KaVo Dexis Titanium User manual

Sensor User Manual
Sensor Benutzerhandbuch
Capteur Manuel de l’utilisateur

DEXIS Titanium Sensor Manual English
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English
Copyright © KaVo Dental Technologies, LLC 2018
This manual and the product described herein are protected by copyright
laws and international copyright treaties, as well as other intellectual prop-
erty laws and treaties.
This manual contains original instructions by KaVo Dental Technologies,
LLC. KaVo Dental Technologies, LLC reserves the right at any time to revise
this manual and the product described herein, and assumes no obligation
to notify any person or entity of such revisions.
Many of the designations used by manufacturers and sellers to distinguish
their products are claimed as trademarks. Where those designations ap-
pear in this manual, and KaVo Dental Technologies, LLC was aware of a
trademark claim, such designations have been printed in capital or initial
capital letters.
The DEXIS Titanium sensor includes the USB interface component copy-
righted by the Cypress Semiconductor Corporation. DEXIS is a trademark of
DEXIS, LLC dba Dental Imaging Technologies Corporation.
Language
The original language of this manual is English.
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1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 A word about the DEXIS Titanium sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Essential Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
1.3 Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.4 Product Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.5 Device Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.6 proficiency with the DEXIS Titanium sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.7 Conventions Used in the Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.8 The DEXIS Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2 Installation, Care, and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1 Protection Against Cybersecurity Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2 Overview of the DEXIS Titanium Sensor System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.1 Top Tier Content: Sensor and Sensor Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.2 Bottom Tier Content: Documentation and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.3 Description of Product Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.4 Hardware Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.4.1 Caution: Hardware Upgrades . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.5 Installing the DEXIS Titanium sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.5.1 Connect the DEXIS Titanium sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
2.5.2 Mount the Sensor Garage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.6 Adjusting the X-ray Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.6.1 Conformance to Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.6.2 Safety Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.6.3 X-ray Generator Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.6.4 Distance of X-ray Source to Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.7 Proper Care of the DEXIS Titanium Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.8 Proper Care of the DEXIS Titanium Sensor Holders . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.9 Image Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Table of Contents
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3 Clinical Use of the DEXIS Titanium Sensor Holders . . . . . . . . . . . . . . . . . . . 21
3.1 DEXIS Titanium sensor Holders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.2 Positioning System Assembly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.2.1 Inserting Sensor into Hygienic Sheath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.3 Correct Placement Using the Paralleling Technique . . . . . . . . . . . . . . . . . . . . . . . . 22
3.4 Pedodontic Placement Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.4.1 Periapical X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4.2 Bitewing X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4.3 Occlusal X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.5 After Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.6 Cable Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
A Additional Help and Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
B Specifications and Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
C EMC Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
D Product Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
E Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
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Introduction
Chapter 1
Introduction
Welcome to the exciting world of DEXIS! Thank you for your recent invest-
ment in the DEXIS Titanium sensor system. We hope you will have an ex-
traordinary experience with our products and services.
1.1 A word about the DEXIS Titanium sensor
The sensor is a USB-driven digital sensor designed from the outset with
you, the clinician, in mind. It has been designed specifically for health care
professionals already acquainted with the standard procedures for acquir-
ing dental intra-oral radiographs. (Refer to Appendix B for the sensor spec-
ification which includes the definition of the intended use.)
The sensor design uses advanced ergonomic principles. Four beveled cor-
ners, a moderate profile, and a rounded casing provide enhanced comfort
for your patients. The sensor is positioned in the patient’s mouth similar to
how intra-oral film is positioned.
WARNING
No modification of this equipment is allowed.
There is no electrical or physical connection between the sensor and the
X-ray generator. The sensor creates a digital image from X-ray doses per-
ceptible by the sensor. The digital image created is immediately visible on
the screen of the personal computer connected to the sensor through the
standard USB port.
With imaging software, acquired images can be optimized for specific di-
agnostic tasks, archived as image files, and printed out on a suitable print-
er if desired. The DEXIS software is one example of a dedicated software
that provides a number of utilities for optimizing viewing and printing of
images.
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1.2 Essential Performance
The essential performance of the DEXIS Titanium sensor systems compris-
es:
• The ability of the sensor to capture X-ray images suitable for recognition
of normal anatomical structures, dental pathologies, and abnormal con-
ditions, where inadequate images may result in misdiagnosis, subject-
ing the patient to incorrect or unnecessary dental procedures that would
present an unacceptable risk to the patient;
• The ability of the sensor holder to align the sensor with the X-ray source
for imaging the desired anatomy.
• The ability of the single use sensor sheaths to isolate the sensor from the
patient, where cross-contamination could present an unacceptable risk
to the patient.
1.3 Indications for Use
The DEXIS sensor is a USB-driven digital sensor which is intended to ac-
quire dental intra-oral radiographic images. The DEXIS sensor shall be op-
erated by healthcare professionals, who are educated and competent to
perform the acquisition of dental intra-oral radiographs.
The DEXIS sensor can be used either in combination with special position-
ing devices to facilitate positioning and alignment with the x-ray beam or it
may also be positioned by hand with the assistance of the patient.
WARNING
Take the necessary steps to protect yourself from radiation. For
proper operator positioning, refer to the ‘Instructions for Use’ of
your intraoral X-ray equipment.
WARNING
Under no circumstances should the dental professional hold the
sensor by hand during X-ray exposure.
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Introduction
1.4 Product Description
The DEXIS sensor is an indirect converting x-ray detector, e.g. incident x-
rays are converted by a scintillating material into (visible) light, this light is
coupled optically to a light detection imager based on CMOS technology.
The design of the sensor assembly supports the automatic detection of the
incident x-rays to generate digital images for dental intra oral applications.
The DEXIS Titanium sensor supports USB2.0 and USB3.x connectivity to
personal computers using a dedicated electronic assembly and a sensor
software driver.
1.5 Device Overview
An X-ray image sensor is positioned in the patient’s mouth just like intra-
oral film. There is no electrical or physical connection between the DEXIS
Titanium sensor and the X-ray generator. Images are automatically ac-
quired when X-rays are present in a dose which is perceptible to the sen-
sor.
Digital X-ray images are quickly displayed on the screen. Images can be op-
timized for viewing via imaging software, stored as image files, and printed
out on a suitable printer if desired. The DEXIS Titanium sensor must be
connected to a PC running on a Windows operating system through the
standard USB port (Universal Serial Bus).
Sensor USB
Connector Cable Label
Sensor
(information for reference only)
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The DEXIS sensor are equipped with a built-in motion detector which en-
ables a quick keyboard/mouse-free acquisition initiation. After holding the
sensor steady for 2 to 3 seconds, the following five acquisition types can be
set, using the sensor-motion option,
• Vertical Bitewing Series - vertical up and down motion for three cy-
cles triggers the Vertical Bitewing Series.
• Horizontal Bitewing Series - horizontal back and forth motion for
three cycles triggers Horizontal Bitewing Series.
• Full Mouth Series - circular motion, clockwise or counter-clockwise,
for three cycles triggers the Full Mouth Series.
• To Go Back - use a triangle motion for three cycles to Go Back during
a series.
• Cancel a Series - move sensor in a “C” motion (12 o’clock to 6
o’clock), clockwise and counter-clockwise, for three cycles to Can-
cel a series.
Vertical
Motion
Horizontal
Motion
Circular
Motion
Triangle
Motion
“C”
Motion
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Introduction
Please note: As with any motion detection device, the subtleties of the
movement may take some time to master. The gesture movement should
be completed by moving your arm at your elbow, not at your wrist. Review
with a DEXIS trainer if you have any questions.
1.6 proficiency with the DEXIS Titanium sensor
The user must be able to read and understand the written language of this
manual. Please become acquainted with your DEXIS Titanium sensor. The
sensor is your tool. Learn to use it well and it will become an effective aid
in your diagnosis, treatment and treatment planning process.
As with all new clinical tools, it is necessary to invest a certain amount of
time for practice in order to become proficient with the sensor.
For new DEXIS users, we highly recommend that you register for in-office
training with a certified DEXIS instructor and that you and all of your clinical
team set aside time to learn the system together. This manual is not in-
tended to serve as a substitute for this training. However, as preparation
for the training, we do encourage you to read the manual thoroughly and
practice with your equipment safely and carefully for at least one week pri-
or to your training date.
Please note that this manual assumes that new users possess basic com-
puter skills and an understanding of the Windows®operating system. Ab-
sent this experience, we highly recommend that you obtain these skills
through a computer course, video, or textbook.
1.7 Conventions Used in the Manual
The following conventions are used to bring the operator’s attention to im-
portant information:
Alerts the operator that failure to follow the pro-
cedure could cause bodily injury or death.
Alerts the operator that failure to follow the pro-
cedure could cause damage to the equipment
or cause loss of data.
WARNING
CAUTION
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1.8 The DEXIS Mission
Our mission at DEXIS is to develop and support the Digital Radiography
community around the world. We seek to build strong partnerships with our
doctors and their teams based on long-term, interactive relationships.
Let’s start your journey into the world of DEXIS Imaging Systems.
Important: Provides advice for the operator regarding use
of the device or a process.
Please note: Highlights important or unusual points.
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Installation, Care, and Maintenance
Chapter 2
Installation, Care, and Maintenance
Most telephone calls for assistance received by the DEXIS Customer Care
specialists stem from inadequate attention to hardware installation. Poor
care of the DEXIS Titanium sensor can result in damage to or destruction of
the fragile electronic components. Also, inattention to basic maintenance
procedures, including adjustment of the X-ray source, can lead to unac-
ceptable image quality.
Please note: DEXIS Technical Support Team: 1-888-883-3947 option 1
We recommend that you engage a qualified computer specialist or network
technician and develop a permanent relationship for your ongoing com-
puter needs. We understand the perspective of “saving money” by imple-
menting a seemingly more cost-effective solution; however, it is our
experience that while this may be true in the short term, such decisions are
considerably more expensive in the long run.
Naturally, turnover and attrition in a dental office will see team members
come and go. The DEXIS Titanium sensor is a highly sophisticated piece of
equipment that must be handled with care and maintained in accordance
with the manufacturer’s recommendations. Despite the pressures of a
busy schedule, please take the time to ensure that all new team members
become familiar with the equipment and the care that it requires.
When calling Technical Support for assistance, please make sure that you
have access to the computer on which the DEXIS sensor is used and on
which the manual may be displayed. You will be instructed where to find
answers and solutions for your particular questions. This allows optimal
“over the phone” assistance.
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2.1 Protection Against Cybersecurity Threats
Protecting your practice against cybersecurity threats is a shared responsi-
bility between us as the manufacturer and you as the heath care provider.
KaVo has taken precautions to ensure that your DEXIS sensor, as shipped
from the factory, is protected against such threats. Additionally, during on-
site repairs, your DEXIS sensor is only accessible by trained KaVo Customer
Support Representatives. However, we cannot protect your network sys-
tem.
We recommend having a qualified IT security professional hired by you to
check your office network system for proper protection against viruses,
malware, and intrusions (e.g. anti-virus software, and/or use of firewall).
WARNING
Failure to maintain cybersecurity can result in compromised device
functionality, loss of data (medical or personal) availability or
integrity, or exposure of other connected devices or networks to
security threats.
2.2 Overview of the DEXIS Titanium Sensor System
The system includes the DEXIS Titanium sensor, a full set of sensor holders,
installation software, and other consumables.
2.2.1 Top Tier Content: Sensor and Sensor Items
• DEXIS Titanium Sensor - Direct USB intra-oral digital X-ray sensor
• Sensor Garage - To store and protect sensor when not in use
(1.013.3841)
• Anterior Holders (2) (1.013.1098)
• Posterior Holders (2) (1.013.1097)
• Horizontal Bitewing Holders (2) (1.013.1099)
• Vertical Bitewing Holders (2) (1.013.1100)
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Installation, Care, and Maintenance
• Universal Alignment Ring (2) (1.010.3775)
• Universal Hand-held Adapter (1.013.1101)
• Bitewing Alignment Bar (1.011.1450)
• Universal Alignment Bar (2) (1.011.1451)
• DEXIS Titanium USB Software Kit (1.013.3134)
2.2.2 Bottom Tier Content: Documentation and Accessories
• DEXIS Titanium Sensor User Manual (1.013.1455)
• Cable Clip Set (5) - Used to attach sensor cable to the bar
(1.013.1114)
• USB Extender, 3 Feet (1 m) - For easy access to computer’s USB port
(1.007.3046)
• Sensor Sheaths 100 Sample Pack - Hygienic barrier for the sensor
(1.013.3253, Bag of 100)
Important: Previous versions of the DEXIS holders are NOT compatible
with the DEXIS Titanium Sensor. The DEXIS Titanium Sensor and Holders
are designed for a custom fit.
Please note: See Accessories List in the back of this manual for additional
accessories and kits.
2.3 Description of Product Symbols
Please refer to “Product Symbols” on page 41.
2.4 Hardware Requirements
Important: For regulatory reasons, all IT components used in connection
with the DEXIS Titanium sensor need to be in compliance with the applica-
ble safety standards. Refer to Appendix B, “Conformance to Standards,”
on page 13.
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Our current hardware system requirements are available in the support sec-
tion on our web site www.dexis.com, from your representative, and from
our Customer Care Center. As technology changes, our requirements are
updated to reflect such changes. Please consult current DEXIS systems re-
quirements before the purchase of any hardware.
Note that systems meeting only the minimum requirements may fail to de-
liver a satisfactory experience. Systems with faster processors, more mem-
ory, and bigger, faster hard drives will significantly enhance performance.
2.4.1 Caution: Hardware Upgrades
Every change in hardware exposes your business to risk. Computers con-
taining patient records are “mission critical.” Careful consideration is re-
quired in order to minimize risk before changes are made to any system
that is currently in use. Whether the change is to be made to hardware or to
the operating system, you should be prepared to deal with an unexpected
outcome including a catastrophic loss of data. For this reason, we offer the
following suggestions for use with mission-critical systems:
Instead of upgrading hardware or the operating system, consider purchas-
ing a new pre-configured system. Computers are amazingly inexpensive to-
day; bringing-up a new system in parallel with an existing system is a good
way to avoid placing the existing system at risk. The existing system will re-
main productive while the new system is qualified and readied for full ser-
vice. Consider the new computer as cheap insurance, but it’s even better
than insurance because you get to keep it.
If you must upgrade your existing system, consider purchasing an addition-
al hard drive and making a bootable, literal copy of the existing hard drive.
Remove the original hard drive and make the changes to the newer (and
probably larger) hard drive. With the original hard drive removed from the
computer, it is not at risk and all of your data will be safeguarded. If the new
changes are found to be unsatisfactory after a suitable evaluation period,
you can always re-install the old hard drive and fully restore your previous
environment.
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Installation, Care, and Maintenance
CAUTION
Be sure to check compatibility and supported hardware when
installing devices that are not from DEXIS or KaVo. Compatibility can
be found at www.dexis.com or simply call our IT Support Team at
1-888-883-3943 option 1.
CAUTION
Always back-up your data and store it off site. Before assuming that
your back-up efforts have been successful, make sure that you
understand the backup process and practice the restore process at
least once on a test system. Verify that both the operating system
and data have been preserved. Consult with our IT Support Team for
questions.
2.5 Installing the DEXIS Titanium sensor
Please note: The Titanium Sensor does NOT require calibration.
Installation includes
• Connecting the sensor to your computer
• Installing the device driver if installing a sensor to an older version of
DEXIS Imaging software.
2.5.1 Connect the DEXIS Titanium sensor
1. Make sure the computer to which you are connecting the sensor has a
compatible imaging software installed.
2. Carefully plug the USB end of the sensor cable into the PC USB port. Do
not use force; ensure that the plug is properly oriented with the PC port.
Try rotating the USB plug if it does not easily insert into port. The USB
connector’s Power Indicator LED will turn green when device is receiving
power from the USB port.
3. Follow the installation instructions appearing on the screen.
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2.5.2 Mount the Sensor Garage
Install the Sensor Garage in a place that is convenient and does not exceed
the maximum length of the USB cable, which is 5 ft. (1.5 m). The Sensor Ga-
rage should also be positioned so that the cable from the sensor does not
create a tripping hazard.
The Sensor Garage comes with two easy to install options. Use with the
supplied double-sided tape or mount with drywall anchors and screws (not
supplied). Remove the double-sided tape and firmly press the Sensor Ga-
rage against the mounting surface. If using screws to mount, use the two in-
dicator notches on the top edge of the garage for proper spacing and
alignment.
2.6 Adjusting the X-ray Source
The DEXIS Titanium sensor is generally compatible with any dental X-ray
unit and generator capable of supplying the required range of exposure
times and doses.
Digital sensors normally require much smaller exposure times than film
sensors thanks to the high sensitivity of the technology used with the sen-
sor. This is why direct current X-ray generators are recommended (“DC,”
“high frequency,” or “average frequency,” “with electronic convertor”).
These generators can normally provide stabilized tube voltage (kV) and re-
producible exposure doses even with very short exposure times. Please re-
fer to your X-ray generator manual for the recommended exposure times for
digital sensors.
Important: X-ray machines, even the same brands and types purchased at
the same time, differ widely in their performance. In addition, on newer X-
ray machines, the “digital” setting on your dial or keypad may not be the
ideal setting.
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Installation, Care, and Maintenance
2.6.1 Conformance to Standards
All X-ray equipment for Dental Intra-oral Radiography used with DEXIS Tita-
nium must conform to IEC 60601-2-65.
The DEXIS Titanium sensor conforms to safety standard IEC 60601-1.
All IT components electrically connected to the DEXIS Titanium sensor
must conform to IEC 60950-1.
Normally, the IT components are placed OUTSIDE the patient environment.
IT components placed INSIDE the patient environment, due to customer
site requirements, must also conform to IEC 60601-1.
IEC 60601-1 defines the “Patient environment” as “any volume in which in-
tentional or unintentional contact can occur between a Patient and parts of
the Medical Equipment (ME) or ME System or between a Patient and other
persons touching parts of the ME Equipment or ME System.”
CAUTION
US Federal law restricts this device to sale by or on the order of a
dentist or other licensed practitioner.
2.6.2 Safety Considerations
All external surfaces of the sensor, sensor cable, sensor holders and the
sensor sheaths are considered to be applied parts and are safe for normal
or accidental patient contact during use.
The DEXIS Titanium sensor has no serviceable parts. Do not open the de-
vice to service it. All aspects of the sensor that are meant to be attended to
by the operator are accessible without opening the internal components of
the device. If there is a service problem, contact a qualified dealer service
representative or DEXIS Technical Support.
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Mains Isolation
Disconnection from the supply mains occurs at the input to the computer.
The sensor can also be disconnected from the computer.
X-ray Protection
The rules of dental radiography still apply to digital X-ray systems. Please
continue to use protection for your patients. As a clinician, clear the imme-
diate area when exposing the sensor.
Prevention of Cross-Contamination
To help prevent cross-contamination between patients, place a
new hygienic barrier on the sensor for each new patient. The hy-
gienic barrier must cover the sensor and at least 3-4 in. (7-10 cm)
of the cable.
For information about cleaning the sensor, refer to“Proper Care of the DEXIS
Titanium Sensor” on page 15.
Prevention of Environmental Contamination
Dispose of sheaths and other consumable products following the normal
dental office procedure for biomedical waste. Improper disposal of bio-
medical waste can lead to the spread of illness or disease.
Properly dispose of the sensor when it has reached its end of life.
For information, refer to the explanation of this symbol on page 42.
Sensor Inspection
Always inspect the sensor, cable, and positioning devices for physical
damage prior to every use. See “Proper Care of the DEXIS Titanium Sensor”
on page 15.
Titanium Manual.book Page 14 Monday, August 6, 2018 4:40 PM