Ecleris VNG Plus User Manual

VNG Plus

Videonystagmography System

USER´S MANUAL

V.18.11.18ENGLISH

For more information, accessories, and replacement parts, contact.

ECLERIS S.R.L

.
FRANCISCO N. LAPRIDA 4955.VILLA MARTELLI
(B1603ABK) BUENOS AIRES. ARGENTINA
Tel/Fax: [phone]
Web: www.ecleris.com
E-Mail: [e-mail]

INDEX

INDEX ............................................................................................. 1

SECURITY WARNINGS ...................................................................... 5

SIMBOLS ......................................................................................... 8

GENERAL INFORMATION ................................................................. 9

INTENDED USES .................................................................................... 9

INTENDED USER .................................................................................... 9

OPERATING PRINCIPE ........................................................................... 9

PATIENT CONSIDERATIONS ................................................................. 10

DESCRIPTION ................................................................................ 12

FRONT PANEL ..................................................................................... 12

REAR PANEL ....................................................................................... 13

JUNTION BOX ..................................................................................... 13

GOGGLES ............................................................................................ 14

INSTRUCTIONS FOR USE ................................................................ 15

RUNNING THE PROGRAM ................................................................... 15

HELP ................................................................................................... 16

NEW PATIENT ..................................................................................... 16

NEW SESSION ..................................................................................... 17

CUSTOM PROTOCOL ........................................................................... 19

DIZZINESS HANDICAP INVENTORY ....................................................... 20

ASSISTANT VNG PLUS ......................................................................... 22

POSITION ............................................................................................................ 22

GOGGLES ............................................................................................................ 23

EYE SELECTION ................................................................................... 24

2

CALIBRATION ..................................................................................... 25

STANDARD .......................................................................................................... 25

HEAD CALIBRATION ............................................................................................ 26

Active calibration: AHR ....................................................................................... 27

Passive Calibration: VHIT .................................................................................... 27

DATA ADQUISITIONS .......................................................................... 29

Registers ............................................................................................................. 29

Warnings ............................................................................................................. 30

Demonstration .................................................................................................... 31

Performing the test ............................................................................................ 32

Using the Footswitch .......................................................................................... 32

Spontaneous Nystagmus .................................................................................... 32

Gaze .................................................................................................................... 33

Saccades ............................................................................................................. 33

Smooth Pursuit ................................................................................................... 33

Optokinetic (OKN)............................................................................................... 33

Active head rotation (AHR) ................................................................................. 33

Video head impulse test (vHIT) .......................................................................... 34

Supine ................................................................................................................. 34

Dix Hallpike ......................................................................................................... 35

Calorics ............................................................................................................... 35

ANALYSIS GENERAL ............................................................................ 37

Spontaneous Nystagmus .................................................................................... 39

Gaze .................................................................................................................... 39

Saccades ............................................................................................................. 39

Smooth pursuit ................................................................................................... 40

Optokinetic (OKN)............................................................................................... 40

Active head rotation (AHR) ................................................................................. 40

Video head impulse test (VHIT) .......................................................................... 41

Passive calibration of the head (VHIT) ................................................................ 41

Supine ................................................................................................................. 42

Dix Hallpike ......................................................................................................... 42

Calorics ............................................................................................................... 42

REPORT .............................................................................................. 44

EDIT ANALYSIS .................................................................................... 45

Nystagmus beat .................................................................................................. 45

Cefalic impulse count (VHIT) .............................................................................. 47

3

EXPORT TESTS .................................................................................... 48

SOFTWARE SETUP ............................................................................... 52

LISTS .................................................................................................................... 53

MANAGEMENT DATA BASE ................................................................................ 53

PROTOCOL .......................................................................................................... 54

DEMOS ................................................................................................................ 57

ADVANCED .......................................................................................................... 57

Warnings ............................................................................................................. 58

Visual stimulator ................................................................................................. 58

Print Report ........................................................................................................ 60

Grafical scale ....................................................................................................... 61

Acquisitions ........................................................................................................ 62

Analysis ............................................................................................................... 63

Pupils .................................................................................................................. 64

Reprocess ........................................................................................................... 65

Hardware ............................................................................................................ 65

TECHNICAL SUPPORT .......................................................................... 66

TECHNICAL SUPPORT TYPE ................................................................................. 66

REMOTE CONNECTION ....................................................................................... 67

TECHNICAL SUPPORT OFF LINE .......................................................................... 67

INSTALLATION ............................................................................... 68

SYSTEM REQUIREMENTS ..................................................................... 68

SOFTWARE INSTALATION .................................................................... 68

AUTOMATIC DRIVERS INSTALLATION ................................................................. 71

CHECKING DRIVERS INSTALLATION (WINDOWS 7) ............................................ 72

HARDWARE INSTALLATION ................................................................. 73

ASSEMBLY OF THE RECEIVER BAR

........................................................................... 73

CONECTIONS ....................................................................................................... 74

WORKSTATION LAYOUT ...................................................................... 76

LAYOUT ............................................................................................................... 76

CARE AND MANTEINANCE ............................................................. 77

CLEANING ........................................................................................... 77

CONSOLE............................................................................................................. 77

RECEIVER BAR ..................................................................................................... 77

4

GOGGLES ............................................................................................................ 77

CHANGE THE CUSHION OF GOGGLES ................................................... 78

FUSES CHANGE ................................................................................... 78

DISPOSE ............................................................................................. 78

MAINTENANCE AND REPAIRS .............................................................. 79

REPAYMENT AND TRANSPORTATION .................................................. 79

TROUBLESHOTINGS ....................................................................... 80

TECHNICALSPECIFICATIONS ........................................................... 82

APENDIX ....................................................................................... 84

ABNORMALITY THRESHOLD ................................................................ 84

Freyss Diagram ................................................................................... 87

DizzinessHandicapInventory ............................................................... 89

ELECTROMAGNECTIC COMPATIBILITY ................................................. 92

5

SECURITY WARNINGS

Before using VNG plus with a patient, familiarize yourself with this user manual,
especially with regard to the safety considerations indicated. This manual is only a
reference; its purpose is not to replace its protocol for the safe use of
videonystagmography

This manual uses the following conventions:

WARNING: Alerts the user of the possibility of injury or other serious adverse
reactions associated with the use or misuse of the device

CAUTION: Alerta al usuario de la posibilidad de un problema conel dispositivo
relacionado con su uso o mal uso, como unfuncionamiento incorrecto, un fallo o
daños en el dispositivoo daños a otros bienes.

NOTE: Emphasize information of special importance.

WARNINGS

• To avoid the risk of electric shock, it must be connected to an AC power
supply with protective grounding.

• To reduce the risk of fire, use the equipment in well-ventilated areas and / or
in the presence of potentially explosive or flammable materials as
environments rich in oxygen or the presence of flammable anesthetic gases.

• The equipment may cause radio interference or may affect the operation of
nearby equipment. It may be necessary to reorient or relocate it.

• Connect it to a power supply network with the specified voltage (100-230V,
50-60 Hz)

• All non-medical equipment that connects to the VNG Plus, must comply with
electrical safety standards according to IEC or ISO of application to said
device. Also, all configurations must comply with the requirements for
medical electrical systems (See IEC 60601-1 Ed. 3.1) When connecting
other equipment to medical electrical equipment, a medical system is being
configured and, consequently, is responsible for ensuring that the system
meet the requirements for medical electrical systems. Keep in mind that local
laws may take precedence over the aforementioned requirements.

• Do not install the equipment near heat sources, such as stoves.

• Install the equipment on firm and horizontal surfaces.

• To reduce the risk of the device heating up, do not obstruct the ventilation

grilles so that there is good air circulation.

• Do not use cables, adapters or extenders that have not been approved by
Ecleris.

• To reduce the risk of electric shock, regularly inspect the AC power cord and
check that it has not frayed or split.

6

• To reduce the risk of strangulation, dispose of the cables so that they do not
get tangled

• To avoid possible injury to the patient due to the use of the device, I
evaluated if the patient is apt to perform nystagmographic tests (See:
Consideration of the patient)

• Only doctors of otolaryngologists, neurologists, balance disorders specialists
or properly trained doctors are authorized to operate the system.

• Turn off the switch before connecting / disconnecting accessories.

• Always position the device so that you can see the PC screen properly and

reach it comfortably,

• The mask contains sensitive electronic and optical devices. Do not subject it
to mechanical shocks

• Turn off the equipment and disconnect it from the AC mains before cleaning
or repairing it.

• Equipment modification is not allowed and may affect performance and
performance. Maintenance must be carried out by qualified technical service
personnel.

• To avoid the risk of communication failures, connect the equipment to USB
ports onboard.

CAUTIÓN:

• Do not attempt to sterilize the mask or any other part of the equipment in an
autoclave or other way.

• To avoid possible damage to the equipment, use only the cleaning and
disinfection products and procedures indicated in this manual.

• To avoid damage, do not drip or spray liquids directly on any part of the
equipment.

• The VNGPLUS has been designed to work in certain environmental
conditions. Respect the following conditions:

Operation Transport

Temperature 10°C-40°C -30°C-50°C

Relative Humidity 30-75% 10-95%

Pressure Atmospheric 700-1060 hPa 500-1060 hPa

• Always transfer it in its original packaging

NOTE:

• The images shown in this manual may not exactly match that of your
VNGPLUS

7

• If you notice changes in performance or performance, stop using it and
contact ECLERIS technical support.

SIMBOLS

Recognize the following symbols indicate information or security to prevent damage

or personal injury

(Blue) See attached
documents

Alt

ernant current

Manufacturer
identification

Fuse

Manufactured date

On

Serial number

OFF

Order number

Prote

ct against water

Equipotential

Up side

RF interferencecan occur
in the vicinity of
equipment that has this
symbol

Fragile

The product must be
eliminated according to
the directives RAEEs
(waste electrical and
electronic equipment)

Temperature limit for

transport and storage

Attention!

Atmospheric Pressure

limit

for transport and

storage

Part type BF

Relative Humidity

for transport and

storage

8

limit

9

GENERAL INFORMATION

INTENDED USES

VNG Plus is a Videonistagmógrafo whose intended use is register, reproduce and
analyze the involuntary eyes movements (Nystagmus).

The eyes movements (Nystagmus) are recorder through the cameras mounted on the
mask. These images are processed, and stored, for later review.

This information is used by a trained professional to diagnose pathologies of the
central and peripheral vestibular system such as otorrinolaryngologists, neurologists,
balance disorders specialist or properly trained medical personnel.

The VNG plus has a basic unit for peripheral vestibular exploration, and accessories
that constitute an expanded system that allows to evaluate the VOR and the central
vestibular system through oculomotor stimulation.

INTENDED USER

VNG Plus has been designed to be used by health professionals with experience in
the technique.

OPERATING PRINCIPE

The VNG goggles hold the cameras that are used to record the eye images. The
cameras use infrared light (IR), which is not visible to the naked eye. The IR
illumination enables sessions to be performed in complete darkness. The mirrors
simultaneously direct IR illumination toward the pupil and reflects an image of the
eye back to the video camera. The mirror reflects short wave infrared (~700-800 nm)
and passes visible wavelengths.

The VNG goggles can function in both free field of view and light occluding mode.
The front cover plate of the mask is magnetically fixed and can easily be removed.

Patient-stimulus relative position and head angles record and
tracking

VNG Plus has two different kinds of sensors to monitor test
conditions:

 Ultrasound sensor to get 3D static patient position relative to visual

stimulator: It is consisting on ultrasound receptor positioned on to visual
stimulator and an ultrasound emitter, located on goggles. System measures
the patient head position relative to the center of visual stimulator.

10

 Accelerometers to get tilt of patient head: Three Axis Low-g micro

machined Accelerometer is used as tilt sensor (measuring gravidity vector
projection at each axis and convert it in angles).

These sensors are just intended to help trained doctor to positioning patient in right
place and with right head angles for
each type of test
andkeepingarecordofthese
parameters. Never are intended to
use these sensor’s data into test
analysis just to monitor test
conditions. Depending of test type
hostsoftware indicates to hardware
witch sensor monitor, for example if
an optokinetic test will be performed
patient needs to use visual stimulator, so system active ultrasound sensors to
monitor patient relative position respect stimulator to achieve desired stimulus.

PATIENT CONSIDERATIONS

Vision: Patients must have adequate vision to follow targets for the
oculomotor portion.

Physical status: If the patient has back or neck injuries, consideration should be
given for some positional testing (head hanging) and the Dix-Hallpike maneuver to
avoid further complications.

To screen for vertebrobasilar insufficiency, the clinician may want to assess the
patient prior to head hanging or Dix-Hallpike maneuvers. This may include having
the patient engage in mental tasking (e.g., counting, reciting multiplication tables)
while gradually tilting the head back and then holding. Change in cognitive status or
reports of lightheadedness may be significant. This screening method is especially
important for older patients.

Status of the outer and middle ear: This should be evaluated prior to caloric
assessment. Presence of drainage in the outer ear canal precludes the use of water
irrigation; it may also affect air caloric stimulation because moisture will change the
calibrated temperature, thus limiting interpretation. Pressure equalization tubes or
perforation of the tympanic membrane precludes the use of water calorics. If
unilateral, large perforations limit interpretation of air calorics. Large perforations can
increase stimulation with cool air above calibrated expectation and can exhibit a
cooling effect for warm air because moisture of the middle ear mucosa is evaporated.
Excessive cerumen must be removed prior to any vestibular stimulation. Middle ear
fluid affects stimulation of the vestibular system with air and water.

11

Medications: Many medications can affect test results. With physician approval,
patients should discontinue all medications, unless contraindicated, for 24-72 hours
prior to testing. Any medications taken should be clearly noted on the test results.
Alcohol ingestion can affect VNG test results for 72 hours post-ingestion; results are
unpredictable because alcohol can be an agonist or antagonist.

Patient preparation: Inform patients that VNG may cause dizziness, nausea, or
both. Patients should be advised to limit food intake prior to examination and arrange
for transportation after the examination, which usually takes 1-1.5 hours.

Request the patient:

 Dress comfortably.
 DO NOT wear contact lenses to the exam
 DO NOT wear eye make-up

For many parts of the test, mental tasking is necessary to prevent central
suppression of responses. If the examiner does not speak the patient’s language or
the patient is hearing- impaired, an interpreter may be necessary to assist in giving
instructions, explanations, and mental tasking.

12

DESCRIPTION

The VNG Plus includes the following components and elements needed for
installation

 MainUnit
 Goggles (withshutter)
 Powercord
 Pen Drive Installation
 User`s Manual

ACCESORIES (OPTIONAL)

 Sensor (gyroscope, accelerometer and ultrasound transmitter)
 T Bar withreceptorsUltrasound
 Cushionmask
 Wirelessfootswitch

It is recommended to identify and verify its existence prior to equipment installation.

WARNING: Las prestaciones del equipo pueden variar de acuerdo a los accesorios

FRONT PANEL

1. Dataconnector

2. ON/OFF

1

2

13

REAR PANEL

1. Power supply cable connection / Fuse holder

2. Ultrasoundsensors(Bar)

3. VGA (Monitor screen)

4. USB Cable

5. Equipotential terminal

JUNTION BOX

1. Right Camera

2. Left Camera

3. Sensor (position, movements)

4. Data wire

1

2 3 4 5

14

GOGGLES

A. Sensor (position /movements)
B. Right Camera
B. Left Camera

15

INSTRUCTIONS FOR USE

In this section the process of implementation and use of equipment detailed.

Only physicians, otolaryngologists, neurologists, balance disorder specialist
physicians trained or are authorized to operate the system

Once the hardware and software have been installed, you can begin using your VNG
Plus.

NOTE: VNG Plus performance may vary depending on version and model
hardwareinstalled

RUNNING THE PROGRAM

Run the program from the icon on your desktop PC, or from the Start / All Programs /
VNG Plus.

The VNG Plus user interface is available in English and Spanish. Language
selections by pressing the icon

16

ENGLISH SPAIN

HELP

Activate audio help

Activate video help (Demonstrations)

NEW PATIENT

To Create Patient File: enter First name (required), last name (required) and #chart,
date of birth (DOB), gender:

To enter demographic data (phone, address, etc.) and Anamnesis press the
OTHERS button (optional).

17

NEW SESSION

The tests performed on a patient are stored in a single session. You can perform
different sessions for the same patient.VNG plus allows you to define the test
protocol, configuring each test as its own characteristics. (See: Configure/Protocols).

The protocol set upped is a user interface that presents a sequence that leads the
user through a series of well-defined step, it allowing you to interrupt or skip tests or
scheduled processes.

To create a session you must complete the following field:

1. Session: Identify the session with a name. If you want create it an automatic

ID press button.

2. Complete the data Clinic, Doctor, Technical (optional)

3. Select a protocol from the drop down menu (See: Create Protocol)

The button opens the database to set the dropdown menu associated with each
parameter

NOTE: Default protocols are set by the hardware installed

START TESTS
Upon completion of patient data and the session can begin the study from the Start

Session button. VNG Plus will instruct and help step by step in a simple and safe way
to perform scheduled tests

OPENING AN EXISTING FILE

Press Load button and select the patient on the list and open the File.

OPENING AN EXISTING SESSION
For the patient press Load session button and select the session on the list

and open the File

OTHER FUNCTIONS

Report: See the print report

18

Session Resume: Open a test table to Access the test recorded

Importtest

Export test (See: Export test)

TOOLBAR:

 Shut down: Close VNG Plus.
 Setup: Setup hardware and software.
 Support: User-friendly assistance for individuals having technical problems

with VNG Plus. The technicalsupportteam, is able to troubleshoot most
problems that a user experiences. Technical support may be provided,
through email, or with remote interface (See: Technical support).

 Start session: Startsthe selected test protocol

19

CUSTOM PROTOCOL

Shows sequence of the test to follow. The list includes patientpreparation, calibration
and test. All will be included in the protocol you selected. (See: Software Setup
Protocol).You can deactivate some items uncheck them. These changes will not be
saved

See the test description by clicking View Detail test description. A label is displayed
that shows the parameters that define the test (Frequency, direction, Time, etc.)

Toolbar bottom:

 Home: Return to Home window.
 Back: Return to previous window.
 Go to: Select another Window.
 Next: Forward to next window

20

DIZZINESS HANDICAP INVENTORY

The dizziness handicap inventory (DHI) is an optional 25-item questionnaire, which
was designed to measure the self-perceived disability or handicap caused by
symptoms of dizziness or imbalance. The individual questions are designed to
address the impact of the symptoms on the physical, emotional, and functional
aspects of daily activities, and there are three possible answers, "Yes," "sometimes,"
and "no," to each question. The maximum total score (indicating maximum handicap)
is 100. There are seven questions that comprise the physical subscale (maximum
score of 28) and nine questions each on the functional and emotional subscale
(maximum scores of 36). For ease of comparison the subscale scores are converted
to percentage scores. (SeeappendixDizzinessHandicapInventory)

Press the answer button or press the keys Y (yes), S (Sometime) or N (No).

You can answer the questionnaire in automatic mode, which happens
after answering the question or you can do it manually with the next / previous arrows

For easy of comparison the subscale (emotional, functional, physical) scores are
converted to percentage scores

Toolbar bottom

 Home: Return to the main window.
 Back: Return to previous window.

21

 Go to: Select another Window.



Next: Forward to next window

22

ASSISTANT VNG PLUS

POSITION

Since the patients distance to the screen is a key part of the geometry to produce the
visual stimulation in degrees (+/- 20º 30º), it should only be changed on purpose. But
do not worries about to return the chair to its original position in case it have
been moved, VNG Plus is controlling it all the time (See: Alarms).

VNG Plus supports screen (monitor) of different geometries, which must be
configured from theConfigure / Advanced / Stimulator

Toolbarbottom:

 Home: Return to Home window
 Back: Return to previous window
 Go to: Select another Window
 Next: Forward to next window

23

GOGGLES

The Video Goggles shall be put in such a way that it fits the patient’s face the best
possible. Both elastic strips shall be firmly fixed to the patient’s head.

The correct placement of the goggles is of vital importance to perform the
tests

Nystagmus assessment depends on the quality of the images. Center the image of
the eye in the respective box. If necessary use the fine adjustment of the cameras
and/or move the mirrors from the top screws to align the image so that the pupil is
perfectly centered. The right frame displays the left eye and the left frame displays
the right eyes.

Place the junction box on the arm of the patient as a bracelet, so
comfortable and avoid getting wires tangle and twist.

Toolbar bottom:

 Home: Return to Home window
 Back: Return to previous window
 Go to: Select another Window
 Next: Forward to next window

24

EYE SELECTION

It especially relevant for the settings in the Test, to define which eye's record to
analyzing. VNG Plus analyzes only one eye record at a time. The selected eye to
analyze default is Left but this may changeat any time.

NOTE: If after carrying out the analysis of a session, you change the eye to
analyze. Youwill lose thepreviousanalysis

Toolbarbottom:

 Home: Return Home Windows
 Back: ReturnpreviousWindows
 Go to: Select another Window
 Next: Forward Windows

CALIBRATION

STANDARD

This is not a true calibration to determi

ne the amplitude of the eye movements in

degrees but more an allowance for a correction factor due to the individual anatomical

differences of the orbit of the eye.

These corrections are especially important in the evidence that eye movements are

compared to a target stimulus from a known position (speed). In

other

is not essential. However, if the mask has been repositioned or removed since the

initial calibration was carried out the procedure must be repeated.
Calibration is recommended for the following tests:

• Gaze

• Saccades

• OKN

• Smooth pursuit

• AHR*

• vHIT*

Note: VHIT and AHR require a head movement’s calibration.

To set the calibration (See Configuration/ Protocol) o

n protocols setting are determine

what stimulus type you want to use for ca

libration (Center, right, left, down and up)

Request the patient tofixate upon points that are projected onto a monitor in a pre

defined pattern for about 5 second while the calibration proceeds. When it iscomplete

the next screen opens automatically.

25

test calibration

-

26

Checkpoint is it a quickly to the calibration state verification. It is only used after the
calibration process. This should only be used after it has been calibrated at least
once. The patient should look at the red light (Led) that lights inside the goggles.
Verification checks if the mask has been moved, in which case it is necessary to re­calibrate again.

In addition to the position and head movements assistance, in this
window a frame is shown whose color (green: Good, yellow: regular, red:
insufficient) indicates the state of detection of pupil according to the

count, lighting.

If the state is red, it is recommended to reduce the ambient lighting and / or to use
the mask cover if possible. Iftheconditionpersists, contacttechnicalservice.

Toolbarbottom

 Home: Return to main window
 Back: Return to previous window
 Go to: SelectanotherWindow
 Next: Forward to next window

HEAD CALIBRATION

Toolbarbottom

 Home: Return to main window
 Back: Return to previous window

27

 Go to: Select another Window
 Next: Forward to next window

Active calibration: AHR

The head movements in this calibration are active, where the patient moves his own
head.
The patient is instructed to keep their eyes on the target shown on the screen and to
swing the head gently to the right and left (as if saying with the head "no-no") trying to
follow the rhythm of the metronome
When all warnings are valid the calibration starts automatically for about 20 seconds
(See: Protocol Settings).

When you hear the metronome, you should start moving your head to the right and
left alternately and the screen will show the graph of the position of the eye and head
in time.

Passive Calibration: VHIT

The head movements in this calibration are passive. The examiner should perform
head calibration by standing behind the patient and holding the head in the same way
as during the cephalic impulse test of the lateral channels. When the alarms are valid
the calibration will start automatically. Approximately for 20 seconds (configurable) the
examiner should perform the sinusoidal oscillations in both directions following the

28

metronome, similar way to AHR, while the patient should try to keep the eye on the
objective shown on the screen

During the head calibration, are shown in the diagrams: the head speed and the eyes
position on time

Once the calibration is finished, the information corresponding to the head calibration
will automatically be generated. The data is displayed in a similar way to the VHIT test
itself. (See: Data Acquisition: VHIT)

29

DATA ADQUISITIONS

Registers

Display on real time eyes position (or velocity) graphically, and superimposed to the
target line plotted as comparison criteria.
The eye position [º] (or speed [º/sec]) is plotted against time, whose description is the
following:

• Horizontal position [º] vs. Time [sec.] In a Cartesian x-t graph. [Green]

• Vertical position [º] vs. Time [sec.] On a Cartesian graph y-t. [Blue]

• Position the stimulus pattern. [Red]

30

Warnings

Alarms can be configured with different degrees of stringency (See: Configure /
Advanced / Warnings).

a) Relative subject position to the visual stimulator to achieve desired stimulus.

b) Head angles

c) Head tilt:

WarningsColors

Duringrecording

OK
Out of range

31

Demonstration

For each test is available an audio-visual support with a video showing how to
conduct the test, and instructions for the user or patient. It also offers
recommendations and a list of artifacts that could influence the results. This support
can be configured so that it is always available before a test or access itat the
discretion of the user and need. (See: Setup/Advanced/Demos and
Setup/Advanced/Acquisitions)

Toolbar:

 Back: Returnto back Window

32

Performing the test

On the window there arethetest warnings and also the eyes video display. When
thepatient is ready, press Start buttonto recordsthetest.

By clicking the Register button data recording starts automatically. All Tests have a
configurable time limit, and they will stop automatically. However, you can stop a test
manually at any time pressing Stop button.

Note: If you run the test, this will be overwritten. To repeat the same test, without
losing data you must start a new session.

Using the Footswitch

The foot switch can be very useful when you need your hands free to care for the
patient orto operate other devices; for example, in the Dix-Hallpike caloric irrigator
oroperate.

The pedal can be used only to record and stop capturing atest, donot respond to other
events

The following icon will be displayed when it is pressed.

See: Installing andConfiguring wireless pedal / advanced / Acquisition

Spontaneous Nystagmus

Spontaneous Nystagmus denotes movement of the eyes without a cognitive, visual or
vestibular stimulus. The tests are conducted with vision occluded, and with the eyes
on primary position. Vestibular Nystagmusistypically inhibited by visual fixation (see
Setup: Spontaneous)

Warnings:

• Patient position

• Head Movements

• Head angles

33

Gaze

For gaze testing, the patient is instructed to look straight ahead and then to fixate on
a target to the right, left, up, and down.

Warnings:

• Patient position

• Head Movements

• Head angles

Saccades

For saccadic testing, one may place dots on the Monitor at specified distances from
each other and then instruct the patient to look back and forth between the dots,
keeping the head fixed.

Warnings:

• Patient position

• Head Movements

• Head angles

Smooth Pursuit

The patient follows a sinusoidal moving target with his or her yes only. Warnings:

• Patient position

• Head Movements

• Head angles

Optokinetic (OKN)

For Optokinetic testing, the patient tracks multiple stimuli. Stimuli are moved at a
rate programmed in each direction. (Clockwise and counterclockwise)

Warnings:

• Patient position

• Head Movements

• Head angles

Active head rotation (AHR)

This test records the movements of the eyes and head. This requires the stereo
loudspeaker. The patient must move the head to the right or left when hears a click in
the respective ear

Warnings

34

• Patient position

Video head impulse test (vHIT)

This test records the movements of the eyes and head. The clinician’s hands must be
well away from the goggles and the goggle-strap to minimize the chance of any
artifact camera movement. The patient should keep staring at target point on the
screen , and the clinician gives the patient brief, abrupt, horizontal head rotations
through a small angle (about 10-20 degrees) unpredictably turning to the left or right
on each trial.

In a full test usually around 20 impulses are delivered randomly in each direction. In a
full test

Usually around 20 impulses are delivered randomly in each direction and it may take
4 or 5 minutes to do that.

This test plots the eyes velocity and head velocity.
Warnings

• Patient position

Supine

The examiner places the patient in each position and evaluates for a minimum of 20­30 seconds. Mental tasking is used to keep the patient from suppressing Nystagmus.
Visual suppression must also be avoided by the use of infrared goggles.
Somestandard positions usedincludethefollowing:

Supine Head 20-30º

1. Supine, head right 60º

2. Supine, head left 60º

3. Supine Head 20-30º (Primary position)

Warnings

• Patient position

35

Dix Hallpike

Dix-Hallpike is performed over a stretcher that allows lying down and sitting the
patient quickly. The Dix-Hallpike maneuver is performed by turning a patient’s head to
the right or left and then briskly assisting him or her to a supine position with the head
hanging to the right or left. The patient is left in this position for a brief period while
eye movements are observed.

Finally, the patient is returned to a sitting position.The testing is conducted whit
fixation suppression (goggles covered).

This test records the patient position and plots the eyes movements

Calorics

The patient is placed in a reclining position with his or her head at a 30° angle. This
position orients the lateral semicircular canals in the most vertical plane.

Careful otoscopic examination allows the stimulus to be directed appropriately
and at an equivalent depth in each ear canal.

Protocol for caloric stimulation, alternating binaural bithermal caloric stimulation
includes the following conditions:

• Leftearwarm (LW)

• Righteararm (RW)

• Leftearcool (LC)

• Rightearcool (RC)

During each stimulation, the cool or warm stimulus is delivered for a preset time that
is determined by the type of stimulus and normative data. The countdown timershows
the warm or cold stimulation time and recovery times.The testing is conducted whit
fixation suppression (goggles occludes)
Important: It should explore the ears (outer and middle) before proceeding with the
caloric test
(See Patient Considerations: Status of the outer and middle ear)

36

FIXATION SUPPRESSION

After each caloric stimulus, the patient is instructed to fixate on a light Red (inside the
goggles). Fixation should normally eliminate or greatly reduce the induced
Nystagmus.

Warnings:

• Head Movements

• Head position = 30º

37

ANALYSIS GENERAL

The test will be opened and test data will be displayed in the analysis window. The
analysis can be recorded immediately after the test or after performing the scheduled
Test Battery.

The tests of the same type with multiple sub-tests are shown in one window. The test
name displayed should be selected from the drop down menu.

Records (horizontal / vertical) and the video are captured, along with alarm status.

StatusAnalysis of alarms [%]:

Excellent
Good

Poor

Playback Record

Pressing the Play button you can review the video, and alarm registers
simultaneously

38

Use the following tools for:

 Increase or decrease the scale of plot.

Zoom out/Zoom in amplitude Scale

Zoom out/ Zoom in Time scale

 Create print windows: cropping a records area to print. (See: Createprintwindow)

 Edit Nystagmus manually. When reviewing an editable test, you can click on

edit Icon to open the Edit mode and display the Edit toolbar. The Edit icon
appears example from Caloric test (See Edit Nystagmus)

 Graphical analysis: Graphs that display the measuring process over time.

Those graphs that show analyzed data (e.g., Peak velocity, latency and
Accuracy in the saccades test). The abnormal threshold is the dotted gray area
(See: APENDIX Abnormality threshold)

39

The software displays all test information in a single display screen. This allows the
user to simultaneously view the data collection along the analysis displays. In each
measurement diagram, you can maximize and minimize the display of the measured
data by using the zoom option

Toolbarbottom:

 Back: Returnpreviouswindow
 Play: Replay the test performed (record, warnings and videos)

Spontaneous Nystagmus

Spontaneous Nystagmus: This may indicate either central or peripheral pathology.
The presence of Nystagmus can be evaluated with fixation (center, right, and left,
down and upon) o without fixation.

 NystagmusCount
 SPV (º/sec) is average slow phase velocity

Gaze

These Nystagmus tests document and measure the inability of the eyes to maintain a
static position. Nystagmus and slow phase velocity are evaluated for each position

 NystagmusCount
 SPV (º/sec) is average slow phase velocity

Saccades

Saccadic test results are influenced by patient cooperation and visual acuity.
Velocity, latency, and accuracy should all be taken into consideration when
interpreting saccades.

• Velocity (º/sec) is approximately proportional to saccadic amplitude for sizes
5º and 20º.

• After amplitude reaches 20º, saccadic velocity undergoes a soft saturation
with respect to further increase in amplitude. Velocity= asymptote (1-e
Amplitude/15) the usual upper limit for saccadic velocity is about 750º/sec
and the lower limit is set at 350º/sec

• Latency (mess) is calculated from difference in time between target
displacement and the onset of the first saccade toward the new target
position

• Accuracy (%) keeping in mind that the goal of a saccadic eye movement is to
fixate visually both quickly and accurately on a new object. The eye

40

movement should be equal in amplitude to the distance between the former
object of interest and the new target.

Smooth pursuit

The smooth pursuit system is responsible for following targets within the visual field.
Care should be taken in interpreting smooth pursuit test results in geriatric and
pediatric patients. Tracking is also affected by attention and patient cooperation. Gain,
Phase, and THD should all be taken into consideration when interpreting smooth
pursuit.

• Gain refers to the ratio of the eye velocity (non saccadic) to the target velocity.

• Phase refers to delay between the target and the tracking wave forms

• THD: Total harmonic distortion. It is refer a global measurement to tracking test

in frequency and amplitude. If the peak is around the target frequency, the
tracking was good

Optokinetic (OKN)

For Optokinetic testing, the patient tracks multiple stimuli. Gain and Asymmetry
should all be taken into consideration when interpreting OKN

• Gain refers to the ratio of the eye velocity to the target velocity.

• Asymmetry refers to gain significantly worse in one direction than another

Active head rotation (AHR)

The vestibular autorotation test provides a measure of vestibular function during
active head rotation. As such, it is a test of canal function during natural active
movement, a common situation for patients. This test is performed recording the eyes
and head movement. The gain, phase and THD of the vestibular ocular reflex are
analyzed.

• Gain refers to the ratio of the eye velocity to the head velocity.

• Phase refers to delay between the head and the eyes movement wave forms,

normalized to the period, and multiplied by 360º

• THD: Total harmonic distortion. It is referring a global measurement to tracking
test in frequency and amplitude. Ifthepeakis around the target frequency,
tracking was good

41

Video head impulse test (VHIT)

The video head impulse test is useful in the assessment of vestibular disorders. The
test offers a clinical indicator of a semicircular canal deficit.

• Velocity Leftward/Rightward: head velocity stimuli and eye velocity responses
are

• Superimposed and displayed.

• Gain Leftward/Rightward vs. Peak head velocity (deg/s): refers to the ratio of the

eye velocity to the head velocity.

• Acceleration Leftward/Rightward: The head acceleration and eyes acceleration
during the head shake (leftward/Rightward.)

• Stimulus Leftward/Rightward vs. the Peak Head velocity: refers to the maximum
angular displacement applied during the head shake.

Results:

• Gain Avg.Leftward/Rightward. The average gain of all Leftward/ Rightward
shakes.

• SD Leftward/Rightward. The standard deviations Leftward/ Rightward
shakes.

• Symmetry: refers to gain significantly worse in one direction than another.

• Avg. Gain: The average gain of all shakes.

• Test Compliance: refers to a measure of performance of thetest.

• Discard left/ right: Impulse not included on the analysis

Passive calibration of the head (VHIT)

It is not a test in itself. But the results are shown in graphical form of the passive
calibration of the head

• Speed Left / Right: The head speed stimuli and the responses of the speed of
the eye over time are superimposed.

• Gain Left / Right vs. head speed peak (º / s): Refers to the ratio of the speed of
the eye to the velocity of the head.

Results:

• Gain avg. Left / right: The average gain to the left / to the right.

• Symmetry: refers to the gain significantly worse in one direction than in

another.

• Gain AVG: The average gain of all impulses.

• Discarded left / right. Stimuli those were not included in any of the previous

calculations.

42

Supine

These are VNG test to diagnose BPPV and other vestibular complaints. Parameters
are calculatedfor horizontal channelall positions

• Nystagmus Count

• Latency (sec) is calculated from the difference in time between head

displacement and the onset the first Nystagmus

• SPV (º/sec) is average slow phase velocity

Dix Hallpike

These are very important as part of the standard VNG to diagnose BPPV and other
vestibular complaints. Parameters are calculated for horizontal channel both side
(Dix-Hallpike Right and Dix-Hallpike Left)

• NystagmusCount

• Latency (sec) is calculated from the difference in time between head

displacement and the onset the first Nystagmus

• SPV (º/sec) is average slow phase velocity

Calorics

The caloric tests evaluate the viability of the peripheral end organs by stimulating
them with warm and cool water or air. The resulting dizziness and Nystagmus is taken
as an index of the viability of the organ. The culmination phase area is automatically
defined (the best 30 sec). Nystagmus that lie outside the area, does not contribute to
the analysis.

• Time /SPV: show the slow-phase velocity evolution of the tests performed.
Tobeableto appreciate the test symmetry, it is possible to generate an
interpolating line that automatically fits.

• Fray’s graph:show the frequency (Hz) and slow-phase velocity (º/s) as well as
absolute anddirectional preponderance data, right and left Nystagmus beats,
symmetry, frequency and slow phase velocity for each ear. (See: APENDIX
Freyss Graph)

• Parameters: show the absolute and directional preponderance data, right and
left Nystagmus beats, symmetry, frequency and slow phase velocity for each
ear.

Unilateralweakness=(RE44+RE

30)-(

LE44 +LE30)x100.

(RE44+

RE30+LE44+LE30)

ABSPrep

=(RE44*LE30-RE

30*LE44) (RE44+RE30+LE44+LEI30)

Dir

Preponderances

= (RE44+LE30)-(

LE44 +RE30)x100.

(RE44+RE30+LE44+LE30)

RightBeat=RE44+LE30

LeftBeat=RE30+LE44

43

RightEar=RE44+RE30

LeftEar=LE44+LE30

Where SPV|

after_fix

represents the average slow-phase Nystagmus eye velocity that

occurs for 5 second after the eyes are fixated and SPV|

before_fix

represent the
average slow-phase Nystagmus eyes velocity that occurs for 5 seconds before
eyes are fixated on the light point

.

FI (Fixationindex) =SPV|

afterfix

SPV

|

b

efore_f

ix

44

REPORT

The report manages the printing functions of VNG Plus. Prints different
configurations and analysis of records obtained as well as use a wide variety of
printers.

Records and analysis on each test will be displayed in the preview. At the bottom
show the current page/Totalpages Number. Use arrows to move betweenpages.

You can select a tests to print by pressing Selection Tests and Options Test of the
same trials Pressed Options (See also: Configure/ Advanced/ Print) Pressing
analysis, a form with the tests summary is open, which you can select any Test to
review it again.

Print Mode: With these controls you can select whether sending the report directly to
a printer, or save it to a pdf. File

PDF printer

Choose output printer in the drop down menu. When
printing a document, all the printers installed in Windows are listed you can always
select a different printe

r

45

Logo: Insert a picture (.bmp/jpg) on to the report header

TOOLBAR

 Page: Printcurrent page.
 All: Printallpages.
 Back: quitthereportwindow

EDIT ANALYSIS

Nystagmus beat

TheNystagmus analysis constitutes a major part VNG Plus system.
Thealgorithmaccuracydependsonseveralfactors:

 The image quality of the eye.
 An accurate eye detection procedure (training during the mask setup)
 The patient cooperation (blink, keeping eyes open, wearing no eye makeup,

etc.)

 Thecalibrationprocess.

The software searches for Nystagmus beats on the eye movement trace and
perform automatics detection. The software alsocalculates other important
recording parameters (slow phase velocity, Nystagmus frequency, etc).

46

Even so VNG Plus offers a function, to allows you to overrule (partial or total) the
automatic analysis performed by the software algorithm. With the possibility of
adding or deleting Nystagmus marks you should optimize the results of the
analysis by exerting your professional training and experience.

To enter editing mode, click the edit mode button, the Edit Toolbar will appear. In
this mode, graph displayed the Horizontal Channel alone

.

Automatic Edition

Modify the algorithm´s sensibility, moving the slider control to vary the criteria used to
determine to the Nystagmus existence. Then press re analuzed
button

(See also Setup/ Advanced/ Beat Count)

Manual Edition:

To include a new Nystagmus press the Add button and then

1. Click on the beat slow phase beginning

2. Drag the mouse to the end of slow phase (blue area)

3. Click on the end Nystagmus edited.
It is marked on the plot the slow phase slope added, an arrow indicating the

Nystagmus, and is shown in the graph properties. The slow phase and fast phase
detected, and the criteria used to determine the Nystagmus existence

To delete a Nystagmus, press the Delete button

 Click over to Nystagmus to moveit

Toolbar

 Cancel: Nystagmus edition (or modification) will be disregarded
 Ok: New edition will be saved.

47

Cefalic impulse count (VHIT)

The analysis is done by separating impulses to Rightward and Leftward from the top
pull-down menu.

For each impulse, the response of the eye in speed and acceleration (green) is
plotted next to the cephalic impulse (red) and the relevant parameters of the same as
gain, maximum speed of eye and head, duration, etc.

The averages of the impulse analysis are shown in graphical form and numerical
data.

Automatic editing:

With the automatic discard option enabled. Increase (+) or decrease (-) the sensitivity
by modifying the gain dispersion: | Gi-Gprom |, those impulses whose gain differs
from the average of the specified value will be discarded. Then press the Re-Analyze

button, so that they are evaluated with pulses with the new sensitivity

Manual editing:

Those impulses that due to their characteristics (acceleration, speed) you want to
ignore in the analysis, you can discard them manually.

1. Click on the right or left arrows to observe each impulse. The impulse is numbered
in the counter

2. Activate the discarded option

48

NOTE. The manual edition is reversible

EXPORT TESTS

In the home window you can access the test summary recorded and export
it.

Select the test to be exported by clicking on it, and the check box of the selected test
will be activated

Pressing the Export testbutton opens a dialog to export the selected test in some
external medium (Pendrive, CD, etc.)

Pressing Publish Test, you can publish the test (data, report or videos on the website
Endodigiweb.com in public or private).

ENDODIGIWEB gives you the possibility to upload and share your own cases or
reports. The wizard will help you publish videos, images or reports. Use the Next,
Back or Cancel buttons.

To ensure the ENDODIGIWeb service you need to be connected to the
internet.

49

First you need register Complete all the required fields to create an account.

Select the publication type you want to make

Public: anyone who visits EndodigiWeb.
Private: only people that you invite by email

In both cases PUBLIC or PRIVATE, you must provide a title and a brief summary
(optional)

50

Make sure not to publish patient’s personal and confidential information

Invite your contacts to visit the publication. Adding contacts from your address book

Add: open a dialog to create a contact list to share your publications

51

ENDODIGI CONTACTS

New: Add a new contact email

Import: This enables you to import your address book from mail clients to ENDODIGI.

Now your publication is ready to upload on the website!

If your publication was uploaded successfully, you'll see an “Upload succeeded "
message.

52

Please note if you attaching many files large, it may result in a long upload
times

Visit the Endodigi website at http://www.endodigi.com to view your
publication

SOFTWARE SETUP

The following section describe all of these options and parameters configurable by
user

53

LISTS

Edit the list to be available in patient records: Doctor, Administrators and
Clinics. Hereyou can addorremoveitems

MANAGEMENT DATA BASE

The database shows a list of stored sessions. You can sort in
ascending / descending order by date or alphabetical items: Last
Name, Name or Chart # (Medical Records), pressing the top of each
column.

Use the search tools, pressing the Search button to locate a patient
and / or sessions. Filters allow discrimination by Name, Last name,
NHC and date. When the

Database is large it is recommended to use filters because it substantially reduces the
searching time The searched matches the data will be displayed in the same list.

To delete the selected patient session (highlighted in blue), pressDelete
icon

54

PROTOCOL

Here you can create custom protocols and adapt it to your needs and
experience in clinical practice. VNG Plus includes default protocols that
fit the characteristics of hardware detected.

55

Details:Show the test description: Time, frequency, direction, etc

The protocol Tree is similar to the one in Windows Explorer and can consist of up to
two levels. First Level: Displays screen/Test
Second level: Displays description (paradigm, Velocity frequency, Etc) for performed
tests

To expand / collapse the description use +/­All tests are saved. The test disabled (unchecked) don't be included on the protocol

sequence and should use the GO TO function, to open this window.

Edit: Allow modify protocols add/ Remove/Move test and/or calibration
process; except the protocols predefined. Any edited protocolcan be
saved as a new protocol and keep the original protocol unchanged.
ForthisselecttheSave As option.

Move up

Move down
Delete

56

Enabled/Desabled

New: To create a new protocol (test sequence),

Identify the protocol with a NAME.
Identify the test with an (optional) personal name
Select the test from the available options by type / subtype

 Nystagmus: Spontaneous
 Visual Stimulation: Gaze, OKN, Saccades, Smooth pursuit
 Posture: Dix-Hallpike, Supine
 Caloric: Cool; Warm
 At: AHR, vHIT
 Questionnaire: DHI, DHI military
 Assistances: Position, Angles, Goggles
 Configuration: Eyes selection, Test selection, Calibration( standard), Head

calibration: AHR(active) AND/OR VHIT( passive)

Save the protocol and will be available to select in the patient session

Delete:Deletes the selected protocol list

57

DEMOS

You can see a Test instructions, recommendation and artifact (most
probable mistakes), and video test demonstration for each test (ex: Dix
Hallpike video demonstration is shown on figure). If you want to see it,
before start the test recording, you must activate Test instruction on the
Advanced / Acquisitions tab

ADVANCED

Different variables grouped by their characteristics are presented to
setting up;

Which are describedbelow:

Toolbar

 Back: returnpreviouswindow
 Default: Resetallparameters

58

 Save and Exit: Store all new parameters and coming back to previous

window

Warnings

Select the warning control: Soft /Normal/ Hard
Depending on the selected warnings level will be more or less stringent (demanding)

perform a test

Visual stimulator

VGA:To produce stimulation patterns of correct size, position and angle velocity, the
required information about the geometry of the screen setup in your laboratory. These
values will have to be updated whenever the display screen geometry is changed

59

Fill out the actual lengths in the fields that describe the Monitor dimensional
characteristics

(

See also Technical Requirements and Setup/ Advanced /Acquisition).

60

Print Report

Check / uncheck the items you want to print. You may change these options on
report print settings by sessions

Options for Tests: These items are applied for all selected tests

 Auto adjusts: Prints entire record based on the time recorded
 Graphics: graphicalanalysis
 Analytics Analysis: To print the measure data of a test
 Records: eye positionplot
 Alarms: warning records
 Eachonown page.
 Print Nystagmus mark: on to printout eyes position trace show Nystagmus

mark

 Only printing window: To print one or more specific sections of the records

(See: Create record print windows)

 Print width: Increase / decrease the thickness of the line of the records to be

printed.

 High register: Increase / decrease the height of the records of each test

61

Tests: Select the test to print

 Spontaneous
 Gaze
 Saccades
 Smooth pursuit
 OKN
 Dix-Hallpike
 Supine
 Calorics
 AHR
 VHIT
 DHI: dizziness Handicap inventory score
 Medical release
 CPT: Current Procedural Terminology codes are numbers assigned to every

task and service a medical practitioner may provide to a patient on USA.
They are then used to determine the amount of reimbursement that a
practitioner will receive. They ensure uniformity. The codes are developed,
maintained and copyrighted by the AMA (American Medical Association.)

Grafical scale

Time plot displays the history of eye position data. The time axis is always horizontal
and directed to the right.

Here you can choose the Time window (time axis) to be displayed or printed.

62

The offset- time area relative to the whole area allocated for the chart is defined here
and the scrollbar may be used to change the chart view. Not so in the printing, will
only print the defined time window.

For example: Test recorded: 60 sec Time plot: 25 sec.
Part of the record does not appear at the viewing, so you must use the scroll bar to

scroll the entire layout. While printing, are printed only the first 25 sec of recording or
window marked to printing (See: Print the Bookmarks)

If set to auto scale the layout adapts to the recorded times

Check time-plot scales when comparing different records

Acquisitions

Tests may be performed in any sequence defined by the user. Mark the Next step
Acquisition desired by test.

When stop recording of the test data,

Stop: the test window

Next: the test next window will be open automatically.
Result: the test analysis window will be open automatically

63

Alert Message: Disable warning’s control messages
Test Instruction: Before start the test, is opening a windows, to show how to

administer the test. There are also recommendations and descriptions of the most
common mistakes to affect the recording and a video demo too (See Demo)

Audio Instructions: Enables the user-mode audio reading
Wireless Footswitch: Turn on the wireless pedal. (See installing the wireless

footswitch)
On VGA: This activate the stimuli-screen when connects a VGA monitor. Overwrite

Camera: Lets you use the system with a single camera (Right / Left) WMI Hardware:
Hardware setup for the technical support only.

Force connect: Communication Protocol
Mask A: select mask type A (hardware)

Mask Nselect mask type N (hardware)
Time out M: Timeout on connection
Wait Filter: Filter video
Render: Enables support for rendering of video depending on the version of Windows

® (XP, 7,

8)

(VRM 0 Video Render/ VRM 9 Video Render/ Window 8 video render:

Analysis

It offers the possibility to adjust the sensitivity of the detection algorithm for each
particular test. (See also Edition of nystagmus)

64

Pupils

The user rarely has to access this configuration tab. This requires technical
information that is specific to its installation. Request technical support before
modifying any parameter, since it could affect the operation of the VNG Plus

65

Reprocess

It allows modifying the eye detection area in tests already registered to improve the
analysis. The modifications are over the video itself and it does not affect the general
mask parameters. You can modify the area from the default configuration drop-down
menu or by reducing / enlarging the central area.

Hardware

Exclusively to use technical support

66

TECHNICAL SUPPORT

To request technical assistance, click on Support button in home window. Remote
Support, access the following screen.

Include your inquiry or problem description in the field below. If this is a support
request, please include a full description of the problem, including the error message.

TECHNICAL SUPPORT TYPE

• Email Support: the field required must be completed and is send the query.
The technical support will receive an email with that data, after that it will
answer through the configured email address.

• Remote Support: This mode allow that technical support establish a remote
connection to try solving the problem.

67

It’s possible that technical support is not available at the moment of realize the query.
If so, you be informed how time the service will be available,to decide wait.See:
Technical support is not available.

REMOTE CONNECTION

After that technical support receive the application to Remote Access and until in fact
is established or canceled the connection you will see the following screen.

If is pressed the Cancel button, technical support will not able to establish the remote
connection.

TECHNICAL SUPPORT OFF LINE

When the technical support request is not available to attend a Remote
Connection, is shown the following message.

68

It is seen that Technical support will establish the connection after 4 hour from the
answer date. If it is desired wait, only you must close the message and wait the
attention. If you do not want to wait, after close the message it is possible cancel the
technical support application.

INSTALLATION

CAUTION: The software must be correctly installed before to install the hardware.
Check hardware requirements

SYSTEM REQUIREMENTS

• Hardware:

Processor Intel I5 2GHz
Memory 6GB RAM
Video card with 512MB of memory
Hard Disk 500GB of free space
USB Port 2.0 ONBOARD port (DO NOT USE WIRED PORT!)

• Software
 SO

Windows® 7/8 (32 & 64 bit)

 SDKs

DirectX
Windows Media distribution version
Windows Media encoder distribution version
Microsoft Framework 3.5

SOFTWARE INSTALATION

With the device disconnected plug in ECLERIS installation Pen drive in a free USB
port.

If it does not executes automatically after a few seconds. You must be run installation
manually, executing USB Drive\Setup.exe

By default, the installation folder is c:\Program Files\Ecleris\VNG Plus
Select the installation language and press

69

Next to start installation process.

It is recommended to follow the options that appear by default, by pressing Next
button in each of the screens, unless indicated otherwise.

Once the files are copied, the installation program will automatically begin drivers’
installation. Remember that theVNG Plus must remain disconnected from the PC

70

You might be asked to restart your PC, you must choose in all cases “No,
Restart later", until installation is finished completely.

Press Install to continue

If consulted, keep the defaults and click Next.

If at this point is consulted on restarting the
computer answer: No, Restart later.

The software and drivers installation has finished.

It is recommended, before loading the drivers, to carefully read the hardware

installation section

If you experience problems during installation of theVideo drivers See:

Troubleshooting section

AUTOMATIC DRIVERS INSTALLATION

When the software and hardware (See hardware installation) are perfectly installed,

two drivers must be automatically loaded:

 USB Video Device Driver
 USB Data Driver

You must have administrator privileges or pa

ssword to elevate privileges,

every time Windows request you, in order to correctly install the device.

When connecting the VNG Plus to the USB port automatically begin the drivers

loading.

At the end, on the Windows® taskbar, you will see a legend confi

correct installation of the device el VNG Plus.

71

rming the

72

In some cases the operating system tries to loading first driver emulation (CDC RS­232 Emulation Demo) and could appear an error message. Ignore it, and then
check the correct driver installation. See: Checking correct installation of the
drivers in Windows7

CHECKING DRIVERS INSTALLATION (WINDOWS 7)

You can check the correct driver installation from the Device Manager. It´s accessed
over: Start/Control Panel/ System and Maintenance/ Device Manager.

1. USB 2862 Device means the VNG Plus Video device was installed.

2. Communications Port means the VNG Plus Data device was installed.

73

HARDWARE INSTALLATION

Unpack the device very carefully and place it on a flat and firm surface, before
proceeding to connect the accessories

The software must be correctly installed before to install the hardware

ASSEMBLY OF THE RECEIVER BAR

WARNINGS:

Make sure you have a Phillips screwdriver for the screws before mounting.
Confirm that the VESA mount of the monitor is suitable for installation (75mmx75mm

or 100mm x100mm)

Prepare at least four 8 mm diameter screws (not supplied).
Be sure to use the screws and fasteners provided following the instructions described

below correctly.
Do not attempt to install the "T" bar mounting bracket if the monitor is mounted to the

wall using a VESA wall mount.
Be sure to tighten the screws, nuts in the corresponding position otherwise the bar

and / or the monitor could be damaged.
The bar of ultrasound receivers should be placed on the monitor where the visual

stimuli are generated (See Requirements of the visual stimulus monitor)
If you have any doubt, it is better to have a professional to assemble the bar (a

distributor or an authorized technician).

Procedure:

1) Fix part A to part B with 2 screws (M8), place washer and nut and adjust
them smoothly (Figure 1)

2) Fix the bar on the part B by means of 2 screws (M8) place the washer and
nut adjust them smoothly (Figure 1)

3) Present the entire system on the monitor and fit piece A to the monitor with 4
screws (not provided) (Figure 2)

4) If necessary, move the piece B upwards / downwards or move the bar
backwards / forwards until it is on the edge of the monitor screen.

5) When the bar is properly placed. Tighten all screws well (Figure 3)

74

Figure 1: Assembling Parts. Figure2: Mount over monitor

(a)(b) (c)

Figure 3: Correct installation. (b)

CONECTIONS

1. Put the position sensor into the center of the mask by pressing.

2. Connect the cameras (Right (1) / Left (2)) to the junction box.

3. Connect the position sensor to the central connector (3) of the junction box.

4. Connect the junction box to the data input in the console (Data source)

B

5.

Connect the ultrasound bar to the connector on the rear pan

6.

Connect the visual stimulus monitor to the VGA on the back panel of the

console.

7. Connect the monitor to the power network

8.

Connect the console to a free USB port of the desktop or laptop PC

Do not use the front ports of desktop PCs, as th

ey are usually not properly

assembled. This can cause communication errors.

9.

Connect the Power Supply Cable to the Power connector located on the

back of the equipment (1)

10. Connect the Power Cable to the Network.

11. Turn on the device from the ON / OFF tab

to finish the automatic loading of

drivers

At the end of the installation, run the software from the desktop icon of

your PC, to verify that it has been installed perfectly. If an error occurs,

restart the PC. If the error persists consult troubleshootin

support

75

el of the console

g or service

76

WORKSTATION LAYOUT

La estimulación visual VNGPlus es generada a través deimágenes (puntos/ bandas)
digitales.La imagen del estímulo se muestra en un monitor (televisor LCD, LED,
Plasma). El paciente debe estar centrado al monitor para lograr el estímulo adecuado
en amplitud

VNG Plus admite dispositivos (TV, LCD, LED) de distintas configuraciones para
generar la estimulación visual. (Ver Configuración/ Avanzados/Estimulador)

El estimulador visual se utiliza en las siguientes pruebas:

• Gaze

• Smoothpursuit

• Saccades

• Optokinetic(OKN)

• Auto rotatory (AHR)

• Impulse test (VHIT)

• Calibration

LAYOUT

1. Eyes height should be level with center of monitor screen

2The Ultrasonic sensors are on the screen top

77

CARE AND MANTEINANCE

WARNING: To reduce the risk of electric shock, turn off and disconnect the
equipment from the power supply before cleaning or repairing it.

NOTE: It is the responsibility of the user to comply with the information provided in
this section

The procedures detailed below must be performed by the operator. For other
maintenance or repair, contact the technical service or an authorized maintenance
representative.

CLEANING

CAUTION: Carry out the cleaning taking great care not to introduce water or humidity
to the equipment or its parts

CONSOLE

CAUTION: Do not use harsh chemicals.
Cleaning the exterior surface of the equipment should be done using a soft damp

cloth that does not drip. Rinse with a clean cloth moistened with water and let it dry
thoroughly before reuse.

RECEIVER BAR

Use a soft cloth to remove dust. In case the dirt is abundant you can go over the outer
surface with a slightly dampened cloth

GOGGLES

Camera lenses and coated mirrors should be cleaned regularly of marks and dust.
These should be cleaned with lens cleaning wipes.

The frame of the glasses should be cleaned with a sterile disposable handkerchief
with a cleaning solution of ethanol (or isopropyl) at 70%

CAUTION: It is recommended to clean the frame every time it is used with different
patients.

Mask straps can be removed and machine washed at 40 ° C with normal washing
detergents. Do not dry in a dryer. Note that the elastic qualities may deteriorate after
more than 10 wash cycles, after which they must be replaced.

78

CHANGE THE CUSHION OF GOGGLES

Peel off the pad and wipe the surface well with a soft cloth lightly moistened with
alcohol.

Remove the protective paper from the new pad and press the self-adhesive side onto
the mask. Do not stretch the pad.

FUSES CHANGE

Replace the fuses as detailed below:

1. Under the connector for the power cable is a small box where the fuses are
housed

2. Open the fuse compartment. To do this, insert a flat head screwdriver into
the notch and gently lift the fuse compartment with a slight downward and
outward movement.

3. Fuses must be replaced if they appear black or burned.

4. Replace the fuses with a new T1AL250V.

5. Close the lid of the fuse box until you hear a "Click".

6. Connect the power cable to the computer.
.

Note: It is convenient to have two spare fuses, in the event of requiring a replacement.

DISPOSE

Dispose of all parts removed from the device according to local, community and
national regulations and then the protocols of the health institutions.
Especially as regards the protection of the environment, especially when disposing of
the electronic device or parts thereof (eg: fuses)

79

MAINTENANCE AND REPAIRS

VNGPLUS must be repaired and / or maintained exclusively by qualified technical
personnel authorized by ECLERIS and only those parts of the equipment that are
designated by ECLERIS as repairable must be repaired. To perform any other
procedure that is not detailed in this section, contact the Ecleris technical support.

REPAYMENT AND TRANSPORTATION

CAUTION: To avoid possible damage, always transfer it with the original packaging

NOTE: Ensure that the environmental conditions of transport are met.

ECLERIS will not be held responsible for any damage or defects caused during
transportation that are linked to poor packaging.

80

TROUBLESHOTINGS

The following table indicates the most frequent problems and their quick solutions.
Please, in case of any inconvenience, consult this table.

PROBLEM CAUSE ACCIÓN

The device does
not turn on.

It is no connected to the
electrical network

Connect the power supply
cable to the electrical
network

The power supply cable
is broken or cut

Change the power supply
cable

The plug is in bad
conditions

Changetheplug

The fuse is broken or
burnt.

Changethe fuse

The Device is
not detected, or
there are faults
in the capture or
assistance
display

The drivers are not
correctly installed

Check drivers
installation/Install drivers

VNGPlus is not
connected to a USBport
on board

You must connect it to a
USB onboard port
(mother). Wired ports do
not guarantee the proper
functioning of VNG Plus.

There aren't
image of (the)
eye (s) and test
cannot be
recorded.

The cameras are not
properly connected to
junction Box

Check for proper
connection of the (right /
left) cameras

The junction box is
unplugged

Connect the junction box
correctly

The software installed is Contact Technical Service

81

single channel (eye). to activate both Channels

The wireless
switch is not
detected or not
working

Missingtoinstall drivers. Install the wireless switch

drivers.

USB wireless receiver is
unplugged.

Plug USB receiver (It is
inside the switch) to a USB
port of the PC.

Function wireless switch
is not activated.

Select the wireless switch
into

Setup/ Advanced /
Acquisition

If you cannot solve the problem, contact your local ECLERIS office or distributor and
request technical services.

82

TECHNICALSPECIFICATIONS

Goggles:

Weight: 330gr (without occlusion)

375gr (with occlusion)
435gr (with position sensor)

Dimensions (LxHxW): 27x14x10 cm

Console:

Weight:4kg
Dimensions:(LxHxW):26.05 x10 x 30 cm

Power

Voltage input: 100-240V, 50-60hz
Consume: 40VA
Fuse: 2x T1AL250V

Electrical security:

Class IEC60601-1:
Electrical Protection: Class I, Type: BF
PROTECTIVE LEVEL AGAINST WATER ENTRANCE: IPX0

NOT suitable for use in the presence of a flammable anesthetic mixture with
air, oxygen or nitrous oxide

Functioning mode: Continue

Service conditions: 10°C-40°C
700-1060 hPa
30-75% (Relative humidity)
Storage and transport Conditions:

-10°C-50°C
500-1060 hPa
10-95%(Relative humidity)

Estándares y Regulaciones:

IEC60601-1: Equipos médicos eléctricos: Requisitos generales para funcionamiento
esencial y seguridad básica

IEC6061-1-2Equipos médicos eléctricos, Parte 1-2: Requisitos generales para
funcionamiento esencial y seguridad básica, Norma colateral: Perturbaciones
electromagnéticas

83

System capabilities

Input: 1/ 2 Eyes. 2/ 4 channels (real time)
Sampling: 60hz
Tracked range: ±30 horizontal ± 20 vertical

Software Features: : Patient database. Test storage and Analysis of main parameters
corresponding to each test. Lighting conditions to perform the test: complete darkness

Test

1. SpontaneousNystagmus

2. Calorics

3. Postural

4. Dix Hallpike

5. Gaze *1

6. Smooth pursuit *1

7. Saccades*1

8. Optokinetics*1 (OKN)

9. Autorotatory head*2 (AHR)

10. Head Impulse

*2

Horizontal (vHIT)

*1 Visualstimuly is required
*2 Position sensor is required

Video cameras

Two cameras
Output signal: monocrome NTSC (CCD IR sensitive)
Sensor size: 1/4 ''
Vertical Resolution: 540TVL
Frame rate: 60 frames /s
Illumination Led: Infrared wavelength: 940 nm Class: No risk according to IEC 62471
(EXEMPT GROUP)

Visual Stimuly

VGA Signal
Patient distance: measured by ultrasound

84

APENDIX

ABNORMALITY THRESHOLD

TEST

ABNORMALITY

SIGNIFICANCE

SPONTANEOUS
Nystagmus: slow
component, followed by
fast component.

Bilateral gaze
Nystagmus: eyes open
and looking to right or
left.

2 Beats (horizontal) in 5
sec. with average velocity
of >6 deg/sec.

CNS: Nystagmus in all
gaze directions or
direction changing
Nystagmus in same
gaze direction.
SPONTANEOUS
NYSTAGMUS: CNS
(brain stem)

PVS: direction-fixed,
horizontal, or torsional
Nystagmus. Inhibited
by fixation, follows
Alexander’s law.* rule
out drugs, lack of
alertness

SMOOTH PURSUIT/
Gain: eye velocity/target
velocity

Phase: lag or lead of
eye relative to target.

Asymmetry: right gain –
left gain

Gain:
Age 50 and under: <70%

or

>140%
Age 60 – 69:
<65% or > 145%
Age 70 – 79 :

<60% or > 150%
Age 80 – 89 :

Low gain in one
direction: CNS lesion.
Marked saccadic
pursuit:(stair step
tracking) CNS lesion

85

SACCADE
Velocity: peak eye

velocity
Latency: reaction time in

msec.

Accuracy:
undershoots/overshoots

Latency:
Age 50 and under : >260

msec
Age 60- 69: >270 msec

Age 70- 79: >280 msec
Age 80– 89: >290msec

Age 90 and above: 300
msec

Velocity:
Age 50 and under: <240

deg/sec
Age 60- 69: < 230º/sec

Age

70-79: <220 º/sec Age
80-89:

< 210 º/sec
Age 90 and above: <200

º/sec
Accuracy:<55%

Significant saccadic
slowing, overshooting
or undershooting: CNS
lesion or ocular
disorder Lower velocity
of trailing eye:

Internuclear
ophthalmoplegia (

Brain stem)

OPTOKINETIC
NYSTAGMUS Gain: eye
velocity/ target velocity.

Symmetry= SPV right/

Gain < 60% is abnormal.
Symmetry > 30%
difference is abnormal.

SPV < 6.0 is abnormal

Symmetrical low gain:
impaired vision or
likely CNS (parietal)
lesion.

DIX-HALLPIKE >2 eats (horizontal) with

average velocity >6.0
deg/sec.

delay onset of Nystagmus
paroxysmal Nystagmus
associated with vertigo
fatigable Nystagmus

Unilateral: Usually
peripheral undermost
ear. Bilateral:
peripheral (both ears)
or CNS

BPPV: both horizontal
and vertical
Nystagmus (with

86

CALORIC TEST
Directional

Preponderance:
Nystagmus beats
stronger one way than
another.

Fixation Index: when
Nystagmus is at its
peak, the ratio of
velocity with no fixation
to velocity with fixation.

Unilateral weakness: of
more than 25% is
abnormal. Bilateral
weakness: sum of
velocities of all 4
irrigations

<20 º/sec
Directional

preponderance:
>25% difference.

Caloric weakness: is a
function of the
labyrinth or VIII cranial
nerve (vestibular
portion).

Unilateral: indicates
disabled side.

Bilateral: peripheral
organs,

Acute unilateral lesion
or perhaps CNS
(cerebellar).
Directional
preponderance: is not
localizing.

Videonystagmography is the most commonly used clinical test to evaluate
vestibular function, remember that the results of normal VNG tests do not
necessarily mean that a patient has a typical vestibular function. The
anomalies detected by VNG can be useful in the diagnosis and

localization of the site. Of the injury; however, many of the abnormalities
are not localized; therefore, the clinical history and otological examination of the
patient are of vital importance in the formulation of a diagnosis and treatment plan for
a patient with dizziness

87

Freyss Diagram

It was designed to perform the bilateral bi-thermal caloric test. Freyss butterfly or
diagram shows the Nystagmus intensity together with the results of absolute
symmetry and preponderance.
In its most traditional form, Freyss butterfly represents the number of nystagmic flaps
observed in a 30-second period. It also requires the stimulus corresponding to
Hallpike rules: irrigate 125cc of water at 30 and 44° C during 30 seconds. The patient
shall be in horizontal position with the head at 30 degrees.
In these conditions, it is possible to use the results of the normative data published by
G. Freyss giving the symmetry normative limits (<15%) and a directional
preponderance (12%). It is also possible to evaluate a hypo-sensitivity condition (<30
saccades) or hyper-sensitivity (>122 saccades) of a single ear, if you add up the
saccades induced by both ears with hot and cold stimulus.
In general, the graph is centered in a point, the ordinate axis represents the
Nystagmus intensity and the abscissa axis is graduated in percentage. There are two

limits: x = +100 and x = -100. Rightwards
Nystagmus flaps are positive while the leftwards
ones are negative. The results obtained from the
right ear are represented in line X = - 100 and the
left ear ones in line x = +100. Both points
corresponding to the intensity measure of a
bilateral isotherm (cold or hot) are thus
connected defining a straight line and the
equation may be represented as y = a x + b
whose slope is positive for cold tests and
negative for hot tests.
Once the four tests are completed, then the

intersection
Point projections in X and Y of both straight lines
Represent the following two results:
In the vertical projection, the lateral symmetry value or channel paresis (X) is
represented in percentage. If the Nystagmus direction for each of the four tests is as
expected, then you may use the traditional Jongkee’s formula:

= RE44 + RE30) - (LE44 + LE30) x100 (RE44 - RE30 - LE44 + LE30)

In the horizontal projection, the absolute preponderance (Y) is calculated using the
following formula

= (RE44 * LE30 - RE30 * LE44) (RE44 - RE30 - LE44 + LEI30)
The hyper or hyposensitivity condition for each ear is assumed from segment length
covered by the butterfly wing in the axis: x = - 100 for the right side and x = + 100 for
the left side.
FREYSS DIAGRAM FOR SLOW PHASE SPEEDS

88

The diagonal intersection coordinates represent the unilateral weakness calculated
using Jongkee’s formula. The absolute directional preponderance is not shown as a
percentage but as an absolute value, in degrees per second.
This format offers different advantages as the ability to compare the preponderance
speed against the speed of any Nystagmus that may be present. The relative
directional preponderance is also shown in % since this format is more familiar.
Diseñado para el examen calórico bitérmico bilateral, el diagrama llamado mariposa
de Freyss, muestra la intensidad del nistagmo junto con los resultados de simetría y
preponderancia absoluta.

89

DizzinessHandicapInventory

YES Sometimes No

(4) (3) (2)

P1. Does looking up increase your problem?







E2. Because of your dizziness do you feel frustrated?







F3.

Because of your dizziness do you restrict your
travel for business or recreation







P4.

Does walking down the aisle of a supermarket
increase your dizziness?







F5.

Because of your dizziness do you have difficulty
getting into or out bed?







F6.

Does your dizziness significantly restrict your
participation in social activities, such as going out to
dinner, going to the Movies, dancing, or going to
parties?







F7

Because of your problem do you have difficulty
reading?







P8.

Does performing more ambitious activities like
sport, dancing, or household chores such as
sweeping or putting dishes away increase your
dizziness?







E9

Because of your problem are you leaving home
without?Eaving someone accompany you?







E10.

Because of your dizziness have you been
embarrassed in front of others?







90

P11.

Do quick movements of your head increase your
dizziness







F12. Because of your dizziness, do you avoid heights?







P13. .Does turning over in bed increases your dizziness?







E14.

Because of your dizziness is it difficult for you to do
strenuous housework or yard work??







E15.

Because of your dizziness are you afraid people
may think you are intoxicated







F16.

Because of your dizziness, is it difficult for you to go
for a walk by yourself?







P17.

Does walking down a sidewalk increase your
dizziness?







E18.

Because of your dizziness, is it difficult for you to
concentrate?







F19.

Because of your dizziness is it difficult for you to
walk around your house in thedark?







E20.

Because of your dizziness are you afraid to stay
home alone?







E21.

Because of your dizziness do you feel
handicapped?







E22.

Has your dizziness placed stress on your
relationships with members of your family or
friends?







E23. Because of your dizziness, are you depressed?







91

F24.

Does your dizziness interfere with your job or
household responsibilities?







P25. Does bending over increase your dizziness







Score:
Functional =Emotional=Physical=..Total=.

92

ELECTROMAGNECTIC COMPATIBILITY

Guidance and manufacturer's declaration -Electromagnetic emissions

The device is indicated for use in the electromagnetic environment specified below.
The client or user of the equipment must ensure that it is used in said environment.

Emissions Test Accomplishments

Electromagnetic

environment-Guide

RF emissions CISPR 11 Group 1

Radio energy is used only
for its internal functioning.
Therefore, RF emissions
are very low and are
unlikely to cause any
interference with nearby
electronic equipment.

RF emissions CISPR 11 Class A

The device is suitable for
use in establishments other
than domestic premises
and other than that directly
connected to a low voltage
power supply network that
supplies buildings for
domestic use.

Harmonic Emissions IEC61000­3-2

Class A

Flickers IEC61000-3-3 OK

93

Guidance and manufacturer's declaration

- Electromagnetic immunity

The VNGPlus unit is intended for use in the electromagnetic environment specified
below. The customer or user of the unit must ensure that it is used in this environment

Test
Immunity

Test level
IEC 60601

Level
of compliance

Electromagnetic
environment - guide

Electrostatic
discharge
(ESD)
IEC 61000-4-2

± 6 kV contact

± 8 kV air

± 6 kV contact

± 8 kV air

The floors must be made
of wood, concrete or
ceramic tile.
If the floors are covered
with synthetic material,
the relative humidity
must be at least 30%.

Transients / rapid
electric bursts
IEC 61000-4-4

± 2 kV for power
lines
± 1 kV for in /
out lines

± 2 kV for power
lines
± 1 kV for in /
out lines

The power quality of the
network should be that of
a typical commercial or
hospital environment

Surge voltage
IEC 61000-4-5

± 1 kV
Line to line
±2 kV
Line to ground

line to ground
± 1 kV
Line to line
±2 kV

The quality of the
network's power should
be that of a typical
commercial or hospital
environment.

Voltage drops,
short interruptions
and voltaje
variations in power
input lines

IEC 61000-4-11

< 5% UT
(>95% drop in
UT) for 0.5
cycles
40% UT
(60% drop in
UT)
for 5 cycles
70% UT
(30% drop in
UT)
For 25 cycles
< 5% UT
(>95% drop in
UT) for 5 s

< 5% UT
(>95% drop in
UT) for 0,5
cycles
40% UT
(60% drop in
UT)
For 5 cycles
70% UT
(30% drop in
UT)
For 25 cycles
< 5% UT
(>95% drop in
UT) for 5 s

The quality of the
network's power should
be that of a typical
commercial or hospital
environment.
The quality of the
network's power should
be that of a typical
commercial or hospital
environment. If the user
of the VNGPLU unit
requires continuous
operation during
interruptions of the
power supply, it is
recommended that the
VNGPlus unit be
activated from an
uninterrupted power
supply or battery.

Power frequency
(50/60 Hz)
Magnetic field

3 A/m 3 A/m The industrial frequency

magnetic fields must be
at characteristic levels of

94

IEC 61000-4-8

a typical location in a
typical commercial or
hospital environment.

NOTE: UT is the voltage of the AC network before the application of the test level.

Guidance and Manufacturer's Declaration - Electromagnetic Immunity

The VNGPlus unit is intended for use in the electromagnetic environment specified
below. The client or user of the unit must ensure that it is used in this environment.

Prueba de
inmunidad

Nivel de prueba
IEC 60601

Level of
compliance

Electromagnetic environment ­guide

RF
conducida
IEC 61000­4-6

RF radiada
IEC 61000­4-3

3 V rms
150 kHz a 80
MHz

3 V/m
80 MHz a 2,5
GHz

3 V rms

3 V/m

Portable or mobile RF
communications equipment should
not be used closer to any part of
the VNGPlus unit, including
cables, than the recommended
separation distance calculated
from the equation applicable to the
transmitter frequency.
Recommended separation
distance:

d = 1.2 √P
d = 1.2 √P 80 MHz at 800 MHz
d = 2.3 √P 800 MHz at 2.5 GHz
where P is the maximum rated
output power of the transmitter in
watts (W) according to the
manufacturer of the transmitter
and d is the recommended
separation distance in meters (m).
The field strength of fixed RF
transmitters, determined by an
electromagnetic site survey, a
must be less than the compliance
level in each frequency range. b
Interference may occur near the
archived equipment with the
following symbol:

NOTE 1 At 80 MHz and 800 MHz, the higher frequency range applies.
NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation
is affected by absorption and reflection from structures, objects and people.

a.- Field strengths from fixed RF transmitters, such as base equipment for radio
(cellular / cordless) telephones and mobile field radios, Amateur Radio, AM and FM
radio stations and TV stations can not be predicted theoretically with accuracy . To
assess the electromagnetic environment due to fixed RF transmitters, an
Electromagnetic site survey should be considered. If the field resistance measured at

95

the location in which the VNGPLUS unit is used exceeds the applicable RF
compliance level above, the VNGPlus unit must be examined to verify normal
operation. If abnormal performance is observed, additional measures may be
necessary, such as a reorientation or relocation of the VNGPlus unit.
b.- In the frequency range from 150 kHz to 80 MHz, the field strengths must be less
than 3 V / m.

ECLERIS S.R.L.
FRANCISCO N. LAPRIDA 4955 - VILLA MARTELLI

96

(B1603ABK) BUENOS AIRES - ARGENTINA
Tel/Fax: [phone]
Web: www.ecleris.com

E-Mail: [e-mail]

All rights reserved. Reproduction or transmission in whole or in part, in any form or by
any means, electronic, mechanical or otherwise, is prohibited without the prior written
consent of the copyright owner