BioVIEW Suite P
Automated Chicago Analysis
Advanced Analysis Tutorial
Automated Chicago Classification
Analysis
Objectives
• Define the different Chicago Classification analysis marks and
what they measure
• Explain the how to activate a measurement and display
Chicago analysis marks
• Demonstrate how to adjust the Chicago analysis marks
• Discuss the appropriate order of operation between Chicago
and conventional analysis
• Describe the Chicago analysis data on a report
Suite P Highlights
• Chicago measurements are automatically marked in the study
• The Chicago analysis marks are seen using the analysis tool in the contour
view
• The Chicago marks show when the waveform is off
• The conventional marks show when the waveform is overlain on top of
the contour
• The Chicago marks are visible in the active measurement (don’t vanish)
• The Chicago values populate to the report if the Chicago table option is
checked
Muscle Segments
The striated muscle segment extends 1-2 cm
below the UES
The smooth muscle segment extends
from below the proximal pressure trough
(or below the striated muscle if there is no
visible pressure trough) through the distal
esophagus and includes the LES
All of the Chicago analysis marks are
made in the smooth muscle segment
of the esophagus
Contractile Deceleration Point
CDP
CDP
The CDP is found 1.5 - 2cm above the proximal margin of the LES
Isobaric Contours
The CFV and the DL
(the two marks that use the CDP)
use the 30 mmHg isocontour
The DCI and PB use the
20 mmHg isocontour
The black contour line should be set at 30 mmHg and
the blue or gray contour line should be set to 20
mmHg
Temperature Compensation
Required for Chicago Analysis
-
-
Click the curser just
after extubation while
the probe is still warm
Click on Edit
Scroll to and click on
Create Compensation
- The flashing line can cross blue, green or
yellow
- The line should not cross red or orange where
the probe was touched
- The area where the curser
was clicked turns all light
blue if the compensation
was done correctly
- If it isn’t, delete and re-do
-
To check if a
compensation has
been done already
on this study, click
Edit
-
If Create and Delete
are both darkened, it
has been done and
need not be
repeated
Waveform button raised (off)
Waveform button depressed (on)
When the waveforms are overlain,
the analysis will be conventional
When the waveforms are off,
The analysis will be Chicago
Display of the Chicago Analysis Marks
•
IRP – Integrated Relaxation Pressure
•
DCI – Distal Contractile Integral
•
DL – Distal Latency
•
PB – Peristaltic Break
•
CFV – Contractile Front Velocity
IRP – Integrated Relaxation Pressure
•
Integrated Relaxation Pressure (IRP) is a measure
of the extent of relaxation of the lower
esophageal sphincter
•
The IRP, measured in mmHg, is a box starting at
the onset of swallow (start of relaxation of the
UES) a little above the proximal edge of the LES
•
It is drawn to the right until the distal end of the
contraction wave reaches the LES or
approximately 10 seconds if no contraction is
seen
•
It is also drawn down to envelope the thickness
of the LES. The values here are compared to a
quiet gastric baseline below the swallow.
•
The IRP box must be at least 4 seconds wide as
the 4 seconds of maximum relaxation are
measured after the swallow is initiated
DCI – Distal Contractile Integral
• The Distal Contractile Integral (DCI)
is a measure of contractile vigor.
• The DCI is a box circumscribing the
amplitude, duration and length of
the smooth muscle swallow
propagation as a 3D topographic
value
• The value considers all data within
the 20 mmHg isocontour
• It is measured in mmHg x sec x cm
DL – Distal Latency
• Distal Latency (DL) is a measure
of peristaltic timing
• The DL is the time, in seconds,
from the onset of swallow (start
of UES relaxation) to the CDP
using the 30 mmHg isocontour.
PB – Peristaltic Break
•
Peristaltic Break (PB) is a measure of
peristaltic integrity
•
The PB, measured in centimeters, is a
break in the 20 mmHg isocontour
•
In a given swallow there may be no
break in integrity or there may be a
break in the proximal, mid or distal
esophagus
•
If there is more than one break in a
single swallow, measure the longest
break to best represent fragmentation
in the contraction.
CFV – Contractile Front Velocity
•
Contractile Front Velocity (CFV) is a
measure of contraction velocity in the
peristaltic phase of the smooth
muscle contraction sequence
•
Proximal and distal points on the front
(left) edge of the 30 mmHg isocontour
along a large intact segment of the
smooth muscle are connected with a
tangent
•
The slope of this tangent is the CFV
•
The CFV, measured in cm/sec, runs
from just below the proximal pressure
trough (or below the striated muscle
segment if no pressure trough is seen)
to the CDP.
Symbols for Adjusting Chicago Analysis Marks
Adjustment of the Chicago analysis marks is quite intuitive. The curser changes to
different symbols to indicate that a certain mark can be adjusted with a left
click and drag.
A white arrow will
adjust margins of
either an
IRP or DCI
box
A quad white
arrow positioned
in the lower right
corner of the
circle will adjust
either end of the
CFV
tangent
A plus symbol
will adjust either
end of a
DL or PB
line
Analysis Marks – Orientation, Add/Delete
and Linked
• It doesn’t matter what the orientation is of the various marks. The reported
values stay the same no matter which side of a line or box is up, down, left
or right
• To add a mark, right click inside the swallow measurement and
select
• To delete a mark, right click on a line or margin of a box and
select delete
• Measurements that share same data points will move together when a mark is
adjusted
• When the lower mark of the CFV is moved, the right end of the DL moves
with it because they both share the CDP
• When the upper edge of the IRP box is moved, the lower edge of the DCI
box moves with it because they both share the proximal edge of the LES
(The lower edge of the DCI can be moved separately without bring the
upper edge of the IRP along)
Analysis, Editing and Re-analysis
When the analysis tool is activated for the first time by clicking on the analysis
tool icon – the small black microscope - the computer analyzes the study both
conventionally (waveform) and in the Chicago format (contour)
A reviewer can move (edit) the analysis marks placed by the computer
You may choose to re-analyze all of the measurements in a study or just a selected
measurement. Re-analyzation will revert the analysis marks back to the where the
computer originally placed them.
But, if you are not aware what moves may lead to re-anlyzation, you may inadvertently
make a change.
If the reviewer wants the corrected data on the report, the measurement will have to be
re-edited
Re-analyze All Measurements
There are a few ways to re-analyze
(return to computer analysis)
All of the Measurements
and a few ways to re-analyze only a
Selected Measurement
To Re-analyze All Measurements:
• Perform or repeat a temperature compensation (see earlier slide)
OR
• Click on Analyze and Analyze All Measurements
Re-analyze a Selected Measurement
Left click inside of a measurement box to activate this measurement.
Only one measurement at a time can be the active box.
To re-analyze a selected (active) measurement
• Click on Analyze / Analyze Selected Measurement
OR
• Double left click inside the measurement
- When the Change Measurement box opens, click the OK button at the bottom
- Clicking the Cancel button will not re-analyze the selected measurement
OR
• Re-size the measurement by left clicking and dragging one of the side margins
IMPORTANT NOTE:
Re-analyzing a measurement in the conventional view will re-analyze the same
measurement in contour and visa versa
Analysis and re-analysis will not move or change the shape of any of the swallow
measurements, change the probe depth or affect the profile events
(PIP, Proximal and Distal)
How to Avoid Inadvertently Re-analyzing a
Measurement
The following steps will help you to avoid unintended re-analyzation
of a measurement:
•
Perform a temperature compensation only once when a study is opened for the first time
•
Review all measurements before editing, by tabbing through them:
• Delete unacceptable multiple swallows
• If needed, re-size any swallow measurements to completely envelope smooth muscle
contraction pressures and make sure all channels are included in the Chicago
measurement boxes
•
If reporting conventional values; complete all waveform edits before editing the Chicago analysis
marks
• Often, in waveform editing, the GBL is adjusted and Analyze All Measurements is clicked so the
LESP and LES residuals will use the new GBL.
• If the Chicago marks were edited, and then the GBL moved and Analyze All Measurements is
selected, the Chicago marks will revert to their original positions.
•
If an individual Chicago measurement is re-analyzed after the waveform edits have already been
done, you will need to flip back to waveform and re-adjust the conventional marks for this
measurement again.
This Concludes the Advanced Analysis Tutorial
Automated Chicago Classification
Analysis
The following documents are attached to
this tutorial available for download
• Chicago Classification Quick Start Guide
• Chicago Marks: Re-analysis