Chapters Transcript Video Zvu® Functional GI Software-HRiM Webinar Overview of using Zvu® Functional GI Software to perform esophageal manometry studies. good afternoon. On behalf of Sandhill Scientific, I'd like to welcome everyone to our webinar on h r. I am analysis using Z view Advanced diagnostic software Before Wendy begins, I'd like to handle a few organizational matters. Everyone at this point is muted. To control sound quality. The webinar is being recorded in. Any participant can listen to this event at a later time by accessing the sandhill scientific website at San Hillside. Com. If you have a question during Wendy's presentation, please type it into the question field at the bottom of your screen. For those of you that may not know her, Wendy O Connor is a registered nurse and senior clinical specialist. Let's sandhill scientific. She brings 30 years of nursing experience in several years of clinical support experience to her role. She has been an active coach in our Safi, Jill and an erectile courses offered at our sandhill training facility. Daily support has also been given by connecting over the phone and in many cases by computer to train on our software and shed light on the analysis of difficult cases. This support has connected her to customers all across the U. S and many locations around the world. I'm pleased to introduce Wendy O Connor. Thank you, Dan. I'm very happy to be here today to introduce many of you to analysis with Z View our new diagnostic software. We're very excited about this product and look forward to being able to assist you with knowing how to use it. This is the home screen for Z View, but I want to back up to my desktop to show you how easy it is to access our software. You would access it from a double left click on the Z View desktop icon brings you right into the home page from the home page. Select patient Management Patient management opens up a patient list on the left hand side. I'm gonna open up a few more studies here. Sample studies. All of your patients will be contained here later. When we add reflux and an erectile products, you can contain the same studies. All the studies with a single patient, so a single patient would have a tile in the patient list, and then all studies for that patient would be contained within that tile. We no longer have separate folders for different types of studies. If you would like to set up a tile for a new patient, the fields on the right are clear, and you can go ahead and type in the patient's name and then a nickname or maiden name or prior to marry. Name anything you'd like to put under other names. That's an optional field. The fields with an Asterix are required. You can type in a date, which will go in as month, month, day, day, year, year. This can be changed through a properties field to be day first, then month, then year. Or you can use our calendar picker. Over here, you can select a decade and a year in a month in a day, so it's very quick to use the calendar picker. You can enter in their medical record number and gender, and you've now got your patient information in there. But in order to complete a tile, you would also have to set up a study for that particular patient. So you set it up under new study in the study section, the first place you'll start is with a workflow. Ah, workflow. Think of it as the instructions that are going to run your study, they will be the data that the computer is going to pull for a particular study. There are no work flows currently on my list, so I'm going to create one. I'll click on Manage Work Flows. I'm gonna add. I will choose the system that I'm going to use. We'll say it's an ultimate system. I'm gonna choose my prototype. Here's our high resolution probe with impedance for, um, most of our adult population. I'll choose that Prue and I can do a manual or auto calibration with an ultimate system, so I'll choose an auto calibration, for example, and then I can choose an extended or standard protocol. Right now, not all of these different types of swallows air going over to the report, so most of you will probably pick a liquid and viscous swallow standard protocol at this time. Then I can choose what type of report I want to see when I actually generate my reports, as we'll see later in the study, all the datas analyzed for all the parts of the study, conventional and Chicago, but I may not want to see a report with all that data So in this case, I'm going to choose a Chicago based report. Or maybe I can choose Chicago based and a combined report, and it will generate both types of reports for me. If if a custom report is created, then it will be named, and it will be listed here is well, and then I can name this particular workflow. So perhaps I want to name it for the doctor in the department because this is the typical workflow for this particular physician prefers. Perhaps another physician prefers something else. And then I may want Thio say what kind of protocol I'm doing. So now it's been named. So I have a protocol there. I can add additional protocols to the list using the manage protocol manage work flow icon. There, I can add additional work flows. Um, or I could just have one for the department. This then highlights all of the fields down below, and they now can be completed under probe. This is also a required field. I will enter my probes. Thes only need to be done one time. And you may have one more than one probe that fits that workflow. We're gonna add a probe. That's the prototype. And then we can put in a serial number and we can give it a nickname. For example, maybe this is my lab One probe and finish. And then I can add an additional probe if I have more than one in my department. So perhaps I want to add a second one, and this is our lab to probe. Now, I have options. I can pick either probe because they're the same model and they'll both work with this workflow. I'll show you briefly how to set up a hospital and a physician. If you need it for the hospital, you would type in a nickname. It does not need to be a formal name, but the name of your hospital and you would add it. And then you can go into the manage, uh, the edit, the hospital report header, and you can type in now the formal name of the hospital, and you can type in all the information that you need on your header. If you have a logo loaded on your computer, you can browse for that logo. The logo can be resized. If need be, you might have to save it into a different field so you can click on it and go to open with. And everybody has paint on their computer, so perhaps you can open it here, resize it here and then save it somewhere on your desktop. Once you select it, it will now go on the tops of your report. So all this header information phone numbers, address emails, etcetera plus a logo can go on to your reports for adding a physician. For example, just start typing in something, and you can go ahead and add it, and then thio add another. You could just scroll over it and type in a different one and add it and your list will grow. Endoscopic findings is one that has been pre populated with various features, and you can collect. You can click on more than one. You can also add your own, and this will be saved to the feet to the field, and you can choose that added item in the future. A swell so your list can grow their asses well, the other fields, unless they have a drop down arrow. These other fields here are free form free type fields at this time I'm on the laptop, so I'll scroll down and show you that there's also a notes field down here at the bottom. You can go ahead and complete that. Once you've completed all the fields that you like, you may click save, and now a tile has been created for that patient in the tiles. The brownfield indicates the number of studies that have been set up but not yet acquired. The Greenfield is the number of studies that have been acquired but not yet reported on. And if there's a number in the purple field, it means that a study has been acquired and a report has been generated for that particular patient. If you have an existing tile and the patients already had a study, but you'd like to add an additional study for that patient, you can click on the plus symbol here, and it will open a new tab for you, and you would set up your study appropriately. We're going to go into an existing study for this particular patient, so I selected the patient tile. I will review the patient information in the upper right. I'll review the study information on the lower, right. This is an acquired study acquired on this day at the top tab here. When I've confirmed that's the correct study. I want to go into a click on the lower left. Excuse me. The lower right on review study. The study page opens with the entire study in view. We have the contour pressure screen with impedance overlaying on top of it at a 50% opacity. And then we have thumbnails of all of our measurements at the bottom of the screen. The thumbnails air Very helpful because you could get a quick overall view off this patient's motility pattern as well as their Bullis transit, all in one quick view in the pressure section. If I don't want the impedance overlaying that strongly, I can change the opacity, Aiken, dial it down a little bit. I can dial it off entirely, or I can make the impedance more intense. So the sliders at the top change the intensity of your view. But it does not change in the thumbnails if you'll notice if the impedance is dialed off in the pressure section up here. But it is not off in the thumbnails, so you can keep keep tabs on what's happening with your impedance. I'm gonna bring the impedance up a little bit, but not too intense, just a light background there to begin analysis of your study. You will click on the options button on the upper right and opened the annotation area from the annotation area. You can see all of your notations, including your compensation line from at the compensation green bubble. Do a double left click in the bubble and you'll zoom into an immediate one minute view you will review to make sure that your compensation is correctly located. It looks good in this particular study. It is close to the end. Excuse me. It is shortly after the probe was pulled out of the patient when the probe is still warm and there is no indication of the probe having been touched after the probe was removed. So that's the proper placement for that. But if it were acquired out further out here, you double left, clicked on it and zoomed into it and saw that it wasn't in the correct location. You'd want to correct it. So you do a left click on the compensation bubble and drag it closer to the area of Ext dib ation, but not over an area of warm colors such as red or orange, indicating the probe was touched. It was touched. You'd move away from the touch area, but you keep the compensation line in soon after the probe was pulled, because that's when the probe is still warm to body temperature. Way over here to the right, it's the probe is cooled off too much, and the colors in the study are temperature dependent. So we wanna make sure that we're using body temperatures best we can. Now that we have corrected the compensation and our annotation areas open, we may want to check and see if we want to adjust or add or delete any other annotations. We can return to full study by using toggle Zoom. Now we can look at other annotations, for example. I know that there's a probe depth mark here, and there's a probe depth mark here, and there's another one over here. But I know this one was incorrect. I remember doing the study, and I remember that I marked the probe depth incorrectly. I'll activate that mark and I can do a right click on it and delete it to take it out. I also remember on this patient, perhaps, that they complained of chest pain after swallow, so I recall that it happened after swallow seven. But I didn't market during analysis. I could market. I'm sorry did market during acquisition, but I could market now during analysis. I could do a right click either up in the annotation area and choose Add adaptation or I can click down in the pressure area. Add annotation. Now I need to tell the computer where to place that annotation, and I'm going to ask it to place it after liquid swallow Number seven. Now I can name that particular annotation. We have a pre populated list, and you can choose from that list. Or if you would like to type something different, you can click on comment and type in your own individual comment. In this case, I'm going to choose chest and click OK, and now there's been a chest pain annotation added after swallow number seven, so you can add, delete or move any annotations. Once all of your annotations air up to date or corrected, you can diesel ect the annotation area in the option screen. This will give you more real estate for your pressure area. Now we're going to navigate to the resting thumbnail on the lower left hand side. I'll double left. Click there, and it zooms me into a one minute window. We have a single resting measurement now for all baselines and L E S P and U. S P pressures. This needs to be interesting area where they're away from swallow activity. Obviously, there's a swallow coming through the middle of this particular measurement, so we'll correct it and resize it. If I hover over the edge of the measurement, I could do I get a double sided white arrow. I could do a left click and drag that measurement where I needed to go to a quiet area away from the swallow and before the next swallow begins. Now I have a quiet resting measurement. The next step would be to set my probe are here on the right hand side. The probe are can be set during acquisition and may save me some work in analysis. But if it wasn't set or wasn't, set it correctly or I want to adjust it I can adjust it now. This area is three us. Let me expand it a little so you can see it. And if I do a left click inside the U. S area on the probe are I get the two margins of the U. S. I can then dragged the margins where I wanted to go. So my proximal margins correct. Now I'll just my distal margin individually with the double sided White Arrow. Now, if I just do a left click and hold, I can see that my margins match up. Well, I could do the same for the lower esophageal sphincter. The lower esophageal sphincter during the resting measurement is quite weak, and it's difficult to see the margins. But I can see outside of the resting measurement to mark my L. E s. I can drag the whole thing down as a unit, and then I can adjust one margin at a time, and then I can just click and hold in the middle of it to see if I like where I placed it. The proximal and distal edges have now been calculated, and are will go to the report from this particular marking now that I have the margins of the L E s set. I can set the high pressure zone blue diamond. I can click and drag the blue diamond to match up with the high pressure of the L. E s. And I can see that in this swallow prior to the resting measurement, moving the HPC diamond is only necessary. If you're going to be doing conventional waveform analysis, it is not necessary for Chicago analysis. The E g J box, next to the L E s will be sized Samos the L E s, and you can adjust it if you feel is, though, there's been a spatial separation between the diaphragm and the lower Softail sphincter. If there is such as in this study, then we can click and drag the e g J line down to the distal edge off the diaphragm pinch area. So the E G J usually runs between the proximal Elias and the distal diaphragm, including everything in between. This will help to set the IRP box for Chicago analysis in the proper E g J area. Now that the pro bar is set, I can look to see if I want to disable any sensors that can be done in this row. Here, the darker gray trying rectangles are pressure sensors. The lighter gray rectangles are impeding sensors. And of course, impedance and pressure are at the same level in the probe, so you can disable a particular sensor. If you'd like to disable a sensor left, click on it and a list of the nearby sensors comes up when you hover on one, you will see that you get a line showing up to show you where that particular sensor is, and you can choose whether you want to disable it or not. If you disable a particular sensor like checking it, then that data will not be included in your analysis. And there'll be a little pink rectangle over here letting you know that a sensor has been disabled to re enable it simply left, click on it and uncheck the mark. So now all sensors are active and we're receiving data from all sensors. Now we're ready to open metrics and show our marks. The metrics is here in the upper right next to options. Metrics will show our data on the right as well as our marks within a particular measurement Right now we're showing the contour view and we have the check mark on That shows that we're showing the marks for the Contour view and some of the marks correspond to the way formas well. But in this case, we're going to be looking at marks and we can adjust. Um, this is arresting measurements, so we'll be getting our baseline values. All of those resting measurement values are here in the metric section under measurement metrics. Down below is a section called Study Metrics that shows us the compiled data from all the measurements each type under its own tab. So the resting measurement eyes here under the resting tab. All the liquid swallow data it's combined under this tab. Had there been viscous or solid swallows, they would each have their own tab. For example, if you don't care to look at this compiled total data at the moment, you can slide it down out of the way. In the resting measurement. When you click on a baseline, it becomes white. I'll slide it up here little so you can see it when it's white. It's the active line, and it's named for you down here in the lower right hand corner under the resting measurement. So this is the gastric reference, and it's the computer placed it in the quietest place it could find. And it is the gastric reference for any measurement that needs or any mark that needs a gastric reference. So that would be for the DSP for conventional way form residuals as well as for the I. R P. The next line in the more in the middle of the esophagus up here is the esophageal baseline or the body reference, and this is the reference for any marking that needs an esophageal baseline. That would be the smooth muscle body portion of the contraction, as well as a reference for the U. S. P. The computer placed it in the quietest spot, but if you want to move it somewhere else, you may do so. This line of the top is the fare in Jill Baseline again, the computer put it in the quietest spot, and this is the baseline used for the coordinations for the pharyngeal amplitude. The fourth line that I skipped over is the pip line. You may feel as though the other three baselines are already in a quiet spot and need no adjustment, but the pipeline will almost always need to be adjusted. It starts out equal to the proximal edge of the ES. According to your probe, are to keep it away from interfering with Theis, a vigil or the gastric baseline. Grab a hold of the pip line and draw it down towards the gastric baseline below the diaphragm pinch area. You will notice there to weigh forms that are peaking up together with a respiration because their abdominal there below the diaphragm. There's a blue line and a red line, and we'll watch as we slowly move up from the bottom for the area of first maximum inversion. So the Blue Channel is maximally inverted compared to the Red Channel, and this indicates that the white line is at pip and then I let go. So once again, we draw it down the pipeline below the diaphragm, both channels air peaking Together. We raise it up until one the Blue Channel inverts compared to the red, and if I kept going up, you would see that both channels invert together because they're both up in the thoracic cavity. So we want to come up from the bottom and find the first area which you have an inversion. Go to the maximal inversion and let go and Pip has been calculated. It appears both here in the measurement metrics, and if we were to look at the study metrics, it appears there as well. So we have completed all of our baseline reviews. There is no zeroing of any channels any longer. There's just review to make sure the baselines Aaron quiet place and then finding your pip. Now we'll move on to the swallow measurements. I have the thumbnails at the bottom. I can do a quick review of the thumbnails to see if any of my measurements need adjusting. I happen to notice that swallow Number four doesn't look right. I might double click on that measurement and realize that that measurement needs re sizing. I could do so now by doing a left click and drag on the edge of the measurement and resizing it. That looks better. Then I can scroll through these additional from the house to see if any other adjustments need to be made. I conduce a left click and drag my thumbnails or I could have used the arrows to go forward or back through the thumbnails. I noticed that liquid swallow number 11 looks like it has multiple swallow starts. I'll double left. Click there. And yes, there are multiple swallow starts there, but I already have 10 good single swallows. According to my thumbnails, This is an extra. I can delete it. I did a right click on the thumbnail title bar and delete I also I'll bring it back. I also could have done a right click in the thumbnail itself and deleted it. Now I have a good set of 10 single swallows and I'll begin my review. I can double left, click on the liquid, swallow number one and start my review. Here. The pressure contour is on the impedance. Over lane is on just a little bit. And because I'm looking at pressure, the marks that air showing indicated by this check mark Here are the Chicago analysis marks to activate a mark that I want to move. I'll do a left click on it, it turns white, and now I can move that mark anyway. I want I can move the entire mark by left clicking inside of it and dragging it. I can move a margin of that mark, their top or sides. I can also do a diagonal move. Once I move on to a different mark, my original mark will turn purple, indicating that it has been moved from original analysis position and there'll be a purple box around it that indicates that that mark has been adjusted. Now, where were counted? Distal agency. Distillate INSEE line has a white line that goes up to start of swallow. So that's easy to see. And when you adjust the circle at the end, the start of swallow doesn't change. So that's very helpful. To keep the swallow starts stable. Mhm. Each of these marks, maybe you moved in turn. If a mark is missing and you'd like to add it, you could do a right click and add a mark, and then you can put it where you want it. You can adjust it as you want it, or you can even delete it if you want. Do a right click on it and delete. If you don't wanna have it present. All of your data is calculated all of the time, so the Chicago data is calculated here, and I need to move this over a little bit, and then the conventional data is also calculated. But if you're not reporting the conventional way, form data that need not be reviewed. If you do want to look at your conventional data, you would turn off your Chicago marks and you would slide on the view of your wave forms. And the way for marks will be on if you want to view them with the contour behind. You may do so, or you may slide off the contour and slide off the impedance and have a pure view of just your weight forms. We have upper Farron Jill, US upper body and then the four body channels and the L. E s showing all at once the lanes that each of these air in a rather small. So if you'd like to start out by increasing the view you can right click on a brace and click on height, then you can also adjust the scale. You can adjust the height for the body channels. You can adjust the height for the less channel separately. You may do so for the U. S. is. Well, if you'd like to zoom in a little more closely, you can do a left click in the pressure area and use the wheel on your mouse to zoom in. You can click and drag to pull it over. You can also use your magnify IRS up here, so a plus symbol will zoom in for you to a smaller view, and the minus symbol will take you back out again. To move a conventional mark, you click on it. It becomes like blue. If you move it when you stop moving it, it becomes purple, indicating that it has been adjusted from original computer placement to move on amplitude, you drag the arrow and the arrow will follow the wave form to move on a deer. Let me change this. Oh, it's scale a little bit so you can see it a little better. It is an arrow also a down facing arrow, and the lower part of the arrow tip right there where the finger of that hand is, is the analysis part. This little stick is there to help you pull it along, so it's the bottom of the down facing arrow that is marking an eight deer. And when you're marking an amplitude, it's the tip of the arrow here that it's marking the amplitude so you can move your conventional marks at any time. When you're done with your pressure conventional way for marks, you can slide on your pressure. I'm sorry, your impedance way for marks again. You can adjust the height, and if you like, you can adjust the scale as well. When the marks air moved their light blue when they are, when you stop adjusting them, they're purple, indicating they've been adjusted. You can delete a mark, and you can right click and add a mark so right click on a mark to delete it right. Click in that lane and add it right click toe at the entry moving. The idea is the same is moving a pressure in a deer and moving a baseline is done with the little stick over here and it follows. The baseline follows the wave form. The nice thing is that in pressure, weaken delete marks now as well, So if you choose to delete a mark, you can right click on it and delete it, and then you can right click and add it if you so choose so you can analyze a particular measurement in the way form. View inthe e pressure, pressure wave form in the impedance way form or in the pressure contour view. You can slide on the pressure contour a little bit in the background. If you want to see that and when you're doing your impedance, you can have the way form impedance on and you can slide on the contour. Impedance is well, so any of you you'd like toe have is possible with sea view. Again, all data is calculated for every swallow at all times. We have the Chicago we have the conventional way form data and we have the impedance data. If you're going to be including it on your report, we do recommend that that data be reviewed. Once you have gone through all your thumbnails, you can either do so by clicking on the next thumbnail. Or you can click on the forward or backward arrow on the on the title bar of a measurement. Once you advanced to a swallow, you can also use the right and left arrow keys on your keyboard to advance to the next measurement or back one measurement, so feel free to move around in any of these ways. You can also do a left click and drag to move through a study. If you'd like to write a note to another reviewer, there is a sticky pad note on each measurement. You can click on that note and write a note saying, um, anything you want and click OK, and now there's a pencil icon on that sticky note, and it appears on the thumbnail as well. So the physician or the other the second review or can see a note pad with a pencil. They can click on that thumbnail, or they can click on that measurement, and then they can click on the sticky note to see what the note says. Once they've read it, they can either keep it within OK or cancel, and if they're ready to get rid of it, they can delete it. Once you reviewed your measurements, you may choose to look at the study metrics for the total data to see how your measurements came out, and I'm trying to pull this up. You gotta stuck together, you know, once the whole study is done, you can pull up the study's summary section. If you're doing Chicago classifications, then the pattern classification is listed here. Based on the Chicago numbers. This pattern classification is not does not constitute a diagnosis, but just is a comment on the pattern noted by the numbers, and it can be altered if need be. So click on the drop down arrow and it can be changed to whatever the reviewing physician would like to change it to. Notes could be written here, and any note written here will populate back to the patient management screen. We were just on where the patient was set up. Impressions can be typed in here for the report, and a diagnosis can be given and a diagnostic tag one could be chosen from here. It's not a requirement, but it can group the patient for searching on later, and multiple tags can be given to the same study that way Later. If I want to search for all local Asia Type two patients, for example, this particular patient will come up because I've tagged them as an ankle Asia type two. Anything that's typed into this study summary will go to the report. Remember, hit your save icon here at any time to save your study, to save any updates that you've done. And if you ever need to back up and undo stuff you have, undo and redo. Think we've touched on all of our buttons except report. It's now time to generate the report. Yes, question that had come in. Could you demonstrate how to show the adjustments for the Is Albert Contour? Oh, yes. So the ice a bear Contour lines are the lines that trace over a set level in the pressure section. It defaults to being the black line, being at 30 millimeters of mercury. So the black line here is tracing all pressure of at least 30 millimeters of mercury. The Blue Line, or gray line traces all pressure of at least 20 millimeters of mercury. Those lines air used for Chicago analysis and the reviewer is welcome to set them at something other than 30 and 20. So, for example, if they want to change that, they just click on the tab on the color scale, and they can alter that value and you will see that black is now only tracing pressures of 65 or greater, But I can alter that toe whatever I want and the same with the gray or blue line and that'll set right as you do it. If you'd like to adjust your colors, let's say you have a weak swallow a week L. E s, and it's difficult to make it out and and see what's going on. You can increase the intensity of the color, and that's not the opacity up here that's changing the color and what's assigned to a particular color. You can click inside the color scale, then adjust the color to make it warmer or cooler. And then when you get to where you like it, you can click again inside the color scale toe. Lock it in if you want to reset it. The easiest way to do that is to come up two options and color theme and reset, and these color bars will reset. For those of you who have used a different color theme, you can click on options and color theme and dark, and you will have the darker color theme with pink impedance. And if you choose to go back to the light, you click on color, theme and light, and it will go back to the light color scheme. Let's go on to reports. I do wanna have time for questions once we have completed our review of all of our measurements and we reviewed our metrics and completed our information. In study summary, we click on the report Oper report icon in the upper right hand corner here and generate reports it will generate the reports I chose in my workflow. But it doesn't mean that you can't choose additional reports toe Look at it this time thes air the types of reports that I asked for when I did my workflow. But I may only want to review one that shows Chicago data and summary information will be on the first page and that the impressions and diagnosis that were typed into the summaries there as well and additional detailed information is to follow, including thumbnail pictures of any measurements I chose to keep that I want on through the report. I'll close out of my report now and go over thumbnails If I all thumbnails will be included on the report to start with if I want to de select a thumbnail I would click on it, do a right click and uninsulated the thumbnail for the report. Now that will not be included on the report. If I want to open a different type of report, I could go into manage templates and I can say, Well, I really didn't want these reports. I wanted the conventional And if I had made a custom report, the customs would be listed here to perhaps I want ah, Dr Smith report. I could select that. Whatever I want to be generated, I could generate. So now when I click generate, I won't have as many report types selected. I only have the conventional base because that's what I changed to when I went in. To manage custom reports are available where you can delete sections, move sections around, uh, those that all can be done under, um, a setting. Under properties, custom reports can be created thes air default reports and customs can be made. That pretty well summarizes theme analysis of a high resolution Manama tree study using the zebu software. So I think we are open for any questions. Thank you, Wendy, for that presentation, a couple of questions that have come in. Uh, one question. Do I have to see the probe? Are how can I hide it? Oh, good question. You can hide anything on the screen. You can turn off metrics by just clicking metrics again. You can open options and you can turn off the color key, which is over here by de selecting it. You can go into options and turn off the probe. Are. If you don't want to see that, you can come in and turn off the thumbnails. If you don't want those you pretty much left with and not a whole lot left, you can even turn off the ice of contour lines. If you're not using the Chicago analysis and you don't care to see the ice of contours, you could turn them off a swell back into options. I didn't show sink view. I can show that is in here, which is a cartoon like picture that we developed based on concurrent video fluoroscope E. So it actually has some pretty strong validation that went with it. But it will follow. What's going on here? The basket on the outside is a model of the esophagus. The probe is down the middle and the purple in the middle. There is some bolas and so you can select a swallow with the cursor here and turn on the button. And it will. As the cursor goes across the swallow, you can see the bullets coming down the middle that purple bullets just went down. Then you can see this contraction in the esophagus chasing that Boulis down the esophagus. Pretty neat view. I'm gonna close sink view now and I'm gonna show you our cursor. Our cursor here is this blue band, a blue triangle at the bottom. You can grab a hold of it with the left click and then run your finger up into the contraction. And it will read pressure because I'm showing control pressure. It will read pressure at any point on the screen if I turn on the contour impedance a little bit, even if it's very low Now when I go up into their, I will get both pressure and impedance at any level on the screen. If I have way form on and various lanes chosen, then when I click on this and just stay where I am down in the time bar, I can see my pressure measurements as I move along across the screen at the levels of those weight forms. Likewise, if that's often I have the impedance on and I move this along the time bar, I will see my impedance markings so that cursor is pretty fun to use and very helpful. So again, if it's contour on Lee, you would click on the cursor and move it up into the pressure Click left, click and drag up into the pressure. If it's way for my constrained down here on the timeline and with my wave forms on and show me the different values. Other questions Yes, thank you. Another question here related to reports can you create to reports at the same time one short version with only two thumbnails and another one with more thumbnails. Yes, you may. You could do those is custom reports, and you can name them separately. Oh, thumbnails. That's a good question. Not with different numbers of thumbnails right now, but with different data. So if you want a short report that just has a summary and that's all the information there is on there, you can create a short summary report and you can have a longer, more detailed report, both of them if the summary had thumbnails chosen, it's kind of yes or no. It's going to show all the thumbnails that you had selected at the bottom of the screen and your detailed report. If thumbnails were selected that they would show all the thumbnails that you had at the bottom of the report, so they'd have to show the same number of thumbnails, I believe, yes, but that's a good question. I hadn't thought about that, but we can hopefully add that in this enhancement in a later version of our software. Thank you for that. Another question. For individuals used to a darker color scheme. Is there a way to switch between color views? You can click on options and go to color theme and go to dark. And that will be the darker color theme with the impedance as a pink impedance instead of purple. And that's just done through the options screen here. I don't believe we have it as a user setting toe, always open that way and stay that way. But that certainly has been discussed a za later enhancement. But right now You have to probably do it every single study. But you're gonna come up to your your option screen anyway. Toe open your annotation area. You can just click on it one more time and go to your color thing. And then it will stay that way for that patient. Another question relating to setting Pip. If the patient has a high, it'll hernia. Yes. Um, when setting Pip, how is that done? Well, the patient that we're looking at now has a hide, a hernia. And so you want to make sure that you go low on the screen and I'm sorry. I'm gonna go back to the light color screen here, and I'm going to take off the impedance for the moment. The lower Softail sphincter is here. The diaphragm. He is here. And then there's a little gap of blue in between. That's the amount of stomach that have been pushed up into the chest cavity. And pip is usually the top edge of the diaphragm squeeze. So you want to make sure that when you are looking at a particular resting measurement and I got the metrics open and I clicked on my measurements and I'm going to check on my mark here. I didn't have my check mark on. That's what shows the marks in the measurement. I would grab that pip line and pull it down below. What I think is the diaphragm. Bring it down near the gastric baseline. I It's not doesn't start out that way because it be hard to figure out which line is which. But I pulled it down near the gas baseline and then slowly begin to come up and looking for the first moment at which there's an inversion. I will artificially pull this over a little bit, so we have some sphincter in this box. You pull it to their and show you the difference. You can pull it down below the diaphragm, and both channels both way forms air peaking together. Then, as I slowly go up, there's a Nen version of the Blue Channel compared to the to the red, and then they seem to sync up again. And then there's another inversion up there. You don't want to go to the second inversion. You want to start out at the lowest point of inversion coming from the bottom. The first inversion that you see. So it's just like when we did conventional way form analysis with our older software. The first inversion coming from the bottom should be the rial pip, and it usually ends up being on the top of these little diaphragm squeezes. Is that helpful? Yes. Thank you for reviewing that. Another question. How often do I have to hit the save icon A Z I've mentioned over the years on Lee. Save what you don't want to do over again if you accidentally trip over the power cable. So save frequently, not every step, but save frequently. Because if something happens and you get called out of the room and somebody shut your computer down and it didn't save, then you you don't wanna lose your edits and your hard work. I will tell you that as soon as you go into reports and you start to generate a report, it will auto save your study. So if you haven't hit save already, it will auto save when you start to do a report. If you make a move and you try to leave the study by Xing out of it, it will ask you if you want to save your edits. So it does Try to catch you and make sure that you get your study saved. But always best to save a little as you go along. Another question here. What if you cannot pass a large hernia or l e s e think in act in acquisition and cannot get a gastric baseline without a gastric baseline? We can't get accurate values for Anneli s resting measurement for way form El es residual data or for the i AARP. Uh, if the L. E s is at the bottom of the page and we couldn't get any lower than the l. E s. We have no gastric data. Then those three things are missing because the L. E s data is always relative to the gastric data. So if we say we have an L. E s residual or alias resting pressure of 34 it means it's 34 higher than the gastric pressure. We need that gastric pressures. A reference doesn't mean you can't get body data, though, So if you were unable to get through and the L E s were at the bottom of the page, you would bring your bar all the way down. And if you could see a little bit of El es, you have a little proximal el es here. If you didn't see any l e s at all. But you set the program disk optically and you know that the tip is at the El es you would you would have no l e s showing whatsoever, and everything would become body data. Thank you. There's been a few questions that have come in about customers who have older equipment and my recommendation. Anyone in that scenario please contact your local Sand Hill scientific rep. They can work with you on opportunities programs that we offer to upgrade your technology to be able to run the Seaview software. Um, one thing I didn't mention Dan is that if you get to us a later swallow and you feel is though, the esophagus or the probe is moved a bit and you want to adjust your probe are you may do so so artificially. I'm just going to say that this swallow they coughed or something happened in the US ended up in a whole different place on this particular swallow. When I go back, this one will be set where it waas. And then when I go forward, the new setting takes over so you can set the l es and us separately for every single swallow. If you wanted to. If you felt like there was a lot of movement going on, you can reset. That probe are and it will mark everything appropriately. It'll move your IRP box. It'll move where you're less. Channel is based on the probe are for that particular measurement. So no longer are we stuck having to have every single measurement of exactly the same place. The other good news for those of you who do us measurements is because we know where the U. S is located. The computer will make those upper sphincter measurements for us right here. So we have that data available and we consume into that those markings and a justice needed. Okay. Okay. Any other questions? Um, mhm. Let's see. Do I have to redo a resting pressure? Also, um, not quite catching the question there. Okay, um, with our older software, we needed to have all address a different question, But maybe this will get at some of what they were asking with our older software, we needed to have arresting or, um, a baseline measurement before our swallows. Now we can actually have arresting measurement at the end of the study or anywhere in the study, and the computer can use that for all of the swallows. We do think it's best toe have a single resting measurement. So if the patient was worked up, a head of swallow number one and you just know that if you get into the swallows, they'll calm down. Go ahead and get arresting Measurement. Go ahead and do swallow one and two and three and later. If they calm down MAWR, you can acquire another resting measurement by just backing up on the steps on your acquisition and grab another resting measurement. Or one could be added in analysis. And then you could get rid of the one back at the beginning, and the later one will be the one that takes over. If you leave more than one resting measurement on this study, the computer will average the values together, but you will be prompted when you open your study. It will notice that you have more than one resting measurement and it will let you know that you might want to cut it down to just one resting. But I could delete this resting measurement here, and the measurements won't be happy about it because they don't have a resting measurement. And then, let's say near the end of the the there's a nice, quiet spot and I want to use that for resting. Maybe I want to use an area out here. I could do a right click, add measurement, tell it where I want the measurement to go and then call it a resting. And now all you could see the calculating going on. Now all of the measurements are using this new resting at the end, and I can still set my baselines, and I can still do my Pip by grabbing my pipeline, taking it back down below the diaphragm and then slowly up over the diaphragm Squeeze and I'll look for that first inversion and stop there. And that measurement can now be used by all the swallows, even though the swallows all come before the resting and I'd hit save. Thank you, Wendy. I think we have time for one or two more questions. I have another one here. Is there a way without the metrics box to know this where I'm sorry. Let me re restate that. Is there a way without the metrics box to know where the sphincter is? In other words, where the tip of the probe is relative to the Nares, The probe depth. So that is up here. If if the probe are over here is set correctly, you can see it. Um, it's hard to see. Sorry. It's hard to see it for the Elias because Elias isn't very wide. But if I pull it down now, that tells me the length it doesn't tell me the actual probe depth. So, um, it's just telling me my swallows gonna be recalculated when I'm moving around. My probe are it tells me the length of each, but it doesn't tell me the probe depth. Um, with the metrics open, what you can do is go to your resting tab and it will show you your proximal us, your distal us, the total length of your us. But then you can see that same information for the L. E s is Well, you're proximal the lengthy inter abdominal in the distal as well as your distal baseline Impedance is included on hair. You can tell from there, but right now we don't have it on here. But that has been suggested as an enhancement for both acquisition, where you can see where your proximal aliases and acquisition as well as in analysis very easily for use in setting a reflex probe, for example. Okay, Thank you. I think we've got time for one last question. This one is related to acquisition. And the question is with Seaview, Uh, with the new Zeevi software, do you need to capture a gastric baseline, Asafa Jill body and high pressure zone during acquisition? Or is that done specifically and Onley in analysis? Great question. That is your resting measurement, and you will be prompted to get arresting measurement. But we no longer have to put the probe down to 60 and get a gastric baseline and then pull it back to final position. Instead, we can insert the probe. I usually go a little deeper than I need to go, but I go in tow, who knows about 50 or so and then back to final position and tape it there, and then I acquire my first measurement, which will be the resting measurement. It will prompt you to do that. So you just ask the patient to hold off on their swallows. And once they've held their swallows for a bit, and you feel is, though, they've come to more of arresting tone than you would go ahead and acquire arresting measurement over a few respirations, and then you can go right into your swallows. And the resting measurement is your gastric baseline, your soffit, Jill, your L E s resting pressure, your US resting pressure, your fair and Jill baseline all at once. So it's not done at a deeper depth that's done at the fight. At the depth of your that your swallows, you're gonna be at Okay. Thank you so much, Wendy, For that comprehensive presentation we have consumed all of our time. And I would like to thank the participants for their excellent questions that you posed anyone who would like to listen to a recording of this webinar. You'll receive a follow up email within the next 24 hours, including a link to this recording. We encourage you to share it with your colleagues so they too can benefit from this event again. Thank you, Wendy. And thank you, Participants. We appreciate your time and wish you all a good afternoon. Thank you. Created by
