How to use seego vhit reload instructions

Capitulos 4 and 5

vHIT
EyeSeeCam

EN Instructions for Use


ES Manual de instructions
SV Bruksanvisning
FR instructions d’utilisation
EL Οδηγίες χρήσης
EN instructions for use
IT Istruzioni per l'uso
PT Instruções de Utilização

D-0101515-D- 2016/10


Instructions for Use - EN
Table of Contents

1 Introduction ................................................ .................................................. ........................... 1
1.1 About this manual .............................................. .................................................. ........ 1
1.2 Intended use ............................................... .................................................. ............... 2
1.3 Included parts ............................................... .................................................. ............. 2
1.4 Notes on safety .............................................. .................................................. ............ 3

2 Unpacking and installation .............................................. .................................................. .... 5


2.1 Unpacking and inspection .............................................. ............................................. 5
2.2 Markings ................................................ .................................................. .................... 6
2.3 General warnings and precautions ............................................. ................................. 6

3 Getting started and system setup ............................................ ............................................. 9


3.1 Hardware requirements ............................................... ................................................ 9
3.2 Power ................................................ .................................................. ........................ 9
3.2.1 Maximizing the power supply ........................................... .................................... 9
3.2.2 Entering BIOS ............................................. .................................................. ....... 9
3.2.3 Changing BIOS setting ............................................ ............................................ 9
3.2.4 Windows Power Setting Setup ........................................... ............................... 10
3.3 USB mode ............................................... .................................................. ................ 11
3.4 Hardware setup ............................................... .................................................. ........ 11
3.5 Goggle setup ............................................... .................................................. ............ 11
3.5.1 Camera and IR illumination ........................................... .................................... 12
3.5.2 Focus adjustment ............................................. .................................................. 13th
3.5.3 Calibration laser adjustment ............................................ .......................................... 13
3.5.4 Corrective Optician Lenses ............................................ .................................... 13
3.5.5 Servicing and maintenance ............................................ ................................... 14
3.6 Software setup ............................................... .................................................. .......... 15
3.6.1 Uninstalling the EyeSeeCam vHIT software - Please refer to the EyeSeeCam
installation CD and instruction. .................................................. ........................ 15
3.6.2 Starting from OtoAccess ™ ........................................... ..................................... 15
3.6.3 Backing up files in OtoAccess ™ ......................................... ............................... 16

4 Test procedures ............................................... .................................................. ................... 17


4.1 User interface ............................................... .................................................. ........... 17
4.2 Standard calibrations ............................................... .................................................. 17th
4.2.1 Prepare the patient ............................................ ................................................ 18
4.2.1.1 Adjust the eye / camera .......................................... ........................................ 18
4.2.2 Start standard calibration ............................................ ....................................... 19
4.2.3 Calibration report- standard ........................................... .................................... 21
4.3 Head calibrations ............................................... .................................................. ...... 21
4.3.1 Prepare patient ............................................. .................................................. ... 22
4.3.2 Start calibration ............................................. .................................................. ... 22
4.3.3 Calibration report - head ........................................... ........................................ 23
4.4 Lateral impulses ............................................... .................................................. ....... 25
4.4.1 Prepare .............................................. .................................................. .............. 25
4.4.2 Display laser during HIT ........................................... .......................................... 25
4.4.3 Training guide ............................................. .................................................. ..... 26
4.4.4 Start test ............................................. .................................................. .............. 26
4.4.5 Impulse counter ............................................. .................................................. .. 27
4.4.6 Auto-stop ............................................ .................................................. .............. 28
4.5 Vertical impulses RALP / LARP protocols .......................................... ........................ 29
4.5.1 Direction / plane guide ........................................... .............................................. 29
4.5.2 Start test ............................................. .................................................. .............. 30
4.5.3 Stop .............................................. .................................................. .................... 30
4.6 Reports ................................................ .................................................. .................... 31
4.6.1 Generate full report for individual tests ......................................... ..................... 31
4.6.2 EyeSeeSix report ............................................. .................................................. 31
4.6.3 Preview .............................................. .................................................. .............. 34
4.7 Denoise ................................................ .................................................. .................... 36
4.8 Video record ............................................... .................................................. ............. 36
4.9 NystagmuspProtocol test ............................................... ............................................ 40
4.10 Report samples and printouts ............................................. ....................................... 41
4.11 Export completed session data ............................................. .................................... 41

5 Maintenance ................................................ .................................................. ........................ 43
5.2 How to clean Interacoustics Products ............................................ ........................... 43
5.3 Concerning repair ............................................... .................................................. ..... 43
5.4 Warranty ................................................ .................................................. .................. 44

6 Technical information ............................................... .................................................. .......... 45
EyeSeeCam vHIT Instructions for Use - EN Page 1

1 Introduction
1.1 About this manual
This manual is valid for the EyeSeeCam system (revsion 1.2). The product is manufactured by:
Interacoustics A / S
Audiometer Allé 1
5500 Middelfart
Denmark
Tel .: +45 6371 3555
Fax: +45 6371 3522
E-mail: [email protected]

It is the purpose of this manual to provide users of the Interacoustics EyeSeeCam module with all the
information required to carry out safe and reliable measurements.

In the past, a variety of techniques have been developed for measuring horizontal and vertical (that is,
two dimensional) eye movements. These include Electro-Oculography (EOG), Scleral Search Coil
(SCC) and photoelectric techniques. All of these techniques have been used in clinical and research
applications.

EOG, using surface electrodes is limited in its application by an accuracy factor of around 2 degrees.
It is further limited by its sensitivity to contamination by other electro-physiological artifacts and
electromagnetic sources in the environment. Signal drift impairs measurement of absolute eye position
and vertical eye position is highly non-linear. Photoelectric techniques have provided a higher degree
of accuracy than EOG (down to 0.25 degrees). However, these techniques are often limited only to the
measurement of the horizontal eye movement component.

Oculometric measurement with photoelectric techniques was first reported approximately fifty years
ago. These early experiments involved manual photographic techniques to measure horizontal and
vertical eye movement. Later, moving image techniques were employed to improve temporal
resolution of the recordings.

With the establishment of electronic techniques for image scanning and reproduction, the image
processing approach to oculometric measurement was introduced. With the development of the video
market, small, high-resolution FireWire and USB cameras have become available.

These systems enable an accurate (0.1 to 0.5 degrees), contact free recording of eye movements.
They can provide data on absolute eye position, and they are easy to handle.

Dizziness is a frequent symptom in ENT, Neurology, and General Medicine. Part of the clinical
Examination of dizzy patients is based on the head impulse test (HIT) of the vestibulo-ocular reflex
(IN FRONT). Head impulses are movements with small positional amplitude (10-20 degrees) but high
acceleration (3,000-6,000 degrees / s2) and high velocity (150-300 degrees / s). When performed
clinically with no quantitative analysis, the test only detects the presence of a corrective saccade as an
indirect sign of a VOR deficit.

The HIT can easily be conducted at the bedside, but it has only a moderate sensitivity (63% in experts
and 72% in non-experts). Its specificity is 78% in experts and 64% in non-experts. Sensitivity,
however, can be improved to up to 100% when quantitative data of the VOR are obtained during the
head impulses. In patients with an acute unilateral vestibular deficit the quantitative HIT is as reliable as
the caloric irrigation test. Chronic patients, however, show a pathological caloric result in only 64% of
the cases but they were reliably identified by quantitative HIT. Hence, in the acute phase of a
vestibular deficit either of these tests is sufficient, but in the chronic phase, which is typical for a
vertigo and dizziness outpatient unit, the quantitative HIT is better.
EyeSeeCam vHIT Instructions for Use - EN Page 2

EyeSeeCam with its lightweight goggles and the integrated inertial measurement unit (IMU) provides a
measurement device for an objective and quantifiable HIT. The mobile setup with a battery-driven laptop
Ensures that the HIT can be applied at the patient’s bedside and in the emergency room. With it, a doctor
can objectively and reliably assess peripheral vestibular function in a few minutes and differentiate
peripheral from central vertigo. This video-based HIT is a novel, time-saving and low-cost tool that can be
readily applied in all clinical setups, such as in vertigo outpatient units or in emergency rooms

1.2 Intended use


The EyeSeeCam vHIT is used to present information on the performance of the balance system by
providing objective measures of eye-velocity response to head-velocity stimulus, showing the VOR
gain in the plane of rotation of the head

The system is to be used by trained personnel only such as audiologists, ENT surgeons, neurologists,
hearing healthcare professionals or personnel with a similar level of education.

The EyeSeeCam is intended for patient from 5 years and up. The patient must be physically sound as
the procedures include some physical stimulation / movement. Patient must be able to see the target
without the use of the shows

Contra indications
• Blindness
• Broken nose or other face / head trauma
• Neck trauma
• Recent eye surgery
• Ptosis
• Excessive eye blinks
• Excessive eye make up

1.3 Included parts


EyeSeeCam - vHIT camera and goggle 1
USB cable
EyeSeeCam vHIT Software and manuals CD
OtoAccess ™ Database software CD
Ferrite beads
Tape measure

1
Applied part including the USB cable as according to IEC 60601-1: 2005
EyeSeeCam vHIT Instructions for Use - EN Page 3

1.4 Notes on safety


Our instruction manuals contain safety notes which follow the ANSI recommendations (American National
Standards Institute) for safety notes.

WARNING indicates a hazardous situation which, if not avoided, could


result in death or serious injury.

CAUTION, used with the safety alert symbol, indicates a hazardous


situation which, if not avoided, could result in minor or moderate injury.

NOTICE NOTICE is used to address practices not related to personal injury.


EyeSeeCam vHIT Instructions for Use - EN Page 4
EyeSeeCam vHIT Instructions for Use - EN Page 5

2 Unpacking and installation


2.1 Unpacking and inspection
Check box and contents for damage
When the instrument is received please check the shipping box for rough handling and damage. If the
box is damaged it should be kept until the contents of the shipment have been checked mechanically and
electrically. If the instrument is faulty please contact your local distributor. Keep the shipping material for
the carrier’s inspection and insurance claim.

Keep carton for future shipment


The EyeSeeCam comes in its own shipping carton, which is specially designed for the EyeSeeCam.
Please keep this carton. It will be needed if the instrument has to be returned for service.

If service is required please contact your local distributor.

Reporting imperfections
Inspect before connection
Prior to connecting the product it should once more be inspected for damage. All of the cabinet and the
accessories should be checked visually for scratches and missing parts.

Report immediately any faults


Any missing part or malfunction should be reported immediately to the supplier of the instrument together
with the invoice, serial number, and a detailed report of the problem. In the back of this manual you will find
a "Return Report" where you can describe the problem.

Please use "Return Report"


Please realize that if the service engineer does not know what problem to look for he may not find it, so
using the return report will be of great help to us and is your best guarantee that the correction of the
problem will be to your satisfaction.
EyeSeeCam vHIT Instructions for Use - EN Page 6

2.2 Markings
The following markings can be found on the instrument:

Icon explanation
Type B applied parts.
Patient applied parts that are not conductive and can be immediately
released from the patient.

Follow instructions for use

WEEE (EU directive).
This symbol indicates that when the end-user wishes to discard this product,
it must be sent to separate collection facilities for recovery and recycling.
Failing to do so may endanger the environment.
The CE mark indicates that Interacoustics A / S meets the requirements of
Annex II of the Medical Device Directive 93/42 / EEC. TÜV Product Service,
Identification No.0123, has approved the quality system.

0123

Year of manufacture.

This product is laser class 1. This means the maximum permissible


exposure (MPE) cannot be exceeded when viewing a laser with the naked
eye.

2.3 General warnings and precautions

This equipment is intended to be connected to other equipment thus forming a medical electrical system.
External equipment intended for connection to signal input, signal output or other connectors shall comply
with the relevant product standard e.g. IEC 60950-1 for IT equipment and the IEC 60601-series for
medical electrical equipment. In addition, all such combinations - Medical Electrical Systems - shall
comply with the safety requirements stated the general standard IEC 60601-1, edition 3, clause 16. Any
equipment not complying with the leakage current requirements in IEC 60601-1 shall be kept outside the
patient environment i.e. at least 1.5 m from the patient support or shall be supplied via a separation
transformer to reduce the leakage currents. Any person who connects external equipment to signal input,
signal output or other connectors has formed a Medical Electrical System and is therefore responsible for
the system to comply with the requirements. If in doubt, contact qualified medical technician or your local
representative.

A separation device (isolation device) is needed to isolate the equipment located outside the patient
environment from the equipment located inside the patient environment. In particular such a separation
Device is required when a network connection is made. The requirement for the separation device is
defined in IEC 60601-1, edition 3, clause 16.
EyeSeeCam vHIT Instructions for Use - EN Page 7

The EyeSeeCam in not intended for operation in oxygen-rich environment, flammable anesthetics,
flammable agents or similar

The goggle should not be worn by patients with strong defective vision and abnormally rare blink. Please
consult a specialist in such circumstances before using the mask on these types of patients.

The system must be switched off before cleaning

When used for longer time in environments temperatures above 30 ° C the surface temperature of the
camera unit can exceed 43 ° C (max 44 ° C). If this feels uncomfortable for the patient turn off the
equipment for a while.

The EyeSeeCam system must be serviced at least once a year. The service must include a safety test.
No parts can be serviced while in use with the patient.

Do not use the equipment if the enclosure is not intact, but have the equipment serviced.

Only personnel with proper training (skilled personnel) should operate the system.

Proper use of this device depends on careful reading of this manual and all additional instructions and
labels

Let the system obtain room temperature before turning it on. Extra time for obtaining room temperature
may be needed to avoid condensation if the system has been moved from a very cold location to a
warm one.

The patients or test persons should not wear any optical utilities such as glasses or contact lenses.

The patients or test persons should not wear make up around the eyes
EyeSeeCam vHIT Instructions for Use - EN Page 8
EyeSeeCam vHIT Instructions for Use - EN Page 9

3 Getting started and system setup


3.1 Hardware requirements
System requirements USB EyeSeeCam systems

Laptop PC: One USB 2 port available

Desktop PC: One USB 2 port available

Furthermore, Microsoft .Net 2.0 Framework and Windows Installer 3.x should be available. If these
programs are not installed on your computer, you will be prompted to install them when running the
EyeSeeCam installation. Just click yes when the installer asks you, and they will be installed
automatically.

Finally, Adobe® Reader® must be installed from the included installation CD.

Operating system requirements:


Windows®7 (32 & 64 bit).
Windows® 8 (32 & 64 bit).
Windows® 10 (32 & 64 bit).

3.2 Power
3.2.1 Maximizing the power supply
Eye images in the vHIT user interface can become flickering and unstable if the power supplied to the
camera is not maximized.
These problems mainly occur in PC systems using chipset technology from INTEL.
To maximize the power supply, CPU power saving features must be disabled either in the bios setup or
via the software as described below. It is recommended to control the CPU power saving features in the
computer’s BIOS rather than via software.

3.2.2 Entering BIOS


BIOS setup can be entered by following the instruction on the screen shortly after the system is switched
on.

3.2.3 Changing BIOS setting


CPU power saving features need to be changed to have maximum power / performance by disabling
Speed ​​Step and other power controlling features.
See example below - changes into "Disabled" must be applied to the functions inside the red boxes
EyeSeeCam vHIT Instructions for Use - EN Page 10

Figure 3-1: Bios settings

3.2.4 Windows Power Setting Setup


It is also necessary to disable Windows’ own power saving features:
In control panel -> Power options properties, power manager, set power schemes to maximum
performance as shown below:

Figure 3-2: Power Option properties


EyeSeeCam vHIT Instructions for Use - EN Page 11

3.3 USB mode


The EySeeCam vHIT camera must only be connected to a USB 2.0 port. If the computer only has USB
3.0 ports the USB 3.0 controller must be disabled so that the ports will work in USB 2.0 mode.
To downgrade from USB 3.0 to USB 2.0 please go to the BIOS / Config menu and select “USB”. Set the
USB 3.0 controller mode to “Disabled” and press F10 to Save and Exit the BIOS Config menu.

3.4 Hardware setup


• Connect the USB cable to the computer
• Connect the other end of the USB cable to the EyeSeeCam camera
• Mount the camera on the goggle using the spherical ball-and-socket joint (see Figure 2.4)
• Mount the calibration laser on the bridge of the goggle (see Figure 2.4)
• Connect the computer power supply to a wall outlet, then connect to the computer

3.5 Goggle setup


The vHIT goggle generally has one camera (monocular) fixed at the top side (s) of the mask. The
camera is held in place mechanically with a spherical ball-and-socket joint. The vHIT goggle has two
spherical sockets: one for the left and one for the right eye. Therefore the camera is interchangeable
between the left and right eyes.

Figure 3-3 EyeSeeCam vHIT goggles


EyeSeeCam vHIT Instructions for Use - EN Page 12

The vHIT goggle supports the USB camera that is used to record the eye images. This constitutes
the major component of your USB vHIT system.

The USB camera uses infrared light (IR), which is not visible to the naked eye. The IR illumination
enables sessions to be performed in complete darkness. Although it seems to be dark, the eye images
will be displayed as clear and visible images due to the IR illumination.

The USB vHIT goggle functions as free field of view only.

Before using the USB vHIT goggle please consider the following:

• The goggle and camera contain sensitive electronic and optical devices. Do not expose the
goggle or cameras to mechanical shock
• Do not expose the goggle to moisture (IPX 0 according to IEC 529)
• USB vHIT goggle is not to be used around explosive gases.

In addition to the camera, there is a calibration laser in the center providing the visual fixation targets
for calibration. The laser projects a luminous dot pattern in the front of the head, for example, onto the
wall, if the tested subject is sitting in front of the wall, or onto the ceiling, if the tested subject is lying.
Just like the camera, this calibration laser can also be removed together with the camera. The
calibration laser is connected to the camera by means of a flexible wire.

3.5.1 Camera and IR illumination


Light Emitting Diodes (LEDs) are positioned at the side of the camera objective lens. The lateral LEDs
emit infrared light (IR), which serves as a spherical camera joint:

• The spherical joint allows the camera to be moved from the mask and plugged into the spherical
socket of the other side. This allows for examining either the left or the right eye, depending on
which eye is better suited for examination. This feature is particularly useful in patients with either
a glass eye or with a ptosis.

Figure 3-4 vHIT goggle and ball and socket joint for camera. Calibration laser is placed on the bridge of the goggle ..
EyeSeeCam vHIT Instructions for Use - EN Page 13

3.5.2 Focus adjustment


The lens of the camera module allows you to focus the image. As eye sockets vary in physical
dimension from patient to patient, absolute focus requires adjustment to provide focused images - and
focused images are a precondition for stable eye tracking and noise-free data. The eye is in focus if
details of the individual patterns in the iris (iral signature) are well visible.

Figure 3-5 Focus adjustment for camera

3.5.3 Calibration laser adjustment


The calibration laser, in the center of the goggle, has a knob that allows you to align the dots on the wall
by slightly rotating the knob until the 5 laser dots are aligned horizontally and vertically. Do not adjust
the calibration laser unduly. Adjust only if the dots have gone out of horizontal / vertical alignment.

Figure 3-6 Calibration laser adjustment

3.5.4 Corrective Optician Lenses


The vHIT goggle has mounts that allow to attach corrective optician lenses with a standard diameter of
38 mm (e.g. from http://www.frohnhaeuser.de/). Such lenses are usually used for examining myopic
patients with, e.g., Oculus trial frames.
EyeSeeCam vHIT Instructions for Use - EN Page 14

Figure 3-7 Corrective optician lenses mounted to the goggle frame in order to facilitate accurate fixation-based calibration even in
myopic patients.

3.5.5 Servicing and maintenance


The vHIT system must be serviced at least once a year. The service must include a safety test.
EyeSeeCam vHIT Instructions for Use - EN Page 15

3.6 Software setup


Installation of Otoaccess ™ - Please refer to the Otoaccess ™ manual and documentation.

Installation of EyeSeeCam vHIT software - Please refer to the EyeSeeCam installation CD and
instruction.

Create ESC as an instrument in Otoaccess ™

Figure 3-8 Create EyeSeeCam as an Instrument

To create EyeSeeCam as an Instrument in OtoAccessTM, type in a name (e.g. EyeSeeCam) for the
instrument and select the instrument you just installed (EyeSeeCam) in the drop down list below
software modules.

Select hardware and set-up type of communication. Please see service manual for the selected
hardware to get information concerning communication. Finally, click on the Create button.

Your OtoAccess ™ is now fully programmed for vHIT testing. Remove the EyeSeeCam CDROM from
the drive and store it safely back in the manual. Once installation has been successful and the
software licenses have been entered, you can start measuring with EyeSeeCam.

3.6.1 Uninstalling the EyeSeeCam vHIT software - Please refer to the EyeSeeCam
installation CD and instruction.

3.6.2 Starting from OtoAccess ™


To start ESC:
1. Double click the OtoAccess ™ icon on the desktop which will open the OtoAccess ™
program

2. Select the instrument (in this example, EyeSeeCam) by double-clicking EyeSeeCam in the
Select instrument box. EyeSeeCam will open in a new window
EyeSeeCam vHIT Instructions for Use - EN Page 16

Figure 3-9 OtoAccess ™ Main Screen

. grade
See the OtoAccess ™ Online Manual for more information about the user interface.

3.6.3 Backing up files in OtoAccess ™


OtoAccess ™ enables you to backup and restore your data in an easy way.

Simply click backup and - for the first ever backup on the computer - select the following
location for the backup file:
C: \ Program Files (x86) \ Microsoft SQL Server \ MSSQL.1 \ MSSQL \ Backup

To restore, please click Restore and select the file to be restored.

Precaution
Please note that all previous data will be deleted by the restore operation.

After a restore operation please restart the application to refresh all content.
EyeSeeCam vHIT Instructions for Use - EN Page 17

4 test procedures
4.1 User interface
EyeSeeCam has a simple and intuitive user interface that allows you to quickly collect and review data.

Data collection
Area

Figure 4-1 vHIT User Interface

4.2 Standard calibrations


Place the goggle on the patient, select Calibration - Standard and then click on Prepare

Figure 4-2 Standard Calibration


EyeSeeCam vHIT Instructions for Use - EN Page 18

4.2.1 Prepare the patient


A click on the Prepare button will display the calibration screen and turn on the calibration LEDs.

Figure 4-3 Calibration Preparation Screen

4.2.1.1 Adjust the eye / camera


Instruct the patient to fix the center luminous dot.

Align the camera by rotating it in its ball-and-socket joint such that the eye is finally centered in the
image. The camera can be rotated in three directions: yaw, pitch, and roll. At one time, however,
rotate the camera only in one of these three possible directions. After the eye is centered in one
direction, e.g., in the horizontal direction, choose the next rotation direction, e.g., the vertical direction.
A possible alignment sequence to center the eye is shown Figure 4-4.

Figure 4-4 Centering the pupil in the image with a sequence of three camera rotations. Immediately after the goggles are placed on
the patient, the eye can assume a position as in the upper left image. From this starting position, the camera first needs to be
rotated such that the pupil is centered horizontally. The red arrow in the top left image indicates how the pupil will move during such
EyeSeeCam vHIT Instructions for Use - EN Page 19

a camera rotation in roll. After this rotation the pupil is centered horizontally (top right image). Then a yaw rotation of the camera
aligns the lower eye lid to an approximately horizontal orientation, as indicated by the red rotated line in the top right image. Finally,
a camera rotation in pitch will move the pupil vertically (red arrow in bottom left image) until the pupil is completely centered (bottom
right image).

4.2.2 Start standard calibration


The patient is seated 1.5 meters from the wall where the red laser dots are projected and is asked to
hold their head still and alternate fixating on the 5 brightest projected dots for 1 sec each until asked to
stop by the examiner. Press Start when you are ready to begin recording.

Figure 4-5 Calibration target with laser images.

Figure 4-6 Calibration in progress screen. The big red dot in the Eye in Space plot (bottom right) indicates that the patient
should fixate on the right calibration dot.

During the calibration, a suggested target will be displayed with a large red dot which will move in a
sequence of jumps from fixation point to fixation point, indicating the next desired fixation. With the
help of this display, the examiner can instruct the patient as to which target they should be looking at.
EyeSeeCam vHIT Instructions for Use - EN Page 20

Figure 4-7 Sequence of calibration fixations displayed in the Eye in Space plot at the bottom right of the calibration screen. The
sequence is: center, right, left, upper, lower. This sequence is repeated twice within a duration of 24 seconds.

In this screen you can see the raw eye movements of the patient as they follow the 5 calibration dots.

Figure 4-8 Calibration screen with raw position data of eye fixations on the calibration targets. The fixations are aligned like a
cross and they are diplayed in the eye in image plot.

The calibration procedure will automatically stop when after about 24 seconds. If you wish to abort the calibration before then,
then select stop.
EyeSeeCam vHIT Instructions for Use - EN Page 21

4.2.3 Calibration report standard


After the calibration procedure is finished, a full report will be generated automatically in a separate
window. The software will automatically correct for any offsets in the calibration allowing you to store the
corrected calibration.

Figure 4-9 Completed Calibration

When asked whether you want to use this new calibration, select Yes in order to store this calibration
data with the patient file, or No if you want to use the default calibration.

Figure 4-10 Save calibration file

4.3 Head calibrations


You can begin testing without calibrating by just selecting a test and starting the impulses. In this case a
default calibration will be taken. This is a good solution for difficult situation or challenging patients, but we
still recommend that the user perform a calibration whenever possible.

After completing the standard (eye) calibration, then you should calibrate the head position of the patient
before beginning impulses. You can click on the Head calibration heading in the recordings menu to
begin.
EyeSeeCam vHIT Instructions for Use - EN Page 22

4.3.1 Prepare patient


Begin by selecting Prepare and instructing the patient.

Figure 4-11 Head calibration headings

The head movements can be passive, the clinician moves the patients head, or active where the patient
moves their own head.

The patient is instructed to keep his eyes on the target on the wall and oscillating the head gently, first
around the yaw axis (like shaking your head “no”) and, after a few oscillations, around the pitch axis (like
nodding your head “yes”). The examiner can perform the head calibration by standing behind the patient
and grabbing the head the same way as during head impulse testing of the lateral canals. About five
sinusoidal oscillations in both yaw and pitch directions need to be performed at moderate peak head
velocities not exceeding 100 deg / sec. The total duration of the head calibration is on the order of 15 sec.

4.3.2 Start calibration


Select Start to begin the test and select stop when finished.

Figure 4-12 Diagram showing the different planes of head rotations.

During the head calibration procedure, you will see a graphical representation of the data. The areas of
interest to you are (a) head velocity in degrees per second, (b) eye position in degrees, (c) a circular plot
of roll / pitch and (d) yaw / pitch
EyeSeeCam vHIT Instructions for Use - EN Page 23

Figure 4-13 Graphical representation of the data

The head calibration aligns the possibly oblique inertial sensor axes with the true earth-horizontal and
earth-vertical directions. During head calibration the real-time preview shows in the upper two diagrams
the head velocity and eye position over time. Please try to keep peak head velocity around 50 deg / sec,
although the exact value is not important. However, it is important to not exceed 100 deg / sec such that
the patient can keep the eyes on the fixation target on the wall. At head velocities exceeding 100 deg / sec
Patients with a vestibular loss will not be able to keep their eyes on the target due to the limitations of the
human smooth pursuit system.

The lower two polar diagrams show the head movement directions in the coordinate system of the
camera-attached inertial sensors. From this information the calibration analysis will automatically remap
the alignment of the sensors.

4.3.3 Calibration report - head


After the calibration is completed, the full report for the head calibration will be generated automatically.
This report presents the information in a similar way as the polar diagrams of the real-time preview.
However, the eye and head motions over time are not shown. Instead, a three-dimensional
Representation of head movements with respect to the earth horizontal and vertical directions is shown
together with the head movements with respect to the possibly oblique axes of the inertial sensor. The
three polar diagrams at the bottom of the report show the head movements from three different
perspectives.
EyeSeeCam vHIT Instructions for Use - EN Page 24

Figure 4-14 Full calibration report

You can click on the red x up in the corner to exist this screen. When you do that you will be prompted;
Do you want to use this calibration? (a) Yes or (b) No, Use the Default Instead.

Figure 4-15 Save head calibration file

If you have performed 2 or more head calibrations then you will be prompted: Do you want to use this
calibration? (a) Yes (b) No, Use Previous or (c) No, Use Default Instead

Figure 4-16 How to save more head calibrations


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4.4 Lateral impulses


Click on Head Impulse - Lateral to get started.

4.4.1 Prepare
After selecting Prepare the head impulse testing screen is displayed. The examiner needs to instruct the
patient to focus on the target in front of them and to relax their neck muscles throughout the impulses

The correct technique for positioning the hands during the impulses is shown below.

Figure 4-17 Proper hand placements for impulses.

4.4.2 Display laser during HIT


Before starting a test you can decide if you want to use an external target you place on the wall or if you
want to use the lights from the laser to project fixation targets for the patient to look at before and
between the impulses.

This feature will automatically toggle the laser lights on between impulses and off during the impulses.
Some people will opt to use the center laser light as the target for the patient to focus on at the onset of
the impulse. If you choose to use a method for generating impulses where the patient is rotated 45
degrees and gazing straight ahead, the availability of these laser dots will eliminate the need for you to
move the target on the wall.

Figure 4-18 Toggle Training Guide On


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4.4.3 Training guide


Before starting the test you can also decide if you need to use a training guide. Head impulses that are in
the accepted range will peak in the dark red or blue shaded area which has a lower cut-off of 150
degree / sec and must peak by 80 ms into the thrust. When the requirements are met, the waveforms for
head and eye movements will be shown together with a check mark. If the head impulse does not meet
these requirements a cross will be shown. The head movements are seen as gray lines and the eye
movements as black lines. See figure 4-18 above.

4.4.4 Start test


Select Start and begin doing lateral impulses.

Figure 4-19 Data collection screen with an accepted lateral impulse


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Figure 4-20 Data collection screen with an unaccepted lateral impulse

4.4.5 Impulse counter


Each correct impulse you perform will generate an increasing count number shown in parenthesis. This
number will count every impulse you perform that produces a green check mark, but not the impulses
that produce red X’s. In the final report, the number of impulses will be the same as you see during the
data collection unless there was artifact or noise present, and then the final algorithm will remove that
tracing from the final report.

Figure 4-21: Data collection screen with Auto-Stop set to 7


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4.4.6 Auto-stop
The software can be set to auto-stop (end data collection) after a pre-defined number of valid impulses to
each side, or it can be set to stop only after the stop button is hit by the operator.

Figure 4-22: Auto-Stop enabled after 7 Valid Head Impulses


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4.5 Vertical impulses RALP / LARP protocols


For testing in the vertical planes you can select RALP and LARP protocols (right anterior, left posterior
and left anterior, right posterior).

Figure 4-23 Head impulse testing - vertical canals

4.5.1 Direction / plane guide


This guide is shown in the upper right hand corner for the vertical impulses (RALP and LARP). The guide
is there to show you if you are performing the impulses in the correct plane for that protocol.

The correct plane for LARP’s The correct plane for RALP’s
Figure 4-24 Direction / Plane guide