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105

Performing Exams

Initial Exam Screen

Tools Palette

The tools palette contains all the tool for adjusting and 
controlling scans.  In the palette there are tabs for:

Probe

TGC

Gamma

Cine

Tools

Probe and Scan Controls

The probe and scan controls shown in Figure 83 on page 
106 allow you to adjust the probe settings and start and 
stop image scans.  In this area you can also adjust the 
probe power level for scanning.

Probe Settings

In the probe settings are you can adjust:

Frequency - 12 MHz or 15 MHz

Range - 6 cm or 3 cm for 12 MHz; 10 cm or 5 
cm for 15 MHz

Cine Buffers - 4.5 sec, 8.5 sec, 17 sec, or 34 
sec.

Scan/Stop and Save Cine

Located below the probe adjustments are the buttons to 
execute and stop probe scanning.  When you are ready 
to start a sequence step the button will display "Scan".  
Clicking "Scan" starts the scanning process and the 
display on the button changes to "Stop".  When you are 
satisfied with image acquired click on "Stop" and "Save" 
to save the scanning for the active step.

This is another location where you can start and stop 
scans in addition to the footswitch and the button on the 
probe.

Содержание B-Scan Plus

Страница 1: ...Accutome B Scan Plus User s Guide 24 6110 Rev D...

Страница 2: ...the user is encouraged to try to correct the interference by one or more of the following measures Reorient or relocate the receiving antenna Increase the separation between the equipment and receiver...

Страница 3: ...3 Components 3 About This Manual 4 Safety 7 Safety Information 7 Safety Issues to Consider When Using the Accutome B Scan Plus 7 Indications for use 7 Disposal Requirements 8 Disposal of the product w...

Страница 4: ...Plus Program 23 How to Start a New Patient Exam 24 Entering Patient Exam Information 25 Operation 32 Scanning 35 How to Print an Exam 35 How to Save Patient Exams 36 Setup 37 Setting Up the B Scan Pl...

Страница 5: ...store 62 Options 63 Folders of Exams 64 Main Folder 64 Restored Folder 66 Exam Name Combination 68 Probe Control 69 Frequency 69 Depth 70 Cine Buffer 71 Start Stop 72 Power 72 System Defaults 73 Info...

Страница 6: ...rt a New Exam 90 No Probe Found 90 Initial Exam Screen 91 Entering Information on Initial Exam Screen 92 Entering Data 92 Moving Between Fields 92 Selecting Items from a Drop Down List 92 Patient Info...

Страница 7: ...ting the Power 106 TGC Adjustments 107 Gamma Adjustments 108 Cine Adjustments Playback 109 Add View 110 Edit Current View 110 Probe Orientation 110 Axial 110 Longitudinal 111 Transverse 111 Edit Exam...

Страница 8: ...ula Scans 129 A Vector 132 Completing Patient Exam 134 Main Menu 134 New Exam 134 Exit 134 Analyze 134 Patient Image Analysis 135 Overview 135 Selecting Images for Analysis 135 How to Select an Existi...

Страница 9: ...ment 152 How to Adjust the TGC 152 Image Enhancement Gammas 154 Linear 155 S Curve 156 Log 157 Color 158 Changing Gamma Settings 159 How to Use Zoom 160 Reset Zoom 161 How to Move Image 162 How to Tak...

Страница 10: ...ing Snapshots 185 Inserting Selected Snapshots 186 Alternate Method for Selecting Inserting Snapshots 186 Print or Save Report 187 Archive and Restore 191 Overview 191 Archive Screen 192 Archive to CD...

Страница 11: ...e from DVD or CD 211 Selecting Patient Exams 211 Selecting Individual Exams 212 Select All 215 Clear All 216 Restore 217 Restore Local Network Hard Disk 219 Selecting the Local Network HD Tool 219 Sel...

Страница 12: ...the Folder 233 Abort 233 Main Menu and Exit 233 Maintenance 235 General Maintenance 235 Specifications 237 Overview 237 Physical Specifications 237 Environmental Specifications 239 Computer Specificat...

Страница 13: ...igure 13 Tools Palette and Current View 32 Figure 14 Probe Tab Active 33 Figure 15 Cine Tab Active 33 Figure 16 TGC Tab Active 34 Figure 17 Gamma Tab Active 34 Figure 18 Selecting Setup 37 Figure 19 S...

Страница 14: ...ndows Browser Locate Exam Folder 67 Figure 50 Selecting Exam Name Combination 68 Figure 51 Selecting Probe Frequency 69 Figure 52 Selecting Probe Depth 70 Figure 53 Selecting Probe Cine Buffer 71 Figu...

Страница 15: ...mple 114 Figure 89 Eye and Probe Marker Alignment 115 Figure 90 New Exam with Selected Protocol First Scan Complete 119 Figure 91 New Exam No Protocol First Scan Selected 120 Figure 92 New Exam First...

Страница 16: ...ed 161 Figure 126 Image Move Icon 162 Figure 127 Line 1 Measurement Selected 163 Figure 128 Line 1 Measurement Displayed 164 Figure 129 Area 1 Measurement Selected 165 Figure 130 Area 1 Measurement Di...

Страница 17: ...igure 167 Selecting the Restore Screen 209 Figure 168 Restore Screen 210 Figure 169 Selecting the First Exam 212 Figure 170 First Exam Selected 213 Figure 171 Selecting the Second Exam 214 Figure 172...

Страница 18: ...B Scan Plus User Guide Figure 188 Removing Exam from Restored Folder Warning 230 Figure 189 Exams on System Acctuome Exam Data Folder 230 Figure 190 Free Space on The System 231 Figure 191 Information...

Страница 19: ...ations 237 Table 3 Environmental Specifications 239 Table 4 Recommended Computer Specifications 240 Table 5 Operating Mode s 241 Table 6 Data Specifications 242 Table 7 Range and Accuracy 242 Table 8...

Страница 20: ...xviii Accutome B Scan Plus User Guide...

Страница 21: ...des high quality B Scan imaging and playback with the ease of plugging into any computer in the world The Accutome B Scan also has many additional features that allow multiple methods of viewing diagn...

Страница 22: ...ome B Scan Plus allows you to adjust the Gain Time Gain Compensation TGC as a default in Setup live during an exam or on a saved existing exam Gamma Settings The Accutome B Scan Plus allows you to adj...

Страница 23: ...Reports and Printouts The Accutome B Scan Plus allows you to prepare reports containing exam information and snapshots of selected imaging views You can also print a snapshot at any time during an ex...

Страница 24: ...ome Provides instructions B Scan Plus on how to set up Setup physicians users and system operational functions Section 5 Performing Provides detailed Exams instructions on how to acquire exam images S...

Страница 25: ...pecifications Section 11 Warranty and Describes Accutome Repairs B Scan Plus warranty information and repair procedures Having read this manual you will be able to set up the Accutome B Scan Plus perf...

Страница 26: ...6 Accutome B Scan Plus User Guide...

Страница 27: ...y in the form of ultrasound is transmitted into the eye The power level of the ultrasound pulses is controllable by the Application Software and the user has control of this power setting The maximum...

Страница 28: ...the delivery note in domestic waste or by municipal waste disposal companies If the B Scan Plus or its components are resold the seller has the duty to notify the buyer that the product must be dispos...

Страница 29: ...the products and procedures are effective and appropriate for ophthalmic applications The following information is provided for the guidance of users and specific products are mentioned for illustrat...

Страница 30: ...nfection issues are confined to the probe tip that comes in contact with the patient s eye In order to prevent the transmission of disease refer to the OSHA and CDC guidelines for proper control of di...

Страница 31: ...transducer and probe daily Keep the transducer and probe connected soak rinse the transducer and probe end thoroughly with distilled water Inspect all surfaces carefully for debris or build up If the...

Страница 32: ...rounding type in compliance with applicable electrical codes To avoid interruption of a procedure the user is responsible for ensuring that all power and USB connections are secure and that the laptop...

Страница 33: ...ass B requirements as its signals may cause the equipment to malfunction The effect of radio signals on medical devices is dependent on various factors and therefore unpredictable To avoid electromagn...

Страница 34: ...ING THE B SCAN PLUS SHOULD NOT BE USED ADJACENT TO OR STACKED WITH OTHER EQUIPMENTAND THAT IF ADJACENT OR STACKED USE IS NECESSARY THE B SCAN PLUS SHOULD BE OBSERVED TO VERIFY NORMAL OPERATION IN THE...

Страница 35: ...The Accutome B Scan Plus is designed to be used in multiple environments and is as simple as carrying a notebook computer and probe The instrument requires virtually no assembly You simply need to in...

Страница 36: ...o the B Scan Plus computer Footswitch The footswitch can be used to start and stop scan image acquisition Table 1 B Scan Computer Specifications PC DellTM Latitude D820 with Intel CoreTM 2 Duo T7200 2...

Страница 37: ...robe 3 Turn your computer to On 4 Follow the steps below to install Accutome s B Scan Plus software to a personal computer 5 Your computer must have Microsoft Windows XP SP2 and NET Framework 1 1 inst...

Страница 38: ...disk into the CDROM drive The installation process will automatically start and a window with Preparing to Install will open Click on Cancel to stop the installation process Open the My Computer wind...

Страница 39: ...the InstallShield Wizard for Accutome B Scan appears click on Next Click on I Accept the Terms in the License Agreement when the License Agreement window appears Click on Next and then Install Click...

Страница 40: ...ork properly on any USB port on which it has not been installed To install the Accutome B Scan Plus probe on another USB port repeat section 1 Be sure to unplug the probe from the current USB port and...

Страница 41: ...the B Scan s computer USB port The marker at the top of the probe is easily aligned with eye tissues during scanning and the start stop button makes operation simple Image scanning can also be started...

Страница 42: ...switch provided with Accutome B Scan Plus can be used to start and stop scanning The footswitch is simple to install plug the end of the footswitch cable into a USB port on the computer running the Ac...

Страница 43: ...o Start a New Patient Exam on page 20 5 Set up the scan 6 Scan the patient eye s 7 Make any necessary image adjustments 8 Analyze the image 9 Print or save the Patient Report Starting Accutome B Scan...

Страница 44: ...Accutome B Scan Plus User Guide How to Start a New Patient Exam To start a new Patient exam 1 On the Accutome Main Screen click on New Exam Refer to Figure 5 below Figure 5 Main Screen Starting New Ex...

Страница 45: ...h shown in Figure 6 below The pre filled information fields the setup defaults 1 When you start a new exam the Accutome B Scan will launch the Exam Info Screen shown below and will clear all fields No...

Страница 46: ...in data fields by clicking in each field and typing accordingly In Figure 7 below the First Name field has just been completed To move from one field to another you may use the Tab Key on your comput...

Страница 47: ...lect a Facility select one from the predefined in B Scan Setup Facility drop down list Position the cursor on the small arrow at the right of the facility field Left click to open the drop down list P...

Страница 48: ...fields Left click to open the drop down list Position the mouse over the up down arrows at the right of the drop down list Click the mouse to move through stored physicians and operators Once you see...

Страница 49: ...fields Left click to open the drop down lists Position the mouse over the up down arrows at the right of the drop down lists Click the mouse to move through stored Scan Group and Protocols Once you s...

Страница 50: ...30 Accutome B Scan Plus User Guide 9 Click on the Start button located at the bottom right of the Patient Exam Info Screen Figure 11 Starting a New Exam...

Страница 51: ...31 Getting Started Basic Operation 10 The Accutome B Scan Plus will launch the Exam Screen shown below Figure 12 Exam Screen...

Страница 52: ...is the probe Axial Transverse or Longitudinal Probe available adjustments are range and power Cine available adjustments are Frame Averaging and Frame Render Delay TGC do the System Near Mid and Far...

Страница 53: ...33 Getting Started Basic Operation The figures that follow show the imaging tools in their respective tabs select the tab to display the tools Figure 14 Probe Tab Active Figure 15 Cine Tab Active...

Страница 54: ...34 Accutome B Scan Plus User Guide Figure 16 TGC Tab Active Figure 17 Gamma Tab Active...

Страница 55: ...to the next view in the sequence you must step on the footswitch or press the start stop button on the probe The B Scan Plus will also create a new view in the sequence if you continue to scan after c...

Страница 56: ...nt records at any point during the exam Whenever you start stop a scan using the probe or footswitch the scan just completed is saved in the patient s exam folder There is no need to do anything other...

Страница 57: ...equences you can also set many operational defaults Setup options include Adding new Users Adding Physicians Creating Sequences Editing Sequences Setting New Exam Defaults including Gamma TGC and Info...

Страница 58: ...ault tab upon launching setup is Facilities as shown in Figure 19 The Setup tabs are as follows Facilities location to add edit and delete exam facilities User location to add edit and delete Accutome...

Страница 59: ...e ability to add facilities where exams will take place The list of available facilities is displayed at the right of the screen and command buttons related to facility functions are located below the...

Страница 60: ...tome B Scan Plus User Guide 2 Activate the Name area under the Facility Information area as shown below The available information fields are Name Address Description Figure 21 New Facility Information...

Страница 61: ...have the current facilities setup become the data restore point click Yes If you would like to retain the old data restore point click No Figure 22 Saving New Facility Deleting Facilities To delete a...

Страница 62: ...as needed Set Selected Facility as Default To set a facility as the default B Scan operation 1 Select the facility you would like to become the default from the Available Facilities list 2 Click on Se...

Страница 63: ...store To restore the previously saved facility information 1 Click on Restore 2 A Restore Facilities dialog will launch Click Yes to revert to the previously saved facilities information Figure 24 Res...

Страница 64: ...elated screen is the second tab from the left in Setup The Accutome B Scan Plus provides the ability to add Users to a B Scan user list How to Add a New User To add a new user 1 In the Users screen se...

Страница 65: ...Name area under the Users Information area as shown below The available information fields are First Name Last Name Facility select entered facility from drop down menu Department Telephone Figure 26...

Страница 66: ...o save all changes and have the current users setup become the data restore point click Yes If you would like to retain the old data restore point click No Figure 27 Saving New User Deleting Users To...

Страница 67: ...ave all user information 1 Click on Save 2 An Update Restore Point dialog will launch If you would like to save all changes and have the current users setup become the data restore point click Yes If...

Страница 68: ...f predefined scans with labelled views scan methods and positions that are executed during B Scan diagnostic imaging A Sequence is defined by the following Number of scans or views Eye being scanned O...

Страница 69: ...isplayed at the right of the screen and command buttons related to available sequences are located below the list How to Add New Sequences To add a new sequence 1 In the Sequences screen select New as...

Страница 70: ...50 Accutome B Scan Plus User Guide 2 The B Scan Plus will list the new sequence as Undefined in the Available Sequences list Figure 32 Adding New Sequence...

Страница 71: ...name of the newly added sequence When you have finished entering the new name the sequence name in Available Sequences will be renamed as shown in Figure 33 below Enter a description of the scanning s...

Страница 72: ...an are the eye OD OS scanning method and probe position for the scan To change the first scan of the sequence 1 Select the first view or scan of the new sequence by either clicking in the checkbox or...

Страница 73: ...can view Using the Edit Current View selections you can change Eye OD OS Probe Scanning Method Axial Long Longitudinal and Trans Transverse Macula Scan HMAC Horizontal Macula LMAC Longitudinal Macula...

Страница 74: ...as shown in Figure 35 below 3 If you would like to change the probe position for the scan select the tip of the position indicator and drag the indicator around the position wheel until it as at the...

Страница 75: ...Under adds a new scan under the currently selected scan Add at End adds a new scan to the end of the sequence Move Up moves the selected scan up in the sequence order Move Down moves the selected sca...

Страница 76: ...wn in Figure 37 below The Scan scan is active is a free scan view and has no definition 3 To assign a particular eye for scanning to the sequence scan either OD or OS click on the appropriate eye In F...

Страница 77: ...sequence scan by dragging the tip of the position indicator as shown in Figure 38 below The new scan defaults to AX as the method for probing If you would like to change the probing method select eit...

Страница 78: ...e in the newly added sequence scan release the position indicator The new position will be reflected in the label for the new sequence scan as shown in Figure 39 below The indicator stopped at 3 00 AX...

Страница 79: ...quences 6 Continue to add and define new sequence scans as previously described When your sequence is complete and ready to save click on the Save button as shown in Figure 40 below Figure 40 Saving N...

Страница 80: ...eleting Sequences To delete a sequence 1 Select the sequence you would like to delete from the Available Sequences list 2 Click on Delete 3 The sequence will be deleted from the list of Available Sequ...

Страница 81: ...ame You may then change any information for the new sequence as necessary If you make more than one copy the number will increment with each copy Figure 42 Duplicating Current Sequence Set Selected Se...

Страница 82: ...t available sequences setup become the data restore point click Yes If you would like to retain the old data restore point click No Figure 43 Update Restore Point Dialog Restore To restore the previou...

Страница 83: ...s you to set up optional operational parameters for the Accutome B Scan Plus application The options you can set are exam folder exam name combination probe controls Start Stop controls information di...

Страница 84: ...you designate for restoring patient exams Main Folder The Exam Folder selection allows you to designate the location of the folder in which you would like to store new patient exams The default locati...

Страница 85: ...s will launch a Windows browser as shown in Figure 47 below Using the browser locate the folder for storing exam data 3 If you would like to restore the default folder for exam data click on Reset Fig...

Страница 86: ...tion to which you would like to restore patient exams from backup The default location is C Program Files Accutome Restored Exams You can store patient records in any computer location you choose To c...

Страница 87: ...nch a Windows browser as shown in Figure 49 below Using the browser locate the folder where you would like to restore exam data 3 If you would like to restore the default folder for exam data click on...

Страница 88: ...that are available for the Exam Name The fields are as follows LastName patient s last name FirstName patient s first name MRN medical record number DateTime date and time that exam occurred The defau...

Страница 89: ...MHz Which frequency you choose for scanning will determine what depth settings you can select If you choose 12 MHz the depth options are 30 mm and 60 mm If you choose a frequency of 15 MHz the depth...

Страница 90: ...dependent upon the frequency selected 12 MHz depths are 30 mm and 60 mm 15 MHz mm depths are 50 mm and 100 mm The default probe settings are 12 MHz at 60 mm To change the depth select the appropriate...

Страница 91: ...last 8 5 seconds of the scanning time are saved as the scanned image The cine buffer options are 4 5 sec 8 5 sec 17 sec 34 sec The default cine buffer is 8 5 sec To change the cine buffer select the a...

Страница 92: ...selection The default setting is Both Power The Power selection allows you to adjust the power level of the signal through the B Scan probe The power level is indicated by a number a percentage from 0...

Страница 93: ...Measured Data Position Info to Show The following fields are available to be shown on any patient image Facility Physician User Patient To have any of the fore mentioned fields display on an image cli...

Страница 94: ...ke a snapshot of a patient image the file name for the image will be stored with the Patient Name entered when starting an exam as the first part of the file name To select deselect this option simply...

Страница 95: ...while you are changing the settings As you make image control adjustments the Small Image Window located at the bottom right of the screen see Figure 55 below displays how the changes will affect imag...

Страница 96: ...ree TGC setup options 1 Near increases the gain for the anterior portion of the eye in the B Scan image near the probe 2 Middle increases the gain for the middle portion of the eye 3 Far increases the...

Страница 97: ...ttings make certain parts of the scanned image brighter and others less bright There are 12 preset gamma settings Linear Full Range S Curve Full Range Log Full Range Color Linear Low Range The default...

Страница 98: ...by dragging the slide indicator as shown in Figure 58 below Brightness You can adjust the brightness of the scanned image capture by dragging the slide indicator as shown in Figure 58 below Figure 59...

Страница 99: ...ge brighter Adjusting the Gain The Accutome B Scan Plus provides an user adjustable gain feature To the left of the Small Image Window there is a knob with a red drag point Adjustment to the gain is a...

Страница 100: ...cutome B Scan Plus User Guide Figure 60 Selecting Gain Adjustment 2 Drag the knob until the dB level and the image visual reaches the appropriate level as shown in Figure 61 on page 77 Gain Adjustment...

Страница 101: ...e 61 Adjusting Gain Image Controls System Defaults If would like to restore all adjustments made to the Image Controls to the System Defaults select System Defaults located under the Gain Adjustment k...

Страница 102: ...settings and not save changes click Yes If you would like to retain the changes made to Option settings click No Figure 62 Restore All to System Defaults Save To save all option information 1 Click on...

Страница 103: ...you want to leave the B Scan Setup function you must select one of the following Done Selecting Done closes the Setup window and returns you to the main Accutome B Scan Plus Screen Cancel Allows you...

Страница 104: ...n is the fifth tab from the left in Setup The Accutome B Scan Plus provides the ability to add Physicians to a B Scan Plus physician list How to Add a New Physician To add a new physician 1 In the Phy...

Страница 105: ...the Name area under the Physicians Information area as shown below The available information fields are First Name Last Name Facility select entered facility from drop down menu Department Telephone F...

Страница 106: ...s and have the current physicians setup become the data restore point click Yes If you would like to retain the old data restore point click No Figure 68 Saving New Physician Deleting Physicians To de...

Страница 107: ...To save all physician information 1 Click on Save 2 An Update Restore Point dialog will launch If you would like to save all changes and have the current physicians setup become the data restore point...

Страница 108: ...88 Accutome B Scan Plus User Guide...

Страница 109: ...igh quality diagnostic images These include the probe TGC and gamma adjustments This chapter provides you with information to scan control and review images Exam Steps The basic steps in performing an...

Страница 110: ...elow Figure 71 Starting a New Exam No Probe Found If the Accutome B Scan Plus probe is not connected not connected properly or for some other reason is not recognized you will receive the message Figu...

Страница 111: ...propriate selections for the new patient The screen is divided into the following areas Patient Info requires you to enter current patient data Probe Info displays the current probe operational specif...

Страница 112: ...te information Moving Between Fields To move from one field to another you can either click in the new field or use the Tab key The tabbing order of fields on the Initial Exam Screen runs in an intuit...

Страница 113: ...The Name fields in the Patient Info area require an entry of a minimum of three alphanumeric characters There is no need to enter names in both First and Last Name fields if you choose to enter a last...

Страница 114: ...94 Accutome B Scan Plus User Guide Figure 74 Initial Exam Screen with Patient Name...

Страница 115: ...gender field Left click to open the drop down list Position the mouse over the up down arrows at the right of the drop down list Click the mouse to move through gender Select M or F by positioning the...

Страница 116: ...e probe through the eye Default Range The Default Range field displays the default depth range displayed on the screen The range can be adjusted in the B Scan Setup See Chapter 4 of this manual Gain T...

Страница 117: ...lecting the name from the drop down list Facility names are entered in the B Scan Setup Refer to Chapter 4 of this manual Position the cursor on the small arrow at the right of the facility field Left...

Страница 118: ...manual Position the cursor on the small arrow at the right of the physician field Left click to open the drop down list Position the mouse over the up down arrows at the right of the drop down list Cl...

Страница 119: ...r 4 of this manual Position the cursor on the small arrow at the right of the operator field Left click to open the drop down list Position the mouse over the up down arrows at the right of the drop d...

Страница 120: ...eld displays the time stamp created by the Accutome B Scan Plus for the time that the current patient exam was started Scan Group The B Scan Plus provides the ability to set up Imaging Sequence protoc...

Страница 121: ...tem default protocols will be listed If you selected User Defined as the Scan Group all the customized sequence protocols will be listed For more information on Sequencing protocols refer to Chapter 4...

Страница 122: ...102 Accutome B Scan Plus User Guide Start Exam After you have completed all necessary fields in the Initial Exam Screen and have made the appropriate selections click Start Figure 81 Starting New Exam...

Страница 123: ...th Selectable Tabs for Probe and Scan Controls TGC Adjustments Gamma Adjustments Zoom Controls Show A Vector Edit Exam Info Analyze Cine Buffers Display Menu Buttons Print and Snap Shot Figure 82 Exam...

Страница 124: ...up Options tab Operator Operator display can be turned on or off in B Scan Plus Setup Options tab Current View in Image Sequence Protocol The information fields displayed and the position of the infor...

Страница 125: ...gs are you can adjust Frequency 12 MHz or 15 MHz Range 6 cm or 3 cm for 12 MHz 10 cm or 5 cm for 15 MHz Cine Buffers 4 5 sec 8 5 sec 17 sec or 34 sec Scan Stop and Save Cine Located below the probe ad...

Страница 126: ...Adjusting the Power Above the Scan Stop and Save buttons there is an adjustable sliding probe power indicator To increase or decrease the probe power drag the indicator to the right or left Figure 83...

Страница 127: ...r the strength of the signal through the eye The TGC adjustments are Near adjustment for signal near the probe Mid adjustment for the middle of signal Far adjustment for portion of signal farthest fro...

Страница 128: ...only the one that best delineates the subject of interest The Gamma adjustments allow you to adjust the brightness mapping of the B Scan image The adjustments area contains a drop down list of predef...

Страница 129: ...ntrol how an image is captured an displayed Frame Averaging is used to smooth out an image A scan takes individual frames and averages up to three frames before displaying the image on the screen Fram...

Страница 130: ...ion indicator in the Current View area and drag the indicator tip to the desired position Edit Current View When you select Edit in the Current View area the B Scan Plus allows changes to the currentl...

Страница 131: ...s of the eye not directly over the cornea as in an Axial image such that the probe crosses or tranverses the optical axis Edit Exam Info When you select Edit Exam Info the Accutome B Scan Plus display...

Страница 132: ...in detail in Chapter 6 Patient Image Analysis of this manual Menu Buttons The three buttons located at the bottom of the Exam Screen New Exam Main Menu and Exit perform Accutome B Scan Plus menu func...

Страница 133: ...greater the signal that is returned Greater tissue density and a stronger echo show up as a brighter spot in the image A Scan is a thin parallel sound beam passing through a small point within the ey...

Страница 134: ...ound beam that pulses pauses and pulses again The pause allows the B Scan Plus to receive process and display the returning echo The pulse echo is repeated thousands of times per second resulting in a...

Страница 135: ...r positioning for a vertical and a horizontal slice You must know where the slice is being directed at all times to produce an accurate scan In Figure 89 below there are two very different slices with...

Страница 136: ...u use When scanning you move the probe around the eye within each of these positions A brief summary of the three positions follows Axial Probe Positions An Axial B Scan is a slice aligned through the...

Страница 137: ...hes the marker is aimed nasally so the upper portion of the screen represents the nasal section of the globe the upper portion of the screen will always be 3 00 in the right eye or 9 00 in the left ey...

Страница 138: ...ration that is the opposite of the last operation executed For example if you start scanning by stepping on the footswitch and press the trigger button on the probe the scanning will stop Using the Pr...

Страница 139: ...nd have stopped the probe you should move the probe to conform to the next scan in the sequence For example in Figure 90 below the first scan is labeled OD 12AX and the second scan is labeled OD 3AX W...

Страница 140: ...are not following a predefined protocol for scanning the first scan always defaults to OD Scan If you are making a free scan of the right eye you should change the view label for this scan see Edit Cu...

Страница 141: ...ams How to Scan Start and stop the scan using the probe trigger button or the footswitch Once the first scan is captured as shown in Figure 92 below proceed with the second scan Figure 92 New Exam Fir...

Страница 142: ...you have completed the first scan and you press the probe trigger button or step on the footswitch the B Scan Plus will automatically add another scan to the All Views list The label for the second sc...

Страница 143: ...to Scan Adding a View You may decide during the scanning process that you need to scan another view of the patient s eye To add another view 1 Click on the Add View button as shown in Figure 94 below...

Страница 144: ...djust the signal gain 1 Select the red dot in the adjustable gain knob with the mouse cursor 2 Holding down the left mouse button drag the knob until you reach the gain value you want 3 If the mouse y...

Страница 145: ...example if the new scan is intended to capture a transverse view of the eye you want to label the view transverse To change a scan view 1 Activate the scan by clicking on the scan view name or clicki...

Страница 146: ...126 Accutome B Scan Plus User Guide 3 Change the slice position by dragging the arrow indicator around the clock until you reach the cor rect slice position Figure 97 Changing a View Slice Position...

Страница 147: ...Scan 4 For transverse scans you must also select the appropriate orbit for the new scan Place the mouse cursor inside the orbit wheel Click on the correct orbit for the new scan Figure 98 Changing a V...

Страница 148: ...128 Accutome B Scan Plus User Guide 5 The edited current view will appear in the list of All Views as shown in Figure 99 below Figure 99 Changing a View Done...

Страница 149: ...aimed at 3 00 for the right eye OD and at 9 00 for the left eye OS Longitudinal Macula The Longitudinal Macula scan is a scan through the temporal meridian The marker should be aimed at 9 00 for the r...

Страница 150: ...ccutome B Scan Plus User Guide To label a scan as a macula scan 1 Select either HMAC or LMAC In the example given in Figure 100 below the scan being labeled is an LMAC scan Figure 100 Labeling an LMAC...

Страница 151: ...1 Performing Exams Macula Scans 2 The macula scan will appear in the All Views list as the label you assigned to the scan In Figure 101 below the new labeled scan is OD LMAC Figure 101 LMAC Scan Label...

Страница 152: ...a graphical picture of the echoes received back through the eye from the ultrasonic probe The echoes are represented as spikes arising from the baseline and indicate the sound beam travelling through...

Страница 153: ...133 Performing Exams A Vector 2 The A Vector will be displayed under the live image as shown in Figure 103 below To close the A Vector select Hide A Vector Figure 103 A Vector Displayed...

Страница 154: ...xam and return you to the Initial Patient Exam Screen see Figure 73 on page 91 Enter new patient information and start a new exam Exit Selecting Exit will close the Accutome B Scan Plus software Analy...

Страница 155: ...am Selecting Images for Analysis There are two methods of selecting an image for analysis 1 In the New Exam Screen by executing Analyze after a patient exam has been scanned 2 By selecting a saved Exi...

Страница 156: ...136 Accutome B Scan Plus User Guide 2 The Analyze Screen shown in Figure 105 below will display Figure 105 Analyze Screen...

Страница 157: ...xams drop down list for selecting an existing exam Current View active display of scan sequence Play Controls for viewing scan film loops TGC Adjustments Tools Palette including Zoom Controls A Vector...

Страница 158: ...nned film loops The default position for exam information fields is at the top left of the screen The information fields that are displayed and the position on the screen where the fields are displaye...

Страница 159: ...e stop move forward and move back through an image scan Zoom Controls The Zoom Controls allow you to zoom in on the image and then return to the normal size view by clicking Reset Zoom Zoom is explain...

Страница 160: ...mation displayed in this window Menu Buttons The three buttons located at the bottom of the Exam Screen Rescan Main Menu and Exit perform Accutome B Scan Plus menu functions Main Menu When you click o...

Страница 161: ...Screen you need to select an existing exam from the All Exams drop down list 1 The All Exams drop down list is located at the top right side of the screen Select the patient exam for analysis from th...

Страница 162: ...tome B Scan Plus User Guide 2 Position the mouse cursor on the name of the Exam you would like to analyze The exam will displayed in the screen as shown in Figure 108 below Figure 108 Existing Exam Di...

Страница 163: ...ysician Operator To change the fields with drop down lists position the cursor on the small arrow at the right of each field Left click to open the drop down list Position the mouse over the up down a...

Страница 164: ...he mouse cursor In the empty text field and type the new text Figure 109 Edit Exam Information Window Restore If you have made any changes in the Edit Exam Information and would like to restore the in...

Страница 165: ...1 below will launch If you would like to cancel the process click OK If you would like to return to the Edit Exam Information window and continue activity click Cancel Figure 111 Exit Edit Exam Inform...

Страница 166: ...ons will display as shown in Figure 112 below There are two selection on the Exams tab Use Main Folder and Use Restored Folder The Restored folder is the folder that has been setup in setup mode for r...

Страница 167: ...VCR or DVD remote controller The playback controls consist of Play Stop and return to the beginning of the film loop Pause Forward one frame at a time or continuously Backward one frame at a time or c...

Страница 168: ...you have started playing a scan film loop the Stop and Pause buttons become active as shown in Figure 114 below When you click the Stop button the scan film loop stops and returns to the beginning Fi...

Страница 169: ...ient Image Analysis Playing an Exam Pause When you click on the Pause button shown in Figure 115 below the scan film loop will pause and not play in any direction Figure 115 Pausing the Scan Film Loop...

Страница 170: ...ward one frame at a time or you can move forward through frames continuously To play one frame at a time click on the forward button once and then click again To play frames forward continuously click...

Страница 171: ...backward one frame at a time or you can move backward through frames continuously To play one frame at a time click on the backward button once and then click again To play frames backward continuous...

Страница 172: ...paralleled control of image quality and thus diagnostic quality The TCG settings can be adjusted to facilitate viewing certain areas of the eye by increasing the gain for that portion of the signal wi...

Страница 173: ...153 Patient Image Analysis TGC Adjustment Figure 118 TGC Adjustments Displayed...

Страница 174: ...t for easy identification of boundaries between tissues of different characteristics For example differences between the vitreous and vitreous condensate floaters or the differences between the retina...

Страница 175: ...lmic structure which reflects the maximum echo would be represented as pure white while no echo would be represented as pure black and echoes in between would be represented proportionally as shades o...

Страница 176: ...he brightness response differs from Linear and Log in that the image contains a higher contrast for mid range signals Figure 120 below displays an example of a B Scan Plus image with a S Curve Full Ra...

Страница 177: ...iffers from the linear algorithm The image represented by the Log gamma produces higher contrast for weaker signals Figure 121 below displays an example of a B Scan image with a Log Full Range gamma s...

Страница 178: ...ting can be advantageous in seeing any abnormalities that may not easily be seen in the other greyscale gamma settings Figure 122 Color Gamma Setting Exam Info Current View Probe Controls Scan Control...

Страница 179: ...ve through gamma list Once you see the gamma setting you want to select position the mouse cursor over the setting and left click The selected gamma will adjust the image on the screen Once you have s...

Страница 180: ...n on a selected patient image Zoom proportionally expands the image and fills the B Scan screen Zoom has preset values that increment by steps of 2 from 1 2 to 8 e g 1 1 2 1 4 1 6 1 8 2 0 etc up to 7...

Страница 181: ...alysis How to Use Zoom Figure 125 Zoom Changed Reset Zoom After you have zoomed in on an image you may want to reset the view back to the default normal view To reset the zoom value simply click on Re...

Страница 182: ...he Accutome B Scan Plus Place the Windows mouse cursor over any location on the image and notice the cursor become a small cross small Then hold down the mouse button and the becomes directional compa...

Страница 183: ...nts Measurements as small as 1 mm can be easily taken There are four separate measurements you can take Line 1 Line 2 Area 1 Area 2 Measurement Types The B Scan Plus provides for two line or distance...

Страница 184: ...hold on the image at the starting point of the measurement and drag the line along the length of the feature you would like to mea sure 3 The measurement will be displayed on the screen as shown in Fi...

Страница 185: ...is How to Take a Measurement on an Existing Taking Area Measurements To take an area measurement 1 Select either Area 1 or Area 2 in the Measure ments area as shown in Figure 129 below Figure 129 Area...

Страница 186: ...e the velocity of the sound to reflect the density of the tissue being measured Click in the Velocity field Select the velocity by holding down the left mouse button and dragging the value Press the k...

Страница 187: ...received back through the eye from the ultrasonic probe The echoes are represented as spikes arising from the baseline and indicate the sound beam travelling through the different intraocular tissues...

Страница 188: ...d under the live image as shown in Figure 132 below 3 The position of the A Vector on the image can be moved by using the buttons or the slide control to the right of the Hide A Vector button 4 To clo...

Страница 189: ...ou to place comments on an image from a patient exam The comments feature can be important in providing an accurate image analysis To place a comment on an image 1 In the Tools tab of the tools palett...

Страница 190: ...ialog shown in Figure 134 below will display on the screen 3 Click in the text field and enter your comments 4 If you would like to clear the comments that you have typed click on Clear 5 Select Done...

Страница 191: ...171 Patient Image Analysis Comments on Image 6 The entered comments will appear on the image as shown in Figure 135 below Figure 135 Comments Appearing on Image New Comments...

Страница 192: ...172 Accutome B Scan Plus User Guide...

Страница 193: ...inter you can also print single snap shots of any elevation of any image print on plain or thermal paper select multiple images and print them in a report Printing Images There are three ways to print...

Страница 194: ...187 Selecting Patient Exam To select the patient exam 1 After launching Accutome B Scan Plus select Existing Exam The B Scan Plus Analyze Screen will display with the existing exam drop down list 2 S...

Страница 195: ...d comments Select Print or Snapshot Note For more information on adjusting images refer to Patient Image Analysis on page 135 of this manual Executing Print To print either a live scan or from an exis...

Страница 196: ...176 Accutome B Scan Plus User Guide Figure 136 Printing a Frame PRINT IMAGE...

Страница 197: ...if not previously captured see Capturing Snapshots on page 178 3 Select Reports tool see Reports Tool on page 179 4 Execute Manage Reports see Executing Manage Reports on page 182 5 Create a New Repo...

Страница 198: ...from the list of scan views 2 Play the selected patient view 3 Pause at the frame you would like to make a snap shot 4 Adjust any of the image settings if necessary 5 Click Snap Shot 6 The frame will...

Страница 199: ...ab from the tools palette as shown in Figure 137 below The Reports tools has three function buttons Snapshot List displays all available snapshots for the active patient Manage Reports launches the ma...

Страница 200: ...apshot List To display all snapshots available for the active patient 1 Click on Snapshots List as shown in Figure 138 below 2 All snapshots will be displayed in the panel below the reports tool butto...

Страница 201: ...manently deleted providing space on the B Scan computer to store more snapshot files To delete a snapshot 1 Select the snapshot by dragging around it or click ing on it 2 You can also select multiple...

Страница 202: ...system from the computer which you are using to operate the B Scan select Yes If you don t want to delete the snapshot select No Figure 140 Confirming Snapshot Deletion Executing Manage Reports When y...

Страница 203: ...e Report Form window also contains function buttons with which you can save additional snapshots to files delete a selected snapshot or refresh the image list after making image edits or selections Yo...

Страница 204: ...l the fields that have been predefined in either the setup or the patient exam either when creating a new exam file or when editing a patient exam The Report template displays the following fields Fac...

Страница 205: ...til you select all snapshots you would like to place in the report as shown in Figure 144 below 2 You can also select individual snapshots by hold ing the Ctrl key and select each snapshot one at a ti...

Страница 206: ...e report is now ready to print or save Figure 145 Inserting Selected Snapshots Alternate Method for Selecting Inserting Snapshots 1 Left click on the snapshot you want to insert into the report and cl...

Страница 207: ...ave the report to keep a copy To print the report 1 Click on the Windows printer icon in the Report Form toolbar 2 The report will print to the printer connected to the Accutome B Scan Plus computer T...

Страница 208: ...ser for you to locate the folder in which to save the patient report 3 Select the file type you would like to save the report as from the save as type drop down list Figure 147 Selecting File Type 4 E...

Страница 209: ...189 Printing Images and Reports Creating Reports...

Страница 210: ...190 Accutome B Scan Plus User Guide...

Страница 211: ...functions burn exam film loops to a CD DVD or backup exam film loops on a local or network hard drive You can also load patient exams from discs acquire disc information verify burn or backup and stor...

Страница 212: ...lable exams 2 Exams to Be Archived after selecting exams for burning to a CD DVD or for backup they will be dis played in this area 3 Process Information Area provides live feedback as text for any se...

Страница 213: ...you would like to archive 3 Select Burn Disc on the CD DVD Recordable Media tab Selecting Patient Exams When you launch the Archive function the B Scan Plus displays all exams found on the system at t...

Страница 214: ...194 Accutome B Scan Plus User Guide 2 You can also click on the name of the exam you would like to select as shown in Figure 152 below Figure 152 Selecting the Second Exam...

Страница 215: ...ke to archive all exams on the system and don t want to select them individually 1 Click Select All as shown in Figure 153 below All system exams will be displayed in the Exams To Be Archived section...

Страница 216: ...chive by clicking in the checkbox or on the exam name or you can clear all the exams from the list to be archived To clear all selected exams from the archive list 1 Click on Clear All as shown in Fig...

Страница 217: ...and Restore Archive to CD or DVD Burn Disc Once you have selected all the exams you would like to burn on the CD DVD 1 Select Burn Disc to execute the burn as shown in Figure 155 below Figure 155 Burn...

Страница 218: ...screen will display in the process information area the burning progress as shown in Figure 156 below Disc burning information includes textual information and burn progress in the status bar at the...

Страница 219: ...2 Select the Backup tool 3 Select the Destination Folder 4 Select Backup Exams Selecting Patient Exams When you are backing up patient exams you select them in the same manner as if you were burning...

Страница 220: ...n Folder After you have selected the exams you would like to back up you need to designate the location at which you would like to store the exams 1 Click on Select Destination Folder as shown in Figu...

Страница 221: ...owser shown in Figure 159 below 2 Using the Windows browser locate the folder in which you would like to backup the patient exams Figure 159 Windows Browser Locating Destination Folder 3 After you hav...

Страница 222: ...202 Accutome B Scan Plus User Guide 4 To complete the backup process click on Backup Exams as shown in Figure 161 below Figure 161 Execute Backup Exams...

Страница 223: ...5 The status bar at the bottom of the Archive Screen will display backup activity indicating that the backup is in process and how much of the backup has been completed see Figure 162 below Figure 16...

Страница 224: ...ad exams from discs Delete Selected Exams After you have archived patient exams you may want to delete them to free up computer disk space The Delete Selected Exams function allows you to permanently...

Страница 225: ...rning Disc Tool Features There are many features in the CD DVD Recordable Media tab of the tools palette that are informational and perform disc operations Save Reports Only The Save Reports Only func...

Страница 226: ...nfo When you select Disc Info the Accutome B Scan Plus displays information about the CD DVD including disc size date the number of sessions amount of space remaining in the disc etc as shown in Figur...

Страница 227: ...D DVD and confirming that the burn process was successful as shown in Figure 166 below Figure 166 Verify Burn Results Check to Fit the Media The Check to Fit Media feature checks the amount of disc sp...

Страница 228: ...vailable on each Space Required The Space Required feature displays the amount of disk space required to backup the selected exams If Name Conflict Found The If Name Conflict Found feature allows you...

Страница 229: ...the original if the backup properly executed Restore Screen Not only can you archive patient exams with the Accutome B Scan Plus but you can also restore them to your computer for analysis and report...

Страница 230: ...on system 2 Exams to Be Restored after selecting exams for restoring from a DVD CD or from a local network hard drive backup they will be displayed in this area 3 Process Information Area provides li...

Страница 231: ...you launch the Restore function the B Scan Plus defaults to displaying all exams found on the DVD CD at the left side of the Exams on Backup tab of restore exams palette top left corner of the screen...

Страница 232: ...12 Accutome B Scan Plus User Guide Selecting Individual Exams To select exams one at a time 1 Click in the checkbox beside the exam name as shown in Figure 169 below Figure 169 Selecting the First Exa...

Страница 233: ...213 Archive and Restore Restore from DVD or CD 2 The selected exam will appear in the Selected Exams To Be Restored list as shown in Figure 170 below Figure 170 First Exam Selected...

Страница 234: ...214 Accutome B Scan Plus User Guide 3 You can also click on the name of the exam you would like to select as shown in Figure 171 below Figure 171 Selecting the Second Exam...

Страница 235: ...all exams on the system and don t want to select them individually 1 Click Select All as shown in Figure 172 below All system exams will be displayed in the Selected Exams To Be Restored section of th...

Страница 236: ...clicking in the checkbox or on the exam name or you can clear all the exams from the list to be restored To clear all selected exams from the restore list 1 Click on Clear All as shown in Figure 173 b...

Страница 237: ...tore from DVD or CD Restore Once you have selected all the exams you would like to restore from the DVD CD 1 Select Restore to execute the restoring process as shown in Figure 174 below Figure 174 Res...

Страница 238: ...creen will display in the process information area the restoring progress as shown in Figure 175 below Exam restoring information includes tex tual information and restore progress in the status bar a...

Страница 239: ...ore exams 3 Select the patient exams you would like to restore 4 Select the Restore tool Note The folder where the restored exams will be placed is preset on the Options Screen during Accutome B Scan...

Страница 240: ...220 Accutome B Scan Plus User Guide 3 The Local Network HD tools will be displayed as shown in Figure 177 below Figure 177 Local Network HD Restore Tools Active...

Страница 241: ...Disk Selecting the Folder for Restoring Exams Before you can restore selected exams you need to locate the folder from which they will be restored 1 Click on Select Folder as shown in Figure 178 below...

Страница 242: ...Folder the B Scan Plus will launch a Windows browser shown in Figure 179 below Figure 179 Windows Browser 3 Browse the local and network drives and folders until you locate the folder from which you...

Страница 243: ...ear as shown in Figure 181 below The contents of the folder will also display in the Exams on Backup tab Figure 181 Source Folder Displayed Selecting Patient Exams When you are restoring patient exams...

Страница 244: ...224 Accutome B Scan Plus User Guide Executing Restore To complete the restore process 1 Click on Restore as shown in Figure 182 below Figure 182 Execute Restore Exams on Local Network HD...

Страница 245: ...atus bar at the bottom of the Restore Screen will display restoring activity indicating that the exam restoration is in process and how much of the restore has been completed see Figure 183 below Figu...

Страница 246: ...on Backup Features When the Exams on Backup tab is active there are many additional features available related to the exams in the backup folder Figure 184 Exams on Backup Tab Active Select All When y...

Страница 247: ...there are duplicate names in the Restored Exams folder and the selected exams in the restore from folder Overwrite Old Exams When you activate Overwrite Old Exams by clicking the radio button the rest...

Страница 248: ...xams folder Additional features allow you to select and delete current restored exams Figure 186 Exams on Destination Restored Exams Folder Select All When you click on Select All all the restored exa...

Страница 249: ...them to free up computer disk space The Remove Selected Exams function allows you to permanently remove a restored patient exam To remove selected exams 1 Select the exam s you would like to delete s...

Страница 250: ...elete the file Click No or Cancel if you would like to terminate the delete process Figure 188 Removing Exam from Restored Folder Warning Exams on System The Exams On System tab when active displays a...

Страница 251: ...ore operations Free Space On The System When you execute Free Space on The System as shown in Figure 190 below the Accutome B Scan Plus will display all available space on all drives Figure 190 Free S...

Страница 252: ...disc size date the number of sessions amount of space remaining in the disc etc as shown in Figure 191 below Figure 191 Information of Media Eject Eject will automatically eject the DVD CD from the co...

Страница 253: ...unches a Windows browser and allows you to select the folder from which you would like to restore exams List Exams in the Folder The List Exams In The Folder feature lists all the exams contained in t...

Страница 254: ...234 Accutome B Scan Plus User Guide...

Страница 255: ...eeping surfaces free of dust and dirt and storing in a dry and cool place so as to not adversely effect electronic parts Care must be taken to use only proper non linting cloths and non corrosive solv...

Страница 256: ...236 Accutome B Scan Plus User Guide...

Страница 257: ...Table 2 Accutome B Scan Plus Physical Specifications Probe Accutome Part Number 24 6120 Frequency 12 MHz 15 MHz Dimensions 7 0 inches long X 1 25 inches diameter 17 78 cm long X 3 18 cm diameter Weigh...

Страница 258: ...A Probe Holder Accutome Part Number 24 6170 Dimensions 7 7 Inches X 4 3 Inches X 2 09 Inches High 19 56 cm X 10 92 cm X 5 61 cm Weight 75 Lb 340 kg Safety and EMI Standards IEC 60601 1 Medical Electr...

Страница 259: ...an Plus system operating and storage values for temperature and humidity Table 3 Environmental Specifications Temperature Operating 10 C to 40 C Storage 20 C to 60 C Relative Humidity Operating 20 to...

Страница 260: ...e B Scan Plus PC DellTM Latitude D820 with Intel CoreTM 2 Duo T7200 2 00GHz 4M L2 Cache 667MHz Dual Core or equivalent I O Ports Minimum 4 USB 2 0 Operating Systems Windows XP Professional SP2 Display...

Страница 261: ...breast thyroid testes etc Neonatal Cephalic Adult Cephalic Musculo Skeletal conventional Musculo Skeletal superficial Examples may include Amplitude Doppler 3 D Imaging Harmonic Imaging Tissue Motion...

Страница 262: ...Specifications Data Storage Capacity Patients Patient Data Only limited by the computer s disk storage capacity Table 7 Range and Accuracy B Scan Plus Setting Line Area Clinical Accuracy Accuracy Ran...

Страница 263: ...c Output Reporting Table for Track 1 Non Autoscanning Mode Acoustic Output MI ISPTA 3 mW cm2 ISPPA 3 W cm2 Global Maximum Value 0 199 0 379 21 1 Associated Acoustic Parameters Pr 3 MPa 0 641 W0 mW 0 1...

Страница 264: ...us User Guide These values are based on measurements of production units Operating Frequency 12 MHz Table 8 Acoustic Output Reporting Table for Track 1 Non Autoscanning Mode Acoustic Output MI ISPTA 3...

Страница 265: ...c or any of its authorized distributors This warranty covers all repairs and servicing of parts that proved defective by manufacture and not by misuse or mishandling This type of service will be handl...

Страница 266: ...tion print the RGA number on the outside of the package and send the instrument to Technical Service Group Accutome Inc 3222 Phoenixville Pike Malvern PA 19355 All Other Returns Returns for non servic...

Страница 267: ...item when placing an order Documenta tion Accutome will make available on request circuit diagrams component parts lists descriptions calibration instructions or other information that will assist qu...

Страница 268: ...248 Accutome B Scan Plus User Guide...

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