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Operating Manual: Orthospec
Operating Manual: Orthospec
OPERATING MANUAL
REVISION B
OrthospecTM Operating Manual OR‐3‐X400 Rev B
Page 2 of 40
OrthospecTM Operating Manual OR‐3‐X400 Rev B
This manual is the property of MEDISPEC LTD. and may not be transferred or
reproduced in any form without the written permission of the company. This
manual is produced under the copyright laws of USA.
Treatment procedures and clinical practices specified in this manual should be
considered as recommendations only and must be determined and implemented by
the physicians supervising the treatment.
This manual may be amended by the company without prior notice at any time.
Warning: Product liability claims, warranties as well as guarantees made by
Medispec with respect to the product are voided, if it is not used, serviced or
maintained in accordance with the instructions in this manual.
Yigal Hahamov
I am approving this document
Nov 5 2015 10:59 AM Page 3 of 40
OrthospecTM Operating Manual OR‐3‐X400 Rev B
LABELS AND SYMBOLS
Manufacturer
Manufacturing Date
This label indicates that the user must refer to the Warnings
Section
Danger Very High Voltage
Type BF applied part classification
Equipotential Terminal
Consult Instructions for Use
Electrical and Electronic Equipment. Do NOT dispose of in the
Municipal Waste Stream
Keep away from sunlight
Store in atmospheric pressure range of 700‐1060 hPa
Store in relative humidity range of 10‐90%
Store in temperature range of 0‐40OC
Date of expiry
Contains natural rubber latex which may cause allergic reactions,
including anaphylactic responses
Page 4 of 40
OrthospecTM Operating Manual OR‐3‐X400 Rev B
Table of Contents
1 Introduction .................................................................................................................................... 7
1.1 Indications for Use ................................................................................................................. 7
1.2 Contraindications .................................................................................................................. 7
1.3 Warnings ........................................................................................................................ 7
1.4 Precautions ........................................................................................................................ 8
1.5 Adverse Events ...................................................................................................................... 8
1.6 Potential Adverse Events ....................................................................................................... 9
2 DESCRIPTION ................................................................................................................................... 9
2.1 Power Unit ...................................................................................................................... 11
2.2 Shockwave Head ................................................................................................................. 11
2.2.1 Electrode ......................................................................................................................... 11
2.2.2 Membrane ...................................................................................................................... 12
2.3 Maintenance Door ............................................................................................................... 13
2.4 Connections Panel ............................................................................................................... 14
2.5 Water System ...................................................................................................................... 14
2.6 Limb Support Assembly ....................................................................................................... 15
2.7 User Control Panel ............................................................................................................... 16
2.7.1 Main / Treatment Screen ............................................................................................... 17
2.7.2 Information Screen ......................................................................................................... 25
2.7.3 Technician Screen ........................................................................................................... 26
2.7.4 Time Screen .................................................................................................................... 26
2.7.5 Error Messages ............................................................................................................... 27
2.7.6 Availability of Functions During Treatment .................................................................... 27
2.8 Consumables ...................................................................................................................... 27
3 OPERATION ................................................................................................................................... 28
3.1 Initial Preparations .............................................................................................................. 28
3.1.1 Electrode ......................................................................................................................... 28
3.1.2 Solution ........................................................................................................................... 28
3.2 Setup ...................................................................................................................... 28
3.3 Treatment Procedure .......................................................................................................... 29
3.4 Membrane Cleaning ............................................................................................................ 29
3.5 Setup for the Next Patient ................................................................................................... 30
3.6 Shut‐Down Procedure ......................................................................................................... 30
3.6.1 Between Treatments on the same day ........................................................................... 30
3.6.2 At the end of a treatment day ........................................................................................ 30
4 MAINTENANCE .............................................................................................................................. 31
4.1 Device Check‐Up .................................................................................................................. 31
4.2 Electrode/Tip Replacement ................................................................................................. 31
4.2.1 Electrode Spanner .......................................................................................................... 31
4.2.2 Replacement procedure ................................................................................................. 32
4.2.3 Electrode Calibration ...................................................................................................... 32
4.3 Membrane Replacement Procedure ................................................................................... 33
4.4 Reservoir Draining / Filling .................................................................................................. 33
4.5 Cleaning the filter ................................................................................................................ 34
4.6 Cleaning the Touch Panel .................................................................................................... 35
4.7 Maintenance Schedule ........................................................................................................ 35
4.8 Expected Service Life ........................................................................................................... 35
5 TROUBLESHOOTING ...................................................................................................................... 36
6 PRODUCT CONTACT INFORMATION ............................................................................................. 38
APPENDIX 1: TECHNICAL SPECIFICATIONS ............................................................................................. 39
APPENDIX 2: ENVIRONMENTAL AND TRANSPORT REQUIREMENTS ...................................................... 40
APPENDIX 3: ACOUSTIC PARAMETERS ................................................................................................... 40
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
List Of Figures
Figure 2‐1: OrthospecTM ‐ rear view ....................................................................................................... 10
Figure 2‐2: OrthospecTM ‐ Front view ..................................................................................................... 10
Figure 2‐3: Multi‐use electrode and the single use tip ........................................................................... 12
Figure 2‐4: shockwave head covered with membrane .......................................................................... 12
Figure 2‐5: Open Maintenance Door – access for internal components ................................................ 13
Figure 2‐6: Connections Panel ................................................................................................................ 14
Figure 2‐7: Water reservoir (with closed and opened cover) ................................................................ 15
Figure 2‐8: Limb Support Assembly ........................................................................................................ 16
Figure 2‐9: User Control Panel ............................................................................................................... 17
Figure 2‐10: Main Screen – Idle mode .................................................................................................... 17
Figure 2‐11: Main Screen – Operation button enabled .......................................................................... 18
Figure 2‐12: Main Screen – Treatment mode ........................................................................................ 18
Figure 2‐13: Main window (countdown mode) ...................................................................................... 20
Figure 2‐14: Energy level display ............................................................................................................ 20
Figure 2‐15: Window for presetting the Countdown Counter ............................................................... 21
Figure 2‐16 (A): Countup mode .............................................................................................................. 21
Figure 2‐16 (B): Countdown mode ......................................................................................................... 21
Figure 2‐17: Reload button ..................................................................................................................... 21
Figure 2‐18: Open door buttons ............................................................................................................. 22
Figure 2‐19: Maintenance Door Movement Control Screen .................................................................. 22
Figure 2‐20: Door movement control screen ......................................................................................... 23
Figure 2‐21: Maintenance Door Movement Control Screen .................................................................. 23
Figure 2‐22: OrthospecTM heigh adjustmement buttons ........................................................................ 23
Figure 2‐23: Frequency button ............................................................................................................... 24
Figure 2‐24: Information Screen (with total pulses displayed) .............................................................. 25
Figure 2‐25: Information Screen (Membrane Date Counter is red) ....................................................... 26
Figure 2‐26: Membrane and Filter Counter Reset buttons .................................................................... 26
Figure 2‐27: Time Screen ........................................................................................................................ 27
Figure 3‐1: Reservoir Drain Port ............................................................................................................. 30
Figure 3‐2: Reservoir Draining Valve Lever ............................................................................................. 30
Figure 4‐1: Electrode spanner ................................................................................................................ 31
Figure 4‐2: Tip unscrew / screw.............................................................................................................. 32
Figure 4‐3: Electrode tip alignment ........................................................................................................ 32
Figure 4‐4: Calibrating the electrode ...................................................................................................... 33
List of Tables
Table 3‐1: System Indicators .................................................................................................................. 19
Table 3‐2: Operation button statuses .................................................................................................... 24
Table 3‐3: Screen Tabs ............................................................................................................................ 24
Table 3‐4: Function avalability during treatment ................................................................................... 27
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
1 INTRODUCTION
The OrthospeTM is a device designed to deliver extracorporeal shock waves therapy
(ESWT).
1.1 Indications for Use
The OrthospecTM is indicated for applying shock wave energy to the muscle,
connective and bone tissues for pain relief and tissue regeneration.
1.2 Contraindications
1. Patients in whom pregnancy is confirmed or suspected.
2. Over or near bone growth centers until bone growth is complete.
3. When a malignancy is known to be present in or near the treatment area.
4. Patients having severe tears of tendon or fascia.
5. On any implanted device that releases substances or medications to the
periphery (such as Insulin pump) and is implanted in the area to be treated.
6. History of latex allergy or allergy to coupling solution.
1.3 Warnings
1. The operator should avoid directing the device's focal point to main nerves or
vessels.
2. The operator should avoid directing the device's focal point to the eye.
3. Treatment of the following patients shall be subjected to the treating
physician discretion:
Patients having INR > 2.5, prolonged partial thromboplastin time (PTT) or
prolonged bleeding time and platelet count less than 100,000 per
microliter.
Patients receiving an anticoagulant or antiagregant therapy (e.g., aspirin).
4. Treatment of patients with skin infection in the treatment area should be
taken with extreme precautions in order to avoid cross‐contamination.
5. Pacemaker or implantable defibrillator: To reduce the incidence of
malfunction to a pacemaker or implantable defibrillator, a distance of at least
45 cm shall be kept between the shockwave head and the implanted device.
Otherwise, the pulse generator should be programmed to a single chamber,
non‐rate responsive mode (pacemakers) or to inactive mode (implantable
defibrillators) prior to treatment procedure, and evaluated for proper
function post‐treatment. Do not focus the shock wave through or near the
pulse generator.
6. Extreme caution must be taken in the treatment of patients with pneumonia
especially while treating the shoulder area.
7. If patient experiences severe pain/discomfort at the shockwave application
site during treatment, the operator should consider interruption or
termination of treatment.
8. If patient experiences a vaso‐vagal reaction during treatment, the patient
should be reclined to a supine position until symptoms disappear.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
9. Do not apply shock waves to air‐filled areas of the body, i.e., intestines or
lungs. Shock waves are rapidly dispersed by passage through an air‐filled
interface, which can cause bleeding and other harmful side effects.
10. In case of patient’s history of allergic reaction to alcohol we recommend
using non‐alcoholic disinfectants.
1.4 Precautions
The device should be used only by qualified and trained personnel
under supervision of the physician trained and/or experienced in
the use of this device as outlined in an appropriate training
program.
Electromagnetic interference: This device may cause electromagnetic
interference to electronic devices.
High voltage: The Orthospec generates high‐voltage that can be hazardous
and cause serious injury or death from electric shock. The power unit should
NEVER be opened, except by properly trained and authorized service
personnel.
Maintenance: For continuous and safe operation, regular maintenance and
inspection by Medispec authorized technicians is required. For the
maintenance procedures and schedule refer to the Maintenance chapter of this
manual and to the Service Manual.
Fire Hazard: The treatment room must be free of flammable or explosive
substances such as volatile solvents, anesthetic gases, etc.
Coupling Media: Coupling media should be used to couple between the
membrane and patient skin. Use any approved ultrasound gel (such as
Aquasonic 100®) or silicon oil (such as Medispec supplied silicon oil).
Cleaning: In order to prevent cross‐contamination, it is important to follow the
cleaning procedure as described in this manual.
1.5 Adverse Events
During the Orthospec™ clinical study, there were 3 reported cases of adverse
reactions out of 172 treated patients. They included two cases of bruising and one
case of mild local swelling observed by the patient but not by the physician. None of
the adverse events was severe, and none required medical intervention or
subsequent medical care.
Summary of All Adverse Events
Orthospec™ Placebo P‐Value
(N = 115) (N = 57)
n (%) n (%)
Any Adverse Event 3 (2.6%) 0 (0%) 0.55
Bruising 2 (1.7%) 0 (0%) 1.0
Mild local swelling 1 (0.9%) 0 (0%) 1.0
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
1.6 Potential Adverse Events
Potential adverse effects that could occur when using the Orthospec™ treatments
include:
Pain
Petechia
Superficial hematoma
Neurosensory conditions: Hypesthesia or Parasthesia
Rare allergic or sensitive reaction to the coupling solution applied to skin
during treatment, or to the Latex membrane.
Tendon rupture
2 DESCRIPTION
The OrthospecTM (Figures 3‐1 & 3‐2) consists of the following main parts:
Power unit
Shockwave head (covered with membrane)
Maintenance Door
Connections Panel
Water system: reservoir, filter and tubes
Limb Support Assembly
User Control Panel
Handles
Swivel casters with brakes
Consumables & Accessories
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Handles
Shockwave
head and
membrane Power Unit
Limb Support Telescopic column
Assembly (for height adjustment)
Swivel casters with brakes
Figure 2‐1: OrthospecTM ‐ rear view
User Control Panel
Limb Support Assembly
Maintenance Door
Connections Panel
Figure 2‐2: OrthospecTM ‐ Front view
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
2.1 Power Unit
The Power Unit includes High Voltage Generator and other electronic and
mechanical modules.
The High Voltage Generator should be replaced only by authorized
qualified, trained personnel.
Warning:
To avoid risk of electric shock, this equipment must only be connected
to a supply mains with protective earth
Warning:
Power unit contains high voltage generator (HVG). Do not open Power
Unit covers.
2.2 Shockwave Head
The shockwave head is the essential part of the OrthospecTM that generates the
shockwaves and delivers them to the targeted area (Figure 2‐1). It consists of
reflector with electrode and is covered with a membrane. The membrane provides
close contact between the shockwave head and patient's skin and is filled with a
solution supplied from an internal reservoir.
2.2.1 Electrode
The electrode (Figure 2‐3) is the component that produces a spark that creates the
pressure wave. It is a consumable component and contains a single use tip which
should be replaced after a predefined number of shocks were applied (refer to the
maintenance schedule). When reaching this number the System Status Indicator
turns to a warning sign. The electrode is supplied with 20 tips and after using them
the whole electrode must be disposed and replaced. Whenever replacing a tip, the
electrode needs to be calibrated and the single use tip shall be aligned with the
internal electrode tip. The replacement procedure is simple and is described in detail
in the Maintenance chapter of this manual.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Internal electrode tip
Single use tip
Figure 2‐3: Multi‐use electrode and the single use tip
Warning:
Do not use the electrode/tip for more shockwaves than the
specified number as this might damage the device.
2.2.2 Membrane
The membrane (Figure 2‐4) provides close contact between the shockwave head and
patient's skin. An internal reservoir supplies the solution to fill the membrane. Its
inflation and deflation is managed through the User Control Panel. A Yellow dot on
the center of the membrane designates the reflector focal point to which the
targeted area shall be coupled.
The membrane shall be replaced once in 50,000 shockwaves (~12‐13 treatments) or
every 3 months whichever comes first. When its time to replace the membrane the
System Status Indicator turns to a warning sign. It shall be also replaced whenever a
sign of wear or tear is visible. For replacement procedure of the membrane refer to
the maintenance chapter of this manual.
Figure 2‐4: shockwave head covered with membrane
Warning:
Avoid contact of membrane with materials that might cause
damage or degradation.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Warning:
The membrane contains natural rubber latex which may cause
allergic reactions, including anaphylactic responses.
2.3 Maintenance Door
The Maintenance Door (Figure 2‐5) provides access for electrode replacement (a),
filling/draining the internal reservoir (b) and cleaning the filter (c). Its movement is
managed through the User Control Panel. When the Maintenance Door is open the
high voltage is disabled.
The Maintenance Door movement mechanism occupies several safety features to
prevent from fingers getting caught inside:
1. Safety sensor that opens the door whenever an object is sensed by the door.
2. Warning "beep" that sounds during door closing.
3. Blinking icon is displayed during door closing.
(a) (b) (c)
Figure 2‐5: Open Maintenance Door – access for internal components
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Warning:
Keep your hands away while the Maintenance Door is moving.
2.4 Connections Panel
The Connections Panel (Figure 2‐6) is located at the bottom of the front side of
OrthospecTM. It includes the following:
Main Power Switch – for turning the device ON/OFF
Fuses housing – Main fuses location (220V‐5A or 110V‐10A)
Power Cable Socket ‐ To connect the power cable
Equipotential Terminal ‐ For connecting the Orthospec™ ground to external ground.
Fuses
Housing
Equipotential
Terminal
Power Cable Main Power
Socket Switch
Figure 2‐6: Connections Panel
Attention!
Replacement fuse must be done by an authorized technician and comply
with the specifications indicated on the device label.
Warning:
To avoid risk of electric shock, disconnect the power cable from the
device and from the mains outlet before replacing a fuse.
2.5 Water System
The water system includes an internal reservoir (Figure 2‐7), tubes connecting it with
the shockwave head, filter, draining tube and draining valve. The maximal capacity of
the reservoir is ~2.5 liters and it should be filled with solution prepared according to
the instructions in the "Operation" chapter below.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
The reservoir needs to be drained daily at the end of each treatment day and the
filter should be cleaned periodically. To learn about draining and filter cleaning refer
to the Maintenance chapter of this manual.
Figure 2‐7: Water reservoir (with closed and opened cover)
2.6 Limb Support Assembly
The Limb Support Assembly (Figure 2‐8) is a removable part that supports the limb
during treatment sessions. This provides optimal contact between the membrane
and the limb.
To attach the Limb Support Assembly to the Limb Support Rod:
1. Release the Limb Support Rod Lever and move the rod to the desired angle
and re‐tighten the lever.
2. Slide the Limb Support Assembly onto the Limb Support Rod to the desired
distance from the membrane and tighten the Limb Support Assembly
distance lever.
3. Release the Limb Support Assembly height adjustment lever to adjust the
height and tighten the lever.
4. Before storage and transportation remove the Limb Support Assembly from
its rod, release the rod lever, and move the rod under the main Orthospec
unit.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Height and
distance
adjustment Rod
levers Lever Limb Support Rod
Figure 2‐8: Limb Support Assembly
2.7 User Control Panel
The User Control Panel (Figure 2‐9) consists of a graphic user interface (GUI) and a
standby button. Communication with the GUI is done via a touch screen. The GUI
provides system information, treatment controls and access to several screens and
supportive windows:
Main / Treatment screen (Figures 2‐10, 2‐11, 2‐12)
Window for presetting the Countdown Counter (Figure 2‐15)
Maintenance door Open/close screen (Figures 2‐19, 2‐20, 2‐21)
System Information Screen (Figures 2‐24, 2‐25)
Technician Screen (Figure 2‐26)
Time screen (Figure 2‐27)
During operation, some of the buttons/screens are disabled. A list of the disabled
and/or enabled functions appears at the end of this chapter.
The screen is coated with delicate film and should be operated with
clean fingers. Refrain from pointing on screen with sharp tools.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Figure 2‐9: User Control Panel
2.7.1 Main / Treatment Screen
After the device was turned ON, the main screen (Figure 2‐10) appears. At this stage,
it is in Idle mode: the Operation button is disabled and the high voltage is not active.
System
Indicators Main Window
Operation
Button
Frequency
Button
Membrane
Inflate/Deflate
button
Screen Tabs
Figure 2‐10: Main Screen – Idle mode
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
To enable operation touch the Membrane Inflate button (Figure 2‐11).
Figure 2‐11: Main Screen – Operation button enabled
To proceed to treatment mode change the energy level from zero to the desired
level (Figure 2‐12A) and press the Operation button. Now shockwaves delivery will
start while the Operation button turns green, the Trigger indicator turns blue and
the High voltage indicator turns yellow (Figure 2‐12B).
A: Energy level was set B: High voltage is active
Figure 2‐12: Main Screen – Treatment mode
Note: if the Operation button is pressed while the energy level is zero, the "+" sign
will blink to remind the user to set the energy level.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
2.7.1.1 System indicators
high voltage is not active (default)
High voltage
indicator high voltage is active
shockwave is not active (default)
Trigger indicator
shockwave is active
OK status
System Status System error /warning /failure
Indicator (touch the indicator and a pop up message will appear)
system error – operation is disabled
(touch the indicator and a pop up message will appear)
SWA capacity
SWA with full capacity
indicator
SWA with partial capacity (image changes in accordance
with the changing capacity)
SWA with low capacity (15 % of the maximal capacity)
Empty SWA (no capacity)
Table 3‐1: System Indicators
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
2.7.1.2 Main Window
The Main Window (Figure 2‐13) contains the following buttons: Open/Close
Maintenance Door, Adjust OrthospecTM Height, Energy Level Control, Set Countdown
Counter value and Counter Reset. It displays the total treatment counter, the
accumulated energy delivered, the countdown counter (when using the countdown
mode) and the energy level.
Total number of shocks Accumulated Energy Delivered
Preset
Counter Reset Countdown
value
Set Countdown
Counter value Countdown
Counter
Energy Level
Control Energy level
Display
Open/ Close
Maintenance
Door
Adjust Height
Figure 2‐13: Main window (countdown mode)
2.7.1.2.1 Energy Level Control
There are 10 available energy levels (Figure 2‐14). To change the energy level, touch
"+" or "‐" button.
Figure 2‐14: Energy level display
2.7.1.2.2 Set Countdown Counter
This button allows presetting the initial value of the Countdown Counter or changing
to "Countup" mode. The default value of the Countdown Counter is 3800. To change
this value, touch the Set Countdown Counter button. A new window with numeric
pad will appear (Figure 2‐15). Type a new value and touch Enter to return to the
Main Screen. To set "Countup" mode leave the numeric field empty or type "0" and
then touch Enter to return to the Main Screen.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Figure 2‐15: Window for presetting the Countdown Counter
Figures 3‐16A and B bellow show the Main Screen in "countup" and "countdown"
modes.
Figure 2‐16 (A): Countup mode Figure 2‐16 (B): Countdown mode
(after 6 shocks were applied) 73 shocks (out of 100) left after 27
shocks were applied
When the preset number of shockwaves was completed, shockwaves delivery will
stop and the Set Countdown Counter value button will change to Reload button
(Figure 2‐17). Touch it to reload the Countdown Counter.
Figure 2‐17: Reload button
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
2.7.1.2.3 Open/Close Maintenance Door
The Maintenance Door is used for maintenance procedures (plug replacement and
water system maintenance). The Maintenance Door movement is accompanied by a
repetitive "beep" sound and a blinking icon.
Touching the Open Maintenance Door button brings up another Open Door button
at the bottom of the Main Window (Figure 2‐18).
Figure 2‐18: Open door buttons
Touching this button initiates the Maintenance Door opening and brings up the Door
Movement Control Screen (Figure 2‐19). At the bottom of the Door Movement
Control Screen a red Stop button appears which allows interrupting/stopping the
Maintenance Door movement.
Note:
When the Maintenance Door starts to open, the membrane empties automatically.
Blinking
Figure 2‐19: Maintenance Door Movement Control Screen
When the Maintenance Door is fully opened the Stop button changes to Close
Maintenance Door and the Electrode Counter Reset button appears at the top
(Figure 2‐20). Touch this button each time you replace an electrode/tip. This will
reset the Electrode Counter that counts the number of shocks since the last reset.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Touch to reset
Electrode
Counter
Touch to close
the
Maintenance
Door
Figure 2‐20: Door movement control screen
To close the door, touch the Close Maintenance Door button. The Maintenance Door
will start moving inwards while the button will change back to Stop (Figure 2‐21).
When the Maintenance Door is fully closed the Main Screen appears.
Blinking
Touch to
interrupt door
movement
Figure 2‐21: Maintenance Door Movement Control Screen
2.7.1.2.4 Adjust Height
When the Adjust Height button is touched, two arrow buttons will appear on the
right to allow increasing/ decreasing the OrthospecTM height (Figure 2‐22).
Figure 2‐22: OrthospecTM heigh adjustmement buttons
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
2.7.1.3 Operation Button
The Operation button has three optional statuses which as listed in the following
table:
Enabled for operation. Touch to start
shockwaves delivery
Active during shockwave delivery
Disabled for operation
Table 3‐2: Operation button statuses
2.7.1.4 Frequency Button
The OrthospecTM shockwaves can be triggered in three different frequencies (90, 120
or 160 PPM ‐ pulses per minute).
To select a frequency, touch the Frequency button several times until the desired
frequency appears (Figure 2‐23).
Figure 2‐23: Frequency button
2.7.1.5 Screen Tabs
Main Screen is displayed
Return
Touch to return to Main Screen
Technician Screen is displayed
Technician
Touch to access to Technician Screen
Information Screen is displayed.
Information
Touch to access Information Screen (Figure 2‐
10).
Time / Date Double touch to access Time Screen. (Figure
Display 2‐11).
Table 3‐3: Screen Tabs
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
2.7.2 Information Screen
This screen (Figure 2‐13) displays information in two sections: System information in
the upper section and maintenance information in the lower section.
The System Information includes:
S/N (OrthospecTM serial number)
Total number of pulses applied by the device (this number will appear
for 5 seconds after you touch the machine icon)
The Maintenance Information includes:
Filter Counter – shows the number of shockwaves delivered since the
last filter cleaning.
Electrode Counter ‐ shows the number of shockwaves delivered with
the current electrode.
Membrane Counter ‐ shows the number of shockwaves delivered with
the current membrane and the next replacement date.
Figure 2‐24: Information Screen (with total pulses displayed)
When one of the counters (including the membrane date counter) reaches its
predefined value for the related maintenance action, its value changes to red.
For example, when the number of shockwaves performed reaches 50,000 the
membrane counter turns red or, when 3 months since the last membrane
replacement passed, the date will turn red even though the membrane shockwaves
counter is less 50,000 (Figure 2‐25).
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Figure 2‐25: Information Screen (Membrane Date Counter is red)
2.7.3 Technician Screen
The Technician Screen is password protected and is intended for the use of an
authorized technician. Yet, on its left side (Figure 2‐26) there are two buttons: Reset
Filter Counter and Reset Membrane Counter. Each time you replace a membrane or
clean the filter it is important to reset these counters. This will assist you to follow up
your maintenance actions properly.
Figure 2‐26: Membrane and Filter Counter Reset buttons
2.7.4 Time Screen
This screen (Figure 2‐14) enables setting the current time. To access this screen,
double touch the Date/Time display on the Main Screen. After setting the value,
touch "Enter" to save and return to the Main Screen.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Figure 2‐27: Time Screen
2.7.5 Error Messages
For Error messages screens refer to the troubleshooting chapter of this manual.
2.7.6 Availability of Functions During Treatment
The following table specifies the availability (enabled/disabled) of the functions
during treatment (while shockwaves are being delivered)"
Function / Screen Enabled Disabled
Energy Level Control
Open/ Close Maintenance Door
Set Countdown Counter value
Counter Reset
Adjust Height
Frequency control
Membrane inflation/deflation
Access to technician /information/time screen
Table 3‐4: Function avalability during treatment
2.8 Consumables
The following parts are consumables of the OrthospecTM:
Electrode with tip (see also paragraph 3.2.1 above )
Membrane (see also paragraph 3.2.2 above )
Coupling solution
For membrane and electrode replacement, refer to the Maintenance chapter of this
manual.
Coupling solution shall be any approved ultrasound gel (such as Aquasonic 100®) or
silicon oil (such as Medispec supplied silicon oil).
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
3 OPERATION
3.1 Initial Preparations
3.1.1 Electrode
1. Take an electrode and verify that its tip is new.
2. Calibrate and align the electrode according to the instruction in the
Maintenance chapter.
3.1.2 Solution
The solution required to fill the OrthospecTM is prepared according to the
instructions below:
a. Fill the reservoir with 2.3 liters of distilled or deionized water.
b. Add 230 cc of saline solution.
c. Thoroughly stir the mixture
As a rule: each liter of water shall be mixed with 100 cc of saline solution
Warning!
Do not overfill the water reservoir.
3.2 Setup
At the end of each treatment day it is important to completely drain the
water system and to replace the electrode/tip.
1. Position the device on a flat surface and lock the wheels.
2. Plug in the device to the electric outlet.
3. Turn the main power switch ON (Figure 2‐12).
4. Reset the Treatment Counter.
5. Using the Information Screen verify there are no maintenance related warnings.
6. Open the Maintenance Door.
7. If this is the start of a treatment day ‐ Fill the internal reservoir with a solution
prepared according to the instructions above. Close the reservoir.
8. If a used electrode is inside, remove it and replace with a new and calibrated
electrode (or replace its tip).
9. Verify the electrode is well seated in its place.
10. Reset the Electrode Counter.
11. Close the Maintenance Door.
12. Inflate the membrane.
13. Verify the membrane is intact and that there are no leaks. If leaks were found,
refer to the Maintenance chapter of this manual.
14. The Orthospec is now ready for use.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Warning!
Do not put the device in a way that will make it difficult to disconnect it
from the Mains electric outlet.
3.3 Treatment Procedure
1. Verify that the membrane is clean and that all the setup instructions were
properly followed.
2. Set the Countdown Counter value to the desired value (for countdown mode) or
"0" for countup mode. Touch Enter to return to the Main Screen.
3. Set the desired energy level and frequency. It is recommended to start at the
lowest energy level and gradually increase it.
4. Put the patient in a chair in a convenient position for treatment.
5. If necessary, use the Limb Support to put his leg or arm in front of the membrane.
6. Locate the treatment area.
7. Adjust the OrthospecTM height such that the center of the membrane is
perpendicular to the treatment area.
8. Ask the patient not to move during the treatment procedure.
9. Apply generous amount of coupling solution to the treatment area.
10.For infected areas, spread a sterile ultrasound gel on the treated area and cover
with protective barrier (such as 3M™ Tegaderm™ Absorbent Clear Acrylic
Dressing). Then, cover the protective barrier with coupling solution.
11.Apply generous amount of coupling solution to the membrane for good coupling
between the skin (or the barrier) and the SWA.
12.Check for good contact between the membrane and patient’s skin. Make sure
there are no air pockets or wrinkles in between.
13.Touch the Counter reset button to clear previous counts.
14.Verify that the energy level and the frequency are according to the protocol.
15.Touch the Operation button.
16.Apply shocks per recommended protocol.
17.Upon completing the treatment, touch the Operation Button to stop the shocks.
18.Clean the membrane immediately after completing the treatment. Follow the
cleaning instructions below.
19.Use soft tissue to clean patient's treated area.
3.4 Membrane Cleaning
Do not omit post‐treatment cleaning procedure. It is necessary for
avoiding cross contamination between patients.
In order to prevent cross‐contamination between patients, the membrane must be
cleaned immediately after the end of each treatment session. Cleaning procedure is
as follows:
1. Be sure to use new single‐use gloves.
2. Use sterile, single‐use, disposable alcohol 70% prep wipes.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
3. Clean the membrane with several wipes until all visible foreign materials are
removed.
4. Do not touch already cleaned areas with bare hands.
3.5 Setup for the Next Patient
To prepare the device for the next patient, repeat steps 4‐14 in the Setup paragraph
(3.2) above.
3.6 Shut‐Down Procedure
3.6.1 Between Treatments on the same day
Verify the membrane is cleaned.
Deflate the membrane.
Press on the Stand‐By button at the top of the Control Panel.
3.6.2 At the end of a treatment day
Verify the membrane is cleaned.
Open the Maintenance Door.
Remove the used electrode and replace it (or its tip).
Put a bucket under the Drain Port to collect the drained solution.
Connect the Draining Tube to the Drain Port of the Water Reservoir and put
its other side inside the bucket.
Pull down the lever to let the solution be drained completely out of the
reservoir.
Push back the lever to close the Drain Port.
Disconnect the Draining Tube from the Drain Port.
Close the Maintenance Door.
Touch Operation button to disable high voltage.
Turn OFF the Orthospec.
Figure 3‐1: Reservoir Drain Port Figure 3‐2: Reservoir Draining Valve
Lever
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
4 MAINTENANCE
Several maintenance procedures are required:
Device check‐up
Electrode/tip replacement
Electrode calibration
Membrane replacement
Draining and filling the reservoir
Cleaning the filter
Cleaning the touch panel
4.1 Device Check‐Up
Every treatment day a visual inspection of the system components should be
performed. This should include:
Power cord – check for any visual damage
Membrane ‐ check for any visual damage and / or leaks
4.2 Electrode/Tip Replacement
Whenever replacing an electrode or tip remember to reset the electrode
counter.
4.2.1 Electrode Spanner
To handle the electrode tip, use the electrode spanner (Figure 4‐1) supplied by
Medispec (P/N: SE‐5‐B037). The spanner contains 4 functional parts as follows:
1. An ellipsoid shape hole for unscrewing the used tip and for screwing a new
tip.
2. A rectangular shape hole for frame alignment.
3. A groove for tip alignment.
4. Flat edge for electrode calibration.
1 ‐ Tip screw /
unscrew 2 ‐ Frame alignment hole
3 ‐ Tip alignment groove 4 ‐ For Electrode calibration
Figure 4‐1: Electrode spanner
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
4.2.2 Replacement procedure
1. Verify the high voltage is disabled (high voltage indicator is not yellow).
2. Open the Electrode Access Door.
3. Remove the used electrode.
4. Using the spanner's ellipsoid hole unscrew the used tip and discard it (Figure
4‐2).
5. Using the spanner's ellipsoid hole insert a new tip into the electrode and
tighten it (Figure 4‐2).
6. Using the rectangular frame alignment hole and/or the tip alignment groove
align the new tip so it is centered relative to the internal electrode tip (Figure
4‐3).
7. Perform Electrode calibration (see next).
Figure 4‐2: Tip unscrew / screw
Figure 4‐3: Electrode tip alignment
4.2.3 Electrode Calibration
1. Using the flat edge of the electrode spanner, close (clockwise) the internal
electrode tip until it touches the new tip. Do not tighten it (Figure 4‐4).
2. Open (counter clockwise) the internal electrode tip by unscrewing 180O back
(Figure 4‐4).
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Close
Open
Figure 4‐4: Calibrating the electrode
4.3 Membrane Replacement Procedure
1. Drain the membrane by touching the Deflate button.
2. Turn off the OrthospecTM.
3. Remove the O‐ring of the membrane.
4. Inspect the O‐ring and replace it if necessary (P/N: NR‐2‐E040).
5. Pull out the membrane from the shockwave head.
6. Discard the old membrane.
7. Take a new membrane (P/N: OR‐3‐D252 and verify it is intact.
8. Slide it down on the shockwave head / reflector.
9. Assemble the O‐ring back to its place and verify it is well seated inside its
groove.
10. Clean the Reflector when replacing the membrane. (**)Orthospec Power OFF
and power cord disconnected
Whenever replacing a membrane remember to reset the membrane
counter.
4.4 Reservoir Draining / Filling
1. Open the Maintenance Door.
2. Put a bucket under the Drain Port to collect the drained solution.
3. Connect the Draining Tube to the Drain Port (Figure 4‐5) of the Water
Reservoir and put its other side inside the bucket.
4. Pull down the Draining Valve lever to let the solution be drained completely
out of the reservoir (Figure 4‐6).
5. Push back the lever to close the Drain Port.
6. Disconnect the Draining Tube from the Drain Port.
7. Close the Maintenance Door.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Figure 4‐5: Reservoir Drain Port Figure 4‐6: Reservoir Draining Valve Lever
4.5 Cleaning the filter
The filter needs to be cleaned periodically (see maintenance schedule below). When
it's time to clean the filter the System Status Indicator turns to a warning sign. To
clean the filter follow these instructions:
1. Open the maintenance door.
2. Put a piece of cloth or absorbing material under the Water Filter to avoid
leakage of water during its disassembly.
3. Open (counterclockwise) the transparent cover of the filter (Figure 4‐7).
4. Rinse the filter under running water.
5. Assemble the filter back in its place.
6. Close the maintenance door.
Figure 4‐7: Water Filter
Whenever cleaning the filter remember to reset the filter counter.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
4.6 Cleaning the Touch Panel
Use dry cloth or soft cloth with alcohol, neutral detergent or ethanol for clearing
the Touch Panel in case of dirt on it. Do not use any organic solvents except
alcohol.
4.7 Maintenance Schedule
Action Frequency
Visual inspection of the system components for Every treatment day.
damage, membrane leaks, etc.
Electrode tip replacement Every treatment session (~3800
shocks)
Electrode calibration Whenever replacing a tip
Electrode replacement (complete) After 20 tips have been used
Membrane replacement Once in 50,000 shockwaves (~12‐13
treatments) or every 3 months
whichever comes first.
When it shows wear or tear (leaks)
Reservoir draining At the end of each treatment day
Reservoir filling At the beginning of each treatment
day
Filter cleaning Every 100,000 shocks
Cleaning the touch panel As required
Apply with the finger some Coupling solution
Monthly
on the O‐Ring located in the reflector.
Warning: No modification of this equipment is allowed unless is done
by Medispec authorized personnel.
4.8 Expected Service Life
The expected service life of the OrthospecTM is 7 years.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
5 TROUBLESHOOTING
The following sections explain how to cope with some common troubles. If these
procedures were not found helpful or the problem persist call Medispec authorized
technician.
Problem Observed Solution / Suggested actions
1. Verify that the power cable is plugged into a
suitable and live electrical outlet and well fitted
inside its socket on the connections panel.
System cannot be turned on 2. Verify that the Main Power Switch is turned on.
3. Check the fuses and replace if necessary.
4. If all of the above doesn't help, call Medispec
qualified Service technician.
1. The door might be interrupted.
2. Verify that the Draining Valve is closed.
Door starts moving outwards 3. Check if any other object interrupts with
during its inwards motion the motion path of the Maintenance Door
and remove it if found.
4. If all of the above doesn't help, call
Medispec qualified Service technician.
Hardware or operational software failure.
Call service.
Electrode is missing.
Open the Maintenance Door and insert an
electrode.
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
Problem Observed Solution / Suggested actions
1. The Electrode performed the maximal number
of pulses.
2. Replace the Electrode
1. The Membrane performed the maximal
number of pulses or it has been used 3 months.
2. Replace the Membrane.
3. Note: only the relevant counter will appear in
red.
The filter requires cleaning
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
6 PRODUCT CONTACT INFORMATION
If an adverse event occurs, such as a malfunctioning of the device, a mistake in using
the device, or an injury relating to the use of the device, report the occurrence
immediately. Alert the physician of any patient health issues that occur while using
the Orthospec. For troubleshooting assistance, complaints or additional
questions, contact the Service Department:
Medispec Ltd.
203 Perry Parkway, Suite 6
Gaithersburg, MD 20877
Tel: 301‐944‐1575
Toll Free: 1‐888‐663‐3477
Fax: 301‐972‐6098
Email:
USA: servicedept@medispec.com
Rest of world: service‐int@medispec.com
Site: www.medispec.com
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
APPENDIX 1: TECHNICAL SPECIFICATIONS
General
Shockwave Source Electro‐hydraulic
Spark Voltage 12‐24 KV
Frequency 60/90/120 Pulse/minute (PPM)
(1/1.5/2 Hz)
Dimensions Height: 1129 mm
Width: 507 mm
Depth: 756 mm (deflated membrane)
Weight ~ 126 kg
Energy levels 1‐10
Electrical Supply
Voltage (Volts AC) (*) Single Phase, 110/115/220/230
100 VAC / 5 Amps
115 VAC / 5 Amps
220 VAC / 10 Amps
230 VAC / 10 Amps
Line Frequency (Hz) 60/50
Current (Amps) 10/5
Compliance with Standards
ISO 13485
MDD (93/42/EEC) (CE)
IEC 60601‐1
IEC 60601‐1‐2
IEC 60601‐2‐36
ISO 10993‐1
ISO 14971
Electrical safety
Type B Applied Part classification
(*) factory set – refer to the label on your device
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OrthospecTM Operating Manual OR‐3‐X400 Rev B
APPENDIX 2: ENVIRONMENTAL AND TRANSPORT
REQUIREMENTS
Temperature
Operating Ambient 10 to 30°C (50 to 95°F)
Extended Term Storage and
0ºC – 40ºC (32ºF – 104ºF)
Transportation
Short Term Storage and
‐10ºC – 55ºC (14ºF – 131ºF)
Transportation
Humidity
Operating 20 to 80% relative humidity, non‐condensing
Transport 10 to 90% relative humidity, non‐condensing
Stability
Positive stability on grades up to 10 degrees
when in transport position, and on grades up to
5 degrees in any position of normal use.
Altitude
Operating altitude 3000 m
Operating / Transport pressure 700‐1060hPa
APPENDIX 3: ACOUSTIC PARAMETERS
Max Peak Positive Pressure 34±12.7 Mpas
Energy @ ‐6dB 9.4 to 142mJ
Energy flux Max: 0.32 mJ/mm2
‐6dB: 0.29 mJ/mm2
Focus size ‐6dB: Ø25 X 95
5 Mpa: Ø35
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