User Manual. Version Release INT EN 003R. Copyright IMAGE Information Systems Ltd.

Transcription

1 iq-x User Manual Version Release INT EN 003R Copyright IMAGE Information Systems Ltd.

2 TABLE OF CONTENTS: 1 INTRODUCTION SYSTEM REQUIREMENTS CHANGES TO PREVIOUS VERSIONS INSTALLATION AND ACTIVATION THE iq-x LICENSING SYSTEM ACTIVATION OF THE iq-x WEB VIEWER USAGE OF THE iq-x WEB VIEWER STARTING THE iq-x WEB VIEWER OVERVIEW OF THE VIEWER THE STUDY/SERIES SELECTION BAR THE IMAGE PROCESSING AREA THE TOOLBOX THE REPORT DIALOG CONFIGURATION OPTIONS LIST OF ABBREVIATIONS INDEX iq-x Manual INT EN 003R 2

3 1 INTRODUCTION iq-x is an optional module for iq-web PACS software and can therefore only be used in conjunction with an iq-web license. iq-x enhances iq-web with advanced viewing capabilities for almost all image modalities (see limitations in chapter 4), e.g. vascular, neuroradiological, traumatological, orthopedic and cardiac imaging. The iq-x module includes: a DICOM viewer, a preview bar that shows thumbnail images overlay script support Scout-Lines (reference lines) measurement tools, fast and interactive windowing including preset window settings fast image zooming, panning, flipping and mirroring compare mode for series comparison support for multi-frame images support for 8, 12 and 16 Bit lossy and lossless JPEG compressed images support for viewing of structured reports automatic cine mode background preloading of images/series/studies one-click retrieval of uncompressed image automatically integrates with NCH dictation software a structured report writer (PRO Version only) series synchronization 1.1 SYSTEM REQUIREMENTS iq-x is an ActiveX application which requires a Windows-based operating system and the Microsoft Internet Explorer. Minimal system requirements are: see minimal system requirements of Windows XP or Windows 7 depending on which OS you use an Internet or Intranet connection via TCP/IP with at least 64KBit/s 5 GB free space on hard drive iq-webx 6.2.3f Recommended system requirements are: Pentium IV CPU > 2.5 GHz using Windows XP 1 GB main memory network connection of at least 100 MBit/s iq-x Manual INT EN 003R 3

4 Furthermore, we recommend the use of up-to-date anti-virus software on the computer on which iq-x is run. The virus definitions must be updated regularly (they should not be older than 2 weeks). 1.2 CHANGES TO PREVIOUS VERSIONS New Features: NCH 5 support: NCH voice recording now also with version 5 or higher Unicode support in Overlay: The text overlay in the Viewer now also supports special Unicode characters Latin1 support in Overlay and Report manager: The text overlay in the Viewer und the Report Manager now also supports special Latin1 characters Series Synchronization: It is now possible to scroll through adequate series synchronal Cine mode with up to 50fps: The Cine mode now supports a higher scroll speed with up to 50fps Bugfixes: Scout lines were not displayed exactly under some circumstances DICOM attribute planar configuration was handled incorrectly iq-x Manual INT EN 003R 4

5 2 INSTALLATION AND ACTIVATION iq-x as a module (ActiveX plug-in for IE) is already included in the iq-webx software package. Thus, you need to install iq-webx on a server first. The installation for iq-webx is described in another document (see iq-webx 6 2 3f Installation Guide). The procedure for installing iq-x on the clients is described below. Please follow all online instructions to install iq-x correctly. A wizard will guide you through this procedure. In case this approach might fail for some reason, you can alternatively install the viewer by following the instructions given below: Installing iq-x on client PCs (alternative approach): Open Internet Explorer. You need to change the security level: Go to Tools -> Internet Options. Select the tab Security. Choose Internet or Local Intranet depending on how the client is accessing the server (if unsure what to select here, please ask your administrator). Press Custom Level. Change option: Download unsigned ActiveX controls to Prompt. Change option: Initialize and script ActiveX controls not marked as safe to Prompt. Log into iq-webx. After logging into iq-webx, you can access the patients by clicking on the Browse link in the main menu. The iq-x plug-in will be available after selecting one or more patients, studies or series and pressing the Show button. Select any study and press the Show button. On message popup asking if iqx.cab from unknown vendor should be installed, press install. 2.1 THE iq-x LICENSING SYSTEM There are three different forms of licenses available for the iq-x web viewer: an evaluation version of iq-x a Basic license a Pro license of iq-x The evaluation version of iq-x is part of iq-webx, which is available at as free download for evaluation purposes. The iq-x viewer is limited to an evaluation period of 30 days. The Pro and Basic licenses of iq-x can be gained only by purchasing a full license of iq-web/x. The Pro License contains all functions of the viewer while the Basic license doesn t include the Report manager for creating Structured Reports. For further information regarding the activation process, refer to chapter 2.2 Activation of the iq-x web viewer. iq-x Manual INT EN 003R 5

6 2.2 ACTIVATION OF THE iq-x WEB VIEWER After downloading and installing the iq-x viewer that comes with iq-webx, the application runs by default as an evaluation version limited in time. After 30 days the iq-x application stops working unless a full license for iq-web/x is obtained and the software is activated with a specially created activation key. The activation process is performed on the server where iq-webx is installed. This should be done by the administrator of iq-webx. For further details about how to register and activate the iq-x web viewer, please refer to the installation guide of iq-webx (iq-webx 6 2 3f Installation Guide). iq-x Manual INT EN 003R 6

7 3 USAGE OF THE iq-x WEB VIEWER 3.1 STARTING THE iq-x WEB VIEWER To start the viewer, just select one or more patients/studies or series and press the Show button. This will open the viewer if the installation has been previously done without errors. If you cannot see the viewer, please refer to chapter 2. Installation and Activation. 3.2 OVERVIEW OF THE VIEWER The viewer is embedded in iq-webx, so you will still see the menu bar of iq-webx. The viewer consists of a main window showing the images, a toolbar with dropdown boxes for fast selection of studies/series and an automatically hiding toolbar at the bottom. The Viewer Interface with 2x1 Tiling iq-x Manual INT EN 003R 7

8 3.3 THE STUDY/SERIES SELECTION BAR The top toolbar with study/series selection bar Study and series selection In the iq-x viewer you may select individual studies or series via dropdown boxes in the study/series selection bar. If more than one study was previously selected (in iq-webx), you can switch between studies by changing the study selection dropdown box, located on the left side of the upper toolbar. The dropdown box besides, is for series selection and shows all series belonging to the active study. The items of these boxes will contain the study or series descriptions. If no description is available, items will be called study[number] or series[number] respectively. After selection is done, the viewer will start requesting the selected series from the server and if successful, download all images of this series. The status of progress is indicated by two progress bars on the right side. The upper bar shows image download progress while the lower bar indicates series download progress. Besides the dropdown boxes, you can see the number of images belonging to the selected series. Fast selection of the next series in the active study You can easily switch between series by repeatedly clicking the button next to the series selection box. If the study contains more than one series, this will switch to the next series in the list. If there are no items left in the series combo box, pressing the button once again will switch to the first series. Download compressed images If you are low on network bandwidth, you can use compression to lower the storage space of the DICOM images (and respectively the transfer time). There are several compression types available: lossy or lossless compression (JPEG or JPEG2000) and RLE compression. The compression type must be set on the server. This can be done individually for each modality. Please ask your server administrator of iq-webx (or see iq-webx 6 2 3f Installation Guide) to change it to the desired compression type. If compression is activated, you can select the compression checkbox. Note: by default, the compression checkbox will be unchecked. Once it is changed, the status will be saved locally on the client using cookies. Hence cookies need to be allowed to use this feature. NOTE: Images that have already been downloaded to the client pc in uncompressed form will not be downloaded again, even if the compression checkbox is activated. Also, if the server does not possess the compressed images it will only serve uncompressed images. iq-x Manual INT EN 003R 8

9 The following functions are available: Refresh and download an uncompressed image By clicking on the refresh button located in the study/series selection bar and not (!) on your browser. This will force a complete new download without using compression. Usage: Scroll down to the image you like to reload and press the refresh button. Comparing studies To compare two studies (e.g. in a 2:1 mode), first mark the Compare Mode checkbox to change from Tilemode to Compare-mode, then click the Tile-Screen button in the tool box (see chapter 3.5 The Toolbox for more information) and select 2:1. The left tile-screen window will display the first study, the right one at first nothing. To add the second study to the right window, select the window and change the study or series dropdown box. After selection, the images will be loaded into the selected view. Tile window If you do not want to compare images but rather display a series like on a film, e.g. image 1-4 of a series, just uncheck the Compare Mode checkbox. This will automatically fill all visible windows. Now, if you scroll down, all windows will be updated with the following images accordingly. Status indicator Several messages shown in the Status indicator provide an overview about active tasks: Status: idle system is idle, active series download has finished. If preloading on idle is activated, this state will change to: Status: processing tasks after some seconds Status: requesting system requests a new series download Status: downloading indicates image download of active series. Will change to: Status: idle once all images finished downloading Status: jobs waiting indicates that preloading of images is activated and will be processed once the active series finished downloading Status: preloading series [completed series]/[max series] Preloading on idle is activated. The system will download series in background, depending on your settings. Status: all jobs processed indicates that all series finished downloading, depending on your setting iq-x Manual INT EN 003R 9

10 Status: retrieving original image appears after clicking the refresh button, indicating parallel download of uncompressed image (only active image) Status: SESSION TIMED OUT iq-webx session time-out for this user due to inactivity. This is a security feature. You need to log-in again to restart working with the viewer. To do this, just click on the back button of Internet Explorer. Note: Time-out can be configured or deactivated. Please read the iq-webx Manual for further instructions. Status: Connection lost if the client loses connection to the server, this message will be shown in red. 3.4 THE IMAGE PROCESSING AREA The ruler on the right side indicates sizes of displayed images. The measurement is given in centimeters (cm) each segment comprising 1 cm; the total length being 4 cm. The ruler is not shown, if the Pixel Spacing attribute is missing. Image with orientation indicators The yellow markers in the images are orientation indicators. Those indicators help to determine the orientation of an image, e.g. right or left, top or bottom. Those indicators will remain in the correct position even if an image is flipped or rotated: R = right L = left iq-x Manual INT EN 003R 10

11 H = head F = foot A = anterior P = posterior NOTE : If an image displayed in the image processing area is or ever was encoded with any lossy compression algorithm, the overlay will show lossy compression even if it is not compressed any more. Be sure to have the overlay active to see those warnings! Images marked with Lossy Compression may not have diagnostic quality. Check with your authorized dealer if those images meet diagnostic requirements! 3.5 THE TOOLBOX The bottom toolbox To open the toolbox, move your mouse to the bottom of the screen. The individual buttons of the toolbox should be mostly self-explaining; some settings are accessible through right-clicking on them. When a tool is chosen, a yellow frame appears around the button. A red frame around LUT (Look-up Table = Color scheme) and image rotation means that the currently active image is somehow modified (rotated, flipped, inverted, etc.). Multi-frame and single-frame DICOM images are treated equally. The cine mode function (see below) is working for both; series of both can be shown in a sequence. It is also possible to display the individual images of a multi-frame series (sequence) in different tiles, make a tiling, select specific frames and export or print them. Cine mode (stack) = Can be used to quickly browse through a series of images (e.g. CT, MRI, Fluoroscopy) by moving your mouse up and down within the image processing area while holding the left mouse button pressed. In case of DICOM multi-frame images (e.g. angiographic or ultrasound images) as well as single-frame images you can right-click the Cine mode button to select Start autoplay, Stop autoplay and to choose the Frame rate. In both cases, the images are shown in a sequence. Windowing = An image can be windowed by moving the mouse left/right and up/down, holding the left mouse button pressed. The mouse pointer turns into a cursor icon for easier handling. Real-time window leveling is possible by right-clicking the Window button. A popup menu opens where you may choose between several standard settings ( Brain base, Brain, Skull, Lung, Mediastinum, Abdomen, Bones ), an Auto Contrast mode and a ROI Window. ROI Windowing is an auto contrast in a selected area. It is used especially for CR and RF images to generate an optimal contrast in the region of interest. iq-x Manual INT EN 003R 11

12 NOTE: You can also directly window an image by moving the mouse left/right and up/down while holding the middle mouse button/scroll wheel pressed. In this case it is not necessary to activate the «Windowing» button first. Color scheme = gives you the following options: normal grayscale output ( B/w ), inverted grayscale output ( B/w negative ), color remapping ( Color remap ) and inverted color remapping ( Negative color remap ). The color remapping assigns a color to each gray tone. Thus, areas with low contrast can be better displayed. Measure tools, = is used to measure distances, angles and density in a selected area (ROI). By right-clicking on the button you can choose between several measurement tools like Distance, Angle and different ROI tools. To measure a distance, simply click with your mouse on one end of the distance you want to measure, hold the left mouse button pressed until you reach the end point. The result is given in millimeters. To measure the density of a certain area, select the option ROI by right-clicking the Measure button and then choose the area you want to measure. For CT images the results are automatically displayed in Hounsfield Units (HE). To measure angles right-click the Measure button and select Angle. Draw the first ray like drawing a distance measuring line. The second ray does not necessarily have to subtend the first ray. NOTE: Measurements can be applied also to rotated and mirrored images. The Shutter makes it possible to select a specific area of an image (only rectangular) and to blacken out the rest. This function is also reversible by using the Reset button (see below). Magnifier = after clicking on the Magnifier button the mouse pointer turns into a magnifying glass. You can move your mouse over the image area you want to magnify. Hold the left mouse button pressed during the process. You may also click into an area of interest of the displayed image and this area will be magnified. A second mouse-click will return the image to normal. Move/Zoom = is used to change the size of an image; right-clicking on the Zoom button opens a menu with which you can adjust the image size to the window or view the image at the size of 1x (original), 1.5x, 2x, 2.5x or 3x. You can also pan and zoom images dynamically with the mouse pointer. The center area of the image acts as a move zone. If you click into the center and move the mouse up/down/ right/left, the image will be moved. The periphery of the image acts as zoom zone. In this zone the mouse pointer turns into a cursor icon, signaling that the zoom zone is reached. If you click into the periphery and move the mouse up and down you can steplessly zoom the image. iq-x Manual INT EN 003R 12

13 Mirror/Rotate = a click on the Mirror/Rotate button opens a menu where you can choose between flipping images ( Flip horizontally, Flip vertically ) or rotating images (90, 180 or 270 rotation clockwise). Selecting Reset current view will reverse all mirror/rotate changes made to the image and return the image to the original. Tile-Screen = makes it possible to split the image processing area into tiles: 1x1, 2x1, 1x2, 2x2, 3x1, 1x3, 2x3, 3x2 and 3x3. Text overlay = is used to display or hide text information of an image. Dictation = downloads and installs the third party add-on NCH express dictate. Once installed, a click on this button starts the dictation software and creates a voice report that includes all the patient information needed. The tool can be configured to save the report to a network path. Structured Report = opens the report dialog and connects to the report server. The report dialog lets you create, store and load reports and store them on the PACS. This is a PRO Feature. Settings = a click on this button opens a popup menu that lets you change various settings described in section Configuration Options Reset = resets all changes made to the image (e.g. if the image was windowed or measured) and returns the image to the original. iq-x Manual INT EN 003R 13

14 3.6 THE REPORT DIALOG The report dialog offers you the possibility to create structured reports, to store draft versions in a special database, as well as to create, delete or edit templates that help you save time when inserting often-used phrases or report fragments. The final report will be created on the server as a DICOM Structured Report and can then be sent to other workstations that support reading of structured reports (e.g. iq-view). The report dialog The report dialog consists of three parts: the report list, the report writer section and the template list. There are two fundamentally different ways to store a report: storing the report in the special report database and storing the report directly on the PACS. The first option is usually used for fragments or draft versions of reports that need further editing or verification. It does not create DICOM-SR files and you will not find the reports on the PACS. However, when stored in the special report database, you can later on load and edit your report on any other PC. Creating the report will convert your textually written report into a DICOM-SR file and import it into the iq-webx PACS system. Once the draft version is created, it will be automatically deleted in the report database. The report list on the left side shows all (draft) reports that belong to this study. You can click on any entry in the list to update the report writer section. The report writer section consists of 6 Parts: A report description field and 5 text fields that let you describe different parts of the report (History, Request, Findings, Impression and Recommendation). To store a draft iq-x Manual INT EN 003R 14

15 version in the report storage database you only need to fill in a descriptive name in order to easily find your report for later editing. If you want to finally create a report, three fields are mandatory: the report description, the reporting physician s name (usually your name will be displayed here automatically) and the verifying institution (will be copied from the attributes found in the image. Please verify that this institution is correct!). The status indicator on top of the report writer will tell you if you have to fill in essential field data. It also informs you about the report creation status (e.g. Report was successfully stored on the PACS or Failed to store/to create the report ). The template list on the right side will be initially empty, but once a template has been created and stored on the server, everyone can use it to fill the report with often-used words or phrases. Of course, you could also store complete reports for special cases that only need to be edited later. To use the templates, just double click on the template name and the template will be filled in the appropriate fields. Buttons that you will find in the report dialog and their meaning: Store Report = stores the report in the special report database. This will NOT create a report on the PACS. The report database is only accessible from within the report dialog. All stored reports are visible to all users in your iq-webx system. Create Report = create a complete and verified report on the PACS. Once done, the report stored in the database will be automatically removed. The report can be found as a SR object on the PACS. Add Report = creates a new entry in the report list (left side of report dialog). You need to save the report using a descriptive name to finally store the report on the server. Delete Report = deletes a report from report storage database. Reports that are already stored on the PACS cannot be deleted with this function. Left align = left align selected text. Center = center selected text. Right align = right align selected text. Bold = change text format to bold. Italic = change text format to italic. iq-x Manual INT EN 003R 15

16 Underline text = underline selected text. New Template = opens the template dialog to create a new template. 3.7 CONFIGURATION OPTIONS The following is a list of menu entries that you can use to configure your local iq-x. Left click on the settings icon to show the option. The settings button Version Indicator Shows the version number of the installed viewer. Synchronize Views When in Compare Mode, this will start the Series Synchronization either in automatic or in manual mode, depending on the option you set in Synchronize Mode described below. If possible all active series will be synchronized. You can exclude single series by clicking on the chain icon. A Yellow chain stands for an incomplete downloaded series. It will turn blue if the download is finished. Preloading On Idle If selected, the viewer will download series when idle. Settings will be saved. Default: not selected. Preloading Target [Active Series Active Study All Studies] You can choose what the viewer will download when idle. All Studies: viewer preloads all studies including all series Active Study: viewer preloads all series of the current selected study. If you change to a new study (via the study selection box) it will preload all series of the new study. Active Series: the viewer just validates if the current selected series finished downloading and reloads missing images. Default: All Studies Clear Cache [Now] Clicking on Now starts deleting all temporary files. This is a fast way to reload a complete series with a different setting (compressed/uncompressed). If you run out of disk space this is a fast way to free some. Download Mode [Downwards Upwards Alternating] This setting allows you to choose your preferred method of download while viewing images: iq-x Manual INT EN 003R 16

17 Downwards: the viewer will download all images beginning from current position (image that is viewed) downwards the images stack until reaching the end of the stack. After finishing, it will start again at the beginning until all images are loaded. Upwards: the viewer will download all images beginning from current position (image that is viewed) upwards the images stack until reaching the beginning of the stack. After finishing, it will start again at the end until all images are loaded. Alternating: the viewer will download all images beginning from current position (image that is viewed) downwards and upwards (alternating) the images stack until reaching the beginning of the stack and until all images are loaded. Default: Alternating Decompression [after receive on the fly] This setting allows you to change the default behavior of how compressed images are treated after they have been downloaded. You can choose between decompress after receive and decompress on the fly. Images are either directly decompressed or decompressed on first access. Both methods come with advantages and disadvantages. The first one results in faster scrolling while the latter one results in faster downloading, as the downloader doesn t have to wait for the decompression. Default: After receive Display [Show Traffic Scout Lines Auto Tiling Show Hints] Show Traffic: If this option is activated the status indicator will show the active traffic using this pattern: [size of image] / [downloaded [Speed in kb/s] This option can be useful to check whether compression works as expected, resulting in a smaller size of image and to check the actual speed of connection. Default: Selected. Scout Lines: If this option is activated series that belong to the same study show reference lines, lines that represent the projection of the active image. This helps to understand where the image is located in space. To see the scout lines you need to enable compare mode and drag several series into a tiled view. Default: Selected. Auto Tiling: If this option is activated, the viewer will always choose the best tiling when displaying a series depending on the amount of images included in the series. Example1: Series contains 1 image auto tiling chooses 1x1 Tiling Example2: Series contains 128 images auto tiling chooses max possible Tiling [3x3] Default: Selected. Show Hints: This option lets you activate/deactivate hints (sometimes called tooltips) in the report dialog. Default: Selected. Synchronize Mode [Automatic Mode Manual Mode] Automatic mode: The automatic mode automatically finds the adequate images in the other series if they are taken by the same modality. If not the chain icon turns red and automatic synchronization is not possible. Manual mode: The manual mode can be used if the automatic mode cannot synchronize the views. For calibration you have to arrange the images before starting the synchronization. This arrangement will be taken as reference. Note that the manual mode only works for series with nearly the same orientation. If the orientations differ significantly, the chain icon turns red and synchronization is not possible in manual mode. iq-x Manual INT EN 003R 17

18 4 LIST OF ABBREVIATIONS CR CT DICOM DR DX IP RF ROI UPS US SR Computed Radiography Computed Tomography Digital Imaging and Communication in Medicine Direct Radiography X-Ray Systems Direct X-Ray Systems, e.g. Angiography or Fluoroscopy Internet Protocol Radiographic Fluoroscopy Region of Interest Uninterruptible Power Supply Ultrasound Structured Report iq-x Manual INT EN 003R 18

19 5 INDEX ACTIVATION OF THE IQ-X WEB VIEWER 6 ACTIVE-X 5 ADJUST IMAGE SIZE 12 ANTI-VIRUS SOFTWARE 4 AUTO CONTRAST 11 CINE MODE (STACK) 11 COLOR REMAPPING 12 COLOR SCHEME 12 COMPARE MODE 3 COMPARING STUDIES 9 DICOM MULTIFRAME IMAGES 11 DICOM VIEWER 3 DOWNLOAD COMPRESSED IMAGES 8 EVALUATION VERSION 5 FLIPPING IMAGES 13 FRAME RATE (SELECTION) 11 FULL LICENSE 5 GRAYSCALE OUTPUT 12 IMAGE PROCESSING AREA 11, 13 IMAGE ROTATION 11 IQ-WEB 3 IQ-X VIEWER 8 LICENSING SYSTEM 5 LUT 11 MAGNIFIER 12 MEASURE DISTANCE 12 MEASUREMENT TOOLS 3 MIRROR/ROTATE 13 MOVE ZONE 12 MOVE/ZOOM 12 MULTI-FRAME IMAGES 11 ORIENTATION INDICATORS 10 OVERLAY 13 OVERVIEW OF THE VIEWER 7 REFRESH A SERIES 9 RESET 13, 15, 16 ROI 12 ROI WINDOW 11 ROTATING IMAGES 13 RULER 10 SHUTTER FUNCTION 12 SINGLE-FRAME IMAGES 11 SOFTWARE ACTIVATION KEY 6 STARTING THE IQ-X WEB VIEWER 7 STUDY AND SERIES SELECTION 8 STUDY/SERIES SELECTION BAR 8 SYSTEM REQUIREMENTS 3 TEXT OVERLAY 13 THE IMAGE PROCESSING AREA 10 THE STUDY/SERIES SELECTION BAR 8 TILE WINDOW 9 TILE-SCREEN 9, 13 TOOLBOX 11 WINDOW 11 WINDOW LEVELING 11 WINDOWING 11 ZOOM 12 ZOOM ZONE 12 iq-x Manual INT EN 003R 19

20 IMAGE INFORMATION SYSTEMS LTD. OFFICE 404, 4TH FLOOR ALBANY HOUSE 324/326 REGENT STREET LONDON W1B 3HH UNITED KINGDOM TEL. UK: TEL. GER: TEL. US: FAX UK: FAX GER: FAX US: INFO@IMAGE-SYSTEMS.BIZ iq-x Manual INT EN 003R 20