User Manual. Contents: 1.General information. 2.Home page. 2.2 Top panel. 2.3 Table. 3. Main elements of the table. 3.1 Drop-down bar. 3.

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1 User Manual Contents: 1.General information 2.Home page 2.2 Top panel 2.3 Table 3. Main elements of the table 3.1 Drop-down bar 3.2 i element 3.3 Attributes 3.4 Filter 4. User account 5. Studies 6. Preview 7. Metastudy 8. Log Report 9. Purchase of studies 10. Uploading of studies to the site 11. Remarks to the moderation 12. Completion of moderation (obtaining public access) 13. How to view a downloaded study 14. Glossary 1. General information The site is a structured database of medical studies, stored in DICOM format. You can download any study and add a study to the archive database yourself. The studies archive contains medical visual images in DICOM format as individual files (archives) zip- and rar- documents, with a name in the form of a sequence number (according to the number of addition).

2 The structure of the archive is based on the compared classification of diseases between pathoanatomical manifestations and clinical classifications, in order to reflect all possible visual changes and determine their situation in the general structure of diseases. The archive of medical images of different pathological processes is designed for demonstration of visual manifestations of diseases, pathological and syndrome-based changes, as well as certain anatomical changes and variants on the images obtained with various radiological methods. The archive can be used openly for both educational and scientific purposes. All information is in free and paid access for users of the site. It is allowed to use the archival data of medical images for research purposes, publication and educational demonstrations. The studies archive of this site contains impersonal data of patients, which is achieved by automatic deletion of data from each study at the moment of uploading studies to the site. 2. Home page 2.1 Top panel. The top panel is a set of icons that reflect the structural organization of the Diagnosis Tree. By clicking on them you can go to the section of interest with automatic sorting of studies in a table, according to the selected section and subsection. The top panel also includes a tool called Filter that allows to sort the studies and show them in the table. General view of the top panel. Changes of the top panel during navigation by its levels 2.2 Table. The table is an organized list of studies, structured according to the addition of studies to the site archive. The table contains a sequence number of a study (by order of addition), drop-down bar, age of the patient, information about the presence of this study in the group of other studies (in

3 a metastudy), date of creation and date of the study, nickname of the user who added this study, method of the study, area of study, chosen diagnosis, note of the cost of the study and attributes. 3. Main elements of the table 3.1 Drop-down bar. The drop-down bar includes the option Edit, by clicking on which the author of the study can edit it and other users can visualize the main parameters of the study and see a screenshot, as well as the presence of attached files and see a detailed diagnosis. The option Download - allows downloading the study in DICOM format in a zip-archive. The option Preview allows opening the study in the on-line DICOM viewer. 3.2 I element. I element is a pop-up table with a brief description of the study and a miniature screenshot with the main data of the study.

4 3.3 Attributes. Attributes are symbolic abbreviations: the number reflects the number of downloads, the letter E reflects the Caucasian race (it can be also the Negroid and the Mongoloid race N and M, respectively), the symbol of sex (male/female), the subjective reliability level established by the author, which reflects the confidence in the correct diagnosis, as well as a mark of public access (the globe) are added after moderation (the mark is in the form of an upward arrow before the moderation). 3.4 Filter. The filter is a tool for sorting studies in the table. It is possible to set and change all the available parameters of the table in the filter. Upon setting the required parameters, click Apply filter. You will see the selected studies in the table. If you need to eliminate the set parameters, click Clear filter.

5 4. User account. User account includes: A. Your profile editable basic information about you. B. My purchases - information about the studies acquired by you and a link to them. C. History register of your actions on the site. D. My studies - table with the studies uploaded by you. E. License agreement set of basic rules and norms for the use of the site. F. Sign out - leave the account. The top menu contains a tab with your Nickname, which is a link to the user account, the Cart, where the studies selected for purchase are shown, Sign out the button for signing out of your account and the mail icon to contact the administrator. 5. Studies. The tab Studies in the top menu includes:

6 A. My studies - allows you to go to the table with the studies that you uploaded. B. Add a study a tool for uploading studies to the site. C. Metastudies a page with the studies grouped by any common characteristic or feature. D. My metastudies - a page with groups of studies united by you. 6. Preview. After clicking the Preview button in the same window (it is recommended to click the right mouse button on Open in a new window ), the on-line DICOM viewer will open. Its loading time can reach 2-3 minutes. On-line DICOM viewer is equipped with the minimum necessary number of tools for viewing and analyzing the images of DICOM files. 7. Metastudy. A metastudy means a group of several studies by a common feature. Such feature can be the studies performed natively and the studies after contrast enhancement, which should be combined for convenient search. It is also

7 possible to combine studies for dynamic observation of the course of a disease during the treatment (several studies with a different time range), studies of different areas of the same patient s body and other reasons for grouping. The general view of Metastudies includes the study number, date of creation and i symbols with the possibility to open a drop-down box with a miniature image and a brief characteristic. The main thing in this table is the comment that reflects the motives for combining the studies into one group into one metastudy. If it is necessary to combine 2 and more studies into one group, go to My metastudies and click Add a study Then, a pop-up window will appear with a list of your studies, from which you need to select a study to be added. You can add only the studies that have passed the moderation (studies with public access). Non-public studies (that have not passed or have not been subjected to the moderation) will not be added. You must add the study by clicking on the study number, after which you will see a note The study was added to the metastudy.

8 After selecting and adding the required studies click OK and the pop-up window will disappear. Now you need to fill in the fields Comment write a short comment in Russian and in English. Then click Actions - select Save. Then select Actions and click on Passed the moderation. This will save your combined studies into one metastudy for public access. Your Metastudy will appear in the general table of metastudies.

9 8. Log Report. The history is a report about any of your activity on the site and the activity of other users associated with you. For convenience and reporting on the use of the resource, the main actions are subject to logging and saving. The history reflects the registration on the site, logging into your account, downloading and uploading of studies with saving of links to these studies. After purchasing a study, the history will show a note of its date, time, number of the purchased study, cost, owner of the study and his/her Purchase of studies. Select the required study and open it by clicking on the diagnosis (in this case, on Agenesis of corpus callosum ). Click on the button with the word DICOM Under the image of the study (if the study is free of charge, the downloading will start immediately).

10 If the study is paid, you will be transferred to a new page prompting to choose one of two buttons Put in the cart and go back to the table or Go directly to the cart. After being transferred to the cart, you will see a list of studies selected for purchase, were you can delete a study from the cart (red button) or go to payment (green button). Payment terminal at Robokassa. Choose the payment method and pay.

11 After paying for the study you need to go to My purchases, where you will find links to the purchased studies with the possibility to download and view them online. 10. Uploading of studies to the site. Click Add a study. It opens a page with the button Download the study. Click on it and select a file in the window for uploading. Important note: - the file must be in ZIP or RAR format - the file must contain DICOM-files (with extension.dcm) - the names of internal folders in the ZIP (RAR) file must not contain an indication of the last name and the first name of the patient, as well as the place of study. - the internal folders in the ZIP (RAR) file must not contain external files (.doc,.pdf,.jpg,.jpeg,.tiff,.html,.png,.xml,.exe, etc.), all files without the extension.dcm will be deleted after the study is uploaded to the site.

12 After selecting a file, click Open and the uploading of the file to the site will start. Uploading stages: copying, unpacking and anonymization of the study, packing and saving of the study. After saving the added study, an information page opens for entry of the data required for description of the study in the table.

13 A screenshot (an image showing the study in jpg format) is attached to the top section. The date of creation of the study, age of the patient and his/her sex are filled in automatically from the data of DICOM-files. You need to fill in the field Patient s race and set the price in the field Price (the price is indicated in $ USA and corresponds to the exchange rate) or leave 0, in which case the study will be public and free. You can upload supporting documents on the tab Attachments in text format (.doc,.pdf) or as a picture (.jpg,.tiff,.png,). The documents must not contain information about the patient and consulting physicians (you need to delete it from the file or pictures in graphic editors). You can write a message for the administrator on the tab Comments when sending the study for moderation (these comments will be available only to the user author of this study and the administrator, who will carry out the moderation). After adding the image (screenshot), it will appear in the window, with a watermark with the name of the site rentgenogram.ru above it. Supporting documents are added after clicking on Add an attachment with the selection of the required file to be uploaded.

14 After adding the documents, they appear on the tab of attachments. The next panel is the Area of the study, where you need to choose an anatomical region subject to the study. You can choose only one area. If several areas were scanned during the study, specify the area with the most important changes and pathologies, which will be designated with the first diagnosis. Assignment of diagnosis. Diagnosis in this case is not a medical concept that includes the main disease and comorbid conditions, but a pathological process identified during the study, which may coincide with a nosologic unit, be a syndrome, a symptom, a local manifestation or another diagnostic finding. The diagnosis can be several (it is not recommended to use more than 3-4 diagnoses in one study). You can add a diagnosis by clicking on the + button. You can delete the added diagnosis by clicking on the - button. Open a Diagnosis Tree by clicking on the button with a pencil. If there is a convincing picture on the methods of visualization or verification of the pathological process, it is recommended to mark the section Diagnosis (Microscopy).

15 The assignment of diagnosis is made by selecting one position in the so-called Diagnosis Tree - a structured set of pathologies, collected by combining and comparing clinical, pathoanatomical and radiological classifications. The section Microscopy includes Histology for designation of changes in the tissue cells and Microbiology for designation of an infectious agent. The next panel includes the selection of the study method, which also has a hierarchical structure of location of the elements of methods, a panel for selecting a subjective level of reliability of the diagnosis, the selection of the location of the

16 place of study. There is also a board to enter important information about the study, where the author can write a brief medical history, some important indicators and give explanations to other users. Selection of the study method Selection of the location on google maps After filling in the fields, check their correctness and the filling in of the mandatory fields (marked with a red asterisk).

17 Then the study is saved click on the Action button and then Save. The DICOM button allows to download the study archive, and the Preview button opens the on-line DICOM viewer in the same window (it is recommended to save the study first, since the unsaved fields will lose the selected information, or open a preview in a new window). If you want to make the study public, send it to the administrator for moderation by clicking the button For moderation, after which the study will be available to all visitors of the site. After study is sent for moderation, it is impossible to make any corrections in it.

18 The moderation process is a test of conformity of the uploaded data with the study. The moderation does not guarantee an absolutely correct assessment of the study and is not aimed at the establishment of an absolutely accurate diagnosis; this is just a test of conformity of the information entered by the user and review of the study, as well as an objective suppression of evident contradictions and mistakes made in the assignment of diagnosis or filling in the fields. The site administrator guarantees the safety, non-disclosure and nondistribution of your study during the moderation process. Studies that do not undergo moderation: 1. Studies containing information about the patient that cannot be deleted automatically. 2. Studies with attached documents, containing information about the patient and/or medical staff. 3. Studies located in the folders with names similar to the last name or first name of the patient. 4. Studies containing DICOM-files not associated with this Diagnosis. 5. Studies in this database, added by another user. Reasons for refusal of public access to the study (failure to pass the moderation): 1. Content of information about the patient that cannot be deleted automatically, for example:

19 2. Folders in the uploaded file that contain information about the patient must be renamed. 3. Images in DICOM format that contain information about the patient must be deleted:

20 11. Remarks to the moderation all administrator s requirements when returning the study to the user without opening public access will be summarized in the comments or sent to with the study number, because the administrator cannot personally change the data chosen by the user. After the correction, the user must send the study for moderation again or delete it, change on his/her computer, recreate an archive, download to the site and send it for moderation with a note (in the comments) about the correction of the previous inconsistencies. 12. Completion of moderation (obtaining public access). After a positive decision of the administrator about the conformity of the user s study with the rules of filling in and publication on the site, a globe icon appears in the attributes on the user's page My studies. When opening this study, its page will look like the rest of public studies:

21 13. How to view a downloaded study You need to download the so-called DICOM Viewer a viewer of the study. There are a lot of such programs, both paid and free. The simplest programs with a rich interface are: 1. RadiAnt DICOM Viewer (for Windows) You can download it here: 2. Horos DICOM Viewer (for MacOS) You can download it here: Glossary

22 14.1 Metastudy means a grouping of several studies by a common feature Moderation means a test of conformity of the information entered by the user and review of the study, as well as an objective suppression of evident contradictions and mistakes made in the assignment of diagnosis or filling in the fields 14.3 Diagnosis tree means a structured set of pathologies, collected by combining and comparing clinical, pathoanatomical and radiological classifications.