STG User Manual - 2004 Stethographics, Inc.
Contents
1. 7 2 3 Sound visualization in time and frequency domains 7 2 4 Digital filtering 7 2 5 View normalized non normalized sound toggle button 7 2 6 Heart Sounds Analysis 7 2 7 Lung Sounds Analysis 8 2 8 Log Window 8 2 9 Opening Sound Files 8 2 10 Saving Data 8 2 11 How To Adjust Recording Level On A PC 10 2 12 How To Adjust Recording Volume On A Pocket PC 122. Increase Spectrogram Sensitivity Reduce Spectrogram Sensitivity Switch to heart sound analysis mode Switch to lung sound analysis mode Trim the signal outside the cursors Mute the signal between the cursors Undo the last editing action Set Filter in Bell mode Set Filter in Diaphragm mode Set Filter in the Extended mode Print screen Help Expand signal horizontally Collapse signal horizontally Default horizontal zoom 910 0035 R8 5 STG User Manual 2 Basic Operating Instructions 2 1 Recording Steps 1 Insert the audio connector from the STG stethoscope into a microphone port of your computer as in dicated in figures below For the information on how to connect other electronic stethoscopes please check www stethographics com gt Products gt Stethoscopes 2 Start the STG software by double clicking icon on your desktop Pocket PC Start gt STG 3 Optional click to open Recording Information Dialog Fill in patient s name and information For privacy reasons you may want to substitute patient s name by a random numeric identifier 4 Click to start recording sounds or use the R key on the keyboard 5 On the Registration Dialog click the Register button and register the software Refer to STG Software Registration section for details on software registration 6 Check information on the Recording Information Dialog and click OK This feature can be turned off on the R
3. 2 13 Why Do I Need To Adjust Recording Level 12 2 14 STG Software Registration 12 2 15 How To Compare Two Sound Recordings 12 2 16 What Pocket PC Buttons Can Be Used With STG Software 13 2 17 File Management On Pocket PC 13 3 Troubleshooting Guide 14 4 Support 14 910 0035 R8 2 STG User Manual Indications The Stethographics Stethograph hereafter referred to as STG is intended for recording audio repro duction graphic display printing and storage of sounds It is also intended for automated identification of lung sounds Caution This manual provides instructions for use and troubleshooting of the STG Stethographics Inc cannot be responsible for the performance of the STG if the user does not operate the system in accordance with provided instructions This man
4. last name on the Recording Information Dialog The name of the file itself consists of the follow ing FirstName_LastName_Date_Time_StethoscopePosition For example if you are recording Mike Smith on July 22 2002 at 3 31pm and you position the stethoscope on the right side of his back this recording will be saved in C STG Mike_Smith Mike_Smith_ Jul 22_2002_153135_RB wav When the chest piece location is chosen from the list drop out box on the Information Dialog the following abbreviations are used AS Aortic Site Right 2nd interspace PS Pulmonic Site Left 2nd interspace TS Tricuspid Site Left Sternal Border MS Mitral Site Apex ICL Infraclavicular Left ICR Infraclavicular Right CPL Cervical proximal Left 910 0035 R8 8 STG User Manual CPR Cervical proximal Right CML Cervical mid Left CMR Cervical mid Right CDL Cervical distal Left CDR Cervical distal Right RAL Renal Artery Left RAR Renal Artery Right IAL Iliac Artery Left IAR Iliac Artery Right FAL Femoral Artery Left FAR Femoral Artery Right PL Popliteal Left PR Popliteal Right PTL Posterior Tibial Left PTR Posterior Tibial Right DPL Dorsalis Pedis Left DPR Dorsalis Pedis Right AXL Axilla Left AXR Axilla Right MBL Mid Back Left MBR Mid Back Right When the chest piece location was indicated by clicking on the anatomical
5. user assumes all risks responsibilities and liabilities when user identification and password protection features are bypassed disabled or ignored Because national state provincial and local laws regulate the data privacy of patients these laws may restrict or prohibit the transmission of files that contain the individually identifiable health information of patients Therefore this software permits the saving of files with and without pa tient information The default mode of saving a sound file is Save with Patient Information Patient information name auscultation site and date is used in the creation and display of each sound file name saved using this mode This information is also embedded in the wav file and can be viewed by anyone with the STG software Transmission of a sound file saved in this manner may result in an unauthorized or unwanted disclosure of protected health information especially if sent over an unsecured or public electronic system e mail Internet etc This software also permits the saving of the sound file using Save without Patient Information No patient information is used in naming the filename or is embedded in the wav file when saving a file using this mode When saved in this manner sound files are given a filename based on PC date and time The user may also modify of edit this filename if desired We strongly recom mend that the software user contact their institutional privacy offic
6. STG User Manual Stethographics Inc STG USER MANUAL Copyright 1998 2004 Stethographics Inc All rights reserved 910 0035 R8 1 STG User Manual STG User Manual Table of Contents Indications 3 Caution 3 Hardware Requirements 4 Specification 4 Instructions for Use 5 1 Toolbar icons 5 2 Basic Operating Instructions 6 2 1 Recording Steps 6 2 2 Sound Playback
7. art gt Programs gt Accessories gt Entertainment or Multimedia gt Volume Control If the shortcut is not there try searching for the program click Start gt Search gt For Files and Folders On the popup win dow type in Volume Control Click OK Look for Volume Control among the files Double click Vol ume Control 2 On the Master Volume dialog on the Options menu click Properties 910 0035 R8 10 STG User Manual 3 On the Properties Dialog click Recording as shown on the illustration below Select the Microphone and as many devices as you want and then click OK 4 On the Recording Control dialog select Microphone or Mic Volume by clicking on the check button next to Select uncheck all other devices 910 0035 R8 11 STG User Manual 5 Adjust the recording level by dragging the Volume Slider up or down to increase or decrease the input volume If you are using STG Stethoscope the recording level should be adjusted to maximum level on most computers 2 12 How To Adjust Recording Volume On A Pocket PC 1 Tap Start gt Settings gt System Tab gt iPAQ Audio gt Microphone AGC Tab 2 Disable Automatic Gain Control 3 Set Microphone Gain to 27 if you use the STG Stethoscope Set Microphone Gain to 3 if you use Cardionics eScope or Andromed Androscope electronics stethoscopes 2 13 Why Do I Need To Adjust Recording Level For optimal sound recording the maximum recording level should be just below
8. diagram the following abbreviations are used RF Right Front LF Left Front RB Right Back LB Left Back RS Right Side LS Left Side Abbreviations for Patient positions drop out box SUP Supine STA Standing SST Sitting Up straight SLF Sitting Up leaning forward PRO Prone LDE Left Decubitus RDE Right Decubitus R60 Semi recumbent 60 degrees from the bed R45 Semi recumbent 45 degrees from the bed R30 Semi recumbent 30 degrees from the bed Abbreviations for Special Techniques drop out box BRV Breathholding after exhaling completely BFR Breathholding at functional residual capacity BVC Breathholding at vital capacity 910 0035 R8 9 STG User Manual SQU Squatting HAN Handgrip VAL Valsalva strain followed by release VSP Valsalva strain phase VRE Valsalva release of Valsalva NBR Normal breathing DBR Deeper than Normal CDB Cough then deeper than normal breathing FVC Forced Vital Capacity Maneuver VEN Patient on a ventilator The Save As button opens the Save As dialog Pocket PC tap File gt Save As The STG saves unfiltered data The sounds saved with the STG are normalized to achieves maximum sound amplification without dis tortion 2 11 How To Adjust Recording Level On A PC 1 Double click speaker icon on your control bar to open Windows Master Control dialog and pro ceed to step 2 If Master Control dialog did not open locate a shortcut to Volume Control software click St
9. e and frequency domains The STG software can display sounds in time and frequency domains To visualize sound in time do main click the Waveform Display button Pocket PC File gt View gt Waveform Display To zoom in horizontally place the cursor on the interval you want to zoom in and click the Zoom In but ton on the right several times until the signal is appropriately expanded Scroll data with the scroll bar Arrow Up Down buttons or rotate the mouse wheel Pocket PC Navigation Button Top Bottom Use the Zoom buttons on the left to expand or collapse the signal vertically To visualize sound in frequency domain click the Spectrogram Display button Spectrogram shows sound intensity as a function of time and frequency dark red correspond to high intensity yellow to white correspond to low intensity Adjust Spectrogram sensitivity with and buttons Pocket PC Highlight the interval by dragging stylus over the interval tap File gt View gt Spectrum Dis play to view spectrum of highlighted interval 2 4 Digital filtering Heart sounds visualization and playback quality may be improved by application of a digital filter Use the following buttons to switch between filter modes Bell mode Diaphragm mode Extended mode unfiltered sound Pocket PC filter modes are under Tools menu Bell mode activates a band pass filter of 30Hz to 500Hz Diaphragm mode activates a bandpass filter of 80Hz to 2000Hz Extended mode show unf
10. ecording Options Dialog PC Options gt Recording Options Pocket PC Tools gt Recording Options 7 Test recording by gently tapping the electronic stethoscope diaphragm You should see sharp spikes on the waveform window If you do not see sharp spikes refer to How to Adjust Recording Level If you see the spikes you are ready to start recording Firmly position the electronic stethoscope on the chest and generate some sound Adjust recording volume by following the steps described in How to Adjust Recording Level 8 Click or Spacebar to stop recording 910 0035 R8 6 STG User Manual 9 Click Yes on the pop up dialog to save the last 20 seconds of the recording in the default directory Click No to save the sound later 10 This recording is cleared when you start a new recording or open a file 2 2 Sound Playback To play sound back point the cursor to the position where you want to start playback and click the Play back button To play the sound in a loop drag the mouse over the interval you want to loop then click the Loop button The sound is looped until the Stop button is clicked You can zoom in and out during the playback If the sound is weak highlight and mute artifacts with the Mute button Pocket PC Tools gt Edit gt Mute The signal will be normalized automatically You can always use the Undo button to undo the last action Pocket PC Tools gt Undo 2 3 Sound visualization in tim
11. er or authority to understand the applicable laws and regulations before transmitting sound files with patient information 910 0035 R8 3 STG User Manual It is the responsibility of the clinician to assure that all recordings correspond to the appropriate patient data Hardware Requirements The STG software can be installed on a PC running Windows 98 ME NT 2000 XP with a sound card STG software is also available for Pocket PC with an external microphone port running Pocket PC 2002 or later Installation on a Pocket PC requires a separate installation package Specification Recording frequency range 20Hz to 3000Hz Sampling frequency 8 000 Hz Data recording Standard wav PCM files at resolution of 16 Bit Mono Recording time 20 seconds Acoustic sensor Electronic stethoscope Compatible models include Andromed iStethos Cardionics e scope II and Stethographics STG stethoscope Number of sensors 1 910 0035 R8 4 STG User Manual Instructions for Use 1 Toolbar icons Left to Right Expand signal vertically Collapse signal vertically Default vertical zoom Display all recorded sound at default vertical and horizontal zoom Start Recording Save the data in to the default directory Open the Save As dialog Start playback Play the signal between the cursors in a loop Stop playback Open file Open Recording Information Dialog box Switch to Waveform Display Switch to Spectrogram Display
12. iltered sound The signal is normalized automatically Digital filtering has no effect on the saved wave file To filter raw sound click Filter gt Filter Raw Signal Choose filter mode Apply this function only if you want to save filtered signal 2 5 View normalized non normalized sound toggle button Normalization achieves maximum sound amplification without distortion Normalized sound will usually have higher waveform amplitude on the phonocardiogram screen and louder volume during playback A non normalized view is more convenient for comparing two recordings with each other Switch be tween normalized and non normalized views by clicking View gt View Sound Normalized 2 6 Heart Sounds Analysis Click to switch the STG to Heart Sound Analysis mode In the Heart Sound Analysis mode the STG marks first and second heart sounds in real time and off line the first sound is marked by a green bar the second heart sound is marked by a blue bar The STG also calculates heart rate in beats per minute 910 0035 R8 7 STG User Manual as well as the average duration of the systole and diastole When recording is stopped drag the mouse over the interval of interest to calculate heart rate on that interval Note Heart Sounds Analysis can be used for educational purposes only 2 7 Lung Sounds Analysis Click to switch the STG to Lung Sound Analysis mode In the Lung Sounds Analysis mode the STG marks abnormal Lung Sounds in real time and
13. off line fine crackles are marked by green bars coarse crackles are marked by blue bars wheezes are marked by red bars and rhonchi are marked by yellow bars The STG also calculates the crackle and wheeze rates Crackle rate is presented as crackles per second When recording is stopped drag the mouse over the interval of interest for example one breath to calculate crackle and wheeze rates on that interval 2 8 Log Window The log window keeps the log of user actions such as sound recording file opening and file saving The log window also supplies the heart and lung sounds automated analysis report To analyze sound interval between the cursors highlight the interval and click on the corresponding analysis button 2 9 Opening Sound Files Sound files can be open by A click File gt Open B Click on the Toolbar C Drag the file into the STG window D When the STG is associated with wav files double clicking on the wav file will load the file into the STG To associate the STG with wave files right click on a wav file gt Open with gt Choose Program gt chose the STG 2 10 Saving Data The Save button saves the data to the default directory which is C STG Pocket PC My Docu ments You can change the default directory by changing Save Files in the Directory field on the Re cording Options Dialog PC only All sounds are saved into the folder named FirstName_LastName you specify the patient s first name and
14. s gt Stetho scopes Inspect cable Contact Stethographics support Turn on per manufacturer s instructions Replace stethoscope battery per manufacturer s instructions Enable microphone input and increase re cording volume using Windows Control Panel gt Sounds and Audio Check the PC microphone port by attempt ing to record with an external computer microphone If no signal can be detected with an external computer microphone contact your PC or sound card manufac turer Sound recorded with electronic stethoscope is very weak Low recording level Adjust recording level 4 Support If you have any questions or require any technical assistance please visit our frequently asked questions section at www stethographics com main faq html or e mail us at support stethographics com 910 0035 R8 14
15. ter 2 17 File Management On Pocket PC Pocket PC users can save recordings by transferring the files to a PC Recordings can be trans ferred automatically using Microsoft ActiveSync or manually by using the file manager to select and move files We recommend weekly use of the iPAQ Backup software to save a full copy of the STG and your data Be sure to save the backup file on an SD card or to the iPAQ File Store To delete files use the Pocket PC File Explorer tap and hold on the file to be deleted then select Delete from the menu 910 0035 R8 13 STG User Manual 3 Troubleshooting Guide Symptom Possible Cause Suggested Solution STG Computer program will not load Problem with program Problem with computer Contact Stethographics support Artifacts on re cording Patient is moving Room noise Finger noise Hair noise Ask patient to remain silent and relax Record in a quiet room Hold chest piece firmly Moisten hair No sound input even when the tapping the dia phragm Cable from stethoscope to PC is not plugged in Cable is connected to the device incor rectly Cable is faulty Electronic stethoscope is not turned on does not apply to the STG Stethoscope Electronic stethoscope does not provide sound output Microphone input is disabled or re cording level is very low Microphone port is defective Plug in the cable Check wiring diagram at www stethographics com gt Product
16. the red region of the recording level meter located in the bottom of the screen Sounds recorded at a very low level are very weak Sounds recorded at inappropriately high level are clipped When recording from the electronic stethoscope or microphone you can adjust the recording level using recording controls of your sound card To adjust the recording level follow the steps described in How to Adjust Recording Level 2 14 STG Software Registration To comply with medical device regulations we must register this software To register the STG soft ware log on to www stethographics com registration You will need to supply the Proof Of Purchase number which was be provided to you with the purchased software and the DeviceID from the Regis tration Dialog After completing the registration form Stethographics will provide you with an Unlock Code Type in the Unlock Code on the Registration Dialog and click the Unlock button 2 15 How To Compare Two Sound Recordings 1 Open the STG in two windows PC only 2 Open the 1st recording in one window and the 2nd recording in another window 910 0035 R8 12 STG User Manual 3 Zoom into the sound to compare characteristic features 4 Switch between the windows to compare the recordings 2 16 What Pocket PC Buttons Can Be Used With STG Software The navigation button on a Pocket PC can be used to start recording left stop recording and playback right scroll up down and enter cen
17. ual should be read thoroughly understood and accessible to all personnel who will be operating and using the STG Sounds are to be recorded using an approved electronic stethoscope See Stethographics website for current list of such electronic stethoscopes Use of system for recording is not recommended in conditions where a stethoscope would not be used The STG is intended for automated identification of lung sounds It provides objective evidence that can aid in clinical decision making Some care of course is necessary in proper recording under the supervision of a physician to be sure that artifacts are not introduced Use the STG in a quiet room avoid talking avoid finger noise avoid clothing and skin noise Some extraneous noise can be identified by the STG as crackles and wheezes Heart and lung sounds are low frequency sounds Playback sound quality can be improved by us ing headphones or amplified speakers with a good frequency response down to 20 Hz Heart sound analysis is for educational use only Half speed playback is for reference only and should not be the only basis of diagnosis It is strongly recommended that the users of the STG software use computing and networking security features to protect patient data created and stored using this software Please consult your institution s data management or computer technical service personnel to implement appro priate security measures The
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