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PACS Admin Manual - Write On Communications

1. Hold down the letter O and left click mouse to display a 2 cm square magnifier Release O and move the magnifier around Press F11 to toggle between full screen theatre mode and the standard MS Windows display mode Bal Use the Power Jacket to Review Data Click the Power Jacket icon to view patient data such as other studies available specific information on a study reports notes and attachments to the study Click and drag one corner or side of the Power Jacket to resize it If the Power Jacket is minimized click the Restore Up button to maximize it EJ Restore Up e Log Off To maintain security of patient information right click Synapse icon and select Log Off Synapse when finished Contact your PACS Administrator at for help installing or using Synapse A Navigate Manipulate Synapse Click an image and use the mouse wheel to move through the slices in a series Use the right arrow on the Synapse toolbar to go to the next series when there are additional series available Click and right click the image to display a context toolbar with image manipulation tools To use the window level zoom and pan tools Select the tool with your left mouse button and keep the mouse button down while moving the tool on top of the image To toggle between tools With the window level zoom or pan tool active left mouse key is down right click the mouse Hold down the letter O and left click mo
2. e In Windows XP click Customize to locate the Time Format dropdown menu Click OK Set initial and maximum virtual memory paging file size to be one and a half times the RAM a b In the Control Panel select System On the Advanced tab under Performance click Settings to open the Performance Options dialog box In Windows 2000 a In the Performance Options dialog box click the radio button at Applications Click Change to open the Virtual Memory dialog box Under Drive Volume Label highlight the drive containing the paging file to change usually C drive Do not change the default in the Initial size MB address box Type a new paging file size in megabytes only in the Maximum size MB address box e Type the number of megabytes that equals 1 5 times the RAM on the computer e Convert if needed See Conversions on page 67 Click Set e Increasing the virtual memory paging file does not typically require a restart Click OK PACS Administrator Manual Workstations Page 67 h In the Performance Options dialog box click the radio button at Background services and repeat steps b through g i Click OK three times to save the changes and return to the Control Panel In Windows XP a In the Performance Options dialog box select the Advanced tab e Under Virtual Memory click Change b Under Drive Volume Label highlight the drive contain
3. CDL in Anaheim CA CR Computed Radiography CRD Care Redesign CT Computed Tomography DAT Digital Audio Tape DBMS Database Management System DICOM ae te and Communications DLT Digital Linear Tape Abbreviations Page 113 PACS Administrator Manual Abbreviations Page 114 DVD DWLM DX FCR GB GUI HIIS HI MSS HI PAA HL7 IDF I HE IIP IIS 10D ISO JBOD LAN MAN MB Mb Mbps MDF MG MOD MRI MRN Digital Versatile Disk DICOM Worklist Manager Digital X Ray Fuji Computed Radiography Gigabyte 1000 MB Graphical User Interface Hospital Information Interface System HealthCare Information and Management Systems Society Health Insurance Portability and Accountability Act Health Level 7 Intermediate distribution frame Integrating the Healthcare Enterprise Image and Information Processor Internet Information Server Information Object Definition International Standards Organization Just a bunch of disks Local Area Network Metropolitan Area Network Megabyte Megabit Megabits per second Main distribution frame Digital Mammography Magneto Optical Disk Medical Resonance Imaging Medical Record Number PACS Administrator Manual Abbreviations Page 115 NEMA NIC NM osi PACS PET RAID RF RIS RSNA SAN SCAR SC SCP SCU SOP SQL SSL SWAT TCP IP UID UPS US VR WAN XA National Electrical Manufacturers Association Network Interface Card Nuclear Medicine
4. 1 Verify that all other programs are closed N Verify that all cables are properly connected w Re connect and re position the brightness sensor A Verify that both monitors are set to 32 bit color e Not applicable to models ME311L ME312L Verify that license agreement was accepted p 6 Verify L min value is set to zero 0 PACS Administration Page 37 PACS Administrator Manual Support Support Page 38 The PACS Administrator is the first line of support for all PACS related issues and is responsible for managing and tracking problems until they are resolved PACS Support PACS Admin notified of problem j Triage m Assign m gt Resolve in a timely manner Yes gt Close Escalate PACS Administrator Manual Support Page 39 Triage Assign The PACS Administrator collects information necessary for troubleshooting the problem If the problem is outside the expertise of the PACS Administrator they should call the SJ HS Help Desk for support The SJHS Help Desk provides a ticket number and assigns a Business Analyst to the ticket If the problem is an obvious Synapse problem the PACS Administrator should place a call immediately to Fuji Support If the problem is an obvious modality problem the PACS Administrator should contact SJ HS Biomedical Department for support If the problem is an obvious vendor pro
5. c Double click the Merge eFilm icon 2 In the eFilm window select a study on the worklist and click View 3 To scroll through the images hold down the left mouse button and move the mouse forward and backward 4 To adjust the contrast hold down the right mouse button and move the mouse side to side 5 To adjust the brightness hold down the right mouse button and move the mouse forward and backward 6 To display another study while a study is open click the question mark on the left side of the toolbar e To replace the open study click Yes at the query e To open the study concurrently click No and then Yes 7 Right click an image to display a dropdown menu of available series 8 On the dropdown select the series to display PACS Administrator Manual 9 To view all eFilm tools select Toolbars Full Reloading RADinfo PowerPACS Software 1 Save all current label files to CD and to the desktop e Reloading the software erases the label files 2 Right click Start and select Explore to open Windows Explorer 3 Browse to C RADinfo 4 Right click the RADinfo folder and select Delete to delete the application 5 Insert the RADinfo PowerPACS CD into the CD drive of the Dell PC and close the drawer e Ifthe CD automatically opens click Cancel 6 In Windows Explorer locate the CD drive 7 Click the plus sign next to CDPowerPACS to expand and view the available files 8 Locate a
6. e Platen roller e Tacky rollers e Air Filter For step by step directions on cleaning maintenance installing ribbons and trouble shooting the label printer see your Everest II User Guide provided by ATR in both hardcopy and CD Media Kits CDs used in the DD DICOM CD Burner system must be thermal re transfer CD disks that are Everest certified Printing supplies are available from ATR ina media kit designed specifically for SJHS The CDs are 52X Mitsui Everest Printable CDs Cleaning kits for the label printer and cardboard CD mailers are sold separately Turn around time is usually 3 days on most supplies from Data Distributing Fax P O s to Nick Fisher at Data Distributing 949 595 7941 Media Kit Part 210762 001 869 00 contains e 1000 CDs e 1000 paper CD sleeves e 2 CMY ribbons color e 1 transfer roll filament Rimage Cleaning Kit DD DICOM CD Burner Page 103 PACS Administrator Manual eFilm Lite MI oz nm D ro zm DD DICOM CD Burner Page 104 Part 210725 001 49 00 Cardboard CD Mailers Part PT7000sleeve 30 cents each contains e 500 mailers First time orders require an electronic copy of the facility logo and the exact text for the return address Each burned CD includes a viewer for eFilm Lite The instructions below are printed on the CD sleeves 1 Insert CD in drive If CD does not auto execute a Right click Start and select Explore b Locate and expand CD drive
7. s Meditech ID and whether the user has an NT account Physicians with SJ HS NT ID PACS Administration Page 7 1 If a physician has an SJHS NT ID the PACS Administrator resubmits the physician to the SJ HS Help Desk for a new SJHS NT ID e Incase of a duplicate ID the PACS Administrator adds a hospital specific append number at the end of the physician s current ID number Table 2 Physician I D Append Numbers Hospital Extension SJO 1 HHS 2 SJF 3 HHN 4 QVH 5 SRM 6 SJE 7 PACS Administrator Manual Table 2 Physician ID Append Numbers Hospital Extension RMH 8 COV 9 MHR 10 PVH 11 GHE 12 SMMC 13 2 The SJHS Help Desk opens a ticket and assigns the request to the Security Access Team 3 The Security Access Team updates the account 4 The Security Access Team contacts the PACS Administrator when the account is established 5 After the physician begins using the updated ID the PACS Administrator inactivates the old ID in Synapse SWAT and notifies the SJ HS Help Desk to inactivate the old SJ HS NT ID 6 The PACS Administrator ensures that provider accounts in other systems such as Physician Connect are changed when necessary to match the new Meditech SJHS NT ID For All Other Users with SJ HS NT ID The naming convention for all other users non physicians is still being evaluated For Users without NT Accounts
8. select the Make the same adjustments as the previous ones radio button and click Start e This calibration setting tells Medivisor to use the same settings the second time around 4 Defaults should be as follows PACS Administration Page 34 PACS Administrator Manual e Calibration radio button e Default L max is 410 and L min is 0 e Barten radio button Note Do not 5 Attach the brightness sensor and bracket to the touch mouse or front of the monitor keyboard during calibration a Spring clamp bracket e Pull the spring clamp on the end of bracket and gently attach it to the monitor making sure that it is flush with the monitor screen elf the monitor is in the usual portrait position the bracket will be horizontal across the width of the monitor elf the monitor is in landscape mode as in the image below the bracket will be vertical on the front of the monitor e Release clamp gently to secure the bracket b Hanging bracket e Hang the bracket from the front top center of the monitor e The position of the monitor does not matter The bracket always hangs vertically Table 6 Brightness Sensors on Monitors Sensor on spring clamp Sensor on hanging bracket bracket 6 Click Start to begin the calibration e A white square displays on the screen e The power light on the monitor begins flashing e A progress bar displays the time remaining PACS Administration Page 35 P
9. Release O and move the magnifier around Press F11 to toggle between full screen theatre mode and the standard MS Windows display mode Bal Use the Power Jacket to Review Data Click the Power Jacket icon to view patient data such as other studies available specific information on a study reports notes and attachments to the study Click and drag one corner or side of the Power Jacket to resize it If the Power Jacket is minimized click the Restore Up button to maximize it EJ Restore Up A W Log Off To maintain security of patient information right click Synapse icon and select Log Off Synapse when finished Contact your PACS Administrator at for help installing or using Synapse View an Image In RADinfo PowerPACS 1 In the DICOM Image List window a Click the plus sign at Local Storage to display the patient b Click the plus sign at patient name to display the study c Click the plus sign at the study folder to display the series 2 Right click a series and select Display series Import or Send from a Guest CD 1 Insert the CD into the Dell PC 2 If the CD auto executes close the program 3 In RADinfo PowerPACS select File Import DICOM Images 4 In the Open dialog box select the folder with DICOM in the name e Folder names vary based on what program was used to create the original CD Click Open to display the Import Images window In the Import Images w
10. b Download unsigned ActiveX controls c Initialize and script ActiveX controls not marked as safe Click OK twice to save the settings and exit the dialog box 2 OD improve Your System s Performance amp Optimize Internet Explorer In MS Internet Explorer select Tools Internet Options 1 On the General tab Click Delete Cookies Click Delete Files At prompt click Delete all offline content Click Clear History and set days to keep history at 1 Click Settings and at Amount of disk space to use type a number equal to your computer s RAM Click OK On the Advanced tab scroll down to Security and select Empty Temporary Internet Files when browser is closed 3 Click OK twice to save the settings and exit the dialog box Ay Regularly Update MS Windows Regularly update MS Windows with critical updates and service packs Go to www microsoft com for more information Run Virus Protection Software To keep your system free of computer viruses please install regularly run and keep current either the Norton or McAfee anti virus program BE 7 B Maintain Security Your access to confidential patient information is designed with security in mind Connections to the Internet are processed through a Secure Sockets Layer SSL with 128 bit encryption between your web browser and the SJHS web server To maintain security of patient information always log off Synapse when finished How to Open and Use yo
11. e Action e Remove deletes message from list e Save saves message e Message Text full message as received from Neon Checking Communication Status This page shows a list of the input data sources and the destinations It shows the machine name and port number they are listening on At this time Fuji only supports TCP IP protocol e Click this link to view information on communication protocols System Configuration This page shows file locations for the integration logs Logs include Message logs messages that have filed successfully into synapse Error logs problematic messages that have not filed into Synapse PACS Administration Page 23 PACS Administrator Manual Reset System This page allows you to reset the system logs The message count on the status screen can be reset and the log files deleted It is recommended to stop the HIIS Router service first before deleting any logs but is not required Send Messages This page allows you to send messages directly to Synapse from a file containing saved messages e Use the browse button to select the saved message Save Messages This page allows you to save selected status messages to a file Options include e All messages e Pending messages e Messages rejected by destination Synapse e Messages that failed translation e Ignored messages When saving files keep in mind This method only allows a limited number of messages from a fi
12. 0 Browser 6 0 or newer or newer Display Mode 32 bit color 32 bit color Monitor 2 3 LCD flat Any screen N A on site Off site a Modem N A high speed modem is recommended Standard PACS Image Both diagnostic and clinical workstations begin with the standard PACS software configuration image This requires a floppy boot disk available from the PACS Technical Analyst PACS Administrator Manual Note For diagnostic workstations do not image the PC with the Totoku monitors attached Use any standard monitor during the install Workstations Page 54 The standard PACS image includes Windows 2000 or XP Monitor s set to portrait in a 3 monitor setup the third monitor is landscape Monitor resolution set based on workstation Totoku drivers installed on diagnostic workstation image 24 hour clock Virtual memory set equal to 150 of RAM Power Management for system set to OFF Power Management for NIC set to OFF Fonts enlarged Mouse pointer enlarged Recycle bin set to 3 Internet Explorer installed Synapse installed Synapse properties configured Virus scan installed Profile set for ALL USERS Install PACS Image on PC Obtain a copy of the SJHS PACS Image boot disk from the PACS Technical Analyst Erik Hill 1 Insert the floppy disk in the drive and boot the system e The floppy disk directs the computer to the SJ HS network and then maps the drive directly to the PACS server where th
13. Click ignored messages to view messages not routed to Synapse Messages found here are usually the HL7 event type filtered out when the incoming message is received Wrong format Click wrong format to view incoming messages in the wrong HL7 format Reviewing Problematic Message Web Pages Each type of problematic message page contains the following data and functionality Message type ORM 001 order message ORU RO1 result message ADT A admission message A01 Admit visit notification inpatient A02 Transfer A03 Discharge A04 Register a patient outpatient A08 Update patient information A18 Merge patient information A34 Merge patient information patient ID only A35 Merge patient information account number only Message destination Message destination always appears as Synapse Arrival date time when message was sent from Neon to Synapse Action search used with message type destination or arrival date time filters to limit the message list Remove used to delete selected messages from list PACS Administrator Manual e Remove all used to delete all messages from list e Details used to view contents of message Viewing message detail This page shows the entire message sent from Neon to Synapse Any data manipulation done on Neon is displayed here This page includes the following information e Status e Message type e Destination where message is directed
14. Click the plus sign at Local Storage to display the patient b Click the plus sign at patient name to display the study c Click the plus sign at the study folder to display the series 2 Right click a series and select Display series Create CD The instructions below are printed separately by SJHS as Quick CD Cards Create CD from the Local Hard Drive In RADinfo PowerPACS 1 In the DICOM Image List window right click the patient s name DD DICOM CD Burner Page 98 PACS Administrator Manual 2 Select Cut CD for Patient 3 Type recipient information and click OK Create CD from the DICOM Server In RADinfo PowerPACS 1 Click Query amp CD 2 On the Query DICOM Server and Create CD window use the Server dropdown arrow to select the DICOM server 3 In the Patient ID box type the AR number a Type AR two leading zeros six digit identifica tion number e g AROO123456 b If the AR number is not available type the patient s name with an asterisk as a wild card e Type last name comma first initial asterisk no spaces e g jones p 4 Click Search 5 Checkmark individual files to burn to CD or select All 6 Type name of recipient 7 Click Create CD 8 Click Reports Task List to check the status of the CD creation The choices are e Processing e Completed e Error Burn a Subsequent CD In RADinfo PowerPACS 1 In the DICOM Image List window selec
15. Radiology s Global Forum in Chicago November 28 through December 3 2004 RSNA website www rsna org index html SJ HS Documentation PACS Resources Page 108 This manual includes both a glossary of PACS related terminology and an acronym directory Other SJHS printed PACS materials available through CRD include e Paper CD sleeves with basic instructions for eFilm Lite e Cardboard CD mailers with facility specific return address e PACS Remote Access Setup Quick Card e Physician Connect Access Quick Card e Pocket Quick Reference Card e Rimage CD Burner Quick Card PACS Administrator Manual The Internet The World wide Web is a great resource for PACS information Yahoo Go to www yahoo com Locate and select Yahoo Groups On the Groups page in the Search address box type PACS to see all of the PACS groups New PACS groups are started all the time You can even start your own Note Not all of Current pertinent PACS listserves include the PACS groups are radiology mypacs oriented e pacs_admin e clubPACS Create a Yahoo account first then join a PACS group to access the discussion thread PACSweb PACSweb is an AGFA site with a lot of information for PACS aficionados PACSweb site www2 dimag com pacsweb Auntminnie com Go to www auntminnie com to look for almost anything to do with radiology or PACS e Real time radiology specific news e Lively topical discussion groups
16. a b c d e On the dropdown menu select New Folder f Name the folder Medivisor g Press Enter to save the folder h Close Windows Explorer Open Internet Explorer Go to http www questinc com drivers html Locate and click the appropriate download e eS In the logon box a At User name type totoku b At Password type download PACS Administration Page 27 PACS Administrator Manual 6 Click Save 7 In the Save in window browse to C Medivisor 8 9 Click Save Double click the Medivisor folder 10 Close Internet Explorer Install the Medivisor Driver Pe ee R 8 9 Right click Start and select Explore Go to C Medivisor Double click the Medivisor folder Double click the Medivisor zipped file Click Extract to unzip the file In the Extract to address box click the down arrow and locate the C Medivisor folder Double click the Medivisor folder so that it displays in the Extract to address box Click Extract Close Winzip 10 In Windows Explorer locate the Medivisor folder 11 Double click to open the folder 12 Select the appropriate version Medivisor folder and double click to open that folder 13 Double click Setup to begin the install process 14 Accept the defaults and click Next in each dialog box until the setup is complete 15 Close the dialog box 16 Close Windows Explorer Assemble Brightness Sensor and Bracket l PACS Administration Pa
17. active left mouse key is down right click the mouse Hold down the letter O and left click mouse to display a 2 cm square magnifier Release O and move the magnifier around Press F11 to toggle between full screen theatre mode and the standard MS Windows display mode Bal Use the Power Jacket to Review Data Click the Power Jacket icon to view patient data such as other studies available specific information on a study reports notes and attachments to the study Click and drag one corner or side of the Power Jacket to resize it If the Power Jacket is minimized click the Restore Up button to maximize it EJ Restore Up To maintain security of patient information right click Synapse icon and select Log Off Synapse when finished Contact your PACS Administrator at for help installing or using Synapse A Navigate Manipulate Synapse Click an image and use the mouse wheel to move through the slices in a series Use the right arrow on the Synapse toolbar to go to the next series when there are additional series available Click and right click the image to display a context toolbar with image manipulation tools To use the window level zoom and pan tools Select the tool with your left mouse button and keep the mouse button down while moving the tool on top of the image To toggle between tools With the window level zoom or pan tool active left mouse key is down right click the mouse
18. array of pixels Every pixel in the image will be made up of a number of bits A common size for imaging systems is 16 bit pixels This is known as the image depth and determines the number of grayscale levels in the image Integrating the Healthcare Enterprise I HE An initiative by HIMSS and RSNA to establish the integration of all hospital information and imaging systems Its aim is to encourage manufacturers to establish common protocols that will allow this integration to take place Intermediate distribution frame A free standing or wall mounted rack for managing and interconnecting the telecommunications cable between end user devices and a main distribution frame MDF For example an IDF might be located on each floor of a multi floor building routing the cabling down the walls to an MDF on the first floor The MDF would contain cabling that would interconnect to the phone company or to other buildings Lossless compression A data compression technique which results in data being returned to its original form without any loss of information when it is decompressed The decompressed file and the original file are identical Lossy compression This is a data compression technique which results in data not being returned to its original form when it is decompressed The benefit of using this technique is that it provides a high degree of compression saving on storage space and transmission time over a network Medical Record
19. correct Unit Number is referred to as the destination folder Resolution DICOM related cause 1 4 If the patient name in the anomaly description field is typed or formatted incorrectly do nothing If the patient name is different validate which images go to that patient Reallocate images to the correct patient if necessary Delete the anomaly entry Meditech related cause I In RIS Scheduler enter the source patient as a new patient Using Meditech as a reference reallocate the appropriate study from the destination patient folder to the source patient folder In the RIS Scheduler access the destination patient folder Update redefine the Visit Numbers that belong to the source patient folder For example change FV0012345678 to FVXX12345678 In the RIS Scheduler access the source patient folder Add Visit Numbers one a time associating the appropriate studies prior to adding next Visit Number Delete the anomaly entry Mismatch Visit Patient I ssue The Visit Number in the DICOM header matches the Visit Number in the destination folder but either the patient name or patient ID is different PACS Administration Page 12 PACS Administrator Manual PACS Administration Page 13 Possible Cause The incorrect patient name or patient ID was manually entered into the DICOM header rather than selected from the modality work list The incorrect Accession Number was manually en
20. exam To start over right click the filter row and select Clear Then type a new filter s for the sort Use the up arrow on menu toolbar to return to the last screen PACS Synapse Quick Reference Card Log On Synapse Double click the Synapse program icon to open Synapse Double click the word Synapse on the gray background to expand the Synapse folder At the logon screen type your Synapse user ID password and domain name a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userID b All other users type sjhs nt in the domain field Press Enter a Locate a Study Double click All Studies or other desired folder Click in the address box in the Patient Name field and type the first few letters of your patient s last name Press Enter to sort or filter by the last name you typed Click any column heading to sort it alpha numerically a Click again to sort the column in reverse b Click a third time to revert to the original unsorted list Locate the correct study and double click to open the exam To start over right click the filter row and select Clear Then type a new filter s for the sort Use the up arrow on menu toolbar to return to the last screen Synapse Toolbar Log On Synapse Double click the Synapse program icon to open Synapse Double click the word Synapse on the gray background to expand the Synapse fol
21. incorrectly at the modality can be currently unique in the Synapse database causing a new patient or new study anomaly This anomaly shows that Synapse created a duplicate patient or study folder in the database Study Matching PACS Administration Page 9 Information is imported to Synapse via two Synapse components the RIS Broker Interface PACS Administrator Manual PACS Administration Page 10 and the DICOM Server Typically the RIS Broker communicates with one data source Meditech and the DICOM Server communicates with several data sources modalities There are four steps to the optimal matching process A study is ordered in Meditech and transmitted to Synapse Synapse creates a patient study folder based on the order information Images for the study are sent to Synapse from a modality Synapse matches the images with the patient study folder based on Study ID Accession Study Matching Study order along with patient data and study data is sent to Synapse from Meditech Patient exists in Synapse Synapse creates patient folder in db Synapse creates study folder in database db Study image s along with patient data and study data are sent to Synapse from ccession fro modality matches existing Accession in Synapse db Synapse creates patient study folder in db Yes Synapse inserts image s into study folder PACS Admini
22. kit 25 download new driver 27 install new driver 28 monitor calibration adjustment buttons 33 adjustment patterns 32 inspect the results 36 log the monitor calibration 36 Index Page 125 PACS Administrator Manual troubleshooting monitor calibration 37 0 Orangewood Centralized Data Center 3 P PACS account setup 7 physicians 7 users with NT accounts 8 users without NT accounts 8 PACS Administrator responsibilities 4 PACS dictionary 117 PACS glossary 117 PACS information resources 107 PACS resources 107 Perot support escalation standards 40 R RADinfo Power PACS configure 96 resources 107 Rimage System Manager configure 95 RIS Broker Interface 9 S study matching 9 study matching table 10 support 38 assign 39 escalate 40 Fuji escalation standards 40 Perot escalation standards 40 resolve 39 triage 39 Synapse components 3 T Totoku monitor adjustment buttons 33 adjustment patterns 32 calibration 24 calibration equipment 25 check for current calibration driver 26 check need for calibration 31 connect communication cable 29 connect sensor cable 29 download calibration driver 27 inspect the results 36 install calibration driver 28 log the calibration 36 troubleshooting the calibration 37 troubleshooting guidelines 42 interface problems 21 network problems 44 remote installations 43 server problems 44 Totoku monitor calibration 37 workstation
23. only Table 3 Calibration Equipment Image Item PS2 connector PACS Administrator Manual Table 3 Calibration Equipment Image Item Serial connector Top of brightness sensor Bottom of brightness sensor Sensor Remote Out Remote in Cable inputs on left side of monitor Check for Most Current Medivisor Driver If Medivisor is installed on the computer 1 Select Start Programs Medivisor PACS Administration Page 26 PACS Administrator Manual 2 Locate version of Medivisor driver a With Medivisor closed open Medivisor e As the program opens the installed version of the Medivisor Calibration driver displays in large text b With Medivisor open click Help About to display the installed version of the Medivisor Calibration driver 3 Go to http www questinc com drivers html to verify the latest Medivisor driver for your operating system 4 Ifthe installed driver is older than the current driver listed on the website a Download the more current driver b In the Control Panel use the Add or Remove Programs utility to remove the out of date driver Do not install the new Medivisor calibration driver over an existing driver Download New Medivisor Driver 1 If there is not a Medivisor folder Right click Start Explore Select C Click the right window Right click to view the dropdown menu
24. open Right click Start and select Explore Browse to C Downloads Totoku drivers Double click Totoku drivers to open the folder Install MS NETFramework This is only necessary if this is a new Totoku monitor installation NETFramework never needs to be updated 1 2 3 Double click _NET_ Framework to open the folder Extract the zipped file to the same folder Double click _NET_FRAMEWORK exe to begin the installation 4 Follow the wizard to install NetFRAME Install the Monitor Driver 2 1 Double click the zipped driver folder Double click the zipped file Click Extract to unzip the file In the Extract to address box click the down arrow and locate the C Downloads Totoku drivers folder Double click the C Downloads Totoku drivers folder so that it displays in the Extract to address box PACS Administrator Manual Note Monitor numbering is Windows based You cannot change their numbers Workstations Page 61 6 Click Extract 7 Close Winzip 8 Double click the folder that is the same name as your operating system 9 Double click Color 10 Double click Portrait 11 Double click setup exe and accept the defaults e Ifa hardware error displays click Continue 12 Check Restart and then click Finish 13 Adjust the monitor resolution Adjust the Monitor Resolution 1 Right click the desktop and select Properties 2 On the Settings tab click the number of the monitor to
25. processes and supporting them with new technologies within the St Joseph Health System Centera EMC Centera is content addressed storage CAS for the PACS Information is backed up nightly to the EMC Centera before being again backed up to tape Clinical Workstation These workstations have one or two 2 megapixel 1200 x 1600 color monitors They are for physicians and clinicians for viewing radiologic images Some clinical workstations are mounted on mobile carts for use in OR suites Compression Lossless compression and lossy compression Glossary Page 117 PACS Administrator Manual Computed Radiography CR CR uses an imaging plate instead of film to capture an image The plate is made of a storage phosphor that captures x ray energy When scanned with a laser the plate emits light This is captured by the plate reader in order to build up an image from measurements made on the released energy Destination Folder The Synapse folder created by a Meditech order or the RIS Scheduler where the DICOM Study has been inserted Diagnostic Workstation These workstations have two Totoku LCD gray scale 3 megapixel 1536 x 2048 monitors They are used by radiologists for primary interpretation DICOM The standard method for transferring radiology images and associated information between devices manufactured by various vendors These devices produce a variety of digital image formats DICOM conformance statement A formal sta
26. responsible for documenting the steps that were taken to resolve the problem Troubleshooting Support Page 42 Guidelines End users should report all issues to the PACS Administrator as soon as possible The PACS Administrator should attempt to solve the problem within the Imaging Services department prior to contacting the SJ HS Help Desk or the PACS Technical Analyst 1 Collect quantitative information pertinent to the problem a If the system is slow identify exactly how slow in number of seconds it takes for an image to dis play Identify the exact PC by name and location Identify the end user If an error message is displayed note the exact message or take a screen print If an image is not appearing in Synapse then identify the exact modality and accession number 2 Identify the scope of the problem a C Determine if the problem is isolated to a single PC location e g Radiology reading room file room ED or type of device diagnostic worksta tions clinical workstations PCs or thin clients Determine if the problem is intermittent or continuous Note when the problem began 3 Manage the resolution process PACS Administrator Manual a If the PACS Administrator is unable to resolve the problem open a ticket with the SJ HS Help Desk b Track the problem until resolved 4 Report progress to the end users e Approximately every 30 minutes for urgent p
27. set up the modalities to send images directly from the modality to the CD Burner 1 In RADinfo PowerPACS select File Configuration 2 On the DICOM Network tab type the host name TCP port number and AE title 3 Checkmark Auto creating CD DVD e Do not checkmark any other options as they tend to slow down the process 4 Click Add 5 Send the file to the printer e If the entire AE title is not shown on the printout handwrite it before filing 6 Repeat for each modality 7 When all modalities have been added click Save 8 Right click Start and select Explore to open Windows Explorer 9 Locate C Windows System32 Drivers ETC HOSTS 10 Double click HOSTS to open the folder 11 In the Open With dialog box select WordPad and click OK 12 Click at the end of the word localhost and press Enter 13 Type the IP address for the modality 14 Press Tab PACS Administrator Manual 15 Type the host address for the modality and press Enter 16 Repeat for each modality 17 When all modalities are listed click Save 18 Print the file to the local printer e Remember to change the printer at the dropdown 19 Close WordPad and all of the Explorer windows 20 Attach the printout to the hardcopies of the modality setup pages and file 21 To delete a modality select the modality and click Remove View an Image In RADinfo PowerPACS 1 In the DICOM Image List window expand the folders a
28. software is closely integrated with dialed sort Microsoft Windows and Microsoft Internet Explorer patches may be f installedwithout Service Packs and updates must be approved by the express Fuji prior to installation on PACS related approval of Fuji equipment The PACS Technical Analyst obtains approval from Fuji and schedules software changes with the PACS Administrator or IT Site Director If a service pack has extreme importance to the operation of Synapse Fuji notifies SJHS of the Product Change Notice and includes instructions on how to apply those changes If the site IT personnel find a need to implement a new OS product patch or service release before Fuji has validated the software for use with Synapse they initially apply the update to the test system After ensuring that the update is safe they apply it to the production system Installing Synapse Facilities should always download Synapse for production workstations from the production server 1 In the Microsoft Internet Explorer address box type the appropriate facility URL listed below for either the test server or the live server and press Enter Table 13 Test Servers Facility URL MHR http sjsnt mhrpactst QVH http sjsnt pacsqvh SJF http pacstest SJO http sjsnt sjopactst Workstations Page 72 PACS Administrator Manual Table 13 Test Servers Facility URL SRM http sjsnt srmpacts
29. the facility s full address for the default CD label design The ATR Systems Engineer configures the CD Power PACS System based on the criteria provided on the spreadsheet and through discussions with the PACS Administrator prior to the installation The PACS Administrator must ensure the planned location for the CD Power PACS System has the following e Electrical outlet e Surge protector power strip with at least 3 outlets e Network connection jack e Sufficient counter space for the keyboard mouse and monitor e Sufficient shelf space for a PC in a small tower case e Sufficient shelf space for the main Rimage unit 24 inches front to back 24 inches in height and 30 inches side to side Some facilities have purchased a SpaceWorks mobile work center from Home Depot for 50 to hold the Rimage unit and consumable supplies The PACS Administrator should schedule with the ATR Systems Engineer times for ATR to train the appropriate personnel Each facility also needs to purchase a CD shredder for the complete disposal of CDs with patient information Shredders that destroy 30 CDs per minute are available at most office supply stores for 50 PACS Administrator Manual Installation Installation of the system is performed by Advanced Tek Rep and requires about a half day To configure the system and demonstrate that configuration to the PACS Administrators requires another half day The Biomedical Department Le
30. the following e Installation of Synapse Code See Installing Synapse on page 72 e Synapse properties configuration See Configure Synapse Properties on page 74 e Internet Explorer configuration See Configure Internet Explorer on page 70 e Set Internet Explorer to blank page See Set Internet Explorer to Blank on page 71 e Internet Explorer optimization See Optimize Internet Explorer on page 71 e Virus scan setup See Virus Scan Settings for Workstations on page 82 Remote Workstations Remote workstations provide access to Synapse through any off site PC or laptop Radiologists and radiology personnel install Synapse directly on their home and office computers because they need only to view radiology images Note Referring physicians doctors offices and other Connections to off site facilities install and use Synapse through a arg Physician Connect Physician Connect access ach an SSL affords them access to patient charts lab tests with 128 bit patient history and other detailed patient encryption information between the web browser and the SJ HS web server Workstations Page 78 PACS Administrator Manual Remote Installation for Radiologists The instructions below are printed separately by SJ HS as Quick Install Cards and are available from the PACS Administrator 1 In the Internet Explorer address box type the appropriate URL listed below and press Enter to
31. the monitors and does not need external power The AC adapter is not needed c The female PS2 connector is not needed Do not attach it to anything PACS Administrator Manual PACS Administration Page 30 3 If desired to save time in the future label the cables Communication cables The communication cables are longer than the sensor cables are black and have male PS2 connectors on both ends Off one of the male PS2 connectors is a six inch cable female serial connector One communication cable is sufficient when calibrating the Totoku monitors The communication cable s can remain attached to the monitor between calibrations or it can removed and stored away with the calibration kit 1 Communication cable 1 a Locate the serial port should be com1 on the back of the PC and attach the female serial con nector e If there are multiple serial ports on the back of the computer use the top one It is most likely com1 Change it later if the calibration is not working as expected Connect the PS2 connector on the other end of the cable to the Remote In on the back of the monitor Do not connect the PS2 connector on the short cable to anything 2 Chaining communication cables not an option on the ME311L a Using a second communications cable connect either of the PS2 connectors to the Remote Out on the monitor connected to the PC by the serial cable b Connect the other end of the same PS2 ca
32. two monitors The SJ HS standard is the Matrox P650 video card Workstations Page 63 PACS Administrator Manual After Installing the Image After installing the PACS image on the PC set the following options 1 Name the computer and add the workstation to the domain 2 Use a static IP address for each clinical workstation 3 Set NIC to LOOMBps Full Duplex Start Control Panel Network Local Area Connection Connect Using Configure Advanced Link Speed amp Duplex 4 Configure the monitor s a If this is a single monitor workstation e See Complete the Clinical Workstation on page 64 b If this is a two monitor workstation e See Install the Graphics Card on page 64 Install the Graphics Card 1 Shut down the PC 2 Disconnect the PC from the electrical power before opening the back of the computer 3 Place the new graphics card in the AGP slot 4 Connect the DVI ports on the monitors to the DVI ports on the video cards Boot the system Install the P650 graphics driver Install Pivot software Set the monitors to portrait mode PS ae Adjust the monitor resolution Complete the Clinical Workstation 1 Install critical updates to MS Windows and Internet Explorer See MS Windows Updates on page 72 Workstations Page 64 PACS Administrator Manual 2 Make any site specific changes to Synapse properties Diagnostic and If no changes are made the setup is com
33. will automatically update the study folder data when the system is back online e If the Accession Number was incorrectly typed into the DICOM header merge the DICOM created study folder into the Meditech created study folder 3 Delete the anomaly entry Study Reset Issue Additional images are sent to Synapse after the Study Status has been marked as Dictated or Finalized PACS Administration Page 15 PACS Administrator Manual Possible Cause e The study is mistakenly marked Dictated prior to images being sent to Synapse e Additional images were sent to Synapse as requested by the interpreting radiologist e Images were reallocated Resolution When images are sent to Synapse the study status changes to Complete causing the study to return to the Unread Studies folder for the radiologist to re dictate 1 If the images require additional interpretation nothing need be done 2 If the images do not require additional interpretation using the Synapse Web Administration Tool SWAT change the study status to Finalized 3 Delete the anomaly entry Additional Anomalies Study Remains in Dictated Status PACS Administration Page 16 Issue The study status displays as Dictated in Synapse while the order status displays as Cancelled in Meditech Possible Cause The order is amended in Meditech causing the order number to change Images are sent to Synapse with the old accession number in the DIC
34. ACS Administrator Manual e Model ME311L ME312L takes 15 minutes per monitor e Model ME315L takes 7 minutes per monitor 7 When the calibration is complete click Save Data 8 Repeat the calibration process for the other monitor c On the ME311L ME312L only e Push the toggle button on the right side of the right monitor e Then use the keyboard arrow down to select monitor 2 Inspect the Results Note Do not 1 Click the Inspection adjustment button to inspect touch mouse or the results of the calibration See Adjustment keyboard during Buttons on page 33 inspection e The deviation percent between the current brightness what the calibration accomplished and the target brightness what the calibration attempted to accomplish is displayed in the Result table onscreen 2 Click Finish to close the Inspection Wizard 3 If desired go back through the 4 adjustment patterns to see if there are any noticeable changes See Adjustment Patterns on page 32 Log the Calibration PACS Administrators should maintain a calibration log for the Totoku monitors The log should contain e Date purchased e Date placed in use e Serials numbers e Location e Warranty contact information e Dates of calibration PACS Administration Page 36 PACS Administrator Manual e Issues reported by radiologists that require calibration Troubleshooting the Totoku Calibration Possible troubleshooting steps include
35. Click Delete Cookies Click Delete Files At prompt click Delete all offline content Click Clear History and set days to keep history at 1 Click Settings and at Amount of disk space to use type a number equal to your computer s RAM Click OK On the Advanced tab scroll down to Security and select Empty Temporary Internet Files when browser is closed 3 Click OK twice to save the settings and exit the dialog box Ay Regularly Update MS Windows Regularly update MS Windows with critical updates and service packs Go to www microsoft com for more information Run Virus Protection Software To keep your system free of computer viruses please install regularly run and keep current either the Norton or McAfee anti virus program BE a B Maintain Security Your access to confidential patient information is designed with security in mind Connections to the Internet are processed through a Secure Sockets Layer SSL with 128 bit encryption between your web browser and the SJHS web server To maintain security of patient information always log off Synapse when finished Troubleshooting Synapse Installation Problems Problem Synapse opens partially then freezes Resolution Your user ID may not be set up properly Contact your PACS Administrator Problem You type your name and password correctly in the dialogbox but every time you press Enter the dialog box refreshes instead of opening Synapse Resolu
36. For users without NT accounts the PACS Administrator forwards the name s in an Excel spreadsheet to the SJHS Help Desk 1 The SJHS Help Desk opens a ticket and assigns the request to the Security Access Team 2 The Security Access Team sets up the new accounts PACS Administration Page 8 PACS Administrator Manual Anomalies e The new accounts are issued a generic one time password that must be changed upon first use 3 The Security Access Team contacts the PACS Administrator when the accounts are established 4 The PACS Administrator sets up the account in Synapse SWAT 5 The PACS Administrator informs end users of their username and password at their initial training class An anomaly is created when there is a discrepancy between the data sent to Synapse from Meditech and the data sent to Synapse from a modality The most common discrepancies are incorrect accession number and incorrect patient ID Incorrect data causes errors in the Synapse Study Matching algorithms Incorrect ID numbers fall into two categories e An incorrect ID number can match an ID that currently exists in the Synapse database For example a patient ID entered incorrectly at the modality can match a different patient s ID number in Synapse In this case a mismatch anomaly occurs and Synapse inserts images or studies into an incorrect folder e An incorrect ID number can be currently unique For example an accession number entered
37. NS NAV sjo sens nav ct CT 5 Obtain the port number that the modality uses for DICOM communications usually 104 6 Provide the AET IP Host Name and port number to e Fuji for configuring Synapse e Corporate PACS Team for maintaining accurate master documentation 7 After Synapse is configured have the modality technician configure the following DICOM targets e All available production DICOM servers e Test server e Printers e CD burner Modalities Page 88 PACS Administrator Manual DD DICOM CD Burner DD DICOM CD Burner Page 89 The DD Data Distributing DICOM CD Burner workstation is comprised of both hardware and software that work together to create CDs of images stored on the DICOM server The image server locates the files in PACS and hands them to the production server The production server sends them to the CD burner The CD burner records the images and associated reports onto the blank CD media that the robotic arm has moved from bin one of the carousel to the CD burner drawer After the CD is burned the robotic arm transfers the CD media from the burner to the label printer that thermally imprints a label using selected meditags from the DICOM header fields After the label is printed on the CD the robotic arm moves the completed CD to bin four PACS Administrator Manual Table 24 DD DICOM CD Burner System Product Includes e Rimage Amigo II CD burner e Ever
38. Number Unique number generated by the RIS and assigned to every patient Megabit A unit of data equal to 1 048 576 22 bits one million bits Glossary Page 120 PACS Administrator Manual Megabyte A unit of computer memory or data storage capacity equal to 1 048 576 22 bytes one million bytes Modality A generic term used to describe an imaging device such as MRI CT Ultrasound DR and CR Network Interface Card NIC A circuit board that allows a computer to communicate on the network There are NICs available for all network protocols Petabyte A unit of computer memory or data storage capacity equal to 1 024 terabytes 27 bytes One quadrillion bytes Picture Archiving and Communication System PACS The acquisition archival and retrieval of digital images over a computer network for diagnosis and review at dedicated workstations Pixel The smallest viewable element rectangular or square in an image or display The function of a workstation determines the number of pixels required in its display Query Retrieve A DICOM service class It supports the ability to query a device for a list of patients studies or series and to initiate the transfer instances of patients studies or series this is the MOVE operation Radiological Society of North America RSNA An organization based in the USA whose purpose is to promote radiology and related sciences through education and research and forward researc
39. OM header Resolution 1 Reallocate the series to the new study 2 Cancel original study in the RIS Scheduler PACS Administrator Manual Images Exist for Cancelled Study Issue The study s status displays as Cancelled in Synapse and has images associated Possible Cause The order is edited in Meditech after the images have been sent from the modality to Synapse with the old Accession Number in the DICOM header Resolution Reallocate the series to the correct study Anomaly Correction All merges and reallocations begin with a source and a destination e Source folder the folder where the image or study currently resides e Destination folder the folder where the image or study should reside Five Types of Anomaly Corrections Patient merge A patient merge is merging two patient folders together to create one patient folder All contents of the source patient folder are transferred to the destination patient folder The source patient folder or shell disappears Study merge A study merge is merging two study folders together to create one study folder All contents of the source study folder are transferred to the destination study folder The source study folder or shell disappears PACS Administration Page 17 PACS Administrator Manual Study reallocation A study reallocation is taking a study folder from one patient folder and putting it into a different patient folder The source study fold
40. Open Systems Interconnection Picture Archiving and Communication System Positron Emission Tomography Redundant Array of Inexpensive Disks Radiology Fluoroscopy Radiology Information System Radiological Society of North America Storage Area Network Society for Computer Applications in Radiology Secondary Capture Service Class Provider Service Class User Service Object Pair Structured Query Language Secure Sockets Layer Synapse Web Administrator Tool Transmission Control Protocol Internet Protocol Unique Identifier Uninterruptible Power Supply Ultrasound Voice Recognition Wide Area Network X Ray Angiography PACS Administrator Manual XRF X Ray Flouroscopy Abbreviations Page 116 PACS Administrator Manual Glossary Accession number A unique number generated by the RIS and assigned to each patient study This is a portion of the information required to define the patient s identification in the imaging modality Bandwidth The amount of data that can be transmitted in a fixed amount of time For digital devices the bandwidth is usually expressed in bits per second bps or more commonly Mbps This is also known as transfer rate Byte The abbreviation for binary term the smallest unit of storage capable of representing a single character On all modern computers a byte comprises 8 bits Care ReDesign CRD The Care ReDesign initiative bridges the information gap by redesigning inefficient manual
41. P when receiving images from a modality which acts as a service class user SCU Service Class User SCU This is a DICOM term A Service Class User is a client where a client is a workstation or modality and hence uses a service provided by the SCP An example of this is a modality which acts as a service class user SCU when sending images to an archiving device which acts as a service class provider SCP Society for Computer Applications in Radiology SCAR This a multi disciplinary body involved in the advancement of computer applications and information technology in medicine This is achieved through educational bodies and conferences http www scarnet org Storage Area Network SAN A network topology which has a series of servers linked through a series of switches through a dedicated network to a central storage This allows all servers to access a large storage and improves access times This topology would be most suitable in a distributed PACS with the PACS servers at remote locations accessing a central data store A dedicated high speed network usually fiber channel connects the storage elements RAID JBOD and tape to the servers Structured Query Language SQL The high level language used to query databases and obtain information Storage This is defined as the data which requires fast access this access does not require any robotic or manual intervention and will be stored on a disk system eithe
42. PACS ADMIN GUIDE PACS Administrator Manual Table of Contents Table of Contents Page i Synapse PACS PACS Administration PACS Administrator Responsibilities 008 4 User ACCOUNTS occa ican saswan caneatinaceretcariedeenteeeacieaeem 7 PANOMANGS scantacciesvazeniudcinnn a aA aa 9 Interface Monitoring sssssssssssrrsrrssreeerrrrrrrrerrreerrre 20 Totoku Monitor Calibration s c 0sccccccsccseesccesnecsesnens cd 24 Support Troubleshooting accaecspcsenbosenncuseirepecenhoteucteiaceegiiets 42 Downtime Procedures sssssssssssssssssreerrrrrrrrrerreerrrr 45 Workstations Set Up a Diagnostic Workstation ccceeeee eee e ees 55 Set Up a Clinical Workstation ccce 63 Diagnostic and Clinical Workstation Settings 65 Installing Synapse csnscicdectdcesscapeeteseemaancsenddeeneiees 72 Review Workstations ssssssssisssssrseerrrrrrrrrrreeerrra 78 Remote Workstations sisneuessscadisatiestietesenssantienninaes 78 Virus Scan Settings for Workstations eese 82 Diagnostic and Clinical Workstation Checklist 85 Modalities Adding a New Modality eeen 87 DD DICOM CD Burner Prior to Installation lt cscscc cusyscciidindesiagsaintsnadecseesiake 90 Installation seriis drenner eea hika 92 LOQ ON rrsan rataan a a aa a Oa A 93 Create a New User ACCOUNT cccceeeeeeeeeeeeeeeenees 94 Configure Rimage System Manager neccen 95 Configure RADinfo Power PACS cecce 96 View an Mage a cencccarsiancdsnct
43. The header holds information about the data which allows the computer to combine all the data units after transmission to form the file sent across the network Health Insurance Portability and Accountability Act HIPAA USA law that came into effect in 2002 Principally the goals are the standardization of information management and exchange in medicine to maintain security improve accuracy and ensure privacy http www hipaadvisory com Health Level 7 HL7 An ANSI accredited standard developed to allow Glossary Page 119 transfer of data between different systems in healthcare This operates at the top level of the open system integration model the application layer http www hl7 org PACS Administrator Manual HealthCare Information and Management Systems Society HIMSS A society which provides a forum for multidisciplinary professionals in healthcare information services to discuss problems and provide educational facilities for its member and aids in the advancement of standards and initiatives such as IHE http www himss org HIIS Router Monitoring Tool HIIS The software component that acts as the interface between HIS RIS and SYNAPSE HIIS receives messages from HIS RIS in an HL 7 format and maps the information to the appropriate locations in the database Image and Information Processor IIP Both the image processing computer and the CR operator interface I mage depth An image consists of an
44. To Install the ePO Agent 1 Click Start Run Pi ee ee Type sjsnt epo epoagent install7 At the licensing page select Perpetual Licensing Accept the defaults After McAfee is installed go to sjsnt epo epoagent epoagent Double click to initiate the ePO agent installation process 7 Accept the defaults to install the agent Notify one of the two Network Design Technicians listed below that you have installed McAfee on a PACS workstation They will need the computer name and IP address Table 21 Network Design Technicians Technician Email Telephone Louis Tillis louis tillis ps net 714 347 7571 Phong Chau phong chau stjoe org 714 937 7434 Within 2 hours of notification of the McAfee install on a PACS PC the technicians enable the ePO server to take over that responsibility Workstations Page 84 PACS Administrator Manual Virus scan settings are maintained by the ePO server Manual changes revert to the ePO settings after 15 minutes Diagnostic and Clinical Workstation Checklist Use the checklist below to verify the workstation is setup as recommended by the Corporate PACS Team Table 22 Workstation Checklist Diagnostic Clinical Workstation No Item Checked 1 Static IP address used 2 PC named and workstation added to domain Appropriate monitor s installed Monitor resolution and appropriate pivot mode portrait or landscape se
45. Windows desktop and select Refresh b If refresh does not solve problem reboot c If rebooting does not solve problem repeat the installation Contact your PACS Administrator at for help installing or using Synapse How to Use PACS Synapse System Requirements Pentium II min 400 MHz 256 MB minimum Windows 98 ME NT 4 0 2000 XP Home or XP Professional Internet Explorer 6 0 or newer 32 bit color High speed DSL or cable A dial up modem can be used but is not recommended A Install Synapse 1 In the Internet Explorer address box type the appropriate URL listed below and press Enter to display a network logon dialog Facility URL St Jude https pacs stjoe org All others https pacs2 stjoe org Type your Synapse user ID password and domain name a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userID b All other users type sjhs nt in the domain field When the Synapse Workstation page displays click Synapse Workstation Code Download When the Security warning message displays check Always trust content from FUJIFILM Medical Systems and click Yes When the message Installation of Synapse version xxx successful displays close Internet Explorer Right click on the Windows desktop and select Refresh Go to Page 2 and configure Synapse properties A Configure Synapse Properties 4 5 Right click the Synapse icon S
46. ad Technician should be available to e Setup the modalities to push to the CD burner e Learn from the ATR reps how to configure the modalities in RADinfo POWERPACS Site IT personnel should be available to e Set up the network printer e Install virus scanning software e Ensure the computer is on the ePO network Caution DD DICOM CD Burner Page 92 e Never unplug the power cable or turn the power switch off during CD creation e Never move or jostle the printer during CD creation it causes misalignment of the laser and results in a malfunction e Do not use the reject mail slot on the left side of the unit The reject slot can hold only one CD If a CD is on the slot and a second CD gets rejected the system freezes e Always remove the clear disk protectors from the top and bottom of each stack of CDs before placing in the carousel e Do not close RADinfo PowerPACS while jobs are waiting to print e Do not remove the dongle or attach anything to the dongle The dongle is attached to the printer s parallel port during installation This dongle acts as a security key for the software If the dongle is not present the system does not work PACS Administrator Manual Dongle Carousel Log On DD DICOM CD Burner Page 93 e The CD carousel has 4 bins Each rotating bin holds 100 CDs Load up to 50 blank CDs in each of bins 1 2 and 3 e Never place blank CDs in bin 4 which is used to catch the b
47. address box click the dropdown arrow to change from test to live window Click OK to save the setting and close the properties Configure Synapse Properties On the desktop right click the Synapse icon and select Properties Table 15 Synapse Properties Tabs Tab Configures Data Source Settings Data sources for the Synapse workstation Synapse View The way information is retrieved and Settings displayed to the user Workstation specific workflow Monto automation functionality Workstation specific security features Security such as automatically logging off Synapse and hiding the Synapse icon from the desktop Data Source Settings Tab For diagnostic workstations the Data Source Settings tab should remain set to the defaults that come across with Synapse installation The Data Source Settings address box populates with the word Synapse the default name of the Data Source The Communication Settings Address box displays the path from which you downloaded the Synapse software None of the boxes in Communications Settings are checked The Cache Address box is blank The AON factor is set at Clinical for Dictated studies and Original for Unread studies PACS Administrator Manual For clinical workstations one change is necessary on the Data Source Settings tab e Change the AON factor for Unread studies to Clinical Synapse View Settings Tab All
48. adjust e Do not use the slider to adjust the resolution 3 Select the monitor 4 Click Advanced 5 Select the Adapter tab 6 Click List All Modes 7 Scroll to bottom and select 1536 x 2048 8 Click OK 9 Click Apply 10 Click Yes 11 Click OK 12 Select the other monitor and repeat steps 1 through 11 to adjust its resolution 13 Close the dialog box Configure the Monitors If this is a two monitor setup e Setup is complete PACS Administrator Manual If this is a three monitor setup e See Configure the Three monitor Setup on page 62 Configure the Three monitor Setup 1 Position the original monitor to the left of the two Totoku monitors 2 In Display Properties checkmark True Color on each of the three monitors 3 In Properties right click each monitor and select Attached 4 Modify the registry settings using these DWORD values d Select Start Run e Type regedit f Browse to My Computer HKEY_ LOCAL MACHINE SOFTWARE Fuji Medical Systems USA Synapse Workstation Monitor Configuration g Double click FullScreenCount and type 2 h Click OK i Double click FullScreenX and type the horizontal resolution of the left color monitor e Left color monitor is not a Totoku monitor e Resolution is normally 1600 pixels wide by 1200 pixels high for the monitor in landscape position e Select the decimal radio button when typing the resolution is in pixels j Cli
49. ame field and type the first few letters of your patient s last name Press Enter to sort or filter by the last name you typed Click any column heading to sort it alpha numerically a Click again to sort the column in reverse b Click a third time to revert to the original unsorted list Locate the correct study and double click to open the exam To start over right click the filter row and select Clear Then type a new filter s for the sort Use the up arrow on menu toolbar to return to the last screen Synapse Toolbar a ST JOSEPH HEALTH SYSTEM Log On Synapse 1 Double click the Synapse program icon to open Synapse Double click the word Synapse on the gray background to expand the Synapse folder At the logon screen type your Synapse user ID password and domain name a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userID b All other users type sjhs nt in the domain field Press Enter a Locate a Study Double click All Studies or other desired folder Click in the address box in the Patient Name field and type the first few letters of your patient s last name Press Enter to sort or filter by the last name you typed Click any column heading to sort it alpha numerically a Click again to sort the column in reverse b Click a third time to revert to the original unsorted list Locate the correct study and double click to open the
50. and clinical workstations to TEST Note Notify After the system is restored resend all exams to users that any their normal production targets notes entered into the system during PACS Administrators reset workstations to this period will be production lost and that comparable studies will not be available Support Page 50 PACS Administrator Manual Support Page 51 Print Film In the event that both the production and test systems are unavailable and exams must be read technicians may need to print exams to film Planning Requirements Each modality and IIP that sends images to PACS must have alternate storage and print targets set up ahead of time in order to be prepared for a downtime contingency Targets are l 2 Primary DICOM storage server Secondary DICOM storage server for sites with more than one DICOM server Test Server 4 Primary printer Secondary printer PACS Administrator Manual Workstations Workstations Page 52 There are five types of PACS Workstations Setting up a PACS workstation is the joint responsibility of the PACS Administrator the PACS Technical Analyst and the site IT personnel The type of workstation to set up is based on the location of the workstation and the personnel that will use the workstation Table 9 Types of PACS Workstations Type Description These workstations have two Totoku LCD gray scale 3 megapixel 1536 x 2048 moni
51. aphical area and typically consists of more than one LAN Worklist The list of patient studies sent from the RIS and displayed at the appropriate acquisition modality Glossary Page 123 PACS Administrator Manual INDEX Index Page 124 A abbreviations 113 account setup DD DICOM CD burner 94 PACS users 7 acronyms 113 add modalities to DD DICOM CD burner 97 anomalies 9 additional 16 by type 11 correction 17 merging 18 reallocation 19 anomaly correction image reallocation 18 patient merge 17 series reallocation 18 study merge 17 study reallocation 18 Cc cables communication cable 30 sensor cable 29 calibrate Totoku monitor 34 calibration check need for 31 connect cables 29 equipment needed 25 start the calibration 34 CDC 3 common anomalies 11 configure RADinfo Power PACS 96 Rimage System Manager 95 connect brightness sensor cable 29 communication cable 30 connect calibration cables 29 D DD DICOM CD burner add modalities 97 carousel 93 caution 92 create CD 98 create new user account 94 dongle 93 logon 93 prior to installation 90 Rimage CD burner 89 view an image on 98 dictionary 117 download new Medivisor driver 27 F Fuji support escalation standards 40 Fuji Object Oriented Database FOOD 2 G glossary 117 l Image Storage Area Network 2 inspect monitor calibration results 36 interface monitoring 20 M Medivisor calibration
52. ble to the second monitor s Remote In c Do not connect the serial connector 3 To save time in the future leave the communication cables connected There is no reason to disconnect them PACS Administrator Manual Configure Medivisor This is only necessary when using Medivisor for the first time If the monitors have been previously calibrated skip to the next section 1 Select Start Programs Medivisor Configuration and Calibration 2 Accept the defaults in the configuration wizard by clicking Next at each dialog box e Never change the settings e The defaults include a dropdown for division pattern the default is 1 column x 1 row 3 Repeat the configuration steps for the second monitor 4 When configuration is complete click Finish to save the calibration settings Check the Need for Calibration 1 In the main window of Medivisor click a numbered monitor button to select that monitor Begin with either monitor Medivisor Open MONITOR SELECTION BUTTONS MONITOR ADJUSTMENT BUTTONS The number of buttons and their locations vary between models Only use Pattern selection Automatic adjustment Inspection MONITOR ADJUSTMENT PATTERNS Only use bottom row of patterns The adjustment pattern buttons display patterns on the screen that show whether or not the monitor requires calibration e Go through any or all of the 8 adjustment patterns for one or both monitors PACS Adminis
53. blem the PACS Administrator should place a call to the correct vendor If the system is down then the PACS Administrator may want to follow up the SJ HS Help Desk call with a direct call to the PACS Technical Analyst Erik Hill and the IT Site Director to let them know of the urgent problem In all cases record ticket numbers provided by Fuji SJHS or other vendors Resolve The PACS Administrator is informed when the problem is resolved and is responsible for informing end users that the problem was resolved PACS Administrator Manual Escalate If the problem is not addressed in a timely manner escalate the issue to the next level of support See Attachment 1 Contact List for the escalation contacts Fuji service level escalation standard Level One e Support calls are routed to a Technical Support Engineer TSE e Any request not closed in 24 hours is escalated to level 2 Level Two A Network Service Engineer NSE for Synapse or a Field Service Engineer FSE for CR will provide phone support or dispatch to site if necessary Level Three If the NSE or FSE is unable to correct the problem support is escalated to the Fuji Engineering or Integration departments Perot service level escalation standard Support Page 40 Information Services assesses ticket severity and provides initial response based on the following criteria Level One Any reported problem where the majority of the use
54. ck OK k Double click MonitorCount and type 0 I Click OK m Close Regedit 5 Reboot for the registry settings to take effect 6 In Display Properties right click and select Identify to see the monitor number displayed on each monitor Workstations Page 62 PACS Administrator Manual 7 Check display 8 e In a3 monitor setup at boot up the worklist displays on monitor one e Studies display on monitors two and three e The worklist goes blank e After the first study is closed the worklist moves to monitor two and remains there Complete the diagnostic workstation Complete the Diagnostic Workstation I Install critical updates to MS Windows and Internet Explorer Make any site specific changes to Synapse properties e f no changes are made the setup is complete e If changes are made copy the changed profile to All Users Notify one of the Network Design Technicians that a new PACS workstation has been set up and needs to be added to the ePO server e Provide the Network Design Technicians with the location of the workstation the IP address and the host name Set Up a Clinical Workstation Clinical workstations begin with the standard PACS image These workstations are configured with one or two 2 megapixel color monitors A single monitor clinical workstation does not need an additional graphic card A dual monitor clinical workstation requires a special graphics card to drive the
55. der At the logon screen type your Synapse user ID password and domain name a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userID b All other users type sjhs nt in the domain field 4 Press Enter A Locate a Study Double click All Studies or other desired folder Click in the address box in the Patient Name field and type the first few letters of your patient s last name Press Enter to sort or filter by the last name you typed Click any column heading to sort it alpha numerically a Click again to sort the column in reverse b Click a third time to revert to the original unsorted list Locate the correct study and double click to open the exam To start over right click the filter row and select Clear Then type a new filter s for the sort Use the up arrow on menu toolbar to return to the last screen A Navigate Manipulate Synapse Click an image and use the mouse wheel to move through the slices in a series Use the right arrow on the Synapse toolbar to go to the next series when there are additional series available Click and right click the image to display a context toolbar with image manipulation tools To use the window level zoom and pan tools Select the tool with your left mouse button and keep the mouse button down while moving the tool on top of the image To toggle between tools With the window level zoom or pan tool
56. display a network logon dialog box Table 18 Remote Installation URLs Facility URL St Jude https pacs stjoe org All others https pacs2 stjoe org 2 Type your Synapse user ID password and domain name a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userl D b All other users type sjhs nt in the domain field 3 When the Synapse Workstation page displays click the Synapse Workstation Code Download box 4 When the Security warning message displays check Always trust content from FUJ IFI LM Medical Systems and click Yes 5 When the message Installation of Synapse version xxx successful displays close Internet Explorer 6 Right click on the Windows desktop and select Refresh 7 Right click the Synapse icon and select Properties 8 In Synapse Properties on the Data Source Settings tab a Type the appropriate address for your hospital Table 19 Synapse Remote Properties URL Facility URL Mission https pacs2 stjoe org mhr Queen of the Valley https pacs2 stjoe org qvh Workstations Page 79 PACS Administrator Manual Table 19 Synapse Remote Properties URL Facility URL Santa Rosa https pacs2 stjoe org srm St Jude https pacs stjoe org St Joseph Eureka https pacs2 stjoe org sje St Joseph Orange https pacs2 stjoe org sjo b Check the follo
57. e Conference calendar e Focused digital communities e Case of the Day and Teaching Files e Medical imaging bookstore e SalaryScan e Job Boards PACS Resources Page 109 PACS Administrator Manual PACS Resources Page 110 e OnLine CME and CE credits e Open Market e Used equipment marketplace DICOM To learn more about DICOM Digital Imaging and Communications in Medicine visit http medical nema org dicom e Purpose and Organization e Process e Products e Partnerships e Technical Assistance like FAQs and the discussion group e Administrative Assistance Medcyclopaedia Amersham Health provides a huge scientific library on the Internet in the field of medical imaging First time users must register and must pass a one step test to logon New users must identify an anatomical region on a radiology image After registering you can search the Encyclopaedia of Medical Imaging for any of 17 000 topics and can even hone your imaging skills using their free tests on words or images Go to www amershamhealth com and select Medcyclopaedia You can also visit their Cybrary take the same test for volumes on Medical Imaging Online Working Tools and Medical Resources There is even a section also available from their Home Page called Medical Imaging Made Easy just in case you have new inductees to educate PACS Administrator Manual Fuji Medical Systems Intelligroup Intelligroup is an online discu
58. e PACS images are located Select the appropriate image based on the following categories e CLIN for Clinical Workstations e DIAG for Diagnostic Workstations e Windows 2K or XP Operating system e PC Model PACS Administrator Manual 3 For both diagnostic and clinical workstations follow the normal procedure to restore an image Set Up a Diagnostic Workstation Diagnostic workstations begin with the standard PACS image These workstations use a pair of Totoku monitors The original monitor may or may not remain part of the diagnostic workstation setup When the workstation is complete test and calibrate the Totoku monitors using the vendor provided calibration kit See Totoku Monitor Calibration on page 24 Note Ensurethe Totoku monitors require a specific graphics card PC boots correctly that is shipped with the monitors into Windows BEFORE installing ME315L requires the Matrox MED3mp graphics card the Totoku Totoku calls this the LV32P1 monitors e ME311L ME312L St J ude only requires the Astro GM184A graphics card If using a disk to image the PC for the Diagnostic Workstation e See After Installing the Image on page 55 If not using a disk to image the PC for the Diagnostic Workstation e See Diagnostic and Clinical Workstation Settings on page 65 Then e See After Installing the Image on page 55 After Installing the Image After installing the PACS image on t
59. ed by the ATR Systems Engineer e The prepared label already has fields created for the DICOM metatags b Click Open to add it to the CD Label File c In the CD Label File window checkmark Default to activate the default label in RADinfo PowerPACS e For labels created but not needed any longer deactivate them by removing the checkmark e Deactivating the label keeps it available in case it is needed at a later date but prevents it from showing up as a current label option in RADinfo PowerPACS d Checkmark Do not separate series to keep a series all on the same CD when the burn involves more that one CD e Checkmark Default Label f In the CD Label window click the top row in Column 1 to activate a dropdown window of DICOM metatags from which to select information for the label fields e Column 1 is the title of the second column in the window and Column 2 is the title of the third column in the window DD DICOM CD Burner Page 96 PACS Administrator Manual g Continue selecting metatags for each label field until the label is finished h When finished click Save 5 After the modalities are set up burn a CD and inspect the label 6 Use CD Designer software to create more labels or edit existing labels Double click the User Guide Manuals folder on the desktop and select the PowerPACS Quickstart guide Add Modalities DD DICOM CD Burner Page 97 The Biomedical Department Lead Technician will
60. elect Properties In Synapse Properties on the Data Source Settings tab a Type the appropriate address for your hospital Facility URL Mission https pacs2 stjoe org mhr Queen of the Valley https pacs2 stjoe org qvh Santa Rosa https pacs2 stjoe org srm St Jude https pacs stjoe org St Joseph Eureka https pacs2 stjoe org sje St Joseph Orange https pacs2 stjoe org sjo b Check the following boxes Use encrypted communication https for images Enable pre caching images for slow networks c In AON Factor for Initial Display select Reference for faster downloads or select Clinical or Diagnostic for more image detail in the initial download Note The AON factor can be changed after the images are downloaded On the Synapse View Settings and Workflow tabs check the desired options Click Apply OK amp Configure Internet Explorer Properties In MS Internet Explorer select Tools Internet Options On the Security tab select Custom Level Inthe Settings box under Active X controls and plug ins click the center radio button to enable the following a Download signed ActiveX controls b Download unsigned ActiveX controls c Initialize and script ActiveX controls not marked as safe Click OK twice to save the settings and exit the dialog box OD improve Your System s Performance amp Optimize Internet Explorer In MS Internet Explorer select Tools Internet Options 1 On the General tab
61. enario Action System is unstable failure is imminent Take immediate measures to stabilize system May schedule downtime during business hours if necessary Disk or system error immediate maintenance required Schedule downtime for that night System error maintenance required low risk of data loss or system failure Schedule next available downtime window OS patch application patch utility upgrade Schedule next available downtime window Communicate Recommendations After the problem is triaged the PACS Technical Analyst communicates recommendations to the PACS Administrator Together they establish a plan of action and estimate the timeframe necessary The PACS Technical Analyst communicates progress with the PACS Administrator before during and after downtime events Table 8 Typical Communications Timing Responsibilities Problem triaged Work with PACS Administrator and IT Site Manager to determine an acceptable downtime window After a window has been agreed upon schedule Change Management and notify stakeholders via email 15 minutes prior to downtime Contact lead PACS Administrator Confirm downtime plans Support Page 47 PACS Administrator Manual Table 8 Typical Communications Timing Responsibilities As soon as it is determined that the system will not come up within the scheduled window contact the PACS Ad
62. end a few exams to the test server to verify that it is working correctly Implement the Plan and Manage the Workflow The PACS Administrator is responsible for managing the downtime event at the hospital They should frequently inform Radiologists technicians and other PACS users of the downtime status Restore Normal Operations When the system is restored the PACS Administrator must restore the workflow back to normal operations e Send all exams performed during the downtime window to the standard production target e Restore workstations that were temporarily pointed to test back to production e Fix anomalies caused by manual data entry Support Page 49 PACS Administrator Manual Downtime Contingencies Wait for system to be restored If the downtime window is short or is being performed during off hours the simplest downtime contingency is to wait for the system to come back online Redirect to alternate production server If a DICOM server fails and the site has more than one DICOM server available send exams to an alternate DICOM server The change will be transparent to end users After the server is restored send exams to the normal production target No exams need to be resent Redirect to test server If production Synapse is completely unavailable and the downtime window is long send exams to TEST Worklist refreshes are not available during this period Redirect diagnostic workstations
63. er is entirely transferred to the destination patient folder All images in the source study folder are displayed in Synapse with the patient information from the destination patient folder Series reallocation Series reallocation is moving a series from a study from one patient s study folder into a different patient s study folder The source series folder is entirely transferred to the destination study folder All images in the source series folder are displayed in Synapse with the patient information from the host patient folder of the destination study folder Image reallocation Image reallocation is moving a study image from a study from one patients study folder into a different patient s study folder The source image is transferred to the destination series or study folder The image displays in Synapse with the patient information from the host patient folder of the destination series study folder Merging Anomalies PACS Administration Page 18 To merge an anomaly drag and drop the incorrect patient or study into the correct patient or study If both a patient merge and a study merge are required for example Patient ID wrong and Accession number wrong Perform the study merge first and then the patient merge If a study with zero images has the correct demographics and the study containing images has the wrong information merge the study with images into the one with zero images because the PACS Administ
64. er the current driver Do not let MS Windows select the driver or recommend the driver e Download the monitor driver for best monitor performance See Download New Monitor Driver on page 58 e Manually install the monitor driver See Install the Monitor Driver on page 60 Download New Monitor Driver Only download the driver if it is the first time you are installing the monitors or if the monitor driver on the Quest website is newer than the currently installed driver 1 2 3 Go to www questinc com Click the image of the Totoku monitor Locate and double click the current driver for your operating system In the logon box a At user name type totoku b At password type download 5 At the File Download prompt click Save 6 In the Save in window browse to C Downloads Totoku Drivers If there is not a Totoku drivers folder PACS Administrator Manual Note Download the driver but do not install the driver Workstations Page 59 Right click in the window Select New folder Name the folder Totoku drivers a b c d Double click to open the new folder e Click Save to begin the download f When the download is complete close the download dialog box For first time installations you must also install Microsoft NETFramework See Install MS NETFramework on page 60 Close Internet Explorer e Do not attempt to install over the current driver Do not
65. erface failure worklist not working e Unable to send images to PACS Scheduled downtime Possible reasons for scheduled downtime include e Synapse upgrades and patches e Operating system upgrades and patches e Storage Area Network SAN upgrades and patches e Network maintenance Support Page 45 PACS Administrator Manual e Maintenance on servers due to disk or CPU errors PACS Technical Analyst During Downtime During a downtime event the PACS Technical Analyst is responsible for restoring the system to its normal production state and for communicating status to the PACS Administrator and the IT Site Manager The sequence of events is e Identify the problem e Perform triage e Communicate recommendations e Resolve the problem e Document the results Identify the Problem The PACS Technical Analyst may learn of system problems from several different sources including PACS Administrators SJ HS Help Desk SJHS Operations NetSaint Fuji Dell EMC or Microsoft After notified the Analyst researches the problem and determines the nature and scope of the problem Perform Triage After the problem has been researched the PACS Technical Analyst identifies priorities and initiates a course of action Table 7 Possible Scenarios Scenario Action Take immediate measures to System is down restore system Support Page 46 PACS Administrator Manual Table 7 Possible Scenarios Sc
66. est II label printer Dell PowerEdge 600 PC monitor keyboard and mouse Rimage Publishing System hardware e Robotic arm e 4 bin rotating carousel e Rimage System Manager enables user to view Windows background services and make changes to the robotics Background services include Production Server Image server Bridge Server and Mes saging Server e Quick Disk which is not used by SJ HS Rimage Publishing Software Suite RADinfo CD PowerPACS DICOM software application GUI for query retrieval and submission of the order to Rimage services for CD burning Prior to Installation DD DICOM CD Burner Page 90 Advanced Tek Rep is the company hired by Data Distributing to install the CD burner systems in the various SJ HS facilities and to train the personnel to use the DD DICOM CD Burner system Before an installation of the Rimage DD DICOM CD Burner system the PACS Administrator receives a 2 page Excel spreadsheet from Advanced Tek titled Check List for DD DICOM Installs The PACS Administrator must complete the form and return it to the Advanced Tek representative at least 10 days before the scheduled installation It is very important that the information provided to Advanced Tek include e Host Name PACS Administrator Manual DD DICOM CD Burner Page 91 e AE Title e Port Address e TCP IP Address Also send the ATR Systems Engineer an electronic copy of the facility logo and
67. ge 28 Holding both the sensor and the bracket position the sensor over the holes in the bracket a Line up the single nipple on the sensor over the single hole on the bracket PACS Administrator Manual b Line up the large optical eye over the large hole on the bracket 2 Attach the sensor to the bracket a Lay the bracket on a flat surface with its legs down b With one hand hold and press down both ridged sides of the sensor c With the other hand lift the body of the sensor and let it down again to seal the suction cup to the bracket 3 Test that the sensor is firmly attached to the bracket a Pick up the sensor and bracket by lifting the sensor b Move the sensor side to side to ensure it is attached 4 To remove the sensor from the bracket reverse the procedure and slip your fingernail under the suction cup to release it Connect Cables PACS Administration Page 29 Sensor cable The brightness sensor and cable are white There is a long cable extending from its base to a male PS2 connector Off the male PS2 connector is a small AC adapter and a female PS2 connector 1 Lay the sensor and bracket on the desk in front of the first monitor to calibrate 2 Insert the male PS2 sensor cable connector in the port marked sensor on the back of the monitor a If calibrating an ME311L or ME312L monitor attach the AC adapter to the sensor and plug it in b The ME315L obtains power from
68. h in both clinical and basic sciences including IT to improve and promote healthcare http www rsna org Radiology Information System RIS A computer system which stores the appointment information for a radiology department and may be linked to the HIS A PACS may take exam booking information and demographics from the RIS to form worklists Redundant Array of Inexpensive Disks RAID A RAID is a multi disk system where one or more of the disks provides fault tolerance A RAID should be able to withstand disk failure and have the ability to reconstruct the data from a failed disk Review workstation A workstation used for checking that acquired images are of the required quality and that all necessary views have been performed or a workstation used on a ward or ina clinic to view images in conjunction with the associated clinical report A review workstation has one or two display monitors usually of lower display quality than the monitors used in reporting workstations Glossary Page 121 PACS Administrator Manual Secure Sockets Layer SSL Secure Sockets Layer provides encryption between web browsers and web servers Service Class Provider SCP This is a DICOM term A Service Class Provider acts as a server and provides a service to a client or user where the client is a workstation or modality that requires information from the server An example of this is an archiving device which acts as a service class provider SC
69. h order interface Neon Engine or Synapse Integration are not functioning Images sent from the modality with the incorrect patient study data such that the images do not match the Synapse study data that was created by the Meditech order message Resolution 1 Validate if the Meditech order message created a study in Synapse If not confirm that the DICOM header Accession Number is correct The order message will overlay the DICOM created Synapse study data when the interfaces begin functioning If so and the incorrect DICOM header Accession Number was manually entered there will be 2 separate study folders for the exam Merge the DICOM created study folder into the Meditech created study folder Delete the anomaly entry PACS Administrator Manual Study Late Issue Synapse receives a Meditech order message after receiving images from the DICOM server Possible Cause e The incorrect Accession Number is manually entered into the DICOM header and therefore does not already exist in Synapse No Accession Number is entered into the DICOM header e Meditech Neon Engine or Synapse Integration downtime Resolution 1 If the Accession Number was incorrectly typed or omitted e Merge the DICOM created study folder into the Meditech created study folder 2 If Meditech Neon Engine or Synapse Integration downtime e Ifthe Accession Number was correctly typed into the DICOM header the order message
70. he desktop b Select the DD DICOM Troubleshooting guide for basic troubleshooting assistance PACS Administrator Manual PACS Resources Books As the fields of digital radiology and PACS Picture Archiving and Communication System expand more and more resources for information become available There are books to read organizations to join conferences to attend the Internet to surf and much more The information is available you just have to know where to look for it PACS A Guide to the Digital Revolution by Keith J Dreyer et al PACS and Imaging Informatics Basic Principals and Applications by H K Huang Organizations PACS Resources Page 107 SCAR SCAR the Society for Computer Applications in Radiology has an informative website It includes their SCAR Expert Hotline a question and answer resource available to anyone PACS Administrator Manual The site includes a wealth of information on PACS technology and the clinical implementation of information systems in imaging Visit the Expert Hotline and submit a question or browse the extensive indexed database of questions and answers SCAR members may post questions to the site free of charge Experts regularly review each question submitted and post timely answers SCAR also holds an annual meeting Visit the SCAR website at www scarnet org RSNA RSNA the Radiological Society of North America will host their annual conference
71. he Font size dropdown menu select Extra Large Fonts for diagnostic workstations and Large Fonts for clinical workstations 7 Enlarge the mouse pointer a In Control Panel select Mouse b On the Pointers tab at the Scheme dropdown menu select Magnified system scheme c Click Apply and OK 8 Set Recycle Bin a Right click the Recycle bin icon on the desktop and select Properties Workstations Page 69 PACS Administrator Manual b Slide the bar 3 and click OK Clean up Start menus a Right click Start and select Open All Users b Right click each unneeded shortcut and select Delete c Confirm deletion d Usually the only items necessary in the Start Menu on a diagnostic or clinical workstation are Synapse and Internet Explorer 10 Clean up the Desktop a Right click any shortcut or file on the desktop that is not needed by users administrators and sup port staff b Select Delete c Click Yes to confirm deletion Configure Internet Explorer Workstations Page 70 In MS Internet Explorer select Tools Internet Options 2 On the Security tab select Custom Level 3 In the Settings box under Active X controls and plug ins click the center radio button to enable the following a Download signed ActiveX controls b Download unsigned ActiveX controls c Initialize and script ActiveX controls not marked as Safe Also in the Settings box scroll down near the bott
72. he PC set the following options 1 Name the computer and add the workstation to the domain Workstations Page 55 PACS Administrator Manual 2 Use a static IP address for each diagnostic workstation 3 Set NIC to LOOMBps Full Duplex Start Control Panel Network Local Area Connection Connect Using Configure Advanced Link Speed amp Duplex 4 Install the graphics card for the Totoku monitors Install the Graphics Card 1 Shut down the PC 2 Disconnect the PC from the electrical power before opening the back of the computer 3 Place the new graphics card in the third PCI slot e Because it was in the third slot when the initial PACS image was created Third PCI Slot for Graphics Card 4 Connect the DVI ports on the monitors to the DVI ports on the Matrox video card 5 Boot the system 6 Configure the monitors a For a two monitor setup Workstations Page 56 PACS Administrator Manual Disable and remove the extra monitor from the workstation b For a three monitor setup e See Configure the Three monitor Setup on page 62 Manually Install the Totoku Monitors If the Totoku monitors do not install correctly from the image or for some reason need to be reinstalled manually install them e Never let Windows select a driver for the Totokus e Always use the most current driver available e Never install a Totoku driver over an existing driver uninstall first using
73. indow select the images to transfer Click one of the following e Import to import selection only e Import All to import everything on the CD e Send to send to any modality capable of receiving DICOM information including Synapse If sending select the Destination DICOM Node from the dropdown menu and click Send to initiate the action When the CD is silent close the Import Images window e There is no acknowledgement from the software that the files are transferred until after the Import Images window is closed e When the Import Images window is closed the files display in Local storage Caution e Never unplug the power cable or turn the power switch off during CD creation Never move or jostle the printer during CD creation e Always remove the clear disk protectors from the top and bottom of each stack of CDs before placing in the carousel Do not close RADinfo PowerPACS while jobs are waiting to print DD DICOM CD Burner Create CD from Local Hard Drive In RADinfo PowerPACS 1 In the DICOM Image List window right click the patient s name 2 Select Cut CD for Patient 3 Type recipient information and click OK Create CD from the DICOM Server In RADinfo PowerPACS Click Query amp CD On the Query DICOM Server and Create CD window use the Server dropdown arrow to select the DICOM server In the Patient ID box type the AR number a Type AR two leading zeros six digit identification nu
74. ing the paging file to change usually C drive c Under Paging file size for selected drive click the radio button at Custom size d Do not change the default in the Initial size MB address box e Type the new paging file size in megabytes only in the Maximum size MB address box e Type the number of megabytes that equals 75 of the RAM on the computer e The total virtual memory paging file maximum for both Applications and Background services should equal 1 5 times the RAM on the computer e Convert if needed See Conversions on page 67 f Click Set e Increasing the virtual memory paging file does not typically require a restart g Click OK three times to save changes and return to the Control Panel Table 11 Conversions 1 Gigabyte 1000 MB megabytes 1 Megabyte 1000 Kb kilobytes 1 Kilobyte 1000 bytes 4 Turn Power Management off for system a In the Control Panel select Power Options PACS Administrator Manual Note Larger fonts are needed due to the screen resolution Larger icons and buttons are for aesthetics only Font should always be Arial or Tahoma Workstations Page 68 b On the Power Schemes tab At the Power Schemes dropdown menu select Always On At the Turn off monitor dropdown menu select After 20 minutes At the Turn off hard disks select Never c Click Apply and OK Turn Power Management off for NIC a In the Contro
75. inistrator Manual 5 6 7 Number of messages ignored Number of messages with the wrong format Status of input active or inactive Checking System Status Note Rejected messages do not appear in Synapse PACS Administration Page 21 Accessing the HIIS Router Monitoring Tool 1 In Internet Explorer navigate to http lt servername gt hiis performance asp 2 At Username type synapseadmin 3 At Password type appropriate password 4 At Domain type lt local gt Viewing Messages Pending messages Click the Pending Messages link to view the messages not yet filed into Synapse The messages remain in this queue until Synapse is able to process them Instances occur when messages from Meditech are received faster than Synapse can process them Messages also queue here if the Synapse database is down Destination rejected Click destination rejected to view messages rejected by Synapse These might include messages with a medical record number visit number and or accession number already in use by another patient in Synapse Failed translation Click failed translation to view messages that failed translation based on the Fuji HL7 specification These might include HL7 message event types not supported by Synapse or messages with missing data such as the patient s medical record number or accession number PACS Administrator Manual PACS Administration Page 22 Ignored messages
76. installation and any time that Rimage System Manager is upgraded l Double click the Rimage System Manager RSM icon to display the DICOM station control center and 4 RSM servers in the left window e Control Center e PS is production server e IS is image server e BS is bridge server e 2nd BS is the messaging server 2 Select Control Center DICOM Station 3 In the right window click the top Settings button to open the Select DICOMStation_PSO1 Settings window On the default Recording tab e Checkmark Reject non ISO for incremental multi session orders e Checkmark Destroy failed recordings On the Printing tab e At the Print Reject Pattern dropdown select On all rejected disks At the bottom of the DICOMStation_PS0O1 Settings window click More to expand the tab views PACS Administrator Manual 7 On the Server tab at the View dropdown select All Orders so that everything displays for the day 8 On the Verify tab checkmark Enable verification 9 Click OK to save the changes and exit the Rimage System Manager Configure RADinfo Power PACS 1 In RADinfo PowerPACS select File Configure Note Change 2 On the Housekeeping tab select All Orders so only the tabs that the history log lists all CDs burned listed Leave all i other tabs set at 3 Click Save their defaults 4 On the CD Label tab a Click Browse and locate C RADinfo default label to access the default label creat
77. k the Synapse icon and select Log Off Synapse 14 Maximize the Transcription Viewer Editor window and click View Detail to open and use Synapse 15 Configure and optimize Internet Explorer as above 16 Recommend to your physicians that they a Use virus scan software and keep it up to date b Regularly update MS Windows with critical updates and service packs Go to http www microsoft com for more information c Maintain security by logging off Synapse when finished Virus Scan Settings for Workstations Workstations Page 82 The McAfee anti virus program is the current standard for SJHS PACS workstations must have an up to date installation of McAfee anti virus software The workstation must also be set to communicate with the McAfee ePO ePolicy Orchestrator The master ePO server maintains configuration virus scanning and routine updates on the SJHS workstations The PACS workstations group on the ePO server has on access scanning at all times and a timed scan daily at noon PACS workstation group scans are set to e Scan boot sectors e Scan floppy drive during shutdown e Enable on access scanning at startup e Enforce a maximum scanning time of 15 seconds for archives and 45 seconds for all files e Scan for macro viruses in all files e Overwrite client exclusions PACS Administrator Manual Workstations Page 83 Scan inside packed executables Scan inside multiple file archives e g zip Quaran
78. l Panel select Network and Dial up Connections b Right click Local Area Connections and select Properties c On the General tab select Configure d On the Power Management tab make sure there are no checked boxes e Click OK to save any changes f Close Network Connections Increase the Windows font size a In the Control Panel select Display b Select the Appearance tab In Windows 2000 On the Appearance tab at the Scheme dropdown menu select Windows Standard extra large At the Header dropdown menu select each item listed in the table below and use the up down arrows to change the font size and the corresponding item size Table 12 Enlarging Fonts in Win 2000 Title Font Size Item size Active Title Bar 20 28 Caption Buttons 20 28 Icons 20 36 PACS Administrator Manual Table 12 Enlarging Fonts in Win 2000 Title Font Size Item size Icon Spacing horizontal ae Icon Spacing 5 x6 vertical Inactive Title 30 38 Bar Menu 20 24 Message Box if 50 T available Palette Title 20 22 Scrollbar 20 24 Selected Items 20 24 Tooltip if 30 54 available e When finished click OK to save the settings and exit the properties window In Windows XP e On the Appearance tab at the Windows and buttons dropdown menu select Windows Classic e At the Color scheme dropdown menu select Default blue e At t
79. le to process at a time Send only the missed studies Avoid sending messages using this method that may revert the study status on those studies already completed or finalized After the status selection is made click Save Messages to create the message file Totoku Monitor Calibration The Totoku monitors require calibration every six months or if a problem with the display is PACS Administration Page 24 PACS Administrator Manual identified Calibration is the responsibility of the PACS Administrator The time requirement is about 30 minutes to calibrate a pair of Totoku monitors After the cables are attached correctly the actual calibration is wizard driven and requires no special training or knowledge Calibration requires The monitors are installed and working Medivisor Calibration Kit Most current Medivisor driver Internet connection to verify and download the latest drivers Equipment Needed Note Never touch the sensor directly to the screen PACS Administration Page 25 Items from the Medivisor calibration kit Brightness sensor a k a photometer Metal bracket that protects the monitor from the sensor One or more communication cables each with a serial connector and two PS2 connectors e There should be at least one communication cable for each monitor purchased The communication cable can remain attached to the monitor between calibrations An AC adapter for the ME311L ME312L SJF
80. let MS Windows select the driver or recommend the driver 10 Manually install the driver for best monitor performance Uninstall the Totoku Monitor Drivers To uninstall a previously installed Totoku monitor driver on model ME315L use the Windows Add or Remove program utility in the Control Panel To uninstall a previously installed Totoku monitor driver on models ME311L and ME312L use the vendor provided uninstaller available on their website 1 Go to the Quest International Incorporated website and locate the uninstaller a Go to www questinc com b Click the photo of the medical monitor c In the gray window on the bottom left side of the screen select Drivers Calibration Software Scroll to the bottom of the page and select Uninstaller Follow the wizard to download the driver 4 Close Internet Explorer Double click to execute the uninstaller PACS Administrator Manua Note Do not allow MS Windows to automatically install the monitors Note If MS NETFramewor k is already installed a notification displays when you attempt installation Workstations Page 60 6 Follow the wizard to uninstall the old driver Begin the Monitor Install Process 1 Power the system on and boot into MS Windows Ne At the MS Windows notification that it has found new hardware click Cancel Do not allow MS Windows to automatically install the monitors Close any dialog boxes that are
81. matic Logoff is not checked e The address box at Logoff time out in minutes has 10 typed in e Enable Logoff when all windows are closed is checked Uninstalling Synapse Workstations Page 77 To completely remove the Synapse Workstation Code from a computer you must manually remove three specific program files 1 In the Control Panel select Add or Remove Programs 2 Select Synapse and click Remove 3 In the Remove Synapse Warning dialog box click OK 4 At the Warning dialog box click OK 5 In the Downloaded Program Files dialog box right click Synapse I nstallHelper Class 6 Select Remove and confirm at the prompt e If you try to remove the Synapse Medical mage Workstation file at this time you will receive an error message 7 Close Downloaded Program Files Add or Remove Programs and Control Panel 8 Reboot the system 9 From the desktop right click Start Explore 10 Locate and expand C WINNT Downloaded Program Files 11 Right click Synapse Medical I mage Workstation 12 Select Remove and confirm at the prompt 13 Locate and right click C SynapseDatasource dat 14 Select Remove and confirm at the prompt 15 Locate and right click C Synapse 16 Select Remove PACS Administrator Manual 17 Confirm the removal at the prompt 18 Reboot the system Review Workstations A review workstation is any on site SJHS PC connected to the SJHS servers These workstations require
82. mber e g ARO0123456 b Ifthe AR number is not available type the patient s name with an asterisk as a wild card e Type last name comma first initialtasterisk no spaces e g jones p Click Search Checkmark individual files to burn to CD or select All Type name of recipient Click Create CD Click Reports Task List to check the status of the CD creation Burn a Subsequent CD In RADinfo PowerPACS 1 In the DICOM Image List window select any patient whose face is partially covered by a CD icon denoting that a CD was burned Select Reports Task List to open the CD Task Dialog window Click Modify Checkmark Write CD Again Type the number of copies needed and click OK JE DD DICOM Card V1_Sept 21 2004 Sar ST JOSEPH HEALTH SYSTEM
83. ministrator and the IT Site Manager to let them know of the updated window Send an email notification to stakeholders that the downtime window is extended Downtime window needs to be extended Production Contact PACS Administrator and notify system restored stakeholders Resolve the Problem The PACS Technical Analyst is responsible for managing the problem resolution process and coordinating vendor activities Document the Results After the problem is fully addressed the PACS Technical Analyst documents the downtime event and resolution activities PACS Administrator During Downtime During a downtime event the PACS Administrator is responsible for identifying an appropriate downtime contingency implementing the contingency and communicating the status of the downtime event with Radiologists technologists and other PACS personnel Sequence of Events e Identify a contingency plan e Implement the plan e Manage the workflow Support Page 48 PACS Administrator Manual e Restore normal operations Identify a Contingency Plan After a problem has been identified work with the PACS Technical Analyst to determine the downtime window Understanding the estimated time and duration of the window will enable the PACS Administrator to select an appropriate downtime contingency See Downtime Procedures on page 45 Regardless of the downtime contingency selected the PACS Administrator should s
84. mplet ing the logon box as shown below displays the radiology images b If Synapse is not installed on the computer completing the logon box as shown below initiates the installation process In the login box type your Synapse user ID and password a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userl D b All other users type sjhs nt in the domain field When the Security warning message displays check Always trust content from FUJIFILM Medical Systems and click Yes When a black screen displays observe the progress bar until it reaches 100 Minimize all windows to reveal your Windows desktop Right click the Windows desktop and select Refresh Right click the Synapse icon and select Properties 10 In Synapse Properties on the Data Source Settings tab e Type the appropriate address for your hospital See Synapse Remote Properties URL on page 79 e Checkmark Use encrypted communication https for images e Checkmark Enable pre caching images for slow networks e In AON Factor for Initial Display select Reference for faster downloads or select Clinical or Diagnostic for more image detail in the initial download PACS Administrator Manual Note The AON factor can be changed after the images are downloaded 11 0n the Synapse View Settings and Workflow tabs check the desired options 12 Click Apply OK 13 Right clic
85. mport to import selection only e Import All to import everything on the CD e Send to send to any modality capable of receiving DICOM information including Synapse 8 If sending select the Destination DICOM Node from the dropdown menu and click Send to initiate the action DD DICOM CD Burner Page 100 PACS Administrator Manual 9 When the CD is silent close the Import Images window e There is no acknowledgement from the software that the files are transferred until after the Import Images window is closed e When the Import Images window is closed the files display in Local storage Reports and Logs RADinfo PowerPACS Reports RADinfo PowerPACS reports are in an MS Access database and remain and are not erased if the application is removed or reloaded In RADinfo Power PACS select Reports to view the following reports e Task List displays the progress of current activities e CD Recipient lists all recipients of CDs for the last seven years e History lists the CD Operation History for the last 14 days Checkmark the box in the lower left corner to list today s data only Timeframes for reports stored in memory can be changed on the File Configure Housekeeping tab It is recommended to leave the above defaults or increase the timeframe rather than decrease it Rimage System Manager Server Logs To view the server logs 1 Double click the Rimage System Manager RSM icon to display the ser
86. nd SYNAPSE HIIS receives messages from HIS RIS in an HL 7 format and maps the information to the appropriate locations in the Synapse database DI COM Server The DICOM server is a process that runs on the PACS server and provides external communication with the modalities that are configured to communicate with SYNAPSE using the DICOM 3 0 protocol Three typical transactions take place between SYNAPSE and a DICOM modality e Image compression and storage e Query retrieval of patient demographic information from the SYNAPSE database Modality Work List e Query retrieval of images from SYNAPSE to a query retrieve station Fuji Object Oriented Database FOOD This is the core of the system All textual information is stored in the database patient demographics procedure codes users etc The database also contains pointers or addresses for the graphical objects used in SYNAPSE images attached documents etc I mage Storage Area Network All graphical objects are stored on the image storage device or the Storage Area Network SAN server Internet Information Server IIS IIS is a software component that allows SYNAPSE to display lists and exams as web pages All SYNAPSE workstations communicate with IIS PACS Administrator Manual which in turn communicates with the database and the image storage device The Synapse components are a combination of hardware and software that resides on the PACS servers at
87. nd double click the Sentinel folder 9 Double click Sent 10 Double click Setup 11 Click File 12 Click Load Driver 13 Click Close All 14 Remove and reinsert the CD into the drawer 15 Expand PowerCDCreator to view the subfolders 16 Double click Setup application 17 Accept the defaults 18 Reboot the computer 19 1n Windows Explorer drag the labels from the desktop to C RADinfo 20 Open RADinfo PowerPACS and configure the labels DD DICOM CD Burner Page 105 PACS Administrator Manual Troubleshooting DD DICOM CD Burner Page 106 I If the Insert Software Key dialog box displays at startup a Click OK b Close the RADinfo CD PowerPACS software application and re open it c Repeat if needed d If the error continues to display after opening and closing the application three times reboot e Repeat if needed f If the error continues to display after rebooting three times reload the application If p If paper printouts are small CD size printouts on 8 5 x 11 inch paper e Locate and install the proper printer driver for your network printer To ensure that the DICOM system is communicating with Synapse ping the server using DICOM C Echo a In RADinfo PowerPACS left window locate the SJHS server b Right click the server and select C Echo to display verification of connectivity To learn more about basic troubleshooting a Double click the User Guide Manuals folder on t
88. ocedures Downtime e Verify technologists are Management following downtime procedures e Perform recovery activities after a downtime event Quality Assurance e Work with technologists and radiologists to ensure that image settings are correct Troubleshooting e Troubleshoot system problems e Coordinate activities with the Information Systems department when troubleshooting system problems e Manage and track problems until resolved Monitor Calibration e Calibrate Totoku monitors every six months e Generate monthly reports on Reporting modality volumes performance measures and system issues Personal e Read PACS related literature Development e Track industry trends Knowledge Sharing e Share knowledge and experience with PACS Administrators from other sites Fuji Users Group e Participate in Synapse groups such as FUSUN and Intelligroup PACS Administrator Manual User Accounts All users are first set up with a user name and password in the SJHS NT domain The PACS Administrator then uses the Synapse Web Administration Tool SWAT to set the amount of access and permissions for each user Synapse through the use of Windows authentication verifies the user s credentials and allows access to the Synapse application Account Setup Process Requests for new accounts must go to the local PACS Administrator The PACS Administrator verifies the user
89. of the network by checking the SJHS online Network monitoring system Netops To Access Netops 1 Open Internet Explorer In the address bar type netops On the Netops page select MRTG WAN Map Click the network links between your facility and the CDC to verify that the links are active ee ee N Server Problems Server problems are difficult to differentiate from network problems To check the status of your site s PACS servers 1 Open Internet Explorer 2 In the address bar type netops 3 On the Netops page select NetSaint for Southern California 4 On the NetSaint page click Status Overview e Allow a few seconds for the page to load 5 Scroll toward the bottom of the page to locate the SJ S NT Servers group Locate your site s servers to determine their status PACS Administrator Manual Interface Problems See Interface Monitoring on page 20 Downtime Procedures Downtime is an event when the PACS is unavailable Downtime can be either scheduled or unscheduled The PACS Technical Analyst schedules short downtimes lt 2 hours for Monday Tuesday or Thursday nights after 10 00 p m and longer downtime events gt 2 hours on weekends Unscheduled downtime Possible reasons for unscheduled downtime include e Server failure e Network failure e Software failure e Virus e Component failure Partial unscheduled downtime events include e Meditech down worklist not working e Int
90. om Fuji if the modality is new and not replacing an existing modality 1 Inform the corporate PACS Team when planning to add or replace a new modality a If the new modality is replacing an existing modality use the same IP and Application Entity Title AET as the replaced modality if possible Go to Step 6 below b If the modality is a newly added modality then perform Steps 2 5 2 Contact Fuji and request a quote for a connection license e Connection licenses are 3000 minus SJ HS standard discount of 27 or 2190 e This pricing is valid through 2007 Modalities Page 87 PACS Administrator Manual 3 Obtain a new IP subnet mask and gateway from Information Systems department 4 Configure the AET Application Entity Title and host names to match the SJ HS naming convention a Create both the AET and host names to include e 3 letter site ID such as SRM or SJO e Multiple letter equipment identifier such as IIP x5000 or Sequoia e 2 or 3 letter location identifier such CT MR or Rm2 b Make host name lower case and the AET full caps c Maximum number of characters is 16 for host name and AET Table 23 Example Host Names and AE Titles System Host Name AET SJO Drystar 5500 thermal camera in sjo ds5500 ct SJ O DS5500 CT CT SJO Sequoia 512 Ultrasound system sj o Sequoia 1 SJ O SEQUOIA 1 SJO Sensation 16 slice CT Navigator acquisition workstation SJ O SE
91. om to User Authentication a Under Logon select Automatic Logon with cur rent username and password Click OK to save the settings PACS Administrator Manual Set Internet Explorer to Blank 1 In Internet Explorer select Tools Internet Options 2 On the General tab in the Home page section below the address box click Use Blank 3 Click Apply OK Optimize Internet Explorer 1 In MS Internet Explorer select Tools Internet Options 2 On the General tab a In the Temporary Internet files section click Delete Cookies b In the Delete Cookies dialog box click OK to confirm the deletion c Click Delete Files d In the Delete Files dialog box check Delete all offline content and click OK e Click Settings f At Amount of disk space to use type a number equal to your computer s RAM and click OK Note To view e Convert RAM if needed See Conversions on RAM go to page 67 Control Panel System aa g In the History section click Clear History and look under h In the Internet Options dialog box click Yes to Computer confirm the deletion i Use the up down arrows to set Days to keep pages in history to 1 3 On the Advanced tab scroll down to the Security section 4 Select Empty Temporary I nternet Files when browser is closed 5 Click OK 6 Close Internet Explorer Workstations Page 71 PACS Administrator Manual MS Windows Updates Note Only Synapse
92. or studies when patients are scheduled for radiology procedures Training e Formal training conduct classroom or one on one user training e Informal training provide application and process support to end user e Personal training attend SJ HS Fuji or other PACS classes as appropriate to maintain and update skills System Testing Perform system testing of all Meditech and Synapse system changes patches and upgrades e Ensure level of testing is commensurate with the degree of change of the system e Ensure testing is end to end i e test of modalities sending amp worklist interfaces ADT Orders amp Reports Synapse functions image display and end user settings Procedure Code Management e Ensure procedure codes are unique and body part specific Hanging Protocols e Work with Radiologists to create maintain and update hanging protocols as needed PACS Administration Page 5 PACS Administrator Manual PACS Administration Page 6 Table 1 PACS Administrator Responsibilities Function Responsibility Comparable Study Table e Create maintain and update as new procedures or modalities are added e Work with Fuji and vendor support technicians to implement and maintain Acad ane communication with PACS such g as programming modalities to send images and retrieve worklist from Synapse e Establish and maintain downtime pr
93. plete If changes are made copy the changed profile to All Users Notify one of the Network Design Technicians that a new PACS workstation has been set up and needs to be added to the ePO server See Network Design Technicians on page 84 Clinical Workstation Settings Workstation settings are automatically loaded as part of the initial PACS image The following instructions can be used if the initial settings have been changed or to perform a manual installation A checklist of diagnostic and clinical workstation settings is located at the end of this chapter See Workstation Checklist on page 85 1 Set the monitor to portrait a 3J Q 7 0 Q ANA 0 j k l In Control Panel select Display Settings Select monitor 2 as the primary monitor Click Advanced Select the Adapter tab Select List all Modes Select 1200 by 1600 Select Display Settings Select monitor 1 as the primary monitor Click Advanced Select the Adapter tab Select List all Modes Select 1200 by 1600 m Select Display Settings n Workstations Page 65 Click OK to save PACS Administrator Manual Workstations Page 66 O a b C For a dual monitor setup set the monitors to Independent Mode using the graphics card software Set clock to 24 hour time format In the Control Panel select Regional Options On the Time tab at the Time Format dropdown menu select HH mm ss
94. properly Contact your PACS Administrator Problem You type your name and password correctly in the dialogbox but every time you press Enter the dialog box refreshes instead of opening Synapse Resolution Your user ID may not be set up properly Contact your PACS Administrator Problem New window opens when you double click a new folder Resolution a From the desktop right click Start and select Explore b On the menu bar select Tools Folder Options c On the General tab click Open each folder in same window d Click Apply OK and close Windows Explorer Problem Action Cancelled message displays during installation Resolution Refer to Configure Synapse Properties on page 2 Problem The logon prompt appears several times in a row when you try to logon Resolution a In MS Internet Explorer select Tools Internet Options On the Security tab select Internet and click Custom Level Scroll down to User Authentication Logon Select Automatic Logon only in Intranet zone Click OK twice to save the settings and exit the dialog box Problem When trying to view an image you receive the message Your display is configured for xxx colors Resolution a Right click the Windows desktop and select Properties b Click the Settings tab c On the dropdown menu at Color quality select Highest 32 bit and click Apply OK Problem Synapse icon does not display on the desktop Resolution a Right click on the
95. r A device used to scan a traditional X ray film to create a digital image data file There are two types of film digitizers in common use Both use lasers to scan the film to create the digital image however one uses photo multiplier tubes PMT to capture the light whereas the other uses charged coupled device CCD technology Dongle A hardware device that serves as copy protection for certain software by rendering the software inoperable when the device is not plugged into a printer port Ethernet This is the most widely used architecture in local area networks LAN It is defined by the IEEE as the 802 3 standard Ethernet operates over various types of physical media such as coaxial shielded or unshielded twisted pair and fiber optics It normally operates at 10 or 100 Mbps but new versions can operate at Gbit 1000 Mbps transfer rates Hanging protocol Default Display Protocol also called reading protocol Header In DICOM a standard medical image has an associated DICOM header containing information pertaining to the image e g patient name or image information such as the size of the image The header contains the information that allows the computer to exchange information related to the image with other devices and perform tasks on the data A header is also used in networking and is attached to each unit of data sent across the network the size of header being dependant on the network protocol being used
96. r RAID or J BOD Synapse Web Administrator Tool SWAT The SYNAPSE Web Administration Tool SWAT is a web based tool intended for use by the PACS Administrator and Fuji service engineers It serves to configure modify and maintain the SYNAPSE system This web based interface allows the PACS Administrator to configure all aspects of Synapse including users permissions roles and access Terabyte A unit of computer memory or data storage capacity equal to 1 024 gigabytes 240 bytes one trillion bytes Glossary Page 122 PACS Administrator Manual Transmission Control Protocol Internet Protocol TCP IP TCP is one of the main protocols in TCP IP networks Whereas the IP protocol deals only with packets TCP enables two hosts to establish a connection and exchange streams of data TCP guarantees delivery of data and also guarantees that packets will be delivered in the same order in which they were sent Ultrasound An imaging technique that uses high frequency sound waves Uninterruptible Power Supply UPS A device which provides back up power in the event of failure in the primary power supply system If there is a power cut or drop out the UPS will keep the system running for a finite period of time allowing the primary power supply to be repaired and or the system to be powered off gracefully This protects the equipment and the stored data Wide Area Network WAN A computer network that spans a relatively large geogr
97. r using Synapse How to Access PACS Synapse through Physician Connect from the Internet Dosistem Requirements Pentium Il min 400 MHz 256 MB minimum Windows 98 ME NT 4 0 2000 XP Home or XP Professional Internet Explorer 6 0 or newer 32 bit color High speed DSL or cable A dial up modem can be used but is not recommended i To View Radiology Images within Physician Connect 1 Locate the patient s radiology study 2 Click See Report to open the Transcription Viewer Editor window 3 Click View Detail to display the Synapse logon box a If Synapse is installed on the computer completing the logon box as shown below displays the radiology images b If Synapse is not installed on the computer completing the logon box as shown below initiates the installation process Note Installation and setup take about 5 minutes and are only necessary the first time Synapse is accessed on a computer a Install Synapse In the login box type your Synapse user ID and password a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userID b All other users type sjhs nt in the domain field When the Security warning message displays check Always trust content from FUJIFILM Medical Systems and click Yes When a black screen displays observe the progress bar until it reaches 100 Minimize all windows to reveal your Windows desktop Right click the Windows desktop and
98. rator Manual one with zero has the correct demographics Reallocating a Series 1 On the Windows desktop right click the Synapse icon and select Explore 2 On the Synapse toolbar click Folders 3 In the left Explore window click the plus sign to expand the Synapse folder 4 Repeat step 3 when there is a Synapse subfolder displayed below Synapse Log on to Synapse when requested Double click All Patients In the All Patients folder locate the source patient eS ee Double click the source patient entry e Inthe Folders window the patient name now displays as a subfolder of the All Patients folder 9 Click All Patients and locate the destination patient 10 Double click the destination patient entry e Inthe Folders window the patient name now displays directly below the source patient e Both the source patient and the destination patient display in the All Patients folder e If you cannot see both the source patient and the destination patient repeat steps six through ten until both patients are displayed 11 Double click the source patient folder to display all of the patient s studies in both the folders window on the left and in the Synapse window on the right 12 1n the Synapse window double click the source study to highlight it in the Folders window 13 After the images display click the Up button on the toolbar 14 Press F11 to view the Folders window 15 Expand the st
99. roblems e Daily for non urgent issues e When the problem is resolved report the findings and summarize the resolution 5 Document the problem details and resolution results in an Excel spreadsheet Troubleshooting Workstations Possible troubleshooting steps include 1 Reboot the system to clear the memory 2 Check all settings on the PC to ensure they are correct 3 Clear history caches and cookies from Internet Explorer 4 Clear Internet Explorer temporary files 5 Verify that Synapse is loaded correctly e If necessary remove the Synapse Code and reinstall 6 Verify that Synapse properties are set correctly 7 Ping a valid network address to verify that the network connection is working 8 Run a virus scan on the PC to verify that the PC is not infected with a virus Troubleshooting Remote Installations 1 Verify that the user ID is set up correctly 2 Verify that the user is typing their password and domain accurately 3 Follow the Troubleshooting Workstations steps above Support Page 43 PACS Administrator Manual Support Page 44 Troubleshooting Other Areas Network problems If all Synapse workstations are equally affected the problem may lie in the network connection Network problems are handled by an Information Systems Analyst but it is always helpful to the PACS Administrator to understand the nature or frequency of a problem when troubleshooting Check the status
100. rs are affected The problem has high visibility and materially impacts ability of SJHS to perform its business and there is no work around PACS Administrator Manual Support Page 41 Service Level Agreement SLA is ticket closed or in Temp Fix within 4 hours of occurrence Initial contact guideline is within 30 minutes Examples e Network connectivity down to one or more sites e Phone system unavailable at one or more sites e Meditech System unavailable at one or more sites Severity Two Any reported problem where the majority of the users for a particular system are affected The problem has high visibility a work around is available however performance may be degraded or functions limited SLA ticket closed or in Temp Fix within 8 hours of occurrence Initial contact guideline is within 30 minutes Examples e GroupWise unavailable at one or more sites e Meditech Order Entry unavailable e Network drive or Home directory unavailable to multiple users Severity Three Definition Any reported problem impacting one customer or small group of customers which is important to business but there is an acceptable work around SLA ticket closed or in Temp Fix within 48 hours of occurrence Initial contact guideline is within 2 hours Examples e Printer problems in patient care area e Unit secretary phone unavailable other lines working PACS Administrator Manual Close The PACS Administrator is
101. s 43 U user accounts 7 PACS Quick Card Order List and Examples Title Status Source file Updated Notes PACS Administrator Manual First draft PDF FrameMaker 10 04 04 See separate manual PACS Technical Analyst Manual In progress FrameMaker N A See separate manual PACS Remote Access Setup Quick Card Approved Illustrator 6 3 04 Print full color sides a and b back to PACS Remote Access Setup_June3_side a back on white light weight card Fold in PACS Remote Access Setup _June3_side b half Physician Connect Access Quick Card Approved Illustrator 6 3 04 Print full color sides a and b back to Physician Connect Access _ une3_side a back on white light weight card Fold in Physician Connect Access _June3_side b half eFilm Lite for CD sleeves Approved Illustrator 9 28 04 Print full color on backs of paper CD CD sleeve_sept28 sleeves with transparent window on front Pocket Quick Reference Card Approved Illustrator 6 3 04 Print 4 up full color sides a and b Pocket QR card_June3_side a back to back on white light weight Pocket QR card_June3_side b card and cut to four DD DICOM CD Burner Quick Card Approved Illustrator 9 21 04 Print double sided full color on white DD DICOM Card v1_Sept21 light weight card and cut to two Troubleshooting Synapse Installation Problems Problem Synapse opens partially then freezes Resolution Your user ID may not be set up
102. s window along with the study Workflow Tab The Workflow tab options configure how the Synapse application reacts to the use of the F8 and F9 keys when a Radiologist reads from an unread studies folder Table 17 Workflow Tab Item Purpose Automatically display next case Manually select next case for display Go back to list to choose another case F8 Key When viewing studies from an unread folder this key marks the open study as dictated and can either a proceed to the next unread study on the list b allow the user to manually select the next study or c return the user to the worklist Automatically display next case Manually select next case for display Go back to list to choose another case F9 Key When viewing studies from an Unread Folder this key skips the open study without marking it dictated and then can automatically go to the next Unread Study on the list or allow user to manually select the next study or automatically return user to the worklist Selected Items Viewed Items F12 Key Automatically mark selected or viewed items as dictated Security Tab For both diagnostic and clinical workstations the Security tab should remain set to the defaults that come across with Synapse installation Workstations Page 76 PACS Administrator Manual e Allow access to Synapse from desktop is checked e Enabled Auto
103. select Refresh Go to Page 2 of this instruction sheet and set up Synapse Properties A Configure Synapse Properties 1 Right click the Synapse icon 2 Select Properties 3 In Synapse Properties on the Data Source Settings tab a Type the appropriate address for your hospital Facility URL Mission https pacs2 stjoe org mhr Queen of the Valley https pacs2 stjoe org qvh Santa Rosa https pacs2 stjoe org srm St Jude https pacs stjoe org St Joseph Eureka https pacs2 stjoe org sje St Joseph Orange _https pacs2 stjoe org sjo b Check the following boxes Use encrypted communication https for images Enable pre caching images for slow networks c In AON Factor for Initial Display select Reference for faster downloads or select Clinical or Diagnostic for more image detail in the initial download Note The AON factor can be changed after the images are downloaded On the Synapse View Settings and Workflow tabs check the desired options Click Apply OK Right click the Synapse icon and select Log Off Synapse Maximize the Transcription Viewer Editor window and click View Detail to open and use Synapse amp Configure Internet Explorer Properties In MS Internet Explorer select Tools Internet Options On the Security tab select Custom Level In the Settings box under Active X controls and plug ins click the center radio button to enable the following a Download signed ActiveX controls
104. settings on the Synapse View Settings tab are optional and should be set by each user to his or Workstations Page 75 her own requirements Table 16 View Settings Tab Item Check box to automatically Save Filter settings Saves the most recent filter value in the search bar Save View settings Saves the last List view used Show Report Automatically opens a report if a report is available when a study is displayed Show notes if report is not Automatically opens the notes page if no report is available when a available study is displayed Automatically opens the Study Show study Information page when a study is Information displayed Display comparison study Automatically displays multiple comparison studies The number of comparison studies can be set for each modality only for unread studies Displays the comparison studies only for unread studies Select comparison studies with Displays the comparison study with the same modality or the same procedure code or a related procedure code or a related procedure code within the same modality Include newer comparison studies Allows user to view newer comparison study when an older study is opened PACS Administrator Manual Table 16 View Settings Tab Item Check box to automatically Close notes window after adding a note Automatically closes the note
105. ssion forum for users of Fuji Synapse PACS Its purpose is for the exchange of experience and knowledge related to the use of Synapse To visit Intelligroup go to www fujimed com and select Communities I ntelligroup This free user s group includes e Threaded discussions dealing in topics such as CRT vs LCD archive solutions etc e Information on updates for Synapse infrastructure software e Topic areas including OEM partners workstations DICOM e Synapse software documentation e Synapse events calendar Synapse PACS To learn more about Synapse from Fuji go to www fujimed com and select Products and Services The Synapse link includes e Architectural Choices e Product Information e Technical Data e Customer Profiles e Standard Compliance Fuji Synapse Users Network FUSUN Email the Fuji Synapse user s network at fusun scarnet org PACS Resources Page 111 PACS Administrator Manual Synapse online help files On the Synapse toolbar click Help Synapse Help to open the Synapse Online User s Manual PACS Resources Page 112 PACS Administrator Manual Abbreviations ACR American College of Radiology AEMR Ambulatory Enterprise Medical Record AET Application Entity Title ANSI American National Standards Institute ASP Application Service Provider bps Bits per second CAD Computer Aided Diagnosis CCOW Clinical Context Object Workgroup SJ HS Centralized Data Center located
106. strator Manual Anomalies by Type Folder Synapse provides a list of all anomalous exams within the Anomalies by Type folder This folder contains the following three subfolders 1 Recent Anomalous Studies containing seven days of anomalous studies All Anomalous Studies containing a listing of all anomalous studies regardless of age Fixed Studies containing a listing of anomalous studies that have been corrected Common Anomalies PACS Administration Page 11 Mismatch patient name Issue The patient name does not match the patient name of the destination folder Possible Cause I 2 3 The incorrect patient name was manually entered into the DICOM header rather than selected from the modality work list The incorrect Accession Number was manually entered into the DICOM header rather than selected from the modality work list The Account Number Visit Number was switched to another Unit Number Patient ID in Meditech Synapse will reject each order result update message for orders that existed prior to the Unit Number Patient ID switch e Currently this functionality causes an A34 ADT Merge message to be sent from Meditech to Synapse The merge message causes Synapse to combine the patient folders with the associated Patient Ds e In the Synapse Patient Merge folder the initial incorrect Unit Number Patient ID is referred to PACS Administrator Manual as the source folder and the new
107. t Graphics card installed if appropriate NIC at 100 Mbps Full Duplex Virtual memory equal to 150 of RAM 5 6 7 24 hour clock 8 9 Power Management for system set to off 10 Power Management for NIC set to off 11 Fonts enlarged 12 Mouse pointer enlarged 13 Recycle bin set to 3 14 Clean Start menu 15 Clean desktop 16 Internet Explorer configured 17 Internet Explorer set to blank page 18 Internet Explorer optimized Workstations Page 85 PACS Administrator Manual Workstations Page 86 Table 22 Workstation Checklist No Diagnostic Clinical Workstation Checked Item 19 Microsoft Windows updates completed 20 Synapse installed 21 Synapse properties configured 22 Virus scan software installed icon visible 23 Profile copied to All Users 24 Virus scan set to ePO server icon visible Items one through six are completed by the PACS Technical Analyst or local IT personnel Item is not part of standard PACS image and must be added after imaging the PC PACS Administrator Manual Modalities Adding a New Modality Before adding a new modality to the PACS both the modality and Synapse are configured so they can communicate The modality technician configures the modality and Fuji configures Synapse A connection license must be purchased fr
108. t If Synapse was previously installed from the test server completely uninstall the test server version of Synapse and install the production version before using Synapse in the production environment Table 14 Production Servers Facility URL MHR http mhrweb1 QVH http sjsnt qvhpacs1 SJF http sjfweb1 SJO http sjoweb1 SRM http sjsnt srmpacs1 Note For off site 2 installation of Synapse See In the network logon box type your Synapse user ID password and domain Remote Workstations on page 78 a Windows XP users type the domain ID before the user ID separated by a back slash i e sjhs nt userl D b All other users type sjhs nt in the domain field 3 When the Synapse Workstation page displays click Synapse Workstation Code Download 4 When the Security warning message displays check Always trust content from FUJIFILM Medical Systems and click Yes 5 After the message Installation of Synapse version xxx successful displays close Internet Explorer 6 Right click on the Windows desktop and select Refresh If both Synapse test and Synapse live are installed on the same computer use the Synapse properties window to navigate from one to the other 1 On the desktop right click the Synapse icon to open the properties window Workstations Page 73 PACS Administrator Manual Workstations Page 74 At the Data Source Settings tab
109. t any patient whose face is partially covered by a CD icon denoting that a CD was burned 2 Select Reports Task List to open the CD Task Dialog window 3 Click Modify DD DICOM CD Burner Page 99 PACS Administrator Manual 4 Place a checkmark at Write CD Again 5 Type the number of copies needed and click OK Import or Send from a Guest CD Each CD is created using the DICOM 3 0 standard for medical communication protocol with a Part X standard for exporting images If a CD is brought in from a facility outside the SJ HS system images view correctly if the same standards were used to create the CD When the standards are used the CD can be viewed as if it were the original based on the viewing station s capabilities Import the images send them to Synapse then notify the physicians they can view the images on the nearest clinical or diagnostic workstation Note that images transferred from film to digital via a film digitizer cannot be manipulated or viewed as originals 1 Insert the CD into the Dell PC 2 If the CD auto executes close the program 3 In RADinfo PowerPACS select File Import DI COM Images 4 In the Open dialog box select the folder with DICOM in the name e Folder names vary based on what program was used to create the original CD 5 Click Open to display the Import Images window 6 In the Import Images window select the images to transfer 7 Click one of the following e I
110. tement provided by a vendor associated with a specific implementation of the DICOM Standard It specifies the service classes information objects and communication protocols supported by the implementation This statement is usually several pages long and specifies precisely how any item of equipment will implement the various options allowed within the DICOM standard DICOM Study The study with images sent to Synapse from a modality Digital Audio Tape DAT A magnetic tape storage device used in the backup of large amounts of data which conforms to the DDS standard The cartridges can store from 2 to 20 GB of native or uncompressed data with an archiving rate of 2 Mbps Digital I maging and Communications in Medicine DI COM The ACR NEMA standard protocol adopted by all manufacturers of equipment associated with medical imaging The standard provides a method of linking a series of heterogeneous modalities workstations and printers without the need for customized hardware to allow them to communicate and transfer images http medical nema org dicom html Digital Linear Tape DLT A magnetic tape storage device used in the backup of large amounts of data The tape cartridges can store from 20 to 40 GB of data and has a transfer rate of 6 MB sec The DLT system was improved to super DLT S DLT which has a maximum storage of 110 GB with a transfer rate of 11 MB sec Glossary Page 118 PACS Administrator Manual Digitize
111. tered into the DICOM header Resolution 1 4 Validate whether the patient name and or Patient ID were mistakenly entered or the images belong to a different patient If the patient name and or Patient ID were mistakenly entered e Using Meditech as a reference validate that the patient s data displays correctly in Synapse e Using the RIS Scheduler make corrections to data as needed If the images belong to a different patient e Reallocate the images to the appropriate study folder Delete the anomaly entry Mismatch Visit Study Issue The incoming Visit Number is not the same as the Visit Number associated to the study in Synapse Possible Cause The incorrect Visit Number is manually entered into the DICOM header rather than selected from the modality work list The Account Number Visit Number was edited in Meditech Resolution 1 Compare the order data in Meditech with the study data in Synapse PACS Administrator Manual PACS Administration Page 14 If the order has been Cancelled in Meditech use the RIS Scheduler to change the Study Status to Cancelled If the orders are still valid in Meditech use the RIS Scheduler to update the Visit Number in Synapse Resend any failed order result messages from Meditech to Synapse Delete the anomaly entry Study Absent Issue Images are received in Synapse prior to the Meditech order message Possible Cause The Meditec
112. tern button e A smooth white screen denotes no dead pixels 2 Click the Gray scale adjustment pattern button PACS Administration Page 33 PACS Administrator Manual e Dark black on the left of the screen graduating to pure white on the right of the screen denotes no problems 3 Click the SMPTE Society of Motion Picture and Television Engineers pattern button e In the center of the pattern on the 0 100 line are two sets of squares within squares at the black end and the white end of the gray scale e It is not necessary that the squares have the same contrast ratio 4 Click the Contrast pattern button e The 4th horizontal band in the center of the pattern should show good contrast e Models 311L ME312L should display steady but not stepless gradation all the way across e Model ME315L should display a smooth stepless gradation Start the Calibration The ambient light in the room affects the calibration results therefore the lighting in the room should be the same during monitor calibration as it will be during monitor use 1 Click a monitor selection button to select that monitor for calibration 2 Click the Automatic Adjustment button the second button down on the left side of the Medivisor window to begin the calibration 3 Select the radio button based on monitor selected a First monitor to calibrate select the New Adjustment radio button and click Start b Second monitor to calibrate
113. the Orangewood Centralized Data Center CDC Synapse Components Ll Orangewood Thin Client Centralized Data Center CDC Fat Client oily Network Closet Clinical Workstation Hospital Data Center IDF an oe Diagnostic i Bs 2 Workstation SZ Radiology A Network Closet Si 7 DICOM Modality N SS Paxport LT in PACS Servers raf Modality Synapse PACS Page 3 PACS Administrator Manual PACS Administration PACS Administrator Responsibilities Responsibilities of the Synapse PACS Administrator are described below for each major functional area or activity Table 1 PACS Administrator Responsibilities Function Responsibility User Management e Add Change inactivate Synapse user access in SWAT e Submit changes to SJHS Help Desk for SJ HS network accounts Study Management e Maintain synchronization of e Manage amp repair anomalies Meditech and Synapse databases PACS Administration Page 4 PACS Administrator Manual Table 1 PACS Administrator Responsibilities Function Responsibility Interface Monitoring e Use the HIIS Interface Monitoring Tool to monitor the state of Fuji integration Meditech messages filing into Synapse e Use the Meditech MIS Outbox to review the status of outgoing messages and to resend messages to Synapse as needed Digitize Prior Studies e Digitize pri
114. the local server every seven days or when the cache is full 100 MB whichever comes first The right upper window displays the detailed view of images and patient information e Images can be dragged and dropped from this window into the window below for CD creation The long window at the bottom of the screen displays studies ready for the CD e Checkmarked studies are marked for burning e Non checkmarked studies are not burned to the CD The bottom right corner displays the information that will be burned as part of the CD e g title ID date and disk space the prospective burn requires Create a New User Account 1 DD DICOM CD Burner Page 94 In RADinfo Power PACS select File User Accounts In the User Accounts window e At User Name type the name of the user e At password type a password for the user e Confirm the password e At Full Name type a name for the type of account e g admin or user PACS Administrator Manual e At the Default CD Label dropdown select both a single patient default label and a multiple patient default label e Under User Right checkmark permissions for the user e Click Add e Repeat for each user e Restart the computer to activate the new user s Configure Rimage System Manager Note Change only the tabs listed Leave all other tabs set at their defaults DD DICOM CD Burner Page 95 The following changes to settings need to be done at first
115. the uninstaller Check for an Installed Monitor Driver Skip this section if no driver is installed 1 In the Control Panel select Display On the Settings tab click Advanced On the Adapter tab click Properties On the Driver tab click Properties e If there is more than one graphics card they will all be displayed here 5 Do not upgrade the driver from the Control panel BOUN Check for the Most Current Monitor Driver 1 Go to the Quest International Incorporated website and determine the latest recommended monitor driver for your operating system a Go to http questinc com b Mouse over and click the photo of the medical monitor Workstations Page 57 PACS Administrator Manual Note If you have problems with the download use the directions in Check for most current driver located above Workstations Page 58 c In the gray window on the bottom left side of the screen select Drivers Calibration Software d In the dropdown window on the Drivers Calibration Software screen select by display On the Drivers for Totoku Displays screen locate your monitor model in bold type Locate the correct download for your operating system and read the version next to the OS name If the driver listed on the Quest website is more recent than the installed driver uninstall the currently installed driver See Uninstall the Totoku Monitor Drivers on page 59 e Do not attempt to install ov
116. tine any infected file Notify user that a virus has been detected Clean the infected file Delete any infected file that does not clean up Log any virus activity Exclude C Program Files Meditech Print The ePO server itself receives the same scheduled scan at noon every day but also receives a more thorough scan every Wednesday morning at 0400 hours The ePO server scans are set to Scan boot sectors Scan floppy drive during shutdown Enable on access scanning at startup Enforce a maximum scanning time of 15 seconds for archives and 45 seconds for all files Scan for macro viruses in all files Overwrite client exclusions Scan inside packed executables Quarantine any infected file Notify user that a virus has been detected Clean the infected file Delete any infected file that does not clean up Log any virus activity Exclude drives O Q W I and J Exclude the Oracle database on D Table 20 PACS Drives System Drive Letters Files C Operating system D Database backup O Synapse live database PACS Administrator Manual Table 20 PACS Drives System Drive Letters Files Notes reports annotations docs 1 J images Q W The v shield icon in the system tray designates the anti virus protection is installed The man shield icon in the system tray designates the PCs connection to the ePO server for uninterrupted scanning and security
117. tion Your user ID may not be set up properly Contact your PACS Administrator Problem New window opens when you double click a new folder Resolution a From the desktop right click Start and select Explore b On the menu bar select Tools Folder Options c On the General tab click Open each folder in same window d Click Apply OK and close Windows Explorer Problem Action Cancelled message displays during installation Resolution Refer to Configure Synapse Properties on page 2 Problem The logon prompt appears several times in a row when you try to logon Resolution In MS Internet Explorer select Tools Internet Options On the Security tab select Internet and click Custom Level Scroll down to User Authentication Logon Select Automatic Logon only in Intranet zone Click OK twice to save the settings and exit the dialog box Problem When trying to view an image you receive the message Your display is configured for xxx colors Resolution a Right click the Windows desktop and select Properties b Click the Settings tab c On the dropdown menu at Color quality select Highest 32 bit and click Apply OK Problem Synapse icon does not display on the desktop Resolution a Right click on the Windows desktop and select Refresh b If refresh does not solve problem reboot c If rebooting does not solve problem repeat the installation Contact your PACS Administrator at for help installing o
118. tors They are used by radiologists for primary interpretation Diagnostic These workstations have one or two 2 megapixel 1200 x 1600 color monitors They are used by physicians and clinicians for viewing radiologic images Some clinical workstations are mounted on mobile carts for use in O R suites Clinical These are standard PC workstations that may already be located throughout the hospital Synapse is loaded on the PC often along with other applications such as Meditech Review PACS Administrator Manual Workstations Page 53 Table 9 Types of PACS Workstations Type Description Thin Client Some thin client workstations may be configured to provide access to Synapse Thin Client workstations are setup and maintained by the Citrix Administrators Remote Access to Synapse outside the hospital is via a remote workstation This may be a standard PC or laptop located in a physician s office or home The system requirements are also based on the location of the workstation and the personnel that will use the workstation Table 10 System Requirements Hardware Diagnostic amp Review and Remote Software Clinical Setup Setup CPU Pentium IV min Pentium II min 400 400 MHz MHz RAM 1 GB or higher 256 MB minimum Operatin Windows 98 ME NT eae Windows 2000 4 0 2000 XP Home y or XP Professional Internet Explorer Internet Explorer 6
119. tration Page 31 PACS Administrator Manual e Skip the adjustment patterns and go directly to Start the Calibration See Adjustment Patterns on page 32 Click the top adjustment button to display the available adjustment patterns for the selected monitor See Adjustment Buttons on page 33 Table 4 Adjustment Patterns Adjustment pattern icon Pattern name Pattern description All white Displays an all white screen to show any dead pixels m Gray scale Displays all gradations of black to white to show a normal screen SMPTE In the center of the pattern are two sets of squares within squares If both inside squares are visible the settings are good Contrast The 4th horizontal band in the center of the pattern should show good contrast PACS Administration Page 32 PACS Administrator Manual Table 5 Adjustment Buttons Adjustment button description Adjustment Adjustment icon button name Display test ae atl patterns on p screen Requires the A Medivisor J Calibration sensor Manual Do not use adjustment Inspection Panormi KA p inspection Advanced Mode Do not use The first 4 patterns that display on your screen are for curved screens only They do not assist in determining flat screen calibration and are not shown in this manual 1 Click the All white adjustment pat
120. udy PACS Administration Page 19 PACS Administrator Manual 16 In the Folders window expand patient s destination folder to reveal all of the patient s studies both in the Folders window and in the Synapse window 17 1n the Synapse window double click the destination study to highlight the study in the Folders window 18 After the image window displays click the Up button on the toolbar 19 Press F11 to view the Folders window 20 Expand the to display the source study series subfolders 21 Double click the source study Series folder to display the series subfolders in the Synapse window 22 Drag and drop each source study series subfolder to the destination study folder 23 When the message box displays move confirm or cancel appropriately Reallocating a Study or Image Reallocating a study or image is performed using the series reallocation process above but moving a study or image rather than a series Interface Monitoring Using the HIIS Router Monitoring Tool PACS Administration Page 20 The Synapse HIIS Router Monitoring Tool provides a graphical interface of web pages for the PACS Administrator to monitor the status of integration between Meditech and Synapse From the Status Page the user can view 1 Number of messages completed 2 Number of pending messages 3 Number of messages rejected by the destination Synapse 4 Number of messages that failed translation PACS Adm
121. uecsesutesaneeoensiiuacsneenane 98 Create D steoiuxeunsathhteancicctewieakenecnnbatenneetecdoeiease 98 Import or Send from a Guest CD ccecce 100 Reports and LOGS ssssssssssssssrrrrrrrrrressrrrrrrrrrresere 101 PACS Administrator Manual Table of Contents Page ii Everest I Label Printer cccccceeeeeeeeeeeeeees 102 Media KitS s cazccncaecewncske tuancenanicoteaccerssacendaccwsadins 103 eFM LITE sence sasticendaraunaciedianesienitansalebsdahduasstaesss 104 Reloading RADinfo PowerPACS Software 105 Troubleshooting Sccccssorsacnserphevasiearsavtereaannaneaunss 106 PACS Resources Abbreviations Glossary PACS Contact Listing PACS Administrator Manual Synapse PACS Fuji Synapse the Picture Archiving and Communication System PACS for the St Joseph Health SJHS System consists of five major components 1 Hospital Information Interface System HIIS DICOM Server Fuji Object Oriented Database FOOD Image Storage Area Network SAN a el Internet Information Server IIS Synapse PACS 1 2 RIS HL7 DICOM server Fuji Object Oriented Database F 0 0 D Modalities Internet Information Server IIS Storage Area Network SAN Synapse Workstation i Synapse PACS Page 1 PACS Administrator Manual Synapse PACS Page 2 Hospital Information I nterface System HIIS This software component is the interface between HIS RIS a
122. ur CD 1 Insert CD in drive If CD does not auto execute in 8 seconds Right click Start and select Explore MI e Locate and expand CD drive e Double click the Merge eFilm icon FFPS 2 In the eFilm window select one or more exams amp click View 3 To scroll hold down the left mouse button and move it forward and backward 4 To adjust contrast hold down the right mouse button and move it side to side 5 To adjust brightness hold down the right mouse button and move it forward and backward 6 To display another study while a study is open click the question mark e To replace the open study click Yes at the query To open the study concurrently click No and then Yes 7 Right click an image to display a dropdown menu of available series e On the dropdown select a series 8 To view all eFilm tools select Toolbars Full CD Sleeve_vla 4 PACS Synapse Quick Reference Card Log On Synapse Double click the Synapse program icon to open Synapse Double click the word Synapse on the gray background to expand the Synapse folder At the logon screen type your Synapse user ID password and domain name a Windows XP users type the domain ID before the user ID separated by a back slash i e sjns nt userID b All other users type sjhs nt in the domain field Press Enter A Locate a Study Double click All Studies or other desired folder Click in the address box in the Patient N
123. urned CDs e An unlimited number of burns can be ordered in succession without waiting for the burner to complete any of them As long as the system is left open and running the process will proceed until all CDs are burned e f more than one CD is needed to complete the series the CDs is labeled 1 of 3 2 of 3 3 of 3 etc The DD DICOM CD Burner workstation should remain on at all times and the RADinfo PowerPACS software should remain open and ready to use This allows the modalities to push to the CD burner without assistance If the computer is rebooted the screen displays two choices for logon Admin and User Select the appropriate icon and use the logon and password supplied by the PACS Administrator If the computer is on and the RADinfo PowerPACS software application is not visible it is minimized Click RADinfo on the taskbar to maximize the application PACS Administrator Manual The RADinfo PowerPACS software application opens to display four windows 1 The left window displays 2 4 e The local hard drive and any studies currently stored there e The DICOM server not available red circle with a line through it The red circle and line disappear after a query is performed e Studies display with human faces Initially the face is a profile The image turns full face when selected The full face has a CD partially over it when a CD was burned e Downloaded files are automatically deleted from
124. use to display a 2 cm square magnifier Release O and move the magnifier around Press F11 to toggle between full screen theatre mode and the standard MS Windows display mode Bal Use the Power Jacket to Review Data Click the Power Jacket icon to view patient data such as other studies available specific information on a study reports notes and attachments to the study Click and drag one corner or side of the Power Jacket to resize it If the Power Jacket is minimized click the Restore Up button to maximize it EJ Restore Up A W Log Off To maintain security of patient information right click Synapse icon and select Log Off Synapse when finished Contact your PACS Administrator at for help installing or using Synapse A Navigate Manipulate Synapse Click an image and use the mouse wheel to move through the slices in a series Use the right arrow on the Synapse toolbar to go to the next series when there are additional series available Click and right click the image to display a context toolbar with image manipulation tools To use the window level zoom and pan tools Select the tool with your left mouse button and keep the mouse button down while moving the tool on top of the image To toggle between tools With the window level zoom or pan tool active left mouse key is down right click the mouse Hold down the letter O and left click mouse to display a 2 cm square magnifier
125. vers 2 Select a server in the left window e The right window displays three tabs Server Info Server Orders and Server Log 3 Select the Server Log tab DD DICOM CD Burner Page 101 PACS Administrator Manual 4 Click View Log File for a more detailed view of the server logs Occasionally during a support call the Data Distributing Rimage or ATR systems engineer requests to have a copy of the server log faxed to them To copy server log information 1 Open the server log 2 Copy the information needed e Highlight the portion needed or press control a to select the entire log e Press control c to copy the selected information 3 Select Start All Programs Accessories WordPad 4 Press control v to paste the information into WordPad 5 Save the file to the desktop 6 Print the file and fax as requested Everest II Label Printer DD DICOM CD Burner Page 102 The Everest II Printer will not operate without at least one ribbon either color or black It is not necessary to have both The clear transfer filament is not a ribbon It is a clear film that protects the printed labels from smearing or wearing off after a period of time and gives the labels a laminated appearance e Do not print labels without filament Do not rewind the ribbons to reuse them PACS Administrator Manual Cleaning the Printer The following items should be cleaned every three months e Printhead
126. wing boxes e Use encrypted communication https for images e Enable pre caching images for slow networks c In AON Factor for Initial Display select Reference for faster downloads or select Clinical or Diagnostic for more image detail in the initial download Note The AON 9 On the Synapse View Settings and Workflow tabs factor can be check the desired options changed after the f images are 10 Click Apply OK downloaded 11 Right click the Synapse icon and select Log Off Synapse 12 Configure and optimize Internet Explorer as above 13 Recommend to your radiology personnel that they a Use virus scan software and keep it up to date b Regularly update MS Windows with critical updates and service packs Go to http www microsoft com for more information c Maintain security by logging off Synapse when finished Remote Installation via Physician Connect The instructions below are printed separately by SJ HS as Quick Install Cards and are available from the PACS Administrator 1 Locate a patient and then the patient s radiology study Workstations Page 80 PACS Administrator Manual Note Installation and setup take about five minutes and are necessary the first time Synapse is accessed ona computer Workstations Page 81 9 Click See Report to open the Transcription Viewer Editor window Click View Detail to display the Synapse logon box a If Synapse is installed on the computer co

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