Document: Multi-page (English)



Provincial Diagnostic Imaging (DI) Viewer User GuideVersion: 01Copyright NoticeCopyright ? 2017, eHealth OntarioAll rights reservedNo part of this document may be reproduced in any form, including photocopying or transmission electronically to any computer, without prior written consent of eHealth Ontario. The information contained in this document is proprietary to eHealth Ontario and may not be used or disclosed except as expressly authorized in writing by eHealth Ontario.TrademarksOther product names mentioned in this document may be trademarks or registered trademarks of their respective companies and are hereby acknowledged. Document ControlThe electronic version of this document is recognized as the only valid version.Approval HistoryAPPROVER(S)TITLE/DEPARTMENTAPPROVED DATEProduct Revision HistoryVERSION NO.DATESUMMARY OF CHANGECHANGED BY12018-05-01DraftValerie Ip Image ViewingClinical (Reference) ViewingMethod to view patient studies that is not meant for diagnosisDoes not have diagnostic quality (i.e., lossy images)By default, all users are configured to use the Provincial DI Viewer as a reference viewerTo view the highest quality images available, users should use the diagnostic (full fidelity) viewing mode.Full Fidelity (diagnostic-quality) ViewingProvides the highest quality image (i.e., lossless DICOM images) availableIntended for diagnostic use, review, and analysis of computed Radiography (CR), computed Tomography (CT), digital radiography (DX), magnetic resonance imaging (MR), ultrasound (US) imagesNot intended to replace full radiology workstations and is validated for use only on certain platforms and for only the modalities as listed aboveNot intended for the display of digital mammography images for diagnosisThe user assumes responsibility to determine whether the display device, lighting conditions, and other factors that can affect image quality are suitable for diagnosis Warnings and Restrictions for Full Fidelity (diagnostic-quality) ViewingType of RestrictionMore InformationValidated ModalitiesOnly the following modalities are validated for full fidelity viewing:? Computed Radiography (CR)? Computed Tomography (CT)? Digital Radiography (DX) ? Magnetic Resonance Imaging (MR)? Ultrasound (US)158755207000 WARNING!Modalities not validated for full fidelity viewing can still be displayed in full fidelity mode, but they are not indicated for diagnosis. Qualified medical professionals using the system are responsible for determining if the images are of sufficient quality to perform diagnostic assessments. The Provincial DI Viewer’s full fidelity is not intended for the display of digital mammography images for diagnosis.Citrix Server Users 104053556000 WARNING!Citrix XenServer and Citrix XenApp are not validated for viewing images for diagnostic purposes. Although licensed Citrix XenServer and XenApp users can switch to full fidelity mode, it is the user’s responsibility to ensure that the image quality is suitable for diagnostic use.Extended Image ViewingFull fidelity is not supported when viewing extended or 3D images.Supported Web BrowsersUsers of the Provincial DI Viewer are advised to review all requirements and recommendations and to test viewing compatibility and image quality prior to use.Validated platforms and devices for full fidelity viewingFull fidelity viewing provides access to the highest quality image available. The qualified medical professional using the system needs to determine if the images are of sufficient quality to perform diagnostic assessments. To use this feature, the site must be licensed and you must be an authorized user. Only the following platforms and devices are validated to use full fidelity mode.BrowserValidated platformsInternet Explorer 9.xWindows 7 SP1Internet Explorer 10.xWindows 7 SP1Internet Explorer 11.xWindows 7 SP1Windows 8.1SafariiPad 3 iOS 9.xiPad 4 iOS 9.xleft000CAUTION! Full fidelity operates on off-the-shelf portable devices and is, therefore, subject to factors not typical for reading room workstations (for example, screen size, environmental variability, network dependencies, and so on). It is, therefore, required that the user follows the operating instructions properly and uses the risk mitigation factors to make decisions safely and effectively.Supported browsers/platforms for reference viewing-36449013652500Important!Browsers listed above are the supported version. The latest version available might not have been tested for your version of the Provincial DI Viewer. If you upgrade to the latest version, the warning “Browser not tested” is displayed in the Provincial DI Viewer.Image Viewing Configurations and ConditionsBy default, all users are configured to use the Provincial DI Viewer as a reference viewer. Full fidelity viewing is available only with the validated platforms and devices indicated in Table 1: Supported browsers for Provincial DI ViewerIf you attempt to view images in full fidelity mode using an unvalidated platform, a warning is displayed: You must either accept or decline the warning before continuing. WARNING!Display monitors used for reading medical images for diagnostic purposes must comply with applicable regulatory approvals and with quality control requirements for their use and maintenance. WARNING!It is the qualified medical professional's responsibility to determine if the display device and lighting conditions are appropriate for diagnostic viewing. CAUTION!IOS devices are not intended to replace full workstations and should be used only when there is no access to a workstation. Assessing your Display DeviceDisplay devices can be a desktop computer monitor or an IOS device screen. Assessing your display device is critical to ensure the quality of the medical images displayed. By adjusting the brightness and contrast, your display device will show subtle differences in attenuation. Once adjusted following the assessment instructions that follow, your device will display the best image quality possible. WARNING!Older Barco displays are incompatible with the Provincial DI Viewer. Due to a limitation in older Barco displays (displays that do not support any colour modes), browsers such as Internet Explorer will display with noticeable visual artifacts. Before using a Barco display, ensure that the display supports colour images.Web Fidelity (Clinical Reference) Viewing on Desktop Display DeviceTo assess your desktop display device for clinical reference viewing:Using your desktop display device, look at the test pattern that follows.Ensure that you can see a box inside the top left and bottom right rectangles.If you do not see the boxes, adjust the brightness and contrast settings of your desktop display device. For instructions, refer to your desktop display device's user documentation.Example Test PatternFull fidelity (diagnostic-quality) Viewing on IOS (mobile) Display DeviceUsers who connect to the Provincial DI Viewer using an IOS device must be aware of the recommended operating environment and conditions. Confirm device compatibility before you begin.2032020637500CAUTION!Full fidelity operates on off-the-shelf portable devices and is therefore, subject to factors not typical for reading room workstations (for example, screen size, environmental variability, network dependencies, and so on). It is, therefore, required that the user follows the operating instructions properly and uses the risk mitigation factors to make decisions safely and effectively.21590-7493000 CAUTION!Mobile devices are not intended to replace full workstations and should be used only when there is no access to a workstation.Assessing your display device is critical to ensure the quality of medical images displayed. By adjusting the brightness and contrast, your display device will show subtle differences in attenuation. Once adjusted following the assessment tool instructions, your device will display the best image quality possible.The first time you view an image for full fidelity viewing on an iPad display, you will need to perform a calibration as per the steps below. To assess an iPad display device for full fidelity viewing:Complete this test in dark lighting conditions. Reading room conditions are recommended.Using an iPad device, log into eHealth Portal and launch eHealth Services- Diagnostic Imaging application (refer to Logging in). Select the patient and image you wish to view.41148034462800The viewer recognizes when you are using an iPad. Click the toggle button to switch from web fidelity (clinical reference viewing) to full fidelity.411480215900Figure 3 Fidelity Toggle for Image Viewing0Figure SEQ Figure \* ARABIC 3 Fidelity Toggle for Image ViewingFrom the Calibration window, tap the circle that appears against the dark background.If you do not see a circle, tap Brighter or Darker to adjust the display. When you see the circle, tap it. WARNING!Some environments, such as outdoors in direct sunlight, are too bright for diagnostic assessments.If you do not see the circle even after attempting to brighten the display, the calibration fails when the Calibration Unsuccessful message is displayed. Recalibrate the device by doing the following:Move to a location with less ambient or artificial light. Tap the Information icon. In the dialog that opens, tap Select Ambient Light Level.Recalibrate the device by following steps 4-5.If the ambient light in your environment is too bright to properly calibrate your display device, you can still use the device in web fidelity (clinical reference viewing) mode.IOS (mobile) Device Configurations and Use ConditionsTo ensure the best possible viewing experience, we recommend the following mobile device configuration and usage.Screen cleanliness Always clean your mobile device's screen prior to use. For specific instructions, see . Dust, smudges, and fingerprints can interfere with your ability to properly calibrate the screen and to view medical images. Clean the screen during use if it should become dirty.Screen protectorsWARNING! Screen protectors can cause visual distortions. The use of a screen protector is not recommended for diagnostic purposes.Screen damage and defectsScreen damage can include cracks or scratches; screen defects can be dead or stuck pixels. Replace or repair a damaged or defective mobile device before using it to view medical images.WARNING!Damaged and defective screens can cause visual distortions. Using a damaged or defective screen is not recommended for diagnostic purposes.Screen brightnessEnsure that your mobile device is set to 100% brightness level. Disable the auto-brightness feature. For instructions, see https:// support.en-ca/HT202613.Lighting and environmental conditionsUse your mobile device for diagnostic viewing only in conditions that resemble a typical reading room environment:A lighting level of less than 5 lux. This is typically a dimly lit interior room without exterior windows and with no fluorescent lighting sourcesVicinity lighting that illuminates the walls behind the displays to make the lighting level consistent between the display and the background surface to reduce eye fatigue when looking back and forth between bright and darkIndirect lighting providing 90% of the room’s lighting. Direct fixtures providing 10% of the room’s lightAmbient lighting not shining directly on the display screenAn environment that is quiet and free from external noise, distractions, and interruptions.An environment that is still and free from vibrations, shaking, or motionBattery powerA fully charged iPad (100% battery power) can operate approximately five hours before its battery is fully depleted, although variances can be expected depending on the age of the device and the other applications that are running at the same time as the Provincial DI Viewer.WiFi connectionsIf you lose your WiFi connection while using the Provincial DI Viewer, your session is terminated. You must reconnect to WiFi before continuing. This might mean moving to an area with a stronger signal.Angle of viewing View your IOS device keeping it perpendicular to your line of sight. Do not view it on an angle greater than 40 degrees or reflections will reduce the optimum image quality.External applications on the deviceSome external IOS device applications can disrupt your Provincial DI Viewer session. For example, video chat applications (such as Face Time), calendar alerts, or incoming e-mail notifications can disrupt your work. To avoid disruptions, disable these applications prior to using the Provincial DI Viewer.Recommendations for the User of IOS DeviceThe following recommendations pertain to the IOS device user. Comparison and practicePractice using the IOS device before using it with the Provincial DI Viewer. The Provincial DI viewer vendor recommends setting aside time to view the same patient study on a diagnostic workstation and your IOS device for comparison purposes. This also helps you become familiar with using the tools such as zoom and window level.Lighting and environmental conditions Remain aware of the lighting conditions if you move from the environment where you initially calibrated your mobile device. Recalibrate your mobile device display screen if the lighting conditions change.Remain stationary Remain stationary while viewing medical images.Measurements on imagesFor more accurate measurement results, zoom into the image and use a stylus pointing device.Viewing StudiesViewing StudiesWhen a study is selected, the DI images will display in a viewport. Single Image Study in ViewportViewing Multiple StudiesWhen two or more DI studies are selected they will always launch in a single viewer instance. Two image studies will display in two separate viewports, side by side. When three or more studies are selected, users can easily navigate between studies. Side-by-side View of Two Image StudiesBasics of Viewing Images and Studies Image Display OverviewFigure 52 Image Display1Image ToolbarAccess tools for image manipulation2Study Information BarStudy information and study selection3Options ButtonSelect display layout or demographic toggle4Reset LayoutRemove all changes made and return image to its original state5Navigate SeriesNavigate between different series6Display Series TrayDisplay and navigate available series7Compare Studies IconView images from the same study in a side-by-side dual viewport8Cine Viewer ToolsCine playback with tools for navigation9CloseCloses the view and returns to the document list10Actions MenuAccess to View Study, Print radiology reports or Close the view and return to the documents list11View Menu Access to:Show Related Documents – displays a list of other documents (reports or studies) related to current documentShow History - Displays a list of previous versions of the report (e.g., preliminary reports or addended reports)Maximize – Enlarge the document view to take up all available spaceRestore – Restores the document view after maximizingFidelity Toggle The Fidelity toggle allows the user to switch between two settings: Web (Clinical reference viewing) and Full (diagnostic-quality). The default setting for the viewer is Web Fidelity. Due to restrictions and conditions for full fidelity, the user may select full fidelity mode but image quality may not be diagnostic. Fidelity ToggleDisplay Layout A study can contain one or more series of images. When the user selects a study to view, the layout is determined by the number of series in the study. Based on the number of series in a study, the default layout aims to display as many series as possible. For example, if a study consists of seven series, they are displayed in the 4x2 layout with one blank image pane.Changing Display LayoutTo change the layout of images:Click the ‘Options’ button located beside the study information bar to view the available layout options.The available layout options will appear in the list. These options are limited by the number of images included in the studySelect the required layout. The study images display in the layout format you select267462027305Click on Options button to display layout options menu.00Click on Options button to display layout options menu.Layout Options MenuTip: Double-click an image or series in a multiple layout format to display it in a 1x1 layout. Double-click it again to return to the previous layout.Image ToolbarThe user can manipulate each image by changing its brightness, contrast, position, and magnification settings using the image toolbar. Each image in the study has its own toolbar. The user can undo any of the manipulations made to the image. The user can also reset the specific type of manipulation being worked on, or perform a global reset that returns the image to its original state. The toolbar can be displayed or hidden but is always docked in the top left corner of the image pane.Depending on the type of modality being viewed, a different toolbar button is selected by default when the user first views the image to help the user perform the most common image manipulations efficiently. 212598017780Click the right arrow to display the Image ToolbarClick the right arrow to display the Image ToolbarImage ToolbarUnderstanding Slice Reference LinesVarious modalities (e.g., CT, MRI) can capture images of the human body in three different planes: coronal, sagittal, and axial. The three planes are represented in the diagram that follows.Figure 56 Body PlanesCalloutCorresponding Plane1 (Red)Coronal2 (Green)Sagittal3 (Purple)AxialTable 4 Body Plane DescriptionTo assist with cross-sectional navigation, the Provincial DI Viewer automatically displays a coloured line on all non-coplanar linked series in a single study within the same frame of reference that intersects with the 3D centre slice position of the active series.Below is a study showing four series that have the same frame of reference. Refer to the line intersecting the images (highlighted).Non-coplanar Linked SeriesUnderstanding Patient Orientation IndicatorsThe Provincial DI viewer enables you to rotate, flip, and move images on your display screen. To help keep track of the patient’s orientation when manipulating the image, use the patient orientation indicators as guides. The patient orientation indicators can also be displayed as composite values. For example, AH represents anterior head; AHL represents anterior head left.Important! Patient orientation indicators are not translated from English into any other languages.Orientation IndicatorMeaningAAnteriorPPosteriorHHeadFFootLLeftRRightTable 5 Patient Orientation Indicators176530topImage showing anterior (A), posterior (P), head (H), and foot (F) orientation indicators 00Image showing anterior (A), posterior (P), head (H), and foot (F) orientation indicators 43815062357000195580topImage showing composite orientation indicators: Anterior foot (AF), posterior head (PH), right (R), and left (L)00Image showing composite orientation indicators: Anterior foot (AF), posterior head (PH), right (R), and left (L)Orientation IndicatorsViewing Studies, Series, and ImagesStudies, Series and Images: How They Are RelatedAn image is a single frame taken by a modality. Certain modalities such as CT, MRI, and PET take consecutive sets of images called series. One study can consist of several series. Studies are combinations of series or images for a single patient. Images in a study are usually from a single modality, but can also originate from multiple modalities. 28073351644650Relationship of Studies, Series and ImagesRelationship of Studies, Series and Images280733521907500The following illustration shows a patient's study with three series, each containing multiple images. This illustrates the relationship between:1. A study2. The series within the study3. The images contained within each seriesNavigating Studies and SeriesAfter selecting a study to view, the images appear in the display area. The user has several options for selecting which information to display and how to lay it out.Navigating Between StudiesWhen the user selects multiple studies to view simultaneously, two studies will display in separate viewports, side by side. The user can easily navigate between the selected studies for the patient while in the display area.PrerequisitesEnsure that the patient has multiple studies available for viewingSelect three or more studies to view (refer to Select a Study)To navigate between studies:In the display area (i.e., viewports), click the study information bar of the study to be changedA list of the studies selected for that patient is displayed. Click on a study name to select it for viewingTo navigate back and forth between the patient’s list(s) of studies, click on the study information bar of either viewport. Repeat step 2To filter the list of studies, type in the exam name in the “Filter Studies” text field. Only studies matching the filter criteria are displayed1981200-264160Click on study information bar to display list of other selected patient studies00Click on study information bar to display list of other selected patient studiesFigure 60 Navigating Between StudiesNavigating Between SeriesSome modalities produce a consecutive set of images called a series. The Provincial DI Viewer enables you to navigate between series in a study.PrerequisitesEnsure that the patient's study has multiple series. The top right hand corner will display an arrow and a “tray” icon with the number of series when multiple series are available19812003149600Figure 61 Image SeriesTo navigate between series in a study:In the displayed study, optionally select the image layout to display by clicking on button next to the study name. Refer to Changing Display Layout for more information about layoutsThe user has two options for navigating.To navigate using navigation buttons:Click on navigation buttons at top right corner of display193040127635Navigation ButtonFunctionMove back to the previous series.Moves ahead to the next series.Figure 62 Navigation ButtonsNote: Depending on the study layout that you choose, the navigation buttons may be disabled at some points in the series. For example, when a study with fewer than four series displays in 2 x 2 layout, the forward and backward buttons are disabled.To navigate using the series tray:Click the ‘display series tray’ icon. The icon will indicate the number of available series. For example, indicates 10 available seriesThe Series Tray expands, showing thumbnail versions of all available series for that study. Drag the scroll bar on the right of the series tray, to scroll through all available series. The series that is being displayed in the series tray is outlined in whiteTo display the series you would like to view:Drag the series into the image area or box to be replaced, ORClick on the displayed imaged box to be replaced and then click on the new series to be displayed211709024765Drag scroll bar to view remaining seriesSeries being viewed is outlined in whiteClick Series Tray icon to display available series00Drag scroll bar to view remaining seriesSeries being viewed is outlined in whiteClick Series Tray icon to display available seriesFigure 63 Expanded Series TrayTo rest the series layout, click on the reset series layout button To hide the series tray, click display series tray icon Navigating Through Automatically-Linked SeriesSome modalities (e.g., CT’s and MRI’s) will produce a consecutive set of images called a series. The Provincial DI Viewer may automatically link a study’s series so that when you start to navigate through one series, the linked series also navigate in synchronicity. Note: Auto linking occurs when a specific set of parameters are metPrerequisitesEnsure the study contains more than one seriesSeries are automatically linked only under the following conditions:Series that are in the same plane (20 degrees or less)Series that refer to the same anatomical area of the bodyTo navigate through automatically linked series:In the displayed patient study, click on to select the image layoutUse the mouse wheel to scroll through the series Automatically linked series navigate synchronously. A corresponding reference line will appear on the other series as you scroll allowing you note the position of each slice you are viewing. Manually Linking SeriesSome modalities produce a consecutive set of images called a series. Manual series linking is normally used with CT and MR images. A clinician typically chooses to manually link series when a patient has a new study to compare against previous ones to detect changes, such as the growth of a tumour. Series from 2 different studies, e.g. MRI and CT can also be manually linked together.PrerequisitesEnsure that the patient’s study has more than one seriesTo manually link series:Identify the first series to linkExpand the image tool bar in the series viewport210312015875Click the right arrow to display the Image ToolbarClick Manual Series Link00Click the right arrow to display the Image ToolbarClick Manual Series LinkFigure 64 Image ToolbarClick the ‘Manual Series Link’ icon . The link icon will display in the top right corner of that series to indicate that it has been selected to be linked to another seriesIdentify the second series you would like to linkFrom the image toolbar in that series viewport, click Manual Series Link icon . The link icon will display on the top right hand corner of that series to indicate that is has been selected to be linked to another seriesNavigate through the stacked images of the one of the series. The second series navigates in synchronicity with the first seriesTo disable the manual linking, click Reset Manual Series linking iconViewing Images Using Full Fidelity (Diagnostic-quality) ModeOnly specified platforms are validated for full fidelity use. Refer to Warnings and Restrictions for Full Fidelity (diagnostic-quality) Viewing and Requirements and Recommended Conditions for Use. If you switch to viewing images in full fidelity mode on an unvalidated platform, a warning will be displayed. You must accept or cancel the warning before continuing. You can still choose to use full fidelity mode on an unvalidated platform but image quality will not be diagnostic.Note: The following modalities are the only currently supported for full fidelity viewing: Computed Radiography (CR), Computed Tomography (CT), Digital Radiography (DX), Magnetic Resonance Imaging (MR), and Ultrasound (US). WARNING!Lossy images that do not have a full quality version include a warning icon in the top right corner of their viewport. This indicates that the image is lossy even though you are in full fidelity mode.Lossy Image WarningTo View Images Using Full Fidelity ModeOpen the patient’s study to view. By default, the fidelity mode is set to Web (i.e., clinical reference viewing)Click on the Fidelity toggle bar (located in the top right corner of the image viewer) to switch to “Full”. You are now viewing in Full Fidelity modeTo return to viewing lossy images, switch the Fidelity toggle back to ‘Web’152401337310Fidelity ToggleFidelity Toggle1524091440 Navigating and Viewing ImagesNavigating Through Stacked ImagesNumbers displayed at the bottom of an image and in the scrubber indicate the number of images in the series. The user can navigate through images using a mouse, the scrubber at the bottom of each image series, or using the arrow keys on the keyboard.-152401012190Number of images in series. Hovering over bottom of image will display scrubber.00Number of images in series. Hovering over bottom of image will display scrubber.2682240141541500184404018122900Image Number and ScrubberThree methods are available for navigating through stacked images.To navigating using the scrubber:To navigate one image at a time, click the arrow buttons on the scrubberTo jump to a specific image in the stack, click the scrubber bar. The system displays the image from that position in the stackTo move ahead or back in the series, the user can also drag the scrubber knob115570-449580Click arrow to move backward one image 00Click arrow to move backward one image 4428490-487680Click arrow to move forward one image 00Click arrow to move forward one image 649605146050001211580688340647700221615 Scrubber Navigation Scrubber NavigationTo navigate using the mouse:Move the mouse pointer to the series to be scrolledTo navigate to the next or previous image, move the mouse wheel forward or backwardTo navigate through the series with variable speed, drag the scrubber knob left or right. The user can control the scrolling speed with speed of the dragging motion1187451968500CAUTION! If images are scrolled through too quickly, some images may not be displayed due to limitations of your hardware.To navigate using the keyboard:To move ahead one image, hover the mouse over the series to navigate and press the Right ArrowTo move back one image, hover the mouse over the series to navigate and press the Left ArrowTo scroll ahead 10 images in the series at a time, hover the mouse over the series to navigate and press Page DownTo scroll back 10 images in the series, hover the mouse over the series to navigate and press Page UpTo move to the first image in the stack, hover the mouse over the series to navigate and press HomeTo move to the last image in the stack, hover the mouse over the series to navigate and press EndPlaying a Series of ImagesSome modalities, such as CT and US, obtain multiple images that are included as a series. These images can be viewed using the auto-play feature (also referred to as cine viewing). The cine playback tools feature a scrubber with speed controls, scrolling navigation, and loop and rocker controls.298704073660Cine Playback Tools (display while series is playing)Playing a Series of ImagesNote: Cine playback is available only with CT and US imagesTo play a series of images: Navigate to the image series to be automatically playedHover the pointer at the bottom of the image to display the cine viewerTo play the series, click Play . The cine playback tools (i.e., controls for playback motion and speed) are displayed once the series is playedTo increase or decrease the auto-play speed, click the accelerator icon The speed slider will display:To increase the speed of the auto-play, move the slider control up2286001424305Speed SliderSpeed Slider22860027178000To decrease the speed of the auto-play, move the slider control down Note: When the playback speed is slower than expected, a warning icon appears next to the speed sliderSetting a Cine Trim RegionTo focus on a subset of images in the series, the user has the ability to set a trim region. Setting a trim region can also improve cine playback speed as the browser can cache only a limited number of images. Setting a smaller trim region may allow the entire region to be cached. The following example shows the cine viewer tool with a trim region set up. The player is limited to a reduced number of images in the series by the left and right trim guides.-438158763000-3941445159385Cine Trim RegionCine Trim RegionTo set a cine trim region:Start cine playbackDrag the left trim guide to the starting point. To assist in finding an accurate starting point for the series playback, a popup appears indicating the frame number Drag the right trim guide to the ending pointTo play the series in a continuous loop, ensure that the loop icon is displayed To play the series in a forwards and backwards motion between the trim guides, ensure that the rocker icon is displayed Note: If the playback speed is slower than expected, an icon is displayed. Playing a Series Using a Continuous LoopThe user can navigate through a series using a continuous loop. Loop mode allows you to see images in repeating successive order. This mode is useful for cardiology applications, like ultrasound and X-ray angiography. For studies that contain relevant information, loop mode is the default. PrerequisitesTo use this feature, the study must have a series of images to play.To play a series using a continuous loop:Navigate through the stacked images to find the image series to automatically displayHover the pointer at the bottom of the image to display the cine viewerClick Play . The cine playback tools (i.e., controls for playback motion and speed) are displayed once the series is played. If no controls are shown on your screen, the screen might be too small. Try switching to a larger screen formatClick Rock/Loop To play the series in a continuous loop, ensure that the following icon is displayed in the Cine viewerTo increase or decrease the auto-play speed, click the accelerator icon to display the speed slider To increase the speed of auto-play, move the slider control upTo decrease the speed of auto-play, move the slider control downChanging Direction during Auto-Play of a SeriesThe user can navigate through a series by forcing it to play forwards and backwards through the same cine trim region. Rocker mode causes the playback to change direction at the ending point. This is useful for viewing an area of interest within a spatial span, like a CT or MR study.PrerequisitesTo use this feature, the study must have a series of images to play.To change direction during auto-play of a series:Navigate through the stacked images to find the image series to automatically displayHover the pointer at the bottom of the image to display the cine viewerClick Play . The cine playback tools (i.e., controls for playback motion and speed) are displayed once the series is played. If no controls are shown on your screen, the screen might be too small. Try switching to a larger screen formatClick Rock/Loop . The direction will change at the ending point of the seriesTo play the series in a continuous loop, ensure that the following icon is displayed in the Cine viewerTo increase or decrease the auto-play speed, click the accelerator icon to display the speed slider To increase the speed of auto-play, move the slider control upTo decrease the speed of auto-play, move the slider control downComparing StudiesThe Provincial DI Viewer enables the user to compare a patient's images from the same study or from different paring Images from the Same StudyThe user has the ability to view images from the same study in a side-by-side dual viewport. Images can also be compared from the same patient as long as the patient has multiple studies available for viewing.To compare images from the same study in a dual viewport: In the displayed, study, click on Compare Studies in the upper right corner of the display area for a 2 up (i.e., display two studies side by side) 16014702584450 Figure 72 Compare Studies IconIn each viewport, select the desired image layout (refer to Changing Display Layout)In each viewport, navigate to the desired image to viewTo return to a single viewport, click on switch to Single Study View (i.e., 1 up) Comparing Images from Different Studies The user can compare images for the same patient from different studies by either selecting specific studies to compare or select all available studies for the patient.PrerequisitesTo compare images from different studies, ensure that the patient has multiple studies available.To compare images from different studies in a dual viewport:Select the studies to compare (refer to Select a Study)Click Compare Studies in the upper right corner of the display area for a 2 up (i.e., to open dual viewports)In each viewport, select the study to view:In the Display area in the top left corner, click the arrow on the study information barFrom the list that appears, select the studyIn viewport, navigate to the image that you want to compare To return to a single viewport, click on to switch to Single Study View (1 up)Tip: To maximize the amount of screen space for viewing on a desktop computer, press F11 to switch to full screen modeManipulating Images in Display50482561468000The Provincial DI Viewer can be used to manipulate images for better viewing by changing the brightness, contrast, polarity, position, and magnification or by measuring distances. The user can make multiple types of changes to manipulate how an image displays on the screen. These manipulations can be deleted one- by-one or universally.WARNING! Older Barco displays are incompatible with the Provincial DI viewer. Due to a limitation in older Barco display monitors, (i.e., monitors that do not support any colour modes), browsers such as Internet Explorer will display with noticeable visual artifacts. Before using a Barco display, ensure that the display supports colour images.Manipulating Images Using an iPadIf using an iPad, refer to the on-line Quick Start Guide for manipulating images. To view the Quick Start guide, click on Help > Quick Start Guide located in the top right corner in the image display window.Image ToolbarImage manipulations are performed using the image toolbar. Each image in the study has its own toolbar. The toolbar can be displayed or hidden but is always docked in the top left corner of the viewport. Depending on the type of modality being viewed, a different toolbar button is selected by default when the user first views the image to help the user perform the most common image manipulations efficiently. 144145058420Click the right arrow to display the Image Toolbar00Click the right arrow to display the Image ToolbarImage ToolbarAdjusting Image BrightnessImages can be made to appear brighter or darker. Any changes made to one image apply only to that group of images (also known as a series).OriginalBrightness increasedOriginalBrightness increased Image BrightnessPrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.Tip: To maximize the amount of screen space for viewing on a desktop computer, press F11 to switch to full screen mode.To adjust image brightness:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Adjust Brightness/Contrast (Window Level) icon To make an image brighterLeft mouse click and holdDrag the mouse pointer downwards to the bottom of the image To make an image darkerLeft mouse click and holdDrag the mouse pointer upwards to the top of the imageTo undo all brightness or darkness changes, click the Original Window Level icon . The image resets to original window level Tip: To undo all changes made to an image, from the toolbar, click the Reset icon Adjusting Image ContrastAdjusting image contrast means changing the difference between lightness and darkness. Any changes made to one image apply only to that group of images (also known as a series). OriginalContrast IncreasedOriginalContrast IncreasedImage ContrastTip: To maximize the amount of screen space for viewing on a desktop computer, press F11 to switch to full screen mode.PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To adjust image contrast:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Adjust Brightness/Contrast (Window Level) icon To increase the image contrast,Left mouse click and holdDrag the mouse pointer to the rightTo decrease the image contrast,Left mouse click and holdDrag the mouse pointer to the leftTo undo all contrast changes, from the toolbar, click the Original Window Level icon . The image resets to original window level Tip: To undo all changes made to an image, from the toolbar, click the Reset icon Adjusting Image Brightness and Contrast SimultaneouslyThe user can adjust an image's brightness and contrast simultaneously. Any changes made to one image apply only to that group of images (also known as a series). Original Window LevelBrightness and contrastadjusted simultaneouslyOriginal Window LevelBrightness and contrastadjusted simultaneouslyImage Brightness and Contrast Adjusted SimultaneouslyPrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To adjust image brightness and contrast simultaneously:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the image.Click on the arrow in the left corner of the viewport to expand the image toolbar.Click or tap the Adjust Brightness/Contrast (Window Level) icon Drag the mouse pointer diagonally across the image. To undo all brightness or contrast changes, from the toolbar, click the Original Window Level icon . The image resets to original window level.Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Applying Brightness/Contrast Presets For MR and CT studies brightness and contrast presets can be applied automatically to adjust the window level and width settings. Any changes made to one image apply only to that group of images (also known as a series).PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To apply brightness/contrast presets:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Adjust Brightness/Contrast (Window Level) icon For MR studies, choose one of the following brightness/contrast presets:T1T2PDThe image display adjusts to the preset brightness and contrast settings.Note: The list of presets available may vary based on system configuration and are not adjustable at the user level.For CT studies, choose one of the following brightness/contrast presets:BONESOFTBRAINLUNGLIVERThe image display adjusts to the preset brightness and contrast settings.Note: The list of presets available may vary based on system configuration and are not adjustable at the user level.To undo all brightness or contrast changes, from the toolbar, click the Original Window Level icon. The image resets to original window level.Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Inverting Image PolarityThe user can invert an image's polarity to exchange the light and dark areas (polarity) in an image. Any changes made to one image apply only to that group of images (also known as a series). OriginalInvertedOriginalInvertedInverting PolarityPrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To invert image polarity:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Adjust Brightness/Contrast (Window Level) icon On the sub toolbar, click the Invert icon . The black and white areas of the image are inverted. Colour images are also inverted To undo polarity inversion, click the Original Window Level icon . The image resets to original window levelTip: To undo other changes made to the image, from the toolbar, click the Reset icon Flipping an ImageThe user can flip study images horizontally. Use the patient orientation indicators to keep track of the original orientation of the image. Any changes you make to one image apply only to that group of images (also known as a series)PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.Original positionFlipped positionOriginal positionFlipped positionFlipping an ImageTo flip an image:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Image Navigate/Flip/Rotate icon To flip the image horizontally, from the sub toolbar, click the Flip Horizontal icon . The image is flipped from its current positionTo undo the image flip and return it to its original position, click or tap the Reset Flip/Rotate icon Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Rotating an ImageImages can be rotated 90 degrees at a time to the right. If Rotate Right is applied more than once, the image is rotated from the current position, not the original position. Use the patient orientation indicators to keep track of any rotations you make. Any changes made to one image apply only to that group of images (also known as a series).PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.317501512570Figure 79 Rotating an ImageFigure 79 Rotating an Image317501512570Rotating an ImageRotating an Image3175060960Original positionRotated positionOriginal positionRotated position To rotate an image:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the image.Click on the arrow in the left corner of the viewport to expand the image toolbar.Click or tap the Image Navigate/Flip/Rotate icon To rotate the image to the right, from the sub toolbar, click the Rotate Right icon . The image is rotated 90 degrees at a time from its current position.To undo all rotations, click the Reset Flip/Rotate icon Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Moving an Image on the Display Device ScreenImages can be moved on the screen (also called panning) for better viewing. Consider using this feature when zooming into a specific area of the image.PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing. To move an image on the display device screen:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Zoom/Pan icon or click the Image Navigate/Flip/Rotate icon Left mouse click and hold and drag the image to the desired locationTo undo all moves:Hold the Ctrl button and click or, Click the Reset Flip/Rotate icon . The image returns to its original positionTip: To undo other changes made to the image, from the toolbar, click the Reset icon Zooming In or Out On ImagesThe user can increase (zoom in) or decrease (zoom out) the magnification on images that are viewed. Part of an image can also be viewed in a magnifying glass. Any changes made to one image apply only to that group of images (also known as a series). OriginalMagnifiedOriginalMagnifiedZoom In On ImagePrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To zoom in or out on images:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Zoom/Pan icon To zoom an image, on the sub toolbar, do one of the following:Click the Zoom In icon or, Scroll the mouse wheel up If necessary, move the image on your screen to get a better view of the magnified areaTo zoom out an image, on the sub toolbar that appears, do one of the following:Click the Zoom Out icon, or Scroll the mouse wheel down To undo all zoom changes, do one of the following:Press the Ctrl button and clickClick the Magnify/Pan Reset icon Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Magnifying Part of an ImageThe Magnifying Glass tool enables you to display part of an image at an increased magnification. Even if an image is already zoomed in, the Magnifying Glass continues to magnify beyond the current zoom settings.Original Magnifying Glass Tool Original Magnifying Glass Tool Magnifying Glass Tool PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To magnify part of an image:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Zoom/Pan icon Click the Magnify Glass icon Move the mouse pointer onto the imageClick and hold to display the Magnifying Glass tool. If using a touch device, touch and hold to display the Magnifying Glass tool. A viewing window appears displaying the selected area in an increased magnificationDrag the mouse pointer to move the Magnifying Glass to different parts of the image that you want to view Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Performing Measurements on ImagesMeasuring Distances on ImagesThe user can measure the distance between two points on an image. Distances are measured using a straight line. More than one measurement can be added to any image.PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing. CAUTION! Markups cannot be saved. They are available only during the active viewing session.For calibrated images, measurements are displayed in millimetres (mm). The accuracy is limited by the calibration provided with the image and by the position of the start and end points of the line drawn, which may vary by one pixel at each end. Based on the calibration provided, pixels are converted into millimetres and rounded to the nearest millimetre.For non-calibrated images, measurements are displayed in pixels (px) and the accuracy of the measurement is limited by the pixel position at each end of the caliper measurement.Note: When measuring distances using an iPad, the accuracy is limited by the touch interface. Double check any measurements made on the iPad for end point accuracy. To improve accuracy when using an iPad, try zooming in on the image.Markup Applied with the Markup Caliper Tool-257175-95885Important! When projected appears beside a measurement, it indicates that the measurement is performed on an image that does not contain calibration information. The measurement value provided is a projected value only, and may not reflect the exact dimensions of the patient under examinationProjected MeasurementTo measure distances on images:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Markup Caliper icon . If necessary, magnify the area that you want to measureOn the image, do one of the following to select the distance to measure:Click the start and end points of the distance Click and drag to select the distanceTo remove the measurement, click the Remove Markup icon Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Performing Angle MeasurementsThe user can perform angle measurements on any image in display. Angle measurements are displayed in degrees with an accuracy of +/- 0.5 degrees and precise to the nearest 0.1 degree. This is especially useful for orthopaedic specialists in measuring curvatures of the spine.Note: Angle measurements are not available with ultrasound studies. CAUTION! Markups cannot be saved. They are available only during the active viewing session.Markup Applied with the Angle Measurement ToolPrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To perform angle measurements:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageIf necessary, magnify the area that you want to measureClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Markup Caliper icon On the sub toolbar, click the Markup Angle icon On the image, click the start and end points of the distance to measure for the first lineClick the start and end points of the distance to measure for the second line or click and drag to select the distances to measure. The angle of the two line measured will be displayedTo remove the measurement, click the Markup Reset Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Performing Ultrasound Measurements-23456336322000When measuring ultrasound images, units are provided in distance, for example, cm, Hz, time, and cm/s (velocity). CAUTION! Markups cannot be saved. They are available only during the active viewing session.Ultrasound MeasurementPrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To perform ultrasound measurements:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Markup Caliper icon If necessary, magnify the area that you want to measureOn the image, click the start and end points of the distance to measure or click and drag to select the distance to measureTo remove the measurement, click Remove Markup Tip:To undo other changes you made to the image, from the toolbar, click the Reset icon Measuring an Object Using an EllipseThe user can measure the perimeter or area of an ellipse. Additionally, the average and standard deviation are also provided. More than one measurement can be added to any image. CAUTION! Markups cannot be saved. They are available only during the active viewing session.For calibrated images, measurements are displayed in millimetres (mm). For non-calibrated images, measurements are displayed in pixels (px). The average is reported in either HU (Hounsfield Units) or GY (Gray, representing 100 Rad or radiation absorbed dose) units.When measuring distances on an iPad, the accuracy is limited by the touch interface. Double check any measurements made on the Pad for end point accuracy. To improve accuracy when using an iPad, try zooming in on the image.330201980565Ellipse Measurement Ellipse Measurement PrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.Tip: To maximize the amount of screen space for viewing on a desktop computer, press F11 to switch to full screen mode.To measure an object using an ellipse:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Markup Caliper icon If necessary, magnify the area that you want to measureOn the sub-toolbar, click or tap the Markup Ellipse ROI icon Use one of the following methods to set the axes of the ellipse:Click and DragOn the image, click and drag to insert the first axis of the ellipseClick and drag to set the secondary axis of the ellipseClick start and end of axisClick to set where one end of the first axis starts, click to set the other end of the axis Click again to set the secondary axisTo remove the measurement, from the sub-toolbar, click Remove Markup Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Measuring Image DensityThe user can measure the density of a selected point on an image. Density is displayed in units that depend on the type of image being shown: Hounsfield Units (HU) for CT images; greyscale (intensity) values for DX, CR, and MG images where units are not specified. You can add more than one measurement to any image. CAUTION! Markups cannot be saved. They are available only during the active viewing session.When measuring distances on an iPad, the accuracy is limited by the touch interface. Double check any measurements made on the iPad for end point accuracy. To improve accuracy when using an iPad, try zooming in on the image.12702518410Image Density MeasurementImage Density Measurement127053340Markup applied with the pixel value (density) tool showing Grayscale (GY)Markup applied with pixel value (density) tool showing Hounsfield Units HUMarkup applied with the pixel value (density) tool showing Grayscale (GY)Markup applied with pixel value (density) tool showing Hounsfield Units HUPrerequisitesBefore starting, assess your display device to determine its suitability for diagnostic viewing.To measure image density:In the displayed study, move the mouse pointer to the viewport that contains the image to manipulate. If using a touch device, tap the viewport that contains the imageClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Markup Caliper icon If necessary, magnify the area that you want to measureOn the sub toolbar, tap the Pixel Value icon Click the area of the image to see the pixel densityTo remove the measurement, from the sub-toolbar, click Remove Markup Tip: To undo other changes made to the image, from the toolbar, click the Reset icon Calibrating ImagesDue to limitations of the modality or the interpretation of the modality data, some images do not contain sufficient information to accurately translate dimensions from pixels to real-world measurements. Before measuring areas on such images, a calibration must be completed. This can be done by drawing a line of known length on the image and entering its value. Future measurements are then based on this entered value. CAUTION! Measurements are projections only. A number of factors influence the accuracy of the measurement:The accuracy of the user doing the calibrationThe perspective of the camera to the image (for example, whether it was taken on an angle)The focus of the camera when the image was takenThe magnification used when calibrating (zooming in provides more accuracy)The accuracy of the pointing device usedThe length of the calibration artifact (a longer distance gives more accuracy)The number typed in the dialogue box to represent the length of the calibration artifact in millimetres (user errors here cause inaccuracies in subsequent markup measurements)Calibrations are applied on a user basis, meaning that your calibrations do not affect measurements made by other individualsGiven these factors, the measurement is only an approximation.Some DICOM images are already calibrated. If you attempt to calibrate an image that is already DICOM calibrated, an icon is displayed on the cursor when you try to use the tool.To calibrate images:In the Display window, navigate to the image to manipulateClick on the arrow in the left corner of the viewport to expand the image toolbarClick or tap the Markup Caliper icon On the sub-toolbar, click or tap the Calibrate icon On the image, click the start and end points of the image with the known distance As a best practice, we recommend including a metric ruler in the image to help provide the known distance. Place the ruler close to the part being measured. If using a mobile device, we recommend using a stylus pointing device to improve accuracyIn the Markup Calibration dialogue box, type a value in millimetres to represent the distance between the two points on the image.Click OK.Add markup using the other markup caliper tools.To calibrate the image again, repeat these stepsExtended (Advanced) Viewing Tools Extended tools (also known as Xero Xtend) provides advanced image viewing functionality in the Provincial DI Viewer. It is available in Web fidelity mode (i.e., clinical reference viewing).Extended Viewing RequirementsExtended viewing requires HTML5 features and is therefore supported only on browsers that also support HTML5. If the browser does not support HTML5, an error dialogue box is displayedExtended viewing is not supported on mobile devicesAccessing Extended Viewing Tools The Provincial DI Viewer provides access to advanced image viewing tools including 3D viewing. These advanced tools, called Extended Tools, can be viewed in several different methods.Viewing MethodDescriptionImage toolbarAdvanced tools can be accessed from the Image toolbar of a study. The type of study determines the options that are available. Search resultsAdvanced tools can be accessed from the search results by selecting a study and clicking an option in the drop-down menu.Extended Tool AccessNote: When extended viewing is accessed in compare mode, the other study closes.To access advanced viewing tools from patient studies:In the study, display the image toolbar.On the image toolbar, hover downwards to the Extended Tools icon which will display at the bottom of the toolbar. The type of study determines the icon or option that will display as listed below: Show 3D/4D (not available by default) Show mammography toolsShow nuclear medicine toolsShow orthopaedic toolsShow ultrasound tools Click on the extended tool icon. The window will refresh with an extended tool bar displayed in the upper left corner of the displayClick Back to exit from extended viewingImportant! Not all options are available for all studies. Availability is determined by the modalities included in the study. For example, only studies containing a nuclear medicine study have access to the Show nuclear medicine tools option.3787140224155Extended Toolbar will display at top of the display. 00Extended Toolbar will display at top of the display. 1699260262255Click Back to exit extended viewing. 00Click Back to exit extended viewing. 10223502092325Hover over the bottom icon to display the Extended Tools icon. 0Hover over the bottom icon to display the Extended Tools icon. Accessing Extended Tools on Image ToolbarShowing and Hiding Demographic Information, Markups, or CAD MarkersIn extended viewing, the user has an option to show or hide demographics, existing markups, or CAD markers (when present) from the image. Hiding this information can provide more room on the display screen.To show and hide demographic information, markups, or CAD markers:On the extended toolbar, click Show/hide From the list, choose any of the following:Demographics MarkupsCAD Markers (annotations that are usually small squares or triangles) The selected information type is displayed or hidden from the imageExtended Viewing Tools ListThe following tables list the toolbars and tools available when working in extended viewing. Icons/options will change according to modality.Extended viewing tools are available for the following modalities:? CR (this modality also has access to Orthopaedic tools)? CT (this modality also has access to MIP/MPR/3D Viewing tools)? DX? MG (this modality also has access to Mammography tools)? NM (this modality also has access to Nuclear Medicine tools)? XAExtended Viewing ToolbarExtended Viewing Generic ToolsListed below are the generic tools which always display when working in extended viewing.ButtonDescriptionPurposeResetRemove all changes and return image to its original state ZoomChange the magnification of an image.PanMove around the image inside the viewport.Window LevelChange the brightness and contrast of an image.InvertReverse the greyscale values of an image.Distance measurementMeasure the distance between two points in an image.AngleDraw two lines in an image and measure the angle between the lines.ArrowDraw an arrow in an image to identify a region of interest.Pixel valueMeasure the interpreted pixel value in an image.Show/HideShow and hide demographic information, markups, or CAD markersHanging Protocol Change display layout. Note: for MIP/MPR/3D refer to online help in the viewer.Generic Viewing Tool IndexExtended Viewing Basic Measurements Click the Measurement icon on the extended toolbar to access the advanced measurement tools.ButtonDescriptionPurpose528955-25590500Length/distance MeasurementMeasure the distance between two points in an image515620-26352500AngleDraw two lines in an image and measure the angle between the lines.495300-37401500ArrowDraw an arrow in an image to identify a region of interest.514350-20320000CurveDraw a curved line and measure the distance defined by that line.542925-37401500Length ratioMeasure the ratio of the lengths of two lines in an image.517525-21272500PolylineDraw a segmented line and measure the distance defined by that line.Basic MeasurementsRegion of Interest (ROI) toolsClick on Polygon tool on the extended toolbar to access the region of interest (ROI) tools. ROI tools are available for CT and MR. ButtonDescriptionPurposePolygonDraw a polygon and measure the area of the polygonCircleDraw a circle (using the center point and a point on the circumference) and measure the diameter and area of the circleCircle 2 PointsDraw a circle using two points on the circumference) and measure the diameter and area of the circleCircle 3 PointsDraw a circle (using 3 points on the circumference) and measure the diameter and area of the circleEllipse 2 PointsDraw an ellipse (using the center point and one other point) and measure the area of the ellipseEllipse 3 PointsDraw an ellipse (using the center point and two other points) and measure the area of the ellipseRectangleDraw a rectangle and measure the area, width, and height of the rectangleShutterDraw a rectangle and obscure the part of the image outside of the rectangleRegion of Interest (ROI) ToolsUltrasound Viewing ToolsUltrasound Standard ToolsClick on Ultrasound tools icon to access the ultrasound standard tools. These will display in the upper left corner of the display. ButtonDescriptionPurpose48577510350500ResetRemove all changes and return image to its original state 508000-24257000ZoomChange the magnification of an image5016505207000PanMove around the image inside the viewport4857753365500Window LevelChange the brightness and contrast of an image504825444500InvertReverse the greyscale values of an image5175256540500Distance MeasurementMeasure the distance between two points in an image4953004508500AngleDraw two lines in an image and measure the angle between the lines494665317500ArrowDraw two lines in an image and measure the angle between the linesTime Access to ultrasound specific time measurements504825127000Pixel ValueMeasure the interpreted pixel value in an image5334007112000Delete Selected MarkupsRemove a selected markup from an imageUltrasound Standard Viewing ToolsUltrasound MeasurementsClick on Time icon on the extended toolbar to access ultrasound specific time measurements.ButtonDescriptionPurposeChamber ValueDefine the perimeter of a chamber to measure the length and circumference of the chamber, and to extrapolate the volume of the chamber in an imageLV DistanceDraw a line with four points to measure the interventricular septum (IVS), left ventricular internal dimension (LVID), and left ventricular posterior wall (LVPW) in an imageMMode distanceDraw a vertical line to measure distance in an imagePHTDraw a line to measure the pressure half time pressure in a Doppler ultrasound imageVelocityDraw a horizontal line to measure the velocity of structures in a Doppler ultrasound imageVTI Draw a line to measure the velocity time integral in a Doppler ultrasound imageUltrasound MeasurementsOrthopaedic Viewing ToolsOrthopaedic tools are available with CR and DX studies.Orthopaedic Standard ToolsButtonDescriptionPurpose5207008763000ResetRemove all changes and return image to its original state5175257620000ZoomChange the magnification of an image5327652730500PanMove around the image inside the viewport5238751270000Window LevelChanges the brightness and contrast of an image514350-2349500InvertReverse the greyscale values of an image517525190500Pixel ValueMeasure the interpreted pixel value in an image5238753365500Delete Selected Markups Remove a selected markup from an imageOrthopaedic Standard Viewing ToolsBasic MeasurementsButtonDescriptionPurpose498475-50292000Length/distance MeasurementMeasure the distance between two points in an image517525-42418000AngleDraw two lines in an image and measure the angle between the lines.527050-41783000ArrowDraw an arrow in an image to identify a region of interest.488950-45021500CurveDraw a curved line and measure the distance defined by that line.488950-43180000Length ratioMeasure the ratio of the lengths of two lines in an image.488950-45656500PolylineDraw a segmented line and measure the distance defined by that line.Basic MeasurementsOrthopaedic MeasurementsButtonDescriptionPurposeCenter lineDefine two pairs of points on an image to draw a line through the center of each pair of pointsCobb AngleDraw two lines to measure the angle between the two linesHip-Knee-Ankle AngleDraw a circle (around the femoral head) and two lines to measure the hip-knee-ankle angle in an imageHorizontal Parallel MeasurementDraw horizontal parallel lines to measure the distance between the lines in an imageMean Length MeasurementDraw multiple lines to calculate the average length of the lines in an imagePelvis Schmid Draw multiple lines to perform a set of coxometry measurements in an imageVertical Parallel MeasurementDraw vertical parallel lines to measure the distance between the lines in an imageOrthopaedic MeasurementsShortcuts for Working Efficiently With Provincial DI ViewerBelow shortcuts can assist in completing frequently-performed tasks more efficiently.ActionShortcutReset only the brightness and/or contrast without resetting other modifications such as zoomPress SHIFT + ClickZoom into the imageSelect the Zoom icon then scroll mouse wheel upZoom out of the imageSelect the Zoom icon then scroll mouse wheel downPan an imagePress CTRL + DragReset image zoom or pan without resetting other modifications such as brightness and contrast changesPress CTRL + ClickFast navigate a group of imagesPress SHIFT + Scroll mouse wheelToggle display of an image between a 1x1 layout and the previously selected layoutDouble-click the imageMeasure a distance on an image using the Markup CaliperPress ALT + DragShortcutsGlossaryTermDESCRIPTIONAccession NumberA unique ID that is generated by the hospital RIS and is used for tracking each exam and its corresponding patient name, date, and exam typeAnnotationsMarkups on an image that can include written information AnteriorThe front. In medical terms, the front of the body.AuthenticationThe use of passwords and other gatekeeper devices to ascertain user identity.AxialDivides the body into cranial (upper) and caudal (lower) transverse segments. The axial or transverse plane is perpendicular (orthogonal) to the sagittal and coronal planes.BandwidthThe amount of data that can be transmitted within a fixed amount of time.BrightnessA reference to how bright the shadows appear in an image or an attribute of visual sensation where an area appears to emit more or less light.BrowserSoftware that allows a user to search through information on a server. The term usually refers to a universal client application, such as Firefox or Internet Explorer, that interprets hypertext documentsContrastThe ratio of intensity between the brightest white and the darkest black of a particular device or environment.CoronalDivides the body into anterior and posterior (front and back) segments. The coronal or frontal plane is perpendicular (orthogonal) to the sagittal and axial planes.Dead PixelOn an LCD display screen, a pixel that remains unlit or black when it should be activated and displaying a colourDICOMDigital Imaging and Communications in Medicine. The standard communication protocol used by a PACS or a modality to exchange information of images with other systems.EMRElectronic Medical Record. A computerized medical record created in an organization, such as a clinic or hospital. EMRs are part of a health information system that allows storage, retrieval, and modification of records.EncryptionTo achieve data security, the translation of important or sensitive data into a secret code that can be decrypted only with a password or keyFull FidelityThe same data as the full representation of the image data stored in a DICOM instance.GUIGraphical User InterfaceVisual computer environment that represents programs, files, and options with graphical images, such as icons, menus, and windowsHIS VerificationAn option that forces the PACS to verify all incoming images from an acquisition station or modality against specific criteria, such as the patient ID and accession number. The PACS sends a message through the RIS Gateway to verify the criteria against what is contained in the HIS. If the criteria match, then the images can be stored permanently.Hounsfield UnitA Hounsfield Unit (HU) is an X-ray attenuation (density) measurement used to describe voxel values in CT scanning. In a 12-bit CT image, the voxel values range from -1024 to +3071 HU. For example, water is defined as 0 HU, air as -1024 HU, fat as -100 to -20 HU, soft tissue as +20 to +80 HU, and bone as > +500 HU. A Hounsfield Unit does not change no matter how the image is displayed, since HU is calculated based on original pixel dataHtml5A W3C specification that defines how HTML structures and presents content for web applications. It provides three kinds of code: HTML (the structure), CSS (the presentation), and JavaScriptImageA single frame taken by a modality. Certain modalities, such as a CT, MRI, or PET, take consecutive sets of images called series. Studies are combinations of series or images for a single patient.Image ManagerA server that stores image data and enables either online or nearline archiving. Some image managers use secondary image managers as an archive.InterpretationsDetailed report on a study.Key ImageThe most clinically relevant images in a study. Key images are links to images or frames in the source study.LatencyThe amount of time a packet of data takes to travel from source to destination.LossyReduces file size by permanently deleting some information, which results in a slight reduction of image quality. When the file is uncompressed, some original information is missing; however, the loss of information is minimal and is not noticeable to most users.LuxA unit to measure illuminance, equal to one lumen per square metre.MarkupGraphic symbols placed on images MIMEMultipurpose Internet Mail Extensions. A specification for formatting non-ASCII e-mail messages so that they can be sent over the InternetModalityAn imaging discipline that gathers digital information such as CT scanners, MRI scanners, Ultrasound, DR/CR devices, workA group of computers, peripherals, or other equipment connected to one another for the purpose of passing information and sharing resources. Networks can be local or remote.PACSPicture Archive and Communication System (PACS). A PACS system makes it possible to electronically store, manage, distribute, and view images.Patient IDA hospital-wide unique identifier for a patient PHIPersonal Health Information. Identifying information about an individual in oral or recorded form, if the information, (a) relates to the physical or mental health of the individual, including information that consists of the health history of the individual’s family, (b) relates to the providing of health care to the individual, including the identification of a person as a provider of health care to the individual, (c) is a plan of service within the meaning of the Home Care and Community Services Act, 1994 for the individual, (d) relates to payments or eligibility for health care, or eligibility for coverage for health care, in respect of the individual, (e) relates to the donation by the individual of any body part or bodily substance of the individual or is derived from the testing or examination of any such body part or bodily substance, (f) is the individual’s health number, or (g) identifies an individual’s substitute decision-maker.? 2004, c. 3, Sched. A, s. 4 (1); 2007, c. 8, s. 224 (6); 2007, c. 10, Sched. H, s. 2PixelThe smallest resolvable rectangular area of an image, either on a screen or stored in memory. Each pixel in a monochrome image has its own brightness, from 0 for black to the maximum value (such as 255 for white. In a colour image, each pixel has its own brightness and colour, usually represented as a triple of red, green, and blue (RGB) intensities.Plug-InIn computing, a set of software components that adds specific capabilities to a larger software application.PolarityPolarity enables you to invert image data. With greyscale images, reverse polarity maps black to white and white to black.PosteriorThe back. In medical terms, the back of the bodyQR CodeAbbreviation for quick response code, a matrix barcode consisting of square dots arranged in a square pattern on a white background. This pattern encodes data, such as a URL. QueryA request for information from a database.R-To-R IntervalThe R-wave to R-wave (R-to-R) interval is the cycle between two consecutive R-waves.Reference ViewingA method to view studies that is not meant for diagnosis and does not have diagnostic quality.SagittalDivides the body into left and right segments. The sagittal plane is perpendicular (orthogonal) to the axial and coronal planes.Search CriteriaSearch criteria are the individual values used in a search. For example, search criteria can be patient name or modality typeSeriesA set of consecutive images taken by a modality such as a CT, MRI, or PET. One study can consist of several seriesSliceA localized three-dimensional image of a specific area of the human body, equivalent to examining an individual slice of bread that is part of a loaf.SmartphoneA mobile computing device that has capabilities such as e-mail, web browsing, and software applications as well as cellular telephonySOPService Object Pair. The combination of an information object and a service (e.g., store an ultrasound, query and retrieve an ultrasound).StudyA collection of one or more series of medical images used to diagnose a patient. Images in a study are usually from a single modality, but can also be from multiple modalities.StylusA pen-like computing accessory that assists with navigation or improves precision when using a touchscreen interface.SyntaxThe spelling and case requirements for a programming language or transfer protocol.URLUniform Resource Locator. Global address of documents and other resources on the Web. The first part of the URL is called a protocol identifier. It indicates what protocol to use. The second part is called a resource name. It specifies the IP address or the domain name where the resource is located. The protocol identifier and the resource name are separated by a colon and two forward slashes.WiFiA technology that allows electronic devices to connect to a wireless network. WildcardRepresents unknown information in search criteria; for example, depending on the type of database, the asterisk (*) or percent sign (%) can substitute for any number of characters, and the question mark (?) or underscore (_) can substitute for a single character. Use the wildcard when you are unsure of spelling or you remember only part of a word or number.Window LevelA medical imaging term that refers to changing the contrast between light and dark areas of an image or the overall brightness of an image by moving the mouse. In window level, window refers to the range of intensities from light (white) to dark (black), so it controls the brightness of an image. Level refers to the intensity of that shade, thus affecting the contrast. The ability to window level is useful when viewing almost any image.WorklistA collection of patients and their studies. For radiologists, the worklist is analogous to a pile of film jackets. They use the worklist to know which studies they must interpret during a specific time period. For technologists, a worklist is a list of the studies they must perform at specific times for each patientXDSXDS is the acronym for Cross-Enterprise Document Sharing. XDS is the current IHE standard for exchanging clinical data across enterprises. XDS provides a centralized method of indexing documents.XMPPExtensible Messaging and Presence Protocol. This is a communications protocol based on XML for real-time communication, For example, instant messaging.Zip FileAn archive file format that enables lossless data compression. Zip files support file encryption.ZoomTo display a smaller area of an image at a higher magnification (zoom in). To display a larger area of an image at a lower magnification (zoom out). ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download