Medical Image Viewer Guide

Transcription

1 Cloud Medical Image Management Medical Image Viewer Guide March 2016

2 Table of Contents Indications for Use 3 Browser Requirements 3 User Interface Overview 4-5 Study Page 6 Main Toolbar 7 Sub-Toolbars 8-11 Multiple Frames 12 Related Studies 13 Meetings Local Study Viewing 16 Settings 17 Printing 18 Keyboard Shortcuts 18 Feedback & Support support@dicomgrid.com (888) ( anytime ) or (321) ( anytime ) 2

3 Indications for Use DICOM Grid is registered with the FDA as a Class I Medical Device. DICOM Grid is a Medical Device Data System. Its FDA number is DICOM Grid is a software system used to send and receive DICOM images and reports. DG Viewer, a component of DICOM Grid, is a clinical viewer intended as a tool for reviewing medical images. DICOM Grid is used by hospitals, imaging centers, radiologist reading practices, private practices, and CROs. DG Viewer is not intended for use as a diagnostic viewer. Name and place of business DICOM Grid, Inc E. Muirwood Drive, Suite 113 Phoenix, AZ Browser Requirements Microsoft Internet Explorer 9 or later, Apple Safari, Google Chrome, Firefox. 3

4 User Interface Overview Main Toolbar See page 6. Study Page Opens a new tab with study details. See page 5. Closes Viewer Study Series Thumbnails Studies are grouped by Series. Series contain one or more images. Click or drag a series thumbnail to load its images in the main image frame. The first series thumbnail displays: Patient name Patient date of birth (DOB) Study description Accession number Date of study Number of series Subsequent thumbnails display: Series name Number of instances in series 4

5 User Interface Overview Protected Health Information (PHI) Patient: Name, and gender: (F) female, (M) male DOB: Date of birth, MM/DD/YYYY Date: Study date, MM/DD/YYYY; time of day, HH24MMSS Primary, Current: Load order, study location in patient history Instance: 1/x: Instance number in study Patient orientation Indicators appear at top, sides, and bottom: A: Anterior, S: Superior. P: Posterior, I: Inferior L: Left, R: Right Ruler Adjusts to scale on zoom in or out. Protected Health Information (PHI) Ref. Phys.: Referring physician Study: Description Series: Modality in parentheses concatenated with the study series number. Image type: Modality dependent DICOM tag that identifies the type of image displayed. Context Menu Displays with right-click, Windows; Control-click, Mac. Zoom: Magnification level Quality: Image quality: SD: Standard Definition: 256 pixels max defintion, JPEG compressed HD: High Definition: 8 bit max definition; JPEG compressed Diagnostic: Full pixel-depth (8, 10, 12, or16 bit max definition) presented as PNG Center/Width: Window level Indicates window level These items display only if the DICOM tags contain data: Slice Thickness: The slice thickness, in mm Machine name: Radiation machine used to acquire image kvp: Peak kilo voltage output of the device used ma: The total exposure expressed in mas 5

6 Study Page The Study Page opens a new tab when the Study Page link in the Viewer is clicked. It is divided into four sections. Overview: information and functionalities shown below. Series: a list of series in the study. Attachments: a list of items attached to the study reports, etc. Meetings: displays a meeting name and host when a meeting is in progress. 6

7 Main Toolbar View Toggles the View sub-toolbar visible/hidden. See sub-toolbar descriptions on a subsequent page. Scroll Scrolls through a study s images. Use mouse wheel to scroll. Window width/level Sets image s window width (contrast) and window level (the number at the center of the window).mouse: Window width: hold left click, move mouse left-right. Window level: hold left click, scroll up-down. Touch pad: Window width: one finger tap, drag left-right. Window level: one finger tap, drag updown. See window width/level description on a subsequent page. Annotate Toggles Annotation sub-toolbar visible/hidden. See annotation sub-toolbar button descriptions on a subsequent page. Probe This button appears only when viewing CTs. Click and drag on an image to read Hounsfield values. Reset Returns series to original state while remaining on current image. Resets window level, invert tone, rotation, zoom, free draw and line measure annotations. 3D Toggles 3D sub-toolbar visible/hidden. See sub-toolbar button descriptions on a subsequent page. Layout Choose number of images to display from the grid. Maximize opens the selected series in a one-up full screen view. New opens the study in a new browser tab. Print Opens a page in a new browser window with a hyperlinked list of all available images in the study(s) being viewed. See a subsequent page for how-to-use instructions. Info Toggle to show/hide study information. Annotations visible/hidden Toggle to show/hide annotations. Invert Inverts image colors. Export Exports main image or displays editable metadata. See Export Sub-Toolbar below. Cine View images as a movie. US ( multi-frame ) studies are displayed with HTML5 video in actual frames per second. See sub-toolbar on a subsequent page. Key Image Makes the visible study image ( highlighted with a blue bounding box ), a Key image. A study s key images can be viewed by selecting View Key Images in the view options menu in the studies list. Thumbs Toggles study thumbnails visible/hidden. Meet Start a live collaborative meeting with other DG users. See a subequent page for meeting instructions. Actions Share shortcuts. See sub-toolbar description on a subsequent page. Delete Delete images or series. See sub-toolbar description on a subsequent page. Settings Opens the viewer settings editor whichs allows you to set a default layout, default mouse tool, thumbnails position, toolbar buttons by modality, default cine speed by modality, Window Level presets by modality, text display by modality, and hanging protocols by modality. See a subsequent page for viewer settings editor use instructions. Enhance Locally enhance the contrast of an image. This filter provides an alternative to the window/level filter for global contrast enhancement. Record ( Audio ) Opens the audio recorder in a new window. Audio recordings are saved to the study as WAV file attachments. Record ( Script ) Captures screen activity in the viewer ( video ), and microphone input ( audio ). Movie files are automatically saved as study attachments, and available for replay from the attachments list at the bottom of the study thumbnails column. 7

8 Sub-Toolbars View Fit Fits image to screen. Zoom Zooms in and out. Mouse scroll wheel: Scroll up-down. Touch pad: Swipe up/down. When you zoom in, the system zooms to the location of your mouse pointer. Move Pans image. Touch pad: Swipe up/down. Flip V Flips image vertically. Flip H Flips image horizontally. Rotate Rotates image in 90 degree increments. Magnify Click and drag magnify an area. Window Level Up to nine window level presets can be saved per modality. They can be accessed from the window level menu or by using the numeric keys 1-9 on the keyboard. CT supports default window level presets for Bone, Head and Neck, Soft Tissue, and Lung. Select Selects frame. Reset Resets window level to level when viewer was opened. Save Saves currently adjusted window level to a preset. Presets Three examples of as many as nine saved presets. 8

9 Sub-Toolbars Annotations Annotation mark-up is not saved in the original DICOM file. However, you can use the GSPS export button to save a copy of the annotations as a secondary DICOM file, or use the secondary capture button (on the Export menu, see previous page ) to save a copy of the image with burned-in annotations. Select Selects an existing annotation. Once an annotation is selected, you can adjust it by clicking on the points that appear. Delete Click to delete a selected annotation. Fill Click to fill a rectangle or ellipse. GSPS Export Click to export annotations as a Grayscale Softcopy Presentation State file. Line Measure Hold left click and move mouse from point to point to measure. Measurements display in millmeters to 100, then in centimeters. Arrow Hold the left mouse button and drag from the source point to the target point. An arrow will be drawn from the source to the target. Angle Select three points using the left mouse button. The angle at the middle point will be measured and displayed. You can also use the line measurement tool to draw an intersecting line across the angle. The angle between the angle annotation and the line measurement will be displayed at each intersection. Cobb Angles Locate the most tilted vertebra at the top of the curve and draw a parallel line to the superior vertebral end plate. Locate the most tilted vertebra at the bottom of the curve and draw a parallel line to the inferior vertebral end plate. The angle formed between the two lines is the Cobb angle. Rectangle Click to create a rectangle. The dimensions will be calculated automatically. Ellipse Click to create an ellipse. The dimensions will be calculated automatically. Text Click to create text annotations. Radius Draw a circle and the radius measurement will be calculated automatically.. Anonymize Series Anonymize PHI in the pixel data for all images within a series by drawing a rectangle over the area to be anonymized, then clicking this button. A new anonymized series will be created. Anonymize Study Anonymize PHI in the pixel data for all images within a study by drawing a rectangle over the area to be anonymized, then clicking this button. A new anonymized study will be created. GSPS Layer Toggle Visible/Hidden Click to toggle saved Grayscale Softcopy Presentation State. 9

10 Sub-Toolbars 3D 3D tools are for interacting with 3D DICOM data such as CT and MR studies. R/L: Reference Lines Toggles the reference lines visibility for all series. Reference lines show the intersection of the selected image s plane with all orthogonal series. Link When selected and either the mouse wheel or Scroll tool is used to scroll a series, all parallel series will scroll in such a way as to display the nearest image. The loading bar ( a blue horizontal incremental bar at the base of the image frames ), shows the amount of DICOM information that needs to be loaded to enable the linked series and plane localization features. Those features will work when the bar reaches the right hand side of the linked image frames. Local: Plane Localization Click/drag with the left mouse button to localize all visible series to the point under the cursor. A red cursor will display the corresponding location on each series, and the series will scroll to display the nearest image. Layout Maximize Fills the screen with current study image. + New Loads a duplicate view of study in a new tab. Grid Selects the number of series to display simultaneously. 10

11 Sub-Toolbars Export Actions Export Click PNG to export main image as a PNG file. Click DICOM to export main image as a DICOM file. Click Meta to display study s editable metadata in a new tab any non-red DICOM tags. Metadata editor supports study level changes to DICOM tags, not series or image level changes. Editable study list fields are not editable in the metadata editor. Actions The Actions button displays for users with the Routing Rules: Create and run manual rules role permission checked. Any routing rule with the Apply rule when a study is manually routed setting enabled will be available from the new Actions button, shown as Test in this example. Cine Delete Cine The cine sub-toolbar controls video playback. Click Play, or Pause. ( Pause shown here. ) Click Faster to increase playback speed. Click Slower to decrease playback speed. Frames-per-second ( FPS ) is displayed next to the primary Cine button when video is playing. Keyboard shortcuts: P Play/Pause all visible cine loops N Next set of series B Back to the previous set of series Delete Image Click to delete the currently highlighted image. Delete Series Click to delete the currently highlighted series. 11

12 Multiple Frames Layout Click Layout to choose from one-up to sixteen-up layouts. One-up is shown here. Layout Two-up is shown here. Active series The active series is highlighted with a blue bounding box. Clicking another frame will make that frame active. 12

13 Related Studies Related studies have the same MRN in the active folder (organization, group or location). The active folder is the folder in which the viewed study resides. Find related studies If related studies for a patient exist in the DG system, they can be found on the right hand side of the thumbnails panel. Scroll to the right if necessary, and click the related study s icon to load its series. The related study s thumbnails will load alongside the existing study in the thumbnails panel. View a related study Scroll to the related study s heading in the thumbnails panel, and click a series image to load the series. This screenshot shows two studies for the same patient: the Primary/Current study and a Related/Prior #1. 13

14 Meetings Collaborate live with other DG users and guests. Start a meeting Click the Meet button. Name the meeting, then click OK. Attendees The meeting is started. All attendees are shown in the Attendees list. Registered DG users already viewing the study can join the meeting by clicking the Meeting thumbnail. Actions performed by the host ( Move, Scroll, Annotate, Probe, 3D, Window/Level, for example ) are synced live with attendees. ( Continues on next page. ) 14

15 Meetings Invite Guests Click Create Public Link to create a hyperlink, that can be ed to guests ( anyone not already a registered DG user ). Change Presenter Click an attendee to make that person the presenter. ( Registered DG users with appropriate permissions can be presenters. Guests do not have permission to be presenters. ) End a Meeting Click End Meeting. Attendee View Attendees will see the presenter s view, minus the toolbar. Leave a Meeting Click Leave Meeting. 15

16 Local Study Viewing We provide two options for downloading and viewing studies locally. Download Viewer Download Viewer enables local viewing of a study using the full DG Viewer, which includes window level and performs at PACS viewer speeds. Clicking the down arrow to the right of the Download button and selecting the Download Viewer, will download a Zip file to your machine. Un-zip it and double click the index file. The study will open in DG Viewer. You do not need access to the Internet to view the study. Download ISO Download ISO downloads a study package that includes any attached reports and DG Simple Viewer software to make it easy to copy the study package to a CD. Simple Viewer does not include the window level function, but it performs at PACS viewer speeds. Clicking the down arrow to the right of the Download button and selecting the Download ISO will download a Zip file. Un-zip the file, and a folder will appear which can be burned to CD. Double clicking the index file within the folder will open the study in DG Simple Viewer. You do not need access to the Internet to view the study. View Unrelated Studies as Related Studies Open a study by clicking Open in New Tab in the Viewer dropdown button in the study list. Return to the study list. Add a study to the Viewer for the same or a different patient, by clicking Open as Related Study in the viewer dropdown button. Return to the Viewer in its tab (some browsers will take you there automatically). The study you added will display in the thumbnails pane after the series of the original study. You can add more studies to the Viewer by continuing this process. 16

17 Settings All settings are per-user. Account-level settings must be edited by contacting support. Open the settings editor by clicking the Settings button on the main viewer toolbar. Save changes at any time by clicking the blue Save button, or undo all changes by clicking the gray Reset button. Use the menu on the left to navigate. Expand or collapse a section by clicking on it. Edit a page by clicking on a blue link. Clicking on a New Page icon on the right hand side of the menu will add a new page to that section. A page can be removed by clicking the x icon on the right side. Sections General Choose: Default Layout, Default Mouse Tool, Thumbnails Position, Show Related Studies, and Show Stack Series. Toolbar Select and arrange toolbar buttons. Context Menu Select and order context menu buttons. Key Shortcuts Customize keyboard shortcuts for viewer tools. Modalities General - Simple settings like the modality name and the default cine speed. Window level presets - Add and remove window level presets, which appear on the window. level menu in the application when a series of the right modality is selected. Toolbar Buttons - Add or remove buttons from the toolbar for this modality. Text Annotations - Add or remove text annotations for this modality. Hanging Protocols A hanging protocol specifies how studies of a particular type should be displayed on the screen. General - The hanging protocol name and layout. Study Filters - Specify which studies this hanging protocol applies to. At least one filter in every filter group must be matched, so for example, to match only CT studies of the head, create two filter groups, one with a modality CT filter, and one with a study description head filter. Filter types: Modality - The Modality DICOM tag must match the specified text. Study Description - The study description must contain the specified text. Image Sets - Specifies how series are selected for display. Filters are applied in the same way as study filters, but there are more options: Series Description - The series description must contain the specified text. Image Type - The Image Type DICOM tag must contain the specified text. View Position - The View Position DICOM tag must contain the specified text. Laterality - The Laterality DICOM tag must contain the specified text. Multiframe - If checked, this filter only matches multiframe series. Ultrasound Image Type - Extra filter options for ultrasound images. Display Sets - Display sets describe how to display the selected series on the screen: Which image set to use. How to transform the image (flips, rotations). Window level and inversion settings. Which overlays to display (text, measurements). Cine Settings - Specify cine settings such as frame rate and automatic playback. 17

18 Printing Clicking the Print icon in the Viewer opens a new browser window with two columns, displayed here. The left column contains links to each image in the study, Fit to Page, Full Size ( one screen pixel for every image pixel ), and True Size ( 1 on the screen or paper equals 1 in the geometry of the patient. ) Full Size should be used when a specific DPI is required for printing. The right column displays images after their respective links in the left column are clicked. All images displayed in the right column will be printed when the Print link at the top of the left column is clicked. ( Studies with less than 20 images display two additional functioning hyperlinks at the top of the left column: Show All Full Size and Show All True Size. ) Keyboard Shortcuts Keyboard shortcuts can be customized by clicking the Settings button, in the main Viewer toolbar, and then the Key Shortcuts link on the Settings page. General N Next set of series B Back to the previous set of series Arrow up/down Previous/next images Page up/down moves 10 images at a time Annotations Control + C Copies a selected annotation to the clipboard Control + V Pastes a copied annotation Control + D Duplicates a selected annotation Delete Deletes a selected annotation Window Level Number keys 1-9 Applies window level presets Cine P Play/Pause all visible cine loops N Next set of series B Back to the previous set of series 18