TWin EEG/PSG!

Transcription

TWin EEG/PSG!

Grass Technologies
TWin
®
Recording & Analysis Software
USERS MANUAL
Versions 4.4-5.0
For use with the following
Digital Recording Systems:
• AURA®24 Ambulatory EEG
• TREA® Ambulatory EEG
• AURA® PSG Wireless/Ambulatory
• AURA® PSG LITE Ambulatory
• Comet® series EEG/PSG
• SleepTrek3® Sleep Screener
• Beehive® Horizon LTM
• Beehive® Millennium LTM
®
600 East Greenwich Avenue, West Warwick, RI 02893
Phone 401.828.4000 • Fax 401.822.2430 • Technical Support 877.472.7779 • E-mail [email protected]
www.grasstechnologies.com
Manual Part Number M665G08
© Copyright 2011 Astro-Med, Inc.
This manual is copyrighted with all rights reserved. No part of this manual
may be reproduced, transmitted, transcribed, stored in a retrieval system,
or translated into any language in any form by any means without written
permission of Grass Technologies, An Astro-Med, Inc. Subsidiary.
Information in this document is subject to change without notice.
Astro-Med, Inc. assumes no responsibility for any errors, omissions or
inaccuracies whatsoever. The software described in this document is furnished
under a software license agreement. The software may be used only in
accordance with the terms of this agreement.
Except as permitted by the software license agreement, no part of this
publication may be reproduced, transmitted, transcribed, stored in a retrieval
system, or translated into any language, in any form or by any means,
electronic, mechanical, magnetic, optical, chemical, or manual, including
photocopying, anywhere in the world without the written permission of
Astro-Med, Inc.
Trademarks
AURA®, Beehive™, Comet®, EC2®, Panorama®, SleepTrek®, SzAC®, TWin® and
TWinLOOK® are trademarks of Astro-Med, Inc.
Windows®, Word®, NotePad®, PowerPoint®, SQL Server®, and Excel® are
trademarks of Microsoft Corporation.
Other brand and product names are trademarks or registered trademarks of
their representative holders.
Printed in the United States of America
Identification Data
Congratulations! Your Grass Technologies purchase is an investment in the
finest of state-of-the-art medical technology. The information provided below
lists the model number, serial number, and software version of your EEG/PSG
system. If, for any reason, it should be necessary for you to contact
Astro–Med, Inc. regarding your purchase, please refer to the following:
Model Number:______________________
Serial Number:______________________
Disclaimer
EXCEPT AS SPECIFIED IN THE SOFTWARE LICENSE AGREEMENT AND TO THE
MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, ASTRO-MED INC. MAKES
NO OTHER WARRANTIES AS TO THE CONTENTS OF THIS DOCUMENT EITHER
EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OR
MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
Astro-Med will not be liable to the Customer or be obligated to so defend the Customer to the
extent that the claim is based on (i) modifications to the Software by a party other than
Astro-Med or its licensors, or (ii) the combination, operation or use of the Software with
software not supplied by Astro-Med or with hardware other than the Hardware, (iii) use of the
Software other than in accordance with the use provided for in the Documentation and this
Agreement, (iv) Third Party Software, including but not limited to, Open Source Software or (v)
the use of a superseded or altered Release or Update of the Software if the infringement would
have been avoided by the use of a current unaltered Release or Update of the Software, which
Astro-Med provided to Customer and notified Customer of the requirement to utilize such
Release or Update in order to avoid such potential claim.
Open Source Software:
As a convenience to Customer and at no additional charge, Astro-Med will acquire on
Customer’s behalf or otherwise furnish Customer with the machine-readable object code version
of the Open Source Software described as the MPEG4 codec under the terms of the GNU General
Public License (GPL), which terms are located at
http://www.gnu.org/copyleft/gpl.html or other open source license modules and which are
incorporated herein by reference. Customer expressly agrees that: (i) the terms and conditions of
Customer’s right to use any such Open Source Software are exclusively set forth solely in
the license agreements included with or displayed by such software and such software is not
covered by this Agreement; and (ii) Astro-Med will have no liability to the Customer that arises
or results from the Customer’s use of such Open Source Software.
Important Note
The TWin® PSG software relies completely on manual user assignments of sleep stage and other
significant event marks. TWin PSG uses the power of the computer whenever possible to aid
and speed the scoring and review of the data files by keeping track of relevant signal information
(duration, time, signal size, etc.) associated with each user marked event.
Grass Technologies supports the position of the American Academy of Sleep Medicine (formerly
ASDA) that every page of the recording must be manually reviewed due the complexity of the
multi-parameter recordings and the confounding aspects of movement and other artifacts typical
in an all-night sleep recording.
Intended Use
Grass Technologies TWin EEG/PSG software is intended for use by qualified research and
clinical professionals with specialized training in the use of EEG/PSG recording instrumentation
for the digital recording, playback, and analysis of physiological signals. Its specifications
and features make it especially well suited to electroencephalography and polygraphic sleep
recordings.
Cautions
TWin SzAC Seizure and Spike Analysis software, TWin NSA Nurse Station Alarm software
and TWin Monitor are intended to serve as aids during acquisition and for data reduction
during review of Long-term Monitoring studies. A certain number of false positive (false alarm)
detections will be made, and it is not guaranteed that ALL true seizure events will be detected
and/or notified. The number of false positives and false negatives varies from
center to center, depending on the patient population, patient level of activity, type of seizures,
type of electrodes used (scalp vs. invasive electrodes), quality of electrode application, detection
parameters used, and other factors. To assist with patient care, Grass Technologies
offers additional hardware options to allow display of waveform and/or patient video at remote
locations.
SzAC, NSA and/or TWin Monitor should not be used as life support systems and users
should not depend solely on them for patient care and safety.
The design of this product is for diagnostic use only, and is not intended for
life-support monitoring purposes.
Federal law restricts this device to sale by or on the order of a licensed physician.
It is strongly recommended not to allow Internet connections or Internet use with
Grass Technologies systems with the exception of remote technical support with Grass
Technologies personnel.
Grass Technologies Software Product
License Agreement
This Grass Technologies software product license agreement shall govern the
use of TWin software to the user.
Use
The customer may use the software on any one computer. Customer may
not network the software or otherwise use it on more than one computer.
The customer may not reverse assemble or decompile the software unless
authorized by Grass Technologies.
Copies
The customer may make copies of the software for archival purposes as long as
the copies are used in no other manner.
Ownership
The customer agrees that he/she does not have any title or ownership of the
software, other than ownership of the physical media. The customer agrees that
the software is copyright protected under copy right laws.
Sublicensing & Distribution
The customer may not lease, sublease the software or distribute copies of the
software in physical media or by telecommunication without the prior written
consent of Grass Technologies.
Updates & Upgrades
Upgrade policy will be set by Grass Technologies with the price structure
dependent on “fixes” or enhancements. Generally, there will be no charge for
bug fixes. New features or enhancements are usually purchased. Any costs
incurred will be determined based on engineering time.
Export Clause
The customer agrees not to export or re-export the software or any copy in
violation of the U.S. Export Administration regulations or other applicable
regulation.
Table of Contents
1. TWin Specifications.........................................................................................1-11
Software Specifications....................................................................................1-11
2.
TWin Introduction & Overview.................................................................. 2-13
Welcome to TWin EEG/PSG!........................................................................ 2-13
Terminology & Conventions used in this Manual .................................. 2-14
Mouse Terminology................................................................................... 2-15
TWin Programs & Workspace...................................................................... 2-16
The TWin Desktop..................................................................................... 2-16
The TWin Program Group. ...................................................................... 2-16
TWin Programs.................................................................................... 2-16
Other TWin Icons..................................................................................... 2-18
Status Bar............................................................................................ 2-19
The Main TWin Window.......................................................................... 2-19
Title Bar............................................................................................... 2-19
Menu Bar. ............................................................................................ 2-19
TWin Shortcuts.............................................................................................. 2-20
TWin Preset Keyboard Shortcuts. .......................................................... 2-20
Navigation**......................................................................................... 2-20
Fast Review Navigation. ..................................................................... 2-20
Change Parameters Keyboard Commands......................................... 2-20
Miscellaneous...................................................................................... 2-20
PSG Keyboard Triggers .................................................................... 2-21
PSG Scoring Numeric Keyboard Triggers......................................... 2-21
EEG Keyboard Triggers ..................................................................... 2-22
Panorama Digital Video Preset Keyboard Shortcuts........................... 2-22
The TWin Toolbar. ................................................................................... 2-23
TWin® EEG/PSG Software
vii
TWin Systems & Options............................................................................... 2-27
TWin Recording Systems. ......................................................................... 2-27
AURA PSG Wireless/Ambulatory Recorder. ................................... 2-27
AURA PSG LITE Ambulatory/Wireless Sleep Screener.................. 2-27
SleepTrek3 Portable Sleep Screener.................................................. 2-27
Comet Series PSG................................................................................ 2-27
Comet Series EEG................................................................................ 2-27
AURA24 Ambulatory EEG................................................................. 2-27
TREA Ambulatory EEG....................................................................... 2-27
Beehive Horizon for Long-term Monitoring.................................... 2-28
Beehive Millennium for Long-term Monitoring............................... 2-28
TWin Review Systems & Software. .......................................................... 2-28
Review Workstation............................................................................ 2-28
System Requirements for TWin.................................................................... 2-28
License Agreements . ...................................................................................... 2-29
Related Documentation................................................................................. 2-29
Getting Help ................................................................................................... 2-29
Turning the System On & Off...................................................................... 2-30
Power On.................................................................................................... 2-30
Power Off................................................................................................... 2-30
3.Montage Editor.............................................................................................. 3-31
Introduction. .................................................................................................. 3-31
Default Recording Montage. .................................................................. 3-32
Select the Default Recording Montage............................................ 3-32
Moving, Deleting & Adding New Channels.......................................... 3-33
Move a Channel. ................................................................................. 3-33
Delete Channel(s)................................................................................ 3-33
Add a Channel..................................................................................... 3-33
Using the Head Diagram.......................................................................... 3-33
DC Channel............................................................................................... 3-35
Editing the AC Inputs............................................................................... 3-36
Using the Individual Input Change Box............................................ 3-36
Typing in an AC Input Name............................................................... 3-36
Editing the DC Inputs............................................................................... 3-36
Typing in a DC Input Name................................................................. 3-37
Using the Individual DC Channel Change Box................................ 3-37
Creating a New Set or Montage.................................................................. 3-38
Create a New Set....................................................................................... 3-38
Create a New Montage. ........................................................................... 3-38
viii
Table of Contents
4.Database Explorer. ......................................................................................... 4-41
Introduction. .................................................................................................. 4-41
Using the Software. ....................................................................................... 4-42
Logging In......................................................................................................... 4-42
Grass Database Explorer – Browse View................................................ 4-43
Browse View – List Section................................................................. 4-44
List by: Options.................................................................................... 4-44
Filtered by Query Option.................................................................... 4-44
Browse View – Patient Information Details. .................................... 4-45
Browse View – Study Details. ............................................................ 4-45
Grass Database Explorer – Query View.................................................. 4-46
Query View – Quick Search................................................................ 4-47
Creating a New Quick Search................................................................. 4-47
Activating an Existing Quick Search................................................. 4-47
Storing a New Quick Search.............................................................. 4-48
Deleting an Existing Quick Search.................................................... 4-48
Editing an Existing Quick Search. ..................................................... 4-48
Clearing the Search Criterion........................................................... 4-48
5. Recording. ....................................................................................................... 5-49
Start Recording.............................................................................................. 5-49
CPAP Study................................................................................................ 5-50
Split Night Study. ..................................................................................... 5-51
MSLT Study................................................................................................ 5-51
Commonly Used Keys. ............................................................................... 5-51
Montage Changes........................................................................................... 5-52
Stopping The Recording................................................................................ 5-53
6. Review............................................................................................................... 6-55
Reviewing the Data. ....................................................................................... 6-55
Patient Explorer (Hard Drive)..................................................................... 6-57
Patient Explorer (CD/DVD)......................................................................... 6-59
Read-Only Record..................................................................................... 6-59
Edit Record................................................................................................ 6-60
Navigation. ...................................................................................................... 6-63
Review Buttons.......................................................................................... 6-64
ix
7.PSG Scoring.................................................................................................... 7-67
Manual Sleep Scoring................................................................................... 7-67
Opening Studies for Review...................................................................... 7-67
Sleep Scoring Mode .................................................................................. 7-68
Scoring Tools. ..................................................................................... 7-68
Sleep Staging.............................................................................................. 7-69
Event Scoring (Respiration, Limb Movements, Arousals...) ................. 7-70
Set the Scoring Defaults.................................................................... 7-70
Marking Events................................................................................... 7-70
Editing Events. .................................................................................... 7-71
Generating a Report. ................................................................................ 7-72
Treatment Studies............................................................................... 7-73
Split-Night Studies.............................................................................. 7-74
MSLT Studies....................................................................................... 7-74
Automatic Sleep Scoring: FASS & ASA..................................................... 7-75
FASS – The Basics...................................................................................... 7-76
FASS – Settings Page.......................................................................... 7-77
ASA – Th e Basics...................................................................................... 7-78
ASA – Channels Used......................................................................... 7-79
ASA – Arousal Classification............................................................ 7-79
ASA – DC channel trends.................................................................. 7-80
Running Auto Sleep Analysis. ................................................................. 7-80
8.Sleep Scoring Comparison............................................................................. 8-85
Sleep Scoring Comparison............................................................................... 8-85
9.Data Management.......................................................................................... 9-93
Setup Quick Copy............................................................................................ 9-93
Archive Studies............................................................................................... 9-95
Delete Studies from the Database............................................................... 9-99
10. Troubleshooting......................................................................................... 10-101
TWin Problem Solving Strategies........................................................... 10-101
x
Table of Contents
1
TWin Specifications
Software Specifications
TWin Analysis�� FFT, CSA
Spectral mapping
Potential mapping
Seizure/Spike detection (on-line/off-line)
Sleep events detection: respiratory events,
desaturation, limb movements, bruxism, snore and arousals (on-line/off-line)
DC trends (real-time)
Fully-Automated Sleep Staging
EDF Import capability
Neuromonitoring (on-line/off-line)
TWin Outputs�� Export waveform data to ASCII, EDF, Excel
Export data and graphics to Word, Excel
Report generation to Word, HTML, XML
Printout of waveforms to standard
Windows-compatible printers
Printout of graphics and study to standard
Windows-compatible printers
TWin Data
Management�� Grass Database Explorer for patient and
study-related information and also file management
Patient-Explorer (TWin version of Windows Explorer) for file management
Grass Patient Scheduler
1-11
TWin Utilities�� Montage editor
Database editor to add or customize database fields
Spatial Montage editor
Event description editor to customize keyboard triggers and events (for example, sleep scoring events, seizure/spike events for LTM, etc.)
Photic sequence editor to customize photic
flash sequences
Functional
Modalities Supported� Routine EEG, PSG, Long-term Monitoring,
Ambulatory EEG, Ambulatory PSG
TWin Acquisition
Real-time Data
Sources Supported�� AURA PSG Amplifiers
AURA Amplifier
AURA LTM64 Amplifier
Comet EEG/PSG AS40 Amplifier
CTE Amplifiers
Digital Video/Audio
TREA Amplifier
Other Hardware Devices
Supported�� NSA-PC Nurse Station Alarm System
Automatic A/V Room switch
Photic Stimulator
SleepTrek Portable Sleep Screener
Operating Systems
Supported�� Windows XP Professional, Windows Vista,
Windows 7, Windows Server 2008
1-12
Chapter 1 Specifications
2
TWin Introduction & Overview
Welcome to TWin EEG/PSG!
TWin is a comprehensive software program intended for
Electroencephalography (EEG), Polysomnography (PSG), and
Long-term Epilepsy Monitoring (LTM). TWin is incredibly powerful and
flexible, but also designed for easy and efficient day-to-day use.
This manual is intended to guide the user through the configuration and
operation of TWin software. This manual should be consulted anytime there
is a question or to gain more knowledge about a certain feature.
This chapter contains some of the basic background information needed
before beginning. See TWin Systems & Options to become more familiar
with the particular system and options that were purchased. To become
more familiar with the TWin windows and menus, TWin Programs &
Workspace gives a brief introduction to the TWin program group and main
program window.
2-13
Terminology & Conventions used in this Manual
The following conventions are used in this manual:
Note:
Signifies interesting information
Important:
Signifies an important note with vital information needed to operate the TWin system. This information may affect data quality, data accuracy, or recording stability.
Warning:
Signifies a warning
Sans serif
Sans serif text denotes dialog boxes, window titles, buttons, and options
Italic Italic text denotes new terms or key concepts
<>
Angle brackets enclose the name of a key on the keyboard:
For example, < Page Up >
<+ >
A “+ “ between two or more key names enclosed in < > denotes that the keys should be pressed simultaneously:
For example, < Shift + F12 >
>
This symbol leads you through nested menu items
In body text, the following conventions are used for TWin menus only:
Bold >
Bold text before a > symbol denotes a menu heading
> Normal
Normal text after the > symbol denotes a menu selection or submenu heading
> Italic
2-14
Italic text after a > symbol denotes a submenu selection
Chapter 2 Introduction & Overview
Mouse Terminology
The mouse is the primary way to interact with TWin software. This manual
uses the following conventions for mouse actions:
Point
Glide the mouse to move the mouse-controlled pointer (cursor)
on the screen to the specified item.
Click
Press once on the LEFT-mouse button. This is generally used for
selecting an item, or performing an action.
Double-click Tap twice quickly on the LEFT-mouse button. This is generally
used to open a file, or to run an application.
Click & Drag Hold down the LEFT-mouse button while gliding the mouse.
This is generally used for selecting an area on the screen, or
moving something on the screen.
Right-mouse
Click
Press once on the RIGHT-mouse button. This is generally used
for obtaining more information about an item on the screen.
Right-mouse
Click & Drag Hold down the RIGHT-mouse button while gliding the mouse.
This is a secondary way of selecting an area on the screen, if
(left-mouse) Click and Drag is already used.
2-15
TWin Programs & Workspace
The TWin Desktop
TWin Folder
The TWin Program Group is created when TWin is
installed and is located in the TWin folder on the desktop.
The program group contains shortcut icons to all TWin
programs and utilities.
The TWin Program Group
Double-click on the TWin folder to access the TWin Program Group icons. The
TWin Program Group window will open displaying all of the TWin programs.
TWin Programs
TWin
This is the main TWin program. Double-clicking on this
icon will open TWin in reviewer mode. See Other TWin
Icons, later in this chapter, for other shortcuts to the main
TWin program.
The remaining TWin Program Group icons in the TWin folder access specific
TWin utilities for customizing, configuring and troubleshooting TWin:
Database Explorer
Event
Description Editor
2-16
The Grass Database Explorer allows the user to Launch
TWin Acquisition and Review, import and view reports,
store and query report statistics, link to and easily access
other files (Word files, reports, pictures, etc.), search, sort,
and query patient and study information, store quick
searches for future use.
The Event Description Editor allows customizing of
TWin event definitions. This includes the definition of
keyboard triggers, as well as scoring events. Use the
Event Description Editor to change, or add a single-key
notation definition.
Montage Editor
The Montage Editor is used to add new montages or
modify existing ones. It is also used to set up AC and DC
input channels (e.g., which electrode, sensor or device is
plugged into which input) and the input type (e.g., EEG,
EKG, respiration, etc.).
Patient Explorer
Patient Explorer is a utility similar to Windows Explorer.
Its function is to locate and view files (studies), as well as
provide a variety of file management options.
Photic DB Editor
The Photic DB Editor is used to setup a new photic flash
sequence, or to modify an existing sequence. It is also used
to add, or remove specific entries from the list of available
photic flash frequencies.
Sleep Report Wizard The Sleep Report Wizard is used to customize the layout
and content of the EEG, PSG, or LTM report templates.
The Sleep Report Wizard is also used to create or modify
statistics for inclusion in the reports.
TWinLOOK
TWinLOOK review only package, permits an EEG, PSG,
or LTM Recording to be reviewed on any Windows
XP, Vista, 7, or Server 2008 computer without any special
software.
Nurse Station Alarm If Nurse Station Alarms were purchased for use with the
Beehive, this icon will also be present.
Spatial Montage Editor Spatial Montage Editor is used to customize Laplacian,
Source Derivation, Weighted Average type montages
2-17
Other TWin Icons
TWin systems configured by Grass Technologies will also have additional
handy shortcuts on the desktop that allow access to the specific TWin functions
that are most often used.
AURA Icons
Double-clicking on the AURA RECORD
(AURA-PSG RECORD, AURA LTM64 RECORD,
AS40 RECORD, TREA START RECORDING, or CTE
RECORD ) icon will open TWin in the monitoring mode.
Note: If the system supports more than one kind of acquisition hardware,
there will be multiple RECORD icons. For example: there may be an
AURA RECORD icon and a CTE RECORD icon if both AURA and CTE
amplifier systems are available.
TWin
2-18
The TWin icon is found on most recording systems.
Double-clicking on this icon will open TWin in review
mode. (This is identical to the icon that is found in the
TWin Program Group folder.)
The Main TWin Window
Title Bar
The main TWin Window is labeled Grass Technologies followed by EEG,
PSG, or LTM. In the left-hand corner, there is a small TWin icon:
Click on
the icon.
Menu Bar
The menu bar contains the
TWin pull-down menus File,
View, Analysis, Window,
Tools and Help.
File
View
Analysis
Window
Tools
Help
Figure 2-5: Title and Menu bars
The File menu accesses commands for reviewing studies,
opening the database, printing and other file-related
operations.
The View menu accesses commands for most of the
settings and configuration options for TWin.
The Analysis menu accesses TWin’s advanced analysis
options, such as Spectral Analysis, Spectral Mapping,
Potential Mapping, Spike and Seizure Detector, Auto
Sleep Analysis, and/or Neuromonitoring.
The Window menu aids in managing multiple windows
within TWin.
The Tools menu accesses the Language selections
available for the TWin software: English, French, German,
Italian, or Spanish.
Help menu is available for some key screens and dialog
boxes.
Status Bar
The Status Bar displays the date and time, and other status information
across the bottom of the main TWin window. Selecting View > Status bar will
show/hide all status bar at the bottom of the window.
Figure 2-6a: Status bar, checked
Figure 2-6b: Status bar, unchecked
2-19
TWin Shortcuts
TWin Preset Keyboard Shortcuts
These keyboard shortcuts apply only to TWin EEG and PSG. For Panorama
Digital Video Preset Keyboard Shortcuts see page 2-16.
Navigation**
< PgUp >
< PgDn >
<
>
<
>
< Home >
< End >
< Ctrl + G >
< Ctrl + F >
< F3 >
Move back one page
Move forward one page
Move back a partial page*
Move forward a partial page*
Go to the first page of the study
Go to the last page of the study (review), or
Return to real-time wiper display (monitoring/recording)
To open the Go To... window
Search for a notation
Repeat last notation search
* A partial page is typically 1 second if Chart Speed is used, or 10% of the page if Page Size is used.
** Navigation Keyboard Commands can be reprogrammed to user’s preferences.
Fast Review Navigation
< PgUp >
< PgDn> <
>
<
>
Start automatically paging backwards
Start automatically paging forwards
Moves back one page
Moves forward one page
Change Parameters Keyboard Commands
< + >
< - >
< >
< >
< Shift + >
< Shift + >
Miscellaneous
< spacebar >
< Ctrl > + click
< Ctrl > + click
< L >
< N >
< backspace >
2-20
Sensitivity up
Sensitivity down
Chart speed up
Chart speed down
Next montage
Previous montage
Enter a free form comment in real-time or review mode
Enter a free form comment in review mode only
On an event to delete or edit it
Channel labels on/off (when the labels are on the waveforms. Montage Labels can also be moved off the waveforms by selecting View > Channel Label Position > Labels Off Waveform.)
Notation display on/off
Repaint (refresh)
PSG Keyboard Triggers

< D >
< O >

< T >
Enter the applied BiLevel/CPAP level
Enter the applied Dental Adjustment level
Enter the applied Supplemental O2 level
Enter the patient’s change in Body Position
Enter a Treatment — None/Start event for split-night sleep
studies
< A >
< C >
< V >
< X >
< Z >
Score Arousal — Spontaneous
Score Respiratory Event — Central Apnea
Score Respiratory Event — RERA
Score Respiratory Event — Mixed Apnea
Score PLM — Periodic
< E >
< M >
< S >
< Shift + S >
< R >
< Ctrl > + Left-click
< Shift > + Left-click
< Shift > + Right-click
Edit Data — Start/End notations
Mark the beginning of a specific MSLT nap number
Snoring time Start/Stop
Sleep Status — Sleeping/Awake/End of Night notations
Tech Notations — Select from a list of typical technician
annotations
Automatically scores an Arousal event associated with a
Respiratory Event, Snore, or Limb Movement
Deletes the selected event
Brings up a pop-up box allowing the user to change the
event classification
< F2 > Lights Out
< F3 > Repeat last notation search
< F4 > Eyes Open
< F5 > Eyes Closed
< F6 > Look Up
< F7 > Eye Blink 5 Times
< F8 > Grit Teeth
< F9 > Flex Right Leg
< F10 >Flex Left Leg
< F11 >Breathe Through Nose
< F12 >Breathe Through Mouth
< Shift + F2 >
< Shift + F3 >
< Shift + F4 >
< Shift + F5 >
< Shift + F6 >
< Shift + F7 >
< Shift + F8 >
< Shift + F9 >
< Shift + F10 >
< Shift + F11 >
< Shift + F12 >
Lights On
Cough
Valsalva
PT to Bathroom
Look Down
Tech in Room
Look Right
Movement
Look Left
n/a
Hold Breath
PSG Scoring Numeric Keyboard Triggers
< . >
< 0 >
< 1 >
< 2 >
< 3 >
< 5 >
< 6 >
No Stage (typically scored before Lights Out and
after Lights On)
Stage W
Stage N1
Stage N2
Stage N3
Stage R
Stage Mvt
2-21
EEG Keyboard Triggers
< H >

< F4 >
< F5 >
< F6 >
< F7 >
< F8 >
< F9 >
< F10 >
< F11 > < F12 > <R>
<T>
Start/Stop HV
Start/Stop Post HV
Eyes Open
Eyes Closed
Awake
Drowsy
Asleep
Move
Talk
Tech In Room
Tech Bookmark
Review Notations list
Tech Notations list
Panorama Digital Video Preset Keyboard Shortcuts
< PgUp >
< PgDn >
<
><
>
< > < >
< Home >
< End >
< + >
< - >
< Insert >
< Delete >
< Tab >
< Alt > + click
2-22
Control video contrast
Control video contrast
Changes the position of the displayed portion of
the original video frame if zoom factor is >1.0
(digital pan/tilt control)
Brightness up
Brightness down
Change the zoom factor
Change the zoom factor
Control color saturation level,
if this control is supported by the VGA card
Control color saturation level,
if this control is supported by the VGA card
Toggles the digital video window overlay capabilities
On an event to see the video for that event
The TWin Toolbar
The Toolbar is programmable and may be customized to display only the
buttons the are needed.
Note: The buttons with the red arrow in the top right-hand corner indicate
that there is an additional function when the icon is right-clicked.
The buttons are as follows:
Start/Stop Recording
Left-click to start or stop recording patient waveforms. This button
is only active during record and is not active in review.
Calibration
Left-click to activate the AC amplifier calibration window. This
button is only active during record and is not active in review.
DC Calibration
Left-click to activate the DC input calibration window. Once a
recording is started, the button becomes inactive. This button is only
active during record and is not active in review.
Impedance Check Values
Left-click to view the electrode impedances. Impedance checking
can be performed before a recording is started or any time after
recording has begun. Impedance checking must be performed
during the recording to later view the impedance values in review.
Properties
Left-click to activate the Review Properties window. Use this
window to view Waveform Settings, Notations, and Select
Montage. Alternate method: Right-click anywhere on the TWin
window to activate the Review Properties window.
TimeLine
Left-click to enable the TimeLine/Hypnogram. Right-click to
activate the Select set of events for scoring window.
Patient Information
Left-click to view patient information and demographics.
2-23
Set Gnomon
Left-click to change the size of the Gnomon indicator.
Marker Mode
Left-click to enable this waveform amplitude measurement tool.
Go To Time...
Left-click to Goto a time or epoch.
Fast Review Mode
Left-click to enable Fast Review Mode. To disable Fast Review
Mode, click on the button again. Right-click to select fast review
speed, and/or to select fast review Through All Data or By Notations.
Clone
Left-click to bring up two windows to review the data. Right-click to
set Synchronize Clone and Do Not Synchronize.
Zoom Mode
Left-click to enable/disable Zoom Mode. Zoom Mode gives the
user the ability to magnify an individual waveform segment and
provides measurement information.
Full Screen
Left-click to maximize the TWin review area. Left click on this
button a second time to return the window to its normal size.
Repaint
Refreshes the screen.
Increase Sensitivity
Left-click to increase the size of the waveforms.
Decrease Sensitivity
Left-click to decrease the size of the waveforms.
Increase Chart Speed
Left-click to decrease the number of seconds per page.
Decrease Chart Speed
Left-click to increase the number of seconds per page.
2-24
Low Filter Up
Left-click to increase the low filter setting.
Low Filter Down
Left-click to decrease the low filter setting.
High Filter Up
Left-click to increase the high filter setting.
High Filter Down
Left-click to decrease the low filter setting.
Montage Explorer
Right-click to select the different montages associated with the
study. Left-click to modify and manipulate different montages using
Montage Editor.
Select Next Montage
Left-click to select the next montage in the current montage set.
Right-click to view a list of the available montages.
Previous Montage
Left-click to select the previous montage in the current montage set.
Right-click to view a list of the available montages.
Commit Montage
Left-click to commit montages changes to disk to be able to “View as
Recorded” while in review.
Change Event Scoring Defaults
Left-click to change the event scoring defaults.
Mouse Selection Mode
When performing Spectral Analysis, left-click on this button, then
click and drag over the waveform to select the area to be analyzed.
Clear All Sections
When performing Spectral Analysis, left-click on this button to clear
all selections.
2-25
SzAC Detector
Left-click to enable automatic real-time seizure/spike analysis.
Edit Pad
Left-click to enable/disable the Edit Pad/SzAC-o-Gram window.
The tools available in this window allow the user to navigate
through a study and to save or delete patient data, video, and other
types of events.
Photic
Left-click to start/stop photic stimulation. Right-click to select a
specific frequency or to select sequence.
Video Link
Left-click to activate the Digital Video playback window.
Help
Left-click to access Help for some key screens and dialog boxes.
Comments
Left-click to activate the Comments / Notes window during
acquisition or review. Type text in the main window, insert
timestamps, and print the comments as needed,
AutoPlay Saved Events
Left-click to activate this mode of data/video playback. Playback of
data/video will be based on Edit Data - Start/End annotations.
Auto Arousal Scoring On/Off
Left-click on this button to activate the quick arousal scoring feature.
When On, arousals will automatically be marked when scoring PSG
events.
Realtime Printing
Left-click on this button to activate printing during acquisition.
Patient Observation Sheet
Left-click on this button to activate and review the Patient
Observation Sheet log.
Notation List
Left-click on this button to activate/view the Notation List.
2-26
TWin Systems & Options
TWin Recording Systems
AURA PSG Wireless/Ambulatory Recorder
The AURA PSG (with AURA PSG amplifiers) is a complete 25-channel,
including 10 DC input instrument, designed for wireless use in the PSG lab or
ambulatory out-of-lab applications. Refer to the separate AURA PSG Manual
for more information.
AURA PSG LITE Ambulatory/Wireless Sleep Screener
The AURA PSG (with AURA PSG amplifiers) is a 16-channel instrument,
designed for use as a sleep screener. It may be used for wireless recording in
the PSG lab or ambulatory out-of-lab applications. Refer to the separate AURA PSG Manual for more information.
SleepTrek3 Portable Sleep Screener
The SleepTrek is a 6-channel instrument, designed for use as an apnea screener.
Refer to the separate SleepTrek Manual for more information.
Comet Series PSG
The Comet PSG (with AS40 amplifiers) is a complete 57-channel instrument,
including 10 DC input instrument, designed for use in the PSG lab. Refer to the
separate Comet Manual for more information.
Comet Series EEG
The Comet EEG (with AS40 amplifiers) is a complete 57-channel instrument,
designed for use in the EEG lab. Refer to the separate Comet Manual for more
information.
AURA24 Ambulatory EEG
The AURA24 EEG (with AURA amplifiers) is a 28-channel instrument,
designed for use in the ambulatory situations. Refer to the separate AURA24
Manual for more information.
TREA Ambulatory EEG
The TREA EEG (with TREA amplifiers) is a 25-channel instrument, designed
for use in the ambulatory situations. Refer to the separate TREA Manual for
more information.
2-27
Beehive Horizon for Long-term Monitoring
The Beehive Horizon (with AURA and AURA LTM64 amplifiers) is a complete
32-128 channel instrument, designed for long-term epilepsy monitoring.
Refer to the separate Beehive Horizon and AURA LTM64 Manuals for more
information.
Beehive Millennium for Long-term Monitoring
The Beehive Millennium (with CTE amplifiers) is a complete 32- to
128-channel instrument, designed for long-term epilepsy monitoring. Refer to
the separate Beehive Millennium Manual for more information.
TWin Review Systems & Software
Review Workstation
Review Workstations (TRW series) are turnkey systems set up for review
purposes only. The TRW series systems are configured at the factory to match
the recording system(s).
The TRW can review studies recorded by all TWin acquisition systems.
System Requirements for TWin
The minimum system requirements for TWin are as follows:
• 3.0 GHz, Pentium or 1.5 GHz Duo
• 2 GB RAM
• 30 GB Hard drive
• 128 MB Graphics card
• Dedicated 10/100 BT NIC Card for Amplifier interface
• Windows XP Professional , Windows Vista, Windows 7
• MS Office 2003 /2007/2010 Professional
• On-board Parallel, Serial, or USB Port (for the TWin key)
Also required:
• USB Port for digital video/audio recording (Model PANO-LAP)
for use with a laptop computer
or...
• (2) PCI or PCIe slots for digital video/audio recording (Model
AUPAN-1) for use with a desktop computer
2-28
License Agreements
Please read the License Agreement at the beginning of this manual before using
TWin. Use of the software indicates acceptance of this agreement.
Related Documentation
The following TWin documents are also available:
• CD-ROM documentation folder contains upgrade instructions.
Getting Help
This manual is the primary source of help for TWin. Some key screens and
dialog boxes in the program offer a Help button for specific instructions for the
current operation.
Astro-Med, Inc. provides Grass Technologies Technical Support Specialists to
help resolve questions relating to the setup and use of TWin software and other
related Grass Technologies and Astro‑Med instrumentation and software.
For additional information, call:
(877) 472-7779 (toll-free, USA and Canada only)
(401) 828-4000 (voice)
(401) 822-2430 (fax)
[email protected] (e-mail)
When calling to report an error, please have the full text of any error messages
along with a description of the events leading to the error. Technical Support
Specialists may also need to know details about the hardware configuration,
make and model of the computer and any accessories installed in the computer,
and the version number of the software. To get the version number of the TWin
software select Help > About.
2-29
Turning the System On & Off
Note: TWin supports automatic power failure recovery. If power to the computer
system goes out during the recording, TWin will automatically resume
recording when power is restored again. It is not necessary to have to
manually re-start the recording.
Power On
1.
Turn the Isolated Power System (IPS) on. The IPS provides power to all
system components in the cart or recording area.
For AURA24, AURA PSG, AURA PSG LITE, and some Comet systems
without the IPS, turn the Medical-grade Power Supply (RPSAS40) on.
2.
Turn the computer power on. When the computer has completed
booting-up the desktop will appear.
Power Off
1.
Close all applications that are currently running.
2.
On the Windows taskbar, select Start > Shut Down. The Shut Down dialog
box will appear.
3. If the Shut Down radio button is not already selected, click to select it.
Click OK. The system will display Windows is shutting down. Then the
computer will power off automatically. If the computer does not power
off automatically, manually turn the computer off when the system displays It is now safe to turn off your computer.
4. Turn the Isolated Power System (IPS) off. The IPS provides power to all
system components in the cart or recording area.
For AURA24, AURA PSG, AURA PSG LITE, and some Comet systems
without the IPS, turn the Medical-grade Power Supply (RPSAS40) off.
2-30
3
Montage Editor
Introduction
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Figure 3-1: Montage Editor Buttons
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
14.
15.
16.
Open Montage File
Save Changes
Set Default Record Montage
Add Montage Set
Add Montage
Delete Montage or Montage Set
Copy
Paste
Insert Channel
Delete Channel
Show Inputs
Show DC Inputs
Show Outputs
Channel Color
Topo View
Help
Each montage is comprised of three parts:
AC inputs: The Show Inputs button displays a list of the electrodes and
sensors connected to the amplifier of the recording system
DC inputs: The Show DC inputs button displays a list of the signals from
the external devices connected to the DC inputs of the recording system
Outputs: The Show outputs button displays the montage,
including G1-G2, filter and sensitivity settings
3-31
Default Recording Montage
The Default Recording Montage is the first montage that is used whenever
a recording is started. The Default Recording Montage is identified though
Montage Editor.
Select the Default Recording Montage
1.
2
In the Montage tree, click on the montage to be the new default montage.
It will be highlighted.
Click on the Set Default Record Montage button. The default Recording
Montage in the status bar will update and highlight in red to reflect the
new selection.
Figure 3-2: Select the Default Recording Montage
3-32
Chapter 3 Montage Editor
Moving, Deleting & Adding New Channels
Move a Channel
Click and drag the channel to be moved. When the desired location has been
reached, unclick to drop the channel.
Delete Channel(s)
Select the single channel or multiple channels to be deleted. Click on the
Delete Channel button. The channel(s) will be deleted.
Add a Channel
Click on the Insert Channel button. The new channel will be added at
the end of the montage. This channel can now be edited like any other
channel. The filter and sensitivity settings are picked up from the last
channel. It is also possible to use the Head Diagram to add channels.
Using the Head Diagram
The Head Diagram is the easiest, most convenient way to program output
channels.
1.
2.
3.
Click on the Topo view button to turn the Head Diagram on/off.
To adjust the size of the Head Diagram, click and drag on the divider
between the Head Diagram and the channel list.
On the Head Diagram, click on the desired channel to anchor the end of
the arrow. (If an error is made, just click again on the channel to detach the
arrow.) Click on the other desired channel to anchor the head of the arrow.
Figure 3-3: Head Diagram
3-33
4.
5.
6.
7.
The new channel will appear at the end of the montage. Continue clicking
on the channel inputs on the Head Diagram to add more channels.
To remove a channel, highlight the channel and click on the Delete
Channel button. The Montage Editor will ask: Are you sure you want to
delete channel(s)? Click on Yes.
Locate the montage to be edited in the Montage tree display, and click to
select it. Click on the Show Outputs button.
Right-mouse click on the channel. The Individual Channel Change box
appears. Click on the LF Filter, HF Filter or Sensitivity drop-down menus
to change the parameters.
Figure 3-4: Individual Channel Change Box
8.
3-34
Click on the desired setting. The new setting will be applied to the
selected channel.
DC Channel
When typing in a DC Channel, it is necessary to use an input name that is
defined in the DC Inputs. (Case is not important: sao2 is the same as SaO2.)
When finished, press < Enter >.
Note: Typing in the DC input name is the only way to program a DC channel
into the montage.
Figure 3-5: DC Inputs
3-35
Editing the AC Inputs
Important: If an input name is changed, or if inputs are added or deleted, make
sure that all other montages in the set are updated to match.
Otherwise, trouble may be encountered when applying the
montages, since there will be a mismatch.
Locate the montage to be edited in the Montage tree display, and click
to select it. Click on the Show Inputs button.
Using the Individual Input Change Box
Right-mouse click on the input to
change. The Individual Input Change
box appears.
Figure 3-6: Individual Input Change
It is possible to:
• Change the name of the input by typing in the AC Input box.
• Include the input in the Average Reference by clicking the Averaged
checkbox to enable it. This will include the input in the average
reference if AVG is programmed into the Outputs of the same montage.
• Assign a channel type to the input from the drop-down list.
Click on Done when finished.
Typing in an AC Input Name
Select the AC input to be edited. Click on the name again. (This is not a doubleclick. There is a pause between the click to select and the second click.) A text
edit box will appear around the entry. The maximum length for an AC input
name is 5 characters. When finished, press < Enter >.
Editing the DC Inputs
The Show DC inputs button displays the list of high-level DC inputs from
external devices (such as an oximeter), as they are connected to the DC inputs
or DC jack box of the system. This includes the input names, the units for
numeric display, and the channel types.
Note: Special DC trend breakdown tables can be created for EtCO2 and
TCO2. The specific DC channel names of EtCO2 and TCO2 must be
used for these trends and tables to be created.
3-36
Locate the montage to be edited in the Montage tree display, and click
to select it. Click on the Show DC inputs button.
Typing in a DC Input Name
Click on the DC input to select it. The selected input is highlighted. Click on
the name again. (This is not a double-click. There is a pause between the click
to select and the second click.) A text edit box will appear around the entry.
The maximum length for a DC input name is 5 characters. When finished,
press < Enter >.
Using the Individual DC Channel Change Box
Right-mouse click on the DC input to be changed. The Individual DC Channel
Change box appears.
Figure 3-7: Individual DC Channel Change Box
It is possible to:
• Change the name of the input by typing in the Channel box.
• Define the unit that will be displayed with the numeric readout for the
DC input, by typing in the Units.
• Assign a channel type to the DC input from the drop-down list.
Click on Done when finished.
3-37
Creating a New Set or Montage
Create a New Set
1
2.
Click on the Add
Montage Set button.
A new set appears at the bottom
of the Montage tree, with an
automatically generated name.
There is a text edit box around
the new set name, so a new
name can immediately be typed
in, then press < Enter >.
Figure 3-8: Montage Tree
Create a New Montage
1
Click on the Add Montage button. The Define Montage Type
window will open. Click on the radio button for the amplifier
system used.
Figure 3-9: Define Montage Type
3-38
2.
Click on Next >. The Define Outputs box appears. To automatically
create a referential display montage, enable Referential and select the
desired G2 from the drop-down list,
Figure 3-10: Define Outputs
3.
or...
Skip this step if it is desirable to create a montage with an empty
Outputs page.
Click on Finish. The montage will be created.
3-39
3-40
4
Database Explorer
Introduction
The Grass Database Explorer is the management software that brings it all
together. Efficiently manage patients and studies with selectable Browse and
Query views.
Fully integrated with the TWin acquisition/review/report software and
optional Grass Patient Scheduler, use Grass Database Explorer to;
• Launch TWin Acquisition and Review
• Import and view reports
• Store and query report statistics
• Link to and easily access other files (Word files, reports, pictures, etc.)
• Search, sort, and query patient and study information
• Store quick searches for future use
4-41
Using the Software
Logging In
1
2.
From the desktop, double-click on the Grass Database Explorer
shortcut icon.
If password protection has
been activated, the Grass Login
window will appear. Type in
the appropriate Username and
Password, and then click Login.
Figure 4-1: Grass Login
Note: Read/Only users will receive an informational message (see
Figure 4-2). Simply click OK to proceed. Read/Only users will not have
the functionality to add/remove patient information, modify database
information, archive study data, or import sleep statistics in the Grass
Database Explorer.
Figure 4-2: Read/Only Users Message
3.
4-42
After a brief moment, the Grass Database Explorer window will open.
The Grass Database Explorer will appear in the last view used.
Chapter 4 Database Explorer
Grass Database Explorer – Browse View
The Browse view is intended to be the means to quickly view and access the
patient list and associated studies. To activate the Browse View, click on the
Browse button located on the Grass Database Explorer toolbar. The Browse
view is made up of three sections; the List by, Patient Information, and Study
Information areas.
Figure 4-3: Database Explorer Browse View
4-43
Browse View – List Section
The List section is the area where
patient and study information can be
sorted for easy accessibility. The list
is presented by patient (LastName,
FirstName) and then by study. There
can be multiple studies per patient.
The study information is displayed
by the type of test performed, and the
date of the recording.
Figure 4-4: List Section
Note: In a long patient list, type one or more characters of the patient’s last
name using the keyboard, and the first patient name matching the
typed characters will appear. For example, to find patients with the last
name of Smith, type the characters sm or smi.
List by: Options
Use the drop-down list to display patients/studies by:
Patient
Displays the patient list in alphabetical order.
Test Type
Displays the patient list by type of study;
PSG, EEG, LTM, ST3, or TREA.
Reviewed
Status
Displays the patient list based on the review status; Yes/No.
Physician
Displays the patient list based on the physician.
ID
Displays the patient list based on an alpha-numeric order.
Date of Test Displays the patient list, in chronological order,
based on the dates the studies were performed.
Technician Displays the patient list based on the selected technician.
The technicians are sorted in alphabetical order.
Archive
Status
Displays the patient list based on the archive status;
In Archive Queue/Not In Archive Queue.
Filtered by Query Option
Enable (check) this option to use the last Quick Search selected in Query Mode.
Only the patient names and studies meeting the criteria set forth by the Quick
Search will be displayed. Query Mode and Quick Searches will be discussed
later in this section.
4-44
Browse View – Patient Information Details
When a patient name is selected, the applicable information is filled into the
Patient Information Details section of Browse mode. The Patient Information
Details section consists of the tabs and information in the upper-right half of
the Browse mode view. Standard tabs of information include Demographics,
Address, and Clinical.
Figure 4-5: Patient Information Details
Browse View – Study Details
When a specific study is
selected, the applicable
information is filled into the
Study Details section of Browse
mode. The Study Details
section consists of the tabs
and information in the lowerright half of the Browse mode
view. Standard informational
tabs include Logbook, Clinical,
Referral, Technical and History.
Figure 4-6: Study Details
4-45
Grass Database Explorer – Query View
The Query view allows a user to quickly and efficiently find study records
meeting selected criteria. To activate the Query View, click on the Query button
located on the Grass Database Explorer toolbar. Once a query/search has been
initiated, a list of study records meeting the criteria is displayed. The Query
view is made up of three sections; the Quick Search, Study List, and Patient/
Study Information areas.
Figure 4-7: Grass Database Explorer Query View
4-46
Query View – Quick Search
The Quick Search area is where queries/searches are selected, created, or
implemented. Stored queries are available in the Quick Search drop-down list.
New queries can be created and saved by typing in the appropriate criterion,
assigning a name for the quick search, and then clicking Save As. Quick
Searches are activated by clicking the Search button. Quick Searches can also
be assigned the 10 available Quick Search buttons.
Figure 4-8: Quick Search
Creating a New Quick Search
By entering a single Field, Condition, and Value information, a simple query
can be created. Selecting the And/Or operator allows for additional Fields,
Conditions, and Values to be entered, thus creating a more complex query.
Field
Condition
Value
And/Or
A drop-down list containing the available database statistics
which can be queried.
A drop-down list containing the available operators for the query.
The area where the desired information that is being looked to
obtain/query is entered.
Logical operators to build multi-leveled queries.
Activating an Existing Quick Search
Use the Quick Search drop-down list to select a stored query, and then click
the Search button. Study records meeting this criterion will be displayed in the
Study List section of the Query view. Also, the total number of records meeting
the criterion is reported as a numeric value on the right-hand side of the Quick
Search area.
4-47
Storing a New Quick Search
Once a query has been created, it can be given a name and stored for future
use. The query can also be programmed to Filter Studies By Recording Date or
assigned to a Quick Search button. By assigning a Filter Studies By Recording
Date value, only studies meeting the query criterion and recorded within the
set number of days will be displayed. By assigning a newly programmed query
to one of the ten available Quick Search buttons, one can easily activate the
query by pressing in the button. Pressing in the related Quick Search button
will immediately apply the query and display the results.
Figure 4-9: Quick Search
Deleting an Existing Quick Search
the Delete button. A Delete Quick Search confirmation appears. Click the Yes
button to delete the quick search, or No to cancel.
Editing an Existing Quick Search
the Edit button. An Edit Quick Search window appears allowing the name,
filter by date, and Quick Search button assignment to be modified. Click the
Save button to save the changes or Cancel to close the window without saving
changes.
Clearing the Search Criterion
Click on the Clear Search button to clear any Quick Search criterion. This
allows the user to start creating a new search.
4-48
5
Recording
Start Recording
1
Double-click on the Grass Database Explorer icon on the
desktop.
Note: The database can be setup to
allow users different options.
If this is the case, enter your
username and password in
Grass Login.
2.
When Grass Database Explorer
opens, select File > New
Patient...
Figure 5-1: Select File > New Patient
5-49
3.
Enter the patient’s Last Name, First Name, Date of Birth and other
pertinent information, then click Save.
Figure 5-2: Add Patient
4.
5.
6.
7.
Click on the red New Recording button in the Grass Database
Explorer to start TWin in MONITORING mode. (A Not
Recording reminder is displayed in the middle of the screen
while monitoring.)
Click on the red Record button in the toolbar of the monitoring
window to start the recording.
In TWin Acquisition click the Calibration icon to verify that the
amplifier is calibrating properly.
Click on the Impedance icon to check the impedance values on
the electrodes.
CPAP Study
Press the key on the keyboard to enter CPAP/BiLevel numbers. (If CPAP,
enter the same numbers for both the IPAP and EPAP.)
5-50
Chapter 5 Recording
Split Night Study
1.
2.
3.
Press the < T > key right after entering the Lights Out notation and select
NONE to indicate the start of the diagnostic portion of the study.
When starting the CPAP, select the CPAP Montage. Then press the < T >
key and select START to indicate the start of the treatment portion of
the study.
Press the key to enter CPAP/BiLevel numbers. (If CPAP, enter the
same numbers for both the IPAP and EPAP.)
Note: While staging/scoring Split Night studies, there must be at least one
No Stage epoch between the diagnostic and treatment portions of the
study.
MSLT Study
1.
2.
3.
4.
After the recording has started, press the < M > key and choose
the appropriate nap number (e.g., Nap 1, Nap 2, Nap 3). The nap
number should be entered in the same epoch as the Lights Out
notation.
Press the red Record button to pause the recording in between naps.
Press the red Record button again to resume the recording for the next nap.
Repeat steps 1 to 3 until all naps have been completed.
Commonly Used Keys

Enter CPAP/BiLevel numbers
< T >
Enter treatment indicators for Split Night recording

Enter position of patient
< N >
Notation display ON/OFF
< L >
Channel label display ON/OFF
< M >
Enter NAP # for MSLT recordings
< F2 >
Enter Lights Out notation
< Shift + F2 >Enter Lights On notation
< Spacebar >Enter freeform notations
5-51
Montage Changes
1.
2.
Right-click on the Montage Explorer icon on the toolbar to view a list of
available montages. Left-click on the montage in the list to change the
montage.
Right-click on any AC channel label to change individual channel
settings.
Figure 5-3: Individual Channel Settings
3.
To turn off numerical values or adjust the waveform for DC channels
(e.g., CPAP Flow, CO2, airflow from a pressure transducer, etc.), rightclick on the channel label and move the sliders to adjust the viewable
range and uncheck the NUM option.
Figure 5-4: Cflow Window
Note: Before turning off the number display, use the numbers to help
determine the best position for the sliders by noting the highest and
lowest numbers displayed in a 30 second epoch. Move the sliders so
that the numbers in the white boxes (see Figure 5.4) will accommodate
that range.
5-52
Chapter 5 Recording
Stopping The Recording
1.
2.
3.
Press the red Record button on the toolbar. This will place the
recording into Monitoring Mode.
Click on the lower X in the upper right-hand corner to close the
waveform window.
Choose NO when asked Would you like to continue the same record on
the next session?. This will formally stop and close the recording.
Figure 5-5: Would you like to continue the same record on the next session?
4.
Click on the X in the upper right-hand corner of the TWin window to close
the software. Alternatively, select File > Exit in the drop-down menu.
Note: If an acquisition is in-progress and the user inadvertently attempts to
close the TWin application, a warning will appear allowing to continue
recording. Click Yes to end the recording or No to continue recording.
Figure 5-6: Recording is in Progress Warning
5-53
5-54
Chapter 5 Recording
6
Review
Reviewing the Data
1.
Double-click on the Grass Database Explorer icon on the
desktop.
Note: The database can be setup to
allow users different options.
If this is the case, enter your
username and password in
Grass Login.
2.
When Grass Database Explorer - Admin (Admin) window opens, a list of
patients will be displayed down the left-hand side.
Figure 6-1: Grass Database Explorer, Patient List
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3.
Click on the + sign next to the patient’s name. It will change to a - sign
and display the patient’s records.
Figure 6-2: Grass Database Explorer, Patient’s Records
4.
Double-click on the record to be reviewed and it will open in TWin.
Note: Multiple records for the same patient will be displayed under the
patient name labeled with type of test and study date.
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Chapter 6 Reviewing the Data
Patient Explorer (Hard Drive)
1
Double-click on the Patient Explorer icon. The TWin Patient
Infomation Explorer - Review Mode window will appear.
Figure 6-3: TWin Information Explorer - Review Mode Window
2.
Browse to the TWin_Data folder by clicking the + signs to navigate
through the directory.
Figure 6-4: TWin Information Explorer - TWin Data Folder
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3.
Click on the record to be opened, to highlight it. The patient’s name, type
of test, and study date will appear in the window on the right-hand side.
Figure 6-5: TWin Information Explorer - Patient Record Highlighted
4.
Open the record for review by double-clicking the patient’s name in the
right-hand side window.
Note: A green check next to the patient’s name indicates the record can be
found in Grass Database Explorer, while a red x means the record is
not in the database. To add a study to the database right-click on the
patient’s name and choose Add to Database.
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Patient Explorer (CD/DVD)
Records can also be reviewed from removable media (i.e., CD, DVD).
Note: This will allow users to have read-only access to the record. No
scoring or editing can be done at this point. Should any changes or
manipulations need to be made, skip to the next section Edit Records.
Read-Only Record
1
Double-click on the Patient Explorer icon. The TWin Patient
Information Explorer - Review Mode window will appear.
Figure 6-6: TWin Patient Information Explorer - Review Mode
2.
Find the drive containing the disk from the available entries under My
Computer. Click the + signs to navigate through the directory.
Figure 6-7: My Computer Folder
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3.
4.
Click on the record to be opened, which will be highlighted. The patient’s
name, type of test, and study date will appear in the window on the
right-hand side (see Figure 6-7).
Open the record for review by double-clicking the patient’s name in the
right-hand side window.
Edit Record
To make changes to a record it must first be copied from the disk to the PC
(hard drive).
1.
Double-click on the My Computer icon on the desktop. The My
Computer window will appear.
Figure 6-8: My Computer Window
2.
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Browse the disk drive and double-click to open.
3.
Right-click on the study to be copied and choose Copy.
Figure 6-9: Select Copy
4.
Using the My Computer window, browse to the location where the study
will be saved.
Note: By default the location should be in the TWin_Data folder
(\TWin_Data).
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5.
6.
7.
Right-click on the location and select Paste. A progress bar should
indicate the files are being transferred.
Once the transfer is complete,
remove the disk from the
computer and right-click on
the folder containing the record
that was just copied. Select
Properties. The Properties
window will appear.
Remove any read only
properties by clicking on the
square marked Read-only until
it is empty. Click OK.
It is now possible to review and edit
the record using the steps detailed
earlier in the Patient Explorer (Hard
Drive) section.
Figure 6-10: Properties Window
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Navigation
After opening the record using Patient Explorer or TWin Database Explorer,
the following keyboard commands may be used to navigate through the study.
Angle brackets enclose the name of a key on the keyboard: For example,
< Page Up >
< >
Chart speed up
< >
Chart speed down
< Page Up > PSG/EEG page left page by page
< Page Dn > PSG/EEG page right page by page
< >
PSG/EEG partial page Left in study
< >
PSG/EEG partial page Right in study
< Home >
Go to the first page of the PSG/EEG study
< End >
Go to the last page of the PSG/EEG study
< Space Bar >To enter a Free Form Comment
< Ctrl+F >
To find a notation
< + >
Increases sensitivity globally (all channels)
< - > Decreases sensitivity globally (all channels)
Sensitivity on all channels can also be changed globally by clicking on the
toolbar buttons
Note: In order to change the sensitivity of individual channels, right click on
the channel label to bring up its properties.
Increase Sensitivity
Left-click to increase the size of the waveforms.
Decrease Sensitivity
Left-click to decrease the size of the waveforms.
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To turn off numerical values or adjust the waveform for a DC channel (e.g.,
CPAP Flow, CO2, airflow from a pressure transducer, etc.) right-click on the
channel label and the Cflow window will appear. To turn off numerical values
uncheck the Num option. To adjust the waveform, move the two sliders to
adjust your viewable range (upper and lower).
Figure 6-11: Cflow Window
Note: Before turning off the number display, use the numbers to help
determine the best position for the sliders by noting the highest and
lowest numbers displayed in a 30 second epoch. Move the sliders so
that the numbers in the white boxes will accommodate that range.
Review Buttons
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Patient Information
Left-click to view patient information and demographics.
Properties
Left-click to activate the Review Properties window. Use this window to view Waveform Settings, Notations, and Select Montage. Alternate method: Right-click anywhere on the TWin window to activate the Review Properties window.
Video Link
Left-click to activate the Digital Video playback window.
TimeLine
Left-click to enable the TimeLine/Hypnogram. Right-click to activate the Select set of events for scoring window.
Marker Mode
Left-click to enable this waveform amplitude measurement tool.
Go To Time...
Left-click to Goto a time or epoch.
Fast Review Mode
Left-click to enable Fast Review Mode. To disable Fast Review Mode, click on the button again. Right-click to select fast review speed, and/or to select fast review Through All Data or By Notations.
Clone
Left-click to bring up two windows to review the data. Right-
click to set Synchronize Clone and Do Not Synchronize.
Montage Explorer
Right-click to select the different montages associated with the study. Left-click to modify and manipulate different montages using Montage Editor.
Auto Arousal Scoring On/Off
Left click on this button to activate the quick arousal scoring feature. When “On”, arousals will automatically be marked when scoring PSG events.
Patient Observation Sheet
Left click on this button to activate and review the Patient Observation Sheet log.
Notation List
Left click on this button to activate/view the Notation List.
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7
PSG Scoring
Manual Sleep Scoring
Opening Studies for Review
1
2.
Double-click on the Database Explorer icon on the desktop.
Double-click on the study to open it in TWin review.
Figure 7-1: Grass Database Explorer Window
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Sleep Scoring Mode
Scoring Tools
1.
Open the hypnogram by clicking on the TimeLine icon.
TimeLine Toolbar
TimeLine
2.
Click on Change
Display Properties
icon in the TimeLine
toolbar to bring up the Timeline
Properties window and select
the Stage Interval Display
option to bring up the Stage
Interval display bar.
Figure 7-3: Timeline Properties Window
Figure 7-4: Stage Interval Display Bar
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Chapter 7 PSG Scoring
Sleep Staging
1.
2.
3.
Go to the epoch where the Lights Out notation is marked. (To find the
Lights Out notation page through the record till Lights Out appears on the
screen.)
or...
Click on the Review Properties icon in the primary toolbar, click
on the Notations tab, and double-click on the Lights Out notation
in the list.
Use these numbers on the keyboard to stage the study. (Make
sure that the < NUM LOCK > is on if the numerical keypad is used.)
< 0 >
W
< 1 >
Stage N1
< 2 >
Stage N2
< 3 >
Stage N3
< 5 >
Stage R
< 6 >
Movement
<.>
No Stage
When the Lights On notation appears in the record, press the period < . >
key to score all of the remaining pages as No Stage. No Stage epochs are
excluded from report calculations.
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Event Scoring (Respiration, Limb Movements, Arousals...)
Set the Scoring Defaults
Click on the Toggle Defaults Window On/Off icon to change the
default classification for events and check which events are to be
automatically scored with arousals.
Figure 7-5: Event Defaults Window
Note:
To activate the auto-arousal feature, click on the Auto-Arousal
Scoring On/Off icon. Alternately, hold down the < Ctrl >
key while scoring Respiratory, Limb Movement, Snore, or
Bruxism events to automatically score an Arousal with the event. The
Arousal event is placed immediately following the Respiratory, Limb
Movement, Snore, or Bruxism on the topmost EEG channel.
Marking Events
Left-click and drag on a waveform
to mark an event. The duration of
the event will be determined by the
length of the drag.
or...
Single left-click on a waveform to
mark an event with a preset duration.
The default event durations for each
event type are shown below.
Figure 7-6: Quick Event Scoring Durations
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Editing Events
Right-click on the marked event and select the delete option.
Left-click and hold the event, drag it to the desired location,
then release the click to drop the event.
Override SaO2 Right-click on a desaturation, select the option to replace with
override event, and enter a new SaO2 value.
Override HR
Left-click and drag the HR channel and enter a new HR value.
Classification Right-click on the event and select a different classification
from the menu by left-clicking on the event. See table for event
classification options below.
Delete
Move
Quick Editing of Events
Hold down the < Shift > key and left-click on an event to
delete that event.
Quick Reclassify Hold down the < Shift > key and right-click on an event to
select a different classification.
Quick Delete
Event Type
Classifications
Central Apnea
Respiratory Events
Arousals
Limb Movements, Snore & Bruxism
EKG Events
Obstructive Apnea
Mixed Apnea
Hypopnea
Partial Obstructive
RERA
Cheyne Stokes Breathing
Hypoventilation
Periodic Breathing
Respiratory Event
Bruxism
Spontaneous
Snore
PLM
Noise
Other
Isolated
Periodic
Sinus Tachycardia
Asystole
Bradycardia
Atrial Fibrillation
Narrow Complex Tachycardia
Wide Complex Tachycardia
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Generating a Report
The final steps before generating a report should include DC trending and
automatic Arousal Classification. To perform the actions, click on Analysis >
Auto Sleep Analysis.
Note: Hypnograms will only generate in the Word report if the TimeLine
is open.
Figure 7-7: Auto Sleep Analysis Sequence Tab
1.
2.
On the Auto Sleep Analysis Sequence tab, make sure DC Trends/Other
Analysis, Arousal Classification, and Create Report are checked.
Select a report to be created from the pull-down menu list.
Note: To automatically save the report within the study folder in HTML
format, select that option. HTML formatted reports can be viewed in the
TWinLOOK viewing application or other types of browser applications.
To automatically save the report within the study folder in a Word
document format, select that option. When the report creation process
is complete the Word report will be saved in the study folder and can be
opened in MS Word.
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To export the report information to an XML file format, select that option.
The XML report will be automatically saved in the study folder. The
Database Explorer will import the sleep statistics, making them available
for viewing and query directly in Database Explorer application.
3.
On the Trend Analysis tab, make sure Min/Max/Avg Trend, SaO2
Histogram, and EKG are selected and click OK.
Note: Grayed out EKG option indicates trending will be run on HR channel.
The Pulse Transit Time option will become active if the EKG Trend is
active and there is a “PPG” type channel in the recording.
The Position Analysis option will become active if there is a “Position”
type channel in the recording.
The CPAP Pressure option will become active if there is a “CPAP” type
channel in the recording.
Figure 7-8: Trend Analysis Sequence Tab
Treatment Studies
Treatment level indicators are needed for the titration
tables to be generated properly in the reports. Press the
 key (BiLevel) and enter the IPAP and EPAP levels.
(For CPAP studies, enter the same value twice.)
Figure 7-9: Enter the
value for BiLevel event
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Split-Night Studies
Treatment indicators must be present in a Split-Night study in order for reports
to generate properly.
1.
2.
3.
4.
At Lights Out, press the < T > key (Treatment) and select None.
Indicate where treatment started in the record by pressing the < T > key
and select Start.
Press the key (BiLevel) and enter the IPAP and EPAP levels. (For
CPAP studies, enter the same value twice.)
There must be at least one No Stage epoch between the diagnostic and
treatment portions of the study. Use the < . > key to No Stage epochs
between the diagnostic and therapeutic portions of the study.
Figure 7-9:
Select None.
MSLT Studies
Nap number indicators must be present in MSLT studies in order for reports
to generate properly. At Lights Out notation for each nap, press the < M > key
(MSLT Nap #) and select the appropriate nap number. There must be at least
one “No Stage” epoch in between each nap and that the MSLT nap # should
occur as close to the first stage of Wake or Sleep into the nap as possible.
Figure 7-10:
Select the
Appropriate Nap
Number
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Automatic Sleep Scoring: FASS & ASA
TWin PSG Record & Review Software has two Automatic Sleep Scoring
Analyses Modules:
FASS: ASA: Fully Automatic Sleep Stager and Arousal Detector — an
optional and added cost module.
Automatic Sleep Analysis — standard module for detection of
Respiratory, Snore, Limb Movement, Bruxism and Desaturation
events, Arousal classification, and DC channel trending (SaO2,
Heart Rate, EtCO2, etc.).
To verify if FASS is installed in the system, open the
TWin Review Window, click on the View > Settings...
Check the Settings page for the presence of the Fully
Automated Sleep Stager- FASS tab as shown below
in red:
Figure 7-11:
Select View > Settings...
Figure 7-12: FASS Tab
The Settings page also includes tabs for each event type detection and analyses
available with ASA. Within each tab, it is possible to define the parameters,
thresholds, and settings for each sub-type of analysis.
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FASS – The Basics
FASS uses a rule-based approach to sleep staging*, which combines
automatically-detected sleep events (spindles, phasic REM, etc.) with
automatically-computed parameters (FFT frequency analysis, amplitude, etc.):
Detected Sleep Events
Computed Parameters
Arousal
Low Voltage Mixed Frequency EEG
Delta Wave
Slow Rolling Eye Movement
Spindle
Phasic REM
K-Complex
Eye Blink
Artifact (EEG, EOG)
EEG Frequency Bands (Delta, Theta, Alpha, Beta)
EMG Minimal Level
Amplitude (EEG, EOG, EMG)
FASS performs two levels of analyses: individual page analysi — followed by
context and stage transition analysis:
• During the First Pass: FASS assigns a sleep stage to each page. The
stage is determined based on a decision flow chart that takes into
account the presence/absence of sleep events and the values of the
computed parameters on that page.
• During the Second Pass: FASS applies context rules (3 minute rule for
Stage 2, REM continue rule, etc.) and stage transition rules (REM-toWake, Stage 1-to-Wake, etc.).
The montage used for FASS processing must contain the following channels
otherwise FASS will not work. (The display sensitivity and filter settings are
not important. FASS uses its own settings.)
Channel
One EEG Channel
Two Eye Channels
Comments
For example, C3-A2 or C4-A1
FASS will automatically select C3-A2 or C4-A1 (in that order) for
processing. Otherwise, FASS will select the first EEG channel in the
montage (for example F4-M1 if using the new AASM nomenclature).
For example, LOC-A2 and ROC-A1 or E1-M2 and E2-M1
if using the new nomenclature. (Channel type EOG)
One Chin EMG Channel For example, Chin1-Chin2 (channel type Chin EMG)
* With TWin version 4.2 and 4.3, the rule-based approach replicates R&K staging rules.
However, some parameters can be changed to adhere to some of the new AASM sleep staging rules.
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FASS – Settings Page
Secondary
Staging
Trends
Advanced
Analysis
Options
Disables the Second
Pass which applies the
3-minute rule and/
or stage change rules
(these are enabled by
default). If disabled,
each epoch will be
staged based only on
the detected events and
computed parameters
of the First Pass.
Allows display of the
computed trends (e.g.,
% Alpha, % Delta, etc.)
on the PSG timeline.
Note that even if these choices are not enabled (they are
disabled by default), FASS will still compute the frequency
and amplitude parameters required for staging, but the trends
will not be displayed nor saved.
Each button will bring up a settings page for changing
parameters.
For example: clicking on the Sleep Stages pad will show the
Sleep Staging Rules Page. To eliminate Stage 4 scoring, change
the Stage 3 definition from 20 < Delta Index % < 50 to 20 <
Delta Index% < 100 and change Stage 4 to Delta Index% >100.
Figure 7-14a: R&K Stage 3 & Stage 4 Rule
Figure 7-14b: New ASSM N3 (Stage3) Rule
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ASA – The Basics
To access the settings and parameters for each type of
analysis click on View > Settings....
The parameters are well defined in the on-line help
screens available by clicking on the Help button at the
bottom of each tab.
Figure 7-15:
Select View > Settings...
Figure 7-16: TWin Help
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ASA - Channels Used
Analysis
Channel(s) Used / Comments
Respiratory Event Detection
The first channel of Type Airflow and the first channel of Type
Leg Movement Detection
One or two Leg EMG channels as available in the display
Heart Rate Analysis (Trending)
SaO2 Trending & Desaturations
Effort as available in the display montage
montage
Either the HR DC channel from the pulse oximeter or based
on R-to-R interval detection on the EKG waveform channel,
defined in the EKG analysis settings page
SaO2 / SpO2 DC channel, channel type oxygen saturation
End-tidal CO2 Trending/Reporting Uses EtCO2 DC channel (name is case sensitive)
ASA – Arousal Classification
The Arousal Classification module of ASA does not automatically detect
arousals. Rather, it will automatically classify arousals — manually scored or
automatically detected with FASS — based on the existence and proximity of
other events manually scored or automatically detected with ASA. Use Arousal
Classification Settings page to define the hierarchy of the other events and the
time intervals between the events and the scored arousal. For example, if the
scored arousal is preceded (within the specified times) by a respiratory event,
a snore event, and a PLM event, the arousal will be classified as caused by the
respiratory event, because it is at the top of the hierarchy list. If none of the
events exist, or they are outside the defined time limits, the arousal will be
classified as Spontaneous.
Note: A Minimum Time after event start of zero seconds means the Arousal
could start at least immediately after the scored Respiratory, Snore, or
PLM event. Although the default value is set to zero, that value may be
adjusted down to -0.5 seconds representing a half-second overlap of the
Arousal and event.
Figure 7-17: Arousal Classification
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ASA –DC channel trends
Even if automatic scoring is not used, at a minimum, Auto Sleep Analysis is
still needed to compute and generate the SaO2, Heart Rate, EtCO2, and other
DC channel trends and histograms. Otherwise, tables in the reports will be
blank (i.e., Min/Max/Avg and % Breakdown SaO2 tables).
Running Auto Sleep Analysis
1
2.
3
Open the study for review and click on the Timeline icon on the
toolbar to open the PSG Hypnogram. As default, the Logfile.TFN
notation/score file is used. Position info, CPAP/BiPAP level,
Treatment None/Start, plus any scoring done
on-line by the recording technologist will be displayed.
If it is desirable to run Auto Sleep Analysis using a different
notation/score file, create a new notation file by clicking on the
Create Notation File icon on the Timeline toolbar.
If the system does not have FASS installed, or if automatic sleep staging
is not going to be used, it is recommended that first Sleep Stage the study
prior to running ASA. It is also possible to score arousals manually. Auto
Arousal classification can be run at the end after other events are scored.
After sleep staging the study, or to run FASS, click on
Analysis and then click on Auto Sleep Analysis.
Figure 7-18: Auto Sleep Analysis Sequence
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With Auto Sleep Analysis Sequence,
select the types of analyses to
perform. If more than one is selected,
several passes through the data will
be made in the order, from top to
bottom, as shown in the Sequence.
Click on the corresponding checkbox
to select or unselect. The process
can be automated all the way to
generating the selected report.
If FASS is not shown on the list of
modules, it is either not installed on
the system, the required channels
do not exist, or the channel types are
incorrectly defined in the currently
selected display montage.
If FASS is not to be run, go to Step 10.
4.
5.
6.
If FASS is to be run, it is recommended that first only run FASS.
Click/unselect DC Trends, Events Analysis, and Arousal Classification
from the Auto Sleep Analysis Sequence. This allows the user to review,
verify and correct FASS results prior to running the other types of
analyses.
Click on the FASS tab. By
default, FASS will use the Light
Out/ Light On study notations
(if available) to set the range of
epochs to analyze and stage.
It is also possible to click on
the checkbox to unselect, and
manually enter the Start and
End time and date.
Click OK to start FASS. The
Staging hypnogram will start
building, and FASS will stop
after it completes the 2nd pass.
Figure 7-20: Epochs Automatically Staged
7.
Note that epochs automatically staged are indicated with an asterisk*
both on the waveform display (bottom-left corner) and in the notations
list. Verify FASS results and correct stages as needed.
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8.
Click the Save all automatic notations icon on the TimeLine
toolbar. This will remove the “auto staged” indicator asterisks
from every page.
9. To continue with ASA, click on the TWin Analysis > Auto Sleep Analysis.
10. Unselect FASS Fully Automated Sleep Staging from the Auto Sleep
Analysis Sequence, and select the ones of interest. At a minimum, DC
Trend Analysis should be selected. It may not be desirable to run Arousal
Classification at this time. It can be run after the auto Respiratory, PLM,
and Snore detections results have been verified and corrected.
11. Select the Trend Analysis tab. Selection checkboxes are available next
to each type of trend to compute. If a selection is grayed out, it means
that the channel needed for that type of analysis is not correctly defined
(channel type), or it is not available in the selected display montage, or
the channel was not recorded at all. EKG Trend will be available if the
EKG analysis is set to use the EKG waveform channel for R-to-R heart
rate computation. Otherwise the Min/Max/Avg heart rate trend will be
computed using the HR channel from the pulse oximeter. As a minimum,
select Min/Max/Avg Trend and SaO2 Histogram.
Figure 7-21: Trend Analysis Tab
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12. Page Selection mode is recommended – click on the Setup Pages pad.
13. Select Page Range = All, and Exclude Stages: No Stage and Movement.
Note that once this is set for DC trend analysis, it will always be used on
the same system until changed. Click on OK to return to the Auto Sleep
Analysis setup page.
If you are only running Trend Analysis, go to Step 17.
14. Select the Event Analysis tab, and select the type of events to detect.
If event choices are grayed out, it means that channels are incorrectly
defined (channel type) or they do not exist in the selected display
montage.
Figure 7-22: Event Analysis Tab
15. Page Selection mode is recommended — click on the Setup Pages pad.
16. Select Page Range = All, and Exclude Stages: Wake, No Stage and
Movement. Note that once this is set for event analysis, it will always be
used on the same system until changed. Click on OK to return to the Auto
Sleep Analysis setup page.
17. Click on Apply and then click on OK at the bottom of the Auto Sleep
Analysis setup page. The auto-analysis progress indicator will be
displayed, and the trends will start building on the TimeLine. Note that
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if DC trends, Event Analysis, and/or Arousal Classification are selected,
several passes will be made through the data, in that order.
Figure 7-23: Auto Analysis Progess Indicator
18. Verify ASA result — manually delete events incorrectly scored, reclassify
events as needed, and manually add missed events.
19.
To delete all automatically scored events, click on the
Delete ONLY Automatic Detections icon on the TimeLine
toolbar.
20.
When done editing ASA results, click the Save All Automatic
Notations icon on the TimeLine toolbar. This will remove the
auto score indicator asterisks from the events.
21. If not already done, score Arousals.
22. If Arousals were scored but did not classified manually, the last pass of
Auto Sleep Analysis can automatically classify arousals based on other
events scored in the proximity of the arousals as described in the ASA –
Arousal Classification paragraph on page 7-13.
Click on Analysis > Auto Sleep
Analysis. In the Auto Sleep
Analysis Sequence page, select
the Arousal Classification
checkbox only. At this time, it is
possible to choose to create the
PSG Report when the Arousal
Classification is complete by
selecting Create Report and
choosing the appropriate Report
Template. Otherwise the user
can manually choose to create
the Report after the Arousal
Classifications have been
verified. Click on OK to begin.
23. When verifying the Auto Arousal Figure 7-24: Auto Sleep Analysis Sequence
Classification results has been
competed, click the Save All Automatic Notations icon on the TimeLine
toolbar. This will remove the auto score indicator asterisks from the
events.
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8
Sleep Scoring Comparison
Sleep Scoring Comparison
1.
2.
Open the scored study for review. (For instructions on reviewing a record,
see Reviewing Data.)
Click the TimeLine icon from the toolbar.
Figure 8-1: TimeLine Open
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3.
4.
From the TimeLine toolbar click on the Create Notation File icon
to create a new scoring file.
Type in the name desired to identify the second scorer and click
Create File.
Figure 8-2: Create Notation File As
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Chapter 8 Scoring Comparison
5.
The scoring will revert back to the original recording. Stage and score
the record.
Figure 8-3: Original Window
6.
Once scoring is finished, select File > Sleep Scoring Comparison.
Figure 8-4: File > Sleep Scoring Comparison
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7.
The Compare Sleep Scoring window will open.
Figure 8-5: Compare Sleep Scoring Window
8. Select the Open button under the First Scorer.
Figure 8-6: Open First Scorer’s Study
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9.
Navigate to the patient’s folder and open the LOGFILE.QQQ.
Figure 8-7: Navigate the Patient’s Study
10. For the First Scorer click Use Logfile.
Figure 8-8: First Scorer
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11.
This will place the first notation file in the First Scorer.
Figure 8-9: First Scorer Notation
12. Select the Open button under the Second Scorer and again select the
LOGFILE.QQQ. Now select the second scorer, example here Scorer2.TFN.
Figure 8-10: Second Scorer
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13. This will place the second notation file in the Second Scorer.
Figure 8-11: Second Scorer Notation
14. Click Calculate to run the analysis.
Figure 8-12: Analysis
15. Analysis complete. Click on Staging QA to review the staging comparison, Events QA to review the event comparison, and Make a Report to
create a Microsoft Word report.
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9
Data Management
Setup Quick Copy
1.
2.
3.
Open Grass Database Explorer and login with an Admin account.
Select Edit > Preferences... from the pull-down menu.
The Preferences window will appear. Under
the Quick Copy section, in the Volume: box
type in the location or click the ... button to
select the desired location to setup for the
quick copy. The location can be a network
path, removable hard drive or on the current
hard dive. Click Save when completed,
which will close the window.
Figure 9-1: Preferences Window
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4.
To use Quick Copy, simply right
click on the desired study to be
copied and click Quick Copy.
Figure 9-2: Select the Study & Quick Copy
Archive Studies
1.
2.
Insert a blank CD or DVD into the ROM drive.
Select My Computer and locate CD Drive. Right click on the icon and
select Format...
Figure 9-3: My Computer Window with CD Drive & Format.. Selected
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Chapter 9 Data Management
3.
The Format Options window will appear with Roxio as the format
utility to format the CD/DVD for use with TWin Archive. Simply leave
everything the way it is and click OK.
Figure 9-4: Format Options Window
4.
Once the disk has been prepared, the Disc Preparation window will
disappear.
Figure 9-5: Disc Preparation Window
5.
Click on TWin Database Explorer icon and login.
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6.
Locate the Patient study to be archived. Right click on the study and
select Add to Archive. To start a new archive job select New Archive... or
to add the study to an existing archive job select Archive #1. If there is not
enough room on the CD/DVD, the option to add it to an existing archive
job will be grayed out.
Figure 9-6: Adding Studies to be Archived
7.
8.
Repeat the same steps for all studies to be archived.
When ready to start the archive process, select File > Create Study
Archive...
Figure 9-7: Select File > Create Study Archive
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9.
The Create Study Archive window will appear. In Select Job: use the
pull-down arrow to select the job to be archived. The studies that are
associated with that job will be listed under Select Studies to Archive:.
Check the box next to the studies to be include on the CD/DVD. Sizes (in
KBytes) will display the size of the EEG and the video, and the total size
combined. Options are available to Include the Patient Data, Digital Video
Files, and TWinLOOK on the CD/DVD. If only the EEG is to be included,
then uncheck the Digital Video Files option. At the bottom of the window,
how much space on the CD/DVD will be used for this process is
displayed. To remove a study from the queue, click on the Remove from
Queue button. To delete the archive job completely, click the Delete Job
button. To burn the data to CD/DVD, click on the Create Archive button.
Depending on the size of the studies selected, it may take some time to
complete burning to CD/DVD.
Figure 9-8: Create Study Archive Window
10. When completed, the Create Study Archive window
will say Archive completed without errors. Click OK.
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11.
The Archive Summary window will appear with a list of studies archived
to CD/DVD. The studies are marked for deletion. It is possible to
uncheck the box next to each study to deselect a study, or select Deselect
All to uncheck them all.
Figure 9-9: Archive Summary Window
12. Either select another Archive Job to burn to CD/DVD or simply close the
archive software by clicking Cancel.
13. When ejecting the CD/DVD, the Eject Options window will appear.
Select Close the disc: Prepare the disc to be used without Drag-to-Disc.
Click Eject.
Figure 9-10: Eject Options Window
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Delete Studies from the Database
1.
2.
Open Database Explorer and
Login with an Admin account.
Find the patient’s name and
click on the + symbol next
to it to expand the list to show
the studies associated with that
patient (the symbol will change
to a – ).
Figure 9-11: Click to Expand the List
3.
Click on the study to be
removed. It will be highlighted
in blue. Right click on the study
and click Remove.
Figure 9-12: Select Study & Remove
4.
The Remove Study window will ask Are you sure you want to remove the
selected Study from the database? Click Yes to removed the study from
the database.
Figure 9-13: Remove Study
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5.
The Delete Study Files window
will ask Do you want to delete
all data for data files for this
study? Click Yes to removed
all study’s file data from the
database.
Figure 9-15: Delete Study Files
Note: Once Yes has been selected, the data will be permanently erased!
Make sure the study was backed up first. If not sure, click No.
6.
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Repeat steps 2 to 5 for all the studies to be deleted.
10
Troubleshooting
TWin Problem Solving Strategies
Note: This guide is intended to assist in resolving TWin error messages by
providing the most likely reasons for the errors and their resolutions.
There may be other problems causing these errors that are not
discussed in this document. Please call Grass Technologies Technical
Support at 877-472-7779 for further assistance.
Default Montage Error Message Recieved:
Figure 10-1: Default Montage Error Message
Possible issues...
1. Head box is not plugged into AS40 amplifier.
Resolution: Plug the head box into the PMA (Personality Module
Adapter), close out of TWin. Try to start recording again. Also, make sure
that the PMA is seated properly in the AS40 amplifier.
2.
The wrong montage has been selected as the default or no default record
montage is selected.
Resolution: Go into the Montage Editor (the icon is on the desktop
and highlight the montage (not a montage set) to start recording with
(Montages are indicated by a single blue wrench and montage sets are
indicated by double blue wrenches.) Make sure the picture of the head
box on the right side of the screen matches the head box that is being
used. Click on the icon of the wrench with the red R in the toolbar to
make the montage selected as the default. The montage name should turn
red once this is done.
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Invalid Key Error Message Recieved:
Figure 10-2: Invalid Key Error Message
Possible issues...
1. Blue software key is not plugged into the computer or is loose.
Resolution: make sure the key is plugged in to the computer. If it is,
unplug it and plug it into another USB port. Windows should detect the
key. Next, go to the Start Menu > Programs > I-Wire Drivers (Win32) >
Default 1-Wire Net {32bit}. Click on the Auto-Detect button and click OK
on the following message.
Figure 10-3: Auto Detect Message
Once the auto-detection is complete, the following message will appear.
Click OK.
Figure 10-4: Adaptor Discovered Message
Note: If this message does not appear, restart the computer and repeat these
steps. If this message still does not appear, contact Grass Technical
Support.
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Chapter 10 Troubleshooting
Connect Failed Error Message Recieved:
This message appears when the computer cannot communicate to the amplifier
in the patient room.
Figure 10-5: Connect Failed Message
Possible issues...
1. Amplifier may be off.
Resolution: Make sure amplifier is plugged in and turned on. Go back
to the computer, close out of the error message and TWin. Start the
recording again.
2.
The connections for the network cable may be loose or unplugged.
Resolution: Unplug the crossover cable (the cables supplied by Grass
Technologies are yellow) from the E-Net port on the back of the amplifier
and plug it back in. Follow that line of network cables as far as possible—
unplugging and re-plugging each connection along the line. Go back
to the computer and make sure the network cable is plugged into the
appropriate network port on the back of the computer. Close out of the
error message and TWin. Start the recording again.
3.
The IP address on the amplifier does not match the IP address on the error
message.
Resolution: Push the menu button on the amplifier until it says Press
ENTER to set IP address, then press ENTER. Next, use the arrow keys to
move from one digit to the next and change the numbers. Once the correct
IP address has been entered, press ENTER. Go back to the computer to
close out of the error message and TWin. Start the recording again.
10-103
10-104
Chapter 10 Troubleshooting

TWin EEG/PSG!

Transcription

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