Radiology Image Access
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1 Radiology Image Access PACS 11 Training Material and Documentation Table of Contents I. How to Log In... Page -2- II. Find A Patient / Study... Page -3- III. Viewing Images... Page -6- IV. Log Out... Page -12- V. Tips... Page -12- VI. PACS 11 FAQ s... Page -13- VII. For Assistance call PACS Helpline Page -15-1
2 I. How to Log In From a PACS Workstation (formerly called ALI, WebGX, or PACS), double click on the PACS11 Icon located in the NAL Window on the computer screen. The upper left-hand corner of the NAL window should say Apps for Radimage. At the login window, enter your Username ID and Password. This is the same as your Firewall ID and password. Click Login or hit enter. Generic login IDs will no longer work. NOTE: If you have not yet received a personal ID and password please call the Help Desk at (26) and let them know that you will need a personal ID and password to access radiology images. You should get a call back from someone in IS Security during normal business hours. 2
3 The Study List A default patient study list will be the first screen to appear. II. Find A Patient / Study Individual patient studies can be accessed by either Patient Name or Patient ID (also known as: Medical Record Number). Four other search methods based on study performance date are available. The Default search option will be With Patient ID Equal To as shown below. Identify the Patient To change the search method, click on the down arrow located to the right of the heading, With Patient ID Equal To. This will display a drop down list of other search methods available. To search by Patient Name, click on the menu item labeled With Patient Name Matching. Enter the patient s name or medical record number in the appropriate box, hit <enter> or click on the Find button. 3
4 Search Filters These filters are used to control which patients are displayed in the list, and the studies that are displayed for each of those patients. The patient list is controlled by the Patient Locations and Work Groups filters. For each patient, the studies displayed are controlled by the Modality Types and Body Regions filters. (Note that restrictions in the Modality Type and Body Region may prevent certain studies from appearing in the list. It is also possible the patient may not appear in the list at all based on the restrictions. To remove these restrictions, set Modality Types to All Modalities, and set Body Regions to All Body Regions. ) If you want to see only plain x-rays (CR or Computed Radiography), click the drop down arrow to the right of the Modality Types filter. First click on All Modalities to uncheck the entire list. Then click on CR, to display only CR studies. The other three filters work in a similar manner. You can use the Work Groups filter to locate many studies done at UWMF and other locations. To find a study done at a UWMF facility, you can search by patient name or by UWMF medical record number. You will not be able to use the UWHC medical record number to retrieve a UWMF study from PACS. (The UWMF Medical Record # can be found in EPIC) AS A STANDARD RULE-OF-THUMB : IF YOU CAN T FIND YOUR PATIENT BY MR#, TRY SEARCHING BY PATIENT NAME WITH ALL FOUR SEARCH FILTERS SET TO ALL. 4
5 Study List Icons This Study List Icon is used to switch to the Radiologist s Study List and in general should not be used by non-radiologists to find a patient. If the Radiology Study List view is active the Study List Icon will change from this to this. Click on the file cabinet icon to return to the Non-radiologists Study List. Click the Refresh Icon to refresh the study list. To close the Study List click the Right Arrow Icon. NOTE: This does NOT close the PACS program. Click on the Study List option from the Main Toolbar to reopen the Study List. (See page -7- ) Select a Study After you identify a patient, you will see a list of all digital studies done on that patient. The most current study will appear at the top of the list. Double click on the study of interest or single click to highlight the study and press the Enter Key to launch a particular study in the list. The Modality Column identifies the type of study in the list. The most common studies of interest are CR (Computerized Radiography = Plain Film), CT, MR (MRI) and US (Ultrasound). The red arrow points to the modality column. 5
6 III. Viewing Images Image Loading Patient demographics display at the top of the screen. Thumbnail Images Thumbnail is the term given to describe the small images that represent each series of the study and are identified (or numbered) as A:1, A:2, A:3, etc. in the upper left-hand corner of each thumbnail. Those same alphanumeric identifiers are also displayed in the upper left-hand corner of the larger images to help identify each series within the study. See example below. 6
7 Main Image Toolbar Close Study Patient Demographics Display Protocol Return to Study List View Reports Text Toggle Annotate and Measure Help Quit Show More Tools User Thumbnail Images Additional Studies for this patient. Study Icons Flagged Images/Total Images Study Date/Time Click on the Clam Shell to expand/contract the Thumbnail Images Study Icons Study Icons (sometimes called Monitor Specific Icons) are located near the upper right-hand corner of the computer screen. They are used to control the image display on that monitor. [Layout] The Series Layout icon is a grid of small black squares that allows you to change the number of views that appear on the screen at one time. Plain Film studies will load with one view per monitor as the default. [Previous] Show Previous series in selected study. [Next] Show Next series in selected study. [Close] Click on the X to close the study. 7
8 Image Indicator Bar The Image Indicator Bar is a series of boxes located directly above each image series. (CR and scout series images contain only one image and the bar contains only one box.) Indicates the Study and Series. Change Display Mode and view Coronal and Sagittal muti-panar reconstructions (MPRs) Changes the Image Layout within that series. Click to Link/Unlink from other viewports. The will display an additional submenu. Represents the image displayed.... Represent the total number of images in that series. If there are no numbers indicated, the series contains more images than the toolbar can display. Image number can also be found in the overlay on the image underneath the patient name. Click to Pin/Unpin Viewport. Pinned viewports will not participate in cycling. Basic Image Controls Zoom Move the cursor over the region that you would like to enlarge. Hold down the Ctrl key and turn the mouse wheel away from you to Zoom In and toward you to Zoom Out. As you zoom, you may need to adjust the mouse cursor slightly. Pan While zoomed in on an image, hold down the Shift key then click and hold the left mouse button and drag the mouse to move the image. Contrast / Brightness (Window / Level) Press and hold the right mouse button down and move the mouse left and right to change the contrast of the image. (Changing contrast makes blacks blacker and whites whiter.) Move the mouse up and down to change the brightness of the image. (Changing brightness makes everything in the image is brighter or darker.) Scroll To scroll between images, turn the mouse wheel located between the right and left mouse buttons. 8
9 Control and Tool Access by Menu Right mouse click anywhere on the image to bring up the menu. Select refers to the cursor or mouse pointer. Click on Window/Level to adjust the brightness and contrast of the image, or to pick a predefined window level setup. Zoom will change the size of the image in percentage increments. Pan: SHIFT + Left Mouse Click + Drag the Mouse Cine functions similar to an animate feature that will automatically scroll through images without having to use the mouse wheel. The Layout option is used to change the number of series that are displayed on the screen (within the viewport or the entire screen). Magnifying Glass will enlarge or zoom a small section or area of the image. (Zoom enlarges the entire image.) The image can be flipped or rotated by using the Re-Orient option. (Access Measuring Tools) Annotate is used to make temporary annotations and/or measurements to the image. Link is used to manually link series from different studies of the same exam type. There are two methods of linking: Quick Registration links series based on the position of the patient on the scanner. Not always accurate. Advanced Reg./Offset is more precise and lets the user determine the linkage. Follow the onscreen instructions after selecting Precise Registration. Pertains to CT and MRI studies. 9
10 Comparison Studies and Other Studies Click on the file folder icon located above the Thumbnails to display a list of other studies available for this patient. An abbreviated list of recent studies will display at first. Read down the list and click on the study of interest or click on the All Studies option to access the entire list. [See Figure 1.1 below] Figure 1.1 The initial series loaded are identified as the anchor study series (labeled A:). When additional studies are loaded, the Thumbnail images are identified with a R1:1, R1:2, R1:3, etc The represents the first reference series loaded. Subsequent series are load as,,, etc Figure 1.2 Figure 1.2 illustrates the Clam Shell for the A or Anchor study is closed. Click on the left side of the Clam Shell to expand or contract the study to view or hide exam series. This functionality works the same for the R or Reference Studies and illustrated below. [Figure 1.3 on page 11] Click the X to close the reference study. Click here to expand the contracted series. Additional Reference Studies Additional Reference studies can also be loaded, by following the same steps The Thumbnail images are incremented to identify another reference study loaded. The represents the second reference series loaded. Subsequent series are loaded as,,, etc 10
11 Figure 1.3 Figure 1.3 Illustrates the Clam Shell for both the Anchor study and the R1 Reference study is closed. Click on the left side of the Clam Shell will expand or contract either study. Click the X to close the reference study. Click here to expand the contracted series. Linking Studies As a user moves up or down between cuts in one study, a link to a second study will force movement to the corresponding cut in that second study. Generic Linking: Using the Quick Registration option will provide linking based on table position. Not always accurate Manual Linking: Manual linking studies refers to using the Precise Registration option to tell it which two images are the same in two different studies. On any series of a CT or MR click on the linking icon and then select from the submenu and select Precise Registration. Follow the on-screen instructions to set the preferred link between the series of an anchor study and a reference study. *Linking can only be done with one reference study at a time Click to Link/Unlink from Other viewports. The will display an additional submenu. 11
12 Closing a Study [Close] To close the study click on the X in the upper right-hand corner of the left monitor. IV. Log Off To log off, click on the quit icon in the upper right-hand corner. V. Tips Find a Patient In general, you should search for a patient by MR# or name. If needed, click on the Folder Finder Icon to bring up the appropriate dialog box. The software is in Folder Finder mode when the search field box displays With Patient ID Equal To. You may also find it helpful to use the Performed Today or Performed Yesterday search method. Figure
13 VI. PACS 11 FAQ s If you are having trouble viewing images or using the PACS11 application please call the Enterprise Imaging PACS Helpline at (26) Q: What if I cannot find a particular study in the patient list? A: First, verify that a Study List Filter has not been enabled. All four sections should read All..., as shown below. If not, click on the down arrow and select All... Second, Search for your patient using With Patient Name Matching. Partial names can be entered. The system will search for all matches to the text entered. Q: How long does PACS 11 stay up before timing out? A: 60 minutes Q: Why does PACS 11 sometimes prompt me to login when the software appears to be already running? A: If PACS 11 is minimized on the screen when it tries to time out (at 60 minutes of inactivity), the program is unable to close itself completely. Then, when the next user attempts to look up a patient, PACS 11 will require that user to sign in again. Q: Is it OK to start looking at a study while it is loading? A: Yes. Turn the mouse wheel to begin to scrolling through the images that are loaded. Q: When I am looking at a particular study, how do I call up other studies on a patient? A: Use the Other Studies icon. When viewing a CT study on the left monitor, you should load the other study on the right monitor. Load or open other studies using the Second (Right-Hand Monitor). 13
14 Q: What is the difference between study, view, series, and image? A: An entire radiological test is called a study. A plain film study consists of a set of views. A CT or MRI study consists of multiple series and each series can contain multiple images. Q: What is a Viewport? A: A Viewport is the window that an image (or series) is displayed in. By default a CT or MR study will display four Viewports on the screen at one time. Q: What is a Clam Shell? A: A Clam Shell is a term given to the semi-circles located at the front and back of a series. The Clam Shells will contract or expand depending on what the user wants to see. Figure 1.2 Open Clam Shell Closed Clam Shell Q: How do I link 2 CT or MR studies done at different times? A: Select Precise Registration after selecting from the menu on any series viewport. Then follow the on-screen instructions to set the preferred link between the series of an Anchor Study and a Reference Study. 14
15 Q: How does the computer decide the layout when it first opens a study? A: The default layout is 1 CR or plain film image on the screen at one time. CT and MRI studies will default in a 2x2 layout (4 series per monitor). Q: Which icon should be used to manually change the layout of the series on the screen? A: Use the layout icon indicated by the red arrow below. *The option with the red X can be used to change how studies open every time that exam is opened. For training please call (26) to schedule a Display Protocol Training Session. Q: How do I view reports? A: With an exam open click on the Documents icon indicated by the red arrow. *It should be noted that WISCR-IT is the official repository of radiographic reports. Q: How do I view images on CDs coming from other hospitals? A: The standard rule-of-thumb for outside CDs is that all CDs should include a viewer that will display the images 'automatically' for staff when placed in the CD drive of the PC. If/when this does not happen, or staff encounters any problems trying to view all the images, the CDs should be sent to the Radiology File Room for import into PACS. VII. For assistance or to schedule one-on-one training, call the Enterprise Imaging PACS Helpline at (26)
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