Chapters Transcript Video High Resolution Anorectal Manometry Analysis This tutorial will guide you through opening an acquired HRAM Study, opening a measurement and analyzing the data, and generating a report. Upon completion of this tutorial, the participant will be able to describe how toe open an acquired study and analysis view. Describe how to open a measurement and analyze the data. Generate a report after reviewing the findings, it is important to review the tools available for editing the bio view analysis prior to editing a study, The toolbar icons who are grouped according to their purpose. The application icons will allow you to open a completed patient procedure, save any editing changes or send your report to the printer. The navigation tools will allow you to move from page to page measurement to measurement or event to event. The viewing icons will allow you to magnify an area for better viewing. The editing icons allow you to turn on the analysis tool to display measurement points and result boxes create events or create measurements. The display chi icons allow you to toggle back and forth between Contour, Klaus view and the way forms, or to activate your sink view option. The View menu will offer different methods for viewing the screen. Rangers will provide the ability to turn on specific channel sets when editing different areas of your study. the channel sets their group by probe depth and will display all channels at the selective level. When using the range sets the way form view with separate the channels on the screen, whereas the Contour View will actually overlay the channels. Analyze that allows the user to turn on the Elektronik ruler to measure way forms and data points manually. By selecting analyze all measurements, the computer will analyze all measurements or you may choose to select just a particular measurement that has been edited. When you're editing is complete, you will click on the report button. If no previous report has been created, the Creator report is the only option available. A new report. What should always so be created if there have been changes in the editing of the study, if a report exists, you will have the option to click on view. Edit report. Use this option If you need to edit any of the patient information on your final report, you may also choose to delete an existing report and create a new report at this time. Open the study by clicking on the sandhill application's icon on your desktop. Double click on the bio view analysis. Click on the file in the top left of the screen. The patient file is found in the following pathway. C slash sandhill slash patients slash anal rectal. The study will open in Klaus View or contour, with all channels turned on and the way form over late on top to turn off the way forms, click on the way form button to turn off the color. Click on the close view, but the study can be opened by selecting a two minute window from the time pull down menu or the access magnifier is useful to zoom in on specific areas. Click and release on the axis magnifier in the toolbar. This will activate the magnifier. Move the cursor onto the way form, and the cursor will become a magnifying glass with two vertical lines. Click and drag left to right across the area. To be viewed, this screen shows you're magnified view. Using the wave form view. Adjust the baseline so that all channels air on the zero access before evaluating other measurements. If the channel is off the zero access click and drag the zero access to the way form when the cursor is placed on the zero line, the cursor will change to a black double arrow. Next, open the resting study in the contour of you. Turn on the analysis tool so that the measurement boxes air visible. Click once inside the resting measurement to activate it. This measurement should be in a quiet area of study pressure. To move the measurement box, place the cursor on the edge of the box. The cursor will change to a dashed box with a double arrow click and drag each side of the box to the desired area. On the study, evaluate the data in the analysis box. Move on to the squeeze measurement. The measurement box should encompass the entire squeeze maneuver. Evaluate the data in the analysis tool. Note the positions with the highest pressures. Thes will typically be located in the lower anal canal stations in the color contour view. The warmer the color, the higher the pressure in the squeeze duration measurement. Note that the measurement box Onley encompasses the lower anal canal positions during the squeeze duration. The emphasis of an analysis is on the stride. It's component off the anal sphincter, which is located in the lower anal canal the measurement box should encompass the entire squeeze maneuver. This measurement should also be viewed in wave form used the axis magnifier to click and drag top to bottom across the lower anal canal channels. The solid black horizontal line in each channel represents the resting pressure. The dotted horizontal line represents 50% above the resting pressure. The first vertical line defines the beginning of the contraction, and the second vertical line defines the point where the pressure drops below the 50% threshold. Each channel will calculate the duration of time. The pressure remained above the threshold. To adjust the duration, click and drag the end pressure vertical line to the desired point. Click the undo magnify button to return to previous magnification. The rectal anal inhibitory reflex is evaluated in an upper anal canal position to evaluate the internal or smooth muscle anal sphincter component and should reflect a relaxation of pressure. The lower anal canal positions evaluate the stride of muscle response, which is reflected in an increase in pressure. Check to make sure that each measurement accurately reflects the increasing balloon volumes. You may also evaluate each measurement in the way form view scroll through each position using the range set button on the toolbar. The lower anal canal channels will measure the stride of muscle contraction as seen on the left of your screen. The upper anal canal channels will calculate the relaxation of the smooth muscle reflects with the balloon stimulation as seen on the right hand side of your screen. Each rare measurement should also have a sensation, positive or negative event marker to correspond with the balloon volume for that measurement to add a sensation event, click once on the study. Ah, flashing reference line will appear. Click on the Create event button on the toolbar. Click on the down arrow, next to name and name the event. Positive sensation. Adjust the volume. Click OK. Note. The positive Sensation event has been added to the screen. The push maneuver evaluates the lower anal canal positions and the stride of muscles Effort to relax simulating defecation. A normal push response will reflect a negative value when compared to resting pressure. If needed. The measurement can be evaluated in the way form view. Magnify the lower anal canal channels using the axis magnifier. The solid black horizontal line will represent the resting pressure in each channel, and the X is placed at the lowest point within the measurement. If there is a rise in pressure from resting, the values will be a positive number. If an increase in color intensity or a rise in pressure is seen. This indicates a paradoxical response by the patient. Slow sensation event Marks of first sense urge and maximum tolerable in relation to the slow inflation of the stimulation balloon will be found during the slow sensation study. Note that the balloon channel the pressure was gradually increasing as volume is slowly added to the balloon. Check to make sure the event marks reflect the volume of each sensation felt by the patient toe. Edit an event mark. Place the cursor on the event line on the study. The cursor will now change to a double black arrow and double click. A change event Dialog box will open. Change the name of the event or the volume as needed in click OK to save the change. The compliance calculations were measured in the Balloon Channel. To visualize the balloon channel, better click and drag the great divider bar down between the sphincter channels and the Balloon channel verify that balloon volumes are annotated correctly and verify that your measurement was taken 30 seconds after the balloon inflation. Upon completion of evaluation of the compliance study, click on the word report, create your report and review the document to activate sink view at any time during your analysis, click on the sink view button. Place the flashing cursor in front of the area you wish to view in Sync View mode, selected to the single play button or the Loop Play button. To start the playback, the cursor will scroll across the area to view as the three dimensional playback exhibits pressures. Created by
