Visage 7 Clinical Training Basic Features

Visage 7 Clinical Training Basic Features

Contents Overview... 4 Usage... 4 Client Server Architecture... 5 Client Login... 6 Study Browser... 7 Query Section... 8 Study Labels... 10 Query Labeled Studies... 11 Presets... 12 Study List View... 13 Session List... 14 Session Menu... 15 Loading Options... 16 View Window... 17 Overview... 17 Study Navigator... 18 Accessing Prior Studies... 18 Display Protocols Selection... 19 Display Protocols Viewer Layouts... 20 Full Screen Viewers... 21 Rearrange Datasets in Viewers... 22 Toolbars... 23 Tool Cards... 24 Default Mouse Controls... 25 Window/Level Adjustment... 26 Text Annotation... 27 3D Viewer Annotation and Key View... 28 Distance Measurement & Line Profile... 29 ROI Measurements... 30 Angle and Density Measurements... 31 V02.00 Aug 2016 2 of 48 Overview

Additional Angle Measurements... 32 2D Tiled View... 33 3D MPR Viewer Navigation... 34 Thick Slices... 35 Oblique Slices... 36 Crop Box... 37 Crop Slab... 38 Remove Tool... 39 Color Templates... 40 Create Screenshots... 41 Export Window... 42 Screenshots... 42 Screenshot Viewer... 43 Configuration... 44 Tool Palette... 44 Window/Level Presets... 45 Keyboard Shortcuts... 46 Overview 3 of 48 V02.00 Aug 2016

Overview Usage Visage 7 supports many different workflows including: Diagnostic / primary reading Referring physician Advanced visualization Mobile results access Select & Load Study Diagnostic Workflow In the Study Browser, select the patient from the list of patients that are available on the server. When Visage 7 is integrated with third party software (such as a RIS, worklist, or other PACS) this screen may not be shown. Diagnostic workflow including measurement and annotation tools, viewer layouts and current and prior comparison. Advanced Visualization Use of advanced visualization tools such as MPR and Volume Rendering. Export Screenshots and Tables Working with screenshots, tables, and report addendums in the Export window. V02.00 Aug 2016 4 of 48 Overview

Client Server Architecture Visage 7 is a powerful Enterprise Imaging system that enables physicians to work with large datasets over a network. The data is collected from imaging modalities such as CT, MR, US, etc. or from an existing VNA / DICOM archive. Visage 7 servers can also be integrated with third party systems, such as a RIS, EMR or workflow engines. When the user wants to read the image data, it can be viewed from any workstation, PC or laptop that is connected to the network using the thin client. With Visage 7, it is not necessary to transfer the large datasets. The data can be streamed to a remote location as if the user was sitting in front of a workstation. Any existing PC (XP, Vista, Windows 7 & 8, including 64 bit) or Mac (Mac OS X) can be used as a thin client. Visage 7 can be used to view images enterprise-wide or even over a wide area network connection with a minimum bandwidth requirement of only a 6Mbps connection. Clinic Network Enterprise Network (Clinic and WAN) MRI Visage 7 Servers Visage 7 Thin Clients CT / PET Mammography / CR Visage Ease Pro (Mobile) Ultrasound / Angiography DICOM Archive Vendor Neutral Archive PACS Archive Overview 5 of 48 V02.00 Aug 2016

Client Login When you start the software, the first thing you will see is the login screen. Here you can specify to which server you want to connect. You have to enter your user name and password that was provided to you by your administrator. It is possible to choose from a list of languages for the application. Just select the dropdown menu and highlight the language you want the application to appear in. V02.00 Aug 2016 6 of 48 Overview

Study Browser Study Browser, View & Export Windows Study / Series List Query Section Preview Window Session List The main application window has three windows: Study Browser, View and Export. Users with permission for quality assurance will have a fourth QA window available. The Study Browser window is used to load image data into the View window and to retrieve data from connected DICOM nodes. It consists of a query section where the search criteria can be defined. The patient list displays all patients that match the current search. Frequently used search filters can be stored as individual presets. In the preview window, a screenshot of the selected series is shown to simplify the selection. In the lower right corner, the session list displays a list of sessions available to that user. For installations that are integrated to an existing HIS, RIS, EMR, workflow engine or third-party PACS, there may be no Study Browser window available, as the data will be loaded directly into the View window. Study Browser 7 of 48 V02.00 Aug 2016

Query Section Query Button issues a search based on search criteria Wildcards available [*,?] The query button in the query section submits a search and the result is displayed in the study/series list. The query can be narrowed to specific search criteria: The name and ID of the patient If incomplete names or IDs are entered, they are automatically appended with wildcards, so that also names starting with the entered letters are found, e.g., type Mil in the patient name box to find Miller, Milford, Miltner, or *mil to find all the above and also Hamilton, or AB??34 in the patient ID box to find AB1234, AB0034 and AB11345678. Date Values or Ranges The patient s date of birth, the accession date of the study or the date when the data was inserted into the database. The modality the data was acquired from There are checkboxes for the most common modalities such as CT, MR and US, but it is also possible to enter other modalities in a field. Specific DICOM tags You can search for datasets with entries in one of these fields: Accession Number; Institution Name; Study Description; Series Description; Referring Physician; Performing Physician; Reading Physician; Patient Comments; Body Part; Study Instance UID; Series Instance UID; Series Number; Patient Location; Study ID; RPID and Study Labels. The query section can be reset to the initial values using the Reset button. It is also possible to search in remote DICOM nodes. In this case, it is not possible to search for modalities and DICOM fields other than accession number and the study description. Study States can be used to query specific states such as interpretation status and interpretation priority. Labels can be assigned to specific studies. This is useful for quickly finding studies for a meeting such as a tumor board meeting. Load a study by selecting the study then click the View button above the query options or by simply double clicking on a study or series. V02.00 Aug 2016 8 of 48 Study Browser

Query Section View Presets Query Name & ID Date Modalities DICOM Tags Labels Study Browser 9 of 48 V02.00 Aug 2016

Study Labels Labels can be assigned to selected studies. This can be useful for quick access to teaching studies or to access studies at a later date. Select desired studies and right click on one of the selected studies to open the Labels dialog box. Type a name for the new label then save the label for access by only your login (private) or everyone who has access to the selected data (public). Select study to label Right-click, select Study Labels... Initially shows all labels Enter new label name V02.00 Aug 2016 10 of 48 Study Browser

Query Labeled Studies To query labeled studies, type the label name in the Labels box then click Query. The labeled studies will appear in the study list to the right. Select Query for labeled studies Enter Study Label Study Browser 11 of 48 V02.00 Aug 2016

Presets Query presets can be defined for any combination of query parameters including Name, ID, Date and Modalities. Once you have created a search, click on New Preset. Example: If a user reads mammography studies on a regular basis, the user can create a preset to query only mammography studies. It is also possible to create a preset to include only mammography studies from today. If the user creates such a preset, the preset Mammo button will be placed above the query section. A single click of the preset will query for the preset parameters. Create New Preset Setup Query Options Name Preset V02.00 Aug 2016 12 of 48 Study Browser

Study List View Studies in Visage DICOM Partners Study List Study Series Volume Indicator 3D Volume ready Volume is converting No volume available (Possibly 2D data) Study Browser 13 of 48 V02.00 Aug 2016

Study List View In the study list view, there is a tab for each data source. The main data source is the database of the Visage 7 server. In addition to this source, there is also one tab for each DICOM node that is connected to the Visage 7 server and one for each Visage partner server if multiple Visage servers exist. These tabs can be added by clicking the + symbol and hidden by clicking the red x in the tab. In the study list, all studies that match the current search are displayed. In addition to the Patient Name the Date of Birth, Patient ID, Accession Number, Modality, Number of Images, Study/Series Description, Study/Series Date, Institution Name and Insertion Date are displayed. Note that the list contains all studies, so if multiple studies of one patient exist they will be shown in separate rows. To expand one of the entries, click on the + sign to the left of the patient name. This reveals all series that are part of this study. If this series is a 3D volume, this is indicated by a green bullet in this line. If the displayed bullet is orange, this series is currently being converted and can be accessed at a later point. If no bullet is present, this means that the series is either not converted yet or it is a 2D series. In order to load all series of a study, select the study and click view or double-click on the study. To load only one series, just select this series and click on view or double-click on the series. Session List A preview of the currently selected study is displayed in the preview window in order to facilitate the selection of the series to be loaded. In the session list, the previous work that was saved can be retrieved. If there is no currently selected study in the list above, this list displays the most recent sessions. If there is a study highlighted, this list displays the sessions that belong to the study selected. Double-clicking on one of the sessions will launch the study exactly in the same state as it has been saved in the session. Sessions shown in orange were created by the system when a user was automatically logged out after the session was inactive longer than the configured timeout value. Preview Session List V02.00 Aug 2016 14 of 48 Study Browser

Session Menu In the View window, you can save and reload sessions from the File menu. When saving a session, you can select between saving this session only for yourself or for all users who have sufficient access rights to view this patient. If you save a session for all users, you can also send a link to another user via email. If the user clicks on the link in the email, it will start the thin client application and display the saved session. It is still required that this user has an account on the Visage server, and permissions to view the study data loaded in the session. Study Browser 15 of 48 V02.00 Aug 2016

Loading Options You can select multiple studies and series by pressing Shift or Ctrl while selecting them with the mouse. In order to view multiple series side-by-side, you can select the series, right-click on them to open the context menu and then select View All Series Side-By-Side. This will open a dynamic protocol with as many viewers as there are series selected. From the context menu, you can also search for all studies from the selected patient in the database. This facilitates the search for prior studies. Once you have selected the series you want to view, you can click on Add to View. This will keep any series that was in the viewer before and just add the new ones to it. If you click on View, the current series in the view tab will be replaced. Select multiple Series / Phases Context Menu View Selection, Replace Existing View selected series or phases in separate viewers Add additional series/studies to View Lists all studies for patient currently highlighted V02.00 Aug 2016 16 of 48 Study Browser

View Window Overview Menu Window Selection Toolbars Layouts MPR Viewer Viewer Control 3D Viewer Series Thumbnails Tool Cards The View window is the main work window of Visage 7. The appearance can vary depending on the display protocol that is selected. The current protocol may have multiple layouts defined, and the user can choose the appropriate layout tab to switch the current views. The menu bar is always present; from here, you can select all functions. More frequently used functions are also available in toolbars that can be freely positioned on the workspace. Sets of functions that belong together are grouped in tool cards on the right side of the screen. The main screen is divided into multiple viewers; in this example, there are three multiplanar views that show the axial, sagittal and coronal view of the dataset. The fourth view shows a 3D reconstruction of the volume. Each viewer has a viewer control bar at the bottom where the properties of this viewer can be specified. With the button selection (top right), you can quickly get back to the Study Browser window or go to the Export window. View Window 17 of 48 V02.00 Aug 2016

Study Navigator Accessing Prior Studies Access to prior images can be configured to load automatically with the current study or you can choose specific prior studies from the Study Navigator. If there are prior studies available, the Study Navigator button, located on the toolbar in the upper left corner will be highlighted in red. Click to open the navigator dialog, which can be placed anywhere on any screen. The study navigator size and position will be remembered. The Study Navigator displays all existing studies of a patient on the Visage 7 server by default. The studies that have already been loaded are marked with a green box along the right edge of the dialog box. Prior studies that are potentially relevant for a case are shown in standard display. Any other studies are slightly grayed out. You might consider more prior studies relevant for the case than the ones suggested by the system. Double-click such a prior study. The study is now marked with a white pin symbol. If a large number of studies exist for a patient on the Visage 7 server, you can type criteria for any field in the filter line to reduce the data shown in this window. For example, you could show only studies from a particular year, of a particular modality, or with a keyword in the study description. Also, the slider can be used for a better overview. With the left slider position only loaded studies and studies you selected with a pin symbol are shown. Is the slider position centered all the above studies plus studies preselected as relevant prior studies by the system as a result of auto-prior loading settings are shown. If the slider is set to the right all studies of this patient on the Visage 7 server are shown. To load further studies click on the box next to the study to highlight it in green and select "Load". To load single series, click on a study entry to visualize the thumbnails. Thumbnails can be dragged from the Study Navigator into a viewer. Studies which are currently hung White Text = current exam and studies which matched autoprior rule settings Grey Text = Studies which did not match auto-prior rule settings V02.00 Aug 2016 18 of 48 View Window

Display Protocols Selection Arrangement of the image data is largely determined by the display protocol that is automatically or manually selected. Display protocols define the type and layout of the viewer, what kind of toolbars and tool cards are visible and other preferences. When a study is loaded, the appropriate protocol is chosen automatically. If you want to change the current display protocol, you can choose one from the protocol menu. Most of the protocols are specific to a certain modality, e.g. CT or a certain functionality, e.g. lesion tracking. Protocol Menu Pre-selected protocols that match the loaded data All protocols sorted by monitor layout Examples of the same dataset with different display protocols View Window 19 of 48 V02.00 Aug 2016

Display Protocols Viewer Layouts Within a display protocol, images are displayed in different viewer layouts. Layouts are created to display images based on various DICOM information such as the type of image series, the modality, body part, and whether the data is the current or a prior study. There may be several different layouts available when the images are loaded. You can switch between the available layouts by clicking on a layout tab, by clicking on the Previous Layout or Next Layout buttons in your tool palette or activating a keyboard shortcut (default shortcuts for switching between layouts are < and > keys). Viewer Layouts Previous Layout and New Layout buttons can be added to your tool palette. Examples of the same dataset with different display protocols V02.00 Aug 2016 20 of 48 View Window

Full Screen Viewers Each viewer can be brought to full screen mode by double-clicking inside the viewer. If you double-click again, the viewer is resized to the normal layout. In the monitor configuration settings, you can configure the system to treat a large horizontal monitor as two displays. In this mode, full screen fills only half the screen as in this example. Double-Click: Full Screen Double-Click again: Normal Layout View Window 21 of 48 V02.00 Aug 2016

Rearrange Datasets in Viewers Once images are loaded into the viewers within a layout, images can be moved from a viewer to an empty viewer or you can swap images. Click on any of the viewer text, typically found in the four corners of a viewer, and now drag the dataset to another (empty) viewer. To clear a viewer of images, click any of the four corners of a viewer where the image text is shown and drag the images to the thumbnail viewer. Click on the viewer text (usually found in the corners of the viewer) Drag images to thumbnail viewer to clear viewer Drag images to another viewer V02.00 Aug 2016 22 of 48 View Window

Toolbars The toolbar is divided into several toolsets that can be moved individually. Just grab a toolset at the dotted line and drag it where you want to place it. Dragging the toolbar to the right or left border aligns them vertically. If there are many toolsets in one toolbar, small horizontal arrows indicate that the toolset can be expanded in order to reveal more icons. A small triangle facing downwards indicates that this tool can be expanded. The list of all available toolbars is displayed if you right-click inside the toolbar area. Note that some tools might not be available to all users depending on the license and/or privileges of the user. Right-Click: Entire toolbar list Drop-Down Menu Extend toolbar Grab dotted line: to make the toolbar free floating Create vertical toolbars by dragging to the left or right border View Window 23 of 48 V02.00 Aug 2016

Tool Cards More complex tools are available in the tool card area. You can hide and show the tool card area using the small, white triangular button located on the border. Each tool card area can be populated with multiple tool cards, indicated by a tab on the top of the area. Double-click the tool card tab to make it a floating tool card, which can be placed anywhere on the screen. Tool cards can be added to the tool card area by clicking on the larger white, triangular button on the upper right of the tool card area. This will produce a list of available tool cards to choose from. Double-click: Free floating Tool Card Tabs Displays Tool Card List Show / Hide Tool Card Area V02.00 Aug 2016 24 of 48 View Window

Default Mouse Controls Most of the interaction in Visage 7 is performed using the mouse. The default function of the left mouse button is dependent on the type of viewer and the selected display protocol. Click and drag LEFT mouse button Scroll MOUSE WHEEL Click and drag RIGHT mouse button Click WHEEL as a button and drag the mouse Click both RIGHT & LEFT mouse buttons, then drag mouse 2D Viewer with Image Stack (e.g. CT, MR) Scroll through Slices Scroll through Slices (one at a time) Pan Image Zoom Image Adjust Window/Level 2D Viewer with static Image (e.g. CR, MG) Adjust Window/Level 3D Viewer Rotate VR (3D) image The Left Mouse behavior can be changed to any of the navigation modes either by selecting the function in the toolbar or by pressing the associated function key. Function key F1 returns the left mouse to the default behavior. Pressing Alt+left mouse button will enable the Target Tool. Pressing Alt+middle mouse button/wheel will interactively thicken the slice for volume data. View Window 25 of 48 V02.00 Aug 2016

Window/Level Adjustment There are five ways to adjust the grayscale Window/Level in the viewer You can click the left and the right mouse button at the same time and drag the mouse. You can select the Window/Level function, press the left mouse button and move the mouse in the viewer. You can select a preset from the Window/Level drop down menu in the viewer control. You can select a preset using the keyboard, 1-9 keys for the presets defined in the protocol and Shift + the 1-9 keys for the presets defined in the DICOM data. You can set the focus on the Window/Level field in the tool card and type in the desired value directly... 1 9.. 1 9 0 DICOM presets Presets from Protocol Reset to initial Window/Level Select Preset Type in Value V02.00 Aug 2016 26 of 48 View Window

Text Annotation In order to add text onto an image, select the annotations tool from the toolbar or from your tool palette. Click on a position in the image and move the mouse, while holding the left button, in order to draw an arrow with the tip pointing towards the first point. Once you release the mouse button, a dialog with the annotation properties appears. You can type a label in the text field and change the color and the appearance of the arrow. When you have finished editing the properties, click OK and the annotation will be displayed in the image. To delete an existing annotation, click on the annotation to select it, and then press the Del key on the keyboard. By right clicking on the annotation, you can also invoke a context menu that lets you deselect or delete the annotation. Arrow / Text Annotation Font / Line Properties Annotation Text Drag: Draw Annotation View Window 27 of 48 V02.00 Aug 2016

3D Viewer Annotation and Key View The same annotations that can be used in the 2D viewers can also be applied in 3D and MPR viewers. You can create a text annotation or a measurement. The annotation will not be visible in a different rotational plane. Along with an annotation, the rotational plane is stored in a key view. These key views are used to retrieve the rotational plane that was used during the measurement. You can cycle through the stored key views with the buttons F11 and F12. The following tools are available via the viewer context menu, which also opens if you right-click in the 3D viewer (if configured): Previous Key View This sets the rotational plane to the previous stored key view. Next Key View This sets the rotational plane to the next key view in the stored list. Store Key View Using this function, you can store a key view without having to create an annotation. Recall Key View Using this function, you can select a key view from the stored list. Delete Key View This allows you to delete a Key View. Context Menu little, white arrow in the Viewer Controls or Tool Palette (if configured) N Annotation K Store Key View V02.00 Aug 2016 28 of 48 View Window

Distance Measurement & Line Profile After the annotation, the distance measurement is the most commonly used tool. In order to measure the length of an object, click on the measurement tool or press D on the keyboard. Click where you want to start your distance measurement, hold the mouse button down, and drag across the image. Release the mouse button at the endpoint of your measurement and the distance will be displayed. It is possible to show the measurement in all slices. Right-click the distance line, select Show on all Slices, and start scrolling. The measurement graphics and results are shown in all slices. You can display the density curve along the line of measurement using the line profile tool card. Note that the accuracy of the distance measurement is dependent on the accuracy of the underlying image and the accuracy of the points selected. Distance Line Profile Tool Card K Store Key View Selected Measurement: Del Edit Measurement Edit Properties View Window 29 of 48 V02.00 Aug 2016

ROI Measurements With the ROI (Region of Interest) measurement tools, you can measure the density (e.g. HU for CTs) of the underlying image. After a right-click on the ROI, the context menu is displayed. The menu enables the user to hide or show the ROI name and its statistics. The statistical data can also be displayed in the corner of the viewer, detached from the ROI name. The annotation that is connected to the ROI can be freely moved across the viewer (if configured). A ROI measurement can be deleted either by selecting delete from the context menu or by pressing the Del key while the measurement is selected. Six tools are available: Elliptical ROI Shows the area, mean, maximum and minimum density values, and the circumference of a 2D elliptical area. Circular ROI Shows the area, diameter, mean, maximum and minimum density values, and circumference of a 2D circular area. Spherical ROI Shows the diameter, volume, mean, maximum and minimum density values, and circumference of a 3D spherical area. Point ROI Shows the density value of one point. Freehand 2D ROI Shows the area, mean, maximum and minimum density values, the circumference and the minimum, maximum, average and effective diameter of a freehand 2D area. Freehand 3D ROI Shows the volume, mean, maximum and minimum density values of a freehand 3D area. V02.00 Aug 2016 30 of 48 View Window

Angle and Density Measurements To perform an angular measurement, select the function in the toolbar and click inside the viewer to define the start point of the first line. Move the mouse while holding down the button and release the button to define the angle point. Then move the mouse again and click on the image to define the second leg. The angle between the defined lines will be displayed in the image. With the Measure Density tool, you can measure the density (e.g. HU for CTs) of a point in the image data. Select this tool then move the mouse curser over a point on the image. The Hounsfield value and the coordinates of this point are displayed in the lower left corner of the image. Angle Measure Density 1 st click Drag & Release 2 nd click Selected Measurement Del Delete Measurement Edit Properties Display Density View Window 31 of 48 V02.00 Aug 2016

Additional Angle Measurements Additional angle measurements include the Cobb Angle and the Disconnected Lines Angle measurement tools. For both of these tools, you click on the starting point of the first line, drag the mouse and release at the ending point, then do the same for the second line. Cobb Angle The Cobb Angle tool allows the user to create many lines, and the user needs to toggle this mode off before going back to the previous mouse behavior. Disconnected Lines Angle Measurement Use this measurement method to make an angle measurement, in which the intersection of the legs of the angle is located outside of the image. V02.00 Aug 2016 32 of 48 View Window

2D Tiled View The tiled viewer is designed to view 2D DICOM images. It consists of several tiles where images of the selected series are displayed. You can select from different layouts in the layout section of the protocol. If more images are available than are shown in the layout moving the scroll wheel will scroll through the images, either by filling all viewers with new images (Scroll Page by Page mode enabled), or adding one new image and shifting the rest. Tiled view Scroll Page by Page View Window 33 of 48 V02.00 Aug 2016

3D MPR Viewer Navigation The three multiplanar views (MPR) are oriented perpendicular to each other. Around each MPR viewer there is a border in a different color. In the other MPR viewers, the position of the slices is indicated by a line in this color. You can change the position of the viewing plane by clicking on the line and moving it with the mouse. If you click near the center, where the two lines intersect, you can move both image planes at once. In order to move the images so that the intersection of the two lines is in the middle of the viewer, you can select the Center View function in the toolbar (which can also be placed in the tool palette or as a keyboard shortcut). You can toggle between a crosshair that covers most of the screen and one that leaves the middle of the screen unobstructed with the keyboard shortcut x. Center Viewers x Partially Show Crosshair Red Viewer Blue Viewer Green Viewer Move Center Move Line V02.00 Aug 2016 34 of 48 View Window

Thick Slices The thickness of the slice that is displayed in the 2D and MPR viewers can be adjusted dynamically. You can change the thickness by selecting and dragging the Thick Slice Handles, two arrows that are pointing towards the slice indicator. While dragging the handles, the current slice thickness is displayed next to the indicator line. The thickness can also be chosen from a list of presets in the viewer control bar. There are different modes for the display of the MPR viewer Thin MPR: In this mode, the thickness of the slice is equivalent to the slice thickness that the volume was acquired with. Maximum Intensity (MIP): The displayed image is the maximum intensity projection through the volume. Minimum Intensity (MinIP): The displayed image is the minimum intensity projection through the volume. Average Intensity (AvIP): The displayed image is the average intensity projection through the volume. Inverse: All displayed pixels are inverted. This option can be combined with any of the above options. Change only affects one viewer Alt T + Change Thickness Toggle Thick Slice Thick Slice Handle Current Thickness Thickness Presets Mode Selection Thin Slice Maximum Intensity Minimum Intensity Average Intensity Inverse View Window 35 of 48 V02.00 Aug 2016

Oblique Slices The MPR viewer can be rotated to show oblique slices. You can either rotate the view by grabbing one of the rotation handles on the indicator lines or by selecting the rotate tool and dragging the mouse over the MPR viewer. The indicator cube in the lower left corner shows the orientation of the current image. If you press the key V while rotating, you will rotate in the plane of the current viewer. Alternatively, you can use the tool "Rotate in Plane". The orientation of the active viewer can be changed to one of six predefined orientations in the toolbar; they are also reachable by the first letters as keyboard shortcuts: A Anterior view P Posterior view L Left view R Right view H Head view F Feet view + Rotate out of Plane v + + Rotate in Plane Reset Orientation Orientation Presets Rotation Handle V02.00 Aug 2016 36 of 48 View Window

Crop Box Another useful tool is the Crop Box, which aids in isolation of a specific area of interest. The position and size of the crop box is indicated by the orange reference lines on the MPR views. First, place the crosshairs on a desired object before selecting the Crop Box button; this will center the Crop Box at the desired position. Grab any of the reference lines to resize the Crop Box. The box can be moved to a favored position by grabbing the inside of the box. You can also grab a corner of the box to rotate it. In the 3D viewer, only the anatomy that lies inside the box is displayed. Crop Box Expand Move Cropped 3D View Using the Crop Lock Region button allows you to change the behavior or rotating in the 3D viewer. In one mode, the data shown in the cropped region moves and what is seen changes; in the locked mode, the crop box is fixed to the data location, and only what is visible is rotated by the cursor movement. View Window 37 of 48 V02.00 Aug 2016

Crop Slab A Thick Slab with MIP display can be created by selecting the slab option and turning on the MIP mode from the viewer control. First, place the crosshairs on a desired object before selecting the Crop Slab button; this will center the Crop Slab at the desired position. The MIP image can be rotated using the left mouse button and translated using the scroll wheel. You can change the thickness of the slab by holding the Alt-key and the middle mouse button or mouse wheel. The Crop Slab toggle button can be placed in the tool palette or accessed via the keyboard shortcut T. Crop Slab Rotate Expand Move Lock Crop Alt + Thickness Translate Rotate V02.00 Aug 2016 38 of 48 View Window

Remove Tool There are two options for manually removing anatomy. This is done by simply drawing a line around an object. Selecting the Remove Inside option removes anything inside the line drawn. Selecting the Remove Outside option will remove anything outside the line drawn. To remove a line drawn, click the Undo Last Contour button, but this must be done before selecting either the Remove Inside or Remove Outside buttons. If a mistake is made, click the Reset button to return to the original image. Select Remove Tool Draw Contours Remove Inside Remove Outside Undo Last Contour Reset Exit Tool View Window 39 of 48 V02.00 Aug 2016

Color Templates The settings of the 3D viewer can be changed using 3D templates. The templates hold numerous configurations and a color profile that is used to display the volumetric data. A screenshot for each template indicates what the settings look like. When you select a template by clicking on it, the 3D viewer will reflect the change. You can adjust display for the specific patient using the Window/Level function. Template Tool Card Templates V02.00 Aug 2016 40 of 48 View Window

Create Screenshots To create a screenshot, select the screenshot function from the toolbar and a screenshot of the active viewer is placed in the Export window. You can toggle the image overlay texts and elements by pressing the spacebar. This is useful if you want to hide the patient specific information. You can create either a screenshot of one viewer, of all viewers separately, or of all viewers together. Measurement functions like distance measurement automatically create a screenshot of the active viewer. The resolution of the screenshot is dependent on the viewer size. For best results, use a large viewer that has little black space, i.e. a large, square viewer. Screenshot One Viewer Screenshot All-in-One Screenshot All Separate View Window 41 of 48 V02.00 Aug 2016

Export Window Screenshots The Export window is the third button in the upper right. The screenshots you have created before are displayed as small thumbnail images in a list on the left side. There are two options for saving these images. You can send selected images to a DICOM server or they can be exported to a local or network drive. Note that this function can be disabled by the administrator for some or all users. If you use the Save/Send button, a DICOM Send dialog will be displayed, listing all DICOM servers configured for your installation. If you select to store the screenshots on your local or network drive, select the Export button which will display a dialog where you can specify the location of the file. You can choose from three file formats: jpeg, png or DICOM. Select Screenshot Use Shift & Control to select multiple Screenshots Send DICOM Save as File V02.00 Aug 2016 42 of 48 Export Window

Screenshot Viewer The Screenshot viewer allows the user to view all current screenshots in full resolution. Double-click on a screenshot and a new window opens. Use the green left and right arrows at the bottom of the viewer to scroll through the screenshots. Click the Delete button at the bottom of the viewer to delete any screenshot. Double-click on thumbnail to open Screenshot viewer Delete Image Scroll through images Export Window 43 of 48 V02.00 Aug 2016

Configuration Tool Palette The tool palette allows access to tools that are routinely used, anywhere on any monitor. You open the tool palette with a right click. Once open, click on the desired tool. To customize the tool palette, open the Tool Palette dialog from the File menu Preferences Tool Palette. From the list of tools to the left, scroll or use the text search field to find the desired tool icon. Left click and drag the tool icon from the list to a desired position in the boxes to the right. Consider grouping tools with similar functionality together such as measurement tools or vessel trace tools. Be sure to add Configure Tool Palette to your tool palette for quick access. A tool can be removed from a box by a right click on the tool icon and selecting Remove. Once you have arranged the selected tools in the palette, click OK to save the new configuration to your user profile. Drag tool icon to a box on the palette Configure Tool Palette Right-click in Image Viewer to open the Tool Palette V02.00 Aug 2016 44 of 48 Configuration

Window/Level Presets You can create Window/Level Presets which will be assigned to the 0 9 keys on the keyboard. Once you have adjusted the Window/Level to the desired values on the image, open the Window/Level Presets dialog from the File menu Preferences Window/Level Presets. Confirm that the correct modality is listed. Select a new preset from the preset drop-down menu. Note that the number of the preset will be the keyboard shortcut key. Next, type a label for the new preset in the Preset Name field. Define the Window/Level values for this preset. To use the current settings, click on Copy Values from Active Viewer. Click OK. Select a preset Type a label for preset Copy manually adjusted values to the newly labeled preset Configuration 45 of 48 V02.00 Aug 2016

Keyboard Shortcuts Many tools in Visage 7 can be configured as a keyboard shortcut. Open the Configure Keyboard Shortcut dialog from the File menu Preferences Keyboard Shortcuts. Scroll or use the search field to find the desired tool icon. To move a tool icon to the desired key or key combination, left click and drag it to any key or key combination. Remove a tool from a key by right clicking on the tool icon and selecting Remove. Drag tool icon to a key or key combination V02.00 Aug 2016 46 of 48 Configuration

Configuration 47 of 48 V02.00 Aug 2016

EU Contact / Manufacturer Visage Imaging GmbH Lepsiusstraße 70 12163 Berlin, Germany Phone: +49 30 700 968-0 www.visageimaging.com Email: info@visageimaging.com US Contact Visage Imaging, Inc. 12625 High Bluff Drive, Suite 205 San Diego, CA 92130, USA Toll Free: (888) 998-4724 San Diego: (858) 345-4410 Corporate Headquarters Pro Medicus Limited 450 Swan Street Richmond VIC 3121, Australia Phone: +61 3 9429 8800