ambra viewer guide
TRANSCRIPT
1
Ambra ViewerGuideAmbra Viewer is a zero-footprint diagnostic HTML 5 medical image viewer that can beaccessed through the web or integrated into any PACS. Easy to use viewing tools are available forannotating and collaboration: hanging protocols, window, cine, measurements, and more.
2
Table of ContentsIndications for Use 3
Browser Requirements 4
Measuring Systems and Standards 5
Getting Started 6-8
Importing Studies 9-15
User Interface Overview 16-17
Study Page 18
Tools 19-25
Multiple Frames 26
Stack Series 27
Related Studies 28
Meetings 29-30
Local Study Viewing 31
Settings 32
Printing 34
Keyboard Shortcuts 34s
Mobile Browser Requirements 35
Viewer Features Comparison 35
Mobile Phone Viewer 37
Mobile Tablet Viewer 37
Feedback & Supportsupport.ambrahealth.com(888) 315-0790 ( anytime ) or(321) 608-9723 ( anytime )
3
Indications for Use510(k) Number: K152977Device Name: Ambra PACSAmbra PACS software is intended for use as a primary diag-nostic and analysis tool for diagnostic images for hospitals, imaging centers, radiologists, reading practices and any user who requires and is granted access to patient image, demo-graphic and report information.
Ambra Viewer, a component of Ambra PACS, displays and manages diagnostic quality DICOM images.
Lossy compressed mammographic images and digitized film screen images must not be reviewed for primary image inter-pretations. Mammographic images may only be interpreted using cleared monitors intended for mammography display.
Not intended for diagnostic use on mobile devices.
Caution: Federal law restricts this device to sale by or on the order of a physician.
Name and Place of BusinessDICOM Grid (dba Ambra Health)199 Water Street, 34th FloorNew York, NY 10038
4
Browser RequirementsAll supported browsers are listed.Other browsers, and older versions ofbrowsers listed, are not supported.Supported Java versions: Java 7, Java 8.Download Java at:java.com/en/download/ manual.jsp
Windows OSInternet Explorer 9Upload Images: Requires Java installation orGoogle Chrome Frame plug-in installation.View Images: Native, no cine tooling support.
Internet Explorer 10Upload Images: Requires Java installation.View Images: Native
Internet Explorer 11Upload Images: Requires Java installation.View Images: Native
EdgeUpload Images: NativeView Images: Native
Google Chrome ( version 28.0 and later )Upload Images: Native.View Images: Native.
Firefox ( version 23.0 and later )Upload Images: Requires Java installation.View Images: Native.
Mac OSSafari ( version 6.0 and later )Upload Images: Requires Java installation.View Images: Native.
Google Chrome ( version 28.0 and later )Upload Images: Native.View Images: Native.
Firefox ( version 23.0 and later )Upload Images: Requires Java installation.View Images: Native.
5
Measuring Systems and StandardsFor diagnostic use, users must use base monitor standards or better per modality below.
Not intended for diagnostic use on mobile devices.
Recommended Monitor Standards
SMPTE is the Society of Motion Picture & Television Engineers. This organization has developed several test patterns to ensure image quality viewing standards. This 1024 x 1024 test image is used to calibrate the monitor on any viewing station running DICOM software. Once the SMPTE pattern is loaded and displayed, the user should ensure the 5% and 95% grey scales are clearly visible. If not, adjust the monitor’s contrast and brightness.
The American Association of Physicists in Medicine (AAPM) Task Group 18 (TG-18) is a national task force consisting of medical imaging experts and organizational af liates dealing with per- formance evaluation of electronic display devices. Used correctly, the AAPM QC test patterns will indicate im-mediately if there are any potential issues with the calibration and/or monitor.
The pixel spacing test images for DICOM developed by David Clunie allows the user to appropri- ately calibrate and con rm display resolution. Test image data with physical pixel spacing bars are rendered allowing the user to quanti ably check spacing.
Modality Capture Modality Matrix Screen Size Pixel Matrix Color Required Comments
Ultrasound IVUS 512, 768 & 1024126 lines
18 to 19 in15 to 18 in
≥1280 x 1024≤ 1280 x 1024
Doppler IVUS, avoid screen sizes above 18” diagonal
NUC/PET PET/CT Variable 18 to 19 in19 to 20.1 in
≥1280 x 1024≥1600 x 1200
Encoding Not recommended on 5 MP Pixel size: ≥ 0.206mm
MRI/CT~ 1mm/Slice Typical
256 & 512 19 to 20.8 in ≤ 1536 x 2048 Enhanced 3dRe-construction
Not recommended on 5MP Large studies on 4 MP 30” di-agonal color. Pixel ≥ 0.206mm
fMRI 256 & 512 19 to 20.8 in ≤ 1536 x 2048 ContrastEnhancement
≤ 3 MP color or mono- chrome or 6MP @ ≥ 0.206mm
Fluoro/R&FCT-Fluoro
1024 x 1024 18 to 20.1 in ≤ 1600 x 1200 N/A 1280 x 1024 minimum for 1:1 aspect image w/in 5:4 screen. Gray-to-Gray cycle response time ≤ 13ms
CR/DR(100-150) microns
4 MP 20.8 to 21.3 in ≥ 1536 x 2048 N/A Ideal t to 3 MP, color or monochrome ≥ 400 cd./m2
Digitized Film(50-150)
8 MP~ 8-10 lp/mm
20.8 to 21.3 in ≥ 1536 x 2048 N/A 3 MP color or monochrome 5 MP monochrome
Mammography(50-100)
20MP+~ 18-20 lp/mm
21.3 in 2048 x 2560 N/A Lossy compressed mammo-graphic images and digitized lm screen images must not be reviewed for primary image interpretations. Mam-mographic images may only be interpreted using cleared monitors intended for mam-mography display.
6
AmbraPoint your web browser to:https://access.ambrahealth.com
Click ‘Register here’.
Getting Started
RegisterComplete all fields.
Read and accept:‘Terms of Use’,‘Privacy Policy’,‘Indications for Use’.
Click ‘Register’.
7
Studies PageAfter clicking ‘Register’ you will be taken to the‘Studies’ page. To search for studies, click ‘advanced’ to display all searchable study fields.
Search for a StudyEnter parameters, and click ‘Search’.
8
View a StudyClick the ‘Images’ icon to view a study’s images.
View Related StudiesClick checkboxes in the left column to select multiple studies. Then click the ‘Actions’ button, and select ‘View as Related’.
9
Importing StudiesThere are four methods of importing studies:
Web UploadEmail RequestDICOM SendDICOM Query/Retrieve
Web UploadClick the ‘Add Study’ dropdown and select ‘Upload Studies’.
Click ‘Choose File’.
10
Navigate to your study or studies.Click ‘Upload’.
After a scan, a list of studies found will appear.‘Check’ studies to upload, and click ‘Upload Selected Studies’.
11
Uploading will begin, with a progress indicator. Uploaded studies are marked ‘Uploaded’ with a green box. Click ‘Back to Studies’ to return to the Studies list. To upload click ‘Upload More’.
The Studies list displays the study just uploaded.
12
Email RequestTo request a study be uploaded by another party,click ‘Add Study’ and select ‘Request Study’.
Enter the email address of the person from whom you are requesting the study, your email address, to receive notification when the study has been uploaded, and a message requesting the study. The party will receive an email with a link to log on (or register) and upload the study. From here the workflow is identical to ‘Web Upload’.
13
About DICOM communicationsIf your user account belongs to a larger Ambra account your ac-count administrator may have set up a Ambra Gateway.Ambra Gateway is a DICOM router used to acquire studiesfrom devices within your network such as modalities,viewers, and PACS.
DICOM SendIn the event that your administrator has set up a Ambra Gateway it is likely that some devices are already configured to automatically send studies to the application. In this event studies will show up on the Studies list as they are acquired.
DICOM Query/RetrieveIf your administrator has set up a Ambra Gateway you maybe able to query downstream destinations for studies and retrieve them. Click ‘Add Study’ and select ‘Query Retrieve’.
14
You will be presented with a search form to indicate any criteria to be used when searching downstream destinations for studies. You must select a Destination and fill in at least one criteria field.
The fields are:
• Destination – The device you want to search for the study on• Study UID• Patient Name – The name of the Patient in DICOM format (e.g.
LAST^FIRST^MIDDLE)• Patient ID – The patient MRN• Accession #• Referring Physician – The name of the Referring Physician in
DICOM format (e.g. LAST^FIRST^MIDDLE)• Modality – A dropdown of Modality types, or ‘All’ if unknown• Start Date and End Date – Must be set together, these are
bounding dates for the date of the study.
15
After the query is conducted the Activities queue is updated with one result per match, indicated by a change in the number next to the Activities link in the main menu. Clicking this link presents the query results.
If you clicked ‘Retrieve’ the study is available in the Studies list.
You can ‘Retrieve’ or ‘Reject’ the study.If you select Retrieve, the study will be acquired from the downstream device.If you select ‘Reject’ the record will bedeleted from the queue.
16
The first series thumbnail displays:Patient namePatient date of birth (DOB)Study descriptionAccession numberDate of studyNumber of series
Study Series ThumbnailsStudies are grouped by “Series”.Series contain one or more images.Click or drag a series thumbnail to load its images in the main image frame.
Closes ViewerMain ToolbarSee page 6.
Study PageOpens a new tab with study details. See page 5.
User Interface Overview
Subsequent thumbnails display:Series nameNumber of instances in series
Study DemographicIf using Ambra Accelerator, a white lightning bolt icon will display next to the study description for accelerated studies. If the study is not accelerated, the icon will be red.
17
Patient orientationIndicators appear at top, sides, and bottom:
A: Anterior, S: Superior. P: Posterior, I: InferiorL: Left, R: Right
RulerAdjusts to scale on zoom in or out.
Context MenuDisplays with right-click, Windows; Control-click, Mac.
Protected Health Information (PHI) Patient: Name, and gender: (F) female, (M) maleDOB: Date of birth, MM/DD/YYYYDate: Study date, MM/DD/YYYY; time of day, HH24MMSSPrimary, Current: Load order, study location in patient historyInstance: 1/x: Instance number in study
Zoom: Magnification level
Quality: Image quality:SD: Standard Definition: 256 pixels max defintion, JPEG compressed
HD: High Definition: 8 bit max definition; JPEG compressedDiagnostic: Full pixel-depth (8, 10, 12, or16 bit max definition) pre-sented as PNG
Center/Width: Window levelIndicates window level
These items display only if theDICOM tags contain data:
Slice Thickness: The slice thickness, in mm
Machine name: Radiation machine used to acquire image
kVp: Peak kilo voltage output of the device used
mA: The total exposure expressed in mAs
Protected Health Information (PHI) Ref. Phys.: Referring physicianStudy: DescriptionSeries: Modality in parentheses concat-enated with the study series number.Image type: Modality dependent DICOM tag that identifies the type of image dis-played.
User Interface Overview
18
The Study Page opens a new tab when the ‘Study Page’ linkin the Viewer is clicked. It is divided into four sections.
Overview: information and functionalities shown below.
Series: a list of series in the study. Series can be downloaded individually, if the ‘Download Study’ permission is enabled. Series descriptions can be edited if the ‘Edit Study’ permission is enabled.
Attachments: a list of items attached to the study – reports, etc.
Meetings: displays a meeting name and host when a meeting is in progress.
Study Page
19
ViewToggles the View sub-toolbar visible/hidden.
Tools
Views and Navigation
This is an inventory of Ambra Viewer tools.Viewer is typically customized for user requirements.
ZoomZooms in and out. Mouse scroll wheel:Scroll up-down. Touch pad: Swipe up/down.
MovePans image. Touch pad: Swipe up/down.
Flip HFlips image horizontally.
Flip VFlips image vertically.
RotateRotates image in 90 degree increments.
Free RotateRotates image.
Previous SeriesLoads previous series.
Show/Hide RulerToggle to show/hide ruler.
Show/Hide Annotation DetailsToggle to show/hide annotation details.
Show/Hide GSPS LayersToggle to show/hide GSPS layers.
Show/Hide Ultrasound RegionsToggle to show/hide ultrasound regions. The “Ultrasound Measurements” annota-tion setting in the General viewer settings must be enabled to use this feature.
Next SeriesLoads next series.
MagnifyClick and drag to magnify an area.
FitFits image to screen.
ScrollScrolls through a study’s images. Use mouse wheel to scroll.
Show/Hide ThumbnailsToggle to Hide//Show study thumbnails.
ResetReturns series to original state while remaining on current image. Resets win-dow level, invert tone, rotation, zoom, free draw and line measure annotations.
Previous StudyLoads the previous study in the Studies list.
Next StudyLoads the next study in the Studies list.
Previous Study by MRNLoads the study for the previous patient.
Next Study by MRNLoads the study for the next patient.
Previous ImageLoads the previous image in the series.
Next ImageLoads the next image in the series.
InvertInverts image colors.
EnhanceLocally enhance the contrast of an image. This filter provides an alternative to the window/level filter for global contrast enhancement.
Show/Hide AnnotationsToggle to show/hide annotations.
Show/Hide InfoToggle to show/hide study information.
ProbeThis button appears only when viewing CTs. Click and drag on an image to read Hounsfield values.
20
LayoutChoose number of images to display from the grid. When a multi-series layout is selected, series can be moved between the displayed panes by clicking the icon in the top right corner and dragging the series to the new location.
MaximizeFills the screen with current study image.
+ NewLoads a duplicate view of study in a new tab.
GridSelects the number of series to display simultaneously.
Layout
ResetResets window level to level when viewer was opened.
SaveSaves currently adjusted window level to a preset.
PresetsThree examples of as many as nine saved presets. Up to nine window level presets can be saved per modality. They can be accessed from the window level menu or by using the numeric keys 1-9 on the keyboard. CT supports default window level presets for Bone, Head and Neck, Soft Tissue, and Lung.
Window Level
Key Images
Window width/levelSets image’s window width (contrast) and window level (the number at the center of the window).Mouse: Window width: hold left click, move mouse left-right. Window level: hold left click, scroll up-down. Touch pad: Window width: one finger tap, drag left-right. Window level: one finger tap, drag up-down.
PrintOpens a page in a new browser window with a hyperlinked list of all available images in the study(s) being viewed. See a subsequent page for how-to-use instructions.
Key ImageMakes the visible study image ( high-lighted with a blue bounding box ), a Key image. A study’s key images can be viewed by selecting ‘View Key Images’ in the view options menu in the studies list.
Key Images OnlyToggle to show/hide key images. When enabled, only images marked as key will display.
Save LayoutClick to save the currently displayed layout for all images marked as key for the patient.
Layout Single SeriesDisplay images from a single-series study in the selected multi-series layout.
Detect Window LevelUpdates the Window Level based on the area within an ellipse or rectangle annotation.
21
AnnotationsAnnotation mark-up is not saved in the original DICOM file. However, you can use the GSPS export button to save a copy of the annotations as a secondary DICOM file, or use the secondary capture button on the Export menu to save a copy of the image with burned-in annotations. Annotation drawing functions can be set to automatically create measurements, or not.
RadiusDraw a circle and the radius measurement will be calculated automatically.
Anonymize SeriesAnonymize PHI in the pixel data for all images within a series by drawing a rectangle over the area to be anonymized, then clicking this but-ton. A new anonymized series will be created.
Anonymize StudyAnonymize PHI in the pixel data for all images within a study by drawing a rectangle over the area to be anonymized, then clicking this but-ton. A new anonymized study will be created.
Crop SeriesCrop a selected series by drawing a rectangle annotation over the displayed image, then clicking this button. A new study will be cre-ated with the cropped series.
CircleClick to create a circle. The dimensions will be calculated automatically.
SquareClick to create a square. The dimensions will be calculated automatically.
Orthogonal AxesHold left click and move mouse from point to point to create an orthogonal axes annota-tion. The measurement is displayed in millime-ters to 100, then in centimeters.
Femoral HeadHold left click and move mouse to draw an an-gle measurement. A resizable circle will display automatically. The measurement of the angle is displayed. The circle displays as a dotted line to indicate that it is for reference only.
Co-LocateSelect an annotation, then click the Co-Locate tool to map the selected annotation to all displayed series that have the same slice geometry. Move or resize the annotation from any displayed series.
Label AnnotationSelect an annotation, then click the LabelAnnotation tool to add a text label.
GSPS Layer Toggle Visible/HiddenClick to toggle saved Grayscale SoftcopyPresentation State.
Color PaletteClick to apply a preset or custom color palette to the displayed study.
AnnotateToggles Annotation sub-toolbar visible/hidden.
SelectSelects an existing annotation. Once an annota-tion is selected, you can adjust it by clicking on the points that appear.
DeleteClick to delete a selected annotation.
FillClick to fill a rectangle or ellipse.
GSPS ExportClick to export annotations as a Grayscale Softcopy Presentation State file.
Line MeasureHold left click and move mouse from point to point to measure. Measurements display in millmeters to 100, then in centimeters.
ArrowHold the left mouse button and drag from the source point to the target point. An arrow will be drawn from the source to the target.
AngleSelect three points using the left mouse button. The angle at the middle point will be measured and displayed.
Cobb AnglesLocate the most tilted vertebra at the top of the curve and draw a parallel line to the superior ver-tebral end plate. Locate the most tilted vertebra at the bottom of the curve and draw a parallel line to the inferior vertebral end plate. The angle formed between the two lines is the Cobb angle.
RectangleClick to create a rectangle. The dimensions will be calculated automatically.
EllipseClick to create an ellipse. The dimensions will be calculated automatically.
TextClick to create text annotations.
22
TraceHold left click and move the mouse to create a free-hand annotation. The dimensions will be calculated automatically as long as the annotation line is not self-intersecting.
PolygonLeft click on each desired vertex point, or hold left click and move the mouse to draw each line seg-ment to create a polygon. The dimensions will be calculated automatically as long as the polygon is not self-intersecting.
StampLeft click and drag your mouse to create a stamp annotation. The annotation displays a lock icon next to your username. Other users will not be per-mitted to create annotations on the same image until the stamp is removed.
PropagateThis tool is used to propagate a text annotation across a selected range of images or all images in a series.
SubtractThe subtract tool can be applied on XA studies to better view blood vessels.
AreaClick to manually create an area annotation us-ing a paint tool.
ThresholdClick to create an area annotation that includes any area with a pixel above a defined Hounsfield unit threshold.
ShrinkClick to create an area annotation that includes any area with a pixel above a defined Hounsfield unit threshold, removing any gaps within the region.
RangeClick to create an area annotation with a pixel between a minimum and maximum Hounsfield unit threshold.
Prostate ToolLeft click and draw three line measurements for length, width, and height. The volume is then automatically calculated as L x W x H x pi/6.
Annotations
Slice SizeSelect an annotation and click this button to manually enter the slice spacing value to use in mm for the volume measurement of the selected annotation. A red message will display at the top of the image indicating that the an-notation measurements were created usingmanually entered data.
CalibrateHold left click and move mouse from point to point to create a line. If the displayed image contains no pixel spacing metadata, you will be prompted to enter the length of the line in mm. The measurements for any other annotations created on the same image will be calculated using your calibration measurement. A red message will display at the top of the image indicating that the annotation measurements were created using manually entered data.
23
Meet Start a live collaborative meeting with other Ambra users. See a subequent page for meeting instruc-tions.
Record ( Audio )Opens the audio recorder in a new window. Audio recordings are saved to the study as WAV file at-tachments.
Record ( Script )Captures screen activity in the viewer (video), and microphone input (audio). Movie files are automat-ically saved as study attachments, and available for replay from the Reports menu in the Studies list, the Attachments section in the Overview tab in the Go to Study page, or the Attachments tab in the Go to Study page.
ExportMeetings
Settings
ExportExports main image or displays editable meta-data.
PNGExport main image as a PNG file.
DICOMExport main image as a DICOM file.
MetaDisplay study’s editable metadata in a new tab – any non-red DICOM tags. Metadata editor supports study level changes to DICOM tags, not series or image level changes. Editable study list fields are not editable in the metadata editor.
Store PNGExport a square thumbnail of the image as a PNG. The PNG will be saved as a study attachment.
AVIExport the active series in AVI format.
MP4Export the active series in MP4 format.
Export SeriesDownload the DICOM images for the active series.
Export StudyDownload the DICOM study.
Export ISODownload the ISO package for the study.
Export ViewerDownload the local viewer package for the study.
MouseSet functions of left button, right button, and scroll wheel.
SettingsOpens the viewer settings editor whichs allows you to set a default layout, default mouse tool, thumb-nails position, toolbar buttons by modality, default cine speed by modality, Window Level presets by modality, text display by modality, and hanging pro-tocols by modality. See a subsequent page for viewer settings editor use instructions.
Pixel SizeSelect an annotation and click this button to manu-ally enter the pixel spacing value to use in mm for the measurement of the selected annotation. A red message will display at the top of the image indicat-ing that the annotation measurements were created using manually entered data.
24
R/L: Reference LinesToggles the reference lines’ visibility for all series. Reference lines show the intersection of the se-lected image’s plane with all orthogonal series.
LinkWhen selected and either the mouse wheel or Scroll tool is used to scroll a series, all parallel series will scroll in such a way as to display the nearest image. The loading bar ( a blue horizontal incremental bar at the base of the image frames ), shows the amount of DICOM information that needs to be loaded to enable the linked series and plane local-ization features. Those features will work when the bar reaches the right hand side of the linked image frames.
Local: Plane LocalizationClick to localize all visible series to the point under the cursor. A red cursor will display the corre-sponding location on each series, and the series will scroll to display the nearest image.
3D3D tools are for interacting with 3D DICOM data such as CT and MR studies.
The cine sub-toolbar controls video playback.Click ‘Play’, or ‘Pause’. ( ‘Pause’ shown here. )Click ‘Faster’ to increase playback speed.Click ‘Slower’ to decrease playback speed.Frames-per-second ( FPS ) is displayed nextto the primary ‘Cine’ button when video is playing.
Keyboard shortcuts:P Play/Pause all visible cine loopsN Next set of seriesB Back to the previous set of series
Cine
Actions
Split Study
Actions‘Share’ shortcuts. The ‘Actions’ button displays for users with the ‘Routing Rules: Create and run manual rules’ role permission checked. Any rout-ing rule with the ‘Apply rule when a study is manually routed’ setting enabled will be available from the new ‘Actions’ button, shown as ‘Test’ in this example.
Split StudyThe “Split” button can be used by users with the permissions to split studies. Click the “Split” button in the viewer toolbar to activate the tool, then select each series to break out into a separate study by clicking on the series thumbnail. Series selected to split into a new study are highlighted in or-ange. Click the “Split” toolbar button again to generate the new study. The selected series are then split into a new study and deleted from the original study.
Delete ImageClick to delete the currently highlighted image.
Delete SeriesClick to delete the currently highlighted series.
Remove ImagesClick to delete an image or range of images within a series.
Delete
3DToggles 3D sub-toolbar visible/hid-den. See sub-toolbar button descrip-tions on a subsequent page.
CineView images as a movie. US ( multi-frame ) studies are displayed with HTML5 video in actual frames per second.
DeleteDelete images or series.
25
Merge SeriesThe “Merge” button can be used to merge multiple series together. Click the “Merge” button in the viewer toolbar to activate the tool, then select each series to merge by click-ing on the series thumbnail. Series selected to merge are highlighted in orange. Click the “Merge” toolbar button again to complete the action. The selected series are then merged into one series.
ReverseThis tool is used to reverse the order of the slices within the selected series.
UnweaveThe Unweave tool is used to separate interleaved series.
RearrangeThis button can be used to reorder the slices within a series using a specific order.
PartThe Part button can be used to move slices from one series to a new series.
ResetThis button can be used to reset the study to the original arrangement.
26
Multiple Frames
LayoutClick ‘Layout’ to choose from one-up to sixteen-up layouts. One-up is shown here.
LayoutTwo-up is shown here.
Active seriesThe active series is high-lighted with a blue bound-ing box. Clicking another frame will make that frame active.
27
Stack Series
Stack Series ThumbnailThe Stack Series thumbnail can beconfigured to display first or last in the series thumbnails. Click the thumbnailto enable Stack functionality.
When enabled, the Stack feature allows users to scroll continuously through all images in a study. Stack functionality is activated in Viewer Settings. It can be set as the default per modality, and/or can be enabled on a study-by-study basis by clicking on the Stack Series thumbnail.
28
View a related studyScroll to the related study’s heading in the thumbnails panel, and click a series im-age to load the series. This screenshot shows two stud-ies for the same patient: the ‘Primary/Current’ studyand a ‘Related/Prior #1’.
Related StudiesRelated studies have the same MRN in the active folder (organization, group or location). If the MRN is blank, no studies will display in the related study’s thumbnails. The active folder is the folder in which the viewed study resides.
Find related studiesIf related studies for a patient exist in the Ambra system, they can be found on the right hand side of the thumbnails panel. Scroll to the right if necessary, and click the related study’s icon to load its series. The related study’s thumbnails will load alongside the existing study in the thumbnails panel.
29
Collaborate live with other Ambra users and guests.
Meetings
Start a meeting
Click the ‘Meet’ button.
Name the meeting,then click ‘OK’.
Attendees
The meeting is started.
All attendees are shown in the ‘Attendees’ list.
Actions performed by the presenter (Annotations, Scroll, Window/Level, Layout for example) are synced live with attendees.
Registered Ambra users can join the meeting by clicking the Meeting icon next to the study in the Studies list.
30
Invite Guests
Click “Share Meeting Link” to send an email with the meeting link to guests(anyone not already aregistered Ambra user).
Change Presenter
Click the blue icon next to an attendee to make that person the presenter.Both registered Ambrausers and guests can be made presenter.
End a Meeting
Click ‘End Meeting’.
Meetings
Attendee View
Attendees will see thepresenter’s view, minusthe toolbar.
Leave a Meeting
Click ‘Leave Meeting’.
31
View Unrelated Studies asRelated StudiesSelect all studies to view as related by clicking the checkbox next to each study on the left side of the Studies list. Next, select the ‘View re-lated’ option in the Actions menu on the top left side of the Studies list. The selected studies will open in a new tab. The most recent study will display as the primary study by default. The other selected studies will be available to view as related studies. To compare a related study to the primary study, click on the related study thumbnail in the viewer.
Local Study ViewingWe provide two options for downloading and viewing studies locally.The local viewer is supported in Windows 7 and higher and OS X 10.9 and higher.
‘Download Viewer’‘Download Viewer’ enables local viewing of a study using the fullAmbra Viewer, which includes window level and performs at PACS viewer speeds. Clicking the down arrow to the right of the ‘Download’ button and selecting the ‘Download Viewer’, will download a Zip file to your machine. Un-zip it and double click the ‘index’ file. The study will open in Ambra Viewer. You do not need access to the Internet to view the study.
‘Download ISO’‘Download ISO’ downloads a study package that includes any attached reports and Ambra Simple Viewer software to make it easy to copy the study package to a CD. Simple Viewer does not include the window level function, but it performs at PACS viewer speeds. Clicking the down ar-row to the right of the ‘Download’ button and selecting the ‘Download ISO” will download a Zip file. Un-zip the file, and a folder will appear which can be burned to CD. Double clicking the ‘index’ file within the folder will open the study in Ambra Simple Viewer. You do not need ac-cess to the Internet to view the study.
32
SettingsAll settings are per-user. Account-level settings must be edited by contacting support.
Open the settings editor by clicking the ‘Settings’ button on the main viewer toolbar.Save changes at any time by clicking the blue ‘Save’ button, or undo all changes by clicking the gray ‘Reset’ button.Use the menu on the left to navigate. Expand or collapse a section by clicking on it. Edit a page by clicking on a blue link.Clicking on a ‘New Page’ icon on the right hand side of the menu will add a new page to that sec-tion. A page can be removed by clicking the ‘x’ icon on the right side.
SectionsGeneral
Layout:Default Layout, Layout Single Series.
Mouse Tools:Default Left Click Hold Mouse Tool, Default Right Click Hold Mouse Tool, Default Mouse Scroll Tool, Reverse Vertical Window/Level Behavior, Reverse Horizontal Window/Level Behavior, Dis-able Annotation Crosshair Cursor, Disable Mobile Image/Series Scroll Arrow.Thumbnails:Thumbnails Position, Smaller Thumbnails, Hide Thumbnails, Hide Thumbnails Date and Time.Loading:Number of Images to Preload, Use Simple Preloading, Diagnostic Quality Always.
Printing:Print Size (inches), Print Margin (inches).
Export Square Images.
Key Image:Show Only Key Image Series, Flatten Key Image Series, Combine Key Image Series, Include Re-lated Studies When Combining Key Image Series, Key Image Series Order.Related Studies:Show Related Studies, Automatically Load Related Studies.
Only Show Priors.
Reports:Show PDFs, Display Reports First.
Annotations:Measurements Always Use Millimeters, Measurements Text Size, Measurements Show Details, Ultrasound Measurements, Measurements - Toggle All Series, Text Overlay - Toggle All Series, Ruler - Toggle All Series, Allow CAD SR, and Support ROI Overlays.Allow Volume Measurements.Show Small Angle Only (Cobb).s
Mobile:Prefer Desktop Viewer, Prompt for Mobile App.
33
ToolbarSelect and arrange toolbar buttons.Context MenuSelect and order context menu buttons.Key ShortcutsCustomize keyboard shortcuts for viewer tools.Modalities
• General - Simple settings like the modality name, default cine speed, display middle slice, show stack series, diagnostic quality always, and series filters. Series filters can be used to exclude certain series based on the series description or DICOM tag value. The filter can be set to “Contains”, “Equals”, or “Does Not Contain”.
• Window level presets - Add and remove window level presets, which appear on the win-dow. level menu in the application when a series of the right modality is selected.
• Color Palette Presets - Add and remove custom color palette presets for this modality.• Toolbar Buttons - Add or remove buttons from the toolbar for this modality.• Text Annotations - Add or remove text annotations for this modality.
Hanging ProtocolsA hanging protocol specifies how studies of a particular type should be displayed on the screen.
• General - The hanging protocol name and layout.• Study Filters - Specify which studies this hanging protocol applies to. At least one filter in
every “filter group” must be matched, so for example, to match only CT studies of the head, create two filter groups, one with a “modality CT” filter, and one with a “study description head” filter. Filter types:• Modality - The Modality DICOM tag must match the specified text.• Study Description - The study description must contain the specified text.
• Image Sets - Specifies how series are selected for display. Filters are applied in the same way as study filters, but there are more options:• Series Description - Define a specific series description and set the filter to “Contains”,
“Equals” or “Does Not Contain”.• Image Type - Define a specific image type value (checked against the Image Type DICOM
tag) and set the filter to “Contains”, “Equals” or “Does Not Contain”.• View Position - Define a specific view position value (checked against the View Position
DICOM tag) and set the filter to “Contains”, “Equals” or “Does Not Contain”.• Laterality - Define a specific laterality value (checked against the Laterality DICOM tag)
and set the filter to “Contains”, “Equals” or “Does Not Contain”.• Multiframe - If checked, this filter only matches multiframe series.• US Image Type - Extra filter options for ultrasound images.• DICOM tag - Define a specific DICOM tag and value to filter on. Set the filter to “Contains”,
“Equals” or “Does Not Contain”.• Display Sets - Display sets describe how to display the selected series on the screen:
• Which image set to use.• How to transform the image (flips, rotations).• Window level and inversion settings.• Which overlays to display (text, measurements).
• Cine Settings - Specify cine settings such as frame rate and automatic playback.
34
Printing
Keyboard Shortcuts
Clicking the ‘Print’ icon in the Viewer opens a new browser window with two columns, dis-played here.
The left column contains links to each image in the study, ‘Fit to Page’, ‘Full Size’ ( one screen pixel for every image pixel ), and ‘True Size’( 1” on the screen or paper equals 1” in thegeometry of the patient. ) Full Size should be used when a specific DPI is required for print-ing.
The right column displays images after their respective links in the left column are clicked. All images displayed in the right column will be printed when the ‘Print’ link at the top of the left column is clicked.
( Studies with less than 20 images display two additional functioning hyperlinks at the top of the left column: ‘Show All Full Size’ and ‘Show All True Size’. )
Keyboard shortcuts can be customized by clicking the‘Settings’ button, in the main Viewer toolbar, and thenthe ‘Key Shortcuts’ link on the Settings page.
GeneralN Next set of series
B Back to the previous set of series
Arrow up/down Previous/next images
Page up/down moves 10 images at a time
AnnotationsControl + C Copies a selected annotation to the clipboard
Control + V Pastes a copied annotation
Control + D Duplicates a selected annotation
Delete Deletes a selected annotation
Window LevelNumber keys 1-9 Applies window level presets
CineP Play/Pause all visible cine loops
N Next set of series
B Back to the previous set of series
35
Mobile Browser RequirementsApple iOSSafari iOS ( version 7.0 and later )Upload Images: Native View Images: Native
Android( Version 4.4 KitKat and later ) Google Chrome ( version 28.0 and later )Upload Images: Native View Images: NativeFirefox ( version 23.0 and later )Upload Images: Native View Images: Native
Viewer Features ComparisonDescription Desktop Mobile Phone Mobile Tablet
Cybersecurity controls - login √ √ √
Search √ √ √
Import a study - web upload √ √ √
Import a Study - Email Request √ √
Import a Study - DICOM Send √ √ √
Import a Study - Query/Retrieve √ √
View images (zoom, move, rotate) √ √ √
PHI overlay √ √ √
Series thumbnails √ √
Study metadata √ √
Window/Level √ √
Annotations (text, distance, area, angle, density) √ √
3D (linked series, planar localization, and reference lines) √ √
Layout √ √
Cine √ √
Delete √ √
Related studies √ √
Meetings √
Local viewing √
Settings √ √
Printing √ √
36
Mobile Viewer GesturesMove ImageSwipe with one finger.
Zoom In or OutMake a pinching or expanding gesture.
Rotate ImagePlace two fingers on the image and move them in a rotating motion.
Navigate Between Images or SeriesSingle tap with one finger in one of four quadrants.
Toggle Patient Information On/OffDouble-tap with one finger.
Mobile Phone ViewerView images on your iPhoneor Android phone using any of the browsers supported on the Mobile Browser Requirements page.Not intended for diagnostic use on mobile devices.
37
Mobile Tablet ViewerView images on your tablet usingany of the browsers supported onMobile Browsers Requirements page.Not intended for diagnostic useon mobile devices.All tools in the Viewer’s desktopversion less the meetings feature andthe local viewing feature are availablein the tablet viewer.
38
LBL0018 v35.0 August 26, 2020