Optomap User Manual | Optos User Manual | How do I use optomap?
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Table of Contents
Chapter 1 – What’s New
1 What’s New
This release supports the display of optomap® af images.
Note:
optomap® af images are captured using a green laser light for illumination. This contrasts with the traditional use of blue illumination or white light for autofluorescence imaging. Green light autofluorescence differs, and allows a different visualization of macular pathologies since macular pigment does not interfere. Also the Optic Nerve Head is clearly visible when green laser light is used for autofluorescence imaging.
Reference Materials
Chapter 1
Chapter 2 – Introduction
2 Introduction
Your device will be installed by Optos trained personnel. Do not operate the device until they have completed the installation and training.
Please read the Safety Guidelines in the Introductory Handbook before using the device.
Warning
About the device
This scanning laser ophthalmoscope is a widefield digital imaging device capable of capturing from the far periphery of the retina. The retinal images are captured in an automated, patient friendly way without scleral depression or contact with the cornea.
The 200Tx uses red, green and blue lasers to produce a digital, high-resolution image, which is displayed on a PC monitor screen. This device can be used to capture angiography images. Red and green lasers are used for digital color imaging. These laser wavelengths penetrate the retinal structures to different depths, each wavelength providing information for interpretation and diagnosis.In autofluorescence mode, the device uses the green laser to illuminate the eye. This allows an image of the natural fluorescence of the eye to be captured. optomap® af images are captured using a green laser light for illumination. This contrasts with the traditional use of blue illumination or white light for autofluorescence imaging. Green light autofluorescence differs, and allows a different visualization of macular pathologies since macular pigment does not interfere. Also the Optic Nerve Head is clearly visible when green laser light is used for autofluorescence imaging. No fluorescent dye has to be introduced into the patient.The blue laser is used when capturing angiography images. A series of images is captured as the fluorescein flows through the retinal vessels.
Optos’ technology is designed to operate through a minimum pupil diameter of 2mm. Although pupil dilation is not required, the decision to dilate is a medical decision to be made by the eyecare professional.
Images are captured on the scan head and then viewed, magnified, annotated and separated into their color components in the Review application.
Indications for use
The 200Tx scanning laser ophthalmoscope is intended to be used as a wide field and retinal fluorescence imaging ophthalmoscope to aid in the diagnosis and monitoring of diseases or disorders that manifest in the retina. Depending on the enabled options, some devices are capable of autofluorescence imaging.
Note:
Depending on the enabled options, the device may have a subset of the above indications.
About images
The device can be used in many clinical areas and can assist in disease detection, monitoring and treatment.
The images can be separated to present distinct retinal sub-structures and can be used to assist in the assessment and recognition of different retinal pathologies.
Traditional ophthalmoscopes produce a reddish picture derived from a white light source. The Optos devices use red and green lasers to compose the retinal images.
Chapter 2 – Introduction
Sample image from 200Tx device.
The composite image supports analysis of the retinal image by allowing individual review of the green and red channel information.
l The Green Channel image contains information from the sensory retina through the pigment epithelium layers of the retina.
l The Red Channel image contains information from the deeper structures of the retina, from the pigment epithelium through the choroid.
Compare the green and red channels derived from the composite image shown above.
Sample image from 200Tx device.
Green Channel view Red Channel view
The diagram below summarizes the retinal layers and structures reached by the lasers. These laser wavelengths penetrate the retinal structures to different depths, each wavelength providing information for interpretation and diagnosis.
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Chapter 2 – Introduction
Image types
There are different types of image for each type of procedure:
l optomap® – captures a retinal image. The standard optomap® procedure is a wellness exam. This procedure captures a standard optomap® retinal image.
l optomap® plus – captures a medical retinal image. The optomap® plus procedure is a medical retinal exam. Following this procedure will allow the use of the enhanced features in the Review application.
l optomap® fa – some systems are capable of capturing fluorescein images. The optomap® fa medical procedure allows the capture of fluorescein optomap® fa images. Following this procedure will allow the use of the enhanced features in the Review application. These images are captured at a higher resolution than standard optomap® images. The image capture rate for the early-phase images can be set in the Capture application settings. You must ensure that the necessary resources are available to administer the fluorescein.
Note
l Some systems are capable of capturing autofluorescence images, How to capture Autofluorescence images on page 27.optomap® af images are captured using a green laser light for illumination. This contrasts with the traditional use of blue illumination or white light for autofluorescence imaging. Green light autofluorescence differs, and allows a different visualization of macular pathologies since macular pigment does not interfere. Also the Optic Nerve Head is clearly visible when green laser light is used for autofluorescence imaging.
l Some image types offer additional options, for example, eye steering, ResMax™, images optimized for the periphery or central pole. These options vary depending on the device being used and the image type selected. All available options are displayed in the Procedure Selection dialog box.
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Chapter 2
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Chapter 3 – Getting to know the device
3 Getting to know the device
The device comprises the scan head module, Image Server PC, and Viewing PC. For more information, please refer to the Technical Data Specification supplied with the device.
Images are captured on the scan head. The scan head runs the Capture application. The Image Server PC runs the Storage application. Admin application, and Scheduler application. The Review application is run on the Viewing PCs. In a typical installation, the images and database will be stored on the Image Server PC. You can review captured images at any Viewing PC that is connected to the Image Server PC across the network.
Understanding the equipment
The device is part of a system of networked PCs.
Scan Head Module
The Scan Head module runs the Capture application. This application lets you select and perform the required patient imaging procedure.
The scan head monitor should not be used to review images for diagnostic purposes.
Caution
l Scan Head – Comprises the lasers and electronics used to capture patient images.
l Scan Head table – Supports the adjustment of the scan head height. The table can be raised or lowered using the hand control.
l Face Pad – The face pad supports the patient’s face when the patient is being imaged. The face pad can be removed for cleaning.
l Scan Head monitor arm – Links the monitor to the scan head.
l Scan Head monitor – Displays the Capture application. The touch screen monitor is used to interact with the Capture application. It displays alignment feedback and captured images.
l Hand Control – Comprises buttons used to raise and lower the scan head table, align the patient, and capture images.
l Head Rest – Comprises the head support and adjustable chin cup. The head rest can be removed for cleaning.
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Chapter 3 – Getting to know the device
l Patient arm support and table wings (if supplied) – Devices used to capture optomap® fa images may be fitted with a patient arm support and table wings. They are used to support the patient when the injection is administered. The patient arm support can be removed for cleaning.
Viewing PCs
Viewing PCs run the Review application. The Review application lets you analyze patient images. You can review images in a variety of ways. You can add annotations to highlight areas of interest, add diagnostic codes, add notes, and email images to third parties.
Image Server
The Image Server PC runs the management applications:
l The Admin application lets you configure the network and data management environment. You can define security levels, create and modify users, and set a variety of system configuration options.
l The Storage application lets you archive and protect database and patient image files. It is essential to archive regularly. For further information refer to the Storage application help file.
Depending on your network configuration you may also run the Review application and Scheduler application from the Image Server PC. When the Review application has been installed on an Image Server PC, the Image Server PC may be used as an additional Viewing PC.
The Scheduler application lets you schedule patient appointments and manage patient details. The Scheduler application may be installed on any PC on the same network as the device.
About the head rest
The head rest supports the patient’s head while images are being captured. It is made up of a forehead strap and a chin cup.
The head rest can be removed for cleaning and should be cleaned between patients. The full instructions can be found in the Introductory Handbook.
Moving the chin cup
l The chin cup height can be altered by turning the knobs on the side of the head rest.
l The chin cup should be slid into position for the eye being imaged. When imaging the left eye slide the chin cup to the first position on the right. When imaging the right eye slide the chin cup to the first position on the left. There is an additional position on each side if the patient’s features require the chin cup to move further.
l Release the chin cup by pulling the lever and slide the chin cup into position.
l The chin cup should be turned to ±15°.
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Chapter 3 – Getting to know the device
Attaching and detaching the Patient Arm Support
The patient arm support is fitted with a clamp and can be attached and removed from the table wings.
Some devices are supplied with a patient arm support. The patient arm support supplied with the device is designed to support the weight of a resting arm. Do not exceed the weight indicated on the patient arm support. When in use, ensure the
Warning patient arm support is securely clamped to the table wing, and that it is covered with a piece of absorbent paper.
Attaching and detaching the Head Rest
To remove the head rest for cleaning, pull the head rest bolt down and turn one-quarter turn to lock it open.
You can then remove the head rest by sliding it toward you.
When attaching the head rest, push the head rest back in place and then turn the head rest bolt a quarter turn to release the lock.
About the detector settings
There are a several factors to be considered when selecting the appropriate detector settings:
l The patient
l The system response
l The operator
The patient
When meeting a patient at the start of the imaging session, it is important to assess the amount of pigmentation in the patient’s iris.
Less laser light is reflected by the retina in patients who have a greater amount of pigmentation. This can result in dark images being captured because less light has been returned from the eye. You should select the appropriate iris category setting to suit the patient’s pigmentation levels.
Small pupil size can also restrict the amount of laser light returned from the retina. Since less laser light is returned through the smaller pupil, the captured image may seem dark. To minimize this, you should capture images in a dimly lit room.
Working in Low Light Conditions
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Chapter 3 – Getting to know the device
Warning The device requires low levels of room light to operate efficiently. Take care to avoid accidents when working under low light conditions.
Media opacities also absorb or scatter laser light and can block retinal structures.
System response
The device has a laser power of 4mW at the patient’s eye and includes a laser safety system that would prevent the system being used if the lasers were operating at unsafe levels. If the power drops, perhaps due to a build up of dust, the amount of light returned from the eye will be reduced and will impair image quality. The accumulation of dust and debris in the return path will also impair image quality.
Detector gains
As the laser power at the eye is a fixed value, the returned retinal information will vary depending on the amount of light reflected by the pigmentation in the patient’s retina. To ensure the greatest amount of information is detected and that the image quality is optimum, the red and green detectors are set to a specific gain level. This gain level is initially set when the patient’s iris category is entered into the patient details.
The iris category sets the detectors to expect a certain amount of light back from the patient’s retina. You should assess the patient’s hair color, eye color and skin tone to determine the most appropriate iris category. You can create your own iris categories if you need to.
l In patients who have high pigmentation levels the “dark” iris category is selected. This sets the detectors to expect less light back from the patient’s retina.
l In patients who have medium pigmentation levels the “medium” iris category is selected.
l In patients who have low pigmentation levels the “light” iris category is selected. This sets the detectors to expect a greater amount of light back from the patient’s retina.
The detector gains can be adjusted and used when the next image is captured.
Note
l Clicking the Optimize button will optimize the current image and sets the detector gains to give a balanced image of the central pole and periphery in the next image.
l Review application optimization – maximizes the range of pixel levels displayed on the screen and adjusts the gamma setting, so that the average intensity of the display matches an ideal value.
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Chapter 3 – Getting to know the device
How to use the hand control
200Tx Hand Control Hand Control table height buttons
Use these buttons to adjust the table height.
Hand Control eye position buttons
Use these buttons to move the pupil circle to the center of the patient’s eye.
The patient’s eye should be displayed inside the target shown on the External Eye Camera view. Use the up, down, left and right buttons on the hand control to align the pupil circle within the patient’s pupil. When the eye is close to the correct position the system will indicate which fine alignment button needs to be pressed to set the distance.
Hint: You can select the eye to be captured using the Hand Control. Press the left button to select Right Eye (OD) and the right button to select Left Eye (OS). Once the eye has been selected this button reverts back to the alignment functionality.
Hand Control in and out fine alignment
buttons
Fine adjustment feedback (either – or +) will be shown on the External Eye Camera view. These fine adjustment symbols correspond to the in and out buttons on the hand control. Press the button indicated to align the limbus circle on the patient’s limbus. When the patient is close enough the symbol will change to a filled in circle. The rings change color, from red to green, when the patient is correctly aligned.
Hand Control Capture button
Once the patient’s eye has been correctly
aligned press the capture button to capture
the image.
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Chapter 3
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Chapter 4 – About the software applications
4 About the software applications
Each application contains the tools needed to perform specific tasks. Some applications run automatically when the device is switched on. You can run other applications by double-clicking the relevant icon on the desktop.
The applications need access to the same network so that images can be saved, reviewed and archived.
The Capture application runs on the scan head. This application lets you control the device and capture and check the quality of images.
V2 Vantage Pro contains a set of applications that let you review and manage images. These applications are installed on the Image Server PC and Viewing PCs. You can run these applications by double-clicking the relevant icon on the desktop.
V2 Vantage Pro Admin
Capture application
Lets you configure your system. You can set password requirements, create new users, modify existing users, and set a variety of system controls.
You can also run the Admin application by selecting Start > All Programs > optos V2 Vantage
Pro > Admin.
Lets you control the device; capturing and checking the quality of images.
The Capture application runs automatically when the scan head is switched on.
Lets you review, annotate, and add diagnostic codes to captured images. Also contains exporting, e-mailing and printing tools.
You can also run the Review application by selecting Start > All Programs > optos V2 Vantage
V2 Vantage Pro Review Pro > Review.
Lets you archive images and manage the database and image files.
| V2 Vantage Pro Storage | You can also run the Storage application by selecting Start > All Programs > optos V2 Vantage | |
| Pro > Storage. | ||
Lets you manage patient records and appointments for the optomap® Retinal Exam.
You can also run the Scheduler application by selecting Start > All Programs > optos V2
V2 Vantage Pro Scheduler Vantage Pro > Scheduler.
Getting Help
Getting Help is easy, just press [F1] on your keyboard for help with your current task
Admin application features
The Admin application lets System Administrators and Optos Representatives configure the system.
Admin application features include:
l Application access control tools to let you create and manage user details.
l Application configuration options let you configure your system.
l Personal data protection controls to let you set password and operation modes to protect medical records. These settings can force login authentication to prevent unauthorized viewing of sensitive patient data. (All passwords are case sensitive).
l Options to create unique patient identifiers to decrease the risk of inadvertent disclosure of a patient’s identity.
When you run the application you will be prompted to enter your Username and Password. If it is the first time the application has been run, enter the default login details listed below. Otherwise enter the changed details.
- Username – Administrator.
- Password – optomap. Click OK. (All passwords are case sensitive)
You should create a username and password for each user.
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Chapter 4 – About the software applications
You can run the Admin application from the following:
l
Double-click the desktop icon – .
l Start Menu – Start > All Programs > optos V2 Vantage Pro > Admin.
Capture application features
The Capture application lets you control the device. You can capture images, check the quality of images and decide which images are saved or discarded, or need to be recaptured.
The Introductory Handbook contains safety information. Please read the Introductory Handbook before attempting to use the system.
Caution
The Capture application features include:
l An image display showing thumbnails of all the images captured in the patient session, with a large image for assessing image quality, field, and exposure.
l The application automatically saving images when the session is closed. Images marked to be discarded will automatically be discarded when the session is closed.
l optomap® plus Capture procedures. Access to these procedures depends on your system settings: ask your Optos representative for more information. These procedures let you capture different types of optomap® images, for example eye steered images and zoomed images. When an image has been captured using an optomap® plus Capture procedure it can be reviewed using one of the optomap® plus Review features.
l optomap® fa Capture procedures. Images must be captured using a device capable of capturing optomap® fa images.
The Capture application starts automatically. The logo is displayed while the software is starting up.
Review application features
The Review application lets you measure, annotate and add diagnostic codes to images. You can also import, export and e-mail optomap® images.
optomap® plus and optomap® fa images are reviewed using the enhanced features that are automatically made available when these images are opened.
Analysis
The Review application contains the following tools.
You can mark-up images using annotations, review notes and diagnostic codes
You can review the current image in the Simulated BIO view. This view simulates the retinal view as it would be seen via a Binocular Indirect Ophthalmoscope (BIO).
You can also use the 3D Wrap view for patient education purposes. The 3D Wrap view displays the current image on a 3D model eye. You can run the animated “Fly-Through” or demonstrate refractive errors and Intraocular Lenses.
Distribution
Once you have completed your review you can send the image to someone else. You can e-mail, export or print images. If the recipient has the optomap® image viewing application they can review the original image, see the Optos web site (www.optos.com) for download instructions. Alternatively, an adjusted image can be sent. The reviewer can look at the image using any common graphics application.
You can print images using in a variety of ways using the printing features.
You can also import images into the patient’s record.
Review application features include:
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l Comparative image reviewing tools that allow images to be easily displayed and linked together for simultaneous image viewing.
l Automatic registration of image features. These registered points are used to align images that are viewed together. You can also register image reference points manually.
l Annotation and Measurement tools that provide graphical mark-ups on the images. These mark-ups are saved with the patient medical record.
l Image Measurements, including distance and area measurements, and cup-to-disk ratio.
l Review Notes indicating image review status, comments and ICD-9 diagnostic pathology coding.
The Review application is run from the following:
l
Double-click the desktop icon –
l Start Menu – Start > All Programs > optos V2 Vantage Pro > Review.
Setting User Preferences
You can control some of the Review application features. Select the options you want to be used each time you log in.
- Select Tools menu > Preferences to display the User Preferences dialog box. You can only set preferences for the user who is currently logged in.
- Image Review tab – Select the options you want to viewing images.
l Image Information pane – Select the options to define how images are initially displayed.
l Remind to Add Review Note – Will prompt the user to add a review note if the image is being reviewed for the first time.
l Hide Information panel when Opening Image – The Information pane shows the Annotations and Review Notes that were saved with the image. You can hide this pane to create a larger viewing area.
l Hide Adjustment panel When Opening Image – The Adjustment pane shows the adjustment controls, including contrast and brightness options. You can hide this pane to create a larger viewing area.
l Show Annotations when Opening Image – Displays all the annotations that were added in previous reviews.
l Automatic Image Registration – Sets the application to automatically locate the optic disk and macula.
l Disable Deletion of Reviewed Images – When selected, this option prevents the deletion of images which have already been reviewed. Only images that have not been reviewed can be deleted.
- Layout tab – Select the Start-Up Screen and Window Layout options.
l Start-up Screen pane – Select the screen you want to be displayed when you run the Review application.
l Welcome dialog – Shows the three most commonly used methods for opening patient images.
l Select Patient – Displays the Select Patient dialog box. Once you have selected a patient the Patient History dialog box is displayed.
l None – No dialog boxes are displayed when you run the Review application. You can open images using the toolbar or menu options.
l Window Layout pane – Select this option to maximize windows that show a set of image thumbnails for example, Patient History, Image Set, Image Library and others when they are opened.
- Confirmations tab – Define which confirmation dialog boxes you want to be displayed.
l Saving Annotations – Displays the Confirm dialog box when annotations have been added to an image that is being closed.
l Deleting Images – Displays the Confirm dialog box when an image is being deleted.
l Change Image Laterality and Move Images between Patients – Displays the Confirm dialog box when an image is moved between left and right sides or between patient records.
l Accept ‘Image Everyone’ session as billable – At sites where the Image Everyone workflow is in place, this option displays the Confirm dialog box when a review session is recorded as billable. Contact Optos for more information on Image Everyone, see Contact us on page 93.
- 3D Wrap Options tab – Set the3D Wrap view Options.
l Quality settings – Set the required quality setting. If your PC runs slowly when viewing the 3D Wrap view, you should reduce the quality setting. You can also disable the 3D Wrap view feature.
l Start fly-through when 3D Wrap view opens – Sets the system to automatically show the animated 3D Wrap view of the current image when the 3D Wrap view is opened.
- Import, Export and Print tab – Define the options to be used when distributing images.
l Image Import and Export pane – Select the options to be used when importing and exporting images.
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l Use File Date/Time as Image Time Stamp – Uses the capture properties stored with the image file to set the time and date in the image database. If you do not select this option, the date and time the file was imported will be used as the image time stamp.
l Show Image Preview when Exporting – Presents a preview of the image as it will be exported. If you do not select this option you will not be able to check the image during the export process.
l Printer Output Compensation pane – helps you compensate for the difference between the screen output and the printed output. Drag the slider to darken or lighten the print output.
- Stereo tab – Some systems are capable of capturing Stereo Images. Select the options to be used when reviewing Stereo Images.
l Stereo View Mode pane – when viewing Stereo Images you need to look at the images in a way that merges a left and right pair of the same eye. Select the viewing technique to be used:
l Divergent – where your focus is behind the images or when you are using a stereo viewer (stereograph) to view the images.
l Convergent (“cross-eyed”) – where your focus is in front of the image.
l Stereo View Center pane – when viewing images the system will open both left and right Stereo Images of the same eye. You need to define where these images should be centered:
l Optic Disk – images are centered on the optic disk.
l Macula – images are centered on the macula.
l Show Stereo Overlays – you can select whether an overlay is shown when reviewing Stereo Images. The overlay can help when you attempt to merge the left and right Stereo Images.
- Click OK to save your settings.
Note
The Preferences dialog box displays the name of the current user.
Storage application features
The Storage application lets you archive the patient database and image files. You can also clean out the hard disk to make space for new images. The database and images must be archived and cleaned up regularly to make space for new image files and to provide a backup if the data is lost or damaged.
Storage application features include:
l Almost fully automated CD or DVD archiving so all you have to do is put in a disk and start the process.
l Scheduled archiving to either a network location or a NAS device1.
l
l
Integrated verification that confirms the data writing process was successful.
Storage Status indicating the online storage status and how many images are not archived.
The database holds patient information and references the location of the image files. The image files are initially held in a separate image store on the PC hard disk. These image files are large and must be archived and cleaned up to make space for new image files. If you do not archive regularly you will fill the hard disk and be unable to capture more images. Lost or corrupted files can be restored from the archived backups. The Review application displays the archive disk label if the image is requested.
The Storage application is run from the following:
l
Double-click the desktop icon –
l Start Menu – Start > All Programs > optos V2 Vantage Pro > Storage.
Scheduler application features
The Scheduler application lets you manage patient records and appointments. You can create patient records before the optomap® Retinal Exam takes place. Patient records are stored on a single database, this helps to eliminate the risk of duplicating patient records.
Scheduler application features include:
1A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network.
It has its own network address.
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l Adding or editing patient details.
l Adding or editing patient appointments.
l Daily, weekly or monthly appointment views.
The Scheduler application is run from the following:
l
Double-click the desktop icon –
l Start Menu – Start > All Programs > optos V2 Vantage Pro > Scheduler.
Note
The Scheduler application only connects to the Optos database and so should not interfere with other applications.
About software updates
Push software is a feature where software updates are pushed out and are automatically downloaded by the system. This is similar to how other software applications automatically update software.
When the application is closed it checks if an update is available. A message box is displayed if an update is available, otherwise the application closes as usual.
The message box lets you choose to install the update now or install the update later. If the update has been assigned the high priority the message box will appear each time the application is closed. The message box will appear less frequently if the update has been assigned a lower priority. The update should be installed as soon as practically possible. Please ensure all PCs in the system are updated.
The update may run and install silently or the user may have to respond to the prompts as the update is installed.
Checking for updates
Each application has a menu option to check for updates. This runs the update checker without having to close the application.
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Chapter 5 – About capturing an image
5 About capturing an image
The following procedure explains how to capture an image using the Capture application. The notes that follow suggest techniques that can be used to deal with any changes that may be appropriate for an individual patient.
You should select the appropriate Iris Category for the patient, see Detector gains on page 10.
You should capture at least two images of each eye. If necessary, you can improve the quality of the next image, see Checking the quality of captured images on page 30.
Warning
Do not capture images when the face pad is not in place.
Do not lean on the head rest, monitor arm, monitor or keyboard tray. Ensure the monitor arm and keyboard tray do not restrict the patient’s access to the device.
Do not start an archive task if a patient is due to be imaged in the next 30 minutes.
Some devices are supplied with a patient arm support. The patient arm support supplied with the device is designed to support the weight of a resting arm. Do not exceed the weight indicated on the patient arm support. When in use, ensure the patient arm support is securely clamped to the table wing, and that it is covered with a piece of absorbent paper.
Care should be taken adjusting the head rest or table height when the patient is resting on the head rest.
Guidance for use on patients with Epilepsy
The device uses flashes of laser light. Some patients with epilepsy may be sensitive to flashes of light. Caution should be exercised for patients who have a history of reaction to camera flashes or strobe lighting.
Working with patient records
Please remember to comply with your practice procedures on personal data protection when storing and distributing patient images.
Patient records are usually created before the image is captured, so you should not normally have to create a new record when reviewing images. When following the instructions below, you should pay particular attention to checking the patient record does not already exist.
You should ensure that the correct patient record is selected for each patient.
How to add or edit a patient’s record
- Click PATIENT LIST to display the Select Patient dialog box.
- Add or edit a Patient Record:
Action
To add…
To edit…
Description
Click New Patient to create a new patient record. You can adjust the scan head table to a comfortable height when typing in patient’s details.
Enter the patient’s name.
Click the patient’s name and click Details to edit the patient record.
- Enter the patient’s Date of Birth. You can use the left and right keyboard arrow keys or [/] to move between day, month and year.
- The Patient ID can be entered manually or is generated automatically depending on the settings in the Admin application.
- Select the patient’s Gender.
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- Select the Iris Category based on the patient’s eye color. The Iris Category sets the system to expect a defined level of light returned from the retina. Lower light levels are returned when the patient’s retina contains greater pigmentation levels. Selecting an Iris Category that is too dark may lead to overexposure in the central pole.
- Select the Practitioner. This information can be used when filtering patient images in the Review application.
- Optional: Enter any Notes about the patient. Click OK.
Note
l Mandatory fields are shown in bold text.
l The software will reject invalid dates. If you need to enter a “29 February” date of birth you should select the year before entering the date and month.
l The software will not allow you to delete a patient record. If you find a duplicated patient record you should move the images from the duplicated record, see Assigning an image to another patient’s record on page 66. You could then edit the patient’s name in the duplicated record; perhaps by adding a “z” to the front to move the record to the end of the list.
How to search the patient list
You can search the patient list using the following methods:
l Click Clear to clear any filters that may be set.
l You can search for an existing patient by typing the last name in the Patient Name field. The closest last name will be highlighted as you type.
l Click the ID column heading to sort patients by ID number. You can then type in an existing ID to go to the closest ID on the list.
l You can check the patient’s date of birth by hovering the mouse over the patient’s name. The date of birth will appear in a pop-up window. This is useful if the same name is used by more than one patient.
Note
If the patient is not shown you will need to create a new patient record.
How to filter the patient list
You can filter the patient list to display only those that meet the filter criteria.
- Set the filter criteria. You can filter by Patient Name, Practitioner, Session Date and Session (Review) Status.
- Click OK to set the filter and return to the Select Patient dialog box where the results will be displayed.
Cleaning before each patient
The areas where the patient comes into contact with the device must be cleaned before each patient is imaged.
How to clean the device before each patient
Do not capture images when the face pad is not in place.
Warning
The following cleaning procedures should be carried out between patients:
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l The face pad and head rest must be cleaned with an individually sealed, 70% isopropyl alcohol wipe and allowed to air-dry between patients. The head rest can be removed for cleaning.
l The patient arm support should be cleaned with an individually sealed, 70% isopropyl alcohol wipe and allowed to air-dry between patients.
l Do not use tissues or other material to dry the areas that have been cleaned as this could create dust. Dust could collect on the scan head mirror and optical components and impair image quality. Always allow cleaned areas to air-dry.
l Do not let the cleaning wipes come into contact with the inside of the instrument.
l The wipes should be checked periodically to ensure that they are within their marked expiration date.
Patient instructions
Take a minute to put the patient at ease. Explain the following to the patient:
l Explain that a set of digital images will be captured during the procedure.
l The imaging process is not invasive and there is no contact with the patient’s eye.
l The procedure is similar to having a photograph taken, so there will be a flash when each image is captured.
| Guidance for use on patients with Epilepsy | |
| The device uses flashes of laser light. Some patients with epilepsy may be | |
| Warning | sensitive to flashes of light. Caution should be exercised for patients who have a |
| history of reaction to camera flashes or strobe lighting. |
l The operator will guide the patient throughout the procedure. The patient should follow all instructions given by the operator.
l Explain that the patient will be asked to look into the instrument with ONE eye. The process will then be repeated for the other eye. It may be beneficial to image the patient’s best eye first.
l Explain that the patient should look directly at the green ball.
l Explain that you will monitor their position on the screen and let them know when you are going to capture the image.
l The patient should maintain fixation on the light at all times and hold the direction of gaze even if the light disappears.
l The patient should keep their eyes open as wide as possible throughout and keep their head in position.
l Explain that the patient will see a flash when the image is captured.
Capturing images
Aligning the patient accurately is the key to capturing good images. It is essential that the patient understands what to do and presents their eye to the device in the correct manner.
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Some Capture procedures allow the capture of eye steered images, How to do eye steering on page 29.Eye Steered Images are images of the same eye where the patient is asked to make a slight change in the direction they are looking. You can select from four directions; Inferior, Superior, Nasal and Temporal. The direction of gaze is marked on the thumbnail image. Always capture a central, on-axis image first and before capturing the required eye steered directions.
In normal imaging the patient’s iris should fit just inside the outer circle (limbus ring) shown on the External Eye Camera view. When the patient is in the correct position, press the hand switch button to capture the image. Contact Optos if you think the limbus ring position needs to be altered, see Contact us on page 93.
To help guide the patient to see the fixation light, the operator can view the patient’s eye in the Capture Right/Left Eye dialog box, see Good Quality Image example on page 30.
- Prepare to capture an image
l Check the device has warmed-up and that the device is ready to capture.
l Clean the relevant parts of the device, see Cleaning before each patient on page 20.
l Work through the dialog boxes and select the patient, procedure and eye to be imaged. Some devices are configured to capture optomap® af images. If you want to capture an optomap® af image you should select the option when selecting the procedure.
l Lower the chin cup to the lowest height, see About the head rest on page 8.
l Dim the lighting in the room to achieve maximum natural dilation of the pupils before attempting to capture an image.
- Position the chair
l Explain to the patient what is about to happen, see Patient instructions on previous page.
l Ask the patient to sit in the chair.
l Move the chair forwards until the patient’s face is approximately 15 cm (6 inches) from the front of the scan head.
- Position the scan head table height
l Adjust the scan head table height so that the tip of the patient’s nose is aligned with the center of the limbus ring shown on the External Eye Camera view, How to use the hand control on page 11.
- Position the Patient
l Ask the patient to look at the green ball.
l Ask the patient to keep their teeth together.
l Ask the patient to place their chin fully in the chin cup with their nose outside the hole in the face pad.
l Position the patient against the forehead strap. The patient should be leaning towards the scan head.
l Use the External Eye Camera view as a guide, adjust the chin cup height to align the pupil with the center ring.
- Position the Patient’s Eye
How to position the patient manually
l Align the patient’s eye so that the center ring is in the center of the pupil and that the 3 and 9 o’clock sides of the limbus ring cover the patient’s limbus.
l Move the patient closer to the device when a (+) is displayed in the center ring, and further from the device when a (-) is displayed. Use the buttons on the hand control to align the patient’s eye with the rings.
l The system is aligned with the patient’s eye when the rings change color from red to green and the center ring is filled.
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l Ask the patient to open both eyes as wide as they can.
l Check the pupil and limbus positioning.
l Capture the image by pressing the capture button on the hand switch. Alternatively, you can capture the image by pressing [F8] on the keyboard.
How the patient uses the self alignment option (not applicable when eye steering or capturing stereo images)
l Ask the patient to keep looking at the green ball.
l As the patient moves in, two red lights will be displayed when the patient is at the correct distance. One red light will appear above and the other below the green ball.
- Select the optomap® af if you are capturing an optomap® af image.
- If you are capturing eye steered images you will need to ask the patient to look in a particular direction, How to do eye steering on page 29. You should always capture an on-axis image before capturing eye steering images.
- Check the quality of the image, see Checking the quality of captured images on page 30.
- Capture more images or click End Procedure to complete the procedure.
Note:
l The Fixation Level controls the brightness of the green ball. Always use the dimmest Fixation Level setting the patient can see.
l 200Tx only – Click RESET POSITION to re-centre the green ball if required.
l If the alignment system does not turn green you should align the rings as accurately as you can. Take an image when you think the alignment is correct.
l If the patient’s lids and lashes are in the way follow your practice procedures to minimize this, see Minimizing lids and lashes in images on page 33.
l Positional Reflex (bright spots) may occur when patient is too far in.
l If the patient is not in far enough, guide the patient a little closer until the rings turn red; at this point the patient is too close. Gently move the patient away again until the rings have just turned green.
l When imaging a patient with a large head, you can use the grooves behind the face pad to get the patient closer.
l If the patient was too far in or too far out you can use the z-axis numbers to improve the patient positioning in the next image. When External Eye Camera view appears, the previous z-axis capture setting is briefly displayed. Remember this number, and increase the number in the next image if the patient was too far in, and decrease the number if the patient was too far out.
l The Image Setting pane shows the External Eye Camera view when the image was captured. You can use this to help determine the adjustments required for subsequent images. You can also adjust the settings for the next image to be captured from this pane.
l You may need to adjust the positioning if the patient moves during the early-phase of an optomap® fa procedure.
l When swapping between left and right eyes you should:
l Check the table and chin cup height and make any adjustments.
l Move the chin rest to the other side and adjust the chin rest angle for aligning the other eye.
l When imaging patients in wheelchairs:
l Where possible the patient should be aligned straight-on, facing the device.
l The patient should be as straight on as possible with accommodation made for the wheelchair or the patient’s physical limitation.
l When imaging children, depending on the height of the child, ask the child to stand straight in front of the device.
Capture Single Eye Image
The single eye image capture procedure is followed for standard optomap® and optomap® plus procedures. It is also used in the first part of the procedure for capturing optomap® fa images.
- Complete the preliminary checks, see Single Image Preliminary checks on next page.
- Tell the patient what will happen, see Patient instructions.
- Align the patient, see Capturing images.
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Depending on the configuration of your device the following procedure types and options may be available:
If following an optomap® plus procedure you can select the following:
l If required, capture an AF image, see How to capture Autofluorescence images on page 27.
l The Fixation Level controls the brightness of the green ball which helps the patient look in the correct direction. The Fixation Level can be altered if the patient is having trouble seeing the green ball. You should select the dimmest level the patient can see to ensure the best possible image.
l If required, capture a stereo pair, see How to capture Stereo images. If required, capture an eye steered image using an eye steering direction, see How to do eye steering on page 29.
l If required, capture a ResMax™ image of the central pole,see How to capture a image. ResMax™ is not available for optomap® fa for central pole procedures.
Single Image Preliminary checks
These preliminary checks should be carried out when following an optomap® or optomap® plus procedure. It is also used in the first part of the procedure for capturing optomap® fa images.
l Clean the face pad and head rest before starting this procedure, see Cleaning Instructions.
l Ensure that the patient understands what will happen during the exam, see Patient instructions.
If following an optomap® fa procedure:
l The system automatically follows the optomap® fa procedure to capture color/red-free images of both eyes. You should capture the fellow eye first and then capture the study eye. This leaves the patient aligned for the study eye on the next step in the optomap® fa procedure.
l If you need to check the settings for controlling the early-phase of the angiography procedure you should do this now, before proceeding. The early-phase criteria are set in the Multi-frame Settings window.
Capturing Stereo Images
Some systems may be configured to capture pairs of Stereo Images. Stereo Images are images of the same eye where two images are captured a few millimeters apart. The images are identified as Stereo 1 and Stereo 2.
You must capture both Stereo 1 and Stereo 2 images to complete the pair.
Stereo Images should not be used for diagnostic purposes.
Caution
The Stereo 1 and Stereo 2 pairs are displayed as Linked Images in the Review application. optomap®, optomap® plus and ResMax™ images can be captured as Stereo Images.
When reviewing Stereo Images you need to either:
l use a stereo viewer (stereograph).
l focus in front of the images.
l focus behind the images.
How to capture
- Prepare to capture an image
l Check the device has warmed-up and that the device is ready to capture.
l Clean the relevant parts of the device, see Cleaning before each patient on page 20.
l Work through the dialog boxes and select the patient, procedure and eye to be imaged. Some devices are configured to capture optomap® af images. If you want to capture an optomap® af image you should select the option when selecting the procedure.
l Lower the chin cup to the lowest height, see About the head rest on page 8.
l Dim the lighting in the room to achieve maximum natural dilation of the pupils before attempting to capture an image.
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- Position the chair
l Explain to the patient what is about to happen, see Patient instructions on page 21.
l Ask the patient to sit in the chair.
l Move the chair forwards until the patient’s face is approximately 15 cm (6 inches) from the front of the scan head.
- Position the scan head table height
l Adjust the scan head table height so that the tip of the patient’s nose is aligned with the center of the limbus ring shown on the External Eye Camera view, How to use the hand control on page 11.
- Position the Patient
l Ask the patient to look at the green ball.
l Ask the patient to keep their teeth together.
l Ask the patient to place their chin fully in the chin cup with their nose outside the hole in the face pad.
l Position the patient against the forehead strap. The patient should be leaning towards the scan head.
l Use the External Eye Camera view as a guide, adjust the chin cup height to align the pupil with the center ring.
- Position the Patient’s Eye
How to position the patient manually
l Align the patient’s eye so that the center ring is in the center of the pupil and that the 3 and 9 o’clock sides of the limbus ring cover the patient’s limbus.
l Move the patient closer to the device when a (+) is displayed in the center ring, and further from the device when a (-) is displayed. Use the buttons on the hand control to align the patient’s eye with the rings.
l The system is aligned with the patient’s eye when the rings change color from red to green and the center ring is filled.
l Ask the patient to open both eyes as wide as they can.
l Check the pupil and limbus positioning.
l Capture the image by pressing the capture button on the hand switch. Alternatively, you can capture the image by pressing [F8] on the keyboard.
How the patient uses the self alignment option (not applicable when eye steering or capturing stereo images)
l Ask the patient to keep looking at the green ball.
l As the patient moves in, two red lights will be displayed when the patient is at the correct distance. One red light will appear above and the other below the green ball.
- Select the optomap® af if you are capturing an optomap® af image.
- If you are capturing Stereo Images you will need to capture Stereo 1 and Stereo 2 images of the same eye. You should always capture a Normal image first and then:
l Select the Stereo 1 option. Align the patient as for a normal image, then when the rings change color to green, move the patient slightly to the side indicated by the arrows displayed on the External Eye Camera view. The center circle should remain inside the patient’s pupil.
l Select the Stereo 2 option. Align the patient as for a normal image, then when the rings change color to green, move the patient slightly to the side indicated by the arrows
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displayed on the External Eye Camera view. The center circle should remain inside the patient’s pupil.
- If you are capturing eye steered images you will need to ask the patient to look in a particular direction, How to do eye steering on page 29. You should always capture an on-axis image before capturing eye steering images.
- Check the quality of the image, see Checking the quality of captured images on page 30.
- Capture more images or click End Procedure to complete the procedure.
Note:
l Stereo Imagecapture is not available when capturing Eye Steered images.
l The Fixation Level controls the brightness of the green ball. Always use the dimmest Fixation Level setting the patient can see.
l As with capturing standard optomap® images, the patient should look directly at the green ball. The extent to which patients are moved to one side or the other is controlled when the alignment rings are moved to the side. There is no change to the patient instructions when capturing Stereo Images.
l Click RESET POSITION to re-centre the green ball if required.
l If the alignment system does not turn green you should align the rings as accurately as you can. Take an image when you think the alignment is correct.
l If the patient is not in far enough, guide the patient a little closer until the rings turn red; at this point the patient is too close. Gently move the patient away again until the rings have just turned green.
l If the patient’s lids and lashes are in the way follow your practice procedures to minimize this, see Minimizing lids and lashes in images on page 33.
l Positional Reflex (bright spots) may occur when patient is too far in.
l When imaging a patient with a large head, you can use the grooves behind the face pad to get the patient closer.
l If the patient was too far in or too far out you can use the z-axis numbers to improve the patient positioning in the next image. When External Eye Camera view appears the previous z-axis capture setting is briefly displayed. Remember this number, and increase the number in the next image if the patient was too far in, and decrease the number if the patient was too far out.
l The Image Setting pane shows the External Eye Camera view when the image was captured. You can use this to help determine the adjustments required for subsequent images. You can also adjust the settings for the next image to be captured from this pane.
l You may need to adjust the positioning if the patient moves during the early-phase of an optomap® fa procedure.
l When swapping between left and right eyes you should:
l Check the table and chin cup height and make any adjustments.
l Move the chin rest to the other side and adjust the chin rest angle for aligning the other eye.
l When imaging patients in wheelchairs:
l Where possible the patient should be aligned straight-on, facing the device.
l The patient should be as straight on as possible with accommodation made for the wheelchair or the patient’s physical limitation.
l When imaging children, depending on the height of the child, ask the child to stand straight in front of the device.
Multiple Image Preliminary Checks
These preliminary checks should be carried out when following an optomap® fa procedure.
l Check the criteria for the early-phase is set in the Multi-frame Settings window.
l Ensure that the patient understands what will happen during the exam, see Patient instructions.
l Some devices are supplied with a patient arm support. Check that the patient arm support is attached to the appropriate side of the device. Loosen the clamp and attach to the opposite side if required. Check that the clamp is secure.
l Place a piece of absorbent paper over the patient arm support.
l Check that the monitor arm will not obstruct access to the patient and the patient’s arm while the injection is being administered.
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l Check that the equipment and personnel required for the procedure are available. Resources will also be required to deal with any possible patient reactions.
Note
l The early-phase criteria can be customized by selecting Settings > Multi-frame tab from the Welcome screen.
l The number of images to be captured and the seconds between each capture can be set. To disable this feature for future sessions select 0 images and 1 second.
l You can stop image capture during the early-phase by pressing the image capture button on the hand control. This can be useful if the patient has a reaction to the fluorescein.
How to capture Autofluorescence images
The optomap® af procedure begins with capturing a set of optomap® plus images and then the optomap® af image capture step follows:
No fluorescent dye should be introduced into the patient.
Warning
optomap® af images are captured using a green laser light for illumination. This contrasts with the traditional use of blue illumination or white light for autofluorescence imaging. Green light autofluorescence differs, and allows a different visualization of macular pathologies since macular pigment does not interfere. Also the Optic Nerve Head is clearly visible when green laser light is used for autofluorescence imaging.
The following procedure can be used for guidance, but you should follow your clinic’s protocol if available:
- Complete the preliminary checks, see Single Image Preliminary checks on page 24.
- Tell the patient what will happen, see Patient instructions.
- If lids and lashes obscure the images to an unacceptable level use your procedures to reduce the image being obscured, see Minimizing lids and lashes in images.
- Align the patient, see Capturing images.
- Capture the optomap® af images.
- Optional: If required, you can now image using an eye steering direction, see How to do eye steering on page 29.
- You can review the image quality of all the images captured.
- Click Right Eye (OD) or Left Eye (OS) to capture more images.
- Discard any unwanted images, see Discarding Images. All other images will be saved to the Image Server PC.
Multi-Frame Settings
These settings define the number of images and the capture frequency applied when early-phase
optomap® fa images are captured on a 200Tx device. You can also set whether optomap® fa procedures can be paused.
Early-Phase Settings
In the early-phase, the system will take multiple images when the capture button on the hand control is pressed, How to use the hand control on page 11. The number of repeated images, and the time between them is configurable. The minimum period between images is 1.2 seconds.
In the early-phase, the system will capture images until the defined number of images have been captured or the hand control capture button is pressed again. You should set the criteria to meet your clinic’s procedure.
You can capture a single optomap® fa image by either:
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l Setting the Multi-Frame Setting to capture just one image. This setting will be applied to future sessions.
l Pressing the hand control capture button immediately after the first image has been taken. This method will only affect the current session.
Note
The early-phase is limited to capturing a maximum of 50 images. The session (early-phase plus any additional images) is limited to capturing a maximum of 70 images.
Patient Management
Selecting the Allow patient procedures to be paused option lets you pause optomap® fa procedures during the multi-frame capture phase.
Capturing Multiple Images (Angiography)
The optomap® fa procedure begins with capturing a set of optomap® plus images and then the angiography image capture step follows. Do not inject the patient until the appropriate point in the procedure.
Pre Capture
After completing the initial color image capture, click either Right Eye (OD) or Left Eye (OS) to start the optomap® fa capture. The window will change to show the capture screen. You can change to the other eye after the early-phase of the exam.
The capture window will be displayed. You can change the Fixation Level, set Eye Steering, and in some procedures you can capture ResMax™images.
How to capture angiography images
The following procedure can be used for guidance, but you should follow your clinic’s protocol if available.
Function keys have been set up for the main actions. The relevant keys are shown in the steps below.
- Complete the preliminary checks, see Multiple Image Preliminary Checks on page 26.
- Tell the patient what will happen, see Patient instructions on page 21.
- If lids and lashes obscure the images to an unacceptable level try to minimize their impact, see Minimizing lids and lashes in images on page 33.
- Align the patient, see About capturing an image on page 19.
- Administer the injection when the patient is aligned. Press the image capture button on the hand control to start the timer when the injection starts, How to use the hand control on page 11.
- Press the image capture button on the hand control again at the end of the injection being administered to begin capturing the early-phase images.
l The capture window displays both the time elapsed since the timer started and the number of images already captured.
l If necessary, increase [F3] or decrease [F4] the contrast of the images by moving the contrast slider or pressing the function keys shown. Increase the contrast setting at the start of the early-phase capture. This will show the dye as it enters the vessels. Decrease the contrast setting as the dye spreads through the eye.
l You can use the External Eye Camera view to check the patient alignment during the series. Use the hand control buttons to make any fine adjustments to the patient’s position.
l You can press the image capture button on the hand control to stop the automatic image capture during the early-phase. This can be useful if the patient has a reaction to the fluorescein.
- Once the early-phase capture has been completed, or stopped, you can capture additional images by pressing the capture button on the hand control.
l If required, you can capture images of the fellow eye. Click CHANGE TO [other eye] to swap to the fellow eye. Align the patient as before. Press the image capture button on the hand control to capture each image. You can repeat swapping between eyes until all the required images have been captured.
l If required, you can select an eye steering direction or the ResMax™[F2] option.
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- You can review all the images captured any time after the early-phase series has been completed. Click Image Series view [F10] to display the thumbnails of all the captured images. This will also enable the images to be saved to the Image Server PC.
- In the Image Series view, click Right Eye (OD)[F5] or Left Eye (OS)[F6] to capture more images.
Note
The early-phase is limited to capturing a maximum of 50 images. The session (early-phase plus any additional images) is limited to capturing a maximum of 70 images.
Post Capture
The image thumbnails are displayed in time order from left to right. Each thumbnail shows the eye (right or left) and time lapse when the image was captured. You can:
l Click Pause procedure to pause the current procedure.
l
l
Double-click an image to view it in a full size window.
Check the quality of each image.
l Discard any images you do not want to keep. Press [Delete] to discard or [Insert] to keep, or click the appropriate application button.
l Click either Right Eye (OD) [F5] or Left Eye (OS)[F6] to capture more images.
When you have completed the procedure click End procedure [F10].
How to discard images
Images are automatically saved. You can discard any images you do not want to save before you end the procedure.
You can discard images by:
l Clicking Discard to discard the current image. The button changes to Keep when the selected image is marked to be discarded.
l Pressing [Delete] on the keyboard to discard the selected image and select the next image. You can choose to keep an image and move on to the next one by pressing [Insert] on the keyboard. These accelerator keys are useful when working with a large number of images.
When you click End procedure the discarded images will be removed from the Image Server PC.
How to do eye steering
- Ask the patient to keep their head in position between eye steered directions.
- Click either Right Eye (OD) or Left Eye (OS) to select the eye you want to capture. Capture the on-axis image (indicated by the green fixation light) first.
- Click the same eye again to prepare the system to capture the next image.
- Align the patient with the green fixation light. Explain that the green fixation light will go out and a red fixation light will appear. Tell the patient which direction they need to look to see the red fixation light. Select the required eye steering direction:
l To see more of the 12 o’clock area of the retina you need to select the 12 o’clock direction. l To see more of the 9 o’clock area of the retina you need to select the 3 o’clock direction. l To see more of the 6 o’clock area of the retina you need to select the 6 o’clock direction. l To see more of the 3 o’clock area of the retina you need to select the 9 o’clock direction.
- Ask the patient to look towards the new red fixation light. It is important that the patient does not move their head.
- Fine tune the alignment.
- Ask the patient to open their eyes wide and to stay still. Press the capture button on the hand control.
- Repeat from step 3 for other directions.
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Note
l Eye steering is not available for every procedure.
l Full user details can be found in the User Guide which is installed with the V2 Vantage Pro applications.
View captured image
The image is identified by the eye and timestamp details. You can:
l Check the quality of the full sized image.
l Central pole shows the close-up image of the optic disk and macula. Once you are in this close-up mode you can drag the image to review other areas in this close-up view. Click, and hold down, the left mouse button and drag the image to the area you want to view. The Central pole button changes to the Full field button when pressed. Click Full field to show the full image.
l Scroll through the series of images by clicking Previous image or Next image. Check the quality of each image.
l Discard any images that are not required by clicking Discard. Images will be discarded at the end of the session.
Click View Image Series to display all the thumbnail images. You can end the session from the Image Series view.
Checking the quality of captured images
You should check the quality of each captured image to determine if the exposure settings need to be changed to suit the patient’s individual characteristics.
Captured image thumbnails are tiled and displayed at the side of the main image display area. Click an image thumbnail to display it in the main image viewing area.
l Poor quality image example, see Badly aligned images – examples on the facing page.
Lids, lashes obscuring the image
You may find that lids and lashes cover part of the image, obscuring some areas of the retina. This may happen if the patient was too far away from the device, or blinked, when the image was captured. Use the External Eye Image to check the patient alignment, see Checking the Exterior Eye Image.
Lids and lashes may sometimes obscure part of the image. You can reduce this by following your practice procedures, see Minimizing lids and lashes in images on page 33.
Patient positioning
You can improve the quality of a captured image by properly positioning the patient. There are simple ways to improve the patient’s positioning.
Capturing an image from a well-positioned patient should produce a good quality image, see Good Quality Image example below.
Note
Sometimes the patient may be misaligned, see Badly aligned images – examples on the facing page.
Good Quality Image example
The following is an example of an optomap® image of a well-positioned eye. This is the type of image you should be trying to achieve.
If you do not capture an image like this you should check the instructions for capturing an image, see Capturing images on page 21.
Note the following:
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l The thin green edge.
l Only a few eye lashes showing at the bottom of the image.
Sample image from 200Tx device.
Well aligned image External Eye Camera view
Badly aligned images – examples
These images show the results of various types of alignment problems.
Patient blinks Patient’s eye closed
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Patient too near Patient much too near
Patient too far away Patient much too far away
Patient too far left Patient too far right
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Patient too high Patient too low
Minimizing lids and lashes in images
In some patients, images may be obscured by the patient’s lids and lashes. You should follow your practice procedures to minimize lids and lashes in images.
In some cases the amount of lid and lash can be minimized by gently lifting the patient’s eyebrow.
- With clean hands, place your thumb below the patient’s eye and your forefinger on the brow line.
- Gently open the eye a little further. Just lifting the upper lid may pull the lower lid further into the image.
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6 About the Patient History view
The Patient History view provides easy access to all the images for the selected patient. Select images from the image list and then choose option you want to use to open them.
To select images
from the…
Session list
Left and right thumbnail image lists
Image list
Description
Each session is identified by its date. Double-click the date to expand the session to show all the images that were saved.
A pink marker indicates sessions which were captured using an
optomap® plus capture procedure. In countries where reimbursement procedures are applicable a purple marker and the procedure code will be displayed next to the procedure name, see Using procedure codes on page 56.
You can mark the images to be opened by clicking the image thumbnail.
optomap® fa image series are represented by a single thumbnail image. Selecting this thumbnail will open all the images in the Image Series view where you can choose how you want the images to be opened, see Image Comparison Methods on page 88.
Eye steered images are shown individually.
Pairs of Stereo Images are shown as one thumbnail. When you open the image, both left and right Stereo Images are displayed, see Setting User Preferences on page 15.
All the images, for both eyes, are listed in date order, with the most recent image at the top. Click each image you want to select.
Once all the images have been selected you can choose how the images should be opened. If you select one image the Open in Image Stack Window is enabled. If you select more than one image all window buttons are enabled. Click the appropriate button to select the most suitable way of comparing the images. You can open images in different ways depending on how you want to review them, see Image Comparison Methods on page 88.
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Note
l Right-click an image to display the pop-up menu where you can open the image or display
Review Notes.
l optomap® plus Review procedures are only available when the image was captured using an optomap® plus Capture procedure. Ask your Optos representative for more information about optomap® plus. These markers are also shown on the image thumbnails.
l If the secondary (compressed) image has been cleaned out, the label of the disk on which the image is sorted will be displayed. Insert this disk in the disk drive to retrieve the image.
l Images that have been imported into the patient’s history are indicated by the Imported Image symbol, see Review Tools Controls on page 82.
Using the Patient History window
The Patient History window lets you carry out a wide variety of tasks:
l Open single or multiple images in a variety of different ways, see Opening images below.
l Import an image into the patient’s record, see Importing an image to a patient’s record on page 63.
l Move an image captured with the wrong eye selected, see Changing eye images from Right to Left (and Left to Right) on page 66.
l Move an image when the wrong patient was selected, see Assigning an image to another patient’s record on page 66.
l Drag and drop images onto the Print Bar. If you want to print annotations, open the image and select the annotations before adding to the Print Bar, see Printing images on page 64.
l Drag and drop unwanted images to the waste-basket, see Discarding unwanted images on page 40.
l Select from all the patient’s images when emailing if you start the email procedure from the Patient History window, see Emailing images on page 61.
Opening images
The Patient History window contains the most common options for opening images. From this view you can select images and choose how the images should be displayed.
How to view the patient’s image history
- Select Review menu > Patient History to display the Select Patient dialog box. If the patient’s name does not appear on the patient list, click Clear in the Filter Patient pane. This will clear the filter and ensure all patient records are displayed.
- Double-click the patient’s name to open the patient’s Patient History view. You can search for a patient’s record, see How to search the patient list on page 20.
- Select the correct patient and click OK to display the Patient History view.
Note
l You can set filter criteria to reduce the number of patients shown. Click Change to display the Filter Patients dialog box. You can select from any (or all) of the sections.
l Click Clear Filters in the Filter Patients dialog box to remove all filters.
l Primary (uncompressed) images will normally be removed from on-line storage after a few weeks (after they have been archived), so historical patient images are likely to be archived. You can use the secondary (compressed) image for a comparative review. However, if you require the full detail of the image, you should locate the disk. The disk label will be displayed.
How to open images in an image stack
An image stack shows multiple linked images in a single window. You can page through the images one at a time to review and compare them.
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Stacked images zoom, pan and move together. Color separations applied to one window are also applied in other linked windows. However, image adjustments such as Restore, Optimize, Gamma adjustment are only applied to the selected window.
- In the Patient History window, click each image you want to open. You must select more than one image to enable the Open in Image Stack Window button.
- Click the Open in Image Stack Window button.
- The images will be stacked in the one window. Click the forward and back buttons to page through the different images.
Note
You can also stack images by dragging an image from the Patient History window or Windows Explorer and dropping on to an open image window.
How to open linked images
Linked images zoom, pan and move together. Color separations applied to one window are also applied in other linked windows. However, image adjustments such as Restore, Optimize, Gamma adjustment are only applied to the selected window.
When you navigate to a retinal feature in one image the other linked images will display the same relative position. This method is particularly useful when comparing multiple images of the same eye. Left and right eye pairs will horizontally scroll in opposite directions.
- In the Patient History window, click each image you want to select.
- Click the Open in Linked Windows button.
- The images will be tiled across the window.
Note
You must select more than one image to enable the Open in Linked Windows button.
How to select optomap® fa images from the Image Series view
optomap® fa image series are displayed in the Image Series view. This view displays all the images in a sequence.
The Image Series view is displayed when you select an optomap® fa image series from the Patient History view.
From this view you can open individual images to review them in detail or display an FA Slideshow, see
Selecting images from the Image Series view on next page.
How to open a set of eye steered images
- In the Patient History window, click each image you want to open. The thumbnails of eye steered images show the steered direction.
- Click Open in Image Stack Window to open the group.
- The eye steered graphic (at the bottom-right of the window) shows which direction is being displayed:
l Light Green – indicates the eye steered direction of the image currently displayed. l Dark Green – indicates the direction(s) of the other eye steered images in the stack. l Black – indicates this eye steered direction was not captured.
- Review the images in the usual way.
How to open stereo images
Stereo Images should not be used for diagnostic purposes.
Caution
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- Select Tools menu > Preferences to display the Preferences dialog box.
- Select the Stereo tab and confirm the selected options are correct for the viewing technique being used, see Setting User Preferences on page 15.
- In the Patient History window, double click the Stereo Images thumbnail for the images you want to open, see Image Indicators on page 81. The images will be opened in the correct layout for the review technique being used, see Viewing stereo images on page 48.
Linking images
Linked images zoom, pan and move together. Color separations applied to one window are also applied in other linked windows. However, image adjustments such as Restore, Optimize, Gamma adjustment are only applied to the selected window.
Where images are unlinked, any zoom, pan or drag features only affect the selected window.
How to switch between linked and unlinked modes
Select Window menu > Link/Unlink All Windows to toggle between all open images being linked or unlinked.
How to open a Set of Linked Images
- Select Review menu > Patient History to display the Select Patient dialog box. If the patient’s name does not appear on the patient list, click Clear in the Filter Patient pane. This will clear the filter and ensure all patient records are displayed.
- Double-click the patient’s name to select it. You can search for an existing patient by typing the last name in the Patient Name field. The closest last name will be highlighted as you type. Select the correct patient and click OK to display the Patient Image dialog box.
l If you want to reduce the number of patients shown, you can set filter criteria. Click Change to display the Filter Patients dialog box. You can select from any (or all) of the sections.
l Click Clear Filters in the Filter Patients dialog box to remove all filters.
- Click the thumbnail of each image you want to open in a linked set of images.
- When all the images have been selected click Open in Linked Windows.
Note
If the secondary (compressed) image has been cleaned out, the label of the disk on which the image is stored will be displayed. Insert this disk in the disk drive to retrieve the image.
How to link selected open windows
- Select Window menu > Select Linked Windows to display the Link Windows dialog box.
- Click the checkbox to select each image to be linked.
- Select the window layout option from the Window Options pane.
l Leave Layout Unchanged – Links the selected windows but does not change the current window layout.
l Cascade Linked Windows – Links the selected windows and displays images in a series of overlapping windows.
l Tile Linked Windows Horizontally – Links the selected windows and displays the images in a series of rows.
l Tile Linked Windows Vertically – Links the selected windows and displays the images in columned windows.
- Click OK.
Selecting images from the Image Series view
The Image Series view displays the images captured during an optomap® fa procedure. You can select which images you want to open and how you want to display them.
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How to select images from the Image Series view
l All images are automatically selected when you open a series of optomap® fa images. Click an image to change the selection status. Selected images are shown with a blue border.
l Select Series menu > Select All to select all the images in the series.
l Select Series menu > Select Left Eye Images to select all the images of the left eye.
l Select Series menu > Select Right Eye Images to select all the images of the right eye.
l Select Series menu > Deselect All to deselect all the images in the optomap® fa series. You can deselect individual images by clicking on them.
How to open the selected images
l Click Open As Stack(s) to open the images in an image stack. If you have selected study eye and fellow eye images they will be opened in separate stacks.
l Click Open in Linked Windows to open a maximum of eight images in linked windows that zoom, pan and move together.
l Click Open in Unlinked Windows to open a maximum of eight images in unlinked windows where zoom, pan and move functions only affect the selected image.
How to print the selected images
- Select the images you want to print.
- Right click and select Add selected image(s) to Print Bar, see Printing images on page 64.
How to view an FA Slideshow
You can review a stack of optomap® fa images in the FA Slideshow.
- Select the images to be displayed in the slideshow, see Opening images on page 36.
- Click Open As Stack(s) to display the images. The windows will be grouped by eye and displayed in a stack view.
- Click FA Slideshow to display the controls.
- Click the Play button on the FA Slideshow pane to display the images in a slideshow. You can use the
Rewind and FastForward buttons to move through the FA Slideshow
Notes
l Only images of one eye can be displayed in the FA Slideshow.
l The Play button changes to a Pause button when pressed.
l The images in the FA Slideshow may jump if different image types are selected, for example including some ResMax™ images.
l You can zoom in or out of the images in the usual way when the FA Slideshow is paused.
Opening images using alternative methods
The Patient History view contains all the functionality for managing how images are opened and is the main interface for opening images, see About the Patient History view on page 35.
Other methods of selecting and opening images are available:
How to open recent images
A record of which images have been viewed is automatically stored. The next time the application is run these recent images can be opened quickly.
Select File menu > Recent Images … and select the recent image you want to open.
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How to browse all the images from thumbnails
You can open any image files on your network without selecting the images from a particular patient record.
- Select File menu > Browse Images to display the Browse Images dialog box.
- Select the appropriate file type from the File Types drop-down menu.
- Select the directory containing the images you want to open.
Note
l Click Pause Loading at any time to temporarily stop images loading in the browser window. You can restart loading images by clicking Restart Loading.
l If necessary, use the scroll bars to scroll up and down to view images in the Browsing dialog box.
l The Browsing dialog box remains open under the image window. You can use it to select more images.
How to search images by criteria
You can search all the saved images by setting the search criteria. You can search by date, image status, whether the image has had any review notes attached or for pathology or diagnostic codes.
- Select Review menu > Image Set to display the Select Images dialog box.
- Complete the Select by Date, Select by Status and Search Image Notes criteria. Click OK. The images that meet the specified criteria are displayed in the View Image Set window.
- Select the image(s) you want to open. If you select one image the Open in Image Stack Window is enabled. If you select more than one image all window buttons are enabled.
- Click the appropriate button to open the image(s).
How to open images from the hard disk
You can select images from the hard disk.
- Select File menu > Open to display the Select Image(s) to View dialog box.
- Select the file(s) you want to open. Click OK.
Note
l You can select multiple files by holding [Ctrl] while clicking each file you want to open. You can select a range of adjacent files by holding [Shift] while selecting the first and last file in the range. The selected files are highlighted.
l You can also drag and drop files directly from the file browser (also know as My Computer or
Windows® Explorer).
Discarding unwanted images
You can discard unwanted images.
How to discard an image from the Patient History view
- Click the image thumbnail, and drag and drop on to the wastebasket icon, see Review application user reference on page 81.
- Click Yes to confirm or No to cancel the operation. Close and reopen the Patient History view to refresh the view.
How to discard an open image
Select Image menu > Delete Image.
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Note
l You should periodically empty the deleted folder to make space for new images
l The database records the location of the image files. It is important that any image deletions are performed using the Optos software and not directly through Windows® Explorer. This will ensure the database record is updated.
l Deleted images can be undeleted if they are still on the system, see Undeleting Images.
How to discard an Image Everyone session
In sites where the Image Everyone1 workflow is used you can discard the images if a patient does not agree to the review.
- Right-click any image in the Image Everyone session to display the menu.
- Select Delete Image Everyone Session to delete all the images in the selected session.
1Some sites operate the “Image Everyone” workflow where every patient is imaged. Billing is associated with the image being reviewed, rather than the image being captured. This means the doctor reviewing the image gains patient acceptance for the review, rather than other staff offering the image capture. Please contact your Optos representative for more information.
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Chapter 6
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Chapter 7 – Using the viewing options
7 Using the viewing options
When you review images it can be useful to use some of the viewing tools to look at the images in different ways. Some viewing tools let you change the color of the image, or help you concentrate on a particular area and use special tools to quickly change the review options for that area.
Color Channels
Images are captured using laser light. Each laser color penetrates the retinal structures to different depths. Looking at the individual layers helps identify where pathology is located in the retina, see Image View Controls on page 83.
Review Tools
Comparison Overlay
The Comparison Overlay lets you compare two images. This feature is particularly useful when comparing images of the same patient over time. This view overlays the images. You can then adjust the transparency to blend the information shown in the image. This helps identity features that have moved or changed shape or size since the last image was taken.
You can alter the size, transparency and view of the Comparison Overlay.
False Color views
The False Color views display the grayscale Green Channel view and Red Channel view using an alternative color palette. The False Color views can make some subtle features more obvious.
Automated view
The Automated view moves around the image. The tool displays the image in the Green Channel view and Red Channel view before showing the image in the Composite Color view, see Using the Automated view on page 45.
optomap® fa Slideshow
Displays the selected sequence of fluorescein angiography images in a slideshow see Selecting images from the Image Series view on page 38. The user can pause, rewind or fast forward the slideshow using the same controls are the Automatic view.
3D Wrap
The 3D Wrap view is a patient education tool. It runs an animated view of the current image.
Stereo Imaging
Some systems are capable of capturing Stereo Images. These images are displayed side-by-side as two linked images.
When reviewing Stereo Images you need to select the viewing technique:
l use a stereo viewer (stereograph)
l focus in front of the images
l focus behind the images
The layout is dependant on the viewing technique you have selected in the User Preferences dialog box, see Setting User Preferences on page 15.
Magnifier
When the image is opened in the Review application the entire image is optimized. The Magnifier lets you review the locally optimized area being magnified. This local optimization can display subtle pathology without having to review the entire image using manually altered view controls, see Image View Controls on page 83.
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Simulated BIO view
The Simulated BIO View simulates the retinal view as it would be seen via a Binocular Indirect Ophthalmoscope.
The image is inverted and mirrored about the center of the image. This view allows you to target the relevant areas during a BIO examination.
Recommended reading protocol
The Review application includes many functions that can help you review images. This recommended protocol guides you through a typical protocol for reviewing individual images.
You should follow this suggested protocol if you do not have one for your practice. The protocol is generic and you should take any additional steps necessary to provide a comprehensive exam for each patient.
- If the patient will be present during the image review, open an image of each eye in the 3D Wrap view. You can use this when explaining details to the patient, see Using the 3D Wrap view on page 46.
Using the 3D Wrap view for diagnostic purposes is not recommended.
Caution
- Select the images and open them in an Image Stack window. In addition, open a previously reviewed image if one is available, for example an image from the previous year.
- Maximize the image window.
- Evaluate the image for peripheral extent:
l Zoom to at least 100%.
l Pan around the image periphery and check that there is good peripheral coverage. Increase the gamma if necessary.
- Review the image for clinical information:
l Switch to the Green Separation view.
l Pan around the image following the numbered sequence of the grading grid. Ensure all areas have been reviewed. Adjust the image adjustment settings if required.
l Mark any areas of interest with the relevant annotation, see Documenting your review on page 51.
l Switch to the Red Separation view and repeat for the deeper structures of the retina, from the pigment epithelium through the choroid.
- Review the full image and complete mark-ups:
l Select the Composite Color view and review the entire image. Check for any areas that may have been missed.
l Check any markups that have been made and complete any annotations.
- Compare the image with patient’s previous images, if available:
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l Move to areas of interest and check for any changes from the previous image.
l Check any mark-ups on the previous image.
- Assess both eyes:
l Open both left and right eye images in unlinked windows.
l Zoom to at least 100% and pan around all color views. Change the image adjustment settings if required.
- Carry out the BIO exam, if required:
l Select the recent image and display it in the Simulated BIO view. You can use this view as a guide to where areas of interest can be found, see Simulating a Binocular Indirect Ophthalmoscope (BIO) view on page 47.
l Carry out the BIO exam.
l Mark-up any additional areas of interest on the image with the relevant annotation.
Notes
l You should take any additional steps necessary to ensure a full review for each patient.
l You can zoom in or out at any stage of the protocol to ensure full review coverage at the required level of detail.
l You can use the Automated view to move around the image, showing each area in Green Separation,
Red Separation and Composite Color views, see Using the Automated view below.
l You can review a stack of optomap® fa images in the FA Slideshow, see Selecting images from the Image Series view on page 38.
l If the image seems pixilated while zoomed in you can apply the Smoothing tool to reduce the pixilation. Select Image menu > Smoothing to apply and remove the Smoothing tool. Some small features may be less distinct when Smoothing has been applied.
l When viewing hemorrhages, switch to the Green Channel view. Reduce the Gamma and increase the Contrast settings. This will enhance hemorrhages, vessels, and so on, however the optic disk will be saturated. Click Optimize to return the image to the optimized settings.
Using the Automated view
The Automated view moves around the image, showing each area in Green Separation, Red Separation and Composite Color views. This provides a framework for carrying out a general review of the image.
You can pause, go back, go to next and change the speed of the Automated view to ensure that you review the entire image.
- Select the image to be reviewed.
- Click Automated view to display the controls.
- Click the Play button to start the Automated view.
- Optional: Use the other buttons to control the Automated view. You can Pause, go Back or go to Next in the
Automated view.
Note
l The Play button changes to a Pause button when clicked.
l To stop the Automated view, click the Pause button. You can then start your next task.
Using the Magnifier
You can review the current image using the Magnifier to inspect parts of the image. The Magnifier lets you look at a locally optimized circular area of the image while maintaining the widefield context of the rest of the image.
The Magnifier may not be available on all systems. Please contact Optos for more information, see Contact us on page 93.
- Select the image to be reviewed.
- Select Image menu > Show Magnifier to display the magnified area.
- Optional: Right click to zoom in or out.
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- Optional: Right click to change to an alternative view. If you select either Green Channel view or Red Channel view you can then select one of the False Color Views to change the contrast of the magnified area, see Using False Color views on page 48.
- Move the Magnifier across the image. Change from Green Channel view to Red Channel view to review different retinal layers. Use the mouse scroll button to zoom in further if necessary.
- Select Image menu > Show Magnifier to close the Magnifier .
Note
Right click and select Local Optimize to switch off the False Color and revert back to the Green Channel view or Red Channel view.
Using the 3D Wrap view
The 3D Wrap view displays the current image on a 3D model eye. It uses the current image view settings and will display annotations.
You can export or email an individual 3D Wrap image or movie file,
Using the 3D Wrap view for diagnostic purposes is not recommended.
Caution
How to use the 3D Wrap View
- Open the image you want to review.
- Select Image menu > 3D Wrap to display the 3D Wrap view dialog box.
- Fly Through starts automatically. You can modify the speed of the Fly Through animated sequence by moving the Fly Through Speed slider. Drag the slider to the left to decrease the speed and to the right to increase the speed.
- You can choose which view to display; either Full Model, Transparent or Retina Only.
- You can demonstrate myopia1 and hypermetropia2 by modifying the shape of the model eye. Drag the Refractive Error slider to the left to simulate a myopic eye and to the right to simulate a hypermetropic eye. The default image shape shows emmetropia3.
- You can demonstrate the effect myopia, hypermetropia and astigmatism have on the patient’s vision by selecting the options in the Ray Types pane. Select Close Object, Distant Object and Astigmatic Ray to display the rays. You can move the Refractive Error slider to demonstrate the differences. Ray types are best displayed when the model eye is zoomed out and viewed from the side.
- When demonstrating the effects of myopia, hypermetropia and astigmatism, you may want to show the effect an IOL4 , Contact Lens or Spectacles would have. When an Eye Lens is selected the Refractive Error slider and Cataract options become unavailable.
- You can demonstrate a cataract. Select the Cataract option to display a cataract on the 3D Wrap view.
- You can display sample images in the 3D Wrap view by selecting the required image from the Sample Images selection.
Notes
l You can stop the Fly Through by clicking anywhere in the image.
l You can stop the Fly Through running automatically by changing the 3D Wrap Options, see Setting User Preferences on page 15.
1(Also known as nearsightedness) a focusing defect where the patient can see close objects more clearly than distant objects.
2(Also known as hyperopia or farsightedness) a focusing defect where the patient can to see distant objects more clearly than close objects.
3Refractive state of having no refractive error when accommodation is at rest.
4Intraocular lens
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l You can control the view point using the mouse or buttons in the 3D Wrap view. You can zoom in or out and move around the image using the mouse or control buttons.
l The performance of the 3D Wrap view will depend on the graphic capability of your PC. You can reduce the quality setting if the 3D Wrap view does not run smoothly or runs slowly, see Setting User Preferences on page 15.
l You can display other sample images from the Image Library in the 3D Wrap view, see Using the Image Library on page 67.
l The iris color is set automatically based on the patient’s Iris Category.
How to email or export the 3D Wrap graphics
You can distribute the 3D Wrap view as a single image or as a movie file.
- Open the image in the 3D Wrap view.
- Zoom in and rotate the 3D Wrap view image to show the required view.
- Select either File menu > Send To > E-Mail Recipient or File menu > Export Image to display the 3D Wrap Email/Export Options dialog box.
- Select the required image or movie option. If you are distributing a single image you can include your customized settings used in the Patient Takeaway. Select Include Customer Graphic and Logo to include the customized settings, see How to customize the Patient Takeaway print layout on page 65.
- Click OK.
- Complete the email content or export file location.
Note
The approximate image size is shown next to the selected file option.
How to print the 3D Wrap View
You can print the current 3D Wrap view as a Patient Takeaway using the customized Patient Takeaway layout, see How to customize the Patient Takeaway print layout on page 65.
- Open the image in the 3D Wrap view.
- Zoom to show the area you want to show, and spin the image to the angle you want to print.
- Click the Patient Takeaway button, see Review Tools Controls on page 82.
Using the Comparison Overlay
You can use the Comparison Overlay to compare two images of the same eye that were taken at different times, for example when comparing an image from last year with an image from this year.
- Select two images of the same eye. The eye has to be from the same patient and of the same laterality.
- Select Image menu > Show Comparison Overlay to overlay the images. If you have more than two suitable images open you will be asked to select one to be used with the currently selected image.
- Optional: Right click to change the size of the comparison area.
- Optional: Right click to change to an alternative view. If you select either Green Channel view or Red Channel view to change the view of both images.
- Move the Comparison Overlay across the image. Change from Green Channel view to Red Channel view to review different retinal layers.
- Select Image menu > Show Comparison Overlay to close the Comparison Overlay.
Simulating a Binocular Indirect Ophthalmoscope (BIO) view
You can review the current image in the Simulated BIO view. This view simulates the retinal view as it would be seen via a Binocular Indirect Ophthalmoscope.
The image is inverted and mirrored about the center of the image. This view allows you to target the relevant areas during a BIO examination.
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- Select the image you want to display using the Simulated BIO view.
- Select Image menu > Simulated BIO View to simulate the BIO view. “Simulated BIO View” will appear in the image window title.
- Repeat the previous step to return the image to the standard view.
Note
In previous versions of the software this view was called “Targeted Ophthalmoscopy View”.
Using False Color views
The False Color1 views are only available when the Green Channel view or Red Channel view have been selected.
The False Color views can make some subtle features more obvious.
- Select the image you want to display using the False Color views.
- Select either the Green Channel view or Red Channel view.
- Select Image menu > False Color > …and select either:
l Off – switches off False Color if in use.
l Fire – shows the current image in tones ranging from dark red, red, orange, yellow to white.
l Spectrum – shows the current image in tones ranging from purple, blue, green yellow to white.
- Optional: Right click to change the size of the magnified area.
Note
On systems where the Magnifier is available, you can display the full image in the Composite Color view and use the False Color views on the Magnifier area, see Using the Magnifier on page 45.
Viewing stereo images
Stereo Images are a pair of images of the same eye. Each image is taken with the patient aligned slightly off center; with one image captured when the patient is aligned slightly to the left and the other when aligned slightly to the right.
The viewing technique being used should be selected before the images are opened, see Setting User Preferences on page 15. This ensures the images are displayed on the correct side of the screen for the technique being used.
Stereo Images should not be used for diagnostic purposes.
Caution
- Open the Stereo Images, see How to open stereo images on page 37.
- If using a Stereo Overlay, you should manually register the images to ensure the optic disk and macula positions match, see Registering Image Reference Points.
- Using your preferred reviewing technique, review the images using a stereo viewer (stereograph) or focus either beyond or in front of the two images, until you see the images as one.
Note
l You will need to close and reopen the Stereo Images if you change the user setting options during the review.
l The Adjustment and Information panels are automatically hidden when Stereo Images are displayed. You can display them if required, see Using the Adjustment and Information panels on the facing page.
1Replaces grey scale with a range of colors. This may help accentuate the differences in the image intensity.
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Comparing with sample disease images
You can discuss pathologies with a patient by comparing the patient’s image and a sample disease image side by side.
- Open the patient’s image.
- Select Image menu > Compare Sample Image and select the sample image from the list. If the sample disease is not available select the Others option to select an image from a location on your network.
- The sample disease image will be linked with the patient’s image. You can review the images in the usual way.
Using the Adjustment and Information panels
You can hide the Adjustment panel and the Information panel to display a larger view of the image.
l Image Adjustment panel – displays the Contrast, Brightness, Gamma and Green Balance controls. Depending on the image type the panel may also show the eye steered direction, the optomap® fa frame time and the Automated view and optomap® fa Slider controls.
l Image Information – displays the Annotation, Review Notes and Comments panes.
To hide/show the Adjustment panel
Select Image menu > View Adjustment panel.
To hide/show the Information panel
Select Image menu > Information.
Note
l The information and adjustment panels can be hidden using shortcut keys, [F7] and [F8] respectively.
l For more information about the adjusting images and displaying information, see Review application user reference on page 81.
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Chapter 8 – Documenting your review
8 Documenting your review
When you review images it can be useful to add notes, drawings, measurements, and codes. These mark-ups are saved with the image. They can be compared with other images or distributed.
Image mark-up tools can be found on the application toolbar, see Review application user reference on page 81.
Annotations
Annotations, Measurements and Image Registration are graphical mark-ups on the image. They are available from the Annotations menu > … They include:
l Annotations and Retinal Drawings – shapes drawn directly on to the image to highlight an area. You might use annotations to circle an abnormality and add a label to suggest what the problem might be.
l Measurements – measures distances and areas and marks the result on the image. Measurements are displayed in pixels.
The scaling of the image cannot be precisely determined because of patient positioning, patient refractive error and off-axis distortions in the periphery. For these reasons you should not attempt to take absolute measurements from the
Warning image.
Review notes
Review Notes are text mark-ups that are saved with the image file. You can add Review Notes by right-clicking the image or by selecting Image menu > Review Notes. Review Notes include:
l Image Status – indicates if the image has yet to be reviewed, has been reviewed with no comments or has been reviewed with comments. This flag is displayed on the Patient History view.
l Comment – a text box where you can enter additional information.
Diagnostic (pathology) codes and procedure codes
Diagnostic (pathology) codes and procedure codes can be added. The optomap® plus procedure code features can be made available by Optos. They can be used when the image was captured using one of the optomap® plus Capture procedures. Contact Optos for more information on using optomap® plus procedures, see Contact us on page 93.
l Diagnostic codes – used to record suspected (or confirmed) pathology.
l Procedure codes – used to record the codes used in reimbursement cases. These procedures are only available when the image was captured using optomap® plus or optomap® fa capture procedures.
Note
Procedures are charged at their own rates.
Image registration
The Review application can automatically register features in images. These registered points are used to align images that are viewed together.
Note
l You can also register image reference points manually.
l Image Registration points are not displayed on the image.
l You can change the position of registered points by manually setting new ones.
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About annotations, retinal drawings and measurements
Annotations are graphical mark-ups drawn onto the image. Standard annotations are available for all image types.
Retinal drawings and measurements are special annotations. Retinal drawings are used to indicate specific information, for example arteries, detached retinas and exudates. Measurements calculate distance and area parameters on the image. The calculated results are added to the image as annotations. Some special annotations are restricted depending on the type of image being reviewed.
You can use annotations to highlight areas of special interest on an image. The annotations are saved with the image and can be sent to another person to be reviewed. Several reviewers can add annotations to an image. You can view all of the annotations, or decide which annotations you want to view and hide the others.
Annotations are saved when the image is closed.
Note
l Annotations and retinal drawings cannot be edited or deleted after the image has been closed.
l Retinal drawings are not available on standard optomap® images.
l If you export or email the image using the Medical Image Format (*.dcm, DICOM file) the mark-ups can be viewed by other medical image applications. Using DICOM format allows for the areas under the mark-ups to be reviewed.
l If you export or email the image using any format other that the Medical Image Format (*.dcm, DICOM file) the mark-ups will ‘burned-in’ the image and the area below the mark-up lines will be obscured.
Using annotations
You can add, edit and remove annotations from the displayed image. You can also control which annotations are displayed.
How to add an annotation
You can add annotations to open images.
- Open the image you want to review and then select Annotation menu > …
- Select the annotation type and draw the annotation, see Annotations, retinal drawings and measurements on page 89.
How to edit an annotation
You can edit annotations that have been added during the current session. Annotations cannot be changed after the session has been closed.
- Select Annotation menu > Edit Annotations to activate the annotator editing mode. ‘Annotation Editing Active’ is displayed in the window status bar to indicate the mode.
- Click the annotation you want to edit.
- Right-click the annotation border to display the pop-up menu. Select the required option from the pop-up menu and make the changes.
Note:
l The cursor will change to a cross-hair shape when in the correct position to display the pop-up menu.
l You can edit the shape of the annotation by dragging individual nodes.
l You can undo changes by selecting Undo in the pop-up menu.
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How to delete an annotation
You can delete annotations that have been added during the current session. You can either select and delete individual annotations or delete them all. Annotations cannot be changed after the image session has been closed.
Action
Delete all
annotations
Delete the most recent annotation
Delete a particular
annotation
Description
Select Annotation menu > Clear This Session to delete all annotations added during the current session.
Select Annotation menu > Undo to delete the most recent annotation.
Select Annotation menu > Edit Annotations to activate the Annotation Editing mode. Right-click the annotation you want to delete and select Delete from the pop-up menu.
How to show/hide annotations
You can control which annotations are displayed.
Action
Show all
annotations
Hide all
annotations
Show annotations
from selected
sessions
Description
Select Annotation menu > Show All Annotations to display all annotations.
Select Annotation menu > Hide All Annotations to hide all annotations.
In the Annotation pane at the bottom of the image window, click the check boxes for each session you want to display.
How to print annotations
You can print saved annotations. Check that the annotations you want to print are currently displayed on the image. Right click the image and select Add to Print Bar to add the annotated image to the images being printed.
When configuring the print settings, check the Selected Annotations option has been selected.
Note
Annotations are saved when the image is closed.
Using retinal drawings
Retinal drawings are not available when the image was captured using a standard optomap® capture procedure. They are only available when the image was captured using an optomap® plus or optomap® fa capture procedure. The relevant tools are made available when the image is opened.
Retinal drawings cannot be edited or deleted after the image has been closed.
Note
l Retinal drawings can be edited, deleted and printed in the same way as annotations, see Using annotations on previous page.
l When the Retinal Drawing dialog box is displayed the mouse can only be used to draw annotations on the image. Close the Retinal Drawing dialog box to return the mouse to the normal operation mode.
l Retinal drawings are not available on standard optomap® images.
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How to add a retinal drawing
You can add retinal drawings to open images.
- Open the image you want to annotate and then select Annotation menu > Retinal Drawing.
- Select the retinal drawing type and draw the retinal drawing in the same way as annotations, see Annotations, retinal drawings and measurements on page 89.
How to mark pathology annotations
Pathology annotations, such as micro aneurysms and exudates, can be marked using the retinal drawing tools.
- Open the image you want to annotate and then select Annotation menu > Retinal Drawing.
- Select the marker from the Retinal Drawing dialog box and click each artifact.
How to count and compare pathology annotations
You can compare pathology annotations marked on two open images for the same patient, for example to compare a recent image with one from a previous session. Select the second image from the drop-down list in the Annotation Counts dialog box to display the pathology annotation count in the lower grid.
- Open the images you want to compare. If you want to count the pathology annotations for a single image just open one image.
- Select Annotation menu > Measure > Count Annotations to display the Retinal Drawing dialog box. The artifact counts for the selected image will be displayed.
- If comparing pathology annotations, select the second image to be counted and then select the annotations layers to be included in the count. Images need to be registered correctly when counting annotations, see Registering image reference points.
- Optional: You can also print the pathology annotation count information by clicking the Print button.
Note
A pathology annotation will be counted twice if annotated in two annotation layers.
Using measurements
You can add, remove and edit measurements on the displayed image. The measurement information is stored in an annotation.
Some measurements are not available when the image was captured using a standard optomap® capture procedure. ISNT Rule Measurements are only available when the image was captured using an optomap® plus or optomap® fa capture procedure. The relevant tools are made available when the image is opened.
Measurements cannot be edited or deleted after the image has been closed.
Note:
Measurements can be deleted and edited in the same way as standard annotations, see Using annotations on page 52.
How to measure an area
- Open the image you want to review.
- Select Annotation menu > Measure > Area Definition and select the method you want to use to mark the area. l Freehand – use the mouse cursor as a pen to draw around the area.
l Polygon – use the mouse cursor to draw a shape, using straight lines, around the area. l Ellipse – use the mouse cursor to draw an ellipse around the area.
- Select Annotation menu > Measure > Measure Area and mark the area as follows:
l Freehand – hold down the left mouse button and draw around the area to be measured. Release the mouse button when you have finished drawing the area.
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l Polygon – click each point around the area to be measured. Lines will be drawn between the points clicked. Double-click to complete the polygon.
l Ellipse – hold down the left mouse button and stretch the circle around the area to be measured. Release the mouse button when you have finished drawing the area.
- Enter the name of the annotation in the Annotation Label dialog box and click OK.
How to measure distance
- Open the image you want to review.
- Select Annotation menu > Measure > Measure Distance. Click the start and end points to draw a line between the points that you want to measure.
- Enter the name of the annotation in the Annotation Label dialog box and click OK.
How to measure the Cup to Disk Ratio
- Open the image you want to review.
- Zoom in to display a close up view of the optic disk.
- Select Annotation menu > Measure > Cup To Disk Ratio and click at least five points on the border of the optic cup. Double click to complete the outline.
- Click at least five points on the border of the optic disk. Double click to complete the outline.
- The software will draw an ellipse around each set of points.
- If required, use the annotation edit feature to adjust the circles into the correct position, see How to edit an annotation on page 52.
Note
l The status bar will indicate which area is to be identified.
l The points are initially shown as a polygon to indicate where the points have been selected on the cup and disk.
l The ratio is calculated using the number of pixels in the area of each ellipse. This produces a different ratio than that calculated using diameter distances of both ellipses.
How to measure the ISNT Rule
The ISNT (Inferior, Superior, Nasal and Temporal) Rule measurement is not available when reviewing standard optomap® images.
- Open the image you want to review, see Opening images on page 36.
- Zoom in to display a close up view of the optic disk.
- Select Annotation menu > Measure > Measure ISNT Rule.
- Draw a line across the inferior neuro-retinal rim.
- Repeat the previous step for superior, nasal and temporal neuro-retinal rims.
- The ISNT Rule will be displayed when the four lines have been drawn. The annotation color will indicate if the result is within expected parameters; pink when results should be queried and pale green when results are within expected parameters.
Note
Cup to Disk Ratio details are also displayed.
About review notes, diagnostic (pathology) codes and procedure codes
Review notes store text information about the image. They also store diagnostic or procedure codes assigned to the image. These notes and codes can be saved and sent to be reviewed by another person. Several reviewers can add review notes to a single image.
l Review notes – record the text information for an image.
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l Diagnostic codes – record the suspected (or confirmed) pathology with the image. You can assign an ICD-9 code to the image.
l Procedure codes – record the codes used in reimbursement cases.
Review notes are listed in the Review Note pane of the image window. Click the review note to display its contents in the right hand pane. Review notes cannot be edited or deleted after the image has been closed.
Diagnostic codes (sometimes called pathology codes) let you assign pathology information to the image.
Procedure codes are assigned to images that are used when the costs of medical procedures can be reclaimed. Procedure codes can only be assigned when the required tasks have been completed.
Note
l Review notes, diagnostic codes and procedure codes cannot be edited or deleted after the image has been closed.
l optomap® plus Review procedures are only available when the image was captured using an optomap® plus or optomap® fa Capture procedure.
l You can set User Preferences that will prompt for a Review Note if an image is opened but no details are added. This is useful if you want to ensure the Image Status field is completed, see Setting User Preferences on page 15.
Using procedure codes
Procedure codes are used in some countries where the costs for medical procedures can be reclaimed, for example in the United States of America. The procedure codes can be assigned to images that have been captured using optomap® plus or optomap® fa capture procedures. Typically, procedures require particular tasks to be performed; adding retinal drawings, diagnostic codes and review notes. The Review application includes guidance notes for each supported procedure code. The doctor can then assign the appropriate code when the required tasks have been completed.
The treating physician is responsible for the appropriate usage, adequate documentation and proper coding of reimbursement claims.
Caution
optomap® plus Review procedures define the steps that must be carried out to comply with requirements for specific procedures. In some countries these steps are clearly defined and the procedures have been given codes.
You can assign a procedure code to an image. When a procedure code has been assigned the image is tagged with a purple marker in the Patient History view, see Review application user reference on page 81.
Note
l optomap® plus Review procedures are not available when the image was captured using a standard optomap® Capture procedure. Some features, such as Retinal Drawings and ISNT Rule Measurements are only available when the image was captured using an optomap® plus or optomap® fa Capture procedure. The relevant tools are made available when the image is opened.
l optomap® plus and optomap® fa procedures are charged at a higher rates than standard optomap® examinations.
l Procedure codes are not available when the image was captured using a standard optomap® capture procedure. Procedure codes are only available when the image was captured using an optomap® plus or optomap® fa capture procedure. The relevant tools are made available when the image is opened.
l Procedure codes cannot be edited or deleted after the image has been closed.
l These procedures may not be available on your system. Please contact Optos if you would like more information, see Contact us on page 93.
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How to add procedure codes
- Open the image you want to review and select Image menu > Procedure Coding to display the Set Procedure Coding dialog box.
- A green tick indicates the required tasks have been completed. When all the required tasks have been completed, a procedure can be assigned to the image. Click the procedure code to select it. Click OK.
How to change or remove a procedure code
You can change or delete procedure codes that have been added during the current session. Procedure codes cannot be changed after the image session has been closed.
- Open the Set Procedure Coding dialog box.
- Make the required changes:
| Action | Description | |
| To change the procedure | Select the other procedure code. | |
| code | ||
| To remove the procedure | Select <No Procedure Code>. | |
| code | ||
- Click OK.
How to identify images where procedure codes have been applied
- Open the Patient History view for the patient, see About the Patient History view on page 35.
- Check the Session List for purple markers. The relevant code will be displayed next to the purple marker.
About Procedure Guidance
Optos does not provide, and the optomap® plus guidelines do not constitute advice on making reimbursement claims. Diagnostic tests should be ordered by the treating physician and this physician is responsible for appropriate usage, adequate documentation and proper coding. It is the responsibility of the physician to comply with Medicare regulations, and check with the local insurance carrier for reimbursement information and instructions. Optos does not accept any liability for reimbursement claims made while using optomap® plus.
Using review notes
You can add, edit and remove review notes from the displayed image. Review notes are displayed in the Review Note pane. The selected review note is displayed to the right of the pane.
Review notes cannot be edited or deleted after the image has been closed.
How to add a review note
You can add review notes to open images.
- Open the image you want to review and then select Image menu > Review Notes to display the Review Notes dialog box.
- Type the information in the Comment box and click OK.
Note:
l You can mark the image as reviewed with no comment by selecting the Mark as Reviewed with No Comment box on the Review Notes dialog box.
l You may add a diagnostic code at the same time, see Using diagnostic codes on next page.
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l Depending on the type of image captured and the available review procedures you may also be able to add reimbursable procedure codes at the same time, see About review notes, diagnostic (pathology) codes and procedure codes on page 55.
l You can set User Preferences that will prompt for a Review Note if an image is opened but no details are added. This is useful if you want to ensure the Image Status is marked, see Setting User Preferences on page 15.
l The status flag is inserted automatically in the Session List of the Patient History window, see About the Patient History view on page 35.
How to delete a review note
You can delete review notes that have been added during the current session. Review notes cannot be changed after the image session has been closed.
- Open the Review Notes dialog box.
- Delete the review note text and select the Mark As Reviewed with No Comment option. Click OK.
How to view review notes without opening the image
- Select the patient in the Patient History view.
- Check the review status of the image, see About Review Notes on page 90.
- Right-click the image to display the pop-up menu. Select View Notes to display the View Image Notes dialog box.
Using diagnostic codes
You can assign diagnostic (pathology) codes to an image. The diagnostic code information is stored in a review note.
Diagnostic codes cannot be edited or deleted after the image has been closed.
How to add diagnostic codes
You can add diagnostic codes to open images.
- Open the image you want to review and then select Image menu > Diagnostic Coding to display the Add Diagnostic Codes dialog box.
- Select the diagnostic code from the list on the left:
Symbol Description
Indicates a diagnostic code directory heading.
Click to display the sub-directories and individual diagnostic codes.
Indicates a selectable code.
- Click OK to add the diagnostic code to the image.
- Repeat for each diagnostic code you want to select.
Note
Your 10 most commonly used diagnostic codes are listed under the Frequently Used Codes heading in the Diagnostic Code dialog box.
How to search for a diagnostic code
You can search for specific diagnostic codes in the Add Diagnostic Codes dialog box.
- Enter the terms to be included in the Including Terms box. Select All to return codes that contain all the terms or One or more to return diagnoses that include any of the terms.
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- Repeat for terms you want to exclude by entering them in the Excluding Terms box. Select All to exclude diagnoses that contain all of the terms or One or more to exclude diagnoses that contain any of the terms.
- Click Search to display the results in the lower box.
- Select the diagnostic code and click OK.
How to delete a diagnostic code
You can delete diagnostic codes that have been added during the current session. Diagnostic codes cannot be changed after the image session has been closed.
- Select Image menu > Review Notes to display the Review Notes dialog box.
- Select the diagnostic code to be removed and click OK.
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9 Distributing images
There are several ways to distribute images. You can export, email or use the print functions. You can also import images into a patient record.
3D Wrap images can be emailed or exported as a single image or movie file, see How to email or export the
Emailing images
If you have an email application configured on your computer you can email an image from the Review application.
There are several steps involved in distributing images. The user interface will guide you through the options in each step. To select all the default settings and jump to the end of the procedure click Finish.
Note
l Distributing an image distributes a copy of the image. The original image file is not removed from the system.
l Annotations and Review Notes in distributed images can be viewed when using the Review application or Optos’ optomap® image viewing application. See www.optos.com for download information.
l When emailing from an optomap® fa image series, all the selected images are emailed at once. Check that all the images you want to email are open when you select the Send to E-Mail Recipient option.
l You can choose from all the patient’s images if you start the process from the Patient History view. Starting from an open image will restrict the image selection to the images that are currently open.
Please remember to comply with your practice procedures on personal data protection when storing and distributing patient images.
- Open the image you want to distribute. If you want to email more than one image, open all images before continuing. Do not open images in a stacked window if you want to email them.
- Set the various options to display the data you want to distribute:
l Select the annotations you want to include, see Using annotations on page 52.
l Zoom in or out and pan to display the area you want to distribute, see Image View Controls on page 83.
- Select File menu > Send To > Email Recipient to display the Export Image to Email dialog box.
- Select the file format to be used. If you want to select the default options click Finish to jump to step 9.
l Generic image formats can be viewed using most graphic applications. Annotations are saved as part of the image and may obscure some detail. Select JPEG to create a compressed file that can be transmitted quickly. Review notes are saved in a comment field. Some other applications may not support the display of the comment field.
l JPEG 2000 images will be of better quality. However, some recipients may not be able to accept this format and will be unable to open the image files.
l Medical Image Format (DICOM format) – Can be viewed only by Optos v2 and other medical imaging applications. Annotations and Review Notes are saved but do not obscure image details.
- If you selected to create a compressed file (JPEG, JPEG 2000 or DICOM) you will be asked to select the Compression Quality. Click Next.
- Select the level of patient data and the data items to be included. Click Next .
- Select image area and settings to be distributed and click Next.
l Select the image area. You can select either whole image or the area currently being displayed.
l Select whether to use the original capture settings or the current adjusted settings. The adjusted settings may increase the perceived quality of the image, but may also cause loss of detail.
l If you are distributing color images, you can select which image plane to distribute.
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- If you started from the Patient History view or have more than one image open, an additional option will be shown. You can select from a list of all the patient’s images. Select the images you want to distribute.
- Complete the email settings.
l Enter subject.
l Select whether to include Review Notes and Diagnoses.
l Select whether to send a ‘Do not reply… ‘ tag line within the text if you do not want emails sent to the account you are sending from. If you select this option you must remember to provide a reply email address with your email.
l Click Next .
- Check the image in the Image Preview window. Click OK. If you are not satisfied with the image, click Cancel to repeat the process.
- Complete the email address and text. Ensure you include a reply email address if you have selected the ‘Do not reply…’ tag line.
- Send the email and check the email has left the outbox. Depending on your system configuration the email may not be sent immediately. Click Send/Receive to ensure the email has been sent.
- Click Finish.
Note
l Increasing the compression may reduce the quality of the image.
l You can click Back to move back through the steps and make different selections.
l You can distribute images from an optomap® fa Image Series view.
l You can distribute images from the 3D Wrap view, see How to email or export the 3D Wrap graphics on page 47.
l Emailing images will work with the configuration of your email client (Microsoft Outlook or Microsoft Outlook Express for example.
l The Image Preview window lets you check the quality of the image before you complete the export or email process. The selections made in the wizard will change the content of the image, the display area, the compression level and the use of ‘burned in’ annotations. Use the Gamma and other controls to check that the image quality has not been compromised by any compression that may have been selected.
l The Image Preview window shows the file size, which is an important consideration if the image is to be sent across the Internet. You can choose whether the preview window is displayed, see Setting User Preferences on page 15.
Exporting images
There are several steps involved in distributing images. The user interface will guide you through the options in each step. To select all the default settings and jump to the end of the procedure click Finish.
Note
l Distributing an image distributes a copy of the image. The original image file is not removed from the system.
l Annotations and Review Notes in distributed images can be viewed when using the Review application or Optos’ optomap® image viewing application. See www.optos.com for download information.
l When exporting optomap® and optomap® plus images, only one image can be exported at a time.
l When exporting from an optomap® fa image series, all the selected images are exported at once. Check that all the images you want to export are open when you select the Export option.
l You can choose from all the patient’s images if you start the process from the Patient History view. Starting from an open image will restrict the image selection to the images that are currently open.
Please remember to comply with your practice procedures on personal data protection when storing and distributing patient images.
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- Open the image you want to distribute.
- Set the various options to display the data you want to distribute:
l Select the annotations you want to include, see Using annotations on page 52.
l Zoom in or out and pan to display the area you want to distribute, see Image View Controls on page 83.
- Select File menu > Export Image to display the Export Image To File dialog box.
- Select the file format to be used. If you want to select the default options click Finish to jump to step 9.
l Generic image formats can be viewed using most graphic applications. Annotations are saved as part of the image and may obscure some detail. Select JPEG to create a compressed file that can be transmitted quickly. Review notes are saved in a comment field. Some other applications may not support the display of the comment field.
l JPEG 2000 images will be of better quality. However, some recipients may not be able to accept this format and will be unable to open the image files.
l Medical Image Format (DICOM format) – Can be viewed only by Optos v2 and other medical imaging applications. Annotations and Review Notes are saved but do not obscure image details.
- If you selected to create a compressed file (JPEG, JPEG 2000 or DICOM) you will be asked to select the Compression Quality. Click Next.
- Select the level of patient data and the data items to be included. Click Next .
- Select image area and settings to be distributed and click Next .
l Select the image area. You can select either whole image or the area currently being displayed.
l Select whether to use the original capture settings or the current adjusted settings. The adjusted settings may increase the perceived quality of the image, but may also cause loss of detail.
l If you are distributing color images, you can select which image plane to distribute.
- If you started from the Patient History view or have more than one image open, an additional option will be shown. You can select from a list of all the patient’s images. Select the images you want to distribute.
- Enter the filename and location where the file is to be saved. Click Save to continue.
- Check the image in the Image Preview window. Click OK. If you are not satisfied with the image, click Cancel to repeat the process.
- Click Finish.
Note
l Increasing the compression may reduce the quality of the image.
l You can click Back to move back through the steps and make different selections.
l You can distribute images from an optomap® fa Image Series view.
l You can distribute images from the 3D Wrap view, see How to email or export the 3D Wrap graphics on page 47.
l Depending on the version of Microsoft® Windows® your system is running you may need to format a recordable disk before you save files to it. Your Microsoft® Windows® help files will contain the appropriate instructions for your PC.
l The Image Preview window lets you check the quality of the image before you complete the export or email process. The selections made in the wizard will change the content of the image, the display area, the compression level and the use of ‘burned in’ annotations. Use the Gamma and other controls to check that the image quality has not been compromised by any compression that may have been selected.
l The Image Preview window shows the file size, which is an important consideration if the image is to be sent across the Internet. You can choose whether the preview window is displayed, see Setting User Preferences on page 15.
Importing an image to a patient’s record
You can import an image to a patient’s record. This feature can be useful, for example, when you are reviewing an image that has been emailed to you or you need to import an image that has been reviewed on a laptop.
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- Select Review Menu > Patient History to display the Select Patient dialog box and select the patient record you want to import the image into.
- Select Tools menu > Import Image > Left Eye (Right Eye or Set) to display the Select Image to Import dialog box. Selecting Set lets you import images from an optomap® fa sequence.
- Select the file (or files) you want to import and click Open.
- Confirm that the image is to be assigned to the current patient.
Note
l You can also drag and drop images from Windows Explorer directly into the Patient History view. Drop the image on to the correct side of the window, either Right or Left Eye Thumbnail Images pane.
l optomap® fa cannot be imported as a series from Windows Explorer. To maintain image series links, you must import the images using the Set option.
Printing images
The Review application includes a variety of printing functions. The functions let you select and adjust images and define the layout of the page.
The use of a print as an assist to diagnosis is determined by the clinician.
Caution
You can print the current image by clicking the print button. This will send a Quick Print directly to the default printer.
You can print single or multiple images by placing each image or image sequence on the Print Bar. The Print Bar is located at the bottom of the Review application window.
You can print the current image for the patient to takeaway. You can customize the layout, for example to display your logo.
How to print the current image as displayed
- Open and zoom into the area you want to print.
- Select the annotations you want to print, see How to show/hide annotations on page 53.
- Select File menu > Print Active Image to display the image in the Print Images dialog box.
- The Print Images tabs contain a variety of settings:
l Image Layout tab – lets you select the layout style. You can select the additional information you want to include.
l Image Adjustment tab – lets you adjust the Contrast, Brightness and Gamma settings for the selected image. The histogram shows the distribution of the pixels in the image as the settings are adjusted.
l Click Optimize to automatically set the print settings to produce a clear, bright image. l Click Restore to restore the default settings.
l Click Equalization to brighten the superior field to match the brightness of the central pole.
Note
The quality of the prints can vary between printers. You can usually achieve the best print quality by using good quality ink, for example using the printer manufacturer’s own ink. The type of paper used has a significant effect on the way the ink is applied. Using paper that does not match the paper type selected can often result in a very poor quality print. You should always use the paper that matches the selected paper type, for example, photo or glossy paper.
How to print a set of images
You can print, adjust and change the layout of the images that have been dragged on to the Print Bar.
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The print preview displays a preview of the current layout selections. Click an image in the print preview to select the image. The selected image will be displayed in the Selected Image pane.
You can use the mouse to drag the image to display the required area. You can use the mouse scroll button to zoom in and out of the image. Alternatively, you can set the Zoom and scroll bars to make these changes. Click Apply this View to Similar to set the same position and zoom setting for all similar images.
The Print Images tabs contain a variety of settings:
l Image Adjustment tab – lets you adjust the Contrast, Brightness and Gamma settings for the selected image. The histogram shows the distribution of the pixels in the image as the settings are adjusted.
l Click Optimize to automatically set the print settings to produce a clear, bright image. l Click Restore to restore the default settings.
l Click Equalization to brighten the superior field to match the brightness of the central pole.
l Click Apply to Similar to apply the adjusted settings to similar types of images, for example if the selected image is an optomap® ResMax™ image, then the adjustment will be applied to all optomap® ResMax™ images on the Print Bar. This will overwrite any previously set image optimization or image adjustments.
l Image Layout tab – lets you select the layout style. You can select the additional information you want to include. Some options are not available when printing more than one image to a page.
l Discard Image tab – lets you remove images from the page (not from the database).
l Click the tab and drag and drop each image to be discarded.
l Right-click a discarded image to display the menu to return the image to the print layout.
The Print Control pane displays the print control buttons.
l Print Setup button – displays the Print Setup dialog box. From here you can select the paper type. Depending on your printer, other settings may be available.
l Print button – displays the Print dialog box. You can set the number of copies and other printer settings from this dialog box.
How to print the Patient Takeaway
You can quickly print the Patient Takeaway by clicking the Patient Takeaway button, see Review Tools Controls on page 82.
How to customize the Patient Takeaway print layout
You can customize the layout of the Patient Takeaway. You can change the text and images in these areas.
- Select the image you want to print, see About the Patient History view on page 35.
- Select File menu > Patient Takeaway to display the Patient Takeaway Print Layout dialog box.
- Select the Print Header option to be used. You can either:
l Select Use default print header to use the Site Identifier information in the Admin application.
l Select Define print header text and type the header you want to use.
l Select Define print header image and select the image you want to use. Click Load to display the Load Image Header for Printing dialog box where you can select the image you want to use.
- Select the Print Footer option to be used. You can either:
l Select Use default print footer to use the default footer.
l Select Define print footer text and type the footer you want to use.
l Select Define print footer image and select the image you want to use. Click Load to display the Load Image Footer for Printing dialog box where you can select the image you want to use.
- You can choose to print two images by default. This will print the currently selected image and another from the images that are open. When you print two images the Select the second image to print dialog box will be displayed. Select the second image from the list and click OK to print both images.
- Click Print to select the printer and change the printer settings.
- Click Print Preview to check the changes.
- Click Save Settings to save the current settings. Future Patient Takeaway prints will use these settings.
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Chapter 9 – Distributing images
Note
l The header graphic will be placed along the top of the page. The aspect ratio of your graphic will be maintained. Your graphic will be scaled to fit the allocated space at the top of the page. The footer graphic will be scaled in the same way, but displayed at the bottom of the page.
l You can print the 3D Wrap view, see How to print the 3D Wrap View on page 47. The 3D Wrap view will use the Patient Takeaway settings.
Changing eye images from Right to Left (and Left to Right)
You can change a patient’s images from right eye to left eye, or left eye to right eye. This is useful if the wrong capture eye option was selected when the image was captured.
You can change the eye in the Patient History view, see About the Patient History view on page 35.
How to swap right and left eyes
For optomap® and optomap® plus images:
l To move an image from right eye to left, select the image in the list of Right Eye Thumbnail Images and drag it to the list of Left Eye Thumbnail Images.
l To move an image from left eye to right, select the image in the list of Left Eye Thumbnail Images and drag it to the list of Right Eye Thumbnail Images.
For optomap® fa images:
l Open the image series, see Opening images on page 36.
l Right click the image you want to change and select Change to Left (or Change to Right).
Assigning an image to another patient’s record
- Open the Patient History view for both patients, see Select Images from the Patient’s Image History.
- Drag the window title bar to position the Patient History view so that areas of both patients’ thumbnail image panes can be seen.
- Select the thumbnail of the image you want to move and drag it to the other Patient History view. Make sure you drop the thumbnail on the correct pane for right or left eye.
Note
The window title bar is the top of the window. The title “Patient History” is displayed.
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Chapter 10 – Using the Image Library
10 Using the Image Library
The Image Library contains images from patients who have had optomap® examinations. The images provide examples of pathology captured by the system and may be used for training purposes or patient education.
The Image Library should only be used for guidance and not as a comparison tool for diagnosing pathology.
You can also create your own Custom Image Library from images you have captured.
How to browse the Image Library
- Select Review menu > Image Library to display the Image Library.
- Select the File Type. If you do not know the file type leave the option set to All File Types.
- Double-click the image you want to open.
Note
l The location of the Image Library is defined in the Admin application. You should not need to change this setting in normal operation of the system.
l You also have a Custom Image Library where you can store copies of patient images.
How to compare images with the Image Library
- Open the patient image, see Opening images on page 36.
- Open the library image, see How to browse the Image Library above.
- Link the images by selecting Window menu > Link/Unlink All Windows.
How to add an image to your Custom Image Library
You can add an image to your own Image Library . You can then use this Custom Image Library to store copies of patient images.
You must ensure that the patient’s details are protected when copying images to the Custom Image Library, for this reason the patient details are removed from the copied image. You should also always rename the image filename.
- Open the image you want to add to your Custom Image Library.
- Select Image menu > Add to Custom Image Library to display the Add to Custom Image Library dialog box.
- The default path will be shown.
- Type the new filename. Ensure that the patient identification is protected.
- Select the file type to be used.
- Optional: Deselect the option to Include Notes and Annotations if required. Click OK.
Note
The location of the Custom Image Library is defined in the Admin application. You should not need to change this setting in normal operation of the system.
How to browse the Custom Image Library
- Select Review menu > Custom Image Library to display the Image Library.
- Select the File Type. If you do not know the file type leave the option set to All File Types.
- Double-click the image you want to open.
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Chapter 10
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Chapter 11 – About archiving
11 About archiving
There are two reasons for archiving; to maintain sufficient file space to take new images and to provide a backup in case the PC fails and the images need to be restored.
Each time you capture an image two copies are saved. The primary image (uncompressed) is stored in a higher resolution format than the secondary file (compressed). Due to the higher resolution, the primary file takes up a large amount of disk space.
The primary files are used for reviewing. The secondary files are used in thumbnails and when primary images have been archived.
Your Optos representative will configure the Task Settings when the device is installed. These settings should not be changed in the course of normal operation.
Caution Please consult your Optos Representative before changing the Task Settings.
Your Optos representative will configure the Storage application to best suit the activity in your practice. These configuration settings will define where archived files will be saved and when archived files will be deleted from the system. Deleting archived files is necessary to clean out the space needed for new images. The time set to retain images on the PC hard drive will depend upon your volume of imaging and available capacity. The default settings of two weeks for primary (uncompressed) images and seven years for secondary (compressed) images should be suitable for most cases.
When to Archive
When archiving to disk (CD or DVD) it is important to balance the risks involved in not backing up data with the convenience of the practice. The recommended approach is to run an archive task when there is sufficient data to fill a recordable disk media item. Since the Storage application should be run daily several archiving approaches are available: CD for lower volume sites, DVD for average volume sites and network for larger volume sites, see Archiving to disk on page 71.
It may occasionally be necessary to write two recordable disk media items rather than one. If the task is not run daily, then it may be necessary to write multiple media items more often, and the hard disk is more likely to become full.
When archiving to a NAS device1 or network location ( see Archiving to a network on page 74.) you can schedule the storage tasks to be run overnight, see Scheduling storage tasks on page 74. When archiving to a network it is important to ensure that the network archive is backed up regularly.
Note
l The Storage application should only be run from the computer that contains the image files and database. Attempting to run the application where either the source or destination drives are on different computers may result in frequent failures when archiving files.
l The disk writer drive should be selected as the Archive Drive for both archive tasks or a network location selected if the files will be archived on the network.
Changing the Archive Task Settings
Once files have been archived they can be removed from the hard disk to create space for new images. Primary images are large and can quickly fill your hard disk. To create space for new images, while keeping the image available, the system creates an additional lower resolution secondary image. When you clean up the hard disk archived images within a defined time frame are removed. Typically, archived primary images are removed after two weeks and archived secondary images are removed after seven years.
You should always retrieve the archived primary image for diagnostic purposes.
1A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network.
It has its own network address.
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Chapter 11 – About archiving
These settings identify the files affected by archiving and cleanup tasks. They specify the locations to be used when archiving files, the age which archived files should be cleaned out and the parameters to be used when archiving.
Optos will configure the Task Settings when the device is installed. These settings should not be changed in the course of normal operation.
Caution Please consult your Optos Representative before changing the Task Settings.
How to access archive task settings
Select Settings menu > Task Settings to display the Task Settings dialog box.
How to set where files are archived
Set the Manage Primary Image Files and Manage Secondary Image Files options.
- Select the disk writer or network location that should be used to store the archived data. Select the location for both primary and secondary images.
| Action | Description |
| To archive to a disk | Select Use CD Writer and select the location of the disk drive to |
| (CD or DVD) | be used. |
| Select User Folder Location and select the network location to be | |
| To archive to a | used. |
| Alternatively, click Browse to select the network folder to be used to | |
| network location | archive the data. |
| You should ensure this network location is backed up | |
| regularly. |
- If you selected to archive to User Folder Location you must set the maximum number of files to be archived during a single task. This is to ensure that archiving is prompted regularly.
Note
If a DVD writer is selected the relevant DVD options will be displayed.
How to set when archived files are cleaned up
You can set the age limit when archived files are removed from the hard disk. Select the Storage Clean-up Settings (Cleanup Task) options to be used when archiving files from the hard disk.
- Select the options to cleanup both primary and secondary image files.
- Set the age limit to be checked. All archived files within the age limit will be deleted. A tick indicates the specified archived files will be deleted.
How to set the disk parameters
The setting to be used during normal working conditions should be:
- CD Write Speed should be no more than 75% of the maximum speed of the disk drive, and no greater than 24x.
- Create CD Image before writing should not be selected during normal operation.
- Disable Auto-Insert Notification should be selected during normal operation.
- DVD Write Speed is only available when a DVD writer has been selected.
- Use DVD as Default Media should be selected if a DVD writer is being used.
- Click OK to save the settings and close the dialog box.
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Chapter 11 – About archiving
Note
l The secondary (compressed) images should be retained for a longer period of time because they contain the thumbnail images used in the Review application. The secondary images use much less disk space than the primary images.
l The length of time for which images can be retained will depend upon the volume of image data captured and the capacity of the hard disk. Your Optos Representative will help define the settings to be used.
Archiving to disk
There are several elements involved in archiving to a recordable disk (either CD or DVD). You can:
l Check how much storage space is available by running the start up tasks.
l Archive image files and the database. You can also choose to start the archive and leave it to run unattended.
l Clean out archived files to leave more space to capture new images.
l Stop the current archiving task.
You should not schedule archiving tasks if CDs or DVDs are used.
Caution
How to run a startup task
Each time you run the Storage application the software automatically checks the archive status of the database, images and the available disk space.
You should run the application each day and run any recommended startup tasks. Assuming your Task Settings are correctly configured for your volume of work, the startup tasks should be sufficient for maintaining your system.
- Select Start > All Programs > optos V2 Vantage Pro > Storage to start the Storage application.
- The application checks how much storage is available. It may recommend some tasks be carried out immediately. Select Yes if you want to run each of the recommended archive and cleanup tasks.
- Insert a recordable disk when prompted. Use a new recordable disk for each archive task. When the startup tasks have been completed the application window will be displayed.
Note
l It is recommended that you run the archiving process at a time when no one is using the capture, review or viewing PCs. This is because the copying process uses a significant proportion of the computer’s resources, and therefore could disrupt the activities of other users.
l You should run the primary archive task a minimum of once a week to ensure the image database is backed-up. Around 80 primary images can be saved to CD and around 500 can be saved to DVD.
l If you cancel an archive task you must discard the disk. The disk should not be re-used.
l If you have used another disk writing application (for example Sonic RecordNow, DirectCD or EasyCD) you must reboot the PC before running the Storage application. This is because their drivers may not let other applications access the disk drive properly. Re-booting the PC clears any settings and lets the Storage application access the disk drives.
How to run an archive task
- Select Start > All Programs > optos V2 Vantage Pro > Storage to start the Storage application see Storage application user reference on page 91.
- The Startup Task will automatically check if any archiving or clean up tasks are required. You should run all of the recommended tasks. If you would like to perform additional tasks that were not recommended, proceed with the rest of this procedure.
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- Run any additional tasks. Insert a new recordable disk when prompted.
l Archive and Verify – copies the database and all primary image files from the PC’s hard disk to the storage device. These original files are usually large, uncompressed files that fill the hard disk quickly. Archiving primary image files can take a considerable amount of time.
l Secondary Archive and Verify – copies all secondary (compressed) images from the hard disk to the storage device. These compressed images require less storage space and so may not need to be cleaned up as frequently as the primary image files.
- The Low Media Item Usage dialog box will be displayed if the disk will only be partially used. If you would like to archive anyway, select Yes.
- Confirm that you want to proceed with the archive task. The Current Task tab will appear and display the progress of the current task. The current step is displayed.
- When the archive tasks have been written the disk drawer is automatically opened and closed. This is the start of the verify task and prompts Windows Explorer to refresh and check the files have been written correctly. Do not remove the disk at this time. Do not touch the drawer, it will close automatically.
- When the archive task has been verified the software displays the disk label1. Write the label on the disk using a permanent marker pen. Put the disk in a disk holder and store it at room temperature.
The label information will have been added to the database’s image record for each archived image.
Images that have a disk label are ignored in subsequent archiving tasks.
Note
l Use a new recordable disk for each archive task. Using a partially filled disk may appear to be economical, but there is a risk that the existing content could be corrupted.
l The disk writing software is designed to write an entire disk at once. If that process is interrupted, the content of the disk will be incomplete and will not be readable.
l You will be notified if the verification task failed. It the verification task fails you must discard the disk.
l The secondary archive task will copy no more than 1000 images to each CD. It is designed to work this way because attempting to write too many files to a CD results in poor performance.
How to run an unattended archive
It is possible to run an archive task overnight. The main difference is that instead of logging off the PC, you choose to lock the computer instead.
- Run the archive task as described above.
- When the progress is displayed, press [Ctrl]+[Alt]+[Del] to display the Windows security window.
- Select the option to Lock the computer. The computer is now locked and can only be unlocked by the current user or by the Administrator.
- When you return to the computer the next morning you must press [Ctrl]+[Alt]+[Del] to display the Windows security window.
- Type in your password and click OK.
- If the archive task has completed the disk label2 will be displayed. Remove the disk and write this label on the disk using a permanent marker pen. Put the disk in a disk holder and store at room temperature.
1When images are archived the archive disk label is stored in the database. The label encodes the date of the oldest image on the disk using the YYYY-MM-DD format, and an additional serial number. For example, OM-2009-10-19-1P is the first disk with primary image from October 19, 2009. Secondary image labels are suffixed with “S” instead of “P”. The disk label is referenced in the database record for each archived image.
2When images are archived the archive disk label is stored in the database. The label encodes the date of the oldest image on the disk using the YYYY-MM-DD format, and an additional serial number. For example, OM-2009-10-19-1P is the first disk with primary image from October 19, 2009. Secondary image labels are suffixed with “S” instead of “P”. The disk label is referenced in the database record for each archived image.
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How to create disk space
The cleanup task removes files that have already been archived. Files are selected if they have been archived and are older than the specified age limit. The age limit (a defined number of days, weeks or years) is set in the Task Settings, see Changing the Archive Task Settings on page 69.
- Select Run menu > Run Cleanup Task to start the Cleanup Task.
- Click Yes to confirm that you want to proceed with the cleanup task. The progress of the cleanup is shown.
Note
If you are still short of storage space you should remove deleted images, see Emptying the “Deleted” folder.
How to stop an archive task
- Select Run menu > Stop Task if you need to stop the current archive task. The option is unavailable when there is no task running.
- Confirm that you want to stop the archive task. The task will continue to run until it has completed processing the current file. This may take up to a minute depending on the task. Subsequent files will not be processed and the task will stop.
- Remove and discard the disk.
Note
l Most menu items and toolbar buttons are unavailable while a task is running, only the Stop Task option is available.
l Do not attempt to re-use a disk from a canceled archive task or that has been partly filled.
l Previous software versions used a technique that wrote one file at a time. Archiving could effectively be stopped and resumed. However, that technique was slower and less reliable.
How to select the correct CD or DVD type
Many types of disk can be used to store your archived information. However, some disks tend to cause problems. Use the following notes to help determine the most appropriate disks to buy:
In all cases you should buy the appropriate disk format for your writer.
CD disks (default):
l Always use CD-R disks. Do not use CD-RW disks.
l Do not use high capacity disks such as 800Mb. Larger capacity disks tend to experience more archiving problems. The likelihood of a successful archive task increases if you use lower capacity disks.
l Disk quality varies, even within a single pack of disks. You may have problems with several CDs in a single pack.
Note
The recommended maximum setting is 24x. Above this speed, the PC and writer drive may not be able to sustain continuous writing to the disk, and the time to write the disk may therefore increase.
For writers with a maximum speed of 24x or less, the maximum speed can be used. If you experience failures in the archive task, you should lower the write speed in the Task Settings dialog box until reliable performance is achieved, see Changing the Archive Task Settings on page 69.
DVD disks (only if recommended by Optos):
l Always use DVD-R or DVD+R 4.7Gb single layer disks. Do not use DVD-RW, DVD+RW.
l Do not use double layer disks.
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l There are two types of DVD writer; + and -. You must ensure that you buy the correct type for your DVD writer.
Archiving to a network
When archiving to a network location or NAS device1 you need to setup the storage location, see Changing the Archive Task Settings on page 69.
In addition, you may wish to set the archive task to happen at a convenient time, perhaps during the night, see Scheduling storage tasks below.
Scheduling storage tasks
You can schedule storage tasks to the network or NAS device2 to be run when convenient. You can control which storage tasks are run, when they are run and how frequently.
You should not schedule archiving tasks if CDs or DVDs are used.
Caution
How to add or change a scheduled storage task
- Select Setting menu > Schedule Tasks to display the Schedule Storage Tasks dialog box.
- Select the time you want the scheduled tasks to be run. You should select a time when the system will not be in use, for example 5 am.
- Select the Frequency for each type of task.
- You should run the Database Backup Task daily. In the Database Backup Settings pane, select No. of copies of Database backup. Optional: Click Browse to select the Location of Database backup.
- Click OK.
Note
l For example, if you select four copies of the database backup, the system will keep the first four copies, then overwrite the first one when the fifth backup is copied.
l You can also run the Compact and Repair Database task from the Admin application’s Storage menu.The Compact and Repair Database task runs automatically after each database backup.
l The Storage application is not displayed when Scheduled Tasks are run.
How to remove a scheduled storage task
- Open the Scheduled Storage Tasks dialog box.
- Select the task you want to remove.
- Change the frequency option to Never.
- Click OK.
1A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network.
It has its own network address.
2A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network.
It has its own network address.
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Chapter 12 – Getting help
12 Getting help
If the help files do not answer your problem, please contact Optos, see Contact us on page 93.
Additional material may be available on the Partner area of the Optos website.
Accessing help from the device
Help is available throughout the application. Press [F1] to display information on the current task.
Accessing help from the applications
There are several ways to access the help files:
Pressing [F1] for Help with Your Current Task
The help system can display a help topic that relates to the current application window or dialog box. Press [F1] on your keyboard to display information on the current task.
Help from the Help Menu
You can access the application help file from the Help menu. Click Help menu > Optos <application> Help to display the help file.
How to display the hierarchy of all help topics
- Click Help menu > Optos <application> Help to display the help file.
- Click the Contents tab to display the help file hierarchy.
- Click a topic to display it in the right-hand pane. Alternatively, double-click the book icon and select from the list of topics that appears.
Note
l New topics are indicated with a yellow star on the topic icon.
l Some graphics expand when the mouse is moved over them. Other graphics include hypertext links at particular points. Hover your mouse over graphics to see if there are any special features available.
l You can save the current topic as a favorite by clicking the Add topic to favorites button in the help toolbar.
l You can see where you are in the hierarchy of help topics by using the “You are here:” breadcrumbs at the top of the help page. You can quickly move back up a level by selecting the You are here link at the top of the topic.
How to search for help
- Click Help menu > Optos <application> Help to display the help file.
- Click the Search tab to display the search pane.
- Type the words you are looking for. Click List Topics to display the search results.
l Use ‘?’ to replace a single letter, for example ‘archive?’ to search on ‘archived’ and ‘archives. ’Use ‘*’ to replace a group of letters, for example ‘archiv*’ for ‘archive’, ‘archived,’ ‘archives’ and ‘archiving’.
- Optional: You can filter the search results by selecting one of the filter options.
- Click a topic to display it in the right-hand pane.
Note
l If you do not get the result you were expecting, it may be that the help file does not contain the exact word or phrase you typed. Try typing a similar word or phrase.
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l You can save the current topic as a favorite by clicking the Add topic to favorites button in the help toolbar.
l You can save the current search criteria as a favorite by clicking the Add search string to favorites next to the Search button.
How to navigate topics
- Click Help menu > Optos <application> Help to display the help file.
- Display the topic you require using the Contents, Index or Search tabs.
- Repeat for each topic you want to view.
- Click Back and Forward to scroll though the topics you have displayed. Only topics you have viewed will be displayed when clicking Back and Forward. This is particularly useful if you want to go back to a previous topic and you do not want to search for it again.
How to print help topics
- Display the topic you want to print.
- Click the Print button on the help toolbar to display the Print Topic dialog box.
Optos on the Web
The Optos web site contains a wide variety of information resources. Simply click the Partner Login link at www.optos.com to access the partner login area or to register for a username and password.
The Partner area of the web site includes:
l Practice Marketing materials.
l Clinical materials.
l Details of training events.
l Software downloads.
How to access additional documentation on the web
- Select Help menu > Visit the Partner pages at optos.com.
- Login when prompted.
- Click your device to display the relevant documentation.
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Chapter 13 – Where to find features
13 Where to find features
The most commonly used features are accessible using the toolbar buttons. All features are available from the menu bar.
Toolbar buttons – offer quick and clear access to the most commonly used features. Hovering the cursor over the button will display the tooltip for the button. Simply click the button to use the feature.
Menu bar – all features are available from the menu bar. Related features are grouped under appropriate menus. Click the menu heading to display the features in that menu. Select the feature you want from the sub-menu.
Pop-up menu – pop-up menus are available in many areas of the application window. When you click the right mouse button a menu will pop-up. This menu will only contain the features that apply to the position clicked.
The following tables provide information about the features accessed from the toolbar buttons.
Capture application user reference
Patient List Indicators
Button/section Description
optomap® plus Patient indicator
This indicator is shown on the Patient List. It indicates that the patient has previously been imaged using an optomap® plus procedure.
System controls
The controls are used to access the system, patient information and system settings.
Button/section Description
LOGIN button
Opens the Login dialog box. You need to log in with your username and password before you can use the system.
SETTINGS button
Opens the Settings dialog box where you can change many of the system settings.
You should only change these settings when instructed by your Optos representative. You will need to login in before the settings options are available.
PATIENT LIST button
Opens the Select Patient dialog box where you can select an existing patient, create a new patient or filter the records to find a particular patient.
WORK LIST button
Opens the Select Patient dialog box and displays the list of patients scheduled for today.
SHUT DOWN button
Shuts down the system.
Once the system has shut down you can switch off the power to the scan head.
LOGOUT button
Logs out of the system and allows you to shut down or access the settings options.
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Image types
Button/section Description
optomap® image button
Captures a retinal image. The standard optomap® procedure is a wellness exam. This procedure captures a standard optomap® retinal image.
optomap® plus image button
Captures a medical retinal image. The optomap® plus procedure is a medical retinal exam. Following this procedure will allow the use of the enhanced features in the Review application. These images are captured at a higher resolution than standard optomap® images.
optomap® fa image button
Captures fluorescein angiography images for a medical procedure. The optomap® fa procedure allows the capture of a fluorescein angiography images. These images are captured at a higher resolution than standard optomap® images and allow the use of the enhanced features in the Review application. The image capture rate for the early-phase can be set in the Capture application settings. You must ensure that the necessary resources are available to administer the fluorescein.
This button is only available when the optomap® fa option is available.
optomap® fa for central pole for central pole button
Captures narrowfield fluorescein angiography images (approximately half the field of optomap® fa ultra-widefield angiography).
This button is only available when the optomap® fa for central pole option is available.
optomap® af image button
Captures autofluorescein medical retinal images. The optomap® af procedure is a medical retinal exam.
Image Capture Controls
Depending on which view mode has been configured, some of these controls may not be available.
Button/section
Right Eye (OD)
or Left Eye (OS)
optomap® af
Fixation Level
Enable Self Alignment
Description
Right Eye (OD) or Left Eye (OS) button
Opens the relevant Capture Right/Left Eye dialog box. You can see the patient’s eye on the External Eye Camera view. You use this view to fine tune the patient alignment, see About capturing an image on page 19.
optomap® af setting
Sets the next image to be an autofluorescence image.
Fixation Level setting
Controls the brightness of the green ball used to control the patient’s gaze direction. The settings should be as dim as possible.
Self Alignment setting
Activates the self alignment LEDs.
As the patient moves in, two red lights will be displayed when the patient is at the correct distance. One red light will appear above and the other below the green ball.
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Button/section
Eye Steering
ResMax
RESET POSITION
Chapter 13 – Where to find features
Description
Eye Steering setting
Controls the additional lights used to control the patient’s gaze when the
eye is being steered. Select the required direction (Nasal, Temporal,
Inferior, or Superior) to switch on the appropriate red ball and switch off the
green ball.
Ask the patient to look at the red ball. The captured images will be tagged with the eye steered direction.
Eye steering is not available with all procedures.
ResMax™ option
Sets the system to capture an enhanced image, typically of the Central Pole.
RESET POSITION button
Re-centres the green ball used in patient positioning.
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Image Quality Controls
Button/section
OPTIMIZE
RESTORE
Red Contrast
Green Contrast
Description
Composite Color view button
Shows the default view used to display an image that has just been captured. This view mixes the red and green channels to present a color image.
The Composite Color view is not available when an optomap® af image is selected.
Red Channel view button
Shows a grayscale image. The Red Channel view shows the deeper layers of the retina and choroid.
The Red Channel view is not available when an optomap® af image is selected.
Green Channel view button
Shows a grayscale image. The Green Channel view shows the anterior layers of the retina.
Central Pole view button
Shows the close-up image of the optic disk and macula. Once you are in this close-up mode you can drag the image to review other areas. Click, and hold down, the left mouse button and drag the image to the area you want to view.
The Central Pole view button changes to the Full Field view button when pressed. Full Field view button
Shows the full, ultra-widefield image. The Full Field view button changes to the Central Pole view button when pressed.
Image Settings pane button
Displays the Image Settings pane. You can review the External Eye Camera view taken when the image was captured. You can also adjust the settings to suit the patient’s individual characteristics. These adjusted settings will be used when subsequent images are captured within the session.
OPTIMIZE button
Adjusts the red and green settings to show the image using the optimal display settings. Based on the colors in the image and the colors expected, the software calculates the ideal value for the red and green contrasts without saturating either color.
RESTORE button
Restores the image settings to those that existed when the image was captured.
Red Contrast Settings slider
This slider controls the exposure of the red channel. Increasing the red settings will give the composite color image a more red hue; decreasing the settings will give the composite image a more green hue.
Exposure level of the captured image. The upper arrow indicates the exposure setting of the image when it was captured. This setting cannot be adjusted. The lower arrow indicates the adjusted exposure setting.
The adjusted settings will be applied to the next image to be captured.
Green Contrast Settings slider
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Button/section Description
Functions in the same way as the Red Contrast Settings slider.
Discard button
Marks the image to be discarded at the end of the session. Click the image thumbnail to select it then click the Discard Image button. The thumbnail will be marked with a cross and the image will be discarded at the end of the session.
The Discard button changes to the Keep button when pressed.
Keep button
Marks the image to be kept at the end of the session. Click the image thumbnail to select it then click the Keep Image button. The thumbnail will be marked with a cross and the image will be discarded at the end of the session. The Discard button changes to the Keep button when pressed.
CHANGE TO LEFT EYE button
Marks the next image captured as a left eye in an optomap® fa session.
CHANGE TO RIGHT EYE button
Marks the next image captured as a right eye in an optomap® fa session.
VIEW IMAGE SERIES button
Displays all the images captured in an optomap® fa capture session.
PAUSE button
Pauses the current optomap® fa procedure . The paused procedures can be restarted later the same day.
End Procedure button
Closes the current session and discards any images marked to be discarded. All other images will be saved.
Next Image button
Selects the next image in the optomap® fa image series.
Previous Image button
Selects the previous image in the optomap® fa image series.
Review application user reference
Image Indicators
Button/section Description
optomap® plus Patient indicator
This indicator is shown on the Patient List. It indicates that the patient has previously been imaged using an optomap® plus procedure.
optomap® plus Assigned Procedure indicator
At sites where insurance reimbursement is carried out, this indicator is shown on the Patient History view. It indicates that a reimbursement code has been assigned to the optomap® plus session.
Stereo Pair indicator
At sites where capturing Stereo Images is available, this indicator is shown on the Stereo Images thumbnail in the Patient History view.
Stereo Images should not be used for diagnostic purposes.
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Review Tools Controls
Button/section Description
Open Files(s) to View button
Opens the Select Image(s) to View dialog box. Hold down [Ctrl] and click each image filename or [Shift] to select the first and last image filenames in a group.
Browse Images in Folder button
Opens the Browsing dialog box. Select the folder and file type to filter the images. Click each image you want to open.
Review Patient History button
Opens the Select Patient dialog box. Select the patient then click OK to open the Patient History view, see About the Patient History view on page 35.
Export button
Opens the Export Image to File dialog box, see Exporting images on page 62.
Send to E-Mail Recipient button
Opens the Export Image To E-Mail dialog box, see Emailing images on page 61.
Quick Print Active Image button
Sends the current image directly to the default printer. The currently displayed annotations, image area and display settings will be used automatically.
If you want to customize what is printed you should use the full print feature to print images that have been dragged to the Print Bar, see How to print the current image as displayed on page 64.
Print Patient Takeaway button
Sends the current image directly to the default printer and prints the image that the patient can take away.
You can customize the layout to include your practice name and logo, see How to customize the Patient Takeaway print layout on page 65.
Imported Image symbol
This symbol indicates that the image has been imported into the patient’s history.
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Image View Controls
Button/section Description
Composite Color View button
Shows the Composite Color view where you can use the zoom and pan features to view the image in detail.
This default view is used when an optomap® or optomap® plus image is opened. This view mixes the red and green separations to present a color image. It is not possible to show optomap® fa or optomap® af images in this view.
You can also select the Composite Color view by clicking Image menu >
Composite Color View.
Red Separation View button
Shows the Red Separation view as a grayscale image where you can use the zoom and pan features to view the image in detail.
The retinal image can be separated to present retinal substructures. The Red Separation view shows deeper layers of the retina.
It is not possible to show optomap® fa or optomap® af images in this view.
You can also select the Red Separation view by clicking Image menu > Red Separation View.
Green Separation View button
Shows the Green Separation view as a grayscale image where you can use the zoom and pan features to view the image in details.
The retinal image can be separated to present retinal substructures. The Green Separation view shows the anterior layers of the retina.
It is not possible to show optomap® fa or optomap® af images in this view.
You can also select the Green Separation view by clicking Image menu > Green
Separation View.
Split Images View button
Shows the Split Images view. This view splits the main pane of the image window into four quadrants.
The quadrants show the following views:
l Top left quadrant – optimized Composite Color view.
l Top right quadrant – Red Separation view.
l Bottom right quadrant – Green Separation view.
l Bottom left quadrant – restored original settings of the Full Image view.
The zoom and pan features are operated on the Composite Color view, Red Separation view and Green Separation view. The Full Image view is not affected and always shows the full size image, with an indicator of the zoomed-in area shown in the other three quadrants.
It is not possible to show optomap® fa or optomap® af images in this view.
You can also select the Split Images View by clicking Image menu > Split Images View.
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Button/section Description
Select View button
Sets the zoom (in and out) to show the selected area of the image.
Click the drop-down arrow button to display the view options:
l Full Image view – zooms to show the full image.
l Central Pole – zooms to show an enhanced view of the optic disk and macula.
l Optic Disk – zooms to show an enhanced view of the optic disk in the green channel.
l Periphery – shows the full images adjusted to present the details of the periphery.
You can also select the view options by clicking Image menu > Select View… and the view option.
Zoom In button
Zooms in on the center of the displayed image, showing a close-up view.
Repeatedly click the button to zoom in further.
You can also zoom in by selecting Image menu > Zoom In.
If you have a mouse wheel you can use this to zoom in or zoom out.
Zoom Out button
Zooms out on the center of the displayed image, showing more of the image. Repeatedly click the button to zoom out further.
You can also zoom out by selecting Image menu > Zoom Out.
If you have a mouse wheel you can use this to zoom in or zoom out.
Select Image menu > Full Field to display the full image in the current window size.
Set Zoom Percent button
Sets the zoom (in or out) to show the selected percentage zoom.
Magnification of 100% means that 1 screen pixel = 1 image pixel.
Click the drop-down arrow button to display the zoom options. The percentage options are:
l 500% – zooms to 1 image pixel across 5 screen pixels.
l 200% – zooms to 1 image pixel across 2 screen pixels.
l 100% – zooms to 1 image pixel to 1 screen pixels.
l 50% – zooms to 2 image pixels in 1 screen pixel.
l 20% – zooms to 5 image pixels in 1 screen pixel.
l Full Image – zooms to show the complete image within the current window size.
Alternatively, you can click the percentage value and type the value you want to use. Press [Enter] to set the percentage.
3D Wrap View button
Runs the animated 3D Wrap view of the current image.
You can show the sequence through a model eye, a transparent eye or across a 3D grid.
Click Fly Through to run the animated sequence.
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Button/section Description
Mouse Move Mode button
Switches to Mouse Move Mode where you can drag the viewed area of the image. This feature is useful when you want to look at another part of a zoomed in view.
When the Mouse Move Mode button has been selected you can:
l Left click mouse to center the image at that point.
l Drag the mouse to move the viewed area to another position.
You can also pan the image by using the keyboard arrow keys or by selecting Image menu > Mouse Mode > Move.
Mouse Zoom Mode button
Lets you select an area to zoom in on, and provides a quick way to zoom in or out of a particular part of the image.
When the Mouse on Drag Mode button has been selected you can:
l Left click mouse to zoom in and center on that point.
l Drag the mouse to zoom in on that area.
l Use the mouse to ‘draw’ a rectangle around the area to be displayed.
l Right-click mouse to display the pop-up menu.
You can also zoom in or out by selecting Image menu > Mouse Mode > Zoom.
Show Magnifier button
Lets you look at a locally optimized area of the image. You can also zoom in and out of the image in the usual way.
The Magnifier may not be available on all systems. Please contact Optos for more information, see Contact us on page 93.
When the Show Magnifier button has been selected you can right click to:
l Zoom in and out of the magnified area.
l Change the color view of the magnified area to Composite Color, Red Separation or Green Separation view.
l Select one of the False Color1 options when either Red Separation or Green Separation views are selected in the magnifier.
You can also show the magnifier by selecting Image menu > Show Magnifier.
Show Comparison Overlay button
Lets you compare two images of the same eye that were taken at different times, for example when comparing an image from last year with an image from this year.
When the Show Comparison Overlay button has been selected you can right click to:
l Change the size of the overlay area.
l Set the transparency of the overlay area. The transparency ranges from Opaque, where the other image details are shown and blend through to Transparent where the current image is shown and no details area blended from the other image.
1Replaces grey scale with a range of colors. This may help accentuate the differences in the image intensity.
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Button/section Description
l Change the color view of the Comparison Overlay area to Composite Color, Red Separation or Green Separation view.
Show/Hide Image Adjustment Pane button
Toggles between hiding and showing the Image Adjustment pane.
The Image Adjustment pane is shown on the right of the image window and contains the contrast, brightness and gamma settings.
You can also hide or display the Image Adjustment pane by selecting Image menu > View Adjustment pane.
Show/Hide Image Information button
Toggles between hiding and showing the Image Comments pane. The image comments are shown on the bottom of the image window and contain the annotations and review notes associated with the image. You can also hide or display the Image Comments pane by selecting Image menu > View Information.
Link/unlink windows modes and view ports button
Toggles between linking and unlinking all the open image windows.
You can also link or unlink all open image windows by selecting Window menu > Link/Unlink All Windows.
You can select which windows to link. Select Window menu > Select Linked Windows to display the Link Windows dialog box and select the windows to be linked.
Page buttons
Displays the Previous Page and Next Page in an Image Stack. Also displays the page number of the current image.
Review Notes button
Displays the toolbar links to Notes, Diagnostic Coding and Procedure Coding dialog boxes.
You can also open these dialog boxes from the Image menu.
Image Adjustment Controls
You can hide the Image Adjustment Controls by selecting Image menu > View Adjustment pane.
Button/section
Contrast control
Brightness control
Description
Contrast control
Drag the slider control to the right or left to either increase or decrease the contrast respectively. The contrast control increases or decreases the pixel intensity by an amount proportional to the source pixel intensity; the intensity of brighter pixels will be changed more than that of dimmer pixels.
You can also change the setting by clicking the control to select it and pressing the left or right arrow on your keyboard to move the slider control.
Brightness control
Drag the slider control to the right or left to either increase or decrease the brightness respectively. The brightness control increases or decreases the pixel intensity by the same amount. If you find that some areas become saturated, try moving the Gamma control slider instead of the Brightness control.
You can also change the setting by clicking the control to select it and
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Button/section
Gamma control
Equalization control
Optimize button
Restore button
Green Balance control
Chapter 13 – Where to find features
Description
pressing the left or right arrow on your keyboard to move the slider control.
This control is not available when reviewing optomap® fa images. Gamma control
The Gamma control will brighten or darken the image without saturating detail changing the exposure settings. Moving the slider to the right improves the contrast of dark areas of the image. Moving it to the left increases the contrast in brighter areas. Gamma correction can be applied to the image. This will range between 0.5 (to accentuate contrast in bright parts of the image) up to 2.5 (to accentuate differences in dark parts of the image). The practical application with optomap® images will be to bring out the detail in the periphery (gamma greater than 1) and in the optic disk (gamma less than 1).
You can also change the setting by clicking the control to select it and pressing the left or right arrow on your keyboard to move the slider control.
Equalization button
The Equalization control will brighten the superior field to match the brightness of the central pole.
You can also change the setting by clicking the control to select it and pressing the left or right arrow on your keyboard to move the slider control.
Optimize button
Based on the colors in the image and the colors expected, the software calculates the ideal value for the red and green contrasts without saturating either color. The image is optimized automatically when it is first opened.
Restore button
Restores the image settings to those that existed when the image was captured.
Green Balance control
Click and drag the slider control to the right or left to increase or decrease the green balance respectively. This control is not available when reviewing optomap® fa images. The Green Balance Contrast and Brightness controls change the relative contrast/brightness of the green separation relative to the red separation. Increasing green settings will give the composite color image more of a green hue; decreasing them will give the composite image more of a red hue.
You can also change the setting by clicking the control to select it and pressing the left or right arrow on your keyboard to move the slider control.
This control is not available when reviewing optomap® fa images.
Image Playback Controls
These controls are available when using the Automated view and FA Slideshow.
Method
Automated View
Description
The Automated view moves around the image, showing each area and in Green Separation, Red Separation and Composite Color views. This provides a framework for carrying out a general review of the image.
The following buttons can be are used to control the Automated view.
Play button
Plays the Automated view. The Play button changes to the Pause button when clicked.
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Method Description
Pause button
Pauses the Automated view. You can stop the Automated view by clicking the Pause button and then moving on to another task.
The Pause button changes to the Play button when clicked.
You can also pause the Automated view by clicking the image.
Previous button
Click this button to work back through the Automated view one phase at a time.
You can use the Progress slider to move back multiple phases at once.
Next button
Click the button to move forward through the Automated view one phase at a time.
You can use the Progress slider to move forward multiple phases at once.
FA Slideshow You can review a stack of optomap® fa images in the FA Slideshow.
The following buttons can be are used to control the FA Slideshow.
Play button
Plays the FA Slideshow. The Play button changes to the Pause button when clicked.
Pause button
Pauses the FA Slideshow. You can stop the FA Slideshow by clicking the Pause button and then moving on to another task.
The Pause button changes to the Play button when clicked.
You can also pause the FA Slideshow by clicking the image.
Back button
Click this button to work back through the FA Slideshow one image at a time.
You can use the Progress slider to move back multiple images at once.
Next button
Click the button to move forward through the FA Slideshow one image at a time.
You can use the Progress slider to move forward multiple images at once.
Progress slider
Progress slider
You can move the slider to go back or forward in the FA Slideshow.
Speed slider
Speed slider
You can change the speed of the FA Slideshow by moving the slider.
Image Comparison Methods
There are several methods available for viewing images using the Review application. Some show large views of a single image, others show several images at once, another stacks images so that you can page through them. You can also link images so that when you zoom in or pan, the images are aligned; keeping a similar area of each image in view. Each method lets you view and compare the images in different ways.
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Method Description
Linked Images
To review and compare several images while keeping the same area of each image in view, open the images using the Open in Linked Windows button in the Patient History window, see About the Patient History view on page 35.
Linked windows zoom, pan and move together. In addition, color separations applied to one window are also reflected in other linked windows. However, image adjustments such as Restore, Optimize, Gamma adjustment etc, are only applied to the selected window.
When you navigate to a retinal feature in one image the other linked images will display the same relative position. This method is particularly useful when comparing multiple images of the same eye. Left and right eye pairs will horizontally scroll in opposite directions.
Separate Multiple Images
To review several images separately, but open the images at the same time use the Open in Unlinked Windows button from the Patient History window.
Stacked Images
To review and compare several images in a large view window, open the images using the Open in Image Stack Window button from the Patient History window. This view stacks the images on top of each other and you select by paging through the stack.
When an optomap® fa series is selected, this option will open the Image Series view. This view displays all the images in the series and lets you select the images you want to open. The Image Series view lets you open the selected images in Linked, Unlinked and Stacked views.
Annotations, retinal drawings and measurements
Annotations are graphical mark-ups drawn onto to the image. Retinal drawings and measurements are special annotations. Retinal drawings are used to indicate specific information, for example arteries, detached retinas and exudates. Measurements calculate distance and area parameters on the image. The calculated results are added to the image as annotations.
Some special annotations are restricted depending on the type of image being reviewed, see About annotations, retinal drawings and measurements on page 52.
Button/Section Description
Freehand annotation tool
Hold down the left mouse button and draw around the area. Double-click the mouse button to complete the shape.
Polygon annotation tool
Click points to draw lines around the area. Double-click the mouse button to complete the shape.
Arrow annotation tool
Click to mark the arrow head, then click again to mark the tail.
Note annotation tool
Hold down the left mouse button at the top left corner of the note and drag to the bottom right corner. Type information into the note.
Ellipse annotation tool
Hold down the left mouse button at the top left corner of the ellipse and drag to the bottom right side.
Retinal Drawing tool
Click to display the retinal drawing palette. Select the pathology type you want to annotate and mark-up the image.
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Button/Section Description
Retinal drawings are not available when reviewing standard optomap® images.
Undo annotation tool
Removes the most recent annotations. Annotations cannot be removed or changed after an image has been closed.
Cup to Disk Ratio measurement
Click at least five points on the edge of the cup, then repeat around the disk. The Cup to Disk Ratio is displayed.
Distance measurement
Click points at both ends of the distance.
The distance is measured in pixels. The number of pixels will be displayed.
Area measurement
Hold down the left mouse button and draw around the area.
The area is measured in pixels. The number of pixels will be displayed.
ISNT Rule Measurement
Hold down the left mouse button and draw and draw a line across the inferior, superior, nasal and temporal neuro-retinal rims.
Further investigation is required if the measurement is displayed in pink.
Cup to Disk Ratio details are also displayed.
ISNT Rule Measurements are not available when reviewing standard optomap® images.
Image Registration
Click the center of the optic disk and then click the center of the macula. Once images have been registered stacked and linked images are align at the optic disk and macula.
About Review Notes
Review Notes are text mark-ups that are saved with the image file. The following symbols are shown in the Patient History view. They indicate whether an image has been reviewed.
Symbol Description
Not reviewed
This symbol indicates the image has not yet been reviewed.
The symbol is displayed in the Patient History’s Session List.
Reviewed with no comments
This symbol indicates if the image has been reviewed but no comments have been added.
The symbol is displayed in the Patient History’s Session List.
Reviewed with Comments
This symbol indicates if the image has been reviewed and comments have been added.
The symbol is displayed in the Patient History’s Session List.
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Storage application user reference
Button/section Description
Archive and Verify button
Copies the database and all primary (uncompressed) image files from the PC’s hard disk to the storage device. These original files are usually large, uncompressed files that fill the hard disk quickly.
Archiving primary image files can take a considerable amount of time, so archiving should be carried out frequently to avoid a large number of images being archived at once.
You can also select Run menu > Archive Task.
Secondary Archive and Verify button
Copies all secondary (compressed) images from the hard disk to the storage device. These compressed images require less storage space and so may not need to be cleaned up as frequently as the primary image files.
You can also select Run menu > Secondary Archive Task.
Run Cleanup Task button
Archived files from within a defined time period are removed from the hard disk. This creates disk space for new images.
You can also select Run menu > Cleanup Task.
Run Restore Task button
Restores the database and/or image files from an archive.
You can also select Run menu > Restore Task.
Stop Task button
Stops the task in progress. The current file is completed and then the process is stopped. This may take up to a minute depending on the task.
You can also select Run menu > Stop Task.
Storage Status button
Displays the current status of the online storage (hard disk) and offline storage (disk).
You can also select Status menu > Storage status.
Delete Media Item button
Deletes the disk archive label reference from the database. The files can be re-archived if they have not been cleaned up. If the files have been cleaned up then the data cannot be restored.
You can also select Media menu > Delete Item.
Clear Task History button
Clears the archive data shown in the Task History tab.
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Scheduler application user reference
Button/section Description
New Appointment button
Shows the Select Patient dialog box and Optomap Appointment Details dialog box where you can select the patient and then set the appointment details respectively.
You can also select Schedule menu > New Appointment.
Edit Appointment button
Shows the Optomap Appointment Details dialog box where you can edit the appointment details or cancel the appointment.
You can also edit an appointment by double-clicking the appointment or by selecting Schedule menu > Edit Appointment.
New Patient button
Shows the Patient Details dialog box where you can add the new patient’s details.
You can also select Schedule menu > New Patient
Edit Patient button
Shows the Select Patient dialog box and Patient Details dialog box where you can select the patient and then edit the patient details respectively.
You can also select Schedule menu > Edit Patient.
Today’s Appointments View button
This is the default view shown when the Scheduler application starts. It shows the appointments scheduled for the current day.
You can also select View menu > Today.
This Week’s Appointments View button
Shows the appointments scheduled for the current week.
You can also select View menu > This Week.
This Month’s Appointments View button
Shows the appointments scheduled for the current month.
You can also select View menu > This Month.
All Appointments View button
Shows all the scheduled appointments.
You can also select View menu > All.
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Chapter 14 – Contact us
14 Contact us
We welcome your questions and comments.
Global Headquarters
| Optos plc | Telephone: +44 (0) 1383 843 300 | |||
| Queensferry House | ||||
| Fax: +44 (0) 1383 843 333 | ||||
| Carnegie Campus | ||||
| Enterprise Way | All inquiries: internationalcustomerservice@optos.com | |||
| Dunfermline, KY11 8GR | ||||
| Website: www.optos.com | ||||
| Scotland, UK | ||||
Existing customers will need to provide their site number to allow Optos to access your details. You can find the Site Number on the documentation received from Optos. Alternatively, open the Admin application and select System menu > Set Site Information to display the Practice Information dialog box.
Regional Offices
Please check www.optos.com for the latest information on new regional offices.
United States and Canada
| Telephone: | |||
| Sales and Marketing Toll Free: 1-800-854-3039 | |||
| Optos North America Inc | Outside continental US & Canada: (508) 787-1400 | ||
| 67 Forest Street | Fax: (508) 486 9310 | ||
| Marlborough MA 01752 | |||
| United States of America | All inquiries: usinfo@optos.com | ||
| Customer Support: 800-854-3039 | |||
| Website: www.optos.com | |||
Germany
| Optos GmbH Germany | Telephone: +49 (0) 7251 9294-0 | ||
| Fax: +49 (0) 621 714191-19 | |||
| Gebäude 5137C | |||
| Werner-von-Siemens-Strasse 2-6 | All inquiries: deinfo@optos.com | ||
| D-76646 Bruchsal | |||
| Germany | Service Hotline: +49 (0) 800 18 22 643 | ||
| Website: www.optos.com/de | |||
Switzerland
| Optos GmbH Germany | Telephone: +41 (0) 79 3085224 | ||
| Fax: +41 (0) 43 810 5174 | |||
| Gebäude 5137C | |||
| Werner-von-Siemens-Strasse 2-6 | All inquiries: chinfo@optos.com | ||
| D-76646 Bruchsal | |||
| Germany | Technical Support: DEtechsupport@optos.com | ||
| Website: www.optos.com/de | |||
United Kingdom and the rest of Europe
| Optos plc | Telephone: +44 (0) 1383 843 300 | ||
| Fax: +44 (0) 1383 843 333 | |||
| Queensferry House | Customer Freephone: 0808 100 45 46 | ||
| Carnegie Campus | Customer Support: +44 (0) 1383 843 350 | ||
| Enterprise Way | |||
| Dunfermline, KY11 8GR | All inquiries: UKinfo@optos.com | ||
| Scotland, UK | |||
| Website: www.optos.com | |||
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Spain
Telephone: +34 900 813015
All inquiries: esinfo@optos.com
Website: www.optos.com/es-es
Norway
Telephone: +47 4691 2460
All inquiries: noinfo@optos.com
Website: www.optos.com/no
Sweden
Telephone: +46 707 57 22 59
All inquiries: seinfo@optos.com
Website: www.optos.com
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Chapter 15 – Training Checklist
15 Training Checklist
This page will list the key training elements. At the end of each training session the trainer should check the trainee understands each element listed below.
Safety Guidelines, see Introductory Handbook (installed on PCs)
Medical safety, including Epilepsy warning.
Cleaning and Biocompatibility
Electrical safety
Peripherals and Optos-supplied PCs
About the system
optomap® plus and optomap® image overview
optomap® fa image overview
optomap® af image overview
Tour of the main component parts, including Image Server PC
Admin application: creating new users, setting roles and making users inactive
Functional description of each part
Brief description of how the system works
Start up process (checking everything is switched ON)
Main power switches & 10 minute warm-up
Automatic software updates
System Log In
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Logging onto the device (with new username)
System checks: using the hand control
Setting options – optomap® fa automated capture
System Navigation
Set up System Administrator
Stepping through the Capture procedures
Terminology used
Help sources
Help on current task (F1)
Application help (Help menu)
Installed documentation (User Guide, Introductory Handbook and Technical Data Specification)
Partner area of website
Getting technical support
Patient Details
Adding new patients to the system
Patient Details (Iris categories, Insurance details (if applicable))
Modifying existing patient details
Patient Alignment Procedure – Theory
Alignment Procedure (chair position and height, table height and chin cup nominal height)
Explanation to Patient (patient experience/procedure)
Patient Positioning & Capture – Practical
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Patient angle to the device for successful imaging
Table adjustments
Head rest adjustments
Explanation to patient
External Camera feedback and XYZ adjustments
Capturing images
Image Acquisition Adjustments
Fixation Pattern brightness
Reviewing the image quality
l Good example images
l Bad example images
Reviewing image quality and improving the next image
optomap® plusResMax™ imaging
optomap® plus Eye steering procedure
Technique for minimizing lid & lash
Cleaning the Main Mirror
Feedback from external camera if no lock obtained
Saving and discarding Images
Choosing images to discard/save
Complete session to save images
Hands-on Practice
optomap® and optomap® plus practice
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optomap® fa practice
Eye Steering practice
Reviewing Images
Tour menu bar and tool bar
Selecting and filtering patients
Choosing images for review
Discarding images in the Review application
Reviewing Images:
l Color channels
l Zooming
l Dragging
l Review Notes
l Annotation
l Counting Annotations
l Procedure Codes (optomap® plus only)
l Retinal Drawings (optomap® plus only)
l Automated view
l Simulated BIO view
l Comparison Overlay
Distributing Images:
l Emailing
l Exporting
l Printing Patient Takeaway
l Printing Images
l Emailing and Exporting 3D Wrap Images and Movies
l Assigning images to another patient record
l Changing eye image from left to right (and right to left)
Reviewing optomap® fa Images
Reviewing the Image Series view
FA Slideshow
Data Management
Review of archiving procedure
l Primary
l Secondary
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Chapter 15 – Training Checklist
l Cleanup
Scheduled archiving to network drive (or NAS device1)
System Shut Down
Shut down steps
Power switches
1A Network Attached Storage device is a hard disk, or Solid State Drive, that is attached to the network.
It has its own network address.
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Chapter 15
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