CT Lung System. User Manual Version 2.0

Transcription

1 C T L U N G CT Lung System User Manual Version 2.0

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3 CT Lung ImageChecker CT Lung System User Manual Version 2.0 PN Rev A

4 Technical Support Use the information in this flip chart to try to solve any system problem you might encounter. If the system generated an alert, take a look at the Troubleshooting, Alerts & Messages tab. If you require further assistance, contact your R2 service representative: US/Canada Toll free: +1 (866) CHECKED ( ) Phone: +1 (408) Fax: +1 (408) techsupport@r2tech.com Hours: 5am - 6pm, PST Europe/South America/Asia Please contact your local dealer/distributor. Caution: Only service engineers certified by R2 Technology are qualified to install or repair the system. R2 Technology, Inc West Fremont Avenue Sunnyvale, CA USA , R2 Technology, Inc. All rights reserved. Reproduction of this document without prior written approval is prohibited. R2 Technology reserves the right to revise this manual. Issued July, Protected by one or more of the following U.S. Patents: , , R2; R2 Technology; the R2 logo; ImageChecker; AutoPoint; PE; CheckMate; Earlier. Smarter. Better.; EmphaSize; DigitalNow; the DigitalNow logo; Gold Standard CAD; PeerView; and RightOn are trademarks and/or registered trademarks of R2 Technology, Inc. in the USA and other countries. Microsoft and Windows are registered trademarks of Microsoft Corporation. This system incorporates the Interface Definition Language Compiler Front End (IDL CFE) and Internet Inter-ORB Protocol (IIOP) technologies, provided and licensed by Sun Microsystems. Refer to the file 3rdPartyLicenses.txt in the c:/r2technology/imagechecker/vendor/3rdpartylic folder on the processing unit for licensing and warranty information. Authorized European representative: MedPass International Limited, Windsor House, Barnett Way, Barnwood, Glouchester GL4 3RT United Kingdom, Telephone/Fax: +44 (0) MergeCOM-3 Advanced Integrator s Tool Kit is a product of Merge efilm.

5 Contents System at a Glance... 1 Study List Screen... 3 Study Search Screen (DICOM Query Retrieve)... 5 Review Screen... 7 Compare Screen... 9 Summary Screen - Table View Summary Screen - Images View Summary Screen - Growth View Server Pages - Queue & Output Managers Selecting Studies for Review Transferring Studies Transferring Prior Studies Navigating Through a Study Reviewing Studies - 2D Tools 27 Reviewing Studies - 3D View 29 Working with Findings Measuring a Possible Finding Probing a Region of Interest Hiding/Showing Borders, Markers, and Measurements Adding a User-Defined Finding Deleting a User-Defined Finding Commenting on Any Finding Working with CAD Nodules Working with Patency Exam Findings Comparing Studies...47 Comparing the Current Study to Priors Linking Studies Based on User-Defined Matches Viewing Summaries Viewing Summary without Loading for Review Adding Your Comments/Impressions Examining Key Images Exporting Key Images Printing a Summary Completing the Summary How Do I...? Start Up/Log Into ImageChecker CT Log Off/Shut Down ImageChecker CT Know Why a Case Failed to Process Delete CAD Results and Re-Process a Study Work with the HIPAA Log Work with the Information Log Setting Viewing Options Creating a Custom Preset Algorithm Description Troubleshooting, Alerts & Messages Troubleshooting Topics Messages & Alerts Index Keyboard Shortcuts i ImageChecker CT Lung User Manual, PN Rev A

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7 System at a Glance This section, System at a Glance, shows the eight major screens that make up the application: Study List Screen Study Search Screen (DICOM Query Retrieve) Review Screen Compare Screen Summary Screen - Table View Summary Screen - Images View Summary Screen - Growth View Server Pages - Queue & Output Managers Each page provides descriptive labels that orient you to the screen and provide a brief outline of the available features. The next five sections after this one mirror a basic workflow, i.e., each tab is named for a major step in the typical workflow and contains references to the various procedures you will perform during a review. Selecting Studies for Review Navigating Through a Study Working with Findings Comparing Studies Viewing Summaries Setting Viewing Options Describes how to configure the various viewing aspects of the application. Algorithm Description An overview of the segmentation algorithm and its criteria. Troubleshooting, Alerts & Messages A list of the various system messages organized by code. This guide also provides a table of contents and an index. Tool Tips and Keyboard Shortcuts Most buttons in the interface provide tool tips that describe the function and also list the keyboard equivalent. For example, when you place the cursor over the Next button in the Review screen, the tool tip reads Go to next finding [Right arrow] indicating that selecting the button takes you to the next finding as does pressing the right arrow key on the keyboard. Context-Sensitive Popup Menus In the Review and Compare views, clicking the right mouse button on any of the image views provides a list of possible choices for that view. For example, on the 3D view, the pop up menu lists the finding, editing, and navigation menu items as well as the 3D tools and Options items. Other sections in the guide contain information that you may need only occasionally: How Do I...? Procedures that you only perform occasionally, e.g., archiving summaries. 1 ImageChecker CT Lung User Manual, PN Rev A

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9 Study List Screen Select a database: Local or DICOM Selecting DICOM opens the Study Search window Filter the Study List Read = Review complete Unread = Review incomplete All = Read and Unread Access the Viewing Options See Setting Viewing Options on page 79 Close ImageChecker CT Access Server pages Select studies to review Double-click to select and load one, or use the Ctrl key to highlight multiple, then click Load Case Load the highlighted study(ies) and start review Thumbnail and details of highlighted study Delete highlighted studies from hard disk or send to archive % of local database utilization indicator. Oldest cases are queued for automatic deletion when 75% capacity is reached (configurable) Archive button is enabled only if there is a default archive configured and the study is marked complete Lists any prior studies available for highlighted study Status and information LAN= network status DICOM = status and activity Info = server error messages CAD = CAD server status View a completed summary without loading the study Opens the Summary screen Submit highlighted study(ies) for processing Used only in the rare instance that a case wasn t processed or additional images are received Search for priors of highlighted study Opens the Study Search screen 3 ImageChecker CT Lung User Manual, PN Rev A (turn page)

10 Study List Screen (continued) Certain columns in the Study List screen are unique to the R2 workstation. These columns in the Study List screen can have the following entries: Patient A green circle indicates nodules results are present; a green triangle indicates patency exam results are present. You will not have patency exam results without nodule results, although you can have nodule results without patency exam results. Contrast If there is an entry is the Contrast column, it means contrast was used in the study and indicates a Patency Exam was attempted. CAD Results None: There are no CAD results on the workstation, and images are not being processed Scheduled: There are no CAD results on the workstation, but the images are on the server queued for CAD processing Processing: There are no CAD results on the workstation, but the images are currently being CAD processed Failed: There are no CAD results on the workstation, and CAD processing failed Partial: Partial CAD results have arrived Ready: CAD results have arrived in their entirety AutoLink A date in this column indicates that at least one prior exists for the study. The most recent prior is listed. Any additional priors are listed in the box at the bottom right of the Study List screen, as indicated on the previous page. Summary - - -: Study is unread Partial: Study is partially read, but not marked complete Complete: Study has been marked complete Archived: Study has been marked complete and was successfully archived in the default PACS archive 4 ImageChecker CT Lung User Manual, PN Rev A

11 Study Search Screen (DICOM Query Retrieve) Enter patient information to use to search remote DICOM database Use the asterisk (*) as a wildcard. Information is filled in automatically for a prior search. Type a date or click the icon to open a calendar from which you can indicate the date Access the Viewing Options See Setting Viewing Options on page 79 Return to Study List by clicking Local Close ImageChecker CT Search control buttons Search = executes search Cancel = cancels current search Clear = clears information Choose to retrieve images or results only, or both Images only are transferred to both the workstation and server; Results only are transferred only to the workstation. View search results Click on a study to select one for transfer, or Use Ctrl+Click to select multiple studies for transfer Select to transfer highlighted studies to the local hard disk Observe transfer progress Click to enter more detailed patient name information (e.g., middle name, or a prefix) Cancel transfer of highlighted study(ies), or refresh to obtain new progress reading 5 ImageChecker CT Lung User Manual, PN Rev A

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13 Review Screen Toggle between Nodule and Patency Exam views Show/hide CAD markers Add/Discard findings and cycle through findings Finding properties & information Current image indicator Comment on findings Move Forward/Back through the study Lung Map Start/Stop the Cine feature Open Study List Open Summary screen (when prior(s) exist, a Compare button is also present) Mark study complete Open next study in list Close application 2D Review Tools - including the measurement tools Select between Tiled and Stack view 2D Review window 3D Review Tools 3D Volume The 3D volume is only visible after you double-click a point of interest in the 2D Review Window Capture 3D Snapshot Show/hide markers & measurements Reset default display properties Select Thin, Thick, or MIP view mode Show/hide finding borders 7 ImageChecker CT Lung User Manual, PN Rev A

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15 Compare Screen The Compare option is available when the current study has one or more prior study, and is available for nodules only. A selection of the 2D and 3D tools are available to use. Current view is marked with caret and bold text As indicated by the dates, the prior study is shown on the left, the current study on the right If there are multiple priors, the date field becomes a drop down list, allowing you to select the prior to view. When using Auto, and stepping through the findings using Prev/ Next, the finding properties & information are displayed, including any growth data Match any two findings or clear any existing matches (CAD or userdefined) Specify the Link Mode: Off: Images in current and prior studies are not linked Auto: Current and prior(s) are linked based on CAD findings (automatic) Manual: Uses the three or more user-defined matches to link studies Add/Discard current or prior findings Step forward and backward through current findings (when Auto is selected, the two studies step in sync) 9 ImageChecker CT Lung User Manual, PN Rev A

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17 Summary Screen - Table View Opens the Review screen Patient and study information Toggle between Nodule, Patency Exam, Measurements, and 3D Snapshot views List of findings or measurements Print Summary Report You can configure to print with or without key images and growth data, see Setting Viewing Options on page 79 Opens the Study List Opens the Compare scree (when prior(s) exist) Current view is marked with caret and bold text Marks study complete Opens next study Closes application Key image for highlighted finding or measurement Select Comments or Impressions Type Comments or Impressions Save Key Images to disk The application gives you a selection of graphic formats in which to save the image View Summary in Images or Growth view You can configure the application to open the Summary window in the Table or Images view. See Setting Viewing Options on page ImageChecker CT Lung User Manual, PN Rev A

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19 Summary Screen - Images View The Images View is an alternate way to view the Summary. You can toggle between images showing nodules, filling defects, measurements, and 3D snapshots. The 3D Snapshot view displays the Lung Map and any 3D snapshots you have taken. It allows you to select and delete the snapshots. See Examining Key Images on page 57. Toggle between Nodule, Patency Exam, Measurement, and 3D Snapshot views For more information on the Summary Screen features, see Summary Screen - Table View on page 11 and Summary Screen - Growth View on page 15. You can configure the application to open the Summary window in either the Table or Images view. See Setting Viewing Options on page 79. Move forward/back through the Key Images Only active when there are more than six key images View Summary in Table or Growth view 13 ImageChecker CT Lung User Manual, PN Rev A

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21 Summary Screen - Growth View This view is available only for nodules. Summary statistics, including total volume Data calculated on findings, comparing current to prior study If a finding in the current study doesn t have a corresponding finding in the prior, the left thumbnail image will be blank Date of prior study If multiple priors exist, this becomes a drop list allowing you to select prior to view Date of current study View Summary in Table or Images view 15 ImageChecker CT Lung User Manual, PN Rev A

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23 Server Pages - Queue & Output Managers The Queue Manager displays all cases currently on the server. Using the manager, you can change the processing order of studies, submit a study and prior for comparison, force results to be sent to the workstation, delete studies from the server, and stop CAD processing for studies. Return to Study List by clicking Local Select a study by clicking the check box. Then, choose one of the actions: Run next: process that study next Auto-link: select two studies, then press. The studies are compared and results are sent to the workstation Send output: CAD results are sent to the selected workstations and/or DICOM archives Delete: deletes studies from the CAD server Stop: stops CAD processing for that study Note: The Queue and Output Managers are web pages and as such will refresh more slowly than the other application screens (up to 30 seconds). Also, when deleting, select no more than 100 studies at a time. Deleted cases cannot be resent. Toggle between Queue and Output Managers Use the search function to filter the studies in the list; enter the desired data and click Search % is a wildcard character and can be used in any text entry field. Date format is YYYYMMDD. Sort the studies in the list by clicking any column heading The Description section shows the details for the study most recently selected in the list 17 ImageChecker CT Lung User Manual, PN Rev A

24 Server Page - Queue & Output Managers (continued) The Output Manager allows you to re-send CAD results to the workstation. Toggle between Queue and Output Managers Return to Study List by clicking Local Select one or more studies by clicking the check boxes. Then, click Re-send. This sends the specified results to the destination workstation. Note: Make sure you always send both the Segmentation and Structured Report results. They are both required by the workstation. Use the search function to filter the studies in the list; enter the desired data and click Search % is a wildcard character and can be used in any text entry field. Date format is YYYYMMDD. Sort the studies in the list by clicking any column heading 18 ImageChecker CT Lung User Manual, PN Rev A

25 Selecting Studies for Review The Study List contains all the studies that the workstation has received. Note that the Local and Unread buttons are highlighted, indicating the current filtering. To transfer studies and/or prior studies from a PACS archive, see Transferring Studies on page 21, or Transferring Prior Studies on page 23. You can review studies one by one or create a work list by selecting several and then run through them by clicking Next Study in the Review screen. To select studies for review: Double-click a single study, or Click the column header to sort Click and drag the column border to resize Select a button to filter the list: Read = Review complete Unread = Review incomplete All = Read and Unread To select several, hold down the Ctrl key and single click the studies. Then click Load Case. Tips! If a study was performed using contrast, the contrast column contains the contrast information. Also, the green circle and triangle indicate CAD results (nodule and patency exam, respectively) are available for that study. If the desired study does not show this icon, and the CAD Results column does not indicate that processing has failed, highlight the study and select Process to send the study to the CAD server for processing. If processing failed, see Know Why a Case Failed to Process on page 71. If CAD results are present, but no images, use the Search Screen to transfer studies to the workstation. This is a rare situation. 19 ImageChecker CT Lung User Manual, PN Rev A

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27 Transferring Studies 1 2 Click DICOM Enter patient or study information and click Search The system fills in the study date fields automatically. The first date is today s date. The second date is the difference between today s date and the Number of months to search back that you configure in the Viewing Options. See Setting Viewing Options on page 79. If you want to search a specific study date (or range), enter that directly in both date fields Also you can choose to retrieve images or CAD results only, or Both. Default is Both. From the resulting list, select one or more studies to transfer: Highlight the single study, or To select multiple, hold the Ctrl key and single click the studies. Then, click Transfer The system requests that the study be sent to the CAD server for processing and to the workstation for review. While the system is processing/transferring studies, you may review cases already in the Study List. Tip! For best results, transfer six or less studies at a time. 3 Shows Transfer progress Cancels transfer 21 ImageChecker CT Lung User Manual, PN Rev A

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29 Transferring Prior Studies To find and transfer a prior study: 1 Highlight the patient whose prior study you want 1 2 Click Find Priors to start the search 3 From the resulting list, select one or more prior studies to transfer: Click to select a single study 2 To select multiple studies, hold down the Ctrl key and single click the studies. Then, click Transfer. 4 4 Watch the transfer progress. When it has finished, click Local to return to the Study List. See Troubleshooting, Alerts & Messages on page 85 for information on query validation. Please note that the Find Priors function will not find cases from the same date as the currently open one. 3 Shows transfer progress 23 ImageChecker CT Lung User Manual, PN Rev A

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31 Navigating Through a Study There are five ways to navigate through the images in a study, and two ways to navigate through CAD or user-defined findings. Note that the apex image is always displayed first. Remember to select Nod or PE, first, to display the desired type of findings. Cine - animates a certain number of slices before and after the current slice. Click to start or stop. Finding - Prev/Next steps you sequentially from finding to finding. To use this method, findings (either user-defined or CAD) must be visible on the Lung Map.To turn on CAD findings, click the R2 button (see Working with CAD Nodules on page 43 or Working with Patency Exam Findings on page 45). Toggle between nodule and patency exam CAD findings by clicking he Nod and PE icons, respectively. Lung Map Scroll - click the Current Image Indicator line and drag up or down. Each view displays a line representing the location of the 2D slice. Move the line to change the other views correspondingly. For instructions on specifying the number of slices, see Setting Viewing Options on page 79. Prev/Next - steps you through the images sequentially, one by one. 2D Review Scroll - click anywhere in the 2D window. Then, scroll by rolling the center mouse button up/down. Or, press and hold the center mouse button, and move the mouse up/down. Directly - place the pointer anywhere in the Lung Map and click to display the image for that slice. Click on the CAD finding to display the slice with the finding. 25 ImageChecker CT Lung User Manual, PN Rev A

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33 Reviewing Studies - 2D Tools You can also access any of these tools by using the right-click menu when your pointer is in the 2D image window. Remember to select Nod or PE, first, to display the desired type of findings. Choose stacked or tiled view Change width/level. Click the left mouse button and drag: Left = decrease width; Right = increase width Up = increase level; Down = decrease level Pan and Zoom. To pan, click and drag the image. When zooming, click and drag: Up = enlarge image Down = shrink image To select a window preset, click the Window down arrow, click the preset. You can define custom presets. Refer to the Setting Viewing Options tab. Click Reset to restore image to its default display settings Click the down arrow, then select Thick to display images as thick slices, or MIP for Maximum Intensity Projection display (See Setting Viewing Options to change thickness default for Thick setting) 27 ImageChecker CT Lung User Manual, PN Rev A

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35 Reviewing Studies - 3D View A new 3D view is rendered whenever a new point is selected in the Lung Nodule Map, a finding is selected, or a finding is navigated.remember to select Nod or PE, first, to display the desired type of findings. 5 Click to Hide/Show chest wall and mediastinum: The icon will change to display status 1 Rotate - Select Rotate Click on the image and drag: Across to rotate around current vertical axis Up/down to rotate around current horizontal axis D Box - Click the Box button to toggle on/off the 3D view bounding box Orientation presets: Click A-P to reset to anterior/posterior; F-H to reset to head/foot. 2 Click outside the image and drag clockwise/ counter clockwise to spin like a wheel. Zoom - Select Zoom, then click and drag: Up = zoom in Down = zoom out 1 2 Double-click in the 2D Review Window to draw/redraw the 3D volume 3 Tissue - Click Tissue, then click and drag up to remove low density soft tissue, and down to restore it Click to toggle colorization of Vessels and Airways: 5 3D Volume 6 = Vessels = Airways 7 29 ImageChecker CT Lung User Manual, PN Rev A

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37 Measuring a Possible Finding Before you take a measurement, select one of the measurement tools from the Measurement Tools menu. If the menu label corresponds to the measurement tool you need, activate the menu, otherwise, open it, then select the tool you want. The menu label changes to that of the selected tool, by default it is labeled Length. Density Click a point in the 2D image. The application displays the pixel density at the point (in HU). 1 Activate or open the measurement menu. To activate: Click the button, then take the measurement. To open: Click the down arrow. 1 Length Click a starting point, drag to the end point, release. Application draws a line, displays length in mm. Irregular ROI Click, then drag the pointer around the region of interest border, i.e., trace the border. Release the button; application displays the region of interest measurements. 2 Point to the tool in the menu and click, then take the measurement. You can delete measurements only until a case is marked complete. To do so: Select the measurement and press the Delete key, right-click and select Delete/Discard, or click the Delete button. 2 Elliptical ROI Click the first point and drag; application draws an oval. Release the button when the region of interest is enclosed; application displays region of interest measurements. Probe - See Probing a Region of Interest on page 33. Measurement details are displayed on the left side of the screen in the Properties area, and the system allows you to keep the measurement or convert it to a finding. See Adding a User-Defined Finding on page 37. Note: This example shows the Nodule view, but these instructions apply to the PE view as well. 31 ImageChecker CT Lung User Manual, PN Rev A

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39 Probing a Region of Interest Before you probe a region of interest, you must either activate or open the Measurement Tools Menu. If the menu label says Probe, activate the menu, otherwise, open it, then select the Probe tool. The menu label changes to that of the selected tool, by default it is labeled Length. Activate or open the measurement menu. To activate: Click the button, then probe the region of interest. To open: 1 Click the down arrow. 11 If the finding exists, the application: Creates a volume measurement and draws contours on every image that is part of the segmented object. Re-renders the 3D volume centered on the probed region of interest. Lets you keep the object as a volume measurement or convert it to a finding. See Adding a User-Defined Finding on page 37. If the finding doesn t exist: A message on the status line (bottom of screen) indicates that no finding was found. Note: This example shows the Nodule view, but the instructions apply to the PE view as well. 2 3 Point to the tool in the menu, then click. Place the pointer over the region of interest and click ImageChecker CT Lung User Manual, PN Rev A

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41 Hiding/Showing Borders, Markers, and Measurements To obtain an unobstructed view of the image, hide the finding borders, markers, and measurements. Note: This example shows the Nodule view, but the instructions apply to the PE view as well. Show/Hide markers and measurements Show/Hide nodule or PE finding borders 35 ImageChecker CT Lung User Manual, PN Rev A

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43 Adding a User-Defined Finding You can convert any measurement to a finding. Remember to select Nod or PE, first, to work with the desired type of findings. 1 Place the pointer over the measurement in the 2D window and click, this selects the measurement. 2 Click Add. You can also right-click in the 2D window and select Add Finding from the menu, as shown. Or alternately, press the Insert key on the keyboard. 2 3 With the finding highlighted, open the Lobe drop down list and indicate the lobe location. If you right-click on the finding in the image, a popup menu lists lung laterality, as well as lobe choices. Choices in the drop down menu may be restricted depending on the lung laterality you have chosen. 3 Note: You can delete any findings or measurements you add. To do so: Select the finding or measurement and press the Delete key, right-click and select Delete/ Discard, or click the Delete button ImageChecker CT Lung User Manual, PN Rev A

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45 Deleting a User-Defined Finding You can delete any finding that you add. You cannot delete CAD findings detected by the system, but you can discard them. Therefore, the Discard button toggles between Delete and Discard depending on the type of finding selected (CAD or user-defined). 1 2 Navigate to a user-defined finding. Click Delete. You can also right-click in the 2D window and select Discard/Delete from the menu.or alternately, you can press the Delete key on your keyboard. 2 Deleted user findings cannot be restored. See Working with CAD Nodules on page 43 for information on discarding and restoring CAD nodule findings, and Working with Patency Exam Findings on page 45 for filling defects found by the patency exam. Note: This example shows the Nodule view, but the instructions apply to the PE view as well ImageChecker CT Lung User Manual, PN Rev A

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47 Commenting on Any Finding You can make comments on each finding as you examine it. The application automatically saves and associates the comments with the finding in the Summary. 1 Navigate to a finding. 2 Place and click the pointer in the Comments box to activate it. Begin typing. While typing, the Comments box acts like any basic text editor. Note: This example shows the Nodule view, but the instructions apply to the PE view as well ImageChecker CT Lung User Manual, PN Rev A

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49 Working with CAD Nodules By default, the initial view shows the top of the stack and the Window setting is set to Lung. You can also press the Home key on your keyboard to navigate to the top of the stack Nod/PE - Select the Nod (nodule) button. Selecting PE displays the filling defects mode R2 Button - Click to toggle the display of findings on/off Lists number of markers by type = CAD Nodule Finding = Discarded CAD Finding = User Defined Finding Sizes - Filters the display of CAD markers by size See Setting Viewing Options on page 79 for information on setting the size threshold. All Findings shows all; Small Findings shows same or smaller than size threshold; Large Findings shows larger than size threshold Add / Discard - Select any finding in the view. Click Discard to discard the finding. To reinstate the finding, select the finding and click Add. Prev/Next - Move forward/back (interior/superior) through all findings in sequence Measurements of the current finding Lobe - Drop list where you can specify the lobe in which the nodule/filling defect occurs. Unspecified is the default. Showing/ Hiding Discarded CAD Markers When you discard findings, the application hides them. At any point, you can choose to display them again. To toggle the discarded CAD findings on and off, click the Discard button. A check mark in the icon indicates discarded findings are displayed. 43 ImageChecker CT Lung User Manual, PN Rev A

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51 Working with Patency Exam Findings By default, the initial view shows the top of the stack, and the Window setting is set to Mediastinal. You can always return to the bifurcation of the pulmonary artery by pressing the Home key on your keyboard. 5 Add / Discard - Select the finding in any view. Click Discard to discard the finding. To reinstate, select the finding and click Add Nod/PE - Select the PE button. Selecting Nod displays the nodule mode R2 Button - Toggles the display of findings on/off Lists number of filling defects by type = Candidate filling defects = Discarded filling defects = User-defined filling defects Sizes - Filters the display of filling defects by size See Setting Viewing Options on page 79 for information on setting the size threshold. All Findings shows all; Small Findings shows same or smaller than size threshold; Large Findings shows larger than size threshold Prev/Next - Move forward/back (inferior/superior) through all findings in sequence Characteristics of the current filling defect Lobe - Drop list where you can specify the lobe in which the nodule/filling defect occurs. Unspecified is the default. Showing/ Hiding Discarded Filling Defect Markers When you discard filling defect markers, the application hides them, but you can choose to display them. To show/hide discarded filling defect markers, click the discarded filling defect icon. A check mark in the icon indicates discarded findings are displayed. 45 ImageChecker CT Lung User Manual, PN Rev A

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53 Comparing the Current Study to Priors When the ImageChecker CT Lung system detects a prior for a patient, the system uses the optional AutoPoint feature to register the studies using the anatomical information segmented during CAD processing. Once the current and prior study are aligned, the system then attempts to match any current and prior CAD findings. To compare the current study to a prior, you will: 1 From the Review page, click Compare. 2 The system automatically displays the most recent prior. If there are more priors, the date box is a drop list that enables you to select a specific prior. 3 Select the Auto link mode and scroll through the images to assess the accuracy of the registration. You can use the mouse to scroll through the images. See Navigating Through a Study on page If registered accurately, you can then step through the images using the Prev/Next buttons, which steps forward/backward through the images finding by finding, enabling you to compare the findings. 5 Note that selecting Prev/Next on the current study (shown in Step 4) steps through the images using the current findings. Likewise, using Prev/Next on the previous study steps through the images using the prior findings. Information for any findings is displayed, along with growth data for any matched findings (findings that the system matched on the current and prior study). The system shows the % volume change and absolute change in average density. See the next page for more detail. If you determine that the images are not registered accurately, you can choose to remove and/or add matching points thereby registering the images manually. See Linking Studies Based on User-Defined Matches on page 49 for instructions on doing so. 5 2 To reveal/hide 3D tools, click the rolldown control 3 4 Finding information and growth data, if the finding has a match in the other study 47 ImageChecker CT Lung User Manual, PN Rev A (turn page)

54 Comparing the Current Study to Priors (continued) Please note that the temporal comparison applies only to nodules, not filling defects. For any matched findings (findings that the system matched on the current and prior study), the system shows the % volume change and absolute change in average density. Specifically: If either change is <= 10, the system indicates no real change with the symbol, ~. If either change is equal to or between 10-50, the system indicates the change with an orange up or down arrow. If either change is >50, the system indicates the change with a red up or down arrow. 48 ImageChecker CT Lung User Manual, PN Rev A

55 Linking Studies Based on User-Defined Matches As described in Comparing the Current Study to Priors on page 47, the system attempts to automatically register the current and prior images. On rare occasion, this may fail or you might determine the automatic registration was not accurate (in which case it is unlikely any findings were matched) and want to register the studies manually. To link the studies based on user-defined matches: 1 First, using the Auto link mode described on page 47, review the matched findings (if any) and determine if any are acceptable. If none are acceptable, while in Auto link mode, select Clear and clear all the matched findings. If some are acceptable, then step through the findings one by one and select the Match button to break the match for those you do not want. Selecting Clear permanently clears the matched findings. To redo the automatic matches, delete the CAD results and have the CAD server re-process the study. See Delete CAD Results and Re-Process a Study on page 73.However, the images remain registered should you choose Auto link mode again. 4 To match findings, click on a finding in each series and select Match. This stores the finding as a matched point, as is indicated by the Match button becoming lit. To unmatch select Match again Then, to mark arbitrary points, click Off to turn off the link mode. Scroll the studies to align them anatomically. Once the studies are aligned, click Mark, and then click on the anatomical landmark in one study. Then, click on the matching point in the other study. The system draws a cross-hair at each point. With the two points marked, select Match. This clears the cross-hairs and you can identify more landmarks This stores the two points as a user-defined match. There is no outward indication that a match is saved. 5 Once a total of four points or findings are matched, including any automatic matches you kept, the Manual button becomes available. Select Manual, and you can navigate through the studies. Any modifications made to the prior study are not saved with the study; they are only saved within the Summary report. 49 ImageChecker CT Lung User Manual, PN Rev A

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57 Viewing Summaries The Summary window can display a list of the findings (nodules or filling defects), measurements, or 3D snapshots in a study, independent of the information displayed in the Review or Compare pages. Discarded findings are not included. 1 CAD results are displayed even when the CAD Marker Toggle button in the Review page is not on. You can choose to view the summary in a table format, which displays the summary in rows with columns for various object properties; or by images, which displays the key images associated with each object. When working with nodules, you can also view the results of any temporal comparisons by using the Growth tab From the Review window, click Summary. You can also open the Summary window from the Patient List, see Viewing Summary without Loading for Review on page 53. Select to display the summary by nodules (Nod), filling defects (PE), measurements (Meas), or 3D snapshots (3D). This example shows nodules, Table view selected. 3 Select the view: Table, Images or Growth. By default, when the application opens, it displays the summary in table format. You can, however, configure the application to display the Summary by images first. See Setting Viewing Options on page ImageChecker CT Lung User Manual, PN Rev A

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59 Viewing Summary without Loading for Review 1 From the Study List, select the study with the summary you want to load. 1 2 Click View Summary. The application only loads the summary. The View Summary button is only available when the case is marked complete. 3 If, later, you need to load the entire study, click Review from the Summary screen. The application loads the entire study into the Review screen ImageChecker CT Lung User Manual, PN Rev A

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61 Adding Your Comments/Impressions You create comments and impressions in the Table view. If the Comments box already has text, it is a comment typed earlier during the review. See Commenting on Any Finding on page 41. If necessary, you can edit that text. Comments apply to selected findings. Impressions apply to the entire study. These cannot be edited after the study is marked Completed. 1 1 On the right side of the Table view, click the tab for the type of note you want to make: Findings or Impressions. 2 To create a comment, click the row corresponding with the image for which you want to note the finding. 2 3 Place the pointer in the box and click to activate it. Type the note. While typing, the box acts like a text editor. The application automatically saves the text when you select another finding / study. To edit existing text, activate the text box and begin editing ImageChecker CT Lung User Manual, PN Rev A

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63 Examining Key Images The Images View is an alternate way to view the Summary. You can toggle between key images showing nodules, filling defects, measurements, and 3D snapshots. The 3D Snapshot view displays the Lung Map and any 3D snapshots you have taken. It allows you to select and delete the snapshots. In addition, the system automatically creates one key image for every finding or measurement. To examine key images, click the Images tab in the Summary screen. When you adjust one image with a review tool, all images are updated. You can delete any 3D snapshots you ve created. When viewing 3D snapshots, a Delete button appears in the bottom of the screen. Select a 3D snapshot and click the Delete button. Note that neither the Lung Map snapshot nor other key images can be deleted. If there are more than six images, use Prev and Next to navigate through them Toggle between nodules, filling defects, measurements, and 3D snapshots 57 ImageChecker CT Lung User Manual, PN Rev A

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65 Exporting Key Images The ImageChecker CT Lung application enables you to export all key images to a file (optionally including any comparison images) A key image is one with a finding or measurement. The application provides you with a selection of graphic formats in which to save the image. 1 2 From the Summary page, click Export If growth data is available and you want to include it, select the check box, Include growth Choose where to save the files The default location is: R2Technology\ImageCheckerCT\KeyImages If necessary, change the filename Choose the file type, e.g.,.jpg 2 3 Click Save ImageChecker CT Lung User Manual, PN Rev A

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67 Printing a Summary You can print the entire summary report and key images, including comparison images and growth data. 1 2 Click Print from any of the summary views: Table, Images, or Growth. If growth data is available and you want to include it, select the check box, Include growth. From the print dialog box, select the printer to which you want to send the summary. To include the key images in the printed summary, ensure you select Include Key Images in printed summary in the viewing options, See Setting Viewing Options on page 79. Print 61 ImageChecker CT Lung User Manual, PN Rev A

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69 Completing the Summary When you finish viewing the study, mark it completed. After you mark the study as Completed, you can no longer add or edit measurements, findings, or impressions. Click Complete... To mark the study completed, click Complete... in any of the review, compare or summary screen. The button label will change from Complete... to Completed. Once completed, the summery will be saved automatically to your PACS archive (if one is configured as default). This will include: The tabular information and key images. The key images are saved as 1 DICOM secondary capture series for each of: The nodule findings, including Lung Map PE findings, including Lung Map Measurements, if they exist 3D snapshots The images may then be reviewed at any PACS workstation. 63 ImageChecker CT Lung User Manual, PN Rev A

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71 How Do I...? This section contains procedures that you perform occasionally. Start Up/Log Into ImageChecker CT Log Off/Shut Down ImageChecker CT Know Why a Case Failed to Process Delete CAD Results and Re-Process a Study Work with the HIPAA Log Work with the Information Log ImageChecker CT Lung User Manual, PN Rev A

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73 Start Up/Log Into ImageChecker CT Use the following procedure to start up the ImageChecker CT workstation and then log into the application. 1 Using the power switches, turn on the workstation, monitor, and printer (optional). 2 Enter your user ID and password, then click Login. 67 ImageChecker CT Lung User Manual, PN Rev A

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75 Log Off/Shut Down ImageChecker CT From any window, click Exit. Click an action, then click OK. Log Off ends your session and opens the Login window, ready for the next review session. Admin opens the Administrative Actions. Go to Step 3. Click an administrative option, then click OK. Clicking an option closes the application first. Log Off takes you to the Windows log in screen. Power Off turns off the workstation. Restart restarts the workstation. Desktop takes you to the Windows desktop ImageChecker CT Lung User Manual, PN Rev A

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77 Know Why a Case Failed to Process As explained on Study List Screen on page 3, the Study List provides the CAD processing status of the study. If the CAD Results column reads None, it means that for some reason, the study was not sent to the CAD server for processing. If it reads Failed, it means that the CAD processing was attempted and it failed. When the Column Reads None When the column reads None, you can send the study to the CAD server for processing. To do so: 1 2 In the Study List screen, highlight the study that was not processed (with no CAD results). Click Process. When the Column Reads Failed When the column reads Failed, you need to determine the failure cause, fix it, and then send the study for processing again. Typically, when a study fails, you need to perform the CT scan again. To determine the failure cause: 1 Open the Information Log icon, as shown on page 77. When a study has failed to process, a message is logged in the Information Log (until the log is cleared). 2 Use the information in the log to determine the failure cause. Typically, the scanning protocol was violated in some way. Refer to the manual, Understanding the ImageChecker CT Lung System v2.0 for a description of the scanning protocol. 3 4 If there was no violation of the protocol, try re-processing the study in the event that the failure was due to a network outage. If that doesn t solve the problem, then perform another CT scan making sure that you address the failure cause. 71 ImageChecker CT Lung User Manual, PN Rev A

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79 Delete CAD Results and Re-Process a Study You can delete the study from the workstation, which also deletes the CAD results. Or, you can choose to delete only the CAD results, in which case, the study remains on the workstation. To delete the CAD results: In the Study List, click to highlight the desired study. Click the Delete button. In the dialog that appears, select the check box, Only delete processing results, and click Yes. The CAD results are deleted from the workstation. To delete both the study and the results, leave the checkbox blank. In this case, you would need to use the Study Search screen to retrieve the study from the PACS archive again. To reprocess the study: 1 2 In the Study List, click to highlight the desired study. Click the Process button. The study is sent to the CAD server for re-processing. 73 ImageChecker CT Lung User Manual, PN Rev A

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81 Work with the HIPAA Log The HIPAA log keeps track of user interaction with the application. For example, the log indicates the time at which the user opens a particular study. You can open and read the individual log files using Microsoft Excel or any spreadsheet or editor that can open comma separated values (CSV) files. Ensure you format the first column in the Excel spreadsheet to display the data in the HH:MM:SS time style. Consult the Excel on-line help for instructions on how to do this. The HIPAA log folder contains a separate file for each day the ImageChecker CT workstation is used. To help manage the size of the folder, you must occasionally purge the log, i.e., delete the older files. How often you do this depends on your site s practices. Consult with your system administrator to determine how often you should do this. We strongly suggest you back up the log files before you purge them. You find the log files at the following location: c:\r2technology\imagechecker-ct\hipaa\ This is their default location. If the system was installed under another directory, the log folder is located there. If you cannot find the log files, ask your system administrator for their location. Diskette: Using Windows Explorer, highlight the files you want to back up, then drag and drop them onto the diskette drive. Network Share: Using Windows Explorer, highlight the files you want to back up, then drag and drop them onto the network share. Check with your system administrator to ensure this option is available. When you finish creating the backup, delete the log files. To delete the log files: Use Windows Explorer to navigate to the log file location. Highlight the files you want to delete. Press the Delete key and confirm the delete action. There are several methods you can use: 75 ImageChecker CT Lung User Manual, PN Rev A

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83 Work with the Information Log When the ImageChecker CT Lung system CAD or DICOM servers encounter a problem, for instance when a case failed to process, the servers log messages in the Information Log. When there are messages for you to review, the Information Log icon illuminates. To view the log, click on the Information Log icon, shown below. Clicking on the icon displays the Information Log only when there is information available. The log lists the: Patient name, Study date, Failure reason, Attribute that failed, and Attribute value...where failure reason is the reason why the CAD server or DICOM server did not process the case properly. Select Clear to clear the log, or OK to close it. 77 ImageChecker CT Lung User Manual, PN Rev A

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85 Setting Viewing Options The Options window lets you configure various viewing aspects of the application, and is organized under the following tabs. The default values are shown in parentheses Study List How many months back to search when loading studies to review (12) Review The size above which a finding is labeled Large (10) Default initial view, tiled or stacked (stacked) Number of images to use for the local Cine option (5) Number of images to average for Thick slice mode (5) Summary Default view when opening Summary window, Table or Images (Table) Whether or not to include key images in printed summaries (Include) Window Default window level preset for loading a study (Lung for Nodule review, Mediastinal for PE review) Width and level for application presets (2000/500) Create/edit a custom, or site, preset. See Creating a Custom Preset on page Click Options Click the desired tab. Edit the desired options on each tab. When you are finished, click OK. The Options window will close. Tip! As you move from tab to tab, click Apply first. This saves the changes as you go. 79 ImageChecker CT Lung User Manual, PN Rev A (turn page)

86 Creating a Custom Preset The application provides three window level presets, which you access using the Window tool in the Review screen: Bone, Lung, and Mediastinal. For the Nodule review, Lung is the default, and for PE review, the default is Mediastinal. 1 In addition, you can create custom (or site) presets. You can specify the width and level for each, as well as make it the default level for either or both the Nodule or PE review mode. To create a site preset: 1 From the Study List window, click Options Click the Window tab. Select Site presets Click Add. Type a name for the preset, and click OK. Edit the width and level values. To add the preset to the Window menu, click Activate. To make it the default view, click either Nodule or PE. 7 When you re done, click OK to close the Options window or select another tab to continue setting other options ImageChecker CT Lung User Manual, PN Rev A

87 Algorithm Description The ImageChecker CT Server algorithm is designed to detect lung nodules that are clinically significant by looking for and identifying the following: solid, parenchymal nodules in the lung tissue, 4mm in diameter or larger, and pleural-based nodules, 4mm in diameter or larger*, provided they project significantly into the lung. Spherical Nodule What the Algorithm Searches For The algorithm generally defines solid, parenchymal nodules as focal densities that: are approximately spherical in shape, have boundaries that are smooth, lobulated, or spiculated, and are the density of water. The algorithm also recognizes that although pleural-based nodules are not generally spherical, their shape usually approximates that of a portion of a sphere. The algorithm ranks its findings by likelihood, then segments those regions above a fixed threshold of likelihood. * For certain studies, it is possible that a nodule with a diameter less than 4 mm will be found by CAD. Pleural-Based Nodule Lobulated Nodule 81 ImageChecker CT Lung User Manual, PN Rev A (turn page)

88 Algorithm Description (continued) What the Algorithm Does Not Search For The algorithm does not look for the following: non-nodular abnormalities (e.g., scars, atelectasis, bronchiectasis), nodules or other abnormalities outside of the lung parenchyma (e.g., in the mediastinum or in the chest wall). Although, on any given slice, a nodule may look like a blood vessel, by also considering other slices in proximity to the suspect slice, the algorithm can measure and report the volume of any mass it finds. The algorithm also differentiates between nodules and blood vessels based on their: shape density size texture, and connectivity (between the slices) Shape analysis is almost exclusively performed in three dimensions. This means that an object that appears very circular in a particular 2D axial slice may not be marked, because in 3D it is very flat (i.e, sheetlike) or elongated (i.e., linear or tubelike). Post-Inflammatory Changes Pleural Scarring Bone Lesion in Chest Wall 82 ImageChecker CT Lung User Manual, PN Rev A

89 Algorithm Description (continued) What the Algorithm May Inadvertently Mark Although the algorithm does not generally detect nodules that are smaller than four millimeters in diameter, it can mark a smaller nodule if the measurement is the only feature outside the range of the algorithm s search criteria. Also, as the result of acquisition artifact, a normal or benign anatomical feature may appear to the algorithm suggestive of a nodule. Acquisition Thickness The individual slices in the target scan must be acquired at a thickness of no less than 0.5 mm and no more than 3.0mm. Slice thicknesses outside of this range can cause unpredictable results. Branching Vessel The vessel likely appeared to grow in width to the algorithm. 3mm Nodule Although smaller than what the algorithm searches for, all other characteristics were suggestive of a nodule. Pleural Tag The algorithm likely believed this pleural tag was a pleural-based nodule. 83 ImageChecker CT Lung User Manual, PN Rev A

90 Algorithm Description (continued) CAD Process for Pulmonary Artery PE (Patency Exam) The identification of low-density regions begins with a simple segmentation process. The process first segments the pulmonary vascular trees using anatomical information derived from segmentations of the lungs, mediastinum, airways, ribs and other normal structures. The vascular segmentation uses morphological information to ensure that nonvascular structures such as nodules, scars, and infiltrates are not incorrectly classified as vascular. The algorithm attempts to distinguish pulmonary arteries from veins in order to reduce the occurrence of findings on poorly-enhanced pulmonary veins. Following the standard segmentation of the vessels, the degree of contrast enhancement is adaptively estimated from the image data and used with shape and position information to identify regions of lower density than is expected of contrast- enhanced blood. These low-density regions are further segmented into discrete objects to produce a final set of regions of probable low density that may represent filling defects. 84 ImageChecker CT Lung User Manual, PN Rev A

91 Troubleshooting, Alerts & Messages This section contains the common troubleshooting topics, as well as a list of messages and alerts. Troubleshooting Topics My study failed to process I have a current prior, but no comparison was made I don t see the localizer series in the Study List My workstation is running slowly/behaving strangely.. 88 I am getting a Can t communicate to Server warning 88 The system says I only have partial CAD results but CAD server is done processing My system is on and so is the monitor, but the monitor is black Messages & Alerts Information Log Messages...85 Query Validation Messages Numbered Messages ImageChecker CT Lung User Manual, PN Rev A

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93 Troubleshooting Topics My study failed to process When a study fails to process, in addition to the Failed status in the CAD results column of the Study List, you will also receive a message in the Information Log. See the topic, Work with the Information Log on page 77. This log explains in detail why the case failed. Reasons for failure can include: A series was sent that violated the scanning protocol There is poor contrast quality on contrast studies being analyzed with the Patency Exam feature Temporary network problems First, try re-processing the study in case a temporary network problem occurred. See Delete CAD Results and Re-Process a Study on page 73. Second, ensure that you retrieved the correct series from the acquisition workstation (and that the series you want processed meets the scanning protocol). Finally, if neither of these fix the problem, contact R2 technical support. Please refer to the manual, Understanding the ImageChecker CT Lung System v2.0. It contains the scanning protocol. Note that CAD processing relies on accurate segmentation. Factors affecting this segmentation can result in a failure to process. Factors can include extreme diffuse lung disease, field of view problems, or foreign objects in the lung field, or any gross deviation from normal anatomical appearance. For Pulmonary Artery Patency Exams, factors include poor contrast quality, interference with the ability to detect the bifurcation of the bronchial tube, and severe respiratory or other motion artifacts. I have a current prior, but no comparison was made In rare instances, the system does not detect a prior study and therefore doesn t perform the AutoLink registration and matching. This can occur for various reasons. In some cases, it may be that the patient last name changed, or there was a temporary computer problem. When this occurs, go to the Study List, click to highlight the current study, and select Process. This reprocesses the study and typically solves the problem. If it does not solve the problem, go to the Queue Manager, select both the current and the prior study, and click Auto-link. I don t see the localizer series in the Study List Localizer series or images are not explicitly shown in the Study List. The localizer will be seen in the Lung Map while the study is loading. This will be replaced by the Lung Map once the study loads. 87 ImageChecker CT Lung User Manual, PN Rev A

94 Troubleshooting Topics (continued) My workstation is running slowly/behaving strangely This might occur when the local database is close to capacity. The system automatically deletes completed studies from the local database when the database reaches 75% capacity. However, this number is configurable and some sites may have set this threshold higher, or, you may not have marked many studies complete. To address this problem in the longer term, make sure you are marking studies complete as you finish reviewing them. Only then can they be automatically deleted. And, make sure your system is set to delete studies when the database reaches 75% capacity. In the short term, go to the Study List, and delete any studies that you have marked complete. See Delete CAD Results and Re- Process a Study on page 73 for instructions on deleting studies and/or CAD results. Then, exit from the ImageChecker CT application, restart your computer and launch the application again. See Log Off/Shut Down ImageChecker CT on page 69 and Start Up/Log Into ImageChecker CT on page 67. I am getting a Can t communicate to Server warning Typically, this occurs during temporary network outages and is indicated by a pop-up warning dialog as well as by warning indications in the DICOM and/or CAD icons in the lower left part of the screen (the icons turn from a green checkmark to a yellow alert triangle). Check with your system administrator to see if there have been network outages. If that s the case, you will have to wait until the network is up and running and the system refreshes the connections. If the system has worked before, it may be that the network is having problems. If the system is new and has never worked, it is possible that the systems are not configured properly. The system says I only have partial CAD results but CAD server is done processing The Study List may display CAD Results for a study as Partial. This means that partial CAD Results have been received. Typically, this happens when the Study List is refreshed as results are being sent from the CAD server to the workstation. When the full CAD results are received, the status should change to Ready. However, in some cases, a network interruption occurs and the results are never received in their entirety. In this unlikely event, delete the CAD results from the workstation. See Delete CAD Results and Re-Process a Study on page 73. My system is on and so is the monitor, but the monitor is black... When the workstation is idle for the amount of time specified by the operating system, the screen will blacken. This is normal behavior and ensures patient privacy and reduces wear on the monitor. However, occasionally, it will take about three minutes for the system to wake up (respond to your moving the mouse or pressing a key on the keyboard). You can either wait or you can turn the monitor off and on again; sometimes this awakens the system right away. 88 ImageChecker CT Lung User Manual, PN Rev A

95 Messages & Alerts Information Log Messages The information log provides expanded information on CAD server and DICOM server processing errors. For instructions on how to work with the Information Log, see the topic, Work with the Information Log on page 77. The messages in this log are listed as follows: Patient name, Study date, Failure reason, Attribute that failed, and Attribute value...where failure reason is the reason why the CAD server or DICOM server did not process the case properly. Query Validation Messages These messages appear in the status line of the Search screen when you are searching for studies. If all the search criteria you entered are valid (within the search parameters of the ImageChecker CT), the status line will display the message Search in Progress followed upon completion with Search Complete. If any of the fields are invalid, the ImageChecker CT Lung system will stop the search, flag the inappropriate field, and position the cursor in that field for your correction. At the same time, the status line will display one of the following messages. Correct the entry and click the Search button to continue. The ImageChecker CT Lung system will continue to flag inappropriate search fields until are all valid, and will then proceed with your search. Possible messages include: Search in Progress... Search complete You must fill in at least one of the (**) mandatory fields Invalid name entered Invalid date of birth entered Invalid Patient ID entered The Study From date is invalid The Study ID is invalid The Referring Physician name is invalid The Study To date is invalid 89 ImageChecker CT Lung User Manual, PN Rev A

96 Messages & Alerts (continued) Numbered Messages The system displays the following alerts and messages when you need to make a decision or to let you know about something unusual that is happening in the application. The messages are listed alphabetically by their prefix, e.g., AP. The messages within a group are listed numerically, e.g., AP1, AP2, AP3. Some of these messages are context-sensitive the message text can vary somewhat, depending on the situation. In these cases, all possible message texts are listed. AP1 Application Startup Failure AP2 Internal Application Problem AP3 License Dongle Validation Failed AP4 Administrative Actions AP5 Log Off ImageChecker CT CAD1 - Incorrect ImageChecker CT Lung Server Configuration 91 CAD2 - ImageChecker CT Lung Server Initialization Failed. 92 CAD3 - ImageChecker CT Lung Server Communication Failed 92 LD1 Confirm Study Delete LD2 Low Free Disk Space LD3 Study Transfer Failed LD4 Automatic Transfer Failed LD5 Study Delete Failed LD6 Unnecessary Processing Attempted OPT1 - Discard Unsaved Changes RD1 - Archive Not Responding SER1 No Images in Study SER2 Processing Data Incompatible Image Mismatch SER3 Processing Data Not Available SER4 Processing Data Not Available for Prior SER5 Current Case Loading Failed SER6 Prior Case Loading Failed SL2 DICOM Initialization Failed SL3 Archive Configuration SL4 DICOM Server Has Stopped SM1 Mark Case Complete SM2 Print Job Failed SM4 Review Complete SM6 Save Key Images Failed SM7 No Key Images TC1 - Clear All Matches UEO Unexpected Error VW1 - Study Load Failed ImageChecker CT Lung User Manual, PN Rev A

97 Messages & Alerts (continued) AP Messages (Application) AP1 Application Startup Failure The application was unable to start running due to a failure in one of its components. Contact R2 technical support. AP2 Internal Application Problem One of the main application components has experienced a serious problem. Exit the application and restart the workstation. See Startup/Log Into ImageChecker CT under How Do I? in the user manual. If this problem persists, contact R2 technical support. AP3 License Dongle Validation Failed The system is not licensed to run the ImageChecker CT Lung application. Click OK to exit the application. AP4 Administrative Actions What administrative action would you like to take after exiting the application? Log off this Windows Session. Power down the workstation. Restart the workstation. Display Windows desktop. AP5 Log Off ImageChecker CT What action would you like to take? End your reporting session. Perform an administrative action. CAD Messages (CAD Server) CAD1 - Incorrect ImageChecker CT Lung Server Configuration The ImageChecker CT Lung Server is not configured correctly. The application will function. Contact your IT department or R2 Technical Support. See the user flip chart for R2 contact details. 91 ImageChecker CT Lung User Manual, PN Rev A

98 Messages & Alerts (continued) CAD2 - ImageChecker CT Lung Server Initialization Failed The initialization of the ImageChecker CT Lung Server failed. The application will function. Contact your IT department or R2 Technical Support. See the user flip chart for R2 contact details. CAD3 - ImageChecker CT Lung Server Communication Failed The application cannot communicate with the configured ImageChecker CT Lung Server. The application will function. Contact your IT department or R2 Technical Support. See the user flip chart for R2 contact details. LD Messages (Local Database) LD1 Confirm Study Delete You are permanently removing these studies from the local database. Are you sure you want to continue? You can choose to delete only the processing results or both the results and the images. LD2 Low Free Disk Space The hard drive is running out of space. If the disk runs out of space all applications will stop responding and your work may be lost. Do one of the following: Use the Delete function to remove cases from the Study list that you no longer require. Contact R2 technical support to have the Auto Delete function enabled. LD3 Study Transfer Failed The application could not transfer the selected study(s) from the remote system. This may indicate a problem with the network or the remote system. Contact your IT department or R2 technical support. LD4 Automatic Transfer Failed A remote system attempted to transfer a study to the workstation, but the transfer did not complete successfully. This may indicate a problem with the network or the remote system. Contact your IT department or R2 technical support. 92 ImageChecker CT Lung User Manual, PN Rev A

99 Messages & Alerts (continued) LD5 Study Delete Failed The application was unable to delete a case. This may indicate a problem with the local database. Contact R2 technical support. LD6 Unnecessary Processing Attempted A successfully processed case was resubmitted to the server for processing. The duplicate results will be discarded. You may want to have your IT department check the HIPAA log to determine the case for which this occurred, and when and why the processing was resubmitted. If necessary, contact R2 Technical support. OPT Messages (Options) OPT1 - Discard Unsaved Changes You made changes to the application options. Are you sure you want to cancel them? To exit without saving your changes, click Yes. Otherwise, click No. RD Messages (Remote Database) RD1 - Archive Not Responding The application cannot communicate with the configured archive(s). This may indicate a problem with the network, workstation configuration, or the archive. Contact your IT department or R2 technical support. See inside front cover for R2 contact details. Ensure the workstation s network cable is firmly connected at both ends. If this doesn t fix the problem, contact your IT department or R2 technical support. SER Messages (DICOM Server) SER1 No Images in Study The next study cannot be loaded, as it has no images. Query the case from your archive or have them pushed from the scanner, or select another case. See Transferring Studies under Selecting Studies for Review in the user manual. 93 ImageChecker CT Lung User Manual, PN Rev A

100 Messages & Alerts (continued) SER2 Processing Data Incompatible Image Mismatch The study you selected has not received 3D information from the ImageChecker CT Lung server. The application will not be able to display the lung map, mask out the chest wall and mediastinum, or render findings in 3D. SER3 Processing Data Not Available The study you selected has not received any information from the ImageChecker CT Lung server. The application will not be able to display the lung map, mask out the chest wall and mediastinum, or render findings in 3D. SER4 Processing Data Not Available for Prior The prior case has not received any information from the ImageChecker CT Lung server. The application will not be able to mask out the chest wall and mediastinum, or render findings in 3D. SER5 Current Case Loading Failed The system was unable to successfully load the current case. There may be missing or corrupted image files. Delete the case from the study list and try retrieving again. SER6 Prior Case Loading Failed The system was unable to successfully load the prior case. There may be missing or corrupted image files. Delete the case from the study list and try retrieving again. SL Messages (Study List) SL2 DICOM Initialization Failed The DICOM server failed to initialize. The application will function. DICOM communication is not possible. OR The DICOM Query/Retrieve data dictionary did not initialize. The application will function and receive pushed cases. OR There are no DICOM AE Titles configured. The application will function and receive pushed cases. Query/retrieve functions are unavailable. Contact your IT department or R2 technical support. 94 ImageChecker CT Lung User Manual, PN Rev A

101 Messages & Alerts (continued) SL3 Archive Configuration There is no default archive configured. The results from completed case will not be archived. Contact R2 Technical Support. See the user flip chart for R2 contact details. This message appears when there is no default PACS archive configured to store CAD results. If you do not intend to use a PACS archive to store CAD results, ignore this message and click OK. If you do intend to use a PACS archive, contact your PACS administrator and ensure you configure a default PACS archive for use by the ImageChecker CT Lung system. SL4 DICOM Server Has Stopped The DICOM Server has stopped working. The application will function but without DICOM communications. Try restarting the workstation software to correct the problem. SM Messages (Summary) SM1 Mark Case Complete Do you want to mark the current study complete before proceeding? After you mark it complete, the application does not allow additions or changes to the summary. SM2 Print Job Failed The application could not print the summary. Ensure that the printer is turned on and is online. If the application still cannot print, contact your IT department. SM4 Review Complete Have you completed reviewing the case? After you mark it complete, the application does not allow additions or changes to the summary. SM6 Save Key Images Failed The application was unable to save the key images. Contact your IT department or R2 technical support. SM7 No Key Images There are no key images to save. At least one measurement must be made or valid finding marked for key images to exist. 95 ImageChecker CT Lung User Manual, PN Rev A

102 Messages & Alerts (continued) TC Messages (Temporal Comparison) TC1 - Clear All Matches Are you sure you want to clear all matching findings? Once cleared, any matches will need to be re-created manually. Only clear all matches if you are sure. Otherwise, select Cancel. UE Messages (Unexpected Error) UEO Unexpected Error An unexpected error has been detected by the application It is recommended that the system be restarted VW Messages (Viewer) VW1 - Study Load Failed The application could not load the selected study. Contact R2 Technical Support. See the user flip chart for R2 contact details. This may indicate a database or file system problem. 96 ImageChecker CT Lung User Manual, PN Rev A

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105 Index A administrative options 69 airways, colorizing 29 alerts 85 algorithm description 81 All filter state, explained 3, 19 anterior/posterior view, resetting in 3D view 29 AP messages 91 application logging off/shutting down 69 restarting 69 starting/logging into 67 application, exiting 3 archive images, retrieving from 5 study, transferring from 21 Auto link mode 47 AutoLink manually submitting studies 17 B bone preset, selecting 27 borders, hiding/showing 7, 35 C CAD markers algorithm description 81 discarding 43, 45 displayed by size 43, 45 moving thru study using 45 reinstating 45 summary, viewing 51 using Add to reinstate 43 CAD messages 91 CAD results algorithm description 81 column definition in Study List 4 deleting ImageChecker CT Lung User Manual, PN Rev A resending to workstation 18 summary, viewing 51 chest wall, toggling display on/off 29 Cine feature animating a range of images, how to 25 defining number of images to use 79 starting and stopping 7 Comment box 7, 11, 55 comments adding 55 Comments, adding to findings 41 Compare screen overview 9 comparing studies 47 Context-sensitive menus 1 Current Image Indicator line location 7 customer support, contacting ii D database local or remote, selecting 3 local, deleting studies from 3 density, displaying pixel density 31 desktop exiting to 69 detailed name search 5 DICOM archive selecting 3 DICOM Query Retrieve overview 5 display properties, reset 7 E Elliptical ROI drawing on 2D image 31 measurements display location 31 error messages AP 91 CAD 91 diagnosing case failure 71 information log 77 LD 92 OPT 93 query validation 89 RD 93 SER 93 SL 94 SM 95 TC 96 UE 96 VW 96 F failure to process a case, diagnosis 71 filling defects algorithm description 81 key images, viewing 57 working with 45 filters in Study List 19 study list 3 findings CAD nodules, working with 43 comments, adding 41 comparison information 47 defining "large" finding 79 deleting 31 deleting user-defined 39 key images, exporting 59 measuring 31 patency exam, working with 45 properties and information, display of 7 summary, viewing 51

106 Index (continued) findings, user-defined adding 37 deleting 39 G growth data displaying 47 understanding 48 H HIPAA log files, working with 75 horizontal axis, rotating 3D image around 29 I image comparing studies 47 display defaults, resetting 27 key images, exporting 59 navigation, how to 25 position, changing (see pan) registering for comparison 47 retrieving from archive 5 size, changing (see zoom) Images view configure as default 79 displaying from Summary screen 51 examining key images 57 impressions adding 11, 55 Information Log, using 77 irregular ROI drawing on 2D image 31 measurements display location 31 K key images default file location when saving 59 examining in Summary screen 57 exporting 59 include in printed report 79 navigating through 13, 57 saving to disk 11 Keyboard shortcuts 1, 103 L LD messages 92 Length, measuring a line on 2D images 31 level changing in 2D review window 27 configure default 79 Link mode auto, manual, off 47 lobe location indicating for user-defined findings 37 local disk images, transferring to 5 logs HIPAA 75 information 77 low density tissue, removing in 3D 29 Lung Map 7 lung preset, selecting 27 M Manual link mode 47 markers, hiding/showing 35 markers, hiding/showing all 7 Measurement tools Probe tool 33 measurement tools density, displaying pixel density 31 Elliptical ROI on 2D images 31 Irregular ROI on 2D images 31 line length on 2D images 31 measurements hiding/showing 7, 35 key images, viewing 57 mediastinum preset, selecting 27 mediastinum, toggling display on/off 29 messages 85 CAD 91 LD 92 OPT 93 RD 93 SER 93 SL 94 SM 95 TC 96 UE 96 VW 96 MIP view mode selecting 7 toggling on / off 27 N Next button used to navigate through a study 25 used to navigate through findings 25 using to navigate in Images view 57 nodules algorithm description 81 key images, viewing 57 working with 43 O OPT messages 93 orientation presets, setting 29 Output Manager overview 17 P pan 27 Patency Exam findings algorithm description 81 working with ImageChecker CT Lung User Manual, PN Rev A

107 Index (continued) patient information detailed name search 5 entering in Study Search screen 21 in Summary screen 11 Study Search screen, entering in 5 Popup menus 1 presets create or edit a custom 80 creating a custom 79 define default 79 window, selecting in 2D review window 27 Prev button used to navigate through a study 25 used to navigate through findings 25 using to navigate in Images view 57 prior studies comparing 47 configuring months back to search 79 growth data, viewing 47 searching for 23 summary screen, growth view 15 summary, viewing 51 transferring 23 Probe tool, using in 2D review window 33 Q query validation 89 Queue Manager overview 17 R RD messages 93 Read filter state, explained 3, 19 remote database, selecting 3 Reset button, resetting image defaults 27 restarting application 69 Review screen overview 7 Rotate tool, using in 3D review window 29 S search error messages 89 Search Screen overview 5 segmented object border, hiding / showing 7 SER messages 93 Server pages overview 17 shutting down application 69 SL messages 94 SM messages 95 soft tissue, removing in 3D view 29 stacked view configuring as first view 79 Stopping CAD processing 17 study 2D review tools 27 3D review tools 29 comparing with prior(s) 47 complete, marking 7 completing 63 date, used for study search 5 deleting from server 17 details listed on-screen 3 halting CAD processing 17 local database, deleting from 3 marking complete 63 navigating Review screen 25 navigating through 7 opening 7 opening next 7 priors, searching for 23 processing 17 processing failure, diagnosing 71 processing order, changing 17 reprocessing 73 selecting for review 3, 19 thumbnails 3 transferring from archive 21 Study List column definitions 4 opening from Review screen 7 overview 3 returning to from Study Search screen 17, 18 studies, selecting for review 19 Study Search Screen patient information, entering 5 results, viewing 5 study transfer explained 21 monitoring 5 summary report comments, adding to study 41 completing 63 printing 11, 61 viewing without loading study 3 Summary screen completing summary 63 examining key images 57 explained 51 growth view, overview 15 images view, overview 13 in Table view or Images view 51 patient information, display of 11 printing 11, 61 report, printing 11 sorting 51 table view, overview 11 views, toggling between 11 superior/inferior view, resetting in 3D view ImageChecker CT Lung User Manual, PN Rev A

108 Index (continued) T Table view configure as default 79 TC messages 96 technical support, contacting ii temporal comparison, performing 47 Thick Slice Mode configure number of images to combine 79 toggling on / off 7, 27 3D box, toggling display on/off 29 3D review tools explained 29 on Review screen 7 3D snapshots as key images, viewing 57 capturing 7 3D volume window on Review screen 7 redrawing 29 thumbnail image listed on screen 3 tiled view configuring as first view 79 Tissue button, used in 3D review window 29 Tooltips 1 transfer progress for studies 5 transferring studies from archive 21 troubleshooting 85 2D review tools on Review screen 7 explained 27 2D review window, on Review screen 7 U UE messages 96 Unread filter state, explained 3, 19 user-defined findings adding 37 deleting 39 V vertical axis, rotating 3D image around 29 vessels, colorizing 29 View Options, configure window presets 79 Viewing Options accessing 3, 5 configure Thick Slice mode 79 create a custom preset 79 default view, table or images 79 define "large" finding 79 define default window preset 79 define images used in Cine feature 79 include key images in printed report 79 preset, create or edit a custom 80 priors, how many months back to search 79 tiled or stacked as Review screen default 79 VW messages 96 W width changing in 2D review window 27 configure default 79 window presets create or edit a custom 80 define default 79 selecting in 2D review window 27 window width and level changing in 2D review window 27 configure default 79 Z zoom 27, ImageChecker CT Lung User Manual, PN Rev A

109 Keyboard Shortcuts Study Selection Screen Delete selected study...delete Review selected study...enter Review Screen Add finding... Insert Delete selected finding...delete Mark study complete... Ctrl+C Most inferior image... End Most superior image (Nodule mode)... Home Next/Previous finding...left/right Arrow Next/Previous image... Page Up/Down Keys, Up/Down Arrow Next study...ctrl+n Pulmonary Artery Bifurcation (PE mode)... Home Scroll stack...mouse wheel forward/reverse (2D only) Sub choice in window, measurement...spacebar Switch tool...f2 for 2D, F3 for 3D Toggle between Nodule and PE review modes...f5 Toggle CAD button on/off...f6 Rotate 3D view about AP axis...f9 Rotate 3D view about SI (HF) axis...f10 Summary Export key images... Ctrl+S Print Summary... Ctrl+P Switch modes (Nod/PE/Meas/3D)...F5 Switch Tabs...Spacebar General Exit application... Alt+F4 or Ctrl+X

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