DRCR.net OCT-A Optovue AngioVue Procedure Manual 2.0 9-19-16
DRCR.net Image Acquisition Protocol
Optical Coherence Tomography Angiography (OCT-A) Using: Optovue AngioVue
Version 2.0
September 19, 2016
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Table of Contents Optovue OCT Angiography (OCT-A) Overview ...................................................................................................... 3
OCT-A Technician Certification ............................................................................................................................... 5
2.1 Overview .................................................................................................................................................................. 5
2.2 Patient Management ................................................................................................................................................. 5
Scan Acquisition: Steps to Acquire OCT Angiography Scans .................................................................................. 8
3.1 AngioVue Scan ........................................................................................................................................................ 8
3.2 Scan Optimization .................................................................................................................................................. 10
Exporting ................................................................................................................................................................. 16
4.1. Renaming Subjects prior to Export ..................................................................................................................... 16
4.2 Exporting Data Files .............................................................................................................................................. 16
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Version History Version Author Approver Effective Date Revision Description
1.0 Adam Glassman Lee Jampol 28 July 2016 Initial version of document
2.0 Adam Glassman Cindy Stockdale 19 September 2016
Optovue will certify imagers; exports should be uploaded not zipped, formatting fixes and minor clarifications added
1. Optovue OCT Angiography (OCT-A) Overview
a. Machine: Optovue Avanti XR AngioVue
b. Certification for OCT-A imaging is not required at this time
c. Scan Type:
˗ Two scan settings on the macula: 3x3 mm scan and 6x6 mm scan centered on the
fovea. Each scan setting should include both x-fast AND y-fast images.
˗ One scan setting for the optic nerve: 4.5x4.5 centered on the optic nerve. The scan
for the 4.5x4.5 should include both x-fast AND y-fast images.
d. Select the PATIENT window from the main menu. Select an existing patient or add a new
patient.
e. Click the Scan button to go to the SCAN window.
f. In the SCAN window, select the patient eye to be scanned; Both/OU or Right/OD or
Left/OS.
g. If the DRCR network protocol has been created on your device, click the protocol – the list
of required scans should appear in the patient’s window.
• If the DRCR network protocol has not been created on your specific device, check
all the AngioVue OCT Angiography scans that need to be captured. Then in the
completed scan window, all selected scans will be displayed with capture number
labeled beside.
h. To start a selected scan, use the mouse to double click any selected scan from the
completed scan window.
i. In the new version of eye tracking software, “Eye Alignment” pop up window will show up.
j. Adjust table height to accommodate the subject comfortably as needed.
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k. Have the subject place his/her chin into the correct chin cup with forehead leaning against
the forehead rest
l. Align eye to be scanned vertically with the canthus mark on the side of the chin rest
assembly
m. Ask the patient to look at the fixation target, a blue dot in the red field.
n. Center the video image on the pupil and move the scan head towards the patient,
controlling it so that the video image passes through the pupil. Carefully advance until the
fundus come into view. Figures below show the progression of views as you move the scan
head forward. The box (the scanning region) on the right panel can also be dragged to the
location to best center the image provided the Follow-Up box is unchecked. This is
particularly important for patient with eccentric fixation.
o. Adjust the working distance between the scan head and the patient eye to optimize the
video image. Optimized fundus images should show Optic nerve head clearly visible and
fundus image is illuminated evenly from edge to edge.
p. When the video image is optimized, click “Auto Adjust” button in the new tracking
software (or “Auto All” button) to adjust Polarization, Z offset, and Focus.
q. The enface OCT image as well as the line scan OCT image will show up in two different
windows.
r. Use the mouse wheel to adjust the line OCT image between the two red lines with correct
orientation.
s. If the SSI indicator is not green, adjust the Z axis, Focus or P-Motor functions until the SSI
indicator is green.
t. Capture image - click the joystick button or the on screen green check mark (Once the
joystick button or green check mark is clicked do not try to adjust the live OCT image by
moving the station in and out)
u. When the 1st OCT Angiography has been captured, a pop-up window will show up and ask
if you want to continue to the 2nd MCT (OCT Angiography) scan. At this step, the
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technician should check the image quality and decide to “Continue” or “Rescan” the 1st
scan one more time.
v. If the 1st scan quality is fine, click “Continue” button.
w. Capture image - click the joystick button or the on screen green check mark
x. When the 2nd OCT Angiography is captured, a pop up window will ask if you want to
continue to the MCT processing and save. At this step, the technician should check the
image quality and decide to “Continue and Save” or “Rescan” the 2nd scan one more time.
y. When the 2nd scan quality is fine, click “Continue and Save” button.
z. Please review the OCT Angiography image again. If a scan has poor saturation or is of poor
quality, have the subject blink or apply artificial tears, and repeat the scan. The Signal
Strength (SSI) should be above 50. If the SSI is below 30, the RTVue will not save the data.
aa. All images will be exported via the DRCR.net uploader
Further clarification regarding any information included in this document may be obtained by
contacting the DRCR.net Coordinating Center [email protected] or 813-975-8690.
OCT-A Technician Certification
2.1 Overview
Initially certification will not be required prior to collecting images. However, technicians will be
required to send images to Optovue for review. Each technician who will be using AngioVue OCTA
in DRCR.net trials will send images from two normal eyes and two eyes from a person with
diabetes to Optovue at [email protected]. In the future, technician certification may be
required.
2.2 Patient Management
a. Manage Patient Information
The system application opens by default to the PATIENT window.
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Figure 1 PATIENT Window Items
Figure 1 Legend:
1. PATIENT tab (highlighted)
2. Basic or Advanced Search area
3. Selected patient in list and on title bar
4. Patient list
5. Patient Detail area
6. Visit list (for selected patient)
7. Scan list (for selected visit)
8. Review button
9. OD and OS Retina OverVue buttons
10. Scan button
11. Edit button
12. Add Patient button
13. Advanced or Basic Search link
Use the PATIENT window to create, find, select, edit and delete patients, visits and scans, and to
initiate scanning or scan review. Features of the PATIENT window help you enter patient
information in advance, preview today’s scheduled patients, and search for patients using a
specified date range or other search criteria. The PATIENT list displays search results.
b. Add a New Patient
To add a new patient, click the Add Patient button. The Add New Patient dialog appears, as
shown in Figure 2.
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Figure 2 Add New Patient Dialog
1. Required fields are in bold. Enter the required information and enter other information as
desired. You must enter the birth date in the indicated format.
2. Use the Optional area to enter:
˗ Physician: Use the down arrow to select one or more physicians to associate with
this patient, or select Add New to enter a new physician name and associate it with
this patient.
˗ Operator: Use the down arrow to select one or more operators to associate with
this patient, or select Add New to enter a new operator name and associate it with
this patient.
˗ Visit Comment: Enter desired comments for this patient.
3. Note: You can also create, edit and delete physicians, operators or diseases by selecting
Physician, Operator or Disease from the Database Management menu.
4. Use the Disease Category area to associate one or more user-defined diseases with this
patient. Once they are created, you can search for patients by disease category. To create
disease categories, click Add New to display the Disease Category Editor dialog, enter a
disease name and click OK.
5. When you finish entering information for the new patient, click Save to save the new
patient and close the dialog, or click Scan to initiate scanning for this new patient. Click
Cancel to discard entered information and close the dialog.
a. Edit Patient Information
1. To edit patient information, select the patient name from the Patient list and click the Edit
button. The Edit Patient/Visit Info dialog appears.
2. Edit the fields as desired.
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3. Click Save to save your changes.
4. Click Cancel to discard the edits and close the dialog.
Figure 3 Edit Patient Dialog
Scan Acquisition: Steps to Acquire OCT Angiography Scans
Note: We recommend you clean the chinrest and forehead rest between patients with a
disinfectant. For example, wipe with an isopropyl alcohol pad or with another germicide using a
clean cloth.
3.1 AngioVue Scan
1. Scan Window (older models may have different view)
a. From the PATIENT window, select an existing patient or add a new patient, then click the Scan
button to go the SCAN window (Fig. 4)
2. Scan Parameters
a. In the SCAN window, select the patient eye to be scanned. Both/OU is selected by default.
To change, click the Right/OD or Left/OS button.
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Figure 4 Scan Selection Options
b. Select the AngioVue OCT Angiography scan type, Angio Retina 3x3 mm, Angio Retina 6x6
mm, and Angio Disc 4.5mm scans. When you finish your selections, click the Scan button
to begin scanning. Ensure that both the x-fast and y-fast images are obtained for
each of the 3 scan settings above.
a. A scanning protocol can also be created to use in the future by clicking Database
Management => Protocol => Add. Once a scanning protocol is created it can be
used by selected the Scan Selection tab
c. During the follow up scanning, the operator should repeat any previous scan for a patient
by double-clicking on the scan name in the Scans list of the PATIENT window.
d. Position the patient correctly as follows:
˗ Chin on the system chin rest with teeth together
˗ Forehead against the forehead rest
˗ Eye to be scanned aligned vertically with the canthus mark on the side of the
forehead and chin rest assembly.
˗ Ask the patient to look at the fixation target, a blue dot in the red field.
e. Center the video image on the pupil and move the scan head towards the patient,
controlling it so that the video image passes through the pupil. Carefully advance until the
fundus comes into view. The figure below shows the progression of views as you move the
scan head forward.
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Figure 5 Video Image Progression as Scanner Approaches Eye
f. Alternate view for some AngioVue models, from Scan Selection menu bar select AngioVue
Retina scan and 3D Clinical under the Retina category and Select AngioVue Disc under
Nerve Fiber Layer. When prompted select 3x3 mm and 6x6 mm for the retina scan and 6x6
mm for the disc scan.
Figure 6 SCAN Selection
3.2 Scan Optimization
a. Adjust the working distance between the scan head and patient eye to optimize the video
image. Optimized fundus images and optic disc images should be illuminated evenly from
edge to edge.
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Note: For fundus imaging, make sure to set the working distance first. If a live OCT scan appears in
the scan window, do not stop forward movement of the camera until you achieve a good infrared
(IR) video image of the fundus.
Figure 7 Optimize Working Distance
b. When the video image is optimized, Click Auto Adjust to optimize scan signal strength and
image quality.
IR video image showing scan
pattern overlay
En face image
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A. B.
Figure 8 Auto Adjust
Options:
A. Pop-up window appearing when aligning the IR image.
B. Permanent button.
˗ Auto Adjust executes Auto Z, Auto F and Auto P in combination. Auto All also tries to place
the scan image in the target area between the red dashed lines. Figure 8 shows an
example of a scan centered vertically. If the scan is not between the red dashed lines but
visible in the window, click once in the scan window and scroll the mouse wheel to bring
the OCT scan between the red dashed lines. This image is also upside down. This means
that the working distance is too close. In this case the joystick should be pulled back and
Auto Adjust repeated so the scan is right side up.
Figure 9 Example of Scan Centered Vertically
c. On the right side of each live scan, a green bar indicates a good signal strength index (SSI)
value. To capture the scan, either press the joystick button or click the checkmark button
. Once you click the joystick button or the on screen green check mark. Do not try to
adjust the live OCT image by moving the station in / out / left / right.
Green bar shows good
signal strength
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d. After the first scan capture (fast X), review the scan images for quality and completeness.
Then continue to capture the fast Y scan, click the Continue button.
Figure 10 Review Fast X scan (lower left) and Rescan or Continue
and Capture OCT Angiography Fast Y Scan
e. To capture the Fast Y scan, either press the joystick button or click the checkmark button
.
f. After the second scan capture (fast Y), review the scan images for quality and
completeness.
g. When both scans don’t have black lines, click the Continue and Save button.
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Figure 11 Review OCT Angiography Fast Y Scan (upper right) and Rescan
or Save Both Scans
h. After the MCT merge the fast X and fast Y OCTA scans, the final OCT Angiography scan
image is ready to review. The scan will be saved in the patient’s file.
Figure 12 Review complete OCTA images
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i. When you are done one scanning, continue to capture other OCT Angiography scans for the
patients.
3. Follow-up Mode
Figure 13 Follow-up and Tracking Mode Buttons
Follow-up mode is on when its checkbox is checked, and off when it is unchecked (see Figure ).
When you are repeating a scan done on a previous visit for this patient, you can use Follow-up to
repeat the scan location and rotation of the previous scan. Repeat scans using Follow-up cannot
be moved or rotated. Turning Follow-up off allows you to move or rotate the scan. Follow-up
mode does not take into account changes in fixation relative to the previous scan.
Note: You may have to guide the patient’s fixation to achieve alignment of the scan to the
previous visit.
In Follow-up mode, the cross-hair on the IR image is red if alignment is not correct, and green
when alignment is correct. The capture button turns green only when the cross-hair is green,
indicating correct alignment. If you want to scan a different location, turn off follow-up mode.
NOTE: Sometimes even with correct alignment, cross hair remains red if signal to noise ratio is
poor. In this case there is no choice but to turn off FOLLOWUP mode.
4. Tracking Mode
Tracking helps to maintain scan placement when the patient blinks or moves their eye. Tracking is
on when its checkbox is checked, and off when it is unchecked.
A good IR image of the fundus is important when tracking is on, because the system tracks image
details to maintain scan placement. Figure 16 below shows examples of good and poor IR fundus
images.
Figure 14 Good IR Image (Left) and Poor IR Image (Right)
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The capture button turns green only when a good fundus image is present. A small green cross on
the IR image indicates good tracking, and a red cross indicates poor tracking. During scan capture,
a small progress bar at bottom left shows scan progress. If scan capture takes longer than
expected because tracking is on, you can turn tracking off during scan capture, and the system
captures remaining scans with tracking off.
Exporting
4.1. Renaming Subjects prior to Export
a. Identifying subject information must be anonymized before sending to the FPRC.
˗ Select Patient tab and Edit.
˗ Enter anonymized information using the following format and select Save.
Last Name: Study Name
First Name: Subject #
Date of Birth: 1/1/1900
4.2 Exporting Data Files
a. Navigate to top left corner TOOLBAR > File > Data Transfer > Output Data
b. A window will appear as seen below. Select destination to save the export.
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c. Create a new folder on the desktop by right clicking and selecting “New” > “Folder.” Name
the new folder according to the labeling convention, click “Save”
d. A new screen will appear. To search for the correct subject, enter their name in the
“Search” area (circled in red below). Then select “Search.”
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e. A list of patients that meet the search criteria will appear on the left side of the screen.
Find the subject and select the correct visit date.
f. Since patient names and identifiers are not in the OCT machine but patients are named
based on study and site number, do not select ‘anonymous’ on the export since this will
re-name the patient.
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g. Select “Start Output.
h. The following screen will pop up if the export has successfully completed. Select “OK.”
i. Select “Save and Exit.”
You should see the following contents when you open the folder to which you exported the
patient data. Upload the folder with all three contents through the DRCR.net Upload Application.