The Interpretation Library
Ambulatory Blood Pressure Measurement Setup Editing the Interpretation Library In this window you can edit the library of interpretative statements. You can enter a maximum of 12 statements. 1. Click Modify... to display the Interpretation library. 2. Click a line to highlight it. 3.
Page 267: Spirometry Setup
Spirometry Setup Spirometry Setup The settings specific to the spirometry modality can be entered either from the spirometry acquisition screen where you click Setup to display the setup menu, or from the General tab of the System Configuration (see “General Tab” on page 12-40).
Page 268: Miscellaneous Tab
Spirometry Setup Miscellaneous Tab Click the Miscellaneous tab to open the window. 208A-SP Click to print the spirometry test setup. Select documents to be included in the report. Select the Configured Report format. Click button to edit the Configured Report or create a new one (see “Report Editor”...
Page 269: Editing The Interpretation Library
Spirometry Setup Editing the Interpretation Library In this window you can edit the library of interpretative statements. You can enter a maximum of 12 statements. 1. Click Modify... to display the Interpretation library. 2. Click a line to highlight it. 3.
Page 270: Custom Setups, Factory Setup
Custom Setups, Factory Setup Custom Setups, Factory Setup The program allows you to save, load, and delete your personal settings for the different test modalities. From the same menu, you can restore the factory defaults. You access the setup menu by clicking the Custom Setup button on the acquisition or pre-acquisition screen, or from the the General tab of the System Configuration (see “General Tab”...
Page 271: Load Or Delete
Custom Setups, Factory Setup Load or Delete 1. Select the drive. 2. Select the name. 3. Click Load to load the setup, or click Delete to delete the setup. Note Be sure to save the current setup BEFORE loading one of the stored setups, or your modifications will be lost.
Page 272: System Configuration
System Configuration System Configuration Click the System Configuration button on the initial screen to display the menu. General Tab 925A Test Patient: Select check box to run a test using simulated patient data.  Select the function each time before starting a simulated test. WARNING Interpretation Hazard—Select the simulated patient data for demonstration purposes only...
Page 273 Click to save or load the System Configuration. Click to quit the program. Click to print the System Configuration. Note If you cannot remember the supervisor password, please contact the GE Healthcare Technical Support or your local Service Representative. Revision C CASE 12-41...
Page 274: Adjusting The Screen Size For Widescreen Monitors
System Configuration Adjusting the Screen Size for Widescreen Monitors 1. Select custom. 2. Click 3. Adjust the height of the displayed window to 10 cm, using a ruler. 4. Adjust the width in the same way. 5. Clear the window. 945A 12-42 CASE...
Page 275: User Administration
System Configuration User Administration User List (G on the General tab, on page 12-40) displays the list of all registered system users if you select the Enable Password Function check box in the preceding window. You can edit user data with Modify... (select name first), delete a user with Delete...
Page 276 Setup: user is authorized to edit the test settings. 5. Enter a password. Be sure to remember the password. If you forget it, you will have to contact the GE Healthcare Technical Support or your local Service Representative. 6. Select the External User check box if you wish to receive data from remote test stations (at the sending stations, enter the addressee's name and password).
Page 277: Receiving Resting Ecgs From Other Ecg Devices
System Configuration Receiving Resting ECGs from Other ECG Devices With the Receive Data from ECG Device function, resting ECGs acquired with other GE Healthcare ECG devices can be transferred to the local database. Note If an ECG is received without patient ID (not even blanks), it will automatically appear in the list for manual assignment with the special patient ID “000000“.
Page 278 System Configuration A device number (e.g. 12) can be entered at the ECG recorder: to do so type hospital %12% at Hospital/Practice Name. 2. Select this option button to receive data from a storage medium and specify the directory. 3. Select this option button to receive MAC ECGs from a USB or memory card (SD card) and specify the directory.
Page 279 PC is required as the communications server. This server is part of a network through which the ECG can be routed to the system or to a MUSE system database. For details, please contact GE Healthcare Technical Support or your local Service Representative.
Page 280: Copying Patient Records
System Configuration Copying Patient Records With the Copy Patient Records function, patient records can be copied from the local database to a removable media or a network drive, or they can be moved from a removable media or network drive to the local database.
Page 281: Archiving Patient Records
System Configuration Archiving Patient Records With the Archive Patient Records function you can export patient records not currently used to an external medium. The date and test type remain included in the patient record list. An asterisk * identifies archived patient records.
Page 282: Compressing Patient Records
System Configuration Compressing Patient Records Older patient records that are seldom used can be compressed with the Compress function to free storage capacity for new data. If you select compressed patient records for viewing, they uncompress automatically. Click Compress (L on the General tab) to display the setup window. 1.
Page 283: Procedure Statistics
System Configuration Note Access to the Date/Time Properties dialog is restricted to authorized system users. Procedure Statistics Click Procedure Statistics (N on the General tab) to display the setup window. 932A 1. Enter the date range for the statistical analysis. 2.
Page 284: Printer Settings
System Configuration Printer Settings Click Printer (O on the General tab, page 12-40) to display the setup window. 946A 1. Select the printer. 2. Select the Color Printouts check box, if desired. 3. Define the colors. 4. Select the ECG grid format. 5.
Page 285: Devices Tab
System Configuration Devices Tab Click the Devices tab to open the window. 933A Select check box, then select a port for the metabolic cart. Click to select the BP monitor model and the port. Click to select the treadmill model and the port. Click to select the spirometry device type and the port (none indicates that the modality is inactive).
Page 286: Modem Tab
System Configuration Modem Tab Click the Modem tab to open the window. 934A Select modem port and baud rate (same baud rate at sending and receiving units). Select the modem type. Field for entry of the initialization string (entered automatically for MultiTech and ELSA modems).
Page 287: Muse Tab
System Configuration MUSE Tab Click the MUSE tab to open the window. Note CASE is compatible with the following versions of the MUSE system: Pre 5C, 5C to 7.1 or 7.2 and above. 935A Select to retrieve patient data and orders from the MUSE system. Enter information required for communication with the MUSE web system.
Page 288 4.0 and later) and the Acrobat Reader program must already be installed. The Internet browser must be set up for proper communication (web address of the MUSE system, etc.). Contact GE Healthcare Service for details. Enter location and cart/device number. Display the location name list.
Page 289 System Configuration The following exercise test information is not transferred to the MUSE system, because MUSE does not support this type of data: Sokolov index, QT dispersion  full disclosure ECG  arrhythmia review  ST/HR slope  ST/HR index ...
Page 290: Option Code Tab
System Configuration Option Code Tab Click the Option Code tab to open the option code window. If you have purchased additional software options, enter the option codes to activate the software options. The code numbers are given on the supplied option code sheets or on a disk.
Page 291: Country Settings Tab
System Configuration Country Settings Tab Click the Country Settings tab to open the window. Note After selecting the language, first load the factory settings to set all text libraries to the new language (Custom Setup — Factory Settings — Load). Select Chinese, Japanese, Korean, or Russian only when the operating system of your computer supports the required character sets.
Page 292: Emr Tab
System Configuration EMR Tab Click the EMR tab to open the window (with XEMR option only). 941A Select to transfer data to the EMR interface via a network. Select to transfer data to the EMR interface via a shared directory. Set or select the communication folders (read orders from the EMR interface, write data to the EMR interface).
Page 293: Connectivity Server Tab
Note Information about installing the connectivity server can be found in the Field Service Manual. Refer the installation of the connectivity server to GE Healthcare service personnel. Click the Connectivity Server tab to open the window. 947A Select to automatically export data in Word, XML or PDF format as configured in the System Configuration (see “System Configuration”...
Page 294: Adding Inbound Connections
System Configuration Click to open a dialog to add shared directories. You select a folder for which you have permission to save data. Normally, a user will be created and the rights needed to save data are assigned to this user. On the cart, this user is used to log onto the system.
Page 295: Dicom Tab
System Configuration DICOM Tab Note A valid DICOM option code will activate the DICOM interface as well as the DICOM tab. Configurations on the DICOM tab should be referred to IT/Service staff (see Field Service Manual). Revision C CASE 12-63 2060290-201...
Page 296 System Configuration For your notes 12-64 CASE Revision C 2060290-201...
Page 297: Cleaning And Maintenance
Cleaning and Maintenance: Cleaning and Maintenance Revision C CASE 2060290-201...
Page 298 Cleaning and Maintenance: For your notes CASE Revision C 2060290-201...
Page 299: Cleaning, Disinfection, And Maintenance
Cleaning and Maintenance: Cleaning, Disinfection, and Maintenance Cleaning, Disinfection, and Maintenance Equipment Surface Warning Shock Hazard — Disconnect the power cord from the wall outlet before cleaning or disinfecting the system. Use a moist cloth to wipe the surface clean; do not allow liquids to ...
Page 300: Maintenance
These checks should be referred to individuals with adequate training and experience. The inspections can be carried out by GE Healthcare Service within the framework of a service agreement. The Technical Inspections include: Visual inspection of the device and of the accessories for mechanical ...
Page 301: Miscellaneous
Miscellaneous: Miscellaneous Revision C CASE 2060290-201...
Page 302 Miscellaneous: For your notes CASE Revision C 2060290-201...
Page 303: Connecting Peripheral Devices
COM ports of the system. Treadmills Connect treadmills to the COM ports. Model Configuration Treadmills without digital communication internal treadmill interface GE Healthcare treadmills T-2000 T2000  T-2100 T2100  Revision C CASE...
Page 304: Blood Pressure Monitor
Miscellaneous: Connecting Peripheral Devices Blood Pressure Monitor Note The blood pressure can be measured in kPa or mmHg. For selection of the blood pressure unit, see “Country Settings Tab” on page 12-59. Connect blood pressure monitors to the COM ports. Model Configuration integrated in the ergometer...
Page 305: Spo2 Monitor
Shock Hazard — In the patient vicinity, the printer installed on the system cart must meet the requirements of IEC 60601, or it must be a GE Healthcare modified printer with a connected protective earth conductor (potential equalization). Observe the installation instructions supplied with the printer.
Page 306: Printers In A Network Environment
Miscellaneous: Application Tips Printers in a Network Environment Warning Patient Hazard — As stipulated in IEC 60601-1, printers operated in the patient environment must be connected via an isolation transformer or to a potential equalization system (protective earth conductor). Recommended storage capacity: 8 MB ...
Page 307: Recording Ecgs During Defibrillation
Miscellaneous: Application Tips Recording ECGs During Defibrillation The patient signal input is defibrillation-proof. Therefore, it is not necessary to remove the ECG electrodes prior to defibrillation. When using stainless steel or silver electrodes a defibrillator discharge current may cause the electrodes to retain a residual charge causing a polarization or DC offset voltage at the electrode/skin interface.
Page 308: Exercise Test Interpretation (Xti
The intention of the statements and reasoning texts is to provide a short, clear, and accurate overview of the results of an exercise test. For more details, please refer to the Physician’s Guide to GE Stress Systems, Part No. 2051167-001.
Page 309: Duke Treadmill Score
Miscellaneous: Duke Treadmill Score Duke Treadmill Score 1. The system automatically generates the Duke Treadmill Score using the following standard computation. (Bruce) maximum Duke – 5 – Exercise Time ST deviation 4 (Angina Index) Treadmill Score (minutes) (mm) Angina-Index 0 = none, 1 = non-limiting, 2 = limiting Note Maximum ST deviation refers to the amount of exercise-induced ST segment deviation, i.e., the largest elevation or depression...
Page 310: References
Miscellaneous: Duke Treadmill Score References Study the following publications for a correct understanding of the Duke Treadmill Score: Gibbons et al.: ACC/AHA Guidelines For Exercise Testing. JACC, 30 (1):260 - 315, July 1997. Mark, D.B.; Shaw, L.; Harrell, F. E.; Lee, K. L.; Bengton, J.R.; McCants, C.B.;...
Page 311: Risk Factors
According to the "Instructions of Using Coronary Risk and Stroke Risk Prediction Charts and Worksheet" proposed by the American Heart Association (AHA) (see also Physician’ s Guide to GE Stress Systems) the system automatically calculates the risk factors for coronary heart disease and myocardial infarction.
Page 312 Miscellaneous: Risk Factors Male Stroke Risk Factor Values for Unknown or Out-of range Parameters Parameter Value Value Used unknown < 54 years > 86 years Systolic Blood Pressure unknown < 95 > 213 HYP RX (anti-hypertensive medication) unknown Diabetes unknown Smoker (cigarettes) unknown CVD (cardiovascular disease)
Page 313: Spirometry Reference Value Equations, Interpretation Modes, Measurements
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Spirometry Reference Value Equations, Interpretation Modes, Measurements Reference Value Equations ECCS/Zapletal This equation uses reference values developed by Q (ECCS93) UANJER and Z APLETAL The ECCS reference values were published 1993 (ISBN 87-16-15024-4). The reference values are height and gender-related and are defined for patients aged 19 to 70 years.
Page 314: Knudson
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Knudson This reference value equation was published 1983 (K et al. Am NUDSON Rev Respir Dis 127 (1983) 725-734). The reference values are height and gender-related and are defined for patients aged 5 to 90 years from the ethnic groups Caucasian (Race selection: Caucasian), African American (Race selection: Black).
Page 315: Brazil
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements The reference values by W are height and gender-related and are ANNE defined for patients aged 6 to 17 years. Note Age range from 6 to 17 years.  For patients younger than 6 years, the age is set to 6. ...
Page 316: Interpretation Modes
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Interpretation Modes Note The authors of the reference values developed the interpretation modes for the reference value equations. Other reference value equations may lead to different interpretations. Europe An interpretation mode on the basis of the ECCS reference values. The flow-volume loop is analyzed according to these criteria: 1.
Page 317 Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Curve typical of restriction Possible causes reduced lung volume (restriction), elevated pulmonary elasticity (fibrosis) Criterion FVC Act. < xx % FVC Ref. and (VC MAX/(2 x MEF50) < 0.8) Definition Interpretative Statement >...
Page 318: Chs
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Impaired peripheral respiration Possible causes reduced pulmonary elasticity (emphysema), impaired ventilatory distribution, peripheral airway obstruction Criterion VC MAX/(2 x MEF50) Definition Interpretative Statement T50 % = < 0.8 s normal* T50 % = 0.8 - 1 s mild expiratory flow limitation at deep expiration T50 % = >...
Page 319: Definition Of Spirometry Test Values
Miscellaneous: Spirometry Reference Value Equations, Interpretation Modes, Measurements Definition of Spirometry Test Values forced expiratory vital capacity FEV05 forced expiratory volume in the first 0.5 seconds FEV1 forced expiratory volume in the first second (same as FVC, if exhalation time < 1 second) FEV1/FVC FEV1 as a percentage of FVC FEV3...
Page 320: Installing The Program In A Network Environment
Miscellaneous: Installing the Program in a Network Environment Installing the Program in a Network Environment Please contact our Customer Service for program updates. To operate the program in a network environment, the server must meet the following requirements: processor Pentium > 1.6 GHz >...
Page 321 Insert the screen from the Clipboard with Edit -> Paste.  Select the page orientation, using File -> Print setup ->  Landscape. Print the page and fax it to GE Healthcare or save the page as a  WordPad document and send it via e-mail. Revision C CASE...
Page 322: Remote Service
Miscellaneous: Remote Service Remote Service In conjunction with the InSiteExC application, CASE is a system with remote service capability. For InSiteExC installation instructions, please refer to the CASE Field Service Manual. You must have access to the internet to be able to use the remote service capability. Warning Patient Hazard —...
Page 323: Direct Fax Transmission Of Printer Documents
Instead of sending documents to the printer, they can be directly routed to another PC or to a fax machine. A modem with a serial port is required for this purpose. The modems recommended by GE Healthcare include the FAX software.
Page 324: Related Physician's Guides
Miscellaneous: Related Physician’s Guides Related Physician’s Guides For detailed information on specific topics, we recommend that you refer to these physician’s guides: Physician's Guide to GE Stress Systems, Part No. 2051167-001  TWA Physician’s Guide, Part No. 2020044-067  Physician’s Guide to Audio ECG Assessment of Stress Tests, ...
Page 325 Order Information: Order Information Revision C CASE 2060290-201...
Page 326 Order Information: For your notes CASE Revision C 2060290-201...
Page 327 Order Information: Order Information Order Information Subject to change. Always refer to latest list of accessories. 2062898-001 CASE ECG analysis system incl. system cart, standard software, optionally with KISS suction pump 2062899-001 CASE Upgrade to add hardware/software options Accessories Peripheral Devices 2079551-001 22-inch EIZO wide-screen LCD monitor 2088456-001...
Page 328 Order Information: Order Information 2077699-017 Keyboard, Swedish/Finnish 2077698-001 Optical scroll mouse, USB, IPX1, black Optional Software Programs 45502401 Resting ECG Interpretation (RESI), requires RESM 45502901 Remote View (ERGM) 45502701 Storage of the Full Disclosure ECG (EGMO) 45503001 Data Storage on Network Server, < 3000 tests (NETS) 2014659-001 Data Storage on Network Server, <...
Page 329 Order Information: Order Information 2014659-020 EMR Interface (XEMR) 2014659-026 DICOM Interface (DICM) 2014659-027 Ergospirometry (ESPI), for CASE-ES only 2014659-028 ST/HR Hysteresis (STHY), requires ERG2 2014659-029 Exercise Test Interpretation (EXTI), requires ERG2 and STHY Cables 405535-001 Power cord, USA 401855-001 Power cord, Europe 401855-002 Power cord, GB 401855-003...
Page 330 Order Information: Order Information CASE Revision C 2060290-201...
Page 331 Technical Description: Technical Description Revision C CASE 2060290-201...
Page 332 Technical Description: CASE Revision C 2060290-201...
Page 333 Technical Description: Technical Specifications – CASE System Technical Specifications – CASE System Table 1. Performance Specifications – Signal Processing Item Description Instrument type Unity-enhanced cardiac stress testing system with 14 channel acquisition and programmable lead configurations. Celeron-based and hard drive storage delivers local and MUSE database access.
Page 334 Technical Description: Technical Specifications – CASE System Table 2. Performance Specifications – Data Acquisition (Continued) Item Description Dynamic range 320 mV, ±10 mV signal superimposed on ±150 mV DC offset Resolution 4.88 µV/LSB @ 500 Hz Noise < 15 µV peak-to-peak noise over 0.01 to 150 Hz (-3 dB) bandwidth Frequency response - 3dB, display and writer High pass filter...
Page 335 Technical Description: Technical Specifications – CASE System Table 3. Display (Continued) Item Description Size 22'' diagonal DVI (22'' monitor) 19'' diagonal DVI (19'' monitor) Monitored leads 3, 6, or 15 Displayed leads 3, 6, 12 or 15 (Resting ECG) and 3 or 6 (Stress Test) Format 3 rhythm, 3 rhythm + medians, 3 rhythm + trends, 6 rhythm, 4 x 2.5 + 1 rhythm, 2 x 6...
Page 336 Technical Description: Technical Specifications – CASE System Table 4. Writer Item Description Technology “Instant” load thermal dot array Leads 3, 6, 12, or 15 (standard, NEHB, Cabrera, configurable) Speeds 5, 12.5, 25, and 50 mm/s (±2 %) Sensitivity/Gain 2.5, 5, 10, or 20 mm/mV (±5 %) Resolution Horizontal 1000 lines/s x 200 dpi dedicated local printing, 200 x 200 dpi generic printing...
Page 337 Technical Description: Technical Specifications – CASE System Table 6. Physical Item Description Height 169 cm (66 ½ inches) with monitor attached (height adjustable, extend and retract, rotates vertical and horizontal for optimum viewing) Width 62 cm (24 in.) with paper tray removed Depth 75 cm (29 in.) Weight...
Page 338 Technical Description: Technical Specifications – CASE System Table 7. Safety (Continued) Item Description Handling of disposable supplies Use only parts and accessories manufactured or recommended by GE  and other consumables Healthcare. Follow manufacturer’s instructions for use for disposable/consumable ...
Page 339 Index Index Numerics Combined Report 7 Comments, Enter in Tabular Summary 17 10-Second ECG With Analysis 7 Comparing Exercise Tests 27 10-Second ECG, View 13 Comparing Spirograms 18 12SL Analysis 54 Cubic Spline 10 12SL ECG Acquisition 15 Custom Setups, Load - Save - Delete 38 3D Graph 35 Danger (Definition) 6 Acquisition Module Buttons 13...
Page 340 Envelope, Measurement Mode 7 Equipment Check Before Each Use 4 Equipment Identification 15 Equipment Symbols 11 Event Marker 10 GE Product Security Database 13 Examinations, Compare Graphic trends 35 Resting ECGs 29 Graphics, Ambulatory Blood Pressure Measure- Resting ECGs, Interpretation 32...
Page 341 Index Local Database, Select Patient Records 4 Location Number 3 LW 15 Offline database 12 Operator's Manual, View, Print 17 Option Code, Enter 58 Options 18 Order 6 Measurement Mark for T-offset, Adjust 19 Order List 6 Measurement Marks, Adjust 17 Order number 4 Measurement Results, Ambulatory Blood Pressure Measurement 11...
Page 342 Index Ambulatory Blood Pressure Measurement 33 System Configuration Exercise Tests 26 Connectivity Server Tab 61 Resting ECG 4 Country Settings Tab 59 Spirometry Tests 36 Devices Tab 53 Recording a 10-second ECG 7 DICOM Tab 63 Recording ECGs of Pacemaker Patients 6 EMR Tab 60 Recovery Phase 28 General Tab 40...

GE CASE V6.7 Operator's Manual

Safety Information

Service Information

2 Equipment Overview

CASE System

Function Keypad

Desk Light

Preparing the Acquisition Module

Loading Writer Paper

Initial Screen

Viewing and Printing the Operator's Manual

Software Options

Preparing the Patient

Applying Electrodes - the Basics

Preparing the Patient's Skin

Applying Electrodes

Attaching the Acquisition Module

Selecting a Patient Record and Test Type

Selecting a Patient Record from the Local Database

Retrieving a Patient Record from the MUSE System Database

Entering a New Patient

Patient Records of External Programs

Resting ECG

Entering Test Information

Recording a Resting ECG

Post Test Review

Exercise Test

Patient Education

Entering Test Information

Before the Test

During the Test

Recovery Phase

Test End Phase

After the Test - Post Test Review

3 D Graph

Report Formats

Monitoring of Remote Exercise Test Workstations

7 Ambulatory Blood Pressure Measurement

Ambulatory Blood Pressure Monitors

Connecting the Ambulatory BP Monitor

Setting up the Ambulatory Blood Pressure Monitor

Post Test Review

8 Spirometry Test

Sensors

Entering Test Information

Conducting Spirometry Tests

Post Test Review

File Management

Overview

Selecting Patient Records

Viewing, Editing, Printing Patient Records

Archiving, Exporting, Deleting Patient Records

Working Temporarily with the Local Database

10 Operation with Administrative Tools

Overview

Description

11 DICOM Interface

Overview

Performing Procedures with the Order List (Scheduled Procedures)

Performing Procedures Without the Order List (Unscheduled Procedures)

12 System Settings

Resting ECG Setup

Exercise Test Setup

Ambulatory Blood Pressure Measurement Setup

Spirometry Setup

Custom Setups, Factory Setup

System Configuration

Cleaning and Maintenance

Cleaning, Disinfection, and Maintenance

Maintenance

Miscellaneous

Connecting Peripheral Devices

Application Tips

Exercise Test Interpretation (XTI

Duke Treadmill Score

Risk Factors

Spirometry Reference Value Equations, Interpretation Modes, Measurements

Installing the Program in a Network Environment

Troubleshooting

Remote Service