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Transcription

English

USER GUIDE
Copyright 2014, Optos plc. All rights reserved.
Optos Plc. products are protected by patents and patent applications listed at
www.optos.com/patents.
The information contained within this document is subject to change without notice. The
latest version of this information can be found at optos.com.
This document should be used in conjunction with the help files supplied in each
application and the Technical Data Specifications supplied with the device. Instructions
and service information can be obtained by contacting the Optos Customer Service
Department through the contact details given in this handbook.
The device is a prescription device.
Warning
In the United States of America, Federal law restricts this device to sale
by or on the order of a physician or practitioner. See CFR 801.109(b)(1)
for more information.
Optos does not provide, and the optomap plus guidelines do not constitute advice on
making reimbursement claims. Diagnostic tests should be ordered by the treating
physician and this physician is responsible for appropriate usage, adequate
documentation and proper coding. It is the responsibility of the physician to comply with
Medicare regulations, and check with the local insurance carrier for reimbursement
information and instructions. Optos does not accept any liability for reimbursement claims
made while using optomap plus.
Copyright
This document may only be used for your personal, non-commercial use. This document
and all its contents (including without limitation, all text, formats, graphics and logos) are
the property of Optos plc and are protected from unauthorized copying and
dissemination by the Copyright, Designs and Patents Act 1988 (as amended), by various
intellectual property laws and by international conventions.
Trademarks
Optos, optos, optomap, Daytona, OptosAdvance, V2, ResMax, 3D Wrap and P200 are ®
Marks. All rights reserved.
WINDOWS is a Trademark of Microsoft Corporation.
ADOBE and ACROBAT READER are Trademarks of Adobe Systems Incorporated.
All other trademarks are the property of their respective owners.
Part Number: G-00081/2
Print Date: February 2014
Table of Contents
1
Introduction
9
1.1
About the device
9
1.2
Indications for use
9
1.3
About images
9
1.4
Switching on each day
11
1.5
Viewing PC
11
1.6
Closing the system each day
12
2
Getting to know the device
13
2.1
Understanding the equipment
13
2.2
About the detector settings
14
3
About the software applications
17
3.1
Admin application features
18
3.2
Capture application features
19
3.3
Review application features
19
3.4
Storage application features
22
3.5
Scheduler application features
22
3.6
About software updates
23
4
Getting help
25
4.1
Accessing help from the applications
25
4.2
Optos on the Web
26
5
About capturing an image
27
5.1
Working with patient records
27
5.2
Cleaning Instructions
28
5.3
Patient Instructions
31
5.4
Capturing images
31
5.5
About eye steering
33
5.6
Capturing Eye Steered Images
34
5.7
Capturing Stereo Images
35
5.8
Checking the quality of captured images
36
5.9
Checking the Exterior Eye Image
37
5.10 Discarding unwanted images
38
5.11 Patient positioning
38
6
About reviewing images
43
7
About the Patient History view
45
7.1
Working with patient records
46
7.2
Using the Patient History window
47
7.3
Opening images
47
7.4
Selecting images from the Image Series view
50
7.5
Opening images using alternative methods
50
7.6
Discarding unwanted images
51
7.7
Undeleting images
52
7.8
Emptying the "Deleted" folder
52
Using the viewing options
53
8
8.1
Color Channels
53
8.2
Review Tools
53
8.3
Recommended reading protocol
54
8.4
Using the Automated view
55
8.5
Using the Magnifier
55
8.6
Using the 3D Wrap view
56
8.7
Using the Comparison Overlay
57
8.8
Simulating a Binocular Indirect Ophthalmoscope (BIO) view
58
8.9
Simulating White Light view
58
8.10 Using False Color views
58
8.11 Viewing stereo images
58
8.12 Comparing with sample disease images
59
8.13 Using the Adjustment and Information panels
59
9
Documenting your review
61
9.1
About annotations, retinal drawings and measurements
62
9.2
Using annotations
62
9.3
Using retinal drawings
63
9.4
Using measurements
64
9.5
About review notes, diagnostic (pathology) codes and procedure codes
66
9.6
Using procedure codes
66
9.7
Using review notes
67
9.8
Using diagnostic codes
68
9.9
10
Registering image reference points
Distributing images
69
71
10.1 Emailing Images
71
10.2 Exporting Images
72
10.3 Configuring One-Click Export Options
74
10.4 Importing an image to a patient’s record
75
10.5 Printing images
75
10.6 Changing eye images from Right to Left (and Left to Right)
77
10.7 Assigning an image to another patient’s record
78
11
Using the Image Library
79
12
About archiving
81
12.1 When to Archive
81
12.2 Changing the Archive Task Settings
81
12.3 Archiving to disk
83
12.4 Archiving to a network
86
12.5 Checking storage status
86
12.6 Scheduling storage tasks
86
12.7 Recovering archived data
87
13
Where to find features
89
13.1 Capture application user reference
89
13.2 Review application user reference
94
13.3 Storage application user reference
105
13.4 Scheduler application user reference
106
14
Troubleshooting
109
14.1 Why can't I login?
109
14.2 Where do I find the site number?
109
14.3 Should I be connected to the internet to access the application help files?
109
14.4 How do I restart a Capture PC?
109
14.5 How do I restart the system?
110
14.6 How do I check everything is switched on?
110
14.7 How do I clear a Light Source Error?
110
14.8 What should I do if the PC drive is full?
110
14.9 What should I do if power is lost?
111
14.10 Will the software be updated?
111
14.11 What screen resolution should I use to review images?
111
14.12What should I do if artifacts remain on the images after cleaning the main mirror? 111
15
Contact us
113
15.1 Global Headquarters
113
15.2 Regional Offices
113
16
Training Checklist
117
Chapter 1 - Introduction
1
Introduction
This section introduces the device and explains the information contained in this document.
Your device will be installed by Optos trained personnel. Do not operate the device until they have
completed the installation and training.
Warning
Please read the Safety Guidelines in the Introductory Handbook before
using the device.
1.1 About the device
This scanning laser ophthalmoscope is a widefield digital imaging device capable of capturing from
the far periphery of the retina. The retinal images are captured in an automated, patient friendly way
without scleral depression or contact with the cornea.
The 200Dx/P200 uses red and green lasers to produce a digital, high-resolution image, which is
displayed on a PC monitor screen. Red and green lasers are used for digital color imaging. These
laser wavelengths penetrate the retinal structures to different depths, each wavelength providing
information for interpretation and diagnosis.
Optos’ technology is designed to operate through a minimum pupil diameter of 2mm. Although pupil
dilation is not required, the decision to dilate is a medical decision to be made by the eyecare
professional.
Images are captured on the scan head and then viewed, magnified, annotated and separated into
their color components in the Review application.
1.2 Indications for use
The 200Dx/P200 scanning laser ophthalmoscope is intended to be used as a wide field and retinal
imaging ophthalmoscope to aid in the diagnosis and monitoring of diseases or disorders that
manifest in the retina.
1.3 About images
The device can be used in many clinical areas and can assist in disease detection, monitoring and
treatment.
The images can be separated to present distinct retinal sub-structures and can be used to assist in
the assessment and recognition of different retinal pathologies.
Traditional ophthalmoscopes produce a reddish picture derived from a white light source. The
Optos devices use red and green lasers to compose the retinal images.
FIGURE 1: Sample image from 200Dx/P200 device.
Copyright 2014, Optos plc. Allrights reserved.
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The composite image supports analysis of the retinal image by allowing individual review of the
green and red channel information.
The green channel image contains information from the sensory retina through the pigment
epithelium layers of the retina.
l The red channel image contains information from the deeper structures of the retina, from
the pigment epithelium through the choroid.
Compare the green and red channels derived from the composite image shown above.
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Green Channel view
Red Channel view
The diagram below summarizes the retinal layers and structures reached by the lasers. These laser
wavelengths penetrate the retinal structures to different depths, each wavelength providing
information for interpretation and diagnosis.
Image types
There are different types of images for each type of procedure:
optomap – captures a retinal image. The standard optomap procedure is a wellness
exam. This procedure captures a standard optomap retinal image.
optomap plus – captures a medical retinal image. The optomap plus procedure is a
medical retinal exam. Following this procedure will allow the use of the enhanced features
in the Review application.
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Note
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Some image types offer additional options, for example, eye steering, ResMax, images optimized for
the periphery or central pole. These options vary depending on the device being used and the image
type selected. All available options are displayed in the Procedure Selection dialog box.
1.4 Switching on each day
You must start and close the system each day.
1. Remove the scan head dust cover.
2. Press the power switch at the rear of the scan head to the ON ( I ) position.
Note
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When switched on from cold, the lasers in the scan head will take a minimum of 15 minutes
to warm up to the operating temperature required for optimum performance.
You must start the Capture application immediately after the scan head has been switched
on. This is because both the scan head and the software need to be running while the
system warms up for optimum performance.
An error message may be displayed if capture is attempted before the required temperature
has been reached, see How do I clear a Light Source Error? on page 110.
3. Check the Capture PC is switched on. Turn it on if it has been turned off or has lost power.
If the PC monitor is switched on, but the screen is blank, check that the PC is
switched on.
l The Capture PC should be powered from the scan head table. Do not switch off the
table’s power supply unless told to do so by Optos.
l The Viewing PCs can only access image files if the PC that stores them is switched
on; this PC is usually the Capture PC. The scan head does not need to be switched
on if you are only using the Capture PC to view stored images.
4. Login to the Capture PC. You may need to press [Ctrl]+[Alt]+[Delete] keys simultaneously to
display the Login screen. Enter your Windows username and password in the Login dialog
box. The default username is "P200" and the default password is "a1010". All passwords
are case sensitive.
5. The Capture application starts automatically. The logo is displayed while the software is
starting up. If the Capture application does not run automatically, select Start > Programs >
Optos V2 Vantage > Capture.
Do not close down the Capture application during the day. If you need to run another
application on the desktop, minimize the Capture application rather than closing it.
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6. If you have additional Viewing PCs, switch on and login to each one.
1.5 Viewing PC
Captured images are reviewed using the Review features. You need to login to the Viewing PCs to
access the patient details and images stored on the system.
Usually, Viewing PCs will have been logged off at the end of each day. To login to a Viewing PC:
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1. Press [Ctrl]+[Alt]+[Del] to display the Unlock Computer dialog box.
2. Type your username and password. Click OK.
3. Select Start menu > All Programs > optos V2 Vantage > Review to run the Review application.
1.6 Closing the system each day
The system must be closed down properly each day by shutting down the scan head and closing the
system.
Turning off the isolation transformer will stop the power supply to the scan head and Capture PC. It
is important before doing this that the PC is shut down in the correct manner – in order to protect the
integrity of information on the disk drives.
You should always log off the Capture PC and switch off the scan head
power at the end of each working day.
The scan head table may also have its own power switch. Ensure this
switch remains on. Your system will need this power source when it
sends log files to Optos overnight.
You should always close the Optos applications on each Viewing PC at
the end of each working day. You should follow the correct procedure in
order to protect the integrity of the information on the disk drives, see
How to close the system below.
You should run the Storage application and archive files at least once a
week. See the Storage application help files for detailed instructions.
How to shut down the scan head
1. Close the Optos applications on the Capture PC.
2. Switch the power at the switch at the rear of the scan head to the OFF (O) position. Do not
switch off the power to the scan head table.
3. Cover the scan head with the dust cover provided by Optos.
How to close the system
1. Shut down the scan head, see How to shut down the scan head above.
2. Close the Optos applications on all PCs in the system. This is to prevent files being
accessed while the archiving task runs.
3. It is important to archive at least once a week. Select Start > All Programs > Optos V2 Vantage
> Storage. Run any recommended start-up tasks. For more information press [F1] to display
the help file when the Start-up Tasks dialog box is displayed.
4. Close the Storage application after completing the start-up tasks indicated in the previous
step.
5. Select Start button > Log Off to display the Log Off Windows dialog box. Select Log Off to log off
from the PC. Repeat on each PC.
Note
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Log off the Capture PC. Do not shut down the Capture PC.
Image files cannot be reviewed if the PC used to store the files (usually the Capture PC) has been
shut down. Ensure the Capture PC is switched on if Viewing PCs need to access images.
Chapter 2 - Getting to know the device
2
Getting to know the device
The device comprises the scan head, Capture PC, and Viewing PCs. For more information, please
refer to the Technical Data Specification supplied with the device.
Images are captured on the scan head which is connected to the Capture PC. The Capture PC can
run all software applications. The Viewing PC can run the Review application, Admin application,
Storage application, and Scheduler application. In a typical installation, the images and database will
be stored on the Capture PC. You can review captured images at any Viewing PC that is connected
to the Capture PC across a network.
2.1 Understanding the equipment
The device is part of a system of networked PCs.
200Dx/P200 Scan Head and Capture PC
The Capture PC runs the Capture application. The Capture application lets you select and perform
the required patient imaging procedure.
Warning
The Capture application should not be used to review images for diagnostic
purposes.
The Scan Head comprises:
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Scan Head – Comprises the lasers and electronics used to capture patient images.
Scan Head table – Supports the adjustment of the scan head height. The table can be
raised or lowered using the table height control.
P200 Eye piece – The eye piece supports the patient when being imaged. The eye piece
can be inflated or deflated to suit the patient and can also be removed for cleaning.
200Dx Face Pad – The face pad supports the patient’s face when the patient is being
imaged. The face pad can be removed for cleaning.
Capture PC – Runs the Capture application. It usually stores the patient details and the
image database and runs the Storage application.
Capture PC Monitor – displays the Capture application. The monitor displays alignment
feedback and captured images.
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Table height control – Comprises buttons used to adjust the height of the scan head table.
Capture control – Comprises the image capture button.
Viewing PCs
Viewing PCs run the Review application. The Review application lets you analyze patient images.
You can review images in a variety of ways. You can add annotations to highlight areas of interest,
add diagnostic codes, add notes, and email images to third parties.
2.2 About the detector settings
There are a several factors to be considered when selecting the appropriate detector settings:
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The patient
The system response
The operator
The patient
When meeting a patient at the start of the imaging session, it is important to assess the amount of
pigmentation in the patient's iris.
Less laser light is reflected by the retina in patients who have a greater amount of pigmentation. This
can result in dark images being captured because less light has been returned from the eye. You
should select the appropriate iris category setting to suit the patient's pigmentation levels.
Small pupil size can also restrict the amount of laser light returned from the retina. Since less laser
light is returned through the smaller pupil, the captured image may seem dark. To minimize this, you
should capture images in a dimly lit room.
Working in Low Light Conditions
Warning
The device requires low levels of room light to operate efficiently. Take
care to avoid accidents when working under low light conditions.
Media opacities also absorb or scatter laser light and can block retinal structures.
System response
The device has a fixed laser power of 2.2mW at the patient's eye and includes a laser safety system
that would prevent the system being used if the lasers were operating at unsafe levels. If the power
drops, perhaps due to a build up of dust, the amount of light returned from the eye will be reduced
and will impair image quality. The accumulation of dust and debris in the return path will also impair
the image quality.
Detector gains
As the laser power at the eye is a fixed value, the returned retinal information will vary depending on
the amount of light reflected by the pigmentation in the patient's retina. To ensure the greatest
amount of information is detected and that the image quality is optimum, the red and green
detectors are set to a specific gain level. This gain level is initially set when the patient's iris category
is entered into the patient details.
The iris category sets the detectors to expect a certain amount of light back from the patient's retina.
You should assess the patient's hair color, eye color and skin tone to determine the most
appropriate iris category. You can create your own iris categories if you need to.
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In patients who have high pigmentation levels the "dark" iris category is selected. This sets
the detectors to expect less light back from the patient's retina.
In patients who have medium pigmentation levels the "medium" iris category is selected.
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In patients who have low pigmentation levels the "light" iris category is selected. This sets
the detectors to expect a greater amount of light back from the patient's retina.
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Note
The detector gains can be adjusted and used when the next image is captured.
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Capture application Optimize Image - changes the red and green contrast settings to the ideal levels
required, see Checking the quality of captured images on page 36. These settings are applied when
the next image is captured.
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Increasing the values will produce a brighter image. Although increasing the values may brighten the
periphery, there is a risk the optic disk may be saturated.
Decreasing the values will produce a darker image. Although decreasing the values may make details in the
optic disk clearer, there is a risk the periphery may be very dark.
The red and green values may be different.
Review application optimization - maximizes the range of pixel levels displayed on the screen and
adjusts the gamma setting, so that the average intensity of the display matches an ideal value.
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Chapter 3 - About the software applications
3
About the software applications
V2 Vantage Pro contains five applications. Each application contains the tools needed to perform
specific tasks. Some applications run automatically when the device is switched on. You can run
other applications by double-clicking the relevant icon on the desktop.
The applications need access to the same network so that images can be saved, reviewed and
archived.
The Capture application runs on the scan head. This application lets you control the device and
capture and check the quality of images.
There are different types of image for each type of procedure:
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optomap - captures a retinal image. The standard optomap procedure is a wellness exam.
This procedure captures a standard optomap retinal image.
optomap plus - captures a medical retinal image. The optomap plus procedure is a
medical retinal exam. Following this procedure will allow the use of the enhanced features
in the Review Application.
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Lets you configure your system. You can set password requirements, create
new users, modify existing users, and set a variety of system controls.
V2 Vantage Pro
Admin
V2 Vantage Pro
Capture
You can also run the Admin application by selecting Start > All Programs > optos
V2 Vantage Pro > Admin.
The Capture application runs automatically when the Capture PC is switched
on. If the Capture application does not run automatically select Start > All
Programs > optos V2 Vantage Pro > Capture.
Lets you review, annotate and add diagnostic codes to captured images. Also
contains exporting, e-mailing and printing tools.
V2 Vantage Pro
Review
You can also run the Review application by selecting Start > All Programs >
optos V2 Vantage Pro > Review.
Lets you archive images and manage the database and image files.
V2 Vantage Pro
Storage
You can also run the Storage application by selecting Start > All Programs >
optos V2 Vantage Pro > Storage.
Lets you manage patient records and appointments for the optomap Retinal
Exam.
V2 Vantage Pro
Scheduler
You can also run the Scheduler application by selecting Start > All Programs >
optos V2 Vantage Pro > Scheduler.
3.1 Admin application features
The Admin application lets System Administrators and Optos Representatives configure the system.
Admin application features include:
Application access control tools to let you create and manage user details.
l Application configuration options let you configure your system.
l Personal data protection controls to let you set password and operation modes to protect
medical records. These settings can force login authentication to prevent unauthorized
viewing of sensitive patient data (all passwords are case sensitive).
l Options to create unique patient identifiers to decrease the risk of inadvertent disclosure of
a patient's identity.
When you run the application you will be prompted to enter your Username and Password. If it is the
first time the application has been run, enter the default login details listed below. Otherwise enter
the changed details.
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1. Username – Administrator
2. Password – optomap (all passwords are case sensitive). Click OK.
You should create a username and password for each user.
You can run the Admin application from the following:
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Double-click the desktop icon Start Menu – Start > All Programs > optos V2 Vantage Pro > Admin
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3.2 Capture application features
The Capture application lets you control the device. You can capture images, check the quality of
images and decide which images are saved or discarded or need to be recaptured.
Warning
Please read the safety information in the Introductory Handbook before
attempting to use the system.
The Capture application features include:
An image display showing thumbnails of all the images captured in the patient session, with
a large image for assessing image quality, field, and exposure.
l The application automatically saving images when the session is closed. Images marked to
be discarded will automatically be discarded when the session is closed.
l optomap plus Capture procedures. Access to these procedures depends on your system
settings: ask your Optos representative for more information. These procedures let you
capture different types of optomap images, for example eye steered images and ResMax
images. When an image has been captured using an optomap plus Capture procedure it
can be reviewed using one of the optomap plus Review features.
If the Capture application does not run automatically:
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Double-click the desktop icon Start Menu – Start > All Programs > optos V2 Vantage Pro > Capture.
3.3 Review application features
The Review application lets you measure, annotate and add diagnostic codes to images. You can
also import, export and e-mail optomap images.
optomap plus, optomap fa and optomap af images are reviewed using the enhanced features that
are automatically made available when these images are opened.
Analysis
Review application features include:
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Comparative image reviewing tools that allow images to be easily displayed and linked
together for simultaneous image viewing.
Automatic registration of image features. These registered points are used to align images
that are viewed together. You can also register image reference points manually.
Annotation and Measurement tools that provide graphical mark-ups on the images. These
mark-ups are saved with the patient medical record.
Image Measurements including distance and area measurements, and cup-to-disk ratio.
Review Notes indicating image review status, comments and ICD-9 diagnostic pathology
coding.
You can review the current image in the Simulated BIO view. This view simulates the retinal
view as it would be seen via a Binocular Indirect Ophthalmoscope (BIO).
You can also use the 3D Wrap view for patient education purposes. The 3D Wrap view
displays the current image on a 3D model eye. You can run the animated "Fly-Through" or
demonstrate refractive errors and Intraocular Lenses.
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Distribution
Once you have completed your review you can send the image to someone else. You can e-mail,
export or print images. If the recipient has the optomap image viewing application they can review
the original image, see the Optos web site (optos.com) for download instructions. Alternatively, an
adjusted image can be sent. The reviewer can look at the image using any common graphics
application.
You can print images using a variety of ways using the printing features.
You can also import images into the patient's record.
The Review application is run from the following:
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Double-click the desktop icon Start Menu – Start > All Programs > optos V2 Vantage Pro > Review.
Setting User Preferences
You can control some of the Review application features. Select the options you want to be used
each time you log in.
1. Select Tools menu > Preferences to display the User Preferences dialog box. You can only set
preferences for the user who is currently logged in.
2. Image Review tab - Select the options you want to viewing images.
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Image Information pane - Select the options to define how images are initially
displayed.
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Remind to Add Review Note – Will prompt the user to add a review note if the image
is being reviewed for the first time.
Hide Information panel when Opening Image – The Information pane shows the
Annotations and Review Notes that were saved with the image. You can hide
this pane to create a larger viewing area.
Hide Adjustment panel when Opening Image – The Adjustment pane shows the
adjustment controls, including contrast and brightness options. You can hide this
pane to create a larger viewing area.
Show Annotations when Opening Image – Displays all the annotations that were
added in previous reviews.
Automatic Image Registration – Sets the application to automatically locate the
optic disk and macula.
Disable Deletion of Reviewed Images – When selected, this option prevents the
deletion of images which have already been reviewed. Only images that have not
been reviewed can be deleted.
200Dx/P200 Image Enhancement pane - Selecting Show Enhanced Image View removes
distortions created by the 200Dx/P200 scanning mechanism.
l Image Projection pane - Selecting Show ProView Image (Show ProView Image ) displays
image in ProView1 mode.
3. Layout tab - Select the Start-Up Screen and Window Layout options.
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Start-up Screen pane – Select the screen you want to be displayed when you run the
Review application.
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Welcome dialog – Shows the three most commonly used methods for opening
patient images.
Select Patient – Displays the Select Patient dialog box. Once you have selected a
patient the Patient History dialog box is displayed.
None – No dialog boxes are displayed when you run the Review application. You
can open images using the toolbar or menu options.
1ProView addresses the inherent bias in any curved surface when shown in a flat plane. ProView is applied to all ultra widefield images and enhances
comparison overlay and 3D wrap features.
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Window Layout pane - Select this option to maximize windows that show a set of
image thumbnails for example, Patient History, Image Set, Image Library and others
when they are opened.
4. Confirmations tab - Define which confirmation dialog boxes you want to be displayed.
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Saving Annotations - Displays the Confirm dialog box when annotations have been added to
an image that is being closed.
Deleting Images - Displays the Confirm dialog box when an image is being deleted.
Change Image Laterality and Move Images between Patients - Displays the Confirm dialog box
when an image is moved between left and right sides or between patient records.
Accept 'Image Everyone' session as billable - At sites where the Image Everyone workflow is
in place, this option displays the Confirm dialog box when a review session is recorded as
billable. Contact Optos for more information on Image Everyone, see Contact us on page
113.
5. 3D Wrap Options tab - Set the 3D Wrap view Options.
Quality settings - Set the required quality setting. If your PC runs slowly when
viewing the 3D Wrap view, you should reduce the quality setting. You can also
disable the 3D Wrap view feature.
l Start fly-through when 3D Wrap view opens - Sets the system to automatically show
the animated 3D Wrap view of the current image when the 3D Wrap view is opened.
6. Import, Export and Printing tab - Define the options to be used when distributing images.
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Image Import and Export pane - Select the options to be used when importing and
exporting images.
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Use File Date/Time as Image Time Stamp – Uses the capture properties stored with
the image file to set the time and date in the image database. If you do not select
this option, the date and time the file was imported will be used as the image time
stamp.
Show Image Preview when Exporting – Presents a preview of the image as it will be
exported. If you do not select this option you will not be able to check the image
during the export process.
Printer Output Compensation pane - helps you compensate for the difference
between the screen output and the printed output. Drag the slider to darken or
lighten the print output.
l Click One-Click Export Settings to configure the options see Configuring One-Click
Export Options on page 74.
7. Stereo tab - Some systems are capable of capturing Stereo Images. Select the options to be
used when reviewing Stereo Images.
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Stereo View Mode pane - when viewing Stereo Images you need to look at the images
in a way that merges a left and right pair of the same eye. Select the viewing
technique to be used:
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Divergent - where your focus is behind the images or when you are using a stereo
viewer (stereograph) to view the images.
Convergent ("cross-eyed") - where your focus is in front of the image.
Stereo View Center pane - when viewing images the system will open both left and
right Stereo Images of the same eye. You need to define where these images
should be centered:
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Optic Disk - images are centered on the optic disk.
Macula - images are centered on the macula.
Show Stereo Overlays - you can select whether an overlay is shown when reviewing
Stereo Images. The overlay can help when you attempt to merge the left and right
Stereo Images.
8. Click OK to save your settings.
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Note
The Preferences dialog box displays the name of the current user.
Enhanced 200Dx/P200 mode is not available when images are being displayed in ProView mode.
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3.4 Storage application features
The Storage application lets you archive the patient database and image files. You can also clean out
the hard disk to make space for new images. The database and images must be archived and
cleaned up regularly to make space for new image files and to provide a backup if the data is lost or
damaged.
Storage application features include:
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Almost fully automated CD or DVD archiving so all you have to do is put in a disk and start
the process
Scheduled archiving to either a network location or a NAS device1
Integrated verification that confirms the data writing process was successful
Storage Status indicating the online storage status and how many images are not archived
The database holds patient information and references the location of the image files. The image
files are initially held in a separate image store on the PC hard disk. These image files are large and
must be archived and cleaned up to make space for new image files. If you do not archive regularly
you will fill the hard disk and be unable to capture more images. Lost or corrupted files can be
restored from the archived backups. The Review application displays the archive disk label if the
image is requested.
The Storage application is run from the following:
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Double-click the desktop icon Start Menu – Start > All Programs > optos V2 Vantage Pro > Storage.
3.5 Scheduler application features
The Scheduler application lets you manage patient records and appointments. You can create
patient records before the optomap Retinal Exam takes place. Patient records are stored on a
single database, this helps to eliminate the risk of duplicating patient records.
Scheduler application features include:
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Adding or editing patient details
Adding or editing patient appointments
Daily, weekly or monthly appointment views
The Scheduler application is run from the following:
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Double-click the desktop icon Start Menu – Start > All Programs > optos V2 Vantage Pro > Scheduler.
Note
The Scheduler application only connects to the Optos database and so should not interfere with other
applications.
1A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network. It has its own network address.
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3.6 About software updates
Push software is a feature where software updates are pushed out and are automatically
downloaded by the system. This is similar to how other software applications automatically update
software.
When the application is closed it checks if an update is available. A message box is displayed if an
update is available, otherwise the application closes as usual.
The message box lets you choose to install the update now or install the update later. If the update
has been assigned the high priority the message box will appear each time the application is closed.
The message box will appear less frequently if the update has been assigned a lower priority. The
update should be installed as soon as practically possible. Please ensure all PCs in the system are
updated.
The update may run and install silently or the user may have to respond to the prompts as the
update is installed.
Checking for updates
Each application has a menu option to check for updates. This runs the update checker without
having to close the application.
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Chapter 4 - Getting help
4
Getting help
The help files contain detailed information about how to use the device. You can access this
information from the application at any time by pressing [F1] on your keyboard. You can also access
help files from the application’s Help menu.
If the help files do not answer your problem, please contact Optos, see Contact us on page 113.
Additional material may be available on the customer area of the Optos website. There is a
convenient link from the Help menu, see How to access additional documentation on the web on
the next page.
4.1 Accessing help from the applications
There are several ways to access the help files:
Pressing [F1] for Help with Your Current Task
The help system can display a help topic that relates to the current application window or dialog box.
Press [F1] on your keyboard to display information on the current task.
Help from the Help Menu
The V2 Vantage Pro help files provide a complete library of information about using your device. As
well as introductory information about the many features the help files contain How to topics which
include:
Assigning images to another patient's record
Changing eye images for right to left (and left to right)
Emailing images
Exporting images to a disc
and step by step instructions for all the other relevant tasks
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You can access the application help file from the Help menu. Click Help menu > Optos <application> Help
to display the help file.
How to display the hierarchy of all help topics
1. Click Help menu > Optos <application> Help to display the help file.
2. Click the Contents tab to display the help file hierarchy.
3. Click a topic to display it in the right-hand pane. Alternatively, double-click the book icon and
select from the list of topics that appears.
Note
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New topics are indicated with a yellow star on the topic icon.
Some graphics expand when the mouse is moved over them. Other graphics include hypertext links
at particular points. Hover your mouse over graphics to see if there are any special features available.
You can save the current topic as a favorite by clicking the Add topic to favorites button in the help
toolbar.
You can see where you are in the hierarchy of help topics by using the "You are here:" breadcrumbs
at the top of the help page. You can quickly move back up a level by selecting the You are here link at
the top of the topic.
How to search for help
1. Click Help menu > Optos <application> Help to display the help file.
2. Click the Search tab to display the search pane.
3. Type the words you are looking for. Click List Topics to display the search results.
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Chapter 4 - Getting help
Use ‘?’ to replace a single letter, for example ‘archive?’ to search on ‘archived’ and
‘archives. ’
l Use ‘*’ to replace a group of letters, for example ‘archiv*’ for ‘archive’, ‘archived,’
‘archives’ and ‘archiving'.
4. Optional: You can filter the search results by selecting one of the filter options.
5. Click a topic to display it in the right-hand pane.
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If you do not get the result you were expecting, it may be that the help file does not contain the exact
word or phrase you typed. Try typing a similar word or phrase.
You can save the current topic as a favorite by clicking the Add topic to favorites button in the help
toolbar.
You can save the current search criteria as a favorite by clicking the Add search string to favorites next to
the Search button.
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How to navigate topics
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2.
3.
4.
Click Help menu > Optos <application> Help to display the help file.
Display the topic you require using the Contents, Index or Search tabs.
Repeat for each topic you want to view.
Click Back and Forward to scroll though the topics you have displayed. Only topics you have
viewed will be displayed when clicking Back and Forward. This is particularly useful if you
want to go back to a previous topic and you do not want to search for it again.
How to print help topics
1. Display the topic you want to print.
2. Click the Print button on the help toolbar to display the Print Topic dialog box.
4.2 Optos on the Web
The Optos web site contains a wide variety of information resources. Simply click the Customer link
at optos.com to access the customerlogin area or to register for a username and password.
The Partner area of the web site includes:
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Practice Marketing materials
Clinical materials
Details of training events
Software downloads
How to access additional documentation on the web
1. Select Help menu > Visit the Partner pages at optos.com to access the customer information on
optos.com.
2. Login when prompted.
3. Click your device to display the relevant documentation.
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Chapter 5 - About capturing an image
5
About capturing an image
The following procedure explains how to capture an image using the Capture application. The notes
that follow suggest techniques that can be used to deal with any changes that may be appropriate
for an individual patient.
You should select the appropriate Iris Category for the patient, see Detector gains on page 14.
You should capture at least two images of each eye. If necessary, you can improve the quality of the
next image, see Minimizing over-exposed areas on page 37.
Do not capture images when the eye piece is not in place.
Do not start an archive task if a patient is due to be imaged in the next 30
minutes.
Guidance for use on patients with Epilepsy
Warning
The device uses flashes of laser light. Some patients with epilepsy may be
sensitive to flashes of light. Caution should be exercised for patients who
have a history of reaction to camera flashes or strobe lighting.
5.1 Working with patient records
Please remember to comply with your practice procedures on personal data protection
when storing and distributing patient images.
You should ensure that the correct patient record is selected for each patient.
How to add or edit a patient's record
1. Click Start Session to display the Select Patient dialog box.
2. Click New Patient to create a new patient record and enter the patient's name.
To edit the patient record, click the patient's name and click Details.
3. Enter the patient's Date of Birth. You can use the left and right keyboard arrow keys or [/] to
move between day, month and year.
4. The Patient ID can be entered manually or is generated automatically depending on the
settings in the Admin application.
5. Select the patient's Gender.
6. Select the Iris Category based on the patient’s eye color. The Iris Category sets the system to
expect a defined level of light returned from the retina. Lower light levels are returned when
the patient's retina contains greater pigmentation levels. Selecting an Iris Category that is
too dark may lead to overexposure in the central pole.
7. Select the Practitioner. This information can be used when filtering patient images in the
Review application.
8. Optional: In the Capture application, if patient insurance details have been created in the
Admin application, you can select the insurance details. Click Ins. Company and select the
company from the list displayed. You can also enter the Ins. Code if known.
9. Optional: Enter any Notes about the patient. Click OK.
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Note
Mandatory fields are shown in bold text.
The software will reject invalid dates. If you need to enter a "29 February" date of birth you should
select the year before entering the date and month.
Depending on your system settings there may be colored markers next to some patient names, see
Capture application user reference on page 89.
The software will not allow you to delete a patient record. If you find a duplicated patient record you
should use the Review application to move the images from the duplicated record. You could then edit
the patient's name in the duplicated record; perhaps by adding a "z" to the front to move the record to
the end of the list.
The system itself is not compliant. The system can be configured to be compliant with data protection
legislation, for example Health Insurance Portability and Accountability Act (HIPAA) 1996 (U.S.) or the
Data Protection Act 1998 (U.K.). However, clearing the password settings or using patient initials in
filenames removes any personal data protection.
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How to search the patient list
You can search the patient list using the following methods:
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Clear any filters that may be set. Check that the Show Only Today's Scheduled Patients option
has not been selected.
You can search for an existing patient by typing the last name in the Patient Name field. The
closest last name will be highlighted as you type.
Click the ID column heading to sort patients by ID number. You can then type in an existing
ID to go to the closest ID on the list.
You can check the patient's date of birth by hovering the mouse over the patient's name.
The date of birth will appear in a pop-up window. This is useful if the same name is used by
more than one patient.
A pink marker is used to indicate the patient has previously been imaged following an
optomap plus procedure.
At sites where Image Everyone1 workflow is in use, a blue marker is used to indicate the
patient has previously declined an Image Everyone review.
Note
If the patient is not shown you will need to create a new patient record.
How to filter the patient list
You can filter the patient list to display only those patient records that meet the filter criteria.
1. Set the filter criteria. You can filter by Patient Name, Practitioner, Session Date and
Session (Review) Status.
2. Click OK to set the filter and return to the Select Patient dialog box where the results will be
displayed.
5.2 Cleaning Instructions
Biocompatible materials have been used where the patient comes into contact with the device.
These materials need to be cleaned between patients to reduce the risk of contamination or crossinfection.
Cleaning of the external surfaces of the device should be carried out on a regular basis.
The device will be subject to a scheduled inspection and maintenance routine carried out by Optos
Technical Personnel.
1Some sites operate the "Image Everyone" workflow where every patient is imaged. Billing is associated with the image being reviewed, rather than the
image being captured. This means the doctor reviewing the image gains patient acceptance for the review, rather than other staff offering the image
capture. Please contact your Optos representative for more information.
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The instrument should be cleaned and decontaminated by trained personnel. Always ensure that
the instrument is clean before imaging patients.
Always wear powder-free gloves when cleaning the device.
Warning
Do not use lint cloths, tissues, or other materials that may create dust, near
the scan head.
Cleaning before each patient
The areas where the patient comes into contact with the device must be cleaned before each patient
is imaged.
Do not capture images when the eye piece is not in place.
Warning
The following cleaning procedures should be carried out between patients:
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The eye piece must be cleaned with an individually sealed, 70% isopropyl alcohol wipe and
allowed to air-dry between patients.
Do not let the cleaning wipes come into contact with the inside of the instrument.
Do not use tissues or other material to dry the areas that have been cleaned as this could
create dust. Dust could collect on the scan head mirror and optical components and impair
image quality. Always allow cleaned areas to air-dry.
The wipes should be checked periodically to ensure that they are within their marked
expiration date.
General Cleaning
The equipment should be kept clean and dust free.
Ensure debris does not fall inside the device.
Warning
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Do not use solvent.
Log off, shut down and power off the scan head before cleaning the outer casing of the scan
head
Use a soft, slightly damp cloth to clean the plastic surfaces
Use a glass-cleaning agent to clean the PC monitor screen
Cleaning the Main Mirror
The device has been designed to minimize the accumulation of dust. Depending on the operating
environment dust particles may affect image quality. If you think dust may be accumulating on the
main mirror you should follow the procedure below.
Note
You should not clean the mirror routinely. Only clean the mirror if dust particles and spots have accumulated on
its surface.
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Safety
The edges of the main mirror are sharp. Do not touch them.
Only clean the area of the main mirror that you can see. Do not put your
hand or any cleaning material into parts of the device you cannot see.
Preventing mirror damage
The mirror surface does not need to be polished; only dust particles and
spots need to be removed.
Warning
Remove any rings, watches, bracelets, jewelry or other items which may
come into contact with the mirror surface.
Dust
Do not use lint cloths, tissues, or other materials that may create dust, near
the scan head.
Gloves
Always wear powder-free gloves when cleaning the device. If gloves
become contaminated in any way they must be disposed of and replaced
immediately.
1.
2.
3.
4.
5.
Capture a reference image.
Shutdown and switch off the device, see Closing the system each day on page 12.
P200 - Remove the eye piece.
200Dx - Remove the face pad.
P200 - Unlock and open the hatch on the front cover. You will need to hold the hatch open
while cleaning the mirror.
6. Using the flashlight, look through the eye aperture and inspect the surface of the mirror for
visible dust. Take notice of any smudges or spots.
7. Gather the corners of a clean dry Opto-wipe® cloth into a ‘mushroom’ shape. Use the
‘mushroom ball’ to gently wipe the mirror.
8. Reach into the eye aperture and carefully wipe the visible surface of the mirror.
Starting at one side of the mirror, use single diagonal downward strokes to gently
wipe the mirror
l Always start from the top of the area you can see
l Do not rub the mirror
l Dispose of the dirty cloth after each wipe to avoid transferring the dust back on to
the mirror. You will have to use several wipes to clean the mirror
Using the flashlight, check the mirror again for any remaining smudges or spots. If the
mirror appears to be clean, go to step 14 (P200)/ 15 (200Dx) of this procedure.
If the main mirror still shows smudges or spots, dip a clean dry Opto-wipe® cloth in deionized water. Shake off excess water and gently wipe the spot.
Use a clean dry Opto-wipe® cloth to remove any water smears.
Inspect the mirror surface with the flashlight and confirm all dust particles and spots have
been removed.
Repeat cleaning with another clean dry Opto-wipe® cloth if necessary.
P200 - Refit the eye piece.
200Dx - Refit the face pad.
Take another image and compare it to the original reference image to determine if the
image quality has been sufficiently improved.
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12.
13.
14.
15.
16.
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Note
Gentle wiping maybe necessary. It is better to gently wipe the spot several times than to rub the spot too hard as
this may damage the mirror.
5.3 Patient Instructions
Take a minute to put the patient at ease. Explain the following to the patient:
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A set of digital images will be captured during the procedure.
The imaging process is not invasive and there is no contact with the patient's eye.
The procedure is similar to having a photograph taken, so there will be a flash when each
image is captured.
Guidance for use on patients with Epilepsy
Warning
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The device uses flashes of laser light. Some patients with epilepsy may be
sensitive to flashes of light. Caution should be exercised for patients who
have a history of reaction to camera flashes or strobe lighting.
The operator will guide the patient throughout the procedure. The patient should follow all
instructions given by the operator.
Explain that the patient will be asked to look into the instrument with ONE eye. The process
will then be repeated for the other eye. It may be beneficial to image the patient's best eye
first.
Explain that the patient should look directly at the green ball.
Explain that you will ask the patient to move in until the patient can see a thin red ring;
center the green ball in the ring. If capturing Stereo Images the patient will see slightly less of
the red ring when aligned to each side.
Explain that you will monitor their position on the screen and let them know when you are
going to capture the image or when to press the capture button, depending on who is
activating the capture.
The patient should maintain fixation on the light at all times.
The patient should keep their eyes open as wide as possible throughout and keep their
head in position.
Explain that the patient will see a flash when the image is captured.
5.4 Capturing images
Aligning the patient accurately is the key to capturing good images. It is essential that the patient
understands what to do and presents their eye to the device in the correct manner.
Some Capture procedures allow the capture of eye steered images, see Capturing Eye Steered
Images on page 34. Eye Steered Images are images of the same eye where the patient is asked to
make a slight change in the direction they are looking. You can select from four directions; Inferior,
Superior, Nasal and Temporal. The direction of gaze is marked on the thumbnail image. Always
capture a central, on-axis image first and before capturing the required eye steered directions.
Depending on your system settings you may be able to capture Stereo Images. The procedure for
capturing Stereo Images differs from the standard procedure in this topic, see Capturing Stereo
Images on page 35.
In normal imaging the iris should fit just inside the outer circle (limbus ring) shown on the External Eye
Camera view. When the patient is in the correct position, press the hand switch button to capture the
image. Contact Optos if you think the limbus ring position needs to be altered, see Contact us on
page 113.
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The external eye view is stored when the image is captured. You can check the External Eye Camera
view to see how the patient was aligned when the image was captured.
The Fixation Level controls the brightness of the green ball which helps the patient look in the correct
direction. The Fixation Level can be altered if the patient is having trouble seeing the green ball. You
should select the dimmest level the patient can see to ensure the best possible image.
To help guide the patient to see the fixation light, the operator can monitor the patient's position in
the Capture Right/Left Eye dialog box, see Good Quality Image example on page 39.
How to capture
1. Prepare to capture an image
Check the device has warmed-up and that the device is ready to capture.
Clean the relevant parts of the device, see Cleaning before each patient on page
29.
l Dim the lighting in the room to achieve maximum natural dilation of the pupils
before attempting to capture an image.
2. Position the chair
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Explain to the patient what is about to happen, see Patient Instructions on the
previous page.
l Ask the patient to sit in the chair.
l Move the chair forwards until the patient is sitting upright and their face is close to
the eye piece.
3. Position the scan head table height
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Adjust the scan head table height so that the patient's eye is aligned with the center
of the limbus ring shown on the External Eye Camera view.
4. Position the Patient
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Ask the patient to look at the green ball.
Ask the patient to rest their head against the eye piece and look into the device.
5. Capture a normal image
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Align the patient's eye so that the cross is in the center of the pupil and that the 3
and 9 o'clock sides of the limbus ring cover the patient's limbus. The system is
aligned with the patient's eye when the patient can see a faint red haze around the
edge of the green ball.
Ask the patient to open both eyes as wide as they can.
l Check the pupil and limbus positioning.
l Capture the image by pressing the capture button on the hand switch.
Alternatively, you can capture the image by pressing [F8] on the keyboard.
6. Capture alternative images
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How to capture ResMax images
Select ResMax before capturing the image.
7. Check the quality of the image, see Checking the quality of captured images on page 36.
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8. Discard any unwanted images.
9. Capture more images or click End Session to complete the session.
Note
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The Fixation Level controls the brightness of the green ball. Always use the dimmest Fixation
Level setting the patient can see.
If the patient's lids and lashes are in the way follow your practice procedures to minimize
this, see Minimizing lids and lashes in images on page 40.
Positional Reflex (bright spots) may occur when patient is too far in.
The Image Setting pane shows the External Eye Camera view when the image was captured.
You can use this to help determine the adjustments required for subsequent images. You
can also adjust the settings for the next image to be captured from this pane.
When swapping between left and right eyes you should check the table height and make
any necessary adjustments.
When imaging children, depending on the height of the child, ask the child to stand straight
in front of the device.
Eye steering is not available for every procedure.
Some devices are fitted with Table Emergency Stop buttons. To halt the table in an
emergency situation, press the red Table Emergency Stop button near the top of the table
pillar. To reset, twist the Emergency Stop button clockwise until it pops out.
5.5 About eye steering
You can use eye steering to control the retinal area that is captured. Eye steering is when you ask
the patient to look in a direction other than directly at the green ball in the fixation pattern. It allows
you to capture more of a peripheral area of interest by guiding where the patient looks.
You should always capture an image on the central, on-axis direction first. This is because eye
steered images often have areas where lid and lash obscures part of the image. Once you have
captured the normal axis image you can then capture the steered images.
Ask the patient to look in the direction indicated to take an eye steered image. For example, to take
an image showing more of the 3 o'clock area of the image (shown as 'B' below) direct the patient's
gaze to 9 o'clock.
When capturing eye steered images, the Capture application displays which directions have been
captured. You can quickly select the next steered direction to be captured by clicking the point on
the graphic.
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In this example the on-axis, 12 o'clock and 3 o'clock directions are shown in a lighter shade of green
to indicate these directions have been captured.
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In the Review application the image thumbnail shows the relevant direction: Inferior (I), Superior (S),
Nasal (N) or Temporal (T).
Eye steering is not available when Stereo Images are being captured.
5.6 Capturing Eye Steered Images
Eye Steered Images are images of the same eye where the patient is asked to make a slight change in
the direction they are looking. You can select from four directions; Inferior, Superior, Nasal and
Temporal.
How to capture
Clean the relevant parts of the device, see Cleaning before each patient on page
29.
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Explain to the patient what is about to happen, see Patient Instructions on page 31.
l Ask the patient to sit in the chair.
l Move the chair forwards until the patient is sitting upright and their face is close to
the eye piece.
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Adjust the scan head table height so that the patient's eye is aligned with the center
of the limbus ring shown on the External Eye Camera view.
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Ask the patient to rest their head against the eye piece and look into the device.
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Align the patient's eye so that the cross is in the center of the pupil and that the 3
and 9 o'clock sides of the limbus ring cover the patient's limbus. The system is
aligned with the patient's eye when the patient can see a faint red haze around the
edge of the green ball.
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Check the pupil and limbus positioning.
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How to capture Eye Steered images
If you are capturing eye steered images you will need to ask the patient to look in a
particular direction before capturing the image, see About eye steering on page
33. You should always capture an on-axis image before capturing eye steering
images.
Ask the patient to keep their head in position between eye steered directions.
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7. Check the quality of the image, see Checking the quality of captured images on the next
page.
9. Capture more images or click End Session to complete the session.
Note
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Eye Steering is not available when capturing Stereo Images.
When swapping between left and right eyes you should check the table height and make
any necessary adjustments.
Some devices are fitted with Table Emergency Stop buttons. To halt the table in an
emergency situation, press the red Table Emergency Stop button near the top of the table
pillar. To reset, twist the Emergency Stop button clockwise until it pops out.
5.7 Capturing Stereo Images
Some systems may be configured to capture pairs of Stereo Images. Stereo Images are images of the
same eye where two images are captured a few millimeters apart. The images are identified as
Stereo 1 and Stereo 2.
You must capture both Stereo 1 and Stereo 2 images to complete the pair.
Stereo Images should not be used for diagnostic purposes.
Warning
The Stereo 1 and Stereo 2 pairs are displayed as Linked Images in the Review application. optomap,
optomap plus and ResMax images can be captured as Stereo Images.
When reviewing Stereo Images you need to either:
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Use a stereo viewer (stereograph)
Focus in front of the images
Focus behind the images
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How to capture
l Clean the relevant parts of the device, see Cleaning before each patient on page
29.
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Explain to the patient what is about to happen, see Patient Instructions on page 31.
Ask the patient to sit in the chair.
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l Check the pupil and limbus positioning.
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How to capture Stereo images
If you are capturing Stereo Images you will need to capture Stereo 1 and Stereo 2 images of
the same eye. You should always capture a Normal image first and then:
Select the Stereo 1 option. The rings will move to one side slightly. Align the patient
using the rings as before and capture the image.
l Select the Stereo 2 option. The rings will move to the other side slightly. Align the
patient using the rings as before and capture the image.
7. Check the quality of the image, see Checking the quality of captured images below.
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Stereo Image capture is not available when capturing Eye Steered images.
As with capturing standard optomap images, the patient should look directly at the green
ball. The extent to which patients are moved to one side or the other is controlled when the
alignment rings are moved to the side. There is no change to the patient instructions when
capturing Stereo Images.
5.8 Checking the quality of captured images
You should check the quality of each captured image to determine if the exposure settings need to
be changed to suit the patient’s individual characteristics.
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Captured image thumbnails are tiled and displayed at the side of the main image display area. Click
an image thumbnail to display it in the main image viewing area.
The captured image will be displayed in the Image Quality view. Depending on your system
configuration other views may also be available, see Capture application user reference on page
89. The Image Quality view displays the Red Channel view in the center, the Exterior Eye Image and the
Composite Image view on the right hand side. Using this view makes it easier to judge if the patient
was correctly aligned and if the capture exposure levels need to be adjusted before the next image
is captured.
Image examples:
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Good quality image example, see Good Quality Image example on page 39.
Poor quality image example, see Badly aligned images - examples on page 39.
Lids, lashes obscuring the image
You may find that lids and lashes cover part of the image, obscuring some areas of the retina. This
may happen if the patient was too far away from the device, or blinked, when the image was
captured. Use the External Eye Image to check the patient alignment, see Checking the Exterior Eye
Image below.
Lids and lashes may sometimes obscure part of the image. You can reduce this by following your
practice procedures, see Minimizing lids and lashes in images on page 40.
Minimizing over-exposed areas
When you have captured an image that is not obscured by lids or lashes you should check the
exposure levels.
The captured image is displayed in a view which automatically shows the areas where the red and
green channels are over exposed. Select one of the Optimize Image options improve the next image.
The system will assess the image and adjust the exposure settings.
Use current settings - maintains the current settings.
l Improve whole image - improves the quality of the next image. This option aims to reduce
any over-exposed areas without making the periphery areas too dark.
l Improve Optic Disk - optimizes the next image to improve the optic disk. Removing overexposed areas of the central pole may result in the periphery being dark. Depending on the
type of image captured, some images may still show over-exposed areas.
You can change the exposure settings manually by dragging the Red Channel Adjusted Level and
Green Channel Adjusted Level sliders to the required level.
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It may not be necessary to remove all saturation. In some cases, attempting to remove all the saturation in the
optic disk may cause the periphery to be too dark in the next image.
5.9 Checking the Exterior Eye Image
The exterior eye camera view from the last image is displayed in Image Quality view. You can use this
to determine what alignment alterations are required for the patient's next image.
The cross should be centered in the patient's pupil, with the ring around the iris:
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Image examples:
Good quality image example, see Good Quality Image example on the facing page.
Poor quality image example, see Badly aligned images - examples on the facing page.
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Images are saved automatically, however too many files can be difficult to manage, so you should
discard those that you do not want to keep.
1. In the Capture application window, click the thumbnail of a captured image to select it and
then click Discard Image. The image will be marked with a red cross.
2. When you end the session the images marked with a red cross are discarded.
If you change your mind, and decide to keep a discarded image, right-click the image marked for
deletion and select Keep Image from the pop-up menu. Discarded images cannot be restored after
the session has ended.
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Images to be discarded are marked with a red cross.
You can choose not to display discarded images by selecting View menu > Show Discarded Images to
switch the display on and off.
The database records the location of the image files. It is important that any image deletions are
performed using the Optos software and not directly through Windows® Explorer. This will ensure the
database record is updated.
5.11 Patient positioning
You can improve the quality of a captured image by properly positioning the patient. There are
simple ways to improve the patient's positioning.
Capturing an image from a well-positioned patient should produce a good quality image, see Good
Quality Image example on the facing page.
Note
Sometimes the patient may be misaligned, see Badly aligned images - examples on the facing page.
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Good Quality Image example
The following is an example of an optomap image of a well-positioned eye. This is the type of image
you should be trying to achieve.
If you do not capture an image like this you should check the instructions for capturing an image, see
Capturing images on page 31.
Note the following:
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The thin green edge.
Only a few eye lashes showing at the bottom of the image.
Well aligned image
External Eye Camera view
Badly aligned images - examples
These images show the results of various types of alignment problems.
Patient blinks
Patient's eye closed
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Patient too near
Patient much too near
Patient too far away
Patient much too far away
Too far left
Too far right
Patient too high
Patient too low
Minimizing lids and lashes in images
In some patients, images may be obscured by the patient's lids and lashes. You should follow your
practice procedures to minimize lids and lashes in images.
In some cases the amount of lid and lash can be minimized by gently lifting the patient's eyebrow.
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1. With clean hands, place your thumb below the patient's eye and your forefinger on the brow
line.
2. Gently open the eye a little further. Just lifting the upper lid may pull the lower lid further into
the image.
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Chapter 6 - About reviewing images
6
About reviewing images
Images can be selected and opened in a variety of different ways. Typically, you select the images
you want to review and then you choose how you want the images to be opened, for example
stacked on top of each other, or linked so that you can see multiple images at the same time.
Images are selected and opened from the Patient History view, see About the Patient History view on
page 45. This view contains all the functionality for managing how images are opened and is the
main interface for opening images. Other methods of selecting and opening images are available,
see Opening images using alternative methods on page 50.
Once an image or group of images has been opened you can use the viewing tools to zoom, pan
and control how the image is displayed. Using these options will help you review the whole image,
see Recommended reading protocol on page 54. Some review tools are not available when the
image was captured using a standard optomap capture procedure. They are only available when
the image was captured using an optomap plus or optomap fa capture procedure. The relevant
tools are made available when the image is opened.
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All optomap images can be reviewed in the Review application, regardless of which type of device was
used to capture the image.
Images from several sessions can be opened together to allow comparisons to be made over time.
Fluorescein images are captured in optomap fa capture procedures.optomap fa image series are
shown as a single thumbnail image in the Patient History view. Opening the thumbnail opens all the
images in the Image Series view. From here you can open single image, or play a stack of images using
the FA Slideshow, see Selecting images from the Image Series view on page 50.
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Chapter 7 - About the Patient History view
7
About the Patient History view
The Patient History view provides easy access to all the images for the selected patient. Select
images from the image list and then choose option you want to use to open them.
To select images from the...
Description
Each session is identified by its date. Double-click
the date to expand the session to show all the
images that were saved.
Session list
A pink marker indicates sessions which were
captured using an optomap plus capture
procedure. In countries where reimbursement
procedures are applicable a purple marker and the
procedure code will be displayed next to the
procedure name, see Using procedure codes on
page 66.
You can mark the images to be opened by clicking
the image thumbnail.
optomap fa image series are represented by a
single thumbnail image. Selecting this thumbnail
will open all the images in the Image Series view
where you can choose how you want the images to
Left and right thumbnail image be opened, see Image Comparison Methods on
lists
page 103.
Eye steered images are shown individually.
Pairs of Stereo Images are shown as one
thumbnail. When you open the image, both left
and right Stereo Images are displayed, see Setting
User Preferences on page 20.
Image list
All the images, for both eyes, are listed in date
order, with the most recent image at the top. Click
each image you want to select.
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Once all the images have been selected you can choose how the images should be opened. If you
select one image the Open in Image Stack Window is enabled. If you select more than one image all
window buttons are enabled. Click the appropriate button to select the most suitable way of
comparing the images. You can open images in different ways depending on how you want to
review them, see Image Comparison Methods on page 103.
Note
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Right-click an image to display the pop-up menu where you can open the image or display Review
Notes.
optomap plus Review procedures are only available when the image was captured using an
optomap plus Capture procedure. Ask your Optos representative for more information about optomap
plus. These markers are also shown on the image thumbnails.
If the secondary (compressed) image has been cleaned out, the label of the disk on which the image
is sorted will be displayed. Insert this disk in the disk drive to retrieve the image.
Images that have been imported into the patient's history are indicated by the Imported Image symbol - § , see Review
Tools Controls on page 95.
7.1 Working with patient records
Please remember to comply with your practice procedures on personal data protection
when storing and distributing patient images.
Patient records are usually created before the image is captured, so you should not normally have
to create a new record when reviewing images. When following the instructions below, you should
pay particular attention to checking the patient record does not already exist.
You should ensure that the correct patient record is selected for each patient.
How to add or edit a patient's record
1. Select Review Menu > Patient History to display the Select Patient dialog box.
2. Click New Patient to create a new patient record and enter the patient's name.
To edit the patient record, click the patient's name and click Details.
3. Enter the patient's Date of Birth. You can use the left and right keyboard arrow keys or [/] to
move between day, month and year.
4. The Patient ID can be entered manually or is generated automatically depending on the
settings in the Admin application.
5. Select the patient's Gender.
6. Select the Iris Category based on the patient’s eye color. The Iris Category sets the system to
expect a defined level of light returned from the retina. Lower light levels are returned when
the patient's retina contains greater pigmentation levels. Selecting an Iris Category that is
too dark may lead to overexposure in the central pole.
7. Select the Practitioner. This information can be used when filtering patient images in the
Review application.
8. Optional: Enter any Notes about the patient. Click OK.
Note
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Mandatory fields are shown in bold text.
The software will reject invalid dates. If you need to enter a "29 February" date of birth you should
select the year before entering the date and month.
The software will not allow you to delete a patient record. If you find a duplicated patient record you
should use the Review application to move the images from the duplicated record. You could then edit
the patient's name in the duplicated record; perhaps by adding a "z" to the front to move the record to
the end of the list.
The system itself is not compliant. The system can be configured to be compliant with data protection
legislation, for example Health Insurance Portability and Accountability Act (HIPAA) 1996 (U.S.) or the
Data Protection Act 1998 (U.K.). However, clearing the password settings or using patient initials in
filenames removes any personal data protection.
How to search the patient list
You can search the patient list using the following methods:
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Click Clear to clear any filters that may be set.
You can search for an existing patient by typing the last name in the Patient Name field. The
closest last name will be highlighted as you type.
Click the ID column heading to sort patients by ID number. You can then type in an existing
ID to go to the closest ID on the list.
You can check the patient's date of birth by hovering the mouse over the patient's name.
The date of birth will appear in a pop-up window. This is useful if the same name is used by
more than one patient.
Note
If the patient is not shown you will need to create a new patient record.
How to filter the patient list
You can filter the patient list to display only those patient records that meet the filter criteria.
1. Set the filter criteria. You can filter by Patient Name, Practitioner, Session Date and
Session (Review) Status.
2. Click OK to set the filter and return to the Select Patient dialog box where the results will be
displayed.
7.2 Using the Patient History window
The Patient History window lets you carry out a wide variety of tasks:
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Open single or multiple images in a variety of different ways, see Opening images below.
Import an image into the patient's record, see Importing an image to a patient’s record on
page 75.
Move an image captured with the wrong eye selected, see Changing eye images from
Right to Left (and Left to Right) on page 77.
Move an image when the wrong patient was selected, see Assigning an image to another
patient’s record on page 78.
Drag and drop images onto the Print Bar. If you want to print annotations, open the image
and select the annotations before adding to the Print Bar, see Printing images on page 75.
Drag and drop unwanted images to the waste-basket, see Discarding unwanted images on
page 51.
Select from all the patient's images when emailing if you start the email procedure from the
Patient History window, see Emailing Images on page 71.
7.3 Opening images
The Patient History window contains the most common options for opening images. From this view
you can select images and choose how the images should be displayed.
How to view the patient's image history
1. Select Review menu > Patient History to display the Select Patient dialog box. If the patient’s
name does not appear on the patient list, click Clear in the Filter Patient pane. This will clear
the filter and ensure all patient records are displayed.
2. Double-click the patient’s name to open the patient's Patient History view. You can search
for a patient's record, see How to search the patient list above.
3. Select the correct patient and click OK to display the Patient History view.
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Note
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You can set filter criteria to reduce the number of patients shown. Click Change to display the Filter
Patients dialog box. You can select from any (or all) of the sections.
Click Clear Filters in the Filter Patients dialog box to remove all filters.
Primary (uncompressed) images will normally be removed from on-line storage after a few weeks
(after they have been archived and cleaned up), so historical images are likely to be archived and
stored elsewhere. You can use the secondary (compressed) image for a comparative review.
However, if you require the full detail of the image, you should locate the primary image.
How to open images in an image stack
An image stack shows multiple linked images in a single window. You can page through the images
one at a time to review and compare them.
Stacked images zoom, pan and move together. Color separations applied to one window are also
applied in other linked windows. However, image adjustments such as Restore, Optimize, Gamma
adjustment are only applied to the selected window.
1. In the Patient History window, click each image you want to open. You must select more than
one image to enable the Open in Image Stack Window button.
2. Click the Open in Image Stack Window button.
3. The images will be stacked in the one window. Click the forward and back buttons
to page through the different images.
Note
You can also stack images by dragging an image from the Patient History window or Windows Explorer and
dropping on to an open image window.
How to open linked images
Linked images zoom, pan and move together. Color separations applied to one window are also
When you navigate to a retinal feature in one image the other linked images will display the same
relative position. This method is particularly useful when comparing multiple images of the same
eye. Left and right eye pairs will horizontally scroll in opposite directions.
1. In the Patient History window, click each image you want to select.
2. Click the Open in Linked Windows button.
3. The images will be tiled across the window.
Note
You must select more than one image to enable the Open in Linked Windows button.
How to open a set of eye steered images
1. In the Patient History window, click each image you want to open. The thumbnails of eye
steered images show the steered direction.
2. Click Open in Image Stack Window to open the group.
3. The eye steered graphic (at the bottom-right of the window) shows which direction is being
displayed:
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Light Green - indicates the eye steered direction of the image currently displayed.
Dark Green - indicates the direction(s) of the other eye steered images in the stack.
Black - indicates this eye steered direction was not captured.
4. Review the images in the usual way.
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How to open stereo images
Warning
1. Select Tools menu > Preferences to display the Preferences dialog box.
2. Select the Stereo tab and confirm the selected options are correct for the viewing technique
being used, see Setting User Preferences on page 20.
3. In the Patient History window, double click the Stereo Images thumbnail for the images you
want to open, see Image Indicators on page 94. The images will be opened in the correct
layout for the review technique being used, see Viewing stereo images on page 58.
Linking images
Linked images zoom, pan and move together. Color separations applied to one window are also
Where images are unlinked, any zoom, pan or drag features only affect the selected window.
How to switch between linked and unlinked modes
Select Window menu > Link/Unlink All Windows to toggle between all open images being linked or
unlinked.
How to open a Set of Linked Images
1. Select Review menu > Patient History to display the Select Patient dialog box. If the patient’s
name does not appear on the patient list, click Clear in the Filter Patient pane. This will clear
the filter and ensure all patient records are displayed.
2. Double-click the patient’s name to select it. You can search for an existing patient by typing
the last name in the Patient Name field. The closest last name will be highlighted as you type.
Select the correct patient and click OK to display the Patient Image dialog box.
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If you want to reduce the number of patients shown, you can set filter criteria. Click
Change to display the Filter Patients dialog box. You can select from any (or all) of
the sections.
Click Clear Filters in the Filter Patients dialog box to remove all filters.
3. Click the thumbnail of each image you want to open in a linked set of images.
4. When all the images have been selected click Open in Linked Windows.
Note
If the secondary (compressed) image has been cleaned out, the label of the disk on which the image is stored
will be displayed. Insert this disk in the disk drive to retrieve the image.
How to link selected open windows
1. Select Window menu > Select Linked Windows to display the Link Windows dialog box.
2. Click the checkbox to select each image to be linked.
3. Select the window layout option from the Window Options pane.
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Leave Layout Unchanged – Links the selected windows but does not change the
current window layout.
Cascade Linked Windows – Links the selected windows and displays images in a
series of overlapping windows.
Tile Linked Windows Horizontally – Links the selected windows and displays the
images in a series of rows.
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Tile Linked Windows Vertically – Links the selected windows and displays the images
in columned windows.
4. Click OK.
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7.4 Selecting images from the Image Series view
The Image Series view displays the images captured during an optomap fa procedure. You can
select which images you want to open and how you want to display them.
How to select images from the Image Series view
All images are automatically selected when you open a series of optomap fa images. Click
an image to change the selection status. Selected images are shown with a blue border.
Select Series menu > Select All to select all the images in the series.
Select Series menu > Select Left Eye Images to select all the images of the left eye.
Select Series menu > Select Right Eye Images to select all the images of the right eye.
Select Series menu > Deselect All to deselect all the images in the optomap fa series. You
can deselect individual images by clicking on them.
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How to open the selected images
Click Open As Stack(s) to open the images in an image stack. If you have selected study eye
and fellow eye images they will be opened in separate stacks.
Click Open in Linked Windows to open a maximum of eight images in linked windows that
zoom, pan and move together.
Click Open in Unlinked Windows to open a maximum of eight images in unlinked windows
where zoom, pan and move functions only affect the selected image.
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How to print the selected images
1. Select the images you want to print.
2. Right click and select Add selected image(s) to Print Bar, see Printing images on page 75.
How to view an FA Slideshow
You can review a stack of optomap fa images in the FA Slideshow.
1. Select the images to be displayed in the slideshow, see Opening images on page 47.
2. Click Open As Stack(s) to display the images. The windows will be grouped by eye and
displayed in a stack view.
3. Click FA Slideshow to display the controls.
4. Click the Play button on the FA Slideshow pane to display the images in a slideshow. You can
use the Rewind and FastForward buttons to move through the FA Slideshow
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Only images of one eye can be displayed in the FA Slideshow.
The Play button changes to a Pause button when pressed.
The images in the FA Slideshow may jump if different image types are selected, for example including
some ResMax images.
You can zoom in or out of the images in the usual way when the FA Slideshow is paused.
7.5 Opening images using alternative methods
The Patient History view contains all the functionality for managing how images are opened and is the
main interface for opening images, see About the Patient History view on page 45.
Other methods of selecting and opening images are available:
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How to open recent images
A record of which images have been viewed is automatically stored. The next time the application is
run these recent images can be opened quickly.
Select File menu > Recent Images ... and select the recent image you want to open.
How to browse all the images from thumbnails
You can open any image files on your network without selecting the images from a particular patient
record.
1. Select File menu > Browse Images to display the Browse Images dialog box.
2. Select the appropriate file type from the File Types drop-down menu.
3. Select the directory containing the images you want to open.
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Click Pause Loading at any time to temporarily stop images loading in the browser window. You can
restart loading images by clicking Restart Loading.
If necessary, use the scroll bars to scroll up and down to view images in the Browsing dialog box.
The Browsing dialog box remains open under the image window. You can use it to select more
images.
How to search images by criteria
You can search all the saved images by setting the search criteria. You can search by date, image
status, whether the image has had any review notes attached or for pathology or diagnostic codes.
1. Select Review menu > Image Set to display the Select Images dialog box.
2. Complete the Select by Date, Select by Status and Search Image Notes criteria. Click OK. The
images that meet the specified criteria are displayed in the View Image Set window.
3. Select the image(s) you want to open. If you select one image the Open in Image Stack
Window is enabled. If you select more than one image all window buttons are enabled.
4. Click the appropriate button to open the image(s).
How to open images from the hard disk
You can select images from the hard disk.
1. Select File menu > Open to display the Select Image(s) to View dialog box.
2. Select the file(s) you want to open. Click OK.
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You can select multiple files by holding [Ctrl] while clicking each file you want to open. You can select
a range of adjacent files by holding [Shift] while selecting the first and last file in the range. The
selected files are highlighted.
You can also drag and drop files directly from the file browser (also know as My Computer or Windows®
Explorer).
You can discard unwanted images.
How to discard an image from the Patient History view
1. Click the image thumbnail, and drag and drop on to the wastebasket icon, see Review
application user reference on page 94.
2. Click Yes to confirm or No to cancel the operation. Close and reopen the Patient History view
to refresh the view.
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How to discard an open image
Select Image menu > Delete Image.
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If optomap fa images are available you can delete individual images from the Image Series using the
same method.
You should periodically empty the deleted folder to make space for new images, see Emptying the
"Deleted" folder below.
The database records the location of the image files. It is important that any image deletions are
performed using the Optos software and not directly through Windows® Explorer. This will ensure the
database record is updated.
Deleted images can be undeleted if they are still on the system, see Undeleting images below.
How to discard an Image Everyone session
In sites where the Image Everyone workflow is used you can discard the images if a patient does not
agree to the review.
1. Right-click any image in the Image Everyone session to display the menu.
2. Select Delete Image Everyone Session to delete all the images in the selected session.
7.7 Undeleting images
Deleted and cleaned-up images are moved to the Deleted folder.
If too many deleted images have been kept you may experience problems when capturing new
images. A message will inform you that too many deleted images are being stored. If this happens
you must undelete any images you want to keep and then click Empty "Deleted" Folder to clear those
that you want to delete permanently.
1. Select Tools menu > Undelete Images to display the Undelete Images dialog box.
2. Select each image you want to undelete and click Undelete. You will have to close and
reopen the Patient History view to refresh the view and list the undeleted images.
Note
The Deleted folder should be emptied periodically to clear space for new images, see Emptying the "Deleted"
folder below. Once the Deleted folder has been emptied the files can not be retrieved.
7.8 Emptying the "Deleted" folder
You may find that after running the archive and cleanup tasks in the Storage application you are still
short of disk space (or have many primary (uncompressed) files remaining on-line). This may be
because the deleted images folder needs to be emptied. These images are kept to allow the
decision to delete to be reversed.
You should periodically empty the deleted folder.
1. In the Review application select Tools menu > Undelete Images to display the Undelete Images
dialog box.
2. Check that you want to delete all the images. Click any images you want to keep. Ensure
that only the images to be deleted are selected.
3. Click Undelete to delete the selected images.
4. The images to be discarded permanently will be left in the list. Select Empty “Deleted” Folder.
5. Click Yes to confirm you want the images to be deleted.
6. Please wait until the dialog box has been cleared before clicking Close.
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Chapter 8 - Using the viewing options
8
Using the viewing options
When you review images it can be useful to use some of the viewing tools to look at the images in
different ways. Some viewing tools let you change the color of the image, or help you concentrate on
a particular area and use special tools to quickly change the review options for that area.
8.1 Color Channels
Images are captured using laser light. Each laser color penetrates the retinal structures to different
depths. Looking at the individual layers helps identify where pathology is located in the retina, see
Image View Controls on page 96.
8.2 Review Tools
Comparison Overlay
The Comparison Overlay lets you compare two images. This feature is particularly useful when
comparing images of the same patient over time. This view overlays the images. You can then
adjust the transparency to blend the information shown in the image. This helps identity features
that have moved or changed shape or size since the last image was taken.
You can alter the size, transparency and view of the Comparison Overlay.
False Color views
The False Color views display the grayscale Green Channel view and Red Channel view using an
alternative color palette. The False Color views can make some subtle features more obvious.
Automated view
The Automated view moves around the image. The tool displays the image in the Green Channel view
and Red Channel view before showing the image in the Composite Color view, see Using the
Automated view on page 55.
3D Wrap
The 3D Wrap view is a patient education tool. It runs an animated view of the current image.
Stereo Imaging
Some systems are capable of capturing Stereo Images. These images are displayed side-by-side as
two linked images.
When reviewing Stereo Images you need to select the viewing technique:
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use a stereo viewer (stereograph)
focus in front of the images
focus behind the images
The layout is dependant on the viewing technique you have selected in the User Preferences dialog
box, see Setting User Preferences on page 20.
Magnifier
When the image is opened in the Review application the entire image is optimized. The Magnifier lets
you review the locally optimized area being magnified. This local optimization can display subtle
pathology without having to review the entire image using manually altered view controls, see Image
View Controls on page 96.
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Simulated BIO view
The Simulated BIO View simulates the retinal view as it would be seen via a Binocular Indirect
Ophthalmoscope.
The image is inverted and mirrored about the center of the image. This view allows you to target the
relevant areas during a BIO examination.
8.3 Recommended reading protocol
The Review application includes many functions that can help you review images. This
recommended protocol guides you through a typical protocol for reviewing individual images.
You should follow this suggested protocol if you do not have one for your practice. The protocol is
generic and you should take any additional steps necessary to provide a comprehensive exam for
each patient.
1. If the patient will be present during the image review, open an image of each eye in the 3D
Wrap view. You can use this when explaining details to the patient, see Using the 3D Wrap
view on page 56.
2. Select the images and open them in an Image Stack window. In addition, open a previously
reviewed image if one is available, for example an image from the previous year.
3. Maximize the image window.
4. Evaluate the image for peripheral extent:
Zoom to at least 100%.
l Pan around the image periphery and check that there is good peripheral coverage.
Increase the gamma if necessary.
5. Review the image for clinical information:
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Switch to the Green Separation view.
Pan around the image following the numbered sequence of the grading grid.
Ensure all areas have been reviewed. Adjust the image adjustment settings if
required.
Mark any areas of interest with the relevant annotation, see Documenting your
review on page 61.
Switch to the Red Separation view and repeat for the deeper structures of the retina,
from the pigment epithelium through the choroid.
6. Review the full image and complete mark-ups:
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Select the Composite Color view and review the entire image. Check for any areas
that may have been missed.
Check any markups that have been made and complete any annotations.
7. Compare the image with patient's previous images, if available:
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Move to areas of interest and check for any changes from the previous image.
Check any mark-ups on the previous image.
8. Assess both eyes:
Open both left and right eye images in unlinked windows.
l Zoom to at least 100% and pan around all color views. Change the image
adjustment settings if required.
9. Carry out the BIO exam, if required:
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Select the recent image and display it in the Simulated BIO view. You can use this
view as a guide to where areas of interest can be found, see Simulating a Binocular
Indirect Ophthalmoscope (BIO) view on page 58.
Carry out the BIO exam.
Mark-up any additional areas of interest on the image with the relevant annotation.
Note
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You should take any additional steps necessary to ensure a full review for each patient.
You can zoom in or out at any stage of the protocol to ensure full review coverage at the required
level of detail.
You can use the Automated view to move around the image, showing each area in Green Separation, Red
Separation and Composite Color views, see Using the Automated view below.
You can review a stack of optomap fa images in the FA Slideshow, see Selecting images from the
Image Series view on page 50.
If the image seems pixilated while zoomed in you can apply the Smoothing tool to reduce the pixilation.
Select Image menu > Smoothing to apply and remove the Smoothing tool. Some small features may be
less distinct when Smoothing has been applied.
When viewing hemorrhages, switch to the Green Channel view. Reduce the Gamma and increase the
Contrast settings. This will enhance hemorrhages, vessels, and so on, however the optic disk will be
saturated. Click Optimize to return the image to the optimized settings.
8.4 Using the Automated view
The Automated view moves around the image, showing each area in Green Separation, Red Separation
and Composite Color views. This provides a framework for carrying out a general review of the image.
You can pause, go back, go to next and change the speed of the Automated view to ensure that you
review the entire image.
1.
2.
3.
4.
Select the image to be reviewed.
Click Automated view to display the controls.
Click the Play button to start the Automated view.
Optional: Use the other buttons to control the Automated view. You can Pause, go Back or go
to Next in the Automated view.
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The Play button changes to a Pause button when clicked.
To stop the Automated view, click the Pause button. You can then start your next task.
8.5 Using the Magnifier
You can review the current image using the Magnifier to inspect parts of the image. The Magnifier lets
you look at a locally optimized circular area of the image while maintaining the widefield context of
the rest of the image.
The Magnifier may not be available on all systems. Please contact Optos for more information, see
Contact us on page 113.
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1.
2.
3.
4.
Select the image to be reviewed.
Select Image menu > Show Magnifier to display the magnified area.
Optional: Right click to zoom in or out.
Optional: Right click to change to an alternative view. If you select either Green Channel view
or Red Channel view you can then select one of the False Color Views to change the contrast
of the magnified area, see Using False Color views on page 58.
5. Move the Magnifier across the image. Change from Green Channel view to Red Channel view
to review different retinal layers. Use the mouse scroll button to zoom in further if
necessary.
6. Select Image menu > Show Magnifier to close the Magnifier .
Note
Right click and select Local Optimize to switch off the False Color and revert back to the Green Channel view or Red
Channel view.
8.6 Using the 3D Wrap view
The 3D Wrap view displays the current image on a 3D model eye. It uses the current image view
settings and will display annotations.
You can export or email an individual 3D Wrap image or movie file.
Note
This view should be used in conjunction with non-3D Wrap views when performing diagnosis.
How to use the 3D Wrap View
1. Open the image you want to review.
2. Select Image menu > 3D Wrap to display the 3D Wrap view dialog box.
3. Fly Through starts automatically. You can modify the speed of the Fly Through animated
sequence by moving the Fly Through Speed slider. Drag the slider to the left to decrease the
speed and to the right to increase the speed.
4. You can choose which view to display; either Full Model, Transparent or Retina Only.
5. You can demonstrate myopia1 and hypermetropia2 by modifying the shape of the model
eye. Drag the Refractive Error slider to the left to simulate a myopic eye and to the right to
simulate a hypermetropic eye. The default image shape shows emmetropia3.
6. You can demonstrate the effect myopia, hypermetropia and astigmatism have on the
patient's vision by selecting the options in the Ray Types pane. Select Close Object, Distant
Object and Astigmatic Ray to display the rays. You can move the Refractive Error slider to
demonstrate the differences. Ray types are best displayed when the model eye is zoomed
out and viewed from the side.
7. When demonstrating the effects of myopia, hypermetropia and astigmatism, you may want
to show the effect an IOL4 , Contact Lens or Spectacles would have. When an Eye Lens is
selected the Refractive Error slider and Cataract options become unavailable.
8. You can demonstrate a cataract. Select the Cataract option to display a cataract on the 3D
Wrap view.
9. You can display sample images in the 3D Wrap view by selecting the required image from
the Sample Images selection.
1(Also known as nearsightedness) a focusing defect where the patient can see close objects more clearly than distant objects.
2(Also known as hyperopia or farsightedness) a focusing defect where the patient can see distant objects more clearly than close objects.
3Refractive state of the eye, having no refractive error when accommodation is at rest.
4Intraocular lens
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Note
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You can stop the Fly Through by clicking anywhere in the image.
You can stop the Fly Through running automatically by changing the 3D Wrap Options, see Setting User
Preferences on page 20.
You can control the view point using the mouse or buttons in the 3D Wrap view. You can zoom in or out
and move around the image using the mouse or control buttons.
The performance of the 3D Wrap view will depend on the graphic capability of your PC. You can
reduce the quality setting if the 3D Wrap view does not run smoothly or runs slowly, see Setting User
You can display other sample images from the Image Library in the 3D Wrap view, see Using the Image
Library on page 79.
The iris color is set automatically based on the patient's Iris Category.
How to email or export the 3D Wrap graphics
You can distribute the 3D Wrap view as a single image or as a movie file.
1. Open the image in the 3D Wrap view.
2. Zoom in and rotate the 3D Wrap view image to show the required view.
3. Select either File menu > Send To > E-Mail Recipient or File menu > Export Image to display the
3D Wrap Email/Export Options dialog box.
4. Select the required image or movie option. If you are distributing a single image you can
include your customized settings used in the Patient Takeaway. Select Include Customer
Graphic and Logo to include the customized settings, see How to customize the Patient
Takeaway print layout on page 77.
5. Click OK.
6. Complete the email content or export file location.
Note
The approximate image size is shown next to the selected file option.
How to print the 3D Wrap View
You can print the current 3D Wrap view as a Patient Takeaway using the customized Patient
Takeaway layout, see How to customize the Patient Takeaway print layout on page 77.
1. Open the image in the 3D Wrap view.
2. Zoom to show the area you want to show, and spin the image to the angle you want to print.
3. Click the Patient Takeaway button, see Review Tools Controls on page 95.
8.7 Using the Comparison Overlay
You can use the Comparison Overlay to compare two images of the same eye that were taken at
different times, for example when comparing an image from last year with an image from this year.
1. Select two images of the same eye. The eye has to be from the same patient and of the
same laterality.
2. Select Image menu > Show Comparison Overlay to overlay the images. If you have more than
two suitable images open you will be asked to select one to be used with the currently
selected image.
3. Optional: Right click to change the size of the comparison area.
4. Optional: Right click to change to an alternative view. If you select either Green Channel view
or Red Channel view to change the view of both images.
5. Move the Comparison Overlay across the image. Change from Green Channel view to Red
Channel view to review different retinal layers.
6. Select Image menu > Show Comparison Overlay to close the Comparison Overlay.
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8.8 Simulating a Binocular Indirect Ophthalmoscope (BIO) view
You can review the current image in the Simulated BIO view. This view simulates the retinal view as it
would be seen via a Binocular Indirect Ophthalmoscope.
The image is inverted and mirrored about the center of the image. This view allows you to target the
relevant areas during a BIO examination.
1. Select the image you want to display using the Simulated BIO view.
2. Select Image menu > Simulated BIO View to simulate the BIO view. "Simulated BIO View" will
appear in the image window title.
3. Repeat the previous step to return the image to the standard view.
Note
In previous versions of the software this view was called "Targeted Ophthalmoscopy View".
8.9 Simulating White Light view
You can review the current image in the Simulated White Light view. This view simulates the retinal
view as it would be seen in a fundus camera image.
1. Select the image you want to display using the Simulated White Light view.
2. Select Image menu > Simulated White Light View to simulate the view.
3. Repeat the previous step to return the image to the standard view.
Note
Ask your Optos representative for more information about enabling the Simulated White Light view.
8.10 Using False Color views
The False Color1 views are only available when the Green Channel view or Red Channel view have
been selected. The False Color views can make some subtle features more obvious.
1. Select the image you want to display using the False Color views.
2. Select either the Green Channel view or Red Channel view.
3. Select Image menu > False Color > ... and select either:
Off - switches off False Color if in use.
l Fire - shows the current image in tones ranging from dark red, red, orange, yellow
to white.
l Spectrum - shows the current image in tones ranging from purple, blue, green
yellow to white.
4. Optional: Right click to change the size of the magnified area.
l
Note
On systems where the Magnifier is available, you can display the full image in the Composite Color view and use
the False Color views on the Magnifier area, see Using the Magnifier on page 55.
8.11 Viewing stereo images
Stereo Images are a pair of images of the same eye. Each image is taken with the patient aligned
slightly off center; with one image captured when the patient is aligned slightly to the left and the
other when aligned slightly to the right.
1Replaces grey scale with a range of colors. This may help accentuate the differences in the image intensity.
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The viewing technique being used should be selected before the images are opened, see Setting
User Preferences on page 20. This ensures the images are displayed on the correct side of the
screen for the technique being used.
Warning
1. Open the Stereo Images, see How to open stereo images on page 49.
2. If using a Stereo Overlay, you should manually register the images to ensure the optic disk
and macula positions match see Registering image reference points on page 69.
3. Using your preferred reviewing technique, review the images using a stereo viewer
(stereograph) or focus either beyond or in front of the two images, until you see the images
as one.
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You will need to close and reopen the Stereo Images if you change the user setting options during the
review.
The Adjustment and Information panels are automatically hidden when Stereo Images are displayed.
You can display them if required, see Using the Adjustment and Information panels below.
8.12 Comparing with sample disease images
You can discuss pathologies with a patient by comparing the patient's image and a sample disease
image side by side.
1. Open the patient's image.
2. Select Image menu > Compare Sample Image and select the sample image from the list. If the
sample disease is not available select the Others option to select an image from a location
on your network.
3. The sample disease image will be linked with the patient's image. You can review the
images in the usual way.
8.13 Using the Adjustment and Information panels
You can hide the Adjustment panel and the Information panel to display a larger view of the image.
Image Adjustment panel – displays the Contrast, Brightness, Gamma and Green Balance
controls. Depending on the image type the panel may also show the eye steered direction,
the optomap fa frame time and the Automated view and optomap fa Slider controls.
Image Information – displays the Annotation, Review Notes and Comments panes.
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To hide/show the Adjustment panel
Select Image menu > View Adjustment panel.
To hide/show the Information panel
Select Image menu > Information.
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The information and adjustment panels can be hidden using shortcut keys, [F7] and [F8] respectively.
For more information about the adjusting images and displaying information, see Review application
user reference on page 94.
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Chapter 9 - Documenting your review
9
Documenting your review
When you review images it can be useful to add notes, drawings, measurements, and codes. These
mark-ups are saved with the image. They can be compared with other images or distributed.
Image mark-up tools can be found on the application toolbar, see Review application user reference
on page 94.
Annotations
Annotations, Measurements and Image Registration are graphical mark-ups on the image. They
are available from the Annotations menu > ... They include:
Annotations and Retinal Drawings – shapes drawn directly on to the image to highlight an
area. You might use annotations to circle an abnormality and add a label to suggest what
the problem might be.
Measurements – measures distances and areas and marks the result on the image.
Measurements are displayed in pixels.
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Warning
The scaling of the image cannot be precisely determined because of
patient positioning, patient refractive error and off-axis distortions in the
periphery. For these reasons you should not attempt to take absolute
measurements from the image.
Review notes
Review Notes are text mark-ups that are saved with the image file. You can add Review Notes by
right-clicking the image or by selecting Image menu > Review Notes. Review Notes include:
Image Status – indicates if the image has yet to be reviewed, has been reviewed with no
comments or has been reviewed with comments. This flag is displayed on the Patient History
view.
Comment – a text box where you can enter additional information.
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Diagnostic (pathology) codes and procedure codes
Diagnostic (pathology) codes and procedure codes can be added. The optomap plus procedure
code features can be made available by Optos. They can be used when the image was captured
using one of the optomap plus Capture procedures. Contact Optos for more information on using
optomap plus procedures, see Contact us on page 113.
Diagnostic codes - used to record suspected (or confirmed) pathology.
Procedure codes - used to record the codes used in reimbursement cases. These
procedures are only available when the image was captured using optomap plus or
optomap fa capture procedures.
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Procedures are charged at their own rates.
Image registration
The Review application can automatically register features in images. These registered points are
used to align images that are viewed together.
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You can also register image reference points manually.
Image Registration points are not displayed on the image.
You can change the position of registered points by manually setting new ones.
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9.1 About annotations, retinal drawings and measurements
Annotations are graphical mark-ups drawn onto the image. Standard annotations are available for
all image types.
Retinal drawings and measurements are special annotations. Retinal drawings are used to indicate
specific information, for example arteries, detached retinas and exudates. Measurements calculate
distance and area parameters on the image. The calculated results are added to the image as
annotations. Some special annotations are restricted depending on the type of image being
reviewed.
You can use annotations to highlight areas of special interest on an image. The annotations are
saved with the image and can be sent to another person to be reviewed. Several reviewers can add
annotations to an image. You can view all of the annotations, or decide which annotations you want
to view and hide the others.
Annotations are saved when the image is closed.
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Annotations and retinal drawings cannot be edited or deleted after the image has been closed.
Retinal drawings are not available on standard optomap images.
If you export or email the image using the Medical Image Format (*.dcm, DICOM file) the mark-ups
can be viewed by other medical image applications. Using DICOM format allows for the areas under
the mark-ups to be reviewed.
If you export or email the image using any format other that the Medical Image Format (*.dcm, DICOM
file) the mark-ups will 'burned-in' the image and the area below the mark-up lines will be obscured.
9.2 Using annotations
You can add, edit and remove annotations from the displayed image. You can also control which
annotations are displayed.
How to add an annotation
You can add annotations to open images.
1. Open the image you want to review and then select Annotation menu > …
2. Select the annotation type and draw the annotation, see Annotations, retinal drawings and
measurements on page 103.
How to edit an annotation
You can edit annotations that have been added during the current session. Annotations cannot be
changed after the session has been closed.
1. Select Annotation menu > Edit Annotations to activate the annotator editing mode. ‘Annotation
Editing Active’ is displayed in the window status bar to indicate the mode.
2. Click the annotation you want to edit.
3. Right-click the annotation border to display the pop-up menu. Select the required option
from the pop-up menu and make the changes.
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The cursor will change to a cross-hair shape when in the correct position to display the pop-up menu.
You can edit the shape of the annotation by dragging individual nodes.
You can undo changes by selecting Undo in the pop-up menu.
How to delete an annotation
You can delete annotations that have been added during the current session. You can either select
and delete individual annotations or delete them all. Annotations cannot be changed after the image
session has been closed.
Action
Description
Delete all annotations
Select Annotation menu > Clear This Session to
delete all annotations added during the current
session.
Delete the most recent annotation
Select Annotation menu > Undo to delete the most
recent annotation.
Delete a particular annotation
Select Annotation menu > Edit Annotations to activate
the Annotation Editing mode. Right-click the
annotation you want to delete and select Delete
from the pop-up menu.
How to show/hide annotations
You can control which annotations are displayed.
Action
Description
Show all annotations
Select Annotation menu > Show All Annotations to
display all annotations.
Hide all annotations
Select Annotation menu > Hide All Annotations to hide
all annotations.
Show annotations from selected
sessions
In the Annotation pane at the bottom of the image
window, click the check boxes for each session
you want to display.
How to print annotations
You can print saved annotations. Check that the annotations you want to print are currently
displayed on the image. Right click the image and select Add to Print Bar to add the annotated image
to the images being printed.
When configuring the print settings, check the Selected Annotations option has been selected.
Note
Annotations are saved when the image is closed.
9.3 Using retinal drawings
Retinal drawings are not available when the image was captured using a standard optomap capture
procedure. They are only available when the image was captured using an optomap plus or
optomap fa capture procedure. The relevant tools are made available when the image is opened.
Retinal drawings cannot be edited or deleted after the image has been closed.
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Retinal drawings can be edited, deleted and printed in the same way as annotations, see Using
annotations on the previous page.
When the Retinal Drawing dialog box is displayed the mouse can only be used to draw annotations on
the image. Close the Retinal Drawing dialog box to return the mouse to the normal operation mode.
Retinal drawings are not available on standard optomap images.
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How to add a retinal drawing
You can add retinal drawings to open images.
1. Open the image you want to annotate and then select Annotation menu > Retinal Drawing.
2. Select the retinal drawing type and draw the retinal drawing in the same way as
annotations, see Annotations, retinal drawings and measurements on page 103.
How to mark pathology annotations
Pathology annotations, such as micro aneurysms and exudates, can be marked using the retinal
drawing tools.
1. Open the image you want to annotate and then select Annotation menu > Retinal Drawing.
2. Select the marker from the Retinal Drawing dialog box and click each artifact.
How to count and compare pathology annotations
You can compare pathology annotations marked on two open images for the same patient, for
example to compare a recent image with one from a previous session. Select the second image
from the drop-down list in the Annotation Counts dialog box to display the pathology annotation count
in the lower grid.
1. Open the images you want to compare. If you want to count the pathology annotations for a
single image just open one image.
2. Select Annotation menu > Measure > Count Annotations to display the Retinal Drawing dialog
box. The artifact counts for the selected image will be displayed.
3. If comparing pathology annotations, select the second image to be counted and then select
the annotations layers to be included in the count. Images need to be registered correctly
when counting annotations, see Registering image reference points on page 69.
4. Optional: You can also print the pathology annotation count information by clicking the Print
button.
Note
A pathology annotation will be counted twice if annotated in two annotation layers.
9.4 Using measurements
You can add, remove and edit measurements on the displayed image. The measurement
information is stored in an annotation.
Some measurements are not available when the image was captured using a standard optomap
capture procedure. ISNT Rule Measurements are only available when the image was captured using
an optomap plus or optomap fa capture procedure. The relevant tools are made available when
the image is opened.
Measurements cannot be edited or deleted after the image has been closed.
Note
Measurements can be deleted and edited in the same way as standard annotations, see Using annotations on
page 62.
How to measure an area
2. Select Annotation menu > Measure > Area Definition and select the method you want to use to
mark the area.
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Freehand – use the mouse cursor as a pen to draw around the area.
Polygon – use the mouse cursor to draw a shape, using straight lines, around the
area.
Ellipse – use the mouse cursor to draw an ellipse around the area.
3. Select Annotation menu > Measure > Measure Area and mark the area as follows:
Freehand – hold down the left mouse button and draw around the area to be
measured. Release the mouse button when you have finished drawing the area.
l Polygon – click each point around the area to be measured. Lines will be drawn
between the points clicked. Double-click to complete the polygon.
l Ellipse – hold down the left mouse button and stretch the circle around the area to
be measured. Release the mouse button when you have finished drawing the
area.
4. Enter the name of the annotation in the Annotation Label dialog box and click OK.
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How to measure distance
2. Select Annotation menu > Measure > Measure Distance. Click the start and end points to draw a
line between the points that you want to measure.
3. Enter the name of the annotation in the Annotation Label dialog box and click OK.
How to measure the Cup to Disk Ratio
2. Zoom in to display a close up view of the optic disk.
3. Select Annotation menu > Measure > Cup To Disk Ratio and click at least five points on the
border of the optic cup. Double click to complete the outline.
4. Click at least five points on the border of the optic disk. Double click to complete the outline.
5. The software will draw an ellipse around each set of points.
6. If required, use the annotation edit feature to adjust the circles into the correct position, see
How to edit an annotation on page 62.
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The status bar, displayed at the bottom of the window, will indicate which area is to be identified.
The points are initially shown as a polygon to indicate where the points have been selected on the
cup and disk.
The ratio is calculated using the number of pixels in the area of each ellipse. This produces a different
ratio than that calculated using diameter distances of both ellipses.
How to measure the ISNT Rule
The ISNT (Inferior, Superior, Nasal and Temporal) Rule measurement is not available when
reviewing standard optomap images.
1.
2.
3.
4.
5.
6.
Open the image you want to review, see Opening images on page 47.
Zoom in to display a close up view of the optic disk.
Select Annotation menu > Measure > Measure ISNT Rule.
Draw a line across the inferior neuro-retinal rim.
Repeat the previous step for superior, nasal and temporal neuro-retinal rims.
The ISNT Rule will be displayed when the four lines have been drawn. The annotation color
will indicate if the result is within expected parameters; pink when results should be queried
and pale green when results are within expected parameters.
Note
Cup to Disk Ratio details are also displayed.
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9.5 About review notes, diagnostic (pathology) codes and
procedure codes
Review notes store text information about the image. They also store diagnostic or procedure codes
assigned to the image. These notes and codes can be saved and sent to be reviewed by another
person. Several reviewers can add review notes to a single image.
Review notes - record the text information for an image.
Diagnostic codes - record the suspected (or confirmed) pathology with the image. You can
assign an ICD-9 code to the image.
Procedure codes - record the codes used in reimbursement cases.
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Review notes are listed in the Review Note pane of the image window. Click the review note to display
its contents in the right hand pane. Review notes cannot be edited or deleted after the image has
been closed.
Diagnostic codes (sometimes called pathology codes) let you assign pathology information to the
image.
Procedure codes are assigned to images that are used when the costs of medical procedures can
be reclaimed. Procedure codes can only be assigned when the required tasks have been
completed.
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Review notes, diagnostic codes and procedure codes cannot be edited or deleted after the image
has been closed.
optomap plus Review procedures are only available when the image was captured using an
optomap plus or optomap fa Capture procedure.
You can set User Preferences that will prompt for a Review Note if an image is opened but no details are
added. This is useful if you want to ensure the Image Status field is completed, see Setting User
9.6 Using procedure codes
Procedure codes are used in some countries where the costs for medical procedures can be
reclaimed, for example in the United States of America. The procedure codes can be assigned to
images that have been captured using optomap plus, optomap fa or optomap af capture
procedures. Typically, procedures require particular tasks to be performed; adding retinal drawings,
diagnostic codes and review notes. The Review application includes guidance notes for each
supported procedure code. The doctor can then assign the appropriate code when the required
tasks have been completed.
The treating physician is responsible for the appropriate usage, adequate
documentation and proper coding of reimbursement claims.
Warning
optomap plus Review procedures define the steps that must be carried out to comply with
requirements for specific procedures. In some countries these steps are clearly defined and the
procedures have been given codes.
You can assign a procedure code to an image. When a procedure code has been assigned the
image is tagged with a purple marker in the Patient History view, see Review application user
reference on page 94.
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optomap plus Review procedures are not available when the image was captured using a standard
optomap Capture procedure. Some features, such as Retinal Drawings and ISNT Rule
Measurements are only available when the image was captured using an optomap plus or optomap
fa Capture procedure. The relevant tools are made available when the image is opened.
optomap plus and optomap fa procedures may be charged at a higher rates than standard optomap
examinations.
Procedure codes are not available when the image was captured using a standard optomap capture
procedure. Procedure codes are only available when the image was captured using an optomap plus
or optomap fa capture procedure. The relevant tools are made available when the image is opened.
Procedure codes cannot be edited or deleted after the image has been closed.
These procedures may not be available on your system. Please contact Optos if you would like more
information, see Contact us on page 113.
How to add procedure codes
1. Open the image you want to review and select Image menu > Procedure Coding to display the
Set Procedure Coding dialog box.
2. A green tick indicates the required tasks have been completed. When all the required tasks
have been completed, a procedure can be assigned to the image. Click the procedure code
to select it. Click OK.
How to change or remove a procedure code
You can change or delete procedure codes that have been added during the current session.
Procedure codes cannot be changed after the image session has been closed.
1. Open the Set Procedure Coding dialog box.
2. Make the required changes:
Action
Description
To change the procedure code
Select the other procedure code
To remove the procedure code
Select <No Procedure Code>
3. Click OK.
How to identify images where procedure codes have been applied
1. Open the Patient History view for the patient, see About the Patient History view on page 45.
2. Check the Session List for purple markers. The relevant code will be displayed next to the
purple marker.
About Procedure Guidance
Optos does not provide, and the optomap plus guidelines do not constitute advice on making
reimbursement claims. Diagnostic tests should be ordered by the treating physician and this
physician is responsible for appropriate usage, adequate documentation and proper coding. It is the
responsibility of the physician to comply with Medicare regulations, and check with the local
insurance carrier for reimbursement information and instructions. Optos does not accept any liability
for reimbursement claims made while using optomap plus.
9.7 Using review notes
You can add, edit and remove review notes from the displayed image. Review notes are displayed
in the Review Note pane. The selected review note is displayed to the right of the pane.
Review notes cannot be edited or deleted after the image has been closed.
How to add a review note
You can add review notes to open images.
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1. Open the image you want to review and then select Image menu > Review Notes to display the
Review Notes dialog box.
2. Type the information in the Comment box and click OK.
Note
You can mark the image as reviewed with no comment by selecting the Mark as Reviewed with No
Comment box on the Review Notes dialog box.
You may add a diagnostic code at the same time, see Using diagnostic codes below.
Depending on the type of image captured and the available review procedures you may also be able
to add reimbursable procedure codes at the same time, see About review notes, diagnostic
(pathology) codes and procedure codes on page 66.
You can set User Preferences that will prompt for a Review Note if an image is opened but no details
are added. This is useful if you want to ensure the Image Status is marked, see Setting User
The status flag is inserted automatically in the Session List of the Patient History window, see About the
Patient History view on page 45.
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How to delete a review note
You can delete review notes that have been added during the current session. Review notes cannot
be changed after the image session has been closed.
1. Open the Review Notes dialog box.
2. Delete the review note text and select the Mark As Reviewed with No Comment option. Click
OK.
How to view review notes without opening the image
1. Select the patient in the Patient History view.
2. Check the review status of the image, see About Review Notes on page 105.
3. Right-click the image to display the pop-up menu. Select View Notes to display the View
Image Notes dialog box.
9.8 Using diagnostic codes
You can assign diagnostic (pathology) codes to an image. The diagnostic code information is stored
in a review note.
Diagnostic codes cannot be edited or deleted after the image has been closed.
How to add diagnostic codes
You can add diagnostic codes to open images.
1. Open the image you want to review and then select Image menu > Diagnostic Coding to
display the Add Diagnostic Codes dialog box.
2. Select the diagnostic code from the list on the left:
Symbol
Description
Indicates a diagnostic code directory
heading
Click to display the sub-directories and
individual diagnostic codes
Indicates a selectable code
3. Click OK to add the diagnostic code to the image.
4. Repeat for each diagnostic code you want to select.
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Note
Your 10 most commonly used diagnostic codes are listed under the Frequently Used Codes heading in the
Diagnostic Code dialog box.
How to search for a diagnostic code
You can search for specific diagnostic codes in the Add Diagnostic Codes dialog box.
1. Enter the terms to be included in the Including Terms box. Select All to return codes that
contain all the terms or One or more to return diagnoses that include any of the terms.
2. Repeat for terms you want to exclude by entering them in the Excluding Terms box. Select All
to exclude diagnoses that contain all of the terms or One or more to exclude diagnoses that
contain any of the terms.
3. Click Search to display the results in the lower box.
4. Select the diagnostic code and click OK.
How to delete a diagnostic code
You can delete diagnostic codes that have been added during the current session. Diagnostic codes
cannot be changed after the image session has been closed.
1. Select Image menu > Review Notes to display the Review Notes dialog box.
2. Select the diagnostic code to be removed and click OK.
9.9 Registering image reference points
The Review application automatically registers features in images. These registered points are used
to align images that are viewed together.
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You can also register image reference points manually.
Image Registration points are not displayed on the image.
You can change the position of registered points by manually setting new ones.
Automatic Image Registration is set in the User Preferences dialog box, see Setting User
When you link right and left eye images they will horizontally scroll in opposite directions to help you
compare retinal features.
How to manually register image reference points
Manually referenced image points are used whenever they have been set. They override any
automatic registration established by the system.
1. Select the image you want to review.
2. Select Annotation menu > Measure > Image Registration. Click the center of the optic disk. The
status bar at the bottom of the image window will indicate when the optic disk should be
clicked.
3. Click the center of the macula. The status bar at the bottom of the image window will
indicate when the macula should be clicked. The images will align at the registered points.
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Chapter 10 - Distributing images
10
Distributing images
There are several ways to distribute images. You can export, email or use the print functions. You
can also import images into a patient record.
You can also configure the One-Click Export to export the current image using the configured
settings and location, see Configuring One-Click Export Options on page 74.
3D Wrap images can be emailed or exported as a single image or movie file, see How to email or
export the 3D Wrap graphics on page 57.
10.1 Emailing Images
Measurements in 3rd party viewers may not be accurate.
Warning
If you have an email application configured on your computer you can email an image from the
Review application.
There are several steps involved in distributing images. The user interface will guide you through the
options in each step. To select all the default settings and jump to the end of the procedure click
Finish.
Note
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Distributing an image distributes a copy of the image. The original image file is not removed from the
system.
Annotations and Review Notes in distributed images can be viewed when using the Review
application or Optos' optomap image viewing application. See optos.com for download information.
When emailing from open optomap and optomap plus image all the selected images are emailed at
once.
When emailing from an optomap fa image series, all the selected images are emailed at once. Check
that all the images you want to email are selected when you select the Email option.
You can choose from all the patient's images if you start the process from the Patient History view.
Please remember to comply with your practice procedures on personal data protection when storing
and distributing patient images.
1. Open the image you want to distribute. If you want to email more than one image, open
them all before continuing. Do not open images in a stacked window if you want to email
them.
2. Set the various options to display the data you want to distribute:
Select the annotations you want to include, see Using annotations on page 62.
Zoom in or out and pan to display the area you want to distribute, see Image View
Controls on page 96.
3. Select File menu > Send To > Email Recipient to display the Export Image to Email dialog box.
4. Select the file format to be used. If you want to select the default options click Finish.
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Generic image formats can be viewed using most graphic applications.
Annotations can be saved as part of the image and may obscure some detail.
Select JPEG to create a compressed file that can be transmitted quickly. Review
notes are saved in a comment field. Some other applications may not support the
display of the comment field.
JPEG 2000 images will be of better quality. However, some recipients may not be
able to accept this format and will be unable to open the image files.
Medical Image Format (DICOM format) can be viewed only by medical imaging
applications. Annotations and Review Notes are saved but do not obscure image
details.
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5. If you selected to create a compressed file (JPEG, JPEG 2000 or DICOM) you will be asked
to select the Image Compression Quality. Click Next.
6. Select the level of patient data and the data items to be included. Click Next .
7. Select image settings and content to be distributed. Click Next .
Select whether to use the original capture settings or the adjusted settings. The
adjusted settings may increase the perceived quality of the image, but may also
cause loss of detail.
l If you are distributing color images, you can select which image plane to distribute.
The displayed plane options will depend on which file format was selected.
l If you are distributing an uncompressed DICOM image you can select either
Composite or Planar. If you are distributing a compressed DICOM image you must
select Composite.
l If you are distributing a single, non-DICOM image you can select the image area.
You can select either whole image or the area currently being displayed.
8. Complete the email settings.
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Enter subject.
Select whether to include Review Notes and Diagnoses.
Select whether to send a ‘Do not reply… ‘ tag line within the text if you do not want
emails sent to the account you are sending from. If you select this option you must
remember to provide a reply email address with your email.
Click Next .
9. Complete the email address and text. Ensure you include a reply email address if you have
selected the 'Do not reply...' tag line.
10. Send the email and check the email has left the Outbox. Depending on your system
configuration the email may not be sent immediately. Click Send/Receive to ensure the email
has been sent.
11. Click Finish.
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You can distribute optomap fa images from the Image Series view.
You can distribute images from the 3D Wrap view, see How to email or export the 3D Wrap graphics on
page 57.
Emailing images will work with the configuration of your email client (Microsoft Outlook or Microsoft
Outlook Express for example).
The Planar option determines how pixel colours are encoded in the image and should be set based on
the needs of your PACS system. The setting of this option does not change the underlying image
content but can affect a PACS system’s ability to display it.
The Image Preview window lets you check the quality of the image before you complete the export or
email process. The selections made in the wizard will change the content of the image, the display
area, the compression level and the use of ‘burned in’ annotations. Use the Gamma and other
controls to check that the image quality has not been compromised by any compression that may
have been selected.
The Image Preview window shows the file size, which is an important consideration if the image is to be
sent across the Internet. You can choose whether the preview window is displayed, see Setting User
Preferences on page 20. Image Preview is not available when emailing or exporting from the Patient
History view.
10.2 Exporting Images
Warning
There are several steps involved in distributing images. The user interface will guide you through the
options in each step. To select all the default settings and jump to the end of the procedure click
Finish.
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Note
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system.
When exporting optomap and optomap plus images only one open image can be exported at a time.
When exporting from an optomap fa image series, all the selected images are exported at once.
Check that all the images you want to export are selected when you select the Export option.
You can choose from all the patient's images if you start the process from the Patient History view.
1. Open the image you want to distribute. If you started from the Patient History view or have
more than one image open, an additional option will be shown. Select the images you want
to distribute.
2. Set the various options to display the data you want to distribute:
Select the annotations you want to include, see Using annotations on page 62.
l Zoom in or out and pan to display the area you want to distribute, see Image View
3. Select File menu > Export Image to display the Export Image To File dialog box.
4. Select the file format to be used. If you want to select the default options click Finish.
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l Medical Image Format (DICOM format) can be viewed only by medical imaging
details.
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select Composite.
l If you are distributing a single, non-DICOM image you can select the image area.
You can select either whole image or the area currently being displayed.
Select the output directory. Select the checkbox if you want to specify individual filenames.
Check the image in the Image Preview window. Click OK. If you are not satisfied with the
image, click Cancel to repeat the process. The image preview window is only available if
selected in your user preferences, see Setting User Preferences on page 20.
Enter the filename and location where the file is to be saved. If you are saving to an external
disk or drive you will have to save to a PC drive before transferring to the disk. Click Save to
continue.
Click Finish.
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Note
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You can distribute optomap fa images from the Image Series view.
You can distribute images from the 3D Wrap view, see How to email or export the 3D Wrap graphics on
page 57.
The Planar option determines how pixel colours are encoded in the image and should be set based on
the needs of your PACS system. The setting of this option does not change the underlying image
content but can affect a PACS system’s ability to display it.
Depending on the version of Microsoft® Windows® your system is running you may need to format a
recordable disk before you save files to it. Your Microsoft® Windows® help files will contain the
appropriate instructions for your PC.
The Image Preview window lets you check the quality of the image before you complete the export or
email process. The selections made in the wizard will change the content of the image, the display
area, the compression level and the use of ‘burned in’ annotations. Use the Gamma and other
controls to check that the image quality has not been compromised by any compression that may
have been selected.
The Image Preview window shows the file size, which is an important consideration if the image is to be
sent across the Internet. You can choose whether the preview window is displayed, see Setting User
Preferences on page 20. Image Preview is not available when emailing or exporting from the Patient
History view.
10.3 Configuring One-Click Export Options
Warning
Please set the default options before using the One-Click Exporter.
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1. Select Tools menu > Preferences to display the User Preferences dialog box. You can only set
preferences for the user who is currently logged in.
2. Select the Import, Export and Printing tab.
3. Select One-Click Export Settings to display the One-Click Export Configuration dialog box.
4. Select the file format to be used.
l JPEG 2000 images will be of better quality. However, some recipients may not be
l Medical Image Format (DICOM format) can be viewed only by medical imaging
details.
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select Composite.
l If you are distributing a non-DICOM image you can select the image area. You can
select either whole image or the area currently being displayed.
8. Select the location where the One-Click Export files will be saved. If saving images to a
remote computer you should ensure that you have the necessary access permissions
needed to write to the disk and directory.
9. Click Finish.
10.4 Importing an image to a patient’s record
You can import an image to a patient’s record. This feature can be useful, for example, when you
are reviewing an image that has been emailed to you or you need to import an image that has been
reviewed on a laptop.
1. Select Review Menu > Patient History to display the Select Patient dialog box and select the
patient record you want to import the image into.
2. Select Tools menu > Import Image > Left Eye (Right Eye or Set) to display the Select Image to
Import dialog box. Selecting Set lets you import images from an optomap fa sequence.
3. Select the file (or files) you want to import and click Open.
4. Confirm that the image is to be assigned to the current patient.
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You can also drag and drop images from Windows Explorer directly into the Patient History view. Drop the
image on to the correct side of the window, either Right or Left Eye Thumbnail Images pane.
optomap fa cannot be imported as a series from Windows Explorer. To maintain image series links, you
must import the images using the Set option.
Images that have been imported into the patient's history are indicated by the Imported Image symbol - § , see Review
Tools Controls on page 95.
10.5 Printing images
The Review application includes a variety of printing functions. The functions let you select and
adjust images and define the layout of the page.
The use of a print as an assist to diagnosis is determined by the clinician.
Warning
You can print the current image by clicking the print button. This will send a Quick Print directly to the
default printer.
You can print single or multiple images by placing each image or image sequence on the Print Bar.
The Print Bar is located at the bottom of the Review application window.
You can print the current image for the patient to takeaway. You can customize the layout, for
example to display your logo.
How to print the current image as displayed
1. Open and zoom into the area you want to print.
2. Select the annotations you want to print, see How to show/hide annotations on page 63.
3. Select File menu > Print Active Image to display the image in the Print Images dialog box.
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4. The Print Images tabs contain a variety of settings: l
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Image Layout tab - lets you select the layout style. You can select the additional
information you want to include.
Image Adjustment tab - lets you adjust the Contrast, Brightness and Gamma
settings for the selected image. The histogram shows the distribution of the pixels
in the image as the settings are adjusted.
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Click Optimize to automatically set the print settings to produce a clear, bright
image.
Click Restore to restore the default settings.
Click Equalization to brighten the superior field to match the brightness of the
central pole.
Note
The quality of the prints can vary between printers. You can usually achieve the best print quality by using good
quality ink, for example using the printer manufacturer's own ink. The type of paper used has a significant effect
on the way the ink is applied. Using paper that does not match the paper type selected can often result in a very
poor quality print. You should always use the paper that matches the selected paper type, for example, photo or
glossy paper.
How to print a set of images
You can print, adjust and change the layout of the images that have been dragged on to the Print
Bar.
The use of a print as an assist to diagnosis is determined by the clinician.
Warning
The print preview displays a preview of the current layout selections. Click an image in the print
preview to select the image. The selected image will be displayed in the Selected Image pane.
You can use the mouse to drag the image to display the required area. You can use the mouse
scroll button to zoom in and out of the image. Alternatively, you can set the Zoom and scroll bars to
make these changes. Click Apply this View to Similar to set the same position and zoom setting for all
similar images.
The Print Images tabs contain a variety of settings:
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selected image. The histogram shows the distribution of the pixels in the image as the
settings are adjusted.
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Click Optimize to automatically set the print settings to produce a clear, bright image.
Click Restore to restore the default settings.
Click Equalization to brighten the superior field to match the brightness of the central pole.
Click Apply to Similar to apply the adjusted settings to similar types of images, for example
if the selected image is an optomapResMax image, then the adjustment will be applied to
all optomapResMax images on the Print Bar. This will overwrite any previously set image
optimization or image adjustments.
Image Layout tab - lets you select the layout style. You can select the additional information
you want to include. Some options are not available when printing more than one image to
a page.
Discard Image tab - lets you remove images from the page (not from the database).
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Click the tab and drag and drop each image to be discarded.
Right-click a discarded image to display the menu to return the image to the print layout.
The Print Control pane displays the print control buttons.
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type. Depending on your printer, other settings may be available.
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Print button - displays the Print dialog box. You can set the number of copies and other
printer settings from this dialog box.
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How to print the Patient Takeaway
You can quickly print the Patient Takeaway by clicking the Patient Takeaway button, see Review Tools
How to customize the Patient Takeaway print layout
You can customize the layout of the Patient Takeaway. You can change the text and images in these
areas.
1. Select the image you want to print, see About the Patient History view on page 45.
2. Select File menu > Patient Takeaway to display the Patient Takeaway Print Layout dialog box.
3. Select the Print Header option to be used. You can either:
Select Use default print header to use the Site Identifier information in the Admin
application.
l Select Define print header text and type the header you want to use.
l Select Define print header image and select the image you want to use. Click Load to
display the Load Image Header for Printing dialog box where you can select the image
you want to use.
4. Select the Print Footer option to be used. You can either:
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Select Use default print footer to use the default footer.
l Select Define print footer text and type the footer you want to use.
l Select Define print footer image and select the image you want to use. Click Load to
display the Load Image Footer for Printing dialog box where you can select the image
you want to use.
You can choose to print two images by default. This will print the currently selected image
and another from the images that are open. When you print two images the Select the
second image to print dialog box will be displayed. Select the second image from the list and
click OK to print both images.
Click Print to select the printer and change the printer settings.
Click Print Preview to check the changes.
Click Save Settings to save the current settings. Future Patient Takeaway prints will use
these settings.
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The header graphic will be placed along the top of the page. The aspect ratio of your graphic will be
maintained. Your graphic will be scaled to fit the allocated space at the top of the page. The footer
graphic will be scaled in the same way, but displayed at the bottom of the page.
You can print the 3D Wrap view, see How to print the 3D Wrap View on page 57. The 3D Wrap view will
use the Patient Takeaway settings.
10.6 Changing eye images from Right to Left (and Left to Right)
You can change a patient’s images from right eye to left eye, or left eye to right eye. This is useful if
the wrong capture eye option was selected when the image was captured.
You can change the eye in the Patient History view, see About the Patient History view on page 45.
How to swap right and left eyes
For optomap and optomap plus images:
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Images and drag it to the list of Left Eye Thumbnail Images.
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To move an image from left eye to right, select the image in the list of Left Eye Thumbnail
Images and drag it to the list of Right Eye Thumbnail Images.
For optomap fa images:
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Right click the image you want to change and select Change to Left (or Change to Right).
10.7 Assigning an image to another patient’s record
1. Open the Patient History view for both patients, see Opening images on page 47.
2. Drag the window title bar to position the Patient History view so that areas of both patients’
thumbnail image panes can be seen.
3. Select the thumbnail of the image you want to move and drag it to the other Patient History
view. Make sure you drop the thumbnail on the correct pane for right or left eye.
Note
The window title bar is the top of the window. The title "Patient History" is displayed.
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Chapter 11 - Using the Image Library
11
Using the Image Library
The Image Library contains images from patients who have had optomap examinations. The images
provide examples of pathology captured by the system and may be used for training purposes or
patient education.
The Image Library should only be used for guidance and not as a comparison tool for diagnosing
pathology.
You can also create your own Custom Image Library from images you have captured.
How to browse the Image Library
1. Select Review menu > Image Library to display the Image Library.
2. Select the File Type. If you do not know the file type leave the option set to All File Types.
3. Double-click the image you want to open.
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The location of the Image Library is defined in the Admin application. You should not need to change
this setting in normal operation of the system.
You also have a Custom Image Library where you can store copies of patient images.
How to compare images with the Image Library
1. Open the patient image, see Opening images on page 47.
2. Open the library image, see How to browse the Image Library above.
3. Link the images by selecting Window menu > Link/Unlink All Windows.
How to add an image to your Custom Image Library
You can add an image to your own Image Library. You can then use this Custom Image Library to store
copies of patient images.
You must ensure that the patient's details are protected when copying images to the Custom Image
Library, for this reason the patient details are removed from the copied image. You should also
always rename the image filename.
1. Open the image you want to add to your Custom Image Library.
2. Select Image menu > Add to Custom Image Library to display the Add to Custom Image Library
dialog box.
3. The default path will be shown.
4. Type the new filename. Ensure that the patient identification is protected.
5. Select the file type to be used.
6. Optional: Deselect the option to Include Notes and Annotations if required. Click OK.
Note
The location of the Custom Image Library is defined in the Admin application. You should not need to change this
setting in normal operation of the system.
How to browse the Custom Image Library
1. Select Review menu > Custom Image Library to display the Image Library.
2. Select the File Type. If you do not know the file type leave the option set to All File Types.
3. Double-click the image you want to open.
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Chapter 12 - About archiving
12
About archiving
There are two reasons for archiving; to maintain sufficient file space to take new images and to
provide a backup in case the PC fails and the images need to be restored.
Each time you capture an image two copies are saved. The primary image (uncompressed) is
stored in a higher resolution format than the secondary file (compressed). Due to the higher
resolution, the primary file takes up a large amount of disk space.
The primary files are used for reviewing. The secondary files are used in thumbnails and when
primary images have been archived.
Your Optos representative will configure the Task Settings when the
device is installed. These settings should not be changed in the course of
normal operation.
Warning
Please consult your Optos Representative before changing the Task
Settings.
Your Optos representative will configure the Storage application to best suit the activity in your
practice. These configuration settings will define where archived files will be saved and when
archived files will be deleted from the system. Deleting archived files is necessary to clean out the
space needed for new images. The time set to retain images on the PC hard drive will depend upon
your volume of imaging and available capacity. The default settings of two weeks for primary
(uncompressed) images and seven years for secondary (compressed) images should be suitable
for most cases.
12.1 When to Archive
When archiving to disk (CD or DVD) it is important to balance the risks involved in not backing up
data with the convenience of the practice. The recommended approach is to run an archive task
when there is sufficient data to fill a recordable disk media item. Since the Storage application should
be run daily several archiving approaches are available: CD for lower volume sites, DVD for average
volume sites and network for larger volume sites, see Archiving to disk on page 83.
It may occasionally be necessary to write two recordable disk media items rather than one. If the
task is not run daily, then it may be necessary to write multiple media items more often, and the hard
disk is more likely to become full.
When archiving to a NAS device or network location (Archiving to a network on page 86) you can
schedule the storage tasks to be run overnight, see Scheduling storage tasks on page 86. When
archiving to a network it is important to ensure that the network archive is backed up regularly.
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database. Attempting to run the application where either the source or destination drives are on
different computers may result in frequent failures when archiving files.
The disk writer drive should be selected as the Archive Drive for both archive tasks or a network
location selected if the files will be archived on the network.
12.2 Changing the Archive Task Settings
Once files have been archived they can be removed from the hard disk to create space for new
images. Primary images are large and can quickly fill your hard disk. To create space for new
images, while keeping the image available, the system creates an additional lower resolution
secondary image. When you clean up the hard disk archived images within a defined time frame are
removed. Typically, archived primary images are removed after two weeks and archived secondary
images are removed after seven years.
You should always retrieve the archived primary image for diagnostic purposes.
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These settings identify the files affected by archiving and cleanup tasks. They specify the locations
to be used when archiving files, the age which archived files should be cleaned out and the
parameters to be used when archiving.
Optos will configure the Task Settings when the device is installed. These
settings should not be changed in the course of normal operation.
Warning
Please consult your Optos Representative before changing the Task
Settings.
How to access archive task settings
Select Settings menu > Task Settings to display the Task Settings dialog box.
How to set where files are archived
Set the Manage Primary Image Files and Manage Secondary Image Files options.
1. Select the disk writer or network location that should be used to store the archived data.
Select the location for both primary and secondary images.
Action
To archive to a disk (CD or DVD)
Description
Select Use CD Writer and select the location
of the disk drive to be used.
Select User Folder Location and select the
network location to be used.
To archive to a network location
Alternatively, click Browse to select the
network folder to be used to archive the
data.
You should ensure this network location is
backed up regularly.
2. If you selected to archive to User Folder Location you must set the maximum number of files
to be archived during a single task. This is to ensure that archiving is prompted regularly.
Note
If a DVD writer is selected the relevant DVD options will be displayed.
How to set when archived files are cleaned up
You can set the age limit when archived files are removed from the hard disk. Select the Storage
Clean-up Settings (Cleanup Task) options to be used when archiving files from the hard disk.
1. Select the options to cleanup both primary and secondary image files.
2. Set the age limit to be checked. All archived files within the age limit will be deleted. A tick
indicates the specified archived files will be deleted.
How to set the disk parameters
The setting to be used during normal working conditions should be:
1. CD Write Speed should be no more than 75% of the maximum speed of the disk drive, and no
greater than 24x.
2. Create CD Image before writing should not be selected during normal operation.
3. Disable Auto-Insert Notification should be selected during normal operation.
4. DVD Write Speed is only available when a DVD writer has been selected.
5. Use DVD as Default Media should be selected if a DVD writer is being used.
6. Click OK to save the settings and close the dialog box.
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Note
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The secondary (compressed) images should be retained for a longer period of time because they
contain the thumbnail images used in the Review application. The secondary images use much less
disk space than the primary images.
The length of time for which images can be retained will depend upon the volume of image data
captured and the capacity of the hard disk. Your Optos Representative will help define the settings to
be used.
12.3 Archiving to disk
There are several elements involved in archiving to a recordable disk (either CD or DVD). You can:
Check how much storage space is available by running the start up tasks.
Archive image files and the database. You can also choose to start the archive and leave it
to run unattended.
Clean out archived files to leave more space to capture new images.
Stop the current archiving task.
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You should not schedule archiving tasks if CDs or DVDs are used.
Warning
How to run a startup task
Each time you run the Storage application the software automatically checks the archive status of the
database, images and the available disk space.
You should run the application each day and run any recommended startup tasks. Assuming your
Task Settings are correctly configured for your volume of work, the startup tasks should be sufficient
for maintaining your system.
1. Select Start > All Programs > optos V2 Vantage Pro > Storage to start the Storage application.
2. The application checks how much storage is available. It may recommend some tasks be
carried out immediately. Select Yes if you want to run each of the recommended archive
and cleanup tasks.
3. Insert a recordable disk when prompted. Use a new recordable disk for each archive task.
When the startup tasks have been completed the application window will be displayed.
Note
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It is recommended that you run the archiving process at a time when no one is using the Capture or
Viewing PCs. This is because the copying process uses a significant proportion of the computer’s
resources, and therefore could disrupt the activities of other users.
You should run the primary archive task a minimum of once a week to ensure the image database is
backed-up. Around 80 primary images can be saved to CD and around 500 can be saved to DVD.
If you cancel an archive task you must discard the disk. The disk should not be re-used.
If you have used another disk writing application (for example Sonic RecordNow, DirectCD or
EasyCD) you must reboot the PC before running the Storage application. This is because their drivers
may not let other applications access the disk drive properly. Re-booting the PC clears any settings
and lets the Storage application access the disk drives.
How to run an archive task
1. Select Start > All Programs > optos V2 Vantage Pro > Storage to start the Storage application.
2. The Startup Task will automatically check if any archiving or clean up tasks are required. You
should run all of the recommended tasks. If you would like to perform additional tasks that
were not recommended, proceed with the rest of this procedure.
3. Run any additional tasks. Insert a new recordable disk when prompted.
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Archive and Verify - copies the database and all primary image files from the PC's
hard disk to the storage device. These original files are usually large,
uncompressed files that fill the hard disk quickly. Archiving primary image files can
take a considerable amount of time.
l Secondary Archive and Verify - copies all secondary (compressed) images from the
hard disk to the storage device. These compressed images require less storage
space and so may not need to be cleaned up as frequently as the primary image
files.
4. The Low Media Item Usage dialog box will be displayed if the disk will only be partially used. If
you would like to archive anyway, select Yes.
5. Confirm that you want to proceed with the archive task. The Current Task tab will appear and
display the progress of the current task. The current step is displayed.
6. When the archive tasks have been written the disk drawer is automatically opened and
closed. This is the start of the verify task and prompts Windows Explorer to refresh and
check the files have been written correctly. Do not remove the disk at this time. Do not touch
the drawer, it will close automatically.
7. When the archive task has been verified the software displays the disk label1. Write the
label on the disk using a permanent marker pen. Put the disk in a disk holder and store it at
room temperature.
The label information will have been added to the database’s image record for each archived image.
Images that have a disk label are ignored in subsequent archiving tasks.
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Note
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Use a new recordable disk for each archive task. Using a partially filled disk may appear to be
economical, but there is a risk that the existing content could be corrupted.
The disk writing software is designed to write an entire disk at once. If that process is interrupted, the
content of the disk will be incomplete and will not be readable.
You will be notified if the verification task failed. It the verification task fails you must discard the disk.
The secondary archive task will copy no more than 1000 images to each CD. It is designed to work
this way because attempting to write too many files to a CD results in poor performance.
How to run an unattended archive
It is possible to run an archive task overnight. The main difference is that instead of logging off the
PC, you choose to lock the computer instead.
1. Run the archive task as described above.
2. When the progress is displayed, press [Ctrl]+[Alt]+[Del] to display the Windows security
window.
3. Select the option to Lock the computer. The computer is now locked and can only be
unlocked by the current user or by the Administrator.
4. When you return to the computer the next morning you must press [Ctrl]+[Alt]+[Del] to
display the Windows security window.
5. Type in your password and click OK.
6. If the archive task has completed the disk label will be displayed. Remove the disk and write
this label on the disk using a permanent marker pen. Put the disk in a disk holder and store
at room temperature.
How to create disk space
The cleanup task removes files that have already been archived. Files are selected if they have
been archived and are older than the specified age limit. The age limit (a defined number of days,
weeks or years) is set in the Task Settings, see Changing the Archive Task Settings on page 81.
1When images are archived the archive disk label is stored in the database. The label encodes the date of the oldest image on the disk using the YYYYMM-DD format, and an additional serial number. For example, OM-2009-10-19-1P is the first disk with primary image from October 19, 2009. Secondary
image labels are suffixed with "S" instead of "P". The disk label is referenced in the database record for each archived image.
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1. Select Run menu > Run Cleanup Task to start the Cleanup Task.
2. Click Yes to confirm that you want to proceed with the cleanup task. The progress of the
cleanup is shown.
Note
If you are still short of storage space you should remove deleted images see Emptying the "Deleted" folder on
page 52.
How to stop an archive task
1. Select Run menu > Stop Task if you need to stop the current archive task. The option is
unavailable when there is no task running.
2. Confirm that you want to stop the archive task. The task will continue to run until it has
completed processing the current file. This may take up to a minute depending on the task.
Subsequent files will not be processed and the task will stop.
3. Remove and discard the disk.
Note
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Most menu items and toolbar buttons are unavailable while a task is running, only the Stop Task
option is available.
Do not attempt to re-use a disk from a canceled archive task or that has been partly filled.
Previous software versions used a technique that wrote one file at a time. Archiving could effectively
be stopped and resumed. However, that technique was slower and less reliable.
How to select the correct CD or DVD type
Many types of disk can be used to store your archived information. However, some disks tend to
cause problems. Use the following notes to help determine the most appropriate disks to buy:
In all cases you should buy the appropriate disk format for your writer.
CD disks (default):
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Always use CD-R disks. Do not use CD-RW disks.
Do not use high capacity disks such as 800Mb. Larger capacity disks tend to experience
more archiving problems. The likelihood of a successful archive task increases if you use
lower capacity disks.
Disk quality varies, even within a single pack of disks. You may have problems with several
CDs in a single pack.
Note
The recommended maximum setting is 24x. Above this speed, the PC and writer drive may not be able to
sustain continuous writing to the disk, and the time to write the disk may therefore increase.
For writers with a maximum speed of 24x or less, the maximum speed can be used. If you
experience failures in the archive task, you should lower the write speed in the Task Settings dialog
box until reliable performance is achieved, see Changing the Archive Task Settings on page 81.
DVD disks (only if recommended by Optos):
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Always use DVD-R or DVD+R 4.7Gb single layer disks. Do not use DVD-RW, DVD+RW.
Do not use double layer disks.
There are two types of DVD writer; + and -. You must ensure that you buy the correct type
for your DVD writer.
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12.4 Archiving to a network
When archiving to a network location or NAS device you need to setup the storage location, see
Changing the Archive Task Settings on page 81.
In addition, you may wish to set the archive task to happen at a convenient time, perhaps during the
night, see Scheduling storage tasks below.
12.5 Checking storage status
The Storage Management Status dialog box shows how much space is available for storing new
images. The status of all storage devices and the size of data held on the disk are displayed.
How to check the storage status
1. Select Settings menu > Task Settings to display the Task Settings dialog box.
2. The application checks how much storage is available. It may recommend some tasks be
carried out immediately. Select No to each of the recommended archive and cleanup tasks.
This is because you are only running the software to check the storage status.
3. Select Status menu > Storage Status to display the Storage Management Status dialog box.
4. After you have checked the status click Close.
The bar color shows the overall status of the drive:
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Green – sufficient capacity for imaging.
Amber – sufficient capacity for now, but cleanup should be done soon.
Red – cleanup is required immediately.
The top pane shows the free space available on the PC hard disk and the volume of data yet to be
archived and cleaned up. The lower pane shows the space available on the disk in the disk drive (if
there is a recordable disk in the disk drive).
12.6 Scheduling storage tasks
You can schedule storage tasks to the network or NAS device to be run when convenient. You can
control which storage tasks are run, when they are run and how frequently.
You should not schedule archiving tasks if CDs or DVDs are used.
Warning
How to add or change a scheduled storage task
1. Select Setting menu > Schedule Tasks to display the Schedule Storage Tasks dialog box.
2. Select the time you want the scheduled tasks to be run. You should select a time when the
system will not be in use, for example 5 am.
3. Select the Frequency for each type of task.
4. You should run the Database Backup Task daily. In the Database Backup Settings pane, select
No. of copies of Database backup. Optional: Click Browse to select the Location of Database
backup.
5. Click OK.
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Note
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For example, if you select four copies of the database backup, the system will keep the first four
copies, then overwrite the first one when the fifth backup is copied.
You can also run the Compact and Repair Database task from the Admin application's Storage menu. The
Compact and Repair Database task runs automatically after each database backup.
The Storage application is not displayed when Scheduled Tasks are run.
How to remove a scheduled storage task
1.
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3.
4.
Open the Scheduled Storage Tasks dialog box.
Select the task you want to remove.
Change the frequency option to Never.
Click OK.
12.7 Recovering archived data
You may want to restore archived images because of hard disk problems or perhaps to review
images spanning a period of time. The restore images task copies the files from the disk back onto
the PC's hard drive.
You can restore the following files:
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View an Archived Image in the Review application – select the patient from the Patient
History dialog box. Then select the blank thumbnail representing the image you want to
open. The label of the disk containing the image will be displayed. Insert this disk in the disk
drive to view the image.
Run menu > Run Restore Task in the Storage application – restores the data from the archive
disk in the disk drive.
Recovery menu > Recreate JPEG Images in the Storage application – rebuilds the JPEG
(secondary/compressed files) files for any TIFFs (primary/uncompressed files) stored on
the hard disk, CD or DVD. These JPEG files may have been cleaned up and are now
needed.
Recovery menu > Restore Database File in the Storage application – recovers the database file
information from the primary archive disk in the disk drive. Please contact Optos before
recovering an archived database. We will help guide you through the options for your
system configuration, see Contact us on page 113.
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Chapter 13 - Where to find features
13
Where to find features
The most commonly used features are accessible using the toolbar buttons. All features are
available from the menu bar.
Toolbar buttons - offer quick and clear access to the most commonly used features. Hovering the
cursor over the button will display the tool tip for the button. Simply click the button to use the
feature.
Menu bar - all features are available from the menu bar. Related features are grouped under
appropriate menus. Click the menu heading to display the features in that menu. Select the feature
you want from the sub-menu.
Pop-up menu - pop-up menus are available in many areas of the application window. When you click
the right mouse button a menu will pop-up. This menu will only contain the features that apply to the
position clicked.
The following tables provide information about the features accessed from the toolbar buttons.
13.1 Capture application user reference
Patient List Indicators
Button/section
Description
optomap plus Patient indicator
This indicator is shown on the Patient List. It indicates that the patient
has previously been imaged using an optomap plus procedure.
Patient previously declined Image Everyone review indicator
This indicator is shown on the Patient List. At sites where Image
Everyone workflow is used, this marker indicates that the patient
declined the previous Image Everyone review.
Image capture controls
Button/section
Description
Start Session button
Opens the Select Patient dialog box where you can select an existing
patient or create a new patient record.
When a patient has been selected the relevant image capture controls
are displayed.
Capture Right Eye button
Opens the Capture Right Eye dialog box.
When this button is clicked the scan head is initiated and the system
prepares to capture an image. The dialog box is displayed when the
system is ready to capture an image.
Capture Left Eye button
Opens the Capture Left Eye dialog box.
prepares to capture an image. The dialog box is displayed when the
system is ready to capture an image.
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Button/section
Description
Capture Right Eye ResMax button
Opens the Capture Right Eye ResMax dialog box.
prepares to capture a narrower field, zoomed image. The dialog box is
displayed when the system is ready to capture an image.
This button is only available when the optomap plus with ResMax
procedure is selected in the Select Operator and Procedure dialog box.
Capture Left Eye ResMax button
Opens the Capture Left Eye ResMax dialog box.
prepares to capture a narrower field, zoomed image. The dialog box is
displayed when the system is ready to capture an image.
This button is only available when the optomap plus with ResMax
procedure is selected in the Select Operator and Procedure dialog box.
Eye steering selector
To see more of the 12 o'clock area of the retina, select the 12
o'clock direction.
l To see more of the 9 o'clock area of the retina, select the 3
o'clock direction.
o'clock direction.
o'clock direction.
Eye steering is not available with all procedures.
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Discard Image button
Marks the image to be discarded at the end of the session.
Click the image thumbnail to select it then click the Discard Image
button. The thumbnail will be marked with a red cross and the image
will be discarded at the end of the session.
If you decide to keep the discarded image you can right-click it and
select Keep Image from the pop-up menu.
End Session button
Appears after optomap images have been captured for both right and
left eyes. The button appears after the first capture when optomap
plus capture procedures are being followed.
When selected, the current patient record is closed and any discarded
images are permanently removed form the system. All other images
are saved and can be reviewed in the Review application.
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Image setting controls
Button/section
Description
Red Channel Setting slider
This slider controls the exposure of the red channel. Increasing the
red settings will give the composite color image a more red hue;
decreasing the settings will give the composite image a more green
hue.
The upper arrow indicates the exposure setting of the image when it
was captured. This setting cannot be adjusted. The lower arrow
indicates the adjusted exposure setting.
The adjusted settings will be applied to the next image to be
captured.
Although a captured image cannot be changed, you can adjust the
exposure of the next image. The changes to be applied to the next
image are simulated on the current image. This lets you use the
patient's current image to fine-tune the settings for the next capture.
You can set this automatically by selecting one of the Optimize Image
options, see Checking the quality of captured images on page 36.
Green Channel Setting slider
Functions in the same way as the Red Channel Setting slider above.
Optimize Image options
These options will automatically adjust the exposure settings for the
next image to be captured.
Use current settings - maintains the current image
improvement settings
l Improve whole image - improves the quality of the next
image. This option aims to reduce any over-exposed areas
without making the periphery areas too dark.
l Improve Optic Disk - optimizes the next image to improve the
optic disk. Removing over-exposed areas of the central pole
may result in the periphery being dark. Depending on the
type of image captured, some images may still show overexposed areas.
Depending on the characteristics of the patient, there may be some
over-exposure in the central areas. The changes applied to the next
image are simulated on the current image.
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You can manually alter these settings by moving the Red Channel
Slider and Green Channel Slider. However, this may result in the next
image being captured at a lower quality.
Gamma Correct slider
Enhances the image contrast without changing the exposure settings.
Moving the slider upwards improves the contrast of dark areas of the
image. Moving it downwards increases the contrast in brighter areas.
Gamma Correct
Gamma correction can be applied to the image. This will range
between 0.5 (to accentuate contrast in bright areas of the image) up
to 2.5 (to accentuate differences in dark parts of the image).
Changing this setting does not change the exposure level of the
current or subsequent captured images.
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Image View Controls
Depending on which view mode has been configured, these controls may not be available.
Button/section
Description
Composite Color View button
(Depending on which mode has been configured, this option may not
be available.)
Shows the Composite Color view where you can use the zoom and pan
features to view the image in detail. This view mixes the red and green
separations to present a color image.
You can also select the Composite Color view by clicking Image menu >
Composite Color View.
Red Channel View button
be available.)
The retinal image can be separated to present retinal substructures.
The Red Channel View shows deeper layers of the retina as a grayscale
image.
You can use the zoom and pan features to view the image in detail.
You can also select the Red Channel view by clicking Image menu > Red
Channel View.
Green Channel View button
be available.)
The Green Channel view shows the anterior layers of the retina as a
grayscale image.
You can use the zoom and pan features to view the image in detail.
You can also select the Green Channel view by clicking Image menu >
Green Channel View.
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Button/section
Description
Image Quality view and Image Quality Legend
Shows the areas on the image that are over-exposed. You can use
this view to improve the quality of the next image, see Checking the
quality of captured images on page 36.
The Image Quality view is the default view used to display the most
recently captured image. This view is available in all view modes. The
button is not displayed when the Image Quality view is the only view
available.
Different colors are used to indicate the channels that have been overexposed:
Areas where the red channel is over-exposed are shown in
red. You can reduce the over-exposed areas in the next
image by selecting one of the Optimize Image options or by
manually adjusting the Captured Red Level.
l Areas where the green channel is over-exposed are shown in
green. You can reduce the over-exposed areas in the next
image by selecting one of the Optimize Image options or by
manually adjusting the Captured Green Level.
l Areas where both red and green channels have been overexposed are shown in orange.
You can also select the Image Quality view by clicking Image menu >
Image Quality View.
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Zoom in button
be available.)
Zooms in on the center of the displayed image, showing a close-up
view. Repeat click the button to zoom in further.
You can also zoom in by selecting Image menu > Zoom in.
If you have a mouse wheel you can use this to zoom in or zoom out.
If you use Pan on Mouse Drag Mode to move the picture, zoom in will
focus on the center point of the area displayed.
Magnification of 100% means that 1 screen pixel = 1 image pixel.
Zoom out button
be available.)
You can also zoom out by selecting Image menu > Zoom out.
Select Image > Full Field to display the image at the original size.
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Button/section
Description
Pan on Mouse Drag Mode button
be available.)
Switches to Pan on Mouse Drag Mode where you can drag the viewed
area of the image. This feature is useful when you want to look at
another part of a zoomed in view.
When the button Pan on Mouse Drag Mode has been selected you can:
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Click the left mouse button to center the image at that point.
Drag the mouse to drag the position of the view.
You can also pan the image by using the keyboard arrow keys.
Zoom on Mouse Drag Mode button
be available.)
Lets you select an area to zoom in on, and provides a quick way to
zoom in or out of a particular part of the image.
When the Zoom on Mouse Drag Mode button has been selected you can:
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Click the left mouse button to zoom in and center on that point.
Drag the mouse to zoom in on that area.
Use the mouse to ‘draw’ a rectangle around the area to be
displayed.
Click the right mouse button to zoom out and center at that
point.
13.2 Review application user reference
Image Indicators
Button/section
Description
optomap plus Patient indicator
This indicator is shown on the Patient List. It indicates that the patient
has previously been imaged using an optomap plus procedure.
optomap plus Assigned Procedure indicator
At sites where insurance reimbursement is carried out, this indicator is
shown on the Patient History view. It indicates that a reimbursement
code has been assigned to the optomap plus session.
Stereo Pair indicator
At sites where capturing Stereo Images is available, this indicator is
shown on the Stereo Images thumbnail in the Patient History view.
Discard Image button
Discards the selected image, see Discarding unwanted images on
page 51.
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Review Tools Controls
Button/section
Description
Open Files(s) to View button
Opens the Select Image(s) to View dialog box. Hold down [Ctrl] and click
each image filename or [Shift] to select the first and last image
filenames in a group.
Browse Images in Folder button
Opens the Browsing dialog box. Select the folder and file type to filter
the images. Click each image you want to open.
Review Patient History button
Opens the Select Patient dialog box. Select the patient then click OK to
open the Patient History view, see About the Patient History view on
page 45.
Browse Image Library button
Displays the Image Library thumbnail images, see Using the Image
Library on page 79.
Browse Custom Image Library button
Displays the Image Library thumbnail images, see How to browse the
Custom Image Library on page 79 and Exporting Images on page 72.
Export button
Opens the Export Image to File dialog box, see Exporting Images on
page 72.
One-Click Export button
Exports the current image using the configured settings, see
Configuring One-Click Export Options on page 74.
Send to E-Mail Recipient button
Opens the Export Image To E-Mail dialog box, see Emailing Images on
page 71.
Quick Print Active Image button
Sends the current image directly to the default printer. The currently
displayed annotations, image area and display settings will be used
automatically.
If you want to customize what is printed you should use the full print
feature to print images that have been dragged to the Print Bar, see
How to print the current image as displayed on page 75.
Print Patient Takeaway button
Sends the current image directly to the default printer and prints the
image that the patient can take away.
You can customize the layout to include your practice name and logo,
see How to customize the Patient Takeaway print layout on page 77.
Imported Image symbol
This symbol indicates that the image has been imported into the
patient's history.
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Image View Controls
Button/section
Description
Composite Color View button
Shows the Composite Color view where you can use the zoom and pan
features to view the image in detail.
This default view is used when an optomap or optomap plus image is
opened. This view mixes the red and green separations to present a
color image. It is not possible to show optomap fa or optomap af
images in this view.
You can also select the Composite Color view by clicking Image menu >
Composite Color View.
Red Separation View button
Shows the Red Separation view as a grayscale image where you can
use the zoom and pan features to view the image in detail.
The Red Separation view shows deeper layers of the retina.
It is not possible to show optomap fa or optomap af images in this
view.
You can also select the Red Separation view by clicking Image menu >
Red Separation View.
Green Separation View button
Shows the Green Separation view as a grayscale image where you can
use the zoom and pan features to view the image in details.
The Green Separation view shows the anterior layers of the retina.
view.
You can also select the Green Separation view by clicking Image menu >
Green Separation View.
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Button/section
Description
Split Images View button
Shows the Split Images view. This view splits the main pane of the
image window into four quadrants.
The quadrants show the following views:
Top left quadrant - optimized Composite Color view.
l Top right quadrant - Red Separation view.
l Bottom right quadrant - Green Separation view.
l Bottom left quadrant - restored original settings of the Full
Image view.
The zoom and pan features are operated on the Composite Color view,
Red Separation view and Green Separation view. The Full Image view is
not affected and always shows the full size image, with an indicator of
the zoomed-in area shown in the other three quadrants.
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view.
You can also select the Split Images View by clicking Image menu > Split
Images View.
Select View button
Sets the zoom (in and out) to show the selected area of the image.
Click the drop-down arrow button to display the view options:
Full Image view - zooms to show the full image.
l Central Pole - zooms to show an enhanced view of the optic
disk and macula.
l Optic Disk - zooms to show an enhanced view of the optic disk
in the green channel.
l Periphery - shows the full images adjusted to present the
details of the periphery.
You can also select the view options by clicking Image menu > Select
View... and the view option.
Zoom In button
l
Zooms in on the center of the displayed image, showing a close-up
view. Repeatedly click the button to zoom in further.
You can also zoom in by selecting Image menu > Zoom In.
Zoom Out button
Zooms out on the center of the displayed image, showing more of the
image. Repeatedly click the button to zoom out further.
You can also zoom out by selecting Image menu > Zoom Out.
Select Image menu > Full Field to display the full image in the current
window size.
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Button/section
Description
Set Zoom Percent button
Sets the zoom (in or out) to show the selected percentage zoom.
Magnification of 100% means that 1 screen pixel = 1 image pixel.
Click the drop-down arrow button to display the zoom options. The
percentage options are:
500% – zooms to 1 image pixel across 5 screen pixels.
l 200% – zooms to 1 image pixel across 2 screen pixels.
l 100% – zooms to 1 image pixel to 1 screen pixels.
l 50% – zooms to 2 image pixels in 1 screen pixel.
l 20% – zooms to 5 image pixels in 1 screen pixel.
l Full Image – zooms to show the complete image within the
current window size.
Alternatively, you can click the percentage value and type the value
you want to use. Press [Enter] to set the percentage.
3D Wrap View button
l
Runs the animated 3D Wrap view of the current image.
You can show the sequence through a model eye, a transparent eye
or across a 3D grid.
Click Fly Through to run the animated sequence.
Mouse Move Mode button
Switches to Mouse Move Mode where you can drag the viewed area of
the image. This feature is useful when you want to look at another part
of a zoomed in view.
When the Mouse Move Mode button has been selected you can:
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Left click mouse to center the image at that point.
Drag the mouse to move the viewed area to another position.
You can also pan the image by using the keyboard arrow keys or by
selecting Image menu > Mouse Mode > Move.
Mouse Zoom Mode button
Lets you select an area to zoom in on, and provides a quick way to
zoom in or out of a particular part of the image.
When the Mouse on Drag Mode button has been selected you can:
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Left click mouse to zoom in and center on that point.
Drag the mouse to zoom in on that area.
Use the mouse to ‘draw’ a rectangle around the area to be
displayed.
Right-click mouse to display the pop-up menu.
You can also zoom in or out by selecting Image menu > Mouse Mode >
Zoom.
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Button/section
Description
Show Magnifier button
Lets you look at a locally optimized area of the image. You can also
zoom in and out of the image in the usual way.
The Magnifier may not be available on all systems. Please contact
Optos for more information, see Contact us on page 113.
When the Show Magnifier button has been selected you can right click
to:
Zoom in and out of the magnified area.
l Change the color view of the magnified area to Composite
Color, Red Separation or Green Separation view.
l Select one of the False Color1 options when either Red
Separation or Green Separation views are selected in the
magnifier.
You can also show the magnifier by selecting Image menu > Show
Magnifier.
l
Show Comparison Overlay button
Lets you compare two images of the same eye that were taken at
different times, for example when comparing an image from last year
with an image from this year.
When the Show Comparison Overlay button has been selected you can
right click to:
l
l
l
Change the size of the overlay area.
Set the transparency of the overlay area. The transparency
ranges from Opaque, where the other image details are shown
and blend through to Transparent where the current image is
shown and no details area blended from the other image.
Change the color view of the Comparison Overlay area to
Composite Color, Red Separation or Green Separation view.
Show/Hide Image Adjustment Pane button
Toggles between hiding and showing the Image Adjustment pane.
The Image Adjustment pane is shown on the right of the image window
and contains the contrast, brightness and gamma settings.
You can also hide or display the Image Adjustment pane by selecting
Image menu > View Adjustment pane.
Show/Hide Image Information button
Toggles between hiding and showing the Image Comments pane. The
image comments are shown on the bottom of the image window and
contain the annotations and review notes associated with the image.
You can also hide or display the Image Comments pane by selecting
Image menu > View Information.
1Replaces grey scale with a range of colors. This may help accentuate the differences in the image intensity.
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Button/section
Description
Link/unlink windows modes and view ports button
Toggles between linking and unlinking all the open image windows.
You can also link or unlink all open image windows by selecting Window
menu > Link/Unlink All Windows.
You can select which windows to link. Select Window menu > Select
Linked Windows to display the Link Windows dialog box and select the
windows to be linked.
Page buttons
Displays the Previous Page and Next Page in an Image Stack. Also
displays the page number of the current image.
Review Notes button
Displays the toolbar links to Notes, Diagnostic Coding and Procedure
Coding dialog boxes.
You can also open these dialog boxes from the Image menu.
Image Adjustment Controls
You can hide the Image Adjustment Controls by selecting Image menu > View Adjustment pane.
Button/section
Description
Contrast control
Contrast control
Drag the slider control to the right or left to either increase or decrease
the contrast respectively. The contrast control increases or decreases
the pixel intensity by an amount proportional to the source pixel
intensity; the intensity of brighter pixels will be changed more than that
of dimmer pixels.
You can also change the setting by clicking the control to select it and
pressing the left or right arrow on your keyboard to move the slider
control.
Brightness control
Brightness control
Drag the slider control to the right or left to either increase or decrease
the brightness respectively. The brightness control increases or
decreases the pixel intensity by the same amount. If you find that
some areas become saturated, try moving the Gamma control slider
instead of the Brightness control.
control.
This control is not available when reviewing optomap fa images.
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Button/section
Description
Gamma control
Gamma control
The Gamma control will brighten or darken the image without
saturating detail changing the exposure settings. Moving the slider to
the right improves the contrast of dark areas of the image. Moving it to
the left increases the contrast in brighter areas. Gamma correction
can be applied to the image. This will range between 0.5 (to
accentuate contrast in bright parts of the image) up to 2.5 (to
accentuate differences in dark parts of the image). The practical
application with optomap images will be to bring out the detail in the
periphery (gamma greater than 1) and in the optic disk (gamma less
than 1).
control.
Equalization button
Equalization control
The Equalization control will brighten the superior field to match the
brightness of the central pole.
control.
Optimize button
Optimize button
Based on the colors in the image and the colors expected, the
software calculates the ideal value for the red and green contrasts
without saturating either color. The image is optimized automatically
when it is first opened.
Restore button
Restore button
Restores the image settings to those that existed when the image was
captured.
Green Balance control
Click and drag the slider control to the right or left to increase or
decrease the green balance respectively. This control is not available
when reviewing optomap fa images. The Green Balance Contrast and
Brightness controls change the relative contrast/brightness of the
green separation relative to the red separation. Increasing green
Green Balance control settings will give the composite color image more of a green hue;
decreasing them will give the composite image more of a red hue.
control.
This control is not available when reviewing optomap fa images.
Image Playback Controls
These controls are available when using the Automated view and FA Slideshow.
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Method
Description
Automated View
The Automated view moves around the image, showing each area and
in Green Separation, Red Separation and Composite Color views. This
provides a framework for carrying out a general review of the image.
The following buttons can be are used to control the Automated view.
Play button
Plays the Automated view. The Play button changes to the Pause button
when clicked.
Pause button
Pauses the Automated view. You can stop the Automated view by
clicking the Pause button and then moving on to another task.
The Pause button changes to the Play button when clicked.
You can also pause the Automated view by clicking the image.
Previous button
Click this button to work back through the Automated view one phase at
a time.
You can use the Progress slider to move back multiple phases at once.
Next button
Click the button to move forward through the Automated view one
phase at a time.
You can use the Progress slider to move forward multiple phases at
once.
FA Slideshow
You can review a stack of optomap fa images in the FA Slideshow.
The following buttons can be are used to control the FA Slideshow.
Play button
Plays the FA Slideshow. The Play button changes to the Pause button
when clicked.
Pause button
Pauses the FA Slideshow. You can stop the FA Slideshow by clicking the
Pause button and then moving on to another task.
The Pause button changes to the Play button when clicked.
You can also pause the FA Slideshow by clicking the image.
Back button
Click this button to work back through the FA Slideshow one image at a
time.
You can use the Progress slider to move back multiple images at once.
Next button
Click the button to move forward through the FA Slideshow one image
at a time.
You can use the Progress slider to move forward multiple images at
once.
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Method
Progress slider
Speed slider
Description
Progress slider
You can move the slider to go back or forward in the FA Slideshow.
Speed slider
You can change the speed of the FA Slideshow by moving the slider.
Image Comparison Methods
There are several methods available for viewing images using the Review application. Some show
large views of a single image, others show several images at once, another stacks images so that
you can page through them. You can also link images so that when you zoom in or pan, the images
are aligned; keeping a similar area of each image in view. Each method lets you view and compare
the images in different ways.
Method
Description
Linked Images
To review and compare several images while keeping the same area
of each image in view, open the images using the Open in Linked
Windows button in the Patient History window, see About the Patient
History view on page 45.
Linked windows zoom, pan and move together. In addition, color
separations applied to one window are also reflected in other linked
windows. However, image adjustments such as Restore, Optimize,
Gamma adjustment etc, are only applied to the selected window.
When you navigate to a retinal feature in one image the other linked
images will display the same relative position. This method is
particularly useful when comparing multiple images of the same eye.
Left and right eye pairs will horizontally scroll in opposite directions.
Separate Multiple Images
To review several images separately, but open the images at the
same time use the Open in Unlinked Windows button from the Patient
History window.
Stacked Images
To review and compare several images in a large view window, open
the images using the Open in Image Stack Window button from the
Patient History window. This view stacks the images on top of each
other and you select by paging through the stack.
When an optomap fa series is selected, this option will open the
Image Series view. This view displays all the images in the series and
lets you select the images you want to open. The Image Series view
lets you open the selected images in Linked, Unlinked and Stacked
views.
Annotations, retinal drawings and measurements
Annotations are graphical mark-ups drawn onto to the image. Retinal drawings and measurements
are special annotations. Retinal drawings are used to indicate specific information, for example
arteries, detached retinas and exudates. Measurements calculate distance and area parameters on
the image. The calculated results are added to the image as annotations.
Some special annotations are restricted depending on the type of image being reviewed, see About
annotations, retinal drawings and measurements on page 62.
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Button/section
Description
Freehand annotation tool
Hold down the left mouse button and draw around the area. Doubleclick the mouse button to complete the shape.
Polygon annotation tool
Click points to draw lines around the area. Double-click the mouse
button to complete the shape.
Arrow annotation tool
Click to mark the arrow head, then click again to mark the tail.
Note annotation tool
Hold down the left mouse button at the top left corner of the note and
drag to the bottom right corner. Type information into the note.
Ellipse annotation tool
Hold down the left mouse button at the top left corner of the ellipse and
drag to the bottom right side.
Retinal Drawing tool
Click to display the retinal drawing palette. Select the pathology type
you want to annotate and mark-up the image.
Retinal drawings are not available when reviewing standard optomap
images.
Artifact marker
Drusens, micro aneurysms and exudates are shown using colored
artifact markers.
Undo annotation tool
Removes the most recent annotations. Annotations cannot be
removed or changed after an image has been closed.
Cup to Disk Ratio measurement
Click at least five points on the edge of the cup, then repeat around the
disk. The Cup to Disk Ratio is displayed.
Distance measurement
Click points at both ends of the distance.
The distance is measured in pixels. The number of pixels will be
displayed.
Area measurement
Hold down the left mouse button and draw around the area.
The area is measured in pixels. The number of pixels will be displayed.
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Button/section
Description
ISNT Rule Measurement
Hold down the left mouse button and draw a line across the inferior,
superior, nasal and temporal neuro-retinal rims.
Further investigation is required if the measurement is displayed in
pink. Cup to Disk Ratio details are also displayed.
ISNT Rule Measurements are not available when reviewing standard
optomap images.
Image Registration
Click the center of the optic disk and then click the center of the macula.
Once registered, images that are stacked or linked are aligned at the
optic disk and macula.
About Review Notes
Review Notes are text mark-ups that are saved with the image file. The following symbols are shown
in the Patient History view. They indicate whether an image has been reviewed.
Symbol
Description
Not reviewed
This symbol indicates the image has not yet been reviewed.
The symbol is displayed in the Patient History's Session List.
Reviewed with no comments
This symbol indicates if the image has been reviewed but no
comments have been added.
Reviewed with Comments
This symbol indicates if the image has been reviewed and comments
have been added.
13.3 Storage application user reference
Button/section
Description
Archive and Verify button
Copies the database and all primary (uncompressed) image files from
the PC's hard disk to the storage device. These original files are
usually large, uncompressed files that fill the hard disk quickly.
Archiving primary image files can take a considerable amount of time,
so archiving should be carried out frequently to avoid a large number
of images being archived at once.
You can also select Run menu > Archive Task.
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Button/section
Description
Secondary Archive and Verify button
Copies all secondary (compressed) images from the hard disk to the
storage device. These compressed images require less storage space
and so may not need to be cleaned up as frequently as the primary
image files.
You can also select Run menu > Secondary Archive Task.
Run Cleanup Task button
Archived files from within a defined time period are removed from the
hard disk. This creates disk space for new images.
You can also select Run menu > Cleanup Task.
Run Restore Task button
Restores the database and/or image files from an archive.
You can also select Run menu > Restore Task.
Stop Task button
Stops the task in progress. The current file is completed and then the
process is stopped. This may take up to a minute depending on the
task.
You can also select Run menu > Stop Task.
Storage Status button
Displays the current status of the online storage (hard disk) and offline
storage (disk).
You can also select Status menu > Storage status.
Delete Media Item button
Deletes the disk archive label reference from the database. The files
can be re-archived if they have not been cleaned up. If the files have
been cleaned up then the data cannot be restored.
You can also select Media menu > Delete Item.
Clear Task History button
Clears the archive data shown in the Task History tab.
13.4 Scheduler application user reference
Button/section
Description
New Appointment button
Shows the Select Patient dialog box and Optomap Appointment Details
dialog box where you can select the patient and then set the
appointment details respectively.
You can also select Schedule menu > New Appointment.
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Button/section
Description
Edit Appointment button
Shows the Optomap Appointment Details dialog box where you can edit
the appointment details or cancel the appointment.
You can also edit an appointment by double-clicking the appointment
or by selecting Schedule menu > Edit Appointment.
New Patient button
Shows the Patient Details dialog box where you can add the new
patient’s details.
You can also select Schedule menu > New Patient
Edit Patient button
Shows the Select Patient dialog box and Patient Details dialog box where
you can select the patient and then edit the patient details respectively.
You can also select Schedule menu > Edit Patient.
Today’s Appointments View button
This is the default view shown when the Scheduler application starts. It
shows the appointments scheduled for the current day.
You can also select View menu > Today.
This Week’s Appointments View button
Shows the appointments scheduled for the current week.
You can also select View menu > This Week.
This Month’s Appointments View button
Shows the appointments scheduled for the current month.
You can also select View menu > This Month.
All Appointments View button
Shows all the scheduled appointments.
You can also select View menu > All.
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Chapter 14 - Troubleshooting
14
Troubleshooting
This section addresses some frequently asked questions and describes the actions you can take to
resolve some commonly encountered problems.
If you still experience problems please contact Optos, see Contact us on page 113.
14.1 Why can't I login?
This is usually a password typing error (all passwords are case sensitive). Please check your
keyboard [Caps Lock] is not on. Contact your System Administrator for assistance if you have
forgotten your username or password.
Ask your System Administrator to:
l
l
l
l
l
l
Confirm that the scan head username is P200 and the password is a1010.
Confirm your username and password.
Check your that user details have been set up in the Admin application. If you have duplicate
user accounts please check the same password is used for both.
Check your user details are still active.
Check the Image Server PC is switched on and that the network is connected.
Check that the scan head is not locked. A message will be displayed if this is the case.
If you still experience problems please contact Optos, see Contact us on page 113.
14.2 Where do I find the site number?
You can find the Site Number on the documentation received from Optos. Alternatively, open the
Admin application and select System menu > Set Site Information to display the Practice Information
dialog box. The Site Number is displayed in this dialog box.
14.3 Should I be connected to the internet to access the
application help files?
The help files are an integrated part of each software application. You do not need to connect to the
Internet to access this information, see Getting help on page 25.
14.4 How do I restart a Capture PC?
Software problems are often temporary and can be fixed by rebooting the PC. You do not have to
switch off the scan head when rebooting the Capture PC.
The Capture PC usually stores the database and images.
Warning
1.
2.
3.
4.
5.
If this PC is used to store the database and images, other users will not be
able to view images while the PC is switched off. Warn other users that you
are about to switch off this PC. Advise them to restart the applications after
the PC has been restarted.
Close all applications on the PC.
Select Start > Shut down > Restart to restart your PC. Exit any programs if prompted.
Log on PC when prompted.
Start the application.
You can now re-open any Optos applications on the other PCs, if necessary.
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14.5 How do I restart the system?
Scan head problems are often temporary. Problems taking images soon after the system has been
started can be caused by not leaving sufficient time for the scan head to stabilize to the required
operating temperature.
You must wait 15 minutes after switching on the scan head and starting the Capture application
before you attempt to take the first image. If you attempt to capture an image before the 15 minutes
have passed you risk experiencing a Light Source Error and other errors and will have to perform
the full system restart below.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Switch off the scan head.
Shut down the Capture PC. It is important to shut down and not just log off.
Switch off the Capture PC. Some PCs will switch off automatically when shut down.
After 30 seconds, switch on the scan head.
Switch on the Capture PC.
Log on to the Capture PC.
Start the Capture application.
Restart any Optos applications on the other PCs.
Wait at least 15 minutes before attempting to capture the first image.
14.6 How do I check everything is switched on?
The scan head, PC and Viewing PC show a constant green light when switched on.
l
l
l
If there are no green lights check that the power connections have not loosened and that
the power supply is switched on.
If the PC monitor shows a green flashing light, check that the PC is switched on.
If both the PC and the monitor show constant green light, but the PC does not seem to be
working, it is likely the PC has gone into hibernation mode. Press [Esc] on the keyboard to
activate the PC again.
14.7 How do I clear a Light Source Error?
Light Source Errors occur when the laser management system detects a problem with the laser
system. This is normally a temporary problem and usually can be resolved by restarting the scan
head. The scan head must be switched off and on again to clear the Light Source Error state. As a
safety measure, no images can be captured until the problem has been resolved.
If you receive this message perform a full system restart, see How do I restart the system? above.
The most common cause of Light Source Errors is trying to capture an image before the lasers have
fully warmed up. Wait at least 30 minutes before imaging.
If the Light Source Error persists contact Optos and supply the Status number, see Contact us on
page 113.
14.8 What should I do if the PC drive is full?
Ask your System Administrator to:
l
l
Empty the PC Recycle Bin.
Empty the Temporary Internet files.
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14.9 What should I do if power is lost?
If power is lost to the Capture PC or the scan head, you will need to perform a full system restart.
Check power is on and follow the full system restart procedure, see How do I restart the system? on
the previous page.
14.10 Will the software be updated?
Periodically Optos will supply software updates. You will be informed when these are available and
installation instructions will be provided for each update.
14.11 What screen resolution should I use to review images?
The recommended screen resolution is 1280 x 1024 pixels, true color.
14.12 What should I do if artifacts remain on the images after
cleaning the main mirror?
If you have cleaned the mirror following the instructions given in the Main Mirror Cleaning
Procedure, please contact Optos for assistance, see Contact us on page 113.
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Chapter 15 - Contact us
15
Contact us
We welcome your questions and comments.
15.1 Global Headquarters
Optos plc
Queensferry House
Carnegie Campus
Enterprise Way
Dunfermline, KY11 8GR
Scotland, UK
Telephone: +44 (0) 1383 843 300
Fax: +44 (0) 1383 843 333
All inquiries: [email protected]
Website: optos.com
Existing customers will need to provide their site number to allow Optos to access your details. You
can find the Site Number on the documentation received from Optos. Alternatively, open the Admin
application and select System menu > Set Site Information to display the Practice Information dialog box.
15.2 Regional Offices
Please check optos.com for the latest information on new regional offices.
United States and Canada
Optos North America Inc
67 Forest Street
Marlborough MA 01752
United States of America
Sales and Marketing Call Toll Free: 1-800-854-3039
Outside continental US & Canada: +1 (508) 787-1400
Fax: (508) 486 9310 All inquiries: [email protected]
Customer Support: 800-854-3039
Brazil
Emergo Brazil Import Importação e Distribuição de Produtos Médicos Hospitalares Ltda. SIA
Trecho 3, Lotes 2010/2020, 1° Andar, Ed. Myrian
Bairro: Zona Industrial
Cidade: Brasília/UF:DF –CEP: 71.200-030
CNPJ: 04.967.408/0001-98
Telephone: +55 (61) 3386-3166
Brazil Registration Holder: Júlia Zema Parente Pinto- CRF/DF 2508
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Germany and Austria
Optos GmbH
Prinzenallee 7
D-40549
Düsseldorf
Deutschland
Telephone: +49 (0) 211 52391-0
Fax: +49 (0) 211 52391-200
Service Hotline (DE): +49 (0) 800 1822 643
Service Hotline (AT): +49 (0) 800 18 24 48 86
Switzerland
Optos GmbH
Zweigniederlassung Egg
Gewerbestrasse 9
8132 Egg
Schweiz
Telephone: +41 (0) 43 277 07 37
Fax: +41 (0) 43 277 07 38
Service Hotline: 0800 55 87 39
Netherlands
Optos BV
Kerkenbos 1079-B
6546 BB Nijmegen
The Netherlands
Telephone: +31 24 750 2800
Fax: +31 24 750 2845
All enquiries: [email protected]
Customer Support: +44 (0) 1383 843 350
Australia
Optos Australia
10 Myer Court
Beverley
South Australia 5009
Telephone: +61 8 8443 4533
Page 114 of 122
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United Kingdom and other European countries
Optos plc
Queensferry House
Carnegie Campus
Enterprise Way
Dunfermline, KY11 8GR
Scotland, UK
Telephone: +44 (0) 1383 843 300
Fax: +44 (0) 1383 843 333
Customer Freephone: 0808 100 45 46
Spain
Telephone: +34 677 452 421
Norway
Telephone: +47 908 55 004
Sweden
Telephone: +47 908 55 004
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Chapter 16 - Training Checklist
16
Training Checklist
This page will list the key training elements. At the end of each training session the trainer should
check the trainee understands each element listed below.
Safety Guidelines, see Introductory Handbook (installed on PCs)
Medical safety, including Epilepsy warning
Cleaning and Biocompatibility
Electrical safety
Peripherals and Optos-supplied PCs
About the system
optomap plus and optomap image overview
Tour of the main component parts, including Image Server PC
Tour of the main component parts, including the Capture PC
Admin application: creating new users, setting roles and making users inactive
Functional description of each part
Brief description of how the system works
Start up process (checking everything is switched ON)
Main power switches & 10 minute warm-up
System login
Logging onto the device (with new username)
System checks: using the hand control
System checks: using the capture switch and table height control
System navigation
Set up System Administrator
Stepping through the Capture procedures
Terminology used
Help sources
Help on current task (F1)
Application help (Help menu)
Installed documentation (User Guide, Introductory Handbook and Technical Data
Specification)
Partner area of website
Getting technical support
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Patient details
Adding new patients to the system
Patient Details (Iris categories, Insurance details (if applicable))
Modifying existing patient details
Patient alignment procedure - theory
Alignment Procedure (chair position and height, table height and chin cup nominal
height)
Alignment Procedure (chair position and height and table height)
Explanation to Patient (patient experience/procedure)
Patient positioning & capture - practical
Patient angle to the device for successful imaging
Table adjustments
Head rest adjustments
Explanation to patient
External Camera feedback
Capturing images
Image acquisition adjustments
Fixation Pattern brightness
Reviewing the image quality
l
l
Good example images
Bad example images
Reviewing image quality and improving the next image
optomap plusResMax imaging
optomap plus Eye steering procedure
Stereo imaging procedure
Technique for minimizing lid & lash
Cleaning the Main Mirror
Feedback from external camera if no lock obtained
Saving and discarding images
Choosing images to discard/save
Complete session to save images
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Hands-on practice
optomap and optomap plus practice
Eye Steering practice
Stereo Imaging practice
Reviewing images
Tour menu bar and tool bar
Selecting and filtering patients
Choosing images for review
Discarding images in the Review application
Reviewing Images:
l
l
l
l
l
l
l
l
l
l
l
l
Color channels
Zooming
Dragging
Magnifier (if applicable to device)
Review Notes
Annotation
Counting Annotations
Procedure Codes (optomap plus only)
Retinal Drawings (optomap plus only)
Automated view
Simulated BIO view
Comparison Overlay
Distributing Images:
l
l
l
l
l
l
l
Emailing
Exporting
Printing Patient Takeaway
Printing Images
Emailing and Exporting 3D Wrap Images and Movies
Assigning images to another patient record
Changing eye image from left to right (and right to left)
Data management
Review of archiving procedure
l
l
l
Primary
Secondary
Cleanup
Scheduled archiving to network drive (or NAS device1)
1A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network. It has its own network address.
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System shut down
Shut down steps
Power switches
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G-00081/2

English

Transcription

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