Elektron Technology MPS II User Manual

MPS II Manual

MPS II User Manual

The MPS II is a world leader in macular pigment density measurement

by Elektron Technology UK Ltd.

MPS II Manual

All rights reserved. No parts of this work may be reproduced in any form or by any means - graphic, electronic, or mechanical, including photocopying, recording, taping, or information storage and retrieval systems - without the written permission of the publisher.

Products that are referred to in this document may be either trademarks and/or registered trademarks of the respective owners. The publisher and the author make no claim to these trademarks.

While every precaution has been taken in the preparation of this document, the publisher and the author assume no responsibility for errors or omissions, or for damages resulting from the use of information contained in this document or from the use of programs and source code that may accompany it. In no event shall the publisher and the author be liable for any loss of profit or any other commercial damage caused or alleged to have been caused directly or indirectly by this document.

Printed: October 2014

MPS II Manual4

Table of Contents

Part I MPS II

................................................................................................................................... 61 Introduction

.......................................................................................................................................................... 7Elektron Company notices

......................................................................................................................................................... 8Revision History

......................................................................................................................................................... 9Important warnings

......................................................................................................................................................... 10Explanation of symbols used in manual and on instrument

......................................................................................................................................................... 11Database warning

......................................................................................................................................................... 12Acknowledgements

................................................................................................................................... 132 How to use this manual

................................................................................................................................... 143 An Introduction to Macular Pigment

................................................................................................................................... 154 MPS II testing

.......................................................................................................................................................... 16MPS II target

.......................................................................................................................................................... 17Testing strategy

.......................................................................................................................................................... 18Standard test

.......................................................................................................................................................... 19Detailed Test Mode

.......................................................................................................................................................... 20Explanation of terms

Part II Installation

Part III Test Modes Best Practice

Part IV Selecting a Patient

21 23 25

................................................................................................................................... 261 Create a New Patient

................................................................................................................................... 282 Select Existing Patient

Part V Standard Test Mode

................................................................................................................................... 301 Standard Test - Summary

................................................................................................................................... 312 Standard Test - Sequence

................................................................................................................................... 343 Patient Instructions

Part VI Detailed Test Mode

................................................................................................................................... 351 Detailed Test - Summary

................................................................................................................................... 362 Detailed Test - Sequence

................................................................................................................................... 403 Patient Instructions Peripheral

................................................................................................................................... 404 Graph Estimate

................................................................................................................................... 415 Test Reports

Part VII Viewing Previous Record Data

Part VIII Configuration Wizard

Part IX Appendix 1 - MPS II Installation

45 46 49

Part X Appendix 2 - Software Installation

................................................................................................................................... 521 Installation on a new PC

................................................................................................................................... 532 Updating an existing installation

................................................................................................................................... 543 Starting the program

5Contents

Part XI Appendix 3 - Confidence Limits

Part XII Appendix 4 - Example data

Part XIII Appendix 5 - Technical Specification

Part XIV Appendix 6 - Maintenance and Warranty

................................................................................................................................... 611 Regular Inspection

................................................................................................................................... 612 Maintenance

................................................................................................................................... 613 Cleaning

................................................................................................................................... 624 Preventative maintenance

................................................................................................................................... 625 Replacement parts

................................................................................................................................... 636 Spare lenses

................................................................................................................................... 637 Repairs and Recalibration

................................................................................................................................... 638 Warranty

Part XV Appendix 7 - Troubleshooting

Part XVI Appendix 8 - Software License Agreement

55 57 59 61

64 65

Index 0

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1 MPS II

www.elektron-healthcare.com

1.1 Introduction

The MPS II / MPS 9000 must be used in accordance with the operating instructions. Please read the instructions before attempting operation.

The instructions in this manual are to be viewed as an accompaniment to correct training on this equipment.

The results of a test are only to be analysed by a suitable qualified person, and it is the responsibility of the practice manager/owner to ensure that only suitably trained personnel are operating this equipment.

Contact your sales agent for details of on-site training.

1.1.1 Elektron Company notices

The information contained in this manual is subject to change without notice.

The only warranties for Elektron Technology UK Ltd. products and services are set forth in the express warranty statements accompanying such products and services. Nothing herein should be construed as constituting an additional warranty.

Elektron Technology UK Ltd. shall not be liable for technical or editorial errors or omissions contained herein.

MPS II 7

MPS II Manual8

Re lea se

Dat e

Chan ge

Version 1.00

24/6/13

New version for V5 software

Version 1.1

03/08/13

Spelling and grammatical corrections and some formatting changes

Version 1.2

30/08/13

Added graph estimate information in Detailed Mode test

Version 1.3

2/14

Information updated

Version 1.4

30/6/14

Information updated and some installation information added

Version 1.5

1/10/14

Information regarding installation added.

1.1.1.1 Revision History

1.1.1.2 Important warnings

WARNING

This unit must be

connected to an

earthed mains supply

WARNING

Hazardous voltages are

present inside the

electrical enclosures of

this unit. No user-

serviceable parts inside

WARNING

This equipment is not

suitable for use in an

oxygen rich

environment

WARNING

This equipment should

be kept dry at all times

MPS II 9

MPS II Manual10

WARNING

Consult manual

WEEE Directive

Power Off (0) Power On (1)

Type B Applied Part

Hazardous voltage CE mark

USB

Protective earth AC Mains

1.1.1.3 Explanation of symbols used in manual and on instrument

Definition of symbols used in the manual and on the instrument.

1.1.1.4 Database warning

To reduce the possibility of loss in the unlikely event of computer hard disk failure, it is strongly recommended that the database of patient records be backed up regularly either on to a USB memory stick or other suitable removable media and kept off-site or in a suitable safe location.

The configuration wizard (shown below) allows for the backup interval and location to be set.

MPS II 11

The default location is C:\users\login_name\ but can be any location on the PC.

It is good practice that a backup copy of the database is kept off-site or in a suitable fire safe location.

The database used in the MPS II software is based on the PostgreSQL database program. The database structure ensures that each patient has an entry (called a record) in the database.

The patient’s record holds all of their contact details and also a copy of every test they complete along with risk factor information and any supplementation recommended.

The database has inbuilt security to stop unauthorised access to the information contained within.

Every time a new MP test is performed the results (if saved) are attached to the patient’s “record” card.

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1.1.1.5 Acknowledgements

Microsoft, Windows, Windows 7TM and Windows 8TM are registered trademarks of Microsoft Corporation.

Elektron Technology UK Ltd. continuously improves the design processes of its equipment to minimize the negative impact on the environment and the communities in which the equipment is manufactured, shipped, and used.

This symbol on the product or on its packaging indicates that to preserve the environment, this product must be recycled after its useful life as required by law and must not be disposed of with your household waste. It is your responsibility to dispose of your waste electrical and electronic equipment by handing it over to a designated collection point for the proper recycling of such equipment. The separate collection and recycling of your waste equipment at the time of disposal will help to conserve natural resources and ensure that it is recycled in a manner that protects human health and the environment. For more information about the authorized collection location nearest to you, please contact your local city office, your household waste disposal service or the agent from whom you purchased the product.

1.2 How to use this manual

This manual is written for use with the MPS II Macular Pigment Screener.

Throughout the manual there are references to MPS II or MPS9000; both of these refer to the standalone MPS II unit which has the manufacturer’s reference number MPS9000 or MPS1000.

Throughout this manual there will be references to laptop or PC where PC stands for Personal Computer. It does not matter which computer you have as the software is the same.

If you have a laptop with touch pad or external mouse connected, you need to move the on-screen arrow cursor over the button/item you want to select and then press the left hand button.

In the event of software upgrades, up to date operational instructions will be installed at the same time as the software.

Updates of the software can be obtained from your agent (when available).

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Some of the screen shots in this manual may be from different versions of software and may differ slightly from the software installed on your machine.

The information in this manual was correct at the time of publishing. It is important that all of the literature and software supplied with the MPS II is kept in a safe place.

Use of the Software

Throughout the software there are visual clues to help you operate the software and perform testing. The on-screen controls will be colour coded to help you.

Greyed out if they cannot be used.

Blue if they are available for use and

Green if they are the next button you should press to progress.

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1.3 An Introduction to Macular Pigment

Age-related Macular Degeneration (AMD) is the most common cause of vision loss in people over 50 and its prevalence increases with age. There is a growing awareness of the disease, the need to measure the risk of getting it and how to take preventative action.

As the World's population ages, the condition is expected to become more prevalent creating a heavy financial burden on health care services. It is safe to say that if the entire population lived to 100 years, we would all exhibit varying levels of macular degeneration.

Given that there is no cure for AMD, it is vital to prevent the disease for as long as possible through diet, lifestyle and optimising Macular Pigment Levels – the internal sunscreen for the eyes.

The macula is the central and most sensitive part of the retina at the back of the eye and macular pigment acts as an antioxidant that protects the retina from the potentially damaging effects of blue light – if the density of this pigment is reduced then the retina is made more vulnerable and more likely to gradually deteriorate. By catching those with low levels of macular pigment, the MPS II makes it possible to reduce their risk of long-term vision loss. People with AMD experience severely distorted vision and find it very hard to read and recognise faces.

Eventually the condition can lead to total blindness. The density of the macular pigment has been shown to be linked to diet and to other lifestyle factors, including smoking.

Normal Amsler Grid Amsler grid with AMD

The scientifically proven technique for measuring the density of macular pigment, heterochromatic flicker photometry (HFP), has been available for over 30 years. The new MPS II uses the same technology, but takes it to the next stage by refining it and making it available in a more accessible package thanks to advances in LED lighting.

The approach adopted by the MPS II is far easier for patients to use than earlier versions of the technology. Unlike conventional methods, where observers have to set the point where flicker disappears (or minimised), the measurement consists of a series of button presses in response to the onset of flicker, which makes it far easier for the subject to take the test and for the Optical Practitioner to accurately determine the flicker thresholds and optical density.

Visit our Website for more up to date information regarding clinical papers and developments in the Prevention, Detection and Treatment of AMD.

Elektron healthcare Website

1.4 MPS II testing

The MPS II is a computerised instrument for measuring a subject’s Macular Pigment Optical Density.

It's purpose is to identify patients at risk of developing early stage AMD.

The MPS II uses low intensity light of specific wavelengths at calibrated intensities to gauge a patient’s heterochromatic flicker response. The patient looks into the instrument at the stimulus light and is asked to press a button when they see the light flicker.

The target background luminance is maintained at 250cdm-2 to significantly reduce detection by rods or short-wave cones.

The MPS II has an internal microprocessor used to control the light intensities and the test program sequence.

For full operation, the unit is connected to, and controlled from, a computer running the Microsoft Windows8™, or Windows 8™ operating system.

MPS II 15

The MPS II is easy to use and does not require advanced computer literacy for its operation.

Once installed, you will immediately have the capability to carry out routine macular screening examinations on your patients.

From then on, your confidence with the unit will grow with every use and you will rapidly discover the simplicity of operation and the ease of obtaining valuable and accurate macular pigment data.

A powerful database is included in the software that stores the macular pigment results alongside the patient details. using the database, reports can be generated to monitor the patient’s progress after supplementation.

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1.4.1 MPS II target

The MPS II target is the most important part of the unit and the lens and optics of the instrument should be kept clean and free from dust and debris by using the supplied dust cover when the unit is not in use. The pictures below shows the view into the eyepiece –

Three circles are visible on a plain white background. During a test, the central (smaller) target will light a blue-green colour and it is here flicker will be seen.

The larger circles (either side) are fixation targets used for the peripheral test in the Detailed Mode.

The peripheral fixation targets light up red and the patient is instructed to look at them during peripheral testing whilst observing the central target through the side of the eye (not required in

Standard mode).

It is important that the patient maintains fixation on the correct target during peripheral testing. If either of the red peripheral fixation targets is illuminated, then the patient should fixate on these. If neither of them is illuminated, the patient should look directly at the central target.

In both cases, the response to flicker in the central targets should be the same.

1.4.2 Testing strategy

Since MP lies within the foveal region other media changes, e.g. lens yellowing, will not affect the MP value. Note that the initial blue/green ratio is pre-set by taking the age of the subject into account. The older the subject the further to the right the start point.

If the subject has been fitted with an Intra-Ocular Lens, the eye may then appear much younger so the software automatically assumes an age of 20 when the IOL button has been ticked (patient’s form).

The MPS II first measures the patient's flicker sensitivity. This is used to normalise each subject as far as possible so that the starting flicker frequency is close to 30Hz. Some subjects still lie outside this normalisation process. This affects the shape of the curve and hence the accuracy of measurement. Too high a sensitivity and the curve starts at a high value (> 30 Hz) and remains shallow. Too low a value, and the curve starts at a low value (< 30 Hz) and is too deep (sometimes below 5Hz) which may halt the run. Optimum sensitivity occurs when the minimum value falls between 20 Hz and 15 Hz In subjects with diabetic media yellowing, the error will be higher because their media appears older.

MPS II 17

When lights are different in colour, it is difficult to say whether or not they are of equal intensity or luminance. This device uses the well-known technique of heterochromatic flicker photometry (HFP) to identify the equal-luminance point of two flickering lights of different wavelengths.

Macular pigment absorbs selectively in the blue region of the visible spectrum, at 460nm, and is present only in the central 8 degrees of vision. HFP is performed for central fixation where macular pigment is maximal.

A constant white background illuminance is used; blue and green light are alternately flickered. The blue light is chosen to match the absorbance of the macular.

In the MPS II, the equal luminance points are obtained by presenting the two lights at a series of different intensity ratios. The flicker frequency starts at a high rate where flicker cannot be detected (target appears a steady blue-green colour) and, for each blue-green intensity ratio, the flicker rate slowly reduces until the patient sees the flicker - at which point they press the response button.

This process is repeated at different intensities to obtain the graph. The curve will have a minimum which corresponds to the equal luminance point for the blue/green target. The software calculates the MP value based on this minimum and the patient’s age.

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1.4.3 Standard test

The latest version of the MPS II software implements the Standard mode algorithm from version 4.

Developed by one of the original inventors of the instrument, the algorithm interprets the validity of screening results.

Previous versions of the software have relied on the operator making subjective judgements on the result’s validity. The new algorithm relieves the operator of this responsibility by automatically interpreting the results. Of course the Detailed mode interface remains for the testing of diabetics, clinical research and teaching, but most will find the ease of use in Standard mode applicable to most test cases. A simple button click toggles between the two modes (shown below, for comparison) –

The Standard mode contains a subset of the Detailed mode controls. The macular index is calculated from the patient’s age and the central run (a peripheral run is not needed).

The algorithm looks at the patient’s response to the test and analyses the shape of the graph and the test values. There are three possible outcomes, clearly displayed below the graph (accept, caution and reject) see Appendix 3 - Confidence limits.

In most cases, the results will be accepted. In a few instances the results will be unacceptable (and the program ensures these cannot be saved as a valid result). When the Standard mode algorithm produces a low, but acceptable result, the final decision is left to the operator.

1.4.4 Detailed Test Mode

The Detailed Mode is used for patients where the Standard Mode is not suitable, people with diabetes for example.

For this test, two measurements are taken, one with the patient looking directly at the stimulus target (using the central region of the macular) with the light from the target passing THROUGH their macular pigment as in standard mode

For the second phase of the test, the patient fixates peripherally on a point 8 to the side of the stimulus light (so they are viewing the stimulus where macular pigment is known to be absent).

The patient responds to the stimulus flicker as before and once the test is finished, the central and peripheral results are then used to determine the patient’s Macular Pigment Optical Density.

This is done by working out the ratio of the amount of blue light absorbed in the central region compared with the peripheral region. The greater the density, the more blue light is absorbed.

MPS II 19

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1.4.5 Explanation of terms

There are three possible results given by the MPS II Software depending on what test you are running.

The Standard test will give an Age estimate.

The Detailed Mode test will give an Age Estimate, an Absolute result and can also give a Graph Adjusted result under operator control.

These three terms are explained below.

MP-Estimate

This means that the peripheral part of the test has been estimated using the patient’s age. The patient's MP level has been calculated from their central test result and the estimated peripheral. It is not an Absolute measurement.

MP-Absolute

This is the full measurement where both parts of the test are undertaken by the patient and is the full measurement. There is no estimating in it. This test is necessary for patients with eye diseases or diabetes where we cannot estimate the peripheral result using their age. (diabetics in particular have different age related results)

To calculate an Absolute measurement we need to perform a central test (where patient looks directly at the target) and then a peripheral test (where the patient looks at the red fixation point) and by comparing these 2 results we work out the patient’s MP level.

MP-Graph Adjusted

This is where the Absolute result of a detailed test is changed by moving the minimum point on the graph.

For example, if the patient’s central test curve looked like the picture below, the software would pick the right hand point (arrowed) as the minimum, but you can see that there are 2 points at exactly the same point on the Y axis. The operator can move to the other point to see what affect it has on their MP level result. (in this example, the change will be minimal).

This new MP value is recorded alongside the calculated result in the database as Adjusted as the operator has changed the result that the software originally calculated.

2 Installation

MPS II 21

The MPS II is designed to be connected to a laptop or PC using a standard USB cable (supplied).

It is not recommended to extend the supplied cable since communications between the PC/Laptop and MPS II may be unreliable.

It is not recommended that the USB cable is connected to a USB 3 port as this can cause connection issues.

See the Quick Start guide or Appendix 1 for connection instructions. See the Quick Start guide or Appendix 2 for software installation instructions.

See the End User License Agreement (EULA) in Appendix 8 for full detailsof the license on the software. (this is the same license agreement that is agreed when installing the software.)

IT IS IMPORTANT THAT YOU DO NOT PLUG THE USB CABLE INTO THE COMPUTER UNTIL YOU HAVE INSTALLED THE MPS II SOFTWARE AND DRIVER.

The software once installed and running will display the status of the connected instrument at the bottom of the screen along with the name of the current operator (in this case AC) and the date of the next scheduled backup.

The MPS II can be placed on any stable, flat surface or electric table. The instrument should be located to prevent rocking or tilting and to allow ventilation to the base and rear of the unit.

It is important that no parts of the unit should overhang the edge of the surface on which the MPS II is mounted. Ensure that there is sufficient space in front of the unit for the patient to sit comfortably. The MPS II has an internal power supply unit. The power supply is universal and does not need adjusting for different mains voltages, but it is important to check that the correctly rated fuses are being used (see Appendix 1 or the label on the rear of the unit).

MPS II Manual22

The patient response button is connected into the rear of the unit and must be accessible by the patient. The on/off switch for the instrument is on the back panel.

3 Test Modes Best Practice

For both of the tests, Standard and Detailed mode, it is important that the patient is informed of what to expect to enable them to perform the test correctly.

Below are some tips and tricks to help optimise a test.

-Put a full aperture (or reduced aperture) trial lens in the front slot of the machine with the reading Rx. If you do not have access to these use the patient’s spectacles (near SV, varifocals or bifocals) or contact lenses (distance Rx with over-readers, multifocals or monovision near lens) but refrain from using tinted lenses. The MPS II has a 5.00D lens within the optics, so a distance Rx will suffice and the Heterochromatic Flicker Photometry (HFP) procedure is relatively insensitive to blur. Remember to record the correction used in the patient's Notes.

-Occlude the eye not being tested using an eye patch. Perform in mesopic or scotopic lighting. Measure the right eye, then the left eye with a central measurement only (ie Standard mode) and save the results

Installation 23

- Inform the patient that this test requires concentration; however they should be encouraged to blink naturally. When you detect flicker on the central spot, it’s ‘finger on the buzzer’ and speed is of the essence.

-There will be a short familarisation test before the main test to check their response to flicker. This sets the initial blue/green ratio and is recorded as squares on the graph. This takes approximately 30 seconds. Only if the responses are very inconsistent will an error message appear stating ‘range too high’ and ‘start again’. When this is over the middle spot will temporally go black. The patient must keep watching (don’t let the patient move their head), as the second actual test will take place immediately the screen lights up again. The flickering central light may appear slightly bleached out and/or leave an after image. Reassure the patient that this is just because you have been staring at it much like ‘staring at the sun’

- Watch the screen and if you see the patient pressing the button too quickly, or indeed losing concentration between responses, pause the test and remind the patient of the original instructions or restart the test, or repeat the test later. The importance of constant communication cannot be over-emphasised. Keep encouraging the patient with phrases like ‘you’re doing well’, ‘look for the flicker’ and‘you’re nearly finished’, as silence will cause the patient to question if they are performing the test correctly.

-On average, depending on MP, this measurement takes approximately 60 seconds to complete. The repeatability of HFP measurements has previously been studied and amended scoring techniques have reduced the Standard Deviation(SD). However, with the Standard test mode of a central-only measurement, any ‘noise’ in repeatability testing is minimised and thus measurements taken at different visits can be compared with confidence

- Only if coexisting pathology is present (diabetic maculopathy, AMD) then take the central and peripheral measurements (ie Detailed mode). Perform the central measurement first. Then inform the patient that they should be fixating at the top of the peripheral red target (left target for RE and vice-versa) and using their side vision to view the central blue flickering target. They will want to glance at this, but you must inform them to resist the temptation.

MPS II Manual24

If they stare at the flickering target directly it forfeits the results, as all they are doing is performing a central measurement again. Half-way during the test, pause it and get them to look at the bottom of the red target from then on, but again only pressing the button when they see the flickering target. This prevents the flickering target from disappearing due to the Troxler effect. Blinking after pressing the button can also prevent this.

4 Selecting a Patient

Start the program and wait until the Main Menu screen is shown –

Test Modes Best Practice 25

You have 2 options here:-

If the patient is new to this test then you will need to create a New Patient in the database.

If you have tested the patient before then you can select their record from the database, so select the Test existing patient button.

MPS II Manual26

4.1 Create a New Patient

If the patient has never been tested on this instrument before then they will not exist in the database. Select the Test New Patient button.

The Patient entry screen will be displayed. The items that MUST to be filled in are highlighted in red.

You have to enter, at least, the patient’s First name, Surname, Date of birth and Gender to create a new record. Selecting the title will also set the gender, for exaple, selecting Mr will set gender as male.

You can see from the screen shot that the age is shown as invalid. This is because the age of the patient is under 1.

All other fields can be left blank, if required, or can be filled-in at a later date. Once all of the required patient's details have been entered, the test button will highlight in green

At this time you can also enter any other relevant Risk Factors the patient has by clicking on the Risk Factors tab.

Selecting a Patient 27

This gives you an opportunity to discuss the risk factors with a new patient.

There are also tabs for Notes and also for Supplementation, the Notes allows you to enter details such as the refractive correction worn by the patient (i.e. whether they wore their own glasses) but it is normal to fill these in after the test.

Press the green test button to create the record and go directly to the test screen or

Press the HOME button to discard all changes made and return to the original screen. (you will be prompted whether you want to discard the record)

It is also possible to SAVE the changes made but not test the patient at this time.

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4.2 Select Existing Patient

If the patient has previous tests stored in the database then select the Test Existing patient button. You will be presented with the database listing all patients in alphabetical order by surname.

To find a particular patient you can type their name in the search box - as you start to type the surname in the search box the records will clear to show all matching records.

When you have found the patient, click on the name to select it. You can then :-

Test this patient

Edit this patients details in the database

View the patients previous test results

Or if you realise that the patient is not in the database after all, you can ADD them by

clicking the add new patient button (without having to go back to the main menu and starting again)

Or cancel and return to the Main menu

5 Standard Test Mode

The Standard test mode performs a central only test (through the patient's macular pigment) and uses their age to estimate their peripheral test result.

The measured centre and age-estimated peripheral are then used to derive the MPOD value.

This test can reliably and repeatably be used on the majority of the population as long as they do not have any pre-existing pathology (diabetic maculopathy, AMD). In these cases the Detailed mode test must be performed.

The details of the test are here

Selecting a Patient 29

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5.1 Standard Test - Summary

Start the program (normally from the Desktop icon) Select New patient - Enter data onto the Patients form

or Existing patient - find them in the database Click the Test icon By default the Right eye is tested first, occlude the patient's other eye

Instruct the patient on what to expect and how to perform the test.

Start the test. give the patient feedback during the test At the end of the test, check that the software has accepted the result for this eye. Occlude the patient's tested eye, press the swap eyes button and test the other eye. After testing both eyes, review the results with the patient.

+ 68 hidden pages

Elektron Technology MPS II User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

1 MPS II

1.1 Introduction

1.1.1 Elektron Company notices

1.1.1.1 Revision History

1.1.1.2 Important warnings

1.1.1.3 Explanation of symbols used in manual and on instrument

1.1.1.4 Database warning

1.1.1.5 Acknowledgements

1.2 How to use this manual

1.3 An Introduction to Macular Pigment

1.4 MPS II testing

1.4.1 MPS II target

1.4.2 Testing strategy

1.4.3 Standard test

1.4.4 Detailed Test Mode

1.4.5 Explanation of terms

2 Installation

3 Test Modes Best Practice

4 Selecting a Patient

4.1 Create a New Patient

4.2 Select Existing Patient

5 Standard Test Mode

5.1 Standard Test - Summary