IDX Imagecast™ PACS 3.3 - Clinical Enterprise Technologies

Transcription

IDX Imagecast™ PACS 3.3.0
RIS/PACS Training
For Radiologist
Software Version
Document Version
Published
Confidential. © 2008-2009 IDX Systems Corporation. All rights reserved.
3.3.0
1
February 2009
IDXR
Contact Information
Please send any inquiries or feedback about this document to [email protected]. Please
include the document name and version with your inquiry or comments.
Copyright Notice
Copyright © 2008-2009 IDX Systems Corporation. All rights reserved.
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Trademarks
IDX®, 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 .................................................................................................................. 7
Radiologist Workstation Terminology................................................................... 8
Logging In to Radiologist Workstation................................................................ 10
Workspace Components....................................................................................... 12
Logging Out of Radiologist Workstation............................................................. 16
Changing Your Password..................................................................................... 16
Calibrating Monitors for Image Viewing............................................................. 18
Dates and Times Displayed in the Patient Timeline and
Filter Worklists..................................................................................................... 19
Working with Exam Memos ................................................................................ 23
Using the Folder List ......................................................................................................... 29
Using Imagecast Tools ......................................................................................... 31
Using Personal Folders......................................................................................... 33
Using Public Folders ............................................................................................ 35
Using the Shortcuts Bar..................................................................................................... 37
Using Shortcuts .................................................................................................... 39
Using Shortcut Groups ......................................................................................... 41
Using the Patient Directory ............................................................................................... 45
Patient Directory Terminology............................................................................. 47
Accessing the Patient Directory ........................................................................... 48
Searching for Patients and Exams ........................................................................ 49
Sorting the Patient Directory................................................................................ 51
Viewing Diagnostic Reports for Exams in the Patient
Directory............................................................................................................... 52
Viewing Documents for Exams in the Patient Directory ..................................... 55
Viewing Exam Memos for Exams in the Patient Directory................................. 56
Exporting Exams to a DICOM Device................................................................. 57
Caching Exams from the Patient Directory.......................................................... 58
Selecting Studies to View/Read from the Patient Directory ................................ 59
Using Filter Worklists ....................................................................................................... 61
Filter Worklist Terminology ................................................................................ 63
Creating Filter Worklists ...................................................................................... 64
Editing an Existing Filter Worklist ...................................................................... 66
Deleting a Filter Worklist..................................................................................... 66
Accessing a Filter Worklist .................................................................................. 68
Customizing the Appearance of a Filter Worklist................................................ 70
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IDX Imagecast PACS 3.3 Radiologist Workstation Training Guide
Contents
Sorting a Filter Worklist .......................................................................................72
Viewing Diagnostic Reports for Exams in a Filter Worklist................................73
Viewing Documents for Exams in a Filter Worklist ............................................76
Viewing Exam Memos for Exams in a Filter Worklist ........................................77
Exporting Exams to a DICOM Device from a Filter Worklist.............................78
Caching Exams from a Filter Worklist .................................................................79
Viewing the List of Exceptions for Exams in a Filter Worklist ...........................80
Viewing Further Exam Information for Exams in a Filter Worklist ....................81
Selecting Studies to View/Read from a Filter Worklist........................................82
Working with the View Exams Tab...................................................................................83
Overview of the View Exams Tab........................................................................83
Loading Different Exams in to the Canvas Page Using the
View Exams Tab...................................................................................................85
Closing All Exams Open on the Canvas Page Using the View
Exams Tab ............................................................................................................86
Loading Unselected Exams in to the Canvas Page Using the
View Exams Tab...................................................................................................86
Working on the Canvas Page .............................................................................................89
Canvas Page Components.....................................................................................90
Using the Navigational Timelines ........................................................................94
Exam Rack Components.......................................................................................99
Using the Exam Summary Window ...................................................................101
Working with Presentation States.......................................................................102
Working with Matching Series Rules .................................................................105
Working with Hanging Protocols .......................................................................108
Exporting Exams to a DICOM Device ...............................................................122
Adding Exams to Folders....................................................................................122
Viewing Extended Exam Information (DICOM Metadata) ...............................123
Setting Horizontal/Vertical Rack Orientation.....................................................125
Marking an Exam Read ......................................................................................126
Using the Navigational Rectangles.....................................................................127
Organizing Images and Series Within the Exam Rack.......................................130
Using the Diagnostic Thumbnails on the Canvas Page ......................................130
Expanding Images and Series into Floating Windows .......................................131
Adjusting Window Width and Window Level ...................................................132
Cine Slices in a Multi–image Series on the Canvas Page...................................133
Using Scout Lines for CT and MR Scout Images...............................................134
Using the Localizer .............................................................................................135
Configuring Your Diagnostic Monitors from the Canvas
Page.....................................................................................................................138
Reading Exams on the Diagnostic Monitors....................................................................141
Diagnostic Monitor Components........................................................................143
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Contents
Selecting Images and Series to View and Read on the
Diagnostic Monitors ........................................................................................... 145
Working with Images in the Diagnostic Monitors ............................................. 145
Adjusting Window Width and Window Level................................................... 146
Zooming ............................................................................................................. 147
Panning............................................................................................................... 149
Cine Slices in a Multi–image Series................................................................... 150
Overview of Measurement Tools ....................................................................... 151
Measuring the Distance Between Two Points (Ruler Tool)............................... 151
Measuring an Angle on an Image (Angle Tool)................................................. 153
Measuring the Area of a Region of Interest ....................................................... 154
Displaying the Point Value of an Image (Measuring
Luminance)......................................................................................................... 156
Using the Measurement Palette.......................................................................... 157
Calibrating an Image .......................................................................................... 159
Understanding US Measurements ...................................................................... 159
Annotating Images ............................................................................................. 160
Editing Measurement and Annotation Formats (Line Style
and Font)............................................................................................................. 163
Deleting Measurements and Annotations........................................................... 164
Inverting Image Brightness and Contrast........................................................... 164
Applying Image Processing Filters .................................................................... 166
Viewing Slices Using Scout Lines ..................................................................... 167
Viewing Slices Using the Localizer ................................................................... 168
Viewing Image Series Using Multi–Image Modes ............................................ 168
Selecting a Monitor Layout................................................................................ 169
Selecting Series .................................................................................................. 170
Selecting Relevant Exams .................................................................................. 170
Cloning Series .................................................................................................... 171
Expanding Images and Series into Floating Windows....................................... 172
Marking Key Images .......................................................................................... 172
Key Image Series Stack...................................................................................... 173
Cycling through Key Images.............................................................................. 175
Comparing Images Using the Linking Option ................................................... 177
Saving an Image to a File ................................................................................... 178
Copying an Image to the Clipboard ................................................................... 179
Printing an Image ............................................................................................... 179
Deleting a Series or Image ................................................................................. 180
Flipping an Image Around the X or Y Axis....................................................... 182
Rotating an Image .............................................................................................. 182
Sorting a Series................................................................................................... 183
Splitting an Exam Series .................................................................................... 184
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Contents
Managing Duplicate Study Instance Unique Identifiers.....................................184
Viewing Diagnostic Reports ............................................................................................189
Accessing Diagnostic Reports ............................................................................189
Viewing Diagnostic Reports for Related Prior Exams .......................................190
Viewing Diagnostic Reports for any Exams for the Selected
Patient .................................................................................................................191
Printing Diagnostic Reports................................................................................192
Viewing Provider Contact Information on the Clinical
Exam Notes Window ..........................................................................................192
Viewing Allergy Information on the Clinical Exam Notes
Window...............................................................................................................192
Viewing Documents from the Clinical Exam Notes Window............................193
Viewing Exam Memos from the Clinical Exam Notes
Window...............................................................................................................193
Signing Reports...................................................................................................202
Working with Diagnostic Reports ......................................................................208
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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.
Diagnostic
monitors
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:
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Getting Oriented
Radiologist Workstation Terminology
n
Understand Radiologist Workstation terminology
n
Log in to Radiologist Workstation
n
Identify components of the Radiologist Workstation workspace
n
Log out of Radiologist Workstation
n
Change your password
n
Calibrate monitors for image viewing
n
n
Describe the logic by which Radiologist Workstation display
dates and times
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 icons
n
iExport button
n
Preferences button
n Help button
n
Tool tab
n
iQuery tab
n View Exams tab
Diagnostic monitors
Monitors on which diagnostic radiological images are displayed.
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Getting Oriented
Radiologist Workstation Terminology
Common Radiologist Workstation Terminology (Page 2 of 2)
Term
Definition
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.
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Getting Oriented
Logging 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
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Getting Oriented
Logging In to Radiologist Workstation
on the navigation console, refer to the Workspace Components
section on page 12.
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Getting Oriented
12
Workspace 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.
Logout button
View Exams tab
Currently-selected
tool/filter
Help button
Preferences button
Folder List
iQuery button
Control
strip
Shortcuts bar
Filter Worklist
Exceptions
panel
The following sections provide detailed information about the
components of the workspace noted above.
IDXR
Getting Oriented
Control strip
The control strip is located at the top of the workspace and contains the
following items:
iExport Queue
button
n
iExport Queue button
n
Preferences button
n
Help button
n
Logout button
n
iQuery tab
n
View Exams tab
n
Currently selected tool or filter tab
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 (
application.
) logs you out of the Radiologist Workstation
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.
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Getting Oriented
Shortcuts Bar
frequently used folders, filters, and tools. For more information refer to
the Using the Shortcuts Bar page 37.
Folder List
The 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.
Imagecast Tools
These folders cannot be renamed or deleted.
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
n
n
IDXR
.
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.
My History—Lists the last 100 exams you have viewed.
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
Logging Out of Radiologist Workstation
For more information about the Patients tab, refer to the Using the
patient Directory on page 45.
n
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
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 panel
The 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.
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Getting Oriented
Changing Your Password
¾
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
n
Your new password cannot be one of the last ten passwords you
have previously used.
Your new password cannot be the same as your user ID.
Changing Your Password When Required by Radiologist Workstation
1 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.
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Getting Oriented
Changing 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 Password
1 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.
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Getting Oriented
Calibrating 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.
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.
!
Caution
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
IDXR
Affected windows/options
Getting Oriented
Dates and Times Displayed in the Patient Timeline and Filter Worklists
!
Caution
Date and time
logic
n
Affects on linked exams with attached studies
n
High–level description of the date and time logic
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.
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)
D (Dictated)
P (Preliminary)
F (Finalized)
A (Addended)
R (Revised)
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Getting Oriented
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.
What windows/
options are
affected?
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.
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 Timeline
n
Patient Directory
n
Filter Worklists
n
n
How are linked
exams with
attached studies
affected?
IDXR
Date and time displayed at the top of the Clinical Exam Notes
window
Related Exams list on Clinical Exam Notes window
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
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).
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Getting Oriented
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
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).
IDXR
Getting Oriented
Working with Exam Memos
Lesson 8: Working with Exam Memos
Potential issues have been identified with Exam Memos. For more
information, refer to the Exam Memos Cautions section on page 43.
!
Caution
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 Directory
n
Filter Worklists
n
Local Exam Cache folder
n
n
Clinical Exam Notes window (diagnostic report) on the exam
rack
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
¾
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.
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Getting Oriented
Accessing Exam Memos from the Filter Worklist
¾
On the Filter Worklist, right-click the exam and click Show Exam
Memos.
Accessing Exam Memos from the Local Exam Cache Folder
¾
On the Local Exam Cache folder, right-click the cached exam and
click Show Exam Memos.
Accessing Exam Memos from the Exam Rack
1 On the exam rack, click
window is displayed.
,
, or
. The Clinical Exam Notes
2 On the Clinical Exam Notes window, click the Memos tab. The
exam memos user interface is displayed.
IDXR
Getting Oriented
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 Timeline
1 On the Patient History Timeline, right-click the exam for which you
want to view exam memos and select Show Exam Memos.
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Getting Oriented
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
IDXR
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
Getting Oriented
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
n
A memo icon ( ) displayed on the Memos tab on the Clinical
Exam Notes window alerts you to the existence of exam memos.
You can right-click text in an exam memo to select the text, copy
it, and paste it into another document.
2 (Optional) Click
through memos.
-
or
or use the vertical scroll bar to navigate
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.
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28
Getting Oriented
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.
-
IDXR
Accessing, creating, and deleting exam memos are audited activities.
Chapter
1
Using the Folder List
Overview of the Folder List ................................................................ 30
Using Imagecast Tools ...................................................................... 31
Using Personal Folders ...................................................................... 33
Using Public Folders .......................................................................... 35
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30
Overview 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.
-
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.
Refer to the following graphic.
Folder List
The Folder List contains the following default folders:
• Imagecast Tools
• Personal Folders
• Public Folders
These folders cannot be renamed or deleted.
IDXR
Using Imagecast Tools
The Imagecast Tools folder is used to access the tools available to
you in Imagecast PACS.
-
The tools displayed in the Imagecast Tools folder will
vary based on user privileges.
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.
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32
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.
IDXR
Using Personal Folders
Personal folders are used to create collections of exams. You can
create up to 25 subfolders.
.
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.
Example
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.
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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.
IDXR
Using Public Folders
Public folders are used to create collections of exams that can be
accessed by all users.
• 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.
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.
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36
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 ........................................................... 38
Using Shortcuts ................................................................................ 39
Using Shortcut Groups....................................................................... 41
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38
Overview of the Shortcuts Bar
Overview of the Shortcuts Bar
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:
IDXR
Using Shortcuts
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.
.
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.
Example
Shortcuts Bar
Click a shortcut to
display desired
content
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40
Using 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.
IDXR
Using Shortcut Groups
Shortcut groups are used to organize your shortcuts.
.
Create a Filters shortcut group in which you could place
all of your most frequently used filters.
-
Example
You can add an unlimited number of shortcut groups. As groups
accumulate, they are stacked in the Shortcuts Bar. Refer to the
following graphic.
Shortcut groups
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42
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.
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.
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44
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Chapter
1
Using the Patient Directory
Overview of the Patient Directory....................................................... 46
Patient Directory Terminology ............................................................ 47
Accessing the Patient Directory .......................................................... 48
Searching for Patients and Exams ...................................................... 49
Sorting the Patient Directory.............................................................. 51
Viewing Diagnostic Reports for Exams in the Patient Directory ............. 52
Viewing Documents for Exams in the Patient Directory ........................ 55
Viewing Exam Memos for Exams in the Patient Directory ..................... 56
Exporting Exams to a DICOM Device .................................................. 57
Caching Exams from the Patient Directory .......................................... 58
FSelecting Studies to View/Read from the Patient Directory ................. 59
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46
Overview 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.
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Patient Directory Terminology
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.
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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.
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.
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.
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...
Patient name
Enter data in the following format...
Enter the patient’s name in the Patient Name
field using the following format: Last name,
First name.
(Page 1 of 2)
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To perform a search
based on...
Enter data in the following format...
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.
(Page 2 of 2)
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.)
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.
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
.
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Viewing 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
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.
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.
To hide the patient’s allergy information, click the red
text that reads, Click here to hide allergies.
-
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.
2. Click
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.
3. Click
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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.
4. Click
Printing a Diagnostic Report
You can print a diagnostic report from the Clinical Info tab on the
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.
IDXR
Viewing Documents for Exams in the Patient Directory
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.
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Viewing 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.
!
Caution
Potential issues have been identified with Exam Memos.
For more information, refer to Exam Memos Cautions.
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).
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.
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Caching Exams from the Patient Directory
You can cache an exam from the Patient Directory.
To cache an exam from the Patient Directory, right-click an exam and
click Cache Exam.
-
IDXR
• 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.
FSelecting Studies to View/Read from the Patient Directory
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.
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FSelecting Studies to View/Read from the Patient Directory
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Chapter
1
Using Filter Worklists
Overview of Filter Worklists ............................................................... 62
Filter Worklist Terminology ................................................................ 63
Defining Filter Worklists..................................................................... 64
Accessing a Filter Worklist ................................................................. 68
Customizing the Appearance of a Filter Worklist .................................. 70
Sorting a Filter Worklist ..................................................................... 72
Viewing Diagnostic Reports for Exams in a Filter Worklist..................... 73
Viewing Documents for Exams in a Filter Worklist................................ 76
Viewing Exam Memos for Exams in a Filter Worklist............................. 77
Exporting Exams to a DICOM Device from a Filter Worklist................... 78
Caching Exams from a Filter Worklist.................................................. 79
Viewing the List of Exceptions for Exams in a Filter Worklist................. 80
Viewing Further Exam Information for Exams in a Filter Worklist .......... 81
Selecting Studies to View/Read from a Filter Worklist .......................... 82
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Overview 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.
.
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 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.
-
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:
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
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Filter Worklist Terminology
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.
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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.
-
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.
Follow the below instructions to create a Filter Worklist.
1. Click the Preferences button (
corner of the control strip.
), located in the upper right
– 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.
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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
– Last 7 Days—to list exams that occurred within the last
7 days
– Last 30 Days—to list exams that occurred within the
last 30 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
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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.
changes.
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.
changes.
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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.
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
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
-
This procedure assumes you have already created a
shortcut to the Filter Worklist you want to display.
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.
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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
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.
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.
Selected columns
Unavailable column for
selection
Available column for
selection
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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.
Click and drag a column heading to rearrange the column
order
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.
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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.
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
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)).
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
2. Click
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.
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.
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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.
To hide the patient’s allergy information, click the red
text that reads, Click here to hide allergies.
-
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.
2. Click
Viewing Diagnostic Reports for Related Exams
A list of related exams appears at the bottom of the Clinical Exam
related exam. (The definition of a related exam has been established
at your site. Contact your application manager or internal application
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.
3. Click
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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.
4. Click
Printing a Diagnostic Report
You can print a diagnostic report from the Clinical Info tab on the
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.
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Viewing Documents for Exams in a Filter Worklist
Viewing Documents for Exams in a Filter Worklist
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
Viewing Exam Memos for Exams in a Filter
Worklist
You can view exam memos for exams in a Filter Worklist.
!
Potential issues have been identified with Exam Memos.
Caution
To view exam memos for exams in a Filter Worklist, right-click the
exam and click Show Exam Memos.
working with Exam Memos (page 23).
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Exporting 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.
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.
-
IDXR
You can click Queue to view the iExport Queue to
determine how many exams are awaiting exportation.
Caching Exams from a Filter Worklist
You can cache an exam 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.
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Viewing 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.)
-
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.
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).
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Viewing Further Exam Information for Exams in a Filter Worklist
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.
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Selecting 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.
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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
n
n
n
n
Understand View Exams tab functionality
Load different exams in to the canvas page using the View Exams
tab
Close all open exams on the View Exams tab
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
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Working with the View Exams Tab
Overview 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.
Previous and next buttons
View Exams tab displays number of
patients selected for review
Close Current Exam
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.
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Loading 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.
Current patients selected; check mark indicates which patient
is now being displayed on the canvas page
Right–clicking the View Exams tab displays the
next ten unread patients in the currently active
Filter Worklist.
Loading Exams Using the View Exams Tab
1 Right–click the View Exams tab.
2 Click a patient in the upper portion of the pop–up menu.
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Closing 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
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.
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.
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Loading 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
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
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Loading Unselected Exams in to the Canvas Page Using the View Exams Tab
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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
n
Identify canvas page components
n
Use the navigational timeline
n
Identify exam rack components
n
Use the exam summary window
n
Work with presentation states
n
Work with matching series rules
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Canvas Page Components
n
Work with hanging protocols
n
Export exams to DICOM devices
n
Add exams to folders
n
View extended exam information (DICOM metadata)
n
Set exam racks vertically and horizontally
n
Mark an exam read
n
Use the navigational rectangles in the exam racks
n
Organize images in an exam rack
n
Adjust diagnostic thumbnail images in the exam racks
n
Expand images and series into floating windows
n
Adjust window width and level settings
n
Cine slices in a multi-image series
n
Use scout lines to view CT and MR scout images
n
Use the localizer
n
Configure diagnostic monitors
Lesson 1: Canvas Page Components
The canvas page consists of the following main areas:
IDXR
n
Control strip
n
Clinical information window
n
Navigational timeline
n
Exam racks
Monitor icon(s)
View Exams tab
Control strip
Clinical
information
window
Navigational
timeline
Exam racks
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.
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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
IDXR
about presentation states, refer to the Working with Presentation States
section on page 102.
Presentation state
icon
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.
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Using 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
IDXR
Both navigation bars are interactive, that is, exams can be loaded and
reports can be retrieved from the items displayed along the 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.
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.
These colored rectangles correspond to your diagnostic
monitors.
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Navigational Timeline Features (Page 2 of 2)
Icon
Description
Meaning
A on an exam in the
timelines
Indicates all of the following:
n
exam date and time is older than 48 hours
n
the Allow DICOM Query From Exam Timeline
System Preferences option is selected
n
exam status is not NON-REPORTABLE
n
iQuery is configured with at least one DICOM QRP
source
n
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.
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
n
n
n
n
IDXR
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.
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.
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.
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.
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.
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 Timelines
¾
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.
¾
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
¾
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 Rack
From the timelines, you can open (display) an exam into the exam
racks on the canvas page.
¾
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 Rack
From the timelines, you can close (remove) an exam from the exam
racks on the canvas page.
¾
On the timeline, right–click the exam and click Close Exam.
Viewing Diagnostic Reports for Exams on the Timeline
¾
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.
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Viewing Exam Memos for Exams on the Timeline
¾
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.
the Working with Exam Memos section on page 23.
Use 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.
High Priority to indicate whether this exam is a
9 Click Finish.
Note: You can click Queue to view the iExport Queue to determine
how many exams are awaiting exportation.
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Exam Rack Components
Caching Exams from the Timeline
Depending on your security, you can cache exams to a local machine or
location from the timeline.
¾
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.
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Exam 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.
Exam summary
window
Navigational
rectangle
Exam
information
(impression
text)
Thumbnail images
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
IDXR
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
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)
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Working with Presentation States
n
n
View, edit, or create user or system hanging protocols (page 108)
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
n
IDXR
If no other presentation states are present, the original DICOM
state is used as the default to display images.
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.
n
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.
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.
Presentation state
icon
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
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was not loaded because new images have arrived since the
presentation state was saved.
Creating a Presentation State
1 Adjust the image(s) as appropriate.
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
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.
IDXR
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 Rules
Depending 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
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received is displayed in the Define Matching Value list (this value
cannot be removed). Refer to the following graphic.
Modality value for
modality from
which series/
image was
received
DICOM tags from selected
series/image
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.
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The following graphic shows the Series Description DICOM tag
added to the Define Matching Values list.
Series
Description
DICOM tag
value
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
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Working with Hanging Protocols
the second modality’s Series Description DICOM tag value. Refer to
DICOM tag value from
second modality
Using Matching Series Rules with Hanging Protocols
Using 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
IDXR
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
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.
.
If you create a user hanging protocol called “MR Brain Special”, that hanging
protocol will only be available to you.
Example
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.
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This is especially useful when you read a lot of the same exam types
that contain a lot of different series.
.
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.
Example
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 Protocol
1 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
IDXR
– 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:
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– 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
n
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.
The following hierarchy applies to default hanging protocols (For
example, a user–defined modality hanging protocol will override
a system–defined modality hanging protocol):
User–defined hanging protocol group (overrides all following
items)
n
System–defined hanging protocol group
n
User–defined modality and body part hanging protocol
n
System–defined modality and body part hanging protocol
n
User–defined modality hanging protocol
n
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
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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.
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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
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– 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.
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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:
Configuration
M1
M2H
M2V
M3H
M3V
M4
M6P
M6L
M1_2
M2_1
M1_3
M3_1
Notes:
n
n
As you change settings, the display will change to show you how
the monitors will hang and where individual series will go.
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.
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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.
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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 Exams
The following rules apply when Radiologist Workstation attempts to
hang relevant prior exams:
n
n
n
Radiologist Workstation always loads one new exam and one
relevant prior exam (if available)
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).
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 Configuration
Hanging protocols are optimized to work with one, two, or four
diagnostic monitor displays. However, You can only define a twomonitor 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
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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 PA
Monitor 2: General LAT
Number of
Monitors
Relevant
Prior?
1
No
Monitor 1
Monitor 2
Monitor 3
Monitor 4
New Exam
General PA
N/A
N/A
N/A
N/A
N/A
N/A
New Exam
General PA
New Exam
General LAT
N/A
N/A
Virtual Monitor
Virtual Monitor
N/A
N/A
New Exam
General PA
Prior Exam
General PA
N/A
N/A
Virtual Monitor
Virtual Monitor
New Exam
General LAT
Prior Exam
General LAT
New Exam
General PA
New Exam
General LAT
Empty
Empty
Virtual Monitor
Virtual Monitor
N/A
N/A
Virtual Monitor
New Exam
General LAT
1
Yes
New Exam
General PA
Virtual Monitor
New Exam
General LAT
2
2
4
No
Yes
No
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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 PA
Monitor 2: General LAT
Number of
Monitors
Relevant
Prior?
4
Yes
.
Example
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Monitor 1
Monitor 2
Monitor 3
Monitor 4
New Exam
General PA
New Exam
General LAT
Prior Exam
General PA
Prior Exam
General LAT
Virtual Monitor
Virtual Monitor
Virtual Monitor
Virtual Monitor
N/A
N/A
N/A
N/A
The following displays the layout of images with relevant priors found on a
two-monitor system.
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 Protocol
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 Protocol
Hanging 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 Protocol
You can rehang an exam according to its default hanging protocol
using the Rehang option.
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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.
1 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.
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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.
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Viewing Extended Exam Information (DICOM Metadata)
The exam information is displayed.
3 Click OK to close the Exam Information window.
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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.
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Marking 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.
¾
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Click Mark Read or press F3 in the exam summary window.
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.
Superimposed rectangles
Loading Images into Your Diagnostic Monitors
Do one of the following to load images into your diagnostic monitors
using the navigational rectangles:
¾
Position your mouse pointer on the edge of a rectangle, click and
drag the rectangle over the images or series.
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¾
¾
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.
Navigation retangle
Dragging the navigation rectangle to another Image/series
splits the navigation rectangle
The image and/or series is displayed in the corresponding diagnostic
monitor.
-
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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.
Click and drag on the
monitor icon to create a
new navigation
rectangle
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Organizing 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.
¾
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
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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).
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Adjusting Window Width and Window Level
¾
Double–click the image or series.
¾
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 Settings
1 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.
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Cine Slices in a Multi–image Series on the Canvas Page
Using Predefined Window Width/Level Settings
1 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.
Wheel mouse
Position your mouse pointer over the image, press
and hold the mouse wheel, and then drag the mouse.
Fast cine review
Two–button mouse
Press and hold the up and down arrows keys or the
PAGE UP
Cine loop
Improve image quality of
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.
Keyboard
Press F9.
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Using 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 image (All scout line
mode)
Cursor on associated
series
Scout line mode
Scout lines can be displayed in one of the following scout line modes:
n
n
n
Single—Show a single scout line corresponding to the current
image in the active window (system default)
Bracket—Show scout lines for the first, last, and current image in
the current window (as shown in the previous screen shot)
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.
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Using the Localizer
Viewing Scout Lines
¾
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
n
When the slices are cined (page 133), the interactive navigation
bar moves in sync with the cine action.
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
¾
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.
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Using the Localizer
(Moving the cursor from its initial position, back towards the spine, and
back up again, with all cross hairs moving in sync.)
Cross hair indicating cursor’s
position on this series
Cursor position on
first series
Cross hair
indicating cursor’s
position on this
series
Cross hair indicating cursor’s
position on this series
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.
IDXR
Unlike other images, clicking and dragging does not adjust the window width/
level of localizer-enabled images.
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 On
1 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).
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Configuring 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
¾
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.
¾
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In an exam rack, right–click an image or series within a navigational
rectangle, click Monitor Layout, and then click a configuration
(monitor layout) on the pop–up menu. Refer to the following
graphic.
¾
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.
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¾
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In the control strip, right–click the corresponding monitor icon and
then click a configuration (monitor layout) on the pop–up menu.
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.
All diagnostic reading should occur on your diagnostic monitors.
!
Caution
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
n
Identify overlays
n
Move scaled rulers on the diagnostic monitors
n
Select images and series to view and read on diagnostic monitors
n
Work with images in the diagnostic monitors
n
Adjust window width and level
n
Zoom
n
Pan
n
Cine
n
Describe the measurement tools available to you
n
Measure the distance between two points on an image
n
Measure an angle on an image
n
Measure the area of a region of interest on an image
n
Display the point value of an image (measure luminance)
n
Use the Measurement Palette
n
Calibrate an image
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Reading Exams on the Diagnostic Monitors
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n
Understand US measurements
n
Annotate images
n
Use the Spine Labeling tool
n
Edit measurement and annotation formats
n
Delete measurements and annotations
n
Invert image brightness and contrast
n
Apply image processing filters to an image
n
View slices using scout lines
n
View slices using the localizer
n
Use multi–image modes
n
Change the diagnostic monitor layout
n
Switch between different images or series in a study
n
Switch between exams for currently-selected patient
n
Clone CT series
n
Expand images and series into floating windows
n
Mark key images
n
Understand the Key Image Series Stack
n
Cycle key images
n
Compare images
n
Save an image to a file
n
Copy an image to the clipboard
n
Print an image
n
Delete a series or image
n
Flip an image
n
Rotate an image
n
Sort a series
n
Split an exam
n
Manage duplicate study instance unique identifiers
Diagnostic 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.
Scaled ruler
Screen overlay
Image
measurement
(18.5 cm^2)
Scaled ruler
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
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Diagnostic 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.
•
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.
Caution
Turning Screen Overlays On or Off
¾
Press F6.
Turn All Overlays On or Off
¾
Press CTRL+F6.
Moving the Scaled Rulers on the Diagnostic Monitors
¾
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.
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Selecting 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
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 level
n
Zoom
n
Pan
n
Cine, fast cine, and cine loop for series
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Adjusting Window Width and Window Level
n
Invert
n
Flip
n
Rotate
n
Image annotation
n
Measurement
n
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.
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Zooming
– 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 Settings
Imagecast 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
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Zooming
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.
Example of Zoom Using Pixel Replication
Example of Zoom Using 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.
Action
Using
Procedure
Zoom in on single-image
series
Wheel mouse
the mouse wheel backward toward yourself.
Two–button mouse
Press ALT, hold the left mouse button, and then drag
the mouse backward toward yourself.
Wheel mouse
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.
Zoom out of singleimage series
(Page 1 of 2)
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Panning
Action
Using
Procedure
Zoom in on multi–image
series
Wheel 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
Two–button mouse
Press ALT, hold down the left mouse button, and then
drag the mouse forward away from yourself.
(Page 2 of 2)
Using Zoom Presets
1 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 Window
n
100% (Original)
n
200%
n
300%
n
400%
Selecting a zoom preset does not resize the window.
Selecting an Interpolation Mode
1 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.
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Cine 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.
Action
Using
Procedure
Pan single image
Wheel mouse
Two–button mouse
Press CTRL, hold down the left mouse button, 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
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).
Action
Using
Procedure
Cine review (frame–by–
frame)
Wheel mouse
the mouse wheel forward or backward.
Two–button mouse
Press the up and down arrows keys or the PAGE UP
Wheel mouse
Fast cine review
Two–button mouse
Press and hold the up and down arrows keys or the
PAGE UP
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)
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Overview of Measurement Tools
Action
Using
Procedure
Improve image quality of
cine loop
Keyboard
Press F9
(Page 2 of 2)
Lesson 8: Overview of Measurement Tools
The Measurement option allows you to indicate and measure specific
areas of an image. Measurement tools include:
n
Ruler
n
Angle
n
Region of Interest (ROI)
n
Freehand ROI
n
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.
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Measuring 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.
-
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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
automatically becomes a key image. For more information about key
images, refer to the Marking Key Images section on page 172.
Measuring 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.
First endpoint
Apex
Second
endpoint
-
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
163.
n
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Measuring 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 Tool
When 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.
-
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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.
Measuring 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
163.
n
Freehand ROI Tool
The 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.
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Displaying 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
163.
n
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
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Using 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.
Cursor (reference point to
which the original DICOM
image is mapped)
Point value of cursor’s location
is continuously displayed at the
bottom of the window
Using the Point Value Tool
1 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,
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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.
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.
Icon
For instructions about how to take
measurements using this tool, refer to the…
Tool
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
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.
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Calibrating 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.
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Annotating Images
Lesson 16: Annotating Images
The Annotations option allows you to annotate images. Several
annotation styles can be applied including:
-
n
Line
n
Circle
n
Arrow
n
Triangle
n
Text
n
Freehand
n
Spine labeling
n
Custom annotation styles
n
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 Tools
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.
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Annotating 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 Annotations
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.
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Annotating 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 Tool
The 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
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Editing 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
right corner of the Spine Label Panel window.
-
in the upper
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.
-
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
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Deleting 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:
¾
Click the measurement or annotation and then press DELETE.
¾
Right–click the measurement or annotation and click Delete on the
pop–up menu.
¾
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.
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Inverting Image Brightness and Contrast
2 Click Image Processing.
3 Click Invert Image.
The image’s colors are reversed.
Image before inversion
Inverted image
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Applying Image Processing Filters
Lesson 20: Applying Image Processing Filters
The following image processing filters are available:
n
n
n
n
Edge Enhance—Utilizes a Laplacian method to increase the
visibility of edges in the image
Edge Detect—Provides an alternative to the edge enhancement
filter, utilizing a Sobel operator to increase the visibility of edges
Median—Utilizes a common filtering method to reduce noise in
an image
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
Enhance
Median
Original
Edge Enhance
Edge Detect
Original
Median
Original
CLAH
CLAHE
Original
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Edge Detect
Viewing 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 Image
1 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.
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Viewing 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
Configuration
1:1
1:2
2:1
2:2
2:3
1:3
3:3
3:4
4:5
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Selecting a Monitor Layout
Selecting a Multi–Image Mode
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.
Monitor Layout Configurations
Configuration
M1
M2H
M2V
M3H
M3V
M4
M6P
M6L
M1_2
M2_1
M1_3
M3_1
Selecting a Monitor Layout
2 Click Monitor Layout on the pop–up menu.
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Selecting 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 Series
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
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.
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Cloning Series
When you select an exam from the list, it replaces the exam that is
currently displayed on your diagnostic monitor.
Viewing Relevant Exams
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 Monitors
2 Click Clone Window With Preset on the pop–up menu.
In the exam rack on the canvas page, a duplicate series is displayed.
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3 To close the cloned series, right–click the image and click Remove
Clone on the pop–up menu.
Cloning Expanded Series
2 Click Clone on the pop–up menu.
3 To close the clone, click
window.
in the upper right corner of the expanded
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.
¾
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.
-
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When a measurement or an annotation is added to an image, that image
automatically becomes a key image.
Key Image Series Stack
Marking a Key Image
¾
– 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
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Key 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
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Cycling 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.
Key Image Series
stack—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 Series
1 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.
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Cycling 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 Stack
You 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.
In exam rack, position
mouse pointer over Key
Image Series stack.
– 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
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Comparing 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 Images
1 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.
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Saving 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 Images
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.
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Copying 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.
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Deleting 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
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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).
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.
1 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.
Free-text reason
Predefined reason
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).
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Flipping 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.
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Sorting a Series
3 Click Rotate 90 CW (clockwise) or Rotate 90 CCW (counter–
clockwise) on the pop–up menu.
Clockwise
Before rotation
Counter–clockwise
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
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Splitting 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
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Managing Duplicate Study Instance Unique Identifiers
of a given study instance UID to more than one study. However,
duplicate study UIDs (DUP UIDs) can occur.
.
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.
Example
The following DUP UID management tools are available:
n
n
n
n
DUP UID message—Enabled by administrators, a demographics
mismatch message is displayed when DUP UID images are
detected
DUP UID Remove Demographics Mismatch option—Allows
you to remove demographic mismatches by accepting and
merging the DUP UID studies
Image/series Delete option—Allows you to delete images or
series, which may be DUP UID images, from the exam rack
DUP UID Assign New Unique Study UID option—Allows you
to assign a new study UID from the exam rack
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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.
Demographic mismatch
message
-
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 Message
Depending 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 Mismatches
Depending on your privileges, you may be able to correct a DUP UID.
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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.
Depending 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 Image
Depending 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.
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The Assign New Study UID Dialog window is displayed. Refer to
Demographic data taken from
image/series
Existing study UID
information
Free-text Reason field
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.
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Viewing Diagnostic Reports
Radiologist Workstation allows you to view diagnostic reports.
Objectives
n
n
Access and view diagnostic reports
Work with the list of related exams and all exams on the Clinical
Exam Notes window
n
Print diagnostic reports
n
View provider contact information
n
View allergy information
n
View documents
n
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.
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Viewing Diagnostic Reports for Related Prior Exams
Refer to the following table for instructions about accessing diagnostic
reports.
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 exam
n
( )—No diagnostic report exists for this exam; exam memos do exist for
this exam
n (
)—A diagnostic report exists for this exam; exam memos may exist for
this exam
For detailed information about working with exam memos, refer to the Working
with Exam Memos section on page 63.
Lesson 2: Viewing Diagnostic Reports for Related Prior
Exams
A list of related prior exams appears at the bottom of the Clinical Exam
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.)
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Viewing 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
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
window.
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Viewing 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.
¾
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.
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.
¾
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.
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Viewing Documents from the Clinical Exam Notes Window
Lesson 6: Viewing Documents from the Clinical Exam
Notes Window
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.
¾
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
Potential issues have been identified with Exam Memos..
!
Caution
¾
Click the Memos tab on the Clinical Exam Notes window.
the Working with Exam Memos section on page 23.
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Viewing Exam Memos from the Clinical Exam Notes Window
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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:
Objectives
n
Review, edit, and sign diagnostic reports online
n
Sign diagnostic reports by proxy online
n
View patient data
n
View and edit exam data
n
Access patient exam and film loan lists
n
Identify exam (report) statuses
n
Identify sign statuses
n
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
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Overview of the Provider Module
Understanding Exam (Report) and Sign Statuses
available to you. Exams that appear in your signature queue include
only those with the following exam (report) statuses:
Exam Statuses
Sign 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.
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.
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Understanding 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.
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Understanding 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
n
n
The LAST signer signs a report (authentication is automatic in this
case)
The LAST signer authenticates a report that was signed for him or
her by proxy
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.
Scenario 1
LAST
signer signs report
The Imagecast system
automatically:
n
Authenticates the report
n
Finalizes the report
Scenario 2
Provider signs report for
LAST signer by proxy
The report is
finalized
signer
authenticates the
report
LAST
Scenario 3
Resident signs report;
report remains in
Preliminary status
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signer signs
the report
LAST
The Imagecast system automatically:
n
Authenticates the report
n Finalizes the report
n Adds the attestation
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.
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.
!
Caution
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.
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-
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 report
n
Rapid edit and
finalization
For more information about whether your organization has defined
attestation text or when charges are generated, contact your Imagecast
application manager.
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
n
all other providers listed on the report are electronic signers who
have authorized others to sign for them
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.
IDXR
Understanding 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
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
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.
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Understanding Keyboard Shortcuts in the Provider Module
IDXR
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
n
Filter and select reports from your signature queue
n
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)
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Signing Reports
Working with Your Signature Queue
Filter Options
Filter option
Reports included in the signature queue
Review
All reports that you need to review, including those sent by other
providers.
Accessing Your Signature Queue
1 On the Module toolbar, click Provider.
2 On the Option toolbar, click Signature Queue.
The Signature Queue window is displayed.
Filter options
Report list
Filtering Reports in the Signature Queue
¾
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 Queue
When 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.
IDXR
Signing Reports
Reviewing 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 Report
1 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.
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205
Signing Reports
Reviewing and Signing Reports
Report text
Signing interpreting
provider(s)
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.
IDXR
Signing Reports
Entering 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 Directly
1 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.
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Signing Reports
Exercises
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.
IDXR
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
n
Edit and view exam data
n
Enter and edit text in a diagnostic report
n
Place a diagnostic report on hold
n
Add an addendum to a finalized report
n
Request a review by another interpreting provider
n
Access a prior report
n
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 Queue
n
Result Reporting
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Working with Diagnostic Reports
Accessing 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 Option
1 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.
IDXR
Editing and Viewing Exam Data
Accessing a Diagnostic Report from the Result Reporting Option
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 examrelated 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 Data
1 Access a diagnostic report.
2 Click edit exam data.
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Entering 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
IDXR
There are two methods by which you can edit text in a diagnostic
report, including:
n
n
Microsoft Word (if Microsoft Word is installed on your
computer)
Text editor
Entering and Editing Text with Microsoft Word
1 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 Editor
1 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
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–
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
IDXR
Placing 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.
If you do not sign the report, placing a report on hold may prevent circulation
and billing.
!
Caution
Placing a Report on Hold
1 Access a report from the Signature Queue sign option.
2 Click hold.
3 Do one of the following as appropriate:
n
Sign the report
n
Continue working with other reports in the Signature Queue
n
Exit the Signature Queue
Removing a Report on Hold from Your Signature Queue
1 Access a report on hold from the Signature Queue Sign option.
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Adding 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 Report
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.
IDXR
Sending 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 Review
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.
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Accessing 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 Report
2 Click prior reports.
3 On the Patient Exam List window, click
whose report you want to view.
next to each exam
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.
IDXR
Viewing 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 Trail
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).
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219
Exercises
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.
IDXR
Exercises
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.
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Exercises
IDXR

IDX Imagecast™ PACS 3.3 - Clinical Enterprise Technologies

Transcription

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