Difra Introduces VisioX D2 Oculography Module

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Maximize Care of VNG, Caloric Equipment

Maximize Care of VNG, Caloric Testing Equipment

Many of the issues we deal with regarding VNG testing equipment and caloric irrigators in need of repair are inadvertently caused by improper care and mishandling of the equipment. Because the issues are typically avoidable, these basic tips will help reduce the chances of damaging your VNG equipment. Each and every one of the situations below have occurred on at least one or more occasions. By taking precautions, the lifespan of your medical devices will improve and the downtime and costs to repair will be minimized. 

Unpack and inspect the equipment immediately upon receipt

Upon receipt of your VNG equipment, unpack it and carefully inspect it immediately to ensure everything is in proper order. Occasionally packages get damaged in shipping and a claim is needed. Problems we've seen include packages that have been bashed or dropped during shipping, which may cause damage to the product and/or broken parts. 

Some of the parts are extremely expensive to repair or replace. If a claim isn't filed with the shipper within the proper period of time, it won't be reimbursed, which then falls on the client. The client's insurance may or may not cover the damage.

Every package we ship is properly insured. However, we've had clients who didn't open their packages for several weeks and then are caught off-guard if there is a problem and it is too late to file a damage claim. Another scenario is packages get misplaced and lost within a busy practice if they aren't opened and unpacked in a timely manner. 

Thoroughly read the product manual/s

Before plugging anything in or setting up your VNG system or caloric irrigator, read the manuals from start to finish. The manuals are very helpful with key tips such as only using distilled water for your water-cooled CoolStar caloric irrigator. An investment in your VNG equipment is worth taking the time to read the product manuals. When you and your team follow all technical and safety precautions this will avoid causing problems due to user error, which will void the warranty.

Always, always, always use a surge protector

Every VNG system we sell includes a brand new surge protector. The reason we include the surge protector is because it is vital to the lifespan of your VNG equipment. 

We do have conversations with staff who freely admit they didn't use the surge protector, but even when clients aren't sure what happened, our electronics engineers have diagnosed damage from power surges more than anyone would care to think. To vastly reduce the chances of a damaging power surge, always use the new surge protector that is included with every system. Replace the power surge periodically with a new one because they do wear out over the course of time.

It is possible that damage from a very strong power surge could happen even with the protection of a surge protector. During a powerful weather storm or when not in use, properly turn off and unplug the equipment.

If the surge protector isn't used, isn't consistently used or a weather or other power surge damages the equipment, it will void the warranty.

Never use a power adaptor that wasn't originally provided by the manufacturer

Power adapters have varying levels of amps and cannot, nor ever should be switched with the original adapter included with your VNG equipment. Substitutions will likely cause a damaging power surge and void the warranty. When in doubt, contact Secure Health for further information.

Handle your equipment with care

Caloric irrigators, VNG medical devices and electronic equipment are able to withstand reasonable handling, but should never be jostled, dropped, tugged on the handles and cords, treated roughly, nor improperly operated. Further, when transporting or shipping your medical device, carefully and properly pack it. For more information, contact Secure Health and refer to the warranty terms provided on this web site.

Binocular glass mirrors are very expensive, handle them with extreme care

Binocular VNG systems include a glass mirror that costs around $1,000 to replace if broken. Therefore, use extreme care when handling the mirror to reduce your chances of breaking it. Broken mirrors are not covered by the product warranty unless due to a valid warrantable event

Ensure everyone using the VNG and caloric equipment follows the same procedures

It is normal to have attrition due to staff turnover, and that is understandable; however, it is imperative to ensure everyone who handles the equipment are all following the same procedures and precautions. It only takes one person to accidentally break or misuse it and it can cause a multitude of fall out. It is worth taking the time to properly train and periodically follow up to prevent avoidable equipment issues.

If you have questions or just want to talk about this post or you have any other questions, please contact us.  We look forward to hearing from you.

Lana Scherer

Secure Health, Inc.

260.804.4041 / [email protected]

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The Right Choice, One or Two Camera VNG?

Difra NysStar II vng equipment
Difra NysStar Binocular VNG: Two camera, four channel

The Right Choice, One or Two Camera?

"Do I need a monocular (one camera) or binocular (two camera) VNG device?" Or "Is the binocular VNG what I need for my clinic?" These are two questions we are frequently asked by potential clients who are expanding into videonystagmography (VNG).

Monocular VNG for Vestibular Disorders

The simple answer is, if you looking to add VNG to diagnose and treat balance disorders, vestibular disorders or for falls prevention, then a monocular VNG is likely your best choice.

Binocular VNG for Specialty Cases

If you are a specialized vestibular clinic or doing or planning to work with personal injury (PI) cases, handle concussion, mTBI (mild traumatic brain injury) or TBI (traumatic brain injury), the binocular VNG is your only choice.

Essentially, the binocular VNG tracks both eyes simultaneously with a report output showing both eyes during all tests.  The ability to record both eyes at the same time is critical in the special cases of P/I, concussion, mTBI, and TBI.

Why Use Binocular VNG for Specialty Cases?

I asked Troy D. Hale, Au.D, FAAA, Assistant Professor at A.T. Still University to explain clinically why binocular VNG is needed for these special cases.  Dr. Hale explained it as follows.

"The primary advantage to a binocular recording rather than monocular is that with monocular you can often miss disconjugate eye movements (i.e., when the eyes are not moving synchronously together).

"This would be most common with paralyses of one or more of the extraocular eye muscles or with lesions affecting the medial longitudinal fasciculus which is the major pathway that pairs the eyes together for versional horizontal deviations. Often times you may also have one eye that captures or records poorer than the other such as with individuals who have had prior eye surgeries in which case having dual recording is also more beneficial."

So in other words, if it's important for you to simultaneously track both eyes to see how well they work together, go with the binocular VNG (NysStar II).  If that isn't as important to you, the monocular VNG (HeadStar) device is the best choice.

Reimbursement is the Same for Monocular or Binocular

One other important point to remember, a binocular VNG does not reimburse any higher than a monocular VNG device.  The same billable CPT codes and units apply for both systems. That's a good reason to make sure you choose the correct VNG configuration that matches your intended use because the cost to purchase a binocular VNG device is higher compared to the monocular VNG.

Our Monocular Can Seamlessly Upgrade to Binocular

Finally, if you purchase a monocular VNG from us today and later decide a binocular VNG is more appropriate for your practice, we can upgrade your monocular (Headstar) VNG to a binocular (NysStar II) VNG for a reasonable upgrade fee.

If the opportunity presents itself for you to expand your patient services that demands a binocular VNG, you don't have to pass up the opportunity or start over and purchase an entirely new VNG device. We will assist you to professionally and seamlessly complete the upgrade.

As always, if you have other questions about our full line of VNG products, please contact me.

--Dan Scherer, CEO

Secure Health, Inc.

260.804.4041 or [email protected]








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When is the right time to upgrade your VNG Device? 

When is the right time to upgrade your VNG device? 

Like anything else, VNG devices have a lifespan.  How long that is may be difficult to say? Much depends on the manufacturer and how well you have maintained the device.  It is entirely possible with proper care a VNG device should last at least 7 to 10 years.  

As with any technology, the older it gets, the more it becomes outdated. It may be lacking new

Difra HeadStar VNG equiment

features and in the case of VNG devices, expensive to repair.  There comes a time with any device to look at replacing yours with new technology. So consider the following major points regarding the decision to upgrade or replace your VNG device.


You start noticing an increasing amount of down time due to malfunctions with your VNG.  No one wants to reschedule patients due to technology failures. Will they return for the rescheduled visit?  You hope so, but we know that not all will. How much patient care is lost and what does that equate into lost revenue?  Plus, what will the repairs cost you?

Reliability problems can be caused by old worn out cameras, aging circuitry, worn out cables, loose connections, improper handling and so much more.  

What if your VNG manufacturer is no longer in business?  Do you have a company that can properly repair your aging VNG equipment?  Older board circuitry components can be difficult to find and replace. Some manufacturers charge a premium for replacing the main circuit boards, often times reaching $10,000.  That’s nearly one half the price of a new VNG device, depending on features and manufacturers. 

Worse yet, after replacing the boards, you are still left with an old computer, unsupported operating system, aging cameras, and little guarantee that next week you don’t encounter another problem, costing even more money, lost time, patients and revenue.  It can turn into a spiraling, out-of-control expense and frustration.

Outdated Computer Operating Systems

Here's another problem.  As long as your computer is working, it isn't an immediate concern, but suddenly, your old VNG computer crashes.  Now what? 

Chances are high your old computer ran an unsupported Windows XP or Windows 7 operating system. Microsoft no longer supports Windows XP and soon will stop supporting Windows 7.  If you need to replace the computer, the VNG software of your older system may not be compatible with new operating systems such as Windows 8 or 10.  Not all VNG manufacturers have kept up with software upgrades to be compatible with current operating systems.

If you can’t update the software from the manufacturer, then your VNG device is rendered useless.  

Data Collection and Output Quality

We covered the reliability and computer problems with your aging VNG device.  Now let's consider the quality and accuracy of your data acquisition.  In other words, are eye tracings and nystagmus accurate and clear?  Are results repeatable and reliable?

It’s a simple fact that current technology for image quality is far superior to older VNG devices.  High-definition cameras allow good eye capture and data tracing.  Eye-tracking technology is much better with today's software technology than your old system.   The end result is more accurate reports and improved diagnosis.  The old adage of “Garbage in, garbage out” is still relevant today.  New VNG technology is increasingly better and more user-friendly than your old VNG is.  

Here's a great example of the benefits of new VNG technology.  Some older VNG devices required your technician to manually “mark” the data after a VNG test. That means the technician would need to scan through the VNG results and "manually" select the extremes of nystagmus.  This takes a fair amount of time, as much as 5 to 10 minutes per test, costing you thousands of dollars over the course of a year in labor costs.  Further, if your technician is really busy, the likelihood of inaccurate marking increases, resulting in an inaccurate report.  

A good VNG device will offer automatic data marking that is incredibly accurate, which provides fewer chances of technician error as well as consistency in reporting.  Plus, automatic marking eliminates the cost of labor for manual marking.  It may seem small, but over the course of a year, you save a ton of money utilizing automatic data marking.  

Remote Access Tech Support

If your clinic has a software problem of any sort, does your older VNG system provide online tech support? There are countless times I have personally assisted clinicians and technicians with remote access tech support that was easily resolved. Not only does it save time, it provides quick, accurate assistance to avoid delays due to downtime, which I already mentioned is not good for patients nor the staff.

Additional Considerations

There are so many other considerations when looking to replace old for new.

Certainly cost is always a factor.  Just always keep in mind what your total costs are, including labor, so you make an accurate assessment. The initial investment in a new VNG system may be less than you think due to many lease and finance options, as well as tax advantages.

Don't forget to check with your accountant on your ability to use the Accelerated Depreciation, one-year write off on your new VNG equipment.  Depending on your tax rate, you can save a significant amount by writing your new VNG device off in the first year of use.  That equates to a cash discount worth thousands of dollars.

All of us know that reimbursement rates are as critical as cost.  So again, specifically ask your billing and coding specialist to ensure you are getting the latest information on reimbursements in your area.

Quality and longevity in business is a huge consideration. Just as with buying a new vehicle, everyone knows the manufacturer, product and price are all reflective of the quality. The same holds true for VNG devices.

Finally, who you choose to work with as your VNG vendor is of the utmost importance.  Are they easy to contact?  Do their actions follow their words?  Do you feel as if they are honest? Are they giving you a fair price? Do you have confidence they can handle your support issues?  All of these are extremely important questions to consider when making any kind of buying decision, not just replacing your old VNG.

I'm always happy to speak with you about VNG old or new.  We are experts in VNG technology with 14 years of experience.  I want you to be happy with your buying decision so feel free to comment, call or write to me if you want to discuss your options.  I would enjoy the opportunity to hear from you.


--Dan Scherer, CEO

Secure Health, Inc.

260-804-4041 or [email protected]

Secure Health, Inc. has assembled the finest vestibular and balance products in the world. Our Better Balance™ technology is comprised of proven systems that identify, diagnose and treat vestibular and balance disorders. An essential component of our Better Balance™ technology is premium VNG diagnostic equipment manufactured by Difra Instrumentation. Difra Instrumentation is a global leading manufacturer of diagnostic balance disorder technology for more than 48 years. CALL 260-804-4041 FOR MORE INFORMATION or via email: [email protected]

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