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iSite Radiology 3.5

1. By clicking the Next gt button you can visit all of the subsequent windows of the Hanging Protocol properties All of these windows are Read Only and cannot be edited from the Preferences page Hanging Protocols must be edited from within the iSite Radiology canvas page To delete a Hanging Protocol from the system highlight that Protocol s listing and click the Delete button If you wish to export a Hanging Protocol listing select the desired Hanging Protocol and click the Export button The following dialog will appear 73 New Folder Save as type rn Files sml Cancel ZA Choose a name for the exported file and click the Save button The file will be saved in xxml format in the chosen directory If you wish to import Hanging Protocol listings click the Import button Choose the desired xml format file and click the Open button Please note that if you import a Hanging Protocol that has the same name as an existing Hanging Protocol on the system you will be prompted to rename the imported Hanging Protocol Imported Hanging Protocols will always be listed as Alternate If you have finished reviewing and or editing your personal preferences click the OK button You will be returned to the program Canvas Page Options You can specify information displayed in the iSite Radiology Canvas Page in the Canvas Page options To access these options click the Canvas Page listing at left a
2. 261 Descending order c1 T C2 72 C3 T3 c4 TA ch T5 5 6 C6 T S5 6 amp 7 C7 7 52 7 T8 S53 8 T3 O S4 940 Tmo 55 10 17 tah 43 4 Show All Hide All Please note that the Spinal Labels L and T13 are not included in automatic labeling but can be chosen manually from the Spinal Labeling Pop up Dialog Labels as well as any other annotation you might use for the image will be saved once you have created a presentation state of the particular configuration 262 Image Processing Several important options for processing images are available including Invert Image Edge Enhance Edge Detect Median Filter CLAHE Contrast Limited Adaptive Histogram Equalization Pixel Replication Bilinear Interpolation and Bicubic Interpolation Options for Edge Enhance Edge Detect Median Filter and CLAHE can be set in the User Preferences Default settings are adjusted by the iSite System Administrator on an institution wide basis For more information on adjusting your Image Processing settings please see the User Preferences Section of this manual Please note that Image Processing options are applied only to the current image and not an entire multi slice series In addition Image Processing filters are not preserved in Presentation States nor can they be printed to a DICOM device Images with Image Processing can be printed to paper if desired The appropriate tool is completely dependent on th
3. Convert an MR slice into a Right click on an image and select the Scout Scout View Line Mode function from the pop up menu Increase or decrease the Hover the mouse over the image that has angle for Edge Enhancement these one of these image processing tools applied and click the comma key to CLAHE and Edge Detection decrease ihe degree parameter and the Image Processing Tools period to increase the parameter Copy to the Windows Right click on the image you wish to save and Clipboard select the Save function from the pop up menu Select To Clipboard View exam information Right click the upper portion of the Exam Summary Window then open Exam Information from the pop up menu View the available Right click the upper portion of the Exam presentation states for an Summary Window then open Presentation exam States from the pop up menu Close an exam Right click the Upper portion of the Exam Summary Window then select Close Exam from the pop up menu Toggle the Marked Read Hit the F3 key while the mouse is over the designation on and off for the X0 you wish to Mark Read active exam Hide Display the Patient Click the P Preferences button in the iSite History Timelines Radiology Control Strio and check or uncheck the Display Timeline option in the General 25 Change between Horizontal Right click the Exam Summary Window then and Vertical Rack Modes select Horizonta
4. FAQs amp How To s Troubleshooting Glossary of Terms Trademarks and Copyrights Copyright amp Disclaimer Information 2000 Koninklijke Philips Electronics N V All rights reserved iSite iSite Enterprise iSite Radiology iVault iIExport iQuery and iSyntax are trademarks of Philips While Philips provides the information in this manual to users of the iSite product we retain copyright on all text and graphic images This means that you may not distribute the text or graphics to others without the express written permission of Philips mirror or include this information on your own server or documents without our permission modify or re use the text or graphics You MAY print copies of the information for your own personal use store the files on your own computer for your personal use only The information contained herein is designed to be as comprehensive and factual as possible Philips reserves the right however to make changes at any time without notice in products performance specifications and availability Other manufacturers product and service names profiled herein are trademarks and service marks of their resoective companies Philips reserves all other rights Please direct all questions about this manual or the trademarks and copyrights contained herein to isitecare philips com Regulatory Information a TO o Company Contact Stentor Inc a Philips Medical System
5. Preferences Dialog H User Preferences System Preferences General Preferences Window Width Center Image Processing l Annotations DICOM Sources Screen Overlays Paper Printing IE x pork Organization Dictionary Location Dictionary Plug Ing Body Part Dictionary Hanging Protocols DICOM Print Machine Preferences Network Testing Filter Name Description Completed E sams CA All CTA Last 3 Days Last 7 Dave Last Month MA All US All Wi The following window containing all the specifications for the selected filter will be disolayed as seen below 90 Add Filter BARDACH MA_NECK Fi Fi All STAT MA BRAIN from ERS with sub specialty NEURO BARDACH NOAH MD lv lv Cancel Make changes as desired and click the OK button Your changes will be saved To delete a listing highlight that listing by left clicking it once and then clicking the Delete button Annotations Annotation preferences allow you to create preset annotations for use by iSite Radiology Users These annotations are displayed alongside the system default annotations You can name the annotation and specify its style To access the Annotation preferences click the Annotations item from the tree as seen below 9 Preferences Dialog User Preferences Annotations System Preferences General Preferences Window Width Center Filters ale lncize Here ie Pin Here Proper
6. 3554429 Referring MAK AROUN MICHEL S status PRELIM SOPUID 1 2 640 715619 254 2157507501 24140 945 s34bbbS 4 ri 19 Horizontal Configuration 11 04 Dee host Recent 110491999 CT No Descriptions 11044999 Acc 42065 Referring MAKARON ty Status PRELIM Relevant Exams CT No Descriptions 06181999 Acc 39617 Referring MAKARON M Status PRELIM coPpuip 1 2e40 A 113619 2 55 1 1 ro2304540 3490 A Least Recent 04 28 7999 CT untae 04 a 999 ccm Siete Referring MAKAROUN i Status PRELIM copuip 1 2es0 amp AL aE 2 59 2715 ro07501 2140 92 a 192 Vertical Configuration Add Exam to Folder This feature allows you to add a patient exam to a folder trom the Patient History Timeline When you select the option the following dialog will appear Folder Dialog Personal Folders Public Folders caca Navigate to the desired folder where you wish to place the new exam as seen below Folder Dialog 2 Public Folders CJ New Folder 29 Teaching Files Mammo Metastatic Cancer Cancel 193 Highlight the desired folder and click the OK button Add the exam to the CD Manager folder if you wish to add it to a Direct Media project The exam will be visible in the folder you have selected the next time you open it Marking an Exam Read When you have finished reading an unread exam you will want to mark that exam read To mark
7. 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 4 Acquisition Exceptions Tony Campbell St 112 17 027 Tony Ritchie Alicia 112 17 024 Tony Harris Christi 112 17 021 Tony Mirza Marina 112 17 018 Tony McCarthy Anne 112 17 015 Tony Frazer Denny 112 17 012 Tony Arenson Arthur 112 17 009 SCIETSFC SCIEISFC SCIE SFC SC IEKoriy oi Siem Os SCIETSFC 09 Stele ore 12 17 2001 15 00 00 12 17 2001 15 00 00 12 17 2001 15 00 00 12 17 2001 15 00 00 12 17 2001 15 00 00 12 17 2001 15 00 00 12 17 2001 15 00 00 a EARCEPTS a Eerie e i od Deer oer ly 8S sib EACEP Ts EAE ER iSite Radiology QAP o 4 Stentino Elin Stentino Gloria Stentino Heathe Stentino Brend Stentino Claudi Stentino Dorthy Stentino Elin Stentino Franceg Stentino Gloria Stentino Heathe Stentino Alice Stentino Brenda Stentino Claudia Stentino Dorthy Stentino Alice Stentino Brenda Stentino Claudia Stentino Dorthy The worklist contains several different elements The most prevalent is the list itself Here exams are organized by Patient Name Patient ID Accession Number Date Modality Body Part Status Patient Location Referring Physician Organization Procedure Code and Procedure Description The report icon O indicates whether a report is available for the exam in question If an exam is in use the lock symbol will be disolayed next to it El In ord
8. Data Bits Parity Stop Bits Handehaking Exam Settings m Cancel The scanner preferences allow you to add and configure a bar code scanner if your institution uses them for reading exams To add a bar code reader click the Select Scanner checkbox as seen below This enables the Scanner Settings 140 Preferences Dialog User Preferences Scanner Preference System Preferences Machine Preferences Display Monitors Plug Ing General Preference Scanner Preference Scanner Settings Network Testing Port Hame COM Baud Fate 9600 Data Bits Parity Stop Bits Handehaking Exam Settings Mark Read And Close Cancel The scanner settings portion of the window provides options for the connection of the bar code reader to the iSite Radiology machine If the Mark Read and Close option is checked when a new exam Is scanned with the bar code reader the previously viewed exam will automatically be marked Read and closed If you only want the previous exam to be closed and not marked Read leave this checkbox unchecked When you are finished with editing or viewing the preferences click the Apply button to save your changes Local Exam Caching This area of the Preferences allows you to modify the default settings for your Local Exam Cache The Local Exam Cache folder in the iSite Folder List allows you to cache patient exams on your local machine for later review To
9. 116 Add iExportRemotesCP Configuration 10 253 156 24 117 If you wish to delete a listing highlight it and click the Delete button Click the Apply button to make your changes permanent The iExport destinations that you have just created or edited will be visible in the iExport dialog which you can access via the pop up menu in the worklists or from the exam timelines The iExport Queue can be easily accessed by clicking the Q button in the iSite Control Strip iQuery iQuery is the iSite mechanism that allows archived exams to be imported into the iSite Server for viewing with iSite iQuery preferences can be added and edited To access the iQuery preferences click the iQuery listing from the list at left as seen below Preferences Dialog User Preferences System Preferences General Preferences Window Width Center Filters BOGUS Ise LTA Annotations B8 STA DICOM Sources JALTA Screen Overlays DASTA Paper Printing Body Part Dictionary IE port Organization Dictionary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing To add a new archive from which to pull exams click the Add button The following window will appear 118 Add 1QueryRemotesCP Configuration AE Title Remote Host Descriptions Host IP Pork 104 Frefered Query Model PATIENT_ROOT a 1 Close On Cancel P Merge Ark Compatibility Cancel Fill in informa
10. 145 View Exams Tab Gateway to viewing diagnostic exams and images The View Exams tab displays the number of Patients that have been selected for review Right clicking the View Exams tab will produce a drop down menu of all the patients allowing you to jump directly to a particular patient s exams Patient exams can be closed by clicking the Close Button at the right end of the View Exams Tab Product Name Displays the name of the iSite product being used Logout Button Click here to end your iSite Radiology session You will be returned to the iSite Radiology Login Page Folder List Tab Displays the name of the most recently accessed tool folder or filter in the iSite Folder List 6 Click the tab to return to that area of iSite Enterprise For example if you select an exam from the CT ALL filter iSite will immediately display that exam in the canvas page The Folder List Tab will display CT ALL Click the tab to return to the CT ALL filter list IExport Queue Button Opens the iExport Queue where you can monitor DICOM exams being sent from iSite Radiology to other DICOM devices Site Radiology Preferences Button Click here fo view your iSite Radiology preferences iSite Radiology Online Help Button Access to iSite Radiology s online help manual demos and other helpful materials The Patient Directory When you first login to iSite Radiology you are presented with the Patient Directory
11. Export via DICOM LL Tr TT ee ee Vertical Rack Please note that iSite Radiology will check to see if new images have been added to the exam in question while you were creating a presentation state If new images are present you will not be able to save the presentation state but will have to reload the exam and begin again In addition if the user opens an exam that has a Technologist or Pre Read Presentation State the Presentation State will override certain features of the Hanging Protocol for the exam The Hanging Protocol settings Invert Clones and WW WL will not be applied If a Hanging Protocol is selected edited or created for this type of exam all of the Hanging Protocol features will be applied regardless of any Presentation States 188 If The exam has only a Original DICOM Presentation State or only a User Presentation State then the Hanging Protocol will be applied when the exam is opened in the Canvas Page If a Presentation State is selected edited or created from this exam the Presentation State will be applied regardless of any Hanging Protocol 189 Hanging Protocols Hanging Protocols are a key feature of iSite Radiology They are discussed at length in the second to last section of this chapter Send via DICOM This feature is described above in the section detailing the Navigational Timelines section Exam Information This feature will disolay a pop up dialog in which the current exam s informatio
12. Linking series that contain different body parts Series that contain different body parts or simply cover a larger smaller region of the body can be linked as well For example a CT series that contains a CHEST ABDOMEN PELVIS may be linked with a CT series that contains only a CHEST By navigating through the CT CHEST series as the master the user will never see the ABDOMEN PELVIS of the other series Conversely by using the CHEST ABDOMEN PELVIS as the master series the user will be able to view the CHEST images side by side as well as at the ABDOMEN PELVIS images of the master series 282 Using the linking feature a user cannot go beyond the scope of the master This might be obvious if the body parts are totally different like in the CHEST ABDOMEN PELVIS example but sometimes they are they same but do not start at exactly the same location In that case you may only miss a few slices Ta faa di d k ofaa Geet Pot a Series Series 2 A warning Linking of oblique series iSite allows users to link oblique series The goal is fo provide users with the ability to link oblique series that are more or less in the same orientation However iSite does not prevent users from linking Obliques that have completely different orientations Please note linking Obliques that are not of roughly the same orientation will lead to unexpected behavior Series Series 2 Save Image This function saves the selected window contents
13. Select Series ei CT Mo Descriptions key Image OS 08M 998 om S305461 Referring 035360 SHAPIRO RON Status PRELIM New Link Save F Print H Flip F otate CT No Descriptions I Of231999 Acc 4294409 Referring ODDIS CHESTER y Status PRELIM SOPUID 1 2 840 113619 2 55 Rl cT No Descriptions O3061998 4cc 3303451 Referring 035360 SHAPIRO RON Status PRELIM SOPUB 1 2 840 1135619 2 1 1 2 01131776 27 3 589 1881446 When Scout Mode is active a check mark will be visible next to the Scout Mode item in the pop up menu In order to leave the image selected for displaying scout lines unobstructed these reference lines will only appear when the cursor is passed over another image or series As the other series are cined the corresponding scout line will highlight to indicate the cursor s location with respect to the designated image as seen below To remove the scout lines right click the scout image and deselect the Show Scout Lines option The Scout Mode tool works in conjunction with the Localizer Mode explained below 203 Localizer Mode Like the Scout Lines the localizer tool helps you visualize and navigate to a location in multiple series with different orientations To initiate the Localizer function for a specific series or image right click and select Show Localizer as seen below Window widthiLewel d Image Processing Scout Line Mode Create Popup b Clone Window Wit
14. The follow is an explanation of how iSite Radiology calculates Window Width and Level values WW WL values are set for images when DICOM Source is not present and also when DICOM Source is applied for example 1 If no DICOM Source Is present and if image has Modality Default WW WL present this will be Used for images 2 If an image does not have Modality Default values and a DICOM Source is not present Histogram Calculation is used for PT and NM on a per image basis in addition to MR 3 If the image does not have Modality Default values WW WL values are based on a Histogram of first image in the series 4 DICOM Sources Histogram is applied now for CT and 8 bit data if specified in DICOM Sources 5 If DICOM Source is present and Histogram is used this will be applied to PT and NM series on a per image basis in addition to MR 6 If a DICOM Source is present and Histogram is used WW WL values will be used based on the histogram of the first image in the series 7 Color Ultrasound Window Width Level Calculations are based on Grayscale Ultrasound The default value is 256 128 8 If no Modality Default or DICOM Source is present for CTs only 500 50 WW WL values will be Used 9 If no Modality Default or DICOM Source is present 8 bits images for example US images will use the entire WW WL range of 256 128 242 VOI LUT Options Digitally acquired images must routinely be processed to produce
15. This feature allows you to add a patient exam to a folder from t he Patient History Timeline When you select the option the following dialog will appear 173 Folder Dialog a Personal Folders 9 Public Folders Navigate to the desired folder where you wish to place the new exam as seen below Folder Dialog HEJ Public Folders ofS New Folder 29 Teaching Files H E Mammo H O Metastatic Cancer Cancel 174 Highlight the desired folder and click the OK button Add the exam to the CD Manager folder if you wish to add It to a Direct Media project The exam will be visible in the folder you have selected the next time you open it Show Report The second function that can be accessed by right clicking the exams in the Navigational Timelines is showing diagnostic reports To view an exams diagnostic report right click the exam and select the Show Report option trom the pop up menu The appropriate diagnostic report will be presented in a separate floating window An example of a diagnostic report is shown below Clinical Exam Notes f Eai Clinical Exam Notes BADOH ROGER DOB 12 21 1946 Age 5 7 TM Sex U MRN 211360205 ACC 4196732 Exam MRSTDCM Org iSite 09 15 1999 12 00 AM Status Preliminary Perf Resource STDC Clinical Info Memos No allergies on record Please validate in your Registration Ordering system STENTOR AUTO GENERATED MESSAGE Exam Stentor Auto Report Patient 4CPT BADOR ROG
16. allows you 10 adjust only the current silica Toggles the Mark Read designation on and off for the selected exam Toggles shutiers on off Toggles SO00 DICOM Overlays on off F7 and F8 Comma and Period HomelEnd keys Toggles ALL Overlays onfoff isite screen overlays latte Annotations amp htegsuremenis and Embedded and Declared DICOM overlays Toggles Screen Overlays on off for all exams inthe active patent The Turbo CR keys used to quickly cycle through plan films in a single exam F8 will advance the navigation rectangle F7 will move it backward These keys wll loop for example if F is pressed at the end of a exam row the navigation reciangle will be moved to the first mnage Increase or decrease the angle for the Edge Enhancement and Edge Detection Image Processing Tools For CL4HE Image Processing alter nately increases or decreases the Clp Parameter Jumps 10 the first and last images in a selected image series respectively 20 Roll wheel NA Plain Films MA forward or Zoom into or out a of the image al backward the cursors loc ation Series frame by frame review L En through slices Click down In Cine Mode mouse wheel More mouse away and move fram you to in crease Speed Ed Hind bs wards you to de crease Shift key Allows selection of multiple WA NAA images while linking or pre
17. as seen below The Patient Directory provides a list of all patients whose exams are available on the iSite server While many of the patients available in the Patient Directory will not pertain to you the list is essential for performing ad hoc queries and accessing exams that might be outside of system and personal filter criteria iSite Radiology 00a Close All Patient Mame Patient ID Exam Date Patient Location JACKSON TYRELL 960819489 04 09 2001 08 35 00 EROS KILARNEY CHRISTOPHER 175228612 04 09 7001 08 36 00 EROS ORTIZ FRED 201260491 04 09 7001 08 36 00 EROS STAVNIZKY JOESPH ea A als gpI 2001 08 39 00 EROS Patients are listed by name either in ascending or descending alphabetical order Each patient listing contains the patient s Patient ID the date of the patient s last exam and the patient s location 146 Patient listings can be expanded by clicking the symbol to the left of the patient name This will reveal the exams available for that patient as shown below 4 iSite Radiology QKPE Close All Patient Name Patient ID Exam Date Patient Location ee JACKSON TYRELL 9608 19439 4092001 08 55 00 EROS KILARNEY CHRISTOPHER Mor O4f09 2001 08 56 00 EROS CR CR TEST Acc 4046710 Referring DI 04 09 2001 08 56 00 MR MR TESiYAcc 4069996 Referring DIER D4 09 2001 06 56 00 CR CRTEST Ace 4207613 Referring DIER D4 09 2001 08 56 00 CR CR TEST Acc 4207620 Referring DIER D4fOS 2001
18. iSite Radiology Placement Guidelines The following diagram is designed to provide guidelines for the proper placement of iSite Radiology 10 New Features New Features in iSite Radiology 3 5 MPR Multi Planar Reconstruction iSite 3 5 now includes an MPR tool allowing the user to reconstruct missing image series orientations using data from orientations that are available Remote Reading Caching of Exams on Remote Client Machines If The Remote Reading Mode checkbox Is selected at login iSite Radiology will engage the teleradiology Remote Reading Mode This mode is designed for site with radiologists who read exams from off site Remote Reading Mode allows a group of offsite radiologists to function as a virtual group within the reading environment The behavior of Remote Reading Mode is dictated by your Reading Preferences You can specify how exams are handled auto locking and maximum file size to be downloaded Fast Cine and Cine Loop Enhancements In iSite 3 5 the Fast Cine and Cine Loop features have been enhanced in several ways to facilitate work with studies that have large numbers of slices Fast Cine and Cine Loop can be more accurately controlled using the mouse and the user now has the freedom to set a preference for the default frames per second playback of cine loops This default rate can now be raised as high as 45 frames per second In addition the user can adjust the playback rate on the fly wi
19. mouse wheel and drag the mouse forward or backward Fast Cine mode be activated by double clicking the mouse wheel button This will automatically engage a single Cine Loop feature which continuously plays through all the slices in an image series from one end of the series to the other Moving the mouse forward will play the cine loop in ascending order while moving the mouse backward plays the loop in descending order The Cine Loop will begin at a rate of 1 frame per second and will accelerate or decelerate depending on how far the mouse is moved forward or backward after the 231 mouse wheel is clicked The default playback rate of the Cine Loop between and 45 frames per second is often sent from the modality as a DICOM tag A default soeed for when this information is not sent can be set in the iSite Preferences To change the playback rate for a specific series on the fly without changing the iSite Preferences click the or buttons Each click of those buttons will raise or lower the playback rate 1 frame per second The Play Cine Loop feature can also be engaged by right clicking a series and selecting Play Cine Loop from the pop up menu Expanded Image Overlay Information If iSite Radiology is configured to display the information with overlays all expanded image windows have text overlay with the following default fields Lossy Compression Indicator Current FPS frames per second multi slice series only Desired
20. name Mora in the Patient Name field will produce a list of patients whose last name begins with Mora and who were examined on November 1 2000 Expanded Search iSite padioloay e fuel br ce Ee RSS SS eRe Gotan a ear ENDL i eeecate anno Sy arr bat eisai TERGA Last 3 days Accession Number Modality Referring Physician Organization Fo E ES E H JACKSON TYRELL 960819469 4 09 2001 065500 EROWS KILARNEY CHRISTOPHER 1752286612 op OIOI 08 56 00 ER0103 CR CR TEST Ace 4046710 Referring DIER O4f09 2001 08 56 00 MR MR TEST Acc 4089996 Referring DIER D4 f09 2001 08 36 00 CR CR TEST Acc 4207615 Referring DIER O4 09 2001 08 56 00 CR CRIEST Ace 420 620 Referring DIER 04 09 2001 08 56 00 CR CRTEST Acc 4207616 Referring DIER D4 f0S 2001 08 56 00 CT CT TEST Acc 4207711 Referring DERG O4 09 2001 08 56 00 CR CRIEST Acc 4309278 Referring DIER 04 09 2001 08 56 00 CR CR TEST Acc 4309281 Referring DIER D4 f09 2001 08 56 00 CR CR TEST Acc 4318077 Referring DIER O4 09 2001 08 56 00 CR CRTEST Ace 4418080 Referring DIER O4 09 2001 08 56 00 CR CR TEST Acc 4318083 Referring DIER O4 09 2007 08 56 00 CT CT TEST Ace 3447461 Referring DERC 04 09 2001 08 55 00 n ORTIZ FRED 2012760491 4 09 2001 08 58 00 EROS STAYNIZKY JOESPH SU 4 09 2001 08 59 00 ER0103 The Patient Directory can also be searched using specific information such as Accession Number Modality and Referring P
21. 08 56 00 CR CR TEST Acc 4207620 Referring DIER 04 09 2001 08 56 00 CR CR TEST Acc 4207616 Referring DIER 4 09 2001 08 56 00 CT CT TEST Ace 4207711 Referring DIERC 04 09 2001 08 56 00 CR CR TEST Acc 4309278 Referring DIER 04 09 2001 08 56 00 CR CR TEST Acc 4309281 Referring DIER 04 09 2001 08 56 00 CR CR TEST Acc 4318077 Referring DIER 04 09 2001 08 56 00 CR CR TEST Acc 4318080 Referring DIER 04 09 2001 08 56 00 CR CR TEST Acc 4318083 Referring DIER 04 09 2001 08 56 00 CT CT TEST Acc 3427461 Referring DERC 4 09 2001 08 55 00 ORTIZ FRED 201260491 04 09 2001 08 58 00 EROS STAYNMZKY JOESPH wS 0409 2001 08 59 00 EROS Patient Location Enter the patient location you wish to search for and then click the Query button Exams that match your search criteria will be displayed below iSite heap 149 iSite pearl Close All Patient Mame Patient ID Exam Date Patient Location Query Last 3 days ORTIZ FRED 201260491 O4f09 2001 08 58 00 ER0103 Example You wish fo find a patient who was examined on November 1 2000 but you do not remember the patient s entire name Simply type 11 01 2000 in the Exam Date field then click the Query button iSite will display all the patients who were examined on November 1 2000 If you remember part of a patient s name you may type that in as well For example running a search with the date 11 01 2000 and the
22. 08 56 00 CR CRIEST Acc 4207616 Referring DIER D4 09 2001 08 56 00 CT CT TEST Ace 4207711 Referring DIERC U4 09 2001 08 56 00 CR CR TEST Acc 4309278 Referring DIER D4fOS 2001 08 56 00 CR CR TEST Acc 4309261 Referring DIER DAfOS 2001 08 56 00 CR CRTEST Acc 4318077 Referring DIER U4 09 2001 08 56 00 CR CR TEST Acc 4318080 Referring DIER D4 fOS 2001 05 56 00 CR CR TEST Acc 4318083 Referring DIER DAfOS 2001 08 56 00 CT CT TEST Acc 3447461 Referring DIERC D4 09 2007 06 55 00 ORTIZ FRED 201260491 4 09 2001 08 58 00 EROS STAVNIZKY JOESPH Heft UES if 4 09 2001 08 59 00 EROS To view an exam from a patient s listing simply double click that exam Sorting the Patients Directory The Patient Directory is automatically sorted by Patient Name in alphabetical order You can also sort the Patient Worklist by Patient ID or Exam Date To sort click the gray column headings above the search fields Clicking the column headings will alternately sort the Patient Directory in ascending order A Z or 1 9 or descending order Z A or 9 1 iSite ae Close All All eS Name Sn SS ID E Date Fatient na m MA Last 3 days JACKSON TYRELL 960319459 0409 2001 08 55 00 ER0103 KILARNEY CHRISTOPHER Peele 2 04 09 2001 08 56 00 ERO103 ORTIZ FRED 201260491 04 09 2001 08 58 00 ERO03 STAYNMZKY JOESPH R b 04092001 0E5800 ER010S 147 iSite Radiology Close All Patient Mame Patient ID Exam Da
23. 7 When you have entered the necessary information in the fields set the Orientation 8 You need to add separate configurations if you intend to print images from multiple modalities or if the same modality uses different image display formats film sizes or Medium types Machine specific Preferences iSite allows you to set preferences for the machine that you are currently working on These preferences are limited to personnel with administrative privileges only To view these options click the Machine listing in the tree view control at left as shown below Preferences Dialog User Preferences System Preferences Sg Machine Preferences Display Monitors General Preference Scanner Preference Network Testing Cancel 136 Display Monitors To access the Display Monitor preferences click the Display Monitors listing at left as seen below Preferences Dialog 4 User Preferences Display Monitors H System Preferences Machine Preferences SES Cisplay Monitors Plug Ing General Preference Scanner Preference Network Testing Display hi Monitor on NWIDIS GeForce Fs Gob200 Screen Resolution Font Sizes Small Fort 10 1680 by 1050 pixels kedim Fonk 14 18 fi Large Font Monitor Functions Menu Font ROF Changes require application restart Cancel Apply Help If you are using more than one monitor pull down the Display menu to reveal additional monitors The
24. Access Server 14 While this will provide you with access to the image feed from the modalities at your institution iSite Radiology s capabilities will be significantly limited In Emergency Access mode all exams are registered as exceptions There will be no access to diagnostic reports prior exams hanging protocols or presentation states You will however be able to view and measure images For more questions about Emergency Access mode please contact your iSite System Administrator Remote Reading Mode When the user has the ISTLCACHE security code enabled and the Enable remote reading checkbox is checked in the Machine Preferences seen below a Remote Reading Mode checkbox will appear on the iSite Radiology Login Screen Preferences Dialog User Preferences Remote Reading System Preferences lt Machine Preferences Display Monitors Plug Ins Local E sam Caching General Preferences Scanner Preference Remote Reading Network Testing Remote Reading Settings Humber of remote exams to cache ahead when ho reading from worklist l il Number of remote relevant priors to cache ahead i with each cached UnA ead exam 1 Maximum study file size MB 128 W Include auto locking caching of STAT exams If the Remote Reading Mode checkbox is selected at login iSite Radiology will engage the teleradiology Remote Reading Mode This mode is designed for site with radiologists who read exams from off site R
25. CLAHE Method Modalities Read Only CLAHE are automatically expanded 84 Preferences Dialog H User Preferences E System Preferences General Preferences FEE dige Enhance Method Degree Modalities Head Only Edge Detect Method Degree Modalities Head Only Median Filter Method Modalities Head Only Location Dictionary CLAHE Plug Ins Method H Machine Preferences Modalities Read Only Network Testing Cancel Click each setting to see the current value and to make changes as seen below 85 Preferences Dialog E User Preferences System Preferences General Preterences Window Width Center Image F E Edge Enhance ee Modalities Read Only Annotations E Edge Detect DICOM Sources hdethod Degree Modalities Read Only Median Filter Method Modalities Read Orly CLAHE Method Body Part Dictionary Modalities Read Only Hanging Protocols DICOM Print Machine Preferences Network Testing Detailed alterations to the method degree and properties of each image processing option can be made in these menus except for the Modalities sections which are Read Only The CLAHE section has extensive preferences which include Contextual Region Dimension Number of Bins Clip Limit and Map Level Filters To access the next page of system wide preferences click the Filters item in the tree view control at left as seen below 86 Prefe
26. Center Filters Annotations DICOM Sources Screen Overlays Paper Printing Body Part Dictionary IE pork Ouer Organization Dictonary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel General Preferences The system wide General Preferences are seen below 79 Preferences Dialog User Preferences General Preferences System Preferences General Preferences Window Width Center Logon welcome message Welcome to Eng Tester 3 5 Image Processing Filters Annotations DICOM Sources Masimum variance for linking 5 Degrees Screen Overlays Paper Printing Export Options Ouer Organization Dictionary Ww Allow DICOM Query From Exam Timeline lrage Senes Linking Location Dictionary Plug Ing Body Part Dictionary Image Orientation Hanging Protocols Enable user preference for automatically flipping of Axial CT DICOM Print images Machine Preferences Network Testing p Allon exams to be marked read more than once Cancel There are three sections to the General System Preferences The Logon welcome message allows you to set a greeting for the iSite Login Screen In the image above it reads Welcome to iSite 3 5 In the Image Series Linking section you can set the number of degrees to allow for linking variance This feature is used to set the variance degree iSite uses to determine if a Series can be linked with another serie
27. Cine is enabled al an Intal frame rate of 1 FPS Double clicking again toggles Fast Cine on off Plain Films Pan WA NSA NFA M NAA 18 Roll wheel WA forward or backward Shift key Allows selection of multiple Images while linking or preparing to print Hold down the shift key while executing mouse or keyboard controls to Plain Films NA Zoom into or qui of ihe image at the cursors location Series frarne by frame review through slices In Cine Mode changes playback direction Asc Dec N A MHA temporarily disconnect an image from any links 19 The following chart lists keyboard commands that are used independently of the mouse Keystroke Action Space bar Page Up and Page Down Right and Left Arrow Keys Control key P Control key M Numbers 1 9 L key F3 Control Key Shift F Control Key Alt key F6 Control Key F6 FG Vile cursoris over an image or Series toggles that mage as a key irnage single rame review for image series Same function as F7 and F8 listed directly above Toogles the Diagnostic Monitor Pane Icons in the Navigational Rectangles on and off Toggles Measurement Palette an and off When viewing a CT seres allows you to quickly select the comesponding preset Window VidthfLevel setting Holding down the L key while adjusting the window width and level of a series
28. Current Link Status santry Detector Tilt Key Image Slice Thickness Zoom Factor Font Sees Ti me ATAT Export Import Cancel Items can be removed by clicking on them and dragging them out of the overlay window Add items as discussed in the sections above When you have finished editing the overlay properties click the OK button to save your changes To edit a screen overlay tag double click that tag The following window will appear Tag Edit Dialog Name Mae alates Value hk 00180050 mom o Cancel Both the name and the value can be changed The value corresponds to the DICOM meta data field which carries the information in question 107 Screen overlay configurations can be removed by highlighting that item and clicking the Delete button If you wish to export a Screen Overlay listing select the desired Screen Overlay and click the Export button The following dialog will appear Save in My Documents de t a My Music ES My Pictures My Webs New Folder File name Save as Ippe xm Files sml Cancel Ze Choose a name for the exported file and click the Save button The file will be saved in xxml format in the chosen directory If you wish to import a Screen Overlay listing click the Import button Choose the desired xml format file and click the Open button You can cancel your changes at any time by clicking the Cancel button 108
29. Latency Threshold ma 10 Log results to file Yetwrork Testini Network Testing Delay between tests seconds ED Log results to server Bandwidth Test Size KBytes i TI Start Static Bandwidth powerscribe UF Sec 0 ms 0 h p worldglazs1 i20 0KrSec 0 O m 0 Cancel Apply Help Set the various options in the Configuration area as needed and then click the Start button to run the test you have configured Results will be displayed below Other Ways to Personalize iSite Radiology There are additional ways to personalize your reading experience in iSite Radiology These options are available from the iSite Radiology Diagnostic Racks and are discussed in detail in the iSite Radiology Diagnostic Racks section of this manual 144 iSite Radiology Worklists iSite Radiology provides several basic lists of patients from which you will select exams to review Which worklists you use will depend largely on your particular work habits and the workflow at your institution The Patient Worklist for example allows you to perform ad hoc searches of the patient database using multiple criteria to produce a worklist There are also preset System Filters such as CT ALL which produce a worklist from a default set of criteria Your system administrator can add new System Filters to the system These Filters are available to all users Finally there are Personal Filters which you create yourself and which are available
30. Print Configurations iSite allows you to configure the way in which exams and images are printed You can create unique print configurations that users can select from and specify exactly how image metadata will be printed as an overlay To access these options click the Print Configurations item in the tree view control at left The following screen will appear Preferences Dialog User Preferences Paper Printing System Preferences General Preferences Window Width Center Add Image Processing 1x1 Single Image Filters 2x Properties ome Annotations re DICOM Sources Sed Stack Delete screen Overlays Awe Paper Printing Export IE port Query Organization Dictionary Location Dictionary Plug Ing Body Part Dictionary Hanging Protocols DICOM Print Machine Preferences Network Testing Import Cancel To add a new print configuration click the Add button The following screen will appear Add Windows Print Configuration me Format 1x1 Overlay Cancel Fill in the necessary information If you wish to configure the print overlay click the Overlay button The following screen will appear 109 Overlay Dialog Name Body Part DEX eres Mumber 7 Calculated Font Procedure Code Image T Export Import Cancel Configure the overlay as discussed in the Screen Overlay section of this chapter When you have finished click OK then click OK
31. Shortcuts Bar and Its operation are described fully in the chapter of the same name Shortcuts are created by either right clicking an icon in the iSite Folder List and selecting the Create Shortcut option or by simply dragging and dropping an icon into the Shortcuts Bar In addition you can toggle the folder list on and off by right clicking the Shortcuts Bar and selecting either the Show Folder List or Hide Folder List options depending upon which Is visible Creating New Folders This feature works in the same way that you create new folders in Windows Explorer or Microsoft Outlook fo name a few New folders can be created in the iSite Folder List by right clicking a folder in which you wish to add the new folder and selecting the Add New Folder option from the pop up menu Please note that new folders cannot be added fo the iSite Tools folder Renaming Folders Folders can be renamed in the iSite Folder List by right clicking the folder and selecting the Rename Folder option from the pop up menu The folder s name will become an editable text field Type the desired name and then click the Return key Please note that some folders cannot be renamed In these instances when you right click the folder the Rename Folder option will be grayed out 43 iSite CD Manager Introduction The iSite CD Manager allows you to create personalized CDs that include an encapsulated version of iSite Enterprise and patien
32. The tag name and value will be listed by default To reference a particular DICOM tag edit the value field as necessary For image number always use the DICOM Tag Instance Number 0020 0013 Please note for Digital Mammography exams MG in order to see the Mammography Orientation and Laterality Display overlays a separate MG Screen Overlay must be created 105 When you have finished positioning the desired overlay elements click the OK button to save your changes You will return to the Screen Overlays dialog and your new overlay will be visible alongside the pre existing ones To edit the properties of an existing screen overlay highlight that listing and click the Properties button as seen below Preferences Dialog H User Preferences System Preferences General Preferences Window Width Center Filters l CT KODAK AUTORAD Screen Overl aps DEFAULT Paper Printing KR Body Part Dictionary MA KODAK AUTORAD Export Organization Dictionary Location Dictionary Plug Ins Hanging Protocols DICOM Print Machine Preferences Network Testing Help The overlay screen will appear as seen below 106 Overlay Dialog Patient Exam Study Seres Station Mame Model Mame Institution Mame Description REWI Exam Mumber DOB Sex PtIO ceres Number Image W ceres Description Slice Locatii Slice Location DFOY Calculated kw P A ray Tube
33. US Expand the various sections of the menu at right as seen in the image below 101 Overlay Dialog Overlay Mame Body Part Patient Name Number MAN Birth Date Ser Age Exam ACCESSION Referring Physician Name Procedure Code Procedure Description Study Tim Description Seres Modality Description Body Part Seres Number Font Procedure Code Image Type Export Import Cancel The sections of the menu represent the various overlay options available to you For example as seen above you can add patient name MRN DOB sex or age as overlay info Up to 50 overlay items can be added to an image approximately 12 in each corner In addition multiple items can be added to each line date age etc To add an item highlight that item by left clicking and then dragging the item into the screen mockup at left The complete list of screen overlays is presented below e Patient o Name MRN Birth Date Sex Age e Exam o Accession Referring Physician Name Procedure Code Procedure Description Study o Date Time Description Series 102 O Modality Description Body Part Series Number Institution Name Patient Position 103 e Images o Image Type Acquisition Date Acquisition Time Instance Number Images in Acquisition Acquisition Number Spacing Between Slices Slice Thickness Slice Location o Dose IgM Please note this computed tag looks for the Agfa specific p
34. access the Local Exam Caching settings click the Local Exam Caching listing in from the Machine Preferences sub menu as seen below 141 Preferences Dialog User Preferences Local Exam Caching System Preferences Machine Preferences General Machine Preterence Display Monitors Local Path ah BardachsLocal Settings 4pplication DatasisitesLocal Cache Plug Ing Cache Size Maximum Cache Size 6699 ME Automatically delete exams not accessed for more thar ao Days 12 His Restore Defaults Cancel The Local Path section shows where the exams are being stored This path cannot be edited The Cache Size options allow you to set the maximum size of the cache In megabytes as well as permitting you system to automatically clean up unused exams in your cache after a certain amount of time Adjust the settings as necessary and then click the Apply button or the OK button to save your changes and close the Preferences Dialog Remote Reading The Remote Reading preferences allow you to control how iSite Radiology will behave when Remote Reading Mode is enabled at login To access the Remote Reading preferences click the listing from the Machine Preferences sub menu as seen below 142 Preferences Dialog User Preferences General Preferences Window Width Center Image Processing Filters Display Preferences Hanging Protocols Canvas Page System Preferences Number of remote exams to cache a
35. button e If you wish to disable the Navigation Rectangle Splitting for your Canvas Page Navigation Rectangles check that box 58 e lf you want the measurements palette to be disolayed automatically when your are viewing images check the Show Measurement Palette box e Clicking the Display Key Image Stack checkbox displays the Key Image Series at the beginning of each Exam Rack e Axial Oblique CT Click this option if you want iSite to automatically display axial and oblique CTs such that the anatomical right is disolayed on the left regardless of the initial orientation of the image Please note that the visibility of this option is dependent on the System Preferences set by your institution s iSite System Administrator If you wish to change your password click the Change Password button The following window will appear Change Password User Hame ME ardachMi O Old Password Hew Password Confirm Hew Password Cancel Enter information as necessary and then click the Change Password button If you wish to cancel the password change and return to the preferences dialog click the Cancel button When you have finished in the General Preferences you can either click the OK button to close the preferences or click another item to continue 59 Window Width Center The next area in the User Preferences window Is the Window Center Settings tab shown below Preferences Dialog El User Prefe
36. click OK when finished 10 253 156 24 104 re e If you wish to delete a listing highlight that listing and click the Delete button Click the Apply button to make your changes permanent 323 Frequently Asked Questions and How To s General Questions Will iSite Radiology be able to handle all of the modalities that use iSite Radiology currently handles the following modalities Computed Radiography CR Computed Tomography CT Magnetic Resonance MR Digital X ray DX X Ray Angiography XA grayscale secondary capture SC including 8 bit grayscale Nuclear Medicine NM Ultrasound Multiframe including grayscale US Positron Emission Tomography PET X Ray RF XRF Radiotheraphy Image RT Image and Digital Mammography X Ray Image We are looking to expand Site s support of other modalities and will post information regarding these accommodations in the Upcoming Features section of the Philips Global PACS Customer Care pages Do my iSite Radiology Monitors need to be calibrated Yes iSite Radiology depends on the Navigational Console where Worklists are displayed and the Diagnostic Monitors where diagnostic radiological images are displayed being calibrated If the monitors are not properly calibrated they may not display the radiological images correctly and as a result patient pathology may be missed and patient care compromised Philips states emphatically that if the monitors use
37. click the Import button Choose the desired xml format file and click the Open button Body Part Dictionary iSite allows you to configure the body part dictionaries that your institution will be Using in conjunction with various parts of the program The various body part definitions can be edited and removed New definitions can also be added To access the Body Part Dictionary click that listing from the list at left as seen below 112 Preferences Dialog H User Preferences System Preferences e General Preferences Window Width Center pea Bicept Forearm Fi adius Tricept Ulna Wrist Abdomen 4dominal Pectoral AibCage T DICOM Sources Ankle Heel Metacarpels Metatarsels Sol screen Overlays Cranium Frenum Mandible Maxible Orbits Paper Printing Body Part Dictionary IE sport Duer Organization Dictionary Location Dictionary Plug Ins Hanging Protocols DICOM Print Machine Preferences Nehwork Testing To add a new body part definition click the Add button The following window will appear 113 Add Body Part Dictionary Dialog Mame Head Equivalents Cranium Mamible Orbit Frenum Supra aea Enter the name for the body part and then a comma delimited list of all equivalents as seen above When you create the list of equivalents try to be as expansive as possible so that iSite is able to process as many variants of a body part as possible To view the properties of an ex
38. dialog which allows you to add a DICOM tag that is not shown by default o Add gt gt lt lt Remove These buttons allow you to add or remove a DICOM Tag and its values to from the selected Tags in the Define Matching Values window o Add Edit Remove Value These buttons allow you to add edit or remove a Tag Value that has been added to the Define Matching Values window Click OK when finished Matching Series Rules can also be exported from your system for use in a different organization or environment Click the Export button to save an XML file with your Rules that is portable and be imported to another iSite system MPR MPR or Multi Planar Reconstruction is a powerful feature that allows you to create a reconstructed series either in the same or using a different orientation on the fly Currently iSite supports the creation of reconstructed series in the Axial Coronal or Sagittal orientation Reconstructed series can also be created with thicker slices or slabs Using this option you will be able to specify the slab thickness the spacing the gap and the applied algorithm Average Intensity Maximum Intensity MIP and Minimum Intensity 29 Before proceeding please note that if iSite is running in a lossy compressed mode then the MPR images generated will be based on lossy data These MPR Images will not be full fidelity and should never be used for diagnostic reading Furthermore if new images arrive for
39. for untransformed data e Hounsfield units based on 1024 air as per DICOM standard no error e lf slooe intercept is provided then the pixel value is Y mx b with floating point values rounded fo the integer pixel value This means that the error is dependent on the magnitude of the value with a maximum deviation of 0 5 254 To use this feature select the Point Value option trom the Measurements sub menu as seen below Window WidthjLevel Measurement Ruler Annotations b Angle Image Processing Region OF Interest Scout Line Mode Freehand ROI Localizer Mode Multi Image Mode Clone Window With Preset Measurements Palette Calibrate Image New Link Link All Asials Save Print To Paper FlipfRotabe Sort b foom Presets li 30 When you select this option screen overlay text will appear at the bottom of the image This text will read PV followed by X Y coordinates in parentheses that will change as you move your cursor over the image The X coordinate value starts at zero from the left and increases in value towards the right side of the image The Y coordinate value starts at zero from the top and increases in value towards the bottom of the image Point Value t 293 151 1165 255 AA Please note e Anytime iSite calculates a measurement using a sub sample of an image the measurement result is disolayed with a meaning approximate value in front of it Measurement Palette
40. group can be populated with shortcuts just as described above by dragging items from the iSite Folder List Renaming and Removing Groups To rename or remove a group simply right click the Group Header and choose the appropriate option If you choose to rename the group the Group Header will become an editable text field Type in the desired name and click the Return key If you choose to remove a group please note that you will lose all of the shortcuts present in the group When you choose the Remove Group option iSite will prompt you with a warning message and will ask you to confirm the removal as seen below site Radiology T Are you sure you want to remove the group Filters If you wish to continue click Yes If not click No iSite Radiology Folder List The iSite Folder List works hand in hand with the Shortcuts Bar It is also an important part of the iSite workflow Please continue on to the chapter Using the iSite Folder List by clicking the Next Chapter button below 36 The iSite Radiology Folder List The iSite Radiology Folder List located on the left of the iSite screen is your gateway to various areas and tools in iSite Radiology This directory tree functions in the same way as those found in programs such as Windows Explorer and Microsoft Outlook Folders can contain tools such as the CD Manager directories such as the Patient Directory preset search filters
41. h Create User Hanging Protocol Create System Hanging Protocal Select User Hanging Protocol d Select System Hanging Protocol Rehang Send via DICOM Add Exam To Folder Exam Information Vertical Rack The first window of the Hanging Protocol settings will appear as seen below Create User Hanging Protocol Identifier Modality CT Modality and Body Part CT CHEST z Type f Default Alternate Use Series Matching Rules p rea 223 Change the settings of the Hanging Protocol as desired following the steps listed in the section above When you are finished click the Finish button and your changes will be saved Please note that after a hanging protocol is edited it must be reapplied to update changes to the exams being viewed If the exam being viewed is the main exam all exams must be reloaded and all changes will be lost Selecting Hanging Protocols To apply a Hanging Protocol to your main exam right click the exam row margin and choose Select User Hanging Protocol or Select System Hanging Protocol from the menu as seen below Presentation State gt Edit Hanging Protocol Create User Hanging Protocol Create System Hanging Protocol Select User Hanging Protocol h d CT Modality CT i p CT 2x2 Modality CT default Select System Hanging Protoce Rehang CT test Modality CT Send via DICOM CT LT Modality CT BodyPart LT Add Exam To Folder w CT LT Bardach Modality CT Bod
42. image in a particular series or exam Images can be marked key images by highlighting the selected image and pressing the space bar The words Key Image will be displayed in that image to Indicate its status Logout Button This arrow button located in the upper right extreme of the iSite Radiology Control Strip will log you out of the system and return you to the iSite Radiology Login Screen when clicked Monitor Layout The monitor layout is the way In which the diagnostic monitor is split There are nine options as well as split horizontally and split vertically The Monitor Layout options allow you to hang your diagnostic monitors exactly as you wish These options can be accessed through the right click pop up Menu or by right clicking the diagnostic monitor icons Multi lmage Mode This option available from the right click pop up menu allows you to split a series window into several panes The available options are 1 1 1 2 2 1 2 2 1 3 3 3 3 4 and 4 5 Please note this option is not available for thumbnail images in the Diagnostic Exam Racks Navigational Console The console is a monitor located directly adjacent to your diagnostic monitors The Navigational Console displays the iSite Shortcuts iSite Folder List Patient Directory and Filter Worklists and the Canvas Page leaving the diagnostic monitors free for diagnostic image viewing 337 Navigational Rectangles These interactive rectangles are displayed in t
43. loop is playing Cine Loop can also be initiated by hitting the C key Hitting the C key will toggle the feature on and off In an expanded window F7 will allow you to view the previous rack series in the exam while continuing to Cine Loop F8 will show you the next series Right clicking the image will stop the Cine Loop Flip This function allows you fo flip the selected image horizontally around the y axis or vertically around the x axis This function allows you fo flip the selected image horizontally around the y axis or vertically around the x axis 288 Flip Horizontally Flip Vertically 289 e Rotate This function allows you to rotate the selected image or series in 90 degree clockwise or counter clockwise increments Rotate 90 Degrees Clockwise Rotate 90 Degrees Counter Clockwise 290 Sort series only This feature has four options that allow you to reorder the exam in the Diagnostic Rack according to your sorting preferences Table Position Ascending Table Position Descending Image Number Ascending and Image Number Descending In some cases the Sort Menu will be disabled If the image is a multi frame image if not all the images have the sort tag in their DICOM or if all of the images have the same value for the sort tag the Sort option will be unavailable Split Exam This feature allows you to split a series according to specific DICOM tags This should not be attempted if you ar
44. monitor listed is the one for which the settings will apply The Screen Resolution of the monitor is displayed at left In the Font Sizes menu you can control the size of the fonts disolayed on your monitors and in pop up menus To designate a monitor as your Navigation Console highlight that monitor and select ROP from the Monitor Functions pull down menu at bottom left Machine level Plug Ins Plug Ins can be created for an individual machine for integration purposes such as a Voxar dongle While this feature is only available for System Administrators it provides a higher level of granularity in setting Up iSite on a specific machine To access the Machine level Plug Ins click that listing from the Machine Preferences sub menu as seen below 137 Preferences Dialog User Preferences Plug Ins System Preferences Machine Preferences Display Monitors Plug Ins General Preference Scanner Preference Network Testing NAB Clinic Lab Results NAB Clinic Pharmacy Pharmacy com Cancel To add a new Plug In click the Add button The following window will appear Plug In Dialog PO Visible in folder tree URE Enable in iSite Radiology Enable in iSite Enterprise Disable AFI Requires Security Code cancel Choose a display name for the Plug Ins folder and then set whether it will be displayed in the folder tree If not it will be invisible to non administrative users For information about
45. no longer displayed and there might be a small uodate change from the measurement values displayed initially KILARNEY 29 Oct 1999 11 52 31 Acc 4309276 m FY No Descriptions shoulder AP Seres 1 Window WidthjLevel Measurement Ruler 4nnotations F Angle Image Processing l Region OF Interest sini C Fehi Paint Yal New Link a Save Measurements Palethe Print To Paper Flip Rotate Sort b Zoom Presets Calibrate Image nics ss wil 11 0 3267 tm 253 Oct 1999 11 52 31 Acc 4309278 a FG MEBKILARNEY 29 Oct 1999 11 52 31 Acc 4309278 Fy hs ia Figure 4 o Figure2 KILARNEY 29 Oct 1999 11 52 31 Acc 4309278 Point Value The Point Value Tool allows users to measure the value of data points at a specific point on the image This feature gives the luminance value for single pixels of the original DICOM image In other words the value given is not related to what is being displayed on your screen Rather it is the value for a reference point which is mapped to the original DICOM image The measurement units depend on the modality type and the information provided in the DICOM image header and will be either e Hounsfield units sloped intercept for CT e Mapped pixel intensity for VOI LUT e Pixel intensity as remaped by modality LUT or rescale slope intercept processing as per DICOM standard The level of accuracy Is the following e True pixel value no error
46. or hide it but you can resize it by placing your cursor on the right divider and dragging 26 User Bardach Noah MD iSite Rad iology F Patient irectory p Q P shortcuts SI Close All i Patient Name Exam Date Patient Location A ADAMS Jf Seu ADAMS JULIE A 156666696 10 23 1999 19 2400 Patient Directory CT CTSTOCM Acc 4295009 Referring L 107231999 19 24 00 CT CTSTOCM Acc 4294409 Referring 1 10 43 1999 17 30 00 ag d CR CRSTOCM Acc 4294000 Referring U 10 25 1999 16 36 00 Last 3 Days Last Days DUPUID Cases The Shortcuts Bar works in similar fashion to shortcut bars in Microsoft Outlook Front Page and other common programs Simply click one of the shortcut links and the area to the right will display the desired content For example clicking the Last 3 Days Filter shortcut displays the Last 3 Days Tab as seen below 21 ye i Shortcut User Bardach Woah MO iSite Radiology Ss QAF J MAT Accession Body Part CARSTEN RICK 2029393829 434417920001 BRAIN aa EDEN MARY 1029384033 434419280001 HEAD Patient Directory FOX VINCENT 0392829304 43441 040001 HAND Ee HARM CLAUDIA 1020393820 434420690001 PELVIS EED Peen LEVIN BOBBY 6628292971 4344222E0001 BRAIN MARTIN REBA 3927828391 434423CF0001 SHOULDER L PECK JENNY 9293829201 434445440001 HAND CT HEAD RICHARSON J 7771282722 434455340001 FOOT ROBERTS ALI 5557389282 434454850001 HEAD VISHNU SANGIT 3029
47. other folders and even clinical exams You can create personalized folders and fill them with links to clinical exams that are important to you simply by dragging and dropping Please note that dragging and dropping an exam listing to a folder will not copy the exam or move data from one folder to the next You are simply moving exam links Depending on the permissions set for you by your iSite System Administrator you may not see all of the Folders displayed in the images below If you have any questions about your permissions please contact your local iSite System Administrator Introduction The iSite Folder list may not open immediately when you log into iSite If you do not see the Folder List click the arrow button on the Shortcuts Bar Shortcuts l or right click on the Shortcuts Bar and select the Show Folder List option The iSite Folder List can be viewed in all contexts except when viewing clinical images in this context the Folder List is hidden to provide as much area as possible for viewing images 37 oe SSL F iSite Tools Shortcuts Last 3 Days Last 7 Days DUPUID Cases Filters User Bardach Noah MD gy Y G 5 J iSite Radiolo Folder List ACD Manager 4 DUPUID Cases i Exception Handler Q iQuery 0 Local Exam Cache H E My Filters E Patient Directory E Statistics E Study Lookup H System Filters H 0 Personal Folders H Public Folders The F
48. preferences click the OK button If you wish to export a Hanging Protocol listing select the desired Hanging Protocol and click the Export button The following dialog will appear 125 Save Ir ay My Documents f a E E My Music Ez My Pictures My Webs New Folder Save as type rn Files sml Cancel ZA Choose a name for the exported file and click the Save button The file will be saved in xxml format in the chosen directory If you wish to import Hanging Protocol listings click the Import button Choose the desired xml format file and click the Open button Please note that the following rules apply to Importing Series Matching Rules 1 If the Series Matching Rule is unique name attributes values it will be imported as new 2 If the Series Matching Rule has a duplicate name and comprises a duplicate set of attributes and values if will not be imported 3 If the Series Matching Rule has a duplicate name but it is unique i e distinct attributes with distinct values the Rule will be imported and the import prefix will be added to its name DICOM Print The DICOM print option allows you to control the printers to which exams and images will be printed Please note to properly configure and validate your DICOM Print settings you will need to obtain information and assistance from the printer vendor Additionally images that have an Image Processing Filter applied to them
49. split right click the screen and select Cancel Split from the pop up menu 233 Please note that while the Diagnostic Monitor has been split when you double click an image or series loaded into one of the Virtual Split Monitors the full real estate of the physical Diagnostic Monitor will be Used to display the image or series regardless of the Virtual Split partition The Diagnostic Monitor Icons in the Canvas Page will be Updated to reflect the split a new Diagnostic Monitor Icon will appear alongside the existing ones and will behave just like other Diagnostic Monitor Icons And just like physical Diagnostic Monitors the Virtual Split Monitors can be incorporated into your Hanging Protocols Selecting Images and Series to Hang iSite Radiology has been designed to be configurable in such a way as to create as little hanging work as possible If you have carefully set up your general preferences and your hanging protocols in most cases you will not have to actively select images or series to hang Ideally you will simply click the Next Exam button on the canvas page and proceed through your personalized worklist If you do have to hang images or series iSite Radiology makes the process quick and intuitive The ad hoc selection of images and series for display in your Diagnostic Monitors takes place in the Canvas Page located in the Navigational Console the monitor that sits adjacent to your Diagnostic Monitors The t
50. the iSite System Administrator in the Statistics page Recovering Deleted Images Deleted images can be recovered however as mentioned above all presentation states measurements and or annotations will be lost To recover deleted images right click the Exam Row Margin of the exam from which images were deleted and select Recover Deleted Image s as seen in the image below 228 79 fF JPL 9 A eH fii roid q bg ba D aes I Per ee n vi Fa Presentation States b Recover Deleted Image s h Minimize Images Vertical Rack Send via DICOM Add Exam To Folder Exam Information PD oe r La Tle lal LA ee oreo tf i wT I A iSite Enterprise f Imagels have been successtully recovered Please close and reopen the esam to view the recovered image s Click OK and then reload the exam to view the recovered images 229 Configuring your Diagnostic Monitors By default the hanging configuration of your Diagnostic Monitors is based on the global settings in your Hanging Protocol preferences There are several ways to quickly change the configuration of your Diagnostic Monitors You can simply right click the corresponding monitor icon in the center of the Navigation Timelines Another method is TO right click an image or series within a Navigation Rectangle and select the Monitor Layout option from the resulting pop up menu In both cases a menu will appear dis
51. their metadata sent from the modality 76 In the Scout Line Mode area you can determine which of the following scout line displays will be employed e Single a single scout line showing the location of the slice being reviewed e Bracket a single scout line showing the location of the slice being reviewed as well as two lines showing the limits of the series being reviewed ry e All a single scout line as well as a line for every slice in the series being reviewed as seen below 7 1 T i i a 7 j p a De La T aaae e pone f ry li Wi t dl oe ga ji f CT RF 5 ea saa a i a T I a i i Wi Py i AW i p dt X rt p EI re In the Localizer Mode option you can set whether or not scout lines are displayed when the Localizer is active and the image Is left clicked Set the options as desired and then click Apply to generate changes in the system System wide Preferences Please note that the preferences listed below are only available to administrators They are not visible to users who do not have administrative privileges Access iSite Radiology s set of system wide preferences by clicking the plus symbol next to the System Preferences item in the tree view control at left The menu will expand as seen below 78 Preferences Dialog User Preferences System Preferences General Preferences Window width
52. to Film will only allow printing of Key Image Only of the Entire Exam option The Selected Window option will be disabled e Delete All Measurements and Annotations when measurements and annotations are present 184 The following right click menu options are NOT available in the Key Images Popup Window e Scout Mode e Localizer Mode e Clone e Play Cine Loop or manual fast cine fast paging option e New Link and any other Image Link Functionality e Adding New Key Images e Sort Split The Key Images Series can be displayed in your Diagnostic Monitors by dragging the Key Series Pop up Window from the Canvas Page into the Diagnostic Monitors The Exam Margin and Pop up Menu The exam margin contains the diagnostic report button located at the top In addition several notification icons may appear in this portion of the Canvas Page during the course of your iSite Radiology session The diagnostic report button El is located at the top of the margin From top to bottom the icons are the Warning Icon the New Images Arrived image added to exam in the last 30 seconds Remote Study and Presentation State Loaded IF Please note that these icons will only appear if necessary In other words you may never see them Right clicking Exam Margin of an exam reveals a pop up menu shown below that provides access to several important functions including Presentation States Edit Protocol Rehang Send via D
53. to select an interpolation scheme the scheme is selected only for that image or series 268 e Scout Mode MRs and CT Scout Images only Use this toggle function to display interactive scout navigation lines on the selected image Scout Mode works in conjunction with Localizer Mode described in detail below Please note you can quickly toggle Scout Mode on and off by hitting the F11 key Please note that the state of the Scout Mode for a particular image or series is not saved as part of Presentation States e Localizer Mode Like the Scout Lines the localizer tool helps you visualize and navigate to a location in multiple series with different orientations Please note that the state of the Localizer Mode for a particular image or series is not saved as part of Presentation States To initiate the Localizer function for a specific series or image right click and select Show Localizer as seen below Please note that Localizer Mode can be toggled on and off by hitting the F12 key Window width Lewel d Image Processing Scout Line Mode Create Popup b Clone Window With Preset p Select Series d key Image Mew Link Link All A ials Save Print d Flip Rotate SorksSplit Matching Series Rules Delete d When you select the Show Localizer option a crosshair will be placed in every image or series of an exam at x y coordinates that correspond to the location of your cursor As you move the cursor over the
54. to simply drag and drop an exam listing to a folder just like in Windows Explorer as seen below me Patient Name a Date Location Query Aw CRAIG JUDY GRACE 1446536 09 20 2000 2 MR SKULL Ace 2236006 09202000 2 Folder List 4 iSite Tools 9 CD Manager Exception Handler A iQuery My Filters Ga My History Patient Directory Statistics System Filters 2 Personal Folders C Teaching Exams Public Folders When you are in the Canvas Page you can add exam links to a folder by right clicking either an exam listing in the Patient History Timeline or the Exam Margin and selecting the Add Exam to Folder option from the pop up menu Exam links can be copied from one folder to another as opposed to moving them by holding down the Control Key while clicking and dragging 4 Right Click Menu The right click menu provides access to features that allow you to customize the Site Folder List such as creating new folders renaming folders deleting folders and creating shortcuts in the Shortcut bar An image of the right click menu Is seen below Please note that not all options are available when right clicking on certain folders Add Mew Folder Create Shortcut Delete Rename Expand All 42 Shortcuts Bar The Shortcuts Bar located to the immediate left of the iSite Folder List is a tool designed to help you organize special links that you use frequently The
55. to the Windows clipboard from which it can be pasted into other applications or as a bitmap Print The Print section of the pop up menu has two sub sections Print to Paper and Print fo DICOM each have separate dialogs 283 Print to Paper This function prints the selected image to your paper printer The following dialog will appear Print to Paper Printer Properties Status Type eran Phaser 7 000M Wihere FiltiLab Printers Noah s Cube 10 2 1 145 Comment Paper test Printer Settings Print Range Print Coniguration 151 Single Image C Entire Exam Number of copies i gt Selected Window s Image Skip 0 Print Options p g Print Measurements and Annotations W Print Header Print Reference Frame Reference Frame Options Serez Image Trim Images w Mone x o pa 22 pages are needed to print 22 images imn 1 1 selected print format Select the desired printer from the drop down menu Configure your settings as desired selecting the number of copies you wish fo print any image skip pattern every other image etc the print configuration the print annotations option and the print key images options For example the Print unstacked images on separate sheets option allows you fo print different plain film series on separate sheets regardless of how much space is available You can change the final output quality of the print by setting the Optimize For drop down Changing t
56. two options Show Report and Export via DICOM These functions allow you to view the Clinical Exam Notes for an exam and to send the exam via DICOM to another DICOM device such as a 3D Imaging device or a DICOM printer The lower portion of exams that are either In Progress or Scheduled display information about the exam including the modality procedure code status and date time The Reading Worklist is highly customizable both in terms of its presentation and its content You can arrange the list according to your individual needs or preferences Customizing the Filter Worklist Appearance Customizing the Filter Worklist appearance involves using your mouse to rearrange add or delete columns of information Please note that these changes are not permanent In other words you will have to make these changes every time you use iSite Radiology The available columns are Patient Name Patient ID Accession Date Modality Body Part Status Location Ref Physician Organization Proc Code Proc Desc and Subspecialty Furthermore certain fields Patient Name Patient ID number 154 Accession Number Date and Modality cannot be removed though they can be rearranged To rearrange the order of the columns simply click on a column heading and drag it to the desired location as shown below Patient Name lent ID Accessi Date Modality When you release the mouse button the screen will refresh with the columns in the new orde
57. using the Plug Ins with APIs please see the iSite API documentation Enter the URL of the Plug In and then choose the programs in which to enable the Plug In If you would like only users with a specific Security Code to be able to access the Plug In select the Require Security Code box and chose the Security Code from the drop down menu 138 To edit an existing Plug In simply highlight that listing and click the Properties button Edit information where necessary as seen in the window below Plug In Dialog Mame Pharmacy W Visible in folder tree URL http Aa rotech com Enable in iSite Radiology W Enable in iSite Enterprise Disable AFI Requires Security Code cancel To delete a Plug in highlight the listing and click the Delete button General Machine Preferences To view the General Machine Preferences click the General Preferences listing as seen below Preferences Dialog User Preferences General Preference System Preferences Machine Preferences OOK Print an Monitors AE Title STENTOR SCP ug Ins General Preference Scanner Preference Overlay Brightness Network Testing Less 502 More 1 O02 100 Workstation Location Locatior Main Location r Cache Size Restrict Cache Size Masimun Cache Size MB Navigation Console Size f Full Screen C 1024768 C 128051024 C 160051200 Overnide Access Group 4utologaut Use Machine Auto Logout Ti
58. which to place all of your filter shortcuts You can add as many groups as you would like As they accumulate they will be stacked in the Shortcuts Bar To create a new Shortcut Group click on the body of the Shortcuts Bar and select Add New Group from the pop up menu as seen below 32 4 User Bardach Noah MD iSite Radiology SII ey PatientName MEN Accession Body Pat js Shomtcuts CARSTEN RICK 2029393829 43447 7920001 BRAIN EDEN MARY 10293864033 434419200001 HEAD Patient Directory FOX VINCENT 0392829304 43441 0040001 HAND eg HARA CLAUDIA 1020393820 434420690001 PELIS BardachMD_ Personal LEVIN BOBBY fa aed Pe 435442720001 BRAIN MARTIN REBA 3927 02039 434425CF 0001 SHOULDER lt gt EEE PECK JENNY 9293029201 4544454 40001 HAND CT HEac Rename Group RICHARSON J te a ree 4354455540001 FOOT Show Folder List ROBERTS ALI 5557 309202 4354454550001 HEAD E i VISHNU SANGIT 30292851020 4353039060001 KNEE Last 3 Days AWICK STACY Sooo 445 434471 DO40001 NECK Last 7 Days P DUPUID Cases Siu Acquisition Exceptions study Lookup After selecting this option a text field reading New Group will appear at the bottom of the Shortcuts Bar as seen below 33 User Bardach Noah MO iSite Rad iology Shortcuts Hp EE Patient Name Accession Body Part E CARSTEN RICK 2029393829 434417920001 BRAIN ae EDEN MARY 1029384033 434419280001 HEAD Patient Directory FOX VIN
59. will display a symbol to indicate the progress of that individual exam A legend to the exam status symbols is seen below Ready to be written In Progress J Completed x Failed Inactive When the export has finished the exam status will change to a check mark Once the program has finished exporting the media your export folder will have the following contents Help Preferences Stack E Wworkkst E Autorun int gt pp4ste dl k teb 5 0c Py JiSiteMediaviewer exe When these contents are written to a CD or other insertable media that disk can be inserted into any PC and the user can view the patient exams using the embedded iSite program There is no need for an internet connection When the disk is first placed into a computer it will olay automatically The following splash screen will appear 49 Tuesday October 16 2005 CE 5000 Marina Blvd Suite 100 Brisbane CA 94005 U S A Koninklipke Philips Electronics M V 2005 All rights are reserved Reporduction or transmission in whole or in part in any torm or by any means elecronic menchanical or otherwise ts prohibited without the prior written consent of the copyright owner Copyrights and all other proprietary rights in any soltware and related documentation Soliware made available to you rest exclusively wilh Philips or its licensors No title or ownership in the Sollware is contlerred to you Use ol ihe Soltware is subject to the end
60. you will notice that the other linked series are synchronized on location and basically display the image with closest location to the one displayed in the master series If The non multi phase series is used as the master iSite will try to find the image with the closest location in the multi ohase series and because there are 211 potentially multiple matches iSite will disolay the best match from the first phase In this example iSite would never display image 7 through 12 2i2 In other words if is not possible to review all images of a multi ohase series by paging through another series while using the localizer functionality aTa fa di d k i fak G f a Series Series 2 e Multi lmage Mode series only This feature allows you to display tiled series slices In one single frame The available options in column row notation are 1 1 1 2 2 1 2 2 1 3 3 3 3 4 and 4 5 The resulting configurations are as follows 1 1 1 2 2 1 2 2 2 3 1 3 3 3 3 4 4 5 HE HH EE UU HE HH ES LU pM i Monitor Layout This feature allows you to quickly configure the monitor you are viewing The available options are shown below Window Width Level Measurement Aninmotahons r FTF Fr h Image Processing Create Popup Monitor Layout mi Select Series iT H MH Select Relevant Exam T mev Clone EJ MGH Key Image mov H m New Link FA meP Save HH M l Print gt H m2 Flip Rot
61. your Diagnostic Exam Racks have been given a gray background as seen in the left and right exams shown below When an exam listing is displayed in green no diagnostic report is present Exams that are being displayed in your Diagnostic Monitors are displayed with colored boxes around them as shown below The color of the boxes correspond to the color of the Monitor Icons displayed in the iSite Radiology Control Strip f If images and exams from the same exam are loaded into different Diagnostic Monitors that exam listing will have half a blue border and half a red border as seen O D O The Main Exam listing is indicated by a yellow arrow above Exams that are present in your institution s archive but which are not loaded on the iSite Server are displayed with an A as seen below This feature is visible if the following conditions are met 171 e Exam Date amp Time Is older than 48 hours e A in Exam Timeline is enabled in the System Preferences e Exam status is not NON REPORTABLE e IQuery is configured with at least one DICOM QRP Source e The iSite User has iQuery Access Privileges To access these exams double click the listing in the timeline iSite Enterprise will automatically query the available archives to retrieve the exam in question An empty exam row will load in the Canvas Page as seen below while the exam is being retrieved Cancel The upper portion of the Exam Inform
62. 001 HEAD Completed Exams VISHNU SANGIT 3029281020 433839DB0001 KNEE P CRAII ZWICK STACY 5868323443 43441D040001 NECK amp CTAIl gt EER SRIETe Last 7 Days amp Last Month amp MR All Test Completed Test HL amp US All 29 Personal Folders H 3 Public Folders Acquisition Exceptions 3 Ea 30 Once you have displayed the iSite Folder List you can create a shortcut in the Shortcuts Bar simply by dragging an icon to it from the Folder List You can also create a shortcut by right clicking an icon and choosing the Create Shortcut option trom the pop up menu If you have added more shortcuts than can fit in the Shortcut Bar the button will appear Click this button to scroll through your shortcuts You can also deal with too many shortcuts by organizing them into groups as discussed below Removing Shortcuts To remove a shortcut from the Shortcuts Bar simply right click the shortcut as seen below and select the Remove from Shortcut Bar option from the pop up menu User Bardach Noah MIO iSite Radiology ev Patient Name Accession BodyPat CARSTEN RICK 2029393829 434417920001 BRAIN EDEN MARY 1029384033 434419280001 HEAD FOX VINCENT 0332829304 434410040001 HAND HARM CLAUDIA 1020393820 434420690001 PELVIS BardachMD Personal LEVIN BOBBY 5628292921 4344227 E0001 BRAIN MARTIN REBA 3927828391 434423CF0001 SHOULDER PECK JENNY 92793829201 43444540001 HAND oP HE S Open I
63. 281020 433839080001 KNEE Last 3 Bays AWICK STACY 5556323443 43441 040001 NECK Last 7 Days E DUPUID Cases study Lookup Acquisition Exceptions Creating Shortcuts To add a shortcut to the Shortcuts Bar you must first reveal the iSite Folders List To do this leff click the arrow button in the Shortcuts header as seen below 28 4 User Bardach Noah MOD i S i te Ra d i O og _ MRN ___ Accession Body Part CARSTEN RICK 2029393829 43447 7920001 BRAIN EDEN MARY 10293864033 434419200001 HEAD FOX VINCENT 0392829304 43441 0040001 HAND HARA CLAUDIA 1020393820 434420690001 PELIS LEVIN BOBBY fa aed Pe 435442720001 BRAIN MARTIN REBA 3927 02039 434425CF 0001 SHOULDER PECK JENNY 9293029201 4544454 40001 HAND RICHARSON J te a ree 4354455540001 FOOT J ROBERTS ALI 5557 309202 4354454550001 HEAD gt VISHNU SANGIT 30292851020 4353039060001 KNEE AWICK STACY Sooo 445 434471 DO40001 NECK Last 3 Days Last 7 Days DUPUID Cases Acquisition Exceptions study Lookup Alternately you can right click the Shortcuts Bar shown below and choose the Show Folder List option 29 L d L a st3 D ays P Shortcuts P BardachMD Personal CT_HEAD Last 3 Days Y Last 7 Days ed DUPUID Cases User Bardach Noah MO iSite Radiology lv Patient Name e MRN Accession Body Part CARSTEN
64. Administrator the button will provide you with general user system wide and machine preferences options Presentation State The presentation state of an exam is a personalized configuration often created by an intern radiologist or technician which can be displayed by right clicking the Exam Summary Window and selecting that state from the pop up menu Presentation states created by technologists interns or a radiologist become the default presentation state when the exam is loaded You can create your own presentation states by right clicking on the Exam Summary Window of an exam and selecting the Presentation States option A presentation state is automatically created every time you annotate or measure an image or whenever you click the Mark Read button Query Button This button located on the left side of the Sort and Search Fields will run a query of the entered criteria when clicked Rotate This function available by right clicking an image or series and selecting the Flio Rotate Sort option allows you to rotate the image or series 90 degrees clockwise or counter clockwise Series Selecting This option available from the right click image pop up menu allows you to quickly switch from different series in an exam Please note that this option is 338 only available in the Diagnostic Exam Racks or in your Diagnostic Monitors not from an Exoanded Window Sort This option available by right clicking a serie
65. CENT 0392929304 43441 D040001 HAND E HARM CLAUDIA 1020393820 434420690001 PELVIS BardachMD Personal LEVIN BOBBY 5625292971 4344222E0001 BRAIN MARTIN REBA 3927628391 43447273C F0001 SHOULDER E PECK JENNY 9293829201 43444540001 HANC CT HEAD RICHAR SON J 7771282722 434455340001 FOOT ROBERTS ALI 5557309282 434454850001 HEAD k VISHNU SANGIT 3029281020 433839D60001 KNEE Lei 3 Dave ANICE STACY 5858323443 43441 D040001 NECK Last 7 Days L DUPUID Cases Acquisition Exceptions study Lookup New Group R Type in the name of the new group and hit the Return key The Group Name will be finalized and will be displayed in the small gray Group Header as seen below To access the Group just click the header 34 User Bardach Noah MO iSite Rad iology k QRPR Body Pat CARSTEN RICK 20293936824 4354417920001 BRAIN 6m Patient Name Accession EDEN MARY 10295354033 4354479200001 HEAD FO VINCENT 0392829304 43441 0040001 HAMD HARM CLAUDIA 1020393820 434420690001 FELIS LEYIN BOBBY pE20292941 J344 E0001 BRAIN MARTIN FEBA 3927020391 fajta F000 SHOULDER PECK JENNY 9295029201 Jajji 40001 HAND RICHARSON J fff 1262722 434455340001 FOOT ROBERTS ALI 5557309204 454454550001 HEAD k VISHNU SANGIT 3029261020 455539060001 KNEE AWICK STACY 50503233 434410040001 MECK Last 3 Days Last 7 Days DUPUID Cases Acquisition Exceptions study Lookup Filters This
66. CHARSON J 7771282722 434455340001 FOOT Remove From Shortcut Bar PSE 5557389282 434454850001 HEAD Rename Shortcut E ISHNU SANGIT 3029281020 433839DB0001 KNEE Show Folder List cen MICK STACY 5856323443 434410040001 NECK Last 7 Days DUPUID Cases gt Acquisition Exceptions study Lookup Renaming Shortcuts To rename a shortcut in the Shortcuts Bar simply right click the shortcut as seen below and select the Rename Shortcut option trom the pop up menu 31 User Bardach Noah MO iSite Rad iology k F OQO Y Shortcuts Ev Patient Name MRN Accession Body Part T CARSTEN RICK 2029393829 434417920001 BRAIN Eei EDEN MARY 1029384033 434419280001 HEAD Fatient Directory FOX VINCENT 0392829304 434410040001 HAND E HARM CLAUDIA 1020393820 434420690001 PELYIS BardachMD_ Personal LEVIN BOBBY 6628292971 4344722E0001 BRAIN MARTIN REBA 3927828391 434423CF0001 SHOULDER PECK JENNY 9293829201 434445440001 HAND me on ICHARSON J 7771282722 434455340001 FOOT ee Remove From Shortcut Bor iii aa 5557389282 434454850001 HEAD Ei SHNU SANGIT 3029281020 433839DB0001 KNEE i Show Folder List E TS NICK STACY 5858323443 434410040001 NECK TF Last 7 Days DUPUID Cases lt Acquisition Exceptions study Lookup Shortcut Groups You can easily organize your shortcuts by creating Shortcut Groups For example you could create a Shortcut Group titled Filters in
67. CP 06 02 2000 06 17 00 4 LT4 gt ENGSERVER_SCP 087022000 06 11 00 4 LTA gt ENGSERVER_SCP 06 02 2000 06 11 00 4 LTA gt ENGSERVER_SCP 06 02 2000 06 17 00 4 LTA gt ENGSERVER_SCP 06 02 2000 06 11 00 IS5_LT4 gt ENGSERVER_SCP 06 02 2000 06 11 00 lS8_LT4 amp gt ENGSERVER_SCP 08 02 2000 08 11 00 S5_LT4 gt ENGSERVER_SCP 09 02 2000 06 17 00 S5_LT4 gt ENGSERVER_SCP 087022000 06 11 00 ld LT4 amp gt ENGSERVER_SCP 08 02 2000 08 11 00 S5_LTA gt ENGSERVER_SCP 06 02 2000 06 17 00 IS5_LT4 gt ENGSERVER_SCP 06 02 2000 06 11 00 IS5_LT4 gt ENGSERVER_SCP 087022000 06 11 00 lS8_LT4 amp gt ENGSERVER_SCP 08 02 2000 08 11 00 S5_LTA gt ENGSERVER_SCP 06 02 2000 06 17 00 IS5_LT4 gt ENGSERVER_SCP 087022000 06 11 00 lS8_LT4 amp gt ENGSERVER_SCP 08 02 2000 08 11 00 4 LTA gt ENGSERVER_SCP 06 16 2000 22 47 00 4 LT4 gt ENGSERVER_SCP 06 16 2000 22 47 00 4 LTA gt ENGSERVER_SCP 06 16 2000 22 47 00 Pending x Complete DODGE ARITA 096095155 CH W DODGE RAITA 70960951 55 0441 DODGE RAITA 70960951 55 CHES DODGE RAITA 096095155 CHES DODGE RAITA 0360957 55 F IN Maya 0857 3S1 5C H CHRISTOPHER 175 CHRISTOPHER 7175 CHRISTOPHER 175 CHRISTOPHER 175 CHRISTOPHER 7175 CHRISTOPHER 7175 CHRISTOPHER 175 CHRISTOPHER 175 CHRISTOPHER 7175 CHRISTOPHER 7175 CHRISTOPHER 175 CHRAISTOFPHER 7175 HOR
68. CRs which have four Also if your mouse is not among those recommended by Philips for use with iSite Radiology the zoom and pan functions maybe inaccessible via the mouse To zoom into an image without using a mouse hold down the Alt key while left clicking and dragging your mouse vertically To pan without using a mouse hold down the Control key while left clicking and dragging your mouse 333 Glossary of Terms Access Groups Access Group Is a term that describes permissions within the iSite security setup Users who belong to an Access Group have access fo the areas of iSite for which that Group has authorization Annotation Annotations are shapes and text that you can add to an image These indicators are saved with the image but can also be removed at the click of a button Annotation styles include line arrow triangle circle text and freehand Annotation styles can also be customized and reused The styles are all editable on the fly by right clicking on the annotation Annotations can be removed by highlighting and clicking the delete button or by dragging the annotation off the screen Canvas Page This area of iSite Radiology consists of the Clinical Information Window the Relevant Exams and Patient History Timelines and the Diagnostic Racks Cine and Fast Cine These two modes describe the rate at which slices of series are viewed Cine indicates a slow but steady and sequential viewing of a series of slices wh
69. D Cancel Make changes to the various tabs as necessary and then click OK to return to the Preferences Dialog Once there make sure to click the Apply button to make your changes permanent To delete a DICOM Source highlight the listing and click the Delete button Screen Overlays iSite allows you to configure the information overlays for the various modalities handled by the program You can specify where various patient and exam information will disolay on the image To access these options click the Screen Overlay item in the tree view control at left as seen below 99 Preferences Dialog User Preferences System Preferences General Preferences Window Width Center Filters l Annotations DICOM Sources Screen Overlays Hanging Protocols DICOM Print Machine Preferences Network Testing CR CR KODAK AUTORAD CT IMPORTED CT KODAK AUTORAD DEFAULT ji eal MA KODAK AUTORAD Export Wi ea a a a r Siero a RT ei E a HIE eS CO eer eee To add a new screen overlay click the Add button at right The following screen will be displayed 100 Overlay Dialog Overlay Name Body Part Patient Exam Study Seres Images CH GI MA MG Calculated nr r i i Font Procedure Code Image Type Export Import Cancel Enter a name for the new overlay Note that this name must correspond to a modality that sends images to iSite for example CR or
70. ER MREN 211360205 Accession 4190732 Body Pat MRSTOCM Report studyUID 1 2 124 115552 120 147 147 112 199909135 155119 2600575 MRI brain wiwo contrast The T1 weighted images demonstrate no evidence of a Chiari malformation SOMAJ amp normal size amp symmetric ventircles which lay on the radial axis wihout evidence of F Shift or non presenting hematomae The is a normal sulcal and gyral development and symmetry of the right and left lobe of the entire cerebrum The myelinization is unremarkable Abnormal signal is absent Masses are absent Findings senesUID 1 2 040 115619 2 5 17 624011907 1332 937 396500 705 Impression SOPUID 1 2 040 113619 2 5 1762011907 1332 937 396000 709 Related Exam List all exams i a a 40927097 P MRSTDCM 07 29 1999 1 28 PM MR BRAIN 4040345 amp MRSTDCM 071971999 12 00 AM MR BRAIN 3612611 P MRSTDCM 03 17 1999 7 22 PM MR BRAIN The type of information provided in the report will vary from institution to institution However certain information such as the patient s name and ID number will always be disolayed when available Navigate through the report using the scroll bar at right There are several sections of information including the Report Findings Impression participating radiologists 175 contact information Diagnosis History Comments and the contact information of the Requesting and Attending Physicians lf related exams are present on the iSite server these wil
71. FPS multi slice series only Zoom Factor Key Image Indicator and Link Indicator The F hot key is used to toggle overlays on and off in the following manners F6 Toggles on off Screen Overlays Ctrl F6 Toggles on off ALL Overlays Ctrlt Alt F6 Toggles DICOM 6000 Overlays on off By default iSite will disolay embedded and declared DICOM overlays on top of images when the full resolution of the image Is available All other overlay content Is set by your iSite System Administrator A complete list of screen overlay information options is seen below e Patient Name MRN Birth Date Sex Age e Exam Accession Referring Physician Name Procedure Code Procedure Description e Study Date Time Description e Series Modality Description Body Part Series Number Institution Name Patient Position e Images Image Type Acquisition Date Acquisition Time Instance Number Images in Acquisition Acquisition Number Spacing Between Slices Slice Thickness Slice Location e CT KVP Scan Options Exposure Time X ray Tube Current Gantry Detector Tilt Generator Power e MR Scanning Sequence Sequence Variant Scan Options Repetition Time Echo Time Echo Train Length 238 e Calculated Window Width Window Level Number of Images in Window Page Number Printing Total Pages Printing Image Number in Window Link Status Key Image Zoom Factor Positioner Primary Angle Positioner Secondary Angle Current Frame R
72. Hanging Protocols Delete Canvas Page system Preterences E Machine Preferences Nehwork Testing If you wish to export your filter settings click the Export button You can save your settings in a sharable format allowing other physicians to share your settings To import a group of filters click the Import button Browse to the desired xml file and click OK The settings will load If you have finished reviewing and or editing your personal preferences click the OK button You will be returned to the Reading Worklist If you wish to revert to the original settings click the Default button Having set up your new filter select that filter from the Personal Filters folder as shown below The worklist window will be rearranged to meet your new criteria 163 Folder List gt x EI m iSite Tools _ j CD Manager Es Exception Handler lt Q iQluery a a Mly Filters os ode Bardach CR Cranium O E lS MR BARDAC a E Patient Directory eh a system Filters D Last 3 Days DB Last 7 Days T S Last Month S A Personal Folders 0 Bardach CTHead g 0 Bardach Images for Clas f I Pa Wduanend CAFO be Fi tl Selecting Exams for Display To view an exam in the Canvas Page and on your Diagnostic Monitors double click the exam listing either from any worklist or folder The View Exams Tab will appear in the lower right hand corner of the iSite Control Strip as seen below The View Exams Tab d
73. ICOM Exam Information and Vertical Horizontal Rack toggle If you have marked key images and or created presentation states for the exam in question you can access them here You can also restore the default presentation state by selecting the Rehang option Presentation State Select User Hanging Protocol d Select System Hanging Protocol amp Close Exam Send via DICOM 4dd Exam To Folder Exam Information Vertical Rack 185 Viewing or Creating Presentation States If you wish you can easily view a presentation state or create a presentation state for later viewing To view a presentation state of an exam right click the Exam Summary Window and select the presentation state you wish to view from the Presentation State sub menu The presentation state Original DICOM created by System will always be present Please note that if additional images have been added fo this exam since a presentation state was created that state will not be visible Rather iSite Radiology will disolay a message indicating that The presentation state was not loaded because new Images have arrived since the presentation state was saved In addition be advised that Scout Lines the Localizer Tool and Image Processing Tool adjustments are not preserved in presentation states To create a new presentation state arrange annotate and or measure the exam as desired and then right click the Exam Summary Window as seen below User Bardach
74. If you will be making numerous measurements of an image iSite Radiology provides a floating Measurement Palette that helps to streamline your workflow To use the Palette select the Measurement Palette option from the Measurement submenu In the pop up menu As seen below the floating Measurement Palette will appear From left to right the tools are the ruler angle region of interest freehand region of interest and text annotation To use a tool click the corresoonding button and then place your cursor over the image you wish to measure Only one tool can be selected ata time The Measurement Palette can be dragged to any location on your screen To close the Palette click the close button You can also toggle the measurement tool off and on by hitting Control key M on your keyboard Calibrate Image This feature allows you to calibrate the image on your screen for certain known measurements Select the Calibrate Image option from the Measurements sub menu as seen below Window Width Level Ruler nnotations d Angle Image Processing Region OF Interest Create Popup Freehand ROT Monitor Layout d Point Value Select Series Select Relevant Exam Measurements Palette Clone Calibrate Image key Image Ri New Link Save Print I Flip Rotate Zoom Presets 256 After selecting Calibrate Image place your cursor at the end point of a known distance and then drag to the end of the known distance When you rel
75. Key Image Flay Cine Loop New Link Link All Axials Save j To Paper Printer Flip Rotate Sort Spit gt oom Presets Li MPR i Delete Delete All Images Delete Image The option Delete All Image s removes every image from a selected series whereas the option Delete Image only removes the current image If the exam being viewed has already been marked Read a confirmation dialog will appear as seen below 304 site Radiology T This exam has been Marked Read are you sure you want to continue and delete images of the selected window If you answer Yes or if the exam has not yet been marked Read a Reason for Rejection dialog will appear as seen below Enter Reason for Rejection Dialog Artifacts Image Too Dark overexposed Image Too Light underexposed Incorrect Patient ID Mechanical Problem No Exposure Patient Motion OCT est Images Scouts Cancel Either enter in a reason in the dialog or select one of the pre canned reasons then click OK The image or images will be deleted When an image s is deleted iSite keeps a record of the following information Site User ID Deletion Date Deletion Time Modality Accession MRN Series Image UID Series Image Description Number Reason for Deletion These audits can be viewed by the iSite System Administrator in the Statistics page 305 Viewing Diagnostic Reports There are several ways to view the dia
76. Location lab AE Title FUJI_PRINTER IP Address 0 7 0 Response Timeout sec 60 Port i TE FLUI_PRINTER After you fill in all the fields click the Ping button to test communication with the printer If the Communication is good the printer should return Ping to the Server is Successful message If you mistype AE Title IP Port or there is not physical IP connectivity between the Radiology Workstation and the Printer an error message will display similar fo the example below only instead of PRINTER_SCP you will see your AE Title iSite Radiology x Unable To Open Association with the server PRINTER_S5CP Failed to connect to remote host After communication with the printer has been established click the Add button to add new configuration The Add DICOM Configuration dialog will display 133 leaningful name for Fill in Min Density and Max Density from DICOM printer configuration table configuration Add DICOMP inter Configuration elect Image Display Format CT 3x4 from DICOM printer a configuration table FimEox Settings 5 Image Display STANDARD 3 4 Min Densi 10 Format orinter configuration table __ 300 Medium Type PAFFR elect Medium Type from Pinter PRESENTATION_LUT 300 DICOM printer configuration Configuration yy table oe Printer Configuration is gt LifeSize Printing taken from printer LifeSize Printing co
77. Make changes as necessary and click the OK button to save your changes Annotation styles can be removed by highlighting the style listing and clicking the Delete button Specify a name for the annotation style and its characteristics then click the OK button The new annotation style will be disolayed in the Annotations screen alongside any pre existing styles DICOM Sources The sources from which iSite receives its default Window Width and Level information can be specified in this dialog These DICOM Sources can be configured using one or more identifiers The DICOM Sources must have unique values A DICOM Source that has the same number of selected identifiers and the exam same values within the identifiers will be deemed a duplicate and a message will be displayed DICOM Source already exists Please modify one or more of the identifiers To access these options click the DICOM Source item in the tree view control at left as seen below Preferences Dialog User Preferences DICOM Sources System Preferences General Preferences Window Widi Cental Description Filters Paper Printing Body Part Dictionary IE pork Duer Organization Dictionary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel Apply Help 94 To add a new DICOM source click the Add button The following window will be displayed Add DICOM Source Main windo
78. NE TIM 241607081 CHEST HORNE TIM 241607081 KMEE HORNE TIM 241607081 CHEST SWINDON RILARNEY KILSANEY RILARNEY KILARNEY KILARNEY RILARNEY EILSANEY EILSANEY KILSANEY KILSANEY EILSANEY KILSANEY Retrying x Failed Bemaove Hem Enare Feta das Close ice _ se I Show all The symbol at the left of each study indicates the status of the request A bright green symbol indicates that the study is being retrieved A dark green symbol indicates that the study is pending A blue check indicates that the study has been retrieved A red 314 X signifies that the retrieval has tailed A red arrow indicates that the system is retrying the retrieval 315 The Retrieval Queue provides you with a number of ways to alter the retrieval process Please note that these functions are only available to users with Administrative privileges To have a study retrieved immediately highlight that study with your mouse and click the Run Now button If you would like to remove a study from the queue highlight that study and click the Remove button To retry the studies which iQuery failed to retrieve click the Retry Errors button To see the progress of the Queue click the Refresh button 316 IExport iSite DICOM Export Tool iExport is a tool that allows users with administrative privileges to monitor the exportation of DICOM exams and the export queue IExport
79. NERATED MESSAGE Exam Stentor Auto Report Patient 4CPT BADOH ROGER MRIN 21 1360205 Accessian 4 190 32 Body Pat MRSTOCM Report studyUlD 1 2 124 115552 120 147 147 112 19990915 1535119 2600575 MRI brain wiwo contrast The TI weighted images demonstrate no evidence of a Chiari malformation SOMAJ amp normal size amp symmetric ventircles which lay on the radial axis wihout evidence of F Shift or non presenting hematamae The is a normal sulcal and gyral development and symmetry of the right and left lobe of the entire cerebrum The myelinization is unremarkable Abnormal signal is absent Masses are absent Findings senesUID 1 2 640 119619 2 5 1762011907 13352 937396080 706 Impression SOPUID 1 2 640 113619 2 5 176261 1907 1332 9357396686 709 Related Exam List all exams i ETE E E E P MRSTDCM 07 29 1999 1 26 PM MR BRAIN E A Pr MRSTDCM 071571599 12 00 AM MR BRAIN E F MRSTDCM 03 17 1999 7 22 PM MR BRAIN 306 The type of information provided in the report will vary from institution to institution However certain information such as the patient s name and ID number will always be displayed when available Navigate through the report using the scroll bar at right There are several sections of information including the Report Findings Impression participating radiologists contact information Diagnosis History Comments and the contact information of the Requesting and Attending Physicians If related e
80. OPHER CR FEMUR 2 ANo LT Acc 4316 CR AIP MIN 2 LT Acc 4576050 CR LUMBAR SP 2 Vv Acc 4310 CR CERVICAL SP AMA Acc 4a CR SHOULDER May L Acc 4309 CT N WeABD WAMO Acc 420 CR LUMBAR SP 2 Vv Ace 4207 CR THORACIC 2 VIEW Acc 420 CR CHEST 2 WIEWS Acc 42076 MR LSPINE WW Acc 4009996 CR BONE SURVEY Acc 4046 7 CT NECK WO Acc 344 461 Ret Patients Listed 5 Studies Selected Submitting the Retrieval List ooh 12 STOP AUER a 4 11021999 14 1101999 14 1101999 14 10229 1990 11 10 29 1955 11 097 421996 TF 09 16 1996 14 09 16 1996 14 09 16 1996 14 OF S0 1996 17 0701996 12 06 22199 5 OF SUBMIT sT WEW QUEUE To submit the list of studies that you have selected for retrieval click the Submit List button in the lower right hand corner The following Confirmation Page will appear Query Confirmation Page Studies requested for retrieyal 5 Studies from GA LTA gt Priority C Stat ie Standard C Scheduled Deadline June 2000 aU Notification M Notify by email in case of error Print submitted query radiot wnabelinic com ermanabclinic corm rebeccawnabelinic com Cancel Confirming the Retrieval Request The number of studies your have selected and the archives in which they are stored will be displayed in the top dialog box of the iQuery Confirmation Page Select a priority for the
81. Patient Directory iSite Radiology Close All Patient Name Patient ID Exam Date Patient Location t Y STAVNIZKY JOESPH AGS AU Sy If 04 09 2001 08 59 00 EROWS a ORTIZ FRED 201260491 4 09 2001 08 58 00 EROWS zi KILARNEY CHRISTOPHER 175428612 04 09 2001 08 56 00 EROWS ar JACKSON TYRELL 960819469 04 09 2001 08 55 00 EROWS 148 iSite Radiology OR PR Close All Patient Marne Patient ID Exam Date Patient Location Query Last 3 days Close All Patient Mare Patient ID Exam Date Patient Location y Last 3 days STAVNIZKY JOESPH Zl i 0408 2001 08 59 00 ER0104 ORTIZ FRED 201260491 O4f09 2001 08 56 00 EROS KILLARNEY CHRISTOPHER 175228612 0gp 09 2001 08 56 00 ER0I0F JACKSON TYRELL 960819489 0409 2001 08 55 00 ER0101 ORTIZ FRED 201260491 opd 2001 08 5600 ER0103 Exam Date Enter the date you wish to search for then click the Query button Patients whose exam dates match your criteria will be disolayed in the Patient Directory The Patient Directory can also be searched using one of the five preset dates shown below The default setting for this field is AI JACKSON TYRELL eens SUAS USNS OOO Selanne ARENELE iSite Radiology Patient Location Last 3 days 960819489 SROs KILLARNEY CHRISTOPHER 175228612 ER0103 CR CR TEST Acc 4046710 Referring DIER MR MR TEST Acc 4089996 Referring DIER Last 4 weeks CR CR TEST Acc 4207615 Referring DIER 04 09 2001
82. Preferences Dialog User Preferences General Preferences Window Width Center Tela Mane i essen dose a ieeee td CHMR_BRAIN Al MA exams of the Brain from E kers BARDACH_CR_SPINE All CRs of the SPINE from ERZ t Properties play Preferences BARDACH CTHEAD All CT heads from ER2 a Hanging Protocols BARDACH_MR_NECK _AlLMAs of the NECK from ER2 tees Canvas Page system Preferences E Machine Preferences Nehwork Testing If you have finished reviewing and or editing your personal preferences click the OK button You will be returned to the program Hanging Protocol Preferences Hanging Protocols are created and edited from within the iSite Radiology Canvas Page The hanging protocol preferences area allows you to view the iSite Radiology Hanging Protocols and to delete them if necessary To access the Hanging Protocol Preferences click the listing as shown below 71 Preferences Dialog El User Preferences i General Preferences Window Width Center Filters Display Preferences Hanging Protocols System Preferences Machine Preferences Network Testing Name KA MA BRAIN CT STNDOCMTE CT 283 Eee CT mle CR STNDCMTE E Be CR HAND 1 Ex r Apply aah OT To view the properties of a hanging protocol highlight the appropriate Hanging Protocol and click the Properties button The following window will be displayed System Hanging Protocol Dialog Read Only Name identifier
83. Printer you will be prompted to rename the imported DICOM Printer Imported DICOM Printers will always be listed as Alternate DICOM printers can be removed by highlighting the printer listing and clicking the Delete button Setting Up DICOM Print A Warning Considerations for Life Size Printing e Philips strongly recommends that you ask for assistance from your printer vendor when configuring the Life Size printing option for a specific printer and that you validate the correctness of the configuration by verifying that the Life Size Print option is indeed printing life sized atter completing the configuration e Due to the inherent nature of projection radiography when using iSite for measurement or life size printing Philips strongly recommends the use of an appropriately placed object of known size for determining what magnification factor has been applied to the image The following screen shots contain sample data Ihe data for your specific print setup must be obtained from your printer vendor s 1 Log on to iSite Radiology Click on the P Preferences icon in the right top corner of the screen The Preferences Dialog will be displayed 2 Navigate to System Preferences DICOM Print and click Add The Add DICOM Printer Definition dialog opens 3 Fill in all the fields as shown in the following example Note that the AE Title is case sensitive 132 4 9 Edit DICOMPrinter Definition Narne CR_PRINTER
84. Queue 96095155 4066356 ff 15 1999 Mormal 192564601 4266580 10 13 1999 Mormal 320 The iExport Queue is an interactive dialog Results are filtered by the Job Status and Export Type criteria in the bottom right hand of the dialog You can sort queued exams by clicking the desired column header You can also remove an exam from the list by highlighting it and clicking the Delete button The status icons display the current status of the exam s export If you would like to refresh the list click the Refresh button To restart an exam export that has failed highlight that listing and click the Restart button When you are finished click the Close button to exit iExport is also controlled via the System Preferences section of the Preferences dialog In this area you can add edit and remove existing DICOM destinations To view the iExoort preferences click the IExport listing trom the list at left as shown below Please note that you must have administrative privileges to access this portion of the iSite Radiology Preferences 321 To add a new DICOM forwarding address click the Add button The following window will appear Fill in all necessary fields and click OK when done The new listing will appear in the list alongside the pre existing ones To edit a listing highlight that listing and click the Properties button as shown below 322 Edit the properties as needed as shown in the window below and
85. RICK 2029393629 434417920001 BRAIN EDEN MARY 1029354033 434419280001 HEAD FOX VINCENT 0392829304 43441 0040001 HAND HARM CLAUDIA 1020393820 434420690001 PELVIS LEVIN BOBBY 6252927921 4344222E0001 BRAIN MARTIN REBA 3927828391 4544273 CF0001 SHOULDER Add New Group PECK JENNY 9293829201 4544454 40001 HAND peeves EE RICHARSON J 7771262722 434455340001 FOOT Rename aroup ROBERTS ALI 5557309262 434454850001 HEAL Show Folder List VISHNU SANGIT 3029281020 433539060001 KNEE FWICK STACY 55656323443 434410040001 NECK Acquisition Exceptions The iSite Folder List will be displayed as seen below Shortcuts Directory Comal Patien L BardachMD Personal T G a T m J gt 5 Q Last 3 Days Last 7 Days E DUPUID Cases Study Lookup User Bardach Noah MD iSite Radiology QAPI x emv Patient Name MRN Accession BodyPat h Folder List j E E iSite Tools oh CARSTEN RICK 2029393829 434417920001 BRAIN anager DUPUID aee EDEN MARY 1029384033 434419280001 HEAD Exception Handler FOX VINCENT 0392829304 43441D040001 HAND Q iQuery HARM CLAUDIA 1020393820 434420690001 PELVIS it m ros saong LEVIN BOBBY 6628292921 4344222E0001 BRAIN 2 My History MARTIN REBA 3927828391 434423CFO001 SHOULDER Patient Directory PECK JENNY 9293829201 4344454A0001 HAND aa RICHARSON J 7771282722 434455340001 FOOT Study Lookup LE System Filters ROBERTS ALI 5557389282 434454850
86. Site Radiology 3 5 User Manual iSite 3 5 Release iSR June 30 2006 This document was published on the date given above at which point the online documentation was complete and cleared for release Please note that subsequent changes to the online User Manual may not be reflected in this Printable version Table of Contents Trademarks and CODVIONIS cerir EAO Regulatory Information iSite Radiology Proper Usage Statement ccccccecccesccceeeccceeees Placement New Features in iSite Radiology 3 5 ssssesesosssssseeeeecccssseseseeecoeeo Logging in to iSite RACIOIOGY c cece eecceescceescceescceesscescessceessees Mouse Control Reference Sheet ccc cece cc ccc cccccccccccccccccsssccceces iSite Radiology Features Reference Sheet iSite Shortcuts Bar Using the iSite Folder List uesesessnsseeseceserseccssescccossesecceseeseeoee CD Mandg r TOON cision ee T Local Exam Cache Personalizing iSite Radiology eeeessssssseeessosssseesececocsssseeeeeecoeoo iSite Radiology Worklists nennnnssseeeeeeocosssseseeccccssssseseeeecceessseee iSite Radiology Canvas Reading from the Diagnostic Monitors ssse00 Viewing Diagnostic REDOING eies diy cet br ead de ees hipe sets ushers eas cawenshs reste oats iQuery DICOM Study Retrieval System cccccccsccescccccecsccevess iIExport DICOM Export Tool
87. T Yaluel CR Yew Position 4P Series Description 0008103e Image Type DERIVED PRIMARY Value temur AFP New Attribute OF Cancel In order for this Rule to work for the same image type coming from other modalities you must verify that the selected Tag Value in this case Series Description is consistent If two modalities use different description with the same meaning ie femur AP and Femur_AP both Tag Values must be included To do this find a matching series from the second machine sending Femur AP images right click the image in question select Matching Series Rules and edit the existing Femur AP rule seen above When you arrive at the Edit Series Matching Rules Dialog seen below add the second Tag Value 296 Edit Series Matching Rules Dialog Matching Rule Name Femur AP Define Series Define Matching Values Series Humber 1 Modality Ox00080060 Valuel CA Ale Senes Description Ox00087 Ose Body Part Examined ESTREME Tr View Position LL Image Type DERIVED PRIMARY Valued femur P Valuez Femur AP Edit Value Remove Value New Attribute OF Cancel The criteria described by the Define Matching Values window Is inclusive In the example above the series must be a CR AND have the description femur AP OR the description Femur_AP Other options available from this dialog are as follows o New Attribute Clicking this button opens a
88. T ethernet images should load nearly instantaneously lt 2 How many patients and exams can view at once The number of patients and exams that can be viewed simultaneously with iSite Radiology depends on your local system resources You should be aware that if you load a very large number of patients or exams the soeed of iSite Radiology may be adversely affected This is an especially important consideration when teleradiology is involved Several safeguards have been built in to iSite Radiology to prevent teleradiology users from overloading their remote connection Does iSite Radiology support color and or ultrasound Yes iSite Radiology supports color in all modalities currently supported MR CT CR DX XA US SC etc Using iSite Radiology What causes an exam to be listed as an exception There are three conditions that cause an exam to be listed as an exception all of which occur when a technologist enters any of the following at the modality e An MRN medical record number that does not exist in iSite e An ACC accession number that does not exist in iSite e An invalid MRN and ACC parr Can iSite exams be used by other DICOM devices Yes by using the Send Export via DICOM option This option is available by right clicking an exam listing in a worklist or in the iSite Radiology Navigation Timelines These functions allow you to send an iSite Radiology exam to a DICOM printer 3D modeling device or DICOM arc
89. The DICOM tag will be displayed alongside the others Sorting The Sorting tab lets you specify how the studies and series coming from this DICOM Source will be sorted Select an option as desired If you wish to sort only by image criteria and not series criteria select the Image Sorting Criteria Only radio button in the Series Sorting options group Add DICOM Source Main Window Center Series Splitting Sorting Senes Sorting Number Descending C Description Ascending Description Descending C Date Time Ascending Date Time Descending C Image Sorting Criteria Only Image Sorting Number Ascending C Number Descending C Table Position amp scending C Table Position Descending C Acquisition Time Ascending C Acquisition Time Descending C Image Time Ascending C mage Time Descending When you have finished specifying the details for the DICOM Source you are adding Click the OK button When you return to the Preferences Dialog you MUST click the Apply button for your changes to be preserved To edit a DICOM Source s settings highlight the listing and click the Properties button The following window will appear 98 Add DICOM Source Main Wwindow Center Seres Splitting Sorting Source Mame ER GE Lightspeed CT Description The Lightspeed CT Scanner in ER2 Identification M AE Title GELGHTSPD_SCP M Modality CT mM Manufacturer GEMS l Serial Number Pe i Model Hame Lightspeed CT i Exam Code CTLHEA
90. The loop can be stopped by clicking on the series You can change the direction of the loops from ascending to descending or vice versa by moving the mouse towards and away from you after clicking or by clicking the arrow keys The Cine Loop will accelerate or decelerate depending on how far the mouse is moved forward or backward after the mouse wheel is clicked The FPS Frames per Second rate is displayed in the lower right hand corner To increase or decrease the FPS rate hold down the wheel button and drag the mouse towards or away from you The maximum FPS rate is 45 and the minimum is 1 The default playback rate of the Cine Loop between 1 and 45 frames per second is offen sent from the modality as a DICOM tag A default soeed for when this information is not sent can be set in the iSite Preferences To change the playback rate for a specific series on the fly without changing the iSite Preferences click the or buttons Each click of those buttons will raise or lower the playback rate 1 frame per second For modalities such as XA US PET and NucMe d iSite Radiology will detect multi frame series and will automatically engage the Play Cine Loop when the series is displayed in an expanded window XA images will have additional screen overlays added to them consisting of the primary and secondary positioner angles These will be displayed as LAO _ CAUD _ There are several key commands that can be initiated while a cine
91. Today or Last 10 days To view the detailed parameters of a filter or to edit delete or create new filters click the Preferences Button P and then the Filter heading in the tree view control at left How do I know the status of an exam in a Filter Worklist How do I know if a report is already present You can view the status of an exam by looking at the Status column in any worklist When a report is present the report icon E will be disolayed next to the exam listing How do I access exam images There are two ways to view an exam from the a Filter Worklist To view a single exam double click that exam listing To view multiple exams single click on the desired exams and then select the View Exams Tab You can select up to 10 exams for review Both the options listed above will take you to the Canvas Page 326 iSite Radiology Canvas Page How do change the layout of the Canvas Page To change the Canvas Page layout from horizontally disolayed exam rows to vertically displayed exam rows or vice versa right click the Exam Summary Window and select either Vertical Rack or Horizontal Rack from the pop up menu 327 D How do I use the Relevant Exams and Patient History Timelines The Timelines provide a very powerful level of functionality giving contextual information about the exams and allowing you to load and unload export and view the reports of prior exams To load or unload an exam from the ti
92. WW WL preset Clones can be created by clicking on the Stacked Image Windows or Single Image Windows and selecting the lt Add Clone gt button When you have finished setting the desired options click the Next gt button You can always click the lt Back button to return to a previous screen The following screen will appear 214 Create User Hanging Protocol Matching Series Monitor Control Monitor 1 Mode M3H Monitor Mode W2H Series 1 Single Image Win Other Series Seres 2 Stack Window s Seres 1 Single Image Window s Individually captured images Single Individually captured images lt Back Cancel In this window you will set how the exams of this type will disolay on your diagnostic monitors For each monitor set the Mode and the Starting Series If you have checked the Use Matching Series Rules checkbox in the previous dialog available Rules will be displayed in the Matching Series window as seen above As you change these settings the display will change to show you how your monitors will hang The monitors provide additional information about where individual series will go iSite Radiology supports up to 4 monitors However if you have more than 2 diagnostic monitors please note that Hanging Protocols are only used for the first two monitors For details on Hanging Protocols monitor automatic loading please see the Hanging Protocols and Monitor Configura
93. Woah MO Patient Directory BADOH ROGER Sex U D O B 12 21 1946 PID 211360705 Procedure Code MRS TDCM Referr Presentation State Edit Hanging Protocol Create User Hanging Protocol Create System Hanging Protocol Select User Hanging Protocal d Select System Hanging Protocol mi Rehang Add Exam To Folder Exam Information Export via DICOM Tr Tr Tr Tr TT TT Tr TT TT TT TT TT TT ee vertical Rack 186 Choose the Presentation State option trom the pop up menu and then choose the Save Presentation State option from the sub menu The following window will appear Save Presentation State Enter Presentation State Mame ee Type Technologist C Pre read C User Cancel The type of presentation state should be specified according to your role If you are a technologist choose the Technologist option If you are an intern select the Pre read option If you would like to create a presentation for personal use only such as a teaching session click the User option Please note that this presentation state will never be displayed automatically Radiologists presentation states are created when a radiologist marks an exam read using the Mark Read button in the Diagnostic Exam Racks The type of presentation state that you enter will determine the weight of the presentation state in terms of automatic display in iSite Radiology and iSite Enterprise For example if no pre
94. a study after an MPR has been generated from images or series in that study the MPR will NOT be automatically updated There are a number of conditions that a study must meet in order for iSite s MPR feature to be available tor a given series o The series must have equidistant soacing between slices o The series must not contain images at the same slice location eg multi phase series o All images in the series must have row and column spacing Information in the DICOM The image series must have at least one level of transform All images in a stack must be of the same resolution All images in the stack must be grayscale The series must be in the shape of a rectangular parallelopiped or cube in any orientation axial sagital coronal or oblique o The machine s memory and Maximum Cache Size must be sufficiently large to handle the series The latter can be set in the Local Exam Cache settings of the Machine Preferences o The Maximum Cache Size must be set above the minimum of 256MB o The system must not be running either Windows 95 or Windows NT4 O O 0 If the selected series does not meet any of the conditions described above iSite will disolay an error message like the one shown below site Radiology a 0303 Error Generating MPR Source senes must hawe equal slice spacing To access the MPR feature right click the desired series and select an option from the MPR sub menu as seen below 298 Wi
95. a where they would be exposed to light from existing light boxes or other light emitting devices e iSite Radiology monitors should be calibrated while in the ambient light conditions where the product will be used Calibration should be performed following the original manufacturer s guidelines e iSite Radiology monitors should be installed such that they are not affected by light from another iSite Radiology system or other softcopy workstations Conversely iSite Radiology monitors should be set up such that they do not affect another iSite Radiology system or another diagnostic reading station e Appropriate specialized furniture is recommended for iSite Radiology to ensure optimal performance ergonomics and safety e Incase of iSite System unavailability the institution should provide for an alternative methodology to provide images of sufficient image quality to the physicians e To facilitate proper system operation all computer equipment should be installed in an environment that meets the original manufacturers guidelines Failure to follow these guidelines could adversely affect the diagnostic integrity of the images being displayed on the iSite Radiology system or could adversely affect the institution s ability to provide imaging services If you have any questions about the guidelines listed above please refer to the iSite System Administrator s Manual or contact Philios Customer Care 24 hours a day at 877 328 2808
96. able for all grayscale Axial Sagittal or Coronal Stacks that are not themselves MPR Clones and that contain at least 3 images and each of which has at least one level of transform The specified MPR images will generated based on sub sampled data MPR Scouts are navigation tools Selecting this item will reveal the MPR Submenu 301 The MPR slab options Axial Slab Coronal Slab and Sagittal Slab provide detailed reconstruction options as seen below MPR Slab Options Axial Reformation Number of Slices 37 Slice Spacing 2 500000 mm Slab Options Slab Thickness 2 Slices 5 000000 mri 2 Slab Spacing Slices 5 000000 mm Gap 0 Slices 0 mr Reformation Method Average Intensity h Cancel The dialog list the type of reconstruction at the top axial for this example followed by the number of slices in the series and the spacing between slices These fields are not user contigurable The Slab Options section allows you to set the thickness of the slab as well as the soacing and gap between slices The millimeter values are a factor of the original series and cannot be changed The Reformation Method drop down menu provides three options Average Intensity Maximum Intensity MIP and Minimum Intensity The reconstruction methods used to generate MPR Slabs are grayscale methods which emphasize different tissues for CT MR and PET volumes MIP Maximum Intensity Projection emphasizes the tissue with the highest pixel valu
97. act name of the performing resource If you wish to limit the filter to multiple performing resources enter their names separated by commas Name your filter in the Name field and then fill the dialogue in with the necessary information making sure that the filter is unique and also functional Please note that you do not have to fill in all the fields Note also that if the Modality field is left blank the filter will apply to all available modalities Only the Modality field has this Characteristic Special care must be taken with the generation of a filter When completing in the fields you must use your institution s standard codes and syntax For example if your institution s code for the Emergency Room is ERC then you must use ERC to specify the Emergency Room If you enter ER Emergency or any other code the filter will not work For example if you wish to create a filter that isolates exams with a description of a particular ailment or symptom the language in your filter must match the description exactly or the filter will fail If you enter High blood pressure in the description field but your institution uses the code HBP as standard notation your filter will fail In that instance you would have to enter HBP in the description field Once you have finished specifying the filter criteria click OK The new filter will be displayed along with the pre existing ones You can create up to 100 system filters 70
98. again in the Print Configuration window to save your changes Your new Print Configuration will be displayed alongside the pre existing ones To edit the properties of a Print Configuration highlight that configuration in the list and click the Properties button as shown below 110 Preferences Dialog User Preferences Paper Printing System Preferences General Preferences Window Width Center Name Add Filters 127 Single Image Annotations Properties DICOM Sources Screen Overlays vA Stack Paper Printing Awe Body Part Dictionary IE port Ouer Organization Dictonary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Delete Cancel The following window will appear Edit Windows Print Configuration Format 3x4 Overlay Cancel Make the necessary changes to the configuration and click the OK button Your edits will be saved If you wish to export a Print Configuration listing select the desired filter and click the Export button The following dialog will appear 111 Save Ir Ey My Documents f a E My Music Ez My Pictures _ My Webs Mew Folder File name PrintCoanfig ERCT xml Save as type rn Files sml Cancel ZA Choose a name for the exported file and click the Save button The file will be saved in xxml format in the chosen directory If you wish to import Print Configuration listing
99. age section of this manual Working with Images in the Diagnostic Monitors iSite Radiology provides numerous tools for you to use while you interrogate diagnostic images and series in your Diagnostic Monitors Among these are zoom pan window width and level control cine and fast cine for series invert flio and rotate as well as a host of advanced image manipulation tools such as image annotation image measurement and spinal labeling All of these tools discussed at length below are immediately accessible by right clicking your mouse 236 The most frequently used image manipulation features in iSite Radiology window width and level adjustment zooming panning cine and fast cine are all available directly from your mouse without having to select an option trom a menu These features are described below e Window Width and Window Level You can adjust the window width and window level in an image for optimal viewing or to highlight certain details for better visibility Click the left mouse button and drag the cursor horizontally across the image to increase or decrease the Window Width Click the left mouse button and drag the cursor vertically across the image to increase or decrease the Window Level Please note that when you adjust the window width and level for a series all slices in that series are affected If you want to adjust the window width and level or one slice in a series hold down the L Key while making the adjustme
100. ages have the same DICOM Frame of Reference Please note that annotations measurement tools and the localizer cannot be used at the same time Selecting a measurement tool or working with annotations will disengage the Show Localizer feature 270 By default you will see scout lines appear when you click and drag These scout lines can be removed in the Display Preferences section of the User Preferences as seen below Preferences Dialog User Preferences Display Preferences General Preferences Window Width Center Screen Overlay Font Size Image Processing C Large Medium C Small Filters Display Preferences Hanging Protocols Canvas Page Cine Playback Resolution ef areeni Fr IPieteniees Full Resolution 5120512 256x256 C 129x129 Machine Freterences Network Testing NOTE Changes require a re login to take effect Scout Line Mode C Single C Bracket Localizer Mode CO No Scout Lines Show Scout Lines Cancel Help For more information on these preferences please see the Preferences Chapter A Warning Using the localizer to navigate a multi phase series Multi ohase studies contain multiple images with the same location identifier Paging through a multi ohase series that not has been split will typically result in Jumping back to the first slice location each time the user reaches the end of each phase within the series If The localizer is used to navigate through a multi phase series
101. ailable otherwise the units are pixelsA2 The values for these measurements are computed in floating point and displayed so that the ROI measurement is presented to two decimal places This means that the accuracy is dependent on the magnitude of the values in the region The area is accurate to approximately 1 part in 1045 The standard deviation is disolayed to one decimal place which means that the accuracy Is dependent on the magnitude of the data To initiate the measurement of a Region of Interest select Region of Interest from the pop up menu Click on a point from which you want to measure and then drag the 249 cursor so as to include the region you are interested in as in figure 1 A circle will delineate the region and a box next to the region will indicate its area in centimeters squared or in Hounsfield units and centimeters squared when viewing a CT To move the entire region without altering its size click on the central box and drag the region to the desired location as in figure 2 The region can be resized by clicking and dragging the box on the circle s perimeter so as to increase or decrease the area of the region as in figure 3 250 A Please note When performing a ROI measurement on an image that is displayed with a resolution smaller than the actual image typically an image in the rack for CT MR or within an Image Popup Window for CR there is a possibility that iSite will calculate the ROI using a sub sam
102. alog seen below and click OK 3 isiteExport Amy Shapes My eBooks My Skype Pictures My iSiteExport My Skype Received Files my Music Emy videos My Pictures 2 my Web Sites To begin configuring the new Matching Series Rule click the Add Rule button The following dialog will be displayed 294 Create Series Matching Rules Dialog Matching Rule Mame Define Series Define Matching Values series Number 1 Modality Ox00080060 Seres Description temur AF valuel CB Body Part Exarnined EXTREMETY View Position AP Image Type DERIVED SPAIMARY New Attribute Cancel Enter a specific name for the new Rule such as Femur AP one that will recognizable by the Radiologists who will be creating Hanging Protocols using the Rule Since the Rules are based on matching DICOM Tag Values the next step is to select the DICOM Tags that will be used as common identifiers for the Rule To add a DICOM Tag Value highlight an item from the Define Series area and click the Add gt gt button to add it to the Define Matching Values area Up to 50 different DICOM Tag Values can be added As seen below Series Description in addition to the default Matching Tag Value for modality has been selected as a matching value 295 Create Series Matching Rules Dialog Matching Rule Name Femur SP Define Series Define Matching alues Series Number 1 Modality Ox00080060 Body Part Examined ESTREME
103. an exam read click the Mark Read button shown below in the Exam Summary Window to the left of the exam rack Upon clicking the Mark Read button iSite Radiology will automatically load the next exam in your worklist Please note that only unread exams will display the Mark Read button If the button does not appear in the Exam Summary Window the exam may have already been read In addition exams can be marked Read various times until their status is Finalized You can also toggle the Marked Read designation on and off for the active exam using the F3 hot key If you notice that an exam status is Complete and the Mark Read button is not present please bring the Issue to the attention of your iSite System Administrator Using the Navigation Rectangles The Navigation Rectangles provide dynamic and interactive flexibility when hanging exams on your Diagnostic Monitors By moving the Rectangles or placing images and series within them you can quickly rehang exams in your Diagnostic Monitors Each Navigation Rectangle contains one or more Layout Icons These small icons E located in the upper left hand corner of each image or series within a Rectangle describe the position of that particular image or series on your Diagnostic Monitor The Layout Icons will change dynamically when you resize the Rectangle or change the Monitor Layout of your Diagnostic Monitor The size of the Navigation Rectangles is determined
104. an use and create filters fo generate a worklist that will only contain MR Head exams You can also create filters that will generate a list of exams only from one location in your organization such as the ER or ICU If you only wish to read exams from today the last 3 7 or 30 days you can create a filter that will generate a list of exams only from your selected period To edit or view the properties of any one of the filters highlight that filter using your mouse and click the Properties button The following window will appear 65 Add Filter BARDACH MR BRAIN AIlMA BRAIN from ERS BARDACH NOAH MD Make changes as desired by entering the appropriate information into the fields and selecting the appropriate buttons below When you have finished click the OK button You will be returned to the Filter Preferences Tab Please note that certain fields must be specified exactly For example if you wish to specify the organization H4 ac32 j you must specify the exact name Any omissions or errors will result in a limited filter If you wish to create a new filter click the Add button A blank filter window the Add Filter Into dialog will appear as shown below 66 Add Filter Specify all pertinent information to create the exact filter you desire as shown below 67 Add Filter BARDACH MR_NECE Fi AISTAT MA BRAIN from ER with sub specialty NEURO BARDACH NOAH MD Cancel Listed below are
105. are indicated by the Usymbol If an exam is already being displayed in your Diagnostic Monitor this will be indicated by the Yor Ul symbols depending on which monitor the exam is displayed in When you select 275 an exam from the list it will replace the currently disolayed exam in your Diagnostic Monitor Clone Window with Presets Clone Remove Clone This function allows you to duplicate any image or series in order to simultaneously view images with different window level values For example one of the cloned CT series could be displayed with the Bone preset window level value and another cloned CT series Could be displayed with Lung If you are cloning a CT series from the Diagnostic Exam Racks select the Clone Window with Presets option In this situation the cloned CT will be displayed in the Diagnostic Exam Racks with a C to designate it as a clone If you are cloning a CT series from a series that has been expanded from the Diagnostic Exam Racks choose the clone option Use the Remove Clone option available from the Diagnostic Exam Rack pop up menu to remove a cloned CT series from the Diagnostic Exam Rack and the Diagnostic Monitor This option is not available in either the Diagnostic Monitors or in the Exoanded Windows In the first case remove the clone in the Diagnostic Exam Rack and It will disappear trom the Diagnostic Monitor In the latter case simply close the Exoanded Window to remove the clone Create P
106. ate Desired Frame Rate Number of Bits iSite Radiology Diagnostic Monitor Pop up Menus The remainder of iSite Radiology s image manipulation tools are available from pop up menus that are displayed when you right click an image or series in the Diagnostic Monitors Please note while they fulfill the same function as the pop up menus seen in the Canvas Page the pop up menus displayed in the Diagnostic Monitors are more robust including more options and tools Right clicking an image or series in the Diagnostic Monitors will produce a context sensitive pop up Menu displaying the various tools available for the modality in question Each menu is modality specific and certain features are only available with certain modalities The font size used in the pop up menus can be changed in the General Machine Preferences to accommodate monitors of different resolution Three different pop up menus are available in the Diagnostic Monitors shown below Window Width Level Window wWidthjLevel Measurement Measurement Window WidkhjLevel Annotations nnotations Measurement j Image Processing b Image Processing Annotations F i b Multi Image Mode Image Processing F Murti Image Mode Create Popup Create Popup Create Popup Monitor Layout Monitor Layout Monitor Layout Select Series Select Series Select Series b Select Relevant Exam b Select Relevant Exam Select Relevant Exam Clone Window With Preset Clone Clone key Image key Ima
107. ate t Al mei Zoom Presets H m3 AJ m3 Series Selecting This option allows you to quickly switch between different images or series in the exam that you are viewing Selecting a different image or series from the Series Selecting menu will change the current image or series being displayed to the image or series you have indicated Please note that this function is not available from an expanded image in the Canvas Page Select Relevant Exam This option allows you to quickly switch between different exams from the patient currently being viewed To access this feature right click an image or series from the Diagnostic Monitor and choose the Select Relevant Exam item as seen below 274 Window WidkhiLeyvel Measurement Annotations Invert Image Monitor Layout Select Series Select Relewank Exam OO CR ABDOMEN 11if2f99 14 10 Create Popup oo CR ABDOMEN 11 2 99 14 4 key Image CR ABDOMEN 11 2199 14 4 BO CR ABDOMEN 10 29799 11 57 CR ABDOMEN 10 29 99 11 48 Save Image CR ABDOMEN 9 16 99 14 15 Print CR ABDOMEN 916 99 14 15 Flip Rotates Sort CR ABDOMEN 9 16 99 14 13 ene ea ale ff GP PRR a ae Se CR ABDOMEN 718799 12 44 Mew Link The resulting list of exams has been determined to be relevant to the image or series you were previously viewing The criteria for relevant is set on a site by site basis by your iSite System Administrator Exams in the list that are loaded in your Canvas Page
108. ation Area displays the modality accession number Referring Physician and Status The bottom portion shows an estimate of how much time remains before the exam Is retrieved and a display of which images are being requested To cancel the archive retrieval click the Cancel button There are three functions available by right clicking an exam as seen below 172 User Bardach Woah MO Fa ara RR eng ee ee ae a ae FAT aL rir LL es ko m ry as F PS a A F F hes FAT T i p F m m p Ss re e Ba E TT d A Th T ETAT rh EFPL F o o Y B a FiF Gy FS aie EP ET TOC E mi L Ee _ O k Te e l J m Fa oo Ra Lh h A Th a aF 1 i eE Lik Ff a TL Thr L ET i i F Tor ee O A Erea kT 7 oe io 2 TE l aes 1 Pr a F oe ho oT hk Be ee a a ae Bow RP ee 7 SEI a air i E a j fiw ra J g Tar E tor K Open Exam Add Exam to Folder Show Report Export via DICOM Cache Exam Mo Key Images Mark Read Open Close Exam First exams that are not loaded into your Diagnostic Exam Racks can be loaded by right clicking an exam and selecting Load Exam from the pop up menu The reverse is also true exams that are currently loaded in the Diagnostic Exa M Racks can be unloaded by right clicking the exam icon on the Navigational Timelines and selecting the Unload Exam option from the pop up menu Please note that all exams can be unloaded with the exception of the Main Exam Add Exam to Folder
109. atus Please note that in the image above the Export to dropdown will only display a CD Drive if the user s system is Windows XP and their machine includes a CD Drive or if a separate drive is attached to the machine being used If neither of these conditions are met the Export to field will show a local directory C Documents and Settings username My Documents My ISiteExport CD Manager Window The upper portion of the window above will contain exam listings once they are added to the CD Manager folder The bottom portion contains the controls for the export The controls are as follows e Export to The field in this folder shows you the location of the export folder where the images information and iSite Control will be written If you want to create a CD and you are connected to an internal or external CD drive choose your CD drive as seen above If you would like to select the desired location from a browser window pull down the menu and choose the Browse option If you choose an existing folder its contents will be overwritten by the export If iSite detects pre existing Tiles it will display the following message 45 site Radiology T The destination directory is not empty Would you like to destroy its contents Cancel Hit OK to overwrite the contents or Cancel to return to the CD Manager and reconfigure the export destination lf The destination is not ready for example if you have selected th
110. ays Lab Results i Pharmacy Paper Printing Unilab Body Part Dictionary IE port Duer Organization Dictonary Location Dictionary Add Delete Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel Apply Help To add a new Plug In click the Add button The following window will appear Plug In Dialog Mame Wisible in folder tree URL Enable in iSite Radiology Enable in iSite Enterprise Disable AFI Requires Security Code cancel Choose a display name for the Plug Ins folder and then set whether it will be displayed in the folder tree If it is not it will not be visible to non administrative users For information about using the Plug Ins with API s please see the iSite API documentation Enter the URL of the Plug In and then choose the programs in which to enable the 122 Plug In If you would like only users with a specific Securify Code to be able to access the Plug In select the Require Security Code box and chose the Securify Code trom the drop down menu To edit an existing Plug In simply highlight that listing and click the Properties button Edit information where necessary as seen in the window below Plug In Dialog Name Phamacy i Visible in folder tree URL http Aey rotech comlogn UCLA Medical Center Logn asp i Enable in iSite Aadiology Disable AFI Requires Security Code Cancel To delete a Plug In highlight the list
111. being used remotely not from the Main Location To cache an exam locally right click the exam listing in a Filter Worklist the Patient Directory or in the Patient History Timeline and select the Cache Exam option as seen below eF All Fatient Mame E Date a Location Query EADOH ka BADOH ROGER vO MR MRSTDCM Acc 4196732 Referring SS Show Report 20 Referring K E cT P5 Referring K vo MR cachean e a Referring vO CT CTSTOCM Acc 4075517 Referring K vO MR MRSTOCM Acc 4040345 Referring vO MR MRSTOCM Acc 3812811 Referring ae 12 00 00 m 97 15 1999 12 00 00 072171999 1200 00 016 1999 3 36 00 PM P281999 1 26 00 PM P 211999 10 07 00 7191999 12 00 00 317 1999 7 22 00 PM Upon selecting the Cache Exam option iSite will download the exam to a location specified in the Local Exam Caching Section of the User Preferences If you want to see the progress of the download click the Local Exam Cache folder in the iSite Folder List as seen below 52 Folder List X J iSite Tools Exception Handler mebLocal Exam Cache 9 Media Export K a My Filter 9 My History MAB Clinic Lab Results NAB Clinic Pharmacy Patient Directory Pharmacy com Statistics System Filter CJ Personal Folders C3 Public Folders The Local Exam Cache Folder displays all exams that have been cached locally In addition the individual listings will disolay p
112. by the layout of your Diagnostic Monitors For example if you have chosen to layout your Diagnostic monitor with a 6 1 configuration the Rectangle will be 6 images or series in length The size of the Rectangles and simultaneously the layout of the Diagnostic Monitors can be easily changed by right clicking the rectangle Doing so produces a pop up menu as seen below 194 MR Mo Descriptions egies OF 294999 Acc 4092897 a y Hide Referring SCHIFF DAID cre E Mi status PRELIM E AERE E scene eee ERES ee H MZH SOPUID 1 2 840 113619 2 1 1 RADA 2702767793 734 933246646 6 HERE 00 eae a mas Moy I E o MR Mo Descriptions FA MEP 07191999 Acot 4040345 i MEL Referring KONDZIOLKA DOUGLAS iii Status PRELIM f H mi2 Joea ee ea eH m2 SOPUID 1 2 640 115619 2 1 1 4 E Mi_3 BA mat 2 O2994 1 76 680 9545656915 4 J as Select the desired monitor layout and both the Diagnostic Monitors and the rectangles will be automatically resized If you wish to hide the Rectangle click the Hide option The Rectangles can be used in two different ways to load images series or exams into your Diagnostic Monitors The first method is to drag images and series into the Rectangle as shown in the previous subsection The second method is to drag the Rectangle itself over the images or series you wish to display in your Diagnostic Monitors To drag the Navigation Rectangle to different images and series or to a
113. can be easily reordered by clicking and dragging the image or series to the desired location To move an image or series click the information bar at the bottom of the image or series and drag it to the new location as shown below This functionality provides an easy way to change the content of your diagnostic monitors If an image or series is dragged into one of the navigational rectangles it will be displayed on the corresponding diagnostic monitor Release the mouse when you reach the desired location and the image or series will be inserted at that point Thumbnail Manipulation While the Navigational Console is not meant for Diagnostic Reading you can still manipulate the thumbnail images and expanded windows in the Canvas Page The following adjustments can be made to Thumbnail images in the Rack e Image and Series Expansion Individual images and series can be expanded into larger floating windows by double clicking on the image or series in question There is no limit to the amount of rack images or series that can be simultaneously expanded Note that additional image manipulation options are available when an image or series from the rack has been expanded to a larger floating window e Window Width and Level WW WL To adjust the Window Width and Level settings of the images and series in the racks click the left mouse button and drag the cursor horizontally across the image to increase or decrease the Window Width or ver
114. cannot be printed to a DICOM device To access these options click the DICOM Print listing from the tree view control The following screen will be displayed 126 Preferences Dialog User Preferences System Preferences General Preferences Window Width Center Image Processing i RINTER_SCI L Filters DPFOOD 5 i PACS PRINT PACSPRINT Umag Desk eee Kodak Drys KODAKPS Horhtwall DICOM Sources DICOM Print H Machine Preferences Network Testing Cancel Apply To add a new DICOM printer destination click the Add button The following dialogue will appear 127 Add DICOMPrinter Defintion Mame Location AE Title IP Address Response imeout sec 60 Fort Ping Configuration Add Fill in The name location AE Title IP Address and Port of the printer To configure the printer you have just added click the Ada button in the Configuration dialog The following screen will appear Add DICOMPrinter Configuration Mame Filmos Settings Image Display STANDARDS Min Density Format FilmSize ID SINS on Max Density Medium Type CLEAR FILM Printer Configuration LiteSize Printing Orientation LifeSize Printing C Landscape ImageBos Heightimm Portrait ImageB os Wwidthimm Overlay Cancel 128 The Add DICOMPrinter Configuration dialog seen above allows you to specify a number of FilmBox settings as well as L
115. ces enter their names separated by commas Name your filter in the Name field and then fill the dialogue in with the necessary information making sure that the filter is unique and also functional Please note that you do not have to fill in all the fields Note also that if the Modality field is left blank the filter will apply to all available modalities Only the Modality field has this Characteristic Special care must be taken with the generation of a filter When completing in the fields you must use your institution s standard codes and syntax For example if your institution s code for the Emergency Room Is ERC then you must use ERC to specify the Emergency Room If you enter ER Emergency or any other code the filter will not work For example if you wish to create a filfer that isolates exams with a description of a particular ailment or symptom the language in your filter must match the description exactly or the filter will fail If you enter High blood pressure in the description field but your institution Uses the code HBP as standard notation your filter will fail In that instance you would have to enter HBP in the description field 89 Once you have finished specifying the filter criteria click OK The new filter will be displayed along with the pre existing ones You can create up to 100 system filters To edit a filter highlight that item in the list and click the Properties button as seen below
116. ch vertebra or vertebral disc The spinal tool is only available on images or series showing the spine To engage the tool select Spine Labeling trom the Annotations section of the pop up menu as shown in figure one A dialog will appear as shown below in figure two 260 Windows WidthjLevwel Measurement Li Annotations Lire Image Processing p Arrow Create Popup Triangle Monitor Layout p Circle Select Series Text Select Relevant Exam Freehand nae Spine Labeling ker Image decd mn Incise Here New Link Fin Here Save Stent Here di H TM4 Left Flip Rotate p zoom Presets TMAERight Spine Label Panel Descending order Ci TI Ce T2 Ta T4 76 Tle Show All Hide All There are two ways to label the image The first is by clicking on the desired label from the dialog and then clicking the location in the image where you wish the label to be placed The second faster way of using the spinal labeling tool is to highlight the label that you wish to use for annotation and begin by clicking on the image At every click iSite Radiology will place a label from the list The order of the automatic labeling can be changed from ascending to descending by clicking the check box at top Labels can by hidden or deleted by clicking the buttons at the bottom of the dialog To delete an individual label click that label with your mouse and hit the Delete key on your keyboard The end result will look like the example below
117. clinically acceptable images These corrections occur to correct detector defects to enhance the image to reduce noise to alter the dynamic range or any of a number of methods used to improve the visibility of soecific pathologies One method to incorporate these corrections is the application of a VOI Value Of Interest LUT This is one or more LUT s look up table which reflect the specified processing for diagnostic presentation VOI LUTs are used primarily with CR DR images are extracted from the DICOM tag 0028 3010 This tag can reference one or more VOI LUTs associated with an image Images can contain single or multiple VOI LUTs By default VOI LUT s are not initially displayed If the image contains Single VOI LUT or Multiple VOI LUT s they will be listed Under the VOI LUT Options Menu from which they can be selected All available VOI LUT s are listed under this menu After applying a VOI LUT you can select Disable VOI LUTs to disable the VOI LUT application for the image and revert to Histogram Calculation WW WL values While the right click WW WL options are replaced by VOI LUT Options when VOI LUT is enabled the image in question can still have WW WL adjusted on top of the VOI LUT presentation This modified VOI LUT can be seen in the image above E25 PS Mod This modified VOI LUT will be preserved when a Presentation State of the exam is saved Please note that once a VOI LUT is saved In a presentation 243 s
118. ctions found in the iSite Radiology Placement Guide must be followed in order to achieve the proper configuration and correct use of this product Lossy compressed mammographic images and digitized film screen images must not be reviewed for primary image interpretations Mammographic images may only be interpreted using an FDA approved monitor that offers at least 5 megapixel resolution and meets other technical specifications reviewed and accepted by FDA Safe Usage Environment Customer equipment for operating the iSite Radiology service must be approved by Philips and must be maintained in accordance with the manufacturer s specifications In addition the iSite Radiology software must be installed on computers in accordance with the guidelines of the Radiology Placement Guide Prior to using this product your computer system must be set up in the proper environment for viewing images Be sure that your computer monitors have been properly configured prior to using iSite Radiology To configure your monitors carefully follow the monitor manufacturer s specifications and or instructions for monitor calibration If the monitors used in conjunction with iSite Radiology navigation console and diagnostic monitors are not properly calibrated iSite Radiology has not been properly configured and should not be used iSite Radiology should be validated in the absence of any diagnostic monitors ie when only the ROP is available When N
119. cursor to enclose the desired area as seen in Figure 1 The shape of your outline can be as complex as necessary The only restriction is that your lines must not intersect Release the left mouse button when you have finished the outline iSite will disolay the enclosed area of the outline in centimeters squared or Hounsfield units for CTs Any portion of the outline can be selected and dragged to adjust the outline s contours as seen in figure 2 The outline can also be dragged to any part of the image by clicking on the box next to the end points of the outline clicking and dragging to the desired location as seen in Figure 3 252 A Please note When performing a Freehand ROI measurement on an image that is displayed with a resolution smaller than the actual image Typically an image in the rack for CT MR or within an Image Popup Window for CR there is a possibility that iSite will calculate the ROI using a sub sample of the original image data The value in this case is an accurate representation of the average measured pixel values represented by the interpolated sub sampled image This is a close approximation to the original pixel values Anytime iSite calculates a measurement using a sub sample of an image the measurement result is disolayed with a meaning approximate value in front of it When opening and displaying an image in full resolution the Freehand ROI Measurement Values are recalculated The sign is
120. d These keys will loop for example if FS is pressed at the end of a exam now ihe navigation rectangle will be moved to the firsi image Comma and Period i f Decrease and increase the angle for the sosed Edge Enhancement and Edge Delection Image Processing Tools 22 iSite Radiology Features Reference Sheet Please note this Reference Sheet has been organized beginning with the most basic image selection and viewing features to the most complex image manipulation features Expand an image or image series Adjust Window Width and Level Compare Link images in an exam Select and deselect images or image series Release any current mouse How to Action Double click the left mouse button on the desired image or image series Left click the image and drag the leff mouse button horizontally or vertically respectively Default WW WL Histogram Calculation and Modality Default values are available for all modalities through the pop up menus CT exams will also display preset Window Level values through the pop up menu These values include the Default WW WL Abdomen Brain Bone Liver Lung Mediastinum and any other custom Window Levels created by the iSite System Administrator on a site by site basis Right click on an image and select the New Link function from the pop up menu Right click on the image you would like to link and then select the Join Link option Place your mouse curs
121. d US All To edit or view the properties of any one of the filters highlight that filter using your mouse and click the Properties button The following window will appear 159 Add Filter lv lv Cancel Make changes as desired by entering the appropriate information into the fields and selecting the appropriate buttons below When you finish click the OK button You will be returned to the Filter Preferences Tab Please note that certain fields must be specified exactly For example if you wish to specify the organization IH4 ac32 you must specify the exact name Any omissions or errors will result in a limited filter If you wish to create a new filter click the Add button A blank filter window the Add Filter Into dialog will appear as shown below 160 Add Filter Cancel Specify all pertinent information to create the exact filter you desire as shown below 161 Add Filter MA BARDACH mm mo m ii mu Ge m a All MAs of the Brain from ER 2 Cancel i When you have finished click the OK button You will be returned to the Filters Preferences Tab where your new filter will be displayed in the list of filters as shown below 162 Preferences Dialog El User Preferences General Preterences Window Width Center Image Processing Filter Name De Jl Cl aia DACH Al ICT t heads frorn ERe s of the Brain from ER2 Properties Display Preferences
122. d in conjunction with iSite Radiology are not properly configured the product is not being used as intended and may not function properly Performance Issues 2 What is the best type of mouse to use with iSite Radiology iSite Radiology is designed to be used with a three button wheel mouse Foremost among these are the Microsoft Intellimouse and the Logitech Wheelmouse While there are other three button mice we cannot assure that iSite will function optimally with them iSite Radiology should not be used with a two button mouse Why are images blurred when I jump from a lower resolution to a higher one Depending on the speed of your institution s network images may be momentarily blurred when you jump from a lower resolution to a higher one With high quality hardware in place and a high speed network there should be no blurring at all If blurring occurs it should last no more than a few seconds This blurring is called intermediate draw and is the result of iSite Radiology processing the digital information of the higher resolution image Can I still use iSite with a two button mouse No iSite Radiology should only be used with a three button mouse 324 2 How fast should images and series load The speed at which iSite Radiology can load images and series is heavily dependant on the speed of your institution s network and the quality of your workstation Assuming that your institution s network uses standard 10 100 Base
123. dach Images for Class J Advanced C Y 9 9 IntroPathology4 104 Ga Pathology 100 Bardach MRBrain J Bardach MSS Article 9 Public Folders 40 The example above demonstrates how the user has placed four folders in the Personal Folders directory One of these folders Bardach Images for Class has three sub folders in it The contents of this folder are only visible to the specific user who created it If you log out of the system on a certain computer and log back in on a different one you and only you will be able to see your Personal Folders There are only a few limitations to the Personal Folders A folder cannot contain more than 500 exam links or 25 sub folders Nor can the folder tree be more than 4 levels deep Exams can be dragged and dropped from one Personal Folder to another To move an exam simply drag and drop To copy an exam from one folder to another hold down the Control key then click drag and drop Public Folders Like the Personal Folders the Public Folders can contain other folders created by the user or links to clinical exams The only difference between the Public and Personal Folders is that the former is available for viewing by all users who have permission to view the Public Folders Adding Exam Links to Folders The basic purpose of the iSite Folders is fo organize and store links to specific exams Adding exam links to a folder can be done in several different ways The easiest way Is
124. dded to an image that image automatically becomes a Key Image All measurements and annotations can be cleared from an image by right clicking the image and selecting the Delete all Measurements and Annotations option Please note that annotations measurement tools and the localizer cannot be used at the same time Selecting a measurement tool or working with annotations will disengage the Show Localizer feature To apply the line arrow triangle or freehand tools select the option from the Zod pop up menu click the image where you wish fo initiate the annotation and drag your mouse cursor as desired When you release the mouse button the annotation will be complete To use the text annotation select the text option from the pop up menu and click the image at the point where you wish to place the text annotation A dialog box will appear Type your annotation into the textbox and click the OK button Your text will be disolayed on the image All annotations can be moved by clicking anywhere on the annotation and dragging it to the desired location 258 The line style and font of an annotation can be changed by right clicking any annotation If you are configuring any type of annotation except for text annotations you will see the Edit Line Style dialog as below Otherwise you will see the Edit Font dialog also pictured below Configurable options include font size for text annotations text color line color l
125. diology iSite Version 3 50 30 FCS Date of Manufacture Thursday June 29 2006 CE 600 Marina Bird Sulle 100 Brisbane CA 94005 USA st nm comet pei io yo Use J F Trae i iari 12 Of EgUCEL LU IRE Tue exe ar 7 m he tonware a my Grd Wheres After the splash screen disappears the iSite Radiology login screen will appear as seen below Please note that running other programs simultaneously with iSite Radiology is strongly discouraged Also note that once iSite Radiology has initiated it will occupy the entire screen of your workstation When you start iSite Radiology the program will check your hardware to make sure that it meets the minimum hardware requirements If you system does not meet this requirements you will be notified by a dialog containing the detected specifications and the required specifications 13 iSite Radiology Logon Name NBardach Password re Logon to iSite W Remote Reading Mode Log In Using Emergency Access Server OK Cancel Koninklijke Philips Electronics N V 2005 Allrights are reserved Reproduction or transmission in whole or in part in any form or by any means electronic mechanical or otherwise is prohibited without the prior written conse nt of the copyright owner Copyrights and all other propriete ary rights in any software and related documentation Software made available to you rest exclusively with Philips or its licensors No tithe or ownershi
126. diology Workstation 4499 Grand M Radiology Workstation 4467 _ Jackson Radiology Workstation 4a57_ Cho C EFILM_1 J build 10 server C dawn C e m PIcToeRtTAo cro Select the DICOM device or devices to which you want the exam s sent and then click the Next gt button The following window will appear DICOM Export Dialog SWINDON MATA MRN 85131 Agta 3D MF Imaging System RADY Agta 3D MR Imaging System RA amp DSa Radiology YYorkstation 4499 Exeter Radiology Workstation tasr Jackson Finish Cancel Queue 177 Revise the exam and destination information in the dialog to confirm that they are correct When you are sure enter in additional information if desired You can notify any number of people via email by typing in their addresses in the email section of the Notification box You can also add a description or denote the exam as High Priority If you would like to check the queue to see how busy it is click the Queue button If you are finished click the Finish button You will be returned to the diagnostic racks You can return to any part of the Export Via DICOM process at any time by clicking the lt Back button You can cancel out of the Export Via DICOM process at any time by clicking the Cancel button Cache Exam This feature allows you to cache an exam to your local machine or other associated location such as a mapped drive When you select this option iSite will download the exam to a locat
127. ds The AE Title field should be filled in with the AE_Title of the DICOM Remote Host to which you wish to forward In the Remote Host Description field enter a brief description of the remote DICOM device List the Port number on which you want the request to take place and enter the number of simultaneous associations that you want the receiving device to entertain in the Max Concurrent 115 Requests field If you wish all exams in the study to be resent when an export fails and is being retried click the Send Entire Study on Retry checkbox If you wish an association between the iSite Server and the receiving device to be kept open when multiple studies are being sent instead of opening and closing a separate association for each study check the Association Across Studies checkbox Click OK when done The new listing will appear in the list alongside the pre existing ones To edit a listing highlight that listing and click the Properties button as shown below Preferences Dialog User Preferences System Preferences General Preferences Window width Center RemoteHostD escrption Filters Annotations DICOM Sources Se Screen Overlays Paper Printing Body Part Dictionary IE x pork Duer Organization Dictionary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Edit the properties as needed as shown in the window below and click OK when finished
128. e Modalities Read Only Median Filter Method Modalities Read Only LCLAHE Method Modalities Read Only Restore Defaults Cancel Detailed alterations to the method degree and properties of each image processing option can be made in these menus The CLAHE section has extensive preferences which include Contextual Region Dimension Number of Bins Clip Limit and Map Level Filter Preferences The Filfers area seen below contains information regarding all of the different filters that can be used to tailor your Reading Worklist to meet your specific needs By creating a personalized filter you can generate a worklist that will contain only the exams that meet your filter criteria Please note it is important that you exercise care in creating your filters lest you accidentally exclude exams which you wish to reading 64 Preferences Dialog User Preferences General Preferences Window Width Center Image Processing BARDACH MA_BRAIN All MF exams of the Brain from E BARDACH CR SPINE All CRs of the SPINE from ERZ t Display Preterences BARDACH CT HEAD AILCT heads from ER Hanging Protocols Canvas Page System Preferences Machine Preferences Network Testing Cancel By using these filters you can create a worklist that displays only those exams that you wish to read For example if you specialize in a particular body part such as the head and in a particular modality such as MR you c
129. e CD drive but no media is present iSite will disolay a warning as seen below site Radiology To the right of the Export destination field are three radio buttons that allow you to choose the format in which the selected studies will be exported iSite Media Format is the standard wavelet encoded iSite format This is the default selection DICOM Format is the raw unadulterated DICOM Part 10 data from the modality If This option is selected the DICOM information will be stored in a separate directory on the portable media called DICOM This directory can be copied directly into other DICOM systems and archives The Start button located to the left of the export location initiates the export Summary This feature shows the Required Disk Soace and the Available Disk Space for a given job Please note that the initial Required Disk Space reflects the size of the CD version of the iSite control Protection This feature is designed to protect patient confidentiality allowing you to require a password when a user tries to use the CD or other media Click the Enable check box enter and then confirm your password If the Enabled checkbox is checked and no password is entered iSite will disolay the following message when the Start button is clicked 46 site Radiology Adding Patient Exams Adding patient exams to the CD Manager can be done in two different ways Patient Exam listings can be dragged and d
130. e Diagnostic Monitors The iSite Radiology Diagnostic Monitors are used for the diagnostic reading of images in iSite Radiology The hanging configuration of these monitors can be established at the click of a button or through customized Hanging Protocols Other settings such as the placement of metadata image sorting and series tiling are easily configured through the Preferences dialog which can be accessed by clicking the Preferences Button in the iSite Radiology Control Strip The selection of the images disolayed on the Diagnostic Monitors takes place in the Canvas Page located below the monitors These images can be annotated labeled and measured Interactive navigational scouts can be employed fo link series together and simulfaneously navigate to a particular anatomical location Also numerous advanced image and series manipulation tools are available by right clicking any image or series A Warning Lossy compressed mammographic images and digitized film screen images must not be reviewed for primary image interpretations Mammographic images may only be interpreted using an FDA approved monitor that offers at least 5 Megapixel resolution and meets other technical specifications reviewed and accepted by FDA As shown below the Diagnostic Monitors display full resolution full fidelity radiological images and series accompanied by a variety of overlays which can be configured by the system administrator on a site to site basi
131. e Popup Clone Create Popup Clone Window With Preset Monitor Layout Clone Select Series b Select Series Select Series Key Image Key Image Key Image d z New Link New Link Mew Link Link All Axials Link All Axdals Save Save Save Print Print Print Flip Rotate Flip Rotate Sort Split i FlipRotate Sort Split Matching Series Rules Matching Series Rules Matching Series Rules Delete Delete Delete Assign New Unique Study UID Assign New Unique Study UID Assign New Unique Study UID CR Menu CT Menu MR Menu Expanded Window Manipulation in the Canvas Page Exoanded Windows are created in the Canvas Page by double clicking a Thumbnail image or series in the Diagnostic Racks as discussed above Exoanded Windows provide additional image manipulation functionality not available with thumbnail images In addition these windows can be arranged according to your preference by dragging them to the desired location in the Canvas Page Along with the image manipulation features available for the Thumbnails images and series in Exoanded Windows can be manipulated in other important ways The following additional image manipulation features are available in Exoanded Windows Zoom To zoom into a plain film image simply roll your mouse wheel forwards The image will zoom in at the location of your cursor To zoom out roll your mouse wheel backwards To zoom into an image series such as an MR or CT exam left click the mouse while holdin
132. e image with the closest location in the multi ohase series and because there are potentially multiple 206 matches iSite will disolay the best match trom the first phase In this example iSite would never display image 7 through 12 207 In other words it is not possible to review all images of a multi ohase series by paging through another series while using the localizer functionality oTa faa di d k Gh I fak G f a Series Series 2 Hanging Protocols Hanging protocols are an important part of an efficient reading workflow and iSite Radiology has been designed with this in mind With regard to how exams are hung in your Diagnostic Monitors iSite Radiology is equipped with a wide and flexible variety of options Hanging Protocols can also be configured for Virtual Split Monitors as if they were distinct physical Diagnostic Monitors Not only can monitor configurations be changed at the click of your mouse iSite Radiology can be configured to recognize certain combinations of exam characteristics and hang the exam according to your specifications iSite Radiology has been designed to save your personal hanging protocols so that they are there every time you use the program Hanging Protocols have a special relationship with Presentation States that affects how exams may be displayed If the user opens an exam that has a Technologist or Pre Read Presentation State the Presentation State will override certain features of
133. e modality responsible for generating the image being measured If the modality Is incorrectly configured or defective iSite measurement values may be adversely affected and may be incorrect Due to the inherent nature of projection radiography when using iSite for measurements Philips strongly recommends the use of an appropriately placed object of known size for determining what magnification factor has been applied to the image Please note that annotations measurement tools and the localizer cannot be used at the same time Selecting a measurement tool will disengage the Show Localizer feature 244 Window VWidth Level Annotations Image Processing Clone Key Image New Link Save To Paper Printer Flip Rotate Zoom Presets Ruler Angle Region of Interest Freehand ROT Paint Value Measurement Palette Calibrate Image 245 Ruler The Ruler tool allows users to make linear measurements to for example measure the diameter of a tumor as a baseline prior to treatment or measure the diameter of the appendix to diagnose acute appendicitis The measurement units for the Ruler tool are MM units if pixel soacing Is specified in the DICOM tags Otherwise it is in pixels The level of accuracy is to tenths of a unit To initiate a Ruler Measurement choose the Ruler option from the pop up menu Click on a point trom which you want to measure and then drag the cursor to the second point as in figure 1 A box next to th
134. e ruler will indicate the measurement of the span in millimeters or pixels depending on the DICOM information available The Ruler measurement tool displays a letter next fo each measurement This allows you to place the measurement display anywhere in the image as seen in figure 4 This naming convention is image specific meaning that you can have an A B or C in different images These letters will be preserved in a Presentation State If you want to move the entire ruler without repositioning either end click anywhere on the ruler and drag it to the new location as in figure 2 If you want to reposition either end of the ruler click on that end and drag it to the new location as in figure 3 You can reposition the end points of the ruler at any time as in figure 4 3 Nov 1999 15 12 12 4320946 eo ie a Eae al ama 4 a d e f Windows WidthjLevel o Annotations T a Image Processing b m Region OF Interest Key Image Freehand ROI int Y New Link Point Value Save b Messurements Palette Print To Paper Calibrate Image Flip Rotate Sort Fee Zoom Presets O Series 1 3 246 Figure 2 Figure 3 Angle The Angle tool allows users to measure the angular alignment of two objects The measurement units for the Angle tool are degrees The level of accuracy is based on the angle being computed as a floating point value and truncated to an integer This implies a maximum angular error of approximately 0 5 deg
135. e type of image you are viewing You may wish to try various Image Processing tools to find the best solution for viewing the enhanced image With the exception of the Invert Image tool anytime an Image Processing Filter is applied to an image displayed in a pop up window or in the Diagnostic Monitors iSite displays a P Processed Icon in the lower right hand corner as seen below This icon is not displayed for images in the Exam Racks 263 o x 7 y yeh A pon ag il oP DN aii a Fr a Please note iSite will apply the Edge Enhance and Edge Detect Image Processing algorithm to all images within a stack series In other words these Image Processing Filfers will be applied to all images within a particular series when selected As such when Image Processing Filters are applied to each and every image of a stack series there may be a slight display delay as iSite actively processes these images In multil image mode or in fast cine mode Invert Image This function reverses the black and white coloration of the highlighted image 264 Edge Enhance Located in the Image Processing sub menu Edge Enhance utilizes a Laplacian method to increase the visibility of edges in the image as seen in the CR image below The Edge Enhance tool has three different degrees of application light medium and strong The default setting can be changed in the Image Processing section of the Preferences To increase or decr
136. e unsure of what to do The feature is available for stacked images with the exception of multi frame stacked windows Please note scout images and clones cannot be split To split the exam right click and select the Flio Rotate Sort Split menu then choose Split Exam from the sub menu as seen below Window WidthjLevel e Image Processing b Create Popup Remove Clone Clone Window With Preset b Monitor Layout d Select Series b Key Image Flay Cine Loop New Link Link All Axials Save d Frint b Flip Rotate Sort Split Flip Horizontal Flip Vertical Rotate 90 CW Rotate 90 CCW v Image Number Ascending Image Number Descending Table Position Ascending Table Position Descending Deen a 291 The following dialog or a similar one will be displayed C 00080032 Acquisition Time C 00180050 Slice Thickness C 00181130 Table Height C 00181150 Exposure Time C 00181151 ray Tube Curent C 00181152 Exposure C 00181170 Generator Power 002000 2 Acquisition Humber Cancel Check the DICOM tags that you wish to use for splitting the series and click OK The tags that are available in this dialog depend on the tags associated with the type of series you have selected At a minimum the series will have a DICOM group 0008 tag or higher and must contain unique attributes greater than 2 and less than 10 If there are no attributes available for splitting or if the split criteria are not met a dia
137. ease the degree being applied to the Edge Enhancement use the comma and period keys while highlighting the image in question by placing your mouse over It 265 1 ri j g 1 a a gt d ana ic nee EMi ta i i E o a E par E a Soe iis i B a Ta r Fe St Pn a y P ai he Sg oe r i ee 7 a a ge i lt 2 j he m al 4 r 5 y A N a D E Jia i m ppm r a iki D i j n z ee ji g i i ss m ee ee 4 ege r a 4 ahd a 7 J r p mis l 4 i n r i a ik a a 4l a p ag Fux LA r A x a z B 5 F eon z a agr j aa 7 A i _ kai k di j Tig i B mr o i a ar i g ae kar l i Ying f L eee ry ere tn 4 i f ey i s Hi i Tae in 4 g i i j q al Kj EF r em a A r i T a ir J ot r r E H GA 5 b i 5 r t gt i r lj pi 7 4 ADAMS JULIE 10 23 1999 4 36 04 PM Acc 4234000 m ADAMS JULIE 10 23 1999 4 56 04 PM Acc 4294000 m F3 Edge Detection Located in the Image Processing sub menu Edge Detection provides an alternative to the Edge Enhance tool utilizing a Sobel operator to increase the visibility of edges The Edge Detection tool has three different degrees of application light medium and strong The default setting can be changed in the Image Processing section of the Preferences To increase or decrease the degree being applied to the Edge Detection use the comma and period keys while highlighting the image in question by placing yo
138. ease your mouse button iSite Radiology will display the following dialog Enter Length mm Enter Yalue PO Cancel Enter the length of the known distance in millimeters and click the OK button From now on all measurements of distance and area will be based on the newly defined scale In addition the interactive scaled rulers will be resized Please note that the calibration tool cannot be used with images that have valid DICOM defined pixel soacing In addition be advised that using the calibration tool on an image that has already been calibrated will alter The measurement values for that image Ultrasound Measurements iSite Radiology supports length measurements on Ultrasound B Mode images There are a few instances when measurements on Ulirasound images may not be possible For example sometimes the scanner does not send iSite Radiology the necessary calibration information needed for measurements iSite Radiology does not support measurements on Spectral M Mode or Dual B Mode images at this time In these instances you might want fo use the calibration tool to manually calibrate the images e Annotations The Annotations feature is a quick and useful tool for annotating images There are several annotation styles that can be applied including line arrow triangle text and freehand These annotation styles are seen demonstrated in the image at the bottom of this section Please note that when an annotation is a
139. ecting the New Link function from the Image Pop up menu cloned or expanded windows of CTs and MRs with the same frame of reference and the same orientation can be automatically linked by juxtaposing their lateral margins To unlink an image highlight that image and select Leave Link To unlink all linked images select Unlink All from the pop up menu Link Indicators There are three different link symbols The Thumbnails display a plus symbol expanded thumbnail images display the link symbol and the linked images in the diagnostic monitors display the word LINKED if this has been configured for your institution in the system preferences section These symbols will appear on the images as they are linked Aligning Linked Series DICOM contains information as to the frame of reference which provides exact information as to the location of the patient at the time of scanning Typically images in the same exam will have the same frames of reference and images in different exams will have a different frame of reference If the linked series are in the same frame of reference iSite will automatically align them when the link is created If the linked series are not in the same frame of reference iSite will not be able to perform the initial alignment automatically It relies in this case on the user to align the series prior to linking them and then uses information about the slice spacing to synchronize them as the u
140. ed above in red and blue correspond to the images being displayed on your Diagnostic Monitors Not only do the rectangles provide a visual representation of the exams being displayed they can also be used to load other images series or exams Into your Diagnostic Monitor The Diagnostic Exam Racks have two main functions The first of these functions is to display and help you arrange exams for diagnostic review in your Diagnostic Monitors The second function is to give you a quick contextual view of the exam you are reviewing and the patient s other relevant exams The uppermost exam rack of the Diagnostic Exam Racks displays the exam from the MyWorklist that needs to be reviewed The exam racks below display exams that are relevant to the exam you are reading Please note that the definition of a relevant exam is determined on a site by site basis For more information ask your iSite System Administrator Key Image Series Key Images are images that have been marked by a user as key The Key Image Series option set in the General Preferences section of the Preferences page allows you to view all of the key images for the current Presentation State of an exam in one single Key Image Series This unique series composed solely of Key Images is located to the left of the exam images when the rack is viewed in horizontal mode and directly above the exam images when the rack Is viewed vertically The window in which the Key Image Seri
141. eline will be populated by other exams most likely CT HEAD that are related to the exam you are viewing Please note that the definition of relevant exams is determined on a site by site basis Ask your iSite System Administrator for more details The right timeline is the Patient History Timeline This area presents a chronological listing of all of the patient s exams present on the iSite Server In the bottom right and left hand corners of the timelines are the most recent and least recent exam dates Green datelines delineate the year as seen above Detailed information regarding any of the exams displayed can be seen by momentarily holding your mouse cursor over the exam in question A pop up window as seen 170 above will disolay the accession number date and time referring physician procedure description and status of the exam If more exam listings are present than can be displayed a small blue arrow will appear in the Upper right hand corner of the timelines You can navigate to the off screen timeline portions by clicking this button You can also access the off screen timeline portions by placing your mouse over the timeline holding down the mouse wheel button and dragging your mouse in the desired direction Of the exams listed in the timeline iSite Radiology identifies exams that have been loaded into your Diagnostic Exam Racks as well as the exams that are being displayed in your Diagnostic Monitors Exams loaded into
142. emote Reading Mode allows a group of offsite radiologists to function as a virtual group within the reading environment The behavior of Remote Reading Mode Is dictated by your Reading Preferences You can specify how exams are handled auto locking and maximum file size to be downloaded While In Remote Reading Mode if the Include auto locking caching of STAT exams box is checked when you open a new exam that is not locked by another user the exam will be locked and iSite Radiology will automatically cache the entire exam on your local machine STAT exams will also be automatically cached for reading 15 In addition when in Remote Reading Mode if the look ahead setting is selected in the Remote Reading Preferences iSite Radiology will deploy a look ahead cache to the local machine automatically caching the next unread exam from your worklist and loading that exam when the exam being viewed is marked Read 16 Monitor Calibration The correct calibration of your Navigational Console the small monitor that displays the iSite Radiology Worklists and Canvas Page and your Diagnostic Monitors where the diagnostic radiological images are displayed is critical to the identification of patient pathology and subsequent patient care iSite Radiology will not work properly if the monitors used in conjunction with it are not properly configured To configure your monitors carefully follow the specifications and directions laid ou
143. eneral Preferences iw T fe rata 1 I ra LL th rm aoe poe H Window Width Center Filters Name Abdominal BardachbiD_Sple Display Preferences Hanging Protocals H System Preferences Brain H Machine Preferences a Network Testing Lung Mediastinum When you have finished in the Window Center Settings tab you can either click the OK button to return to the Modality Worklist or click another tab to continue Image Processing To access the settings for iSite s Image Processing features click the mage Processing listing as seen below 62 Preferences Dialog EF User Preferences General Preferences Image Processing tdethod Filters Daae a eeeiers Modalities Read Only H System Preferences Fl Edge Detect l Machine Preferences Method Network Testing Degree Modalities Head Only Median Filter Method Modalities Head Only CLAHE Method Modalities Read Only Restore Del Cancel Apply The four image processing options Edge Enhance Edge Detect Median Filter and CLAHE are listed 63 Click each setting to see the current value and to make changes as seen below Preferences Dialog User Preferences lina ye Pro cessing General Preferences Window Width Center Edge Enhance 5 pt Laplacian Image Processing Method C Oot Laplacian Filters Degree Display Preferences Properties System Preferences Edge Detect Machine Preferences Hethod Network Testing Degre
144. er to support internal Radiology workflow exams with the status of In Progress Completed Dictated or Preliminary will be automatically locked by the iSite Server If you try to view a locked exam the following dialog will be displayed iSite Radiology i AN This exam is being read by another user Would vou like bo view ik anyway Locked exams can be viewed but you cannot create a presentation state or mark the exam read Below the main list of exams Is a list of acquisition exceptions if any are present When you open an exam from the Exceptions portion of the Worklist iSite Radiology will check to see if the exam matches any patients in the iSite database If the system detects a match you will be prompted to view other exams from the identified patient You can answer Yes or No If the query results in more than one matching MRN or if the patient name does not match a dialog will be disolayed showing the 153 MRN and patient name for the exception study and all matching patients You can select OK to accept the suggested prior exams or choose Cancel to not load them as seen below Select Patient xj BEE etmeler Justin MRAN 211 15 000 30 9537F Cancel Right clicking exam listings provides additional functionality revealing a status sensitive pop up Menu shown below Show Report Export via DICOM MRYSTNOCMTE SINPRGG 01 29 2002 09 10 00 All exam listings display the first
145. erences Button P in the iSite Control Strip open the Machine Preferences section and click Local Exam Caching The following window will appear Preferences Dialog User Preferences Local Exam Caching General Preferences Window Width Center Image Processing Filters Local Path s nbardach Local settings Application Data icitesLocal Cache Display Preferences System Preferences Machine Preferences Cache Size General Machine Preference Hamur Cae SEE e197 4 Me Display Monitors Plug Ins Local Esam Caching Network Testing Pi Dae oS His C Automatically delete exams not accessed for more thar Restore Defaults Cancel Apply Help The Local Path section shows the full path of the location where exams are cached In the Cache Size area you can set the Maximum Cache Size in Megabytes If you would like iSite to automatically delete exams that have not been accessed for a certain amount of time click the radio button and set the period in Days and Hours To restore default settings click the Restore Defaults button When finished click the Apply button to preserve your changes 54 Personalizing iSite Radiology General and System wide Settings One of the most potent features of iSite Radiology is its ability to be customized to fit the user s individual needs iSite Radiology can recognize a particular user on login and load that user s specific settings Among the user specifiable set
146. es is disolayed cannot be moved or resized The Key Image Series updates in real time When an exam is first viewed for example there will be no key images in the Key Image Series as seen below 181 H MR Mo Descriptions TD ACCE 4 5 J T o ae No Key Irages No Key Images ECT r Study OMR BRAIN O MRONOSEL BLUE eSfSEND FILMS VP ATIENT Tam AS images in the exam are marked Key Images by hitting the Space bar the Key Image Series will oe populated simultaneously as seen below orice hone 9873 Referring DOHERTY MELISSA J Statue COMPLETE MR fio Desr riptio nz oe Acca 4092897 Mo Key Images SCH VWWSHARONMOSEL BLUE S209H02S SEND FILMS VwPATIENT iM From the image above you can see that the Key Image Stack has nine key images in it and that the one being displayed is the eighth one of nine All of the image manipulations measurements window width and level annotations etc will be displayed in the Key Image Series exactly as on the exam image with the exception of scout lines as seen in the example above Just as the Key Image Series will be Updated as key images are selected if a key image designation is removed from an image the image will be removed trom the Key Image Series The Key Image Series can be navigated just like a normal series using the mouse s wheel or the up and down arrow keys to cine through slices The Tab and Tab Shitt keys can be used to cycle fully through the Series Key I
147. es such as bone and vasculature angiography aneurysms plaques stenoses and other vascular anomalies and improves visualization of nodular lesions MinIP Minimum Intensity Projection emphasizes tissue with the lowest pixel values such as air filled structures This method is best for visualization of tissue attenuation and pulmonary tissues AvelP Average Intensity Projection displays tissue with average pixel values Upon clicking the OK button a progress dialog will appear shown below and the new Clone will be placed next to the original series 302 MPR Progress Processing image 51 of 97 images If you wish to abandon creating the clone click the Cancel button MPR Key Images can be saved as reconstructed images in Presentation States on the iSite Server as valid DICOM These MPR Key Images will be stored in a new series as part of the exam The stored images and their series will be assigned new UIDs All changes that the user made to the MPR Key Images will be saved in user Presentation States i e measurements annotations alterations to WW WL values etc The MPR Key Images saved fo iSite Server will become part of the Original DICOM Presentation State However all changes that the user made to the MPR Key Images i e measurements annotations alterations to WW WL values etc will not be saved in the Original DICOM Presentation State If user uses IExport to DICOM send the study over to another DICOM dev
148. esult This troubleshooting section of the iSite Radiology User Manual is organized by areas of the program where you might experience trouble Of course if there is a problem that you cannot work around or remedy on your own do not hesitate to contact either your iSite System Administrator or Philips Global PACS Customer Care by calling 877 328 2808 or emailing isitecare philips com Image Viewing Very few image viewing problems have been identified with iSite Radiology Most of these issues are related to the mouse Please make sure that you are using a mouse that Philips has identified as appropriate for this program Series Will Not Cine If you find that series do not cine when using your mouse s wheel button try the up and down arrow keys If this does not work check to make sure that the series you are trying to cine has been stacked In the Exam Rack look in the lower right hand corner of the series you are trying to cine A description will read of images Of course If this reads 1 then you will not be able to cine Furthermore some modalities may not be stacked by default This decision is made on a institution wide basis For more information please contact your iSite System Administrator Zoom and Pan Not Possible If you find that it is impossible to zoom into an image it may be that the image Is already at its highest resolution MRs for example have only two different resolutions that can be displayed unlike
149. f Interest This measurement tool is available through the right click pop up menu The complex region of interest tool is a freehand tool which allows you to trace shapes as you please Hanging Protocol Hanging protocols are a feature of iSite Radiology which allow you to configure and customize how certain types of images will be hung displayed in the Canvas Page For example if you would like Head CTs to be ordered in ascending order 3 to a row with a splif monitor etc you can configure iSite Radiology to always disolay Head CTs that way Help Button The iSite Help Button disolayed as a question mark is a component of the iSite Control Strip When clicked the Help Button will activate the iSite Radiology User Manual in a separate window IExport This fool allows you to export exams via DICOM to another DICOM device such as a DICOM printer or a 3D DICOM Imaging Device The export process can be monitored by viewing the iExport Queue accessed through the iExport Queue button in the iSite Radiology Control Strip iExport Queue The iExport Queue provides a real time display of the status of exams that have been exported using the iExport feature In the iExport Queue you can also delete and restart exported exams iIExport Queue Button This button located in the iSite Radiology Control Strip provides access to the iExport Queue 336 iSite Folder List The iSite Folder List located on the left of the iSite screen is your
150. f the box Is leff unchecked select a preset Window Width and Level value from the pull down menu Show Scout Lines This option allows you to automatically show scout lines on MR series or CT Scout Images Show Localizer This option allows you to automatically engage the Localizer Tool Invert Image This option allows you to automatically invert the contrast and brightness of the images to which the Hanging Protocol is applied The following options are available for Single Image Window s Default Window Level or Window Level Preset If you wish for the default Window Width and Level value for the modality to be applied check the Default Window Width Level box If the box Is leff unchecked select a preset Window Width and Level value from the pull down menu Show Scout Lines This option allows you to automatically show scout lines on MR series or CT Scout Images Show Localizer This option allows you to automatically engage the Localizer Tool Invert Image This option allows you to automatically invert the contrast and brightness of the images to which the Hanging Protocol is applied iSite provides the ability to create clones automatically as part of a Hanging Protocol Clones are basically copies of the images or series that can be used to provide alternative views For example Clone all Single Image Windows and apply the Invert Image option to the clone s or Clone all Stacked Image Windows with a LUNG and BONE
151. g down the Control key and drag your 200 mouse forwards to zoom in or backwards to zoom out Pan To pan through a plain film image simply hold down your mouse wheel button while dragging your mouse in the desired direction To pan through an image series such as an MR or CT exam left click the mouse while holding down the Alt key and drag your mouse forwards to zoom in or backwards to ZOOM out Advanced Image Manipulation All advanced image manipulation options are available by right clicking on an image or series This action will produce a contexti sensitive pop up Menu displaying the various tools available for the modality in question There are three different pop up Menus one for plain films such as CRs SCs and OTs one for CTs and one for MRs Each menu is modality specific and you should be aware that certain features are only available with certain modalities These functions will all be discussed in detail in the Diagnostic Monitors section of this manual As discussed above the advanced image manipulation options available in an Exoanded Window are more robust than those available with the Thumbnails in the Diagnostic Exam Racks As such their respective pop up Menus are distinct Options that are available from the Exoanded Windows and not the Thumbnails are Annotations Measurements and Clone for Plain Films and MR exams as seen below These functions will all be discussed in detail in the Diagnostic Monitors section
152. gateway to various areas and tools in iSite Radiology This directory tree functions in the same way as those found in programs such as Windows Explorer and Microsoft Outlook Folders contain tools such as the CD Manager directories such as the Patient Directory preset search filters other folders and clinical exams iSite Folder Tab This tab displays the name of the iSite Folder tool currently being displayed For example if the CT ALL Filter Worklist is being displayed the iSite Folder Tab will display CT ALL You can click the iSite Folder Tab to quickly return to a worklist or other tool from the Canvas Page iSite Radiology Control Strip This is the portion of the iSite Radiology screen that stays constant throughout your operations in iSite Radiology It is composed of the iSite Folders Tab the View Exams Tab the iExport Queue Button the Help Button the Preferences Button the Diagnostic Monitor Icons and the Logout Button iSite Shortcuts Bar The iSite Shortcuts Bar is a customizable way for you to access your most frequently used folders filters and tools The Shortcuts Bar is located on the left hand side of the screen The only time the shortcut bar will not be seen is when you are viewing the iSite Canvas Page You cannot remove the Shortcuts Bar or hide it but you can resize it by placing your cursor on the right divider and dragging Key Image A Key Image is one that has been selected and marked as an important
153. ge key Image Mew Link Mew Link Mew Link Link All Axials Link All Sagittals Save d Save d save Print d Print d Print Flip Rotate d Flip Rotate Sort d Flip Rotate Sort Zoom Presets d Zoom Presets d Zoom Presets CR Pop up Menu CT Pop up Menu MR Pop up Menu The menu items are all explained in the sections below 239 FT F F F T F F F Window Width Level iSite will use the modality s default Window Width Level setting as the initial value for an image where that information is available in the DICOM This modality specific function opens a sub menu that allows you to choose from one of several preset window width and window level settings that have been found to be effective for viewing various types of exams All exams include the Default WW WL and Modality Default options CR images also include Histogram Calculation as a default WW WL option In addition any custom Window Width and Level presets that you have added In your preferences will be displayed iSite also provides VOI LUT Value of Interest LUT access by right clicking the desired image and selecting VOI LUT Options from the pop up menu iSite allows you to adjust WW WL when VOI LUT options are activated However iSite s WW WL options in the pop up menu will be disabled As seen below CT Window Width Level menus are broken into three separate areas from top to bottom the Default WW WL and Modality Default WW WL values custom user Window Width Level values Abdom
154. ghlighted using the mouse and copied to another application by clicking Ctrl key C Diagnostic Monitor Icons The Diagnostic Monitor Icons shown above in red and blue represent the physical Diagnostic Monitors connected to your iSite Radiology Workstation For every Diagnostic Monitor connected to the workstation there will be one Diagnostic Monitor Icon The Icons are numbereq and of different colors to avoid confusion The color of the Diagnostic Monitor Icons corresponds to the the navigational rectangles displaying the same colors seen in the racks below By right clicking these icons you can quickly change the hanging configuration of your diagnostic monitors As seen below the right click pop up menu allows you to choose one of the many split monitor options You can also split your Diagnostic Monitors virtually via the last three right click menu options Virtual Split Monitors are discussed at length here 168 ied 5 plit vertical Cancel Split 169 4 Relevant Exams and Patient History Navigational Timelines This area of the Canvas Page located below the Clinical Information Window is composed of the Relevant Exams and Patient History Timeline navigational bars These bars provide chronologically organized contextual and historical information and rapid access to related exams and priors The navigational bars are interactive In other words exams can be loaded and reports can be retrieved from the listing
155. ging while simultaneously holding down the Alt key How dol pan across an image This depends on the type of image that you are viewing You can pan across plain film images by holding down the wheel button and dragging the mouse in the direction you wish to pan You can pan series images by left clicking and dragging while simultaneously holding down the Shift key How do Icine through image series such as MRs and CTs 328 You can cine through MR and CT series by rolling the wheel button back and forth Alternately you can use the up and down arrow keys fo cine through slices How do I fast cine through image series such as MRs and CTs You can fast cine through MR and CT series by holding down the wheel button and moving your mouse back and forth Alfernately you can use the up and down arrow keys How do l link series or images for simultaneous interrogation First double click both the series or images you wish fo link so that they are in expanded pop up windows Resize the windows if needed so that they both fit on the screen Right click one of the images and select the New link option Then right click the second image and select the Join link option The two images or series will be linked ey e e e e e How do I perform advanced manipulation of images such as invert flip rotate annotation and measurement To access the advanced image manipulation features of iSite just right click on t
156. gnostic report associated with an exam From the Patient Directory right click on the exam listing and select the Show Report option From the Reading Worklist double click on the Report Icon E This small button has three states each one corresponding to the status of the Diagnostic Report in question When the button is red El the Diagnostic Report for the particular exam being viewed is available When his button displays a sticky note 5 there is no Diagnostic Report yet but an Exam Memo is available When the report button is empty L iSite is unable to perfectly match a report with the exam being viewed and will provide a summary of diagnostic reports for the patient being viewed In the Canvas Page there are two ways to view a report Either right click the exam s listing in the Navigational Timeline and choose Show Report from the resulting pop up menu or double click the Image Metadata Area of a loaded exam In all instances the appropriate diagnostic report will oe presented in a separate floating window An example of a diagnostic report is shown below Clinical Info e Clinical Exam Notes Clinical Exam Notes audt BADOH ROGER DOB 12 21 1946 Age 57T Y TM Sex U MRA 211360205 ACC 4198732 Exam MRSTDCM Org iSite 09 15 1999 12 00 AM Status Preliminary Perf Resource STDC Clinical info c Memos No allergies on record Please validate in your Registration Ordering system STENTOR AUTO GE
157. h Preset Select Series d key Image Mew Link Link All amp xials Save Print d Flip Rotate SorksSplit Matching Series Rules Delete d When you select the Show Localizer option a crosshair will be placed in every image or series of an exam at x y coordinates that correspond to the location of your cursor AS you move the cursor over the specified image or series all crosshairs will move in sync In the examples below when the cursor is passed over the first series at left crosshairs appear at the corresponding location on every other series in the exam 204 Moving the cursor from its initial position back towards the spine As with the Link feature the Localizer can be used to navigate through multiple series simultaneously By holding down the left mouse button and dragging the cursor all exams with the same DICOM frame of reference regardless of their specific orientations will move in synch Above clicking the left mouse button produces scout lines and brings all series with the same DICOM frame of references to the same location By dragging the cursor as seen above all series move in synch The benefit of using this feature instead of the Linking fool is that series with different orientations Axial Saggital and Coronal can all aligned simultaneously Please note that the measurement tools and the localizer cannot be used at the same time Selecting a measurement tool will disengage
158. h between what is disolayed and what is displayed on the second monitor in virtual memory Number of Relevant monitors Prior Found NOMAAA General PA 1 No 1 Yes 2 No 2 Yes 4 No 4 Yes gt gt New Exam New Exam General PA gt gt New Exam New Exam General PA gt gt New Exam General PA gt gt New Exam General LAT General LAT General LAT N A N A New Exam General LAT gt gt Prior Exam General PA gt gt Prior Exam N A N A N A N A New Exam General PA gt gt New Exam General PA General LAT New Exam General LAT gt gt New Exam General LAT Prior Exam General PA N A N A N A N A Prior Exam General LAT 217 gt gt gt gt gt gt N A N A N A Example Two monitor system with a relevant prior found Pressing lt F2 gt will move the rectangles to the virtual monitors 218 Of course if you wish to display images or series on your additional monitors you can manually place the image there When you have finished configuring the monitor displays click the Next gt button The following screen will appear 219 Create User Hanging Protocol Main Exar Settings Linking M iLink All Axials Link All Saqgittals Link All Coronals Link All Obligue
159. he image that you wish to manipulate and select the desired option from the pop up menu Advanced image manipulation takes place in expanded windows or in the Diagnostic Monitors How do I change the size of the Navigational Rectangles To change the size of the Navigational Rectangles on an exam by exam basis right click the corresponding monitor icons in the iSite Radiology Control Strio and select the desired configuration To change the size of the Navigational Rectangle on a modality by modality basis click the Preferences Button in the iSite Radiology Control Strip select the Hanging Protocol option from the tree control view at left and then add or edit a hanging protocol as necessary How do I view a presentation state How do I create a presentation state You can view presentation states if available of an exam by right clicking the Exam Summary Window and selecting the Presentation States option from the pop up menu If you are a technologist or an intern or if you wish to create a personal presentation state right click the Exam Summary Window and select the Save Presentation State option from the Presentation States section of the pop up menu If you are a radiologist a radiologist s presentation state will be created when you mark an exam read by clicking the Mark Read button in the Exam Summary Window D How do I mark an exam Read 329 If an exam has not yet been read the Mark Read button will be d
160. he diagnostic exam racks and correspond to the diagnostic monitors The content of the diagnostic monitors can be changed by moving the rectangles within the diagnostic racks The rectangles size can also be changed automatically by configuring and editing your hanging protocols for each modality and body part Navigational Timelines These interactive timelines include the Relevant Exams Timeline and the Patient History Timeline These timelines are located above the diagnostic racks below the iSite Radiology Control Strip and provide a view of a patient s related exams and complete exam history Exams listed in the timeline can be loaded or Unloaded by double clicking and reports can be viewed by right clicking the listing Other options such as DICOM export are also available by right clicking an exam listing Patient Directory The Patient Directory contains an index of the patient exams that are available for viewing The Directory provides information about the patients including the patients name ID number the location where the exams were captured and the date of the patient s last exam The Patient Directory is designed to provide ad hoc query capability and can be accessed by clicking the Patients Worklist Tab in the iSite Radiology Control Strip Preferences Button This button located in the iSite Radiology Control Strip provides you access to your personal and machine preferences If you have logged in as an iSite System
161. he procedure code ex CTABD for exams that you wish the filter to search for e Organization If your institution is broken up into separate organizations enter the name of the organization you wish the filter to search for e Sub Specialty Enter an exam sub specialty ex Neuro Ortho etc for exams you wish the filter fo search for e Description Enter a description for the filter you are creating e Ref Phys Name Enter the name of the Referring Physician who s patients you wish the filter to search for e Type Use the Stats pull down menu to indicate how Stat exams should be included in your search If you only want the filter to search for exams with images check the Must Have Images checkbox and if you wish to exclude exams that have already been read check the Must not be Read option e Date Period These options limit the chronological scope of the filtered search e Exam Statuses These options limit the scope of the filter fo certain Exam Statuses e Patient Age This option limits the scope of the filter to patients of a certain age If you wish to limit the results of the filter based on the patient s age check the box and enter an age range e Performing Resource This option limits the scope of the filter to exams Coming from a particular performing resource or multiple performing resources Add the exact name of the performing resource If you wish to limit the filter to multiple performing resour
162. head when 1 l l reading from worklist Machine Preferences Display Monitors Plug Ing Local Exam Caching Remote Reading W Enable remote reading Remote Reading Settings Number of remote relevant priors to cache ahead 1 l with each cached UnA ead esam l General Preferences m eanne Pieire lasimum study file size MB i z9 Remote Reading Network Testing W Include auto locking caching of STAT exams Cancel The Enable Remote Reading box is checked by default To disable Remote Reading Mode at login uncheck this box and the Remote Reading option will not appear on the iSite Radiology login page The Remote Reading Settings allow you to specify the number of exams to cache in advance as well as the number of relevant priors to cache with each unread exam You can also stipulate the maximum file size in MBs and whether or not to include the locking and or caching of exams labeled STAT 143 Network Testing iSite allows you to configure numerous aspects of network testing and to view the results of those tests on a server by server basis To access these options click the Network Testing item in the preferences menu at left The following screen will be displayed Preferences Dialog User Preferences Network Testing System Preferences Machine Preferences Configuration Display Monitors Bandwidth Threshold KBytes Second E000 Run Continuously General Preference Scanner Preference
163. hese settings will impact how long each job takes to print Next select the desired print range either the entire exam or the selected window You can decide to trim images from the front back or both if desired The dialog will display the number of pages that are necessary to print the configuration you have selected Click OK when you are finished and the exam or image that you chose will be printed 284 285 If you wish to print only one image in a series one slice of an MR exam navigate to that slice and click the space bar to mark that image as a Key Image Right click the series and select Print fo paper from the pop up menu The dialog seen above will appear Check the Print key images only checkbox grayed out in the image above and then click OK Only the key images will be printed Print to DICOM This function prints the selected image to your DICOM printer The following dialog will appear Print Film Hame KO DAK LiteFilm T 4444Film Room 4 4nderson Settings Print Range Configurations BARDACH MD C Entire Exam Copiez 2 a Image Skip 2 a Selected Windows Print Justification Print Options o mi We Print Measurements and Annotations i Print Reference Frame Reference Frame Options SENES Series 1 Image Image 1 Trim Images ia amp 18 pages are required to print 18 images in STANDARD AT1 selected print format Cancel Select the desired printer from the drop down
164. hive Using the iExport tool your iSite System Administrator can monitor these exports How To s Logging In How do change my username or password To change your username or password speak to your iSite System Administrator who controls all user account information 325 Ad Hoc Patient Searches How do I perform an ad hoc patient query From the Patient Directory enter pertinent information into the Sort and Search Fields and click the Query button View extended search fields by clicking the symbol next to the Query button Available options are Patient Name Patient ID Exam Date Patient Location Accession Number Modality and Referring Physician How do I reveal and view patient exams from the Patients Directory From the Patient Directory click the symbol next to a patient listing to reveal the exams present for that patient To view a single exam simply double click that exam listing To view multiple exams single click each exam and then click the View Exams Tab Filter Worklists 3 How do I access Filter Worklists You can access Filter Worklists by clicking either the Personal Filters or System Filters folders in the iSite Radiology Folder List How do I know what parameters are shaping a Filter Worklist How can I change these parameters The basic parameters for a Filter Worklists are Usually disolayed in the Filter s name Some examples are CT all CT Head MR Brain US
165. hysician name To access the expanded search features click the plus symbols on the Query button The expanded search fields function in the same manner as the default search options Enter your search criteria in the appropriate field and then click the Query button To search using the name of a Referring Physician use the following guidelines 150 e Search on the Last Name of the referring physician O For example lt Doe gt e Search on partial Last Name of the referring physician O O For example lt Do gt The symbol represents a wildcard in this case and will allows you to match on all last names that start out with Do e Search on Last Name First Name O O For example lt Doe John gt The symbol is used to separate the Last Name from the First Name e Search for multiple referring physicians O O O For example lt Doe John Smith Ken gt or lt Doe Smith gt The symbol is used to separate the names from each other It Is not possible to use the wildcard when searching for multiple referring physicians It is not possible to search for multiple physicians using a Last First Name for one and only a Last Name for another one Restoring the Default Patient Directory To restore the default Patient Directory after having narrowed the Directory through a search select the All option from the Exam Date pull down menu and click the Query bu
166. ice iSite will also send the MPR Key Images as well Delete This feature allows authorized users to permanently removed images from the iSite system Images may need to be to be deleted for any number of reasons some of which are listed below 1 Technologists sometimes send image s to iSite accidentally using the wrong patient or exam demographics or with a SUID that was already in use In those cases where the SUID is already in use the new images are automatically merged with an existing study These duplicate images should be removed 2 Sometimes an image series or part of a series needs to be rescanned due to imaging or patient problems such as mechanical problems overexposure underexposure patient movement or incorrect patient position etc 303 3 Sometimes test images are created at the beginning of a procedure and accidentally end up in iSite A warning Once images have been deleted they can be recovered However all presentation states measurements and annotations will be lost In addition please note that if an image has been deleted after receiving a new Study UID the image shall not be recoverable The two deletion options allow users with the correct permissions to delete images from exams as seen below Window WidthiLevel b Measurement Annotatons Delete All Measurements and Annotations Image Processing Scout Line Mode Localizer Mode Multi Image Mode Clone Window With Preset d
167. icking the Tab and selecting the desired patient from the resulting list 340
168. ifeSize Printing and general orientation choices Fill in the Configuration information obtained from the printer vendor and click the OK button to return to the Add DICOM Printer screen Once there verify the information that you entered and click the OK button to save your entry The new printer listing will be displayed in the Preferences DICOM Print screen To edit an existing printer listing highlight that listing and click the Properties button as seen below Preferences Dialog User Preferences DICOk Print General Preferences Window Width Center Filters AE Title Location Add Display Preferences Con PRINTER SCP WE Lab FUJI Printer OPODO Server Room PACS PRINT PACSPRINT Umag Desk Kodak Dms KODAKPS Norhtwal Hanging Protocols z System Preferences General Preferences Window width Center Filters Annotations DICOM Sources Screen Overlays Paper Printing Body Part Dictionary IE pork Duer Urganization Dictionary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing The properties of that DICOM printer will be displayed in the subsequent window seen below and can be edited as necessary 129 Add DICOMPrinter Defintion MHorhtwall KODAKPS 1 Name Lite Size Custom In this window you can also edit a DICOMPrinter configuration by highlighting a listing and clicking the Properties button The following window shows a sample co
169. ile Fast Cine indicates an accelerated sequential viewing Clinical Exam Notes If a report is available this area of the program can be accessed by right clicking an exam listing in the worklists or in the Interactive Navigation Timelines and choosing the Show Report option The Clinical Exam Notes displays both the Diagnostic Report as well as links fo other relevant Diagnostic Reports for the patient in question Clinical Information Window This portion of the Canvas Page located directly below the iSite Radiology Control Strip provides basic information about the patient whose exam Is being displayed Close All Button In the Upper left hand corner of the Sort and Search Fields of the Patients Query Page the Close All button closes all open patient listings when clicked Diagnostic Exam Racks The exam racks are where diagnostic exams containing images and or series are displayed The exam racks are fitted with interactive navigational rectangles which correspond to your diagnostic monitors Diagnostic Monitors These large monitors are designed for the diagnostic reading of radiological images iSite Radiology provides all navigational and exam selection features on the Navigational Console such that the Diagnostic Monitors are kept completely free for exam review 334 Diagnostic Monitor Icons These interactive monitor icons are located in the upper right hand corner of the iSite Radiology Control Strip The icons corre
170. inal_NAB Bone_NAB Brain_NAB etc and System WW WL Presets Window Width Lewel Default WWW L Image Processing Modality Default Scout Line Mode Abdominal _MAB Localizer Mode Bona NAB Create Popup Brain_ NAB Clone Window With Preset Liver _NAB Monitor Layout d Lung MAB Select Series Mediastinum _MAB key Image System Wii WL Presets Abdominal New Link Bone Brain Save ne Liver Print d Lung Flip Rotate Mediastinum Matching Series Rules Delete voxar 3D You can display images series with the preset System WW WL values by right Clicking the desired image or series and selecting the preset from the popup menu as seen in the image above 240 iSite Radiology also allows you to create up to 9 custom Window Width Level values in the Window Width Level Preferences Custom WW WL options can be created for all modality types in the Window Width Window Level section of the Preferences Area To access this area click the Preferences Button in the iSite Radiology Control Strio and then select the Window Width Center item from the menu aft left Please note that you can quickly select one of these custom user WW WL settings by placing your mouse over the exam in question and hitting the corresponding number key 1 9 of the WW WL value in the list 241 For example in the image above there are six custom WW WL values These can be accessed by pressing the number keys 1 6 O Window Width and Level Calculations
171. ine size and line style When you have finished customizing the annotation style click the OK button to save your changes and return to reading Custom annotations can also be created and personalized by the iSite System Administrator If you have any questions regarding custom annotation styles please ask your iSite System Administrator Line Size d Line Style f Solid C Dash C Dot Lancel 5 le Anal Black 4 O Arial Narrow 10 Fp Aral Unicode MS 11 Fp ArtBrush 12 7 Cancel 259 Sep 1999 12 12 51 Acc ARTESA MESEI 9 12 12 59 Acc 3 450 i ep 1999 12 12 a1 Acc 413 430 D i A j No Descriptions TE 30 0 TR S000 SE No Descriptions TE 30 0 TR SO00 SE E No Descriptions TE 30 0 TR 3000 SE AA VEMP 5 Omm 6 0mm C p AX VEMP 5 0mm 6 0mm O AX VEMP 5 0mm Urm O Series 2 24 Images fl Series 2 24 Images MM Series 2 24 Images Line Arrow Triangle Sep 1999 12 12 51 Acc 4137 438 m BR Sep 1999 12 12 51 Acci 4137438 eI E ENAR 51 Acc 4137433 y EDC NY WE Ay ra f You can insert text annotations s X N No Descriptions TE 30 0 TR 3000 S 3 wt TET at TE s0 0 TR 3000 SE Gj Mo Descriptions TE 30 0 TR SU00 SE AX VEMP 5 0mm 6 0mm BAX VEMP 5 Ommi6 0mm LO AX VEMP 5 Omm Omm Series 2 24 Images Ill Series 2 24 Images Ti Series 2 24 Images Circle Text Freehand Spine Labeling Tool Images of the spine only The spine labeling tool allows you to place markers at ea
172. ing and click the Delete button Hanging Protocols Hanging Protocols are created and edited trom within the iSite Radiology Canvas Page The hanging protocol preferences area allows you to view the iSite Radiology Hanging Protocols and to delete them if necessary To access the Hanging Protocol Preferences click that listing as shown below 123 Preferences Dialog H User Preferences System Preferences i General Preferences s Window Width Center Name Properties Filters CT_HEAD4 Annotations CT_HEAD2 Delete DICOM Sources CT_CHEST4 Screen Overlays CT_CHEST2 Export Paper Printing CT_LABD4 Body Part Dictionary CT LABD MR_BR AIM MF_BRAIM2 EJE Import Hanging Frotocols DICOM Frint Machine Preferences Network Testing To view the properties of a hanging protocol highlight the appropriate Hanging Protocol and click the Properties button The following window will be displayed 124 System Hanging Protocol Dialog Read Only Name identifier By clicking the Next gt button you can visit all of the subsequent windows of the Hanging Protocol properties All of these windows are Read Only and cannot be edited from the Preferences page Hanging Protocols must be edited from within the iSite Radiology canvas page To delete a Hanging Protocol from the system highlight that Protocol s listing and click the Delete button If you are finished reviewing and or editing your personal
173. ing elements 1 Exam Summary Window In this area located at the left of each Exam Rack information about each exam is displayed The information includes modality body part date of acquisition accession number referring physician and status as seen above When available the Impressions portion of the report is disolayed beneath the exam information as seen in the third exam row in the image above Right clicking on the margin of the exam information area provides access to various additional features as seen below Presentation State Select User Hanging Protocol d Select System Hanging Protocol F Close Exam Send via DICOM 4dd Exam To Folder Exam Information Vertical Rack 179 180 2 Unread exams will disolay the Mark Read button as seen in the top exam Click this button once you have completed your diagnostic read of the exam and the exam will be marked Read 3 Thumbnail Images This area to the right of the Exam Summary Window contains the thumbnail diagnostic images and or image series of an exam Each image or image series has an information bar below it which displays information about the particular image or series in question Double clicking an image or series in this area will create an enlarged Expanded Window of the image or series Right clicking a thumbnail image provides access to advanced image manipulation tools 4 The Navigation Rectangles These interactive resizable rectangles pictur
174. ing feature provides users with the ability to synchronize multiple images or series with an image or series that they have designated as the master In this case synchronize refers to the fact that iSite will try to do two things o Apply to all linked images the same image navigation options that are applied to the master like Zoom or Pan Functions such as flip invert rotate and WW WL adjustment remain independent o Line up the images from the linked series with the one currently selected as the master As a result the user will be able to page through multiple series simultaneously The series that the user is paging through will act as the master and all the linked slaves will display the image in their series that is at the closest location to the master Types of Links and Linking Options iSite supports the creation of five different kinds of links Single Image Axial Sagittal Coronal Oblique Mirrored A series is considered to be Axial Sagittal or Coronal if it is oriented within 5 degrees of the corresponding axis A series is considered to be oblique if 1 It is not within 5 degrees of one of the major axes ex Axial Sagittal Coronal or 2 It contains images of different orientations such that they are not aligned with the same axis Mirror linking is available for Mammography MG only The following linking options are available Linking of single i
175. ion and basically display the image with the closest location to the one displayed in the master series If a non multi ohase series is used as the master iSite will try to find the 280 image with the closest location in the multi phase series If there are multiple matches iSite will disolay the best match from the first phase In this example iSite would never display image 7 through 12 281 In other words if is not possible to review all images of a multi ohase series by paging through another series and use the link functionality Ta fa dai d k I fak G f ia Series Series 2 A Warning Linking multiple series with different slice thickness An exam might contain multiple series acquired at different or even variable slice thickness For example one series could be acquired at 10mm slice thickness and one at 2mm If a user now links these series and cines through them using the very thick 10mm series as the master many images from the 2mm series will be skipped If the User cines through the images using the very thin 2mm series as the master every single image of the 10mm series will be displayed In other words cineing through multiple series simultaneously is possible via the link option but images will be skipped unless the series with the thinnest slice thickness is used as the master This is because iSite will synchronize images based on location Gh I faa G f a Series Series 2 A warning
176. ion specified in the Local Exam Caching Section of the User Preferences If you want to see the progress of the download click the Locally Cached Exams folder in the iSite Folder List Exams that are present in your institution s archive but which are not loaded on the iSite Enterprise Server are disolayed with an A as seen below To access these exams double click the listing in the timeline iSite Enterprise will automatically query the available archives to retrieve the exam in question An empty exam row will load in the Canvas Page as seen below while the exam is being retrieved Cancel The upper portion of the Exam Information Area displays the modality accession number Referring Physician and Status The bottom portion shows an estimate of how much time remains before the exam Is retrieved and a display of which images are being requested To cancel the archive retrieval click the Cancel button 178 Using the Diagnostic Exam Racks The Diagnostic Exam Racks seen below are a powerful tool within the Canvas Page There are many functions that can be performed and as such it may take you a short while to become fully accustomed to operating in the Racks Take time to carefully read this section and if necessary ask your iSite System Administrator for additional help or call Philips Customer Care 24 hours a day seven days a week at 877 328 2808 Mark Fead The Diagnostic Exam Racks contain the follow
177. ired exam Invert brightness and contrast Right click on an image and select the Invert function from the pop up menu Deselect in the same manner Flip an image around the x or Right click on an image select the Flio Rotate Sort function from the pop up menu and choose Flip Horizontal or Flip Vertical Rotate an image clockwise or Right click on an image select the counter clockwise Flio Rotate Sort function from the pop up menu and choose Rotate 90 CW or Rotate 90 CCW Sort an MR or CT series Right click on an image select the Flio Rotate Sort function from the pop up menu and choose Image Number Ascending Image Number Descending Table Position Ascending or Table Position Descending Annotate an image with text Access these tools through the pop up menu or symbols by right clicking on an image and selecting the Annotations option This function is only available in the Diagnostic Monitors and Floating Windows Measure lengths angles or Access these tools through the pop up menu regions of interest by right clicking on an image and selecting the Measurement option This function is only available in the Diagnostic Monitors and Floating Windows Apply spine labeling to an Right click on any image or series which image of the spine includes the vertebrae and select the Spine Labeling option from the Annotations sub menu Click the image where you would like labels inserted in confor
178. irst MG image right click and choose the New Link option Select the MG image to be linked right click and choose the Link as Mirror option Mirrored Linking will now be engaged To add additional MG images select those images right click and choose the Join Link option A warning General warning message The current implementation of the linking functionality allows you to synchronize other windows series with the window series you are currently browsing through In other words there is one master window series typically the one that you select with your mouse and iSite will attempt to line up the images of the other linked windows Therefore users should always review each and every series by paging through them individually and never rely on linking as a way to review all images within a given exam There are a number of known use cases where simply browsing through a series that is part of a link will NOT DISPLAY ALL the images that are available in the other linked series A Warning Linking a multi phase series with another series Multi ohase studies contain multiple images with the same location identifier Paging through a multi phase series that has not been split will typically result in jumping back to the first slice location each time the user reaches the end of each phase within the series If a multi ohase series is used as the master you will notice that the other linked series are synchronized on locat
179. ished click the Next gt button The following screen will appear 212 Create User Hanging Protocol Matching Series Display Settings Multi Image Mode i Default Window Level WindowsLevel Preset Show Scout Lines Show Localizer Other Series Invert Image Add Rule Remove Rule Add Clone lt Back Cancel In this window you will be able to adjust the display settings for image series Stacked Images Windows and plain film images Single Image Windows In addition you will be able to create clones If you have checked the Use Matching Series Rules checkbox in the previous dialog available Rules will be displayed in the Matching Series window seen above To adjust the settings that will be applied to ALL Stacked Image Windows click on the Stacked Images Window s listing in the Series window and adjust the settings as appropriate To adjust the settings that will be applied to ALL Single Image Windows click on the Single Image Window s listing in the Series window and adjust the settings as appropriate The following options are available for Stacked Images Window s 213 Multi Image Mode This allows you fo split an image window so that multiple slices can be displayed in a single image window Default Window Level or Window Level Preset If you wish for the default Window Width and Level value for the modality to be applied check the Default Window Width Level box I
180. isplayed in the Exam Summary Window To mark that exam Read click the Mark Read button How do move to the next unread exam in MyWorklist Click the Next Exam button in the Patient Exam Tab 330 Diagnostic Monitors How do I view images and series in my Diagnostic Monitors As soon as you enter the canvas page images and or series from your primary exam will be displayed in the Diagnostic Monitors There are two ways to view additional images and series You can drag images and series into the Navigational Rectangles or you can drag the Rectangles onto the desired images or series How do I use the interactive scaled rules To use the scaled rules left click and drag them to the desired location When you release the mouse button the rule will snap back to its original place AE e e e e e lt 2 How do I perform advanced manipulation of images such as invert flip rotate annotation and measurement To access the advanced image manipulation features of iSite Radiology just right click on the image that you wish to manipulate and select the desired option from the pop up Menu How do reconfigure my Diagnostic Monitors There are two ways to reconfigure your Diagnostic Monitors To change the monitor configuration on an exam by exam basis right click the corresponding monitor icons in the iSite Radiology Control Strio and select the desired configuration To change the monitor configuration on a m
181. isplays the number of patients that have been selected for review iSite AEO Aty Multiple exam listings can be selected Each patient that you open will increase the number displayed on the View Exams Tab Please note that a maximum of 30 patients can be selected at one time This is a useful function for selecting more than one patient from a worklist at once as opposed to double clicking a single exam and returning repeatedly to the list Once you have selected all the exams you wish to initially view click the View Exams Tab and you will be transferred immediately to the Canvas Page area of iSite Radiology where you will be able to read and annotate exams If you would just like to run through the exams you currently have open click the Next Exam or Last Exam buttons on the View Exams Tab seen below 164 The View Exams Tab also provides extended functionality through right clicking Right click on the View Exams Tab fo view a list of 10 unread exams that are in a CT Filter worklist as seen below User Bardach Noah MO f iSite To ols F Epp Michael Mi DOB 03 10 1982 PID 306 12 000 Accession 3EE9O2FD0001 iRobert Frances F DOB 04 18 1943 PID 306 10 000 3EE64E4B Accession 3EE64E460001 Cata cata Ui DOB 07 14 2000 PID CRI IDO00003 Accession 3SEDF6F180014 CRI 5Q NOOOOOS O DOB 12 04 1940 PID CRI IDS Accession 3EDF6F18001E Close All Exams CRI 50 WO00014 PID CRI IGDOO0014 Acce
182. isting body part definition or to edit a definition highlight the definition listing and then click the Properties button A window similar to the one shown below will appear Edit Body Part Dictionary Dialog fx Hame Head Equivalents Cranium Frenum Mable Orbit Sagit Cancel Make changes as necessary and then click the OK button Click the Apply button to make your changes permanent iExport iExport is the mechanism by which iSite exports exams in DICOM format to another DICOM device such as a DICOM printer or 3D imaging system In the iExport Preferences section DICOM forwarding addresses can be added and or edited To view the iExport preferences click the iExport listing from the list at left 114 Preferences Dialog User Preferences System Preferences General Preferences Window Width Center Filters BONUS QE DL380 WK BS OR Annotations DICOM Sources Screen Overlays Paper Printing Body Part Dictionary us ort Organization Dictionary Location Dictionary Plug Ins Hanging Protocols DICOM Print Machine Preferences Network Testing rea To add a new DICOM forwarding address click the Add button The following window will appear Add iExportRemote CP Configuration AE Title Remote Host Description PO Hast IP oe 2 a Fort 104 Max Concurrent Requests a Send Entire Study On Retry Association Across Studies Cancel Fill in all necessary fiel
183. izes has been increased from 2GB to an unprecedented 25GB While the most technologically innovative studies are currently at 3 4GB iSite 3 5 removes all size related barriers fo supporting the most technologically advanced modalities Image Overlays The maximum number of image overlays has been increased to 50 In addition several new preset overlays have been added Low memory Warning iSite will now display a warning message to the user if low memory is detected on the client machine volur iSite now supports VOI LUTs via the right click pop up menu VOI LUTs can also be preserved using Presentation States New Image Arrival Notification If new images for an exam arrive while you are working on that exam iSite will notify you visually V Image Processing Filters Updated The Edge Enhance and Edge Detect processing filters have been Updated so that they are applied to the entire series being viewed 12 Logging in to iSite Radiology Once the iSite System Administrator at your institution has properly configured your workstation and given you an iSite login password combination you will find an iSite Radiology icon placed on your workstation s desktop To begin working with iSite Radiology double click this icon During startup iSite Radiology will disolay a splash screen for a few seconds with information about the product The same information can be found within the About Dialog ia iSite Ra
184. kopf Dennis 201 02 012 3C336ADE IT 12 17 00 STNDC INPROG 677701 Sachs Gene 201 02 018 3C336ADE 01 02 2002 12 17 00 gt STNDC INPROG 677701 Barcio Don 201 02 021 3C336ADE 01 02 2002 12 17 00 Cr STNDC INPROG 677701 Pryor Duane 201 02 027 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Cano Gina 201 02 030 3C336ADE 01 02 2002 12 17 00 E STNDC INPROG 677701 Fredericks Erica 201 02 033 3C336ADE 01 02 2002 12 17 00 er STNDC INPROG 677701 Harless Mary 201 02 036 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Coyne Alan 201 02 039 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Stewart Aimee 201 02 042 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Cyprus Jim 201 02 045 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Reddy Steve 201 02 048 3C336ADE 01 02 2002 12 17 00 eT STNDC INPROG 677701 Sonneborn Andrea 201 02 051 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Hunter Roger 201 02 054 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Wiediger Rebecca 201 02 057 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Steve Shaun 201 02 000 3C336ADE 01 02 2002 12 17 00 Gi STNDC INPROG 677701 Rupert Gary 201 02 003 3C336ADE 01 02 2002 12 17 00 eT STNDC INPROG 677701 Zitterkopf Deanne 201 02 006 3C336ADE 01 02 2002 12 17 00 CT STNDC INPROG 677701 Ongley Barry 201 02 009
185. l Rack or Vertical Rack from the pop up menu Show Hide Image Overlays Hitting just F will toggle screen overlays on and off for all exams in the active patient Ctrl Alt F6 will toggle only DICOM 6000 overlays on off Finally Ctrl F6 toggles all overlays on off iSite screen overlays iSite Annotations amp Measurements and Embedded and Declared DICOM Ovelays Toggle Diagnostic Monitor Hitting the Control key P will toggle the Pane Icons in Navigation Diagnostic Monitor Pane Icons in the Rectangles On Off Navigation Rectangles on and off Reorder images in an exam Place your cursor on the image s gray top row margin or bottom annotation area left click and drag to a new location Right click on an image and select the Print function from the pop up menu Select To Paper Printer or To DICOM Printer as desired Save Right click on the image you wish to save and select the Save Image function from the pop up menu Select to clipboard or to file Click the Logout Arrow Button in the upper right hand corner of the iSite Radiology Control Strip The iSite Radiology Shortcuts Bar The iSite Shortcuts Bar is a customizable way for you to access your most frequently used folders filters and tools As seen below the Shortcuts Bar is located on the left hand side of the screen The only time the shortcut bar will not be seen is when you are viewing the iSite Canvas Page You cannot remove the Shortcuts Bar
186. l appear shown below This window is the gateway to your personal profile Here you can set numerous options and configure many aspects of iSite Radiology to meet your specific needs iSite Preferences are discussed aft length in the Personalizing iSite Radiology section of this manual 157 Preferences Dialog I User Preferences General Preferences General Preferences Window Width Center Image Processing Filters Two Monitor eft Four Monitor Left Display Preferences Hanging Protocals Canvas Page Mode Ea rage C Patient Based Exam Based System Preferences Machine Preferences Network Testing Main Exam Monitor Layout i Automatically open nest exam from active filter after marking read i Show tips at startup Disable Navigation Rectangle Splitting Show Measurements Palette Display Key Image Stack i Asial Obligue CT Anatomical right on left side of image window Change Password Cancel Help The User Preferences window contains many settings all of which will be discussed in a later section Click the Filters Preferences listing to reveal the window shown below The Filters area seen below contains information regarding all of the different filters that can be used to tailor your Reading Worklist fo meet your specific needs By using a preset filter or by creating a new one you can generate a worklist that will contain only the exams that meet your filter criteria It is i
187. l be listed below as seen above This list of exams is interactive An exams report can be viewed by clicking its accession number If you wish to view a list of all exams belonging to the patient in question click the all exams button To toggle back to a list of only related exams click the related exams button When you are finished reviewing the report close the window by clicking the close button at upper right Export Via DICOM The third function available from the right click menu is Export via DICOM This function is for use in sending exams or images to a DICOM device such as a 3 D imager or a CD ROM burner External DICOM devices must be specified and connected by your iSite System Administrator If no devices are connected this option will be grayed out When the option is available iSite will display a list of associated exams which are available for export as seen below DICOM Export Dialog SWINDON MAYA MRN 85131 Please select the exams you wish to export MA MASTOCM 03 01 2000 14 23 00 585265 9 cared aume Select the exams that you wish to export and then click the Next gt button The following screen will appear 176 DICOM Export Dialog SWINDON MATA MRN 85131 Mm 10 2 0 235 Agfa 30 MR Imaging System RADA Agfa 3D MR Imaging System RADS ai Radiology Archive COR C Records Billing Archie CORVY M Radiology Workstation 4499 Exeter C Radiology Workstation 4499 Robertson C Ra
188. l dictates a different monitor setup the Rectangle will change size to accommodate it To quickly swap the contents of your monitors you can drag one of the monitors onto the first image or series in the second and the Navigational Rectangles will swap places The Navigation Rectangles also provide a contextual view of the images or series being disolayed on your Diagnostic Monitors As seen in the images below the Zoom 196 Rectangle the smaller rectangle superimposed on images and series gives a contextual view of the Diagnostic Monitor display in relation to the image as a whole Splitting Navigational Rectangles Navigational Rectangles do not need to be contiguous and can be split according to your preference You can split a single Navigational Rectangle into two parts for example with each part of the Navigational Rectangle residing in a separate Patient Exam To split a Navigational Rectangle lefi click any Layout Icon except the first and drag the separated portion of the Navigational Rectangle to the desired images or series as seen in the two images below To recombine a Navigational Rectangle simply drag the split portion to the image directly adjacent to the other portion Please note if you wish to disable the split Navigation Rectangle feature you may do so in the General Preferences section of the iSite Radiology User Preferences 197 Reordering Images and Series in an Exam Images in any given rack
189. l remain locked thereby slowing workflow Please remember to either mark an exam read or to close the exam when you are finished reviewing it The Canvas Page has several components and myriad functions all of which will be discussed in this section of the manual The image of the Canvas Page seen below is interactive Click on an area of the image that you wish to read about and you will be taken to the appropriate section of the manual 166 User Bardach Noah MD iS ite Ra d i 6 og y Ey View Exams 1 Exam s Selected 167 There are four main components to the Canvas Page l The iSite Radiology Control Strip The uppermost area of the Canvas Page is the iSite Control Strip In most respects the iSite Control Strio shown in the Canvas Page is the same as described in the iSite Radiology Worklists Section of this manual Clinical Information Window The area directly below the iSite Radiology Control Strip in the Canvas Page is the Clinical Information Window in which information related to the patient being viewed is disolayed The patient listing includes Patient Name Sex Date of Birth DOB Patient ID number PID Procedure Code and Referring Physician In addition iSite Radiology will display the Patient Comments History and Study Comments from the Clinical Exam Notes of the main exam If your institution s HIS RIS provides Admitting Diagnosis data it will be disolayed as well This information can be hi
190. log will be displayed stating that The exam cannot be split When you finish the original series will be broken into different split series according to the split attributes This is not a permanent change to the exam but rather a type of display If you wish to preserve the split for later viewing you must save a presentation state Matching Series Rules Users with the ISTHPSTD security code can configure Rules used to match specific series or images within a Hanging Protocol By default series images are sorted in the rack based on the DICOM Source system configuration settings by acquisition time alohabetically etc Sometimes however this default sort order does not fit the radiologist s needs For example a radiologist might always want CR PA Chests to be displayed as the first image in the Rack The technologist or radiologist could sort the series or images manually and create a Presentation State every time However if a user always wants a certain type of exam to be displayed a certain way it is inefficient to repeatedly create Presentation States just for the purpose of sort order 292 By creating a Hanging Protocol using Series Matching Rules the relevant series images can be sorted automatically without having to create Presentations States Use of the Matching Series Rules feature is described at length in the Hanging Protocols section of the iSite Radiology Canvas Page Chapter The sections below discuss ho
191. lt Hanging Protocol per combination You can however create as many alternate Hanging Protocols as you desire For example you might create one default and three alternate Hanging Protocols for MR Brain exams Hanging Protocols that are defined as type Alternate are never automatically applied by the iSite system However they are available and can be selected and applied to an exam on the fly Creating New Hanging Protocols To create a new Hanging Protocol right click on the margin of the main exam s row and select the Create User Hanging Protocol option as seen below Presentation State Edit Hanging Protocol Create User Hanging Protocol Create System Hanging Protocal Select User Hanging Protocol d Select System Hanging Protocol F Rehang Send via DICOM 4dd Exam To Folder Exam Information vertical Rack You will be led through a series of dialogs designed to help you specify every detail of the Hanging Protocol The first window will appear as seen below 210 Create User Hanging Protocol Mame ETECHE SE Identifier C Modality CT Modality and Body Part CT CHEST pas Type Default C Alemate Use Series Matching Rules EB rea Name iSite Radiology will suggest a name for the Hanging Protocol based on the modality and body part if available in this case MR BRAIN You can edit this name for your convenience If the name you choose is already in use the following warning
192. mage Series displayed in the Canvas Page Racks have limited right click menus and image manipulation functionality More functionality is available by double clicking the Key Image Series as discussed below Double clicking the Key Image Series will expand the image from the rack into a Key Images Pop up Window seen below in 1 1 and 1 2 Multi lmage Mode 182 183 olx BAD0GH ROGER Stentorian Heath Group BAGOH ROGER Stentorian Health Group Mo Descriptions Age 0524 U Wednesday September 15 1999 Age 0524 U Wednesday September 15 1999 series number 3 5 00 mim series number 6 5 00 mm Image 14 26 Image 10 26 iiae O ay e H 5 We i TA 2500 TE 81 Key Image vie hil Se Ae Zoom S0 Key Image keyg 7g T mym TI 100m Suse The Key Images Pop up Window provides access to all key images of an exam just like the Key Image Series in the rack However unlike the Key Image Series in the rack the Key Image Pop up Window can be manipulated more thoroughly The Key Images Pop up Window supports the following right click menu options e Window Width Level When selected will be applied to all images belonging to the same Series e Measurements e Annotations Excluding Spine Labeling e Image Processing e Multi Image Mode e Zoom Presets When selected will be applied to all images belonging to the same Series e Removing Key Images e Save Image Windows As e Print to Paper Print
193. mages like CR or DR images within one or multiple exams same modality type Example Linking a CR CHEST AP image of anew exam with a CR CHEST AP image from a prior exam Linking of single images like CR or DR images within one or multiple exams different modality types Example Linking a CR CHEST AP image with a DR CHEST AP image trom a prior exam Linking of series like CT or MR series that are of the same orientation within one or multiple exams same modality type Example Linking All Axials in CT CHEST Exam that contains multiple Axial Series Linking of series like CT or MR series that are of the same orientation within one or multiple exams different modality tyoes Example 21 Linking a CT HEAD Axial Series of a new exam with a MR HEAD Axial Series of a prior exam Linking of Mammography MG images using the Mirrored Linking feature How fo Initiate Linking Unlinking To initiate a link right click the desired image or series and then select New Link Then right click the subsequent image or images and select Join Link Note an image can only be joined to a link of its type ex Single Image Axial Sagittal Coronal or Oblique If more than one series in the same exam has the same orientation and the same reference you will be able to link them all simultaneously using the Link All Axial Link All Sagittal Link All Coronal or Link All Oblique option Along with sel
194. mance with the Spine Labeling dialog Delete Measurements Right click the measurement handle and select Delete Measurements and Annotations from the pop up menu Alternately place the mouse cursor over the y axis 24 measurement and click the Delete button The measurement can also be removed by dragging it out of the image window This function Is only available in the Diagnostic Monitors and Floating Windows Edit Measurements Format Right click the measurement handle and select edit font or edit line style from the pop Up menu This function is only available in the Diagnostic Monitors and Floating Windows Display Multi Ilmage Modes To simultaneously view multiple images from an image series right click the image series and choose Multi lmage Mode from the pop Up menu The available options in column row notation are 1 1 1 2 2 1 2 2 1 3 3 3 3 4 and 4 5 Please note that this option is only available for images in the Diagnostic Monitors and Expanded Windows not for Thumbnail Images in the Diagnostic Exam Rack Mark an image as a key To designate the active image as a key image image hit the space bar Temporarily disconnect a Hold the shift key down while performing linked image image manipulation with the mouse or the keyboard Please note that this does not apply to images from the same exam Unlink images in an exam Right click on the image you wish to unlink and select the Unlink option
195. me sec to disable Cancel Help 139 In the AE Title field enter the AE title that you wish iSite to have This title can have up to seven letters all in capitals Philios_ SCP for example The Debugging option lets you decide how error messages should be handled The Overlay Brightness option allows you to set how bright the textual information presented with diagnostic images will be To designate the location of this machine as seen in the login dialog select the desired default location from the pull down menu If you are running a secondary application validated by Philips such as VOXAR and you wish to adjust your machine s cache size please contact your iSite System Administrator The Navigation Console Size can be adjusted below If you need to override the Access Group based Auto Logout times for your institution on this machine you can set a machine spe cific auto logout time in the Override Access Group Auto Logout dialog This time is set in seconds If you do not want the machine to auto logout enter 0 for the auto logout time Scanner Preferences To access the Scanner Preferences click the Scanner Preferences listing at left as seen below Preferences Dialog User Preferences Scanner Preference System Preferences Machine Preferences Display Monitors Plug Ing General Preference Select Scanner Scanner Preference Network Testing Scanner Settings Port Hame Baud Rate
196. meline simply double Click the listing To access other options right click the exam listings How do l arrange patient images Individual images or series can be arranged within an exam rack by clicking the image header or footer and dragging it to the desired location Exam row order is chronological and cannot be modified How do I enlarge an image from the exam rack Individual images and series can be enlarged to an expanded pop up window by double clicking anywhere on the image This expanded pop up window can then be enlarged by placing your cursor on the window s periphery clicking and dragging How do I quickly adjust the window width and window level of an image The window width and window level values of images can be easily changed on the fly in iSite Radiology To make adjustments simply click and hold down the left mouse button while simultaneously dragging your mouse To adjust window width drag the mouse laterally to adjust window level drag vertically You can create preset window width and level settings such as Bone Brain Liver Mediastinum and others for any modality in the preferences section These can be applied to any image or series by right clicking the series fe MH H How do I zoom into an image This depends on the type of image that you are viewing You can zoom into plain film images by scrolling the wheel button back and forth You can zoom into series images by left clicking and drag
197. menu Configure your settings as desired selecting the print configuration the number of copies you wish to print any image skip pattern every other image etc the desired print justification if applicable the print range the print measurements and annotations option and the Print key images only option For example the Print single images on separate sheets option allows you to print different plain film series on separate sheets regardless of how much space is available Next select the desired print range either the entire exam or the selected window You can decide to trim images from the front back or both if desired The dialog will disolay the number of pages that are 286 necessary to print the configuration you have selected Click OK when you are finished and the exam or image that you chose will be printed 287 If you wish to print only one image in a series one slice of an MR exam navigate to that slice and click the space bar to mark that image as a Key Image Right click the series and select Print fo DICOM from the pop up menu The dialog seen above will appear Check the Print key images only checkbox grayed out in the image above and then click OK Only the Key Images will be printed Play Cine Loop series only This feature allows you to play a continuous loop of an image series For example if a series has 30 slices they will be played sequentially from 1 to 30 and will repeat endlessly
198. most all of the personalization of iSite Radiology will take place 57 Preferences Dialog User Preferences General Preferences General Preferences Window Width Center Image Processing Filters Two Monitor eft Four Monitor Left Display Preferences Hanging Protocals Canvas Page Mode Ea rage C Patient Based Exam Based System Preferences Machine Preferences Network Testing Main Exam Monitor Layout i Automatically open nest exam from active filter after marking read i Show tips at startup Disable Navigation Rectangle Splitting Show Measurements Palette Display Key Image Stack i Asial Obligue CT Anatomical right on left side of image window Change Password Cancel Help General Preferences In this area you will set the basic properties of your iSite Radiology account Main Exam Monitor Layout these options let you specify which of your Diagnostic Monitors should display the Main Exam Canvas Page Mode these options specify whether exams displayed in your Canvas Page are organized by patient or by exam Several options are provided to help you configure iSite Radiology to maximize your work environment e If you wish iSite Radiology to automatically open the next exam in Worklist Filters when you mark an exam Read click the corresponding checkbox e iSite Radiology shows helpful tips at login if you wish to disable this feature uncheck the Show tips at startup
199. mportant that you exercise care in creating your filters lest you accidentally exclude exams which you wish to read 158 Preferences Dialog User Preferences Filters General Preferences Window Width Center Image Processing BARDACH MA_BRAIN All MF exams of the Brain from E BARDACH CR SPINE All CRs of the SPINE from ERZ t Display Preterences BARDACH CT HEAD AILCT heads from ER Hanging Protocols Canvas Page System Preferences Machine Preferences Network Testing Cancel By using these filters you can create a worklist that displays only those exams that you wish to read For example if you specialize in a particular body part such as the head and in a particular modality such as MR you can use and create filters fo generate a worklist that will only contain MR Head exams You can also create filters that will generate a list of exams only from one location in your organization such as the ER or ICU Finally iSite comes with preset filters based on the date of the exams in question If you only wish to read exams from today the last 3 7 or 30 days you can chose a filter that will generate a list of exams only from that period iSite comes hardcoded with a number of preset filters all of which can be modified if so desired The preset filters may include CR All CR Chest CT Abdomen CT All CT Chest CT Head DS All ER ICU Last 3 Days Last 30 Days Last 7 Days MR All MR Head MR Spine OR Today an
200. n entirely new exam place your mouse on the edge of the Rectangle click and drag it to a new location as shown in the illustrations below MR Mo Descriptions Referring SCHIFF DAVID status PRELIM SOPUID 1 2 640 115619 2 1 1 ArU Or roa 4 9557460466 MR Mo Descriptions OF NSA 999 Acct 4040345 Referring KONDZIOLKA DOUGLAS Status PRELIM SOPUID 1 2 040 115619 2 1 1 ee em a a ome es om te ome a4 195 MR Mo Descriptions 0772971999 Acc 4092597 Referring SCHIFF DAVID status PRELIM SOPUID H1 2 640 11sb19 2 1 1 Ji 27027 EF 793 734 9599246646 6 pAs an _ E pen F a T a ie a m m urak T i ae JU TER EE LS Ty MR Mo Descriptions 07191999 Acc 4040345 Referring KONDZIOLKA DOUGLAS Status PRELIM i Ca ee _ a MR Mo Descriptions Referring SCHIFF DAVID Status PRELIM a a 2f U2 06 rgd 734 Ss 4460466 MR Mo Descriptions OFA SN 999 Acc 4040345 Referring KONDZIOLEKA DOUGLAS Status PRELIM SOPUID 1 2 640 115619 4 1 fF 0499951 70 660 95256581 6 2 3 The Rectangle has been designed to snap into place meaning that when you approach the final destination to which you are moving the Rectangle it will snap into place Once the Rectangle has been placed the Diagnostic Monitor in question will reload with the new images series or exam Please note that when a Rectangle Is dragged from one exam to another if the Hanging Protoco
201. n is disolayed as seen below Exam Information Patient Patient Hame ACPT1 BADOH ROGER MAM 211360205 Patient Location 677701 Birth Date 19461221 ger u Esam ACCeEsIOr E Jordz Modality MA Body Part BRAIN Procedure Code MASTDC Procedure Description MASTDCM Exam Status PRELIMIN Exam Date 09 15 1999 00 00 00 Subspecialty hie Organization ite Gi v E Admitting Diagnosis a Referring Physician SCHIFF DAID Study UID 1 2 124 113532 128 147 147 112 1999091 3 133119 2600375 In BB Date 19990915 Time 93328 Sending AE STENOLSCP Description No Descriptions Uther Patient IDs PO Patient Comments aaa Patient History aL Es Reason tor Study IMAI VOLUMETRIC HEAD wwO CONTRASTISCH WS TACEY 2 4724 SEND FILMS W PTIS Study Comments Pe 190 Vertical Horizontal Rack This toggling option allows you to quickly reconfigure the Canvas Page to view exams vertically or horizontally as seen below The default setting can be set in your preferences Relevant Exams 11 04 06 18 bost Recent 117041999 Least Recent 0428 1999 CT No Descriptions 1104999 Acc 4206506 Reterring MAKAROUN MICHEL S status PRELIM SOPUID 1 2 1244 1155s2 120 147 145 172 79991 104 132942 coor anh a CT Mo Descriptions 061571999 Acc 3961764 Referring MAK AROUN MICHEL S status PRELIM SOPUID 1 2 640 115619 2 55 1 176235 AFA CT Mo Descriptions O4204999 Acc
202. n this one as main exam If you click the Yes button in response the first exam will be closed and the newly selected exam will take its place as the Main Exam Furthermore please note that if you open an unread exam that exam will become locked for your use only in order to prevent it being opened and read by another user If you do not either mark an exam read or close the exam it will remain locked thereby slowing workflow Please remember to either mark an exam read or to close the exam when you are finished reviewing it 165 iSite Radiology Canvas Page Once you have selected an exam to view and clicked the View Exam Tab the iSite Radiology Canvas Page will appear shown below The Canvas Page is a navigational tool that provides you with quick access to diagnostic images and series diagnostic reports patient information and diagnostic reading workflow The Canvas Page should be used to select the images and series that you want to display on your diagnostic monitors as well as to gain contextual historical information about the patient Please note as the Canvas Page is designed to be a navigational tool it is not designed for diagnostic reading All diagnostic reading should be done using your Diagnostic Monitors If you open an unread exam that exam will become locked for your use only in order to prevent it being opened and read by another user If you do not either mark an exam read or close the exam it wil
203. ndow WidthLevel Measurements Annotations rr F Y F Image Processing Scout Line Mode Localizer Mode Multi Image Mode Clone key Image Play Cine Loop New Link Link All Axials Sawe To Paper Printer Flip Rotate Sort Spit oom Presets MPR Clone Coronal view MPR Scout Clone Sagittal view N Axial Slab Coronal Slab Sagittal Slab The available MPR Clone options are Sagittal View Coronal View and Axial View not pictured o Axial View visible for all non Axial stacks Selecting this item will initiate the creation of an Axial MPR Clone for the given stack series o Sagittal View visible for all non Sagittal stacks Selecting this item will initiate the creation of an Sagittal MPR Clone for the given stack series o Coronal View visible for all non Coronal stacks Selecting this item will initiate the creation of an Coronal MPR Clone for the given stack series The MPR feature also provides 3 slab configurations discussed below The clone options that are displayed depend on the view of the current exam For example an axial exam will display the Sagittal Clone and Coronal Clone options o Axial Slab selecting this item will open the MPR Slab options dialog with the default parameters for the creation of an Axial Slab MPR o Sagittal Slab selecting this item will open the MPR Slab options dialog with the default parameters for the creation of a Sagittal Slab MPR 299 o Coronal Slab
204. nfiguration For Lifesize Printing you will need to obtain the correct Image Box Height and Width settings from the printer vendor 130 Edit DICOMPrinter Configuration Mame PlainF ilr Filmos Settings Image Display STANDARDS Min Density Format FilmSize IL SINS on blas Density Medium Type CLEAR FILM Printer Configuration LiteSize Printing Orientation W LifeSize Printing Landscape ImageBox Height mm 228 f Portrait ImageBox Width rr 203 Aver veray Cancel Make changes as necessary Once back in the Edit DICOMPrinter Configuration window click the OK button to return to the Edit DICOM Printer Definition dialog When you have finished editing the DICOM printer properties click the OK button to save your changes If you wish to export a DICOM Printer listing select the desired DICOM Print and click the Export button The following dialog will appear Save in E My Documents d t ie My Music ES My Pictures _ My Webs __ New Folder Save as type rn Files sml Cancel Ze Choose a name for the exported file and click the Save button The file will be saved in xxml format in the chosen directory 131 If you wish to import DICOM Printer listings click the Import button Choose the desired xml format file and click the Open button Please note that if you import a DICOM Printer that has the same name as an existing System DICOM
205. nformance statement If not Poa specified printer is going to ImageBox Height mm use its default settings ImageBox Width mm ees crea 6 You can choose to use life size printing by checking the Life Size Printing check Dox o iSite can be configured on a printer by printer basis to enter the maximum printable height and width of the film information to be provided by the printer vendor o iSite will do the rendering before sending the image to the printer Based on the modality type defined in DICOM header iSite will either use the DICOM data element 0028 0030 with the attribute description of Pixel Soacing or DICOM tag 0018 1164 with the attribute description of Imager Pixel Spacing o iSite will use the tags as mentioned above together with the maximum printable height and width as provided in millimeters to render the image and if necessary adapt the number of rows and columns to match the capability of the printer When this is done the image will be sent to the printer 134 O Using the information provided by the printer vendor please enter values in millimeters for the ImageBox height and ImageBox width based on the desired Orientation Landscape or Portrait 135 o When the films are printed they will disolay a tag that reads iSite Life Size Print in the upper left hand corner above the screen overlays o Please note that iSite maintains and audit trail of all life size prints
206. nt In addition preset Window Width and Window Level values can be created for any modality These can be chosen from the right click pop up menu as seen below iSite also provides VOI LUT Value of Interest LUT access by right clicking the desired image and selecting VOI LUT Options from the pop up menu iSite allows you to adjust WW WL when VOI LUT options are activated However Site s WW WL options in the pop up menu will be disabled e Zooming and Panning You can zoom in and out of the image or series and can pan around zoomed images viewing detailed portions in smaller windows To zoom into or out of plain film images scroll the mouse wheel To pan hold down the mouse wheel and drag the mouse To zoom into a CT or MR series hold down the Alt key and click the left mouse button simultaneously then drag the mouse towards you to zoom in or away from you to zoom out To pan around CT or MR series hold down the Shift key and click the left mouse button simultaneously then drag your mouse Please note the degree to which you Can zoom info an image or series depends on the modality type and the native resolution e Viewing Slices in Image Series Multi slice series from MR CT XA US or other multi slice modalities can be cined and looped You can scroll through the slices in a series either one by one Cine mode or rapidly Fast Cine For a frame by frame review slowly scroll the mouse wheel For rapid review hold down the
207. odality by modality basis click the Preferences Button in the iSite Radiology Control Strip select the Hanging Protocol option from the tree control view at left and then add or edit a hanging protocol as necessary How do I remove an image or series from my Diagnostic Monitors If you would like to remove an image or series from your Diagnostic Monitors simply drag that image or series out of the Navigational Rectangles in the iSite Radiology Canvas Page 331 iExport How do I export an exam to a DICOM device There are four ways to export an exam From the Patients Directory or a Filter Worklist right click an exam listing and select the Send via DICOM option from the pop up menu From the Canvas Page right click on an exam listing in the timelines or right click the Exam Summary Window of an exam rack and select the Export via DICOM option from the pop up menu How do I view the progress of the exam exportation To view the iExport Queue click the Q button in the iSite Radiology Control Strip 332 Troubleshooting iSite Radiology iSite Radiology is designed to be as problem free and self healing as possible Still there are certain instances in which you will not receive the result you expected either because of user error a network problem or a problem with iSite Radiology itself Fortunately on many of these occasions there are simple workarounds that you can perform to achieve the expected r
208. ody part exam code date patient age and other criteria Click any one of the search filters and the results will be displayed at right Patient Directory This tool is Used to search the iSite server for exams Ad hoc searches can be made using Patient Name MRN Exam Date Patient Location Modality Referring Physician and other criteria System Filters This folder contains all of the system s default search filters These include searches based on Completed Exams CR All CT All Last 3 Days Last 7 Days Last Month and MR All Click any one of the search filters and the results will be displayed at right My History This folder contains the last 100 exams you have viewed Additional exam listing information includes User and Read by fields Statistics iSite System Administrators have access to a full range of statistics and billing information from this folder Personal Folders Initially empty this folder is designed to hold your personally created folders You can use these folders to create special collections of exam links For example if you were writing a paper on a certain type of disease you could create a folder and fill it with links to exams that display effects of the disease Another example would be to create a personal folder for teaching exams as seen below in the folder titled Bardach Images for Class You can add up to 25 sub folders Personal Folders C Baidach CTHead 20 Bar
209. of this manual Expanded Window Pop up Menus Window vWidthy Level i Window Width Level gt EREN i Measurement b Annotations j Annotations P Image Processing i I Window WidthyLevel Image Processing Show Scout Lines Measurement d Multi Image Mode Multi Image Mode Annotations d Play Cine Loop Play Cine Loop I Pi i ene Global Stack Mode Global Stack Mode Global Stack Mode _ New Link Mew Link New Link Link All Asdals Link All Axials Save b Save Save p Print Print b Print b FlipfRotate Flip Rotate Sort b Flip Rotate Sort i oom Presets Zoom Presets b Zoom Presets t CR Menu CT Menu MR Menu Please note that the pop up menus available from the Canvas Page are different from those which are available by right clicking an image or series in the Diagnostic Monitors Diagnostic reading performed on diagnostic monitors 201 offers additional options in the pop up Menus For more information on the pop Up menus seen by right clicking an image or series in the Diagnostic Monitors please see the corresponding section 202 Using Scout Views This feature allows you to display scout lines on any series by right clicking the series and selecting Scout Mode from the pop up menu as seen below CT Mo Descriptions 102341999 Acc 4294409 l _ Referring ODDIS CHESTER a d Status PRELIM Image Processing SOPUID 1 2 840 113819 2 55 Secu Lins Hade P 1 176265606770 1760 94066096 2 Create Popup 2 158 Clone
210. older List is the means by which you will access the different areas and tools in iSite As in Windows Explorer or Microsoft Outlook clicking a folder or element in the Folder List will change the appearance of the screen accordingly For example if you are viewing the contents of a personal folder in the right hand portion of the screen and you click the Patient Directory icon in the Folder List the right hand portion of the screen will display the Patient Directory as seen below 38 User Bardach Noah MD i S i te Ra d i O og y Folder List X Close All Patient Mame iSite Tools Query CI CO Manager Exception Handler Q iQuery F My Filters Bardach CR Cranium BardachMD Personal 4 Bardach CT Head lt gt Bardach MR Brain E Patient Directory 29 System Filters k 2 MEAL Completed Exams ood CR All E CTHEAD Last 3 Days o Last 3 Days Last 7 Days gt Last Month i T MR All Last 7 Days Personal Folders H Public Folders DUPUID Cases Filters Default Folders The Folder List contains three basic folders the iSite Tools folder the Personal Folders and the Public Folders In addition iSite Enterprise can incorporate user defined system wide plug ins These top level folders are permanent meaning that they cannot be renamed or deleted For more information on the nature and contents of each of these three folders please see below iSite Tools This folder c
211. ols DICOM Print Machine Preferences Network Testing Cancel Apply Help This window displays the various default window width and center values for iSite This list can be appended with new items by clicking the Add button and specifying the window with and center For example you could create a custom window width and center setting by clicking the Add button specifying a name and filling in the window width and center values as seen below 8 1 Add Window Width Center Marne BardachM D SpleenGB Modality CT Width 1 500 Center 75 Cancel Having clicked the OK button to save your changes the new custom window width and center setting will be displayed in the list To edit a window width and center setting highlight that listing and click the Properties button as seen below Preferences Dialog User Preferences Window Width Center System Preferences General Preferences window width Center Filters Abdominal L 1 Te N eee ar re Annotations Bone Properties DICOM Sources Brain Liver Screen Overlays Lung Paper Printing Kediastinur Body Part Dictionary IE port Duer Organization Dictionary Location Dictionary Plug Ins Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel Apply Help The Edit Window Width Center window will appear Make changes as necessary and click the OK button as seen below 82 Edit Window Width Cente
212. only to you All of these worklists can be found in the iSite Radiology Folder List iSite Radiology Control Strip The first component of iSite Radiology with which you should become familiar is the iSite Radiology Control Strip located at the top of the screen 1 2 3 4 5 User Bardach Noah MO iSite Radiology d5 00 6 789 The Control Strip contains nine elements that will remain present throughout your work in iSite Radiology Please note that not all of the elements are available in the Control Stripo Some of these elements such as the iExport button depend on your authorization level The nine elements are the Product Information Button 1 the Username 2 the View Exams Tab 3 the product name 4 the Logout Button 5 the iSite Folder List tab 6 the iExport Queue Button 7 the Preferences button 8 and the iSite Radiology User Manual button 9 The View Exams Tab discussed below will appear in the lower right hand corner of the iSite Control Strio once you have selected an exam for review To access patient exams click the View Exams Tab Each one of these Tabs and Buttons offers one click access to a different region or component otf iSite Radiology Detailed descriptions of the nine elements of the iSite Control Strip follow 1 Product Information Button Provides information on the version of iSite Radiology that you are currently using 2 Username Displays the name of the currently logged in user
213. ontains the basic tools of the iSite programs The tools that are present will depend on the user s particular preferences and permissions The complete list of iSite Tools is displayed below Please note that available tools are based on user permissions As such not all users will have access to all tools For detailed information on using each of these tools please refer to the appropriate section of this manual by clicking the links or by choosing a topic trom the table of contents e CD Manager This tool is used for burning CDs of clinical exams with all of their related diagnostic reports and information The resulting CD includes an embedded iSite CD Viewer allowing the user fo examine all the clinical images and information without having to connect to the internet or download the iSite Viewer 39 Exceptions Handler This tool is used for viewing resolving and removing exceptions exams whose DICOM information conflicts with information trom the RIS in anyway that might cause a risk of identity confusion iQuery This tool is used for retrieving studies from remote archives for display in the iSite system MyFilters While initially empty this folder will contain all of your personalized search filters These filters are created in the preferences by clicking the P button in the upper right of the iSite Control Strio and selecting the Filters subheading from the menu at left Filters can be based on combinations of modality b
214. opup This feature allows you to quickly create an Exoanded Window of the image or series in question Key Image This feature allows you to mark a particular image or series slice as a Key Image This feature is particularly useful when preparing presentation states or educational presentations This image will be identified by the text message Key at the lower right hand corner of the image Images can also be marked as a Key Image by clicking the soace bar while your mouse is over the desired image The space bar toggles the Key Image status if pressed again the image will no longer be a Key Image Use the Tab key to cycle forward through all the visible key images and Shift Tab to cycle backwards Please note that when a measurement or an annotation is added to an image that image automatically becomes a Key Image The Key Image feature can work in conjunction with the Key Image Series option which places all Key Images in a series at the beginning of each Exam ROW Linking The linking feature allows you to link two or more images and zoom pan or view slices simulfaneously Images and series can also be linked by dragging their respective pop up windows together Please note that iSite will only link images and series that are appropriate for linking For more details on the criteria iSite employs for allowing images and series to be linked see the Types 276 of Links and Linking Options section below The link
215. or over the desired image or image series Left mouse button click Right mouse button click on the desired image Plain Films With a wheel mouse click and drag the wheel button With a two button mouse click the left mouse button and drag the mouse while holding down the Control Series Click the leff mouse button and drag the mouse while holding down the Control _mode l Access an image pop up menu or image series Pan Key pea _ Key _ Zoom Plain Films With a wheel mouse roll the mouse wheel back and forth With a two button mouse click the left mouse button and drag the mouse while holding down the Alt Key Series Click the left mouse button and drag 23 the mouse while holding the Alt Key Frame by Frame Review for With a wheel mouse roll the mouse wheel image series back and forth Alternately press the up and down arrow keys Fast Cine is enabled by double clicking a Fast Cine Review for image series multi image stack series Fast Cine will start with an initial rate of 1 FPS Access Diagnostic Reports for From the worklists right click an exam listing a exam or Patient and choose Show Report from the resulting pop up Menu From the Canvas Page right click the exam listing of the desired exam in the Patient History or Relevant Exam Timelines and select the Show Report option Alternately double click the Exam Summary Window of the des
216. ot to Use iSite Do not use this product if You know that the computer system you are using is clearly malfunctioning Your system administrator tells you not to There is an error or warning message being displayed on the computer system You are in a surgical room or other environment where chemically volatile Compounds are in use this product is not intended for use in such environments You are aware of any system problems or malfunctions Always notify your system administrator of any potential system problems or availability issues as soon as possible CAUTION Never render a primary diagnosis on images if you are using a monitor that was not certified or calibrated for primary diagnosis purposes The goal of this placement guide is to ensure an optimal environment for the placement and operation of the iSite system There is a great deal of diversity in the IT and clinical environments in which the iSite System will be placed the items below are meant to serve as general broad guidelines and should not take the place of a specialized consultation with Philips personnel and or an ergonomics specialist e iSite Radiology should be installed in a dimly lit soace consistent with current clinical reading environments e iSite Radiology monitors should not be exposed to direct light of any kind in order to avoid glare Particular attention should be given to ensuring that the iSite Radiology monitors are not situated in an are
217. p in the Software is conferred to you Use of the Software is subject to the enduser license condi as are aVailalbe on request To the maximum extent permitted by law you shall not decompile and or reverse engineer the software or any part thereof Enter the username and password provided to you by your institution s iSite System Administrator Choose the proper authentication scheme iSite or Domain Authentication then click the Enter key or click the Log In button with your mouse Your iSite System Administrator should tell you which authentication scheme to use To exit the iSite Radiology login screen click the Cancel button If your username or password is invalid iSite Radiology will display the following message Invalid user name or password There are a number of possible reasons that your login password combination could have gone unrecognized by the system Contact your iSite System Administrator as soon as possible to have your login and password revised and or reinstated Remote Reading and Emergency Access There may be times when your iSite Radiology workstation has lost communication with the iSite Server but you still need access to the diagnostic images being sent out by the various modalities For these situations iSite Radiology provides Emergency Access To engage the Emergency Access mode you must click the Log In Using Emergency Access Server checkbox as seen below Log In Using Emergency
218. paring to print Hold down the shift key while executing mouse or keyboard controls to temporarily disconnect an image from any links The following chart lists keyboard commands that are used independently of the mouse Keystroke Action Space bar While cursor is over an image or series toggles thal image as a key mage Page Up and Page Down Smgle frame rewew for image genes Right and Left Arrow Keys Same function as F7 ang F8 dlisted directly above Control key P Toogles the Diagnostic Monitor Pane Icons In the Navigational Rectangles on and off Control key M Toggles Measurement Palette on aaa and off Numbers 1 9 When viewing a CT seres allows you to quickly select the corresponding preset Window Vvidih Level setting L key Holding down the L key while adjusting the window widih and level of a senes allows you to adjust only the current slice F3 Toggles the Mak Read designation on and off for ihe selecied exam Control Key Shift F6 Toggles shutters on off Control Key Alt key F6 Toggles 6000 DCOM Overlays on off Control Key F6 Toggles ALL Screen Overlays onoff latte screen overlays Dite Annotations amp Measurements and Embedded and Declared DICOM overlays F6 Toggles Overlays onfoff for the active pop up window F7 and F8 The Turbo CR keys used to quickly cycle through plain films in a single exam F will advance the navigation rectangle FF will rnove it backwar
219. playing the available configuration options as seen below k Hide m1 HJ MZH May H M3H i mav HH m4 H Me P HH m l H Miz H m2_1 H mis H mat Click the desired option and your monitor will be reconfigured Depending on how you change the monitor layout the size of the Navigation Rectangles may change when you change the configuration of your diagnostic monitors For example if your monitor is set to the M1 setting and you change it to an M3V setting the Navigation Rectangles will change from containing one image or series to containing three as seen below 230 MR Mo Descriptions 017 0671999 Acc 3683629 Hide Referring KONDZIOLK A DOUGLAS Ml Status PRELIM MZH SOPUID 1 2 540 113619 2 1 1 LL Mev 3915625503 E MH 456 Ty Mav h i HH M4 MR Mo Descriptions FA Mer 12 294 998 Acc 3674676 AH meL Referring SOLANO FRANCIS Status PRELIM ALE m H 2_1 SOPUID 1 2 840 113619 2 1 1 IM 2 029935154 612 914958221 6 A E mat Choosing the M3V sized Navigation Rectangle from a one on one M1 layout ME Mo Descriptions 01106999 Acct 3683629 Referring KONDZIOLKA DOUGLAS status PRELIM SOPUID 1 2 040 115619 2 1 1 4b MR Mo Descriptions 12294998 Acc 3674676 Referring SOLANO FRANCIS x statue PRELIM 2 02995154 612 91 49502 4 2 Fi The same series after the monitor layout was changed to M3V 231 Reading from th
220. ple of the original image data The value in this case is an accurate representation of the average measured pixel values represented by the interpolated sub sampled image This is a close approximation to the original pixel values Anytime iSite calculates a measurement using a sub sample of an image the measurement result is disolayed with a meaning approximate value in front of it When opening and displaying an image in full resolution the ROI Measurement Values are recalculated The sign is no longer displayed and there might be a small uodate change from the measurement values displayed initially 18 Feb 1999 18 07 57 3761596 m Window WidthjLevel Measurement Ruler Annotations b Angle Image Processing Key Image Freehand ROT k Naw Link Point Value Saya b Messurements Palethe Print To Paper Calibrate Image Flip Rotate Sort a Zoom Presets 251 i P E 00 57 HU 113 2 sd 15 493 cm Figure 3 Freehand ROI The Freehand ROI Tool allows users to measure the average data value for a non circular freehand region of an image The units and accuracy are identical to the ROI tool described above The Freehand ROI tool is similar to the Region of Interest tool To initiate the Freehand Region of Interest tool right click on an image or series and select the Freehand Region of Interest option Measurement section of the pop up menu Using your cursor left click and drag the
221. pplies the highest ranking Hanging Protocol available for a given exam and always applies the User Hanging Protocol when available at the same level The following rank order is used 1 User Hanging Protocol Group Hanging Protocol available for this exam System Hanging Protocol Group Hanging Protocol available for this exam User Modality Body Part Hanging Protocol available for this exam a ee System Modality Body Part Hanging Protocol available for this exam 5 User Modality Hanging Protocol available for this exam 6 System Modality Hanging Protocol available for this exam Default vs Alternate Hanging Protocols iSite offers the ability to create multiple Hanging Protocols for the same Exam Type This can be beneficial when you read a lot of the same Exam types that contain a lot of different series For example a Neuroradiologist that primarily reads MR HEAD exams might want to define a few alternate HPs that he or she can quickly switch fo rather than having to re hang the entire study Another use case is that Radiologists might want to define a few alternate Hanging Protocols at the Modality level that they can quickly select and apply if there is no matching Hanging Protocol available for that particular exam or if the System Hanging Protocol applied differs from their personal preference 209 Hanging Protocols come in two types default and alternate There can only be one defau
222. r To remove a column of information right click the column you wish to remove A pop up menu Is displayed as seen in the illustrations below Mody Body Pan Saws 155 Modality Bar w Modality w Date of birth wf Accession wf MRN w Patient Mame Status w Location w Ref Physician w Organization w Proc Code w Proc Desc w Subspecialty w Performing Resource Select the name of the column from the list and release the mouse button The column will be removed as seen below Patient Name Patient ID Modality To add columns that you have removed right click the column nearest to where you would like to reinsert the column A pop up menu will appear as seen below 156 w Date w Modality w Date of birth w Accession w MRN w Patient Mame Body Park Sbatus w Location w Ref Physician w Organization Proc Code w Proc Desc w Subspecialty w Performing Resource Column names that have been grayed out Patient Name Patient ID Accession Date and Modality cannot be removed Select the column you would like to add from the list of columns that have been removed When you release the mouse button the Reading Worklist will be refreshed and the column will be added Customizing your Personal Filters To create a set of personal specialized filters click the iSite Radiology Preferences Button in the iSite Control Strip The Preferences Dialog wil
223. r Modality CT Width 400 Center 40 Cancel Upon returning to the Preferences Dialog your changes will be visible in the settings list as seen below Preferences Dialog User Preferences Window Width Center System Preferences General Preferences window Width Center Filters Abdo minal l Pa Bone ee el as 2 LL Soar DICOM Sources Brain Liver Screen Overlays Lung Delete Paper Printing Mediastinum Body Part Dictionary IE port Duer Organization Dictionary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel Apply Help Items can be removed from the window width and center settings list by highlighting the item you wish to remove and clicking the Delete button Image Processing To access the settings for iSite s Image Processing features click the Image Processing listing as seen below 83 Preferences Dialog H User Preferences aj System Preferences General Preferences Window Width Center Image Processing Organization Dictionary Location Dictionary Plug Ins Body Part Dictionary Hanging Protocols DICOM Print Machine Preferences Network Testing The four image processing options Edge Enhance Edge Detect Median Filter and Edge Enhance Method Degree Modalities Read Only Edge Detect Method Degree Modalities Read Only Median Filter Method Modalities Head Only
224. re configured with an equal number of matching identifiers then the DICOM Source containing an Exam Code will take precedence and will be applied over the DICOM Source that doesn t contain an Exam Code Window Center In this tab choose which Window Center values you wish to use for this source The options are Histogram calculation DICOM values and Fixed values as seen in the example below If you are configuring a manufacturer s DICOM Source you must select the DICOM Values option 96 Add DICOM Source Main Window LCenter Series Splitting Sorting Window Center Values C Histogram calculation CO Fixed values Wf ith Center Series Splitting This tab allows you to specify how you would like to split series The listing of attributes displays the DICOM tag and the tag s name as seen below Please note that predefined default attributes tags cannot be removed Add DICOM Source Main Window Center Senes Splitting Sorting C 0008 0018 SOF Instance UID C 0018 0010 Contrast Bolus Agent C 0018 0020 Scanning Sequence C 0018 0050 Slice Thickness C 0018 0081 Echo Time C 0018 0086 Echo Nurnber s C 00181210 Convolution Meret C 0020 0012 Acquisition Mumber Add Attribute I1 If you would like to add an attribute click the Add Attribute button The following window will appear Enter Tag Enter alue DsGGGGEEEE canos Enter the value as desired and click the OK button
225. rees To initiate an Angle Measurement choose the angle option from the pop up menu Click on the point that you want to serve as the angle s endpoint move the cursor to a second point the angle s apex and click again To complete the angle move the cursor to the second endpoint and click again The resulting complete angle is shown in figure 1 A box in the angle will indicate the measurement of the angle in degrees If you want to move the entire angle without repositioning either end point click on the center box and drag it to the new location as in figure 2 If you want to reposition either end of the angle tool click on that end and drag it to the new location as in figure 3 The arms of the angle can be fully articulated by clicking anywhere on them and dragging them to a new location as seen in figure 4 247 18 Feb 1999 18 07 57 3761566 m Window Width Level ae Measurement Ruler nnatations d Image Processing k Region OF Interest Key Image Freehand ROT Point vValue New Link iiia Sava b Measurements Palette Print To Paper Calibrate Image Flip Rotate Sort Zoom Presets 18 07 57 3761556 e 07 5F 37615565 1 07 57 3761556 mM Feb 1999 18 07 57 3761585 my a ames Cobb Measurements The Angle Measurement tool can be used to take Cobb measurements Just as with a normal Angle measurement to take a Cobb measurement click on the point that you want to serve as
226. rences General Preferences S Window Width Center Filters l Display Preferences Hanging Protocols Bone Properties H System Preferences va H Machine Preferences ve Aetwork Testing dedain Modal y TI Cancel Displayed in the Window Center Settings tab are the default Window Width and Level settings used for each CT body part iSite Radiology comes hardcoded with the settings shown above but these settings can be edited to suit your personal viewing needs In addition new body part settings can be added fo the list To edit or view the properties of a particular setting highlight that setting with your mouse and click the Properties button The following window will be displayed Edit Window Width Center Mediastinum Cancel 60 Edit the Name Width or Center fields as desired and click the OK button You will be returned to the Window Center Settings tab and your changes will be visible in the window To create a new Window Center setting click the Add button A blank Edit Window Center dialog will appear Enter the name window and center settings as desired and click the OK button as shown below Add Window Width Center Name BardachMD_SpleentGb Modality CT Width 1 FOO Center 75 Cancel You will be returned to the Window Center Settings tab and the new Window Center Setting will be displayed in the list as seen below 61 Preferences Dialog User Preferences G
227. rences Dialog E User Preferences System Preferences General Preferences Window Width Center 3 CR all Annotations CT All DICOM Sources Last 3 Days Screen Overlays Last 7 Days Paper Printing Last Month Body Part Dictionary i a Delete Organization Dictionary e Location Dictionary FEJ Plug Ins Hanging Protocols DICOM Print Machine Preferences Nehwork Testing This page displays all of the various filters that can be employed when generating patient and modality worklists As in the Window Width Cenfter page new items can be created or existing items can be edited and or removed To add a new item click the Add button The following dialogue will appear 87 Add Filter Eo e Listed below are the various fields and their significance Please note that you do not have to fill in all the fields The default for an empty field is all For example leaving the Patient Location field blank would search for all Patient Locations e Name This is the display name of the filter e Modality Enter the Modality codes ex MR US CT etc that you want the filter to search for If you leave this field blank the filter will search all modalities e Patient Location Enter the location of exams that you want the filter to search for e Body Part Enter the Body Part code or identifier ex Abdomen or ABD of anatomy that you wish the filter to search for 88 e Procedure Code Enter t
228. request you are submitting in the Priority dialog e The Stat setting will request that the archive send the studies immediately and with high priority e The Standard setting will have the studies available as soon as possible and with normal priority This is the default setting e Selecting the Scheduled priority activates the Deadline dialog and allows you to set the date and time that you need the studies by If you wish to be notified if an error occurs while your request is being processed click the notify by email in case of error check box and type the email address es to which you want notification sent in the dialog box below 313 To print a copy of the request list for your records select the Print submitted query checkbox When the request is complete a copy of the request will print to your default printer Click OK when you have finished and the request will be processed After clicking OK you will be returned to the iQuery main screen To return to iSite click the Patient Directory Tab Viewing the Retrieval Queue If you wish to view the studies awaiting retrieval click the View Queue button The following dialog will appear Displayed in the main dialog box are studies that have recently been requested or are in the process of being retrieved Query Retrieval Queue eeeeee eee 84686466 6 6 4 4 Active 4 LT4 gt ENGSERVER_SCP 08 02 2000 08 11 00 4 LTA gt ENGSERVER_S
229. rganization Dictionary select its listing from the System Preferences pull down list as seen below Preferences Dialog User Preterences Organization Dictionary System Preferences General Preferences Hopkins Window width Center MMecF aren Filters Physic Annotations Labs DICOM Sources Pediatrics Screen Overlays Paper Printing Body Part Dictionary IE sport Ouen Organization Dictionary Location Dictionary Plug Ine Hanging Protocols DICOM Print Machine Preferences Network Testing 120 To add an organization to the Dictionary simply type the name in the bottom field and click the Add button The organization will be added to the list above To remove an organization click the listing and then the Delete button Location Dictionary The Location Dictionary allows you to specify the various locations present at your institution if you use location in your exam records The listings are then used for the purposes of exam searches The names listed in this dictionary must match those present in your HIS RIS system exactly for searches to work correctly To access the Location Dictionary select Its listing from the System Preferences pull down list as seen below Preferences Dialog User Preferences System Preferences General Preferences Window Width Center Filters Annotations DICOM Sources Screen Overlays Paper Printing Body Part Dictionary IE x pork Duer Organization Dictionary Loca
230. rivate tag 0019 1015 Non Agfa specific non CR will not seek this tag o KVP Scan Options Exposure Time X ray Tube Current Gantry Detector Tilt Generator Power FOV Recon Diameter Slice Gap o Scanning Sequence Sequence Variant Scan Options Repetition Time Echo Time Frac NEX Slice Spacing Echo Train Length Freq amp Phase FOV Recon Diameter Slice Gap e MG o Orientation e Calculated o Window Width Window Level Number of Images in Window Page Number Printing Total Pages Printing Image Number in Window PET Image Number Link Status Key Image Zoom Factor Positioner Primary Angle Positioner Secondary Angle Image Processing Parameters As seen below a red box will indicate the location of the new element Note that overlay information can only be placed in one of the screen s corners and not in the center of the image 104 Overlay Dialog Overlay Mame Body Part Patient Date Name Number MAN Birth D ate Jer Age Exam Accession Referring Physician Name Frocedure Code Procedure Description Study Time Description Seres Modality Description Body Part Seres Number Font Procedure Code Image Type Export Import Cancel Furthermore each individual tag can be customized by referencing specific DICOM tags To customize the tags in this way simply double click The following dialog will appear Tag Edit Dialog Name Walue 00080020 Cancel
231. rogress information as the exam is cached as seen at the left of the image below Close ia ai BADOR ROGER CT CHEST AS02004 1 1bc2 yourself v LA 10 CT Accession 414 120 Referring Physician KONDZIOLEAAD 3 60 MB As can be seen from the image above the exam listings in the Local Exam Cache provide information about the patient and exam that has been cached The columns include from left to right Close exam level listings Status Subject Patient name Modality Body Part Received and Sender The list can be sorted by clicking these columns The Status icon in the exam listing indicates whether the exam was successfully cached Right clicking individual exam listings provides access to a pop up Menu with additional options seen below The Diagnostic Report for the exam if available can be viewed by selecting the View Report option If the exam is in the process of being cached you can Cancel the download or start it if it has yet to begin If the locally cached exam is no longer necessary select the Delete option to remove it from your local machine 53 Subject Ra v BADOH ROGERM CT CHEST AfS0 2004 1 16 2 yourself v o 10 CT Accession 4147129 Rete Ste ne OMT OLKA 3 60 WE View Report Delete To open an exam for viewing simply double click the exam listing Options for the Local Exam Cache are configured in the iSite Preferences To access these options click the Pref
232. rom exams as seen below Window Width Level l Image Processing Scout Line Mode Localizer Mode Create Popup Clone Window With Preset li Select Series key Image New Link Link All Axials Save Print F Flip Rotate Sort Spit Matching Series Rules Delete Delete All Image s The option Delete All Image s removes every image from a selected series whereas the option Delete Image only removes the current image If the exam being viewed has already been marked Read a confirmation dialog will appear as seen below site Enterprise T This exam has been Marked Read are you sure you want to continue and delete inmagels of the selected window If you answer Yes or if the exam has not yet been marked Read a Reason for Rejection dialog will appear as seen below 2 Enter Reason for Rejection Dialog Reason l Artifacts Image Too Dark overexposed Image Too Light Underxposed Incorrect Patient ID Mechanical Prablern No Exposure Patient Motion QL T est Images Scouts Cancel Either enter in a reason in the dialog or select one of the pre canned reasons then click OK The image or images will be deleted When an image is deleted iSite keeps a record of the following information Site User ID Deletion Date Deletion Time Modality Accession MRN Series Image UID Series Image Description Number Reason for Deletion These audits can be viewed by
233. ropped into the CD Manager folder from any filter or directory You could also add all of a patient s exams by dragging the patient listing to the CD Manager folder Secondly exams can be added to the CD Manager by right clicking an exam listing in the Patient History Timeline or an Exam Row Margin and selecting the Add Exam fo Folder option As you add exams to the CD Manager folder the worklist will oe populated with exam listings as seen below 47 BADOH ROGER 211360205 MRSTDCM MRSTOCM 3417 1999 19 22 00 MR 3012511 BADOH ROGER 211360205 CTSTIDCM CTSTOC I i2 171999 10 07 00 CT 4075517 BADOH ROGER 211560205 MRSTOCM MRSTOCMl 291999 13 26 00 MR 4092897 BADOH ROGER 211360205 CISTIDCM CTSTOCAI 016 1999 15 36 00 CT 4135625 Exportto ESTA Start Site Media Format DICOM Format C Both SUMMAN Frotection 0 Exam s Media Viewer Enable Password Required Disk Space Password Available Disk Space Confirm Password Status 200 0MB 400 0KM6 623 0MB Please note if you logout with exam links in the CD Manager those links will be lost You will have to recompile the CD export list again once you log back in 48 Writing the Media When you have added all the desired patient exams to the CD Manager begin exporting by clicking the Start button The status bar at the bottom of the screen will provide updated information on the progress of the export In addition each exam being written to the media
234. s 5 Diagnostic Exam Racks The bottom area of the Canvas Page window is composed of the Diagnostic Exam Racks These Racks display thumbnail images and series belonging to the exam you have selected The Exam Racks also disolay exams that are related to the exam you have selected The left portion of the Exam Rack called the Exam Summary Window displays information about each exam including Modality Procedure Description Exam Date Accession number Referring Physician and Exam Status Colored Navigation Rectangles indicate the images and or series that you have selected for display in your Diagnostic Monitors These Rectangles can be resized or moved to display other images and series These components their specific uses and capabilities are discussed at length below Using the Navigational Timelines The navigational timelines are an integral part of the Canvas Page They are a fast and intuitive way of navigating through a patient s clinical history of diagnostic exams and reports There are two timelines provided the Relevant Exams Timeline and the Patient History Timeline Acct 4135625 DateTime 8 52 0 1999 0844 Ref Physician DIERCES DEBORAH ProcedureDescription T TEST Status PRELIM The left timeline called the Relevant Exams Timeline is a chronologically ordered representation of all related exams belonging to the patient in question For example if you have chosen to review a CT HEAD exam the Relevant Exams Tim
235. s Load Relevant Prior Based On Matching Body Part Only C Modality And Body Part Split Mode Available For 1 And 2 Monitor Systems Ho Split C Vertical Split C Horizontal Split Hang Multiple Friors Number OF Priors To Load i Cache Entire Study Show Spine Label Tool On Sagittal Back Cancel Set the Linking options as desired You can link all axial sagittal coronal or oblique views of an exam Please note that linking parameters will only be applied to the main exam If you wish to load relevant priors based on body part only or both modality and body part set that option as necessary Relevant priors are prior exams which pertain to the current exam being viewed The definition of Relevant is set on a site by site basis by the iSite System Administrator Most often this definition is based on modality and body part criteria In the Split Mode area specify whether you would like the Hanging Protocol to display In Virtual Split Monitors by selecting the option that best applies As indicated in the dialog the Split Monitor feature is only available for systems with 1 or 2 monitors 220 If you would like the Hanging Protocol to display multiple priors check the Hang Multiple Priors box and specify how many priors should be loaded The table below shows how these priors will be distributed between physical Diagnostic Monitors and Virtual Split Monitors of Virtual of Priors Description E
236. s Please note that 6000 DICOM overlays can be toggled on and off by pressing the F6 key Hitting Ctrl F6 will toggle ALL overlays on and off The scaled rules that accompany the overlays are an ever present element whose size will adjust accordingly at every resolution Each tick on the scale represents 1cm with each 5cm mark called out The scales can be dragged to examine various portions of an image When the mouse Is released the scales will snap back into place DZ TE 8 O TR 400 5 Omm 6 0rmm 17 LIVIR I i k LUIRG 5 0mm 0mm Ts aiee 5 0mm 0mm iSite Radiology Virtual Split Monitors To maximize the total display soace available for reviewing diagnostic images particularly in situations where the radiologist needs to review a large amount of prior exams iSite Radiology allows you to split your Diagnostic Monitors in half thereby creating 2 virtual split monitors from a single physical monitor A single monitor system can be split and represented to the system as 2 Virtual Split Monitors a 2 monitor system can be split and represented to the system as 4 Virtual Splif Monitors To split a Diagnostic Monitor place your cursor on its screen and right click From the resulting pop up menu select either Split Horizontal or Split Vertical according to how you wish to divide the Diagnostic Monitor s real estate The Virtual Split Monitors will be separated by a noticeable partition To remove the
237. s This feature is primarily used to link Oblique Series that are 5 15 of the Axial Plane with Axial Series In iSite 3 2 x the variance was fixed to 5 degrees In iSite 3 3 the variance is configurable at a site level and could be increased to 25 degrees iSite 3 5 has increased the maximum variance to 40 degrees The Options section of this dialog provides the following configurations e Allow DICOM Query Permits users to perform a DICOM query from the Exam Timeline e Allow exams to be marked Permits Users To mark an exam Read more than once iSite Radiology only 80 e Image Orientation Options These two options allow the administrator to decide whether individual users should be able to set their own flipping preferences for Axial CTs or whether Axial and Oblique CTs should always be displayed with the anatomical right on the left side of the image Window Width Center This section of the system wide preferences can be accessed by clicking the Window Width Center item in the tree view control at left The following options will be displayed Preferences Dialog User Preferences System Preferences General Preferences window Width Center Window YridthiCenter Add Filters Abdominal Annotations DICOM Sources Screen Overlays Paper Printing Bone Properties Brain Lung Mediastinum Body Part Dictionary IE x pork Ouer Organization Dictionary Location Dictionary Plug Ing Hanging Protoc
238. s Company Global PACS Business Unit 5000 Marina Blvd Suite 100 Brisbane CA 94005 USA Authorized European Representative Philips Medical Systems Nederland B V PMS Quality amp Regulatory Affairs Europe Veenpluis 4 6 5684 PC Best The Netherlands Product and Classification e iSite Radiology Class Il CFR e iSite Radiology Class MDD Annex IX Statement of Compliance with the following Code of Federal Regulations CFR Title 21 Parts 800 1299 as applicable Food Drug and Cosmetic Act The Sherman Act ISO 13485 03 CAN CSA ISO 13485 03 Medical Devices Regulations MDD 93 42 EEC iSite Radiology Proper Usage Statement Who Should Read This Manual This manual is intended for clinical users of the Philips iSite Radiology product Anybody in a healthcare organization who intends to use this product should read this manual carefully We also recommend that you receive basic product use training from your local systems administrator or from a Philips Global PACS applications specialist When to Use iSite Radiology CAUTION This product should be used by a licensed radiologist or by a non radiologist technologist or intern in conjunction with a licensed radiologist This product is intended to be used as a tool to assist in rendering clinical diagnosis Improper use or configuration of this product may preclude an accurate clinical diagnosis adversely impacting patient diagnosis or patient care All instru
239. s and selecting the Flip Rotate Sort option allows you to sort series in ascending or descending order according to either Table Position or Image Number Sort and Search Fields These fields located in the Patient Directory allow you to sort and search the Patient Directory This can be accomplished either by clicking on the column headings thereby sorting the entries or by entering the desired criteria in the search fields and clicking the Query button narrowing the Patient Directory Spine Labeling Tool This option available from the right click image pop up menu allows you to apply spine labels to images and series and then to save these specialized annotations ina Presentation State Thumbnail Images Located in the Diagnostic Exam Racks of the Canvas Page these small format images are not meant for diagnostic reading but rather for navigational purposes The Thumbnails can be enlarged in an Expanded Window by double clicking Thumbnails can be loaded into your Diagnostic Monitors by dragging them into the Navigation Rectangles or by dragging the Navigation Rectangles over them 339 View Exam Tab This tab appears in the lower right corner of the iSite Radiology Control Strip after a patient exam has been selected from the Patient Directory or the Filter Worklists You can view a patient s exams or easily switch between patients by right clicking the View Exam Tab You can quickly switch between open patients by right cl
240. s seen below 74 Preferences Dialog User Preferences General Preferences Window Width Center Image Processing Filters Display Preferences i Patient Comments Hanging Protocols i Patient History W Study Comments Canvas Page Patent Information Area System Preferences Machine Preferences Network Testing Exam Information Area W Reason for Study iM Impressions Cancel Check the boxes of the information that you wish to display in the Patient Information Are and the Exam Information Area If you wish to continue editing your preferences click the Apply button Your changes will be saved If have finished reviewing and or editing your personal preferences click the OK button You will be returned to the program Display Preferences You can specify many elements of how images are displayed on your monitors in the Display Preferences To access these options click the Display Preferences listing as seen below 75 Preferences Dialog User Preferences General Preferences Window Width Center screen Overlay Font Size Image Processing Lee Filters Display Preferences Hanging Protocols Canvas Page System Preferences e ee ee se ee f Full Resolution C 512512 C 256x256 C 1285128 Network Testing Display Preferences Wedium C Small NOTE Changes require a re login to take effect Cine Playback Resolution Default Cine Hate 15 Scout Line Mode Single C Bracke
241. selecting this item will open the MPR Slab options dialog with the default parameters for the creation of a Coronal Slab MPR MPR Series will have the same Series Number as their volume source series When an MPR window Is created If will be initialized to display the image in the middle of the stack For example if an MPR reconstruction has 512 Images when the series is created image 257 will be disolayed MPR Series will have the same Series Number as their volume source series If all the source volume stack series images have the same WW WL values then the MPR images will be initialized with these WW WL values If all the source volume stack series images do not have the same WW WL values the MPR images will use a Histogram Calculation to compute WW WL values Below are examples of a typical Axial CT series and the resulting clone titled MPR Coronal The new series window shown at the right is fully enabled and will support all normal iSite series functionality with the exception of the Calibration and Full Fidelity features In addition Series Matching is not supported in MPR windows To remove an MPR clone right click the image and select the Remove Clone option MPR Scout Clones can also be created These reconstructions load a lot faster and provide a navigational scout or reference series in the desired orientation at lower resolution and are not meant for diagnostic interpretation Clones are 300 avail
242. sentation states have been created the initial presentation state displayed is the Original DICOM state If a technologist has created a presentation state that will be presented initially instead of the Original DICOM If an intern has created a presentation state it will be displayed initially instead of the technologist s presentation state If a radiologist has created a presentation state that will trump the other presentation state and will be presented initially instead of the technologist s presentation state When you finish filling in the necessary information as seen below click the OK button Save Presentation State Enter Presentation State Name Bardach Kepa APD TT 11 Type C Technologist C Pre read f User Cancel 187 Your presentation state will be saved and will be available for future viewing by you and your colleagues when right clicking on that exam s Exam Summary Window as seen below When a exam presentation state is being displayed the Presentation State icon IE will be shown in the Exam Margin User Bardach Woah MO 105 Procedure Code MRSTDCM Referr BADOH ROGER Sex U D O B 12 2 a d Presentation State w 1 created by iadmin on May 12 cn eee Technologist K Edit Hanging Protocol Create User Hanging Protocol Create System Hanging Protocol iar Select User Hanging Protocal d Select System Hanging Protocol Rehang Add Exam To Folder Exam Information
243. ser navigates through them It is possible for the user to adjust the initial alignment whether it was done 278 automatically or manually This is done by temporarily disconnecting a series image from a link and manipulating it independently by pressing the Shift key while performing mouse or keyboard actions Linking Selected Exams Multiple images or series from different exams can be selected an linked by clicking the images or series while holding down the Shift key The information area of the image window will change to a darker shade as seen below The image in the center is selected Once the images are selected right click and select the Link Selected Images option Images that meet the linking criteria as described above will be linked 279 Mirrored Linking for Mammography MG Mirrored linking is only available for mammography studies By the nature of how these images are acquired mammography studies typically capture bilateral breasts and display images which are positioned sidelong either to the left or right side of image windows The linking functionality for mammography allows you to link images at opposite coordinates mirrored linking With Mirrored Linking engaged when you zoom into an image that is positioned along the right side of an image window iSite will automatically zoom into the other image positioned along the left side of the linked image window To engage Mirrored Linking select the f
244. settings by acquisition time alohabetically etc Sometimes however this default sort order does not fit the radiologist s needs For example a radiologist might always want CR PA Chests to be displayed as the first image in the Rack The technologist or radiologist could sort the series or images manually and create a Presentation State every time However if a user always wants a certain type of exam to be displayed a certain way it is inefficient to repeatedly create Presentation States just for the purpose of sort order By creating a Hanging Protocol using Series Matching Rules the relevant series images can be sorted automatically without having to create Presentations States If you wish to use a Matching Series Rule to configure your new Hanging Protocol check the Use Series Matching Rules checkbox When the Matching Series Rule is selected the Use Current Exam Layout checkbox is selected by default allowing the Hanging Protocol to take into account features of the current exam layout such as clones These pertinent Matching Series Rules will be visible in the next step of the Hanging Protocol creation process In this step available Rules can be selected and Clones can be created using the buttons below the series window Add Rule Remove Rule Add Clone Remove Clone and all display settings can be adjusted as well Multi Image Modes Default WW WL Show Scout Lines Show Localizer Invert Image etc When fin
245. specified image or series all crosshairs will move in sync 269 In the example below when the cursor is passed over the first series at left crosshairs appear at the corresponding location on every other series in the exam Stentorian Health Group No Descriptions A Stentorian Health Group Sl mt DOB Tuesday July 05 197 j UW f 2 50 mm DOB Tuesdayaduly 05 1977 Ag Saturday 9 Image 49 97 _ x Saturday Octobe KS s Aoi agai a dts ie on iin chlctnlalrbdektehlocan izer whl 500 5 S xels Square Pix Stentorian Health Group ACPT1 DOB Tuesday July 05 19 Saturday October 199 As with the Link feature the Localizer can be used to navigate through multiple series simultaneously By holding down the left mouse button and dragging the cursor all exams with the same DICOM frame of reference regardless of their specific orientations will move in synch Please note that unlike other images clicking and dragging will not adjust the Window Width Level of Localizer enabled images By dragging the cursor as seen above all series move in synch The benefit of using this feature instead of the Linking tool is that series with different orientations Axial Saggital and Coronal can all aligned simultaneously One particularly good use case for this tool are PET CT studies where the Localizer tool can be used to create a ghost cursor on the other Axial Slices This will only work if the CT and the PET im
246. spond to your diagnostic monitors and by right clicking the icons you can quickly configure the layout of your diagnostic monitors 335 Exam Summary Window This portion of the Diagnostic Exam Racks located to the left of the Thumbnail Images displays critical information about the exam in question including modality type date and time of the exam accession number referring physician name the exam s status and the Study UID Unique Identifier information The Exam Summary Window also contains the Impressions portion of the Diagnostic Report if it is available Exceptions Exceptions denote exams that due to missing or incorrect information such as MRN or accession numbers cannot be reconciled for processing in the Modality Worklist These exams must be resolved by providing the missing or correct information using the Exceptions Handler or the Modality Worklist Filter Worklists These are the exam based lists produced by iSite System Filters or Personal Filters Filter Worklists are named after the filter that produces them For example if you have a Filter named CT ALL which filters through the available exams for all CTs the resulting worklist would be called CT ALL and would only display exams matching the filter criteria Flip This function available by right clicking an image or series and selecting the Flio Rotate Sort option allows you fo flip the image or series horizontally or vertically Freehand Region o
247. ssion 3EDFEF1S004 CT CRI 5Q NO000014 PIC CRI IDOOOOI 4 Accession SEDFEFISO046 CT CRI 5Q NO000015 PID CRI IDOQ00015 Accession SEDFEFLa004C CT CRI 50 NO000015 PID CRI IDOOO01S Accession SEDFEFISO050 CT CRI 5Q NO000016 PID CRI IDQO0016 Sccession SEDFEFIG0051 CT CRI 5Q MO00016 PID CRI IDQO0016 Accession SEDFEFIS0055 CT CRI 50 NO000017 PID CRI IDOOO01Y Accession SEDFEFIS0056 CT CRI 50 NO000017 PID CRI IDOOO01 Accession SEDFEFLS0054 CT CRI 50 MOO0018 PID CRI IDOOO01S Accession SEDFEFISOQ056 CT CRI 50 NO000186 PID CRI IDQO0015 SQccession SEDFEFIS005F CT gt In the resulting list The currently viewed exam is marked with a checkmark and displays the patient s name sex date of birth and Patient Identification number Up to 10 exams in the current worklist are listed with the patient name Patient Identification Number Accession number and modality The various exams in the displayed list can all be selected with your mouse cursor To select a different exam from your worklist or to close all open patients left click the desired item Please note that if an unread exam is selected from a worklisf and opened in the Canvas Page it will become the Main Exam If an exam with the status In Progress from the same patient is selected in addition to the Main Exam a message will appear advising you that You have already opened one exam as main exam Do you want to close it and ope
248. t Localizer Mode No Scout Lines Show Scout Lines Cancel Help The font size of the Screen Overlays that are displayed on diagnostic images can be set in the Screen Overlay Font Size area After making changes you must logout of the program and login again to activate the new font size The image playback resolution not the window of a Stacked Image Window displayed in cine Is set in the Cine Playback Resolution For example a cine clip captured at a resolution of 1024 x 1024 can be played back at a resolution of 256 x 256 The result is that the clip is loaded faster because there Is less data retrieved from the server but the quality will be lower The user has the ability to improve the image quality on the fly by pressing the lt F9 gt hot key Note The Popup Window Size is independent from the image resolution for example in the use case just described the initial Window Size might by 512 x 512 If the clip is displayed at 256 x 256 it will be stretched fo fit the window size after pressing lt F9 gt it will retrieve the additional image information to improve image quality to full fidelity for that window size which is 512 x 512 The Default Cine Rate drop down menu lets you chose a default frames per second playback rate between and 45 This Default Cine Rate will be applied only when images don t have the DICOM Recommended Cine Rate fag 00082144 or DICOM Cine Rate tag 00180040 specified in
249. t All D3 pla arene Hanging Protocols LCanvasPage lt System Preferences General Preferences Window Width Center Image Processing Filters Annotations DICOM Sources Screen Overlays Paper Printing IE part Query Organization Dictionary Location Dictionary Plug Ins Body Part Dictionary Hanging Protocols DICOM Print lt Machine Preferences Display Monitors Name Abdominal Bone Brain Liver Lung Mediastinum Window Yridth Center CT 400 40 CT z000 a300 CT ou 35 CT 200 50 CT 1500 r00 CT 400 40 Cancel Apply Help If you select the import option a browse window will open and you will be prompted to select the specific xml file to import If you select the export option you will be prompted to save the specific xml file that corresponds to the preference group you have selected as seen below Seven Ep asin E Scom_ dri em 1025 1026 1031 1033 li 1037 Bim 1042 E File name 1054 2052 3076 9 Adobe O AdogiwerugwerCache Jappmgmet C CatRoot G CatRoot2 Bindawlenterseting srl feheren s _ x G a porre COLOR Com config 9 Cult3D idhep Direct drivers export aye Save as type vara Files xrl Cancel 56 Please note that importing preferences will override any preferences in the system The following warning will be disolayed when you import preferences site Radiology Importing preferences will override
250. t by the manufacturers of your monitors Some links that might be helpful are listed below Barco Medical Equipment e htto www barcomedical com e hito www barcomedical com cs manuals htm Dome Imaging Systems e hito www dome com e hito www dome com support prod_docs html If you have any questions regarding the calibration of your iSite Radiology Monitors please contact Philips at 877 328 2808 or write an email to isitecare philips com 17 iSite Radiology Mouse Control Reference Sheet for working with images Action Left Button Wheel Right Button Click select and deselect images andfor senes Also releases any other mouse modes currently in effect Double Click Open image in a floating window In the Patient Query Page and My Vorklist double clicking an exam listing will open that exam as well as any related exams according to the hanging protocol for that exam s modality On the imaje Dray verically window level Drag honzontally window width On the image header and footer Used for mowng images or series vathin an exam rack oom for expanded images and images in the diagnostic monitors only Pan in zoomed in weve for expanded images and Images in the diagnostic riontars only Click Drag Alt key Drag Control key Drag M A Activates pop up menu In Canvas Page if WA a multi imnage stack series Is double clicked using the Mouse wheel Fast
251. t exams of your choosing The patient images are all lossless Unless the iSite Server received lossy images from another source Diagnostic Reports are exported along with the patient exams Please note that Exam Memos and some Diagnostic Report fields are not exported to the CD The program works by exporting the necessary materials including patient images and information such as reports to a portable media or local destination These export folders can then be written to a direct media such as a CD DVD or zip disk If you are running Windows XP you will be able to burn CDs directly trom iSite without having to exit the application The CD Manager provides for easy distribution but most importantly no internet connection is needed to view patient exams Please note that exam memos allergies and other clinical information is not exported To access the CD Manager click the CD Manager listing in the iSite Radiology Folder list as seen below Folder List La site Tools Ca CO Manager Exception Het Q iQuery My Filters I My History Patient Directory Statistics Stentor 0 System Filters 3 Personal Folders Michelle Steve Public Folders The following window will be displayed 44 Modality Body Par Ctar Site Media Format C DCOM Format C Both SUMMAN Frotection 0 Exam s Media Viewer Enable Password Required Disk Space Password Available Disk space Confirm Password St
252. tate the original VOI LUT may not be reproducible If a subsequent Presentation State is created from this second VOI LUT the pop up menu will designated it as PS MOD PS MOD to indicate that the VOI LUT is removed by two degrees from the original If the original VOI LUT option was modified by adjusting the image WW WL manually the Restore Default Settings menu option will become available Selecting this option will return the VOI LUT to the original settings and the renamed VOI LUT option will be removed from VOI LUT pop up sub menu Selecting the Disable VOI LUTs option will re enable Window Width and Level options in the pop up menu Please note that when a VOI LUT is selected then subsequently disabled the default WW WL value will become histogram calculation based The only way to recover the initial default WW WL will be to reload the initial presentation state Measurement The measurement tools Ruler Angle Region of Interest and Freehand ROI allow you fo indicate and measure specific areas of an image The Point Value tool is used for measuring the Window Width and Level value of a single pixel Please note that all measurements and annotations can be cleared from an image by right clicking the image and selecting the Delete all Measurements and Annotations option Ad waning measurement values are modality dependant The measurement values that iSite displays are derived trom information sent by th
253. te Patient Location Query Last 3 days STAYNZKY JOESPH aa 0p0I2001 08 59 00 ER0103 ORTIZ FRED 201260491 CAO OIE 08 55 00 ER0103 KILLARNEY CHRISTOPHER 175228612 04p0g2001 08 56 00 EROS Ve S Wie 9605194859 04092001 08 55 00 EROS Searching the Patient Directory The Patient Directory can be searched using one or more of the following criteria Patient Name Enter part or all of a patient s last name then click the Query button Patients whose names match your criteria will be displayed in the Patient Directory To search for both first and last name the names should be entered in the Last Name First Name format Please note the comma separation In order to search for all patients with the last name Smith and the first name Robert you would enter Smith Robert into the Patient Name field iSite Radiology OPH Close All Patient Marne Patient ID Exam Date Patient Location G I Last 3 days STAYNMZKEY JOESPH a Sal S Te 04 09 2001 06 59 00 EROS ORTIZ FRED 201260491 04 09 2001 06 58 00 EROS KILARNEY CHRISTOPHER 175225612 0409 2001 0 56 00 EROS JACKSON TYRELL 960819489 0409 2001 08 5900 ER0103 iSite Radiology 000 Close All Patient Name Patient ID Exam Date Patient Location a JACKSON TYRELL 9608 19469 04 09 2001 08 53 00 ER0103 Patient ID Enter all or part of a patient ID number then click the Query button Patients whose Patient ID match your criteria will be displayed in the
254. te System Administrator If authorization has been granted you will see iQuery in the Folder List Click the iQuery listing as seen below to access this tool Folder List J iSite Tools 9 CD Manager Exception Handler S Lab N 9 My Filters Ga My History Patient Directory Statistics System Filters Personal Folders Public Folders The iQuery Main Page When you click the iQuery Tab the following screen will appear This is the iQuery Main Page and it functions as the center of your activities while using iQuery The iQuery Main Page contains the search fields in which you enter patient data that you wish to retrieve Retrieved patient and study listings will be listed in the dialog below 309 iSite deco All Patient Name _ Date Enter 10 2 0 234 20 234 T Patients Listed STOP GUER F SUBMIT sT VIEW QUEUE Studies Selected Querying for Patient Studies To select studies to be retrieved from the digital archive type either a Patient Name and or a Patient ID into the search fields and click Enter iQuery will automatically search all available archives However if you wish to restrict your search to a particular archive you can select If from the Archive pull down menu You can add as many patients as you would like to the list by entering their names or ID numbers to the search fields and clicking Enter Upon clicking the Enter button the Stop Query button will be ac
255. th the and buttons DICOM Part 10 Export The CD Manager tool in iSite 3 5 now allows the user to export exam images and information in DICOM Part 10 either alone or together with the standard Philips iSite syntax The resulting export includes a DICOM folder which can be easily imported into other DICOM devices DUP UID Cases History Folder iSite now shows a History Folder of Duplicate Unique ID cases that have been observed or resolved Pop up Menu Font Control The font size of iSite Radiology s pop up menus can now be independently controlled via the Machine specific Display Preferences This solves a problem of small display sizes that was being experienced by users with very high resolution monitors 11 DICOM Source Enhancements DICOM Sources can now be configured using exam code criteria allowing for greater granularity in organizing how exams are sorted in the exam racks In addition exam rack sorting via DICOM Sources can now be performed entirely with image level tags if desired Matching Series Rules Import and Export Matching Series Rules can now be imported to and exported from the iSite server This facilitates improved configuration of an institution s radiology protocols by eliminating the need for extensive data entry thereby shortening the time needed to bring iSite Radiology on line Support for Larger DICOM Study Sizes As of iSite 3 5 the limit for acceptable uncompressed DICOM study s
256. the Hanging Protocol for the exam The Hanging Protocol settings Invert Clones and WW WL will not be applied If a Hanging Protocol is selected edited or created for this type of exam all of the Hanging Protocol features will be applied regardless of any Presentation States If the exam has only a Original DICOM Presentation State or only a User Presentation State then the Hanging Protocol will be applied when the exam is opened in the Canvas Page If a Presentation State is selected edited or created from this exam the Presentation State will be applied regardless of any Hanging Protocol 208 User and System Hanging Protocols iSite Radiology provides User and System Level Hanging Protocols A User Hanging Protocol is created by an individual user and Is available only to that user For example if you create a User Hanging Protocol called MR Brain Special that Hanging Protocol will only be available to you System Hanging Protocols are created by your iSite System Administrator and are available to all users User and System Hanging Protocols are created edited and selected in the same WAY Hanging Protocol Hierarchy Hanging Protocols can be created at three different levels 1 Modality Generic Level 2 Modality and Body Part Specific Level 3 Hanging Protocol Group Exam Code Level Very Specific In addition as discussed in the previous section Hanging Protocols can be created at a User or System Level iSite a
257. the Show Localizer feature 205 By default you will see scout lines appear when you click and drag These scout lines can be removed in the Display Preferences section of the User Preferences as seen below Preferences Dialog User Preferences Display Preferences General Preferences Window Width Center Screen Overlay Font Size MAE eeng f Large Medium f Small Filters Display Preferences Hanging Protocols Canvas Page Cine Playback Resolution ee Full Resolution C 512x512 0 256x256 C 128x128 Machine Preferences Network Testing NOTE Changes require a re login to take effect Scout Line Mode C Single C Bracket Localizer Mode No Scout Lines Show Scout Lines Cancel Help For more information on these preferences please see the Preferences Chapter A Waring Using the localizer to navigate a multi phase series Multi ohase studies contain multiple images with the same location identifier Paging through a multi phase series that not has been split will typically result in jumping back to the first slice location each time the user reaches the end of each phase within the series If the localizer is used to navigate through a multi phase series you will notice that the other linked series are synchronized on location and basically display the image with closest location to the one displayed in the master series If The non multi ohase series is used as the master iSite will try to find th
258. the angle s endpoint move the cursor to a second point the angle s apex and click again Note that when the angle measurement has been created each end of the angle lines are active indicated by the small squares at the end of the lines Cobb measurements are in degrees and the limits of accuracy are the same as the canonical angular measurements The user can then select either line to move and separate the point of the angle This is demonstrated in Figure 4 above Move the upper portion of the angle measurement line to represent a parallel line with the superior aspect of the upper most vertebrae that is to be measured Then move 248 the lower line to represent a parallel line with the inferior aspect of the lower vertebrae being measured The angle measurement represents the Cobb Angle measurement for this image as seen below Region of Interest ROI The ROI Measurement Tool allows users to measure the average data value for a circular region of an image The measurement units of the ROI tool are determined by the modality For example with CT the pixel intensity represents Hounsfield units For other modalities in the iSite system the pixels represent intensity The units used are explicitly disolayed or in the case of pixels left blank Standard deviation is unitless and is a standard statistical measure of the dispersion of the values in the region of interest The area measurement is CMA2 if pixel soacing is av
259. the end of the audit trail 2 32 Phl Preliminary Report transcribed by Interface ADT T Time _ Status _ Report Status Event Who Notes T10 PM P Preliminary Image viewed by Admin Stentor 0 59 Phi P Preliminary Image viewed by Admin Stentor 901 PM P Preliminary Image viewed by Admin Stentar Y _ Time Status Report Status Event Coote 10 24 AM P Preliminary Image viewed by Admin Stentor 14 46 PM P Preliminary Image viewed by Admin Stentor en E 1 14 AM Freliminary Image viewed by Admin Stentor 4 52 AM Preliminary Image viewed by Admin Stentor 6 06 Afl Preliminary Image viewed by Admin Stentor 1 56 Ph Preliminary Image viewed by Admin Stentor o 03 Ph Preliminary Image viewed by Admin Stentor 3 07 Pha Preliminary Image viewed by Admin Stentor Akko ff10 2 0 1 7 Sfisuite ModalMain asp Title Exam s204udith20Trail amp scrolling no amp src isuitesidxrad patientrecord Internet When you have finished reviewing the report close the window by clicking the close button at upper right 308 iQuery DICOM Study Retrieval System iQuery is a tool that allows an authorized user to retrieve DICOM studies from your institution s digital archive and send them fo the iSite Patient List If you do not have authorization or if your institution does not have a digital archive iQuery will not appear in the Folder List Accessing iQuery To access iQuery you must have appropriate authorization from your iSi
260. the existing preferences Do you want to continue User Preferences User preferences are those preferences which you can personalize and which are available only to you If you are not a iSite System Administrator you will only have access to the User Preferences and the Machine Preferences To begin personalizing iSite click the Preferences P button located in the upper right hand corner of the iSite Control Strip User Bardach Noah MD iSite Radiolc y There are three sections to the Preferences Dialog 1 User Preferences this section allows the currently logged in user to Customize their user preferences 2 Systems Preferences this section the iSite System Administrator to customize system wide settings that will affect every user System Preferences are only available to administrators and are not visible to standard users 3 Machine Preferences this section allows you to configure settings related to the machine on which you are currently working The second and third preference options are only available to administrators and are not visible to standard users If you have any questions about the administrative preferences discussed below please do not hesitate to contact Philips Global PACS Customer Care at any hour by calling 877 328 2808 or by sending email to isitecare philips com Upon clicking the Preferences button the Preferences Dialog will be displayed as seen below This is where al
261. the various fields and their significance Please note that you do not have to fill in all the fields The default for an empty field is all For example leaving the Patient Location field blank would search for all Patient Locations e Name This is the display name of the filter e Modality Enter the Modality codes ex MR US CT etc that you want the filter to search for If you leave this field blank the filter will search all modalities e Patient Location Enter the location of exams that you want the filter to search for e Body Part Enter the Body Part code or identifier ex Abdomen or ABD of anatomy that you wish the filter to search for 68 Procedure Code Enter the procedure code ex CTABD for exams that you wish the filter to search for Organization If your institution is broken up into separate organizations enter the name of the organization you wish the filter to search for Sub Specialty Enter an exam sub specialty ex Neuro Ortho etc for exams you wish the filter fo search for Description Enter a description for the filter you are creating Ref Phys Name Enter the name of the Referring Physician who s patients you wish the filter to search for using the following guidelines o Search on the Last Name of the referring physician For example lt Doe gt o Search on partial Last Name of the referring physician For example lt Do gt The symbol represents a wildcard in
262. this case and will allows you to match on all last names that start out with Do o Search on Last Name First Name For example lt Doe John gt The symbol is used to separate the Last Name from the First Name o Search for multiple referring physicians For example lt Doe John Smith Ken gt or lt Doe Smith gt The symbol is used to separate the names from each other It is not possible to use the wildcard when searching for multiple referring physicians It is not possible to search for multiple physicians using a Last First Name for one and only a Last Name for another one Type Use the Stats pull down menu to indicate how Stat exams should be included in your search If you only want the filter to search for exams with images check the Must Have Images checkbox and if you wish to exclude exams that have already been read check the Unread Only option Date Period These options limit the chronological scope of the filtered search Exam Statuses These options limit the scope of the filter to certain Exam Statuses Patient Age This option limits the scope of the filter fo patients of a certain age If you wish to limit the results of the filter based on the patient s age check the box and enter an age range 69 e Performing Resource This option limits the scope of the filter to exams Coming from a particular performing resource or multiple performing resources Add the ex
263. tically across the image to increase or decrease the Window Level Please note that when you adjust the window width and level for a series all slices in that series are affected If you want to adjust the window width and level or one slice in a series hold down the L Key while making the adjustment e Viewing Slices in MRs and CTs You can scroll through the slices in a series either one by one Cine mode or rapidly Fast Cine For a frame by frame 198 review slowly scroll the mouse wheel For rapid review hold down the mouse wheel and drag the mouse forward or backward 199 Advanced Image Manipulation Options Advanced image manipulation options can be accessed by right clicking any image or series and selecting the desired item from the pop up menu The pop up menus are shown below The functions available trom the right click pop up menu are Window Width and Level settings CTs also have preset settings for Abdominal Bone Brain Liver Lung and Mediastinum invert image flipo rotate image clone image only CTs print series selection remove window link and mark key image These functions will all be discussed in detail in the Diagnostic Monitors section of this manual Diagnostic Exam Rack Right Click Menus Window Width Level Window Width Leveal Image Processing Image Processing Scout Line Mode Scout Line Mode Localizer Mode Window Width Level b Localizer Mode Create Popup Image Processing b Creat
264. ties DICOM Sources Cert Here screen Overlays TH 4ciLeft Delete Paper Printing THAR ight Body Part Dictionary IE pork Ouer Organization Dictonary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel To add a new style click the Add button The following screen will be displayed Add Annotation re Font Arial Font ATTO Arrow Line Size Line Style SE Cancel Specify a name for the annotation style and its characteristics then click the OK button The new annotation style will be disolayed in the Annotations screen alongside any pre existing styles 92 To edit the properties of an annotation style highlight that style and click the Properties button as shown below Preferences Dialog User Preferences Annotations System Preferences General Preferences Window Width Center Filters oer Annotations Se iii i Fin Here mope DICOM Sources Cert Here screen Overlays Th 4ciLeft Delete Paper Printing THAR ight Body Part Dictionary IE port Duer Organization Dictonary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Add cae a The annotation style properties dialog will appear as seen below Edit Annotation lncise Here Font Arial Font ATTO iv Ao Line Size Line Style 2 Solid reel Help 93
265. tings are the way in which exams are hung the types of exams displayed the window width and level settings for a particular modality the type of information displayed with each exam and numerous other aspects of radiology reading If you are to reap the full benefits that iSite Radiology offers it is very important that you take the time to carefully personalize your iSite Radiology profile The personalization of iSite Radiology can be done on several different levels Users can personalize their own account specific preferences while iSite System Administrators can customize options at a system level for an entire institution These System Preferences are only visible to iSite System Administrators Importing and Exporting Preferences Many preference settings can be imported and exported to facilitate setting up User and System Preferences The User Preferences that can be imported and exported are Window Width Cenfter and Filters The System Preferences that can be imported and exported are Window Width Center Filters Annotation DICOM Sources Screen Overlays Paper Printing Organization Dictionary Location Dictionary and Body Part Dictionary To import or export a preference group select that group in the preference tree by left clicking then right click The resulting pop up Menu will disolay both import and export options as seen below 55 Preferences Dialog User Preferences General Preferences Filters Expor
266. tion section below 215 Hanging of Relevant Prior Exams iSite always loads ONE new Exam and ONE relevant prior Exam if available New and Prior exams are hung based on the Hanging Protocol of that exam type not on whether it is a new exam or a prior The general mechanism for the selection and hanging of a relevant prior is based on o The definition of a relevant prior for a given exam type o The applicable Hanging Protocol of the prior exam o The number of monitors available to display the prior exam Hanging Protocols and Monitor Configuration Not all workstations have the same monitor configuration and users want to know what happens to a HP when logging into a system with a different monitor configuration Hanging Protocols are optimized to work with ONE TWO or FOUR diagnostic monitor displays iSite supports TWO monitor Hanging Protocols and provides a hotkey lt F2 gt to toggle between what is visible and what might not be visible The following examples are used to explain how this works First create a 2 Monitor Hanging Protocol Hanging Protocol Name CR CHEST one AP one Lateral Monitor 1 General PA Monitor 2 General LAT 216 The following examples are used to explain how the Hanging Protocol will be applied based on the number of monitors available for an exam and whether or not there is a relevant prior available The following table is used to explain how using the hotkey It is possible to switc
267. tion Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Location Dictionary Bldg 4 Floor 1 Section Blue Bldg C Floor 1 Delete Bldg 4 Floor 1 Section Red Bldg 4 Floor 1 Section Green Bldg A Floor 2 Section Blue Bldg 4 Floor 2 Section Red Bldg A Floor 2 Section Green Bldg E Floor 1 Bldg C Floor 1 Bldg C Floor 2 Bldg C Floor 3 Bldg C Floor 3 ICU Bldg C Floor 2 ICU Cancel Apply Help To add a location to the Dictionary simply type the name in the bottom field and click the Add button The location will be added to the list above To remove a location click the listing and then the Delete button Plug Ins The Plug Ins preferences allow you to create links in the iSite Folders List and the iSite Shortcuts that point to other web interfaces or websites For example if your institution s lab results are available from an in house server you can display that server s interface in iSite by creating a Plug In The preferences dialog allows you to name the Plug Ins enable them in different iSite programs and set security codes for 121 them if necessary To access the Plug Ins select its listing from the System Preferences pull down list as seen below Preferences Dialog User Preferences Plug Ins System Preferences General Preferences Window width Center Filters Annotations Talk Dictation i Froperties DICOM Sources DMCS Online Screen Overl
268. tion as required and then click the OK button The new archive listing will appear with the pre existing ones To edit a listing highlight that listing and click the Properties button as seen below Preferences Dialog User Preferences System Preferences General Preferences Window width Center Filters Annotations DO A ee ee Eee ee ee ee eee Properties X DICOM Sources a a Screen Overlays Delete Paper Printing Body Part Dictionary IE port Duer Organization Dictionary Location Dictionary Plug Ing Hanging Protocols DICOM Print Machine Preferences Network Testing Cancel Edit information where necessary as seen in the window below 119 AE Title Remote Host Description 1888 TA Host IF i0 2 0 153 Pork 104 Frefered Query Model i PATIENT_ROOT a 1 Close On Cancel P Merge Ark Compatibility Cancel When you have completed your edits click the OK button If you wish to delete a listing highlight that listing and click the Delete button Click the Apply button to make your changes permanent Organization Dictionary The Organization Dictionary lets you specify the various organizations present in your institution if you use organization in your exam records The listings are then used for the purposes of exam searches These names listed in this dictionary must match the information coming from your institution s HIS RIS system To access the O
269. tivated and a flashing red light on the button will indicate that your query is being performed If you would like to stop the query click the Stop Query button 310 logy ee P 2 ia a iSite Radio Patient study Date 10 2 0 234 vy 0 Patients Listed STOP QUERY SUBMIT LISTI VIEW QUEUE 0 Studies Selected Selecting Studies for Retrieval The patients that match your query are disolayed below If no studies match your query you will be notified by a message in the iSite Control Strip If more than 50 studies match your search criteria only 50 will be disolayed and you will be notified in the iSite Control Strio that you must narrow your search As with the iSite Patient List the list of available studies can be sorted by Patient Name or Patient ID by clicking the gray column headings above the search fields View the studies available for a patient by clicking the plus symbol at left Select the studies you wish to retrieve by checking the boxes to the left of the studies If you wish to select all of a patient s studies simultaneously you can double click on that patient s name Please note that this function is only available on an internal network connection The number of patients listed and studies selected will be displayed in the dialog box at lower left 311 iSite Radiology 00a All Patient Name _ Date Enter 10 2 0 234 l 20 234 SA 0 0 0 g OODE E KILLARNEY CHRIST
270. tton The Filter Worklists There are two different types of Filter Worklists Personal Filters MyFilfers and System Filters Both of these can be access from the iSite Folder List as seen below 151 Folder List gt x C iSite Tools 9 CD Manager Exception Handler A iGuery 9 My Filters 1 Bardach CR Cranium to Gardach CT Head i Bardach MR Brai Patient Directory 2 System Filters i Completed Exams i CR AI 1 CT All i Last 3 Days i Last 7 Days gt Last Month Ta MEA All 3 Personal Folders C Bardach CTHead 8 Bardach Images for Glas 4 iiil gt The Filter Worklist contains all available unread exams and will be organized according to the filter currently being employed The bottom portion of the Worklist contains any acquisition exceptions that have been created in your institution s Radiology Information System RIS These exams can be selected and viewed like any other allowing you to provide a diagnostic report even if the exam has not been fully resolved By soending some time at the outset of your first interaction with iSite Radiology you can quickly tailor a set of filters to meet your needs Once you have created your personal filters when you subsequently use the program you will be able to begin working immediately with your personalized configuration and workilist 152 Patient Name PatientiD_ Accession A Date Modality Body Part Status Location Ref Physiciay Zitter
271. uble click the desired Hanging Protocol and the exam you are viewing will be rehung accordingly The same steps can be followed when you choose the Select System Hanging Protocol option from the pop up menu Rehang If you have made changes to your currently applied Hanging Protocol and wish to revert the Hanging Protocol s original presentation click Rehang Deleting Images Authorized users can remove images from the iSite system by clicking the corresponding images in the Exam Racks Images may need to be to be deleted for any number of reasons some of which are listed below 1 Technologists sometimes send image s to iSite accidentally using the wrong patient or exam demographics or with a SUID that was already in use In those cases where the SUID is already in use the new images are automatically merged with an existing study These duplicate images should be removed 2 Sometimes an image series or part of a series needs to be rescanned due to imaging or patient problems such as mechanical problems overexposure underexposure patient movement or incorrect patient position etc 3 Sometimes test images are created at the beginning of a procedure and accidentally end up in iSite 223 warning Once images have been deleted they can be recovered However all presentation states measurements and annotations will be lost 226 The two deletion options allow users with the correct permissions to delete images f
272. ur mouse over it 266 ADAMS JULIE 10723 1999 4 36 04 PM Acc 4294000 olx Median Filtering Located in the Image Processing sub menu the Median Filtering tool utilizes a common filtering method to reduce noise in the image R 267 CLAHE Contrast Limited Adaptive Histogram Equalization Located in the Image Processing sub menu this tool utilizes an adaptive form of histogram equalization that enhances the contrast adaptively across the image CLAHE may be used with the following modalities CR DX DR DF MG XA DS RG and OT Please note that when CLAHE is applied the Window Width Level of the image will be automatically adjusted Please note that when CLAHE Is selected the WW WL will be automatically recalcualted using Histogram Calculation because the data range will have changed The initial WW WL values will be restored when CLAHE is turned off ADAMS JULIE 10 25 1999 4 36 04 PM Acc 4294000 m FY ADAMS JULIE 10 25 1999 4 56 04 PM Acc 4294000 m Fy gt A 3 f r i _ i i Interpolation Schemes Located in the Image Processing sub menu iSite Radiology provides three types of interpolation schemes for you to choose from Pixel Replication Bicubic Interpolation and Bilinear Interpolation A checkbox as seen above shows which scheme Is in use for interpolation Of the three schemes Pixel Replication is the fastest while Bicubic is the most accurate When you use the pop up menu
273. user license conditions as are availalbe on request TO the maximum extent permitted by law you shall nol decompile and or reverse engineer the soltware or any part thereo If the Media Export has been protected with a password you will see the following login screen If not you will be taken directly to the Media Exports Patient Directory 50 Pil iSiteViewer ont Koninklijke Philips Electronics N V 2005 AIHA are reserved Reporduction or transmission in whole or if part in any form or by any means electronic mechanical or otherwise is prohibited without the prior written consent of the copyright owner Copyrights and all other proprietary rights in any software andvelated documentation Software made available fo You rest exclusively with Philips or its licensors Nozitle or ownership in the Software is conferred to you Use ofthe Software is subject to the enduser license conditions as are availalbe on request To the maximum extent permitted by law you shall not decompile and orfreverse engineer the software or any part thereof When the user logs in he or she will be presented with a Patient Directory in which alll exams stored on the disk are displayed A Quick Reference Guide and iSite CD Direct Helo Manual are also displayed for the user s convenience 51 Local Exam Cache iSite allows users to download patient exams to their local machines This feature helps soeed up access to patient exams when iSite is
274. ve selected the devices click the Next gt button The following screen will be displayed 318 DICOM Export Dialog SWINDON MATA MRN 85131 ou are sending the esame MA MASTDCH 03 01 2000 14 23 00 55526579 To the destinatiorn s Agta 3D MF Imaging System RADY Agta 3D MR Imaging System R amp DSa Radiology Workstation 4499 Exeter Radiology Workstation 4457 Jackson Notifications Email I High Priority Description Back Cancel Queue This dialog provides a summary of the export If you wish to send out an email notification when the export is complete enter the address or comma separated addresses to the Email field with a description of the export in the Description field If the notification is of high priority check the corresponding box When you are finished click the Finish button to begin the export At any time you can view the iExport Queue to view the status of all exams being exported in the system To access the iExport Queue click the Queue button trom the DICOM Export Dialog as seen above or click the Q button in the iSite Control Strip as seen below Please note only users with administrative permissions will see the Q button User Bardach Noah MO When you click the Q button the DICOM queue will be displayed as seen below Please note that this queue can also be seen by clicking the Queue button in the Send Export Via DICOM dialogs 319 1Export
275. w Center Seres Splitting Sorting Source Name Description Identification AE Title Modality Manufacturer Serial Number PO Model Name Exam Code Cancel As can be seen from the image above the Add DICOM Source dialog has four tabs Main Window Center Series Splitting and Sorting Each one of these tabs needs to be filled in with the appropriate information for the DICOM Source to be adequately identified and properly linked to iSite Radiology Click each tab to proceed Main In the Main Tab enter a name for the DICOM Source as well as a description These two fields do not have to match a setting on your DICOM Source rather you can fill them in as desired In the Identification section check each box for which you have information For example if your DICOM Source does not have a serial number leave that check box blank The information that you do provide must exactly match that of the DICOM Source you wish to add 95 Add DICOM Source Main window Center Series Splitting Sorting Source Name ICU GECT_Lightspeed 4 Description ICUs GE Lightspeed Scanner Humber 4 Identification M AE Title GE_Lightspeed 4 M Modality CT mM Manufacturer GEMS l Serial Number Pe i Model Hame Lightspeed CT i Exam Code CTHEAD Cancel If you wish to add a generic DICOM Source you can do so by only specifying the modality field Please note that if two or more DICOM Sources a
276. w users with the ISTHPSTD security code can create Series Matching Rules that will be available for other iSite Radiology users Getting Started with Series Matching Rules The first step in creating a library of Rules is to talk with your iSite Radiology users to determine which series and images require Matching Rules The next step is to figure out which modalities in your facility are creating these types of series and images For example if a Radiologist asks for a Matching Rule for CR Femur AP than the Rule must be configured for all modalities which are sending CR Femur AP images Please note only one Rule should be created for each type of series or image Configuring the Matching Rules Below is an example of a Matching Rule for CR Femur AP o To create the Rule right click the series or image in question and select Matching Series Rules as seen below Window WidthfLeyel d Image Processing j Create Popup Clone Monitor Layout P Select Series d key Image Mew Link Save Print Flip Rotate d Matching Series Rules h Delete 293 o The following dialog will appear Hanging Protocol Series Matching Rules Dialog Seres Matching Rules Rule Name Move Up Move Down Add Aule Edit Rule Delete Rule OF Cancel Import E sport If there are existing Matching Series Rules that you would like to import to the system click the Import button Select the XML file from the ensuing di
277. will be displayed site Radiology A protocol of the same name already exists Flease enter another name E Identifier Once you have named the Hanging Protocol choose the principal identifier of the Protocol Choose Modality if you wish the Hanging Protocol to be applied to all exams of this modality ex MR or Modality and Body Part to apply the HP to all exams of this modality and body part ex MR BRAIN Finally choose the type for this Hanging Protocol Select Default if you want this exam to be applied as the default 211 for all MR BRAIN exams Or if you want this Hanging Protocol as a optional configuration that you can engage when needed select the Alternate option Please note that the Hanging Protocol Group option will only be available if your iSite System Administrator has configured a Hanging Protocol Group for this identifier type ie CT CHEST Select the Hanging Protocol Group option if you want this Hanging Protocol to be applied to all Exams belonging to this Hanging Protocol Group Use Series Matching Rules The Use Series Matching Rules checkbox concerns Matching Series Rules that have been set up by the iSite System Administrator These Rules can be used to match specific series or images within a Hanging Protocol Please note only one Rule should be created for each type of series or image By default series images are sorted in the rack based on the DICOM Source system configuration
278. wo different colored Navigation Rectangles indicate which exams are displayed in your Diagnostic Monitors The colors used correspond to the two monitor icons located in the upper right hand corner of the iSite Radiology Control Strip 234 User Bardac h Noah MD iS ite Rad iol ogy IF View Exams 1 Exam s Selected As shown above the red Rectangle indicates that the six enclosed series from the MR exam in the first exam row accession number 4198732 are being displayed in the left Diagnostic Monitor represented by the red Monitor Icon The blue Rectangle indicates that the four enclosed series from the MR exam in the second exam row accession number 4092897 are being displayed in the right Diagnostic Monitor represented by the blue Monitor Icon The Diagnostic Monitor Pane Icons seen in the upper left hand corner of each series thumbnail show where in the Diagnostic Monitor that series is being displayed These Icons can be toggled on and off by clicking Control key P The resulting displays are graphically illustrated below 235 Left Diagnostic Monitor Right Diagnostic Monitor The Rectangles can be used in two different ways to load images series or exams into your Diagnostic Monitors The first method is to drag images and series into the Rectangle The second method Is to drag the Rectangle itself to other images series or exams Both of these techniques are discussed in detail in the iSite Radiology Canvas P
279. works in conjunction with the Export Via DICOM and Send Via DICOM features which allow users to export iSite exams as DICOM to another DICOM device such as a DICOM printer a 3D imaging tool or a DICOM archive To export an exam via DICOM right click an exam listing from any worklist or the Patient Timelines and select the Export via DICOM option The following dialog will appear DICOM Export Dialog SWINDON MAYA MRN 85131 Please select the exams you wish to export MA MASTOCM 03 01 2000 14 23 00 585265 9 Check the exam s that you wish to export and then click the Next gt button The following screen will be displayed 317 DICOM Export Dialog SWINDON MATA MRN 85131 Please select the destinations for the exported exams Agta 30 MR Imaging System RAD Agfa 3D MR Imaging System RAD Sa C Radiology Archive CORY C Records Billing Archie CORVY M Radiology Workstation 4499 Exeter C Radiology Workstation 4499 Robertson C Radiology Workstation 4499 Grand M Radiology Workstation 4467 _ Jackson Radiology Workstation 4a57 Cho C EFILM_1 J build 10 server PMI cTChITOO cro lt Back Cancel Queue Select the DICOM devices that to which you wish to export the exam The DICOM devices listed are compiled from an iSite Dictionary set up by your iSite System Administrator If you don t see a device that you believe should be available please contact your iSite System Administrator When you ha
280. xams are present on the iSite server these will be listed below as seen above This list of exams is interactive An exams report can be viewed by clicking its accession number If you wish to view a list of all exams belonging to the patient in question click the all exams button To toggle back to a list of only related exams click the related exams button Exam Memos To view any notes associated with this exam click the Memos tab at the upper left hand corner next to the Clinical Info Tab Use the buttons in the upper right hand corner to delete audit or add memos To add anew memo click the add button To create a text memo type the desired comments into the blank field When you have finished click the save button to upload your comments The new memo will be displayed alongside the existing memos Your name and a date stamp will be added automatically to the memo Exam Audit Trail To view an audit trail for the exam click the Audit Button in the upper right hand corner of the dialog The following window will appear 307 Z Exam Audit Trail Web Page Dialog Exam Audit Trail for Accession Number 4135625 hall 2 32PM S Exam scheduled by Interface ADT manually as exam CTSTDCM In STDC for 06 16 1999 3 36 PM 22 Phl Exam begun by Interface ADT at 087 1671999 3 36 PM 2 32 Ph C Exam completed by Interface ADT as exam CTSTOCM in STDC at 05 02 2005 2 32 Ph Performing providers are listed at
281. y j Recticule Recticulehungonmainexam ss lt ssS on main exam 2 Both Recticules hung on main exam 2 Recticule 1 on main exam recticule 2 on prior Recticule 1 on main Recticule 2 on main 4 O Recticule 3 not hung Recticule 4 not hung Recticule 1 on main Recticule 2 on main 4 Recticule 3 hung on prior Recticule 4 hung on prior Recticule 1 on main Recticule 2 on main 4 Zt Recticule 3 hung on prior Recticule 4 hung on prior 2 If you wish to cache the entire study on your local machine check the Cache Entire Study option Specify if you wish the spinal labeling tool to automatically display for all sagittal views as well as the number of priors to load with this type of exam The Spinal Labeling Tool is Used for placing specialized spinal annotations on images of the vertebra If you wish to review your settings click the lt Back button and make changes as necessary If you are satisfied with your settings click the Finish button 271 The main exam you have been working on will automatically be rehung based on the settings of the hanging protocol and this hanging protocol will now be visible along with your other User Hanging Protocols 222 Editing Hanging Protocols To edit an existing Hanging Protocol right click the exam row margin and select the Edit Hanging Protocol option from the pop up menu as seen below Presentation State Edit Hanging Protocol
282. yPart LT default Exam Information CT tgest Modality CT BodyPart LT Vertical Rack Other Protocols If you choose Select User Hanging Protocol all of the User Hanging Protocols available for the modality of the current exam will be disolayed The top portion of the sub menu shows the Modality based Hanging Protocols The middle portion shows the Hanging Protocols based on Modality and Body Part If you wish to see Hanging Protocols for other modalities choose the Other Protocols option The following window will appear as seen at bottom left 224 select Hanging Protocol select Hanging Protocol User Protocols User Protocols Modality Modality Modality amp BodyPart CR Modality CR default HangingProtocal Group CT Modality CT System Protocols CT 2x2 Modality CT default Modality CT test Modality CT Modality amp BodyPart Modality amp BodyPart HangingProtocol Group CT LT Modality CT amp BodyPart LT CT LT Bardach Modality CT amp BodyPa CT tgest Modality CT amp BodyPart LT MR BRAIN Modality MR amp BodyPart B MA BRAIN ALT 1 Modality MIA amp Bock HangingProtocol Group System Protocols Modality Modality default Modality amp BodyPart l CT LT Modality CT amp BodyPart LT def HanginaProtocal Group w i gt j Cancel x To browse the available Hanging Protocols expand the directory tree as seen in the image at right Do

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