idx imagecast™ pacs 3.3cet.med.miami.edu/documents/ris-pacs for radiologist.pdfidx imagecast pacs...

Confidential. © 2008-2009 IDX Systems Corporation. All rights reserved. IDXR

IDX Imagecast™ PACS 3.3.0

RIS/PACS Training

For Radiologist

Software Version 3.3.0Document Version 1Published February 2009

Contact InformationPlease send any inquiries or feedback about this document to [email protected]. Please include the document name and version with your inquiry or comments.

Copyright NoticeCopyright © 2008-2009 IDX Systems Corporation. All rights reserved.

Confidentiality and Proprietary RightsThe information contained in this document is the confidential property of IDX Systems Corporation (IDX). It is furnished under an agreement with IDX and may only be used in accordance with the terms of that agreement. The use of this document is restricted to customers of IDX and their employees. The user of this document agrees to protect IDX’s proprietary rights as expressed herein. The user further agrees not to permit access to this document by any person for any purpose other than as an aid in the use of the associated application software (“System”). In no case will this document be examined for the purpose of copying any portion of the System or to design another system to accomplish similar results. No part of this document may be reproduced in any form, by photostat, microfilm, xerography, or any other means, or incorporated into any information retrieval system, electronic or mechanical, without the written permission of the copyright owner. The information in this document is subject to change without notice, and should not be construed as a commitment by IDX. Though every effort has been taken to ensure the validity and usefulness of its contents, IDX assumes no responsibility for errors that may appear in this document.Inquiries regarding permission for use of material contained in this document should be addressed to:

IDX Systems Corporation40 IDX DriveP.O. Box 1070

Burlington, VT 05402IDX would like to remind its customers that there may be legal, ethical, and moral obligations for medical care providers to protect sensitive patient information when dealing with vendors such as IDX. Before customers allow IDX to access confidential patient information from the customers’ data processing systems, they must obtain the written consent of the patient. In addition before disclosing confidential information to IDX, customers should obtain the explicit written consent of IDX. Please direct any questions concerning these matters to the IDX Legal Department.

TrademarksIDX®, Imagecast™, IDXrad™, IDXConnectR™, Mammography Administration Module™, and MAM™ are trademarks or registered trademarks of IDX Investment Corporation. All other brand and product names are trademarks or registered trademarks of their respective companies.


Contents

Getting Oriented .................................................................................................................. 7Radiologist Workstation Terminology................................................................... 8Logging In to Radiologist Workstation................................................................ 10Workspace Components....................................................................................... 12Logging Out of Radiologist Workstation............................................................. 16Changing Your Password..................................................................................... 16Calibrating Monitors for Image Viewing............................................................. 18Dates and Times Displayed in the Patient Timeline andFilter Worklists..................................................................................................... 19Working with Exam Memos ................................................................................ 23

Using the Folder List ......................................................................................................... 29Using Imagecast Tools ......................................................................................... 31Using Personal Folders......................................................................................... 33Using Public Folders ............................................................................................ 35

Using the Shortcuts Bar..................................................................................................... 37Using Shortcuts .................................................................................................... 39Using Shortcut Groups ......................................................................................... 41

Using the Patient Directory ............................................................................................... 45Patient Directory Terminology............................................................................. 47Accessing the Patient Directory ........................................................................... 48Searching for Patients and Exams ........................................................................ 49Sorting the Patient Directory................................................................................ 51Viewing Diagnostic Reports for Exams in the PatientDirectory............................................................................................................... 52Viewing Documents for Exams in the Patient Directory ..................................... 55Viewing Exam Memos for Exams in the Patient Directory................................. 56Exporting Exams to a DICOM Device................................................................. 57Caching Exams from the Patient Directory.......................................................... 58 Selecting Studies to View/Read from the Patient Directory ................................ 59

Using Filter Worklists ....................................................................................................... 61Filter Worklist Terminology ................................................................................ 63Creating Filter Worklists ...................................................................................... 64Editing an Existing Filter Worklist ...................................................................... 66Deleting a Filter Worklist..................................................................................... 66Accessing a Filter Worklist .................................................................................. 68Customizing the Appearance of a Filter Worklist................................................ 70

4 IDX Imagecast PACS 3.3 Radiologist Workstation Training GuideContents

Confidential. © 2008-2009 IDX Systems Corporation. All rights reserved.IDXR

Sorting a Filter Worklist .......................................................................................72Viewing Diagnostic Reports for Exams in a Filter Worklist ................................73Viewing Documents for Exams in a Filter Worklist ............................................76Viewing Exam Memos for Exams in a Filter Worklist ........................................77Exporting Exams to a DICOM Device from a Filter Worklist .............................78Caching Exams from a Filter Worklist .................................................................79Viewing the List of Exceptions for Exams in a Filter Worklist ...........................80Viewing Further Exam Information for Exams in a Filter Worklist ....................81Selecting Studies to View/Read from a Filter Worklist........................................82

Working with the View Exams Tab...................................................................................83Overview of the View Exams Tab........................................................................83Loading Different Exams in to the Canvas Page Using theView Exams Tab...................................................................................................85Closing All Exams Open on the Canvas Page Using the ViewExams Tab ............................................................................................................86Loading Unselected Exams in to the Canvas Page Using theView Exams Tab...................................................................................................86

Working on the Canvas Page .............................................................................................89Canvas Page Components.....................................................................................90Using the Navigational Timelines ........................................................................94Exam Rack Components.......................................................................................99Using the Exam Summary Window ...................................................................101Working with Presentation States.......................................................................102Working with Matching Series Rules .................................................................105Working with Hanging Protocols .......................................................................108Exporting Exams to a DICOM Device ...............................................................122Adding Exams to Folders....................................................................................122Viewing Extended Exam Information (DICOM Metadata) ...............................123Setting Horizontal/Vertical Rack Orientation.....................................................125Marking an Exam Read ......................................................................................126Using the Navigational Rectangles.....................................................................127Organizing Images and Series Within the Exam Rack.......................................130Using the Diagnostic Thumbnails on the Canvas Page ......................................130Expanding Images and Series into Floating Windows .......................................131Adjusting Window Width and Window Level ...................................................132Cine Slices in a Multi–image Series on the Canvas Page...................................133Using Scout Lines for CT and MR Scout Images...............................................134Using the Localizer .............................................................................................135Configuring Your Diagnostic Monitors from the CanvasPage.....................................................................................................................138

Reading Exams on the Diagnostic Monitors....................................................................141Diagnostic Monitor Components........................................................................143

IDX Imagecast PACS 3.3 Radiologist Workstation Training Guide 5 Contents


Selecting Images and Series to View and Read on theDiagnostic Monitors ........................................................................................... 145Working with Images in the Diagnostic Monitors ............................................. 145Adjusting Window Width and Window Level................................................... 146Zooming ............................................................................................................. 147Panning............................................................................................................... 149Cine Slices in a Multi–image Series................................................................... 150Overview of Measurement Tools ....................................................................... 151Measuring the Distance Between Two Points (Ruler Tool)............................... 151Measuring an Angle on an Image (Angle Tool)................................................. 153Measuring the Area of a Region of Interest ....................................................... 154Displaying the Point Value of an Image (MeasuringLuminance)......................................................................................................... 156Using the Measurement Palette.......................................................................... 157Calibrating an Image .......................................................................................... 159Understanding US Measurements ...................................................................... 159Annotating Images ............................................................................................. 160Editing Measurement and Annotation Formats (Line Styleand Font)............................................................................................................. 163Deleting Measurements and Annotations........................................................... 164Inverting Image Brightness and Contrast........................................................... 164Applying Image Processing Filters .................................................................... 166Viewing Slices Using Scout Lines ..................................................................... 167Viewing Slices Using the Localizer ................................................................... 168Viewing Image Series Using Multi–Image Modes ............................................ 168Selecting a Monitor Layout................................................................................ 169Selecting Series .................................................................................................. 170Selecting Relevant Exams .................................................................................. 170Cloning Series .................................................................................................... 171Expanding Images and Series into Floating Windows....................................... 172Marking Key Images .......................................................................................... 172Key Image Series Stack...................................................................................... 173Cycling through Key Images.............................................................................. 175Comparing Images Using the Linking Option ................................................... 177Saving an Image to a File ................................................................................... 178Copying an Image to the Clipboard ................................................................... 179Printing an Image ............................................................................................... 179Deleting a Series or Image ................................................................................. 180Flipping an Image Around the X or Y Axis....................................................... 182Rotating an Image .............................................................................................. 182Sorting a Series................................................................................................... 183Splitting an Exam Series .................................................................................... 184

6 IDX Imagecast PACS 3.3 Radiologist Workstation Training GuideContents


Managing Duplicate Study Instance Unique Identifiers.....................................184Viewing Diagnostic Reports ............................................................................................189

Accessing Diagnostic Reports ............................................................................189Viewing Diagnostic Reports for Related Prior Exams .......................................190Viewing Diagnostic Reports for any Exams for the SelectedPatient .................................................................................................................191Printing Diagnostic Reports................................................................................192Viewing Provider Contact Information on the ClinicalExam Notes Window ..........................................................................................192Viewing Allergy Information on the Clinical Exam NotesWindow...............................................................................................................192Viewing Documents from the Clinical Exam Notes Window............................193Viewing Exam Memos from the Clinical Exam NotesWindow...............................................................................................................193Signing Reports...................................................................................................202Working with Diagnostic Reports ......................................................................208


Getting Oriented

Welcome to Radiologist Workstation!

The Radiologist Workstation application is a specialized workstation designed for radiologists and those who read images to render clinical diagnoses.

!Caution

The Radiologist Workstation application should be used by a licensed radiologist or by a non–radiologist (technologist or intern) while in direct/live consultation with a licensed radiologist.

Radiologist Workstation is a reading workstation that separates diagnostic image presentation and navigation. The workstation consists of two diagnostic monitors and a console.

The console provides the radiologist with a user interface from which he or she can select images to view on the diagnostic monitors or view clinical information about a patient. The console also displays a complete real–time overview of the entire patient history in a clinical history timeline. The timeline feature presents a graphical representation of the patient’s clinical history and allows the radiologist to interactively select any study without returning to their worklist. Images are displayed on the diagnostic monitors (thereby dedicating the diagnostic monitor space for image display only) and all image manipulation functions are built in to the mouse.

This chapter provides a brief overview of Radiologist Workstation.

Objectives Upon completing this chapter, you will be able to:

Diagnostic monitors

Console

IDXR Confidential. © 2008-2009 IDX Systems Corporation. All rights reserved.

8 Getting OrientedRadiologist Workstation Terminology

n Understand Radiologist Workstation terminologyn Log in to Radiologist Workstation n Identify components of the Radiologist Workstation workspace n Log out of Radiologist Workstationn Change your passwordn Calibrate monitors for image viewing n Describe the logic by which Radiologist Workstation display

dates and times n Work with exam memos

Lesson 1: Radiologist Workstation Terminology

Common terms are used throughout the Radiologist Workstation application when referring to selecting and reading exams. In order to better understand Radiologist Workstation functionality, refer to the following terms.

Common Radiologist Workstation Terminology (Page 1 of 2)

Term Definition

Console The small monitor that displays your worklists and the canvas page. You can view patient information and select exams to read on the console. Also referred to as the navigation console.

Control strip Area located at the top of the workspace and contains the following items:n Monitor iconsn iExport buttonn Preferences buttonn Help buttonn Tool tabn iQuery tabn View Exams tab

Diagnostic monitors Monitors on which diagnostic radiological images are displayed.


Getting Oriented 9Radiologist Workstation Terminology

iExport Queue Allows users (generally application managers) to export Radiologist Workstation exams in DICOM format to another DICOM device, such as a DICOM printer, a 3–D imaging tool, or a DICOM archive.

Folder List The folder list organizes, in a directory structure, all the tools and filters available to a particular user.

Image exceptions Situations in which patient or exam information entered at a modality (scanner) does not match information in Radiologist Workstation. (Image exceptions are also referred to as broken studies, exceptions, or image acquisition exceptions.)

iQuery A tool that allows you to retrieve DICOM studies from your organization’s digital archive and send them to your diagnostic workstation.

Main Menu tool Provides access to additional Imaging Suite and Imagecast RIS functionality (such as the Exceptions Handler option and various Patient Record options) that, depending on your user privileges, you may or may not have access to.

User Filters (My Filters) Filter Worklists available only for the user that defined them.

My History folder Lists the last 100 exams you have viewed.

Patient Directory Allows you to search for patients and exams with images.

Radiologist Workstation A specialized workstation designed for radiologists and those who read images to render clinical diagnosis. The application is comprised of a navigation console and two diagnostic monitors.

Shortcut Bar The Shortcuts Bar is a customizable way for you to access your most frequently used folders, filters, and tools.

System Filters Filter Worklists available to all users

Vertical toolbar Located on the left side of the Imaging Suite window, it allows you to access the various modules and options necessary to perform your tasks.

Workspace Displayed on the console. The Radiologist Workstation or Imaging Suite window in which you enter information or select exams to read.

Common Radiologist Workstation Terminology (Page 2 of 2)

Term Definition


10 Getting OrientedLogging In to Radiologist Workstation

Lesson 2: Logging In to Radiologist Workstation

Your first task in using Radiologist Workstation is to log in to the application. During training, you will receive a user ID, password, and instructions on the address and database name for your system.

1 Do one of the following:

– Start Microsoft Internet Explorer, in the Address field, enter the application address and press ENTER.

– Click the desktop icon for Radiologist Workstation.

The login window appears.

2 In the Username field, type your user name and press TAB.

3 In the Password field, type your password and press TAB.

4 Click Login.

The system validates your entries and determines your privileges from the security database. If you have previously logged in, the workspace appears and you can begin performing tasks. If this is your first time logging in, the system prompts you to specify a new password.

!Caution

To avoid unauthorized access to patients’ medical images and reports, do not leave a computer unattended while the application is running. As a user of this application, you assume responsibility for unauthorized access as long as you are logged in to the program. Before leaving a computer, you should exit the application.

When you first access Radiologist Workstation you are presented with the Patient Directory on the navigation console. Depending on your user privileges you may or may not have access to some items on the workspace. For more information about the items that appear


Getting Oriented 11Logging In to Radiologist Workstation

on the navigation console, refer to the Workspace Components section on page 12.


12 Getting OrientedWorkspace Components

Lesson 3: Workspace Components

The navigation console displays the user interface you will use to select exams to view and read. Refer to the following graphic.

The following sections provide detailed information about the components of the workspace noted above.

Shortcuts bar

Currently-selected tool/filter

Help button

Filter Worklist

Preferences button

Exceptions panel

Control strip

Folder List

View Exams tab

iQuery button

Logout button


Getting Oriented 13Workspace Components

Control stripThe control strip is located at the top of the workspace and contains the following items:

n iExport Queue buttonn Preferences buttonn Help buttonn Logout buttonn iQuery tabn View Exams tabn Currently selected tool or filter tab

iExport Queue button

Depending on your privileges, the iExport Queue button ( ) may be available. This button displays the iExport Queue, which allows users (generally application managers) to export Imagecast PACS exams in DICOM®1format to another DICOM device, such as a DICOM printer, a 3–D imaging tool, or a DICOM archive.

Preferences button

The preferences button ( ) displays the Preferences Dialog window where you can define your work environment to suit your individual needs.

Help button

The Help button ( ) displays the Help system which provides step–by–step instructions on how to complete tasks and explains essential concepts about the application.

Logout button The logout button ( ) logs you out of the Radiologist Workstation application.

Currently selected tool/filter tab

The left tab on the workspace displays the currently selected tool or filter.

1. DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information.


14 Getting OrientedWorkspace Components

Shortcuts BarThe Shortcuts Bar is a customizable way for you to access your most frequently used folders, filters, and tools. For more information refer to the Using the Shortcuts Bar page 37.

Folder ListThe Folder List organizes, in a directory structure, all the tools and filters available to a particular user.

The Folder List contains three default folders: Imagecast Tools, Personal Folders, and Public Folders.

- These folders cannot be renamed or deleted.

Imagecast Tools Use this folder to access the tools available to the Imagecast PACS user. Refer below for a description of the tools available.

- The tools displayed in the Imagecast Tools folder will vary based on user permissions.

n .n Main Menu—The Main Menu tool allows access to additional

functionality such as the Exceptions Handler option and various Patient Record options that, depending on your user privileges, you may or may not have access to.

- For more information about working with the Exceptions Handler or the Patient Record options, refer to the Help which is accessed by clicking the Main Menu tab and then clicking Help below the vertical toolbar.

n My Filters—Use this folders to access all of your personalized Filter Worklists. These filters are created in the Filters section of the Preferences Dialog window. Filters can be based on combinations of modality, body part, exam code, date, patient age and so on. For more information, refer to the using the filterworlist section on page 61.

n My History—Lists the last 100 exams you have viewed.n Patient Directory—Use this tool to search for exams. Ad hoc

searches can be performed using Patient Name, MRN, Exam Date, Patient Location, Modality, Referring Physician and so on.


Getting Oriented 15Logging Out of Radiologist Workstation

For more information about the Patients tab, refer to the Using the patient Directory on page 45.

n .n System Filters—Use this folder to access the system’s default

search filters. These include Completed Exams, CR All, CT All, Last 3 Days, Last 7 Days, Last Month, and MR All. For more information, refer to the Using Filter Worklists section on page61

n Plug Ins—Depending on how Imagecast PACS is defined at your organization, you may see additional tools not listed here (for instance, a link to your dictation system). For more information, contact your application manager.

Personal Folders Use this directory to create collections of Exam Links. You can create up to 25 subfolders. For example, if you were writing a paper on a certain type of disease, you could create a folder and add exams links that display the effects of the disease. For more information, refer to the Using the Personal Folder section on page 33.

Public Folders Use this directory to create collections of exam links that can be accessed by everyone. For more information, refer to the Using Public Folders section on page 35.

Exceptions panelThe Exceptions Panel on a Filter Worklist displays a list of acquisition exceptions if any are present. Image exceptions are situations in which patient or exam information entered at a modality (scanner) does not match information in Radiologist Workstation. (Image exceptions are also referred to as broken studies, exceptions, or image acquisition exceptions.)

- For more information about working with exceptions, refer to the Help which is accessed by clicking the Main Menu tool and then clicking Help below the vertical toolbar.

Lesson 4: Logging Out of Radiologist Workstation

After completing your work, you must log out of the application.


16 Getting OrientedChanging Your Password

Click in the upper right corner of the workspace.

Lesson 5: Changing Your Password

Your application manager determines how frequently your password should be changed. Once this time period has elapsed, you will receive a message instructing you to change your password. You may designate a new password at any time (accessing the Passwords tab within the Prefs option on the upper right area of the Homepage). Consider changing your password if you feel that someone else might know your password.

When choosing a new password:n Use a password containing a combination of letters, numbers, and

symbols. n Your password must be a minimum of three characters in length.n Passwords are case sensitive. n Your new password cannot be one of the last ten passwords you

have previously used.n Your new password cannot be the same as your user ID.

Changing Your Password When Required by Radiologist Workstation1 If your application manager has determined that you must change

your password, when you log in the following message appears: Your password has expired, please change it after hitting the OK button!

2 Click OK.

Note: To change your password voluntarily, you can click Prefs (located on the upper right area of the homepage) then select the Passwords tab. For more information about changing your password, refer to the Manually Changing Your Password section on page 17.


Getting Oriented 17Changing Your Password

The Change Password window appears.

3 In the Old Password field, enter your current password.

4 In the New Password field, enter your new password.

5 In the Confirm New Password field, enter your new password again.

6 Click OK.

The login window is displayed again.

7 In the Username field, type your user name, and then press TAB.

8 In the Password field, type your password, and then press TAB.

9 Click Login.

Manually Changing Your Password1 Return to the homepage.

2 On the right upper corner, click Prefs

Select the Passwords tab.

3 In the Enter your current System Password field, enter your current password.

4 In the Enter new System Password field, enter your new password.

5 In the Type new System Password again for verification field, enter your new password again.

6 Click change password.

Radiologist Workstation displays the following message: System Password successfully changed.

7 Click OK.


18 Getting OrientedCalibrating Monitors for Image Viewing

8 Click close.

Lesson 6: Calibrating Monitors for Image Viewing

The correct calibration of your navigation console (the small monitor that displays your worklists and the canvas page) and your diagnostic monitors (where the diagnostic radiological images are displayed) is critical to the identification of patient pathology and subsequent patient care. Accurate diagnoses cannot be obtained if the diagnostic monitors used in conjunction with Radiologist Workstation are not properly configured and calibrated.

To ensure that your diagnostic monitors and your navigation console monitor are calibrated for optimum image viewing, contact your application manager or your internal application support help desk.

!Caution

This product should be used by a licensed radiologist or by a non–radiologist (technologist or intern) while in direct/live consultation with a licensed radiologist.

Monitors should be configured carefully following the specifications and directions specified by the manufacturer. Refer to the documentation provided with your monitors for information about calibrating the console and diagnostic monitors appropriately.

Lesson 7: Dates and Times Displayed in the Patient Timeline and Filter Worklists

This topic describes the logic by which Enterprise Access and Radiologist Workstation display dates and times in the Patient History Timeline and Filter Worklists. This topic also addresses the following issues:

n Affected windows/options


Getting Oriented 19Dates and Times Displayed in the Patient Timeline and Filter Worklists

n Affects on linked exams with attached studiesn High–level description of the date and time logic

!Caution

Potential issues regarding the logic by which dates and times are displayed in the worklists have been identified. For more information, access the Help, and search on “cautions” using the Index tab.

Date and time logic

If a study date and time is supplied by the modality (that is, if digital images exist for an exam), then that date and time will display. This date and time is supplied to Enterprise Access and Radiologist Workstation by a DICOM message from the modality and is considered the most accurate date and time as it denotes the precise date and time at which the images were acquired. In cases where multiple studies are attached to a single exam, the earliest date and time associated with one of the studies will display as the date and time for the exam.

If a date and time is not supplied by the modality or if digital images are not attached to an exam, then dates and times from the RIS (radiology information system) are used. The following rules apply.

Dates and Times Displayed in Enterprise Access and Radiologist Workstation

If an exam’s status is… And a date and time is not available/supplied by the modality, then the following will be used…

O (Ordered) Date and time on which exam was ordered

S (Scheduled) Date and time for which exam is scheduled to occur (as entered during scheduling)

X (Canceled) Date and time assigned to the exam prior to its cancellation is retained

I (In progress) Date and time at which the exam was begun

C (Completed) Date and time at which the exam was completed

N (Non–reportable) Date and time at which the exam was completed

D (Dictated) Date and time at which the exam was completed

P (Preliminary) Date and time at which the exam was completed

F (Finalized) Date and time at which the exam was completed

A (Addended) Date and time at which the exam was completed

R (Revised) Date and time at which the exam was completed


20 Getting OrientedDates and Times Displayed in the Patient Timeline and Filter Worklists

A study’s date and time is stored in Enterprise Access or Radiologist Workstation exactly as it is supplied by the DICOM source. If the data is supplied in an invalid format, the data is stored as NULL and the date and time displayed in the applications is determined by the rules set forth in the table above. (Invalid refers to instances in which the date and time are missing, the date and time are in an unrecognizable format, or the date and time are outside of the range of dates the SQL server can store (that is, prior to 01/01/1753).) Previously, invalid study date and times sent for Imagecast PACS studies were stored as 1/1/2200 and study dates and times sent through third party interfaces that were invalid or dated prior to 1/1/1970 were stored with the current date and time.

- Dates and times captured at modalities and digitizers cannot be manually edited in Enterprise Access or Radiologist Workstation, therefore it is pertinent that you maintain the clocks on your modalities and applications to ensure that they are in sync with each other.

What windows/options are affected?

The following areas in Enterprise Access and Radiologist Workstation display dates and times based upon the rules described in the table on page 19:

n Patient History Timelinen Patient Directoryn Filter Worklistsn Date and time displayed at the top of the Clinical Exam Notes

windown Related Exams list on Clinical Exam Notes window

How are linked exams with attached studies affected?

If one or more studies are attached to linked exams, the date and time displayed in Enterprise Access or Radiologist Workstation for each exam is determined individually according to the rules noted in the table on page 19. For example, if the modality supplied a date and time of image acquisition, all exams will share that date and time. If an image acquisition date and time is not available, then the date and time for each exam is determined based upon the rules in the table on page 19.


Getting Oriented 21Dates and Times Displayed in the Patient Timeline and Filter Worklists

High–level description of the date and time logic

The following table provides a high–level description of the logic used to determine dates and times displayed in Enterprise Access and Radiologist Workstation.

Enterprise Access and Radiologist Workstation Date and Time Logic (Page 1 of 2)

High–Level Description of Enterprise Access and Radiologist Workstation Date and Time Logic

Definitions: n Study date and time—the date and time supplied to Enterprise Access/

Radiologist Workstation by a DICOM message denoting the precise date and time at which images were acquired (also referred to as acquisition date and time)

n Creation date and time—the date and time at which a study was created (that is, when Enterprise Access/Radiologist Workstation was notified of the existence of the study)

n NULL—no value

Imaging Suite Date and Time Rules:1 For image exceptions without a study date and time (NULL), the date and time

on which the exception was created (that is, when Enterprise Access/Radiologist Workstation was notified of the existence of the study) is used.

2 When an image exception without a study date and time (NULL) is manually resolved to an exam via the Exceptions Handler, the exam’s date and time is determined by the rules explained on page 19 (the image exception’s creation date and time is no longer used as described in item 1 above).


22 Getting OrientedDates and Times Displayed in the Patient Timeline and Filter Worklists

3 If a study without a study date and time (NULL) is attached to an exam, the exam’s date and time (as determined by the rules on page 19) is displayed in red on the Digital Image Management window.

4 A user manually resolves an exception to an exam via the Exceptions Handler. If the exam (or any exam linked to that exam) to which the exception was resolved is in O (Ordered) or S (Scheduled) status, the application asks the user if he wants to begin the exam. If the user responds yes, for each exam, the study (acquisition) date and time is used. If the study date and time is NULL, the date and time at which Enterprise Access/Radiologist Workstation was notified of the existence of the study (creation date and time) is used.

5 If a new study is automatically resolved to an existing exam (the exam may be linked to other exams with attached studies), for each exam in the linked set with a status of O (Ordered) or S (Scheduled), the following occurs:– The exam is automatically begun (the exam’s status changes to I (In

progress)).– The earliest study date and time associated with one of the studies displays

as the date and time for the exam. If the study date and time is NULL, the earliest date and time on which Enterprise Access/Radiologist Workstation was notified of the existence of the study (creation date and time) is used.

6 If a new study is automatically resolved to an existing exam in O (Ordered) or S (Scheduled) status and the exam is not begun, then the study date and time is used. However, if the study date and time is NULL, exams in O (Ordered) status will use the date and time on which the exam was ordered and exams in S (Scheduled) status will use the date and time for which the exam is scheduled to occur (as entered during scheduling).

7 If an existing exception is automatically resolved to an exam in O (Ordered) or S (Scheduled) status and the exam is not begun, then the study date and time is used. However, if the acquisition date and time is NULL, exams in O (Ordered) status will use the date and time on which the exam was ordered and exams in S (Scheduled) status will use the date and time for which the exam is scheduled to occur (as entered during scheduling).

Enterprise Access and Radiologist Workstation Date and Time Logic (Page 2 of 2)

High–Level Description of Enterprise Access and Radiologist Workstation Date and Time Logic


Getting Oriented 23Working with Exam Memos

Lesson 8: Working with Exam Memos

!Caution

Potential issues have been identified with Exam Memos. For more information, refer to the Exam Memos Cautions section on page 43.

An exam memo is a mechanism technologists, radiologists, clinicians, and referring physicians use to share information about an exam. An unlimited number of exam memos can be attached to one exam.

Depending on your user privileges, you can access exam memos from the following Imagecast PACS areas:

n Patient Directoryn Filter Worklistsn Local Exam Cache foldern Clinical Exam Notes window (diagnostic report) on the exam

rackn Show Exam Memos Patient History Timeline pop-up menu

option

After you have accessed the exam memos user interface, you can perform the following tasks:

n View exam memos n Create an exam memo n Delete an exam memo n View exam memo audit information

Accessing Exam Memos from the Patient Directory

On the Patient Directory, right-click the exam and click Show Exam Memos.

The appropriate exam memos appear in the Memos tab on the Clinical Exam Notes window.


24 Getting OrientedWorking with Exam Memos

Accessing Exam Memos from the Filter Worklist

On the Filter Worklist, right-click the exam and click Show Exam Memos.


Accessing Exam Memos from the Local Exam Cache Folder

On the Local Exam Cache folder, right-click the cached exam and click Show Exam Memos.


Accessing Exam Memos from the Exam Rack1 On the exam rack, click , , or . The Clinical Exam Notes

window is displayed.

2 On the Clinical Exam Notes window, click the Memos tab. The exam memos user interface is displayed.



Note: If a diagnostic report is not yet available, the Memos tab is automatically displayed when you click , ,

- n If you do not have access privileges, the Memos tab is not available. Positioning the cursor over the tab displays a tooltip informing you of the lack of privileges.

n You cannot access exam memos for exams in statuses for which access privileges have not been granted.

Accessing Exam Memos from the Patient History Timeline1 On the Patient History Timeline, right-click the exam for which you

want to view exam memos and select Show Exam Memos.



The the exam memos user interface is displayed.

- n If you do not have access privileges, the Memos tab is not available. Positioning the cursor over the tab displays a tooltip informing you of the lack of privileges.

n You cannot access exam memos for exams in statuses for which access privileges have not been granted.

Viewing Exam Memos 1 Access exam memos.

Exam memos appear in the Memos tab on the Clinical Exam Notes window.

Notes:n If multiple exam memos are attached to an exam, they are

displayed in reverse chronological order. If one of the memos is of a document type that has been flagged to appear first in the list, it appears before all others in the list, and the float-to-top



indicator ( ) appears to the left of its timestamp. If several memos are of differing document types that have all been flagged to appear first in the list, they all appear before others in the list in reverse chronological order. Exam memos below the float-to-top group appear in reverse chronological order.

n A memo icon ( ) displayed on the Memos tab on the Clinical Exam Notes window alerts you to the existence of exam memos.

n You can right-click text in an exam memo to select the text, copy it, and paste it into another document.

2 (Optional) Click or or use the vertical scroll bar to navigate through memos.

- The ability to view exam memos is based on user privileges and the document type of the memos.

Creating an Exam Memo 1 Do one of the following from the exam memo user interface:

– If exam memos already exist for the exam, click add new.

– If no exam memos exist for the exam, go to the next step.

2 In the New Memo field, type your message.

Note: An exam memo has a maximum length of 1000 characters.

3 Click save.

The Dictionary Lookup window is displayed if you have more than one exam memo document type that you can apply to the exam memo. In this case, select a document type to assign to the exam memo.

- n The ability to create exam memos is based on user privileges and the document type of the memos.

n Exam memos cannot be edited once they have been saved.

Deleting an Exam Memo 1 From the exam memo user interface, select the memo to delete.

The selected memo is highlighted in yellow.

2 Click delete.

The Audit window is displayed.



3 In the Reason field, enter a reason for deleting the text memo, or click to select a reason.

4 In the Authorized By field, enter your user ID, or click to select your user ID.

5 Click ok.

- The ability to delete exam memos is based on user privileges.

Viewing Exam Memo Audit Information 1 From the exam memo user interface, select the memo to audit. The

selected memo is highlighted in yellow.

2 Click audit.

The Exam Memo Audit Trail window is displayed and shows audit information for the selected exam memo.

- Accessing, creating, and deleting exam memos are audited activities.

Confidential. © 2008-2009 IDX Systems Corporation. All rights reserved.

IDXR

Chapter 1

Using the Folder List

Overview of the Folder List ................................................................ 30Using Imagecast Tools ...................................................................... 31Using Personal Folders ...................................................................... 33Using Public Folders .......................................................................... 35

30 Using the Folder ListOverview of the Folder List


Overview of the Folder List

The Folder List organizes all the tools, filters, and folders available to a particular user in a directory structure.

Refer to the following graphic.

The Folder List contains the following default folders:

• Imagecast Tools

• Personal Folders

• Public Folders

These folders cannot be renamed or deleted.

- For Enterprise Access users only:

The Folder List can only be accessed when you access Enterprise Access from the Patient option in the Worklist module. Follow these steps to access Enterprise Access from the Patient option in the Worklist module:

• On the Module Toolbar, click Worklist.• On the Option Toolbar, click Patient.

Folder List

Using the Folder List 31Using Imagecast Tools


IDXR

Using Imagecast Tools

The Imagecast Tools folder is used to access the tools available to you in Imagecast PACS.

The following tools are available in the Imagecast Tools folder:.

• Main Menu (Radiologist Workstation only)—Allows you to access additional functionality such as the Exceptions Handler option and various Patient Record options.

• My Filters—Allows you to access all of your personalized Filter Worklists. Filters can be based on combinations of criteria (such as modality, body part, exam code, date, and patient age). Filter Worklists are created, edited, and deleted using the Filters option in User Preferences and System Preferences. For more information about Filter Worklists, refer to Using Filter Worklists (page 61).

• My History—Allows you to list the last 100 exams you have viewed.

• Patient Directory—Allows you to search for exams. Ad hoc searches can be performed using various criteria (such as Patient Name, MRN, Exam Date, Patient Location, Modality and Referring Physician). For more information about the Patient Directory, refer to Using the Patient Directory (page 45).

• Plug Ins—Allows you to access additional tools (such as a dictation system), depending on how Imagecast PACS is defined at your organization, For more information about Plug Ins, contact your application manager.

- The tools displayed in the Imagecast Tools folder will vary based on user privileges.

32 Using the Folder ListUsing Imagecast Tools


Accessing an Imagecast Tool or Filter

Follow the below instructions to access an Imagecast tool or filter.

1. On the Folder List, double–click Imagecast Tools.

2. Click on the desired tool or Filter Worklist.

The tool or Filter Worklist appears to the right of the folder list.

Using the Folder List 33Using Personal Folders


IDXR

Using Personal Folders

Personal folders are used to create collections of exams. You can create up to 25 subfolders.

Creating a New Personal Folder

Follow the below instructions to create a new personal folder.

1. On the Folder List, right–click Personal Folders or right–click on a folder within the Personal Folders directory.

2. Click Add New Folder.

A new subfolder is displayed below the folder you selected.

3. Enter the name of the folder.

4. Press ENTER.

Renaming a Personal Folder

Follow the below instructions to rename a personal folder.

1. Right–click a folder.

2. Click Rename Folder.

3. Enter the new name.

4. Press ENTER.

Adding an Exam to a Personal Folder

Follow the below instructions to add an exam to a personal folder.

1. Make sure the personal folder in which you want to place the exam is displayed on the Folder List.

Example. If you were writing a paper on a certain type of disease,

you could create a folder and add exams that display the effects of the disease.

- • Personal folders can only be accessed by the user who created them.

• A personal folder cannot contain more than 500 exam links or 25 subfolders.

• The folder list cannot be more than five levels deep.

• Folders cannot be added to the Imagecast Tools directory.

34 Using the Folder ListUsing Personal Folders


2. Click and drag an exam into the desired folder.

Displaying an Exam Located In a Personal Folder

Follow the below instructions to display an exam located in a personal folder.

1. Click on the personal folder that contains the exam(s) you want to display.

2. Double–click on an exam.

Adding an Exam to a Personal Folder from the Canvas Page

Follow the below instructions to add an exam to a personal folder from the canvas page.

1. Right–click on an exam in the Patient History Timeline.

2. Click Add Exam To Folder.

The Folder Dialog window is displayed.

3. Select the personal folder in which you want to place the exam.

4. Click OK.

Using the Folder List 35Using Public Folders


IDXR

Using Public Folders

Public folders are used to create collections of exams that can be accessed by all users.

Creating a New Public Folder

Follow the below instructions to create a new public folder.

1. On the Folder List, right–click Public Folders or right–click on a folder in the Public Folders directory.

2. Click Add New Folder.

A new public subfolder displays below the folder you selected.

3. Enter the name of the folder.

4. Press ENTER.

Renaming a Public Folder

Follow the below instructions to rename a public folder.

1. Right–click a public folder

2. Click Rename Folder.


4. Press ENTER.

Adding an Exam to a Public Folder

Follow the below instructions to add an exam to a public folder.

1. Make sure the public folder in which you want to place the exam is displayed on the Folder List.

2. Click and drag an exam into the desired folder.

- • Public folders can be accessed by any user who has permission to use public folder functionality.

• A folder cannot contain more than 500 exam links or 25 subfolders.

• The folder list can not be more than five levels deep.

36 Using the Folder ListUsing Public Folders


Viewing an Exam Located in a Public Folder

Follow the below instructions to view an exam located in a public folder.

1. Click on the public folder that contains the exam(s) you want to display.

2. Double–click on an exam.

Adding an Exam to a Public Folder from the Canvas Page

Follow the below instructions to add an exam to a public folder from the canvas page.

1. Right–click on an exam in the Patient History Timeline.

2. Click Add Exam To Folder.

The Folder Dialog window is displayed.

3. Select the folder in which you want to place the exam.

4. Click OK.


IDXR

Chapter 1

Using the Shortcuts Bar

Overview of the Shortcuts Bar ........................................................... 38Using Shortcuts ................................................................................ 39Using Shortcut Groups....................................................................... 41

38 Using the Shortcuts BarOverview of the Shortcuts Bar


Overview of the Shortcuts Bar

The Shortcuts Bar is a customizable way for you to access your most frequently used folders, filters, and tools.


The Shortcuts Bar can only be accessed when you access Enterprise Access from the Patient option in the Worklist module. Follow these steps to access Enterprise Access from the Patient option in the Worklist module:


Using the Shortcuts Bar 39Using Shortcuts


IDXR

Using Shortcuts

Shortcuts allow quick access to your most frequently used folders, filters, and tools.

Using a Shortcut

To use a shortcut, on the Shortcuts Bar, click on the desired shortcut. The folder contents, filter, or tool you selected will display to the right of Shortcuts Bar. Refer to the following graphic.




Example. Clicking the Completed Exams shortcut displays the

Completed Exams Tab and all patients who match completed exams filter criteria, as shown below.

- The Shortcuts Bar cannot be removed. You can resize it by clicking and dragging on the right divider.

Click a shortcut to display desired content

Shortcuts Bar

40 Using the Shortcuts BarUsing Shortcuts


Creating a Shortcut

Follow the below instructions to create a shortcut.

1. Do one of the following:

– On the Shortcuts Bar, click to display the Folder List.

– Right–click the Shortcuts Bar and select Show Folder List.


– Click and drag an icon from the folder list to the Shortcuts Bar.

– Right–click a tool, folder, or Filter Worklist and select Create Shortcut.

Deleting a Shortcut

1. Right–click a shortcut.

2. Click Remove From Shortcut Bar.

Renaming a Shortcut

1. Right–click on a shortcut.

2. Click Rename Shortcut.


4. Press ENTER.

Using the Shortcuts Bar 41Using Shortcut Groups


IDXR

Using Shortcut Groups

Shortcut groups are used to organize your shortcuts.

You can add an unlimited number of shortcut groups. As groups accumulate, they are stacked in the Shortcuts Bar. Refer to the following graphic.

Example. Create a Filters shortcut group in which you could place

all of your most frequently used filters.




Shortcut groups

42 Using the Shortcuts BarUsing Shortcut Groups


Accessing a Shortcut Group

To access shortcut group, on the Shortcuts Bar, click on the shortcut group’s header.

Creating a Shortcut Group

Follow the below instructions to create a shortcut group.

1. Right–click anywhere on the Shortcuts Bar.

2. Click Add New Group.

The New Group field is displayed at the bottom of the Shortcuts Bar.

3. Enter a new name for the shortcut group.

4. Press ENTER.

Adding Shortcuts to a Shortcut Group

To add a shortcut to a shortcut group, do one of the following:

• Click and drag an icon from the folder list to the desired shortcut group on the Shortcuts Bar.

• Click on the desired shortcut group, right–click an icon in the Folder List, and click Create Shortcut.

Deleting a Shortcut Group

Follow the below instructions to delete a shortcut group.

1. Right–click the shortcut group you want to remove.

2. Click Remove Group.

The following message is displayed: Are you sure you want to remove the group YourGroupName?

3. Click Yes.

The shortcut group and all the shortcuts within that group are removed.

Using the Shortcuts Bar 43Using Shortcut Groups


IDXR

Renaming a Shortcut Group

Follow the below instructions to rename a shortcut group.

1. Right–click on the shortcut group you want to rename.

2. Click Rename Group.


4. Press ENTER.

44 Using the Shortcuts BarUsing Shortcut Groups



IDXR

Chapter 1

Using the Patient Directory

Overview of the Patient Directory....................................................... 46Patient Directory Terminology............................................................ 47Accessing the Patient Directory .......................................................... 48Searching for Patients and Exams ...................................................... 49Sorting the Patient Directory.............................................................. 51Viewing Diagnostic Reports for Exams in the Patient Directory ............. 52Viewing Documents for Exams in the Patient Directory ........................ 55Viewing Exam Memos for Exams in the Patient Directory ..................... 56Exporting Exams to a DICOM Device .................................................. 57Caching Exams from the Patient Directory .......................................... 58FSelecting Studies to View/Read from the Patient Directory ................. 59

46 Using the Patient DirectoryOverview of the Patient Directory


Overview of the Patient Directory

Imagecast PACS has two types of worklists. The first type of worklists are Filter Worklists. A Filter Worklist is organized by exam and contain only exams that meet the criteria specified by your filter criteria. Filter Worklists are accessed from the Imagecast Tools folder in the Folder List or from the Shortcuts Bar. For more information about Filter Worklists, refer to Using Filter Worklists (page 61).

The second type of worklists is the Patient Directory. The Patient Directory provides access to all patients with images in Imagecast PACS. You can select exams to view/read from both Filter Worklists and the Patient Directory.

This chapter details the tasks you can perform using the Patient Directory.

Using the Patient Directory 47Patient Directory Terminology


IDXR

Patient Directory Terminology

Common terms are used throughout Imagecast PACS when referring to tasks performed in the Patient Directory. In order to better understand the Patient Directory, refer to the following table.

Common Patient Directory Terminology

Term Definition

Filter Worklist Displays studies to be read.

Patient Directory A tool used to list all patients and exams with images. You can then select the exam whose images you want to view.

Sort A function that allows you to change the default order in which exams appear on the Patient Directory. For example, you may want to sort the Patient Directory by exam date or status instead of by patient name.

48 Using the Patient DirectoryAccessing the Patient Directory


Accessing the Patient Directory

The Patient Directory allows you to view a list of all patients with images. You can then select the exam whose images you want to view. The Patient Directory is essential for performing ad hoc queries and accessing exams that might be outside of your worklists. Refer to the following graphic.

Accessing the Patient Directory

To access the Patient Directory, do one of the following:

• If you are running Enterprise Access, on the Module Toolbar, click Worklist, then, on the Option Toolbar, click Patient.

• If you are running Radiologist Workstation, log in to Radiologist Workstation.

The Patient Directory is displayed.

Using the Patient Directory 49Searching for Patients and Exams


IDXR

Searching for Patients and Exams

Use the Patient Directory to search for patients and exams whose images and reports you want to view.

You can perform searches based on the following criteria:

• Patient name

• Patient ID (MRN or department number)

• Exam date

• Patient location

Although an entry in most of the fields on the Patient Directory window is optional, the more specific you make your search, the faster Imagecast PACS processes the list.

Expanded search You can also search the Patient Directory using specific information such as accession number, modality, referring provider and organization. To access the expanded search features, click on the Query button. Refer to the following graphic.

Searching for Patients and Exams

Follow the below instructions to search for patients/exams from the Patient Directory.

1. Access the Patient Directory.

2. Enter information in the search fields to identify the patient or exam. Refer to the following table.

To perform a search based on... Enter data in the following format...

Patient name Enter the patient’s name in the Patient Name field using the following format: Last name, First name.

(Page 1 of 2)

50 Using the Patient DirectorySearching for Patients and Exams


3. Click to access the expanded search fields and enter information as appropriate.

Note: The most efficient way to find a patient is to use the patient’s MRN. The most efficient way to find a specific exam for a patient is to use the accession number.

4. Click Query or press ENTER.

The search results list is displayed.

Note: To display all exams with images in the Patient Directory, click in the Exam Date field, select All, and then click Query. (Please note that searching for all exams is a large query that may take a lot of time.)

MRN (or department number)

Eight digits are required. If MRNs and department numbers are less than eight digits in length at your organization, append leading zeros to the MRN or department number. For example, a patient’s MRN is 112233. This MRN is only six digits in length. You must append two leading zeros to the MRN. Enter 00112233 in the Patient ID field.

Exam date Do one of the following:

• Enter a date in the Exam Date field using the following format MM/DD/YYYY. (For example, 01/01/2002.)

• Click and select one of the following predefined date ranges: – All– Today– Last 3 days– This week– Last 2 weeks

Patient location Enter the patient location in the Patient Location field or click and select a location from the drop down list.

To perform a search based on... Enter data in the following format...

(Page 2 of 2)

Using the Patient Directory 51Sorting the Patient Directory


IDXR

Sorting the Patient Directory

You can sort the Patient Directory by patient name, patient ID, exam date, or patient location. Click the gray column headings above the search fields to sort the Patient Directory in ascending order (A–Z or 1–9) or descending order (Z–A or 9-1). The and symbols indicate the column by which the Patient Directory is sorted. indicates that the list is sorted in ascending order. indicates that the list is sorted in descending order.

Sorting the Patient Directory

Follow the below instructions to sort the Patient Directory.


2. Click the column heading by which you want to sort the Patient Directory.

appears in the column heading, indicating that the list is now sorted by that property in ascending order.

3. To order the list by the same property in descending order, click .

Notice that changes to .

52 Using the Patient DirectoryViewing Diagnostic Reports for Exams in the Patient Directory


Viewing Diagnostic Reports for Exams in the Patient Directory

You can view diagnostic reports for exams in the Patient Directory. The report is displayed in the Clinical Info tab on the Clinical Exam Notes window. In the Clinical Info tab on Clinical Exam Notes window, you can also:

• View a diagnostic report

• View allergy information

• Display provider contact information

• View diagnostic reports for related exams

• View diagnostic reports for any of the selected patients’ exams

• Print a diagnostic report

The report icon ( ) indicates whether a report is available for an exam in the Patient Directory. The report icon only displays next to a study in the Patient Directory after the study is in F (Finalized) status (that is, after the report has been dictated and typed (marked read)).

Viewing a Diagnostic Report for an Exam in the Patient Directory

Follow the below instructions to view a diagnostic report for an exam in the Patient Directory.

1. On the Patient Directory, right–click the exam and then click Show Report.

The diagnostic report is displayed in the Clinical Info tab on the Clinical Exam Notes window.

2. Click in the upper right corner of the Clinical Exam Notes window to return to the Patient Directory.

Viewing Allergy Information

You can view a patient’s allergy information from the Clinical Info tab on the Clinical Exam Notes window.

If the patient has allergy information on record, the following message is displayed in red text next to the exam status: NOTE: This patient has allergies recorded. Click here to display allergies. If the patient does not have allergies on record, the following message is displayed in red text next to the exam status: No allergies on record. Please validate in your Registration/Ordering system.

Using the Patient Directory 53Viewing Diagnostic Reports for Exams in the Patient Directory


IDXR

To view a patient’s allergy information, in the Clinical Info tab on the Clinical Exam Notes window, click the red text next to the exam status.

Displaying Provider Contact Information

You can display contact information for the requesting or attending provider from the Clinical Info tab on the Clinical Exam Notes window.

Follow the below instructions to display provider contact information.

1. In the Clinical Info tab on the Clinical Exam Notes window, click to display the provider’s phone number, beeper number, and e-mail address.


Viewing Diagnostic Reports for Related Exams

A list of related exams appears at the bottom of the Clinical Exam Notes window. From this list, you can view a diagnostic report for a related exam. (The definition of a related exam has been established at your site. Contact your application manager or internal application support help desk for more information.)

Follow the below instructions to view diagnostic reports for related exams.

1. In the Related Exam List section of the Clinical Exam Notes window, click the accession number of the exam whose prior report you want to read.

Notes:

– If there are no related exams for this patient, the following message displays: No related exams found.

– You can sort the list of related prior exams by clicking a column heading.

2. Read the report and the notes displayed on the second Clinical Exam Notes window, and then click close.


- To hide the patient’s allergy information, click the red text that reads, Click here to hide allergies.

54 Using the Patient DirectoryViewing Diagnostic Reports for Exams in the Patient Directory


Viewing Diagnostic Reports for any of the Selected Patients’ Exams

You can view a complete list of all exams (including unrelated exams) for the selected patient on the Clinical Exam Notes window.

Follow the below instructions to view diagnostic reports for any of the selected patients’ exams.

1. In the Related Exam List section on the Clinical Exam Notes window, click all exams to see a complete list of all exams (including unrelated exams) for this patient.

Note: You can sort the list of exams by clicking a column heading.

2. In the list of all exams, click the accession number of the exam whose report you want to read.



Printing a Diagnostic Report

You can print a diagnostic report from the Clinical Info tab on the Clinical Exam Notes window.

Follow the below instructions to print a diagnostic report.

1. Right–click anywhere in the Clinical Info tab on the Clinical Exam Notes window.

2. Click Print on the pop–up menu.

3. On the Print window, enter printing information as appropriate.

4. Click Print.

Using the Patient Directory 55Viewing Documents for Exams in the Patient Directory


IDXR

Viewing Documents for Exams in the Patient Directory

If you are using the Document Management Solution and documents exist for the patient or exam, you can view these documents from the Patient Directory.

Follow the below instructions to view documents for exams in the Patient Directory.

1. On the Patient Directory, right-click the exam and click Show Report.

2. On the Clinical Exam Notes window, click .

For more information about the Document Management Solution, refer to the Document Management Solution Help.

56 Using the Patient DirectoryViewing Exam Memos for Exams in the Patient Directory


Viewing Exam Memos for Exams in the Patient Directory

You can view exam memos for exams in the Patient Directory.

To view exam memos for exams in the Patient Directory, right-click the exam and click Show Exam Memos.


For detailed information about working with exam memos, refer to working with Exam Memos (page 23).

!Caution

Potential issues have been identified with Exam Memos. For more information, refer to Exam Memos Cautions.

Using the Patient Directory 57Exporting Exams to a DICOM Device


IDXR

Exporting Exams to a DICOM Device

Depending on your user privileges, you may be able to export exams in DICOM format to another DICOM device, such as a DICOM printer, a 3–D imaging tool, or a DICOM archive. Once you specify that you want to export the exam, it appears on the iExport Queue, which allows you to monitor the exportation of exams. Your application manager must specify and connect external DICOM devices.

Sending/Exporting Exams to a DICOM Device

Follow the below instructions to send/export an exam to a DICOM device.

1. On the Patient Directory, right–click an exam or patient and select Export via DICOM on the pop–up menu.

The selected exam and a list of associated exams which are available for export is displayed.

2. Click the exams you want to export and click Next.

3. Click the DICOM device(s) to which you want to send the exam(s) and click Next.

4. Verify that the correct exams are going to the correct devices.

5. In the Email field, enter the e–mail address(es) of individual(s) who should be notified of this action.

6. In the Description field, enter a description of the action.

7. (Optional) Click High Priority to indicate whether this exam is a high priority.

8. Click Finish.

- You can click Queue to view the iExport Queue to determine how many exams are awaiting exportation.

58 Using the Patient DirectoryCaching Exams from the Patient Directory


Caching Exams from the Patient Directory

You can cache an exam from the Patient Directory.

Caching Exams from the Patient Directory

To cache an exam from the Patient Directory, right-click an exam and click Cache Exam.

- • If a exam has not been marked read and is cached, the exam is locked for reading. Logging out or marking the exam read releases the lock.

• If there is not enough disk space for a selected exam to be cached, the oldest cached exam is deleted. If there is still not enough disk space available to cache the exam, an error message displays and the cache stops.

• All images are cached in an encrypted format. Image metadata (patient or exam information) is not stored with the image due to patient confidentiality issues.

• When you cache an exam, only that exam’s images are cached. That is, related prior exams are not included in the exam cache.

Using the Patient Directory 59FSelecting Studies to View/Read from the Patient Directory


IDXR

FSelecting Studies to View/Read from the Patient Directory

When you select a patient on the Patient Directory, the View Exams tab is displayed on the canvas page.

Selecting Studies to View/Read on the Patient Directory

Follow the below instructions to select studies to view/read on the Patient Directory.


2. Search for a patient or exam and sort the list as appropriate.

3. On the Patient Directory, click the patient’s name to display their available exams.

4. Double–click the exam you want to view/read.

The View Exams tab is displayed in the control strip and the canvas page opens.

5. Review/read the images.

6. Review the study.


– To return to the Patient Directory, click the Patient Directory tab.

– To close all exams and return to the Patient Directory, right–click the View Exams tab and click Close All Exams on the pop–up menu.

60 Using the Patient DirectoryFSelecting Studies to View/Read from the Patient Directory



IDXR

Chapter 1

Using Filter Worklists

Overview of Filter Worklists ............................................................... 62Filter Worklist Terminology ................................................................ 63Defining Filter Worklists..................................................................... 64Accessing a Filter Worklist ................................................................. 68Customizing the Appearance of a Filter Worklist .................................. 70Sorting a Filter Worklist ..................................................................... 72Viewing Diagnostic Reports for Exams in a Filter Worklist..................... 73Viewing Documents for Exams in a Filter Worklist................................ 76Viewing Exam Memos for Exams in a Filter Worklist............................. 77Exporting Exams to a DICOM Device from a Filter Worklist................... 78Caching Exams from a Filter Worklist.................................................. 79Viewing the List of Exceptions for Exams in a Filter Worklist................. 80Viewing Further Exam Information for Exams in a Filter Worklist .......... 81Selecting Studies to View/Read from a Filter Worklist .......................... 82

62 Using Filter WorklistsOverview of Filter Worklists


Overview of Filter Worklists

Imagecast PACS has two types of worklists; the Patient Directory and Filter Worklists.

The Patient Directory provides access to all patients with images in Imagecast PACS. For more information about the Patient Directory, refer to using the Patient Directory (page 45).

Filter Worklists are organized by exam and contain only exams that meet the criteria specified by the Filter Worklist. You can create Filter Worklists to display only those exams you want to read.

Filter Worklists are created, edited, and deleted using the Filters option in User Preferences and System Preferences. Filter Worklist are accessed from the Imagecast Tools folder in the Folder List or from the Shortcuts Bar.

Your Filter Worklists are stored with your user login ID, therefore, your preferences are available to you regardless of what machine you use to access Imagecast PACS.

Predefined Filter Worklists

The following predefined Filter Worklists are installed with Imagecast PACS:

• Completed Exams

• CR All

• CT All

• Last 3 Days

• Last 7 Days

• Last Month

• MR All

• US All

Example. You can create Filter Worklists that generate a list of:

• CT exams performed today.• All MR head exams.• Exams performed in a specific location in your

organization, such as the ER or ICU.


Filter Worklists can only be accessed when you access Enterprise Access from the Patient option in the Worklist module. Follow these steps to access Enterprise Access from the Patient option in the Worklist module:


Using Filter Worklists 63Filter Worklist Terminology


IDXR

Filter Worklist Terminology

Common terms are used throughout Imagecast PACS when referring to tasks performed in a Filter Worklist. In order to better understand Filter Worklists, refer to the following table.

Common Filter Worklist Terminology

Term Definition

Filter Worklist A function that allows you to display exams to be viewed or read (mark read functionality is only available in Radiologist Workstation).

iExport Queue Allows users (generally application managers) to export Imagecast PACS exams in DICOM format to another DICOM device, such as a DICOM printer, a 3–D imaging tool, or a DICOM archive.

Image exceptions Situations in which patient or exam information entered at a modality (scanner) does not match information in Imagecast PACS. (Image exceptions are also referred to as broken studies, exceptions, or image acquisition exceptions.)

Patient Directory A tool used to list all patients and exams with images. You can then select the exam whose images you want to view.

Sort A function that allows you to change the order in which exams appear on your worklist. For example, you may want to sort a list by exam date or status instead of by patient name.

64 Using Filter WorklistsDefining Filter Worklists


Defining Filter Worklists

You can create, edit, and delete Filter Worklists from the Filters option in User Preferences and System Preferences.

Creating a Filter Worklist

You can create Filter Worklists from the Filters option in User Preferences and System Preferences. Worklist Filters created in User Preferences are only available to the user that created the filter. Worklist Filters created in System Preferences are accessible by any Imagecast PACS user. Typically, system administrators set up system Worklist Filters.

Follow the below instructions to create a Filter Worklist.

1. Click the Preferences button ( ), located in the upper right corner of the control strip.


– Double–click User Preferences and then click Filters.

– Double–click System Preferences and then click Filters.

3. Click Add.

4. In the Name field, enter the name of the filter.

5. (Optional) In the Modality field, enter a modality code (such as CT or MR) or leave blank to include all modalities.

6. (Optional) In the Patient Location field, enter a patient location or leave blank to include all patient locations.

7. (Optional) In the Body Part field, enter a body part code or leave blank to include all body parts.

8. (Optional) In the Procedure Code field, enter an exam code or leave blank to list all exams.

9. (Optional) In the Organization field, enter an organization code or leave blank to include all organizations.

- In the free text fields (such as modality or patient location) ensure that you enter information in these fields exactly as it is stored in the Imagecast PACS dictionaries. For example, to create a Filter Worklist that includes exams for organization ABC, enter the exact organization code/name in the Organization field. Omissions or errors result in an inaccurate filter. For more information about Imagecast PACS dictionaries, contact your Imagecast application manager or internal application support help desk.

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10. (Optional) In the Sub Speciality field, enter a subspecialty code or leave blank to include all subspecialities.

11. (Optional) In the Perf. Resource field, enter a performing resource code or leave blank to include all resources.

12. (Optional) In the Description field, enter a description for this filter.

13. In the Ref. Phys. Name field, enter a referring physician code or leave blank to include all referring physicians. Enter a name in one of the following formats:

– Last name only (such as SMITH)

– Partial last name followed by an asterisk (*) wildcard symbol (such as SMI*)

– Last name, first name (such as SMITH, EDWARD)

– Multiple referring physician lookup separated by a semicolon (;) (such as SMITH, EDWARD; DOE, JOHN or SMITH; DOE)

Note: If using a multiple referring physician lookup, the names must be entered in the same format. That is, if entering the first referring physician by last name, first name, subsequent referring physician lookups must also use the last name, first name lookup. For example, SMITH, EDWARD; DOE, JOHN is correct. SMITH, EDWARD; DOE is incorrect.

14. (Optional) In the Type panel, select the following as desired:

– Must Have Images—to only list exams that have images

– Unread Only—to only list exams that have not been read

– Stats—a drop-down list allowing you to only list STAT exams, to only list non-STAT exams, or to list both STAT and non-STAT exams

15. In the Date Period panel, select one of the following:

– Today—to list exams that occurred today

– Last 3 Days—to list exams that occurred within the last 3 days



– 30-60 Days—to list exams that occurred within the last 31 to 60 days

– 60-90 Days—to list exams that occurred within the last 61 to 90 days

66 Using Filter WorklistsDefining Filter Worklists


16. In the Exams Statuses panel, select at least one of the following statuses as desired:

– InProg

– Prelim

– Dictated

– Complete

– Final

– Nonreportable

17. (Optional) In the Patient Age panel, click and enter the minimum age in the From field and the maximum age in the To field to include only those patients whose age is equal to or between the ages entered.

18. Click OK.

19. On the Preferences Dialog window, click Apply to save your changes.

20. Click OK to close the window.

The Filter Worklist is added to the list. When you define a new Filter Worklist, that Filter Worklist is available for selection in the My Filters or System Filters folders on the Folder List.

Editing an Existing Filter Worklist

You can edit Filter Worklists from the Filters option in User Preferences and System Preferences.

Follow the below instructions to edit an existing Filter Worklist.


2. On the Preferences Dialog window, click Filters.

3. Click a Filter Worklist in the list and click Properties.

4. On the Edit Filter window, edit the properties as appropriate and click OK.



Deleting a Filter Worklist

You can delete Filter Worklists from the Filters option in User Preferences and System Preferences.

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Follow the below instructions to delete a Filter Worklist.


2. On the Preferences Dialog window, click Filters.

3. Click a Filter Worklist in the list and click Delete.



68 Using Filter WorklistsAccessing a Filter Worklist


Accessing a Filter Worklist

Filter Worklists are accessed from the Imagecast Tools folder in the Folder List or from the Shortcuts bar.



Filter Worklists can only be accessed when you access Enterprise Access from the Patient option in the Worklist module. Follow these steps to access Enterprise Access from the Patient option in the Worklist module:

On the Module Toolbar, click Worklist.

On the Option Toolbar, click Patient.

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Filter Worklist icons Icons may be displayed next to a exam listed in a Filter Worklist. The following table describes these icons and their meaning.

Accessing a Filter Worklist from the Folder List

Follow the below instructions to access a Filter Worklist from the Folder List.


– On the Folder List, double–click My Filters.

– On the Folder List, double–click System Filters.

2. Click the desired Filter Worklist.

The Filter Worklist is displayed on the navigation console.

Accessing a Filter Worklist from the Shortcuts Bar

Follow the below instructions to access a Filter Worklist from the Shortcuts Bar.

1. (Optional) If you are running Enterprise Access, on the Module Toolbar, click Worklist, then, on the Option Toolbar, click Patient.

2. On the Shortcuts bar, click the desired Filter Worklist.

The Filter Worklist is displayed on the navigation console.

Filter Worklist Icons

Icon Description

Exam is a STAT exam

Exam is locked by another user

A diagnostic report exists for the exam

Exam has been marked as read

- This procedure assumes you have already created a shortcut to the Filter Worklist you want to display.

70 Using Filter WorklistsCustomizing the Appearance of a Filter Worklist


Customizing the Appearance of a Filter Worklist

Customizing the appearance of a Filter Worklist involves rearranging, adding, or deleting columns of information on the Filter Worklist. Columns can be added or removed from the Filter Worklist using the column pop-up menu.

Pop-up menu Columns that are available for selection appear in black text on the Filter Worklist column pop–up menu. Certain columns (Patient Name, MRN, Accession, Date, and Modality) cannot be removed from the Filter Worklist, however they can be rearranged. These column names are grayed out and are unavailable for selection. All column names are preceded by a check mark. When a column is added to a Filter Worklist, a check mark is displayed next to the column name on the pop–up menu indicating that the column is displayed on the Filter Worklist. Columns are added to the Filter Worklist in the order in which they are listed on the pop–up menu. When a column is removed from the Filter Worklist, the check mark is removed from the pop–up menu. Refer to the following graphic.

- Column changes are valid only for your current Imagecast PACS session. The next time you log in to Imagecast PACS, you must make the changes again.

Available column for selection

Unavailable column for selection

Selected columns

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Rearranging the Order of Columns on a Filter Worklist

To rearrange the order of columns on a Filter Worklist, click a column heading and drag it to the desired location. Refer to the following graphic.

When you release the mouse button, the Filter Worklist is refreshed and the columns are displayed in the new order.

Adding Columns to a Filter Worklist

Follow the below instructions to add a column to a Filter Worklist.

1. Right–click a column heading.

2. On the pop-up menu, select the name of the column you want to add.

The column is added to the Filter Worklist.

Removing a Column from a Filter Worklist

Follow the below instructions to remove a column from a Filter Worklist.

1. Right–click the column heading.

2. On the pop-up menu, deselect the name of the column you wish to remove.

The column is removed from the Filter Worklist.

Click and drag a column heading to rearrange the column order

72 Using Filter WorklistsSorting a Filter Worklist


Sorting a Filter Worklist

You can also sort a Filter Worklist by any column heading property. This includes the STAT column ( ).

For example, you may want to sort the list by exam date rather than patient name. Click the column headings to sort the Filter Worklist in ascending order (A–Z or 1–9) or descending order (Z–A or 9–1). The

and symbols indicate the column by which the Filter Worklist is sorted. indicates that the Filter Worklist is sorted in ascending order. indicates that the Filter Worklist is sorted in descending order.

Sorting a Filter Worklist

Follow the below instructions to sort a Filter Worklist.

1. Click the column heading by which you want to sort the Filter Worklist or click the STAT column ( ) to sort by STAT exams. The following is true if you click a column heading other than the STAT column ( ):

– or appears in the column heading.

– indicates that the Filter Worklist is now sorted by that property in ascending order.

– indicates that the Filter Worklist is now sorted by that property in descending order.

2. To order the Filter Worklist by the same property in a different order, click the column heading again.

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Viewing Diagnostic Reports for Exams in a Filter Worklist

You can view diagnostic reports for exams in a Filter Worklist. The report is displayed in the Clinical Info tab on the Clinical Exam Notes window. In the Clinical Info tab on Clinical Exam Notes window, you can:

• View a diagnostic report

• View allergy information

• Display provider contact information

• View diagnostic reports for related exams

• View diagnostic reports for any of the selected patients’ exams

• Print a diagnostic report

The report icon ( ) indicates whether a report is available for an exam on a Filter Worklist. The report icon only displays next to a study on a Filter Worklist after the study is in F (Finalized) status (that is, after the report has been dictated and typed (marked read)).

Viewing Diagnostic Reports for Exams in a Filter Worklist

Follow the below instructions to view diagnostic reports for exams in a Filter Worklist.

1. On the Filter Worklist, right–click the exam and then click Show Report.

The diagnostic report is displayed in the Clinical Info tab on the Clinical Exam Notes window.

2. Click in the upper right corner of the Clinical Exam Notes window to return to the Filter Worklist.

Viewing Allergy Information

You can view a patient’s allergy information from the Clinical Info tab on the Clinical Exam Notes window.


74 Using Filter WorklistsViewing Diagnostic Reports for Exams in a Filter Worklist


To view a patient’s allergy information, in the Clinical Info tab on the Clinical Exam Notes window, click the red text next to the exam status.

Displaying Provider Contact Information

You can display contact information for the requesting or attending provider from the Clinical Info tab on the Clinical Exam Notes window.

Follow the below instructions to display provider contact information.

1. In the Clinical Info tab on the Clinical Exam Notes window, click to display the provider’s phone number, beeper number, and e-mail address.


Viewing Diagnostic Reports for Related Exams

A list of related exams appears at the bottom of the Clinical Exam Notes window. From this list, you can view a diagnostic report for a related exam. (The definition of a related exam has been established at your site. Contact your application manager or internal application support help desk for more information.)

Follow the below instructions to view diagnostic reports for related exams.

1. In the Related Exam List section of the Clinical Exam Notes window, click the accession number of the exam whose prior report you want to read.

Notes:

– If there are no related exams for this patient, the following message displays: No related exams found.

– You can sort the list of related prior exams by clicking a column heading.



- To hide the patient’s allergy information, click the red text that reads, Click here to hide allergies.

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Viewing Diagnostic Reports for any of the Selected Patients’ Exams


Follow the below instructions to view diagnostic reports for any of the selected patients’ exams.

1. In the Related Exam List section on the Clinical Exam Notes window, click all exams to see a complete list of all exams (including unrelated exams) for this patient.

Note: You can sort the list of exams by clicking a column heading.

2. In the list of all exams, click the accession number of the exam whose report you want to read.



Printing a Diagnostic Report

You can print a diagnostic report from the Clinical Info tab on the Clinical Exam Notes window.

Follow the below instructions to print a diagnostic report.

1. Right–click anywhere in the Clinical Info tab on the Clinical Exam Notes window.

2. Click Print on the pop–up menu.

3. On the Print window, enter printing information as appropriate.

4. Click Print.

76 Using Filter WorklistsViewing Documents for Exams in a Filter Worklist


Viewing Documents for Exams in a Filter Worklist

If you are using the Document Management Solution and documents exist for the patient or exam, you can view these documents from the Filter Worklist.

Follow the below instructions to view documents for exams in a Filter Worklist.

1. On the Filter Worklist, right-click the exam and click Show Report.

2. On the Clinical Exam Notes window, click .

For more information about the Document Management Solution, refer to the Document Management Solution Help.

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Viewing Exam Memos for Exams in a Filter Worklist

You can view exam memos for exams in a Filter Worklist.

To view exam memos for exams in a Filter Worklist, right-click the exam and click Show Exam Memos.


For detailed information about working with exam memos, refer to working with Exam Memos (page 23).

!Caution

Potential issues have been identified with Exam Memos.

78 Using Filter WorklistsExporting Exams to a DICOM Device from a Filter Worklist


Exporting Exams to a DICOM Device from a Filter Worklist

Depending on your user privileges, you may be able to export exams in DICOM format to another DICOM device, such as a DICOM printer, a 3–D imaging tool, or a DICOM archive. Once you specify that you want to export the exam, it appears on the iExport Queue (page 273), which allows you to monitor the exportation of exams. Your application manager must specify and connect external DICOM devices.

Sending/Exporting Exams to a DICOM Device

Follow the below instructions to send/export an exam to a DICOM device.

1. On a Filter Worklist, right–click an exam and select Export via DICOM on the pop–up menu.

The selected exam and a list of associated exams which are available for export is displayed.

2. Click the exams you want to export and click Next.

3. Click the DICOM device(s) to which you want to send the exam(s) and click Next.

4. Verify that the correct exams are going to the correct devices.

5. In the Addresses field, enter the e–mail address(es) of individual(s) who should be notified of this action.

6. In the Description field, enter a description of the action.

7. (Optional) Click High Priority to indicate whether this exam is a high priority.

8. Click Finish.

- You can click Queue to view the iExport Queue to determine how many exams are awaiting exportation.

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Caching Exams from a Filter Worklist

You can cache an exam from a Filter Worklist.

Caching Exams from a Filter Worklist

To cache an exam from a Filter Worklist, right-click an exam and click Cache Exam.

- • If a exam has not been marked read and is cached, the exam is locked for reading. Logging out or marking the exam read releases the lock.

• If there is not enough disk space for a selected exam to be cached, the oldest cached exam is deleted. If there is still not enough disk space available to cache the exam, an error message displays and the cache stops.

• All images are cached in an encrypted format. Image metadata (patient or exam information) is not stored with the image due to patient confidentiality issues.

• When you cache an exam, only that exam’s images are cached. That is, related prior exams are not included in the exam cache.

80 Using Filter WorklistsViewing the List of Exceptions for Exams in a Filter Worklist


Viewing the List of Exceptions for Exams in a Filter Worklist

Below the main list of exams on a Filter Worklist is a list of the acquisition exceptions.

Image exceptions are situations in which patient or exam information entered at a modality (scanner) does not match information in Imagecast PACS. (Exceptions are also referred to as broken studies.)

You can select a patient in the list of exceptions and view that patient’s study on the canvas page. For more information, refer to Selecting Studies to View/Read from a Filter Worklist (page 61).

- For more information about working with the Exceptions Handler, refer to the IDX Imagecast Worklist Training Guide or the Help which is accessed by clicking the Main Menu tool and then clicking Help below the Module Toolbar.

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Viewing Further Exam Information for Exams in a Filter Worklist

For exams in I (In progress) or S (Scheduled) status, Enterprise Access displays information about the exam including the modality, procedure code, status, and scheduled date and time.

To view further exam information for exams in a Filter Worklist, right–click an exam on a Filter Worklist.

82 Using Filter WorklistsSelecting Studies to View/Read from a Filter Worklist


Selecting Studies to View/Read from a Filter Worklist

When you select a patient on a Filter Worklist, the View Exams tab is displayed on the canvas page.

Selecting Studies to View/Read from a Filter Worklist

Follow the below instructions to select a study to view/read from a Filter Worklist.

1. Access a Filter Worklist.

2. Sort the Filter Worklist as appropriate.

3. On the Filter Worklist, double–click the patient’s name.

The View Exams tab is displayed in the control strip and the canvas page opens.

4. Review/read the images.


– To return to the Filter Worklist, click the Filter Worklist’s Name tab.

– To close all exams and return to the Filter Worklist, right–click the View Exams tab and click Close All Patient(s) on the pop–up menu.


Working with the View Exams Tab

To load studies on the canvas page and the diagnostic monitors for reading, you must first select an exam from your Filter Worklist or from the Patient Directory.

- n For more information about the canvas page, refer to the Working on the Canvas Page section on page 153.

This chapter details the tasks you can perform using the View Exams tab.

Objectives Upon completing this chapter, you will be able to:n Understand View Exams tab functionalityn Load different exams in to the canvas page using the View Exams

tabn Close all open exams on the View Exams tabn Load an unselected exam (from a Filter Worklist or Patient

Directory) in to the canvas page using the View Exams tab

Lesson 1: Overview of the View Exams Tab

You can select studies for reading from a Filter Worklist (page 61) and the Patient Directory (page 45). When you select an exam to read, the View Exams tab is displayed in the control strip. The View Exams tab displays the number of patients selected for review. For each patient you select on a Filter Worklist and the Patient Directory, the number displayed on the View Exams tab increases. A maximum of 30 patients can be selected at one time. The (previous) and (next) buttons


84 Working with the View Exams TabOverview of the View Exams Tab

are also displayed. These buttons allow you to advance to the next and previous patients selected for review. Refer to the following graphic.

To view exams for the select patients, click the View Exams tab.

When you select an exam for review, if the image is being viewed (locked) by another user, a message displays in the exam summary window indicating who is viewing the image. You are able to view the exam images; however, you are unable to mark images read. The mark read functionality is only available to the first user that selected the image for viewing (that is, the user who has the exam locked). The primary purpose of this lock is to prevent double–reads of an exam. For more information about the exam summary window, refer to the Exam summary window section on page 101. For more information about marking an exam read, refer to the Marking an Exam Read section on page 126.

View Exams tab displays number of patients selected for review

Close Current Exam

Previous and next buttons


Working with the View Exams Tab 85Loading Different Exams in to the Canvas Page Using the View Exams Tab

Lesson 2: Loading Different Exams in to the Canvas Page Using the View Exams Tab

From the View Exams tab, you can load a different exam that was selected for review on a Filter Worklist or the Patient Directory in to the canvas page (that is, you can use the View Exams tab to switch between exams you selected on the worklists). You can right–click the View Exams tab and select the exam to load.

For each exam on the pop–up menu, the patient’s name, sex, date of birth, and patient identification number are displayed. The exam currently being viewed on the canvas page is indicated by a check mark.


Loading Exams Using the View Exams Tab1 Right–click the View Exams tab.

2 Click a patient in the upper portion of the pop–up menu.

Right–clicking the View Exams tab displays the next ten unread patients in the currently active Filter Worklist.

Current patients selected; check mark indicates which patient is now being displayed on the canvas page


86 Working with the View Exams TabClosing All Exams Open on the Canvas Page Using the View Exams Tab

The exam is displayed on the canvas page. For more information about working on the canvas page, refer to the Working on the Canvas Page section on page 89.

Lesson 3: Closing All Exams Open on the Canvas Page Using the View Exams Tab

From the View Exams tab on the canvas page, you can close all exams selected for review.

1 Right–click the View Exams tab.

2 Click Close All Patient(s).

Radiologist Workstation displays a message asking if you are sure you want to close all patients.

3 Click Yes.

All exams are closed and you are returned to the Filter Worklist. For more information about working with Filter Worklists, refer to the Using Filter Worklists section on page 61.

Lesson 4: Loading Unselected Exams in to the Canvas Page Using the View Exams Tab

From the View Exams tab on the canvas page, you can access unselected patients/studies from a Filter Worklist. You can right–click the View Exams tab to view a pop–up menu that displays a list of ten unselected unread exams in a Filter Worklist. For each of the ten exams displayed, the patient name, MRN, accession number, and modality type appears. You can load any of these exams in to the canvas page by clicking the exam on the pop–up menu.


Working with the View Exams Tab 87Loading Unselected Exams in to the Canvas Page Using the View Exams Tab

Loading Unselected Exams in to the Canvas Page Using the View Exams Tab

1 Right–click the View Exams tab.

2 Click an exam in the lower portion of the pop–up menu.

The exam is displayed on the canvas page. For more information about working on the canvas page, refer to the Working on the Canvas Page section on page 89.


88 Working with the View Exams TabLoading Unselected Exams in to the Canvas Page Using the View Exams Tab


Working on the Canvas Page

Once you select an exam to view and click the View Exams tab, the canvas page is displayed. The canvas page is a navigational tool that provides you with quick access to diagnostic images and series, diagnostic reports, patient information, and diagnostic reading workflow. The canvas page should be used to select the images and series that you want to display on your diagnostic monitors as well as to gain contextual and historical information about a patient.

- n The canvas page is designed as a navigational tool, it is not designed for diagnostic reading. All diagnostic reading should occur on your diagnostic monitors.

n When you select an exam for review, if the image is being viewed (locked) by another user, a message displays in the exam summary window indicating who is viewing the image. You are able to view the exam images; however, you are unable to mark images read. The mark read functionality is only available to the first user that selected the image for viewing (that is, the user who has the exam locked). The primary purpose of this lock is to prevent double–reads of an exam. For more information about the exam summary window, refer to the Exam summary window section on page 100. For more information about marking an exam read, refer to the Marking an Exam Read section on page 126.

Image manipulation tools such as window width/level, inverting, and displaying scout lines are available for images in expanded floating windows (page 131) and thumbnail images (page 130) in the exam racks on the canvas page. While some of these tasks are detailed in this chapter, all image manipulation tasks are covered in the Reading Exams on the Diagnostic Monitors section on page 211.

Objectives Upon completing this chapter, you will be able to:n Identify canvas page componentsn Use the navigational timeline n Identify exam rack componentsn Use the exam summary windown Work with presentation statesn Work with matching series rules


90 Working on the Canvas PageCanvas Page Components

n Work with hanging protocolsn Export exams to DICOM devicesn Add exams to foldersn View extended exam information (DICOM metadata)n Set exam racks vertically and horizontallyn Mark an exam readn Use the navigational rectangles in the exam racksn Organize images in an exam rackn Adjust diagnostic thumbnail images in the exam racksn Expand images and series into floating windowsn Adjust window width and level settings n Cine slices in a multi-image seriesn Use scout lines to view CT and MR scout imagesn Use the localizern Configure diagnostic monitors

Lesson 1: Canvas Page Components

The canvas page consists of the following main areas:n Control stripn Clinical information windown Navigational timelinen Exam racks


Working on the Canvas Canvas Page Components


Control strip The control strip is located at the top of the canvas page and contains the following items:

n View Exams tab (page 12)n iExport Queue button (page 12)n Preferences button (page 12)n Help button (page 12)n Logout button (page 13)

Monitor icons The monitor icons correspond to your diagnostic monitors and the navigational rectangles in the exam racks on the canvas page. Each monitor is color–coded and is marked with a number. In the exam rack, a colored rectangle surrounds the image. This indicates the diagnostic monitor that displays the corresponding image and/or series.

View Exams tab The View Exams tab is displayed when patients are selected on either a Filter Worklist or the Patient Directory. The number of patients selected for review is displayed on the tab. The View Exams tab allows you to access the canvas page to view a patients clinical information and select studies for display on the diagnostic monitors.

Control strip

Clinical information window

Navigational timeline

Exam racks

View Exams tabMonitor icon(s)


92 Working on the Canvas PageCanvas Page Components

Clinical information window

The area directly below the control strip on the canvas page is the clinical information window which displays information related to the patient being viewed. The information displayed includes patient name, sex, date of birth (DOB), MRN, procedure code, and the name of the referring provider.

Navigational timelines

The area directly below the clinical information window on the canvas page is composed of the Relevant Exams and Patient History Timeline navigational timelines.

The Relevant Exams timeline is a chronologically–ordered representation of all related exams belonging to the patient in question. For example, if you chose to review a CT head exam, the Relevant Exams timeline is populated by other exams that are related to the exam you are viewing.

The Patient History Timeline provides a chronological listing of all of the patient’s exams that are present in Radiologist Workstation.

Each timeline is interactive. In other words, exams can be loaded and reports can be retrieved from the items listed. For more information about the navigational timelines, refer to the Using the Navigational Timelines section on page 94.

Exam racks The bottom area of the canvas page is composed of the diagnostic exam racks. These racks display thumbnail images and series belonging to the exam you selected. The exam racks also display exams that are related to the exam you selected.

Series/images displayed in the exam rack are sorted by an series/image sorting algorithm. The algorithm sorts (from left to right and top to bottom) in the following order:

1 Study

2 Series sort order

3 Image sort order for split series

Each exam rack has margins (or borders) on the top, bottom, and sides of the rack. Margins appear as gray bars. If a presentation state has been applied to an exam, a presentation state icon ( ) displays in the rack’s margin. Refer to the following graphic. For more information


Working on the Canvas Canvas Page Components

about presentation states, refer to the Working with Presentation States section on page 102.

The left side of the exam rack is referred to as the exam summary window. The exam summary window displays information about each exam including modality, procedure description, exam date, accession number, referring provider, and exam status. If defined (page 82), the exam summary window also contains patient and exam information (if patient and exam information exists). If an exam is unread and not being viewed (locked) by another user, the Mark Read button displays. If the exam is being viewed (locked) by another user, a message displays indicating who is viewing the exam and the Mark Read button (and the F3 mark read hot key) is not available.

A colored rectangle surrounds images and/or series in the exam rack. These colored rectangles correspond to the colored monitor icons in the control strip. Each monitor is color–coded and is marked with a number. In the exam rack, a colored rectangle surrounds the image. This indicates the diagnostic monitor that displays the corresponding image and/or series.

Presentation state icon


94 Working on the Canvas PageUsing the Navigational Timelines

Lesson 2: Using the Navigational Timelines

The Relevant Exams timeline and Patient History Timeline are an integral part of the canvas page. They provide a fast and intuitive way to navigate through a patient’s clinical history of diagnostic exams and reports.

The Relevant Exams timeline, is a chronologically–ordered representation of all related exams belonging to the patient in question. For example, if you chose to review a CT head exam, the Relevant Exams timeline is populated by other exams that are related to the exam you are viewing.

- The definition of related exams is defined by your organization. Contact your application manager or internal application support help desk for more information.

The Patient History Timeline presents a chronological listing of all of the patient’s exams present in Radiologist Workstation. This timeline provides a fast and intuitive way to navigate through a patient’s clinical history of diagnostic exams and reports.

You can perform the following tasks using the navigational timelines:n Scroll to other exams (page 97)n View detailed information about an exam (page 97)n Display (load) exams into the exam rack (page 97)n Remove (unload) exams from the exam rack (page 97)n View diagnostic reports (page 97)n View exam memos (page 98)n Export exams to a DICOM device (page 98) n Cache exams (page 99)


Timeline features Both navigation bars are interactive, that is, exams can be loaded and reports can be retrieved from the items displayed along the timelines.


Working on the Canvas Using the Navigational Timelines

The most recent and least recent exam date appear in the bottom right and left corners, respectively, of the timelines. Other symbols are displayed on the timelines as well. Refer to the following table for a description of their meanings.

Navigational Timeline Features (Page 1 of 2)

Icon Description Meaning

Green datelines Delineate one year from the next.

Navigational arrows Display in the upper right and upper left corners of the timelines allowing you to scroll forward or backward, chronologically, through the exams displayed on the timelines.

Gray background Indicates exams that are currently displayed in the exam racks on the canvas page.

Colored rectangles around the exams on the timelines

Indicates the exams that are currently displayed on your diagnostic monitors.

These colored rectangles correspond to your diagnostic monitors.

Yellow arrow above the exam on the timelines

Indicates the exam currently being reviewed on the canvas page.

A half red and half blue rectangle around an exam on the timelines

Indicates that images from the same exam are loaded into different diagnostic monitors.

X on an exam in the timelines

Indicates that the exam exists in the RIS but not on the Radiologist Workstation servers. You must use the iQuery tool to fetch these exams. For more information about iQuery, refer to the Retrieving Exams from Digital Archives (iQuery) section on page 275.



Detailed information regarding any of the exams displayed on the timelines can be viewed by holding your mouse pointer over the exam in question (page 97). The accession number, date and time, referring provider, procedure description, and exam status is displayed.

A pop–up menu is available from the timelines. The following functions are available when you right–click an exam listed on the timelines:

n Add Exam To Folder—allows you to send a link to this exam to the CD Manager folder, a personal folder, or a public folder.

n Load/Unload Exam—allows you to load (display) and unload (remove/close) exams in to and out of the exam racks on the canvas page.

n Show Report—allows you to display the diagnostic report of the selected exam on the timeline. If a report is not yet available, the Show Report option is not available on the pop–up menu.

n Show Exam Memos—allows you to display exam memos of the selected exam on the timeline. If exam memos are not yet available, you are able to create them from the exam memos user interface. For more information about working with exam memos, refer to the Working with Exam Memos section on page 63.

n Export via DICOM—allows you to send (export) exams in DICOM format to another DICOM device such as a 3–D imager or a CD–ROM burner.

A on an exam in the timelines

Indicates all of the following:n exam date and time is older than 48 hoursn the Allow DICOM Query From Exam Timeline

System Preferences option is selectedn exam status is not NON-REPORTABLEn iQuery is configured with at least one DICOM QRP

sourcen user has iQuery access privileges

Double-clicking an exam in the timeline with the A icon performs a DICOM move from the archive to Imagecast PACS, and then loads that exam into the rack.

Navigational Timeline Features (Page 2 of 2)

Icon Description Meaning


Working on the Canvas Using the Navigational Timelines

n Cache Exam—Allows you to cache exams to a local machine or location. For more information about caching exams, refer to the Using the Local Exam Cache Tool section on page 101.

Scrolling to Other Exams on the TimelinesDo one of the following:

On the timeline, click the navigational arrow in the upper right or upper left corner of the timeline to scroll forward or backward, chronologically, through the exams shown on the timelines.

Position your mouse pointer over the timeline, press and hold the mouse wheel, and then drag the mouse in the desired direction.

Viewing Detailed Information About an Exam on the Timeline

On the timeline, position your mouse pointer over the exam for which you want to view detailed information.

The accession number, date and time, referring provider, procedure description, and the status of the exam are displayed.

Opening (Displaying) Exams in the Exam RackFrom the timelines, you can open (display) an exam into the exam racks on the canvas page.

On the timeline, do one of the following:

– Click the exam.

– Right–click the exam and click Open Exam.

Closing (Removing) Exams from the Exam RackFrom the timelines, you can close (remove) an exam from the exam racks on the canvas page.

On the timeline, right–click the exam and click Close Exam.

Viewing Diagnostic Reports for Exams on the Timeline

On the timeline, right–click the exam and click Show Report. The diagnostic report is displayed in the Clinical Info tab on the Clinical Exam Notes window.



Viewing Exam Memos for Exams on the Timeline

On the timeline, right-click the exam and click Show Exam Memos. The exam memos appear in the Memos tab on the Clinical Exam Notes window.

For detailed information about working with exam memos, refer to the Working with Exam Memos section on page 23.

Sending/Exporting Exams to a DICOM DeviceUse the Send via DICOM option to select exams to export in DICOM format to another DICOM device such as a 3–D imager or a CD–ROM burner. Once you specify that you want to export the exam, it appears on the iExport Queue. External DICOM devices must be specified and connected by your application manager. If no devices are connected, this option is not available on the pop–up menu.

- n You can also select exams for exportation on the Patient Directory (page 45)

n and a Filter Worklist (page 68). Right–click the exam you want to export and then click Export via DICOM.

1 On the timeline, right–click the exam.

2 Click Send via DICOM on the pop–up menu.

The selected exam and a list of associated exams which are available for export are displayed.

3 Click the exams you want to export and click Next.

4 Click the DICOM device(s) to which you want to send the exam(s) and click Next.

5 Verify that the correct exams are going to the correct devices.

6 In the Addresses field, enter the e–mail address(es) of individual(s) who should be notified of this action.

7 In the Description field, enter a description of the action.

8 (Optional) Click High Priority to indicate whether this exam is a high priority.

9 Click Finish.

Note: You can click Queue to view the iExport Queue to determine how many exams are awaiting exportation.


Working on the Canvas Exam Rack Components

Caching Exams from the TimelineDepending on your security, you can cache exams to a local machine or location from the timeline.

From the timeline, right-click an exam and click Cache Exam.

Notes:

– If a exam has not been marked read and is cached, the exam is locked for reading. Logging out or marking the exam read releases the lock.

– If there is not enough disk space for a selected exam to be cached, the oldest cached exam is deleted. If there is still not enough disk space available to cache the exam, an error message displays and the cache stops.

– All images are cached in an encrypted format. Image metadata (patient or exam information) is not stored with the image due to patient confidentiality issues.

– When you cache an exam, only that exam’s images are cached. That is, related prior exams are not included in the exam cache.

Lesson 3: Exam Rack Components

The diagnostic exam racks are a powerful tool within the canvas page. The exam racks display and help you arrange exams for diagnostic review on your diagnostic monitors. They also give you a quick contextual view of the exam you are reviewing and the patient’s other relevant exams.

The uppermost exam rack on the canvas page displays the exam you selected on your Filter Worklist or the Patient Directory. The lower exam racks display exams that are relevant to the exam you are currently reading.


100 Working on the Canvas PageExam Rack Components

- The definition of related exams is defined by your organization. Contact your application manager or internal application support help desk for more information.


Series/images displayed in the exam rack are sorted by an series/image sorting algorithm. The algorithm sorts (from left to right and top to bottom) in the following order:

1 Study

2 Series sort order

3 Image sort order for split series

The exam racks contain the following elements.

Exam summary window

The left side of the exam rack is referred to as the exam summary window. The exam summary window displays information about each exam including modality, procedure description, exam date, accession number, referring provider, and exam status. If defined, the exam

Exam summary window

Exam information (impression text)

Thumbnail images

Navigational rectangle


Working on the Canvas Using the Exam Summary Window

summary window also contains patient and exam information (if patient and exam information exists). If an exam is unread and not being viewed (locked) by another user, the Mark Read button displays. Click this button (or press the F3 mark read hot key) when you complete your diagnostic read of the exam. The exam is marked read. If the exam is being viewed (locked) by another user, the Mark Read button (and the F3 hot key) is not available and the following message displays: Exam is locked by LastName, FirstName (where LastName, FirstName is the name of the user who has the exam locked).

You can right–click the margin next to the exam information to display a pop–up menu that allows you to perform a variety of tasks. For more information, refer to the Using the Exam Summary Window section on page 101.

Diagnostic image thumbnails

Thumbnails of diagnostic images and/or image series are displayed to the right of the exam summary window.

A gray information bar is displayed below each image or image series. Double–clicking an image or series in this area opens the image or series in an expanded floating window on the console. You can right–click a thumbnail image to access advanced image manipulation tools. For more information about manipulating thumbnail images, refer to the Using the Diagnostic Thumbnails on the Canvas Page section on page 130.

Navigational rectangles

Navigational rectangles are the colored rectangles surrounding images and/or series in the exam racks. These rectangles indicate the diagnostic monitor that displays the corresponding image and/or series.

For more information about working with the navigational rectangles, refer to the Using the Navigational Rectangles section on page 127.

Lesson 4: Using the Exam Summary Window

You can right–click the margin next to the exam summary window (page 100) to display a pop–up menu that allows you to perform the following tasks:

n Apply or create a presentation state (page 102)


102 Working on the Canvas PageWorking with Presentation States

n View, edit, or create user or system hanging protocols (page 108)n Rehang images in the exam racks according to the default

hanging protocol of the selected exam (page 121)n Send images to a DICOM device (page 122)n Add an exam link to a folder (page 122)n View extended exam information (page 123)n Change the vertical or horizontal orientation of the exam racks

(page 125)

Lesson 5: Working with Presentation States

The Presentation State option allows you to create and save a new presentation state or load a predefined presentation state created by a radiologist or technologist at your organization. If no other presentation states are defined, the original DICOM presentation state is the default for all loaded exams. (Original DICOM refers to the DICOM captured with the image at the modality. This is the raw image data captured before any image manipulation has occurred.) Radiologist Workstation specifies when the original DICOM was generated. For example, the following text appears: Original DICOM created by System on Dec 10, 2002@11:30:34. If other presentation states are created by technologists or radiologists, they appear below the original DICOM listing on the pop–up menu. For more information about the presentation states available at your organization, contact your application manager or internal application support help desk.

The different presentation states are always available by accessing the pop–up menu. The default presentation state depends on the following hierarchy:

n If no other presentation states are present, the original DICOM state is used as the default to display images.

n If a technologist creates a presentation state, the technologist’s presentation state overrides the original DICOM state and is used as the default to display images.


Working on the Canvas Working with Presentation States

n If an internist creates a presentation state, the internist’s presentation state overrides the technologist’s presentation state and is used as the default to display images.

n If a radiologist creates a presentation state, the radiologist’s presentation state overrides all other presentation states available and is used as the default to display images.

If a presentation state has been applied to an exam, a presentation state icon ( ) displays in the rack’s margin. Refer to the following graphic.

Selecting a Presentation State 1 Right–click the margin next to the exam summary window.

2 Click Presentation State on the pop–up menu.

3 Click the appropriate presentation state on the pop–up menu.

Note: If additional images were added to this exam since a presentation state was created, that state is not visible. Radiologist Workstation displays a message indicating that the presentation state

Presentation state icon


104 Working on the Canvas PageWorking with Presentation States

was not loaded because new images have arrived since the presentation state was saved.

Creating a Presentation State1 Adjust the image(s) as appropriate.

2 Right–click the margin next to the exam summary window.

3 Click Presentation State on the pop–up menu.

4 Click Save Presentation State.

5 In the Enter Presentation State Name field, enter the name of the presentation state.

6 Click next to the type of presentation state. You can select one of the following:

– Technologist—for technologists

– Pre–read—for interns

– User—for personal use (for example, a teaching session)

Note: Radiologist presentation states are created when a radiologist marks an exam read using the Mark Read button or the F3 mark read hot key on the exam summary window. For more information about marking an exam read, refer to the Marking an Exam Read section on page 126.

7 Click OK.

The presentation state is saved and is available for future viewing by you and your colleagues when presentation states are accessed using the exam summary window.


Working on the Canvas Working with Matching Series Rules

- n If new images were added to the exam while you were creating a presentation state, you cannot save the presentation state. Instead, you must reload the exam and begin the process of creating a presentation state again.

n When you save a presentation state, the presentation state preserves any annotations you made to the image, however, modifications to hanging protocols are not saved with the presentation state.

Lesson 6: Working with Matching Series Rules

Matching series rules are rules that can be used to match specific series or images within a hanging protocol. By creating hanging protocols using matching series rules, the relevant series or images can be sorted automatically without having to create multiple presentation states.

- n Matching series/image rules are usually only required for the more complex hanging protocols.

n Only one rule should be created for each type of series or image.

System administrators typically set up matching series rules. Once matching series rules are set up, end users can then use these matching series rules when creating their hanging protocols.

Setting Up Matching Series RulesDepending on your user privileges, you may be able to set up matching series rules.

1 Determine the types of series and images that require rules and the modalities that are creating these series and images.

2 Load the appropriate series/image in the exam rack.

3 Right-click the series/image and click Matching Series Rules.

4 The Hanging Protocol Series Matching Rules Dialog window is displayed.

5 Click Add Rule.

The Create Series Matching Rules Dialog window is displayed. DICOM tag values from the selected series/image are displayed in the Define Series list. The modality from which the series/image was


106 Working on the Canvas PageWorking with Matching Series Rules

received is displayed in the Define Matching Value list (this value cannot be removed). Refer to the following graphic.

6 In the Matching Rule Name field, type a name for the new rule (such as Femur AP).

Note: Be sure to type a name that will be recognized by end users creating hanging protocols using this rule (such as radiologists and technologists).

7 Add the series’/image’s DICOM tags that will be used as common identifiers for the rule. Do the following to add a DICOM tag:

– Select an item from the Define Series list and click . The item is moved from the Define Series list to the Define Matching Values list.

– Repeat the previous step for each DICOM tag value you want to include in the rule.

– To remove a DICOM value from the Define Matching Values list, select the parent of the value and click .

– To add a new DICOM tag value, click New Attribute.

– To edit a displayed DICOM tag value, select it and click Edit Value.

DICOM tags from selected series/image

Modality value for modality from which series/image was received


Working on the Canvas Working with Matching Series Rules

The following graphic shows the Series Description DICOM tag added to the Define Matching Values list.

8 Click OK.

Note: In order for rules to work across all modalities, you must verify that the selected DICOM tag value is consistent between modalities. If they are not, you need to include DICOM values for each modality in the rule.

For Example: If two different modalities use different Series Descriptions for the same type of image (for example, one modality uses “femur AP” and the other modality uses “Femur_AP”), both DICOM tag values must be included in the rule in order for the rule to work. To do this, find a matching series from the second modality sending femur images, right-click an image from this series, select Matching Series Rules, and edit the existing Femur AP rule to include

Series Description DICOM tag value


108 Working on the Canvas PageWorking with Hanging Protocols

the second modality’s Series Description DICOM tag value. Refer to the following graphic.

Using Matching Series Rules with Hanging ProtocolsUsing matching series rules with your hanging protocols is described in the Working with Hanging Protocols section on page 108. Refer to this section for more information.

Lesson 7: Working with Hanging Protocols

Hanging protocols are an important part of an efficient reading workflow. Radiologist Workstation can be configured to recognize certain combinations of exam characteristics and hang the exam according to your specifications. Radiologist Workstation saves your personal hanging protocols so that they are there every time you use the application.

Hanging protocols and presentation states

Hanging protocols have a unique relationship with presentation states that affects how exams may be displayed. If a user opens an exam that has a technologist or pre-read presentation state, the presentation state will override certain features of the hanging protocol for the exam. The

DICOM tag value from second modality


Working on the Canvas Working with Hanging Protocols

hanging protocol settings: Invert, Clones, and WW/WL will not be applied. If a hanging protocol is selected, edited, or created for this type of exam, all of the hanging protocol features will be applied, regardless of any presentation states.

If the exam has only an original DICOM presentation state or only a user presentation state, then the hanging protocol will be applied when the exam is opened in the Canvas Page. If a presentation state is selected, edited, or created from this exam, the presentation state will be applied regardless of any hanging protocol.

User and system hanging protocols

Radiologist Workstation contains user and system-level hanging protocols. A user hanging protocol is created by an individual user and is available only to that user.

.Example

If you create a user hanging protocol called “MR Brain Special”, that hanging protocol will only be available to you.

System hanging protocols are created by your system administrator and are available to all users. User and system hanging protocols are created, edited, and selected in the same way.

Hanging protocols can only be edited for the main exam being viewed. The option is not available for related exams displayed on the Canvas Page. You can also work with hanging protocols on the Preferences Dialog window. For more information, refer to the Defining Hanging Protocols section on page 79.

Hanging protocol hierarchy

Hanging protocols can be created at the following levels:n Hanging Protocol Group (exam code level, very specific) n Modality and Body Part (specific)n Modality (generic)

Once Radiologist Workstation determines which hanging protocol should be used, it then determines if the hanging protocol was created at the user or system level. User defined hanging protocols will override system defined hanging protocols at the same level.

Default vs. alternate hanging protocols

There are two types of hanging protocols, Default and Alternate. There can only be one default hanging protocol per level (for instance, there can be only one default user–defined CT hanging protocol). You can, however, create as many alternate hanging protocols as you want.



This is especially useful when you read a lot of the same exam types that contain a lot of different series.

.Example

n A neuroradiologist that primarily reads MR HEAD exams might want to define a few alternate hanging protocols that they can quickly switch to, rather than having to re-hang the entire study.

n A radiologist might want to define a few alternate hanging protocols at the modality level that they can quickly select and apply if there is no matching hanging protocol available for that particular exam, or if the system hanging protocol applied differs from their personal preference.

Alternate hanging protocols are never automatically applied. However, they are available to you and can be selected and applied to an exam on the fly.

Creating a Hanging Protocol1 Right–click on the margin next to the exam summary window. The

exam summary pop-up menu is displayed. Refer to the following graphic.

2 Click one of the following:

– Create User Hanging Protocol—create a user–level hanging protocol



– Create System Hanging Protocol—create a system–level hanging protocol

The Create User/System Hanging Protocol window is displayed.

3 In the Name field, edit the name of the hanging protocol, if appropriate.

Note: Radiologist Workstation suggests a name for the hanging protocol based on the modality and body part (if available). You can leave this name or edit the name. A warning message is displayed if you choose a name that is already in use.

4 In the Identifier panel, select one of the following:

– Modality—this hanging protocol will be available to all exams using this modality (such as MR and CT)

– Modality and Body Part —this hanging protocol will be available to all exams with the same modality and body part (such as MR Brain and CT Abdomen)

– Hanging Protocol Group—this hanging protocol will be available for exams with the same exam code

5 In the Type panel, click one of the following:



– Default—to apply this hanging protocol by default for the identifier selected in step 4

– Alternate—to make this hanging protocol available for the identifier selected in step 4

Notes: n Only one default hanging protocol can be created for a matching

identifier. For example, you can have only one default MR Brain hanging protocol.

n The following hierarchy applies to default hanging protocols (For example, a user–defined modality hanging protocol will override a system–defined modality hanging protocol):

n User–defined hanging protocol group (overrides all following items)

n System–defined hanging protocol groupn User–defined modality and body part hanging protocoln System–defined modality and body part hanging protocoln User–defined modality hanging protocoln System–defined modality hanging protocol (overridden by all

items above)

6 (Optional) Click Use Series Matching Rules to use matching series rules (set up by your system administrator) to match specific series or images within this hanging protocol.

Notes: n By default, series/images are sorted in the exam rack based on the

DICOM source system configuration settings (by acquisition time, alphabetically, and so on). Sometimes, however, this default sort order does not fit the radiologist's needs. For example, a radiologist might always want CR PA Chests to be displayed as the first image in the Rack. The technologist or radiologist could sort the series or images manually and create a presentation state every time. However, if a user always wants a certain type of exam to be displayed a certain way, it is inefficient to repeatedly create presentation states just for the purpose of sort order. By creating a hanging protocol using series matching rules, the relevant series/images can be sorted automatically without having to create presentations states.



n When you select Use Series Matching Rules, the Use Current Exam Layout field is selected (and is display only) allowing the hanging protocol to take into account features of the current exam layout (such as clones). This selected check box will automatically populate a subsequent Create User/System Hanging Protocol window with the currently-selected series’ settings.

For more information about matching series rules, refer to the Working with Matching Series Rules section on page 105.

7 Click Next.

The following window is displayed.

8 (Optional) If you selected the Use Series Matching Rules on the previous screen, all matching series rules that match your selected series are displayed in the Matching Series list. If appropriate, do the following:

– To add a predefined matching series rule to your hanging protocol, click Add Rule, select the rule and click OK.

– To remove a matching series rule from this hanging protocol, select the rule and click Delete Rule.



9 (Optional) In the Other Series list, do the following:

– Click Stack Window(s) to apply settings to all stacked image windows and set the Display Settings panel options as desired. Refer to step 14 for more information.

– Click Single Image Window(s) to apply settings to all single image windows and set the Display Settings panel options as desired. Refer to step 14 for more information.

10 [Optional] To create a clone of the stacked image window, click Stack Window(s) and then click Add Clone.

11 [Optional] Click Clone X (where x is the clone number) and set the Display Panel Settings panel options as desired. Refer to step 14 for more information.

12 [Optional] To create a clone of the single image window, click Single Image Window(s) and then click Add Clone.

13 [Optional] Click Clone X (where x is the clone number) and set the Display Panel Settings panel options as desired. Refer to step 14 for more information.

14 In the Display Settings Panel for Stack Window(s), Single Image Window(s), and Clone X windows, set the following fields as desired:

– Multi Image Mode—to split an image window so that multiple slices can be displayed in a single window

Configuration How images appear on your monitor

1x1

1x2

2x1

2x2

2x3

1x3

3x3

3x4

4x5



– Default Window/Level—to apply the default Window Width/Level value for the modality.

– Window/Level Preset—to select a preset Window Width /Level value.

– Show Scout Lines—to automatically show scout lines on MR and CT scout images.

– Show Localizer—to automatically engage the localizer tool

– Invert Image— to invert the brightness and contrast values for the image.

15 Click Next.


In this window you will set how the exams of this type will display on your diagnostic monitors. For each monitor, you will set the mode and the starting series. If you have selected the Use Matching Series Rules option (step 6), available matching series rules will be displayed in the Matching Series list. As you change these settings the display will change to show you how your monitors will hang.



The monitors provide additional information about where individual series will go.

16 (Optional) In the Matching Series list, click Move Up and Move Down to select the order in which matching series will display on the monitors.

Note: Series listed in the Other Series list will be displayed on the monitors after any matching series and in the order in which they are listed within the Other Series list.

17 In the Monitor Control panel, select one of the following monitor display modes in the Monitor 1 Mode and Monitor 2 Mode fields:

Notes: n As you change settings, the display will change to show you how

the monitors will hang and where individual series will go.n Hanging protocols are only used for the first two monitors.

Additional monitors will display priors if present. For more information about the hanging of relevant priors, refer to the Hanging of Relevant Prior Exams section on page 118.

18 Click Next.


M1

M2H

M2V

M3H

M3V

M4

M6P

M6L

M1_2

M2_1

M1_3

M3_1




19 In the Linking panel, select the following as desired:

– Link All Axials—to link all axial views of an exam

– Link All Sagittals—to link all sagittal views of an exam

– Link All Coronals—to link all coronal views of an exam

– Link All Obliques—to link all oblique views of an exam

20 In the Load Relevant Prior based on matching panel, select one of the following:

– Body Part Only—to load relevant priors by body part

– Modality and Body Part—to load relevant priors by modality and body part

21 In the Number Of Priors To Load field, enter the number priors to load with this exam type.

22 Click Cache Entire Study to cache all of an exam’s images when you open the exam in the Canvas Page.



Note: Although this option can be enabled for all modality types, this feature should only be used for larger CT exams (with more than 125 images). The goal of this feature is to prevent a user from getting “ahead” of the caching mechanism when navigating quickly through a large CT series after opening the exam.

23 Click Show Spine label Tool on Sagittal to automatically display the spine labeling tool for all sagittal views.

24 Click Finish.

Hanging of Relevant Prior ExamsThe following rules apply when Radiologist Workstation attempts to hang relevant prior exams:

n Radiologist Workstation always loads one new exam and one relevant prior exam (if available)

n New and prior exams are hung based on the hanging protocol of that exam type (not on whether it is a new exam or a prior).

n The general mechanism for the selection and hanging of a relevant prior is based on the following:

– The definition of a relevant prior for a given exam type.

– The applicable hanging protocol of the prior exam.

– The number of monitors available to display the prior exam.

Hanging Protocols and Monitor ConfigurationHanging protocols are optimized to work with one, two, or four diagnostic monitor displays. However, You can only define a two-monitor hanging protocol. To get around this limitation, Radiologist Workstation uses the F2 key to toggle between a virtual monitor.

The following example explains how the hanging protocol will be applied based on the number of monitors available for an exam and whether or not there is a relevant prior available. The following table is



used to explain how, using the hot key, it is possible to toggle the virtual monitor on and off.

Example Display of a Two–Monitor Hanging Protocol Definition with a Single–, Dual–, and Quad–Monitor Configuration (Page 1 of 2)

Hanging Protocol Name: CR CHEST (one PA, one Lateral)Monitor 1: General PAMonitor 2: General LAT

Number of Monitors

Relevant Prior? Monitor 1 Monitor 2 Monitor 3 Monitor 4

1 No New Exam General PA

N/A N/A N/A

Virtual Monitor

New Exam General LAT

1 Yes New Exam General PA

N/A N/A N/A

Virtual Monitor




N/A N/A

Virtual Monitor

N/A

Virtual Monitor

N/A


Prior Exam General PA

N/A N/A

Virtual Monitor


Virtual Monitor

Prior Exam General LAT



Empty Empty

Virtual Monitor

N/A

Virtual Monitor

N/A



.Example

The following displays the layout of images with relevant priors found on a two-monitor system.



Prior Exam General PA

Prior Exam General LAT

Virtual Monitor

N/A

Virtual Monitor

N/A

Virtual Monitor

N/A

Virtual Monitor

N/A

Example Display of a Two–Monitor Hanging Protocol Definition with a Single–, Dual–, and Quad–Monitor Configuration (Page 2 of 2)

Hanging Protocol Name: CR CHEST (one PA, one Lateral)Monitor 1: General PAMonitor 2: General LAT

Number of Monitors

Relevant Prior? Monitor 1 Monitor 2 Monitor 3 Monitor 4



Pressing F2 moves the rectangles to the virtual monitors.

- Of course, you can always manually place whatever images and series you want on your additional monitors.

Viewing Information About a Hanging Protocol1 Right–click the margin next to the exam summary window.

2 Click Edit Hanging Protocol on the pop–up menu.

The Edit Hanging Protocol window is displayed.

3 Click Cancel to close the Edit Hanging Protocol window.

Editing a Hanging ProtocolHanging protocols can be edited from Preferences and from the Canvas Page. This section describes how to edit hanging protocols from the Canvas Page.

1 Right–click the margin next exam summary window.

2 Click Edit Hanging Protocol on the pop–up menu.

3 On the Edit Hanging Protocol window, edit information as appropriate.

4 Navigate to the last hanging protocol window and click Finish.

Restoring the Default Hanging ProtocolYou can rehang an exam according to its default hanging protocol using the Rehang option.


122 Working on the Canvas PageExporting Exams to a DICOM Device

1 Right–click the margin next to exam summary window.

2 Click Rehang on the pop–up menu.

The exam’s default hanging protocol is restored.

Lesson 8: Exporting Exams to a DICOM Device

Use the Export via DICOM option to specify exams to export in DICOM format to another DICOM device such as a 3–D imager or a CD–ROM burner. Once you specify that you want to export the exam, it appears on the iExport Queue. External DICOM devices must be specified and connected by your application manager. If no devices are connected, this option is not available on the pop–up menu.

Sending/Exporting Exams to a DICOM Device1 Right–click the margin next to exam summary window.

2 Click Export via DICOM on the pop–up menu.

3 Enter information as appropriate.

For more information, refer to the Sending/Exporting Exams to a DICOM Device section on page 98.

4 Click Finish.

Lesson 9: Adding Exams to Folders

You can add exams to a folder using the Add Exams to Folder option.

.Example

If you were writing a paper on a certain type of disease, you could create a folder and add exams that display the effects of the disease.


2 Select Add Exam To Folder.


Working on the Canvas Viewing Extended Exam Information (DICOM Metadata)

The Folder Dialog window is displayed. Refer to the following graphic.

3 Select the folder in which you want to place a link to the exam.

4 Click OK.

Lesson 10: Viewing Extended Exam Information (DICOM Metadata)

The Exam Information option allows you to view extended information, referred to as DICOM metadata, about an exam in the rack. DICOM metadata is the raw data obtained for the image at the modality. The information is sent from the modality with the image to the image’s destination.

1 Right–click the exam summary window.

2 Click Exam Information on the pop–up menu.


124 Working on the Canvas PageViewing Extended Exam Information (DICOM Metadata)

The exam information is displayed.

3 Click OK to close the Exam Information window.


Working on the Canvas Setting Horizontal/Vertical Rack Orientation

Lesson 11: Setting Horizontal/Vertical Rack Orientation

The Horizontal Rack and Vertical Rack options allow you to quickly reconfigure an exam rack’s orientation.


2 Click Horizontal Rack or Vertical Rack on the pop–up menu.

The graphic below displays the exam racks in vertical orientation.


126 Working on the Canvas PageMarking an Exam Read

Lesson 12: Marking an Exam Read

When you finish reading an exam, you can mark that exam read using the Mark Read button or the F3 mark read hot key in the exam summary window. When you mark an exam read, the next exam automatically loads on the canvas page.

- n Only unread exams and exams that are not being viewed (locked) by another user display the Mark Read button. If the exam is being viewed (locked) by another user, the Mark Read button (and the F3 hot key) is not available and the following message displays: Exam is locked by LastName, FirstName (where LastName, FirstName is the name of the user who has the exam locked). If the exam is not being viewed by another user and the button is not displayed in the exam summary window, the exam may have already been read.

n If new images have arrived after the user opened the exam and they click Mark Read (or press F3), the following message displays: New images have just arrived for the exam with accession X. Do you want to load and review the new images or continue with operation?; where “X” is the accession number. Imagecast PACS searches the server for new exam images that have arrived within the last 12 hours. Imagecast PACS only searches for new images belonging to existing series within the exam. That is, Imagecast PACS does not search for new studies arriving for an exam, just images for existing studies.

n To mark an exam read, it must be selected from the Patient Directory (exams selected from the Patient History Timeline cannot be marked read).

n The mark read functionality is audited in Imagecast PACS. Information for this audit event displays in the Exam Audit Trail window (accessed by clicking audit from the Clinical Exam Notes window). The text for this mark read audit event displays as Exam marked read. The date and time the exam was marked read, the exam’s status, and the full username of the Imagecast user who marked it read also displays for this audit event. For more information about the Clinical Exam Notes window, refer to the Viewing Diagnostic Reports section on page 189.

If you notice that an exam’s status is C (Complete), no other user is viewing the exam, and the Mark Read button is not present (or the F3 hot key is not available), contact your application manager or internal application support help desk.

Click Mark Read or press F3 in the exam summary window.


Working on the Canvas Using the Navigational Rectangles

Lesson 13: Using the Navigational Rectangles

The navigational rectangles are colored rectangles surrounding images and/or series in the exam racks. These rectangles indicate the diagnostic monitor that displays the corresponding image and/or series.

By moving the rectangles or placing images and series within them, you can quickly load images in to your diagnostic monitors.

The size of the rectangles is determined by the layout of your diagnostic monitors. For example, if you chose to apply a 6:1 configuration to your diagnostic monitor, the rectangle will be 6 images or series in length (that is, 6 images are encompassed in the rectangle).

The navigational rectangles can also provide a contextual view of the images or series displayed on your diagnostic monitors. For example, when you zoom in on a particular area of an image on your diagnostic monitor, a smaller colored rectangle is superimposed on images and series in the exam rack on the canvas page. This smaller rectangle gives a contextual view of the diagnostic monitor display in relation to the image as a whole. Refer to the following graphic.

Loading Images into Your Diagnostic MonitorsDo one of the following to load images into your diagnostic monitors using the navigational rectangles:

Position your mouse pointer on the edge of a rectangle, click and drag the rectangle over the images or series.

Superimposed rectangles


128 Working on the Canvas PageUsing the Navigational Rectangles

Click on the navigation rectangle and drag it to the image or series you want to view.

Note: Doing this splits the navigation rectangle. Refer to the following graphic.

The image and/or series is displayed in the corresponding diagnostic monitor.

- If the navigation rectangle is not present on the exam rack, click a Monitor icon and drag a new navigation rectangle onto an images/series. Refer to the graphic below.

Navigation retangle Dragging the navigation rectangle to another Image/series splits the navigation rectangle


Working on the Canvas Using the Navigational Rectangles

Click and drag on the monitor icon to create a new navigation rectangle


130 Working on the Canvas PageOrganizing Images and Series Within the Exam Rack

Lesson 14: Organizing Images and Series Within the Exam Rack

You can move images and series to a different location within an exam rack.

Click the top or bottom margin/border of the image you want to move, and drag the image or series (left or right) to the desired location within the exam rack.

Note: If an image or series is dragged into one of the navigational rectangles, it is displayed on the corresponding diagnostic monitor.

Lesson 15: Using the Diagnostic Thumbnails on the Canvas Page

While the navigation console is not meant for diagnostic reading, you can manipulate the thumbnail images and expanded windows on the canvas page.

The following adjustments can be made to diagnostic thumbnail images in the exam racks:

n Expand images or series into floating windows (page 131)n Adjust window width and window level (page 132)n View MR slices (page 134)n View CT slices (page 134)

You can also access a pop–up menu from which you can perform the same image manipulation tasks performed on the diagnostic monitors. For more information about image manipulation on the diagnostic monitors, refer to the Reading Exams on the Diagnostic Monitors section on page 211.


Working on the Canvas Expanding Images and Series into Floating Windows

Lesson 16: Expanding Images and Series into Floating Windows

You can expand images and series in the exam racks into larger floating windows that appear on the canvas page. Refer to the following graphic.

Images and series displayed in floating windows can be manipulated using the same mouse and keyboard controls used with images on the diagnostic monitors (for example, zooming and panning). You can access a pop–up menu from which you can perform these image manipulation tasks. The pop–up menu is modality–specific (that is, it only displays options available for certain modalities).


132 Working on the Canvas PageAdjusting Window Width and Window Level

Expanding Images and Series into Floating WindowsDo one of the following:

Double–click the image or series.

In the exam rack, right–click the image and click Create Popup.

Lesson 17: Adjusting Window Width and Window Level

You can manually adjust the window width and window level of an image for optimal viewing or to highlight certain details for better visibility. You can also use the Window Width/Level option to select from a variety of predefined window width and level settings identified as effective for viewing various types of exams. You can access the Window Width/Level option from the pop–up menu in the exam racks or an expanded floating window on the canvas page.

- Window width and level settings are defined using the Preferences Dialog. Or contact your application manager or your internal application support help desk.

Manually Adjusting Window Width and Level Settings1 Position your mouse pointer over the image.

2 Click and hold the left mouse button.


– To adjust window width (contrast), drag the mouse horizontally (left or right) across the image to increase or decrease the window width.

– To adjust the window level (brightness), drag the mouse vertically (up or down) across the image to increase or decrease the window level.

Note: When you adjust the window width and level for a series, all slices in the series are affected. If you want to adjust the window width and level of one slice in a series, press CTRL and move the mouse as appropriate.


Working on the Canvas Cine Slices in a Multi–image Series on the Canvas Page

Using Predefined Window Width/Level Settings1 Right–click an image.

2 Click Window Width/Level on the pop–up menu.

3 Click the window width/level setting with which you want to work.

Lesson 18: Cine Slices in a Multi–image Series on the Canvas Page

You can scroll through the slices in an multi–image series frame–by–frame (one slice at a time or cine mode), rapidly (fast cine), or continuously (cine loop).

- Fast cine review is not available for thumbnail images in exam racks on the canvas page. Fast cine is only available for use with expanded windows (accessed from the canvas page) and on the diagnostic monitors.

Action Using Procedure

Cine review (frame–by–frame)

Wheel mouse Position your mouse pointer over the image and roll the mouse wheel forward or backward.

Two–button mouse Press the up and down arrows keys or the PAGE UP and PAGE DOWN keys on your keyboard.

Fast cine review Wheel mouse Position your mouse pointer over the image, press and hold the mouse wheel, and then drag the mouse.

Two–button mouse Press and hold the up and down arrows keys or the PAGE UP and PAGE DOWN keys on your keyboard.

Cine loop Wheel or two–button mouse

Right–click a series and select Play Cine Loop.

Keyboard Press C to toggle the Cine Loop on/off.

Improve image quality of cine loop

Keyboard Press F9.


134 Working on the Canvas PageUsing Scout Lines for CT and MR Scout Images

Lesson 19: Using Scout Lines for CT and MR Scout Images

Scout lines can be displayed for CT and MR scout images. When you turn on scout line mode for a scout image and you move your cursor over an associated window, series, or image in the exam rack (within the same DICOM frame of reference) scout lines appear on the scout image. This functionality allows you to review a series or image without obstructing the image (active) window with scout lines. Refer to the following MR example graphic.

Scout line mode Scout lines can be displayed in one of the following scout line modes:n Single—Show a single scout line corresponding to the current

image in the active window (system default)n Bracket—Show scout lines for the first, last, and current image in

the current window (as shown in the previous screen shot)n All—Show scout lines for all images in the current window

You can set the scout line mode in the Display Preferences section of User Preferences.

Cursor on associated series

Scout image (All scout line mode)


Working on the Canvas Using the Localizer

Viewing Scout Lines

Right–click the scout image and select Scout Line Mode on the pop–up menu.

Alternatively, you can turn scout line mode on and off by pressing F11.

Notes:n When the slices are cined (page 133), the interactive navigation

bar moves in sync with the cine action.n If you move the position of the scout in the exam, that position is

preserved the next time the exam is opened.

Hiding Scout Lines

Right–click the scout image and select Scout Line Mode on the pop–up menu.

Alternatively, you can turn scout line mode on and off by pressing F11.

Lesson 20: Using the Localizer

Similar to scout lines (page 134), the localizer helps you visualize and navigate to a location in multiple series with different orientations. The localizer allows you to hover on a single point on an image and see that point displayed on all other series in a given exam that are in the same frame of reference. In addition, when in localizer mode, and the you click a point on an image, all other series in the same frame of reference in that series will cine to display the closest possible image.

When you select localizer mode, a cross hair ( ) is placed in every image or series of an exam at x/y coordinates that correspond to the location of your cursor. As you move the cursor over the specified image or series, all cross hairs move in sync.

The following example shows the cross hairs that appear at corresponding locations on every other series in the exam when the cursor is passed over the first series at the top left of the exam rack.


136 Working on the Canvas PageUsing the Localizer

(Moving the cursor from its initial position, back towards the spine, and back up again, with all cross hairs moving in sync.)

As with the link feature (page 249), the localizer can be used to navigate through multiple series simultaneously. By holding down the left mouse button and dragging the cursor, all exams with the same DICOM frame of reference, regardless of their specific orientations, move in sync.

- Unlike other images, clicking and dragging does not adjust the window width/level of localizer-enabled images.

Cursor position on first series

Cross hair indicating cursor’s position on this series




Working on the Canvas Using the Localizer

The benefit of using the localizer (instead of the linking tool) is that series with different orientations (axial, sagittal, and coronal) can all be aligned simultaneously.

.Example

In PET/CT studies, the Localizer tool can be used to create a “ghost” cursor on the other axial slices. (This will only work if the CT and the PET images have the same DICOM frame of reference).

- The localizer is used independently of annotation and measurement tools. Selecting a measurement tool or working with annotations while in localizer mode turns the localizer off.

Scout lines and the localizer

By default, scout lines appear when in localizer mode. This default is controlled in the Display Preferences section of User Preferences.

Multi-phase series and the localizer

Multi-phase studies contain multiple images with the same location identifier. Paging through a multi-phase series that not has been split may result in jumping back to the first slice location each time the user reaches the end of each phase within the series.

If the localizer is used to navigate through a multi-phase series, other linked series are synchronized on location and display the image with the closest location to the one displayed in the master series. If the non multi-phase series is used as the master, Imagecast PACS tries to find the image with the closest location in the multi-phase series, and because there are potentially multiple matches, Imagecast PACS displays the best match from the first multi-phase series.

The localizer should not be used to review all images of a multi-phase series by paging through another series.

Turning the Localizer On1 Right-click the image/series for which you want to use the localizer

and select Localizer Mode.

Alternatively, you can turn the localizer mode on and off by pressing F12.


– Hover the cursor over a location on the selected image or series. Cross hairs appear in the same location (in different orientations) on all other series in the given exam (that are in the same frame of reference).


138 Working on the Canvas PageConfiguring Your Diagnostic Monitors from the Canvas Page

– Move the cursor across the selected image/series. As you move the cursor over the specified image or series, all cross hairs for all other series in the given exam (that are in the same frame of reference) move in sync.

– Click a single point on the selected image/series to view that point on all other series in the given exam (that are in the same frame of reference). When you click the selected image/series, all other series in the same frame of reference in that series will cine to display the closest possible image for that selected point.

Turning the Localizer Off

Right-click the selected image/series and deselect Localizer Mode.

Alternatively, you can turn the localizer mode on and off by pressing F12.

Lesson 21: Configuring Your Diagnostic Monitors from the Canvas Page

By default, the hanging configuration of your diagnostic monitors is based on the settings specified in the Hanging Protocol option of the Preferences Dialog window.

Do one of the following:

In an exam rack, right–click an image or series within a navigational rectangle, click Monitor Layout, and then click a configuration


Working on the Canvas Configuring Your Diagnostic Monitors from the Canvas Page

(monitor layout) on the pop–up menu. Refer to the following graphic.

In an exam rack, right–click the navigation rectangle and then click a configuration (monitor layout) on the pop–up menu. Refer to the following graphic.


140 Working on the Canvas PageConfiguring Your Diagnostic Monitors from the Canvas Page

In the control strip, right–click the corresponding monitor icon and then click a configuration (monitor layout) on the pop–up menu. Refer to the following graphic.


Reading Exams on the Diagnostic Monitors

From the canvas page, you can load studies into your diagnostic monitors. Diagnostic monitors display full–resolution, full–fidelity radiological images and series accompanied by a variety of overlays which can be configured by your application manager.

!Caution

All diagnostic reading should occur on your diagnostic monitors.

Numerous advanced image and series manipulation tools are available by right–clicking any image or series displayed on the diagnostic monitors.

This chapter details the tasks you can perform while reading studies on your diagnostic monitors.

Objectives Upon completing this chapter, you will be able to:n Identify overlaysn Move scaled rulers on the diagnostic monitors n Select images and series to view and read on diagnostic monitorsn Work with images in the diagnostic monitorsn Adjust window width and leveln Zoomn Pann Cinen Describe the measurement tools available to youn Measure the distance between two points on an imagen Measure an angle on an imagen Measure the area of a region of interest on an imagen Display the point value of an image (measure luminance) n Use the Measurement Paletten Calibrate an image


142 Reading Exams on the Diagnostic Monitors

n Understand US measurementsn Annotate imagesn Use the Spine Labeling tooln Edit measurement and annotation formatsn Delete measurements and annotationsn Invert image brightness and contrast n Apply image processing filters to an image n View slices using scout linesn View slices using the localizern Use multi–image modesn Change the diagnostic monitor layoutn Switch between different images or series in a studyn Switch between exams for currently-selected patientn Clone CT seriesn Expand images and series into floating windowsn Mark key imagesn Understand the Key Image Series Stackn Cycle key imagesn Compare imagesn Save an image to a filen Copy an image to the clipboardn Print an imagen Delete a series or image n Flip an imagen Rotate an imagen Sort a series n Split an examn Manage duplicate study instance unique identifiers


Reading Exams on the Diagnostic Monitors 143Diagnostic Monitor Components

Lesson 1: Diagnostic Monitor Components

When you load a study into your diagnostic monitor, Radiologist Workstation displays the image, image measurements, image annotations, embedded and declared DICOM overlays, screen overlays as defined by your application manager, and scaled rulers. Refer to the following graphic.

The information displayed in the screen overlays and where it appears on the image is determined by your application manager. You can turn the screen overlays on and off by pressing F6 (page 144). You can turn

Screen overlay

Scaled ruler

Image measurement (18.5 cm^2)

Scaled ruler


144 Reading Exams on the Diagnostic MonitorsDiagnostic Monitor Components

all overlays (screen, annotation, measurement, and embedded and declared DICOM overlays) and the scaled ruler on and off by pressing CTRL+F6.

The size of the scaled ruler adjusts accordingly at every resolution and each tick on the ruler represents 1cm. The rulers can be moved to different locations on the image to measure various portions of the image.

- Unprocessed mammography images are loaded into your diagnostic monitor “as is”. Images are flagged as unprocessed when Imagecast PACS has not been provided with enough information from the source modality to process the image (such as when vendor-specific proprietary information is excluded). Imagecast PACS displays the following caution message on the image: CAUTION: Unprocessed Image.

!Caution

• Lossy compressed mammography images and digitized film screen images should not be reviewed for primary image interpretations.

• Mammography images may only be interpreted using an FDA-approved monitor that offers at least 5-mega-pixel resolution and meets other technical specifications reviewed and accepted by the FDA.

Turning Screen Overlays On or Off

Press F6.

Turn All Overlays On or Off

Press CTRL+F6.

Moving the Scaled Rulers on the Diagnostic Monitors

Click and drag the rule to the location you want to measure.

When you release the mouse button, the rule returns to its original location.


Reading Exams on the Diagnostic Monitors 145Selecting Images and Series to View and Read on the Diagnostic Monitors

Lesson 2: Selecting Images and Series to View and Read on the Diagnostic Monitors

Radiologist Workstation was designed to require as little hanging work from the user as possible. If you carefully defined your general preferences and your hanging protocols, you may not have to actively select images or series to hang. Ideally, you will access the next exam from the canvas page and proceed through your worklist. If you need to hang images or series, Radiologist Workstation makes the process quick and intuitive.

Selection of images and series for display on your diagnostic monitors takes place on the canvas page. The navigational rectangles in the exam racks on the canvas page indicate which exams are displayed on your diagnostic monitors. The colors correspond to the monitor icons on the control strip. Each monitor is color–coded and is marked with a number. In the exam rack on the canvas page, a colored rectangle surrounds the image. This indicates the diagnostic monitor that displays the corresponding image and/or series. You can click the icons in the control strip to change the configuration of your diagnostic monitors .

Use the navigational rectangles to load images, series, or exams into your diagnostic monitors. For more information about loading images into your diagnostic monitors using the navigational rectangles in the exam racks, refer to the Loading Images into your Diagnostic Monitors section on page 127.

Lesson 3: Working with Images in the Diagnostic Monitors

Radiologist Workstation provides numerous tools for reading exams on your diagnostic monitors. Available tools include:

n Window width and leveln Zoomn Pann Cine, fast cine, and cine loop for series


146 Reading Exams on the Diagnostic MonitorsAdjusting Window Width and Window Level

n Invertn Flipn Rotaten Image annotationn Measurementn Spine labeling

A pop–up menu is displayed when you right–click an image or series on the diagnostic monitors. The options that display depend on the modality type associated with the exam you are viewing (that is, the pop–up menu is modality–specific and certain features are only available for certain modalities).

The following lessons explain how to use the tools listed above.

Lesson 4: Adjusting Window Width and Window Level

You can manually adjust the window width and window level in an image for optimal viewing or to highlight certain details for better visibility. You can also use the Window Width/Level option on the pop–up menu to select from a variety of predefined window width and level settings identified as effective for viewing various types of exams.

All predefined window width and level options are configured on an organization–specific basis and can include: Abdomen, Bone, Brain, Liver, Lung, and Mediastinum. Window width and level settings are defined using the Preferences Dialog. These predefined settings can be edited to suit your personal viewing needs.

Manually Adjusting Window Width and Level Settings

1 On the diagnostic monitor, position your mouse pointer over the image.

2 Click and hold the left mouse button.


Reading Exams on the Diagnostic Monitors 147Zooming


– To adjust window width (contrast), drag the mouse horizontally (left or right) across the image to increase or decrease the window width.

– To adjust the window level (brightness), drag the mouse vertically (up or down) across the image to increase or decrease the window level.

Using Predefined Window Width/Level SettingsImagecast PACS uses the optimal Window Width/Level setting as the default value. The submenus of this item can include Default Window/Level, Modality Default and Histogram Calculation and may contain other custom Window Width/Level values if your Imagecast PACS system administrator has created them.

1 In the exam rack, right-click on an image.

2 Click Window Width/Level on the pop-up menu.


– To select from your user-specific window width/level setting presets, on the Window Width/Level pop-up menu, select the user window width/level setting with which you want to work.

– To select from organization-specific window width/level setting presets, on the Window Width/Level pop-up menu, click System WW/WL Presets and then select the system window width/level setting from the (System WW/WL Presets submenu) with which you want to work.

Lesson 5: Zooming

You can zoom in on and out of plain film images or series by up to 1600%. You can either do this manually or use preset zoom settings. You can also specify how the image appears when zoomed in. This is called interpolation.

Interpolation is the mathematical process by which a digital image is made larger. This is done by stretching the size of the image and then


148 Reading Exams on the Diagnostic MonitorsZooming

generating pixels (based on the interpolation algorithm chosen) to fill in the blanks. Interpolated images produce smoother lines and generally better quality than if the original, smaller image was simply displayed larger.

The following interpolation modes are available:n Pixel Replication (faster)n Bilinear Interpolation (better quality)n Bicubic Interpolation (best quality)

The following exam shows pixel interpolation and bicubic interpolation.

The following table details the procedures you can use to zoom an image depending on the type of image and whether you have a wheel mouse or a two–button mouse.

Example of Zoom Using Pixel Replication Example of Zoom Using Bicubic Interpolation


Zoom in on single-image series

Wheel mouse Position your mouse pointer over the image and roll the mouse wheel backward toward yourself.

Two–button mouse Press ALT, hold the left mouse button, and then drag the mouse backward toward yourself.

Zoom out of single-image series

Wheel mouse Position your mouse pointer over the image and roll the mouse wheel forward away from yourself.

Two–button mouse Press ALT, hold the left mouse button, and then drag the mouse forward away from yourself.

(Page 1 of 2)


Reading Exams on the Diagnostic Monitors 149Panning

Using Zoom Presets1 Right–click an image on the spot where you want the zoom centered.

2 Click Zoom Presets on the pop–up menu.

3 Select one of the following:n Fit To Windown 100% (Original)n 200%n 300%n 400%

- Selecting a zoom preset does not resize the window.

Selecting an Interpolation Mode1 Right–click on an image.

2 Click Image Processing.

3 Select the desired interpolation mode.

Lesson 6: Panning

You can pan plain film images and series to view detailed portions of images.

Zoom in on multi–image series

Wheel mouse

Two–button mouse

Press ALT, hold down the left mouse button, and then drag the mouse backward toward yourself.

Zoom out of multi–image series

Wheel mouse

Two–button mouse

Press ALT, hold down the left mouse button, and then drag the mouse forward away from yourself.


(Page 2 of 2)


150 Reading Exams on the Diagnostic MonitorsCine Slices in a Multi–image Series

The following table details the procedures you can use to pan an image depending on the type of image and whether you have a wheel mouse or a two–button mouse.

Lesson 7: Cine Slices in a Multi–image Series

You can scroll through the slices in an multi–image series frame–by–frame (one slice at a time or cine mode), rapidly (fast cine), or continuously (cine loop).


Pan single image Wheel mouse Position your mouse pointer over the image, press and hold the mouse wheel, and then drag the mouse.

Two–button mouse Press CTRL, hold down the left mouse button, and then drag the mouse.

Pan multi–image series Two–button mouse Press CTRL, hold down the left mouse button, and then drag the mouse.


Cine review (frame–by–frame)

Wheel mouse Position your mouse pointer over the image and roll the mouse wheel forward or backward.

Two–button mouse Press the up and down arrows keys or the PAGE UP and PAGE DOWN keys on your keyboard.

Fast cine review Wheel mouse Position your mouse pointer over the image, press and hold the mouse wheel, and then drag the mouse.

Two–button mouse Press and hold the up and down arrows keys or the PAGE UP and PAGE DOWN keys on your keyboard.

Cine loop Wheel or two–button mouse

Right–click a series and select Play Cine Loop.

Keyboard Press C to toggle the Cine Loop on/off.

(Page 1 of 2)


Reading Exams on the Diagnostic Monitors 151Overview of Measurement Tools

Lesson 8: Overview of Measurement Tools

The Measurement option allows you to indicate and measure specific areas of an image. Measurement tools include:

n Rulern Anglen Region of Interest (ROI)n Freehand ROIn Measurement Palette

The following lessons explain the different measurement tools available.

- When a measurement or annotation is added to an image, that image automatically becomes a key image. A key image is one that was selected and marked as an important image in a particular series or exam. When an image is marked as a key image, the words key image are displayed on the image. For more information about key images, refer to the Marking Key Images section on page 172.

Lesson 9: Measuring the Distance Between Two Points (Ruler Tool)

The Ruler tool allows you to measure the distance (in millimeters or pixels) between two points on an image.

Improve image quality of cine loop

Keyboard Press F9


(Page 2 of 2)


152 Reading Exams on the Diagnostic MonitorsMeasuring the Distance Between Two Points (Ruler Tool)

1 Right–click the image.

2 Click Measurement on the pop–up menu.

3 Click Ruler on the pop–up menu.

4 On the image, click the point where you want to begin your measurement.

5 Drag the mouse to the endpoint of your measurement, and click the mouse button again.

The measurement (in pixels or millimeters depending on the DICOM information available) appears.

- n To move the entire ruler to another location on the image without changing the distance between either endpoint, click anywhere on the ruler and drag it to the new location.

n To reposition either endpoint of the ruler and take a new measurement, click on an end and drag it to a new location. The new measurement is displayed. You can reposition the endpoints of the ruler at any time.

n To delete the ruler, click the ruler and press DELETE, or right–click the ruler and then click Delete on the pop–up menu.

n To customize the line style or font of the measurement, refer to the Editing Measurement and Annotation Formats (Line Style and Font) section on page 163.

n When a measurement or annotation is added to an image, that image automatically becomes a key image. For more information about key images, refer to the Marking Key Images section on page 172.


Reading Exams on the Diagnostic Monitors 153Measuring an Angle on an Image (Angle Tool)

Lesson 10: Measuring an Angle on an Image (Angle Tool)

The Angle tool allows you to measure the angle between points on an image.



3 Click Angle on the pop–up menu.

4 On the image, click the points that serve as the angle’s first endpoint, apex, and second endpoint.

The measurement (in degrees) appears.

- n To move the entire angle to another location on the image without changing either endpoint or the angle, click the apex (center box of the angle), and drag it to the new location.

n To reposition either endpoint of the angle and change the angle being measured, click an end and drag it to the new location. The arms of the angle can be fully articulated by clicking anywhere on an arm and dragging it to a new location.

n To delete an angle, click the angle and then press DELETE, or right–click the angle and then click Delete on the pop–up menu.

n To customize the line style or font of the angle, refer to the Editing Measurement and Annotation Formats (Line Style and Font) section on page 163.


Apex

Second endpoint

First endpoint


154 Reading Exams on the Diagnostic MonitorsMeasuring the Area of a Region of Interest

Lesson 11: Measuring the Area of a Region of Interest

The Region of Interest and Freehand ROI tools allow you to pinpoint a region of interest on an image and determine its area.

Region of Interest ToolWhen you use the Region of Interest tool, measurement is displayed in Hounsfield units for CTs or centimeters squared for other modalities.

!Caution

If compression is engaged, the Hounsfield unit measurements are not accurate unless the image is being viewed at full–fidelity. If the image is not viewed at the highest available resolution, the value displayed by the Region of Interest tool includes the tilde (~) symbol indicating that the value is an approximation.



3 Click Region of Interest on the pop–up menu.

4 On the image, click and hold the mouse button on the point from which you want to measure.

5 Drag the mouse to include the area of interest.

A circle identifies the selected region and the area of the region is indicated in Hounsfield units for CTs or centimeters squared for other modalities.

- n To move the entire region to another location on the image without changing its area, click the box in the center of the circle and drag the region to the new location.

n To resize the region, click and drag the box on the circle’s perimeter to increase or decrease the area of the region.


Reading Exams on the Diagnostic Monitors 155Measuring the Area of a Region of Interest

n To delete the region, click the region and then press DELETE, or right–click the region and then click Delete on the pop–up menu.

n To customize the line style or font of the region, refer to the Editing Measurement and Annotation Formats (Line Style and Font) section on page 163.


Freehand ROI ToolThe Freehand ROI (region of interest) tool is similar to the Region of Interest tool. It allows you to pinpoint a region of interest on an image and determine its area. However the Freehand ROI tool allows you to outline the region you want to measure using complex shapes. The shape of your outline can be as complex as necessary. The only restriction is that your lines must not intersect.

When you use the Freehand ROI Tool, measurement is displayed in Hounsfield units for CTs or centimeters squared for other modalities.

!Caution

If compression is engaged, the Hounsfield unit measurements are not accurate unless the image is being viewed at full–fidelity. If the image is not viewed at the highest available resolution, the value displayed by the Region of Interest tool includes the tilde (~) symbol indicating that the value is an approximation.



3 Click Freehand ROI on the pop–up menu.

4 On the image, click and drag the mouse to outline the desired area.


156 Reading Exams on the Diagnostic MonitorsDisplaying the Point Value of an Image (Measuring Luminance)

5 Release the mouse button when you finish the outline.

A dashed line identifies the selected region and the area of the region is indicated. The area is indicated in mean units with standard deviation (sd) and centimeters squared.

- n To move the entire outline to another location on the image without changing its area or shape, click the box in the center of the outline and drag it the new location.

n To adjust the contours of the outline, click the region and click a box on the outline and drag the line.

n To delete the region, click the region and then press DELETE, or right–click the region and then click Delete on the pop–up menu.

n To customize the line style or font of the region, refer to the Editing Measurement and Annotation Formats (Line Style and Font) section on page 163.


Lesson 12: Displaying the Point Value of an Image (Measuring Luminance)

The Point Value tool allows you to continuously display the luminance value for single pixels of the original DICOM image. In other words, the value given is not related to what is being displayed on your screen. Rather, it is the value for a reference point which is mapped to the


Reading Exams on the Diagnostic Monitors 157Using the Measurement Palette

original DICOM image. Point values for CT's are displayed in Hounsfield units. All other values are displayed in mean units with standard deviations. Refer to the following graphic.

Using the Point Value Tool1 Right–click an image.

2 Select Measurement.

3 Click Point Value.

The point value is displayed at the bottom of the window.

4 To turn off the Point Value tool, click anywhere on the image.

Lesson 13: Using the Measurement Palette

If you need to take numerous measurements on an image, you can use the Measurement Palette to streamline your work. The Measurement Palette provides a floating toolbar of measurement tools (ruler, angle,

Point value of cursor’s location is continuously displayed at the bottom of the window

Cursor (reference point to which the original DICOM image is mapped)


158 Reading Exams on the Diagnostic MonitorsUsing the Measurement Palette

region of interest, and freehand ROI) that you can drag to any location on the window. This palette gives you quick and easy access to measurement tools without having to right–click an image and access the tool on the pop–up menu option.

Using the Measurement Palette1 Right–click the image.


3 Click Measurement Palette on the pop–up menu.

The Measurement Palette is displayed.

4 Click the tool with which you want to work and take measurements as appropriate. Refer to the following table.

5 To close the Measurement Palette, right–click, click Measurement, and then click Measurement Palette.

Note: When a measurement or annotation is added to an image, that image automatically becomes a key image. For more information about key images, refer to the Marking Key Images section on page 172.

Icon Tool For instructions about how to take measurements using this tool, refer to the…

Ruler Measuring the Distance Between Two Points (Ruler Tool) section on page 151

Angle Measuring an Angle on an Image (Angle Tool) section on page 153

Region of Interest Region of Interest Tool section on page 154

Freehand ROI Freehand ROI Tool section on page 155


Reading Exams on the Diagnostic Monitors 159Calibrating an Image

Lesson 14: Calibrating an Image

The Calibrate Image tool allows a user to redefine the scale used to calculate measurements for an image. Calibrations are made image by image but can be saved as part of a presentation state.

Using the Calibrate Image Tool

- In order to calibrate an image, you must know the exact distance between two points on the image.



3 Click Calibrate Image on the pop–up menu.

4 Place your cursor at the start point of a known distance and then click and drag to the end point of the known distance.

The Image Calibration Dialog is displayed.

5 In the Enter Length field, enter the known length in millimeters.

6 Click OK.

All measurements (including area and distance) are now based on the newly defined scale and the interactive, scaled rulers, are resized.

Lesson 15: Understanding US Measurements

Length measurements for ultrasound images are implemented for B–mode and B/F–mode (2–D measurements). However, there are a few instances when measurements may not be possible. For example, the scanner will sometimes not send the necessary calibration information needed for measurements. In these instances, you might want to use the Calibrate Image tool (page 159) to manually calibrate the image. Measurements on Spectral, M–Mode or Dual B–Mode images are not supported at this time.


160 Reading Exams on the Diagnostic MonitorsAnnotating Images

Lesson 16: Annotating Images

The Annotations option allows you to annotate images. Several annotation styles can be applied including:

n Linen Circlen Arrown Trianglen Textn Freehandn Spine labelingn Custom annotation styles

- n When a measurement or annotation is added to an image, that image automatically becomes a key image. A key image is one that was selected and marked as an important image in a particular series or exam. When an image is marked as a key image, the words key image are displayed on the image. For more information about key images, refer to the Marking Key Images section on page 172.

n Labels and any other annotation placed on an image are saved when an exam is marked read, or upon saving a particular configuration as a presentation state.

Using the Line, Circle, Arrow, Triangle, or Freehand Tools1 Right–click the image.

2 Click Annotations on the pop–up menu.

3 Click the annotation style with which you want to work.

4 On the image, click the point where you want to initiate your annotation.


Reading Exams on the Diagnostic Monitors 161Annotating Images

5 Hold the left mouse button, drag the mouse as desired, and then release the mouse button.

When you release the mouse button, the annotation is complete. (The graphic below displays the triangle style.)

- n To move annotations without changing their shape or size, click anywhere on the annotation and drag it to the new location.

n To resize line or arrow annotations, click on an end and drag it to a new location.

n To resize a circle annotation, click and drag a box on the circle’s perimeter to increase or decrease its size.

n To resize a triangle annotation, click on a corner of the triangle and drag it to the new location.

n To adjust the contours of a freehand annotation, click a box on the outline and drag the line.

n To delete an annotation, click the annotation and then press DELETE, or right–click the annotation and then click Delete on the pop–up menu.

Adding Text Annotations1 Right–click the image.


3 Click Text on the pop–up menu.

4 On the image, click where you want to place the text annotation.

A dialog box appears.

5 Type your annotation text.

6 Click OK.


162 Reading Exams on the Diagnostic MonitorsAnnotating Images

The text is placed on the image.

- n To move the annotation, click anywhere on the annotation and drag it to the new location.

n To resize the text of the annotation, click the annotation and drag the box at one of the corners of the annotation.

Using the Spine Labeling ToolThe Spine Labeling tool allows you to place markers at each vertebra or vertebral disc.



3 Click Spine Labeling on the pop–up menu.

The Spine Label Panel window is displayed.


– To place a single label on the image—Click the label and then click the location on the image where you want to place the label.

– To place a range of labels on the image—Click the label with which you want to begin and then click the locations on the image


Reading Exams on the Diagnostic Monitors 163Editing Measurement and Annotation Formats (Line Style and Font)

where you want to place the labels. With every click a label is placed on the image.

Note: To change the order of the labels from ascending to descending, click Descending order.

5 When you finish placing labels on the image, click in the upper right corner of the Spine Label Panel window.

- n To hide all labels on the image, on the Spine Label Panel window click Hide All. To display all labels on the image, on the Spine Label Panel click Show All.

n To delete an individual label, click the label and press DELETE on your keyboard. To delete all labels on an image, click Delete All on the Spine Label Panel window.

Lesson 17: Editing Measurement and Annotation Formats (Line Style and Font)

You can change the line style used for measurements and annotations. In addition, you can change the font used to indicate measurements and annotations.

- When a measurement or annotation is added to an image, that image automatically becomes a key image. A key image is one that was selected and marked as an important image in a particular series or exam. When an image is marked as a key image, the words key image are displayed on the image. For


164 Reading Exams on the Diagnostic MonitorsDeleting Measurements and Annotations

more information about key images, refer to the Marking Key Images section on page 172.

1 Right–click the measurement or annotation.


– Edit Line Style—for all types of annotations excluding text

– Edit Font—for text annotations

3 Change the properties as appropriate.

4 Click OK.

- Annotations and annotation styles can also be created and personalized by your application manager using the Preferences Dialog window. For more information about custom annotations and annotation styles, contact your application manager or internal application support help desk.

Lesson 18: Deleting Measurements and Annotations

You can delete a measurement or annotation from an image. Use one of the following procedures:

Click the measurement or annotation and then press DELETE.

Right–click the measurement or annotation and click Delete on the pop–up menu.

Click the measurement or annotation and drag it off the monitor.

Lesson 19: Inverting Image Brightness and Contrast

The Invert Image option allows you to reverse the black and white coloration of an image.



Reading Exams on the Diagnostic Monitors 165Inverting Image Brightness and Contrast

2 Click Image Processing.

3 Click Invert Image.

The image’s colors are reversed.

Inverted imageImage before inversion


166 Reading Exams on the Diagnostic MonitorsApplying Image Processing Filters

Lesson 20: Applying Image Processing Filters

The following image processing filters are available:n Edge Enhance—Utilizes a Laplacian method to increase the

visibility of edges in the image n Edge Detect—Provides an alternative to the edge enhancement

filter, utilizing a Sobel operator to increase the visibility of edges n Median—Utilizes a common filtering method to reduce noise in

an image n CLAHE (Contrast Limited Adaptive Histogram Equalization)—

Utilizes an adaptive form of histogram equalization that enhances the contrast adaptively across the image

The following graphic shows before and after examples of each image processing filter.

Edge EnhanceOriginal

Edge Enhance

Edge DetectOriginal

Median

MedianOriginal

CLAHE

CLAHOriginal

Edge Detect


Reading Exams on the Diagnostic Monitors 167Viewing Slices Using Scout Lines

- n Image processing filters can only be applied to one image at a time. That is, when an image processing filter is applied to a selected image, the filter is applied to only that image, even if the selected image is part of a stack or displayed in multi-image mode.

n A stack of images can have different image processing filters applied to different images within the stack. In addition, the stack can contain images that have image processing filters applied and images that do not have image processing filters applied.

n Image processing filters are temporary settings; they cannot be saved with presentation states. If you try to save a presentation state for which image processing filters have been applied, a warning message is displayed informing you that the image processing filters will not be saved with the presentation state.

n Image processing filters cannot be applied to hanging protocol clones.

Applying an Image Processing Filter to an Image1 In the exam rack, right-click on an image.

2 On the pop-up menu, click Image Processing.

3 Select one of the following:

– Edge Enhance

– Edge Detect

– Median

– CLAHE

Lesson 21: Viewing Slices Using Scout Lines

The Scout Line Mode option allows you to designate an image as a scout view and view scout lines on the scout view for different images within the series.


168 Reading Exams on the Diagnostic MonitorsViewing Slices Using the Localizer

Lesson 22: Viewing Slices Using the Localizer

The Localizer Mode option allows you to visualize and navigate to a location in multiple series with different orientations.

For more information about working with the localizer on the canvas page, refer to the Using the Localizer section on page 135.

Lesson 23: Viewing Image Series Using Multi–Image Modes

You can configure image series displayed on your diagnostic monitors into one of nine different column/row configurations using the multi–image mode function.

The following table displays all of the possible configurations. One image slice equals one section in each table below.

Multi–Image Mode Configurations


1:1

1:2

2:1

2:2

2:3

1:3

3:3

3:4

4:5


Reading Exams on the Diagnostic Monitors 169Selecting a Monitor Layout

Selecting a Multi–Image Mode1 Right–click the image.

2 Click Multi Image Mode on the pop–up menu.

3 Click a configuration on the menu.

Lesson 24: Selecting a Monitor Layout

The Monitor Layout option allows you to quickly configure the diagnostic monitor on which you are viewing images. The following table displays all of the possible configurations.

Selecting a Monitor Layout1 Right–click the image.

2 Click Monitor Layout on the pop–up menu.

Monitor Layout Configurations


M1

M2H

M2V

M3H

M3V

M4

M6P

M6L

M1_2

M2_1

M1_3

M3_1


170 Reading Exams on the Diagnostic MonitorsSelecting Series

3 Click a configuration from the menu.

Lesson 25: Selecting Series

The Select Series option allows you to quickly switch between different images or series in the exam that you are viewing. Selecting a different image or series from the menu displays the image or series you selected.

- The Select Series option is not available for expanded images on the canvas page.

Selecting Series1 Right–click the image.

2 Click Select Series on the pop–up menu.

3 Click the series you want to view.

Lesson 26: Selecting Relevant Exams

The Select Relevant Exam option allows you to quickly switch between exams for the currently selected patient. When you access this option, a pop–up menu is displayed. The menu contains a list of exams that are related/relevant to the image or series you are currently viewing. (The definition of a related exam has been established at your organization. Contact your application manager or internal application support help desk for more information.)

indicates that the related exam is loaded on the canvas page. indicates that the related exam is currently displayed in the left diagnostic monitor. indicates that the exam is currently displayed in the right diagnostic monitor. If no icon is displayed, this indicates that the related exam is not loaded on the canvas page nor is it loaded into one of the diagnostic monitors.


Reading Exams on the Diagnostic Monitors 171Cloning Series

When you select an exam from the list, it replaces the exam that is currently displayed on your diagnostic monitor.

Viewing Relevant Exams1 Right–click the image.

2 Click Select Relevant Exam on the pop–up menu.

A list of exams displays in a pop–up menu.

3 Click the exam you want to view.

Lesson 27: Cloning Series

The Clone and Clone Window With Preset options allow you to duplicate a CT series in order to simultaneously view the series with different window level values.

.Example

One of the cloned CT series can be displayed with a present window level value for bone. The other cloned CT series can be displayed with a present window level value for lung.

You can clone a CT series in the exam racks and in the diagnostic monitor using the Clone Window With Preset option. The cloned CT is displayed in the exam rack on the canvas page. The letter C is displayed in the gray margin/border at the bottom of the image to designate it as the cloned image.

You can also clone a series from a floating window (page 172) in the exam racks on the canvas page and on the diagnostic monitors (page 172) using the Clone option. The cloned image displays as another expanded/floating window on the canvas page or diagnostic monitor.

Cloning Series in the Exam Racks and on the Diagnostic Monitors1 Right–click the image.

2 Click Clone Window With Preset on the pop–up menu.

In the exam rack on the canvas page, a duplicate series is displayed.


172 Reading Exams on the Diagnostic MonitorsExpanding Images and Series into Floating Windows

3 To close the cloned series, right–click the image and click Remove Clone on the pop–up menu.

Cloning Expanded Series1 Right–click the image.

2 Click Clone on the pop–up menu.

3 To close the clone, click in the upper right corner of the expanded window.

Lesson 28: Expanding Images and Series into Floating Windows

You can expand images and series into expanded/floating windows on your diagnostic monitors. You can use the same mouse and keyboard controls with floating windows that are used with images on your diagnostic monitors.

Right–click the image and click Create Popup.

Lesson 29: Marking Key Images

The Key Image option allows you to mark a particular image or series slice as a key image. A key image is one that was selected and marked as an important image in a particular series or exam. When an image is marked as a key image, the words Key and Key Image are displayed on the image.

- When a measurement or an annotation is added to an image, that image automatically becomes a key image.


Reading Exams on the Diagnostic Monitors 173Key Image Series Stack

Marking a Key Image

Do one of the following:

– Right–click the image and click Key Image on the pop–up menu.

Note: To remove the key image status from the image, right–click the image and click Key Image on the pop–up menu.

– Position your mouse pointer over the image and press the SPACEBAR on your keyboard.

Note: To remove the key image status from the image, press the SPACEBAR again.

Lesson 30: Key Image Series Stack

The Key Image Series stack displays all key images for an exam in a single Key Image Series stack on the canvas page. If enabled, the Key Image Series stack is displayed to the far left of images and series in the exam rack (for horizontal exam racks), or the top of images and series


174 Reading Exams on the Diagnostic MonitorsKey Image Series Stack

in the exam rack (for vertical exam racks). Refer to the following graphic.

Key Image Series stack in horizontal rack

Key Image Series stack in vertical rack


Reading Exams on the Diagnostic Monitors 175Cycling through Key Images

If there are no key images marked for the exam selected, the Key Image Series stack is still displayed in the exam rack; however, the stack contains the following message: No Key Images.

- n If you mark an image as a key image, the Key Image Series stack is automatically updated with the new key image.

n If the Key Image Series stack is displayed in a floating window and you delete the last key image in the Key Image Series stack, the Key Image Series stack floating window closes.

Lesson 31: Cycling through Key Images

Once images have been marked as key images (page 172), you can easily cycle through all key images for the selected exam, including exams that have more than one series. You can cycle through key images from any image or series belonging to the exam selected or from the Key Image Series stack, if this feature is turned on.

Cycling through Key Images from an Exam’s Image or Series1 To cycle through all key images for an exam from an exam’s image

or series, do one of the following:

– Double-click an image or series belonging to the exam selected.

Key Image Series stack—no key images


176 Reading Exams on the Diagnostic MonitorsCycling through Key Images

– Right-click an image or series belonging to the exam selected and click Create Popup.

The image/series is displayed in an expanded/floating window.

2 Press TAB to cycle through all key images for the exam selected.

Cycling through Key Images from the Key Image Series StackYou are able to cycle through key images from the Key Image Series stack in the exam rack or from the Key Image Series stack floating window.


– From the exam rack, position your mouse pointer over the Key Image Series stack. Refer to the following graphic.

– Double-click the Key Image Series stack or right-click the Key Image Series stack and select Create Popup. The Key Images Series stack is displayed in a floating window.


– Press TAB (to cycle to a previous key image, press SHIFT + TAB)

– Roll the mouse wheel forwards and backwards

– Press PAGE UP and PAGE DOWN

In exam rack, position mouse pointer over Key Image Series stack.


Reading Exams on the Diagnostic Monitors 177Comparing Images Using the Linking Option

Lesson 32: Comparing Images Using the Linking Option

The Link option allows you to link two or more images. Linking allows you to simultaneously manipulate the images.

When images are linked, you can simultaneously zoom, pan, and sort. When images are linked, other functions such as flip, invert, rotate, and window width/window level adjustment remain independent. That is, if you zoom one image, the other image zooms as well. If you flip, invert, or perform any other action on one image in a linked set, the other image is not affected.

- CT scout views can only be linked to plain film images such as CRs.

There are three link symbols that appear when images are linked. The diagnostic thumbnails on the canvas page display a plus symbol (+), expanded images on the canvas page display the link symbol ( ), and linked images on the diagnostic monitors display the word linked (if this has been configured for your organization in the system preferences section).

Linking series When you link two series from the same exam, Radiologist Workstation automatically orders the slices so that both series windows display the same slice. (The slice location that takes precedence is that of the first series.)

For a single exam, if more than one series has the same orientation and the same frame of reference, you can link each series simultaneously using the Link All Axial, Link All Sagittal, Link All Coronal, or Link All Oblique options.

- The variance used to determine if a series can be linked with another series is set in General Preferences of System Preferences. This variance is primarily used in linking oblique series that are 5 to 15 percent of the axial plane with axial series. For more information about System Preferences, contact your internal support help desk.

Linking Images1 Right–click the first image you want to link.

2 Click New Link on the pop–up menu.

3 Right–click the second image you want to link.


178 Reading Exams on the Diagnostic MonitorsSaving an Image to a File

4 Click Join Link on the pop–up menu.

The appropriate link symbol or text is displayed.

- n For a single exam, if more than one series has the same orientation and the same frame of reference, link the series by clicking Link All Axial, Link All Sagittal, Link All Coronal or Link All Oblique (depending on the orientation).

n Linked images can be temporarily disconnected and manipulated independently by pressing SHIFT while performing mouse or keyboard actions.

Linking Cloned or Expanded Images 1 Expand or clone the images you want to link.

2 Right–click the first image you want to link and click New Link on the pop–up menu.

3 Right–click the second image you want to link and click Join Link on the pop–up menu.

Unlinking Images1 Right–click the image.

2 Click Leave Link to unlink the selected image or Unlink All to unlink all of the images.

Lesson 33: Saving an Image to a File

The Save option allows you to save the current image as a JPEG, Bitmap, GIF, TIFF or PNG on your hard drive.


2 Click Save on the pop–up menu.


– Click Window to File on the pop–up menu. Use this option to save the entire window (including annotations and the screen overlay) to a file.


Reading Exams on the Diagnostic Monitors 179Copying an Image to the Clipboard

– Click Image to File on the pop–up menu. Use this option to save the full resolution image, without annotations or the screen overlay, to a file.

4 On the Save Image As window, identify the location to which you want to save the image.

5 Click Save.

Lesson 34: Copying an Image to the Clipboard

The Save option also allows you to copy the image to the Windows clipboard. Saving the image to the clipboard allows you to paste the image into other applications.


2 Click Save on the pop–up menu.


– Click Window to Clipboard on the pop–up menu. Use this option to copy the entire window (including the annotations and screen overlay) to the clipboard.

– Click Image to Clipboard on the pop–up menu. Use this option to copy the full resolution image, without annotations or the screen overlay, to the clipboard.

Lesson 35: Printing an Image

The Print option allows you to print an image to your default printer (paper) or to a DICOM printer (film).

Printing an Image to your Default Printer (Paper)1 Right–click the image you want to print.

2 Click Print on the pop–up menu.

3 Click To Paper Printer on the pop–up menu.


180 Reading Exams on the Diagnostic MonitorsDeleting a Series or Image

4 On the Print to Paper window, enter printing information as appropriate.

5 Click OK.

- If you want to print only one image in a series (one slice of an MR exam), navigate to that slice and mark that image as a key image (page 172). Access the Print to Paper window and click Print key images only. Only the key images will be printed.

Printing an Image to a DICOM Printer (Film)1 Right–click the image you want to print.

2 Click Print on the pop–up menu.

3 Click To DICOM Printer on the pop–up submenu.

Note: This pop-up submenu option is only available when you have a DICOM printer set up on your network.

4 On the Print Film window, enter printing information as appropriate.

5 Click OK.

- If you want to print only one image in a series (one slice of an MR exam), navigate to that slice and mark that image as a key image (page 172). Access the Print to Paper window and click Print key images only. Only the key images will be printed.

Lesson 36: Deleting a Series or Image

Depending on your user privileges, you may be able to delete a series or image. Deleted series or images can be recovered.

- n Deleting a series/image functionality is disabled in the following instances:

– If the image is the last or only image in the exam. (In this instance, the study must be detached from the exam and removed from the database.)

– If the image is within a navigational rectangle.

n When you delete a series or image that contains cloned images, the cloned images are deleted as well. However, cloned images cannot be deleted individually (that is, they can only be deleted when the image from which they were cloned is deleted).


Reading Exams on the Diagnostic Monitors 181Deleting a Series or Image

n If you select an image for an exam that has been marked read, Imagecast PACS displays the following warning message: This exam has been Marked Read, are you sure you want to continue and delete image(s) of the selected window?

n If two users open the same exam and try to delete the same image, the system displays the following message about the already deleted image to one of the users: The selected series is already deleted by another user.

n If an image containing measurements or annotations is deleted, the presentation state information is deleted as well.

Deleting a Series or Image1 Right–click the series/image.

2 On the pop-up menu, select Delete.


– Delete All Image(s)—Deletes all images in the series

– Delete Image—Deletes the selected image only

The Enter Reason for Rejection Dialog window is displayed. Refer to the following graphic.

4 Select a predefined delete reason or type a reason for the deletion in the Reason field.

Note: Typed reasons are not saved in Imagecast PACS; however, this field is audited.

Recovering a Deleted Series or Image 1 Right–click the exam rack margin and select Recover Deleted

Image(s).

Free-text reason

Predefined reason


182 Reading Exams on the Diagnostic MonitorsFlipping an Image Around the X or Y Axis

The following message is displayed: Are you sure you want to recover the deleted image(s)?

2 Click Yes.

The following message is displayed: Image(s) have been successfully recovered. Please close and reopen the exam to view the recovered image(s).

Note: Recovering a deleted series or image is audited in Imagecast PACS.

Lesson 37: Flipping an Image Around the X or Y Axis

The Flip option allows you to flip an image horizontally (around the y–axis) or vertically (around the x–axis).


2 Click Flip/Rotate/Sort/Split.

3 Click Flip Horizontal or Flip Vertical on the pop–up menu.

Lesson 38: Rotating an Image

The Rotate option allows you to rotate an image or series clockwise or counter–clockwise in increments of 90 degrees.


2 Click Flip/Rotate/Sort/Split.


Reading Exams on the Diagnostic Monitors 183Sorting a Series

3 Click Rotate 90 CW (clockwise) or Rotate 90 CCW (counter–clockwise) on the pop–up menu.

Lesson 39: Sorting a Series

The Sort option allows you to change the sort order of the series you are reviewing from ascending to descending order in the exam rack on the canvas page according to your sorting preferences. This is helpful as it allows you to determine how you want the series to be presented.

1 Right–click the series.

2 Click Flip/Rotate/Sort/Split on the pop–up menu.


– Table Position Ascending—to sort the slices in ascending order (head to foot) according to physical location/anatomy

– Table Position Descending—to sort the slices in descending order (foot to head) according to physical location/anatomy

– Image Number Ascending—to sort the slices in ascending order (first to last) according to the order in which the images were captured

– Image Number Descending—to sort the slices in descending order (last to first) according to the order in which the images were captured

Before rotation Clockwise Counter–clockwise


184 Reading Exams on the Diagnostic MonitorsSplitting an Exam Series

Lesson 40: Splitting an Exam Series

The Split Exam option allows you to split a series according to specific DICOM tags. This option is only available for stacked images (that is, a multi–image series). However, scout images, clones, and multi–frame stacked windows cannot be split.

To Split an Exam 1 Right–click the series.

2 Click Flip/Rotate/Sort/Split on the pop–up menu.

3 Click Split Exam on the pop–up menu.

4 On the Split Exam window, select the DICOM tags by which you want the exam split.

Note: The DICOM tags that are displayed on the window depend on the tags associated with the type of series you have selected. At a minimum, the series will have a DICOM group 0008 tag or higher and must contain unique attributes greater than two and less than ten. If there are no attributes available for splitting or if the split criteria are not met then the exam cannot be split.

5 Click OK.

The original series is split into different series.

- This is not a permanent change to the exam but rather a type of display. If you wish to preserve the split for later viewing, you must save a presentation state.

Lesson 41: Managing Duplicate Study Instance Unique Identifiers

Due to a non-conforming modality or user error, the potential exists for multiple patients’ studies to be merged into a single study on an Imagecast PACS server. This case is commonly referred to as a duplicate study instance unique identifier (UID). Digital Imaging and Communications in Medicine (DICOM) standards prohibit assignment


Reading Exams on the Diagnostic Monitors 185Managing Duplicate Study Instance Unique Identifiers

of a given study instance UID to more than one study. However, duplicate study UIDs (DUP UIDs) can occur.

.Example

n A nonconforming modality, which assigns study UIDs, is already in use with the Imagecast PACS environment.

n A study is not closed out before a scan on another patient is started and an attempt is made to correct the patient demographic information after the fact. Typically, even if the technologist realizes that a mistake has been made and corrects the demographic information, it is too late because the scanner reuses the previous study instance UID.

The following DUP UID management tools are available:n DUP UID message—Enabled by administrators, a demographics

mismatch message is displayed when DUP UID images are detected

n DUP UID Remove Demographics Mismatch option—Allows you to remove demographic mismatches by accepting and merging the DUP UID studies

n Image/series Delete option—Allows you to delete images or series, which may be DUP UID images, from the exam rack

n DUP UID Assign New Unique Study UID option—Allows you to assign a new study UID from the exam rack


186 Reading Exams on the Diagnostic MonitorsManaging Duplicate Study Instance Unique Identifiers

DUP UID caution message

The DUP UID notification tool displays a demographics mismatch caution message when DUP UID images are detected. Refer to the following graphic.

- The DUP UID caution message is enabled in the Imagecast PACS Configure Client option in the Imagecast PACS configuration tool. For more information about the configuration tool, contact your internal support desk or application manager.

Hiding a Demographic Mismatch MessageDepending on your privileges, you may be able to temporarily hide a demographic mismatch message.

1 Right–click the series/image on which the message is displayed.

2 On the pop-up menu, select Hide Demographics Mismatch Warning.

Removing Demographic MismatchesDepending on your privileges, you may be able to correct a DUP UID.

Demographic mismatch message


Reading Exams on the Diagnostic Monitors 187Managing Duplicate Study Instance Unique Identifiers

1 Right–click the series/image on which the DUP UID message is displayed.

2 On the pop-up menu, select Remove Demographics Mismatch. The following caution is displayed: Caution - you are about to permanently merge the images! Are you sure you want to keep the Demographics of Patient Name: X, MRN: #? (where x is the name of the patient and # is the patient’s MRN number).

3 Click Yes.

Deleting a Series or ImageDepending on your privileges, you may be able to delete a DUP UID series or image. For more information about deleting series or images, refer to Deleting a Series or Image section on page 180.

Assigning a New Study UID for a Series or ImageDepending on your user privileges, you may be able to assign a new study UID for a single image, single series, or multiple images and series.

1 On the exam rack, right–click the DUP UID series or image.

2 On the pop-up menu, select Assign New Unique Study UID.


188 Reading Exams on the Diagnostic MonitorsManaging Duplicate Study Instance Unique Identifiers

The Assign New Study UID Dialog window is displayed. Refer to the following graphic.

3 Select a predefined assign new study UID reason or type a reason for assigning the new study UID in the Reason field.

Note: Typed reasons are not saved in Imagecast PACS; however, this field is audited.

Demographic data taken from image/series

Free-text Reason field

Existing study UID information


Viewing Diagnostic Reports

Radiologist Workstation allows you to view diagnostic reports.

Objectives Upon completing this chapter, you will be able to:n Access and view diagnostic reportsn Work with the list of related exams and all exams on the Clinical

Exam Notes windown Print diagnostic reportsn View provider contact information n View allergy informationn View documentsn View exam memos

Lesson 1: Accessing Diagnostic Reports

There are several ways to access the diagnostic report associated with an exam.

The diagnostic report contains several sections including the report text, findings, impression, participating radiologists’ contact information, diagnosis, history, comments, allergy information, requesting and attending provider contact information, and related priors.


190 Viewing Diagnostic ReportsViewing Diagnostic Reports for Related Prior Exams

Refer to the following table for instructions about accessing diagnostic reports.

Lesson 2: Viewing Diagnostic Reports for Related Prior Exams

A list of related prior exams appears at the bottom of the Clinical Exam Notes window. From this list, you can view a diagnostic report for a related prior exam. (The definition of a related exam has been established at your organization. Contact your application manager or internal application support help desk for more information.)

To access diagnostic reports from the… Do the following…

Filter Worklist Right–click an exam and click Show Report.

Double–click (report icon).

Patient Directory Right–click an exam and click Show Report.

Canvas page In the Relevant Exams timeline or the Patient History Timeline right–click an exam and click Show Report.

Click the diagnostic report button located on the margin next to the exam summary window. The diagnostic report button may appear as follows:

n ( )—No diagnostic report or exam memos are attached to this examn ( )—No diagnostic report exists for this exam; exam memos do exist for

this examn ( )—A diagnostic report exists for this exam; exam memos may exist for

this exam



Viewing Diagnostic Reports 191Viewing Diagnostic Reports for any Exams for the Selected Patient

1 In the Related Exams section on the Clinical Exam Notes window, click the accession number of the exam whose prior report you want to read.

Notes:

– If there are no related exams for this patient, the following message displays: No information found. You can click all exams to see a complete list of all exams (including unrelated exams) for this patient (page 191).

– You can sort the list of related prior exams by clicking a column header.

2 Read the report and the notes displayed on the second Clinical Exam Notes window, and then click close.

3 Click in the upper right corner of the Clinical Exam Notes window.

Lesson 3: Viewing Diagnostic Reports for any Exams for the Selected Patient


1 In the Related Exams section of the Clinical Exam Notes window, click all exams to see a complete list of all exams (including unrelated exams) for this patient.

Note: You can sort the list of exams by clicking a column header.

2 In the list of all exams, click the accession number of the exam whose report you want to read.

3 Read the report and the notes displayed on the second Clinical Exam Notes window, and then click close.

4 Click in the upper right corner of the Clinical Exam Notes window.


192 Viewing Diagnostic ReportsViewing Provider Contact Information on the Clinical Exam Notes Window

Lesson 4: Viewing Provider Contact Information on the Clinical Exam Notes Window

In the Clinical Info tab on the Clinical Exam Notes window, you can view the contact information for the requesting or attending provider.

In the Clinical Info tab on the Clinical Exam Notes window, click to display the provider’s phone number, beeper number, and e-mail address.

Lesson 5: Viewing Allergy Information on the Clinical Exam Notes Window

In the Clinical Info tab on the Clinical Exam Notes window, you can view a patient’s allergy information.


In the Clinical Info tab on the Clinical Exam Notes window, click the red text next to the exam status.

Note: To hide the patient’s allergy information, click the red text that reads, Click here to hide allergies.


Viewing Diagnostic Reports 193Viewing Documents from the Clinical Exam Notes Window

Lesson 6: Viewing Documents from the Clinical Exam Notes Window

If you are using the Document Management Solution and documents exist for the patient or exam, the Clinical Exam Notes window also includes a paperclip icon ( ) which allows you to view documents attached to the patient or exam.

On the Clinical Exam Notes window, click .

For more information about the Document Management Solution, refer to the Help.

Lesson 7: Viewing Exam Memos from the Clinical Exam Notes Window

!Caution

Potential issues have been identified with Exam Memos..

Click the Memos tab on the Clinical Exam Notes window.



194 Viewing Diagnostic ReportsViewing Exam Memos from the Clinical Exam Notes Window


Overview of the Provider Module

The Provider module allows you to efficiently manage your work with diagnostic reports. With the Provider module, you can perform the following tasks:

n Review, edit, and sign diagnostic reports onlinen Sign diagnostic reports by proxy onlinen View patient datan View and edit exam datan Access patient exam and film loan lists

Objectives Upon completing this chapter, you will be able to:n Identify exam (report) statusesn Identify sign statusesn Understand report authentication

Lesson 1: Understanding Exam (Report) and Sign Statuses

Exam (report) statuses

The Imagecast system assigns different exam (report) statuses to an exam or its corresponding diagnostic report from the time the exam is ordered to the time the associated diagnostic report is finalized. In some situations, the status of the exam/report determines what options are


195 Overview of the Provider ModuleUnderstanding Exam (Report) and Sign Statuses

available to you. Exams that appear in your signature queue include only those with the following exam (report) statuses:

Sign statuses The Imagecast system uses sign statuses in the Provider module to track diagnostic reports. The display of sign statuses depends on who is viewing the report.

There are two exceptions to this rule: D (Dictated) and L (Locked) sign statuses. These statuses will be displayed with any report to which they have been assigned, regardless of who views them. For example, a report in a provider’s signature queue with the LO (Locked/Overdue) sign statuses would appear as L (Locked) sign status when viewed by another provider.

Exam Statuses

Exam (report) status Description

P (Preliminary) The preliminary diagnostic report has been transcribed in the Imagecast system; the report needs to be reviewed and signed.

F (Finalized) The diagnostic report has been signed by the LAST signer, or has been signed by proxy for the LAST signer.

A (Addended) An addendum has been added to the diagnostic report and the report needs to be finalized again.


Overview of the Provider Module 196Understanding Exam (Report) and Sign Statuses

The following list identifies the sign statuses.

Sign Statuses

Status Description

No sign status You have not signed the report.

S (Signed) You have signed the report, or it has been signed for you. The S (Signed) sign status can also appear in combination with R (Review), A (Awaiting review and authentication), and H (Hold) sign statuses.

A (Awaiting review and authentication)

The report has been signed by proxy for you and is awaiting your review and authentication. This sign status always appears in combination with S (Signed) sign status.

D (Dictated) You or another interpreting provider has dictated changes to the report. Providers cannot view, edit, or sign the report while it is in D (Dictated) sign status. The D status is removed after the changes have been transcribed.

R (Review) A provider has sent you the report for review. Depending on your system setup, this sign status may also appear in combination with S (Signed) sign status for reports that were signed for you by proxy.

H (Hold) The report is on hold, meaning that it remains in your signature queue even after you sign it. Placing a report on hold prevents other providers from signing the report for you by proxy. It also prevents rapid edit and finalization of the report if you are a provider who is defined as required to sign and you have placed the report on hold without signing it.

To remove a report in H (Hold) sign status from a signature queue, click the Remove button.

L (Locked) The report has been locked by the transcriptionist and must be edited before it can be signed.

O (Overdue) The report is overdue for signing.


197 Overview of the Provider ModuleUnderstanding Report Authentication

Lesson 2: Understanding Report Authentication

Authentication is the process by which an interpreting provider responsible for a diagnostic report, referred to as the “LAST signer,” verifies that he or she has reviewed and signed a report. Providers can authenticate reports that have been signed electronically.

Authentication takes place when:n The LAST signer signs a report (authentication is automatic in this

case)n The LAST signer authenticates a report that was signed for him or

her by proxyn The LAST signer signs a report previously signed by a resident

who is not a LAST signer

The following diagram illustrates these three scenarios at an organization where authentication, attestation, and “rapid edit and finalization” functions are being used. Attestation and “rapid edit and finalization” are described on the following pages.

LAST signer signs report

Provider signs report for LAST signer by proxy

LAST signer authenticates the report

Resident signs report; report remains in Preliminary status

LAST signer signs the report

The Imagecast system automatically:

n Authenticates the reportn Finalizes the report

The report is finalized

The Imagecast system automatically:n Authenticates the reportn Finalizes the reportn Adds the attestation

Scenario 1

Scenario 2

Scenario 3


Overview of the Provider Module 198Understanding Report Authentication

Authentication when LAST signer signs report

If your site is using the Imagecast system’s authentication function, then every report is automatically authenticated when the LAST signer electronically signs a report.

!Caution

The Imagecast system does not attempt to authenticate reports on which the LAST signer is a manual signer. Your organization is responsible for developing a procedure for the authentication of manually signed reports. If the report is manually authenticated, an attestation statement must also be added to the report manually.

Authentication after a resident signs a report

According to the Health Care Financing Administration (HCFA) policy regarding the signing and authentication of diagnostic reports in the teaching setting, if a diagnostic report is signed by more than one interpreting provider and one of those signing is a resident, the attending interpreting provider must review and authenticate the report.

When a resident signs a report:n The sign status does not change to S (Signed) status.n The exam (report) status remains as P (Preliminary).

The exam (report) and sign statuses remain unchanged until the LAST signer signs the report. In such a teaching situation, billing may not be initiated until the report is finalized and authenticated.

Authentication after proxy signing for LAST signer

In cases where the diagnostic report is signed by proxy for the LAST signer, the report needs to be reviewed and authenticated by the LAST signer. The report appears in the signature queue of the LAST signer in SA (Signed/Awaiting review and authentication) status.

Although the report has not yet been reviewed or authenticated by the LAST signer, the exam is in F (Finalized) exam (report) status, and the report may already be circulated. The report is authenticated when the LAST signer reviews and authenticates it.

Attestation An attestation of review and authentication appears on the report if one has been defined for your organization, and if a resident and an attending interpreter are listed on the report. If professional and/or hospital charges are defined to generate at report finalization, then billing for a report awaiting review and authentication is held until the report is authenticated.

If an authenticated report is subsequently revised or addended, the report is no longer considered authenticated, and the attestation is removed from the report. When the report is finalized again, it is checked again for authentication and inclusion of the attestation.


199 Overview of the Provider ModuleUnderstanding Report Authentication

- n The attestation must be appropriate for all situations in which it may be automatically applied, and its use should be fully supported by departmental policies and procedures. In addition, providers should be aware of the wording and documentation implication of the attestation. The provider must assess each situation, and if the attestation would conflict with the actual physical teaching situation, then the provider must perform one of the following tasks:

– Restrict the automated attestation by removing the name(s) of the resident(s) from the report

– Dictate an additional statement to clarify the particular situation

– Add an additional statement by editing the reportn For more information about whether your organization has defined

attestation text or when charges are generated, contact your Imagecast application manager.

Rapid edit and finalization

Generally, reports are finalized when all of the required-to-sign providers listed on a diagnostic report sign the report. However, if your organization uses “rapid edit and finalization,” the LAST signer's signature finalizes the report even if other interpreting providers listed on the report have not yet signed, provided the following are true:

n all other providers listed on the report are electronic signers who have authorized others to sign for them

n no required-to-sign interpreting provider listed on the report has placed the report on hold in his or her signature queue without signing it

If you are not the LAST signer, and not all interpreting providers have signed yet, your signature will not finalize the report—the report remains in P (Preliminary) exam (report) status.

The ability to serve as LAST signer and sign for other providers listed on a report depends on a system setting; Each provider who uses electronic signature can specify whether other electronic signers are authorized to sign for him or her. If a provider who uses electronic signature does not authorize other providers to sign for him or her, a LAST signer using rapid edit and finalization will not be able to finalize a report on which that provider is listed.


Overview of the Provider Module 200Understanding Keyboard Shortcuts in the Provider Module

Lesson 3: Understanding Keyboard Shortcuts in the Provider Module

Several shortcut keys are available in the Provider module. These shortcut keys are available when you are working with diagnostic reports in the Signature Queue, Proxy Sign, or Result Reporting options.

The following list identifies the Provider module shortcut keys.

Keyboard Shortcuts

Shortcut Key Description

ALT+E Allows you to edit diagnostic report text using the text editor, provided the report is in the appropriate exam (report) status; pressing ALT + E again cancels the editing process without saving your changes.

ALT+O Saves edits to the diagnostic report text. Also saves changes to information in the report window (interpreting providers, and diagnosis codes).

ALT+K Saves information on the report window (including changes to the diagnostic report text, interpreting providers, and diagnosis codes) and launches the Demand Print window, which allows you to demand print the report.

ALT+S Saves information on the report window (including changes to the diagnostic report text, interpreting providers, and diagnosis codes) and launches the Sign window, where you can enter your signature code (signing password) and electronically sign a diagnostic report. This shortcut is available only if you are listed as an interpreting provider on the report.

ALT+P Saves information on the report window (including changes to the diagnostic report text, interpreting providers, and diagnosis codes) and launches the Sign window, where you can enter your signature code (signing password) and electronically sign a diagnostic report; then, the Demand Print window is launched, which allows you to demand print the report. This shortcut is available only if you are listed as an interpreting provider on the report.


201 Overview of the Provider ModuleUnderstanding Keyboard Shortcuts in the Provider Module


Signing Reports

Your signature queue is a listing of diagnostic reports that you need to review and sign. You can filter the list to include only those exams that are overdue, or to display reports that have been sent to you for review.

When you sign a report, the system records your electronic signature and removes the report from your signature queue. Signing a diagnostic report indicates that you have reviewed the report. You can also sign reports by proxy for another interpreting provider.

Objectives Upon completing this chapter, you will be able to:n Filter and select reports from your signature queuen Review and sign a diagnostic report

Lesson 1: Working with Your Signature Queue

The signature queue contains reports that are ready for your review. You select reports in your signature queue in order to review and sign them.

Filtering the signature queue

You can filter the reports that appear in your signature queue by clicking one of the filter buttons described in the following table. When you filter reports in your signature queue, only those reports that meet the filter criteria are displayed.

Filter Options

Filter option Reports included in the signature queue

All All reports, regardless of exam (report) status

Overdue Only reports that are in O (Overdue) sign status (placed on the signature queue but not signed within a specified number of hours)


203 Signing ReportsWorking with Your Signature Queue

Accessing Your Signature Queue1 On the Module toolbar, click Provider.

2 On the Option toolbar, click Signature Queue.

The Signature Queue window is displayed.

Filtering Reports in the Signature Queue

In the signature queue, click one of the filter options.

Only those reports that meet the filter criteria are displayed.

Report Selection and the Signature QueueWhen you access your signature queue, all of the reports listed in your queue are automatically selected. You can then filter your queue or deselect any reports that you do not want to work with during this signing session.

1 Access your signature queue.

2 (Optional) Filter your queue as desired.

Review All reports that you need to review, including those sent by other providers.

Filter Options

Filter option Reports included in the signature queue

Report list

Filter options


Signing Reports 204Reviewing and Signing Reports

3 (Optional) Click next to any report(s) you do not want to work with during this signing session. (Clicking deselects the report(s)).

4 Click continue.

The first report selected is displayed.

Lesson 2: Reviewing and Signing Reports

Reviewing and Signing a Report1 On the Module toolbar, click Provider.

2 On the Option toolbar, click Signature Queue.

3 (Optional) Click next to any report(s) you do not want to work with during this signing session. (Clicking deselects the report(s)).

4 Click continue.


205 Signing ReportsReviewing and Signing Reports


5 Review the report and click sign (or sign&print if you also want a printed copy).

6 On the Sign window, enter your signature code (signing password) and click ok.

The signed report is removed from your signature queue, and the next report (if you selected more than one report from the queue) is automatically displayed.

- If you selected more than one report, you can click or to scroll through the reports before you sign them.

7 Click continue.

The signature queue of the selected interpreting provider is displayed with all of the reports that are available for proxy signing selected.

Report text

Signing interpreting provider(s)


Signing Reports 206Entering and Signing Reports without Transcription

Lesson 3: Entering and Signing Reports without Transcription

You can bypass transcription services and enter reports directly for completed exams. This feature is useful for stat exams or for a common interpretation that has been predefined as a standard report.

Entering and Signing a Report Directly1 On the Module toolbarOption toolbar, click Provider.

2 On the Option toolbar, click Result Reporting.

3 Identify a completed exam, or identify a patient and then, in the Acc field on the report window, select a completed exam.

4 Click edit above the report text field.

You can now work with the contents of the diagnostic report.

Note: You can also create or edit a report using Microsoft Word if Microsoft Word is installed on your computer. See the chapter entitled Working with Diagnostic Reports for more information.

5 Enter new text or edit existing text as appropriate.

Note: You can use the controls above the report to format the report text. See the chapter entitled Working with Diagnostic Reports for more information.

6 Specify at least one interpreting provider for the report.

7 Click ok (or ok&print if you also want a printed copy).

8 Review the report, and then click sign (or sign&print if you also want a printed copy).

Note: The sign and sign&print buttons are available only if you specify yourself as an interpreting provider for this report (Step 6).

9 On the Sign window, enter your signature code and then click ok.


207 Signing ReportsExercises

Exercises

Exercise 1: You are an interpreting provider who is ready to review transcribed diagnostic reports. Access your signature queue and review the reports in P (Preliminary) exam (report) status.

Exercise 2: You have a short period of time in which to review your reports, so you start by looking only at overdue reports. Select all overdue reports and display the first report.

Exercise 3: You are an interpreting provider who has read a dictated report that has been correctly transcribed. Sign the report to remove it from your signature queue.

Exercise 4: You are an interpreting provider covering for your colleague who has left for vacation. Access your colleague’s signature queue and proxy sign those reports that have not been signed.


Working with Diagnostic Reports

Once you access a diagnostic report, you can perform several tasks such as editing text in a preliminary report and adding an addendum to a finalized report.

Objectives Upon completing this chapter, you will be able to:n Edit and view exam datan Enter and edit text in a diagnostic reportn Place a diagnostic report on holdn Add an addendum to a finalized reportn Request a review by another interpreting providern Access a prior reportn View an audit trail

Lesson 1: Accessing a Diagnostic Report

You can access a diagnostic report from two options in the Provider module:

n Signature Queuen Result Reporting


209 Working with Diagnostic ReportsAccessing a Diagnostic Report

Once you access a report, the procedures for working with the report are the same, regardless of how the report was accessed in the Provider module.

Accessing a Diagnostic Report from the Signature Queue Option1 On the Module Toolbar, click Provider.

2 On the Option Toolbar, click Signature Queue.

Your signature queue is displayed with all of the reports listed in the queue automatically selected.

3 (Optional) Deselect any reports you do not want to work with during this signing session.

4 Click continue.


displayed and all of the reports in that provider’s queue that are available for proxy signing are automatically selected.


Working with Diagnostic Reports 210Editing and Viewing Exam Data

Accessing a Diagnostic Report from the Result Reporting Option1 On the Module Toolbar, click Provider.

2 On the Option Toolbar, click Result Reporting.

3 On the Find Patient/Exam window, identify an exam, or identify a patient, and then, in the Acc field on the report window, identify the exam (accession number) you want to work with.

The selected exam is displayed along with the exam’s diagnostic report if one has been dictated and transcribed.

Lesson 2: Editing and Viewing Exam Data

While reviewing a diagnostic report, you may be able to edit exam-related information that was previously entered in the Imagecast system. For example, when an exam is scheduled, the scheduler specifies which providers should receive a copy of the diagnostic report. When you review the report, you can add a provider to the list of those who should receive the report by entering his or her name in the Report to field of the Enter/Edit Exam window.

The ability to edit exam data in the Provider module depends on the selected report’s exam (report) status and sign status. You can edit exam data if the edit exam data button is displayed.

Regardless of whether you can edit the exam data, you can view exam data for any exam by clicking the accession number (ACC) link in the patient banner.

Editing Exam Data1 Access a diagnostic report.

2 Click edit exam data.


211 Working with Diagnostic ReportsEntering and Editing Text in a Report

The Enter/Edit Exam window is displayed.

3 Edit the exam information as appropriate.

4 Click save/close to save the information and return to the previous window.

Lesson 3: Entering and Editing Text in a Report

You can enter and edit text whenever you create a new diagnostic report, or when you want to make changes directly to a report that has already been transcribed, but has not yet been signed and finalized.

Text editing tools There are two methods by which you can edit text in a diagnostic report, including:


Working with Diagnostic Reports 212Entering and Editing Text in a Report

n Microsoft Word (if Microsoft Word is installed on your computer)

n Text editor

Entering and Editing Text with Microsoft Word1 Access a completed exam or preliminary report.

2 Click enter/edit report.

The Imagecast system launches Microsoft Word.

3 On the Microsoft Word window, enter new text or edit existing text as appropriate.

Note: You can use Microsoft Word to format the text just as you can with other documents in Microsoft Word.

4 On the Imagecast window, click end enter/edit to update changes in the displayed diagnostic report.


Entering and Editing Text with the Text Editor1 Access a completed exam or preliminary report.

2 Click edit above the report text field.The color of the Report Text box changes color, indicating that the content can be edited.

3 Add standard text or standard reports as appropriate.

4 Enter new text or edit existing text as appropriate.

You can use the following controls to format the report text.

– allows you to change to the font size to extra small (XS), small (S), medium (M), large (L), or extra large (XL)

Note: If you change the font size, you must click ok before leaving the Result Reporting window in order for the change to take effect when you subsequently return.

Regardless of the font size in which you display the diagnostic report text on the report window, the Imagecast system saves and prints the report in 12-point font.

– bolds the selected text

– italicizes the selected text

– underlines the selected text


213 Working with Diagnostic ReportsEntering and Editing Text in a Report

– strikes–through the selected text

– makes the selected text superscript

– makes the selected text subscript

– inserts a numbered list (also called an ordered list)

– inserts a bulleted list (also called an unordered list)

– aligns the selected text along the left margin of the report text window (also called left justified)

– aligns the selected text in the middle of the report text window (also called center justified)

– aligns the selected text along the right side of the report text window (also called right justified)

– cuts the selected text

– copies the selected text

– pastes the selected text

– deletes the selected text

– undoes the edit to the text

– indents the selected text

– decreases indent of selected text

– selects all the text in the report

– allows you to overwrite (replace) text from the selected starting point

– allows you to select and insert all available standard text

– allows you to select and insert provider specific text

– allows you to select and insert common standard text



Working with Diagnostic Reports 214Placing a Report on Hold

Lesson 4: Placing a Report on Hold

You can place a report on hold to keep it in your signature queue after you sign it. Placing a report on hold changes the sign status to H (Hold) and prevents other providers from signing the report for you by proxy. Additionally, placing a report on hold may prevent rapid edit and finalization, if you are a provider who is defined as required to sign reports.

In order to hold a report in your signature queue, you must place the report on hold first, then sign the report if desired. (If you sign the report first, it is immediately removed from your signature queue before you can place it on hold). If you sign the report, the sign status changes to SH (Signed/Hold).

If you are the LAST signer on the report and your organization uses rapid edit and finalization, the exam (report) status changes to F (Finalized) once you sign it, provided no required-to-sign providers listed on the report have placed the report on hold in their signature queues without signing it. Once the report is finalized, it can be circulated in the diagnostic report batches and the exam can be billed, even though the report remains in your signature queue until you remove it.

You can also place a report on hold without signing it. Doing so will not prevent another provider from signing the report.

!Caution

If you do not sign the report, placing a report on hold may prevent circulation and billing.

Placing a Report on Hold1 Access a report from the Signature Queue sign option.

2 Click hold.

3 Do one of the following as appropriate:n Sign the reportn Continue working with other reports in the Signature Queuen Exit the Signature Queue

Removing a Report on Hold from Your Signature Queue1 Access a report on hold from the Signature Queue Sign option.


215 Working with Diagnostic ReportsAdding an Addendum to a Finalized Report

2 Click remove (or print&remove if you also want a printed copy).

Lesson 5: Adding an Addendum to a Finalized Report

You can add text to the end of a finalized diagnostic report. When you add an addendum to a report, the exam (report) status changes to A (Addended) and the report must be refinalized.

- n Do not confuse addend with revise. Adding an addendum adds a section of text to the end of the diagnostic report. The original text of the report remains unchanged. Revising a report is the process of editing the original report text.

n Addenda can also be dictated and then entered into the system by the transcriptionist using the Results module.

Adding an Addendum to a Report1 On the Module Toolbar, click Provider.

2 On the Option Toolbar, click Signature Queue.

3 Access a diagnostic report in F (Finalized) exam (report) status.

4 Click addend.

The Imagecast system launches Microsoft Word. Two documents are open; the addendum (a new document) appears in the upper window, and the existing report appears in the lower window. The existing report cannot be edited.

5 Enter the report addendum in the upper window.

6 On the Imagecast window, click end addend to update the changes in the displayed diagnostic report.


The report is assigned an exam (report) status of A (Addended).

8 Review the addendum and click sign (or sign&print if you also want a printed copy).

If you do not sign the report at this time, the report will be included in your signature queue.


Working with Diagnostic Reports 216Sending a Report for Review

9 On the Sign window, enter your signature code (signing password) and click ok.

Lesson 6: Sending a Report for Review

You can send a diagnostic report to another interpreting provider for his or her review. When the receiving interpreting provider selects the report from his or her signature queue, your name and the message (if you entered one) appear on the Review Message window.

Sending a Report for Review1 Access a diagnostic report.

2 Click review.

The Review Diagnostic Report window is displayed.

3 In the For Radiologist field, enter the name of the interpreting provider to whom you want to send the report or click and select the name.


217 Working with Diagnostic ReportsAccessing a Prior Report

4 In the Comment field, type a message if desired.

5 Click OK.

The report is placed in the specified interpreting provider's signature queue with the R (Review) sign status.

- After reviewing a report in R (Review) sign status, you can remove it from your signature queue by clicking remove (or print&remove if you also want a printed copy).

Lesson 7: Accessing a Prior Report

You can access a list of prior diagnostic reports for a selected patient. The list includes reports for exams that were performed both before and after the currently displayed report.

Accessing a Prior Report1 Access a diagnostic report.

2 Click prior reports.

3 On the Patient Exam List window, click next to each exam whose report you want to view.

Note: You can select all fields by clicking select all.

4 Click continue.

The first diagnostic report is displayed on the Report Inquiry window.

If you selected more than one report, you can click and to scroll through the prior reports.


Working with Diagnostic Reports 218Viewing a Report Audit Trail

Lesson 8: Viewing a Report Audit Trail

You can view an audit trail of each diagnostic report. Each report audit trail includes information such as the date and time that the report was transcribed, finalized, and authenticated. The audit trail also lists the person responsible for each transaction.

Viewing a Report Audit Trail1 Access a diagnostic report.

2 Click audit trail.

The Diagnostic Report Audit Trail window is displayed.

Note: The audit trail is also available from the Report Inquiry window (accessed from the Exam List option in the Provider module).


219 Working with Diagnostic ReportsExercises

Exercises

Each of the following exercises assumes that you are an interpreting provider working with transcribed diagnostic reports.

Exercise 1: You want to review the pharmaceutical information associated with an exam before you sign the transcribed report. Select a report and determine the contrast agent and dosage used for the exam.

Exercise 2: You are reviewing a diagnostic report and notice that the transcriptionist has incorrectly transcribed a small section of text and misspelled a medical term throughout the report. Use Microsoft Word to find and replace the misspelled terms.

Exercise 3: You decide to add a brief additional note to a preliminary report. Use the text editor to add the note.

Exercise 4: You are reviewing a report that you are ready to sign; however, you want to keep the report in your signature queue after you sign it. Place the report on hold and then sign it.

Exercise 5: You are preparing to authenticate a report when you notice that a change needs to be made in the report text. Dictate the appropriate corrections and then place the report in D (Dictated) sign status.

Exercise 6: While viewing a finalized report, you decide to add an addendum. Access a report and create the appropriate addendum.

Exercise 7: You are reviewing a finalized report that was signed for you by proxy. You decide to revise the report to include additional comments. Access the finalized report and edit the text using the Revise function.

Exercise 8: You are covering for an interpreting provider who specializes in pediatrics and you decide to ask another interpreting provider to review your report on a three-year old patient before you sign it. Send the report to your colleague for review.


Working with Diagnostic Reports 220Exercises

Exercise 9: You are reviewing a transcribed report for a CT exam and you decide to look at the report from a similar exam performed six months ago on the same patient. Identify the patient and display the prior report.

Exercise 10: You are reading a preliminary diagnostic report and find that there are some problems with the text. You decide to speak with the transcriptionist to avoid future miscommunications. Access the audit trail for the report and identify the transcriptionist.


221 Working with Diagnostic ReportsExercises