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QuickGuide
Software Version 5.0
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
This QuickGuide is not intended as a replacement for the SPECTRALIS Manuals. Do not use the Spectralis without reading the full Operating Instructions. Please read the Cautions and Warnings in the Hardware Operating Instructions and always follow their contents. The Spectralis HRA is a confocal scanning laser ophthalmoscope (cSLO) for retinal angiography and reflectance imaging. Available imaging modes are fluorescein and ICG angiography, infrared and redfree reflectance, and fundus auto-fluorescence. The imaging modes can be used separately or simultaneously. The Spectralis OCT is a dual beam spectral domain optical coherence tomograph (SD-OCT) and cSLO system that acquires transectional images or volume scans of the retina and a fundus image simultaneously. A real time eye tracker couples cSLO and SD-OCT scanners to position and stabilize the OCT scan on the retina. Spectralis OCT and Spectralis OCT Plus are two version of the Spectralis OCT that differ only by the set of accessories. Camera head and power supply of Spectralis OCT and Spectralis OCT Plus are identical. Spectralis OCT Plus uses a different head rest and joystick than Spectralis OCT. Spectralis OCT has no control panel, no footswitch and is not upgradable to Spectralis HRA+OCT. The Spectralis HRA+OCT combines the features of the Spectralis HRA and the Spectralis OCT Plus. All six acquisition modes are available, separately or simultaneously with one other mode.
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Spectralis with Control Panel1 (and Micromanipulator or Joystick) Filter lever A/R (not shown) Camera handle Canthus mark Focus knob Adjustment for chin rest Unlock button to slide camera left/right Control panel Chinrest XYZMicromanipulator1 for adjustment of camera position (joy-stick micromanipulator option available) : Inner knob: forward / backwards (Z) Middle knob: height (Y) Outer knob: left / right (X) Forehead rest with external fixation lamp (not shown) Camera objective
Automatic or Manual4 Brightness Control High Myopia Compensation3 Movies3,4 Wide Field Images (55/120)2,3,4 Advanced Sensitivity Control3 Tomography3,4 Stereo Images3,4 Peripheral OCT4
ART Automatic Real Time Optional Laser Scanning acquisition modes only Not available for Spectralis OCT
Eye Tracking, Heidelberg Noise Reduction All Spectralis devices obtain a high cSLO and SD-OCT image quality through Heidelberg Noise Reduction technology. All devices operate with an active real time eye tracker with dual beam scanning system, resulting in OCT scans free of motion artifacts Stable cSLO images Reproducible and reliable data. Automatic rescan function and eye tracker, track changes over time.
As the viewing conditions may change during an examination, these settings can be readjusted continuously if necessary: Illumination Focus Laser intensity and detector sensitivity2 Focus knob on camera head
Working distance Joystick / Z adjustment knob1 Lateral alignment Joystick / X, Y adjustment knobs1 Area of interest
1 2 Only available for Spectralis HRA+OCT, Spectralis OCT Plus and Spectralis HRA. Only for Spectralis HRA+OCT, Spectralis OCT Plus and Spectralis HRA. Please see the Spectralis Operating Manuals for full instruction. 2
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Image Acquisition II
Spectralis OCT with Joystick and Special Headrest1 Filter lever A/R (not shown) Forehead rest External fixation lamp Camera handle Focus knob Canthus mark Camera objective Chinrest General Workflow Overview 1. Prepare the device (headrest and camera). o Make sure camera head is pulled all the way back. o Clean camera chinrest and forehead rest. o Check that lens is clean. o Adjust table height and chinrest for the patient. 2. Prepare the patient. 3. Start the software and Acquisition window. o o Joystick: Move camera and start Acquisition / Eye Tracker (button) 4. 5. 6. 7. 8. 9. 10. 11. 12. Create or open a patient file, start a new acquisition. Pre-set the default Acquisition Parameters (optional).
o Select an Acquisition mode. Choose a fixation target (internal or external). Ask patient to put head on headrest. Make sure canthus mark is at eye / canthus level. Bring camera forward, align the camera for optimum image quality. Activate desired imaging modes. Acquire images. Move camera backwards and then over to fellow eye to acquire images for fellow eye. Save images and close the Acquisition window (Alt + E). Review images for content and quality, select inferior/redundant images to be deleted in order to save disk space.
Not available for Spectralis HRA+OCT, Spectralis OCT Plus and Spectralis HRA; see page 1. Please see the Spectralis Operating Manuals for full instruction. 3
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Spectralis OCT Start the laser by pressing the on/off button in the lower right corner of the Acquisition window. Turn the filter lever to R for the reflection mode1.
1 2
The control panel is available for Spectralis HRA+OCT, Spectralis OCT Plus and Spectralis HRA. Filter lever not available for Spectralis OCT and Spectralis OCT Plus. Please see the Spectralis Operating Manuals for full instruction. 4
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Image Acquisition IV
Preparations (cont.) It is recommended to pre-set the default Acquisition Parameters. In the Acquisition window, open the menu Setup and choose the option Acquisition Parameters. The window shown on the right will open. Select high speed or high resolution (high speed recommended for standard applications). The Cyclic Buffer Size is important for movie acquisition available for all fundus imaging modes: Once the Acquire button on the control panel has been pressed, the system will save several additional fundus images from the cyclic buffer before the acquisition button was pressed and add them to the beginning of the movie. The number of cyclic buffer images saved is dependent on the selected cyclic buffer size and the scan resolution. The Automatic Image Brightness Control1 is recommended for users new to the device. It automatically increases/decreases the detector sensitivity so that the image is not too dark or overexposed. This feature can be enabled/disabled any time via the control panel2 (menu More). Manual control gives experienced users the best control over the image quality. Ask the patient to place his/her chin on the chinrest and to place their forehead against the headrest. Adjust the chinrest height so that the patients eyes are at the same level as the red canthus marks on the headrest posts. Use the central internal fixation target if appropriate, or select a different fixation target using the Select Target sub-menu of the control panel2 or via the Acquisition window3. Slowly bring the camera towards the patients eye, move the camera (up, down, right or left) to the center of the pupil and adjust the distance between the objective and the examined eye to approx. 14 mm between the front edge of the objective and the cornea. As soon as the laser beam enters the pupil, you will see the image of the fundus on the screen (Acquisition window, see also pages 11 and 16).
1 2 3
For Spectralis OCT, the Automatic Image Brightness Control is always active. For Spectralis OCT Plus, it can be activated or deactivated via control panel (see next page). For Spectralis HRA+OCT, Spectralis OCT Plus and Spectralis HRA; see page 9 for further information. See page 11 for further information. Please see the Spectralis Operating Manuals for full instruction. 5
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Image Acquisition V
Camera Alignment - Fundus Image Turn the camera so that the structure of interest is visible on the screen. Move the camera slightly up/down and sideways until the image appears brightest and most evenly illuminated. Then, move the focal plane (using the focus knob) until the image is brightest. For less experienced users, we recommend to use the Automatic Image Brightness Control1. It is activated either via the Auto button in the More menu on the control panel2, default setting (see page 5), or in the Acquisition window3. Aim for even illumination, minimal artifacts and a centered macula, unless otherwise indicated. Manual Sensitivity Control1 If the image is overexposed (white) reduce the sensitivity using the sensitivity button on the control panel (see page 9). In order to optimize sensitivity, increase the sensitivity to the point just before saturation / blooming (i.e. white areas or white dots with colored specs) occurs using the Sensitivity / ART knob on the control panel2.
Image with dark corners and overexposed area
Camera Alignment - OCT Image4 First, align the camera using the fundus image as described above. For Spectralis OCT, the OCT live image is automatically opened. For Spectralis OCT Plus and Spectralis HRA+OCT, the OCT window is opened by pressing the OCT button on the control panel.
Overexposed image
The optimum camera position is reached when no dark corners and overexposed areas are visible in the live image (see image to the right).
Then, move the camera towards the patient until a cross sectional image of the retina appears in the Acquisition window. If no OCT image becomes visible, adjust the scan depth by selecting a different eye length using the buttons in the Acquisition window shown on the right.
Evenly illuminated image
1 2 3 4
For Spectralis OCT, the Automatic Image Brightness Control is always active. For Spectralis OCT Plus, it can be activated or deactivated via control panel. Available only for Spectralis HRA+OCT, Spectralis OCT Plus and Spectralis HRA. See page 11 for further information. Not available for Spectralis HRA; for Spectralis HRA+OCT, the OCT button must be selected (see page 9). Please see the Spectralis Operating Manuals for full instruction. 6
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Image Acquisition VI
Camera Alignment - OCT Image (cont.) The bar above the OCT image will appear red if the OCT image touches the upper border. Move the camera further away from the patient if the OCT image is shown mirrored (upside down). If the OCT image is tilted in a horizontal direction, move the camera slightly left/right (if capturing a horizontal scan) or up/down (if capturing a vertical scan). The blue Quality bar in the lower part of the image indicates the signal strength1. The quality score range is 0 (bad quality) to 40 (excellent quality). If the score is 15 or less, the quality bar turns red. A long bar represents a high signal strength. To achieve optimum image quality, position the OCT image in the upper half of the Acquisition window. Move the camera slightly up/down and sideways until the fundus and OCT image appear brightest and most evenly illuminated. Fine tune brightness and sharpness of the fundus image using the focus knob. The optimum camera position is reached when no dark corners and overexposed areas are visible.
Fundus Image OCT Image
Acquiring and Saving Images To acquire images with the settings highlighted in blue, press the foot switch2, the Acquire button on the control panel2 or the button on the joystick3.
After acquiring images, save them using the Save images option in the top left corner of the Acquisition window. To end the acquisition session, exit the Acquisition window. The camera will automatically turn off. For Angiography, the timer is started using the Inj. button on the control panel4. When the Acquisition window is closed, the Show Timer window displays the duration since the last injection.
OCT image in correct orientation 1 2 3 4 Based on the signal to noise ratio Only available for Spectralis HRA+OCT, Spectralis OCT Plus, Spectralis HRA. Only available for Spectralis OCT; not available for Spectralis HRA+OCT, Spectralis OCT Plus, Spectralis HRA. Note: Prior to angiography, a set of infrared and red-free fundus images should be taken as a control. Please see the Spectralis Operating Manuals for full instruction. 7
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Open More menu for: Resolution Mode / Brightness Control / Myopic Lens sub-menu (see next page) Single imaging modes Open Select Target menu Start injection timers (for FA and ICGA) Enable OCT imaging modes Laser on / off
Spectralis HRA and Spectralis HRA+OCT2: Activate primary acquisition mode: single image Spectralis OCT Plus and Spectralis HRA+OCT3 : Activate a section scan (press this button once) and select the desired scan pattern using the buttons in the Acquisition window (see page 11)
Spectralis HRA and Spectralis HRA+OCT2: Activate the indicated secondary acquisition mode (press this button once) or open Acquisition Mode menu (double click) to choose other mode (see next page) Spectralis OCT Plus and Spectralis HRA+OCT3: Select volume scan (press this button once)
Movie (Image sequence) Tomography (Layered 3D image sequence) Mean (Averaged image)
Composite 3x3
Movie Mode
Tomography Mode
fr
Time
Frames
Control panel menu for Spectralis HRA+OCT and Spectralis HRA; for Spectralis HRA+OCT, OCT button deselected. Please see the Spectralis Operating Manuals for full instruction. 10
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
The blue pattern indicates the location of the OCT scan. The blue arrow indicates the scan direction. To center the scan pattern, on the region of interest, move it with a left mouse click.
Fundus Image
OCT Image
Grey scale or color scale; if the OCT image "touches" the upper border of the acquisition screen, the color scale above the OCT image is replaced by a red bar Quality Bar The quality score range is 0 (no signal) to 40 (excellent quality). If the score is 15 or less, the quality bar turns red. Preset : select preset or previously selected scan patterns and settings Follow Up : open work list of images that were set as reference images Scan: select scan pattern; for linear scans, select vertical or horizontal scan direction (see following page) Volume scans: change field of view and density of sections HR: select High Resolution (HR) or High Speed mode Fixation target selection OCT: switch OCT on or off Camera on/off button
System Status Line Green: Information Yellow: Warning Red: Error message
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Volume and Star-Shaped Scans Size and number of sections in the selected patterns are displayed in the Acquisition window. Furthermore, for volume scans, the distance between the sections is displayed. Star-shaped scans are always acquired in ART mode. In this mode, the vertical scan is used for targeting.
1. 2. 3.
The OCT mode must be active.(see page 6). Not available for Spectralis HRA. The circle diameter in mm is dependent on image settings and the corneal curvature. For example, for corneal curvature of 7.7 mm, the circle is approximately 3.5-3.6 mm in diameter. . The Fast volume scan mode should only be used when strong eye movements make it impossible to acquire good quality ART volume scans. When ART is disabled, the acquired scans may not correspond to the scan lines indicated on the fundus image Please see the Spectralis Operating Manuals for full instruction. 12
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Blue pattern indicates the location of the OCT section in the fundus image. The blue arrow indicates the scan direction. Click in the image with the mouse to move the scan pattern (see previous page) .
ART Slider Set number of images (frames) that are used for averaging (maximum 100) with the slider. The chosen value is indicated below the slider. The blue part of the bar represents the current number of averaged frames processed.
Settings (see page 11) Timers (for fluorescein / ICG angiography only) Laser off in (remaining exposure time, see page 16) Tracking time left (remaining laser on time in ART Mean and follow-up acquisition modes2) Memory Images taken Free memory available
Fundus Image (Live) OCT Image (Live)
HR: select High Resolution (button selected) or High Speed mode (as displayed) Fixation target selection OCT: switch OCT on (as displayed) or off Camera on/off button
Live images
In the OCT live image, the Quality bar indicates image quality; if the OCT image "touches" the upper border of the acquisition screen, the color scale above the OCT image is replaced by a red bar (see previous page)
The top and bottom of the OCT live image are marked by black lines to make it easier to adjust the camera position.
1 2
The OCT mode must be active.(see page 6). Not available for Spectralis HRA. After expiration of the tracking time limit, ART Mean mode and follow-up imaging are disabled. Please see the Spectralis Operating Manuals for full instruction. 13
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Baseline image, not defined as reference image Follow-up image is defined as reference image Follow-up image, not defined as reference image
1
The OCT mode must be active.(see page 6). Not available for Spectralis HRA. Please see the Spectralis Operating Manuals for full instruction. 14
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Acquiring a Follow-Up Image The reference images will now be visible as small images in the Acquisition window below the live images. The scan type, orientation of scan and fixation target chosen for the baseline exam are automatically activated. Move the camera so that the live fundus image is showing approximately the same area on the retina as the baseline image. As soon as the overlap between live and reference image is sufficient, a green frame appears on the reference image, indicating the borders of the reference image. Optimize the camera position for maximum overlap between live and reference image . The blue scan line and green box will automatically follow the eye movement. However, if there is too much eye movement and the live image can not be matched to the baseline image, the blue line will appear as a dotted red line.
1 2
The OCT mode must be active.(see page 6). Not available for Spectralis HRA. This option is only available if no follow-up images exist. Please see the Spectralis Operating Manuals for full instruction. 15
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Timer Log Window Shows the injection timers of all patients imaged using angiography modes on the same day (unless the HEYEX was closed); start the timer via control panel, (see page 9)
System Status Line Green: Information Yellow: Warning Red: Error message
HR: select High Resolution (button selected) or High Speed mode (as displayed) Fixation target selection OCT3: switch OCT on (as displayed) or off Camera on/off button
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Close window to end acquisition Green frame shows the position of current live image2 in the composite image
1 For Spectralis HRA+OCT and Spectralis OCT Plus, the OCT button must be deselected in the lower right corner of the Acqusition window or control panel (see page 9). 2 If the live image cannot be matched, the last image stays on the screen and the position of the last live image is shown by a dotted frame. Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0 Please see the Spectralis Operating Manuals for full instruction. 17
Live image to evaluate brightness and even illumination of image enables optimum camera adjustment2 Set number of images (frames) that are used for averaging (maximum 100) with the slider. The chosen value is indicated below the slider (here: 51 frames). The grey part of the bar represents the current number of averaged frames processed3 Settings (see previous page) Timers (for fluorescein / ICG angiography only; start via control panel, see page 9) Laser off in (remaining exposure time2) Tracking time left (OCT only) Memory (see previous page) System Status Line Green: Information Yellow: Warning Red: Error message
Close window to end acquisition Green frame shows the position of current live image2
1 2
For Spectralis HRA+OCT, the OCT mode must be deselected (see page 6).. If the current live image cannot be aligned to the mean image for more than 1 second, the mean image will be discarded, the blue bar will disappear, and the automatic averaging process will start anew. The same happens when ART mode is deactivated and then again activated. Please see the Spectralis Operating Manuals for full instruction. 18
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Lightbox The Patient File contains the data and images of a patient. Each thumbnail represents an image or scan of the right or left eye. Images can be viewed, analyzed, printed, imported, exported and archived. All images from one acquisition session are stored under the same visit tab. To open the Context Menu, click on a thumbnail image with the right mouse button. Choose the desired menu item by selecting it with either the left or right mouse button. From the patient file, patient data regarding diagnosis, referring physician, operator, eye data, etc. can be accessed via the buttons Patient, Examination and Eye Data.
Examination Data / Comments In order to write a comment, click on the Examination button in the Patient File to open the Examination Data window and select the Diagnosis tab. The text in the Comment field will be automatically inserted on the printout if the respective option is ticked in the Print Spectralis Report window (see page 36). If the text is too long, it is automatically truncated.
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
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Save as image
Print Report
Add to Lightbox
Display (images taken during acquisition, this window) 3D View Thickness Profile Thickness Map A central grip point enables movement of the measuring arrow
Zoom functions: Zoom Mode: Use left mouse button to zoom in or out Zoom In Zoom Out Pan Mode: Move the enlarged image with the mouse Window sizes Y-Scale: Shows all pixels acquired during the scan Shows a compressed view where the pixels are equally scaled horizontally and vertically Information about the size of the displayed images are shown in the status bar (bottom of the window)
For follow-up images: Flicker between baseline and follow-up image Speed of flicker
For volume or pattern scans: Play Save the movie Speed of movie
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
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Choose one of three buttons at the bottom left of the display screen. The first button has an equal size viewing space for the fundus and the OCT image.
Progression
The second button has a small fundus image and a large viewing area for the OCT image.
The third button1 is used to compare a reference B-scan to another B-scan within a progression series1. This can be from two volume scans or section scans.
Window
This button is only available for images from progression series. Please see the Spectralis Operating Manuals for full instruction. 21
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Viewing OCT Volume Scans For volume scans, a green frame in the fundus image indicates the borders of the scanned area. The total number of B-scans and the number of the currently displayed B-scan are shown in the upper left corner of the fundus image. The green arrow indicates the direction of the OCT scan. If the scans in this area are densely, spaced only the active OCT scan is indicated. Choose a different scan from the series by left-mouse clicking on the fundus image within the green frame. If the scans of a volume scan are less . densely spaced, the inactive scans are indicated in dark green. Left-click on these lines to view the corresponding OCT scans
For the 3D View tab, the option Automatically adjust vertical position may be selected. In this case, the fundus image is automatically positioned slightly below the lowest segmentation line.
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
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OCT B-Scan
OCT scan pattern and location are indicated on the fundus image to the left Select the option RNFL to view thickness measurements for circular scans (see next page)1.
Thickness Profile
of retina calculated from OCT B-Scan above Information about the size of the displayed images are shown in the status bar (bottom of the window) For follow-up examinations: Locations with retinal thickness changes compared to the reference image are marked in red (increased retinal thickness) or green (decreased retinal thickness)
Click on the arrows (up/down) to change scaling of y-axis (x-axis: thickness in mm linear scans, sectors and degrees for circular scans)
Menu is only available for circular scans.. Please see the Spectralis Operating Manuals for full instruction. 23
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
In the Thickness Profile tab1, the RNFL thickness profile can be displayed. From the dropdown menu in the center of the window, select the option RNFL to view classification results. Thickness Profile The profile on the lower right of the window presents the RNFL thickness detected along the circular scan, compared to values from the normative database. The normative database comprises 170 eyes of 169 Caucasian subjects (Mardin et al., University of Erlangen, Germany, publication in preparation). The black curve indicates the measured values. For followup examinations, the values of the reference exam are indicated as gray line. The green area represents the 95% normal range. The green line within the area indicates the average thickness values from the normative database. The yellow area represents values outside the 95% confidence interval but within the 99% confidence interval of the normal distribution (.01<p<.05), indicating borderline classification, and the red area represents values outside the 99% confidence interval of the normal distribution, indicating outside normal limits.
Tab is only available for circular scans.. Please see the Spectralis Operating Manuals for full instruction. 24
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Segmentation Tools Enter/exit Segmentation line edit mode Undo Changes (alternatively, use context menu option Undo Changes) Save changes1 Create Segmentation Line2
Modify the Segmentation Line Select the Thickness Profile tab in the Analysis window. Click the Enter/exit Segmentation line edit button under the OCT image to change the segmentation lines. The segmentation tool buttons will appear.
1 2
Button only visible if segmentation mode active Button only visible if applicable Please see the Spectralis Operating Manuals for full instruction. 25
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Manual Segmentation If the software could not create a segmentation line, the Create Segmentation Line button appears under the OCT image when the segmentation line edit mode is started. To add the missing line, click on the arrow button and select the type of segmentation line you would like to add from the appearing context menu. A horizontal segmentation line will be created in the OCT image. Since it initially contains three drag points, it is recommended to add more points to the line before dragging these points to their final positions. Currently three options are available depending on the missing segmentation line: Create ILM Segmentation (Internal Limiting Membrane), Create RNFL Segmentation (lower boundary of Retinal Nerve Fiber Layer) and Create BM segmentation (Bruchs Membrane). A manually modified segmentation line is marked with an m at the left end. When you move the mouse over a manually modified segmentation line, the last edit date is displayed in the status bar at the bottom of the window and in the info bubble (if activated; see page 22).
To segment sharp angles, try adding additional drag marks (shown by red arrows in the above image) to the corners where you do not want the segmentation line to be affected. This will help to stabilize the segmentation line that is beyond this sharp angle.
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
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A single pixel position (Marker) can be altered by drag and drop (left mouse button), the pixel position is moved synchronously in all 4 images
200 m
Pan Mode: Move the enlarged image with the mouse Zoom Mode: Use left mouse button to zoom in or out Zoom In Zoom Out Transparency of overlay Circle grid functions: Change the diameter of the ETDRS circle grid (options: "1, 2, 3 mm", "1, 2.22, 3.45 mm" and "1, 3, 6 mm") Center the circle grid in the image Reset circle to the position last saved The position and size of the circle grid can be saved for each examination. For follow-up exams, the position of the circle grid is automatically taken from the baseline exam.
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Set range of thickness difference map down to +/- 50 m (default range +/- 400 m)
Total volume of all segments in mm3 Average thickness of segment in m Average volume of segment in mm3
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Display Options
Cube: Displays a volume scan as solid block Surface: Removes the part of a volume scan above the ILM1 Volume: (Not yet available) Single: Displays volume or pattern scans as single slices Show Grid: Shows a bounding box around the volume scan Y-Scale (pixel/um): see p. 16 Reset View to standard display settings Moves the fundus image up or down (see page 22 for default setting) Movie function for volume scans: Play Save the movie Speed of movie Single scan
Use the keyboard keys (see p. 28) or use the mouse to view the 3D image: mouse wheel: scroll through scans right mouse button + move up/ down: zoom left mouse button + move: rotate view
Volume scan
Note: In order to change the color of the OCT scan, use the Contrast & Brightness window (see page 35) 1 Internal Limiting Membrane Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0 Please see the Spectralis Operating Manuals for full instruction. 28
View next image View previous image View next image in progression View previous image in progression Volume and radial OCT scans only: Display previous OCT scan Display next OCT scan Add to lightbox Print Report Export as Picture Image Information (see p. 28) Brightness & Contrast Home End / Ctrl + L Ctrl + R Ctrl + E Ctrl + I Ctrl + B Page down Page up
Move visible layer towards back Move visible layer towards front
Hold the Alt key down and move the mouse over the respective image to change contrast (left/right) and brightness (up/down, only for fundus image) or use keys while pressing the Alt key.
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Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Zoom Mode Activate Zoom In Mode Zoom in Activate Zoom Out Mode Zoom out Zoom in/out 100%, Zoom off Pan Mode 1 Activate Pan Mode Move visible part of image Rotate view Shift Shift + Shift + Or left mouse button + move mouse Reset 3D view (straight on surface) Reset view to default
1 Move
Ctrl + Ctrl + Shift Ctrl + mouse wheel Right mouse button + move mouse F5
2 2 2 2 2 2
3 3 3 3 3
2 2
2
2 2
3 3
Move mouse over Fundus image. Please see the Spectralis Operating Manuals for full instruction. 30
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Overlay tools (see next page) Image Info (see page 40)
Movies Scroll through single images Play Pause Stop Show last/ first image of movie Show previous/ next image of movie Add to Lightbox Eye Movement Correction
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
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ETDRS Grid Overlay The grid is composed of four concentric circles with radius 360m (dashed line), 600m, 1800m and 3600 m. The two bisecting lines are indicated. The window size can be adjusted with the mouse It can be moved by drag and drop. When the cursor is within the center of the inner circle and the left mouse button is pressed, the cursor symbol will turn into a cross and enables movement of the grid. Similarly, the grid can be rotated by drag and drop on any of the concentric circles using the left mouse button. The ETDRS context menu is opened by a right mouse click on any of the grid lines. The option Overlay Properties enables the change of the color of the grid or the font. Note: The ETDRS Grid Overlay function is dependent on image scaling. Please make sure that the cornea curvature is entered correctly for the relevant eye in the Eye Data window (see page 8).
Zoom
Window
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Simultaneuos image
Movie
View next image View previous image Add to lightbox Delete image Print Screenshot Export as Picture (.bmp, .jpg) Copy to Clipboard Image Information (see p. 28) Brightness & Contrast Apply Defaults / Ctrl + L Del Ctrl + P Ctrl + E Ctrl + C Ctrl + I Ctrl + B Ctrl + D
1 Movies
only; 2 Current frame Please see the Spectralis Operating Manuals for full instruction. 33
Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0
Simultaneuos image
Movie
Overlays Enter Text Draw Arrow Draw Region Measure Distance Measure Circle Insert ETDRS-Grid Zoom Zoom in 100%, Zoom off Left mouse button + move mouse F5 Ctrl + T Ctrl + A Ctrl + R Ctrl + S Ctrl + M Ctrl + G
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OCT Images Open the control window by selecting the shortcut icon or the option Brightness & Contrast from the Image menu. For the OCT image, contrast can be adjusted using the slider. For the fundus image, brightness and contrast can be adjusted together by moving the black dot in the white square (up and down = brightness, left and right = contrast) or separately using the respective slider below the white square.
During Acquisition, the OCT Color Scale can also be changed by selecting this option from the Setup menu.
Screen Shots / Screen Printing A screen print of the active window (uppermost window displayed on the screen) can be obtained by holding down the Ctrl and P keys simultaneously.
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Printing I
Printing Reports To print one or multiple fundus or OCT images on a report, select the desired thumbnail images into the lightbox of the Patient File, select them all and select Print from the context menu. The Print Spectralis Report window will open. The report types available in the Print Spectralis Report window depend on the types of images selected for printing, as well as the context from which the print function was started. In the section Reports, select the type of Report or number of images per page2, report language, and information to be printed on the printout and page layout (see section Options below). Printouts can be previewed using the button Preview in the Print Spectralis Report window. Options Display Page Header: Title of the report and custom header (if implemented, see Software Manual) are displayed. Display Patient Information: Patient name and other patient data. If all printed images are from the same examination date, this date will be displayed together with the patient data. Display Diagnosis and Commen: If this Option is selected and if all printed images are from the same examination date, text entered in the Comment field! of the Patient Data window will be displayed in the Notes section on the bottom of the report. On progression printouts, the information of the reference exam will be shown. Provide Space for Notes: Shows or hides the Notes box at the bottom of the printouts. Add Page Margins: Remove this option to avoid additional software-generated margins. Automatic Page Orientation: Page orientation (portrait or landscape) is automatically set according to the report type (e.g. Selected Image Only reports are always printed in the landscape orientation, Single Visit Reports are always printed in the portrait orientation).
For further information on the Comment field, please refer to page 19. Please see the Spectralis Operating Manuals for full instruction. 36
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Printing II
OCT or Fundus Images Overview Reports When printing multiple images from the Patient File (or lightbox), an Overview Report will be printed. The number of images per page can be selected in the Print Spectralis Report window (1, 2, 4, 6, 8, 9,12,16 images/page, OCT scans or HRA simultaneous images count as 2 images each).The best setting for the number of selected images will be chosen automatically. If the Automatic Page Orientation check mark is set, the orientation for the 2 and 8 images per page layout will be landscape, all other layouts will be printed in portrait mode. OCT Reports Single Visit Report The Single Visit Report is only available for single OCT B-scans. For volume or star pattern scans, a single scan must be selected in the Analysis window or by using the Expand option in the Patient File.
Follow-up Reports (Retinal Thickness Change Analysis Reports) The report All Follow-ups is available for any OCT B-scan that is part of a progression series. Recent Follow-ups is only available when the selected image is a follow-up image acquired after the reference image (see page 14). The reference image is highlighted with a red frame. Both report formats are available with enlarged OCT images (see lower printout).
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Printing III
Thickness Map Report Open the Thickness Map tab and use the Quick Print button or the menu option Image / Print Report. This report is only available for volume scans. RNFL Basic Report OU (cont.) values for the respective sectors and global (G). In the middle section, the Thickness Profiles are displayed. The green area represents the 95% normative range. The green line indicates the average thickness values from the normative database. The yellow areas represent values outside the 95% confidence interval but within the 99% confidence interval of the normal distribution (.01<p<.05), indicating a borderline classification, and the red areas represent values outside the 99% confidence interval of the normal distribution,indicating outside normal limits. For follow-up examinations, the values of the reference exam are indicated as gray line. The lower section comprises a diagram presenting asymmetry values between eyes as well as four pie charts indicating average RNFL height measurements for the different sectors and the global values (G). If the average height measurement falls outside the 95% confidence interval of the normal distribution (p>.05), the respective sector is colored yellow or red. The overall classification result for each eye is presented as a green, yellow or red bar on the bottom of the page.
3D-View Report Open the Thickness Map tab and use the Quick Print button or the menu option Image / Print Report.
RNFL Basic Report OU This printout format is designed to provide a comprehensive analysis of the RNFL in an easy to read format for clinical interpretation. It is only available on circle scans. To print both sides, select a circle scan of each eye and exam date in the patient file, then select the option Print.from the context menu (right mouse button). Asymmetry comparisons between both eyes are given in the two gray pie charts in the upper section. The numbers indicate the difference of both thickness
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* For fundus images, only movies can be expanded to individual images Heidelberg Engineering 2008. Art. No. 19061. QM 97187-002. Spectralis Software Version 5.0 Please see the Spectralis Operating Manuals for full instruction. 39
Image Information Scan parameters of the OCT and fundus images are available in a separate window. It is opened via the Info shortcut button or the option Image Information of the Image menu in the Analysis window. E2E File Export1 To export images and other data in an examination as an E2E file, select the desired thumbnail image(s) from the Patient File window, and select the item Export as E2E from the Context Menu in the Patient File. The Batch Export E2E feature in the Database window enables export of multiple patient records at once.
Viewing an E2E file requires HEYEX software for the respective module. Please see the Spectralis Operating Manuals for full instruction. 40
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File Formats Images can be exported in .bmp, .jpg., .tif or .png format. Fundus image movies can be exported as AVI files. For export of images as TIF files, it is possible to select a compression method (None / LZW / Packbits). This reduces the size of the exported image file without loss of image information. Additional Information Below the image, the following information can be displayed optionally: Patient Name, ID, date of birth, ancestry Examination Date, OS/OD, diagnosis Image Image type, time In the Save as... window, select the option Add Info Block and choose the Displayed Patient Info by ticking the respective boxes.
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Software Versions To check the versions of the Heidelberg Eye Explorer as well as the acquisition and viewing modules, please open the About box using the Help / About menu item in the Database window. The software release 5.0 includes Spectralis Acquisition Module 5.0, Spectralis Viewing Module 5.0 and Heidelberg Eye Explorer software version 1.6.1.
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