Mortara X-Scribe User Manual
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Mortara X-Scribe User Manual

Mortara X-Scribe User Manual

Stress exercise testing system
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REF 9515-151-50-ENG Rev S1
Manufactured by Mortara Instrument, Inc., Milwaukee, Wisconsin U.S.A.
CAUTION: Federal law restricts this device to sale by or on the order of a physician.
X-Scribe
STRESS EXERCISE TESTING SYSTEM
USER MANUAL

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  • Page 1 REF 9515-151-50-ENG Rev S1 X-Scribe STRESS EXERCISE TESTING SYSTEM USER MANUAL Manufactured by Mortara Instrument, Inc., Milwaukee, Wisconsin U.S.A. CAUTION: Federal law restricts this device to sale by or on the order of a physician.
  • Page 2 Mortara Instrument, Inc. Mortara is a registered trademark of Mortara Instrument, Inc. T12, VERITAS, X12+, and X-Scribe are trademarks of Mortara Instrument, Inc. “SCF” (Source Consistency Filter) is a copyright of Mortara Instrument, Inc. Adobe, Acrobat, Microsoft, and Windows are trademarks or registered trademarks of Microsoft Corporation.
  • Page 3 Physician Practice: orderspc.us@mortara.com European Union U.S. Distribution: orderspc.us@mortara.com Representative Mortara Instrument Germany Bonifaciusring 15 Mortara Instrument Europe, s.r.l. 45309 Essen (European Headquarters) Germany Via Cimarosa 103/105 Tel: +49.201.18 55 69 70 40033 Casalecchio di Reno (BO) Fax: +49.201.18 55 69 77...
  • Page 4 Failure to do so may cause undue failure and possible health hazards. Equipment Identification Mortara Instrument, Inc. equipment is identified by a serial and reference number on the back of the device. Care should be taken so that these numbers are not defaced.
  • Page 5 Product/s. If Mortara should be found liable to anyone under any theory (except the expressed warranty set forth herein) for loss, harm, or damage, the liability of Mortara shall be limited to the lesser of the actual loss, harm, or...
  • Page 6 PRODUCT/S FOR ANY AND ALL LOSSES AND DAMAGES RESULTING FROM ANY CAUSE SHALL BE THE REPAIR OR REPLACEMENT OF DEFECTIVE PRODUCT/S TO THE EXTENT THAT THE DEFECT IS NOTICED AND MORTARA IS NOTIFIED WITHIN THE WARRANTY PERIOD. IN NO EVENT, INCLUDING THE CLAIM FOR NEGLIGENCE, SHALL MORTARA BE LIABLE FOR INCIDENTAL,...
  • Page 7 Inadequate knowledge or training could result in increased risk of harm to users, patients and bystanders, or damage to the device. Contact Mortara service for additional training options. ...
  • Page 8  The device is initially configured with the X-Scribe application running under the local administrator login. Although it is possible to reconfigure the application to run under a standard user account, it is not recommended and may potentially cause unintended behavior from network communication during an exam.
  • Page 9 USER SAFETY INFORMATION Note(s)  Patient movements may generate excessive noise that may affect the quality of the ECG traces and the proper analysis performed by the device.  Proper patient preparation is important to proper application of ECG electrodes and operation of the device. ...
  • Page 10 USER SAFETY INFORMATION viii...
  • Page 11 EQUIPMENT SYMBOLS Symbol Delineation Attention, consult accompanying documents Alternating current Protective earth Fuse Defibrillator-proof type CF applied part Input Green light illuminates when power is ON Green light illuminates when paper is out or an error condition is detected Advances paper to the next paper perforation and will reset a paper error condition.
  • Page 12 GENERAL CARE Precautions  Turn off the device before inspecting or cleaning.  Do not immerse the device in water.  Do not use organic solvents, ammonia based solutions, or abrasive cleaning agents which may damage equipment surfaces. Inspection Inspect your equipment daily prior to operation. If you notice anything that requires repair, contact an authorized service person to make the repairs.
  • Page 13 See Table X-4 for recommended separation distances between the radio equipment and the device. The use of accessories and cables other than those specified by Mortara Instrument, Inc. may result in increased emissions or decreased immunity of the system.
  • Page 14 ELECTROMAGNETIC COMPATIBILITY (EMC) Table X-1 Guidance and Manufacturer’s Declaration: Electromagnetic Emissions The equipment is intended for use in the electromagnetic environment specified in the table below. The customer or the user of the equipment should ensure that it is used in such an environment. Emissions Test Compliance Electromagnetic Environment: Guidance...
  • Page 15 ELECTROMAGNETIC COMPATIBILITY (EMC) Table X-3 Guidance and Manufacturer’s Declaration: Electromagnetic Immunity The equipment is intended for use in the electromagnetic environment specified in the table below. The customer or the user of the equipment should ensure that it is used in such an environment. IEC 60601 Compliance Emissions Test...
  • Page 16 ELECTROMAGNETIC COMPATIBILITY (EMC) Table X-4 Recommended Separation Distances Between Portable and Mobile RF Communications Equipment and the Equipment The equipment is intended for use in the electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the equipment can help to prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the equipment as recommended in the table below, according to the maximum output power of the communications equipment.

  • Page 17: Table Of Contents

    X-Scribe Specifications ..............................4 Parts and Accessories ..............................5 Support Parts ................................. 6 SETUP AND INSTALLATION SECTION 2 X-Scribe System Setup and Installation ........................7 USING THE X-SCRIBE SECTION 3 Starting the X-Scribe ..............................11 Using the X-Scribe ..............................12 User Interface ................................
  • Page 18 DIRECT CONNECT APPENDIX D Direct Connect ................................67 TREADMILL/ERGOMETER HOOKUP APPENDIX E X-Scribe to Treadmill Hookup Instructions ........................ 69 X-Scribe to Ergometer Hookup Instructions ....................... 69 Treadmill Remote Keypad ............................70 Z200+ THERMAL PRINTER AND SUPPLIES APPENDIX F Z200+ Thermal Printer ..............................73 Z200+ Thermal Printer Specifications ........................

  • Page 19: Introduction Section

    The software records ECG, heart rate, and ST data, creates summary tables, trends and a final report regarding a variety of cardiac data indices. The cardiac data provided by X-Scribe is reviewed, confirmed, and used by trained medical personnel to assist in the diagnosis of the electrocardiographic data reflecting the patient’s physiological condition during stress exercise testing.

  • Page 20: System Description

    NIBP without SpO Miscellaneous System Information  X-Scribe is capable of supporting the following video resolutions: 1280 x 1024 at 16M colors, 1920 x 1080, and 1920 x 1200.  X-Scribe is capable of supporting HP LaserJet printers with 600 dpi and PCL5 capabilities, and Mortara Instrument’s Z200+ thermal printer.

  • Page 21: X-Scribe System

    SECTION 1 X-Scribe System Figure 1-1 X-Scribe with Laser Printer X-Scribe with Z200+ Thermal Writer and Additional Storage Bin A. Display D. Mouse G. Thermal array printer B. Paper tray E. Storage bin H. Laser printer C. Keyboard F. CPU...

  • Page 22: X-Scribe Specifications

    Device Classification Printer Options High-speed laser printer or thermal array 200 dots per inch Data Acquisition Direct connect or wireless connection using Mortara digital transmitter Thermal array, laser, or network print capability with user-selectable Final Report Export print options External Output...

  • Page 23: Parts And Accessories

    SECTION 1 Parts and Accessories For more information on parts/accessories or to place an order, contact Mortara Instrument. See Appendix A for contact information. Part Number Description 9293-044-50 PAT CBL T12x 10 WIRE AHA SNAPS 9293-044-51 PAT CBL T12x 10 WIRE IEC SNAPS...

  • Page 24: Support Parts

    SECTION 1 Support Parts The following parts can only be ordered by Mortara personnel. Part Number Item Isolation Transformer and Power Cord 1404-002 TRANSFORMER ISOLATION 1000VA MED DOM 3181-008 POWER CORD US/CAN HOSPITAL 5-15P+320-C13 1404-003 TRANSFORMER ISOLATION 1000VA MED INTN'L...

  • Page 25: Setup And Installation Section

    ON position. Connect the isolation transformer to an approved hospital-grade AC power outlet and turn the isolation transformer to the ON position. 5. Start the X-Scribe system by turning on the CPU power button; the program will start automatically. When the Windows screen appears, log onto the system.
  • Page 26 SECTION 2 X-Scribe Interconnect Diagram Figure 2-1...
  • Page 27 SECTION 2 Medical Isolation Transformer Figure 2-2 Product Specifications Frequency: 50/60 Hz Output Ratings: 115/230V 1000VA Weight: 22 lbs. (9.98 kg) Dimensions: Height 5.1” (130 mm) Width 8.0” (203 mm) Depth 11.0” (280 mm) REF: 1404-002 Input 115VAC 50/60 Hz 2x10AT Fused REF: 1404-003 Input 230VAC 50/60 Hz 2x6.3AT Fused CAUTION: Before connecting system components to the isolation transformer, ensure the voltage...
  • Page 28 SECTION 2...

  • Page 29: Starting The X-Scribe

    Turn the system power switch ON. After Windows completes the boot-up sequence, a password will be requested. Enter the system password and the X-Scribe startup screen will appear. If the startup screen does not appear, double click the X-Scribe icon on the computer desktop.

  • Page 30: Using The X-Scribe

    SECTION 3 Using the X-Scribe The X-Scribe performs and documents four phases of a patient’s exercise test: pre-exercise (resting ECG), exercise, recovery, and final report (Report Manager). The X-Scribe uses common computer elements to perform its tasks. The device’s keyboard provides easy means for entering patient ID information at the start of the test as well as comments in the Final Report phase;...
  • Page 31 SECTION 3 At the start of a stress test, the X-Scribe will acquire an initial 12-lead dominant QRS complex and use it to build the first QRS template for all 12 ECG leads. The X-Scribe will update the average QRS waveform for each of the 12 leads after every beat.
  • Page 32 SECTION 3 The user can choose from several rhythm display screens:  3-LEAD DISPLAY WITH ZOOMED ST ANALYSIS AND TRENDS Three channels consisting of 7.5 seconds of three user-defined leads with 24” display  3-LEAD DISPLAY WITH ZOOMED ST ANALYSIS WITHOUT TRENDS Three channels consisting of 10.5 seconds of three user-defined leads with 24”...
  • Page 33 SECTION 3 During the Recovery phase, X-Scribe will display both a “PATIENT” and a “COMMENTS” icon which allows the user to define and enter data into the final report or narrative summary. At the end of the Recovery phase, the Report Manager will display a summary page that allows the user to define and create the final report.

  • Page 34: User Interface

    Selected 12-lead ECGs User Interface The X-Scribe display is designed to offer the same feeling as a control panel with buttons. Each command is a button accessible via mouse, keyboard, or optional remote keypad (used for treadmill and automatic BP device control).

  • Page 35: System Display

    SECTION 3 System Display Figure 3-2 Total Exercise Stage Time/ Protocol Treadmill Speed/ Patient Name Time Stage Name Grade % or Watts Heart Rate, % of Target HR, and Max HR to be obtained ST Level Blood Pressure, SpO Level and time/phase it was acquired in METs ST/Index...
  • Page 36 ST Profile Displays ST value for the on-screen average in a graph format. When Begin is selected, X-Scribe will acquire and analyze the incoming ECG data to develop the current ST level at the beginning of the procedure. The graph displays the current ST level in black and the reference level in green.

  • Page 37: Function Keys

    Calculates and displays the ST/HR index value in micro-V/bpm. NOTE: ST/HR index value displays only if X-Scribe detects a change in HR by an increase of greater than 10% and any ST depression greater than 100 µV.
  • Page 38 SECTION 3 End or F1 starts the Final Report phase.  Recovery display freezes while test information transfers to system storage.  Report Manager loads and displays final report menu options.  TTL and analog output is maintained in Report Manager. ABORT Abort or ESC will cause the user to exit the Pre-exercise portion of the test and return to the main menu.
  • Page 39 Select EVENT or F4 to display an Event pop-up window. Select an event name from the drop-down menu and click OK to generate a 12-lead ECG. X-Scribe will document the event name on the ECG and hold the event and the 12-lead ECG in memory, reproducing it in the summary page, final report, and minute-by-minute average QRS final reports.
  • Page 40 Use the Continuous Print Speed drop-down menu to choose the paper speed for continuous rhythm printouts. Use the Sync Lead drop-down menu to select the ECG lead used for TTL or analog output. X-Scribe defaults to lead II.
  • Page 41 Click OK to save changes. During the Final Report phase, the user can adjust the QRS onset and/or the QRS offset retrospectively. After the adjustment, X-Scribe generates the final reports in which all ST levels printed correspond to the degree of QRS onset/offset adjustment.
  • Page 42 SECTION 3 RHYTHM Select RHYTHM or F10 to run a continuous rhythm strip. X-Scribe will generate a continuous 6-channel printout of the leads defined in Settings for the particular profile. The rhythm button will change to RHY LEADS. Clicking RHY LEADS switches the printout to the frontal leads (I, II, III, aVR, aVL, aVF); clicking again changes the printout to the precordial leads (V1, V2, V3, V4, V5, V6).

  • Page 43: Patient Preparation

    CONDUCTING A STRESS TEST SECTION 4 Patient Preparation TIP: Leads are attached to the patient cable which connects to the patient module the patient wears during the stress test. If conducting multiple stress tests and if multiple patient cables are available, streamline the process by prepping all patients beforehand.
  • Page 44 SECTION 4 Figure 4-1 NOTE AND CAUTION: Placement of the Left Leg (LL) electrode in the original Mason-Likar position increases the similarity of the acquired ECG with a standard 12-lead ECG and is therefore recommended; however, clothing may interfere with this position and increase the amount of artifact. The modified position may decrease the sensitivity of inferior ECG leads and cause axis shift with respect to the standard 12-lead ECG.
  • Page 45 SECTION 4 Patient Hookup Summary Table AAMI Lead IEC Lead Electrode Position Right side of the sternum in the 4th intercostal space. Left side of the sternum in the 4th intercostal space. Yellow Yellow Midway between V2/C2 and V4/C4. Green Green Left midclavicular line in the 5th intercostal space.

  • Page 46: Using Filters

    AC filter Source Consistency Filter (SCF) Mortara Instrument’s patented Source Consistency Filter (SCF) is an exclusive feature used for reducing noise associated with stress testing. Using the morphology learned during the Pre-exercise phase or during a relearn operation, the SCF distinguishes between noise and the actual signal in each of the 12 leads. This filtering reduces muscle tremor noise, low-frequency and high-frequency noise, and baseline artifact while preserving diagnostic- quality waveforms.

  • Page 47: Conducting A Stress Test

    NOTE: Manual control of any exercise protocol during the test is always available; however, this may cause the X-Scribe to exit the current protocol. Selecting pause will halt the advancement of the current stage. The clinician can re-enter the protocol at the stage and time where the protocol was paused. The pause will be entered into the report for documentation.
  • Page 48 SECTION 4 Work List If equipped with the bidirectional interface option, select Work List followed by Refresh. Download the displayed orders by date, last name, or patient ID, or make a selection from the drop-down list. The drop-down list allows the user to select all orders, today, last three days, or last seven days. Once a selection has been made, select OK to download.
  • Page 49  Exit by clicking OK. Select Begin to begin the Learn phase. The X-Scribe acquires ECG data to develop the patient's cardiac template and uses the template for arrhythmia detection. Once the Learn mode is completed, the Pre-exercise phase will begin.
  • Page 50 The treadmill or ergometer advances the workload to the parameters identified for the first stage of exercise. 1. Allow the X-Scribe to acquire ECGs at the prescribed times set by the protocol being used. 2. Allow the automated NIBP device to obtain NIBP readings at the prescribed times as programmed into the protocol, or manually acquire and enter an NIBP value as your policy requires.
  • Page 51 ECG or F11. At the end of the Recovery phase, click on End to enter the Final Report phase of the test. If configured (see Section 5), X-Scribe will ask “Are you Sure?” Select Yes to confirm end of test or Cancel to return to the test.

  • Page 52: Using Report Manager

    SECTION 4 Using Report Manager Patient Data If patient demographic data has not been entered, enter it now by clicking Patient Data. The Patient Demographics pop-up window will appear. Print Report Use the Print Options drop-down menu to choose the desired printer. Check the Grid box to include grid when printing to a laser printer.
  • Page 53 Select the template icon to display a drop-down window of up to 20 user-definable templates. Upon selecting the desired template, the conclusions window will automatically populate with the appropriate clinical data and be included in the final report. Main Menu Click Main Menu to return to the X-Scribe startup screen.

  • Page 54: Using Archive Manager

    X-Scribe automatically stores the last 100 stress tests including final reports and full-disclosure data. To review and/or edit a saved report, click ARCHIVE from the X-Scribe startup screen (main menu). The Archive Manager screen will appear with all saved reports listed. Use the side scroll bar when the report list exceeds the available onscreen space.

  • Page 55: Reviewing And Printing Pdf Files

    Reviewing and Printing PDF Files To review a PDF file, exit the X-Scribe application. If the file was stored to the local hard drive, use Windows Explorer to locate the directory. If the file was stored to the network, go to the appropriate PC on the network.
  • Page 56 SECTION 4...

  • Page 57: System Configuration Section

    AC Frequency — Use the drop-down menu to select the AC frequency (50 Hz or 60 Hz). Set frequency to that used in the country of operation. (60 Hz for U.S.) RF Channel — Setting must match between the digital transmitter and X-Scribe. To change channels on the digital transmitter, refer to the transmitter user manual.

  • Page 58: Rf Scan (Wireless Option Only)

    To reduce the amount of noise or interference that can be induced while using the wireless option, perform a RF scan. Users must first power off the digital transmitter and then click RF Scan. X-Scribe will scan all channels and display a bar graph showing the RF activity found on each channel. Display values for each antenna, or select Best (using both antennas).
  • Page 59 Running Trends: when enabled, the HR, METs, NIBP, and ST trends are displayed during the test. NOTE: The above options are available only if “Zoom ST Lead” is enabled. If disabled, X-Scribe will use a larger portion of the screen to display ECG rhythm data.
  • Page 60 12 Lead Average: when enabled, the 12 median average beats appear on all 12-lead ECG printouts.  Use the drop-down menu to choose the desired printer: choose Z200+ to use the Mortara thermal printer (Grid check box is disabled); choose Default Printer to use the default printer currently set in Windows (Grid check box can be selected for grid printing);...
  • Page 61 Export Directory: multiple export directories may exist to allow the export of final reports across the network.  Export Format: select PDF, Mortara XML, Alternate 1 XML, TIFF, or DICOM.  Request Directory: type the desired path to receive patient demographics from a hospital information system or other appropriate medical records device.

  • Page 62: Exercise Protocols

    SECTION 5 Exercise Protocols As with User Profiles, users can create, modify, or delete an exercise protocol. Click Settings on the X-Scribe main menu to access the System Configuration page, and then select the Exercise Protocols tab. When all options have been set as desired, select OK. You can select a specific protocol to use for the next stress test. This protocol remains selected until you select another protocol or until you exit X-Scribe.
  • Page 63 ECG Print/BP Measure above. NOTE: When using a device to acquire a BP measurement at the beginning of a stage, X-Scribe will start BP acquisition immediately upon stage start. When acquiring a BP measurement at the end of a stage, X-Scribe will start acquisition one minute before stage end enabling the BP measurement to be printed on the ECG printout.

  • Page 64: Network Data Export And Import (Request Directory)

    SECTION 5 Network Data Export and Import (Request Directory) If the Network option has been installed on the X-Scribe, users may export data to a compatible management system or other systems that accept PDF, XML, TIFF, and/or DICOM files. 1. Select Settings.

  • Page 65: Setting A Standard User Configuration

    To ensure network communication continues to function as intended, the system can be configured to run as a standard user that will prompt for an Administrator password. CAUTION: When running X-Scribe under any user other than Local Administrator, the network card may not be correctly disabled when performing a stress test which may cause unintended behavior.

  • Page 66: Drop-Down Menu Overview

    Entries should be entered in the format and order they should appear in the drop-down menu. When finished with a category, select File followed by Exit. Select Yes, No, or Cancel when prompted to save. Exit the X-Scribe application. From the main Windows display: 1. Select My Computer 2.
  • Page 67 SECTION 5 10. Conclusions1.txt NOTE: Up to 20 Template Summary reports can be created with each having their own particular label if so desired. The label will be formulated under the progressive folders of Conclusions2.txt, Conclusions3.txt, and so on. To create a title to be included in the drop-down window (such as Normal study), type “#” followed by the desired title on the first line (“#Normal study).
  • Page 68 SECTION 5 <MaxMets> maximum METs obtained during test <ReasonsForEnd> reason the test ended <DukeScore> calculated Duke Score <Fai> Functional Aerobic Impairment 11. DiagnosisList.txt Enter desired diagnoses. 12. Dose.txt Enter desired pharmacological protocols (Persantine, Dobutamine, etc.). 13. Drug.txt Enter medication names associated with the defined pharmacological protocols along with the dose and route in which they will be administered.

  • Page 69: Maintenance And Troubleshooting

    Broken lead wire/cable. Replace patient cable. Channel of transmitter doesn’t match Match channel of transmitter to channel on X-Scribe. channel of X-Scribe. Muscle noise Electrode placed over muscle or fatty Find stable electrode site, re-prep tissue.
  • Page 70 Cause Correction Treadmill does not respond to Equipment powered up in wrong Turn treadmill OFF using Softkey the ON command from X-Scribe sequence. menu. Turn power to the treadmill OFF. Wait one minute and turn Treadmill power switch off, or power back ON.
  • Page 71 No signal onscreen With the patient connected (or with a Check that X-Scribe and the digital simulator) no waveforms are transmitter work on the same displayed, but only the squared channel. Refer to the transmitter...
  • Page 72 The TRPC or EPC is not recognized TRPC or EPC is not compatible with Manufacturer” due to an incorrect installation or lack X-Scribe V3.10. Will need MMM of installation of the device driver. device and drivers. No signal from M12-USB USB cable is unplugged.

  • Page 73: System Information Log

    In addition to having records of this information, the system information provides a warranty record of when your system was placed in service. A warranty card is also included with the system documentation. It is imperative that it is filled out and returned to Mortara Instrument, Inc. System Information Log Manufacturer: Mortara Instrument, Inc.
  • Page 74 APPENDIX A...

  • Page 75: Protocols

    PROTOCOLS APPENDIX B The following protocols are delivered with every X-Scribe:  Bruce  Modified Bruce  Naughton  Modified Balke  High Ramp  Medium Ramp  Low Ramp  USAF/SAM 2.0  USAF/SAM 3.3  Astrand (Ergometer) ...
  • Page 76 APPENDIX B PROTOCOL: BRUCE STAGE NUMBER DURATION SPEED GRADE Pre-Exercise ---- 3:00 10.0 3:00 12.0 3:00 14.0 3:00 16.0 3:00 18.0 3:00 20.0 3:00 22.0 Recovery ---- 2:00 1:00 PROTOCOL: MODIFIED BRUCE STAGE NUMBER DURATION SPEED GRADE ---- Pre-Exercise 3:00 Begin 3:00 Begin...
  • Page 77 APPENDIX B PROTOCOL: NAUGHTON STAGE NUMBER DURATION SPEED GRADE Pre-Exercise ---- 2:00 2:00 2:00 2:00 2:00 10.5 2:00 14.0 2:00 17.5 ---- 2:00 1:00 Recovery PROTOCOL: MODIFIED BALKE STAGE NUMBER DURATION SPEED GRADE Pre-Exercise ---- 1:00 1:00 1:00 1:00 1:00 1:00 1:00 1:00...
  • Page 78 APPENDIX B PROTOCOL: HIGH RAMP TIME STAGE NUMBER SPEED GRADE Rest/Recovery 0:30 0:30 10.0 0:30 10.0 0:30 10.0 1:00 11.0 0:30 11.5 0:30 12.0 0:30 12.5 0:30 13.0 1:00 13.5 0:30 14.0 0:30 14.0 0:30 14.5 0:30 15.0 1:00 15.5 0:40 16.0 0:40...
  • Page 79 APPENDIX B PROTOCOL: MEDIUM RAMP TIME STAGE NUMBER SPEED GRADE Rest/Recovery 0:30 0:30 0:30 0:30 1:00 0:30 0:30 0:30 0:30 1:00 10.0 0:30 11.0 0:30 11.5 0:30 12.0 0:30 12.5 1:00 13.0 0:40 13.5 0:40 14.0 0:40 14.5 0:40 15.0 0:40 15.5 0:40...
  • Page 80 APPENDIX B PROTOCOL: LOW RAMP TIME STAGE NUMBER SPEED GRADE Rest/Recovery 0:30 0:30 0:30 0:30 1:00 0:30 0:30 0:30 0:30 1:00 0:30 0:30 0:30 0:30 1:00 10.0 0:40 10.5 0:40 11.0 0:40 12.0 0:40 13.0 0:40 14.0 0:40 15.0 0:40 16.0 0:40 17.0...
  • Page 81 APPENDIX B PROTOCOL: USAF/SAM 2.0 TIME STAGE NUMBER SPEED GRADE Rest/Recovery 3:00 3:00 3:00 10.0 3:00 15.0 3:00 20.0 3:00 25.0 PROTOCOL: USAF/SAM 3.3 TIME STAGE NUMBER SPEED GRADE Rest/Recovery 3:00 3:00 3:00 10.0 3:00 15.0 3:00 20.0 3:00 25.0...
  • Page 82 APPENDIX B PROTOCOL: ASTRAND (ERGOMETER) TIME STAGE NUMBER WORKLOAD (WATTS) Rest/Recovery 6:00 6:00 6:00 6:00 6:00 6:00 PROTOCOL: PHARMACOLOGICAL STAGE NUMBER DURATION SPEED GRADE DOSE Pre-Exercise ---- 2:30 3:00 2:30 3:00 2:30 3:00 2:30 3:00 2:30 3:00 2:30 3:00 2:30 3:00 2:30 Recovery...

  • Page 83: Ttl/Analog Output

    TTL/ANALOG OUTPUT APPENDIX C Mortara Instrument provides the capability of interfacing an X-Scribe to a cardiac ultrasound (Echo) imaging system. This function is accomplished through an optional TTL (transistor, transistor, logic) or analog output. WARNING: Equipment connected via the TTL or analog cable must be IEC 60601-1 compliant.

  • Page 84: M12C And M12Rf Analog And Ttl Interface Ports

    APPENDIX C M12C and M12RF Analog and TTL Interface Ports The TTL option requires a BNC male connector on one end with the other end having the connector required by the Echo or device you are interfacing to. The analog option requires a RCA male connector on one end with the other end having the connector required by the Echo device you are interfacing to.

  • Page 85: Direct Connect

    DIRECT CONNECT APPENDIX D X-Scribe offers the capability of using Mortara Instrument’s M12 series “Multi-Modality Module (MMM)” patient interface cable for direct or wireless connection to the patient. Follow patient hookup instructions as previously described in this manual. Connect the M12A or the M12B patient cable to the Multi-Modality Module device.
  • Page 86 APPENDIX D Direct-Connect Module  permits the X-Scribe to function in a wired or tethered mode. This may be accomplished by a direct connection to the MMM ECG port with either the M12A or the M12B patient module. Quick-Connect Module ...

  • Page 87: Treadmill/Ergometer Hookup

    APPENDIX E X-Scribe to Treadmill Hookup Instructions 1.Connect one end of the X-Scribe-to-treadmill interface cable to the top 9-pin serial Com 1 port on the back of CPU, and the other end to the 9-pin serial port on the treadmill.

  • Page 88: Treadmill Remote Keypad

    APPENDIX E Treadmill Remote Keypad Increase Speed: Increases speed by 0.1 mph. Decrease Speed: Decreases speed by 0.1 mph. Increase Elevation: Increases elevation by 1%. Decrease Elevation: Decreases elevation by 1%. 12 Lead ECG: Acquires a 12-lead ECG at any time during Pre-exercise, Exercise, Recovery, or Post recovery.
  • Page 89 APPENDIX E Start Treadmill: Starts treadmill belt at the speed set in the Pre-exercise phase. Stop Treadmill: Stops treadmill.
  • Page 90 APPENDIX E...

  • Page 91: Z200+ Thermal Printer And Supplies

    Z200+ THERMAL PRINTER AND SUPPLIES APPENDIX F Z200+ Thermal Printer The Z200+ thermal printer uses an eight-dot-per-millimeter (dpm) print head to print ECG tracings and report data. Multiple print formats, and standard (8.5" x 11") or A4 thermal paper sizes are supported. The Z200+ thermal printer includes: ...
  • Page 92 APPENDIX F Z200+ Thermal Printer Dimensions and Specifications Figure F-2...

  • Page 93: Z200+ Thermal Printer Specifications

    APPENDIX F Z200+ Thermal Printer Specifications Feature Specification* Instrument Type Thermal printer Paper Type 8 ½” x 11”, cued, perforated, Z-fold with full grid or A4 Recording Technique Computer controlled, thermal dot array, 8 dots/mm Writer Speeds 5, 10, 25, or 50 mm/sec, computer controlled External Ports and Data Networking capability to allow high-speed data transfer for printing Interfaces...

  • Page 94: Setting Up The Z200+ Thermal Printer

    AC connector (for power cord) Integrated network (LAN) connector The Z200+ thermal printer operates on line power and is controlled by a LAN connection to the X-Scribe. To configure the LAN connection for the Printer 1. On the X-Scribe PC, log in as Administrator.

  • Page 95: Maintaining The Z200+ Thermal Printer

    APPENDIX F Maintaining the Z200+ Thermal Printer If the hospital or institution fails to implement a satisfactory cleaning and inspection schedule for this equipment, it may result in equipment failure and health hazards. NOTE: Only qualified service personnel should repair or replace Z200+ thermal printer parts. Inspect the equipment for the following conditions on a regular basis: ...

  • Page 96: Testing Printer Operation

    After cleaning and inspecting the Z200+ thermal printer, confirm the printer is working properly. To test printer operation 1. Using an ECG simulator with the X-Scribe, acquire and print ECGs of known amplitude. A successfully printed ECG report has the following characteristics: 1.

  • Page 97: Loading The Thermal Printer Paper

    APPENDIX F Loading the Thermal Printer Paper Figure F-4 1. Remove the outer packaging from the paper stack. 2. Facing the front of the unit, use the release latch on the left side and slide the paper tray cover to the left. 3.

  • Page 98: A4 Paper Spacer Insertion

    APPENDIX F A4 Paper Spacer Insertion If your Z200+ thermal writer was ordered with A4 paper, the paper-tray spacer will be inserted in the paper tray. If units are purchased with standard paper, the paper-tray spacer will not be provided. To insert the paper-tray spacer: Figure F-5 1.
  • Page 99 APPENDIX F Figure F-6 2. The paper-tray spacer should be parallel to the rear wall of the writer tray as pictured above. 3. Gently press paper-tray spacer in place. NOTE: If you wish to remove the paper-tray spacer, gently press on the top three plastic arms to remove.

  • Page 100: Troubleshooting Chart

    10 seconds to reset the printer. If the problem persists, contact technical service. Check to see that the proper Mortara paper is being used. Uneven printing Possible causes of uneven printing could be the print head itself, the platen, poor or damaged paper, or the mechanical alignment of the print head.

  • Page 101: Remote Review Workstation Setup

    REMOTE REVIEW WORKSTATION SETUP APPENDIX G Mortara Instrument’s remote review workstation works in conjunction with X-Scribe and the Network option. It is recommended that a link between the network, the remote review workstation, and the X-Scribe be accomplished through a shared UNC path for registration.

  • Page 102: Setup And Installation

    APPENDIX G Setup and Installation 1. Place software into the CD-RW drive. 2. Select appropriate language. 3. Follow instructions on display for completion of software installation. 4. Place dongle into any USB port. 5. Connect the Network cable from the PC to the network receptacle. 6.

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