gehealthcare centricity™universalviewer webclient usermanual
TRANSCRIPT
GE Healthcare
Centricity™ Universal ViewerWeb Client
User ManualVersion 6.0
Do not duplicateCopyright © 2015-2016 General Electric Co.™Centricity is a trademark of General Electric Co.
Copyright Information
All Licensed Software is protected by the copyright laws of the United States and byapplicable international treaties. No rights under copyrights are transferred to Customer,except as specifically provided in the License Grant.
Trademark Information
GE and the GE Monogram are trademarks or registered trademarks of the GeneralElectric Company. All other product names and logos are trademarks or registeredtrademarks of their respective owners.
Confidentiality and Proprietary Rights
This document is the confidential property of GE and/or its affiliated entities. It is furnishedto, and may only be used by, customers and their employees under a written agreementwith GE and may only be used in accordance with the terms of that agreement. Theaccess and use of this document is restricted to customers and their employees. The userof this document agrees to protect the confidentiality of the information contained hereinand GE’s proprietary rights as expressed herein and not permit access to this documentby any person for any purpose other than as an aid in the use of the GE software. In nocase may this document or any portion hereof be accessed, made available, examined, orcopied for the purpose of developing, marketing, or supporting any system or computerprogram similar to the GE software. No part of this document may be copied without theprior written permission of GE. The information in this document is subject to change byGE without notice.
Inquiries regarding permission for use of material contained in this document should beaddressed to:
GE Healthcare ATTN: General Counsel, 540 W. Northwest Highway, Barrington, IL 60010
Publication Date and Document Numbers
December 19, 2016
DOC1928855
2101085-001
Service Pack
SP5.0.1
2101085-001 2
Global Regulatory Information
Information for individual countries’ regulatory requirements is included below.
United States
U.S. Federal law restricts this device to sale by or on the order of a physician.
China
# Label RequirementTitle Wording inChinese Contents
1 Product name 产品名称 影像归档及传输软件
2 Product model 型号、规格 Centricity Universal Viewer (发布版本：6.0)
3 Name of the registrationapplicant/filing applicant
注册人名称 GE Healthcare
4 Residence of the registrationapplicant/filing applicant
注册人住所 540 W. Northwest Highway, Barrington, IL60010 USA
5 Contacts of the registrationapplicant/filing applicant
注册人联系方式 540 W. Northwest Highway, Barrington, IL60010 USA
6 After-sale service institute ofthe registration applicant/filingapplicant
售后服务单位 通用电气医疗系统贸易发展（上海）有限公司
7 Imported Medical Device: Nameof the agent
代理人名称 通用电气医疗系统贸易发展（上海）有限公司
8 Imported Medical Device:Residence of the agent
代理人住所 中国（上海）自由贸易试验区意威路96号1幢
9 Imported Medical Device:Contacts of the agent
代理人联系方式 中国（上海）自由贸易试验区意威路96号1幢
11 Name of the manufacturer 生产企业名称 GE Healthcare
12 Residence/Address of themanufacturer
生产企业住所 540 W. Northwest Highway, Barrington, IL60010 USA
13 Manufacturing Address of themanufacturer site
生产地址 540 W. Northwest Highway, Barrington, IL60010 USA
14 Contacts of the manufacturer 生产企业联系方式 540 W. Northwest Highway, Barrington, IL60010 USA
15 Number of the Mfg Cert forMedical Device/Filing Cert MfgClass I Medical Device of themanufacturer (Not applicable forimport medical device)
生产许可证编号 Not applicable/不适用
16 Number of the registrationcertificate for Medical Device orthe Filing Certificate for MedicalDevice
医疗器械注册证编号 国食药监械(进)字2014第2702186号
17 Number of product registrationstandard
产品注册标准编号 YZB/USA 2204-2014《影像归档及传输系统》
2101085-001 3
# Label RequirementTitle Wording inChinese Contents
18 Service life 使用期限 Centricity Universal Viewer预期使用寿命为5年。
19 Indication 适用范围 本产品可以接收、存储、传输、处理和显示符合DICOM的医学图像（包括乳腺X射线摄影图像）。不用于有损压缩的乳腺X射线摄影图像。
Japan
管理医療機器/特定保守管理医療機器
一般的名称： 汎用画像診断装置ワークステーション
販売名： セントリシティ・ユニバーサル・ビューワ
製造番号： 記録メディアの製造元表記を参照
製造販売業者： GE ヘルスケア・ジャパン株式会社東京都日野市旭が丘4-7-127
2101085-001 4
CE Marking Information
Compliance
The Universal Viewer bears CE mark "CE 0459", indicating its conformity with theprovisions of the Council Directive 93/42/EEC concerning medical devices and fulfillingthe essential requirements of Annex I of this directive.
The standards the product complies to are listed in the General Information section.
The country of manufacture can be found on the equipment labeling.
The safety and effectiveness of this device has been verified against previously distributeddevices. Although all standards applicable to presently marketed devices may not beappropriate for prior devices (i.e. electromagnetic compatibility standards), this device willnot impair the safe and effective use of those previously distributed devices.
General Information
This manual is an integral part of the product and describes its intended use. Observanceof the manual is a prerequisite for proper product performance and correct operationand ensures patient and operator safety.
The symbol indicates that the waste of electrical and electronic equipment mustnot be disposed as unsorted municipal waste and must be collected separately. Pleasecontact an authorized representative of the manufacturer for information concerningthe decommissioning of your equipment.
This product consists of devices that may contain mercury, which must be recycledor disposed of in accordance with local, state, or country laws. Within this system, thebacklight lamps in the monitor display contain mercury.
Information, which refers only to certain versions of the product, is accompanied bythe model number(s) of the product(s) concerned. The model number is given on thenameplate of the product.
Warranty does not cover damages resulting from the use of accessories and consumablesfrom other manufacturers.
GE Healthcare is responsible for the effects on safety, reliability, and performance ofthe product, only if
● assembly operations, extensions, readjustments, modifications, or repairs are carriedout by persons authorized by GE Healthcare
● the electrical installation of the relevant room complies with the requirements of theappropriate regulations; and
● the device is used in accordance with the instructions for use.
The manufacturer is not responsible for any interference caused by using other thanrecommended interconnect cables or by unauthorized changes or modifications to thisequipment. Unauthorized changes or modifications could void the users' authority tooperate the equipment.
The GE Healthcare quality management system complies with the international standardsISO 9001:2008, ISO13485:2003 and the Council Directive on Medical Devices 93/42/EECAnnex II Section 3.
2101085-001 5
General Definitions of Symbols
Symbol Definition
This symbol indicates the AUTHORIZED REPRESENTATIVE IN THEEUROPEAN COMMUNITY of the product.
This symbol indicates the MANUFACTURER of the product.
This symbol indicates the DATE OF MANUFACTURE of the product.
This symbol indicates that the operator should CONSULTINSTRUCTIONS FOR USE for further information.
This symbol indicates the manufacturers BATCH CODE, or lot numberof the product.
The symbol for CAUTION highlights the fact that there are specificwarnings or precautions associated with the device.
0459
The product bears CE mark indicating its conformity with the provisionsof the Council Directive 93/42/EEC, concerning medical device andfulfills the essential requirements of Annex I of this directive.
The WEEE symbol indicates that the waste of electrical and electronicequipment must not be disposed as unsorted municipal waste andmust be collected separately.
Rx Only For products distributed in the US, the symbol for “Rx Only” indicates:Caution: Federal law restricts this device to sale by or on the order of alicensed healthcare practitioner.
2101085-001 6
Contents
Preface: About this Release .............................................................................20i About Centricity Universal Viewer ...................................................................... 20
ii Hardware and Software Requirements .............................................................. 20
ii-i Supported Client Operating System and Web Browser Versions ................. 20
ii-ii Monitor Configurations............................................................................. 21
ii-iii Universal Viewer Requirements ............................................................... 22
ii-iv Server Requirements .............................................................................. 22
iii Contacting GE Support .................................................................................... 23
iii-i Contacting the ROC ................................................................................ 23
iii-ii Applications Support and Service Support (Asia Regions) ......................... 23
iii-iii Applications Support Using iCenter, eService, and ApplicationsAnswerline ............................................................................................. 24
iii-iv Contact Information for GE Healthcare Offices......................................... 24
iv Documentation Conventions ............................................................................ 25
iv-i Text ........................................................................................................ 25
iv-ii Screen Captures .................................................................................... 25
v Safety ............................................................................................................. 25
v-i For Your Safety........................................................................................ 25
v-ii System Safety......................................................................................... 27
v-iii Measurement Limits of Accuracy Statement ............................................. 28
v-iv Certifications .......................................................................................... 28
1 Centricity™ Universal Viewer Super Quick Start Guide..............................29
2 Logging In and Out .........................................................................................312.1 To Log In ...................................................................................................... 31
2.2 To Log Out ................................................................................................... 32
2.3 To Change Your Password ............................................................................ 32
2.4 Resolving Login Issues.................................................................................. 32
3 Study Lists.......................................................................................................343.1 What Is a Study List? .................................................................................... 34
3.2 Study List Basics .......................................................................................... 34
3.2.1 Study List Basics.................................................................................. 34
3.3 Paging through the Study List ........................................................................ 39
3.3.1 To See Other Pages in the Study List .................................................... 39
3.4 Searching the Study List................................................................................ 40
3.4.1 Using Quick Search.............................................................................. 40
3.4.2 Searching RA1000 Worklists in Universal Viewer ................................... 41
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3.4.3 Search Criteria..................................................................................... 41
3.4.4 To Refine the Accuracy of Your Search.................................................. 46
3.4.5 To Refresh a Search............................................................................. 47
3.4.6 Searching: For Japanese Users Only .................................................... 47
3.4.7 Searching: For Hebrew Language Users Only ....................................... 48
3.5 Tabs............................................................................................................. 49
3.5.1 To Create a New Study List Tab ............................................................ 49
3.5.2 To Move or Edit a Tab........................................................................... 49
3.5.3 Auto-fetch............................................................................................ 50
3.6 Configure Auto-launch and Close Dictation..................................................... 51
3.7 Changing the Viewer’s Color Scheme ............................................................ 52
3.8 Sorting Columns ........................................................................................... 52
3.9 Configuring Columns..................................................................................... 52
3.9.1 Configuring Columns............................................................................ 52
3.10 Setting Display Preferences by Modality ....................................................... 55
3.10.1 Setting Display Preferences by Modality .............................................. 55
3.10.2 Setting General Display Options.......................................................... 56
3.10.3 Setting the Date and Time................................................................... 57
3.10.4 Setting the Appearance of Worklist Tabs.............................................. 58
3.10.5 Configure Single-Frame Image Thumbnails by Modality........................ 58
3.11 Set the Number of Comparisons to Load Automatically.................................. 58
3.12 STAT Studies.............................................................................................. 60
3.12.1 STAT Studies ..................................................................................... 60
4 Study List Tools ..............................................................................................614.1 Selecting and Opening Studies ...................................................................... 61
4.1.1 To Open One Study.............................................................................. 61
4.1.2 To Open Multiple Studies ...................................................................... 61
4.1.3 To View Selected Studies ..................................................................... 62
4.1.4 Incomplete Studies............................................................................... 62
4.1.5 To View Unverified Studies ................................................................... 62
4.2 Reports and Notes ........................................................................................ 63
4.2.1 Adding a Report or Note to a Study ....................................................... 63
4.3 Series and Image Information ........................................................................ 65
4.3.1 To Display Series Information................................................................ 65
4.3.2 To Display Image Information................................................................ 65
4.4 Image Thumbnails ........................................................................................ 66
4.4.1 Thumbnail Information.......................................................................... 66
4.4.2 To Display and Use Thumbnails ............................................................ 66
4.5 Audit ............................................................................................................ 67
4.5.1 Auditing a Study................................................................................... 67
2101085-001 8
4.6 Marking a Study............................................................................................ 67
4.6.1 Marking a Study ................................................................................... 67
4.6.2 To Mark a Study as Reviewed............................................................... 68
4.6.3 To Reverse the Reviewed Status........................................................... 68
4.6.4 To Mark a Study as Dictated ................................................................. 68
4.6.5 To Reverse the Dictated Status ............................................................. 68
4.6.6 To Mark a Study as QC......................................................................... 68
4.6.7 To Reverse the QC Status .................................................................... 69
4.6.8 Mark Study as Verified (for Systems with EA Only) ................................. 69
4.6.9 Matching a Report to a Study................................................................ 70
4.6.10 To Manage Unmatched Reports .......................................................... 70
4.6.11 To Detach a Report............................................................................. 70
4.6.12 Marking and Unmarking Confidential Exams ........................................ 71
4.7 Matching a Document to a Study ................................................................... 72
4.7.1 Matching a Document to a Study........................................................... 72
4.7.2 To Manage Unmatched Documents....................................................... 72
4.7.3 Matching an Order to a Study ............................................................... 72
4.7.4 To Manage Unmatched Orders ............................................................. 73
4.7.5 To Detach an Order from a Study .......................................................... 73
4.8 Merging........................................................................................................ 73
4.8.1 Launching CPACS Exam Manager or SA Tools ...................................... 74
4.8.2 Merging Studies ................................................................................... 74
4.8.3 Merging a Series.................................................................................. 74
4.9 Rejecting and Unrejecting Images.................................................................. 75
4.9.1 Notes on Rejecting Images and on Rejected Images .............................. 75
4.9.2 Rejecting an Image .............................................................................. 76
4.9.3 Unrejecting an Image ........................................................................... 77
4.10 Deleting a Series or Image .......................................................................... 78
4.10.1 Deleting a Series or Image.................................................................. 78
4.10.2 To Delete a Series .............................................................................. 79
4.10.3 To Delete an Image ............................................................................ 79
4.11 Change Patient or Study Information ............................................................ 79
4.11.1 Launching CPACS Exam Manager or SA Tools .................................... 79
4.11.2 Changing Patient/Study Data .............................................................. 80
4.12 Temporary Access to a Study....................................................................... 81
4.12.1 Granting and Revoking Temporary Access to a Study........................... 81
4.12.2 To Grant Temporary Access to a Study ................................................ 81
4.12.3 To Revoke Temporary Access ............................................................. 81
4.13 Working with Worklists................................................................................. 82
4.13.1 Assigning a Study to a Worklist ........................................................... 82
2101085-001 9
4.13.2 To Assign a Study to a Worklist ........................................................... 82
4.13.3 To Assign a Study to a Specific User's Worklist .................................... 82
4.13.4 To Detach a Study from a Worklist....................................................... 82
4.13.5 To Rename a Worklist......................................................................... 83
4.13.6 To Delete a Worklist............................................................................ 83
4.14 Linking Studies ........................................................................................... 83
4.14.1 Linking Studies................................................................................... 83
4.15 Working with Scanned Documents ............................................................... 85
4.15.1 Adding a Scanned Document.............................................................. 85
4.16 Sending a Study in DICOM.......................................................................... 86
4.16.1 To Send a Study in DICOM ................................................................. 86
4.17 Sending One or More Series in DICOM ........................................................ 86
4.18 DICOM Query/Retrieve ............................................................................... 87
4.19 Create or Import CDs .................................................................................. 89
4.19.1 Create CDs........................................................................................ 89
4.19.2 Importing a Study ............................................................................... 93
5 Image Viewer ...................................................................................................955.1 Compression ................................................................................................ 96
5.1.1 Determining if an Image is Compressed ................................................ 97
5.2 Refreshing the Image Viewer......................................................................... 97
5.2.1 To Refresh the Study in the Viewer........................................................ 97
5.3 Dictating or Reviewing a Study in a Third-Party Dictation System..................... 98
5.3.1 To Dictate a Study Using a Third-party Dictation System......................... 99
5.3.2 To Mark a Study as Dictated or Reviewed.............................................100
5.4 Cross Enterprise Display ..............................................................................100
5.4.1 Health Status Indicator ........................................................................101
5.4.2 Remote Studies ..................................................................................103
5.4.3 Access to Migrating Studies ................................................................105
5.4.4 Unsupported Functions When Using Cross EnterpriseDisplay ................................................................................................105
5.5 Patient Folder ..............................................................................................105
5.5.1 To View All Studies for a Patient...........................................................107
5.5.2 Workflows for Adding Images to an Existing Study ...............................108
5.5.3 To Add an Additional Note or Report to a Study.....................................109
5.5.4 To View and Detach Orders from a Study .............................................110
5.5.5 To View and Add Scanned Documents .................................................110
5.5.6 To View Key Images Information for a Study .........................................110
5.5.7 To Configure Patient Folder Tabs ......................................................... 111
5.5.8 To View a Series in the Patient Folder .................................................. 111
5.5.9 To Send a Study in DICOM.................................................................. 111
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5.5.10 Sending One or More Series in DICOM ..............................................112
5.5.11 Loading a Mammography Study from the Patient Folder ......................112
5.5.12 To Import a Study ..............................................................................113
5.5.13 Display DICOM SR............................................................................114
5.6 Closing a Study ...........................................................................................116
5.6.1 Closing a Study...................................................................................116
5.6.2 To Close a Study.................................................................................116
5.6.3 To Establish Default Settings for the Done Command ............................116
5.7 Printing .......................................................................................................117
5.7.1 The Print Window................................................................................117
5.7.2 Adding and Removing Print Templates .................................................118
5.7.3 Editing, Creating, and Deleting Print Templates.....................................119
5.7.4 The Print Template Editor ....................................................................119
5.8 Key Images .................................................................................................121
5.8.1 Marking and Unmarking Key Images ....................................................121
5.8.2 Viewing Key Images............................................................................122
5.8.3 Significant Images from RA1000 ..........................................................122
5.9 One-Click Image Snapshot (Secondary Capture) ...........................................123
5.10 One-Click Image Print ................................................................................123
5.11 Saving a Study to a CD...............................................................................123
5.11.1 To Save a Study to a CD....................................................................124
5.11.2 To Upload a Study to a DICOM Server from a CD................................125
5.12 To Import a Study.......................................................................................127
6 Viewing Options............................................................................................1296.1 To Access and Use the Series Selector .........................................................129
6.2 The Navigator in Universal Viewer ................................................................131
6.2.1 To Enable and Use the Navigator .........................................................131
6.2.2 The Study Selector..............................................................................132
6.2.3 The Navigator and Adding and Removing Studies.................................133
6.2.4 To Use the Navigator to Page through One or More Series ....................134
6.2.5 Navigating through Multiple Series with Quick Cycle..............................135
6.2.6 Display Middle Image in Navigator .......................................................135
6.2.7 To Set Defaults from the Navigator .......................................................136
6.3 EchoPAC Viewer..........................................................................................144
6.3.1 To Add an EchoPAC Viewport to an HP ................................................144
6.3.2 Configuring EchoPAC..........................................................................145
6.3.3 Launching EchoPAC ...........................................................................145
6.4 Tomtec Viewer .............................................................................................147
6.4.1 To Add a Cardiology Advanced Analysis (Tomtec) Viewport to anHP........................................................................................................147
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6.5 Comparing Studies ......................................................................................147
6.5.1 To Compare Studies............................................................................148
6.6 Swapping ....................................................................................................148
6.6.1 To Swap Using the Title Bar .................................................................149
6.6.2 To Swap Images within the Navigator ...................................................149
6.7 Stack (Series) View......................................................................................149
6.7.1 To View the Images in a Series ............................................................149
6.7.2 To View the Images in Multiple Series Simultaneously ...........................150
6.8 To Display and Use the Timeline ...................................................................150
6.8.1 Configure Navigator Thumbnail Size ....................................................152
6.8.2 Configure Border For Timeline Thumbnails ...........................................153
6.8.3 Display DICOM SR .............................................................................154
6.9 Hiding and Showing the Toolbar and Navigator ..............................................156
6.10 Presentation State......................................................................................156
6.10.1 PS Application and Limitations ...........................................................158
6.10.2 To Save a Presentation State Through the Menu.................................159
6.10.3 To Save a Presentation State Automatically ........................................160
6.10.4 To Retrieve a Presentation State ........................................................160
6.10.5 To Hide a Presentation State..............................................................160
6.10.6 To Export a Presentation State as a DICOM Object .............................161
6.10.7 Quality Control and QCPS .................................................................161
6.10.8 To Save a QC Presentation State .......................................................161
6.10.9 To Mark a Study as QC'd ...................................................................161
6.11 Viewing for Referring Physicians .................................................................162
6.11.1 To Manage the Referring Physician Viewer .........................................162
6.11.2 To Change the Referring Physician for a Study....................................163
6.11.3 To Change the Referring Physician Email Address ..............................163
6.12 Hanging Protocol Tool ................................................................................164
6.12.1 To Use the Hanging Protocol (HP) Tool ...............................................164
6.12.2 To Update the Apply Hanging Protocol Menu ......................................165
6.12.3 To Apply a New Hanging Protocol ......................................................165
6.12.4 To Embed Notes / Reports in Viewport................................................166
6.12.5 Hanging Protocol Quick Save.............................................................166
6.13 Smart Reading Protocols ............................................................................169
6.13.1 Smart Reading Protocols: Overview ...................................................169
6.13.2 Teaching the System Your Hanging Preference ...................................172
6.13.3 Applying a Smart Reading Protocol (SRP) or Trend SRP .....................173
6.13.4 Using SRP Quick Search...................................................................174
6.14 Sheet View ................................................................................................175
6.14.1 Creating a Temporary Sheet View ......................................................177
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6.14.2 Creating a Sheet View as a Hanging Protocol .....................................177
6.14.3 Breaking a Sheet View ......................................................................178
6.14.4 Adding a Viewport to a Sheet View.....................................................178
6.14.5 Deleting a Viewport from Sheet View ..................................................178
6.15 Site-level Paging .......................................................................................179
6.15.1 How Special Paging Works ................................................................181
6.15.2 Using the Cine Toolbar .....................................................................182
6.16 Bookmarks ................................................................................................183
6.16.1 To Apply a Bookmark.........................................................................183
6.16.2 To Save a Bookmark .........................................................................184
6.16.3 To Delete a Bookmark .......................................................................184
6.16.4 To View a List of Your Saved Bookmarks ............................................185
6.16.5 To View a List of All Saved Bookmarks for a Patient ............................185
6.16.6 To Change the User Preferences for Bookmarks .................................185
6.17 Conference Display Protocols .....................................................................186
6.17.1 To Apply a CDP.................................................................................186
6.17.2 To Save a CDP .................................................................................186
6.18 Add Studies to a Teaching Folder................................................................187
6.18.1 Display a Teaching Folder..................................................................187
6.18.2 Remove a Study from a Teaching Folder ............................................187
6.19 Notes About the Display of X-ray Modality Images in Universal Viewer ...........188
6.20 Viewing Mammography Images ..................................................................188
6.20.1 To configure Image Laterality .............................................................189
6.20.2 To configure View Position .................................................................190
6.20.3 Automatically Displaying Comparison Studies .....................................191
6.20.4 Suppressing Mammography Workstation Pop-up Messages ................192
6.21 Using 3D Advanced Clinical Applications .....................................................193
6.21.1 Adding AW Server Viewports to Hanging Protocols .............................194
6.22 Vitrea ........................................................................................................195
6.22.1 To View a Study in Vitrea ...................................................................195
6.23 MedImage .................................................................................................195
6.23.1 To view a study in MedImage .............................................................196
6.24 TeraRecon.................................................................................................196
6.24.1 To View a Study in TeraRecon............................................................196
6.25 RadNet......................................................................................................197
7 Image Viewer Tools.......................................................................................1987.1 Paging/Scrolling...........................................................................................198
7.1.1 Creating Scrolling Shortcuts.................................................................198
7.1.2 Inter-series Scrolling............................................................................199
7.1.3 Slab Scroll ..........................................................................................200
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7.2 Global Stack ................................................................................................201
7.2.1 To Use Global Stack............................................................................201
7.2.2 To Set Up Global Stack........................................................................202
7.2.3 Configuring Hanging Protocol Criteria in Global Stack Mode ..................202
7.3 Selecting an Image ......................................................................................202
7.3.1 To Select One Image From a Series .....................................................203
7.3.2 To Select Multiple Images in a Series ...................................................203
7.4 Saving and Uploading Images ......................................................................203
7.4.1 To save an image or images ................................................................204
7.4.2 To Upload a Series to the Server..........................................................205
7.5 To Reset Image Manipulations ......................................................................205
7.6 Window/Level (W/L) .....................................................................................205
7.6.1 To Adjust the W/L of an Image .............................................................206
7.6.2 To Adjust the Brightness Level of an Image...........................................206
7.6.3 To Adjust the W/L in a Region of Interest (ROI) .....................................206
7.6.4 To Select a Preset W/L Setting.............................................................207
7.6.5 PET and Nuclear Medicine (NM) Window/Level ....................................207
7.7 Selecting a VOI LUT ....................................................................................208
7.7.1 To Choose an Alternate VOI LUT .........................................................209
7.7.2 To Create or Modify a Preset Definition.................................................209
7.8 Flip, Rotate and Mirror..................................................................................210
7.8.1 To Flip, Rotate, or Mirror the Image ......................................................210
7.9 Copy a Series..............................................................................................213
7.9.1 To Create a Copy of a Series ...............................................................213
7.9.2 Display Image Settings for Copy Series ................................................213
7.10 Copy to Clipboard ......................................................................................219
7.10.1 To Copy a Window to the Clipboard....................................................219
7.11 Cine ..........................................................................................................219
7.11.1 To cine a study ..................................................................................219
7.11.2 Enable the Cine Series Toolbar for Viewing US, XA, or NM CineImages .................................................................................................220
7.12 Cine for Cardiology Workflow......................................................................220
7.12.1 To Configure Progressive Cine ...........................................................221
7.12.2 Global Cardiology Cine Controls.........................................................221
7.12.3 Adding a Cardiology Cine Control Overlay ..........................................222
7.12.4 Saving a Study as an AVI...................................................................223
7.13 To View Image and Patient Properties .........................................................223
7.13.1 Cross-Reference Lines ......................................................................224
7.13.2 To display cross-reference lines .........................................................224
7.14 Triangulation..............................................................................................224
7.14.1 To Use Triangulation..........................................................................224
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7.15 Synchronizing Parallel Series......................................................................225
7.15.1 To Synchronize Studies .....................................................................225
7.15.2 To Select How to Apply Synchronization .............................................226
7.15.3 To Synchronize Parallel Series ...........................................................226
7.16 Sync by Image Registration ........................................................................226
7.16.1 To Use Sync by Image Registration ....................................................229
7.16.2 Image Registration Considerations .....................................................230
7.17 Field of View Synchronization .....................................................................230
7.17.1 To Use Field of View Synchronization .................................................230
7.18 Image Enhancement ..................................................................................231
7.18.1 To filter an image...............................................................................231
7.18.2 To edit the Image Enhancement algorithm menu .................................232
7.18.3 Zoom................................................................................................232
7.18.4 Size Synchronization Overview ..........................................................235
7.18.5 Applying Angiography Enhancements (Digital Subtraction) ..................237
7.18.6 Applying Edge Enhancement .............................................................238
7.19 Magnifying a Portion of an Image ................................................................239
7.20 Pan ...........................................................................................................240
7.20.1 To Pan an Image ...............................................................................240
7.21 Sharpen ....................................................................................................240
7.21.1 To Sharpen an Image ........................................................................240
7.22 Calibrate....................................................................................................241
7.22.1 To calibrate an image ........................................................................241
7.22.2 To Calibrate a Monitor........................................................................241
7.23 Image Overlay ...........................................................................................242
7.23.1 To Enable Image Overlay...................................................................242
7.23.2 To Display Graphic Overlay................................................................243
7.23.3 To Jump Overlay Templates ...............................................................243
7.24 Measurements ...........................................................................................244
7.24.1 To Add Measurements.......................................................................244
7.24.2 To Delete One or More Measurements ...............................................245
7.24.3 Moving Measurements ......................................................................246
7.24.4 Measurements and LUT ....................................................................249
7.24.5 Measurement and Annotation Tool Synchronization with 3DApplications ..........................................................................................250
7.25 To Measure CTR (Cardio-Thoracic Ratio) ....................................................250
7.26 Ultrasound Measurements..........................................................................252
7.26.1 To take an ultrasound measurement ...................................................252
7.26.2 To Delete One or More Measurements ...............................................253
7.27 Annotations ...............................................................................................254
7.27.1 To Add or Change a Label (Annotation) ..............................................254
2101085-001 15
7.27.2 To edit an annotation .........................................................................255
7.27.3 To Delete One or More Annotations....................................................255
7.27.4 Measurement and Annotation Tool Synchronization with 3DApplications ..........................................................................................255
7.28 Spine Labeling...........................................................................................256
7.28.1 OrthoTools ........................................................................................257
7.28.2 To Add a Prosthesis Template to an Image .........................................257
8 Reformatting Images ....................................................................................2598.1 Multi-Planar Reformatting ............................................................................259
8.1.1 Using MPR Images as Key Images ......................................................259
8.1.2 Opening Reconstructions in a Viewport ................................................260
8.1.3 To Construct Standard MPR Images for a Study....................................260
8.1.4 To Construct Spine MPR Images for a Study.........................................263
8.1.5 To Construct Curved MPR Images for a Study ......................................265
8.1.6 To construct Cross-Curved MPR images for a study ..............................267
8.1.7 Changing Slab Thickness from an Embedded MPR...............................268
8.1.8 Switching MPR Image Planes ..............................................................268
8.1.9 Scrolling through an MPR Series..........................................................269
8.1.10 Rotating and Moving Slice Views with Multi Oblique MPR ....................269
8.1.11 To Restore the Original Series from an MPR .......................................271
8.2 Maximum Intensity Projection (MIP) ..............................................................271
8.2.1 Maximum Intensity Projection (MIP) .....................................................271
8.2.2 To Construct MIP Images for a Study....................................................272
8.2.3 Rotating MIP View...............................................................................274
8.2.4 To add Cine to a placeholder................................................................274
8.2.5 To create Linear Measurements ...........................................................275
8.3 3-D Rendering .............................................................................................275
8.3.1 To Render a Three-Dimensional Image (Review Mode) .........................275
8.3.2 To Target an Area of Interest in a Three-Dimensional Image (TargetedMode)...................................................................................................278
8.3.3 To segment a three-dimensional image (Segmentation Mode)................279
8.3.4 Vessel Analysis...................................................................................287
8.4 3-D Anchors ................................................................................................289
8.4.1 To Create an Anchor ...........................................................................289
8.4.2 To Edit an Anchor................................................................................289
8.4.3 Measuring with Anchors ......................................................................290
8.4.4 Using Linear Measurements with Anchors ............................................290
8.5 PET-CT Fusion............................................................................................291
8.5.1 PET-CT Views ....................................................................................292
8.5.2 To Fuse CT and PET into One Image ...................................................292
2101085-001 16
8.5.3 Source Series .....................................................................................293
8.5.4 To instantly re-render ..........................................................................293
8.5.5 Switching PET, CT, or PET–CT Image Planes .......................................294
8.5.6 Fusion Windowing Controls .................................................................294
8.5.7 Measurements ....................................................................................295
8.5.8 Hanging Protocols...............................................................................296
8.5.9 Saving and Reporting in Advanced PET-CT..........................................303
8.5.10 Standard Uptake Value (SUV) and PET or PET-CT .............................304
9 Configuring the System ...............................................................................3099.1 Configuring the System ................................................................................309
9.1.1 Referring Physician Users ...................................................................309
9.2 Working with the Layout Editor......................................................................310
9.2.1 To Create or Edit a Layout ...................................................................310
9.2.2 To Load a Layout ................................................................................311
9.2.3 To Reload a Layout .............................................................................311
9.2.4 General Settings .................................................................................311
9.2.5 More Settings .....................................................................................313
9.2.6 Configuring Shortcuts ..........................................................................313
9.3 W/L Configuration ........................................................................................317
9.3.1 To Configure W/L Settings ...................................................................317
9.3.2 To Change the User Preferences for W/L Sensitivity..............................318
9.4 Configuring Image Overlay ...........................................................................318
9.4.1 To configure an Image Overlay template ...............................................319
9.5 Configuring Hanging Protocols......................................................................320
9.5.1 To Edit a Hanging Protocol...................................................................320
9.5.2 To Edit an Existing Hanging Protocol ....................................................322
9.5.3 Multi-resolution Monitor Setup..............................................................322
9.5.4 To Edit Hanging Attributes for a Placeholder .........................................325
9.5.5 To Set W/L for a Placeholder................................................................327
9.5.6 To Define Specialized Placeholders......................................................327
9.5.7 To Clear Defined Hanging Protocols .....................................................329
9.5.8 To Attach a Hanging Protocol to a Layout .............................................329
9.5.9 MIP/MPR in the Viewport.....................................................................329
9.6 Mammography Viewer Integration.................................................................330
9.6.1 To Set Mammography Viewer Integration..............................................330
9.7 EchoPAC Integration ....................................................................................330
9.7.1 Opening the EchoPAC Integrations Settings Panel ................................330
9.7.2 Layout Editor — EchoPAC Integration Settings .....................................330
9.8 Cardiology Advanced Analysis Integration .....................................................331
2101085-001 17
9.8.1 Opening the Cardiology Advanced Analysis Integration SettingsPanel....................................................................................................331
9.8.2 Layout Editor — Cardiology Advanced Analysis IntegrationSettings ................................................................................................331
9.9 Main Menu Configuration..............................................................................332
9.9.1 Main Menu Configuration.....................................................................332
9.9.2 Configuring the Main Menu ..................................................................332
9.9.3 To Create a New Menu Item with a Drop-down List................................333
9.9.4 To Add a Separator between Items in a Drop-down List .........................333
9.9.5 Film View Menu Configuration..............................................................333
9.9.6 To configure the Film View menu..........................................................334
9.9.7 To Create a New Menu Item with a Drop-down List................................334
9.10 Series Menu Configuration .........................................................................335
9.10.1 Series Menu Configuration.................................................................335
9.10.2 To Configure the Series Menu ............................................................335
9.10.3 To Create a New Menu Item with a Drop-down List..............................336
9.10.4 Key Images Menu Configuration.........................................................336
9.10.5 To Configure the Key Images Menu....................................................336
9.11 Main Toolbar Configuration .........................................................................337
9.11.1 To Configure the Main Toolbar ............................................................337
9.11.2 Toolbar Wrapping ..............................................................................338
9.11.3 Jumping templates ............................................................................339
9.12 Measurements Button Configuration............................................................340
9.12.1 Measurements Button Configuration...................................................340
9.12.2 To Configure the Measurements Toolbar.............................................340
9.13 Annotations Button Configuration ................................................................341
9.13.1 Annotations Toolbar Configuration ......................................................341
A Frequently Asked Questions.......................................................................342
B Network Requirements and Performance..................................................345
C Using Universal Viewer with AW Server Integration .................................346C.1 Advantage Workstation Server Overview ......................................................346
C.2 Opening a Series in a 3D Protocol ................................................................347
C.3 Opening Multiple Series in 3D Protocols .......................................................348
C.4 Working with Images and Series from AW Server Applications .......................348
C.4.1 Measurement and Annotation Tool Synchronization with 3DApplications ..........................................................................................349
C.5 Working with AWS Key Image Notes ............................................................349
C.6 Patient Context with AW Server Client ..........................................................350
C.7 Adding AW Server Viewports to Hanging Protocols........................................351
2101085-001 18
C.8 Impacts of Changes to Patient or Study Information on HybridIntegration...................................................................................................352
C.9 Mouse Scroll Direction Limitation..................................................................352
C.10 AW Synchronized Scrolling ........................................................................353
D Integration with RIS......................................................................................354D.1 Integration with RIS-IC.................................................................................354
D.2 Avoiding Patient Context Mismatch with RISi Integrations ..............................355
D.3 Confidential Patients....................................................................................355
E Integration with a CVIS (Cardiovascular Information System).................356
F Universal Viewer and Imaging Desktop......................................................358F.1 Universal Viewer Accessed from Imaging Desktop .........................................358
F.2 Study Selector, Series Selector, and Patient Folder ........................................360
G Calculating Patient Age ..............................................................................362
H Acronyms and Abbreviations ....................................................................363
I Software License; Intellectual Property.......................................................365I.1 Preamble .....................................................................................................365
I.2 License Grant ...............................................................................................365
I.3 Restrictions ..................................................................................................366
I.4 Ownership of Media ......................................................................................366
I.5 Proprietary Service Materials .........................................................................366
I.6 Damage in Transportation .............................................................................366
I.7 Certified Electrical Contractor Statement ........................................................367
I.8 Third-Party Software .....................................................................................367
2101085-001 19
About this Product
Preface: About this Release
i: About Centricity Universal Viewer
Centricity Universal Viewer is used to read and review radiological and cardiology imagesand patient reports, and also for running diagnostic tools. For more information, refer to thisoperator manual.
Some features may not be available in your system. Contact your GE representative for moreinformation about feature availability.
ii: Hardware and Software Requirements
ii-i: Supported Client Operating System and Web Browser Versions
Windows® Operating Systems
Centricity UniversalViewer Web Client Types
Windows® Version Required
Centricity Universal ViewerWeb Diagnostic Workstation
● Windows® 10 64-bit
● Windows® 10 32-bit
● Windows® 8.1 64-bit
● Windows® 7 64-bit
Centricity Universal ViewerWeb Clinician Workstation
● Windows® 10 64-bit
● Windows® 10 32-bit
● Windows® 8.1 64-bit
● Windows® 7 64-bit
● Windows® 7 32-bit
Centricity Universal ViewerWeb Diagnostic Workstation– Breast Imaging
● Windows® 10 64-bit
● Windows® 10 32-bit
● Windows® 7 64-bit
Centricity Universal ViewerWeb Diagnostic Workstation– Breast Imaging withTomosynthesis
● Windows® 10 64-bit
● Windows® 10 32-bit
● Windows® 7 64-bit
Microsoft® Internet Explorer®
Versions Notes
Internet Explorer® 12 64-bit
Internet Explorer® 12 32-bit
Internet Explorer® 11 64-bit
Internet Explorer® 11 32-bit
2101085-001 20
Versions Notes
Internet Explorer® 10 64-bit
Internet Explorer® 10 32-bit
Internet Explorer® 9 64-bit
Internet Explorer® 9 32-bit
Internet Explorer® 8 64-bit
Internet Explorer® 8 32-bit
Third-Party Components
.NET Framework version 2.0 SP1 or higher is required.
Administrator Privileges Required
Administrator privileges are required to install, uninstall, repair, or upgrade the packages.
ii-ii: Monitor Configurations
The system supports the monitor configurations listed in the table below. Use of otherconfigurations may produce unpredictable results.
Configura-tion Name
# of ColorMonitors -Landscape
# of ColorMonitors -Portrait
GrayscaleMonitors -Portrait
PatientFolder, 3D,MPR
ViewerOpening onColor
ViewerOpening onGrayscale
SingleMonitor
1 (#1) - - #1 #1 #1
2-ColorLandscape
2 (#1,#2) - - #1 #1, #2 #1, #2
3-ColorLandscape
3 (#1,#2,#3) - - #1 #2, #3 #2, #3
1+2 ColorLandscape
3 (#1 low-res;#2,#3 high-res)
- - #1 #2, #3 #2, #3
1+2 ColorPortrait
1 (#1) 2 (#2, #3) - #1 #2, #3 #2, #3
1+2Grayscale
1 (#1) - 2 (#2, #3) #1 #1 #2, #3
1+2+2 1 (#1) 2 (#2, #3) 2 (#4, #5) #1 #2, #3 #4, #5
1+4 1 (#1) - 4 (#2-#5) #1 #1 #2-#5
2+2 2 (#1, #2) - 2 (#3, #4) #1 #1, #2 #3, #4
2+2 ColorLandscape
4 (#1,#2 low-res; #3,#4high-res)
#1 #3, #4 #3, #4
2+2 ColorPortrait
2 (#1,#2) 2 (#3, #4) #1 #3, #4 #3, #4
2+4 2 (#1,#2) 4 (#3-#6) #1 #1, #2 #3-#6
1+3 ColorPortrait
1 (#1) 3 (#2-#4) - #1 #2-#4 #2-#4
1+3Grayscale
1 (#1) 3 (#2-#4) #1 #1 #2-#4
2101085-001 21
ii-iii: Universal Viewer Requirements
Minimum Hardware Requirements for Universal Viewer
The Universal Viewer must meet the following requirements:
Function CPUType
# CPUs x#Cores/CPU
Disk Space Memory Monitor
Diagnostic Workstation x64 8 146 GB, RAID 0 8 GB ● Single color display of1024 x 768 resolutionor better with 65536colors.
● High-resolutiongray-scale 2MP orbetter display.
Review/Tech Workstation x64 4 146 GB, RAID 0 4 GB ● Single color display of1024 x 768 resolutionor better with 65536colors.
● High-resolutiongray-scale 2MP orbetter display.
Clinician ReviewWorkstation
x32 4 146 GB, RAID 0 4 GB ● Single color display of1024 x 768 resolutionor better with 65536colors.
● High-resolutiongray-scale 2MP orbetter display.
Diagnostic Workstation,breast imaging
X64 8 2x500 GB, RAID0 or 1x512 GBSSD
8 GB High-resolution gray-scale5MP or better display.
Diagnostic Workstation,breast imaging withtomosynthesis
X64 8 2 partitions:OS/App -1 x 250GB2x500 GB, RAID0
32 GB High-resolution gray-scale5MP or better display.
Diagnostic Workstation,cardiology
X64 8 146 GB, RAID 0 16 GB min.;32 GB rec-ommended
● Single color monitorwith 1280 x 1024 orhigher resolution with32–bit color
● High-resolutiongray-scale 2MP orhigher resolution
ii-iv: Server Requirements
Minimum Hardware Requirements for Server
The server must meet the following requirements:
2101085-001 22
CPU Type CPU Cores Disk Space Other Memory
x64 8 OS Partition: 60GB, RAID 1+0 10KminimumData Partition:300 GB, RAID 5,10K minimum
Two 1–GB NICs,DVD-RW, RemoteAccess (Lights-out)capability
8GB
Server Software
The servers require Microsoft Windows Server 2008 R2 SP1 or 2012 R2, using the Standard,Enterprise, or DataCenter edition.
The system requires one of the following database platforms as part of the system environment:
● Microsoft SQL Server 2008 R2
● Microsoft SQL Server 2012 R2
● Sybase 12.5.4 or 15.7 (installed on the CPACS servers for systems with a CPACSfoundation)
Desktop Extension Technologies
Important This product is not intended for diagnostic use when used with Citrix orother desktop extension technologies.
iii: Contacting GE Support
iii-i: Contacting the ROC
Use the following information to contact the ROC (Remote Online Center).
Table 1 Online Center contact information
OLC/USA OLC/Europe OLC/ANZ
1–855-762-6650(US/Canada)
+33 (0) 1 30 831300 61-2-316-3700
Latin America: contact yourfield service representative
Contact your field servicerepresentative.
Contact your field servicerepresentative.
iii-ii: Applications Support and Service Support (Asia Regions)
To request applications support or service support for the Asia regions, refer to the followingphone numbers.
Table 2 Applications support and service support (Asia regions)
Country Support Phone Number
Australia 1800659465
China 8008108188
Hong Kong 21006288
India 1800114567
Japan 0120055919
2101085-001 23
Country Support Phone Number
Korea 15446119
Malaysia 1800883911
New Zealand 0800659465
Singapore 63880932
Taiwan 0800021770
iii-iii: Applications Support Using iCenter, eService, and ApplicationsAnswerline
To request applications support, English-speaking customers may open a support request inGE Healthcare iCenter™ or eService. Other customers should contact the GE Remote OnlineCenter support personnel.
With iCenter or eService you can:
● Initiate requests for service and applications support from the web
● Get rapid, online access to the Remote Online Center (ROC) where expert serviceengineers review and respond to service requests quickly
● View the status of open service requests
● View service history and reports about your systems, including uptime, remote fix andservice call trends, and other service delivery metrics
If you do not have access to iCenter or eService, contact your Director of Service or theRemote Online Center to open an account. English-speaking customers can also use thefollowing resource:
● GE PACS Applications Answerline 1-855-762-6650, Option 3 (available for US andCanadian customers)
iii-iv: Contact Information for GE Healthcare Offices
Addresses and phone numbers for GE Healthcare offices are listed below.
Manufacturer
GE Healthcare540 W Northwest HighwayBarrington, IL 60010 USATel: +1 847 277–5000 or +1 800 437–1171 or 800 682–5327Fax: +1 847 277–5240
European Authorized Representative
GE Medical Systems SCS283 rue de la Miniére78530 BUC, France
Asia Headquarters
GE Healthcare
2101085-001 24
1 BLD-3FNo. 1 Hua Tuo Road,Zhang Jiang Hi-Tech ParkShanghai 201203 ChinaTel: 8621–38777888Fax: 8621–38777499
Turkish Importer
Türkiye'ye İthalatçıGE Medical Systems Türkiye Ltd. Şti.Esentepe Mah. Harman Sok. No: 834394 Şişli-İstanbulTürkiye
iv: Documentation Conventions
iv-i: Text
Table 3 Text convention descriptions
Description Example
This typeface represents allbuttons, entry fields, menus, andother user interface controls.
On the File menu, click New.
This typeface represents windowand dialog box names.
This opens the Preferences dialog.
This typeface represents textyou enter in a user interfacecontrol.
Enter localhost in the proper field.
This typeface represents usernames and passwords andcommands you type in responseto a command prompt.
Default user name: sysadmin.
This typeface represents filepath names.
Open lib\readme.txt.
This typeface representscross-references and otherhypertext links.
See Documentation Conventions.
iv-ii: Screen Captures
The example screens in this manual may not represent what you see on your monitor. Usethem only as guidelines.
v: Safety
v-i: For Your Safety
2101085-001 25
v-i-i: Indications for Use
Centricity Universal Viewer is a device that displays medical images and data from variousimaging sources, and from other healthcare information sources. Medical images and data canbe displayed, communicated, stored, and processed
Typical users of this system are authorized healthcare professionals.
Centricity Universal Viewer is intended to assist in the viewing, analysis, diagnosticinterpretation, and sharing of images and other information.
Mammography images may only be interpreted using a monitor compliant with requirements oflocal regulations and must meet other technical specifications reviewed and accepted by thelocal regulatory agencies.
v-i-ii: Contraindications
Centricity Universal Viewer is contraindicated for the use of lossy compressed mammographicimages. Lossy compressed mammographic images and digitized film screen images must notbe reviewed for primary image interpretations.
v-i-iii: Terminology
The terms danger, warning, and caution are used throughout this manual to point out hazardsand to designate a degree or level of seriousness. Hazard is defined as a source of potentialinjury to a person.
Familiarize yourself with the terminology descriptions listed in the following table:
Table 4 Terminology descriptions
Notice Type Description
Danger Indicates an imminently hazardous situation which, if not avoided,will result in death or serious injury.
Warning Indicates a potentially hazardous situation, which, if not avoided,could result in death or serious injury.
Caution Indicates a potentially hazardous situation, which, if not avoided mayresult in minor or moderate injury.
Important Indicates important information pertaining to a non-hazardoussituation.
Note Indicates informational messages providing application tips or otheruseful information that do not pertain to a hazard.
v-i-iv: Typical Users
The following classes of users are expected to use the system; these users will use thesystem in standalone mode or in integration with various information systems and advancedvisualization packages:
Diagnosing Physician — uses the product to review, manipulate and interpret content ofimaging and ECG studies, with the purpose of rendering diagnosis and documenting it in theform of notes, reports, key images, annotations and other objects as may be necessary by theworkflow and procedural requirements of particular Healthcare Enterprise.
Technologist— uses the product during the acquisition of imaging studies, quality control andcreation of additional clinical evidence for further use by physicians in interpretation process.
Physician — uses the product to review the interpretation results of a diagnosing physicianand to determine further steps in clinical care, such as surgery or biopsy. They may createadditional clinical evidence for further use by other physicians.
2101085-001 26
Support and Clinical Staff— users within and outside the department (nurses, administrators,clerks, front desk staff, and service engineers) who access and modify patient records byadding notes, scanning documents, viewing, printing and exporting studies.
The product is not intended to be used by Patients.
v-ii: System Safety
The safety statements in this chapter refer to the equipment in general. Additional safetystatements specific to particular operations of the product can be found in the applicablechapter describing that operation.
v-ii-i: Dangers
There are no dangers that refer to the equipment in general. Specific "Danger" statements maybe given in the respective sections of this manual.
v-ii-ii: Warnings
The warning statements in this section refer to the equipment in general. Additional warningstatements specific to particular operations of the product can be found in the applicablechapter describing that operation.
Warning: The system is not intended for diagnostic use with Mammography images.
Note: The Mammography Viewer can be integrated with Universal Viewerand used for diagnosis.
Warning: When calibrating projections images, the calibration object should be at thesame distance from the detector as the anatomy to be measured.
Warning: Minifying (zooming out) an image may reduce image quality.
Warning: Magnifying (zooming in) an image may truncate some of the image causing itto be moved out of the visible area.
Warning: Secondary Capture images may have reduced image quality.
Warning: Derived images may have reduced image quality.
Warning: The display setting should be configured for 32-bit color for best imagequality; there is a potential reduction in image quality if the viewer islaunched with a display color setting less than 32-bit.
Warning: Lossy image compression may reduce image quality.
Warning: Images that were accepted into the system using Lossy compression mayhave reduced image quality. Pay attention to Lossy indicator on images torecognize images that have been subjected to lossy compression.
Warning: A mismatch warning message may appear if studies being compared donot belong to the same patient. The system displays this message whenstudies in comparison mode have different accession numbers. This maybe desired under certain circumstances, such as when comparing studiesfor training purposes. To continue, you must click Yes to acknowledge themessage. Be aware that when displaying studies this way, the risk existsthat the studies can be erroneously attributed to the same patient, withunintended consequences.
The following Warnings are applicable to query results. Notify your administrator to investigatethe query problem if a query warning message is displayed in the software.
Warning: Query results may be incomplete if there are any problems querying orretrieving data from the Muse servers.
Warning: Query results may be incomplete if there are any problems querying orretrieving data from the Enterprise Archive servers.
2101085-001 27
The following warning applies to systems using Cross Enterprise Display partial demographicmatching to locate comparison exams.
Warning: Partial demographic matching, an option for identifying a patient’s remotecomparison exams in a Cross Enterprise Display setting, may be lessaccurate than matching using the Patient ID. When using partial demographicmatching, check the patient information to ensure a complete match whenthe primary and comparison studies first display.
The following Warnings are applicable to the Advanced Cardiology features.
Warning: MRNs: MRNs longer than 16 characters may not match between UniversalViewer and Muse. Confirm the displayed Muse data is from the correctpatient before proceeding.
Warning: Cath measurement tools must only be used to provide supportinginformation for diagnosis or treatment decisions made during a Cathprocedure. The primary source for these decisions is always the informationprovided by the Cath Lab equipment.
Warning: Images saved in AVI format may have reduced image quality.
Warning: Desktop virtualization technologies may leverage lossy compression anduse variable screen refresh rates which may reduce image quality.
.
v-ii-iii: Cautions
The caution statements in this section refer to the equipment in general. Additional cautionstatements specific to particular operations of the product can be found in the applicablechapter describing that operation.
Caution: Mobile Devices may not provide display quality sufficient for diagnostic use.
Caution: The system is not intended for diagnostic use for digital pathology.
v-ii-iv: Ergonomics
Improper or prolonged keyboard or mouse use may result in injury. Viewing the monitor screenfor extended periods of time may result in eye strain. Users should follow the ErgonomicGuidelines specified by the vendor/ manufacturer of their PC equipment.
v-iii: Measurement Limits of Accuracy Statement
The level of accuracy of the viewer measurement functionality (i.e. ROIs, lines, etc.) is +/- 1pixel. The width and height of the pixel is found in the image header. When drawing anymeasurement, this level of accuracy can only be achieved if the image is zoomed to a scale ofat least 1:1 before drawing the measurement.
v-iv: Certifications
The Centricity Universal Viewer system meets the following:
● Council Directive 93/42/EEC of 14 June 1993 concerning medical devices
The software meets the following:
● EN 62304: Medical device software – Software life cycle processes
● EN 62366: Medical devices – Application of usability engineering to medical devices
The hardware components of the system meet the following:
● Safety of Information Technology Equipment, EN 60950 or an equivalent informationtechnology equipment safety standard
2101085-001 28
1Centricity™ Universal ViewerSuper Quick Start Guide
Task StepsLaunchCentricityUniversalViewer
1) Open Microsoft® Internet Explorer® to your Centricity™ Universal Viewer web site.
2) Answer Yes to security questions.3) If necessary, click the pop-up bar near the Internet Explorer bar to allow ActiveX controls.
Log in 1) When the login screen appears, enter your case-sensitive user name and password.2) Click Login or press Enter.
Quick Searchon the StudyList
1) On the far left of the Study List window, select Patient Name, MRN / Patient ID, orAccession # from the drop down list.
2) Enter the search criterion.Note Search for MRN/Patient ID and Accession # by entering an exact match, or forPatient Name using the “Begins” criterion by entering at least the first two characters ofthe patient’s last name.
3) Press Enter or click Search to execute the search.
Search for aStudy
● Click a Study List tab.
● Click Search on the toolbar.● Enter the criteria for your search and click Search.
Save a NewStudy List
1) Right-click the Search Results tab and select Save Search As from the menu.
2) Enter a unique name for the new tab.
3) Click OK.Open a Study Click anywhere in the study row. The study displays in the viewer.
RearrangeDisplayedSeries orDisplay aSeries NotLoaded
● To rearrange series within the Navigator, click and drag the thumbnail to a differentlocation in the Navigator.
● Use the Series Selector to display the series in the Active Series window.
Page throughSeries
Click a series to make it active and then:
● Scroll using the mouse wheel.● Hold down the left mouse button and drag the mouse up or down.● Click the Up and Down Arrow keys or Page Up/Page Down keys.
2101085-001 29
Chapter 1: Centricity™ Universal Viewer Super Quick Start Guide
Edit LayoutGrid 1) Click the Edit Grid icon ( ) on the toolbar.
2) Select a grid layout from the drop-down menu.
Adjust theWindow/Level(W/L)
● Click W/L on the toolbar.In the image, click the left mouse button and drag thepointer up or down.
● Click the Preset Window item and select one of the available definitions for this study.● Right-click anywhere in the image to display a floating menu.
Access OtherFeatures
● Use the Main Menu or toolbar.● Right-click to display the floating menu.● Hover over any button or icon to display the tooltip that defines its function.
Access OnlineHelp
● From the Study List window, click Help , or● From the Viewer window, select Display Help Page from the Main Menu Help option.
Close theStudy
● Click Done in the toolbar to perform the default operations and close the study.● To override the default settings for Done without changing it, click the down arrow next to
Done to display the drop-down menu and make a selection.End YourSession Click the logout icon from the Study List .
This information does not constitute a representation or warranty or documentation regarding the product featured.All illustrations or examples are provided for informational or reference purposes and/or as fictional examplesonly. Your product features and configuration may be different than those shown. Information contained herein isproprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE.GE Healthcare, 540 W. Northwest Highway, Barrington, IL 60010
2101085-001 30
2Logging In and Out
When you launch the system, you see the login screen. The system administrator assignsuser names, initial passwords, and privileges for each user account. Your accountprivileges tell the system which features you are allowed to use. For example, youraccount privileges may allow you to mark a study as dictated, to grant privileges to aremote user, or use other functionality. If the system administrator granted you referringphysician privileges, a special viewing application opens for you upon launch.
When accessing the Universal Viewer from a Centricity PACS foundation, you areautomatically added as a user with the same privileges when you log into the UniversalViewer for the first time. CPACS user information is automatically added to the UniversalViewer database, so the initial login accepts the existing CPACS username/password.Other user information, such as groups and institutions, also transfers to the UniversalViewer database at the initial login.
You may log in from only one computer at a time. If you log in from a second computerusing the same login name and password, the system accepts your second login, andallows you to work on that computer. The first login session remains open, but it is in aread-only mode. Any activities in the first login session will trigger a system messagewhich indicates that session is invalid.
2.1 To Log In1. Open Microsoft® Internet Explorer® to your Centricity™ Universal Viewer web site.
2. Answer Yes to security questions.3. If necessary, click the pop-up bar near the Internet Explorer bar to allow ActiveX
controls.
4. When the login screen appears, enter your case-sensitive user name and password.
Note: If the system has been configured to use Windows Active Directoryfor login authentication, the user name you use must use only ASCII(English) characters.
5. If the system has been configured to use Windows® Active Directory and does notuse Centricity PACS, select your Domain from the drop-down menu.
6. Click Login or press Enter.7. When the Security dialog displays, click Yes. The Study List opens. Your user name
displays in the banner at the top of the screen.
8. If the viewer is not installed or is out of date, a new viewer is automatically downloadedand installed. At the end of the installation, click Finish.
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2.2 To Log OutUse the logout icon to exit the system.
� Click the logout icon from the Study List .
Note: You may be logged out automatically after a period of inactivity; the default isten minutes.
2.3 To Change Your PasswordUsers may be required to change their password after the first login.
The administrator may also require you to change your password after a set period oftime; warnings will alert you to this necessity. The password expiration date resets afteryou change the password.
Note If your site uses Windows Active Directory or another external authenticationserver, you must change your password in that user account authenticationsystem.
1. After entering both your User ID and your current password in the login screen, clickChange Password.
2. On the Change Password screen, enter your current password.
3. Enter a new password in the second field.Passwords can be letters, numbers, symbols or any combination up to 12 characters.Passwords are case sensitive.
4. Re-enter the new password in the last field to verify the change. The last field mustmatch the second field exactly.
5. Click OK. The new password is now valid. The previous password will no longer work.
2.4 Resolving Login IssuesIf the login fails, consider the following issues:
● Both the user name and password are case sensitive. Check the Caps Lock keyand try again.
However, if the system is integrated with Centricity PACS and uses Windows ActiveDirectory for login authentication, the user name is case insensitive.
● If the Study List does not appear after login, the ActiveX controls may be blocked.Look for a pop-up information bar near the top of the browser (beneath the addressline). Click this pop-up bar to install the proper controls.
● If the pop-up bar does not appear, ActiveX may be blocked according to the defaultsecurity settings. The server must be added as a Trusted Site in the Security settingspanel of the Internet Options dialog. For Windows Internet Explorer 7 and laterversions the Enable Protected Modecheckbox must be unchecked for Trusted Sitesin this security settings panel. See the administrator.
● If the viewer install package runs during the login process and displays a messagestating it cannot complete because a viewer is already running, close the viewer
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and log in again. If the issue continues, open Task Manager and end the viewerprocess (MIV2Lib.exe).
● If you change the password in the third-party dictation system through the RADPortalsite, update the password manually in Universal Viewer.
● If the previous suggestions do not resolve the issue, you may not have administratorrights on the computer operating system. These rights are necessary to installthe viewer. A user with administrator rights can log in to initiate installation of thenecessary components. After an automatic update, a user with administrator rightsmust log in again to initiate automatic installation of the updates.
● If the system uses Windows Active Directory for login authentication and is notintegrated with Centricity PACS, logging in the Universal Viewer using a Windowsaccount which has non-ASCII (non-English) characters is not supported.
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3Study Lists
3.1 What Is a Study List?A Study List is a group of similar studies, such as CTs, MRs, or all studies performedtoday. Each Study List displays in a separate tab on the Study Lists window. A Study Listshows descriptive information for all the studies in the list. When you log in, the systemimmediately opens to the left-most Study List (which is the second tab from the left).Click a Study List tab to display its contents.
Your user account privileges determine which studies are made available to you. Someusers may view all the studies, while others need access only to certain studies. Forexample, a user without the proper privileges to view a confidential patient cannot see thatperson’s studies in the study list.
From the Study Lists window, you can use a variety of criteria to search for similar studies,and then create a new Study List from the search results. Search results appear in theleft-most tab in the Study Lists window.
3.2 Study List Basics
3.2.1 Study List Basics
The Study List contains a summary of patient data as well as frequently-used viewingfeatures.
The institution's name appears at the top of the Study Lists window, along with youruser name.
Note You can refresh the Study List at any time by pressing F5 or clicking anyactive tab or column on the Study List. You can also set the system to refreshautomatically; see the section on Configuring Columns.
To access other features:
● Use the Main Menu or toolbar
● Right-click to display the floating menu
● Hover over any button or icon to display the tooltip that defines its function
Note All search text entries are case insensitive.
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3.2.1.1 Study List Toolbar
The toolbar at the top of the Study List contains shortcuts to the most frequently usedviewing and paging features.
Color display: Click to display color images.
Grayscale display — click to display grayscale images.
Series information: Select one or more studies and click to show detailed informationabout each series in the studies. (availability depends on system configuration)
Show thumbnails: Select one or more studies and click to show image thumbnailsfor the studies. (availability depends on system configuration)
Study compare: Click to compare the selected studies.
Select All: Click to select all studies on this page.
Clear All: Click to clear all selections.
Page controls (first page, previous page, next page andlast page): Click to page through the Study List.
Note When a search returns more than 1,000 results, the Last Page buttonis disabled.
Total and Per-Page: Shows the totalnumber of studies available on the selected Study List and the number displayed oneach page.
Available Domains: Shows theavailable domains. (availability depends on system configuration)
Search: Search the Study List using filter criteria. (This toolbar button appearsbelow the tabs.)
STAT Studies: Click to show all studies marked as STAT. If no studies have beenmarked as STAT, this button is gray.
3.2.1.2 Patient Information
The patient information is arranged in columns in the Study List. These columns canbe configured to display the data you prefer. The same columns appear in every tab.Common data includes:
● Patient name.
● Date of birth (DOB).
● Unique ID number (such as the Medical Record Number).
● NHS ID. Depending on your system configuration, this second patient identifier mayappear immediately following the MRN.
● Modality used for the study.
● Date and time the study was captured.
● Description of the study.
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● Number of series and images captured.
● Scanning unit's unique identifier.
● Unique accession number assigned to the study by the Radiology Information System(RIS).
● Referring physician's name.
Note A study matched to multiple orders shows as multiple entries, each denotingan explicit order. While the study information is identical for each entry,the user can use the Procedure Code and Procedure Description fields todistinguish one order from another. You can display these fields in the Study
List from the Configuration dialog (open by clicking ).
3.2.1.3 Study List Icons
An area containing icons appears to the left of each study in the Study List. Use the iconsto determine the status of a study or to view the study.
● Icon Description
● Study is selected.
● Depending on your configuration, indicates that you have the study open.
● Another user currently has the study open. This feature helps diagnosingphysicians to make updates to only one copy of a study.
● Click this icon to view the study.
Note: If you open a study that another user is viewing, an alert messagedisplays. Click OK to view the study or Cancel to return to the study list.
● No note or report is attached to the study.
● A note is attached to the study.
● A final report is attached to the study.
● An internal note has been attached to the study.
● A preliminary (wet read) report has been added to the study.
● Indicates Read or Reviewed status. A study may have a large check mark, asmall check mark, both, or neither.
▪ A large green check mark ( ) indicates that the study has been read and markedas dictated.
▪ A small green check mark ( ) indicates that the study has been reviewed but notdictated. The Reviewed flag can also be used to mark studies read by residentsor ER physicians.
● An unmatched document. Click the icon to view the document in the ImageViewer.
● An unmatched report. Click the icon to view the report in Image Viewer.
● Offline study. Clicking the study will bring the study online.
● An offline study that is in the process of being brought online.
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● Indicates an error loading the study.
3.2.1.4 To Access Commands from the Study List Context Menu
1. In the Study List, position the mouse in the row of the desired study and right-click.This displays the context menu. The commands available depend upon your systemconfiguration and user account privileges.
Note: Any command you select in the menu applies to all selected studies. Toperform the menu action on multiple studies, select the check boxes tothe left of each study, and then right-click to see the menu.
2. Click the menu item to execute the command.
3.2.1.5 Study List Commands
Note Some of the commands below may not be available, depending upon yourconfiguration.
Table 5 Commands Available from the Study List Context Menu
Command Description
Select All Select all studies on the open page.
De-select All Clear all selections.
View Selected Studies Load images in the selected study (or studies) into theImage Viewer.
View Selected Studiesfor Conference
Open studies with saved presentation states and layoutinformation for presenting studies at conferences.
Compare SelectedStudies
Loads the selected studies into the Image Viewer forcomparison, two at a time.
All Studies for SelectedMRN
Displays all the studies with the same Medical RecordNumber (MRN), which is useful for comparing or viewingall studies for a particular patient. If more than one MRNis selected, all the studies for all the selected MRNs aredisplayed.
Note The system supports Enterprise MRNs, usingan Enterprise Master Patient Index (EMPI). SeeLinking Studies (page 83) to determine how thisfeature affects this command. See the administratorto determine whether Enterprise MRN is enabled onyour installation.
View or EnterReport/Note
View the existing note(s) or report(s) attached to eachselected study. From the report/note view, authorizedusers can add a note or report to the study.
Show Series List Display a list of series contained in the study. Includesnumber of images, modality, and other information.
Show Thumbnails Displays the thumbnails contained in each series.
View Audit Trail Displays full details about who accessed the study, when,and what operations they performed on the study.
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Command Description
Mark as DictatedMark as Not DictatedMark as ReviewedMark as Not ReviewedMark as QCMark as Not QCMark as STATMark as Not STAT
Change the state of the study without opening it. Theability to mark and unmark a study with different states isonly available to authorized users.
Lock from DeletionUnlock Study
Prevents others from deleting the selected studies or canremove any locks on the studies. This task is performedby administrators.
Pin StudyUnpin Study
Prevents others from deleting the selected studies orreturns the study to the normal state where it can beremoved from the Study List by filters. This task isperformed by GE field engineers.
Match Reports This feature displays all reports (preliminary and dictation)from a Radiology Information System (RIS) that the systemcould not match to a study.
Match Documents This feature displays all documents (such as scanneddocuments) that the system could not match to a study.
Match with Order This feature displays all orders transmitted from RIS thathave not been attached to a study; the selected study ismatched to whatever order is selected here.
Detach Orders All orders attached to the selected study are displayed; theselected order is then detached from the study.
Merge Studies Authorized users can merge two selected studies, if onestudy must be performed on two different machines, forexample. A warning is displayed if the user attempts tomerge more than two studies.
Split Study Authorized users can split a study. If two patients haveaccidentally been included in one study, you can correctthis by splitting the study.
Delete Authorized users can delete the selected study or studies.Note The study is permanently deleted with thisaction. A verification prompt displays. Use DeleteStudy cautiously.
Change Patient/StudyInfo
Authorized users can add missing data or correcterroneous data captured when the study was created.
Send in DICOM Send the selected studies to a DICOM server.
Send in DICOM,Anonymized
Send the selected studies to a DICOM server and scramblethe patient information to maintain patient privacy.
Grant Temporary Access Grant a remote user (such as a specialist or familyphysician) temporary access to the study.
Revoke TemporaryAccess
Remove a grant of temporary access that you assigned.
Manual Assign toWorklist
Assigns the selected studies to a particular user’s Worklist.
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Command Description
Assign to Worklist Assigns the selected studies to a Worklist (that is, to aspecific user or group).
Detach from Worklist Removes the study from a worklist.
Link Studies Treats the selected studies as belonging to the samepatient record.
Unlink Studies Severs the Enterprise MRN link between the selectedstudies.
Build Link Candidates Creates a list of possible Enterprise MRN matches forreview.
Scanned DocumentCD-Film Authorized users can send an order to a CD station to
create a CD of the selected study.
3.3 Paging through the Study ListYou can divide the studies into any number of pages -- or group them all on one page. Avertical scroll bar appears if your monitor can't display all studies requested per page.
Note Paging is not available on systems with an EA-only backend.
For example, if 20 studies were found, and you entered 10 as the number to show perpage, the Study List will have two pages, each of which will show 10 studies.
To specify how many studies are shown per page
● Enter the number in the Per Page field on the toolbar.
3.3.1 To See Other Pages in the Study List
� Click the appropriate button on the toolbar:
First page
Previous page
Next page
Last page
Note: When a search returns more than 1,000 results, the Last Page buttonis disabled.
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3.4 Searching the Study ListNote You can perform a quick search by Patient Name, MRN/Patient ID, or
Accession # directly from the Study List window by using the drop-down listnear the top left of the window.
If the system is configured to support NHS information:
● NHS No. is an available option for quick search.
● When using NHS No., the domain MRN for the patient is displayed in theMRN field. If the patient does not have an MRN in the selected domain,the MRN field is blank.
● Enter either the MRN or the 10–digit NHS No. as search criteria. If youenter information in one of these fields, the other field is disabled.
● To search using criteria:
1. Click Search on the toolbar.
2. Enter the criteria for your search and click Search.3. Click Last Search at the bottom of the dialog to repeat your most recent search.
● To search for a study using only the accession number (the unique number assignedto the study by the scanning unit):
1. Press Ctrl-g (if using Internet Explorer 7 or greater).
2. In the resulting dialog, type an accession number and press Enter.
Expected Result: This adds the accession number to the list above the dataentry field.
3. If you want to add another accession number, type the additional number andpress Enter.
Expected Result: This adds the additional number to the list above the data entryfield.
4. When you are finished entering numbers, click OK or press Enter again.
3.4.1 Using Quick Search
On the Study List window, use the Quick Search drop down box to search by MRN/PatientID, Accession Number, or Patient Name without displaying the Search window.
The search criterion remains in the Quick Search field until changed.
1. On the far left of the Study List window, select Patient Name, MRN / Patient ID, orAccession # from the drop down list.
2. Enter the search criterion.
Note: Search for MRN/Patient ID and Accession # by entering an exact match,or for Patient Name using the “Begins” criterion by entering at least thefirst two characters of the patient’s last name.
3. Press Enter or click Search to execute the search.
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3.4.2 Searching RA1000 Worklists in Universal Viewer
You can use RA1000 worklists in the Universal Viewer Search window, if both of theseconditions are met:
You must have the Open privilege for the worklist. This privilege can be assigned to youruser account, or you can be a member of a user group that has this privilege.
The worklist must belong to one of these folder classes:
● Folder:AllExamsFolder
● Folder:AllExamsSearch
● Folder:AllScheduledWorklist
● Folder:AllUnreadWorklist
● Folder:ApprovalWorklist
● Folder:ArchiveErrorWorklist
● Folder:ArchiveQueueWorklist
● Folder:ExamsWithAcqStat
● Folder:ManualFolder
● Folder:ParentFolder
● Folder:RecentExams
● Folder:RecentReferralWorklist
● Folder:RejectAnalysisFolde
● Folder:ResidentReviewEStat60Folder
● Folder:ResidentReviewEStat70Folder
● Folder:RetrievalErrorWorklist
● Folder:RetrievalQueueWorklist
● Folder:RootFolder
● Folder:TodaysExamsWorklist
● Folder:TranscriptionWorklist
● Folder:UnreadStatWorklist
● Folder:UnverifiedWorklist
3.4.3 Search Criteria
Criterion Description
Patient Name Enter all or part of the patient's last name, and select oneof the following radio buttons:● Begins Returns search results that contain the entered
text at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry.
MRN Enter all or part of the patient's unique primary ID andselect one of the following radio buttons:
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Criterion Description
● Begins Returns search results that contain the enteredtext at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry.
Note If you entered information in the EMPI or NHSNo. fields, the MRN field is unavailable.
Note To limit the search to studies performed in thecurrent facility, you must enter the facility's standardMRN prefix in the MRN field, and then select BeginsWith. Otherwise, the system will search for all studiesfor the patient across all facilities. If you do not knowthe standard prefix, try the patient's date of birthinstead. This applies only if EMPI is enabled on yourinstallation. See the administrator to verify whetheror not EMPI is enabled. See Linking Studies to learnmore about how this feature affects a search.
EMPI Enter either all or part of the patient’s unique ID in theEnterprise Master Patient Index, and select one of thefollowing radio buttons:● Begins Returns search results that contain the entered
text at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry.
Note If you have already entered information in theMRN field, this field will be unavailable.
Depending upon your system configuration, this criterionmay not be available.
NHS No. If the enterprise uses NHS information, enter all or part ofthe patient's NHS No. using the NNN NNN NNNN formatand select one of the following radio buttons:● Begins Returns search results that contain the entered
text at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry. No formattingis applied to this criterion.
Note If you enter the NHS No., the MRN field isdisabled.
Date of Birth Enter the patient's birthdate in MM-DD-YYYY format (forexample, 09-29-1964).
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Criterion Description
Accession Number Enter all or part of the unique accession number assignedto the study by the scanning unit, and select one of thefollowing radio buttons:● Begins Returns search results that contain the entered
text at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry.
Referring Physician Enter all or part of the referring physician's name, andselect one of the following radio buttons:● Begins Returns search results that contain the entered
text at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry.
Study Description Enter all or part of the conventional name used to describethe study (for example, chest, brain, CAP, etc.), and selectone of the following radio buttons:● Begins Returns search results that contain the entered
text at the beginning of the entry.
● Exact Returns only search results that exactly matchthe entered text.
● Contains Returns search results that contains theentered text anywhere within the entry.
Modality Available modalities depend upon your systemconfiguration. If the All option is available, select it toinclude all modalities.
Study Status For each status, select the following:● All The search includes studies, regardless of whether
or not the study has that status.
● Yes The search only includes studies with the specifiedstatus.
● No The search only includes studies which do not havethe specified status.
Note RIS-Verified indicates that the study has beenmatched to the original order by comparing the MRNto the accession number.
Depending upon your system configuration, this criterionmay not be available.
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Criterion Description
Study Status Change Click this check box to search studies that have beenchanged recently. When checked, this shows detailedstatus change search criteria.
Criterion Description
QC’dReviewedDictatedUnmarked
Choose the status the studies werechanged to.
Note Unmarked indicates that QC’d,reviewed, or dictated status wasremoved from the study.
by menot by meother user
Choose whether to select for studiesthat you changed the status of, studiesthat you did not change the status of, orpick another user and select for studieschanged by that user.
Date ofChange
Specify a date range during which thechange occurred.
Depending upon your system configuration, this criterionmay not be available.
Date of exam Specify the date range during which the exam occurred.
Ordering Dept./ReferringService
Click the ellipses to the right of the field and choose thearea or department within your facility which generatedthe order. Depending upon your system configuration, thisoption will read Ordering Dept. or Referring Service.Depending upon your system configuration, this criterionmay not be available.
Filter Select one or more additional criteria to narrow the list. Usethe boolean operators to refine the search. AND indicatesthat only studies that meet both criteria will be included.OR indicates that studies that meet either criteria will beincluded. The PACS administrator controls which criteriaare available.Depending upon your system configuration, this criterionmay not be available.
Priority Choose whether to select on STAT or routine studies.Select All to ignore study priority. If your system does notallow filtering on Priority, you can choose whether to filteron exams which are STAT or not from Study Status.Depending upon your system configuration, this criterionmay not be available.
Online Status Specify whether to select from any combination of examswhich are online, incomplete, or offline. Offline exams arestored in long-term storage.Depending upon your system configuration, this criterionmay not be available.
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Criterion Description
Include Specify whether to limit the search to any combination ofthe following:
Criterion Description
Studies Include studies.
UnmatchedReports
Include reports not yet matched to a study.
UnmatchedDocuments
Include documents which were scanned tono particular study.
UnmatchedOrders
Include inbound HL7 orders that have notbeen matched to a study.
Zero imagestudies
Include studies which do not have anyimages.
Note Depending upon your system configuration,either the Zero image studies option is availableor the Studies, Unmatched Reports, UnmatchedDocument, and Unmatched Orders options areavailable.
Depending upon your system configuration, this criterionmay not be available.
From a DICOM server Select the check box to include studies from a DICOMserver.Depending upon your system configuration, this criterionmay not be available.
From a Worklist ● For PACS-IW foundation customers, select this checkbox and click the ellipsis. Select a Worklist, and clickOK.
● For CPACS foundation customers, select the checkbox to display additional options.
● Select RA1000 Studylist to open the StudylistSelector or Worklist to open the native Worklistsscreen that shows folders that the user can access.
Note A folder that contains other Worklists has itscontents listed directly under it, with an indentation tothe right. A folder that contains exams has a radiobutton to the left of its name.
● Click a radio button to the left of the Worklist andclick OK.
Note If your selection criteria includes an RA1000Worklist, the following information applies:
● The search covers the contents of the RA1000Worklist only. Additional search criteria filter outcontents from this worklist only.
● If you create a tab from this search, the RA1000Worklist used to search remains part of the tabdefinition. When this tab is opened or refreshed,the current contents of the specified Worklist issearched, and additional search criteria are appliedas in the original search.
● Up to 500 studies can be returned.
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Criterion Description
● You must have the Open privilege for the Worklist.This privilege can be assigned to your useraccount, or you can be a member of a user groupthat has this privilege.
● The Worklist must belong to one of these folderclasses:
♦ Folder:AllExamsFolder
♦ Folder:AllExamsSearch
♦ Folder:AllScheduledWorklist
♦ Folder:AllUnreadWorklist
♦ Folder:ApprovalWorklist
♦ Folder:ArchiveErrorWorklist
♦ Folder:ArchiveQueueWorklist
♦ Folder:ExamsWithAcqStat
♦ Folder:ManualFolder
♦ Folder:ParentFolder
♦ Folder:RecentExams
♦ Folder:RecentReferralWorklist
♦ Folder:RejectAnalysisFolde
♦ Folder:ResidentReviewEStat60Folder
♦ Folder:ResidentReviewEStat70Folder
♦ Folder:RetrievalErrorWorklist
♦ Folder:RetrievalQueueWorklist
♦ Folder:RootFolder
♦ Folder:TodaysExamsWorklist
♦ Folder:TranscriptionWorklist
♦ Folder:UnreadStatWorklist
♦ Folder:UnverifiedWorklist
Depending upon your system configuration, this criterionmay not be available.
Hospital Enter all or part of the hospital or institution name.Depending upon your system configuration, this criterionmay not be available.
Locations to search Highlight the locations (EA partitions) to search.Depending upon your system configuration, this criterionmay not be available.
3.4.4 To Refine the Accuracy of Your Search
As with any Search function, more data narrows the search, while less data expands thesearch. The system provides features to bridge those two extremes.
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In the row next to each text box field (patient name, patient ID, etc.) in the Search dialog,three option buttons are displayed: Begins With, Exact and Contains. These options helpclarify the search and ensure that no studies are lost due to misspellings or nonstandardnaming practices. Examples of their usage are provided below.
● Begins: If you aren't sure whether the referring physician's name is "Eldredge" or"Eldridge," enter "Eldr" and click Begins to return studies listed under both spellings.
● Exact: If you are certain that the study's information precisely matches your searchcriteria, you can enter that criteria to exclude all other possibilities. If you know thatthe study has the correct patient ID, for example, you can enter that data and clickExact to get very specific results.
● Contains: If you don't remember whether "Shirley" is the patient's last name or firstname, you can enter "Shirley" in the field and clickContains to include all studies thatcontain that word anywhere in the name field.
3.4.5 To Refresh a Search
� To refresh the contents of the Search Results tab, press F5, or click Search .
3.4.6 Searching: For Japanese Users Only
While similar studies can be grouped into tabs to make finding the appropriate studyeasier, you also can perform a search to find a particular study using more narrow criteria.
For Japanese users only: The system supports multiple syllabaries for flexiblesearching. You can search on one or any combination, using the equal key (=) to controlresults. Use the following guidelines when searching by patient name.
Table 6 Japanese Language: Searching
syllabary input value result
English or Katakana only name, without the =character in front of thename
patname column issearched
ideographic (Kanji) only name, with the = characterspecified in front of thename
i_patname column issearched
phonetic (Hiragana) only name, with == (two equalsigns, no space between)specified in front of thename
p_patname column issearched
two representations:Katakana (or English)and ideographic (Kanji)only
name, with the = characterspecified between the tworepresentations
patname and i_patnamewill be searched; valuesfrom both columns willbe matched to the searchcriteria
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both ideographic (Kanji)and phonetic (Hiragana)
name, with = specifiedin front of the nameand between the tworepresentations
i_patname and p_patnamewill be searched; valuesfrom both columns willbe matched to the searchcriteria
all three representations(English/Katakana;Kanji orempty;Hiragana or empty)
name, with = separating allthree representations
patient is searched on allcolumns; values from allcolumns will be matched tothe search criteria
When refining a search, Japanese users can use the following guidelines:
● Begins With – The entered search string remains at the beginning and is followedby an asterisk.
● Exact – If you are certain that the study's information precisely matches your searchcriteria, you can enter that criteria to exclude all other possibilities. If you know thatthe study has the correct patient ID, for example, you can enter that data and chooseExactly to get very specific results. The search criteria remains as it was entered.
● Contains – This option includes al l studies that contain the entered criteria anywherein the field. Asterisks are added at the beginning and end of the search criteria.
3.4.7 Searching: For Hebrew Language Users Only
While similar studies can be grouped into tabs to make finding the appropriate studyeasier, you also can perform a search to find a particular study using more narrow criteria.
For Hebrew language users only: The system supports multiple alphabets for flexiblesearching. You can search on one or any combination, using the equal key (=) to controlresults. Use the following guidelines when searching by patient name.
Table 7 Hebrew Language: Searching
alphabet input value result
English only name, without the =character in front of thename.For example: [Shapiro].
pat_name column issearched
Hebrew only in i_pat_namecolumn
name, with the = characterspecified in front of thename.For example: .[=שפירא]
i_pat_name column issearched
Hebrew only in p_pat_namecolumn
name, with == (two equalsigns, no space between)specified in front of thename.For example: .[==שפירא]
p_pat_name column issearched
two representations:English and Hebrew
name, with the = characterspecified between the tworepresentations.For example:.[Shapiro=שפירא]
pat_name and i_pat_namewill be searched; valuesfrom both columns willbe matched to the searchcriteria
When refining a search, Hebrew users can use the following guidelines:
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● Begins With – The entered search string remains at the beginning and is followedby an asterisk.
● Exact – If you are certain that the study's information precisely matches your searchcriteria, you can enter that criteria to exclude all other possibilities. If you know thatthe study has the correct patient ID, for example, you can enter that data and chooseExactly to get very specific results. The search criteria remains as it was entered.
● Contains – This option includes all studies that contain the entered criteria anywherein the field. Asterisks are added at the beginning and end of the search criteria.
The same rules apply to a search by the referring physician.
3.5 TabsEvery Study List you create and save is displayed under a tab. You can create tabs forstudies grouped by modality, Worklist, date, physician, ordering department, or othercriteria.
Note To configure the way tabs display in the viewer, see Setting the Appearanceof Worklist Tabs.
.
3.5.1 To Create a New Study List Tab
1. Perform a search for the information that you want the tab to hold.
2. Select the Search Results tab to view the studies.
3. Right-click the Search Results tab and select Save Search As from the menu.
4. The Name Tab dialog is displayed. Enter a unique name for the new tab.
5. Click OK or press Enter. The new tab is displayed, with its search results, to theimmediate right of the Search Results tab. For example, you might create tabs forcertain modalities or for dates (yesterday and today).
3.5.2 To Move or Edit a Tab
The Search Results tab is the only standard tab and always holds the left-most position.You create, move, or delete other tabs as needed.
Note You can rename a tab by deleting it, re-executing the search, and then savingit with the new name.
● Right-click the tab and select one of the following items:
● Move Left: The tab is moved one position to the left; repeat the action to moveit left again.
● Move Right: The tab is moved one position to the right; repeat the action tomove it right again.
● Delete: The tab is removed.● Edit: The Search dialog box is displayed; enter new search criteria for this tab.
You must display the worklist tab to edit it. After you edit the search criteria andclose the Search dialog, the Search Results tab is displayed.
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3.5.3 Auto-fetch
Users can designate a tab on Study List as the auto-fetch tab. As you view a study in theviewer, the system can fetch and load the next study in your workflow. That study can bethe next study in the Study List -- one after the next, until all have been read -- or a studythat is anatomically related to the open study. After setting default behavior for auto-fetchin the Preferences dialog, you activate the feature from the Study List.Note Only users with the proper privileges can access auto-fetch; see your
administrator.
3.5.3.1 To Set Up Auto-fetch
The number of studies to include in the auto-fetch batch is not limited by the system.However, a reasonable approach is to include the number of studies that typically presentin the Study List.
Other users are locked from viewing any studies that you auto-fetch. Thus, studies inthe auto-fetch queue are denoted by a yellow monitor icon on your workstation anda red monitor icon on other clinicians’ workstations.
1. Click the Configuration Tool in the upper right corner of the screen.2. Select Preferences.3. In the Auto-Fetch section at the bottom, in the Batch Size field, enter the number of
studies that should be fetched while the first study is loaded.
4. To fetch studies anatomically related to the first study, enter a number in theComparison field.
5. To open the fetched studies simultaneously, select the Open Multiple Studies asBatch check box.
6. Click Save.
3.5.3.2 To Activate Auto-fetch
Prerequisite: In the Configuration Tool > Preferences, define the parameters forauto-fetch. The auto-fetch tab should be configured to include the conditions such as“Not reviewed” or “Not dictated”. The Done option should be configured with “Mark asReviewed” or “Mark as Dictated” accordingly.
Other users are locked from viewing any studies that you auto-fetch. Thus, studies inthe auto-fetch queue are denoted by a yellow monitor icon on your workstation anda red monitor icon on other clinicians’ workstations.
1. From the Study List, go to the tab that holds the studies to auto-fetch.Example: For example, to load and quickly review, one after the next, all oftoday's studies, go to the Today tab. (For information on how to create a tab,see the Organizing Studies section.)
2. Right-click that tab to display a small floating menu.
3. Select Auto Fetch On. Certain changes in the Study List and Viewer take effectimmediately:
Expected Result: The tab updates to include an icon indicating that studies in thattab will be auto-fetched, i.e., after the first selection is loaded the others will follow insuccession, up to the configured maximum. Before a study is selected, the icon isdimmed ; after the first study is selected, the icon is active (green) to denote thatthe fetch is underway.
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4. After you complete work on the study, click Next in the Patient Folder or Viewer toclose the open study (and execute the standard Done commands) and automaticallydisplay the next study in the Study List. Fetching studies continues until the laststudy is loaded.
Note: If you make user preference changes to Navigator Options and/or SRPModality Preferences during auto fetch, those changes will only besaved after all instances of the viewer are closed by clicking Next andselecting Done from the drop down menu.
5. To de-activate the auto-fetch process:
● In the Viewer, click the down arrow next to the Next button and select Finish fromthe drop-down menu.
● In the Study List, right-click on the auto-fetch column header and select AutoFetch Off.
3.6 Configure Auto-launch and CloseDictationPrerequisites:
● The dictation system client must be installed on the workstation.
● The Centricity Universal Viewer server must be configured in the Site ConfigurationTool with a dictation system that uses Integrated Desktop Reporting (IDR). If theserver does not use IDR, this procedure does not apply.
● The Dictation Options display in the Study List Configuration window only for userswith the “Dictation_Mark” and/or “Review_Mark” privileges.
1. Click (Configure your Study List) in the upper right corner of the screen.2. At the bottom right of the Configuration Tool screen, select or clear these options:
Option Description
Auto-Launch Dictation ● Select the Auto-Launch Dictation check box to startthe dictation system when an exam is opened andthe dictation system is not already running. First, theviewer starts the dictation system and then requests thedictation system to bring report in focus. If the dictationsystem is already running and minimized, the viewerrequests the dictation system to bring the report intofocus.
● Clear the Auto-Launch Dictation check box to manuallystart the dictation system by clicking the Dictate iconin the main toolbar.
Close Viewer on Signoff ● Select the Close Viewer on Signoff check box andthe dictation system auto-closes the Viewer. If multipleViewers are open, the dictation system auto-closes onlythe Viewer for which a report was signed. The dictationsystem changes the report context when the context inCentricity Universal Viewer changes without clickingDictate.
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● Clear the Close Viewer on Signoff check box tomanually close the Viewer after closing the dictationsystem.
3. Click Save.
3.7 Changing the Viewer’s Color SchemeYou can select a light or dark color scheme for the application. If you are using the Viewer,it will use the same color scheme defined for the Study List.
To change the color scheme for both the Study List and Viewer:
● In the Study Lists window, click and toggle between lights on and lights off.OR
● Click and select either the Lights On or Lights Off radio button. Then, click Save.
3.8 Sorting ColumnsYou can sort columns in two different ways: from the study list or from the CPACS worklist.
Note When a search returns more than 1,000 results, the sort function is disabled.
From the Study List
You can choose any one or two columns to sort.
● To select the primary sorting column, click on the column heading. This will sortinformation in an ascending order. Click the column heading again if you want theinformation to sort in a descending order.
● To select the secondary sorting column, Ctrl - click on the column heading. This willsort information in an ascending order. Ctrl - click the column heading again if youwant the information to sort in a descending order.
From the CPACS Worklist
When you select the From Worklist option in the search window, sorting is predefined bythe backend (as displayed on the RA1000) and cannot be changed on the study list. Aclick on any column is ignored.
3.9 Configuring Columns
3.9.1 Configuring Columns
You determine which data appears as columns in your Study List—and in what ordercolumns are displayed. You also can establish default sort behavior and select defaultmonitors to display certain studies.
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Studies will be sorted according to default selections, and you can click the headingto sort another way.
3.9.1.1 Enable New Study List Columns
Prerequisite:
● If changing Study List settings for Group or Common levels, the user must haveAdministrator privileges
SP6 added the new Studylist Columns shown below. They are automatically visible fornew SP6 installations, but for sites upgrading to SP6, follow the procedure below to makethem “visible” in the “Available Fields” of the “Study List Configuration”.
● DATE_LAST_FILE_CHANGE
● DEPARTMENT
● DICTATED_FLAG
● DICTATED_FLAG_DATE
● DICTATED_FLAG_USER
● STATION
● REPOSITORY_ID
● PERFORMINGPHYSICIAN
● PATIENT_NAME_ORIGINAL
● OTHERPATIENTSIDS
● NAMEOFPHYSREAD
● ISSUER_PATIENT_ID
● INSTANCE_AVAILABILITY
● FL_STAT
1. Access the Study List.
2. Select Settings.3. Highlight the first entry in “Assigned Fields”.
4. Click Down.5. Click Up to return it to the original position.
6. Select Private, Group, or Common, depending on the scope you would like for thischange.
7. Select Saveand then click Close.8. Click Settings again and confirm the fields are now listed in “Available Fields”.
3.9.1.2 To Configure the Study List Columns
1. Click (Configure your Study List) in the upper right corner of the screen.
The left pane of the resulting dialog contains the current columns, arranged in theorder they are displayed in the Study List. The right pane contains data you can useas columns. Additional settings are shown under these panes.
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Note: Order Status, Order Procedure Code and Description, and the OrderPriority can be displayed as columns in the Study List. These are usefulsince a study matched to multiple orders shows as multiple entries, eachdenoting an explicit order, in the Study List. While the study informationis identical for each entry, the user can use the Procedure Code andProcedure Description fields to distinguish one order from another.
● To add a column to your Study List, click the data field in the right pane and thenclick <<. To add all available fields as columns to your Study List, click << All.
● To remove a column from your Study List, select the data field in the left pane andthen click >>. To remove all the current data fields as columns, click >> All.
● To rearrange the order of columns, in the left pane, click the column to move. ClickUp to move the column left in your Study List, click Down to move it to the right.
2. In the Column Caption field, enter a descriptive name. This name appears as thecolumn heading. Leave this field blank to use the standard data column name.
3. In Column Width, enter the number of pixels for the column width. A reasonablestandard is 200 pixels, and you can always resize the column.
4. Select the text alignment for the column text.
5. From the drop-down list, select the format for displaying date fields.
● Short: MM-DD-YY● Medium: MM-DD-YYYY or DD-Mmm-YYYY
● Long: MM-DD-YY HH:MM:am/pm
● Full: MM-DD-YYYY HH:MM:am/pm
6. Select the Autorefresh check box to automatically refresh the Study List at theinterval you specify.
For example, to refresh the Study List every 30 seconds, select Autorefresh andenter 30 in the Autorefresh Timeout field.
7. From the set of drop-down lists at the lower right of the dialog, select the followingdefault sort order Parameters:
● First Sort Column Select the primary sort column.
● First Sort Direction Select Ascending or Descending as that column's sortorder.
● Second Sort Column Select the secondary sort (or double sort) column.
● Second Sort Direction Select Ascending or Descending as that secondarycolumn's sort order.
8. In the lower-middle of the dialog, designate to whom the configuration is available.
● Common All users may share this configuration.
● Group Users in your user group may share this configuration.
● Private You are the only one allowed to use this configurations.9. You may click Preferences to open the configuration Preferences dialog.
From the Preferences dialog, you can specify study display preferences by modality.
10. Click Preview to see the new settings before you save them.
11. Click Save to save and immediately apply the new column settings.
Troubleshooting: If the Available Fields list does not include a specificcolumn1. Add one or more available fields to your study list by moving them from the Available
Fields list to Assigned Fields list.
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2. Save the new settings and close the Configuration Tool window.
3. Click again to re-open the window.
Adding a field and then closing and re-opening the window will update the list ofAvailable Fields.
4. Scroll through the Available Fields to find the column in the updated list.
If the column is still not available, contact your system administrator.
5. Select the column and add it to the Assigned Fields list.
6. Complete any other configuration changes for that field, and then save the newsettings.
3.9.1.3 Resizing Columns
● To resize columns with the mouse:
1. Click (Configure your Study List) in the upper right corner of the screen.2. Click Preview to display the Preview Study List dialog.
3. Hold the mouse next to a column heading border.
Expected Result: It changes to an arrow shape .
4. Hold down and drag right or left to alter the size of that column. Repeat thisstep as needed.
5. Close the Preview Dialog.
6. Click Save on the Configuration Tool dialog.● To resize columns numerically:
1. Click (Configure your Study List) in the upper right corner of the screen.2. Select the column name in the Available Fields pane on the right.3. Enter a width (in pixels) in the Column Width field.
4. Click Save.
3.10 Setting Display Preferences by Modality
3.10.1 Setting Display Preferences by Modality
You can define a default monitor for a study based on its modality. For example, you canestablish that CT studies always show on a color display.
1. Click (Configure your Study List) in the upper right corner of the screen.2. Click Preferences.3. Choose from the following for each modality:
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Show on Color Display If ColorImages Exist in Study
If any color images exist in a study of thismodality, the study displays on a color monitor.
Always Show on Color Display All studies of this modality displays on a colormonitor.
Always Show on GrayscaleDisplay
All studies of this modality displays on agrayscale monitor.
4. Below these columns, select to whom the preferences apply.
● Common All users may share this configuration.
● Group Users in your user group may share this configuration.
● Private You are the only one allowed to use this configurations.5. Click Save.
3.10.2 Setting General Display Options
This section explains how to set default behavior for the Patient Folder, related comparisonstudies, STAT display and viewer launch.
1. Click (Configure your Study List) in the upper right corner of the screen.2. Click Preferences.3. Set any of the following:
Open Patient’sFolder
● Always The patient's folder opens every time you view astudy.
● Never The patient’s folder does not open when you view astudy.
● On a Separate Display Every time you view a study, thePatient Folder opens on a separate monitor than the study.
STAT Alert Select when the system displays STAT alert highlighting on aSTAT study on the study list. STAT alert highlighting turns thefont red for that study row.
Note: This setting does not mark a study as STAT; itindicates how the study list displays a study onceit is marked as STAT. Users still mark specificstudies as STAT from the study list.
● Never Disables display of a STAT alert highlighting.
● On for Not Dictated Shows STAT alert highlighting onstudies that are not dictated.
● On for Not Reviewed and Not Dictated Shows STATalert highlighting on studies that are neither reviewed nordictated.
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AutomaticDisplay of RelatedComparisonStudy
Select a default behavior for related comparison studies (sameMRN, same anatomy). These studies open in comparisonmode. See Changing Patient/Study Data (page 80) forinformation on how to define the anatomy on which to search.
● Never Related comparison studies do not open when youview a study.
● Always Related comparison studies automatically openevery time you view a study
● For Not Dictated Related comparison studies open everytime you view a study that has not been dictated
Note: The system supports Enterprise MRNs, usingan Enterprise Master Patient Index (EMPI). Thismeans that a patient is recognized across theenterprise, even though that patient may havedifferent MRNs from disparate systems in separatefacilities. See Linking Studies (page 83) for moreinformation. If EMPI is enabled, the comparisonstudies include all studies for this patient fromall facilities in the enterprise. The user selectswhich studies to compare. See the administratorto determine whether EMPI is enabled on yourinstallation.
Note: If you have a mammography workstation, priorcomparison study display is also affected by themammography Integration option you choose inthe Layout Editor. See Automatically DisplayingComparison Studies (page 191) for more details.
Viewer Launch ● Single Click When single-click is selected, the viewerwill launch when a user performs a single-click anywherein the study row.
● Double Click When double-click is selected, the viewerwill launch when a user performs a double-click anywherein the study row.
3.10.3 Setting the Date and Time
1. Click (Configure your Study List) in the upper right corner of the screen.2. Click Preferences.3. Set the date and time as follows:
Date Format Determines the order of day, month, and year.
Month Day Year: MM-DD-YYYY
Day Month Year: DD-MM-YYYY
Year Month Day: YYYY-MM-DDStyle Determines how much information displays with a date.
Full: MM-DD-YYYY HH:MM:SS
Long: MM-DD-YY HH:MM
Medium: MM-DD-YYYY
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Short: MM-DD-YYDelimiter The character used to separate the month, day, and
year
Time Format AM/PM: 12 hour clock
24h: 24 hour clockDelimiter The character used to separate hours, minutes, and
seconds
4. Click Save.
3.10.4 Setting the Appearance of Worklist Tabs
Users who work with a large number of worklist tabs may configure the viewer to wrapexcess tabs to a new row. This avoids additional scrolling to access worklist tabs.
To wrap the worklist tabs:
1. In the study list, click (Configure your Study List).2. In the lower right-hand corner of the Configuration Tool screen, ensure that the
Wrap Study List Tabs radio button is ON (default).
3. To turn off worklist tab wrapping, select the OFF radio button.
3.10.5 Configure Single-Frame Image Thumbnails by Modality
You can configure a Study List setting per modality which controls if single-frame imagesshould be placed into their own thumbnail or clustered into one series (thumbnail). The listof modalities displayed will match the Searchlist for either CPACS or EA.
1. Click (Configure your Study List) in the upper right corner of the screen.2. Click Preferences.3. Under View Images As Separate Series, select the desired modalities. The default is
no modalities selected.
4. Choose an option from the Maximum Number of Images Per Series dropdown.The default is 100.
5. Click Save.
3.11 Set the Number of Comparisons to LoadAutomaticallyTo avoid loading comparison studies manually, set a preference to automatically load up tonine comparison studies when the primary study opens in the viewer. With this preferenceenabled, set a preference to automatically load up to nine comparison studies whenthe primary study is opened in the Viewer.
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When this preference is enabled, all of the pre-configured number of comparison studiesdisplay in the Navigator as thumbnails; primary study along with the two most recentcomparison studies hang in the viewports as per the hanging protocol.
You can also set a preference to hang one or two studies automatically. The primarystudy along with one or two of the most recent comparison studies hang in the viewportsaccording to the hanging protocol when you open the primary study.
Note When using an EA backend (for example, with a Cardiology workflow), theAuto Load Comparison preference can be set to All studies only. There isno preference setting for Non-dictated studies.
The Autoload Comparisons preference works in conjunction with the relevance logicsetup to determine if comparison studies are relevant. When both preferences areselected, up to two anatomically related comparisons automatically hang when you opena study. Other related comparisons load in the Navigator thumbnails up to the numberof comparisons specified.
These settings are preserved during an upgrade.
1. On the Study List window, select Configuration > Preferences.2. (Optional) Indicate the group to whom this preference applies:
Private You
Group The user group(s) to which you belong (requires additionalprivileges)
Common All users (requires additional privileges)
3. In the Automatically Load Comparisons: field, select an option:
Never Load all comparisons manually.
For Not Dictated Studies Only Display a drop down list and choose thenumber of comparison studies to numberof comparison studies to automatically loadwhen a non-dictated study is opened as aprimary study in the viewer.
For All Studies Display a drop down list and choosethe number of comparison studies toautomatically load when any study is openedas a primary study in the viewer.
4. In the Smart Reading Protocols panel, set Automatically Hang Comparisons to 1 or2 to indicate the number of comparisons to automatically hang using SRP.
Automatically HangComparisons
Determines # of comparisons to automatically hang* usingSRP.
1 Default non-Trend SRP hangs one comparison study.
2 Default non-Trend SRP hangs two comparison studies.
*Automatic hanging refers to hanging of comparison studies along with Primary studywhen Primary study is opened.
Note: Ensure Automatically Load Comparisons is enabled for SRPAutomatically Hang Comparisons to take effect.
5. Click Save.
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3.12 STAT Studies
3.12.1 STAT Studies
Depending on your system configuration, you can mark studies as STAT from the floatingmenu, an indication that a study needs immediate attention. You can mark any individualstudy as STAT, and you can configure multi-level alerts for STAT studies -- from a simpleflag to more granular controls that correspond to your institution's workflow. You can alsoperform a shortcut search for STAT studies.
If you mark a study as STAT, the STAT button is illuminated, indicating that a searchfor STAT studies would return at least one study. If a column has been configured todisplay the STAT status, the flag in that column updates to Yes. If a STAT alert has beenconfigured, the row is in a red font.
Note If a STAT column is configured, you can also see all STAT studies immediatelyby sorting that column.
3.12.1.1 To Mark a Study as STAT or Not STAT
1. In the Study List, position the mouse in the row of the desired study and right-click.(The row is highlighted, and the check box indicates which study you have selected.)
2. Select Mark as STAT from the floating menu.
3. To remove the STAT status from a study, repeat the previous step, but select Mark asNot STAT from the floating menu.
3.12.1.2 To Search for STAT Studies
● Click the red STAT button on the Study List. The Study List is refreshed with all studiesmarked as STAT. To narrow the list, use the standard Search tool; select the STATcheck box to include that status along with additional search criteria.
3.12.1.3 To Configure a STAT Alert
This setting does not mark a study as STAT; it is concerned with how an alert is displayedonce a study is marked. The STAT alert is a red font applied to any row in the StudyList that contains a study marked as STAT.
1. Click the Configuration Tool in the upper right corner of the screen.
2. Click Preferences in the middle of the window.3. Under STAT Alert, select how the system should display a STAT alert.
● Never : Disables display of STAT alerts.
● On for Not Dictated : Display alert on STAT studies that are not dictated.
● On for Not Reviewed and Not Dictated : Display alert on STAT studies that areneither reviewed nor dictated.
Note: This setting does not affect the STAT status, only the display of a STATalert. Depending on the system configuration, users may still markspecific studies as STAT from the Study List, and the STAT flag will alwaysupdate if that column is configured to display in the Study List.
4. Click Save.
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4Study List Tools
4.1 Selecting and Opening StudiesYou can manage a single study or a group of studies from the Study List. Those functions,such as importing, linking, and assigning to a Worklist are explained in the Study List Toolssection. To perform those functions, first select the study (or studies) to open. The systemprovides different ways of opening one or more studies.
The available options depend on your system configuration.
Note Only open studies that use the same character set that your system isconfigured to use. Opening studies with a different character set may result insome of the characters not displaying properly on your system. For example,a study created for a Simplified Chinese system may not display properlyon a Traditional Chinese system, resulting in ? characters displayed in apatient name.
4.1.1 To Open One Study
� Use one of the following methods to open a study:
● Click anywhere in the study row. The study displays in the viewer.
● Click the view icon for the desired study.
● Select the check box next to the desired study and right-click. Select View SelectedStudy from the menu.
4.1.2 To Open Multiple Studies
� Use one of the following methods to select multiple studies:
● Select the checkbox next to each study desired.
● To select all the studies on the displayed page, click Select All on the toolbar.
● To select all the studies on the displayed page, right-click anywhere in the Study Listto open the menu, and click Select All.
● To display all studies that have the same Medical Record Number as the selection,select a study and right-click anywhere in the Study List to open the menu. SelectAll Studies for Selected MRN.
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4.1.3 To View Selected Studies
1. On the Study List, select the checkboxes for the studies to view.
2. Right-click and select View Selected Study from the menu.
Note: The system supports Enterprise MRNs, using an Enterprise MasterPatient Index (EMPI). See Linking Studies to determine how this featureaffects the command. See the administrator to determine whetherEnterprise MRN is enabled on your installation
.
Note: You can open related studies for comparison automatically or by selectingthem. See Comparing Studies .
4.1.4 Incomplete Studies
Sometimes, a study may be included on the study list before all of the study’s imageshave been stored on the system. This may happen if the study has a very large numberof images, or if there are network issues between the modality and the Universal Viewersystem, for example.
If a study includes any images that were received in the Universal Viewer with a PACS-IWsystem less than three minutes ago, the system treats the study as an incomplete study: astudy that includes images which are not yet available to the system. The images aredisplayed with the Unverified Study indicator.
If the Universal Viewer is integrated with a Centricity PACS system, the Centricity PACSexam status Arrived determines if the study is considered incomplete.
An exam status of Arrived is used to mean that either:
● The images have arrived into PACS and are available for review.
● The scan is complete, but is being reviewed by the modality technician to determinewhether or not the scan quality is sufficient for diagnostic use.
An exam status of Verified is typically used to mean that:
● The scan is complete, and the modality technician has verified the scan qualityis sufficient for diagnostic use.
Some customers use the Centricity PACS automatic verification feature. This allowsexams to have their status automatically changed to Verified after a specified time period.
When an exam is marked as Verified, all of the images for the studies in the exam arearchived to the Enterprise Archive. The images are also available in the short-termstorage.
Exams that are Arrived (not yet Verified) may not yet all be on the short-term storage andwill not have been written to the Enterprise Archive (until marked Verified). Therefore,exams in the Arrived state are considered to be an incomplete study.
4.1.5 To View Unverified Studies
Prerequisites:
● The site uses EA integration.
● The site is configured for Study Verification Workflow.
● (Optional) The Status column has been added to the Study List.
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See the section “Enable New Study List Columns” for more information on adding theStatus column. This column can also be configured to display unverified studies only.Unverified studies can then be marked as Verified.
Search for Unverified Studies
1. Click Search on the main screen.
2. Look for the Exam Status option In the Search window.
3. Click the Unverified check box to enable it.
4. Perform a search by selecting options in the Modality section of the Search window.
5. Scroll to the Status column in the Study List
Expected Result: The Status column in the Study List will show only show Unverifiedstudies.
6. (Optional) Select a study to verify, right-click and select Mark as Verified from themenu to verify the study.
4.2 Reports and NotesNote Reports and notes are enabled for systems with a PACS-IW backend or a
Centricity PACS backend. On systems with an EA-only backend, reportsand notes are disabled.
4.2.1 Adding a Report or Note to a Study
While using the viewer tools to read a study, you can add a preliminary report or note. Thepreliminary report can become the final report upon dictation of the study.
Note You can also add a note from the Patient Folder.
Note Depending on your configuration, you may add a report and edit it.
4.2.1.1 To Add a Report or Note to a Study
Note You can add a report or note from the Patient Folder or the Study List. Afteryou add a report or note, the Note/Report icon changes color in the Study List.
A note displays as yellow.
An internal note is pale yellow.
A preliminary report shows as pale green.
A dictated (finalized) report appears dark green.
1. When the study is loaded in the Image Viewer, click Notes on the Image Viewertoolbar.
or
2. Click the Note/Report icon next to the desired study in the Study List.3. Select the kind of note to add. The text pane changes color.
● Add Note: A general comment about the patient or study. The pane appears gray.
Note: Depending on your configuration, a “subject” line may display in the note.
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Note: Depending on your configuration, audio notes may be added.
Note: Depending on your configuration, you may be able to add Canned notes.For information on Canned Notes, see To Add an Additional Note orReport to a Study.
● Add Internal Note: Comments that are protected by privileges. Typically, theprivilege to add and read an internal note is granted to radiologists only. Thepane appears green.
Note: Depending on your configuration, you may not be able to add internalnotes.
● Add Preliminary Report: A "wet-read" of the study. The pane appears blue.
4. Enter the information in the text pane and click Done to accept the entry.
Note: More options are available if you add a note from the patient folder. SeeTo Add an Additional Note or Report to a Study
5. Select Done again to exit the dialog.
4.2.1.2 Adding a Note from a RIS System
Final reports can be received in encoded form from a RIS and displayed in Rich TextFormat in the Patient Folder. If integrated with a RIS, the system also sends a notificationto the external system about the change in status when Notes/Preliminary Reports orDictations are entered for a study.
Note You cannot delete a note or preliminary report. If you save a note or reportand then wish to delete it, click Hide. This option appears when you begin toenter text into the text area. Only the author has privileges for hiding a noteor report. This preserves your institution's audit trail, while allowing you todisplay or print the appropriate information.
4.2.1.3 To View ECG Reports from MUSE
This feature only applies to systems configured for cardiology workflow.
You can view reports from MUSE as a PDF. These reports show a patient’s ECG priors.
To view ECG reports:1. Open the study in the viewer.
2. Click FOLDER from the menus.
3. Double-click on a Muse ECG item in the priors list.
ExpectedResult:The report opens as a PDF in a floating window.
4.2.1.4 To Print a Note or Preliminary Report
1. When the study is loaded in the viewer, click Notes on the toolbar.2. Add the Note or Preliminary Report, if none exists.
3. From the Notes dialog, click Print.
4.2.1.5 To Detach a Report
A report, whether preliminary or final, may be dictated into a RIS. The system interfaceswith the RIS and automatically attaches the external RIS report to the appropriate study.The patient's MRN and the accession number serve as criteria for matching the RISreport to the correct study.
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You can manually attach a report to a study, bypassing the system's automatic matching.If you match the wrong report to a study, you can detach that report. The Detach optionappears when a final or preliminary report has been dictated.
1. When the study is loaded in the Image Viewer, click Notes on the Image Viewertoolbar.
or
2. Click Note/Report next to the desired study in the Study List.
3. Click Detach to detach the report from this study.
4.3 Series and Image InformationFrom the Study List, you can view details on each series in a study. If you wish to discover,for example, how many images are in each series or which series used contrast, you canaccess that additional information quickly and easily. You can also load – directly from theStudy List – only certain series in a study.
In addition, you can view specific images in a series.
4.3.1 To Display Series Information
1. Select a study on the Study List.
2. On the Study List toolbar, click Series Information ; or right-click and selectShow Series List from the menu.
Series Information is a table with data on all the series in the selected study. A headershows the patient name, MRN, study description and other identifying data. The listprovides data specific to each series, such as the number of images, the contrast (ifused), the creation date/time stamp, and series number.
3. To view only certain series in the Image Viewer, click the check box next to theseries to view.
4. To load the selected series from this list, click View in the toolbar or right-click andselect View Series.
5. To return to the Study List, click Back in the toolbar.
Note: You can configure the Series List window using the Configuration tool inthe upper right corner of the Study List. You can also Delete, Merge orChange Series Information by first selecting the series and then selectingthe appropriate menu item from the floating (right-click) menu.
4.3.2 To Display Image Information
1. Select a study on the Study List.
2. On the Study List toolbar, click Series Information or right-click the studyand select Display Series List from the menu.
3. From the Series Information window, select the series that contains the desiredimages.
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4. Click Series Information to display the Images List.
5. To load a specific image, select it and click View. Or, right-click and select ViewImage.
Note: You can configure the Images List window using the Configuration toolin the upper right corner of the Study List. Depending on your userprivileges, you can also Delete and Split Series.
4.4 Image Thumbnails
4.4.1 Thumbnail Information
You can preview images in the Study List before you load them into the Viewer. Thesethumbnail images include not only a miniature display of all the images in each series, butalso information about each series in a study.
Note With a system configured for cardiology workflow, an instance number will bedisplayed on the thumbnail for all multi-frame images.
You can discover, for example, how many images are in each series and which seriesused contrast. You can also load -- directly from the Study List -- only certain images fromthe study, even when those images are in different series.
With a system configured for cardiology workflow, by default the thumbnail image willupdate as the viewport changes frames. In order to stop this behavior, select therepresentative Frame check box in theWorking with the Layout Editor (page 310) to havea thumbnail not change.
4.4.2 To Display and Use Thumbnails
1. Select a study.
2. On the Study List toolbar, click Thumbnails , or right-click and select ShowThumbnails from the floating menu.
In the Thumbnail Information window, a header for each series in the study includesthe patient name, MRN, study description and other identifying data. The table beloweach header shows the series information and the thumbnail preview of all images inthat series. The table provides data specific to each series, such as the number ofimages, the contrast (if used), the creation date/time stamp, and series number.
3. To load only certain images in the Image Viewer, click the image you want to view.Each selected image is highlighted to indicate its selection status. (To clear aselection, click it again.)
4. To load the selected images from this preview, click View in the toolbar.
5. To return to the Study List, click Back in the toolbar.
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4.5 Audit
4.5.1 Auditing a Study
Note For Universal Viewer Web, audited events are limited to events that occur inUniversal Viewer Web and exclude events from other systems and sources.
Depending on the system configuration, you can monitor activity performed on a particularstudy. The audit feature registers actions performed on a study and makes that informationavailable in the audit report. Actions audited include:
● Study opened for viewing
● Confidential study opened for viewing
● Changes in study status, including Marked as Dictated, Verified, Signed/Completed,Confidential/Not Confidential, Transcribed, and Unverified
● Study closed by user
● Study closed when timeout occurs due to HIPAA policy
For each study, the audit report shows the Patient Name, MRN, Accession Number,Date of Birth, Age, Current Date, and Study Description. The audit report shows thefollowing information for activities regarding that study: Date, Time, Action, User #1, User#2, Device or Destination, and Comments.
4.5.1.1 To Audit a Study
Note You can select multiple studies to audit at the same time. A report displays foreach study selected.
1. In the Study List, select the studies to audit and right-click to display the floating menu.
2. Select View Audit Trail. The patient's name and study information is displayed in aheader. The date, time, action, and user are displayed on the audit report screen.
3. After viewing the audit information, click Done to exit or Print to print the report.
4.6 Marking a Study
4.6.1 Marking a Study
The system shows each study's status, so that the study progresses through a logicalworkflow. After reviewing or dictating the study, a clinician marks that study accordingly.Likewise, the clinician or technologist can mark that the study has passed quality controlmeasures (QC'd).
Marks can be removed if added by mistake.
Both marking and unmarking a study are available only to users with the proper privileges.These actions are audited, and the system tracks alterations in status, who made thechange, and when. Other users can search for particular status changes, by user and bydate or date range.
For more information, see the following sections: Dictating or Reviewing the Study and
Quality Control.
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4.6.2 To Mark a Study as Reviewed
When a study has been marked as reviewed, a small checkmark displays next to thatstudy in the Study List, to indicate its status.
� Use one of these options to mark the study as reviewed:
● Study List: To mark the study without opening Image Viewer, select the study tomark. Right-click to display a floating menu and click Mark as Reviewed. See theStudy List menu section.
● Done options: From the Image Viewer toolbar, select the down arrow next to the Donebutton and select Mark Study as Reviewed. You can also make Mark as Reviewed adefault action when the study is closed. See the Closing a Study section.
4.6.3 To Reverse the Reviewed Status
� If a study is marked as reviewed by mistake, it can be unmarked by:
● Study List: To unmark the study without opening Image Viewer, select the study tounmark. Right-click to display a floating menu and click Mark as Not Reviewed.See the Study List menu section.
4.6.4 To Mark a Study as Dictated
� Use one of these options to mark a study as dictated:
● Study List: To mark the study without opening Image Viewer, select the study to mark.Right-click to display a floating menu and click Mark as Dictated.
● Done options: From the Image Viewer toolbar, select the down arrow right next tothe Done button and select Mark Study as Dictated. You can also make Mark asDictated a default action when the study is closed; see the Closing a Study section.
When a study has been marked as dictated, a large checkmark displays next to thatstudy in the Study List, to indicate its status. If both a small and large checkmarkdisplay, then the study has been reviewed and dictated.
4.6.5 To Reverse the Dictated Status
� If a study was marked as dictated by mistake:
● Study List: To unmark the study without opening Image Viewer, select the study tounmark. Right-click to display a floating menu, and click Mark as Not Dictated. Seethe Study List menu section for more information.
4.6.6 To Mark a Study as QC
The QC feature can be accessed only by privileged users.
� Use one of the following methods to indicate that the study has passed Quality Controlmeasures:
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● Study List: To mark the study without opening Image Viewer, select the study tomark. Right-click to display a floating menu and click Mark as QC. See the StudyList menu section.
● Done options: From the Image Viewer toolbar, select the down arrow next to the Donebutton and select Mark as QC'd. You can also make Mark as QC'd a default actionwhen the study is closed; see the Closing a Study section.
4.6.7 To Reverse the QC Status
� Use this method if a study is marked as QC'd by mistake:
● Study List: To unmark the study without opening Image Viewer, select the study tounmark. Right-click to display a floating menu, and click Mark as Not QC. See theStudy List menu section for more information.
4.6.8 Mark Study as Verified (for Systems with EA Only)
Systems with EA-only integration do not have PACS-IW or CPACS integration. Markingstudies can be enabled on EA-only systems when there is both a a local EA (EA Router)for routing images, and an EA (CCA-EA) for receiving verified images for storage in a datacenter. There are two workflows for marking studies as verified for systems configuredfor this feature.
Basic Workflow: Open Study, QA Study Images and Verify the Study1. Select a study to be verified and open it.
2. Perform QA, or quality control, on the image. This allows technologists to check astudy before it is viewed by a diagnosing physician or other clinician.
3. Click the down arrow next to the Done button; select Mark as QC’d.4. Click the Done button to exit the study.
Expected Result: The Universal Viewer system performs the following:
● Applies any changes made to the study
● Closes the study
● Updates the study status as Verified● Enables the local EA to send the verified study to the data center EA with storage
commitment
5. (Optional) If the Status column in the Study List is configured, the system displaysthe corresponding Unverified study status in that column. See the section “To ViewUnverified Studies” for more information.
Alternative Workflow: Quick Verify Selected Study(ies)1. Select a study to be verified in the Study List.
2. Right-click to open the floating menu, and select Mark as Verified to verify the study.
Expected Result: Universal Viewer updates the study status as Verified and enablesthe local EA to send the verified study to the data center EA with storage commitment.
3. (Optional) If the Status column in the Study List is configured, the system displaysthe corresponding Unverified study status in that column. See the section “To ViewUnverified Studies” for more information.
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4.6.9 Matching a Report to a Study
A report, whether preliminary or final, is often dictated into a third-party dictation system.The system can interface with the RIS and automatically attach an external report to theappropriate study. In this way, all pertinent data is held with the study. The system usesthe patient's MRN and the accession number as criteria for matching a report to thecorrect study. If the system cannot find a study with an MRN and accession number thatmatch the report, then that report is unmatched. This preserves the integrity of the dataand helps prevent reports from being matched to the wrong studies.
The system allows privileged users to list all unmatched reports: to view those reportsthat have not been assigned to a study. The Unmatched Reports option allows you tosearch for the appropriate study and attempt to match the report again. You can alsodetach a report that has been assigned to the wrong study. Privileges are requiredto execute these actions.
Note You can search for unmatched reports, orders and documents. See theSearching for a Study section.
4.6.10 To Manage Unmatched Reports
When an automatic match (i.e., the same MRN and the same accession number for boththe report and the study) does not occur, the system uses additional criteria to find a closematch. It searches for a study with the same MRN, last name and study date as the report.
1. Click Search in the Study List. The Search dialog displays.
2. Select the Unmatched Reports check box and clear all other fields. (If other dataabout the unmatched report is known, enter it to narrow the results.)
3. Click Search. Unmatched reports that match the search criteria are shown,
designated by an icon.
4. Click the icon to view a particular report, or select the report, right-click to open thefloating menu and select Match Reports.
5. If no study matches the broader criteria, the search results list in this dialog is empty,and you will add more criteria to search for the correct study for this report. ClickStudy Search to adjust the criteria.
6. The Search dialog displays, populated with the MRN of that report. Widen the searchto find the appropriate study: for example, click Reset to clear all fields, change theMRN, or click the Contains option for the MRN field.
Note: Studies is now the only possible option in the Include parameter.
7. After entering new criteria, click Search to display the Match Report dialog with newresults. The system could not verify any one of these studies as a valid match.Perhaps no accession number or MRN was recorded for the study. After changingthe criteria, the user must "manually" verify that one of the resulting studies is theone that matches the unassigned report.
8. If the report matches a listed study, select the radio button next to that study.
9. Click Match. The report (shown in the header) is now matched to that study.
4.6.11 To Detach a Report
Privileged users can detach mistakenly matched reports.
� When the study is loaded in the viewer, click Notes on the Image Viewer toolbar.
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or
Click Note/Report next to the desired study in the Study List.
Click Detach to detach the report from this study.
4.6.12 Marking and Unmarking Confidential Exams
If you have the necessary privileges, then you can mark an exam as confidential andrestrict the availability of the patient’s data – including studies, images, and reports – onlyto the users that have the necessary permissions. You must have the privilege to viewconfidential patient information in order to use DICOM Send, merge, and print confidentialpatient information functions.
Note This feature requires particular system configurations. Contact your GErepresentative for more information.
4.6.12.1 Marking an Exam as Confidential
When you mark an exam as confidential, the patient’s data – including exams, studies,images, and reports – become confidential. You can mark exams as confidential only ifyou have the necessary privileges.
Note Unmatched exams or reports cannot be marked as confidential. An errormessage displays when this is attempted. You must first match the exam tothe patient.
To mark an exam as confidential:
1. In a worklist, select the exam that you want to mark as confidential.
2. Right-click the exam and select Mark Patient as Confidential.
Note: Mark Patient as Confidential is enabled only if you have the necessaryprivilege and your selection is not marked confidential.
Note: You can only select one exam to be marked as confidential.
Expected Result: A dialog box prompts for confirmation to mark the selection asconfidential.
3. Click OK.
ExpectedResult: That exam and all other exams, studies, images, and reports belongingto the patient are marked as confidential. The VIP column indicates True.
4.6.12.2 Unmarking an Exam as Confidential
You can unmark confidential exams as non-confidential only if you have the necessaryprivileges.
To unmark an exam as confidential:
1. In a worklist, select the exam that is marked confidential.
2. Right-click the exam and select Mark Patient as Not Confidential.
Note: Mark Patient as Not Confidential is enabled only if you have thenecessary privilege and your selection is marked confidential.
Note: You can only select one exam to be marked as non-confidential.
Expected Result: A dialog box prompts for confirmation to unmark the selection.
3. Click OK.
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ExpectedResult: That exam and all other exams, studies, images, and reports belongingto the patient are marked as non-confidential. The VIP column indicates False.
4.7 Matching a Document to a Study
4.7.1 Matching a Document to a Study
Any document can be scanned into the system, either directly to a specific study or as anunmatched document, to assign to a study at a later point.
This section describes how to match scanned documents to a specific study after theyhave been added to the system. Users must have the proper privileges to access thisfeature. (To learn how to scan a document directly to a specific study, see Add a ScannedDocument.)
You can search for unmatched reports, orders, and documents. See the Searching for aStudy section.
4.7.2 To Manage Unmatched Documents
1. Click Search in the Study List.
2. Select the Unmatched Documents check box and clear all other fields. (If you knowdata about the unmatched document, enter it to narrow the results.)
3. Click Search. Unmatched documents that match the search criteria display are
designated by .
4. Click the icon to view a particular document, or select the report, right-click to openthe floating menu and select Match Documents.
5. To find the study that matches this document, click Study Search.6. Enter criteria to find the appropriate study: for example, click Reset to clear all fields,
enter the MRN or the patient name.
7. Click Search to display the Match Document dialog with new results.
8. If the document matches a listed study, select the radio button next to that study.
9. Click Match.
4.7.3 Matching an Order to a Study
The system accepts different types of HL7 messages, including orders, on different ports.Using the patient's MRN and the accession number as criteria, the system attaches ordersautomatically to the appropriate study. Orders can be viewed in the Patient Folder.
If the system cannot find a study with an MRN and accession number that match theorder, then that order is unmatched. This matching process preserves the integrity of thedata and prevents orders from being matched to the wrong studies.
When manual matching confidential studies:
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● If the system is configured to Allow Patient info update while manual matching,patient demographic information for the study updates the order, including the VIP flag.If the VIP flag changes, all associated exams and reports update to reflect the change.
● If the system is not configured to Allow Patient info update while manual matching,patient demographic information, including the VIP flag, will not update.
Only privileged users can execute match and detach orders to studies.
You can search for unmatched reports, orders and documents. See Searching for a Study.
Note Orders are disabled on systems with an EA-only backend (that is, on systemswhich do not have PACS-IW or CPACS).
4.7.4 To Manage Unmatched Orders
1. From the Study List, right-click the study that is missing an order.
2. From the floating menu, click Match with Order.3. Click Search for Orders to adjust the criteria. An abbreviated Search dialog displays,
with the Unmatched Orders check box checked.
4. Change the search criteria to find the appropriate study; for example, click Reset toclear all fields, change the MRN, or click Contains for the MRN field.
5. After entering new criteria, click Search to display the Match Report dialog with newresults.
6. Select the check box next to the order(s) to match to the study shown in the header.
7. Click Match to assign these orders to the study.
4.7.5 To Detach an Order from a Study
Privileged users can detach an order from a study directly from the Study List (withoutopening the study).
1. From the Study List, right-click the study that is incorrectly matched to an order.
2. From the floating menu, click Detach Orders.3. Select the check box(es) next to the order(s) to detach.
4. Click Detach.
4.8 MergingThis feature requires particular system configurations. Contact your GE representativefor more information.
Note Customers who are using Universal Viewer with Centricity PACS must usethe Centricity PACS exam merging and deleting tools. For more information,see Launching CPACS Exam Manager or SA Tools and the Centricity ExamManager online help.
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4.8.1 Launching CPACS Exam Manager or SA Tools
Prerequisites:
● You are a system administrator or technologist.
● Your system uses CPACS integration.
Exam Manager Used to modify patient information, merge exams, and splitexams.
SA Tools Used for configuring Exam Manager.
1. Click on the study list toolbar.
2. Log into Centricity EM or SA Tools with the same username and password youuse for Universal Viewer.
If the CPACS Tools window does not open, or if you get a security message, contactyour system administrator.
4.8.2 Merging Studies
Authorized users can merge two selected studies. For example, if a study mustbe performed on two different machines, this feature is useful for merging theseparately-captured images into one study. A warning is displayed if the user attemptsto merge more than two studies.
Note If the study selected for merge has presentation states or key image notes,those may be deleted in the process of merging.
Note Customers who are using Universal Viewer with Centricity PACS must usethe Centricity PACS exam merging and deleting tools. For more information,see Launching CPACS Exam Manager or SA Tools and the Centricity ExamManager online help.
4.8.2.1 To Merge Two Studies
1. From the Study List, select two studies to merge.
2. Right-click to view the floating menu; select Merge Studies.
The drop-down lists below the Primary radio buttons update to reflect the newsequence. The selected Primary study is shown as Sequence #1, and the otherstudy is shown as Sequence #2. All series numbers (shown in the grids) also updateto reflect the new order.
3. To rearrange the sequence, enter values for the series numbers in the New Series #.4. Click Merge to merge the images of the secondary study into the primary study.5. To view the merged study, double-click the primary study on the Study List.
4.8.3 Merging a Series
Authorized users can merge series in a study.
Note If the selected series belong to a study with presentation states or key imagenotes, the merge operation may invalidate the content of these objects.
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Note Customers who are using Universal Viewer with Centricity PACS must usethe Centricity PACS exam merging and deleting tools. For more information,see Launching CPACS Exam Manager or SA Tools and the Centricity ExamManager online help.
4.8.3.1 To Merge Series
1. From the Study List, select the check box next to the study to manage, and then
click Display Series .
2. Select the checkboxes for the series to merge; right-click to display the floating menu,and select Merge Series.
3. Designate one series as the primary series — the series that receives the additionalimages — by selecting the Primary radio button to the left of that series’ grid.
Expected Result: The selected Primary series is shown as Sequence #1, and theother series is shown as Sequence #2. All image numbers (shown in the grids) alsoupdate to reflect the new order; the first image in the Primary study retains its numberand all others follow that number.
4. To rearrange the automatic sequence, enter new values for the image numbers inthe New Image # field.
5. Click Merge to merge the images of the secondary series into the primary series.
4.9 Rejecting and Unrejecting ImagesThis feature requires particular system configurations. Contact your GE representativefor more information.
4.9.1 Notes on Rejecting Images and on Rejected Images
Image rejection is the process of tagging an image so that it is not part of a normalworkflow process, such as image display. This allows you to reject poor quality images,image profiling errors, and exam or patient merge mistakes. Image rejection is typicallyperformed by a Technologist or Administrator prior to exam review by the Radiologist.
● To reject an image:
● You must have the required administrative privileges.
● The exam must be in the Arrived status.
● For images being processed: If you need to roll back an exam to Arrived status,note that if the exam is currently being processed in the archive queue, the printqueue, or the send queue, or if the exam is not fully online, then you cannot roll backthe exam to Arrived status. You must wait until the queue is cleared or until the examis fully online before changing the status to Arrived.
● For images in an archive: Centricity PACS does not allow external access torejected images by way of the DAS. However, it is possible for external devices toaccess rejected images directly from the archive, by way of DICOM query retrieve,depending on the archive type. This applies to non-Centricity Enterprise Archive andCentricity Enterprise Archive. These types of archives are defined here.
● Non-Centricity Enterprise Archive: Sites using this type of archive allowexternal systems to access all images regardless of their rejection status.
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● Centricity Enterprise Archive: Sites using Centricity Enterprise Archive do notallow external systems to access rejected images. After images are rejected,the archive must be completed before the Enterprise Archive is prohibited fromaccessing the rejected images.
● From the time of any image rejection status change, there is a lag time for the archiveto be updated with the image rejection status change. The lag time for the archiveto be updated is dependent on factors including but not limited to the archive used,archive online status, your site's system configuration, and network traffic.
● The rejected image displays the date that the image was rejected, the reason for theimage rejection, and the name of the user who rejected the image.
● Rejected images are removed from the normal workflow process. For example,they are not included in cumulative image counts, they are not displayed by anyclient applications, they cannot be saved, and they cannot be exported or printedfrom the system.
The only exception is a C2C transfer. Exams with rejected images may be transferredbetween systems independent of exam status.
For each rejected image, the system records:
● The name of the user who rejected the images.
● The date and time when the image was rejected.
● Warning for Rejecting Exported Images. The PACS system includes a warningabout rejecting images that, prior to their rejection, might have been exported toexternal systems. These external systems include, but are not limited to: third-partyarchives, specialty workstations, and manual C2C destinations.
In one possible scenario, Site A exports images outside of its PACS system to Site B.Site A then later rejects the images from its PACS system. Site A must inform Site Bthat the images sent to Site B prior to the rejection have now been rejected.
● After rejecting an image: To update the archive with the rejected image status, theexam in which the rejected images are located must reach the Verified status.
Note: By default, exams in the workstation are submitted to the queue forarchival when they have reached the Verified status. If you need toknow your site’s configuration for exam archiving, contact your SystemAdministrator or GE Service Representative.
4.9.2 Rejecting an Image
Prerequisite: To reject an image, you must have the user privilege of "RejectImage".If you need your user privileges changed, contact your site administrator or your GEService Representative.
To reject an image:
1. Open the exam that contains the image(s) that you want to reject.
Note: You can only reject images that are in the Arrived status. If the exam is ina different status, you must first roll it back to Arrived status to enable theReject Selected Images option.
2. Select the image(s) that you want to reject. To select multiple images, hold down theCtrl key while selecting the additional images.
3. Right-click and select either Reject Active Image or Reject All Selected Images.
Note: If you select a multi-frame image for rejection, all frames in the imagewill be rejected.
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4. To continue with the rejection for the selected image(s), click Yes. To cancel therejection for the selected image(s), click No.
5. From the Reject Reasons drop-down list, select a reason for rejecting the image(s).6. Click OK.7. After rejecting images, to update the archive with the rejected image status, the exam
in which the rejected images were located must reach the configured exam status.
Note: After images are rejected, the archive must be completed for the imagestatus to be changed to rejected in the Enterprise Archive. From the timeof any image rejection status change, there is a lag time for the archive tobe updated with the image rejection status change. The lag time for thearchive to be updated is dependent on factors including but not limited tothe archive used, archive online status, your site's system configuration,and network traffic.
Note: The system does not allow you to export, save, or print rejected images.
Note: By default, exams in the workstation are submitted to the queue forarchival when they have reached the Verified status. If you need toknow your site’s configuration for exam archiving, contact your SystemAdministrator or GE Service Representative.
Note: By default, rejected images are archived along with unrejected images.However, if the Rejected Image Deletion feature is enabled at your site,rejected images are not archived and are permanently deleted fromthe system after a configurable period of time (a sitewide setting). Thismeans that there is a configurable period of time after rejecting an imageduring which you can unreject it. After a configurable period of time haspassed after the rejection of an image, a configurable task that runs onthe system deletes the rejected image from the system.
Note: To find out your site's settings for the Rejected Image Deletion feature,contact your site administrator or your GE Service Representative.
Note: After rejected images are deleted: 1) image references that might stillreside in GSPS/KINs (and that refer to rejected images that have beendeleted) will no longer be able to display the rejected images that havebeen deleted from the system, 2) the unreject feature is no longeravailable for the image, 3) the reasons for image rejection are not retainedin the system, so the Centricity Administration Tool (CA Tool) RejectImage report will not display information for rejected images deleted fromthe system, and 4) unless the rejected image deletion event “DeleteSOP”is subscribed to, there will be no permanent record of image rejection.
Note: Only your site's System Administrator or your GE Service Representativecan change the sitewide settings for handling the archival of local examsand foreign exams (non-local exams). For more information, contact yoursite's System Administrator or your GE Service Representative.
4.9.3 Unrejecting an Image
Prerequisites:
● To unreject an image, you must have the user privilege of "UnrejectImage". If youneed your user privileges or folder privileges changed, contact your site administratoror your GE Service Representative.
● To unreject an image, you must have the Unreject privilege and the exam must be inthe Arrived status. The system does not allow you to unreject image(s) if the exam isnot in the Arrived status.
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To unreject an image:
1. Select an exam from the worklist which has rejected images. Right-click and selectUnreject all Images.
2. After unrejecting images, to update the archive with the unrejected image status,the exam in which the unrejected images are located must reach the configuredexam status.
Note: After images are unrejected, the archive must be completed for the imagestatus to be changed to unrejected in the Enterprise Archive. From thetime of any image rejection status change, there is a lag time for thearchive to be updated with the image rejection status change.The lagtime for the archive to be updated is dependent on factors including butnot limited to the archive used, archive online status, your site's systemconfiguration, and network traffic.
Note: The system allows you to export, save, and print unrejected images.
Note: By default, exams in the Workstation are submitted to the queue forarchival when they have reached the Verified status. If you need toknow your site's configuration for exam archiving, contact your SystemAdministrator or GE Service Representative.
Note: By default, rejected images are archived along with unrejected images.However, if the Rejected Image Deletion feature is enabled at your site,rejected images are not archived and are permanently deleted fromthe system after a configurable period of time (a sitewide setting). Thismeans that there is a configurable period of time after rejecting an imageduring which you can unreject it. After a configurable period of time haspassed after the rejection of an image, a configurable task that runs onthe system deletes the rejected image from the system.
Note: To find out your site's settings for the Rejected Image Deletion feature,contact your site administrator or your GE Service Representative.
Note: Only your site's System Administrator or your GE Service Representativecan change the sitewide settings for handling the archival of local examsand foreign exams (non-local exams). For more information, contact yoursite‘s System Administrator or your GE Service Representative.
4.10 Deleting a Series or Image
4.10.1 Deleting a Series or Image
You can easily manage the series in a study from the Study List. Series and evenindividual images can be organized or deleted without opening the viewer.
You can refresh the Viewer to show any changes made to an open study.
If a series or image selected for deletion belongs to a study with presentation states or keyimage notes, the delete operation may invalidate the content of these objects.
Note Customers who are using Universal Viewer with Centricity PACS must usethe Centricity PACS exam merging and deleting tools. For more information,see Launching CPACS Exam Manager or SA Tools and the Centricity ExamManager online help.
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4.10.2 To Delete a Series
Use this option with care because the series is permanently deleted.
1. From the Study List, select the check box to the left of the desired study.
2. Near the top of the screen, click Display Series List .
3. Select the check box(es) next to the series to delete.
4. Right-click to display the floating menu. From the menu, select Delete Series.5. Click OK.
4.10.3 To Delete an Image
Use caution when performing this task because this action cannot be reversed. Selectedimages are permanently deleted from the series.
1. From the Study List, select the check box to the left of the study that holds the imageto delete.
2. Near the top of the screen, click Display Series List .
3. Select the check box next to the series that holds the image to delete.
4. Click Display Series List again to display all images within that series.5. Select the check box next to the image(s) to delete.
6. Right-click to display the floating menu, and select Delete Image.7. Click OK.
4.11 Change Patient or Study InformationThis feature requires particular system configurations. Contact your GE representativefor more information.
Note Customers who are using Universal Viewer with Centricity PACS must usethe Centricity PACS exam merging and deleting tools. For more information,see Launching CPACS Exam Manager or SA Tools and the Centricity ExamManager online help.
4.11.1 Launching CPACS Exam Manager or SA Tools
Prerequisites:
● You are a system administrator or technologist.
● Your system uses CPACS integration.
Exam Manager Used to modify patient information, merge exams, and splitexams.
SA Tools Used for configuring Exam Manager.
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1. Click on the study list toolbar.
2. Log into Centricity EM or SA Tools with the same username and password youuse for Universal Viewer.
If the CPACS Tools window does not open, or if you get a security message, contactyour system administrator.
4.11.2 Changing Patient/Study Data
When a study is first captured, information about that study is entered into the systemelectronically or manually . If the information is mistyped or otherwise entered incorrectly,the system’s ability to provide useful information is compromised. You can update patientand study data when errors are discovered, increasing the efficiency of searches.
For confidential / non confidential studies:
● If a study is not marked Confidential and the MRN changes to that of an existingconfidential patient, that study becomes confidential and can be accessed only forusers with the appropriate privileges.
● If a study is marked Confidential and the MRN changes to that of an existing nonconfidential patient, that study and all prior studies, orders, and reports changeto confidential.
● If the MRN changes to a new patient, it retains the existing Confidential / NonConfidential flag.
This feature requires particular system configurations. Contact your GE representativefor more information.
Note Customers who are using Universal Viewer with Centricity PACS must usethe Centricity PACS exam merging and deleting tools. For more information,see Launching CPACS Exam Manager or SA Tools and the Centricity ExamManager online help.
4.11.2.1 To Update Patient or Study Data
1. In the Study List, select the check box next to the study to update.
2. Right-click to open the menu.
3. From the floating menu, select Change Patient/Study Data. The ChangePatient/Study Data dialog box displays. The patient information, such as name,MRN, date of birth, etc., appears in the left pane. The study information, such asthe modality, time and date and physician, appears in the right pane. (Click Findto search for valid referring physicians.)
4. Enter changes as needed. See the section on Changing the Referring Physician.
5. If you are using Anatomic regions and need to make a modification, click the ellipsisnext to Anatomic Region and select the new region. This field defines which studiesthe system pulls as related comparison studies. A comparison study refers to recentstudies for this patient or any of the patient's studies of the same anatomical region,whether defined here or automatically by the RIS.
6. After updating the desired field with the correct data, click Change.
Note: Click Notes to display the Notes in a view-only window. To view SeriesInformation for this study, click View Series.
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4.12 Temporary Access to a Study
4.12.1 Granting and Revoking Temporary Access to a Study
You can allow an external party, such as a family physician or specialist, to access one ormore studies. You allow temporary access to that external user only for a fixed numberof days, which you define. Once that length of time has elapsed, the temporary user nolonger has access to the study. If temporary access is no longer necessary, you canrevoke it before the defined length of time has elapsed.
You can grant and revoke temporary access from the Study List Menu.
4.12.2 To Grant Temporary Access to a Study
1. In the Study List, position the mouse in the row of the study you want to makeavailable, and right-click to open the floating menu.
Note: You can grant temporary access to multiple studies with the same MRN.This is useful if the external user needs to see all studies for a particularpatient. Select the check box for a desired study, and then right-click toopen the floating menu, and click All Studies for Selected MRN. Allstudies for that patient will display. You can then select the studies tomake available and proceed.
2. Select Access to open the sub-menu.3. Select Grant Access.4. In the Grant access to field, enter the name (partial or entire) of the person who will
gain temporary access to this study; then click Find.
Note: You can see a list of all users in the system by leaving the field emptyand clicking Find. If the user does not exist in the system, click CreateTemporary User, add the user information, and click Create.
5. After the user has been created or selected, enter the number of days that this studywill be available to the temporary user.
6. Select the study by clicking the ellipsis next to that field. Click OK.7. Click Grant Access.
4.12.3 To Revoke Temporary Access
1. In the Study List, select the check box next to the study to make unavailable.
2. Right-click the mouse to open the floating menu.
3. Select Revoke Temporary Access.4. In the lower pane, select the check box next to the user whose access will be revoked.
To select all users in the list, click Select All.5. Click Revoke Access.
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4.13 Working with Worklists
4.13.1 Assigning a Study to a Worklist
In order to manage studies efficiently, you can create Worklists and assign studies tothose lists. For example, you can create a Worklist for presentations or teaching files,or for interesting or rarely diagnosed studies. You can create Worklists for individualsor groups, or use other criteria to group similar studies. Some worklists allow up to 30studies to be assigned.
By creating a study list tab to hold all studies in a particular Worklist, you can quickly findand manage those studies. You can also use the Worklist as a search criterion.
4.13.2 To Assign a Study to a Worklist
Note Only privileged users may carry out this action. Some worklists allow amaximum of 30 studies to be assigned.
1. In the Study List, select the check box next to the study to assign.
2. Right-click the mouse to open the floating Study List menu.
3. Select Assign to Worklist. The Assign to Worklist dialog box displays, with thatstudy's basic information as a headline at the top of the dialog. The current, globallyavailable worklists are displayed.
4. Select the worklist to which this study will be assigned.
5. Click Assign.6. Click Close.
4.13.3 To Assign a Study to a Specific User's Worklist
Note Only privileged users may carry out this action. Some worklists supportassigning a maximum of 30 studies to a user’s worklist.
1. In the Study List, select the check box next to the study to assign.
2. Right-click the mouse to open the floating Study List menu.
3. Select Manually Assign to Worklist. The dialog box displays, with that study's basicinformation as a headline at the top of the dialog and two text fields below it.
4. Click Find next to the first text field (Pick User) to display a list of users.
5. Click the radio button next to the desired user.
6. Click the Worklist ellipsis to see that user's current and available worklists.
7. Select a worklist.
8. Click OK.9. Click Assign.
4.13.4 To Detach a Study from a Worklist
1. Position the mouse in the row of the desired study and right-click the mouse to openthe floating Study List menu.
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2. Select Detach from Worklist. The Detach from Worklist dialog box displays,displaying the worklists to which this study is assigned.
3. Select the worklist from which to detach this study.
4. Click Detach.5. Click Close.
4.13.5 To Rename a Worklist
1. In the Study List, right-click the mouse to open the floating menu.
2. Select Assign to Worklist.3. Select the worklist to rename.
4. Click Rename.5. Enter a new name for the worklist in the pop-up dialog.
6. Click OK.
4.13.6 To Delete a Worklist
1. In the Study List, right-click the mouse to open the floating menu.
2. Select Assign to Worklist.3. Select the worklist to delete.
4. Click Delete.5. Click OK.
4.14 Linking Studies
4.14.1 Linking Studies
The system supports Enterprise MRNs, using an Enterprise Master Patient Index (EMPI).This means that a patient is recognized across the enterprise, even if that patient hasdifferent MRNs in separate facilities.
For example, if a patient visits more than one facility in the enterprise, and each facilityassigns a unique MRN to that patient, the system can recognize those different MRNs asbelonging to the same patient. If EMPI is enabled, then a command such as "All Studiesfor selected MRNs" would open not only the relevant studies from the current facility, butall studies for this patient from all facilities in the enterprise. See the administrator todetermine whether EMPI is enabled on your installation.
Typically, the system automatically recognizes different MRNs as one patient record, byreading a specific tag in the HL7 order. It may be necessary to manually link differentstudies together for the same patient. You can link (and unlink) studies in this way, and thesystem can also provide a list of candidates for your review.
This section explains how to link studies, sever a link between studies, and create a listof candidates for linking.
Consider the following scenarios when considering whether to link studies:
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● When searching for a study by MRN, studies with the same MRN and all linkedstudies are returned.
● When searching for "All Studies for Selected MRNs" from the Study List menu, allstudies with the same MRN and all linked studies open.
● The Patient Folder displays other studies with the same MRN and all linked studies.
● When fetching comparison studies, the system returns studies with the same MRNand all (anatomically relevant) linked studies.
4.14.1.1 To Link Studies
When you link studies, they are treated as belonging to the same patient record.
1. From the Study List, select two or more studies to link.
2. Right-click to view the floating menu; select Link Studies.
4.14.1.2 To Unlink Studies
When you unlink studies, the connection between the selected studies is severed, and thestudies are no longer treated as belonging to the same patient record.
1. From the Study List, select the studies to unlink.
2. Right-click to view the floating menu; click Unlink Study.
4.14.1.3 To Manage Link Candidates
You can define the criteria for the list of link candidates. For example, the systemcan provide a list of studies with the same patient last name and month of birth as theselected study, or a list of studies with the same birth month and day as the selectedstudy, regardless of name. If the user determines that a study in the candidates listshould, in fact, be treated as belonging to the selected patient, then the user can easilylink that study to the selected one.
1. Select the study to match in the Study List.
2. Right-click to see the floating Study List menu; select Build Link Candidates List.
In the dialog, the selected study is shown in a header at the top. Below the header,studies similar to the selected study are listed. This is the candidate list. Thesestudies may belong to the same patient listed in the header. The Date of Birth, MRN,Referring Physician and other data are shown in the candidate list, to help determinewhether to link this study to the study shown in the header.
3. To link a candidate, select the check box next to that study and then click Link.4. To change the criteria used to determine candidates, click Change Matching Criteria.5. For Patient Name, select a radio button to indicate how the system should search for
the patient name.
6. Enter the First Name and Last Name as desired.7. For Date of Birth, select the check box to indicate how the date of birth is used
in the search.
8. To include those studies that match by gender, select the Allow Match by PatientSex check box.
9. Click Search to find candidates for the selected study.
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4.15 Working with Scanned DocumentsNote Scanned documents are disabled on systems with an EA-only backend (that
is, on systems which do not have PACS-IW or CPACS).
4.15.1 Adding a Scanned Document
You can add any scanned document to the system, either to a specific study or as anunmatched document to attach to a study later. When added to a specific study, scanneddocuments are added as a "document series" and treated as any other series, thoughaccessible only from the Patient Folder. From the Patient Folder, you can use any of theImage Viewer tools, such as pan, zoom, rotate and annotations on a document series.You can also add scanned documents as key images.
The document types are set by the administrator and can be, for example, a dischargequestionnaire, driver's license copy, insurance card copy, or some other document. Thetype simply organizes documents into categories.
This section explains how to add and match a scanned document to a specific study.
4.15.1.1 To Add a Scanned Document to a Specific Study
1. Right-click on the desired study in the Study List to display the floating menu.
2. Select Scanned Document.3. Select a document type.
4. Click Scan.5. Select whether to scan the document on a scanning device or to import the document
as an image file.
6. Depending on the selection in Step 5, choose which scanner (if scanning) or a filelocation (if importing).
7. Click Save.8. From the Filter drop-down list, select which scanned documents to view, i.e.,
Document Type A, B or C. The date and type of the currently displayed scanneddocument is shown just below in the Document Info section.
9. Use Tools to manipulate the scanned document: Zoom, Pan, W/L, Zoom to Fit,Rotate, Zoom to ROI, and Save.
Note: The section on Adding a Report or Note explains how to detach adocument from a study.
4.15.1.2 To Add a Scanned Document to Match Later
1. Click Scan in the upper right corner of the system's main screen.
2. Enter the Patient Name, MRN, and Date of Birth.3. Click Start Scanning. The document is added to the system as an unmatched
document. See the Matching a Document section to learn how to match this documentto a study at a later point.
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4.16 Sending a Study in DICOM
4.16.1 To Send a Study in DICOM
You can send a study directly to a DICOM server. This feature is not designed to migrateall studies in the system. Select no more than two dozen studies to migrate.
1. In the Study List or the Patient Folder window, select the check box next to eachstudy to migrate.
● If you are working in the Study List, you can use the Select features to selectall studies with a certain MRN to get the primary and comparison studies forone patient.
● If you are working in the Patient Folder window, the newest study you haveselected and opened will always be included. If you do not want to include thatstudy, close it and then open a study that you do want to migrate.
2. Open the DICOM Send dialog:
● From the Study List, right-click and select Send in DICOM from the context menu.
● From the Patient Folder, click Send DICOM.
Expected Result: The selected studies are listed at the top of the DICOM Senddialog, and the available DICOM servers are shown in the pane.
3. In the pane, select the server to which to send the studies.
4. Click Send to send the selected studies to that server.
5. Click Close.
4.17 Sending One or More Series in DICOMDepending upon your system configuration, you may be able to send a series directly to aDICOM server. This feature is not designed to migrate all series in the system.
To send one or more series in DICOM:1. Right-click in the Worklist to open the pop-up menu, and select Send Series in
DICOM. A window will open with series details.
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2. Use the check boxes to select one or more series to send in DICOM. You can use
Select All ( ) and Select None ( ) when making your selections.
3. Select the destination from the drop-down list at the bottom of the window.
4. Click Send.
If you want to cancel the send, click Cancel.
A progress window will appear during the send. If you cancel the send, or if any (orall) of the series fails to send, the progress window will notify you of the failure(s). Ifthis happens, click View Error Log in the progress window to see which series failedto send and to retrieve a tech support code that you can give to your administrator.
Note: If the send does not complete in 300 seconds (5 minutes), a pop-upmessage will display to ask if you want to continue waiting. Click eitherOK to continue waiting or Cancel to stop the send.
4.18 DICOM Query/RetrievePrerequisite: The DICOM Query/Retrieve functions are available for Centricity UniversalViewer with a CPACS Foundation. External DICOM destinations are pre-configured byyour system administrator or GE Service personnel.
With the DICOM query/retrieve functionality, you can choose a DICOM ‘destination’,search for studies by available filters using DICOM standard format, get search results,select studies to retrieve, and execute the ‘retrieve’ to a DICOM server. The DICOMdestination is an archive or other source for images that is the destination of the DICOMrequest.
The system will return up to 500 query results, and you can retrieve up to 10 studiesat a time.
Query: Search for studies1. Click the Query/Retrieve icon in the upper-right corner of the study list.
The icon is on the far left in the image below.
2. In the External DICOM Archive Query & Retrieve dialog, select an archive and enteryour query criteria.
● You must select an archive.
● Enter as many query criteria as you know. Use the standard DICOM format foreach field.
● DICOM wildcards include the ? for one character, the * for zero or morecharacters, and the \ (backslash) for “or”.For example, J*n\Ja?e* would return results including John, Jon, Jan, Jain, Jane,James, Jaden, and other names.
● Click Clear to erase your entries and reset the form fields.
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Field Action
Select Archive Select the archive or other location where the studies are stored.Note Archive names may be in the format EA###, with thenumber corresponding to the last digits of the archive’s IPaddress.
Patient Name Enter the patient name: family name first, then ^, then givenname. Entries without a ^ will search the family name only.
MRN Enter the Master Record Number patient ID.
Accession Number Enter the Accession Number of the study.
Study Instance UID Enter the Study Instance UID.
Date of Birth Enter the patient date of birth in the format YYYYMMDD.
Sex Select the patient sex from the list.
Study Description Enter keywords used in the study description.
Referring Physician Enter the name, family name first, then ^, then given name.Entries without a ^ will search the family name only.
HCN Enter the HCN number. (This field is available for Health Canadasites only.)
Modality Select one or more modalities, or select the Custom field. Forthe Custom field, enter the requested modalities separated by a\ (backslash). Entering text in the Custom fields,
Date of Exam ● To search all studies on the archive, select All.● To limit searches to a date range, select Period and select
the From and To dates. (These are the dates used in theDICOM headers of the studies.)
3. Click Search to run a C-FIND query on the selected DICOM archive.
Note: If the information entered is invalid or uses an invalid format, the invaliddata will be highlighted. Correct the data and click Search again.
Expected Result: The Search button is disabled, and a progress bar indicates thesearch is in progress. The results of the query are shown in the External DICOMArchive Query & Retrieve dialog.
Retrieve: Move studies1. In the list of search results, click the check boxes to select the studies you wish to
retrieve.
Click the check box in the header row to select all the listed studies. Only ten studiesmay be retrieved at one time.
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Note: The #Ser and #Img columns indicate the number of series and imagesas the query counts them. This can differ from the way the study listcounts them. The series of non-image objects, like presentation states,key images, or structured reports, will be counted as a separate seriesfor this purpose. For a series of multiframe images, multiframe imagecounts as one image; the study list counts each multiframe image as aseparate series.
2. Click Retrieve to initiate a C-MOVE transfer of the selected studies to the localCPACS system.
Note: If an error occurs before the retrieve process starts, the row turns redand the dialog displays an error message. To retry the retrieval, re-selectthe study and click Retrieve again.
Expected Result: When a study retrieve status is pending, the row is yellow and thecheck box is disabled.
Open retrieved studies1. To find and open the retrieved studies, use the Search features from the study list.
Depending on the configuration of the retrieving server, the retrieved studies will havethe status Reference Only or Arrived.
4.19 Create or Import CDs
4.19.1 Create CDs
The system's CD-Film utility allows you to create multiple CDs from a centralized location.The CD serves as a portable record of the study, to disseminate to a patient or to anotherclinician or institution. The study can thus be read on any computer, even those withoutaccess to the system. The CD also helps users load a study quickly, in the event ofa slow connection.
CD-Film sends orders to a CD workstation to create one or several CDs at once. Forexample, primary and comparison studies for one patient can be written to a CD, andmultiple copies of that CD can be created. It is distinct from the Save to CD feature, whichis used to create only one CD of the open study.
Note This feature is only available in certain configurations.
Note CD-Film is available only to licensed users.
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Note You can also import a study from a CD. (See Importing Studies.)
4.19.1.1 To Save a Study to a CD
Prerequisite: Verify that all studies you wish to burn are online on the short-term storageor cache before creating the CD.
1. Open the study to save to a CD.
2. From the main menu, or by right-clicking to display the floating menu, click Burn CD.3. Select the device to use from the drop-down list. If only one device is installed, this
field is disabled.
4. Click Refresh to update the first field under Media Info; this field identifies the mediaand displays how much space is available on the CD. The second field displays howmuch space is required to record the study.
5. Use the option buttons to select which study to save.
When Selected Study is selected, you can select the required studies from the list ofloaded studies to burn.
● Both Active Study and Whole Study selected — All the series of the activestudy will burn.
● Only Active Study selected — The loaded series of the active study will burn.
● Both Primary Study and Whole Study Selected— All the series of the primarystudy will burn.
● Only Primary Study selected — The loaded series of the primary study will burn.
● Both Selected Studies and Whole Study selected — All the series of theselected studies will burn.
● Only Selected Studies selected — The loaded series of the selected studieswill burn.
●
Both Primary Study and Comparisons and Whole Study selected— All the series of the displayed studies and all online comparison studies willburn.
●
Only Primary Study and Comparisons selected— The loaded series of the primary and comparison studies, as well as all theseries of the online comparison studies, will burn.
Note: Offline studies are not burned.
6. Choose the data format under Target Disk Content.
Note: You must save the images as Autoplay or Autoplay/DICOM to allow themto be viewed in the viewer.
Autoplay only— The image data is saved on the CD using the system's proprietaryfile format; the computer will launch the saved study in Image Viewer upon insertionof the CD in a drive. The proprietary file format provides faster access to the imagedata saved on CD, and images occupy less space. (The lossless compression ratio isabout three times the uncompressed image size.)
Autoplay and DICOM— The image data is saved in the proprietary file format andalso in the DICOM file format; this is the default selection. The computer will launchthe saved study in Image Viewer upon insertion of the CD in a drive.
DICOM only — The image data is saved on the CD in the DICOM format only; thesaved study cannot be viewed in the viewer. Storing data in the DICOM file format
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allows you to manipulate study data with third-party software that supports the DICOMfile format; it also allows you to send image data to a DICOM server.
Note: DICOM Structured Reports are not included in the CD image.
Note: Large studies with hundreds of images can usually be saved only with theproprietary format due to space restrictions on a typical CD.
Note: Large cardiology studies can be saved across multiple CDs/DVDs. Thisfeature is available for Autoplay only, Autoplay and DICOM, and DICOMonly. Insert a new CD/DVD when prompted with the message “Media isfull. Please insert another empty media.” When Autoplay and DICOM ischosen, the same objects shall be written onto a specific media for bothmodes.
If multiple studies of the same patient are saved to a CD, they open in the viewercomparison mode when read from the CD (if they were saved in Autoplay orAutoplay/DICOM). If multiple studies from different patients are recorded, a pop-updialog prompts the user to select whether to open in comparison mode.
7. To save all images of the selected study as .JPG files as well as full quality (DICOM orproprietary) images, select the Web Content check box.
Note: Web Content images are not intended for diagnostic purposes. They arerecorded with reduced size and quality and are suitable for viewing asthumbnails in Windows Explorer or the Windows Preview utility. Even ifyou enlarge the thumbnails, the quality of these .JPG images is poor. Toview these images, the user reading from the CD should navigate to theIHE_PDI directory of the disk. See To View Web Content.
The default name is displayed: patient name/saved date/saved timestamp.
8. To give the CD an anonymous, system-generated and consistent title, check theAnonymize check box. The Disk Title field updates. To control, at a granular level,what data is anonymized and how, click the ellipsis button next to the Anonymizecheck box. A dialog displays all patient and study information, populated withsystem-generated "dummy" strings. Overwrite any of these strings with other data tocontrol how the CD is identified.
Note: Anonymized CDs do not contain notes, reports or any non-image objects.
9. To remove private tags, select the Remove Private Tags check box. (Somenecessary sensitive information may be retained in the DICOM files.)
10. If the disk already contains some data, select the Leave Previous Session Intactcheck box to preserve that data; clear the check box to overwrite that data.
11. Click Burn. Other tasks can be performed during the process.12. A pop-up window displays when the recording is complete. Grayscale presentation
state (GSPS) objects and key image notes are stored on the CD along with imagesand other study objects.
13. Click OK.
Note: CD media is "finalized" (no other writing to the media is possible) whenthe write operation is completed.
4.19.1.2 To Send an Order to the CD Workstation
1. In the Study List, enable the check box next to each study you want to add to the CD.To get the primary and comparison studies for one patient, you can use the Selectfeatures to select all studies with a certain MRN.
2. Right-click to open the floating menu.
3. Select Create, and then select Create CD-Film.
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4. From the CD Film Server drop-down list, select the workstation to receive the order.
5. If multiple studies are selected, select the check box to include all studies on a singleCD, or clear the check box to write each study to a separate CD.
6. Select the format of the content:
● CD-Film The image data is saved on the CD using a proprietary file format; thecomputer will launch the saved study in Image Viewer upon insertion of theCD in a drive. The proprietary file format provides faster access to the imagedata saved on CD, and images occupy less space. (The lossless compressionratio is about three times the uncompressed image size.) This is the defaultselection.DICOM/IHE The image data is saved in IHE and also in the DICOM fileformat. Storing data in the DICOM file format allows you to manipulate study datawith third-party software that supports the DICOM file format; it also allows you tosend image data to a DICOM server.
● CD-Film + IHE The image data is saved on the CD in IHE and also in theproprietary file format. The computer will launch the saved study in Image Viewerupon insertion of the CD in a drive.
7. Select a label to attach to the CD. Labels are created and named by the administratorof the CD workstation.
8. Enter the number of copies to create.
9. Click OK. Orders appear in a queue, which can be accessed from the main screenof the viewer.
Note: Additional operations can be performed on the study while it is beingburned to a CD; these changes, however, will not be included in the burn.After the process is complete, the system prompts the user on whether toredo the operation to include any new changes.
4.19.1.3 To View or Cancel CD Requests
You can view requests that have been sent to any CD workstation. You can cancel CDburning requests in Retrieving, Pending, or Processing states.
1. Click My CD-Film Orders in the upper right corner of the home page.
2. To view the study details, click the plus sign (+) next to the request to expand the row.3. To view the requests for a particular CD workstation, click the CD-Film station
drop-down list and make the appropriate selection.
4. To view requests from a particular user, click the User drop-down list and make aselection. To shorten the drop-down list, enter all or part of a user's name in the textfield and click Search.
5. To view only requests with a certain status, click the Status drop-down list and make aselection, according to the following definitions:
● Pending: The request has been received. A Cancel button appears next toPending requests.
● Retrieving Studies: The system is retrieving the study and preparing to write itto a CD.
● Processing: The system is writing the study to the CD.
● Finished: The system has completed the process, and the CD is ready.
● Failed: The process has encountered an error. The reason for the failure isshown in the Error Details column.
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● Canceled: The process was canceled.
Note: The Status Time automatically refreshes every time the status changes.
6. To limit the queue to a specified date range, enter a start date (mm/dd/yyyy) in the firsttext box and an end date in the second text box. This date refers to the date of therequest (not the date/timestamp of the study).
7. Click Refresh to filter the queue according to the entered criteria.
4.19.2 Importing a Study
You can view and manipulate studies that were saved to a CD by another system. If apatient brings a CD loaded with his studies, a clinician or technologist can view or importthose studies while also correcting any inconsistencies, such as identification numbers,between the systems.
● Insert the CD into the appropriate drive; Universal Viewer launches automatically.
You can also save a study to a CD. See Saving a Study to a CD for more information.
4.19.2.1 To Import a Study
1. Insert the CD that contains the study into your workstation's CD drive.
2. Click Import Study.
Expected Result: The DICOM Import dialog displays. At the top left of the dialog, theDICOM Server section defines the destination of the imported study; the study will beimported to that location. Typically these fields will default to values set by the systemadministrator. However, the values can be changed if necessary.
3. Change the destination of the imported study as needed:
● Server: Enter the IP Address of the destination server.
● Port: Enter the appropriate port for the destination.● Calling AE: Enter the DICOM Application Entity title to be used by the import
utility.
● Called AE: Enter the DICOM Application Entity title of the destination server.
4. In the Import From section, click the ellipsis ... and select the directory that containsthe study to import. (The OK button is inactive until a valid directory has beenselected.) Or, type the full path in the Import From text box.
5. After you click OK or enter a valid path, the DICOM Import dialog is populated withthe study information from the CD. Select the Validate Patient Info check box toenable the text fields.
Note: Each study that is being imported must include a valid dicomdir file inorder to be recognized by the study import tool. The DICOM serverspecified must then be accessible on the Local Area Network or via VPNfrom the workstation that is being used to run the import.
6. Select one or more studies that belong to the same patient.
Note: If you need to change accession numbers, select only one study.Accession numbers cannot be changed if multiple studies are selected.
7. If necessary, enter new information in the Patient Info fields to make the studiescorrespond to the identification conventions that your institution uses.
8. Click the Import Selected button to import only the selected (highlighted) study, orselect Import All to import all the studies on the CD.
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9. Select the following actions as needed:
● Break to stop the process at any time.● View Log to check the Log List and view a record of this action.
● Close to exit.
CD Import Limitation
When CD import is launched from the patient folder, the DICOM Server information is notpre-populated with the Universal Viewer server information.
If your site is not using a RIS-driven workflow, you can launch the CD import from thestudy list and the DICOM Server information will be pre-populated for you.
If your site uses a RIS-driven workflow (and therefore does not use the study list), you willneed to manually enter the server IP address, Calling AE Title, and Called AE Title.
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5Image Viewer
Once you have selected a study or studies to view, that selection is loaded and displayedin the viewer. All studies load according to defaults that you define, such as thecompression method, patient folder display, and view preferences.
All image manipulation and output takes place in the viewer. Image manipulation refersto the various means by which you view, position, measure, recalibrate, and work withthe study to render the diagnosis.
The title bar can show, in the upper right corner, the progress of the download:
● The first block (purple bar) indicates the download progress of the study descriptors,necessary for displaying an image.
● The second block (green bar) indicates the progress of the image download.
● The last block (dark green with arrow position) indicates the progress of theimage decompression. Images are presented for viewing even as they are beingdecompressed.
When the decompression of all images is complete, the progress bar disappears. Bydefault, the progress bar does not display. See the Navigator section to configure thisoption.
The main screen of the viewer includes the following:
● Title Bar: Provides descriptive information for what is contained in a particular window.The viewer's title bar includes the Patient's Name, Date of Birth, MRN, SecondaryPatient Identifier (if available), Accession Number, Patient Location, Study Timestampand Study Description.
● Menu Bar: Access commands through the menu bar. The user can define whichcommands appear in the menu, whether those items have sub-menus, and whereexactly they are located. See the Configuration section to define the menu.
● Toolbar: Contains the most frequently-accessed commands, so that they can beexecuted with one click. The toolbar is configurable.
To hide the viewer toolbar, click [EDIT]. In the Preferences window, find ToolbarPosition, select Hide, and then click Save. The toolbar is hidden in this and all futureseries that are opened on any workstation to which the user logs in.
● Navigator: Displays thumbnail views of each series in the study along with basicinformation about that series. Manage Image Viewer behavior.
● Series Windows: In Series View, each series displays in its own window. The windowshows the image along with any other tools that have been applied to aid thediagnosis, such as Overlay, Cross-Reference Lines, and Measurements.
● If the "Fit to Screen with Double-Click" setting is enabled in the Navigator Options,you can expand a series window to full screen by double-clicking anywhere inside
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that window. Double-click again to restore the size of the window. This feature ison by default.
The double-click behavior is affected by the active Mouse Mode. If the Mouse Mode(also set in the Navigator Options) is set to Select, Add Images to Print Preview,Free Text Label, then a double-click action has no effect. Also, if the Mouse Modeis set to point measurement, the double-click action will assign and then remove ameasurement.
Regardless of these settings, you can always expand a series window to full screen bydouble-clicking its title bar. Double-click the title bar again to restore the window size.
● Series Title Bar: Like the main title bar, each series window has a title bar that holdsdescriptive information for that series (e.g., Series #4). The series title bar also holdsthe Swap icon, which enables the user to move images easily from one locationto the next, and the Percentage of Images Displayed Indicator. The Percentage ofImages Displayed Indicator, displayed on the title bar of each viewport, tells the user,at a glance, approximately how many images in that series and in that viewport havebeen displayed:
● : 0% through 24% of the images in the series have been displayed
● : 25% through 49% of the images in the series have been displayed
● : 50% through 74% of the images in the series have been displayed
● 75% through 99% of the images in the series have been displayed
● 100% of the images in the series have been displayed
Note Only open studies that use the same character set that your system isconfigured to use. Opening studies with a different character set may result insome of the characters not displaying properly on your system. For example,a study created for a Simplified Chinese system may not display properlyon a Traditional Chinese system, resulting in ? characters displayed in apatient name.
5.1 CompressionCompression affects how quickly an image will load into your computer. Depending onthe kind of network used by your institution, an uncompressed image may take time toload. You can opt to compress the data in an image to speed up the load. Compressingthe image data means that you compact the data so that it flows faster through thetransmission protocol.
The administrator can configure different compression ratio factors for each modality.Mammography can be left lossless, for example, while X-ray can have a highercompression ratio than cross-sectional modalities.
The system provides two compression options for the user:
Lossy Wavelet
The data for the study is compressed and delivered to your computer in that form. "Lossy"means that some of the image data is lost in the compression; therefore, the imagequality is compromised. You can enrich the image quality at any time by requesting thefull image data.
Lossless Wavelet
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The data for the study is compressed and delivered to your computer in that form, but theimage gradually receives the rest of the data after the initial display. Thus, the full imagedata is transmitted, and there is no loss (lossless) to the image quality. The benefit oflossless compression is that it provides enough image data for you to begin the diagnosiswhile you wait for the rest of the transmission.
5.1.1 Determining if an Image is Compressed
When the study loads, the compression mode shows in the lower left corner of theimage, if Image Overlay is enabled. Lossy compressions show a ratio as well. Becausenot all of each pixel's data is used in a lossy compression, the ratio signifies the ratio ofshown data to full data.
A lossless compression will show the ratio increasing until all pixels are transmitted.Because not all of each pixel's data is used in a lossy compression, the ratio signifies theratio of shown data to full data. A lossless compression will show the ratio increasing untilall pixels are transmitted.
Note Lossy ratios are based on the size of the image. Very large images maydisplay at a very high, and possibly ineffective, compression ratio.
5.2 Refreshing the Image ViewerThe SmartLoading™ feature delivers diagnostic quality images to any location quickly.The system uses a sophisticated algorithm to immediately deliver discernible images andto adapt its load method to the user. It “reads” any actions by the user and upgradesimages accordingly.
First, the system quickly loads the initial images of series; these images allow interpretationto begin right away. As the remaining images are loaded in the background, the resolutionof the initial images automatically upgrades. If, however, the user takes any action, suchas clicking on a specific stack window to make it active, the system responds by upgradingthe resolution of images in that series. It anticipates which images the user needs anddelivers them in high quality, without intervention from the user.
Since clinicians can begin to diagnose even as images are still coming in from thescanner, the Refresh feature allows any newly scanned images to load in the Viewer. Theuser does not have to close and then re-open the study.
5.2.1 To Refresh the Study in the Viewer
If series or images have been added or deleted since the study was initially loaded, whenyou refresh the study, you see a pop-up message summarizing the changes. Removedseries are highlighted in yellow, and added series are highlighted in green. (Double-clickan added series in the Navigator to view it.)
1. If necessary, add Refresh Viewer to the Main Menu via the Layout Editor.2. From the Main Menu, click Refresh Viewer.
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5.3 Dictating or Reviewing a Study in aThird-Party Dictation SystemRemember the following points when creating reports or reviewing studies in a third-partydictation system:
Logging In
● When using a third-party dictation system, the Universal Viewer user name andpassword must match the third-party dictation system user name and password.
● If you change the password in the third-party dictation system through the RADPortalsite, update the password manually in Universal Viewer.
Keep the Patient Information and Dictation in Context
To make sure the patient information and dictation stay in context, the following rules apply:
● If you have a dictation session started and launch the study list of another site andtry to initiate dictation for a study, you see an error message indicating that dictationcannot be initiated.
● If someone else logs into the Universal Viewer study list while the Dictation client isrunning under your login, an error message indicates that dictation cannot be initiatedfor the other person’s login.
● If the dictation client is closed and you try to dictate, Universal Viewer displays an errormessage indicating that the dictation system is not responding and you should logout of Universal Viewer, close any viewer instances and the Dictation client, and logback in.
● If the third-party system receives dictation that does not match existing records,temporary patient information can be created for that report.
Configuring Third-party Dictation Options
When using a third-party dictation system with Integrated Desktop Reporting (IDR), youcan configure the system to suit your workflow. There are two options on the ConfigurationTool screen that you can use: Auto-launch Dictation and Close Viewer on Signoff. SeeConfigure Auto-launch and Close Dictation (page 51) for details.
Restrictions on Dictation
● If you try to bring up another viewer instance during a dictation session, the report issaved and the Dictation system is minimized.
● If you launch the study list of another site and try to start dictation for a study, you seea message asking if you want to terminate the existing dictation session. If so, clickYes. the old session ends and a new session begins. If you click No, the existingsession continues and a new session does not start.
● If you launch a study list other than the one through which you launched dictation andtry to start dictation a second time, you see a message asking if you want to terminatethe existing session. Click Yes to terminate the existing session and start a new one,or click No to continue the existing session.
● If you associate studies in the third-party dictation system, all associated studies aremarked dictated when a report is saved in Universal Viewer.
Third-party Dictation Privileges
Depending on your user privileges, you can mark a study as reviewed or dictated.
If you do not have privileges to mark the study as dictated or mark the study as reviewed,the Dictate button is disabled. You must have the dictate privilege in order for thethird-party system to mark a study as dictated. If you only have review privileges, anerror message displays.
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Note
● The system can interface with a third-party system to match voice dictationsto the appropriate study. See Matching a Report to a Study. If integratedwith a RIS, the system also sends a notification to the external system aboutthe change in status when a Note/Preliminary Report or Dictation is enteredfor a study.
● Changing the dictated or reviewed status for one or more studies can be donefrom the study list or from the third-party dictation system.
5.3.1 To Dictate a Study Using a Third-party Dictation System
Prerequisites:
● Your username and password must be the same on both the dictation system and theUniversal Viewer for the dictation system to automatically launch at login.
● To launch the third-party dictation system using Integrated Desktop Reporting (IDR),you must have the “Mark Dictated” and/or “Mark Reviewed” privileges.
● Verify that the exam being dictated matches the viewer images that are displayed. Ifyou independently launch the dictation system and the viewer(s) manually, navigationin the dictation system is not synched with the viewer application.
When integrated with a third-party dictation system using Integrated Desktop Reporting(IDR), you can set your preferences so that Universal Viewer launches the dictationsystem when you open an exam. First the dictation system launches and then thereport window comes into focus. If the dictation system is already running, the dictationsystem brings the window into focus. If you prefer, you can click the Dictate button tostart dictation manually.
1. Display the study for which you want to dictate a report.
2. Depending on the setting for Configure Auto-launch and Close Dictation (page 51),the Reporting window may open, or you may enable dictation by clicking Dictate fromthe Patient Folder window, the microphone button from the viewer toolbar, or a hot keyto load the study context in the third-party dictation system.
Note:
● Before you start dictation, the dictation system matches the Patient MRN andAccession Number to store the dictation with the correct patient record.
● If the dictation system allows association of multiple accession numbers to areport, the system may send multiple accession numbers back to the systemwhen the report is saved. The dictation system will mark the studies withmatching accession numbers for that patient as Dictated
3. Complete the dictation and save the report in the appropriate status in the third-partysystem (draft, preliminary, final, etc.)
Note:
● When you save the report, the report status in the third-party system isupdated to Dictated.
● When you sign a report, depending on the setting for Configure Auto-launchand Close Dictation (page 51), the instance of the Viewer for the signedreport may close.
4. Continue to review studies and dictate reports.
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5.3.2 To Mark a Study as Dictated or Reviewed
If you mark a study as dictated or reviewed, the status of the study is updated in theWorklist. A large check mark ( ) indicates a study has been dictated. A small check mark( ) indicates a study has been reviewed. A study can be reviewed and not dictated.
Note You do not need to pull the menu down every time you want to mark a study.You can establish default actions for the Done button, so that when you clickDone, the default setting is always applied. The Done Options command setsthe default actions. If you forget to mark the study when it is open, you canmark it as dictated or reviewed directly from the Worklist.
1. Select the study to load into Image Viewer.
2. Do one of the following:
● Right-click the study to display the pop-up menu, and select the option desired.
● From the toolbar, select the down arrow next to the Done button.3. Make a selection according to the following descriptions:
● Mark Study as Dictated indicates that the diagnosing physician has read thestudy.
● Mark Study as Reviewed typically indicates that a resident has read the study.
● Mark Study as QC'd indicates the study has been checked for compliance withthe institution's quality control procedures.
● Save Presentation State prompts you to enter a name and description for thepresentation state and then click OK.
● Exit prompts you to exit the system by selecting an option from the Exit menu.
5.4 Cross Enterprise DisplayCross Enterprise Display is an add-on module requiring additional environments andconfiguration to the base Universal Viewer product. If your organization did not installthis module, this information does not apply. To use this module, contact your SalesRepresentative or the National Service Center.
Using Cross Enterprise Display in Universal Viewer, you can access and review patients’imaging studies from across the enterprise within a single instance of the viewer. Imagingstudies that reside in repositories outside the local facility are considered remote studies.Cross Enterprise Display can provide access to remote studies on GE Enterprise Archiverepositories, as well as 3rd party or VNA repositories. Remote studies are not moved tothe local repository; they are streamed from the source such that you can review remotestudies side by side with the local primary and comparison studies. You can manipulateremote studies (such as adjust W/L settings, pan, zoom, annotate, generate reformats,and so on) in the same way as local studies. Remote studies can also be included as partof a bookmark or Conference Display Protocol in the same way as local studies.
If Cross-Enterprise Document Sharing (XDS) is available within your enterprise, and XDSis configured as one of the remote repositories for Cross Enterprise Display, documentsand reports from XDS can also be accessed within a single instance of the UniversalViewer.
Supported document types from an XDS repository are as follows:
● Plain text
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Note
● Artifacts from manipulations of remote studies (such as presentation states, notes,and reports) cannot be saved to the remote study.
● If a remote study is determined to be a duplicate of a local study, that study isfiltered out.
● If the same study is available at more than one remote repository, then the studywill be listed multiple times as part of the patient's imaging history.
● GE personnel can turn the Cross Enterprise Display functionality on and off.
Supported Languages
Cross Enterprise Display is supported in the following languages in the Universal Viewer:
● Chinese, simplified
● Chinese, traditional
● Danish
● Dutch
● English
● French
● German
● Hebrew
● Hungarian
● Italian
● Japanese
● Korean
● Norwegian
● Polish
● Portuguese, Brazilian
● Portuguese, European
● Russian
● Spanish
● Swedish
● Turkish
5.4.1 Health Status Indicator
Under the toolbar at the far right of the left-most diagnostic monitor, when Cross EnterpriseDisplay and the Health Indicator are enabled in the Universal Viewer, an indicator givesthe status of responses to a query for remote patient information.
If Cross Enterprise Display is disabled, the status indicator is not shown. The HealthStatus indicator updates the archive response status as results are received:
Icon Description
Query in progress.
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Query complete 100% successful.
Query complete with some successes and some failures.
Query complete 100% failure.
5.4.1.1 To Display Remote Archive Details
Prerequisite:
This procedure applies only if Cross Enterprise Display and the Health Indicator areenabled in the Universal Viewer.
Configure the Main Toolbar to add the Health Indicator to the Image Viewer, if needed.
1. To display details regarding the status of remote archive information, click the CrossEnterprise Display icon under the toolbar.
Expected Result: A drop-down list shows the number of results from each category inparentheses.
2. Click an entry to display the names of the remote archives in that category.
5.4.1.2 To Set Cross Enterprise Display Options
From the Navigator, set preferences to show or hide indicators and notifications for CrossEnterprise Display:
● The status of responses from remote sites after a request is sent by the local site.
● Information for patient studies that use partial matching criteria.
Important Partial demographic matching, an option for identifying a patient’sremote comparison exams in a Cross Enterprise Display setting, maybe less accurate than matching using the Patient ID. When using partialdemographic matching, check the patient information to ensure acomplete match when the primary and comparison studies first display.
1. Right-click anywhere in the Navigator. Click Navigator Options.
2. Select Cross Enterprise Display .
3. For the Hide XED pop-up notifications field, clear the check box to show CrossEnterprise Display notifications, or select the check box to hide Cross EnterpriseDisplay notifications.
4. For the Hide notification about partial demographic matching field:
a. Clear the check box to display the Potential Patient Mismatch dialog box whenopening a partial match study for the first time in a Viewer session. The dialogbox shows a message about the matching criteria and the difference between the
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Patient Name of the primary and remote comparison. Click Acknowledge andOpen to display the remote comparison study.
b. Select the check box to prevent the Potential Patient Mismatch window fromdisplaying. The partial match icon still displays on the partial match studies in thetimeline, series selector, study selector, patient folder, and viewport.
5. Click OK to save your selections.
5.4.2 Remote Studies
When Cross Enterprise Display is enabled:
● Icons related to remote studies display in the Timeline, Patient Folder, Navigator,Study/Series Selector, and Viewport.
Icon Description
When Cross Enterprise Display is enabled, a curved arrow inindicates a remote comparison study. Remote studies maybe matched to the primary study using the Patient ID or fullmatching (full first name, full last name, date of birth, and sex).Hover over the timeline tile containing the remote indicator todisplay where the study was performed.
The icon can indicate that an error occurred when thesystem tried to retrieve an offline study. Hover over the icon todisplay additional information.
andImportant Partial demographic matching, an option foridentifying a patient’s remote comparison exams in aCross Enterprise Display setting, may be less accuratethan matching using the Patient ID. When using partialdemographic matching, check the patient informationto ensure a complete match when the primary andcomparison studies first display.
When both and icons appear, the remote comparisonis based on partial demographic matching (a number ofcharacters at the beginning of the patient’s first name and lastname with an exact match for date of birth and sex) rather thanPatient ID. Hover over the icon to view the patient’s entire firstand last name and ensure the proper patient is displayed.
A remote study that resides on a third-party PACS or VNArepository is considered offline. Remote offline studies are notavailable for display on the Universal Viewer until downloadedinto a GE Enterprise Archive repository. Remote offline studiesare indicated with a download icon in the Timeline, StudySelector and Series Selector. Clicking the download icon willstart the download process.
When the remote offline study is being brought online, the
download icon is replaced with a download in-progressindicator. When the download is complete, remote study isavailable for display in the Universal Viewer.
● Remote studies may take longer to load than local studies.
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These specific viewer functions are not supported for use with remote studies:
● Saving presentation states
● Saving dynamically generated multi-planar reformats
● Adding preliminary notes or reports in the Patient Folder
● Using 3D advanced visualization tools
● Using the Mammography viewer (the Mammography viewer application does notdisplay remote studies.)
● Smart Reading Protocols (SRP) do not support learning and generating hangingprotocols for remote studies. If an SRP Learn is initiated with remote studies hung onthe screen, the user is warned to close the remote studies. SRP learns and generateshanging protocols for local studies only.
● If a remote study is loaded when the user initiates an SRP Quick Search action, theSRPs will be generated for the primary exam only.
5.4.2.1 To View Reports for Remote Studies
Reports for remote studies are accessible from the Patient Folder and Timeline.
� Select one of these options:
To display reports... Description
From the Patient Folder: Click aremote study in the Patient Studieslist in the top pane of the PatientFolder.
The report displays in the Notes/Reports tab in the bottom pane, ifavailable. The Notes/Reports tab displays the basic text structuredreport (SR) associated with the study.
From the Timeline: Click theunderlined study date on the remotestudy tile.
The Report dialog displays the basic text structured report (SR)associated with the study.
5.4.2.2 To View Reports from Cross Enterprise Document Sharing (XDS)
XDS documents are listed in the top pane of the Patient Folder and are identified by theXDS report icon. XDS documents are made available at the patient level; they are notlinked to imaging studies. Supported XDS document formats include: PDF and plain text.
Note
● Functionality in the Patient Folder applicable to studies, such as adding anote/report, is disabled when an XDS document is selected.
● Adobe PDF reader is required to view XDS documents.
� To view an XDS document, double-click the XDS document line item in the top pane ofthe Patient Folder.
ExpectedResult: A pop-up containing the report displays over the Patient Folder. Onlyone XDS report can be viewed at a time.
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5.4.3 Access to Migrating Studies
Migrating studies from an existing PACS to Universal Viewer can take prolonged periods,depending on the size of the archive. With Cross Enterprise Display enabled at the site,studies can used as comparison studies during archive adoption.
The system checks for duplicate UIDs, and then determines if the local study containszero images (usually an order or a report) while the remote study contains images. If so,both studies are retained. If the UIDs are identical and both studies contain images, thelocal copy of the study is used.
Information about the two studies is synchronized on the timeline, patient folder, seriesselector, and study selector. The studies can be selected separately. Selecting the zeroimage study displays a message indicating the study contains no images.
Depending on the system setup, zero image studies can be filtered out. In this case, onlystudies containing images display.
5.4.4 Unsupported Functions When Using Cross EnterpriseDisplay
With Cross Enterprise Display enabled in the Universal Viewer, you can review andmanipulate remote studies side-by-side with local studies. All core viewer functionalitieswork the same way with remote studies as they do with local studies, with theseexceptions:
● Saving artifacts from image manipulation (for example, presentation state, notes, andreports) to the remote studies is not supported.
● 3D advanced visualization applications and mammography viewer support for remotestudies are not available.
These specific viewer functions are not supported for use with remote studies:
● Saving presentation states
● Saving dynamically generated multi-planar reformats
● Smart Reading Protocols (SRP) do not support learning and generating hangingprotocols for remote studies. If an SRP Learn is initiated with remote studies hung onthe screen, the user is warned to close the remote studies. SRP learns and generateshanging protocols for local studies only.
● If a remote study is loaded when the user initiates an SRP Quick Search action, theSRPs will be generated for the primary exam only.
● Adding preliminary notes or reports in the Patient Folder
● Using 3D advanced visualization tools
● Using the Mammography viewer (the Mammography viewer application does notdisplay remote studies.)
5.5 Patient Folder
The Patient Folder button can be added to the viewer toolbar. Click the PatientFolder button or use a keyboard shortcut to show or hide the Patient Folder. You canalso set the Patient Folder to launch automatically when you open a study. See SettingGeneral Display Options (page 56).
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The Patient Folder displays information for primary and comparison studies performedon the patient (as matched by the MRN or full or partial demographic matching). Youcan see the patient's studies, notes, reports, orders, and scanned documents. You canview key images associated with a study. You can import a patient’s studies from CD, orsend a study to a DICOM server.
Note The system supports Enterprise MRNs, using an Enterprise Master PatientIndex (EMPI). This means that a patient is recognized across the enterprise,even though that patient may have different MRNs in different facilities. See“Linking Studies”. If EMPI is enabled, the Patient Folder includes not only thecomparison studies from the current facility, but all primary studies for thispatient from all facilities in the enterprise. See the administrator to determinewhether EMPI is enabled on your installation.
Patient Folder Icons
The Patient Folder uses the icons listed below for the user to determine the status ofa study or for the user to view the study.
● Icon Description
● No note or report is attached to the study.
● A note is attached to the study.
● A final report is attached to the study.
● An internal note has been attached to the study.
● A preliminary (wet read) report has been added to the study.
● When Cross Enterprise Display is enabled, a curved arrow in the Remote columnindicates a remote comparison study. Remote studies may be matched to the primarystudy using the Patient ID or full matching (full first name, full last name, date ofbirth, and sex).
● When both and icons appear, the remote comparison is based on PartialDemographic matching (a number of characters at the beginning of the patient’sfirst name and last name with an exact match for date of birth and sex) rather thanPatient ID. Hover over the icon to view the patient’s entire first and last name andensure the proper patient is displayed.
The icon can also indicate an error that an error occurred when the system triedto retrieve an offline study. Hover over the icon to display additional information.
Confirm a partial demographic match
Important Partial demographic matching, an option for identifying a patient’sremote comparison exams in a Cross Enterprise Display setting, may
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be less accurate than matching using the Patient ID. When using partialdemographic matching, check the patient information to ensure acomplete match when the primary and comparison studies first display.
If the remote comparison studies use Partial Matching (a number of characters of first
and last name, exact date of birth and sex), an additional icon displays. Dependingon the configuration, a window may display, for you to acknowledge and confirm this isthe correct patient. This confirmation window appears once for each partially matchedcomparison exam for a Viewer session.
To keep the confirmation window from displaying, go to the Navigator > Cross EnterpriseDisplay to select the Hide Notification of Partial Demographic Match check box.
You can also confirm the match by hovering over the orange triangular icon to display thepatient’s full first and last name.
Artifacts from manipulating remote studies (such as presentation state) cannot be saved.
For remote studies, you can view Basic Text Structured Reports (SRs) from the PatientFolder. Select a remote comparison study in the top pane of the Patient Folder. If a BasicText SR is available, Cross Enterprise Display shows it in the Notes/Reports tab in thebottom pane. If the report is saved in another format, it cannot be displayed.
5.5.1 To View All Studies for a Patient
1. When a study is open, click Patient Folder on the toolbar. (Or, set the system tolaunch the patient folder automatically when a study is opened.)
The Patient Folder displays in a large dialog box.
● The top pane lists all the patient studies in chronological order. The selected studydisplays in blue with additional information in the bottom panes. Displayed studiesare in bold. A note/report icon displays next to studies containing that information.
Note: Command button actions (Detach Order, Dictate, Update Archive State)are taken on the selected (blue font) study. All information in the lowerpanes refers to the selected (blue font) study.
● The middle pane allows you to add a new note or report to the selected study.
Note: Depending on your configuration, you may add a report and edit it.
● The bottom pane shows study information for the selected (blue font) study,as well as five additional tabs of information. Click Maximize to display theinformation in the entire Patient Folder window. Right-click in this row of tabsto define default behavior, such as which tab should display upon opening andwhether this pane should be maximized upon opening.
Note: You can decrease the size of the Patient Folder by using the standardMinimize button in the upper right corner of the dialog box. This actionworks only on single-monitor configurations.
2. To display one or more studies in the viewer, click the check box next to the study inthe upper pane and then click Display.
● If the study is online, it opens in the viewer in comparison mode alongside theprimary study, with Navigator thumbnails for each.
● If the study is offline (shows the indicator), the image viewer behaviordepends on your system configuration.
● In the default configuration, a message displays. Click Yes to download thestudy, and click Display again after the study comes online (the indicatordisappears) to view it.
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● If the one-click bring online feature is enabled, the system will pull the image
online without additional messages. The icon displays while the image isloading.
3. To update the Patient Folder with new information, such as additional series from thescanner, click Refresh.
4. To dictate the selected (blue font) study, click Dictate.5. To view or manage further data about the selected study, click a tab in the lower pane.
6. To change the comparison study, select another study
7. Select Close to close the Patient Folder, or select Done to close both the PatientFolder and all open studies for this patient. The Done button in the Patient Folderexecutes all default Done commands and its drop-down arrow opens an option list forthose commands, just as in the viewer.
5.5.2 Workflows for Adding Images to an Existing Study
This applies only to sites using CPACS integration.
If a radiologist requests additional images for a specific study or exam, specific workflowsare recommended for sites using CPACS integration.
If these workflows are not followed, when a radiologist attempts to read the updated study,the additional images may not be available in the mammography viewer or AW Server.
In general, any Unspecified exam containing duplicate SOPs (DICOM Service-ObjectPairs, such as images or structured reports) will experience this issue. The Unspecifiedexam may have only some of the SOPs that are duplicates, or the Unspecified exammay consist entirely of duplicate SOPs.
Recommended workflow for adding imagesThis workflow will prevent Unspecified exams from being created.1. Check the exam status. Unverify the exam if its exam status is Verified (or higher).
Note: Exams can be Verified by a technologist or other user, or they can beautomatically Verified by the system.
2. Send only the additional images (if the modality equipment allows it). Otherwise,resend the entire study, including the additional images.
3. Read the study and additional images.
Alternate workflow for adding imagesUse this workflow if a technician has sent additional images when the exam is in theVerified status and CPACS has created an Unspecified exam, and there are additionalimages in the Unspecified exam.1. Unverify the original exam.
2. Use Centricity Exam Manager to merge the Unspecified exam into the original exam.
3. Read the study and additional images.
Recommended workflow for duplicate examsUse this workflow if a technician has resent an exam that is an exact duplicate of anexisting exam.1. Read the first exam that was sent.
2. Use Centricity Exam Manager to merge the Unspecified exam into the original exam.
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5.5.3 To Add an Additional Note or Report to a Study
The appropriate security privileges are necessary to add a note or report, otherwise theseitems are disabled. Once added, notes cannot be deleted, only hidden.
Note Depending on your configuration, you may add a report and edit it.
Note Depending on your configuration, a “subject” line may display in the note.
1. From the drop-down list in the middle pane of the patient folder dialog, select a study.Primary refers to the study that is now displayed in the viewer; it is in a bold font in thePatient Folder. Selected refers to the study that is highlighted in a blue font.
2. Click the option button to add an internal note, note or preliminary report.
3. Click the option button to define the note's text alignment: Left to Right or Right toLeft.
4. Select the options for the note.
Some configurations will have Category and Canned note above a Subject line. Acanned note is one that has been specifically customized for a particular departmentor function in the healthcare facility. To use canned notes:
a. Select a predefined category from the Category list.
Example canned note categories include “Diagnostic Tech to Radiologist”,“Radiologist to ER Physician”, and other categories designed to facilitatecommunication.
b. Select a predefined note from the Canned note list.
When you select a canned note, the Subject field and the description areautomatically filled out.
Example canned notes include “Preliminary Report”, “Discrepancy”, or other typesof notes that are frequently used.
Note: Contact your system administrator for more information about when touse different categories of canned notes and specific canned notes. If youoften create specific types of notes, your system administrator may beable to create a canned note for that purpose.
5. Click in the text area and type the note or report.
6. Click Save.
Note: You can view all current notes/reports for a study by clicking theNotes/Reports tab across the bottom pane of the Patient Folder. Click theHide button to hide new notes from other users. (This hide functionalitymay not be available, depending upon your system configuration.) ClickPrint to print a specific report, or the Print All button to print all notesand reports for this patient.
Note: Final reports can be received in encoded form from the RIS and displayedin Rich Text Format in the Patient Folder. If integrated with the RIS, thesystem also sends a notification to the external system about the changein status when Notes/Preliminary Reports or Dictations are entered fora study.
Note: You can also add a note or report from the Study List. Canned notes mustbe added from the patient folder.
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5.5.4 To View and Detach Orders from a Study
The Orders tab of the Patient Folder provides a full clinical picture of the patient, asany information in the RIS for this patient is shown here, including the procedure code,procedure description, ordering department, ordering individual, reason for the study andso on. This tab includes HL7 orders attached to a study.
Note A study matched to multiple orders shows as multiple entries, each denotingan explicit order, in the Study List. While the study information is identical foreach entry, the user can use the Procedure Code and Procedure Descriptionfields to distinguish one order from another in the Study List. These fields canbe found in the Configuration dialog for the Study List. Related orders maytransmit from the RIS separately. For example, one chest-abdomen-pelvisstudy may have three orders from RIS; all three are for the same study, butthey were transmitted separately for each body part.
Note Orders are disabled on systems with an EA-only backend (that is, on systemswhich do not have PACS-IW or CPACS).
1. Click the Orders tab in the bottom pane of the Patient Folder.
2. To remove an extraneous order from a study, select the order and click Detach Orderin the top pane. (You can also detach orders directly from the Study List, withoutopening the Patient Folder; see Matching an Order to a Study.)
5.5.5 To View and Add Scanned Documents
Note Scanned documents are disabled on systems with an EA-only backend (thatis, on systems which do not have PACS-IW or CPACS).
1. Click the Scanned Documents tab. This tab includes all scanned documents for theselected (blue highlighted) study.
2. Under the Display section, click the arrow buttons to go to the next or previousscanned document. Click Maximize or double-click the scanned document to displaythe document at full screen. Click Restore, or double-click again in the document, torevert to the original size.
3. To add a new document from the scanner, select a document type from the drop-downlist.
4. Click Scan. See adding a scanned document for more information.
5. Click Save to save this document as the last image in the series, or click Deleteto remove it.
6. From the Filter drop-down list, select how to view the scanned documents. The dateand type of the currently displayed scanned document is shown just below in theDocument Info section.
7. Use the buttons in the Tools section to manipulate the scanned document.
5.5.6 To View Key Images Information for a Study
� Click the Key Images tab in the bottom section of the Patient Folder. This tab includesall key images for the selected (blue highlighted) study.
● To page through the key images: Under the Display section, click the arrow buttons.
● To switch to a larger view of the image: Click Maximize.● To switch back: Click Restore.
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● To add a temporary measurement: Click one of the measurement buttons and drawthe measurement. Measurements you draw on the patient jacket are temporary. Thesystem discards them when you exit the study.
5.5.7 To Configure Patient Folder Tabs
Users can define the default behavior of tabs in the Patient Folder.
� Right-click any tab to configure its settings:
● Make This Tab Default: Select to open this tab by default when the Patient Folder islaunched.
● Properties: Opens the Properties dialog. To maximize the display area of a tab onlaunch, select the tab from the drop-down list and click the Maximize Tab check box.Click OK to accept the setting.
Note: You can maximize the display area of a tab at any time by clicking Maximize.The button toggles to Restore displaying the area back to its standard size.
5.5.8 To View a Series in the Patient Folder
1. From Image Viewer, click the series to display in the Patient Folder to make it active.
2. Right-click to display the pop-up series menu.
3. Click Display in Patient Folder.4. The active series appears in the Series tab of the Patient Folder. Limited commands
from the right-click menu remain available from this pane, and paging/scrolling arepossible. Any changes are temporary and not saved to the image.
Note: Series displayed on a grayscale monitor are displayed in color whenopened for viewing in the Patient Folder.
5. Double-click anywhere in the series in the Patient Folder to maximize that tab.Double-click again to restore to its original size.
6. To clear the series from the pane, click Clear.
5.5.9 To Send a Study in DICOM
You can send a study directly to a DICOM server. This feature is not designed to migrateall studies in the system. Select no more than two dozen studies to migrate.
1. In the Study List or the Patient Folder window, select the check box next to eachstudy to migrate.
● If you are working in the Study List, you can use the Select features to selectall studies with a certain MRN to get the primary and comparison studies forone patient.
● If you are working in the Patient Folder window, the newest study you haveselected and opened will always be included. If you do not want to include thatstudy, close it and then open a study that you do want to migrate.
2. Open the DICOM Send dialog:
● From the Study List, right-click and select Send in DICOM from the context menu.
● From the Patient Folder, click Send DICOM.
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Expected Result: The selected studies are listed at the top of the DICOM Senddialog, and the available DICOM servers are shown in the pane.
3. In the pane, select the server to which to send the studies.
4. Click Send to send the selected studies to that server.
5. Click Close.
5.5.10 Sending One or More Series in DICOM
Depending upon your system configuration, you may be able to send a series directly to aDICOM server. This feature is not designed to migrate all series in the system.
To send one or more series in DICOM:1. Right-click in the Worklist to open the pop-up menu, and select Send Series in
DICOM. A window will open with series details.
2. Use the check boxes to select one or more series to send in DICOM. You can use
Select All ( ) and Select None ( ) when making your selections.
3. Select the destination from the drop-down list at the bottom of the window.
4. Click Send.
If you want to cancel the send, click Cancel.
A progress window will appear during the send. If you cancel the send, or if any (orall) of the series fails to send, the progress window will notify you of the failure(s). Ifthis happens, click View Error Log in the progress window to see which series failedto send and to retrieve a tech support code that you can give to your administrator.
Note: If the send does not complete in 300 seconds (5 minutes), a pop-upmessage will display to ask if you want to continue waiting. Click eitherOK to continue waiting or Cancel to stop the send.
5.5.11 Loading a Mammography Study from the Patient Folder
The Patient Folder column (Advanced Mammo) provides the option of adding a studyto the mammography application with or without adding the study to Universal Viewer.Selecting the Advanced Mammo check box does not open the study in the mammographyviewer; click Display to open the study.
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For studies that do not meet the criteria for mammography or when the current HP doesnot include mammography, the Advanced Mammo column does not contain a check box.Changing the HP causes the Advanced Mammo column to clear if the new HP does notinclude mammography.
Once selected, the check box cannot be cleared; that is, the study cannot be closed in themammography application from the Patient Folder.
1. From the Patient Folder, select the check box in the Advanced Mammo column to adda study in the mammography application only, OR, click the first check box to displaythe study in both Universal Viewer and the mammography application.
2. To open the study, click Display.
5.5.12 To Import a Study
1. Insert the CD that contains the study into your workstation's CD drive.
2. Click Import Study.
Expected Result: The DICOM Import dialog displays. At the top left of the dialog, theDICOM Server section defines the destination of the imported study; the study will beimported to that location. Typically these fields will default to values set by the systemadministrator. However, the values can be changed if necessary.
3. Change the destination of the imported study as needed:
● Server: Enter the IP Address of the destination server.
● Port: Enter the appropriate port for the destination.● Calling AE: Enter the DICOM Application Entity title to be used by the import
utility.
● Called AE: Enter the DICOM Application Entity title of the destination server.
4. In the Import From section, click the ellipsis ... and select the directory that containsthe study to import. (The OK button is inactive until a valid directory has beenselected.) Or, type the full path in the Import From text box.
5. After you click OK or enter a valid path, the DICOM Import dialog is populated withthe study information from the CD. Select the Validate Patient Info check box toenable the text fields.
Note: Each study that is being imported must include a valid dicomdir file inorder to be recognized by the study import tool. The DICOM serverspecified must then be accessible on the Local Area Network or via VPNfrom the workstation that is being used to run the import.
6. Select one or more studies that belong to the same patient.
Note: If you need to change accession numbers, select only one study.Accession numbers cannot be changed if multiple studies are selected.
7. If necessary, enter new information in the Patient Info fields to make the studiescorrespond to the identification conventions that your institution uses.
8. Click the Import Selected button to import only the selected (highlighted) study, orselect Import All to import all the studies on the CD.
9. Select the following actions as needed:
● Break to stop the process at any time.● View Log to check the Log List and view a record of this action.
● Close to exit.
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5.5.12.1 CD Import Limitation
When CD import is launched from the patient folder, the DICOM Server information is notpre-populated with the Universal Viewer server information.
If your site is not using a RIS-driven workflow, you can launch the CD import from thestudy list and the DICOM Server information will be pre-populated for you.
If your site uses a RIS-driven workflow (and therefore does not use the study list), you willneed to manually enter the server IP address, Calling AE Title, and Called AE Title.
5.5.13 Display DICOM SR
Prerequisites:
● This procedure is for customers using the Universal Viewer with Centricity PACS
● To display DICOM Structured Report, exams must contain DICOM SR
There are two ways to display DICOM SR: from the patient folder and from the timeline.
Display DICOM from the patient folder1. Open an exam from the study list.
2. Open the patient folder for the exam.
3. Select the Notes/Reports tab.
Note: While retrieving DICOM SR, a Structure Report: Loading inProgress..... message displays at the bottom of the patient folderNotes/Reports tab.
Expected Result: The DICOM SR displays in the patient folder Notes/Reports tab.
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Display DICOM from the timeline1. Open a study.
2. In the timeline, look for the icon with the underlined date.
3. Click that icon.
Expected Result: The Report dialog displays the SR, preliminary report, and finalreport.
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5.6 Closing a Study
5.6.1 Closing a Study
When you have completed work on a study, close the study to clear your screen; theStudy List remains open. You can establish default actions for the system to perform uponclosing a study to help automate common tasks and speed up workflow.
5.6.2 To Close a Study
Click Done to close the active study but not the application. Referring Physician usersmay only select Close Study and Exit.
1. Click Done in the toolbar to perform the default operations and close the study.
2. To override the default settings for Done without changing it, click the down arrownext to Done to display the drop-down menu and make a selection.
5.6.3 To Establish Default Settings for the Done Command
The operations selected in this task will be applied every time you click Done. To overridethis default without changing it, click the down arrow next to Done to display the drop-downmenu and make a selection.
1. From the Image Viewer toolbar, select the down arrow right next to Done .
2. Choose a command to execute for this occasion only, or to define default behavior,select Done Options to show the Done Options dialog.
3. Choose which settings will automatically activate when Done is clicked.
Note: Some options are available only to authorized users.
● Save presentation state for primary Automatically adds the current presentationstate to the presentation state history every time a study is closed. Thepresentation state is the display of any and all modifications and rearrangementsmade to the study (such as measurements, annotations, etc.).
Note: This setting automatically saves only the standard presentation statefor the primary study. Quality Control presentation states cannot besaved automatically, nor can dependent presentation states.
● Save for local comparison also In addition to saving the presentation statefor the primary exam, this saves the presentation state for any comparisonexams.
● Mark study asdictated Marks every study as dictated upon closing.
● Mark study as reviewed Marks every study as reviewed upon closing.
● Mark study as QC’d Marks every study as QC’d upon closing.
● Save key images Designates that key images are automatically saved uponclosing.
● Save Created Series Saves any series created during this session, such as anew series created from Multi-Planar Reformatting (MPR) or 3-D Rendering, orany new images added to an existing series.
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● Print key images Prints key images upon closing.● Close study and exit Closes the primary study and exits the application.● Finish up in the background Minimizes the study while it closes. For larger
studies, this option allows the screen to be clear while the system finishesall operations, including print jobs.
● Load presentation state on startup Loads the most recent presentation statethe next time a study is opened.If this automatically-loaded presentation state has dependent presentation states(i.e., it was saved in compare mode and included the presentation for all openstudies), a prompt displays about how to handle the loading.If you confirm that dependent presentation states exist, and those other studiesare already open, then the system applies the dependent presentation states.If you confirm that dependent presentation states exist, and those studies are notopen, the system prompts you to open those studies.Click Yes to apply the presentation states as those dependent studies are opened.
● Save 3–D data Designates that 3–D data is automatically saved upon closing.
4. Click OK.
5.7 PrintingTo print images:1. From the viewer context menu (right-click menu), select one of the Print options:● Add selected images to Print Page: Opens the Print window and populates it
with all the selected images. The system fits as many images as it can onto aprint page using the current Print Template. If they all do not fit, the system addsmore pages.
Note: This option is not available on the Key Images view port.
● Add this image to Print Page: Opens the Print window populated with thecurrent image in the current series. The system displays the image using thecurrent print template.
● Add all images to Print Page: Opens the Print window populated with all theimages from the current series. The system fits as many images as it can ontoa print page using the current Print Template. If they all do not fit, the systemadds more pages.
Note: Each time you add images, any previous images are removed from thePrint window.
2. Adjust the images, if necessary.You can select a different print format, zoom to True Size, or show a scale on theimages.
3. Print the pages.
Note: If you format the pages with a film format, you can print to a DICOM printer.
5.7.1 The Print Window
From the Print window you can adjust the images by clicking any of the following buttons.
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Print Window Tools
● Format : Select from the list of available Print Formats. This applies the selectedformat to all the images. Each template includes attributes such as the backgroundcolor, header and footer data, preview size and so on.
● Print : Prints the pages in the window to a non-DICOM (paper) printer.
● DICOM Print : If you apply a film format to the images, you can print the pages toa DICOM (film) printer.
● Page/Scroll : Toggles page/scroll.
● True Size : Scales the images so they print at the actual size indicated in theDICOM header. With True Size on, the system displays a calibration scale on eachon-screen image preview. The top and left side show the scale in centimeters whilethe bottom and right side show the scale in inches.
Note: Do not use non-DICOM output for True Size measurements. Non-DICOMprinters may not be able to accurately represent the measurements. TrueSize printing uses system-calculated calibration based on Pixel Spacinginformation available in the DICOM tags. True Size prints do not usemanual calibration.
● Show Scale : Displays a scale with tic marks on each printed image. You canuse this to approximate the relative size of the anatomy in each image. The scaledoes not display on images with no pixel size information in the DICOM header.
5.7.2 Adding and Removing Print Templates
From the Layout Editor you can edit the list of templates which can be applied to printedimages. Each template includes attributes such as the background color, header andfooter data, preview size and so on. Templates can also be assigned to a template set. (Atemplate set is simply a group of templates that correspond to a particular modality.)
1. Select Layout > Create/Edit to open the Layout Editor dialog.2. Select Print > Print Templates from the folders on the left.
To add a print template:1. Select a template in the list at the right.
2. Click <<.
To remove a print template:1. Select a template in the list on the left.
2. Click >>.
To change the order in which templates will appear on the menu in thePrint window:1. Select a template in the list on the left.
2. Click Up or Down.
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5.7.3 Editing, Creating, and Deleting Print Templates
To edit a print template:1. From the Print > Print Templates page of the Layout Editor, select a template from
the list on the left (the currently available templates).
2. Click Edit.This opens the Print Template Editor dialog. Use the tabs in this window to changethe attributes of the template.
To create a new print template:1. Edit a template similar to the one you want to create.
2. Click the Templates list tab.3. On that page, click New.4. On the resulting dialog, enter the name of the new template and select whether it is
only visible to you (Personal), only visible to people in your group (Group), or visibleto everyone on the system (Common).
5. Click OK.6. Use the other tabs in the Print Template Editor to adjust the attributes of the new
template.
To delete a print template from the system:1. Edit the template you want to delete.
2. Click the Templates list tab.3. On that page, click Delete. The system will ask you whether you are sure. Clicking
Yes will completely remove the template from the system.
5.7.4 The Print Template Editor
Templates list
● New To create a new template by copying the current template, click New. On theresulting dialog, enter the name for the new template and specify who can use thetemplate: you (Personal), everybody in your group (Group), or everybody on thesystem (Common).
● Delete Remove the current template from the system. If you answer Yes on theresulting dialog, the current template will be removed from the entire system.
Page layout
● Units Select the unit measurement (inches, centimeters, and so on) to use for settingthe margins and paper size.
● Background color Select the color to display as a background behind the key images.● Media Select the media for printing and its size. Selections in the drop-down list
update to correspond with the selected option button (Paper or Film).If you selecta custom format from the drop-down list, enter a value for the width and height inthe fields below the drop-down.Film printers are usually DICOM devices, while paper printers are usually not.
● True Size Printing On a DICOM printer, this prints the images with a 1:1 ratio.The preview window includes a calibration scale both in inches (the right andlower sides) and centimeters (the left and upper sides). This scale corresponds toreal unit measurements on a printed page.
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● Margins Set the margins. The numeric entries use the Units you specified at thetop of the dialog.
● Orientation Select Portrait or Landscape.
Header/Footer layout
The header is the bar that appears at the top of the template. The footer is the bar thatappears at the bottom of the template.
● Header Click one of the buttons (Left, Center, or Right) to edit the specified portionof the header. Near the bottom of the dialog, the system shows a thumbnail of thecurrent header. The label on the area on the right side of the dialog indicates whichportion of the header you are editing.For example, if you click Left, the label to the area at the right indicates that youare editing the Header / Left.● Height Enter the header height (in the units specified on the Page Layout tab).● Color Specify the header color.
● Footer Click one of the buttons (Left, Center, or Right) to edit the specified portionof the footer. Near the bottom of the dialog, the system shows a thumbnail of thecurrent footer. The label on the area on the right side of the dialog indicates whichportion of the footer you are editing.For example, if you click Left, the label to the area at the right indicates that you areediting the Footer / Left.● Height Enter the footer height (in the units specified on the Page Layout tab).● Color Specify the footer color.
● (Page Region / Location) Specify the content of the current Page Region (Header orFooter) and Location (Left, Center, or Right). The text for this label on the dialog boxindicates which portion of the page is current.
● Font Click to specify the font which the system will use in the currently selectedportion of the page.
● Patient Info Choose this to put the indicated patient information in the currentlyselected portion of each page. You can choose the type of information from thedrop-down list below. You can also specify a label which will print in front of theinformation.
● Custom Text Choose to print the text you specify on the currently selectedportion of each page.
● Page No Choose to print the page number on the currently selected portion ofeach page. The number prints in the format: page # of #
● Comparison Legend This option is enabled only when the Use for Comparisoncheck box in the Advanced tab is selected. If selected, the following information isadded to the print images: a "for comparison only" watermark in the comparisonimage, a double or dashed frame around the comparison image (to distinguishit from the primary study), and the accession numbers for both studies in theheader, with a box around the comparison study's number. Only the primarystudy's day displays.
Images layout
● (Rows) Specify the layout of the rows on each page.● Height Specify the height of the indicated row of images.
● Columns Specify the number of columns in the indicated row of images.
● Used Deselect to omit this row from each page.
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● Add New Row Add a new row to the template.
● Equal Heights Set all rows to the same height so that all used rows fit on a page.● Remove Unused Remove any row specifications with the Used checkbox unchecked.● Remove All Remove all row specifications from the template.
Scout Cells
● (Cells) Specify which Row and Column contains the scout cell. Uncheck the Usedcheckbox to omit the specified cell from each page.
● New Scout Cell Add another scout cell. You may set up to half the cells on a pageas scout cells.
● Remove Unused Remove all unused scout cell specifications.
● Remove All Remove all scout cell specifications.
Advanced
● Line Categories Select the line category to adjust -- Cross-Reference or Labels.● Line thickness Enter a value for the thickness of the selected line category.● Font Factor Enter a value for the labels font.
● Numerators and Signs Select the sign to adjust in the upper pane. Click ChangeFont to modify the default font for the selected sign.
● Resolution Enter the printer and file/email resolutions.
● Comparison Select this check box to allow printing of both primary and comparisonstudies. When this box is checked, the Comparison Legend option is enabled onthe Header / Footer layout tab.
● Save Labels Click to save the labels defined in the current Print window to the PrintTemplate. Whenever this template is used, those labels automatically appear.
5.8 Key ImagesKey images are slices of diagnostic importance that you can cull and save for furtherexamination and distribution. The clinically important images may occur in different series.
Note To save key images, set the Done Options so key images are saved whenyou close an exam. If the Save Key Images done option is not set, anychanges to key images will be lost when you exit the exam.
Note Referring Physician users cannot invoke this component.
5.8.1 Marking and Unmarking Key Images
When viewing images in a series, the phrase Key Image in the upper right corner of thedisplay region indicates that the image is a key image.
To add a key image to a study, do one of the following:● If your system is set to Mark Key Image when measurement is created, add any of
the following to an image:
● Measurements
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● Labels
● ROIs
Note: You can set Mark Key Image when measurement is created on theMiscellaneous page of the User Preferences dialog. Access that dialogfrom the Preferences item on the drop-down next to the Triangulation
tool ( ) or the Navigator Options item on the Navigator contextmenu.
Or● Select the viewport showing the proper image and press the Quick Add Key Images
key (default K).
Note: You can change the keyboard shortcuts from the Shortcuts page of theLayout Editor dialog.
If you marked the wrong image as a Key Image:● You can unmark it by pressing the Quick Add Key Images key again.
Note: You can mark reconstructed (PET-CT and MIP) images as key images.This creates an Auxiliary series containing just the reconstructedimages which are key images. To unmark a reconstructed image,open the Auxillary series (the last series in the Navigator), scroll to thereconstructed image you just marked and press the Quick Add KeyImages key.
Once saved, you can no longer unmark a key image.
5.8.2 Viewing Key Images
When there are Key Images in a study, a key images thumbnail appears as the first item
in the Navigator. An icon ( ) in the lower right corner indicates that this thumbnailrepresents the key images in the study. The thumbnail shows a count of how many keyimages there are in the study.
To view key images:� Drag the key images thumbnail into one of the display regions, just like you would for an
image series.You can scroll through the key images, just like scrolling through an image series. You canalso add labels, measurements, and ROIs to a Key Image, just like images in a series.When you modify the key image, that also modifies the original (or, when you modify theoriginal, that also modifies the key image).
Note: You cannot add or modify key images in comparison exams.
5.8.3 Significant Images from RA1000
The viewer displays Significant Images (SI) from RA1000 in the Key Images view port.There are, however, several limitations on Significant Images.
Limitations on Significant Images
● The view port renders the Significant Image without applying presentation parametersfrom RA1000 such as W/L, Zoom, Pan, Rotate, and Flip.
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● You must apply the presentation state from the Significant Image to the original imagein the original series to show Annotations and Measurements from RA1000 on theSignificant Image.
● Like normal Key Images, you can add or edit annotations and measurements on thedisplay in the Key Image Viewport or on the original image. The annotations andmeasurements are synchronized between the two. However, when you save the keyimages, the new annotations and measurements are not saved with the SI.
5.9 One-Click Image Snapshot (SecondaryCapture)This feature is only available with a system configured for cardiology workflow.
If the Image Snapshot button is not visible:1. Create a shortcut, menu item or toolbar button for Image Snapshot.
To take a snapshot of an individual image:1. Click Image Snapshot.
ExpectedResult:The system creates a still of the currently selected image as it appears atthe moment. The system also adds a thumbnail of the snapshot to the Navigator.
5.10 One-Click Image PrintThis feature is only available with a system configured for cardiology workflow.
If the Image Print button is not visible:1. Create a shortcut, menu item or toolbar button for Image Print.
To print an individual image:1. Click Image Print.
ExpectedResult:The system uses the current Windows printer to print a still of thecurrently selected image.
5.11 Saving a Study to a CDYou can save a copy of a study to a CD to disseminate to a patient or as a portable record.This feature enables the study to be read on any computer, even those without access tothe viewer. It also helps users load the study quickly (in the event of a slow connection) orto send a study to an external DICOM archive.
This feature is distinct from the Create CD feature, which sends orders to a CD workstationto create CDs. To save a study, you must have a CD burner installed on your computer.
Note First-time users of this feature will be prompted to install the CD Film Viewer.Choose Yes to download the appropriate utilities. The download is fast, andit is necessary for saving studies to a CD. If a new version of the CD FilmViewer becomes available, this pop-up prompt will appear again. This featureis available only to licensed customers.
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You can also import a study from a CD. See Importing Studies.
5.11.1 To Save a Study to a CD
Prerequisite: Verify that all studies you wish to burn are online on the short-term storageor cache before creating the CD.
1. Open the study to save to a CD.
2. From the main menu, or by right-clicking to display the floating menu, click Burn CD.3. Select the device to use from the drop-down list. If only one device is installed, this
field is disabled.
4. Click Refresh to update the first field under Media Info; this field identifies the mediaand displays how much space is available on the CD. The second field displays howmuch space is required to record the study.
5. Use the option buttons to select which study to save.
When Selected Study is selected, you can select the required studies from the list ofloaded studies to burn.
● Both Active Study and Whole Study selected — All the series of the activestudy will burn.
● Only Active Study selected — The loaded series of the active study will burn.
● Both Primary Study and Whole Study Selected— All the series of the primarystudy will burn.
● Only Primary Study selected — The loaded series of the primary study will burn.
● Both Selected Studies and Whole Study selected — All the series of theselected studies will burn.
● Only Selected Studies selected — The loaded series of the selected studieswill burn.
●
Both Primary Study and Comparisons and Whole Study selected— All the series of the displayed studies and all online comparison studies willburn.
●
Only Primary Study and Comparisons selected— The loaded series of the primary and comparison studies, as well as all theseries of the online comparison studies, will burn.
Note: Offline studies are not burned.
6. Choose the data format under Target Disk Content.
Note: You must save the images as Autoplay or Autoplay/DICOM to allow themto be viewed in the viewer.
Autoplay only— The image data is saved on the CD using the system's proprietaryfile format; the computer will launch the saved study in Image Viewer upon insertionof the CD in a drive. The proprietary file format provides faster access to the imagedata saved on CD, and images occupy less space. (The lossless compression ratio isabout three times the uncompressed image size.)
Autoplay and DICOM— The image data is saved in the proprietary file format andalso in the DICOM file format; this is the default selection. The computer will launchthe saved study in Image Viewer upon insertion of the CD in a drive.
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DICOM only — The image data is saved on the CD in the DICOM format only; thesaved study cannot be viewed in the viewer. Storing data in the DICOM file formatallows you to manipulate study data with third-party software that supports the DICOMfile format; it also allows you to send image data to a DICOM server.
Note: DICOM Structured Reports are not included in the CD image.
Note: Large studies with hundreds of images can usually be saved only with theproprietary format due to space restrictions on a typical CD.
Note: Large cardiology studies can be saved across multiple CDs/DVDs. Thisfeature is available for Autoplay only, Autoplay and DICOM, and DICOMonly. Insert a new CD/DVD when prompted with the message “Media isfull. Please insert another empty media.” When Autoplay and DICOM ischosen, the same objects shall be written onto a specific media for bothmodes.
If multiple studies of the same patient are saved to a CD, they open in the viewercomparison mode when read from the CD (if they were saved in Autoplay orAutoplay/DICOM). If multiple studies from different patients are recorded, a pop-updialog prompts the user to select whether to open in comparison mode.
7. To save all images of the selected study as .JPG files as well as full quality (DICOM orproprietary) images, select the Web Content check box.
Note: Web Content images are not intended for diagnostic purposes. They arerecorded with reduced size and quality and are suitable for viewing asthumbnails in Windows Explorer or the Windows Preview utility. Even ifyou enlarge the thumbnails, the quality of these .JPG images is poor. Toview these images, the user reading from the CD should navigate to theIHE_PDI directory of the disk. See To View Web Content.
The default name is displayed: patient name/saved date/saved timestamp.
8. To give the CD an anonymous, system-generated and consistent title, check theAnonymize check box. The Disk Title field updates. To control, at a granular level,what data is anonymized and how, click the ellipsis button next to the Anonymizecheck box. A dialog displays all patient and study information, populated withsystem-generated "dummy" strings. Overwrite any of these strings with other data tocontrol how the CD is identified.
Note: Anonymized CDs do not contain notes, reports or any non-image objects.
9. To remove private tags, select the Remove Private Tags check box. (Somenecessary sensitive information may be retained in the DICOM files.)
10. If the disk already contains some data, select the Leave Previous Session Intactcheck box to preserve that data; clear the check box to overwrite that data.
11. Click Burn. Other tasks can be performed during the process.12. A pop-up window displays when the recording is complete. Grayscale presentation
state (GSPS) objects and key image notes are stored on the CD along with imagesand other study objects.
13. Click OK.
Note: CD media is "finalized" (no other writing to the media is possible) whenthe write operation is completed.
5.11.2 To Upload a Study to a DICOM Server from a CD
Only studies that are saved to the CD in Autoplay/DICOM or DICOM Only format can beuploaded to a DICOM server. The system writes image data to the CD, and it also writesa set of files, including the ImpDicom utility which is used to send images to a DICOM
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server. The ImpDicom.exe file is recorded to the APPS directory on the CD, if the study issaved in Autoplay/DICOM or DICOM Only format.
You can use the ImpDicom utility to upload a study, or you can use Image Viewer.
ImpDicom1. Insert the CD with a study saved in DICOM format into the CD drive.
2. Open Windows Explorer; navigate to the CD branch in the directory and open thatdrive.
3. Open the APPS directory.
4. Double-click the ImpDicom utility icon. The DICOM Import Study dialog displays.
5. In the Server IP/Name field, enter the server name or IP address; this is the DICOMserver to which you will upload the study.
6. By default, the Port is designated as 104. Overwrite this value only if the DICOMserver uses a different port.
7. In the Working Drives field, enter a directory where DICOM files are located. Click theellipsis button to browse a list of available directories.
8. Click OK.
Note: The study that is being imported must include a valid dicomdir file in orderto be recognized by the study import tool. The DICOM server specifiedmust then be accessible on the Local Area Network or via a VPN from theworkstation that is being used to run the import.
9. Click Run in the DICOM Import Study dialog to start the upload. The system willsearch for DICOM files in the chosen folder and all its subfolders and send themto the specified DICOM server.
10. Click Close. Click View Log to check the Log List.
Image Viewer1. Open the study to send in Image Viewer.
2. From the main menu, or by right-clicking to display the floating menu, select DICOMSend. The DICOM Import Study dialog displays.
Note: The feature's actual location depends on the layout configuration.However, the layout is saved to the CD along with the image data.Therefore, in order for the CD user to view the study in Image Viewerfrom the CD, you must insure that the DICOM Send item is on the mainmenu of Image Viewer or the floating (Study List) menu. See Main MenuConfiguration.
3. In the Server IP/Name field, enter the server name or IP address; this is the DICOMserver to which you will upload the study.
4. By default, the Port is designated as 104. Overwrite this value only if the DICOMserver uses a different port.
5. In the Working Drives field, enter a directory where DICOM files are located. Click theellipsis button to browse a list of available directories.
6. Click OK.7. Click Run in the DICOM Import Study dialog to start the upload. The system will
search for DICOM files in the chosen folder and all its subfolders and send themto the specified DICOM server.
8. Click Close. Click View Log to check the Log List.
To view Web content:
If the Web Content check box was selected, the system writes all of the study's imagesto the CD as .jpeg files, in addition to the images written in the DICOM or proprietary
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file format. You can view these images as thumbnails, in a Windows Preview utility;for example, but they are not for diagnostic purposes. The image quality makes themappropriate only for quickly familiarizing oneself with the content or sequence; evenwhen enlarged they are not for diagnoses.
Thumbnail files are recorded in the IHE_PDI directory of the target disk.
9. Insert the CD with Web content in the CD drive of your computer.
10. Use the Windows Explorer utility to open the CD drive and navigate to the IHE_PDIdirectory.
Expected Result: Thumbnails for each study written to the CD disk are saved intoa separate folder. The folder name does not refer to the patient name. Click thisfolder to open a list of thumbnails.
The list of thumbnails displays in the right pane of window. The icon to the left of each.jpg file indicates the file type. Use custom Windows operations to manipulate theimages.
5.12 To Import a Study1. Insert the CD that contains the study into your workstation's CD drive.
2. Click Import Study.
Expected Result: The DICOM Import dialog displays. At the top left of the dialog, theDICOM Server section defines the destination of the imported study; the study will beimported to that location. Typically these fields will default to values set by the systemadministrator. However, the values can be changed if necessary.
3. Change the destination of the imported study as needed:
● Server: Enter the IP Address of the destination server.
● Port: Enter the appropriate port for the destination.● Calling AE: Enter the DICOM Application Entity title to be used by the import
utility.
● Called AE: Enter the DICOM Application Entity title of the destination server.
4. In the Import From section, click the ellipsis ... and select the directory that containsthe study to import. (The OK button is inactive until a valid directory has beenselected.) Or, type the full path in the Import From text box.
5. After you click OK or enter a valid path, the DICOM Import dialog is populated withthe study information from the CD. Select the Validate Patient Info check box toenable the text fields.
Note: Each study that is being imported must include a valid dicomdir file inorder to be recognized by the study import tool. The DICOM serverspecified must then be accessible on the Local Area Network or via VPNfrom the workstation that is being used to run the import.
6. Select one or more studies that belong to the same patient.
Note: If you need to change accession numbers, select only one study.Accession numbers cannot be changed if multiple studies are selected.
7. If necessary, enter new information in the Patient Info fields to make the studiescorrespond to the identification conventions that your institution uses.
8. Click the Import Selected button to import only the selected (highlighted) study, orselect Import All to import all the studies on the CD.
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9. Select the following actions as needed:
● Break to stop the process at any time.● View Log to check the Log List and view a record of this action.
● Close to exit.
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The system automatically loads images to suit your viewing preferences. If you normallyview an MRI, for example, with all the study images on one sheet, the system allowsyou to do the same in the viewer. If you usually hang a hand x-ray upside-down, thesystem can load all your hand x-rays that way. You can establish a preferred view, basedon the study's modality, description and number of series; the system loads the studyaccordingly. See the configuration section.
Viewing features — such as comparing studies, swapping images and others — increaseyour flexibility and aid diagnosis.
6.1 To Access and Use the Series SelectorNote The toolbar has a Series Selector. The Navigator has a Study Selector.
1. To access the Series Selector, perform one of the following actions:
a. In the viewport for an open study, left click on the study date.
b. In an empty viewport, right-click.
c. Click the Series Selector icon ( ) on the toolbar to display the Series Selector.
2. On the Series Selector bar, click the “greater than” symbol (>) to display the studiesin the Series Selector.
In the Series Selector, the current series displays in bold. Other series for a patientthat are currently displayed in a viewport have a check mark next to them in theSeries Selector.
The Series Selector includes the following icons:
Icon DescriptionAn orange triangular tooltip icon indicates a partial demographicpatient match, based on partial first and last name, date of birth, andgender rather than Patient ID. Click the icon to view the informationand ensure the proper patient is displayed.
A box with a check mark indicates that the study is selected.
When Cross Enterprise Display is enabled, a curved arrow indicatesa remote study.
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This icon indicates that the study is offline. Click the study to bringonline.
An hourglass icon indicates that an offline study is in the processof being brought online.
Key Images are denoted in the Series Selector with “KO” in the Modality columnand “Of Interest” in the Description column. Click the row to launch a 2D viewportand show the key images.
Multiphase series may be split into multiple series, with the images grouped into oneseries per phase. If this image grouping feature is enabled by your site administrator,the series description has a prefix of “Ph” and the phase number, followed by a slash(/) and the original series description.
3. Do one of the following:
● To expand or collapse the tree view in the Series Selector, you can either hoverover a study or single-click the “greater than” symbol (>). Only one study isexpanded at a time.
● To display only series from a specific modality, check and select the desiredmodality from the ones displayed above the series list. Check All to display allthe series.
● To display series of the same body part, select Relevant. Select All Exams todisplay all the series.
Note:
● When Cross Enterprise display is enabled, selecting Relevant will displayrelevant remote studies that match the same body part. Relevancychecks for remote studies are only available for the languages CrossEnterprise Display supports. See Cross Enterprise Display (page 100)for more information.
● In some configurations, studies may be listed twice: as a zero-image localstudy and as a remote study with images.
● To open a series in a viewport, single-click the series.
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6.2 The Navigator in Universal ViewerThe Navigator displays thumbnail views of each series in the study, along with basicinformation about that series. The Navigator is particularly useful if the study containsmany series. By viewing series thumbnails, you can navigate the series, distinguishing allseries at once and opening those that are relevant or rearranging where series display.Thumbnails are also useful if your Internet connection is slow, because you can vieweach series as it loads. You can also drag and drop images from the Navigator to imageview areas or to 3D Advanced Applications.
Consider the following factors when using the Navigator:
● Depending on how the layout is defined, the Navigator can launch automatically.
● The mammography viewer has its own thumbnail display.
● If the system is set to open and compare anatomically-related studies automatically,then the Navigator shows the series from both studies, in separate rows headed byaccession number.
● The Navigator also displays series from remote studies. Remote studies are indicatedwith the icon.
Note: When Cross Enterprise Display is enabled, selecting Relevant will displayrelevant remote studies that match the same body part. Relevancychecks for remote studies are only available for the languages that CrossEnterprise Display supports. See Cross Enterprise Display (page 100)for more information.
● Remote offline studies (i.e. studies residing in a third-party PACS outside of the localfacility) will be unavailable for display in Universal Viewer until downloaded into a GEEnterprise Archive repository.
● The Image Grouping feature (if your site administrator has enabled it) splits amultiphase series into one series per phase. Each single-phase series will haveits own thumbnail in the Navigator. The thumbnail includes the series description,prefixed by “Ph” and the phase number.
● With a system configured for cardiology workflow, in most instances the thumbnailimage in the Navigator will be taken from the DICOM public tag “RecommendedFrame Number” rather than the first frame on the study.
● For local offline studies (i.e. studies stored in long term storage), series informationwill display in temporary thumbnail overlays while the study loads.
6.2.1 To Enable and Use the Navigator
� In Image Viewer, select Navigator ( ) or ( ). The icon toggles the navigator on/off.
The current active series are always bordered in blue; a white border indicates that theseries is displayed, but is not the currently active series. Series that are not displayedhave no border.
● To display a series, double-click the thumbnail.
Click and hold a thumbnail to see where that series is located in the main display. Theseries window flashes to indicate that it matches the thumbnail you selected.
● To view a series using one of the 3D Advanced Applications, drag its thumbnail to anopen 3D Advanced Applications viewport. You can do this with standard image series,3D Saved States previously created in the 3D Advanced Applications, and RadiationTherapy Structure Sets (RTSS). If you drag a standard image series thumbnail
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to the 3D Advanced Applications, you may see a dialog asking which protocol youwant to use.
Note: You may not be able to drag and drop RTSS images from the Navigatorto 2D viewports.
● To rearrange series within the Navigator, click and drag the thumbnail to a differentlocation in the Navigator.
Click and hold a thumbnail to see where that series is located in the main display. Theseries window flashes to indicate that it is the match for the thumbnail you've selected.
Note: This note only applies to a system configured for cardiology workflow:
To view a Secondary Capture as a thumbnail, select the SecondaryCapture check box under Navigator Study Presentation Optionsin User Preferences > Navigator. When this check box is selected,thumbnails for Secondary Capture images will have "(SC)" appended tothe thumbnail annotation.
Note: Thumbnails have to be set to a size between four (4) and twenty (20) inorder to be dragged in the Navigator. Thumbnails will resize automaticallyupon resizing the Navigator. Images of the series not loaded in theviewport can be scrolled.
6.2.2 The Study Selector
When you open the Navigator, the Study Selector displays. The default state of the StudySelector is expanded, but it can be collapsed so that it displays as a gray bar on theleft side of the Navigator.
Note In some configurations, studies may be listed twice: as a zero-image localstudy and as a remote study with images.
Study Selector Icons
The following icons appear in the Study Selector:
⧫ ICON DESCRIPTION
● The study is loaded into the Navigator.
● This icon indicates that the study is offline. Clicking the study will bring thestudy online.
● An hourglass icon indicates that an offline study is in the process of being broughtonline.
● Depending on your configuration, indicates that you have the study open.
● Another user currently has the study open. This feature helps diagnosingphysicians to make updates to only one copy of a study.
● Click this icon to view the study.
Note: If you open a study that another user is viewing, an alert displays thefollowing information: the name of the user who originally opened thestudy, the patient’s name, and the MRN. Click OK to view the study orCancel to return to the study list.
● A gray notepad indicates that no note or report is attached to the study.
● A yellow notepad icon indicates that a note is attached to the study.
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● A green notepad icon indicates that a final report is attached to the study.
● A pale yellow notepad icon indicates that an internal note has been attachedto the study.
● A pale green notepad icon indicates that a preliminary (wet read) report has beenadded to the study.
● A green check mark indicates Read or Reviewed status. A study may have a largecheck mark, a small check mark, both, or neither.
▪ A large green check mark ( ) indicates that the study has been read and markedas dictated.
▪ A small green check mark ( ) indicates that the study has been reviewed but notdictated. The Reviewed flag can also be used to mark studies read by residentsor ER physicians.
● When Cross Enterprise Display is enabled, a curved arrow indicates a remotecomparison study. Remote comparisons match the primary study using Patient ID orFull Matching (full patient first name, full patient last name, date of birth, and sex).
● When both and icons appear, the remote comparison is based on PartialMatching (a number of characters at the beginning of the patient’s first name and lastname with an exact match for date of birth and sex) rather than Patient ID. Hoverover the icon to view the patient’s entire first and last name and ensure the properpatient is displayed.If the Health Indicator shows that not all studies loaded successfully, the icon canindicate an error loading the study.
6.2.3 The Navigator and Adding and Removing Studies
1. If it is not already displayed, click the Navigator icon to display the Navigator.
Expected Result: The Navigator displays, along with the Study Selector, as a gray baranchored to the left side of the Navigator. The Study Selector will be displayed inthe expanded state by default. Therefore, the Study Selector may not be displayedas a bar unless saved in the collapsed state.
2. Do one of the following actions.
● To add a study to the Navigator, find the study in the Study Selector that you wantto add and single-click it. The study is added is added to the Navigator. A checkmark in the Study Selector indicates the study is loaded.
If you single-click a study in the Study Selector to add it and the study is alreadyloaded in the Navigator, the Navigator automatically scrolls to the thumbnails forthe study, showing that the thumbnails are already loaded in the Navigator. Thethumbnails in the Navigator are displayed in chronological order.
● To remove a study from the Navigator, double-click the study title. The thumbnailfor the study is removed from the Navigator.
● The report icon in the Study Selector indicates report information is available.To access the report information, click on the report icon .
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● The line below the date of the study folder icon in the Timeline alsoindicates that report information is available. To access the report information,click on the date.
● Configure a shortcut to show/hide a report. See Configuring the System (page309) for more information.
● The show/hide report toggle closes the report window only if the text in the reportwindow in not in focus.
● The show/hide report toggle is unavailable on AW embedded viewports, Tomtecviewports, and the Notes/Reports and Orders window.
6.2.4 To Use the Navigator to Page through One or More Series
The Navigator lets you page through one or more series page by page, according to theorder of the thumbnails that are displayed in the Navigator.
Paging through one or more series is mainly used for reviewing MR images. Default MRhanging protocols use Overview viewports only. Alternately, you can define Overviewviewports only hanging protocol by using the from Layout-Hanging Protocol Tool.
You can also use the Quick Cycle feature to navigate quickly between series. SeeNavigating through Multiple Series with Quick Cycle for more information.
Note With a system configured for cardiology workflow, the Navigator (bydefault) will not open when both of the following conditions are in effect:
● there is only one monitor being used
● a Tomtec placeholder exists in the hanging protocol for the current study
1. If you have not already done so, configure the toolbar to add the Next Sheet andPrevious Sheet toolbar icons. See To Configure the Main Toolbar for more information.
2. In the viewport, use the Overview viewports and regular viewports to create a hangingprotocol. There are two patterns to create a hanging protocol for MR images. Onemethod is using Overview viewports only and the other method is using a mixof overview viewports and standard viewports. To create an Overview viewport,right-click in the Hanging Protocol Editor and select Overview.
Example:
● You might define a regular viewport with hanging criteria "series desc = scout"in the leftmost placeholder, and in the Overview viewports you might defineother placeholders. In this example, you can page through all series whilekeeping the scout series displayed in a separate viewport.
● You might define an Overview viewport for the primary study and anotherOverview viewport for the comparison study. In this example, you can pagethrough the series of both the primary and the comparison studies at thesame time.
3. Drag and drop the desired series in the Navigator, in the desired order of display forpaging view.
Expected Result: The series display following the order of the navigator. If you decideto change the order by dragging and dropping a thumbnail at another place within thenavigator, the viewports automatically refresh to display the first series.
4. If you load a hanging protocol that loads a study with multiple series, you can use theNext Sheet and Previous Sheet icons to page through all the series.
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6.2.5 Navigating through Multiple Series with Quick Cycle
Quick Cycle is a feature available for the Original Series, Overview, and Copy viewportsthat allows you to navigate through multiple series in the Navigator. You can use thenavigation controls available in the viewport title bar, or you can create keyboard shortcutsfor the Next Series and Previous Series commands (see Configuring Shortcuts for moreinformation on creating keyboard shortcuts). The navigation controls in the title bar alsoinclude a button to toggle scrolling through multiple series one image at a time.
Note The series viewport must be active in order for navigation to work. In addition,this navigation is unavailable in Sheet View mode.
To navigate through multiple series by entire series:1. Load multiple series in the Navigator.
2. Open a series viewport from the Navigator.
3. Click the Next Series ( ) and Previous Series ( ) buttons, or use the keyboardshortcuts that you created for Next Series and Previous Series, to navigate betweenentire series.
When navigating using Next Series, the navigator will stop at the last series and notloop to the first series. When navigating using Previous Series, the navigator willstop at the first series and not loop to the last series.
To navigate through multiple series one image at a time:1. Click the scroll toggle button ( ).
2. Click the Next Series ( ) and Previous Series ( ) buttons, or use the keyboardshortcuts that you created for Next Series and Previous Series, to navigate betweenimages.
● When you reach the last image of a series while scrolling forward, continuing toscroll forward will load the first image of the next series. If you are at the lastimage of the last series, nothing will happen.
● When you reach the first image of a series while scrolling backward, continuing toscroll backward will load the last image of the previous series. If you are at thefirst image of the first series, nothing will happen.
6.2.6 Display Middle Image in Navigator
When the Display Middle Image check box is selected, each series thumbnail in theNavigator displays the middle image of the series when the Navigator first opens. Forexample, if there are 30 images in the series, the Navigator thumbnail shows the 16thimage.
Note
● If a series is open in the viewport, the Navigator thumbnail shows the currentimage in the viewport. When scrolling, the images in the viewport and thumbnailssynchronize.
● If the Display Representative Frame, if present, for Multiframe Series checkbox is selected, the Navigator thumbnail shows the representative frame evenif the Display Middle Image check box is selected.
To configure, do the following:
1. Select Layout from the Image Viewer menu.2. Select Edit to display the Layout Editor.3. Click More Settings.
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4. Under Navigator, select the Display Middle Image check box.5. Click Apply and Save. If you want to save it with a different name, click Save As and
enter the name. (For Used By, Personal is selected by default.) Then, click OK.6. Click Close and Done.
6.2.7 To Set Defaults from the Navigator
You can use the Navigator to define default behavior for certain aspects of the viewer.
1. Right-click in the Navigator. Click Navigator Options.2. Select an icon and set its properties.
3. Click OK.
6.2.7.1 Mouse Preferences
To scroll through images in a series:1. Hold down the left mouse button and drag the mouse up or down.
To change the scrolling options:1. Right-click in the Navigator.
2. Click Navigator Options.3. Select Mouse ( ) and set the following options:● Scroll Modes: Lets you control how many images you want to navigate through
in an image series based on mouse drag speed.
Note: To use Anatomic and Dynamic pagination in Native MPR viewports,you must define a volume in the series.
● Manual: Controls how many images you navigate through in a series baseddirectly on the mouse drag speed. The length of the series does not affectthe scrolling rate.Based on mouse drag speed, Manual scroll mode can page through everyimage within the image series without skipping any images.Paging through images in Manual scroll mode is slower than Dynamic andAnatomic modes.
● Dynamic: Allows faster pagination through images within a series. Theamount you move your mouse corresponds to the percentage of the totalseries length that you scroll through. If the series is longer, you scroll throughmore images with the same mouse movement. If the series is shorter, youscroll through fewer images.Dynamic scroll mode pages through images within a series with fewer mousemovements, by skipping images based on mouse drag speed.
Note: When paging through images in Dynamic scroll mode, the mousecursor does not appear unless images are skipped. Images areskipped when you drag the mouse quickly.
● Anatomic: Allows faster pagination through images within a series. Theamount that you move your mouse across the in-body portion of the image,corresponds to number of pages you scroll through. The scrolling rate adjuststo the size of the body in the image.Anatomic scroll mode pages through images within a series with fewermouse movements, skipping images based on the amount of in-body distancecovered by mouse drag.
● Slow — Fast: Controls the drag rate.
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● Double-click — Fit to screen with double-click: When checked, the serieswindow can be expanded with a double-click anywhere inside that window. SeeImage Viewer for more information.
● Scrolling Direction Up: Indicate whether scrolling up increases or decreasesthe image number.
● Maintain Scrolling Speed: Select to skip slices in order to maintain the rateof navigation.
● Limit scrolling memory usage to: When scrolling, the system loads all theimages into the series into memory up to the scrolling memory usage limit set here.
● Quick Cycle:● Enable Auto-Scroll On Launch: Select or clear the check box to set the
scrolling behavior.
▪ Select the check box to enable Auto-Scroll on all viewports.
▪ Clear the check box to manually enable Auto-Scroll on a viewport.
This preference works in combination with Loop Scroll to set Quick Cyclestack scrolling behavior. The table indicates how the scrolling behaviorchanges when the Auto Scroll and Loop Scroll settings change.
Enable Auto-Scroll On LaunchOn Off
On All stacked series considered asone series, so that you can see allseries by stack scrolling. At theend of images in the last series,you automatically return to the firstimage of first series.
Loops the image while scrollingwithin the selected series.
LoopScroll
Off All stacked series considered asone series, so that you can see allseries by stack scrolling. At theend of images in the last series,loop scrolling ends.
Stops scrolling images when thelast image of the series is reached.
● Loop Scroll: Select the check box to loop through all series while scrollingthe images; clear the check box to loop through the selected series only.
Note:
● Loop scroll works using mouse scroll, Up/Down arrow key, and fastforward/backward shortcut keys. When scrolling images using the
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fast forward/backward shortcut keys, loop scrolling occurs only withinthe current series.
● Loop scroll works using Quick Cycle next/previous buttons. See“Navigating Through Multiple Series with Quick Cycle” for moreinformation.
● Page Scrolling on the toolbar is unavailable for use with loopscrolling.
● In Quick Cycle, while changing the series, loop scroll jumps to the firstor last image of a series.
● The following layout settings do not apply when Loop Scroll is active:
● Display first image
● Display middle image
● Display image with saved number
● Display first non-localizer image
4. Click Apply, and then click OK.
6.2.7.2 Overlays
The system supports the display of graphic DICOM data. These overlays cannot bealtered as they are captured at the scanner, but the color of the pixels can be changed. Ifmultiple graphics exist, each layer is assigned a unique color to differentiate it from theothers. The colors are assigned according to the sequence defined in this tab.
1. Right-click in the Navigator. Click Navigator Options.2. Select Overlays.3. Select the Color Overlays check box to enable the Overlay Color Sequence panel.
The Overlay Color Sequence panel shows the existing color sequence. The topmostcolor is assigned to the first graphic overlay, and the sequence goes down from there.
● To reorder a color, select it and click Up or Down.● To add a color, select a black bar and click Add, select a color from the Color
Palette, and click OK.● To delete a color, select it and click Delete.● To change a color, select the color to change, click Change, and select a new
color from the Color Palette. Click OK to save and close the Color Palette window.
4. Click OK to save your selections.
6.2.7.3 Navigator
1. Right-click anywhere in the Navigator. Click Navigator Options.2. Select Navigator.3. Drag the indicator to set the size (small to large) of the thumbnail images, or select the
maximum number of thumbnails to include in a row (width of screen). If the size is11-20, the thumbnails cannot be dragged in the Navigator.
4. To display certain fields of data in the thumbnail, select the check box next to thatdata. If you check Accession Number, for example, that data will display in theheader above each study in the Navigator.
5. Select the width and the color for the line that separates each study in the Navigator.
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6. Select the Download Progress Indicator check box to display an hour glass thatindicates the progress of a download. The hour glass displays on the thumbnails untilthe series download is complete. The default setting is unchecked.
7. Click OK.
6.2.7.4 Study Category Indication
Since anatomically-related studies can be set to open simultaneously with the primarystudy in compare mode, you can distinguish between primary and comparison studiesat a glance. The primary study is displayed with the border width, style, and colorselected. The primary study displays the date on the title bar and the label “Primary”.Comparison studies are displayed with the same border and each comparison studyis labelled “Comparison”.
1. Right-click anywhere in the Navigator. Click Navigator Options.
2. Select Study Category Indication .
3. In the Primary and Comparison panels, click the Draw Frame check box to distinguishthis study by surrounding its series windows with a uniquely-styled frame.
4. Click the Double Line check box to double the frame.5. From the drop-down list, select a width for the frame. If the width is 1 pt, then the Line
Style drop-down list is activated, and you can select solid, dashed or dotted. Theseoptions are not available for widths over 1 pt.
6. Click Color to select a color for the frame. Once selected, click OK in the colorselection palate. A sample frame showing the selection results appears in thecategory section.
7. Click OK to accept the settings.
6.2.7.5 3D Anchors
Use 3D Anchors to attach measurements to the anchor when it is defined. In PET images,the measurement displays in SUV; in CT images, the measurement displays in Hounsfieldunits.
1. Right-click anywhere in the Navigator. Click Navigator Options.2. Select 3D Anchors.3. Select Attach Measurement.4. Select Show Measurement to display a floating indication of the measurement when
the mouse is hovered over the anchor.
6.2.7.6 Percentage of Images Displayed Indicator
1. Right-click anywhere in the Navigator. Click Navigator Options.
2. Select Percentage of Images Displayed Indicator ( ).
Expected Result: The user preferences display in the dialog. These preferences areset independently of each other and function independently of each other.
● Check box for Indication: Shows/hides the Percentage of Images DisplayedIndicator on the title bar of each viewport and on the thumbnails in the Navigator.
If selected, the system displays a Percentage of Images Displayed Indicator ineach series thumbnail in the series Navigator to indicate approximately howmany images have been viewed. The Percentage of Images Displayed Indicatoralso displays on the title bar of each viewport and tells the user, at a glance,
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approximately what percentage of images in that series and in that viewport havebeen displayed
Note: The formula to calculate the percentage of images viewed is asfollows:
(Number of Images viewed *100) / (Total Number of Images in theSeries Viewport / Global Stack / Overview/ Sheet View)
When the value resulting from the formula is fractional, it is roundedoff to the lower value (for example, 35.4% to 35%).
● Check box for Not All Images Displayed: Shows/hides a message if a “MarkDictated” action is selected and one or more images of the primary study havenot been displayed.
3. Select the desired user preferences.
4. To apply the user preference to your current session and for use in your futuresessions, click Apply or OK.
6.2.7.7 Miscellaneous
1. Right-click anywhere in the Navigator. Click Navigator Options.
2. Select Miscellaneous .
3. Select the Hide Loading Progress Bar check box to hide display of the progress bar.4. Select the VOI LUT check box so that the system checks the DICOM header for a VOI
LUT. The first VOI LUT found is used as the Recommended W/L preset.
5. Select or clear the check box for Hide PET-CT feature disable message.6. Select or clear the check box for Automatic Display Notes.7. Select or clear the check box for Show study already open message once per
patient.
Note: This setting applies to the Mammography Workstation and suppressesmultiple pop-up messages. See “Suppressing Mammography WorkstationPop-up Messages” for more information.
8. Click OK to save your changes.
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6.2.7.8 To Set Cross Enterprise Display Options
From the Navigator, set preferences to show or hide indicators and notifications for CrossEnterprise Display:
● The status of responses from remote sites after a request is sent by the local site.
● Information for patient studies that use partial matching criteria.
Important Partial demographic matching, an option for identifying a patient’sremote comparison exams in a Cross Enterprise Display setting, maybe less accurate than matching using the Patient ID. When using partialdemographic matching, check the patient information to ensure acomplete match when the primary and comparison studies first display.
1. Right-click anywhere in the Navigator. Click Navigator Options.
2. Select Cross Enterprise Display .
3. For the Hide XED pop-up notifications field, clear the check box to show CrossEnterprise Display notifications, or select the check box to hide Cross EnterpriseDisplay notifications.
4. For the Hide notification about partial demographic matching field:
a. Clear the check box to display the Potential Patient Mismatch dialog box whenopening a partial match study for the first time in a Viewer session. The dialogbox shows a message about the matching criteria and the difference between thePatient Name of the primary and remote comparison. Click Acknowledge andOpen to display the remote comparison study.
b. Select the check box to prevent the Potential Patient Mismatch window fromdisplaying. The partial match icon still displays on the partial match studies in thetimeline, series selector, study selector, patient folder, and viewport.
5. Click OK to save your selections.
6.2.7.9 Cine (for Cardiology Workflow)
To enable automatic cine playback for images displayed in cardiology cinemodeNote: Progressive cine allows for cine images to be delivered with progressively
increasing image quality up to full fidelity when using slow networks. See “ToConfigure Progressive Cine.”
1. Right-click anywhere in the Navigator. Click Navigator Options.2. Select Cine.3. Select Start playing Cine automatically.
6.2.7.10 Multi-monitor Setting
Use the Multi-Monitor setting to exclude a monitor from the workspace, select theresolution, or designate a monitor as color or gray scale.
You can have a Regular monitor treated as a Medical monitor or a Medical monitor treatedas a Regular monitor. In addition, Mammo monitors can be treated as Medical or Regularmonitors. This feature allows you to apply a hanging protocol which specifies monitorsconfigured differently from your physical monitor configuration.
Note Regular or Medical monitors cannot be treated as Mammo monitors.
You can assign these values to all users of this workstation or only yourself.
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Note The setup cannot contain an excluded monitor that separates two activemonitors. The active monitors must be contiguous. For example, in a fourmonitor setup, you cannot exclude only monitor 2, but you can excludemonitors 1 and 2 or all monitors except monitor 3.
1. Right click in the Navigator and select Navigator Options > User Preferences >Multi Monitor Setting.
2. Click the Multi-Monitor Setting icon(s) ( ) to exclude from Image Viewer for futurelaunch(es). The order of monitor icons displayed in the Current Monitor Setting showsthe physical arrangement of monitors on the workstation. The monitor name(s) showunder Excluded Monitor(s).
3. For the Gray Scale Setting, select the check box under the monitor to indicate thatthe monitor is a gray scale monitor, or clear the check box to indicate the monitoris a color monitor.
Note: To improve contrast for optimal viewing of triangulation marks and studyseparator headers, select the Gray Scale Setting check box when usinga gray scale monitor.
4. For Monitor Resolution, the categories are determined using resolution by default.
● Regular (<2 MP)
● Medical (between 2 and 5 MP)
● Mammo (>5 MP)
5. (Optional) Click the arrow beside a monitor resolution to change the default resolutionof a Regular to a Medical monitor, a Medical monitor to a Regular monitor, or aMammo monitor to a Regular or Medical monitor.
6. Select the type of setting:
● For all users of this specific workstation, click Workstation Default. You musthave the appropriate privileges to save a Workstation Default. Note that selectingWorkstation Default overwrites that specific user’s My Setting.
● For a user-specific setting (this setting overwrites Workstation Default for thisuser only), click My Setting.
7. Click OK.
6.2.7.11 Window Leveling
Note
● This configuration parameter impacts PET modality images only, and applies toall PET images that the user opens.
● The hanging protocol Invert preference selection overrides this window levelingbackground color selection.
Based on user preference, PET images may be viewed with a white background(interpreted as a Monochrome 1 image) or a black background (interpreted as aMonochrome 2 image).
1. Right-click anywhere in the Navigator. Click Navigator Options.2. Select Window Leveling.3. To view PET images on a white background, select the Display PET images with
white background (Monochrome 1) check box (default setting).4. To view PET images on a black background, uncheck the Display PET images with
white background (Monochrome 1) check box.5. Click OK to save the selection.
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6.2.7.12 Snap Tool
The snap tool allows you to display a thumbnail in a specific viewport with a single clickwhen the Navigator is open.
� When the Navigator is open, hold down the mouse pointer on a thumbnail.
● If the thumbnail is already displayed in a viewport, the outline of the viewport blinksto indicate the location.
● If the thumbnail is not displayed in a viewport, a red graphic indicates the hangingprotocol. Highlight a viewport and release the mouse pointer to display the thumbnailin that viewport.
6.2.7.13 Dock the Navigator
Available docking positions depend on your workstation setup:
● One monitor setup: left/right/top/bottom
● Multi-monitor setup with the first monitor used for RIS/HIS/EMR/etc. All UniversalViewer monitors have the same resolution: far left or far right within the CentricityUniversal Viewer frame
● Multi-monitor setup with the first monitor used for RIS/HIS/EMR/etc. Universal Viewermonitors have different resolutions: far right only within the Centricity UniversalViewer frame
In this example, the color low-resolution monitor is used for a RIS and two mid-resolutionand two-high-resolution monitors comprise the Centricity Universal Viewer frame. Sincethe monitors have different resolutions, the only available docking position is on the farright.
After docking, the Navigator displays in the same position for subsequent studies youopen.Note You can also toggle between showing and hiding the Navigator using the
shortcut N or clicking the Navigator icon on the toolbar.
1. On the viewer window, hold down the mouse pointer on the Navigator title bar.
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Expected Result: After a moment, arrows display along the sides of the screen and a
four-pointed arrow displays in the middle of the window.
2. Move the Navigator to the desired location and release the mouse pointer.
Expected Result: The Navigator is docked.
6.2.7.14 Navigator "Save" and "Open" State
When exiting the viewer or applying user preferences, the Navigator size, position,docking, pinning, auto-hide, and Study Selector and Timeline states, are saved. Thenext time the viewer is launched, the Navigator opens in the saved state.
Note The following exceptions are not saved:
● The Navigator position on the non-diagnostic monitor
● A repositioned Navigator that is covered, for example, by the Patient Folder● The docked Navigator after it has been resized
● A Navigator in the middle of two monitors
● A Navigator that is a part of an applied HP
6.3 EchoPAC ViewerEchoPAC PC plugin is a post-processing program designed for ultrasound image reviewand analysis. The EchoPAC PC plugin allows post-processing of raw data images fromGE ultrasound scanners and DICOM ultrasound images.
EchoPAC has a floating license. The associated privilege is EchoPAC Base. On the UVserver, there is also a specific admin group, namely EchoPAC Base, which containsthat privilege only.
EchoPAC is launched when the user has EchoPAC privileges, when there is an availablelicense, when ultrasound studies are opened with one of the supported modalities, andwhen primary studies are from either GE or supported third-party scanners.
EchoPAC has the following capabilities:
● Create measurements: Saves measurements as DICOM SER
● Create new images: Creates new Ultrasound and Secondary Capture images
● Export measurements to CVIS : Allows the transfer of measurements to CVIS
● Compare Previous Studies: Allows you to compare the most recent studies fromany vendor’s ultrasound machine.
Note The date/time format for EchoPAC is determined by the date/time settings inthe Web Client viewer; however, when integrated with CVIS the date/timeformat is determined by that which is set in CVIS instead.
For further information, refer to the EchoPAC Plugin User Manual or EchoPAC online help.
6.3.1 To Add an EchoPAC Viewport to an HP
If your system is configured for cardiology workflow, you can embed an EchoPAC windowinto a viewer window for US studies.
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Note It is not possible to select an HP containing an EchoPAC Viewport unless theuser has the privilege EchoPAC Base.
1. Select Layout > HP Tool from the viewer menus to open the Hanging Protocol Editor.
2. Double click on the monitor where you want to embed the EchoPAC viewport.
Note: The monitor selected cannot be the middle monitor in a 3–plus monitor HP.
3. Select EchoPAC from the menu.
Note: The viewer will only run on a color monitor for echo studies.
4. Once you’ve specified which monitor you want to use for EchoPAC, you can specifythe rest of the HP normally.
Note: You can only have one EchoPAC viewport defined in an HP. EchoPACtakes up the entire layout on that monitor (that is, EchoPAC displays ina 1 x 1 layout only).
5. Like any other HP, you may Apply the HP to the current view or Save the HP forlater use.
6. Click Close to return to the viewer.
The EchoPAC viewport hides the Web Client cardiology cine toolbar. Use the cinetool in the EchoPAC viewport instead.
6.3.2 Configuring EchoPAC
Follow the steps below to customize EchoPAC launch parameters.
1. Create a new tab in Layout Editor > Integrations.2. Name the new tab EchoPAC.3. Select a value under Export Measurements from EchoPAC to CVIS Reports. The
values are Automatic and Manual (default).4. Select a value in the Tiling drop down list. The values (ColRow) are 1x1, 2x1, 3x1,
4x2, 3x3 and 4x3. The default is 2x2.5. Select a value from the Number of Recent Priors to Include drop down list. The
values are from 0–10. The default is 1.6. Select a value under Notify when there are more recent priors than configured
above. The values are Enabled (default) and Disabled.7. Select a value under Restrict EchoPAC use to primary studies from GE
equipment. The values are Enabled (default) and Disabled.
6.3.3 Launching EchoPAC
Manual EchoPAC HP Launch
After creating an EchoPAC HP, selecting it launches the plugin. See the section titled “ToAdd an EchoPAC Viewport to an HP” for more information on creating an HP.
Note: It is only be possible to have one instance of EchoPAC running at a time. IfEchoPAC is open and another viewer is selected (even if is not EchoPAC),EchoPAC temporarily closes until the EchoPAC Viewer is re-selected by theuser.
If the any of the following is NOT true, the HP is blocked:
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1) The monitor is color.
2) At least one of the series has the Modality of “US.”
3) The user has EchoPAC Base privilege.
4) The EchoPAC Base license is acquired.
5) The Manufacturer Model Name setting is enabled (see the section titled “ConfiguringEchoPAC”), and at least one series in the study has a Manufacturer Model Name tag(0008,1090) from the following list of valid EchoPAC values:
● Vivid 3
● Vivid 7
● Vivid E7
● Vivid E9
● Vivid E80
● Vivid E90
● Vivid E95
● Vivid i
● Vivid q
● Vivid S5
● Vivid S6
● Vivid S60
● Vivid S70
● Vivid T8
● EchoPAC PC Integrated
● EchoPAC
● EchoPAC PC
● EchoPAC PC SW-Only
● EchoPAC 7
When EchoPAC is launched, a launched file will have the following settings:
1) The language is based on the settings in the UV or the CVIS.
2) The date format is mapped to the UV setting.
3) The time format is mapped to the UV setting.
4) The sort order is set to the content date and time.
5) The units are set to metric.
6) The tiling is based on the Layout setting.
Saving New Objects
Measurements (DICOM SR files) and images created by EchoPAC are saved whenEchoPAC is exited.
Launching Another Viewer Session
If an EchoPAC session is active and the user opens another Viewer session, the firstEchoPAC session is temporarily suspended. When the second Viewer session is closedor hidden, the first EchoPAC session is restored, which may cause a slight delay asthe data is reloaded.
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6.4 Tomtec ViewerThe Cardiology Advanced Analysis viewport allows you to embed the TomTec-Arenaproduct for ultrasound and cath lab studies into a Universal Viewer window. .
This Tomtec viewport is used specifically for US and XA studies.
Priors of the same modality (US or XA) are listed in the Tomtec viewport. Priors ofother modalities are listed in the FOLDER and are displayable in comparison mode ona 2nd monitor.
When Tomtec closes, it saves SR files into the same study on the server.
All of the features of Cardiology Advanced Analysis are enabled with a user privilegeand a purchased license. Contact your administrator to have your privileges configuredfor cardiology workflow.
Note The date/time format for Tomtec is determined by the date/time settings in theWeb Client viewer; however, when integrated with CVIS the date/time formatis determined by that which is set in CVIS instead.
6.4.1 To Add a Cardiology Advanced Analysis (Tomtec)Viewport to an HP
If your system is configured for cardiology workflow, you can embed a Tomtec-Arenawindow into a viewer window for US or XA studies.
Note It is not possible to select an HP containing a Cardiology Advanced AnalysisViewport unless the user has the privilege IC_2DCardiologyReview-Enable.
1. Select Layout > HP Tool from the viewer menus to open the Hanging Protocol Editor.
2. Double click on the monitor where you want to embed the Tomtec viewport.
3. Select Cardiology Advanced Analysis from the menu.
Note: The viewer will only run on a color monitor for echo studies; for cath, bothcolor or black/white monitors are supported.
4. Once you’ve specified which monitor you want to use for Tomtec, you can specify therest of the HP normally.
Note: You can only have one Tomtec viewport defined in an HP. Tomtec takesup the whole layout on that monitor (that is, Tomtec displays in a 1 x 1layout only).
To replace a Tomtec viewport with a Web Client viewport, just return to the HP editorand drag an image to the monitor.
5. Like any other HP, you may Apply the HP to the current view or Save the HP forlater use.
6. Click Close to return to the viewer.
Note: The Tomtec viewport hides the Web Client cardiology cine toolbar. Usethe cine tool in the Tomtec viewport instead.
6.5 Comparing StudiesDifferent studies can be displayed side-by-side for comparison purposes. For example,you can display recent studies for a particular patient, to determine any changes in a
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region of interest, or you can display the last two brain CTs performed by your department,for training purposes. You could also display studies of different modalities, comparing apatient's brain CT with an MR, for example. Any number of studies can be compared.
You can launch comparison mode from the Study List or the Patient Folder.
You can set the system to open the anatomically-related study automatically forcomparison each time a study is opened.
Note
● When you open a study to compare to the primary study, that study is labeled asa comparison study. Even when the comparison study is more recent than theprimary study, the more recent study is considered a comparison study.
● When using Universal Viewer configured with an EA backend (example: in aCardiology workflow), the Auto Load Comparison user preference behaviordiffers from other configurations. When selecting All studies or Non-dictatedstudies with the EA backend, a drop down menu does not display. Instead, thesystem automatically loads one comparison. In other configurations, Auto LoadComparison can load up to nine comparison studies.
6.5.1 To Compare Studies
1. From the Study List, select the check boxes next to the studies to compare.
2. Click Compare on the toolbar, or right-click anywhere and select CompareSelected Studies from the floating menu, or select studies for one patient and clickthe check box for that patient's study.
3. Right-click to display a floating menu and select All Studies for Selected MRN. Thestudies for that particular Medical Record Number are displayed as a Study List.
4. Select the studies to compare and click Compare from the Study List toolbar.Studies are loaded into Image Viewer for comparison. (See Configure HangingProtocols to set up the comparison display.)
Note: The Synchronize and Cross-Reference can be applied to any displayedseries. For example, you can set the system to page related imagesfrom two different studies in concert. See Inter-Series Synchronization.Accordingly, the Navigator shows thumbnails for both studies.
Note: Anatomically-related studies can be set to open automatically in comparemode. See Organizing Studies.
6.6 SwappingYou can switch the location of an image in your display. If one image shows the optimalview of the region of interest, for example, you can bring that image to the foremostposition in the monitor nearest to you. This feature is called swapping. Just as the nameimplies, it simply swaps the position of two images. This feature is advantageous whenyou are working with multiple monitors and rearranging multiple series.
Swapping is enabled in Stack View, where every series in a study opens in its ownwindow. You can swap using the title bar or the Navigator.
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6.6.1 To Swap Using the Title Bar
The title bar of every window gives information about the series in that window, such asthe series number and a date/time stamp. The title bar also contains the swap icon.
� Click and hold the swap icon of the image you want to move. A thumbnail of theimage floats near your mouse pointer.Drag the thumbnail to the image you want to replace and then release the mouse. Thetwo images trade positions.
Note: Swap moves the entire series to the new position, not just that one image.The image sequence in both series is preserved.
6.6.2 To Swap Images within the Navigator
1. In the Navigator, click and hold the mouse on the thumbnail of the image to swap.The actual image flashes to indicate its current position.
2. Drag the thumbnail to a new position in the Navigator. Although the Navigator mayshow rows of thumbnails, indicating that multiple studies are open, an image can beswapped only with another from the same study. In other words, the thumbnail cannotbe moved to a new row in the Navigator.
Note: You can swap images in the key images preview. See Defining KeyImages.
6.7 Stack (Series) ViewWith MRI and CT studies, the images are normally acquired in more than one run. Eachrun is a series, also sometimes known as a scan or sequence. So, two or more series maycomprise one study. In Stack View, the system displays multiple series on the screen,each in a separate window. The title bar for each window shows the series number.(Use a hanging protocol to set a default view mode for a modality.) Thus, a study withfour series will open four different windows.
Since each window holds a "stack" of images, i.e., the images in that series, you can scrollthrough the stack to see those images. You can scroll through one series at a time ormultiple series simultaneously. Scrolling through multiple series simultaneously gives youa dynamic view of the region of interest, as all the images move in concert. You can alsoadd a cross-reference line to show the region of interest while viewing it from divergentplanes. You can tailor the way Universal Viewer functions when in Stack View, includinghow the toolbars, menus and features operate.
6.7.1 To View the Images in a Series
Click anywhere in the window of the desired series to make it active.
Click the left mouse button, or click the mouse roller down, or click the down arrow onthe keyboard, to advance one by one through the "stack" of images in the active series.Click the mouse roller up, or click the up arrow on the keyboard, to see the previousimage. See the section on Paging/Scrolling.
OR
1. Click anywhere in the window of the desired series to make it active.
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2. Click Page Format on the menu bar, or right-click to select it from the floating menu.A list of choices is displayed, showing Number of Columns X Number of Rows. Forexample, 3X2 would arrange the images in the stack window in three columns andtwo rows (i.e., six images on one screen).
3. Select your desired choice. The small window pops up displaying only that series'images in the selected format.
6.7.2 To View the Images in Multiple Series Simultaneously
Note You can configure a shortcut to link/unlink series for synchronization. SeeConfiguring the System (page 309) for more information.
1. Click Synchronize on the toolbar.
2. Click in the window of any series.
3. Click the left mouse button once, or scroll the mouse roller up or down, to see theprevious or next image in parallel series. All images in series with cuts in the sameplane will move in concert.
To “unlink” a series from synchronization:1. Click the synchronized icon ( ) at the top of the viewport showing the series for
which you want to disable synchronization.
To reestablish synchronization on the series:1. Click the unsynchronized icon ( ) at the top of the viewport.
6.8 To Display and Use the TimelineThe Timeline is a graphical display of the studies for a single patient, using a Timelineformat.
1. If the Navigator is not displayed, click either the Navigator icon ( ) or the Timelineicon ( ).
Expected Result: Timeline will be displayed in the expanded state by default.Therefore, the Timeline may not be displayed as a bar unless saved in the collapsedstate.
2. To hide the Timeline, click the Hide icon ( ) in the Timeline title bar. To show the
Timeline, click the Show icon ( ) in the Timeline title bar.
Expected Result: The chronological Timeline displays, with a tile for each studygrouped by dates associated with the patient selected.
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Tile Description
Darker-colored tiles with an angled corner are relevant studies.Relevant studies are studies of the same body part.
Lighter-colored tiles without the angled corner are not relevant studies.
A shaded folder within the tile indicates that the study is loaded intothe Navigator.
An unshaded folder indicates that the study is not loaded.
The primary study shows a single 1-point border around the tilewhen configured in the Study Category Indication under NavigatorOptions.
When Cross Enterprise Display is enabled, remote studies (imagingstudies that reside in DICOM repositories outside of the local facility)display a curved arrow ( ) in the lower left corner of the tile. Remotestudies can be accessed and reviewed alongside local studies withinsame Viewer instance. The remote study may be matched usingPatient ID or Full Demographic Matching (full first name, full lastname, date of birth, and sex).
When a remote comparison study uses Partial Demographic Matching(a number of characters from the beginning of the patient’s first andlast name along with the exact date of birth and sex), an orange
triangular icon appears in the upper right corner of the tile along
with the remote study indicator in the lower left corner. Theicon can also indicate an error loading the study.
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Tile Description
Offline studies display a download indicator ( ). An offline studycan be either local (stored on long term storage) or, if Cross EnterpriseDisplay is enabled, remote (residing in a third-party PACS outsideof the local facility).
Studies in the process of loading display an hourglass indicator ( ).
3. To display additional information about a study, hover over that study. A tooltip listsadditional information about the study.
4. You can use the plus and minus buttons (+ and -) at the top right of the timeline tozoom in and zoom out from the current view. A zoomed-in view provides more detailabout the studies, including the ability to access the report. A zoomed-out viewprovides less detail about the studies.
In the zoomed-in view, an underlined study date in the Timeline indicates reportinformation is available. To access report information, click on the underlined studydate.
5. To add a study from the Timeline as a thumbnail in the Navigator, click anywhereabove the date in the study tile. The study is added as a thumbnail to the Navigatorand the Navigator scrolls to the thumbnail of the study you added.
6. To remove a study from the Navigator, double-click the study tile. The thumbnail forthe study is removed from the Navigator.
6.8.1 Configure Navigator Thumbnail Size
The Timeline thumbnail size may be configured based on the number of thumbnailsdisplayed within the width of Navigator window.
Note The following exceptions are not saved:
● The Navigator position on the non-diagnostic monitor
● A repositioned Navigator that is covered, for example, by the Patient Folder● The docked Navigator after it has been resized
● A Navigator in the middle of two monitors
● A Navigator that is a part of an applied HP
1. Under the User Preferences menu, select Navigator.2. Configure the thumbnail size under the Thumbnail size frame:
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● Maximum Number of thumbnails per screen width: Use the scroll to adjustthumbnail size based on the maximum number of thumbnails that fit within thewidth of the Navigator window.
● Minimum Number of thumbnails per screen width: Use the scroll to adjustthumbnail size based on the minimum number of thumbnails that fit within thewidth of the Navigator window.
● Wrap Thumbnails: When the checkbox is selected (the default setting), thethumbnails wrap to the next row when there’s no more space for thumbnailson the current row.
The minimum and maximum settings above limit the number of thumbnails to display.A scroll bar will appear if the total number of thumbnails exceeds the maximum setting.
Note: When the Navigator window is re-sized, each thumbnail size will adjustaccordingly to fit within the width of the window.
6.8.2 Configure Border For Timeline Thumbnails
You can configure the Timeline thumbnail border style, color, and visibility. Attributes canbe assigned independently to differentiate primary and comparison studies. The timelinethumbnail border gets displayed only for the primary study if it is configured.
1. Under the User Preferences menu, select Study Category Indication.2. Configure the primary study thumbnail preferences under the Primary frame:
●
Draw Frame: check to set border visibility on
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● Double Line: check to create a double border effect● Line Width: select the border thickness● Line Style: select the border line style to solid, dash or dot.● Color: click button to launches the color palette dialog for customizing the border
color.
Note: The border for the primary study can only have a line width of 1 pointwithout double line irrespective of the configuration. The line style andcolor will be taken from the configuration.
3. Configure the comparison study thumbnail preferences under the Comparison frame:
●
Draw Frame: check to set border visibility on.● Double Line: check to create a double border effect.● Line Width: select the border thickness.● Line Style: select the border line style to solid, dash or dot.● Color: click button to launches the color palette dialog for customizing the border
color.
Note: The timeline thumbnail border is not displayed for comparison studies,even if options are configured in User Preferences.
4. Click OK / Apply to save settings or Cancel to discard.
6.8.3 Display DICOM SR
Prerequisites:
● This procedure is for customers using the Universal Viewer with Centricity PACS
● To display DICOM Structured Report, exams must contain DICOM SR
There are two ways to display DICOM SR: from the patient folder and from the timeline.
Display DICOM from the patient folder1. Open an exam from the study list.
2. Open the patient folder for the exam.
3. Select the Notes/Reports tab.
Note: While retrieving DICOM SR, a Structure Report: Loading inProgress..... message displays at the bottom of the patient folderNotes/Reports tab.
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Expected Result: The DICOM SR displays in the patient folder Notes/Reports tab.
Display DICOM from the timeline1. Open a study.
2. In the timeline, look for the icon with the underlined date.
3. Click that icon.
Expected Result: The Report dialog displays the SR, preliminary report, and finalreport.
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6.9 Hiding and Showing the Toolbar andNavigatorYou can click the Hide or Show icons on the title bar to hide or show the main toolbarand the Navigator. This affects all monitors simultaneously.
● To hide the main toolbar and Navigator, click the Hide icon ( ) in the title bar.
● To show the main toolbar and Navigator, click the Show icon ( ) in the title bar.
Note: If the user preferences are set to hide the main toolbar, then the Showicon will affect only the Navigator.
6.10 Presentation StateYou can save the positioning or modifications to a study for future reference. This is knownas the presentation state (PS) and includes the appearance of the study as you arranged it.
The system allows you to save a PS for many reasons. You may find a certain PSparticularly helpful for diagnoses, and you may want to retrace the different presentationsused to arrive at a diagnosis. You can see the PSs that others have used, which may helpyou to gain an understanding of how another user viewed the study.
Note You can use the PS tools in conjunction with the Done options to improvethe efficiency of your workflow. However, only users with the appropriateprivileges have access to this feature.
Slab scroll and MPR viewports are not supported for PSs. Remote studies can bedisplayed with a PS, but the PS is not saved back to the remote study.
Which parameters comprise the PS?
A PS saves these attributes:
● Annotations
● Measurements
● Window/Level (W/L)
● The image opened in the series
● Page format
● Magnification
● Image overlay (DICOM metadata text displayed on top of the images in a viewport)
● 3D anchors
● Zoom
● Pan
● Flip, Mirror, and Rotate
PS types
● Standard: The user saves the presentation automatically via the Done options whenthe study is closed, or the user saves the presentation manually via a menu selection.
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● QCPS: The Quality Control Presentation State is reserved for critical changes to thepresentation, not for preferences, and is therefore loaded automatically, regardless ofthe settings in the Done options. QCPSs are labeled as such in the PS list.
● GSPS: Grayscale Presentation States are encoded DICOM objects captured at anexternal workstation. If multiple GSPSs are attached to a study, the study opens withthe most recent GSPS, and the user can select an alternate PS from the list. Theautomatic display of PSs must be enabled for a GSPS to load automatically. SeeClosing a Study for more information.
Each type is labeled appropriately in the PS list, along with a date/time stamp and thecreator’s name. If the open study has related comparison (dependent) studies which inturn have PS, then all PS are available for selection from the list.
Sync annotations and measurements
If you create the annotation and measurements on a series, the system seamlessly syncsthe measurements and annotations across all viewports within the same series in aunsaved viewing session.
Sync in PSs
Viewport types Parameters thatautomatically sync
Parameters saved to mostrecently changed viewport
● Overview● Sheetview● Global stack● Quick cycle
● Measurements● Annotations
● Pan● Zoom● W/L● Orientation (flip, mirror,
rotate)
Saving a PS
A PS can be saved manually through the PS menu or through the Done option. SeeClosing a Study for more information.
If you close a viewport without saving the PS, the changes are retained and displayedif the viewport is reopened. If the study is saved without reopening the viewport, thePS that applies to that viewport is saved. If you close a study without saving the PS,any temporary PS changes are discarded.
Regardless of the type of viewport, HP, or SRP used to review the study, you can loada saved PS and display it on the study. Annotations and measurements display on theoriginal source series. The original series displays the latest version of W/L, Zoom, andPan before the PS was saved.
A PS created in RA1000, the mammography viewer, or ZFP can be opened in UniversalViewer. Annotations and measurements display on all series, copies, and the original;other PS parameters display as acquired from the source series.
Similarly, PSs created in Universal Viewer can be displayed in RA1000, the mammographyviewer, or ZFP.
Last changed viewport saved
With the exception of copy viewports, the system saves the presentation state parametersfrom the latest viewport interaction. When the study is reloaded, the original retains its PSsettings and the last changed viewport also retains its PS settings.
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Unsaved changes
When you make changes that affect the PS, save the changes to update the PS. Unsavedchanges are discarded if you close the study without saving the changes. You can close aviewport without losing your changes as long as you save the study before closing it.
PS containing copies of series
With the exception of annotations and measurements, which dynamically synchronize tothe original/source series, other PS parameters from copy series are not saved as partof the PS. Upon applying a PS, the system will apply the saved PS from original/sourceviewports. If the study is displayed with copies or if user creates a copy of a original/sourceviewport, the system creates an exact copy of this series. To save the PS parametersapplied on a copy viewport, save as a Bookmark. Refer to Bookmark functionality forfurther information.
6.10.1 PS Application and Limitations
How PS is applied
On global stack, if the user saved PS parameters from this viewport only, the systemsaves the PS parameters regardless of whether the setting on the HP is image based orseries based.
If the user reapplies the saved PS on any viewport, (such as global stack, overview, copyor quick cycle), the system applies the PS exactly as it was saved on each image ofthe stacked series.
On overview, quick cycle, and source viewports, if the user saved PS parameters fromthese viewports, the system will save the PS parameters as series based. This means if auser reapplies the saved PS on any viewport (global stack, overview, copy, or quick cycle),the system displays all saved PS parameters on all images within the series.
On copied viewports, the user can create and manipulate the copied series for reference.Upon saving, the system saves the PS parameters from the original/source series.
How PS is applied in mixed viewport scenarios
Sometimes, a study can display in different types of viewports (for example: global stackand overview). In these scenarios, PS behaves as follows:
The user applies a saved PS from a created global stack viewport on the study which isdisplayed in overview, quick cycle, and source viewports. When the user applies this PS,the system applies the saved PS parameters on each of the images the same way it wassaved from global stack. If user makes any changes after the PS have been applied, thechanges display on all images within the series.
The user manipulates the study that contains mixed viewports, such as global stack(image based) and overview (series based) to create PS parameters on both viewporttypes. Upon saving the PS, the system combines both series and image based PSparameters. When applying this PS, the system applies both image and series based PSparameters to the study.
Limitations on how page format is applied as part of PS
Page format is saved from overview view ports and not global stack or sheet viewports. Page format from the first series displayed in navigator window is applied to globalstack/sheet view when applying PS.
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Key image (KI) behavior in relation to GSPS
With the introduction of dynamic synchronization of annotations or measurements, if youopen a saved KI, the system dynamically synchronizes annotations and measurementsof the KIs to the images displayed on the study. If you do not want KI annotationsand measurements to sync back to the study, use the Reset functionality to reset theannotations and measurements on the study displayed.
Unsupported PS parameters
The Sharpen filter, Auto CR, and collective window level are not supported PS parameters.
PET-CT fusion and manual reconstructions
PET CT fusion and manual reconstructions do not support dynamic synchronization ofannotation and measurements.
PS autoload workflows on IW and CPACS foundations
AutoloadWorkflows
IW Backend CPACS backend
Primary System loads thelatest saved PS on theprimary study.
System loads the latest PS on theprimary study.
Primary +Comparison
System loads thelatest saved PS on theprimary and also theDP presentation statefor comparison.
System loads the latest savedPS on the primary and the latestsaved primary system on thecomparison.For DP presentation states on thecomparison, access and manuallyapply through the PresentationState Manage window.
Primary +Comparison 1+ Comparison 2
System loads thelatest saved PS on theprimary and also theDP presentation statefor comparison.
System loads the latest savedPS on the primary and the latestsaved primary system on thecomparison.For DP presentation states on thecomparison, access and manuallyapply through the PresentationState Manage window.
PresentationState vs.Bookmark
System willautomatically applythe latest bookmarksaved on the study.You can retrieve thelatest PS from thedrop-down menu orPresentation StateManage Window.
System will automatically applythe latest bookmark saved on thestudy.User can retrieve the latestPS from the drop-down menuor Presentation State ManageWindow.
6.10.2 To Save a Presentation State Through the Menu
This procedure allows you to capture the presentation of comparison studies (known asdependent presentation states) along with the primary study in compare mode.
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1. After arranging the study according to your preferences, select the down arrow next tothe Done button on the toolbar. A drop-down menu displays.
2. Select Save Presentation State from the menu.
3. If more than one study is open in comparison mode, the system prompts you for adecision on saving dependent presentation states, i.e., the presentation for studiesother than the primary study. Click No to save only the primary study’s presentationstate, or click Yes to save the presentation states of all open studies.
The exact appearance of the study or studies is preserved, as you left it, as a selectionin the presentation state list.
6.10.3 To Save a Presentation State Automatically
1. From the Image Viewer toolbar, select the down arrow right next to the Done button.
2. Select the Save Presentation State check box. The current presentation state isautomatically added to the presentation state list every time a study is closed.
3. Click OK to accept the setting.
Note: Only the presentation state for the current study is automatically saved.Dependent presentation states are never automatically saved; use thesteps described in Save a Presentation State from the Menu to savedependent presentation states. See Closing a Study.
6.10.4 To Retrieve a Presentation State
Note After an upgrade, Presentation States may display with the aspect ratioretained, even if this option was not included in the saved Presentation state.
1. Select Pres State from the main menu.
2. From the drop-down menu, select Saved Presentation States.
A catalog of all saved presentation states corresponding to this study and anycomparisons related to this study is listed. Each presentation state is identified by adate/time stamp, the name of the user who created the state, and an indication if thepresentation state is QCPS or GSPS. The active presentation state is surrounded bya blue frame.
3. Select any presentation state in the list to change the display to that state.
6.10.5 To Hide a Presentation State
You can hide a presentation state from the list. (You must have appropriate privileges.)The presentation state remains accessible to you, but it is not displayed in the presentationstate list to other users and so remains unavailable to them.
1. Select Pres State from the main menu.
2. From the drop-down menu, select Manage. The Manage Presentation Historydialog displays with a list of all presentation states. The presentation state currentlydisplayed is marked by a left-pointing arrow.
3. In the "H" column, click the check box next to each presentation state you wantto hide; the box will be checked and highlighted in yellow. If you need to view apresentation state to decide whether to hide it, click the green box in the first columnto point the arrow to that item and display that presentation state. The dialog remainsopen so you can view that presentation state.
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4. When you have selected all the items you want to hide from the presentation statehistory, select Save. To cancel the operation without saving, click the Close buttononly.
Note: Hidden presentation states can be retrieved via DICOM.
6.10.6 To Export a Presentation State as a DICOM Object
The system exports one presentation state at a time.
1. From the main menu, select Pres State and then click Manage.2. From the list of presentation states, select a presentation state (not already marked as
GSPS) to export.
3. Click Export. The selected Presentation State is saved as a DICOM object as partof the study.
6.10.7 Quality Control and QCPS
In support of quality control procedures, the workflow allows technologists to check astudy before it is viewed by a diagnosing physician or other clinician. A technologist canmark a study as QC'd to indicate that the study has been checked and that this phase ofthe workflow is complete.
A study can be marked as QC'd from the Study List without opening the study again. Thisaction does not make any changes to the study but simply changes the QC column'sflag to Yes.
A Quality Control presentation state (QCPS) is reserved for critical changes to thepresentation, not for preferences, and is therefore loaded automatically, regardlessof the settings in the Done options. QC presentation states are labeled as such in thePresentation State list. See Presentation States for more information.
By using the Quality Control tools in conjunction with the Done options and thePresentation State features, you can substantially improve the efficiency of your workflow.For example, you can use the Done options to QC every study upon closing it. The Doneoptions can be used to correspond to your workflow and automate your most commonactions.
You can see a study as it was before the QC. See Presentation State for more information.
6.10.8 To Save a QC Presentation State
QCPS must be saved in this manner; the command for automatic Save from the Donemenu refers to the save of standard presentation states only, not QCPS. Further, QCPSdoes not include dependent presentation states, only the presentation state for thecurrent study.
1. Select Pres State from the main menu.
2. From the drop-down menu, select Save QCPS. The current display is saved as aQuality Control presentation state and will load each time the image is opened.
6.10.9 To Mark a Study as QC'd
1. Make changes to the study as necessary.
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2. Click the down arrow next to the Done button; select Mark as QC'd. If a column hasbeen configured for QC in the Study List, the flag in that column will update to Yes.
6.11 Viewing for Referring PhysiciansReferring physicians launch a viewing application specific to referring physicians. Thesystem recognizes referring physicians by their login. This viewer shows only the studyinterpretations (reports, annotations, key images, etc.), instead of the entire study, tospeed up workflow for physicians. The full Image Viewer can be invoked at any time tosee the entire study in the standard way.
The floating menu for the referring physician viewer is abbreviated from the standardStudy List menu. Only those actions that are relevant to a study interpretation, suchas viewing reports/notes, comparing studies, viewing a series or thumbnails, matchingreports and assigning the study to a worklist are shown. Referring physicians can alsoreceive email notification of updates to studies.
Note Authorized users can change the referring physician on a study. SeeChanging Patient Study Data.
Important The system supports different categories of users, providing each withthe full range of tools necessary for optimum performance. Yet, there isa significant distinction between Referring Physician users and otheruser categories.
When viewing a complete study, Referring Physician users are presented with common(system-level) layouts defined for a particular type of study. They can use all the tools ofthe system but they cannot personalize system behavior such as creating, modifying orusing personal- and group-level
● layouts and layout components
● annotation templates
● print templates and
● lexicons
Done button options are not applicable for the Referring Physician even when configuredin the layout.
References to the personal- and group-level layouts, templates and lexicon are notapplicable to Referring Physician users. Referring View Own Patient privileges limitthe referring physicians' access; for example, while the list of comparisons includes allrelevant studies, those studies outside the privilege set cannot be downloaded.
6.11.1 To Manage the Referring Physician Viewer
1. Select a study from the Study ListOpen the study via the study icon, or right-click and choose View Study.
A variation of the Patient Folder displays. The top pane shows all studies for thispatient. The most recent study is highlighted in blue, and its data is shown in thebottom panes. The bottom left pane shows any reports that have been attached to thehighlighted study. The bottom right pane shows any key images that were createdfrom this study. Right/left scroll buttons at the top of each pane allow you to scroll tothe next/previous note or key image set. Click the Print button to print the contentsof that pane.
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2. To compare the notes and key images from two studies, click the Compare buttonand then highlight a second study in the top pane. The bottom panes update to showthe interpretations side-by-side.
3. To toggle between viewing the key images side-by-side or viewing the reportsside-by-side, click the Images button. From the key images pane, you can use thebuttons to print or scroll through key image pages.
4. To view the entire study in the full Image Viewer, click the View Study button. TheReferring Physician viewer remains open.
Note: The View Study button is not activated in Compare mode.5. To grant temporary access to a remote user, choose the desired study, and then click
the Refer button. Refer requires a full-function license.6. Click Close.
You can configure the system to send email to referring physicians based on studyor final report availability. This feature automatically notifies the referring physicianvia email that new studies have been performed or that current studies have beenupdated. It automates collaboration between a diagnosing physician who examinesstudies and a referring physician who requests results. Notifications can includeinformation on both images and reports attached to studies.
Note: The system administrator manages privileges for this feature.
You can send three kinds of notifications to a referring physician.
● Blank: The message states that the patient's images have arrived, and the studycan be viewed in Image Viewer.
● Detailed: The message includes details about the patient and study description.
● Linked: The message includes two links. The first, patient details, populates theSearch Results tab with related studies. The user can click the Note/Report icon.The second link, access images, launches the study in the Image Viewer.
Note: To preserve security the user must log in after clicking an email link.
6.11.2 To Change the Referring Physician for a Study
1. Open the Change Patient/Study Data dialog for the study you want to update.
2. Next to the Ordered By field, click the Find button. A dialog requests the name of thenew referring physician.
3. Click the Find button again to display a list or begin typing the name.
4. In the resulting list, click the option button next to the new referring physician's nameand then click Select.
5. The name appears in the Ordered By field of the Change Patient/Study dialog6. Click Change.
6.11.3 To Change the Referring Physician Email Address
1. Click Configuration on the main screen.
2. Click the My Emails button at the bottom.3. Click the ellipsis button.
4. Enter the email address.
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5. Click Save.6. Click Close.
6.12 Hanging Protocol ToolYou can quickly arrange stack windows in an orderly, even grid without having to redefineand save a new layout and without having to open the Layout Editor. The HangingProtocol Tool snaps stack windows into user-defined rows and columns. This featurehelps order the display quickly when several series are open at once.
This feature can quickly create an appropriate display for different monitor configurations(i.e., two, three or four monitors on a workstation). The layout can be saved and applied tostudies of the same modality and with the same properties.
Note You can define several hanging protocols for each modality and switch fromone to the next with one click of a toolbar button. See Toolbar Configuration.
6.12.1 To Use the Hanging Protocol (HP) Tool
1. From Image Viewer, click HP Tool from the main menu. (If this feature is not on themain menu, add it using the Layout Editor. See Configuration.)
The Hanging Protocol Editor is displayed, with a thumbnail strip of the displayedseries across the top, and a canvas below. Use the tools in the HP toolbar to definethe layout in the canvas. The bottom pane (canvas) enables definition of a protocolbased on attributes of the series. See Configuration.
Note: If multiple monitors are used, each is represented by a rectangle in thecanvas.
Note: In Preferences, if you have your Open Patient's Folder set to Always,make sure you leave the low resolution monitor representation blank. SeeSetting General Display Options.
2. In a monitor representation, right-click the mouse to open a table grid, and drag themouse until the desired number of rows and columns is displayed.
3. Release the mouse to set the defined number of rows and columns onto the canvas.
Note: You can also draw lines on the canvas one at a time by clicking anddragging the cursor in drawing mode. A blue dotted line indicates wherethe line will be drawn. Any drawn line will snap straight and extend itselfto the border of the closest neighboring line; to extend past that line to theborder of the canvas, drag the mouse past the adjacent line.
4. The cursor changes to a pencil shape, indicating that you are in drawing mode. DrawCells is the default.
5. To move an existing line, click Move Lines. Hold the mouse over the line until itchanges to a double-headed arrow; click and drag the line to a new location.
6. To erase a row or column, click the Erase Cells. The mouse changes to an erasershape. Click and drag the mouse over the area to erase. The mouse will shape a bluedotted rectangle. Any lines that intersect this rectangle are highlighted in blue alsoand will be erased once the mouse is released. In a monitor representation, right-clickthe mouse to open a table grid, and drag the mouse until the desired number ofrows and columns is displayed.
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7. Once the layout is arranged, click a series thumbnail and drag it into the desired cell inthe canvas. Repeat this step until all the desired series have been added to the grid.Release the mouse to set the defined number of rows and columns onto the canvas.
Note: When a hanging protocol includes a Navigator placeholder, the Navigatordisplays with the Study Selector and Timeline collapsed.
8. Click Apply.
Note: You can also draw lines on the canvas one at a time by clicking anddragging the cursor in drawing mode. A blue dotted line indicates wherethe line will be drawn. Any drawn line will snap straight and extend itselfto the border of the closest neighboring line; to extend past that line to theborder of the canvas, drag the mouse past the adjacent line.
Note: You can create an automated study layout, i.e., the presentation isbased on series attributes that you define, regardless of variations in thescanning sequence. See Configuring Hanging Protocols.
9. To save this layout for use at the target workstation, click Save.10. Enter a name for the layout.
11. Select who can use it: you only (personal), your group (group), or everyone (common).Only authorized users can create common layouts.
12. Click OK.
To apply the layout immediately, use Load Layout. After the hanging protocol hasbeen attached to the layout, the study will open in this layout on the target workstation.
6.12.2 To Update the Apply Hanging Protocol Menu
Prerequisite: One or more custom hanging protocols have been created with the HangingProtocol Editor.
After you create a new custom hanging protocol with the Hanging Protocol Editor, thecustom hanging protocols can be added to the list in the Apply Hanging Protocolcontext menu.
1. Select Layout > Create/Edit to open the Layout Editor.2. Click Hanging Protocol in the left pane of the Layout Editor.
Expected Result: Two lists of hanging protocols are displayed in the right pane ofthe Layout Editor.
3. Select the custom hanging protocol that you created from the list on the right and clickthe << button to move it to the list on the left.
4. Click Apply or Save.5. Close the Hanging Protocol Editor if you are done with the Layout Editor.
ExpectedResult:The new custom hanging protocols are listed with the default protocolswhen you select Apply Hanging Protocol from the context menu.
6.12.3 To Apply a New Hanging Protocol
Prerequisite: Open a study.
1. Open the list of available hanging protocols:
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● Right-click on a displayed image to open the context menu and select ApplyHanging Protocol
● Click the arrow on the hanging protocol selection icon.
Expected Result: A submenu displays, as modified by any customizations to the list.
2. Select one of the available hanging protocols to apply it, or select one of the following:
● Next applies the hanging protocol that is listed below the one you are currentlyusing.
● Previous applies the hanging protocol that is listed above the one you arecurrently using.
● More details opens the Apply HP dialog, which lists all the hanging protocols forthe modality. From that dialog, select a hanging protocol and click Apply.
ExpectedResult:The images are redisplayed in the hanging protocol you selected.Note Clicking the hanging protocol selection icon multiple times (without clicking its
arrow) is equivalent to using the Apply Hanging Protocol > Next option.
6.12.4 To Embed Notes / Reports in Viewport
This feature allows you to configure Hanging Protocol to display finalized reports for apatient in the Notes/Reports place holder.
The report header displays the title and creation date. You can scroll through all thehistorical reports for the patient.
1. Open a study with reports. On the menu bar, click the Layout Editor menu andselect Hanging Protocol Tool.
2. Double click in an empty place holder and select Note/Reports from the menu.
Expected Result: A place holder is created for notes and reports.
3. Click Apply, then click Save.4. Click Close.
ExpectedResult:
● Now, you can view reports in a place holder within the viewer, as determined bythe hanging criteria defined for the study.
● By default, the most recent finalized report will be displayed in the place holder.
● You can scroll through comparison reports within the place holder, the same way youscroll through a study.
6.12.5 Hanging Protocol Quick Save
The hanging protocol quick save feature (HP Quick Save) allows you to modify and savethe hanging protocol that is currently in use directly from the Image Viewer without usingthe HP Editor.
Notes on HP Quick Save
● The HP Quick Save edit feature lets you modify the following presentation-levelparameters:
● Window level (Any Window Level presets applied are saved as part of the hangingprotocol.)
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● Page format
● Zoom
● Pan (if Zoom is enabled)
● HP Quick Save lets you modify the grid layout on each monitor in the workspace ofthe hanging protocol that is being modified independently.
● Viewports that are misaligned to a new grid layout are snapped to the nearestplaceholder. Also, if the new grid layout has more viewports than placeholders, thenthe extra viewports are not displayed when you save the hanging protocol usingHP Quick Save.
● HP Quick Save lets you modify modality-specific series hanging criteria for each ofthe displayed series windows.
● HP Quick Save works for all supported multi-resolution monitor setups.
● You can overwrite the existing hanging protocol directly if you have the appropriateprivileges, or you can save the modified parameters as a new hanging protocol. Thenewly saved hanging protocol is given the highest priority for being applied on anystudy that meets the hanging criteria.
Note: If a hanging protocol at a Group or Common level is overwritten, then thepriority of the protocol does not change when the modifications are saved.
● HP Quick Save can save an image series that is pasted into a MIP/MPR palette.However, modifications made to the images are not retained when you save andclose the study.
● HP Quick Save does not support Sheet View. If the hanging protocol being modifiedusing HP Quick Save contains Sheet View, then the Sheet View will not be retainedafter you save the hanging protocol using HP Quick Save.
6.12.5.1 Editing a Hanging Protocol Grid
The Hanging Protocol (HP) Edit Grid feature allows you to modify the display gridlayout in your hanging protocol workspace. Grid layout can be modified independentlyon a per-monitor basis on the viewer workstation. Viewports automatically align to thenew grid layout. Images can be placed in the new grid from Series Navigator or SeriesSelector tools.
To edit a Hanging Protocol Grid
1. Click the Edit Grid icon ( ) on the toolbar.
2. Select a grid layout from the drop-down menu.
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6.12.5.2 Using HP Quick Save
Note To edit the HP grid, see Editing a Hanging Protocol Grid.
1. Click the down arrow beside the Apply HP button ( ) on the toolbar.
Expected Result: A drop-down menu displays.
2. Make any of the following edits, if desired:
● Select the Edit Hanging Criteria option to choose a hanging criteria.● Modify the modality-specific series hanging criteria for each of the displayed
series windows.
● For Overview viewports, when you select Edit Hanging Criteria under the ApplyHP toolbar button, select the Study Category and click Done.
3. Click Save from the Apply HP drop down menu.
Expected Result: A dialog box displays.
4. Enter a name for the hanging protocol.
Expected Result: If you enter the same name as the current hanging protocol, andyou have the required privileges, then the hanging protocol is overwritten and saved.If you enter a different name, then it is saved as a personal hanging protocol. A dialogbox displays with the message that the hanging protocol was saved successfully.
5. Click OK.
ExpectedResult:The HP quick save is complete.
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6.13 Smart Reading Protocols
6.13.1 Smart Reading Protocols: Overview
Introduction
Smart Reading Protocol (SRP) employs machine learning techniques to provide aninnovative and simplified process for creating and applying hanging protocols in radiologyworkflow. SRP is designed to improve image setup efficiency compared to the traditionalhanging protocol function in PACS software.
Instead of manual pre-configuration of layouts with a large number of parameters, the newapproach to HP creates a system that learns the users’ preferences through an explicit“teach” action as they work, so that when they open a new study/exam, the system setsup the images in a user-preferred layout: viewports layout, image series placement,automatic post-processing, etc. The whole process of creating and applying HP with SRPis as simple as an occasional single mouse click during your normal review process. (SeeSection 6.12.2, Teaching the System Your Hanging Preference.)
Later, when you open another similar exam, SRP makes HP suggestions based onpreviously learned HPs. If at least one suggestion is made, the first suggested HP appliesautomatically to set up images for this exam; otherwise, a default traditional HP applies asit did for the very first exam – however, falling back to traditional HPs becomes less likelywith continuous user-driven SRP learning..
Learning
The SRP Learn process does not interfere with your activities in the viewer. It is a quickprocess that works by taking a snapshot of the hanging and presentation as it displayson the screen, such as viewport layout, series placement, and presentation parameters(e.g. window level), together with various contextual information. This informationincludes such items as user name, global viewer settings, monitor configurations, orderinformation, modality, body part, procedure name, study description, series descriptions,various DICOM tags, and comparison studies.
The system can learn your hanging preferences for any monitor configuration, modality(except PET/CT and MG), mixed modality, and studies with and without comparisons.
Note: The SRP feature does not select relevant comparison studies. SRP generateshanging protocols for preselected combinations of primary and comparisonstudies.
SRP supports learning of special objects like the Navigator and scanned documentsif included as part of a hanging protocol.
Note SRP can learn Navigator positioning as part of a hanging protocol only whenthe Navigator is housed in a placeholder.
SRP supports learning of native MIP/MPR application within a viewport, if MIP/MPRapplication is included as part of a hanging protocol. SRP also supports learning multiplenative MIP/MPR applications included in a hanging protocol.
SRP supports learning of the following image manipulation/presentation tools as part ofa hanging protocol:
● W/L Presets
● Zoom Presets
● Page Format
● Copy series
● Global Stack
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3D Applications
SRPs can learn your preferences for 3D applications and views, so that your preferred 3Dapplications automatically launch as part of your preferred hanging protocol. SRP supportslearning of embedded advanced visualization applications only. When best-matching 2Dand 3D SRPs are both available for an exam, the system applies a 2D SRP by default.You may choose to apply the 3D SRP from the HP drop down list if needed.
Note This feature is only available on Universal Viewer systems with AW Serverintegration, which provides access to embedded 3D applications within thePACS viewer.
Trend SRPs
A Trend SRP is a hanging protocol that can hang more than one or two comparisons. ThisSRP feature supports learning and generating hanging protocols that can hang more thantwo comparison studies along with primary study. The system will auto-generate TrendSRPs based on the study context and the number of comparison studies.
Trend SRPs do not apply automatically. By default, non-Trend SRPs with up to twocomparison studies are applied. Trend SRPs can be accessed and applied manually fromthe Apply HP menu in the Main Toolbar or Series Menu.
Note: Conventional hanging protocols continue to support hanging up to twocomparison studies only. Trend hanging protocols with more than twocomparison studies are not supported for creation via the HP Tool or fordisplay/hanging using conventional HP.
SRP Naming Conventions
For visual clarity, the system lists SRPs with 3D applications separately from those with2D objects. When best-matching 2D and 3D SRPs are both available for an exam,the system applies a 2D SRP by default. You may choose the 3D SRP from the HPdrop-down list if needed. The system offers up to three best-matching SRPs with 3D (3D= embedded AW applications).
The system offers up to three best-matching SRPs with 2D images/objects. 2D and3D SRPs are distinguishable by name. 3D SRPs have the word “3D” appended to theSRP name.
Additionally, if TREND SRPs are available, the system offers one TREND SRP by default.
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For visual clarity, SRPs display in a specific order. The system groups 2D, 3D and TRENDSRPs separately and sorts them by confidence. By default, the system groups up to three2D SRPs as the first choice. Next, it lists up to three 3D SRPs. 3D SRPs display with“3D” appended to the SRP name (3D = embedded AW applications or native MIP/MPR).Then, up to three TREND SRPs display after the 3D SRPs with “TREND” appended to thename. The SRP confidence level displays at the end of the SRP as a percentage.
Monitors
You can use an SRP on any workstation as long as the number and orientation of monitorsmatch between the workstations used. This flexibility prevents you from having to retrainthe system on every workstation.
Important The monitor configuration settings under Navigator options must reflectthe user’s intended workstation conditions (by default, the systemauto-detects monitor configurations and this is reflected under theMulti-monitor setting in the Navigator options). If the monitor conditionssuch as grayscale setting and Monitor Resolution inadvertently change(for example, a medical resolution monitor changed to regular resolutionOR a color monitor changed to grayscale), SRP may hang exams inan unexpected way.
Algorithms
Behind the SRP workflow is a set of machine learning algorithms that track the way a useror a group of users set up images for reading in particular workflows, collect relevantcontext information, and reproduce Hanging Protocols for new studies of this type. SRPalgorithm is designed to give higher preference to user’s own hanging protocols overothers’ hanging protocols when making HP suggestions.
Limitations
SRP is disabled for the following modalities. Standard/Conventional hanging protocolscontinue to be available and can be applied when reviewing exams from these modalities:Mammography (MG); Positron Emitting Tomography – Computed Tomography (PET/CT)
SRP does not support:
● Learning of native PET/CT application
● Learning Sheet View method of hanging
● Step hanging protocols (MG, MR)
● Invocation of mammography applications
● Learning of the following non-image objects as part of a hanging protocol:
● Patient Folder
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● Study Selector
● Timeline
● Notes/Reports (non-DICOM)
When Cross Enterprise Display is enabled on the Universal Viewer, SRP does not supportlearning and generating hanging protocols for remote studies. The following limitationsapply:
● If an SRP Learn is initiated with remote studies hung on the screen, the user iswarned to close the remote studies. SRP learns and generates hanging protocols forlocal studies only.
● The SRP Quick Search feature is available, but if a remote exam is loaded then theSRP results will only hang the primary exam.
● In the patient folder, if the user selects a remote study and clicks Display, then theselected studies will hang using conventional HP instead of SRP.
● SRP Quick Search will only generate SRPs for the primary exam if there is a remoteexam loaded in the viewer.
Supported Languages
SRP is supported in the following languages:
● Chinese, simplified
● Chinese, traditional
● Danish
● Dutch
● English
● French
● German
● Italian
● Japanese
● Korean
● Polish
● Portuguese, Brazilian
● Russian
● Spanish
● Swedish
● Turkish
6.13.2 Teaching the System Your Hanging Preference
Prerequisite: Complete the task, Set the Number of Comparisons to Load and HangAutomatically, before training the system to apply your SRPs.
1. Open an exam for review from the worklist.
Expected Result: A traditional Hanging Protocol (HP) is applied before the systemlearns your SRP.
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2. Setup or arrange images from primary and comparison studies per your preferenceusing one of the many tools available on the Universal Viewer:
● Drag and drop images from the Navigator to the existing viewport grid.
Note: If you are training the system on an SRP with more than one or twocomparison studies, system learns this as a TREND SRP.
● Drag and drop images from the Series Selector to the existing viewport grid.
● Use Edit Grid to edit the viewport grid layout. (Use options 2 or 3 to populateviewports.)
● Launch Layout > HP Tool (Setup images and apply; no need to save.)
3. Click the Learn HP button on the main toolbar.
Note: The button is disabled if the SRP feature is disabled at the site level, theuser group level, or at an individual user preference level (per modality).
4. Open a similar exam for review.
Expected Result: A desirable HP is applied automatically by SRP. There may be upto 3 SRP suggestions under the Apply Hanging Protocol drop-down menu. The firstsuggested SRP is automatically applied. If necessary, you can manually choosesecondary SRP suggestions, or a traditional HP.
Note: If a SRP match is not found for the opened study, a traditional HP willbe applied. If the suggested SRPs do not meet your expectations, thesystem is designed to accept your corrections, and adapt and converge toyour preferred HPs after a few teaching sessions.
5. If desired, manually apply a Trend SRPs (SRPs containing more than one or twocomparison studies) from the HP drop-down menu.
To Refine / Reteach a Hanging Protocol1. Edit the current HP by adjusting, per your preference, series placement, series
presentation, and grid layout.
2. Click Learn HP in the main toolbar.
6.13.3 Applying a Smart Reading Protocol (SRP) or Trend SRP
Prerequisite: Complete the task, Set the Number of Comparisons to Load and HangAutomatically, before training the system to apply your SRPs.
Note
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● The system makes SRP recommendations only if it finds an SRP match for thecurrently open study, based on the hanging preferences on which it has beentrained.
● Trend SRPs must be manually applied. Open the primary study and then selectthe Trend SRP from the HP drop-down menu.
To apply an SRP to a study:
1. Make sure the SRP feature is enabled.
2. Open a study from the Study List. If the system finds an SRP match, then thehighest confidence SRP is automatically applied and listed in the Hanging Protocoldrop-down menu.
Expected Result: The SRP is applied.
3. To apply a Trend SRP, after opening the primary study, select the desired Trend SRPfrom the HP drop-down menu to apply it.
Expected Result: The Trend SRP is applied.
6.13.4 Using SRP Quick Search
With the SRP (Smart Reading Protocol) Quick Search feature you can dynamicallyretrieve a new set of SRPs based on search criteria. You can access the quick-searchdialog from the drop-down menu of the Apply Hanging Protocol toolbar item, or you canassign a keyboard shortcut.
Note SRP Quick Search will not return TREND SRPs (i.e., SRPs hanging morethan one or two comparison studies).
1) Open a study.
2) Select Apply Hanging Protocol > SRP Quick Search.
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Note: You can also assign a keyboard shortcut. See Section 9.3.3, ConfiguringShortcuts.
The following dialog displays.
3) Select one of the three options and click OK.
Option Description
Find system best matchSRP
Returns the SRPs that best matches the context of theopened studies, regardless of who created the SRP.
Find specialist SRP Returns SRP(s) as created by the specified user, that bestmatches the context of the opened studies.As the first or last name of the user is being typed into thedialog, matching suggestions are automatically displayedfor convenient selection.
Note Only users with Radiologist privileges areconsidered in this search criteria.
Find my best match SRP(default)
Returns the SRP(s) that best match the context of theopened studies, as created by the user.
Note This is the default criteria used to select SRPsduring normal study launch. In the event that theuser has not trained the system on his/her hangingpreference, the default system behavior is to launchthe study with system-best SRP or a pre-configuredconventional HP.
6.14 Sheet ViewSheet view allows you to quickly view multiple images in a study across multiple viewportsand monitors at the same time. Sheet view allows you to scroll through the images in thestudy synchronously, that is, all the viewports display the images in a configured order.
The configured order may vary among modalities. For example, by default, x-ray images(CR, DX, XA, RF) are ordered by acquisition time, and non-x-ray images are orderedby the series/instance number.
Navigation Buttons
When you create a sheet view, a set of six navigation buttons appears in the toolbar:
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Table 8 Sheet View Navigation Buttons
Click these buttons: To:
Scroll through the study one image at a time.
Scroll through the study one page at a time.Note You can also navigate one page at a time by clickingthe left mouse button or by pressing the Up and Downarrow keys on the keyboard.
Scroll to the first or last page of images in the study.
Page Formatting
● Each sheet view can be partitioned into different page formats to display more imageson the monitor(s) at the same time.
● Page formats can be applied to the viewports.
● If you apply a page format other than 1x1 to one or more sheet view viewports, thenimage-wise navigation is disabled (as well as global cine controls, if the system isconfigured for cardiology workflow). You are limited to navigating by page only.
● Sheet view displays blank viewports if the number of images currently displayed isless than the number of placeholders in the sheet view.
Supported Properties for Sheet View
Sheet view supports the following properties for viewports:
● Study Category
● Image Order (The options are Acquisition Time and Series Number.)
● Image Sorting
● Apply Presentation Parameters
Sheet View and the Image Viewer
● Throughout the session, during which you have the study open in the viewer, allchanges made to the presentation parameters and annotations for each image areretained. By default, for x-ray images, changes to the presentation parameters areapplied to the single image only. For non-x-ray images, the changes are applied toall images in the series.
● Each viewport selected for sheet view has the title Sheet View in its header.
● You can scroll through the images of primary and comparison studies in correspondingsheet views independently of each other.
Sheet View and Global Stack
Sheet view and global stack cannot be present in the viewer at the same time. In thePreferences dialog box, if the Create Global Stack View on startup option is selected, itis ignored if a hanging protocol being loaded contains sheet view.
Sheet View and Series Synchronization
The series synchronization feature is disabled when sheet view is displayed in the viewer.
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Sheet View and Cine Mode
Cine mode is disabled for sheet view.
6.14.1 Creating a Temporary Sheet View
You can create a Sheet View for the duration of the current session only, or you cancreate a Sheet View as a hanging protocol. This topic explains how to create a temporarySheet View.
1. From the toolbar, click Layout > HP Tool to open the HP Editor.
2. Create the series viewports in the placeholders. For multi-monitor workstations, youcan use more than one monitor, if desired.
3. Connect the series viewports for the study.
● For the primary study, click the Sheet View — Primary button.● For comparison studies, click the Sheet View — Comparison button.
When you click the Sheet View — Primary button, only the series viewports andglobal stack are converted to a Sheet View. Viewports (Overview, MIP/MPR, Note andReports, etc.) are not converted to Sheet View.
Expected Result: A link icon displays on each viewport placeholder in theSheet View.
Note: To remove the Sheet View for a primary study, click the Break Sheet—Primary button. To remove the Sheet View for a comparison study,click the Break Sheet — Comparison button. The link icon is removedfrom the placeholders.
4. Click the Apply button.
Expected Result: The images display in the Image Viewer in Sheet View. In addition,
the Sheet View navigation buttons displayin the toolbar.
5. Click the Close button to exit the HP Editor.
6. Use the mouse scroll wheel, the navigation buttons, or the up and down keyboardarrows to scroll through the images in Sheet View. The scroll wheel and keyboardbuttons navigate a page at a time only.
As you navigate through the images, the series/images display synchronously amongthe connected viewports. To easily identify which viewports are part of the Sheet View,each viewport selected for Sheet View has the title Sheet View in its header.
ExpectedResult:The temporary Sheet View is created. The Sheet View is not savedwhen you end the current session.
6.14.2 Creating a Sheet View as a Hanging Protocol
You can create a sheet view that is temporary for the duration of the current sessiononly, or you can create a sheet view as a hanging protocol. This topic explains how tocreate a sheet view as a hanging protocol.
1. From the toolbar, click Layout > HP Tool to open the HP Editor.
2. Create the series viewports in the placeholders. For multi-monitor workstations, youcan use more than one monitor, if desired.
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3. Connect the series viewports for the study.
● For a primary study, click the sheet view —Primary button .● For a comparison study, click the sheet view — Comparison button.
When you click the sheet view — Primary button, only the series viewports andglobal stack are converted to a sheet view. Viewports such as Overview, MIP/MPR,Note and Reports, etc. are not converted to sheet view.
Expected Result: A link icon displays on each viewport placeholder in thesheet view.
Note: To remove the sheet view for a primary study, click the Break Sheet —Primary button. To remove the sheet view for a comparison study, clickthe Break Sheet — Comparison button. The link icon is removed fromthe placeholders.
4. Click Save. The Enter new name dialog box displays.
5. Type a name in for the hanging protocol, and click OK.6. Click Close to exit the HP Editor.
6.14.3 Breaking a Sheet View
When a sheet view is broken, the sheet view viewports are converted into seriesviewports. For example, if a sheet view with four viewports is showing two images fromseries 1 and two images from series 2, then after breaking the sheet view, the systemcreates two viewports for series 1 and two viewports for series 2.
After the sheet view is broken, the viewports do not retain their presentation parameters orannotations (if any).
You cannot separate individual viewports from a sheet view.
To break a sheet view:
� Do one of the following:
● Load a series from the Navigator into one of the sheet view viewports.
● Swap a series or overview viewport with a sheet view viewport.
● Load a series from the Patient History dialog box into one of the sheet view viewports.
ExpectedResult:The sheet view is broken. Also, the sheet view navigation buttonsdisappear from the toolbar.
6.14.4 Adding a Viewport to a Sheet View
To add a viewport to a sheet view:
1. Break (that is, unlink) the sheet view.
2. Create the sheet view again with the new viewport.
ExpectedResult:The viewport is added to the sheet view.
6.14.5 Deleting a Viewport from Sheet View
You can delete a viewport from sheet view without affecting the rest of the sheet view.
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To delete a viewport from sheet view:
1. Open the HP Editor and load the hanging protocol with the sheet view.
2. Right-click on the viewport that you want to delete and select Delete from the pop-upmenu.
3. Click Save.
ExpectedResult:The viewport is deleted, and the remaining viewports stay in sheet view.
6.15 Site-level PagingSpecial paging overview
When the special paging mechanism is enabled, you can page through one or more
studies contiguously using the Next shortcut or on the cine toolbar or Previous
shortcut or on the cine toolbar.
Paging goes from the left monitor to the right monitor for the Next button or shortcut. ForPrevious, paging goes from the right monitor to the left monitor.
Rules for special paging
Special paging behavior follows these rules:
● Paging follows the navigator sequence.
● Blue border/highlighted viewport determines the next page in the sequence
● When viewports are moved, resized, or closed, the next and previous pages retain thesame number of viewports defined in the HP
● When using snap tool, drag-and-drop, and make to fit in a blank viewport, pagingcontinues with the fitted viewport
In the example, a primary and comparison study have been loaded. The navigator showsprimary series P1-P5 and comparison series C1-C6. The first picture shows the primaryand comparison arranged in a 3x2 layout.
When you select the primary viewport and press the Next shortcut or to paginate,P4 and P5 are loaded and the third viewport designated for the primary remains empty.The comparison study does not paginate along with the primary study.
To independently/separately paginate through a comparison study, select a comparison
viewport and press the Next shortcut or .
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Pagination continues from the viewport next to the active viewport. All series pagecontiguously based on the order in the Navigator.
If the navigator sequence is not in order (due to series drag and drop to viewport or HPchosen not-in-sequence series or manual rearrange of series in navigator), then pagingwill start from navigator thumbnail next to active thumbnail to reflect the new arrangement.For example, if the navigator new arrangement is P4, P1, P2 and P3 with P4 as activethumbnail, and you click Next, the viewport arrangement changes to P1, P2, and P3.
If you enlarge a viewport and click Next, the viewport returns to its original size andposition.
Restrictions for special paging
If a special viewport such as such as MPR, Global stack, Fusion, Slab scroll, Angio,Sheet view, AW Embedded, Note/Report, Key Image, and Orders is created as part ofthe HP, then the special viewport does not participate in the paging scheme and remainsconstant/static.
If a special viewport, such as MPR/Global Stack, is created after the HP is loaded, movethe floating/special viewport out of the way and then resume paging.
In the example, P5 is an MPR viewport and does not page.
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6.15.1 How Special Paging Works
� This table describes the paging behavior when special paging is enabled.
Action ResultNavigate through the seriesHighlight the desired primary/comparisonviewport and use the Next and Previousshortcut keys or the cine toolbar icons
Page through selected series in the primaryor comparison study contiguously
Clicking the Next or Previous shortcutkey or cine toolbar keys repeatedly
Page through a study rapidly
● Rearrange the thumbnails in thenavigator
● Drag and drop a series into anyviewport
● Use the snap tool to replace a seriesin the layout
● Swap series in layout
Pagination resumes at the active viewportand continues through the series in theorder indicated in the navigator. Thehanging protocol retains the original layout.
Note Paging scheme remains constantand follows the navigator, irrespectiveof whether or not a series was draggedand dropped.
● Change the layout grid● Close some viewports in the layout● Resize one or more viewports
The viewports revert to the original layoutand paging continues.
Drag and drop a comparison series ontoa primary series viewport
The primary series viewport that wasfilled with the comparison series closes.Pagination of the comparison continues asaccording to the layout.When the primary series is in focus, theprimary viewports are restored according tothe layout and paging continues.
Use the snap tool to position a primaryseries onto a comparison series viewportand page the comparison series
The comparison viewport that was filledwith a primary series closes and pagingcontinues with the same number ofcomparison viewports as configured in thelayout.
Include special viewports in layoutStudy includes Fusion, Snapshot, orRTSS thumbnails
The special viewports remain constant anddo not paginate. The regular viewportspaginate according to the navigatorsequence.
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Create special viewports after the HPhas been appliedMPR, Global stack, Fusion, Slab scroll,Angio, Sheet view, AW Embedded,Note/Report, Tomtec, Key Image, orOrders
Move the special viewport out of the way orclose it and resume paging.
Open a floating viewport Move the floating viewport out of the way orclose it and resume paging.
Note If a floating viewport was opened,the floating viewport closes.
Other actions
● Close all viewports in the layout● No viewport in focus
Paging does not continue.
6.15.2 Using the Cine Toolbar
The site-level paging option can be configured to provide additional icons at the bottom leftof the viewer window for easy navigation. Consult your system administrator to determineif special paging is active at your site.
Note When special paging is enabled, go to the Layout > Create/Edit > GeneralSettings. In the Global Cine Toolbar panel, select an checkbox for when toshow the toolbar: Always, Auto, or Never. Click Save.
� Use these controls when the cine toolbar is displayed at the bottom of the viewer windowand special paging is enabled:
Name Icon Description
PreviousPage
Open the previous page. That is, if four series are shown,Previous Page shows the previous four series.
Previous Go to the previous image in a series.
Play Start playing the cine from the current frame.
Pause Stop playing the cine at the current frame.
Next Go to the next image in a series.
Next Page Open the next page. That is, if four series are shown, NextPage opens the next four series.
ToggleDirection
Switch from the current direction of cine play to the oppositedirection.
Cine Speed Drag the slider left or right to change the speed at which thecine plays. 100% corresponds to the cine speed specified inthe image.
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6.16 BookmarksBookmarks allow you to capture the display state of an exam and reapply the samedisplay state quickly. Bookmarks can be used for Resident reading reviews, pre-op setupfor operating room display, conferences, consultations, etc. There is no limit to the numberof bookmarks that can be created per exam.
You can create a snapshot of the current hanging including presentation state (W/L,Zoom, Annotations, Measurements, etc.). Bookmarks can be used for demonstration,teaching or conference purposes. A bookmark is saved and associated with the primarystudy; however, the bookmark can contain displayed images from the primary study aswell as any displayed images from the comparison studies.
Bookmark can contain images from any number of comparison studies. Images fromremote studies can also be included in a bookmark. Remote studies are accessible in thesystem when Cross Enterprise Display is enabled.
Applying a bookmark restores the snapshot by hanging all the referenced studies in theuser-saved layout and applying the corresponding presentation state.
When applying a bookmark that references comparison studies, if one of more referencedcomparison studies are unavailable to display, you will be notified about the missingstudies. The bookmark however will continue to apply for the available referenced studies.
There may be a delay when performing Bookmark save and apply functions, if theBookmark references multiple comparison studies. This delay may also occur whenthe Bookmark references remote studies.
You can either apply a bookmark that you saved with the study or you can apply abookmark that someone else saved with the study. You can delete your own bookmarks,but not the bookmarks of another user. Bookmarks are saved in the system and arestudy specific.
Note
● Bookmarks are disabled on systems with an EA-only backend (that is, onsystems which do not have PACS-IW or CPACS).
● After an upgrade, the presentation states of bookmarks saved withoutpreserving the aspect ratio may change to preserve the aspect ratio.
● The bookmark feature is not supported on the studies that contain multiframe,multiphase images. In addition, the bookmark workflow is not supported onthe PET CT modality.
● Bookmark does not support workflows with AW, Mammography Viewer, andother third-party applications.
● Copy Series can be saved and correctly applied as part of the bookmark whencopies are saved in the sequence (left to right, top to bottom) and in thenumeric, incremental order. There cannot be skipped or missed copies, andthe monitor setups spanning the bookmark/HP must be ordered sequentiallyfrom left to right.
6.16.1 To Apply a Bookmark
Prerequisite: To use the Bookmark feature, the Bookmark option must be available. Toadd the bookmark icon to the Main Toolbar, see “To configure the Main Toolbar”.
1. To apply a bookmark, do the following:
a. Open the study to which you want to apply the bookmark.
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b. Click the triangle to the right of the Bookmark icon on the Main Toolbar andselect from the drop-down list the bookmark you want to apply.
2. To apply a bookmark from the study list, do the following.
a. Make sure you have set the user preference for bookmarks. See "To Changethe User Preferences for Bookmarks.”
b. Click Display to display a study from the study list. The selected user preferencefor bookmark application takes effect. Note that the user preference for Bookmarksis not honored when you are displaying more than one study in comparison mode.
6.16.2 To Save a Bookmark
Prerequisite: To use the Bookmark feature, the Bookmark option must be available onthe toolbar. To add the bookmark icon to the Main Toolbar, see “To Configure the MainToolbar”.
1. Open the primary study and any relevant comparison studies to include in theBookmark.
● Create multi-planar reformats if necessary or apply a preferred Hanging Protocol;create multi-planar reformats as necessary.
● Adjust the presentation parameters (such as W/L, Zoom, annotations, markings,etc.), if necessary.
Note: Presentation state information that is part of the embedded MIP/MPRviewer is not saved.
2. Click Bookmark on the Main Toolbar.3. Do one of the following:
● If your user preference is set to Save Bookmark with Single Click, the bookmarkis automatically named and saved.
● To use the default name displayed in the dialog, click OK.● To specify the bookmark name, type the desired bookmark name in the field to
replace the default name and click OK.
Expected Result: The bookmark is saved and accessible in the Manage Bookmarkdialog. For information on applying a bookmark, see “To Apply a Bookmark”.
6.16.3 To Delete a Bookmark
Prerequisite: To use the Bookmark feature, the Bookmark option must be available. Thebookmark option can be added to the Edit menu, to the Series Menu, or as a Bookmarkicon to the Main Toolbar. To add the bookmark icon to the Main Toolbar, see To configurethe Main Toolbar.
You can delete your own bookmarks, but not the bookmarks of another user.
1. If the Bookmark icon is on the Main Toolbar, click the triangle to the right of theBookmark icon and select Manage Bookmark. Or, from the Image Viewer menu,click the Edit menu or the Series menu and select Bookmark > Manage Bookmark.
2. From the list, select the bookmark(s) that you want to delete. Use Ctrl + Click to selectnon-adjacent bookmarks or use Shift+ Click to select a range of adjacent bookmarks.
3. Click Delete to delete the selected bookmark(s).
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6.16.4 To View a List of Your Saved Bookmarks
Prerequisite: To use the Bookmark feature, the Bookmark option must be available. Thebookmark option can be added to the Edit menu, to the Series Menu, or as a Bookmarkicon to the Main Toolbar. To add the bookmark icon to the Main Toolbar, see To configurethe Main Toolbar.
� Do one of the following:
● If the Bookmark icon is on the Main Toolbar, click the triangle to the right of theBookmark icon. The list of your saved bookmarks is displayed in the drop-down list,along with the Manage Bookmark option.
● Or, from the Image Viewer menu, click the Edit menu or the Series menu and selectBookmark > Manage Bookmark. The list of your saved bookmarks is displayed.
6.16.5 To View a List of All Saved Bookmarks for a Patient
Prerequisite: To use the Bookmark feature, the Bookmark option must be available. Thebookmark option can be added to the Edit menu, to the Series Menu, or as a Bookmarkicon to the Main Toolbar. To add the bookmark icon to the Main Toolbar, see To configurethe Main Toolbar.
Note that in the Manage Bookmark dialog, when viewing a list of all saved bookmarks fora patient, you can only delete bookmarks that you have created.
1. Open a study for the patient for which you want to see all bookmarks.
2. Do one of the following:
● If the Bookmark icon is on the Main Toolbar, click the triangle to the right ofthe Bookmark icon and select Manage Bookmark.
● Or, from the Image Viewer menu, click the Edit menu or the Series menu andselect Bookmark > Manage Bookmark.
3. Click the checkbox for All bookmarks for this patient.
Expected Result: The list of all saved bookmarks for the patient displays.
6.16.6 To Change the User Preferences for Bookmarks
Bookmark preferences are saved for future logins.
1. Do one of the following:
● Right-click in the Navigator and select Navigator OptionsOR
● Right-click on the image number in any viewport and select Scroll Options >User Preferences
Expected Result: The User Preferences dialog opens.
2. Click the Bookmarks tab.
3. In the Bookmark On Study Open panel, select one of the following: Show recentBookmark, Show my current Bookmark, or No Bookmark.
4. Select or clear the check box Save Bookmark with Single Click.
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If selected, bookmarks are saved with one click without showing a confirmationmessage. A message displays if the bookmark save fails.
5. To save your selections, click OK.
6.17 Conference Display ProtocolsWith the Conference Display Protocol (CDP) feature, you can create a snapshot of thecurrent hanging including presentation state (W/L, Zoom, Annotations, Measurements,etc.). CDP can be used for demonstration, teaching or conference purposes. CDP issaved and associated with the primary study, but CDP can contain both displayed imagesfrom the primary study and any displayed images from the comparison studies.
CDP can contain images from any number of comparison studies. Images from remotestudies can also be included in a CDP. Remote studies are accessible in the UniversalViewer when Cross Enterprise Display is enabled.
While a study can have multiple bookmarks, a study supports only one CDP at a time.This means that you can either use a CDP that is already saved with the study, or youcan overwrite that CDP with another CDP.
Also, unlike a bookmark, you apply a CDP only from the Study List when launching theviewer, not from the patient folder inside the viewer.
6.17.1 To Apply a CDP
1. In the study list, select the study or studies to which you want to apply a CDP. If youselect multiple studies, you are selecting to apply each study’s respective CDP.
2. In the study list, right-click and select View Selected Studies for Conference.
6.17.2 To Save a CDP
Prerequisite: To use the CDP feature, the Bookmark option must be available. To add thebookmark icon to the Main Toolbar, see “To configure the Main Toolbar”.
1. Open the primary study and any relevant comparison studies that you prefer to beincluded in the CDP.
● Adjust the hanging as necessary or apply a preferred Hanging Protocol; createmulti-planar reformats if necessary.
● Adjust the presentation parameters (such as W/L, Zoom, annotations, markings,etc.), if necessary.
Note: Presentation state information that is part of the embedded MIP/MPRviewer is not saved.
2. Find the Bookmark icon on the Main Toolbar. Click the triangle to the right of theBookmark icon and select Save for Conference.
● If a CDP is already saved for this study, a prompt displays asking if you want tooverwrite the existing CDP or cancel.
● For information on applying a CDP, see “To apply a CDP”.
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6.18 Add Studies to a Teaching FolderFor systems with a Centricity PACS backend, add exams to teaching folders using thistask.
The following operations on teaching folders require Centricity PACS privileges:
● Create a manual folder in Centricity PACS (administrators or GE service personnelcan perform this function using the Centricity Administration Tool, if needed)
● Access the folder to assign exams
● View the folder in which to place exams
● Remove exams from the folder
1. On the Study List window, search for studies to include in the teaching folder.
2. Select the desired studies, right-click to display the floating menu, and select Assignto Worklist.
3. On the Assign to Worklist window, select the radio button for Assign to CPACSWorklist, select a folder, and click Assign.
Expected Result: The files are added to the folder.
6.18.1 Display a Teaching Folder
For systems with a Centricity PACS backend, use these instructions to access theteaching folders.
1. To access a teaching folder, from the Study List window, click Search.2. On the Search window, select the From a Worklist check box.3. Click CPACS Studylist.4. On the CPACS Studylist Selector window, select a folder and click OK.
Expected Result: The selected folder appears in the From a Worklist field.5. Click Search.
Expected Result: The folder lists the available exams.
6.18.2 Remove a Study from a Teaching Folder
Note If you created a Teaching Folder tab on the Study List, you cannot removestudies from the folder on the worklist directly. Follow the instructions in thistask to remove studies from the Teaching Folder.
1. Follow the instructions in the task “Display a Teaching Folder” to display the foldercontaining the study to remove.
2. Select the study or studies and right-click to display the floating menu.
3. Select Unassign from CPACS Worklist.4. At the confirmation message, click Yes.
Expected Result: The study or studies are removed from the folder.
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6.19 Notes About the Display of X-rayModalityImages in Universal ViewerImages of the x-ray modality are CR, DR, DX, RF, and XA.
In the viewer, any series of x-ray modality images with more than one image in the seriesdisplay in the Viewer as separate series of one x-ray image per series.
The example that follows lists how a single series of three x-ray images displays in theNavigator as three separate thumbnails, with each series having one image.
● series 1 with 1 x-ray image
● series 2 with 1 x-ray image
● series 3 with 1 x-ray image
Note If a series of x-ray images contains more than 100 images, the x-ray imagesare not split into separate series.
6.20 Viewing Mammography ImagesThe system includes support for viewing mammography images.
● If you have a mammography workstation, studies that you select from the Study Listwill open in the mammography viewer.
● If you do not have a mammography workstation, you can still view mammography,breast MRI images, and associated reports via the Universal Viewer.
Note: Depending on your site’s configuration, you may see a message thatthe Universal Viewer should not be used for primary diagnosis formammography images. You are responsible for knowing whether theregulations at your site allow for the use of the viewer regardless ofwhether a message is displayed. For more information, contact yoursystem administrator.
If you choose to view a mammography study in the Universal Viewer, thatchoice applies to your whole viewing session.
The mammography viewer launches automatically for licensed users who select an MGstudy from the Study List and when the layout specifies that the mammography viewershould be used. You can use the available tools and features of this specialized viewer.For more detail, you can access the help for mammography features directly from themammography viewer.
You can configure hanging protocols for mammography images. When you opena mammography study from the Study List, it will display according to the hangingprotocols you have configured, including displaying the mammography images on thehigh-resolution monitors.
Note Switching between Hanging Protocols with different monitor configurationsrequires restarting the mammography viewer to correctly apply the monitorconfiguration.
You can select a patient's primary and comparison mammography studies from the StudyList and have them display in the mammography viewer at the same time. You canconfigure hanging protocols to display primary and comparison studies. You can use theLayout Editor to configure the number of comparison mammography studies to display withthe primary study (see Automatically Displaying Comparison Studies (page 191) for moreinformation). Comparison study display is also affected by the general display options.
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Multimodality studies are also supported. If you open a multimodality study, themammography images are displayed in the mammography viewer, and the othermodality’s images are displayed in the main imaging viewer. Similarly, if you are viewinghistorical studies from other modalities and then open a historical mammography study,the mammography study is displayed in the mammography viewer.
You can use the mammography viewer’s tools to configure it to display images accordingto your preferences. Any changes or edits to mammography images that you make in themammography viewer will be saved and stored in PACS.
You can work in batch mode if you have multiple mammography studies to review, or youcan work on both mammography and other studies in any sequence. You can change theconfiguration of the Done button to facilitate the way you want to work.
Mammography CAD objects
If your mammography workflow includes working with Computer Aided Detection (CAD)objects, Universal Viewer will send mammography CAD objects to the integratedmammography workstation.
CAD objects must use the correct DICOM tags. Some mammography modalities may beconfigured to send CAD objects as Radiotherapy Structure Set (RTSS) objects. Somesystems may use the modality of the study for the CAD objects. In that case, the objectwill not display as might be expected.
Note By comparison, RTSS objects must use the modality code RTSTRUCT.
6.20.1 To configure Image Laterality
Depending on your system configuration, you can add an Image Laterality annotationthat places identifying information, such as R and L, on the image. Contact your siteadministrator for information.
Note Image Laterality replaces the Laterality annotation selection, and Lateralityannotations are now permanently removed from the overlay. Follow thisprocedure to add an Image Laterality annotation.
To configure Image Laterality, do the following:
1. In the viewport, right-click on an image to display the floating menu. SelectAnnotation Overlay.
Expected Result: A sample image overlay template displays.
2. In the Edit Image Overlay Template dialog box, select <Empty> from the Annotationlist.
3. To make changes to the template, click <Empty> in the template.
Expected Result: The field is bordered in green.
4. Under Annotation, select Image Laterality.
Expected Result: The Image Laterality information displays on the sample imageoverlay template.
5. Define the features, such as:
● Font: Font attributes● Color: Font color● Background: Background color for the data
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● Transparent Background: No background color allows the image to be seenbehind the data.
● Length: Allows you to limit the length of the data cell from the drop-down menu.
● Transparency: Choose whether to limit the length of the data cell6. Click Close and Save.
Note: If you are editing an existing annotation template, you will be prompted toclick either OK to replace the existing annotation template or Cancel toexit without saving the changes.
ExpectedResult: Image Laterality is configured.
6.20.2 To configure View Position
Depending on your system configuration, you can add a View Position annotation thatplaces identifying information and modifiers, such as MSCCIDRL, on the image. Contactyour site administrator for information.
To configure View Position, do the following:
1. In the viewport, right-click on an image to display the floating menu. SelectAnnotation Overlay.
2. In the Edit Image Overlay Template dialog box, select <Empty> from the Annotationlist.
3. To make changes to the template, click <Empty> in the template.
Expected Result: The field is bordered in green.
4. Under Annotation, select View Position.
Expected Result: The View Position information and modifiers display on the sampleimage overlay template.
5. Define the features, such as:
● Font: Font attributes● Color: Font color● Background: Background color for the data● Transparent Background: No background color allows the image to be seen
behind the data.
● Length: Allows you to limit the length of the data cell from the drop-down menu.
● Transparency: Choose whether to limit the length of the data cell6. Click Close and Save.
Note: If you are editing an existing annotation template, you will be prompted toclick either OK to replace the existing annotation template or Cancel toexit without saving the changes.
ExpectedResult: View Position is configured.
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6.20.3 Automatically Displaying Comparison Studies
Universal Viewer allows you to compare multiple mammography studies viaMammography Viewer integration. In addition to selecting no studies or all studies, userscan select studies based on the following variables:
● Studies over a specific number of years
● A specific number of studies
● The oldest available study
To specify the rules for comparison study selection:1. Under Integration: Mammography Viewer in the Layout Editor, click the Comparisons
Configuration radio button.
2. Select any combination of the following:
● # Years Back Check the box and use the drop-down list to select the number ofyears’ worth of prior studies you wish to compare, from 1 year to 50 years.
● # Comparisons Check the box and either use the drop-down list to select thenumber of prior studies you wish to compare or enter your own value from 1 to1,000. You can also select All from the drop-down list.
● Oldest Check this box to retrieve the oldest study.
These options can be combined for several different types of results. The followingtable shows the outcome of possible selection combinations:
# Years Back(example numbers)
# Comparisons(example numbers)
Oldest Result
2 Retrieve all priorstudies from last 2years
5 Retrieve 5 latestprior studies
Checked Retrieve oldest priorstudy
1 Checked Retrieve oldest priorstudy
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2 Checked Retrieve oldeststudy and 1 latestprior
2 5 Checked Retrieve oldeststudy and 4 latestprior studies
1 1 Retrieve latest priorstudy
1 Retrieve latest priorstudy
All Retrieve all priorstudies
3 All Checked Retrieve oldeststudy and all priorstudies from the last3 years
3 Retrieve all priorstudies from the last3 years
6.20.4 Suppressing Mammography Workstation Pop-upMessages
When multiple users access the same study, Universal Viewer will display multiple pop-upmessages when Mammography Workstation integration is enabled. Perform the stepsdescribed below in order to suppress these pop-up messages.
1. Open an exam.
2. Right-click on the thumbnail window.
3. Select Navigator Options to open the User Preferences window.4. Select Miscellaneous from the list on the left-hand side of the window.
5. Check the box next to Show study already open message once per patient.
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6. Click Apply and then OK.
6.21 Using 3D Advanced Clinical ApplicationsThe integration with Advanced Clincal Applications provides access to advancedvisualization from the viewer.
The Advanced Clinical Applications server has ability to read image data directly from thePACS. This makes all the images on PACS automatically available to the AdvancedClinical Applications’ 3D protocols.
The integration also supports an interrupted workflow. You can save the state of yoursession and send that data to PACS, and then resume work at a later time. You can alsouse multiple protocols on the same exam.
The PACS manages user authentication and authorization centrally without requiring anindependent set of credentials for the Advanced Clinical Applications.
If you modify or reconstruct an image with a 3D protocol, when you save the image, it isassociated with the exam that included the image you modified or reconstructed.
The system also includes the ability to create a 3D Saved State, which is analogous to abookmark. Creating a 3D Saved State saves a screen shot along with your sessioninformation and stores it in PACS after you exit the protocols. The saved state is thenavailable as an entry in the series list. Opening that series launches the appropriateprotocol and restores the session information, so you can resume work where you left off.
You can add Advanced Clinical Applications to hanging protocols.
If the patient name or demographic information is changed in the study list, you will geta mismatch between the Universal Viewer’s and the Advanced Clinical Applications’displayed data. Because the database’s demographic information is not shared withthe Advanced Clinical Applications Server, it displays the original patient informationfrom the DICOM headers.
● If the 3D window is open, you can close it by clicking the Exit button in the left panelof the window.
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● To change the NX compression ratio used by the 3D Advanced Applications, open theUser Preferences and open the 3D Anchor tab. Then select an option for the TransitCompression Ratio. This value is used by the 3D Advanced Applications when youscroll through images. You do not need to change this value from its default.
6.21.1 Adding AW Server Viewports to Hanging Protocols
Prerequisite: You must have embedded integration to add an AW Server viewport toa hanging protocol.
You can add an AW Server viewport to a hanging protocol.
Note A hanging protocol can use either AW Server or the viewer’s native MIP/MPR,but not both.
1. Open a study in the viewer, and launch one of the AW Server protocols from that study.
2. Open the Hanging Protocol Editor by selecting Layout > HP Tool .3. Create a placeholder for the 3D protocol you wish to use.
4. Configure the placeholder to use a specific 3D protocol:
● Using the context menu:
1) Double-click on the place-holder to open the context menu.
2) From the context menu, select 3D Applications and then the protocol youwant to add to the hanging protocol.
The placeholder will change color and show the name of the protocol orapplication you selected in the upper left corner.
● Using the Choose hanging criteria dialog:
1) Double-click on the placeholder to open the Choose hanging criteria dialog.
2) Right-click the 3D Applications row.5. Optionally, use hanging criteria to select which series to display.
● Study Category
● Series Description — this is a free-text field; it applies to the current study only
● 3D Applications
● Position of Series in Navigator — use 1 for the series shown on the left end of theNavigator, 2 for the next series, and so on; this is not the series ID
Note: The default value is zero (0). This must be changed. If a differentvalue is not specified, the system will not open the 3D AdvancedApplications unless other hanging criteria are matched.
● Use Series with the most slices
● Most recent 3D save state series
The list of criteria will vary depending on your user account credentials.
Note: When the hanging protocol is used, the best-matched series will bedisplayed in the AW Server viewport. Based on your selection, theVolume Viewer may show the series selection panel.
6. Click Save or Save As to save the hanging protocol.7. Click Close to exit the Hanging Protocol Editor.
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6.22 VitreaThe system supports integration with third-party viewers to provide specialized imagingcapabilities. When used in concert with the system, the user gains greater flexibility inmanipulating certain types of studies.
Vitrea is used specifically for CT and multi-slice images. You can open studies in Vitreaand save and export studies back to the system. Context management — that is, the abilityto close the Vitrea application from the system — is enabled for this third-party integration.
Note The Vitrea application closes automatically when you close the study.
Note You can launch Vitrea from the main toolbar, the main menu, the series menuor from a shortcut. See Configuring Shortcuts, Main Menu Configuration,Series Menu Configuration, Main Toolbar Configuration. Select Open in Vitrea.
6.22.1 To View a Study in Vitrea
1. While the study is open, launch Vitrea. The Vitrea application displays, with differentviews of the study on the right and display options and controls on the left. Notethe tabs across the bottom of the screen.
2. After manipulating the image(s), use the snapshot button to cull any number ofimages into a report.
3. Click the Report tab. An empty set of panes is shown on the right, with thumbnailimages of all snapshots on the left.
4. Click and drag a desired snapshot image into a pane on the right. Repeat until alldesired images are collected on the right.
5. In the lower left of the control panel, click DICOM Export.6. Ensure that the system server is selected in the list.
7. Click Export.
Note: The images are sent to a preconfigured location. There is no need tobrowse to the file location.
8. Refresh the study (from the main menu, a shortcut, or the Patient Folder). Allthe Vitrea images are added as one or more series. (Two protocols will result intwo series.) The series is shown highlighted in green in the Navigator, which isautomatically launched upon successful export.
6.23 MedImageMedImage is a third-party viewer, used specifically for nuclear medicine images, thatallows users to view those studies in greater detail. Any changes cannot be saved orexported back to the system. Its advantage is as a viewer.
Note You can launch MedImage from different parts of the system. See ConfiguringShortcuts, Main Menu Configuration, Series Menu Configuration, MainToolbar Configuration.
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6.23.1 To view a study in MedImage
� From the list, select the item Open in MedImage. You can launch MedImage from one ofthe following:
● Main toolbar
● Main menu
● Series menu
● Shortcut
Note: The MedImage application remains open until you close it.
6.24 TeraReconTeraRecon is a third-party viewer used specifically for multi-slice images. You can openstudies in TeraRecon. Saved studies are sent by the TeraRecon server back to the system.
6.24.1 To View a Study in TeraRecon
Note You can launch TeraRecon from different parts of the system. See ConfiguringShortcuts, Main Menu Configuration, Series Menu Configuration, or MainToolbar Configuration.
1. While the desired study is open in the system, select Open in TeraRecon from:
● Main toolbar
● Main menu
● Series menu
● Shortcut
2. To open the entire study (all series), select it in the upper left pane. To open only oneseries of the study, select it in the lower left pane.
3. Click Load. The study is loaded, under the activated Review tab.
4. Click the image to edit.
5. After manipulating the image using the TeraRecon tools, right-click from the desiredimage to display a floating menu and select Capture. This action captures the activeimage and displays its thumbnail under the Output tab (in the control panel on theright).
6. From the Output tab, click DICOM Server to store the image in the system. Thiscommand is also accessible from the floating menu.
7. From the export dialog, select the system server from the list. (Use ctrl+click to selectmultiple servers.)
8. Refresh the study in the system from the main menu, a shortcut, or the Patient Folder.All the TeraRecon images are added as one or more series. (Two protocols will resultin two series.) The series is shown highlighted in green in the Navigator, which isautomatically launched upon successful export.
Note: The TeraRecon application remains open until you close it.
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6.25 RadNetIf RadNet is installed on your system, you can launch RadNet from the viewer to seeorders associated with the accession number of the study you are viewing.
To launch RadNet:
● Click the RadNet icon ( ). RadNet will open with orders associated with theaccession number of the active study in the viewer.
To add the RadNet icon to the toolbar, see To Configure the Main Toolbar
If you switch studies in the viewer and click the RadNet icon, RadNet will update withthe accession numbers associated with the study you switched to.
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7Image Viewer Tools
Once a study is loaded in the viewer, the system provides tools to assist with diagnosis ofthe study. Frequently-used tools are accessible through the Image Viewer toolbar, or theright-click floating menu. The menu bar at the top of the screen also provides access tomany of the tools in Image Viewer.
Note This toolbar can be configured. See Configuring Toolbars.
7.1 Paging/Scrolling
The Page/Scroll button on the Image Viewer toolbar appears to be pressed downwhen enabled.
Depending on the layout, studies open in Overview, Stack View or Global Stack. In StackView, each series opens in its own window, as though the images in that series were"stacked" in that window. To see the rest of the images in the "stack," you page (scroll)through the images in the series.
Centricity Imaging Viewer presents several different ways to page through the stack,whether you use the mouse or the keyboard.
Page/Scroll is always enabled upon opening a study. The toolbar must be configured toinclude this button.
Note You can zoom the image without leaving Page/Scroll mode by clicking anddragging the mouse wheel or middle mouse button. When the mouse pointerchanges ( ), the zoom feature is enabled. Drag the mouse cursor left or upto zoom out, or drag the mouse cursor right or down to zoom in.
7.1.1 Creating Scrolling Shortcuts
Scroll shortcuts are available to expedite scrolling through a large series.
● Home – Go to the first slice● Insert – Display the middle slice of a series, rather than scrolling through several
images. For example, if the series has 212 images, this feature displays image #106.
● End – Go to the last slice.
● Page Up/Page Down– Advance through the images in increments of about 15% ofthe total number of images in the series.
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● Shift + mouse scroll wheel – The Fast Forward/Fast Backward feature allows youto advance through pages of images in a viewport in increments of 10 pages. Thisfeature is available for Series, Global Stack, and Sheet View viewports.
Note While fast scrolling in the forward direction, if the number of images to bescrolled is less than 10, then the fast scroll feature will scroll to the last imagein the viewport. While fast scrolling in the reverse direction, if the number ofimages to be scrolled is less than 10, then the fast scroll feature will scroll tothe first image in the viewport.
Note Using fast scrolling will skip images. The Percentage of Images DisplayedIndicator of the Navigator may not display the value of 100% even whilethe last image within the series is displayed. If the Percentage of ImagesDisplayed Indicator value is less than 100% then all of the images of thatseries have not been displayed.
Note The Slab Scroll feature lets you redefine the size of slices in a study.
7.1.2 Inter-series Scrolling
Inter-series scrolling is available in Stack View.
In standard scrolling, you page through one series at a time. Inter-series scrolling allowsyou to scroll through all images of the study in sequence, without interruption betweenseries. You do not have to click on a new series to begin scrolling through that "stack."When this feature is activated, series are ordered according to series time (i.e., newestfirst to oldest) and then according to image number.
You activate inter-series scrolling through the More Settings tab of the Layout Editor,and you can use only two of the standard scrolling methods: the mouse roller or theup/down arrows on the keyboard. After paging/scrolling to the last image in one series, thesystem moves automatically to the next series. If the next series has not been opened,the system opens it.
At the beginning of a study, scroll to "previous" effects no change, and at the end of thestudy (the last image of the oldest series), scroll to "next" effects no change.
See also the section on Global Stack, in which all series are combined into a singlephysical series for uninterrupted scrolling.
7.1.2.1 Paging Through Images
Click a series to make it active and then:● Hold down the left mouse button and drag the mouse up or down.
Drag up to scroll up or drag down to scroll down. The mouse pointer changes to anup arrow to indicate that you are scrolling up and a down arrow to indicate that youare scrolling down. You can change how the system determines your scroll rate(scroll mode) or change the scroll speed from the Navigator mouse preferences (seeMouse Preferences (page 136)).
● Scroll using the mouse wheelMouse preferences also affect the rate of scrolling with the mouse wheel.
● Click the left mouse button in succession to scroll down the "stack" one-by-one.
● Click the Up and Down Arrow keys or Page Up/Page Down keys
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7.1.3 Slab Scroll
You can choose the thickness of a slice, and the system regenerates the slices of thestudy according to an algorithm that you select. You can create a
keyboard shortcut to toggle to slab scrolling.
Note This feature is for a series with defined a defined location or position, inparticular for CT and MRI modalities. You cannot, for instance, use this optionfor US or CR images because they have no spatial information. To check thespatial information, right-click the mouse when in the stack window to displaythe floating menu; select
Image Info.
Image Overlay also displays location or position.
Note You cannot render 3-D images from a series that has been slab scrolled.
Use the Main Toolbar configuration to include Slab Scroll on the toolbar. You can alsoconfigure the system to open a study with slab scroll already enabled; see the MoreSettings section to learn how to set a certain thickness as a default.
7.1.3.1 To change the slice thickness
1. From an open study in Image Viewer, select the Slab Scroll menu item or Slab Scrollon the toolbar. A copy of the active series is immediately launched, with a verticalscroll bar on the right. The current slice thickness is shown in the scroll button.
2. Position the mouse pointer over one edge of the scroll button, until the shape changesto a double-arrow.
3. Click and drag the edge up (to increase the slice thickness) or down (to decreasethe slice thickness).
The value in the scroll button changes to reflect the new definition. The new slicethickness is applied to all images in the series, but only in the copy window. Theoriginal series displays, with the original slice thickness, next to the copy. If you usePaging/Scrolling to leaf through the series, both displays will update, though theupdate may not be visible until the mouse is released. To see all images in the copyonly, click and drag the entire slab scroll button in the vertical scroll bar.
Note: You can also select a pre-defined slice thickness by clicking the downarrow next to the Slab Scroll button, instead of clicking and draggingthe scroll button.
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The number of images (the blue number) changes in the copy window when youchange the slice thickness, since there are fewer slices in the copy.
Note: It can be useful to use Triangulation with Slab Scrolling.
4. To delete the copy, click the X in the copy's title bar, or click the Slab Scroll button onthe toolbar again to disable it.
7.1.3.2 To Change the Algorithm for Calculating Slice Thickness
When you select a different slice thickness, the system does not arbitrarily recalculate theoriginal slices. It applies an algorithm that uses one value to determine how the slicesshould be "cut." That value is user-defined; it can be the average of all pixel values, themaximum pixel values or the minimum pixel values.
Note You can only choose a slab slice thickness that is a multiple of the originalslice thickness. For example, in a series with an initial slice thickness of 5mm,you can select a target slice of 10, 15, 20 mm, etc., but not 6 or 8 mm. Ifyou choose a thickness which cannot be applied, the system will use thenearest acceptable value (the closest multiple of the initial slice thickness).The maximum slice thickness is 36mm.
1. Click the down-arrow next to the Slab Scroll button. A slab definition menu displays.
2. Select the value to be used in the algorithm, according to the following definitions:
● MIP (maximum): Every point of the slab image is a maximum of correspondingpoints of slices in this slab; this is the default algorithm.
● MIN (minimum value): Every point of the slab image is a minimum ofcorresponding points of slices in this slab.
● Plain averaging: Every point of the slab image is an average of correspondingpoints of slices in this slab.
7.2 Global StackGlobal stack is available in Stack View. Inter-series scrolling is not used with global stack.In global stack mode, all series are combined into a single physical series. The user canscroll through in sequence, with no interruption between series.
Within global stack mode you can do the following:
● Configure hanging protocol criteria. This includes sorting x-ray images based onacquisition time or series number.
● Control if changes in the presentation parameters in an x-ray image are applied toonly the active image (that is, the image that the cursor is over) or to all images in theentire series. Presentation changes can include W/L, zoom, flip, and rotate.
7.2.1 To Use Global Stack
1. Select Global Stack from the main menu or toolbar if it has not been set as a defaultupon opening.
2. Scroll through, or select the Cine feature to see all images sequentially. The title barchanges to reflect which series is currently displayed in the global stack. Use normalscroll methods to move forward or back through the stack.
Note: You can synchronize and cross-reference a global stack series.
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3. Use the left and right arrow keys to navigate to either the previous series or thenext series in the global stack viewport. The first image in the selected series willbe displayed.
Note: If the viewport is sorted by acquisition time, then this feature will bedisabled.
7.2.2 To Set Up Global Stack
1. From the More Settings tab of the Layout Editor, select the Create Global Stack Viewon startup check box.
2. To use the Cine feature with a global stack, enter a cine rate. The global stack seriescines at this rate if you use the cine feature when that series is active. Cine does notactivate upon startup. It must be explicitly selected, as described in Cine.
Note: You can add global stack as a main menu, toolbar or shortcut item. Thisallows you to use the feature selectively, without making it a default actionupon launching a study.
Note: The system attempts to use frame rate values in the DICOM header or inGlobal Stack to determine a frame rate value for cine.
3. Click Save.
7.2.3 Configuring Hanging Protocol Criteria in Global StackMode
1. Create a global stack in a viewport as a part of the hanging protocol configuration.
2. Configure the hanging protocol order criteria for the global stack viewport.
● Configure the image order criteria. Your choices are Series Number andAcquisition Time.
● Configure the presentation state criteria. Your choices are Active Image andPer Series.
3. Save the hanging protocol.
ExpectedResult:Hanging protocol criteria is configured in global stack mode.
7.3 Selecting an Image
When you use the Image Viewer tools, changes are applied to all images in the activeseries. (The active series is indicated by a vivid title bar.) In some cases, you may wishto apply the changes only to certain images in the series. To accomplish this, you canselect the images that will receive the changes. The system provides ways of selectingimages besides manually selecting each image you want. You can also save selectimages to a file.
Note It may be easier to see the images that you want to select if you use PageFormat to arrange the series in rows and columns. Use the Main Toolbarconfiguration to include the Select option on the toolbar.
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7.3.1 To Select One Image From a Series
1. Click Select on the Image Viewer toolbar.2. Click the desired image.
Expected Result: A gold check mark indicates that only that image has beenselected. That image receives all further actions that you perform using the ImageViewer tools.
7.3.2 To Select Multiple Images in a Series
You can select each image manually, or you can quickly select multiple images at once.For example, if an MR series was acquired with a dual echo protocol, you can select allthe images from one echo.
1. Click Select in the Image Viewer menu at the top of the screen, or right-click to seethe floating menu, then click Select.
Note: To open multiple series in a 3D protocol, disable the Select tool.
2. Select all the even-numbered images in the active series, all the odd-numberedimages, or reverse your current selections by clicking Invert selection. ClickUnselect All to clear your selections.
3. The selected images will receive all further actions that you perform using the ImageViewer tools.
or
4. Use the standard Windows selection controls to select and clear your images.
● While holding down CTRL, click once in each non-adjacent image you want toselect.
● To select adjacent images, hold down SHIFT and select the first and last imagesof a group that you want to select.
● To clear a selection, hold down CTRL and click the image to clear.
7.4 Saving and Uploading Images
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The Save Image option can be located on the
Image Viewer toolbar; use the Main Toolbar
configuration to include it on the toolbar.
This section also describes how to upload reformatted images to the server.
7.4.1 To save an image or images
1. To save only certain images in the active study, first select those images. You canalso arrange certain images within a series in rows and columns to make themvisible. If you want to save a certain series or only one image, make sure that seriesor image is active by clicking it.
2. Right-click and select Export Image > Save Image from the floating menu. The SaveImage dialog title bar shows which series is currently active.
3. Accept the default root folder or choose another. The root folder defaults to thelast saved location. You can override this default and choose a new root folder byclicking Browse.
4. In the root folder you selected, the system automatically creates a subfolder with thepatient's name. Accept the default or enter a new subfolder name.
Note: Selecting the Anonynize option changes this field to Anonymize.
To disable this feature, select the Do not create subfolder check box to the right ofthis field.
5. Under File Name Header, enter a name that will serve as the beginning of the filename. The file name with the patient's last name and first name by default, but youcan enter any alphanumeric string in this field.
Note: Selecting the Anonynize option changes this field to Anonymize.6. Select a graphic file format from the drop-down list.
7. Use the definitions below to select which images are saved:
● Active -- Only the active image will be saved.● Visible -- Only those images arranged in rows and columns in the active series
will be saved.
● Selected -- Only the selected images will be saved.
● Entire Series -- Only the active series will be saved.● Entire Study -- All images in the study will be saved.
Depending on which option button you choose, the text box at the bottomof the dialog updates to reflect your selection. This text box shows the filename assigned to the new file. The file name is in the following format:PATIENTNAME.SeriesNumber.ImageNumber.xxx If multiple images are selected,such as an entire study, every image is saved as a separate file with a distinct filename in the location specified.
8. To give the exported data an anonymous, system-generated and consistent title,check the Anonymize check box. All the fields that previously displayed a patientname will be updated. To control, at a granular level, what data is anonymized andhow, click the ellipsis button next to the Anonymize check box. A dialog displays allpatient and study information, populated with system-generated "dummy" strings.Overwrite any of these strings with other data to control how the export is identified.
Note: Anonymized studies, series, or images do not contain notes, reports,or any non-image objects.
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9. To remove private tags, select the Remove Private Tags check box.10. Click Save to accept the definitions and save the image(s).
7.4.2 To Upload a Series to the Server
In addition to saving images to a file system, you can upload new series to a server. If youwish to retrieve any new series for subsequent use, as in the case of a new series createdvia reformatting, you must upload that series to the server.
� In the Image Viewer, right click the series to upload.
From the floating series menu, click Upload Series. This menu item is enabled onlywhen a new series has been created. A brief status bar displays, and the new series isuploaded. It will now appear along with the other series whenever this study is retrieved.
7.5 To Reset Image ManipulationsAny image manipulations and presentation changes made to an image in an activeviewport can be reset, which will restore the image to it’s initial display state, by clicking
Reset on the main toolbar, or by selecting Reset from the main menu or series menu.A keyboard shortcut may also be configured.
The manipulations, which are reset by a single click, include:
● W/L
● Zoom
● Pan
● Rotate
● Flip
● Mirror
● Page Format
● Annotations and measurements
● ROI
Note:
● There is no change to the current hanging (display order or layout).
● The reset image stays on the same image number.
● Triangulation, Cross-reference, and Synchronization remain unchanged afterreset.
● Reset is not supported on an AW advanced Visualization viewport
7.6 Window/Level (W/L)You can adjust both the width of the contrast range and the brightness level of the image.You can also use pre-set definitions and window a region of interest (ROI). Changes made
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to the open image are applied to all images in that series. To make changes only to certainimages in a series, you must select the desired images before adjusting the settings.
You can apply specific W/L settings upon image load. See More Settings.
Use the Main Toolbar configuration to include the W/L icon ( ) on the toolbar.
PET images may be viewed with a white background (interpreted as a Monochrome 1image) or a black background (interpreted as a Monochrome 2 image). See WindowLeveling.
Note The W/L synchronization between Viewport and Navigator thumbnail is onlyfor preset W/L. The W/L settings for images in the Navigator which arenot loaded in the Viewport will have W/L settings from the Layout Editor.Changing the W/L preset in the Viewport will change the W/L of respectiveseries in the Navigator.
7.6.1 To Adjust the W/L of an Image
W/L changes made to the open image are applied to all images in that series. To makechanges only to certain images in a series, select the desired images before adjusting thesettings.
1. Click W/L on the toolbar. The mouse pointer changes shape.
2. In the image, click and drag the mouse to the left or right. The pointer again changesshape to show right/left arrows. Drag left to increase the contrast of the image. Dragright to decrease the contrast.
3. Release the mouse to accept the displayed W/L.
7.6.2 To Adjust the Brightness Level of an Image
1. Click W/L on the toolbar. The mouse pointer changes shape.
2. In the image, click the left mouse button and drag the pointer up or down. The pointeragain changes shape to show up/down arrows. Drag up to increase the brightnesslevel of the image. Drag down to decrease the brightness level.
3. Release the mouse to accept the displayed level. Changes made to the open imageare applied to all images in that series. To make changes only to certain images in aseries, you must select the desired images before adjusting the settings.
7.6.3 To Adjust the W/L in a Region of Interest (ROI)
You can automatically apply the optimal W/L settings for a certain region of interest (ROI),enabling you to clarify that region and disregard extraneous parts of the image. Thisfeature is most useful in general radiography. For example, during central line placementon the portable chest x-ray, often the end of the line is not conspicuous.
Note You can page through the images without leaving W/L mode. Hold downCTRL to temporarily suspend W/L mode. Click the mouse to page throughuntil you see the image you want, then release CTRL to return to W/L mode.
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1. Click W/L on the toolbar. The mouse pointer changes shape.
2. Starting at the upper left and dragging toward the lower right, right-click and drag themouse, creating a rectangle until it surrounds your region of interest.
3. Release the mouse. The optimal W/L settings for that ROI are automatically appliedto the displayed series.
7.6.4 To Select a Preset W/L Setting
You can select a pre-defined W/L setting so that you can quickly switch to an optimalrange for your study. This obviates the need to adjust the settings manually for everyimage. Once it is selected, you can always modify the pre-set manually with the W/L tool.
1. Right-click anywhere in the image to display a floating menu.
2. Click the Preset Window item and select one of the available definitions for this study.
● Automatic— Applies the optimum W/L setting for the exact center of the imageto the whole image. This is the default setting, but can be changed; see theConfiguration section.
● Recommended — Applies the optimal settings, as determined by the scannerand sent as DICOM data. See also VOI LUT.
Note: The Recommended menu item displays only if the scanner sendsDICOM information.
● Collective—Applies the automatic setting to every image in the active series.
● Invert— Reverses the current black/white background settings.
● Auto Series — Applies W/L settings for the active image to every image in theseries. This setting is important for FSAT and Breast MR exams.
● Preset AbdPel Tissue/Lung/Bone etc. — Applies optimal settings for thatanatomy. The particular modalities have these W/L presets already assigned inthe Layouts. Further modifications can be made through the Layout Editor.
● Next — Apply the next preset that appears in the menu.
3. At any time, press the space bar once to toggle through all definitions.
7.6.5 PET and Nuclear Medicine (NM) Window/Level
Windowing of PET and NM images is controlled differently than other modalities. For othermodalities (CT, MR, and other general radiology modalities), images are windowed bycontrolling the gray scale level window center and width. For NM and PET, windowing isinstead applied by manipulating the low and high value of the window range. The systemthen applies colors from a color map to the calculated values within the window range.
In order to control window level in NM and PET, you can add the specialized Window/Levelcontrol, called the Nuclear Medicine Window/Level (NM W/L) to the applicable overlay.
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The control is a vertical strip, with the low window boundary at the bottom and the highwindow boundary at the top. See the Fusion View Controls section for additional W/Lcapabilities for fused PET-CT images.
To automatically optimize the W/L for an area1. Click either numerical value on the W/L control.
2. Right-click and drag in the image to select an area.
Expected Result: The system calculates an optimal W/L for that region.
To manually control the W/L1. Click and drag either numerical value on the W/L control.
The direction you drag the mouse controls the W/L as follows:
● Up Increases the high value.
● Down Decreases the high value.
● Right Increases the low value.
● Left Decreases the low value.
To apply a different color map1. Right-click the vertical strip to open the entire color map collection.
2. Click any horizontal bar to select it. (The currently selected map is bounded bya frame.)You can select any one of the ten system-supplied color maps, including a directand inverse grey scale.
7.7 Selecting a VOI LUTIf VOI LUT is included in the DICOM header, then that VOI LUT is applied automaticallyto the image upon display — provided the Use VOI LUT as Recommended W/L settingis on. See the More Settings section to learn how to open a study with a desired W/Lpreset by default.
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If the modality does not send DICOM information, then the system does not display"Recommended" as a choice in the Preset Window menu.
The DICOM header may include multiple VOI LUTs. In such a case, the first VOI LUT inthe header is used to fulfill the "Recommended" setting.
7.7.1 To Choose an Alternate VOI LUT
1. From the toolbar "Get Next Recommended" icon, select an alternate VOI LUT fromthe list.
2. Select an alternate VOI LUT from the list or select another W/L setting.
Note: You define how to display the VOI LUT selections. You can configure thelist to display from the series menu or from a toolbar button or shortcut.See Configuring the System for more information.
The W/L annotation shows the selected VOI LUT name and the appropriate Widthand Centering values, but Image Overlay must be enabled to see that indication.
7.7.2 To Create or Modify a Preset Definition
The W/L Settings Editor allows you to change the settings for any modality, not just themodality for the current study.
Note You can create window settings for any modality, not only the modality forthe current study.
The W/L Editor allows you to create or modify a preset for any modality directly fromthe stack window.
1. Right-click in the image to display the floating menu.
2. Select W/L Editor.
Expected Result: The W/L Editor is displayed; each modality is an option on theleft, and the defined settings for the selected modality are shown in the pane onthe right under W/L Setting Name. Below the pane, the dialog displays parametersfor the selected setting.
3. Select a setting from the pane to modify, or click New to create a name to a newsetting.
4. Set the parameters for the setting, using the following definitions:
● Auto: Auto allows you to create an ROI-based setting for any modality other thanCT. You define a region of interest (ROI) in the image, which populates this dialogwith the optimum parameters for that region. Those optimum settings can then beapplied to the entire image. The settings are explained below.
● W/L Settings Name: The name assigned to this setting.● Learning By: Select which images will be used to calculate the normalization
parameters: all the images in the series, only the active image or all selectedimages.
● Normalization Parameters Clear the Pixel Range check box. Check theCollective check box only if you want Universal Viewer to use all series in thestudy to calculate the normalization parameters. The Alpha and Beta values willupdate automatically when you click the Learn button.
● Clipping Parameters: Accept the current values or enter new values in theBegin and End fields.
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● ROI: An outline, representing the region of interest (ROI), appears around thecurrent image. Select Reset to Default to reset the ROI to the center of theimage. Resize the ROI, if necessary, by clicking and dragging one or more sides.Click Set to Full Image to make the entire current image the ROI.
● Learn/Test: Click Test to update the image with the current parameters. Afteryou click Test, the button changes to Restore. Click Restore to return to theoriginal image W/L. Click Learn to apply the W/L values of the current ROI tothe entire image.
● Shrinking Parameters: Accept the current values or enter new values in theBegin and End fields.
● Filter: Select an image filter to apply from the drop-down list. Click Sharpen toinclude sharpening with this preset definition.
● CT/MR/NM/US/CR: Select the appropriate option:
● Name: The name assigned to this setting.● Parameters: Enter a numerical value for center and width, respectively.● Filter: Select a filter from the drop-down list, and click Sharpen to include
sharpening with this preset definition. Filters are enhancements calculatedfrom a sophisticated set of algorithms and applied to make certain aspects ofthe image more conspicuous, while introducing noise or distortion to the restof the image. See Image Enhancements for more details.
5. Click Save.
Note: This dialog merely creates or modifies a preset definition. To apply it to aparticular layout, you must use the Layout Editor.
7.8 Flip, Rotate and MirrorYou can modify how an image "hangs" in the display. Although you define the hangingprotocol in
Configuration, you can change the orientation of an image, to accommodate an exceptionor a capture mistake. Flip, rotate and mirror apply only to the active image; the otherimages in the series are not re-positioned.
7.8.1 To Flip, Rotate, or Mirror the Image
1. Click the desired image to ensure that it is active.
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Figure 1 Original Image
2. Right-click to display the pop-up menu. Make the appropriate selection based onthe following definitions:
● Flip: The bottom of the displayed image switches to the top. You are turning theimage upside-down from its current position.
● Mirror: The left side of the displayed image switches to the right. You are turningthe "sheet" over.
● Rotate Clockwise 90: The image rotates 90° clockwise from its current position.
● Rotate Counter Clockwise 90: The image rotates 90° counter clockwise from itscurrent position.
Figure 2 Flipped Image
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Figure 3 Mirrored Image
Figure 4 Rotated Clockwise 90 Image
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Figure 5 Rotated Counter Clockwise 90 Image
7.9 Copy a Series
Copy You may copy a series so that you can see the same series with differentcontrast settings or with different views. Like any other series, copies can receivecross-reference lines, synchronization and other Image Viewer actions.
Use the Main Toolbar configuration to include Copy on the toolbar.
7.9.1 To Create a Copy of a Series
1. Click in the series you want to copy to make it active.
2. Select Copy from the Image Viewer toolbar, or right-click to display the floating menuand select Create Copy.
A new display window shows the copy. The copy is denoted as such in the displaywindow's title bar -- Series X, Copy 1.
7.9.2 Display Image Settings for Copy Series
The user defines on which image the series copy displays on the viewer.
There are four choices:
● Display Image with Saved Number
● Display First Image
● Display First Non-Localizer Image
● Display Middle Image
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To configure, go to [EDIT] > Layout Editor > Settings > More Settings and refer to thehighlighted area of the dialog box (see below).
7.9.2.1 To Display Image with Saved Number
When Display Image with Saved Number is selected, Copy Series displays on theimage that is saved.
To apply this setting, do the following:
1. Select the Display Image with Saved Number radio button.2. Click Apply and Save. If you want to save the image with a different name, click
Save As and enter the name.
Note: For Used By, Personal is selected by default.
3. Click OK.4. Click Close and Done.5. Open the study again.
6. Look at the image number of the series you want to copy (for example, image number30). Right click on the same series viewport and select Copy This Series from theseries menu.
ExpectedResult:In this example, Copy Series always displays on the 30th image ofthe created series.
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7.9.2.2 To Display First Image
When Display First Image is selected, Copy Series displays on the first image in thatseries.
To apply this setting, do the following:
1. Select the Display First Image radio button.2. Click Apply and Save. If you want to save the image with a different name, click
Save As and enter the name.
Note: For Used By, Personal is selected by default.
3. Click OK.4. Click Close and Done.5. Open the study again.
6. Look at the image number of the series you want to copy. Right-click on the sameseries viewport and select Copy This Series from the series menu.
ExpectedResult:Copy Series always displays on the first image of the created series.
7.9.2.3 To Display First Non-Localizer Image
When Display First Non-Localizer Image is selected, Copy Series displays on the firstimage in that series. When Synchronize is ON, both series display with the first image.
To apply this setting, do the following:
1. Select the Display First Non-Localizer Image radio button.2. Click Apply and Save. If you want to save the image with a different name, click
Save As and enter the name.
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Note: For Used By, Personal is selected by default.
3. Click OK.4. Click Close and Done.5. Open the study again.
6. Look at the image number of the series you want to copy (for example, image number65). Right-click the same series viewport, and select Copy This Series from theseries menu.
The Synchronize button on the toolbar is ON:
Expected Result: Copy Series always displays on the first image of the created series.When the Synchronization button is ON, both series display with the first image.
Example: Synchronize button on the toolbar is ON:
Synchronize button on the toolbar is OFF:
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7.9.2.4 To Display Middle Image
When Display Middle Image is selected, Copy Series always displays on the middleimage in that series. For example, if there are 32 images in the series, Copy Seriesdisplays on the 16th image in the series. When Synchronize is ON, both series displayon the middle image.
To apply this setting, do the following:
1. Select the Display Middle Image radio button.2. Click Apply and Save. If you want to save the image with a different name, click
Save As and enter the name.
For Used By, Personal is selected by default.
3. Click OK.4. Click Close and Done.5. Open the study again.
6. Look at the image number of the series you want to copy (for example, image number128). Right-click the same series viewport and select Copy This Series from theseries menu.
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Example:
Synchronize button on the toolbar is ON:
Synchronize button on the toolbar is OFF:
ExpectedResult:Copy Series displays on the middle image (in this example, the 65thimage) of the created series.
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7.10 Copy to ClipboardThe Copy to Clipboard option allows you to copy the current window as a bitmap (.BMP)and paste it into another application that can accept the contents of the Windows clipboard(For example: Microsoft Word or Paint). The Copy to Clipboard option can be configuredas a button on the main toolbar, an item in the main menu, or a shortcut.
7.10.1 To Copy a Window to the Clipboard
1. Display the window you would like to copy.
2. Click Copy to Clipboard to copy the content of the current active window tothe Windows clipboard.
3. Open the file into which you want to paste the image, and use that program's tools topaste the image.
7.11 Cine
Cine is short for cinematic, and -- as the name implies -- this feature allows you tosee all images in the study in a cinematic "loop." Each image in the study is projectedsequentially so that it appears as if you are flipping through the stack. You can choose thedirection of the "loop" and pause or stop the cine.
The same tools apply for cine as for any other feature. For example, if series aresynchronized, cine works on all series simultaneously. If cross-reference lines areenabled, those will appear during the cine. If image overlay is enabled, you will seeimage data during the cine. If you pause the cine, you can use paging to go to the nextimage in the sequence.
7.11.1 To cine a study
1. To make sure it is active, click once in the series.
2. On the main menu of Image Viewer, click Cine.3. Use these controls as needed:
● Stop -- stop cine and exit cine mode.
● Pause/Play -- pause the cine on the currently displayed image. Click it again toresume the cine.
● Cine Back -- view the cine sequence from the last image to the first. When theentire series has been cined, the sequence resumes from last to first.
● Cine Forward -- view the cine sequence from the first image to the last. Whenthe entire series has been cined, the sequence resumes from first to last.
● Bounce -- Reverse the selected sequence after completion of a cine loop. So,after completing a first to last loop, the cine would then move from last to first.
● Frames Per Second Controls -- modify the speed at which the cine loops. Thedown arrow decreases the number of frames per second, and the up arrow
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increases the number of frames per second. The status bar updates to showyour selection.
● Status Bar --Numerical values of the images in the current series and thecurrently displayed image. As the cine progresses, the first number updates. Thefirst number matches the image number displayed in the upper left of the screen,if image overlay is enabled. If you adjust the FPS controls, the number of framesper second will briefly display in this field. The progress bar shows the directionand progress of the cine. Click anywhere on the progress bar to jump the cineforward or backward to a different image.
4. Use the tools to adjust the cine as necessary. Click Stop to exit cine mode.
7.11.2 Enable the Cine Series Toolbar for Viewing US, XA, or NMCine Images
Prerequisite:
● User has Administrator privileges
There is a toolbar available on the viewports for controlling cine playback of cine imageswith modality of Ultrasound, X-Ray Angiography, or Nuclear Medicine. The toolbar isavailable as an Annotation Overlay. If it is enabled, it will apply to all users, i.e., it is a“Common” setting, so should only be enabled for sites that want it to apply to all users.
1. Open the Viewer with a study of the modality for which you would like the Cine SeriesToolbar to be enabled.
2. Select Manage Overlay from the Series Menu.
3. Select the appropriate Annotate Template and click Edit.4. Enable the Cine series toolbar (See Universal Viewer Operator Manual for
instructions).
5. Select Save and Close.
7.12 Cine for Cardiology WorkflowIf the system is configured for cardiology workflow, XA, US, and NM images automaticallydisplay in cardiology cine mode. Progressive cine allows for cine images to be deliveredwith progressively increasing image quality up to full fidelity when using slow networks. Itis enabled by a setting in the Cine tab of User Preferences and applies to images storedwith lossless compression or no compression. Lossy cine images are not deliveredprogressively.
With the tools available in this mode, you can cine through any multi-frame (MF) imageor any image series composed entirely of single-frame (SF) images. The global cinecontrol at the bottom of the viewer allows you to cine through all visible MF images andSF series at once. You can also activate a control in any viewport to allow you to cinethrough that viewport individually.
You can use other image viewer tools (like Window/Level, Pan, Zoom, and so on)regardless of whether or not cine is running.
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7.12.1 To Configure Progressive Cine
1. Right-click anywhere in the Navigator. Click User Preferences.2. Select Cine.3. Select Use progressive streaming.4. Click OK.
Note: The “Compression” annotation can be enabled to indicate when imagequality reaches full fidelity. In the example below, the annotation “Lossy1:3.8” indicates that the viewed image is currently ‘lossy compressed’with a ratio of 1:3.8. When the “Lossy…” annotation goes away, then fullfidelity is achieved.
7.12.2 Global Cardiology Cine Controls
In cardiology cine mode, the global cardiology cine control bar displays at the bottom ofthe viewer. Use this control bar to start and stop cine in all visible viewports at once.
Note In cardiology cine mode, when cardiology cine controls are available, youcannot use the general cine controls from the viewer menus.
You can control whether or not the global cine control is visible from the Layout Editor onthe General Settings panel with the Global Cine Toolbar buttons.
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Name Icon Description
PreviousPage
Open the previous page. That is, if 4 series are shown, PreviousPage shows the previous 4 series.
PreviousFrame
Go to the previous frame in the current multi-frame image (or tothe previous image in a series composed entirely of single-frameimages).
Play Start playing the cine from the current frame.
Pause Stop playing the cine at the current frame.
NextFrame
Go to the next frame in the current multi-frame image (or to the nextimage in a series composed entirely of single-frame images).
Next Page Open the next page. That is, if 4 series are shown, Next Pageopens the next 4 series.
ToggleDirection
Switch from the current direction of play (increasing frame numbersor decreasing frame numbers) to the opposite direction.
CineSpeed
Drag the slider left or right to change the speed at which the cineplays. 100% corresponds to the cine speed specified in the image.
See Cine (for Cardiology Workflow) (page 141) to configure automatic cine playback.
7.12.3 Adding a Cardiology Cine Control Overlay
In cine mode for cardiology workflow, you can add a small cine control to the annotationoverlay of each viewport. This overlay controls the cine within it’s own viewport.
See Cine (for Cardiology Workflow) (page 141) to configure automatic cine playback.
To add a cine control to the annotation overlay in a viewport:1. Right-click in the viewport and select Annotation Overlay.
Expected Result: The opens the Edit Image Overlay Template dialog and shows theviewport you are editing divided into areas with red lines.
2. Click on a visible overlay element in the image (or click on <Empty> in the Annotationslist in the dialog).
Expected Result: This reveals all the possible annotation locations within the currentviewport.
3. Choose the location for the cine control by clicking on an <Empty> element in thatlocation.
4. Click Cine series toolbar in the Annotation list on the dialog.
7.12.3.1 Cardiology Cine Control Overlay Functionality
With systems configured for cardiology workflow, you can show a cine control in theannotation overlay within any viewport. This allows you to control the cine within thatviewport.
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Go to the first frame in the multi-frame image (or the first image in the series ofsingle-frame images).
Go to the previous frame.
Toggle between play and pause.
Go to the next frame.
Current frame location. You can drag this control along the timeline todynamically change the current frame.
Go to the last frame.
Cine speed in frames per second.
7.12.4 Saving a Study as an AVI
Studies can be saved as an AVI file for later Cine playback either on to your computer ora server.
1. Right-click the Cine viewport to bring up the floating menu and select Save.2. In the resulting dialog, specify the AVI configuration and file location.
7.13 To View Image and Patient PropertiesWhile the most pertinent information is displayed as you view a study, you can seeadditional information in certain circumstances. You can access details on the currentimage or the patient at any time. You can also navigate in the viewer while these dialogboxes are displayed.
1. Right-click the mouse over a series to display the floating menu. Click Image Info.In the Image Properties dialog, tabs are arrayed across the top, each holding specificinformation about the image. The image number, shown when Image Overlay isenabled. Detailed information captured by the scanner is also available. You mayneed to know the slice thickness or spacing, for example, from the General tab, orthe window data.
2. Click the X at the upper right to close the Image Properties window.
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7.13.1 Cross-Reference Lines
The cross-reference button on the Image Viewer toolbar shows where an imagein one series is located in another series.
In Stack View, each series is displayed in its own window in the Image Viewer. Oneseries may show axial cuts, while the other may show coronal or sagittal. While viewingan image in the first series, you may find it helpful to know precisely where that image islocated in the other plane. With cross-reference lines, the system provides the location ofthe "slice" in those other planes. Cross-Reference Lines function similarly to Triangulation.
The cross-reference lines are immediately displayed in those series that have orthogonalcuts different from that of the active series. The "slice" containing the active image isdenoted by yellow lines.
Use the Main Toolbar configuration to add Cross-Reference to the Image Viewer toolbar.
7.13.2 To display cross-reference lines
1. Click Cross-Reference on the Image Viewer toolbar.2. As you page through the images in the active series, note that the cross-reference line
shifts to correspond with the displayed "slice."
3. Click Cross-Reference again to disable the feature.
7.14 Triangulation
Triangulation functions similarly toCross-Reference in that it allows you to locatea region of interest in another plane simultaneously. Triangulation, however, allows youto follow that region of interest (such as a mass or anatomical structure) specifically andto define its outer limits.
In
Stack View, cuts in different planes are displayed as separate series. With Triangulation,you can click a region of interest in one plane and see that precise region identified in theorthogonal (perpendicular) plane. Further, you can continue to drag the selection to seewhere that region ends in the other plane.
Use the Main Toolbar
configuration to include Triangulation in the toolbar. You can create a
keyboard shortcut to toggle to Triangulation mode, and
Slab Scroll is a useful corresponding feature.
7.14.1 To Use Triangulation
1. Click Triangulation in the viewer toolbar, or click and hold F2. The mouse pointer
changes shape to indicate that this feature is enabled.
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2. Click in the image that includes your region of interest. In that active series, the
cursor changes to a cross-hairs shape to indicate that you are pinpointing the
desired area. A corresponding symbol is displayed in the series that displaythe orthogonal plane; that symbol moves in concert with the cross-hairs in the activeseries.
3. Drag the cursor to see updates to all series and to track the region of interest. If that
series does not include cuts of that region, a red symbol displays, and the seriesupdates to show the closest cut to the region of interest.
Note: Triangulation is also useful for jumping to the desired image in all series,sidestepping the need to scroll image by image.
4. To add additional 3D anchor points to an image, click the middle mouse button.
7.15 Synchronizing Parallel SeriesIn Stack View, each series is displayed in its own window in the viewer. One series mayshow axial cuts, while the other may show coronal or sagittal. While you are paging oneseries, you may wish to see the corresponding images in a related series, (that is, aseries with cuts in the same plane).
For example, you may wish to view series acquired with different scanning protocols (T1,T2, FSE, etc.) so that you can see the same region of interest under diverse techniques.You could also make copies of a series, define each copy under a different window setting(lung, liver, tissue, bone) and synchronize the copies to see all settings simultaneously.
You can also synchronize two different studies in compare mode. For example, you candisplay a primary and comparison study side by side and synchronize series from each.
Use the Main Toolbar configuration to include Synchronize ( ) in the toolbar.
Note It can be helpful to use cross-reference lines with Synchronization.
Note You can synchronize reconstructed PET-CT images to a W/L setting; seeAdvanced PET-CT for details.
7.15.1 To Synchronize Studies
1. Open the studies in comparison mode, usually a primary and comparison study.
2. The studies are arranged side-by-side in the viewer. Click Synchronize in the mainmenu to drop down a sub-menu.
3. Click Inter-studies Synchronization to indicate that images from different studieswill page in concert.
4. Click to page/scroll in any series; parallel series in both studies will page in concert.
You can individually disable or re-enable synchronization on each series by togglingthe synchronized ( )/unsynchronized ( ) button at the top of each viewport.
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7.15.2 To Select How to Apply Synchronization
The system updates the images in each series according to a defined protocol, whichyou select.
1. Click Synchronize and select one of the following choices.● Absolute Position (Bed Position) Matches images that are at the same image
position or location. This option is recommended for normal viewing.
● Absolute Number Matches images according to the image number. Image #10in all series corresponds; image #11 corresponds, and so on.
● Relative Position Allows you to manually match image position or location. Loadmatching images in each series manually, without synchronization, and then apply
● Synchronize by Relative Position to match images from that position on. Thisis recommended for comparison viewing or if the patient seems to have movedbetween series.
● Relative Number Allows you to manually match images by image number. Youcan load matching images in each series manually, without synchronization,and then apply Synchronize by Relative Number to match images from thosenumbers on.
● Image Registration In CT, PET, or MR studies, the system can automaticallymatch the relative spatial positions of corresponding anatomy between differentseries. Synchronize by Img Registration uses this calculation to match images.
2. Page through the series.
7.15.3 To Synchronize Parallel Series
1. Select a series with images captured in the plane you wish to view, i.e., coronal,sagittal, etc.
2. Click Synchronize on the Image Viewer toolbar.3. Page through the images in the series. All series with cuts in the same plane will
page in the same direction.
7.16 Sync by Image RegistrationImage registration provides another method of comparison review as the algorithmregisters and calculates the anatomical position of multi-modality studies. ImageRegistration allows you to synchronize two or more series on the same anatomical planeto perform a comparison. With the Sync by Image Registration option, you can line uptwo studies side by side even if the studies are not tilted in position due to respiration ordifferent modality scouting position. This option allows you to access Image Registr icon
changes to Sync Enabled ( ) or Sync Disabled (ation as part of native synchronizationalgorithms in the system. A visual indicator shows when Image Registration is in progress
( ). When complete, the ).
Important: Image Registration supports these modalities: ComputedTomography (CT), Magnetic Resonance (MR), and PET.
● Only for single phase series● No support for MPR viewports
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● Comparison review onlyImage registration can be saved as part of the layout, Sync by Image Registration,accessible through the Sync menu.
Sync by Image Registration matches the series to the closest anatomy and works by:
● Registration Calculation—the process of finding a coordinate transformation betweenDICOM spaces of two studies, which properly converts 3D DICOM points betweenrelated anatomical features of these two studies.
● Registration Usage—an application of found function to convert coordinates betweenthese studies.
One series is selected from each study and used for calculation of the registration. Then,the result is applied to all the series in the study for the synchronization purpose.
Manual sync and Image Registration
● When syncing two studies manually, Image Registration is unsuccessful if a studycontains only one image per series. If one study contains one image per seriesand the other study has x number of series and x number of images, then ImageRegistration is disabled and no synchronization between the two studies occurs.
● When syncing three or more studies manually, Image Registration omits the studywith one image per series and that study does not sync; however, other studiescontaining more than one image per series sync successfully.
What is the accuracy tolerance of Image Registration?
The success rate of the automatic registration evaluates the registration error, the errorbetween automatic registrations and manual ground truth registration as defined by clinicalexperts. To calculate the error, the Z offset is compared with the ground truth. Imageregistration uses the RIGID registration method to calculate and register.
Table 9 Accuracy Tolerance
Rate Anatomy Max Error Occurrence
Success rate Body/ Neuro Error ≤ 10mm >70%
Complete failure Body/ Neuro Error > 25mm <30%
Table 10 Supported modalities
Registration
Reference Registered Anatomy
CT CT Body/Neuro
CT MR Body/Neuro
MR CT Body/Neuro
MR MR Body/Neuro
PET CT Body/Neuro
CT PET Body/Neuro
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Table 11 Possible combinations for a single comparison
Primary Comparison 1 Anatomy
CT CT Body / Neuro
CT PT Body / Neuro
CT CT-PT Body / Neuro
PT CT Body / Neuro
PT PT Body / Neuro
PT CT-PT Body / Neuro
PT MR Body / Neuro
CT-PT CT Body / Neuro
CT-PT PT Body / Neuro
CT-PT CT-PT Body / Neuro
MR PT Body / Neuro
MR MR Body / Neuro
MR CT Body / Neuro
CT MR Body / Neuro
Table 12 Possible combinations for two comparisons
Primary Comparison 1 Comparison 2 Anatomy
CT CT CT Body / Neuro
CT PT PT Body / Neuro
CT CT-PT CT-PT Body / Neuro
PT CT PT Body / Neuro
PT PT CT Body / Neuro
PT CT-PT MR Body / Neuro
CT-PT CT CT-PT Body / Neuro
CT-PT PT MR Body / Neuro
CT-PT CT-PT CT Body / Neuro
MR MR CT Body / Neuro
MR CT MR Body / Neuro
MR PT CT-PT Body / Neuro
MR CT-PT PT Body / Neuro
CT MR PT Body / Neuro
PT MR CT-PT Body / Neuro
CT-PT MR CT Body / Neuro
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7.16.1 To Use Sync by Image Registration
Note Each additional study added to Sync by Image Registration decreasesperformance as registration is rendered for each pair of series.
1. Open two or more studies for comparison review.
2. Select a method to apply Sync by Image Registration.
Option DescriptionManual
Select Sync > Sync by Image Registration
When syncing three studies manually, registration is triggeredby the active viewport when the sync is turned on. Forinstance, if Primary is active, then registration will be triggeredfor Primary/Comparison1, and then Primary/Comparison2. IfComparison1 is active, then sequence is Comparison1/Primaryand Comparison1/Comparison2.
AutomaticApply a saved layout that contains Image Registration.
When syncing three studies automatically, registration occursin this order: Primary/Comparison1, Primary/Comparison2,Comparison1/Comparison2.
Note: If you select an unsupported modality, the system shows the ImageRegistration algorithm check from the Sync menu option, and theImage Registration algorithm does not render. You can drag and drop asupported modality to render.
3. Select an option, as needed:
Option DescriptionScroll on viewport You may scroll on each viewport while the Sync waiting icon
( ) displays, but you cannot toggle on/off until registrationis completed
Change toa differentalgorithm
Manually select another algorithm from the Sync Menu. Youcan change algorithms while Image Registration is rendering.
Drag and drop Drag and drop a different series to render
DisableSynchronization
You can disable the synchronization to adjust a specificviewport manually. To disable synchronization, single click the
Sync icon to change the status from Enable Sync ( ) to
Disable Sync ( ). To save the manual adjustment, changeto Sync by Relative Position, or Sync by Relative Number.
EnableSynchronization
If needed, you can sync a viewport by singleclicking&#160; the icon on the title bar,&#160;to
change the Disable Sync icon to the Enable Sync
icon . Images will return to the original Sync by ImageRegistration algorithm.
ExpectedResult:After Sync by Image Registration completes processing, the registrationis applied to all series and the icon returns to its original state.
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7.16.2 Image Registration Considerations
When does Image Registration fail?
Image Registration could fail due to the following reasons:
● Unsupported modality
● No suitable series such as multiphase
● The registration engine fails
● A DLL is not found (this is a rare scenario, since DLLs can only be removed manually)
How do I know if Image Registration failed?
For failure scenarios, no synchronization occurs between the studies, but the menu itemstill shows image registration selected. The menu selection remains enabled to allow youto introduce more series for which image registration can succeed. If a DLL is not found,a message box alerts you to this issue.
What are the benchmarks for Image Registration? What causes systemdegradation?
The benchmark of Image Registration is the time between initialization of registration andvisualization of the results with the ability to interact with them. Benchmarks are based onperformance tests done with a primary and single comparison workflow. When registeringmultiple studies for comparison review, performance will decrease as registration mustrender for each pair of series and apply registration. Performance will also be affectedwhen using a system with low bandwidth.
7.17 Field of View SynchronizationWhen activated, this feature adjusts all views in that same plane to the same anatomicalregion. For example, if you zoom an axial series of a Brain CT, all other axial series in thatstudy — even those of a different modality — update to display the same area.
Note The other series do not update to the same digital zoom factor, as that factordepends on the pixel size of the modality, the size of the viewport, and othervariables. Rather, the other series update to the same field of view; the sameanatomical details display.
Field of View Synchronization works even when different modalities are included ina study. In PET-CT, any zoom executed on an axial CT image automatically andsimultaneously applies the field of view to the axial PET images and axial fused images aswell. Field of View Synchronization also works for Pan and Scissors (Zoom to ROI).
7.17.1 To Use Field of View Synchronization
1. Create a shortcut, toolbar button or menu item for Field of View Sync.
2. Click the button or menu item to activate the feature.
3. In the desired series, execute a Zoom, Pan or Zoom to ROI command; all similarplanes in the study, no matter which modality, update to that same field of view.
4. Click the toolbar button or menu item again to turn Field of View off.
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7.18 Image EnhancementThe system allows you to apply additional processing to the image for a clearer diagnosticviewpoint. Sometimes known as "filtering," this enhancement is a sophisticated setof algorithms applied to make certain aspects of the image more conspicuous, whileintroducing noise or distortion to the rest of the image. The system provides a variety ofthese algorithms, so you can sharpen or smooth the image according to your preferencesand needs. The system also allows you to apply the desired enhancement to otherimages in a study.
This section explains how to apply image enhancements and how to add algorithms tothe Image Enhancements menu.
Note Referring Physician users cannot invoke this component.
7.18.1 To filter an image
1. Right-click the mouse while viewing the desired image. The floating menu displays.
2. Select Image Enhancements. A menu bar is added to the active image.
3. From the drop-down list at the bottom of the menu bar, select the image enhancementalgorithm to apply to this image. (You define which algorithms are displayed in this list,as explained in the task To edit the Image Enhancement algorithm menu.)
4. After selecting the desired algorithm, click Apply to This Image at the top ofthe menu. The image is processed with that algorithm, and the Image Overlayimmediately updates to reflect the new status, displaying "Filtered" in the lower leftcorner of the image.
5. Once you apply a filter to the image, the other features on the menu bar are activated.Make adjustments to the image(s) according to the following explanations of thosefeatures:
● Undo Last Filter — Reverses the application of the last enhancement youapplied.
● Undo All Filters— Returns the displayed image to its original state by reversingall the enhancements you applied. To undo the enhancements you made to allimages in the study, click Apply to All Images after clicking Undo All Filters.
● Done — Exits the Image Enhancement feature and saves the image in its currentstate.
● Clone to This Image — Applies the current enhancement to a different imagein the study. The Paging, Zoom, Pan and other tools are available in ImageEnhancement, so you can page to a different image in the study, and click thisbutton to apply the current enhancement to that image.
● Clone to Visible Selected Image — Applies the current enhancement only to theselected image that is displayed. If you use the Selection tool to select an image(or images) in the study, the Clone to This Image selection changes to Cloneto Visible Selected Image. The enhancement is applied only to the displayedselected image, not to all images you may have selected.
● Apply to All Images — Applies the current enhancement to all images in thestudy.
● Apply to All Selected Images— Applies the current enhancement to all imagesin the study that you have selected.
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7.18.2 To edit the Image Enhancement algorithm menu
1. Right-click the mouse while viewing the desired image.
2. Select Image Enhancements Filter Editor.3. To add a new filter to the list, click New.4. Enter a name for the new filter in the first text box, then select the appropriate
algorithm for this filter from the drop-down menu and click OK.5. To use an existing filter as the basis for creating a new filter, select the existing filter
from the list and click Clone.6. Enter a new name, if desired, in the first text box and adjust the settings for this
algorithm.
Note: Each algorithm has different settings. In sharpening filters, for example,the kernels operate on rectangles of different widths, with M as the largerectangle, N as the small rectangle and A as the relative contribution.Radius is the width of averaging kernels. The same dialog box displayswhen you select a filter and click Edit.
7. Perform the following actions, as needed.
● Click Try to apply this algorithm (and the new settings) to the displayed image.
● Click Restore to restore the image to its previous state.
● Click OK to save the filter.
● Click Delete to delete a filter. You will be prompted to verify that action.8. To save your modifications, click Save and Exit.
7.18.3 Zoom
Zooming allows you to magnify or reduce the on-screen size of an image. Thezoom factor for an image is displayed in the lower left corner of the image (when ImageOverlay is enabled). The zoom factor is the extent to which the image is resized for thedisplay. For example, an image might display a zoom factor of 1.62, which means that itis displayed at 1.62 times its captured size. If the zoom factor is greater than one, theimage is magnified; if the zoom factor is less than one then the image size is reduced. Ifthe zoom factor is displayed in red, the image is shown smaller than its captured size. Inaddition to standard zoom, this section also explains how to zoom a region of interest, andhow to use size synchronization.
Zoom has the following characteristics:
● Zooming centers on the location you clicked with your cursor.
● Zoom magnifies or shrinks the image proportionally to the percentage of the screenthat you drag the mouse across. So, if you drag your cursor half way to the top of thescreen, the view magnifies by 50% of the current magnification.
● While you are zooming an image, the cursor becomes invisible so you can see thearea that the cursor was over.
● The visible image area always occupies at least 10% of the size of the viewportduring interactive zoom, so the maximum zoom out size of the image equals 10%of the size of viewport.
Use the Main Toolbar configuration to include Zoom on the toolbar.
Warning: Zooming an image may cause some of the image to be moved out ofthe visible area.
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7.18.3.1 To Zoom an Image
1. Click Zoom on the Image Viewer toolbar.
2. In the image to zoom, click at the center point of the zoom.
3. Drag the mouse cursor up to increase the zoom factor or down to decrease thezoom factor.
Expected Result: The cursor disappears so that no portion of the image is hidden bythe mouse cursor.
4. Release the mouse to display the image with the zoom factor indicated in the overlayat the bottom left of the viewport.
5. To return to the original factor, right-click to display the floating menu. Select ZoomFactor. From the sub-menu, choose Zoom To Fit or another factor. These selectionsare also available from the Set Zoom menu at the top of the screen in Image Viewer.
Note: The visible image area always occupies at least 10% of the size of theviewport during interactive zoom, so the maximum zoom out size of theimage equals 10% of the size of viewport.
7.18.3.2 To zoom a region of interest (ROI)
Zoom to ROI is applied to the entire active series.
1. Click Zoom to ROI on the Image Viewer toolbar, or select it from the menu.
2. Click the mouse button and drag the mouse across the part of the image that you wishto emphasize. A red rectangle indicates your selection. Drag from the upper left tothe lower right. Release the mouse to end the capture.
3. If necessary, resize the region of interest by dragging a corner or side of the rectangle;the side or corner can be resized only when the cursor changes to a cross-hair shape.To redo the capture altogether, simply repeat step two to overwrite the first rectangle.
4. Double-click inside the rectangle to zoom the region of interest and fill the entirestack window with only that content. If the aspect ratio of the ROI differs from thatof the stack window, the window is resized for the zoom. All images in the seriesare zoomed to the selected ROI.
5. Use Pan or any other Image Viewer tools to further manipulate the zoomed ROI. Usepaging/scrolling as normal to page through the zoomed series. To use the mousebutton for W/L, press the Ctrl button while doing so. To return to the standard image,use the standard Zoom tool.
Note: You can also use Zoom to ROI with key images. In that case, the featureis applied to selected images only.
7.18.3.3 Adjusting Zoom to Fit Values
Zoom to Fit is the value based on the view port size. This is the minimum value you canzoom out to and cannot go further.
1. To add Zoom to Fit to the overlay template, right-click and select Annotation Overlay.2. Select an <Empty> position on the image displayed with the Edit Image Overlay
template.
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3. Select Zoom to Fit from the Annotation options.
4. Click Close and Save. Zoom to Fit displays on the images.
Expected Result: If you change the size of the viewport, the Zoom to Fit value adjustsbased on the viewport.
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7.18.4 Size Synchronization Overview
Size synchronization helps users when working with images with different size, resolution,magnification, field of view, or other format characteristics.
Images acquired from different scanners can have different resolutions and sizes, for oneor more of the following reasons.
● An older generation of scanner might have a lower resolution than a newer scanner,so historical images taken using the older scanner would be at a lower resolution thanimages taken using the newer scanner.
● Historical images might have been taken with a different field of view or a at differentmagnification. This might be because of the size of the patient’s body changed, or theoperator specified different settings when taking the image.
● Some images might have been reformatted with post processing workstations orsoftware.
To coordinate scaling in two or more images so that the same physical measurement inthe images appears to be the same size on screen, regardless of the image resolutionor size, size synchronization displays images originally taken at different resolutions sothat one centimeter displays as one centimeter on screen on all the images that aresize synchronized.
Images are size synchronized based on a Normalized Zoom Factor (NZF). The NZFindicates the magnification with respect to the measurements saved in the DICOM header.All size synchronized images display at the same NZF, regardless of the image resolution.
NZF is a number which indicates the approximate displayed magnification of the imagewith respect to its actual, physical size. The system uses the image’s pixel spacinginformation and the monitor calibration information to determine the NZF.
When you view multiple images that were taken at different resolutions and that are notsize synchronized, the sizes of the anatomical feature(s) will be different when you viewthese anatomical feature(s) across multiple viewports. Size synchronization lets youview multiple images using the same Normalized Zoom Factor, so that the sizes of theanatomical feature(s) are the same when you view the size synchronized images acrossmultiple viewports.
For example, at NZF 1, the system displays the image at approximately its actual, physicalsize. At NZF 0.5, the system displays the image at approximately one half of its actualsize. At NFZ 2, the system displays the image at approximately two times its actualsize. The accuracy of the approximation depends upon the accuracy of the pixel spacinginformation from the modality or upon image calibration by the user.
When using panning with the size synchronization feature, images are panned based onthe NZF value and on a Normalized Pan Position (NPP) value. The Normalized PanPosition value is calculated using both the monitor's pixel spacing information and theimage's pixel spacing information.
Notes about Size Synchronization
● If a pixel spacing value not present in an image’s DICOM header information, sizesynchronization is not supported or applied.
● If the “source viewport” (the viewport in which you initiate size synchronized zoomor pan) does not have a pixel spacing value in its DICOM header information, sizesynchronized zoom and pan are not supported or propagated to any of the otherviewports.
● If any “destination viewport” (a viewport in which you did not initiate size synchronizedzoom or pan) does not have a pixel spacing value in its DICOM header information,size synchronized zoom and pan are not supported or applied on that viewport.
Notes about NZF, Zoom, and Pan
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● When using size synchronization, the system displays the NZF in the overlay for anyviewport where the image displayed contains pixel spacing information.
● For viewports where the images displayed do not contain pixel spacing information,the NZF displayed in the overlay is zero (0).
● When you are not using size synchronization, the NZF does not display in the overlay.
7.18.4.1 Activating, using, and deactivating size sync
1. To activate size sync, do one of the following (depending on your interfaceconfiguration).
● use the size sync hotkey
● select the size sync icon on the toolbar
● select size sync on the main menu or series menu
Note that when you activate size sync, the system prompts you for calibration ifapplicable. See To calibrate a monitor.
2. Select the zoom tool, using one of the following, depending on your configuration.
● use the zoom tool hotkey
● use the the zoom icon on the toolbar
● select zoom on the main menu or series menu
3. To use size sync, use the scroll button in the same way as with the zoom tool. See Tozoom an image.
Expected Result: Because size sync is activated, the function of the zoom toolchanges. The system calculates the Normalized Zoom Factor (NZF) and propagatesit to all viewports that contain pixel spacing information.
4. To pan while in size sync mode, click the Pan icon on the toolbar. .
Expected Result: Because size sync is activated, the mouse cursor changes to
a hand.
5. Click and drag in any viewport in the direction you want to pan.
Expected Result: Because size sync is activated, the function of the pan tool changes.The system calculates the Normalized Zoom Factor (NZF) and the Normalized PanPosition (NPP) and propagates these values to all viewports that contain pixel spacinginformation. All viewports pan when you pan while in size sync mode
6. To stop panning, deselect the Pan icon on the toolbar.
7. To deactivate size sync when you are done using it, do one of the following (dependingon your interface configuration).
● use the size sync hotkey
● select the size sync icon on the toolbar
● select size sync on the main menu or series menu
Expected Result: Size sync is deactivated and the function of the zoom tool changesback to its standard zoom tool behavior.
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7.18.5 Applying Angiography Enhancements (DigitalSubtraction)
You can increase the visibility of some details (particularly, the blood vessels) in an XAimage by applying digital subtraction to the image.
1. With an XA study displayed in the viewer (not in a Tomtec viewport), click Angio
( ).
2. You can adjust the sharpness filter level and change the background image framewith the controls at the bottom of the window.
● No Digital subtraction with no sharpness filter.
● Low, Normal, and High Increasing levels of sharpness filtering.
● Background image The digital subtraction window shows the visual differencebetween the selected background image frame and the current image frame.
3. You can use your mouse scroll wheel to cine through the image frames.
Example: If frame 1 of the image shows the bones of a hand and frame 12 shows thebones and blood vessels, setting the Background image to 1 and the current image to 12will show just the blood vessels.
Figure 6 Frame 1
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Figure 7 Frame 12
Figure 8 Enhancement of frame 12 with background set to frame 1
7.18.6 Applying Edge Enhancement
This feature is only available with a system configured for cardiology workflow.
You can increase the visibility of some details by applying edge enhancements to anXA image.
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If the Edge Enhancement button is not visible:1. Create a shortcut, menu item or toolbar button for Edge Enhancement.
To apply edge enhancement:1. With an XA study displayed in the viewer (not in a Tomtec viewport), click the Edge
Enhancement dropdown ( ) and select a filter.The number in your selection indicates the strength of the filter. Images from InnovaXA modalities contain extra information which allows better edge enhancement. Forthese images you can select an Innova Filter or an XA Filter. For images from otherXA modalities you can only select an XA Filter.
Expected Result: The filter is applied to all images in the study. When you close thestudy the current level is saved as your default filter level for XA studies.
Recommended Innova filter settingInnova images may have a recommended filter defined in the DICOM tag FilterStrength. To automatically apply that recommended filter setting:1. Select Layout > Create/Edit.2. Click Cath Settings (under Settings).3. Select Apply recommended Edge Enhancement to Innova images.
7.19 Magnifying a Portion of an ImageSometimes you want to quickly magnify portions of an image rather than zooming thewhole image. The magnification tool works similarly to a magnifying glass. With thistool you can magnify an area around your mouse cursor. While magnification is on, themagnified region moves as you move your cursor.
To magnify the area around your cursor:
● Click the magnification tool ( ) and move your mouse cursor over the area youwant to magnify.The current magnification displays at the top of the magnified area.
To toggle magnification off:● Click the magnification tool again.
To adjust the magnification:● Hold down the Ctrl key and use the scroll wheel.
Up increases magnification. Down decreases magnification.
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Note: You can increase the magnification beyond the actual resolution of theimage. You cannot decrease the magnification so that it is smaller thanthe current displayed image resolution.
To adjust the magnification window size:● Hold down the Alt key and use the scroll wheel.
Up increases the size of the window. Down decreases the size of the window.
7.20 Pan
Panning allows you to move the image back and forth or up and down in its window.Panning can be used alone or in conjunction with zooming, when the image may becomelarger than the display window.
Note Use the Main Toolbar configuration to include Pan on the toolbar.
7.20.1 To Pan an Image
Note The following conditions apply:
● You cannot pan the entire image outside the visible area of the viewport.At least 10% of the image always displays within the Viewport.
● It is possible to pan an image even when the image displays in zoom-to-fitmode within an viewport.
1. Select Pan on the toolbar.
2. In the desired image, click and drag in any direction to move the image in that direction.
Note: You can page through the images without leaving pan mode by usingthe scroll wheel on the mouse or the up and down arrow keys on thekeyboard. You can also hold down the Ctrl key to temporarily suspendpanning, click the mouse to page through until you see the image youwant, then release the Ctrl key to return to panning.
7.21 SharpenSharpen applies an algorithm to maximize certain aspects of an image. This featurecan be set to
launch on startup. Use the Main Toolbar
configuration to include this button on the toolbar.
7.21.1 To Sharpen an Image
1. Click Sharpen in the viewer toolbar.
or
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2. From an open study in the viewer, right-click the mouse to display a floating menu andclick Sharpen. This is a toggle button; when selected, it displays a check mark.
The edges of all bones in the image are sharpened.
3. To revert to the original image, click Sharpen, or open the floating menu and clickSharpen again to clear the check mark.
7.22 CalibrateThe system allows you to calibrate an image to display at true size. When an imageis calibrated to display at true size, you can measure actual distances in the patient'sanatomy right on the monitor. The system allows you to calibrate the image itself to fit astandard ruler or to calibrate the monitor to fit a standard ruler or paper size.
7.22.1 To calibrate an image
1. Right-click in the image to display the floating menu.
2. Select Calibrate Image. The Calibrate Image dialog displays, prompting you to drawa measurement between two points in the image.
Note: Depending on the layout, the menu may also display the option to zoomthe true size by a certain factor, such as True Size x 1.2 or True Size by.90. See Zoom to learn what effect this will have on your image display.
3. With an item with a known measurement on the image, click and drag the mouse onthe image to draw a line between two measurable points.
4. In the text field, enter the length of the line you have drawn. Click the arrow next to thedrop-down list to choose the appropriate measurement unit.
5. Select the method by which you measured the line: Film Landmarks (scale markshatched on film), Opaque Ruler or an Ultrasound Scale.
6. Select Apply to Image, Apply to Series, or Apply to Study.
7.22.1.1 Measurements in Historical and/or Comparison Images
If your site uses images from a modality that does not use the Pixel Spacing DICOM tag(0028, 0030) for a magnification factor, there is a potential that any measurements shownon historical or comparison key images could have been given an incorrect measurementlisted in Centimeters.
To be certain of the measurement in a historical image, you must re-calibrate it andre-draw the measurement with the new logic enabled under Universal Viewer 6.0 SP1.0.1or greater.
Note In order to remeasure and recalibrate, a reference of known measurementmust be in place at the time of image acquisition.
7.22.2 To Calibrate a Monitor
Note When you calibrate the width of a digital monitor, the height should adjustautomatically. If further calibration is required, contact the PACS administrator.
1. Right-click in the image to display the pop-up menu.
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2. Select Calibrate Monitor.3. Perform one of the following actions:
● Hold an 8.5x11-inch piece of paper up to the monitor and use the arrow keys tomatch the display exactly to the paper.
● To measure the inches by a ruler instead, select Ruler in the Calibration Toolsfield.
4. Click OK to accept the calibration.
7.23 Image OverlayWhen an image is captured, DICOM data is transported with the study. Thus, informationabout each image is attached to that image. You can view this data (known as imageoverlay) as markings in the image window, or you can hide the markings.
An image overlay is the DICOM metadata text displayed on top of the images in aviewport. Image overlay templates can be configured using the Manage Overlays window.These templates include such information as the following:
● Image date
● Series description, date, and time
● Patient details
Beyond simply showing or hiding the image overlay, which is accomplished with oneclick, you can define different templates of data to show and click through the display ofeach template. See Configuring Image Overlay to define how and where the DICOMdata displays in each template.
Image overlay is distinct from the display of user-defined markings, such asmeasurements, annotations, and spine labels. User-defined markings can be changed orremoved; only the display of DICOM data can be changed, not the data itself.
For the image overlay, the system supports basic DICOM data, such as the scannerprotocol or image orientation, as well as the display of graphic-based DICOM data.Separate toolbar buttons are used for each; use the Main Toolbar configuration to includethese on the toolbar.
Shows or hides DICOM data.
Shows or hides graphic-based DICOM data.
Note Even if you choose to hide the markings, you can always retrieve detailedimage and patient data through the menu.
7.23.1 To Enable Image Overlay
1. Click Image Overlay on the Image Viewer toolbar, or right-click to displaythe floating menu and select Manage Overlay. The markings, many of which aredescribed below, appear on the image.
2. To disable image overlay, click the button again, or right-click to display the menu andclick Manage Overlay again. The markings are hidden.
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● Image Number -- This designates the image number within the series.● Contrast -- If Contrast was used in the study, a blue C appears in this section.
● Anterior, Posterior, Head, Foot -- These designations refer to the imageorientation. Other designations that may appear, depending on the modality andkind of study, are Right, Left, Inferior, Superior.
● NHS No. -- National Health Service Number. If the NHS No. is unavailable or ifthe system uses a foundation other than Centricity PACS, the overlay displays<Empty> for the NHS No. field.
● Compression Status -- A compressed image shows the ratio of compressionhere. If the image has not been compressed, this space is left blank.
● Zoom -- This shows the ratio of the display to the original size.● Series ID -- This is the name of the scanning protocol.
Note: Non-DICOM (user-defined) markings, such as measurements,annotations and spine labels, also comply with the image overlaysetting. They display only when image overlay is enabled.
● Series and Image # – This displays the image number and series number for usewith cardiology workflow (where multiframe images are common). The informationdisplays in the following format:Se: <DICOM_Series_#>(<DICOM_Multiframe_Instance_#><Biplane>)Im: <Frame_#>/<Total_Frames>Example: Multiframe image: For DICOM Series 1, Multiframe Instance 3, viewingframe 13 of 50
Se: 1(3)
Im: 13/50
Example: Multiframe Biplane image: For DICOM Series 1, Multiframe Instance3, Biplane A, viewing frame 13 of 50
Se: 1(3A)
Im: 13/50
7.23.2 To Display Graphic Overlay
If graphic information is captured at the scanner, that information is also attached tothe image and transported with the study. The system supports the display of graphicoverlay data as well.
1. Click Graphic Overlay ( ) on the viewer toolbar. Graphical information attachedto the image displays.
2. To disable Graphic Overlay, click the button again. The graphics are hidden.
Note: Graphic DICOM data cannot be altered, only hidden. However, the colorof the pixels can be changed, and if multiple layers exist, each layer canhave a distinct color. See Overlays to learn how to change the GraphicOverlay colors.
7.23.3 To Jump Overlay Templates
You can configure several overlay templates for each modality and quickly switch fromone to the next.
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� Perform one of the following actions:
● Click Overlay repeatedly to jump from one template to the next.
● Jump to a specific template by clicking the down arrow next to Overlay and selectingthe template from the drop-down list.
Note: You can also jump the Graphic Overlay templates by clicking that toolbarbutton repeatedly as well. Each "template" is simply a different color graphic.See Overlays for more information.
7.24 Measurements
The Measurements ( ) button allows you to define a region of interest for reference,teaching, or diagnostic purposes. Like annotations, measurements can be saved with thestudy so that you can refer to these remarks in the future. The system provides a varietyof measurement tools, so that you can measure values at any point in the image, includingdistances, angles and regions of interest (ROIs). Measurements and annotations displayonly when Image Overlay is enabled.
Note Special tools to measure the gestational age of a fetus in an ultrasound imageare also available.
Use the Main Toolbar configuration to include Measurements on the toolbar. Whenclicked, the Measurements button displays a sub-toolbar.
7.24.1 To Add Measurements
1. Click Measurements. The sub-toolbar is displayed.2. Select the appropriate measurement tool, according to the following descriptions.
Icon DescriptionPoint-to-Point -- This tool allows you to measure the distance between two points.Measurement is provided in millimeters; if the measurement exceeds 100 millimeters, itchanges to centimeters.
Note The Point-to-Point measurement value for non-square pixel data in a USmodality study displays in PIXELS instead of CM when using a CPACS foundation.
Freehand -- This tool allows you to draw a freehand area. The measurement is shown inaverage Hounsfield units, minimum pixels, maximum pixels, and standard deviation. Themeasurement of the ROI surface area is also shown in square centimeters (cm2).
Rectangular ROI -- This tool allows you to capture measurement and image informationfor the rectangular area you select. The measurement is shown in average Hounsfieldunits, minimum pixels, maximum pixels, and standard deviation. The measurement of theROI surface area is also shown in square centimeters (cm2).
Central Elliptical ROI -- This tool allows you to capture measurement and imageinformation for the circular area you select. Position the mouse in the center of the desiredarea; the circle expands outward from the center as you drag in any direction. Themeasurement is shown in average Hounsfield units, minimum pixels, maximum pixels,and standard deviation. The measurement of the ROI surface area is also shown insquare centimeters (cm2).
Elliptical ROI -- This tool surrounds the area that you drag, rather than expandingoutward from the center.
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OB Measurements -- This tool provides a menu of methods to measure the gestationalage of a fetus in an ultrasound image. See the next section for more details.
Single-Point ("probe") ROI -- This tool allows you to capture measurement and imageinformation for one point you select. Measurement is provided in Hounsfield units.
Angles -- This tool allows you to measure an angle. Measurement is provided in degrees.
SUV -- This tool measures the Standard Uptake Value in a PET study. The SUV can becalculated for each pixel of the image and denotes the ratio of activity in tissue per milliliterto the activity in the injected dose per patient body weight.
Note: The system accurately calculates SUV measurements even if the pixeldata is not already in the proper SUV representation at the scanner.The system still derives industry-standard SUV values by using DICOMinformation. The proper SUV coefficient is calculated, and this featuresupports major makes and models.
3. Once you have selected the appropriate tool, take the mouse to the image andperform the corresponding mouse action:
● For point-to-point measurements, click once on the first point and drag to thesecond point. The measurement is displayed in millimeters. If the measurementis larger than 100 millimeters, it displays in centimeters, clearly marked.
● The Point-to-Point measurement value for non-square pixel data in a US modalitystudy displays in PIXELS instead of CM when using a CPACS foundation.
● For angle measurements, click and drag to draw the first line, then release themouse. Click either end of that line to form an angle at that juncture; draw thesecond line by dragging the mouse.
● For elliptical and rectangular ROI, click and drag the mouse around the areato measure.
● For single-point ROI, simply click the point you wish to measure. For a rovingHounsfield measurement, click and drag when this button is enabled.
After you draw the measurement, it is displayed in the image, along with a labelindicating the actual measurement. (You can configure the thickness of the line.) Youcan take multiple measurements in one image, each in a different color if desired. Athick, solid red highlight indicates that the measurement is selected.
4. When the measurement is selected, you can perform additional operations on it.
● Increase or decrease its size by clicking on an edge or point and dragging itin or out.
● Move the measurement label by clicking and dragging it out of the way. Thepointer changes to a hand shape when you perform this action.
Note: If you drag the angle measurement label to the adjoining angle, thesystem displays the measurement of the complementary angle. Thebaseline of the angle extends to indicate which complementary angleis being measured.
Example: If you dragged an angle labeled 107° into the adjoining angle, the labelwould change to 73°. The system would display both the baseline and the edgecommon to both angles.
7.24.2 To Delete One or More Measurements
You can delete a single measurement or other annotation, or you can delete allmeasurements in either a single image or a series.
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Note In order to delete all measurements and other annotations in a series, youmust first create a keyboard shortcut to enable the Delete All Annotationsin Series command. See Configuring Shortcuts for information on creatinga keyboard shortcut.
To delete a single measurement or other annotation:1. If you are deleting a single measurement, either double-click the label (the Hounsfield
units, millimeters, degrees, etc.) or right-click the measurement and select Delete fromthe pop-up menu. If you are deleting an annotation, either double-click the annotationto delete it or right-click the annotation and select Delete from the pop-up menu.
To delete all measurements and other annotations in a single image:
1. Click Delete ( ) on the sub-toolbar to delete all measurements and otherannotations on that image.
To delete all measurements and other annotations in a series:1. Click the viewport that contains measurements that you want to delete. This viewport
can be any of the following:
● Series
● Global Stack
● Sheet View
● MPR
● Key Image
● Fused PET-CT
2. Press the keyboard shortcut you assigned. All annotations for images in the activeviewport will be deleted.
7.24.3 Moving Measurements
You can select a measurement and move it to another location in the same viewport.
Every time measurements are moved they are recalculated. Measurement text is alsodragged along with the measurement.
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Examples
Viewport with angle measurement
Mouse hover over measurement to see angle in yellow
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Mouse click and drag to new location
Viewport with point-to-point measurement
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Mouse hover over measurement to see yellow border line
Move measurement to new location
7.24.4 Measurements and LUT
If modality LUT is present in the DICOM header of an image, it is applied to the originalpixel data as the image is loaded. Measurements are thus performed on the post-modalityLUT pixel data. Modality LUT is usually linear and expressed through two parameters-- Rescale Slope and Intercept.
If no Rescale Type or Modality LUT Type is present, the point measurement is displayedin Hounsfield Units for CT, a unit value for PET and nothing for other modalities.
To change the color of an annotation
� To change the default color of the annotation, click the down arrow beside Color Well andchoose another color. You can select a different color for each annotation.
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7.24.5 Measurement and Annotation Tool Synchronization with3D Applications
For sites using the 3D Advanced Applications in embedded mode, AWS 3.2 offersmeasurement and annotation tools that are common on Universal Viewer. Tools accessedfrom the 3D viewport can be used on both viewers.
● Arrow
● Free Text
● Point measurement
● Point to Point
● Elliptical Region
● Free hand ROI
● Angle measurement
These tools are also configurable using the right-click menu on the toolbars in the 3Dviewport.
7.25 To Measure CTR (Cardio-Thoracic Ratio)Prerequisite: To manipulate the CTR measurements and label in the viewer and in the
print page, the button must be enabled. The tool can be applied only to CR, DX,and CT images.
Cardio-thoracic Ratio is the ratio of the maximum transverse diameter of the heart to themaximum diameter of the thorax. It is used to measure the heart size (usually less than50% is normal) to prevent cardiac diseases.
Note These measurements are estimated values. Confirm and adjust theplacement of the lines as needed.
1. Click Measurements to display the sub-toolbar.
2. Click CTR .
3. Click anywhere on the image to measure the diameter of the heart and chest.
Expected Result: Four vertical boundary lines display. An algorithm processes theimage data and estimates the location of the heart and chest boundaries. The fourvertical boundary lines are placed at these calculated locations. The two outer solidlines indicate the boundaries for the diameter of the chest, and the two inner dashedlines indicate the boundaries for the diameter of the heart. The algorithm calculatesthe measurements based on the inner edges of the lines, similar to a caliper.ThreeCTR measurements are automatically calculated and displayed.
● TCD -- Transverse chest diameter
● THD -- Transverse heart diameter
● CTR -- Cardiothoracic ratio. This is the ratio of THD/TCD.
Note: The algorithm used to estimate the initial heart and chest boundariesperforms best when the image being analyzed is a chest X-Ray. The algo-rithm works best when the full image shows only the chest cavity. If otherbody parts or other artifacts are part of the image, the boundary estimates
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may be less accurate than an image showing only the chest cavity.
4. To move a boundary, click and drag it. (A selected boundary is highlighted.)Boundaries cannot cross over other boundary lines. As you move boundaries, themeasurement information automatically updates.
5. To rotate a boundary, click the rotate handle of the boundary line and drag right orleft. As you rotate a boundary, the measurement information automatically updates.
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6. To delete the CTR measurement, right-click the label or any boundary and selectDelete, or double-click the label.
7.26 Ultrasound MeasurementsIn addition to the standard measurement tools, there are tools for measuring thegestational age of a fetus in an ultrasound image. Various parameters are available:CRL (Crown-Rump Length), BPD (Biparietal diameter), HC (Head circumference), AC(Abdominal circumference), Femur (Femur length) and GCD (Gestational sac diameter).Results are shown in Weeks, Days form.
7.26.1 To take an ultrasound measurement
1. When viewing an ultrasound image, click Measurements on the toolbar. Thesub-toolbar displays.
2. Along with the standard measurement tools, an additional button is displayed for
ultrasound images. Click that button to see a sub-menu of available obstetricmeasurements.
3. Select a parameter or select About to learn more about each parameter.
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4. Once you have selected the appropriate parameter, click and drag across the area tomeasure. Click once on the first point and drag to the second point. The measurementis displayed in millimeters.
5. After you draw the measurement, it displays in the image, along with a label indicatingthe actual measurement. You can take multiple measurements in one image.
6. To select a measurement, click it once. A thick, solid red highlight indicates that themeasurement is selected. When the measurement is selected, you can performadditional operations on it.
● Increase or decrease its size by clicking on an edge or point and dragging itin or out.
● Move the measurement label by clicking and dragging it out of the way. Thepointer changes to a hand shape when you perform this action.
7.26.2 To Delete One or More Measurements
You can delete a single measurement or other annotation, or you can delete allmeasurements in either a single image or a series.
Note In order to delete all measurements and other annotations in a series, youmust first create a keyboard shortcut to enable the Delete All Annotationsin Series command. See Configuring Shortcuts for information on creatinga keyboard shortcut.
To delete a single measurement or other annotation:1. If you are deleting a single measurement, either double-click the label (the Hounsfield
units, millimeters, degrees, etc.) or right-click the measurement and select Delete fromthe pop-up menu. If you are deleting an annotation, either double-click the annotationto delete it or right-click the annotation and select Delete from the pop-up menu.
To delete all measurements and other annotations in a single image:
1. Click Delete ( ) on the sub-toolbar to delete all measurements and otherannotations on that image.
To delete all measurements and other annotations in a series:1. Click the viewport that contains measurements that you want to delete. This viewport
can be any of the following:
● Series
● Global Stack
● Sheet View
● MPR
● Key Image
● Fused PET-CT
2. Press the keyboard shortcut you assigned. All annotations for images in the activeviewport will be deleted.
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7.27 Annotations
The Annotations feature ( ) displays a sub-toolbar of labeling buttons. Likemeasurements, annotations can be saved with the study so that you can refer to theseremarks in the future. You can include free-form text or make part of an image moreconspicuous.
An annotation is a graphical or textual addition created by a user on an image. Forexample, annotations include distance measurements, region of interest measurements,and text.
Use the main toolbar Main Toolbar Configuration (page 337) to include Annotations onthe toolbar.
7.27.1 To Add or Change a Label (Annotation)
The system displays the label in the image. You can enter multiple labels in one image.A border surrounds each alphanumeric character so that it displays clearly against anybackground. A solid highlight indicates that the annotation is selected. With a systemconfigured for cardiology workflow, annotations such as Patient Name, Table Tilt, HeartRate, Stage Name, and View Name can be added to the image, as well.
1. Click the Labels icon ( ).
2. To change the color of the label, click the down arrow of Annotation Color andchoose another color. You can select a different color for each label.
3. Select an annotation tool, according to the following descriptions:
● Free Text: Click where you want the annotation to appear and start typing.Click OK to accept the text and then move it to a precise location by clickingand dragging it.
● Arrow: Click on the region you want to point out and drag the mouse away.● Centered Ellipse: Position the mouse in the center of the desired area. The
ellipse expands outward from the center as you drag in any direction.
● Delete graphics: Delete all labels.4. To edit or delete a label, click the existing label to display a secondary color beside
it and then right-click. Make a selection from the right-click menu, using thesedescriptions:
● Edit: Change the text as needed. Click inside an ellipse to display the secondarycircle, and hold down the mouse and drag the ellipse to move it or change theshape by pulling one of the handles (dots) on the circle.
● Font: Select the font characteristics.● Color: Select the color.
● Delete: Delete the selected label.● Update: Update the selected label.
5. Click OK.
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7.27.2 To edit an annotation
1. Edit the annotation by selecting it to get a highlight and then right-clicking to selectEdit from the floating menu.
or
2. Drag a corner of an arrow, rectangle or ellipse when it is highlighted to increase ordecrease its size.
Note: You can add spine labels automatically, in the format you prefer. Notealso that annotations display only if Image Overlay is enabled.
7.27.3 To Delete One or More Annotations
You can delete a single measurement or other annotation, or you can delete allmeasurements in either a single image or a series.
Note In order to delete all measurements and other annotations in a series, youmust first create a keyboard shortcut to enable the Delete All Annotationsin Series command. See Configuring Shortcuts for information on creatinga keyboard shortcut.
To delete a single measurement or other annotation:1. If you are deleting a single measurement, either double-click the label (the Hounsfield
units, millimeters, degrees, etc.) or right-click the measurement and select Delete fromthe pop-up menu. If you are deleting an annotation, either double-click the annotationto delete it or right-click the annotation and select Delete from the pop-up menu.
To delete all measurements and other annotations in a single image:
1. Click Delete ( ) on the sub-toolbar to delete all measurements and otherannotations on that image.
To delete all measurements and other annotations in a series:1. Click the viewport that contains measurements that you want to delete. This viewport
can be any of the following:
● Series
● Global Stack
● Sheet View
● MPR
● Key Image
● Fused PET-CT
2. Press the keyboard shortcut you assigned. All annotations for images in the activeviewport will be deleted.
7.27.4 Measurement and Annotation Tool Synchronization with3D Applications
For sites using the 3D Advanced Applications in embedded mode, AWS 3.2 offersmeasurement and annotation tools that are common on Universal Viewer. Tools accessedfrom the 3D viewport can be used on both viewers.
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● Arrow
● Free Text
● Point measurement
● Point to Point
● Elliptical Region
● Free hand ROI
● Angle measurement
These tools are also configurable using the right-click menu on the toolbars in the 3Dviewport.
7.28 Spine LabelingAlong with annotation and measurement features, the system provides a method ofattaching spine labels automatically. Rather than creating and then positioning anannotation for each vertebra, you can insert spine labels with a few clicks. The systemallows you to tailor the labels to your preference, with a label for every vertebra or everyother vertebra and with letters and numbers (C2, C3, etc.) or numbers only.
To attach spine labels to an image
1. In an image with a sagittal or axial view of the patient's spinal cord, right-click todisplay the floating menu.
2. Select Spine Labels from the menu.
Note: Spine labeling defaults to commence from the first cervical vertebra/spaceand move down; this is reflected in the default selection under NextLabel and in the sample display. You can change these defaults in thefollowing steps.
3. The system recognizes whether the image is axial or sagittal and defaults the LabelType accordingly, i.e., to mark the vertebra or inter-vertebral spaces. You can changethis default by selecting the other option button.
4. Under Labeling Step, select the label frequency. Select 1 to label every bone orspace, select 2 to label every other bone or space, or select 3 to label every thirdbone or space.
5. Under Labeling Direction, select Up to order the sequence from the bottom (sacrum)up; select Down to order the sequence from the top (cervical spine) down.
6. Under Label Appearance, select Font to set the font style, size, color and effects(bold, italics, etc.) that appear in the label.
7. Select the Display Letters check box to include letters (L for lumbar, T for thoracic,etc.) in the labels. To insert only numbers in your labels, clear the check box.
Under Labeling Step, select the label frequency. Select 1 to label every bone orspace, 2 to label every other bone or space, or 3 to label every third bone or space.
Under Labeling Direction, select Up to order the sequence from the bottom (sacrum)up; select Down to order the sequence from the top (cervical spine) down.
Under Label Appearance, select Font to set the font style, size, color and effects(bold, italics, etc.) that appear in the label.
8. In the option list to the left of the dialog, select the label that will begin the sequence.
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9. In the image, click the vertebra or inter-vertebral space that corresponds with theselection you just made.
Note: Spine labels are part of the image overlay. If the Image Overlay featureis toggled off, the spine labels do not display.
The sample display in the dialog box updates to show the next label to insert. In theimage, click the vertebra (or inter-vertebral space) that corresponds with the sampledisplay.
10. Continue inserting the next label until you are finished. The spine labels adhereto every image in that series, and -- especially when used with synchronization,cross-reference lines or triangulation -- help you know exactly where you are in allplanes of the study.
11. Click Close to save the changes and close the dialog. Click Remove All to deleteall the labels.
Note: You can use cross-reference lines when labeling inter-vertebral spaces;on a sagittal image this enables you to find the level of disc space.
7.28.1 OrthoTools
OrthoTools is a planning tool for orthopedic surgery that has been integrated into theImage Viewer. Users can open OrthoTools from the viewer and plan a surgery. Imagescreated with prosthesis templates can be imported and saved to the system.
7.28.2 To Add a Prosthesis Template to an Image
1. Click the Open TraumaCad item from the Image Viewer menu.
Note: If OrthoTools is not installed, an installation wizard guides you through thesetup process.
2. Each image in the series is displayed as a thumbnail in the left (wizard) pane. Go toa particular image thumbnail and select the desired display orientation: AP, LT/MLor axial and left or right.
3. Click the display button next to the thumbnail. The thumbnail displays full size inthe right pane.
4. Click Next at the bottom of the left (wizard) pane.
5. Select a procedure type from the wizard menu: deformity analysis, trauma or one ofthe joint replacements.
6. Click Next at the bottom of the left (wizard) pane.
7. Based on the procedure selection, an array of templates is displayed, organized bymanufacturer and type. Select the manufacturer from the first drop-down list, thenselect the type of implant. The lower section updates to reflect the templates thatcorrespond to your selections.
8. In the lower section of the wizard pane, click the down arrow next to a template tosee its details. Then either double-click or drag and drop the desired template ontothe image.
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9. Use the mouse to move the template to fit the patient's anatomy. Drag the green circleto rotate, and drag the red circle to re-anchor. Select a different color or size for thetemplate from the wizard pane, if desired.
10. Click Commit in the wizard pane. The OrthoTools application closes, and the image isupdated to show the prosthesis template in the Image Viewer. The image can now besaved and/or refined with Image Viewer tools.
Note: OrthoTools has a variety of other features, such as calibration, zoom, pan,measurements, etc., that can be used to augment surgery planning.
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8Reformatting Images
8.1 Multi-Planar Reformatting
Multi-Planar Reformatting (MPR) is a method of reconstructing cross-sections ofother planes (such as coronal or sagittal planes) from the original plane used in the study(such as axial). You can "cut" at a different angle or thickness, manipulating the area ofinterest to obtain the most beneficial view. Once created, these reconstructed imagescan be saved as a series and treated like any other series in the study. You can view,triangulate, annotate, cross-reference and create key images from an MPR series. Usethe Main Toolbar configuration to include MPR on the toolbar.
The different modes for rendering MPR images include Standard, Spine, Curved, andCross-Curved.
Note
● By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
● MPR exhibits different behavior from other modalities for zoom andpan in that the cursor remains visible when zooming, negative zoom isunavailable, and you cannot pan the image in zoom-to-fit mode.
8.1.1 Using MPR Images as Key Images
Reconstructed images generated by the MIP/MPR module are not suitable for directplacement onto the Key Image Print Page. If any reconstructed images are intended foruse as Key Images, the series of reconstructed images must first be exported into themain viewer and saved. Images from that series can be placed on the Print Page onlyafter reconstructed images appear as an MPR reformatted series.
Save the reformatted series to use any of its images as key images. To use thereformatted series in a subsequent session, you must upload it to the server. If you do notupload the series, the new data you created is lost when you exit the study.
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8.1.2 Opening Reconstructions in a Viewport
You can select any viewport with a series and launch the reconstruction of the particularprojection for that series from the context menu in the viewport. For example:
● If the series is an axial view, an axial MPR will open.
● If the series is a coronal view, a coronal MPR will open.
● If the series is a sagittal view, a sagittal MPR will open.
The default layout for these projections is a 3x1 grid.
You can open up to three MPR viewports.
Note The system allows you to place more than three MPR viewports within ahanging protocol; however, at the time of display, the system will only openup to three.
1. Open a series.
2. Right-click in the series viewport and select either Embedded MPR or MIP/MPR.Your system configuration controls which menu option you will see.
3. Select either Lossy or Lossless when the Images Quality dialog opens.
ExpectedResult:The series reconstruction opens in an MPR viewport. The series number,modality, and date/time are displayed in the MPR viewport title.
8.1.3 To Construct Standard MPR Images for a Study
Standard MPR renders new slices from an original image.
1. Open the desired study and select the desired series. From the toolbar or mainmenu, click MPR.
The MPR dialog displays, with a control panel for the MPR features on the right and afour-view palette for the images on the left. The palette is populated with three panesof source data (i.e., from the selected series), known as localizers; the lower right paneis the rendered image, known as the target image. So the palette is arranged like this:
● Target Image: new slices are rendered in this dimension -- lower right pane.Initially, the target image is axial, so the reformatted slices will be axial slices
● Localizer: axial plane of source -- lower left pane
● Localizer: coronal plane of source -- upper left pane
● Localizer: sagittal plane of source -- upper right pane
Note: The control panel launches in standard mode/axial series by default. Theother modes are discussed below.
Two lines are shown: yellow and cyan. The yellow lines are cross-reference lines.If you activate cross-reference, the localizers display with these cross-hairs; whenthe cross-hairs are moved, the other localizers update to correspond. The cyan lineis the slice definition bar, and it shows the location of the slice currently displayedin the target view.
2. Take slices of any plane by clicking a different target series button.
3. In the Display section of the MPR control panel, use these buttons to rearrange thefour-palette view:
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Icon DescriptionTo stack all the source images on the left, click the stack button.
To return to an even palette (the default), click Layout2x2.
To toggle the Image Overlay, click Overlay.
4. In the Tools section of the MPR control panel, use the Zoom, Pan, Paging and W/Lfeatures to manipulate an image in the panes.
5. When you have reached the desired effect, create a new slice from the source data.In the two localizers with planes that are different from the target series, you see ablue slice definition bar. Use these properties of the slice definition bar to establish thethickness and direction (i.e., straight or transverse) of the reformatted ("new") slice:
The slice definition bar.
Change the slice thickness: Thetwo parallel lines indicate the slicethickness. The closer the lines, thethinner the slice. When a squarecaliper is selected, the mouse pointerchanges into a hand shape, and thatline can be dragged closer to or furtherfrom the other line, to make the slicethinner or thicker.
Change the slice anchor point: Theanchor point of the slice is denoted bya blue circle, which defaults to sit atthe center of the bar. When the anchorpoint is selected, the mouse pointerchanges into a hand shape, and theanchor point can be dragged right, left,up or down.
Change the slice direction: The barcan be rotated to create a transverse(single or double oblique) slice in theplane. The mouse pointer changesto a round arrow shape when it is oneither side of the anchor point. Thatside of the bar can be dragged up ordown to move it, with the anchor pointas the fulcrum.
Note: You can also enter a slice thickness, in millimeters, into the SliceThickness field, under Slice Parameters in the control panel. You can also
click Slab on the control panel to select from a list of availablethicknesses. The slice definition bar updates immediately to reflect theselection.
6. In the Instant Graphics section of the MPR control panel, use the Measurement andAnnotation features to add graphics to an image in any one of the four planes.
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7. In the Tools section of the MPR control panel, click Series. A green griddisplays in the two localizers with planes that are different from the target series.Using this grid, you will define an entire series of reformatted images, i.e., a "stack" ofimages. The series grid has the following properties:
The series definition grid. The numbers on the leftindicate how many slices will be created betweenthe top and bottom boundaries.
Note You can also manipulate the number ofslices, their thickness and the space betweenslices via the Slice Parameters section of theMPR control panel. By decreasing the spacebetween slices, for example, you increase thenumber of slices that fit in the grid.
The blue slice definition bar shows the imagenumber for that location. Dragging this bar shows apreview (in the target pane) of each target image inthe series.The anchor point (the large blue circle in the center)can be dragged left, right, up or down, and movesthe entire grid with it.
Rotate the series grid: The grid can be rotated tocreate transverse slices in the plane. When themouse pointer is directly over one of the small bluecircles in each corner, it changes to a round arrowshape. That corner can be dragged up or down torotate the grid, with the anchor point as the fulcrum.
NoteIf the slice definition bar was already transverse, thegrid is applied in that direction. Also, in standardMPR, all slices in a series are parallel to each other,and neighboring slices have the same distancebetween them. You cannot have an inconsistentdirection or separating space within the same series.
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Changing the number of slices: The grid can beresized to increase or decrease the number of slicesin the series. When the mouse pointer is on the topor bottom boundary, it changes to a hand shape.That line can be dragged up to increase the numberof slices in the series, or down to decrease thenumber of slices in the series. Notice that the blueslice definition bar changes number. You can alsomanually enter the number of slices in the controlpanel.
Resizing the slices: The grid can be resized tocreate different-sized slices. When the mousepointer is on the right or left boundary, it changesto a hand shape. That line can be dragged out toincrease the area of the slices in the series, or in todecrease the area of the slices in the series.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
8. Use the series grid properties explained above to define the images -- their number,orientation and area -- that will be included in the reformatted series.
9. Click Export Series. (This button activates after you select Series.) Thereformatted stack of images is exported into the study and can be treated as astandard series. The series displays in its own window, and can be triangulated,annotated, cross-referenced, etc.
10. To save the series to the file system, click Save on the toolbar. You must savethe reformatted series to use any of its images as key images. To use the reformattedseries in a subsequent session, you must upload it to the server. If you do not uploadthe series, the new data you created is lost when you exit the study.
8.1.4 To Construct Spine MPR Images for a Study
Spine MPR functions in much the same way as standard MPR, except that slices do nothave to be parallel to each other. You can create slices that follow the natural curve ofthe spine, with each individual slice "bent" to a different orientation. All slices are alwaysof the same thickness, however.
1. Open the desired study and select a series. From the toolbar or main menu, clickMPR.2. Under Mode, at the top of the control panel, click Spine MPR. In Spine MPR, the
localizers are populated, but the target image pane remains empty until you take anaction. The slice definition bar does not appear by default, but only after you explicitlyenter it in a pane with a left click.
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3. Click Spine Cut which is automatically activated in the control panel when you select
Spine MPR.
4. Take these actions, as needed:
● Click a vertebra or disk in a coronal or sagittal localizer. Spine MPR automaticallyapplies a slice definition bar to the selected location and renders an image in thetarget view. It uses special image processing algorithms to estimate the properorientation, thus minimizing the level of effort required by the user.
● Change the location or direction of the slice using the properties of the slicedefinition bar.
● Change the thickness using the Slice Parameters section of the control panel.
● Click a different vertebra or disk to add another slice. The active slice ishighlighted in green; the other slices are blue.
● Drag the end of the bar in or out to change the FOV. The target view updates asyou make changes in the localizers.
Note: To center the output images properly, place the center of the bar on thespinal canal area using a sagittal series.
5. In the Slice Parameters section of the MPR control panel, enter the number of slicesto be drawn adjacent to each slice that you entered, and enter their thickness and thespacing between them. For example, after you click certain vertebrae or disks to defineslices (as shown above), you then enter slice parameters in the control panel (shownat right, below), and the localizers display those definitions (shown at left, below).
6. Enter new values in the Slice Parameter fields, until you get the desired "stack" ofimages. You can scroll through the target pane to see each image; the current targetview image is highlighted in red in the localizer panes.
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7. After defining the stack of reformatted images to render, click Series to create thatdata.
8. Click Export. (This button activates after you select Series.) The reformatted stack ofimages that you defined is exported into the study and can be treated as a standardseries. The series displays in its own window, and can be triangulated, annotated,cross-referenced, etc.
9. To save the series to the file system, click Save . on the toolbar. You mustsave the reformatted series to use any of its images askey images. To use thereformatted series in a subsequent session, upload it to the server. If you do notupload the series, the new data you created is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
8.1.5 To Construct Curved MPR Images for a Study
Curved MPR allows you to follow a curve that you define. For example, you could followthe curve of a jawbone or a carotid artery. Curved MPR then "unfolds" the user-definedcurve to render one, "flat" image; however, that slice comprises data reformatted fromseveral different planes, i.e., three dimensions. As always, the localizers show the otherplanes.
1. Open the desired study and select a series. From the toolbar or main menu, clickMPR.2. Under Mode at the top of the control panel, click Curved MPR. In Curved MPR, the
localizers are populated with images from the selected series, but the target imagepane remains empty until you take an action. The slice definition bar appears bydefault, in the pane that you select in the next step.
3. Under Generatrix View near the top of the control panel, select Axial, Sagittal orCoronal.
4. Click the Curved MPR tool on the main toolbar, which activated when you selected
Curved MPR in the dialog box.
5. Click once at the start of a curve in any localizer, and then drag the mouse pointeralong the curve you want to define. Use the following navigation tips to define thecurve precisely:
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● As you drag, nodes are arranged along the curve. You can add additional nodes,which refines the rendered image by adding more data, and you can move thenodes to add data from a different location.
● To change the curve, click once on a node, which is red when activated. Drag thenode to a new location. All the localizers update to display the new location.
● To add a new node, click anywhere on the curve. The localizers update to displaythe new data. The currently active node is red.
● To delete a node, double-click it. To delete the entire curve, click Delete All onthe MPR control panel.
6. In the Slice Parameters section of the MPR control panel, enter the number of slicesto be drawn adjacent to each slice that you entered, and enter their thickness andthe spacing between them. For example, after you draw a curve to define a slice (asshown above), you then enter slice parameters in the control panel, and the localizersdisplay those definitions.Continue to enter new values in the Slice Parameter fields, until you get thedesired "stack" of images. You can scroll through the target pane to seeeach image; the current target view image is highlighted in red in the localizer
panes.
Note: Any curve you create in Curved MPR is retained if you switch toCross-Curved Mode while the rendered image is open.
7. Click Export Series. (This button activates after you select the Series button.) Thereformatted image (or stack of images) that you defined is exported into the study and
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can be treated as a standard series. The series displays in its own window, and can
be triangulated, annotated, cross-referenced, etc.
8. To save the series to the file system, click Save .
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
8.1.6 To construct Cross-Curved MPR images for a study
If you define a curve in Curved MPR, that definition displays when you switch toCross-Curved MPR. In this mode, you can position the slice definition bar across thedefined curve. The slice intersects the curve at a perpendicular angle.
1. After defining a Curve MPR, click the Cross-Curved MPR button on the control panel.The original curve you created is still displayed. In Cross-Curved MPR, the localizersare populated, but the target image pane remains empty until you take an action. Theslice definition bar appears by default, in the pane that you select in the next step.
2. Under Generatrix View near the top of the control panel, select Axial, Sagittal orCoronal. This is the plane of the target image.
3. Click Curved MPR on the main toolbar, which activated when you clicked Curved
MPR in the dialog box.
4. Click on the curve to intersect. A slice definition bar displays -- intersectingand perpendicular to the original curve. Click and drag the bar to thedesired position; it remains always perpendicular to the defined curve. Toshorten or lengthen the bar, click and drag one of the calipers at either end.
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5. In the Slice Parameters section of the MPR control panel, enter the number of slicesto be drawn adjacent to the slice definition bar, and enter their thickness and thespacing between them. Continue to enter new values in the Slice Parameterfields, until you get the desired "stack" of images. You can scroll through thetarget pane to see each image; the current target view image is highlightedin red in the localizer panes.
6. Click Export Series. (This button activates only after you select the Series button.)The reformatted image (or stack of images) that you defined is exported into the studyand can be treated as a standard series. The series displays in its own window, and
can be triangulated, annotated, cross-referenced, etc.
7. To save the series to the file system, click Save . You must save thereformatted series to use any of its images as key images. To use the reformattedseries in a subsequent session, you must upload it to the server. If you do not uploadthe series, the new data you created is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
8.1.7 Changing Slab Thickness from an Embedded MPR
To change slab mode and thickness directly from the embedded MPRviewport toolbar:
1. Click the slice icon at the bottom of the viewport ( ).
2. Select a thickness from the menu.
Note: Changes on slab mode and thickness will only apply to the MPRTarget/specialized series, not MPR localizers.
8.1.8 Switching MPR Image Planes
To switch image planes in an MPR, PET, or CT series, or a PET-CT fused series:� Click one of the image plane buttons near the bottom of the view (Axial, Coronal, or
Sagittal).
The buttons are only visible on an MPR, PET, CT, or PET-CT series when cine is notenabled.
Note: When switching planes on a PET, CT, or PET-CT fused image, thereconstructed images display in the navigator. They are available until thestudy closes (that is, they are not saved to the server.)
When switching planes on an MPR series, the reconstructed images do notdisplay in the navigator.
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8.1.9 Scrolling through an MPR Series
You can set up the viewer to scroll through images in a Standard, Spine, Curved, or CrossCurved MPR series. While scrolling, you can also switch to a zoom mode and back.
To scroll through images in an MPR series:1. Open a study in the viewer.
2. Select the MPR mode from the MPR 3D icon’s drop-down list.
3. If you have not already done so, create slices for an MPR series. For information oncreating slices, see one of the following:
● To Construct Standard MPR Images for a Study
● To Construct Spine MPR Images for a Study
● To Construct Curved MPR Images for a Study
● To Construct Cross-Curved MPR Images for a Study
4. Right-click the image viewport, and select Page/Scroll.5. Click and hold the left mouse button. The mouse cursor will change to indicate you
are in scroll mode.
6. Drag the mouse cursor up and down to scroll through the images in the series.
To switch to zoom mode:1. Click the lower left corner of the viewport, over the zoom information for the image.
The cursor will change to indicate you are in zoom mode.
2. Click and hold the left mouse button.
3. Drag the mouse cursor up to zoom out, and drag the mouse cursor down to zoom in.
4. Click the upper left corner of the viewport to resume scroll mode. The cursor willchange back.
8.1.10 Rotating and Moving Slice Views with Multi Oblique MPR
In an MPR exam, you can rotate the planes along which slices are taken by switching toMulti Oblique mode. Once in this mode, you can rotate the views so they no longer showaxial, coronal, and sagittal planes. You can also manipulate the thickness and location ofthe slices. All the view planes remain at right angles to each other, but can intersect thereconstruction at any angle relative to the axial, coronal, or sagittal planes.
Note This feature is intended for use on color monitors only. You may not be ableto distinguish between planes in a black and white view.
To enter Multi Oblique mode:
1. Select Multi Oblique from the MPR 3D menu button.This opens four views of the reconstruction. You can manipulate the angle of the slicesshown in the third rotation views with the colored borders. The fourth reference viewhas all of the functionality of a normal MPR view, including MIP, MIN, plain averaging,scrolling through the reconstructed slices, and switching between axial, coronal, andsagittal views. These operations apply to all four views. The mm measurements onthe slab menu only apply to the fourth view.
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Note: Multi Oblique mode does not support the Define Series to Exportfeature.
As with other MPR modes, you can generate a series with a single key image fromthe current reconstructed image. Other key image work flows such as short cuts andautomatic annotations are currently not supported.
To change the slice angle:1. Click and drag one of the colored axis lines in one of the rotation views with a colored
border.This rotates both lines and rotates the slices in the other two rotation views.
Example: If you drag the orange axis line in the blue view about 30° off of vertical,the green line rotates the same amount off of horizontal. That rotates the sliceplanes in the orange and green views by the corresponding amount (about 30°).
To change the slice thickness:1. Click and drag one of the square handles at the ends of one of the short lines crossing
a colored axis line.The axis line splits in two, showing the thickness of the slice.
Example: Drag the top orange handle in the green view up. The orange axis linesplits in two, showing the slab thickness for the orange view. The orange axis linein the blue view also splits by the same amount.
To change the position of a slice plane:1. Click and drag one of the circles at the intersection of two colored axis lines.
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This changes the position of the slices shown in the two views corresponding to theaxis line colors.
Example: In the green view, drag the circle at the meeting point between the blueand orange axis points. This changes the position of the blue and orange slicesby a corresponding amount.
The position of the yellow location mark (cross-hairs) in the reference viewchanges to reflect the changes you made in the rotation views.
After moving the location of the slices, the center of rotation shifts to the newlocation. (That is, the slice planes always rotate around the current location.)
To scroll through a view:1. Drag your cursor up or down or use your mouse wheel in any view, just like you
would in a normal MPR.The positions of the slice plane lines move to reflect the distance you scrolled.
To create a multi oblique hanging protocol:1. Add an Embedded MPR to a view as with any other MPR.
2. Right click and choose Hanging Features.3. On the resulting dialog, scroll down to MPR Modes and select Multi Oblique as
the value.
8.1.11 To Restore the Original Series from an MPR
1. Right-click in the MPR viewport.
2. Select Restore series.
Note: You can also assign the Restore Original Series command to a keyboardshortcut in order to access this feature. See Configuring Shortcuts formore information.
8.2 Maximum Intensity Projection (MIP)
8.2.1 Maximum Intensity Projection (MIP)
Maximum Intensity Projection (MIP) is a rendering mode for reconstructing images. MIPpicks up the most dense part of the image and renders it at a certain pixel. Use the presetW/L settings to define which part of the image to focus on. After the image is rendered,you can manipulate it further, enhancing it to get the most vital information.
With the MIP feature, you can:
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● Render a reformatted image
● Change its orientation instantly
● "Crop" a volume of interest
● Sculpt out parts of the image
● Triangulate the rendered image with its source data
● Create a movie of actions taken on the image
Reconstructed images generated by the MIP/MPR module are not suitable for directplacement onto the Key Images Print Page. If any reconstructed images are intended foruse as a Key Image, the series of reconstructed images must first be exported into themain viewer and saved. Images from that series can be placed on the Print Page onlyafter reconstructed images appear as a MIP reformatted series.
To use the reformatted series in a subsequent session, you must upload it to the server. Ifyou do not upload the series, the new data you created is lost when you exit the study.
Note By definition, reconstructed images use the data in the source series. If thatdata is lossy, the reconstructed images are as well. Attend to the lossy tag inthe overlay. Also consider that even when upgrading a reconstructed imageto full resolution, the original data was lossy.
8.2.2 To Construct MIP Images for a Study
1. Open the desired study and select a series.
2. From the toolbar or main menu, click MPR.
The MPR dialog displays, with a control panel on the right and a four-view palette forimages on the left. This four-view palette reserves three panes for source data (i.e.,original images from the selected series), known as localizers, and one for the imagethat will be rendered, known as the target image.
3. In the control panel on the right, click MIP. The control panel updates to display the
palette in stacked view ( ), with the three localizers stacked on the left and thetarget view on the right. It also shows a set of Capturing tools in the control panel.
Note: You can double-click in the target pane to toggle (hide/display) thelocalizers.
The palette is populated as follows:
● Target Image: a three-dimensional model (right pane)
● Localizer: axial plane of source (lower left pane)
● Localizer: sagittal plane of source (middle left pane)
● Localizer: coronal plane of source (top left pane)
The target view shows the rendered image, overlaid with letters that indicate theorientation (A for anterior, R for right. etc.). You can also record the actions you takewhile manipulating the image, such as changing the size and orientation, and savethat recording for later viewing.
4. Click Display to show a menu of display options for the image. Check the displaycomponents to show and capture with the rendered image.
5. To record the changes you make to the image, click Freehand under the CreateMovie section of the control panel.
Note: You can click the Axial button instead of Freehand. This produces arecord (movie) by rotating the current MIP image 180 degrees in a vertical
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axis. Define how many rotations by entering a value in the Steps Numberfield.
6. Choose the appropriate method:
● Freehand Straight: Produces a record (movie) by capturing the optimal (moststreamlined) number of slices between the start orientation and the orientationwhen you click Finish, i.e., the straightest line between the start and finish. Enterthe number of steps to capture in the Steps Number field.
● Freehand Actual: Produces a record (movie) by capturing every slice betweenthe start orientation and the orientation when you click Finish, i.e., everymovement you took between the start and finish.
7. Click Start ( ) on the control panel.
8. Make any desired changes to the image:
● Right-click in the target view to select a different W/L setting.
● Rotate the target image by clicking Rotate or by clicking on a corner and draggingthe mouse pointer. A spatial rotation is performed on the image. Or click oneor more of the Instant Orientation buttons to snap the image to that orientation(Anterior, Posterior, Left, Right, Superior , Inferior).
● Triangulate the target image with the localizers by clicking Triangulate. Thisallows you to locate and follow the region of interest in the other planessimultaneously.
● "Crop" the area of interest by clicking the border of one side of the cube anddragging the border closer to its counterpart on the other side. This renders across-section of the body, dispensing with the volume outside the border. Dragthe border back to enlarge the area of interest.
● "Sculpt" the image by clicking the Sculpt tool and then clicking sections of theimage that you want to remove.
9. When you have manipulated the image to the desired effect, click Finish ( ) onthe control panel.
The Steps Number field on the control panel shows the number of steps you tookbetween Start and Finish; each step becomes an image in the new series. Thisvalue is an estimate. The MIP feature reformats images from the sequence that youalready recorded.
10. Adjust the number of images in the series by entering a higher or lower value in theSteps Number field, as needed.
11. After defining the number of images to add to the new series, click Export ( ).
The reformatted set of images that you recorded is exported into the study and canbe treated as a standard series. The series displays in its own window, and can betriangulated, annotated, cross-referenced, cined, etc.
12. To save the series to the file system, click Save ( ) on the toolbar.
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8.2.3 Rotating MIP View
Maximum Intensity Projection (
MIP) takes only the brightest pixels of all encountered in the line of sight to render thedestination pixels. In other words, it renders an image that shows bright hot spots withnearly transparent surroundings. The Cine tool is particularly useful in combination withMIP, as it provides spatially accurate perception of the region of interest.
The system provides more than a visual perception aid. Its deployment of Rotating MIPalso provides hard data on the depth of the spatial element visualized in every pixel ofthe MIP. The user can position the cursor of any hot spot of the MIP to display all threecoordinates of the point of interest and to highlight that point in the other views, even if theother views have a different orientation. The user can also triangulate the other viewsto that point of interest.
The user can bookmark, or anchor, the point of interest so that it is persistently projectedon all MIP views. The Rotating MIP thus becomes a type of scout view (or localizer),simultaneously visualizing all anchors and allowing any one to be activated. Anchorsare described in detail in
3-D Anchors, and
linear measurements in MIP explains more.
8.2.4 To add Cine to a placeholder
Cine allows you to see all images in the reconstruction in a cinematic "loop," and it isparticularly useful for Rotating MIP. The system projects each image in the reconstructionsequentially so that it appears as if you are flipping through the stack. You can choose thedirection of the "loop" and pause or stop the cine.
Note The Layout Tool supports the use of Cine in only one series window at a time.If Cine is set in one cell, previous definitions in other cells are automaticallydisabled.
1. In the Layout Tool, double-click the placeholder (cell) that will be cined.
2. From the Criteria dialog, click Properties. The Cine Properties dialog is displayed.3. Select the Activate this placeholder check box to make this window the active
window upon opening the study. The Cine will launch as soon as the study is loaded.(If this box is cleared, the Cine will launch only after clicking the window to makeit active.)
4. Select the Run Cine in this Placeholder check box to cine the reconstruction inthis cell.
5. Enter the number of frames per second (FPS); the higher the number, the fasterthe cine rate.
● The system attempts to use frame rate values in the DICOM header or in HangingProtocols to determine a frame rate value for cine. If this information is not presentin the DICOM header or in Hanging Protocols, then the default system frame rateis used as the frame rate for cine. This value is 6 Frames per Second (FPS) andit is not configurable.
6. Select the Cine Mode. Continuous repeats the same sequence after one loop (firstto last, then first to last again). Sweep reverses the sequence after one loop (firstto last, then last to first, etc.).
7. Select the Cine Direction.
8. Click OK to accept the Cine settings.
9. Click OK to accept the attribute entries as criteria for that placeholder.
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8.2.5 To create Linear Measurements
When used in MIP, the linear tool sets two 3D anchors at the endpoint of the segmentand calculates the distance between those points. The measurement is displayed onthe segment label. When the MIP is rotated, the position of the endpoints adapts tothe current viewing angle; the measurement readout, however, remains the same, as itreflects the actual
distance between the points.
1. In a MIP image, click Measurements on the toolbar.2. From the sub-toolbar, click Line Measurement.3. Click the beginning of the segment to measure; drag to the endpoint of the segment to
measure. A measurement for that segment is displayed; each point is anchored.
4. Cine the MIP to display the measurement persistently throughout the rotation.
8.3 3-D Rendering
A selected series from a study can be rendered as a three-dimensional image. Datafrom a single series is used as the source, and the system generates a three-dimensionalvolume from all images in that series. Alongside the rendered three-dimensional volume,three orthogonal planes – transverse, saggital, and coronal – are also displayed.
You can modify the volume, which is displayed as a cube, in a number of ways: by addingannotations, rotating it, cropping it, removing regions within the volume, and so on. Usethe Main Toolbar configuration to include a 3-D button on the toolbar.
You must save the reformatted series to use any of its images as key images. To use thereformatted series in a subsequent session, upload it to the server. If you do not uploadthe series, the data you created is lost when you exit the study.
Basic steps for rendering and refining a three-dimensional image include targetingand segmenting. These are followed by advanced rendering and refining techniques:endoscopic images, oblique MPR and adjusting the histogram. Vessel Analysis is anotheradvanced technique.
Note 3-D rendering is available only to licensed customers.
8.3.1 To Render a Three-Dimensional Image (Review Mode)
1. Open the desired study and select the desired series. (You cannot use a slab-scrolledseries to render 3D images.) From the toolbar or main menu, click 3D.
The 3D dialog displays, with a control panel for the 3D features on the right anda four-view palette for the images on the left. At the top of the control panel, theReview button is pressed down; 3D opens to Review mode by default. The palette ispopulated with three panes of source data (i.e., from the selected series), known aslocalizers; the lower right pane is the rendered image, known as the target image. Sothe palette is arranged like this:
● Target Image: new slices are rendered in this dimension (large or lower right pane)
● Localizer: axial plane of source (lower left pane)
● Localizer: coronal plane of source (upper left pane)
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● Localizer: sagittal plane of source (upper right pane)
Note: You can toggle (alternately hide and display) the localizer panes bydouble-clicking in the target pane. You can also change the display froma stacked view to a two-by-two view by clicking the appropriate displaybutton in the control panel.
2. Locate the target image and, if necessary, adjust the W/L setting by doing one ofthe following:
● Click the down arrow next to the W/L button on the control panel and selectinga parameter.
● Click W/L in the control panel. Click or click-and-drag in the image to makealterations to the W/L settings. Drag left/right or up/down.
The brightness of tissue depends on its pixel value, or density. Tissue below a certainpixel value is dark, and tissue above a certain pixel value is light. Tissue in the range,or window, between those values increases in brightness from dark to light. Levelis the center position of that window: the threshold between dark and light. SeeChanging the Opacity for more information.
Note: You can click Undo in the control panel to reverse the last action, or click
Reset All to begin again.
3. To see the 3D image from another angle, do one of the following:
● Click Rotate ( ) on the control panel. The mouse changes into acurved arrow shape, indicating that you can click and drag any corner of thethree-dimensional cube to alter the orientation of the image.
● In the Rotate panel’s Angle field, enter the number of degrees the volumerotates with each click. Click the arrow buttons in the Rotate panel to rotate theorientation. Click Screen to rotate the image relative to the screen position orPatient to rotate the image relative to the patient position.
● To get an exact orientation, select an option on the Instant Orientation panel: A(anterior), P (posterior), L (left), R (right), S (superior) or I (inferior).
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● Click the down arrow next to the Rotate button and select an option from themenu.
4. To crop the three-dimensional image, click on any side of the cube and drag themouse forward or backward. The cursor changes to a hand with two arrows, and theselected side of the cube is highlighted as a dashed line.
5. To take a closer look at the image, click Zoom. The cursor changes shape to indicatethat Zoom is enabled. In the target pane, click and drag the mouse up or right toincrease the zoom factor. Click and drag down or left to decrease the zoom factor.
6. To move the entire image back and forth or up and down in the target pane, clickPan. The cursor changes shape to indicate that Pan is enabled. Click and drag theimage to a new location in the window.
7. To add an annotation or measurement to the image, click the appropriate tool on thecontrol panel, according to the following definitions:
● Line: To measure the distance between two points, click once on the first pointand drag to the second point. Measurements are provided in millimeters; if themeasurement exceeds 100 millimeters, it changes to centimeters.
● Angle: To measure an angle, click and drag to draw the first line, and then releasethe mouse. Click either end of that line to form an angle at that juncture; draw thesecond line by dragging the mouse. Measurement is provided in degrees.
● Ellipse: To capture measurement and image information for the elliptical area youselect, click and drag the mouse around the area to measure. Measurement isprovided in average Hounsfield units, along with a standard deviation.
● Annotation Text : For free text, click where you want an alphanumeric label toappear and start typing.
● Annotation Arrow: To insert an arrow that points to an area of interest, click onthe region you want to point out and drag the mouse away.
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8. To add images to the study, do one of the following:
● To capture a single image, click Capture ( ) and click on any localizer or therendered three-dimensional image to add that image as its own series to the study.
● To capture all four images, click the down arrow next to Capture, and selectCapture All.
The three-dimensional image and each localizer are added as separate "slices" inthe new series.
9. To save the series to the file system, click Save ( ).
You must save the reformatted series to use any of its images as key images. To usethe reformatted series in a subsequent session, you must upload it to the server. Ifyou do not upload the series, the new data you created is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
8.3.2 To Target an Area of Interest in a Three-DimensionalImage (Targeted Mode)
You can render the three-dimensional image so that a particular area of interest is targetedwith the localizer panes.
Save the reformatted series to use any of its images as key images. To use thereformatted series in a subsequent session, upload it to the server. If you do not uploadthe series, the data you created is lost when you exit the study.
Note By definition, reconstructed images use the data in the source series. If thatdata is lossy, the reconstructed images are as well. Attend to the lossy tag inthe overlay. Also consider that even when upgrading a reconstructed imageto full resolution, the original data was lossy.
1. Access the image to target. See the task To render a three-dimensional image(Review Mode) for more information.
2. In 3D mode, click Targeted in the Mode panel. The display updates to a two-by-twopalette, with the target view in the lower right pane.
3. In one of the localizer panes, click and drag the square to the desired area of theimage. The cursor changes to a hand shape with arrows, and the lower left paneupdates to reflect the targeted area. Crop or increase the target area by dragging oneside of the square in a localizer pane.
4. Control panel actions, such as Rotate, W/L, Zoom, Pan and Annotations, can beapplied to the targeted area of interest.
5. To add images to the study, do one of the following:
● To capture a single image, click Capture and click on any localizer or therendered three-dimensional image to add that image as its own series to the study.
● To capture all four images, click the down arrow next to Capture and selectCapture All.
The three-dimensional image and each localizer are added as separate "slices" inthe new series.
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Note: Define Movie on the Capture menu applies only to MIP.
6. To save the series to the file system, click Save ( ) on the toolbar.
You must save the reformatted series to use any of its images as key images. To usethe reformatted series in a subsequent session, you must upload it to the server. Ifyou do not upload the series, the new data you created is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
8.3.3 To segment a three-dimensional image (SegmentationMode)
Segmentation allows you to select certain areas of the image. Often segmenting is usedin conjunction with the Sculpt tool to remove an obstruction to the area of interest, or toremove everything except the segmented area.
● Once a segment is selected, you can make refinements to that selection. Thereare two methods of segmenting:
● Shape -- The region is manually selected.
● Regioning -- All connected pixels of the same intensity are selected.
8.3.3.1 Shape
1. Display the image of interest. See the task To render a three-dimensional image(Review Mode).
2. In 3-D mode, click Segmentation in the Mode panel.
3. Click Shape. The cursor changes to a pencil shape.4. Click and drag the cursor around the area to segment. Double-click to end the
drawing action.
In the figure below, the user wants to remove the cervical spine to see the jaw andskull more clearly during rotation. To manually select the cervical spine, the user firstclicked R (for Right orientation) in the instant orientation section of the control panel.The user then clicked Segmentation and then Shape. The user dragged the mouse tosurround the cervical spine. The drawn Shape segment is indicated by a green line.
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5. After completing the drawing action, click once inside the segment. The segmentturns blue to indicate that it is highlighted. See the Sculpt section to learn how toremove the selection and make other refinements.
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8.3.3.2 Regioning
1. Display the region of interest. See Shape for more information.
2. In 3D mode, click Segmentation in the Mode panel.
3. Click the down arrow next to Region.4. Specify what tissue the system should segment by clicking the down arrow beside
Region; from the menu, choose an intensity using the following definitions:
● High: Selects visibly connected tissue that is in the same color/opacity bandor higher.
● Single: Selects visibly connected tissue that is in the same color/opacity band.● All Visible: Selects all the visible tissue.
5. Click a part of the image to segment. All connected pixels of the same intensity areselected. See To Sculpt a Segment to remove a selected segment.
To refine a selection
Upon completing the segmentation, you can refine the selection.
1. Display the image of interest. See the task To render a three-dimensional image(Review Mode).
2. Click the down arrow next to Refine in the Mode panel.
3. Choose an action from the Refine menu, according to the following definitions:
● Reshape -- Allows you to redraw the selection.
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● Dilate -- Increases the size of a selection by adding a layer of voxels immediatelyoutside its surface; this is the opposite of erode.
● Erode -- Decreases the size of a selection by excluding a layer of voxels at thesurface; this is the opposite of dilate.
● Open -- Erodes then dilates a selection, which can break thin connections insidethe selection.
● Close -- Dilates then erodes a selection, which can close small holes andinvolutions inside the selection.
● Fill -- Selects large unselected holes inside a selection.
● Shell -- Excludes all voxels from a selection, apart from a layer of voxels at thesurface.
4. To remove areas from the image, sculpt the segment. See To sculpt a segment.
To sculpt a segment
After a segment has been selected and/or refined, the Sculpt tool is activated. Sculptremoves certain areas from the image.
1. Select a segment using the Shape or Region tool.
2. Click Sculpt to remove the segment immediately, or click the down arrow besideSculpt.
3. From the Sculpt menu, choose the appropriate action according to the followingdefinitions:
● Undo Sculpt -- Revokes the last sculpt action. Clicking Undo on the controlpanel accomplishes the same action.
● Redo Sculpt -- Reverses the last Undo Sculpt action. Clicking Redo on thecontrol panel accomplishes the same action.
● Undo All Sculpting -- Revokes all Sculpting actions.
● Redo All Sculpting -- Reverses all Undo Sculpt actions.
● Apply Sculpting to 3D Mode -- A checkmark indicates that sculpting is enabledfor 3-D mode.
● Sculpt Selection -- Removes the selected segment from the image. ClickingSculpt accomplishes the same action.
● Sculpt all except selection -- Removes everything from the image except theselected segment.
● Unsculpt selection -- Returns only the portion of the image that is currentlyselected.
● Sculpt selection boundary -- Removes only the boundary of the selection.
● Unsculpt selection boundary -- Revokes the Sculpt Selection Boundary action.
● Sculpt Options -- Allows you to enter the size of a sculpt boundary (in millimeters)and to select whether or not to apply that boundary by default to all sculpt actions.
Note: You can click Reset All to clear all actions (including not only sculptactions, but any and all other actions) and begin again.
4. To add images to the study:
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● To capture a single image, click Capture and click on any localizer or therendered three-dimensional image to add that image as its own series to the study.
● To capture all four images, click the down arrow next to Capture and selectCapture All.
The three-dimensional image and each localizer are added as separate "slices" inthe new series.
5. To save the series to the file system, click Save . You must save thereformatted series to use any of its images as key images. To use the reformattedseries in a subsequent session, upload it to the server. If you do not upload the series,the new data is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series. Ifthat data is lossy, the reconstructed images are lossy as well. Attend tothe lossy tag in the overlay. Remember when upgrading a reconstructedimage to full resolution, the original data was lossy.
To Construct Oblique MPR Images
In Oblique MPR, you select a plane and render an image of that plane for capture. Anoblique plane is a plane that rotates on one axis. There are three different kinds of singleoblique planes: Sagittal, Coronal and Transverse. In its 3-D feature, the system alsoprovides for double-oblique imaging, i.e., a plane that rotates between two axes. Thediagrams below illustrate the position of each type of oblique.
Sagittal: Rotated on Anterior-Posterioror Superior-Inferior axis.
Double sagittal: Rotated between bothaxes.
Coronal: Rotated on a Superior-Inferioror Right-Left axis.
Double coronal: Rotated between bothaxes.
Transverse: Rotated on a Right-Leftor Anterior-Posterior axis.
Double transverse: Rotated betweenboth axes.
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1. Open the desired study and select a series. From the toolbar or main menu, click 3-D.2. When the 3-D dialog opens, click MPR.3. In the Mode panel, click Oblique. In Oblique mode, the localizers are populated
with images rendered from the selected series, and the target image pane instructsyou to select Single or Double Oblique.
4. In either case, begin by clicking Oblique on the control panel.
5. Specify the first axis to use by clicking the appropriate pane:
● Click the Transverse localizer (pane) to use the Superior-Inferior axis
● Click the Coronal localizer (pane) to use the Anterior-Posterior axis
● Select the Sagittal localizer (pane) to use the Right-Left axis
6. An oblique controller is applied to the selected localizer; the crosshairs indicate theposition and angle of the planes in the other two orthogonal MPR views. Move to thedesired position by clicking in the center of the crosshairs and dragging the entirecontroller.
7. Click and drag the crosshairs to specify the position of the axis. The cursor changesinto a hand shape with two straight arrows. Note that the crosshairs will only moveon the selected plane.
8. Drag the outer circle of the controller to specify the angle of rotation around the axis.The cursor changes into a hand shape with two curved arrows.
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9. Click and drag the calipers on the crosshairs to increase or decrease the thickness ofthe new slice. You can also select a pre-defined thickness by clicking the down arrownext to the Slab Thickness button on the control panel.
10. If you want a single oblique plane only, skip to step 14. To render a double oblique
plane, click Double Oblique (crosshairs).11. Specify the second axis by clicking on the appropriate pane.
12. Drag the inner circle or line of the controller to specify the position of the axis.
13. Drag the outer circle of the controller to specify the angle of rotation around the axis.
14. To add images to the study:
● To capture a single image, click Capture and click on any localizer or therendered three-dimensional image to add that image as its own series to the study.
● To capture all four images, click the down arrow next to Capture and selectCapture All. The three-dimensional image and each localizer are added asseparate "slices" in the new series.
Note: Define Movie in the Capture menu applies only to MIP.
15. To save the series to the file system, click Save on the toolbar. You must savethe reformatted series to use any of its images as key images. To use the reformattedseries in a subsequent session, you must upload it to the server. If you do not uploadthe series, the new data you created is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
To Construct Endoscopic Images
The system can take source data and render an endoscopic series; the Endoscopic modeallows you to examine visually the interior of a bodily canal or a hollow organ.
Save the reformatted series to use any of its images as key images. To use thereformatted series in a subsequent session, you must upload it to the server. If you do notupload the series, the data is lost when you exit the study.Note By definition, reconstructed images use the data in the source series. If that
data is lossy, the reconstructed images are as well. Attend to the lossy tag inthe overlay. Also consider that even when upgrading a reconstructed imageto full resolution, the original data was lossy.
1. Open the desired study and select a series. From the toolbar or main menu, click 3D.2. When the 3D dialog opens, click MPR. The MPR dialog, described in the MPR
section, displays.
3. Under Mode at the top of the control panel, click Endoscopic. In Endoscopic mode,the localizer panes are populated with images rendered from the selected series, andthe target pane instructs you to select a curve direction.
4. You will "draw" a curve through an organ, cavity or vessel. Click the image to specifythe direction that curve runs:
● Left-Right: Click the Sagittal thumbnail in the target pane.● Anterior-Posterior: Click the Coronal thumbnail in the target pane.
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● Superior-Inferior: Click the Transverse thumbnail in the target pane.
5. After clicking a thumbnail, the Draw Curve tool activates in the target pane.Select the button.
6. Click and drag the mouse, which now has a pencil shape, through the organ, cavity orvessel. As you drag, nodes are arranged along the curve. You can add additionalnodes, which refines the rendered image by adding more data, and you can move thenodes to add data from a different location. A blue arrow indicates the endoscopicdirection.
● To change the curve, click once on a node, which turns red when activated. Dragthe node to a new location. All the localizers update to display the new location.
● To add a new node, click anywhere on the curve. The localizers update to displaythe new data. The currently active node is red.
● To alter the direction of the curve, click and drag the circle to rotate the arrow head.
● To delete a node, double-click it. To delete the entire curve, click Delete All onthe MPR control panel.
7. Use any of the tools on the control panel to modify the image.
8. To add images to the study, do the following:
● To capture a single image, click Capture and click on any localizer or therendered three-dimensional image to add that image as its own series to the study.
● To capture all four images, click the down arrow next to Capture and selectCapture All. The three-dimensional image and each localizer are added asseparate "slices" in the new series.
9. To save the series, click Save ( ) on the toolbar. You must save the reformattedseries to use any of its images as key images. To use the reformatted series in asubsequent session, you must upload it to the server. If you do not upload the series,the new data you created is lost when you exit the study.
Note: By definition, reconstructed images use the data in the source series.If that data is lossy, the reconstructed images are as well. Attend tothe lossy tag in the overlay. Also consider that even when upgrading areconstructed image to full resolution, the original data was lossy.
To Change the Opacity for Rendering Three-dimensional Images
The opacity of tissue depends on its pixel value. Certain tissue is set to show noopacity (clear), while other tissue is completely opaque. The tissue of interest in athree-dimensional image is within those two extremes. The range of pixel values isdivided into five bands, and each band has its own color and opacity value. You canadjust these bands.
1. Display the region of interest. See the task To Render a Three-dimensional Image(Review Mode).
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2. Click the down arrow next to the W/L button and select Color Histogram from themenu, or click Opacity on the control panel. The opacity histogram displays.
Five bands are shown in the graphic on the left and as columns in Opacity panel atthe upper right. The numbers assigned to each band in the Opacity panel representpixel values. Tissue with a lower pixel value is shown on the left (black, red, orange)and tissue with a higher pixel value is shown on the right (yellow, white); these arethe colors at the center of the band. The green lines represent the boundaries ofeach band; the exact boundary position is represented as a number in the Positionfields. The red line denotes the level of opacity in each band; note that it curvesfrom zero to a high value.
3. To change the position of a band's boundary, enter a new value for that boundary inthe respective Position field, or click and drag the green line of that boundary in thegraphic.
4. To change a band's opacity, enter a new value for that band's opacity in the respectiveOpacity field, or click and drag the red line to a new position within the band. Enter avalue between 0 (completely transparent) and 100 (opaque).
5. Use the Zoom, Pan and Level buttons below the graphic to apply those actionsto the histogram.
6. Click Close to return to the 3-D view.
8.3.4 Vessel Analysis
8.3.4.1 Vessel Analysis
From its 3D Rendering tool, the system features a means of analyzing contrast-enhancedstudies of key vessel regions in the body, including carotid, renal and coronary arteries, aswell as the abdominal aorta. Whether these studies are used for stenosis, stent and stentgraft planning or stent graft surveillance, the system provides key measurements quickly.
As with other reformatted images, a Vessel Analysis (one of the localizer windows or afull report with system-generated measurements) can be added to the selected studyas its own series. This section explains how to generate a vessel analysis and how toadd that report to a study.
You must save the reformatted series to use any of its images as key images. To use thereformatted series in a subsequent session, upload it to the server. If you do not uploadthe series, the data you created is lost when you exit the study.
Note By definition, reconstructed images use the data in the source series. If thatdata is lossy, the reconstructed images are as well. Attend to the lossy tag inthe overlay. Also consider that even when upgrading a reconstructed imageto full resolution, the original data was lossy.
8.3.4.2 To perform Vessel Analysis
1. Open the desired study and select the desired series. From the toolbar or main menu,click 3-D.
2. Click MPR.3. Click VesselMetrix.
The palette is populated with three panes of source data (i.e., from the selectedseries), known as localizers, and one target pane for rendered data.
● Target Image: new data are rendered here -- lower right pane
● Localizer: transverse plane of source -- lower left pane
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● Localizer: coronal plane of source -- upper left pane
● Localizer: sagittal plane of source -- upper right pane
Vessel Analysis shows an additional pane to the far right. The straightened vesselview and calculations are displayed here.
Note: You can change the palette from a 2x2 view to a stacked view (localizersstacked to the left) by clicking the appropriate button in the Displaysection of the control panel.
4. Arrange the localizers by scrolling to view exactly the desired image, windowing andclicking and dragging the green cross-reference lines to center on the desired area.
5. In the lower right pane, select a direction for the curve: Left-Right, Anterior-Posterioror Superior-Inferior. The cursor changes to a pencil shape.
6. In any of the localizer panes, click the area of the vessel that will serve as the startpoint for the measurement. This start point is marked as a green box in all localizerpanes.
Note: The cursor changes to a hand shape when held over a set start point.This indicates that you can click and drag that point to a new location.
7. Click the end point of the vessel. The system automatically calculates the centerlineof the lumen and displays the result in the target (lower right) pane. A rendering ofthe unfolded, straightened lumen is displayed in the vessel localizer (vertical) paneto the far right.
8. If necessary, click and drag any single point along the centerline to edit themeasurement. The selected point is surrounded by a circle.
9. Click Measure. Area (yellow) and diameter (blue) measurements display in the vessellocalizer (far right) pane, as well as in the target (lower right) pane.
Note: At any time you can clear the panes and begin again; click Reset All
.
10. To see all measurements for the vessel, click and drag the navigation bar in the vessellocalizer (far right) pane. The navigation bar is the uppermost bar; click and draginside the circle to move it down. The other panes "cine" to indicate the tortuosity ofthe vessel, and the target pane updates measurements along with the movement.
11. To change the display, click Profiles and select which measurements to display(average, minimum, maximum, etc.)
12. To calculate stenosis, click the down arrow next to the Stenosis button and select thetype of measurement: average diameter, minimum diameter or cross-sectionalarea.
13. To differentiate calcium from contrast, enter a calcium threshold value at the bottom ofthe control panel; to change it, drag the calcium threshold tool over the image.
14. To render this image in 3-D, click 3D Segm in the control panel.
15. To capture any one of the localizer images, click Capture on the control panel. Thecursor changes to a camera shape. Click one of the localizers or the target image toadd that image to the study as its own series.
16. To add the straightened vessel view with measurements to the study, click Report inthe control panel. The image is added as its own series to the study.
17. To save the series to the file system, click Save on the toolbar.
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8.4 3-D AnchorsNote A middle button on the mouse is required to use anchors.
Anchors enhance triangulation by keeping the point of interest persistent. The spatialreference is planted on any view of any modality and is preserved throughout thediagnostic reading session. Anchors can be measured, labeled and saved to apresentation state for display in a future session.
When a 3D anchor is set, moved or activated, all other planar views automatically scroll tothe slice that holds that anchor. The
MIP view does not rotate automatically, but the anchor is displayed in the proper planeand location on that view. As the user rotates the MIP, the system re-renders all anchorsaccording to the line of sight.
Note If modality LUT is present in the DICOM header of an image, it is applied tothe original pixel data as the image is loaded. 3-D anchor measurements arethus performed on the post-modality LUT pixel data.
8.4.1 To Create an Anchor
1. Click the Triangulation button in the Image Viewer toolbar, or press and hold
the F2 key. The mouse pointer changes shape to indicate that triangulation isenabled.
2. Click the middle mouse button to "pin" a 3-D anchor at the point of interest. Theanchor references the pixel of the visible slice. The anchor also appears in thecorresponding location in the source images (PET and CT) and all other views. If theanchor was set on a MIP view, it references the currently displayed bright spot andholds in all planes of the image, all through the rotation.
3. Hover the mouse over any anchor (in any plane) to highlight it and automaticallytriangulate all other views to its position. Views always triangulate to the active anchor.
4. Click outside the anchor to resume standard paging.
Note: Anchors, along with their labels and measurements, are saved to thecurrent presentation state. In Key Images, anchors (and their labels andmeasurements) are preserved as a graphic annotation.
8.4.2 To Edit an Anchor
� Use any of the following methods to edit an anchor.
● To relocate the anchor anywhere in the slice, click and drag it . All other views aretriangulated to the new position.
● To move the anchor to a neighboring slice, click it and scroll the mouse wheel. Theanchor is repositioned in the same location on the neighboring slice. All other viewsare triangulated to the new position.
● Right-click over an anchor to display a delete option.
● Click the triangulation button’s down arrow to display a drop-down menu; a "delete allanchors" option is included in that menu.
● Toggle between show and hide to clear the display of anchors and their labels; theshow/hide option is in the triangulation button’s drop-down menu.
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● Multiple anchors are automatically numbered, beginning with 1. To attach ameaningful label to an anchor, right-click it and select Edit to enter a name.
8.4.3 Measuring with Anchors
When an anchor is placed, it can be configured to perform a measurement by default,based on the region of interest surrounding that anchor. To facilitate reads, each newanchor is set in a unique color and labeled sequentially. You can set defaults for anchorproperties and change properties for an individual anchor.
The measurement shows the average values of the pixels within a spherical region ofinterest. In PET images, the measurement displays in SUV units; in CT images, themeasurement displays in Hounsfield units. Fused images (Fused Axial, Sagittal, andCoronal) display separate measurements for both PET and CT images in SUV andHounsfield units, respectively.
8.4.3.1 To Set Default Measurement Behavior for All Anchors
1. In the Layout Tool or in the Navigator, right-click a thumbnail to display a floating menu.
2. Click Navigator Options.3. Click the 3D Anchors tab in the User Preferences dialog.
4. Select the Attach Measurement check box. When this box is checked, the systemautomatically attaches a measurement to the anchor when it is placed.
5. If the Attach Measurements check box is selected, then the Show Measurementson the 3D Anchor right-click context menu is selected. Deselect the menu option toshow the anchor measurements only when the mouse hovers over the anchor. Selectthe menu option to always show the measurements.
6. Enter a maximum diameter, in millimeters, for the spherical region of interest.
7. Click OK to save the measurement setting. Measurements display in all planes.
8.4.3.2 To Change Properties for a Single Anchor
To control the properties of one particular anchor, right-click on that anchor to display afloating menu.
1. Select Properties to edit the measurement display. A dialog shows the measurementdisplay values for that anchor. The settings apply to that anchor only.
2. Select Color to change the color of the anchor.3. Select Font to change the font, font style, and size of the anchor’s measurement label.
8.4.4 Using Linear Measurements with Anchors
The Measurements section discusses standard linear measurements in AdvancedPET-CT.
When used to measure the distance between two "hot spots" in MIP, the linearmeasurement tool sets a 3D anchor at each endpoint of the segment. It then calculatesthe distance between those points in 3D space and displays the measurement on thesegment label. When the MIP is rotated, the position of the endpoints adapts to the newviewing angle; the measurement read-out, however, remains the same, as it reflects theactual distance between the points.
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8.4.4.1 To Navigate between Anchors
You can set up a keyboard shortcut or menu item to move to the previous or next anchor.
1. In the Layout Editor, click the tab that indicates where the navigation command will be:Main Menu, Shortcuts, or Series Menu.
2. In the Definition dialog, look for "Previous 3D Anchor" or "Next 3D Anchor" in theright pane.
3. Proceed with the layout definition as described in Configuring Shortcuts.
Note: The triangulation button's drop-down menu also includes a Go ToPrevious/Next Anchor item, as well as a numbered list of each anchor.Click an anchor to make it active.
8.4.4.2 To Save Anchors
All anchors are automatically saved to the presentation state. If the presentation state issaved, anchors display when that presentation state is loaded. If the presentation state isnot saved, anchors do not display when the study is reloaded.
1. Complete the task To_create_an_anchor to create a 3-D anchor in PET-CT.
2. After you create an anchor, save it by saving the presentation state.
8.4.4.3 To Use W/L Sync
Series of the same modality reconstructed from the same source can be set to synchronizeto a new W/L setting. That is, if the W/L setting is changed in one view, all other viewsof that same modality update to that W/L setting, regardless of orientation or origin (i.e.,source or reconstructed). The corresponding component of a fused view is included inthe W/L synchronization.
Note This feature applies to PET-CT images only.
1. Create a shortcut, toolbar button, or menu item for Sync W/L.2. Click the button or menu item to activate the feature.
3. Update the W/L setting in the desired series; all views of that modality, no matterwhich plane, update to that same W/L setting.
4. Click the toolbar button or menu item again to turn Sync W/L off.
Note: Field-of-View Synchronization can also be applied to PET-CT images.
8.5 PET-CT Fusion
PET-CT Fusion is a method of combining, or "fusing," images from two differentmodalities to gain the benefits of each. For example, you may evaluate how a tumorreacts to treatment in follow-up CTs; the same size may appear, but when combinedwith PET, the active (hot) cells inside the mass may show a change. By fusing the twomodalities, the viewer makes the tumor status clear. Fusion creates a copy on whichanatomical information (from CT) is computationally merged with a map of isotope densityin the patient's body (from PET).
Fusion applies only to studies that contain both CT and PET images, and it can be used inStack View. The viewer's Advanced PET-CT toolset provides more extensive features forthis modality.
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The viewer PET related features/tools are disabled on PET or CT-PET viewports underthe following conditions:
● The workstation has the 3D Advanced Applications client installed.
● You don’t have the “UVPET-Enabled” ADM privilege.
In those cases, please use the 3D Advanced Applications tools.
8.5.1 PET-CT Views
By definition, PET-CT produces three types of axial series:
● Original transaxial PET, also known as "Non-Attenuation Corrected" or NAC.
● Original transaxial CT series. Multiple axial CT series can be produced with differentreconstruction filters, e.g., "Lung" or "Abdomen."
● So-called "Attenuation Corrected" transaxial PET series. These use reconstructed CTdata to correct the aberrations in a PET image due to Positron radiation attenuation inthe human body.
PET series visualize the functional information, and CT series provide complementaryanatomical views, which are necessary to properly attribute the functional data with spatialpositioning. For better perception of both the functional and anatomical data, and forbest diagnostic results, additional views are rendered from the original axial views. Trulyproductive PET-CT reading depends on the quality of rendered views.
The system supports all of the industry-standard rendered views:
● Sagittal CT and sagittal PET
● Coronal CT and coronal PET
● Fused PET-CT views — axial, sagittal and coronal
● MIP projections of PET volumetric data obtained along multiple horizontal lines of viewand separated by equal angles
8.5.2 To Fuse CT and PET into One Image
1. In a study that contains a CT series and a PET series, make sure that the Navigatoris displayed.
2. Arrange the two corresponding images to fuse, one from each series, side-by-side inthe viewer. Either series can be active.
3. Select Fusion from the menu, or select Fusion on the toolbar. A copy of theactive image displays, as noted in that window's title bar, and an adjustment bardisplays at the bottom of this copy window. The copy window will have a headlineindicating that it is waiting for the second image to complete the fusion.
Note: You can use cross-reference and synchronization on this copy, but notslab scroll, MPR, or 3-D. Also, you cannot create a copy of this Fusioncopy window. See the section on Measurements to learn how to calculatethe SUV for a PET image.
4. In the Navigator, drag the thumbnail of the image to fuse onto the thumbnail of thebase image.
or
5. Click the swap icon of the image to fuse with the active image and drag it onto theactive image.
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The copy window immediately updates to display a fusion of the two modalities.
6. Slide the adjustment button to the left or right to make one modality more visiblethan the other. (If the adjustment button is moved all the way to the left of the scale,only the CT image will display. If it is moved all the way to the right, only the PETimage will display.)
7. The color scale indicates how colors are to be interpreted in the fusion image, andit corresponds to the adjustment bar. The leftmost (darker) colors indicate the CTmodality, while the red and yellow colors are from the PET images. Yellow representsthe areas of maximum positron emission.
8. Click the windowing buttons next to the adjustment bar to modify the contrast andbrightness of the fused image. The black and white (standard) windowing buttonadjusts the contrast and brightness of the CT components. The color windowingbutton (which also displays automatically on the main toolbar when Fusion is enabled)adjusts the contrast and brightness of the PET components.
9. Fusion images cannot be saved to the server. To preserve a fusion image, you mustmake it a key image and print it.
8.5.3 Source Series
The system stores only the source PET and CT axial series, then renders thereconstructed lateral views (sagittal, coronal and rotating MIP) on-the-fly each time thestudy is loaded. The PET-CT modality always provides multiple axial PET series andcan provide (optionally) multiple CT axial series; therefore, reconstructed series canbe derived from multiple sources. At a simple level, Centricity Imaging Viewer allowsusers to hang multiple PET or CT reconstructions derived from a PET or CT axial series.However, users can also hang series with the same plane as the reconstructions butfrom a different source.
Rendering from the source is managed via the Navigator. As is standard, the Navigatordisplays thumbnail images of series in the layout. By dragging any thumbnail representinga source series onto any view derived from that same modality (included fused views), theuser causes all derived views from that source to be re-rendered, respective to the draggedthumbnail. See this section to learn more about instant rendering from a different source.
Though the images are rendered upon opening, the system supports full annotation oforiginal, reconstructed and fused images.
8.5.4 To instantly re-render
You may, as a matter of course, review two sets of a derived view (e.g., a rendering with acorrected PET source and a rendering with a non-corrected PET source, or a renderingwith a lung-filtered CT source and a rendering with an abdomen-filtered CT source). Thesystem facilitates a simple switch to the other set, via instant re-rendering. Rather thanre-loading an entirely new hanging protocol to distinguish the other set, the user candisplay the other rendering with a drag-and-drop.
� Instantly re-render from a different source in one of two ways:
● In the current protocol display, click and drag an image from the new source ontoany derived view of the same modality.
or
● Click and drag an image from the new source onto the placeholder that appears inthe Navigator.
See
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Source Series in Advanced PET-CT Concepts for more information on rendering fromthe source.
8.5.5 Switching PET, CT, or PET–CT Image Planes
To switch image planes in an MPR, PET, or CT series, or a PET-CT fused series:� Click one of the image plane buttons near the bottom of the view (Axial, Coronal, or
Sagittal).
The buttons are only visible on an MPR, PET, CT, or PET-CT series when cine is notenabled.
Note: When switching planes on a PET, CT, or PET-CT fused image, thereconstructed images display in the navigator. They are available until thestudy closes (that is, they are not saved to the server.)
When switching planes on an MPR series, the reconstructed images do notdisplay in the navigator.
8.5.6 Fusion Windowing Controls
The following components control the windowing of the fused view:
● CT W/L The standard W/L controls (the W/L tool, selection from the preset menu, orROI windowing) apply to the CT portion of the fused image. (See Window/Level(W/L) (page 205).)
● PET W/L and color palette The standard PET (and NM) W/L and color controlsapply to the PET portion of the fused image. (See PET and Nuclear Medicine (NM)Window/Level (page 207).)
● PET W/L and backgrounds PET images may be viewed with a white background(interpreted as a Monochrome 1 image) or a black background (interpreted as aMonochrome 2 image). See Window Leveling
● Fusion ratio You can control the transparency of the PET image with respect to theCT image from the PET W/L control for the fused image. (See To Control the FusionRatio (page 295))
8.5.6.1 To Optimize W/L for PET-CT
The strip displays the selected color palette, with two numerical labels. The low windowboundary, or value, displays at the bottom and the high window value at the top.
1. Click either numerical label.
2. Then right-click and drag a rectangular region in the image. The optimal PET W/Lfor that region is applied automatically.
Note: You can manually change either boundary value by clicking the numberand dragging horizontally (for a lower value) or vertically (for a highervalue). This action applies a simple change; it does not apply the optimalW/L value.
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8.5.6.2 To Control the Fusion Ratio
� Click and drag the green triangle next to the color strip. Drag the triangle up or down,for greater or less transparency:
● 0% — The green triangle is positioned at the topmost point of the control, and hotspots of the PET image completely obscure the underlying anatomical structure.
● 100% — The green triangle is positioned at the lowest point of the control, and thePET overlay is completely invisible. Thus, the fused view is indistinguishable froma pure CT image.
8.5.7 Measurements
The system provides measurement tools for PET-CT images. The standard measurementtypes — linear and point measurements — are supported, along with Standard UptakeValue (SUV) measurements, which are especially useful in fused views. This sectionexplains how to use SUV and point measurements. (See Finding the Maximum SUV(page 306) for information on finding the maximum SUV value.)
In PET-CT exams, the linear measurement tool is used in the standard way. It ismost commonly used to measure the distance between two "hot spots" in the MIPrepresentation (See To create Linear Measurements (page 275)).
8.5.7.1 To Use SUV Measurements
1. Click SUV measurement on the toolbar.2. Point to any pixel in a PET or a fused PET-CT image. The system displays the
average, max and mean SUV values of the selected vicinity.
3. Set the SUV tool to take measurements in a circular, cylindrical or spherical region,depending on the plane of the image.
4. To change the area of measurement, right-click a current SUV measurement. Afloating menu displays several options; the selections are denoted by a checkmark.
5. To measure the volume of interest, select VOI. To measure a region of interest, selectROI.
6. Depending on the plane of the image, the menu also displays shape selections:Sphere or Cube for sagittal views and Circle or Rectangle for other views. Select ashape to measure.
7. To change the diameter of the measurement, click Settings. Enter a new diameter (inmillimeters) in the pop-up dialog and click OK.
Note: SUV values can be computed only if the modality sends the necessaryparameters from the PET-CT study to PACS.. Even if the pixel data is notalready in the proper SUV representation at the scanner, the system cancalculate SUV measurements automatically. It derives industry-standardSUV values by using DICOM information, calculating the proper SUVcoefficient. This feature supports major makes and models.
Note: SUV values are typically available only to non-attenuation correctedseries.
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Validation:
● To view the input parameters used for SUV calculation that were sent in the DICOM,select Display SUV Details from the series menu.
Expected Result: This opens the SUV Details dialog, which allows you to verify thatthe PET-CT modality sent the correct information.
8.5.7.2 Viewing SUV Details and Recalculating SUV Values
From the SUV Details dialog, you can view and experimentally change the values used tocalculate the SUV.
To open the SUV Details dialog:1. In a PET or PET-CT exam, select Display SUV Details from the series menu.
To recalculate the SUV from the SUV Details dialog:1. Change any value shown on the dialog.
2. Click Recalculate.
Expected Result: If you entered valid values, the SUV and the min and max values onthe PET-CT fusion bar will change to reflect the new values.
Note: In Comparison mode, the new values will reflect only on the active studyand not on the other studies.
3. When you are finished trying different values, click Cancel, and the values will revertto those stored in the DICOM.
Note: Your changes do not change the values in the DICOM and cannot besaved in the presentation state. Recalculating the SUV shows you whatthe SUV would be if the values were different. It does not change theactual SUV.
8.5.7.3 To create point measurements
The point measurement tool is used to reflect the value of the pixel, as sent to the systemfrom the modality. If that data was sent in an SUV calibration, the point measurementmay display the local SUV value.
1. Click Measurements on the toolbar.2. From the sub-toolbar, click Point Measurement.3. Click the point to measure in the image. The value displays immediately.
Note: The point tool and the SUV tool may display different values for the samepixel; the point tool assesses the exact local value, while the SUV toolreturns average, max and mean values for the selected vicinity.
Note: When used in a fused view, the point tool returns both the Hounsfieldvalue (for CT) and the pixel value (for PET).
8.5.8 Hanging Protocols
Any combination of original and rendered views can be arranged in a specialized PET-CThanging protocol. You can attach a particular hanging protocol to a study layout andset the system to use that protocol when a certain requirement is recognized, such asa specific display configuration or physician preference.
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You can define a hanging protocol to include not only placeholders for rendered series butalso for the Navigator and key images. Configuration of hanging protocols is explained inPET-CT Hanging Protocols.
8.5.8.1 Creating PET-CT hanging protocols
PET-CT views are created in much the same way as new automated study layouts(hanging protocols). Set parameters that define what image populates a placeholder(cell). The difference with PET-CT is that the system can populate a cell with new,derived views of the
source series. These derived views are rendered each time the study is opened, savingconsiderable storage space. The settings define what to construct from the sourcestudies, and that rendering is presented when the PET-CT study is loaded.
You can create a PET-CT view so that the desired images present in the desired format.There are two steps to creating a PET-CT view: creating the canvas and definingattributes.
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To Create the Canvas
1. From Image Viewer, click Activate Layout Tool from the main menu. (If this feature isnot on the main menu, add it using the Layout Editor.)
As is standard, thumbnails of each series are arrayed across the top of the dialog,beneath the toolbar. (If more than one study is loaded, each has its own row ofthumbnails.) In Advanced PET-CT, two placeholders for the source series appear in asidebar to the left of the main canvas.
2. Click Actual H/W to display a list of monitor choices. Select the number of monitors tobe used in this protocol. (Select the Actual H/W item to use the current configuration.)The canvas updates to reflect the selection; e.g., if you select "2 monitors," thentwo canvases are shown.
3. Using the following descriptions, click the toolbar buttons to draw the desired numberand arrangement of placeholders (cells) in each canvas. Each placeholder representsa window position.
● Draw Rows and Columns – Click Draw Cells and then right-click in the canvas.Drag to arrange the desired rows and columns and then release or click the leftbutton.
● Draw Cells Manually – Click Draw Cells and then click and drag the cursoranywhere to draw one straight line. A blue dotted line indicates where the line willsnap straight and extend itself to the border of the closest neighboring line.
● Move Lines – Click Edit Cells. Hover the mouse over the line until the cursorchanges to a double-headed arrow; click and drag the line to a new location.
● Erase Cells – Click Erase Cells and then click and drag over the area to erase.The cursor will shape a blue dotted rectangle. Any lines that intersect thisrectangle are highlighted in blue and erased upon release or left-click.
To define attributes for a placeholder
After drawing the cells, you define attributes for each. Attributes are the criteria that animage must meet before it can be displayed in that particular window position. Onlyimages that have the defined attributes will populate that placeholder.
The system supports the placement of specialized views, such as global stack, Navigatorand key images, as well as Cine for a selected cell. Each is explained in the followingsteps.
1. After drawing the cells, double-click inside a cell to define which view will display inthat position. A floating menu displays the following items:
● Primary — The current study displays in this position. If this standard view isselected, the user must further define criteria for that cell via a dialog box, asexplained in the Comparison Protocols section.
● Comparison 1— Studies anatomically related to the selected study are displayedin this position. If this standard view is selected, the user must further definecriteria for that cell via a dialog box, which is explained in the ComparisonProtocols section.
● Comparison 2 — If three studies will be compared, the oldest of the three(sometimes called the baseline) will be shown in this position. If this standardview is selected, the user must further define criteria for that cell via a dialog box,which is explained in the Comparison Protocols section.
● Global Stack— If this specialized view is selected, this position will be reservedto show all series of the selected study as a single physical series; the usercan scroll through in sequence, with no interruption between series. No furtherdefinition is required.
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● Navigator — If this specialized view is selected, the Navigator will be shown inthis position. No further definition is required.
● Key Images — If this specialized view is selected, key Images will be shown inthis position. No further definition is required.
● Overview— If selected, series in the primary study that have not yet been viewedare shown in this position.
● Planes— The final section of the list shows each available plane: two CT planes,two PET planes and three fused planes, as well as Rotating MIP (all planessimultaneous in a rotating, three-dimensional view).
Note: It is useful to Cine a Rotating MIP image; you can add Cine to aplaceholder.
2. Select the appropriate item for that cell. The canvas updates to reflect the selectedattributes, or a dialog displays. See Comparison Protocols, to learn how to entervalues into the dialog box.
3. Repeat this task from the beginning for each cell until all are defined. To delete anattribute from a cell, right-click and select Delete.
4. From the thumbnail strip at the top of the Layout Tool dialog, click and drag the desiredsource CT image into the Source CT placeholder in the sidebar. The source mustbe an axial CT image.
5. Likewise, click and drag the source PET image into the Source PET placeholder inthe sidebar. The source must be an axial PET image.
Note: The reconstruction will not execute unless proper source images areselected. A coronal orientation or another modality, for example, willnot cause the reconstruction to fail. The mouse pointer changes to aprohibition shape if the selected image does not qualify as a source image.
6. To control which images are used for reconstruction in comparison mode, you definecriteria for the source images. This is explained in the Comparison Protocol section,and also described here.
When you set Comparison 1 as an attribute in one of the canvas placeholders,only those comparisons that match the attributes of the source series are used toreconstruct in that placeholder.
For example, if "attenuation corrected" is set as an attribute on the source, then onlyattenuation corrected comparisons will be pulled and used to execute a reconstructionin a Comparison 1 placeholder. Thus, the comparison correlates appropriately.
Note: Reconstruction in a Comparison 1 placeholder will fail if no comparisonsmatch the source criteria.
To set attributes for a source series, right-click a source placeholder in the left sidebarof the dialog and click the Hanging Features item. The Hanging Criteria dialog isdisplayed.
To fill in all primary attributes from the source, click Get Values from Sequence. Todefine specific attributes, right-click a row to edit the value and then select the checkbox on the left to include that attribute as a criteria. In the above example, attenuationcorrected is set as a hanging criterion; only attenuation corrected comparisons will bepulled and used to reconstruct in the Comparison 1 placeholders.
Click OK to use the defined values as matching criteria for comparison studies, orclick the Cancel button to exit the dialog without saving.
7. Further narrow the use of this protocol by defining parameters in the lower pane.
● Under Supported Modalities, specify the modality that each type of study mustmatch in order for the protocol to be used. For example, if CT-PET is selected forPrimary and MR is selected for Comparison 1, the protocol becomes availableonly when those conditions are met. The Comparison 1 and Comparison 2
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fields become active only in comparison mode -- when two (for Comparison 1) ormore (for Comparison 2) studies are present as the hanging protocol is defined.If all three fields are defined, the protocol is applied only when conditions for allthree are met (i.e., at least three studies are open and their modalities matchthe definition).
● Under Default Mouse Mode, select the default action of the left mouse buttonwhen this protocol is used.
8. Click Apply to create the new view based on the defined settings. The systemimmediately updates and adds the reconstruction as a new series to the study.
To Set a Default Active Window
You can define any location to be the active window by default when the study is opened.
1. In the Layout Tool, double-click the placeholder (cell) that will be the active windowby default.
2. From the Criteria dialog, click Properties.3. Click the Activate this Placeholder check box to make this window the active window
upon opening the study.
4. Click OK.
To Define the Protocol Sequence
The down arrow next to the hanging protocol button displays a list of available protocolsfor the selected layout. (Only the protocols that correspond to the selected layout aredisplayed.) As explained in the Hanging Options section, you can jump to the next orprevious protocol in the list. To define the sequence of the protocols, follow these steps:
1. Open the Layout Editor.
2. Click the Hanging Protocols tab. The pane on the right displays all available protocols.The pane on the left shows the display sequence.
Note: The number of protocols in the right pane reflects the selected optionbutton (Private, Group or Common).
3. To add a protocol to the sequence, select it in the right pane and click the Movearrow button.
4. To rearrange the sequence, click the item to move in the left pane and use the up ordown arrows to reorder it.
Consider that the first applicable protocol in the list will be applied automatically."Applicable" means that the number of exams and the modalities match the protocoldefinition. Thus, a logical grouping of protocols is recommended, such as single examprotocols first, followed by those protocols defined for dual-exam comparisons, andthen the protocols that compare three exams.
To Define a Comparison Protocol
See the Advanced PET-CT Concepts section for information on comparing studies inAdvanced PET-CT.
The system can compare two or three studies, synchronize across compared studies andcan automatically fetch and load anatomically-related comparison studies. The AdvancedPET-CT toolset takes full advantage of these powerful features, to create side-by-sidereconstructions that aid diagnosis.
One protocol can define up to three studies at the same time: a primary and twocomparison studies.
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In the Advanced PET-CT toolset, you create a specific scenario in which a protocol isapplied to any one or all of these study types. For example, the system may be set toload both the primary and comparison studies automatically. In that case, you couldbuild a protocol that is applied only when the primary study is a CT and the comparisonstudy is an MR.
To define source criteria for comparisons
In comparison mode, the clinician views the similarities and differences betweena comparison study (or studies) and a later study. Centricity can reconstruct fromcomparison and primary studies, and the user must define which images to use as asource for reconstruction.
Because the sources should correlate for to be useful, any comparison study must matchcriteria set on the source series. For example, if "attenuation corrected" is set as anattribute on the source, then only attenuation corrected priors will be pulled and used toexecute a reconstruction in a "prior series" placeholder.
This section explains how to set criteria in the source series. Again, only priors that matchthese criteria will be used to reconstruct a new series. The reconstruction will fail if nopriors match the source criteria.
1. To set attributes for a source series, right-click a source placeholder in the left sidebarof the dialog and click Hanging Features.
2. To fill in all primary attributes from the source, click Get Values from Sequence. Todefine specific attributes, right-click a row to edit the value and then check the boxon the left to include that attribute as a criteria. In the above example, attenuationcorrected is set as a hanging criterion; only attenuation corrected priors will be pulledand used to reconstruct in the "prior series" placeholders.
3. Click OK to use the defined values as matching criteria for prior studies.
To define comparison properties in placeholders
1. In the Layout Tool, double-click a placeholder to define a cell's attributes. Attributesare the criteria that an image must meet before it can be displayed in that particularwindow position. Only images that have the defined attributes will populate thatplaceholder. (See the Create Hanging Protocols section above, to learn how to setplaceholders and define attributes.)
If a comparison type is selected — Primary or Comparison — then the Criteria dialogimmediately displays. The Criteria dialog requests more information about exactlywhat images should display in this position. (Click the Get Values from Sequencebutton to refresh the criteria list with the attributes of the selected series.)
2. Select the check box next to each attribute to include as criteria for this cell. (Youchange the value of a criterion in the next step.)
● Orientation -- The spatial orientation of images (axial, sagittal, coronal, oblique).
● Modality -- CT, MR, etc.
● Description -- Free text that can be matched against a series ID, which canbe found in Image Info.
● Contrast Flag -- Indicates if a contrast agent was used before scanning.
● Pixel Data (image type 1) -- Indicates whether the images are original (receiveddirectly from the scanner), derived (processed after receiving from scanner) ormixed; this value is strictly defined by the DICOM standard.
● Patient Examination (image type 2) -- Primary (corresponds to original images)or secondary (corresponds to derived images).
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● Modality Specific (image type 3) -- Any labels specific to the modality, such aslocalizer or axial in a CT image.
● Implementation Specific (image type 4) -- Flags specific to a modality andscanner manufacturer.
● Study Category – This information should already be selected and populatedproperly (primary or comparison).
● Reconstruction view – Indicates the plane of the rendered image.
3. To change the value of a criterion, right-click it. Either a floating list or a text boxwill display, as appropriate, for you to select or enter a new value for that attribute.Only images with values that match all criteria set in this dialog will be displayedin the selected position.
4. Click OK to accept the criteria entries.
5. In the Supported Modalities section at the lower left the Layout Tool, specify themodality that each type of study must match in order for the protocol to be used.
If CT is selected for Primary, for example, then this protocol is applied only if thatcondition is met (i.e., the primary study is a CT). The comparison fields become activeonly when two or more studies are present as the hanging protocol is defined.
Note: As with single exam protocols, only those protocols that are applicable —those with the same number of exams and the same modalities as theprotocol definition — are displayed for selection in a layout.
8.5.8.2 To Change Hanging Options
You can create any number of hanging protocols; however, only those that are applicable— that is, only those included in the layout — are available for selection. (A layout caninclude protocols for hanging a single exam as well as protocols for hanging comparisonstudies. Again, only the applicable protocols — those that match the number of studiesselected for display — are made available.)
When studies are selected in the Patient Folder for display, the system applies the firsthanging protocol from the list of available protocols. For example, if three studies areselected for comparison, the system automatically applies the first protocol defined in thelayout. The Configuring Advanced PET-CT section explains how to define the protocolsequence.
Change a hanging protocol in one of three ways:
● Click the down arrow next to the hanging protocol button to display the availableprotocols. The current protocol is checked; to change it, click a new item in the list
or
● Click the hanging protocol button to jump to the next protocol in the list.
or
● Set up a keyboard shortcut to jump to the next/previous protocol with a simplekeystroke.
8.5.8.3 Comparisons
Original and derived series from up to three different PET-CT, PET and/or CT studies canbe used in a hanging protocol. These are defined as follows:
● Primary — the study to which other studies are compared
● Comparison — other studies opened for review (these studies may be more recentthan the primary study)
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Comparisons, to be useful, must be side-by-side. In other words, all studies in thecomparison render lateral, fused or MIP series from a similar source axial series. Forexample, all lateral PET views are derived from attenuation-corrected axial series. Or alllateral CT views are derived from axial series labeled as "Lung Filter." Fused views arebuilt from the underlay and PET overlay derived from axial series.
If a study to be compared doesn't have an axial series with the necessary criteria, then therespective views are not rendered.
To hang multiple studies in compare mode, select up to three studies in the Patient Folderand click the Display button. The system uses the hanging protocol with a definition thatmost closely matches those studies. For example, the defined protocol hangs threestudies, each of a specified modality; if the selected studies match that definition, thenthe studies will be loaded using that hanging protocol. All original and derived views arehung as defined in the protocol.
Note If the selected studies match more than one protocol, then the first protocol isapplied and the others are made available for selection. Only those protocolsthat correspond to the selected studies are made available.
See Re-render or change the protocol to change the current protocol, and see HangingProtocol Sequence to learn how to sequence the protocols. Comparison Protocol forPET-CT explains how to configure a hanging protocol for comparison studies.
8.5.9 Saving and Reporting in Advanced PET-CT
8.5.9.1 Hanging Protocols
The standard save tools are used to save a hanging protocol. Use Save or Save As andselect the level of visibility — Private, Group or Common.
8.5.9.2 Key Images
Rendered PET-CT images can be saved as key images. Any derived image, includingMIP or fused views, can be added to the key images page. Measurements applied to theimage are replicated on the key image page when the image is loaded. The user can alsouse PET-CT measurements and labeling on a key image page.
3D anchors and their associated measurements can be preserved on a key image page.
8.5.9.3 Snapshot
The system provides a snapshot tool that captures all aspects of the current display. Thesnapshot is an exact representation of what appears on all monitors and can be saved asa file to email or share.
Note The snapshot does not capture the Navigator or the 3D AdvancedApplications.
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8.5.9.4 Presentation State
All the advantages of the presentation state feature apply to PET-CT views. When theuser saves a presentation state in PET-CT mode, all aspects of that protocol are displayedagain when the presentation state is displayed. Anchors, labels, measurements andimage positions are all replicated when that presentation state is selected.
8.5.9.5 CD Film
The system supports the use of CD Film with the Advanced PET-CT module. When aPET-CT study is burned into auto-playing CD Film, only the source axial series is burnedto the CD. All specialized hanging protocols are also added, however, and all derivedviews required by a hanging protocol are rendered on-the-fly. This occurs even if theworkstation used to play the CD Film does not have the Advanced PET-CT license.
8.5.10 Standard Uptake Value (SUV) and PET or PET-CT
8.5.10.1 To calculate SUV
Prerequisite: This feature applies only for PET series in which the uptake is recordedin BQML.
This feature calculates SUV based on the following formulae:
● Standard uptake (BQML)
● Body Weight (g/ml)
● Body Surface Area (cm2/ml)
● Lean Body Mass (g/ml*)
To select a formula, click on the SUV bar (indicated by white arrow, below) and selectthe appropriate formula.
ExpectedResult:The formula change applies to all the PET and CT-PET series in allstudies loaded in the viewer.
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8.5.10.2 Default SUV Unit Preferences
You can set the default SUV units for PET-CT studies by opening the User Preferencesdialog and clicking Miscellaneous. Once set, click OK or Apply to save your change.
Available units and the DICOM tags required for calculating SUV in those units.
Units Description DICOM tags required
kBq/ml Kilobecquerels per milliliter None1
g/ml Grams of body weight permilliliter
Study Patient Weight (0010,1030)
cm2/ml Square centimeters permilliliter
Study Patient Weight (0010,1030)Study Patient Height ( 0010,1020)
g/ml* Grams of lean body massper milliliter
Study Patient Weight (0010,1030)Study Patient Height ( 0010,1020)Study Patient Sex (0010, 0040)
● Set default SUV Units To set the default SUV units, check this option and thenchoose the unit type you want. Once selected, the images displaying SUV in thecurrently open viewports will change to reflect that new default unit type. When youopen a PET-CT study which supports the selected units, the SUV will display in thoseunits. If Set default SUV Units is unchecked the units default to kBq/ml.If the proper DICOM tags are not included in the current study, the correspondingdefault will not be available for selection. The default will, however, remain unchangedunless you explicitly select a different default unit type.
Example:
1) On a PET-CT study that supports all SUV units, the user selects cm2/ml as thepreferred default unit type.
2) The user saves the setting and closes the viewer.
3) The user launches the viewer with another PET-CT study which doesn’t support anySUV units other than kBq/ml.
● The viewer shows SUV values in kBq/ml units.
1. SUV, regardless of default units, only applies to PET series in which the uptake is recorded in BQML.
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● The Set default SUV Units option is unchecked and disabled.● The default choice in the disabled control still shows as cm2/ml.
4) The user launches another study which supports KBq/ml and g/ml, but not the othertwo possible choices.
● The viewer shows SUV values in kBq/ml units.● The Set default SUV Units option is enabled and checked.● The kBq/ml and g/ml choices on the User Preferences dialog are enabled, but
thecm2/ml and g/ml* choices are disabled.● Even though cm2/ml is disabled, the User Preferences dialog shows it as
selected.
5) The user then launches another study which supports kBq/ml, g/ml, and cm2/ml.
● The viewer shows SUV values in cm2/ml.● The Set default SUV Units option is enabled and checked.● The three supported units are enabled and cm2/ml is selected.
8.5.10.3 Finding the Maximum SUV
To help identify a tumor hot spot across all correlated PET and CT images in a fusedPET-CT study, you can have the system locate the maximum SUV within the images.
To find the maximum SUV within a region of interest:1. Right-click on the SUV measurement.
2. Select Go to max SUV.
ExpectedResult:The system places a 3D anchor on corresponding PT, CT and fusedPT-CT series where the calculated SUV value is maximum. All correlated views thenshift to that location.
8.5.10.4 To calculate ROI or VOI measurements on PET and PET-CT series
To create a PET or PET-CT series measurement, do the following:
Click SUV, then click on the region where the measurement should be applied.
ExpectedResult:The measurement displays on the selected region, and values arerepresented in the chosen SUV calculation.
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8.5.10.5 To Create a Preset for a PET Series
Prerequisite: This feature applies only for PET series in which the uptake is recordedin BQML.
To create a preset for a PET series, do the following:
1. Right click on the viewport that displays a series.
2. From the menu, select W/L Editor.
3. On the W/L Settings Editor, select the PT radio button.
4. UnderW/L Settings Name, select the desired formula for the preset. Then, click New.5. Enter the name of the new preset. Then, select the appropriate Used By radio button.6. Set the SUV Min and Max value for the preset.7. To save, click OK.
ExpectedResult:The new PET series preset is created.
8.5.10.6 To Apply a PET Preset
Prerequisite: This feature applies only for PET series in which the uptake is recordedin BQML.
1. Right-click on the value at the top of the fusion bar (indicated by the white arrow,below).
2. Select the appropriate preset.
ExpectedResult:The preset applies to the series with the configured Min/Max value andSUV calculation formula.
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Note: In Comparison mode, if the user changes SUV unit for any of the studiesbeing compared, then the same SUV unit is applied for all studies. However,if any of the comparison studies do not support the changed SUV unit, thenthe SUV unit of that study is not changed.
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9.1 Configuring the SystemYou can tailor the system to suit your preferences and working style. Depending on yourprivileges, you can apply changes to affect the whole system or only your personalsettings.
You configure the system in the Layout Editor. A layout is a full set of feature and displayinstructions that you define. You name the layout and apply it, manually or automatically,to a study.
For example, you could define a layout and call it "Brain-CT-2-SingleC." You direct thatlayout to be applied to all brain CTs with two series that will be displayed on a singlecolor monitor. Every time the system recognizes that a brain CT will be shown on thathardware setup, it applies the layout.
Note A layout naming convention is strongly recommended. A name with theStudy Type-Modality-Number of Series-Monitor Setup, is clear and easy toremember. Consistency helps you manage layouts.
Because a layout is associated with a certain kind of study, the Layout Editor is accessiblewhen a study is displayed in the viewer. To create or modify a layout, you base it on thelayout currently loaded.
9.1.1 Referring Physician Users
Important The system supports different categories of users, providing each withthe full range of tools necessary for optimum performance. Yet, there is asignificant distinction between Referring Physician users and other usercategories. When viewing a complete study, Referring Physician userssee common (system-level) layouts defined for a particular type of study.They can use all the tools of the system, but they cannot personalizesystem behavior in any way. This includes creating, modifying or usingpersonal- and group-level layouts and layout components.
● layouts and layout components● annotation templates● print templates and lexiconsIn addition, the Done button options will not execute for the ReferringPhysician even when configured in the layout. Personal- and group-levellayouts, templates and lexicon are not applicable to Referring Physicianusers.
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9.2 Working with the Layout EditorFirst, select and open a study in the viewer. Access the Layout Editor by clicking [EDIT].
Note Referring Physician users cannot invoke the Layout Editor.
9.2.1 To Create or Edit a Layout
New layouts are always monitor agnostic (the same setup will be used regardless of thephysical monitor arrangement). If a monitor-agnostic setup exists, it loads as the defaultlayout for any monitor configuration. For these layouts, the Layout Editor displays theNumber of Monitors & Screen resolution as “N/A” in the Main tab.
1. From the Layout menu, click Edit.
The Layout Editor dialog is displayed, featuring display settings that you can applyto your layout. Full details on configuring the general settings, shortcuts, W/Lsettings, menus, and toolbars are provided in the following sections. You will also findinformation on configuring the key images template and menu.
2. Choose an icon from the sidebar and make the desired selections in the dialog.
3. At the prompt, enter a name for the layout and designate it as Personal, Group,or Common.
4. Click Save, Save As, or Apply.
● Click Save to save the changes to the layout.● Click Save As to save the new layout (the previous layout remains with its original
settings).
● Click Apply to preview the new layout settings on the current study withoutsaving the layout.
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5. If you selected Save As, you are asked to select whether to save as monitor agnosticor monitor dependent.
● Click Yes to save as monitor agnostic.● Click No to save in the current format (monitor agnostic or monitor dependent).
9.2.2 To Load a Layout
1. From the Layout menu, select List.
The Layout List is displayed to show layouts created in the system. Notice that variouslayouts have been defined for different kinds of studies (abdomen, brain, spine, etc.)and that those layouts are listed in alphabetical order.
By default, the dialog opens to show personal layouts. You can narrow this list byselecting one of the filters to the right of the list:
● Personal: Layouts that you created.● Group: Layouts created by you and other users in your group (as set up by the
system administrator).
● Common: All layouts created in the system that are available to you.
● All: Layouts common to all users.2. Click a filter option.
3. Select the check box for All Screen Sizes to display layouts that do not match yourmonitor settings. For example, if you are using one monitor with a 1280x990 screenresolution, normally only the layouts that fit that resolution are displayed. If you selectthe check box, however, the layouts with different resolutions and multiple monitorswill also display. The list updates if you enable this filter.
4. Highlight the layout to load, and click Apply.
9.2.3 To Reload a Layout
If you made temporary changes to a study's display, such as copying several series, youmay want to reload the original layout rather than manually undo all your changes. Thisfeature reloads the study's default layout. Use Reload to update the study with features,functions and display settings defined in the original layout.
� From the Layout menu, select Reload.
9.2.4 General Settings
The General Settings in the Layout Editor include the toolbar position, the overlay font,the Navigator startup, and other features.
9.2.4.1 To Define the General Settings
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the Image Viewer menu.
3. Select Edit. The Layout Editor dialog is displayed.4. Use the explanations below to make selections or enter data:
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Note: The Layout Name is the first field at the top of the dialog. This field showsthe name of the current layout and cannot be edited.
● Global Cine Toolbar – With a system configured for cardiology workflow,selections available are Always, Never, Automatic:
● Auto: When saved in Auto mode, Global Cine Toolbar is available on loadonly for US, XA and NM studies.
● Always: When saved in Always mode, Global Cine Toolbar is available forall modalities.
● Never: When saved in Never mode, Global Cine Toolbar is not available forany of the modalities.
● Load By – Select whether to load the images by the DICOM-assigned seriesnumber, the series description or sequentially.
● Film View Format – Enable the check box to open the study in Film View. Whenthat box is enabled, the Auto and Manual option buttons become activated. Ifyou select Manual, the format fields become active; enter the number of rowsand columns to display on one "sheet." Select Auto to automatically display themaximum number of images that will fit on your monitor.
● Toolbar Position – Select the edge of the computer screen on which to displaythe toolbar.
● Open Navigator – Select the default start up state for the Navigator. ClickAlways Open to open the Navigator every time a study is loaded. Select Openwhen Series Do Not Match to open the Navigator when the number of seriesin the loaded study does not match the number of series defined in this layout.(To load a study, the system uses the layout with definitions that match the study.When no layout is a direct match, it uses the closest match. This option opensNavigator to let the user see all the series as thumbnails, though only some ofthose series may be displayed in full windows. See Layout Editor.
● Graphics and Font – Enter the number of pixels to use when drawing lines withthe Measurements tool, and enter the font and size to use for Image Overlay. Toselect a different font or font size, click the Change button on the right to displayavailable choices.
● Matching Strings – A "string" is a word or succession of letters. Enter the stringyour institution typically uses to describe studies that will use this layout. Separateeach string using a comma or a space. For example, you could create a layout toapply to brain CTs with two series on a single color monitor. The technologistsand clinicians in this institution usually enter the terms "BR," "HD," "HEAD" and"SKULL" as the description for such a study. By entering all possible terms in theMatching Strings field, you tell the system to match this layout to studies withany one of those descriptors.
Note: You can – and should – include all possible descriptions for the selectedstudy type in this field, including commonly misspelled terms, such as"BRIAN," along with the appropriate spellings ("BRAIN").
● Default PP Template – From the General drop-down list, select the default printpreview template for key images. From the Snapshot drop-down list, select thedefault print preview template for one-click (snapshot) printing.
● Push SC to End With a system configured for cardiology workflow, the defaultvalue of this check-box is unchecked. When checked, the series in a study isarranged such that all the SC within a study are placed at the end. For instance,a study comprising a mixture of SC and other images will have thumbnailsdisplayed as: First: all the series not having SC then Second: followed by allthe series with SC.
5. Click Apply, Save or Save As.
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9.2.5 More Settings
This dialog is a continuation of the General Settings. Primarily it contains startup optionsfor certain system features.
9.2.5.1 To Define More (General) Settings
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the Image Viewer menu.
3. Select Edit. The Layout Editor dialog is displayed.4. Click More Settings.
● Global Stack – If this check box is selected, Global Stack is enabled on startup.Enter a cine rate.
● Slab Scroll – To apply Slab Scroll automatically to a study, select the checkbox and enter the number of images a study must have before the feature isautomatically applied. Select a default algorithm and slice thickness.
● Default W/L – Select a default W/L setting to apply to images. Pre-set definitions,which can include sharpening, can be selected from the drop-down list. Pre-setsare created in the Grayscale Window Editor.
● Inter-Series Scrolling – When selected, this setting allows scrolling through allimages of the study in sequence, from one series to another, without interruption.You do not have to click on a new series to begin scrolling through that "stack."See Paging/Scrolling.
● Navigator – If you select the Display Middle Image check box, when theNavigator first opens it displays the middle image of each series as the seriesthumbnail.
5. Click Apply, Save or Save As to exit.
9.2.6 Configuring Shortcuts
The system allows you to assign shortcuts to the operations that you use most frequently.This speeds up your work, reducing the need to open dialog boxes and menus to performthe same actions over and over. You can assign one key (such as F4) or a combinationof keystrokes (such as Ctrl+Shift+H). You have the flexibility to make the keyboard fityour associations.
The following shortcuts are pre-configured:
Action Keyboard Shortcutpage/scroll the Key Imagepage...
hold down the Control key while clicking the mouse orthe arrow keys
zoom when in Page/Scrollmode...
Middle mouse key/roller
pan when in Zoom mode... Middle mouse key/roller
zoom when in Pan mode... Middle mouse key/roller
open presets when in W/Lmode...
Middle mouse key/roller
get 1.00 zoom... Shift key
refresh the Study List... F5 key
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9.2.6.1 To Configure Shortcuts
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the Image Viewer menu.
3. Click Edit to display the Layout Editor dialog.4. Click the Shortcuts icon in the sidebar.
The right pane shows the shortcut modality sets that have already been created. Theleft pane shows the shortcut modality set currently in use.
5. Select the modality set in the left pane.
You must move a modality set to the left pane to edit it. Select the set and click theleft-pointing << move button.
6. Click Edit. All available shortcut actions display in the right pane, and actions currentlyincluded in the modality set are in the left pane.
7. From the right pane, select the action for which you want to establish a shortcut.
8. Click the left-pointing arrows (<<).9. If this shortcut will be a Global shortcut, select the Global shortcut checkbox.
Global shortcuts work even when the window is not in focus. For example, if a reportwindow has focus, clicking a global shortcut, such as Viewport Sync, toggles viewportsync on or off.
10. Insert the cursor into the text box at the lower left of the dialog. On your keyboard,press the key(s) that will serve as the shortcut for your selection.
11. Click Assign to assign that keyboard shortcut to the selected action.Example: Toggle Overlay is moved from the right pane to the left, and Ctrl + Shift+ T is pressed on the keyboard. After clicking Assign, that keyboard shortcut willappear next to Toggle Overlay in the left pane, and when the user strikes thosekeys, the Overlay will toggle on or off.
12. To save this shortcut to the current modality set, click Save. To create a new modalityset that includes all the actions in the left pane, click Save As.
If you select Save As, you will be prompted to name the new definition set.
13. To Apply the new or modified modality set, click Apply.14. Click Close.
9.2.6.2 Configurable Shortcut Keyboard Strokes
Shortcuts are optional. However, the following shortcuts are available for configuration tostreamline the users' workflow.
Table 13 Available Shortcuts
Action Suggested Keyboard Shortcut
go to first image/page Home
go to last image/page End
go to middle image/page Insert
fast page Page Up/Page Down
next page up arrow
previous page down arrow
fast backward Shift + left arrow or Shift + down arrow
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Action Suggested Keyboard Shortcut
fast forward Shift + right arrow or Shift + up arrow
next preset window spacebar
remove key image from page Delete
Patient Folder F1
Triangulation F2
Add series to print page F4
Add series to film preview F5
Burn CD F8
Sace QCPS F9
Update the study F11
Done F12 or D
Reset auto-windowing A
Cine c
Flip F
Magnifying Glass G
Next Hanging Protocol H
Insert Key Image I
Previous Hanging Protocol J
Quick Add Images K
Labels (annotations) L
Measurements M
Open Navigator N
Show Overlay (toggle) O
Page/Scroll P
Sync on/off Q
Recommended W/L R
Sharpen S
Invert V
W/L Mode W
Exit X
Zoom mode Z
Rotate 0 (zero)
Set zoom to 1 1
Set zoom to 1.5 5
Set zoom to 2 2
Set zoom to 2.5 Ctrl + 2
Set zoom to 3 3
Set zoom to 3.5 Ctrl + 3
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Action Suggested Keyboard Shortcut
Set zoom to 4 4
Undo the zoom 6
Mirror 9
Next bookmark Ctrl + B
Global Stack Ctrl + G
GUI editor Ctrl + Alt + G
Display HTTP statistics Alt + H
Open Key Image Preview Ctrl + K
Layout editor Ctrl + Alt + L
Show DICOM Overlay Ctrl + O
Activate key image template editor Ctrl + Alt + P
Select Ctrl + S
Scroll Options Ctrl + Alt + S
W/L editor Ctrl + Alt + W
Zoom to ROI Ctrl + Z
9.2.6.3 Additional Shortcuts to Configure
Angle measurementApply hanging protocolArrow labelBenchmarksCalculate SUVCine toolbar — next pageCine toolbar — previous pageCircle ROICopy seriesCopy to ClipboardCross-referenceDone auto-fetchDICOM printDICOM sendDictateDisplay cross-reference for print previewExternal ViewerFusionFOV syncHide DICOM overlayImage infoPatient infoLoad by location
Open xxx module (all RIS-IC modules)OverlayPanPoint ROIPrevious 3D anchorPT/CT default layoutRefresh the studyReport problemReport show/hideSave image to fileSave to CD recorderSelect all images on print pageSet base seriesSet overlay seriesSlab scrollRequest full quality for imageRequest full quality for seriesRequest full quality for studyReset performance countersRIS xxx (all RIS-IW modules)Select all images in active seriesSend print preview by emailSend print preview to printer
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MPRNew 3D anchorNext 3D anchorNext auto-fetchOB measurementOpen in MedImageOpen in Trauma-CadOpen new studyOpen next studyOpen previous study
SnapshotSynchronizeText labelToggle comparison viewToggle single series viewTrace performance countersUpload seriesViewport sync on/offWindow editorW/L sync
Cycle page format (go to the nextpre-defined page format, e.g., 1x1,1x2,...6x6, back to 1x1, etc.)Cycle zoom (go to the next pre-definedzoom factor, e.g.,1, 1.5,... 4, back to 1, etc.Zoom factors not accommodated by thewindow size are skipped.)Cycle true size (go to the next pre-definedtrue-size factor, e.g., 0.9, 1, 1.1, 1.2,... backto 0.9, etc.)
Cycle image overlaysSwitch patient folder scheme (darkbackground for patient folder, primarilyfor reading mammography studies)
9.3 W/L ConfigurationWhen you window a study in the viewer, you can use pre-set definitions that applyspecifically to the anatomy examined in the study. For example, in sinus exams, you canapply the optimal contrast and brightness to show the sinus tissue or the optimal contrastand brightness for the bone. These pre-set definitions are displayed as menu choiceswhen you right-click over a series to open the floating menu. You can also toggle betweenpre-set definitions by pressing the spacebar.
Under the W/L icon of the Layout Editor, you create the pre-set definitions. You canassign various definitions to match the anatomy featured in your layout, and you canadjust the exact W/L parameters for the optimal display, including a Collective option forall modalities.Note With a system configured for cardiology workflow, the Collective option is
the default for US/XA/NM images.You can also establish the order in which the pre-set definitions are listed in the menu, andtherefore the order in which they will toggle.
Note You can adjust or create pre-set W/L settings directly from the viewer;right-click and select W/L Editor.
Note Referring Physician users cannot invoke this component.
9.3.1 To Configure W/L Settings
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the viewer menu.
3. Select Edit. The Layout Editor dialog is displayed.
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4. Click the W/L Settings icon in the sidebar.
In the W/L Settings dialog, the right pane shows all available preset W/L definitions.The left pane shows the preset definitions currently in use.
Note: See Grayscale Window Editor to create a preset definition.
5. From the right pane, select the item you want to make available as a preset definition.
6. Click the left-pointing arrows (<<). To move all the items into the left pane, click <<All.7. The items in the left pane will appear as preset definitions in the W/L menu of the
viewer, and they will toggle in the listed order when you use the spacebar in W/Lmode. To re-arrange the order, select an item and click Up or Down.
8. To adjust the actual W/L parameters for an item, select it in the left pane and clickEdit. The W/L Settings Editor is displayed.
9. Select the parameter to change (Window or Level), and enter a new value in theparameter field. Click Save.
10. When you have completed configuration, select an option:
● To save these W/L settings to the current definition set, click Save.● To create a new definition set with these modified settings, click Save As. Enter a
name for the new definition set.
● Click Apply to use these new settings in the current session without savingthem to a layout.
9.3.2 To Change the User Preferences for W/L Sensitivity
1. Do one of the following:
● Right-click in the Navigator and select Navigator OptionsOR
● Right-click on the image number in any viewport and select Scroll Options >User Preferences
Expected Result: The User Preferences dialog opens.
2. Click the W/L tab.
3. For each modality selected in the drop-down list, you can either enable or disable theProportional W/L Algorithm for W/L sensitivity.
4. When the Proportional W/L Algorithm for W/L sensitivity is enabled for a modality, theslider for sensitivity for that modality is enabled.
5. For each modality selected that is enabled for W/L sensitivity, you can set a separateW/L sensitivity for that modality.
6. To apply the W/L sensitivity to your current session and for use in your future sessions,click Apply or OK.
9.4 Configuring Image OverlayInformation about each image is attached to that image and called the Image Overlay.All Image Overlay data is DICOM data, transported with the study when the image iscaptured. You can view or hide this data in the image window.
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When Image Overlay is displayed, the data appears in default locations -- the series ID inthe lower right corner, the image number in the upper left corner, etc. You can changewhat data is shown, and where it is shown, by configuring the Image Overlay.
You can define multiple overlay templates for each modality and then use the ImageOverlay button to jump, with one click, to the next template. See Jumping Templates.
Note Referring Physician users cannot invoke this component.
9.4.1 To configure an Image Overlay template
1. Right-click to display a floating menu and select Manage Image Overlay Template.(You can add this feature to the main menu. See Main Menu Configuration.)
2. The list defaults to show only those templates that correspond to the current modality,which is named in the title bar. To show the templates for all modalities, enable theShow All Modalities check box.
3. Select the template you wish to manage. You can select multiple entries.
4. Select from the command buttons:
● Delete – Delete the selected template(s).
● Edit – Edit the selected template. (Select one template at a time.)
● New – Create a new template, based on the selection.
● Copy – Create a copy of the selected template.
● Rename – Rename the selected template.5. If you select New or Edit, the Edit Template dialog displays. Data to include in the
overlay are shown in the left pane. The properties for the selected data are definedin the middle pane. Command buttons are to the right.
Note: To skip steps 1-4 to directly open this dialog for the current template;select Edit Image Overlay Template from the floating menu.
In tandem with this dialog box, a sample image overlay template is displayed. As youenter commands in the edit template dialog, this sample image overlay templateupdates to show those changes. Enter and move items in the sample template, whichis divided by a grid into nine sections.
6. To make changes to the template, first click a field, surrounded by brackets, in thesample template. Any field will do; once selected, the field is bordered in green.
7. In the dialog box, double-click an item that to include in the overlay, such as MRN orPatient Name. That data will immediately appear in the sample template.
8. Change the location of the new data by using the direction buttons in the lower rightof the dialog box.
9. Define the features in the middle pane to establish properties of the data selectedin the sample template.
● Font – Font attributes.
● Color – Font color.
● Background – Background color for the data.
● Transparent Background – No background color to allow the image to be seenbehind the data.
● Length – Choose whether to limit the length of the data cell from the drop-downmenu.
● Transparency – Enter a value for the transparency of the background.
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● Hot Tracking – Check this box to enable the field to light up when the cursorhovers over it.
● Show in Small Window – Enable this check box to show the selected data evenwhen the active window shrinks. Normally, the image overlay data disappearswhen the window becomes too small to fit the data. This feature overrides thatdefault. Click Small Window to see a sample.
10. Repeat steps 6-9 for every data field you wish to add to the template. To delete adata field, select it and click Delete. Click Load Defaults to erase your changesand begin again.
11. Click Save or Close & Save.
9.5 Configuring Hanging ProtocolsUsers can create different hanging protocols for each modality and switch to the nextor previous protocol with one click. Hanging protocols can be defined to address userpreferences or variations in the scanning sequence. If the scanning operation does notsequence exactly to a defined layout, the presentation can instead be based on seriesattributes defined by the user.
The Hanging Protocol feature provides more granular control of study loading than theLoad By setting. The user can choose from several parameters, such as orientation orMR parameters (TE, TR, IR, dual echo), to define how and where the image hangs. Youcan create and edit a hanging protocol, define specific attributes for each series position,pre-define W/L for each series in the protocol, use specialized placeholders and attach aprotocol to a layout.
Note You can also define the protocol with the Layout Tool.
Consider these factors before defining a Hanging Protocol:
● A layout selection is always based on the characteristics of the primary study, i.e., thestudy that opens the viewer. If more than one study is selected in the Study List andopened for comparison, then the layout selection is based on the study characteristics(modality, number of series, keywords in study description) or on the most recent study.
● A layout can have more than one Hanging Protocol attached to it, so that differentHanging Protocols can be used to display the study by itself or to display it inconjunction with comparison studies.
● A Hanging Protocol can present up to three studies at the same time on the availablescreen space, without separating them into zones for each study.
You can create a toolbar button to jump from one hanging protocol to the next in oneclick. See Toolbar Configuration.
9.5.1 To Edit a Hanging Protocol
1. Open the number of studies to be part of the Hanging Protocol definition (one, two orthree studies). For example, to define a protocol for three studies, begin by openingthree studies.
2. Select Layout from the Image Viewer menu, and then select Edit.3. Click Hanging Protocols.
The Hanging Protocols configuration dialog is displayed. The right pane shows theprotocols that have already been created. Change the Filter settings at the bottom ofthe dialog to show additional protocols.
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4. To attach a protocol to the current layout, first move it to the left pane by selectingit and clicking <<.You can also edit the monitor setup for a hanging protocol. See To Create a MonitorSetup for a Hanging Protocol (page 323).
5. Select that protocol in the left pane and click Edit.
The Hanging Protocol dialog is displayed. Across the top is a thumbnail strip of thecurrent series (with multiple rows if more than one study is open). In the middle pane,below the thumbnail strip, is a canvas that includes a representation of each monitorin the current configuration. If window positions have been defined previously, Thebottom pane holds fields to define the protocol further.
6. Inside one of the monitor representations, right-click and drag to define a grid ofplaceholders. Placeholders position the series window; e.g., 2x2, 3x3, etc.
7. Use the Alignment toolbar buttons in this dialog to subdivide or erase certain lines orto arrange an irregular grid. See Layout Tool. The resulting arrangement shows howthe series windows will display.
8. In the Automatic Hanging section below the canvas, select which of the seriesattributes will be automatically assigned to a placeholder when a series from a study isdropped onto that placeholder. The attributes that can be assigned automatically areSequential Number of a series in a study, Modality, Orientation and Series Description;check the desired boxes. These are the broader definitions for a placeholder and areassigned automatically when the series is dropped.
Example: For example, if By Modality is checked, and you drag a MR series ontothe placeholder, then that placeholder will automatically display only MR studies inthat window position.
Note: You can associate more exact attributes for a specific placeholder. SeeEdit Placeholders.
9. Drag and drop thumbnails of series onto the desired placeholders in the canvas. Asyou drop a thumbnail, it appears in the placeholder, with values of the attributes youselected, which are taken from the actual series.
Note: When a hanging protocol includes a Navigator placeholder, the Navigatordisplays with the Study Selector and Timeline collapsed.
10. To create a copy of the series, drag the same series onto more than one placeholder.To delete a series from a placeholder, right-click the placeholder and select Delete.
The Hanging Protocol can be applied to primary and comparison studies. The systemuses an algorithm to determine whether a particular hanging protocol can be madeavailable for the studies that are open. In other words, you can define a specificscenario in which a protocol becomes available. For example, if you open two studies,primary and comparison, in Compare mode, you can make a certain protocol availableonly when the primary study is a CT and the comparison study is an MR. In theSupported Modalities section of the bottom pane, you specify the modality that eachtype of study must match in order for the protocol to be used.
11. To specify the combination of studies to which the Hanging Protocol is applicable, usethe check boxes and drop-down lists in the Hanging Protocol Editor.
● Primary – Select one or more modalities from the list. The protocol is applied onlyif the primary study matches the selection(s).
● Comparison – Comparison is enabled only when two studies are open. Checkthe box to make the protocol applicable when two studies are open, then selectone or more modalities from the drop-down list. The protocol is applied only if thecomparison study matches the selection(s).
12. Under Default Mouse Mode, select the default action of the left mouse button when thisprotocol is used. For example, the first operation for some studies would be Paging(scrolling), and for others it could be an adjustment of the window width and level.
Note: You can view the effect of a hanging protocol. Click Apply.
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13. Click Save or Save As to save the Hanging Protocol on the server. Depending onyour privileges, the protocol may be saved on the Personal, Group or System level.
Note: Save the Hanging Protocol on the same level as the layout you plan toattach it to.
9.5.2 To Edit an Existing Hanging Protocol
1. Open one, two or three studies, whichever number corresponds to the number ofstudies in the Hanging Protocol to edit.
For example, to edit a protocol with three studies, begin by opening three studies.
2. From the Layout menu, select Layout Tool.3. Select Attached to layout or Load from server.4. Click Load.5. Use the Layout Tool features to re-define the settings for this protocol. All operations
are available as if creating the protocol for the first time, with the exception of draggingthumbnails and creating copies. If a placeholder definition must be re-defined, deleteit (right-click and select Delete) and then double-click the placeholder to begin anew.
9.5.3 Multi-resolution Monitor Setup
When setting up the monitors for a hanging protocol, you can create new configurations orrevise existing ones. The Hanging Protocol (HP) Tool displays a Hanging Protocol Editorcontaining a thumbnail strip of displayed series at the top and a canvas below.
Up to six monitors can be added to a hanging protocol (four high-resolution and two coloror low-resolution). On the canvas, rectangles represent the monitors. Click the iconsabove each rectangle to select setup options for that monitor.
When adding monitors to a new HP setup, the default configuration of the monitorschanges depending on the number of monitors added. For example, if you add threemonitors, the first is color/low resolution, the second is color/low resolution, and the thirdmonitor is grayscale/high resolution. You can change the configuration of individualmonitors at any time.
Note With a system configured for cardiology workflow, the Tomtec viewport willonly work on colored monitors.
Table 14 Default Monitor Configuration
# ofMoni-tors
Type/Resolution/Orienta-tion of Each Monitor
Graphic Depiction of Monitor Configuration
1 Color/Low/Landscape
2 Color/Low/LandscapeColor/Low/Landscape
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3 Color/Low/LandscapeGrayscale/Mid/PortraitGrayscale/Mid/Portrait
4 Grayscale/Mid/PortraitGrayscale/Mid/PortraitGrayscale/Mid/PortraitGrayscale/Mid/Portrait
5 Color/Low/LandscapeGrayscale/Mid/PortraitGrayscale/Mid/PortraitGrayscale/Mid/PortraitGrayscale/Mid/Portrait
6 Color/Low/LandscapeColor/Low/LandscapeGrayscale/High/PortraitGrayscale/High/PortraitGrayscale/High/PortraitGrayscale/High/Portrait
9.5.3.1 To Create a Monitor Setup for a Hanging Protocol
By default, the monitor setup opens using the current monitor configuration. Across the topof the Hanging Protocol window a thumbnail strip shows the current series (with multiplerows if more than one study is open). In the middle pane, below the thumbnail strip, isa canvas that includes a representation of each monitor in the current configuration. Ifwindow positions have been defined previously, the bottom pane holds fields to define theprotocol further. Monitors representations can also be left blank.
1. From the Image Viewer, click HP Tool from the main menu.If the HP Tool is not available on the main menu, use the Layout Editor to add it.
2. To create a new configuration, click the Actual H/W above the thumbnail strip orclick Clear Screen to delete the existing configuration and then click Add Monitorto start adding monitors.
3. Above each monitor representation, icons display so that you can quickly configurethe monitor.
Note: In Preferences, if you have your Open Patient's Folder set to Always,make sure you leave the low resolution monitor representation blank. SeeSetting General Display Options.
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Option DescriptionClick the Configuration icon to display the Monitor Settingwindow. Make selections as needed:
Option Description
Mon-itorType
Color, Grayscale or Any (either color or grayscale)
Reso-lution
Mammo (greater than 5 MP), Medical (between 2and 5 MP), Regular (less than 2 MP) or Any (anyresolution)
Orien-tation
Landscape, Portrait, or Any (either portrait orlandscape)
Click the X in the upper right corner to close the window.
Click the Delete icon to delete the monitor representation.
Click the Monitor Type icon to toggle between color and grayscale monitor types.
Click the Orientation icon to toggle between portrait andlandscape orientation.
4. Choose these options as needed:
Option DescriptionAdd a Grid Inside one of the monitor representations, right-click and drag to
define a grid of placeholders. Placeholders position the serieswindows; e.g., 2x2, 3x3, etc. To set exact attributes for aplaceholder, see Edit Placeholders.
Add Monitor Click the down arrow beside Add Monitor to add a monitorrepresentation to the screen. Then, select Regular Landscape,Medical Portrait, or Mammo Portrait. The size of the monitorrepresentations increases or decreases as you delete or addmonitor representations. This option is useful if you need aconfiguration other than the actual hardware.
Clear Screen Click Clear Screen above the series strip to delete all currentmonitor representations and display a blank screen.
Add Seriesto a MonitorRepresentation
Click a thumbnail and drag that series onto the monitorrepresentation.
SpecifyHangingFeatures
Right-click the series inside a monitor representation, selectHanging features, and specify the hanging criteria. Then, clickProperties, set the properties, and click OK twice.
AddSpecializedPlaceholders
Double-click in a monitor representation to specify attributes asneeded. See To Define Specialized Placeholders.
5. Repeat from step 3 until you have entered details for each monitor representation.
6. Enter a name for the layout.
7. Select who can use the layout: only you (Personal), your group (Group), or everyone(Common). Only authorized users can create common layouts.
8. Click OK to save.
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9.5.4 To Edit Hanging Attributes for a Placeholder
You can apply standard attributes to a placeholder or define the attribute matching morenarrowly.
1. Double-click in a placeholder in the canvas, or right-click and select Hanging Features.If the placeholder is not specialized, the criteria list is displayed with values.
2. Select an attribute and right-click to specify additional information. A floating list or atext box displays, as appropriate. Select or enter a new value for that attribute. Onlyattributes that match the selected criteria will be displayed in this placeholder.
Note: You can click the Get Values from Sequence button to refresh the criterialist with the original attributes of the current series.
Attribute Description
Apply PresentationParameters
Select Active-Image or Per-Series.
Attenuation Corrected Select Yes or No.
Description Free text that can be matched against a series ID, whichcan be found in Image Info. Specify one or more words.A series will be selected if it matches all words.
Dual echo Defines whether or not the image was acquired with adual echo protocol.
Image type 1 Indicates whether pixel data characteristics of the imagesare original (received directly from the scanner), derived(processed after receiving from scanner) or mixed. Thisvalue is strictly defined by the DICOM standard.
Image type 2 Indicates whether patient examination characteristics areprimary (correspond to original images) or secondary(correspond to derived images).
Image type 3 Modality specific characteristics that include any labelsspecific to the modality, such as localizer or axial in a CTimage.
Image type 4 Implementation-specific identifiers flag specific to amodality and scanner manufacturer.
IR high limit, IR lowlimit
Inversion recovery pulse sequence parameters.
Modality Select CT, MR, etc.
MPR Modes Right-click to select an MPR type.
MPR/MIP Right-click to select MPR or MIP.
MPR/MIP DisplayLayout
Double click to display a list of layouts.
Orientation The spatial orientation of images (axial, sagittal, coronal,oblique).
Reconstruction View Select the appropriate view.
Series Description Free text that can be matched against a series ID, whichcan be found in Image Info. Specify one or more words.A series will be selected if it matches all words.
Series Number Free text to indicate the series number.
Study Category Indicates the category (primary or comparison).
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Attribute Description
Target Series Type Select Axial, Sagittal, or Coronal.
TE high limit, TE lowlimit
Echo time parameters.
TR high limit, TR lowlimit
Repetition time parameters.
View position Right-click to select a view position.
3. At the bottom of the window, click Properties and make selections.
Note: Changes made to these properties for one Sheet View viewport apply toall the viewports in that Sheet View.
Attribute Description
Activate thisplaceholder
Active Imageapplies the presentation parameterchanges to the currently active image only, or Per Seriesapplies the presentation parameter changes to the wholeseries to which the active image belongs.
Note: This parameter is disabled for Global Stackand Sheet View viewports.
Run Cine in thisplaceholder
Select this check box to automatically cine the serieswhen the hanging protocol is applied. Cine parametersactivate if this box is checked.
Note: Only one cine placeholder can be set asactive, and only one placeholder can startCine automatically. If Cine is set in onecell, previous definitions in other cells areautomatically disabled. Run Cine is disabledfor Global Stack and Sheet View viewports.
Frame rate Enter the number of frames per second (FPS). The higherthe number, the faster the cine rate.
Note: The system attempts to use frame ratevalues in the DICOM header or in HangingProtocols to determine a frame rate value forcine. If this information is not present in theDICOM header or in Hanging Protocols, thenthe default system frame rate is used as theframe rate for cine. This value is 6 Framesper Second (FPS) and it is not configurable.
Cine Mode Continuous repeats the same sequence after one loop(first to last, then first to last).Sweep reverses the sequence after one loop (first to last,then last to first).
Cine Direction Forward begins at the first image in the series.Back begins at the last image.
Preset Window Select from the drop-down menu.
Invert Select the check box if desired.
Page Format Select an option.
Zoom Select an option.
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Attribute Description
Image Order Acquisition Time orders the images by Acquisition TimeSeries Number orders the images by Series/ImageNumber
Note: This option is disabled for Series andOverview viewports.
Image Sorting Ascending or Descending. This property iscomplementary to the Image Order property.
Note: This option is disabled for Series andOverview viewports.
Apply PresentationParameters
Active Image applies the presentation parameterchanges to the currently active image only, or Per Seriesapplies the presentation parameter changes to the wholeseries to which the active image belongs.
4. Click OK to accept the additional settings.
5. Click OK to set these attributes as criteria for that placeholder (window position).
6. Repeat the steps in this task for each placeholder (window position). The viewer loadsseries that match these defined criteria into the appropriate windows. If a series doesnot match any criteria, it can be accessed through the Navigator. To leave a windowposition open for manual placement of a series, i.e., no automatic population, do notdefine any criteria for that placeholder.
7. Click Save to overwrite the selected protocol with these new definitions, or click SaveAs to create a new hanging protocol. (Enter a descriptive name and choose theaccess level.) This protocol will be available from the Hanging Protocol configurationdialog.
8. Click Close to exit the dialog, and click Save to exit the configuration dialog.
9.5.5 To Set W/L for a Placeholder
When a Hanging Protocol is created, the W/L for each series in a placeholder is not set.Thus, the placeholders display the default setting specified for the layout (as defined inthe More Settings section of the Layout Editor). Use the following steps to adjust the W/Lfor a series that displays in a placeholder.
Note The W/L preset defined for a placeholder is applied on image display, whetherthe placeholder is populated automatically or whether an image is draggedinto the placeholder.
1. Ensure that the Hanging Protocol is attached to a layout.
2. Open a study or studies with the layout that has the Hanging Protocol applied. (Applythe protocol if it is not applied automatically.)
3. Use the standard W/L commands to modify the setting in those series that requiremodification.
4. Open the Layout Editor and click the Hanging Protocol icon.
5. Click Save Applied HP W/L. The modified settings are saved to the Hanging Protocol.
9.5.6 To Define Specialized Placeholders
Certain placeholders can be used to specify an exact screen position for componentsof the viewer.
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Attribute NotesPrimary seriesComparison series
Displays the selected series in this placeholder.
Global Stack Reserves a monitor to show all series of the selected study as asingle physical series; the user can scroll through in sequence,with no interruption between series. One placeholder of this typeper study category can be specified. Click Properties to furtherdefine the criteria.
Navigator Shows the Navigator, which is used to quickly position seriesmanually, if the default layout needs to be changed during studyinterpretation. Only one such placeholder can be specified, andno further definition is required.
Key images Displays the Key Images window. Only one such placeholder canbe specified, and no further definition is required.
Overview Displays series of a study that have not been displayed in anyother placeholders; any number may be specified.
Orders Reserves the placeholder for the orders for this exam.
Notes/Reports Shows notes and reports in this monitor representation.
MPR/MIP Creates a MIP/MPR placeholder in Hanging Protocol LayoutEditor, and explains how to edit hanging criteria for MIP/MPR.This enables MIP/MPR in the viewport.
CT SagittalCT Coronal
Shows the selected CT orientation. Define the hanging criteria,and click Properties to further define the criteria.
PET SagittalPET Coronal
Displays the selected PET orientation. Define the hanging criteria,and click Properties to further define the criteria.
Fused SagittalFused Coronal
Displays the fused orientation. Define the hanging criteria, andclick Properties to further define the criteria.
Rotating PET MIP Reserves this placeholder for rotating PET MIP. Definethe hanging criteria, and click Properties to add additionalinformation.Advanced Mammo Displays mammography images in this placeholder using theadvanced mammo application.
Note If the monitor setup includes >5MP monitors, configurethe mammography application on these monitors only. If>5MP monitors are unavailable, a warning message displayson the monitor representation, and the mammographyapplication can be configured on monitors with lowerresolution.
System SpecificAttributes
Your system setup may include additional attributes that can beassigned.
1. To define a specialized placeholder, double-click an empty placeholder.
2. From the floating menu, select the type of placeholder. Any placeholder can be leftempty. Empty placeholders are not populated by any series when a Hanging Protocolis applied. In that placeholder; however, the user can manually place any seriesfrom any study displayed in the Navigator.
3. For some placeholders, you can double-click to specify hanging criteria.
4. Click Properties to add details as needed.5. When you have finished specifying details for placeholders, click Save or Save As to
save the Hanging Protocol on the server.
6. Specify a name for the Hanging Protocol.
7. Select a radio button to indicate whether the protocol is common, group or personal.
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8. Click OK.
9.5.7 To Clear Defined Hanging Protocols
You can clear previously set attributes and return to the default settings. All placeholdersare assigned only the Study Category and the Ordered Sequential Number attributesfrom the series placed in that placeholder.
� Click Default Hanging Protocol in the HP Editor to remove all defined hanging attributeson all placeholders.
9.5.8 To Attach a Hanging Protocol to a Layout
1. After a Hanging Protocol has been saved on the server, select Edit from the LayoutEditor menu.
2. Click Hanging Protocol.3. Select a Hanging Protocol from the list on the right and click << to attach it to the
current layout.
4. Click Save.
9.5.9 MIP/MPR in the Viewport
Use this feature to create an MIP/MPR placeholder in the Hanging Protocol LayoutEditorand edit hanging criteria for MIP/MPR. This enables MIP/MPR in the viewport.
Note Hanging criteria for MIP/MPR applies only to CT, MR, and PET-CT exams.
The following table lists the values for the Hanging Protocol MIP/MPR attributes. Thedefaults are displayed in bold.
Table 15 MIP/MPR Criteria and Values
Criteria ValueMPRMIP/MPR
MIP
Standard MPRSpine MPR
Curved MPR
MPR Mode
Cross Curved MPR
AxialSagittal
Target SeriesType
Coronal
2x2Display
3+1
Note MPR Mode and Target Series Type are enabled if MPR is selected in theMPR/MIP field.
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Note Target Series Type is enabled if Standard MPR or Curved MPR is selectedin MPR Mode.
1. Open a study for MIP/MPR. On the menu bar, click the Layout Editor menu andselect Hanging Protocol Tool.
2. Double click in an empty placeholder and select MPR
Expected Result: A placeholder is created for MIP/MPR with default values.
3. Double click the MIP/MPR placeholder to launch a window where you may edit thehanging criteria for MIP/MPR. Then, click OK.
4. Click Apply, then click Save.
9.6 Mammography Viewer Integration
9.6.1 To Set Mammography Viewer Integration
1. From the Image Viewer, select Layout and then select EDIT.2. From the Layout Editor, select Integration.3. Set the configuration options for selecting comparison studies. See Automatically
Displaying Comparison Studies (page 191) for more information.
9.7 EchoPAC Integration
9.7.1 Opening the EchoPAC Integrations Settings Panel
1. From the viewer, select Layout and then select Create/Edit.2. From the Layout Editor dialog, select Integration.3. Select EchoPAC.
ExpectedResult:This opens the Integrations: EchoPAC pane in the Layout Editor dialog.
9.7.2 Layout Editor — EchoPAC Integration Settings
You may set the following from the Integrations: EchoPAC pane in the Layout Editor dialog.
● Export Measurements from EchoPAC Reports:● Automatic: System automatically sends measurements to CIVS Reports upon
loading a study.
● Manual: After the system loads a study, the user must click a button in the toolbarin order to send measurements to CVIS Reports.
Note: Both options trigger the Viewer to transfer DICOM SR files in theEchoPAC export folder to the CVIS. If the Viewer was not launched fromthe CVIS, these events are ignored.
● Tiling: Choose one of the available on-screen tiling arrangements.Select a value in the drop down list. The values (ColRow) are 1x1, 2x1, 3x1,
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4x2, 3x3 and 4x3. The default is 2x2.● Number of Recent Priors to Include:
Select a value in the drop down list. The values are from 0–10. The default is 1.
● Notify when there are more recent priors than configured above:Click to select one of the two options. The values are Enabled (default) and Disabled.
● Restrict EchoPAC use to primary studies from GE equipment:Click to select one of the two options. The values are Enabled (default) and Disabled.
9.8 Cardiology Advanced AnalysisIntegration
9.8.1 Opening the Cardiology Advanced Analysis IntegrationSettings Panel
1. From the viewer, select Layout and then select Create/Edit .2. From the Layout Editor dialog, select Integration.3. Select Cardiology Advanced Analysis .
ExpectedResult:This opens the Integrations: Cardiology Advanced Analysis pane inthe Layout Editor dialog.
9.8.2 Layout Editor — Cardiology Advanced AnalysisIntegration Settings
You may set the following from the Integrations: Cardiology Advanced Analysis pane inthe Layout Editor dialog.
For Echo Cardiology Advanced Analysis Studies:
● Export Measurements from Cardiology Advanced Analysis to CVIS Reports:● Automatic: System automatically sends measurements to CVIS Reports upon
loading a study.
● Manual: After the system loads a study, the user must click a button in the toolbarin order to send measurements to CVIS Reports.
● Tiling: Choose one of the available on-screen tiling arrangements.● IAC Echo/Vascular verification:● Magnification:● Auto-Magnification Scale the image to it’s default size on loading.
● 1:1 Scale the image to a magnification of 1:1 on loading.● Measurement Units: Choose mm or cm (default).
For Cath Cardiology Advanced Analysis Studies:
● Tiling: Choose one of the available on-screen tiling arrangements.● Magnification:
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● Auto-Magnification Scale the image to it’s default size on loading.
● 1:1 Scale the image to a magnification of 1:1 on loading.
9.9 Main Menu Configuration
9.9.1 Main Menu Configuration
A menu displays a list of commands, such as Layout, Key Images, Page Format andSynchronize, and is located at the top of the screen. The main menu is the group ofcommands displayed when Image Viewer is launched. You can customize the main menu— adding and removing commands as needed.
When you have modified the menu to suit your preferences, save the modifications forthat modality. That menu is then applied to all studies for that modality. See Layout Editor.
In the Edit Main Menu dialog, the current menu for this layout shows in the left pane; theavailable menu options shows in the right pane. In the left pane, a black circle indicatesa single selection that is immediately enabled. Menu items with drop-down lists areindicated by a gray circle and a plus sign. Click the plus sign in the left pane to expand themenu item and view its sub-menu.
9.9.2 Configuring the Main Menu
1. Load a study that has the layout from which you want to modify or create.
2. Select Layout from the Image Viewer menu.
3. Select Edit. The Layout Editor dialog is displayed.4. Click the Main Menu icon.
In the Main Menu dialog, the right pane shows the main menu definition sets that havealready been created, one for each modality. The left pane shows the main menudefinition set currently in use.
5. Edit a definition set by selecting it in the right pane and moving it to the left paneby clicking the left-pointing << arrows.
6. Click Edit.7. To include your selection as part of a current menu item's drop-down list, click the plus
sign next to the current menu item that will receive the addition.
8. From the right pane, select the action to include on the main menu.
9. Move the selection to the left pane by clicking once on the left-pointing << arrows.10. Use these options as needed:
● To add an item to an existing sub-menu, select the item to add in the right pane,select the parent item in the left pane, and add the selection by clicking AddInto Submenu.
● To re-arrange the order of menu items, select an item in the left pane and clickUp or Down.
● To delete a menu item, select it in the left pane and click the right-pointing>>arrows.
● To rename a menu item, select it in the left pane, click Rename, and type thenew name.
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● To apply the modifications to the open session without saving the definition set,click Apply.
● To save this menu to the current definition set, click Save.
● To create a new definition set with these changes, click Save As and type aname for the new definition set.
11. Click Close.
9.9.3 To Create a New Menu Item with a Drop-down List
Options in the right pane are arranged in alphabetical order.
1. In the right pane, find and select the menu item that will have a drop-down list.
2. Click the left-pointing << arrows. The new menu item shows with a gray circle,indicating it is ready to build a drop-down list.
3. If necessary, select the item in the left pane and click Rename. Name the menu itemthat will have a drop-down list.
4. In the right pane, select the first item in the drop-down list and click Add IntoSubmenu. The selection appears beneath the parent menu item. Repeat thisprocedure until the Submenu's drop-down list is built.
5. To delete an item, select it and click the right-pointing >> arrows.
Note: You can click and drag to re-position items in the left pane.
9.9.4 To Add a Separator between Items in a Drop-down List
1. Click the plus sign to expand the desired Submenu and show its drop-down list.
2. Select the drop-down item in the left pane that will appear before the separator.
3. In the right pane, select Separator.4. Click the left-pointing << arrows to add the separator after the selected item.5. Click Up and Down to move the separator to the desired position, if necessary.
6. Click Apply to add the separator, and click Save to save the changes.7. Click Close.
9.9.5 Film View Menu Configuration
The Film View Menu is the floating menu displayed when you right-click an image whilein Film View. You can easily customize the Film View Menu -- adding commands mostpertinent to your study and removing commands that you don't need to access quickly.
You can add or remove commands from the Film View Menu. When you have modifiedthe menu to suit your preferences, you save the modifications for that modality. Thatmenu is then applied to all studies for that modality. To learn more about how changesare applied, see Layout Editor.
Note Regarding Film View, prior to version 3.7.3, plain films (such as CR andDX modalities) and their comparisons were read in Film View mode. Laterversions use Hanging Protocols that enable the comparison of more than twostudies at a time, the flexible layout of multiple studies on the monitors, andother viewing features. This change retires support for Film View mode, as it
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is not compatible with Hanging Protocols. The new recommended methodfor reading plain film studies is to use Overview Hanging Protocols that allownavigation through the images using drag-and-drop in the Navigator. Thisminiature overlay of the screen configuration enables quick positioning ofimages with minimal mouse movement.
9.9.6 To configure the Film View menu
1. Load a study with the layout you want to modify or copy.
2. Select Layout from the Image Viewer menu.
3. Select Edit.4. Click Film View Menu.
In the Film View Menu dialog, the right pane shows existing Film View Menu modalitysets, one for each modality. The left pane shows the Film View Menu modality setcurrently in use.
5. Select a modality set in the right pane and move it to the left pane by clicking theleft-pointing << arrows.
6. Click Edit.
In the Edit dialog, Film View menu items display in the right pane, and the currentmenu for this layout shows in the left pane. In the left pane, single-action menuitems are indicated by a black circle; when this item is selected in Image Viewer, theassociated operation is immediately enabled. Menu items with drop-down lists areindicated by a gray circle and a plus sign. Click the plus sign in the left pane to expandthe menu item and view the drop-down list.
7. From the right pane, select the option to include on the main menu.
8. To include your selection as part of a current menu item's drop-down list, select theitem in the right pane.
9. In the left pane, click the plus sign next to the menu item that will receive the addition,select the sub-menu item above the location for the new item, and click Add IntoSubmenu.
10. To re-arrange items, select an item in the left pane. Click Up or Down.11. To delete a menu item, select it in the left pane and click the right-pointing >> arrows.12. To rename a menu item, select it in the left pane and click Rename.13. Add a separator between menu items, if desired.
14. To save this menu to the current modality set, click Save.15. To create a new modality set containing these changes, click Save As and name the
new modality set.
16. To apply the modifications to the open session without saving the layout, click Apply.Click Close to exit the dialog.
9.9.7 To Create a New Menu Item with a Drop-down List
1. Scroll through the options in the right pane. Select Submenu.2. Click the left-pointing << arrows. The submenu shows as a menu item with a gray
circle, indicating it is ready to build a drop-down list.
3. Select Submenu in the left pane and click Rename. Name the menu item that willhave a drop-down list.
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4. In the right pane, select the first item that will appear in the drop-down list and clickAdd Into Submenu. The selection appears beneath the parent menu item. Repeatthis procedure until the drop-down list is built. To delete any item, select it and clickthe right-pointing >> move button.
Note: You can click and drag to re-position items in the left pane.
9.10 Series Menu Configuration
9.10.1 Series Menu Configuration
The Series Menu is the floating menu displayed when you right-click an image whilein Stack View. You can easily customize the Series Menu -- adding commands mostpertinent to your study and removing commands that you don't need to access quickly.
This section describes how to add or remove commands from the Series Menu. Whenyou have modified the menu to suit your preferences, you save the modifications for thatmodality. That menu is then applied to all studies for that modality. To learn more abouthow changes are applied, see Layout Editor.
In the left pane of the Series Menu Editor, single-action menu items are indicated bya black circle; when this item is selected in Image Viewer, the associated operation isimmediately enabled. A common set-up is a menu with a drop-down list of selections.Menu items with drop-down lists are indicated by a gray circle and a plus sign (or a minussign when expanded). You can click the plus sign in the left pane to expand the menuitem and view the drop-down list.
9.10.2 To Configure the Series Menu
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the Image Viewer menu.
3. Select Edit. The Layout Editor dialog is displayed.4. Click Menu > Series Menu icon in the sidebar.
In the Series Menu dialog, the right pane shows the Series Menu modality sets thathave already been created, one for each modality. The left pane shows the modalityset currently in use.
5. To edit a modality set, move it to the left pane (if necessary) by clicking selecting itand clicking the left-pointing << arrows.
6. Select the modality in the left pane and click Edit.
The Edit Series Menu dialog displays. Available menu items display in the right pane,and the current menu for this layout shows in the left pane.
7. From the right pane, select the action to include on the main menu.
or
To include your selection as part of a current menu item's drop-down list, click the plussign next to the current menu item that will receive the addition.
8. Move the selection to the left pane by clicking once on the left-pointing << arrows.
or
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To add the selection to a current drop-down list, select the parent menu item in theleft pane and click Add Into Submenu.
9. Use these options as needed:
● To re-arrange the position of any menu item, select it in the left pane and clickUp or Down.
● To delete a menu item, select it in the left pane and click the right-pointing >>arrows.
● To rename a menu item, select it in the left pane and click Rename.
● To add a separator, select the item above where the separator will be insertedin the left pane, select Separator in the right pane, and click the left-pointing<< arrows.
● To save this menu to the current modality set, click Save.
● To create a new modality set that will include these changes, click Save As andtype the new layout's name.
● To apply the modifications to the open session without saving the layout, clickApply.
10. Click Close.
9.10.3 To Create a New Menu Item with a Drop-down List
1. Scroll through the options in the right pane. Select Submenu.2. Click the left-pointing << arrows. Submenu shows as a menu item with a gray circle,
indicating it is ready to build a drop-down list.
3. Select Submenu in the left pane and click Rename. Enter a name for the menu.4. In the right pane, select the first item that will appear in the drop-down list and click
Add Into Submenu. Repeat this step until the drop-down list is built.
Note: You can click and drag to re-position items in the left pane or remove itemsfrom the list by selecting them and clicking the right-pointing >> arrows.
9.10.4 Key Images Menu Configuration
The Key Images menu displays when you right-click the mouse from the key imageswindow. A floating menu of selections displays. You can customize the menu to addand remove commands that fit your workflow and streamline your work. To learn moreabout how layouts are applied, see
Layout Editor.
In the left pane of the Edit Key Images Menu dialog, single-action menu items areindicated by a black circle; when this menu is selected in Image Viewer, the associatedoperation is immediately enabled. A more common set-up is a menu with a drop-downlist of selections. Menu items with drop-down lists are indicated by a gray circle and aplus sign (or a minus sign when expanded). You can click the plus sign in the left pane toexpand the menu item and view its current drop-down list.
9.10.5 To Configure the Key Images Menu
1. Load a study that has the layout you want to modify or copy.
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2. Select Layout from the Image Viewer menu.
3. Select Edit. The Layout Editor dialog is displayed.4. Click Key Images Menu in the sidebar.
The Key Images dialog is displayed. The right pane shows the Key Images modalitysets that have been created. The left pane shows the Key Images modality setcurrently in use.
5. Select the modality set in the left pane and move it to the left pane by clicking theleft-pointing << arrows.
6. Click Edit.
The Edit Key Images Menu dialog displays. All available menu items display in theright pane, and the current menu for this layout shows in the left pane.
7. From the right pane, select the item to include on the main menu. To include yourselection as part of a current menu item's drop-down list, click the plus sign next to thecurrent menu item that will receive the addition.
8. Move the selection to the left pane by clicking the left-pointing << arrows. To add aselection to a current drop-down list, select the parent item in the left pane and clickAdd Into Submenu.
● To re-arrange menu items, select the item to move in the left pane. Click Upor Down.
● To delete a menu item, select it in the left pane and click the right-pointing >>arrows.
● To rename a menu item, select it in the left pane, click Rename and type thenew name.
● Add a separator between menu items, if desired.
● To save this menu to the current layout, click Save.
● To create a new layout that will display the menu in the left pane, select SaveAs and type the new layout's name.
● To apply the modifications to the open session without saving the layout, clickApply.
9. Click Close.
9.11 Main Toolbar ConfigurationToolbars allow you to organize commands into buttons near the top of the screen soyou can find and use them quickly. You can customize toolbars-- adding buttons forfrequently-used commands or removing buttons you don't need. You can also move theentire toolbar from the top of the screen to the bottom, left or right.
The Main Toolbar is the set of buttons displayed when the viewer is launched. You canconfigure the Main Toolbar and save the modifications for a specific modality. Thattoolbar is then applied to all studies for that modality. To learn more about how changesare applied, see Layout Editor.
9.11.1 To Configure the Main Toolbar
1. Load a study that has the layout you want to modify or create from.
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2. Select Layout from the Image Viewer menu.
3. Click Edit.4. Click the Main Toolbar icon in the sidebar.
The right pane shows the Main Toolbar modality sets that have already been created,one for each modality. The left pane shows the Main Toolbar modality set currently inuse.
5. Select the modality set in the left pane. (You must move a modality set to the left paneto edit it. You move a modality set to the left pane by selecting it and clicking theleft-pointing << move button.)
6. Click Edit.
All available toolbar items in the system are in the right pane, and the current MainToolbar for this layout is in the left pane.
7. From the right pane, select the action to include on the Main Toolbar.
8. Move the selection to the left pane by clicking once on the left-pointing << arrows.9. Use the following options as needed:
● To rearrange the toolbar buttons, select a button in the left pane and click Up orDown. (The item at the top of the list is the first button in the row. The last itemis the last button on the row.)
● To delete a toolbar button, select it in the left pane and click the right-pointing>> arrows.
● Add a separator between toolbar items, if desired. See To add a separatorbetween items in a drop-down list
● To save this toolbar to the current definition set, click Save.
● To create a new definition set including these changes, click Save As and enter aname for the new definition.
10. Click Close.
9.11.2 Toolbar Wrapping
In a dual-monitor configuration (see illustration below), the first (Left) monitor toolbar isalmost full. (Both first and second (Right) monitors have separate toolbars.)
Upon adding more items or expanding measurements/labels, the toolbar on the firstmonitor spreads over to the second monitor. (The second monitor now does not have aseparate toolbar.)
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Follow these steps to engage the Wrap feature to have a toolbar in each monitor.
1. Locate the Wrap check box in the General Settings area of the Layout Editor, underToolbar Position. (By default the Wrap box is unselected.)
2. Select the Wrap check box and click Apply, then Save.
Now, upon adding more items or expanding measurements/labels, there is toolbaron each monitor, and spill-over items are added to the drop-down menu at the endof the toolbar.
9.11.3 Jumping templates
You can quickly jump from one image overlay template to another by creating a toolbarbutton and clicking it.
See Main Toolbar Configuration to create a toolbar button. Select Next AnnotationTemplate from the list of available buttons.
Once created, only those templates that apply to the current modality display in adrop-down menu from the toolbar button. Select the down arrow next to the buttonto display the drop-down menu. Or, click the button repeatedly to quickly display onetemplate after the next.
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9.12 Measurements Button Configuration
9.12.1 Measurements Button Configuration
The Measurements Button displays a sub-toolbar, which means that it does not replacethe main toolbar but is added to it. You can add or remove the commands that display inthe sub-toolbar when you click Measurements. After modifying the toolbar to suit yourpreferences, save the modifications to the Measurements Toolbar menu. That menu isthen loaded with all studies that have been saved with the Measurements Toolbar. Tolearn more about how changes are applied, see Layout Editor.
9.12.2 To Configure the Measurements Toolbar
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the Image Viewer menu.
3. Select Edit.4. On the Layout Editor, click Measurements.
The Measurements Toolbar dialog is displayed. The right pane shows theMeasurements Toolbar modality sets that have already been created. The left paneshows the Measurements Toolbar modality set currently in use.
5. Select the modality set in the left pane. (You must move a definition set to the leftpane to edit it. You move a definition set to the left pane by selecting it and clicking theleft-pointing << move button.)
6. Click Edit.
The Edit Measurements Toolbar dialog displays. All available measurement actionsare in the right pane, and the current toolbar for this layout is in the left pane.
7. From the right pane, select the action to include on the Measurements Toolbar.
8. Move the selection to the left pane by clicking once on the left-pointing << arrows.9. To re-arrange the position of the new toolbar button, or any toolbar button, select it in
the left pane. Click Up or Down. (The item at the top of the list will appear as the firsttoolbar button on the row. The last item will be the last toolbar button on the row.) Todelete a toolbar button, select it in the left pane and click the right-pointing >> arrows.You can also add a separator between toolbar items.
10. Select an option:
● To save this toolbar to the current definition set, select Save.● To create a new definition set that will include these changes, select Save As. If
you select Save As, you will be prompted to enter a name for the new definition.
● To apply the modifications to the open session without saving the layout, clickApply.
● To exit the dialog, select Close.
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9.13 Annotations Button Configuration
9.13.1 Annotations Toolbar Configuration
The Annotations Button displays a sub-toolbar, which means that it does not replace thecurrent toolbar but is added to it. You can add or remove the commands that display inthe sub-toolbar when you click Annotations. When you have modified the toolbar to suityour preferences, save the modifications to the Annotations Toolbar menu. That menu isthen loaded with all studies that have been saved with the Annotations Toolbar. To learnmore about how changes are applied, see Layout Editor.
Note Referring Physician users cannot invoke this component.
9.13.1.1 To Configure the Annotations Toolbar
1. Load a study that has the layout you want to modify or create from.
2. Select Layout from the Image Viewer menu.
3. Select Edit.4. Click Annotations Toolbar in the sidebar.
The right pane shows the Annotations Toolbar modality sets that have already beencreated. The left pane shows the Annotations Toolbar modality set currently in use.
5. Select the modality set in the left pane. (You must move a modality set to the left paneto edit it. You move a modality set to the left pane by selecting it and clicking theleft-pointing << arrows.)
6. Click Edit.
All available annotation actions in the system display in the right pane, and the currenttoolbar for this layout displays in the left pane.
7. Use the following actions to edit the toolbar:
● To add a button to the toolbar, select the button in the right pane and click theleft-pointing << arrows.
● To remove a button from the toolbar, select the button in the left pane and clickthe right-pointing >> arrows.
● To rearrange toolbar buttons, select a button in the left pane. Click Up or Down.(The item at the top of the list will appear as the first toolbar button on the row.The last item will be the last toolbar button on the row.)
● You can also add a separator between toolbar items.
8. Select from the following actions:
● To save this toolbar to the current definition set, click Save.● To create a new definition set that will include these changes, select Save As. If
you select Save As, you will be prompted to enter a name for the new definition.
● To apply the modifications to the open session without saving the layout, clickApply.
9. Click Close to exit the dialog.
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AFrequently AskedQuestions
This section answers common questions about the system.
I entered a note or preliminary report by mistake. How can I delete it?
Click Hide. The system's audit feature does not allow any user to delete a note orpreliminary report. If you successfully enter a note or report and then wish to delete it,you can click Hide, which appears when you begin to enter text into the text area. Thispreserves your institution's audit trail, while allowing you to display or print the appropriateinformation.
If your site uses Centricity PACS integration, you will need to contact your administrator orGE service personnel to hide the note or preliminary report.
Why should I compress data?
When Study sizes and images are quite large, it can take longer to bring a study to yourworkstation. If you want to minimize the wait time, you can use data compression. Ifyou don't want to compress images, you can select multiple studies for viewing. If youselect multiple studies, it may still take time, but you can view the first study while theothers are loading.
Aren't compressed images poor in quality?
"Quality" depends on your perspective, the kind of study viewed and your aversion torisk. Even radiologists are not unanimous on whether a compressed image is "goodenough" for primary interpretation, or on which kind of studies best lend themselves todata compression.
Doesn't the American College of Radiology (ACR) stipulate that onlynon-compressed images are acceptable for primary interpretation or "goodmedicine"?
The ACR standards cover two topics: the ACR Standard for Teleradiology and theACR Standard for Digital Image Data Management. Neither topic states that only anuncompressed image is acceptable. (You will need Adobe Acrobat reader to view thesedocuments. If you do not have that program, click here.)
I clicked Synchronize, but images that are parallel do not move in concert. Why?
Synchronizing depends on a "common frame of reference," which is a common physicalreference point for all images in the study. This reference point is typically sent by thescanner, and it is the only way the system can calculate how each image is related (and,thus, which images are parallel). In some cases, the scanner does not send a commonframe of reference, which makes synchronization impossible.
The patient moved in between MR series. Can I still synchronize?
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Yes. For example, if the study protocol called for 20 axial images using a T1-weightedseries and then an equal number in a T2-weighted series, and you had to reposition thepatient between series, you would need to accommodate the different anatomical range ineach sequence. To do so, turn Synchronize off temporarily, manually advance one of theseries so that the same "slice" is displayed in both series, and then select Synchronizeby Relative Position.
Unequal slice thicknesses were used for two series. Can I still synchronize?
Yes. If you Synchronize by Absolute Number, slice #1 in the first series will line up withslice #1 in the second series, but as you page through, the same anatomical slice wouldnot be displayed in both series. In that case, select Synchronize by Absolute Position.The system automatically delivers the slice from the synchronized series that is nearestin position to the active image.
The patient moved and I have unequal slice thicknesses. Can I still synchronize?
Yes. Turn off Synchronization temporarily. Manually page through one series until thesame anatomical slice is displayed in both series. Select Synchronize by RelativePosition.
How do I view more than one image at a time?
Right-click the image and choose Page Format. Select the number of rows and columnsyou would like displayed.
Images are displayed at different sizes on different computers. Why?
The system automatically checks the display resolution of your monitor and adjusts thewindow sizes accordingly. For example, a monitor with a 1074x768 resolution would showlarger images than a monitor with a 800x600 resolution.
My images are upside-down. Can I fix this?
Yes. Right-click on the image and select Flip from the menu. Flip turns image from top tobottom, and vice versa. Rotate turns the image 90 degrees clockwise.
How can I make the image larger or smaller?
You can use the standard Windows technique for changing a window size, which is to"grab" a corner of the window when you have a double-headed arrow and drag thatcorner out (larger) or in (smaller). You can also zoom the image with the Zoom tool or byright-clicking the image and selecting preset magnification factor.
I'm not sure whether I changed the brightness or contrast, but the image isunrecognizable. How can I fix it?
Right-click the image, select Pre-Set Window and then Automatic, or press the spacebaron the keyboard. The image updates to the optimum W/L.
I'm using the magnifying glass to get an enlarged image, but I see no difference.Why?
Magnify means to update a study to its true resolution. You are probably using the TrueResolution/Magnify tool on an MRI, CT, US or NM study. These kinds of studies arealready loaded at their true resolution on most monitors, whereas most monitors cannothandle plain-film studies at true resolution. Thus, the True Res/Magnify tool is reallyintended for use with plain-film studies. To see enlarged images for CT, MR, etc., usethe Zoom tool.
I'm used to seeing x-rays with lots of information displayed around the image. Can Isee that information?
Yes. Enable Image Overlay to populate the image with study information. You can alsoright-click and select Patient Information from the menu to see additional details on thepatient. Click Image Information to see additional information on the image.
I keep clicking, but no more images show up. Why?
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You may be at the beginning or end of the series. Left-click (or up arrow on your keyboard)brings up the next image and right-click (or down arrow on your keyboard) brings up theprevious image. Also, make sure you are clicking in the display area of the image.
I keep clicking on the X in the top right corner of the screen, but it won't close. Why?
Make sure you are clicking on the X in the title bar that contains the patient's name andage. If that doesn't close the study, you probably have another window open, probably adialog box. You can always use the recommended way of closing out a study by clickingon the DONE icon.
I am viewing multiple MRI series and made a complete mess putting one stackwindow on the top of the others. How can I come back to the original screen?
Click Layout from the main menu, and select Reload. If you're not on the default hangingprotocol, you can either click on the Hanging Protocol icon or select the Hanging Protocolfrom the drop down menu.
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BNetwork Requirementsand Performance
Expected Network Characteristics for GE Performance Targets
“First image display” and “study load” times and other performance targets are based onsystems with certain network requirements.
For best results, review workstations should have connections with:
● Network bandwidth of at least 4MB/second
● Network latency of less than 100 ms (milliseconds)
If your system has less bandwidth or more latency, performance times will be affectedproportionally.
Causes of Slow Image Load Times
Slow image loading can be caused by one or more factors.
● Network latency
● Network bandwidth usage by other programs
● Physical distance between reviewing workstation and image storage
● Image location: online, nearline, offline, archive
● Use of a VPN connection with low throughput on the VPN side
● Use of a VPN connection with a slow ISP speed on the remote side
● Type of images (CR/DX images often take longer to load than CT images, for example)
Causes of Slow Study Load Times
Slow study load times can be caused by all of the items listed for slow image load times.Slow study load times can also be caused by a large number of images in the study(more than 3000 images).
Example: These three examples all used a CT study with approximately 200 images.
● Using an internal LAN Local Area Network connection at one site, first image displaywas typically a few seconds or less for small studies.
● For a site connecting via intranet, over a connection with approximately 150msnetwork latency, first image display took over five seconds.
● Using a VPN, first image display took roughly two minutes.
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CUsing Universal Viewerwith AW ServerIntegration
This section includes:
AdvantageWorkstation Server Overview 346
Opening a Series in a 3DProtocol 347
OpeningMultiple Series in 3DProtocols 348
Working with Images and Series fromAWServer Applications 348
Working with AWSKey ImageNotes 349
Patient Context with AWServer Client 350
Adding AWServer Viewports to Hanging Protocols 194
Impacts of Changes to Patient or Study Information onHybrid Integration 352
C.1 Advantage Workstation Server OverviewAW Server integration provides access to advanced visualization from the readingworkstation. Any studies viewed on the AW Server are launched from the UniversalViewer. The study context on AW Server is driven from the Universal Viewer whenmultiple studies are opened on AW Server.
Integrating with AW Server 3.x allows an enhanced back-end integration, also calledembedded integration. With this option, the AW Server has the ability to read image datadirectly from the Universal Viewer servers. This makes all the images in the systemautomatically available to AW Server. Alternatively, if hybrid integration is being usedwith AW Server 2.8 or 3.x, the site needs to manage data availability on AW Server byusing DICOM to push data to the AW Server.
Note Embedded integration with AW Server 3.x does not support dual monitors.You could, potentially, work around this issue by using a single largewide-screen monitor (like a Barco Coronis Fusion) which can simulate twomonitors on a single screen. Hybrid integration with AW Server 3.2 doesnot have this limitation.
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The integration between Universal Viewer and AW Server also supports an interruptedworkflow. You can save the state of your AW Server client session and send that data tothe Universal Viewer server, and then resume work in AW at a later time. You can alsohave multiple exams open in both Universal Viewer and the AW applications, as well asopen multiple AW applications on the same study.
The Universal Viewer system manages user authentication and authorization centrallywithout requiring an independent set of credentials for AW Server.
C.2 Opening a Series in a 3D ProtocolYou can open a series in an AW Server 3D protocol using the 3D Applications menu, theNavigator, or a hanging protocol.
Important You must select a study or series that is valid for the protocol you wantto launch. See the AW Server online help for information about thestudy- and series-based requirements for use for each protocol.
1. Open a study, with different series in different viewports.
If you have not already opened an AW Server viewport, use the 3DApplications menu.1. Click in a viewport to select its series.
Expected Result: The viewport displays a yellow border, with a selection checkboxin the upper-left corner. The series on the right shows a white border, so it is readyto be selected.
2. Depending on your system configuration, the 3D Applications menu may be on acontext menu, the menu bar, or both. Open the menu, select 3D Applications andthe protocol you want to use.
If you have an open AW Server viewport, you can use the Navigator:1. Open the Navigator for the study.
2. Select the thumbnail for the series you wish to view in AW Server.
Note: You can select a RadioTherapy Structure Set (RTSS), a 3D Save State(3DSS) or AutoSave State. (These are series you can create in AWServer to save a work session and resume it later.)
3. Drag and drop the thumbnail into the AW Server viewport.
ExpectedResult:The series is opened in the 3D protocol you selected.
● For systems using hybrid integration, the AW Server client window will open in itslast known position.
● If the series is already open in an AW Server protocol, another viewport or client tabwill open and display the series in the protocol you just selected.
● If you opened a 3D Save State or AutoSave State, AW Server restores your session.
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C.3 Opening Multiple Series in 3D ProtocolsYou can open multiple series in a 3D protocol by selecting them in the viewer and thenselecting the 3D protocol.
1. Open a study, with different series in different viewports.
2. Click in a viewport to select its series.
Expected Result: The viewport displays a yellow border, with a selection checkboxin the upper-left corner. The series on the right shows a white border, so it is readyto be selected.
3. Hold down the Ctrl key while clicking the other series you want to display in the 3Dprotocol.
Note: To deselect all series, let up on the Ctrl key. To deselect a single series,click that series again (with the Ctrl key still held down).
4. When you are done selecting series, with the Ctrl key still held down, right-click andselect 3D Applications and the protocol you want to use.
ExpectedResult:The series are opened in the 3D protocol you selected.
● For systems using hybrid integration, the AW Server client window will open in itslast known position.
● If the series is already open in an AW Server protocol, another viewport or client tabwill open and display the series in the protocol you just selected.
● If you opened a 3D Save State or AutoSave State, AW Server restores your session.
C.4 Working with Images and Series from AWServer ApplicationsIf you modify or reconstruct an image with AW Server applications, when you savethe image, it is associated with the study that included the image you modified orreconstructed.
You can open and manipulate reformatted series and secondary capture images receivedfrom AW Server applications on any Universal Viewer workstation, whether or not AWServer client is installed on the workstation.
AW Server also includes the ability to create a 3D Saved State, which is analogous to abookmark. Creating a 3D Saved State saves a screen shot along with your sessioninformation and stores it in the Universal Viewer system after you exit the AW Serverclient. The saved state is then available as an entry in the series list. Opening that serieslaunches the AW Server client and restores the session information, so you can resumework where you left off. You can customize the series description of the 3D Saved Stateseries. The default description is 3D Saved State — <series description of the seriesfrom which it was created>.
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If your site is using the preprocessing option to improve 3D rendering performance, thenAW Server also creates a series called AutoSaved State. This is a single-image seriesthat also includes session information for AW Server. Opening the AutoSaved State serieslaunches the AW Server client with the preprocessed 3D information.
If you open a 3D Saved State or an Auto State on a workstation that does not have theAW Server client installed, Universal Viewer will show the series and display the screenshot image.
You can open images or series that were created in AW Server applications the same wayyou open other images or series.
● To change the NX compression ratio used by AW Server, open the User Preferencesand open the 3D Anchor tab. Then select an option for the Transit CompressionRatio. This value is used by the AW Server protocols when you scroll through images.You do not need to change this value from its default.
C.4.1 Measurement and Annotation Tool Synchronization with3D Applications
For sites using the 3D Advanced Applications in embedded mode, AWS 3.2 offersmeasurement and annotation tools that are common on Universal Viewer. Tools accessedfrom the 3D viewport can be used on both viewers.
● Arrow
● Free Text
● Point measurement
● Point to Point
● Elliptical Region
● Free hand ROI
● Angle measurement
These tools are also configurable using the right-click menu on the toolbars in the 3Dviewport.
C.5 Working with AWS Key Image NotesIf your system includes integration with AW Server, you can select key images in the AWServer client and view the AW Key Image Note in Universal Viewer. AW Key Image Notesinclude minimal information: a series description and the note creator. Key Image Notescreated from within Universal Viewer may also include additional text.
Note This feature is not available if the system is integrated with Centricity PACS3.2 (SP 6 or SP7), or with Centricity PACS 4.0.1.
To create an AWS Key Image Note in the AW Server client and view it in Universal Viewer:
1. With an exam open in the client, go to the Tools palette and select My Tools.2. Click the camera icon.
3. Make sure Key Image Note is selected as the format. (See the operator manual ofthe AW Server client for information about the other format options.)
4. Select an item from the Current Description list, or check Ask for description.
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Note: This description will be included in the name of the series that the systemcreates for the new AW Key Image Note. All AW Key Image Notes areassigned the IHE title “Of Interest”.
5. Move the mouse to the image you want to mark as significant. When the cursor is theoutline of a camera, click on the image.
6. If a dialog prompts you for a series description, enter or edit the text in the field, orchoose an existing entry from the drop-down list. Then click OK.
Expected Result: The image is marked as a key image in the AW Server client. TheAW Key Image Note, and any other Structured Report (SR) objects you may createin the AW Server client, are held in a queue for later transmission to the UniversalViewer server.
7. When you are done working with the exam in the AW Server client, exit the client.
Expected Result: When you exit the AW Server client, the client will send the AW KeyImage Note and other Structured Reports to the Universal Viewer server.
A few moments after you exit the AW Server client, the AW Key Image Note will beavailable in Universal Viewer. The key image will be in a new series with a name thatincludes the description you specified when you created the AW Key Image Note.
8. Open the AW Key Image Note using any of the methods to view Key Image Notesthat were created in the Universal Viewer.
ExpectedResult:You can work with the AW Key Image Note using the Universal Viewer’sKey Image Note tools.
Note: You should always verify the AW Key Image Note in Universal Viewer. If thereis a network issue between the AW Server and the Universal Viewer server,the asynchronous transfer from AW Server to the Universal Viewer servermay fail. If that happens, you will need to recreate the AW Key Image Note.
C.6 Patient Context with AW Server ClientFor systems with hybrid integration, when you select an AW Server application fromthe 3D Applications menu, the AW Server client will display the selected AW Serverapplication in a new tab window on top of all other tab windows within its window. Tabs forAW Server applications opened with image data from the current study set will be enabled:in the AW Server client, you can select tabs that display the exam that is displayed in theimage view area. All other tabs will be disabled. In other words, any tabs that are not incontext with the exam you are viewing in Universal Viewer are not enabled.
If you need to view a tab in the AW Server client, and that tab is disabled, you need tochange the exam context in Universal Viewer. You can do this by:
● Selecting the desired study from the menu in the image view area.
● Reopening the desired study from the study list.
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● Closing all studies in Universal Viewer, except for the study you want to view in theAW Server client. This will also close all other study tabs in the AW Server client.
Example: Jane Smith’s exam is displayed in the Universal Viewer, and the AW Serverclient has a tab where you have started working on reconstructing some of the images.A John Doe stat exam comes in, and you use the AW Server comparison tool with thatexam. To get back to the reconstruction you started with Jane Smith’s images, you wouldneed to select her study from the menu in the image view area, reopen her study from thestudy list, or close the John Doe study (and any other open studies) in Universal Viewer.
C.7 Adding AW Server Viewports to HangingProtocolsPrerequisite: You must have embedded integration to add an AW Server viewport toa hanging protocol.
You can add an AW Server viewport to a hanging protocol.
Note A hanging protocol can use either AW Server or the viewer’s native MIP/MPR,but not both.
1. Open a study in the viewer, and launch one of the AW Server protocols from that study.
2. Open the Hanging Protocol Editor by selecting Layout > HP Tool .3. Create a placeholder for the 3D protocol you wish to use.
4. Configure the placeholder to use a specific 3D protocol:
● Using the context menu:
1) Double-click on the place-holder to open the context menu.
2) From the context menu, select 3D Applications and then the protocol youwant to add to the hanging protocol.
The placeholder will change color and show the name of the protocol orapplication you selected in the upper left corner.
● Using the Choose hanging criteria dialog:
1) Double-click on the placeholder to open the Choose hanging criteria dialog.
2) Right-click the 3D Applications row.5. Optionally, use hanging criteria to select which series to display.
● Study Category
● Series Description — this is a free-text field; it applies to the current study only
● 3D Applications
● Position of Series in Navigator — use 1 for the series shown on the left end of theNavigator, 2 for the next series, and so on; this is not the series ID
Note: The default value is zero (0). This must be changed. If a differentvalue is not specified, the system will not open the 3D AdvancedApplications unless other hanging criteria are matched.
● Use Series with the most slices
● Most recent 3D save state series
The list of criteria will vary depending on your user account credentials.
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Note: When the hanging protocol is used, the best-matched series will bedisplayed in the AW Server viewport. Based on your selection, theVolume Viewer may show the series selection panel.
6. Click Save or Save As to save the hanging protocol.7. Click Close to exit the Hanging Protocol Editor.
C.8 Impacts of Changes to Patient or StudyInformation on Hybrid IntegrationIf your site is using hybrid integration, using the study merge feature will break theintegration with AW Server for the merged studies.
In hybrid integration, the study and image data are stored on the AW Server storage ratherthan the Universal Viewer system storage. The system database includes the patientdemographic information as well as information about the exams and studies, such aswhich study IDs are included in each exam.
When you use the AW hot zone in Universal Viewer to open an exam or study in an AWServer application, AW Server requests the study IDs from the system to determine whichexam or study to open. The system determines which study IDs to send from its list ofstudy IDs corresponding to the patient and exam or study you have selected. Then theAW Server uses those study IDs to determine which studies to display.
If the studies are merged, the study IDs will change. The next time you try to open thatstudy in an AW Server application, the system will send the new study IDs to AW Server.The AW Server application will not be able to match the new study IDs to existing studiesin its storage.
If the patient name or demographic information is changed, you will get a mismatchbetween Universal Viewer and the AW Server application. Because the system database’sdemographic information is not shared with AW Server in hybrid integration mode, the AWServer displays the original patient information from the DICOM headers.
C.9 Mouse Scroll Direction LimitationUniversal Viewer lets you specify a preference for mouse scroll direction. You can chooseto have the image numbers either increasing or decreasing as you scroll up.
AW Server is configured to always have the image numbers decreasing as you scroll up.
If your mouse scroll direction preference does not match the one used by AW Server,when you switch between AW Server viewports and the main Universal Viewer viewports,your mouse scrolling direction will switch back and forth. This can result in “backwards”scrolling in some viewports.
Configuring your mouse scroll preferences to always decrease the image number whenscrolling up will ensure consistent behavior across all viewports. This will also enablecorrect synchronization when scrolling AW Server and other viewports.
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C.10 AW Synchronized ScrollingBy default, Universal Viewer synchronizes movement data for every frame in the imagewith the corresponding image on AW as you scroll through an image. In some cases, thismay negatively impact Universal Viewer functionality. If this occurs, or if you would simplylike synchronized scrolling disabled, contact your system administrator.
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DIntegration with RIS
D.1 Integration with RIS-ICIntegration with Centricity RIS-IC supports these capabilities:
● Universal Viewer can notify Centricity RIS-IC about incoming studies, and aboutchanges in Order Status, via HL7.
● The Image Viewer can be launched from the RIS via an API. A set of studies canbe opened and navigated from the Viewer in this way; opening the Patient Folderis not necessary.
● RIS modules can be launched from either the Image Viewer or the Study List.
● Different types of inbound HL7 messages (ADT, Orders and Reports) can be acceptedon different ports.
● Notes and all types of reports can be accepted via HL7.
● Unmatched orders can be searched and viewed in the Study List.
● The Order Status can be a search criterion, making it easy to exclude unmatchedstudies from a search.
● The Order Status, Order Procedure Code and Description, and the Order Priority canbe displayed in the Study List.
Note Activation of API-based integration within Centricity RIS-IC requires eachuser to perform configuration steps on the client computers where suchintegration is used. Before performing configuration steps as prescribed byGE Healthcare, users must ensure that they have logged in and downloadedthe latest version of the viewer. Attempts to activate integration on CentricityRIS-IC without the viewer present on client machines may cause an exceptionmessage to appear; integration will not be operable.
Users should log out of Centricity RIS-IC after activating integration and log in againbefore proceeding to use the integrated workflow. Contact your GE Field Service Engineerfor the proper setup and configuration.
The system supports bi-directional integration with Centricity RIS-IC. This integrationsupports a seamless workflow within the institution, enabling the PACS system to launchRIS modules, such as Clinical Notes, Exceptions and Order Entries, and to receive HL7orders that can be viewed in the Patient Folder.
Note Integrations with third-party systems outside the Centricity family are specificto the implementation and not addressed in this Help system. See thecorresponding documentation to understand the pertinent issues.
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D.2 Avoiding Patient Context Mismatch withRISi IntegrationsIf your RISi worklist includes studies that are unspecified in Universal Viewer, care mustbe taken to avoid patient context mismatches.
Unspecified studies can be generated if a technologist does not use the correct item in themodality worklist, or if a study is not matched to the correct RIS order.
When you open a study from RISi, and the study is unspecified in Universal Viewer, theviewer shows a blank screen. You can open the study from the Universal Viewer StudyList and complete the reading for that study. After you have finished working with thatstudy, you must close the Universal Viewer window opened by the Study List. Then youcan return to the RISi worklist to open the next study.
If you leave the Universal Viewer window open, and then go back to the RISi worklistand open another unspecified study, the Viewer will return to the study that you openedfrom the Universal Viewer Study List. This may be a study for a different patient thanthe study you intended to open.
The following steps show a workflow that avoids this issue.
If RISi worklist opens an unspecified study:1. Open the study from the Universal Viewer Study List.
2. When you are finished working with the study, close the Viewer window that displaysthe study.
3. Return to the RISi worklist to select the next study.
D.3 Confidential PatientsYour account privileges determine whether you may view confidential patient’s studies. Ifyou do not have the proper privileges, an error message displays. Contact your GErepresentative for more information.
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EIntegration with aCVIS (CardiovascularInformation System)
This feature only applies to systems configured for cardiology workflow.
If you launch the viewer from a CVIS, the “Export Image to CVIS” and “ExportMeasurements to CVIS” features are activated.
Export Image to CVIS
The “Export Image to CVIS" feature can be used to send an image to the DMS or CCWsystem. It does nothing when an EPIC CVIS is being used.
● From Cardiology Advanced Analysis, the button is called Export image to Reportand has the label selector described below.
● The feature is not available from EchoPAC.
This button stops cine if it is running and opens the Export Image to CVIS dialog withthe following fields:
● Label The image title. (Read only)● Description Brief description of the image. (Read only)
● Text Field for comments or context so someone looking at the image from the CVISunderstands what the image shows.
The Export button sends the current frame of the image to the CVIS in JPEG format.Along with the image, the export function sends the label and description from the viewer,and the text you provided.
Note If the user opens a prior image for the study that's open, the Export Image toCVIS button will be disabled.
Note The first time you use Universal Viewer with the CCW or DMS client, you muststart the CCW or DMS client from an account that has Windows administratorprivileges. These privileges are required for the CCW or DMS client to invokethe Universal Viewer web client installer.
Export Measurements to CVIS
The “Export Measurements to CVIS" feature can be used to send a full measurement setto the DMS, CCW, or EPIC CVIS systems. This button will differ depending on the system:
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● This button is not available from UV.
● From Tomtec, the button is called Export measurements to report.● From EchoPAC, the button is called Export to report.
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FUniversal Viewer andImaging Desktop
F.1 Universal Viewer Accessed from ImagingDesktopUniversal Viewer Web Client displays a different look and feel when launched fromImaging Desktop. Please note these changes apply to Universal Viewer web clientdeployments with Imaging Desktop only.
To converge with the look and feel of Imaging Desktop, imaging history tools in theviewer (Timeline, Study Selector, Series Selector, Series Navigator, and Patient Folder)have new indicators for
1) Primary study
2) Comparison study
3) Relevant comparison study
In addition, image viewport borders in the viewer show the new indications for primaryand comparison studies.
Customization of study category indications, such as changing Viewport or Timeline tileborders (User Preferences > Study Category Indication ) has been disabled in thisdeployment.
Timeline
Table F–1 Timeline indicators
Visual Indicator Description
Primary Study Solid white line above a tile denotes the primary study. The blue colorindicates that the study is active and selected.
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Comparison Study Dashed white line above a tile denotes a comparison study. The blue colorindicates that the study is active and selected.
Relevant Study A tile with a check mark in a circle icon in the lower right corner indicates arelevant comparison study.
Remote Studies The curved arrow in the bottom left corner indicates a remote study.
Offline Studies Offline studies display a download indicator ( ) near the top of the tile.Click the indicator to bring the study online.
Navigator
The Navigator shows studies differently when accessed from Imaging Desktop. Primarystudies have a solid white line above the thumbnail; comparisons have a dashed whiteline above the thumbnail.
Viewports
The Viewport Line Style, Line Width, Double Line, or Color for the Viewport borders cannotbe customized when accessing the viewer from Imaging Desktop. These settings in UserPreferences > Study Category Indication do not alter the viewport borders for primaryor comparison studies when accessing the viewer from Imaging Desktop.
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Table F–2 Viewports
Visual Indicator Description
In the viewport, a two-pixel wide solid white border indicatesthe primary study.
In the viewport, a two-pixel wide dashed white border indicatesthe comparison study.
F.2 Study Selector, Series Selector, and PatientFolderDepending on the application used to access Universal Viewer, the Study Selector, SeriesSelector, and Patient Folder may display differently. The following graphic shows howthe Study Selector, Series Selector, and Patient Folder display if you log in to UniversalViewer using Imaging Desktop.
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● The selected study displays on a blue row. Unselected studies display on a black row.
● A solid white line (see yellow arrow) displays at the top of the primary study.
● A dashed white line (see purple arrow) displays at the top of the comparison study.
● When offline studies are present, the Download Indicator displays in this column(see green box).
Note: This column displays only when offline studies are present.
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GCalculating Patient Age
The system calculates and displays patient age according to the following criteria:
Age Units Example
< 1 day days 0d
< 2 days days 1d
< 4 weeks days 3d
< 1 year weeks and days 4w 2d
< 2 years months and days 13m 8d
< 18 years years and months 4y 1m
Time unit abbreviations are: y for years, m for months, w for weeks, and d for days.
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HAcronyms andAbbreviations
Table H–1 Acronyms and abbreviations used in this manual
Term Definition
AVI Audio Video Interleave
CAD Computer Aided Design
CAT Centricity Administration Tool
CCI Centricity Cardio Imaging
CPACS Centricity PACS
CR Computed Radiography
CTR Cardio-thoracic Ratio
DAS DICOM Acquisition Server
DICOM Digital Imaging and Communications in Medicine
EMR Electronic Medical Record
FCE Folder Control Element
GSPS Grey Scale Presentation State
HP Hanging Protocol
HL7 Health Level Seven
IHE Integrating the Healthcare Enterprise initiative; also the set oftechnical frameworks established by it.
JRE Java Runtime Environment
MIP Maximum Intensity Projection
MPR Multi-Planar Reconstruction
MRN Medical Record Number
NAT Network Attached Storage
NIO Non-Image Object
NM Nuclear Medicine
PACS Picture Archive and Communication System
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Appendix H: Acronyms and Abbreviations
Term Definition
PACS-IW Centricity PACS-IW
PDQ Patient Demographics Query
PIX Patient Identifier Cross Referencing
Provider Providers are the remote sites in the enterprise that providecomparison exams to the requestor. Providers supply patient andexam information when requested froma trusted site. One providerservice needs to be installed for each repository instance.
RBAC Role Based Access Control
Requestor The requestor consolidates and filters remote exam informationbefore passing it along. The requestor service queries for patientand exam information from other sites configured in the enterprise.One requestor service is installed with each instance of WorkflowManager (WFM).
RF Radio Fluoroscopy
RIS Radiology Information System
ROI Region of Interest
RP Requested Procedure
RPPS Requested Procedure Presentation State
RTSS Radiation Therapy Structure Set or Radiotherapy Structure SetThe radiotherapy structure set (RTSTRUCT) object of the DICOMstandard is used for the transfer of patient structures and relateddata, between the devices found within and outside the radiotherapydepartment. It mainly contains the information about regions ofinterest (ROIs) and points of interest. For example, it may includedose reference points or the set of contour points for a tumor.
SRP Smart Reading Protocol
TCD Transverse Chest Diameter
THD Transverse Heart Diameter
UDI Unique Device Identifier
US Ultrasound
VNA Vendor Neutral Archive
VR Volume Rendering
W/L Window Level
XDS Cross Enterprise Document Sharing
XED Cross Enterprise Display
XEaaS Cross Enterprise as a Service
ZFP Zero Footprint
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ISoftware License;Intellectual Property
I.1 PreambleAny software provided to the customer is subject to the specific license terms andconditions of the applicable agreement, or shrink-wrap, or click-wrap license.
In the event of any conflict between those specific terms described below, the specificterms will supersede and prevail.
Generally those terms provided are as follows.
I.2 License GrantGE grants to Customer a limited non-transferable license to use the Licensed Softwaresubject to the limitations imposed under this Agreement and to the following:
The Permitted Users shall use the Licensed Software only on the Equipment located atthe Site and solely for the purpose of processing, storing, and transmitting images anddata related to Customer's patients. Customer must obtain a supplementary license fromGE (which GE may or may not grant, at its option) before using the Licensed Software(a) in connection with any equipment components other than the Equipment (except asexpressly contemplated by this Agreement or any applicable Software documentation);(b) at any location other than the Site, or (c) to process, store, or transmit data related topatients other than Customer's patients.
Customer may make one copy of the Licensed Software in machine-readable form solelyfor backup purposes and shall reproduce on any such copy the copyright notice and anyother proprietary legends that were on the original copy.
Customer shall comply with all restrictions on the use of Licensed Software that Customeris subject to as a licensee or sublicensee of GE under the terms of licenses or otheragreements or arrangements with third parties.
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I.3 RestrictionsExcept as necessary for Customer to exercise its express rights hereunder, Customer maynot itself or allow any third party to (i) make copies of the Licensed Software, (ii) distributethe Licensed Software to others, (iii) electronically transfer the Licensed Software from onecomputer to another over a network, or (iv) decompile, reverse engineer, disassemble,or otherwise reduce the Licensed Software to a human perceivable form. CUSTOMERMAY NOT MODIFY, ADAPT, TRANSLATE, RENT, LEASE, LOAN, RESELL FOR PROFIT,DISTRIBUTE, NETWORK, OR CREATE DERIVATIVE WORKS BASED UPON THELICENSED SOFTWARE OR ANY PART THEREOF.
I.4 Ownership of MediaThe media on which the Licensed Software is recorded or fixed is Customer's property.If Customer receives Licensed Software hereunder that renders Licensed Softwarethat Customer has previously received redundant, Customer will return the redundantLicensed Software to GE or certify in writing that all copies of such Licensed Softwarehave been erased.
I.5 Proprietary Service MaterialsIn connection with the installation, configuration, maintenance, repair, and/or de-installationof the Equipment, Seller may deliver to or store at the Site, or attach to or install on theEquipment, and use an InSite Package. Buyer acknowledges that it has not purchased orlicensed from Seller any InSite Package. Buyer hereby consents such delivery, storage,attachment (provided that such attachment does not affect functionality or performanceof the Licensed Software or the System), installation, and use, and to the presence ofSeller's locked cabinet or box at the Site for storage of all or part of the InSite Package,and to Seller's removal of all or any part of the InSite Package at any reasonable time,all without charge to Seller. The presence of the InSite Package at the Site will not giveBuyer any right or title to the InSite Package or any license or other right to access or usethe InSite Package. Any access to or use of the InSite Package by anyone other thanSeller is prohibited. Buyer shall use reasonable efforts to protect the InSite Packageagainst damage or loss and to prevent any access to or use of the InSite Packagecontrary to such prohibition.
I.6 Damage in TransportationAll packages should be closely examined at time of delivery. If damage is apparent write“Damage in Shipment” on ALL copies of the freight or express bill BEFORE delivery isaccepted or “signed for” by a GE representative or hospital receiving agent. Whethernoted or concealed, damage MUST be reported to the carrier immediately upon discovery,or in any event, within 14 days after receipt, and the contents and containers held forinspection by the carrier. A transportation company will not pay a claim for damage if aninspection is not requested within this 14 day period.
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Call Traffic and Transportation, Milwaukee, WI (414) 785 5052 or 8*323 5052 immediatelyafter damage is found. At this time be ready to supply name of carrier, delivery date,consignee name, freight or express bill number, item damaged and extent of damage.
Complete instructions regarding claim procedure are found in Section S of the Policyand Procedures Bulletins.
14 July 1993
I.7 Certified Electrical Contractor StatementAll electrical installations that are preliminary to positioning of the equipment at the siteprepared for the equipment shall be performed by licensed electrical contractors. Inaddition, electrical feeds into the Power Distribution Unit shall be performed by licensedelectrical contractors. Other connections between pieces of electrical equipment,calibrations and testing shall be performed by qualified GE personnel. The productsinvolved (and the accompanying electrical installations) are highly sophisticated, andspecial engineering competence is required. In performing all electrical work on theseproducts, GE will use its own specially trained field engineer. All of GE’s electrical work onthese products will comply with the requirements of the applicable electrical codes.
The purchaser of GE equipment shall only utilize qualified personnel (i.e., GE’s fieldengineers, personnel of third-party service companies with equivalent training, or licensedelectricians) to perform electrical servicing on the equipment.
©2012 General Electric Company, 3000 N. Grandview Blvd, Waukesha, WI 53188.
All rights reserved. This product or document is protected by copyright and distributedunder licenses restricting its use, copying, distribution and decompilation. No part of thisproduct or document may be reproduced in any form by any means without prior writtenauthorization of General Electric and its licensors, if any.
I.8 Third-Party SoftwareNo third-party software is to be loaded onto any subsystem of the Universal Viewersystem, including the Universal Viewer. Loading of software other than that supplied byand authorized by GE Healthcare is prohibited and will void the workstation warranty.
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GE Healthcaregehealthcare.com
Manufacturer
GE Healthcare540 W Northwest HighwayBarrington, IL 60010 USATel: +1 847 277–5000 or +1 800 437–1171 or 800 682–5327Fax: +1 847 277–5240
European Authorized Representative
GE Medical Systems SCS283 rue de la Miniére78530 BUC, France
Asia Headquarters
GE Healthcare1 BLD-3FNo. 1 Hua Tuo Road,Zhang Jiang Hi-Tech ParkShanghai 201203 ChinaTel: 8621–38777888Fax: 8621–38777499
Turkish Importer
Türkiye'ye İthalatçıGE Medical Systems Türkiye Ltd. Şti.Esentepe Mah. Harman Sok. No: 834394 Şişli-İstanbulTürkiye
Rx Only
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