natus Otometrics ICS Chartr 200 VNG/ENG Installation manual

ICS Chartr 200 VNG/ENG
Installation and Startup Guide
Doc. No. 7-26-3000-EN/11
Part No. 7-26-30000-EN

Copyright notice
© 2015,2019Natus MedicalDenmark ApS. All rights reserved. ® Otometrics, the OtometricsIcon, AURICAL, MADSEN, Otoscan,
ICS and HORTMANN are registered trademarks of Natus MedicalDenmark ApS in the U.S.A. and/or other countries.
Version release date
2019-05-15 (213483)
Technical support
Please contact your supplier.
Otometrics - ICS Chartr 200 VNG/ENG
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Table of Contents
1 Introduction 5
2 Prepare System for Data Collection 6
3 Prepare Patient for Testing 15
4 Collect Patient Data 18
5 Review and Analyze Collected Data 28
6 Print a Patient Report 43
7 System Options and Settings 48
8 Maintenance and Troubleshooting 51
9 Safety 55
10 Manufacturer 58
11 Technical Specifications 59
12 Installation 68
3
Otometrics - ICS Chartr 200 VNG/ENG

1 Introduction
ICS Chartr 200 VNG/ENG is indicated for videonystagmography and/or electronystagmography testing for patients with a
complaint of dizziness or imbalance.
The ICS Chartr 200 VNG/ENG Installation and Startup Guide is intended for first time users of the system. It begins with
step-by-step instructions for setting up records, preparing the patient, collecting data, reviewing and analyzing data, and
preparing reports. The Installation Reference section provides information on setting up the hardware.
This guide is organized as follows:
• Prepare System for Data Collection
• Prepare Patient for Testing
• Collect Patient Data
• Review and Analyze Collected Data
• Print a Patient Report
• System Options and Settings
• Maintenance and Troubleshooting
• Safety
• Technical Specifications
• Installation
Once you are comfortable with the basics, take the time to explore the extensive capabilities of the ICS Chartr 200
VNG/ENG system.
1.1 Intended Use
The ICS Chartr 200 VNG/ENG is a nystagmograph that is intended to measure, record,and display involuntary movements
(nystagmus) of the eyeball.
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1 Introduction

2 Prepare System for Data Collection
2.1 Step 1 System Startup
A. Press the Power button on the PC and wait for the Windows®Desktop todisplay.
B. Double-click (ICS VNG or ENG icon) to display the Patient Selection dialog. Alternate: Click the Start button on
the Taskbar. Select Programs >Otometrics > Chartr 200 VNG/ENG for Windows.
C. Click New to prepare the system for a new patient record.
Patient Selection Dialog Box
Note •To comply with HIPAA regulations, the ICS Chartr 200 system relies on Windows password protection.
D. Go to Step 2 Start a New Patient Record ►7
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2 Prepare System for Data Collection

2.2 Step 2 Start a New Patient Record
A. Complete the patient information.
Patient Information Dialog Box, Patient Information Tab
1. Select the Patient Information tab.
2. Type the patient’s
–Last Name [required]
–First Name [required]
–Birth information [required]
3. Select the Gender [required]
4. Type the patient’s
–Address
–City
–State,Zip Code (postal code), Country
–Telephone Number
–Identification (such as a Medical Record Num-
ber, etc.)
5. Click the qand select the Operator. If your name
is not on the list go to Step 5 Add an Operator ►
10.
Note •Click New Patient to create another
patient record while an existing patient record is
open.
B. Go to Step 3 Select a Referring Physician and Facility ►8
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2 Prepare System for Data Collection

2.3 Step 3 Select a Referring Physician and Facility
A referring physician can be associated with a patient record. This association is called a Physician Order.
A. Select a Referring Physician and Referring Facility.
Patient Information Dialog Box, Physician’s Order Tab
1. Click the Physician’s Order tab
2. Click the qand select the Referring Physician.
If not listed, click Info and go to Step 8 Add a
Referring Physician ►13.
3. Click the qand select a Referring Facility. If not
listed, click Info and go to Step 9 Add a Referring
Facility ►13
4. (optional) Type information about the referral
(Referring Notes). This information will appear in
the patient report.
Note •If this patient was tested previously, click
New Order to start a new physician order for the
patient.
B. Go to Step 4 Answer Clinical Information Questions ►9.
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2 Prepare System for Data Collection

2.4 Step 4 Answer Clinical Information Questions
The clinical information questions seek information about the patient’s general condition, and eye and ear examination
findings. This information can be included in the patient report.
A. Click the Clinical Information tab.
B. Click on a button and answer the questions.
Patient Information Dialog Box, Clinical Information
Tab
1. Click the Clinical Information tab.
2. Click General and select an option. Click Next to
see another question.
3. Click Eye Movement Examination and select an
option. Click Next to see another question.
4. Click Ear Examination and select an option. Click
Next to see another question.
5. Click the Patient Information tab.
C. Click Patient Information tab and click OK.
D. Go to Step 5 Add an Operator ►10 to modify operator information, Step 6 Modify Operator Options ►11 to modify
operator options, and Step 7 Modify the Test Battery ►12 to modify the test battery. Go to Step 36 Peak Fre-
quency/GDT Interface ►50 to modify the German interface.
E. Go to Step 10 Study the Main Window ►14.
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2 Prepare System for Data Collection

2.5 Step 5 Add an Operator
A. Select Edit >Operator Info.
B. Complete the operator information.
Edit Operators
1. Click New
2. Type your:
–Last Name [required]
–First Name [required]
–Address
–City
–State,Zip Code (postal code), Country
–Telephone Number
–Identification (such as a work ID, etc.)
3. Click OK
C. Go to Step 2 Start a New Patient Record ►7or click F2 New Patient.
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2 Prepare System for Data Collection

2.6 Step 6 Modify Operator Options
Each operator may establish collection, review, and report settings. These settings will be in effect each time the oper-
ator’s name is selected.
A. Select Edit >System Options. Select the Operator Settings/Test Battery tab.
B. Customize the Collection, Review, and Report Settings.
System Options, Operator Settings/Test Battery Tab
1. Click the Operator Settings / Test Battery tab
2. Select an operator. If your name is not on the list,
go to Step 5 Add an Operator ►10.
3. Select the Settings Shared by All Operators:
–Beats Averaged in Peak SPV Calc [x]
–Automatic Save
– Caloric Countdown Timer [x secs]
–Automatic Analysis
–Automatic Analysis Display
–Automatic Waveform Filtering
–Maximum Saccade Latency [x]
–Omit GN Logo from Printed Report
4. Select the Operator Specific Settings:
–Require Calibration Before Collection
–Center Tracings Every [x] secs (except
gaze, saccade, tracking)
–Footswitch/Irrigator Buttons – Center
waveform during collection
–Display Lightbar Center Fixation Light
–Lightbar Brightness [Low, Medium, High]
–Enable Distance Ranger
–Show Averaged Saccade and Tracking Val-
ues
5. Select Caloric Test Only Settings:
–Automatic Fixation Light On [x] /Off [x]
(secs)
–Show Directional Preponderance
–Show Right Ear Data in Red
C. Click OK and go to Step 7 Modify the Test Battery ►12.
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2 Prepare System for Data Collection

2.7 Step 7 Modify the Test Battery
In addition to establishing collection, review, and report settings, each operator may create a customized test battery (test-
ing sequence).
A. Select Edit >System Options. Select the Operator Settings/Test Battery tab.
B. Arrange the test protocols in the sequence you want to conduct the tests. The Available test protocols (on the left)
lists all possible tests. The Selected test protocols (on the right) lists the operator’s test sequence. Note: if the hard-
ware is not turned on, the Test Battery Lists will be empty because the available protocols are hardware dependent.
System Options, Operator Settings/Test Battery Tab
1. Click the Operator Settings / Test Battery tab.
2. Select an operator. If your name is not on the list, go
to Step 5 Add an Operator ►10
3. Click on a + to show the protocols listed under a pro-
cedure.
4. Click on a protocol or procedure to highlight it.
5. Click the Insert >> button to move the highlighted
protocol to the selected test protocols (test battery)
box.
Click the <<Remove removebutton to delete a high-
lighted protocol or procedure from the test battery.
Click the Remove All button to delete all of the pro-
tocols and procedures from the test battery.
Click the Default Battery button to use the ICS
default test battery.
Installation Note:
If your facility has a different protocol than what is set up in the default test battery, it is recommended that when you first
install the system, you set up a facility default operator test battery. Then add all other operators, and they will inherit the
default test battery. If desired, each operator’s test battery can be further customized.
C. Click OK and go to Step 10 Study the Main Window ►14.
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2 Prepare System for Data Collection

2.8 Step 8 Add a Referring Physician
Referring physician records are available to all operators. If the referring physician’s name is not on the list, create a new
record.
A. Click New to start a new record and type the requested information.
Referring Physician Information Dialog Box
1. Click New.
2. Type the physician’s:
–Last Name [required]
–First Name [required]
–Address
–City
–Zip Code (postal code)
–Country
–Identification (work ID, etc.)
–Telephone number (up to 5)
–Fax number
–Email address
3. Click OK.
B. Click OK to save the record and return to the Patient Information dialog.
C. Go to Step 3 Select a Referring Physician and Facility ►8(item A3 Referring Facility).
2.9 Step 9 Add a Referring Facility
Referring facility records are available to all operators. If the referring facility’s name is not on the list, create a new record.
A. Click New to start a new record and type the requested information.
Referring Facility Information Dialog Box
1. Click New.
2. Type the facility information:
–Name [required]
–Address
–City
–State
–Zip Code (postal code)
–Country
–Phone Number
–Contact Person
3. Click OK.
B. Click OK to save the record and return to the Patient Information dialog.
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2 Prepare System for Data Collection

C. Go to Step 3 Select a Referring Physician and Facility ►8(item A4 Referring Notes).
2.10 Step 10 Study the Main Window
The Main Window is the primary workspace. When a patient record is open, it contains patient test and analysis data.
A. Study each area of the Main Window.
VNG/ENG Main Window with Patient Data
A. Title bar
B. Menu bar
C. Toolbar
D. Waveform Display Area
E. Eye image area
F. Function keys
G. Status bar
H. New Test & Review tabs
I. New Test/Review area
J. Information area
K. Text comments
B. ENG: go to Step 11 ENG – Apply Electrodes ►15.
VNG: go to Step 13 VNG – Place Goggles on Patient ►17.
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3 Prepare Patient for Testing
3.1 Step 11 ENG – Apply Electrodes
The ENG system records 2 or 4 channels of eye movement information. Channel designations relate to electrode place-
ment both on the face and in the electrode patient cable.
A. Place electrodes on the patient as needed for 2 or 4 channel collection.
Channel Electrode cable
Connections
Normal Electrode Placement (4 channels)
Horizontal both (HB)
red – blue
Vertical right (VR) orange – white
Vertical left (VL) orange – white
Horizontal right (HR) red – black
Horizontal left (HL) blue – black
Note •For 2 channel recordings, use the green and brown openings on the patient cable for the vertical chan-
nel. The green and brown electrodes can be placed above and below the right or left eye.
B. Connect the electrode leads to the designated color on the patient cable.
C. Go to Step 12 ENG – Check Electrodes ►16.
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3 Prepare Patient for Testing

3.2 Step 12 ENG – Check Electrodes
Impedance is measured at each skin-electrode interface. A question mark (?) indicates an unacceptable electrode con-
nection.
A. Select a protocol in the New Test tab, then click F7 Electrode Test .
B. Read the status of each active electrode and channel.
Electrode Test Dialog Box
1. Check each electrode connection.
2. Check mV or K Ohm values.
3. Click OK.
C. Reapply electrodes or leads as needed.
D. Click OK to close the dialog.
E. Go to Step 16 Check the Range ►21.
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3 Prepare Patient for Testing

3.3 Step 13 VNG – Place Goggles on Patient
The video goggles contain video camera lenses and mirrors. The video image displays on the monitor. For more inform-
ation about how the goggles function, refer to the User Manual.
A. Place the VNG video goggles on the patient. Proper placement of the goggles is very important. Refer to the User
Manual for detailed instructions.
1. Make sure the mirror is clean. Avoid touching the mirror while placing the goggles on the patient.
2. Place the goggles on the bridge of the patient’s nose.
3. Make sure the back head strap is over the back of the patient’s head below the inion (bump on the lower part of
the skull.) Replace worn head straps. See the User Manual.
VNG Video Goggles
A. Fine focus adjustment knob. Turn this knob
to fine tune (focus) the eye images in the
Video Adjustments dialog box. Focus adjust-
ment may be needed if the patient has deep-
set or protruding eyes.
B. Horizontal positioning knob. Turn knob to
adjust the horizontal position of the eyes.
Adjustment may be needed if the patient has
wide-set or close-set eyes.
C. Vertical positioning knob. Turn knob to adjust
the vertical position of the eyes.
B. VNG: Go to Step 14 VNG – Center and Focus the Video Image ►18 to adjust the video image.
C. Go to Step 17 Select a Protocol ►22.
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3 Prepare Patient for Testing

4 Collect Patient Data
4.1 Step 14 VNG – Center and Focus the Video Image
A. Click the New Test tab on the Main Window and choose the eye(s) to be tested.
B. Click F7 Video Adjust to display the Video Adjustments dialog.
C. Adjust the eye image.
1. Ask the patient to look straight ahead.
2. Move the goggles to center and level the pupils. Make sure the pupils are inside the boxes, as close to the center
as possible.
3. Tighten the back head strap until the goggles are snug. The goggles should fit securely so they will not move dur-
ing positional testing.
4. Straighten and tighten the top head strap to assist in positioning the goggles on the patient’s face and positioning
the pupils in the box.
Video Adjustments Dialog Box, Both Eyes
5. Use the goggle horizontal
and vertical positioning
knobs to center each pupil
image.
6. Use the goggle focus knobs
to focus each image.
7. Repeat as needed to center
the pupils and focus the eye
images.
Note •For monocular testing, only the selected eye will be visible. If testing both eyes, make sure both eye images dis-
play, both pupils are centered, and both eye images are in focus.
D. Use the goggle controls (knobs) if needed to align the patient’s eyes and focus the image while the patient looks
straight ahead.
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Caution •Do not over tighten the knobs as this may damage the adjustment pieces that hold the mirror.
E. Click the Auto Adjust button to move the slides automatically until the pupils begintracking.
Video Adjustments Dialog Box, One Eye
F. Go to Step 15 VNG – Fine Tune the Video Image ►20.
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4 Collect Patient Data

4.2 Step 15 VNG – Fine Tune the Video Image
A. Use the software controls to fine tune the video image for each eye, if needed.
1. Only the pupil should be blue. There should be none or a minimal amount of blue surrounding the eye (i.e., eye-
lashes). The crosshair will automatically go where the blue resides, and this should only be the pupil.
2. If the room is very light, close the goggle cover during these adjustments.
3. If needed, move the sliders to manually adjust the threshold, brightness, and contrast to improve the quality of
the tracking.
Video Adjustments Dialog Box
1. Drag the Threshold (A) slider
slightly up or down until the
pupil tracks properly.
2. Select Adjust Both Eyes to
change brightness and con-
trast for both eyes at the
same time
3. Drag the Brightness (B) and
Contrast (C) sliders until the
image is clear and good
tracking is obtained.
B. Ask the patient to look left, right, up, and down. Verify that the crosshairs track both eyes.
C. Click OK to accept the video image settings.
D. Go to Step 17 Select a Protocol ►22.
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