Given Imaging GIVENIMAGING User Manual
Given Imaging Limited
Contents
User Manual
Given® Diagnostic Imaging System User’s Manual DRAFT Given® Diagnostic Imaging System User’s Manual COPYRIGHT This manual is the property of Given® Imaging Limited. and may not be transferred or reproduced in any form without the written permission of Given® Imaging Limited. This manual is protected under the copyright laws of Israel. Copyright © 2001, Given® Imaging Limited. All rights reserved. TRADEMARKS The RAPID™ Application and the M2A™ Capsule are trademarks of Given® Imaging Limited. Given® is a registered trademark of Given® Imaging Limited. MS Windows is a registered trademark of Microsoft Corporation. WARRANTY Given® Imaging Limited warrants that the components of the Given® Diagnostic Imaging System have been designed, manufactured, packaged and tested with reasonable care and is free from any type of defects. Given® Imaging Limited is not liable for any incidental or consequential loss, damage, or expense arising , directly or indirectly , from the use of the Given® Diagnostic Imaging System. Given® Imaging Limited obligation as implied in this warranty, is to repair or replace any component of the system. Customers are liable for all matters beyond Given® Imaging Limited control such as handling, storage, cleaning, misuse, treatment and diagnosis. This warranty is in lieu of and excludes all other warranties whether expressed or implied warranties of merchantabilty or fitness. FCC ID#=O8PGIVENIMAGING This device complies with Part 15 of the FCC rules. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Note: Changes or modifications not expressly approved by Given® Imaging Limited could void authority to operate the Given® Imaging Diagnostic System. US Federal Law restricts this device to sale by or on the order of a physician Given Imaging Ltd. Table of Contents Table of Contents CHAPTER ONE ............................................................................................... 1 GIVEN® DIAGNOSTIC IMAGING SYSTEM...................................................... 1 System Overview........................................................................................ 1 M2A™ Capsule...................................................................................... 3 Data Recorder Set................................................................................... 5 Data Recorder..................................................................................... 5 Sensor Array....................................................................................... 6 Battery Pack ....................................................................................... 6 Waist Belt ........................................................................................... 6 Battery Charger .................................................................................. 6 RAPID™ Application Software and Workstaion .................................. 8 Indications and Contraindications .............................................................. 9 Indications .............................................................................................. 9 Contraindications.................................................................................... 9 Warnings................................................................................................... 10 Warnings........................................................................................... 10 Precautions ............................................................................................... 12 Precautions ....................................................................................... 12 Adverse Events......................................................................................... 13 System Labeling ....................................................................................... 14 System Specifications............................................................................... 15 M2A™ Capsule.................................................................................... 15 Data Recorder....................................................................................... 16 RAPID™ Application Software........................................................... 16 About this Manual .................................................................................... 17 Conventions.......................................................................................... 18 Contacting Given® Imaging..................................................................... 19 CHAPTER TWO............................................................................................ 20 SYSTEM SETUP ............................................................................................. 20 Before Your System Arrives .................................................................... 20 Connecting the System............................................................................. 21 Items to Connect................................................................................... 21 Connecting the Workstation................................................................. 22 Connecting the Connection Box........................................................... 25 System Setup Scheme....................................................................... 27 Given Imaging Ltd. Contents CHAPTER THREE........................................................................................ 28 GETTING TO KNOW RAPID™ .................................................................... 28 Running the RAPID™ Application.......................................................... 28 Selecting a Language............................................................................ 29 Changing Display Settings ................................................................... 30 Changing the Units ............................................................................... 32 Main Screen.............................................................................................. 33 Title Bar................................................................................................ 35 Main Screen Menus.............................................................................. 35 File Menu.......................................................................................... 36 Video Menu ...................................................................................... 37 Online Menu..................................................................................... 38 Tools ................................................................................................. 38 Video Section ....................................................................................... 39 Thumbnail Section................................................................................ 39 Timebar Section.................................................................................... 39 Patient Check-In....................................................................................... 41 Creating a Movie ...................................................................................... 46 Creating a PRR Movie.......................................................................... 46 Defining Directories ......................................................................... 46 Connecting the Recorder and Downloading..................................... 48 PRR Movie Name............................................................................. 50 Selecting an Existing Movie................................................................. 50 Guidelines for Watching the Movie ..................................................... 51 Watching the PRR Movie..................................................................... 52 Primary Screening of the Movie....................................................... 52 Selecting the PRR Movie Speed....................................................... 54 Setting the Fast and Slow Speed Rate.............................................. 54 Restarting the Movie ........................................................................ 56 Moving by Frames............................................................................ 56 Moving by Time Indication.............................................................. 57 Playing and Pausing.......................................................................... 58 Capturing an Image .......................................................................... 59 Thumbnail Section.................................................................................... 60 Selecting a Thumbnail...................................................................... 61 Scrolling through the Thumbnails .................................................... 62 Saving a Thumbnail.......................................................................... 63 Given Imaging Ltd. Contents Saving a Group of Thumbnails......................................................... 64 Removing a Thumbnail .................................................................... 65 Creating or Editing a Comment........................................................ 65 Reading the Comment ...................................................................... 66 Moving from a Thumbnail to the Movie.......................................... 67 Timebar..................................................................................................... 68 Scrolling Through the Movie ............................................................... 69 Moving from Comment Indication to Frame ....................................... 69 CHAPTER FOUR .......................................................................................... 70 PERFORMING CAPSULE ENDOSCOPY .......................................................... 70 Preparing the Patient ............................................................................ 71 Preparing Patient Examination Set....................................................... 73 Checking In a Patient ........................................................................... 73 Deploying the Data Recorder Set......................................................... 74 Adjusting the Recorder Battery Belt ................................................ 75 Connecting Belt Components........................................................... 76 Attaching the Sensor Array to the Patient........................................ 78 Putting the Belt on the Patient.......................................................... 82 Dispensing the M2A™ Capsule ........................................................... 84 Discharging the Patient ........................................................................ 86 Receiving the Examination Set............................................................. 87 Charging the Battery Pack................................................................ 88 Troubleshooting........................................................................................ 91 Electrical Outage .................................................................................. 91 Data Recorder....................................................................................... 92 Recorder Initialization ...................................................................... 92 Data Recorder Operation.................................................................. 93 Data Recorder Download ................................................................. 99 Sensor Array....................................................................................... 100 Sensor Array Condition .................................................................. 100 Sensor Location .............................................................................. 100 M2A™ Capsule.................................................................................. 101 NDEX .......................................................................................................... 103 Given Imaging Ltd. Contents Given Imaging Ltd. Chapter One Given® Diagnostic Imaging System System Overview The Given® Diagnostic Imaging System is an easy-to-use non-invasive and ambulatory device that permits visualization of the patient’s gastrointestinal tract, especially the small intestine. The system is comprised of three main components: • M2A™ Capsule • Data Recorder Set • RAPID™ Application Software and Workstation Given Imaging Ltd. Overview RAPID™ Workstation Waist Belt Data Recorder Sensor Array M2A™ Capsule The M2A™ Capsule acquires pictures of the gastrointestinal tract and transmits them to the Data Recorder. The Data Recorder stores the pictures and downloads the data to the RAPID™ Workstation. On the workstation, the data is processed into a colorful, easy-to-control Patient RAPID™ Report (PRR) video movie. You can view the PRR movie to analyze and make diagnoses about any abnormalities in the gastrointestinal tract. Even though the Given® Diagnostic Imaging System performs the complicated tasks of filming the digestive activity and image and other data processing, it is very easy to use, eliminating the need for sedation. Moreover, it does not require the patient to undergo an invasive and uncomfortable procedure, and assists in the early detection of pathologies of the small bowel. Given Imaging Ltd. Overview M2A™ Capsule The ingestible imaging M2A™ Capsule acquires video images while traveling along the patient’s gastrointestinal tract. The M2A™ Capsule is propelled by peristalsis through the gastrointestinal tract and does not require a pushing force to propel it through the bowel. The M2A™ Capsule contains a miniscule color video camera with a flash (CMOS Imager), a watch battery, a transmitter, and an antenna, all of which are embedded within a regular size ingestible capsule. The Capsule is a two-dome, cylinder shaped unit having an outer diameter of 11mm and length of 26mm, and it is made out of biocompatible plastic. M2A™ Capsule with blister M2A™ Capsule M2A™ Capsule with holder The M2A™ Capsule is provided ready for ingestion, stored in a blister, a hermetically sealed magnetic packaging. The proximity of a magnet in the blister inactivates the M2A™ Capsule. Each M2A™ Capsule comes with a holder that covers the Capsule’s imager and enables you to handle the M2A™ Capsule until ingestion. Given Imaging Ltd. Overview The M2A™ Capsule starts immediately after its removal from the proximity of the magnet in the blister and the consequent closing of the magnetic switch in the capsule. After a brief (less than one minute) test by the physician to verify that the capsule is active, the capsule is ingested by the patient. While active, the capsule transmits images at a rate of 2 images per second. For each image, an illuminating light flash of 100ms is applied with the illuminating LEDs. When the battery power is depleted, the transmitter disables the imager and switches the M2A™ Capsule off. For specification and technical parameters of the M2A™ Capsule, refer to System Specifications on page 15. For Indications and Contraindications, refer to Indications and Contraindications on page 9. Given Imaging Ltd. Overview Data Recorder Set The Data Recorder Set includes the following items: • Data Recorder • Sensor Array • Battery Pack • Waist Belt • Battery Charger Data Recorder The Data Recorder is an external receiving/recording unit that receives the data transmitted by the M2A™ Capsule. The Data Recorder is a portable Walkman™-size batteryoperated unit attached to a waist belt worn by the patient during the examination. The Data Recorder is comprised of a receiver, processor module and a hard disk drive for storing the data. All of these components are encased in a plastic (ABS) box. The Data Recorder is ready for operation once you connect the Battery Pack and the Sensor Array to the Data Recorder. However, the actual recording requires that the input signal cross a threshold. A green blinking LED indicates whether and when the Data Recorder records data. Given Imaging Ltd. Overview Sensor Array The Sensor Array receives data from the M2A™ Capsule and transfers it to the Data Recorder. It is comprised of 8 identical sensors. Each sensor is connected to the Data Recorder module by a flexible coaxial cable. The sensor is built of flexible printed circuit board (PCB) and is attached to the skin by means of disposable, medical adhesive pads. Battery Pack The Battery Pack is the power supply of the Data Recorder. It includes 8 Nickel-metal 6V rechargeable batteries. The Battery Pack is disconnected from the Data Recorder at the end of each examination and is connected to the Charger supplied with the Given® Diagnostic Imaging System to be ready for the next procedure. Waist Belt The Waist Belt is an adjustable waist-belt that includes two pouches to hold the Data Recorder and the Battery Pack. The belt also includes a flap to hold the excess Battery Pack-Data Recorder cable. The Waist Belt also contains shielding that facilitates FCC compliance. The Waist Belt must therefore be worn at all times while the M2A™ Capsule is active inside the patient. Battery Charger The Battery Charger charges the Battery Pack and should be used after each examination. Given Imaging Ltd. Overview Sensor Array Sensor Array cable Battery Pack Data Recorder M2A™ Capsule with holder M2A™ Capsule For specification and technical parameters of the Data Recorder, refer to System Specifications on page 15. Given Imaging Ltd. Overview RAPID™ Application Software and Workstaion The RAPID™ Workstation is a modified standard personal computer designed for storage, presentation and processing of the acquired images and for generating reports. The RAPID™ (Reporting and Processing of Images and Data) Application Software is a program installed on the Workstation, which performs various tasks as the following table lists: Task Explanation Recorder communication Enables Recorder initialization and data download from the Recorder to the workstation. Data conversion Image processing Handles various data formats. Performs the image processing algorithm and condenses up to 10 hours of filming into a 30 minute movie. Displays the Patient RAPID Report (PRR). Video display Thumbnail display AVI movie Timebar display Patient Check-In Enables copying individual images from the movie, to display, annotate, print and save them. Creates a short movie of the selected image and its adjacent images. Shows the exact time of the current image displayed in the Video section. Enables etntry and storage of all patient information. Note: To use the RAPID™ Application, you should be familiar with Microsoft Windows® interface and capable of using a mouse. Given Imaging Ltd. Overview Indications and Contraindications Indications The Given® Diagnostic Imaging System is intended for the detection of pathologies as an adjunctive tool in the diagnosis of small bowel gastrointestinal disorders and diseases. The Given® Diagnostic Imaging System may be used in hospitals, outpatient clinics and physician offices. After the M2A™ Capsule is ingested the patient is not restricted to a medical environment. Contraindications The M2A™ Capsule is contraindicated for use under the following conditions: • In patients suspected to suffer from intestinal obstruction based on the clinical picture or pre-procedure testing and profile. • In patients with cardiac pacemakers or other implanted electromedical devices. • During pregnancy. • With patients who have known or suspected gastrointestinal obstruction or strictures. Prior abdominal surgery is a relative contraindication to the use of the M2A™ Capsule. Given Imaging Ltd. Overview Warnings A Warning indicates a condition that may endanger the patient or the operator. Warnings • The M2A™ Capsule should be used only after consulting a physician. • A thorough understanding of the technical principles, clinical applications and risks associated with the Given® Diagnostic Imaging System is necessary before using this product. Read the entire manual before using the system for the first time. • To prevent the patient from being exposed to unforeseen risks during passage of the M2A™ Capsule, make sure the patient thoroughly understands the procedure, and provide the patient with a copy of the Patient Instructions for Undergoing Capsule Endoscopy. (You can print it from the RAPID™ Application.) • If there is reasonable doubt concerning the integrity of the M2A™ Capsule due to dropping, biting or any other eventuality, it should not be used until consulting with an authorized Given® representative and should be deactivated by returning it in its holder into its blister. • Do not use an M2A™ Capsule after its expiration date. • Instruct the patient to avoid biting the M2A™ Capsule prior to swallowing. • After ingesting the M2A™ Capsule and until it is excreted, the patient should not be near any source of powerful electromagnetic fields such as one created near an MRI device. Given Imaging Ltd. 10 Overview • The patient should be instructed to contact the physician immediately if after ingesting the M2A™ Capsule he/she has any abdominal pain, nausea or vomiting. • The patient should be instructed to keep the Data Recorder Waist Belt on throughout the procedure, for a minimum of 8 hours. • This M2A™ Capsule must be stored in a safe place out of the reach of children and/or infants. • If contrary to instructions a patient ingested two capsules, he/she should be instructed to contact the physician immediately. • If a child has accidentally swallowed an unused or spent M2A™ Capsule, the child should be brought immediately to a hospital. • The M2A™ Capsule should be ingested only in the presence of authorized personnel. The patient should be instructed not to let his/her relatives, neighbors or acquaintances use the M2A™ Capsule. • This device has not been tested in pediatric population (children 18 and below) and safety in young children is unknown. Given Imaging Ltd. 11 Overview Precautions A precaution indicates a condition that may damage the equipment. Precautions • USA Federal law restricts this device to sale by or on the order of a physician. • Make sure that only trained personnel familiar with all of the Given® Diagnostic Imaging System operating procedures use the system. • Use the system only with components purchased from Given® Imaging Ltd. Use of other components can void the system’s warranty and may damage it. • When dispensing the M2A™ Capsule use the Capsule’s holder. • To ensure proper imaging acquisition, verify the following: Given Imaging Ltd. • The patient has fasted for a period of 8 hours prior to the M2A™ Capsule ingestion. • The Battery Pack is fully charged. • The Sensor Array is properly attached to the patient’s body. 12 Overview Adverse Events In patients with strictures of the gastrointestinal tract, the M2A™ Capsule can potentially cause intestinal obstruction resulting in the need for hospitalization and surgery. The use of the M2A™ Capsule in patients with strictures of the gastrointestinal tract is contraindicated. Based on the experience gained so far, there is no adverse event related to the proper use of the Given® Diagnostic Imaging System. Given Imaging Ltd. 13 Overview System Labeling The following table lists the labels attached to various components of the Given® Diagnostic Imaging System. Labeling Explanation The M2A™ Capsule should be stored and used at a distance from any powerful magnetic fields such as the one created by an MRI. The M2A™ Capsule is intended for single use only. Attention! Consult the documentation provided with the Given® Diagnostic Imaging System. Class II equipment Type BF equipment FCC compliance Given Imaging Ltd. 14 Overview System Specifications Note: Specifications are subject to change without prior notice and without any obligation to users on the part of the manufacturer. M2A™ Capsule Properties Physical Optical Operational Dimensions Length: 26mm Diameter: 11mm Weight 3.7 gr Material Illumination Biocompatible plastic 4 white light emitting diodes Field of View 1400 Effective Visibility Distance: 3 cm Magnification 1:8 Min. Detectable Object Less than 0.1mm Sampling Rate 2 fps Operating Time 7 ± 1hours Mechanical Safety Passed 50 kg bite test Chemical Safety Resistant to dissolution in pH=2 to pH=8 Silver Oxide batteries Battery Type Operating Temperature Storage Temperature Given Imaging Ltd. 20 - 45C0 0 - 50C 15 Overview Data Recorder Software Proprietary firmware Recording time Up to 10 hours Weight 305 gr Battery type External, nickel-metal, 6V, 6500mAH Battery Pack weight 912gr Sensor Array 8 flat 40 mm diameter flexible PCB Operating Temperature 5 - 50C0 Storage Temperature -40 - 70C0 Shielding Shiledex® Supra, from Less EMF Inc. RAPID™ Application Software Software RAPID™ proprietary Languages English/French/German/Italian/Spanish Data export JPEG Images, AVI Movies, HTML Reports Displayed data Images, Timebar and other diagnostic data. Event marker Annotated thumbnails Viewing rate 1-25 fps REMOVE!!! Given Imaging Ltd. 16 Overview About this Manual This manual guides you through the use of the Given® Diagnostic Imaging System. It instructs you on how to connect, and use the system. The manual is comprised of the following chapters: Chapter 1: Given® Diagnostic Imaging System – describes the Given® Diagnostic Imaging System, indications and contraindications, System specifications and this Manual. Chapter 2: System Setup – instructs you on how to set up the Given® Diagnostic Imaging System. Chapter 3: Getting to Know the RAPID™ Application – describes and instructs you on how to use the RAPID™ Application. Chapter 4: Performing Capsule Endoscopy – instructs you on how to prepare and check in the patient, deploy the Receiving set and dispense the M2A™ Capsule. The chapter also includes a troubleshooting section to guide you on how to cope with various potential difficulties. Given Imaging Ltd. 17 Overview Conventions Menu, dialog box, tab and button names and options are bolded and begin with uppercase letters. For example: Click Save or select the Save All option. Convention ExplanationKeyboard keys File > Open Open the File menu and select the Open option. An important note Bulleted List A one step procedure or a list of items. • Click Open. Numbered List A multistep procedure. You need to perform the procedure step by step according to the order of the steps. A warning Given Imaging Ltd. A precaution 18 Overview Contacting Given® Imaging Information and Technical support for the RAPID™ Application and other system components is available from: Company Headquarters Europe Given Imaging Limited POB 258 Yokneam, Israel 20682 Tel: +972-4-909-7777 Fax: +972-4-959-2466 info@givenimaging.com North America Australia & New Zealand Given Imaging Inc. Oakbrook Technology Center 5555 Oakbrook Parkway, # 355 Norcross, GA 30093 Tel: 770-662-0870 1-800-GIVENGI Fax: 770-662-0510 infousa@givenimaging.com Given Imaging Unit 4, 277 Lane Cove Road North Ryde, 2113, NSW, Australia Postal: Box 8, 293 Lane Cove Road North Ryde, NSW, 2113, Tel: 0419 144 836 infoaus@givenimaging.com Worldwide Support support@givenimaging.com Given Imaging Ltd. 19 Chapter Two System Setup Before Your System Arrives Before the Given® Diagnostic Imaging System arrives in your clinic prepare the following: • Five outlets: an outlet for the computer, monitor, power supply, printer and an outlet for the charger. Note: You may use a multiple outlet. • Space for placing the system components: a computer, monitor and a printer. • Space next to the Workstation for the Connection Box and its wiring (about 8-12 inches, 20-30 cm) and for the Data Recorder. • A storage space protected from any powerful electromagnetic source for storing the M2A™ Capsule 10-Pak box. 20 Given Imaging Ltd. System Setup Connecting the System This section describes the various connectors and cables of the Given® Diagnostic Imaging System and instructs you on how to connect the system. Items to Connect Following is a list of items you need to connect in order to setup the Given® Diagnostic Imaging System: • RAPID™ Workstation • Monitor • Keyboard • Intel Mouse with Thumbwheel • Printer • Connection Box • Connection Box Power Supply • Data Recorder • Battery Pack • Telephone Connection • 9-pin Male-Female Cable • 9-pin Female-Female Cable • LAN Network Cable Given Imaging Ltd. 21 System Setup Connecting the Workstation Use the back panel of the workstation for connecting the monitor, keyboard, mouse, printer, LAN cable, modem, and the Connection Box according to the scheme below: Monitor Backpanel Printer Backpanel Telephone Line Workstation Backpanel Parallel/Printer Port Serial (com) Port 2 Monitor LAN Modem Network Socket Serial (com) Port 1 USB Mouse Given Imaging Ltd. Keyboard 22 System Setup The following table lists the connectors of the Workstation back panel: Connector Explanation Power cord Connects the Workstation to the electric socket. Keyboard Connects the keyboard to the Workstation. Mouse Connects the mouse to the Workstation. Monitor Connects the monitor to the Workstation. Parallel Port Connects the Workstation to the printer. USB Port Connects the Workstation to the printer, alternative to Parallel Port. LAN Connects the Workstation to the Connection Box to transfer data from the Recorder to the Workstation and vice versa. COM Connects the Workstation to the Connection Box. Modem Connects the Workstation to a phone line. Given Imaging Ltd. 23 System Setup ! To connect the workstation 1. Connect the IntelliMouse (Intel Mouse w/Thumbwheel)) cable to the Mouse connector. 2. Connect the Keyboard cable to the Keyboard connector. 3. Insert the LAN cable to the LAN connector. Note: The LAN cable is a special cable and cannot be replaced by a standard LAN cable 4. Connect the Monitor cable to the Monitor connector. 5. Insert the Modem cable to the Modem connector and the other jack phone connector of the Modem cable to the phone outlet. 6. Connect the printer to the LPT connector or to the USB connector, according to your printer connection cable. 7. Connect the Connection Box cable to COM 1. 8. Connect the Power cable of the monitor to the electric socket. 9. Connect the Power cable of the Workstation to the electric socket. Given Imaging Ltd. 24 System Setup Connecting the Connection Box The Connection Box connects between the Workstation and the Data Recorder. Workstation Backpanel Parallel/Printer Port Serial (com) Port 2 Power Supply Monitor LAN Modem Network Socket USB Serial (com) Port 1 Network Cable 9 Pin Fe male-Female Connection Box Mouse Keyboard The following table lists the connectors and indicators of the Connection Box. Connector/Indicator Explanation 9-pin Male connector Connects the Connection Box to the Workstation with a 9-pin Female-Female cable LAN connector Connects the Connection Box to the Workstation with the LAN cable. Power Supply Connects the Connection Box to the electric socket Connects the Connection Box to the recorder with a 9-pin Male-Female cable. 9-pin Female connector Control LED Given Imaging Ltd. Indicates that the Connection Box is connected to the electric socket and is operating. 25 System Setup ! To connect the Connection Box 1. Connect the 9-pin Male connector of the Connection Box to the serial Com 1 of the Workstation with the 9-pin Female-Female connection cable. 2. Connect the LAN cable to the LAN connector of the Connection Box. 3. Connect the Connection Box to the Power supply. 4. Connect the Power supply to the electric socket. 5. Verify that the Control LED is on. 6. To connect the Recorder cable to the Connection Box, connect the Male connector of the Recorder cable to the Female connector of the Connection Box. Note: Connect the Recorder to the Connection Box only when instructed to do so. Given Imaging Ltd. 26 Given® Diagnostic Imaging System User’s Manual System Setup Scheme Once you have finished connecting the Given® Diagnostic Imaging System, use the following figure to verify the various connections. Monitor Backpanel Printer Backpanel Telephone Line Power Supply Workstation Backpanel Parallel/Printer Port Serial (com) Port 2 Serial (com) Port 1 9 Pin Fe male-Female Data Recorder Monitor LAN Modem Network Socket Connection Box USB Network Cable Mouse Keyboard 9 Pin Male-Fe male 27 Given Imaging Ltd. Chapter Three Getting to Know RAPID™ Running the RAPID™ Application The RAPID™ Application software complies with the conventions of Windows® operating system applications conventions. However, various functions of the Windows operating system are disables or modified to enable the proper function of the RAPID™ Application.. During its operation, the RAPID™ Application writes files and reads files from pre-defined locations on the RAPID™ Workstation hard disks. Handle files only through the RAPID™ Application and not by using the Windows Explorer application. Do not change directory and file names. Note: The directory and file names should not be modified unless under instructions from Given® Imaging technical support. There are two hard disks in the RAPID™ Workstation. It allows a total separation of RAPID™ Application software from RAPID™ Application data. The RAPID™ Application data is always written to disk E. Raw data downloaded from the Data Recorder is written to the Recorder data directory 28 Given Imaging Ltd. RAPID™ Application while PRR data is written to Patient Rapid Report directory . Data in these subdirectories should never be meddled with. Before using the RAPID™ Application, you should create a “User” subdirectory on drive E:\. Whenever he saves images as files, use the “User” subdirectory. To copy files from the RAPID™ Workstation use only the “User” subdirectory. Running the RAPID™ Application is very easy and simple. All you need to do is to double-click the RAPID™ Application icon that appears on the Workstation desktop. ! To run the program 1. Turn on the computer. The Windows desktop appears 2. Double click the RAPID™ Application icon. The RAPID™ Application is running and the main screen appears. Selecting a Language You can change the language of the RAPID™ Application. By default, the RAPID™ Application language is English. You can change it to either one of the following languages: • French • Spanish • German For the language change to take effect, you have to restart the RAPID™ Application. ! To change the language 1. Select Tools > Options. Given Imaging Ltd. 29 RAPID™ Application The Options window appears: Click here to select a language E:\rdata E:\trials Automatic 2. Open the Language drop-down list and select the desired language. 3. Click OK. 4. Select File > Exit option to close the application. 5. Double click the RAPID™ Application icon to re-run the program. The RAPID™ Application is running with the language of your choice. Changing Display Settings The RAPID™ Application is supplied with a default Automatic display setting. With this setting, the RAPID™ Given Imaging Ltd. 30 RAPID™ Application Application Main Screen has a resolution of 480x640 pixels. This setting enables a clear view of the PRR movie. You can change the display settings of the RAPID™ Application to reduce the size of the RAPID™ Main Screen. For the display setting change to take effect, you have to restart the RAPID™ Application. ! To apply specific display settings 1. Select Tools > Option. The Options window appears. Click here to select display settings E:\rdata E:\trials Automatic 2. Open the Display Settings drop down list and select None. 3. Click OK. 4. Select File > Exit option to close the RAPID™ Application. Given Imaging Ltd. 31 RAPID™ Application 5. Double click the RAPID™ Application icon. Changing the Units You can set the unit of measure for the measurements that you type in dialog boxes. By default, the RAPID™ Application is using centimeters and kilograms. You can set the unit of measure to inches and pound. ! To change the unit of measure 1. Select Tools > Options. The Options window appears: Click here to select the unit of measure E:\rdata E:\trials Automatic Given Imaging Ltd. 32 RAPID™ Application 2. Open the Measurement System drop-down list and select the desired measurement system. 3. Click OK. The RAPID™ Application is running with the unit of measure of your choice. Main Screen The RAPID™ Main Screen enables you to watch the PRR movies and to diagnose irregularities in the gastrointestinal tract. The following sections introduce you to the various sections of the RAPID™ Main Screen and guide you through the various available menu options. Timebar section Main screen menus Displays patient details Thumbnail section 33 Given Imaging Ltd. Indicates the time of the current image Video section Control buttons RAPID™ Application The RAPID™ Main screen is comprised of the following sections: • Title bar • Menu section. • Video section • Thumbnail section • Timebar section Given Imaging Ltd. 34 RAPID™ Application Title Bar The title bar displays the patient ID, initials and test date. You entered these details during the Check-In process and they were derived from the recorder during download. Main Screen Menus The drop-down menus of the RAPID™ Main Screen enable you to use the various options available through the menus. The following tables list the various menus and their options. Given Imaging Ltd. 35 RAPID™ Application File Menu The File menu enables you to open or to save the PRR movies and groups of thumbnails and to quit the RAPID™ Application. Option Explanation Open Enables you to select a PRR movie of previous examinations. Save Video As Saves the video under a different file name. However, while watching the movie, the name of the movie as derived from the recorder appears in the Title bar. Open Thumbnail Opens a selected file of thumbnails. Save Thumbnails As Saves a selection of thumbnails as a GRML file. The file name is comprised of the movie name from which you created the reproductions with the extension TN.GRML. Print Screen Creates a printout of the RAPID Main Screen with the current display. Print Setup Opens the standard Print window. File list Displays a list of the last 7 files you opened. Exit Quits the RAPID™ Application. Given Imaging Ltd. 36 RAPID™ Application Video Menu The Video menu enables you to control the PRR movie. Option Explanation Step Forwards Moves forward to the proceeding frame. Step Backwards Moves backward to the previous frame. Play Forwards Starts the movie. Play Backwards Plays the movie backward. Pause Temporarily stops the movie presentation. Restart Restarts the movie. End Moves the PRR movie to the last frame. Go To Frame Moves the movie to a frame that matches a specific time indication. Capture Thumbnail Duplicates a frame along with 100 adjacent images, 50 before and 50 after the thumbnail. Given Imaging Ltd. 37 RAPID™ Application Online Menu The Online menu enables you to check in a patient and to download and construct a PRR movie. Option Explanation Patient Check-In Opens the Recorder Initialization screen. Recorder Download Opens the Recorder Download screen. Service This option is enabled only for an authorized Given® technician. Tools The Tools menu allows you to change the RAPID™ Application interface and to set the source and target path prior to the download. Option Explanation Options Defines the RAPID™ Application interface language, movie speed, Data Recorder directory and the Patient RAPID Report directory prior to the download. Help Provides information on the RAPID™ Application version. It also enables you to print the Patient Instructions for Undergoing Capsule Endoscopy and the RAPID™ Application User’s Manual. Given Imaging Ltd. 38 RAPID™ Application Video Section The Video section includes the presentation area and the Control Buttons. The Control Buttons are located at the bottom of the Video section and they allow you to do the following: • Set the projection rate • Play/stop the movie • Move backwards or forwards frame by frame • Move to the last frame • Rewind the movie • Create thumbnails. The Video section also displays the exact time of each frame that is currently projected, as derived from the Recorder. Thumbnail Section The Thumbnail section presents images from the movie, and enables you to annotate the snap shots. For further information, refer to Thumbnail Section on page 60. Timebar Section The Timebar section is synchronized with the PRR movie and it displays the time in relation to the frame currently Given Imaging Ltd. 39 RAPID™ Application presented in the Video section. In addition it presents the time of any thumbnail. For further information, refer to Timebar on page 68. Given Imaging Ltd. 40 RAPID™ Application Patient Check-In The RAPID™ Application enables you to check in the patient who is intending to undergo the Capsule Endoscopy. The checking in process includes the following: • Patient Registration – filling in the Registration computerized form. • Recorder Initialization – downloading patient details to the Recorder. • Disconnecting the Recorder. ! To check in a patient 1. Select Online > Patient Check-In. The following screen appears guiding you through connecting the Recorder. Given Imaging Ltd. 41 RAPID™ Application 2. Follow the instructions on the Recorder Initialization screen: Verify that the Connection Box is connected to the computer. Verify that the power supply is connected to the electric socket. Verify that the Connection Box is connected to the power supply. Verify that the Recorder is NOT connected to the Connection Box. Note: Connect the Recorder to the Connection Box only when instructed to do so. 3. Click Yes. The Add New Patient window appears. Given Imaging Ltd. 42 RAPID™ Application Enter patient’s details Enter protocol number and date of test Messages area Click to initialize the Recorder Click to cancel 4. Under Patient Initials enter the information as follows: In F, enter the first letter of the patient’s first name. In L1, enter the first letter of the patient’s last name. In L2, enter the second letter of the patient’s last name. 5. Under ID, enter the number of patient in the clinical protocol. Given Imaging Ltd. 43 RAPID™ Application 6. Open the Gender drop-down list and select the required gender. 7. Under Birth Date, click the arrow and select the required date of birth. 8. Open the Physique drop-down list and select either skinny, normal, stocky or potbelly. Use the following figure: skinny normal stocky potbellied 9. Under Protocol Number, enter the code of the clinical trial protocol, you have been assigned by Given® Imaging Limited, Division of Medical Affairs. 10. Under Test Date, enter the date of the test. 11. Click Check-In Patient. In the Message area, a message appears asking you to connect the Data Recorder to the Data Recorder cable. 12. Connect the Data Recorder to the Data Recorder cable. Connect the 9-pin Female connector of the Data Given Imaging Ltd. 44 RAPID™ Application Recorder cable to the 9-pin Male connector of the Data Recorder. In the Message area, a message appears notifying you that the Recorder initialization starts. The details you entered during the patient registration are saved in the Data Recorder directory and are downloaded to the Data Recorder. Upon completion, a message appears notifying you that the Data Recorder initialization is complete. Once the initialization process is complete a message appears asking you to disconnect the Data Recorder. 13. Disconnect the Recorder from the Data Recorder cable. Given Imaging Ltd. 45 RAPID™ Application Creating a Movie Once you open the RAPID™ Application Main Screen and you wish to watch a PRR movie, perform either one of the following: • Create a movie. • Select and watch an existing movie. Creating a PRR Movie To create a movie, you need to download raw data from the Recorder to the workstation. This process is comprised of two stages: • Defining Data Recorder and Patient RAPID Report directories. • Connecting the Recorder to the workstation. Defining Directories Recorder data directory - Define a directory for saving the downloaded raw data. The default path is: E:\rdata. Patient Rapid Report directory - Define a path for saving the processed data, i.e., the PRR movie. The default path is: E:\trials. 46 Given Imaging Ltd. RAPID™ Application ! To define the directories 1. Select Tools > Options. The Options window appears: Define here a directory Click to modify the default Input or Output path E:\rdata E:\trials Define here a directory Automatic 2. The default Recorder Data directory is: E:\ rdata. You should not change this setting unless instructed so by Given® Imaging technical support. To change the setting, click Modify and define the path of your choice. 3. The default Patient RAPID Report is: E:\trials. You should not change this setting unless instructed so by Given® Imaging technical support. To change the setting, click Modify and define the path of your choice. 4. Click OK to apply the changes and to close the Options window. Given Imaging Ltd. 47 RAPID™ Application Note: The Data Recorder requires a shared \rdata directory in order to be able to download data to the workstation. This directory should not be modified unless under instructions from Given® Imaging technical support. Connecting the Recorder and Downloading Once you have defined directories for saving the downloaded and the processed data, you can connect the Recorder and download the raw data. The RAPID™ Application guides you on how to connect the Recorder to the workstation. All you need to do is to follow the instructions on the screen. ! To connect the recorder and start downloading 1. Select Online > Recorder Download option. The Recorder Download window appears. Given Imaging Ltd. 48 RAPID™ Application 2. Follow the instructions that appear on the Recorder Download screen: • Verify that the Connection Box is connected to the computer. • Verify that the power supply is connected to the electric socket and to the Connection Box. • Verify that the Recorder in NOT connected to the Connection Box. 3. Verify that all files in the Recorder data directory path can be deleted. If they cannot be deleted, click Cancel and re-define a shared \rdata Recorder data directory path. Note: If, in the Recorder Download window, you click Cancel, the download does not start and we advise you to define a new Data Recorder directory. 4. To proceed, click OK. A message appears asking you to connect the Data Recorder to the Connection Box. 5. Connect the Data Recorder to the Recorder cable. All raw data is being downloaded and simultaneously the movie is being constructed and saved in the Patient RAPID Report directory. During the construction, the movie is projected in the Video section. Once the download and the construction are complete, messages appear respectively. The first frame of the movie appears in the Video section. Given Imaging Ltd. 49 RAPID™ Application PRR Movie Name Once the download process is complete, a new PRR movie appears in the Output path you have defined. The movie file name is comprised of the following components separated by an underscore. The components are derived from the Recorder during the download process: • A prefix (GI) • Patient’s initials • Examination date in the following format: (YYYY/MM/DD) • Patient number • File extension (GTD) For example, the file name GI_JBS_2000/12/06_12349.GTD is a PRR movie of a patient number 12349 whose initails are JBS and who went through the examination on 12/06/2000. Precaution Do not modify the files in the Patient RAPID report directory in any way. Modification may result in loss of files. Selecting an Existing Movie The PRR movies are stored on the workstation in the Video folder unless you choose to save them in another location or under a different name. Given Imaging Ltd. 50 RAPID™ Application If you saved a movie under a different name, once you open the file and watch the movie, the Title bar of the RAPID™ Main Screen displays the original movie name. ! To select a movie 1. In the RAPID™ Main Screen, select File > Open. The Open window appears indicating the default directory of the PRR movies. 2. The default directory of the PRR movie appears. If you stored the video in another location, navigate to the desired location. 3. Select the desired movie (*.gtd file) and click Open. Once the movie is loaded the first frame appears in the Video section and you can start watching the movie. Guidelines for Watching the Movie • Verify that the display setting is Automatic. If not, increase the RAPID™ Application resolution by setting display setting to Automatic. • Dim the lights in the room. Given Imaging Ltd. 51 RAPID™ Application Watching the PRR Movie The Video section enables you to watch the video captured by the M2A™ Capsule during the examination. The PRR movie is comprised of a series of single images and it can present from 1 to 25 frames per second according to the selected movie speed. Primary Screening of the Movie A primary screening of the movie is available while watching the movie in Automatic speed mode. The Automatic speed mode changes from a fast display rate to a slow rate according to differences between consecutive images. When the RAPID™ Application detects large differences between adjacent images, it slows down the show rate to enable a better look at the images. The video presentation is synchronized with the Timebar section. The Timebar progresses as the movie progresses. To control the movie presentation, use the Control Buttons located at the bottom of the Video section. The following table lists the Control Buttons and the action each button provides: Given Imaging Ltd. 52 RAPID™ Application Button Action Video speed Selects the projection rate. The available rates are Automatic, Slow and Fast. The Video Speed button changes according to the selected speed. Restart Restarts the movie. Back Step Moves back to the previous frame. Play backward Plays the movie backward. If you click the Play backward button, the Play forward button changes to the Pause button while the movie is playing. Plays the movie forward. If you click the Play forward button, the Play backward button changes to the Pause button while the movie is playing. Play forward Stops the movie and a still picture appears. The Pause button changes to a Play button. Pause Moves forward to the next image. Forward Given Imaging Ltd. 53 RAPID™ Application Step Moves to the last frame of the movie. End Duplicates a frame. The duplication immediately appears in the Thumbnail section. Capture Thumbnail Selecting the PRR Movie Speed There are three available modes of the PRR movie speed: Automatic, Fast and Slow. Automatic – automatically sets the display rate of the images (between maximum 25 frames per second and a minimum 5 frames per second) according to the rate of change in successive images. When the RAPID™ Application detects a large difference between successive images, it slows down the show rate to enable a careful examination of the pictures. Fast – displays the movie in fast speed of 10 frames per second (default). You can change the Fast rate by selecting Tools | Options. Slow – displays the movie in slow speed of 5 frames per second (default). You can change the Slow rate by selecting Tools | Options. Given Imaging Ltd. 54 RAPID™ Application Setting the Fast and Slow Speed Rate By default the fast speed is 10 frames per second and the slow speed is 5 frames per second. The Options window allows you to change the default settings of the Fast and Slow modes. ! To change the default settings of Fast and Slow modes 1. Select Tools > Options. 2. The Options window appears. Set the desired speed for the Slow mode Set the desired speed for the Fast mode 3. Under Slow select the desired speed rate for the Slow mode. 4. Under Fast select the desired speed rate for the Fast mode. E:\rdata The default speed mode of the movie is Automatic. You can easily switch between the modes of speed. E:\trials ! To select a speed mode • Given Imaging Ltd. Click the Video Speed button to select the desired speed mode. The letter that appears Automatic on the Video Speed button indicates the selected speed. 55 RAPID™ Application Restarting the Movie When you restart the movie, the time and frame indications are automatically updated along with the Timebar. ! To restart the movie • Click the Restart button. The PRR movie starts from the beginning and the related features such as the Time and Frame indications at the bottom of the Video section automatically resets to zero. Moving by Frames You can move along the movie one frame forward or backward, or to the last frame. While moving along the movie, the related features are updated accordingly. ! To move by frames • To move one frame forward, click the Forwards Step button. The movie moves one frame forward. • To move one frame backward, click the Back Step button. The movie moves one frame backward. Given Imaging Ltd. 56 RAPID™ Application • To move to the last frame in the PRR movie, click the End button. The movie moves to the last frame and the time indication at the bottom of the Video section representing the end of the study, is automatically updated. Moving by Time Indication You can move to a certain section of the movie by indicating a time unit in the Time text box at the bottom of the Video section. The movie automatically moves to the related section of the movie. ! To move by time indication 1. In the Time text box at the bottom of the Video section, type in the desired time in the following format: HH:MM:SS. 2. Press the key on your keyboard. The movie automatically scrolls to the desired video section and the Timebar is updated accordingly. Given Imaging Ltd. 57 RAPID™ Application Playing and Pausing When you watch the movie and you would like to have a longer look at one of the frames, you can temporarily stop the projection of the movie. ! To Play/Pause the PRR Movie To play the movie, click the Play forward button. The movie is on. The Play backward button changes to the Pause button. To play the movie, click the Play backward button. The movie is on. The Play forward button changes to the Pause button. To pause the movie, click the Play button. The movie stops playing, the current frame appears as a still picture and the Pause button changes to Play. Given Imaging Ltd. 58 RAPID™ Application Capturing an Image When you capture a frame the following occurs: • The captured frame immediately appears at the bottom of the Thumbnail section. The time indication derived from the Recorder appears next to the captured frame in the Thumbnail section. • An indication of the thumbnail appears in the Timebar section of the RAPID™ Main screen. ! To capture a frame 1. 1. While the movie is playing, click Pause. 2. While the movie is still, click Capture Picture. The selected frame appears with a time indication in the Thumbnail section. An indication that a thumbnail was created appears in the Timebar section. Given Imaging Ltd. 59 RAPID™ Application Thumbnail Section The Thumbnail section displays images captured from the PRR movie. Each reproduction appears in the Thumbnail section with a time indication derived from the Recorder and the first few words of the attached comment. A picture captured from the movie Drag the scroll bar to scroll through the thumbnails Time indication derived Once youfrom havethecaptured three images, a scroll bar appears Recorder along the right side of the Thumbnail section. Use this scrollbar to scroll through the captured images. The first word of You can scroll through the thumbnails, save, delete and edit the attached any of the comments attached to the picture. You can also comment move from a thumbnail to its exact location in the movie and view the adjacent pictures. Any of these operations requires the selection of a thumbnail. Selecting a Thumbnail You can select one, a few or all thumbnails. Follow the provided instructions according to your needs. ! To select a thumbnail • Move the mouse pointer to the desired thumbnail and click. A blue square appears over the thumbnail. 60 GIven Imaging Ltd. RAPID™ Application ! To select several thumbnails 1. Select a thumbnail. 2. Move the mouse pointer to another frame you wish to select and simultaneously click the mouse and the key of your keyboard; both selected thumbnails are covered by a blue square. 3. Repeat step 2 until you selected all the desired pictures. Given Imaging Ltd. 61 RAPID™ Application ! To select all thumbnails 1. Select the thumbnail at the top of the Thumbnail section. 2. Scroll to the last thumbnail and simultaneously click the mouse and the key of your keyboard; all thumbnails are selected. Scrolling through the Thumbnails To scroll through the thumbnails, use the scroll bar located on the right side of the Thumbnail section. The thumbnails are arranged according to the sequence of capturing. The last thumbnail appears at the bottom of the Thumbnail section. Scrolling up reveals the more recent Thumbnails and scrolling down reveals the previous ones. ! To scroll through the thumbnails • To observe a thumbnail previously captured, drag the scroll bar toward the top of the main screen. • To view the most recently captured thumbnail, drag the scroll bar toward the bottom of the main screen. Given Imaging Ltd. 62 RAPID™ Application Saving a Thumbnail When you save a thumbnail, you actually save the thumbnail AND a short movie. The movie is comprised of 100 adjacent frames, 50 frames before and 50 frames after the selected frame. To watch this short movie, use any Windows media player, which is already installed on the Workstation. The thumbnail is saved as a JPEG file and the short movie as an AVI file. You need to select only the location for saving the thumbnail. The RAPID™ Application automatically saves the thumbnail as a *.jpg and an *.avi file in the selected location. The file name of the *.jpg and the *.avi file contains the same components as the PRR movie they were captured from. For further information, see PRR Movie Name on page 50. ! To save a thumbnail 1. Click a thumbnail to select it. A blue square appears over the thumbnail. 2. Click the right mouse button. A popup menu appears. 3. Select Save. A window appears. 4. Select a folder for saving the thumbnail. 5. Click OK. Given Imaging Ltd. 63 RAPID™ Application The thumbnail is stored in the location of your choice as a JPEG and an AVI file, and a message appears notifying you that the operation is complete. ! To watch a the AVI movie 1. Open the Windows media player. 2. Navigate to the *.avi file of the thumbnail you wish to examine. 3. Select the file. 4. Click OK. The short movie of 100 images is running. Saving a Group of Thumbnails You can save a group of thumbnails as an independent file. This file name contains all of the components of the PRR movie file name with the extension tn.grml, i.e., GI_(patient initials_examination date_patient number_tn.grml. ! To save a group of thumbnails 1. From the File menu, select File > Save As Thumbnails option. The Save As window appears. 2. Select a folder for saving the thumbnails. 3. Click Save. The group of thumbnails is saved as a file that its name is identical to the PRR movie file name with the extension tn.gml. Given Imaging Ltd. 64 RAPID™ Application Removing a Thumbnail 1. Select a thumbnail. A blue square appears over the thumbnail. 2. Click the right mouse button. A popup menu appears. 3. Select Delete; the reproduction disappears from the Thumbnail section. Creating or Editing a Comment If you want to annotate a Thumbnail by entering a comment or to edit a comment, do the following: ! To edit a comment 1. In the Thumbnail section, select a thumbnail. 2. Click the right mouse button; a menu appears. 3. Select Comment. The Enter Comment window appears: Enter here your comment 4. Type in a comment, or edit the existing comment. Given Imaging Ltd. 65 RAPID™ Application 5. Click OK to save the changes and to close the Comment window. Reading the Comment In the Thumbnail section, you can read the annotating comment of a thumbnail by placing the pointer of the mouse on the beginning of the comment that appears below the thumbnail. Move the mouse pointer to here to view the complete comment Given Imaging Ltd. 66 RAPID™ Application ! To read the comment • Position the mouse pointer on the first word of the comment located under the thumbnail. The full comment appears and you can read it. Moving from a Thumbnail to the Movie If you wish to look at the images adjacent to the captured one, you can move from the Thumbnail section to the Video section. The PRR movie automatically displays the captured frame to enable you to look at what preceded or followed the captured frame. ! To move from a thumbnail to the movie 1. Select the desired thumbnail. A blue square appears over the thumbnail. 2. Click the right mouse button. A popup menu appears. 3. Given Imaging Ltd. Select Go To; the movie automatically updates to display the desired frame. Use the Forward and Backward Step buttons to view the adjacent pictures. 67 Given® Diagnostic Imaging System User’s Manual Timebar The Timebar indicates the time as derived from the Recorder during the movie projection. The Timebar is synchronized with the movie and it moves along indicating the elapsed time by changing the moving bar into light blue. When you create a thumbnail, the Timebar section presents the first word of the thumbnail annotation as the following figure shows: The section of the movie you have already watched Thumbnails that were captured The section of the movie you did not watch 68 GIven Imaging Ltd. RAPID™ Application Scrolling Through the Movie You can scroll through the movie by dragging the Timebar up or down. The movie presentation is updated accordingly. ! To scroll through the movie • Drag the gray area of the Timebar up, to view the first section of the movie and down to view the last section of the movie. The displayed PRR movie is updated accordingly. Moving from Comment Indication to Frame If you select a comment indication in the Timebar section the movie automatically moves to the frame belonging to the selected comment. ! To move from comment to frame • In the Timebar section, select a comment. The comment indication appears in red, the mouse pointer changes to red and the frame that the comment refers to appears in the Video section. Given Imaging Ltd. 69 Chapter Four Performing Capsule Endoscopy Once the Given® Diagnostic Imaging System is connected and ready for use and you are familiar with the system and the RAPID™ Application, you can perform a Capsule Endoscopy. Performing a Capsule Endoscopy consists of the following: • Preparing the patient. • Preparing the examination set for the patient. • Checking in the patient. • Deploying the Data Recorder Set. • Dispensing the M2A™ Capsule. • Discharging the patient. • Receiving from the patient the Data Recorder, Sensor Array, Battery Pack and Waist Belt. • Downloading data from the Data Recorder to the Workstation and processing it to a PRR movie. 70 Given Imaging Ltd. Capsule Endoscopy Preparing the Patient Once you have decided that the patient should undergo the Capsule Endoscopy, inform the patient that the Capsule Endoscopy involves the following: • Ingesting a small (the size of a large vitamin pill) Given® Imaging M2A™ Capsule which will pass naturally through the patient’s digestive system while taking pictures of the intestine. • Attaching to the abdomen a Sensor Array. The images captured by the M2A™ Capsule are transmitted to the Sensor Array. • Wearing a belt around the waist during the examination, which lasts approximately 8 hours. The belt contains a Walkman®-like Given® Data Recorder which saves all the images and shielding that ensures FCC compliance. The belt must be worn at all times throughout the procedure, a minimum of 8 hours. • Returning the Data Recorder set for further processing. Inform the patient in writing and verbally that he/she needs to do the following to achieve accurate results: • Abstain from food and drink for 8 hours prior to undergoing the Capsule Endoscopy. • Male patients should shave their abdomen 6 inches above and below the navel. • After ingesting the M2A™ Capsule, the patient should not eat or drink for 2 hours. After 2 hours the patient may drink water. After four hours the patient may have a light snack. After the completion of the study, the patient may return to his/her normal diet. Given Imaging Ltd. 71 Capsule Endoscopy • After ingesting the M2A™ Capsule, the patient should immediately contact the physician’s office if he/she has any abdominal pain, nausea or vomiting. • After ingesting the M2A™ Capsule and until it is excreted, the patient should not be near any source of powerful electromagnetic fields such as one created near an MRI device • During the examination, the patient should avoid any strenuous physical activity. He/she should not bend or stoop during the Capsule Endoscopy. • During the examination, the patient should check every 15 minutes that the green light at the top of the Data Recorder is blinking. If it stops blinking during the first 6 hours of the examination, the patient should write down the time and contact the physician’s office. • During the examination, the patient should not remove the Data Recorder belt. • In the Event Form, the patient should write down the time and the nature of any event such as eating, drinking and unusual sensations. The patient will have to return this form along with the examination set. Note: Before the patient leaves the clinic, you should give the patient the Event Form along with a copy of the Patient Instructions for Undergoing Capsule Endoscopy. Given Imaging Ltd. 72 Capsule Endoscopy Preparing Patient Examination Set Verify that the Given® Diagnostic System is set up according to the instructions provided in the Connecting the System on page 21, and that you have the following equipment and accessories: • M2A™ Capsule • Data Recorder • Sensor Array • Charged Battery Pack • Belt with belt extension, pouches and suspenders. • Application kit (10 adhesive sleeves, a Sensor Template, two adhesive pads). • Marker • Razor • Disinfectant • Measuring tape • Scale Checking In a Patient The Check-In procedure is done through the RAPID™ Application. The procedure includes entering the patient’s details and initializing the Data Recorder. Before you start checking in the patient, verify the following: • Given Imaging Ltd. The RAPID™ Workstation has a shared \rdata directory. 73 Capsule Endoscopy • The \rdata directory is defined as the Data Recorder directory. • The RAPID™ Application is configured according to your convenience, i.e., the language, screen settings and measurement system. • The patient abstained from eating or drinking for the last 8 hours. • The patient did not take any medication in the last 2 hours. • The patient (if male) shaved the area of the abdomen 6 inches above and below the navel. For further information, on how to check in, refer to the Patient chapter on page 41. Deploying the Data Recorder Set Deploying the Data Recorder Set includes the following: • Adjusting the Recorder-Battery belt. • Connecting belt components. • Attaching the Sensor Array to the patient. • Putting the belt on the patient. Given Imaging Ltd. 74 Capsule Endoscopy Adjusting the Recorder Battery Belt The Recorder-Battery belt is an external belt that the patient wears during the examination. It contains two pouches for holding the Recorder and the Battery pack. It is important that the belt fits the patient and the patient is comfortable wearing the belt. ! To fit the Recorder-Battery belt 1. Ask the patient to stand up. 2. Place the belt around the patient’s waist. 3. Adjust the belt to fit the patient. For shorter patients, it will be necessary to add the belt extension. 4. Make sure that the Battery Pack and the Recorder pouch are at the patient’s waist as the following figure shows: 5. Adjust the suspenders to fit the patient. 6. Remove the belt. 7. Place the belt next to the Battery Pack and the Recorder. Given Imaging Ltd. 75 Capsule Endoscopy Connecting Belt Components This section instructs you on how to connect the Battery Pack to the Recorder and how to secure both Battery Pack and the Data Recorder in their pouches. Note: Since fully charged batteries slowly discharge, use only a Battery Pack you have just charged. For information on how to charge the Battery Pack, refer to Charging the Battery Pack on page 88. ! To connect belt components 1. Place a recently fully charged Battery Pack in the battery belt pouch. 2. To connect the Battery Pack to the Data Recorder, connect the 9-pin Female connector of the Battery Pack cable to the 9-pin Male connector of the Data Recorder. 3. Secure with the securing screws. Note: While connecting the Battery Pack to the Data Recorder, hold the Data Recorder. The Data Recorder green LED blinks, turns on and then off. Once the recording starts the LED blinks at the receiving rate. 4. Insert Data Recorder into the Data Recorder pouch, and bring the Battery Pack cable out from the top opening of the pouch. (See the following picture). Given Imaging Ltd. 76 Capsule Endoscopy 5. Use the Velcro straps to secure the Data Recorder and Battery Pack cable. 6. Fold the remaining length of the Battery Pack cable and secure it with the Velcro flap along the back of the belt. 7. Put the belt aside until the patient is ready to wear it. Warning Do not connect the Data Recorder to the RAPID™ Workstation while Data Recorder is connected to the Sensor Array that is worn by the patient or while the Waist Belt is in the belt being worn by the patient. Given Imaging Ltd. 77 Capsule Endoscopy Attaching the Sensor Array to the Patient The Sensor Array is attached to the patient’s abdomen. Use the Sensor Template to place each one to the eight sensors of the Sensor Array in its correct location. Given Imaging Ltd. 78 Capsule Endoscopy Necessary equipment and accessories The M2A™ Capsule 10-Pak of the Given® Diagnostic Imaging System also includes the Sensor Application kit. The kit contains the following items which are necessary for deploying the Sensor Array: Item Explanation Sensor Template Helps you position each one of the eight sensors in their proper location. Marker Enables to mark the location of each sensor. Adhesive Sleeves Holds each one of the eight sensors and securely attaches each one of the sensors to its place. Adhesive Pads Enables secure attachment the Sensor Array cable to the patient’s hip. Disposable Razor Removes any hair from the abdomen. Warning Do not use the Sensor Array if it is torn or damaged. Given Imaging Ltd. 79 Capsule Endoscopy The template has 9 holes. Eight holes indicate the recommended location of each one of the eight sensors and the additional hole indicates the navel as a reference point. Place the template on the patient’s abdomen and use the marker to make a small dot at each location. Remove the template and locate each sensor over the dot. Securely attach the eight sensors to the patient’s body with the adhesive sleeves. The adhesive sleeves are supplied with the Sensor Application kit. To secure the Sensor Array cable to the patient’s hip, use the adhesive pads. The adhesive pads are supplied with the Sensor Application kit. Note: Any object which comes in between the patient’s body and the sensors, including hair or air, and any changes in the sensors arrangement may interfere with the quality of the data. ! To attach the Sensor Array 1. Insert each sensor into an adhesive sleeve. The sensor markings (dots or “THIS SIDE UP”) should face away from the patient and the adhesive side of the sleeve should face the patient’s abdomen. Given Imaging Ltd. 80 Capsule Endoscopy 2. To secure the sensor in the sleeve, remove the liner from the adhesive line at the opening of the adhesive sleeve and press both lips together. 3. Ask the patient to lie down and to expose his/her stomach area down to the pubic bone. 4. If a male patient arrives unshaven, wipe the patient’s abdomen with disinfectant and shave the abdomen 6 inches above and below the umbilicus (navel). 5. To mark the location of each sensor, place the Sensor Template on the patient’s stomach with the drawing facing up while using the navel as a reference point and insert the marker into the holes. Mark the location of each sensor. 6. Remove the Sensor Array Template from the patient and keep it for reference until you complete the procedure. 7. Place the Sensor Array on the patient’s abdomen using as a guideline the numbers on each sensor wire and the numbers on the Sensor template. The Sensor Array connector should be at the LEFT SIDE of the patient. 8. To attach each sensor, start with the rightmost sensor. Remove the protective backing from its Adhesive Sleeve. Secure the sensor to the patient’s abdomen so that the hole at the center of the sleeve approximately overlaps the marking on the patient’s abdomen. 9. Repeat step 1 - 8 for all sensors. Given Imaging Ltd. 81 Capsule Endoscopy 10. To secure the Sensor Array cable to the left side of the patient’s body, use the remaining adhesive pads as the following scheme shows: 11. Instruct the patient to get dressed. The Sensor Array connector and approximately 10 inches of cable should remain outside of the patient’s clothes. Putting the Belt on the Patient Since you adjusted the belt, putting it on the patient is very quick and simple. ! To put the belt on the patient 1. While the patient is standing, place the Recorder-Battery Pack belt around the patient’s waist. Note: The Sensor Array connector and wire should dangle from above the belt. 2. To connect the Sensor Array to the Recorder, insert the Sensor Array 8-pins male connector to the 8-pins Female connector at the top of the Recorder. Verify that the protrusion of the Sensor Array connector is facing outwards. Given Imaging Ltd. 82 Capsule Endoscopy 3. Instruct the patient that the belt should not be removed during the course of the examination for any reason, at least 8 hours. Given Imaging Ltd. 83 Capsule Endoscopy Dispensing the M2A™ Capsule Before dispensing the capsule ascertain that there is no other M2A™ Capsule or other diagnostic capsule in the patient’s gastrointestinal tract. Note: Verify that you read the Indications and Contraindications, Warnings and Precautions in the Package Insert of the M2A™ Capsule or in chapter one prior to dispensing the M2A™ Capsule. ! To dispense the M2A™ Capsule 1. Prepare a glass of water for the patient. 2. To activate the M2A™ Capsule, open the blister containing the M2A™ Capsule. 3. Take the capsule with its holder out of the blister. The capsule should start blinking Note: If for any reason, after activating the M2A™ Capsule by removing it from it’s blister, the patient is not taking the M2A™ Capsule, it should be deactivated by replacing it, in its holder, to the blister. The capsule should stop blinking. If it does not stop on your first attempt, turn the capsule in its holder and replace in blister until blinking stops. 4. To verify that the capsule is operating, hold it in front of the patient’s abdomen, close to the sensors. Given Imaging Ltd. 84 Capsule Endoscopy The Data Recorder LED starts blinking in green. 5. Instruct the patient to take the M2A™ Capsule out of its holder. 6. Ask the patient to put the M2A™ Capsule in his/her mouth, and to hold it under the tongue WITHOUT INGESTING. 7. If after a short adjustment period, with the M2A™ Capsule in the patient’s mouth, the green light keeps on blinking, ask the patient to ingest the capsule with a sip of water. Note: The time elapsed between capsule activation and ingestion should usually not exceed 1 minutes. 8. In the Event Form, write down the ingestion time of the M2A™ Capsule. Given Imaging Ltd. 85 Capsule Endoscopy Discharging the Patient Once the patient has ingested the M2A™ Capsule, the patient may leave the clinic. The examination lasts as long as the Data Recorder LED is blinking but not less than 6 hours unless the M2A™ Capsule was excreted. Verify that the patient knows how to behave during the examination. ! To discharge the patient 1. Verify that the patient has the Patient Instructions for Undergoing Capsule Endoscopy, and a Capsule Endoscopy Event Form. 2. Verify that the patient knows how to behave during the examination: Given Imaging Ltd. • The patient should avoid any physical activity that involves sweating, bending or stooping. • The patient should avoid any source of powerful electromagnetic fields such as one created near an MRI device • The patient needs to abstain food for another 2 hours after capsule ingestion. After 2 hours the patient may drink water. Four hours after ingesting the capsule, the patient may eat a light snack. • The patient may take usual prescribed medication 2 hours after ingesting the capsule. • The patient must not remove the Data Recorder Waist Belt until 8 hours after the procedure has begun. 86 Capsule Endoscopy 3. Ask the patient to check that the green LED of the Data Recorder is blinking. If it stops blinking, the patient should write down the time the patient noticed it. If it is less than 6 hours since the ingestion of the Capsule, the patient should immediately call your office. 4. Ask the patient to return to the clinic with the Data Recorder, belt and Sensor Array after approximately 8 hours. 5. Instruct the patient whether, at the end of the examination, he/she should take off the Data Recorder and Sensor Array by him/her self or should return to the clinic for removing the equipment. 6. If the patient should take off the Recorder and Sensor Array by him/her self, verify that the patient understands the instructions provided in the Patient Instructions for Undergoing Capsule Endoscopy. 7. Discharge the patient. Receiving the Examination Set At the end of the examination, the patient should return to your clinic and you may take off the examination set unless the patient has already done this. It is recommended to recharge the Battery Pack immediately after return. Note: Given Imaging Ltd. 87 Capsule Endoscopy The Battery Pack should be charged only with the charger supplied by Given® Diagnostic Imaging System. After removing the sensors from the adhesive sleeves, clean them before storing. ! To receive the examination set 1. Disconnect the Data Recorder from the Battery Pack. 2. Take the Data Recorder and the Battery Pack out of the belt. Recharge the Battery Pack. For instructions refer to Charging the Battery Pack on page 88. 3. Carefully remove adhesive sleeves from sensors. This can be done easily by tearing them in the middle along the perforation. 4. To clean the Sensor Array, wipe it lavishly with 90% alcohol and let it air-dry for 20 minutes. 5. When the Sensor Array is dry, return it to the Carrying Case in which they were supplied. 6. To download the data from the Data Recorder, refer to Creating a PRR Movie on pate 46. Charging the Battery Pack Use only a fully charged Battery Pack. Since even fully charged batteries discharge slowly, recharge the Battery Pack Given Imaging Ltd. 88 Capsule Endoscopy just before use. If a patient returns a Battery Pack at the end of an examination and on the following day another examination will take place, immediately recharge the Battery Pack. Recharging a Battery Pack is an overnight process. Note: The rechargeable Battery Pack lasts at least 2 years. After two years of daily use or after 500 rechargings, it is recommended to replace it. Warning: For charging the Battery Pack use only the Charger supplied with the Given® Diagnostic Imaging System ! To recharge the Battery Pack 1. Connect the Charger male 9-pin connector to the Battery Pack 9-pin Female connector. 2. Connect the Charger to the electric socket. The Charger indicator is on. When the Charger indicator blinks, the Battery Pack is fully charged. 3. Unplug the Charger from the socket and from the Battery Pack. Given Imaging Ltd. 89 Capsule Endoscopy 4. Use the charged Battery Pack. Given Imaging Ltd. 90 Troubleshooting Troubleshooting This section describes common problems you may encounter when performing the Capsule Endoscopy, and instructs you on how to cope and overcome these problems. Note: If you encountered a problem that is not mentioned in this section, or you followed each step as advised in this section and the problem persists, call Given® Imaging Limited technical support Tel: +972-4-909-7706 . Electrical Outage PROBLEM An electrical outage occurred during patient Check-In, Recorder Initialization, or during download. SOLUTION Once electrical power has returned, restart the process. 91 GIven Imaging Ltd. Troubleshooting Data Recorder The following section describes common problems you might encounter while using the Data Recorder during the Capsule Endoscopy. Recorder Initialization PROBLEM During the Check-In process, after clicking Check-In, the message Initializing Recorder stays on and the message Initialization is complete does not appear. SOLUTION • Check the Connection Box connection to the mains and verify that the Connection Box LED is on. • Check the Recorder data directory: • Verify that the Recorder data directory is E:\rdata. • Verify that the \rdata directory is a shared directory. Use Windows Explorer or My computer to do that. If it is not a shared directory, select the E:\rdata directory, right-click it and use the sharing sub-menu. • Check the Connection Box-Workstation connection: • Verify that the LAN cable is properly connected. • Check the connection of the 9-pin female-female cable to the Workstation and to the Connection Box. • Given Imaging Ltd. Verify computer name: 92 Troubleshooting My computer\properties\Network Identification\Full computer name=RAPID. If not, change to RAPID and restart the computer. Data Recorder Operation To check the Data Recorder operation, always verify that the Data Recorder LED blinks as soon as you connect it to the Battery Pack in the following blinking sequence: The Data Recorder green LED blinks, turns on and then off. Once the recording starts the LED blinks at the receiving rate. PROBLEM #1 The LED of the Data Recorder does not blink upon connecting the Battery Pack to the Data Recorder. SOLUTION • Change the Battery Pack. If the problem persists: • Change the Data Recorder and repeat the Recorder Initialization process. • Call technical support to report the faulty Data Recorder. Given Imaging Ltd. 93 Troubleshooting PROBLEM # 2 The Data Recorder LED does not blink while the M2A™ Capsule is held near the Sensor Array. SOLUTION 1. Move the M2A™ Capsule away from the Sensor Array. 2. Disconnect the Battery Pack from the Data Recorder and then reconnect them. 3. Verify that the Data Recorder LED blinks and then turns off. If it blinks and then turns off, bring the M2A™ Capsule close to the Sensor Array. If the Data Recorder LED blinks, you may proceed with the procedure of dispensing the M2A™ Capsule. If the Data Recorder LED does not blink, use another M2A™ Capsule. Be sure to dispose of the first capsule as per the instructions in this manual. If the Data Recorder LED does not blink, change the Battery Pack. If the Data Recorder LED blinks upon Battery Pack connection, you may proceed with the procedure of dispensing the M2A™ Capsule. If the problem persists: • Given Imaging Ltd. Change the Data Recorder and repeat the Recorder Initialization process. 94 Troubleshooting • Call technical support to report the faulty Data recorder PROBLEM #3 Data Recorder LED does not blink when the M2A™ Capsule is in the patient’s mouth. SOLUTION 1. Tell the patient to keep the Data Record belt on, and instruct the patient to take the M2A™ Capsule out of his/her mouth. 2. Hold the M2A™ Capsule next to a sensor attached to the patient’s abdomen. If the LED blinks, ask the patient to ingest the Capsule. If not, replace the M2A™ Capsule and restart the M2A™ Capsule Dispensing procedure as described on page 84. Be sure to dispose of the first capsule as per the instructions in this manual. PROBLEM #4 The Data Recorder LED stops blinking during the examination and more than 6 hours have passed since the Capsule ingestion. SOLUTION A minimum of 6 hours is considered a successful examination. However, it is recommended to try and continue with the examination, and to check that the termination is not due to a connection fault or to a Battery Pack premature Given Imaging Ltd. 95 Troubleshooting depletion. (However, the belt must be worn in any event for a minimum of 8 hours.). To check the connection and the Battery Pack, perform the following: • Battery Pack and Data Recorder Connection If there is a problem with the connection, 1. Reconnect the Battery Pack to the Recorder 2. Verify the blinking sequence of the Data Recorder LED: If the LED blinks upon Battery Pack connection and then blinks according to the rate of recording, continue with the examination. If the LED does not blink upon connection of the Battery Pack,, refer to Data Recorder Problem #1. If the LED blinks upon Battery Pack connection but does not start blinking according to the rate of recording with an active capsule, the capsule’s battery is depleted. Consider completing the examination. If the connection is intact, 1. Change Battery Pack. 2. Verify the Data Recorder LED blinking sequence: If the LED blinks according to the sequence proceed with the examination. If the LED blinks upon Battery Pack connection but does not start blinking according to the rate of recording with an active capsule, the capsule’s Given Imaging Ltd. 96 Troubleshooting battery is depleted. Consider completing the examination. If the LED does not blink upon Battery Pack connection according to the blinking sequence, refer to Data Recorder Problem #1. PROBLEM #5 The Data Recorder LED stops blinking during the examination and less than 6 hours have passed since the Capsule ingestion. SOLUTION • Tell the patient to keep the Data Record belt on, and heck the Battery Pack-Data Recorder connection. If there is a problem with the connection: 1. Reconnect. 2. Verify the blinking sequence of the Data Recorder LED: If the LED blinks upon Battery Pack connection and then blinks according to the rate of recording, continue with the examination. If the LED blinks upon Battery Pack connection but does not blink when receiving data, the M2A™ Capsule is defective. Reschedule for another examination at a different date after excretion of the M2A™ Capsule. Given Imaging Ltd. 97 Troubleshooting If the LED does not blink upon Battery Pack connection, refer to Data Recorder Problem #1. If problem persists, reschedule for another examination at a different date after excretion of the M2A™ Capsule, and contact Given® Imaging Limited technical support. If connection is intact: 1. Change Battery Pack. 2. Check blinking sequence of the Data Recorder LED: If the blinking sequence is correct, proceed with the examination and discharge the patient. If the LED blinks, turns on and then off, but does not blink according to the receiving rate, reschedule for another examination at a different date after excretion of the M2A™ Capsule. If the LED does not blink upon Battery Pack connection, refer to Data Recorder Problem #1. If problem persists, reschedule for another examination at a different date after excretion of the M2A™ Capsule, and contact Given® Imaging Limited technical support. Given Imaging Ltd. 98 Troubleshooting Data Recorder Download PROBLEM The download does not start and the Please Wait message constantly appears. SOLUTION • Check the connection of the Connection Box to the electric socket and verify that the Connection Box LED is on. • Check Data Recorder directory: • Given Imaging Ltd. • Verify that the Data Recorder directory is \rdata. • Verify that the \rdata directory is a shared directory. Use Windows Explorer or My computer. Check the Connection Box-Workstation connection: • Verify that the LAN cable is properly connected. • Check the connection of the 9-pin female cable to the Workstation and to the Connection Box. • If all above are OK and the problem persists, call Given® Diagnostic Imaging System technical support. 99 Troubleshooting Sensor Array Sensor Array Condition PROBLEM The Sensor Array you use is worn or torn. SOLUTION Use another Sensor Array supplied by Given® Imaging Limited. Do not use a torn or a worn Sensor Array. Sensor Location PROBLEM You applied a sensor to the wrong location. SOLUTION 1. Remove the sensor from its location. 2. Carefully, take the sensor out of the adhesive sleeve. 3. Insert the sensor in a new adhesive sleeve. 4. To secure the sensor in the adhesive sleeve, remove the liner from the adhesive area at the opening of the adhesive sleeve and press the two lips together. 5. Reapply to correct location. Given Imaging Ltd. 100 Troubleshooting M2A™ Capsule PROBLEM The M2A™ Capsule does not blink when removed from its blister. SOLUTION Replace the M2A™ Capsule with another M2A™ Capsule, and discard the defective capsule. Given Imaging Ltd. 101 Troubleshooting Given Imaging Ltd. 102 Index Index Add New Patient window, 42 AVI movie, 64 editing a comment, 66 capturing a frame, 59 capturing thumbnail, 53 changing display settings, 31 checking in a patient, 41 comment editing, 66 reading, 65 connecting the Recorder, 48 Control Buttons, 40, 52 creating a movie, 46 Data Recorder Directory, 46 Defining Data Recorder and Patient RAPID Report, 46 disconnecting the Recorder, 41 downloading, 48 GIven Imaging Ltd. File menu, 37 frame, 56, 59 capturing, 59 moving by, 56 gastrointestinal tract, 1, 2, 3, 35 initializing the Recorder, 41 M2A™, 41 Main Screen, 36, 50 menus, 36 Title Bar, 36 movie, 56, 58, 67 Control Buttons, 40 creating, 46 file name, 50 103 Troubleshooting moving from repruduction to, 67 pausing, 58 presentation, 52 restart, 56 selecting, 50 speed, 53, 54, 55 time indication, 57 movie file name, 50 movie speed, 52 Online menu, 39 Options window, 31, 39, 47, 54 patient registration, 41 Quitting the RAPID™ Application, 37 RAPID™, 29, 31 Main Screen, 31, 35 running, 29 selecting a language, 29 reading a comment, 65 Recorder Download window, 48 removing a thumbnail, 65 saving a group of thumbnails, 64 saving a thumbnail, 63 Given Imaging Ltd. scrolling through thumbnails, 62 selecting a language, 29 selecting a movie, 46, 50 selecting a thumbnail, 61 small intestine, 1 thumbnail, 61 thumbnail moving from, 67 removing, 65 saving, 63 saving a group of, 64 scrolling through, 62 selecting, 61 Thumbnail section, 40, 59, 60, 65, 66, 67 Timebar, 40, 52, 57, 59, 68, 69 Title Bar, 50 Tools menu, 39 video, 52 Video menu, 38 Video section, 40, 51, 52 Video speed, 53 watching the movie, 52 Window Add New Patient, 42 Options, 30, 31, 39, 47, 54 Recorder Download, 48 104
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