Manual en Us

Centricity
Radiology RA 600 V6.1
online reference guide

F O R E W O R D ............................... 9
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Working in the Viewing Section ....................................................... 31 Adjusting the Viewing Section screen.............................................. 31 Using the Pictorial Index.................................................................. 32
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Scope, pinning and key images....................................................... 33 Windowing ....................................................................................... 35 Examining images in detail.............................................................. 36 Viewing cine loops ........................................................................... 37 Measuring and annotating images................................................... 38 Masks and overlays......................................................................... 41 Reporting ......................................................................................... 42 Going further.................................................................................... 44
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Ease of use...................................................................................... 12 The Data Selector............................................................................ 14 The Viewing Section........................................................................ 15 Advanced tools for viewing and diagnosis....................................... 17 Other parts of RA 600...................................................................... 18 Going further in this guide ............................................................... 19
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Finding studies in the Data Selector................................................ 22 Changing worklist views .................................................................. 22 Exploring your local view ................................................................. 23 Tracking down a study..................................................................... 23 Pinpointing studies with querying .................................................... 24 Creating a worklist view................................................................... 25 The Filing tooltab and folders .......................................................... 26 Remote views .................................................................................. 27 Importing studies ............................................................................. 28 Importing and viewing studies directly............................................. 28 Viewing studies................................................................................ 29 The Data Selector as a gateway to other parts of RA 600 .............. 30
F I ND I N G AN D O R GAN I Z I N G Y OU R D A T A ................................................ 45
The Data Selector screen................................................................ 46 Patient and study views................................................................... 48 Local and remote views................................................................... 49 Checking your hard disk space........................................................ 50 Removing studies from your local view ........................................... 50 Importing studies from remote view to hard disk ............................. 51 Hiding the Import dialog box............................................................ 51 Examining your patient and study lists ............................................ 52 Examining the series within a study................................................. 52 Examining the images within a series.............................................. 52
GE Medical Systems IT
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Viewing detailed information down to image level ........................... 52 Exporting and printing study information using the clipboard .......... 53 Finding studies quickly using the keyboard ..................................... 54 Narrowing your search with sorting and filtering.............................. 55 Sorting ............................................................................................. 55 Extended sorting.............................................................................. 55 Filtering with the Data Selector tooltab............................................ 55 Selecting all the studies for a particular patient ............................... 56 Resetting your filters........................................................................ 57 Pinpointing your data with queries................................................... 58 Using Queries with sorting and filtering how it works ................... 59 Removing filters and queries with a single click .............................. 60 Including common sorts, filters and queries in worklist views.......... 61 Selecting studies and opening them for viewing ............................. 62 Selecting studies, series or images ................................................. 62 Opening studies for viewing ............................................................ 62 Viewing multiple studies .................................................................. 63 Using the Automatic buttons............................................................ 63 Manually selecting a hanging protocol ............................................ 64 Directly viewing studies with a remote view, DICOM server or DICOM volume ............................................................................................. 65 Working with folders ........................................................................ 66 Moving your studies between folders .............................................. 66 Saving hard disk space by compressing studies............................. 67 Automatically compressing all incoming studies.............................. 68 Protecting studies with delete locks................................................. 69 Seeing which studies are locked against deletion ........................... 69 Changing the status of studies ........................................................ 70 Seeing the status of studies in the Data Selector............................ 70 Displaying your worklist ................................................................... 70 Defining worklist view properties ..................................................... 71 Including sorts ................................................................................. 72 Adding filters.................................................................................... 73 About initial values........................................................................... 73
Centricity Radiology RA 600 V6.1 reference guide online
Defining queries............................................................................... 73 Highlighting parts of your worklist using fonts and colors ................ 74 Item types and DICOM hierarchy .................................................... 75 The order of the items in the list and how RA 600 displays lines .... 75 Managing your remote views........................................................... 77 Changing patient and study list headers.......................................... 79 Modifying columns........................................................................... 79 Arranging the order of columns in your study list............................. 80
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VIEWIN G
I M A G E S ......... 81
The Viewing Section screen ............................................................ 82 The Pictorial Index in detail.............................................................. 83 Series and study headers in the Pictorial Index............................... 83 Expanding and collapsing series in the Pictorial Index.................... 83 Viewing multiple studies in the Pictorial Index ................................. 84 Sorting the images in the Pictorial Index ......................................... 85 Previewing images in the Pictorial Index ......................................... 85 Using the Pictorial Index to navigate ............................................... 85 Resizing the Pictorial Index ............................................................. 85 Customizing the Pictorial Index ....................................................... 85 The active viewport.......................................................................... 87 Configuring viewports ...................................................................... 88 Using the Layout tooltab to select layouts ....................................... 88 Selecting layouts with the right mouse button menu ....................... 88 Defining a layout with series and viewport areas............................. 89 Filling the viewport areas with images............................................. 89 Undoing actions while viewing images ............................................ 90 Setting the Scope of your changes.................................................. 91 Setting the Scope to a selection of viewports.................................. 91 Working with presentation states..................................................... 92 Creating presentation states............................................................ 92 Modifying presentation states.......................................................... 93 Viewing a presentation state............................................................ 94
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Defining Windowing parameters...................................................... 95 Windowing images .......................................................................... 96 Windowing with the mouse.............................................................. 96 Windowing and Scope..................................................................... 96 Windowing using the tooltab............................................................ 97 Using the slider bar.......................................................................... 97 Directly entering exact values for level and width............................ 97 Using pre-defined settings............................................................... 97 Creating and saving pre-defined windowing settings ...................... 98 Creating pre-defined windowing settings for body parts.................. 98 Using non-linear windowing functions ............................................. 99 Optimizing parts of images using regions of interest (ROIs)......... 100 Inverting images ............................................................................ 100 Pseudo colors (palette).................................................................. 101 Panning ......................................................................................... 102 Quick browsing with the Up and Down buttons and keyboard ...... 103 Configuring buttons in the Viewing Section ................................... 103 Using the keyboard for quick browsing.......................................... 104 Scope settings and browsing......................................................... 105 Pinning images .............................................................................. 106 Key notes....................................................................................... 107 Creating key notes......................................................................... 107 Saving key notes ........................................................................... 108 Modifying or removing key notes................................................... 108 Viewing key notes.......................................................................... 109 Automatically sending key notes ................................................... 110 Zooming and the magnifying glass................................................. 111 Quick zoom shortcut....................................................................... 111 Zooming in fixed steps.................................................................... 111 Zooming with the slider................................................................... 111 Relative, absolute and true size ..................................................... 111 Zoom quality .................................................................................. 112 The magnifying glass..................................................................... 112 Flipping and rotating images.......................................................... 113 Enhancing images with filters ........................................................ 114 Using filter sets and custom filters................................................. 115 Creating cine loops........................................................................ 116 Automatic cine loops...................................................................... 116 Using tags to make precise selections of images.......................... 117 Manually controlled cine loops (stack-mode displays)................... 118 Using the right mouse button to run cine loops ............................. 118 Synchronizing cine loops............................................................... 119 Selecting the master cine .............................................................. 119 Starting and linking cines by selecting multiple viewports ............. 119 Linking methods for cines.............................................................. 120 Changing the offset of linked cines................................................ 120 Annotating images......................................................................... 122 Patient annotation.......................................................................... 122 Adding markers.............................................................................. 122 Annotating with text ....................................................................... 123 Keeping your annotations appearance settings............................ 123 Cutting, copying and removing annotation .................................... 123 Saving your annotation.................................................................. 124 Showing and hiding your annotation.............................................. 124 Pre-defined text annotations.......................................................... 125 Showing and hiding image overlays .............................................. 126 Making measurements on your images......................................... 127 Using probes.................................................................................. 127 Working with calipers..................................................................... 127 Measuring distances...................................................................... 128 Viewing profiles.............................................................................. 129 Measuring angles .......................................................................... 130 Creating regions of interest (ROIs) ............................................... 130 Viewing ROI information ................................................................ 131 Exporting ROI information ............................................................. 131 Saving your measurements........................................................... 132
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Moving and copying annotations between viewports .................... 133 Copying annotation........................................................................ 133 Moving annotation ......................................................................... 133 Using labels to ease reporting ....................................................... 134 Including user information ............................................................. 135 Creating and using masks and overlays........................................ 136 Masks and overlay areas, and how to draw them ......................... 136 Showing, hiding and removing masks and overlays...................... 137 Copying and pasting masks and overlays ..................................... 137 Moving masks and overlays between viewports............................ 138 Saving masks ................................................................................ 138 Adding and adjusting overlay images............................................ 138 Windowing overlays....................................................................... 139 Changing the transparency of an overlay image ........................... 139 Synchronizing overlay image quality ............................................. 140 Using plug-ins................................................................................ 141 Structured reports.......................................................................... 143 Viewing the Reports window.......................................................... 143 Creating a report............................................................................ 143 Configuring structured reports ....................................................... 145 Setting where and how the reports window is displayed ............... 145 Reporting profiles .......................................................................... 145 Assigning reporting profiles to study statuses ............................... 146 Exporting and printing single images............................................. 147 Copying to the clipboard................................................................ 147 TIFF export .................................................................................... 147 Printing single images ................................................................... 147 Presentation sheets....................................................................... 149 Changing the status of your studies .............................................. 151 Configuring study statuses ............................................................ 152 Setting permissions to change study status .................................. 152 Going further with viewing ............................................................. 153 Comparing studies and series ....................................................... 156 Selecting multiple studies and series............................................. 156 Viewing selected studies and series.............................................. 156 Creating your own viewport layouts............................................... 157 Placing your images in the viewports ............................................ 157 The importance of Scope............................................................... 157 Pinning combinations..................................................................... 158 Comparing cine loops.................................................................... 158 Working with multi-frame images................................................... 159 The Pictorial Index and viewing multi-frame images ..................... 159 Viewing multi-frames as cines ....................................................... 160 Viewing and manipulating individual frames in multi-frames ......... 161 Printing multi-frame images........................................................... 161 Teleradiology.................................................................................. 162 Displaying cutlines......................................................................... 163 Displaying a set of cutlines ............................................................ 163 Criteria for determining cutlines..................................................... 164 Customizing the display of cutlines................................................ 164 Using cutlines to select images ..................................................... 165 Viewing multiple sets of cutlines .................................................... 166 Printing and saving cutlines........................................................... 166 Working with collages .................................................................... 167 Creating collages........................................................................... 167 Presenting collages ....................................................................... 168 Sending collages to a specific destination..................................... 168 What is not saved with collages..................................................... 168 Putting studies on hold to view a second study (STAT exam) ..... 170 Viewing images as they arrive ....................................................... 171 Directly viewing studies in a remote view or archive ..................... 171 Viewing worklist items that are not local ........................................ 171 If you dont want your Viewing Section updated... ......................... 172 Limitations when using direct view ................................................ 172
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ADVANCED
V I E W I N G 155
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Monitoring mode............................................................................ 173 Working with hanging protocols..................................................... 174 Using hanging protocols (or selecting a different layout)............... 174 Managing automated hanging protocols ....................................... 175 Disabling and removing automated hanging protocols.................. 175 Disabling all automated hanging protocols and displaying the best 176 Importing and exporting automated hanging protocols ................. 176 Creating and modifying automated hanging protocols .................. 176 The Hanging Protocol Editor in detail ............................................ 178 Creating the layout ........................................................................ 178 Assigning hang criteria .................................................................. 179 Assigning area properties.............................................................. 179 How to see what hang criteria and properties you have applied ... 180 Assigning general viewing modes ................................................. 181 Fine tuning your hanging protocols ............................................... 181 Determining which automated hanging protocol RA 600 will use.. 181 Default hanging protocols.............................................................. 182 Managing your default hanging protocols...................................... 182 Creating and modifying default hanging protocols ........................ 182 Changing the order of default layout buttons................................. 182 Importing and exporting default hanging protocols........................ 183 Viewing images at their true size ................................................... 184
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Rotating your view in steps............................................................ 192 Creating MPR and MIP cine loops................................................. 194 Setting up cine loops with Quick Setup ......................................... 194 Setting up MPR/MIP cines in detail ............................................... 195 Viewing your cines......................................................................... 195 Speed versus image quality........................................................... 197 Setting the pixel range................................................................... 197 Using range presets....................................................................... 197 Using volumes of interest (VOIs) .................................................. 198 Enhancing, measuring and annotating images.............................. 199 Using the Pictorial Index for MPR/MIP .......................................... 200 Adding MPR/MIP images to the Pictorial Index............................. 200 Loading images into the MPR/MIP (oblique) viewport................... 200 Add oblique or current image?....................................................... 201 Saving your MPR/MIP images....................................................... 202 Saving images or transferring them to the Viewing Section .......... 202 Saving cine loops........................................................................... 203
S E N D I NG A N D R E C E I V I N G D A T A ........ 205
What you need for teleradiology.................................................... 206 Receiving series and studies......................................................... 207 Looking to see what you have received......................................... 207 Deleting entries in your receive log................................................ 208 Exporting (saving) your receive log ............................................... 208 Monitoring the receive process...................................................... 209 Sending images using the Data Selector....................................... 210 Working with study management................................................... 212 Monitoring and controlling the send process ................................. 214 Setting priorities and sending in an emergency............................. 215 Setting the default priority of send jobs.......................................... 215 Sending a job immediately in an emergency................................. 216 Looking in detail at what you have sent......................................... 218
3D VIEWI NG WITH M P R A N D M I P ................... 185
Starting MPR and MIP................................................................... 187 Selecting series ............................................................................. 187 The MPR/MIP screen .................................................................... 187 Manipulating your view .................................................................. 189 Moving the cross hairs in the orthogonal viewports....................... 189 Dragging in the MPR/MIP viewport ............................................... 190 Looking at slices through your MPR/MIP view .............................. 192 Stepping through the image volume.............................................. 192
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Deleting entries in your send log ................................................... 218 Exporting (saving) your send log ................................................... 218 Sending from the Viewing Section................................................. 220 Compression in teleradiology ........................................................ 222 Lossless or lossy compression?.................................................... 222 The compression options .............................................................. 222 JPEG and Wavelet what compression factor? ........................... 223 How to tell if lossy compression has been used when receiving studies 224 Sending studies automatically ....................................................... 225 Automatically locking and unlocking studies ................................. 226 Unlocking individual studies when you send them ........................ 226 Redirecting images to a backup site.............................................. 227 Storage commitment ..................................................................... 228 Setting a time-out value................................................................. 229
Automatically adding patient information using a previous study .. 244 Using worklists to enter patient information................................... 245 Using a RIS system to add patient information.............................. 245 Mandatory patient information ....................................................... 245 Saving your study .......................................................................... 246 Automatically sending acquired studies to another system........... 246 Selecting which folder acquired studies are saved in.................... 246 Using compression when saving studies....................................... 246 Specific device support.................................................................. 247
ADVANCED 249
PRINTING .
Printing series and studies with the Data Selector ........................ 250 Fine tuning settings in the Print Study dialog box.......................... 251 Monitoring and controlling the print process.................................. 253 Finding out which printers are available ........................................ 254 Reviewing what you have printed.................................................. 255 Reprinting a job that has already been printed.............................. 255 Removing entries in your print log ................................................. 255 Exporting (saving) your print log.................................................... 255 Printing while viewing images........................................................ 257 Printing a single image or viewport................................................ 257 Printing using virtual film sheets .................................................... 257 Adding to and modifying your virtual film sheet ............................. 258 Modifying the images on your virtual film sheet............................. 258 Multiple film sheets ........................................................................ 259 Printing your virtual film sheet(s) ................................................... 259 Creating custom print layouts ........................................................ 260
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ACQUIRING IMAGES A N D D A T A .............................. 231
An overview of the acquisition process ......................................... 232 The acquisition screen................................................................... 234 The Patient Information dialog box................................................ 234 Acquiring an image........................................................................ 236 Adding images directly to the Pictorial Index................................. 236 Controlling acquisition devices within RA 600 ............................... 237 Pre-defining image formats (image types)..................................... 238 Using the clipboard and directly importing files ............................. 240 Importing graphics files.................................................................. 240 Manipulating and refining your images.......................................... 241 Saving only parts of images using ROIs........................................ 241 Creating studies using various acquisition types........................... 242 Organizing your images................................................................. 243 Adding patient information............................................................. 244 Adding patient information manually ............................................. 244
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EXPORT ING IMAGES A N D A R C H I V I N G ........... 261
Single Media Archive..................................................................... 262 Setting up RA 600 to copy data to your media .............................. 262
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Copying data to a single archive medium...................................... 266 Viewing images with the RA 600 CD Viewer ................................. 268 Setting up RA 600 for viewing from your media ............................ 269 Indexing studies............................................................................. 270 Managing your media with the Index Tool ..................................... 271 Lending out studies ....................................................................... 271 Removing (deleting) volumes ........................................................ 272 Querying for volumes and studies ................................................. 273 Displaying the volumes of studies ................................................. 273
What about empty studies and series?.......................................... 287 Moving images between series using drag and drop .................... 288 Windowing, annotating, flipping and rotating................................. 289 Saving studies and changing study status..................................... 290 Reverting the status of a study ...................................................... 290 Automatically sending studies after saving them........................... 291 Setting which demographics can be edited ................................... 292
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C U S T OM I Z I N G 295
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Q U AL I T Y
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Making changes while using RA 600............................................. 296 Resetting your window positions ................................................... 296 Configuring your toolbars............................................................... 297 Showing, hiding and changing the look of your toolbars ............... 297 Creating your own toolbars............................................................ 297 Changing the buttons on your toolbars.......................................... 298 Creating keyboard shortcuts.......................................................... 299 Using special commands for changing study status...................... 300 Configuring right mouse button (pop-up) menus ........................... 302 Custom tooltabs, menus and right mouse button menus .............. 303 Customizing your fonts in RA 600 ................................................. 304 Fonts in your Data Selector patient and study lists (worklist views) 304 Image annotation fonts .................................................................. 305 Working quickly with RA 600 ......................................................... 306 Toolbars and buttons ..................................................................... 306 The double-click............................................................................. 306 Keyboard shortcuts and special commands.................................. 307 Mouse / keyboard combinations.................................................... 307 Right mouse button menus............................................................ 307
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The Quality Control tooltab in the Data Selector ........................... 277 Viewing study status histories........................................................ 277 The quality control indicators......................................................... 277 Starting quality control ................................................................... 278 Opening a copy of a study............................................................. 278 The Quality Control screen............................................................ 279 Editing patient demographics ........................................................ 281 Viewing the study status history .................................................... 281 Matching studies automatically...................................................... 282 Matching all incoming studies automatically.................................. 282 Adding, rearranging and removing data ........................................ 283 Rearranging images within a series .............................................. 283 Removing images and series ........................................................ 283 Adding and combining images and series..................................... 283 Renumbering images .................................................................... 284 Changing patient orientation.......................................................... 284 What are correct values for patient orientation?............................ 284 Splitting and joining series and studies ......................................... 286 Selecting images in the Pictorial Index.......................................... 286 Placing selected images in a new series or study ......................... 286 Splitting using contrast or echo time.............................................. 287 Combining images into new series or studies ............................... 287
COMMON TASKS FOR R A D I O L O G I S T S .............. 311
How to view a chest film ................................................................ 311
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Sending a report ............................................................................ 313 Looking at two studies ................................................................... 314
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COMMON TASKS FOR R A D I OG R A P HI C T E C H N O L O G I S T S ......... 317
Preparing studies for viewing by a doctor...................................... 317 Sending a report ............................................................................ 319 Printing viewport images ............................................................... 320
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AGREEMENT
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D E C L A RA T I ON O F C O N F O R M I T Y ..................... 325 G L O S S A R Y ............................. 327
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Key to note icons

A note offering additional information on an aspect described in the text. Read this. An aspect of particular importance to take note of. A tip or trick to help you get more out of RA 600..
Foreword
edical facilities around the world continue to introduce RA 600 into their workflow. In fact, RA 600 stations continue to be installed in hospitals on every continent.
We believe the success of our product is attributable to the ease with which it allows radiologists, doctors and radiographic technologists to view medical images using the familiar Windows user interface. Perhaps the most important step weve taken in this direction is the introduction of presentation states, structured reports, key notes and study statuses that can be sent over a hospital network. You can now edit an image, draw up a new report, create a set of key notes or simply change the status of a study and send only the changes over the hospital network - without all the accompanying images. One advantage of this is a more flexible workflow. Another is a decrease in the bandwidth the PACS requires, which will inevitably reduce the traffic on a hospitals network and therefore increase the availability of IT resources. In a time in which health care is spanning greater physical distances, this can only be good. We hope that you continue to find RA 600 valuable in your work. The development team Zeist, The Netherlands September 2002
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Introducing Centricity Radiology RA 600

This chapter offers a very brief introduction to Centricity Radiology RA 600 and the philosophy behind it. It covers the general way you will work in two key parts of the software: the Data Selector and the Viewing Section. It also provides a quick description of what else you can find in RA 600.
I N T H I S C H A P T E R
Ease of use ..............................................................12 The Data Selector ....................................................14 The Viewing Section ................................................15 Advanced tools for viewing and diagnosis ...............17 Other parts of RA 600 ..............................................18 Going further in this guide ........................................19
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The Centricity Radiology RA 600 workstation or software is not to be used for the final interpretation of digital mammography examinations. Final interpretation should be performed using the laser-printed digital images only.
entricity Radiology RA 600 is a PC-based medical viewing system designed for routine use at locations inside and outside a hospital or other institution. It runs under Microsoft Windows 2000 and XP with the same user interface as is familiar to millions of PC users. RA 600 lets you load, display and manipulate virtually any medical image or patient study that may consist of an individual or a series of digital images. With it, you can import CT, MR, X-ray, Digital X-ray (DX), Digital Mammography X-Ray (MG), Digital Intra-oral X-ray (IO), XA, NM, RF, US multiframe, CR and many other types of image, either from a digital outlet or via secondary capture (e.g. digitized or frame-grabbed images). It also supports monochrome through to 24-bit true-color images, thereby allowing the clinical use of it in many application areas outside the Radiology department. The versatility of RA 600 means that computerized diagnostic imaging can be applied at almost any location inside or outside the hospital - even at home. The PCs involved can also be used for many other tasks that may or may not be related to medical imaging, such as word processing and HIS functions. In addition to displaying images for diagnosis and reporting, a full RA 600 system can cover many other areas, such as image acquisition, archiving, teleradiology, printing, 3D imaging and quality control.
Ease of use
Centricity Radiology RA 600 comes with comprehensive on-line help for every aspect of using the software. Press F1, any Help button or select Help from the menu bar to find out more while using RA 600.
RA 600 is designed to combine its powerful functionality with ease of use for everyone, even those without extensive experience of using a computer. All the features of RA 600 can be found on tooltabs which are highly characteristic of RA 600. These group together and provide rapid access to functions in specific areas such as windowing, annotation, teleradiology etc. As with other Windows applications, you can use the menu bars to perform your tasks with RA 600, although you will often find it much quicker to use the mouse, keyboard shortcuts or toolbar buttons for many tasks, especially those you perform frequently. A little time spent becoming familiar with using these will pay dividends in terms of your speed and efficiency.
13 For example, dragging with the right mouse button performs functions such as windowing, while a single click with this button reveals a pop-up menu with all kinds of options for commonly performed tasks in the particular part of RA 600 you happen to be in. The tool buttons, which are arranged on fully configurable toolbars, can be dragged to any side of the screen and used to perform frequent tasks with a single click of the mouse. Finally, RA 600 lets you assign keyboard shortcuts to perform common tasks simply by pressing a particular key combination. Apart from customizing your toolbars and keyboard shortcuts to your particular needs, you can show or hide particular parts of the screen, such as the Pictorial Index and reporting window, and move these elements to the part of the screen where you prefer them. Again, spending a little time setting up RA 600 to your own personal needs and preferences will allow you to use it even more easily and quickly.
Even if you are just one of a number of users of the RA 600 workstation, you can freely customize it without risk of inconveniencing other users - RA 600 remembers all the custom settings for each individual user and will use your own particular settings when you log on.
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The Data Selector

The basic functions of Centricity Radiology RA 600 are divided between finding and loading images and studies and viewing them. For the former task you use the Data Selector.
The Data Selector is your home base when using RA 600
In some configurations, the Data Selector may be supplied with information from a worklist source.
This always appears when you first start RA 600 and when you have finished viewing a study. It lets you manage your images and patient studies and load them from local or remote DICOM 3.0 compliant storage devices. The Data Selector can be configured to use worklists from a HIS or RIS system, for example. It shows configurable lists of studies that can be sorted and filtered according to various criteria such as modality, acquisition date, type of study, etc. Within the Data Selector you can call up all the available DICOM 3.0 information on the patient, study, series, and individual images. It lets you manage the status of individual studies, and also to keep them in separate folders, to delete ones that have been reviewed or to send them to remote storage devices if RA 600 is connected to them. The Data Selector also gives you access to other modules of RA 600 that have been installed on your system, such as acquisition or archiving.
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The Viewing Section

When you have used the Data Selector to find a study or series you want to view, you open the series or study (generally with a double-click of the mouse) and automatically enter the Viewing Section of RA 600. The images in your study or series will be displayed in the center of the screen. You will also see a miniaturized overview of all images you have opened for viewing, the Pictorial Index. This is an orientation and navigation tool that can be windowed independently, adjusted in width, repositioned at any side of the screen and switched on and off at will.
The Viewing Section, with tool bars (just below the menu bar), Pictorial Index (left), tooltabs (right), viewport area for viewing images (center), reporting window (bottom center left) and mini version of the Data Selector (bottom center right)
The center of the screen consists of viewports, each of which will contain a single image from your series or study. You can have just a single viewport, or a whole array of them of various sizes. All kinds of layouts for your viewports are possible. Depending on the procedures in your organization and how RA 600 has been configured, studies may be opened using pre-defined hanging protocols thereby automatically being displayed in just the way they should be. You can also select alternative viewport arrangements for particular tasks such as comparing studies and series, and even define your own if RA 600 does not provide exactly what you need.
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16 chapter 1 The Viewing Section provides powerful tools for viewing and diagnosis. You can window images according to numerous methods (various look-up tables are provided and others can be defined). You can also zoom in for a close look at any image (or use a magnifying glass which you can drag over the image). You can invert, flip or rotate your images. Filters provide various image enhancements for revealing specific features within your images. Cine loops are a valuable diagnostic tool. With RA 600, you can have multiple cines running at the same time and even synchronize them. They can generally be set up with just a couple of clicks of the mouse. Many kinds of measurement facilities are provided, from probes to regions of interest and profiles. You can also add various annotations, such as overlays over the images (text and markers pointing out particular features for example). Yet another valuable feature of the Viewing Section is the ability to pin (freeze) an image in a viewport, which is very useful when comparing images and series. Particular images in a study can also be designated as key images (key notes), allowing just these images to be displayed when the study is viewed. You can create reports and save them while viewing your images.
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Advanced tools for viewing and diagnosis

Centricity Radiology RA 600 includes many more advanced tools which will be of particular interest to radiologists. You can, for example, view and manipulate cutlines, view images at their true size and even create 3D images from MR slices (for example) to literally add a new dimension to diagnosis.
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Other parts of RA 600

Centricity Radiology RA 600 is modular, so not all of the parts of RA 600 described here may be available on your particular workstation.
Although RA 600 will most often be used for finding and viewing images, it is designed to provide a complete solution for virtually all medical imaging needs. The ability to send and receive images over phone lines and networks is an increasingly important aspect of medical imaging. RA 600 provides comprehensive facilities in the field of teleradiology. Getting images from a scanner, frame grabber or other imaging device into RA 600 (and then onto a hospital network perhaps) is another vital aspect. RA 600 offers full acquisition capabilities. For hard copy, powerful features for routinely printing whole series and studies are needed. RA 600 provides all that is required for this, as well as the ability to compose and print sets of images on the fly while viewing them. Archiving images so that they are stored safely and can be quickly retrieved is essential. RA 600 allows archives of images to be created and maintained using various types of media. An RA 600 system can be turned into a full quality control workstation, acting as a gatekeeper between an acquisition device and a hospitals network to ensure that acquired images are correct and are assigned the proper patient information.
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Going further in this guide

Chapter 2 of this guide, Getting started, offers a short guided tour of some of its main features. It is designed for those new to the software and aims to give you a quick feel of what Centricity Radiology RA 600 can do and how to go about using it. The remaining chapters cover all the various parts and functions of RA 600 in detail. The appendices contain specific information and tips for particular types of user. At the back of the guide you will also find a glossary which you may find useful before you become more familiar with RA 600 and the terminology of medical imaging.
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C H A P T E R
Getting started
If youre new to RA 600, run through the step-by-step instructions in this chapter to gain quick hands-on experience of performing some of the most common tasks.
Finding studies in the Data Selector ........................22 Changing worklist views...........................................22 Creating a worklist view ...........................................25 The Filing tooltab and folders...................................26 Remote views...........................................................27 Importing studies......................................................28 Working in the Viewing Section................................31 Using the Pictorial Index ..........................................32 Scope, pinning and key images ...............................33 Windowing................................................................35 Viewing cine loops ...................................................37 Measuring and annotating images ...........................38 Masks and overlays .................................................41 Reporting..................................................................42
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Your system will most likely contain important medical data. You are advised to use the sample studies to explore and familiarize yourself with RA 600. When you leave the Viewing Section you should click No when asked if you want to save changes - especially if you are using other studies. It is assumed that the sample studies provided with RA 600 were installed along with RA 600 on your system. If not, you can probably use different studies than the ones named in the procedures.
or newcomers to Centricity Radiology RA 600, this chapter introduces some main parts of the software and typical activities you might undertake, such as finding a particular study, opening it for viewing, examining it and writing a report. By spending just a few minutes going through the procedures in this chapter, you will have a quick introduction to many of the key features of RA 600 and hopefully gain an idea of how you might go about using it in your particular line of work.
Finding studies in the Data Selector

Using the Data Selector, you can search for and quickly locate studies and images you want to view. 1 Start Centricity Radiology RA 600 (if it is not already running on your system).
RA 600 always opens by showing the Data Selector. You use this to find and open studies to view, or perhaps to go to another part of RA 600.To locate studies, you use the Data Selector tooltab. This will generally be on top when RA 600 first opens. To bring it to the top and view it at any time, simply click the tab with this icon.
Changing worklist views

With RA 600, you can view various worklists in the center section of the screen. Two of the main worklists are called Local Patients and Local Studies.The advantage of the Local Patients view is that studies on a particular patient are grouped together. The view you initially see will depend on how your system was set up, but you can readily switch from one to the other using the Worklist View drop-down list. 1 Open up the drop-down list near to top of the Data Selector tooltab (with the icon).This lets you choose how the studies are displayed (patient view or study view). Click on Local Studies (scroll down through the drop-down list if necessary to find it). Your local view (the large window in the center of the screen) will show a list of studies, each with its own folder icon. (If the Data Selector was already showing a local studies view, you may not see any change).
23 3 Go back to the Data Selector tooltab, and select Local Patients from the drop-down list near the top of the tooltab. The center of the screen will change to show a list of patients, with each patient indicated by this icon.
By default, the Worklist View drop-down list also displays the Today, Unread and Unverified worklists which show selections of studies of the types they their names describe.
Exploring your local view

The Local Patients list in the center of your screen shows the images in your local database (the ones stored on your system). You can browse through these right down to image level. 1 Click on the + symbol next to the icon for Buxton, Steven. (This is an Centricity Radiology RA 600 sample study. If this is not in your local view, pick another patient.) The list will expand (much like Windows Explorer) to show one or more study icons. Click on the + symbol next to this study icon. The list will expand again to show two series icons. Click on the + symbol next to the first series icon. You will now see a full list of all the images in the series. Click on the (minus sign) symbol next to the patient ( ) that you opened up. The list will close up again.
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Tracking down a study

The Data Selector offers you a great deal of help in tracking down a particular study, even if you only have limited information on what you are looking for. You do this by narrowing down your search to studies which meet certain criteria. In RA 600, this is called filtering. 1 Make sure the Data Selector tooltab is on top (click on the tab with this icon to bring it into view). Select Local Studies from the Worklist View drop-down list (if this is not selected already). Go to the Modalities section of the tooltab and click on the None button. All the studies which appear in your local view will disappear, since RA 600 has been instructed not to show any modalities at all.
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24 chapter 2 3 Click in the small box (check box) next to MR. A check mark will appear in the box and the local view will show a number of studies again. Note that these are all MR studies (in fact all the MR studies that are on your local system). You can also filter according to the origin of the study (which system it came to your system from). Click in the check boxes next to whatever origins you might have and see how your local view changes to show only those studies that are from particular origins. Note also that the studies are still all MR. The modality filter remains in effect. Do the same for the folders which are on your system. Finally, since filters remain in effect until you remove them, click on the All buttons on the Data Selector tooltab and ensure that all the check boxes on the tooltab have ticks inside them. You will now have cleared all the filters and be able to view all your studies again.
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Pinpointing studies with querying

Apart from filtering, you can also find studies by querying. This lets you display studies with very specific characteristics such as those for a patient with a particular name, birth date, study date, etc. 1 Click the Query button on the Data Selector tooltab. A Query Parameters box will appear in the middle of the screen. This is where you enter your query. Click with the mouse in the area (field) next to Patient Name, type Bailey* and then click on the OK button. If you have the RA 600 study cases installed on your system, you should see just one patient and study in your local view that of Nicole Bailey. If you receive a message such as Result of query empty, RA 600 was unable to find the study, so it is probably not on your system. Pick a study you can see in your local view and try the patient name for this. Click once again on the Query button on the Data Selector tooltab, then on the Clear button, and then on OK. This will clear the query, so you will see all the available studies in your local view again.
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The asterisk is an example of a wildcard that lets you specify parts of names, etc. that can be anything for the purposes of the query. Barnsley* will therefore find all patients with the surname Barnsley, including those with different initials.
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Creating a worklist view

You may not have the rights as a user to create and modify worklist views. If not, you should skip this section.
With RA 600 you can create and use many different types of views of the information stored on your local computer. These are called worklist views. If your system is connected to a HIS/RIS and has been so configured, these worklist views may be actual worklists. If not, you can create and use them to display only some of the studies on your system, such as those which have just been received or those of a particular modality for example. 1 2 Select Database Data Selector. Add View from the menu bar at the top of the
Type CT only in the Description field of the Add view dialog box and select (if necessary) Local Studies from List drop-down list and Local Studies from the Copy Settings from drop-down list. Click OK. You have now created a new worklist view that you can view by selecting it from the Worklist View drop-down list. At the moment your new worklist view is identical to your Local Studies worklist view (the settings were copied from it). To make your new worklist view useful, you need modify its properties (customize it). To do this, select the new CT worklist view from the Worklist View drop-down list and then Database View Properties from the menu bar at the top of the Data Selector. A rather complex-looking dialog box called Configure View will appear (described in full in chapter 3!). What you need to do is have RA 600 apply a filter to show only CT studies each time you open this worklist view. Click on the line that starts with Modality in the Filters section to select it. Then click the Edit button below it. In the Filter dialog box that appears, click inside the Initial values box and type CT. Then click OK to close the Filter dialog box and OK again to close the Configure View dialog box. Note that your worklist view now shows only those studies of type CT. To remove your new worklist, make sure it has been selected from the Worklist View drop-down list. Then select Database Delete View the menu bar at the top of the Data Selector and select the worklist. Confirm the deletion by clicking Yes in the Delete view confirmation box.
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The Filing tooltab and folders

The Filing tooltab (the one which has this icon) lets you see what disk space you have left on your system, create and manage folders for holding your studies, and select which remote views you want to look at. 1 2 Click the tab with the filing cabinet to the top. icon to bring the Filing tooltab
Look at the display at the top of the tooltab. This shows you how much disk space you have left. (Medical imaging data can take up a lot of space and fill up your systems hard disk quite quickly. The display gives you an early warning of when you might need to remove or archive some studies.) Go to the Folders section and click the New button. A New Folder dialog box appears on your screen. Click in the field next to Folder and type a name (such as My Folder). Then click on the OK button. You will see that a folder with the name that you typed in the Folders window on the Filing tooltab. Click on one of the Centricity Radiology RA 600 study cases (if these were installed on your system). This will select it (it should appear highlighted in blue). Click with the right mouse button on the line which is highlighted. A (pop-up) menu will appear. Move the mouse pointer to Move to Folder on the menu. A submenu will appear showing the name that you typed in previously. Click on this name (with the left mouse button). A Move Data box will appear. Click on OK to confirm that you want to move the data (study). Go back to the Data Selector tooltab (click on the tab with this icon). Filter on the new folder you created (make sure the box next to it is the only one in Folder section with a tick in it). The study you moved should be the only one which appears in your local view. Move the study back by clicking on it in your local view to highlight it. Right click and this time select Move to folder General. Click OK to confirm the move in the Move Data box. Finally, remove the filter by clicking the All button at the bottom of the Folder section on the Data Selector tooltab.
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Remote views
The filing tooltab lets you select which remote views will appear in the center of your screen. A remote view lets you look at studies which are on other systems connected to yours via a network. 1
The indicators will appear different on monochrome monitors (circles with and without a cross inside).
Click on the tab with this icon to bring the Filing tooltab to the top. Look at the check box at the top of the section called Remote Views. If it is not checked, click on it. A check mark should now appear inside it. In the area immediately below the check box, you should see a number of remote views which have been configured for your system. (If you cannot see any remote views, you may have a stand-alone system, or possibly your remote views have not been configured yet. You should then skip this section.) Look at the center of your screen. You should have your local view at the top, but beneath this a second window showing one of your remote views. If you have a number of remote views, you will see tabs at the bottom of this lower (remote view) window. Click on each tab in turn to see each remote view. After a moment, the indicator light on the left at the top of this lower window should turn from red to green, indicating that a connection has been properly established. (If it stays red, you should consult your system administrator). Initially, you will quite possibly not see any studies in your remote view windows. This is because the remote systems could contain a great many studies and it can take some time to get the information on them all. To show the studies in a remote view, you should perform a query. An empty (show all) query will show you all the studies available on the remote system. To do this, click within the remote view window to ensure that it is the active window (tell RA 600 this is the window you are working in). Then click the Query button on the Data Selector tooltab. Without entering anything in the Query Parameters box, click OK. All the studies in the remote database should be displayed.
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Importing studies
When you import studies from a remote view to your local view, they remain on the remote system (the studies are copied, not moved). This means that you can safely remove (delete) the study you import without destroying any data.
All the studies you see in your remote view are on another system. To be able to display the information contained in these studies efficiently, RA 600 needs to get the information from your local hard disk, since this will be faster than trying to get the information over the network. This means that when you want to view a study which is in your remote view, you should import it first. 1 2 Click on a study in one of your remote views that you want to import. Click on this study with the right mouse button to reveal a pop-up menu and select Import. In the Import Data box which appears, click OK. When importing is completed, you will see the study appear in your local view (the window in the upper part of your screen) ready for viewing.
Importing and viewing studies directly

Importing and viewing studies directly (direct view) must be explicitly enabled after RA 600 is installed. If you cannot see View on the popup menu, this has not been done on your system. To enable direct view, consult your system administrator or, if you have administrator rights, select Configuration Viewing... from the Data Selector menu bar and make sure the Direct View check box is checked on the Machine tab of the Viewing Properties dialog box. (If you cant see the Machine tab, you do not have appropriate rights, and should contact your system administrator.)
In fact, you do not have to explicitly import studies to your local view before viewing them. Provided your system has been configured for Direct View, when you right-clicked in your remote view, you will have seen another item on the pop-up menu - View. If you use this rather than import, RA 600 will import the images and display them as they arrive. This acts as a shortcut for importing a study and then viewing it, with the added bonus that you do not need to wait for all images to arrive before you can start viewing them. Right-click on a study in your remote view and select View from the pop-up menu. The Viewing Section of RA 600 will open, and, if you are using DICOM format, as the images arrive they will appear one by one in the Pictorial Index on the left. Depending on the image format used, the Pictorial Index will update with all the images when the last one has arrived. Click the Back button in the bottom right corner to return to the Data Selector.
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Viewing studies
Once you have a study in your local view, you can open it for viewing in a number of ways. The quickest is to double click on it, but you can also use the Viewing tooltab (with this icon), the right mouse button menu, or the menu bar. 1 Double click on any of the studies in your local view. The study will open in the Viewing Section of RA 600, which lets you look in detail at images, add annotation, write reports and much more. We will look at this in more detail later. For now, click the Back button located below the tooltabs. This will return you to the Data Selector. Click the tab with this icon to bring the Viewing tooltab to the top. This contains a number of layout buttons for viewing studies. They indicate how the viewports will be laid out when a study is opened. The thicker lines on the buttons indicate how the screen will be divided up in areas for displaying separate series contained in a study. Click on a study in your local view to select it, and click on one of the buttons on the Viewing tooltab. The study will open in the Viewing Section. Notice that the layout of the viewports in the center of the screen matches the layout of the button you clicked. Click on the Back button and then on No in the Save As dialog box to return to the Data Selector and try out some of the other buttons. You will have seen the button labelled Automatic at the top of the View section on the Viewing tooltab. If you use this button instead of clicking one of the layout buttons, RA 600 will automatically calculate how best to show the particular series you have selected. In addition, with RA 600 you can select a number of studies in the Data Selector and then view them either simultaneously or one after the other without having to return to the Data Selector each time. To try this, select a range of studies in your local view (click on the first study in the range and then, while holding down the Shift key, on the last study in the range). The range of studies should now be highlighted. Click the Automatic button in the View section of the Viewing tooltab. RA 600 will display a message pointing out that you selected multiple studies for viewing and ask you whether you want to view them simultaneously. This offers you the choice of viewing all the studies at the same time, or viewing them one after the other in the Viewing Section.
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30 chapter 2 7 Select Yes. RA 600 will display a message warning that the items you selected are from different patients. Click OK to view the studies. One study will display in the viewport, while the others appear as thumbnails in the Pictorial Index ready for easy access. Click the Back button to return to the Data Selector. Repeat step 6, but this time select No, when asked whether you want to view the images simultaneously. RA 600 will place the first images of the first study in the viewport and display the full range of images in the Pictorial Index. Click the Next and Prev buttons in the Viewing Section to move from one study to another. Note how RA 600 automatically selects the most appropriate layout for the study (if the layouts are the same, the studies you selected must have a lot in common). Click the Back button to return to the Data Selector.
The Data Selector as a gateway to other parts of RA 600

If you have gone through the above, you have covered most of the key aspects of the Data Selector. This is primarily a tool for finding studies before you open them for viewing. The Data Selector has another important function, however. It also provides you with a quick way to get to various other parts of RA 600 to perform such tasks as image acquisition, printing, archiving, 3D viewing, teleradiology, and more. Depending on what capabilities have been installed on your system, you will see a number of other tooltabs with various icons. Describing each and every one of them is beyond the scope of this brief introduction, but you may like to click on each of the tabs to gain a quick impression of what you can do with your Centricity Radiology RA 600 system.
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Working in the Viewing Section

If you have gone through the introduction to the Data Selector, you will already have briefly visited the Viewing Section, the part of Centricity Radiology RA 600 where you will probably spend most of your time. It is in many ways the heart of RA 600 where you can view images in detail for diagnosis, measure and annotate them and write reports.
Adjusting the Viewing Section screen

The Viewing Section is, like other parts of RA 600, highly configurable, even while you are working in it. You can easily resize and move parts such as the tooltabs around, and even hide them altogether. This can be useful for maximizing your actual viewing area on smaller monitors, for example. 1
Because RA 600 is highly configurable, you may or may not see all of the elements described.
Double click on the RA 600 sample study for Bailey, Nicole in your local view in the Data Selector. (If you cannot find this study, double-click on another study which preferably includes two or more series.) The Viewing Section will open to display the images in the study you clicked on. This screen has a number of key elements. The Pictorial Index displays miniature views of all the images that were opened for viewing. The center of the screen contains a number of viewports in which some of your images are displayed. The tooltabs provide you with everything you need to examine images in detail, measure and annotate them, create cine loops and much more. You may also see a Reports window (where you can create a report while viewing your images) and a Data Selector window (which is a smallscale view of your local studies as shown in the Data Selector). Click the tab with the Swiss Army knife icon. In the Windows section of the tooltab, you will see three check boxes: Show Pictorial Index, Show Data Selector and Show Reports. Click in each of the check boxes in turn to show or hide the screen elements. Before leaving this tooltab, make sure all the check boxes are checked (have a check mark inside them) and that the Reports window, your Data Selector window and Pictorial Index are all displayed. Move your mouse pointer to the border between the Pictorial Index and the viewports in the center of your screen. The mouse pointer should change to a double arrow . Click the left mouse button and hold it down. Then move the pointer to the left and right to resize the width of the Pictorial Index. Do the same with the tooltabs and Reports window. You should find that you can resize all of these elements.
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32 chapter 2 4 Move the mouse pointer until it is over the two gray lines at the top of the Pictorial Index. Click with the left mouse button and, holding the button down, drag the mouse pointer towards the opposite side of the screen. You will find you can drag the Pictorial Index across to the opposite side, allowing you to choose whether you have it on the left or right. You can also position the Pictorial Index at the top or bottom of the screen in the same way. Click on the two gray lines at the top of the tooltabs and do the same thing. Click on the gray lines of the Reports and Data Selector windows and drag these to relocate them on the screen. Finally, place the Pictorial Index so it is on the left, the Reports and Data Selector windows at the bottom of the screen and the tooltabs on the right.
Using the Pictorial Index

The Pictorial Index is a powerful navigation tool which lets you see and select which images you are displaying in your viewports. It always shows all the images that were opened for viewing, even if you have opened a number of series or even studies for viewing at the same time. 1 If you are not already viewing the RA 600 sample study Bailey, Nicole, open this in the Data Selector by double-clicking on it. (Or, if you cant find it, open another study which contains at least two series.) You will see that the Pictorial Index is divided into three by thick gray lines labeled with the word Series and a number indicating the number of images in the series. These indicate the divisions between the three series in the Bailey study. Click on the tab with the Swiss Army knife icon to bring the Layout tooltab to the top. From the Hanging Protocols buttons, click on the one with four viewports arranged as two horizontal pairs one above the other . Your viewports will change to show this viewport layout. Note that the top two viewports contain the first two images of the upper series in the Pictorial Index, while the lower two show the first two images of the lower series displayed in the Pictorial Index. The two pairs of viewports are separated by a thick horizontal line to indicate that they are showing images from different series.
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The active viewport is effectively the viewport in which you are currently working. By choosing an appropriate Scope setting, you can restrict changes you make to the active viewport or have them apply to all the images in a series or study. You will be able to use the All radio button if you have opted to view more than one study in the Viewing Section screen.
Click on the bottom left viewport. Note how the viewport becomes highlighted to indicate it has been selected, or that it is now the active viewport. Click on one of the images in the second series towards the bottom of the Pictorial Index. Note that the images shown in the lower two viewports have changed. In fact, the viewport you previously clicked on (the active viewport) now shows the image you just clicked on in the Pictorial Index. The other viewport shows the next image in the series. In general, when you click on the Pictorial Index, the active viewport will show the image you clicked on, and the remaining viewports will fill with the subsequent images from the series. Click on one of the top two viewports to make it the active viewport and experiment with clicking in the Pictorial Index to change the images displayed in the viewports. Note that the Pictorial Index also shows what images are in being shown in your viewports by red borders (light gray on monochrome monitors) around the miniature images.
Scope, pinning and key images

The combinations of right-clicking with the mouse and the Ctrl and Shift keys for marking key images and zooming described are the way RA 600 is set up during a standard install. Your system may, however, have been set up for compatibility with previous versions of RA 600. In this case, you must hold down the Ctrl key or Shift key and click with the left mouse button to mark key images or zoom in, respectively.
When adjusting your images, sometimes you will want to change just one particular image in a viewport, and at other times you might want to change all the images in a series, or even a study, at the same time. You use RA 600s Scope to do this. There will also be times when you want to freeze an image (such as a scout image for example) in a viewport, so that you can change the images in the other viewports but have this image remain unchanged. You do this by pinning the viewport containing the image. You can also mark images of special significance as key images. 1 With the Bailey study open for viewing in four viewports as described in Using the Pictorial Index on page 32, click on the radio button (option button) next to Viewport just above the Prev, Next, Reset and Back buttons. (This radio button will now have a black dot inside it to indicate it is selected.) Click with the mouse in the top left viewport and hold the mouse button down. Drag with the mouse across the viewport. The pointer will change to a hand symbol and the image in the viewport will move with the mouse pointer. You are now panning in your viewport. Notice also that only the image you are dragging moves. The images in the other viewports are not affected. This is because you set the Scope to Viewport by clicking the radio button.
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34 chapter 2 3 Click the One Series radio button just above the Prev, Next, Reset and Back buttons and again drag with the mouse in the top left viewport. Note that now the image in the top right viewport also moves. In general, with the scope set to One Series, actions such as panning that you perform will affect all the images in the same series. Click on the Study radio button just above the Prev, Next, Reset and Back buttons and drag with the mouse in the top left viewport. Now all the images will move, because you have now set the Scope so that all the images in the whole study (hence both series) will be affected. Double-click on one of your viewports. Notice that a thumb tack appears in the top left hand corner of the viewport to indicate that the viewport is pinned. Now try to change the image in the pinned viewport by clicking on the Pictorial Index, dragging in the viewports etc. It will remain unchanged no matter what you do. Unpin the viewport you pinned by double-clicking on it again. Finally, right-click in a viewport, holding down the Ctrl key as you do this. A key icon will appear in the corner of the viewport to indicate that the image has been marked as a key image. This lets you mark images of particular significance and later ask RA 600 only to show these images. Unmark the image by holding down the Ctrl key and right-clicking the viewport again.
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Clicking the All radio button in the Scope section will mean that all the images in all the studies you may have opened will be updated in the same way.
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Try holding down the Shift key while clicking with the right mouse button in a viewport. This will display the image you clicked on in a single large viewport - great for quickly zooming in to view more detail. Hold down the Shift key and right-click again to return to your previous view.
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Windowing
Windowing is one of the most common tasks in digital medical imaging. RA 600 recognizes this by displaying the Windowing tooltab (with the sun icon) on the top when you first open a study for viewing. This lets you window in a variety of ways, and you can also window quickly and easily using the right mouse button.
Right-click in a viewport and drag to window your images
Click with the right mouse button in one of your viewports and hold the mouse button down. After a moment or two, the cursor will change into a sun symbol. Now, keeping the mouse button pressed, drag the cursor to the left or right to adjust the center, and up and down to adjust width (or a combination of the two). If necessary, click on the tab with the sun icon to bring the Windowing tooltab to the top. Click in the area (field) to the right of where it says Center and type in a value. Do the same for the field next to Width. Select the Invert check box to display the negative of the gray scale of an image or images. Click the ROI (Region of Interest) button and then select an area in a viewport by clicking and holding down the left mouse button and dragging to create a rectangle. Adjust the size of this ROI by dragging on its edges or corners and reposition by clicking inside it and dragging. Note how the windowing changes as you move the ROI around. RA 600 optimizes windowing of the image for the area inside the ROI. When you have finished, right-click inside the ROI and click on Delete on the pop-up menu to remove the ROI. Open the drop-down list immediately underneath the Invert check box. This is a list of windowing settings. Select one of these and see what effect this has on your viewports.
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Non-linear windowing functions are useful for compensating for inherent non-linearity in modalities such as photographic film. The exponential function, for example, makes your images darker since pixel values at the high end of your windowing range will be shown in a greater range of gray tones.
Try selecting the options in the Type drop-down list. These offer various non-linear windowing functions. Move the Slope slider for each type to increase and decrease the slope and see what effect this has. Click with your mouse in the center (between the two small lines) on the vertical slider bar at the bottom of the Windowing tooltab and, holding the mouse button down, drag the slider up and down. This changes the windowing center. To change windowing width, place the mouse pointer at either end of the slider bar (outside the two lines) and again click and drag up and down with the mouse. Restore the original windowing settings by clicking the Reset button underneath the tooltabs. This will return all your images in your viewports to how they were when you first opened the study.
Examining images in detail

Even on quite a small monitor, you can view images in great detail by zooming in. You can also flip images and rotate them. You use the Zooming and Flip/Rotate tooltab to do this.
Magnifying glasses are ideal for viewing fine detail
Before looking at this tooltab, however, try this very useful shortcut: Hold down the Shift key on your keyboard and right-click on a viewport. This viewport will now fill the whole viewing area. Repeat this to return to your previous layout. Now click the tab with the magnifying glass Zooming and Flip/Rotate tooltab to the top. icon to bring the
37 3 Click on the 1, 2, 3 and 4 radio buttons and drag the slider to see what effect this has on your viewports. Click with the left mouse button in a viewport and drag to pan zoomed images in the viewport. Note that the cursor turns into a hand icon when you do this. Try selecting the Relative and Absolute radio buttons in turn to see what effect these have. Relative means that with a zoom factor of 1 RA 600 will display the images so they just fit completely in the viewports. Absolute means that RA 600 will (at a zoom factor of 1) show images so that one pixel on your display represents one pixel of the image that was actually acquired. If true size display has been configured on your system, you can try the True Size radio button. Now the images will be displayed at the same size as the original films etc., allowing you to take measurements directly from your screen, for example. Note that the other zoom options are now grayed out (disabled) since you cannot zoom and display images at true size at the same time! Click on the Magnifying Glass button. Click anywhere inside the window which appears and, holding the button down, drag it over your viewports. Drag the slider to increase or decrease the magnification. You can use as many magnifying glasses as you like at the same time. Open another one by clicking on the Magnifying Glass button again. Two magnifying glasses can be very useful when comparing images. Close the magnifying glasses by clicking on the close button the top right hand corner of the magnifying glass window. in
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Try the flipping and rotating buttons at the bottom of the tooltab. Click the Reset button below the tooltabs to restore your images to their initial condition.
Viewing cine loops

Cine loops are continuous displays of sequences of images in a viewport. They convey the effect of motion and can be a powerful diagnostic tool. They are also very easy to set up and use in RA 600. 1 Click the tab with the movie camera to the top. icon to bring the Cine tooltab
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A bar appears at the side of the viewport to allow you to control your cine
Click the On radio button in the Cine section of the tooltab. Your active viewport will start to play a cine. This will show all the images in the series in turn. Note that a bar has appeared in the viewport showing the cine. This shows the loop and its direction. Click within the bar. You have now limited the range of the loop which is shown by the blue line. Only the images within this range are now displayed in the cine. You can have a number of cines running at the same time. Click in another viewport to make it the active viewport and again click on the On radio button on the Cine tooltab. Turn your cines off by clicking on the viewport and then on the Off radio button on the Cine tooltab.
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If you have a wheel on your mouse, you may be able to move through your images using this.
Measuring and annotating images

You can perform all kinds of measurements on your images and also include annotation, to point out specific features, for example. Annotations are overlays (placed as though on a transparent film over the images), so that they do not affect the original images. You can save this annotation with your images so that they can be seen when the study is opened again for viewing. 1 2 3 Click on the tab with the ruler icon to bring the Annotation and Measurement tooltab to the top. Click the Marker button and move your mouse pointer over one of your viewports. Note that an arrow follows your mouse pointer. Click in the viewport and type in a label for the pointer.
39 4 Try repositioning the pointer by clicking on the arrow and dragging with the mouse. Click on the center of the arrow to move the whole thing, click on the front of the arrow to stretch the arrow to point at a different part of the image, click on the tail of the arrow to move it and the label to another part of the viewport. Right click on the arrow and experiment changing the color, font and line style of the marker by using the pop-up menu. Remove the marker by right clicking on it and selecting Delete from the pop-up menu.
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Distance (1) and angle (2) measurements, profiles (3), COBB angle measurements (4) and probes (5)
Click on the Text button and click on a viewport. Enter some text. Click on the text and drag it to a new position in the viewport. Try a different way to remove the annotation simply drag the text until it is outside the viewport. Click on the Probe button and then in a viewport. The number next to the cross hair indicates the pixel value at the position of the cross hair. Drag the probe across the viewport and note how the pixel value changes. Remove the probe by dragging it outside the viewport. Click on the Distance button and then in a viewport, but hold down the mouse button. Drag to another part of the viewport and release the mouse button. Move the two ends of the line in turn by clicking and dragging on them. Move the whole line by clicking on its center and dragging. Remove the line by dragging it out of the viewport.
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40 chapter 2 10 Click the Profile button and then in a viewport and hold the mouse button down. Drag to another part of the viewport and release the mouse button. A Profile window will appear which shows the pixel values along the line you have drawn. Move the two ends of the line in turn by clicking and dragging on them, or the whole line by clicking on its center and dragging. Note how the profile changes. Move the profile graph by clicking on its title bar and dragging. Close the profile window by clicking the Close button in the top right hand corner. Click the line you drew to make the profile graph reappear. Finally, drag the profile line out of the viewport to remove it.
Profiles provide detailed information on pixel values to aid diagnosis
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Click on the Angle button and then in a viewport. Experiment with dragging the points to create various angles in the viewport. Try the COBB button. This is particularly useful for measuring small angles. Click on the Box, Ellipse and Draw ROI (Region of Interest) buttons in turn and click and drag in a viewport to create ROIs. Note the information that pops up in the ROI Statistics window. Experiment with resizing and moving your ROIs.
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You can create box (1), ellipse (2), freehand (3) and polygon (4) ROIs
41 13 Click on the Polygon ROI button and then in a viewport. Move the mouse pointer to another place in the viewport and click again. The two points you clicked will be joined by a line. Move the pointer and click again. Finally, move the pointer and then double click. This will close the polygon. Before removing all your ROIs by dragging them out of the viewport, click on the viewport to make sure it is the active viewport and check and uncheck the Image Annotation check box. Note that the ROIs (and any other annotation you have in the viewport) is hidden with the Image Annotation check box unchecked. Now make sure the Image Annotation check box is checked and check the Show Labels check box. Note the numbers that appear next to the ROIs you created. You can refer to these labels, which are created for all your annotation, when writing your reports. Try the None, Basic and Full Annotation Level radio buttons. This lets you display none, some or all of the patient information provided with the images. Select the Show Caliper check box to display a caliper for making rough measurements.
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Masks and overlays

RA 600 lets you create masks, or shutters, to screen out unwanted parts of an image. You can also create areas which are shown with inverted windowing values, and even superimpose part of a second image on top of an image (for before-after comparisons for example). You create these masks and overlays using the Mask and Overlay tooltab. Click the tab with this icon to bring it to the top. 1 Check that Shutter is selected in the drop-down list at the top of the tooltab and that the Activate radio button is selected. Click the Box button and then click and drag in a viewport. The area around the box you have drawn will turn black, removing unwanted information from view so you can concentrate on the area within the box. Notice that almost all the tooltab is now grayed out (disabled). This is because you can only have one mask or overlay in a viewport at any one time. So lets remove the shutter you just created to make way for a new one. Click somewhere within the box and drag the shutter outside the viewport. Try the other shutter buttons - these work very much like the ROIs you created when looking at measurement and annotation.
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A shutter (here drawn freehand) allows you to focus on areas of particular interest
Remove any shutters from the viewport and select Inverted Window ROI from the drop-down list at the top of the Mask and Overlay tooltab. Again click the Box button and click and drag in a viewport. This time, the area within the box you have drawn will appear with inverted window values. Remove the ROI in the same way as for the shutters - drag it outside the viewport. Select Image Overlay from the drop-down list. Click the Box button and click and drag inside the viewport. You will see the border of the box you drew, but nothing else will look any different. You still need to specify which image to overlay on the viewport. Right-click within the box you created and select Insert Image from the pop-up menu. Using the sub-menus, select one of the images in the study. This will appear inside your box. Using the lower section of the Mask and Overlay tooltab, try moving the Blend and Zoom sliders. Blend allows you to adjust the transparency of the overlaid image. You can also click inside the box and drag to pan the image, and right-click and drag to adjust the window levels of the overlaid image. When you have finished, right click inside the box and select Delete to remove the image overlay.
Reporting
You can readily write your reports while working in RA 600 by using the Reports window. How this will look will depend very much on how your system has been configured. You may see a form with buttons and options, or perhaps just a plain text box. 1 If you cannot see the Reports window on your screen, click the tab with the Swiss Army knife icon and then check the Show Reports check box. Click in the Reports window and type a short report.
43 3 Click on the Back button underneath the tooltabs. You will be asked whether you wish to save your report with the study. Click the No button to avoid saving any changes.
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Going further
This chapter has only briefly touched on some of the features of RA 600. Once you have become somewhat familiar with working with it, you will find a great many other things you can do. Only aspects relating to the Data Selector and the Viewing Section have been covered in this chapter it is quite possible that you have other capabilities installed, such as printing, 3D viewing, teleradiology and more. All these are covered elsewhere in this guide, where you will also often find other ways of doing what has been described in this chapter more quickly.
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Finding and organizing your data

This chapter covers the main aspects of the Data Selector, which always appears when you first start RA 600 and to which you always return after using another part of RA 600, such as the Viewing Section. You use the Data Selector to find and organize your data.
The Data Selector screen ........................................46 Patient and study views ...........................................48 Local and remote views ...........................................49 Importing studies from remote view to hard disk......51 Examining your patient and study lists.....................52 Narrowing your search with sorting and filtering ......55 Pinpointing your data with queries ...........................58 Selecting studies and opening them for viewing ......62 Working with folders.................................................66 Saving hard disk space by compressing studies .....67 Protecting studies with delete locks .........................69 Changing patient and study list headers ..................79
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46 chapter 3 hen you first start RA 600 you will initially see the Data Selector. You use this to select which images you want to view. It lets you browse and pick from databases, studies and series. You can even run queries (perform searches) to pinpoint the cases and studies youre interested in. With the Data Selector you can also organize your database into folders and perform other housekeeping tasks such as configuring other parts of RA 600. The Data Selector is your gateway to the rest of RA 600. Using the menu bar or tooltabs, you can go directly to any other part, such as image acquisition, archiving, 3D imaging, quality control, teleradiology and more (if, of course, you have these capabilities installed).
The Data Selector screen

As for other parts of RA 600, the Data Selector is highly configurable, so your Data Selector may look somewhat different to the one described here.
The menu bar gives you access to all the functions of the Data Selector. The actual menus you see will depend on which RA 600 modules have been installed on your machine and what user rights you have (aspects such as configuration may, for example, only be accessible to those with administrator rights). Often you will find it quicker to use tool bar buttons for tasks you perform frequently. These are grouped together on tool bars which can be positioned at any side of the screen by clicking on their two gray lines and dragging. RA 600 comes with a set of pre-defined tool bars, but it is very easy to create your own (or modify the existing ones).
The Data Selector
On the right of the screen are tooltabs. Highly characteristic of RA 600, these offer a quick alternative to the menu bar.
47 In the bottom right hand corner is the Exit button which you can use to close RA 600. The main area in the center of the screen shows you the contents of your local database (your local view) and possibly one or more of the remote databases which you also have access to (your remote views). You can browse the information within these windows and with a click of the mouse select the studies, series or even individual images you want to view. A further term you will come across is worklist views. If your system is connected to a HIS or RIS, these may be actual worklists provided outside of RA 600 (lists of new studies which require some action, for example). Generally, however, you can create and select worklist views which show particular views of what is in your database - just studies of a certain modality, for example, or perhaps only studies with the status New.
Double-clicking on a study or series will automatically open it for viewing.
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Patient and study views

With RA 600, you can initially choose to view your image database in one of two ways: as a patient view or as a study view. In study view, you will see a list of studies each containing one or more series. You may possibly see more than one study belonging to the same patient. In patient view, you will see a list of patients. Each of these entries may contain one or more studies for that patient. In effect, patient views group together all the studies relating to a particular patient. To change your view from patients to studies (or vice versa) click the tab with the Data Selector icon to show the Data Selector tooltab (if this is not on top already). Select Local Patients or Local Studies from the Worklist View drop-down list.
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Local and remote views

If you believe your system is connected to at least one other remote system but you cannot see any remote views, make sure the Remote Views check box on the Filing tooltab (with the filing cabinet icon) is checked. If it is not, RA 600 will not show your remote views on your main screen.
The images you want to access may be on a hard disk in your own machine (your local database) or possibly on any one of several databases elsewhere to which your machine is connected (remote databases). If your machine is not connected to a network (you have a stand-alone system), you will see only your local database in the center of the Data Selector. If, however, you also have one or more remote databases to choose from, you will generally see two windows, one above the other. The upper window, your local view, shows your local database. The lower window, the remote view, shows one of your remote databases. You can only view one remote database at a time, but you can easily switch between the current one being shown by clicking on the tabs located at the bottom of the remote view window (provided more than one remote view has been set up on your system). As with the local view, the title bar for the remote view window shows you how many studies are in the database and the name of the database. It also has an indicator on the left (green or red on color monitors, an open circle or a circle with a cross inside it on monochrome). A green light or open circle indicates that the connection to the database is working properly. A red light or circle with a cross means that the connection is broken and you will not be able to view any studies in the window.
If you see a red indicator when trying to view a database you regularly have access to, it may well be that the system on which the database resides is not switched on. You should check this and/or contact your technical support if necessary. If you cannot do a query on a remote system (and so cannot import data from it), this could be because the remote system does not support DICOM Query and Retrieve. Between RA 600 systems there might also be a configuration setting enabled on the remote system restricting the number of systems that can do queries and retrieves to known and pre-configured systems (origins). If, however, you suddenly cannot do a query on a remote system you use regularly, you should first check that the host machine is not turned off.
If your remote view is empty

All remote views are empty when they are first created or when RA 600 first starts up. This is because there can be many remote views and each may contain a great many studies. Automatically fetching all the study information for all these remote views could take quite some time. To view the data in a remote view, you perform an empty (i.e. show everything) query. This will tell RA 600 to display all the studies in that remote view. To display the contents of an empty remote view click with the right mouse button anywhere inside the remote view window and select Query... from the pop-up menu. Click OK in the Query Parameters dialog box. (You can also do this by making sure the remote view window is active by clicking anywhere inside it, and selecting Database Query... from the menu bar.)
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Checking your hard disk space

RA 600 can be configured so that the oldest studies will be automatically deleted when the free hard disk space drops below a defined threshold. This configuration should be undertaken by your system administrator or distributor. If you see a message Locked study in selection... and cannot delete a study, this means that at least one item that you selected has been locked against deletion to protect it from accidental removal. You will need to remove all locks before you can delete such studiesFor more on delete locks, see Protecting studies with delete locks on page 69.
Medical images can be substantial in size and soon eat up hard disk space when they are included in your local database. With RA 600 you can see how much room you have left at any time. To view the space left on your hard disk click the tab with the filing cabinet icon to reveal the Filing tooltab. You will see an indicator at the top of the tooltab, together with a number stating the megabytes you have left on your hard disk.
Removing studies from your local view

As more and more studies appear in your local view (and are stored on your systems hard disk), your available disk space will decrease. There will come a time when you need to make room for new studies. To remove (delete) studies from your local view select the studies you want to remove (see Selecting studies and opening them for viewing on page 62 for details on how to do this). Then either select File Delete from the Data Selector menu bar or right-click in your local view and select Delete from the pop-up menu. You can also delete series and images in the same way.
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Importing studies from remote view to hard disk

To show studies effectively, RA 600 needs fast access to the information. Studies should be held locally on your hard disk and not have to travel over a network. While you can directly view studies from a remote view (see Directly viewing studies with a remote view, DICOM server or DICOM volume on page 65), you can also import studies beforehand to your local view, so they are already on your systems hard disk and ready for immediate display. To import a study or series from a remote view to local view right click on the study or series you want to import and select Import from the pop-up menu. The study or series you selected will be copied to your local database. You can also import a number of studies or series at the same time. First select your studies or series (to select multiple studies or series, hold down the Ctrl key when you click on them or, to select a range, click on the first one in the range and drag with the mouse to the last in the range). Then right click on any of the selected studies or series and select Import from the pop-up menu. The Import dialog box that appears lets you define the Transmission Type (DICOM or standard), the Transmission Format (compression or no compression) and the Transmission Priority you want to use to copy the files to your hard disk.
During import you can click the Cancel button under the progress bar to stop the transfer of subsequent studies (RA 600 will complete the import in progress before stopping). If your remote view is a patient view and you select a patient to import, RA 600 will import all the studies for that patient.
Hiding the Import dialog box

It may be that you almost always want to import your studies with the same settings in the Import dialog box. You can then avoid having always to click the OK in this dialog box by checking the Only show dialog when Shift key is down check box. If you do this, RA 600 will simply go ahead and import your selected studies without showing you the Import dialog box. To change the settings for particular studies, you will then need to hold down the Shift key when you click Import on the pop-up menu. A progress bar will indicate how the import process is proceeding. Importing is a background process, so you can continue working while it is underway. If you have chosen to only import a series of a study that contains more data and decide afterwards to import the remainder, RA 600 will add the later import to the same study as the first, so maintaining the integrity of your data.
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Examining your patient and study lists

The information in the study list is taken from the DICOM 3.0 header sent with the studies. For more details on a particular study, see Viewing detailed information down to image level on page 52 of this chapter.
Your local view (and any remote view you may have) will show a study list or patient list which lists all the studies or patients in the database concerned. Each row represents a single study or patient. If you have a patient list, double-clicking on the patient icon (or just a single click on the + sign next to the patient icon) will reveal all the studies available for that patient. Each study may itself contain a number of series which may in turn contain many images. Each column contains specific information concerning the studies, such as the patients name, kind of modality used, and so on. As for many parts of RA 600, the information in these columns is configurable (see your system administrator or Changing patient and study list headers on page 79).
Examining the series within a study

You can double click the edge of a worklist header column to automatically expand the header column to its appropriate length. However, the worklist must contain studies for this option to work.
Each study in a study list may contain a number of series (the actual number is shown in the Series column). Using the Data Selector, you can quickly look at exactly what each study contains. To look at the series within a study double-click on the study icon or singleclick on the plus (+) sign next to the studys icon . The study list will expand to show all the series and various items of information on them. (Typically, you will open up studies in your studies view if you dont want to view a whole study but only one series or a selected number of series from it, or if you want to compare different series from the same or different studies.)
Examining the images within a series

Just as you can open up a patient to reveal studies, and studies to reveal series, you can double-click on the series icon to reveal all the images in the series: To close them up again, double-click again on the icons or (single-)click on the minus (-) sign next to the icons.
Viewing detailed information down to image level

With RA 600 you can quickly view detailed (DICOM 3.0) information on any patient, study or its elements (series and images).
53 To view details on a patient (study, series or image) click with the right mouse button on the patient (study, series, image) in your patient or study view and select Info from the pop-up menu. On the left-hand side of the Info dialog box you will see an icon of the patient and, at the next level down, the study folder icon. If the study contains more than one series, you can open the study up by double-clicking on the icon. You will see the underlying series and, in the right hand side of the box the DICOM information. You can likewise open up the series by double-clicking on them. A list of individual images is then shown. By clicking on one of the images you will see the DICOM information corresponding to that image. You can close series and studies up by double-clicking on their icons.
You can also view this information by selecting File menu bar. Info from the
Exporting and printing study information using the clipboard

If you wish to include study information in another document, or perhaps just print this out, you can do this quite easily by copying the information to the Windows clipboard. To export study information via the clipboard Display the information you want to export in the Info dialog box (see above). Click on the right hand side of the dialog box and then on Ctrl A to select the information you want to export. The text you want to export should now be highlighted. To copy to the clipboard, press Ctrl C. You can now switch to your other application such as a word processor and paste the information into it (with Ctrl V or other paste command). Once the information is in this other application you can, of course, also print it.
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Finding studies quickly using the keyboard

Centricity Radiology RA 600 offers many ways of quickly locating studies you want to view. These include sorting, filtering and performing sophisticated queries on your database. A quick and easy way which will probably suffice in many cases is simply to type in the first few characters of what you are looking for. You can use this method for any type of information displayed in your study or patient list. An obvious example would be patient name, but you could also track down a particular Patient ID, a referring physician, even study status or description. To track down a study using the keyboard click on the column header in your study list of the item of information you want RA 600 to search for (this will perform a sort on your local database, see Narrowing your search with sorting and filtering on page 55). Then simply start typing in the first characters of the item of information you want to find. As you type each character, RA 600 will search the database and display the first match it finds for what you have typed. Typically after only a few keystrokes it will display what you are looking for. For example, if you want to find the study in your local database for patient Brown, A, you would click on the Patient Name header and then type the letter B. If the study you want is not immediately shown (perhaps RA 600 will show a study of patient Booth, D), you would type the letters BR. Hopefully this will be enough to take RA 600 to the right name. There could, however, be a study from patient Brightman, S on your system. Then you would need to type the letters BRO of Brown to select the right study. Once the correct study is highlighted, you can display it by pressing Enter, or any other way (such as using the menu bar, a tool bar or simply by doubleclicking on it).
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Narrowing your search with sorting and filtering

Your databases may well contain a great many studies each of which may in turn consist of a number of series. To help you quickly pinpoint the studies or series you want to view, RA 600 includes comprehensive sorting and filtering as well as querying (described next in this chapter). These work in both the local and remote views.
Sorting
Sorting applies to the studies currently being displayed and involves arranging the rows (studies) in the study list in ascending or descending order. To sort your studies by column click on the header of the column you want to sort on. The first click will rearrange the study list in ascending order. A second click will reverse the sort order. A small arrow appears in the header pointing up or down to indicate the direction of the sort.
Extended sorting
You can set the sort order (ascending or descending) independently for each field. Click on each field in turn to select them then check or uncheck the Ascending check box. You cannot directly change the order of fields in the Extended Sorting list. You will need to remove the fields and add them again in the correct order.
You can perform more sophisticated sorting of the studies in your local and remote views. RA 600 will then first sort according to one column you select, and then within these groupings on any other criteria you select. You might, for example, choose to perform the main sort on patient name and, as a secondary criterion, on study date. RA 600 will then display the studies for each patient grouped together, and within these groups for each patient the studies will be arranged in chronological order. To perform an extended sort right click on the header in your local or remote view that you want to perform the main sort on and select Sort Extended from the pop-up menu. In the Extended Sorting dialog box, select from the sort criteria listed in the box on the left and place them in the order in which you want RA 600 to sort in the right hand box by selecting them and clicking the >> and << buttons to add and remove them. Place the main sort criterion at the top of the list.
Filtering with the Data Selector tooltab

As well as sorting the studies which appear in your study list, you can also narrow down your search by asking RA 600 only to show certain studies. When you have very large databases, this filtering can be a very powerful way of tracking down what you are looking for. By default when RA 600 is first installed, you can use the Data Selector tooltab to filter according to modality, origin or folder.
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A note on filtering
Filtering does not actually remove studies from the database but merely hides them from view for as long as you apply the filter. Nevertheless, if filter conditions are set (either with or without Query conditions), you will most certainly hide available studies from view. This can be confusing for other users or even to yourself at a later time. You are therefore advised to regularly check which filter conditions are active while working with RA 600!
Viewing particular modalities The Modality section on the Data Selector tooltab shows all the modalities used to create the studies in the study list of the active database view (local or remote). You can select or deselect individual modalities by clicking on the check boxes to the left of the modality abbreviation. If modalities are selected, RA 600 will show all the relevant studies in the study list. The All and None buttons at the bottom of the Modality section let you quickly select or deselect all the modalities in the list. Viewing studies of a certain origin You can use the Origin section on the Data Selector tooltab to show all known remote systems or sites that have sent studies or series to your system which are shown in your patient or study list. These might be a variety of systems or sites both inside and outside the hospital. You can include one or more of these remote origins by selecting them. The study list will then only show studies originating from the selected sites. The All and None buttons select or deselect all listed origins. This filter option only works on remote databases if they are on other RA 600 systems. Viewing studies in particular folders The Folder section shows all folders that have been created on your local system (and on remote systems if these are also RA 600 systems). You can select or deselect folders by clicking on them. The All and None buttons select or deselect all the folders.
The filtering options in the Modalities, Origins and Folders sections are always combined (and/and conditions). So, if you have selected MR as the modality and General as the folder, you will create a filtered view that only shows MR studies in the General folder. To avoid any confusion, sort and filter settings are not saved when the system is turned off or you log off. When RA 600 is first started up, or a new user logs on, there are no active filter conditions (unless an initial worklist view has been configured which does contain filters).
Selecting all the studies for a particular patient

A frequently-performed task is selecting all the studies relating to a particular patient. This is very easy to do in RA 600. To select all the studies for a particular patient find and select one of the studies relating to the patient in your worklist view and click the All Studies button on the Data Selector tooltab. All the studies on this patient in your worklist view will then appear highlighted (selected).
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Resetting your filters

It is very easy to remove all the filters you apply. Simply click the Reset button on the Data Selector tooltab. Your worklist view will then be as it was when you first selected the view.
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Pinpointing your data with queries

The query option is always available for the local database. You will also be able to query DICOM 3.0 compliant remote databases, RA 600 and some other third party systems. RA 600 Query is not case-sensitive. This means that Chest, chest and CHEST will, for example, yield identical results.
While sorting and filtering can help greatly in narrowing down your search, RA 600s Query feature allows you to pinpoint exactly what you want if you have some item of information, such as a specific name, ID, description etc. To perform a query click on the Query button near the top of the Data Selector tooltab. Enter your query in the dialog box. You simply enter in this box what you want to search for. Fields you leave blank will not form any part of the query. So, for example, if you enter Bailey, Nicole in the top field, RA 600 will display only those studies for this patient. To keep the same query to use the next time make sure the Keep Query check box in the bottom left corner of the Query Parameters dialog box is checked. The next time you perform a query, the same details will be entered in the fields when you the Query Parameters dialog box opens, even if you query another (remote) view. Using wildcards The parameters are DICOM 3.0 information as provided in the study headers. To avoid any confusion, RA 600 will display only exact matches. So, for example, Bailey, N. will not show the same studies as Bailey, Nicole. If you cant be sure of the exact wording, you can use wildcards. Simply type in an asterisk (*) after what you are looking for. This tells RA 600 to allow any characters after what you have entered. So, for example, if you enter B* in the first field of the Query Parameters dialog box, RA 600 will display studies of all patients whose names begin with B. A query such as a*\b* will retrieve all studies starting with an A or B; e.g., Anderson AND Buxton. The query *An* will return all items containing the letter combination 'an'; e.g., Anderson, Tim and Riquelme, Juan. When you click on the OK button, the dialog box will disappear, but the query will remain in force until you remove it, log off, or turn off the system. You are reminded that a Query is in force by the message [Query] in the title bar of your database view.
The use of wildcards can be especially important when querying descriptions. Entering Chest will only yield exact matches, i.e. descriptions which include the word Chest and nothing else. To display all studies whose descriptions start with the word Chest, you should add an asterisk after your entry (Chest*). You can quickly reset all the filters and queries you might have created on your worklist view by clicking Reset on the Data Selector tooltab.
59 Nevertheless, if a query and/or filter conditions are set, you will almost certainly not be displaying many of the studies in the database. This can subsequently be confusing to others, or even possibly yourself. Filters and queries are extremely powerful tools for pinpointing your studies, but should be used with some caution. You are advised to regularly check what filter and query conditions are in force while working with RA 600.
Using Queries with sorting and filtering how it works

You can use queries in conjunction with sorting and filtering. In this case, the query precedes any other filtering or sorting conditions. In other words, the query examines the full database. Only then are the other filtering and/or sorting conditions applied to the result of the query. Example Say your modality filter is set to MR studies. You make a new query for studies whose patient names start with a C (C*). All MR studies which have patient names beginning with a C will be displayed. If you now also select CT in your modality filter, will see that CT studies which have patient names beginning with a C will be added to your study list.
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Removing filters and queries with a single click

Filters and queries are very powerful ways of tracking down your studies, but by their nature they will not provide a complete view of your database. Confusion may arise if you, or some subsequent user of the system who has not logged in separately, if filters and queries are still active. For this reason, RA 600 makes it very easy to reset (remove) all the filters and queries you might have created. Your worklist view will be restored to its state before you created these filters and queries. To reset all filters and queries the Data Selector tooltab. click on the Reset button in the View section of
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Including common sorts, filters and queries in worklist views

You can have RA 600 display a particular worklist view in the Data Selector when you start RA 600. Contact your system administrator for details on how to do this.
If there are particular sorts, filters or queries (or some combination of these) you perform frequently, you can save these settings as worklist views which you can then select at any time from the drop-down list at the top of the Data Selector tooltab. You might, for example, create a worklist view just to show MR studies if you are frequently only involved in working on these. Or, if you typically want to look at only those studies with the status NEW, you could set up a worklist view to show only those studies with this particular status. Whatever you can sort, filter or query on, you can create a worklist view for. You can also configure your worklist views so that patients, studies, series etc. with particular attributes (such as the status NEW for example) are highlighted in a different font or color. Contact your system administrator for details.
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62 chapter 3
Selecting studies and opening them for viewing

As you open studies for viewing by doubleclicking, RA 600 will use the best hanging protocol to display your studies, if possible. If you yourself wish to choose how your images are displayed, you should open your studies by selecting a hanging protocol on the Viewing tooltab.
Once you have found the data on your system that is of interest, you will typically want to open it for viewing. You can select for viewing all the information on a patient, all the series within a study, a particular series or even an individual image. Or you can select multiple patients, studies, series or images which are all to be opened for viewing. Generally, you will open studies for viewing from your local view. Such studies are on your systems hard disk and ready for immediate display. You can, however, also open studies stored elsewhere. For more on this, see Directly viewing studies with a remote view, DICOM server or DICOM volume on page 65. When in the Viewing Section of RA 600 (see the next chapter), there are many possible layouts or hanging protocols that can be used to show your information. You can ask RA 600 to automatically select the best hanging protocol/ layout for the studies or series you have selected or assume full control of the selection yourself.
Selecting studies, series or images

If you are using a patient list and double-click on the row containing the patient name, RA 600 will open all the studies available on that patient.
You select studies (or series) in your study or patient list simply by clicking on the + signs next to the icons to reveal the information you are interested in and then clicking on the appropriate row in your study or patient list. To select more than one study, series or image, hold down the Ctrl key while you select additional ones. To select a range of studies, series or images, click on the first and then drag with the mouse to the last in the range. (Alternatively, you can use the standard Windows method of clicking on the first in the range and then pressing the Shift key when you click on the last in the range.)
Opening studies for viewing

Once you have found the study you want to look at, you can open it for viewing in a number of ways. To open a study for viewing study or patient list). double-click on it (anywhere in the row in your
If you double-click on a study, all the series it contains will be opened automatically and RA 600 will switch to the Viewing Section and display the study. To view a single series which is part of a study click on + sign next to the icon of the study containing the series. Select the series you want to view. Then right-click on the series and choose View from the pop-up menu that appears.
63 Again RA 600 will switch to the Viewing Section and show you your chosen series.
Viewing multiple studies

Even if RA 600 automatically selects a layout or hanging protocol for you, you can still change this once you are in the Viewing Section by using the Layout tooltab. If you want to view a range of consecutive studies, you can select them simply by clicking on the first in the range and then dragging with the mouse to the last in the range.
You may often need to view a number of series or studies at the same time - to compare them, for example. With RA 600, you can view two or more studies one after the other or all at the same time. To view a number of studies or series one after the other select the studies and/or series you want to view from the list in the Data Selector (click on them while holding down the Ctrl key). Right-click in one of the selected areas and select View from the pop-up menu. Click on Yes in the View Studies message box to view all the selected studies at the same time or No view them one after the other. If you choose Yes, RA 600 displays a message confirming that the items you selected are from different patients. Click OK to view the studies. If you have chosen a hanging protocol suitable for viewing two or more studies, both studies will display in the viewport. If you have chosen a hanging protocol capable of displaying only one study, the first selected study will appear in the viewport area, while the others will appear as thumbnails in the Pictorial Index ready for easy access. In that case, you can use the Previous and Next buttons at the bottom of the Viewing Section to toggle between the sets of images. If you choose No, RA 600 places the first images of the first study in the viewport and displays the full range of images in the Pictorial Index. Clicking the Next button enables you to move from one study to another without having to return to the Data Selector. You click the Previous button to view a preceding study.
Using the Automatic buttons

Depending on what studies or series you have selected for viewing, the Automatic button on the Viewing tooltab offer an alternative to double-clicking on a study or series. Clicking the Automatic button tells RA 600 to find and use the best hanging protocol (layout) for the selection you want to view. To view a number of studies or series one after the other using the Automatic button select the studies and/or series you want to view from the list in the Data Selector (click on them while holding down the Ctrl key). Click on the Automatic button on the Viewing tooltab in the Data Selector. Click on Yes in the View Studies message box to view all the selected studies at the same time or No view them one after the other.
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64 chapter 3
Manually selecting a hanging protocol

If you use any of the methods described above for opening studies for viewing, RA 600 will automatically use the best hanging protocol for displaying your studies if an appropriate one has been installed on your system (see Working with hanging protocols on page 174 for details). If RA 600 cannot find a hanging protocol suitable for displaying your study or studies, it will use the default hanging protocol with the highest priority (Default hanging protocols on page 182). You can, however, always tell RA 600 which hanging protocol (layout) to use when opening studies for viewing. To manually select a hanging protocol (layout) for viewing your images in the Data Selector, click the tab with this icon to display the Viewing tooltab. Select the study you wish to view and then click on the hanging protocol you want to use. Thick lines in the display represent divisions between studies or series and thinner lines divisions between images.
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Directly viewing studies with a remote view, DICOM server or DICOM volume
Viewing studies stored in a remote view, on a DICOM server or on a DICOM volume (CD or other removable disk) is somewhat different than viewing studies stored on your hard disk. This is because studies in the former situation are not on your local hard disk but elsewhere in your system. To be able to display images quickly, however, RA 600 needs fast access to them. You can always import studies from a remote view to a local view (see Importing studies from remote view to hard disk on page 51). This will transfer them over the network to your systems hard disk. You can then open and view the study from your local view as described earlier. It is, however, possible to view studies in a remote view directly (without importing them first). To directly view a study in a remote view, on a DICOM server or DICOM volume click on the study and select View from the pop-up menu. right-
When RA 600 is first installed, the direct viewing of the studies feature is not turned on. To do this, select Configuration Viewing... from the Data Selector menu bar and make sure the Direct View check box is checked on the General tab of the Viewing Properties dialog box.
You will be taken to the Viewing Section and can start viewing the study. If the study is of a significant size it may take a little while for all the images to arrive on your workstation, depending on the speed of your network connection. While these images are arriving, you can still view the ones that have already been received (if you are using a DICOM connection). Your Pictorial Index will continually update itself with the new images as they arrive. For more on viewing images that are not (yet) on your local system, see Viewing images as they arrive on page 171.
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66 chapter 3
Working with folders

RA 600 is initially installed with just one folder called General. Until you decide to use folders, all new studies will be stored in this folder and displayed in your study list.
You can organize your studies into folders to group similar studies together for example, or keep studies that are not relevant separate from each other. You can create, rename and delete folders and move studies between them. You do this using the Filing tooltab (click the tab with this icon). The Folders section shows all the folders created on your system. To create a new folder click the New button in the Folders section on the Filing tooltab. In the New Folder dialog box, enter a name for the new folder. You can also specify a Windows folder (directory) into which the folder should be placed. If you leave the field blank, the folder will be placed in the main RA 600 Database directory. To change the name of a folder click the Edit button in the Folders section on the Filing tooltab. In the Edit Folder dialog box, enter a new name for the folder. To remove (delete) a folder first make sure it is empty by moving or deleting any studies it contains (to avoid inadvertent data loss, RA 600 will not delete a folder unless it is empty). Then select the folder in the list in the Folders section of the Filing tooltab and click the Delete button.
You can also create and delete folders by selecting Folder New or Folder bar. Delete from the menu
Moving your studies between folders

The RA 600 folder feature allows you to organize your local database. You cannot use Move to Folder to move studies from a folder on one RA 600 system to a folder on any other system. To do this, you need to use teleradiology to send a copy of the study. The user of the other system will then be able to move the study to a folder of their choice.
You can move your studies between folders using either the menu bar or the right mouse button menu. To move a study to a new folder click on the study in the study list to select it. Select File Move to Folder on the menu bar or right click on the study in the study list and select Move to Folder from the pop-up menu.
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Saving hard disk space by compressing studies

Although compressing studies saves on disk space, a performance penalty will be incurred since RA 600 will need to decompress the studies again before they can be viewed, for example. This penalty will depend on the speed of your system. You should be sure of the trade-off between disk space requirement and performance before compressing your studies. If the Compressed and All check boxes are grayed out, this may be because you are a using a nonNTFS file system (such as FAT). RA 600 can only compress folders that are on a hard disk partition formatted with NTFS.
Studies containing large numbers of detailed images can grow large in size, and as the number of them on your system grows you might find yourself running low on disk space even if you have quite a large hard drive and remove old studies regularly. Generally, RA 600 stores studies on your hard disk in uncompressed form since this offers the quickest way to access the information and display your images. If, however, your priorities lie more towards creating more disk space than the absolute best performance, RA 600 allows you to compress your studies when they are placed on your hard disk. They will then take up considerably less space and so allow you to store a greater number of studies at any given time. RA 600 compresses studies depending on which folder they are placed. You can, therefore, compress all or just some of your images by specifying that all or just some of your folders should be compressed and placing your studies in the folders appropriately. If a folder already contains (uncompressed) studies and you decide that it should be compressed, you can either have RA 600 compress all the studies in the folder, or just compress new studies that are added to that folder. You can decompress the studies in a compressed folder at any time (provided you have sufficient disk space!). To create a new compressed folder select Folder New... from the Data Selector menu bar. In the New Folder dialog box, make sure the Compressed check box is checked. All the studies you subsequently place in this folder will be compressed. To compress studies in an existing folder select Folder Edit and then the name of the folder you want to compress. In the Edit Folder dialog box, check the Compressed check box if you want all studies subsequently placed in the folder to be compressed. Check the All check box if you want RA 600 to compress the studies already in this folder. (When you click OK, RA 600 will start compressing these studies. This process may take some time.) To decompress studies in a folder select Folder Edit and then the name of the folder you want to decompress. In the Edit Folder dialog box, uncheck the Compressed check box if you do not want all studies subsequently placed in the folder to be compressed. Uncheck the All check box if you want RA 600 to decompress the studies already in this folder.
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68 chapter 3
Automatically compressing all incoming studies

Rather than have studies compressed depending on which folder they are placed in, you can tell RA 600 to compress all incoming studies provided it can do so. See the Configuring Teleradiology chapter of the Installation and Configuration Guide for details.
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Protecting studies with delete locks

If you cannot see the Lock item on the right mouse button menu, you have not been granted permission as a user to lock or unlock studies. Consult your system administrator or RA 600 distributor.
Depending on how your workstation is used, there may be studies on your system which you might want to protect against accidental deletion. RA 600 allows you to do this using delete locks. Once a study has been locked it cannot be deleted without first removing this lock. To lock or unlock a study against deletion click with the right mouse button on the study in your patient or study view and select Lock Lock or Lock Unlock from the right mouse button menu.
Seeing which studies are locked against deletion

You can see which studies in your worklist view are locked against deletion by creating a new column (if this has not already been done) in your patient or study list. To create a column to show whether studies are locked
If you are in a patient view, right-clicking on a patient and selecting Lock Lock or Lock Unlock from the right mouse button menu will lock or unlock all the studies on that patient.
Make sure the worklist view you want to add the column to is being shown in the Data Selector (select the worklist view from the dropdown list at the top of the Data Selector tooltab). Right-click on the column to the left of which you want to add the new column and select Insert column... from the right mouse button menu. Click the >> button to open the Edit Column Properties dialog box. Select All from the Level drop-down list. Find and double-click on Delete Lock from the drop-down list. Click OK.
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A new column will now appear in your worklist view. Studies which are locked are indicated by an L in this column.
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70 chapter 3
Changing the status of studies

Generally the study status IDs of studies (New, Reported, Authorized etc.) are changed after they have been viewed (and perhaps reported on) in the Viewing Section to reflect the work done on them, but you can also change them when in the Data Selector. To change the study status ID of a study (in the Data Selector) right-click on the line in your patient or study list containing the name of the study whose status you want to change. On the right mouse button menu, select Set Status and click on the status you want to change the study to.
If you cannot see all the possible options on the right mouse button menu, this probably means that you have not been given permission as a user to change the status of studies to any other status. It could also be that your are not allowed to set back the status of studies to a previous status (from Authorized to Created for example), since this can cause problems for workflow. Consult the installation guide or your system administrator for details on how to set study statuses.
Seeing the status of studies in the Data Selector

You can see what statuses your studies have by creating a new column (if this has not already been done) in your patient or study list (worklist view). To create a column to show the statuses of studies 1 Make sure the worklist view you want to add the column to is being shown in the Data Selector (select the worklist view from the dropdown list at the top of the Data Selector tooltab). Right-click on the column to the left of which you want to add the new column and select Insert column... from the right mouse button menu. Click the >> button and select All from the Level drop-down list. Then select the Study Status ID DICOM tag, or use the blank fields on the left of the grayed out field to enter the group and element for the tag: 0032, 000A.
Displaying your worklist

Before you can view a worklist, you must first configure RA 600 to display it in the Worklist View drop-down list on the Data Selector tooltab. To configure a worklist view 1 2 Select Database Add View from the Data Selector menu bar.
In the Add View dialog box, type in a description in the Description text box. The description you enter here will appear in the Worklist View drop-down list on the Data Selector tooltab. Use the List drop-down list to select the worklist view you just created.
71 4 5 Use the Copy settings from drop-down list if you want to set up a worklist view similar to one that already exists. Click OK. If required, select the new worklist view from the drop-down list at the top of the Data Selector tooltab and then select Database View Properties... from the Data Selector menu bar. Use the Configure View dialog box to modify the properties of the worklist view.
To remove (delete) a worklist view select the worklist view you wish to remove from the drop-down list at the top of the Data Selector tooltab. Select Database Delete View from the Data Selector menu bar and then select the worklist view you want to remove.
Defining worklist view properties

As well as being able to specify in detail which font RA 600 should use to display the information in your worklist views, you can have RA 600 highlight particular lines in the worklist view (in a different font or color) which are of special interest to you (studies with the status New for example). This will make them easy to locate amidst the large amount of information the worklist view may contain. To define the properties of a worklist view 1 Select the worklist view you wish to change from the drop-down list at the top of the Data Selector tooltab, then select Database View Properties... from the Data Selector menu bar. In the Configure View dialog box, set a refresh time to have RA 600 automatically update your view so that, for example, you can see new studies arriving on your system (only for DICOM connections). If you dont want your view to be updated when the database changes, check the Lock update check box. You can also adjust the time between retries if a remote system is down when RA 600 queries it. Set an appropriate value in the Reconnect time field. If desired, select the type of sort which will be performed as soon as the worklist view is selected from the drop-down list (in the Sort section, select the Initial radio button, then click Define). Make sure the Initial Query check box is checked if you wish RA 600 to immediately perform a query (and hence show the appropriate studies in your study list) as soon as the worklist view is selected from the drop-down list. Set the query to be performed by clicking Define in the Query section (see Defining queries on page 73 for details on how to do this).
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Do not use too low a value for the period between refreshes or the performance of your RA 600 system may be affected (a period of no less than five minutes is recommended).
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72 chapter 3 5 Add any filters you wish applied by clicking the Add button, and remove or edit existing filters by clicking on them and then on Delete or Edit (see Adding filters on page 73 for details). Change the appearance of the worklist view by selecting fonts for each level in the Fonts section of the dialog box. Click on the level in the window and then on the Font button - see Customizing your fonts in RA 600 on page 304 for details.
Including sorts
If the None radio button is selected, you should disable the Allow Sort check box or the original sort order will be lost after doing a local column sort.
In the Sort section of the Configure View dialog box, select the None radio button if you do not wish to change the order in which the studies were generated. Selecting Keep last sort will keep the list sorted according to the last sort that was performed, even if you close and restart RA 600. If the Initial radio button is selected, you can define an initial sort which will be performed when the worklist view is first displayed. Defining initial sorts You define an initial sort by first clicking the Initial radio button and then clicking the Define... button. In the Extended Sorting dialog box you can set multiple sort criteria using the options given on the left of the box, which are in fact the same as the headers which currently appear in your worklist. For details on completing the Extended Sorting dialog box, see Extended sorting on page 55.
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Adding filters
When you have created the filter it will appear in the list in the Configure View dialog box. The Allow user to change filter setting check box permits users to change the active fields for a filter (in the Filter section of the Configure View dialog box, click on the filter you want to enable or disable, then on the Edit button. In the Filter dialog box you can now uncheck the Allow user to change filter setting check box. The fact that the filter is now disabled will be indicated by a No in the Allow change column of the list in the Filters section of the Configure View dialog box).
You can create your own filters which will then appear on the Data Selector tooltab and thus allow you to filter your worklist according to particular DICOM tags. You can also specify initial values so that the worklist will be automatically filtered according to the parameters you specify when the worklist view is initially opened for viewing. To create a filter 1 2 Click the Add button in the Filters section of the Configure View dialog box. In the Filter dialog box, select a DICOM description by typing in the group and element of a DICOM tag filter or click the >> button to find the tag you want to use to filter. Check the Allow user to change filter setting check box. Enter initial values if you wish (see About initial values on page 73).
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The filter you have specified will now appear as a separate section on the Data Selector tooltab. All the values for the DICOM tag which appear in your worklist view will be listed with check boxes next to them. If you specified various initial values, only the check boxes next to these quantities will be checked (and only the studies which include these values will be shown in your worklist view). To edit or remove a filter click on the filter in the Filters section of the Configure View dialog box to select it. Click the Edit or Delete button.
About initial values

Do not press Enter after typing the last line in the Initial value window. It may cause the filter to show studies that have an empty entry in the corresponding DICOM tag.
By default, all the check boxes next to the possible options will be checked on the Data Selector tooltab after you create a new filter. If you initially want only certain of these check boxes checked, type the names of the check boxes you want checked in the Initial values field of the Filter dialog box. Each value should be on a separate line (press Enter to go to a new line.)
Defining queries
Apart from including sorts and filters, you can also have RA 600 perform an initial query on your worklist view.
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74 chapter 3 If you check the Initial check box in the Query section of the Configure View dialog box, RA 600 will perform a query on the worklist view when it is opened. If this check box is not checked, the worklist view will be empty when opened. If the Allow Query check box is not checked, clicking the Query... button on the Data Selector tooltab will refresh the list instead of displaying the Query dialog window. The Allow Empty Query button gives you the option of telling RA 600 not to perform empty queries. Click the Define... button in the Query section of the Configure View dialog box to define the query which will be initially performed when you open the worklist view. Use the Query Parameters dialog box in exactly the same way as when normally making a query. The Fields... button lets you define what should appear in the Query Parameters dialog box when you perform a query on the worklist view, allowing you to simplify the options or offer a comprehensive range of items you can query on.
Some systems do not allow empty queries to be performed on their databases. And using a worklist to query an archive with thousands of studies may take a very long time to produce a result if an empty query is used. In general it is therefore best to disable this option. Although in RA 600 you can define any field to be queried, the database that is queried must support this field.
Highlighting parts of your worklist using fonts and colors

While you may not wish to filter out all other studies, you might be particularly interested in studies of a certain type, such as ones which have just arrived (and hence have the status New). You can have RA 600 display these in a different font (bold, italic, underline or even a completely different typeface) or, for those with color monitors, in a different color. These studies will then be easy to pick out from your worklist view. You specify what information is to be highlighted, and how, using the Fonts section of the Configure View dialog box. It is essentially a three-stage process: 1 Specify one or more items that RA 600 should look for. The items that you have specified (and RA 600 will look for) will appear in the list in the Fonts section of the Configure View dialog box. For each of these items, specify the font (and/or color) that RA 600 should use to display the line containing this information. Adjust the order of the items in the list (using the Up and Down buttons) to specify exactly how you want RA 600 to search for the items you have specified.
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These steps are described in detail below.
75 To specify specific information to be highlighted in your worklist view 1 In the Fonts section of the Configure View dialog box, click on the type of item in the list (for example, click on Study item if you want to have RA 600 look for a property which relates to a study) and then the Add button. In the Add font criteria dialog box, select the DICOM tag from the Field drop-down list (click the >> button), or manually enter the DICOM values for the tag into the text boxes on the left. Specify the Value you want RA 600 to search for. For example, if you selected Patient Sex (0010, 0040) from the Field drop-down list, a sensible value would be M, F or O (Male, Female or Other). Click OK. Repeat steps 1 to 3 until you have added all the items you wish to the list. Click on one of the items you created and then the Font button. Specify the font you want to use in the Font dialog box for this item. Repeat for the remaining items you created. Click on the items you created in the list and use the Up and Down buttons to rearrange them as necessary to have RA 600 search for the items in the order you wish.
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Item types and DICOM hierarchy

Before any items are added to the list in the Fonts section of the Configure view tooltab, the list contains only a list of items which contain the font specifications for the default or unhighlighted text in the worklist view (you can modify these to change the overall appearance of the worklist view, see Customizing your fonts in RA 600 on page 304 for details). These original seven items, which do not have values associated with them, are arranged in the list in the Fonts section of the Configure View dialog box in terms of the hierarchy under DICOM (you cannot change this order). This is the order in which RA 600 will search for your items.
The order of the items in the list and how RA 600 displays lines
RA 600 works from the top of the list to the bottom according to the DICOM hierarchy. Although you cannot use the Up and Down buttons to change the overall hierarchy (you cannot place a series item above a study item for example), you can rearrange the items you have defined within each level (reorder your study items, for example).
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76 chapter 3 The order in which you place the items in the list can affect how RA 600 displays a line in the worklist view. If a line contains more than one item in the list, RA 600 displays the line in the font of the item which is higher in the list. Thus, if you specify that lines containing a status of Seen should be red and lines containing a Patient Sex of M should be green, a line which contains both items will be red if the Status item appears above the Patient Sex item in the list, and green if the Patient Sex item is higher up the list.
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Managing your remote views

RA 600 allows advanced users to show or hide, create, edit and delete remote views. To do this, use the Remote Views section on the Filing tooltab (with the icon). To show or hide remote views in the main Data Selector screen the Remote Views check box on the Filing tooltab. To create a new remote view 1 2 3 4 Check that the device on which you want to open this view is switched on and connected to your network. Click the New button in the Remote Views section of the Filing tooltab. In the New Remote View wizard, enter a name in the Description field (such as Dr. Jones, ICU or CT Scanner for example). Select the appropriate Type radio button to set the remote database as a database on another RA 600 system or as a DICOM database on a DICOM 3.0 compliant device. Click a List Root radio button to select whether the remote view should be initially displayed as a patient view or as a study view. Click Next >. If the remote view is to be established on another RA 600 system, enter the name of the computer (station name) in the Computer field. (Do not alter the contents of the Pipe field.) If the remote view is to be established on the database of a DICOM compliant device, enter the Application Entity (AE) Title, the Host Name and the Port Number of the remote system. If you are uncertain about what to enter here, consult your system administrator. Click Finish. check or uncheck
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Newly created remote views will be empty at first. To see the data you will need to perform a query on the remote view.
As soon as you have created one or more remote views click (if necessary) the Remote Views check box on the Filing tooltab to make the created remote views visible in the Data Selector.
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78 chapter 3 To edit a remote view

Incorrectly modifying your remote views may well result in lost functionality. Please consult your system administrator or RA 600 distributor if in any doubt about the changes you intend to make.
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Click on the name of the remote view in the window in the Remote Views section of the Filing tooltab. Click the Edit button. Modify the settings in the Edit Remote View dialog box.
To delete a remote view click on the name of the remote view in the window in the Remote Views section of the Filing tooltab. Then click the Delete button.
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Changing patient and study list headers

Some options will only be available to you if you have administrator rights and/or certain RA 600 modules have been installed. If you are unable or not certain about making the changes yourself, consult your administrator or RA 600 distributor.
RA 600 allows you to add, remove and change the headers which appear at the top of your studies and patients lists so that you can change the information displayed in the columns (and the order in which these are displayed). To do this, use the right mouse button menu which appears when you rightclick on one of the study list headers. Column Properties... allows you to change the alignment of the header or change its title (with the Edit option). Delete will remove the column from your study list (although it will not delete the actual DICOM data). Adding columns The Insert Column... option allows you to add columns to your study list. The new column is inserted to the left of the column whose header was rightclicked on to reveal the right mouse button menu. To add a column to your study or patient list 1 2 3 Right-click on the header to the left of which you want to add the new column. Select Insert column... from the right mouse button menu. In the Edit Column Properties dialog box, select the DICOM information you want to display in the column from the >> drop-down list (or manually enter the actual DICOM values into the fields on the left). If desired, use the Description field to change the title of the column as it appears in the Data Selector. Select one of the radio buttons to justify the information to the Left, in the Center or to the Right in the column.
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Modifying columns
You can change the name of an existing column and the information it displays. To modify a column to your study or patient list 1 Right-click on the header of the column you want to change and select Column Properties....
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80 chapter 3 2 In the Edit Column Properties dialog box, make any changes you wish by modifying the contents of the list, the description or the alignment of the column heading. Click the Default button if you want RA 600 to consider your modifications as a default in the future. (Clicking Default before exiting the dialog box will undo any changes you have made.).
Arranging the order of columns in your study list

To change the order of your columns, simply click on the column you want to move, drag it to where you want it to go then release the mouse button.
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Viewing images
Once you have used the Data Selector to locate studies you want to view, you use the Viewing Section to examine them. You can quickly adjust windowing, create cine loops, examine images in detail with magnifying glasses and a great deal more. To aid diagnosis, a wide range of measurement annotation tools is also at hand. Changes made to images can be recorded and sent over the netwok as separate DICOM entities in the form of Presentation States, Reports too, can be sent and retrieved as separate items. Also described is how you can install and work with plugins to enhance the power of of RA 600.
The Pictorial Index in detail ......................................83 Viewports ................................................................ 87 Undoing actions .......................................................90 Working with presentation states .............................92 Windowing................................................................95 Panning ..................................................................102 Navigating between images ...................................103 Key notes ...............................................................107 Zooming and the magnifying glass ........................ 111 Filtering images ..................................................... 114 Creating and using cines........................................ 116 Annotating images .................................................122 Creating reports .....................................................143 Study Statuses .......................................................151
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he Viewing Section of RA 600 opens automatically when you doubleclick on a study in the Data Selector (see chapter 3). You use it to manipulate and view studies for comparison and diagnosis.
In many respects the Viewing Section is the heart of RA 600 where you will probably spend much of your time. You can window images, zoom in and out, flip and rotate them, process them with filters, measure and annotate them, create cines (film clips), send them to other systems, print them, include reports and much more.
The Viewing Section screen

As with the rest of RA 600, the Viewing Section is highly customizable to let you adapt it precisely to your needs. If your system has been customized, it may well appear somewhat different to how it is described here.
When the Viewing Section opens to display the images you want to view, the Pictorial Index on the left of the screen shows you miniature views of all these images. In the center of the screen are the viewports, each of which shows you one of the images. The large Up and Down buttons above and below the viewports let you scroll through your images. On the right of your screen are tooltabs for manipulating and analyzing the images in the viewports. Above the tooltabs is a window giving details on the patient(s) and study (studies). Immediately below the tooltabs is the Scope which lets you limit what you do (such as windowing) to just a single viewport or a number of studies (or have it apply to more than one study). The Prev and Next buttons display the previous or next study/series without having to go back to the Data Selector. You can use the Reset button to return all the images in the viewports to their condition when they were originally opened, undoing any changes (such as zooming or filtering) you have made to them. The Back button returns you to the Data Selector. There is also a simplified version of the Data Selector available while you are viewing images. Usually located under the viewports, this Data Selector window lets you search for and open other studies in your local database while in the Viewing Section. Next to this is a Reports window in which you can produce a report on a study while viewing it.
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The Pictorial Index in detail

With the Pictorial Index you can see at a glance what images are in a study and which part of the study you are currently looking at in the viewports. You can quickly move to any point in a series simply by clicking at the appropriate place within the Pictorial Index.
An example of a Pictorial Index displaying three series
Series and study headers in the Pictorial Index

The Pictorial Index shows miniature images of all the images in the study or series you are viewing, automatically adjusting their size to fit the available space on the screen. If you open a study, the Pictorial Index displays a study header which contains the name of the study in bold. Beneath the study header is a series header. The left of the series header displays the name of the header, while the right side shows a figure indicating the number of images the series contains. A series summary appears beneath the series header. It shows a smaller representation of the series as black squares.
Expanding and collapsing series in the Pictorial Index

If your Pictorial Index displays more than one series or study, you can collapse these to provide extra room to view other images in the Pictorial Index.
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84 chapter 4 From the Data Selector, open one or more studies containing more than one series. In the Pictorial Index, click on each study header to collapse the study. To expand a study, click on its study header again. Beneath the study header, you should see the series headers of the series containing the studys images. Click on a series header to collapse and expand the series. You can partially collapse an expanded series by clicking on the small black box on the right side of the series summary. The index will reduce itself to one image, the first one in the series, provided you are working with a series displayed in the viewport. Click on the box again, and the Pictorial Index will display the first, middle and last image of the series. (The gray boxes in the series summary represent images not visible in the Pictorial Index, but which are part of the series nonetheless.) Click on the black box to the right yet again and RA 600 displays all the images comprising the series. You can reach the same objective by right-clicking an image in a series in the Pictorial Index and selecting the appropriate command from the pop-up menu: Show all images One image only or First, middle, last image. You can also try the 1 image out of command displayed in the pop-up menu. This contains a submenu with the numbers 2 through 10. By selecting a number, you select the image interval you want to view in the Pictorial Index.
If you expand and collapse a series not displayed in the viewport, the series summary displays its representations in black and gray.
Viewing multiple studies in the Pictorial Index

You are not restricted to viewing thumbnails of the images in a single study in your Pictorial Index. If you want to view thumbnails from more than one study, you select the studies you are interested in from your study list (mini Data Selector). To select multiple studies in your study list 1 2 Click one of the studies. Hold down the Ctrl key on your keyboard, and click the other studies you want to view.The Pictorial Index will now display all the images from all the studies you have selected. The different studies will be separated by a light gray bar.
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Sorting the images in the Pictorial Index

When you change the order of series in the Pictorial Index, series displayed in series areas in the viewing area of the screen will also be updated.
When your system first opens a series for viewing, it displays the images in the Pictorial Index in ascending order of the index numbers of the images (essentially the order in which the images were stored). You may, however, wish to view the images in the Pictorial Index in a different order - according to image number, acquisition number or slice location perhaps. You can quickly sort series in this way. To sort series in the Pictorial Index right-click in the Pictorial Index on the series you want to sort and select Sort Series and then the type of sorting you desire from the pop-up menu. It may be that the images are sorted according to the correct number, but they are displayed in reverse order. To reverse the order of images in the Pictorial Index right-click in the Pictorial Index on the series you want to reverse the order of and select Sort series Reversed from the pop-up menu.
Previewing images in the Pictorial Index

You can preview images by pressing Shift and then right-clicking on an image in the Pictorial Index. A window will open with an enlarged version of the image.
Using the Pictorial Index to navigate

You can quickly move to exactly the images you want to view by clicking in the Pictorial Index (outside the highlighted area). The viewports will now fill with images from the miniature view which you clicked.
Resizing the Pictorial Index

You can resize the Pictorial Index to give yourself more viewing area. To change the width of the Pictorial Index left or right. click on its right hand border and drag
Customizing the Pictorial Index

You can move the Pictorial Index to other sides of the screen, window it (change its brightness and contrast) separately from the viewports or even hide it altogether to give yourself more viewing area. To independently window the Pictorial Index click with the right mouse button over the Pictorial Index and keep it pressed. The cursor will change into a small sun icon. Drag the mouse to the right or left to increase or decrease the window width, or up or down to increase or decrease the window level.
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86 chapter 4 To move the Pictorial Index to another part of the screen click on the two lines at the top of the Pictorial Index, drag it to another side of the screen and release the mouse button. Your Pictorial Index will dock automatically at the new location. To turn off (hide) the Pictorial Index click the Layout tooltab (with the Swiss Army knife icon). Then uncheck the Show Pictorial Index check box.
You can also hide or show the Pictorial Index (or the tooltabs and Reports window) using the Layout menu on the menu bar (or hide it by clicking the Close button in the top right hand corner).
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The active viewport

The center of the Viewing Section screen consists of a number of rectangular viewports. These are where you view your images. Whenever you are displaying more than one viewport, one of them will always be active. Whenever you do anything such as zooming, panning or windowing, RA 600 will update this viewport first and then the others (provided your Scope is not set to Viewport, see Setting the Scope of your changes on page 91). To make a viewport active click anywhere inside it.
Your active viewport is highlighted by a box around it (red on color displays, white on monochrome).
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Configuring viewports
When you are viewing images, you can have anything from just one large viewport to a sophisticated layout with larger and smaller viewports showing images from a number of different series or studies. This would, for example, enable you readily to compare two different series or studies from a patient taken at different times. You can decide on the layout of your viewports in the Data Selector before you actually view your images (see Selecting studies and opening them for viewing on page 62). But you can quickly change this at any time while you are in the Viewing Section. To quickly select from a range of standard hanging protocols (layouts), use the Layout tooltab (with the Swiss army knife icon).
Using the Layout tooltab to select layouts

The Layout tooltab provides a number of ready-made hanging protocols (layouts) for your viewports. The options which include a number of separate areas (separated by gray lines) let you view a number of series or studies at the same time (or view different parts of the same series in different windows). There are buttons for all the default hanging protocols and some or all of the automated hanging protocols that have been defined in RA 600 and are currently enabled. While RA 600 comes with a good selection to choose from, additional hanging protocols can be readily defined to meet your precise needs or the particular requirements of your organization. For more details, see Working with hanging protocols on page 174. To select a standard hanging protocol (layout) want on the Layout tooltab. click the button for the layout you
The screen will immediately adapt to your chosen hanging protocol.
Selecting layouts with the right mouse button menu

You can also select a hanging protocol using the pop-up menu which appears when you right click inside the viewing area. To select a hanging protocol using the right mouse button menu click the right mouse button anywhere in the viewport area. Click Hanging Protocols and then on the layout option you want.
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Defining a layout with series and viewport areas

You can have RA 600 display a regular matrix of series or viewport areas. You could, for example, then display four series in a 2 x 2 layout, with each area containing a single viewport displaying an image from a different series. Or display a single series in six viewports with a 2 x 3 layout. You can specify settings for viewport areas within series areas. This means you could perhaps have a total of four series areas, three with just a single viewport and the other with four viewports. To specify a new series or viewport area layout in the Viewing Section, rightclick within the series that you want to change the layout of and select Change Layout from the pop-up menu. If you create a new series layout, you can adjust the layout of the viewports within each series area independently. Simply right-click within each series area, select Change Layout and then Viewport Areas. In this way you can effectively create virtually any viewport layout.
Filling the viewport areas with images

When you select a different hanging protocol or layout, there may well be areas for series in the viewport area which are empty at first since RA 600 will not know what images you wish to place in them. To place images in a newly-created series area first click anywhere within the series area (this tells RA 600 which series area it is to place the images in). Then click the image in the Pictorial Index which you want to appear in the active viewport of this series area. The series area will fill up with images starting from the image you clicked on in the Pictorial Index.
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Undoing actions while viewing images

If you find yourself making significant use of the Undo feature, create a shortcut for it (Ctrl + Z is commonly used in Windows programs for Undo) - see Creating keyboard shortcuts on page 299 for details. A generally more drastic form of undo is the Reset button under the tooltabs. This will restore the images to how they were when you first opened the study for viewing. Any changes you made to the study, including annotations, etc. will then be lost. RA 600 currently provides only a single level of undo, so you cannot undo multiple actions. You cannot perform an Undo action with magnifying glasses, virtual film sheets or compose teleradiology jobs. Pinning a viewport, running a cine and changing layout and series area content are not subject to undo. This means that the action previous to these will be undone (if it is possible to do so).
As in many Windows programs, RA 600 includes an Undo feature. So if while viewing images you perform some action, such as windowing, you can go back to the situation immediately prior to this action. You might do this if you have simply done something you quickly wish you had not done, but also for experimenting and trying out various options. To undo an action you performed while viewing images before performing any other action, select Study Undo from the menu bar or right-click in a viewport and select Undo from the pop-up menu. You can undo almost all actions you perform while viewing images. There is, however, a limited number of actions, such as clicking the Reset button, that RA 600 cannot undo. In these cases, RA 600 will warn you that the action cannot be undone before proceeding.
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Setting the Scope of your changes

RA 600 offers many features and tools to manipulate images in the viewports. You will probably want to window the image, zoom and pan for example. With Scope you have a versatile tool for limiting changes to a single viewport, a selection of viewports, a series or a study. If, for example, you click the Viewport radio button in Scope (immediately underneath the tooltabs) you can window, zoom, and pan every individual viewport on your screen. At other times, when you are zooming and panning to view a particular structure, for example, you will want all the other viewports (all the images in the series area in fact) to follow suit and to pan and zoom in the same way. You do this by clicking the One Series radio button in Scope. When you are viewing more than one series in a study, to compare them for example, you can have RA 600 update the images of all the series in the study by clicking the Study radio button. If you are viewing multiple studies or series from a number of studies, the All radio button will cause all viewports to be updated regardless of which series or study the image they are displaying is from. The Scope is set to One Series when you first enter the Viewing Section.
Setting the Scope to a selection of viewports

There may be times when you want to set the Scope to a number of viewports, but not all the viewports in a series. One example would be if particular images in a series appear unduly dark compared to the others, so you want to adjust the windowing of just this limited number of images. To set the Scope to a selection of viewports first make sure the Scope is set to Viewport (click the Viewport radio button if this is not already active). Then hold down the Ctrl key and click on the viewports you want to include in the Scope, or hold down the Shift key and click on the first and last viewports to select a range (very much like using Windows Explorer). On color displays, you will see that the selected viewports acquire a blue border to indicate that they are part of a multiple selection (dashed borders will appear on monochrome displays). The viewport you clicked last will continue to have a red border to indicate that this is the active viewport. To reset the Scope to a single viewport Scope to. click on the viewport you want to set the
Apart from the borders around the viewports, a further indication that the Scope is set to a selection of viewports is that the word Viewport next to the radio button in the Scope section becomes Viewports.
You can also click the Series, Study or All radio button. Your multiple selection will remain, but the Scope will now be active on all the viewports in the series, study or all displayed studies.
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Working with presentation states

Presentation states allow you to manipulate images and save them in their changed state without modifying the original images of a study. As a separate DICOM entity, each presentation state can be distributed as you would normally send and store studies.
Creating presentation states

Presentation states are scope dependent. Before creating a presentation state, make sure you adjust the scope so that the presentation state includes the images you want.
You open a study from the Data Selector and manipulate images in the Viewing Section as you normally would; create annotations, window images, zoom, and pin for example. When you are sure you have made the adjustments you wish, you save your work by adding it to the study. In effect, you will be able to view two copies of the same study: the original study as you initially viewed it and the study with your manipulations (the presentation state). To create a presentation state 1 2 Double-click on a study in the Data Selector. In the Viewing Section, make whatever changes you wish to an image or images by annotating, windowing, magnifying etc. (image overlays not supported). Click the Add... button in the Presentation States section of the Layout tooltab (with this icon). Select an appropriate label from the Label drop-down list in the Add Presentation State dialog box, or type in a label of your choice. If you choose not to label the presentation state, RA 600 does it for you by attaching the date and time at which the presentation state was created. The label annotation 2001111615H30M, for example, indicates that the presentation state was made on 16 Nov 2001 at 3:30 PM. Give the presentation state a description by specifying the Description field and click OK. Click the Back button to exit the Viewing Section. The Presentation States check box in the Save Data dialog box will be checked (click the Advanced button in the Save Data dialog box to view the check box, if necessary). Click Yes to permanently save the changes you made.
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93 It is not necessary to exit the Viewing Section each time you want to create a presentation state. You can, in fact, create several presentation states in one viewing by selecting <none> from the Presentation States drop-down list and making new manipulations to the original images. Or you can re-manipulate images you have not yet permanently added to a study by repeating steps 2 through 5 above.
A presentation state is actually a reference that effectively enables you to save the way you look at an image.
The <RadWorks 5.1 option>

The Presentation States drop-down list shows the <RadWorks 5.1 option>. You can use this option to view annotated images originating from previous versions of RA 600. If you turn the option off, RA 600 will display the images without the annotations.
Modifying presentation states

You can modify a presentation state if you have not permanently saved it. To modify a presentation state 1 2 Double-click on a study in the Data Selector. In the Viewing Section, make whatever changes you wish to an image or images by annotating or magnifying etc. (image overlays not supported). Click the Add... button in the Presentation States section of the Layout tooltab. Select an appropriate label from the Label drop-down list in the Add Presentation State dialog box, or type in a label of your choice. Give the presentation state a description by specifying the Description field and click OK. Manipulate the image again by windowing or providing a measurement etc. and then click the Modify button. Click the Back button to exit the Viewing Section. Click the Advanced button in the Save Data dialog box. The Presentation States check box in the Save Data dialog box will be checked. Click Yes to permanently save the changes you made.
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94 chapter 4 You can delete a presentation state in the Viewing Section at any moment by clicking the Delete button, provided, of course, that you have not permanently saved it. A permanently saved presentation state, however, can be removed from the Data Selector by selecting it and pressing the Delete button on the keyboard.
Viewing a presentation state

RA 600 will display all the images of a presentation state, provided they are available. Removing a series upon which a presentation state is dependent, for example, means that the Presentation State will no longer show the full range of images initially included in the Presentation State.
You can identify a presentation state in the Data Selector by expanding to series level the study to which the presentation state belongs. A presentation state at this level will have the modality PR. You can identify a presentation state at image level by the Label you gave it when you added it to the study. To view a presentation state from the Data Selector double-click on the study to which the presentation state belongs. You can also open the study up to series level, right-click on it and select View from the pop-up menu. This also works at image level. If you open a study (by double-clicking on its study icon for example) that has one or more presentation states, RA 600 will display the most recent presentation state. You can select a different presentation state from the Presentation States drop-down list on the Layout tooltab. To view the original images, select <none> from the Presentation States drop-down list. If you open multiple studies, the content of the Presentation States drop-down list will change when the study in the active viewport changes.
Some additional facts about presentation states

You cannot edit permanently saved presentation states. You always make new ones. If you make changes to an existing presentation state, and save it without giving it a new name, RA 600 creates a new presentation state and labels it with the date and time at which the presentation state was created; e.g. 1001111615H30M for 16 Nov 2001, 3:30 PM. You can see the name of the presentation state in the Data Selector by adding the Presentation State label to image level. You can send presentation states to workstations that support presentation states. This means that older versions of RA 600 will not display presentation states. You select AMI Private from the Presentation States drop-down list to view annotations, flipped and rotated images and calibrations etc. that have been made in earlier versions of RA 600.
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Defining Windowing parameters

When windowing images, some doctors prefer to use the values Width and Center. Others are accustomed to using Minimum and Maximum. RA 600 supports both types of measurements, and you can easily configure the Windowing tooltab (with this icon) to show either. To configure the windowing parameter with which you want to window 1 2 3 Select Configuration Viewing from the Data Selector menu bar.
In the Viewing Properties dialog, click on the Modalities tab. Select from the Modality Type drop-down list the modality for which you want to adjust the windowing parameters. (If you do not see the modality you need, place your cursor in the drop-down list, type in the name of the modality (e.g. MR) and click New). You can use the Default setting if you want to apply adjustments to non-configured modalities. Go to the Windowing section of the Viewing Properties dialog and select from the Parameters drop-down list either center/width or min/max. Click OK to exit the Viewing Properties dialog box. In the Data Selector, double-click on a study with a modality for which you have adjusted windowing parameters. In the Viewing Section, select the Windowing tooltab (with this icon). In the Window section, you will see the parameters you just configured; i.e., center/width or min/max. If the Basic or Full annotation level option is selected on the Annotation and Measurement tooltab (with this icon), you will also see your images annotated in accordance with the configuration you just made.
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Windowing images
There are two main ways you can window your images in RA 600. For quick and easy adjustments, you can right-click and drag in a viewport or, for more precise adjustments, you can use the Windowing tooltab.
Windowing with the mouse

In much the same way as you can window the Pictorial Index, you can drag using the right mouse button to adjust both window center and width in a viewport. To use the mouse to change the window center click the right mouse button inside a viewport and keep it pressed down. The mouse pointer will change into a sun icon. With the right mouse button still depressed, move the mouse up or down. To use the mouse to change the window width click the right mouse button inside a viewport and keep it pressed down. The mouse pointer will change into a sun icon. With the right mouse button still depressed, move the mouse left or right. The further you drag the mouse, the greater your changes will be. You can also drag in any other direction to change both the window center and width at the same time. As a rule of thumb, if you drag downwards in the direction of the light half of the sun your image will become lighter, dragging towards the dark side of the sun will make your image darker. The viewport will be updated almost in real time, giving you a truly interactive windowing tool.
If the Windowing tooltab is visible, you will see the controls move and the settings change as you drag in the viewport. The current settings are also generally visible in the lower left corner of the viewport.
Windowing and Scope

As with other adjustments you make in the viewports, the images in your other viewports will be updated (or not be updated) in the same way depending on your Scope setting selected (Viewport, One Series, Study or All) in the lower right corner of the Viewing Section.
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Windowing using the tooltab

All windowing in every RA 600 module is performed on the DICOM data and so is true windowing and not simply display palette adjustments.
The Windowing tooltab gives you precise control over windowing your images. Since windowing is one of the most frequent tasks when using the Viewing Section, the Windowing tooltab is always on top when you first open a study. You can, however, get to it at any time by clicking the tab with the sun icon.
Using the slider bar

The slider bar lets you accurately adjust both level and width. To adjust windowing width using the slider bar first make the viewport you want to window active (click on it it will become highlighted with a box around it). Then click on either end of the slider on the Windowing tooltab and, keeping the button pressed, drag upwards or downwards. If you drag towards the center of the bar, the bar will shorten indicating a reduced width. Dragging away from the center will widen the bar and increase width. To adjust windowing level using the slider bar first make the viewport you want to window active (click on it it will become highlighted by a box around it). Then click on the slider on the Windowing tooltab (between the two horizontal bars) and drag upwards or downwards. The range of the scale next to the slider will automatically adjust as you change the position of the slider. The numbers in the Center and Width fields towards the top of the Windowing tooltab will also change to indicate your current values.
RA 600 supports two sets of windowing parameters on the windowing tooltab: center and width, and minimum and maximum. The parameters you see will depend on how RA 600 has been configured.
Directly entering exact values for level and width

Instead of adjusting the slider bar, you can enter exact values for level and width directly in the Center and Width fields. To enter center and width values directly click in the Center or Width field on the Windowing tooltab and type in your value for center or width.
Using pre-defined settings

You can also create and use pre-defined settings so you can quickly use preferred settings. You can define these for a specific modality on the Windowing tooltab. To use a pre-defined setting click the small down arrow to the right of the settings field beneath the Invert check box to display the drop-down list. Click the setting you want.
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98 chapter 4 The Auto setting You will always find a pre-defined setting called Auto in the drop-down list. This applies values optimized for all the images in the series by finding the maximum and minimum pixel values of your image and by selecting window center and width values that span this range. Auto windowing is also automatically applied if no pre-defined windowing settings have been stored for your images.
If you open a study and cannot see any images, this may well be because the windowing values saved with the study have been inappropriately set. You can then select the Auto setting in the drop-down list on the Windowing tooltab. This will optimize the window level settings so you will be able to view the images.
Creating and saving pre-defined windowing settings

You can easily save your windowing settings for use later with the same images. You can also make them available for use with other images by making them into pre-defined settings. These will then appear in the drop-down list on the Windowing tooltab ready for you to select when you need them. To save or create pre-defined windowing settings 1 Adjust the windowing level in the active viewport to your preference, using the mouse or slider bar or by typing specific values in the Center and Width fields on the Windowing tooltab. Click the Add button on the Windowing tooltab. In the Add Window Level dialog box, type a name for the settings if you wish (or leave the name based on the current windowing settings as is). Check the Body part specific check box if you want RA 600 to save the settings for use with a specific part of the body. Click Create Shortcut if you want to assign a shortcut key combination to use your windowing settings.
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Removing (deleting) predefined settings Just as you can create pre-defined settings, you can also remove (delete) them. To remove pre-defined windowing settings select the settings you want to remove in the drop-down list on the Windowing tooltab. Click the Del button.
Creating pre-defined windowing settings for body parts

If you save windowing settings (presets) for use with other studies, RA 600 always saves these for a particular modality. This means that you can create various presets for each modality you work with. These will then appear as options on the Windowing tooltab.
99 If you wish, you can also have RA 600 save presets not only for a particular modality but also for a particular body part. Then, if you are viewing an UltraSound series with body part Abdomen for example, you will only see presets created for viewing US images of abdomens in the list on the Windowing tooltab. To create a windowing preset for a body part when viewing a study of the appropriate body part, adjust the windowing levels (center and width) to the values you want to use for the preset. On the Windowing tooltab, click the Add button. In the Add Window Level dialog box, make sure the Body part specific check box is checked. RA 600 will create a new set of presets for the modality and the body part. For example, for a CR study of the Wrist, your presets will be included in the CR, Wrist set. Stopping using body-part specific presets Once you have selected body-part specific presets for a particular kind of study (such as SC, Abdomen or NM, Heart for example), new windowing levels will always be saved body-part specific without asking you. If you no longer wish to save windowing levels body part-specific for a particular body part, remove all the windowing presets previously saved for this body part (select them from the drop-down list on the Windowing tooltab and click the Del button). RA 600 will then save presets without regard to body part (specific only to the modality), unless you check the Body part specific check box again.
If the Body part specific check box is grayed out and you cannot check it, it may well be that a body part has not been defined for the study. To identify body parts, RA 600 uses the Body Part Examined DICOM tag. This tag must have been defined for the study you are viewing. Try another study for which the body part has been defined in this way. You can check in the Data Selector which studies have body parts defined by adding a Body Part Examined column to your local view See Changing patient and study list headers on page 79 for details.
Using non-linear windowing functions

The Windowing tooltab also lets you select from any non-linear windowing functions (such as exponential and sigmoid). These compensate for the inherent non-linearity of various modalities such as film. For additional control, you can also adjust the slope of the function using the slider. The logarithmic function will make your image lighter since pixel values towards the upper end of your windowing range will be shown in a wider range of gray tones on your display. The exponential function has exactly the opposite effect and so will make your images darker. Sigmoid effects images in the same way except for values in the middle of your windowing range. To use a non-linear windowing function simply select the function you wish from the Type drop-down list on the Windowing tooltab.
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Optimizing parts of images using regions of interest (ROIs)

You may want to optimize your window settings for just part of an image when studying bone or soft tissue for example. You can do this by creating a Region of Interest (ROI) and letting RA 600 optimize windowing settings for this area. You can resize this ROI and move it around your image. Almost in real time, RA 600 will automatically adjust the windowing of the image to optimize it for the part of the image inside the ROI. To use an ROI to optimize windowing for part of an image 1 2 Click the ROI button on the Windowing tooltab. Click inside the viewport containing the image youre interested in and hold the left mouse button down. Drag to create an ROI window in the viewport and release the mouse button. Move the ROI to the region you want to optimize by clicking within the ROI and dragging. Adjust the size of your ROI if necessary by dragging its borders or corners.
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You can create more than one ROI inside the viewport by repeating this procedure. Then RA 600 will use the last active ROI for optimizing windowing. When you have finished using your ROI, you might want to remove it. To remove an ROI used to optimize windowing select Delete on the pop-up menu. right-click within the ROI and
Inverting images
The Windowing tooltab also allows you to invert (display the negative of) the gray scale of your images (set the Scope to change some or all the images). To invert an image check the Invert check box on the Windowing tooltab.
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Pseudo colors (palette)

The Viewing Section has a palette color Lookup Table (LUG) selector dialog, and a palette color display, both of which are accessible when you view certain images; e.g., US or USMF images. When you select a particular palette color LUT, both the range bar and the palette color display show the selected palette. To select a new palette color with which to view images 1 2 3 From the Data Selector, open a study made with an appropriate modality. On the Windowing tooltab, click the Select... button at the bottom of the Window section. Select the palette you wish to use from the list in the Select Palette Color Lookup Table dialog that appears. Click OK.
The option is disabled if you open a study whose modality is not suited for this option, RG and SC for example.
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Panning
When you zoom or magnify images in your viewports, they will become larger than the viewport itself. Panning (moving the image within a viewport) then becomes important. This is very easy to do by dragging within the viewport. To pan (move the image around) within a viewport click (with the left mouse button) within the viewport and hold the mouse button down. The pointer will change into a hand icon . Now pan the image by dragging in the desired direction. Panning and Scope options If the Scope option is set to One Series, Study or All, images within other viewports will be updated in the same way. If you just want to pan one viewport, make sure Scope is set to Viewport.
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Quick browsing with the Up and Down buttons and keyboard

Apart from using the Pictorial Index, you can quickly browse a series by using the large Up and Down buttons located above and below the viewports. Click these and the viewports will show the next or previous page of images in the series (if you have four viewports, for example, you will see the next four images in the series when you click Down). The highlighted area in the Pictorial Index is also updated so you always know where you are in the series.
Configuring buttons in the Viewing Section

You can define the location of the Up and Down buttons, in addition to the position of the Previous, Next and Back buttons in the Viewing Section. RA 600 will even let you add Up Series and Down Series buttons, so you can scroll more easily through successive series of studies. You can group the buttons so they are positioned next to each other or above or below the images in the Viewing Section. Similarly, you can place only the Up and Down buttons at the top or bottom of your images, or choose to hide all buttons from appearing in the vicinity of your images. To configure the location of buttons in the Viewing section 1 2 3 Select Configuration Viewing from the Data Selector menu bar.
Grouping buttons in a concentrated area can increase the speed at which you work because you do not have to move your mouse across the Viewing Section to navigate through your images. Removing all buttons from the Viewing Section creates additional space which you can use for viewing images.
On the General tab of the Viewing Properties dialog box, click the Configure button in the Viewing Area section. Left click the arrow on the drop-down list in the Navigation Buttons dialog box and make the proper adjustment:
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None Above Viewport Below Viewport Above and Below Viewport
What it does
Hides all buttons that could otherwise appear in the vicinity of your images. Displays buttons above your images. Shows buttons below images. Displays the Up button at the top of the Viewing Section and the Down button at the bottom of the Viewing Section.
Options for displaying the location of buttons in the Viewing Section
Remaining in the Navigation Buttons dialog boxes, select the types of buttons you wish to see by left-clicking in one or more of the following check boxes beneath the drop-down list (this option will be active only if you have selected the Above Viewport or Below Viewport options). Option
Up Image Down Image Up Series Down Series Previous study Next study Back to data selector
What it does
Brings you to the image preceding the current image in a series. Scrolls to the image following the current image in a series. Takes you to the series preceding the series you are viewing. Lets you view the series following the series you are viewing. Displays the study preceding the study you are viewing. Shows the images of the study following the study you are viewing. Returns you to the Data Selector.
Options for displaying the types of buttons in the Viewing Section
Exit the Navigation Buttons and Viewing Properties dialog boxes by clicking OK.
Using the keyboard for quick browsing

You can also move through a study using the Page Up and Page Down keys on your keyboard (which act in the same way as the Up and Down buttons), or the and keys on your keyboard (to scroll by one row of viewports) or the or keys (to move forwards or backwards by a single image). You can also use the Home and End keys to jump to the first or last image.
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Scope settings and browsing

Browsing with the Up and Down buttons and keyboard works slightly differently if you are comparing studies or series and Scope is set to One Series. Using the buttons or keys will then take you through the images at the series level.
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Pinning images
You cannot pin images that are part of a cine loop. If you are printing or sending images, you will not be able to pin images in viewports while you have the Virtual Film Sheet/Compose Send Job dialog box on your screen (double-clicking then performs a different function).
When you are examining a series you may have an important scout or reference image which you would like to keep on your screen while you browse through the rest of the series. RA 600 lets you do this by pinning images in your viewports. When an image has been pinned in a viewport it will remain in place and unchanged while the images in the other viewports change. The image is truly frozen. It will stay just as it is even as you pan, zoom, window or filter the other viewports. To pin an image in a viewport double-click in the viewport.
A thumb tack symbol will appear in the top left corner of the viewport to indicate it is pinned. You can pin as many viewports as you like.
An icon appears in the top left corner when you pin an image
To unpin a pinned image
double-click in the pinned viewport.
Possible use of pinning

You can use pinning to place images within your viewports in a different order than they were acquired in. Pin the first image in your top left viewport, then select the next viewport by clicking in it. Now go the Pictorial Index and click the image that you want to see in this viewport, then pin it as soon as it appears in this viewport. Repeat for all the viewports on the screen. This offers a versatile method for comparing images.
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Key notes
Out of the many images in a study there are often just a few which contain the key diagnostic information a physician may need. RA 600 lets you mark these key notes so that you (and others) can subsequently view just them rather than the whole series. Like presentation states, a key note can be saved with a study as an individual DICOM entity that can be distributed across a network.
Creating key notes

You can create one or more key notes while on the Layout tooltab (with this icon) in the Viewing Section.
An example of an image selected as a key note
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108 chapter 4 To mark an image as a key note hold down the Ctrl key and right-click in the viewport showing the image you want to mark. A key icon will appear in the top left corner of the viewport to indicate your selection. To remove a key note from your selection hold down the Ctrl key and right-click the viewport containing the key note. The key icon will disappear. Once you have created key notes you can save them for later viewing.
If right-clicking in the viewport while holding down the Ctrl key does not appear to work, RA 600 may have been set up for compatibility with previous versions. Try holding down the Ctrl key and using the left mouse button instead. If you find you are still unable to add or remove key notes, the study you are working with has been set to a particular status, such as Authorized, which does not permit key images to be changed. You will also not be able to create and store key notes if you do not have suitable user rights on your system.
Saving key notes

To save key notes 1 Hold down the Ctrl key and right-click in the viewport showing the image you want to mark. Repeat the procedure until you have marked all the images you need. Click the Add... button in the Key Notes section on the Layout ( ) tooltab. In the Add Key Note dialog box, select a Label for the key note you want to save and supplement it with a Description if you wish. Click OK. Repeat the process for each additional set of key notes you want to create. Click OK and close the study by clicking the Back, Previous or Next buttons. Click the Advanced button in the Save Data dialog box to expand it, if necessary. The Key Images check box in the Save Data dialog box will be checked. Click Yes to permanently save the changes you made.
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Modifying or removing key notes

You can use the Delete button in the Viewing Section to remove key notes you have not permanently saved, or the Modify button to change the Label and Description of key notes you have not permanently saved. To modify or remove a set of key notes 1 Hold down the Ctrl key and right-click in the viewport showing the image you want to mark. Repeat the procedure until you have marked all the images you need. Click the Add... button in the Key Notes section on the Layout tooltab.
109 3 In the Add Key Note dialog box, select a Label for the key note you want to save and supplement it with a Description if you wish. Click OK. Select the key note from the drop-down list if you have made more than one key note in a session. Then click the Modify button to change the label or description of the key note. You click the Delete button to remove the key note altogether.
Close the study by clicking the Back, Previous or Next buttons.
Viewing key notes

A key note is actually a set of references to images or frames that effectively enables you to save multiple sets of key image/frames per study.
You can identify a key note in the Data Selector by expanding to series level the study to which the key images belong, provided you have added the Modality column to series level. A key note at this level will have the modality KO. You can delete key notes from the Data Selector by rightclicking on them and selecting Delete from the pop-up menu or by pressing the Delete button on the keyboard. To view key notes from the Data Selector double-click on a study to which key notes belong. You can also open the study up to series level, right-click on the key note and select View from the pop-up menu. This also works at image level. If you open a study (by double-clicking on its study icon for example) that has one or more set of key notes, RA 600 will display the most recent set of key notes first. You can select a different set of key notes from the Key Notes drop-down list on the Layout tooltab. If you open multiple studies, the content of the Key Notes drop-down list will change when the study in the active viewport changes. Viewing only key notes in the Viewing Section While you are viewing a study which has key notes, you can decide to view just these key notes or the whole study. To view just the key notes in a study check the Key Images only check box on the Layout tooltab (with this icon). Similarly, you can view all the images in a study rather than just the key ones by unchecking this box.
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Some additional facts about key notes

You cannot edit permanently saved key notes. You always make new ones. You can double-click a key note in the Data Selector and RA 600 will display all the images of that particular key note, provided they are available. If some images are available while others not, RA 600 displays the ones it can. RA 600 will prompt you to provide a Key Note label when clicking the Back button if you did not click the Add button to save your work. You can send key notes to workstations that support key notes. This means that older versions of RA 600 cannot display key notes.
Automatically sending key notes

When the status of a study is set to Authorized, it is possible to instruct RA 600 to automatically transmit the set of key notes (which now become fixed) to another system. This Auto Transmit facility is covered in Sending studies automatically on page 225.
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Zooming and the magnifying glass

RA 600 offers various ways of zooming in and magnifying your images to examine fine detail. You will find these options mainly on the Zooming and Flip/Rotate tooltab (with the magnifying glass icon). You can, however, also quickly zoom in using a mouse shortcut in any of your viewports.
Quick zoom shortcut

If right-clicking while holding down the Shift key does not appear to expand your viewport, it is possible that RA 600 has been set up on your system for compatibility with previous versions. Try holding down the Shift key and using the left mouse button instead.
While the Zooming and Flip/Rotate tooltab provides detailed control over zooming, you can quickly zoom in very conveniently if the image you want to examine in more detail is in one of many viewports on your screen. To expand a viewport to fill the whole viewing area hold down the Shift key and right-click in the viewport. (Repeat to return to your previous view.)
Zooming in fixed steps

Near the top of the Zooming Flip/Rotate tooltab is a row of four radio buttons numbered 1 to 4 which allow you to zoom in by fixed steps of 2x, 3x and 4x. To zoom in or out in fixed steps make the viewport of the image you want to zoom active (click within the viewport to highlight it) and then click one of the four numbered radio buttons near the top of the Zooming Flip/Rotate tooltab. However, you can also zoom and flip and rotate images using the right mouse button pop-up menu in any viewport.
Zooming with the slider

You can also zoom more flexibly by using the zooming slider on the Zooming Flip/Rotate tooltab. To zoom in or out using the slider first make the viewport of the image you want to zoom active (click within the viewport to highlight it), then drag the slider on the Zooming Flip/Rotate tooltab to the right or left. The zoom factor is displayed below the slider.
Relative, absolute and true size

At the top of the Zooming Flip/Rotate tooltab are three radio buttons which size the images in the viewports somewhat differently.
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112 chapter 4 If you click Relative, the image in the selected viewport will be shown in the selected viewport relative to the size at which the image will just fit in the viewport no matter what size the image was originally (this is how RA 600 displays images by default in the viewports). Clicking Absolute means that at, a zoom factor of 1, the image will be displayed in the active viewport so that one pixel of the image when it was acquired will be represented by one pixel on the screen, hence at absolute size. Clicking the True Size radio button will display the image in the viewport at its actual size, so you can take a ruler and measure the image on the screen and these distances will be the same as those that would be measured on the patient. See Viewing images at their true size on page 184 for more on this.
True size display requires calibration of your monitor or monitors. If this option is grayed out, it may well be that your system is not properly set up for true size display. See Viewing images at their true size on page 184 or consult your system administrator for more information.
Zoom quality
When you zoom in, RA 600 will often have to generate new pixels to fill in the gaps in the zoomed image. You can choose between two ways in which RA 600 does this using the radio buttons in the Quality section of the Zooming Flip/Rotate tooltab. Normally RA 600 uses Linear Interpolation for zooming since it typically provides a smoother and more natural image. Pixel Replication, however, renders what was originally captured more faithfully.
The magnifying glass

Apart from zooming in and out, you can also use magnifying glasses to look at small details in your images. To use a magnifying glass 1 On the Zoom and Flip/Rotate tooltab in the Viewing Section, click the Magnifying Glass button. A magnifying glass window will appear. Click on the magnifying glass and drag it over the viewport you want to look at in detail. Resize your magnifying glass if desired by dragging on its borders or corners. Use the slider at the bottom of the magnifying glass to increase or decrease the magnification. in the top right hand
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To remove a magnifying glass click the close button corner of the magnifying glass window.
113 The magnification produced by a magnifying glass is always in addition to any zooming which has been set on the Zooming Flip/Rotate tooltab. You can create as many magnifying glasses as you like at the same time.
Although you can resize magnifying glasses, you cannot examine more than one viewport with the same magnifying glass. Also, the glass does not work on the Pictorial Index.
Windowing inside magnifying glasses You can window within magnifying glasses. This works in just the same way as for windowing in a viewport (see Windowing images on page 96). Either hold down the right mouse and drag or right click and select from the pop-up menu. You can select from one of the available presets or invert the image. You can also show or hide image annotation shown in the magnifying glass (right click on the magnifying glass and select Image Annotation from the pop-up menu).
Flipping and rotating images

Using the Zooming Flip/Rotate tooltab you can flip an image in the active viewport both horizontally and vertically as well as rotate them in 90 degree steps either clockwise or counterclockwise. You can save your flip and rotate actions with the study so that when they are next viewed the images will appear in their rotated/flipped state. To save flip/rotate actions with a study make sure the Presentation States check box is checked in the Save Data dialog box when you leave the Viewing Section.
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Enhancing images with filters

You can apply a filter to a series, a study, or a range of studies at the same time by means of the Viewport, Study, One Series or All radio buttons at the bottom of the Viewing Section screen. If you are using an RA 600 Standard system, only Sharpening and Enhance Edges will be available. It is possible to modify the filter algorithms in RA 600. If this has been done, effects other than those described might occur. You can also create custom filters and filter sets that apply just to a single modality and/or body part. See Using filter sets and custom filters on page 115 for details.
RA 600 includes a number of image processing filters to remove noise and enhance small structures. You can apply these filters to an image in a viewport by using the Filtering tooltab (with the icon). To apply a filter to an image first click the viewport containing the image you want to filter. Then click the button for the filter you want to apply on the Filtering tooltab. Reset resets your image. The effects of any filters previously applied to the image are removed and the image reverts back to its original condition. Median is useful for removing noise from images and can effectively filter out very high or very low pixel values. The filter looks at the pixels surrounding a pixel (3x3 neighborhood) and displays the median value of these pixels. Minimum tends to shrink structures in images (it produces an erosion effect). Like the Median filter, it looks at surrounding pixels (3x3 neighborhood). It displays the minimum value of these pixels. Maximum tends to grow structures in images (it produces a dilation effect). Like the Median and Minimum filters, it looks at surrounding pixels (3x3 neighborhood). It displays the maximum value of these pixels. Smoothing is a differentiating kernel filter which effectively smooths images. It softens hard or rough edges in images. Sharpening is a kernel filter which increases the visibility of small lines and fissures which may otherwise be difficult to spot. Shadowing is a kernel filter that has the effect of casting a shadow across the image, tending to enhance the visibility of small structures. Enhance Edges also increases the visibility of small lines which might otherwise be difficult to see. It does this to a greater extent than the Sharpening filter, but also produces more overall distortion in the image. Detect Edges clearly reveals changes in an image but produces an even greater amount of distortion which typically means that the image will need to be windowed after it has been used.
To increase the effect of a filter simply apply it more than once to the image. You can also combine the effects of filters by applying one after another. If you show the same image twice on the screen (using pinning for example), you can apply different filters to it and compare the results. So, for example, you could examine the different effects of the Sharpening and Edge Enhancement filters.
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Using filter sets and custom filters

Some filters are typically only appropriate for particular modalities and/or body parts, so you may only wish to see certain filters when viewing a CT study for example. You may even want to define your own, custom filters for particular tasks. RA 600 offers a great deal of flexibility concerning imageenhancement filters. You can define sets of filters for various modalities, so that when you are viewing a CT study for example, you will see the set of filters defined for CT images. You can also define sets of filters to be used just for particular body parts from a certain modality. As part of any of these sets, you can have your own custom filters. Filter sets are user-specific, which means that you can define and use your own filter sets, while someone else using the same system can use their own sets. If you define a set of filters for CT studies, for example, whenever you are viewing a CT study the Filtering tooltab will show a button for each of the filters in the set. If a filter set has also been created for CT studies of the body part Abdomen, and you view such a study, this filter set will be shown. If you view a CT of a different body part, the CT filter set will be shown. If you are viewing a modality for which no special filter set has been created, you will see the standard filter options on the Filtering tooltab. To create and modify custom filters and filter sets select Configuration Viewing... from the menu bar in the Data Selector. Add or modify your filters and filter sets using the Filters tab of the Viewing Properties dialog box. Click the Help button for details on how to do this.
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Creating cine loops

If you start a cine loop in a viewport where the initial image forms part of a series within the study, the cineloop will limit itself to that particular series. This allows you to create and compare cine-loops of different studies or series. However, you can also select the Scroll to next series check box so the cine includes the following series in its cycle.
The automatic display of a sequence of images and the effect of motion this creates can greatly assist in the diagnostic process. RA 600 allows you to quickly create and manipulate such cine loops. A cine loop is a continuous, sequential display in a viewport of all the images (or a subset of them) in your study or series. You can run cine loops in a number of viewports at the same time. And you can even adjust the windowing level and pan and zoom in the viewport while a cine loop is running. You create and control cine loops using the Cine tooltab (with the camera icon). This lets you turn cine loops on and off, take manual control of the cine loop, decide how the cine loop should play, set the speed the cine should play at and select which images should be in the cine
Automatic cine loops

If you are using an RA 600 Standard system, you will only be able to have one cine loop active at a time.
Although you can exert a great deal of control over your cine loops, creating them is very easy since, with the click of a button, RA 600 will automatically start playing a cine with suitable values. Using the Cine tooltab, you can then adapt the cine more precisely to your wishes while it is playing. The changes will take effect almost instantly, so you can see the effect they have and fine tune as necessary. To create (and play) a cine loop make the viewport you want to use to display the cine active (click inside it) then click the On radio button on the Cine tooltab. To stop a cine loop make sure the viewport containing the cine loop you want to stop is active (click inside it) then click the Off radio-button on the Cine tooltab. The viewport will revert to the image it held prior to hosting the cine. If you open a new study or exit the Viewing Section while a cine loop is still running it will be stopped automatically by RA 600. Up, down and bounce You can decide how you want the cine loop to play and repeat itself by using the Up, Down and Bounce radio buttons. If you click on the Up button, the cine will start playing from the last image through to the first and then repeat. Clicking on the Down button will make the cine play from the first image to the last and then repeat. Bounce means that the cine will play from the first to the last and then reverse the playing order and play from the last to the first and then repeat.
117 Setting the speed On the Cine tooltab you can set the speed (in number of images per second) you would like the cine loop to play at. Playing cine loops fast will place significant demands on your hardware and, especially if you are playing more than one cine loop at the same time, the actual speed will be determined by what your systems hardware is capable of. Slider for cine speed The Cine tooltab has a slider control so you can easily adjust the speed of cines. Under the slider, RA 600 displays the speed you requested and the actual speed RA 600 is managing to achieve with your system hardware. Selecting a range of images for the cine Unless instructed otherwise, RA 600 will include in the cine all the images in the series that the image in the viewport is part of. You can easily change this, however, so that you only see the particular range of images you are interested in. To do this you can use either the Cine tooltab or, more conveniently perhaps, the cine loop bar which appears at the right side of the viewport when the cine plays. To adjust the range of images in a cine loop either change the numbers in the Maximum and Minimum boxes on the Cine tooltab or click the cine loop bar where you want the loop to begin and end (the blue bar will adjust in length to show what range is currently selected).
To maximize display speed, set the zoom factor to 1x absolute. Setting the annotation level to None also allows a higher frame rate (see Annotating images on page 122). For magnification factors other than 1x absolute, setting the Quality to Pixel Replication on the Zooming Flip/ Rotate tooltab will also help improve display speed.
Using tags to make precise selections of images

Apart from selecting just the range of images you are interested in to include in your cine, you can make precise selections of which images you want to include in or exclude from your cine. You could, for example, exclude particular blank images that have found their way into the series. You tag the images you want to include in your cine. Those that are tagged will be displayed in the cine, those that are not will be skipped by RA 600 when it displays the cine. To tag images for inclusion in your cine click the Tag Images button on the Cine tooltab (or right-click on the cine). Check or uncheck the check boxes to include or exclude images from the cine, or select one or more rows and click the Tag or Untag button. You can tag or untag all the images by clicking the Select All or Deselect All button and then the Tag or Untag button. After you have tagged images, the slider bar will change to indicate that certain images have been excluded from the cine (and which images these are).
If you are tagging a cine of a multi-frame image, the Tag Cine Images dialog box will look somewhat different. You will only see columns for Index Number and Frame Number.
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Manually controlled cine loops (stack-mode displays)

If you have an Intellimouse with mouse wheel, you can use this to control manual cine loops (stack mode displays).
For additional control, you can decide to operate a cine manually. This will result in a manual cine loop, also known as stack-mode display. To create a manual cine loop make the viewport you want to use to display the cine active (click inside it), then click the Manual radio-button on the Cine tooltab. As with automatic cine loops, the cine loop bar appears on the right of the viewport. You can then play the cine by dragging the cine loop bars pointer. You can also adjust the range by clicking on the bar where you want the cine to begin and end.
Using the right mouse button to run cine loops

A quick way to run cine loops is to use the right mouse button menu which appears when you click with the right mouse button inside a viewport. To start or stop a cine using the right mouse button menu click within the viewport with the right mouse button and select Cine and then On, Manual, Off etc. You can also use the right mouse button menu to go from Manual to On and vice versa.
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Synchronizing cine loops

With RA 600, you can have a number of cine loops running at the same time. Initially these will run independently and unsynchronized. You may, however, wish to link them so that they play together in synchronization. RA 600 lets you link cines in this way using the image numbers of the images, the index numbers, the acquisition numbers or the slice locations. Creating a link between cine loops Synchronizing cine loops by linking them is as easy as clicking the appropriate radio button on the Cine tooltab. To create a link between cines create the cines you want to link together in the viewports in the viewing area of your screen. Click the By Image No., By Index No., By Acquisition No. or By Slice Location radio button in the Link Cines section of the Cine tooltab. Or Click with the right mouse button in the viewport of the cine you want to be master (see below) and select Cine Link and then the appropriate link option.
If all the radio buttons in the Link Cines section of the Cine tooltab (or the options on the right mouse button menu) are grayed out (disabled), this probably means that only one cine has been created (create at least one more cine). If just some of the options are grayed out, this will be because RA 600 disables all options which, for whatever reason, are not possible (see Which method should you use? on page 120 for more on this).
Selecting the master cine

When cines are synchronized, one of them will be the master. When you change the speed, range and image index of this master cine, all the others will adjust to keep in synchronization. RA 600 will automatically add blank frames or skip frames in slave cines to ensure that they stay in sync with the master. To select a cine as the master click on the cine you want to be master before selecting any of the Link Cines radio buttons. If you are already playing linked cines, click on the viewport of the cine you want to become master. This viewport will then become the master and the previous master will become a slave.
Starting and linking cines by selecting multiple viewports

If you select all the viewports you want to have cines in, you can start all the cines at the same time and have them automatically linked.
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120 chapter 4 To start and link multiple cines select the viewports you want to start the cines in (hold down the Ctrl key as you click on the viewports or the Shift key to select a range - see Setting the Scope to a selection of viewports on page 91 for details). Right-click on a viewport and select Cine Link and then By Image No., By Index No., By Acquisition No. or By Slice Location.
Linking methods for cines

The (full) range of all cines will be adjusted so that it includes all possible images. To adjust the range of a particular cine, blank images are inserted. Speed is determined by the master cine, which means images in the slave cines will be skipped if these cines cannot keep up with the master cine. No new cines can be started while a current set of cines is linked. Also, you cannot change the link method while cines are already linked. If a master cine is removed, the link between the cines is also removed.
RA 600 provides a number of methods for linking cine loops. This is because it uses DICOM information stored with the images to synchronize them, but this information may not always be usable. Slice location, for example, only applies to CT and MR studies, while neither Image No. or Acquisition No. are mandatory in DICOM, hence may or may not be included with the images in the cines you want to link. Even if they are, there may be other technical reasons why the numbers are not appropriate for linking cines. From the options available, you should be able to find a suitable way of linking your cines (you can always link by frames, see below). RA 600 will perform checks to see what possibilities there are for the cines you may want to link, and disable the radio buttons of the linking methods which are not possible for the cines which are being displayed. Which method should you use? Generally, if the cines are of CT or MR series, it is best to link by slice location. The cines are then linked according to relative positions in the body and thus truly synchronized. If, however, this is not possible, it is recommended that you try linking by image number. You will then see when viewing the cines if there are missing images in any of the cines, and generally the images and synchronization will accurately reflect the actual positions in the patients body. Linking by acquisition numbers (the numbers which reflect the actual order in which images were acquired) is also a possibility. If none of the above methods is possible, you should always be able to link by index number since cines are then essentially synchronized according to their position as shown in RA 600 Pictorial Index. Any inherent offsets and missing images in the original series will not, however, be apparent if you choose this method.
If when you attempt to link using a particular method the radio button immediately jumps back to its unselected state, this means that, although this method passed RA 600 initial tests, RA 600 was still unable to create a link for some reason. Please try another method.
Changing the offset of linked cines

When cines are linked, they will typically play so that the first image in one viewport appears at the same time as the first image in another viewport. You can, however, change the offset (or phase) between the cines so that, for example, image 6 of one cine is visible when image 1 of the master cine is visible.
121 To change the offset between linked cines 1 Make sure the cines are in manual mode and there is no link between them (break a link between the cines by clicking the Off radio button in the Link Cine section of the Cine tooltab). Drag the sliders in the cine viewports to align the images you wish to coincide when the cines are playing. Establish the link between the cines by clicking the appropriate radio button in the Link Cines section of the Cine tooltab. Click the On radio button in the Cine section of the tooltab if you want the cines to play automatically.
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Annotating images
Cutlines are another form of annotation which can be shown, saved and printed. See Displaying cutlines on page 163 for details.
With RA 600 you can add all kinds of annotation to images to indicate points of interest, for example. Such annotation is created on top of the image you are annotating, hence the original image data is not affected. All your annotation - such as text, markers, measurement tools and ROIs - will remain in the same relative position on the image even if you pan or zoom. Once annotation has been created, it can be displayed or hidden, saved with the study or deleted. To create annotations, use the Annotation and Measurement tooltab (with the ruler icon) while in the Viewing Section.
Patient annotation
If lossy compression has been used, a non-erasable message stating the compression method and ratio is displayed in every image.
In addition to annotations you create yourself, RA 600 will automatically display essential patient information with every image in the viewports. This is derived from the DICOM 3.0 data file or was entered via the keyboard during acquisition. The layout and contents of the annotation can be configured or adjusted for each modality by the system administrator or your distributor. Typically the patients name, date of birth, patient number, nature of the study and image number are shown. The displayed information cannot be altered, but you can reduce or even completely hide it while viewing your images in the viewports. To change the patient information displayed in the viewports click the Annotation and Measurement tooltab (with the ruler icon). Click the None, Basic or Full radio button in the Annotation Level section of the tooltab.
The None option which removes all annotation allows you to view images without names on them. In some countries it is however forbidden to make diagnoses using images without this information.
Adding markers
You can place one or more arrows (markers) on an image to point out details of interest. To add a marker click Marker on the Annotation and Measurement tooltab and then on the location in the viewport where you want to add the marker. A colored arrow appears with a cursor that allows you to enter accompanying text next to the arrow.
123 To change a marker double-click on the text to edit it. Change the length and direction of the arrow by dragging its tip or tail with the mouse. Click on the center of the arrow and drag or move it around without altering its direction (if you have also entered text, this will automatically follow the arrow movement). Click with the right mouse button on either the text or arrow and select from options to change the color, line style, font, or text.
Annotating with text

You can add text to an image and edit in a similar way to adding markers. To add annotation text click Text on the Annotation and Measurement tooltab and then on the location in the viewport where you want to add the text. Then type your text. To change annotation text double-click on the text to edit it. Click with the right mouse button on the text and select from the available options to change the color or font size.
Keeping your annotations appearance settings

You can set the color, font and line-style of each item of annotation (or measurement) individually by right-clicking on it and selecting Color, Font... and Line Style (if the annotation includes lines). You may, however, wish to change to a particular font, for example, and then use the font for all future annotations. This will save you having to change individual annotations to your preferred style. You can save your settings, either just for annotations of the same type or for all future annotations of all types. To save your annotation appearance settings right-click on an annotation and set the color, font and line style if appropriate until you are satisfied with its appearance. Then right-click again and select Keep Settings For all or Keep Settings For (the type of annotation you clicked on).
Cutting, copying and removing annotation

You can cut or copy and paste your annotation between viewports - see Moving and copying annotations between viewports on page 133 for details. You can also delete all annotations and measurements either by selecting Delete on the right mouse button menu or by clicking on them and dragging them outside the viewport.
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Saving your annotation

If you have added annotations to a study, RA 600 will ask you whether you wish to save them with the study when you return to the Data Selector. If you wish to keep your annotations, make sure you check the Presentation States check box in the Save Data dialog box and complete the Current Presentation State section. See Working with presentation states on page 92 for more information on presentation states.
Showing and hiding your annotation

You can have RA 600 display or hide the annotations you have made by checking or unchecking the Image Annotation check box on the Annotation and Measurement tooltab.
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Pre-defined text annotations

If you are frequently involved in annotating similar images with similar annotations, RA 600 allows pre-defined text annotations to be defined which you can then assign to shortcuts. All you then need to do to add a specific item of annotation is to place the mouse pointer where you want the annotation to appear and press the shortcut. One example of this is the labelling of Cervical Spines and Lumbar Spines. After defining the function keys as shortcuts, all the radiologist has to do is place the mouse cursor between each vertebra and press the appropriate shortcut key to add the labels C1/2, C2/3, etc. Pre-defined text annotations can also be included using the right mouse button menu that appears when you right-click in a viewport, so it is not necessary to define keyboard shortcuts for them. Setting up pre-defined text annotations You can include whatever text you like in your list of pre-defined text annotations. To create or change your list, select Configuration Viewing... and enter the list (each new entry on a separate line) in the Predefined Text Annotations field on the Image Annotations tab of the Viewing Properties dialog box. To create separators to define separate groups enter at least two minus signs on a new line where you want the separator to appear. Click the Help button for further details. To add pre-defined text annotation to an image right-click in the viewport and select Add Predefined Text from the right mouse button menu. The submenu that appears lists all annotations that have been predefined on your system. After selecting an annotation, click the left mouse button where you want it to appear. To further speed the addition of the annotation, create a shortcut for the right mouse button menu option - see Creating keyboard shortcuts on page 299 for details.
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Showing and hiding image overlays

These are not the same as the image overlays you can create in RA 600 (see Creating and using masks and overlays on page 136).
You may have images that have overlays associated with them. These can be thought of as transparent sheets that can be placed over the image and typically show information such as cutlines or annotations. RA 600 lets you view such overlays if your images have them. To show image overlay information right-click on an image that has an image overlay associated with it and select Annotation Show Image Overlay from the right mouse button menu. Repeat these steps to hide the overlay.
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Making measurements on your images

While viewing images, you have powerful tools available on the Annotation and Measurement tooltab (with the ruler icon) for making measurements on your images. You can measure values at any point in an image using a probe, measure distances and angles, view and compare profiles of pixel distribution and create regions of interest (ROIs) on which you can view statistics.
Using probes
Probes allow you to measure point values within a viewport. To use a probe click the Probe button on the Annotation and Measurement tooltab. Then click on the location within the viewport where you want the probe to go. A colored probe appears with the numeric pixel value next to it. Drag the probe to move it to its precise location. If the modality is CT, the value shown is in Hounsfield Units. If you right-click on a probe you can change the color and font of the probe (or delete it) using the right mouse button menu.
Working with calipers

You can use a caliper to get a rough idea about the size of an object in an image, or the distance between two points. When displayed, the caliper appears to the right and in the middle of your viewport. The calipers scaled units change as you zoom in on or away from an image. To enable caliper display for a modality automatically 1 2 3 Select Configuration bar. Viewing... from the Data Selector menu
In the Viewing Properties dialog box click the Viewport Annotations tab. In the Layout section of the tab, select a modality from the Modality Type drop-down list. (The Default setting applies to modalities not defined in the Modality Type drop-down list.) Make sure you select the appropriate Annotation Level radio button to which you want the caliper to apply. Select Basic if you want the caliper to appear with a partial annotation set, or Full if you want it to appear with a complete annotation set. Select the Show caliper check box at the bottom of the Layout section.
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128 chapter 4 6 Click OK and open a study of the chosen modality for viewing.
To manually display a caliper in the Viewing Section 1 2 Click the Annotation and Measurement tab in the Viewing Section. In the Annotation Level section, make sure either the Basic or Full radio button has been selected. (If the None option has been selected, RA 600 will gray out the Show Caliper check box, making the caliper unavailable.) Click the Show Caliper check box.
There are also alternative ways of displaying a caliper. Right-click on a viewport and select Annotation from the right mouse button menu that appears. Create a shortcut to display the caliper (Tools Shortcut keys) Select Image Annotation Section menu bar. Show Caliper Customize
Show Caliper from the Viewing
Measuring distances
You can measure distances very accurately using RA 600.
In accordance with the DICOM standard, distances are measured in millimeters for CT and MR studies and for some CR images. CR images sometimes have explicit or implicit pixel size information. If at all possible, RA 600 will use this information to calculate and display distances in millimeters or inches rather than units.
To measure a distance click the Distance button on the Annotation and Measurement tooltab. Then click on the location within the viewport from which you want to measure. Then click the point where you want to measure to. To adjust the positions of the start and end points, click and drag on them. Zoom if necessary for very fine adjustment. (You can also move the whole line by clicking on its center and dragging.) Setting your units of measurement You can select whether you wish RA 600 to display measurements in inches or in millimeters. You can do this using the Windows Control Panel, or you can overrule the Control panel and specify within RA 600 which system should be used.
129 To change the units of measurement using the Windows Control Panel doubleclick Regional Options in the Windows Control Panel. Click the Numbers tab and select U.S. or Metric from the Measurement System drop-down list. Then click OK. In the Data Selector, select Configuration Generic... from the menu bar. On the System tab, make sure REGIONAL SETTINGS is selected from the System Measurement drop-down list. To override the Control panel and set the units of measurement within RA 600 in the Data Selector, select Configuration Generic... from the menu bar. On the System tab, select either US or METRIC from the System Measurement drop-down list. If the units of measurement are changed while a study is open, the change will come into effect the next time you create or modify a measurement. Configuring distance units for measurement lines You can set the minimum pixel distance between two units of distance on a measurement line. To configure the distance units of a measurement line 1 2 3 4 5 Select Configuration bar. Viewing... from the Data Selector menu
If you have secondary capture images (SC), from a film digitizer for example, your distances will be in units i.e. the number of pixels along the line. However, if there is a caliper on the image, you can right-click on the measurement and use the right mouse button menu to calibrate. This will allow you to measure in millimeters or inches.
In the Viewing Properties dialog box, select the Image Annotations tab. Check the Show check box in the Tickmarks section if you want to adjust the default distance units of the caliper. In the Min. Pixels per Tick list, enter the minimum number of pixels you want to display between two distance units on the caliper. Click the Default Value button if you want to use the standard RA 600 pixel value (10).
Viewing profiles
With RA 600, you can also view profiles. A profile is a graph of pixel value distribution along a given line. To create a profile click the Profile button on the Annotation and Measurement tooltab. Move the mouse over the viewport. Next to the mouse pointer you will see a small green graph symbol. Now draw by clicking on the starting point and dragging the line in the desired direction. As soon as you do this the Profile graph appears.
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130 chapter 4 You can modify the graph by stretching the line or changing its direction. If the graph window obscures a part of the viewport you would like to see, move it to a different location by clicking on its title bar and dragging. To remove the profile window click on the close button in the top right hand corner of the Profile window. To make the Profile window reappear, click on the line again. Comparing multiple profiles by pinning You can pin profile windows by clicking their Pin buttons (in the top left corner of the window). This allows you to create and compare multiple profiles. Clicking a second time on the Pin button releases the profile.
Measuring angles
You can also measure angles in much the same way as distances.
COBB measurements are particularly useful for small angles and when the intersection point is outside the image area.
To measure an angle click the Angle button or COBB button on the Annotation and Measurement tooltab, then click in the viewport. You can resize angles and drag them around. Angle and COBB measurements are in degrees.
Creating regions of interest (ROIs)

The Region of Interest (ROI) section of the Annotation and Measurement tooltab lets you create ROIs and view statistical information on the image data they contain. To create an ROI click one of the buttons in the ROIs section of the Annotation and Measurement tooltab. By clicking the Box button or Ellipse button you can create rectangular or elliptical ROIs in your viewport. They can be resized and moved by dragging with the mouse on their edges and centers. By clicking the Draw button you can define your own irregular ROI by drawing free-hand in the desired viewport. Keep your left mouse button down while drawing. As soon as you release the mouse button the figure will automatically close by connecting the two ends. You cannot edit a free-hand ROI, although you can drag it around.
This is not the same function as the ROI button on the Windowing tooltab.
131 Click the Polygon button and then in the viewport to create a multiple-sided ROI. Keep your left mouse button pressed while drawing a straight line. At the point where you want an angle to appear, release your mouse button and click it again. Now draw a second line in a different direction. Repeat the process as many times as you like to create a polygon. To close the ROI, either click once with the right mouse button or double-click with the left mouse button. The two ends will be connected. You can edit a polygon ROI by dragging its angles or by clicking inside it.
Viewing ROI information

As soon as you create an ROI, an ROI Statistics window will automatically open. This provides various information on the ROI. To remove the ROI window click the close button in the top right hand corner of the window. To make it reappear, click on the ROI again. Viewing information on multiple ROIs As with profiles, you can view and compare multiple ROI Statistics windows by pinning them. To pin an ROI Statistics window, click its Pin button (in the top left corner of the window). Clicking a second time on the pin button releases the Statistics window.
Exporting ROI information

As well as viewing ROI details on screen, you can also export this information, as well as the actual pixel values, for future reference or use in another program. This means, for example that you can create a graph of ROI values in Excel. To export ROI information click with the right mouse button inside the ROI. Select Export Info from the right mouse button menu. In the Export ROI Statistics dialog box, check the check boxes of the information you want to save. Then select an export destination file (or select export to the clipboard using the radio button). Finally, select whether you want to export in standard text file format (optionally specifying a separator) or in a standard easy to read format. If you want to keep the same selections for the next time you want to export ROI information, make sure the Keep settings check box is checked.
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Saving your measurements

As with annotations, you will be asked if you want to save your measurements with the study when you return to the Data Selector. If you wish to save them, make sure the Presentation States check box is checked and complete the Current Presentation State section of the Save Data dialog box. See Working with presentation states on page 92 for more information on presentation states.
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Moving and copying annotations between viewports

Although you will create annotations and make measurements inside a single viewport, there is nothing stopping you from copying them to other viewports, even sharing them across all the images in a series or study. In RA 600 you copy and paste your annotations in much the same way as in Windows.
Copying annotation
To prevent annotations ending up directly on top of each other and hence completely hidden from view, RA 600 does not paste annotations in exactly the same place, but displaced by two pixels from the original location. When copying annotations to a whole series or study, you should be sure this is really what you want to do. To avoid the possibility of inadvertent loss of annotations, RA 600 does not provide an easy way to remove all the annotation you add using copy and paste.
To copy annotation from one viewport to another right-click on the annotation and select Copy from the right mouse button menu. Move the mouse to the other viewport and right-click again. Select Paste Paste from the right mouse button menu. A copy of your annotation will appear in (almost) the same relative location in the second viewport. This means that you could, for example, create a probe or an ROI in one viewport and copy this to (almost) the same location in the image in the other viewport and then compare probe or ROI values between the viewports. You can even copy annotation to all the images in the series you are working on, or indeed all the images in the study if this contains multiple series. To copy annotation to all the images in a series or study right-click on the annotation and select Copy from the right mouse button menu. Move the mouse to the other viewport and right-click again. Select Paste Paste to All Images in Series or Paste to All Images in Study from the right mouse button menu. You can even copy all the annotation you have placed in a viewport with a single click of the mouse. To copy all the annotation in a viewport right-click on the viewport and select Annotation Copy All from the right mouse button menu. Then right-click in the viewport you want to copy it to and select Paste Paste.
Moving annotation
Instead of copying annotation, you may wish to move it from one viewport to another. You do this in exactly the same way as copying annotation, except you select Cut or Cut All rather than Copy or Copy All from the right mouse button menu. You can also paste the annotations you have cut in this way in all the viewports in a series or study.
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Using labels to ease reporting

Apart from using labels, you can create your own special text annotations and include these using keyboard shortcuts - see Pre-defined text annotations on page 125.
When you are producing reports, you may often wish to refer to your annotation. RA 600 makes this easy for you by automatically creating labels for your annotations and measurements. These labels are unique to the study you are working on and can be saved along with your study and report. They can readily be viewed (or hidden) at any time. To show (or hide) your annotation labels check (or uncheck) the Show Labels check box at the bottom of the Annotation and Measurement tooltab. Each item of annotation or measurement is given a unique label based on the order in which it is created. To further aid recognition, labels can be given prefixes to indicate what type of annotation or measurement they refer to. You could, for example, then have labels such as ROI3, Probe7, COBB4 etc. To set prefixes for the labels you create select Configuration Viewing... from the Data Selector menu bar. On the Image Annotations tab of the Viewing Properties dialog box, make sure the Add Prefix check box in the Label Creation section is checked and enter suitable prefixes in the fields provided.
RA 600 will only create labels for annotation you add after you have set it up to create labels. It will not add labels to annotation you created previously or annotation by another user, since the report might already refer to these labels.
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Including user information

User information (and labels) are created and stored by RadWorks version 5.0 (the former name of RA 600) and later. If you use a previous version of RA 600 (RadWorks, therefore) you will not be able to store user information or labels, nor will you be able to view labels and user information created on a version 5.0 or later RA 600 system.
In many cases it may be important to know who added particular annotation and when. RA 600 allows a record of such information to be automatically added to and stored with the study. This information, created and kept for each item of annotation, can be readily viewed at any time. You can include any or all of the following: Who created the annotation (based on the Windows user name). The date and time the annotation was created. Who last modified the annotation. The date and time the annotation was last modified.
To include user information with your annotation select Configuration Viewing... from the Data Selector menu bar. On the Image Annotations tab of the Viewing Properties dialog box, make sure the appropriate check boxes are checked in the Show User Info section. To show (or hide) the user information check (or uncheck) the Show User Info check box at the bottom of the Annotation and Measurement tooltab. You can also show or hide the user information using the check box in the Additional Information section on the Image Annotations tab of the Viewing Properties dialog box.
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Creating and using masks and overlays

To make it easier to see certain details, you can create masks, or shutters, that block out all but a certain part of an image. You can also show certain areas of an image with inverted window levels. And you can even superimpose a second image on part of an image. You can readily create these masks and overlays using the Mask tooltab, with the icon. In all cases, you first select the type of mask or overlay you want to create. To create a mask or overlay select the type of mask or overlay you want to create from the drop-down list at the top of the Mask tooltab. Make sure the Show or Activate radio button in the State section of the tooltab is selected and then select a shape for the mask/overlay area by clicking the Box, Ellipse, Draw or Polygon button (You can also right-click on a viewport and select Masks and then either Shutter, Inverted Window ROI or Image Overlay from the right mouse button menu, and then select Create and Box Mask, Ellipse Mask, Draw Mask or Polygon Mask from the right mouse button menu). Create and adjust the area for the mask/overlay as described in Masks and overlay areas, and how to draw them. For image overlays, you will also need to add and adjust the image you want to overlay - see Adding and adjusting overlay images on page 138.
You can have only one mask or overlay in a viewport at any one time, so if you want to add a mask or an overlay to a viewport that already has one, you will have to remove the old one first. To do this, rightclick on the mask or overlay and select Delete from the right mouse button menu. (You can also simply drag the mask or overlay outside the viewport.)
Masks and overlay areas, and how to draw them

After selecting the type of mask or overlay and the type of area you want to draw on the Mask tooltab, move the mouse over the viewport and start drawing the area for the mask or overlay. Dont worry about getting it absolutely right the first time. You can readily move, resize and reshape your areas after you have created them. Use the Box and Ellipse buttons to create rectangular or elliptical areas in your viewport. Place the mouse cursor over the viewport after selecting the area type. A rectangle or ellipse should appear next to the mouse pointer to indicate that RA 600 is ready to draw the mask or overlay area. Hold down the left mouse button and drag to create the box or ellipse. They can be resized and moved by dragging with the mouse on their edges and centers. The Draw button allows you to define your own irregular area by drawing freehand in the desired viewport. Keep your left mouse button down while drawing. As soon as you release the mouse button the figure will automatically close by connecting the two ends. You cannot edit a freehand area, although you can drag it around.
137 The Polygon button lets you create a multiple-sided area. Keep your left mouse button pressed while drawing a straight line. At the point where you want an angle to appear, release your mouse button and click it again. Now draw a second line in a different direction. Repeat the process as many times as you like to create a polygon. To close the mask, either click once with the right mouse button or double-click with the left mouse button. The two ends will be connected. You can edit a polygon mask by dragging its angles or by clicking inside it. If you are adding an image overlay, you will need to add the image to be overlaid when you have finished creating the overlay area. See Adding and adjusting overlay images on page 138.
Showing, hiding and removing masks and overlays

You can configure which mask state and mask type is initially selected when you enter the Viewing Section. To do this, select ConfiguraViewing... from the Data tion Selector menu bar and choose the appropriate values from the dropdown lists in the Initial Settings section on the General tab of the Viewing Properties dialog box.
You can show and hide your masks and overlays using the radio buttons in the State section of the Mask tooltab. To make a mask or overlay visible click the Activate radio button. click the None radio button.
To hide (temporarily remove) a mask or overlay
The Show button In addition to the Activate and None radio buttons, there is also a Show radio button on the Mask tooltab. This lets you show the outline of the mask or overlay area, but without the actual mask or overlay being actively displayed. This is particularly useful when moving and resizing mask and overlay areas. For example, if you select Show rather than Activate before drawing a shutter, you will see outline of the shutter area but will still be able to see the rest of the image in the viewport, making it easier to position the mask exactly where you want it. When you have finished creating your shutter, click the Activate radio button to make only the image inside the viewport visible. To remove (delete) a mask or overlay right-click on it and select Delete from the right mouse button menu, or simply drag the mask or overlay outside the viewport.
Copying and pasting masks and overlays

Once you have created a mask or overlay, you can copy it to other viewports To copy a mask or overlay from one viewport to another right-click on the mask or overlay and select Copy from the right mouse button menu. Move the mouse to the other viewport and right-click again. Select Paste Paste from the right mouse button menu.
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138 chapter 4 A copy of your mask or overlay will appear in (almost) the same relative location in the second viewport. You can even copy masks and overlays to all the images in the series you are working on, or indeed all the images in the study if this contains multiple series. To copy annotation to all the images in a series or study right-click on the mask or overlay and select Copy from the right mouse button menu. Move the mouse to another viewport and right-click again. Select Paste Paste to All Images in Series or Paste to All Images in Study from the right mouse button menu.
Moving masks and overlays between viewports

Instead of copying a mask or overlay, you may wish to move it from one viewport to another. You do this in exactly the same way as for copying, except you select Cut rather than Copy from the right mouse button menu. You can also paste the mask or overlay you have cut in this way in all the images in a series or study. If you ask RA 600 to copy your mask or overlay to all the images in a study or series, but one or more of these images already has a mask or overlay, RA 600 will not replace the existing mask or overlay. Instead, RA 600 will ask whether you want to continue with copying the mask or overlay to the remaining images. If you do not click the Yes button when prompted, your mask or overlay will not be copied to any of the images.
Saving masks
It is not possible to save image overlays. When overlaying images, the bits allocated must be the same for both images. You will not be able to overlay an image with a different bit allocation.
You can save your shutters and inverted window ROIs with a study for later viewing. To save shutters and inverted window ROIs for later viewing make sure the Presentation States check box is checked in the Save Data dialog box and the Current Presentation State section has been completed when you stop viewing the study.
Adding and adjusting overlay images

Once you have added an image overlay area, you will need to insert an image inside this area to act as the overlay. To add an image to an overlay area right-click inside the image overlay area and select Insert Image from the right mouse button menu. Then select the image you want to insert from the Insert Image dialog box that appears.
139 You can insert any image from any study visible in the Pictorial Index. Adjusting your overlay images To let you create the best possible view for comparing the image in the viewport with the overlay image, you can adjust the image inside an image overlay in a number of ways. To pan the overlay image click and drag inside the overlay area.
Because clicking and dragging in the image overlay pans the image in the overlay you cannot, unlike shutters and inverted window ROIs, click and drag to move the overlay around in the viewport. To do this, you can only click and drag near the edge of the overlay area. Clicking and dragging on the actual edge of the overlay area will resize the area.
To resize (zoom) the overlay image click and drag the Zoom slider in the Image Overlay section on the Mask tooltab. You can also independently window the overlay - see Windowing overlays on page 139 for details.
Windowing overlays
You can window the image inside an overlay by right-clicking inside the overlay and dragging, in just the same way as when normally windowing in viewports. Moving the mouse to left and right adjusts width, moving it up and down adjusts center. When you window inside an overlay in this way, the remainder of the viewport will always remain unaffected. You can, however, choose to synchronize windowing so that any changes you make to the windowing in the viewport will also affect the overlay image. To do this, make sure the Synchronize Windowing check box in the Image Overlay section on the Mask tooltab is checked. If this box is unchecked, any changes you make to windowing in the viewport will not affect the overlay.
Changing the transparency of an overlay image

To make it easier to compare features on an overlay image with the underlying viewport image, RA 600 lets you make the overlay image partially transparent. To change the transparency of the overlay image Image Overlay section on the Mask tooltab. drag the Blend slider in the
You can place the slider somewhere in the middle to view both images at the same time or, by rapidly moving the slider from one end to the other, switch between the two images.
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Synchronizing overlay image quality

When RA 600 displays images at anything other than their original size, it has to generate new pixels (interpolate) to fill in the gaps in the resized image. Normally RA 600 uses bi-linear interpolation since it typically provides a smoother and more natural image. It can, however, also use pixel replication, which renders the originally captured image more faithfully and can have performance benefits. The type of image quality to be used can also be specified in the information in the DICOM header. And you can change the interpolation method on the Zooming and Flip/Rotate tooltab (with the magnifying glass icon). If the overlay image is from a different series or study to the image displayed in the viewport, it may therefore be displayed using a different interpolation method. You can decide whether the same method should be used for both images or RA 600 should display the overlay image using the interpolation method it would use to display the image normally. If you want RA 600 to use the same interpolation method (image quality) for the overlay image as for the viewport image, make sure the Synchronize Quality check box in the Image Overlay section of the Mask tooltab is checked. The overlay image will then be displayed using the same interpolation method as is used to display the viewport image. If the Synchronize Quality check box is unchecked, the interpolation method used for the overlay image will not change even if the interpolation method for the viewport image is changed.
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Using plug-ins
Plug-ins can be used to change, enhance or extend the operation of RA 600. You can install DICOM-based plug-ins to work with RA 600 if you want it to display images differently than it otherwise would. The plug-ins operate at series level and, when running, RA 600 supports them with tooltabs, menus and hanging protocols. Once you have installed a plug-in, you can use the RA 600 interface to configure it (RA 600 does not come with a standard plug-in). For detailed configuration information, see the RA 600 Installation and Configuration Guide. To view images with a plug in 1 Open a study from the Data Selector. In the Viewing Section, click on the Layout tooltab (with the Swiss Army knife icon) to view the list of available plug-ins. Select a viewport in the series area that you want to use for the plugin. In the Select Plug-in Definition section of the Layout tooltab, double-click the plug-in and view the results in the selected viewports. If necessary, click another plug-in to view the images in yet a different way or select a new series area and repeat this step using the plug-in of your choice. Select RA 600 Series Area from the Select Plug-in Definition section of the Layout tooltab to turn off the plug-in and return the image to its original view before the plug-in was activated.
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The plug-in is automatically integrated into the RA 600 interface. This means, for example, that you can use the Up and Down buttons to scroll through images and select images in the Pictorial Index for display in the viewport. When the plug-in is active, an extra tooltab appears in the Viewing Section. The tooltab contains features which enable a user to work with the plug-in; e.g., options to change the colors or font of text. It is also possible to open an additional plug-in in another series area of the Viewing Section.
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142 chapter 4 Hanging protocol integration You can assign one or more hanging protocols to a particular plug-in so that you can quickly and easily view images in a very specific way. This keeps you from having to define a hanging protocol each time you want to view images with a particular plug-in. To define a hanging protocol for a plug-in 1 2 3 4 5 6 7 Select Viewing Manage Hanging Protocols... from the menu bar in the Data Selector. Click the New... button in the Hanging Protocols Manager (Viewing) dialog box. In the Hanging Protocol Editor (Viewing), specify a name for the hanging protocol in the Name field. Make sure the Series radio button has been selected in the Edit mode section. In the Layout section of the dialog box, click the button that corresponds to the hanging protocol you want to assign to the plug-in. Select the plug-in from the drop-down list in the Series and Image Properties section. Click OK in the Hanging Protocol Editor (Viewing) dialog box and then in the Hanging Protocols Manager (Viewing) dialog box to save your work.
In the Data Selector and the Viewing Section, plug-in hanging protocols are displayed in the Viewing and Layout tooltabs, respectively. If a hanging protocol is marked with diagonal lines, it is associated with a plug-in. If you place your cursor over such a hanging protocol, RA 600 will display in a tool tip the name of the plug-in to which the hanging protocol belongs. You can apply the hanging protocol and its plug-in by selecting a study and clicking on the hanging protocol.
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Structured reports
RA 600 allows you to create structured reports which you can send, query on, modify and receive etc. Treated as a separate item from the images with which it is associated, a report can be sent on its own over the network so you can view, amend and save it without needing to receive and send the images as well. This can greatly reduce network traffic. You can write reports while in the Viewing Section or in the Data Selector. The reports you see will depend on their configuration.
Viewing the Reports window

You view and produce reports using the Reports window. You open this window somewhat differently depending on whether you are in the Data Selector or actually viewing images. To view the Reports window in the Data Selector right-click on the study you want to view the report of (or create a new report for). In the right mouse button menu, select Show Report(s). To view the Reports window when viewing images check the Show Reports check box on the Layout tooltab (with the Swiss Army knife icon). The Reports window will now be visible on the screen. In the Viewing Section this will typically be located at the foot of the screen, although you can (just as with the Pictorial Index and tooltabs) drag it around and dock it at some other location. If you are viewing multiple studies or series, you will see tabs at the bottom of the Reports window which you can click on to select the report you want to view. If you select a viewport in a study different to that for which the report is currently being displayed, RA 600 will automatically bring the report for this other series or study to the top. You can use the Reports drop-down list at the top left hand corner of the report page to view the different reports that have been created. If different reports have been created, you will see the most recent report to the right of the previous reports.
Creating a report
To create or modify a structured report 1 In the Data Selector, right-click the relevant study and select Show Report(s)... from the right mouse button menu.
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144 chapter 4 2 3 Draw up your report in the report window. Click Close and then click Yes in the Save Report dialog box to save your report.
Other buttons in the report window The report window has additional buttons to help you manage reports. Click the View Study button to open the images with which the report is associated. The Print button allows you to make a print out of the report. The Previous and Next buttons enable you to scroll to the following or preceding reports of the next or previous studies in the Data Selector.
You might want to configure RA 600 so that it displays the SR entry in your Data Selector with a certain font or color so you can easily recognize it.
Once you have created a structured report, you can see it noted as SR in the Data Selector when you expand the study with which the report is associated to series level.
Some additional facts about structured reports

When you amend a structured report, RA 600 can make a copy of the original and store it with the study, if the proper configurations have been made under Configuration Reporting.... RA 600 will then show two SR entries in the Data Selector, distinguished by the Date/Time tags associated with the reports. Structured Reports can be read in earlier versions of RA 600 if the RadWorks 5.1 Format check box has been checked in the Add Destination dialog box or on the Transmission Paramaters tab of the Destination Properties dialog box.
Consult the context-sensitive Help, the RA 600 Installation and Configuration Guide or your system administrator for more details on either of these two topics. In RA 600 6.0, reports created with earlier versions of RA 600 (RadWorks, therefore) are rendered in a simpler form than reports created with RA 600 V6.1. So, for instance, a report initially created in RadWorks 5.1 will appear as a single text field that contains the reports contents.
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Configuring structured reports

Reporting in RA 600 is intended to adapt flexibly to and closely integrate with other systems in the hospital such as a HIS or RIS. How your Reports window should be configured will typically depend on the procedures and other systems in your organization. This section is intended only to present some of the options available in RA 600 and to sketch how it can be configured in various situations. More specific information is available in the on-line Help. To configure your reports window the Data Selector menu bar. select Configuration Reporting from
The Reports Configuration dialog box with three tabs will appear. All the settings for governing the Reports window are made using this dialog box.
Setting where and how the reports window is displayed

On the General Reporting Properties tab of the Reports Configuration dialog box, you can specify an identification for a study report in the form of a DICOM tag. When RA 600 is first installed this is set as the patient name but you can change it if desired (a full list of DICOM tags is provided in the Installation and Configuration Guide). This identification appears in the title bar of Reports windows and on the tabs which appear when studies from multiple patients are open. The Reports window can be completely removed from the Data Selector and/ or Viewing Section. To do this, select Disabled from the Reports in Viewing Section and/or Reports in Data Selector drop-down lists. You check the Report storage in local database check box if you want reports to be stored in the local database. You will be able to write and save one report for each study. Another limitation is that you can only save a single study result. The size of the report may not exceed 10 kilobytes. RA 600 will warn you this limit is reached. Once a report has been authorized, it cannot be edited nor can an amendment be created.
Reporting profiles
On the Reporting Profiles tab of the Reporting Configuration dialog box, RA 600 lets you set up a number of reporting profiles which you can then use to display the Reports window in a particular way.
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146 chapter 4 All the profiles configured on the system are shown on the Reporting Profiles tab. Click on a profile to select it. You can view the details of this profile at the foot of the tab. Click New or Modify to create or change a profile. To help save time when creating new reporting profiles, use the Copy button to copy the parameters of an existing profile. You can then modify the configuration and, so, create a new reporting profile. You remove a reporting profile by selecting it with your cursor and clicking the Delete button.
Assigning reporting profiles to study statuses

Since you may want different Reports windows depending on the stage reporting has reached (effectively the study status), RA 600 lets you assign the reporting profiles that have been created to different study statuses. This means that when you open the Reports window of a study, the profile that is used to display the window will depend on the status of that study. You could, therefore, create a special reporting profile for studies with status Authorized that contains read-only fields to allow the report to be viewed but not changed. You assign profiles to statuses using the Reporting Study Status Mapping tab of the Reports Configuration dialog box. To change the profile assigned to a status, simply click on the status to select it, then click the Modify button, and select a profile from the drop-down list. If you do not assign reporting profiles to a status, RA 600 displays the report with the Default profile.
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Exporting and printing single images

When you copy the screen to the clipboard, the image is still of the same quality as the original image. However, if the image file is then pasted into another application (such as Microsofts Power Point), there might be a significant loss in image quality, so you should use it for illustrative purposes only. If you transfer the image file to computers with inferior graphical display capabilities, you might also notice a loss in image quality.
While viewing images in RA 600, you can readily export them for use in other applications.
Copying to the clipboard

Perhaps the quickest way to do this is to copy the entire screen and put it into the memory of the computer (the Windows clipboard). If you do this, you can paste the images into other applications such as word processing or presentation software. You should be aware, however, that for higher resolutions a whole screen will create a file of a considerable size. To copy the whole screen to the Windows clipboard press the Ctrl key and, keeping it down, press the Print Screen key on your keyboard. You can also copy the image in a single viewport into another application using the clipboard. To copy a single viewport image to the Windows clipboard right-click in the viewport containing the image you want to copy. Select Copy to clipboard from the right mouse button menu. The image and its annotation in that particular viewport are copied to the clipboard. You can now paste the contents of the clipboard into another Windows application such as a word processor or a presentation package using the Paste command in that application.
Although printing on Windows printers can be useful in various situations, laser or even dye sublimation printing does not offer a print quality comparable compared to that of laser imagers. For far more comprehensive printing capabilities, you should use the Print tooltab in the Data Selector (to print studies or series) or in the Viewing Section (to print selections of images).
TIFF export
You can also export images for use in other applications as TIFF files. To export a viewport image as a TIFF file click with the right mouse button in the viewport of the image you want to export. Select Export TIFF from the right mouse button menu. Specify a file name and location for the file to be saved.
Printing single images

You can also print an image using the right mouse button menu.
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148 chapter 4 To print a single viewport image right-click in the viewport containing the image you want to print and select Print Image from the right mouse button menu. To print a single viewport right-click in the viewport and select Print port from the right mouse button menu. View-
For more on printing while viewing images, including using virtual film sheets see Printing using virtual film sheets on page 257.
The full contents of the viewport, including annotations, and windowing changes you have made, etc., will be sent to the printer that you selected (for example using the Destination drop-down list on the Print tooltab in the Viewing Section) in a one-up format.
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Presentation sheets
Part of the daily routine in many hospitals is to have morning rounds to discuss clinical cases. During these rounds, only the most important images from a study are presented and discussed, summarizing the study for the participants. RA 600 supports presentation sheets that allow you to place all relevant images from multiple studies on one sheet for presentation purposes. More specifically, it allows you to print a composed sheet to a presentation sheet printer. These virtual sheets are then converted into a new study that becomes available in the Data Selector. You can then select these and previous studies for display (when available on the local database). To create a presentation sheet
Setting up printers is typically a task for system administrators. For detailed information on setting up Presentation Sheet printers, see the RA 600 Installation and Configuration Guide.
View the study or studies you want to use for your presentation sheet (select the item or items in the Data Selector, right-click on one the items and select View from the right mouse button menu). In the Viewing Section, click the tab with the printer the Print tooltab. icon to reveal
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From the Destinations drop-down list, select the printer destination that is specifically set up for presentation sheets; e.g., Presentation Sheets. From the Layouts section, select the appropriate hanging protocol you want to use. In the Viewport, double-click on the images you want to use in the presentation sheets. This will insert them into the virtual sheet in the Compose Print Job dialog box. Click the Submit... button in the Job section of the Compose Print Job dialog box. Click OK in the Print Study to... dialog box. Click the Close button in the Compose Print Job dialog box to exit. Exit the Viewing Section, saving your data appropriately.
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This feature is really intended for creating presentation sheets of the same patient. If a presentation sheet is created from different patients and submitted to the printer, the print job will be saved in the Data Selector under the study first selected.
Search for the presentation sheet in the Data Selector. It will be marked as Presentation Sheet in the Data Selector and can be easily seen if the Description or Study Description column (0008, 1030) has been added to the Data Selector. If desired, have your system administrator setup a worklist view for presentation sheets. This will ensure that RA 600 puts your presentation sheets in one place and give you easy access to them - particularly if your Data Selector is filled with many studies.
Presentation sheets can be modified. To modify a presentation sheet 1 2 3 Open the presentation sheet for viewing. Modify it by windowing or annotating etc. Exit the Viewing Section, making sure to save your work.
Presentation sheets can also be removed from the system. To remove a presentation sheet from the database 1 2 3 Select the presentation sheet in the Data Selector Press the Delete key on your keyboard. Confirm by clicking OK.
Alternatively, you can select the presentation sheet in the Data Selector, rightclick on it with your mouse and select Delete from the right mouse button menu.
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Changing the status of your studies

Depending on how RA 600 is configured, every time you leave the Viewing Section, a Save Data dialog box might ask you whether you wish to save the changes you have made. In this dialog box, you can also set the status of the study you have been viewing. To set the status of a study after viewing it when leaving the Viewing Section (after clicking the BACK button for example), select a status from the Update Study Status drop-down list in the Save Data dialog box. You do not necessarily have to view studies in the Viewing Section to change their status. To set the status of a study while in the Data Selector right-click on the study you want to change the status of and select Set Study Status ID and then the status you want from the right mouse button menu. You can also change the status of a study while reporting on it in the Data Selector. To set the status of a study while reporting in the Data Selector select a status from the list in the top right hand corner of the Reports window.
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Configuring study statuses

With RA 600 it is possible to configure additional study statuses and give them whatever name you like. This makes it readily adaptable to the procedures in any organization. Since study statuses are generally closely linked to the workflow in an organization, configuring them is typically a task for a system administrator. To edit or add study statuses select Configuration Generic from the Data Selector menu bar. In the Generic Properties dialog box, click the Study Statuses tab. Click in the Study status field to edit existing statuses. To add a new status, click at the end of the last status shown, press Enter on the keyboard and type in the new status.
The order in which statuses are entered defines their order in terms of the progression of studies in the workflow. If, therefore you were to enter Printed after Authorized, this will mean that Printed would be higher than Authorized.
Setting permissions to change study status

To allow RA 600 to be used by staff with a wide range of skills and responsibilities, each user can be allowed (or not allowed) to change the status of studies to particular statuses. Only certain users may, for example, be able to give a study the status Authorized or Reported. Also, due to workflow considerations, it may not be allowed for (some) users to turn the status back, i.e. give a study the status New when it previously had the status Authorized (as an extreme example). There are in fact two sets of permissions for changing study status. One set governs the Data Selector (the options available after right-clicking on a study and selecting Set Study Status ID from the right mouse button menu), and the other set the Viewing Section (the options available in the drop-down list in the Save Data dialog box when closing a study after viewing it). To change study status permissions for the Data Selector select Configuration User from the Data Selector menu bar. In the User Properties dialog box, click the Study Status Permissions tab. Check or uncheck the check boxes to assign or unassign permissions. Check the Allow user to set back the study status check box if setting back the status is to be allowed. To change study status permissions for the Viewing Section select Configuration Viewing from the Data Selector menu bar. In the Viewing Properties dialog box, click the Study Status Permissions tab. Check or uncheck the check boxes to assign or unassign permissions. Check the Allow user to set back the study status check box if setting back the status is to be allowed.
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Going further with viewing

This chapter does not cover all the features of the Viewing Section. You can, for example, also view multi-frame images and work with cutlines. These and other topics, such as comparing studies and series, hanging protocols and viewing at true size are covered in detail in the next chapter, Advanced viewing which discusses how to get the most out of the viewing features of RA 600. Depending on your configuration, you may also have MPR and MIP capabilities. These offer you new ways of looking at your imaging data. See chapter 6, 3D viewing with MPR and MIP for details.
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Advanced viewing
This chapter covers some more advanced viewing capabilities of RA 600, such as viewing with multi-monitors, comparing studies, displaying multi-frame images and cutlines, creating and using hanging protocols and using RA 600s ability to display images at their true size.
Comparing studies and series................................156 Working with multi-frame images ...........................159 Displaying cutlines .................................................163 Working with collages ............................................167 Viewing images as they arrive ...............................171 Monitoring mode ....................................................173 Working with hanging protocols .............................174 The Hanging Protocol Editor in detail.....................178 Default hanging protocols ......................................182 Viewing images at their true size ...........................184
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Comparing studies and series

RA 600 lets you display both color and monochrome images on your monitor at the same time. If, however, your display is set to only 256 colors, all images will be displayed in monochrome.
With RA 600 you have a powerful and versatile tool for comparing studies and series on both single and multiple monitors. It allows you to compare multiple studies or series from the same or different patients, to compare CT, MR (T1/T2 comparison for instance), US studies with color frame-grabbed images, and much more. To use RA 600 to its full potential for comparing studies and series, you should be familiar with opening multiple studies, using different screen layouts, setting the Scope, pinning images, and creating cine loops. All these aspects of RA 600 are covered in the previous chapter Viewing images, but they are briefly described again here as they relate to comparing studies and series.
Selecting multiple studies and series

When comparing studies, you will typically want to open two or more studies from the same patient at the same time. These can be the newest and prior studies from the same modality acquired at different times or studies from the same patient acquired by different modalities, or some combination of these. Before you can open studies, you need to select them. For this, they must be displayed in your patient or study list in the Data Selector. If you keep studies in different folders, you should make sure that your filter is set to include the appropriate folders. Once you have the studies you want to compare in your study or patient list, you select them in the usual Windows way. Click on one of the studies to select it. To add to your selection, hold down the Ctrl key and click on additional studies. To select a range of studies, hold down the Shift key instead while you click, or simply drag with the mouse over the range of studies you want to select. You can select a number of series in the same way. To view a series in the study list, click on the + sign next to the study icon of the study it is in. In the same way you can open multiple series, either from the same study or originating from different studies.
If you want to open all the series in a particular study, just double-click on the study.
Viewing selected studies and series

Once you have selected the studies and series you want to compare, you can view them either by selecting Viewing View from the Data Selector menu bar (in which case a hanging protocol will be used if available), or by selecting a pre-defined hanging protocol (layout) on the Viewing tooltab (with this icon).
157 Using the Viewing tooltab can save you time because you will not have to select a different hanging protocol once you have opened your selection. To open a number of studies or series at the same time, you should use the layouts in the View section of the Viewing tooltab. The thicker dividing lines on the buttons indicate how the various studies or series will be displayed. Once in the Viewing Section, you will see the various studies and series you selected in the viewports with thick dividing lines in the viewing area and the Pictorial Index to indicate the separation between the studies or series.
Creating your own viewport layouts

Although RA 600 comes with a wide range of pre-defined layouts suitable for many kinds of viewing requirements, it is also quite easy to create your own special layouts to meet your particular needs. You do this by defining new hanging protocols which are then represented by buttons on the Viewing tooltab of the Data Selector and the Layout tooltab in the Viewing Section (see Creating and modifying automated hanging protocols on page 176 for details).
Placing your images in the viewports

Once you have opened your studies for comparison in a suitable layout, you will want to locate your images appropriately in your viewports. If you want to change the contents of a series area, click within its first viewport. Now click in the Pictorial Index on the first image of the study or series you want to see in the area. The image will appear in the viewport you just selected. In this way you could, for example, compare two versions of the same series displayed simultaneously in two areas or compare three series alternately in a two series layout by exchanging one for another.
The importance of Scope

When the Scope is set to One Series, only the images in the same series area will be affected by your actions. So, if you have a number of series areas on your screen and place the same series in these areas (for comparison perhaps), only the images in the currently active series area will be part of the Scope.
Located immediately below the tooltabs, the Scope in RA 600 lets you determine which images certain actions, such as windowing, zooming and panning, will affect. It is particularly useful for comparing studies and series (see Setting the Scope of your changes on page 91 for more details). If the Viewports radio button has been selected, your actions will only affect the active viewport or selection of viewports. If the One Series radio button is selected, then only the active series (the one containing the image in the active viewport) will be affected by your actions. If Scope is set to Study, all the displayed series will be changed in the same way by your actions.
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158 chapter 5 Scope is also important while scrolling through the images using the Up and Down buttons. If Scope is set to One Series, only the active series will scroll. If you set Scope to Study, all the displayed series will scroll in synchronization.
Pinning combinations
When you have an image in a particular viewport that you want to keep in view, you can pin it simply by double-clicking on the viewport (see Pinning images on page 106). You can pin as many viewports as you like with whatever images you like, so you can quite literally display exactly the images you want where you want them in the viewing area.
Comparing cine loops

Creating a layout for study and series compare in combination with Scope options makes it possible to compare cine loops from different studies or series.
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Working with multi-frame images

You can use RA 600 to view multi-frame secondary capture images with the same features as for other multi-frame images.
Multi-frame images are DICOM images for which the pixel-data space has been extended to be able to contain multiple pictures called frames. All frames in an image share the same DICOM Image header (containing various non-pixel data concerning the image, its circumstances of creation and parameters for optimal viewing). There are various types of multi-frame image. For example, 2D + T multiframes (cine runs) contain sets of 2-dimensional images, all taken on the same coordinates, with different timestamps at more or less fixed intervals (DICOM specifies that the time intervals may differ). They typically show the effect over time of some contrast agent through vessels. One example of these is cardiac cine runs. In 3D multi-frames (slices of a volume), sets of 2-dimensional images are created at (more or less) the same time on different layers or at different angles. These sets look much like CT or MR series, and some are indeed MPR or MIP processed images. An example is the full body scan. There are also combinations of the above types, such as the SPECT gated study. RA 600 supports multi-frame images in many areas such as Nuclear Medicine (including Static, Dynamic, Gated, Tomo, Gated Tomo, Recon Tomo and Recon Gated Tomo), Ultrasound, X-ray Angiography (including bi-plane studies) and Radio Fluoroscopy.
The Pictorial Index and viewing multi-frame images

You open series and studies containing multi-frame images for viewing in much the same way as for ordinary image types (although you may wish to set up specific hanging protocols to display these images in a particular way). When you open a study containing multi-frame images, you can view the images using one of several settings after right-clicking in the Pictorial Index: Show all frames; One frame only; First, middle, last frame; show all frames. To change how multi-frame images are depicted in the Pictorial Index click on the small rectangle in the top right corner of the series summary in the Pictorial Index. Keep clicking on the rectangle to cycle through the three following options: One frame only; First, middle, last frame; and show all frames. You can reach the same objective by right-clicking an image in a series in the Pictorial Index and selecting the appropriate command form the pop-up menu.
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160 chapter 5 Setting how multi-frames initially appear in the Pictorial Index It may well be that you almost always want to have multi-frames depicted in the Pictorial Index in same way when you initially open a study of a particular modality (such as XA or NM). You can set up RA 600 to do this. Select Configuration Viewing... from the Data Selector menu bar and make the appropriate adjustments on the Modalities tab of the Viewing Properties dialog box.
Viewing multi-frames as cines

You can readily view all the frames in a multi-frame image as a cine. To view a multi-frame image as a cine Click on the viewport you want to display the cine in to select it. Then right-click on the images in the pictorial index and select Start Cine from the pop-up menu. A cine will open in the current viewport. If it is an automatic cine, its speed will be related to the recommended display frame rate. Setting how multi-frames are initially shown as cines Using the DICOM information in the image, RA 600 can often determine the type of cine (manual or automatic) that it should start when you select Start Cine in the Pictorial Index. You can, however, set for each modality how multi-frames are shown as cines (to always have them open in manual or automatic mode, or for RA 600 to decide). To configure how multi-frames are shown as cines 1 2 3 Select Configuration Selector. Viewing from the menu bar in the Data
By setting the Scope to multiple viewports, you can quickly start a number of cines, particularly useful for certain NM studies. See Setting the Scope to a selection of viewports on page 91 for details.
Click on the Modalities tab in the Viewing Properties dialog box. Select one of the three settings from the Cine Mode drop-down list in the Multi-Frame section: Auto, Detect or Manual.
A Cine will start automatically when the Cine Mode adjustment has been set to Auto and the Pictorial Index to One Frame Only (Configuration Viewing Pictorial Multi-Frame images Initial layout). The Cine will start as soon as a Multi-Frame image is clicked on in the Pictorial Index. The Mode Detect will start a Cine automatically if the Recommended Frame Rate is detected in the image information. Select Manual if you want to start cines manually for the modality.
161 You can also set up automated hanging protocols to have cines of multi-frame images automatically start when the images are opened for viewing (do this by setting the cine property of a viewport to on in the hanging protocol using the Hanging Protocol Editor see The Hanging Protocol Editor in detail on page 178). Annotations and the magnifying glass while viewing multi-frame cines When you are working with a cine in manual mode, you can closely inspect individual frames using the magnifying glass and even add annotation to just one frame.
Viewing and manipulating individual frames in multi-frames

You can have the viewports show the frame numbers of the frames they are displaying by using the tag @frame@. Assuming you have administrator rights, select Configuration Viewing from the Data Selector menu bar. Then click the Viewport Annotations tab of the Viewing Properties dialog box and add the tag @frame@ to the viewport annotation (click the Help button for details on how to do this). For example, entering the text Frame @frame@ of @00280008@ will display Frame M of N in the viewports. This information will also appear on your hard copy when you print multi-frame images. If you dont have the rights to make this configuration, contact your Windows system administrator.
When a multi-frame image is shown fully expanded in the Pictorial Index, you can work with it in very much the same way as you would a series of normal single-frame images. Click on one of the frames in the Pictorial Index, and this image and whatever subsequent images will fit in the viewports will appear in your viewing area. The usual viewing features are supported for frames. A single viewport will behave like it contains a single-frame image. Hence you can, for example, window each individual frame (depending on your Scope setting). You can also add annotations to individual frames.
Printing multi-frame images

You can print individual frames of a multi-frame image. If you are printing using a virtual film sheet in the Viewing section and include a collapsed multiframe image in the virtual film sheet, only the frame that is currently being displayed will be inserted. When printing from the Data Selector, all images will be printed in fully expanded form. If you right-click in a viewport containing a multi-frame image and select Export TIFF or Print Image, only the currently visible frame will be exported or printed.
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Teleradiology
If you insert series in a virtual film sheet while working with multiframe images, you should be aware that RA 600 will create a great many sheets if the multiframe image contains a large number of frames. In extreme circumstances, this may cause RA 600 to run out of memory.
Multi-frame images can be sent by RA 600 in just the same way as other images. In DICOM the smallest entity is, however, an image, so it is not possible to send individual frames of a multi-frame image using teleradiology.
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Displaying cutlines
Cutlines are often also called scoutlines for CT images, planning lines for MR images or, in general, intersection lines.
RA 600 displays a Cutlines tooltab (with this icon) in the Viewing Section which you can use to display intersections between two planes. You can display cutlines, provided your study has images suitable for this. They must, in particular, be part of CT or MR studies. If they are not, the cutline option is disabled.
Displaying a set of cutlines

Alternatively, you can click the right mouse button in a viewport. From the pop-up menu, select Cutlines and then the range you want to view.
If you enter the Viewing Section and the scout image is in the active viewport, you can show or hide a cutline set by checking the check box in the Cutline Sets section of the Cutlines tooltab (with this icon). The Cutlines tooltab also has an All and a None button which you can click on to show all or none of the available cutline sets. If you display a series of cutlines by clicking in a Cutline Set check box, RA 600 enables a number of additional options for working with cutlines. Click the All Images radio button if you want to display in the active viewport all the cutlines representing all the images in the series of images. Click the Displayed Images radio button if you want to display in the active viewport only the cutlines representing the images you actually see in the Viewing Section. Click the None of the Images radio button if you want to remove from the active viewport all the cutlines representing all the images in the series of images. Check the Show First And Last Cutline check box to display in the active viewport only the first and last cutlines within a set of cutlines. Note that RA 600 displays the first and last cutlines of a series of images even if you select either the Displayed Images or None of the Images radio button. Check the Show Labels check box if you want to display on both sides of the cutlines the labels made for the image. RA 600 will also display labels in a tool tip when you place your cursor on a cutline in the active viewport regardless of whether the Show Label check box has been turned on or off.
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Criteria for determining cutlines

When determining which images an image intersects with, RA 600 distinguishes between single-series studies and multi-series studies. In a singleseries study, RA 600 will try to find ranges of images within the complete set of images. To be part of a range, the images must have the same orientation (be parallel to each other) and their centers must be linked in a straight line. Once RA 600 has determined what ranges there are, it then sees if these ranges intersect with the image in the viewport. If so, this range of images will appear in the Cutlines sub-menu. For a multi-series study RA 600 simply intersects each series with the series of the image in the viewport (including the series it is a part of). If any images in a series intersect with the image in the viewport, this will be offered as a selection in the Cutlines sub-menu. Another criterion for determining whether images intersect is that the intersection line should be located within the image in the viewport. If the intersection line falls completely outside the image it is not considered to have any clinical relevance and will be ignored by RA 600.
The reason that the series of the image in the viewport itself is also tested when determining what cutlines there are is because this series may contain images that are nonparallel and therefore offer cutlines.
Customizing the display of cutlines

You can customize RA 600 to display cutlines in a certain way. Among other things, you can give cutlines a particular color and display them as a solid or broken line, in addition to configuring how text, figures, labels should be displayed etc. To customize the display of cutlines 1 2 3 Select Configuration Selector. Viewing... from the menu bar in the Data
Click on the Cutlines tab in the Viewing Properties dialog box. In the Color and Line Style section, select from the Default dropdown list the color you want to apply to the cutlines when they are initially displayed. Use the adjacent drop-down list to define the type of line you wish to see; e.g., solid or dash. Select from the Displayed Images drop-down list the color you want the cutlines to be when they have been selected in the active viewport of the Viewing Section. Use the adjacent drop-down list to define the type of line you wish to see; e.g., solid or dash.
165 5 Select from the Active Image drop down list, the color you want a cutline to be when you activate an image in the Viewing Section. Use the adjacent drop-down list to define the type of line you wish to see; e.g., solid or dash. In the Label Font section, click the Set Font button. Once in the Font dialog box, define the Font, Font style, Size and Script with which you want to display labels and then click OK. In the Properties section define what you want RA 600 to display by default when you check a Cutline Set check box in the Cutline Sets section of the Cutline Tool bar. In the Compose Set Description section, indicate how you want to be able to identify a series of images in the Cutline Sets section of the Cutline tooltab; e.g., by series number, study description or body part etc. Check the Show Image Information check box if you want RA 600 to display image information. Use the Compose Label section to determine how you want to denote series and images on labels. Select from the first drop-down list the way you want to denote a series on a label. Use the second drop-down list to select a separator. Select from the third drop-down list the way you want to denote an image on a label.
Using cutlines to select images

You can also use the cutlines to select images for display.
It is often a good idea to pin the viewport containing your cutlines (double-click on it) since you will usually want to view it along with the other images that intersect with it.
To view the image represented by a cutline pin the viewport containing your cutlines (to prevent it being replaced). Click on the cutline of the image you want to show. The corresponding image will be displayed with as many subsequent images as will fit in the remaining viewports on your screen.
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Viewing multiple sets of cutlines

If you are displaying cutlines for another series and you are also viewing this other series on the screen (while comparing series, for example), you will not need to pin the viewport containing the cutlines. When you click on a cutline, the images in the viewports of the other series will change to display the images from the cutline you clicked on.
You can show cutlines in more than one viewport at a time. For each viewport, you simply select the appropriate check boxes in the Cutline Sets section of the Cutline tooltab (with this icon). If more than one set is offered, you can display as many of them as you like in the viewport.
Printing and saving cutlines

RA 600 treats cutlines as normal annotations so they can be printed and saved just like other annotations.
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Working with collages

Collages are composites of a number of images from one or more studies. You can use these selected cases in presentations for example. They can also be useful for saving your current workspace if you need to continue from the same point at some later time. (You would then typically delete your temporary collage after continuing.)
Creating collages
To use images from different studies or patients in the same collage, you must open all of the necessary studies in the Viewing Section.
When you create a collage, you open the appropriate worklist items in the Viewing Section. You make whatever changes you need to the images and then add them as a collage. To create a collage 1 In the Data Selector, open the appropriate studies for viewing. (To open multiple studies hold down the Ctrl or Shift key and select the studies. Then right-click one of the selected studies and select View from the right mouse button menu.) In the Viewing Section, scroll through the images and make whatever changes you wish to make to them (windowing etc.). If necessary, select the layout you wish to apply on the Layout tooltab (with the Swiss army knife icon). Click the icon to bring the Collage tooltab to the top and then click the Add... button. In the Add Collage dialog box, enter a name for the collage in the Title field and any comments on the collage in the Comment field. Click the OK button. When you leave the Viewing Section (or open another study in the Viewing Section), make sure that you click the Yes button in the Save Data dialog box to save the collage.
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You must click the Yes button in the Save Data dialog box. Otherwise your collage data will not be saved.
The collage will now be available in your local database. (For a workgroup server configuration, the collage will be available in the local database of the workgroup server and thus to all workstations connected to the workgroup server.)
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Presenting collages
In the Data Selector, collages appear as separate series with the modality COLLAGE within the study the collage is of. Collages containing multiple studies appear as separate series in each of the studies. To open a specific collage in the Data Selector Open the study for which you created the collage, then double-click the series with the modality COLLAGE that has the appropriate collage name before it. The collage will open up, using the same layout and presentation states as when it was saved. To open another collage in the Viewing Section select the Collage tooltab (with the icon), then a previously created collage from the list and click the Apply button.
In the Data Selector, you can use the filter check boxes in the Modality section to only view studies that contain collages.
Sending collages to a specific destination

RA 600 allows you to set up a separate destination (which could be located in a meeting room for example) to which you could only send collages. To set up a collage only destination 1 2 Select Connection bar. Destinations... from the Data Selector menu
In the Add Destinations dialog box, enter a Name (for example Collages only), Description, Host Name and make sure that the Presentation States, Key Images and Other IODs check boxes are checked. Click the Next > button and then Finish.
Some additional facts about collages

If you make any changes in the Viewing Section (windowing etc.) to whatever studies you include in your collage, RA 600 will save those changes by creating a new presentation state for each of these studies. If you open a collage in the Data Selector where a presentation state or key object is missing, the data is not automatically fetched. In this case, a message will appear indicating that part of the collage could not be applied.
What is not saved with collages

With collages you cannot save the following: Comments on each set of collages.
169 A collage for a plug-in series area. Linked cine settings. Cutline settings. Settings for tooltabs, Pictorial Index, reports, worklists and toolbars. The state of the reports window (the usual report selection functionality may or may not select the same reports on different workstations for the same collage). Collages for more than one monitor group.
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Putting studies on hold to view a second study (STAT exam)

When you are viewing the second study, the Viewing Section will look and act just the same as normal, except that the right-mouse button pop-up menu in the Data Selector window does not include the View STAT Exam option. In addition, the Previous Item and Next Item options on the main Study menu are disabled, just as the Prev and Next buttons are under the tooltabs. Since the original study is locked by the original viewing session, you cannot view the same items for the STAT Exam.
You can put a study you are currently viewing on hold while you open and view another study (a stat or consultation for example). This might be useful if you are performing some routine work and a case which immediately requires your attention comes in, such as an emergency exam. You can quickly switch to the new study, process it and, when you have finished viewing it, save it and return to the previous one exactly as you left it. To put a study on hold to view a different study (STAT exam) right click on the new study you want to view in the Data Selector (Local Studies) window. (If you cant see Data Selector window while you are in the Viewing Section, select Layout Show Data Selector from the menu bar). From the pop-up menu, select View STAT Exam. You can also click on the study in the Data Selector window to select it and then select Study View STAT Exam from the menu bar. This is not possible during a Receive New Study action.
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Viewing images as they arrive

When RA 600 is first installed, the Viewing Images As They Arrive feature is not turned on. To do this, select Configuration Viewing... from the Data Selector menu bar and make sure the Direct View check box is checked on the Machine tab of the Viewing Properties dialog box. Before you can set this adjustment, however, you will need administrator rights. If you do not have these rights, contact your system administrator.
You can open and start to view studies whose images are not (yet) all on your system. While you are viewing such a study, the Pictorial Index will be constantly updated to show the new images as they arrive. It could be that some of the images you want to view are not on your local system and need to be transferred to your system over a network. Or it could simply be that, for whatever reason, new series or images are added to a study while you are viewing it. After you start viewing a study, RA 600 will immediately add any new images from that study that are received to the Pictorial Index so that you can view them if you wish.
Directly viewing studies in a remote view or archive

Studies in a remote view or archive are not stored on your local system but typically on another system elsewhere on your network. To be able to display images quickly, however, RA 600 needs fast access to them from your hard disk. You can always import studies from your remote view to your local view (right click on the study and select Import from the pop-up menu). This will transfer them over the network to your local view (and your systems hard disk). You can then open and view the study from your local view. It is, however, possible to view studies in a remote view directly (without importing them first). To directly view a study in a remote view from the pop-up menu. right-click on the study and select View
You will be taken to the Viewing Section and can start viewing the study. If the study is of a significant size, and depending on the speed of your network connection, it may take a little while for all the images to arrive on your workstation. While these images are arriving, you can view the images that have already been received. Your Pictorial Index will continually update itself with the new images as they arrive if you are using a DICOM connection. (With an AMI connection, the Pictorial Index will not update and show the images until all the images have been received.)
Viewing worklist items that are not local

Studies in a worklist view may be stored remotely and hence not immediately accessible from your systems hard disk. In fact, they may contain a mixture of images and studies that are stored locally and remotely, such as a new study that is in your local database and priors that are held in an archive. You can start viewing such items directly, before all the images that are not held locally are received by your system.
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172 chapter 5 To directly view a worklist item containing images that are not local right-click on the worklist item and select View from the pop-up menu, or double-click on the item. If your selection contains a worklist item that contains at least one study that is not in the local database, a dialog box will appear listing the various items and indicating whether they are held locally or remotely. This allows you to specify which study items you want to view. Locally held images will display immediately, while remotely held ones may take a little time to arrive on your system. Once you have specified which items you want to view, you will be taken to the Viewing Section and can start viewing the images. If you also asked to view remote images, these will be shown in the Pictorial Index as soon as they arrive.
If you dont want your Viewing Section updated...

If you do not see the appropriate Fallback Retrieve AE Title, you or your system administrator will first have to set it up as a destination under Connection Destinations... from the Data Selector menu bar (requires administrator rights).
It could be that you never want your Viewing Section to be updated while viewing studies. You can turn off the direct viewing of images as they are received. Note, however, that this will turn off all the features relating to viewing images as they arrive, such as monitoring mode and directly viewing images from a remote view. To do this, select Configuration Viewing... from the Data Selector menu bar and make sure the Direct View check box is not checked on the Machine tab of the Viewing Properties dialog box.
Limitations when using direct view

When opening worklist items, the origin must be specified in the worklist item itself or RA 600 will try to find it using the Fallback Retrieve AE Title if one is specified (select Configuration Viewing... from the Data Selector menu bar and specify the Fallback Retrieve AE Title on the Machine tab of the Viewing Properties dialog box). If this fails, RA 600 will not be able to retrieve and display the item. Newly arrived images will be displayed according to the image data received. They will not be synchronized with any of the images already present. This means that any action you have already performed (such as windowing, zoom, pan, etc.) before the new image arrived will not be applied to this new image. To synchronize the images, you will need to reapply the action (window all the images again for example). The hanging protocol used to display images when you are using direct view will be based on the first image received. It will not be changed when subsequent images arrive.
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Monitoring mode
All the time you are in monitoring mode, newly received images will be added to the Pictorial Index and be placed in your systems memory ready to be viewed. If you stay in monitoring mode for some time and receive a large number of images quite quickly, you could end up with a very large number of images which may slow performance and your system could potentially run out of memory. You should periodically save (or discard) studies that arrive in monitoring mode. If your system does run out of memory and you need to restart RA 600, the studies containing the images that were received will still appear in your local view. If you cannot see the Receive New Study item on the Viewing menu or on the right mouse button popup menu, monitoring mode has not yet been enabled on your system. To enable it, select Configuration Viewing... from the Data Selector menu bar and make sure the Direct View check box is checked on the Machine tab.
If you are waiting for a new study to arrive, you can put RA 600 in monitoring mode. This is typically used when receiving newly-created studies from a modality. After entering the Viewing Section in monitoring mode, no images will initially be displayed. When images arrive from the origin you have selected, the Pictorial Index will update itself with the images. All subsequent images from this origin will be added to the Pictorial Index as they arrive and for as long as you are in monitoring mode. These do not have to be images from the same study or series. If images from a second study or series start arriving, RA 600 will also show these in the Pictorial Index as a separate study or series. To go to the Viewing Section in monitoring mode select Viewing Receive New Study from the menu bar in the Data Selector (or right click in your local view and select Receive New Study from the pop-up menu). In the dialog box that appears, select the origin from that drop-down list the you want to receive studies from.
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Working with hanging protocols

If you frequently work with the same kind of data series or set procedures, you may wish images to be viewed in very specific ways when they are opened. RA 600 lets you define and use such hanging protocols. These are essentially highly configurable and (potentially) sophisticated layouts which can be automatically used each time a study is opened in the Data Selector, or which can be selected on the Viewing tooltab prior to opening a study for viewing. Hanging protocols are particularly useful on large, multi-monitor systems and when images always have to be laid out according to specific guidelines or procedures. Not only can you readily define exactly how your viewports are to be laid out, you can also have a selected viewport or viewports display images at specific window levels or automatically be pinned when the study is opened. Or you can have one or more viewports play a cine loop of the series when it opens. You can even have particular hanging protocols only used if certain criteria are met. So, for example, you can create a hanging protocol which is to be used only for CR studies or for a certain number of series in the data selection for MR and CT studies. RA 600 will then use this protocol for these studies. Properly configured, RA 600 therefore offers a powerful way of displaying images automatically in just the way you want them to be.
Using hanging protocols (or selecting a different layout)

You can have RA 600 automatically open your series and studies with the correct hanging protocol. To open studies or series for viewing automatically with a hanging protocol doubleclick on the series or study in the Data Selector or select the studies or series you want to view and select Viewing View from the Data Selector menu bar or select View from the right mouse button pop-up menu. If you choose any of these three methods, your studies or series will open with the appropriate hanging protocol. There may be times, however, when you want to select a particular layout yourself for viewing studies or series. To manually select a hanging protocol when opening a study in the Data Selector, select the studies or series you want to view in your study list and click the hanging protocol you want to use on the Viewing tooltab (with this icon).
175 Even if you have automatically opened studies or series with a hanging protocol (or opened a study with another layout), you can change the layout of the viewports at any time by selecting a hanging protocol on the Layout tooltab in the Viewing Section. To manually select a hanging protocol when viewing a study click the button for the hanging protocol you want on the Layout tooltab (with this icon).
Managing automated hanging protocols

If you are using hanging protocols and open a study without selecting a layout first (by double-clicking on it for example), RA 600 will automatically display the study using an appropriate automated hanging protocol if there is one. You can affect how RA 600 does this. Setting priority It could well be that a number of automated hanging protocols have been defined that are suitable for displaying a study you open. Which one does RA 600 use? The answer is the one with the highest priority (of the enabled automated hanging protocols). You can arrange all the hanging protocols that have been defined in an order or priority, so RA 600 will first check whether the hanging protocol with the highest priority is suitable, and use it if it is. If this protocol is not suitable (i.e., the criteria have not been met see Creating and modifying automated hanging protocols on page 176), RA 600 will try the one with the next highest priority, and so on. To change the priorities of automated hanging protocols select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated Hanging Protocols radio button. Then click on the name of the protocol you want to increase or decrease the priority of. Click the or button. The protocol at the top of the list has the highest priority.
You can make multiple selections in the list of hanging protocols in the Hanging Protocols Manager for copying, disabling, deleting and exporting. This works just like in Windows (hold down the Shift and/or Ctrl key while clicking in the list).
Disabling and removing automated hanging protocols

You can readily remove (delete) hanging protocols in the Hanging Protocols Manager. To remove (delete) a hanging protocol select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated hanging protocols radio button. Then click on the name of the protocol you want to remove and click Delete. Sometimes you may want to stop a hanging protocol from being used, but without deleting it so you can reinstate it at a later time. You do this by disabling the protocol.
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176 chapter 5 To disable a hanging protocol select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated hanging protocols radio button. Then click on the name of the protocol you want to disable. Then click Disable.
Disabling all automated hanging protocols and displaying the best

You can disable all automated hanging protocols, so RA 600 will never use an automated hanging protocol to open a study. Uncheck the Use automated hanging protocols check box in the Hanging Protocols Manager to do this. You can also decide that all appropriate hanging protocols should be shown on the Viewing tooltab, or only the one that RA 600 calculates to be the best for the study being viewed. Check the Calculate best hanging protocol only check box if you want just the best one to be shown.
Importing and exporting automated hanging protocols

RA 600 lets you export and import automated hanging protocols so you can re-use them. To export automated hanging protocols 1 2 3 Select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated hanging protocols radio button. Click on the name of the protocol you want to export. Hold down the Ctrl key and click on additional protocols if you want to export a set of protocols. Click Export.... In the Export Hanging Protocol to XML file dialog box, specify a name for the file and click Export.
Once you have done this, you can copy the file to another system ready for importing. To import automated hanging protocols select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated hanging protocols radio button. Then click Import....In the Import Hanging Protocol to XML file dialog box, specify a name for the file (or use the Browse button to locate one) and click Import.
Creating and modifying automated hanging protocols

The Hanging Protocols Manager lets you create and change your protocols.
177 Automated hanging protocols are sophisticated tools for displaying studies in particular ways, but can be also be complex to set up. To make it easier for you to create them, RA 600 includes wizards that cover the most important parts of the process. Unless you are already an expert in setting up hanging protocols, the wizards should greatly speed the set-up task. To create or modify an automated hanging protocol using wizards select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated hanging protocols radio button. Then click the New... or Modify... button. In the Hanging Protocol Editor, enter a name for the protocol if you are creating a new one, and click Wizard. Follow the on-screen instructions and refer to the on-line help as necessary. You can also create and modify hanging protocols fully manually. You may wish to do this if you are expert in creating them, or for fine-tuning purposes after you have used the wizards to create something close to what you want. To manually create or modify an automated hanging protocol 1
If you are creating a hanging protocol similar to an existing one, you can save time and effort by using this as a basis for your new hanging protocol. Select the similar hanging protocol and click the Copy button. Then select the copy that RA 600 creates and modify it as necessary.
Select Viewing Manage Automated Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Automated hanging protocols radio button. Then click New or Modify.... If you are creating a new protocol, in the Hanging Protocols Editor, type a name for the hanging protocol in the Name field. Create a layout for the hanging protocol using the Layout section of the Hanging Protocol Editor. Use the Series and Image radio buttons to add boundaries between series or viewports (images). Click on a button and then click in the layout area to add boundaries. To clear the layout area, click the box button and then on the layout area. Assign properties and criteria to viewports and series using the Hang Criteria and the Series and Image Properties sections of the Hanging Protocol Editor. Use the Series and Image radio buttons to apply properties to a series area or (pinned) viewport (image) area. Select from the drop-down lists, click on a button and then in the layout area. Modify the General Viewing Modes section as required. If you want to fine tune the hanging protocol or specify data selection criteria, click Fine Tuning (see Fine tuning your hanging protocols on page 181).
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The Hanging Protocol Editor in detail

The Hanging Protocol Editor lets you graphically create layouts for your protocols and assign criteria and properties to them. When you want to create a new protocol, first enter a name for the protocol in the Name field. Then create the protocol graphically by using the remainder of the Hanging Protocol Editor. To create a hanging protocol, you need to create a layout and assign hang criteria, area properties and general viewing modes. You may need to fine tune your hanging protocols and set priorities to determine which hanging protocol RA 600 will use.
Creating the layout

You create the layout for your protocol using the buttons in the Layout section of the Hanging Protocol Editor. First, decide if you want to create divisions that produce new series, or just subdivide a series into more viewports. Make sure the appropriate radio button (Series or Image) is selected. Then click on one of the buttons. Next, click in the appropriate place in the layout area. To remind you of what you are about to do, as you move the cursor over the layout area after clicking a button, the cursor will change to display a symbol indicating the button you have clicked. Each button divides up the area you click in a different way. The for example, will divide up any area you click in the layout area into four equally sized viewport areas (or series areas if the Series radio button is selected). The button is an eraser. If you click on this and then on the layout area, the complete layout will be cleared. (If you change the layout and realize you want to undo this, click the Undo button.You can undo multiple actions). The button lets you define other ways of creating boundaries between series and viewports. Change the numbers next to the button to fill areas with whatever number of rows and columns you wish, then click the button and the layout area.By checking various check boxes (the Edit mode radio buttons first), you can fully control how multiple series are laid out, and how the viewports are arranged within each series.
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Assigning hang criteria

If you wish to apply a criterion (DICOM or time ordering) to a viewport area it must first be pinned (see Assigning area properties on page 179 of this chapter).
Once you have defined your viewport and series layout for your hanging protocol, you can specify hang criteria for areas of your layout. The hang criteria determine at which positions in the layout certain image data will be displayed. They can be formulated using DICOM tags or by specifying a time order. You could, for example, decide that a scout image should always be displayed in the first viewport of a series, or that the first series area displays images with contrast bolus agent and the second series area displays images without contrast bolus agent. Or, using a time order, that a series area displays images from the least recent series. For a DICOM criterion, you select one of the DICOM tags from the dropdown list, enter the required value and assign it to a series area or a pinned viewport area by clicking the DICOM button and then on the area. To assign a time ordering criterion, you again select from the drop-down list, click the clock button and then on the area you want to assign the criterion to in your layout.
DICOM tags can be added to the drop-down list in the Hang Criteria section of the Hanging Protocol Editor. Contact your system administrator or RA 600 distributor for assistance.
Assigning area properties

Apart from hang criteria, you can assign properties to an area of your layout. These properties will be applied to the images displayed in the viewports or series area you assign with them. To assign a windowing property to an area, enter the values manually or by clicking on the little arrows to the right of the field. Select a Function and, if you select a non-linear function, specify the slope you require (see Windowing images on page 96 for details). Then click the windowing button and on the area in your layout you want to assign the windowing to. Similarly, assign a zoom level to an area by selecting the type of zooming and a zoom factor, clicking on the zoom button and then on the area you want to assign the zoom level to. (See Zooming and the magnifying glass on page 111 for more on zooming.) You set the annotation level of viewports or series using the annotation ton. but-
If your Design Scope is set to Series (the Series radio button is active), the Pin and Cine options in the Area Properties section will not be available. This is because these properties can only be assigned to viewports. Likewise, if you select the Image radio button, the plug-in option becomes disabled. You can only assign the Window, Zoom and Annotation properties to a viewport if the viewport is pinned or has the cine property assigned to it.
You can have RA 600 automatically orientate images (based on the orientation information in the DICOM header of the images). Select valid orientations from the drop-down lists and use the orientation button to do this. If the button is disabled, you have selected an incompatible pair of orientations from the drop-down lists.
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180 chapter 5 You can have a viewport (image) pinned by using the pin button. In this part of the Area Properties section you can also activate cutlines (if a study or series has them) and select which cutline sets are to be shown (see Displaying cutlines on page 163). Finally, you can have a cine start in a particular viewport by using the cine button. Select the speed and direction using the drop-down lists.
Since a viewport cannot be both pinned and have a cine running it, if you apply a pin to a viewport which already has the start cine property assigned to it, the pin property will replace the start cine property. Conversely, if the viewport is pinned and you then apply the start cine property to the viewport, the start cine property will replace the pin property.
How to see what hang criteria and properties you have applied
When you assign hang criteria and properties to areas, small squares appear in these areas. The colors signify: Yellow: DICOM tag criterion White: time ordering criterion Green: windowing Pink: zoom factor Gray: annotation level Red: pin image Orange: orientation Blue: start cine
You can find out more about what has been assigned to an area simply by moving your mouse cursor over the area in the layout. The details of assigned criteria and properties will appear in the window immediately underneath the layout.
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Assigning general viewing modes

If you state in the Hanging Protocol Editor that only key images should be shown but a series which does not contain any key images is subsequently opened using this hanging protocol, the viewports would be blank. To avoid this, you can fine-tune the script of the hanging protocol to only activate this hanging protocol if there is at least one key image present (see Fine tuning your hanging protocols on page 181 for details). Colored squares are not shown in the layout or layout preview for the key images and scope settings in the Hanging Protocol Editor since these apply to the whole layout.
In the General Viewing Modes section of the Hanging Protocol Editor, you can state whether only key images should be shown (see Viewing key notes on page 109 for more on this). You can also specify the initial Scope setting when the images are opened for viewing (see Setting the Scope of your changes on page 91). So, for example, if you prefer to always have the Scope set to Viewport while viewing ultrasound images, in your hanging protocol you would check the Scope check box and select Viewport from the dropdown list. You can also set up how the Viewing Section will initially display. By checking or unchecking the remaining check boxes in the General Viewing Modes section, you can show or hide the tooltabs, Pictorial Index and the Data Selector and Reports windows when the Viewing Section opens.
Fine tuning your hanging protocols

Click the Fine Tuning... button in the Hanging Protocol Editor if you wish to make small changes to the layout definition or if you want to invoke that a certain hanging protocol will only be selected in certain conditions. The Hanging Protocol Fine Tuning dialog box will then appear. Consult the online Help for detailed information. If necessary, contact your local support group for additional information.
Determining which automated hanging protocol RA 600 will use

The Hanging Protocol Fine Tuning dialog box is also used for defining which hanging protocol RA 600 should use when opening particular studies and series. Hanging protocols can be defined for all kinds of circumstances. For example, you could define a specific hanging protocol to be used solely for MR studies, or for viewing studies which contain at least one CT series. When you open a study or studies, RA 600 will then look to see which protocol meets the criteria required to display this study or studies, and use this automatically. (If more than one protocol meets the criteria, RA 600 will use the one with the highest priority.) When RA 600 is properly set up, this means that all kinds of studies can be automatically displayed in just the right way. Once the criteria for deciding which protocol should be used are included with the protocol layout, the conditions for using the hanging protocol are added using the Hanging Protocol Fine Tuning dialog box (click Fine Tuning... in the Hanging Protocol Editor). Details and examples of using scripting to set conditions can be also be found in the on-line Help. and the RA 600 Technical Reference Manual. If necessary, contact your local support group for additional information.
Maximize the Hanging Protocol Fine Tuning dialog box when working on your scripts.
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Default hanging protocols

You can also use default hanging protocols to provide special layouts. With these, you can not only define exactly how your viewports are to be laid out, you can also have a selected viewport or viewports automatically pinned when the study is opened or play a cine loop, and much more. See Working with hanging protocols on page 174 of this chapter.
When you are viewing images, your viewports can be arranged in all kinds of ways. In fact, the possibilities are unlimited. In addition to automated hanging protocols, RA 600 is installed with a range of standard layout options, or default hanging protocols. These are available as buttons on the Viewing tooltab in the Data Selector and on the Layout tooltab while you are viewing images. In the Data Selector, you select the default hanging protocol you want to use when you open studies or series for viewing. To select a default hanging protocol for viewing a study in the Data Selector, click on the study you want to view to select it. Then click the button for the default hanging protocol you want to use on the Viewing tooltab (with this icon).
Managing your default hanging protocols

You can create new default hanging protocols and change the order in which RA 600 displays these in the Viewing tooltab (Data Selector) and Layout tooltab (Viewing Section).
Creating and modifying default hanging protocols

The Hanging Protocol Manager lets you create and change your layouts.
If you are creating a hanging protocol similar to an existing one, you can save time and effort by using this as a basis for your new hanging protocol. Select the similar hanging protocol and click the Copy button. Then select the copy that RA 600 creates and modify it as necessary.
To create or modify a default hanging protocol 1 2 3 Select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Default hanging protocols radio button. Then click New or Modify.... Use the Hanging Protocol Editor to create or modify your hanging protocol.
You create default hanging protocols in just the same way as automated hanging protocols (see The Hanging Protocol Editor in detail on page 178).
Changing the order of default layout buttons

To change the order in which default layout buttons appear on the tooltabs select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Default hanging protocols radio button. Click on the name of the layout you want to move upwards or downwards and then the or button accordingly.
183 Disabling and removing default hanging protocols You can readily remove (delete) default hanging protocols in the Default Hanging Protocols Manager. To remove (delete) a default hanging protocol select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Default hanging protocols radio button. Click on the name of the layout you want to want to remove from the list and then on Delete. Sometimes you may want to stop a default hanging protocol appearing on the Viewing and Layout tooltabs and right mouse button menu, but without deleting it so you can reinstate it at a later time. You do this by disabling the protocol. To disable a default hanging protocol select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Default hanging protocols radio button. Click on the name of the layout you want to want to disable and then on Disable.
Importing and exporting default hanging protocols

RA 600 lets you export and import default hanging protocols so you can reuse them. To export default hanging protocols select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Default hanging protocols radio button. Then click on the name of the protocol you want to export. Hold down the Ctrl key and click on additional protocols if you want to export a set of protocols. Click Export....In the Export Hanging Protocol to XML file dialog box, specify a file name and click Export. Once you have done this, you can copy the file to another system ready for importing. To import default hanging protocols select Viewing Manage Hanging Protocols from the Data Selector menu bar. In the Hanging Protocols Manager, select the Default hanging protocols radio button. Then click Import.... In the Import Hanging Protocol to XML file dialog box, specify a name for the file (or use the Browse button to locate one) and click Import.
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Viewing images at their true size

To be sure to accurately view images at their true size, you should ensure that RA 600 is frequently recalibrated to take account of the changes in your monitor or monitors over time. For most systems, recalibration every two weeks to a month is sufficient.
With RA 600 you can display images at their true size. This will allow you to make measurements directly across the screen to measure actual distances in the patients body. To view images at true size click the True Size radio button on the Zoom Flip/ Rotate tooltab in the Viewing Section (or select from the right mouse button menu). With the True Size radio button selected, you will not, of course, be able change the zoom factor, though you will still be able to use magnifying glasses to view small detail. Note that if the True Size radio button is grayed out, it probably means your monitor (or at least one of the monitors on a multi-monitor system) has not been calibrated yet. RA 600 will not be able to compute the real size, and the true size option will not be available if the images you want to view are not calibrated (i.e. pixel spacing is not present or 0). See the Installation and Configuration Guide for details on how to calibrate your monitor (this can only be done by an administrator).
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3D viewing with MPR and MIP

Three-dimensional image processing can produce new ways of looking at data to provide spatial insight and assist diagnosis. This chapter discusses what you can do with MPR and MIP, how to quickly produce and adjust your images, how to create cine loops for added diagnostic capability, how to fine tune for optimum display of the data, and how to save your images for later viewing.
Starting MPR and MIP ...........................................187 Manipulating your view...........................................189 Looking at slices through your MPR/MIP view.......192 Creating MPR and MIP cine loops .........................194 Speed versus image quality ...................................197 Using volumes of interest (VOIs)...........................198 Enhancing, measuring and annotating images ......199 Using the Pictorial Index for MPR/MIP...................200 Saving your MPR/MIP images ...............................202 Saving cine loops ...................................................203
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MPR and MIP image processing will only be available if this module has been installed on your system. If it has, you will see an MPR item on the Data Selector menu bar and the MPR/MIP tooltab.
A 600 harnesses the computing power of todays workstations to provide new ways of looking at medical imaging data. This can help give you additional insight during viewing and diagnosis. The two approaches used by RA 600 are known as MPR (Multi-Planar Reformatting) and MIP (Maximum Intensity Projection). These both work with series of images evenly spaced directly above each other, hence essentially forming a three-dimensional volume. These series are typically produced by CT and MRI scanners. MPR in effect allows you to slice through and view this three-dimensional volume along a direction other than that of the original images. You might want to convert transversal image ranges to sagittal or coronal, for example, although the new direction may be at any angle to the original direction. In fact, by creating a cine loop which generates images displaced by successive amounts along a particular direction, you will automatically create the images for such a conversion. MIP provides what is essentially a three-dimensional view of the image range. RA 600 casts imaginary rays through the image volume. Along these rays, it finds the maximum pixel value and displays these as though projected onto a plane. These maximum values tend to indicate specific structures such as bone or blood vessels. The effect is similar to looking at a translucent 3D model of the subject. You can freely rotate this along any axis and so view the subject from any angle. As with MPR, RA 600 lets you make MIP cine loops. An MIP cine loop in which you change the viewing angle by successive amounts creates the impression of the subject rotating in front of you or, at higher zoom factors, of flying round the object.
You can also create cine loops involving rotation when using MPR. This effectively makes it appear as though you are passing through the image space. It does not, however, have much intuitive significance or diagnostic value.
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Starting MPR and MIP

Although the calculations performed by RA 600 to achieve MPR and MIP may be quite complex, using MPR and MIP is in fact quite easy and intuitive. You can start MPR or MIP on any suitable study you have selected in the Data Selector, or you can switch to MPR or MIP (and back again) while you are actually viewing a study in the Viewing Section. To start using MPR or MIP if you are in the Data Selector, first select the series of images you would like to view with MPR or MIP. Then select MPR MPR or MPR MIP from the menu bar. You can also click the Start MPR or Start MIP button on the MPR/MIP tooltab (with the MPR/MIP icon).
Selecting series
You may also see a warning message if the series contains information which is barely suitable for MPR/MIP. You will then be asked if you want to proceed anyway. (See Requirements for MPR and MIP.)
If you are opening a study containing more than one series for MPR or MIP (or in some cases just a single series), there may be times when RA 600 finds more than one series or different sets of images within a series which meet the criteria for MPR and MIP. If this happens, you will see a dialog box asking you to specify which set of images should be used. If RA 600 finds only one set of images suitable for MPR and MIP, it will immediately open this for viewing.
Requirements for MPR and MIP

You can only use MPR and MIP with specific types of series. Such series need to have evenly spaced images. The image planes must be parallel, and if they are not directly above each other, adjacent planes must be displaced by the same amount. In addition, the pixels must be square (rather than rectangular). Even if a series meets the above criteria, RA 600 will not be able to create useful MPR or MIP images if the distance between the planes is too great. It generates the additional pixels it needs to display MPR and MIP images by interpolating between the original images, but it cannot, of course, display information that was not recorded in the original series. The greater the distance between the images in the series, the greater the loss of definition in the direction normal to the images.
The MPR/MIP screen

Provided the series you selected is suitable for MPR/MIP, RA 600 will open the series and display the MPR/MIP screen. This is where you will adjust your view of the subject and view the MPR and MIP results.
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188 chapter 6 The viewing area is divided into four viewports. Top left, top right and bottom left are the three orthogonal views of the image volume: Coronal, sagittal and transversal. The bottom-right viewport is where the MPR or MIP results are shown. Each of the three transversal, coronal and sagittal ports has cross hairs which you can drag and rotate to adjust your view in the MPR/MIP viewport. You will also see a Pictorial Index on your screen. You can add images of interest to this for later viewing during your current MPR/MIP session and even for saving for future reference. The small viewport, located at the bottom of the screen when RA 600 is installed but easily draggable to a different position, contains a cube which provides an intuitive view of how you have rotated the image volume and the orientation of the new viewing plane. The cube represents the dimensions of the 3D image data you are working with. There are also (usually located on the right of the screen) the familiar RA 600 tooltabs. These allow you to select MPR or MIP, reset the viewed image to a default direction, set the action performed by dragging the mouse, create and play cines, and adjust image quality, pixel range, windowing, etc. The Reset button underneath the tooltabs resets your viewports and takes you back to original settings when you first started MPR/MIP. The Back button closes MPR/MIP and returns you to where you started MPR/MIP from (the Data Selector or Viewing Section).
If you cannot see a Pictorial Index on your screen, this is probably because it is empty. Until you actually save some images in it, RA 600 may hide it from view.
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Manipulating your view

You will typically use the MPR/MIP tooltab (with the icon) as a starting point when manipulating your view in the MPR/MIP viewport. The radio buttons in the Algorithm section let you select either MPR or MIP. You can switch between these different types of image at any time. The three buttons in the Defaults section let you decide on the starting image in the MPR/MIP viewport. Click the Coronal button, for example, and the view in the MPR/MIP viewport will (before you manipulate it further) be the same as that of the Coronal viewport. You use the Mouse Action radio buttons to determine what happens when you drag with the mouse in the MPR/MIP viewport. This is covered in detail in Dragging in the MPR/MIP viewport on page 190. The Add Oblique Image and Add Current Image buttons let you save the image currently being displayed in the MPR/MIP viewport or the image in the active viewport respectively (see Saving your MPR/MIP images on page 202).
Moving the cross hairs in the orthogonal viewports

When a series is opened for MPR/MIP processing, the cross hairs which allow you to rotate your view will be hidden behind other cross hairs. You will, however, still see the (light blue) handles which you drag to rotate the cross hairs.
The three orthogonal (transversal, coronal and sagittal) viewports allow you to adjust your viewing plane (and hence your view in the MPR/MIP viewport) in all three directions. Each port has a set of cross hairs which represent the planes of the other two directions. Hence the vertical cross hair in the transversal viewport represents the sagittal plane and the horizontal cross hair the coronal plane. In addition to the vertical and horizontal cross hairs, there is a third line with a handle (a small circle). This line shows the intersection of the oblique (MPR or MIP) view with the image in the viewport. You can drag the handles to rotate the lines in their viewports. This rotates the viewing plane about the same axis as the viewport. So, if you rotate the cross hair in the transversal viewport for example, the viewing plane will rotate about the transversal axis. By moving and rotating the various cross hairs in the three orthogonal viewports, you can view any cross-section from any direction you wish in the MPR/MIP viewport.
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190 chapter 6 You can move the cross hairs to the left or right (vertical cross hair) or up and down (horizontal cross hair) by clicking on them and dragging. This changes the position of the viewing plane in the orthogonal direction represented by the line. So, if you drag the vertical cross hair in the transversal viewport, you will see the view in the sagittal viewport change to reflect the repositioning of the cross hair. Drag the horizontal cross hair in the transversal viewport and the coronal viewport will change. By clicking close to the intersection of the two cross hairs, you can move both at the same time. While you are dragging, the cursor will change to indicate that you are moving a cross hair. Dragging elsewhere in one of the orthogonal viewports If you click elsewhere in one the orthogonal viewports than on a cross hair and drag, the cursor will turn into a hand and you can pan within the viewport in the usual way. Returning to a well-defined section After moving any of the cross hairs, you can always return to a well-defined section in any of the viewports by clicking the Transversal, Coronal or Sagittal button on the MPR/MIP tooltab.
The blue intersection lines with handles also indicate progress with calculating the MPR/MIP images. They become dashed lines while RA 600 is computing and turn to solid when the new image is displayed. This is most noticeable on relatively slow systems.
If you rotate a single blue intersection line, the image in the MPR/ MIP viewport will be single oblique. If you rotate more than one blue intersection line, three blue intersection lines will be visible in the orthogonal viewports, and the image in the MPR/MIP viewport will be double oblique.
Dragging in the MPR/MIP viewport

Instead of dragging the cross hairs in the three orthogonal viewports, you can also change your view in the MPR/MIP viewport by clicking and dragging anywhere within the MPR/MIP viewport. What happens when you do this is determined by your mouse action setting. You can view and change your mouse action setting on the MPR/MIP tooltab (with the icon). Alternatively, you can right click in the MPR/MIP viewport and select Mouse Action and then the particular action you want to perform from the pop-up menu. (Yet a third way is to select the action from the Mouse Action menu on the menu bar.) When you drag in the MPR/MIP viewport, your mouse cursor will indicate which mouse action is currently selected. There are a total of five options to choose from. If you select Rotate About Horizontal Axis, when you drag upwards or downwards in the MPR/MIP viewport, the image cube in the small viewport near the top right corner of the screen will rotate about its horizontal axis. Dragging left or right in the MPR/MIP viewport after selecting Rotate About Vertical Axis will make the image cube rotate about its vertical axis.
191 Selecting Rotate About Both Axes allows you to rotate the image cube about both its horizontal and vertical axes by dragging up and down or left and right or in some combination of these. Rotate About Viewing Direction means that when you drag left or right in the MPR/MIP viewport the image cube will rotate about the axis you are viewing from. Move Along Viewing Direction means that when you drag up or down in the MPR/MIP viewport your viewing plane will move towards or away from you. By combining these actions (and with a little practice!) you will be readily able to view any cross-section of the image cube from any angle.
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Looking at slices through your MPR/MIP view

Once you have manipulated your view in the MPR/MIP viewport, you may wish to look at various slices through the image volume but without necessarily creating a cine. You can readily do this using the Slice buttons on the Create Cine tooltab (with the clapperboard icon).
Stepping through the image volume

Using the Slice buttons gives you a virtual stack-mode display of slices going backwards or forwards through the image volume. It allows you to step through the image volume (if translation is selected) or rotate the image in steps (if rotation is selected). To step through the image volume 1 2 3 4 Adjust your view as desired in the MPR/MIP viewport. Select the Translation radio button on the Create Cine tooltab (with the clapperboard icon). Set the distance between slices in the Distance/Step (mm) field. Click the << Slice and Slice >> buttons to move backwards and forwards through the image volume.
Rotating your view in steps

This works in much the same way as translation slices, except that you select the Rotation radio button at the top of the Create Cine tooltab. RA 600 will also need to know what axis you want the image to rotate about. You do this by rotating the image in the MPR/MIP viewport in the way in which you want RA 600 to rotate the image when you use the Slice buttons. To rotate your view in steps 1 2 3 4 Adjust your view as desired in the MPR/MIP viewport. Click the Rotation radio button on the Create Cine tooltab (with the clapperboard icon). Set the angular step (amount of rotation per step) in the Distance/ Step (mm) field. Click with the mouse in the MPR/MIP viewport and drag to rotate the image slightly. (This tells RA 600 around which axis you want to rotate the image.)
193 5 Click the << Slice and Slice >> buttons to rotate the image backwards and forwards.
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Creating MPR and MIP cine loops

RA 600 gives you the ability to create and save cine loops of your MPR/MIP generated images. If you save your cine loop, RA 600 stores it with a suitable name together with the original images as a separate series. This means that if you create a translation cine loop after applying MPR, you will obtain a new series of images of the subject which appear to have been taken from a different angle. With MIP, rotation cine loops can help clarify three-dimensional structures and relationships by allowing you to see the subject from different angles. Any MPR/MIP cine loops you save can be played back on any RA 600 system, whether it has MPR/MIP capability or not. This is very useful for referring physicians. When in the MPR/MIP section, you can create a cine loop using the Create Cine Loop tooltab (with the clapperboard icon). This contains all the controls you need to define and create your cine.
If you have a transversal set of images and you want to create a set of sagittal ones (or any other combination of orthogonal directions), this is very easy to do using Quick Setup. Start MPR/MIP with the series you want to convert, then click the Sagittal button on the MPR/MIP tooltab. The MPR/MIP viewport will show the sagittal view of the image volume. Now click one of the translation buttons in the Quick Setup section at the foot of the Create Cine tooltab, and then on Create. Once the cine has been created, click Save.
Setting up cine loops with Quick Setup

While the Create Cine tooltab gives you full control over the cine creation process, it also contains a number of buttons in the Quick Setup section which let you view cines quickly and easily without having to make adjustments in the viewports or enter specific values on the Cine Creation tooltab. The rotation options allow you to create cine loops with 90 or 180 rotation either clockwise or counterclockwise about the vertical and horizontal axes. The translation options (the two buttons at the foot of the tooltab) let you create a translation cine along your viewing direction either from front to back (the button with the down arrow) or back to front (the button with the up arrow). To create an MPR or MIP cine using quick setup 1 2 3 Adjust the image as appropriate in the MPR/MIP viewport. Click the appropriate button in the Quick Setup section of the Create Cine tooltab. Optionally set the size of the steps (distance or angle between the images). If you do not do this, RA 600 will use an appropriate default value. Click Create.
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Setting up MPR/MIP cines in detail

If you create a cine and do not want to save it, click the Off radio button at the top of the Cine Creation tooltab.
While quick setup provides a quick and easy way to create MPR/MIP cines, you can use the controls on the Create Cine tooltab to create precisely the cine you want to see. In the Cine Creation section, you can select the type of cine you wish to create (rotation or translation) or turn off and discard a cine you have created (with the Off radio button). The total distance of the translation or total angle as set by you in the viewports is shown at the top of the Cine Settings section. Below this, you can specify the change in angle in degrees (for rotation cines) or the step in millimeters (for translation). RA 600 then divides this into the total distance or angle to report the number of frames (images) that the newly created cine will contain. Normally it may take RA 600 a few seconds to perform all the calculations required for a complete cine. If you want to view the cine immediately as it is being created, check the Display Cine Creation check box. Once you are happy with your settings, use the Create button to create your cine. When a cine is created, the Create button is replaced by Add and Save buttons that allow you to add your cine to the Pictorial Index or immediately save it as a series within a new study (see Saving cine loops on page 203 for details). To create precisely the MPR or MIP cine you want to view 1 2 3 4 5 Manipulate the cross-section until you are happy with the image in the MPR/MIP viewport as the first image in your cine. Click the Translation or Rotation radio button on the Cine Creation tooltab. Manipulate the cross-section until you are happy with the image in the MPR/MIP port as the last image in your cine. Set the size of the steps (distance or angle between images) under Cine Settings (hence also defining the number of images in the cine). Click Create.
Viewing your cines

To have full control of your cine loops as you view them, use the Cine tooltab (with the movie camera icon). This works in just the same way as when viewing cines of regular series while in the Viewing Section.
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196 chapter 6 You can also save any cines you create while using MPR/MIP for later reference, even on systems that do not have MPR/MIP capability. See Saving cine loops on page 203 for more on this.
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Speed versus image quality

If the radio buttons and Automatic check box on the Quality tooltab are grayed out so you cannot adjust the quality, check that you are not in MPR mode - quality can only be set for MIP images.
MIP in particular requires a considerable amount of computing power. If your system appears to be sluggish and you are having to wait unduly for images to display, you can lower the quality of the MIP images RA 600 produces to improve performance. The quality level can be modified at any time, so you might, for example, set the quality to Low while you set up an appropriate view, and then switch the quality to High to gain the best view of the image. You set the quality of your MIP images using the Quality tooltab. This also contains an Automatic check box. When this is checked, RA 600 will start by creating images at relatively low quality and then, if there is enough time, it will generate images of progressively higher quality. To adjust the quality / speed of display of MIP images click the Quality tooltab (with the sliders icon). Select Low quality (high speed), medium quality or high quality (lowest speed), or check the Automatic check box.
Since MIP demands significant computing power, images are rendered by RA 600 with progressive quality. This means that it produces a quick (and less precise) version of the image to provide a first impression, and then recalculates the image at progressively higher quality levels when time permits. Even if you want to use MIP, use MPR first when selecting a pixel range (since this will display faster). Switch to MIP once you have found appropriate values.
Setting the pixel range

The Quality tooltab also lets you set the pixel range that RA 600 shows when rendering MPR and MIP images. This can be useful in, for example, head CTs, when you can filter out the bone structure by lowering the upper limit appropriately. One use of the lower limit is to remove noise if this is mainly confined to the lower end of the pixel range. To set the upper and lower limits of the pixel range drag the sliders or type specific values in the lower and upper limit fields.
Using range presets

At the bottom of the Pixel Range section of the Quality tooltab you will see a drop-down list and Add and Del buttons. These let you use, create and remove preset ranges of pixel values. It means you can find a good range to use for one study, save this range and then reuse it for future studies. To add a preset pixel range to the drop-down list move the sliders until you have the range you want to include in the list. Click Add. In the Add Pixel range dialog box, enter the name you want to appear in the drop-down list for the range. To remove a preset pixel range select a range from the drop-down list on the Quality tooltab and click Del. To use a preset pixel range ity tooltab. select a range from the drop-down list on the Qual-
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Using volumes of interest (VOIs)

Apart from assisting in the diagnostic process, VOIs can also help speed up the display of MPR and MIP images on slower systems. If you create a VOI, RA 600 only has to calculate values for pixels within this VOI, so permitting higher quality display and speed. The MPR/MIP module may not work optimally with CT Angiography (CTA) because some Hounsfield values may be below contrast-enhanced blood vessels. This happens when it is not possible to use the VOI tool to limit the volume appropriately.
While you are using MPR or MIP, you can also create volumes of interest (VOIs). RA 600 will then only consider image data within this volume. This can be of particular help in the diagnostic process with a CT scan of the head, for example, you can select just one part within the head, effectively allowing you to look inside the skull which will not be displayed. To create a volume of interest (VOI) check the VOI check box on the Quality tooltab (with the sliders icon). Drag the boundaries of the VOI which appear in the orthogonal viewports to define the VOI you want. Click and drag within the VOI to move the VOI (click and drag outside the VOI to pan in the viewport).
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Enhancing, measuring and annotating images

While performing MPR or MIP, you have a number of other tooltabs you can use to perform most of the image processing functions possible when viewing images in the Viewing Section, such as windowing, zooming and measurement and annotation. For details on how to use these tooltabs, see the appropriate sections in chapter 4.
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Using the Pictorial Index for MPR/MIP

If you cannot see a Pictorial Index on your screen, this is probably because it is empty. Until you actually save some images in it, RA 600 may hide it from view.
The Pictorial Index on the MPR/MIP screen is similar to that found in the Viewing Section, except that it also acts as a kind of clipboard to which you can add any image shown in your viewports for viewing at a later time.
Adding MPR/MIP images to the Pictorial Index

When you first open a series in MPR/MIP, the Pictorial Index will be empty. As you explore the series using MPR or MIP and create views that you might wish to go back to, you can readily place these in the Pictorial Index. They will be temporarily stored in the Pictorial Index ready for you to view again at any time during your MPR/MIP session. You will also be able to save the contents of the Pictorial Index for future reference when you leave MPR/MIP (see Saving your MPR/MIP images on page 202). To add an image in any viewport to the Pictorial Index click on the viewport containing the image you want to add. (This will make the viewport the active viewport, indicated by a box (red on color monitors) around the viewport.) Click the Add Current Image button on the MPR/MIP tooltab (with the icon). Or To add the image from the MPR/MIP (oblique) viewport to the Pictorial Index the Add Oblique Image button on the MPR/MIP tooltab. click
If you start MPR/MIP while in the Viewing Section, you can readily add the images you are interested in to the MPR/MIPs Pictorial Index and switch back from MPR/MIP to the Viewing Section. The MPR/MIP images will be available in the Pictorial Index in the Viewing Section (as part of a new series) for further processing (with filtering for example), annotation, etc.
Loading images into the MPR/MIP (oblique) viewport

Once you have added images to your Pictorial Index, you can view them again in the MPR/MIP viewport at any time during your MPR/MIP session. To load an image in the Pictorial Index into the MPR/MIP (oblique) viewport on the image in the Pictorial Index. click
The contents of the MPR/MIP viewport will be replaced by the image you click on.
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Add oblique or current image?

You will notice two Add buttons in the Pictorial Index section of the MPR/ MIP tooltab Add Oblique Image and Add Current Image. If you use the Add Oblique Image button, the image saved will always be the image in the MPR/MIP (oblique) viewport, irrespective of which viewport is currently active. Clicking on Add Current Image will save the view in the currently active viewport, whether one of the orthogonal viewports or the MPR/MIP viewport.
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Saving your MPR/MIP images

While using MPR or MIP, you can save any images or cines you create for later reference, or perhaps to send to another RA 600 workstation which does not have MPR/MIP capabilities. To save images displayed in any of the viewports while using MPR/MIP add them to the MPR/MIP screens Pictorial Index (see Using the Pictorial Index for MPR/MIP on page 200). You will then be given the opportunity to save these images when you leave MPR/MIP. Any images you save will be placed in a special series in the same study as the series you were looking at in MPR/MIP.
Saving images or transferring them to the Viewing Section

If you have placed images in the MPR/MIP screens Pictorial Index when you leave MPR/MIP, you will see one of two dialog boxes, depending on whether you started MPR/MIP from the Data Selector or from within the Viewing Section. If you opened a series for MPR/MIP viewing from the Data Selector (i.e., with the MPR or MIP button), you will see the Transfer to Viewing dialog box. You check the Newly created image(s) check box if you want to add to the study the images you included in the Pictorial Index. RA 600 will create a new series from the images. You check the Presentation State check box in conjunction with the Newly created image(s) check box if you also want to save the images as a presentation state. In addition to a new series being added to your study, a presentation state will appear at instance level in the Data Selector. (See Working with presentation states on page 92 for more information on presentation states). Checking only the Presentation State check box will not result in any addition to the study; i.e., neither a presentation state nor a series will be added your data for the study. Checking only the Newly created image(s) button will result in the images appearing as an additional series in the study. If, however, you opened a series for MPR/MIP from within the Viewing Section you will see the Save Data dialog box after saving images to the Pictorial Index. This allows you to immediately add your new MRP/MIP images as a series to the study you were viewing in the Viewing Section.
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Saving cine loops

As well as saving sets of individual images, you can save cine loops you have created using MPR/MIP, either as new studies or as new series within the study containing the series you originally opened in MPR/MIP. You save cines you create in MPR/MIP using the Add button or Save button on the Create Cine tooltab. These buttons replace the Create button which you use to create cines and are shown as soon as a cine has been created. To save an MPR or MIP cine as a series in a new study after creating your cine loop, click the Save button on the Create Cine tooltab. In the Save Cine dialog box, change the folder the study is to be saved in, the study description and the series description as desired. Complete the Presentation State section if you want to save your work as a presentation state (see Working with presentation states on page 92 for more information on presentation states). To save an MPR or MIP cine as a series within the same study as the series you are viewing in MPR/MIP after creating your cine loop, click the Add button on the Create Cine tooltab. Then give your work a description in the Add Cine to Pictorial Index dialog box. This will place the images in the cine in a separate series in the Pictorial Index.When you leave MPR/MIP, make sure that the Newly created cine series check box is checked in the Transfer Data to Viewing dialog box (if you started MPR/MIP from the Data Selector) or that the Newly created cine series check box is checked in the Save Data dialog box (if you started MPR/MIP from the Viewing Section). In the latter case you will be returned to the Viewing Section where you can view and possibly modify your cine. When you leave the Viewing Section, make sure that the New image(s) check box is checked in the Save Data dialog box to save your cine. You check the Presentation States check box if you want to save your work as a presentation state (see Working with presentation states on page 92 for more information on presentation states).
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C H A P T E R
Sending and receiving data

Teleradiology - sending image and image-related data over networks and telecommunications links - is a vital aspect of medical imaging. This chapter explains how you can keep track of the data you receive, and how you can send series and studies to specific destinations. It also covers how you can send individual images in urgent cases directly from the Viewing Section of RA 600, as well as how to use many automatic features such as locking and unlocking studies, forwarding them to another site, redirecting them to a backup site and using storage commitment to ensure that important image data is safely stored on another system.
What you need for teleradiology ............................206 Receiving series and studies .................................207 Monitoring the receive process ..............................209 Sending images using the Data Selector ...............210 Working with study management ...........................212 Monitoring and controlling the send process..........214 Setting priorities and sending in an emergency .....215 Looking in detail at what you have sent .................218 Sending from the Viewing Section .........................220 Compression in teleradiology.................................222 Sending studies automatically................................225 Storage commitment ..............................................228
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206 chapter 7 eleradiology allows you to send series, studies, images or image-related data to another RA 600 or other DICOM 3.0 compliant system. Lossless compression is used as standard and there are elaborate built-in checks to ensure that the data received is exactly the same as the data sent. In addition, the whole process of sending and receiving data can be monitored and checked at a later stage. You will generally routinely send studies while you are in the Data Selector, but you can also quickly send selections of images while in the Viewing Section as and when required.
What you need for teleradiology

Teleradiology can be achieved via normal analog telephone lines, ISDN lines, satellite links, ATM, and hospital local area networks using Ethernet, for example. To use an analog or ISDN telephone line, your system will require a modem or ISDN terminal adapter. The faster this is, the shorter your transmission times will be. Since medical images represent large amounts of data, ISDN (or ATM) is recommended for routine use of teleradiology. To use teleradiology within a hospital using a local area network, a network card must be used instead of a modem. Please refer to your distributor or hospital network integrator for installation. You receive studies from an origin, and send them to a destination. To create and configure these, see the RA 600 Installation and Configuration Guide.
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Receiving series and studies

Receiving studies is in some ways rather like you might receive email. It takes place automatically in the background, so you can continue to work undisturbed. Indeed, you can be sent studies when you are not even using RA 600. As long as your system is switched on, you will continue to be able to receive. When RA 600 has received a study, it will - provided no errors have been reported - automatically place it in the appropriate place(s) in your study list and/or folders ready for you to use.
Looking to see what you have received

You can check on what you have received at any time. You do this by using the Teleradiology tooltab (with the telephone icon). To see what images youve received diology tooltab. click the Receive Log button on the Telera-
You can also select Connection Receive Log from the Data Selector menu bar to view your Receive Log.
Your Receive Log will appear. This will show you all the studies or series you have received along with various details about them and the transmission. You can scroll and resize the columns to view all the information. All successfully received studies are displayed in the Data Selector unless there is already a study present in the list with the same DICOM UID (Unique IDentifier). This prevents confusion as a result of double entries in your study or patient list. Also, studies will be displayed in the study or patient list only when they have been completely received and checks have verified the integrity of the transmission. For security reasons and for the protection of both users and patients, RA 600 will never accept and display partially received or unchecked data. If a study consists of a number of series and the remote site decides to send one series or even a smaller selection of images first and the rest at a later stage, then all series received that belong to the same study will be placed automatically in the relevant study folder in your study list.
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208 chapter 7 To view more details on an entry in the Receive Log click in the first (Origin) column of the entry to select it and then click Details.
To select an entry in the Receive Log, you must click the entry in the left-most column. You can also double-click on the left-most column of an entry to view the Receive Log.
Deleting entries in your receive log

Periodically you will want to clear out your receive log (although if you wish to keep a permanent record of what you have received, you should first export (save) your receive log to a file, see Exporting (saving) your receive log on page 208). To delete entries in your receive log click the Receive Log button on the Teleradiology tooltab. Then select the entries you wish to delete (click in the first column of an entry to select it, hold down the Ctrl key to select multiple entries, or the Shift key to select a range of entries). Click Delete.
RA 600 can be configured to automatically remove (delete) the oldest log entries when your receive log reaches a certain size (the default is 500 entris). To check if your system is using this feature and perhaps to enable or disable it, select Configuration Connection Service, click the Maintenance tab and then the Help button for further information.
Exporting (saving) your receive log

You may well want to keep a permanent record of what you have received and when. You can do this by exporting the receive log information to an external file. To export (save) your receive log 1 2 Open the Receive Log (click Receive Log on the Teleradiology tooltab). Select the entries you want to export (click in the first column of the entry you want to save hold down the Ctrl key to select multiple entries, or the Shift key to select a range of entries) and click Export. In the Export dialog box, enter the name of the file you want to export to in the To File field (or click the Browse... button to locate a file). If required, change the separator to be used between field entries in the exported file. If required, change the list of items of information to be exported (shown in the Exported list). Select items in the Available Fields list and use the Add >> and << Remove buttons to add or remove selected items to and from the Exported list. (You will not need to do this each time you export the contents of the receive log RA 600 automatically remembers what settings were used the last time it was exported.) Click Export.
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Monitoring the receive process

You can follow the progress of the receive process by viewing the Teleradiology tooltab. When your system is receiving, you will see at the top of the tooltab and to the right of the word Active a number usually followed by a percentage. You should also see an indicator light (green on color monitors) to the right of these. The number to the right of Active indicates the number of jobs currently being received. For systems with a single modem or ISDN adapter, this will be 1 since they can only receive one job at a time. If, however, you have more than one modem or adapter and/or a network card in your system, the number may be higher. If you are receiving a single study coming from another RA 600 system you will see that the figure is followed by a percentage indicating how much of the study has so far been received. Viewing the receive process in detail Also close to the top of the Teleradiology tooltab is the Receive Queue button. This lets you see exactly what you are receiving and what progress is being made. You can resize the columns and scroll to view more information.
The Remaining column in the Receive Queue dialog box is shown only if the remote system supports this. Otherwise a - is shown.
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Sending images using the Data Selector

You can also select and send a few images on the fly when viewing them in the Viewing Section (see Sending from the Viewing Section on page 220). This may, for example, be important during an emergency when time is at a premium. Sending a selection of images from a study is, however, a potential source of confusion. For routine teleradiology, you should use the Data Selector whenever possible.
You can send images from your system to another RA 600 system or other DICOM 3.0 compliant system. Like receiving, sending happens in the background. You do not even need to run RA 600 to be able to send studies. You generally send images while you are working in the Data Selector. You do this by using the Send section of the Teleradiology tooltab (with the telephone icon). This section includes a list of possible destinations, a Send button, a display of information on the progress of your transmissions and buttons to let you view your Send Queue and Send Log. To send a study or series from the Data Selector 1 Select the study or series in your study or patient list (select multiple studies and/or series by holding down the Ctrl key or by using the Shift key to select a range). In the Destinations pane, select the site or sites to which you want to send one or more images. Click Send. In the Send to dialog box, specify the format you would like to use from the Format drop-down list (and use the Compression Parameters drop-down list if you have specified some form of compression). Make sure the Send Immediate check box is checked if you wish to send immediately. If you want to send at a later time, uncheck the Send Immediate check box and enter a time in the Transmission Time fields. If you wish the study or series to be deleted from your system after it has been sent successfully, make sure the Delete After Send check box is checked. Check the Study Status ID check box if you want to send the study status ID of the study you have selected for transmission. Make sure the Images check box is checked and select any other Information Object Definitions (IODs) you want to send. See Working with study management on page 212 for more information on this topic.
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You can also send a study by right-clicking on it in your study or patient list and selecting Send from the right mouse button menu.
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If you are sending a series which is just part of a study, the whole study to which this series belongs will be deleted from your system if you check the Delete After Send check box.
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The Transmission Parameters section initially shows the default settings for the site to which you are sending data. If you generally transmit data using different settings to these defaults, you can avoid re-entering the settings each time by reconfiguring the teleradiology settings for your destination. Consult the Installation and Configuration Guide or consult your System Administrator for more information on configuring destinations. In many countries call charges for using the public infrastructure (telephone/ISDN lines) are lower during the evening or night. If you routinely send data from your system to others, you may consider it more cost-effective to use this period.
Click OK to send your study, or OK All if you are sending multiple studies and wish them all to be sent with the same parameters.
When you click OK in the Send To dialog box, the job will be sent immediately or at the later time you have specified. If you have selected multiple studies to send, your next job will be displayed. Click OK All if you do not want to alter the transmission parameters for each one of your multiple studies individually. Clicking this button will start the send process for all your studies. Click Cancel to cancel the individual job or Cancel All to cancel all the jobs you were preparing to send. Click Advanced to view a dialog with additional settings. Consult the online Help for more information. Sending parts of studies Typically, you will send complete studies or series using the Data Selector. It is, however, possible to send selected images, although you will not be able to visually check which ones you have selected. If you want to send an individual image or selection of images, you could use the Teleradiology tooltab in the Viewing Section.
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Working with study management

Just as RA 600 can send and receive images, it can send and receive presentation states, key images, key notes, structured reports and study status information. If other workstations with which RA 600 is communicating are using the DICOM standard - or at least parts of it - they, too, can operate in this fashion.
Archive Images from Modality/QC
Images
Images
Intensive Care Unit
Study Status ID Presentation States Structured Reports Key Notes
Diagnostic
A typical situation in which study status management can be used
Because RA 600 can send these particular data elements on their own (i.e., without the image data), it uses less bandwidth, which consequently increases network performance. Other advantages include less likelihood of image corruption and fewer double readings. To send study items to a new destination 1 2 3 4 Select a study in the Data Selector. Select a destination from the Send section of the Teleradiology tab in the Data Selector. Click the Send button beneath the Destinations pane in the Send section of the Teleradiology tab. Check the Send Immediate check box if you want RA 600 to send your image-related data immediately. Otherwise, leave this check box unchecked and specify the time at which you want it to send your images using the Transmission Time drop-down list. In the Options and Send IODs sections, click in the check boxes to indicate the IOD items you want to send. Check the Delete After Send check box if you want RA 600 to remove the items after it has sent them.
213 6 Click OK.
If you receive presentation states or key images etc., you will not see an update of the images if you are viewing images in normal mode. If you are viewing images in Direct View mode, the viewing station will display them as they arrive. (See Viewing images as they arrive on page 171 for further information on direct view mode.) When you are in viewing mode, you cannot send a study status ID, just as you cannot send key notes, structured reports and presentation states you have just created.
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Monitoring and controlling the send process

Using the Teleradiology tooltab (with the telephone icon), you can see at a glance if and how many studies are waiting to be sent (pending), whether any are currently being sent (active) and whether any errors have occurred during transmission. If you routinely send data to other sites while absent, you can very quickly check the status of your transmission when you return. For a more detailed view, click Send Queue on the Teleradiology tooltab. The Send Queue dialog box gives you information on the jobs that are currently active and those that are waiting to be sent out. The buttons on the right of the Send Queue dialog box let you view more details on a particular job, remove (delete) a job from your queue, stop a job currently in progress (though this may continue until the current series has been sent) and suspend (postpone) or resubmit (resume) a job. You can also set the priorities of jobs by using the Increase Priority and Decrease Priority buttons (see Setting priorities and sending in an emergency on page 215). To stop, suspend, resubmit or delete a job in the Send Queue first select the job or jobs in the list by clicking in the first (Destination) column (hold down the Ctrl key to select multiple jobs, or the Shift key to select a range of jobs). Then click Stop, Suspend, Resubmit or Delete.
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Setting priorities and sending in an emergency

You can assign priorities to each job you submit for sending to determine the order in which they will be sent. This may be particularly important if a study needs to be sent immediately even if there are other jobs waiting to be sent (see Sending a job immediately in an emergency on page 216). You can see the priorities assigned to your send jobs at any time in the Send Queue dialog box. To view the priorities of send jobs click the Send Queue button on the Teleradiology tooltab in the Data Selector. Look in the Priority column of the send queue. You can set the priority of a send job when you submit it or when the job is in the send queue waiting to be sent. To set the priority of a send job when submitting it click the Advanced... button in the Send to... dialog box and then the Transmission Parameters tab of the Advanced Transmission Properties dialog box. Select the priority you require from the Priority drop-down list. To change the priority of a send job after submitting it click the Send Queue button on the Teleradiology tooltab in the Data Selector to view the Send Queue. Click in the first column on the job you wish to change the priority of to select it. Click the Increase Priority or Decrease Priority button until the desired priority is shown in the Priority column.
Setting the default priority of send jobs

Unless you explicitly set a priority to a send job, RA 600 will assign a default priority to the job. Typically this will be the Normal priority. You can, however, change the priorities that RA 600 automatically assigns for each destination that you send images to. This makes it possible, for example, to send images to an archiving system with Low priority but to a system in an Intensive Care Unit (ICU) or Emergency Room (ER) with High priority without requiring any manual intervention.
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Sending a job immediately in an emergency

An alternative way to send a job immediately in an emergency which does not rely on assigning priorities is as follows: Prepare the job for sending it should appear in your send queue. Select all jobs other than your high priority job (select ranges of jobs by clicking in the first (Destination) column on the first job in the range and, holding down the Shift key, click in the first column on the last job in the range; add jobs to the selected ones by holding down the Ctrl button as you click on the first column of the job). Click Suspend. All the jobs except your high priority job will now be suspended, and your high priority job will be sent. Once the urgent job has completed, reselect all the suspended jobs and click Resubmit.
In an emergency, it may be important for a particular job to be sent immediately even if there are other jobs in the queue waiting to be sent. You do this by assigning the priority Highest to the job. If there are other jobs in the send queue which also have the priority Highest assigned to them, you will need to change the priority of these other jobs if you are to be certain that your particularly urgent job is sent first. To send a job immediately 1 Click on the study to be sent in the study or patient list in the Data Selector, and click on the destination to which the study is to be sent in the Send section of the Teleradiology tooltab to select it. Then click the Send button. In the Send to... dialog box, make sure the Send Immediate check box is checked and change the send parameters and add notes as necessary. You can set the priority of this job to Highest at this point, or do this later in the send queue (if you do it now, you can skip step 4). To set the priority now, click the Advanced... button and then the Transmission Parameters tab of the Advanced Transmission Properties dialog box. Then select Highest from the Priority drop-down list. Click OK in the Send to... dialog box to submit the job and then the Send Queue button on the Teleradiology tooltab to view the send queue. If you have not yet assigned the priority Highest to the job, locate the job in the send queue (the Patient and Study columns should provide enough information for this - if you cannot see them completely, use the scroll bar along the bottom of the send queue to bring them fully into view). Click in the first (Destination) column of the job which is to be sent immediately and then on the Increase Priority button until the priority is set to Highest. Check the Priorities column of the send queue to see whether any other jobs have the priority Highest. If there are other jobs, select these jobs by clicking in the first (Destination) column of the jobs to select them (hold down the Ctrl key to select multiple jobs) and then click once on the Decrease Priority button to set their priority to High.
217 6 Optionally select the job that is currently being sent (if this is not already your priority job!) and then click the Stop button to halt this transmission and so allow the urgent job to start more quickly. This could be useful if the current job being sent is very large, although RA 600 may well complete the transmission of the series currently being sent before it stops the job. If you have not yet assigned the priority Highest to the job, locate the job in the send queue (the Patient and Study columns should provide enough information for this - if you cannot see them completely, resize the send queue by dragging on a corner or use the scroll bar along the bottom of the send queue to bring them fully into view). Click in the first column of the job which is to sent immediately and then on the Increase Priority button until the priority is set to Highest.
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Looking in detail at what you have sent

You can also select Connection Send Log from the Data Selector menu bar to view your Send Log.
You can check in detail on what image data you have sent at any time using the Teleradiology tooltab (with the telephone icon). To see what data you have sent tooltab. click the Send Log button on the Teleradiology
Your Send Log will appear. This will show you all the studies or series you have sent along with various details about them and the transmission. You can scroll and resize the columns to view more information. To view more details on an entry in the Send Log click in the first (Destination) column of the entry to select it and then click Details.
To select an entry in the Send Log, you must click in the left-most column. You can also double-click on the left-most column of an entry to view more details on it.
Deleting entries in your send log

Periodically you will want to clear out your send log (although if you wish to keep a permanent record of what you have sent, you should first export (save) your send log to a file - see Exporting (saving) your send log on page 218). To delete entries in your send log open the send log (click Send Log on the Teleradiology tooltab). Then select the entries you wish to delete (click in the first column of an entry to select it, hold down the Ctrl key to select multiple entries, or the Shift key to select a range of entries). Click Delete.
Exporting (saving) your send log

RA 600 can be configured to automatically remove (delete) the oldest log entries when your send log reaches a certain size (the default is 500 entries). To check if your system is using this feature and perhaps to enable or disable it, select Configuration Connection Service, click the Maintenance tab and then the Help button for further information.
You may well want to keep a permanent record of what you have sent and when. You can do this by exporting the send log information to an external file. To export (save) your send log 1 2 Open the Send Log (click Send Log on the Teleradiology tooltab). Select the entries you want to export (click in the first column of the entry you want to save hold down the Ctrl key to select multiple entries, or the Shift key to select a range of entries). Click Export. In the Export dialog box, enter the name of the file you want to export to in the To File field (or use the Browse... button to locate a file). If required, change the separator to be used between field entries in the exported file.
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219 6 If required, change the list of items of information to be exported (shown in the Exported window). Select items in the Available Fields list and use the Add >> and << Remove buttons to add or remove selected items to and from the Exported list. (You will not need to do this each time you export the contents of the send log RA 600 automatically remembers what settings were used the last time it was exported.) Click Export.
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Sending from the Viewing Section

Although you will routinely send studies and series using the Data Selector, there might be situations - such as urgent cases or when connection time or bandwidth is scarce - in which you would like to select just a few images on the fly and send them while looking at images in the Viewing Section. In such cases, you can use the Teleradiology tooltab (also with the telephone icon) in the Viewing Section. This tab only offers you a Send section in which you can select a pre-configured destination site. To send images from the viewing section
You should use this method of sending selections of images only in well defined situations. At the receiving end there is no easy way of knowing that what you have sent is just a selection from a larger entity. This can lead to misunderstandings. You should develop procedures to handle this form of teleradiology. This could mean, for example, that you always add a submission note explaining that the material sent is just a selection.
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Open a study from the Data Selector. Click on the Teleradiology tab in the Viewing Section. Select the site in the Destinations list you want to send images to. Click the Send button. Select the viewport containing the image you want to send. Double-click on the viewport. The image will be added to the list in the Compose Teleradiology Job dialog box. Repeat steps 5 and 6 until you have added all the images you want to send. Click Submit in the Compose Teleradiology Job dialog box. Adjust the settings in the Send to... dialog box as required and click OK.
The double-click action to pin images to a viewport is temporarily disabled to allow you to select images to send with a doubleclick. If you want to view your send queue or send log, you will have to switch back to the Data Selector and use the Teleradiology tooltab there.
If you want to send a whole series, you do not need to double-click on each image individually, simply click on one of the images in the series and then Insert Series in the Compose Teleradiology Job dialog box. If you decide you dont want to send an image which has been selected for sending, select it in the Compose Teleradiology Job dialog box and then click Delete. You can move the Compose Teleradiology Job dialog box around by clicking on and dragging its title bar. While you can use all the features of the Viewing Section when selecting images to send, you can only send original images. In other words, if you zoom an image or apply a filter before selecting the image for transmission, RA 600 will send the original image without the changes you have made.
221 Permanently saved presentation states and key notes will reach their destination. This means you must exit the study and save it using the Save As dialog box. If a selection has been sent to another DICOM-compliant destination, the images will be stored in the remote database as a DICOM study. If the remainder of the series is sent to the same remote site at a later time, the newly arrived information will be stored with the same study.
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Compression in teleradiology
Teleradiology is, of course, a very powerful tool for distributing image information quickly to where it is needed. Many types of study are, however, very large and telecommunications links often comparatively slow, so studies can take a considerable time to send in uncompressed form. RA 600, therefore, offers a variety of ways of compressing images before sending them (and decompressing them at the other end).
Lossless or lossy compression?

When selecting a form of compression to use when sending studies, the most fundamental choice is between lossless and lossy compression. As the name implies, lossless compression means that none of the information in images is lost when decompressed on the other system, images will appear exactly as they were sent. This is not the case with lossy compression some of the image detail will be lost in the compression and decompression process. The advantage of lossy compression is that it achieves greater compression and hence smaller and faster transmission jobs than lossless compression. Generally, it is best to use lossless compression when practicable when you are sending images over a reasonably fast network or sufficient time is available even over a connection of limited bandwidth. For low bandwidth connections and/or when time is at a premium, you may well need to use lossy compression.
The compression options

RA 600 offers a much wider choice besides lossy or lossless. Depending on how your system is configured, you can choose some or all of these options when sending studies using teleradiology. DICOM 3.0 is not a compressed format at all. Images are sent in uncompressed form. It is part of the DICOM standard and allows images to be transferred between systems from different manufacturers. It is used for transmitting images with no loss of quality to non-RA 600 systems over relatively high bandwidth links. JPEG Lossy is a lossy form of compression. As part of the DICOM standard, it allows images to be readily transferred between different manufacturers' systems. Use for sending images when bandwidth and transmission time are an issue.
223 If it is used to send images to versions older than 6.0, the actual transfer syntax will consist of a DICOM transfer syntax (DICOM JPEG Lossy), in which case, only unsigned 8- and 12- bit images can be compressed. If you use this option to send images from one version of RA 600 V6.1 to another version of 6.0, the actual transfer syntax used will be a private transfer syntax for images other than unsigned 8- and 12- bit images. In that case, all images can be compressed, except for images containing image overlays. DICOM JPEG Lossless like the lossy version, this is a format which, as part of the DICOM standard, allows images to be readily transferred between different manufacturers' systems. Compression is not as high as for the DICOM lossy format, but image quality is of course not diminished. This transfer syntax can handle 2 - 16 bit, grey-scale images and 8 bit (stored) RGB images (color per pixel). ZLIB a general all-purpose lossless compression method that compresses everything in lossless format. It is based on a private transfer syntax. Run length encoding a new compression method. Used often with YBR images, it is particularly useful for encoding black and white images where the data units are single-bit pixels. It is often used for Doppler ultrasound images. RA 600 V6.1 can only decompress images by means of run length encoding. Wavelet lossy Wavelet compression which produces high levels of compression. It is not part of the DICOM standard and, so, depends on a private transfer syntax. If you use this option to send images to versions older than 6.0, the actual transfer syntax used will be a plain DICOM (3.0) transfer syntax, so images will not arrive in compressed form.
JPEG and Wavelet what compression factor?

If you are using JPEG lossy compression, the higher the quality factor, the lower the compression ratio. A quality factor of 10 will, therefore, produce much higher compression but poorer image quality than a quality factor of 50. Likewise, for Wavelet compression, the greater the quality factor the lower the compression. A QF of 5 will therefore produce lower quality images than a QF of 99.
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Some additional notes about compression

RA 600 compresses data as is, unless the auto-compress or auto-decompress option has been turned on. Plain DICOM or lossless formats can be compressed or re-compressed in any other compression type. Once an image has been compressed lossy, you cannot apply another lossy compression - not even after decompression.
The results you achieve depend very much on the types of images you send. If you are unsure about which quality factor to use, you may wish to experiment with various settings, using a selection of images which are typical of what you normally transmit. Also note that JPEG and Wavelet quality factors are not interchangeable. For example, a JPEG quality factor of 90 is not the same as a Wavelet quality factor of 90.
JPEG Lossy compression and storage commitment

Storage commitment will always fail when Service Class Providers automatically compress incoming images with JPEG Lossy format! This is because the pixel data of images compressed with JPEG lossy changes and, so, images receive a new instance UID. Service Class Providers will therefore always return a different instance UID to Service Class Users than that which Service Class Users expect to receive. You should therefore make sure that clients are not configured to automatically compress incoming images with JPEG Lossy format if you want to ensure successful storage commitment.
How to tell if lossy compression has been used when receiving studies
You can also see whether an image has been compressed by adding the Derivation Description tag (0008, 2111) to the Data Selector at instance (image) level. Adding this tag at this level will also show the quality factor with which an image has been compressed.
It is often of great importance to know whether the images received by a system have been compressed with a lossy form of compression. You will then know that the image is not as it was originally sent, but has lost some detail in the transmission process. Because of the importance of this, RA 600 will always indicate with a non-removable message in a viewport that the image it contains has been lossy compressed. This is consistent with the American FDA recommendations for the display of lossy compressed images.
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Sending studies automatically

You can also use Auto Transmit to automatically send images converted from another format when these need to be made available on another system.
As well as sending studies manually, you can instruct RA 600 to send studies automatically when a particular event takes place. This is called auto-routing. A simple and widely used example of this is having studies received by your system forwarded to another system or systems. Doctors might, for example, use auto-routing to forward studies received at a system in the hospital to a system at their practice or home. Or studies could be sent to one destination during office hours and to another system at other times. Apart from forwarding received studies, auto-routing can be used to send sets of newly-defined key images, studies saved after acquisition or viewing, and studies after various events in quality control. To set up automatic routing, see the RA 600 Installation and Configuration Guide.
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Automatically locking and unlocking studies

Studies can be locked in RA 600 to prevent their accidental deletion and the loss of data this would cause. Locking and unlocking can be performed manually in the Data Selector (see Protecting studies with delete locks on page 69). It is, however, also possible to have RA 600 lock studies automatically as soon as they are received, thus immediately protecting the data they contain. To set up automatic locking and unlocking, see the RA 600 Installation and Configuration Guide.
Unlocking individual studies when you send them

Apart from having RA 600 automatically unlock studies, you can specify for particular send jobs that the sent studies should be unlocked when you create those send jobs. To specify that studies for a particular send job should be unlocked when sent prepare the send job for sending in the usual way, but before clicking OK in the Send to dialog box to submit the job, click the Advanced button. Click the Transmission Parameters tab of the Advanced Transmission Properties dialog box and make sure the Unlock Study After Send check box is checked. Overriding automatic unlocking of studies for individual studies If RA 600 has been set up to automatically unlock studies sent to the destination you are sending to, you can have the studies for a particular send job not unlocked. When you create send jobs you can override the RA 600 default setting concerning unlocking studies. To do this, simply make sure that the Unlock Study After Send check box on the Transmission Parameters Tab of the Advanced Transmission Properties dialog box is unchecked.
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Redirecting images to a backup site

For any one of a number of reasons, the transmission of images to a particular site may fail. RA 600 will typically retry sending them a specified number of times, but if the transmission has not then been successful, workflow problems might arise as it would not be possible to delete these images from the sending system. For this reason, RA 600 allows backup sites to be defined to which images will be sent if the intended destination is not available. To configure a backup destination, see the RA 600 Installation and Configuration Guide.
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Storage commitment
Storage commitment will, of course, only work if the other system supports it. In particular, storage commitment will only work with other DICOM systems. For storage commitment, the receiving system must also be configured correctly. In particular, since it must send back the storage commitment it must know the DICOM connection parameters (host name, AE title and port number) of the sending system. When the receiving system is a RA 600 workstation, you do this by simply adding a DICOM destination to the sending system.
When transferring medical image data from one system to another using teleradiology, it is obviously important to know that the system the images are being sent to has received them correctly before they are removed from the system that sent them. This may, however, not be sufficient to ensure that valuable data is not lost. Suppose, for instance, that the system receives the images okay, but that they are deleted from this system as well shortly afterwards. To deal with this situation, DICOM defined storage commitment. This means that when a system sends images, it can check before deleting its own copies of them to make sure that the images were not only received by the other system but that this other system has also committed to storing those images. It is possible to request storage commitment from a client other than the one to which images have been sent. In practice, this means you can send images to a machine that can subsequently forward the data to an archive, for example. The archive can then open a new DICOM connection and send the commit to the machine requesting storage commitment. The result is fewer transfers over the network and quicker response times. To use storage commitment when sending images 1 2 3 4 5 Prepare your studies for sending in the usual way (see Sending images using the Data Selector on page 210). Before clicking OK in the Send to dialog box, click the Advanced... button. In the Advanced Transmission dialog box, click the Transmission Parameters tab. Make sure the Use Storage Commitment check box is checked. Select from the drop-down list the client from which you want storage commitment if this machine is different than the destination you selected.
229 It may well be that you always want to use storage commitment when sending studies to a specific system. You can arrange this by modifying the properties of this destination. (You will always be able to override this for particular send jobs by following the procedure above for sending images using storage commitment, but by making sure the Use Storage Commitment check box is not checked.)
Storage Commitment and JPEG Lossy Compression

Storage commitment will always fail when Service Class Providers automatically compress incoming images with JPEG Lossy format! This is because the pixel data of images compressed with JPEG lossy changes and, so, images receive a new instance UID. Service Class Providers will therefore always return a different instance UID to Service Class Users than that which Service Class Users expect to receive. You should therefore make sure that clients should not be configured to automatically compress incoming images with the JPEG Lossy format if you want to ensure successful storage commitment.
You can always use storage commitment for a particular destination by setting this option in the destination. You need administrator access to do this. See the Installation and Configuration Guide for information on editing destinations.
Setting a time-out value

You can set a maximum time for your system to wait for an answer from the other system before indicating that storage commitment has not succeeded. If this time has exceeded, the job in the send queue receives the status Error. To set a time-out value for storage commitment, see the Installation and Configuration Guide.
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C H A P T E R
Acquiring images and data

An RA 600 system can be configured as a full acquisition workstation. This chapter explains how you can select and control specific acquisition devices directly from within RA 600, manipulate and refine your acquired images, compose studies and series, and add patient information.
RA 600An overview of the acquisition process ......232 The acquisition screen ...........................................234 Acquiring an image ................................................236 Controlling acquisition devices within RA 600........237 Pre-defining image formats (image types) .............238 Using the clipboard and directly importing files......240 Manipulating and refining your images ..................241 Creating studies using various acquisition types ...242 Organizing your images .........................................243 Adding patient information .....................................244 Saving your study...................................................246 Specific device support ..........................................247
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An overview of the acquisition process

RA 600 includes comprehensive facilities for acquiring images and patient data on your system to await diagnosis, or for viewing or sending elsewhere using other parts of RA 600. There are three main types of device you can use for acquiring images: a digitizer for photographic film, a frame grabber for video or a document scanner for documents, illustrations or photographs. You can also import images from other Windows applications (such as a digital photography software package) via the Windows clipboard, or directly from standard bitmap files (BMP and TIFF). How you acquire images will depend on which type of acquisition device you are using but the general processes involved are the same.
Acquisition support
RA 600 supports a wide range of acquisition devices. Please refer to your distributor for details on which specific models are supported. Before you can start acquiring images, your system and acquisition devices must be properly installed and configured. Installing acquisition devices can be a complex process and is beyond the scope of this manual. You should also refer to your system administrator or distributor for assistance in this. Importing from the clipboard and graphics files will be available only if these options were selected during installation. If you cannot use these options, consult your system administrator or distributor.
To create a new study using acquisition 1

If the acquisition device (digitizer, document scanner) is a SCSI device, such as the Howtek and Vidar models, it must be switched on before you turn on your system. If you switch the digitizer on later, your system will not recognize it and you will not be able to use it.
Gather all the images you want to acquire. Digitize a film, grab an image or scan your document, illustration or photograph. Select a region of interest (ROI) and/or manipulate the acquired image as required. Add the selected image or ROI to the study (RA 600 can also do this automatically for you). Repeat steps 2 to 4 for all the other images which are to be added to the same study.
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If you are using a digitizer, you may also want to scan patient cards and enter patient information before you digitize your films.
After you have acquired and processed all the images that relate to a study, add the patient information. Save the study.
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The acquisition screen

To acquire images, you use the Acquisition tooltab in the Data Selector.
If you click the Acquire Image(s) button and see the message No default device could be activated (instead of going to the acquisition screen), its possible that you have installed acquisition devices on your system but have not activated any as the default. See the Installation and Configuration Guide for details.
To start acquiring images click the Acquisition tooltab (with the camera icon) in the Data Selector. Then click the Acquire Image(s) button. The acquisition screen has one large viewport in the center, and typically the Pictorial Index on the left and your Acquisition tooltab on the right. Below the tooltab you will see a Save button (to save your acquired images), a Reset button (to undo any processing you have made to your images and return them to their state when first acquired) and a Back button (which you use to return to the Data Selector when you have finished acquiring images).
The Patient Information dialog box

Depending on how RA 600 has been configured (see Adding patient information on page 244), a Patient Information dialog box may appear in the center of your screen when you start your acquistion. The dialog box will already contain the details of the last study you selected in the Data Selector. If you dont want to enter your patient information immediately, just click Cancel. You can add the information at any time you like (by clicking Info in the Demographics section of the Acquisition tooltab), but you will need to do this before saving your acquired study.
The center of the screen is where you will view your acquired images, and manipulate and process them prior to including them in the study you will create. The Pictorial Index on the left is where you place each image when you have finished working on it and are ready to acquire the next one. Here you can also rearrange them into the order in which they are to appear later in the study when you save it.
For details on how to configure whether acquired images are automatically added to the Pictorial Index, see Adding images directly to the Pictorial Index on page 236.
235 When acquiring images, you can use five tooltabs. Apart from the acquisition tooltab, you will also see a Windowing tooltab (with the sun icon), a Zooming/Flip/Rotate tooltab (with the magnifying glass icon), an Annotation and Measurement tooltab (with the ruler icon) and a Mask tooltab (with this icon). You use these last four to process and ready your acquired images for inclusion in your study. The worklist window underneath the work area can contain a study list, a DICOM modality worklist or other type of worklist. You can select an entry in this and add the patient information it contains to a newly acquired study, see Adding patient information on page 244.
Depending on what hardware you have connected and how your system is configured, you will see in the Device drop-down list on the Acquisition tooltab a number of devices which may be film digitizers, frame grabbers or document scanners. You may also see two additional options; Clipboard and Graphics file reader which let you paste from the Windows clipboard or include a graphics file in your study (see Using the clipboard and directly importing files on page 240 for more details). Depending on what type of device you select, the buttons in the Acquire section of the Acquisition tooltab will look somewhat different to reflect what you need to do to acquire images using that type of device. You use these buttons to control the equipment you are using to acquire your images.
You need only use the Add button on the Acquisition tooltab if your system has been configured for nonautomatic addition of acquired images. Otherwise, RA 600 will automatically add your images to the Pictorial Index as they are acquired.
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Acquiring an image
You will find all you need to acquire your images on the Acquisition tooltab. The precise details (covered later in this chapter) will differ slightly depending on the type (and model) of acquisition device, but the process is very similar for all types. Depending on how your system is configured, the finished image will be added to the Pictorial Index automatically, or you can define a region of interest or zoom/window, etc., and then add the result to the Pictorial Index. To acquire an image 1 2 3 4 Select which device you want to use for the acquisition from the drop-down list in the top (Device) section of the Acquisition tooltab. Select an image type from the drop-down list at the top of the Image section of the Acquisition tooltab. Make sure your film is loaded, frame grabber is ready, etc. Operate the acquisition device by clicking the buttons in the Acquire section of the Acquisition tooltab.
Once the acquisition process for the image has finished, the image will appear in the large viewport (work area) in the center of the screen.
Adding images directly to the Pictorial Index

When grabbing multiple images, you need not worry about the order in which images appear in the Pictorial Index. You can easily change them later.
Images become part of the study you are composing when you add them to the Pictorial Index. RA 600 can automatically add each image you acquire to the Pictorial Index as you acquire them, or you can decide to add these manually. You may opt to do it manually if you want to perform some post-processing on the images prior to adding them to the study. (Even if RA 600 adds the images directly to the Pictorial Index, you will still be able to process and manipulate them simply by clicking on them in the Pictorial Index.) To enable automatically addition of acquired images to the Pictorial Index you need to edit the Acquisition properties. You need to be logged in as a user with administrative rights to do this. See the Installation and Configuration Guide for details.
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Controlling acquisition devices within RA 600

When frame grabbing, you may have foot pedals or handheld devices with grab buttons that will allow you to continuously watch the console of the modality.
The Acquire section of the Acquisition tab lets you control your acquisition device from within RA 600. The buttons you see will depend on the type of device you are using.
If you are using a film digitizer

Scan starts the digitizer (insert the film first). In some cases it might be necessary to select an image type prior to scanning. A progress bar appears while the film is being digitized and you will also see information on the status of the device (busy or error). Use the Eject button to eject any film that is still in the digitizer (not for flatbed digitizers).
or a frame grabber
For single image grabbing you can watch the console of the modality from which you are grabbing. Then you just click Grab when you see an image you want to include in the study you are composing. If you check the Continuous check box, you will see a continuous sequence of images in your work area within RA 600. Click the Add button in the Image section when you want to add a frame to your study. The continuous option is useful for fast grabbing or when there is a considerable distance between the console and your RA 600 system.
or a document scanner
If you have scanned an image and selected a region of interest in it (see Saving only parts of images using ROIs on page 241) and the digitizer you are using supports a high resolution re-scan of the ROI, the text on the Scan button will change to Rescan to allow you to re-scan just the ROI you selected at this higher resolution.
Clicking Scan starts the document scanner (insert the document first). You may need to select an image type first. A progress bar will appear while the document is being scanned and you will also see information on the device status (busy or error).
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Pre-defining image formats (image types)

The Image section on the Acquisition tooltab lets you pick a pre-defined image format. If you regularly acquire images with the same characteristics, you might want to pre-define formats so they appear in the Image drop-down list. You can then select the type you want prior to acquiring. The exact appearance of the Image Type Settings dialog box will depend on the type of acquisition device you are intending to use (the one currently selected). To create a new image format 1 2 Click Image Types... immediately underneath the Image drop-down list in the Image section of the Acquisition tooltab. In the Image Type Settings dialog box, enter a name for the new image format in the Description field at the top of the box. This is the name you will see in the drop-down list of image formats after you have saved the new format. Click New to confirm you want to create a new format. In the Common section, enter values for the height, width, offset, actual object height, photometric interpretation, bit depth and lookup table for the image format. In the FG or DIG settings section, enter values appropriate to that type of device. In the Device Specific Part section, enter values appropriate to the specific type of device that you have. Click Default at any time to restore the fields to their previous values.
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The Actual object height field lets you enter the height of the object in real life for a particular image type. The units are set according to the unit settings of the Acquisition module (i.e. inches or cm). If the current image type during a frame grab or a digitalization contains a valid Actual object height, a vertical calibration measurement is displayed in the upper left corner of the image. The length of this measurement reflects the height of the object in real life in units according to the system measurement settings of RA 600 (i.e. inches or mm). If this field is left empty or set to zero, the feature is disabled for that image type.
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Settings and pre-defined image formats

Frame grabber sizes are in pixels, digitizer sizes in inches or centimeters (depending on the global acquisition setting). Lookup tables are defined in the general acquisition configuration in the Data Selector (select Configuration Acquisition from the menu bar in the Data Selector you may or may not have access to this depending on your user rights). For digitizers, Default Re-scan Image Type is the image format you want to use to re-scan the image or part of an image selected with an ROI (see Saving only parts of images using ROIs on page 241). For frame grabbers, Auto update interval is the time between the start of two grab actions.
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Using the clipboard and directly importing files

You can paste in this way if the contents of the clipboard are graphical (a bitmap image or illustration). You cannot paste text.
A powerful and versatile way of making images available for inclusion in a RA 600 study is to use the Windows clipboard. You can do this with almost any kind of image. One possible use would be to add digital photographs of patients along with other medical information about them. To do this, you again use the Acquisition tooltab. To import an image from the clipboard 1 2 3 4 Open your graphics program and copy the image to the clipboard (often the Copy command in the Edit menu of the application). Switch to RA 600 and make sure you are at the acquisition screen. Select Clipboard from the Device drop-down list at the top of the Acquisition tooltab. Click Paste in the Acquire section of the Acquisition tooltab.
The image will appear in your work area and you can now window, zoom, otherwise manipulate it or define a ROI.
Importing graphics files

You can also import graphics files in either the standard Windows BMP or uncompressed TIFF format. Virtually any graphics program will be able to save or convert files in one of these formats. To import an image file 1 2 3 4 Make sure the image you want to import has been saved as either a BMP or uncompressed TIFF file. Select Graphics file reader from the Device drop-down list at the top of the Acquisition tooltab. Click Load File. Open the file as in any other Windows program.
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Manipulating and refining your images

You can always window directly on the image in your work space by dragging with the right mouse button as in the Viewing Section.
When you have acquired an image, you can manipulate and post-process them prior to adding them to your Pictorial Index. You use the Windowing tooltab (with the sun icon), Zooming/Flip/Rotate tooltab (with the magnifying glass icon), Annotation and Measurement tooltab (with the ruler icon) and Mask tooltab (with this icon) for this in the same way as when in the Viewing Section of RA 600.
Saving only parts of images using ROIs

When you zoom images (in fixed steps or with the slider) and then save them, they will be added to your Pictorial Index in their zoomed state. If you place a magnifying glass on the image this will not, however, be saved in the Pictorial Index. Any annotations and measurement options will also be saved with the image in the Pictorial Index.
Once you have acquired an image, you can decide to save just part of this image in the study. You do this by creating a region of interest (ROI) on the acquired image. If you have digitized the image and your digitizer allows high resolution re-scans of selected regions of interest (such as the Howtek and Vidar models) you can also re-scan the selected ROI before adding it to the Pictorial Index. To select part of an image using an ROI click Select on the Acquisition tooltab. Click and drag the mouse in the viewport to define the ROI (reposition and resize as desired by dragging the ROI around the viewport or by dragging on a side or corner). Then click Add Selection to place the selection in the Pictorial Index. To remove an ROI click inside it and drag it out of your viewport (work area).
If you have digitized an image, measurements will be in units (i.e. pixels). If the image has a caliper, you can calibrate it in the Viewing Section by using the Calibrate option on the right mouse button menu or clicking Measurement on the Measurement and Annotation Tab. Creating and saving multiple ROIs By repeatedly clicking Select and dragging in the viewport, you can define a number of ROIs. You can then save some or all of these ROIs as desired. To select which one you want to save, simply click on it. It will be displayed in a different color to the others to indicate it is the active ROI. Then click Add Selection. (Repeated clicking of the Add Selection button without selecting individual ROIs will first save the active ROI and then the remaining ROIs in the order in which they were originally drawn.)
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Creating studies using various acquisition types

Due to DICOM regulations, input from different devices is always placed in separate series.
You can easily mix different input from acquisition devices, like clipboard input, digitized input, frame grabbed input and graphics files. You might, for example, like to combine a digitized study with some clipboard input of digital photographs from a digital photography software package. Start both software packages. First digitize the films you need. Then put the first digital photo on your clipboard using the photographic software. Switch back to RA 600, select Clipboard as the device and paste the image into your work space. Repeat the process as required for other photos. You can do the same with scanned reports or patient cards (using document scanning).
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Organizing your images

When a study you have acquired is saved and subsequently opened, the images will appear in the same order as they appeared in your Pictorial Index when you saved the study. If you wish to change the sequence of the images in your Pictorial Index prior to saving your study, you can do so by dragging images around in the Pictorial Index. To move an image in the Pictorial Index click the image and, holding the left mouse button down, drag the image to its new location. You may also wish to clean up your Pictorial Index by removing images from it. To remove an image from your Pictorial Index click the image in the Pictorial Index you want to remove (it will now appear in full form in your work area). Then click the Delete button in the Image section of the Acquisition tooltab.
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Adding patient information

You will be forced to add at least some patient information before saving the acquired study if one or more mandatory data fields have been configured (see Mandatory patient information on page 245). Unless these have been filled in, RA 600 will not let you save the study.
You will almost certainly wish to include some patient information with your acquired study. To speed the data entry process and reduce the risk of error, RA 600 provides a number of ways of doing this automatically using the information from previous studies, a worklist or even a RIS system.
Adding patient information manually

You can, however, always add patient information manually at any time prior to saving your acquired study using the Info button on the Acquisition tooltab: To add patient information manually click Info on the Acquisition tooltab and enter the patient information in the fields provided in the Patient Information dialog box.
Automatically adding patient information using a previous study

To save time entering your patient information, select an existing study for the same patient in the Data Selector before you start acquisition. The demographic data of that study will be entered by default in the Patient information dialog box (if so configured). You need now only change a few details.
When you start acquisition you can have RA 600 display the Patient Information dialog box with the patient details from a study or patient that you have previously selected in the Data Selector useful if you are preparing a new study for a patient for whom you have a previous study available on your system. To do this, on the Patient Information tab of the Acquisition Properties dialog box (select Configuration Acquisition from the menu bar in the Data Selector to open this dialog box), the Copy patient info from Data Selector check box must be checked. You need administrator access to set this. To add patient information using a previous study on a patient 1 Before starting acquisition, click the patient or study in the Data Selector which contains the patient information you want to use for the newly acquired study. Click Acquire image(s) on the Acquisition tooltab in the Data Selector. In the Patient Information dialog box, check and modify any of the information in the fields and click OK.
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Using worklists to enter patient information

You can also use a worklist while in the acquisition screen to add your patient information. Worklists typically appear in a window underneath the large viewport in the center of the acquisition screen (although, like other screen elements in RA 600, this can be dragged to another part of the screen). As when using a previous study to automatically add patient information, you select a patient or study from the worklist which contains the patient information you want to use. To add patient information using a worklist 1 2 3 Click on the study or patient in your worklist containing the patient information you want to use. Click Match on the Acquisition tooltab. Click Info on the Acquisition tooltab, check and modify any of the information in the fields and click OK.
If you cannot see a worklist If you are in the acquisition screen and cannot see the worklist window, make sure the Show Worklist check box on the Acquisition tooltab is checked. If you want to use a different worklist It is possible that a number of worklists are available on your system. You need administrator access to change this, see the Installation and Configuration Guide for details.
Using a RIS system to add patient information

If your system has been configured to do this, it will also be possible to query a RIS system for the patient information and add it automatically. To add patient information using a RIS click Info on the Acquisition tooltab. In the Patient Information dialog box, enter a RIS number and query the RIS system.
Mandatory patient information

In the Patient Information dialog box there may be mandatory fields. These will be indicated by asterisks. RA 600 will not let you save an acquired study unless all these fields have been filled in. You can change the fields which are designated as mandatory. You need administrator access to change this, see the Installation and Configuration Guide for details.
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Saving your study

Once you have saved your study, it will no longer be possible to change the data it contains using RA 600 acquisition capabilities. You will need to use RA 600s quality control features to do this see chapter 11 for details.
When you are happy with the study you have created from your acquired images and added the patient information, saving your work is simply a matter of clicking the Save button underneath the Acquisition tooltab. If you dont want to return to the Data Selector Once you have saved your acquired study, RA 600 will generally return you to the Data Selector. If, however, you wish to create a number of studies in a session, you can elect to stay in the Acquisition screen after you save your studies so that you are ready to immediately start on the next one. You need administrator access to change this, see the Installation and Configuration Guide for details.
Automatically sending acquired studies to another system

When you save a study you can have RA 600 automatically send it to another system, ready for viewing and diagnosis, for example. For this, you will need to have the destination (system you are sending to) properly configured on your system and then create an auto transmit protocol using Save After Acquisition as the trigger. You need administrator access to change this, see the Installation and Configuration Guide for details.
Selecting which folder acquired studies are saved in

Your acquired studies are automatically saved to one of the folders on your system. You need administrator access to select a different folder, see the Installation and Configuration Guide for details.
Using compression when saving studies

Uncompressed studies can take up a lot of space. It is possible to save your studies in compressed (ZLIB) form which will reduce the disk space they occupy by a factor of about ten. You need administrator access to enable compression, see the Installation and Configuration Guide for details.
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Specific device support

RA 600 can be used with a wide variety of acquisition devices. Digitizers RA 600 currently provides support for and has been tested with digitizers from Lumisys (Kodak), Howtek and Vidar. A TWAIN driver also supports a limited number of document scanners. Contact your distributor for the most recent information on support for specific devices. Frame grabbers RA 600 currently provides support for and is tested with frame grabber boards from Data Translation, Foresight Imaging (Imagraph) and Matrox. Again, contact your distributor for the latest information on supported devices.
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Advanced printing
RA 600 includes printing capabilities that go well beyond those of most other Windows applications. This chapter covers how you can print series and studies from the Data Selector using a wide range of layouts, monitor and control the printing process and review what you have printed. You might also want to print custom sets of images when in the Viewing Section using virtual film sheets, as well as create your own layouts for printing.
Printing series and studies with the Data Selector.250 Monitoring and controlling the print process ..........253 Finding out which printers are available.................254 Reviewing what you have printed ..........................255 Printing while viewing images ................................257 Creating custom print layouts.................................260
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250 chapter 9 ith RA 600, you can select and print whole studies or series, in monochrome or color, to DICOM 3.0 compliant laser imagers (or print servers) and Windows printers. Your system can be connected to and configured to work with a number of printers. You will generally use the Print tooltab in the Data Selector (with the printer icon) for routinely printing studies and series. You can, however, also print when viewing images. You then compose virtual film sheets which gives you a versatile way to create print jobs on the fly. Printing is done in the background and will not tie up your system, so you can continue viewing and reporting while your print jobs are running. You can also export files in standard file formats (BMP and TIFF). This is useful for including high quality digital images in slide shows, teaching presentations or reports, for example.
You can select single and multiple studies for printing or file export. You can also print single or multiple series from within a study or from different studies. The smallest entity you can select for printing from the Data Selector is one series. If you want to compose customized print jobs, you should use the virtual film sheet in the Viewing Section..
Printing series and studies with the Data Selector

You can create your own special layouts, for each printer or when exporting files. See Creating custom print layouts on page 260 of this chapter. When printing multi-frame images, all images will be printed in fully expanded form. Priority settings will only affect your own print queue in RA 600. If you are sharing the printer with others, the networks printer server will have control over queuing and what gets printed first.
When you want to print whole series and studies, you can simply select these in your local view in the Data Selector and use the Print tooltab (with the printer icon) to start, monitor and control the printing process. The Destinations list shows you all the printers you can print to as well as options for exporting images as files. The indicators show you whether any print jobs are still to be performed (pending), whether a print job is currently underway and whether there have been any errors while printing. The graphic in the Layout section shows you the layout that will be used to print your images. Click the Select... button to choose a different one. You can also specify whether to print in portrait or landscape and the size of the sheets that will be used for printing. At the bottom of the Print tooltab, you can assign a priority to your print job, view your print queue and log and finally print your selected studies and series.
251 To print a series or study from the Data Selector

If you specify more than a certain number of copies to print you may receive a warning concerning your request. If you frequently make a number of copies and often see this warning, the setting for the number of copies above which RA 600 issues the warning can be increased. Select Configuration Print Service... from the Data Selector menu bar and change the Maximum Number of Copies on the General tab of the Print Service Properties dialog box. You will require administrator rights to do this.
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In the Data Selector, select the studies and/or series you want to print. Click the Print tab (with the printer tooltab. icon) to reveal the Print
Click the printer you want to print to in the Destinations section. Click Select, then on the layout you want to print in (if necessary). Next click OK. Change the size of your paper or film and orientation (if necessary) Set a priority (if you wish). Click Print. Change any additional print options in the Print Study to... dialog box.
Fine tuning settings in the Print Study dialog box

You can change the format of your printed headers by selecting Print Destinations from the menu bar in the Data Selector, selecting the Windows Printer in the Print Destinations dialog box and then clicking Modify. Click the Header tab and edit the header format. More details can be found in the on-line Help.
The Print Study dialog box, which appears after you have clicked Print on the Print tooltab, lets you see what you are about to print and includes some additional print options. The Study Identification and Print Parameters sections give key information about what is to be printed. The Print Options section gives you additional control over the appearance of your printouts. The Annotation Level radio buttons let you set the amount of annotation that will be printed on the images in much the same way as the annotation settings in the Viewing Section. The Image Annotations check box allows you to decide whether any annotation created by yourself (or others) is to be printed with the images. You can set separately the amount of annotation to be shown with the first image (Full perhaps) and subsequent images (Basic for example). The Header check box lets you insert a header at the top of each printed page in the study. This only works with Windows printers.
Configured Windows printers always refer to the default Windows printer already installed on your PC. If you have multiple Windows printers installed you can print to the correct printer using the Setup... button
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252 chapter 9 If you have only selected one study or series to print or export, you will only see OK and Cancel buttons. If you have selected a number of studies or series (and hence have a number of print jobs to submit), you will see a number of additional buttons. When you click OK in the Print Study to dialog box, the job will be printed and, if you have selected multiple studies to print, your next job will be displayed. Click OK All if you do not want to alter the print settings for each one of your multiple studies individually. Clicking this button will start all the print jobs for your studies. Click Cancel to cancel the individual job or Cancel All to cancel all the jobs you were preparing to print. The Setup button (only visible if you are printing to a Windows printer) displays the usual Windows setup dialog box for the printer.
If you almost always print studies in the same way and do not want to go through the Print Study to... dialog box each time, check the Only show dialog when Shift key is down check box. When you click Print on the Print tooltab, your studies will print immediately. If you want to change your settings, hold down the Shift key as you click on the Print button. The Print Study to... dialog box will then appear.
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Monitoring and controlling the print process

Using the Print tooltab, you can see at a glance if and how many studies are waiting to be printed (pending), whether any are currently being printed and whether any errors have occurred. For a more detailed view, click Queue on the Print tooltab.
A red indicator in front of the printer destination means that a print job has failed. This is typically due to the connection to your printer being lost. You can, however, still submit jobs. RA 600 will try again to establish the connection.
The Print Queue dialog box gives you information on the job that is currently active and those that are waiting to be sent out. The buttons on the right of the Print Queue dialog box let you suspend (postpone), resubmit (resume) or delete your jobs. You can also change the priority of a job, or view more details on a job. To suspend, resubmit, delete or change the priority of a job in your print queue first select the job or jobs in the list by clicking in the first (Destination) column (hold down the Ctrl key to select multiple jobs, or the Shift key to select a range of jobs). Then click Suspend, Resubmit, Delete, Increase Priority or Decrease Priority. To find out more about a job, click Details (or double-click on a print job). A window will show more detailed information on the selected job.
You cannot delete a job currently printing. You can only use priorities to manage your own print queue. If you are connected to a network printer, the printer server on the network will generally decide what gets printed when. With DICOM printers it is possible to set priorities for systems which submit jobs to them (a system in an emergency room may be assigned a higher priority for example). Contact your system administrator or RA 600 distributor for more information.
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Finding out which printers are available

RA 600 will not necessarily show all the printers on your network, only the print destinations configured on your system. If you do not have access to a particular printer, the printer may not have been configured yet. Contact your system administrator.
You may wish to find out which printers you are able to print to, or you might perhaps experience difficulty printing to a particular printer. From RA 600, you can quickly see which DICOM printers are available and what their current status is. To show the status of all your DICOM printers select Print Status... from the Data Selector menu bar. DICOM Printer
You will see a progress bar as RA 600 connects to all the printers attached to your system. When it has finished, you will see a list of all the printers along with their status and other relevant information.
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Reviewing what you have printed

You can check in detail on what studies you have printed or exported at any time using the Print tooltab (with the printer icon). To see what studies you have printed (or exported) Print tooltab. click the Log button on the
You can also select Print Log on the Data Selector menu bar to view your print log.
Your Print Log will appear. This will show you all the studies or series you have printed along with various details about them and the printing process. You can scroll and resize the columns to view more information.
Reprinting a job that has already been printed

Using the Print Log, you can resubmit a job that, as far as RA 600 is concerned, has already been printed successfully. To reprint (resubmit) a successful print job open the Print Log (click Log on the Print tooltab), click on the (first column of) the job you want to reprint and click the Resubmit button.
Removing entries in your print log

Periodically you will want to clear out your print log (although if you wish to keep a permanent record of what you have sent, you should first export (save) your print log to a file, see Exporting (saving) your print log on page 255. To remove entries in your print log open the print log (click Log on the Print tooltab). Then select the entries you wish to delete (click in the first column of an entry to select it, hold down the Ctrl key to select multiple entries, or the Shift key to select a range of entries). Click Delete.
Exporting (saving) your print log

You may perhaps want to keep a permanent record of what you have printed and when. In some situations you might also want to use some or all of the information in the Print Log in other applications if, for example, you need to charge printing costs to other departments or customers, or to perform an analysis, you can do this by exporting the print log information to an external file. To export (save) your print log 1 Open the print log (click Log on the Print tooltab).
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256 chapter 9 2 Select the entries you want to export (click in the first column of the entry you want to save hold down the Ctrl key to select multiple entries, or the Shift key to select a range of entries). Click Export. In the Export dialog box, enter the name of the file you want to export to in the To File field (or click the Browse... button to locate a file). If required, change the separator to be used between field entries in the exported file. If required, change the list of items of information to be exported (shown in the Exported list). Select items in the Available Fields list and use the Add >> and << Remove buttons to add or remove selected items to and from the Exported list. (You will not usually need to do this RA 600 automatically remembers what settings were used the last time your print log was exported.) Click Export.
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Printing while viewing images

For routine printing you will mainly use the Print tooltab in the Data Selector. There may be times, however, when you want to quickly print some images while viewing them. You can do this using the Print tooltab in the Viewing Section of RA 600. This does not offer all the features you will find in the Data Selector for printing studies and series, but with it you can quickly print single images or selected images on virtual film sheets.
Printing a single image or viewport

At any time while you are viewing images, you can print single images, or even a viewports entire contents, including annotation, revised windowing levels, filtering etc. To print a single image while viewing it right-click in the viewport containing the image and select Print Image from the right mouse button menu. The image will be printed to your systems Windows printer as it appeared when you first opened the study for viewing, i.e. without any windowing, annotation or other changes you may have made. If you want to print out an image plus any changes you have made, you should print the viewport. To print images in a single viewport right-click in the viewport and select Print Viewport from the right mouse button menu. The full contents of the viewport will be sent to your current print destination (printer) in a one-up format.
Printing using virtual film sheets

RA 600 lets you combine various images on virtual film sheets which you can then print out. This offers great flexibility, enabling you to add annotation, zoom, filter or otherwise process images before they are printed. You can also combine images from different studies or series on the same virtual film sheet. To print images on virtual film sheets 1 On the Print tooltab in the Viewing Section ( with the icon), click the printer (or export destination) in the Destinations list that you want to use. Click one of the pre-defined layouts. Display an image you want to send in one of your view ports.
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The double-click action to pin images to a viewport is temporarily disabled to allow you to select images to add to your virtual film sheet with a double-click.
Double-click on the viewport. The image will be added to the virtual film sheet in the Compose Print Job dialog box. Repeat steps 3 and 4, creating more film sheets if required, until you have included all the images you want to send to your virtual film sheet(s). Click the Submit button. Change any options in the Print Study to dialog box (see Printing series and studies with the Data Selector on page 250 for details) and click OK.
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Adding to and modifying your virtual film sheet

You can move the Compose Print Job dialog box around the screen by clicking and dragging its title bar. It is also resizable click and drag the bottom right corner. Double-click on any viewport and the image it contains is added to your virtual film sheet. The next viewport on the virtual film sheet is then automatically selected. This means that you can quickly fill your virtual film sheet simply by double-clicking on all the images you want to include. If you want to include all the images in a series, you dont need to doubleclick on each image - simply click on one of the images in the series and then Insert Series in the Compose Print Job dialog box. If you want to remove an image from a virtual film sheet but leave the space it occupies blank ready to receive a new image, click Clear. If you want to remove an image and have all the following images rearrange themselves to fill the gap, click Delete. If the Overwrite check box is checked, an image selected on your virtual film sheet will be overwritten (replaced) by any new image you add to the film sheet (so to replace images, you dont need to clear them first).
You can include collapsed multi-frame images in your virtual film sheet, although only the currently shown frame will be displayed and printed.
Modifying the images on your virtual film sheet

While composing a virtual film sheet, you can view and modify images in all the usual ways (pan, zoom, filter, annotate etc.). When you double-click on a viewport, the image is added to the virtual film sheet in its current (modified) state. You can also modify images already included on your virtual film sheet. rightclick on the image you want to modify and select the appropriate option (Zoom/Flip/Rotate, Annotation, Quality and Reset) from the right mouse button menu.
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Multiple film sheets

If you have a lot of images to print, you can compose and print a number of virtual film sheets at the same time. In fact, RA 600 will automatically create a new film sheet for you if you try to insert an image in the bottom right viewport of the current sheet when this has already been filled. You can also add a new film sheet yourself at any time - to do this click Insert in the Sheet section of the Compose Print Job dialog box. Before adding any images to this new sheet, you can select a different layout for it by clicking Layout. When you have more than one film sheet, you can move between them using the scroll bar at the bottom of the dialog box. To clear all the images from the film sheet you are currently viewing, click Clear in the Sheet section of the Compose Print Job dialog box. You can remove a film sheet you have created by clicking Delete.
Printing your virtual film sheet(s)

You cannot save a print job composed using virtual film sheets.
Once you finished composing your virtual film sheet(s), use the Job section to change (if you wish) the printer you want to use, the print orientation and film or paper size. Then click Submit to submit the print job.
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Creating custom print layouts

Access to layout configuration may be restricted to system administrators.
RA 600 has a layout pool which contains a wide range of pre-defined layouts for printing images. These layouts can be selected when defining a new printer (destination). This means that specific layout options can be provided for each particular printer. If you want to print using a special layout not included in the layout pool, you should first add this to the layout pool and then make this layout available for the particular printer or printers. To add or change a layout, see the RA 600 Installation and Configuration Guide.
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Exporting images and archiving

This chapter covers the main aspects of RA 600s single media archiving capabilities. This allows you to store images efficiently and retrieve them quickly and easily. Used with the CD Viewer, the single media archive allows you to view and manipulate images almost anywhere.
Single Media Archive .............................................262 Setting up RA 600 to copy data to your media.......262 Copying data to a single archive medium ..............266 Viewing images with the RA 600 CD Viewer..........268 Setting up RA 600 for viewing from your media.....269 Displaying data from your media in RA 600...........269 Indexing studies .....................................................270 Managing your media with the Index Tool..............271 Querying for volumes and studies..........................273
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Single Media Archive

RA 600 allows you to copy images from your local RA 600 database to a storage medium such as a zip disk, CD or DVD. Similarly, you can copy images from a disk to your local RA 600 database. In addition, RA 600 includes tools that facilitate the proper archiving and retrieval of images from your disks, so you can create a single media archive.
Setting up RA 600 to copy data to your media

If your workstation is capable of writing to Zip disks, CDs or even DVDs, you can readily set it up to allow studies to be copied and archived to these disks. The procedures for setting up differ for read-write media (such as Zip disks) and for read-only (such as CD-R and DVD-R), and so are described separately below. To configure single media archiving for use with a read-only medium 1 Select Configuration Single Media Archive from the Data Selector menu bar. In the Configure Single Media Archiving dialog box select Read-Only from the Media Type drop-down list. Select the type of disk you want to use from the File system dropdown list: ISO 9660 (CD) or UDF (DVD format). In the Device field, enter the drive of the device to which you are copying data (or click the Browse button to navigate to the path). In the Total Size field, specify the storage limit of the medium you are using. For CD this is 650 or 720 MB; for DVD, 2.9 GB or 4.3 GB, depending on the DVD and the device you are using. In the Block Size field, define the size of the blocks you want for your read-only medium. The recommended setting is 4. Specify the Prefix you want displayed. The prefix you specify here will be displayed on the media label that the Archiving Index Tool uses to identify CDs.
You need administrator rights to configure your system for single media archiving. If you do not have these rights, you must contact your system administrator for assistance.
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263 7 Check the Copy files check box if you want to copy additional items to your read-only medium; e.g., the RA 600 CD Viewer. Then enter the path from where you want to copy those items (or use the Browse button). Note that you copy the contents of entire folders, not individual files. In the Image directory field, type in the path and directory where you want your images to be temporarily stored before they are burned onto your CD or DVD (or use the Browse button). Check the Verify burned contents check box if you want a message stating that your data has been has been copied to the CD or DVD. Enable the Show write options dialog check box if you want to more specifically steer the functionality that burns content to disk. This is used in the event that you encounter problems burning a CD or DVD. Check the Delete marked studies after archiving check box if you want the study deleted after it has been copied, and then click OK. Note that this function will only be performed after data from the local database is archived, not with archiving data you selected. Check the Enable Archive Index Tool check box if you want to enable the Index Tool for managing your media; e.g., to delete volumes from the index or mark them as missing or lent out. Check the Automatically add volumes to Archive Index Tool check box if you want RA 600 to automatically register data in the Archive Index Tool. (For this work, the Direct View option must have be configured on your system. Assuming you have administrator rights, navigate to Configuration Viewing from the Data Selector menu bar, click on the Machine tab of the Viewing Properties dialog box and check the Direct View check box.)
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Application profiles provide precise control over the kind of data you can and cannot burn to a medium. RA 600 supports a number of application profiles as defined in the DICOM standard. Consult your system administrator if you do not see the profile you require or do not have the know edge or system rights to configure application profiles.
Check the relevant Application Profiles: Explanation of profile

Burns single frame or multi-frame XA images up to 512 x 512 x 8 bits. Burns single frame or multi-frame X-ray images up to 1024 x 1024 x 12 bits. The profile also supports the burning of secondary capture images. A combination of Basic XA and US Image Display (MF). A combination of 1K=XA and US Image Display (MF). Burns single frame ultrasound images to disk. Burns both single frame and multi-frame ultrasound images to disk. Burns single frame ultrasound images with spatial calibration for quantitative purposes. You can also use it to capture single frame ultrasound images without spatial calibration data. Burns multi-frame ultrasound images with spatial calibration data for quantitative purposes. Burns CT, MR and secondary capture images. Burns Composite SOP Instances, such as images, structured reports, presentation states and waveforms (in uncompressed form). Burns uncompressed images to disk. Burns compressed images to disk.
Application profile
Basic XA 1K-XA Exchange CD Archive CD US Image Display (SF) US Image Display (MF) US Spatial Calibration (SF)
US Spatial Calibration (MF) CT and MR General Uncompressed Compressed
To configure single media archiving for use with a read-write medium

You need administrator rights to configure your system for single media archiving. If you do not have these rights, you must contact your system administrator for assistance.
Select Configuration Single Media Archive from the Data Selector menu bar. In the Configure Single Media Archiving dialog box, select Read-Writable from the Media Type drop-down list. In the Device field, enter the drive of the device and the path to which you are copying data (or click the Browse button to navigate to the path). In the Total Size field, enter the storage limit of the medium you are using. Use the Block Size field to define the size of the blocks you want for your read-write medium. The recommended setting is 4. Specify the Prefix you want displayed. The prefix you specify here will be displayed on the media label that the Archiving Index Tool uses to identify media.
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265 6 Check the Copy files check box if you want to copy additional items to your read-only medium; e.g., the RA 600 CD Viewer. Then enter the path from where you want to copy those items (or use the Browse button). Note that you copy the contents of entire folders, not individual files. Select the Write speed you require. Check the Delete marked studies after archiving check box if you want the study deleted after it has been copied. Check the Enable Archive Index Tool check box if you want to enable the Index Tool for managing your media; e.g., to delete volumes from the index or mark them as missing or lent out. Check the Automatically add volumes to Archive Index Tool check box if you want RA 600 to automatically register data in the Archive Index Tool. (For this work, the Direct View option must have be configured on your system. Assuming you have administrator rights, navigate to Configuration Viewing from the Data Selector menu bar, click on the Machine tab of the Viewing Properties dialog box and check the Direct View check box.) Check the relevant Application Profiles: Explanation of profile
Burns single frame or multi-frame XA images up to 512 x 512 x 8 bits. Burns single frame or multi-frame X-ray images up to 1024 x 1024 x 12 bits. The profile also supports the burning of secondary capture images. A combination of Basic XA and US Image Display (MF). A combination of 1K=XA and US Image Display (MF). Burns single frame ultrasound images to disk. Burns both single frame and multi-frame ultrasound images to disk. Burns single frame ultrasound images with spatial calibration for quantitative purposes. You can also use it to capture single frame ultrasound images without spatial calibration data. Burns multi-frame ultrasound images with spatial calibration data for quantitative purposes. Burns CT, MR and secondary capture images.
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Application profiles provide precise control over the kind of data you can and cannot burn to a medium. RA 600 supports a number of application profiles as defined in the DICOM standard. Consult your system administrator if you do not see the profile you require or do not have the know edge or system rights to configure application profiles.
Application profile
Basic XA 1K-XA Exchange CD Archive CD US Image Display (SF) US Image Display (MF) US Spatial Calibration (SF)
US Spatial Calibration (MF) CT and MR
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General Uncompressed Compressed Burns Composite SOP Instances, such as images, structured reports, presentation states and waveforms (in uncompressed form). Burns uncompressed images to disk. Burns compressed images to disk.
Copying data to a single archive medium

Once you have configured RA 600 so you can copy images from the local database to your removable media, you can actually begin exporting data from RA 600. You can either copy this data immediately or mark it for copying at a later time. To immediately export data to a single medium archive 1 2 3 4 On the Data Selector tooltab, select from the Worklist View dropdown list the worklist from which you want to export studies. In the Data Selector, select the studies you want to archive and then click on the Archiving tooltab ( ). Click the Create Volume button in the Current Selection section to immediately archive the studies selected in the Data Selector. From the Write Media dialog box, select the appropriate Application Profile and click OK. A progress bar will report the stages of the export as RA 600 copies your data. If you are copying more data than a medium will hold, you must insert a new medium when RA 600 prompts you. When the job has finished, view the results with the CD Viewer (see Viewing images with the RA 600 CD Viewer on page 268 for details).
To export data to a single medium archive later on 1 2 On the Data Selector tooltab, select from the Worklist View dropdown list worklist from which you want to export studies. In the Data Selector, select the studies you want to archive and then click the Archiving tooltab ( ).
267 3 Select Archiving Select for archiving on the menu bar. Your studies have now been marked for archiving. If at any time you decide not to archive a study, select the study and go to Archiving Unselect for archiving. You can add the Archive DICOM tag (3109, 102C) to the Data Selector to see which studies have been marked for archiving. Click the click the Create Volume button in the Local Database section of the Archiving tooltab. From the Write Media dialog box, select the appropriate Application Profile and click OK. A progress bar will report the stages of the export as RA 600 copies your data. If you are copying more data than a medium will hold, you must insert a new medium when RA 600 prompts you. When the job has finished, view the results with the CD Viewer (see Viewing images with the RA 600 CD Viewer on page 268 for details).
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Viewing images with the RA 600 CD Viewer

While you can always view images you have copied to your media on an RA 600 workstation, you may wish to view them on another computer, possibly at home or one without any form of viewing software installed. With this in mind, the RA 600 CD Viewer was developed. This is a freely distributable, web-based viewing tool you can burn onto CD's or other media to directly view images exported from RA 600. The Viewer enables you to examine all the modalities RA 600 can. Though its functionality is very limited compared to RA 600, you can use it to zoom, window on single images and make simple annotations - even run cines. It is copied to disk when you export images if the Copy files check box has been checked in the Configure Single Media Archiving dialog box (assuming system administrator rights, Configuration Single Media Archive from the Data Selector menu bar). To view images with the CD Viewer 1 2 Insert your disk into the drive of your computer. If you are viewing from a CD, the CD Viewer will automatically start up. If you are using a zip disk, click on the drive that will run the CD Viewer. Then click on the AutoRun.exe file that was automatically copied when you exported images to disk. After RA 600 loads the CD Viewer, read the disclaimer and warranty and click I agree to consent to the terms. The CD Viewer will display the images.
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The Viewer will not display compressed images. Before exporting images to disk, you can see whether an image has been compressed by adding the Derivation Description tag (0008, 2111) to the Data Selector at instance (image) level. Adding this tag at this level will also show the quality factor with which an image has been compressed.
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Setting up RA 600 for viewing from your media

Just as you can you view data originating from the local RA 600 database, you can view data in a worklist from your media. The first step entails creating a worklist in RA 600 to which you can import data. You need administrator access to do this, see the Installation and Configuration Guide for details. The worklist type must be DICOM Volume. Displaying data from your media in RA 600 Once you have configured the worklist view, you can view it in RA 600 and export your data to it from the read-write medium. To view studies from a single medium archive in a worklist view 1 2 3 4 5 6 In the Data Selector, select Database bar. Add view from the menu
In the Add View dialog, specify the Description field by typing in a description for your new study list. Select from the List drop-down list the worklist you created to view your single media archiving images. Use the Copy settings from drop-down list to indicate the list whose settings should apply to the one you want to create. Click OK and view the worklist by selecting it from the Worklist View drop-down list on the Data Selector tab. View the study by double-clicking it (make sure your disk in the proper drive first). If you want to import the study first, select it, right-click it and then left-click on Import from the pop-up menu.
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Indexing studies
Making sure your archive is properly indexed is vital. If it is not, your studies will be very difficult to find again. Indexing can be performed automatically by RA 600 during the archiving process when new volumes are created. If, however, you prefer to index them afterwards you can also register them yourself. To register media in the archive index 1 2 3 Insert the media you want to register in your drive. Click on the Add Volume button on the Archiving tooltab ( ) in the Data Selector. Navigate to the drive containing the disk and click OK. If you see a Browse for Folder dialog box, navigate to the drive containing the media you want to register and click on it to select it. (If you dont see this box, just proceed to step 5). In the Add Volume dialog box, enter a Name for the volume (be consistent!), specify its Storage Place and add a Note and a short Description of the volume if you wish. (The other fields are predetermined by RA 600 and cannot be changed). Click OK.
Some additional notes on indexing

You will typically see the Browse for Folder dialog box if you have more than one drive on your system which can read archive media (a CD-ROM drive and a zip drive, for example). This dialog essentially allows you to tell RA 600 which drive to read. In addition, it is vital to physically mark the volume for storage with the same name as the one entered in the Name field of the Add Volume dialog box. This will be needed later when retrieving the volume from storage.
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Managing your media with the Index Tool

The Index Tool also allows you to manage your media. You can delete volumes from the index, or mark them as missing or lent out.
Lending out studies

It may be possible for people to borrow from an archive. RA 600 allows you to keep track of who has what and when it was lent out. You use the Index tool for this. To mark a volume as lent out 1 2 Click on the Show Volumes button on the Archiving tooltab ( ) in the Data Selector. On the Volumes tab of the Archive Index Tool, click on the Query button to perform an empty query (if necessary) to show all the available volumes. You can also perform a specific query to narrow your search for the volume that is to be lent out. Select the volume that is to be lent out. Click the Lend button. Enter the name and ID of the borrower in the Lend volume dialog box.
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The fact that the volume has been lent out, the name and ID of the borrower and the date it was lent are all shown in the list on the Volumes tab of the Archive Index Tool. At some point the volume will probably be returned and you will need to register this fact. To mark a volume as returned 1 2 3 Click on the Show Volumes button on the Archiving tooltab ( ) in the Data Selector. On the Volumes tab of the Archive Index Tool, select the volume that was lent out. Click the Return button and confirm your action by clicking OK.
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272 chapter 10 If a volume is lost Rather than be returned, a volume may end up as lost and will effectively no longer be available to the archive. You should also register this with the Index Tool. To mark a volume as lost 1 2 Click on the Show Volumes button on the Archiving tooltab ( ) in the Data Selector. On the Volumes tab of the Archive Index Tool, click on the Query button to perform an empty query (if necessary) to show all the available volumes. You can also perform a specific query to narrow your search for the volume that is to be lent out. Select the volume that is lost and click the Volume Sheet button. Select Lost from the State drop-down list.
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If a lost volume is subsequently found, repeat this procedure but select Present on the State drop-down list.
Removing (deleting) volumes

There may be occasions when you want to remove volumes from the index. This is also achieved using the Index Tool. To remove (delete) a volume from the index 1 2 3 Click on the Show Volumes button on the Archiving tooltab ( )in the Data Selector. On the Volumes tab of the Archive Index Tool, select the volume or volumes you want to remove from the index. Click the Delete Volume button.
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Querying for volumes and studies

Provided volumes and studies have been indexed properly, finding them in the archive index is quick and straightforward. To do this, you use the Index Tool with which you can perform queries much like you can query your local and remote views. To query for a volume 1 2 3 Click on the Show Volumes button on the Archiving tooltab ( ) in the Data Selector. Click the Query button on the Volumes tab of the Archive Index Tool. In the Query Volumes dialog box, specify or mark the items you want to search for in the archive index.
Querying for studies is very similar: Click on the Show Volumes button, select the Studies tab and click the Query button. In both cases, you can use wildcards. If you enter N* in the Name or Patient Name field, for example, RA 600 will retrieve an entry that begins with N. All query parameters act as "and/and" conditions and are not case-sensitive.
Displaying the volumes of studies

Once you have managed to query for a study and have displayed it on the Studies tab, viewing the index to which the study belongs is simply a question of clicking the Show Volumes button. The Studies tab also enables you to modify the status of a study. You do this by selecting the study in the study list and clicking the Study State button. The drop-down list in the Study State dialog box gives you the option of specifying whether the status of the study is OK or Corrupt.
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Quality control
An RA 600 system can become a complete quality control workstation, acting as a gatekeeper to ensure that studies and series made available for permanent storage and to other systems on a hospital network are correct and include the right demographics. This chapter explains how to open studies for quality control, edit demographics, modify the images in a study, and automatically send them to other systems when you have finished working on them.
The Quality Control tooltab in the Data Selector....277 Starting quality control............................................278 The Quality Control screen ....................................279 Editing patient demographics.................................281 Matching studies automatically ..............................282 Adding, rearranging and removing data.................283 Splitting and joining series and studies ..................286 Windowing, annotating, flipping and rotating .........289 Saving studies and changing study status .............290 Automatically sending studies after saving them ...291 Setting which demographics can be edited............292
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The quality control features of RA 600 permit the user to modify image, patient and DICOM data. Due to the potential risk involved in this, quality control demands strict procedures or protocols. GEMS IT nor its distributors will accept any liability whatsoever for the consequences of the modification of data using the quality control software.
A 600 includes many special features intended to allow various quality control tasks to be undertaken at designated workstations (Quality Control Workstations) within a hospital. These workstations are generally located between an acquisition device (such as a CT scanner) and the hospitals network. They perform a gatekeeper function by ensuring that acquired images and studies are correct and have the right patient information associated with them before they are made available at other locations on the network. With RA 600 you can add or change patient demographics before studies are saved and stored or routed to other clinical workstations for viewing and reporting. Previous studies can be (pre-)fetched from the hospitals archive and used, for example, to adjust the window width and level settings or orientation of a CR image to comply with previously acquired CR studies. You can also re-order images within a series, or remove images that have no clinical relevance. To speed the process and minimize the possibility of manual error, RA 600 automates quality control activities as much as possible. You can, for example, add all the demographic information on a patient to a newly acquired study by copying the information from a worklist entry for that patient. Then you need only change details specific to the new study, so minimizing the risk of typing error.
If your hospital information system is capable of generating a DICOM 3.0 modality worklist, some of the quality control work can be automated. For example, the patient demographic information that is part of a worklist entry can be automatically inserted in a study.
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The Quality Control tooltab in the Data Selector

If your system has the quality control software module installed (and you have appropriate user rights), you will see the Quality Control tooltab (with the icon) when you are in the Data Selector. This lets you open studies for quality control tasks as well as viewing the status history of all the studies in your local view or worklist. At the top of the Quality Control tooltab there are also indicator lights that show current configuration settings.
Viewing study status histories

At any time while you are in the Data Selector you can view the status history of any study or series in your local view or worklist. To view the status of a study click Status History on the Quality Control tooltab. To view more precise details on a study click the patient name in the Current Study Status dialog box to select it and then History (or double click on the patient name). Click Close to return to the Current Study Status dialog box. Every time a study is changed, details are added to the Study Status History so the study status list will continue to increase in size. This means that you may periodically wish to remove some or all of the entries it contains. To remove studies from the status history list click Status History on the Quality Control tooltab in the Data Selector and select the studies you want to remove. Then click Delete. If you wish to completely empty the Study Status History, click Delete All.
You can also view the status of studies by right-clicking in your patient or study view and selecting Quality Control Status History from the pop-up menu.
The quality control indicators

At the top of the Quality Control tooltab are a number of indicator lights. The Auto Window save indicator means that any changes to the windowing settings you make will be automatically saved when you leave the Quality Control screen. The Re-number images indicator shows that if you change the order of images in a series, these images will be automatically re-numbered by RA 600 to reflect this.
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Starting quality control

One of the main functions of the Quality Control tooltab ( ) in the Data Selector is to allow you to open a study (or copy of a study) to work on in detail in the Quality Control screen. If you have access to an acquisition worklist (such as a DICOM modality worklist), you can also open a worklist entry from the Data Selector. This will create an empty study (no images) with the demographic data taken from the worklist. Once you are in the Quality Control screen you can add studies from your local database. To start using quality control first select a study in your local patient or study view (or worklist) by clicking on it, then click the Open Study button on the Quality Control tooltab (with the icon). or right click on the study you want to work on in your local view (or worklist) and select Quality Control Open Study from the pop-up menu. Sometimes you may wish to make changes but keep the original for reference. In this case, you will want to open a copy of a study for Quality Control.
If you select a whole study to open for quality control which contains more than one series, RA 600 will open all the series contained in the study.
Opening a copy of a study

Sometimes you may want make changes to a study but keep the original version of the study as a backup, for reference or for teaching purposes. To open a copy of a study for quality control select a study in your local view (or worklist) by clicking on it, then click Open Copy on the Quality Control tooltab (with the icon). or right click on the study you want to work on in your local view (or worklist) and select Quality Control Open Copy from the pop-up menu. In either case, Presentation States, Structured Reports and Key Notes are not copied!
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The Quality Control screen

If quality control is installed on your system, and you have appropriate rights, you will always see the Quality Control tooltab when using the Data Selector. You will, however, only see the Quality Control tooltab when viewing images if you are in the Quality Control screen (i.e. you have opened a study for quality control using the Quality Control tooltab in the Data Selector or from the right mouse button pop-up menu). The Quality Control tooltab is not available in the Viewing Section.
When you open a study to work on, the Quality Control screen will open. It is where you will spend most of your time when performing quality control procedures. With its familiar Pictorial Index and tooltabs, it looks in many ways similar to the Viewing Section screen. Since, however, the quality control screen is not intended for advanced viewing and diagnostics, it does not offer all the tooltabs available in the Viewing Section. While you will have full windowing capabilities using the Windowing tooltab (see Windowing images on page 96), as well as complete zoom and flip/rotate capabilities and measurement and annotation, you will not be able to perform MPR/MIP, apply image enhancement filters, or create cines. In the Quality Control section you will, however, have two additional tooltabs - the Quality Control tooltab (which has this icon and is somewhat more sophisticated than the one in the Data Selector), and the Split/Join tooltab (with this icon). The Quality Control tooltab on the Quality Control screen lets you add and change demographics, insert patient and study demographic information from a worklist and, as in the Data Selector, view the status history of the currently loaded study. It also lets you insert and delete images and series and change the patient orientation annotation shown on the images (see Adding, rearranging and removing data on page 283). The Split/Join tooltab lets you create multiple series and studies out of a single series or study and combine images from different series or studies into a single series or study (see Splitting and joining series and studies on page 286). In addition, you may see two other windows on the Quality Control screen (depending on whether the appropriate check boxes on the Quality Control tooltab are checked). One is your Local Data window, which essentially lets you view all or part of the studies in your local database as in the Data Selector. The other window is the Worklist window which will contain an acquisition (modality) worklist if one is available. You use this list to select entries you want to copy the demographics information from when you are working on a study. You can select queries from the drop-down lists at the foot of the Quality Control tooltab to view particular types of studies in these windows.
The matching worklist shown must be specified in the Quality Control configuration. This will always be a (DICOM) modality worklist.
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280 chapter 11 Below the tooltabs you have the Scope which operates in the same way as in the Viewing Section and, below this, three large buttons. The Save button allows you to save a study (or the changes to it) without having to return to the Data Selector. The Reset button undoes all your unsaved changes and the study will revert back to how it was when you opened it. The Back button returns you to the Data Selector (giving you the option of saving the study first).
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Editing patient demographics

When using a Quality Control workstation, you can edit the information provided with a study right down to individual image level. To edit patient demographics click Edit Demographics on the Quality Control tooltab on the Quality Control screen. In the Edit Demographics dialog box, click on the icons in the left pane to reveal studies, series and images and select the patient ( ), study ( ), series ( ) or image ( ) by clicking on it (or the name next to it). In this way you can select any item at the patient, study, series, or image level. On the right side of the dialog box, the upper pane will show DICOM and other information which cannot be modified about the item selected in the left hand pane. The lower pane on the right of the dialog box will contain a number of fields relating to the selected item which you can fill in and change as you wish. For details on how to do this, see Setting which demographics can be edited on page 292. Once you have changed the information for a particular item, you can change the information on another item simply by selecting it in the left hand pane. When you have finished adding and changing the demographics information, click OK and confirm that you want to keep changes.
Viewing the study status history

While you are in the Quality Control screen, you can also view the status history of the study you are working on. Just click Study Status History on the Quality Control tooltab. This works in much the same way as when you are in the Data Selector (see Viewing study status histories on page 277), except that you can view details only on the study you are working on rather than all the studies in your local view.
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Matching studies automatically

MPPS is not used in automatic match mode, but only for manual matching.
A powerful feature of RA 600 is its ability to match patient demographics for a new study with that of a previous study on the same patient, so that the information can be automatically entered by RA 600 for the new study. This can save a considerable amount of time and greatly reduce the risk of human error. To match a study with a worklist while performing quality control click the Automatic button on the Quality Control tooltab in the Quality Control screen. An indicator light will show that matching is in progress. You can also see the results of your previous matching actions. To view a log of previous matching attempts click the Log button on the Quality Control tooltab in the Quality Control screen. In the Match Log you can also click in the first (Patient Name) column and then on Open to view more details on that particular entry. You can also set up RA 600 so that all incoming studies are matched automatically.
Matching all incoming studies automatically

Apart from performing matches in this way, it is also possible to configure RA 600 so that matching is undertaken fully automatically as studies are received by the RA 600 Quality Control system. Typically matched studies will be given special statuses (such as Matched and Unmatched) to indicate whether matching has been successful or not. It is also possible to automatically transmit studies depending on the result of the matching process. Details on setting up this form of automatic matching is covered in detail in the on-line Help and the RA 600 Installation and Configuration Guide.
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Adding, rearranging and removing data

Apart from adding and changing demographics, you can rearrange images within series and adjust the patient orientation of images, remove non-relevant images and series, and append images to series and series to studies. You use the Pictorial Index and the Quality Control tooltab to perform such tasks.
Rearranging images within a series

You can move images to different positions within a series using drag and drop within the Pictorial Index. To rearrange images within a series in the Pictorial Index in the Quality Control screen, click on the image you want to move and, keeping the mouse button down, drag the image to its new location. Moving selections of images You can also move a selection of images. Make your selection and drag any of the images in your selection to the new location. The images you selected will be placed before the image you dragged to in the order in which they previously appeared in the Pictorial Index.
Removing images and series

You can readily remove incorrect or unnecessary images and series using the Quality Control tooltab. To remove an image from a series click on the image in the Pictorial Index you want to remove. Click the Image button in the Delete section of the Quality Control tooltab (with the icon). To remove a series from a study click on an image within the Pictorial index which is part of the series you want to remove. Click the Series button in the Delete section of the Quality Control tooltab (with the icon).
Adding and combining images and series

You must select a study to combine with another study (rather than a series within a study). RA 600 will add all the series in this study to the study you are working on.
You can combine other images and series with the study you are currently working on. To combine a different series with a study open the study in the Quality Control screen. In your local studies list window, navigate to the study containing the series you want to combine with your study and select it. On the Quality Control tooltab (with the icon), click Series in the Insert as section.
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284 chapter 11 The series within the study you selected will be added as series within the study you are working on. Rather than add series to the study you are working on as separate series in the study, you can append the series as images to the end of a series within the study you are working on. To add a series as images to a study click on the series in the Pictorial Index you want to add the images to. In your local studies list window, navigate to and select the series whose images you want to add to the series you selected in the Pictorial Index. Click the Images button in the Insert as section of the Quality Control tooltab.
You can only append images of the same type to a series. And, if you select a study (rather than a series) in the local studies list window before attempting to append the images to a series, RA 600 will not do this if there is more than one series in the study you have selected.
Renumbering images
When you change the order of, add to or delete images in a series, you can have the images keep their original numbers or have RA 600 renumber them so they run consecutively again. You need administrator access to change this setting, see the Installation and Configuration Guide for details.
Changing patient orientation

The patient orientation is used to indicate the orientation of the patient during the acquisition process. For example, for an x-ray the patient orientation defines the Left-Right and Top-Bottom directions of the image according to LPH (Left Posterior Head) space. The patient orientation field is normally used for images that do not have image orientation vectors. In the Quality Control screen, you can change the orientation annotation on images in your study if for whatever reason they are incorrectly marked. To change the orientation annotation of an image or series select the image (or any image within the series you want to change) by clicking on the image in the Pictorial Index or in the viewing area of the Quality Control screen. Click Patient Orientation in the Quality Control section of the Quality Control tooltab. In the Patient Orientation dialog box, enter the correct notation in the fields provided (RA 600 will automatically fill in the corresponding opposite values). If you want to change the orientation annotation of the whole series, make sure the Apply to all images in series check box is checked.
Since CT and MR studies already contain predefined orientation information, you cannot change the orientation annotation of their images. (In general, you cannot change the orientation information of images that have valid image orientation vectors).
What are correct values for patient orientation?

RA 600 will not allow you to insert incorrect values in the fields in the Patient Orientation dialog box. When setting your patient orientation values, you may only specify a main and a secondary orientation and no more than two directions.
285 For example, if the main axis from left to right across the images is from H(ead) to F(eet), the other axis can only be PA or LR. If the second axis is then determined as PA, then the secondary orientation must be LR.
You cannot use double characters such as LL, RR etc. LF is not the same as FL. In the first case, L is the main orientation and F the secondary, while in the second case the reverse is true.
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Splitting and joining series and studies

The Quality Control screen gives you complete freedom to create new series and studies, remove selected images from a series and include them in a separate series, combine series and studies, and more. You do these tasks using the Pictorial Index and the Split/Join tooltab (with this icon). You can also use drag and drop to move images between series and studies in the Pictorial Index in much the same way as rearranging images within the same series - see Rearranging images within a series on page 283.
Selecting images in the Pictorial Index

Before splitting images off into a new series and performing similar tasks, you need to select them in the Pictorial Index first. To select a single image click on it in the Pictorial Index.
The image will become grey (just one image in this case). To select multiple images hold down the Ctrl key and click on the images you want to include in your selection. A grey film will cover all the images to indicate they are included in your selection. To select a range of images hold down the Shift key, click on the first image in the range and then on the last image in the range. To add a range of images to your selection hold down the Ctrl and Shift keys, click on the first image in the range and then on the last image in the range. To remove an image from your selection the Ctrl key. click on the image while holding down
Placing selected images in a new series or study

Once you have selected a number of images, you can remove them from the series they are in and place them in a new series. If you wish, you can also place them in an entirely new study. To place images in a new series select the images you want to move to the new series and click Series in the Split to section on the Split/Join tooltab. (You can also right-click in the Pictorial Index and select Split to Series, or select Manipulate Split to Series from the menu bar).
287 To place images in a new study select the images you want to move to the new series and click Study in the Split to section on the Split/Join tooltab. (You can also right-click in the Pictorial Index and select Split to Study, or select Manipulate Split to Study from the menu bar).
Splitting using contrast or echo time

If you have series that contain images with different contrasts or echo times, you can quickly separate these off into separate series. To create a new series of images with a particular contrast or echo time select an image with the contrast or echo time that all the images in the new series or study should have (you can right-click on an image in a viewport and select Info from the pop-up menu to view the Info dialog box in which you will be able to find the contrast or echo time used for that image). Then click Contrast or Echo time in the Split series on section on the Split/Join tooltab. (You can also right-click in the Pictorial Index and select Split series on Contrast or Echo time, or select Manipulate Split series on Contrast or Echo time from the menu bar). All the images with the same contrast or echo time as the image you selected will be split off into a new series.
Combining images into new series or studies

You can combine images in new series and studies provided they share the same modality and frame of reference. To combine (join) images into a new series (or study) in the Pictorial Index, select the images you want to combine in each series (see Selecting images in the Pictorial Index on page 286). If you want to fully combine two series, select all images in each by clicking on the first image in each series and, holding down the Shift key, on the last image in each series. Then click Series (or Study) in the Create new section on the Split/Join tooltab. (You can also rightclick in the Pictorial Index and select Create new Series (or Study), or select Manipulate Create new Series (or Study) from the menu bar). Finally, drag the selected images into the new series (or study).
What about empty studies and series?

You do not need to remove empty studies and series in the Quality Control screen. When you save your work, any empty studies or series in the Pictorial Index will not be saved, but automatically discarded by RA 600. They will not appear in the Data Selector, nor will empty series appear in the Pictorial Index when you reopen the study.
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Moving images between series using drag and drop

Just as you can move images around in the Pictorial Index in the Quality Control screen (and hence adjust their order in a series) using drag and drop, you can move images between series. Simply select the images you want to move, click on one of them and drag to the position in the new series where you want them to go. As for combining series, you can only drag and drop images to a different series if the images in this series are of the same modality and have the same frame of reference.
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Windowing, annotating, flipping and rotating

When flipped and/or rotated, pixel data is changed accordingly so that images still display correctly even on systems that do not support flip or rotate operations.
While in the Quality Control screen, you can window images, add annotation, flip and rotate images. You do this using the tooltabs in just the same way as when in the Viewing Section. You can also have RA 600 automatically save your windowing settings when you return to the Data Selector. You need administrator access to change this setting, see the Installation and Configuration Guide for details.
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Saving studies and changing study status

When you have finished working on a study in the Quality Control Screen, you save your work by clicking either the Save button or Back button in the bottom right hand corner of your screen. If you use the Save button, you will remain in the Quality Control screen ready to work on another study, while the Back button will return you to the Data Selector. When studies are saved, their status is automatically changed to indicate that they have been processed. RA 600 allows you to select what the status should be changed to when you save your studies. To select the new status of studies saved after Quality Control select Configuration Quality Control... from the Data Selector menu bar. On the General tab, select the status you want to assign to saved studies from the Status QC Success drop-down list in the Quality Control Module Properties dialog box.
Reverting the status of a study

During normal use of RA 600, the status of studies progresses from New through to Reported and Authorized, but cannot be reverted to a previous status. This is, however, possible using Quality Control. (If, for example, a study is taken from an Archive with the status Authorized). This could cause problems (depending on your workflow and organization), so the administrator may have disabled this. If the Allow user to set status back check box is checked (and so you can revert the status of studies when you save them), RA 600 can ask you to confirm that you wish to do this when you are about to revert the status of a study. To ask for confirmation when setting back the status of studies select Configuration Quality Control... from the Data Selector menu bar. Make sure the Confirm to set back study status check box is checked on the General tab of the Quality Control Module Properties dialog box.
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Automatically sending studies after saving them

When you have finished work on a study and saved it, you can have RA 600 automatically send this on to a specific destination (or destinations) ready for viewing and diagnosis. For this, you will need to have the destination (system you are sending to) properly configured on your system and then create an auto transmit protocol using a special trigger for Quality Control. See the RA 600 Installation and Configuration Guide for details.
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Setting which demographics can be edited

When in the Quality Control screen, you can change various demographic information on the study you are working on (see Editing patient demographics on page 281). The demographic information which you can change is configurable using the Edit Demographics tab of the Quality Control Module Properties dialog box. This dialog box essentially lets you create the fields and drop-down lists which appear when you are viewing the Edit Demographics dialog box while working on a study. You can define the information that can be edited at the DICOM levels of Patient, Study, Series and Image. You can also define the editable demographics for all modalities or for each individual modality. To add or change the demographics information that can be edited 1 Select Configuration Quality Control... from the Data Selector menu bar. Then click the Edit Demographics tab of the Quality Control Module Properties dialog box. Select a modality (see Selecting modalities on page 293) and level from the drop-down lists in the Select section of the Edit Demographics tab. (To have the editable information apply for all modalities, select Generic from the Modality drop-down list.) If you cannot find the modality you need, type a two-character value in the Modality drop-down list (CT or MR for example). This will create a new entry in the drop-down list. To add new editable information, click the Add button. To change existing editable information, select the information by clicking on it in the Controls section to select it and then click the Modify button. In the Add/Modify dialog box, select a DICOM tag using the Dicom Tag drop-down list or the Group and Element drop-down lists. Select the type of field (or drop down list) that should appear from the Type drop-down list (see About field types on page 293). Enter a description in the Description field. This will appear in the list of editable information on the Edit Demographics tab and in the Edit Demographics dialog box when you are working on your studies. Enter a default value for the information. This will be the option that is initially shown in the field or drop-down list and the value stored if no change is made in the Edit Demographics dialog box.
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293 8 If you have specified a drop-down list in the Type field in 5, enter the various options which should appear in this drop-down list in the Selection list field. Place each option on a new line.
To remove demographics information that can be edited 1 Select Configuration Quality Control... from the Data Selector menu bar. Then click the Edit Demographics tab of the Quality Control Module Properties dialog box. Select a modality and level from the drop-down lists in the Select section of the Edit Demographics tab. Select the information by clicking on it in the window in the Controls section to select it and then click the Delete button.
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Selecting modalities If you select the Generic modality in the Modality drop-down list, the settings will apply to studies from all modalities. If a DICOM element is specified at both the Generic level and for a specific modality, the latter will be used. The Generic level is the only level at which Patient and Study parameters can be set. You should never delete this level. About levels The options to change demographics will only appear when the same level is being viewed in the Edit Demographics dialog box when working on studies in the Quality Control screen. About field types You can select various types of data fields in the Type drop-down list. If you select Edit Box, this will allow normal text strings to be entered on a single line. The Multi-Line Edit Box will let text be entered on a number of lines. The Date Box means that a date must be entered in a particular format. This format is determined by the users Windows settings. RA 600 will only allow the information to be entered in the correct format. If an incorrect format is used, RA 600 will inform the user of this and indicate the format which should be used. Selecting Time Box will mean that the information must be entered in the time format as specified in the Windows settings. Again, RA 600 will only allow time entries with this format and will indicate the correct format if an incorrect one is used. There is also a Patient Name Box in the Type drop-down list. This creates the five fields required to fully specify a persons name in DICOM. Finally, you can select a drop-down list (Drop List Box). You then type the entries to go in this list in the Selection list field.
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Customizing RA 600
This chapter shows how you can customize RA 600. It tells you how to display, hide and re-size screen elements, create personal toolbars and keyboard shortcuts and use special commands for changing statuses. Because RA 600 lets you create your own tooltabs, menus and right mouse button menus, you can take customization further than is the case with many other software products. Such features not only provide additional convenience, but permit very tight integration with other systems, such as a HIS or RIS. The end of the chapter provides a list of items to help you work more efficiently with RA 600.
Making changes while using RA 600 .....................296 Configuring your toolbars .......................................297 Creating keyboard shortcuts ..................................299 Using special commands for changing study status300 Configuring right mouse button (pop-up) menus....302 Custom tooltabs, menus and right mouse button menus ....................................................................303 Customizing your fonts in RA 600..........................304 Working quickly with RA 600..................................306
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ach user of RA 600 will have their own specific needs and ways of working. RA 600 is designed to be highly configurable (even on the fly in many ways) so you can have it look, and use it, just the way you want.
When you start RA 600, it will look to see who has logged on and use your own special settings. This means that you, and any other users of the system, can create their own favorite settings without worrying about inconveniencing anyone else.
Making changes while using RA 600

While actually using RA 600 you can change a number of aspects about how it looks, to create more screen area for viewing, or to position screen elements more conveniently for you. When you leave RA 600, it will automatically save your current window positions, so it will look the same the next time you start it up. Showing and hiding the Pictorial Index, Reports window and worklists In the Data Selector and the Viewing Section (and MPR/MIP screen), you can show or hide elements such as the Pictorial Index and Reports and worklist windows by checking or unchecking the check boxes on the Viewing tooltab. Moving elements around the screen At any time when you are using RA 600, you can also move your Pictorial Index, tooltabs, Reports window and worklists around the screen. To move a window to a new part of the screen click on the two lines at the top of the window, drag it to another side of the screen and release the mouse button. Your window will dock automatically at the new location.
Resetting your window positions

After moving your screen elements around, you may want to go back to how they were when RA 600 was first installed. A special button is provided for this purpose. To restore your windows to their original positions select Tools Customize from the menu bar. On the Toolbars tab of the Customize dialog box, click Reset All Window Positions.
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Configuring your toolbars

When RA 600 is first installed, you are provided with a selection of toolbars which let you perform many common tasks with just the click of a button. These are initially located under the menu bar at the top of the screen. You can, however, position them at any side of the screen. The toolbars RA 600 initially provides are just the start. You can easily modify them by removing or adding buttons (available for virtually every action you are likely to undertake with RA 600), or you can hide toolbars altogether. You can also create your own custom toolbars from scratch.
Showing, hiding and changing the look of your toolbars

Since you perform different tasks in different parts of RA 600, the toolbars you will see in the Data Selector will be different to those in the Viewing Section, for example. This means you can set up the toolbars you want to use for each part of RA 600.
You change the appearance of your toolbars by selecting Tools Customize from the menu bar of whatever part of RA 600 you are in. The Toolbars tab of the Customize dialog box lets you select which toolbars you want available and whether the Tool tips (the pop-up descriptions of the buttons) are shown when you pause with the mouse pointer over a button. You can also choose between Cool Look (flat) buttons or (more traditional) 3Dstyle buttons, and have larger buttons (useful for high resolution monitors).
Creating your own toolbars

You can create your own custom toolbars with any combination of buttons you wish. To create a new toolbar select Tools Customize from the menu bar. On the Toolbars tab of the Customize dialog box, click New. In the New toolbar dialog box, enter a name for your toolbar in the New Tool bar dialog box. Initially your new toolbar will not contain any buttons, so you will now need to add them. See Changing the buttons on your toolbars on page 298 for details.
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298 chapter 12 To remove (delete) a toolbar you have created select Tools Customize from the menu bar. On the Tool bars tab of the Customize dialog box, click on the name of the toolbar you want to remove. Click Delete.
If when trying to remove a toolbar, you see a Reset button rather than a Delete button, you have selected one of the standard toolbars installed with RA 600. While you cannot Delete these, you can undo any changes that have been made to them using the Reset button. While they cannot be deleted entirely, you can of course hide them from view by unchecking the check box next the name of the toolbar.
Changing the buttons on your toolbars

You can easily add and remove buttons from any toolbar, and also change their order on the toolbar. To add a button to a toolbar select Tools Customize from the menu bar and click the Commands tab of the Customize dialog box. Click a category on the left of the dialog box to see the buttons available for the category. To see what a button does, click on it and look in the Description section of the dialog box. When you find a button you want to add to a toolbar, simply click on it, drag it over the toolbar and release the mouse button. The button will now be incorporated into your toolbar. To remove a button from a toolbar select Tools Customize from the menu bar. Click on the button you want to remove and, holding the mouse button down, drag the button out of the toolbar. To change the order of buttons on a toolbar select Tools Customize from the menu bar. Click on the button you want to move and drag it along the toolbar to where you want it to go.
You do not have to open the Customize dialog box to be able to move buttons around. Press the Alt key as you drag the buttons. This has the same effect as opening the Customize dialog box. You can also quickly open the Customize dialog box by rightclicking on any toolbar and clicking Customize.
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Creating keyboard shortcuts

RA 600s keyboard shortcuts include the Page Up and Page Down keys and cursor keys in the Data Selector and Viewing Section. And, as in other Windows applications, the shortcuts are visible on the menu bar and drop-down menus. (Hold down the Alt key while pressing the same key as the underlined character of the menu on the menu bar you want to access. To access a command on a dropdown menu, just hit the same key as the underlined character of the command.)
Keyboard shortcuts, which let you perform tasks by pressing a simple key combination, can be much faster than using a mouse. Accelerator keys (key combinations which include sequences of keys) can also be useful to know and might even become essential if for some reason it is not possible to use a mouse. RA 600 comes with many shortcuts and accelerator keys already included for numerous tasks, but it also lets you define shortcuts for just about anything you might want to do. To create a keyboard shortcut select Tools Customize from the menu bar and click the Shortcut Keys tab of the Customize dialog box. Look through the commands in the list on the left of the dialog box. When you find a command you want to create a shortcut for, click on it and click Create Shortcut. Then press the key you want to use for the shortcut. The key combination will appear in the Shortcut key column. Exporting shortcut lists To help you more easily remember the shortcuts you have created, you can export them to a text file so they can be printed out, for example. To export the shortcut list select Tools Customize from the menu bar and click the Shortcut Keys tab of the Customize dialog box. Click on the Export button and select a location to save the list in the Save as dialog box. Click Save. To remove a keyboard shortcut select Tools Customize from the menu bar and click the Shortcut Keys tab of the Customize dialog box. Click on the command whose keyboard shortcut you want to remove. Then click Remove. The Reset All button removes all the keyboard shortcuts that have previously been assigned.
Shortcuts you assign will override any previous shortcut with the same key combination. This means you should be sure not to use any other combinations you might need, such as the Ctrl X, Ctrl C and Ctrl V for Windows Cut, Copy and Paste.
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Using special commands for changing study status

You can use Special commands to view one study after another without being bothered by the Save Data dialog box which otherwise appears when you leave a study.
When you are in the Viewing Section and wish to close a study, change its status (to Reported for example) and then open another study for viewing, you can do this with single key combinations. These are called special commands, and they can help save time and effort when you have a number of studies to work through. To create a special command 1 In the Viewing Section, select Tools Customize from the menu bar and click the Special Commands tab of the Customize dialog box. Click the Add button and then enter a descriptive name for the special command in the Add/Modify Special Commands dialog box. Check the check boxes next to the study statuses the special command is to be able to change. (Specify here the original study statuses before the special command is used). You may, for example, not want the special command to change the status of a study from Authorized to something else. In this case, do not check the Authorized check box. Select a final study status from the drop-down list. This is the status that the special command will set the study to when you apply the command. Select <Do not change> if you do not want RA 600 to change the status of the study. Click the Previous Item, Next Item or Back radio button if necessary. If the Previous Item radio button is active, RA 600 will show the study immediately before the one you are looking at in your list. Selecting the Next Item radio button will mean that the next study in your list is shown. If the Back radio button is selected you will be returned to the Data Selector. Check the Save added/changed data check box if you want RA 600 to automatically save your changes when you use the shortcut. Click the Create Shortcut button. When the Assign Shortcut dialog box appears, simply press the key combination you want to use for the special command (hold down the Ctrl key and press one of the letter keys for example).
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You can only create special commands which work in the Viewing Section. The Special Commands tab will therefore only appear on the Customize dialog box if you open this dialog box in the Viewing Section. Since special commands involve changing the status of studies, you will also only be able to create them if you have permission as a user to assign statuses to studies. If you do not have this permission you will also not see the Special Commands tab on the Customize dialog box. You can display the Special Commands tab (if you have the appropriate permissions) by choosing Configuration Viewing... from the Data Selector menu bar. On the Study Status Permissions tab, check any of the check boxes.
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301 To modify or delete a special command 1 In the Viewing Section, select Tools Customize from the menu bar and click the Special Commands tab of the Customize dialog box. Click on the name of the special command you want to modify or delete in the list and click the Modify or Delete button. If modifying a special command, follow steps 3 to 7 in the To create a special command procedure described above.
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Configuring right mouse button (pop-up) menus

You can also add completely new items to your right mouse button menus if you have the Integration Module installed. See Custom tooltabs, menus and right mouse button menus on page 303.
Right mouse button menus, which pop-up by right-clicking with the mouse, offer a quick way to use RA 600. There are, however, a great many commands that can appear on them. To avoid them becoming longer than you might like, you can readily specify which items should appear on your right mouse button menus. You can then include commands you use frequently and leave off those commands which you seldom if ever use. You can specify separately what items appear in the right mouse button menus in the Viewing Section and in the Data Selector. To add or remove items from the Data Selector right mouse button menu select Configuration User... from the Data Selector menu bar and check or uncheck the check boxes on the Popup Menu tab of the User Properties dialog box. To add or remove items from the Viewing Section right mouse button menus select Configuration Viewing... from the Data Selector menu bar and check or uncheck the check boxes on the Popup Menu tab of the Viewing Properties dialog box.
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Custom tooltabs, menus and right mouse button menus

Custom tooltabs, menus and right mouse button menus rely on whether the Integration Module has been installed on your system. To check this, click on the Configuration menu in the Data Selector. If there is a menu item Integration Module... it is on your system. Setting up and configuring custom tooltabs and menus are tasks for support staff or RA 600 distributor and hence are beyond the scope of this user guide. It is especially important that it be undertaken only by expert users since incorrect configuration may lead to errors and inconsistencies between RA 600 data and RIS data, for example.
While most Windows programs allow some degree of customization to the users preferences, RA 600 takes this a great deal further by allowing new, fully customized tooltabs, menus and right mouse button menus to be created. When you have your own tooltabs, these will contain sets of buttons that perform particular actions. You have a great deal of choice about what you include on these, but generally the items fall into three categories: applications, web page access and HIS/RIS functions. Any application you can run separately on your system under Windows can be started by clicking a custom button you create. You could, for example, have Microsoft Word or Excel start (perhaps with a particular template document) or have the Windows calculator just a mouse-click away. If you have access to the Internet or an intranet, you can include buttons that will launch a web browser showing a particular HTML page. This could, of course, be especially useful for browser-based HIS/RIS systems. Particularly powerful for workstations connected to HIS/RIS systems is the ability to include commonly-used HIS/RIS functions on tooltabs and menus. So, for example, you could have a Look Up Patient button which, when clicked, will query a HIS for certain details about the selected patient. Further discussion of custom tooltabs and menus is beyond the scope of this guide. If you already have them, or would like them set up on your system, contact your system administrator or RA 600 distributor for further information.
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Customizing your fonts in RA 600

RA 600 works with monitors with resolutions from 800 x 600 up to multimonitor systems with very high resolutions. Particularly when using a very high resolution, you may wish to adjust the font used for your patient and study lists (worklist views), and in image annotations. You can also change the font used on tooltabs, dialog boxes etc. You need administrator access to do this, see the Installation and Configuration Guide.
Fonts in your Data Selector patient and study lists (worklist views)
The appearance of your patient and study lists in the Data Selector is highly configurable. You can specify different fonts for different levels (such as patient, study, series etc.) and even highlight rows which contain specific information of interest (such as the status New for example). To change the fonts used for worklist views 1 In the Data Selector, select the worklist view you want to change the fonts of from the drop-down list at the top of the Data Selector tooltab. Select Database bar. View Properties... from the Data Selector menu
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In the Fonts section of the Configure View dialog box, click on Study item to which you want to apply a font and then on the Font button. Select the font to be used for lines in the worklist view displaying information on studies and click OK. Repeat steps 2 and 3 for Series item, Image item and, if you are configuring a patient view, Patient item.
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In this way, you will be able to have RA 600 display information at each level (patient, study, series and image) differently. You might, for example, want to have information on images shown in a somewhat smaller size.
305 Configuring your worklist views to look the same You can readily configure each of your worklist views in this way. If, however, you have a number of worklist views which you want to look the same, you can simply configure one of them and then click the Make default check box in the Fonts section of the Configure View dialog box. All your other worklist views will be configured in the same way as this default worklist view.
Image annotation fonts

You can also change the font used when annotations are added to images. To change the image annotation font 1 2 3 In the Data Selector, select Configuration menu bar. Viewing... from the
In the Viewing Properties dialog box, click on the Image Annotations tab. In the Font section, specify a minimum and maximum font size and set a relative size if desired.
Minimum, Maximum and relative font sizes RA 600 does not always display fonts at the same size in the viewports, but resizes them according to the size of the viewport. If the viewport is large, RA 600 will use a relatively large font, but if you have a large number of small viewports, RA 600 will use a small font. The maximum and minimum values in the Viewing Properties dialog box allow you to specify the largest and smallest fonts that RA 600 should use. If the fonts generally appear too large or small, you can also set a Relative Size other than 1. This will scale all the fonts displayed either up or down.
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Working quickly with RA 600

RA 600 is designed to be easy to use for newcomers to the program, but it also offers many ways of working more quickly and effectively for those that become more familiar with it. Some of the shortcuts and other ways of working more effectively with RA 600 are discussed briefly below. When you are familiar with RA 600, you might like to glance through this list to see if there are ways of working more efficiently.
Toolbars and buttons

Whatever tasks you perform frequently in any particular part of RA 600, you can have a button for it permanently available on a toolbar at the edge of the screen. You can decide which side of the screen you want the toolbar on (click on the two gray lines at the end of the toolbar and drag the toolbar to the side you want it). You can readily define exactly which buttons you want on which toolbar for each part of RA 600, so that different toolbars will appear depending on the section of RA 600 you are in. For more on this, see Configuring your toolbars on page 297.
The double-click
You will probably be aware that double-clicking on a study or series in your study or patient list will open it for viewing. But there are also other many other occasions when a double-click can save you time. Double-click on a study in your study view in the Data Selector to open all the series in the study for viewing. on the patient in a patient view to open all the studies on that patient inside a viewport to pin or unpin that viewport. inside a viewport while creating a virtual film sheet to add the image to that film sheet. inside a viewport while sending images (from within the viewing section) in order to add an image to the teleradiology send job. on a print job in the Print Queue to reveal details on it. on the first (Origin) column of the Receive Log in teleradiology to view details on what you received. on the first (Destination) column of the Send Log in teleradiology to view details on what you sent.
307 on patient name in Quality Control to view details on a study. on first (Name) column of the Destinations dialog box to modify its properties. on a marker or text to edit the text. on an ROI to close it.
Keyboard shortcuts and special commands

RA 600 already comes with many key combinations you can use to perform particular tasks, and you can define your own for the actions you perform frequently, see Creating keyboard shortcuts on page 299. You can also create special commands for changing the status of a study and opening the next one for viewing, see Using special commands for changing study status on page 300.
Mouse / keyboard combinations

If you have an Intellimouse with mouse ball, you can use this to control manual cine loops (stack mode displays).
If you hold down the Ctrl key while right-clicking in a viewport, you will mark the image in that viewport as a key note (see Viewing key notes on page 109 for details). Repeating this process will unmark the image. Holding down the Shift key while right-clicking in a viewport displays a single viewport containing the image you clicked on. Very useful for quickly zooming in to view an image more closely. Repeat the process to zoom out again.
Right mouse button menus

You can customize the contents of your right mouse button menus see Configuring right mouse button (pop-up) menus on page 302. If you have the Integration Module installed, you can also add fully custom items and sub-menus to your right mouse button menus.
Right-clicking in certain parts of the screen brings up a menu which allows you to do just about everything possible using the tooltabs, and even includes one or two additional functions. The right mouse button menu is context sensitive the items which appear on this menu depend on the part of RA 600 you are currently working in, and where you click on the screen. As you gain experience with RA 600, you will find that you can work more quickly by just using these right mouse button menus. In fact, you might possibly wish to hide the tooltabs to give yourself more viewing area. The items which may appear on the right mouse button menu should be quite familiar once you are familiar with RA 600 so will not be listed here. We recommend that you look to see what the right mouse button menus offer and become familiar with what is included on them in the various parts of RA 600. They really can help speed up your work.
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Appendices
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Common tasks for radiologists
s a radiologist or physician, there will probably be various tasks you will perform regularly with RA 600. This RA 600 appendix includes step-by-step instructions for a number of these. You can work through them as exercises when familiarizing yourself with RA 600 or, if you already have some experience of using it, you might want to see if the procedures here offer better ways of utilizing RA 600 for these tasks.
How to view a chest film

If you do not have the RA 600 sample studies installed on your system, you can use a similar case which is available in your local database.
You are requested to view the chest film of Sophie Temple (Patient ID PO113, a sample study installed with RA 600). 1 First filter for the patient name and/or ID and/or modality. Click the Patient name column header in the study list to sort patient names alphabetically and locate Temple, Sophie or In the Modality section of the Data Selector tooltab (with the icon), click None then check the CR check box. Only CR studies will appear in the study list. 2 Click the + next to the study icon to show all the series in the Sophie Temple study. This contains two series. Open one of the series for viewing by double-clicking on it. Once in the Viewing Section, look in the drop-down list on the Windowing tooltab (with the sun icon) to see whether there is a default established for the images. If there is, select it to set a pre-defined windowing level.
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312 appendix A 4 If not, and you want to make further adjustments, click with the right mouse button in the viewport and, holding the button down, drag up, down, right or left (or some combination of these) to adjust width and center. Click the Filtering tooltab (with the icon) and apply various filters by clicking on the appropriate button. Try the magnifying glass on the Zooming tooltab. Click the right mouse button and select a zoom level from the pop-up menu to check details made visible by your filtering. You now want to hide the Pictorial Index. On the Layout tooltab (with the Swiss Army knife icon), uncheck the Show Pictorial Index check box (you can also select Layout Show Pictorial Index from the menu bar to show and hide the Pictorial Index). Access any other tools on the tooltabs or via the right mouse button pop-up menu you think you might need to aid diagnosis. You are now ready to send a report.
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Sending a report
Based on the protocols established in your unit, you might dictate your report or use the reporting functions in RA 600. 1 2 3 4 To turn on the report function, check the Show Reports check box on the Layout tooltab (with the Swiss Army knife icon). Type your report in the window which appears under the viewport. Click the Back button in the bottom right hand corner of the screen. In the Save Data dialog box, make sure the Reports check box is checked (click on the Advanced button if you do not see the check box). Change the Study status to Reported by selecting this status from the Update Study Status drop-down list and click Yes. The report will now be saved with the study. You will now be back in the Data Selector. Click on the tab with the telephone icon to bring the Teleradiology tooltab to the front. Select a destination in the Destinations section and then on the Send button. A Send to... dialog box appears. Set your transmission parameters as necessary. Format must be completed. If the Delete After Send check box is checked, the entire study will be deleted from your system even if you are only sending one series from a study containing a number of series. If you check the check box Structured Reports only, RA 600 will send only the structured report, not the images. Click OK to immediately start transmission. Unless procedures have been established otherwise, most cases are not send immediately. The times at which transmissions are made are typically set by the system administrator for maximum efficiency.
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The protocols established in your unit may have you input your name, the referring physicians name, date, etc. in the Send to dialog box.
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Looking at two studies

You are asked to look at two studies from a particular patient (in this case Laura Baxter, a sample study installed with RA 600). 1 2
Since RA 600 is highly configurable, you may not see a Modality section on the Data Selector tooltab. In this case, ignore step 2.
In the Data Selector, click the tab with the Selector tooltab to the front.
icon to bring the Data
In the Modality section, click None. Then check the MR and DR check boxes. You have now filtered the local database (study list) for MRs and DRs. Click Patient name at the top of the column in the study list to sort patient names alphabetically. If you still cannot see the Baxter, Laura studies, click the Query... button in the View section of the Data Selector tooltab. In the Patient name field of the Query Parameters dialog box, type B*. You will now see a list of all MRs for patients whose names start with B (see Pinpointing your data with queries on page 58 for details on querying). Click the study icons for the two Baxter, Laura entries in the study list to see the underlying series. Holding down the Ctrl key, click each series in turn to select both of them. Click the tab with the icon to bring the Filing tooltab to the front. Click New in the Folders section. In the New Folder dialog box, make a folder with the referring physicians name and move the studies to this folder (select File Move to Folder from the menu bar and then select the new folder you have just made). Bring the Viewing tooltab ( ) to the front. Select a multi-study option (the thicker lines indicate divisions between studies). Confirm the choice to select multiple studies in the View Studies message box by clicking Yes and then OK in the Viewing message box. After the studies have opened in the Viewing Section, window as necessary (see Windowing on page 35 for details). You decide you would like cine loops in two of the series. Click the tab with the icon to bring the Cine tooltab to the front.
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You can leave the Directory field in the New Folder dialog box empty.
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315 12 13 Turn on the cine loop for the series (see Viewing cine loops on page 37 for details). You want to hide the DICOM data on the study of an image. Click the right mouse button in the viewport and select Annotation None (or select Image Annotation None from the menu bar). After manipulating the series as necessary, check the Show Reports check box on the Layout tooltab (with the Swiss Army knife icon). Type your report in the window which appears under the viewport. Click the Back button in the bottom right hand corner of the screen.
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In the Save Data dialog box, click Yes to save any annotations and your report with the study. Also update the Study Status if necessary. The referring physician can now access the study at his or her convenience.
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Common tasks for radiographic technologists
his RA 600 appendix looks at some possible situations a radiographic technologist might face and gives step-by-step instructions on how to use RA 600 to complete the tasks.
Preparing studies for viewing by a doctor

A doctor calls to ask you to get a patients studies ready for him. You need to find the appropriate studies, select a layout for viewing and open them. You then need to check the images for contrast, annotations etc. and set up reporting arrangements. 1 2 3 Turn on the system and start RA 600 if necessary. In the Data Selector, first create a folder for the doctor. Go to the File menu and select Folder New.... In the New Folder dialog box, type the doctors name as the name of the folder and then click OK. The folder will now appear in the Folders section of the Filing tooltab. Select Local Patients from the Worklist View drop-down list at the top of the Data Selector (with the icon). Scroll through your local view to find the patient whose studies the doctor wants to view. Click on the + sign next to the patient icon. All the studies for this patient will now be visible.
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318 appendix B 7 Hold down the Ctrl key and click each study that is required in turn. (If you need all the studies, just double click on the patient icon to select the patient.) Select File Move to folder from the menu bar.
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Select the folder you just created and click OK in the Move Data confirmation box. To verify all the studies have been correctly placed in this folder, click the None button in the Folders section on the Data Selector tooltab. Then check the check box next to the folder you created. Only those studies the doctor wishes to look at should appear in your local view. On the Viewing tooltab, select an appropriate layout for viewing by clicking on the appropriate button.
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Adjusting window level 1 Select on the Viewport scope radio button in the Viewing Section. Then click inside a viewport and right-click and hold the mouse button down until the sun icon appears. 2 3 4 Move the mouse up and down and to the left and right until the window level is how you want it. Repeat for the other view as required. If there are preferred settings for a specific modality or image, you can find these in the drop-down list near the top of the windowing tooltab.
Hiding annotations 1 Select a viewport, right click on it and select Annotation from the pop-up menu. 2
None
You can also turn annotation off using the menu bar (Image menu) or selecting the None radio button in the Annotation Level section on the Annotation and Measurement tooltab.
Finally Depending on the protocol established for creating reports, you may now need to set up dictation equipment, prepare the Reports window in RA 600 (turning off the Pictorial Index on the Viewing tooltab will provide more room for viewing and reporting), or open a word processor.
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Sending a report
The doctor finishes reporting on the case and asks you to send out the report. He or she should have saved their Presentation States and Key Note Objects and RA 600 should be back in the Data Selector. If the doctor has left with the Viewing Section still showing, you should check with a supervisor since the doctor may not have processed the Save Data dialog box (which is shown before returning to the Data Selector). 1 2 Verify that the appropriate study or series is selected in your local view in the Data Selector. Go to the Teleradiology tooltab (with the telephone icon) and select the destination in the Destinations section by (single) clicking on it. Click the Send button. In the Send to dialog box, confirm the Study Identification data. Unless procedures have been established otherwise, most cases are not sent immediately. Click OK.
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320 appendix B
Printing viewport images

You are asked to print out a number of viewports of a patient for immediate viewing by the surgeon. 1 2 3 Open the requested study for viewing. On the Print tooltab (with the printer icon) in the Viewing Section, select a printer from the Destinations drop-down list. Click on your choice of layout (single or multiple images on a sheet depending on your printer), or click the Select... button, scroll to find the one you want and click OK. Your virtual film sheet will appear on the screen. Drag it around and resize it as necessary to gain a proper view of your viewports. Double-click on the desired viewports to quickly fill the virtual film sheet. If you need more than one sheet, RA 600 will automatically provide you with one, or click the Insert button to add another virtual film sheet manually. Continue to add images as required. Right-click in a viewport to bring up the right mouse button menu with manipulation options before sending the print job. You can Clear, Delete or Overwrite images as needed (see Printing while viewing images on page 257 for details). When you have finished composing your film sheet(s), click the Submit button.
4 5 6
7 8 9
Confirm everything is correct in the Print Study to dialog box and click OK.
A P P E N D I X
License agreement
GE MEDICAL SYSTEMS INFORMATION TECHNOLOGIES SOFTWARE LICENSE AGREEMENT IMPORTANT: READ CAREFULLY BEFORE PROCEEDING WITH SOFTWARE INSTALLATION. BY OPENING THE ENCLOSED SEALED DISK PACKAGE AND INSTALLING THIS SOFTWARE OR PERMITTING A GE SERVICE REPRESENTATIVE TO OPEN THE SEALED DISK PACKAGE AND INSTALL THE SOFTWARE ON YOUR BEHALF, YOU (CUSTOMER) ARE AGREEING TO BE BOUND BY THE TERMS OF THIS GE MEDICAL SYSTEMS INFORMATION TECHNOLOGIES(GEMS IT) SOFTWARE LICENSE AGREEMENT (AGREEMENT). IF YOU DO NOT AGREE TO THE TERMS OF THIS AGREEMENT, PLEASE DISCONTINUE USE AND IMMEDIATELY RETURN THE SOFTWARE TO GEMS IT. OTHERWISE, YOUR CONTINUED USE WILL BE DEEMED TO CONSTITUTE ACCEPTANCE OF THE TERMS OF THIS AGREEMENT. 1. Software License; Intellectual Property. a. License Grant. Subject to the terms of this Agreement, GEMS IT grants to Customer a nonexclusive, limited, nontransferable license to use the software and any accompanying user manuals and documentation (Licensed Software), subject to the following: (i) Customer may use the Licensed Software for internal purposes only. Customer may make one copy of the Licensed Software in machine readable form solely for backup purposes. Customer shall reproduce on any such copy the copyright notice, and any other proprietary legends that were on the original copy; (ii) Customer shall use the Licensed Software only on equipment located at Customers site and solely for the purpose of processing, storing, and transmitting data of Customer. Customer shall not sublicense, distribute, transfer or otherwise make the Licensed Software available for use by any other person or entity. Customer must obtain additional licenses from GEMS IT before using the Licensed Software in any manner or for any purpose not expressly stated above. If Customer receives Licensed Software hereunder that renders software that Customer has previously received redundant, Customer will return the redundant software to GEMS IT or certify in writing that all copies of such Licensed Software have been erased. b. Restrictions. Customer shall not: (i) make copies of the Licensed Software (except for one back-up copy); (ii) distribute or transfer the Licensed Software to third parties by any means, including electronically; or (iii) modify the Licensed Software or create derivative works therefrom. Any such modifications or derivative works shall be owned exclusively by GEMS IT.
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322 appendix C
CUSTOMER MAY NOT AUTHORIZE OR PERMIT ANY PERSON OR ENTITY TO, MODIFY, ADAPT, TRANSLATE, RENT, LEASE, SUBLICENSE, LOAN, RESELL, DISPLAY, DISTRIBUTE, NETWORK, OR CREATE DERIVATIVE WORKS BASED UPON THE LICENSED SOFTWARE OR ANY PART THEREOF. Customer may not authorize or permit any person or entity to, either directly or indirectly, decompile, reverse engineer, disassemble, or otherwise reduce the Licensed Software to a human perceivable form or derive the source code for such Licensed Software. c. Intellectual Property Rights; Injunctive Relief. As between Customer and GEMS IT, GEMS IT is and shall remain the sole owner of all right, title, and interest in and to the Licensed Software, including all upgrades, updates, and error corrections, and to all intellectual property rights embodied therein or related thereto. No rights thereto are granted (whether by implied license or otherwise), to Customer, except as specifically provided in Section 1.a. hereof. If Customer or its personnel acquire any right, title, or interest therein, Customer hereby assigns all such right, title and interest to GEMS IT. GEMS IT hereby reserves any and all rights in and to the Licensed Software that are not expressly granted or otherwise transferred to Customer herein. Customer agrees that breach of this Section 1 will cause irreparable harm to GEMS IT for which the award of money damages may be inadequate. Customer agrees that in the event of any breach of this provision, GEMS IT shall be entitled to receive injunctive relief in addition to immediately terminating the license granted herein and requesting that Customer cease use of and return the Licensed Software, including all copies in any media, in addition to seeking any other legal or equitable remedies available to GEMS IT. This Section shall survive termination of this Agreement. 2. License Fees. In consideration for the license to the Licensed Software granted to Customer herein, Customer shall pay GEMS IT the applicable license fees as set forth in the applicable quotation. 3. Warranties. GEMS IT warrants the media on which the Licensed Software is furnished to be free from material defects for a period of thirty (30) days from the date of shipment or transfer by GEMS IT to Customer. GEMS ITs entire liability and Customers exclusive remedy for any warranty breach shall be, at GEMS ITs option, either the return of the license fee or replacement of the media that does not meet GEMS ITs limited warranty and which is returned to GEMS IT. If failure of any media has resulted from accident, abuse, or misapplication, GEMS IT shall have no responsibility to replace the media or refund the license fee. Any replacement media will be warranted for another thirty (30) days. EXCEPT AS SET FORTH IN THIS SECTION 3, NO OTHER WARRANTY WITH RESPECT TO LICENSED SOFTWARE OR OTHER PRODUCTS OR SERVICES IS MADE BY GEMS IT AND GEMS IT EXPRESSLY DISCLAIMS ANY OTHER WARRANTIES, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, DATA ACCURACY OR INTEGRITY, NONINFRINGEMENT OR QUIET ENJOYMENT. GEMS IT does not represent or warrant that: (i) the Licensed Software will operate error-free; (ii) Customers use of the Licensed Software will be uninterrupted; (iii) all defects will be identified, reproducible, or resolved; or (iv) the Licensed Software will meet Customers particular business needs. In the event Customer transfers or relocates the Licensed Software, all obligations under the warranties described in this Section terminate unless Customer receives GEMS ITs prior written consent for the transfer or relocation. The warranties do not cover: (a) failure to follow in all material respects GEMS ITs written recommendations or instructions; (b) using or combining the Licensed Software with products or services of others or with products or services incompatible with products or services of GEMS IT; or (c) Licensed Software installed outside the United States and Canada.
323
4. Confidentiality Obligation; Relief for Breach. a. Confidentiality Obligation. Customer will not, nor will it permit its respective employees, agents or independent contractors, to use, copy, disclose, distribute, sell, license, publish, reproduce or otherwise make available the GEMS IT Confidential Information, including the Licensed Software. Customer will: (i) secure and protect GEMS ITs Confidential Information by using a level of care consistent with the maintenance of its own confidential and proprietary information of like kind, but in no event less than a reasonable degree of care, and (ii) advise employees, agents and independent contractors who have access to such GEMS IT Confidential Information, of the terms of this Section 4. Notwithstanding the foregoing, Customer may disclose the GEMS IT Confidential Information to the extent required by applicable law or regulation, in which case Customer will notify GEMS IT as soon as practicable and in any event prior to making such required disclosure. All employees, agents and independent contractors of Customer shall be deemed bound by the terms of this Section 4 prior to receiving the GEMS IT Confidential Information. Customer acknowledges and agrees that breach of this Section 4 may cause irreparable harm to the non-breaching party for which the award of money damages may be inadequate. Customer therefore agrees that in the event of any breach of this provision, GEMS IT shall be entitled to receive injunctive relief in addition to any other remedy provided in this Agreement or available at law. This Section 4 shall survive termination of this Agreement. 5. Limitations of Liability. GEMS IT SHALL HAVE NO LIABILITY TO THE CUSTOMER FOR ANY SPECIAL, INDIRECT, CONSEQUENTIAL OR INCIDENTAL DAMAGES FOR ANY ACT OR OMISSION ARISING OUT OF OR IN CONNECTION WITH THE LICENSED SOFTWARE OR ANY OTHER PRODUCT OR SERVICES PROVIDED HEREUNDER, OR WITH THE SALE, OPERATION, PERFORMANCE OR USE OF IT, INCLUDING ANY LOSSES, EXPENSES, OR DAMAGES INCURRED BY REASON OF LOSS OF USE, LOST REVENUES OR PROFITS, COSTS ASSOCIATED WITH DOWN-TIME, COSTS OF SUBSTITUTE PRODUCTS, FACILITIES, OR SERVICES, AND ANY SIMILAR OR DISSIMILAR DAMAGES, EXPENSES OR LOSSES. Unless Customer gives GEMS IT prompt written notice of the problem complained of, Customer will be barred from any remedy. This is a commercial sales transaction. Any claim related to the Agreement will be covered solely by commercial legal principles. Notwithstanding any attempts to resolve difference or negotiation, any action brought by Customer must be commenced within one year after such action accrues. Each party waives its right to a jury trial of any claim or cause of action based upon, relating to, or arising out of this Agreement. This Agreement may be filed as a written consent to a trial by the court. Each partys liability for damages to the other for any cause, and regardless of the form of the action shall not exceed the fees paid for the product which is the basis for the claim. GEMS IT shall have no tort liability to Customer arising from this Agreement including for claims relating to negligence or defects in product design. Customer acknowledges and agrees that this limitation of liability shall apply even if the exclusive remedies provided in Section 5 fail. 6. Miscellaneous Provisions. a. Assignment and Binding Effect. Customer may not assign the Agreement or any rights or obligations thereunder to any person without the prior written consent of GEMS IT. GEMS IT may freely transfer and assign this Agreement without Customer's consent. b. Governing Law. The Agreement and the rights and obligations of the parties thereunder shall be governed by and construed in accordance with the laws of the State where the Licensed Software is installed, without regard to the conflicts of law principles thereof.
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A G R E E M E N T
324 appendix C
c. Use of Name. Customer shall not under any circumstances whatsoever use GEMS ITs name, trade names, trademarks, service marks, logos, or other symbols or other source identifying devices, or combinations or variations thereof, or the name of any employee, in any public announcement, news release, advertising, or promotional literature, without first obtaining the written consent and approval of GEMS IT. d. Medical Diagnosis and Treatment. Customer hereby acknowledges and agrees that all clinical and medical treatment and diagnostic decisions are the responsibility of Customer and its professional healthcare providers. GEMS IT is not responsible, and Customer is solely responsible, for determining the type and quality of the images necessary for Customer to make medical and diagnostic decisions, as well as for complying with all laws, regulations and licensing requirements applicable to Customer's delivery of healthcare services. GEMS IT does not make any medical or diagnostic decisions or determinations, or otherwise act upon the patient data in any professional capacity or determine the type or quality of the images Customer needs to make such determinations or decisions. e. Force Majeure. Neither party shall be liable for any default or delay in the performance of its obligations under this Agreement to the extent that such default or delay is caused, directly or indirectly, by acts of God, acts of civil or military authority, civil disturbance, war, strikes, fiber cuts, or other labor disputes, fires, transportation contingencies, laws, regulations, acts, or orders of any governmental body, agency or official, other catastrophes, or any other circumstances beyond such partys reasonable control. f. Survival. Sections 1, 4, 5,and 6 survive the termination of this Agreement.
A P P E N D I X
Declaration of Conformity
medical devices class I annex VII

We hereby declare that the distributed CE marked products specified below conform to the required technical documentation in accordance with Annex VII of the EC Directive, the Council Directive 93/42/EEC of 14 June 1993, concerning medical devices. In addition, we ensure and declare that the distributed CE marked products, as mentioned and falling within Class I, meet the provisions of the EC Directive which apply to them. This Declaration of Conformity covers the complete Centricity Radiology RA 600 V6.1 release and is valid for all products concerned bearing the CE mark and manufactured at the following site: GE Medical Systems IT Sparrenheuvel 38 3708 JE Zeist The Netherlands Bernie van Welt Engineering Manager GE Medical Systems IT, Zeist December 2002
A P P E N D I X
Glossary
Absolute size
This is selected in the Viewing Section, images in the viewports are shown (at a zoom factor of 1) in such a way that one pixel of the image when it was acquired is represented by one pixel on the screen, hence at absolute size. See also Relative size. A displayed cutline is active when the image it represents is also being shown in another viewport. They are displayed in a different color (normally yellow). The currently selected viewport. This will be indicated by a box around it (red on color monitors). If the Scope is set to Viewport, your actions will only affect the active viewport. Extra modules for printing, acquisition, archiving, teleradiology, etc. Facility to store notes and markers with separate images or with the study. Also used to describe the imported text information that arrived with the images. External database, mainly used for long term storage.
Active mode (for cutlines)
Active viewport
Additional modules Annotation
Archive
G L O S S A R Y
328 appendix E Archive buffer An intermediate storage location between the local database and the archiving medium. Typically a buffer is used when the archiving medium must (as for CD-Recordables) be written to in a single go or when the archiving process is going to take some time). Studies that are archived are first moved to the buffer and then moved to the archive medium at some later time. A tool which is part of the RA 600 Single Media Archive module that lets you manage and retrieve studies that have been archived. The automatic sending of studies by RA 600 to other systems. You set this up by creating auto transmit protocols. These are triggered by particular events (such as saving studies) and can contain rules that, for example, let you only automatically transmit studies received at certain times, or only those of a particular modality. Bitmap files in the standard Windows format. You can export images in RA 600 in this format which is very widely supported by other Windows applications. A sequential projection of images in a study to create the illusion of movement. A means of measuring angles, particularly useful for small angles and when the apex of the angle lies outside the viewport. Method of compacting data in order to use less storage space or take up less transmission time in teleradiology. The physical and software links between two devices that allow them to successfully exchange data. Intersection between two planes. RA 600 can find and display cutlines provided your study has suitable images. Part of RA 600 that manages the databases of images and studies.
Archive Index Tool
Auto transmit
BMP files
Cine loop COBB angle
Compression
Connectivity
Cutlines
Data Selector
329 Database Delete locks Collection of studies/patients. Databases can be manipulated using the Data Selector. To guard against accidental loss of data, you can protect studies from inadvertent deletion by locking them. The delete lock must be removed before a study can be deleted. DICOM (Digital Imaging and Communications in Medicine) is a detailed specification for formatting and exchanging images and associated information. DICOM is rapidly becoming the industry standard and is already supported by many modality, imager, PACS and workstation manufacturers. The amount of storage capacity on a hard disk. Small hardware device that is delivered with the software and that has to be connected to the parallel port of the PC while working with RA 600 (unless a license file is used). Using the mouse (with left mouse button pressed) to move or resize an object. A non-linear windowing function that modifies the pixel data so that lower values are shown in a wider range of gray tones, thus generally making images darker. It is used to compensate for inherent non-linearity in various modalities. A place for storing studies. You can create various folders so that you can keep studies of a particular type together, such as those for a particular physician for example. For each folder, you can specify if you want the studies to be stored in compressed form or not. Method of acquiring medical images from an analog or video signal using a frame grabber board. Usually used for ultrasound images or with older types of scanners.
DICOM 3.0
Disk space Dongle
Dragging Exponential windowing
Folder
Frame-grabbing
G L O S S A R Y
330 appendix E Hang criteria Criteria which determine which hanging protocol RA 600 will use if instructed to automatically select a hanging protocol to display a study. They can be time-dependent (such as Most Recent) or DICOM-dependent (such as CT Only). A pre-defined layout of viewports which can be selected and used automatically for displaying studies. Selected on the Viewing tool tab in the Data Selector or the Layout tool tab in the Viewing Section. Hospital Information System or Radiology Information System widely used in medical institutions. A single slice from a CT/MR or US study or a single, digitized film. See Archive Index Tool. See Cutlines. Changing the gray (or color) palette to contrasting levels. Option on the Windowing tool tab. A compression method used for reducing the size of digital images when transmitting them to other systems. RA 600 allows you to use various types of JPEG compression, both lossy (so that image quality is diminished) and lossless (the image quality remains the same). Overview of all teleradiology jobs (sending and receiving of studies), used at both sending and receiving sites. Images of particular interest or clinical significance which can be marked as such so that you can subsequently just view these images when examining the study. When you are viewing multiple cine loops, you can typically link these so they are synchronized to each other.
Hanging protocol
HIS/RIS
Image Index Tool Intersection lines Inverting an image JPEG
Job list
Key images
Linked cines
331 Local database Locking studies Database of studies stored on the local hard disk of the RA 600 system. Studies can be locked against deletion to prevent inadvertent loss of valuable medical data. RA 600 can automatically lock incoming studies from particular origins, and automatically unlock them after they have been successfully transmitted. Studies can also be manually locked and unlocked in the Data Selector. A non-linear windowing function that modifies the pixel data so that higher values are shown in a wider range of gray tones, thus generally making images lighter. It is used to compensate for inherent non-linearity in various modalities. Compression methods used in RA 600. Lossless means that none of the information in images is lost when decompressed on the other system. Images appear exactly as they were sent. This is not the case with lossy compression some of the image detail will be lost in the compression and decompression process. Possibility of enlarging or reducing the images in the viewport. Also called zooming. A window you can place over your viewports that lets you zoom in on a particular part of an image. When you have access to a worklist, RA 600 can automatically insert worklist entry items into studies, thereby importing information from the external worklist. To do this, RA 600 must know what information is available in the external worklist and how it should use this information. Mapping lists provide this information. Their high level of configurability lets RA 600 work with all kinds of DICOM and non-DICOM worklists. When cines are linked (synchronized), one of the linked cines will be the master cine. All the other cines will synchronize with this master.
Logarithmic windowing
Lossless/lossy
Magnification Magnifying glass
Mapping lists
Master cine
G L O S S A R Y
332 appendix E Matching studies Used in Quality Control and acquisition to associate patient information to a study based on a previous study on the same patient. This saves time and helps reduce the possibility of human error. Device for medical image acquisition (scanner). Maximum Intensity Projection. A method of computing new views of subjects based on the image volume created by sequences of MR slices for example. Multi-Planar Reformatting. Another 3D image processing method to assist in viewing and diagnosis. Multi-frame images are DICOM images for which the pixel-data space has been extended to be able to contain multiple pictures called frames. All frames in an image share the same DICOM Image header (containing various nonpixel data concerning the image, its circumstances of creation and parameters for optimal viewing). There are various types of multi-frame image. For example, 2D +T multi-frames (cine runs) contain sets of 2-dimensional images, all taken on the same coordinates, with different time stamps at fixed intervals. They typically show the effect over time of some contrast agent through vessels for example. One example of these is cardiac cine runs. In 3D multi-frames (slices of a volume), sets of 2-dimensional images are created at (more or less) the same time on different layers or at different angles. These sets look much like CT or MR series, and indeed, some are MPR or MIP processed images. An example is the full body scan. There are also combinations of the above types, such as the SPECT gated study.
Modality MIP
MPR
Multi-frame images
333 RA 600 supports multi-frame images in many areas such as Nuclear Medicine (including Static; Dynamic; Gated; Tomo; Gated Tomo; Recon Tomo and Recon Gated Tomo), Ultrasound, X-ray Angiography (including bi-plane studies) and Radio Fluoroscopy. Non-linear windowing Windowing functions that compensate for the inherent non-linearity of various modalities such as film. RA 600 includes exponential, logarithmic and sigmoid functions. Source of a study, a specific site for example, when using teleradiology. Using the mouse to move an image in a viewport if, for example, the image has been magnified and can no longer be shown in its entirety in the viewport. General term for all forms that can be scanned using the RA 600 Document Scanner Module. Information on the patient that needs to be added to a study. A view of the studies in a database grouped according to the patients the studies concern (see study list). Part of the Viewing Section that gives an overview of all images in the study or studies that have been opening for viewing. You can select which images appear in your viewports by clicking on the miniature images in the Pictorial Index. There are also a Pictorial Indexes in other parts of RA 600, such as acquisition, which serve a similar purpose. Smallest unit of image information. Marker for a point of interest. When a probe has been placed in an image, it shows the pixel value at the chosen location.
Origin Panning
Patient card Patient information Patient list
Pictorial Index
Pixel Probe
G L O S S A R Y
334 appendix E Quality Control A RA 600 Quality Control workstation is used to ensure that studies and series made available on a hospital network are correct and include the correct patient information. Part of an image that deserves special attention. Usually used while digitizing films. ROIs can be cut out from a complete image. This saves disk space and reduces transmission time during teleradiology. If this is selected in the Viewing Section, the images in the viewports will be shown so that they will just fit in the viewport no matter what size they were acquired at originally. This is the way RA 600 normally initially displays images in the viewports. See also Absolute size. A view of a database on another system connected to your RA 600 system via a network. Process of digitizing documents. A collection of a number of images typically acquired at the same time by the same modality. A black overlay over the viewport which contains a window through which you can view part of the image. Useful for hiding bright, distracting parts of an image when you want to examine specific detail. A non-linear windowing function that modifies the pixel data so that lower and higher values are shown in a wider range of gray tones. It is used to compensate for inherent non-linearity in various modalities. An archive of medical images created by RA 600 using storage media such as CD and DVD. User-configurable key combinations that allow you to save studies and change their status quickly and easily. Manual cine loops. A cine loop in which you can step through the images that make up the cine.
Region of Interest (ROI)
Relative size
Remote view Scanning Series Shutter
Sigmoid windowing
Single media archive Special commands
Stack-mode displays
335 Status Storage commitment Condition of a specific study: New, Seen, Received, Reported, Transcribed, Approved etc. The process of ensuring that medical image data sent over a DICOM network is not only transmitted correctly but retained at the other end. Number of interrelated images of one patient which may consist of a number of series. Consists of an overview of all studies in a database arranged as a list of studies (see patient list). See Linked cines. Images that have been marked for inclusion in a cine loop. Sets of buttons that perform particular commands. You can readily create your own tool bars in RA 600 containing the functions you use most frequently. To be found in various parts of RA 600, tool tabs contain interrelated commands and functions. They can be compared with menus in other software applications. The process of sending and receiving medical images, either using the telephone network (ISDN) or within the hospital over the network. The process of sending and receiving studies from one site to another. The display of images at their actual size. This allows you to make measurements directly across the screen. One cm in the display will be the same as one cm on the patient. Your monitor will need to be regularly calibrated to display images at true size. Part of RA 600 that shows the actual medical images. The Viewing Section consists of the Pictorial Index, viewports, the tool tabs, local data window and Reports window.
Study Study list
Synchronized cines Tagged images Tool bars
Tool tabs
Teleradiology
Transmission True size display
Viewing Section
G L O S S A R Y
336 appendix E Viewport Virtual film sheet Segment of the Viewing Section that actually displays images of frames in a study. In the Viewing Section, you can place individual images on virtual film sheets which you can then print. They offer a quick means of selecting images and creating hard copy of them. Equivalent to Region of Interest, except in three dimensions rather than two. Used in MPR/MIP to have RA 600 only consider image data within a certain volume. One of the most effective lossy compression algorithms for medical teleradiology. This is provided as an option with RA 600 and is proprietary to it. A character, generally an asterisk (*) in RA 600, that you can use to indicate any character string when performing a query. Changing the light/dark and contrast settings of images. A server that allows different RA 600 systems (clients) to view the same data. Studies placed on the server can be seen in the Data Selector of all the clients and can be opened for viewing. A set of tasks to be undertaken which may be provided by a HIS or RIS. A customizable view of studies in a database or worklist. A form of lossless compression used by RA 600 when saving studies after acquisition. It is proprietary to RA 600. The extent to which an image is displayed enlarged on the screen. A zoom factor of 1 means that images are shown in viewports at either absolute or relative size (depending on which of these has been selected). Enlarging the images in the viewport.
Volume of Interest (VOI)
Wavelet compression
Wildcard
Windowing Workgroup server
Worklist Worklist view ZLIB
Zoom factor
Zooming
337
Index A
Absolute size 112, 327 Absolute zoom factor 37 Acquiring images 232 acquisition device types 232 acquisition screen 234 controlling acquisition devices 237 importing graphics files 240 importing images via clipboard 240 manipulating acquired images 241 mixing acquisition types 242 procedure for 236 rearranging images in Pictorial Index 243 refining acquired images 241 removing from Pictorial Index 243 sending studies automatically when saving 291 starting 234 Acquisition devices, controlling from RA 600 237 Acquisition screen 234 Acquisition tooltab in acquisition screen 236 in Data Selector 234 Active mode for cutlines 327 Active viewport 33, 327 Add View dialog box 269 Adding buttons to toolbars 298 overlay images 138 series to study in quality control 284 Adjusting annotation level in viewports 41 overlay images 138 windowing of images 97 AMI Private presentation states 94 Angles, measuring in viewports 40, 130 Annotating images with markers and text 38, 122 Annotation assigning level in hanging protocol 179 automatic labels 134 changing appearance of 123 copying to other viewports 133 cutting, copying and pasting between viewports 123, 133 of multi-frame images 161 patient 122 pre-defined text 125 removing 123 saving appearance settings 123 setting level of when printing 251 setting level of when viewing 41, 122 showing and hiding 94, 97, 159, 318 user information 135 Annotation and Measurement tooltab 38, 122 Applying collages 168 Archive buffer description of 328 Area properties assigning to hanging protocols 179 Arranging images in series during acquisition 243 Auto Transmit definition of 328 using for key images 110 Automatic labels to help reporting 134 Automatically compressing incoming studies 68 orientating images using hanging protocols 179 sending key images 110 setting windowing 98 Automating quality control 276 Available printers displaying 254
B
Blending overlay images 139 BMP files, importing for acquisition 240 Body part specific check box 99 Body parts pre-defined window settings for 98 Buttons - adding, removing and changing on toolbars 298
C
Calipers 127 CD Viewer viewing images 268 Changing buttons on toolbars 298 default layouts 182 demographics that can be edited in quality control 292 images on virtual film sheets 259 layout of viewports 88, 89 offset of linked cines 120 patient information displayed in viewports 122
338 index
patient orientation in quality control 284 priority of hanging protocol 175 remote views 78 status of studies 151 windowing of images 97 Chest film, viewing 311 Cine loops assigning to viewports in hanging protocols 180 comparing 158 creating in MPR/MIP 186, 195 creating in Viewing Section 37 creating links between 119 definition of 328 linking methods 120 manual 117, 118 saving in MPR/MIP 203 setting the speed of 117 stopping 116, 118 synchronizing 119 tagging images for inclusion in 117 up, down and bounce 116 viewing multi-frame images as 160 Cine tooltab in MPR/MIP 195 in Viewing Section 37, 116 Clipboard copying single images to 147 using to export study information 53 using to import images 240 COBB angle measurement 130, 328 Collages additional facts 168 creating 167 description of 167 restrictions 168 selecting 168 sending 168 tooltab 167 Combining series in quality control 283 Common tasks printing viewport images 320 sending a report 313 viewing a chest film 311 Comparing cine loops 158 multiple profiles by pinning 130 studies and series 156 Compose Print Job dialog box 258 Compose Teleradiology Job dialog box 220 Compression CD Viewer 268 in teleradiology 222 of studies to save disk space 67 telling if compression used when viewing studies 224 Configuring demographics editing in quality control 292 hanging protocols 175, 178 location of buttons in Viewing Section 103 RA 600 for copying from read-write medium 269 read-write medium for single media archive 264 single media archive for read-only medium 262 study statuses 152 Viewing Section 85 windowing parameters 95 Continuous frame grabbing 237 Contrast splitting images according to 287 Copying annotation between viewports 133 annotation to other viewports 133 image overlays to other images 137 images to clipboard 147 masks to other images 137 Create Cine tooltab in MPR/MIP 194 Creating collages 167 filters 115 filters in worklist views 73 folders 26, 317 hanging protocols 177 image formats for acquisition 238 image overlays 42, 136 inverted window ROI 42, 136 magnifying glasses 112 manual cine loops (stack-mode displays) 117, 118 masks and overlays 41, 136 overlays 136 pre-defined text annotations 125 pre-defined windowing settings 98 presentation states 92 print layouts 260 remote views 77 ROIs 130 shutters 41, 136 studies from different acquisition types 242 studies using acquisition 232 toolbars 297 Criteria for determining cutlines 164 for using MPR/MIP 186 Current Study Status dialog box 277 Custom filters 115 Customize dialog box 297 Customizing RA 600 296 toolbars 297 Cutlines criteria for determining 164 description of 328 displaying 163 normal and active modes 327 show and hiding 170 using to select images 165
339
viewing multiple sets of 166 Disk space saving by compressing studies 67 viewing how much is left 26 Displaying available printers 254 Displaying cutlines in viewports 163 Distance line, measuring in viewport with 39, 128, 129 Document scanners, controlling from within RA 600 237 Double oblique images in MPR/MIP viewport 189 Dragging with mouse in MPR/MIP viewports 190 to pan in viewports 102 Drawing ROIs 130 Drawing ROIs 136
F
Filing tooltab 66, 77 Film digitizers, controlling from RA 600 237 Filter sets for image enhancement 115 Filtering resetting with single mouse-click 60 setting up in worklist views 73 studies 55 Filters creating 115 Finding studies by filtering 55, 56, 59, 60 by querying 59, 60 by typing first characters of item 54 Fine tuning hanging protocols 181 Folders creating 26, 66, 317 filtering in Data Selector 56 moving studies between 66 renaming and removing 66 Fonts, changing 304 Frame grabbers, controlling from RA 600 237
D
Data import graphics files 240 Data Selector introduction to 22 sending images from 210 Data Selector tooltab 55 Declaration of conformity 325 for Centricity Radiology RA 600 325 Default hanging protocols 64 changing 182 disabling 183 managing 182 removing 183 selecting to use for viewing 182 Delete locks locked study in selection 50 to protect studies 329 Deleting images in quality control 283 presentation states 94 studies from your hard disk 50 Demographics configuring editing in quality control 292 editing 281 Detect Edges filter 114 DICOM criterion in hanging protocol 179 DICOM tags entering for worklist views 72 Directly viewing worklist items 171 Disabling automated hanging protocols 176, 183 default hanging protocols 183
E
Ease of use of Centricity RA 600 12 Echo time splitting images according to 287 Edit Demographics dialog box 281 Editing demographics 281 Enhance Edges filter 114 Excel, importing ROI information into 131 Exponential windowing function 99 Exporting hanging protocols 176, 183 images as TIFF files 147 Print Log 255 ROI information to Excel 131 Send Log 218 single images 147 study information via clipboard 53
G
General viewing modes in Hanging Protocol Editor 181 Graphics file reader 240 Graphics files exporting 147 importing 240
H
Hang criteria
340 index
assigning to hanging protocols 179 definition of 330 Hanging Protocol Fine Tuning dialog box 181 Hanging Protocol Editor 178 Hanging Protocol Fine Tuning dialog box 181 Hanging protocol wizards 177 Hanging protocols 174 assigning area properties to 179 assigning hang criteria to 179 creating 177 defining for a plug-in 142 disabling 176, 183 fine tuning 181 importing and exporting 176, 183 manually selecting 175 opening studies to use hanging protocols 174 removing 175 setting conditions for one which will be used 181 setting priority of 175 time dependent criteria 179 Hanging Protocols Manager 175 Hard disk viewing space left on 50 Hiding Pictorial Index 86 Reports window 296 screen elements 13 toolbars 297 worklists 296 Highlighting parts of worklist views 74 copying to other images 137 creating 42, 136 how to draw 136 showing and hiding 137 windowing 139 Image Type Settings dialog box 238 Images acquiring 232 adding pre-defined text annotations to 125 adding to Pictorial Index after acquisition 236 arranging in series during acquisition 243 browsing using the keyboard 103 browsing with Up and Down buttons 103 combining in Quality Control 287 creating in MPR and MIP 189 deleting from your hard disk 50 displaying cutlines on 163 displaying in viewports 89 enhancing with filters 114 exporting as TIFF files 147 flipping 37 importing via clipboard 240 including and excluding from cines 117 manipulating in acquisition screen 241 measuring 39, 127 orientating using hanging protocols 179 panning 102 placing in viewports for study compare 157 printing single images 147 printing while viewing 257 printing with virtual film sheets 320 rearranging and removing in quality control 283 removing from your local view 50 removing in Quality Control 283 renumbering in quality control 284 rotating 37 selecting for display in cines 117 selecting with cutlines 165 sending from Viewing Section 220 sending using teleradiology 206, 210 showing and hiding overlays on 126 sorting in Pictorial Index 85 tagging for display in cines 117 unpinning 106 viewing 3-D images with MPR and MIP 186 viewing as they arrive 171 viewing at absolute size 112 viewing at relative size 112 viewing at true size 112, 184 viewing in monitoring mode 173 Importing graphics files 240 hanging protocols 176, 183 images for acquisition 232 images via clipboard 240 studies from remote to local view 51 Importing ROI information into Excel 131 Incoming studies automatically compressing 68 viewing in monitoring mode 173 Index Tool 328 Index tool lending volumes 271 marking volumes lost 272 removing volumes 272 returning volumes 271 Indexing volumes in archive index 270 Info dialog box 53 Information on patients in viewports 122 Initial filters in worklist views 73
I
Image enhancement using filter sets 115 Image overlays
341
Initial sort in worklist views 72 Integration module 303 Inverted window ROI creating 42, 136
M
Magnifying glasses 112 and multi-frame images 161 windowing inside 113 Managing automated hanging protocols 175 default hanging protocols 182 Mandatory patient information 245 Manipulating views in MPR and MIP 189 Marker, annotating with 38, 122 Marking key images 108 Mask tooltab 136 Masks copying to other images 137 how to draw 136 saving 138 showing and hiding 137 working with 41, 136 Master cine, selecting 119 Matching studies in Quality Control 282 Maximum filter 114 Maximum Number of Copies when printing 251 Measurement profile 129 Measurements copying between viewports 123 saving 132 Measuring small angles using COBB 130 Measuring images with distance line 39, 128, 129 with probe 39, 127 with profile window 40, 129 with ROIs 40, 130 Median filter 114 Minimum filter 114 MIP
J
JPEG compression 223
K
Key images automatically sending 110 creating, viewing, saving and removing 107 setting display of in hanging protocol 181 Keyboard creating shortcuts for 299 using for scrolling through images 104
adjusting display speed 197 annotating images in 199 automatic quality setting 197 dragging in viewports 190 how it works 186 introduction to 186 manipulating views in 189 measuring images in 199 mouse action settings 190 pixel range 197 Quality tooltab 197 quick setup for cine loops 194 requirements for 186, 187 returning to well-defined section 190 saving cine loops 203 screen layout 187 selecting series to open 187 setting display quality 197 setting up cine loops 195 speed versus image quality 197 starting 187 Modalities filtering in Data Selector 56 Modifying default layouts 182 images on virtual film sheets 259 patient information displayed in viewports 122 patient orientation in quality control 284 presentation states 93 remote views 78 study state in archive index tool 273 worklist views 71 Monitoring print process 253 send process in teleradiology 214 Monitoring mode 173 Moving annotation between viewports 133 elements around screen 296
L
Labels for reporting 134 Layout pool 260 Layout tooltab in Viewing Section 32 Layouts changing 89 changing viewport configuration 89 Layouts, selecting for printing 251 Linking methods for cine loops 120 Local database, viewing in Data Selector 47 Locking studies against deletion 331 Logarithmic windowing function 99 Lossless and lossy compression 222
342 index
Pictorial Index 86 studies between folders 26, 66 MPR annotating images in 199 dragging in viewports 190 how it works 186 introduction to 186 manipulating views in 189 measuring images in 199 mouse action settings 190 moving crosshairs in 189 pixel range 197 quick setup for cine loops 194 requirements for 186, 187 returning to well-defined section 190 saving cine loops 203 screen layout 187 selecting series to open 187 setting up cine loops 195 speed versus image quality 197 starting 187 MPR/MIP screen 187 MPR/MIP tooltab 189 Multi-frame images annotating 161 description of 332 printing 161 using the Pictorial Index with 159 viewing as cine loops 160 viewing individual frames of 161 working with 159 Multiple ROIs, viewing information on 131 Multiple studies selecting in study list 84 Multiple viewports setting Scope to 91
N
Non-linear windowing functions 36, 99 Nuclear Medicine multi-frame images in 159
Pictorial Index changing width of 85 hiding and showing 86, 296 in acquisition screen 234 multi-frame images in 159 navigating with 85 rearranging images in during acquisition 243 relocating on screen 86 reversing order of images in 85 sorting images in 85 using to fill viewports with images 89 viewing multiple studies in 84 windowing independently 85 Pinning viewports 33 when comparing studies 157, 158 Pixel range in MPR/MIP 197 Placing images in viewports 89, 91 Plug-ins hanging protocol integration 142 viewing 141 Pre-defined text annotations 125 windowing settings 98 Pre-defined text annotations setting up 125 Presentation sheets 149 Presentation states additional facts 94 AMI Private 94 creating 92 deleting 94 modifying 93 viewing 94 Print jobs 253 Print Log 255 exporting 255 removing entries in 255
O
Offset of linked cine loops changing 120 Orientating images using hanging protocols 179 Origins filtering in Data Selector 56 Overlay images adding and adjusting 138 changing transparency of 139 synchronizing quality of 140 Overlays copying to other images 137 creating 136 how to draw 136 showing and hiding 137 windowing 139 working with 41, 136 Overlays on images, showing 126
P
Palette color lookup table 101 Panning and scope 102 in viewports 33, 102 Patient demographics editing 281 Patient orientation changing in quality control 284 Patient Orientation dialog box 284 Patient view selecting 25, 48, 317
343
Print Queue 253 Print Study dialog box 251 Print tooltab in Data Selector 250 Printers finding out which are available 254 status of 254 Printing 253 Compose Print Job dialog box 258 destinations list 250 exporting Print Log 255 from the Data Selector 250 images while viewing them 257 indicators on tooltab 253 inserting header at top of page 251 introduction to 250 Maximum Number of Copies when 251 monitoring 253 multi-frame images 161 multiple series 252 Print Log 255 Print Queue 253 Print Study dialog box 251 priority settings 250 removing entries in Print Log 255 reprinting printed job 255 resubmitting printed job 255 selecting printer for 250 setting annotation level 251 setting annotation level of first image 251 single image 257 single images 147 single viewport 148 study information using clipboard 53 using virtual film sheets 257 viewing printed jobs in detail 255 viewport 257 viewport images 320 virtual film sheets 259 Printing with virtual film sheets 257 Priority of hanging protocol 175 Probe, measuring with 39, 127 Profiles comparing by pinning 130 creating 129 removing from viewport 130 Putting studies 'on hold' 170 in Data Selector 277 on Quality Control screen 279 Quality of images in MPR/MIP 197 when zooming 112 Quality of overlay images synchronizing 140 Quality tooltab in MPR/MIP 197 Queries defining in worklist views 73 resetting with single mouse-click 60 Querying volumes and studies 273 Quick browsing with Up and Down buttons 103
Q
Quality Control splitting images using contrast 287 splitting images using echo time 287 splitting series and studies in 286 Quality control adding series to studies 284 automatically creating mapping lists 282 automatically matching studies in 282 automatically sending studies 291 automating 276 changing patient orientation 284 combining series 283 configuring demographics editing 292 copies of studies in 278 introduction to 276 local studies window 279 opening study for 278 Quality Control screen 279 rearranging images 283 renumbering images 284 starting 278 using RA 600 for 276 worklist window 279 workstations 276 Quality Control Module Properties dialog box 292 Quality Control screen 279 Quality Control tooltab
R
RA 600 customizing 296, 297 Radio Fluoroscopy multi-frame images in 159 Receive Log in teleradiology 207 exporting (saving) 208 removing entries from 208 viewing entry details in 208 Receive New Study and monitoring mode 173 Receive Queue in teleradiology 209 Receiving studies with teleradiology 207 Redirecting images to back-up sites 227 Relative size 112, 334 Relative zoom factor 37 Remote studies viewing directly 28, 65, 171 Remote views creating 77 displaying 27, 49
344 index
displaying studies in empty remote view 49 importing studies from 51 modifying 78 querying to show studies in 27, 49 removing 78 selecting 49 Removing annotation 123 buttons from toolbars 298 entries in Print Log 255 hanging protocols 175, 183 images in Quality Control 283 images in quality control 283 key images 108 magnifying glasses 112 pre-defined windowing settings 98 profiles from viewports 130 protecting studies against 69 remote views 78 series in quality control 283 studies from your local view 50 toolbars 298 worklist views 71 Renumbering images in quality control 284 Reporting using automatic labels for 134 Reporting on studies, introduction to 42 Reporting profiles 145 Reports sending 313 Reports window selecting 143 showing and hiding 296 viewing 134, 135, 143 Reprinting already printed job 255 Requirements for displaying cutlines 164 for MPR and MIP 187
for teleradiology 206 Reset button in viewing 90 Resubmitting already printed print job 255 Right mouse button menu selecting hanging protocol with 88 ROI statistics, exporting to Excel 131 ROIs creating 41, 130 removing 100 using for measurement 40 viewing information on 131
images for display in cines 117 images with cutlines 165 master cine to synchronize loops to 119 multiple studies and series for viewing 156 multiple studies in study list 84 remote views 49 series to open in MPR and MIP 187 viewport layouts 88 Send Log in teleradiology 218 exporting (saving) 218 removing entries from 218 Send Queue in teleradiology 214 Send To... dialog box in teleradiology 211 Sending collages 168 images using the Data Selector 210 reports 313, 319 studies with teleradiology 206 Series adding to study in quality control 284 combining in quality control 283 comparing 156 deleting from your hard disk 50 printing from Data Selector 250 rearranging and removing in quality control 283 rearranging images of in Pictorial Index 85 removing from your local view 50 removing in Quality Control 283 selecting multiple series for viewing 156 sending using teleradiology 210 viewing a series within a study 52, 62 viewing as they arrive 171 Series areas defining 89
S
Saving cine loops in MPR/MIP 203 flip and rotate actions 113 masks 138 measurements in viewports 132 Print Log 255 Receive Log in teleradiology 208 studies with single keystroke 300 Scanners, controlling from within RA 600 237 Scope controlling panning in viewports with 102 importance of for comparing studies 157 setting in Hanging Protocol Editor 181 setting to multiple viewports 91 Scout image, pinning in viewport 106 Scrolling images using the keyboard 104 Select Layout dialog box for printing 251 Selecting hanging protocols 175, 182
345
Server workgroup 336 Setting speed of cine loops 117 Setting up printers 252 Shadowing filter 114 Sharpening filter 114 Shortcuts, creating for keyboard 299 Showing Pictorial Index 86 reports window 296 screen elements 13 toolbars 297 worklists 296 Shutters 334 creating 41, 136 Sigmoid windowing function 99 Single Media Archive to configure 262 Single media archive configuring for read-only medium 262 configuring for read-write medium 264 viewing data in worklist view 269 Single oblique images in MPR/MIP viewport 189 Smoothing filter 114 Sorting defining in worklist views 72 images in Pictorial Index 85 Special commands creating 300 description of 334 Split/Join tooltab 279, 286 Splitting series and studies in Quality Control 286 Starting image acquisition 234 MPR and MIP 187 quality control 278 STAT exam opening while viewing another study 170 Status of studies, changing 151 Storage commitment description of 335 setting up 228 Studies adding series to in quality control 284 automatically compressing incoming 68 automatically sending in quality control 291 automatically unlocking after sending 226 changing the status of 151 comparing 156 compressing to save disk space 67 creating from different acquisition types 242 creating using acquisition 232 deleting from your hard disk 50 filtering 23 importing from remote to local view 51 importing rather than viewing directly 28 moving to folders 26, 66 opening copy of for quality control 278 opening for quality control 277 printing from Data Selector 250 putting 'on hold' 170 receiving with teleradiology 207 removing from local view 50 removing from status history list 277 saving with single keystroke 300 selecting all from same patient 56 selecting multiple studies for viewing 156 sending in an emergency 215 sending with teleradiology 206, 210 setting priority of when transmitting 215 viewing 62, 156 viewing as they arrive 171 viewing details on in Data Selector 52 viewing directly 28, 65, 171 viewing in monitoring mode 173 viewing one after the other 63 viewing status of 277, 281 Study information exporting via clipboard 53 Study lists arranging order of columns in 80 viewing in Data Selector 47 Study status histories, viewing 277, 281 Study statuses assigning reporting profiles to 146 changing 151 configuring 152 Study view, selecting 25, 48 Synchronizing cine loops 119 quality of overlay images 140
T
Tagging images for cine display 117 Teleradiology automatic transmission 225 back-up sites 227 Compose Teleradiology Job dialog box 220 compression types for 222 controlling send jobs 214 Export dialog box 208 exporting (saving) Receive Log 208 exporting (saving) Send Log 218
346 index
introduction to 206 locking and unlocking studies in 226 monitoring send process 214 Receive Log 207 Receive Queue 209 receiving studies 207 removing entries from Receive Log 208 removing entries from Send Log 218 requirements for 206 Send Log 218 Send Queue 214 Send To... dialog box 211 Sending images from Viewing Section 220 sending reports 319 viewing details in Receive Log 208 viewing details on sent studies 218 viewing what has been received 207 Teleradiology tooltab in Data Selector 207, 208 in Viewing Section 220 Text, adding annotation to viewport 39 TIFF files exporting images as 147 importing for acquisition 240 Time ordering criterion in hanging protocol 179 Time-out value for storage commitment 229 Toolbars adding buttons to 298 creating 297 Tooltab collages 167 Tooltabs Acquisition in acquisition screen 236 Acquisition in Data Selector 234 Annotation and Measurement 38, 122 Cine in MPR/MIP 195 Cine in Viewing Section 37, 116 Create Cine in MPR/MIP 194 Filing 66, 77 Filtering 114 Layout in Viewing Section 32, 88 Mask 136 MPR/MIP 189 Print in Data Selector 250 Quality Control in Data Selector 277 Quality Control on Quality Control screen 279 Quality tooltab in MPR/MIP 197 Split/Join in Quality Control 279, 286 Teleradiology in Data Selector 207, 208 Teleradiology in Viewing Section 220 Windowing 97 Zooming and Flip/Rotate 36, 111, 140 Transparency of overlay images 139 True size 112 viewing images at 37, 184 True size display description of 335 3-D images with MPR and MIP 186 chest film 311 cine loops 37, 116 cine loops in MPR/MIP 195 details on sent studies in teleradiology 218 images as they arrive 171 images at true size 37, 184 images with CD Viewer 268 in monitoring mode 173 information on multiple ROIs 131 key images 107 multi-frame images 159 presentation states 94 printing images while 257 putting studies 'on hold' 170 received studies in teleradiology 207 selecting a layout for 64 single frame of multi-frame images 161 single series within a study 62 studies from single medium archive in worklist view 269 studies one after the other 63 study status histories 277, 281 undoing action when 90 Viewing remote studies directly 28, 65, 171 Viewing Section sending images from with teleradiology 220 Viewing tooltab in Viewing Section 88 Viewport printing 148 Viewport areas defining 89 Viewport layouts, selecting 88 Viewports active 33, 327 browsing in 103
U
Ultrasound multi-frame images in 159 Undo limitations of 90 while viewing images 90 Unpinning images 106 User information 135
V
Viewing
347
changing layout of 89 changing patient information displayed in 122 copying annotation between 123 copying images from the clipboard 147 creating automatic labels in 134 creating cines in 117, 118 creating layouts for 157 cutting, copying and pasting annotation between 133 displaying cutlines in 163 filling with images 157 introduction to 15 measuring in 127 MPR/MIP 188 panning in 33, 102 pinning for study compare 158 pinning images in 33, 106 printing 147, 257, 320 selecting multiple 91 transversal, coronal and sagittal in MPR/MIP 188 zooming in 111 Virtual film sheets 257, 320, 336 adding to and modifying 258 modifying images on 258 using pre-defined settings 35, 97 using the tooltab slider 36, 97 with right mouse button 35, 318 Windowing tooltab 97 Windows printers, setting up 252 Wizards hanging protocol 177 Workgroup server 336 Worklist items viewing directly 171 Worklist views creating filters in 73 defining initial queries for 73 defining sorts in 72 highlighting parts of 74 Worklists adding patient information using 245 hiding 296 in Acquisition screen 235 in Quality Control screen 279 showing on screen 296
X
X-ray Angiography multi-frame images in 159
W
Windowing assigning to hanging protocols 179 defining parameters for 95 entering values for 35, 97 exponential function 99 image overlays 139 inside magnifying glass 113 logarithmic function 99 non-linear functions 36, 99 Pictorial Index 85 pre-defined sets for body parts 98 sigmoid function 99
Z
Zooming and quality of images 112 assigning to hanging protocols 179 in fixed steps 111 in viewports 111 with magnifying glasses 112 with slider 111 Zooming and Flip/Rotate tooltab 36, 111, 140
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Centricity

Radiology RA 600 V6.1

online reference guide

3D VIEWI NG WITH M P R A N D M I P ................... 185

ACQUIRING IMAGES A N D D A T A .............................. 231

EXPORT ING IMAGES A N D A R C H I V I N G ........... 261

Centricity Radiology RA 600 V6.1 reference guide online

COMMON TASKS FOR R A D I O L O G I S T S .............. 311

How to view a chest film ................................................................ 311

COMMON TASKS FOR R A D I OG R A P HI C T E C H N O L O G I S T S ......... 317

D E C L A RA T I ON O F C O N F O R M I T Y ..................... 325 G L O S S A R Y ............................. 327

Key to note icons

Centricity Radiology RA 600 V6.1 reference guide online

Centricity Radiology RA 600 V6.1 reference guide online

Introducing Centricity Radiology RA 600

Centricity Radiology RA 600 V6.1 reference guide online

The Data Selector

The Data Selector is your home base when using RA 600

Centricity Radiology RA 600 V6.1 reference guide online

The Viewing Section

Centricity Radiology RA 600 V6.1 reference guide online

Advanced tools for viewing and diagnosis

Other parts of RA 600

Centricity Radiology RA 600 V6.1 reference guide online

Going further in this guide

Centricity Radiology RA 600 V6.1 reference guide online

Finding studies in the Data Selector

Changing worklist views

Centricity Radiology RA 600 V6.1 reference guide online

Exploring your local view

Tracking down a study

Pinpointing studies with querying

Centricity Radiology RA 600 V6.1 reference guide online

Creating a worklist view

The Filing tooltab and folders

Centricity Radiology RA 600 V6.1 reference guide online

Importing and viewing studies directly

Centricity Radiology RA 600 V6.1 reference guide online

The Data Selector as a gateway to other parts of RA 600

Centricity Radiology RA 600 V6.1 reference guide online

Working in the Viewing Section

Adjusting the Viewing Section screen

Using the Pictorial Index

Centricity Radiology RA 600 V6.1 reference guide online

Scope, pinning and key images

Centricity Radiology RA 600 V6.1 reference guide online

Right-click in a viewport and drag to window your images

Examining images in detail

Magnifying glasses are ideal for viewing fine detail

Centricity Radiology RA 600 V6.1 reference guide online

Viewing cine loops

Measuring and annotating images

Centricity Radiology RA 600 V6.1 reference guide online

Profiles provide detailed information on pixel values to aid diagnosis

Centricity Radiology RA 600 V6.1 reference guide online

Masks and overlays

Centricity Radiology RA 600 V6.1 reference guide online

Centricity Radiology RA 600 V6.1 reference guide online

Finding and organizing your data

The Data Selector screen

The Data Selector

Double-clicking on a study or series will automatically open it for viewing.

Patient and study views