MEDISTIM VQ4122 User manual

MEDISTIM V
eri
Q™ SYSTEM USER MANUAL
Mod. VQ4122 | VQ2111 | VQ1111 | VQ4001 | VQ2011 | VQ1011 | VQ1001 |

CONTENTS
1. INTRODUCTION 3
1.1 Purpose ......................................3
1.2 Contact information ............................3
1.3 Manual structure and use .......................3
1.3.1 Relevant books and documents................... 3
1.3.2 Update of user manual .......................... 3
1.4 Warning statements and safety markings ..........3
1.4.1 User manual warning statements.................. 3
1.4.2 User manual language options.................... 3
1.5 Safety marking description ......................3
2. INDICATIONS FOR USE 4
2.1 Indications for use statement ....................4
2.2 Contraindications ..............................4
2.3 Health, environment and safety...................4
2.4 Warranty .....................................4
2.5 Operational environment requirements ............4
2.6 Requiredqualicationsofpersonnel ..............4
2.7 Limitations for use .............................4
2.8 Possibleoperationalinuence ...................5
2.9 Consumables .................................5
2.10 Access to spare parts and service ................5
3. TECHNICAL DESCRIPTION 6
3.1 Frontpanelandchannelcongurations ............6
3.1.1 Pay-Per-Procedure ............................. 6
3.1.2 USB port connections .......................... 6
3.2 Principle of measurements ......................6
4. DELIVERY AND CONFIGURATION 7
4.1 Receiving the Medistim VeriQ™ system............7
4.2 Unpacking and packing .........................7
4.3 Verifying system identity ........................7
4.4 Verifying electrical safety........................7
4.4.1 Starting the system............................. 7
4.5 Initialconguration.............................7
4.6 Auxiliary inputs ................................8
4.6.1 Calibrating the AUX channel for ECG............... 8
4.6.2 Calibrating the AUX channel for pressure ........... 8
4.6.3 Shutting down the system ....................... 8
5. OPERATING THE V
eri
Q™ 9
5.1 Requirements for personnel .....................9
5.2 Basic principles of operation.....................9
5.2.1 Correct plugging and unplugging of probes ......... 9
5.3 Preparations by system operator ................10
5.3.1 Probe preparation............................. 10
5.3.2 System Start-up .............................. 10
5.3.3 Entering patient data .......................... 10
5.3.4 Connecting ECG (optional)...................... 10
5.3.5 Inserting key-card (PPP systems only)............. 10
5.3.6 Probeverication ............................. 10
5.3.7 Deningthevesselnames .......................11
5.4 Preparation by surgeon ........................11
5.5 Tasks during procedure by operator..............11
5.5.1 Doppler measurements .........................11
5.5.2 Performing vessel search ....................... 12
5.5.3 Detect position and quantify a stenosis ........... 12
5.5.4 Transittimeowmeasurements. . . . . . . . . . . . . . . . . . 12
5.5.5 OptimizingtheDopplerandowdisplay ........... 12
5.5.6 Saving Measurements ......................... 13
5.5.7 Memory scroll and trace review .................. 13
5.5.8 Review of recorded data ....................... 13
5.6 Tasks during operation by surgeon...............14
5.6.1 Doppler velocity measurements ..................14
5.6.2 Flow measurements ............................14
5.7 Post-operative procedures .....................14
5.7.1 Retrieve patient from database ...................14
5.7.2 Cleaning and disinfection of probes ...............14
5.7.3 Sterilization ...................................14
5.7.4 Reporting ................................... 15
5.8 Icon description ..............................16
5.9 System settings description ....................17
5.10 Other adjustments ............................18
5.10.1 Tuning Doppler noise .......................... 18
5.11 Data Management ............................19
5.11.1 Search function............................... 19
5.11.2 Edit, print, delete and export measurements. . . . . . . . 19
5.11.3 Export and import data ........................ 19
5.11.4 Safe removal of storage devices ................. 20
5.12 Derived traces................................20
5.12.1 Fast Fourier Transformation (FFT) ................ 20
5.13 Trend measurements ..........................21
5.13.1 Save, review and edit trend curves ............... 21
5.14 Measurement and Analysis (M&A) ...............21
6. TROUBLESHOOTING 23
6.1 Service of the VeriQ™ System...................23
6.2 Basic troubleshooting .........................23
6.2.1 Troubleshooting users guide .................... 23
7. MAINTENANCE 24
7.1 Probe statistics...............................24
7.2 Periodic maintenance..........................24
7.3 S torage .....................................24
7.4 Packing and transport .........................24
7.5 Disposal instructions ..........................24
8. TECHNICAL SPECIFICATIONS 25
8.1 System overview..............................25
8.2 Technicalspecications........................26
APPENDIX A. PROBE APPLICATION OVERVIEW 30
A.1 Probe application and size guide ................30
A.2 List of available Medistim probes ................31
APPENDIX B.PROBE CLEANING, DISINFECTION AND STERILI-
ZATION 33
B.1 General .....................................33
B.2 Overview of probe cleaning manuals .............33
B.2.1 PA-, PB-, PR-, and PQ-probe series .............. 33
B.2.2 Doppler probe................................ 33
B.2.3 PS-probe series .............................. 33
B.2.4 PV-probe series .............................. 33
B.2.5 EL15 Ultrasound Imaging probe.................. 33

© MEDISTIM 2015
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1. INTRODUCTION
1.1 Purpose
The purpose of this User Manual is to give a thorough de-
scription of the Medistim VeriQ™ System.
1.2 Contact information
Medistim ASA
HeadOfce:
Økernveien 94
0579 Oslo, Norway
Telephone:+4723059660
Fax:+4723059661
E-mail:[email protected]
Internet:http://www.Medistim.com
ManufacturingandServicesupport:
Moloveien 10,
3187 Horten, Norway
Telephone:+4733031710
Fax:+4733031726
E-mail:[email protected]
1.3 User Manual structure and use
1.3.1 Relevant books and documents
Please refer to the following relevant information in addition
tothisUserManual:
• www.medistim.com
• ServiceManualforVeriQ™p/n:VQ1980GB
• IntraoperativeGraftPatencyVericationduringOn-and
Off- Pump Coronary Bypass Surgery” by Hratch L. Kara-
manoukian, MD and Harry W. Donias, M.D.,Medistim ref.
number MM117803
• IntraoperativeGraftPatencyVericationinCardiacand
Vascular Surgery”. ISBN# 0-87993-488-3s
1.3.2 User Manual Update
IntheincidenceofadditionalmodicationstotheVeriQ™,
a new revision of the Medistim VeriQ™ User Manual will be
distributed by Medistim ASA.
1.4 Warning statements and safety markings
1.4.1 User Manual warning statements
This User Manual uses Warnings and Notes according to the
followingdenitions:
Warning
This warning will describe clinical contraindications and
possible damage to the device if the recommended instruc-
tions or recommendations are not followed. Please read and
follow these warnings carefully. If Warnings are not taken
into consideration, serious injury and damage to personnel,
devices and the operating environment can occur. The man-
ufacturer cannot be held liable for injury or damage if these
precautions are disregarded.
Note
A Note contains important tips, recommendations and sup-
plementary information intended to optimize the use of the
system.
1.4.2 User Manual language options
The User Manual is, upon request, available in English,
French, Spanish, Swedish, Danish, Norwegian, German and
Italian.
1.5 Safety marking description
On/Offbutton(push-push)
Attention, consult accompanying documents
Protective earth (ground)
Terminal for Potential Equalization
Consult accompanying documents
(Required to consult for safety)
Pushing prohibited
Warning
Medical electrical equipment needs special precautions
regarding electromagnetic compatibility (EMC) and needs
to be installed and put into service according to the instruc-
tions provided in this manual. Portable and mobile radio fre-
quency (rf) communications equipment can affect medical
electrical equipment. No connection from the internal signal
input/outputs located at the lower side of the electronic
unit to external equipment are allowed. For DICOM enabled
systems, the network connection marked with IEC60601-1
compliance are excepted from this.
Warning
To avoid risk of electric shock, this equipment must only be
connected to a supply mains with protective earth
Warning
Equipment connected to the systems signal input/ output
shall comply with iec 60601-1 clause 16
Potential Equalization conductor
A terminal for potential equalization is located at the back
of the power unit of the system. The terminal can be used if
potential equalization needed but is no replacement for the
protective earth conductor of the power chord as required
by IEC60601-1 cl. 8.6.7.

© MEDISTIM 2015
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4
2. INDICATIONS FOR USE
The Indications for use statement for the Medistim VeriQ™
System is shown in Section 2.1 below. For the System model
that supports Ultrasound Imaging, VeriQ C™, refer to indica-
tionsforusestatementin:“MedistimVeriQC™SystemUser
Manual, Addendum to the Medistim VeriQ™ System User
Manual VQ1990 for model VQ4122C.”
2.1 Indications for use statement
The Medistim VeriQ™ System is designed to perform
intra-operative guidance and quality control during cardio-
vascular surgical procedures and meets the demands for
documentation of surgical procedures. The following is the in-
dication for use statement cleared by the US Food and Drug
AdministrationonApril29th2004(K040228):
“TheMedistimVeriQ™Systemisanintraoperativediagnostic
system that utilizes ultrasonography to guide surgeons to
successfully plan and accomplish surgical interventions. The
clinicalindicationsforthedeviceare:
1. Accurate transit time blood volume and Doppler velocity
owmeasurementsduringcardiovascular-,vascular-,
transplantation- and neurosurgery.
2. Simultaneous measurements of blood pressure, vascular
resistance, interfaced physiological signals and other
derived parameters during these procedures.
3. Detection of normal and abnormal blood volume and
Dopplervelocityowpatternsduringtheseprocedures.
4. Provides guidance to prepare surgical plans at the initi-
ation of surgery and to support the successful accom-
plishment of surgery including detection and location of
vessels during surgical procedures.
5. Detectionandquanticationofthedegreeofstenosisin
arteriesbyusingtheDopplervelocityprole.”
2.2 Contraindications
Warning
Do not use this device for other applications than the intend-
ed use. The Medistim VeriQ™ System is not intended for any
kind of fetal applications.
Warning
Transit time and Doppler ow measurements are routinely
used for non-diseased vessels such as saphenous vein
grafts, different arteries and harvested mammaries. In the
vessels, thrombus or calcied plaque will not be present.
However, thrombus or calcied plaque may be present
before certain clinical procedures, such as carotid endar-
terectomy, or before performing a proximal anastomosis on
the aortic arch. In such, or similar procedures the surgeon
may want to measure blood volume ow or velocities prior to
performing the surgical intervention.
Manipulation of vessels with thrombus, calcication or other
conditions may have serious consequences for the patient,
and represents a contraindication for the Measurement of
blood ow. Sound medical judgment should therefore be
exercised and the nal responsibility for measuring ows in
diseased vessels lies with the physician. Please avoid any
pinching of vessels during the ow measurements.
2.3 Health, environment and safety
No health, environment or safety considerations are related to
the Medistim VeriQ™ System.
2.4 Warranty
The Medistim VeriQ™ system is warranted against defective
material and poor workmanship for a period of 24 months
after installation, and limited to 25 months from date of ship-
ment.
The Medistim probes are warranted against defective materi-
alandpoorworkmanshipforaperiodof12monthsafterrst
use,andlimitedtoamaximumof50.(Seespecicationsfor
each probe.)
All other probes are warranted against defective material and
poorworkmanshipforaperiodof6monthsafterrstuse,
and limited to a maximum of 50 usages.
2.5 Operational environment requirements
Thefollowingarerequirementsforuse:
• Correct electrical supply
• Ground terminal
• Indoor use only
• For intra-operative use only
2.6 Required qualications of personnel
All persons operating VeriQ™ must have read this User Man-
ual before using the device.
2.7 Limitations for use
TransitTimeFlowMeasurement(TTFM)andDopplerow
measurements are routinely used for non-diseased vessels
such as saphenous vein grafts, different arteries and har-
vestedmammaries.Inthesevessels,thrombusorcalcied
plaque will not be present.
However,thrombusorcalciedplaquemaybepresentbefore
certain clinical procedures such as carotid endarterectomy or
before performing a proximal anastomosis on the aortic arch.
In such procedures, or similar procedures, the surgeon may
wanttomeasurebloodvolumeoworvelocitiespriortoany
surgical intervention.
Manipulationofvesselswiththrombus,calcicationorother
malfunctionsinordertomeasurebloodowmayhaveseri-
ous consequences for the patient and is a possible contra-
indicationforperformingbloodowmeasurements.Sound
medicaljudgmentshouldthereforebeexercisedandthenal
responsibilityformeasuringowsindiseasedvesselswilllie
withthephysician.Anypinchingofthevesselsduringow
measurement should be avoided.

© MEDISTIM 2015
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2.8 Possible operational inuence
As probe size, positioning and placement on the vessel may
inuenceaccuracy,itisimportantthatallmeasurementsare
made as described in this manual. To avoid the disruption
or corruption of the calculated Diastolic Filling Percentage
(DF), no action should be taken that compromises the quality
of the ECG signal, and DF is dependent on a stable ECG
recording.SimultaneoususeofDiathermyandow/velocity
measurements should be avoided as the Diathermy interferes
with the measurements and can make them unreliable.
2.9 Consumables
Necessaryconsumableitemstoperformanoperation:
• Various probes
• Sterile Ultrasound couplant
• Ink cartridges for color printer
• Printer paper
2.10 Access to spare parts and service
Please contact your local representative to request VeriQ™
service or spare parts.
Refer to our website www.medistim.com for a list of local
contacts and distributors.
Warning
No modication of this equipment is allowed.
Warning
Do not modify this equipment without authorization of the
manufacturer.
Warning
If this equipment is modied, appropriate inspection and
testing must be conducted to ensure continued safe use of
the equipment.

© MEDISTIM 2015
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6
3. TECHNICAL DESCRIPTION
The VeriQ™ system is designed for intra-operative quality
control and the need for documentation of surgical proce-
dures. Through its capability to measure transit time volume
owandDopplerowvelocity,theVeriQ™canhelpdevelop
optimal grafting strategies and to document graft patency.
The VeriQ™ system consists of a 19 inch touch screen, dis-
playingsignicantowvariables.Themenu-drivenprogram
is managed through the use an intuitive graphical, icon-driven
interface. Improper data entry and incorrect operations are
minimized through the use of an on-screen keyboard that
appears only when it is required.
TheVeriQ™usesvemainscreenviews;theHomescreen,
the Measure screen, the Data screen, the Help screen and
the System Settings screen. The user can move between
screens by pressing the screen tabs located in the top left
corner.
All reports and documentation can be written directly to the
printer connected to the system.
3.1 Front panel and channel congurations
The VeriQ™ system can be supplied with a range of differ-
entchannelcongurationstoaccommodatevariousclinical
needs.Thechannelcongurationsaredescribedinthemodel
number,wheretherstdigitliststhenumberofowchan-
nels, the second digit is the Doppler channel, third digit is
the number of pressure channels, and the fourth digit is the
number of auxiliary channels.
TheVeriQ™4122hasfourowchannels,oneDopplerchan-
nel two pressure channels and two auxiliary channels. The
model number is part of the system identity and can be found
on the front of the system under the blue top cover.
3.1.1 Pay-Per-Procedure
The VeriQ™ system is either supplied as a capital purchase,
or through a pay-per-procedure (PPP) program, where license
“smartcards”arerequiredinordertoactivatethedevice.
3.1.2 USB port connections
The VeriQ™ system has 2 USB 2.0 ports located on the left
side of the front panel for connecting external equipment like
a memory stick to import or export data .
Warning
The front panel USB connector has no galvanic separation.
In order to maintain continued patient safety, no equipment
powered by an external power source must be connected to
the USB port during clinical use of the system.
3.2 Principle of measurements
Transit time ow volume
Medistim transit time probes surround the vessel, gener-
atingauniformultrasoundeldacrossthevessellumen.
Ultrasound pulses are transmitted from a crystal on one side
oftheprobe,tothereector,andbacktoacrystalonthe
opposite side. The transit time is measured for each pulse,
with the difference in transit time between the pulses going
upstream and downstream being proportional to the volume
(Q) passing through the probe.
Doppler principle
Whenanultrasoundbeamisreectedbyamovingobject,
thefrequencyofthereectedpulseischanged.Anobject
moving towards the ultrasound beam will compress the
waveform and increase the frequency. Correspondingly, an
object moving away from the beam will lengthen the wave-
form and decrease the frequency.
The change in frequency, also called Doppler shift, represents
the velocity and direction of the moving target. To limit prob-
lems relating to the ultrasound beam’s angle of incidence
with the blood, the Doppler probe has a built-in angle of
45 degrees. Holding the probe perpendicular to the vessel
direction will ensure accurate velocity measurements Note
that this causes the probe to measure the velocities in front
or behind the actual probe position, but never right under the
probe.
The VeriQ™ applies a pulsed Doppler, allowing the user to
control the depth from where the velocity should be mea-
sured. Additionally, sample volume is adjustable, and select-
ed as a range around the depth setting. The default settings
are a depth of 5 mm, and a volume of 6 mm. These settings
allowforsamplingowvelocitiesatdepthsfromto2to8mm
from the probe surface.

© MEDISTIM 2015
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4. DELIVERY AND CONFIGURATION
The purpose of this section is to prevent damage to property
and injury to personnel through the delivery, installation and
preparation of the VeriQ™.
4.1 Receiving the Medistim VeriQ™ system
The system is shipped complete in one large, wooden crate
Probes and accessories may be packed in a carton placed
inside the system crate.
Upon receipt, please observe that there is no visible damage
to the crate, and that the handling indicators (shock and tilt)
attached to the crate are still intact.
Any visible damage should be reported to the freight forward-
er upon receipt.
4.2 Unpacking and packing
Please refer to the instructions provided with each crate for
proper unpacking.
Medistim recommends that the original packing materials be
used when the system is transported between facilities. For
service purposes, a specially-designed container is available
through your local representative.
4.3 Verifying system identity
The model number, serial number and revision number are
Noted on the system identity label located on the upper front
side of the electronic unit, just under the blue top cover.
4.4 Verifying electrical safety
The system has been tested for electrical safety prior to
delivery,andareportisattachedtothesystemconguration
sheet placed together with the User Manual in the shelf under
the printer.
Ifanewvericationismadeinconnectionwiththeinstal-
lation, please refer to the chapter 8.2, External wiring, for
system grounding information.
Warning
The Medistim VeriQ™ System can be seriously damaged
if the system is turned off before the Windows booting se-
quence is complete. Do not turn the device off during the
booting sequence. Wait until the patient data entry screen is
displayed.
4.4.1 Starting the system
Check to make certain the main power switch, located on the
righthandsideunderneaththeprintershelf,isinthe“on”po-
sition. When this switch is on, both the switch itself and the
printer indicator lights will be on. To start the VeriQ™, press
the soft-power button, located on the right side of the top
cover beside the monitor. The software boot sequence will
take approximately 35 seconds before the system is ready for
use.
4.5 Initial conguration
StarttheVeriQ™andselectthe“systemsettings”screen.
The system setup menu is accessed by pressing the System
settings icon in the top left of the screen.
Software version
The software version currently installed on the system can be
identiedbyopeningthe”SystemInformation”pagelocated
on the ”Advanced System Functionality” page.
Enter hospital name and address
The hospital name and address should be entered before
the system is put into service. On the system settings screen
press“edit”intheupperleft,andatouchscreenkeyboard
will appear. Enter the name and address of the hospital in the
available dialog boxes. Press OK when completed.
Select system prole
TheVeriQ™canhandledifferentproles;Cardiac,Vascular
and Experimental. adapting the available vessel names to the
selectedprole.Eachprolecanbeedited,andoperating
surgeonscanbestoredundereachprole.Selecttheap-
propriateprolebypressingthedrop-downmenu“System
prole”
Select ECG Channel
The VeriQ™ should always be hooked up to the anesthesia
monitoring system in order to slave the ECG signal. The
ECG signal is used to synchronize the timing of the recorded
oworvelocitytraces.VeriQ™willbesuppliedwithanECG
cable,ttingoneofthetwoAUXconnectors,andshouldbe
matched to the manufacturer of the anesthesia monitoring
system. Verify that the AUX channel selected for ECG in the
system setup menu corresponds to the available ECG cable.
Set measuring unit
Metric or US measuring units are selected by pressing the
drop down menu ”Measurement unit”. Note that the measur-
ing unit is for display use only, and can be changed at any
timewithoutinuencingdataalreadystoredinthesystem.
After connecting a pressure transducer, the system allows the
settingofzero-levelandne-tuningofthegainforoptimal
measurements. The procedure requires reference signals
of 0 mmHg and 100 mmHg. Enter the calibration screen by
pressing the Pressure properties button.
First apply 0 mmHg and press the zero-button. Wait until the
curve stabilizes at zero. Then apply 100 mmHg and adjust the
gain until the curve rests at 100 mmHg.
The calibration of the pressure channels are non-persistent
and must be done for each new transducer.

© MEDISTIM 2015
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8
4.6 Auxiliary inputs
The auxiliary inputs can be used to measure any external
voltagesignalwithin±4V.Thesignalisltered,conditioned,
assigned to a measurement unit and included in the VeriQ™
measurement set. The available signal ranges are ±10mV,
±100mV, ±500mV and ±4V. The user can select signal level,
measurementunit,lteringandsignalconditionfromtheAUX
calibration screen as described in the sections below.
When selecting mmHg as the measurement unit, the sys-
tem treats the AUX input as a pressure input with respect to
derived traces and calculations.
The AUX channel selected for ECG input will automatically
display the heart rate in BPM and the systolic and diastolic
phases can be drawn on the curve trace (user selectable).
For other measurement units selected, the curve trace will
simply show the measured value in terms of the selected
unit.
4.6.1 Calibrating the AUX channel for ECG
Turn on the system and connect the ECG cable to the
anesthesia monitoring system. For the purpose of calibration,
an ECG simulator can be used with the monitoring system.
Select the Live session screen, and the Auxiliary curve
window will appear. Depending on signal strength, the ECG
waveform will be visible. If the scale and measuring unit ap-
pear correct, no further adjustments are necessary.
To improve the settings for optimal display, press the ECG
properties button and the Calibrating ECG window will
appear.
After selecting the correct measuring unit, ECG, select
an input factor that corresponds to the signal input. If the
displayed signal has a low amplitude, then select a smaller
input range. Note the AD range displayed in the upper right-
hand corner of the curve window, as it is important that the
ADrangeislessthenthesaturationlevelof100%.Forne
adjustments within the selected range, use the Scaling up
and down buttons.
When the correct ECG curve is displayed, the settings should
be saved by pressing the Save button. To ensure that the
new setup is used whenever the ECG is connected, press the
Set current as default button.
Note
When using the Medistim VeriQ™ System with more than one
monitoring system that requires independent adjustments,
different calibration settings can be saved under a prole
name, such as OT 1 and OT 2. The operator can choose the
stored calibration each time the system is moved by entering
the calibration menu and selecting the appropriate saved
prole.
4.6.2 Calibrating the AUX channel for pressure
Turn on the system and insert the cable from the signal mon-
itor. For calibration, a simulator that emits known signals can
be used. Select the Live session screen, and the auxiliary
curve window will appear. Depending on the signal strength,
the monitored curve may be visible straight away. To cali-
brate the curve, press the AUX1/2 properties button and the
Calibrating AUX1/2 window will appear.
In order to calibrate the curve properly, a signal with two
known amplitudes is needed. One of these is typically zero,
the other can be chosen randomly as long as it is feasible
and known.
First, select the correct measuring unit. (For pressure, it
would be mmHg.) Then select an input range that corre-
sponds to the physical signal. If the signal has low amplitude,
select a smaller input range.
It is important that the AD range displayed in the upper part
of the curve window is less than the saturation level of 100%.
When the signal from the monitor is set to zero, press the
Zero button on the lower right side of the curve view to set
the zero signal level. Change to the signal value with known
amplitude and use the scale up and scale down buttons to
adjustthedisplayedvaluesothatittstheinput.Readjust
the input range if necessary.
Whenthecalibrationissatisfactory,assigntheprolean
appropriate name in the Currentprole edit box and press
Save.
Tosettheactiveproleasdefaultforthechannel,pressthe
Set current as default button on the lower left part of the
screen.
For all types of AUX measurements the calibration process
is exactly the same. Exchange the unit to suit the measured
variable. Adjust input range and gain so that the signal is
within saturation limits and correct for two known values.
4.6.3 Shutting down the system
The system should be turned off by the soft-power button
rst,andbeallowedtopowerdownbeforeusingthemain
power switch on the transformer unit. Do not unplug the
power cable before this is done.
It is not necessary to exit the application or do additional
saving before powering down the system.
When preparing for storage, unplug the power cord from the
wall by pulling on the plug itself, do not pull on the cable. If
the system is equipped with a network cable, be careful to
also unplug this from the wall socket. Use the cable hook on
the back cover of the VeriQ™ to coil the cable(s). All probes
should be unplugged and stored properly if not sent to clean-
ing and sterilization.

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5. OPERATING THE VeriQ™
The purpose of this section is to provide the user with a refer-
ence for the operation of the VeriQ™.
5.1 Requirements for personnel
To successfully operate the VeriQ™, at least two persons are
required. One controlling the probe and the other the system
controls.
The main task for the system operator is to prepare the
system before use, adjust the system during operation and to
saveessentialndingsinordertodocumenttheprocedure.
During the operation, it is important for the surgeon and op-
erator to maintain a good dialog to work effectively and get
the best possible results.
5.2 Basic principles of operation
VeriQ™ incorporates 19-inch touch screen with a graphical
user interface. Operation of the VeriQ™ is intended to be very
intuitive, eliminating non-essential commands, and present-
ing an on-screen keyboard only when necessary. To further
simplify operation for novice users, certain advanced func-
tions are not readily-accessible. Advanced functions can be
activated once the operator is familiar with the basic system
operation.
The patient name will always be displayed at the top center
of the screen. When no patient data has been entered or
selected, the system will use the current date and time as
the patient name. In the top right corner the current data and
time is displayed. On Pay-Per-Procedure (PPP) systems a
eldinthetoprightcornerwilldisplaytheremainingproce-
dure time once a procedure has been activated.
The VeriQ™ has ve main screen views:
1. Home screen
2. Measure screen
3. Data screen
4. Help screen
5. System Settings screen.
The user can move between screens by pressing the screen
tabs located in the top left corner. The ”Home” screen is used
to enter patient data when starting a new surgical procedure
and when searching for a patient in the database. This is the
start-up page, and by pressing the ”Home” tab the system
will return to this screen.
The”Measure”screenisthemainscreenforowmeasure-
ments, and can be accessed by pressing the ”Measure”
screen tab or by pressing ”OK” on the patient data screen.
Systems installed based on a ”pay-per-procedure” model
must be activated by using a smart card. On-screen prompts
will assist in system activation, and when a smart card has
not been inserted into the system, the message ”Insert valid
smart card to activate” will be shown in the message bar.
System status is displayed in the message bar that appears
near the top of the VeriQ™ monitor. To alert the user of status
changes, the background color will change. Press the ”Data”
tab to enter the screen that presents a thumbnail view of
each recorded curve on the current selected patient. Here,
stored datasets can be selected for viewing, editing, report-
ing or exporting. The ”Help Screen” contains an electronic
UserManual,andvideotutorials.The“Systemsettings”
screencontaintheusercongurablesettingsfortheVeriQ™.
5. 2.1 Correct plugging and unplugging of probes
To avoid accidental errors related to plugging a probe in the
wrong connector, the VeriQ™ probe panel and all probes
have unique keying features. This ensures that only TTFM
probescanbepluggedintotheowchannelsandviceversa
for the other channels.
When plugging a probe into the system connector, hold the
probe with the embossed arrows facing upwards, see picture
below, and press straight inwards.
All Medistim probes require very little force to be inserted
or removed. If excessive force is needed to plug a probe
this is a sign that something is damaged either in the probe
connector or on the system side connector. Inspect both
connectors carefully to identify possible bent or broken pins
in the probe connector, plugged or otherwise obstructed
holes in the system side connector.
Unplugging the probe is done by gripping the probe on the
widest part of the connector and pulling straight out. This
will release the locking mechanism and the probe will unplug
correctly. Do not attempt to unplug by pulling on the cable
or strain relief, this will not release the locking mechanism
and may damage the probe. See below image correct and
incorrect removal technique.

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10
5.3 Preparations by system operator
5.3.1 Probe preparation
Locate the necessary probes to perform the planned mea-
surements. For CABG procedures, a variety of QuickFit
probes will be required to verify graft patency. Additionally,
a Doppler probe will be needed to detect vessels, or locate
stenoses.
To select the optimal probe sizes, please refer to section 10
Probe Assortment.
5.3.2 System Start-up
Turn the system on before taking measurements, in order to
interface the necessary auxiliary signals and to enter patient
information.
Make sure the following items are available before the proce-
dures:
• A selection of sterile probes suitable for the planned pro-
cedure
• The ECG interface cable
• A valid key card (PPP systems only)
5.3.3 Entering patient data
When the system is turned on, it will start in the Home
screen. Use the soft-keyboard on the screen to enter patient
information, select the surgeon, and press OK. The system
will automatically proceed to the Measure screen.
Note
Medistim recommends that the patient name is entered in an
orderly and uniform way for easy storage and retrieval, e.g.
always with the last name rst. If no patient name is entered,
the date and time of operation will be used as the patient
identier.
5.3.4 Connecting ECG (optional)
Connect the ECG cable from the monitoring system and to
the appropriate Aux connector on the VeriQ™. Verify that
the ECG waveform is displayed correctly on the screen. For
adjustments of the ECG signal please refer to section 4.5.3.
The system may be left in this state until the surgeon is ready
to start measuring.
5.3.5 Inserting key-card (PPP systems only)
In order to do measurements, a valid license key card (Smart
card) is required for PPP-enabled systems. Insert the license
card into the card reader on the front of the device and await
thedialogboxconrmingvalidityofthelicense.Theproce-
duretimerofvehours(sevenhoursforimaginglicenses)
will start when ”Activate” is pressed. The ECG curve will be
visible and the ”Insert valid smart card to activate” message
will disappear.
Medistim supplies different smart cards to activate the sys-
tem.Thesearethedifferentsmartcardsversions:
1. Single use full function (transit time and Doppler).
2. Singleuseow(transittimeonly).
3. Single use Vascular.
4. Single use Imaging Add-On.
5. Singleuseow+Imaging.
6. Time-Limited full function (transit time and Doppler).
7. Time-Limitedow+Imaging.
The“singleuse”licensesaredisposableandrequirethat
anewcardbeusedforeverynewprocedure.The“time
limited” licenses opens the given functionality for a period of
time.Attherstuse,thecurrenttimeisregisteredinthecard
andthecountdowntimerstarts.Duringtheperiodspecied
by the license there are no limitations on the number of pro-
cedures performed.
The“ImagingAdd-on”licensecanonlybeusedafteraow
license has been activated. It activates the Imaging modal-
ity and resets the procedure timing. The procedure time for
all imaging licenses is seven hours. For more information
about the VeriQ™ System model(s) that supports Ultrasound
Imaging,VeriQC™referto:“UserManualVeriQC™,Ad-
dendum to VeriQ™ System User Manual VQ1990 for model
VQ4122C.”
Note
The validity of license cards can be tested at any time by
inserting them in the card reader. The system will display
the status of the card, and if cancel is pressed or the card
removed without pressing ”Activate procedure”, the card
license will remain intact.
5.3.6 Probe verication
Before probes are connected to the system, the monitor will
display ECG traces.
1. Connect the selected probes to the respective sys-
temchannels(ow,DopplerorImaging.)
2. For each entered probe a vessel name dialog box
willappear.Fortheprobevericationpurposethe
vessel name is not important, just press cancel until
the measuring screen is displayed.
3. Verify that the probe identity of the connected
probes appear on the screen.
Medistim recommends placing the probe head in sterile
saline and connecting it to the system before the surgeon is
ready to measure. This allows each probe to be tested before
use and it will improve the acoustical coupling when placed
on a vessel. With the probe immersed in saline, all transit
time probes should obtain an ACI value of > 90%. If a lower
value is obtained, shake the probe in the saline solution to
removeanybubbles.Airbubblesontheprobewillsigni-
cantly affect the ACI value. After removing any interfering air
bubbles, re-check the ACI value. If the displayed ACI value is
not a minimum of 90%, the probe is not working properly and
should be replaced.
Note
On PPP systems, acoustical coupling can be tested before
inserting the key card. The system will only display the acous-
tical coupling indicator and other probe related information.

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5.3.7 Dening the vessel names
When a probe is connected, a Vessel name dialog page will
automatically appear.
Note
The automatic appearance of the dialog page can be
switched off in the system settings menu.
During a measurement, or if the graft dialog does not
automaticallycomeup,pressthebutton“Vesselname
Undened”tolaunchthegraftdialog.Thisbuttonwillalso
be displaying the previous graft selection if one is made i.e.
LIMA - LAD. Press this button to get into the graft dialog to
set a new graft name.
Register vessel
1. Select type of graft conduit, source, target artery
and any attributes in the dialog page (1). The selec-
tioncanalsobemadefromthelistofthevemostly
used graft combination on the current machine.(2)
2. Thefreetexteld(3)canbeusedwhenthevessel
names already given do not cover the grafts and
vessels in question. Only one of these selections can
be made and the present selection will exclude the
previous.
The selection will be displayed under current graft directly
abovetheOKbutton.Tonish,pressOK(4)toselectorcan-
celtogobacktothemeasurementwithoutdoingthechange/
selection.
When generating a report or reviewing the case at a later
time, the vessel name will be important.
Note
The source may be omitted when obvious, and is primarily
intended for sequential grafts. The top ve most commonly
used graft names on the current machine can be selected
directly on the screen
Searching for vessels and detecting stenoses with the
Doppler probe will only require a target vessel and, possibly,
an attribute if measurements from different positions on the
same vessel are stored.
5.4 Preparation by surgeon
The surgeon needs to judge the diameter of the vessels to be
measured and inform the operator which probe(s) to connect.
Arterial conduits such as the internal mammary arteries have
to be skeletonized for a length corresponding to the width of
the probe, approximately 1cm.
5.5 Tasks during procedure by operator
5.5.1 Doppler measurements
The VeriQ™ will display the Doppler spectrum at the default
5 seconds sweep rate as soon as a probe is connected, as
shownongurebelow.

© MEDISTIM 2015
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12
Note
The Doppler velocity curve is sensitive to the ow direction. If
the signal appears under the baseline (see gure above), the
Doppler probe needs to be rotated 180º to accommodate the
measured ow direction.
5.5.2 Performing vessel search
When searching for intramuscular vessels, the surgeon
places the probe in the approximate area of the vessel, and
listens for the audible Doppler signal. The operator should se-
lect an appropriate volume setting that enables the surgeon
tohearthesignal,andpossiblyhelpdifferentiatearterialow
(pulsatilewaveformasthegureabove)orvenousow(con-
tinuousow)fromnoiseoriginatingfromprobemovements.
5.5.3 Detect position and quantify a stenosis
Whenlookingforastenosis,thesurgeonrstneedstomea-
sure a normal, patent segment of the vessel. When a stable
curve is displayed, the operator should press the ”reference
button”.
The system will display a reference line, demonstrating the
recorded reference peak velocity. When the surgeon relocates
the probe, the measured peak velocity will be compared
with the reference line. The system will display the change in
peak velocity as a percentage of stenosis. The velocity scale
may also need to be changed when the probe is on a narrow
stenosis, causing the peak velocity to increase by four times.
As soon as a stable measurement is reached, or whenever
the surgeon says so, save the measurement by pressing the
”Save” button.
5.5.4 Transit time ow measurements
TheVeriQ™displaystheowcurveatadefaulted5-seconds
sweep rate upon probe connection. Look for a green Acous-
tical Contact Indicator, which indicates appropriate contact
between the probe and the vessel. Inform the surgeon of
themeanowrate,thepulsatilityindex(PI)andthediastolic
lling(DF).Assoonasastablemeasurementisreached,or
whenever the surgeon says so, save the measurement by
pressing the ”Save” button.
5.5.5 Optimizing the Doppler and ow display
Change of vertical scale
IftheDopplerspectrumortransittimeowcurveappearvery
small, or exceed the height of the display, the vertical scale
should be changed.
1. Press on the top left part of the scale to increase
the scale. This will decrease the height of the dis-
played signal.
2. Press on the bottom left part of the scale to de-
crease the scale. This will increase the height of the
displayed signal.
Adjusting baseline position
The baseline position can be changed by dragging the base-
line up or down. The Doppler baseline can only be adjusted
whenrecording”live”,whiletheowandAUXchannelscan
bechangedin”Pause”,“Edit”andliverecordingmodes.

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Change of time sweep
Press either one of the icons on the top right side to change
the horizontal time scale.
1. Press (1) to increase the time sweep.
2. Press (2) to decrease the time sweep.
5.5.6 Saving Measurements
When saving, the last one minute of the recorded trace will
be stored. During a search for vessels, only the velocity trace
of the located vessel is necessary to save. When detecting
a stenosis, it will be important to save both the reference
velocity trace and the trace from the position of the stenosis.
Atransittimeowmeasurementcanbesavedassoonasa
stable measurement is reached.
Press the ”Save” button on the icon menu to store recorded
traces.
5.5.7 Memory scroll and trace review
The measurements need to be paused before memory scroll
can be performed.
1. Press the ”Pause” icon on the icon menu (1) to halt
the measurements.
2. Dragangeracrossthedisplaytoreviewrecorded
data.
a. Dragangerfromlefttorighttomovebackin
time.
b. Dragthengerfromrighttolefttomoveforward
in time.
Allowsometimeforthesystemtorecognizethengerpo-
sition before scrolling. Press the ”Save” icon (2) to store the
current position
Memory scroll can be used in the ”Archive” screen or
”Paused” mode when editing curves.
5.5.8 Review of recorded data
All stored measurement data can be reviewed. A thumbnail of
each stored data-set is presented on the screen, and the
number of thumbnails visible on a single page can be adjust-
ed.
System settings description
1. Press the ”Data screen” tab (1) to enter the explorer
screen.
2. Use the scroll bar (2) to view any thumbnails may not
be visible on the screen.
3. Select the wanted thumbnail for additional informa-
tion by pressing on the thumbnail (a check will ap-
pear on the selected thumbnail).
4. Pressthe”Edit”button(3)toreviewand/oreditthe
selected thumbnail.
5. Press the ”Printer” button (5) to print the patient re-
port with the selected thumbnails.
6. Press the ”Export” button (6) to export the report to
a desired external memory device. The report will
beexportedasaPDFle,withthesamedataasthe
printout.
7. Press the ”Delete” (7) button to delete the selected
thumbnail(s).
Note
After editing a curve, changes can be made permanent by
pressing the ”Save” icon. When multiple curves are selected
for editing, pressing the arrows on the bottom of the screen
will bring the next selected le into
edit mode.
Note
All thumbnails can be selected by pressing the box containing
the date and time of operation.
Pressthe”Back”icontore-enterthe“Archive”screenwhen
in editing mode. For the more-advanced user, an”Advanced”
system mode can be chosen.

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14
5.6 Tasks during operation by surgeon
5.6.1 Doppler velocity measurements
To get an accurate velocity measurement, the Doppler probe
should be held perpendicular to the vessel being measured,
asitstransmittingcrystalisxedata45ºfromtheprobe’s
surface. Movements of the probe, such as those caused by
a beating heart, will cause a strong low-frequency noise on
the Doppler spectrum. This can be avoided by applying a
mechanical stabilizer, or for smaller movements, by increas-
ingthelowvelocitylterinthesystem.
The Doppler probe should be held with the angled crystal
pointingagainsttheowdirection,asshownontheillustra-
tion above. If the probe is held the opposite way, the velocity
curve will appear below the baseline.
Theoperatorcanchangetheltersettingsbypressingthe
Doppler probe identity button.
For correct data management, it is important to inform the
system operator about the measured vessel name and the
probe position on the vessel (Ex. LAD Proximal, LAD Stenosis
or LAD Distal) and to inform the operator when to save the
recorded Doppler spectrum.
5.6.2 Flow measurements
As with the Doppler measurements, the operator needs to be
informed which type of conduit, connection, and target ves-
selisbeingmeasured.Whentheowprobeisplacedontoa
conduit, the system will generate a simulated Doppler sound,
indicatingthatowhasbeendetected.
The volume of this sound is adjustable, using on-screen
buttons.TheoperatorshouldconrmthatACI(Acoustical
Coupling Index) value is > 50%, with a green background,
ensuring that measurements will be valid . If the ACI is not
green, consider using sterile ultrasound couplant, spraying
saline on the probe head, skeletonizing the vessel or using a
different probe size. If there is a gap between the vessel wall
and the probe surface, the probe is too large and a smaller
probe should be used. If parts of the vessel are squeezed out
of the probe, the probe is too small and a larger probe should
be used.
Toensureaccurateowmeasurement,itisimportantthatthe
probe is placed perpendicular to a straight segment of the
measured vessel. All parts of the vessel should be inside the
probe.
Recommended probe placement on straight vessel seg-
ments.
5.7 Post-operative procedures
5.7.1 Retrieve patient from database
1. Go to the Home screen by pressing the ”Home” icon
2. Press the ”Search” button
3. Specify search criteria
4. Press ”Perform search”
5. Selectapatientbyclickingonhis/hernameand
then ”Select Patient” at the bottom of the page. To
export the patient data, click on the patient’s corre-
sponding blank box under the heading ”Select”.
6. Click on ”Export”
7. Press the ”Data” icon to view the stored data for the
selected patient
5.7.2 Cleaning and disinfection of probes
It is important to clean the probe immediately after the opera-
tion, to prevent blood from drying on the probe. During clean-
ing, the probe must be handled carefully, avoiding stretching
ofthecableorbendingoftheneckorsteelreectoronthe
probe. The probe can be cleaned in lukewarm water using a
mild soap-solution.
If the probe needs to be disinfected before handling, it is
important that only solutions tested and validated by Me-
distim ASA are used on the probe. An updated list of tested
solutions may be found on our web site, www.medistim.com
5.7.3 Sterilization
The different Medistim probe series must be sterilized using
specicmethodsforeachseries.SeeAppendixB.2foran
overview of the probe cleaning manuals available for each
probe series.
Note
The probes have been limited to 50 sterilization cycles / usag-
es. When a probe reaches 50 usages it will be deactivated.

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5.7.4 Reporting
Following the operation, the surgeon should review the stored
data in the ”Archive” screen, and select the measurements
that best represent the performed surgical procedure.
The selected measurements will be marked with a green
check-mark, indicating that they are selected for reporting.
Thereportcaneitherbeprinteddirectlybypressingthe“Print
reportbutton”orstoredasaPDFlelocallyoron a remov-
able USB stick.
Thereportlayoutcanbechangedinthe“Reportlayout”pop-
up.
Measurementsthathavebeenreportedwillbeaggedwitha
greencheckmarkandthetext“Qualied”.These“Qualied”
measurements should not be changed as they are now re-
garded as valid documentation for the performed procedure.

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5.8 Icon description
The following overview gives a description of all icons
used in the different system screens.
Home data screen - Screen to record patient data,
edit patient information and retrieve saved information
Measure screen-ScreenforDopplerandow
measurements, identifying vessel names and saving
measurements
Imaging screen - Screen for Imaging measurements.
Do 2D, CFM or PW-Doppler,identify vessels and save
measurements. Only available on VeriQ C™.
Data screen - Edit, delete, print and export saved
measuerments.
Help screen - Video tutorials and the electronic User
Manual for the VeriQ™ System can be found here.
System Settings - Customize system setup here.
Time Compression - Decrease time sweep for all trac-
es in steps. Down to 1 second.
Time expansion - Increase time sweep for all traces in
steps. Up to 60 seconds.
Save Data - Save recorded data to the patient data-
base.
Measurement pause - Press to pause measurement.
The icon will change to the play symbol.
Measurement play - Press to resume measurement.
The icon will change to the pause symbol.
Derived curves-Choosecombinationofowand
pressure channels for derived curves.
Trend setup - choose number of channels and set
sweep time for trend recordings.
Trend / live - In trend measurement mode, this button
will allow the user to switch between trend and live
mode measurements.
Measure and Analyze - Displays calculated values
and measurement tools.
Volume control - The lowest position will turn sound
off.
Soundon/off
Probe properties-Probeinformation,ltersettings,liquid
type, temperature and sound, velocity settings, Measure and
Analyze, index selection and ACI.
Flow wizard-Displaysstandardowcurveswhen
commonly-used vessel names are chosen.
Invert-Iftheowcurvesgoesbelowthebaseline,
pressing this button will invert the curve.
Export report - Selected measurements are exported
to an external memory device in PDF format.
Print - All selected measurements will be printed.
Delete - Will delete selected item(s).
Select / Edit - View or edit selected measurement
curves.
Display 4 measurements at a time. Displays mea-
surements with large thumbnails in a 2 by 2 arrange-
ment.
Display 9 measurements at a time. Displays mea-
surements with large thumbnails in a 3 by 3 arrange-
ment.
Display 16 measurements at at time. Displays mea-
surements with small thumbnails in a 4 by 4 arrange-
ment.
Thumbnails - Go to explorer screen. Press this icon
to return to the explorer screen when in editing mode.
Screen shot or video export - The selected screen
shot or a video of the ultrasound recording can be
exported to an external memory device.
Move up onelevelwhenbrowsingthelesystem.
Create new folder.
Video tutorials - Press this icon to access video tutori-
als on the VeriQ system.
User manual - Press this icon to access the electronic
user manaul.
Increase Doppler gain - The spectrum will become
darker with the possibility of increased noise. Used
with the Medistim Doppler probe.
Decrease Doppler gain - The spectrum will become
more transparent with less noise. Used with the Me-
distim Doppler probe.
Increase sample volume - Increases the sample vol-
ume of the Doppler by 1mm.
Decrease sample volume - Decreases the sample
volume of the Doppler by 1mm.
Doppler reference speed - This button will mark the
current maximum speed and use it for stenosis grade
calculations.

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Search Archive - Triggers a search operation and
searches for patient(s) in the internal archive.
New patient - Triggers the creation of a new patient
intheinternalarchiveandwillopena“newpatient”
screen.
Edit patient info - Edit or add information to a patient
le.
Comments-Opensacommentseldforthecurrent
measurement set.
5.9 System settings description
Under the tools icon there is a comprehensive system set-
tingsmenu,controllingsystemcongurationsandfeaturenot
frequently used.
The system settings menu contains the following set-
tings:
1. Nameandaddressofhospitalcanbeentered/ed-
ited and will be recorded on the patient report
2. Surgeonsetup,withdrop-downmenutoenter/se-
lect name of surgeon
3. The vessel name setup allows editing or adapting
factory pre-stored vessel names
4. Report settings allows selecting desired number of
curves per page in the patient report
5. Probe report indicates the usage status of each
probe being used on the system
6. The manage projects setting allows creating projects
names for sub-groups of patients
7. The advanced system functionality setting allows for
management of patient database and other rarely
used system operations
There are 4 pull down menus:
1. Systemprole for selecting the AUX channel used
for the ECG signal
2. ECG channel selecting the AUX channel used for the
ECG signal
3. Measurement unit allows the displayed unit to be
changed from metric to US
4. System mode
allows hiding the most advanced
functions for easier operation
There are also 5 optional selections:
1. Show scale buttons displays the buttons to increase
and decrease vertical scale
2. Use automatic vessel pop up will prompt use for
vessel name each time a probe is connected
3. EnableAutoInvertautomaticallyinverttheow
curvewhenmeanowisbelowbaseline
4. Show Button Help Text explains the function of each
screen icon.

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5.10 Other adjustments
For adjustments such as setting the time and date, name of
surgeons, editing the vessel names, deselecting automatic
vessel pop-up and adjusting the number of thumbnails visible
inthe“Archive”screen.
Therearetwosystemmodes:advancedandclinical.The
advanced mode contains options such as derived curves and
trend recordings. The clinical mode is tailored for common
cardiac and vascular surgeries, and only the most frequently
used options are available. The advanced and clinical user
modes are activated in the system settings menu.
5.11.1 Advanced Doppler mode
If the probe controls are not visible in the Doppler display
therearetwooptions:
1. Pressthebuttonreading“DPV45°”andadjustthe
settings in the screen that appears.
2. Pressthebuttonreading“DPV45°”,select“Show
Probe Controls in Curve View” and adjust the gain in
the Doppler display. The selection will be active until
it is de-selected.
Optimizing display gain
When the Doppler spectrum appears faint or saturated, the
gain can be adjusted.
1. Pressthe”+”button(1)inthelowerrightpartofthe
Doppler display to increase the gain if the spectrum
appears faint.
2. Press the ”-”button (2) in the lower right part of Dop-
pler display to decrease the gain if the spectrum
appears noisy.
Change of sample volume
By default the system measures all velocities at depths
between2mmand8mm.Theeldofmeasurementandthe
sample volume can be changed.
To change sample volume
1. Pressthe”+”button(3)intheDopplerdisplaytoin-
crease the sample volume
2. Press the ”-” button (4) in the Doppler display to de-
crease the sample volume.
3. To increase or decrease depth, press the top or bot-
tom of the scale respectively.
Asshowninthegureabove,thenumberontherightindi-
cates the depth of the measurement in mm and the number
on the left indicates the sample volume in mm.
Note
The depth is measured from the probe surface, and indicates
the real depth to the center of the sample volume. However,
since the beam is transmitted at a 45º angle, the actual mea-
sured sample is situated in front or behind the probe depend-
ing on probe direction.
Change the lter settings
Probe movements may introduce noise close to the baseline,
especially when measuring on a beating heart. Increasing the
ltersettingcanreducetheamountofnoise.Pressthe”DP
V45º”buttonandselectahigherltervalueunder”HPFilter
Frequency”. The factory default is 100hz.
5.10.1 Tuning Doppler noise
The Doppler measurement is sensitive to noise from the
instruments nearby, possibly causing the calculated val-
ues from the measurement to be inaccurate. Therefore this
calibration should be done in an environment resembling
the working environment of the VeriQ™ in question. For the
purpose of tuning of the noise reduction, the probe can be
placed in a cup of water.

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19
Turn on the VeriQ™ and insert a Doppler probe. Enter the
Doppler settings panel.
Press the ”Advanced” button. The ”Noise Suppression set-
ting” should now be visible.
The slider indicates the level of noise reduction to be applied
to the measurement. A negative value will make the measure-
ment more sensitive to weak signals and noise, and a large
positive value will make it less sensitive. Setting the noise
reduction too high may cause problems calculating mea-
surement parameters, as the measured signal is interpreted
mostly as noise. Similarly, setting the value too low will result
in much noise being incorporated into the calculations. Adjust
the slider so that the probe stops measuring the environmen-
tal noise.
The noise reduction value can at any time be readjusted if the
value initially chosen is causing problems or the environment
changes.
5.11 Data Management
All measurements are stored in a database associated with
the patient’s record. The capacity of the database is typically
about 40,000 records, depending on the number of measure-
ments stored per patient.
5.11.1 Search function
With the option of multiple search criteria, any desired record
is easily found. To search for a particular patient, operation
date or surgeon, go to the ”Home” data screen and select
”Search”. The screen ”Search Criteria” appears. Search for
a particular patient by entering parts of the patient name, the
patient ID number, the birth date, the gender, the operation
date or the surgeon. Press ”Perform Search”. Choose the
desired patient record from the list that appears by pressing
on the name - a green check appears - and pressing ”Select
Patient”.
Note
The project can be used to identify patients part of a study
making search easier.
5.11.2 Edit, print, delete and export measurements
To access a patient’s measurements, make sure the name of
thepatientisselected,andgotothe“Archive”screen.View
the desired measurements by pressing on the curves.
Press the ”Edit” button and edit the curves by either scrolling
theowcurvebackwards,draggingthebaselineupordown,
changing the scale of the measurements, or editing the ves-
sel name.
The scale and the position of the baseline cannot be changed
on Doppler measurements. Move between the selected
measurements by pressing the arrows visible at the bottom
of the screen. To store the edited curves, press the ”Save”
button. The old measurement will then be overwritten.
To print measurements, select the measurements to print
by pressing on the curve and pressing the ”Print” button.
To change the number of measurements visible on a print-
ed page, change the setting under ”Report Settings” in the
system settings.
To delete, select the measurements by pressing on the curve
and then press the ”Delete” button The question ”Delete
selection?”willappear,press“OK”.
To export measurements in a PDF format, select the desired
measurements and press the ”Export report” button. The
screen ”Specify File-name and Folder” will appear. Choose
thedesiredfolderintowhichtheleistobeexported,specify
thenameoftheleandpress”OK”.Thereportcanbe
exported to the hard disk, an external USB or LAN storage
device.
Thefullscreencanbeexportedasapictureleforinserts
into presentations or other documents. Press the screen
capture button for the edit screen and follow the dialog box
tostorethepictureleonaremovablemedia.
5.11.3 Export and import data
It is possible to export either the entire patient database, or
portions of it, for backup purposes. This can be done by us-
ing an external USB or LAN storage device. To export single
patients, choose Advance Mode under System settings to
gain access to the export function. Go to the ”Patient data”
screen and obtain the full list of patients by pressing ”Search”
and then ”Perform Search”.
Undertheheading“Export”,selectthedesiredpatientdata
andpress“Export”.Multiplepatientscanbeselected.
Choose the desired folder under ”Specify Filename and Fold-
er” and press ”OK”.
On the advanced systems settings page there is an option
to export various types of data, including the entire patient
database.Thedataavailableforexportis:
• Entire patient database
• Languageles
• System settings
• GUIconguration
• Probe usage information

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Toimportdata,enterthe“Advancedfunctionality”menu
found in the system settings and select ”Import”. Select eh
desiredlesandpress”OK”.
Note
The raw patient data les can only be read by VeriQ™ or
Medistim workstation program.
5.11.4 Safe removal of storage devices
Removable storage devices must be prepared for safe re-
moval before disconnectiong from the system.
If a removable storage device is disconnected while the sys-
tem is transferring or saving data there is a risk of data loss or
data corruption.
The option for safe removal will appear automatically but can
alsobeselectedunder“SystemSettings”.Oncearemovable
storage device has been prepared for safe removal, it must
be disconnected and then reconnected in order to be detect-
ed by the system for further use.
5.12 Derived traces
In the advanced mode it is possible to calculate derived
traces. This is done by adding, subtracting or dividing the
traces of two inputs. Resistance can be calculated by divid-
ingpressurebyow.Whenmeasuringthecarotidbifurcation,
theowintheCarotisExternaandtheCarotisInternacanbe
derivedintoonetotalowamount.
For enabling derived traces, enter the ”Measure screen”,
insertthedesiredowandpressureprobes,andpressthe
button ”Derived curves”. Choose the desired calculations of
traces and press ”OK”.
5.12.1 Fast Fourier Transformation (FFT)
Included in the M&A software is a capability of doing Fourier
analysis (frequency analysis). The analysis can be performed
onallow,pressureandAUXcurves,includingderived
curves. By using this capability it is possible to analyze the
frequency content of the physiological signals, changing the
x-axis into a frequency axis with the unit Hz. The signal is
converted into different columns along the x-axis, showing
where the different frequency components are located. The
height of the different columns is proportional to the intensity
of the different frequency components. The highest frequency
component is normalized to 1 on the display.
It is recommended that a long time signal, 30 seconds or
longer, is used when performing a Fourier analysis of a phys-
iological signal. The Fourier analysis is done just by pressing
the Derived Curves Button.
In the pop-up menu, select the channel to be FFT analyzed.
The result of a Fourier analysis will be shown in a new win-
dow at the bottom of the screen.
The Fourier analysis can be stored and printed. M&A cal-
culations can also be performed on an analyzed signal. By
moving the cursors CI and C2 along the x-axis, frequency
and intensity of the different frequency component will be
updated in the M&A window.