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The Metron `Quick Start` Tutorial

1. LA Fine Rotation ooa S10 30 oz A108 a 30 deg Jog Position Reset ei m ieh piel Trim Left Trin Fight Eoo Trim Top PEE Timeo lt lt _ _ lt _ Use calibration from this image Pay ay fT Remove Image Resolution 1 2 Add Image New Image Size 2284 x 1264 Stitch Done Addto Study Figure 7 The user uses the Fine Jog buttons red colored arrows to carefully jog the image into position Metron MD User Manual Version 6 EponaTech LLC 2011 70 Ei Stitch Two or more Images into One Click and Drag to Move Images 0 All C Curent C None Actions Apply to Current Image Highlighted in Red Large Rotations a D gt 90 90 180 i ema i Scale i 1 A Fine Rotation S024 10 53 0 ox a 30 deg Jog Position t os a step pial Trim Left Trim Right Trim Top oe a M Use calibration from this image er Pani zO New Image Size Sitch Done 2284 x 1264 Figure 8 The red highlight box around the active image can be temporarily turned off so the user can see exactly how the stitch will look Satisfied with the alignment of the images the user clicks the button labeled Stitch Done Add to Study and the stitched image is added to the study Figure 9 The original two images are not disturbed Items in the Selected Study Click to Select or DoubleClick to Open Stitch
2. Next easiest is something metallic of your own that you may have that could be placed In this case Metron won t automatically find it but you can use the calibration option to Pick 2 Points that are a known distance apart and you are calibrated so very easy Known Pixel Pitch Now on to ways that require knowledge of FFD and OFD If there is no scale marker in the plane of interest then the only way to get calibrated is to know the relationship between pixels and physical length on the CR or DR plate and also to know the FFD and OFD so that Metron can do the math to transform all measurement into a plane parallel to the CR or DR plate but offset from it the plane of interest This is known as the Known Pixel Pitch method of calibration In the case of CR Metron knows the scan setting used In the case of DR Metron knows the pixel spacing of the detector plate But to transform the measurements that is to take the magnification out we must have the FFD and OFD and this is entered into the calibration panel In case you want an approximate plane of interest always to be a certain height off or your table you can enter these values once and you ll see that Metron will remember values put in for FFD and OFD from session to session Metron MD User Manual Version 7 EponaTech LLC 2013 23 N WARNING WARNING Metron provides several methods to calibrate images Failure to carefully follow calibration
3. Metron MD User Manual Version 6 EponaTech LLC 2011 77 The user then clicks on the Next Step gt gt button in the Guide Panel to advance to the next step Step 2 and the user is instructed to select the two superior points on S1 the Sacrum Figure 7 When the user has picked the two points on the sacrum in the actual radiograph a green line is drawn on the radiograph which signals the user that he has completed this step Figure 8 Guided Mark Up Follow these Step by Step Instructions to add Markers to the image 2 Pick 2 superior points on 51 o Overlays Size 2 v Pick Point 1 rita Pick Difficulty Picking as Instructed Feature unclear These picks are guesses Figure 7 Guide Panel for Step 2 pick two superior points on S1 Wita Figure 8 Step 2 is completed Metron MD User Manual Version 6 EponaTech LLC 2011 78 Again when the user clicks on Next Step gt gt the process advances to Step 3 and the user is instructed to pick the anterior inferior point on the L5 Figure 9 Since this step of the instructions calls for just a single point being picked it is immediately highlighted in green after the user has selected the point on the radiograph indicating that the user has completed this step Figure 10 Guided Mark Up Follow these Step by Step Instructions to add Markers to the image 3 Pick anterior inferior point on L5
4. Pick Point 1 Difficulty Picking as Instructed Feature unclear These picks are guesses Figure 9 Guide Panel for Step 3 pick anterior inferior point on L5 eS Figure 10 The user has selected the requested point Metron MD User Manual Version 6 EponaTech LLC 2011 79 In the next step Step 4 the user is instructed to pick 2 points on the anterior body of L3 Figure 11 Guided Mark Up Follow these Step by Step Instructions to add Markers to the image 4 Pick 2 points on the anterior body of L3 Pick Point 1 Unelo Pick Difficulty Picking as Instructed I Feature unclear These picks are guesses Figure 11 Guide Panel for Step 4 pick 2 points on the anterior body of L3 Figure 12 After the user selects the two points on the radiograph a green line is drawn between them to indicate that the requested picks are complete Metron MD User Manual Version 6 EponaTech LLC 2011 80 When the user clicks on Next Step gt gt the Guide Panel for Step 5 is presented which is the last step in the guided mark up of the lateral lumbar spine The user is instructed to pick the two points on the anterior of the T12 vertebra Figure 13 When the user has selected the two points on the radiograph a green line is drawn to indicate that this step of the process is complete Figure 14 Guided Mark Up Follow these Step by Step Instructions to add Markers to the ima
5. deg Reset Jog Position t anini aE el Tit TimBits Trim Top SENEE Trim Bot 1 Use calibration from this image Pushy org 1 Remove Image Resolution 1 2 v Aaa image New Image Size Stitch Done 2284 x 1264 Add to Study Figure 4 The Stitch Images panel The user begins by clicking on an image and dragging it with the mouse The palette enlarges as needed as images are dragged on the screen In Figure 5 a rough initial positioning has been done by just dragging the image of the hand lick and Drag to Move Images Show Borders S Corer C Noe Actions Apply to Current Image Highlighted in Red Large Rotations os hai 30 30 180 Scale i CA Fine Rotation c S02 oo 30 coz 10 30 deg Jog Position t zeta dee mp ci 4 Trim Left Trim Right Trim Top TREIE Trim Bot 1 Use calibration from this image Ea E T Remove Image _ Resolution 1 2 v Add Image New Image Size Stitch Done 2284 x 1264 Add to Study Figure 5 User has dragged the image of the hand to the left side of the area Metron MD User Manual Version 6 EponaTech LLC 2011 69 In this example the user now sees that the left image hand and forearm must be rotated slightly in the clockwise direction Since this image is highlighted in red it is the active image which the tools on the right han
6. 17 Lumbar Lordosis 35 26 deg pi p Figure 17 This example shows the lumbar lordosis overlaid on the image Itis an angle related to the top of the sacrum and the bottom of the T12 vertebra Metron MD User Manual Version 6 EponaTech LLC 2011 84 A user may check multiple checkboxes and have multiple measurements overlaid on the radiograph Figure 18 shows the radiograph when the checkboxes for L1 2 Angle L2 3 Angle L3 4 Angle and L4 5 Angle are checked Note that the guided mark up process gives the practitioner a guide to pick certain key anatomy points in order to compute well known measures It is merely the presentation of simple picking instructions to the user so that these measures can be made in a standard way The guided mark up process itself is objective no judgments are made regarding what these values should be in a healthy normal individual L1 2 Angle 0 79 deg L2 3 Angle 5 81 deg L3 4 Angle 3 44 deg L4 5 Angle 13 09 deg Figure 18 In this image four of the check boxes have been checked so that the relative angles between these vertebrae are all displayed on the image Metron MD User Manual Version 6 EponaTech LLC 2011 85 Metron does offer the ability for the physician to enter a set of zones which describes desirable ranges for each of these measured parameters These ranges are entered by the physician if they wish to use this feature While the measurements made
7. DICOM Data panel The most important tags are displayed in this panel An item near the lower left portion of this panel lets you view all the tags supported by Metron When you are viewing these tags during a DICOM Send operation they are in read only mode If you see something you need to change you ll have to click Cancel Send go edit the tag s and then again click DICOM Send to send the image s Editing of the tags is permitted when you see the DICOM Data button in Metron s Single Image View panel Since Metron particularly when is used as acquisition software of a DR or CR system is the source of DICOM images we have the philosophy that the user is allowed to edit DICOM tags since the image is being created in Metron and obviously the creator Metron MD User Manual Version 7 EponaTech LLC 2013 46 needs to be able to set the tags as needed On the other hand since Metron can import DICOM files that may have come from other DICOM sources it is not recommended to edit the tags of those foreign DICOM files While it is not strictly forbidden in Metron the editing of tags of a foreign DICOM file in Metron causes a record to be kept in a special log file known as an Audit Trail This would allow some responsible person to make a review and learn that Metron was used to alter DICOM tags in a foreign DICOM file Metron encapsulates all the Metron specific data such as calibration free mar
8. EA Appendix B Setting up Automatic Image Rotations 865 Appendix C Image Stitching in Metron MD cece eee eee ees Appendix D Guided Mark Up in Metron MD ce cece ence Metron MD User Manual Version 7 EponaTech LLC 2013 Software License Agreement END USER LICENSE AGREEMENT FOR THIS SOFTWARE Important read carefully This End User License Agreement EULA is a legal agreement between you either an individual or a single entity and the author of this Software for the software product identified above which includes computer software and may include associated media printed materials and online or electronic documentation SOFTWARE PRODUCT By installing copying or otherwise using the SOFTWARE PRODUCT you agree to be bound by the terms of this EULA If you do not agree to the terms of this EULA do not install or use the SOFTWARE PRODUCT you may however request a full refund SOFTWARE PRODUCT LICENSE The SOFTWARE PRODUCT is protected by copyright laws and international copyright treaties as well as other intellectual property laws and treaties The SOFTWARE PRODUCT is licensed not sold GRANT OF LICENSE This EULA grants you the following rights Installation and Use You can install and use as many copies of the software product as you have paid license fees for NO WARRANTIES The Author of this Software expressly disclaims any warranty for the SOFTWARE P
9. LLC 2013 1 Table of Contents Useotthe Mantial s 2 2scnuieeteaieieeutee r Ta E T toes Table Of Cont nts skeerne sina nclene are eayeie nd egies a E TEE E nn caidas DAA Software LICENSE Agreement rruen cileca mand tics aie raaa i a T E E kS Conventions Used in this Manual 4 2 0 se uissuiadens ab newinsind dein nae elnesanesatovasaedanetaatanaes Metron PC Minimum Requirements 0 cece e ccc e eee e een a ceseeeesteeeesteeeeaes Metron PC Suggested Configuration co0ck ccsaicausdciadsassaven daa deraedontasadeaeen QOUICK S tart Gudes resena wae sole T ule eases ced alee sae ata dra gid a etal Sa wa ae at Starina Metohi pau digsaa5 cee sncssmencin n neek E eka a ace bakonmie EO E EAE A S heroes li Screen esnia aa a a a a dave came S The Databas Browse sssrrnrersisrntoneoss ouran NES Pie EOE EAA RE Multi Image Operations Adding Images into your Metani Daabase eadi ree A OEE e E E OE Importing Images from Files sesessssssssssssseseerererressersseressressseessresseessee Single Image LOGS saan saesn rneer by pais pak E E E E EENE Image Calibrations ireren aa ere nana T EE T E A E ARR Free Mark UP iis aiasat ves pin ia oiin T E R ETR E E ERER G ided M rk UP zerrena a a a n A a e Report Creation Burn CD or DVD mass Export and Import of Metin Daaba Sending Images out of Metron ssssssuseurerrereressssssessrrsseeesseeesseesseesseessee Lossy Compression Appendix A DICOM S in iNeo E A
10. compressed in any way However Metron MD does provide some image compression tools which an end user may choose to apply There are 2 places in Metron MD where image compression might be applied these are 1 When sending images via DICOM send 2 When saving an image to a file when JPEG is selected Here is compression ratio information for both of these situations 1 DICOM send By default when a DICOM server is specified in Metron the transfer syntax is set to code 2 which stands for Implicit Little Endian and the image is sent in full fidelity with no compression applied If the user so chooses he may select a different setting for transfer syntax If any method is chosen which applies compression the user is able to specify the desired compression ratio by giving a number between 2 and 255 where 2 specifies the least compression and 255 specifies the most compression In such cases the compression ratio in effect is approximately the value specified divided by 5 That is a value of 100 would specify a 20 to 1 compression ratio Such a formula is approximate as it depends on the particular image content images with little detail can be highly compressed whereas image with lots of detail do not compress by as high a ratio 2 When saving an image as a JPEG These images are saved as JPEG images with a fixed quality metric of 95 which corresponds to a compression ratio of approximately 8 to 1 This is not user adjustab
11. of your database to a colleague These things are found under the Database entry in the top bar of Metron It is important to note that in the upper right hand corner of the Database Browser the current database you are viewing is shown This is usually Default Some Metron users will only ever have this database In fact unless there is a good reason to have multiple databases it is simplest to just have one In the database tools the terms Export and Import are always meant relative to the current Metron database That is you export out of the current database or import into the current database You can export your database or a portion of it onto a thumb drive then carry it to another computer with Metron then import from the thumb drive into the database of that Metron In the Export Database panel there is also the ability to export the current database to a CD or DVD This is a way to accomplish a back up of your database N WARNING WARNING It is up to the operator of Metron to perform timely back ups of the Metron database and any other data of importance Metron contains no automated back up facility Back ups are the responsibility of the user or clinic staff Metron MD User Manual Version 7 EponaTech LLC 2013 37 Export Database SF A subset of the entire database can be specified by giving a range of dates of the studies It is often convenient to export only the stu
12. the screen Figure 3 where instructions are presented The user works on the actual radiograph on the left side of the screen picking points etc following the instructions on the Guide Panel W View Edit the image file C Epona Databases MainWr Smith Meyer Oscar 25 10 2011 im48089241 2 jpg METRON MD i ibrati Free Guided Annotation Calibration Measures Zones Ptiysician Dre Smith Monee Mare Patient Meyer Oscar Date 25 Oct 2011 Voice LL Spine Lateral Annotation Follow these Step by Step Instructions to add Markers to the image 1 Pick 2 points on the posterior body of each vertebra from L5 up to T12 Overlays Size 2 v Pick Point 1 Difficulty Picking as Instructed F Feature unclear These picks ae gueses SE Database Browser I Blank Anno M BlankMarkUp I Grid 3 Metron Detail Fiters Importedimage Pizel eis 2 ajm a Eis 2 3 4 Tune 1 w wT aC n Zoom Q las Figure 3 Screen shot after the Guided Markup button is pressed Metron MD User Manual Version 6 EponaTech LLC 2011 74 On the Guide Panel Figure 4 step by step instructions that instruct the user which points to pick in the radiograph are shown near the top of the window Here the user is instructed to pick 2 points on the posterior body of each vertebra from L5 to T12 An Instructional Image is displayed at the center of the Guide Panel There are red boxes on the Instructional Im
13. viewing image files that happen to be on your computer s disk On the right hand side of the screen is a folder Browser which you use to navigate to any folder on your computer indeed to any folder anywhere on your office network as long as remote disks are mounted with drive letters on your PC e SampleRadiograph im21945698 1 tif a a o a 70 a a a fe a a O DRS S om s Import Highighted Aulo4nport Images AN DICOM Images Soarch ah aubois Deubie ch a Thamen tor a Singe Ingot You can double click one thumbnail to bring it into Metron or you may highlight a group of images and then click the button Import highlighted Images This brings to a screen in which you see one image at a time in its full size and with the Anatomy Diagram shown on the right hand portion of the screen Metron MD User Manual Version 7 EponaTech LLC 2013 16 g Click on the appropriate anatomical zone one of the green dots to indicate to Metron what anatomy is in the image you are importing into Metron Additionally there is a list in which you select the View that best describes the image e g Lateral DP etc You can adjust the size and location of the annotation on the image as well When complete click the button Accept into Metron to finalize bringing the image into Metron If you had selected several images you would now see the next one repeat the procedure
14. 012 HF 31 Apr 1732 COOPER 0 00005 M For Selected Paart Archie Payne 25 Mar 2009 2009325103130 12 May 1989 Smith John 3 i R Foot of Scott Dianna on 25 Mar 2009 F OSent gt Foe New Patent Archie Payne 19 Apr 2009 2009325103130 12 May 1989 Smith John 2 1 L Foot of Scott Dianna on 25 Mar 2009 MO Sent ANTONIO VIVALDI 17 Dec 2012 AV35674 4 Mar 1678 CONARD 0 00003 M ANTONIO VIVALDI 23 Jan 2013 AV35674 4 Mar 1678 CONARD 1 a ANTONIO VIVALDI on 23 Jan 2013 MO Sent Q ANTONIO VIVALDI 24 Feb 2013 AV35674 4 Mar 1678 CONARD 3 sj ANTONIO VIVALDI on 24 Feb 2013 M Items in the Selected Study Click to Select or Double Click to Open Spee Later E Spine Latent Palis AP Tapes w Ce_ Lo Coe Spine rapon Vitae chp Case Cer C Ce Leino The Study List Screen The Study List screen is like the home page of Metron You always start here and you often come back to it The database consists mostly of images but can also contain video clips and reports Additionally there is something called a form which is an image but it is created from several individual images arranged in a certain pattern a in tives asi k Amma d Ba lae Dax i3 FAIM Lepoet Lith eh nee cette le hae des samme mi basiron sampa o dotee Hha rame p poqo T Spine AP Spine Report Video Clip 1 Big 2 Small Horizontal Left to right An Image a Report a Video Clip and a Form Metron MD User Manual Version 7 EponaTech LLC 2013 11
15. E Pn Acquire te Un Accent Use this panel to define anew DICOM system or edit one that you previously set up The Peer Address Peer Port and Peer AE values must be given to you by whoever you wish to send a DICOM image to These three values specify a particular DICOM enabled product somewhere on your local network or out on the internet somewhere in the world The Nickname is chosen by you as a handy way to remember what each of these DICOMs servers is Once you have filled in the top portion of the panel you can click the Test This Connection button to quickly check if the DICOM server can be found The next items are for specifying Transfer Syntax and Compression If you are unsure of these settings you can set both values to 2 in order to send full sized uncompressed images which will be of the highest quality but perhaps large and slow to send Click on the button labeled to see other possible settings You probably should discuss this with the person in charge of the DICOM system you are sending to Metron MD User Manual Version 7 EponaTech LLC 2013 43 as they may have a preference or it may be the case that their DICOM system cannot accept all possible transfer syntaxes Again choosing 2 and 2 is a safe choice and it is the default in Metron Here is more information on the values that you can use for these two settings Use an integer code to select the desired transfe
16. MVE TRONMID User Manual Version 7 07 EponaTech LLC 2013 July 2013 Use of the Manual The Metron MD software is designed to meet international quality and performance standards Personnel operating the software must have a thorough understanding of the proper operation of the software This guide has been prepared to aid medical and technical personnel to understand and operate the software Do not operate the software before reading this manual and gaining a clear understanding of the operation of the software If any part of this manual is not clear please contact EponaTech LLC or your equipment dealer s representative for clarification The information contained herein is based on the experience and knowledge relating to the subject matter gained by EponaTech LLC prior to publication No patent license is granted by this information EponaTech LLC reserves the right to change this information without notice and makes no warranty express or implied with respect to this information EponaTech LLC shall not be liable for any loss or damage including consequential or special damages resulting from any use of this information even if loss or damage is caused by EponaTech LLC s negligence or other fault EponaTech LLC 6720 Linne Rd Paso Robles CA 93446 www Metron Imaging com Metron MD is a registered trademark of EponaTech LLC Metron MD has been granted FDA K number K103554 Metron MD User Manual Version 7 EponaTech
17. RODUCT The SOFTWARE PRODUCT and any related documentation is provided as is without warranty of any kind either express or implied including without limitation the implied warranties or merchantability fitness for a particular purpose or non infringement The entire risk arising out of use or performance of the SOFTWARE PRODUCT remains with you NO LIABILITY FOR DAMAGES In no event shall the author of this Software be liable for any damages whatsoever including without limitation damages for loss of business profits business interruption loss of business information or any other pecuniary loss arising out of the use of or inability to use this product even if the Author of this Software has been advised of the possibility of such damages Because some states jurisdictions do not allow the exclusion or limitation of liability for consequential or incidental damages the above limitation may not apply to you DATA PRIVACY Author of the SOFTWARE PRODUCT has the rights to use the data content and images to enhance the comparative database used with the SOFTWARE PRODUCT This data will be used in an aggregate form and will not be distinguishable per individual patient Metron MD User Manual Version 7 EponaTech LLC 2013 3 Conventions Used in this Manual N WARNING WARNING warning points out procedures that you must follow precisely to avoid damage to the system in the form of loss of data or corruption of files in the sof
18. Send functionality allowing any image in Metron to be sent to any other DICOM compliant product located anywhere on the internet To prepare to send via DICOM you must first define a DICOM system that you will send to This is done by going to Preferences in the top bar then choose DICOM Preferences On the Servers tab you will see a list of all the DICOM systems that you have set up in Metron Metron MD User Manual Version 7 EponaTech LLC 2013 41 Eponatech FHATEST Metron on Giganto This panel lists all the servers you have configured Metron for Additionally you can indicate your favorite server to Query and Retrieve from and your favorite server to fetch Worklists from A new DICOM system can be added to the list by clicking the New button just to the right of the list and a server can be removed by highlighting one and then clicking the Del button The settings for each server can be reviewed and possibly edited by highlighting one and clicking the Edit button Doing this brings up the DICOM Peer panel shown below N WARNING WARNING Failure to properly configure the Peer address Peer Port and Peer AE Title will result in Metron s inability to send DICOM images to that server Always click the Test this Connection button to ensure that these values have been properly specified Metron MD User Manual Version 7 EponaTech LLC 2013 42 69 239 168 241 METRON_A
19. Tech LLC 2013 20 Concept The Plane of Interest To be precise with radiographic calibration it is not possible to simply program constant offsets into the imaging software This is because it is subject dependent and view or procedure dependent exactly where the calibration is needed An important concept is the plane of interest which is a plane parallel to the imaging plate but offset some distance towards the generator Calibration can be used so that accurate measurements can be made in this plane of interest But this requires that A The practitioner decide where the plane of interest should be and B The imaging software must be told where this plane of interest is located For example for a human lying on their side on a table the best general choice for the plane of interest would be at about half the body thickness approximately the plane containing the spine However if you were shooting radiographs intended for pre surgical planning for the knee or some other specific anatomy the ideal choice for the plane of interest is the plane most nearly containing those anatomical features you intend to measure The figure below shows the best general plane for a person lying on the table Of course this is just an example and the same applies for a subject standing in front of a wall mounted detector and so forth Xray Source FFD 37 5 OFD 2 HB Table Top CR plate The best general choic
20. You may right click on an image thumbnail to see some information about it for example its dimension sin pixels Right click on an image thumbnail The Info button will show you further information including a history of where and when this image was DICOM sent out of Metron Information including the DICOM Send History for any image Metron MD User Manual Version 7 EponaTech LLC 2013 12 To the side of the list of studies is a set of items shown below The top section is where you may specify a Filter so that the study list only contains studies from a certain year or only the ones created in the last week etc The next section lets you create a new study either for an existing animal or a new animal Finally there are a set of DICOM tools The Receive button will blink red if a DICOM image has been sent to your copy of Metron unless a Routing Rule has been set up in which case the received images go directly into your database The Q R button lets you query and retrieve images from a remote PACs The MWL button lets you query a remote PACs for a worklist and MPPS is used to tell that PACs that you have completed a request imaging task NOTE Your study list panel may appear with a different icon as that shown above depending which imaging hardware your copy of Metron is configured for NOTE Under Preferences you can choose whether names are displayed in fo
21. age that indicate where the user should pick the points on the actual radiograph The Instructional Image is NOT the actual radiograph in question Rather it is a fixed sample radiograph just used as part of the instructions to show where to pick the points There is a new Instructional Image for each step of the process showing which points to pick in that step Note that if anything is obscured or difficult to pick during any step of this process the user may indicate this fact by selecting the box labeled Feature unclear and These picks are guesses which box is near the bottom of the Guide Panel If this selection is made the procedure continues but the measurements resulting from these picks will be highlighted in a blue font so that the user is reminded that they may not be fully accurate Guided Mark Up Follow these Step by Step Instructions to add Markers to the image Instructions 1 Pick 2 points on the posterior body of each vertebra from L5 up to T12 Overlays Size 12 Instructional Image Pick Point 1 Wide Pick Difficulty Picking as Instructed Feature unclear lt lt Previous Step These picks are guesses Next Step gt gt Figure 4 Guide Panel for Step 1 Metron MD User Manual Version 6 EponaTech LLC 2011 75 The user uses his medical judgment to pick the actual points in the actual image on the left side of the screen Figure 5 As the user picks the points small red sq
22. ages Cover Page Text Page One Image Page Two lmage Page Four lmage Page Signature Page Contents of this Report You create a report by choosing a page type adding it to the report and then using a page editor panel its details depends on the type of page to fill in the images and text on that page Pages come from 2 main categories represented by the 2 tabs in the upper portion of the repot generator panel Generic Pages and Form Pages Most reports are built from Generic Pages the Form Pages allow multiple images to be laid out on a page in various ways Users can create their own forms to get particular layouts of interest Reports in Metron can be re opened and edited at any time From the report generator panel you can choose to export a report as a PDF file the free Adobe Acrobat software is need to view these If you burn a CD or DVD in Metron and include a report in the Metron MD User Manual Version 7 EponaTech LLC 2013 35 study that goes onto the disk it will automatically be converted to a PDF file and put on the disc This way the recipient of your CD will not be able to edit the report Likewise you can e mail a report directly from your Metron database and it will be converted to a PDF file and attached to the e mail There is also a choice in the e mail panel which will let you send a report as well as anything else in your Metron database by e mail to another Metron use
23. ages that are nearly equally exposed and that are suitable for stitching In this example we use an image of a hand and forearm Figure 1 along with a second image of the forearm and elbow Figure 2 Physician Wensley James MD Patient Craig John Date 29 Nov 2011 16 18 30 R Hand AP Figure 1 First image Metron MD User Manual Version 6 EponaTech LLC 2011 67 Physician Wensley James MD Patient Craig John Date 29 Nov 2011 16 19 07 R Elbow Lateral Figure 2 Second image The original images have been acquired and are in the same study in Metron Figure 3 Items in the Selected Study Click to Select or DoubleClick to Open Stitch two images together to create one ir ETC SUIT Figure 3 Two images suitable for stitching in the same study in Metron MD The user begins by selecting two or more images by clicking to highlight them and then clicks on the Stitch Images button Figure 4 Metron MD User Manual Version 6 EponaTech LLC 2011 68 A new Stitch Images panel is presented Figure 4 The Stitch Images panel has several controls on the right hand side which allow the user to drag and position images rotate them scale them trim them etc a Click and Drag to Move Images C oO Select Hose Al C Curent C None Actions Apply to Current Image Highighted in Red Large Rotations a 5 gt 90 30 180 Scale oon O i a Fine Rotation S02 510 30 coz o 3 0
24. at least 4GB of RAM Disk Space To install Metron and have needed space for the images the desktop PC or laptop must have at least 200GB of available disk space Consider 350GB 1TB disk Also consider the new Solid State Drive SSD for laptops used in mobile laboratory application They are more tolerant of rough use Processor Speed Metron will typically perform better on newer faster desktop PC or laptop To maximize the speed efficiency of the Metron program and your overall image processing viewing experience use the fastest desktop PC or laptop possible Internet Connection High speed Internet connection availability is required for any desktop PC or laptop that will be running Metron The internet connection is critical for training amp support New software releases are also provided automatically via internet Also with Metron you can send diagnostic images electronically to a remote radiologist this is not possible without an Internet connection Metron MD User Manual Version 7 EponaTech LLC 2013 5 N WARNING WARNING Failure to ensure that the host computer satisfies the above stated minimum requirements may cause Metron to be unacceptably slow or cause user interface elements to be off screen and un viewable or other problems with operation Metron MD User Manual Version 7 EponaTech LLC 2013 6 Quick Start Guide Thank you for your purchase of Metron Software This guide will walk you through the simple
25. at point should pass near the disc space between C4 and CS This parameter gives this measure Actual Arc Some literature suggests that the arc fitting thru the vertebrae should be a 42 degree section of a circle This parameter shows the actual value of the best fit arc Metron MD User Manual Version 7 EponaTech LLC 2013 29 Analysis of the Lateral Lumbar Radiograph There are a series of 5 instructions to follow in order to pick key points on the lateral radiograph of the lumbar spine These 5 steps are 1 Pick 2 points on the posterior body of each vertebra from L5 up to T12 2 Pick 2 superior points on S1 3 Pick anterior inferior point on L5 4 Pick 2 points on the anterior body of L3 5 Pick 2 points on the anterior body of T12 It is up to the user s medical training and best judgment to pick these points in the correct locations After completion of the guided mark up picking for a lateral radiograph of the lumbar vertebra a set of 11 measures are computed A sample set of numbers are shown below r Geviy fet O85 fa rema 103 fn r Lt2Angle 415 dea M L23 Ange 472 deg M L34Ange 834 deg L45Ande 14 40 deg r paaie oa The 11 measurements computed for the lateral lumbar radiograph Click the small box to the left of the parameter name and the measurement is visualized on the radiograph with overlaid markup which makes it easy to understand its meaning Note that for proper interpretation of t
26. ble this is where the results of the mark up are found e Normals Only available if Guided Mark Up is available this is where normal zones are displayed e Voice Annotation Connect a microphone to your PC and you can record comments for an image N WARNING WARNING Metron provides several methods to calibrate images Failure to carefully follow calibration procedures may result in the inability to make accurate measurements in the affected image s Metron MD User Manual Version 7 EponaTech LLC 2013 18 METRON MD ee ee SK hel 2 1 2 3 4 Tunel In the single image view edit screen a row of buttons across the bottom of the screen provide image filtering tools and other functions Metron MD User Manual Version 7 EponaTech LLC 2013 19 Image Calibration Due to the nature of the geometry of radiographic imaging all radiographs have inherent magnification in them For example if one puts a ruler on a radiographic film the measurements one would get are not true size of the radiographed objects but rather they would measure larger than actual size Example Table Arrangement The figure below shows the physical setup patient on a table The two numbers shown are constant Xray Source Table Top CR plate The two fixed offsets of importance in a table setup Where CR plate is indicated it could instead be a DR flat plate CCD technology or film Metron MD User Manual Version 7 Epona
27. by guided mark up are standard and known to medical practitioners in this case chiropractors there is not always agreement on what the normal and healthy values should be Because of this disagreement among practitioners Metron does not prescribe these normal ranges but gives the physician the ability to enter the ranges that they believe in In Figure 19 we show the zones panel for a set of desirable ranges entered by the physician user of Metron Computed Measurements and Desirable Zones Smith Jimn MD Moyer Oscar 25 0 ct 2011 R H_LUMBAR Zones Lumbar ave Zones Delete Zones Parameters Parameter Name Value Best when lnpalinee aaa ES few Been SOT an 00 Fgh ca Uimer s Messe 000 e MMos 10000 High Edt 3m 427 jes Eaa 6200 low ec L 5Ange 1401 fdg Equalto 15900 flow Edt Figure 19 Once the user has entered desirable ranges and saved them as a set of zones Metron will display each parameter alongside its desirable range and this line will be highlighted in red if the value from the current image falls outside this range Metron MD User Manual Version 6 EponaTech LLC 2011 86 Computed Measurements and Desirable Zones Figure 20 The Edit button next to each parameter can be used to edit the desirable range used in the set of zones The user may also assign an importance as Low Medium or High to each measure These importance values are not used i
28. ck Cannon in fact every shot that has a view called DP You see later in the file I have Head 0 Meaning that any view of the head I think we want an image wider than tall so we use rotation 0 which happens to be the correct number for one certain panel it may not be for yours The only values of rotation you can give are 0 90 90 180 You have to use RR and LR for hind limbs not RH and LH Finally you want to keep this list the number of lines in the file as short as possible simplicity is good the system searches down this list after each shot to check if the shot should be rotated or not so its best if the list is not hundreds of lines long Note if you look at the default values in SamsungViewRotations txt which is for equine you will see a rather complete example of good settings for an equine system DENTAL Similar files exist for DR Dental systems e g DRDentalViewRotations Accent txt They are essentially only used for flipping the image by 180 depending if in the Right side or the Left side of the mouth Metron MD User Manual Version 7 EponaTech LLC 2013 66 Appendix C Image Stitching in Metron MD Image stitching is available in Metron MD so that two or more images can be joined together into a single image This is a purely manual process and it is up to the Metron user to align images and then to store the stitched image First the Metron user must take two or more im
29. d side of the panel will control So the Fine Rotation buttons are used to rotate this image as shown in Figure 6 Click and Drag to Move Images Show Borders Selectimageis gy r Current None Actions Apply to Current Image Highlighted in Red Large Rotations a gt gt 90 90 180 Scale es fios Fine Rotation oaa 10 53 0 co 10 3 0 deg Jog Position Reset a t mp eof prel at moa C Trim Right a Trim Top _ Tim I Use calibration from this image Push Rop T Remove Image gt Resolution 1 2 _Addimage New Image Size Stitch Done 2284 1264 Add to Study Figure 6 The user has rotated the left hand image hand and forearm into alignment with the forearm portion of the second image This rotation can be further tuned when the images are slid together The user drags the left image on top of the right hand image and uses the Fine Jog buttons in the panel to carefully position it into alignment Figure 7 Other options available to the user were not required in the case of these two images options such as scale to enlarge one image relative to other trim options to trim edges push pop to control which image is on top etc ow Glick and Drag to Move Images Show Borders Al C Curent C None Actions Apply to Current Image Highlighted in Red Large Rotations iz 30 90 180 Scale Select Image
30. dies created in say the prior week and merge them into some other database Metron MD User Manual Version 7 EponaTech LLC 2013 38 Database Tools DataBase Defaut 6 Location C Epona D atabases Main Delete Database Remove All Locks Make Write able Un Declare Repair Database Compute Disk Size 46 4 Megabytes Count Images 10 Images Database Report The Database Tools panel gives you a way to count how many images are in your database and to see the total size your images occupy on disk Sending Images out of Metron Items in the Selected Study Click to Select or Double Click to Open G Report Cleeen eet k Asvinmcal Tid Var Dic 53 Fas Tile 1 Big 2 Small Horizontal To send images out of Metron via the internet click Send Images In order to send by DICOM first go to Preferences then choose DICOM Preferences and then configure a server to which you will send You will have to ask the recipient for the coordinates of their server You may also post images to www MetronWebViewer com for your colleagues to view there All images posted to our server are encrypted and userid and password protected at the web site Metron MD User Manual Version 7 EponaTech LLC 2013 39 Lossy Compression and Compression Ratios By default Metron MD does not apply image compression So the general user will not create nor view images which have been
31. e Images log so you can always check the log and see that this has occurred A Recognized Foreign DICOM is one that did not originate from a Metron system but it is from a system that Metron can recognize For example Metron knows how to tell that a DICOM file originated from an Eklin DR system If Metron can recognize the source of the DICOM file Metron can know where to look to find the anatomical region and other details Some of these details are not always in standard locations despite the DICOM standard METRON_AE Vv g e mno Database E Eklin Rule DICOM Receive tab with a Routing Rule specified Metron MD User Manual Version 7 EponaTech LLC 2013 50 In the panel shown above a routing rule has been created called Eklin Rule You click on the New button to create a new routing rule or click on Edit to view or modify an existing routing rule The panel below shows the definition of the Eklin Rule v 9 mno Database F Auto kowad to Example of a Routing Rule The Nickname can be chosen as you wish The important keyword Eklin has been inserted in the For DICOMs from field Please ask EponaTech if Metron knows how to recognize DICOMs from a particular system of interest and what the corresponding keyword is for that system This routing rule says that if a DICOM arrives that is recognized as being from an Eklin system it will be auto imported into the current Me
32. e is to locate the plane of interest at a distance above the table corresponding to half of the subject s thickness Metron MD User Manual Version 7 EponaTech LLC 2013 21 FFD OFD and Magnification Factor In the Metron software we use the terms Film Focal Distance FFD and Object Film Distance OFD to describe the physical set up and location of the plane of interest The FFD is the distance from the source of X rays to the imaging plate and OFD is the distance from the plane of interest to the imaging plate Given these values the magnification factor evident in the radiograph is FFD M FFD OFD For example for a subject that is 6 thick so HB in figure 2 is 3 we have the values FFD 37 5 OFD 5 0 Which gives a magnification factor of 1 154 This means everything in the image is 11 54 bigger than true size For all the films you shot on this system if you were to measure with a ruler on the film a 10 distance along the spine would measure 11 54 with your ruler Pragmatism and General Use A great majority of radiographs of interest are not used for measurements in any way so none of these issues of calibration matter at all However in some procedures measurements are important Itis also our belief that the small amount of extra effort that must be expended to ensure calibrated images should be expended for all images as a matter of standard practice Clinics spend a great d
33. eal of money for diagnostic imaging and they should be able to have the benefit of accurate measurements in the images obtained The current state of the art is that very few practitioners think about calibration and support for it in the major CR and DR systems on the market is generally lacking The solution adopted by some vendors is simply to add a line to the radiograph s annotation that states Scale is approximate Metron MD User Manual Version 7 EponaTech LLC 2013 22 Radiographic Calibration in Metron Metron supports several schemes to achieve calibration due to the number of different systems and situations we work in In some schemes knowledge of the FFD and OFD are not required at all but these schemes require that a special marker was placed in the plane of interest when the image was acquired Metron Scaler The easiest and best ways of calibrating require a marker of known size placed in the plane of interest To this end we sell a little widget called the Metron Scaler which works well It can be Velcro strapped to a leg or placed at mid body or if super accurate calibration not required can simply be placed on the table hence lower than mid body The Metron Scaler will be automatically located by the Metron software most of the time something obstructs it or if the exposure is off it may not find it then you simply pick two points on it and you are calibrated Pick 2 Points
34. ew lines will appear in the log as images arrive at Metron You can go look at them and return to this panel later to again check progress Depending on the kind of remote server you are retrieving from and how you have your copy of Metron configured the retrieved images might show up as Pending causing the Receive Images button to blink or they might be Auto Imported directly into your local Metron database which does not cause the Receive Images button to blink but does leave a line in the log seen in the Receive Images panel In the DICOM Preferences panel under the DICOM Receive tab it may be possible for you to set up an auto import rule for DICOM images arriving from a Q R transfer Troubleshooting Query Retrieve 1 I can Query but Retrieve does not return any images Most likely the remote server has not been set up to know about your Metron and so it is not allowing the unknown system to pull images from it The administrator of the remote system has to set it up to know about your Metron What they need is 1 Your IP address use www ipchicken com to get your IP address if you don t know it 2 Your Port Metron listens on port 4002 by default 3 Your AE title Metron is known as METRON_AE by default Metron MD User Manual Version 7 EponaTech LLC 2013 58 Note if you don t have a static IP address your IP address may change from time to time without your k
35. f Windows select the compatibility mode that matches that earlier version Help me choose the settings Compatibility mode Run this program in compatibility mode for s AP Service Pack 3 Settings F Run in 256 colors E Run in 640 x 480 screen resolution E Disable visual themes Disable desktop composition Disable display scaling on high DPI settings Privilege Level J Run this program as an administrator Pp Change settings for all users OK Set a program to Run as Administrator Repeat this for 3 programs in the C Epona Diclis folder Make sure to enable this setting for all 3 of the programs and click the OK button at the bottom of the panel each time 2 Now double click the program called Launch Metron exe This should start a process on the computer called Metron Service Metron MD User Manual Version 7 EponaTech LLC 2013 52 3 Now check with the Task Manager to see that there is a process called Metron Service running To get the Task Manager do a CTRL ALT Delete and then choose the Task Manager Choose the tab labeled Processes To check if Metron Service is running you may have to click on the choice to show processes from all users See screen capture below E Show processes from all users Processes 60 CPU Usage 7 Physical Memory 17 lire Reet es Click this button for a full li
36. g the Worklist panel the technician at Metron can see the schedule of upcoming exams Any given exam can be used to create a new patient in Metron thus avoiding re entering of patient information in Metron 6 DICOM Compliant CDs DICOM compliant CDs and DVDs can be written by Metron This function is found in the Database Browser panel and is labeled Burn CD DVD To send a partial study highlight the thumbnails of the images you wish to include before going into the Burn CD DVD function Adding of full studies can be done from within that panel These CDs contain the images in DICOM format as well as a viewer program which resembles Metron itself so that the CD you create may be sent to a recipient and they can view the images directly off the CD without the need for any particular software on their PC Alternate DICOM viewers can also view the images on the CD because the CD in addition to the images contains the required DICOMDIR file which some systems require Metron MD User Manual Version 7 EponaTech LLC 2013 54 7 Query Retrieve from a Remote Server Introduction Metron supports the client side or SCU of the DICOM Query Retrieve capability By this means Metron can pull images from a DICOM PACs system back to Metron Configuring Systems for Q R The following steps must be taken to prepare for using Query Retrieve 1 Under DICOM Preferences create a server with the information given to you by
37. ge f Pick 2 points on the anterior body of T12 Pick Point 1 Inco Pick Difficulty Picking as Instructed Feature unclear ep These picks are guesses Figure 13 Step 5 pick 2 points on the anterior body of T12 Figure 14 Step 5 is complete Metron MD User Manual Version 6 EponaTech LLC 2011 81 When the final points have been picked in the guided mark up process clicking the Next Step button leads the user to a table of measurements that is made from these picks Figure 15 The small check box to the left of each measurement name can be selected to display the measurement overlaid on the image so that the meaning of the measure will be clear to the user Computed Parameters Figure 15 A table of computed measures Clicking the check box to the left of the measure s name will display it graphically on the image Metron MD User Manual Version 6 EponaTech LLC 2011 82 The Jackson s Angle measurement is displayed when the user checks the checkbox next to Jackson s Angle Figure 16 ackson s Angle 23 04 deg Figure 16 Example showing Jackson s Angle displayed on the image This is a well known measure which is the angle between lines constructed from the posterior sides of the L5 and LI vertebrae Metron MD User Manual Version 6 EponaTech LLC 2011 83 The Lumbar Dordosis measurement is displayed when the checkbox next to Lumbar Lordosis is checked Figure
38. he tops of the Ilium Ilium Angular Ofset This is the angle that the line connecting the tops of the left and right Ilium makes with a horizontal Sacral Base Angle This is the angle made by the base of the sacrum relative to the horizontal Metron MD User Manual Version 7 EponaTech LLC 2013 33 L5 Angle This is the angle made by the base of LS relative to the horizontal Symphsis L5 Offset This is the horizontal offset from the center of the L5 body to the center of the symphsis Pelvis Width This is the distance between the tops of the femur heads N WARNING WARNING It is the responsibility of the Metron user to interpret the results of the guided mark up analysis EponaTech LLC assumes no liability for the improper use of these results Metron software is a tool to make physical measurements from calibrated images it is not a diagnosis system All diagnoses must be made by licensed professionals Metron MD User Manual Version 7 EponaTech LLC 2013 34 Report Creation An important function of Metron is to generate reports These reports are multi page formatted reports containing images and text Metron users create these reports for their clients and they are a vital communication tool The report generator panel is shown below In this image a report has already been constructed which consists of several pages Create Edit a Report Report Name Report Rename Report Generic Report Pages Form based P
39. he transmission fail or should it succeed Note that in any case you will always get a pop up telling you of a transmission failure The pop up telling you of success is optional only downside the click required to clear it off the screen after you see it In addition to the failure pop up and the optional success pop up is a log file which is always kept in which you can review all the details of the DICOM sending activity Servers DICOM Send Dicom Receive Default Tags Owner Animal Other AE Title of this Metron for Send METRON_AE Pop Send panel in On Accept send Offer Send even when no recipients checked m Review DICOM tags on Send No perSend per Study per Image The DICOM Send tab provides some controls and supports a log of all sends In the panel shown above you can see where you can pop up the log file or clear it out Also the panel shows how many images are in the queue waiting to be sent and Metron MD User Manual Version 7 EponaTech LLC 2013 45 there is an Abort button in the unlikely event that you decide you want to cancel the transmission of images awaiting being sent At the bottom of the panel you see that you have a choice regarding viewing the DICOM header tags when you perform a DICOM send Choosing No means the system won t show you these tags at the time of sending at all this choice minimizes mouse clicks as otherwise you w
40. hese measures the patient must be positioned appropriately Here are some brief notes and comments on each of the measures George s Deviation George s line is the curve created by connection points chosen on the posterior sides of all vertebral bodies Some literature suggests that in the ideal case these points lie on a smooth curve which is a section of an ellipse with certain major to minor axis ratio Metron s George s Deviation parameter is a sum of all the offsets from a best fit elliptical arc A perfect value would be zero 0 0 meaning that all points lie on an elliptical arc The higher the value of this parameter the more deviation there is from an elliptical arc An ideal elliptical arc is drawn in blue Metron MD User Manual Version 7 EponaTech LLC 2013 30 Jackson s Angle The angle between two constructed lines one at the posterior of the body of L1 and the other at the posterior of the body of L5 Ulman s Measure A perpendicular to the sacral base line is created at the sacral promontory L5 should be at or behind this line Ulman s measure quantifies how far anterior to this line L5 lies in terms of a percentage of the vertebral body s size Gravity Offset A vertical line is constructed from the centroid of the L3 body Some literature suggests that this line should pass near the sacral promontory The Gravity Offset parameter measures this distance L5 T12 Offset Construct a l
41. ill use one or more mouse clicks to take this panel off the screen when a send occurs If you select Once per Study then a panel showing the DICOM tags will pop up when you have clicked DICOM Send once for each study being sent This gives you a chance to review the tags if you spot something wrong there is a Cancel Send button so you could cancel the send got fix the tags and then send again The panel shown below shows the DICOM header tags DICOM Data x r Patient r Study Name CHIN MORI Study Description feo 1127 124424 ID ANNIE Study ID 201 1 Date 201171727 Time 1244 24 Sex F z Date of Birth fisss1 A Tn aes yyyyimmdd Accession Number ee el Other Modality em Physician of Record l gt Institution Friendship Hospital for Animals Inc Refernng Physician E zl EponaTech Metion DVM Tigers Manufacturer EponaT ec Model Metron Series Description A LAT Thorax Image Perfroming Physician x M j Series fi Instance fi Operator E pan zi Veterinary Tags Image Size 2568 x 2208 pixels Papon dia Perean a Aas foreo i ER i ing 0 157 4 0 157 Imager Pixel Spacing Reeponsbie Om E ae ai r Breed Registry Information View DICOM Dump of Tags Breed Registry 5 Breed Registration Number Patient ID Type RFID x ID Issuer Other Patient ID The
42. ine from the inferior posterior corner of the L5 body vertically in the image and then measure horizontal displacement of the inferior posterior corner of the T12 body Some literature suggests this value be small Lumbar Lordosis The angle between two constructed lines one along the inferior side of the T12 body and the other along the sacral base line L1 2 Angle The angular change in going from the L1 body to the L2 body measured by comparing lines constructed along the posterior side of each vertebral body Some literature suggests the ideal value is 2 5 degrees L2 3 Angle The angular change in going from the L2 body to the L3 body measured by comparing lines constructed along the posterior side of each vertebral body Some literature suggests the ideal value is 6 3 degrees L3 4 Angle The angular change in going from the L3 body to the L4 body measured by comparing lines constructed along the posterior side of each vertebral body Some literature suggests the ideal value is 9 7 degrees L4 5 Angle The angular change in going from the L4 body to the L5 body measured by comparing lines constructed along the posterior side of each vertebral body Some literature suggests the ideal value is 15 9 degrees Actual Ellipse This gives the minor axis to major axis ratio of the best fit ellipse used in the Georges line deviation parameter Some literature suggests that a normal value is 0 39 Metron MD User Manual Vers
43. ion 7 EponaTech LLC 2013 31 Analysis of the AP Spine Radiographs The following guided markup analysis can be used for images of any of the three spine segments Lumbar Thoracic or Cervical There is a single guided mark up instruction to pick three points on each vertebral body These picks are then repeated on as many vertebrae as desired Two points are picked on symmetric features on each side of the vertebral body and the third point is a centered feature such as the spinous process It is up to the user s medical training and best judgment to pick these points in the correct locations After completion of the guided mark up picking for a AP radiograph of the spine vertebra a set of 3 measures are computed A sample set of numbers are shown below g Max Cobb ng 1 38 idea E Max Ang Deviation 2 72 deg Iv Max Lin Deviation l 0 48 in The 3 measurements computed from the analysis of an AP view of the spine Click the small box to the left of the parameter name and the measurement is visualized on the radiograph with overlaid markup which makes it easy to understand its meaning Max Cobb Angle This is the largest angular difference between any two vertebrae Max Angular Deviation This is the largest angular value away from vertical of any vertebra Max Linear Deviation A vertical blue line is drawn on the image starting at the center of the lowest vertebra picked This is the largest distance horizontally a
44. k up and guided mark up etc inside a Private Tag in the DICOM file If you send a DICOM file from Metron to another Metron user the recipient will be able to receive the image and all of its mark up and data into their copy of Metron A DICOM Send is initiated from the main Database Browser panel of Metron by highlighting one or more thumbnail images and clicking the Send Images button Items in the Selected Study Click to Select or Double Click to Open B Report Uven isik Daw i3 Fas There are 3 ways to send images DICOM post to http www metronwebviewer com or by e mail You can select your default or favorite method in the general preferences panel or simply choose the method each time you enter the Send Images panel Metron MD User Manual Version 7 EponaTech LLC 2013 47 Metron on Giganto Mark the check box for one or more recipients and click Send Metron MD User Manual Version 7 EponaTech LLC 2013 48 4 DICOM Receive If DICOM images are sent to Metron the Receive Images button in the Database Browser panel will begin to blink within 7 seconds of the image s arriving By clicking on the Receive Images button you can see a transcript showing where they will go in Metron when you click on the Import button there We will also discuss auto import below in this scheme the button does not blink and arriving images are silently accepted into your Metron database To c
45. le Metron MD User Manual Version 7 EponaTech LLC 2013 40 Appendix A _DICOM Support in Metron 1 Introduction Metron supports the DICOM standard A DICOM Conformance Statement is available at http www metron imaging com 2 DICOM File I O Metron can import and export a DICOM files in exactly the same way as it imports and exports files of types like jpeg bitmap or tiff When you browse your disk looking for images from Metron thumbnails appear for each folder that you select and DICOM images will be displayed just like the other image types When importing image files into Metron look for the button labeled Auto Import all DICOM Images this will import all the DICOM images found in a selected folder and will use the information in the DICOM tags to place them into the Metron database At any time click on the Receive Images button in the Database Browser panel to see a log showing where all imported DICOM images have been stored in Metron Likewise anyplace in Metron where you are allowed to Export images or Save As an image you will find DICOM on the list of possible output formats The simple reading and writing of DICOM files is the most basic support for DICOM But DICOM also specifies a communication protocol for sending and receiving images across a local network or the internet and these topics are addressed in the next sections 3 DICOM Send Metron supports the DICOM
46. m and to describe the query you will use to hunt for images on that server DICOM Query Retrieve EklinPacsFHA X E Sunday March 20 2011 Check one or more of the query criteria and enter values usually with for wildcard It is recommended to use the character as a wild card unless you know the exact value used on the remote system for patient name or other criteria You can query on one or more of 1 Patient Name 2 Patient ID 3 Study ID 4 Date of the Study After setting up your criteria click on Query Server After a short delay a list of all studies on the remote system matching your criteria will be displayed If you don t see what you are seeking just alter your query keys and click Query Server again Metron MD User Manual Version 7 EponaTech LLC 2013 56 To retrieve one of the displayed studies back to your local Metron click on that study to highlight its line in the list At the bottom of the panel you will see how Metron will extract the storage names from the DICOM tags You can alter the source of these tags with the three associated pull down menus to try to extract these names as you would like to see them in Metron Click the Retrieve button to commence the retrieval of the study images DICOM Query Retrieve Sunday March 20 2011 CRAIG FIFI 2484761 17 Oct 2601 CRAIG BLACKJACK 6862826 14 Jun 2667 CRAIG ISABELLA 7261751 9 Aug 2605 ISABELLA 2nd
47. many per page to print e Stitch 2 or more images into a single image Appendix C e Send images by DICOM see later section in this manual e Burn some images to a DVD or CD Just above the buttons that perform operations on multiple images at once are three buttons that can be used to help you highlight or select which images you want to do the operation to You can Select All Select None or Select Next Region The Select Next button will highlight all images from a certain anatomical zone and subsequent clicks to this button will step through the various anatomical zones found in the study Adding Images into your Metron Database Import an image from a file If your Metron software came as part of a DR or CR system there will be an icon labeled Acquire as shown above which you will click in order to acquire new radiographs The button Add Form lets you add a Form to your study and the button Add Report lets you create a report and add it to your study The button Import Image is the way to import any image file on your PC into Metron and also any avi video file can be imported this way Metron MD User Manual Version 7 EponaTech LLC 2013 15 Importing Images from Files To import images from a digital camera or from any other source you start by clicking on the Import Image This will bring up a display of thumbnails They are not in Metron yet you are simply
48. mode Metron MD User Manual Version 7 EponaTech LLC 2013 7 4 Unlocking the Software 4 1 Start up Metron In the top bar the menus across the very top of the screen click on the Register option and then choose the Pre Paid choice Pre Paid Registration 4 2 Contact your software dealer or EponaTech LLC to obtain the Unlock Code They will need the Registration Number shown on the panel along with information on who the end user of Metron will be 4 3 Once you get the Unlock Code enter it in the space provided near the bottom of the above panel then click on the OK button 4 4 Use the Check Status choice under the Register pull down to check if your software is now enabled You re done WARNING WARNING Failure to unlock the Metron software will leave your system in Trial Mode which is not fully functional Metron MD User Manual Version 7 EponaTech LLC 2013 8 Starting Metron The installation program has placed an icon on your desktop that looks like this td Metron Double clicking the icon will start Metron If the icon does not appear on your desktop you can start Metron by going to the Start button extreme lower left on your computer screen then choosing Programs and then choosing EponaTech and then Metron The installation program also places an icon on your desktop called Metron Guide which is a shortcut t
49. n any computation but merely as notes to the practitioner Metron MD User Manual Version 6 EponaTech LLC 2011 87 Computed Measurements and Desirable Zones Figure 21 If a user edits the desirable ranges for one or more measures the Save Zones button may then be used to save this new set of desirable ranges as a set of zones which can then be used for future patients Metron MD User Manual Version 6 EponaTech LLC 2011 88
50. n you may specify how much compression to use by giving an integer on the range 2 255 where 2 specifies the least compression highest quality and 255 specifies the most compression For transfer syntaxes which don t use compression this value is ignored N WARNING WARNING The default settings of 2 and 2 in the DICOM Peer panel will ensure that no compression of the image will occur Some other choices e g 2490 for the first setting also employ lossless compression scheme with which full fidelity of the image is maintained Some other settings may cause lossy compression to be used which may remove detail or contrast from the image or may introduce artifacts Metron MD User Manual Version 7 EponaTech LLC 2013 44 Next we can configure Metron to send to this particular recipient when the Metron user manually clicks a DICOM Send button or automatically when a CR or DR image is taken with Metron This only available if you have a DR or CR system which is based on Metron If you choose the Auto Send option you have the further option of having the image sent immediately when acquired or only when the user clicks the Accept button Use of the later allows the user to possible rotate crop and filter the image before pressing Accept to save the image locally and send it out via DICOM communications The last two items in the panel allow you to configure the behavior of the DICOM send function should t
51. nowledge You can always check with www ipchicken com but of course it will be inconvenient to be continually having to ask the remote system s administrator to update your IP address in their server 2 Retrieve gets stuck and never completes You can stop an active retrieve operation in Metron by going back to the Q R panel and clicking on the Retrieve button It will tell you that a retrieve is underway and will offer to let you stop it DICOM Query Retrieve EklinPacsFHA EA CRAIG ISABELLA rac ham E ISABELLA 2nd part of Patient Name v At first Comma v Click Retrieve while Metron is retrieving and you can kill the retrieve Metron MD User Manual Version 7 EponaTech LLC 2013 59 8 DICOM Print DICOM Print is supported as of release 6 07 Configuring DICOM Print In the DICOM Preferences panel there is a tab for DICOM Print DICOM Preferences Jace Pie Yetaut Tage Owner Animal Other No DUMInsight Remote Back Up No DYMInsight Remote Back Up X Initially DICOM Print will not appear in Metron s user interface until it is turned on by checking the box at the top of the DICOM Print Preferences page Metron MD User Manual Version 7 EponaTech LLC 2013 60 DICOM Preferences Servers Send Receive Print Default Tags Owner Animal Other Fuji DryPix 1000 v You should then choose which DICOM Printer you will be using from the pull down These names
52. o this document When Metron Starts Up When you first start up Metron you will see a panel informing you that you are in Trial Mode In Trial Mode you will find many features of Metron are blocked to you But you may be able to explore Metron a little bit and get a feel for it Welcome to Metron in Trial Mode If you have already purchased Metron the company you purchased it from can supply you with an Unlock Code which will take you out of Trial Mode and fully enable Metron Metron MD User Manual Version 7 EponaTech LLC 2013 9 The Log In Screen Once unlocked and enabled Metron MD always starts by displaying the Log In screen Users may log in at three different levels Operator Physician or Administrator There is only one administrator account Logging in as Administrator gives you the ability to set up other user accounts and passwords The Administrator can also restrict privileges for certain operations within Metron For example an Operator may be able to delete an image but may be restricted from performing a permanent delete from the Trashcan Px METRON IMAGING Advanced Imaging Technology Physician Fred P Snoodle DC l Physician Log In Operator John J Craig Phd Operator Log In Administrator Log In In a new installation of Metron MD it is recommended that the first time the Log In screen pops up the administrator should log in and assign their password and set up accounts for o
53. of labeling the anatomy and view of each image Metron MD User Manual Version 7 EponaTech LLC 2013 17 N WARNING WARNING It is up to the operator of Metron to properly choose the anatomy and view corresponding to the image that has been acquired Failure to do this labeling properly will result in an image with an inaccurate annotation label Single Image Tools When an image is in Metron and you view it alone on the screen you can perform various operations on the image You get into Single Image View Edit immediately after importing a new image into Metron or by double clicking any image thumbnail from the Database Browser screen The single image operations are entered by clicking on the large buttons just below the Metron MD label and above the anatomy chart The number of buttons will depend on the kind of image that you are viewing Not all operations are available on all image types In the example below there are these operations available e Annotation All images have this feature which lets you pick the anatomy and view e Calibration Prior to making measurements in images you need to calibrate e Free Mark Up A set of tools that let you make measurements and add notes to an image e Guided Mark Up This is only available for certain anatomical shots for which Metron support a guided mark up analysis e g Lumbar Spine lateral Cervical Spine lateral e Measures Only available if Guided Mark Up is availa
54. onfigure the system which will send DICOM images to Metron you need to know three things the IP address of the PC that Metron runs on the Port that Metron listens on default value is 4002 and the name or AE Title of Metron default value is METRON_AE With those three bits of information the system which will send images to Metron can be configured The Port and AE Title used by Metron can be changed on the DICOM Receive tab if need be If you do not know the IP address of your computer you can find out by going to the site http www ipchicken com which will display your IP address Vv g Pinte Database a DICOM Receive tab Configure auto importing of native DICOMs and or routing rules for recognized foreign DICOMS Metron MD User Manual Version 7 EponaTech LLC 2013 49 Receiving Native DICOMs and Recognized Foreign DICOMs A Native DICOM is one which was created on a Metron system and therefore it has the special private data tag which holds all of the original Metron information calibration markup measurements etc Generally it is a good idea to choose to auto import them directly into the Metron database this is the default setting When Metron is configured to auto import these DICOMs their arrival will not cause the Receive Images button to blink red rather they will be silently and automatically inserted into the Metron database A record of their auto importation is kept in the Receiv
55. ons is the Default choice In the future we will have more flexibility by adding some optional inputs to the printing Metron MD User Manual Version 7 EponaTech LLC 2013 62 Using DICOM Print DICOM Print is in the multi image print interface familiar to Metron users First highlight the thumbnails corresponding to the images you wish to print remember the All button is helpful if printing all images of a study Then click the Print button at the bottom of the Study List screen Items in the Selected Study Click to Select or Double Click to Open Metron MD User Manual Version 7 EponaTech LLC 2013 63 Choose the number of images you wish to print per page Indicate if you want Annotation and or Mark up to be shown on the images Then click DICOM Print Multi Image Printing The printing will be sent to the printer Problems If the images do not print please send us the log file at C Epona DP LOG TXT Metron MD User Manual Version 7 EponaTech LLC 2013 64 Appendix B Setting up Automatic Image Rotations For most DR systems and some CR systems that Metron supports there is a way to assign a rotation to the image when it is acquired For small animal systems usually the animal is viewed across the screen but for DV and VD shots it is customary to have the body oriented up and down on the screen For this and other reasons we need a way to rotate images in an automatic fashion de
56. part of Patient Name v At first Comma A study is selected criteria for determining storage names selected and retrieval is underway As soon as the retrieval has commenced you are free to leave this panel and do other activities in Metron while the images are fetched You can even exit Metron and they will still be fetched of course the computer must stay on and connected to the internet Metron s Q R feature is study based you query for a list of studies and you may decide to retrieve a study There is not a way to only retrieve a subset of the images in the study it is always the full study that is retrieved Metron MD User Manual Version 7 EponaTech LLC 2013 57 At any time you may click on the Receive Images button in Metron s main Database Browser panel to see the status of your retrieval operation When Received Owner Animal Date Status 26 Mar 11 11 34 CHAMBERS DYOJI 4 Feb 2611 Auto Imported 26 Mar 11 13 37 CRAIG ISABELLA 9 Aug 2665 fAuto Imported 26 Mar 11 13 37 CRAIG ISABELLA 9 Aug 2665 fAuto Imported 0 items have been received and are ready to import to Metron 2 rt all Pending into Metri J to Highlighted St The Receive Images panel shows a log of images that have come into Metron via DICOM including those retrieved as part of a Q R action If the retrieval animation is running it means Metron is running the retrieval process in the background N
57. pending on the anatomy and the view taken For equine systems the required view rotations can become elaborate The lt Platform gt ViewRotations txt File Here is how to assign automatic image rotations It is done in a file which sits in C Epona Databases Main and the file is called depending on the system one of these Samsung ViewRotations txt Rpanel ViewRotations txt or maybe another name Please ask EponaTech if you can t find the file name for your hardware Here is an example of the contents of the lt Platform gt ViewRotations txt file for an equine system VERSION 1 0 Default 90 DP RF 90 DP RR 90 Lateral LF 90 Lateral LR 90 Head 0 The idea is this in the second line I give the Default Rotation which is applied to all images unless the default is overridden in a following line in the file So the current default is 90 To understand it you have to know where zero is Each line of the file can specify the rotation to use instead of the default for a given Region View and Limb Metron MD User Manual Version 7 EponaTech LLC 2013 65 For example if you put in the line Foot Lateral RF 90 it would use a 90 degree rotation for the Right Front lateral of the Foot Then Metron is set it up so that asterisk is the wild card So in the current file the line DP RF 90 Means that the DP view of ANY region for the RF will be 90 So this works for Foot Pastern Fetlo
58. procedures may result in the inability to make accurate measurements in the affected image s Metron MD User Manual Version 7 EponaTech LLC 2013 24 Free Mark Up The Free Mark Up panel provides a number of different measuring and annotation options Free Mark Up Properties of Currently Selected Item ro 2 Al CREAT Background Hide Clear Fill Current Mark Select Next gt T Detach Handle c va Update Text NOTE If you elected not to calibrate the current image then many of the measurement tools shown above will be absent from this panel Metron MD User Manual Version 7 EponaTech LLC 2013 25 Guided Mark Up Metron supports a process we call Guided Mark Up in order to provide a uniform way to analyze certain types of images For example if you have a lateral radiograph of the cervical spine or of the lumbar spine or an AP image of the spine or of the pelvis Metron supports guided mark up of these images The idea in guided mark up is to follow the instructions and pick the key points in the image as Metron guides you to Then Metron computes several parameters from these points that were picked Then you choose which set of measurements you wish to display overlaid on the image Selecting all makes quite a cluttered image so generally you select 1 to 4 measurements that are of importance for the particular case Appendix D provides a step by step illustration of the guided markup process u
59. process of installing Metron Software 1 Load the CD if applicable Load the CD into the CD Drive of your computer The CD should auto start and present you with an informative installation screen If it does not start automatically navigate to the CD using Explorer or My Computer and double click on Metron exe 2 Runa Downloaded Installer if applicable If you do not have a CD but have downloaded a Metron installer file simply double click this file to launch the installer If you were given two installer files one for code and one for data run both of them before attempting to enter Metron For a new install of Metron on a computer that it has never been installed on you are required to run the provided Data Installer If it is an upgrade install for a previously installed copy of Metron there is no need to run the Data Installer N WARNING WARNING Failure to run the provided Data Installer during a first time install of Metron will result in an incomplete installation of the software If you are not sure if the Data Installer was previously run always run it again it does no harm to run it additional times 3 Starting the Software After the software has installed you will find new icons on your desktop There are shortcuts to the Metron manuals and the shortcut to start the Metron software Metron Double click the Metron software icon and Metron will start in trial
60. r syntax 2 IMPLICIT_VR_LITTLE_ENDIAN 1 2 840 10008 1 2 21 EXPLICIT_VR_LITTLE_ENDIAN 1 2 840 10008 1 2 1 22 EXPLICIT_VR_BIG_ENDIAN 1 2 840 10008 1 2 2 25 RLE_LOSSLESS 1 2 840 10008 1 2 5 2199 DEFLATED_EXPLICIT_VR_LITTLE_ENDIAN 1 2 840 10008 1 2 1 99 2450 JPEG_BASELINE_1 1 2 840 10008 1 2 4 50 2451 JPEG_EXTENDED 2 4 1 2 840 10008 1 2 4 51 2452 JPEG_EXTENDED_3_5 1 2 840 10008 1 2 4 52 2453 JPEG_SPECTRAL_NONHIER_6_8 1 2 840 10008 1 2 4 53 2454 JPEG_SPECTRAL_NONHIER_7_9 1 2 840 10008 1 2 4 54 2455 JPEG_FULL_NONHIER_10_12 1 2 840 10008 1 2 4 55 2456 JPEG_FULL_NONHIER_11_13 1 2 840 10008 1 2 4 56 2457 JPEG_LOSSLESS_NONHIER_14 1 2 840 10008 1 2 4 57 2458 JPEG_LOSSLESS_NONHIER_15 1 2 840 10008 1 2 4 58 2459 JPEG_EXTENDED_HIER_16_18 1 2 840 10008 1 2 4 59 2460 JPEG_EXTENDED_HIER_17_19 1 2 840 10008 1 2 4 60 2461 JPEG_SPECTRAL_HIER_20_22 1 2 840 10008 1 2 4 61 2462 JPEG_SPECTRAL_HIER_21_ 23 1 2 840 10008 1 2 4 62 2463 JPEG_FULL_HIER_24_ 26 1 2 840 10008 1 2 4 63 2464 JPEG_FULL_HIER_25 27 1 2 840 10008 1 2 4 64 2465 JPEG_LOSSLESS_HIER_PROCESS_28 1 2 840 10008 1 2 4 65 2466 JPEG_LOSSLESS_HIER_PROCESS _29 1 2 840 10008 1 2 4 66 2470 JPEG_LOSSLESS_NONHIER_14B 1 2 840 10008 1 2 4 70 2490 JPEG2000_LOSSLESS_ONLY 1 2 840 10008 1 2 4 90 2491 JPEG2000 1 2 840 10008 1 2 4 91 For transfer syntaxes that use compressio
61. r who will then be able to bring the items into their own copy of Metron In that case it is not a PDF file that is sent but a fully editable report Burn CD or DVD Another important function is to burn a CD or DVD with images and other items to be given to another person The panel is shown below Export Image CD or DVD with Viewer Oscar Ortho DPM ESSERNE F PHILIPS DVD Riw DYD8881 viN By default the CD or DVD created by Metron will also contain a mini Metron viewer so that the recipient of the disk can view the images and reports easily To write a partial study onto a CD highlight the thumbnails of the images you want to select prior to entering the Burn CD panel From within the panel you can include additional full studies on the disk There is an option at the top of the panel to write a disk without the min Metron viewer but rather with images only If you choose this style of disk you can select the format of the images JPEG TIFF or DICOM Metron MD User Manual Version 7 EponaTech LLC 2013 36 Export and Import of Metron Databases There are several reasons why you might want to import or export an entire Metron database or a portion of one For example e To make a back up of your database export a copy of it to another disk e To merge images from a portable Metron based system that went out into the field back into your main database at your office e To give a copy of part or all
62. refer to text files that specify the capabilities of a given printer These files reside in C Epona DP Desc and if you open the one for Fuji DryPix 1000 it s contents are Fuji DryPix 1000 Aetitle PRINTER_AE Description Fuji DryPix 1000 Hostname localhost Port 4008 Type LOCALPRINTER BorderDensity 150 20 BLACK WHITE DisableNewVRs false DisplayFormat 1 1 1 2 2 2 2 3 3 3 3 4 3 5 4 4 4 5 EmptylmageDensity 20 BLACK WHITE FilmDestination MAGAZINE PROCESSOR BIN_1 BIN_2 FilmSizelD 8INX10IN 10INX141IN ImplicitOnly false MagnificationType REPLICATE BILINEAR CUBIC NONE MaxDensity 320 MaxPDU 32768 Metron MD User Manual Version 7 EponaTech LLC 2013 61 MediumType PAPER CLEAR FILM BLUE FILM MinDensity 20 OmitSOPClassUIDFromCreateResponse false PresentationLUTMatchRequired false PresentationLUTinFilmSession false ResolutionID STANDARD HIGH SmoothingType NONE Supports12Bit true SupportsDecimateCrop true SupportsImageSize true SupportsPresentationLUT true SupportsTrim true Important You must edit the lines in the first section of this file in order to give the AEtitle the Hostname and the Port of your actual DICOM Printer Other entries in this file may be edited if you think that it does not accurately describe this printer Other files in this same format may be added to this folder to define other DICOM printers At present the only selection under Opti
63. rmat of Last comma First or not Metron MD User Manual Version 7 EponaTech LLC 2013 13 Multi Image Operations Items in the Selected Study Click to Select or DoubleClick to Open An important concept behind the Metron user interface is that you can perform some operations on multiple images at a time whereas other operations only make sense to perform on one image at a time Any time you want to perform an action on several images at once the place you do that is the row of buttons along the bottom of the screen You specify the images by single clicking on the thumbnails which will turn the border of the thumbnail red showing that it is selected For example as in the image above you can highlight two images in the study and then click Delete to delete them For example click on 6 thumbnails to highlight them with a red border then click the button labeled Multi View You will see those 6 images side by side as below View Six images i Metron MD User Manual Version 7 EponaTech LLC 2013 14 In multi view below each image you are able to zoom and you can choose to turn off or on any mark up that is drawn over the image Other multi image operations that you can do are e Delete a group of highlighted images e Export a group of images that is write them out to your disk in whatever image format you choose JPEG Bitmap DICOM etc e Print a group of images you can choose how
64. sing a real lateral lumbar spine radiograph as an example Physican Dr Smith Patient Meyer Oscar Date 6 Feb 2011 LC Spine Lateral Sample guided mark up results for the cervical spine This image shows just 1 of 10 measurements that Metron reports for this analysis Metron MD User Manual Version 7 EponaTech LLC 2013 26 Physican Dr Smith Patient Meyer Oscar Date 6 Feb 2011 R L Spine Lateral ackson s Angle 36 39 deg Sample guided mark up results for the lateral lumbar spine radiograph This image shows just 1 of the 10 measurements that Metron computes for this image Metron MD User Manual Version 7 EponaTech LLC 2013 27 N WARNING WARNING Failure to follow the directions given for Guided Mark Up and or lack of care in picking the key points can result in loss of accuracy of the resulting computed values Analysis of the Lateral Cervical Radiograph There are a series of 6 instructions to follow in order to pick key points on the lateral radiograph of the cervical spine These 6 steps are 1 Pick 2 points on the posterior body of each vertebra from C1 down to T1 2 Pick anterior inferior on C4 and anterior superior on C5 3 Pick the anterior inferior point on C7 4 Pick 2 points on Atlas to specify its main axis 5 Pick 2 points to specify skull base at level of foramen magnum 6 Pick one point at the anterior lip of the sella turcica It is up to the user s medical training and best judgmen
65. sting of all running processes If you see Metron Service is running you are done and Metron is ready to receive DICOM transmissions If it is not running something is wrong so please check these instructions again If you shutdown the computer and re boot the Metron_Service process should be automatically started for you so you should not have to perform any of these actions again The Metron Service is the thing that listens for DICOM files that might be sent to Metron so it needs to be running in order for DICOM Receive to function in Metron N WARNING WARNING Failure to perform these steps when installing on a Windows 7 computer will make Metron unable to receive DICOM files sent to it Always verify that Metron Service is running in the background 5 DICOM Modality Worklist Modality Worklist allows Metron to query s remote DICOM server to fetch worklists That is Metron can query a practice management system to ask are there scheduled appointments requiring radiography This way the patient information entered in the PM system can be transferred to Metron In the DICOM Preferences Servers panel there is a setting where you indicate which server will be used to fetch worklists from Then on the Database Browser panel of Metron a small button in the lower left labeled W L can be clicked to query that server Metron MD User Manual Version 7 EponaTech LLC 2013 53 Usin
66. t to pick these points in the correct locations After completion of the guided mark up picking for a lateral radiograph of the cervical vertebra a set of 11 measures are computed A sample set of numbers are shown below M Atlas SkullAngle 6 75 deo M Occiput Ange 10 84 deg M Jackson s Ange 8 65 deg i George s Deviation 117 in M CTT Ose 065 fin rroa oaa M f ctulAre 3400 deg The 11 measurements computed for the lateral cervical radiograph Click the small box to the left of the parameter name and the measurement is visualized on the radiograph with overlaid markup which makes it easy to understand its meaning Metron MD User Manual Version 7 EponaTech LLC 2013 28 Note that for proper interpretation of these measures the patient must be positioned appropriately Here are some brief notes and comments on each of the measures Atlas Angle The angle that the major axis of C1 from this aspect makes with the horizontal Atlas Axis Angle The perpendicular to the posterior side of the C2 body is constructed and the angle between this constructed line and the major axis of Cl Atlas Skull Angle The angle between a line at the base of the skull at the level of the foramen magnum and the major axis of C1 Occiput Angle The angle between a line at the base of the skull at the level of the foramen magnum and the horizontal Jackson s Angle The angle between two constructed lines one at the posterior of
67. the administrator of the PACs that you intend to retrieve images from 2 Under DICOM Preferences you can choose which of possibly several servers you intend to use as your principle Q R server This simply will make it the default setting later when you enter the Q R panel Query Retrieve Server EklinPacsFHA Choose your favorite Q R server as the default 3 The administrator of the remote server that you intend to query and retrieve from must be told the IP address Port and AE Title of your copy of Metron The default values for the latter two are 4002 and METRON_AE These can be altered if need be under DICOM Preferences under the DICOM Receive tab If the remote server has not be configured to know of your Metron you may find that you can query but not retrieve N WARNING WARNING Failure to make sure that the remote server has been set up to allow your queries and retrieves will prevent retrieve from working You must ask the administrator of the PACs system to enter your information into their server Metron MD User Manual Version 7 EponaTech LLC 2013 55 Using Query Retrieve Since the use of Q R results in adding images to your system it is located in the center section of the main Database Browser panel of Metron Click on the button labeled Q R or in some layouts DICOM Q R The top portion of the panel lets you select the server you wish to pull images fro
68. the body of C2 and the other at the posterior of the body of C7 Cervical Lordosis The angle between two constructed lines one along the major axis of C1 and the other along the inferior side of the body of C7 George s Deviation George s line is the curve created by connection points chosen on the posterior sides of all vertebral bodies According to some literature in the ideal case these points lie on a circular arc Metron s George s Deviation parameter is a sum of all the offsets from this perfect circular arc A perfect value would be zero 0 0 meaning that all points lie on a perfect circular arc The higher the value of this parameter the more deviation there is from a circular arc In blue the ideal arc is shown C1 T1 Offset Construct a line from the inferior posterior corner of the T1 body vertically in the image and then measure horizontal displacement of the superior posterior corner of the C1 body Some literature suggests this value be small C2 C7 Offset Construct a line from the inferior posterior corner of the C7 body vertically in the image and then measure horizontal displacement of the superior posterior corner of the C2 body Some literature suggests this value be small Gravity Line Offset Some literature suggests that a point at the anterior lip of the sella turcica serves as a good reference of the center of mass of the head and further that a line dropped vertically from th
69. ther users Note that when an Operator logs in it is implied that he is working under the supervision of the Physician that is displayed on the log in screen The currently logged in user of Metron is displayed in the upper blue bar around that main Metron window An image acquired by Metron controlled hardware will be tagged with the logged in user at the time of acquisition This information can later be seen by right clicking on a thumbnail and clicking the Info button Metron MD User Manual Version 7 EponaTech LLC 2013 10 The Study List Screen Metron always starts in the Study List screen This is where you can browse and find all images video clips and reports in your Metron database The study list screen always shows thumbnails small images for all the items in the selected study Ce in Grubb Fred MD ag x Seach METRON MD m C riy wek He Patient Study Date _ Patient ID DOB ___ Physician Items Accession Study Description Sex Status E Ees e Baxter Akin 6 Feb 2011 PID 29 22 Mar 1968 Smith John 4 1 Meyer Oscar on 6 Feb 2011 M OSent Pat John J Craig 13 Dec 2012 2012121322475 21 Jun 1955 Smith John 5 1 John J Craig on 13 Dec 2012 M OSent Pryacen John J Craig 14 Dec 2012 2012121322475 21 Jun 1955 Smith John 2 1 John J Craig on 14 Dec 2012 M OSent John J Craig 16 Dec 2012 2012121322475 21 Jun 1955 Smith John 1 1 John J Craig on 16 Dec 2012 MO Sent Doete New Saxiy FRANZ HAYDN 17 Dec 2
70. tron database and will be converted to a native Metron image Further it will be automatically filtered with Detail 2 from the filter set called Canon Note The only way that a foreign DICOM can be auto imported into Metron s database is by use of a routing rule If not matching routing rule is found they will arrive in pending mode and the Receive Images button will blink red to alert you Metron MD User Manual Version 7 EponaTech LLC 2013 51 Special Requirement when Installing on Windows 7 After installing Metron on a Windows 7 computer there are a few more steps that need to be done to enable it for DICOM receive These things occur automatically on Windows XP but for Windows 7 which has a stricter security environment these things must be done manually This is a one time operation performed just once after installing Metron 1 Look in folder C Epona Diclis and you will see three files with exe extensions They are called launch_service exe metron_service exe and remove_service exe For each of these right click on the file and choose Properties In the properties panel that pops up choose the Compatibility tab As shown in figure 1 below check the box labeled Run this program as an administrator Launch_Service exe Properties General Compatibility Securty Details Previous Versions If you have problems with this program and it worked correctly on an earlier version o
71. tware NOTE Notes provide additional information such as expanded explanations hints or reminders IMPORTANT Important highlights critical policy information that affects how you use this manual and this product Metron MD User Manual Version 7 EponaTech LLC 2013 4 Metron Desktop PC or Laptop System Requirements Minimum Below are the minimum requirements for the Metron software to operate but may not display images at the speed and image quality you might need Operating System Windows XP Pro 32 bit Windows 7 or Windows 8 Make sure the acquisition device supports the specific operating system some of the older devices Older X Ray devices are like printers many older printers will not work on new computers with Windows 7 or Windows 8 Graphics System and Monitor Desktop PC Widescreen 20 monitor with a minimum resolution of 1600 x 1200 or greater 60 Hz image contrast ratio 800 1 the higher the better and response time of 8 ms or better plus an independent graphics card with 512MB is strongly recommended for best image presentation quality Graphics System and Monitor Laptop Laptop should have a 17 inch screen for best display of X Rays Display resolution of 1600x900 or greater with High Definition Anti Glare display strongly recommended RAM Computers running Windows XP Pro will perform best with at least 2GB of RAM Computers running Windows 7 or newer operating system will perform best with
72. two images together to create one it Figure 9 Stitch is complete This image may now be used in Metron just like any other image Metron MD User Manual Version 6 EponaTech LLC 2011 71 The final stitched image is shown in Figure 10 Physician Wensley James MD Patient Craig John Date 29 Nov 2011 R Elbow Lateral Figure 10 The final stitched image The stitch line is apparent because the two X Ray exposures were not the same in this exam Metron MD User Manual Version 6 EponaTech LLC 2011 72 Appendix D Guided Mark Up in Metron MD Example Measurements for the Lateral Radiograph of the Lumbar Spine Guided Mark Up is provided for certain radiographic views for which current practice has well defined measurements The guided mark up process prompts the user to pick key points in the image from which these measures are computed The guided mark up process will be illustrated by the example of measurements for the lateral radiograph of the lumbar spine as shown in Figure 1 Figure 1 Lateral Lumbar Spine Radiograph The process starts by acquiring the image labeling the anatomy by selecting the appropriate region on the anatomy chart and clicking the Guided Mark Up button Figure 2 Figure 2 Select the Guided Mark Up Tool Metron MD User Manual Version 6 EponaTech LLC 2011 73 A new panel for the Guided Mark Up process the Guide Panel is presented on the right side of
73. uares are overlaid on the image to show the points that have been picked These selected points may be dragged with the mouse so that the user can be sure to position them where he wishes Figure 5 Step 1 of the lumbar spine picking mark up in progress This image shows this task after the user has selected 6 points Metron MD User Manual Version 6 EponaTech LLC 2011 76 When the requested number of points have been picked by the user a green curve is displayed that is constructed from these points Figure 6 In guided mark up the appearance of green overlaid graphics always indicates that the picks are complete for the current instruction step E View Edit the image file C EponaWatabasesWain Dr SmithWeyer Oscar 25 10 2011 im48089241 2 jpg Physician Dr Smith z Patient Meyer Oscar Calibration nee Gua Date 25 Oct 2011 LL Spine Lateral ie Guided Mark Up Follow these Step by Step Instructions to add Markers to the image 1 Pick 2 points on the posterior body of each vertebra trom L5 up to T12 Overlays om Marker Complete Difficulty Picking as Instructed I Feature unclear These picks are guesses Next Step gt gt I Blank Anno Blank Mark Up l Grid B Metron Detail Filters Importedlmage Appl Pixel ag ae alsleleal e 1 2 3 4 tuner u ao siam a a S Figure 6 The picks for Step 1 of the guided mark up have been completed
74. way from this central line of the center of any vertebra Metron MD User Manual Version 7 EponaTech LLC 2013 32 Analysis of the AP Pelvis Radiograph There are a series of 5 instructions to follow in order to pick key points on the lateral radiograph of the lumbar spine These 5 steps are 1 Pick 2 points highest points on each side of the illium 2 Pick 2 points to indicate the top of the sacrum 3 Pick the four corners of the L5 vertebral body 4 Pick 2 points the tops of the femur heads 5 Pick 1 point at the symphysis It is up to the user s medical training and best judgment to pick these points in the correct locations After completion of the guided mark up picking for a lateral radiograph of the lumbar vertebra a set of 8 measures are computed A sample set of numbers are shown below m iium Lin feet 028 in w lSAnge 0S0 deg M SymphysisL5 Offset 0 43 fin r PeisWidh 1356n The 8 measurements computed from the analysis of an AP view of the pelvis Click the small box to the left of the parameter name and the measurement is visualized on the radiograph with overlaid markup which makes it easy to understand its meaning Femur Linear Offset This is the difference in vertical height between the tops of the femur heads Femur Angular Ofset This is the angle that the line connecting the tops of the femur heads makes with a horizontal Ilium Linear Offset This is the difference in vertical height between t

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