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Importing, Viewing & Saving Digital Images

MiPACS is our digital radiography software that manages all of our digital x-rays, photos, and other images. MiPACS integrates with our digital film scanning units, Optime, and our clinic software, axiUm.

This training manual addresses:

1. Scanning exposed plates into MiPACS using the Optime scanners 2. Saving the images to local and permanent servers3. Retrieving and viewing the images with axiUm4. Manipulating the images in MiPACS5. Importing and Exporting images in MiPACS6. Printing7. Quality Control8. Troubleshooting9. Server layout

2 axiUm Training—Importing, Viewing & Saving Digital ImagesMedical College of Georgia - School of Dentistry 5/09

Getting Ready

Beginning with your exposed phospher plates, you will need to open axiUm and wake up your Optime scanner.

Scanning Exposed Digital Film into MiPACS via the Optime Scanner

Ungloved (when touching clean surfaces)

1. Open axiUm and select patient .

2. Open (MiPACS) software.3. Make a template selection from the top menu bar.

a. If you are entering your images directly into a template in the order they should be placed, choose the correct template. When you scan in plates with a template selected, the images will be placed in sequence in the template.

b. If you want to arrange your images after scanning them in, choose No Template where they will be placed into the workspace at the bottom of the window for correct placement.

1. Make sure the Active dot at the top of the MiPACS window is solid green (not blinking). If the Active dot is red , press the start button on the Optime unit

. The Optime readout panel will show that it is warming up with a flashing yellow light before turning green.

2. With the Optime processing unit light green, the plate-reader door on the Optime

unit will open .

Gloved (when touching contaminated surfaces)1. Place exposed film on a prepared work space in front of

Optime unit.2. Open the film pack and remove the plate from the

plastic wrap by grasping the cardboard sheath.3. Place plate in machine with the magnet facing right,

toward the unit . Do not touch the plate; Optime will grasp the plate by the magnet and pull it out of the sheath . Hold the cardboard lightly so that the plate can slip out. Do not allow the Optime unit to eat the cardboard sheath.

axiUm Training—Importing, Viewing & Saving Digital Images 3Medical College of Georgia - School of Dentistry 5/09

4. Dispose of the sheath and wrap into a paper cup.5. The plate will be ejected into the holding area on the front of the unit; do not

remove at this time because the plate is clean and your gloves are not.6. Complete the entire series. If a plate falls out of the sheath, do not pick it up. Wait

until you have finished the rest of the plates, unglove, and place the plate in the machine for processing.

Ungloved1. As the film is processed, it will appear in either the work area on the bottom of the MiPACS screen

(no template) or in the selected template from left to right as they are scanned in.

2. After processing, if your images are in the bottom window, select your template from the top drop-down window and drag and drop the images into their appropriate frame

3. Change orientation if necessary. See Retrieving and Viewing the Images with AxiUm below for instructions on manipulating images. Do not otherwise alter the images before saving.

4. Save the film (instructions follow). The saved images will appear outlined in red with a red triangle in the upper left corner.

5. Retrieve the plates from the Optime bin and repackage.

Saving Scanned in Images in MiPACS

Do not delete any unused images; let them remain in the bottom window outside of a template to maintain an accurate exposure count. Poor images may be retaken and added to the template before saving. If faculty are available to approve saves, skip local saves and save directly to DICOM.

Saving Locally (use only when saving to DICOM is not an immediate option)

Before saving, the file name that displays in the Series window on the left will look like this:

Students should click on (either save button) to open a Save Series window. The cursor will have the series description highlighted and you can change or add to the description. Unless you are importing, the default should suffice. Click OK

Locally saved radiographs can now be viewed on any pc with defaults set to that local server. They will display in the Series window like this:

Saving Permanently to DICOM

Faculty should click on (save and approve button) and accept the defaults to save to the DICOM server. You can either yype in your Groupwise ID and password or swipe your card to approve and save. The red triangles will disappear and radiographs can now be viewed on any


PC with MiPACS installed. Series window on the left will look like this:

See Troubleshooting for error messages that arise while saving.

Retrieving and Viewing Images with AxiUm

To retrieve films, click on the desired film series from the left of the page. Slide the bar to right to view series data. The images will appear in their templates in the right screen. To enlarge an image, double click on the small image that first appears after selecting a series. The image will open full screen. To return to the smaller size, double click again.

The yellow canister indicates the series has been approved and saved to the DICOM server. This radiograph is viewable throughout the entire school.

The four squares indicate the series has been approved and saved locally. This radiograph can only be viewed within your current clinic. Get the radiograph saved to the DICOM server.

The red triangle in the corner indicates that the series has not been approved. This radiography can only be viewed

within your clinic. Get the radiograph approved and saved to the DICOM server.

Manipulating the images in MiPACS (except for orientation, only alter saved images)

Before an image is selected to work with, the top toolbar is grey.

Once an image is selected (image is framed in red), icons in the toolbar become active.

Image Orientation

If plates or sensors are exposed or scanned with the

wrong orientation, they can be mirrored

or rotated to the correct orientation.

Select the image (cannot select multiple images) you wish to manipulate (notice the red frame), and click on the appropriate button until the image is in its correct position.

Clicking on the Revert to Rotated/Mirrored Original button does not undo any orientation changes. Just click the Mirror or Rotate 90 Degrees buttons to return to the original position.


Inversion

Inversion reverses the light and dark areas of your x-ray to produce a negative of the image. The main use for this is to see soft tissue a little better, as the white of all the bone can make it difficult to see.

Brightness and ContrastClick on the Brightness and Contrast button to open its window. Move the red button up and down to change contrast and right and left to change brightness

Optimize Brightness

Simplifies caries diagnosis by placing a selected area in the middle of the gray scale, where vision perception is optimal.

Equalization

The equalization tool makes diagnosing easier by maximizing the contrast in a desired area of an image.

Colorization

Converts the gray scale to color on radiographs. Changes in color are more easily perceived than changes in shades of grey, so this tool benefits you by making diagnosis easier. To revert back to the original image, click on the Revert button (far right on top tool bar).


Edge Enhancement

Create clear, sharp edges out of blurry radiographs

Magnify

Without zooming into the image, magnify a certain portion of the image

Zoom

Zoom in to a specific section or zoom to match the screen resolution for optimal clarity. The first button allows you to select a rectangular area to magnify. The second button fits the image to the size of the frame. The third buttons adjusts image size based on screen resolution. To return to normal size, choose Image - Zoom Selection - Fit to Frame.

Measurement Calibration

To be sure that any measurement you take is accurate, perform measurement calibration each time you open a patient record that requires measurement. • Scan in something of a known length. A #2 image plate is 40 mm wide and

30 mm high so you can use either side as your initial measure.• Double click to open that image to full screen.• From the top menu, open Image - Measurement calibration. Your cursor

turns into a little ruler with an arrow.• Click the tool, draw a line with the left mouse button over an object in the

image with a known length, type the length in millimeters and click OK.• MiPACS states that the calibration is for this image only but we are

comfortable with using the calibration for all images in this patient's record at this viewing.

• To delete a measurement line, right click on the line and select delete.

Linear Ruler

Measure distances in a straight line accurately. Left click from point to point and right click to finish.

Noise Reduction

If scanned in X-rays appear grainy, the noise reduction tool can make them seem clear again.

Stretch Histogram

Use to stretch a small part of the histogram to the full gray scale. Areas with small differences of the gray scale can be expanded, and even the smallest change in the gray scale will be enlarged.


Polygonal Ruler

Take more complex non-linear measurements. Left click from point to point and right click to finish.

Protractor

Take measurement of angles. Left click on midpoint of protractor, hold and drag to end of line representing one side of measure. Release mouse, left click and drag to point representing end of second line. Release and click to set.

Annotations

Annotate the image with notes, arrows, measurements, and shapes that will remain with the image the next time it is viewed by anyone. The best way to learn to use all of the tools in this section is by trying them out. Each one has a variety of right mouse click options such as size, color, and font. Clicking the Annotation button will turn created annotations on and off. To delete a note or drawing made through this option, right mouse click and select Delete.

An important thing to remember about Annotate is that it stays on until you turn it off (by clicking the button). When it is on, it may keep you from moving images into frames and it may try to draw squares on images.

Undo

If you want to undo all changes you have made, select the Revert to Rotated/Mirrored Original button (far left in image). This will undo everything except orientation changes. To undo one step, choose the Undo button (middle of image). To redo a step, chose the Redo button (last one in image.

Importing and Exporting images in MiPACS

Exporting Images out of MiPACS

MiPACS will offer you the option of saving to your C:/temp folder. If this folder is empty, it's a reasonable choice. If you have lots of files in it, you may want to create a folder (e.g., exports) inside the temps folder and have it ready to hold your exported images.

Open axium, select your patient, open MiPACS. Notice that the default window on the top left is Series view. Choose the series that has the images you need to export.

Notice the drop-down box. If you are exporting only part of the images in a series, you will need to select this icon to change the view.

Save your images to DICOM BEFORE altering them. Altered images should only be saved to DICOM if you or others will need to view the altered image in the future. Otherwise, say NO when closing MiPACS and asked if you want to save. Do not save altered images as a local view.


Exporting All the Images in a Series

From the top menu, choose Image - Export Images.

This brings up the Export Image card. • Check All images in current series. • Choose the folder where you want to

put your exported images. • Choose JPG from the drop-down file

format window. If you are planning to import the images back into MiPACS, leave default at DICOM.

• Leave Quality scroll bar at far left if you want full resolution. Moving the scroll bar to the right reduces file size by up to 90%.

Your exported images are now in the designated folder.

Exporting Some of the Images in a Series

• Click on the drop-down box and choose Images. • In the Images window, hold down the control key and click on all of the images you wish to

export.

Right mouse click on top of one of the selected images and choose Export Images.

This brings up the Export Image card.

• Leave the default at Selected Images.


• Choose the folder where you want to put your exported images.

• Choose JPG from the drop-down file format window. If you are planning to import the images back into MiPACS, leave default at DICOM.

• Leave Quality scroll bar at far right if you want full resolution. Moving the scroll bar to the right reduces file size by up to 90%.

Your exported images are now in the designated folder.

Emailing Images

• Use any method described above to select your images.

• Right mouse click on one of the selected images and choose Email.

The images are full size ( a pan might be 1.3 MB) so you may need to send images in multiple emails.

Importing Images into MiPACS

Save Images to Hard Drive

Save the images you want to import as jpeg files and put them in an easy to locate place (e.g., file folder on desktop). Other file formats will work but jpeg is the most common and will balance quality with file size. If you are going to delete the images after you import

them, name is unimportant. Call them 1, 2, 3, etc. if you’d like. Most of our monitor resolutions are 1024 x 768 mps. Ideally your images will be at least that big to open up full screen.

Open AxiUm & MiPACSOpen axium, select your patient, open

MiPacs. If you want your images to go directly into a template, select a template first. If you want the images to go to the bottom of the page to be moved manually later, choose no template.

Import Images

From top menu, choose Image - Import Images. This will open the Import Images window.


Destination - Leave as New series.Image type - Leave at default Sec. Capture SC.Comments - Leave blank.Anatomic description - Leave at None. This information is unnecessary if you put the image in a labeled template and can be added later for the rest.Click on Browse to open the Open a file window.

Click on Browse and locate image(s) to import. Hold down your shift or control key to select all of the images you are importing. Click on Open to move first image to view window.

Click OK to import. If you selected multiple images to import, you will need to click on OK for each one.

If you selected a template, the images will go into the template in the order imported. If you selected no template, choose one now and drag the images in place.

Common Errors Encountered When Saving Imported


Images

Conversion Error: Under Properties – Object, Conversion Type will say None.

Sometimes the Properties window is hidden in the bottom left-hand corner of the window. You can grab the top edge with your mouse and raise it up and the right edge and expand it to the right.

Click on Conversion Type to activate the drop-down box and select DF – Digitized Film.

Laterality, Region, Modifier Error: Under Properties – Anatomic information, Description may say None and Laterality, Region, and Modifier may say Unknown.

Click on Description to activate the drop-down box and select the correct teeth descriptor. The other qualities will fill in automatically.

Printing

Choosing Printer

Black and white clinic printers are unlikely to provide the detail necessary for a usable radiographic print. Select a color of photo printer to make image copies. Higher quality paper also increases detail.

Printing One Image

• Select image.• With cursor on top of selected image, right mouse click; choose Print to

open Print Menu.

• Choose printer.• Choose Portrait or Landscape.• Leave at Selected image.• Click OK.

The image will fill the page.


Printing All Images in Current Series on One Page

• Open Print Menu.• Choose printer.• Choose Landscape.• Choose Current Series layout.• Click OK.

The image will fill print on one page just as it appears in the MiPACS window, including unused images at the bottom.

Printing All Images in Current Series on Individual Pages

• Open Print Menu.• Choose printer.• Choose Portrait or Landscape.• Choose All images in current Series.• Click OK.

The image will fill print on one page just as it appears in the MiPACS window, including unused images at the bottom.

To remove patient info from prints, uncheck Print Patient info.

Comparing Images From Different Series

Comparing All Images From Multiple Series

• Select patient.• Open MiPACS.• Series View will be showing.• Using the Shift or Ctrl key, select

all the series you want to compare.• Right mouse click and choose Compare. • Images will appear in Images Card - Local View. They can be arranged and sized as desired. You


can delete irrelevent images as the deletion is only from the Image Card, not from the server.• When closing the window, answer No when asked if you want to save the changes.

Comparing Selected Images From All Series

• Select patient.• Open MiPACS.• Switch to Series to

Images view (drop-down menu) in left window.

• Switch to Series to Local view in right window.

• Using the Shift or Ctrl key, select all the images you want to compare.• Drag and drop selected images into the blue window. The images can be arranged and sized as

desired. • When closing the window, answer No when asked if you want to save the changes.

Quality Control

Please follow these rules to maintain a safe environment and to obtain good quality radiographs.

• Follow strict infection control protocol (watch the digital radiography video). The key points being- discard the contaminated gloves from the clinic before coming to the scanner area. Bring up patient record in axiUm and start the imaging software. Wear a new pair of gloves and open the plates one at a time and scan one after the other until you have completed that series. Discard your gloves and drag the images into proper orientation.

• Eliminate exposure of plates to bright light (this can be avoided if you scan the plates as soon as you take them out of the protective cover)

• The plates should be handled with utmost care as it gets scratched easily - any residue and scratches on the plate can show up as artifacts on the images.

• Any plate that is visibly damaged should be taken out of circulation- label it as damaged plate while you return it.

• Repacking damp plates will result in rusting of the metallic area on the black surface of the plates and such plates need to be pulled out of circulation. Therefore, be sure plates are completely dry prior repacking.

• Use proper XCP rinn instruments to place the plates into the holder without bending the plates. ( Use the new bitewing holders)

• A number of plates are thrown away inadvertently- each plates cost approximately 15-20 dollars.

In many of the clinical areas individual supervision is not possible and hence following the protocol is extremely important for quality assurance. Please contact any of the radiology staff if you have questions.(1-2264)


Troubleshooting

Q: I can't save because of "Conversion Error." A: Under Properties – Object, Conversion Type will say None. Click on Conversion Type to activate the drop-down box and select DF – Digitized Film. Do this for every image that has this problem, including images beneath the template.

Q: I can't save because of "Laterality, Region, Modifier Error." A: Under Properties – Anatomic information, Description may say None and Laterality, Region, and Modifier may say Unknown. Click on Description to activate the drop-down box and select the correct teeth descriptor. The other qualities will fill in automatically. Do this for every image that has this problem, including images beneath the template.

Q: Can't view all of the images in a series saved to DICOM. Part of the images show in that mount and rest of the areas show a big black “x”. A: If you are sure your images were saved to DICOM (look for the yellow canister), highlight the damaged series name in the right window and press your delete key (or have faculty log in and do this). The server will then automatically repopulate the workstation with the uncorrupted images.

Q: I click on the MiPACS button on the desktop and nothing happens.A: Do not attempt to use MIPACS outside of Axium. It will not work. You must select a patient from within Axium first and then use the radiography icon from within Axium.

Q: MiPACS freezes when launching. A: This occurs when a user clicks on the icon within Axium multiple times. You only need to click on the icon once. Be patient and give the program a chance to launch. Clicking on the X-ray button numerous times will likely cause MiPACS to crash, taking axiUm down with it.

Q: MiPACS crashes when I try to change patients.A: Switching patients without closing MiPACS may cause it to crash, taking axiUm down with it. Close MiPACS before switching patients.

Q: I can't drag an image into or out of a template. A: First, the image must be unnapproved (red triangle in the corner). If your cursor makes little squares every time you try to drag, your Annotate button is turned on. Click on Annotate (a little white square will appear on your image) and then click it again to turn it off. Now drag. Make sure no button is activated if the problem persists.

Q: The number at the top of the window next to the patient's name doesn't match the number in axiUm.A: MiPACS uses a Patient Number and axiUm uses a Chart Number. When referencing the patient, always use the Chart Number.

Q: There's a little circle on my image.A: Your image was exposed backwards. Don't redo if the image is useable. Mirror the image if appropriate.

Q: My tool bar disappeared.A: Contact IT. They'll need to reinstall the software.


Q: Optime ate my sheath/plate or won't power up or won't take the plates.A: Call Biomedical Services at 1-2620.

Q: My screen freezes when scanning in the image. A: Close MiPACS. Exit out of axiUm. Open axiUm. Select the same patient. Open MiPACS. The image might be there. Send an email to IT to report the problem.

Q: I saved my images in the wrong template.A: Leave them there if it doesn't make any difference. If they need to be in another template, export the images out of MiPACS (instructions on page 7)and import them into the correct template (instructions on page 8).

Q: I saved my images in the wrong patient records.A: Export the images out of MiPACS (instructions on page 7)and import them into the correct record (instructions on page 8). Contact Shawn Parham to remove the invalid series.

Q: I want to delete an approved or unapproved image or series that has been saved to the local server. A: Highlight the image or the series and push the Delete key on the keyboard. Requires faculty approval.

Q: I want to delete a series that has been saved to DICOM. A: You can't delete any series or part of a series that has been saved to DICOM. You can export images and import them into a new series if you need to. Contact Shawn Parham to delete inappropriately placed images.

Q: When scanning to DICOM, box says Saving and then pops up with error message saying, "unable to transfer (a number of) images. Check the connection with the server." Tried to export images and import into new template but got the same error message. Not Saved to DICOM image. A: No clue - contact IT.

Credits go to Dr. Sajitha Kalathingal, Asst. Professor, Oral Diagnosis and Patient Services for providing insite on how much of the software worked.

importing, viewing & saving digital images€¦ · medical college of georgia - school of...

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