This tutorial will describe how to open an acquired study, open up a measurement, analyze the data, and generate a report from a study utilizing a high-resolution esophageal manometry study utilizing a small diameter probe in BioVIEW® Software.
high resolution impedance small diameter Asafa Geo Manama tree analysis overview. Yeah. Upon completion of this tutorial, the participant will be able to describe how toe open an acquired study and analysis view. Describe how toe open a measurement and analyze the data. Generate a report after reviewing the findings. Supporting tutorials found on the Santa University website include Chicago Classifications, Basics of measurement Creation, High resolution Impedance Manama, Tree editing tools and techniques understanding impedance when using bio view versions set 5.7 dot 0.0 or newer Chicago measurements will be automated. The Chicago Classifications Basics tutorial mentioned above, though, will provide more information about each type of measurement and the normal values. If you are unfamiliar with the toolbar icons, please review the HR I am Tools and techniques tutorial. Open a study in the analysis software by selecting the analysis icon. Click on select Patient on the top left of the screen. The patient file will be found in the following path. See Dr Backslash sandhill backslash patients back slash e f. T. The complete study will open in the Klaus view with the impedance data displayed on the top of the screen and the pressure Manama tree data displayed on the bottom section of the screen. The purple color in the impedance section represents Bullis presence, and the color ingredient in the pressure section represents pressure changes with the warmer colors representing higher pressure and the cooler colors representing lower pressure as indicated on the color ranges on the right side of your screen. The Isil Contour Lines of 20 and 30 millimeters of mercury outline areas with thes continuous pressure values. These defined YSL contour areas will be used with the Chicago Classifications measurements. Using the set time range drop down menu. Change the time to a one minute window scroll to the end of the study. Click once, just after the pro was removed from the patient, a flashing line will appear. Click on edit on the toolbar. Click. Create compensation. This will adjust the Klaus view or contour colors based on the patient's body temperature. To display the way from tracings, click on the Klaus View or Contour icon. This button can be toggled on or off to move back and forth from Klaus View or Contour toe way for mode. When editing the study, evaluate each area of the esophagus, including the L. A s profile, which measures the length and position of the esophagus. The lower body L E s study which evaluates the pressures of the L E s in esophagus, at rest and during swallows. Evaluation of the upper body in us, which evaluates the strident muscle, is optional. Yeah, with high resolution, there are two different methods available for editing and reporting patient results. Conventional will use way forms and the report will contain patient results as well as normal values for the L. E s resting pressure. Elliott's residual lower body velocity, amplitude and duration of contractions, as well as upper body amplitude, duration of contractions, U S resting pressure, residual and coordination values. Bolas transit editing in the pizzas channels will be done using wave forms, and the report will reflect patient results along with normal values. The Chicago Classifications method will use Contour and reports patient results for integrated relax ation pressure distal contract tile integral. Just a leighton See parasol, tick breaks and contract. How front velocity. The next two slides will review Chicago editing. After completing the temperature compensation moved the screen in contour mode to the first wet swallow click on the analysis tool in the toolbar. This will bring up the measurement boxes around each. Measured what swallow? Activate the first West, followed by clicking in it. Chicago markers will appear on the measurement, and the analysis box will appear to the left of the measurement. Open each liquid swallow measurement to verify that you agree with how the software has marked the Chicago values. For more information on how to adjust, Marks referred to Santel University Tutorial, Chicago Classifications, Automated Analysis or the Sweet Pea Quick Start Guide For automated Analysis. Be sure you're using bio view analysis software version 57.0 dot zero or newer Chicago classifications. Measurements will not be created for impedance channels or viscous swallows. If you want to profile the l ES and review the results of the L. E s resting pressure. Refer to slides 12 through 27 in this tutorial. Otherwise, once all the liquid swallow measurements have been viewed, you can proceed to the report. Yeah, to review measurements and wave form. Toggle off the contour color by clicking on the Klaus View icon. L. A s profiling can be done in either way, form or contour markers for distal edge pressure and version point or pip in proximal edge of the L E s will be entered. Yeah, click on ranges on the toolbar, then select Elia's profile. This will change the channels viewed on the screen to the channel surrounding the L E s. If more channels air needed to view, click on view and select show slash disable channels to select the additional channels needed. With this probe, you will select range sets based on a long esophagus greater than 18 centimeters or a short esophagus less than 18 centimeters. The first yellow box is the act of measurement. This is indicated by the dashed lines outlining the box. This measurement is the gastric baseline confirmed that all the way forms arresting on the zero reference line. Yeah, the gastric baseline measurement should be taken in a quiet area. If the measurement location needs to be adjusted, place the cursor on the side of the yellow measurement box. The cursor will change to a dash to box with double arrow click and drag the sides of the box so that the measurement box does not include any area of increased pressure. Yeah, 20 the channel. Place the cursor on the X axis until it changes to align with a double black arrow, then click and hold to drag the X axis line to a flat area of the way form. In this example, the gastric baseline now reflects a quiet area with no areas of increased pressure in all way. Forms are resting on the zero reference line. Yeah, to mark distal Pippen proximal scroll to the area near the L ES measurement box just before the swallows, after the probe depth was changed. Marking in this area will assure you are positioned at the proper probe. Depth markers of distal Pippen proximal can be added here in this view. Or you may choose to only mark Pip in way form and to mark distal and proximal in Contour. Pippa's best seen in wave form to still a proximal could be easily marked in contour of most studies. The distal edges of the L. A s is in the most distal channel, showing a rise in pressure off baseline, identifying the first sensor that has entered the lower salvage ills Victor in this example, the channel that first rises off the baseline is Channel 45. The next three slides will outline the profiling process using way form left click so that there is a flashing line on the way form in the area where the distal will be labeled. Then either right click and select. Create an event or click on the create event icon in the toolbar. Name the event distal and select the appropriate channel in the relative to box. In order to identify Pip, compare the respiratory wave form pattern. There will be a positive inflection Orpik with inspiration and channels below the diaphragm and a negative deflection or trough with inspiration above the diaphragm. Use the flashing reference line by clicking on a peak in the lower channels. This will help to guide your eye to identify the channel where the way from changes from a positive inflection to a negative deflection. Anti Pippen the appropriate channel in this example. It is in Channel 43. Yeah, annotate the proximal border of the S and the appropriate channels by identifying the channel where the way form drops to or below the baseline and flatten somewhat when the patient swallows the channel of the proximal edge will show a contraction wave. Yeah, To profile the L E s in the contour view, click on the Contour icon. The way forms can also be viewed at the same time. This is optional. The contour color plot sets the colors so that the more intense the yellow and red colors, the higher the pressure. The L E s is the area of high pressure. At rest, the contour view utilizes a reference line. Place the cursor on the reference bar and click and drag to the desired position to annotate the profile events. Click and drag the reference line to the distal edge of the L. E. S or bottom area of highest pressure. Right click when it is in the correct position and select create event. Yeah. Name the event distal. The create event tool will calculate the channel in depth Click. OK, yeah. Move the reference line up to the proximal border of the L. E s or top of area of highest pressure. Right click. When it is in the correct position and select create event name the event proximal that create event tool will calculate the channel and depth click. OK, Yeah. Thes Safra Geo Baseline and L E s resting pressure are both acquired at the same time, this savage ill baseline measurement is located directly above the less pressure measurement. This after geo baseline should be in a quiet area. Edit this Safra Jail baseline if needed. Avoid any contraction waves or areas of pressure within the analysis area. There should be no data displayed for a baseline measurement click in the l. E S P measurement opened the analysis tool. When active, the L S P data will be displayed to the left in the analysis box. The number displayed in bold black print is the high pressure zone and will be the reported value Check that this measurement was taken in an area with no artifact, such a swallows or movement. Adjust or move the measurement if needed. By dragging the sides of the box. Yeah, moved to the first saline swallowed by dragging the open black box at the bottom of the screen. Click on ranges and select a lower body LS range set for either a long or short esophagus. This will shift the channels on the screen to measurement Boxes will appear. The top box is for the four impedance channels. The lower measurement includes four pressure channels in the esophagus designated to measure the body activity during the swallow and four or five distal channels To calculate the relaxation of the L. E s. The number of L. A s channels displayed will be dependent on esophageal length selection. Yeah, click on the first impedance measurement. The study bar will indicate this is an my eyes. Follow multi channel inter Luminal impedance. Note. The bottom of the analysis box says complete bolas transit. Yes, remember for Bolas transit to be complete, the bolas must enter in Z one and exit in Z two, z three and four. Edit is needed. Yeah, the next slides air magnified In order. Thio easily view the measurement area. If editing is required for an impedance measurement, click once inside the first impedance measurement area To activate the box. Open the analysis tool on the toolbar. If there is entry and exit identified in each channel, the bullets, presence time or B P T will be displayed in the analysis tool. The total Bullis Transit time will be displayed at the bottom of the analysis tool. Normal bullets Transit time is 15 seconds or less for liquid and viscous swallows. The total Bullis Transit time RTB TT is calculated from the entry of the bullets in the proximal impedance channel to the exit of the bullets in the most distal impedance channel. If there is entry in the proximal channel and exit in the next three impedance channels and the time requirement is met, complete Bolas transit will be yes for swallows, whose exit time in any of the distal three impedance channels exceeds 15 seconds from the entry point in Z one, the label will be complete B t know for time. If the measurement says complete Bt and know what time and Princess sees, there will be exit points in each channel. There will be Ebola's presence. Time reported time from entry to exit in the measuring segment as the Bolas does eventually leave the measuring segment but does not meet the criteria for complete transit. In less than 15 seconds between the one entry and the exit point in that measuring segment for swallows missing an exit point in any of the distal impedance channels, the swallows will be labeled complete Bt no, with exits in parentheses and there will be no bolas presence time in the segment missing the exit point. Yeah, to edit a measurement which says Complete BT no for exits. It is important to check the missing exit point and make sure that the impedance has not risen above the 50% threshold line for the required five seconds. To add the exit point right click on the area where the exit point should be at the dashed line, indicating the 50% threshold right click. The menu will appear select Add Bullis exit. The exit point will be added. Yeah, now the exit point has been added in Z four and the analysis box shows complete Bullis transit. Click on the first liquid swallow measurement indicated as a swallow. Relax measurement. This measurement includes four pressure channels in the esophageal body and 4 to 5 channels in the l. E s. The L ES channels calculate the residual pressure in all of the L ES channels. However, only the highest residual pressure value will be used for the final report. This is indicated in bold black print. Yeah, when editing the l es relaxation thes few principles apply. Residual pressure is marked by the X is at the low point of the relaxation. The highest residual pressure of the channels is indicated in the black print and is the one used to calculate residual pressure for the report. Click and drag any X so that it is in the low point of the curve when editing the esophageal body. Remember these few principles. Start of contraction should be where the slope of a stroke of the contraction intersects the baseline. The peak is the highest point of the contraction, and the end of the contraction is where a line drawn through the down slope of the contraction intersects the baseline. Move any analysis marks needed left, click and hold to drag the mark to the desired location. The vertical lines were used to mark the onset and the end of the contraction for time, and the X is used to indicate the highest peak of the contraction. For pressure, observe the data in the analysis box Yeah, to view Contour plus way form during editing, click on the Klaus View icon again. This will change the view back to Contour with away form overlay to toggle between views. Click on the F three key on your keyboard. Continue editing all the measurements in the study noted viscous follows were done. You will only need to edit the impedance data. This is done in the same manner as the liquid swallows impedance creating measurements for the U. S. U S coordination and upper body study is optional. The following 12 slides will provide detail on creating and editing these measurements. You can also refer to the tutorial HR I am analysis of the U. S. On this website moved to the beginning of the study where the gastric baseline measurement was taken. By dragging the open black box at the bottom of the screen, click on ranges and select the appropriate upper body US range set. This will change the channels viewed on the screen to the channels displaying the U. S and upper body. Check the esophageal baseline measurement that was created during the gastric baseline. Make sure all channels around the expert zero access and that there is no artifact in the baseline which may cause artificial pressure if necessary. Moved the measurement to avoid any contractions by clicking and dragging the edges. Yeah, scroll to the first liquid swallow just after the pro positioning. Identify a quiet area. Identify the channels in the upper esophageal sphincter by the rising pressure off the baseline. In this example, three channels are located within the sphincter. To create the ESPN measurement, click and drag across the channels where a rise in pressure a scene, creating a green box right click to get a menu or click on the create measurement icon in the toolbar. Note. If the probe was pulled back 3 to 5 centimeters for a longer esophagus, used the's additional swallows for marking the US resting pressure and coordination for study. If T should be selected, select USP for upper esophageal sphincter pressure. Each of the checked channels on the right should be labeled us Click OK opened analysis tool to analyze the measurement pressure reading will be calculated in each of the selected channels. When active, the U. S data will be displayed to the left in the analysis box. The number displayed in bold black print is the high pressure zone and will be the reported value. Create a fair and geo baseline click and drag across all the channels above the ESP measurement. A green box will indicate the selected area right, click and select Create measurement Select Fair NGO Baseline. Each of the selected channels on the right should be labeled fair Knicks. The number of fair in jail channels will be dependent on the probe location. Click OK. In order to get US coordination data, you must have a least three channels in the fair Knicks at the first liquid Swallow measurement. Identify the most proximal US channel. Click and drag across the U. S. Relaxation and up through the fair and Jill channels during the swallow, the U. S wave will look like an M r J configuration during relaxation. This is elevation of the US Relax ation and returned to rest right click and select. Create measurement. Select U. S coordination. The distal channel in the measurement box should be labeled us in this example. This is Channel 20 de Select the two channels proximal to the U. S. Channel. The first fair NGO channel should be three centimeters above the U. S. Channel. This allows for movement of the U. S. During the Swallow label, the third channel proximal to the U S Fair Knicks. If there are fair in jail channels viewed above this channel they may also be selected, but do not select more than two above the distal fair in Jail channel. Click. OK, note that your channel numbers may be different than this example. Edit the U. S. Coordination as follows for the Ferengi Oh contraction wave. The start of contraction should be where the slope of the upstroke of the contraction intersects baseline. The peak is the highest point of the contraction. The end of contraction is where the slope of the down stroke of the contraction intersects the baseline. Move any analysis marks of needed by left clicking and dragging the mark to the desired location for the US relaxation, start of relaxation occurs where pressure drops below. Resting you is pressure. The end of relaxation occurs where the pressure returns to resting pressure. The residual pressure marked by the X is at the low point of the relaxation. Move. Any analysis marks, if needed by left clicking and dragging the mark to the desired location. Create 3 to 5 US coordination measurements. Check the data in the analysis box for accuracy Yeah, to create a swallow measurement, click and drag across the contraction area. A green box will appear Then click on the create measurement icon. Select Swallow you E S o B for Upper Sava Geo body. The checked channel on the right should be labeled body click OK, opened analysis tool. To view the analysis data, edit the measurement box in the same manner as the lower esophageal body Contractions Create 5 to 10 upper body measurements The final report to create the final report Click on the word report. If there is no previous report on Li, the create report will be active Options can be selected for inclusion or exclusion in the report. Yeah, Each subsection of the report has its own tab tab through each section and enable the data for the final report. Once the options for all the subsections of the study are selected, click OK. You only need to make these selections once they will remain for all future reports unless you change them. Thumbnails of individual measurements can be included in on the report. Select as many measurements is desired. Yeah, review the data on the report to assure it reflects the editing of the study, put the report and say review the data on the report to assure it reflects the editing of the study. Put the report and safe
