To launch RTM-Diagnosis select Program from the Taskbar Start menu. Then select RTM-Diagnosis and click on the RTM-Diagnosis icon. It runs RTM-Diagnosis.

In the start dialog box you should specify an examining doctor, i.e. choose a user. If you run RTM-Diagnosis for the first time the User’s name drop-down list contains only Unknown and Manager. The Unknown has no rights. The Manager has all rights. At first you should register a new user.

To register a new user go through the following steps:

Choose Manager from the User’s name drop-down list.

Then choose Settings – Users – Register new user.

Enter a surname of a new user.

Enter a password of a new user.

Reenter a password of a new user to avoid mistakes.

Then select the rights for the new user.

For example select View Examination Data, Print Examination Data, Own Examination Text Data Editing, Own Examination Numeric Data Editing, Own Examination Data Deleting.

It is enough for a normal user. The Manager has all rights and grants appropriate rights to all users.

Click on the OK button.

The new user is included in the User’s name drop-down list. Select it and type the password in the User’s Identification dialog box. Then press Enter or click on OK. If you type a correct password you obtain the access to the program.

Choose an organ you want to examine, e.g. Mammary glands. Then click on Primary Examination.

In the opened dialog box you can specify information on the patient, his or her surname, name, etc. To bypass to the next edit field press Tab or just click on an appropriate edit field. Specify a medical card number, home and work phone number, birthday (the year is essential data). Also type a surname of a doctor in the Own Doctor’s Name edit field. If there are several doctors you can include them to the drop list and then select a required doctor. In the next two parts of the dialog box there are data of the current and previous examination. In the Examination Data box the system indicates a date of examination, assigned protocol number, examining doctor and air temperature.

The fist four figures of the protocol number identify a user of RTM-Diagnosis. The following two letters specify an examined organ (e.g. AA specify the breast), the following five figures are a protocol number and the last letter specifies the number of the examination of a particular patient.

After completing the form click on Next. It opens the Special Patient Information dialog box. In this dialog box the doctor types specific information on a patient such as a case history and other additional information.

You can specify if the patient has thyroid disorders, gynecology disorders, and performed operations on the examined organ.

In the Note edit field type when the menopause occurred (if it has been occurred) and what medicines the patient takes.

In the Diagnosis edit field type the diagnosis of the patient. Select it from the drop-down list. We recommend to use templates from this list as it is useful for working with the database.

Then select appropriate options from the following:

Hormone dependent (i.e. the patient takes any hormones);

Aggravating heredity (i.e. there has been oncological cases in the patient’ family among women);

Pain in the left gland or in the right gland;

Tumor is outside of the gland or it is close to the center;

Information on the patient constitution (very thin, thin, normal, stout or vary stout);

Type a diameter of the breast in centimeters in the Diam. edit field. Then type a length of the menstrual cycle in days in the Cycle edit field, e.g. type 28, and in the Day edit field type the number of days after the first day of menstruation. The value indicated in the Ovul. field is the deadline for performing an examination, i.e. it must not be higher than the value in the Day edit field. It is best to perform RTM-Diagnosis on the 6 – 9 day after the first day of menstruation. For the post menopause patient type “m” in the Day edit field.

Specify the number of pregnancies, childbeds, the age when the patient gave birth to her first child and the result of her first pregnancy. Then type the date of control examination and recommendations on treatment. This information may be specified after the examination. Then click on Next.

The Measurement dialog box allows you to measure the internal temperature. In the Current Temperature field the system automatically indicates a current temperature that displayed on the temperature indicator of the data processing unit. The value in the Mean Temperature field is an average temperature for last four seconds. The number of an examined point and the type of the breast (right or left) are displayed in the Point N and Side fields.

The points are measured in the following order. At first you should measure two points on the sternum. Then measure points on the breasts. Measure the temperature of the right and then left nipple. Then measure the first point on the right breast and the corresponding point on the left breast. Continue in accordance with the measurement scheme. This measurement method allows to reduce the time interval between measuring corresponding points that prevents accidental changes in temperature and therefore increases the accuracy of measurement. The system does not allow to measure the temperature in the next point on the same breast until the current point on the opposite breast is measured.

When all points are measured, you can analyze results. For analyzing results the doctor uses a thermogram, temperature field and expert system.

Click on Thermogram. It opens a temperature diagram that represents measured temperature. The thermogram helps a doctor to analyze thermal differentials between corresponding points and dispersion of the temperature within the same breast. The solid black boundaries indicate an average temperature for healthy women of the given age. If any point does not conform to the main trend, it should be re-measured.

For that close the Thermogram dialog box and return back to the previous dialog box. Select the point that should be re-measured and click on Take. During examination you can review three series of examinations in a thermogram. However you can store only those temperature values that are unblocked (i.e. the background of a cell is white). To unblock a cell click on it.

The thermogram is useful to observe a temperature differentials between corresponding points. However it is difficult to analyze temperature distribution in one breast. For this purpose a doctor uses a temperature field.

Click on Temperature Field. In the temperature field the system draws isotherm-lines through points with the same temperature. To construct the isotherm-lines the system computers an average temperature of all measured points. Then it adds to the average temperature 1.2 degrees and calculates a high bound of the displayed temperature range. To calculate a low bound it subtracts 1.2 degrees from the average temperature.

In the temperature field cold areas are blue, hot areas are red. The color of the background corresponds to the average temperature of healthy women in the given age for the current color scale. Thus if the background is red it means that the average temperature of the current patient is much lower than the average temperature of the healthy women of this age. If background is blue it means that the average temperature of the current patient is much higher than the average temperature of the healthy women of this age.

To change settings of the temperature field click on Settings. You may select the option to make the temperature field gray scale. It may be useful if you print a temperature field on a black printer as in this case red and blue colors can not be distinguished. In the gray scale image the hot areas are light and cold ones are dark.

Also in this dialog box you can choose the following options:

Show temperature value;

White backdrops for temperature value;

Show isotherms.

You can choose the method for creating a temperature field. Normally we use a recommended temperature and change deviation value. The temperature interval can be also changed. If temperature dispersion of the patient is higher than 2.4 ° C in the bottom of the dialog box the message that the maximum or minimum temperature of the patient is out of temperature range appears. In this case to review the temperature field increase a value in the Deviation edit field. If you need to make a picture more contrast, set a smaller value in the Deviation edit field. To restore a default value click on Set.

To print the temperature field click on Print. Choose a printer and click OK.

If you need to copy a temperature field for inserting it into other applications, e.g. MS Word, click on Copy.

In the temperature field the system displays the temperature for measured points. At other points it computers an approximated value. These values are displayed in the Probable temperature value in the specified point field, when you point out a point by courser displayed as a thermometer. To close the Temperature Field dialog box, click on Close.

The doctor makes conclusion after analyzing a thermogram and a temperature field. RTM-Diagnosis includes an expert system that performs numerical analysis and helps doctor to diagnose. To run the expert system click on the Diagnosis button. It opens six windows.

During our investigation we have selected six key parameters for breast cancer. They are the following:

Each window is for its own parameter. Parameters of all patients with verified breast cancer are displayed as six 2-D diagrams. Each patient is represented by a black point. A current patient is represented by red circle. Parameters and their links are selected so as to points are compact in the diagrams. This compact area is called as a "risk area". It is blue. The age related changes in temperature are taken into consideration.

The expert system evaluates how much the patient is close to the risk area. If a patient’s parameters for all RTM-parameters of breast cancer locate within the risk area, this patient is similar to the cancer patients. If the current patient is out of the risk area, there are no features of breast cancer.

Also the expert system performs quantity analysis. There are two methods.

The system compares parameters of the current patient with parameters of the patients with verified breast cancer and selects a patient that is similar to the current patient. Then this patient is displayed in diagrams as a green circle and her protocol number is indicated in the Close Object edit field. For every parameter the system calculates a differential between the parameter of the current patient and the parameter of the selected breast cancer patient. Then these differentials are summed up and this value is indicated in the Mark 1 field. If it is positive it means that parameters of the current patient are worse that the parameters of the selected patient. Therefore the current patient has features of breast cancer.

The second method is based on scores. If the patient’s parameter is out of the risk area this parameter gets 0 scores. If the patient’s parameter is in the risk area this parameter gets 9 scores. If a parameter is on the boundary of the risk area it gets from 0 to 9 scores, that depends on how closely it locates to the risk area. Then these scores are summed up and the system calculates an integrate indicator of RTM-Diagnosis that is displayed in Mark 2 field. In the next field system displays scores for each parameter. The positive integrate indicator of RTM-Diagnosis says that the patient has features of breast cancer. In this case the background of the field is red.

The clinical trials have shown that the reliability of the Mark 2 is higher then one of the Mark 1. However sometimes the Mark 1 is useful to find a patient having a thermogram that is similar to the current one. More detail information you will obtain during RTM-Diagnosis practical training.

To leave the Diagnosis mode close the Exert System dialog box by pressing Esc, and then press Esc again or click right to close other six windows. At this stage the examination with the internal temperature sensor is finished.

Click on Next to begin the examination with the skin temperature sensor. This dialog box looks like the previous dialog box, only there is not the mean temperature field. Have measuring all points click on Thermogram to analyze a thermogram. To display internal temperature choose Show internal temperature. The thermogram can be printed.

To analyze a skin temperature field click on the Temperature field button. The options of creation are similar to the ones of the internal temperature field. The examination is finished. Click on Next.

In the Examination Inference you can type the results of RTM-Diagnosis in the Doctor’s Inference edit field. The results of the expert system are indicated in the Diagnostic Formula field. For conclusion you can choose an appropriate template from the Inference templets drop-down list and click on Insert Templet. Then click on Next.

In the Finish dialog box you may preview and print the examination protocol. The data will be saved in the database after you click on Finish. If during examination you close the program or click on the Cancel button, all data will be lost. So in this case the system asks you to confirm that you want to close the program. If you click on Yes all data will be lost. Not to close the program click on No or Cancel.

When you click on Finish, the program will save the data and inform you that all data have been saved in the database.

Let’s review the Repeated examination mode. Click on the Repeated examination button in the started dialog box. It opens the Examination Data Retrieval dialog box. In this dialog box you may type a protocol number. If you do not know the protocol number click on Find to find a required patient by a patient’s surname or medical card number. Also the system can find all patients with a specific diagnosis (Therefore we recommend to use templates for entering diagnosis.) Also you can review all patients examined by a specific doctor. You can review the whole database or records of last several days, weeks, months or years.

To find a specific patient type first letters of her surname and then click on Find. The system will find all patients with surname started with typed letters.

To review the whole database click on Find typing nothing in the edit fields. You can sort the list by any field by clicking on its title.

Select an appropriate patent. You may review the protocol of the selected patient by clicking on View Protocol. Then double click on the selected patient or click on OK.

It opens the Common Information dialog box. The form and the Last examination box are completed. Type the ambient temperature in the Air Temperature during the Examination.

The next dialog box is completed too. The doctor should correct such information as the first day of menstruation or control examination date.

In the next dialog box the first column is completed. They are the data of the previous examination. So we begin with the second series of measurement. In this case in the thermogram the data are represented by two lines, if you select Show all series. The data of the first examination are a blue line and the data of the current examination are green one. It is helpful to analyze changes that have occurred since the previous examination.

Click on Next and measure the skin temperature for the second series. Then click on Next again. It opens the Examination Inference dialog box. Click on the proper location in the Inference dialog box and insert an appropriate template. After indicating diagnosis click on Next. The data of the current examination will be saved after you clicking on Finish.

The Edit mode does not differ from the View mode. The only distinction is that in the View mode you are not allowed to edit data. So we only go through the Edit mode.

In this mode you can type data that you did not indicate during the examination. To save corrected data you should click on the Finish button in the finish dialog box.

The examination of other organs is similar to the breast cancer examination. However you have to indicate less special information on the patient. You are allowed not to measure all points. Also RTM-Diagnosis does not include expert systems for other organs. For pair organs you are required to measure temperature in the corresponding point order. For other organs the method for creating a thermogram is modified a little.

We have discussed how to register a new user. Also you can remove a user or change his information selecting Delete User or Change User’s Information from the User menu. However you have to have rights to do it.

The system allows you to register doctors who perform examination, and then select them from the Doctor’s Name down-drop list. To register a new doctor select Settings from the main menu, then select Doctors and Add Doctor. Type the name of the doctor and click on OK.

To remove a doctor from the list select Settings – Doctors – Delete Doctor. Select an appropriate name and click on Unregister.

In the Device Interface dialog box you can select the type of connection between the device and the PC. During installation of RTM-Diagnosis, the system automatically sets up the Simulation mode, i.e. the program simulates device operation (a device may be turn off or disconnected).

To perform examination connect the device to one of parallel ports (COM 1 or COM 2) of your PC, and select it in the Device Interface dialog box. Then click OK. The system will check connection. If the system does not receive response from the device, it reports an error. In this case check to be sure that you select an appropriate port and the device is connected to the PC properly. Then re-click on OK. The Inner Card option is not used presently.

You can change information on the licentiate of the software, but only if you have a right. You can change the place of examination and the contact information that indicated at the end of an examination protocol (a phone number and a clinic’s address). Also you can add required information. The default contact information is an address and phone number of RES, Ltd.

The doctor often needs to copy the database, for instance, to store it in another PC or to make a backup copy.

To copy the database select Database from the main menu and then select Create Reserve Copy of the Database File. Select a folder, which you want to save a database file in and click on OK. It saves the database of the selected organ.

If your database file has been replaced, you have to run the Database – Register Database Changes command. The system checks the database, check the last protocol number, update ini-files and create a report that is saved in the Report folder. It is a text file, the name of which begins with two letters represented the organ and then Change.txt. In the file you can review protocol numbers and changes of the database. Also the system asks you weather it should update diagnostic data.

The system also allows to save the database as a text file. In this case you can open it with MS Excel for processing.

This menu includes besides the commands corresponding to the buttons in the start dialog box several other commands. The Delete command allows to remove data on a selected examination. Specify a patient by typing her protocol number or clicking Find. Then click OK. The selected examination will be removed from the database.

To add a new template select Examination – Templets – Add New Examination Templet. Select a file of an appropriate template and click Open.

To remove a template select Examination – Templets – Delete Examination Templet. Select an appropriate organ and click on Delete.

To exit RTM-Diagnosis click on the Exit button.